集束化护理在胫腓骨骨折早期肿胀病人中的应用

目的:探讨集束化护理在胫腓骨骨折早期肿胀病人中的应用效果。方法:选取某医院2018年1月—2020年2月收治的80例胫腓骨骨折早期肿胀病人为研究对象,采用随机数字表法将病人分为对照组及观察组,每组40例,对照组采取常规护理,观察组采取集束化护理,比较两组病人的疼痛评分情况、骨折康复情况及并发症发生情况。结果:两组护理前后疼痛评分差异有统计学意义,且观察组疼痛评分下降幅度显著高于对照组(P<0.05);观察组康复有效率为85.00%,显著高于对照组65.00%(P<0.05);观察组并发症发生率为7.50%,显著低于对照组的22.50%(P<0.05)。结论:针对胫腓骨骨折早期肿胀病人,采用集束化护理能有效改善病人疼痛,减少并发症,取得良好的康复效果。     

Rescue of a patient with a 50 cm broken PICC tube retracted and wrapped in pulmonary artery: a case report

Objective: With the increasing use of a peripherally inserted central catheter (PICC) in clinical application, the breaking of the PICC is increasing as well, which would turn into the emboli and drift to the heart and pulmonary artery, causing severe consequences.However, few cases have been reported on the rescue of patients with a broken PICC.Patient concerns: A 33-year-old man, diagnosed with chronic hepatitis B-related decompensated cirrhosis and cryptococcal meningitis, was treated with amphotericin B combined with flucytosine and fluconazole by means of PICC catheterization. The patient was discharged with a catheter; when he returned for re-examination, a 50cm length of PICC broke and slipped into the vein after his sudden dysphoria. First aid was immediately administered, and then the intervention therapy to extricate the tube, including pulmonary artery angiography and intravascular removal of foreign matter, was performed based on the consensus of the in-hospital vein treatment group. At last, the broken PICC fragment was successfully taken out of the vessel. Re-examination after surgery showed that he recovered well.Conclusions: Once the catheter is broken, the X-ray examination should be performed at the first instance and re-examined frequently.Moreover, the involvement of a multidisciplinary team should be formed to decide the appropriate method of treatment to ensure a successful rescue.     

壳聚糖抗菌成膜喷剂预防老年病人牵引床复位手术相关性皮肤损伤的效果观察

目的:探讨壳聚糖抗菌成膜喷剂在老年股骨粗隆间骨折行牵引床复位手术所致皮肤压力性损伤预防中的应用效果。方法:选取2018年12月—2019年12月丹阳市人民医院创伤骨科收治的60例择期行牵引床下股骨粗隆间骨折闭合复位防旋股骨近端髓内钉(PFNA)内固定术病人,按照随机数字表法将其分为试验组与对照组,各30例。试验组病人在大腿内侧上1/3及会阴部喷壳聚糖抗菌成膜喷剂后会阴柱包棉垫,对照组病人会阴柱包裹棉垫,对比两组病人术后即刻、30 min、2 h、24 h、72 h会阴部受压部位皮肤情况及两组病人舒适度。结果:试验组皮肤保护效果及舒达度优于对照组,差异均有统计学意义(P<0.05)。结论:在老年股骨粗隆间骨折行牵引床复位手术会阴部使用壳聚糖抗菌成膜喷剂可预防或减少皮肤压力性损伤的发生,提高病人舒适度。     

脊柱转移瘤病理性骨折的危险因素及影像学预测研究进展

病理性骨折是脊柱转移瘤的严重并发症,而癌症患者数量的增加和生存期的延长导致了脊柱转移瘤患者的数量增加。早期识别病理性骨折的高危人群,有助于提前干预,提高患者晚期生存质量。该综述总结了脊柱转移瘤患者发生病理性骨折的危险因素及影像学预测工具的研究进展。     

手法复位石膏外固定联合盘龙七片治疗A3型桡骨远端骨折的早期疗效

目的探讨手法复位石膏外固定术联合口服盘龙七片治疗A3型桡骨远端骨折的早期疗效,为临床治疗提供参考。方法选取2018年6月至2020年1月于邳州医院治疗的A3型桡骨远端骨折患者100例,随机分为对照组(手法复位石膏外固定术,50例)和研究组(手法复位石膏外固定术联合口服盘龙七片,50例)。比较两组患者治疗前和治疗7 d血清IL-1、IL-6、TNF-α水平及治疗后4周Gartland-Werley腕关节评分,评价两组患者早期临床治疗效果。结果经过7 d治疗后,两组血清IL-1、IL-6、TNF-α水平均低于治疗前,且研究组低于对照组,差异有统计学意义(P<0.05,P<0.01)。研究组患者拆除石膏后Gartland-Werley腕关节评分优良率高于对照组,差异有统计学意义(82.0%vs 48.0%,χ²=12.703,P<0.01)。结论手法复位石膏外固定术联合口服盘龙七片治疗A3型桡骨远端骨折,较之单纯手法复位石膏外固定能有效降低骨折炎性反应,缓解疼痛、肿胀。     

胫腓骨骨折内固定后应用中西医结合护理的效果研究

目的探究胫腓骨骨折内固定后应用中西医结合护理的临床疗效。方法选择2017年1月至2019年12月在本院进行治疗的胫腓骨骨折内固定患者60例为研究对象,先入院的30例患者视为对照组,并行常规护理,后入院的30例患者视为观察组,并行中西医结合护理,记录两组患者治疗期间出现的并发症,评估患者护理满意度,对比临床疗效。结果观察组患者并发症发生率6.67%(2/30)较对照组26.67%(8/30)更低,P<0.05,差异有统计学意义;观察组患者护理满意率96.67%(29/30)较对照组76.67%(23/30)更高,P<0.05,差异有统计学意义。结论针对胫腓骨骨折内固定患者,临床给予中西医结合护理效果显著,可降低并发症发生风险,提高患者对护理工作的满意程度。     

Minimally invasive removal of a deep-positioned cannulated screw from the femoral neck: A case report

BACKGROUNDClinical femoral neck fracture is common. Based on patient age and fracture type, different surgical methods can be selected, including cannulated screw fixation of the femoral neck and artificial total hip joint or semi-hip joint replacement. When patients with femoral neck fracture are treated with cannulated screw fixation, a cannulated screw may be positioned too deep. The excessively deep-placed screw is difficult to remove and causes major trauma to the patient.CASE SUMMARYA patient with poliomyelitis and femoral neck fracture was treated with a cannulated screw that was placed too deep. A self-made auxiliary tool (made of a steel sternal wire) was used to remove the cannulated screw near the pelvic cavity.CONCLUSIONThe depth of the cannulated screw can be estimated before screw placement using an improved hollow screwdriver with a scale mark, thus improving the safety of screw placement and facilitating clinical use.     

Tube Technique with Light-curing Composite for Removing Fractured Root Canal Instruments: Influence of Polymerization Cycles and Mechanical Exposure

IntroductionThe purpose of this study was to investigate the influence of both polymerization cycles and mechanical exposure procedures on the adhesion of instrument fragments using a modified tube technique with a light-curing composite.MethodsEighty Mtwo instruments (size 15.05; VDW, Munich, Germany) were cut at a diameter of 35/100 mm and clamped in a vice with an overlap of 2 mm. Matching cannulas were filled with SDR composite (Dentsply, York, PA) and placed over the instruments. Prime & Bond Active (Dentsply Sirona, Bensheim, Germany) was used as the bonding material. Glass fiber was inserted from the opposite side into the cannula, and 1, 2, 4, or 6 polymerization cycles of 30 seconds were applied (800 mW/mm²) (n = 20/group). Sixty further identical instruments (n = 20/group) were divided into the following groups: group 1, cut at 10 mm and left unprepared (taper = 5%); group 2, parallelized using diamond instruments (taper = 0%); and group 3, prepared in a way that an inverted conical taper resulted (taper = 2%). Polymerization was performed for 2 minutes. The failure load and mode of failure were determined using a tensile testing device (2 mm/min). Data were statistically analyzed using the Kruskal-Wallis or chi-square test.ResultsThe failure load increased significantly with the number of polymerization cycles (P < .0001). More than 4 polymerization cycles had no further benefit (P > .05). The failure load in the inverted conical group was significantly lower (P < .0001) compared with the parallel and the unprepared groups. Adhesive failure was significantly more frequent in groups 2 and 3 (20/20) than in group 1 (16/20) (P < .05).ConclusionsBoth the number of polymerization cycles and the mechanical exposure procedures had a significant impact on the adhesive force when using the tube technique.     

Accuracy of High-resolution Small-volume Cone-Beam Computed Tomography in the Diagnosis of Vertical Root Fracture: An In Vivo Analysis

IntroductionThe purpose of this in vivo study was to evaluate the accuracy of small-volume cone-beam computed tomographic (CBCT) imaging compared with conventional periapical radiography (CPR) in the diagnosis of vertical root fractures (VRFs) using exploratory surgery as the reference standard.MethodsEighty-two dental records of 85 teeth with suspected VRFs that underwent CPR, CBCT imaging, and exploratory surgery were included. Two observers assessed CPR and CBCT images independently for the presence or absence of root fractures, and findings from the exploratory surgery were considered the reference standard. Diagnostic sensitivity, specificity, accuracy, and the receiver operating characteristic curve values were obtained. The effect of single- and multirooted teeth on diagnostic accuracy as well as the association between clinical symptoms and the presence of VRFs were also assessed.ResultsVRFs were surgically detected in 64 of the 85 teeth (75.3%), of which 62.5% were multirooted and 76.6% had intracanal posts. CBCT imaging was more sensitive and accurate (65.6% and 64%) than CPR (27.3% and 40.5%). Both CPR and CBCT diagnostic accuracies were higher in single- than multirooted teeth. Pain on percussion, a localized periodontal pocket, and tooth mobility were associated with the presence of VRFs (P < .05; odds ratio = 4.15, 13.5 and 4.1, respectively).ConclusionsThe accuracy of CBCT imaging for the diagnosis of VRFs was poor, although it was higher than with CPR. Multirooted teeth in the presence of intracanal posts may limit its diagnostic value.