浅析髋关节置换术后股骨假体周围骨折的治疗

目的：探讨人工髋关节置换术的患者股骨假体周围骨折的发生原因和治疗方法。方法：回顾该院行人工髋关节置换术后股骨假体周围骨折的患者200例,统计分析所有患者的性别、年龄、诊断、假体固定类型、假体形态、假体周围骨折类型,并探讨相关骨折影响因素。结果：200例患者中有22例患者术中发生股骨假体周围骨折,根据 Vancouver 分型,A 型骨折15例,B 型骨折4例,C 型骨折3例。女性患者术中骨折的发生率要明显高于男性,右侧手术、使用生物型股骨假体的患者为骨折高发的危险因素。结论：在治疗时应根据不同的骨折分型以及骨折的发生影响因素充分考虑,避免髋关节置换术中的股骨假体周围骨折的发生。     

人工髋关节置换术后股骨假体周围骨折发生的影响因素

目的探讨影响人工髋关节置换术后患者发生股骨假体周围骨折的相关危险因素,为临床预防和治疗提供可借鉴的资料。方法回顾性分析2010年5月至2016年5月在我院接受人工髋关节置换术的768例患者的临床资料。分析影响患者发生股骨假体周围骨折的危险因素。结果 Logistic回归分析结果显示,性别、年龄、骨折类型及假体固定方式与股骨假体周围骨折的发生率呈正相关,相关系数(OR值)分别为2.993、2.712和3.363。结论高龄女性患者是发生股骨周围假体骨折的高危人群,骨质疏松及骨量减少是引发该并发症的主要危险因素。因此,临床治疗中应给予足够的重视,以减少人工髋关节术后股骨周围假体骨折的发生率。     

全髋关节置换术后股骨假体周围骨折的治疗

目的:探讨人工髋关节置换术中及术后股骨假体周围骨折的治疗方法。方法:人工髋关节置换术中及术后股骨假体周围骨折4例,按Vancouver分型,其中,B1型3例,B2型1例。1例B1型采用钢丝环扎固定;2例B1型骨折采用异体皮质骨板加钢丝环扎、自体髂骨混合植骨;1例B2型保留假体行骨折切开复位锁定钢板钢丝内固定及自体髂骨植骨术。结果:术后随访3～24个月,4例患者骨折达骨性愈合,未发生骨折不愈合和术后感染。随访Harris评分比术前明显提高,平均82分,所有患者均可下床行走。结论:假体选择不当、术中追求假体与股骨皮质紧密配合强行击入假体柄、外伤等是造成人工髋关节置换股骨假体周围骨折的主要原因。采用骨折切开复位,异体皮质骨板加钢丝环扎、自体髂骨混合植骨不但能提供良好的固定支撑作用,而且长条异体皮质骨作为生物接骨板恢复假体周围骨折骨量并且没有应力遮挡效果,可促进骨折愈合,是一种有效治疗人工髋关节置换术中及术后股骨假体周围骨折的治疗方法。     

切开复位内固定术治疗股骨假体周围Vancouver B2型骨折1例

虽然人工全髋关节置换术(total hip arthroplasty,THA)的临床应用日趋成熟,临床效果日趋令人满意,但假体周围骨折(teriprostlleticfemoral fractures),这一最严重手术并发症之一的发生率却在逐年增加。尤其是患者因各种原因行人工全髋关节置换术后,随着年龄的增大,日常生活中意外的低能量暴力因素导致的股骨假体周围骨折(periprosthetic femoral fracture,PFF)是目前常见的病例特点。相对于一般骨折,股骨假体周围骨折在手术操作上更为复杂,骨折不愈合风险更高。本文中针对1例股骨假体周围Vancouver B2型骨折高龄患者行切开复位内固定术,手术效果满意,患者术后恢复良好。     

非骨水泥型股骨假体周围骨折的治疗

目的 探讨非骨水泥型股骨假体周围骨折的发生原因、临床特点及治疗方法.方法 1999年11月至2008年5月收治人工髋关节置换术后股骨假体周围骨折患者9例,结合患者的身体状况、经济能力,按骨折的Vancouver分型进行骨折复位内固定或股骨假体翻修手术.结果 术后8例患者获得8～36个月(平均15个月)随访,患者骨折均达到骨性愈合,无感染、假体松动等并发症发生,髋关节Harris评分平均为78分.结论 非骨水泥型股骨假体周围骨折的发生与老年患者骨质疏松、手术中扩髓导致应力集中、假体力线不正、术后早期不恰当运动等因素有关,术后半年内是发生骨折的危险期.治疗方案的制定应兼顾骨折、假体、骨量等多方面因素,根据骨折的不同分型采取不同的治疗方法,以达到假体稳定、骨折愈合的目的 .     

人工髋关节置换术远端固定生物型股骨假体在高龄股骨转子间骨折患者中的效果

目的 探究远端固定生物型股骨假体与骨水泥型股骨假体在行人工髋关节置换术治疗高龄股骨转子间骨折患者中的应用可行性。方法 选取2019年1月-2023年1月我院收治的84例行人工髋关节置换术的高龄股骨转子间骨折患者,以随机数字表法将其分为对照组和观察组,每组各42例。对照组应用骨水泥型股骨假体进行远端固定,观察组应用生物型股骨假体进行远端固定,比较两组患者临床指标、炎症因子以及并发症发生率。结果 两组患者术中出血量、下床锻炼时间比较无统计学意义（P>0.05）,观察组患者手术时间以及住院时间等临床指标显著低于对照组（P<0.05）;干预前两组患者炎症因子水平比较无统计学意义（P>0.05）,干预后观察组患者各炎症因子指标水平显著低于对照组（P<0.05）;两组患者发生假体周围骨折、深静脉血栓以及切口感染等并发症发生率无统计学意义（P>0.05）,观察组患者心肺事件发生率显著低于对照组（P<0.05）。结论 在人工髋关节置换术中应用生物型股骨假体与骨水泥型股骨假体远端固定均能够取得良好效果,但生物型股骨假体能够缩短术中及住院时间、稳定炎症反应,降低心肺事件...     

记忆合金环抱器在人工髋关节置换术后股骨假体周围骨折中的应用

目的:研究应用记忆合金环抱器内固定治疗人工髋关节置换术后股骨假体周围骨折的临床疗效.方法:将2004年1月至2009年10月收治的人工髋关节置换术后股骨假体周围骨折患者10例采用记忆合金环抱器内固定治疗.结果:随访4～12个月(平均6.5个月),10例患者术后髋关节活动度、屈曲位均大于100°,X线示骨折均骨性愈合,肢体功能恢复良好.结论:记忆合金环抱器内固定可作为人工髋关节置换术后股骨假体周围骨折的首选治疗方法.     

全髋关节置换术后股骨假体周围骨折环抱器治疗的疗效

目的 探讨环抱器治疗全髋关节置换术后股骨假体周围骨折的疗效.方法 从1998年1月～2006年1月我科采用环抱器治疗全髋关节置换术后股骨假体周围骨折14例,B1型8例,C型6例 .结果14例患者术后随访4～36个月,平均随访20个月.全部获得愈合,功能良好.结论 环抱器为全髋关节置换术后股骨假体周围骨折Vancouver B1型及C型提供了一种简单有效的方法.     

温哥华B型股骨假体周围骨折的治疗

目的:总结温哥华B型股骨假体周围骨折治疗的经验和体会。方法:自2004年2月～2009年8月收治人工髋关节置换术温哥华B型股骨假体周围骨折病人12例,均行手术治疗,包括:单纯钢丝环扎固定2例,普通接骨板固定1例,锁定加压接骨板固定4例,钢板结合钛缆固定1例,形状记忆合金环抱器内固定1例,生物型加长柄股骨假体置换2例,骨水泥型加长柄假体置换1例,术中植骨4例,术后结合石膏外固定1例。结果:术后随访4个月～18个月,平均15个月。11例病人骨折获得骨性愈合,1例股骨假体翻修术中出现骨水泥外溢,随访未出现假体松动临床症状。Harris评分单纯行骨折固定未行股骨假体翻修的病人Harris评分无明显影响,同时行翻修的病人Harris评分明显升高。结论:髋关节置换术中、术后股骨假体周围骨折以VancouverB型骨折多见,术前应根据此型骨折特点全面计划、准备,选择适合的内固定,术中仔细操作,可获满意疗效。     

全髋关节置换术中并发股骨假体周围骨折32例报告

目的总结全髋关节置换术中并发股骨假体周围骨折的防治经验。方法回顾性分析32例髋关节置换术中并发股骨假体周围骨折的原因,总结骨折的预防措施和治疗方法。结果32例采用Mallory分型,Ⅰ型25例,Ⅱ型5例,Ⅲ型2例。除1例Ⅰ型骨折不愈合,1例Ⅰ型骨折、1例Ⅱ型骨折延迟愈合,其余29例均一期愈合,平均愈合时间10周,无假体松动下沉和出现并发症病例。Harris评分平均93分。结论全髋关节置换术中并发股骨假体周围骨折与患者的年龄、基础疾病、骨质疏松、手术切口和假体类型的选择等因素密切相关。应用钢丝环扎术、形状记忆环抱器固定术治疗,疗效满意。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.