解剖钢板和压力螺栓治疗跟骨骨性毁损伤的生物力学稳定性及临床应用研究

目的探讨解剖钢板(AP)和压力螺栓(PB)治疗跟骨骨性毁损伤(CBD)的生物力学稳定性及临床应用效果。方法选择2014年2月~2016年6月期间我院收治62例跟骨骨性毁损伤患者,按照数字表法随机分为两组,对照组31例给予传统解剖钢板(TAP)联合螺钉治疗;观察组31例给予小切口微创解剖钢板联合加压螺栓固定治疗,并比较两组的临床疗效情况。结果观察组跟骨长度、高度、宽度、Bholer角及Gissnae角与本组术前比较,差异有统计学意义(t值分别为9.316、14.258、16.232、21.975、10.639,P<0.05);术后观察组观察组跟骨长度、高度、宽度、Bholer角及Gissnae角与对照组比较,差异有统计学意义(t值分别是4.136、8.639、9.528、7.737、3.964,P<0.05),观察组的总有效率为87.10%而显著地高于对照组的70.97%,差异有统计学意义(χ~2=2.4333,P<0.05),观察组术后并发症发生率为3.23%而显著地低于对照组25.81%,差异有统计学意义(χ~2=16.5109,P<0.05)。结论采取小切口微创解剖钢板联合加压螺栓固定治疗跟骨骨性毁损伤(CBD),疗效显著满意,患者在术后跟骨结构、功能均能够得到有效的恢复,安全、可靠,并减少术后并发症发生率,值得临床大力推广应用。     

解剖锁定钢板不植骨治疗SanderⅢ、Ⅳ型跟骨骨折的临床疗效

目的 探讨解剖锁定钢板不植骨治疗SanderⅢ、Ⅳ型跟骨骨折的临床疗效.方法 选取我院收治的52例SanderⅢ、Ⅳ型跟骨骨折患者,随机均分为对照组(切开复位、解剖锁定钢板固定+自体髂骨植骨治疗)和观察组(切开复位、解剖锁定钢板固定不植骨治疗),使用Maryland足部评分系统对疗效进行评价,比较两组手术时间、骨折愈合时间、优良率、治疗前后B(o)hler角、Gissane角和跟骨宽度的差异.结果 观察组手术时间显著短于对照组(P＜0.05),两组患者骨折愈合时间、优良率和术后1年B(o)hler角、Gissane角和跟骨宽度比较均无统计学差异(P＞0.05).结论 切开复位解剖锁定钢板不植骨治疗跟骨骨折疗效确切.     

不同内固定方式治疗跟骨骨折112例临床效果分析

目的 对比分析使用不同内固定方式治疗跟骨骨折的临床效果.方法 从我院选取的跟骨骨折112例作为研究对象,随机分为观察组和对照组各56例,对照组采用经皮撬拨复位克氏针固定,观察组采用切开复位钢板固定,比较两组患者术后的骨折恢复情况、并发症发生率等指标.结果 观察组手术时间明显短于对照组,愈合时间与住院时间均长于对照组,差异均有统计学意义(P＜0.05),但组间术中出血量差异无统计学意义(P＞0.05).治疗后组间Bohler角、Gissane角、跟骨高度和跟骨宽度等指标优于对照组,差异有统计学意义(P＜0.05).治疗后观察组的足部功能恢复优良率为96.23％,明显高于对照组的78.57％ (P＜0.05);并发症发生率为16.07％,明显高于对照组的1.79％;组间差异有统计学意义(P＜0.05).结论 切开复位钢板内固定在促进足部形态和功能预后等方面具有更显著的效果,可迅速促进预后,但经皮撬拨复位克氏针固定在控制并发症方面更具优势.在保障患者生活质量的基础上,应综合患者的实际情况选择合适的内固定方式.     

解剖钢板和加压螺栓微创治疗跟骨关节内骨折的疗效分析

目的探讨解剖钢板和加压螺栓微创治疗跟骨关节内骨折疗效。方法挑选2015年1月至2016年6月我院104例跟骨关节内骨折患者,随机分成观察组与对照组,每组52例。观察组执行小切口微创解剖钢板联合加压螺栓固定治疗,对照组执行传统解剖钢板联合螺钉治疗。对比两组术后跟骨结构、功能恢复情况与并发症出现情况。结果对比两组术后跟骨结构、功能恢复情况与并发症出现情况,差异具有统计学意义(P<0.05)。对比手术前两组踝-足评分系统(AOFAS)评分,差异无统计学意义(P>0.05)。对比手术后两组踝-足评分系统(AOFAS)评分,观察组比对照组高,差异具有统计学意义(P<0.05)。观察组并发症出现率3.8%,对照组并发症出现率21.2%,观察组比对照组低(P<0.05)。结论小切口微创解剖钢板联合加压螺栓疗效明显,手术后患者跟骨结构、功能都得到有效恢复,安全系数高,值得大力推广运用。     

跟骨骨折切开复位内固定不同手术时机与术后软组织并发症的关系

目的 观察跟骨骨折切开复位内固定不同手术时机与术后软组织并发症的关系.方法 选取本院2014年4月至2017年4月收治的90例跟骨骨折患者(90足),依据手术时机将这些患者分为伤后3～8h组(n=30,30足)、伤后8h ～ 7d组(n=30,30足)和伤后7～14d组(n=30,30足)3组,对3组患者的跟骨高度、宽度、Bohler角、Gissane角、临床疗效、术后软组织并发症发生情况进行统计分析.结果 伤后3～8h组、伤后7～ 14d组患者的根骨高度、Bohler角、Gissane角均显著高于伤后8h～7d组(P＜0.05),根骨宽度均显著低于伤后8h～7d组(P＜0.05),术后功能恢复优良率93.3％(28/30)、90.0％ (27/30)均显著高于伤后8h ～ 7d组的63.3％ (19/30) (P＜0.05),术后软组织并发症发生率10.0％(3/30)、10.0％(3/30)均显著低于伤后8h～7d组的43.3％ (13/30)(P＜0.05).结论 跟骨骨折切开复位内固定伤后3～8h、7～14d较伤后8h ～ 7d手术更能有效减少术后软组织并发症.     

切开复位植骨加解剖钢板固定治疗跟骨关节内粉碎性骨折

目的探讨利用跟骨解剖型钢板内固定治疗跟骨骨折的疗效。方法跟骨关节内粉碎性骨折23例,采用跟骨外侧可延伸的L形切口入路,切开撬拨复位解剖钢板内固定。结果所有患者均获得6～32个月的随访,根据Maryland足部评分系统：优10例,良7例,可6例,优良率73.9%。末次随访X线片上的跟骨形态学指标（Bohler角）较术前均有明显改善,差异有统计学意义（P〈0.05）。结论跟骨解剖型钢板内固定对跟骨骨折治疗疗效满意。     

关节镜辅助复位内固定治疗跟骨骨折的临床分析

目的探讨关节镜辅助下复位内固定治疗跟骨骨折的临床疗效。方法将25例跟骨SandersⅡ型骨折患者随机分为治疗组和对照组,比较两组患者的手术时间、切口不良率、住院天数差异,同时比较两组患者手术前后跟骨高度、宽度、Bohler角、Gissane角的改变以及末次随访时AOFAS评分的差异。结果25例患者均获得随访,治疗组手术时间、切口不良率、住院天数显著优于对照组。两组治疗后跟骨高度、宽度、Bohler角、Gissane角均较术前明显改善(P<0.05),但两组间对比无显著差异(P>0.05)。结论关节镜辅助下跟骨骨折复位内固定手术效果理想,具有手术时间短、切口小、能直视下复位、切口不良率低、住院天数短等优点,是SandersⅡ型跟骨骨折较理想的治疗方法。     

微创空心钉内固定术结合植骨治疗跟骨移位骨折的临床研究

目的探讨微创空心钉内固定术结合植骨治疗跟骨移位骨折的临床疗效。方法将60例跟骨移位骨折患者随机分为空心钉组和钢板组各30例。空心钉组行微创空心钉内固定术结合植骨治疗,钢板组行钢板内固定术。比较2组术后跟骨Maryland评分、跟骨结节关节角(Bohler角)和跟骨交叉角(Gissane角)角度、术后并发症发生率。结果空心钉组Maryland评分为47～93(80.1±11.2)分,钢板组Maryland评分为45～92(78.20±10.2)分,差异无统计学意义(P>0.05)。空心钉组治疗后Bohler角为(27.8±8.4)°,Gissane角为(124.3±4.2)°;钢板组治疗后Bohler角为(24.3±8.4)°,Gissane角为(129.6±8.1)°,2组比较差异无统计学意义(P>0.05)。空心钉组术后并发症发生率为0,低于钢板组的16.7%(5/30),差异有统计学意义(P<0.05)。结论微创空心钉内固定术结合植骨治疗跟骨移位骨折疗效显著,是一种简单可行的治疗方法。     

液体骨结合微创内固定治疗跟骨骨折的临床研究

目的观察评价液体骨结合微创内固定与传统的切开复位手术治疗跟骨骨折的临床疗效。方法将102例SandersⅡ、Ⅲ型跟骨骨折患者随机接受液体骨结合微创内固定和传统的切开复位手术进行治疗,观察比较2组治疗前后的影像学指标、手术相关指标等。结果 2组跟骨宽度、跟骨高度、跟骨Bohler角、跟骨Gissane角等主要影像学指标均具有明显的改善(P<0.05);治疗组术后的跟骨Bohler角、跟骨Gissane角改善均优于对照组(P<0.05);治疗组和对照组在治疗后Maryland足部功能评分均明显下降,差异具有统计学意义(P<0.05),但治疗组的Maryland足部功能评分下降更为明显(t=6.598,P=0.000,有效率比较:χ2=5.184,P=0.023);治疗组的手术时间、住院时间和住院费用均明显低于对照组(P<0.05);2组的并发症发生率差异无统计学意义(χ2=2.000,P=0.157)。结论液体骨结合微创内固定治疗跟骨骨折优于切开复位内固定术,有利于缩短愈合时间和住院时间,降低患者的经济负担,并可以促进跟骨骨折的治疗,加快功能恢复。     

传统解剖钢板联合自体植骨与锁定钢板非植骨疗法在SandersⅡ、Ⅲ型跟骨骨折中治疗效果和安全性差异

目的探讨分析传统解剖钢板联合自体植骨与锁定钢板非植骨疗法在SandersⅡ、Ⅲ型跟骨骨折中治疗效果和安全性差异。方法选择东莞市中医院收治的60例SandersⅡ、Ⅲ型跟骨骨折患者作为本次研究对象,根据治疗方式分为观察组和对照组,各组30例患者。观察组患者予以锁定钢板非植骨疗法,对照组患者予以传统解剖钢板联合自体植骨疗法;随访12个月,比较两组患者的手术情况、术后并发症、Bohler、Gissane角、跟骨高度、长度、高度及Maryland评分之间的差异。结果两组患者的术后引流量及完全负重时间差异无统计学意义(P>0.05)。观察组患者的手术时间、术后非负重下地时间及出院时间分别为(65.1±10.3)m L、(4.7±2.1)d、(13.6±1.2)d,明显少于对照组的(80.3±8.2)m L、(8.5±1.6)d、(16.1±0.8)d,差异均有统计学意义(P<0.05);对照组中有7例患者出现取骨区疼痛,与观察组差异具有明显的统计学意义(P<0.05);两组患者术前、后的Bohler、Gissane角、跟骨高度、长度及高度间的差异均无统计学意义(P>0.05),但术后12个月,两组患者的Bohler、Gissane角、跟骨宽度、长度及高度均明显大于治疗前,差异均具有统计学意义(P<0.05);两组患者Maryland评分优良率差异无统计学意义(P>0.05)。结论传统解剖钢板联合自体植骨疗法与锁定钢板非植骨疗法在SandersⅡ、Ⅲ型跟骨骨折的治疗中治疗效果无明显差异,均具有较好的复位效果及跟骨功能恢复,但锁定钢板非植骨疗法具有术后恢复更快的优势,且无传统解剖钢板联合自体植骨疗法导致的取骨区疼痛等不良反应,故锁定钢板非植骨疗法具有可靠的安全性和良好的疗效。     

Blockade of hoarding in rats by diazepam: an analysis of the anxiety and object value hypotheses of hoarding

The security hypothesis suggests food hoarding by rats serves to preempt attack and therefore might be motivated by anxiety. The object value hypothesis suggests rats hoard objects that they perceive as valuable as related to some state or need. These hypotheses were evaluated with the anxiolytic drug diazepam, which is purported to both decrease anxiety and increase motivation to eat, and which accordingly either may decrease or increase hoarding. Using a new hoarding paradigm, diazepam (Valium: 0.25–5 mg/kg), was found to produce a dose-related reduction in hoarding that was dependent upon food pellet size and that was reversed by flumazenil (Ro 15-1788), a benzodiazepine receptor antagonist. Diazepam also slowed eating speed, blocked dodging, a movement used to initiate hoarding, and impaired spatial navigation in a learning-set swimming pool task. The results fail to support the object value hypothesis of hoarding. Since perception of food size, motivation, motor ability and spatial abilities all probably contribute to successful food hoarding, the results provide several explanations other than, or in addition to, anxiety reduction for the drug's effects on hoarding. Nevertheless, the study provides a number of new sensitive measures of the effects of anxiolytic drugs and new insights into their behavioral effects.     

Addiction medicine and domestic violence

Domestic violence is a major medical and legal problem, resulting in a great many deaths and injuries each year. Alcohol and other drug dependencies are frequently found in both the perpetrators and victims of violence. This fact gives addiction medicine practitioners a unique opportunity to intervene in both life-threatening disorders. This article gives diagnostic and intervention guidelines for dealing with the issue of domestic violence in the addiction medicine patient population.     

Does Resilience Moderate the Relationship Between Stress and Smoking Status?

Background: There is a growing evidence that resilience to stress can promote nonsmoking. However, few studies have undertaken quantitative research to investigate whether resilience, generated by internal and external factors, moderates the impact of stress on the likelihood of smoking. Objective: This study aims to help fill this knowledge gap in relation to smokers and ex-smokers, and those people who have never smoked. Methods: A large online cross-sectional survey was administered in Australia (2015–2016) to collect data on demographic variables, levels of internal and external resilience, and stress from current and past smokers (n?=?400) and those who have never-smoked (n?=?921). Logistic regressions were employed to test our hypotheses. Results: Most participants were female (82%) and ranged between 18 and 77?years. Higher levels of reported perceived stress and stress-related variables did significantly predict smoking. The combined impact of internal and external resilience factors predicted never-smoking and lessened the relationship between perceived stress and stress-related variables, and the likelihood of smoking. Conclusion: These results are important because they suggest that the social environment should be developed to augment social support and internal properties such as developing “a strong sense of purpose in life” to encourage people not to commence smoking, rather than focus on smoking cessation.     

Sensitivity of morphine-tolerant rats to muscarinic and dopaminergic agonists: Relation to tolerance or withdrawal

Male hooded Wistar rats were treated chronically once daily with morphine sulfate (20 mg/kg SC) after completing a session in an operant chamber. Periodical challenges with morphine (8 mg/kg) prior to the operant session established that tolerance development was virtually complete within 10 days. The morphine-treated rats were more sensitive to the behavioral suppressing effects of apomorphine, a dopamine agonist, and pilocarpine, an acetylcholine agonist, when administered in the tolerant state (morphine given 30 min prior to operant session), regardless of whether they were administered peripherally or directly into the striatum. Conversely, the morphine-treated rats were less sensitive to both agonists when administered in the withdrawal state (morphine given 24 h prior to the operant session). In animals undergoing a similar regimen of chronic morphine treatment, receptor binding studies revealed a lowered affinity (Higher K _D apparent) for the dopamine receptor in the striatum of morphine-withdrawn rats, using ³H-spiroperidol as the ligand. The morphine-withdrawn rats also appeared to have fewer muscarinic cholinergic receptors (lower B _max), using ³H-QNB as the ligand. The also had a lower concentration of membrane-bound phosphodiesterase modulator protein. In general, no significant differences were observed for the above parameters in the morphine-tolerant rats. These behavioral and neurochemical studies are consistent with the view that morphine-tolerant rats are supersensitive to dopamine and acetylcholine agonists and morphine-withdrawn rats are subsensitive.     

急重症自发性颅内出血的脑血管造影和栓塞处理

目的总结急重症自发性颅脑出血患者的血管内诊治中遇到的问题，找出解决对策。结果2例出现脑缺血表现，其中1例出现永久并发症；80％患者出现术中不配合，需要有效的镇静措施。     

Shaving effects on percutaneous penetration: clinical implications

Context: Human/animal shaving biology.

Objective: To assess the effect of shaving on percutaneous penetration and skin function.

Methods: We screened 500+publications in Pub Med, Scopus, Cochrane Library and pertinent journals out of which only 17 were deemed relevant. Terms for searches included shaving and skin, percutaneous penetration and shaving, skin absorption and shaving, absorption of dyes and shaving, skin penetration, effects of shaving and absorption, shave and dyes, axillary shaving and stratum corneum, shaving and breast cancer, shaving and infections, etc.

Result: Shaving appears to have an exaggerated effect on percutaneous absorption; however, some studies do not support this evidence.

Conclusion: Shaving enhances percutaneous penetration of some chemicals; however this effect is species and chemical specific. Further investigations of chemicals of varying physio-chemical properties are mandated before a generalized theory can be promulgated.     

Understanding the molecular pharmacology of the serotonergic system: using fluoxetine as a model

Objectives Serotonin is a monoamine neurotransmitter that is widely distributed in the body and plays an important role in a variety of psychological and other body functions such as mood, sexual desire and function, appetite, sleep, memory and learning, temperature regulation and social behaviour. This review will assess the use of fluoxetine, one of the most commonly used selective serotonin reuptake inhibitors, as a model for understanding the molecular pharmacology of the serotoninergic system. Key findings Seven serotonin receptor families have been discovered to date. All serotonin receptors, except 5‐HT₃, are G‐protein coupled, seven transmembrane receptors that activate an intracellular second messenger cascade. The 5‐HT₃ receptor is a ligand‐gated ion channel. Furthermore, 5‐HT_1A receptors are known as autoreceptors since their stimulation inhibits the release serotonin in nerve terminals. A transporter protein found in the plasma membrane of serotonergic neurones is responsible for the reuptake of this neurotransmitter. Selective serotonin reuptake inhibitors, such as fluoxetine, act primarily at the serotonin transporter protein and have limited, if any, reaction with other neurotransmitter systems. Selective serotonin reuptake inhibitors appear to bind with the serotonin transporter with different rates of occupancy, duration and potency. Summary The following review focuses on the interaction of serotonin with this membrane transporter in the body and assesses the use of fluoxetine as a reference drug in the understanding of this interaction.     

Decreased potency of CNS depressants after prolonged social isolation in mice

Summary The duration of hypnosis induced by hexobarbital, pentobarbital, chloral hydrate or barbital was markedly reduced after prolonged social isolation of male mice. Hexobarbital and pentobarbital were affected more than chloral hydrate and barbital. The onset of barbital hypnosis was not affected. The in vitro metabolism of hexobarbital by hepatic microsomal enzymes was enhanced in isolated mice with an overall increase in liver weight. Mice deprived of social interaction gained righting reflex at a higher body level of hexobarbital as compared to the undeprived animals. These data show that chronic deprivation of social stimuli in mice increased the drug-metabolizing activity of hepatic microsomes and raised arousal levels such that CNS susceptibility to drugs was altered.This investigation was supported by PHS Training Grant No. 1T01ES 00104 from the Division of Environmental Health Sciences.     

十二指肠损伤的临床特点及诊治

目的探讨十二指肠损伤的临床特点及手术方法,以提高十二指肠损伤的诊治水平。方法回顾性分析1993-10～2003-11我科收治的30例十二指肠损伤患者的临床特点、诊治方法、手术方式及治疗效果。结果腹部X线透视、诊断性腹腔穿刺阳性率分别为24%(6/25)、30%(6/20)。单纯十二指肠损伤占20%(6/30),合并其他腹腔内脏器损伤占80%(24/30)。损伤部位以降部多见占46.67%(14/30),水平部次之占30%(9/30)。术后并发症发生率60%(18/30),病死率20%(6/30)。结论十二指肠损伤具有术前确诊率低、术中漏诊率高、合并损伤多的特点,故并发症发生率及病死率较高。因而掌握其特点,注重早期诊断、早期手术,根据术中具体情况选择简单而合理的手术方式是提高治愈率、降低病死率的关键。