抗骨质疏松治疗老年髋部骨折的疗效比较

目的：比较单纯骨科牵引和手术治疗与在其基础上辅以抗骨质疏松治疗对老年髋部骨折远期效果的影响。方法：选择1999—09／2004-01广州医学院第二附属医院及广州市第六人民医院骨科住院的新鲜(2周内)老年髋部骨折患者206例，男84例，女122例；年龄60～89岁。根据患者自愿原则将患者分为单纯骨科治疗组(单纯骨科牵引治疗28例：采取传统的牵引治疗；单纯手术治疗41例：采用一般骨科手术治疗)和综合治疗组(牵引+抗骨质疏松治疗49例，手术+抗骨质疏松治疗88例：单纯牵引和手术治疗基础上给予抗骨质疏松治疗，抗骨质疏松症治疗包括饮食调整、抗骨质疏松西药应用、中药治疗、物理治疗及康复运动治疗等)。观察各组方法对髋部骨折患者干预效果，≥10个月随访结果评估。结果：206例髋部骨折患者中，诊断为骨质疏松症160例(77．7％)．145例获得≥10个月随访，随访率90％(145／160)。综合治疗组疗效总优良率明显高于单纯骨科治疗组(74．0％，65．5％，X^2=1．327，P&;lt;0．05)：住院时间明显短于单纯骨科治疗组[(28．1&;#177;5．6)，(42．4&;#177;4．4)d，t=9．86．P&;lt;0．01]；长期卧床引起的各种并发症发生率明显少单纯骨科治疗组[9％(9／96)，16％(8／49)，X^2=1．515，P&;lt;0．05]；其他部位再次发生骨折率明显低于单纯骨科治疗组(6％，14％，X^2=2．567，P&;lt;0．01)。结论：老年髋部骨折患者在手术后给予抗骨质疏松治疗近期可提高疗效，缩短住院时间，减少并发症，远期可防止再骨折发生。     

抗骨质疏松治疗老年髋部骨折的疗效比较

目的:比较单纯骨科牵引和手术治疗与在其基础上辅以抗骨质疏松治疗对老年髋部骨折远期效果的影响。方法:选择1999-09/2004-01广州医学院第二附属医院及广州市第六人民医院骨科住院的新鲜(2周内)老年髋部骨折患者206例,男84例,女122例;年龄60～89岁。根据患者自愿原则将患者分为单纯骨科治疗组(单纯骨科牵引治疗28例:采取传统的牵引治疗;单纯手术治疗41例:采用一般骨科手术治疗)和综合治疗组(牵引+抗骨质疏松治疗49例,手术+抗骨质疏松治疗88例:单纯牵引和手术治疗基础上给予抗骨质疏松治疗,抗骨质疏松症治疗包括饮食调整、抗骨质疏松西药应用、中药治疗、物理治疗及康复运动治疗等)。观察各组方法对髋部骨折患者干预效果,≥10个月随访结果评估。结果:206例髋部骨折患者中,诊断为骨质疏松症160例(77.7%),145例获得≥10个月随访,随访率90%(145/160)。综合治疗组疗效总优良率明显高于单纯骨科治疗组(74.0%,65.5%,χ2=1.327,P<0.05);住院时间明显短于单纯骨科治疗组(28.1±5.6),(42.4±4.4)d,t=9.86,P<0.01;长期卧床引起的各种并发症发生率明显少单纯骨科治疗组9%(9/96),16%(8/49),χ2=1.515,P<0.05;其他部位再次发生骨折率明显低于单纯骨科治疗组(6%,14%,χ2=2.567,P<0.01)。结论:老年髋部骨折患者在手术后     

老年骨质疏松并髋部骨折综合治疗体会

目的介绍老年骨质疏松并髋部骨折的综合治疗方法，并探讨其优越性。方法对52例老年骨质疏松并髋部骨折病人进行回顾，设立单纯骨科治疗组与综合治疗组，比较其疗效优良率。结果所有病人随访3个月至3年，综合治疗组比单纯骨科治疗组疗效总优良率高，差异具有显著性（P〈0．05）。 结论老年骨质疏松并髋部骨折综合治疗，即除治疗骨折外，同时处理骨质疏松症（OP），有利于提高骨折的愈合率，降低并发症发生率及死亡率。     

老年髋部骨折患者手术治疗后对侧髋部再骨折发生情况及影响因素分析

目的探讨老年髋部骨折患者手术治疗后对侧髋部再骨折发生情况,并对其影响因素进行分析。方法选取老年髋部骨折206例作为研究对象,根据治疗方法不同将其分为手术治疗组(151例)和保守治疗组(55例)两组,比较两组出院后1年对侧髋部再骨折发生情况,并对老年髋部骨折151例手术治疗后对侧髋部再骨折发生的可能影响因素进行单因素和多元Logistic回归分析。结果出院后1年,手术治疗组对侧髋部再骨折发生率15.89%(24/151)低于保守治疗组对侧髋部再骨折发生率29.09%(16/55),差异有统计学意义(P0.05)。单因素分析结果显示,年龄、骨质疏松程度、手术时机、合并基础疾病、术后卧床时间、术后功能锻炼及锻炼依从性是影响老年髋部骨折患者手术治疗后对侧髋部再骨折发生的因素(P0.05或P0.01)。多元Logistic回归分析结果显示,年龄≥70岁、重度骨质疏松、合并基础疾病、未术后功能锻炼及锻炼依从性差是影响老年髋部骨折患者手术治疗后对侧髋部再骨折发生的独立危险因素(P0.01)。结论老年髋部骨折经手术治疗较保守治疗发生对侧髋部再骨折的概率低。年龄≥70岁、重度骨质疏松、合并基础疾病、未术后功能锻炼及锻炼依从性差是影响老年髋部骨折患者手术治疗后对侧髋部再骨折发生的独立危险因素。     

影响老年骨质疏松性髋部骨折术后功能康复的相关因素初探

目的 探讨影响老年骨质疏松性髋部骨折术后功能康复的相关因素.方法 分析2000年1月至2014年1月间206例老年骨质疏松性髋部骨折患者的相关临床资料,其中股骨颈骨折93例,股骨转子间骨折113例.评估对术后功能康复有重要影响作用的相关因素.结果 本组206例均成功进行手术治疗,其中184例(89.3％)伤后1周内手术,22例(10.7％)伤后1周后手术,71例(34.5％)术后出现系统并发症,148例(71.8％)住院时间＜3周.本研究206例中失访5例,随访201例,术后随访10～38(14.6±2.7)个月.采用Sanders髋关节创伤后的功能评分系统评估疗效,优92例,良68例,可31例,差10例,优良率79.6％.经多元回归分析患者术前全身状况与术后并发症发生率及临床康复程度有明显的相关性.患者术前全身状态、营养状况、认知障碍、治疗方法、年龄、手术时机、复位质量、骨密度值是影响骨质疏松性髋部骨折术后功能康复的独立危险因素.结论 老年骨质疏松性髋部手术治疗时要充分认识到这些独立因素对疗效的影响以指导临床治疗.     

医护一体结合快速康复护理在老年髋部骨折患者中的应用效果

目的考察医护一体结合快速康复护理对老年髋部骨折患者术后康复指标和生活质量的影响。方法选取2020年5月至2021年7月于联勤保障部队第925医院行手术治疗的216例老年髋部骨折患者,采用随机数字表法的分组方法为对照组和观察组,各108例。对照组施以优质护理,观察组施以医护一体结合快速康复护理。比较2组老年髋部骨折患者的并发症、髋关节功能、康复指标及生活质量。结果观察组的感染、压疮等并发症总发生率明显低于对照组(P<0.05)。观察组的留置尿管时间和住院时间与对照组相比均更短,首次下地活动时间、骨折愈合时间均更早(P均<0.05)。干预1个月、2个月和3个月后,2组的髋关节Harris评分标准评分与干预前对比均更高(P均<0.05),且观察组与同期对照组对比均更高(P均<0.05)。干预3个月后,2组的欧洲五维健康量表5个维度评分与干预前相比均更高(P均<0.05),且观察组与对照组相比均更高(P均<0.05)。结论医护一体结合快速康复护理对降低老年髋部骨折患者术后并发症发生率、加快康复进程,以及改善髋关节功能和生活质量均具有积极影响。     

聚焦解决模式联合早期营养干预对老年髋部骨折手术患者的影响

目的探讨聚焦解决模式联合早期营养干预对老年髋部骨折手术患者营养状况及并发症的影响。方法选择2016年1月至2017年12月本院收治的老年髋部骨折手术患者168例作为研究对象,随机将其等分为观察组与对照组,对照组给予常规护理,观察组采用聚焦解决模式联合早期营养干预。比较两组患者血清营养学指标、并发症发生率。结果观察组血清前白蛋白(PA)、白蛋白(ALB)、血红蛋白(Hb)含量均明显高于对照组(P 0. 05),并发症发生率明显低于对照组(P 0. 05)。结论聚焦解决模式联合早期营养干预可明显改善老年髋部骨折手术患者营养状况,降低并发症发生率。     

老年髋部骨折患者不同手术时机的比较分析

目的比较老年髋部骨折患者骨折48 h内和48 h后实施手术的临床疗效。方法选取本院确诊且接受手术治疗的94例老年髋部骨折患者为研究对象,根据接受手术时机不同分为早期组(n=40)和延期组(n=54)。早期组于骨折后48 h内接受手术治疗,延期组于骨折后48 h后接受手术。比较2组手术基本指标、住院时间、并发症发生率、骨折愈合和髋关节功能Harris评分等情况。结果 2组手术时间、手术出血量比较,差异无统计学意义(P 0.05);早期组住院时间、骨折愈合时间均显著短于延期组(P 0.05); 2组术后切口感染、肺部感染、下肢深静脉血栓(DVT)和谵妄等并发症发生率比较,差异无统计学意义(P 0.05),但早期组手术总并发症发生率(12.50%)显著低于延期组(31.48%)(P 0.05);术后6个月,早期组Harris评分优良率(87.50%)略高于延期组(77.78%),但组间差异无统计学意义(P 0.05)。结论老年髋部骨折患者应在骨折48 h内尽早接受手术,有助于缩短住院时间和骨折愈合时间,减少并发症的发生。     

人工髋关节置换术与内固定对老年髋部骨折患者术后功能康复的影响

目的探讨人工髋关节置换术与内固定对老年髋部骨折患者术后功能康复的影响。方法选取80例老年髋部骨折患者按照随机双盲法分为2组,各40例。对照组行内固定治疗,观察组行人工髋关节置换术治疗,观察并比较2组手术指标、术后首次负重时间、髋关节功能恢复及并发症情况。结果对照组术中出血量显著低于观察组,术后首次负重时间显著晚于观察组(P 0. 05); 2组手术时间及术后引流量比较,差异无统计学意义(P 0. 05);观察组术后3个月、6个月Harris评分均显著高于对照组(P 0. 05);观察组并发症发生率显著低于对照组(P 0. 05)。结论与内固定治疗相比,人工髋关节置换术更利于促进老年髋部骨折患者术后髋关节功能恢复,缩短术后首次负重时间,降低术后并发症发生率。     

FRAX骨折风险因子预测在老年糖尿病患者中的应用

目的:探讨FRAX骨折风险因子预测在老年糖尿病患者中的应用效果。方法:将2019年1月1日～2020年6月30日收治的187例糖尿病患者作为实验组。将同期门诊收治的220例非糖尿病患者作为对照组。两组同时行骨密度测量,计算骨密度T值。比较两组不同年龄段骨量减少发生率并分析影响骨代谢的风险因子;采用FRAX计算两组10年主要部位骨质疏松性骨折发生率(PMOF)、无骨密度值10年主要部位骨质疏松性骨折发生率(PMOF~*)、10年髋部骨折发生率(PHF)和无骨密度值10年髋部骨折发生率(PHF~*)。结果:实验组股骨颈和腰椎L_(1-2、4)骨密度T值高于对照组(P0.01),实验组腰椎L_3骨密度T值低于对照组(P0.01);两组不同年龄段骨量减少发生率比较差异无统计学意义(P0.05),两组患者骨量减少发生率均随年龄增加而升高(P0.05);两组PMOF≥20%和PMOF~*≥20%发生率比较差异无统计学意义(P0.05),实验组PHF≥3%发生率和PHF~*≥3%发生率高于对照组(P0.05);年龄、体质量指数(BMI)、既往骨折史、父母髋骨骨折史、吸烟史、补钙、绝经时间、糖尿病等风险因子与患者10年骨折发生率均具有相关性(P0.05)。结论:FRAX骨折风险因子可对老年糖尿病患者骨折风险行有效预测,有助于早期抗骨质疏松治疗,降低患者PMOF。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.