多导气道闭合图仪与闭合点气量

多导气道闭合图仪系指作者根据“气道闭合流速受限内扰动波”概念及假说设计的测量小气道功能的仪器,可快速无损伤的测量呼气末期的瞬时流量,平均流量、容量和时间,用二维图纸,显示三维空间指标。 本仪器结构简单,便于维修及移动,且省去同类测量所需的氮气机,氧气瓶,真空泵,而便于普及,现已使用两年,未出现故     

心脏瓣膜闭合的力学分析

文中分别对二尖瓣(三尖瓣)和主动脉瓣(肺动脉瓣)的闭合进行了力学分析,从而说明逆向压力梯度使瓣膜关闭的原理。     

腹部闭合伤106例诊治体会

目的 总结腹部闭合伤的诊治体会. 方法回顾分析我院2005年6月～2009年6月收治的腹部闭合伤106例.结果 106例中61例(57.5%)出现腹腔单一脏器损伤,45例(42.5%)出现腹腔多脏器损伤,37例(34.9%)合并其他脏器系统(颅脑、胸、泌尿、骨等)损伤,57例(53.8%)出血性休克.97例手术治疗,总手术率为91.5%.全部治愈,无死亡病例.结论 腹部闭合伤病情复杂,迅速准确诊断、及时有效治疗是关键.     

闭合AO空心螺钉治疗Jones骨折

目的总结闭合AO空心螺钉固定治疗第五跖骨基底部Jones骨折15例的临床疗效。方法回顾分析2008年6月~2010年9月采用闭合AO空心螺钉治疗Jones骨折15例的临床资料。结果 15例获得3~8个月随访,骨折均愈合,平均愈合时间2~3.5个月,功能恢复良好,按Maryland足部评分系统评分,优8例,良5例,可2例,优良率达86.7%。结论闭合AO空心螺钉固定治疗Jones骨折具有创伤小,固定牢靠,对软组织破坏少,有利于踝关节功能恢复等优点,是治疗Jones骨折的有效方法。     

闭合气量就是下肺区小气道开始闭合时的肺容量吗?

Dollfuss 等于1967年首先将在深呼气过程中在低肺容量阶段呼出气体中指示气体的浓度突然升高的一段称为第IV相,并认为这是由于下肺区小气道开始闭合所引起的。在此础基上,Holland等在1968年将第IV相开始时的肺容量命名为闭合气量(简称为CV)。以后,教科书和期刊中凡是谈到CV的基本上都是沿用了这一定义,即 CV就是深呼气过程中下肺区小气道开始闭合时的肺容量。     

理想主动脉瓣模型闭合机制的研究

目的；分析理想状态下主动脉瓣关闭机制。方法：建立理想的主动脉瓣模型，用几何学的方法对不同瓣叶情况下的瓣膜受力情况进行分析。结果：二叶瓣无法开放，不符合生理要求。四叶瓣完全开放后，瓣叶完全贴于瓣环，在血液返流的方向上没有受力面积，不利于瓣膜的关闭。三叶瓣在完全开放的状态下，在血液返流的方向上有一个大小较为合理的截面积，有利于瓣膜的闭合受力。结论；在完全开放状态下，主动脉瓣在血液返流方向上的截面积是其关闭动力的重要来源，从关闭角度来讲，三叶瓣是唯一理想的瓣膜。     

闭合皮肤创口的氰基丙烯酸酯组织胶粘剂

闭合皮肤创口的氰基丙烯酸酯组织胶粘剂［英］／ＶａｎｈｏｌｄｅｒＲ…／／Ｂｉｏｍａｔｅｒｉ－ａｌｓ．－１９９３，１４（１０）．－７３７皮肤创口的愈合常常需要通过外科缝合技术，缝线缝合表皮、真皮组织，达到固定伤口的目的。由于缝线是一种异物，细菌对异物有一...     

动脉导管闭合机理探讨与临床

对３０具幼尸动脉导管（索）与主动脉弓（左下）夹角（θ），以及动脉导管（索）上端（Ａ）至左第四肋骨体后端下缘水平面与主动脉内缘交点（Ｂ）的距离（ＡＢ）进行解剖测量。结果θ值男性大于女性；（ＡＢ）平均值为６．１±３．５ｍｍ。作者认为动脉导管能否闭合，决定于θ值大小，θ越大，动脉导管越易闭合；反之，θ越小，动脉管越难闭合，当θ小到一定值时，导致动脉导管不闭合。文中讨论了θ及（ＡＢ）的临床意义。     

儿童四肢闭合性骨折保守治疗102例

我院自１９８４—１９９４年共收治儿童股骨、肱骨、胫腓骨闭合性骨折１０２例，均采用非手术治疗，取得了满意效果。作者认为，儿童四肢闭合性骨折，非手术治疗为首选，而早期正确的复位，合理有效的局部外固定，积极的功能锻炼则是治疗成功的关键。儿童的骨折不同于成人。儿童的骨膜较成人厚，通常在骨折的一侧仍保持相连，有利于稳定复位，减少移位的机会；其次，骨的生长与患者年龄有关，年幼的儿童对不满意的对位，甚至不良的对线和缩短具有代偿能力。     

The timing of tourniquet release and 'retransfusion' drains in total knee arthroplasty: A stratified randomised pilot investigation

The timing of tourniquet release is a potential confounding factor in the use of retransfusion drains in total knee arthroplasty. A pilot randomised trial was performed using retransfusion drains to determine whether releasing the tourniquet after wound closure reduced the overall blood loss and allogenic transfusion rate. Forty eight patients undergoing total knee arthroplasty were randomly allocated to receive either a retransfusion drain or no drain. Within each group the tourniquet was released before or after wound closure at the discretion of the surgeon. The peri-operative fall in haemoglobin, allogenic blood transfusion rate and complication rate were measured. There was an overall transfusion rate of 16%. There was no difference in the peri-operative fall in haemoglobin or the allogenic transfusion rates between the No Drain and Retransfusion Drain groups for patients undergoing total knee arthroplasty. Furthermore, the timing of the tourniquet release did not alter these findings. The results of this study suggest that the timing of the tourniquet release does not impact upon the ability of retransfusion drains to reduce the peri-operative fall in haemoglobin or the requirement for allogenic blood transfusion in total knee arthroplasty.     

单髁置换与全膝关节置换后隐性失血的对比研究

文题释义： 隐性失血：一般是指较大的创伤或手术后,排除手术创面失血、术中及术后引流丢失等可计算的显性失血之外,患者机体内丢失的血量。试验中由于所有患者术后均未放置引流管,未观察到显性失血,所以术后第4,21,42天的总失血量为隐性失血量,用血红蛋白和红细胞比容数值变化来体现隐性失血的变化。 显性失血：一般是指较大的创伤或者手术后,手术创面失血、术中及术后引流丢失等可计算的失血量。 背景：单髁置换相较于全膝关节置换的术中失血量相比较低,但二者之间的术后隐性失血量差异尚未得到广泛研究。 目的：对比单髁置换与全膝关节置换后隐性失血的差异,分析术前贫血患者是否也可以在无输血风险的情况下进行单髁置换手术。 方法：选择2014年1月至2016年12月联勤保障部队第904医院收治的膝关节骨性关节炎患者148 例,其中58例进行单髁置换手术,90例进行全膝关节置换手术。术前及术后第1,4,21,42天,检测两组血红蛋白水平、红细胞比容,计算隐性失血量与输血率。试验获得联勤保障部队第904医院伦理委员会批准,批准号：2019-01-03。 结果与结论：①单髁置换组术后第1,4天的血红蛋白水平高于全膝关节置换组(P < 0.01),两组术前及术后21,42天的血红蛋白水平比较差异无显著性意义(P > 0.05);②单髁置换组术后第1,4天的红细胞比容高于全膝关节置换组(P < 0.01),两组术前及术后21,42天的红细胞比容比较差异无显著性意义(P > 0.05);③在术后第1,4天之间,单髁置换组中女性没有隐性失血,男性平均血红蛋白下降量为 4 g/L;全膝关节置换组中女性平均血红蛋白下降量为 10 g/L,男性为 7 g/L,单髁置换组男性与女性的隐性失血量均低于全膝关节置换组的对应性别患者(P < 0.05或P < 0.01);④单髁置换组的输血率为0%,全膝关节置换组的输血率为4.4%;术前中度贫血的患者(血红蛋白60-89 g/L),单髁置换组3例均无需输血,而全膝关节置换组6例中2例(33%)需输血;⑤结果表明,单髁置换较全膝关节置换在术后隐性失血方面有明显优势。 ORCID: 0000-0002-7314-5548(彭超) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

胫骨前肌肌腱在膝关节置换术胫骨髓外定位系统中的作用分析

目的　探讨胫骨前肌肌腱在膝关节置换术胫骨髓外定位系统的作用。 方法 59例行膝关节置换术中患者的59个下肢,用X线定位胫骨冠状位力线以及踝关节中点,并在皮肤上标志,标志胫骨前肌肌腱内侧缘纵轴,在内、外踝连线上测量胫骨前肌肌腱内侧缘距离踝关节中点的距离,测量胫骨力线与胫骨前肌肌腱交点到内、外踝连线距离,并用独立t检验做统计学分析。 结果 胫骨前肌肌腱内侧缘在内、外踝连线上与踝关节中点距离为(13.32±2.75) mm,胫骨前肌与胫骨力线交点与内外踝连线距离(71.23±6.45) mm,均有统计学意义(P<0.001)。 结论 胫骨前肌肌腱在胫骨远端有2个可以作为膝关节置换术中髓外定位系统中胫骨远端解剖标记,具有实际应用价值。     

全膝关节置换后循环加压冷疗系统与间断高渗盐水冰敷应用

背景：膝关节置换后肿胀可产生张力性水泡,使疼痛加重,严重时可阻碍静脉回流,使骨筋膜室内压力增高,甚至可阻碍动脉血液循环,严重时可导致骨筋膜室综合征。 目的：评价循环加压冷疗系统(Cryf/cuff Systems)与间歇高渗盐水冰敷在全膝关节置换后的疗效。 方法：将60例单侧全膝关节置换后患者随机分为2组,持续冷冻组患者关节置换后采用循环加压冷疗系统处理;间断冰敷组关节置换后采用间断高渗盐水冰敷处理。 结果与结论：持续冷冻组和间断冰敷组髌骨上极、髌骨中点腓肠肌最粗点周径差在全膝关节置换后第1,2天差异有显著性意义(P < 0.05),第3天两组差异无显著性意义;持续冷冻组关节置换后第1,2天静止和运动疼痛目测类比评分显著低于间断冰敷组(P < 0.01),置换后第3天两组差异无显著性意义;持续冷冻组置换后第1,2,3天膝关节活动度优于间断冰敷组(P < 0.01),置换后第1,2周两组差异无显著性意义;持续冷冻组关节置换后3 d膝关节周围皮肤平均温度高于间断冰敷组(P < 0.05)。说明全膝关节置换后第1,2天Cryo/cuff Syestems处理较间断高渗盐水冰敷能减轻组织肿胀、减轻疼痛、增加活动度,但3 d后没有显著性差异,说明置换后第3天间断冰敷能达到Cryf/cuff Systems同样的效果。     

Iliotibial band friction syndrome after knee arthroplasty

Iliotibial band (ITB) friction syndrome is known to be one of the main causes of lateral knee pain related to an overuse injury. In the field of knee arthroplasty, ITB traction syndrome has been reported following guided motion total knee arthroplasty, due to posterior femoral translation and internal tibial rotation during knee flexion. However, ITB friction syndrome following conventional knee arthroplasty has not been reported. This paper reports four cases of this syndrome following conventional knee arthroplasty, mainly caused by an obstruction just under the ITB. Cases 1 and 2 presented extruded cement at the femoral component's lateral side after total knee arthroplasty. Case 3 presented a highly sharp-edged bearing at the lateral compartment after bicompartmental knee arthroplasty. Case 4 presented an osteophyte at the femoral component's lateral side after total knee arthroplasty. Although none of the cases responded well to conservative treatment, ITB friction syndrome was completely relieved just after excising the obstruction. Excision of an obstruction should be considered for ITB friction syndrome caused by obstruction just under the ITB following knee arthroplasty.     

初次全膝关节置换中应用倒刺缝线和传统缝线的Meta分析

文题释义：全膝关节置换：是在近代人工关节成功应用于患者后逐渐发展起来的一种治疗膝关节疾病的新技术，能有效根除晚期膝关节疾病，极大提高患者生活质量。 倒刺缝合线：一种新的缝合材料，由于本身材料结构的特殊性，可以提供持续免打结缝合。 背景：在临床上新型的倒刺缝合线在一些外科领域得到了广泛应用，并且取得了良好的效果，但是在全膝关节置换中的应用较少，其临床效果仍存在争议。 目的：收集相关文献进行系统评价，为倒刺缝线在全膝关节置换中的应用提供证据。 方法：2名研究员独立检索PubMed、EMBASE、Cochrane library、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方数据库、维普中文科技期刊数据库中有关倒刺缝线和传统缝线在全膝关节置换中应用的随机对照试验，手工检索其余相关文献，检索时间均为建库至2019年6月。使用Cochrane手册推荐的随机对照试验偏倚风险评估工具对文献质量进行评估，采用RevMan 5.3软件进行Meta分析。 结果与结论：①共有8项随机对照试验纳入，共计1 004例膝关节；②结果表明，倒刺缝合可以明显缩短伤口缝合时间[MD=-5.17，95%CI(-6.26，-4.09)，P < 0.000 01]，减少伤口关闭总成本[SMD=-1.66，95%CI(-2.58，-0.75)，P=0.0004]，降低伤口缝合时针刺伤发生率[RR=0.14，95%CI (0.03，0.78)，P=0.02]；③2种缝合方法在术后并发症[RR=0.96，95%CI(0.65，1.42)，P=0.85]、缝线断裂情况[RR=4.58，95%CI(0.16，128.29)，P=0.37]、术后6周膝关节活动度[MD=−0.74，95%CI(-4.19，2.71)，P=0.67]、术后3个月膝关节活动度[MD=−0.30，95%CI(-2.62，2.02)，P=0.80]和术后6周美国膝关节协会评分[MD=-0.22，95%CI (-3.10，2.66)，P=0.88]方面差异均无显著性意义，但是在术后3个月倒刺缝合组获得了较好的美国膝关节协会评分[MD=-2.04，95%CI(-3.92，-0.15)，P=0.03]；④提示在初次全膝关节置换中，倒刺缝线缝合是一种快速、安全有效并且低成本的缝合办法，值得临床使用，同时也需要更多的随机对照试验及更长时间的随访来进一步证实此结论。 ORCID: 0000-0003-4504-6101(张文辉) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程     

氨甲环酸在全膝关节置换中的应用及安全性

BACKGROUND: Studies suggested that blood loss was great during total knee arthroplasty, even blood transfusion was needed. Application of the tourniquet will destroy the coagulation system, and is not conducive to hemostasis after replacement. Recently, tranexamic acid has been extensively used to reduce blood loss during total knee arthroplasty, because of low price, simple administration pathway, and effective effects on hemostasis. OBJECTIVE: To summarize the application and safety of tranexamic acid in total knee arthroplasty. METHODS: The first author retrieved PubMed and Chinese Journal Full Text Database for articles from inception to October 2015. The key words were tranexamic acid, total knee arthroplasty, hemorrhage. More than 200 articles were retrieved, and finally 50 articles met the inclusion criteria. RESULTS AND CONCLUSION: Tranexamic acid is a fibrinolytic inhibitor, can reversibly block the binding of plasminogen to fibrin, effectively inhibit fibrinolysis, and reduce hemorrhage after total knee arthroplasty. Nevertheless, there were significant differences in the use, dose and effect of tranexamic acid on hemostasis among different studies. Tranexamic acid was an effective drug for hemostasis during total knee arthroplasty. During total knee arthroplasty, tranexamic acid had been used to reduce dominant blood loss and hidden blood loss after arthroplasty, and could not increase the risk for venous thrombosis of lower limb. Currently, the timing of use, dosage, route of administration, and possible complications of tranexamic acid remain controversial.      

活动衬垫和固定衬垫全膝关节置换的临床效果

背景：对于近期活动衬垫型和固定衬垫型全膝关节置换后患膝关节功能改善情况目前专家意见并不一致。 目的：比较活动衬垫型和固定衬垫型全膝关节置换的近期临床效果。 方法：90例膝关节骨性关节炎患者行全膝关节置换,其中活动衬垫型全膝关节置换43例,固定衬垫型全膝关节置换47例。分析患者膝关节置换前、置换后1,3,6个月及1年时术膝的膝关节评分、疼痛评分、功能评分、髌骨评分和膝关节活动度,两组置换前各指标差异无显著性意义。 结果与结论：全膝关节置换后1,3个月,两组患者的膝关节评分、疼痛评分、功能评分、髌骨评分比较,差异无显著性意义(P > 0.05);置换后6个月及1年时术膝的膝关节评分、疼痛评分、功能评分、髌骨评分中活动衬垫组较固定衬垫组明显进步(P < 0.05)。说明活动衬垫型和固定衬垫型全膝关节置换后患膝关节功能明显改善,且近期结果显示活动衬垫型效果更令人满意。     

Successful total knee arthroplasty in the presence of sporotrichal arthritis

Articular sporotrichosis, a chronic granulomatous fungal infection, is a rare entity but when present may lead to significant joint destruction. Severe knee arthrosis due to sporotrichal arthritis has traditionally been treated with arthrodesis. Total knee arthroplasty in the presence of sporotrichal arthritis has been treated with long-term suppressive antifungal agents or 1-stage exchange total knee arthroplasty. We present a case in which primary total knee arthroplasty in the presence of sporotrichal arthritis resulted in good functional outcome at 2.5 years of follow-up.     

Biomechanical factors in wound healing following knee arthroplasty

A significant proportion of deep infections following knee arthroplasty are consequent on a failure of primary wound healing. The management of such infections is difficult and the functional outcome is poor. It is essential to ensure that the initial biomechanical conditions are such that wound healing is encouraged. The ability of a wound to heal is dependent on factors such as the orientation of the skin incision, the wound tension and the viability of the wound edges as assessed by skin oxygen tension estimations. Consideration of these factors has led us to advocate the use of the medial parapatellar incision for knee arthroplasty. Early, excessive knee flexion following arthroplasty can lead to significant wound edge hypoxia but by modifying the rehabilitation programme and with the administration of 24% oxygen to the patient in the perioperative period, this effect can be minimized. Modification of the surgical techniques involved in knee arthroplasty can help preserve the vascular supply and hence the viability of the wound edge, and thus achieve a suitable biomechanical environment for primary wound healing.