蔗糖铁联合重组人促红细胞生成素治疗老年股骨粗隆间骨折围术期贫血患者的作用

目的探讨应用蔗糖铁联合重组人促红细胞生成素(EPO)对老年股骨粗隆间骨折围术期贫血恢复及术后功能恢复的影响。方法回顾性对比分析2016年7月至2018年12月于我院行防旋股骨近端髓内钉(PFNA)治疗老年股骨粗隆间骨折治疗患者78例,观察组围术期使用蔗糖铁联合EPO,共40例;对照组围术期未采取其他干预措施。比较两组术后第1天、第3天、第5天、第7天、出院前血红蛋白;术前,术后2周及术后3个月髋关节Harris评分等。结果观察组术后5 d[(98.8±8.6)g/L和(92.2±8.5)g/L,t=3.389,P=0.001]、7 d[(105.4±8.9)g/L和(94.8±8.5)g/L,t=5.370,P=0.000]及出院前[(115.4±8.6)g/L和(100.6±8.2)g/L,t=7.771,P=0.000]血红蛋白高于对照组;观察组术后3个月Harris评分高于对照组[(82.4±3.8)分和(75.8±2.5)分,t=8.933,P=0.000];Pearson相关分析显示,术后第5天,第7天血红蛋白与术后3个月Harris评分呈正相关。出院前Hb对术后3个月Harris评分有影响。结论老年股骨粗隆间骨折围术期联合应用蔗糖铁及EPO能促进患者术后血红蛋白恢复,降低贫血发生率,并加快术后早期功能恢复,提高患者生存质量。     

纤维桩修复离体牙抗折强度的研究进展

纤维桩因其良好的力学性能和生物相容性,在临床上得到广泛应用。临床上纤维桩的抗折强度对纤维桩的固位起着非常重要的作用,因此学者们进行了一系列体外实验研究纤维桩的抗折强度。本文主要从纤维桩的长度、不同桩核系统、纤维桩表面处理等方面对影响纤维桩核抗折强度的因素做一综述,以期能为纤维桩核修复提供一定的临床依据。纤维桩核系统可以增强离体牙的抗折强度,折裂模式均为可修复性,利于牙根的保留,能够满足临床的治疗需要。     

螺旋形长型PHILOS接骨板治疗肱骨中上段骨折的生物力学研究

目的比较长型PHILOS接骨板(Synthes公司,瑞士)扭转成螺旋形前后的生物力学特性,为临床治疗肱骨中上段骨折提供生物力学依据。方法 12例Synbone人工骨(SYNBONE公司,瑞士)的右侧肱骨平均分为两组,对照组(n=6)采用10孔的长型PHILOS接骨板固定,实验组(n=6)采用相同的接骨板扭转成螺旋形后固定。肱骨中上段骨折造模后,利用万能力学试验机分别检测并比较两组接骨板固定后的整体构件在轴向拉伸和压缩、同向和反向扭转、前后及内外向三点弯曲6种加载方式下的生物力学特性。结果在100~500 N拉伸和压缩载荷下,实验组骨折断端位移分别较对照组增加约95%和58%;在0.6~3 N·m反向扭矩下,实验组扭转角度始终明显小于对照组,减少幅度达到55%~64%;在0.6~3 N·m的同向扭矩和1.5~7.5 N·m的前后向弯矩下,实验组的扭转角度和桡度均大于对照组,差异有显著性意义(P0.05);当内外向弯矩为1.5、3 N·m时,实验组与对照组的桡度差别无显著性意义(P0.05),而内外向弯矩为4.5、6、7.5 N·m时,实验组的桡度较对照组小20%~30%。实验组与对照组构件相比,拉伸和压缩刚度分别低49%和36%,同向和反向扭转刚度分别低19%和高150%,内外向和前后向弯曲刚度分别高18%和低70%,差异均有显著性意义(P0.05)。结论长型PHILOS接骨板扭转成螺旋形后固定肱骨中上段骨折的总体力学性能有所改善,可以满足临床对该类骨折的手术固定和术后康复需要。结合微创手术的优势,该技术有望在临床得到广泛应用。     

单、双侧接骨板内固定治疗干骺端粉碎股骨远端骨折的生物力学比较

目的 比较单、双侧接骨板治疗干骺端粉碎股骨远端骨折的生物力学稳定性。方法22根人工股骨标本建立干骺端粉碎股骨远端骨折（AO分型：C2.3）模型,随机分成2组,每组11根。单钢板组用外侧远端解剖锁定板固定,双钢板组外侧用远端解剖锁定板、内侧用直型锁定接骨板固定。每组标本中5根进行垂直加压,3根进行循环垂直加压测试,检测干骺端内侧间隙压缩位移,剩余3根进行极限加压测试,记录固定失败时的最大负荷。结果 垂直加压测试中,单钢板组平均内侧压缩位移为(2.61±0.28) mm,双钢板组为(0.46±0.08) mm。循环垂直加压测试中,单钢板组平均内侧压缩位移为(1.56±0.12) mm,双钢板组为(0.43±0.05) mm。极限加压测试中,单钢板组平均最大负荷为(5 567±338) N,双钢板组为(9 147±186) N,每组差异都有统计学意义（P<0.05)。结论 双钢板固定干骺端粉碎股骨远端骨折的内侧抗压缩能力较单钢板固定显著增强,使股骨远端内侧结构更加稳定,有助于病人早期功能康复锻炼。     

Hip fracture incidence in nursing home residents and community-dwelling older people,Washington State, 1993-1995

OBJECTIVES: To establish and validate a method of linking data from the Minimum Data Set (MDS) and Medicare hospital claims, to estimate hip fracture incidence rates for Medicare beneficiaries aged 65 and older in Washington State, and to compare the incidence rates of hip fractures in nursing home and non-nursing home residents. DESIGN: Retrospective analysis of Medicare population-based enrollment, hospital claims, and nursing home administrative data sets. SETTING: Nursing home and non-nursing home setting. PARTICIPANTS: Medicare beneficiaries in Washington State residing in the community or in skilled nursing facilities. MEASUREMENTS: Crude age- and sex-specific and standardized age- and sex-adjusted hip fracture incidence for persons residing and not residing in nursing homes. RESULTS: From October 1, 1993, through September 30, 1995, 7,812 Medicare beneficiaries aged 65 or older were hospitalized for hip fractures (6,566 fractures for 1,155,234 person-years of exposure in non-nursing home residents and 1,246 fractures for 42,986 person-years of exposure in nursing home residents). The standardized age- and sex-adjusted hip fracture rate of nursing home residents (23.0 per 1,000 person-years) substantially exceeded that of non-nursing home residents (5.7 per 1,000 person-years) (incidence rate ratio = 4.0, 95% confidence interval = 3.7-4.5). CONCLUSION: The incidence of hip fracture in nursing home residents far exceeds that in noninstitutionalized older people. Linkage of MDS and Medicare hospital claims data is a useful tool for epidemiological surveillance regarding events in nursing homes that are likely to result in hospitalization.     

Effects of exercise training on bone mineral density and some health-related outcomes in HIV conditions: A randomized controlled trial

Introduction:Human Immunodeficiency Virus (HIV) infection remains prevalent co-morbidity, and among fracture patients. Few studies have investigated the role of exercise interventions in preventing bone demineralization in people who have fractures and HIV. If exercise exposed, HIV-infected individuals may experience improved bone health outcomes (BMD), function, quality of life (QoL). The study will aim to assess the impact of home based exercises on bone mineral density, functional capacity, QoL, and some serological markers of health in HIV infection among Nigerians and South Africans.Methods and design:The study is an assessor-blinded randomized controlled trial. Patients managed with internal and external fixation for femoral shaft fracture at the study sites will be recruited to participate in the study. The participants will be recruited 2 weeks post-discharge at the follow-up clinic with the orthopaedic surgeon. The study population will consist of all persons with femoral fracture and HIV-positive and negative (HIV-positive medically confirmed) aged 18 to 60 years attending the above-named health facilities. For the HIV-positive participants, a documented positive HIV result, as well as a history of being followed-up at the HIV treatment and care center. A developed home based exercise programme will be implemented in the experimental group while the control group continues with the usual rehabilitation programme. The primary outcome measures will be function, gait, bone mineral density, physical activity, and QoL.Discussion:The proposed trial will compare the effect of a home-based physical exercise-training programme in the management of femoral fracture to the usual physiotherapy management programmes with specific outcomes of bone mineral density, function, and inflammatory markers.Trial registration:The study was prospectively registered with the Pan African Clinical Trials Registry (Reference number – PACTR201910562118957) on October 21, 2019. (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9425).     

Evaluation of coronary subclavian steal syndrome using sestamibi imaging and duplex scanning with observed vertebral subclavian steal

Coronary subclavian steal is defined as retrograde blood flow from the myocardium through the internal mammary artery graft, secondary to a proximal subclavian artery stenosis. The incidence of this syndrome in patients undergoing internal mammary artery grafts for coronary artery bypass is estimated to be 0.44%. Angiography remains the definitive diagnostic test for confirming this condition. We describe a noninvasive method for evaluating coronary subclavian steal syndrome in a 57-year-old man, with a 50-55% subclavian stenosis confirmed by angiography. Noninvasive evaluation using duplex scanning demonstrated normal vertebral artery blood flow. Technetium 99m-sestamibi (99mTc) imaging confirmed a fixed anterolateral defect. When left-arm isometric exercise was employed, retrograde vertebral artery blood flow was observed by Doppler imaging. A repeat 99mTc-sestamibi study documented an increase in tracer distribution in the anterolateral defect confirming reperfusion of the myocardium through the left internal mammary artery graft. The use of duplex scanning and 99mTc-sestamibi may serve as an adjunct in evaluating coronary subclavian steal syndrome as well as documenting transient vertebral subclavian steal in this patient population.     

Doppler reference values of the fetal vertebral and middle cerebral arteries,at 19–41 weeks gestation

Objectives: Blood flow to the fetal brain is supplied by two vascular systems: the vertebral artery (VA) and the internal carotid artery with its anatomical continuation, the middle cerebral artery (ICA/MCA). In this work, our aim was to establish consistent reference values for the comparative study of both arterial systems.

Methods: The study group consisted of 2323 Doppler examinations of the VA, MCA and UA performed on 2323 single pregnancies between 19 and 41 weeks. These values were afterwards used to calculate the pulsatility index (PI), peak systolic velocity (PSV) and cerebro-placental ratio (CPR) percentiles.

Results: The VA and MCA PI reached maximum values at the end of the second trimester and decreased afterwards due to an increase in the diastolic flow. Conversely, the VA and MCA PSV increased progressively until the end of pregnancy. Regarding the VA and MCA CPR values, they were higher in the middle of the third trimester and decreased afterwards.

Conclusions: In both arterial systems, Doppler reference values have been calculated for the PI, PSV and CPR, being available for future comparative studies.     

家庭-社会支持对3D打印辅助治疗复杂创伤骨折患者心理应激的影响

目的 探讨家庭-社会支持对3D打印辅助个体化定制治疗复杂创伤骨折患者心理应激的影响。 方法 以2015年1月-2017年2月我院收治的80例复杂创伤骨折患者为对象,按随机数字表法将其分为对照组和观察组各40例,2组均接受3D打印辅助个体化定制治疗,对照组实施认知行为干预,观察组在对照组基础上给予家庭-社会支持,比较干预前后2组汉密尔顿抑郁量表(Hamilton depression scale, HAMD)及汉密尔顿焦虑量表(Hamilton anxiety scale, HAMA)评分、视觉模拟疼痛(visual analogue scale/score, VAS)评分及生活质量调查问卷(the EORTC quality of life questionnaire-core 30,EORTC QLQ-C30)评分。 结果 干预后,2组HAMD、HAMA、VAS评分均低于对照组, EORTC QLQ-C30评分高于对照组。 结论 家庭-社会支持应用于3D打印辅助治疗复杂创伤骨折患者中,在改善其心理应激、术后疼痛和预后等方面具有积极作用,在临床中有推广应用价值。