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不同方法治療股骨粗隆間骨折

【摘 要】 目的 探討不同方法治療股骨粗隆間骨折的手術適應證及療效。 方法 1999 年1 月－ 2006 年12 月，收治176 例股骨粗隆間骨折患者。男103 例，女73 例；年齡34 ～ 91 歲，平均63.5 歲。交通傷31 例，高處墜落傷11 例，跌倒傷134 例。按AO 分型：31A1 型79 例，31A2 型18 例，31A3 型7 例，31B 型15 例，32A 型34 例，32B 型12 例，32C型11 例。病程2 h ～ 7 d。35 例采用非手術治療，83 例采用動力髖螺釘（dynamic hip screw，DHS）固定，23 例采用股骨近端髓內釘（proximal femoral nails，PFN）固定，27 例采用動力髁螺釘（dynamic condyle screw，DCS）治療，8 例采用解剖鋼板手術治療。 結果 患者均獲隨訪6 個月～ 7 年，平均15.2 個月。非手術治療組3 例骨折不愈合，均放棄治療。解剖鋼板手術治療組1 例術后10 周發生鋼板斷裂，予對癥處理骨折愈合。余患者于術后10 ～ 15 周骨折達臨床愈合。6 個月后髖關節功能根據Brumback 評價標準評定，非手術治療者優9 例，良18 例，差8 例；DHS 手術治療者優68 例，良12例 ，差3 例；PFN 手術治療者優18 例，良5 例；解剖鋼板手術治療者優5 例，良1 例，差2 例；DCS 手術治療者優15 例，良11 例，差1 例。 結論 股骨粗隆間骨折首選手術治療，手術方案應綜合考慮骨折類型、內固定器材特點以及患者病情，采取個性化的治療方案。

Irrational prescriptions of antibiotics in Beijing Hospital from 2016 to 2019

ObjectiveTo evaluate the rationality of antibiotics use by analyzing the prescription reviewing results.MethodsThe review data of antibiotic prescriptions in Beijing Hospital was randomly selected from 2016 to 2019, from which unreasonable prescriptions and the antimicrobial agents were analyzed, and the use of antibiotics and unreasonable prescriptions annually were compared.ResultsThe evaluation of rational use of antibiotics involved 79 701 outpatient prescriptions from 2016 to 2019. There were 10 drugs in the top five irrational rates of outpatient antibiotics, primarily cephalosporin and quinolones, accounting for 50% and 30%, respectively. The primarily unreasonable problems were over prescription (common in gastroenterology and dermatology), unsuitable indications (common in otolaryngology), inappropriate usage and dosage (common in urology, dermatology and gastroenterology), and failure to write clinical diagnosis or incomplete clinical diagnosis (common in obstetrics and gynecology and general surgery). During the four years, the proportion of antibiotics prescriptions and the irrational rate decreased annually.ConclusionsThe use of antibiotics in outpatient department of Beijing Hospital has achieved initial results, however, there are still some problems. We should further strengthen the management of antibiotics usage, strengthen training and learning, and increase medical cooperation to promote rational drug use in clinic.

The Diagnosis and Treatment of Acute Mesenteric Venous Thrombosis

ObjectiveTo investigate the early diagnosis and proper treatment of acute mesenteric venous thrombosis (AMVT). MethodsThe clinical data of 105 cases of AMVT treated from January 2000 to December 2013 were analyzed retrospectively. ResultsThe diagnostic accuracy of ultrasonography and abdominal contrast-enhanced CT was 67.6% (71/105), 88.0% (81/92) respectively. The accuracy rate of abdominal cavity puncture or abdominal drainage in the diagnosis of intestinal necrosis was 100% (38/38). All cases received anticoagulation and thrombolysis as soon as the definite diagnosis of AMVT were made. Twenty-five cases underwent emergency operation due to the bowel necrosis at the visiting time, Anticoagulation and thrombolysis were performed in 80 patients, of which 7 patients received surgical treatment because of ineffective anticoagulation and thrombolytic therapy. Thrombectomy was performed in 15 cases simultaneously. Surgical treatment of 32 cases, 30 cases were cured and 2 patients died of multiple organ failure or short bowel syndrome within 1 month after operation. Seventy-three cases were treated with anticoagulation therapy alone, 72 patients were cured and discharged, the effective rate was 90.0%, another 1 case died due to cerebral hemorrhage within 1 month after operation. ConclusionsEarly diagnosis of AMVT and bowel necrosis, timely and accurate anticoagulation and thrombolysis, and proper surgical intervention can often achieve satisfactory results.

原發性甲狀旁腺功能亢進癥放射性核素顯像誤診1例報道

Diagnosis and Treatment of Asymptomatic Primary Hyperparathyroidism Duo to Parathyroid Adenoma（A Retrospective Analysis of 24 Cases）

目的　探討甲狀旁腺腺瘤所致無癥狀原發性甲狀旁腺功能亢進癥（PHPT）的診斷和治療。方法　回顧性分析中國醫科大學附屬第一醫院1990年1月至2013年4月期間收治的24例甲狀旁腺腺瘤所致無癥狀PHPT患者的臨床資料。結果　24例甲狀旁腺腺瘤所致無癥狀PHPT患者中男9例，女15例；年齡（47.92±12.96）歲。均無骨關節疼痛、病理性骨折、泌尿系結石或胃腸道癥狀等典型PHPT的臨床表現，均為體檢和并存或誤診為甲狀腺疾病時發現。24例患者術前血鈣升高18例，正常6例；血磷降低7例，正常17例；16例術前行血甲狀旁腺激素檢測患者中11例升高，正常5例；22例患者術前測定血堿性磷酸酶升高9例，正常13例。血鈣與甲狀旁腺激素均正常者4例，其中1例為體檢時超聲發現甲狀旁腺病變，3例為手術治療甲狀腺疾病術中探查發現。24例患者術前均行超聲檢查，15例行甲狀旁腺ECT檢查，14例行甲狀旁腺增強CT檢查，陽性率分別為66.67% （16/24）、93.33% （14/15）及78.57% （11/14）。15例術前定性定位檢查獲得明確診斷，5例定性或定位檢查高度懷疑甲狀旁腺病變，4例術前誤診為甲狀腺病變。均行甲狀旁腺腺瘤切除，其中甲狀旁腺腺瘤位于左側上位2例、左側下位9例、右側上位2例、右側下位11例。腫瘤最大徑為（2.22±0.88） cm。24例患者中13例合并甲狀腺病變。本組患者術后有8例出現手足、口周麻木，給予靜脈或口服補鈣后緩解，其余患者均無自覺癥狀。術后血鈣及甲狀旁腺激素均有不同程度下降，術后2周均降至正常范圍。結論　甲狀旁腺腺瘤所致無癥狀PHPT臨床癥狀不典型，血清鈣和甲狀旁腺激素同步升高即可診斷，具有手術指征的患者應積極手術治療。