旋入式防滑跟骨牵引器骨界面剪切应力问题研究

目的探讨旋入式防滑跟骨牵引器牵引时与跟骨之间界面剪切应力和界面摩擦力的大小,为临床选择提供基础理论依据。方法 16具新鲜中国人跟骨标本,用生物力学实验应力分析方法,比较旋入式防滑跟骨牵引器(A组)和传统跟骨牵引器固定(B组)牵引时与跟骨之间界面剪切应力和摩擦力的改变。结果①A组界面剪切应力值最大为(2.17±0.16)N/mm2,远高于B组(1.29±0.11)N/mm2,呈显著性差异(P0.05);②A组界面摩擦力为(343.13±25.78)N,同样高于B组(202.20±16.20)N,差异有统计学意义(P0.05)。结论跟骨牵引采用旋入式防滑跟骨牵引器不但具有优越的生物力学性能,而且操作简便、安全可靠,是目前跟骨牵引术式的理想选择,尤其适用于老年骨质疏松患者。     

跟骨后距下关节面压缩骨折的手术治疗

目的：探讨跟骨后距下关节面压缩骨折切开发位克氏针内固定植骨的手术治疗。方法：38例(41个跟骨)跟骨后距下关节面压缩骨折，采用切开复位克氏针内固定加植骨术治疗。结果：经38足平均随访3．7年，总优良率76．32％。结论：1．外侧入路利于整复跟骨塌陷移位的关节西骨折块及跟骰关节；2．在腓骨肌腱腱鞘“桥”下操作，可减少后遗症；3．以距骨后距下关节面为模板，用骨刀复位，有利于后距下关节面的复位控制，且副损伤小；4．1．5mm的细克氏针足以起到固定作用，且创伤小；5．跟骨短缩、跟骨增宽及内外翻畸形的矫正，Bohler′s角、Gissane角及跟骨大体形态的恢复很重要；6．植骨起到填充、支持和促进骨折愈合的作用，植骨是必要的；7．术后在医生指导下的程序化、个体化的早期积极功能锻炼也很重要。     

微创距下关节融合术治疗距下关节创伤性关节炎

目的：探究微创距下关节融合术治疗距下关节创伤关节炎的效果。方法：选取该院2011年7月至2012年5月期间收治的52例距下关节创伤性关节炎患者作为研究对象,男35例,女17例,年龄21～48岁,平均（34.5±1.2）岁,给予患者微创距下关节融合术治疗,在跟腱后外侧做切口,在距下关节内打入导针,扩开通道,将距下关节两侧关节面破坏,填充关节间隙采用自体骨骼,打入2～3枚螺钉固定。结果：5～13个月的随访发现大部分患者骨性融合充分,均达到标准,评分患者足部功能,优良率为94.23％,治疗效果显著。结论：治疗距下关节创伤性关节炎应用微创距下关节融合术,骨骼愈合率高,创伤小、术后无复发,疗效显著,值得临床实践应用。     

两种手术方法治疗跟骨骨折的临床效果

目的评价闭合撬拔复位克氏针内固定与切开复位接骨板内固定治疗跟骨骨折的临床效果。方法选择2008年1月~2012年12月于昌吉市第二人民医院治疗的52例(60足)跟骨骨折患者进行回顾性分析,并将其分为闭合撬拔复位克氏针内固定组(撬拔复位组,28例28足)及切开复位接骨板内固定组(切开复位组,28例32足)。观察并比较两组患者术后的并发症、影像学资料(Bohler角、Gissane角、跟骨外形)及功能恢复的情况。结果患者均获随访,随访时间9~18个月。撬拔复位组患者术后并发创伤性距下关节炎2例,其余患者骨折愈合良好,无切口并发症发生;切开复位组患者术后2例出现局部皮缘的坏死,1例患者距下关节面塌陷畸形愈合,3例患者并发距下创伤性关节炎。两组患者术后跟骨Bohler角及Gissane角均恢复良好,两组差异无统计学意义(P>0.05)。术后功能恢复,撬拨复位组优良率为93%;切开复位组为88%,两组差异无统计学意义(P>0.05)。结论针对患者的跟骨骨折类型,闭合撬拔复位克氏针内固定及切开复位内固定治疗跟骨骨折各有优缺点,均可达到满意的治疗效果,可根据患者的病情酌情使用。     

跟骨骨折手术中皮瓣不同牵开方式术后切口并发症的比较

目的:回顾比较跟骨骨折手术中对皮瓣采用拉钩牵开及克氏针固定牵开的病人术后切口的并发症发生率,探讨跟骨骨折手术中对皮瓣最优的牵开方式。方法:对81例89足跟骨骨折应用跟骨外侧"L"形延长切口手术治疗。术中皮瓣拉钩牵开组52足,克氏针固定牵开组37足。结果:术后切口皮肤边缘坏死10例,切口延迟愈合2例,感染1例。其中拉钩牵开组5例,克氏针固定牵开组7例,切口并发症发生率分别为:9.62%,18.92%。经统计比较有差异性(P<0.01)。结论:在跟骨骨折的开放手术治疗中,对皮瓣采用拉钩牵开较克氏针固定牵开的病人术后切口的并发症发生率低。在应用跟骨外侧"L"形延长切口时宜采用拉钩动态牵开皮瓣。     

关节镜下距下关节融合术治疗终末期距下关节炎的疗效分析

目的评价关节镜下距下关节融合术治疗终末期距下关节炎的临床疗效。方法 2008年10月至2013年10月本科以关节镜下距下关节融合术治疗终末期距下关节炎共14例14踝,其中男性12例,女性2例,平均年龄35.5岁。包括创伤性关节炎11例,类风湿性关节炎3例。术中采用后侧入路,全镜下切除后距下关节软骨面及部分软骨下骨面。在骨面上微骨折后,透视引导下置入2枚直径7.0 mm的空心螺钉进行固定。术前及术后随访AOFAS评分及VAS评分。结果 14例患者均获得随访,随访时间平均41个月。术后8周X线片显示后距下关节均已获得骨性融合。AOFAS评分从术前53.8分改善至术后89.2分,VAS评分从术前7.8分降低至术后1.5分。结论全关节镜下距下关节融合术治疗终末期距下关节炎融合率高,并发症少,可以获得良好的临床疗效。     

跟骨关节内骨折的钛板治疗临床分析

目的 探讨跟骨骨折波及距下关节行钛板内固定的手术方法 和疗效.方法 我院2011年1月—2014年12月对58例82足累及距下关节的跟骨骨折行切开复位钛板内固定术,分析其治疗及随访情况.结果 全部获得3个月~2年的随访,疗效满意.结论 切开复位钛板内固定术可作为波及距下关节跟骨骨折的首选治疗方案.     

波及距骨下关节面的跟骨骨折的手术治疗

目的探讨波及距骨下关节面的跟骨骨折的治疗。方法波及距骨下关节面的跟骨骨折32例，均采用切开复位异形钢板内固定术，同时行髂骨或人工骨植骨。结果32例患者均获5～40个月，平均16个月的随访，按Creighton—Nebraska评分标准，优良25例，中5例，差2例。结论采用切开复位异形钢板内固定术，同时行髂骨或人工骨植骨治疗波及距骨下关节面的跟骨骨折，效果较好。     

外侧入路关节镜辅助微创距下关节融合

目的 探讨外侧入路踝关节镜辅助微创距下关节融合术(ASA)的临床效果。 方法 对21例距下关节炎的患者行单肢外侧入路踝关节镜辅助微创距下关节融合(ASA)术。观察汇总患者术前及术后美国足踝外科协会评分(AOFAS)、视觉模拟评分(VAS)、融合率、优良率、并发症及融合时间。行X线及CT检查观察距下关节融合情况。 结果 21例患者均成功随访。随访12~41个月,平均(22.7±4.2)个月。随访期间无感染、坏死、退行性关节炎、血管神经损伤、螺钉断裂等并发症发生,出现踝外侧撞击疼痛1例、螺钉尾帽刺激1例、胫后神经部分损伤1例。21例患者X线均提示骨性融合,平均融合(8.3±0.5)周。AOFAS评分由术前的(41.73±3.87)分提高至末次随访的(83.24±3.65)分,差异有统计学意义(P<0.01);末次随访评分较差1例、中1例、良1例、优18例,优良率为90.48%。VAS评分由术前的(6.5±1.2)分变为末次随访的(1.5±0.4)分,差异有统计学意义(P<0.01)。 结论 外侧入路踝关节镜辅助微创距下关节融合具有创伤小、术后恢复快、并发症少、融合率高、效果确切等优点,是治疗距下关节病变的有效方法。     

经皮撬拨固定治疗跟骨折17例

自 1995年 5月— 2 0 0 0年 5月 ,我们应用经皮撬拨 ,电视Ｃ -型臂监视下复位固定 ,治疗粉碎性跟骨折 17例。效果满意 ,报告如下。1　临床资料1.1一般资料　本组 17例 ,男 15例 ,女 2例 ,右侧 13例 ,左侧 2例 ,双侧 2例。年龄 2 1～ 46岁 ,平均 32岁。高处坠落伤12例 ,下楼时踩空摔伤 2例 ,扭伤 1例 ,车祸 2例。 17例骨折均涉及距下关节面 ,1例跟骨呈前后劈裂性骨折。1.2　手术方法　腰麻 ,跟骨结节后缘平行穿入 4ｍｍ斯氏针2根 ,进入跟骨至距下关节处 ,然后电视下向远端撬拨 ,恢复Ｂｏｈｌｅｒ角 ,再将斯氏针向上打入距骨或舟状骨。使复位…     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

A preliminary screening study on the associated proteins in human psoriasis vulgaris by serum proteomics technologies

Objective：To investigate the optimum screening conditions of associated proteins in human psoriasis vulgaris by serum proteomics technique, and to screen the different expression proteins related with psoriasis vulgaris. Methods：Serum samples of peripheral blood were collected from newly diagnosed psoriasis vulgaris patients in the clinic, and 20 matched healthy persons. Serum albumin IgG was removed by filtering with ProteoExtract Albumin/IgG. After comparative proteomics analysis the different protein spots were identified using 2-DE and MS. Results ：Electrophoresis figures with high resolution and reproducibility were obtained. Three different expression proteins were found only in the serum from psoriasis vulgaris patients, while nine other different proteins expressing from healthy volunteers. Conclusion：The protein expression was different in the serum between the psoriasis vulgaris patients and healthy volunteers. It was hoped that we could find the biomarkers related to psoriasis vulgaris by using proteomics.     

A CASE OF HUGE GASTRIC DISOPYROBEZOAR

PYTOBEZOARS are common bezoars in gastrontestinal tract, commonly seen in stomach and mall intestine,1but huge disopyrobezoars are     

Acupuncture Treatment of Chest Bi Syndrome

CASE HISTORY A male,a retired officer of 61 years old,paid his first visit on May 12,2006.The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain,with irregular attacks.Each attack would last several seconds to several minutes.The attack was accompanied with heavy oppressed sensation in the precordial region,palpitation,lassitude,and in severe cases,sweating,which was once diagnosed by a hospital as'coronary heart disease'.Recalling the case history,the patient said that several days before he got angry with others because of some affairs in work,and he was not so used to the life pattern since he had just retired from his busy working post.At usual times,he was quick tempered and peevish.In recent days,he had poor appetite,and loose stool.     

Instructions to Contributors

The English edition of Chinese Journal of Integrative Medicine is edited and published by the Chinese Journal of Integrated Traditional and Western Medicine Press.Original scientific papers of advanced clinical and experimental medicine in the field of complementary/alternative medicine or integrative medicine are expected.