高值耗材的溯源管理

目的：实现对高值耗材的溯源管理。方法：通过对HIBC编码的解读达到向上溯源的目的,通过对闭环网络的开发达到向下溯源的目的。结果：通过高值耗材向上、向下的溯源可以做到对于高值耗材完整的追踪,减少由于信息传输错误造成的损失。结论：高值耗材的溯源管理能够满足卫生部门规定的要求,减少由于耗材错误造成的医疗事故。     

大型医用设备的管理

目的：依据法律法规探讨大型医用设备的管理.方法：结合实际情况与相关法律法规的要求对大型医用设备进行规范化管理.结果：提出了大型医用设备管理中出现的问题及规范化的管理措施.结论：大型医用设备的管理对保障医疗安全和预防医疗事故的发生具有重要作用.     

医学装备的信息化管理

分析了目前医学装备在信息化管理过程中遇到的困难,应用商品在物流管理中的方法与原理,并通过借鉴国际通用标准,制定了符合医院实际管理工作需要的编码,开发了符合部门规定的医学装备信息化管理系统,以实现全院医学装备的数字化管理,解决医院医学装备管理混乱的现状.     

带蒂深筋膜重建环状韧带治疗陈旧性单纯桡骨头脱位

目的 探讨带蒂深筋膜重建环状韧带治疗陈旧性单纯桡骨头脱位的临床效果.方法 2004年1月至2009年1月共治疗10例小儿陈旧性单纯桡骨头脱位.年龄5～16岁,平均9.7岁.采用带蒂深筋膜重建环状韧带,术后按照Broberg-Morrey肘关节评分标准进行功能评价.结果 术后随访1～6年,平均2.5年.肘关节功能评分:优4例(占40%),良5例(占50%),差1例(占10%);优良率为90%.结论 对于小儿陈旧性单纯桡骨头脱位,应用带蒂深筋膜重建环状韧带,有利于维持肱桡、尺桡关节对合关系,可以尽最大可能地恢复肘关节功能.但对于14～16岁以上的少年,尤其在骨骺闭合之后,应慎行此手术.

Abstract：

Objective To evaluate the clinical outcomes of treating chronic isolated radial head dislocation by reconstruction of annular ligament with pedicled deep fascia. Methods Ten children with chronic radial head dislocation were treated between January 2004 and January 2009. The patients varied in age from 5 to 16 years (mean 9.7 years). They were treated by reconstruction of annular ligament with pedicle deep fascia. A clinical and radiographic assessment was undertaken at follow-up. The results were rated according to the Broberg-Morrey scoring for elbow function. Results All cases were follow-up for 1 to 6 years, the average follow-up time being 2.5 years. According to the Broberg-Morrey elbow function scores, the results were rated excellent in 4 cases (40%), good in 5 cases (50%), and poor in 1 case ( 10% ). The overall satisfactory rate was 90%. The range of functional motion and carrying angle was restored in all ten patients. No complications,such as recurrent dislocation, infection, or neurovascular injury were observed. Conclusion Reconstruction of annular ligament with pedicled deep fascia in pediatric chronic isolated radial head dislocation is fundamental to obtain stable reduction of the dislocated radial head, maintain humeroradial and ulnoradial alignment, and restore elbow function. However this procedure should be considered with caution for patients older than 14 to 16 years especially when their epiphyseal plate is closed.     

Inverted V-shaped valgus osteotomy for congenital coxa vara

Objective To assess the outcome of inverted V-shaped valgus osteotomy as a treatment for congenital coxa vara in children. Methods Between Feb. 1990 and Jan. 2000,27 patients (35 hips) with congenital coxa vara underwent inverted V-shpaed valgus osteotomy. There were 16 males and 11 females. The average age was 7. 8 years (range:3 to 14 years). They all presented with limp or concomitant pain in the older children. The clinical result was evaluated according to Shi's criteria. The X-ray films of preoperative, postoperative and the most recent follow-up periods were analyzed. Results Twenty-two patients (28 hips) were followed-up for a mean of 5. 4 years (14 months to 9 years). According to Shi' s criteria, the excellent and good results accounted for 82. 1 % of cases. The preoperative NS angle, HE angle and ATD value were 94.5° ±9.1° ,67.2° ± 1.8° and - 3.8 mm ± 6. 9 mm respectively whereas those of the immediate postoperative were 148.0° ± 6.5°, 28.6° ± 4.3° and 27.5 mm ± 3. 1 mm; and the     

快速 DTI 在急性颈髓损伤的临床应用

目的：研究扩散张量成像(DTI)在急性颈髓损伤(CSCI)的成像特点,评估其临床应用价值。方法本组8例 CSCI 患者(发病72 h 内)均采用3.0T 磁共振仪进行快速颈髓 DTI 扫描,并在工作站进行扩散张量纤维束成像(DTT)。同时,在工作站分别测量并计算颈髓病变区及上下相对正常区的各向异性(FA)值和表观扩散系数(ADC)值,之后进行统计学组间配对 t 检验分析(SPSS 13.0)。结果急性 CSCI 以 C5~C6节段(占4/8)和 C4~C5节段(占3/8)多见,且快速 DTI 均获得了较好的图像质量。急性 CSCI 时病变区 FA 值和 ADC 值均明显低于相对正常区域数值(P <0.01),相应在 FA 图和 ADC 图均表现为低信号,而上下相对正常区 FA 值和 ADC 值间无明显区别;同时,DTT 有利于显示刀刺伤导致的颈髓纤维束断裂,颈髓闭合伤则主要表现为脊髓纤维束紊乱等。结论3.0T 快速 DTI 序列可以在2 min 扫描时间内获得临床较为满意的诊断图像,并通过 FA 值和 ADC 值更敏感地反映急性 CSCI 后髓鞘损伤导致的 FA 改变及细胞毒性水肿和血管源性水肿导致的水分子扩散的变化。     

医疗器械的分类管理

介绍了医疗器械的安全性分类,阐述了医疗器械流通环节的分类及代码管理,分析了一次性使用无菌医疗器械、消毒产品、一次性使用医疗用品、一次性卫生用品4个方面的管理,提出了制定不同的管理制度及管理标准来对医疗器械进行规范化管理,为医疗器械的分类管理提供了借鉴.     

发育性髋关节脱位患儿术后股骨骨密度的变化及临床意义

目的 研究发育性髋关节脱位患儿手术前后股骨骨密度的变化,讨论术后患儿发生骨折的可能性及如何减少骨折的发生.方法 采用美国Norland XR46骨密度扫描仪,以双能X线吸收法测定92例发育性髋关节脱位患儿在手术前及术后2、4、6个月的双侧股骨骨密度.同时测定15名健康儿童骨密度值,作为对照.结果 术前手术组与对照组的股骨骨密度无明显差异,手术组患儿双侧股骨骨密度无明显差异.92例患儿术后2个月手术侧股骨骨密度均明显下降(平均值自0.5178±0.0829降至0.2878±0.0674),至术后6个月出现不同程度的恢复(平均值恢复至0.4927±0.1073).结论 接受髋关节切开复位手术患儿,术侧股骨骨密度在术后2个月内出现明显降低,拆除石膏后逐渐恢复,术后6个月股骨骨密度仍明显低于正常,此期间为功能锻炼期,易发骨折.

Abstract：

Objective To analyze the risks and treatments of post-operative fracture by assessing the femoral bone mineral density in the children with developmental dislocation of hip. Methods The Norland XR46 bone densitomer system (USA) was employed and dual X-ray absorptiometry was employed to measure the bilateral femoral density of 92 children with developmental dislocation of hip pre-operatively and,2,4 and 6 months post-operatively. Results All 92 children demonstrated significant femoral bone mineral density reduction on the operated side 2 months posts-operatively (from 0. 5178 ± 0. 0829 to 0. 2878 ± 0. 0674). They recovered to different degree after 4 months after removing plaster and internal fixation plate (the average recoved to 0. 4927 ± 0. 1073). Conclusions The mineral density of the femur in children who underwent operative reduction for developmental dislocation of the hip joint decreased significantly 2 months post-operatively. It recoverd after the removal of the plaster. The femoral bone density during this period was lower than normal and it is susceptible to fracture.     

髂腰肌盆底悬吊术结合Malone顺行灌肠治疗神经性大便失禁

目的 探讨髂腰肌盆底悬吊术结合Malone顺行灌肠治疗神经性大便失禁的临床价值。方法 选择由脊髓发育不良所致的神经性大便失禁14例（年龄4～13岁），均行双侧髂腰肌悬吊盆底加强术和阑尾造口术，术后配合顺行灌肠治疗。结果 14例获得随访6～16个月（平均10.4个月），术前术后临床主客观评分有显著性差异，术前术后直肠静息压无明显变化；直肠感觉阈、肛管直肠压差、肛管高压区长度和主动收缩压均有明显变化，2例因造瘘口狭窄未能坚持顺行灌肠。结论 髂腰肌盆底悬吊术结合Malone顺行灌肠是治疗神经性大便失禁的有效方法，可明显改善患儿的生活质量。     

先天性马蹄内翻足的病因

先天性马蹄内翻足是小儿常见足部畸形 ,有关马蹄内翻足的病因未完全确定 ,主要有以下几个方面。1　遗传因素研究发现 ,先天性马蹄内翻足的发病率中国人为0 .39‰ ,高加索人为 1.2‰ ,波利尼西亚人为 6 .8‰。L ochmiller等最近报道该病男女之比为 2 .5∶ 1。另外 ,马蹄内翻足畸形的患儿其同胞患病几率增加 30倍 ,两位同胞同时患病在单卵双生中的几率为 32 .5 % ,而在双卵双生中仅为2 .9%。上述研究结果提示先天性马蹄内翻足的发病至少部分受遗传因素的影响 ,其遗传模式被称作复合性遗传 ,有以下特点 :1多基因遗传 ;2有非遗传因子如环境、毒…