目的 研究脑室-腹腔分流术在治疗创伤性脑积水中有效性及安全性.方法 采用回顾性地分析方法,分析了在2012年到2018年间因创伤性脑积水而接受脑室-腹腔分流手术的患者资料,通过定义临床显著改善及影像显著改善来评估手术的有效性,并通过并发症的研究来评估手术的安全性.结果 患者手术前后GCS评分及EI均有改善;术后GCS显著改善的为39.5％,EI显著改善的为25.6％;术后脑出血的发病率为14％,感染为4.7％,过度引流为4.7％,分流管堵管为2.3％.结论 早期行脑室-腹腔分流手术有助于改善创伤性脑积水的患者的神经、影像表现及预后.

Objective To observe the effect of dynamic articulars panning external fixation combined with limited internal fixation for distal radius comminuted fracture.Methods 100 comminuted distal radius fractures patients during September 2014 and September 2014 in our hospital were selected and randomly divided into control group and research group,50 cases in each group.Patients of the control group accepted conventional manual reduc-tion combined with plaster external fixation,patients of the research group accepted dynamic articulars panning exter-nal fixation combined with limited internal fixation treatment.Curative effect,the palm inclination angle and feet were compared between the two groups.Results (1)After surgical treatment and rehabilitation therapy,15 patients in the control group achieved optimal degree,28 cases in the research group achieved optimal degree(P =0.086);9 cases in the control group were the poor degree;only 2 patients in the research group were poor degree(P =0.025).Statistical analysis showed that two differences were statistically significant,(P <0.05).(2)After 3 months,the palmar tilt of patients in the control group was (6.5 ±2.2)°,while that of the research group was (8.5 ±2.5)°(t =4.25,P <0.000 1 );The average ulnar deviation of control group was (12.3 ±4.3)°,and that of the research group was (15.6 ±6.6)°(t =2.96,P =0.003 8).In a word,the average palmar tilt and ulnar deviation of the research group were greater than those in the control group,the difference showed statistically significant.6 months later,the average palmar tilt of the control group patients was (6.2 ±2.3)°,that of the research group was (8.8 ±2.5)°(t =5.41, P <0.000 1 );the ulnar deviation of the control group was (12.1 ±4.1 )°,and that of the research group was (16.3 ±4.4)°(t =4.93,P <0.000 1),the difference was statistically significant.Conclusion Dynamic articulars panning external fixation combined with limited internal fixation for the treatment of distal radius comminuted fracture effect is significant,which is worthy of clinical promotion.

目的：探讨颅脑损伤后低钠血症的原因、处理方法及治疗效果。方法回顾性分析79例颅脑损伤后低钠血症患者的临床表现及治疗。结果79例中68例血钠恢复正常，6例死于脑衰竭，2例自动出院。结论及时发现并根据不同病因正确处理颅脑损伤后低钠血症对改善患者预后有重要意义。

目的：探讨急性硬膜下血肿快速自然消散现象及机制。方法对13例急性硬膜下血肿快速消散患者临床资料进行回顾性分析，结果所有血肿均在伤后72小时内消失，患者均恢复良好，出院时均无神经功能缺失。结论急性硬膜下血肿快速消散主要机制为血液的重新分布，脑脊液的稀释及适当的颅高压、颅底颅骨骨折伴硬脑膜破裂等。

对于手部多处组织缺损与坏死,临床皮瓣修复往往比较复杂。笔者所在科室收治1例一手多指及一指多个不同部位皮肤缺损的患者,采用真皮下血管网的腹部带蒂皮瓣修复,术后17d,皮瓣断蒂,且皮瓣全部成活。随访1年,皮瓣少许色素沉着,质地可,外形较满意,皮瓣周缘有感觉,证实取得了良好的临床效果。

目的:观察缩宫素在剖宫产术中不同给药方法对产妇循环功能的影响。方法:选120例足月子宫下段剖宫产孕妇,随机分三组,均于胎儿娩出后子宫肌内注射缩宫素10U,A组同时静脉注射10U缩宫素。B组同时静脉滴注20U缩宫素。C组静脉未给药。观察三组产妇用药前后的SBP、DBP、HR、SPO2等指标的变化。结果:A组和B两组的HR明显上升,SBP、DBP有明显下降,C组产妇变化不明显。结论:剖宫产术中应用缩宫素在不同给药方法对循环功能影响不同,静脉推注影响尤著。

做好重型颅脑损伤患者的急诊救护,对提高救治成功率,降低死亡率有重要意义,现回顾分析本院2003年2月～2006年4月急诊救治的重型颅脑损伤患者97例的临床资料如下.

<正>随着社会的发展,交通的发达,重型颅脑损伤的患者也越来越多。但由于其有病情重、发展迅速的特点,致残率和死亡率极高,多愈后不良。由于其不仅原发

儿童缺血性无菌性股骨头坏死(Legg-Calve-Perthes Disease,以下简称LCPD)治疗后容易出现股骨头畸形、包容不好、短缩等后遗症,致残率较高.我院运用双下肢主动外展塑形疗法、患髋被动旋转推压塑形疗法、内服活骨胶囊合股骨头经皮钻孔减压、改良Chiari骨盆截骨延长术综合治疗LCPD166例198髋,并随访1～8年,平均3年11个月,疗效满意,分析如下.

颅脑损伤后大面积脑梗塞(large cerebral infarcts after head trauma)是颅脑损伤所致大动脉痉挛、变窄乃至闭塞,引起该动脉供应区的脑组织缺血、缺氧,最终导致功能丧失.其致死率和致残率极高,是重型颅脑损伤预后不良的一个重要因素.但如果诊断及时,治疗得当,仍有一部分患者恢复良好.现就本院近年来收治的40例颅脑损伤后大面积梗塞作回顾性分析总结诊治体会.报告如下.

膝骨性关节炎(OA)为老年常见病、多发病.关节镜下清理术对早期骨关节炎有良好的疗效[1],但对重度膝OA效果不佳.全膝关节置换术则是治疗重度OA的有效手段之一.我院自2003年3月开始,对收治5例此类患者进行了全膝关节置换,取得了满意的临床效果.报告如下.

儿童股骨头缺血性坏死(Legg calve perthes disease LCPD)的治疗方法很多,但治疗后容易出现股骨头畸形、包容不好、短缩等后遗症,致残率较高.自1996～2004年,我院运用双下肢主动外展塑形及患髋被动旋转推压塑形疗法,配合内服活骨胶囊(以上简称基本疗法),并辅以股骨头经皮钻孔减压治疗LCPD147例179髋,经1～8年,平均3年10个月随访,疗效满意.现总结报告如下.

[目的]探讨晚期儿童缺血性无菌性股骨头坏死(Legg-Calve-Perthes Disease,LCPD)的治疗方法.[方法]采用改良Chiari骨盆截骨延长术、双下肢主动外展塑形疗法及患髋被动旋转推压塑形疗法对19例19髋晚期LCPD进行治疗.[结果]本组19髋患者,随访2～7 a,平均4 a 7个月,其中优14髋,良3髋,中2髋,可0髋,差0髋,优良率89.4%.髋臼一股骨头指数(AHI)恢复正常.治疗后患肢无跛行,无髋膝部疼痛,髋关节功能恢复正常.股骨头塌陷得到纠正.[结论]改良Chiari骨盆截骨延长术可有效增加股骨头的包容,双下肢主动外展塑形疗法及患髋被动旋转推压塑形疗法能纠正股骨头塌陷,改善髋关节功能.