目的:探讨外伤性颅内迟发性血肿CT表现特点和规律,为临床即时诊治提供可靠依据。方法:对136例外伤性颅内迟发性血肿患者首次CT及伤后迟发性血肿发生时间进行分析。结果:外伤性颅内迟发性血肿患者多数首次CT检查,可仅表现为蛛网膜下腔出血、脑肿胀、脑挫裂伤和颅骨骨折;颅内迟发性血肿发生的高峰期为伤后24～72小时。结论:外伤性颅内迟发性血肿首次CT检查多有异常,但无颅内血肿者,应在24~72小时内进行CT复查,以发现颅内迟发性血肿,方不至贻误诊治。
ObjectiveTo investigate the safety and feasibility of the treatment of laparoscopic splenectomy for patients with traumatic splenic rupture. MethodsBetween October 2006 and October 2009, 48 cases of traumatic splenic rupture underwent laparoscopic splenectomy were analyzed in this hospital. According to the differrent styles of splenic stalk, different operative methods were taken， including titanic clipping in 12 cases， titanic clipping combining silk suture ligation in 8 cases， snare combining titanic clipping in 10 cases， LigaSure in 8 cases， and EndoGIA in 8 cases. ResultsLaparoscopic splenectomy was successfully completed in 32 cases; Handassisted laparoscopic splenectomy was applied in 14 cases, and 2 cases were converted to laparotomy because of tight spleen adhesion with surrounding tissues and bleeding rupture of the short gastric vessels. The operation time was 120－170 min with an average 140 min; the estimated intraoperative amount of blood loss was 300－1 200 ml with an average 800 ml. No postoperative complication occurred such as gastric fistula, pancreatic fistula or hemorrhage. Conclusion According to the differrent styles of splenic stalk, individual operative method can improve mission success rate in the laparoscopic splenectomy in traumatic splenic rupture.
目的:探讨对合并脑疝形成的外伤性颅内血肿患者进行小硬脑膜窗口显露预防急性脑膨出的临床价值。方法:收集我院2005年1月至2007年1月收治符合标准的合并脑疝形成的外伤性颅内血肿患者126例,均行开颅去大骨瓣减压手术,治疗组67例行小硬脑膜窗口显露的方式进行血肿清除术,对照组59例采用传统的硬脑膜切开进行清除血肿清除术。结果:治疗组患者颅内压下降速度和程度优于对照组(Plt;0.05),治疗组术中急性脑膨出的发生率低于对照组(Plt;0.05)。结论:小硬脑膜窗口显露是预防急性脑膨出发生的一种有效手术方式。
Objective To investigate the feasibility and clinical outcomes of emergency reconstruction of traumatic dynamic muscle defects using functional superficial vastus lateralis chimeric perforator flap based on descending branch of lateral femoral circumflex artery. Methods A retrospective analysis was conducted of 10 patients with traumatic dynamic muscle defects treated between March 2020 and April 2024. There were 8 males and 2 females, aged 23-52 years (mean, 36.7 years). Injuries included 7 cases of Gustilo type ⅢB forearm trauma (2 with flexor muscle group defects, 3 with extensor muscle group defects, and 2 with combined flexor and extensor muscle group defects), 1 case of right first metacarpal defect with concomitant thenar muscle and skin defect, 1 case of complete transection of the right upper arm musclecutaneous nerve extracted from the biceps brachii muscle, and 1 case of Gustilo type ⅢC lower-limb trauma with extensor hallucis longus and toe extensor defects. Soft tissue defects ranged from 10 cm×8 cm to 36 cm×11 cm. Preoperative musculoskeletal ultrasound of the contralateral side was used to measure cross-sectional area, length, and pennation angle of the target muscles. Based on these parameters, anterolateral thigh flaps combined with one or two superficial vastus lateralis muscle segments were designed and transplanted to the recipient sites. The grafts were used to cover wounds, reconstruct major missing muscle groups, and were fixed in place. Vascular and neural anastomoses were performed simultaneously with repair of bone and soft tissue injuries to restore limb perfusion and function. Postoperative evaluation included musculoskeletal ultrasound, electrophysiology, and dynamic assessment of muscle strength during follow-up. Results All transplanted muscles and flaps survived primarily without vascular or neural complications. All the 10 patients were followed up 10-38 months, with an average of 22.8 months. The muscle strength recovery reached M5 in 6 cases, M4 in 3 cases, and \begin{document}${{{\mathrm{M}}_{{{3}}^+}}} $\end{document} in 1 case. Patients achieving M4 or above regained their original work capacity; limb contours were symmetrical, with no joint deformities, and patients achieved effective ranges of motion; functional recovery included the ability to push or lift weights of 2-30 kg, perform opposition, and achieve grasping function. All flaps were soft and lustrous, and the protective sensation restored in all patients. There was no discomfort in the donor site and knee joint. Musculoskeletal ultrasound showed that the average cross-sectional area of the transplanted muscles increased by 4%-66% in 10 cases at 1 month after operation, and the ratio of the average cross-sectional area of the transplanted muscles in contraction and relaxation was 1.37±0.16 in 7 cases at 6 months after operation. Electrophysiological examination showed that motor potential could be detected in 8 cases at 2 months after operation, and then the amplitude increased gradually, and 2 cases were not detected. ConclusionEmergency reconstruction of traumatic dynamic muscle defects using functional superficial vastus lateralis chimeric perforator flap based on descending branch of lateral femoral circumflex artery achieves near-normal muscle strength recovery and effective joint motion. This technique allows for reconstruction of one or two major muscle groups as clinically required.
ObjectiveDetermine the effect of Semen ziziphi spinosae decoction combined Sodium valproate (VPA) sustained-release tablets on treating patients with Post-traumatic epilepsy (PTE).Methods30 patients are chosen among the patients who were hospitalised in Epilepsy Department of Kunshan Traditional Chinese Medicine Hospital from Jan 2017 to Jan 2019. The age ranges from 31 to 75, averaging at (42.5±13.5) years old, and composed of 16 male samples and 14 female, randomly divided into experimental group (Semen ziziphi spinosae decoction combined VPA, n=15) and control group (VPA, n=15). In general, imaging data and EEG data are collected. Regular follow-up is also carried out for these 30 patients. The results are analysed to determine the effect of treatment.ResultsAfter 9-months treatment of Semen ziziphi spinosae decoction combined VPA, morbidity of experiment group is significantly lower than that of the control group. It is also found that the differenes of imaging data and EEG data of patients were of no statistical significance.ConclusionIt is demonstrated that Semen ziziphi spinosae decoction combined VPA has superior performance in treating patients with PTE. The efficiency of Semen ziziphi spinosae decoction combined VPS in treating PTE is 93.3%, higher than the 80% of VPA. It can serve as reference for clinical diagnosis and treatment.
Objective To investigate the difference of effect between laparoscopic and open surgery in patients with traumatic rupture of spleen. Methods The literatures on comparison of laparoscopic and open surgery in patients with traumatic rupture of spleen were retrieved in PubMed, Web of Science, CNKI, Wanfang, and VIP databases from Jan. 2007 to Jan. 2017, and then Stata 12.0 software was applied to present meta-analysis. Results ① The condition during operation: compared with the OS group, operative time of the LS group was shorter [SMD=–0.71, 95% CI was (–1.12, –0.30), P=0.001] and intraoperative blood loss of the LS group was less [SMD=–1.53, 95% CI was (–2.28, –0.78), P<0.001]. ② The postoperative condition: compared with the OS group, the postoperative anal exhaust time [SMD=–2.47, 95% CI was (–3.24, –1.70), P<0.001], postoperative ambulation time [SMD=–2.97, 95% CI was (–4.32, –1.62), P<0.001], and hospital stay [SMD=–1.68, 95% CI was (–2.15, –1.21), P<0.001] of the LS group were all shorter. ③ The overall incidence of complications and the incidence of complications: on the one hand, compared with the OS group, patients in the LS group had a lower overall incidence of postoperative complications [OR=0.29, 95% CI was (0.19, 0.43), P<0.001]. On the other hand, compared with the OS group, patients in the LS group had lower incidences of infection [OR=0.27, 95% CI was (0.13, 0.55), P<0.001], ascites [OR=0.36, 95% CI was (0.13, 1.00), P=0.049], bleeding [OR=0.29, 95% CI was (0.10, 0.90), P=0.032], ileus [OR=0.34, 95% CI was (0.13, 0.90), P=0.030], incision fat liquefaction [OR=0.27, 95% CI was (0.08, 0.94), P=0.040], and incision rupture [OR=0.17, 95% CI was (0.03, 0.96), P=0.045]. However, there was no statistical difference on splenectomy fever [OR=0.41, 95% CI was (0.13, 1.27), P=0.123], pancreatic fistula [OR=0.40, 95% CI was (0.06, 2.63), P=0.343], liver function lesion [OR=0.36, 95% CI was (0.10, 1.34), P=0.127], and thrombosis [OR=0.33, 95% CI was (0.09, 1.22), P=0.097] between the 2 groups. Conclusions Laparoscopic surgery can not only significantly reduce the incidence of multiple complications of traumatic rupture of spleen, but also can speed up the recovery rate of postoperative recovery. Therefore, it is safe and beneficial in treatment of patients with traumatic rupture of spleen.
目的：探讨覆膜支架治疗外伤性颈内动脉海绵窦瘘（TCCF）的临床治疗经验。方法：11例TCCF经血管内介入治疗，1例外伤性颈内动脉海绵窦瘘患者复发，压迫颈总动脉无效，行球囊闭塞颈内动脉及瘘口。结果：术后杂音立即消失，数天后结膜水肿消退，造影见瘘口完全闭塞，10例TCCF患者颈内动脉保持通畅。1例患者颈内动脉闭塞。无操作所产生的并发症出现。结论：覆膜支架是处理TCCF的有效手段；瘘口再通可能与支架移位、贴壁不良有关。压迫颈总动脉对再通瘘口的治疗无效。