The digital defects which severely interfered with the hand functions must be reconstructed. The primary repair by vascularized skin flap with the dorsal branch of proper palmar digital nerve could be done. The vascularized flap was rich in blood circulation, perfect sensibility and a good contour, as well as preserving donor digital sensation. However, it was simple, safe, and with higher success. From 1989 to 1991, 10 cases of digital defects were treated, all of the patients gained very good results. The indication and technique of thismethod wasdiscussed in detail.
目的探讨诊治闭合性肝外伤的有效方法。方法回顾分析了1990～2000年收治的168例闭合性肝外伤的临床资料。结果均行腹腔穿刺，阳性率为94.6%（159/168），B超检查92例，阳性率为95.7%（88/92），CT检查33例，阳性率为93.9%（31/33），术前确诊率为98.2%。168例中，行非手术治疗37例（22.0%），手术治疗131例（78.0%）。治愈161例（95.8%），其中非手术治疗37例均痊愈； 手术治疗131例中痊愈124例，死亡7例（4.2%）。结论外伤史、体征、腹腔穿刺、B超和CT检查是诊断肝外伤的重要依据，及时手术治疗是降低严重肝外伤病死率的关键。
目的探讨腹腔镜在腹部外伤诊断与治疗中的应用价值。方法 对36例腹部外伤患者行腹腔镜探查术，首先明确诊断，根据不同的损伤脏器和类型，进行腹腔镜下处理，处理困难或无效时及时中转开腹。结果本组病例术中均明确诊断。10例开放性腹部外伤中，胃破裂伤2例，肝裂伤2例，脾破裂1例，小肠破裂伤2例，大网膜损伤1例，肠系膜血管破裂1例，单纯腹壁裂伤1例。26例闭合性腹部外伤中，胃破裂2例，肝破裂7例，脾破裂12例，小肠破裂2例，肠系膜血管破裂1例，单纯腹膜后血肿2例。于腹腔镜下行缝合、修补、电凝、明胶海绵止血等治疗20例（55.6%），10例（27.8%）未做特殊处理，6例（16.6%）中转开腹。本组病例术中出血量为55~1 800 ml（平均520 ml），手术时间为60~186 min（平均128 min）。 所有病例均放置腹腔引流2~5 d（平均3 d），住院时间3~16 d（平均9 d）。全组均无气腹相关并发症和死亡病例。结论腹腔镜诊治腹部外伤具有创伤小、诊断率高、恢复快等优点，大部分病例还可在腹腔镜下达到诊治一体化的目的。
目的总结外伤性心脏破裂的急救流程及手术治疗方法。 方法回顾性分析广元市第一人民医院2001年6月至2013年6月收治13例心脏破裂患者的临床资料，其中男11例、女2例，年龄20～45（32.0±10.5）岁；病程30 min至2 h，平均（45.0±9.6）min。立即行床旁B超检查，其中12例急诊在全身麻醉、气管内插管下行心脏修补术，同期处理合并脏器损伤。 结果1例术前死于腹腔大出血，1例死于术后弥漫性血管内凝血（DIC），术中发生恶性心律失常2例，术后发生慢性胸骨骨髓炎2例，痊愈出院11例。出院后1个月复查心脏彩色超声，发现4例少量心包积液，余未见异常。 结论对于高度怀疑心脏破裂患者，建立快速的救治通道，早期准确诊断、及时手术治疗，是挽救患者生命的关键。
目的 回顾性分析2008年5月12日汶川地震及2013年4月20日芦山地震中，笔者所在医院收治的8例地震肝外伤住院伤员情况，为地震肝外伤的诊治提供参考。方法 于笔者所在医院病案科查询因地震伤入院且诊断为肝外伤的伤员，收集其相关临床资料并分析。结果 笔者所在医院在汶川及芦山地震后共收治地震肝外伤患者8例，其中7例患者伴随有其他合并伤。入院后2例患者接受了肝脏手术治疗，其余6例患者行保守治疗。所有患者均治愈出院。结论 早期明确诊断，选择恰当的治疗方式，及时处理合并伤，可以使地震肝外伤患者获得良好的预后。
ObjectiveTo compare and observe the visual acuity and ocular anatomical outcome of different subtypes in open-globe injury (OGI) Ⅲ. MethodsA retrospective study. A total of 187 eyes of 187 patients with OGI involving zone Ⅲ who were admitted to the Department of Ophthalmology of The First Affiliated Hospital of Army Medical University from January 2020 to December 2023 were included in the study. According to the 2022 International Globe and Adnexal Trauma Epidemiology Study groups consensus, zone Ⅲ was further divided into Ⅲa zone (5-8 mm posterior to the limbus) and Ⅲb zone (＞8 mm posterior to the limbus), with 58 eyes (31%, 58/187) in group Ⅲa and 129 eyes (69%, 129/187) in group Ⅲb. Best corrected visual acuity (BCVA) was examined using the international standard decimal visual acuity chart, converted into the logarithm of the minimum angle of resolution (logMAR) visual acuity when recorded. The injured zone, initial visual acuity, final visual acuity, retinal detachment (RD), uveal prolapse, and proliferative vitreoretinopathy (PVR) were collected. The follow-up time after surgery ≥ 6 months. The final visual acuity and anatomical prognosis of the two groups were observed. Silicone oil dependence, phthisis, and enucleation were defined as poor anatomical outcomes. Multiple linear regression analysis was performed to analyze the impact of zone Ⅲb of OGI on the final visual acuity. ResultsAt the 6-month follow-up, the logMAR BCVA of group Ⅲa and group Ⅲb was 1.49±1.0 and 2.51±0.85; there was a statistically significant difference in the logMAR BCVA between the two groups (t=−2.736, P＜0.05). Compared with group Ⅲa, the proportion with light perception in group Ⅲb was higher, and the proportions with visual acuity of hand movement, counting fingers, and ＞0.01 were lower, and the differences were all statistically significant (P＜0.05). Compared with group Ⅲa, RD and PVR were more likely to occur in group Ⅲb, and the differences were all statistically significant (χ2= 16.696, 8.697; P＜0.05). Among the affected eyes in group Ⅲa and group Ⅲb, there were 14 eyes (24.1%, 14/58) and 95 eyes (73.6%, 95/129) with poor final anatomical outcomes respectively; the incidence of poor final anatomical outcomes in group Ⅲb was higher, and the difference was statistically significant (χ2= 40.332, P＜0.01). The results of multiple linear regression analysis showed that initial visual acuity, RD, and uveal prolapse were independent risk factors affecting the final visual acuity (odds ratio=2.407, 4.162, 3.413; P＜0.05). ConclusionsPatients with OGI in zone Ⅲb have a worse visual prognosis and a higher incidence of poor anatomical outcomes. The subclassification of zone Ⅲ is helpful for better predicting the prognosis of OGI clinically.
目的:分析汶川8.0级大地震致腹部外伤的患者的心理问题并探索其护理对策。方法:以汶川8.0级大地震致腹部外伤的19名患者为暴露组,普通患者20名和医务人员19名作为对照组。由3名医护人员运用汉密顿抑郁量表进行调查和分析。结果:地震伤员在睡眠质量、精神焦虑、抑郁情绪等3个方面与普通患者及医务人员比较有明显异常。结论:地震致腹部外伤患者的心理影响明显大于普通患者及医务人员,应进行及时有效的心理干预护理,以控制和减缓其心理问题。