逆行交锁髓内钉结合CPM治疗股骨远端骨折24例

目的：总结应用逆行交锁髓内钉内固定结合CPM治疗股骨远端骨折的疗效及经验。方法：应用逆行交锁髓内钉固定股骨远端骨折,术后配合CPM行患肢膝关节功能锻炼。结果：24例术后随访5～20个月,平均10个月。骨折愈合时间为3～5个月。膝关节功能恢复良好,优良率83.3％,无畸行愈合、不愈合、断钉、感染等并发症。结论：采用逆行交锁髓内钉结合CPM治疗股骨远端骨折,固定坚强并发症少,利于骨折愈合及关节功能恢复,是理想的治疗方法。     

Improved T cell assay for identification of type 1 diabetes patients

Diabetes mellitus is comprised primarily of two clinically separate diseases: type 1 (T1D) and type 2 diabetes (T2D). T1D is a cell-mediated autoimmune disease directed against the beta cells and characterized by autoantibody (Ab) and T cell reactivity to islet proteins whereas, T2D is non-autoimmune. Despite the fact that the pathological process in autoimmune diabetes involves T cells, immune markers of diabetes have primarily centered on the presence of circulating serum islet autoantibodies. In two masked NIH sponsored workshops, our cellular immunoblotting T cell assay, which uses isolated human islets separated into 18 molecular weight fractions, has been validated to be able to distinguish T1D patients from controls with excellent specificity and sensitivity. In this study, we utilized the first workshop to select eight molecular weight fractions of human islets that were the most discriminatory between T1D patients and controls. Using these eight molecular weight fractions identified in the first workshop, we validated the preferential recognition of these 8 blot sections in a second workshop. We then re-calculated the sensitivity and specificity of the cellular immunoblotting assay for both workshops using only the data from these 8 blot sections. We observed increases in both sensitivity and specificity compared to the original workshop data for both workshops. The use of 8 instead of 18 molecular weight regions allows for a significant reduction in the amount of blood needed from patients, thus allowing cellular immunoblotting to be performed on pediatric patients participating in immunomodulatory studies. This improved T cell assay, which directly measures islet reactive T cell responses in autoimmune diabetes patients with excellent sensitivity and specificity, will likely improve patient follow-up during intervention studies.     

Nutritional status and cognitive performance of mother–child pairs in Sidama,Southern Ethiopia

The purpose of this study was to assess the nutritional status and cognitive performance of women and their 5‐year‐old children using a cross‐sectional design. Cognitive performance of mothers and children was assessed with Raven's Colored Progressive Matrices (CPM) and Kaufman Assessment Battery for Children‐II (KABC‐II). Demographic characteristics, food consumption patterns and anthropometry were also measured. Four rural districts in Sidama, southern Ethiopia served as the setting for this study. Subjects were one hundred women and their 5‐year‐old children. Mean ± standard deviation age of the mothers was 29 ± 6 years and family size was 7.0 ± 2.6. Maternal body mass index (BMI) ranged from 15.3 to 29.0 with 14% of the mothers having BMI < 18.5. Anthropometric assessment of children revealed 29% to be stunted (height‐for‐age z‐score < ?2) and 12% to be underweight (weight‐for‐age z‐score < ?2). Mothers' education significantly contributed to prediction of both mothers' and children's cognitive test scores. There were significant differences in mean cognitive test scores between stunted and non‐stunted, and between underweight and normal‐weight children. Height‐for‐age z‐scores were correlated with scores for short‐term memory (r = 0.42, P < 0.001), and visual processing (r = 0.42, P < 0.001) indices and weight‐for‐age z‐scores were also correlated with scores of short‐term memory (r = 0.41, P < 0.001) and visual processing (r = 0.43, P < 0.001) indices. Malnutrition in the community likely contributed to the cognitive performance of the subjects. Performance on memory and visual processing tasks was significantly lower in children with growth deficits suggesting that efficient and cost effective methods to alleviate malnutrition and food insecurity would impact not only child health but also cognitive function.     

不同康复疗法对人工膝关节置换术后早期功能恢复的影响

目的：观察不同康复疗法人工膝关节置换术后早期膝关节功能恢复的临床疗效。方法：将45例患者按随机数字表法分为主动康复组、被动康复组和系统康复组。主动康复组采用主动康复训练,被动康复组采用被动康复训练,系统康复组治疗则以主动康复训练联合CPM机的被动康复训练为主,在进行患者主动康复训练前,先使用CPM机进行锻炼。治疗后采用AKSS标准对康复疗效进行评估并比较三组疗效。结果：在人工膝关节置换术的早期功能康复临床疗效观察中,在改善膝评分方面,主动康复组与采用CPM的被动康复组比较无明显差异,但被动康复组在膝功能评分明显低于主动康复组,而集主动康复与CPM锻炼于一体的系统康复疗法可收获最佳的膝评分与功能恢复效果。结论：主动康复疗法与被动康复疗法各具所长,而系统康复疗法可综合二者优势,在改善术后膝关节活动度,恢复膝关节屈伸膝肌群整体肌力等方面疗效显著,并可尽最大程度恢复膝关节功能。     

CPM在膝关节骨折术后应用的临床护理

目的探讨CPM在膝关节骨折术应用临床效果和护理体会。方法在膝关节骨折术急性期后即应用CPM活动器,使膝关节行被动的持续的活动,配合股四头肌主动舒缩活动,做好相应护理。结果本研究中68例患者效果满意,膝关节术后功能恢复良好。结论 CPM的应用可有效防止膝关节内粘连、僵硬强直,并促进损伤的软骨再生与修复,利于骨折的愈合与关节功能的恢复。     

关节镜下肘关节松解术的护理及功能锻炼

肘关节活动障碍多是继发于急性关节损伤或慢性关节劳损的退行性改变。主要表现为关节伸屈及旋转受限伴活动疼。传统的关节切开清理松解手术,自关节两侧切开,切口大,术后血肿、易造成血管神经损伤及再粘连,出现骨化性肌炎。近年来国内关节镜下治疗肘关节活动障碍的优点已逐渐被骨科医生们认可,我院自2001年2月至2009年4月,共对38例肘关节活动受限患者施行了镜下松解术,效果较为满意,现将松解术后指导功能锻炼和康复护理体会总结如下。     

CPM对骨折后肘关节功能障碍的疗效观察

目的：观察关节持续被动活动（CPM）治疗骨折后肘关节功能障碍的效果。方法：63例骨折后肘关节功能障碍患者分为CPM组33例和对照组30例,均采用常规康复治疗。CPM组加用CPM。结果：治疗2个月后,CPM组患者肘关节活动范围及有效率均明显优于对照组（P〈0.05）。结论：CPM能显著提高骨折后肘关节功能障碍的疗效。     

Central pontine myelinolysis

A 9 year old boy presented with fever, drowsiness, quadriparesis and facial myokymia. MRI showed demyelination in the pontine region. A diagnosis of central pontine myelinolysis was made. Literature review revealed the rarity of uneventful recovery as has been seen in our case.     

AO技术结合CPM功能锻炼等综合治疗肱骨髁间骨折

目的 探讨AO技术结合CPM功能锻炼等综合治疗肱骨髁问骨折的效果。方法：12例肱骨髁间骨折按AO／ASIF分类，C13例，C2 6例，C3 3例，均采用后路舌状瓣入路切开复位，髁间用拉力螺钉固定，内髁后部予钢板固定。关节内应用SH(玻璃酸纳)，术后早期CPM功能锻炼。结果 平均随访一年，骨折全部愈合，平均愈合时间五个月。1例并发骨化性肌炎，无切口感染、肘内翻畸形及迟发性尺神经炎。肘关节功能优良率为91％。结论：AO技术结合早期CPM功能锻炼等综合治疗肱骨髁间骨折疗效显著。