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。
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。
目的 探讨外伤性脾破裂非手术治疗的可行性、适应证及其治疗效果。 方法 回顾性分析我院1990年1月至2005年1月收治的外伤性脾破裂非手术治疗46例临床资料。结果 非手术治愈43例，3例因提前下床活动致大出血而中转手术，其中1例并发膈下脓肿，仍经保守治疗痊愈。无死亡病例。结论 在严格掌握适应证前提下非手术治疗外伤性脾破裂安全可行，年龄及腹腔外合并伤不是影响非手术治疗的主要因素。
目的 探讨自制封闭式负压引流冲洗治疗四肢难愈性创面的护理要点。 方法 对2011年8月－2012年9月收治的38例使用自制封闭式负压引流冲洗+Ⅰ期植皮修复四肢难愈性创面的患者进行护理观察。 结果 34例四肢难愈性创面Ⅰ期成功修复创面，减轻了患者住院期间痛苦，缩短患者治疗时间，住院费用明显下降，4例创面因感染植皮大部分融解，经2次冲洗引流，培养肉芽后再植皮痊愈，无护理并发症发生。 结论 术后患者维持在适应的体位、间歇式冲洗，持续恒定的负压吸引、密切的护理观察和引流管的管理是护理的关键环节。
目的探讨腹腔镜技术在治疗外伤性脾破裂中的可行性和安全性。 方法回顾性分析笔者所在医院2012年3月至2014年3月期间应用腹腔镜技术救治的19例外伤性脾破裂患者的临床资料。 结果本组19例患者中，顺利完成腹腔镜手术17例，中转开腹2例，均获得成功救治，痊愈出院。其中行腹腔镜下电凝止血＋生物蛋白胶黏合保脾4例，行腹腔镜下无损伤线缝合＋网膜覆盖保脾8例，行腹腔镜脾切除术5例，中转开腹行脾切除术2例。手术时间50～186 min，平均90 min；术中失血250～2 200 mL，平均780 mL；术后住院时间7～26 d，平均13.5 d，术后均无并发症发生。术后19例患者均获访，随访时间为3～12个月，平均8个月。随访期间无死亡及远期并发症发生。 结论对外伤性脾破裂患者选择性施行的腹腔镜脾修补术和脾切除术具有良好的效果，其具有创伤小、痛苦轻及恢复快的优点，安全而可行，值得推广。
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 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.