闭合复位空心螺钉治疗股骨颈骨折后股骨头坏死的影响因素分析

目的回顾性分析闭合复位空心螺钉治疗股骨颈骨折后股骨头坏死的影响因素。 方法对2009年1月至2017年3月293例采用加压空心螺钉治疗股骨颈骨折的患者进行回顾性分析，其中获得随访的患者247例。应用SPSS20.0软件进行统计学分析，并对影响股骨头坏死的各项因素进行Logistic回归分析。 结果247例患者获得平均58个月（24~80个月）随访，32例出现股骨头坏死，发生率12.9%，随访时髋关节Harris评分平均81.4±3.9分（54~98分）。影响股骨颈骨折术后股骨头坏死的因素和顺序依次为复位质量（OR=9.854，P=0.012），空心钉排列方式（OR=7.965，P=0.017），骨折分型（OR=6.453，P=0.021），空心钉取出与否（OR=5.364，P=0.027），术前是否牵引（OR=2.561，P=0.042）。 结论复位质量是影响股骨颈骨折预后最为关键的因素。空心螺钉正三角形排列、空心螺钉取出以及未及时术前牵引均可能加重股骨头坏死。     

老年重症心力衰竭急诊内科治疗效果探析

目的观察老年重症心力衰竭病人实施急诊内科治疗后的效果，并对其临床意义进行总结。方法随机选取2010年6月一2012年6月2年期间某医院急诊内科门诊接受治疗的32例老年重症心力衰竭病人。并将其随机分为两组，即观察组（16例）与对照组（16例），观察组病人，给予厄贝沙坦氢氯噻嗪，并结合关托洛尔进行治疗；对照组病人，给予美托洛尔进行治疗。然后对两组病人的临床治疗效果实施观察。结果观察组中治疗总有效率达到了89．1％，而对照组中治疗总有效率达到了69．2％，对两组患者的死亡率与疗效进行对比，差异有统计学意义（P〈0．05）。结论老年重症心力衰竭病人进行厄贝沙坦氢氯噻嗪并辅以美托洛尔治疗效果明显。     

肱骨近端锁定钢板治疗儿童股骨转子部骨折

正2009年1月~2013年12月,我科采用肱骨近端锁定钢板内固定治疗10例股骨转子部骨折患儿,疗效满意,报道如下。1材料与方法1.1病例资料本组10例,男7例,女3例,年龄6~12岁,均为闭合骨折。其中转子间骨折4例,根据Evans分型:Ⅰ型2例,Ⅱ型2例;转子下骨折6例,根据Seinsheimer分型:Ⅰ型2例,Ⅱ型3例,Ⅲ型1例。受伤至手术时间2 h~3d。1.2治疗方法全身麻醉下手术。取     

Environmental variables associated with an increased risk of invasive aspergillosis

Information on the environmental variables that may affect the incidence of invasive aspergillosis (IA) is scarce. We sought to determine the relationship between airborne spore counts, climatic conditions and IA. We also examined whether circulating respiratory viruses predispose patients to IA in a multicentre cohort study of hospitalized adults with IA. Data on environmental mould spores, climatic conditions and circulating respiratory viruses were obtained from the Environmental Department of the Autonomous University of Barcelona, the Meteorological Service of Catalonia and the Acute Respiratory Infection Surveillance Project in Catalonia, respectively. Between 2008 and 2011, 165 patients with IA were identified. Diagnosis was based on one or more of the following: culture (125 cases), galactomannan antigen (98) and histology (34). One hundred and twenty-seven cases (77%) had criteria for probable IA and the remainder for proven IA. Environmental mould spore counts from the period 28–42 days preceding infection presented significant associations with admissions due to IA. None of the climatic conditions were associated with an increased risk of IA, but the presence of circulating respiratory viruses was associated with a higher risk of infection: the most strongly associated viruses were respiratory syncytial virus, influenza A(H1N1)pdm09 and adenovirus. In conclusion, the presence of high numbers of spores in the air increases the risk of admission due to IA. Circulating respiratory viruses appear to be associated with a higher risk of developing IA. Physicians should be aware of this association in order to optimize prevention and diagnosis strategies for IA during viral epidemic periods.     

经直接前方入路切开复位与闭合复位治疗股骨颈骨折的疗效对比

目的 比较经直接前方入路（DAA）切开复位与闭合复位经皮空心螺钉内固定治疗股骨颈骨折的临床疗效。方法 回顾性分析2015年12月～2018年12月因股骨颈骨折在我院分别行切开复位（n=46）和闭合复位空心螺钉内固定（n=46）治疗的患者，统计患者基本资料，骨折Garden类型，从受伤到手术治疗时间，手术时间，术中出血量，术后Garden复位指数，术后1 d、术后3、6、12及24月患髋Harris功能评分，并统计术后骨折不愈合率及股骨头缺血坏死发生率；采用Spearman相关分析及Logistic多元回归分析，研究影响股骨颈骨折术后股骨头缺血坏死的因素。结果 切开复位组术中出血量、手术时间大于闭合复位组，但术后Garden复位指数优于闭合复位组（均P＜0.05）；术后6、12月切开复位组患髋Harris功能评分优于闭合复位组（P＜0.05）；术后24月内切开复位组患者股骨头缺血坏死率显著低于闭合复位组（P=0.01）；两组骨折不愈合率无统计学差异（P=0.06）。Spearman相关分析发现，股骨颈骨折Garden分型与股骨颈骨折术后股骨头缺血坏死发生率呈显著正相关（R=0.521，P＜0.001），但Logistic多元回归分析未能发现影响股骨颈骨折术后股骨头坏死发生率的相关因素。结论 DAA入路切开复位空心螺钉内固定治疗股骨颈骨折比闭合复位经皮空心螺钉内固定质量更佳，术后12月内患髋功能更好，术后24月内股骨头缺血坏死发生率更低。     

Clinical implications of additional posterior fractures in combined anterior-posterior pelvic ring fractures in elderly patients

ObjectivesHistorically, pelvic ring fractures (PRF) are considered to occur predominantly in the anterior ring and therfore to be mechanically stable. Combined anterior and posterior (A + P) PRF are expected to be less mechanically stable and therefore to be associated with higher levels of pain and reduced mobility compared to isolated anterior fractures. The current study investigates the clinical relevance of combined A + P PRF in elderly patients.MethodsA prospective multicentre cohort study was conducted in patients >70 years of age with anterior PRF after low-energy trauma diagnosed on conventional radiographs. All patients underwent an additional CT-scan. Patients were divided into two groups; isolated anterior or combined A + P fractures. Patients were treated conservatively with adequate analgesia for at least one week. If patients could not be mobilised after conservative treatment, surgical fixation was performed. Numerical Rating Scale (NRS) pain scores, dependence on walking aids and Activities of Daily Living scores (ADL) were measured at 2–4 weeks, and 3, 6 and 12 months after fracture.Results102 patients (age 81.1 ± 7.6 years) were included. Isolated anterior fractures were diagnosed in 25 (24.5%) and A + P fractures in 77 (75.5%) patients. Baseline characteristics did not differ between the two groups. Most patients were successfully treated conservatively and 5 (4.9%) underwent percutaneous trans-iliac, trans-sacral screw fixation after failure of conservative treatment. At 2–4 weeks post trauma, patients with A + P fractures had similar median pain scores (3 (range 0–8) vs. 5 (0–10), p = 0.19) and ADL scores (85 (25–100) vs. 78.6 (5–100), p = 0.67), but were more dependent on walking aids (92.8% vs. 72.2%; p = 0.02) compared to patients with isolated anterior fractures. There were no significant differences at 3 months. At one year follow-up the median NRS pain and ADL scores for both fracture groups were 0 and 100, respectively. Mortality was 10.8%, and additional loss to follow-up was 17.6%.ConclusionsThe vast majority of elderly patients with PRF have combined A + P fractures. The clinical implications of additional posterior pelvic ring fractures in elderly patients appears to be limited.     

PCMC联合创新实践实训平台的教学模式在中医内科教学中的应用

目的探讨PCMC联合创新实践实训平台的教学模式在中医内科教学中的教学效果。方法选择长春中医药大学2015级本科生,共计80人。随机分成2组,其中试验组40人,对照组40人。试验组采用PCMC联合创新实践实训平台的教学模式进行教学,对照组采用传统教学模式进行教学。2组均由同一教师负责教学。结果试验组中医系本科生不仅其理论成绩和技能成绩均高于对照组,差异具有统计学意义(P<0.05)。而且其学习兴趣、自学能力、语言和文字的表达能力、逻辑思维能力、实践能力、解决问题能力、理论和实践结合能力、提高学习效果、拓展知识面、加强师生互动等10项调查结果也均优于对照组,差异具有统计学意义(P<0.05)。结论PCMC联合“创新实践实训平台”的教学模式能够提高成绩,还能有效地调动学生学习的主动性与积极性。