Objective:To explore the predictive value of WBC, C-reactive protein (CRP) and serum creatinine (Scr) on the prognosis of the limb necrotizing fasciitis (NF).Methods:The clinical data and WBC, CRP, Scr detection data of 35 patients with limb NF who where treated in the Department of Emergency Surgery in Affiliated Hospital of Jining Medical University from January 2012 to March 2021 were retrospectively analyzed. According to the prognosis of patients, they were divided into survival group (n=22) and death group (n=13). The general situation and laboratory examination indexes of patients in the two groups were subjected to univariate analysis, and the independent factors impacting the prognosis of NF patients were investigated by using a Logistic regression model with statistically significant variables. The value of different indexes in predicting the prognosis of NF was analyzed by receiver operating characteristic (ROC) curve.Results:Among 35 patients , 13 died and 22 survived, with a case fatality rate of 37.14%. In the indexes of sex, age, red blood cell (RBC), platelet (PLT), procalcitonin (PCT), hemoglobin (HB), WBC, CRP and Scr, only WBC count [(12.53±3.76)×109/L, (20.69±7.83)×109/L], CRP levels[(112.99±20.34)mg/L, (152.81±47.35)mg/L] and Scr levels [(97.19±20.19)μmol/L, (136.81±40.53)μmol/L] were significantly different (t=3.53, 2.88, 3.29, all P<0.05)between the survival and death group, respectively. Further Logistic regression analysis showed high levels of WBC (OR=0.706, 95%CI: 0.505-0.987), CRP (OR=0.953, 95%CI: 0.911-0.997) and Scr (OR=0.953, 95%CI: 0.909-0.999) were all independent factors affecting the poor prognosis of NF patients. The areas under the ROC curve predicted by WBC, CRP and Scr were 0.881 (95%CI: 0.773-0.990, P<0.01), 0.776 (95%CI: 0.596-0.956, P<0.01), 0.790 (95%CI: 0.608-0.973, P<0.01), and the combined AUC was 0.951 (95%CI: 0.875-0.996, P<0.01).Conclusion:WBC, CRP and Scr are independent factors affecting the prognosis of NF patients, and can be used as blood biochemical indexes to evaluate the prognosis of patients with NF.

目的 探究创伤骨科临床治疗应用微创技术的临床效果,以及对患者护理满意度的影响.方法 随机抽取2019年1月～2019年10月济宁医学院附属医院治疗的82例创伤骨科患者,采用双盲法将患者均分为两组,对照组采用常规治疗,观察组采用微创技术治疗,对两组临床应用效果进行评估.结果 与对照组相比,观察组术中输血量少、伤口愈合速度快,换药次数少,比较差异显著(P<0.05);对照组治疗效果优良率为80.49％,显著比观察组95.12％的优良率低,比较差异显著(P<0.05);对照组满意度为82.93％,比观察组95.12％的满意度低,差异显著(P<0.05).结论 微创技术应用于创伤骨科临床治疗,能够有效提高治疗效果,帮助患者快速康复,能够更好的满足患者对临床治疗的要求.

切开复位钢板内固定治疗锁骨中段骨折术后1 年的功能优于保守治疗,并明显降低骨不连及二次手术发生率[1 ].Den-ise等[2]认为手术治疗锁骨中段骨折可获得较优越的肩关节功能及更高的满意度.目前,大多数骨科医师倾向于手术治疗锁骨中段骨折.我们应用关键骨块技术联合解剖锁定加压钢板治疗锁骨中段粉碎骨折23 例,取得较好的临床疗效.现报道如下.

小腿严重开放伤多由高能量暴力如交通事故、矿难、战伤等导致,多为碾压伤、机器绞伤、爆炸伤等[1-3].常合并严重的皮肤、皮下软组织损伤(肌肉、血管、神经、肌腱),若处理不当,容易出现严重的并发症,如损伤肢体软组织感染、坏死、骨髓炎,甚至出现感染性休克[4-5].近年来,随着创面VSD和皮瓣移植技术的发展,为下肢严重开放伤提供了较多的修复方法,临床效果较为满意.

目的 进一步观测枕骨大孔的形态及变异等特征,为颅颈交界区病变的影像学诊断、手术治疗提供参考数据.方法 具有完整枕骨大孔的颅骨标本73例,采用游标卡尺测量枕骨大孔的长度、宽度,并计算其表面积.结果 ①枕骨大孔的长度、宽度及周长分别为(34.45±2.95)、(29.18±2.15)和(11.56±9.88) mm;枕骨大孔的表面积为(791.85±110.44)mm2;②枕骨大孔具有5种形态:圆形35例(47.9%)、椭圆形33例(45.2%)、菱形2例(2.7%)、不对称形2例(2.7%)及五边形1例(1.5%).结论 枕骨大孔以圆形和椭圆形为主.为枕骨大孔提供的重要解剖学参数,有助于提高对于颅颈交界区解剖及相关病变的认识,进一步降低手术风险.

目的 观察非小细胞肺癌(NSCLC)组织血管内皮生长因子(VEGF)的表达及微血管密度(MVD)的变化,初步探讨VEGF在NSCLC发生发展及转移中的作用.方法 采用免疫组化法对36例NSCLC患者及17例肺良性瘤样病变患者周围正常组织中MVD及VEGF的表达进行检测.结果 NSCLC组织VEGF的阳性表达率及MVD值变化显著高于正常肺组织(P＜0.05;P＜0.01).VEGF表达和MVD值与肿瘤组织学类型及分化程度有关,在高、中、低(Ⅰ、Ⅱ、Ⅲ级)分化癌中存在显著差异(P＜0.01;P＜0.05);有淋巴结转移组VEGF表达和MVD值显著高于无淋巴结转移组(P＜0.05).结论 VEGF在肿瘤的血管形成、发展和转移中起重要作用,并可能成为肿瘤预后判断的参考指标.