目的 提高对囊性纤维化的认识。 方法 2011年11月收治1例自幼有临床表现的囊性纤维化患者,回顾其诊断及治疗经过,复习相关文献总结其临床特征、诊疗进展及预后评价。 结果 囊性纤维化起病年龄较早,患者自幼年起即反复出现肺、消化道、肝脏等多系统病变,最终导致多器官功能衰竭。 结论 应提高对囊性纤维化的识别度,对于发病年龄过早、反复发作的严重支气管扩张,伴随生长发育延迟、肝硬化等临床征象应注意对囊性纤维化的筛查。
Objective To explore the relative prognostic factors of Tile C pelvic injury after iliolumbar fixation. Methods Between March 2007 and March 2010, 60 patients with Tile C pelvic injuries were surgically treated with iliolumbar fixation, including 39 males and 21 females with an average age of 37 years (range, 17-66 years). Of them, 27 cases were classified as Tile C1, 20 as Tile C2, and 13 as Tile C3. The preoperative injury severity score (ISS) was 12-66 (mean, 29.4). The time from injury to surgery was 2-25 days (mean, 8.1 days). Iliolumbar fixation was performed in all patients. Unconditional logistic analysis was used to analyze the relationship between the age, sex, body mass index (BMI), operation opportunity, the preoperative combined injury, classification of fracture, the postoperative complication, reduction outcome, sacral nerve injury, and the time of physical exercise and the prognosis. Results All 60 patients were followed up 12-56 months (mean, 27.3 months). Infection of incisions occurred in 12 cases and were cured after dressing change; healing of incision by first intention was obtained in the other patients. Delay sacral nerve injury was found in 15 patients, 6 patients underwent nerve decompression, and 9 underwent conservative treatment. Ten patients had nail protrusion of Schanz screws at the posterior superior illac spine, and 3 patients had pain, which was relieved after removal of the internal fixator. One patient had bone-grafting nonunion of sacroiliac joint, which was improved by pressured bone graft. Five patients had the beam breakage without significant effect. Six patients had deep vein thrombosis, among them 4 underwent filter and 2 underwent nonsurgical treatment. The healing time of fracture was 3-6 months (mean, 3.9 months). According to the Matta function score, the results were excellent in 31 cases, good in 24 cases, fair in 3 cases, and poor in 2 cases with an excellent and good rate of 91.7% at last follow-up. Majeed score was 58-100 (mean, 86), 28 were rated as excellent, 12 as good, 16 as fair, and 4 as poor with an excellent and good rate of 66.7%. The logistic analysis showed that the age, sex, BMI, and postoperative complications were not prognostic factors; early operation (within 10 days), early function exercises (within 7 days), the better reduction quality, and the less sacral nerve injury were in favor of prognosis; and the worse preoperative combined injury and pelvic injury were, the worse the prognosis was. Conclusion Operation opportunity, the preoperative combined injury, reduction outcome, sacral nerve injury, and the time of physical exercise are all significantly prognostic factors of Tile C pelvic injuries