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小切口撬撥復位鎖定鋼板外固定治療跟骨關節內骨折

目的 總結采用小切口撬撥復位、鎖定鋼板外固定治療有移位的跟骨關節內骨折的臨床效果。 方法2006 年8 月－ 2007 年6 月，采用小切口撬撥復位、鎖定鋼板外固定術治療13 例15 足跟骨關節內骨折。男9 例，女4 例；年齡16 ～ 81 歲，中位年齡37.6 歲。墜落傷9 例，交通傷4 例。左側4 例，右側7 例，雙側2 例。骨折根據Sanders 分型：Ⅱ型6 足，Ⅲ型9 足。患者傷后至手術時間2 ～ 6 d，平均3.6 d。術中對3 例骨缺損者植入同種異體骨3 g。 結果 術后2 周未發生皮膚壞死及其他并發癥。術后10 d 2 例釘道有滲出，經換藥后愈合。術后13 例均獲隨訪，隨訪時間6 ～ 15個月，平均10.6 個月。患者骨折均愈合，愈合時間5 ～ 8 個月，平均6.7 個月。完全負重時間2 ～ 4 個月，平均3.2 個月。功能評價采用美國足踝協會的后足評分系統，優10 足，良3 足，可2 足，優良率86.7%。術后Bouml;hler 角（29.00 ± 0.42）°，與術前（4.82 ± 0.32）° 比較，差異有統計學意義（P lt; 0.05）。 結論 小切口撬撥復位、鎖定鋼板外固定治療跟骨關節內骨折損傷小、促進骨折愈合；外置鋼板可避免皮瓣壞死、鋼板外露及發生骨髓炎等風險，是治療跟骨關節內骨折的一種有效方法。

Radioactive Iodine-131 Treatment for Differentiated Thyroid Carcinoma

The characteristics of high-resolution magnetic resonance imaging with focal cortical dysplasia in children

ObjectiveTo discuss the 3D high resolution Magnetic resonance imaging (MRI) features of focal cortical dysplasia (FCD) in children.MethodsMRI data of 42 children with FCD confirmed by pathology, from April 2015 to June 2018, which were admitted to Qilu Children’s Hospital of Shandong University, were retrospectively analyzed. The following MRI signs were observed, blurring of junction of the gray matter-white matter, abnormality of structure with focal cortex (thick or thin), gray matter and white matter signal, white matter signal increased with T2WI/FLAIR, with or without transmantle sign (abnormal signal of white matter extending in the direction of ventricle), gray matter signal increased with T2WI/FLAIR, the abnormal sulci or gyri morphology and segmental and/or hypoplasia/atrophy of the lobes.ResultsAmong the 42 cases, 37 cases (88.1%) showed MRI positive signs, FCD typeⅠ accounted for 13 cases (35.1%), the main MRI features are focal blurring of junction in the gray matter-white matter, abnormality of structure with focal cortex in the corresponding part,and white matter signal increased with T2WI/FLAIR. FCD TypeⅡ accounted for 17 cases (45.9%), the MRI features are focal blurring of junction in the gray matter-white matter, abnormality of structure with focal cortex, white matter signal increased with T2WI/FLAIR, and transmantle sign. FCD TypeⅢ accounted for 7 cases (18.9%), among which hippocampal atrophy 2 cases (28.6%), dysembryoplastic neuroepithelial tumor (DNET) 2 cases (28.6%), section cell tumor 1 case (14.3%), softening lesion with gliosis 2 cases (28.6%).ConclusionThe 3D high-resolution MRI features of FCD in children are specific and could improve the detection rate of FCD lesions.

上消化道多原發癌的診治分析

目的 探討上消化道多原發癌的診斷及手術治療。方法 對48例診斷為上消化道多原發癌患者，42例按腫瘤不同的生長部位采取3種不同的手術方式，同時清掃頸、胸、腹三區域或胸、腹二區域淋巴結。結果 頸部淋巴結鱗癌轉移13例；胸部淋巴結鱗癌轉移21例，腺癌轉移9例；腹部淋巴結鱗癌轉移8例，腺癌轉移25例。本組無手術死亡，均獲得隨訪，存活5年8例，存活3年12例，存活1～2年10例，現有10例仍在隨訪中。結論 上消化道多原發癌以淋巴結轉移為主，徹底的手術切除是患者獲得長期生存的關鍵，頸、胸、腹三區域或胸、腹二區域淋巴結清掃極其重要。

小切口切開復位Herbert 螺釘內固定治療有移位的鎖骨中段骨折

目的 總結采用小切口切開復位Herbert 螺釘內固定治療有移位的鎖骨中段骨折臨床效果。 方法 2008 年5 月－ 2010 年3 月，采用微創小切口切開復位Herbert 螺釘內固定治療32 例有移位的鎖骨中段骨折。男21 例,女11 例；年齡16 ～ 75 歲，中位年齡32.3 歲。交通事故傷18 例，摔傷9 例，重物砸傷5 例。左側14 例，右側18 例。其中橫形骨折6 例，斜形骨折8 例，粉碎性骨折18 例。患者傷后至手術時間為18 ～ 42 h，平均26.4 h。 結果 術后32 例均獲隨訪，隨訪時間13 ～ 18 個月，平均14.6 個月。32 例均獲解剖復位，無成角、短縮或分離移位，內固定物無移位。術后6 ～ 8 周骨折均達臨床愈合，無畸形或延遲愈合、骨不連等并發癥發生。術后肩關節功能根據Neer 評分標準均獲優。 結論 小切口切開復位Herbert 螺釘內固定治療有移位的鎖骨中段骨折損傷小，促進了骨折愈合，可避免鎖骨下動、靜脈及臂叢神經損傷、氣胸等并發癥及二次手術。

同期食管、肺雙原發癌六例

0.3—0.5mm小動脈套入法與間斷縫合法的實驗觀察

Characterization of rabbit corneal biomechanical properties after corneal refractive surgery based on rapid loading-unloading uniaxial tensile test

In order to understand how the biomechanical properties of rabbit cornea change over time after corneal ablation, 21 healthy adult rabbits were used in this study, with the left eye as experimental side and the right eye as the control side. Firstly, a lamellar knife was used to remove a portion of the anterior corneal surface tissue (30%~50% of the original corneal thickness) from the left eye of each rabbit, as an animal model simulating corneal refractive surgery. Secondly, postoperative experimental rabbits were kept for one, three, or six months until being euthanized. Strip specimens were produced using their corneas in vitro to perform a uniaxial tensile test with an average loading-unloading rate of approximately 0.16 mm/s. Finally, the visco-hyperelastic material constitutive model was used to fit the data. The results showed that there was a significant difference in the viscoelastic parameters of the corneas between the experimental and the control eyes at the first and third postoperative months. There was a difference in tangential modulus between the experimental and the control eyes at strain levels of 0.02 and 0.05 at the third postoperative month. There was no significant difference in biomechanical parameters between the experimental and the control eyes at the sixth postoperative month. These results indicate that compared with the control eyes, the biomechanical properties of the experimental eyes vary over postoperative time. At the third postoperative month, the ratio of corneal tangential modulus between the experimental and the control eyes significantly increased, and then decreased. This work lays a preliminary foundation for understanding the biomechanical properties of the cornea after corneal refractive surgery based on rapid testing data obtained clinically.

真核細胞翻譯起始因子eIF4E的研究進展

鎖骨鉤鋼板結合錨釘治療肩鎖關節脫位22例