经皮微创接骨板内固定术治疗四肢骨折的方法和临床效果

目的探讨经皮微创接骨板内固定术治疗四肢骨折的方法和临床效果。方法随机选取2015年5月至2017年5月本院收治的四肢骨折患者60例,依据手术术式将这些患者分为经皮微创接骨板内固定术组(经皮微创组,n=30)和开放复位接骨板内固定术组(开放复位组,n=30)两组,对两组患者的临床疗效、手术相关指标、术后并发症发生情况进行统计分析。结果经皮微创组患者治疗的优良率90.0%(27/30)显著高于开放复位组63.3%(19/30)(P0.05),手术时间、下地时间、骨折愈合时间均显著短于开放复位组(P0.05),术中出血量显著少于开放复位组(P0.05),切口长度显著短于开放复位组(P0.05),术后并发症发生率6.7%(2/30)显著低于开放复位组16.7%(5/30)(P0.05)。结论经皮微创接骨板内固定术治疗四肢骨折的临床效果较开放复位接骨板内固定术好。     

锁定接骨板治疗外侧壁粉碎的股骨转子间骨折

目的完整的外侧壁对股骨转子间骨折内固定术后的稳定性有着重要意义。本文旨在探讨采用锁定接骨板治疗外侧壁粉碎的股骨转子间骨折的疗效。方法回顾2009年12月至2013年6月以来南京大学医学院附属鼓楼医院收治的股骨转子间骨折患者,术前CT证实为外侧壁粉碎的AO/ASIF A3型骨折、接受锁定接骨板内固定手术治疗且随访超过18个月者共24例,其中男15例,女9例;年龄48~79岁(平均63.5岁)。术中在牵引床辅助下行骨折复位内固定手术治疗,14例采用对侧股骨远端外侧锁定加压接骨板倒置固定,10例采用股骨近端外侧锁定加压接骨板固定。术后定期随访并行髋关节功能评分。结果 24例患者中,手术骨折复位优良率为91.7%。术后3个月时骨折全部愈合。平均随访时间26.4个月(18~44个月),末次随访时髋关节功能评分(harris hip score,HHS)62~86分,平均71.4分。无复位丢失、内固定失败等。结论采用锁定接骨板治疗外侧壁粉碎的股骨转子间骨折,可获得满意的临床疗效。     

数字骨科技术在复杂关节内骨折手术中的应用

目的探讨数字骨科技术在复杂关节内骨折手术中的应用价值。方法对2013年12月至2017年1月中山火炬开发区医院收治的14例关节内骨折患者采用数字骨科辅助手术治疗。行双侧肢体CT扫描,利用数字骨科软件重建患者骨骼模型,术前通过计算机分析、模拟手术复位制定三维设计手术方案,术中将3D打印个性化模板用于辅助骨折复位、截骨和内固定手术的精确实施。结果按照术前三维设计方案完成手术,术程顺利,患者均获解剖复位。术后肢体外形对称、轴线恢复良好,接骨板、螺钉的位置、方向与模拟手术完全一致;无一例患者出现皮肤坏死、切口感染、神经血管损伤并发症。随访时间12～18个月,平均随访时间(13±4)个月。患者骨折均获愈合,骨折愈合时间(6±2)个月。末次随访时所有患者关节活动功能恢复良好。结论数字骨科技术辅助复杂关节内骨折手术,可通过术前三维设计完善和优化手术方案,借助术中个性化模板引导实施精准手术操作,提高了手术的精确性和安全性。     

低切迹腓骨远端后外侧接骨板治疗B型踝关节骨折的临床观察

[摘要]目的：探讨低切迹腓骨远端后外侧接骨板治疗B型踝关节骨折的方法及疗效。方法：2010年5月～2011年12月对58例B型踝关节骨折的患者使用低切迹腓骨远端后外侧接骨板对外踝骨折进行内固定治疗,手术采用踝关节后外侧入路,首先处理外踝骨折,复位骨折后,将低切迹腓骨远端后外侧接骨板置于腓骨后外方或后方,然后在同一入路内复位后踝骨折并固定,     

弹性髓内钉与接骨板固定治疗儿童股骨骨折疗效分析

目的比较弹性髓内钉与钛合金接骨板内固定治疗儿童股骨干骨折的疗效。方法将58例股骨干骨折患儿分为2组,观察组28例采用闭合复位弹性髓内钉内固定,对于难以闭合复位和插钉困难的骨折采用小切口辅助复位和插钉;对照组30例采用切开复位接骨板内固定。结果观察组平均手术时间及术中出血量均优于对照组,差异有统计学意义(P0.05)。58例患儿均获12~24个月随访,骨折全部愈合。未发生切口感染、骨髓炎、骨折不愈合。按照Flynn评价标准,观察组优良率96.4%,对照组为96.7%,2组差异无统计学意义(P0.05)。结论弹性髓内钉闭合复位内固定和接骨板切开复位内固定治疗儿童股骨干骨折,效果均较为满意。但弹性髓内钉闭合复位内固定创伤小,可根据具体病情加以选择。     

生物可吸收内固定材料及其在掌骨干骨折治疗中的应用

近年来,越来越多的可吸收内固定材料被发现并应用于骨科临床治疗中,其中生物可降解材料依靠其优越的生物相容性及降解速度的可调节性脱颖而出,生物可吸收接骨板已应用于掌骨干骨折治疗。该文对可吸收内固定材料及其在掌骨干骨折治疗中应用的研究进展作一综述。     

锁定接骨板内固定治疗移位的关节内跟骨骨折

目的 探讨锁定接骨板内固定治疗移位的关节内跟骨骨折的效果。方法 对49例(58足)移位的跟骨关节内骨折(SandersⅡ、Ⅲ、Ⅳ型)采用切开复位锁定接骨板内固定术治疗,术中关节面复位后跟骨外侧放置跟骨锁定接骨板。手术前后测量Bhler角和Gissane角,评价跟骨骨折的复位情况。结果 患者均获随访,时间6~28个月。患者切口均无严重感染和广泛的皮肤坏死;骨折均愈合,时间3.5~4.5个月。术后6个月复查X线片显示Bhler角和Gissane角分别为28.3°±6.1°和125.7°±8.5°,与术前比较差异均有统计学意义(P<0.05)。术后功能按Maryland足部评价系统评分:优40足,良14足,差4足,优良率93.1%。结论 切开复位锁定接骨板内固定术治疗移位的关节内跟骨骨折手术方法简单,疗效满意。     

腓侧锁定接骨板桥接治疗胫骨下段骨折

目的探讨腓侧锁定接骨板桥接治疗胫骨下段骨折的临床疗效。方法对48例胫骨下段骨折患者采用腓侧锁定接骨板内固定。结果 48例均获得随访,时间8~25个月。患者骨折均愈合,其中骨折延迟愈合4例,未发生内固定断裂。创面皮肤浅表坏死2例,深部感染1例。骨折复位情况影像学评估：解剖复位38例,复位一般10例。按Mazur踝关节功能系统评分标准：优40例,良6例,可2例。结论合理评估软组织条件,掌握手术时机,关节面解剖复位,腓侧锁定接骨板治疗胫骨下段骨折可获得良好的疗效。     

多轴锁定接骨板、重建接骨板、重建带治疗锁骨中段骨折

背景：切开复位接骨板内固定是移位性锁骨中段骨折的常用治疗方法。目前,临床上有多种植入物可供选择。然而,不同的植入物各有其特点,对于哪种植入物更为理想尚无定论。 目的：比较解剖型多轴锁定接骨板、重建接骨板与通用重建带接骨板治疗锁骨中段骨折的疗效。 方法：2009年11月至2012年2月,切开复位内固定治疗锁骨中段骨折91例,男61例,女30例;年龄18~70岁,平均43.5岁。其中解剖型多轴锁定接骨板内固定30例（锁定组）、重建接骨板内固定30例（重建接骨板组）、通用重建带接骨板内固定31例（重建带组）。记录三组手术时间、骨折愈合时间、术后并发症;采用Constant评分评定肩关节功能。 结果：三组患者年龄、性别、优势侧别、损伤机制、骨折类型、受伤至手术时间、随访时间等方面无显著统计学差异（P〉0.05）。所有患者均获得良好骨折复位及内固定。无感染、医源性神经血管及胸膜损伤。锁定组手术时间、软组织激惹发生率低于重建接骨板组及重建带组（〈0.01,〈0.05）,肩关节功能优于重建接骨板及重建带组（〈0.05,〈0.01）;三组患者骨折愈合时间及肥厚性瘢痕形成率无显著差异（P〉0.05）。 结论：解剖型多轴锁定接骨板、重建接骨板、通用重建带接骨板均可用于治疗锁骨中段骨折;应用多轴锁定接骨板手术时间更短,临床效果优良,并发症更少。     

胫骨下段骨折切开与闭合复位内固定术疗效比较

目的比较闭合性胫骨下段骨折切开复位与闭合复位内固定术的疗效,以期寻找更合适的治疗手段。方法对50例胫腓骨下段骨折行内固定术,随机分为2组:A组25例(闭合复位、经皮锁定加压接骨板内固定)、B组25例(切开复位、锁定加压接骨板内固定)。结果 A组平均手术时间较B组长、术中透视次数多、解剖复位率低,但平均术中出血量少、切口长度短、住院时间短、骨折临床愈合时间短、下地负重时间短、术后并发症发生率低、术后Johner-Wruhs评分优良率高,两组差异均有统计学意义(P<0.05)。结论对于胫骨下段闭合性骨折,采用闭合复位、经皮胫骨内侧锁定加压接骨板内固定术总体疗效优于切开复位、胫骨内侧锁定加压接骨板内固定术,可以推广使用。     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.     

The multiply injured child

Blunt trauma is the principal cause of childhood death in many developed countries. This review outlines the differences between adults and children with respect to resuscitation and treatment of orthopaedic injuries in a child with polytrauma. Recent advances in techniques of fracture stabilization are reported.     

Development of Selective Low-Density Lipoprotein (LDL) Apheresis System: Immobilized Polyanion as LDL-Specific Adsorption for LDL Apheresis System

Abstract: Low-density lipoprotein (LDL) is widely recognized as one of the major risk factors for developing coronary heart diseases. Despite intensive development of LDL-lowering drugs, there still exist those patients with refractory hyperlipidemia whose plasma LDL levels are not sufficiently lowered by drugs. LDL apheresis, direct removal of plasma LDL from circulating blood, is thought to be the most promising treatment for such refractory patients. Various techniques, such as the use of an im-munoadsorbent utilizing an anti-LDL antibody, have been used in an attempt to achieve the selective removal of LDL. However, none were widely used because of complications, poor selectivity, and so forth. To establish a safe and effective LDL apheresis system, we chose a synthetic affinity adsorbent as the LDL-removing device. Synthetic polyanion compounds were used as the affinity ligands for LDL adsorbent to simulate the anion-rich sequence of LDL binding sites in the human LDL receptor. Among various polyanion compounds, those polyanions with sulfate or sulfonate groups and hydrophilic backbone were found to have strong affinity for LDL. In contrast, polyanions with carboxyl groups showed poor affinity. Dextran sulfate (DS) was selected as the affinity ligand of LDL adsorbent for its high affinity and low toxicity. The influence of its charge density and molecular weight on its affinity for LDL was suitable. The affinity rapidly increased as the charge density increased, then, reached a constant value. Little affinity was found for either the DS monomer (glucose sulfate) or DS with a molecular weight higher than 10⁴ daltons whereas DS with molecular weights in the midrange showed strong affinity. DS with a midrange molecular weight was immobilized on cellulose hard gel to give LDL adsorbent clinical application. The adsorbent demonstrated an excellent selectivity for LDL and very low density lipoprotein (VLDL) in vitro. Adsorption of high-density lipoprotein and major plasma proteins was almost negligible. Additional study of the LDL-binding mechanism revealed that DS directly interacts with positively charged sites on LDL, which demonstrates that the nature of the interaction is the same as that of LDL receptor. An LDL adsorption column (Liposorber) packed with an LDL adsorbent and polysulfone hollow-fiber plasma separator (Sulflux) was developed as an efficient LDL apheresis system. Clinical investigation proved that this system is capable of intensively lowering the plasma LDL level without affecting major plasma components.     

Artificial organs 2010: a year in review

In this Editor's Review, articles published in 2010 are organized by category and briefly summarized. As the official journal of The International Federation for Artificial Organs, The International Faculty for Artificial Organs, and the International Society for Rotary Blood Pumps, Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level."Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide such meaningful suggestions to the author's work whether eventually accepted or rejected and especially to those whose native tongue is not English. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, Wiley-Blackwell, for their expert attention and support in the production and marketing of Artificial Organs. In this Editor's Review, that historically has been widely received by our readership, we aim to provide a brief reflection of the currently available worldwide knowledge that is intended to advance and better human life while providing insight for continued application of technologies and methods of organ Replacement, Recovery, and Regeneration. We look forward to recording further advances in the coming years.     

Avaliação do clube de revista de anestesiologia por meio de mudanças semânticas

Background and objectives

The interactive approach of a journal club has been described in the medical education literature. The aim of this investigation is to present an assessment of journal club as a tool to address the question whether residents read more and critically.

Methods

This study reports the performance of medical residents in anesthesiology from the Clinics Hospital – University of São Paulo Medical School. All medical residents were invited to answer five questions derived from discussed papers. The answer sheet consisted of an affirmative statement with a Likert type scale (totally disagree–disagree–not sure–agree–totally agree), each related to one of the chosen articles. The results were evaluated by means of item analysis – difficulty index and discrimination power.

Results

Residents filled one hundred and seventy three evaluations in the months of December 2011 (n = 51), July 2012 (n = 66) and December 2012 (n = 56). The first exam presented all items with straight statement, second and third exams presented mixed items. Separating “totally agree” from “agree” increased the difficulty indices, but did not improve the discrimination power.

Conclusions

The use of a journal club assessment with straight and inverted statements and by means of five points scale for agreement has been shown to increase its item difficulty and discrimination power. This may reflect involvement either with the reading or the discussion during the journal meeting.     

Soluble TNFα Receptors Are Increased in Chronic Renal Insufficiency and Hemodialysis and Inhibit Neutrophil Priming by TNFα

Abstract: The oxidative burst of neutrophils from azotemic patients is refractory to priming by tumor necrosis factor-α (TNFα). Soluble TNFα binding proteins (TNFR) accumulate in the plasma of azotemic patients. To test the hypothesis that these increased sTNFR concentrations inhibit TNFa priming of oxidative burst activity, we measured plasma sTNFR concentrations in nondialyzed azotemic patients, hemodialysis patients, and normal subjects, and determined TNFa priming of fMet-Leu-Phe-stimulated superoxide production in neutrophils incubated in plasma with differing levels of sTNFR. These sTNFR concentrations increased significantly as creatinine clearance decreased and were significantly greater in hemodialysis patients than could be accounted for by loss of renal function alone. TNFα primed superoxide production by normal neutrophils in normal plasma, but this effect was significantly reduced in plasma with increased concentrations of sTNFR. Neutrophils from azotemic and hemodialysis patients were refractory to priming by TNFα in autologous plasma, and incubation in normal plasma only partially corrected this defect. We conclude that sTNFR accumulate as a result of the loss of renal function and hemodialysis and inhibit TNFα priming of neutrophils in azotemic and hemodialysis patients, but that these cells also have an intrinsic functional defect.     

Lymphocytapheresis

Abstract: Leukocytapheresis has long been performed with the centrifugal method. But in 1989 in Japan, the Asahi Medical Co. developed the extracorporeal leukocyte-removal filter, Cellsorba. This filter consists of non-woven fabric, which can remove leukocytes from whole blood during extracorporeal circulation. In the incipient stage, this filter was applied to collagen diseases, rheumatoid arthritis, and systemic lupus erythematosus. During the following studies, this filter has been found to have an immunosuppressive effect. Now, it is beginning to be applied to various kinds of autoimmune diseases. Moreover, this filter has recently been recognized to be effective in inflammatory bowel diseases, ulcerative colitis, and Crohn's disease. The outline of Cellsorba and the application of this filter is described here.