踝足矫形器矫治脑瘫患儿尖足初步疗效分析

目的对痉挛型脑瘫患儿踝足矫形器配戴前后的尖足改善情况进行量化评定。方法对24例痉挛型脑瘫患儿(48足)配戴矫形器6个月后进行疗效评定。结果48只尖足均得到了明显改善,其中显效25%,好转64.6%,无变化10.4%,与配戴踝足矫形器前比较差异有显著意义(P<0.01)。在尖足改善的同时,患儿的站立和步行能力均得到了提高。结论踝足矫形器在纠正脑瘫患儿尖足、提高下肢运动功能方面有积极的作用。     

藻酸包埋异体关节软骨细胞修复兔膝关节软骨缺损

目的 探讨异体关节软骨细胞作为软骨种子细胞修复关节软骨缺损的可行性。方法 无菌取成年新西兰大白兔四肢关节软骨，酶消化法分离细胞，条件培养基体外培养扩增，藻酸钙凝胶包埋培养1周，植入兔膝关节股骨髁间软骨缺损，对照组缺损旷置。术后3、6个月分别取材，观察缺损修复情况；切片特染和免疫组化观察修复组织病理，并Wakitnni评分评估修复质量。结果 7／8缺损为成熟透明软骨组织修复，1／8为纤维软骨修复；Wakitani平均评1．75分；空白对照组评7．65分。实验组3个月组标本未见淋巴细胞或白细胞浸润，6个月组标本未见明显退变；所有标本均未见藻酸残留。结论 用藻酸包埋异体关节软骨细胞修复兔膝关节软骨缺损的方法是可行的，异体关节软骨细胞在适当的处理后可成为关节软骨组织工程种子细胞。     

邓铁涛浴足方治疗高血压病120例临床观察

目的:观察邓铁涛浴足方浴足治疗高血压病的临床疗效,为中药浴足方浴足治疗和护理高血压病的推广应用提供依据.方法:采用临床单纯随机分组方法,将240例住院高血压患者随机分为试验组和对照组,建立数据库,运用描述性分析、t检验、X2检验及秩和检验等方法.结果:(1)两组高血压患者降压疗效比较差异有显著性(P＜0.01);(2)高血压患者各中医证型治疗前后变化情况组间比较,肝火亢盛型患者治疗两周后收缩压差、舒张压差(入院值-疗后2周值)组间比较,差异均无显著性(P＞0.05);痰湿壅盛型患者治疗两周后收缩压差、舒张压差(入院值疗后2周值)组间比较,差异均有显著性(P＜0.05);气虚痰瘀型患者治疗两周后收缩压差、舒张压差(入院值-疗后2周值)组间比较,差异均有显著性(P＜0.05).结论:邓铁涛浴足方降压效果确切,对最常见的气虚痰瘀型、痰湿壅盛型疗效尤佳,值得临床推广应用.     

针刺足三阳经穴对胃黏膜损伤家兔生长抑素受体基因表达影响的比较

目的:比较针刺足三阳经对胃黏膜损伤的保护作用及对生长抑素受体基因表达的影响,探讨经脉脏腑相关的特异性.方法:乙醇灌胃造成家兔胃溃疡模型后,采用经络刺激仪进行针刺.治疗结束后用放射免疫及PC-PCR法测定胃黏膜表皮生长因子(EGF)、生长抑素(SS)及生长抑素受体(SSR1mRNA)表达.结果:模型组EGF含量较正常组明显降低;胃黏膜损伤指数、SS含量及SSR1mRNA表达则显著升高(P<0.01).与模型组比较,胃经组EGF明显升高,胃黏膜损伤指数、SS含量及SSR1mRNA表达显著降低(P<0.01).但胆经及膀胱经组与模型组比较上述指标未得到改善,与胃经组比较差异有非常显著性意义(P<0.01).结论:针刺足三阳经以胃经组对家兔胃黏膜损伤保护作用最强,其机制可能与调整有关脑肠肽及生长抑素受体基因表达有关.     

High incidence of screw penetration in the proximal and distal tibiofibular joints after intramedullary nailing of tibial fractures—A prospective cohort and mapping study

BackgroundIntramedullary-nails (IMN) are the treatment of choice for most tibial shaft fractures due to their minimally-invasive nature and non-demanding surgical technique. However, a potential iatrogenic pitfall is intra-articular interlocking screw positioning within the proximal (PTFJ) and distal (DTFJ) tibiofibular joints that may go unrecognized.ObjectiveTo evaluate the incidence of intra-articular screw penetration of the PTFJ and DTFJs after interlocking of IMN for tibial fractures.InterventionReamed IMN using modern techniques, including proximal interlocking via standard aiming jig and distal interlocking either freehand or using SureShot^®.MethodsProspective series of 165 consecutive patients with a tibial shaft fracture managed with an IMN. Diagnosis and incidence of penetration of the PTFJ and DTFJ was assessed on protocolled low-dose postoperative CT-scans (standardized clinical practice for assessing rotational alignment). The degree of penetration of the TFJ’s was graded as: Grade 1–slight breach of the tibial cortex; Grade 2–clear penetration of the tibial cortex with intra-articular screw tip; and Grade 3–penetration of both tibial- and fibular cortices with screw tip in fibula.ResultsOf the 165 tibial shaft fractures, using the AO/OTA classification, 69% were simple, 16% wedge and 15% complex fractures. Following IMN 42% of patients had intra-articular screw penetration of their PTFJ whilst 39% had penetration of their DTFJ. 66% of patients had penetration of either one- or both of their TFJs. The grading of PTFJ violation was distributed as follows: Grade 1 in 24 patients; Grade 2 in 26 patients and Grade 3 in 19 patients. DTFJ violation was graded as: Grade 1 in 21 patients; 40 patients had Grade 2 violation; and four patients had a Grade 3 penetration.ConclusionsThis diagnostic imaging study reports a high rate of intra-articular screw penetration of the PTFJ and DTFJ after interlocking of IMN for tibia shaft fractures. A prospective cohort study is underway to evaluate its clinical significance.Changes to enable alteration in forced angle of interlocking screw trajectory and avoidance of the anteromedial to posterolateral locking screw may reduce the incidence of TJF violation.Level of evidenceLevel II – Diagnostic Imaging Study     

游离皮瓣修复足外伤性缺损的临床研究

目的:评价游离皮瓣修复足外伤缺损的临床价值。方法:对46例足外伤缺损患者采取皮瓣修复情况进行回顾性分析,根据采取皮瓣修复方法不同分组,其中以游离皮瓣修复者24例(皮瓣修复组),以其他皮瓣方法修复者22例(对照组),分析修复结果。结果:游离皮瓣修复组完全成活率为91.67%,其他皮瓣修复方法修复的对照组完全成活率为59.09%,差异有统计学意义(χ2=6.69,P<0.05),成活率(完全成活率+部分坏死率)游离皮瓣修复组为95.83%,对照组为90.91%,差异无统计学意义(χ2=0.01,P>0.05);术前两组缺损面积差异无统计学意义(t=0.11,P>0.05),修复术后皮瓣成活面积游离皮瓣修复组平均为(16.24±3.41)cm,对照组为(10.18±2.29)cm,差异有统计学意义(t=7.01,P<0.05)。结论:游离皮瓣对于大面积足外伤缺损修复效果较好,皮瓣完全成活率高。     

经封闭式负压引流后应用游离股前外侧皮瓣移植修复足部皮肤缺损的临床疗效

目的探讨经封闭式负压引流后应用游离股前外侧皮瓣移植修复足部皮肤缺损的临床疗效。方法选取2017年1月至2019年1月我院收治的76例足部皮肤缺损患者,随机分为两组,对照组进行经封闭式负压引流治疗,研究组在对照组基础上进行游离股前外侧皮瓣移植修复。比较两组治疗总有效率、生活质量评分、感觉功能恢复状况、植皮成功率。结果与对照组比较,研究组治疗总有效率更高(P0.05);与对照组比较,研究组生活质量评分更高(P0.05);与对照组比较,研究组S3、S1区感觉功能恢复率更高(P0.05),但其余区感觉功能恢复没有明显差异;与对照组比较,研究组植皮成功率更高(P0.05)。结论对足部皮肤缺损患者,应用经封闭式负压引流治疗基础上联合游离股前外侧皮瓣移植修复治疗,效果理想,可提高皮瓣移植成功率,改善生活质量,恢复部分感觉功能。因此,该治疗方法值得广泛应用。     

The immediate effects of hallux valgus orthoses: A comparison of orthosis designs

BackgroundHallux valgus orthoses are available in a wide range of designs and materials, but the effects of their design on functional performance have not been fully investigated.Research questionThis present study aims to comprehensively analyze the immediate effects of soft and semi-rigid hallux valgus orthoses on balance, plantar pressure, hallux valgus angle, and subjective sensations.MethodsSixteen female subjects have participated in the study, including 10 subjects with healthy feet and 6 with hallux valgus. Three conditions are tested, including in the barefoot and using two types of commercially available hallux valgus orthoses. The subjects participate in static and dynamic (walking) tests with the use of the Novel Pedar® system. The peak pressure values in the hallux, lateral toes, first metatarsophalangeal joint, 2-4th metatarsal heads, 5th metatarsal head, medial midfoot, lateral midfoot and rearfoot in the various foot conditions are examined and compared. The hallux valgus angle of each subject is measured based on their footprint. Their subjective feelings towards the orthoses are also evaluated. A repeated-measures analysis of variance, and independent-sample t-test are performed.ResultsThe correction of the hallux valgus angle is statistically significant when the subjects with hallux valgus use the orthoses. In comparing the two types of orthoses, the use of the orthosis made of soft materials results in correction in the hallux valgus angle and higher wear comfort, and lower plantar pressure in hallux area.SignificanceThe results provide insights into the design of hallux valgus orthoses, thus offering practical reference for the selection of hallux valgus orthosis with compromise between functional performance and wear comfort.