国产高膨胀性海绵用于鼻腔填塞的临床观察

目的:比较两种鼻腔填塞材料的疗效,选择理想的鼻腔填塞物。方法:将324例鼻出血及鼻腔鼻窦术后患者分为凡士林纱条填塞组(A组)、国产高膨胀性海绵填塞组(B组)。结果:两组在止鼻出血方面疗效无显著性差异,但在鼻腔填塞后头鼻胀痛、取出填塞物后渗血量及粘膜情况有显著性差异(P<0·01)。结果:高膨胀性海绵是较理想的鼻腔填塞材料。     

异体楔形骨块在颈椎双开门椎板扩大成形术中的应用

[目的]观察异体楔形骨块在双开门扩大成形术中的应用效果。[方法]2003年4月~2004年6月,22例患者使用预制异体楔形骨块行棘突纵割式椎板扩大成形术。术后随访16~30个月,平均18.4个月。术前术后采用JOA评分了解脊髓功能状态,X线片和CT了解颈椎活动度(ROM)和植骨融合状况。[结果]末次随访时,JOA评分由术前(8.3±2.6)分改善至(13.3±3.1)分;颈椎ROM由术前(41.3±10.8)°下降至(23.4±8.7)°,未见术后颈椎失稳;67.9%异体骨块与棘突完全骨性融合,23.2%部分骨性融合,8.9%骨块部分吸收,未融合;未见骨块破裂和移位。[结论]使用异体楔形骨块的双开门扩大成形术是一种安全有效的手术方法。     

两种止血材料在颈椎单开门椎管扩大成形术中的止血效果观察

目的:比较可吸收止血流体明胶(HFG)和可吸收明胶海绵(GS)在颈椎后路单开门椎管扩大成形术中的止血效果。方法:回顾性分析2014年2月至2016年5月接受颈椎后路单开门椎管扩大成形术治疗的患者83例,根据患者术中使用不同止血材料分两组:HFG组41例,男30例,女11例;年龄29~81岁,平均(55.6±11.6)岁;其中14例为单纯颈椎管狭窄症,9例合并后纵韧带骨化,18例合并多节段颈椎间盘突出。GS组42例,男32例,女10例;年龄36~78岁,平均(55.4±11.1)岁;其中12例为单纯颈椎管狭窄症,10例合并后纵韧带骨化,20例合并多节段颈椎间盘突出。两组患者性别、年龄及病变类型等一般资料比较,差异均无统计学意义(P0.05)。比较两组手术时间、术中出血量、术后引流量、术后不良事件及术后并发症。结果:HFG组和GS组患者手术时间分别为(137.2±30.0)、(154.8±33.5)min(P0.05);术中出血量分别为(156.1±74.6)、(242.9±120.7)ml(P0.001);术后引流量分别为(212.1±67.6)、(303.3±115.5)ml(P0.001)。HFG组手术时间、术中出血量及术后引流量均少于GS组。两组患者均未发生术后切口急性血肿及其他止血相关并发症。结论:颈椎后路单开门椎管扩大成形术中,HFG操作简单,可以减少手术时间、术中出血量和术后引流量,是一种安全并且效果优于传统止血方式的止血材料。     

EOLP不同椎板固定方法对颈椎曲度及轴性症状的影响

目的 探讨颈椎后路单开门椎管成形术(EOLP)不同椎板固定方法对颈椎曲度及轴性症状的影响.方法 回顾性分析天津市人民医院2009年1月至2012年1月因多节段脊髓型颈椎病(CSM)行EOLP的101例患者临床资料.其中32例采用传统缝线悬吊“门轴”(A组),35例患者采用锚钉法进行“门轴”固定(B组),34例患者采用微型钛板Centerpiece固定法(C组).对3组患者手术前、后日本骨科学会(JOA)评分,颈椎曲度变化及轴性症状评分进行分析.结果 3组患者平均随访时间为(31.83±5.10)个月,JOA评分改善率A、B、C组分别为(61.53±24.00)％、(60.72±19.82)％、(65.17±21.13)％,3组比较差异无统计学意义(F=0.41,P=0.67);颈椎曲度丢失A、B、C组分别为(3.38±1.51)％、(3.12±1.91)％、(2.24±1.30)％,3组比较差异有统计学意义(F=4.67,P=0.01);术后24个月轴性症状评分A、B、C组分别为(9.13±0.66)、(10.77±0.49)、(11.11±0.77)分,3组差异有统计学意义(F=88.30,P=0.00).JOA评分改善率与轴性症状评分无相关性(r=0.07,P＞0.05),颈椎曲度丢失与轴性症状评分呈负相关(r=-0.21,P=0.03).结论 EOLP传统缝线悬吊“门轴”法、锚钉固定“门轴”法、微型钛板centerpiece固定法均是开门法“门轴”固定的有效方法,但微型钛板内固定法可有效地减少术后颈椎曲度的丢失,降低轴性症状的发生率.     

Working with gender-expansive clients in psychotherapy

Gender expansive individuals of all ages are at an elevated risk for mental and physical health problems compared not only to the general population, but also to lesbian, gay, and bisexual individuals. Yet mental healthcare providers tend to be underprepared to provide services to this population, which is due in part to the dearth of scholarship on how to provide competent care to gender-expansive people. The present article introduces themes and terminology crucial to working with this population, as well as three case studies—two individuals and one family—highlighting the nuances inherent in workng with gender expansive clients. We conclude by offering ways to conceptualize each case, and by highlighting certain areas that we believe deserve specific considerations from care providers.     

颈椎单开门OsteoMed M3钉板内固定椎管扩大成形术的临床应用

目的 介绍一项新技术在颈椎单开门椎管扩大成形术中使用OsteoMed M3钉板内固定,评价其在颈椎疾患手术中的应用效果.方法 选择多节段椎间盘突出并椎管狭窄等颈椎疾患16例,行颈椎单开门OsteoMed M3钉板内固定椎管扩大成形手术治疗,术后随访半年以上.结果 16例患者全部得到随访,术后随访半年以上,术前JOA评分:9.06±2.380(5~13),术后JOA评分:13.63±1.408(11~16),差异有统计学意义(P<0.005),大部分病人症状明显改善,术后改善率57.5%.1例症状改善不明显的患者,二期实施前路减压固定融合术后症状缓解,无一例出现继发性椎管狭窄.结论 在颈椎单开门椎管扩大成形术中应用OsteoMed M3钉板内固定具有避免开门后再关闭,保持椎管扩大效果,同时对脊柱活动度影响小的优点,且操作简单,并发症少,适合临床运用.     

Laboratory Study on Improvement of Expansive Soil by Chemically Induced Calcium Carbonate Precipitation

This paper proposes the use of calcium carbonate (CaCO₃) precipitation induced by the addition of calcium chloride (CaCl₂) and sodium carbonate (Na₂CO₃) solutions as a procedure to stabilize and improve expansive soil. A set of laboratory tests, including the free swell test, unloaded swelling ratio test, unconfined compression test, direct shear test, scanning electron microscopy (SEM) test, cyclic wetting–drying test and laboratory-scale precipitation model test, were performed under various curing periods to evaluate the performance of the CaCO₃ stabilization. It is concluded from the free swell tests and unloaded swelling ratio tests that the addition of CaCl₂ and Na₂CO₃ can profoundly decrease soil expansion potential. The reduction in expansion parameters is primarily attributed to the strong short-term reactions between clay and stabilizers. In addition, the formed cementation precipitation can decrease the water adsorption capacity of the clay surface and then consequently reduce the expansion potential. The results of unconfined compression tests and direct shear strength tests indicated that the addition of CaCl₂ and Na₂CO₃ has a major effect on geotechnical behavior of expansive soils. Based on the SEM analyses, new cementing crystalline phases formatted by sequentially mixing CaCl₂ and Na₂CO₃ solutions into expansive soil were found to appear in the pore space, which results in a much denser microstructure. A laboratory-scale model test was conducted, and results demonstrate the effectiveness of the CaCO₃ precipitation technique in stabilizing the expansive soil procedure. The test results indicated that the concentration of CaCl₂ higher than 22.0% and Na₂CO₃ higher than 21.2% are needed to satisfactorily stabilize expansive soil. It is proposed to implement the precipitation technique in the field by the sequential permeation of CaCl₂ and Na₂CO₃ solutions into soils in situ.     

骨质疏松绵羊腰椎内不同椎弓根螺钉界面的组织学研究

目的通过硬组织切片及染色技术观察骨质疏松绵羊腰椎内膨胀式椎弓根螺钉(expansive pedicle screw,EPS)与骨水泥强化螺钉(polymethylmethacrylate-augmented pedicle screw,PMMA-PS)的钉道界面。方法建立骨质疏松绵羊后将每只绵羊的腰椎(L1~6)随机分入三个不同的置钉组。使用相同的方法制备钉道后,普通椎弓根螺钉(CPS)组:经椎弓根向椎体内拧入CPS;PMMA-PS组:向制备好的钉道内注入1.0 m L的PMMA后拧入CPS;EPS组:直接经椎弓根向椎体内拧入EPS。术后6周和12周处死绵羊,经硬组织切片及染色后行组织学观察。结果组织学观察表明,在术后6周和12周,CPS组和EPS组中骨小梁直接与螺钉接触,形成了"螺钉-骨质"界面。PMMA-PS组中PMMA包裹螺钉,阻碍了螺钉与骨小梁的直接接触,形成了"螺钉-PMMA-骨质"界面,EPS组螺钉的前端明显膨胀形成了一个"爪状"结构,挤压并显著改善了局部的骨质条件。从术后6周到12周,CPS组和PMMA-PS组中螺钉周围的骨质条件无明显变化,PMMA无明显降解吸收,PMMA组中形成了二次界面,然而,术后12周EPS前端周围的骨质情况和钉道界面均明显优于术后6周。结论在骨质疏松绵羊腰椎内,术后早期EPS通过螺钉前段的膨胀挤压刺激周围骨小梁生长,显著改善了周围的骨质基础,随着螺钉膨胀部分持续挤压的刺激,螺钉前段周围的骨质条件在远期有进一步的显著改善,形成了良好的生物性界面,为螺钉的远期稳定提供了良好的骨质条件。     

Modification of Mechanical Properties of Expansive Soil from North China by Using Rice Husk Ash

The construction of buildings on expansive soils poses considerable risk of damage or collapse due to soil shrinkage or swelling made likely by the remarkable degree compressibility and weak shear resistance of such soils. In this research, rice husk ash (RHA) was added to expansive soil samples in different quantities of 0%, 4%, 8%, 12%, and 16% by weight of soil to determine their effects on the plasticity index, compaction parameters, consolidation performance, and California bearing ratio (CBR)of clay soil. The results show that the use of RHA increases the effective stress and decreases the void ratio and coefficient of consolidation. Adding 16% RHA resulted in the greatest reduction in the hydraulic conductivity, void ratio, and coefficient of consolidation. The void ratio decreased from 0.96 to 0.93, consolidation coefficient decreased from 2.52 to 2.33 cm²/s, and hydraulic conductivity decreased from 1.12 to 0.80 cm/s. The addition of RHA improved the soil properties and coefficient of consolidation due to the high density and cohesiveness of RHA. The results of this study can be used to provide a suitable basis for the treatment of expansive soil to provide improved conditions for infrastructure construction.