目的:觀察蛇傷患者凝血、抗凝和纖溶系統各項指標的變化并探討其臨床意義。方法:以36例蛇傷患者和32例健康體檢者為研究對象,測定血漿凝血酶原時間(PT)、部分凝血活酶時間(APTT)、纖維蛋白原(Fg)、血管性血友病因子(vWF)、凝血酶調節蛋白(TM)、組織型纖溶酶原激活物(tPA)、纖溶酶原激活物抑制物1(PAI1)含量。結果:與正常對照組比較,蛇傷患者PT、APTT、vWF、TM、tPA、PAI1水平明顯升高,Fg水平明顯降低(Plt;001)。結論:蛇傷患者存在凝血、抗凝、纖溶系統的紊亂,早期使用抗蛇毒血清對于防治彌散性血管內凝血(DIC)和多器官功能障礙(MODS)的發生有積極意義。
Objective To observe the effectiveness of the superior fibular head approach for the treatment of posterolateral fracture of the tibial plateau. Methods Between June 2010 and February 2012, 20 cases of posterolateral fracture of the tibial plateau were treated through superior fibular head approach, including 1 case of simple posterolateral fracture of the tibial plateau and 19 cases of posterolateral fracture of the tibial plateau with other fractures. There were 12 males and 8 females with an average age of 42.2 years (range, 28-58 years). All patients had closed fractures. Fracture was caused by traffic accident in 14 cases, by falling from height in 4 cases, and by twist injury in 2 cases. Associated injuries included lateral meniscus injury in 5 cases, medial meniscus injury in 2 cases, and anterior cruciate ligament injury in 1 case. The time from injury to admission ranged from 90 minutes to 32 hours (mean, 4.5 hours), and the time from admission to operation was 5-12 days (mean, 7.8 days). All cases underwent fracture reduction and fixation with Pilon plates through the superior fibular head approach, and associated fracture and meniscal injury were treated. Results All incisions healed by first intention, and no numbness or articular instability occurred. All patients were followed up 6-26 months (mean, 19.1 months). The average fracture healing time was 10.2 weeks (range, 8-12 weeks). During following-up, no related complication of fixation loosening or articular surface loss occurred. According to Rasmussen knee score criteria at last follow-up, the score was 18-30 (mean, 27.9); 16 cases were graded as excellent, 3 cases as good, and 1 case as fair, with an excellent and good rate of 95%. Conclusion The superior fibular head approach for the treatment of posterolateral fracture of the tibial plateau is simple, safe, and effective, and can achieve a good surgical outcome.