Precontoured Locking Compression Plate with Titanium Alloy Cable System: In Treatment of Neer Type IIb Distal Clavicle Fracture

ObjectiveTo describe a new method which involves anatomical distal clavicle plate fixation and titanium alloy cable system‐augmented coracoclavicular ligament reconstruction to manage Neer type IIb distal clavicle fracture.MethodsBetween January 2013 and June 2018, 28 patients with acute Neer type IIb lateral clavicle fracture were treated by a new method – precontoured locking compressive distal clavicular plate fixation of the fracture combined with titanium alloy cable system‐augmented reconstruction of the coracoclavicular ligament. There were 11 females and 17 males treated in this way. There were 15 cases of the right side and 13 of the left. The mean age of the patients was 48.5 years (range, 18–78 years). The mean time from injury to surgery was 3.9 days (range, 1–7 days). After completing the preoperative examinations and evaluations, surgeries were performed for all these patients, anatomical distal clavicle plates were used for fractures, and titanium alloy cables were implanted for the augmented reconstruction of coracoclavicular ligaments. Postoperative protocols, including arm sling management and rehabilitative activities, were unified and recommended to all the patients. These patients were followed up for at least 1 year. The mean duration of postoperative follow‐up was 23.3 months (range, 12–52 months). At the last follow‐up, the coracoclavicular distances were recorded and shoulder functional outcomes were assessed by the Constant scores and the Fudan University Shoulder Scores (FUSSs) questionnaires.ResultsRadiographic bony unions were achieved in all patients within 20 weeks. Functional and radiographic outcomes were retrospectively evaluated. The mean coracoclavicular distance was 9.61 ± 0.61 mm on the injured side vs 9.62 ± 0.57 mm on the contralateral uninjured side. The mean Constant score and mean FUSS were 90.1 ± 6.6 (range, 68–98) and 86.1 ± 7.2 (range, 64–95) respectively, which indicating good restoration of function and high level of satisfaction for both the patients and their physical therapists. There were a few major complications, including one delayed healing of the skin, one severe shoulder stiffness, three incidences of moderate shoulder stiffness, and five incidences of symptomatic hardware. There is no deep infections, neurovascular injuried, delayed union or nonunion, peri‐implant fracture, loss of reduction, implant malposition or failure, or other severe complications.ConclusionThis combined method for the treatment of Neer type IIb distal clavicle fracture could yield high bony union rate, good functional outcome, and low complication rate. Further prospective randomized controlled studies are needed to confirm the benefits of this method of treatment.     

计算机3D导航技术在脊柱肿瘤外科治疗中的应用

脊柱肿瘤外科治疗在过去几十年经历了诸多科技变革,包括手术方式、内植入物、生物制剂及计算机辅助下导航技术应用等,特别是实时影像引导和3D影像重建为脊柱肿瘤精准定位和切除提供了理论与技术支撑。术中计算机辅助导航技术已被广泛应用于脊柱疾病的外科治疗中,如椎弓根螺钉置入、骨盆骨折固定等,并取得较好的疗效。导航技术平台的应用也极大提高了脊柱肿瘤微创治疗和精准切除效果,同时降低了术中辐射暴露损伤。本文综述了计算机辅助导航技术在脊柱肿瘤手术切除中的有效性、安全性及发展前景。     

海军某部舰艇官兵骨骼肌肉系统疼痛的流行病学调查与分析

目的调查海军某部大型舰艇官兵骨骼肌肉系统疼痛的发生情况,并分析相关危险因素,为采取有效的防治措施提供科学依据。方法采用横断面和相关性研究设计,通过问卷调查了解官兵一般情况、工作及训练状况、骨骼肌肉系统疼痛发生情况,采用logistic回归分析危险因素。结果所调查的501名官兵中,1年内发生过疼痛较多的部位包括腰背部375例,占74.9%;膝部354例,占70.7%;颈背部336例,占67.1%。对这3个部位疼痛的影响因素进行分析,发现年龄、职务、舰上工作年限、工作部门、每周搬重物次数、每天坐着工作的时间及每周跟产助建次数是不同部位疼痛的危险因素。结论舰艇官兵中骨骼肌肉系统疼痛发病率较高,应积极开展健康教育并及时排查和治疗疼痛。针对可矫正的危险因素,应采取适当的干预措施,进而提高官兵的健康状况和工作能力。     

一种神经源性膀胱排尿报警装置的设计

目的 介绍一种神经源性膀胱排尿报警装置的设计及其工作原理.方法 根据指南针原理设计神经源性膀胱排尿报警装置,通过动物实验对该装置的有效性进行验证.结果 神经源性膀胱排尿报警装置由固定在膀胱前壁的永磁铁和固定在下腹壁的报警仪组成,报警仪由指南针开关、电源、蜂鸣器和电源开关组成.膀胱容量的变化导致永磁铁位置变化,永磁铁位置变化导致报警仪所在点的磁场变化,磁场变化可通过具有指南针功能的报警仪来检测.犬的膀胱从初始状态被充盈到200mL,永磁铁上移距离为31.3～34.1mm,平均32.8mm,报警仪指针旋转47～57°,平均52°,膀胱容量与报警仪指针位置具有一一对应关系,两者成正相关(r=1.0,P<0.01).当膀胱充盈量预设为150mL时,使报警仪开始报警的膀胱实际充盈量为135～160mL,平均147.6mL,误差<15mL(10%).结论 由报警仪和永磁铁构成的神经源性膀胱排尿报警装置能够达到持续监测膀胱容量和报警排尿的目的 ,并具有结构简单、易生产制造、价格便宜、使用方便等优点,值得进一步研究.     

神经源性膀胱排尿报警装置的生物相容性研究

目的 研究神经源性膀胱排尿报警装置采用硅胶包埋永磁铁的生物相容性.方法 根据国家标准GB/T16886医疗器械生物学评价的要求对硅胶包埋的永磁铁进行细胞毒性实验、致敏实验、皮内刺激实验和急性全身毒性实验.采用琼脂扩散法计算永磁铁作用24 h后L929细胞的褪色指数和溶解指数,评价样品细胞毒性.使用样品浸提液对30只雄性豚鼠进行常规诱导和激发,24、48 h观察豚鼠腹侧皮肤的红斑水肿反应等级,评价样品的致敏性.观察2只雄性健康新西兰兔皮内注射浸提液后24、48及72 h局部组织的红斑水肿反应等级,评价样品的皮内刺激作用.观察10只雄性昆明种小鼠经尾静脉注射浸提液后4、24、48及72 h一般状态、毒性表现和死亡动物数,评价样品的急性毒性反应.将永磁铁固定在3条犬的膀胱前壁后2、4及8周,观察犬一般反应和局部病理变化.结果 硅胶包埋的永磁铁具有轻微细胞毒性作用,无致敏作用、皮内刺激作用和急性全身毒性作用.永磁铁植入后,犬耐受性好,精神、食欲及二便无明显异常,切口愈合良好,未发生感染.术后2、4周犬大网膜与膀胱壁在永磁铁周围发生粘连,8周犬下腹壁与膀胱壁在永磁铁周围发生粘连.永磁铁周围的纤维囊壁薄,其下方的膀胱壁增厚,膀胱黏膜面正常.镜下见膀胱壁各层均有不同程度充血和水肿,从浆膜层到黏膜层逐渐减轻.在浆膜层内可见大量的急慢性炎性细胞浸润,血管充血明显,肌层明显增厚,肌间可见少量炎性细胞浸润,血管轻度充血.结论 神经源性膀胱排尿报警装置所采用的永磁铁经硅胶包埋后具有良好的生物相容性,符合临床使用要求.     

Vascular dementia: A microglia's perspective

Vascular dementia (VaD) is a second most common form of age-related dementia. It is characterized by cognitive impairment associated with vascular pathology, symptoms mainly caused by cerebral damage due to inadequate blood flow to the brain. The pathogenesis of VaD is complex, and a growing body of literature emphasizes on the involvement of microglia in disease development and progression. Here, we review the current knowledge on the role of microglia in regulating neuroinflammation under the pathogenesis of VaD. The commonly used animal and cell models for understanding the disease pathogenesis were summarized. The mechanisms by which microglia contribute to VaD are multifactorial, and we specifically focus on some of the predominant functions of microglia, including chemotaxis, secretory property, phagocytosis, and its crosstalk with other neurovascular unit cells. Finally, potential therapeutic strategies targeting microglia-modulated neuroinflammation are discussed.     

Long-term living in unfavorable socioeconomic conditions impairs late-life gait performance.

BackgroundLow socioeconomic status has been associated with individual health-related problems; however, no study has specifically investigated the impact of socioeconomic disparities on gait performance using an index that considers the population aggregation, as the Human Development Index (HDI). Thus, the aim of the present study was to assess gait parameters of older people living in cities with differences in socioeconomic conditions, identified by HDI.MethodsCross-sectional design study conducted with a sample of 233 older people from two Brazilians regions: Coari, state of Amazonas, Brazil (n= 124, low-HDI-Bra) and Ribeirão Preto, state of São Paulo, Brazil (n= 109, very high-HDI-Bra). The gait performance was assessed by an electronic walkway, and the interest variables were gait speed, cadence, stride time, step length and stride width.ResultsLow-HDI-Bra group presented worse gait performance as identified by slower gait speed (p = < .001), slower cadence (p = < .001), higher stride time (p = < .001), shorter step length (p = < .001), compared with the very high-HDI-Bra group. There was a positive association between HDI, and gait spend, cadence and step length, and there was a negative association between HDI and stride time and stride width.ConclusionsLong-term exposure to socioeconomic inequalities found in low HDI cities may impair gait performance in late life. Such information may be relevant to create public politics that use the gait parameter based on the region where the people live.