外固定支架结合负压封闭引流技术治疗开放性胫骨骨折疗效观察

目的：探讨外固定支架结合负压封闭引流技术（VSD）治疗开放性胫骨骨折的临床效果。方法：回顾性分析2012年1月-2013年1月在本院接受治疗的43例胫骨骨折患者的临床资料,观察外固定支架结合VSD治疗开放性胫骨骨折的手术方法及治疗效果。结果：本组43例患者骨折一期愈合40例（93.02%）,延迟愈合3例（6.98%）,骨折愈合时间16~42周,平均（24.32±8.26）周。VSD使用次数1~3次,34例创面明显缩小直接缝合后痊愈,7例创面肉芽组织新鲜后经植皮后愈合,2例患者经皮瓣转移后痊愈。结论：外固定支架结合VSD治疗开放性胫骨骨折具有固定效果好、创面恢复快等优点,且操作简单,可作为目前治疗开放性胫骨骨折的首选治疗方案。     

VSD联合抗生素链珠菌植入术治疗股骨干骨折术后感染的护理体会

目的：探讨持续闭式引流（VSD）结合骨水泥抗生素链珠菌植入治疗股骨干骨折术后早期感染的临床疗效及护理措施。方法：将42例股骨干骨折术后感染患者随机分为观察组22例、对照组20例,观察组采用VSD联合抗生素链珠菌植入术及相应的围手术期护理,对照组采用常规换药。观察2组换药次数、住院天数、住院费用。结果：换药次数、住院天数、住院费用观察组均少于对照组,差异具有统计学意义（P＜0.05）。结论：VSD结合骨水泥抗生素链珠菌植入治疗股骨干骨折术后早期感染操作简单、安全有效,积极的护理配合,可有效减短患者住院时间,减少换药次数,减轻经济负担。     

持续封闭式负压引流治疗糖尿病足的观察与护理

目的探讨持续封闭式负压引流技术(vaccum sealing drainage,VSD)治疗糖尿病足的效果及护理对策。方法回顾性总结2010年9-12月行持续封闭式VSD治疗的60例糖尿病足患者的临床资料及治疗过程中的护理干预措施。结果 4例患者在行VSD治疗后采用人造皮肤覆盖创面后愈合,1例患者因创面肉芽过度生长而接受再次清创换药治疗,3例患者因发生堵管问题疗效较差,其余患者肉芽组织生长良好,创面明显缩小,术后无感染。结论糖尿病足患者VSD治疗过程中的护理配合可有效减少了堵管等情况的发生,提高了治疗的有效性和安全性。     

24例跟骨骨折术后应用VSD 治疗亚急性期伴皮肤软组织坏死缺损的护理

目的:探讨应用封闭负压引流(VSD) 治疗跟骨开放粉碎性骨折术后亚急性期伴皮肤软组织坏死缺损的的效果.方法:2007 年1月～2008 年6月间,将36 例患者随机分为两组,24 例作为实验组,采用手术切开复位内固定的同时辅助恒定负压封闭引流技术治疗.12 例作为常规治疗组,对比分析两组患者术后伤口愈合、患者满意度、术后并发症、预后及平均住院天数.结果:使用VSD 的实验组伤口Ⅰ期愈合及满意度均显著高于常规治疗组,平均住院天数也显著低于常规治疗组.实验组总有效率96%,对照组总有效率86.36%.结论:VSD 使治愈率明显提高,积极的心理疏导,治疗前彻底的创面清创,严格的消毒隔离,高负压引流的有效保持,是VSD 治疗跟骨开放粉碎性骨折术后亚急性期伴皮肤软组织坏死缺损的重要保证.     

Impaired myelination of the human hippocampal formation in Down syndrome

Myelination is considered as one of the last steps of neuronal development and is essential to the physiologically matured function of afferent and efferent pathways. In the present study, myelin formation was examined in the human fetal, postnatal and adult hippocampal formation in Down syndrome and in age-matched controls with immunohistochemistry detecting a protein component of the myelin sheath, the myelin basic protein synthesized by oligodendroglial cells. Myelination is mainly a postnatal event in the hippocampal formation of both healthy controls and in patients with Down syndrome. In patients with Down syndrome the sequence of myelination of the hippocampal formation followed a similar developmental pattern to that in controls. However, myelin formation was generally delayed in Down syndrome compared to age-matched controls. In addition, in the hilus of the dentate gyrus a decreased density of myelinated axons was detected from the start of myelination until adulthood. The majority of local axons (mossy fibers) are not myelinated in the hilar region and myelinated fibers arriving in the hilus come mainly from the subcortical septal nuclei. Since intact septo-hippocampal connections are necessary for memory formation, we hypothesize that decreased myelination in the hilus may contribute to the mental retardation of Down syndrome patients.     

VSD技术联合外固定架治疗胫腓骨开放性骨折伴软组织缺损的护理

目的 探讨负压封闭引流术(VSD)联合外固定架治疗胫腓骨开放性骨折伴软组织缺损的治疗效果.方法 对20例胫腓骨开放性骨折伴软组织缺损采用VSD联合外固定架治疗.结果 20例患者骨折愈合良好,无感染发生,创面愈合良好,肢体功能良好.结论 VSD使创面引流充分,降低感染发生率,促进创面愈合,配合外固定架治疗胫腓骨开放性骨折伴软组织缺损是一种简单、有效的方法.     

Temporal Trends and Outcomes of Mechanical Complications in Patients With Acute Myocardial Infarction

ObjectivesThe aim of this study was to examine the temporal trends and outcomes of mechanical complications after myocardial infarction in the contemporary era.BackgroundData regarding temporal trends and outcomes of mechanical complications after ST-segment elevation myocardial infarction (STEMI) and non–ST-segment elevation myocardial infarction (NSTEMI) are limited in the contemporary era.MethodsThe National Inpatient Sample database (2003 to September 2015) was queried to identify all STEMI and NSTEMI hospitalizations. Temporal trends and outcomes of mechanical complications after STEMI and NSTEMI, including papillary muscle rupture, ventricular septal defect, and free wall rupture, were described.ResultsThe analysis included 3,951,861 STEMI and 5,114,270 NSTEMI hospitalizations. Mechanical complications occurred in 10,726 of STEMI hospitalizations (0.27%) and 3,041 of NSTEMI hospitalizations (0.06%), with no changes in trends (p = 0.13 and p = 0.83, respectively). The rates of in-hospital mortality in patients with mechanical complications were 42.4% after STEMI and 18.0% after NSTEMI, with no significant trend changes (p = 0.62 and p = 0.12, respectively). After multivariate adjustment, patients who had mechanical complications after myocardial infarction had higher in-hospital mortality, cardiogenic shock, acute kidney injury, hemodialysis, and respiratory complications compared with those without mechanical complications. Predictors of lower mortality in patients with mechanical complications who developed cardiogenic shock included surgical repair in the STEMI and NSTEMI cohorts and percutaneous coronary intervention in the STEMI cohort.ConclusionsContemporary data from a large national database show that the rates of mechanical complications are low in patients presenting with STEMI and NSTEMI. Post–myocardial infarction mechanical complications continue to be associated with high mortality rates, which did not improve during the study period.     

应用VSD治疗12例大面积皮肤剥脱伤的临床体会

目的 探讨负压封闭引流(VSD)技术在骨科大面积皮肤剥脱伤治疗过程中应用的疗效观察及优点.方法 对12例大面积皮肤剥脱伤病人行清创皮下置入聚乙烯酒精水化海藻盐泡沫敷料(VSD辅料)行负压封闭引流,7～10d后行皮肤切孔后表面放置聚乙烯酒精水化海藻盐泡沫敷料(VSD辅料)行负压封闭引流或清创反取皮植皮后使用VSD负压封闭引流技术进行治疗.结果 10例创面 Ⅰ 期愈合,2例出现小面积皮肤坏死后经植皮和缝合后愈合,创面平均愈合时间30 d.结论 负压吸引技术在治疗骨科大面积皮肤剥脱伤的临床工作中,可以很好的保证皮肤成活,保护创面,利于护理,缩短病程,减轻病人的经济负担.