【摘要】 目的 探討超聲引導下導絲定位在不可觸及的乳腺病灶切除中的應用價值。 方法 對2005年1月－2010年9月127例女性患者的137個乳腺病灶（臨床捫診均為陰性），在超聲引導下進行導絲定位，后進行外科切除活檢，并對相關資料進行回顧性分析。 結果 137個病灶的組織學結果中，良性病灶101個（73.7%）、高風險病灶27個（19.7%）和癌9個（6.6%）。9個癌中3個為導管原位癌，6個為浸潤性導管癌（大小11～19 mm，平均14.2 mm）。超聲引導下導絲定位的時間為3～15 min，平均6 min；無血腫、導絲脫落及折斷等并發癥發生。外科手術切除時間20～40 min，平均30 min。 結論 超聲引導下進行導絲定位安全、迅速，能協助外科手術進行準確的活檢和切除。【Abstract】 Objective To determine the application value of ultrasound-guided wire localization in surgical excision of non-palpable breast lesions. Methods Between January 2005 and September 2010, 127 women with 137 non-palpable breast lesions underwent surgical excision at West China Hospital. Palpation results for all the lesions were negative. Wire localization guided by ultrasound was performed before operation and biopsy. Related imaging studies and medical records were reviewed retrospectively. Results Histological findings showed there were 101 benign lesions (73.7%), 27 high-risk lesions (19.7%), and 9 carcinomas (6.6%). Among the 9 carcinomas, 3 were ductal carcinoma in situ, and 6 were infiltrating carcinoma (with their size ranged from 11 to 19 mm averaging at 14.2 mm). The time of performing ultrasound-guided wire localization was from 3 to 15 minutes averaging at 6. No complications like hematoma, wire fragments, and wire breakage occurred in all cases. The surgical excision time ranged from 20 to 40 minutes averaging at 30. Conclusions Ultrasound-guided wire localization can be performed quickly and safely for the cases of non-palpable breast lesions. It is useful in assisting surgical excision and biopsy.
ObjectiveTo investigate the feasibility and effectiveness of unexposed ulnar nerve medial elbow incision, open reduction and internal fixation of anatomical locking compression plate (LCP) for distal humerus fractures.MethodsFourteen patients with distal humerus fracture were treated between January 2014 and June 2017. There were 5 males and 9 females, aged 18-85 years (mean, 65.5 years). The causes of injury included falling from height in 12 cases and traffic accident in 2 cases, all were closed fractures. Fractures were classified according to the AO/Association for the Study of Internal Fixation (AO/ASIF): 3 cases of type A2, 2 cases of type A3, 4 cases of type B2, 2 cases of type C1, 2 cases of type C2, and 1 case of type C3; without ulnar nerve damage. The time from injury to operation was 4-15 days, with an average of 7 days. The type B2 fractures were treated with unexposed ulnar nerve elbow medial incision and anatomic LCP internal fixation, the rest patients were all treated with unexposed ulnar nerve medial plus conventional lateral approach and bilateral LCP internal fixation.ResultsThe operation time was 50-140 minutes (mean, 80 minutes), and the intraoperative blood loss was 20-200 mL (mean, 70 mL). There was no blood vessels or nerve damage during operation. All incisions healed by first intension, and no incision infection occurred. All the 14 cases were followed up 9-24 months (mean, 13 months). X-ray films showed that all fractures healed within 4 months without complications such as nonunion and osteomyelitis. No ulnar nerve injury, cubitus varus deformity, and ossifying myositis occurred during follow-up. At last follow-up, the elbow function was assessed by Mayo Elbow Performance score (MEPS), the results were excellent in 8 cases, good in 4 cases, fair in 1 case, and poor in 1 case (type C3 fracture), with the excellent and good rate of 85.7%.ConclusionThe unexposed ulnar nerve medial elbow incision can be used effectively to reduct the fracture, and it is not prone to ulnar nerve injury. Combined with the lateral approach to treat the distal humerus fracture, which has the advantages of short operation time, few trauma, little bleeding, and reliable effectiveness.