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开放性气管、食管横断伤一例

膝关节镜下松解术治疗膝关节功能障碍

【摘 要】 目的 总结膝关节功能障碍行关节镜下松解，以及术后康复方法及疗效。 方法 2002 年10 月－2006 年2 月，采用膝关节镜下松解术治疗膝关节功能障碍15 例，男11 例，女4 例；年龄25 ～ 56 岁。左侧9 例，右侧6 例。髌骨骨折7 例，胫骨平台骨折4 例，前交叉韧带断裂3 例，化脓性关节炎1 例。病程6 个月～ 3 年，平均1.5 年。膝关节功能障碍程度：伸膝0 ～ 10º，屈膝30 ～ 60 º；膝关节活动范围30 ～ 50 º。术后行关节腔冲洗，早期CPM 机功能锻炼，手法屈膝按摩。 结果 患者术后切口Ⅰ期愈合，无并发症。获随访1 ～ 3 年半，平均2 年。膝关节活动度: 屈110° ～伸0°者4 例，屈100° ～伸0° 者7 例，屈90° ～伸0° 者3 例，屈70° ～伸0° 者1 例。按KSS 评分标准，优11 例，良3 例，可1 例，优良率为93.3％。 结论 关节镜下行膝关节内松解，术后关节腔冲洗，为早期行膝关节功能锻炼创造了条件，有利于膝关节功能康复。

Experience of Diagnosis and Treatment of Duodenal Injuries (Report of 16Cases ）

目的 探讨十二指肠损伤的诊断、手术治疗及手术方式的选择。方法 对我院2000年3月至2007年5月收治的16例十二指肠损伤患者的临床资料进行回顾性分析。结果 16例均进行手术治疗，仅3例术前明确诊断，术中确诊13例； 术后并发症4例； 16例均治愈出院。结论 十二指肠损伤的病情复杂，治疗成败的关键是掌握好早期手术探查指征和选择合适的术式。对于较重的Ⅲ、Ⅳ级十二指肠损伤者，改良十二指肠憩室化手术为一种较理想的手术方法。

The Effects of Apoptosis and Proliferation on Choledochal Cyst

ObjectiveTo observe apoptosis and proliferation of choledochus wall epithelial cell and fibrocyte, to understand the effects of apoptosis and proliferation on choledochal cyst development.MethodsThirty two cases of cystic dilatation,35 cases of cylindrical dilatation，and 25 cases of cholangiectasis caused by choledocholith were collected. All specimens were offered by department of hepatobiliarypediatric surgery. The apoptosis related index (bcl2 and bax) and cell proliferation index (PCNA) were detected by the immunohistochemical technique; Apoptosis was detected by TUNEL method. ResultsThere was serious mucosal epithelial cell damage in cystic dilatation group. In cylindrical dilatation group there was a damage similar to that of the cystis dilatation group, but the damage was not serious. In control group there was little damage in the duct wall, but there was a low positive rate of apoptosis of 〔epithelium cell (2.74±1.00)% and fibroblast (2.95±0.87）%〕, and a low bcl2 and bax’s expression rate, and a high PCNA’s expression rate 〔epithelium cell (3.74±1.00)%, fibroblast (3.71±1.77)%〕. There was no obvious difference between cylindrical dilatation group and cystic dilatation group (Pgt;0.05): the PCNA’s expression rate was low 〔(0.99±0.51)% and (0.90±0.38)% respectively〕, the bax expression rate was high in remaining epithelial cell, and the positive rate of bax was apparently higher than that of bcl2 (P＜0.05), the positive rate of the apoptosis cell was high 〔(13.94±4.77)%, (7.51±3.46)%〕; the expression rate PCNA were high 〔(9.91±2.91)%,(9.70±3.18)%〕, and expression rate of bax’s was low in the fibre tissue, the positive rate of bcl2 was markedly higher than that of bax, and the positive rate of the apoptosis cell was low 〔(3.74±2.12)%,(4.46±2.41)%〕. There were no marked difference between the two groups (Pgt;0.05). The expression of bcl2 and bax had marked difference both in cylindrical dilatation group and cystic dilatation group and as compared to control group (P＜0.05). ConclusionApoptosis has certain promoting effect in the course of choledochal cyst formation.