目的 比较尺神经原位松解术和皮下前置术两种手术方法治疗肘管综合征的疗效,为临床选择适当的治疗术式提供理论依据.方法 2009年3月～2012年10月收治64例肘管综合征患者,其中32例采用尺神经原位松解术(原位松解组),32例采用尺神经皮下前置(皮下前置组).两组患者性别、年龄、手术侧、病程及临床分型等一般资料比较,差异均无统计学意义(P＞0.05),具有可比性.测量手术前后两组患者手部第一背侧骨间肌肌力、小指展肌肌力以及小指末节指腹皮肤测量两点辨别觉,肘上5cm～肘下5cm尺神经传导速度和术后并发症,进行比较.结果 两组患者术后切口均Ⅰ期愈合.患者均获随访,随访时间24～32个月,平均27个月.末次随访时,二组患者手部第一背侧骨间肌肌力、小指展肌肌力及小指末节两点辨别觉,神经传导速度比较,差异均无统计学意义(P＞0.05);但均较术前显著改善,差异有统计学意义(P＜0.05).但尺神经原位松解组并发症的发生率6.25％明显低于皮下松解前置组25％,差异有统计学意义(P＜0.05).结论 尺神经单纯松解及皮下前置两种方法治疗肘管综合征均可达到良好疗效,其中尺神经原位松解法并发症较少.

Objective To explore the effect of single-incision treatment for children with congenital muscular torticollis.Methods From July 2002 to March 2011,176 children with congenital muscular torticollis (ages from 10 months to 15 years old,an average of 4.8 years) were selected.All patients underwent singleincision release on the clavicular head and sternal head of sternocleidomastoid,and took postoperative functional exercise early and received the pillow jaw traction at the same time.All children wore a neck collar or brace to keep the neck in an overkill posture.Results The patients were followed up from 1.0 to 7.5 years with an average of 4.2 years.The postoperative appearance and the neck activity were improved significantly; strabismus and facial developmental abnormalities gradually got back to normal with a good rate of 96.0％ (169/176).Conclusion For the children with congenital muscular torticollis,the use of single-incision surgery and postoperative active rehabilitation exercises would achieve good outcomes.

In order to provide a better service of water pollution emergency monitoring,the paper described the adoption case of Fourier transform infrared multi-component gas analyzer with headspace theory.The process included identifying the gas-phase pollutants from the water samples,screening the main pollutants quickly and qualitatively,and then choosing the standard method to quantify the concentrations of corresponding targets.Thus the research provided an efficient method for emergency monitoring which showed the advantages of wide determination range,fast qualitatively screening and instruments easy to carry.

目的分析少数重度肾积水在逆行尿路造影(RGU)中的特殊影像表现,以提高诊断准确性。方法回顾性分析两例经手术后确诊为重度肾积水患者的影像表现,两例均为中年女性。结果两例临床患者均表现为反复腰痛,一例胀痛放射至会阴部,两例均进行了静脉肾盂造影及逆行尿路造影,静脉肾盂造影表现为阴性,逆行尿路造影在盆腔内可见造影剂呈片状弥散,随后进行手术治疗。结论重度肾积水达盆腔内,当静脉肾盂造影表现为阴性、逆行尿路造影中表现特殊时,要注意和造影剂外漏等鉴别,为临床提供正确指导。

Objective To investigate the methods of operative treatment of proximal humeral fractures and its clinical results.Methods From September 2003 to January 2009,75 cases of proximal humeral fractures underwent operation.According to Neer classification,there were 29 cases of two-part fractures(13 cases of surgical neck fractures and 16 cases of greater tuberosity fractures),33 cases of three-part fractures and 13 cases of four-part fractures.Fractures were fixed with absorbable nails in 16 cases having greater tuberosity fractures and with plate and screw in 48 cases;replacement of humeral head prosthesis was given in 11 cases.Results All patients were followed up 15.4 months on average(range,5～40 months).In one patient having surgical neck fractures with humeral shaft fracture,internal fixation loosening and nonunion of surgical neck fractures occurred;fracture union was achieved in the other patients undergoing internal fixation without humeral head necrosis.In the patients undergoing replacement of humeral head prosthesis,no complications of periprosthetic fracture,prothesis loosening,shoulder instability or dislocation occurred.According to the Neer scoring system,the results were excellent in 24 cases,good in 37 cases,fair in 13 cases and poor in 1 case,and the excellent and good rate was 81.3%.Conclusion For proximal humeral fractures,a satisfactory clinical result can be obtained if appropriate internal fixation materials are selected.Replacement of humeral head prosthesis is a good method for the treatment of three-part and four-part fractures in over fifty-year-old patients,especially in patients associated with osteoporosis.Early and reasonable post-operative rehabilitation is closely related to the treatment results.

Objective To probe the relationship between lung-head imaging findings and clinical performance for scrub typhus.Methods A retrospective collection of recent 70 cases of scrub typhus patients diagnosed as clinical and imaging performance were analyzed.Results The main clinical manifestations were fever,convulsions,eschar and skin ulcers,rashes,body aches,or superficial lymph nodes,headache,heart palpitations,but the performance of children and adults had some differences.30 patients were taken chest plain film,24 cases were found abnormal.Head CT scan were detected in 7 cases,2 cases were abnormal.After treatment,69 cases recovered or improved and discharged,one died.Conclusion Although the diagnosis of scrub typhus depends mainly on clinical and laboratory examinations,but imaging has an important supporting role in clinical.The appearance of outer skin Eschar and the positive of WiFi test have a characteristic sense for the diagnosis,but not necessarily linked.Scrub typhus can lead to complications of multiple organ involvement.Early diagnosis is very important.We will see that the cure rate is very high if timely being cured by effective medicine.

Objective To investigate the efficacy and safety on prophylaxis of venous thromboembolism(VTE)in patients undergoing hip or knee operation using low-molecular-weight heparin(LMWH) in combination with intermittent pneumatic compression(IPC).Methods 53 cases of hip or knee surgery were treated with LMWH and IPC to prevent VTE.Among them,18 cases were received total hip arthroplastics,7 cases were received total knee arthroplastics,17 cases were received dynamic hip screw(DHS),11 cases of acetabular fracture were received internal fixation with reconstruction plate.Every cases were given LMWH staring with post-operative 8h for 10 days(Once a day) and post-operative IPC for 10 to 14 days.IPC was continuously used for 8h on the day of operation,and used for 2h since second day(1 hour bid).All patients were evaluated by clinical symptom of VTE,colour duplex ultrasonography and measure of platelet count and blood coagulation were performed within 5 to 7 days after operation to check the presence of DVT.Patients suspected with pulmonary embolism underwent computed tomography pulmonary angiography.Colour duplex ultrasonography were performed again for those suspected with DVT after 1 to 3 months of postoperation follow-up.Results Among the 53 cases,4 DVT cases accompanied by lower limb swelling of varying degrees were found,the incidence was 7.54%.The 4 case were occurred within 3 months of the postoperative follow-up period after discharged from hospital.Pulmonary embolism and serious bleeding complications did not occur in all cases.International normalized ration(INR) did not exceed 2.5 and platelet count has not decreased.Conclusion LMWH in combination with IPC can significantly reduce the incidence of VTE after hip or knee surgery,and has a good security.

目的:观察银翘散加减治疗甲型H1N1流感的临床疗效.方法:用银翘散为基础方随症加减,治疗甲型H1N1流感29例.结果:运用中医药治疗甲型H1N1流感可迅速退热,较快缓解咳嗽、咯痰、咽痛等临床症状,总有效率100%.结论:银翘散加减治疗甲型H1N1流感疗效确切,且无明显毒副反应.

Objective To assess the related factors to influence catheter-directed thrombolysis in lower extremity deep venous thrombosis(DVT).Methods From January 2006 to September 2008 175 cases with lower limb DVT were treated,and clinical data of patients were retrospectively reviewed.According to the contact thrombolytic effect patients were divided into two groups.Data analysis was done with univariate analysis and multivariate logistic regression.Results The total effective rate of thrombolysis was 77.7%.Univariate analysis showed that age,course of disease,cause,consolidated basis disease,dose urokinase were related to the effective rate.Multivariate logistic regression analysis showed that cause,dose urokinase,course of disease were related to the cure rate.Conclusion DVT treatment is affected by many factors,whether cause and dose urokinase as well as course of disease are major dependent factor for catheter-directed thrombolysis.Clear etiology,course 1 month of DVT treated with high dose urokinase thrombolysis catheter contact is recommended.

患者,女,40岁.因尿频、尿急、尿痛、血尿1h于2005年10月24日入院,入院前1h无诱因出现尿频、尿急、尿痛、血尿伴下腹隐痛不适、无发热、畏寒.查:生命体征正常.皮肤无瘀点、瘀斑、心肺正常.