交锁髓内钉和锁定加压钢板治疗肱骨干骨折的临床疗效比较

目的比较交锁髓内钉(locked intramedullary nail, LIN)和锁定加压钢板(locking compression plate, LCP)内固定治疗闭合性肱骨干骨折的临床疗效。方法回顾性分析2016年2月至2018年6月在黄冈市黄州区人民医院行手术治疗的100例闭合性肱骨干骨折病人的临床资料,根据手术选用的内固定方案不同分为LIN组和LCP组。LIN组47例,其中男24例,女23例,年龄为(33.03±11.52)岁;LCP组53例,男28例,女25例,年龄为(32.68±11.74)岁。收集并比较两组病人术中出血量、手术时间、住院时间、骨折愈合时间、术后并发症、Neer肩关节功能评分和Mayo肘关节功能评分。结果 LIN组术中出血量、手术时间、住院时间、术后早期(1、3个月)Neer肩关节功能评分、桡神经相关并发症均低于LCP组,差异均有统计学意义(P均<0.05)。LIN组术后早期(1、3个月)Mayo肘关节功能评分、术后中后期(6、12个月)Neer肩关节功能评分高于LCP组,差异有统计学意义(P<0.05)。结论对于闭合性肱骨干骨折,与传统锁定加压钢板内固定术相比,采用交锁髓内钉内固定术创伤小、桡神经相关并发症少、术后早期肘关节功能和术后中后期肩关节功能更佳。     

顺行交锁髓内钉与锁定钢板内固定治疗肱骨干骨折疗效比较

目的比较顺行交锁髓内钉与锁定钢板内固定治疗肱骨干骨折的临床疗效。方法回顾性分析自2012-02—2016-03诊治的45例新鲜闭合性肱骨干骨折,26例采用切开复位锁定钢板内固定治疗(钢板组),19例采用闭合复位顺行交锁髓内钉内固定治疗(髓内钉组)。比较2组手术时间、术中出血量、骨折愈合时间,末次随访时肩关节功能Neer评分与肘关节功能Mayo评分,以及并发症情况。结果 45例均获得随访,钢板组随访时间平均20.9(12～36)个月,髓内钉组随访时间平均22.3(12～35)个月。与钢板组比较,髓内钉组手术时间更短,术中出血量更少,但末次随访时肩关节功能Neer评分更低,差异有统计学意义(P 0.05)。钢板组与髓内钉组骨折愈合时间、末次随访时肘关节功能Mayo评分比较差异无统计学意义(P0.05)。钢板组与髓内钉组并发症发生率比较差异无统计学意义(P0.05)。结论对于新鲜闭合性肱骨干骨折,锁定钢板内固定术后患者肩关节功能恢复更好,但手术创伤大、医源性桡神经损伤发生率更高;顺行交锁髓内钉内固定创伤小、生物力学性能优、不易造成桡神经损伤,但术中需切开肩袖而影响术后肩关节功能。     

LC-DCP与LCP内固定治疗肱骨干骨折的疗效比较与适应证分析

目的比较有限接触动力加压钢板(LC-DCP)与锁定加压钢板(LCP)内固定治疗肱骨干骨折的临床效果并分析其手术适应证。方法回顾性分析自2010-05—2014-10采用LC-DCP与LCP内固定治疗的156例肱骨干骨折,其中LC-DCP组64例,LCP组92例。比较2组手术时间、术中出血量、住院时间、骨折愈合时间、肩肘关节活动度及术后并发症,末次随访时采用UCLA肩关节功能评分和Mayo肘关节功能评分评定疗效。结果所有患者均获得平均18(12~28)个月随访。LCP组术中出血量少于LC-DP组,骨折愈合时间短于LC-DCP组,差异有统计学意义(P0.05)。2组手术时间、住院时间、肩肘关节活动度、UCLA及Mayo评分比较差异无统计学意义(P0.05)。LCP组内固定失效率明显低于LC-DCP组,差异有统计学意义(P=0.0330.05);但2组医源性桡神经损伤及感染发生率比较差异无统计学意义(P0.05)。结论 LC-DCP和LCP均是切开复位内固定治疗肱骨干骨折的有效固定材料,相比于LC-DCP,LCP内固定具有骨折愈合时间短、内固定失败率低及适应证广的优点。     

前外侧入路与前侧入路前内侧接骨板内固定治疗肱骨中下段骨折的疗效比较

目的比较前外侧入路与前侧入路前内侧接骨板内固定治疗肱骨中下段骨折的临床疗效及并发症发生率。方法回顾性分析自2010-01—2013-10诊治的56例肱骨中下段骨折的临床资料,其中Ⅰ组30例采用前外侧入路内固定,Ⅱ组26例采用前侧入路前内侧固定。结果Ⅰ组获得随访12~22(15.63±2.62)个月,Ⅱ组获得随访12~22(16.22±2.88)个月。2组在手术时间、术中出血量方面的差异有统计学意义(P0.05)。Ⅰ组骨折愈合时间10~18(14.87±2.32)周,肘关节最大屈曲范围134°~146°(138.60±3.27)°,肘关节最大伸直范围0°~8°(4.87±1.91)°,Mayo肘关节功能评分(MEPS评分)70~100(88.04±7.72)分,Neer肩关节功能评分75~100(89.13±4.32)分。Ⅱ组骨折愈合时间10~19(15.06±2.22)周,肘关节最大屈曲范围130°~145°(137.95±4.15)°,肘关节最大伸直范围0°~9°(5.15±2.33)°,MEPS评分70~100(85.15±7.66)分,Neer肩关节功能评分75~100(88.54±2.30)分。2组在骨折愈合时间、肘关节最大屈伸范围及MEPS、Neer肩关节功能评分方面差异无统计学意义(P0.05)。Ⅱ组并发症发生率低于I组,差异有统计学意义(P=0.04)。结论前外侧入路与前侧入路前内侧固定均能有效治疗肱骨中下段骨折,但后者术中出血量及手术时间均较短,且并发症发生率更低。     

顺行旋入式髓内钉与锁定钢板治疗肱骨干骨折疗效比较

目的比较顺行旋入式髓内钉和锁定钢板系统治疗肱骨干骨折的临床疗效。方法对38例肱骨干骨折患者,采用顺行旋入式自锁髓内钉固定21例,锁定钢板系统内固定17例。结果 38例均获随访,平均18.6个月。旋入式自锁髓内钉组平均手术时间(47.90±4.98)min,桡神经损伤1例,骨折平均愈合时间(23.04±1.62)周,肩关节Constant评分平均(77.71±5.84)分,肘关节Mayo评分(91.33±1.73)分;锁定钢板系统组平均手术时间(62.64±4.71)min,桡神经损伤2例,骨折平均愈合时间(27.88±1.57)周,肩关节Constant评分(86.14±2.27)分,肘关节Mayo评分(92.44±2.29)分。治愈率均为100%。旋入式髓内钉组在手术时间、骨折愈合时间上短于锁定钢板组(P0.01),但Con-stant肩关节评分较低(P0.01),其他指标无统计学差异(P0.05)。结论旋入式自锁髓内钉手术操作简单、时间短、损伤小、术中并发症少、骨折愈合快,适合稳定性骨折、非缺损性粉碎性骨折,但抗旋转及抗短缩方面不及锁定钢板系统,对非稳定性骨折、断端缺损性粉碎性骨折宜选择锁定钢板系统。     

对比肩关节镜治疗肱骨大结节骨折与传统切开复位内固定手术的临床效果

目的探究对比肩关节镜治疗肱骨大结节骨折与传统切开复位内固定手术的临床效果。方法随机选取本院收治的肱骨大结节骨折患者110例,将其分为开复组、肩关节镜组两组,分别采用传统切开复位内固定手术、肩关节镜手术治疗,对比分析两组肩关节功能及活动情况。结果肩关节镜组患者治疗后的肩关节稳定性量表评分(94.12±8.97)分、(95.22±9.01)分及功能评分与开复组(82.56±8.79)分、(83.23±7.88)分相比明显较高,差异有统计学意义(P0.05)。肩关节镜组患者治疗后的外旋活动度、内旋活动度及前屈活动度与开复组相比明显较大,差异有统计学意义(P0.05)。结论肩关节镜治疗肱骨大结节骨折效果显著,明显优于传统切开复位内固定手术治疗效果,改善患者肩关节功能,增加关节活动度,临床意义重大。     

锁定钢板与髓内钉2种微创方法内固定治疗肱骨干复杂骨折的疗效比较

目的回顾性研究比较锁定加压钢板与交锁髓内钉2种微创方法内固定治疗肱骨干复杂骨折的临床疗效。方法自2001-01—2014-06采用交锁髓内钉经皮穿钉闭合复位(MINO)治疗肱骨干复杂骨折(AO分型B型及C型)25例,自2007-01—2014-06采用锁定加压钢板经皮微创固定(MIPO)治疗同型骨折21例。结果 MINO组术后3例,MIPO组术后1例出现桡神经一过性损伤,随访3周~4个月后均完全恢复,2组差异无统计学意义(P0.05)。骨折愈合时间:MINO组(25.08±10.70)周,MIPO组(22.76±5.77)周,差异无统计学意义(P0.05)。肩关节UCLA评分:MINO组(31.44±2.18)分,MIPO组(33.05±1.32)分,差异有统计学意义(P0.01)。肘关节Mayo评分:MINO组(98.96±1.27)分,MIPO组(98.81±1.57)分,差异无统计学意义(P0.05)。结论采用MIPO和MINO 2种微创方法内固定治疗肱骨干复杂骨折均可获得良好愈合,MIPO技术内固定术后肩关节功能相对较好。     

带锁髓内钉和锁定钢板内固定治疗肱骨干骨折的疗效比较

目的比较带锁髓内钉和锁定钢板内固定治疗肱骨干骨折的临床效果。方法对38例肱骨干骨折采用带锁髓内钉内固定(髓内钉组)17例,锁定钢板(锁定钢板组)21例。结果髓内钉组发生桡神经损伤1例,锁定钢板组发生2例,差异有统计学意义;髓内钉组发生延时愈合1例,锁定钢板组发生3例,差异有统计学意义;髓内钉组肩关节评分为(78.71±5.64)分,肘关节评分为(90.33±1.73)分,锁定钢板组肩关节评分为(88.23±3.24)分,肘关节评分为(91.44±2.22)分。两组肩关节评分差异有统计学意义,肘关节评分差异无统计学意义。结论带锁髓内钉固定和锁定钢板内固定治疗肱骨干骨折均可获得良好的疗效。髓内钉内固定易影响邻近关节的功能,而锁定钢板内固定更容易引起桡神经损伤及骨折的延时愈合。     

切开复位有限内固定结合外固定治疗肱骨干下1/3处骨折

目的评估有限切开内固定结合外固定支架治疗肱骨干下1/3处骨折的近期疗效,探索肱骨干下1/3处骨折新的治疗方式。方法对采用有限切开内固定结合外固定支架固定技术治疗肱骨干下1/3处骨折的10例患者进行分析总结。其中男7例,女3例,年龄16～60岁,平均(38.60±13.78)岁。左侧6例,右侧4例。采用肩关节Constant评分、肘关节Mayo评分评估功能。结果本组患者均获随访,随访时间12～18个月,平均(15.00±2.26)个月,肩、肘关节功能恢复良好。术后6个月随访时,肩关节Constant评分平均为(87.50±6.26)分,肘关节Mayo评分平均为(89.90±4.63)分。2例发生钉道轻度感染,经换药及口服抗生素后感染控制。结论对于肱骨干下1/3处骨折采用有限切开内固定结合外固定支架固定效果可靠,可早期功能锻炼,术后功能恢复良好,疗效满意。     

肱骨近端骨折术中内侧柱支撑与其术后放射学参数变化及功能相关性

目的观察肱骨近端骨折解剖锁定钢板内固定术中有无内侧柱支撑与其术后放射学参数变化及肩关节功能之间的关系。方法回顾性分析自2012-01—2014-12获得完整随访的59例肱骨近端骨折,所有患者均采用肱骨近端解剖锁定钢板内固定,根据术中肱骨近端有无内侧柱支撑分为内侧柱支撑组(31例)及非内侧柱支撑组(28例)。观察2组术后肱骨头高度丢失、内翻角度及Constant肩关节功能评分。结果 59例术后均获得随访,随访时间平均12.5(6~24)个月。末次随访时,内侧柱支撑组肱骨头高度丢失0.149~4.761(1.527±1.042)mm,内翻角度0.046°~6.772°(2.150±1.802)°,Constant肩关节功能评分(78.129±7.527)分。非内侧柱支撑组肱骨头高度丢失0.343~5.317(2.501±1.290)mm,内翻角度1.429°~22.978°(10.870±4.217)°,Constant肩关节功能评分(65.250±7.801)分。非内侧柱支撑组肱骨头高度丢失(t=3.206,P=0.002)及内翻角度(t=9.962,P0.001)明显高于内侧柱支撑组,内侧柱支撑组Constant肩关节功能评分明显高于非内侧柱支撑组(t=6.451,P0.001)。结论肱骨近端骨折解剖锁定钢板内固定术中内侧柱支撑对于维持术后肱骨头高度及颈干角、改善肩关节功能具有重要的意义。     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Recognition and management of phaeochromocytoma and paraganglioma

Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in perioperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist and nabilone, a synthetic cannabinoid.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist, and nabilone, a synthetic cannabinoid.     

Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines

Background:

Controversy continues regarding the best treatment for compression and burst fractures. The axial distraction reduction utilizing the technique employing the long straight rod or curved short rod without derotation to reduce fracture are practised together with short segment posterolateral fusion (PLF). Effects of the early postoperative mobilization without posterolateral fusion on reduction maintenance and fracture consolidation were not evaluated so far. The present prospective study is designed to assess the effectiveness of i) reduction and restoration of sagittal alignment, ii) no posterolateral fusion on the reduced, fractured vertebral body and injured disc, iii) fracture consolidation and iv) the fate of the unfused cephalad and caudal injured motion segments of the fractured vertebra.

Materials and Methods:

The study includes 15 Denis burst and two Denis type D compression fractures between T₁₂ and L₃. The lordotic distraction technique was used for ligamentotaxis utilizing the contoured short rods and pedicle screw fixator. Three vertebrae including the fractured one were fixed. The patients after surgery were braced for ten weeks with activity restriction for 2-4 weeks. The patients were evaluated for change in vertebral body height, sagittal curve, reduction of retropulsion, improvement in neural deficit. The unfused motion segments, residual postoperative pain and bone and metal failure were also evaluated.

Results:

The preoperative and postreduction percentile vertebral heights at, zero (immediate postoperative), at three, six and 12 months followup were 62.4, 94.8, 94.6, 94.5 and 94.5%, respectively. The percentages of the intracanal fragment retropulsion at preoperative, and postoperative at zero, 3, 6 and 12 months followup were 59.0, 36.2,, 36.0, 32.3, and 13.6% respectively.The preoperative and postreduction percentile loss of the canal dimension and at zero, three, six and 12 months were 52.1, 45.0, 44.0, 41.0 and 29% respectively suggesting that the under-reduced fragment was being resorbed gradually by a remodeling process. The mean initial kyphosis of 33° became mean 2° immediately after reduction and mean 3° at the final followup. The fractured vertebral bodies consolidated in an average period of ten weeks (range 8-14 weeks). The restored disc heights were relatively well maintained throughout the observation period. All paraparetic patients recovered neurologically. There were no postoperative complications.

Conclusion:

Instrument-aided ligamentotaxis for compression and burst fractures utilizing the short contoured rod derotation technique and the instrumented stabilization of the fractured spine are found to be effective procedures which contribute to the fractured vertebral body consolidation without recollapse and maintain the motion segment function.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.

     

动静脉穿刺网络课件的开发及其应用

目的:确保护理教学效果,提高教学水平。方法:应用多项信息技术将动静脉穿刺技术制作成教学网络课件,并用于临床教学。结果:该课件在本校园网上运行半年余,2000余人次对其进行访问,受到师生好评。结论:该课件能及时反映动静脉穿刺的最新研究进展及具体操作步骤和使用方法,实现护理教学的直观性和交互性,对护理教学和临床带教指导有一定的借鉴作用。     

Physiology and pharmacology of nausea and vomiting

The physiology of nausea and vomiting is poorly understood. The initiation of vomiting varies and may be due to motion, pregnancy, chemotherapy, gastric irritation or postoperative causes. Once initiated, vomiting occurs in two stages, retching and expulsion. The muscles responsible for this sequence of events are controlled by either a vomiting centre or a central pattern generator, probably in the area postrema and the nearby nucleus tractus solitarius. Drugs which induce vomiting include ipecacuanha, a gastric irritant, and apomorphine, a dopamine-receptor agonist. Opioid drugs also induce vomiting, but opioid antagonists are not useful to treat nausea and vomiting. Anti-emetic drugs consist of a variety of neurotransmitter antagonists and may act in the periphery, the central nervous system or both sites. The most important drugs are antagonists at muscarinic, dopamine D₂, 5-HT₃, histamine H₁ and neurokinin NK₁ receptors. These drugs are discussed with particular attention to post-operative nausea and vomiting (PONV).