目的 探讨锤状指畸形的分型及临床治疗效果. 方法 2000年3月—2013年2月,收治52例锤状指畸形患者,术中根据锤状指的损伤分型分别采取相应的手术方式. 结果 本组52例术后14 d拆线,均一期愈合,全部获得随访,随访时间2~24个月,平均13个月.采用Dargan功能评定法评定:优44例占84.6%,良5例占9.6%,可3例占5.8%,优良率94.2%.其中2例术后因伸指功能欠佳,再次行远侧指间关节融合术. 结论 根据锤状指畸形的分型,选择合适的治疗方法,注意手术操作,才能获得良好的治疗效果.

目的:评估应用肌电图仪进行经皮电刺激治疗对损伤周围神经功能恢复的促进作用,探讨电刺激治疗的最佳方法.方法:60例经神经电生理检查确诊腓总神经不全损伤的患者,男女不限,年龄20～35岁,采用随机数字表法将患者分为3组(n=20),非电刺激治疗组(NS组)、电刺激治疗1组(S1组)、电刺激治疗2组(S2组).NS组不给予电刺激治疗;S1组电刺激治疗每日10分钟,连续10天;S2组电刺激治疗每日10分钟,连续20天.3个月后复查腓总神经传导速度(NCV)与趾短伸肌复合肌肉动作电位(CMAP)波幅,比较3组患者治疗前后腓总神经电生理数据改善程度.结果:(1)NS组、S1组和S2组腓总神经NCV分别增加3.7±2.4 m/s、7.5±4.3 m/s和7.5±3.1 m/s,与NS组比较,S1组和S2组的腓总神经NCV均增加(P＜0.05);与S1组比较,S2组的腓总神经NCV无增加(P＞0.05).(2)NS组、S1组和S2组趾短伸肌CMAP波幅分别增加2.7±1.8mv、4.1±1.9mv和5.3±2.0mv,与NS组比较,S1组和S2组的趾短伸肌CMAP波幅均增加(P＜0.05);与S1组比较,S2组的腓总神经CMAP波幅增加(P＜0.05).结论:(1)经皮电刺激治疗对不全损伤周围神经功能的恢复有明显的促进作用,表现为NCV增快、CMAP波幅增加.(2)延长经皮电刺激治疗疗程有利于神经功能恢复.

Objective Lower extremity blood vascular lesion is the main reason of mutilation caused by diabetes.We discuss the risk factors of lower extremity arteries of diabetes and try to find the morphologic characteristics of diabetic peripheral blood vascular lesions,thus to find the early diagnosis method.Methods Totally 172 cases of diabetic patients who were hospitalized in our hospital were given lower extremity ultrasonic examination,while 60 cases of meantime in patients were as control.IMT(internal membrane thickening),incidence of plaque,stenosis occlusion and hemodynamic index were compared between the two groups.Results The incidence of lower extremity atherosclerotic plaque,arterial stenosis and obliteration of diabetes is apparently higher than that of control group.The incidence of atherosclerotic plaque was mainly involved in femoral artery.While the incidence of stenosis and obliteration were mainly involved in the distal arteries below popliteal artery,especially,anterior tibial artery.Conclusion Color Doppler flow imaging is an important clinical examination wethod for the early diagnosis,prevention and treatment.

【Objective】 Lower extremity blood vascular lesion is the main reason of mutilation caused by diabetes.We discuss the risk factors of lower extremity arteries of diabetes and try to find the morphologic characteristics of diabetic peripheral blood vascular lesions.Find the way of early diagnosis method.【Methods】 Total of 172 cases diabetic patients who were hospitalized in our hospital were given lower extremity CDFI examination while 120 cases of meantime in patients were as control.IMT(internal membrane thickening),incidence of plaque,stenosis occlusion and hemodynamic index were compared between the two groups.【Results】 The incidence of lower extremity atherosclerotic plaque,arterial stenosis and obliteration of diabetes is apparently higher than that of control group.The incidence of atherosclerotic plaque was mainly involved in femoral artery.While the incidence of stenosis and obliteration were mainly involved in the distal arteries below popliteal artery,especially,anterior tibial artery.【Conclusion】 Color Doppler flow imaging is an important clinical examination for the early diagnosis,prevention and treatment.

目的探讨高频彩色多普勒超声(彩超)对肠系膜淋巴结炎的诊断价值。方法对236例急、慢性腹痛患儿应用高频彩超观察腹腔内有无增大淋巴结,及增大淋巴结大小、边界、形态、内部回声、血流及分布特征。结果 224例(94.9%)显示有增大的肠系膜淋巴结,其中197例确诊为肠系膜淋巴结炎,淋巴结增大均为多发,以右下腹及脐周多发为主,血流信号增多。18例为急性阑尾炎,9例转诊后失访。12例无明显淋巴结增大。结论高频彩超能清晰、直观地显示增大的肠系膜淋巴结,对诊断患儿肠系膜淋巴结炎诊断有重要意义。

Objective To investigate the value of real-time ultrasound elastography technology in differential diagnosis of thyroid nodule.Methods 91 patients with thyroidnodule(104 nodules) confirmed by operations from January 2009 to January 2010 underwent two-dimentional combined color Doppler ultrasound examination and real-time ultrasound elastography technology examination.The results were compared with pathologic findings.Results Results of two-dimentional combined color Doppler ultrasound: 66 nodules were diagnosed as thyroid malignancy,among which,54 were coincident with pathologic findings;36 were diagnosed as benign lesion,and 20 were coincident with pathologic findings;The sensitivity,specificity and accurate rate of combined diagnosis were 73.0%,57.2%,and 71.2% respectively,but of real time utrasound elastography,they were 92.0%,86.0% and 90.0% respeltively,which were higher than those of combined detection,and the differeces were significant(P0.05).Lesions with grade Ⅲ~Ⅳ found in Real-time ultrasound elastography technology were highly suspected as being malignant.Conclusion Real-time ultrasound elastography technology may provide more detailed information for further differential diagnosis of thyroid nodules which are found by conventional ultrasonic.

目的:探讨无扩张输尿管的超声检查方法.方法:对无明显输尿管扩张的受检者127例(202根输尿管),其中无泌尿系疾病75例(150根输尿管)、输尿管下端结石52例(52根患侧输尿管),经肠道准备、水利尿、膀胱充盈后采用连续移行加压扫查.结果:除1例过度肥胖者的中段输尿管深部未能显示外,其它均得到清晰的显示.结论:超声检查能够清晰的显示输尿管及其周围的解剖关系,是输尿管检查的重要手段之一.

目的:探讨经阴道彩超诊断早期未破裂型输卵管妊娠的价值。方法:回顾分析我院2002年12月～2008年5月行阴道超声检查并经术后病理检查证实的68例早期未破裂型输卵管妊娠的超声声像资料。结果:68例中右侧输卵管妊娠36例,左侧输卵管妊娠32例;根据超声声像图特点分为输卵管环型34例(50.0%),非特异性肿块型27例(39.7%),胎心、胎囊型7例(10.3%)。结论:经阴道彩超分辨率高,能较清楚显示子宫、卵巢及宫内假妊娠囊,区分未破裂输卵管妊娠囊与妊娠黄体,且能较准确地提示输卵管妊娠肿块的大小、部位以及胚芽是否存活,是提高输卵管妊娠检出率的最佳方法。

目的:探讨改良腓肠神经营养血管逆行岛状皮瓣在修复足踝部皮肤软组织缺损中的疗效。方法:我院2002年3月~2008年5月应用改良腓肠神经营养血管逆行岛状皮瓣修复足踝部软组织缺损39例。切取的皮瓣面积应大于创面15%,将皮瓣旋转点改为外踝上0~7 cm任意一点处,根据创面大小及最远端距离调整旋转点位置,筋膜蒂宽度在5 cm左右,将蒂部保留1 cm左右宽的皮条采用明道转移修复创面,术中创面彻底清创,防止坏死组织继发感染影响皮瓣成活。结果:术后39例皮瓣全部成活,其中4例皮瓣远端部分表皮坏死,经换药后2期愈合。结论:改良腓肠神经营养血管逆行岛状皮瓣切取简单,成活率高,是修复足踝部较大面积皮肤缺损的一种理想术式。

高能量损伤所致小腿中段软组织大面积缺损可引起肌腱、骨骼、内固定装置外露及骨髓炎,常规手术方法处理较困难,局部可利用的组织瓣有限,采用交腿皮瓣治疗需损伤肢体的主要血管,给患者造成的痛苦较大.

Objective To develop animal model using dorsal root ganglion end-to-side neurorraphy for delaying atrophy of denervated gastrocnemius muscle,and investigate the effectiveness of the procedures.Methods Sixty Sprague-Dawley rats were randomly divided into two groups:experimental group,complete denervation with dorsal root ganglion(DRG)end-to-side neurorrhaphy;Control group,simple complete denervation.To compare the degree of muscle atrophy,fibrillation potential amplitude,muscle wet weight,diameter and cross section area of myocytes were measured in 1,2,3 months of postoperative intervals.Changes of the sensory neurons in DRG were also observed.Results Sensory neurons were found to survive in DRG throughout the experiment.Fibrillation potential amplitude in experimental group was higher than that in controls.Wet weight,diameter and cross section area of myocytes in experimental group were significantly higher than those in controls in 1,2,3 months of postoperative intervals.Conclusions The sensory neurons of DRG in end-to-side neurorraphy can delay effectively the atrophy of denervated skeletal muscles within 3 months after peripheral nerve lesion.

胫骨下段粉碎性骨折往往由高能量损伤所致,骨折粉碎,局部软组织损伤重.由于髓内针固定在胫骨远端应用受限,传统方法采用切开复位解剖钢板内固定术,但这又会进一步加重软组织损伤,广泛的骨膜剥离破坏了骨折愈合的生物学环境,同时由于胫骨远端血供特点,最终造成骨折不愈合、畸形愈合,严重时造成皮肤坏死、感染,钢板外露等并发症,加重患者痛苦.随着骨折内固定治疗理念向生物学的转变,保护骨折的生物学环境受到重视.自2003年3月～2006年7月应用经皮微创钢板内固定技术(MIPPO)[1]治疗胫骨远端粉碎性骨折36例,取得满意疗效.

本研究对2005年8月～2005年12月在我院就诊的32例肝转移癌患者进行增强超声(Contrast enhanced-ultrasonography,CEUS)和增强CT(Contrast-enhanced computed tomography,CECT)检查,比较两者显示肝肿瘤不同的血流动力学表现,探讨其临床应用价值.

B超和CT检查对胆囊癌的诊断因独特的影像学特点,而具有一定的诊断价值,但都存在误漏诊现象.本文回顾性总结我院2000年5月～2006年5月经手术证实为胆囊癌98例的B超和CT影像特点.

Objective:To evaluate the clinical value of Color Doppler Ultrasound in the diagnosis of deep venous thrombosis syndrome.Methods:134 patients with femoral vein thrombosis were studied before and after therapy by two dimensional Color Doppler.The studies included measurement of blood vessel diameter,intima thickness,lubricity,vasoconstrictive effects,resonance echo,the function of venous valve,collateral circulation and blood flow.Results:Of these 134 patients,107 cases were cured;the conditions in 27 cases improved.Sonography revelaed normal contraction of the blood vessel walls,smooth and glossy endothelium,well recovered contractibility of biood vessels,establishment of collateral circulation and improved function of venous valve.Conclusions:High-frequency color Doppler ultrasound was significantly valuable in assessing the treatment and diagnosis of deep vein thrombosis syndrome.

目的观察高频彩色多普勒超声在下肢深静脉血栓形成后遗症治疗前后的变化以判定其疗效.方法采用二维及彩色多普勒超声对67例下肢静脉血栓形成后遗症进行治疗前后下肢静脉的血管内径、内膜厚度、光滑度、血管压缩性、管腔内回声、静脉瓣功能、彩色血流等进行对比观察.结果 67例下肢静脉血栓形成的患者治疗后血管内膜毛糙程度明显好转,血管内清晰度及血管压缩性有了很大的改善,静脉瓣功能不全明显减轻.结论高频彩色多普勒超声观察对指导下肢静脉血栓患者治疗措施的选择有其重要临床意义.

乳腺肿块是女性的常见病、多发病[1].现将我院1999年～2003年资料完整的104例乳腺肿块进行分析,探讨不同疾病的声像图改变及其诊断价值.