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误诊为视神经炎的Leber遗传性视神经病变一例

宫颈癌和预防性人乳头瘤病毒疫苗的应用与研究

人乳头瘤病毒（human papillomavirus，HPV）感染与宫颈癌的发生密切相关，预防性HPV疫苗是一种预防宫颈癌的新方法，其效果得到了多项临床试验的肯定。现综述HPV感染情况及其致癌机制，HPV疫苗的作用机制、有效性和安全性，并且对疫苗的应用和发展提出了展望。

眶内霉菌感染一例并文献复习

【摘要】　目的　报道眶内霉菌感染一例。　方法　2011年3月4日收治1例眶内霉菌感染患者，结合文献分析其临床特点及诊治方法。　结果　患者为47岁女性，有霉菌性鼻窦炎病史，右眼肿胀、视物模糊。经抗真菌治疗，病情稳定出院；后多次复发入院，且出现肝肾功能损害。经抗真菌、保肝、保肾、对症治疗，病情稳定出院。　结论　眶内霉菌感染多系鼻窦炎扩散而来，易复发，疗程较长，治疗过程中应监测肝肾功能。

微创稳定系统治疗股骨远端 C 型骨折

目的 总结采用股骨远端微创稳定系统（less invasive stable system for distal femur，LISS-DF）治疗复杂股骨远端骨折患者的治疗效果。 方法 2005 年 6 月－ 2008 年 5 月，采用 LISS-DF 通过髌骨旁外侧切口解剖复位并加压固定关节内骨折，经皮逆行插入钢板桥接固定关节内与干骺端骨折块治疗股骨远端骨折 23 例。男 19 例，女 4 例；年龄 22 ～ 58 岁，平均 36.7 岁。车祸伤 16 例，高处坠落伤 4 例，重物砸伤 3 例。均为闭合性骨折。骨折按 AO 分型： 33-C1型 11 例，33-C2 型 7 例，33-C3 型 5 例。受伤至手术时间 5 ～ 14 d，平均 10 d。  结果  术后切口均Ⅰ期愈合。23 例均获随访，随访时间 14 ～ 34 个月，平均 22 个月。术后 X 线片示骨折均于 10 ～ 16 周愈合，平均 12.3 周。无内固定松动、折断等并发症发生。膝关节功能按 Merchan 评分标准评定，优 13 例，良 9 例，可 1 例，优良率 95.6%。 结论 LISS 结合经关节面逆行插入钢板接骨技术治疗股骨远端 C 型骨折，具有显露充分、手术损伤小、固定可靠的特点，能较好地保留骨折区域血供，骨折愈合可靠，关节功能恢复好。

延期锁定加压接骨板治疗高能量 Pilon 骨折

目的 总结采用延期 AO 胫骨远端锁定加压接骨板（locking compression plate，LCP）治疗高能量Pilon 骨折的疗效。  方法 2004 年 6 月－ 2007 年 12 月，采用延期 AO 胫骨远端 LCP 治疗高能量 Pilon 骨折 23 例。其中男 20 例，女 3 例；年龄 20 ～ 62 岁，平均 42.6 岁。车祸伤 16 例，高处坠落伤 5 例，重物砸伤 2 例。骨折按 Rüedi-Allgouml;wer 分型：Ⅱ型 15 例，Ⅲ型 8 例。开放骨折 6 例，其中 Gustilo Ⅰ型 4 例，Ⅱ型 2 例。待患者伤口愈合、水肿和张力性水疱消退、软组织条件恢复后，于伤后 10 ～ 17 d 行手术治疗。  结果 术后 2 例发生切口皮肤浅表感染，经更换抗生素和局部换药后愈合；其余切口均Ⅰ期愈合。23 例均获随访，随访时间 14 ～ 54 个月，平均 37.4 个月。无皮肤坏死、深部感染、骨外露、螺钉进入关节间隙及内固定断裂等并发症发生。 X线片示骨折均愈合，愈合时间3.6～5.0个月，平均4.3个月。踝关节功能参照 Mazur 等评价标准，评分为（89.35 ± 8.21）分；获优 13 例，良 8 例，可 2 例，优良率 91.3%。  结论 延期锁定加压接骨板治疗 Pilon 骨折可有效促进骨折愈合，减少早期并发症的发生。

机械通气在胸部肿瘤术后急性呼吸衰竭治疗中的应用

目的 总结胸部肿瘤患者术后发生急性呼吸衰竭（ARF）行机械通气治疗的经验。 方法 根据64例胸部肿瘤患者术后发生ARF的情况，如原发病、手术后的肺疾病、呼吸肌力和手术并发症等进行不同的机械通气治疗，其中61例进行有创通气治疗，3例进行无创性正压通气。对12例肺不张或严重肺部感染者进行床旁纤维支气管镜吸痰、支气管肺泡灌洗（BAL）。 结果 64例ARF中 54例治愈，10例死亡。12例肺不张或严重肺部感染者经纤维支气管镜治疗均有效；随访54例，随访时间2个月，无ARF复发。 结论 胸部肿瘤患者术后发生ARF应选择恰当的通气模式，进行个性化机械通气治疗，良好的机械通气有利于治疗术后并发症；对有肺不张或严重肺部感染者进行纤维支气管镜吸痰和BAL治疗效果良好。

Effect of Limited Fluid Resuscitation on Intestinal Injury of Hemorrhagic Shock in Rats

ObjectiveTo determine the effects of different volume fluid resuscitation on intestinal injury and the permeability of intestine in hemorrhagic shock rats. MethodsSprague-Dawley male rats(n=72) were randomly equally divided into 4 groups after the model establishment of blood pressure-controlled hemorrhage, 45, 30, and 15 mL/(kg·h) of fluid resuscitation were performed in high dosage of resuscitation(HLR), moderate dosage of resuscitation(MLR), and low dosage of resuscitation(LLR) group respectively, but rats of Sham group didn't accept fluid resuscitation. After resuscitation, ten centimeters ileum was harvested for testing intestinal permeability. Then 6 rats of each group were sacrificed at 24, 48, and 72 hours after fluid resuscitation respectively. Over the specified time interval, blood was collected for testing levels of lactic acid and plasma tumor necrosis factor-α(TNF-α). The ileums of 3 resuscitation groups were obtained for testing the ratio of wet weight to dry weight and observing the histological changes. ResultsAfter resuscitation, the intestinal permeability was higher in HLR group(P<0.05). At 3-8 hours after resuscitation, rats of Sham group were all died, and the other rats of 3 groups were all alive. The level of plasma lactic acid was lower in LLR group than those of other 2 groups at 24 hours(P<0.05). The levels of TNF-α were higher in HLR group than those of other 2 groups at 24, 48, and 72 hours(P<0.05), and at 48 hours, level of TNF-α in LLR group was lower than MLR group(P<0.05). At 24 hours after resuscitation, ratio of intestinal wet weight to dry weight in LLR group was the lowest, and HLR group was the highest(P<0.05). According to the histopathology, intestinal injuries of the 3 groups were tend to be remission with the time, and at 48 and 72 hours after resuscitation, intestinal villus of LLR group appeared to be normal. ConclusionLimited fluid resuscitation of 15 mL/(kg·h) could not only decrease the levels of lactic acid and TNF-α, but also moderate the intestinal permeability and the intestinal injury in early stage after shock and surgery.

掌背动脉肌腱皮瓣修复手指皮肤合并肌腱缺损

目的 总结第2、4 掌背动脉肌腱皮瓣修复手指皮肤合并肌腱缺损的临床疗效。 方法 1995 年7 月－ 2010 年6 月，采用第2、4 掌背动脉肌腱皮瓣修复28 例外伤致手指皮肤合并肌腱缺损患者。男19 例，女9 例；年龄17 ～ 48 岁，平均29 岁。示指14 例，中指9 例，环指5 例。指背23 例，指腹5 例。皮肤缺损范围为2.5 cm × 2.4 cm～ 5.6 cm ×4.5 cm，肌腱缺损长度为1.3 ～ 4.8 cm。急诊手术19 例，择期手术9 例。术中皮瓣切取范围为3.5 cm × 3.4 cm ～ 6.6 cm ×5.5 cm。5 例伴指骨缺损者取自体髂骨植骨修复。供区直接拉拢缝合。 结果 术后4 d 7 例皮瓣远端出现水疱，经换药痊愈；其余皮瓣均顺利成活，创面Ⅰ期愈合。供区切口均Ⅰ期愈合。28 例均获随访，随访时间5 ～ 12 个月，平均10 个月。5 例指骨缺损者术后3 个月植骨均骨性愈合。皮瓣外形较满意，质地柔软。末次随访时肌腱功能恢复按手指总主动活动度（TAM）评定法：获优9 例，良15 例，中4 例，优良率85.7%。 结论 第2、4 掌背动脉肌腱皮瓣修复手指皮肤合并肌腱缺损具有外形及功能恢复满意的优点，是一种较好的修复方法。

Photocoagulation of X-linked congenital retinoschisis in progress stage

ObjectiveTo evaluate the outcomes of laser photocoagulation of congenital X-linked retinoschisis (XLRS) at progressive stage. MethodsTwenty-seven cases (36 eyes) of XLRS sick kids were enrolled in this study. All patients were followed up for more than 1 year, retinoschisis has developed slowly but complications occurred during the follow-up. They are all boys from 3 to 12 years old; the average age was 6.47 years old. There were 18 unilateral cases, 9 bilateral cases. The affected eyes were randomly divided into treatment group and control group (n=18 eyes). The treatment group eyes received multi-wavelength krypton yellow laser photocoagulation around the retinoschisis, but no laser spots were laid in a optic-disk area surrounding the macular and optic disc. Children in the control group were followed up every six months without treatment. Both groups of children were followed up for 3 years. The best corrected visual acuity (BCVA, logMAR), complications (vitreous hemorrhage, retinal detachment) were measured at the last follow up. ResultsAt the last follow-up, the treatment group mean logMAR BCVA was 0.73±0.41, which is the same as pre-treatment BCVA (t=1.187, P=0.201). The control group mean logMAR BCVA 0.88 ±0.60, which is the same as pre-treatment BCVA (t=-2.093, P=0.033). The changes of the BCVA in these two groups was statistically different (t=-2.093, P=0.033). For the treated 18 eyes, visual acuity improved in four eyes (22.2%); not changed in 10 eyes (55.6%) and decreased in four eyes (22.2%). For the 18 eyes in the control group, visual acuity improved in three eyes (16.7%); not changed in four eyes (22.2%) and decreased in 11 eyes (61.1%). The vision reduction rate in treatment group was statistically less than the control group (χ2=5.600, P<0.01). There were 2 eyes (11.1%) and 7 eyes (38.9%) with serious complications in the treated and control eyes respectively. The complication rate treatment group was statistically less than the control group (χ2=3.710,P<0.05). ConclusionLaser photocoagulation can stabilize or improve vision of advanced XLRS patients, and prevent the occurrence of serious complications.

Eoidemiologic studay on the prevalence rate and risk factors of diabetic retinopathy in eastern countryside of Changzhi

Objective　To estimate the prevalence rate and risk factors of diabetic retinopathy (DR) in rural residents in Changzhi. Methods　With the help of an established resident health data, a epidemiology study was performed on 63 409 residents (ge;15 years old) in the rural area of Changzhi; while the standard of diagnosis of diabetes was in accordance with the standard made by WHO in 1997. Diabetes was diagnosed in 2632 residents, and these patients underwent the investigation and examination including the disease history, glycosylated hemoglobin (HbA1c), fasting blood glucose, visual acuity, ocular diseases and intraocular pressure. The standard of DR was drawn according to the diagnosis standard made by Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Society, Chinese Medical Association in 1985. The data was statistically analyzed by SPSS 13.0 software. Results　A total of 57 500 residents underwent the examination with the participating rate of 90.68%; 2632(4.58%) were diagnosed as with diabetes, in whom 986 were with DR (with DR prevalence of 37.46%). The duration of diabetes was the independent risk factor of DR (r=0.210,P＜0.001). The duration of diabetes and combined with hypertension were the influence factors of the development of DR. The visual acuity in residents with or without DR differed significantly（P＜0.01）. The level of HbA1c was positively related to DR. Conclusions　　The incidence of DR is high in residents with diabetes in eastern countryside area of Changzhi. The duration of diabetes and combined with hypertension were the influence factors of the development of DR. The level of HbA1c may be the important indicator which can monitor the occurrence and development of DR in patients with diabetes.