旋转臂自锁式髓内钉置入治疗胫骨骨折29例

背景：由于胫骨解剖的特殊性,骨折后治疗方法较多并各有优缺点。 目的：观察旋转臂自锁式髓内钉置入内固定治疗胫骨骨折的临床效果。  方法：选择贵州省黔西南州医院骨一科收治的胫骨骨折患者29例,其中闭合性骨折26例,开放性骨折3例(均为GustiloⅠ型),均采用旋转臂自锁式髓内钉置入内固定治疗。以X射线平片观察骨折愈合及并发症发生情况。 结果与结论：29例患者均获得随访,随访时间12~24个月,治疗后切口均获Ⅰ期愈合,髓内钉置入内固定后6~18个月复查X射线片,骨折线消失,骨痂生长良好。未发生切口感染、创伤性滑膜炎、髓内钉松动及骨不愈合,膝踝关节伸屈功能及行走正常。根据Johner-Wruh功能评定标准,优11例,良16例,中2例,优良率为93.3%。提示旋转臂自锁式髓内钉具有内固定牢靠、操作简单、骨折愈合率高等优点,是治疗胫骨骨折比较理想的方法。     

Integrating nursing education into a trauma outreach program

A level 1 trauma center is challenged to provide optimal trauma care to patients in the region it serves. One approach is to increase the knowledge and clinical skills of all trauma care providers, especially those who work outside urban areas. This article describes one trauma center's experience of integrating rural nursing education into an existing medical trauma outreach program. The educational strategies, examples of course content, and organizational aspects of the program are described, along with marketing strategies used to promote the program.     

前路单钉棒系统内固定在超长节段相邻多椎体柱结核治疗中的应用观察

[目的]评价前路单钉棒系统内固定在超长节段相邻多椎体脊柱结核治疗中的应用价值。[方法]2007年3月～2009年12月对9例胸腰椎超长节段相邻多椎体结核患者行前路一期病灶清除植骨融合,单钉棒内固定治疗。术前采用标准化疗方案,术中彻底清除病灶、椎体间植骨,椎体侧前方单钉棒系统固定重建脊柱稳定,术后规则抗痨治疗18个月。[结果]全部病例得到随访16～48个月,平均27.3个月。8例1次治愈;1例复发并窦道形成,经再次病灶清除后治愈。术后3～5个月血沉及C反应蛋白逐渐恢复正常。术后融合节段后凸角17.3°±4.4°,终末随访时畸形矫正角度丢失3.4°±2.2°。CT证实植骨于术后3个月开始出现融合,随访期间未发生植骨块或内固定松动移位。6例不完全截瘫患者术后12个月神经功能恢复正常。[结论]超长节段相邻多椎体结核病变范围广,侵犯椎体多、破坏重,脊柱稳定性差。前路病灶清除、植骨融合并单钉棒内固定具有重建脊柱的稳定性、提高植骨融合率、达到早期安全功能锻炼及降低总体医疗费用等优点,为该类患者的外科治疗提供选择,具有较高的临床应用价值。     

Cementless total hip arthroplasty with structural allograft for massive acetabular defect in hip revision

Objective： To study retrospectively 20 hip revison patients treated by cementless total hip arthroplasty with structural allograft. Methods： Twenty patients suffering from aseptic loosening of an uncemented cup complicated by a large defect underwent cementless total hip arthroplasty with structural allograft and were followed up for at least 5 years. Clinical results were evaluated by Harris score and leg length measurements. Radiographic analysis included implants migration, graft absorbance, osteolysis and liner wear. Results： No cup loosening or graft reabsorption was found at final follow-up. Clinical improvements in pain and functional status were demonstrated during the follow-up period. The mean Harris hip scores improved from 29 preoperatively （range 20-41） to 81 postoperatively （range 73-89）. Conclusion： Our study shows that cementless total hip arthroplasty with allograft is a good way for massive defect in aeetabular bone stock.     

重度僵硬脊柱侧后凸截骨策略量化标准的探讨

目的 探讨重度僵硬脊柱侧后凸截骨策略的量化标准.方法 对2012年5月至2020年5月贵州省骨科医院脊柱外科采取牵引后手术治疗的重度脊柱侧凸患者63例的临床资料进行回顾性分析.其中男30例,女33例,年龄(19.8±5.0)(13～34)岁.主弯顶椎位于胸段43例,胸腰段9例,腰段 11 例;主弯冠状面 Cobb 角(...     

Predictive value of capnography for severity of acute gastroenteritis in the emergency department

ObjectiveThis study first aims to assess the utility of ETCO2 levels in evaluating the severity of dehydration in adult patients that present to the ED with acute gastroenteritis. AGE. Second, it intends to evaluate the correlation between ETCO2 and several metabolic parameters: creatinine, pH, bicarbonate (HCO3), and bases excessive (BE).MethodThis prospective study was conducted with AGE patients in the ED of a training and research hospital between June 2018 and April 2019 after approval of the local ethical-committee. The two groups were defined according to the severity of AGE: mild and non-mild groups. For both groups, ETCO2 levels were measured and recorded on admission of the patients.Results87 patients were included in the analyses. The median of ETCO2 values was found as lower in non-mild group than mild group; 30 (25–35) & 39 (33–34), respectively (p < 0.001). In ROC analysis for distinguishing between the both groups, the AUC value was found to be 0.988 and the best cut-off level was found as 33.5 with 95% sensitivity and 93% specificity. In addition, strong negative correlation between ETCO2 and creatinine (p < 0.001, r: −0.771) were found.ConclusionETCO2 levels decreased in the non-mild group of AGE patients; it could be useful to distinguish the mild group from the non-mild group. ETCO2 could be a reliable marker in predicting AKI in the management of AGE patients.     

头盆环牵引后截骨矫形治疗重度脊柱侧后凸伴骨性脊髓纵裂的安全性与疗效

【摘要】 目的：探讨头盆环牵引后截骨矫形治疗重度脊柱侧后凸伴骨性脊髓纵裂的安全性及临床疗效。方法：2012年8月~2019年8月我院收治8例重度脊柱侧后凸伴骨性脊髓纵裂患者,均行头盆环牵引后截骨矫形治疗,未行骨性纵裂切除。随访时间为12～36个月（20.33±8.11个月）。分析牵引时间,牵引前、后与矫形术后、末次随访时的身高、体重、主弯冠状面Cobb角、矢状面Cobb角,牵引前、后及矫形术后肺活量（vital capacity,VC）、用力肺活量（forced vital capacity,FVC）、第一秒用力呼气量（forced expiratory volume in one second,FEV1）、FEV1/FVC（%）、PO2、PCO2、三头肌皮皱厚度、血清白蛋白浓度、血清转铁蛋白浓度等指标。结果：8例患者牵引时间为22~49d（32.13±7.66d）。牵引前身高143~165cm（155.13±6.28cm）,牵引后身高156~175cm（167.88±4.66cm）,增高12.75±2.11cm,矫形术后及末次随访时身高无明显变化。牵引前体重47.20±4.55kg,牵引后48.84±4.19kg,体重增加1.92±0.32kg,矫形术后49.21±4.22kg,末次随访时50.32±5.36kg,体重随营养状态改善逐渐增加。牵引前主弯冠状面Cobb角92°~176°（119.50°±15.13°）,牵引后46°~66°（54.88°±5.88°）,矫正率39％~68%[（53.55±7.76）%];矫形术后43°～66°（51.34°±7.47°）,矫正率40％~72%[（58.54±8.87）%];末次随访时矫正角度无丢失。牵引前矢状面Cobb角62°~132°（91.13°±10.23°）,牵引后29°~51°（40.48°±6.32°）,矫正率46％~71%[（51.17±12.14）%];矫形术后30°～55°（36.11°±6.19°）,矫正率47％~72%[（52.55±12.69）%];末次随访时矫正角度无丢失。牵引前VC为3.75±0.26L,牵引后4.20±0.04L,改善率为（12.85±7.72）%,矫形术后4.22±0.05L。牵引前FVC为3.65±0.26L,牵引后4.14±0.04L,改善率为（14.21±8.30）%,矫形术后4.16±0.04L。牵引前FEV1为3.34±0.22L,牵引后3.54±0.15L,改善率为（6.44±2.78）%,矫形术后3.54±0.15L。牵引后及矫形术后FEV1/FVC、PO2、PCO2均回归正常范围。牵引后较牵引前三头肌皮皱厚度改善（11.55±4.60）%,白蛋白浓度改善（21.96±7.75）%,转铁蛋白浓度改善（23.13±8.51）%;矫形术后较牵引前三头肌皮皱厚度改善（14.12±4.97）%,血清白蛋白浓度改善（23.12±7.87）%,血清转铁蛋白浓度改善（25.43±8.18）%。所有患者牵引中及矫形术中、术后均未出现不可逆性神经功能损伤,牵引过程中均未出现钉道松动、感染等并发症。末次随访时均未出现内固定移位、松动及断裂。结论：头盆环牵引后截骨矫形治疗重度脊柱侧后凸伴骨性脊髓纵裂安全有效,可避免风险更高的骨嵴切除术,不失为首选方案之一。     

Saving the foot: Simple orthopaedic surgical intervention demonstrates improved outcomes and reduced costs

BackgroundForefoot ulceration in diabetes requires significant resources, with high cost and low rates of success. The authors present the results of tendon procedures (percutaneous toe tenotomy and percutaneous tendo-achilles lengthening) under local anaesthetic to adjust mechanics in patients with diabetic neuropathic forefoot ulceration.MethodsRetrospective review of electronic patient record of 19 patients (22 feet) undergoing local anaesthetic tendon procedures between April 2019 and April 2021 with a 12 month follow up period. Size of ulcer, rate of ulcer healing, complication rates and ulcer recurrence were recorded and compared to a population of conservatively-managed patients (14 patients, 15 feet) treated prior to the introduction of tendon procedures. All clinical information obtained from electronic patient records.ResultsAll patients undergoing tendon procedures achieved complete ulcer healing at a mean time of 3.3 weeks for toe tip ulcers (after toe tenotomy) and 4.5 weeks for metatarsal head ulcers (after Achilles lengthening). There were no admissions for diabetic foot sepsis, reduced recurrence, reduced amputation rates and no mortality.Of the conservatively managed cohort, only 3 of the 15 achieved ulcer resolution without recurrence within the 12 month study period.The cohort managed conservatively had an average cost of £ 9902 per patient, per annum. The intervention cost was £ 1211 per patient, saving an average of £ 8691 per patient, per annum with ulcer resolution (88 % reduction in costs).ConclusionSignificant patient benefit, reduction in resource use and cost saving was seen with this simple intervention, which merits full evaluation in a clinical trial.Level of EvidenceLevel-IV     

混合现实技术在骨肿瘤精准化外科治疗中的应用

目的 探讨混合现实技术在骨肿瘤精准外科治疗中的应用价值。方法 回顾性分析2018年9月—2019年3月辽宁省肿瘤医院14例骨肿瘤患者临床资料,其中男7例、女7例,年龄13~57岁、平均32岁。肿瘤部位股骨远端4例、胫骨近端3例、肩胛骨3例、骨盆2例、肱骨近端1例、锁骨近端1例。恶性肿瘤11例,其中骨肉瘤6例、软骨肉瘤2例、横纹肌肉瘤1例、转移癌2例;良性肿瘤3例,其中骨巨细胞瘤1例、骨母细胞瘤1例、嗜酸细胞肉芽肿1例。所有患者术前采用640层螺旋CT扫描仪行肿瘤部位增强三维重建,收集患者CT 原始DICOM 数据,将其导入到三维医学影像工作站进行分割、重建、材质设定,通过“星图”混合现实影像系统获得全息影像数据。术前应用全息影像制定个体化手术方案,术中采用全身麻醉,按照术前规划完成手术。观察患者手术时间、术中出血量、术后并发症发生情况、肿瘤安全外科边界,假体置换患者对比术前、术后双下肢肢体长度差,末次随访采用肌肉骨骼肿瘤学会(MSTS)93评分标准对患肢功能进行评价。结果 本组中14例患者在混合现实技术引导下准确定位,完整切除肿瘤组织。手术时间60~180 min,平均133 min。术中出血量50~1 100 mL,平均364 mL。术后均无切口感染、皮肤坏死等并发症发生。6例行膝关节肿瘤型假体置换患者术前测量双下肢长度差1.3～6.5(3.70±1.87)mm,术后测量双下肢肢体差为1.7～4.9(2.95±1.24)mm,术前、术后双下肢肢体长度差比较,差异无统计学意义(t=0.672, P>0.05)。术后第3天复查MR检查或CT扫描评价外科手术边界,肿瘤完整切除,内固定物位置良好。14例患者均获随访,随访时间15～20个月,平均16个月。至末次随访MSTS评分为17～28分,平均23.9分;患肢功能优7例,良2例,可5例。随访期间14例患者无一例死亡,未见肿瘤复发及转移。结论 通过混合现实技术提供的立体直观、全方位病变部位的解剖细节,可以辅助骨肿瘤患者术前手术规划,提高术中肿瘤切除精确性、安全性及组织重建的有效性,实现了骨肿瘤手术规划的可视化、个体化,具有临床推广价值。