骨科术后自控镇痛的应用及护理

目的:探讨骨科患者术后自控镇痛(PCA)的临床应用及护理。方法:选取2009年1月～2010年1月我科手术治疗的下肢骨科手术患者80例,术后分别采用自控静脉镇痛(PCIA组)40例、采用自控硬膜外镇痛(PCEA组)40例,对比两组患者术后镇痛效果、不良反应发生情况,总结护理措施。结果:PCIA组镇痛总有效率为95%,PCEA组总有效率为85%,组间比较差异有统计学意义(P<0.05),可能与个体差异有关。PCIA组尿潴留发生率仅有2例(5%),明显低于PCEA组20例(50%)。结论:PCIA用于骨科术后镇痛效果确切,管理方便,不良反应发生率较PCEA低,值得推广应用。     

中医骨伤与西医骨科学发展的比较探究

中西医长期并存、共同发展是我国医学面临的现实和长期发展的方向。中西医骨科学均是各自医学发展中的重要标准,在对中西医骨科的比较研究中,尝试对骨科的中西医未来发展作一种回应。通过对中西医骨科在病理解释、诊断机制、治疗方式在过程中的各个环节的平行比较中,凸显两者的异同。勾勒出中西医骨科各自独特的发展历史和理论方法特点,旨在说明两种不同的医学体系在临床实践中可以形成优势互补,并且在治疗理念上趋于同一性。     

骨科择期手术术中细菌污染的监测分析

目的：探讨骨科择期手术术中细菌污染情况及预防性抗生素的选择和使用。方法：手术结束前于切口内组织及术野皮肤取样进行细菌培养及药敏试验，术后使用青霉素钾和奈特预防性用药3-5d。结果：本组术中细菌污染率为14.29%，术后基本无发热，伤口均甲级愈合，术中细菌污染与伤口类型密切相关。结论：骨科择期手术术中细菌污染不溶忽视，术后采用β-内酰胺类和氨基糖苷类配伍预防感染可行。     

《中华骨科杂志》2002-2004年引文分析

目的研究《中华骨科杂志》文献引用规律及我国骨科学研究领域科研人员的文献利用与需求特征。方法利用引文计量分析法,统计《中华骨科杂志》2002-2004年间刊载的614篇论文所引用的参考文献。结果614篇论文中,有引文的论文共565篇,引文率为92.02%,篇均引文11.66条;引文中期刊6672条(93.22%),图书451条(6.30%);普赖斯指数45.44%,期刊自引361条,自引率5.04%。被引用频次居前20位的中、外文期刊的引文量占总引用期刊引文量的53.30%。结论《中华骨科杂志》涉猎文献范围广,引文类型以期刊为主,语种以英文文献为主,引文的外文语种结构较为单一,研究引用文献比较滞后,文献半衰期较长,专业人员利用近5年内新文献的能力有待于进一步提高。     

Prophylaxis against venous thromboembolism in orthopedic surgery

Venous thromboembolism (VTE), which is manifested as deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a significant cause of death, disability, and discomfort. They are frequent complications of various surgical procedures. The aging population and the survival of more severely injured patients may suggest an increasing risk of thromboembolism in the trauma patients. Expanded understanding of the population at risk challenges physicians to carefully examine risk factors for VTE to identify high-risk patients who can benefit from prophylaxis. An accurate knowledge of evidence-based risk factors is important in predicting and preventing postoperative DVT, and can be incorporated into a decision support system for appropriate thromboprophylaxis use. Standard use of DVT prophylaxis in a high-risk trauma population leads to a low incidence of DVT. The incidence of VTE is common in Asia. The evaluation includes laboratory tests, Doppler test and phlebography. Screening Doppler sonography should be performed for surveillance on all critically injured patients to identify DVT. D-Dimer is a useful marker to monitor prophylaxis in trauma surgery patients. The optimal time to start prophylaxis is between 2 hours before and 10 hours after surgery, but the risk of PE continues for several weeks. Thromboprophylaxis includes graduated compression stockings and anticoagulants for prophylaxis. Anticoagulants include Warfarin, which belongs to Vitamin K antagonists, unfractionated heparin, low molecular weight heparins, factor Xa indirect inhibitor Fondaparinux, and the oral IIa inhibitor Melagatran and ximelagatran. Recombinant human soluble thrombomodulin is a new and highly effective antithrombotic agent. Prophylactic placement of vena caval filters in selected trauma patients may decrease the incidence of PE. The indications for prophylactic inferior vena cava filter insertion include prolonged immobilization with multiple injuries, closed head injury, pelvic fracture, spine fracture, multiple long bone fracture, and attending discretion. Multiple-trauma patients are at increased risk for DVT but are also at increased risk of bleeding, and the use of heparin may be contraindicated. Serial compression devices (SCDs) are an alternative for DVT prophylaxis. Compression devices provide adequate DVT prophylaxis with a low failure rate and no device-related complications. Immobilization is one of important reasons of VTE. The ambulant patient is far less Ukely to develop complications of inactivity, not only venous thrombosis, but also contractures, decubitus ulcers, or osteoporosis ( with its associated fatigue fractures), as well as bowel or bladder complications.     

The influence of bariatric surgery on hip and knee joint pain: a systematic review

Obesity increases the risk of osteoarthritis and the chance of needing joint replacement arthroplasty to reduce lower limb joint pain. Although nonsurgical weight loss interventions can reduce hip and knee joint pain, bariatric surgery may be a more feasible treatment option for people with severe obesity. However, it is unclear whether weight loss through bariatric surgery can positively influence hip and knee joint pain. Our objective was to evaluate the influence of bariatric surgery on hip and knee joint pain in people with obesity by conducting a systematic review of the literature. The PubMed, EMBASE, and Cochrane bibliographic databases were searched for studies published between 1947 and September 2019. Risk of bias of the identified studies was independently assessed by 2 reviewers using JBI’s Critical Appraisal Checklist for Case Series and the Newcastle-Ottawa Scale. This review included 23 studies, all of which evaluated knee pain and 9 of which also evaluated hip pain. Reported results regarding hip pain intensity and the proportion of participants with hip pain were too limited to draw useful conclusions. Reported results regarding knee pain suggest that weight loss after bariatric surgery reduced knee pain intensity, as well as the proportion of participants with knee pain. The overall risk of bias of the majority of included studies (83%; n = 19) was judged to be unclear to high. Four small studies were judged as having a low risk of bias. Results of this systematic review suggest that bariatric surgery can positively influence hip and knee joint pain, but conclusive evidence is lacking because most of the included studies were judged as having plausible bias overall and in their key domains. Well-designed randomized controlled trials evaluating the influence of bariatric surgery on hip and knee joint pain using standardized joint pain measures are needed.     

碘仿纱布联合美宝湿润烧伤膏治疗骨科创面感染46例

目的:探讨碘仿纱布联合美宝湿润烧伤膏治疗骨科创面感染的临床效果。方法:将2019年1月至2019年12月兴国县人民医院收治的92例骨科创面感染患者按随机数字表法分为观察组和对照组,各46例。观察组给予碘仿纱布联合美宝湿润烧伤膏治疗,对照组给予常规清创、换药等处理。比较两组患者的临床疗效、创面感染相关临床指标及治疗前后白细胞计数(WBC)、C反应蛋白(CRP)、创面细菌计数。结果:观察组总有效率明显高于对照组(P<0.05);观察组肉芽覆盖时间、肉芽痊愈时间、创面愈合时间、住院时间均明显低于对照组(P<0.05);观察组治疗后5 d、10 d的WBC、CRP、创面细菌计数均明显低于对照组(P<0.05)。结论:碘仿纱布联合美宝湿润烧伤膏治疗骨科创面感染临床效果显著,能有效控制感染,促进创面愈合和康复进程。     

抗菌药物对骨科围术期预防感染的影响

目的探究抗菌药物对骨科围术期预防感染的影响。方法选择2016年1月-2019年1月瑞安市人民医院骨科收治的手术患者82例,随机数表法分为对照组和研究组,每组各41例,其中对照组围术期给予常规应用抗菌药物,研究组围术期给予干预性应用抗菌药物,观察两组抗菌药物使用情况、抗菌药物费用,并对抗菌药物使用的合理性进行评价。结果研究组住院时间、手术部位感染、治疗各项费用均低于对照组,差异有统计学意义(P<0.05);两组体温异常情况比较,无统计学差异;两组围术期抗菌药物使用均主要以单一用药为主,研究组单一用药多于对照组,二联用药低于对照组,差异有统计学意义(P<0.05);研究组在抗菌药物品种选择、预防用药时机、术后用药时间等围术期抗菌药物使用合理率均高于对照组,差异有统计学意义(P<0.05);两组治疗前肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、IL-8、C-反应蛋白(CRP)各项血清炎性因子水平比较,无统计学差异;治疗后,两组血清炎性因子水平均下降,差异有统计学意义(P<0.05)。结论干预性应用抗菌药物对骨科围术期预防感染效果显著,在降低手术部位感染发生率的同时,提高抗菌药物使用合理性、缩短住院时间、降低住院费用。     

平乐郭氏正骨联合小夹板外固定对老年桡骨远端骨折患者掌倾角及腕关节功能的影响

目的：探讨平乐郭氏正骨联合小夹板外固定对老年桡骨远端骨折（DRF）患者掌倾角及腕关节功能的影响。方法：回顾性分析2019年3月—2022年4月本院收治的103例老年DRF患者的临床资料,根据复位手法的不同分成常规复位组（n=51,常规手法复位）、中医复位组（n=52,平乐郭氏正骨手法复位）,两组复位后均予以小夹板外固定。比较两组腕关节尺偏角、掌倾角、腕关节主动活动度（AROM）及腕关节功能恢复效果。结果：两组腕关节尺偏角、掌倾角均随治疗时间增加而减小（P <0.05）,尺偏角的组间与时点无交互作用（P>0.05）,掌倾角的组间与时点存在交互作用（P <0.05）,其中中医复位组治疗后即刻、6周及12周的尺偏角、掌倾角均明显大于常规复位组（P <0.05）;治疗后12周,两组患侧腕关节背伸、掌屈、旋后时的AROM均大于治疗前,且中医复位组均明显大于常规复位组（P <0.05）;中医复位组腕关节功能恢复优良率为96.15%,明显高于常规复位组的82.35%,差异有统计学意义（P <0.05）。结论：对老年DRF患者实施平乐郭氏正骨联合小夹板外固定治疗,可...     

E-scooter use continues to rev up fracture diagnoses and hospital admissions compared to other modes of transportation

IntroductionThe COVID-19 pandemic was associated with an increase in popularity of e-scooter usage and a rise in e-scooter related injuries. Recent studies have elucidated trends within e-scooter injuries but there are few epidemiological studies that evaluate injury rates amongst multiple modes of transportation. This study seeks to investigate trends of e-scooter orthopedic fracture injuries compared to other traditional methods of transportation using a national database.MethodsThe National Electronic Injury Surveillance System (NEISS) database was queried between 2014 and 2020 for patients who were injured after usage of e-scooters, bicycles, or all-terrain vehicles. Primary analysis included patients with a diagnosis of fracture and utilized univariate/multivariate models to evaluate risk of hospital admission. Secondary analysis included all isolated patients to evaluate the odds of fracture development amongst modes of transportation.ResultsA total of 70,719 patients with injuries associated with e-scooter, bicycle, or all-terrain vehicle use were isolated. 15997 (22.6%) of these patients had a fracture diagnosis. Both e-scooters and all-terrain vehicles reported increased odds of fracture-related injury and direct hospitalization when compared to bicycles. E-scooter users reported a greater odds of both associated fracture (OR 1.25; 95%CI 1.03–1.51; p = 0.024) and hospital admission (OR: 2.01; 95%CI: 1.26–3.21; p = 0.003) in 2020 compared to 2014–2015.DiscussionE-scooter related orthopedic injuries and hospital admissions had the largest incidence rate increase compared to bicycle and all-terrain vehicles between 2014 and 2020. E-scooter fractures were most commonly located in the lower leg in 2014–2017, the wrist in 2018–2019, and the upper trunk in 2020. In comparison, bicycle and all-terrain vehicle fractures was most commonly shoulder and upper trunk within the study period. Further research will help to promote further understanding of the e-scooter health care burden and in prevention of these injuries.Level of evidence3.