Retrieval of fractured dialysis catheter through phlebotomy of internal jugular vein: a case report

A central venous catheter is the most common access for initiating hemodialysis. Prolonged access through a central venous catheter increases the risk of infection and dysfunction of the catheter with potential development of catheter-induced thrombosis and embolism. However, fracture and dislodgement of the catheter with subsequent embolization is an unexpected complication. Endovascular treatment is a promising method to remove intravascular foreign bodies. We herein report a case of a 58-year-old woman undergoing prolonged hemodialysis who required central venous catheter removal because of mechanical fracture of the tunneled cuffed catheter and its migration in the internal jugular vein. An urgent chest X-ray showed that the two free ends of the fractured tunneled cuffed catheter were located in the right atrium and right internal jugular vein. Phlebotomy of the internal jugular vein was successfully performed to retrieve the fractured tunneled cuffed catheter and the associated thrombi. In this case, phlebotomy for retrieval of the embolized catheter fragment extending into the right atrium was a safe alternative to an endovascular technique of catheter fragment retrieval. Phlebotomy preserved the integrity of the catheter fragment and its associated thrombus and was both cost-effective and safe.     

Two cases of atypical femoral fracture in cancer patients administered with bone-modifying agents

Objective: We report two cases of atypical femoral fracture (AFF) in patients with cancer.Patients: Two patients, a 53-year-old woman with breast cancer and a 77-year-old man with prostate cancer, could not walk after being injured in a fall. They used bone-modifying agents (BMA) for the prevention of bone metastasis for three and four years, respectively.Results: Intramedullary nails were placed to fix the femoral fractures in each patient. Neither of them had pathological metastatic femoral fractures based on fracture site specimens; however, severe suppression of bone turnover at the fracture site was suspected. Both patients could ambulate with a T-cane and were free of hip pain after surgery. Radiographs showed no callus formation at the fracture site.Conclusion: Based on the two cases of AFF in patients with cancer related to BMA use, we should consider that the incidence of AFF may be associated with long-term BMA use.     

3D打印技术在快速治疗老年股骨转子间骨折医患沟通中的应用

目的　探讨3D打印技术在快速治疗老年股骨转子间骨折医患沟通中的应用效果。 方法　选取2018年7月~2019年4月本院老年髋部中心30例老年股骨转子间骨折拟行PFNA内固定手术治疗的患者。经签署知情同意书,利用随机数表将患者分成实验组和对照组,每组15例。实验组采用3D打印模型进行术前沟通,对照组采用常规术前沟通方法,分别进行术前医患沟通调查问卷信息采集,记录手术时机（入院到手术的间隔天数）、手术时间、出血量等,并进行统计分析。 结果　术前应用3D打印模型进行医患沟通,患者对病情、手术方案、护理等方面的理解有明显优势,患者满意度较高;实验组从入院到手术间隔时间明显较短,为（2.92±1.16）d,对照组（4.36±2.10）d,P<0.05。 结论　3D打印技术在快速治疗老年股骨转子间骨折医患沟通方面有显著效果,缩短术前间隔时间,提高患者满意度。     

儿童肱骨髁上骨折相关的神经损伤研究进展

肱骨髁上骨折常见于7岁以下儿童,约占儿童肢体骨折的30%和肘部骨折的50%~70%;根据受伤机制的不同可分为伸直型和屈曲型,其中伸直型约占96%~98%、屈曲型约占2%~4%,是最常见的儿童骨折之一[1,2]。Gartland分型是目前应用最广泛的肱骨髁上骨折分型系统:Ⅰ型骨折无移位常采取保守治疗,Ⅱ型和Ⅲ型骨折因创伤严重致治疗棘手。由于儿童肱骨远端特殊的解剖生理特点,尺神经、正中神经及桡神经均容易损伤,文献报道肱骨髁上骨折导致的神经损伤发生率高达10%~20%[1-3],医源性神经损伤也高达3%~6%[2-4],给临床带来严重挑战。本文就儿童肱骨髁上骨折伴神经损伤的研究进展作一综述。     

不同方式颈椎融合手术对上颈椎Jefferson骨折稳定效果的影响

目的建立人体上颈椎C0～3节段Jefferson骨折有限元模型,分析后路寰枢椎融合(posterior atlantoaxial fusion,PSF)和枕颈融合(occipitocervical fusion,OCF)对颈椎椎体生物力学特性和钉棒系统力传导特性的影响。方法基于CT图像建立人体上颈椎C0～3节段Jefferson骨折模型,依据临床手术方案实施PSF、OCF1和OCF2内固定术,施加50 N集中力和1.5 N·m力矩于枕骨底部,研究上颈椎C0～3节段在前屈、后伸、侧屈和旋转运动时,颈椎椎体的应力分布和关节活动度(range of motion,ROM)、钉棒系统最大应力以及椎间盘的应力分布情况。结果 OCF1和OCF2椎体ROM较PSF增加,钉棒应力减少,OCF具有较好的固定效果。结论 PSF、OCF1、OCF2固定术式均可减少上颈椎ROM,重建上颈椎的稳定性,使椎体和椎间盘应力分布趋向正常水平。研究结果可为临床手术方案提供理论依据。     

空气压力波治疗仪联合体感诱发电位监测预防脊柱骨折术后下肢深静脉血栓形成的应用效果

目的:分析空气压力波治疗仪联合体感诱发电位（SEP）监测预防脊柱骨折术后下肢深静脉血栓（DVT）形成的应用效果。方法:选择99例脊柱骨折患者,按照随机数字表法分为观察组（n=50）和对照组（n=49）。对照组采用SEP的疗法,观察组采用空气压力波治疗仪联合SEP监测的疗法。在治疗期间观察与记录两组患者的DVT发生率、住院期间疼痛、肿胀情况,血液流变学指标、恢复正常活动的时间和住院时间、生活质量量表-74（GQOL-74）以及护理服务的满意度情况。结果:观察组下肢DVT形成、疼痛和肿胀的发生率均低于对照组（P<0.05）。观察组下肢肿胀程度明显小于对照组（P<0.05）,下床时间、住院时间均短于对照组（P<0.05）。干预前,两组的相关血液流变学指标与GQOL-74评分比较,无明显统计学意义（P>0.05）;干预后,两组血浆粘度、全血低剪切粘度、高剪切粘度和红细胞聚集均下降,但是观察组以上指标明显低于对照组（P<0.05）。干预后,两组的GQOL-74评分均较干预前明显提高（P<0.05）,但观察组显著高于对照组（P<0.01）。观察组患者的护理服务满意度明显高于对照组（P<0.05）。结论:空气压力波治疗仪联合SEP干预措施有助于改善手术治疗的脊柱骨折患者的高凝状态和预防下肢DVT形成。此外,它还能有效缓解下肢疼痛和肿胀,提高生活质量和患者满意度,值得临床推广。     

基于集成学习的骨质疏松性骨折预测研究

骨质疏松性骨折是老年人发病和死亡的重要原因之一,建立高效的预测模型为老年人尽早提供诊断和治疗建议十分必要。实验利用Stacking构建了一种异构分类器EtDtb-S,将16个相关性较高的特征作为特征向量,选用极端随机树(ET)、基于决策树的装袋集成模型(DTB)作为初级学习器,逻辑回归作为次级学习器进行集成。实验验证将EtDtb-S与单模型、同构分类器进行骨质疏松性骨折预测对比,结果表明异构分类器相对于最优单模型预测精度提高2.8%,相对于最优同构分类器预测精度提高1.5%,具有更高的预测性能。     

骨质疏松症患者脊柱胸腰段椎体力学稳定性变化与椎体压缩性骨折风险预测的有限元分析

目的:通过有限元分析骨质疏松症（OP）患者的脊柱胸腰段椎体在不同运动状态下椎体力学稳定性变化,与人体正常模型进行对比分析,针对椎体是否存在压缩性骨折的风险进行预测,为干预性策略标准化建立和完善提供理论和生物力学依据。方法:选择没有脊柱胸腰段椎体伤病史的健康志愿者男女各1人;选择2例住院老年OP女性患者胸腰椎CT及MRI扫描资料。建立T11~L2骨质疏松性椎体的三维有限元模型并验证有效性。在正常生理载荷分析不同运动状态下的生物力学变化,对两组模型之间椎体、关节突关节、终板、纤维环、松质骨、椎间盘、髓核的Von Mises应力及椎体最大位移进行比对分析,同时对应力云图进行比对,分析其生理与病理关节应力变化。结果:正常人体与OP患者脊柱椎体的材料属性、弹性模量、刚度、强度以及所处的力学生物学环境变化进行分析结果表明,OP患者在脊柱前屈、后伸、左右侧弯、左右旋转、轴向7种不同运动状态下与正常人体脊柱胸腰段相比较,椎体、关节突关节、椎间盘、终板、纤维环、髓核的Von Mises应力有明显降低趋势,椎体最大位移呈现增大趋势。此外本研究对OP模型的建立并非采用文献中降低正常皮质骨、松质骨、终板弹性模量的模型,而是采用临床中根据CT数据、临床症状、骨密度等明确诊断的OP患者数据,与目前文献所提供的模型数据对比,更符合临床OP患者真实的脊柱胸腰段椎体与附属结构的生物力学特性和属性变化。与正常人体模型相比较,从筋骨系统进行分析,骨与肌肉、韧带所代表的动静力变化都有明显降低,这也印证了临床真实数据的变化。结论:OP患者脊柱胸腰段椎体应力分布不均匀、应力的集中趋势导致脊柱胸腰段椎体、椎间盘、髓核、纤维环、关节突及周围附属结构应力异常变化,即骨弹性模量的异常改变、周围附属结构的束缚力下降,引起筋骨系统平衡失常和长期稳定性下降,进而增加脊柱胸腰段椎体骨折的退变过程和风险,通过有限元分析针对椎体压缩性骨折风险建立标准化预防策略,提供理论和生物力学依据。     

Association between Daily Sunlight Exposure and Fractures in Older Korean Adults with Osteoporosis: A Nationwide Population-Based Cross-Sectional Study

PurposeWe aimed to investigate the association between daily sunlight exposure duration and fractures in older Korean adults with osteoporosis.Materials and MethodsWe utilized data from the 2008–2011 Korea National Health and Nutrition Examination Survey. Osteoporosis was diagnosed based on a T-score of ≤−2.5 using dual energy X-ray absorptiometry. The duration of daily sunlight exposure and fracture were assessed via intensive health interviews by trained staff using standardized health questionnaires. Fracture was defined as one or more fractures of the femur, wrist, and spine.ResultsA total of 638 patients with osteoporosis aged ≥65 years were included. The odds ratio (OR) of total fractures was 0.55 times lower in the group with ≥5 h of daily sunlight exposure than in the group with <5 h of exposure after adjusting for age, sex, family history of osteoporosis or fracture, body mass index, bone mineral density of the femoral neck, serum 25-hydroxyvitamin D, current smoking, alcohol intake, daily calcium intake, and physical activity [95% confidence interval (CI) 0.31–0.97, p=0.040]. In patients with vitamin D insufficiency, the OR of total fracture was 0.52 times lower in the group with ≥5 h of daily sunlight exposure than in the group with less exposure after adjusting the above variables (95% CI 0.28–0.97, p=0.041).ConclusionSunlight exposure for ≥5 h a day was significantly associated with a decreased OR of fracture in older Korean adults with osteoporosis. This association was also significant in patients with vitamin D insufficiency.