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不同方法治疗股骨粗隆间骨折

【摘 要】 目的 探讨不同方法治疗股骨粗隆间骨折的手术适应证及疗效。 方法 1999 年1 月－ 2006 年12 月，收治176 例股骨粗隆间骨折患者。男103 例，女73 例；年龄34 ～ 91 岁，平均63.5 岁。交通伤31 例，高处坠落伤11 例，跌倒伤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 例采用非手术治疗，83 例采用动力髋螺钉（dynamic hip screw，DHS）固定，23 例采用股骨近端髓内钉（proximal femoral nails，PFN）固定，27 例采用动力髁螺钉（dynamic condyle screw，DCS）治疗，8 例采用解剖钢板手术治疗。 结果 患者均获随访6 个月～ 7 年，平均15.2 个月。非手术治疗组3 例骨折不愈合，均放弃治疗。解剖钢板手术治疗组1 例术后10 周发生钢板断裂，予对症处理骨折愈合。余患者于术后10 ～ 15 周骨折达临床愈合。6 个月后髋关节功能根据Brumback 评价标准评定，非手术治疗者优9 例，良18 例，差8 例；DHS 手术治疗者优68 例，良12例 ，差3 例；PFN 手术治疗者优18 例，良5 例；解剖钢板手术治疗者优5 例，良1 例，差2 例；DCS 手术治疗者优15 例，良11 例，差1 例。 结论 股骨粗隆间骨折首选手术治疗，手术方案应综合考虑骨折类型、内固定器材特点以及患者病情，采取个性化的治疗方案。

原发性甲状旁腺功能亢进症放射性核素显像误诊1例报道

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.

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.

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

目的　探讨甲状旁腺腺瘤所致无症状原发性甲状旁腺功能亢进症（PHPT）的诊断和治疗。方法　回顾性分析中国医科大学附属第一医院1990年1月至2013年4月期间收治的24例甲状旁腺腺瘤所致无症状PHPT患者的临床资料。结果　24例甲状旁腺腺瘤所致无症状PHPT患者中男9例，女15例；年龄（47.92±12.96）岁。均无骨关节疼痛、病理性骨折、泌尿系结石或胃肠道症状等典型PHPT的临床表现，均为体检和并存或误诊为甲状腺疾病时发现。24例患者术前血钙升高18例，正常6例；血磷降低7例，正常17例；16例术前行血甲状旁腺激素检测患者中11例升高，正常5例；22例患者术前测定血碱性磷酸酶升高9例，正常13例。血钙与甲状旁腺激素均正常者4例，其中1例为体检时超声发现甲状旁腺病变，3例为手术治疗甲状腺疾病术中探查发现。24例患者术前均行超声检查，15例行甲状旁腺ECT检查，14例行甲状旁腺增强CT检查，阳性率分别为66.67% （16/24）、93.33% （14/15）及78.57% （11/14）。15例术前定性定位检查获得明确诊断，5例定性或定位检查高度怀疑甲状旁腺病变，4例术前误诊为甲状腺病变。均行甲状旁腺腺瘤切除，其中甲状旁腺腺瘤位于左侧上位2例、左侧下位9例、右侧上位2例、右侧下位11例。肿瘤最大径为（2.22±0.88） cm。24例患者中13例合并甲状腺病变。本组患者术后有8例出现手足、口周麻木，给予静脉或口服补钙后缓解，其余患者均无自觉症状。术后血钙及甲状旁腺激素均有不同程度下降，术后2周均降至正常范围。结论　甲状旁腺腺瘤所致无症状PHPT临床症状不典型，血清钙和甲状旁腺激素同步升高即可诊断，具有手术指征的患者应积极手术治疗。