Kirschner wire和Cable-pin在髌骨骨折手术治疗中的临床效果分析

目的分析比较Kirschner wire和Cable-pin在髌骨骨折治疗中的临床效果和应用价值。方法回顾2006年12月～2009年12月间笔者医院收治的107例髌骨骨折病人,分别用Kirschner wire和Cable—pin手术治疗68例和39例,记录两组病人的骨折类型、手术历时、术中出血量、住院日、医疗费用、术后并发症及远期膝关节功能恢复情况,应用SPSS11．0软件对观察指标进行统计学分析。结果107例病人全部获得随访,随访时间为3～21个月,平均14．2个月。Cable-pin治疗组患者的手术历时和术中出血量均明显少于Kirschner wire治疗组（P〈0．05）,但医疗费用远高于后者（P〈0．01）。两组病人术后并发症、住院日、骨折愈合时间和远期膝关节功能恢复情况无统计学差异。结论应用Kirschner wire手术治疗髌骨骨折更为广泛,方法灵活且疗效肯定,是一种性价比较高的治疗方法;Cable—pin操作简单、疗效可靠,但仅适用于横断性髌骨骨折,且医疗费用昂贵,在临床应用中有一定局限性。     

Results and complications of facial reanimation following cerebellopontine angle surgery

The present study was undertaken to evaluate the results of a group of patients following treatment for cerebellopontine angle lesions who developed postoperative facial palsy and underwent facial nerve repair in order to reanimate the muscles of facial expression. A retrospective study was performed on 23 patients treated between 1988 and 1997 at the 2nd and 4th ENT chairs of University "La Sapienza" of Rome for facial palsy following cerebellopontine angle surgery. Tumors included acoustic neuromas (n = 3). Seventeen patients underwent hypoglossal-facial anastomoses [10 with end-to-end anastomoses, 4 with May's interposition "jump-nerve" grafts and 3 with partial (30%) use of the hypoglossal nerve plus a facial cross-over]. The remaining patients were operated on using a cable graft with the sural nerve (n = 2) and the great auricular nerve (n = 4). Postoperative facial function was determined by the House-Brackmann 6-scale classification The hypoglossal-facial anastomoses resulted in long-term grade III or IV findings. Cable grafts improved facial function from grade VI to grade III. None of the patients operated on with the modfied VII-XII anastomosis developed swallowing disturbances. The ten patients having traditional hypoglossal-facial anastomoses showed different degrees of tongue disability and retention of residue in the oral cavity. Surgical recovery of postoperative facial palsy can be obtained with various techniques according to the availability of the proximal facial nerve stump at the brain stem. Since a traditional hypoglossal-facial anastomosis procedure can be a source of a separate disability for the patient, techniques are preferred that leave the hypoglossal nerve mostly intact and uncompromised.     

Barbiturate depression of a K+ dependent inhibitory synapse is independent of dendritic cable filtering

Summary Technical limitations with intracellular electrophysiological methods usually restrict recording of postsynaptic potentials only from neuronal soma, a site remote from the actual synapse. The intervening dendritic cable interposed between the actual synapse and the site of recording can significantly filter the synaptic signal. Therefore, investigations of drug effect on synaptic mechanisms, based on postsynaptic recordings obtained at the soma, must be interpreted with care. The potential role of dendritic cable filtering in the atypical pentobarbital depression of a K⁺-dependent inhibitory synapse between the P to Nut cell in the posterior packet of the leech was investigated. The effective electrical geometry under the conditions of control and 0.5 mM PNB sufficient to completely abolish the postsynaptic potential were determined from analyses of the membrane charging curves assuming the lumped-soma-short-cable model. Under the control condition, the postsynaptic Nut cell exhibits dendritic dominance with rho = 2.52, normalized equivalent cable length l= 1.08, and a membrane time constant tau_o=52 ms. With phenobarbital application, changes in the geometrical parameters consistent with a decrease in the specific membrane resistance R_m are observed. Simulation of the drug induced change in the electrical geometry demonstrates that the decrease in the post synaptic potential is largely due to the decrease in the soma input resistance and an increase in the cable filter contributes little to the observed depression of the postsynaptic potential. However, the combined effect of the decrease in the input resistance and the increase in the cable filtering of synaptic current is insufficient in explaining the observed total block of the synaptic potential by PNB. Therefore, in leech, PNB block of a K⁺-dependent inhibitory synapse is not an epiphenomenon due to altered cable filtering.     

长Gamma钉结合Cable环扎治疗股骨转子下粉碎性骨折

目的探讨长Gamma钉结合Cable内固定治疗股骨转子下粉碎性骨折的手术方法和临床疗效。方法回顾性分析2010年8月~2013年7月共收治股骨转子下粉碎性骨折23例,其中男性18例,女性5例,平均年龄41.6岁。术前按Seinsheimer分类:IIIA型12例,IIIB型3例,IV型6例,V型2例。手术均采用牵引床初步复位,骨折端有限切开后点式复位钳钳夹或环抱,透视下复位满意后用Zimmer公司Cable1~3根环扎固定,最后经大转子打入Stryker公司长Gamma钉。部分严重粉碎性骨折,牵引后骨折块间分离仍明显,可先打入长Gamma钉,然后用多根cable环扎将碎骨块围绕主钉复位固定。临床疗效评定采用Harris髋关节功能评分标准。结果 5例失访,其余18例患者术后随访11~24个月,均未发生切口感染、骨折不愈合或内固定松动断裂,骨折愈合时间平均5.1个月。Harris髋关节功能评分:优良率为94.4%。结论股骨转子下粉碎性骨折,可采用近端撬拨维持或远端控制牵引来初步复位,进一步切开复位并用Cable环扎固定。骨块间的接触,尤其是内侧皮质的接触和支撑非常重要,严重的粉碎性骨折,可以在髓内钉插入后再用Cable复位固定。结合微创理念和相关的器械,长Gamma钉结合Cable内固定治疗股骨转子下粉碎性骨折,可望获得良好的临床疗效。     

挪威荷兰—世界最长的电力电缆（译文）

经过三年时间的不断努力,挪威荷兰的电缆工程终于在2008年5月6日投入运行。这个成就十分重要,因为这一个项目的核心小组,已经成立了较长的时间,负责办理所有的许可证,所有主要的供货合同等等。 本文将介绍这个项目的详细工程内容,生产制造和安装敷设等,总共1160公里的高压电缆。 一部分为双芯电缆,而主要部分为普通的单芯电缆。 严格的指南针磁偏移要求,以及敷设一根电缆所产生的磁场对环境的影响等 ,使得挪威荷兰项目选用特殊双芯强浸渍（mass-impregnated）电缆。在北面水较深的路径,采用普通的单芯电缆。 北海具有有名困难的工作环境,而离岸的工作则远比其他任何海底电缆项目困难得多。这里将叙述挪威荷兰项目管理所遇到的挑战。离岸的艰苦接头工作创出了经验,对今后类似的工程显得十分重要。 电缆敷设完成后,全线约97%的电缆采用水冲喷坑保护,其余的电缆包括与其他管线交叉跨越处,则采用岩石堆放保护。 当电缆进行敷设后的安装试验,海上出现两处电缆故障。当时要重新动员多艘船只,以便进行故障修复。 目前对试验方法和工作程序产生了争议。     

110kV XLPE电缆外护套修补

通过对齐齐哈尔市地区中高压电缆外护套故障的调查和分析,说明高压和超高压XLPE绝缘电缆外护套应有的绝缘性能和防水性能,外护套故障存在的严重性,提出的对策是对外护套及时、有效修补。     

悬臂梁支撑线缆牵拉复位固定融合术治疗陈旧性齿状突骨折伴寰枢椎脱位

目的:总结应用悬臂梁支撑线缆牵拉复位固定融合术治疗陈旧性齿状突骨折伴寰枢椎脱位的临床效果。方法:2011年9月~2015年12月共收治42例陈旧性齿状突骨折伴寰枢椎脱位的患者,其中男29例,女13例;年龄16~67岁,平均43.8±12.2岁。根据Anderson-D'Alonzo分型,Ⅱ型骨折31例,Ⅲ型骨折11例。42例患者均有明确外伤史及枕颈部疼痛,35例有颈椎活动受限,30例有不同程度颈髓受压的症状和体征。患者均为寰椎前脱位,术前行颅骨牵引术,27例有不同程度的复位,15例无复位。所有病例均接受经后路悬臂梁支撑线缆牵拉复位固定融合术,记录手术时间、术中失血量和并发症发生情况,随访观察患者神经功能改善情况,用X线片及CT三维重建观察内置物稳定性和植骨融合情况,并采用脊髓有效空间(space available for the cord,SAC)评估寰枢椎复位情况。结果:本组患者均顺利完成手术,手术时间115~220min,平均123±18min,术中失血量30~350ml,平均110±80ml。所有患者均获得随访,随访时间6~54个月,平均34.1±14.8个月。42例患者的枕颈部疼痛均较术前明显减轻,末次随访时NDI及J0A评分较术前明显改善(P0.001)。术后各随访点影像学检査均提示35例复位满意,另外7例为部分复位,SAC由术前的8.5±3.3mm增加到末次随访时的14.9±3.0mm(P0.001)。1例患者植骨颗粒部分吸收,并于术后12个月出现线缆断裂,刺入脊髓导致了相应的症状体征,取出内固定后神经症状明显改善;其余患者均在术后6个月获得骨性融合,融合率为97.6%。1例患者术后出现脂肪液化,导致了切口延迟2周愈合。另有2例出现脑脊液漏,经延长引流管安置时间、预防感染等处理,切口愈合良好无感染。未出现椎动脉损伤、螺钉钛棒松动、移位、断裂以及寰枢椎再脱位、失稳等并发症。结论:悬臂梁支撑线缆牵拉复位固定融合术具有操作简单、手术风险低、术中复位、固定可靠等优势,采用该术式治疗陈旧性齿突骨折等导致的寰枢椎脱位可获得优良的疗效。     

振荡波技术在高压XLPE电缆局放检测中的分析及应用

为提高高压XLPE电缆的局放检测准确性,对局放进行精确定位,本文介绍了振荡波技术进行XLPE电缆局放检测的原理,分析了该技术基于TDR时域反射的局放判断方法,论述了振荡波电压下与工频运行电压下XLPE电缆局放的良好等效性。重点介绍了北京市电力公司最新引进的适用于高压XLPE电缆的OWTS设备的系统结构功能及使用,通过对北京市高压电缆现场振荡波局放测试数据的分析,验证了振荡波技术能够有效的发现并定位对110kV、220kVXLPE电缆的不同类型缺陷局放,并指出振荡波技术针对近端电缆终端局放判断受环境干扰影响过大的问题。     

Japanese Macaques (Macaca fuscata) as Natural Reservoir of Bartonella quintana

Bartonella quintana bacteremia was detected in 6 (13.3%) of 45 wild-caught Japanese macaques (Macaca fuscata). Multilocus sequence typing of the isolates revealed that Japanese macaques were infected with a new and specific B. quintana sequence type. Free-ranging Japanese macaques thus represent another natural reservoir of B. quintana.     

北京地区高压电缆局部放电带电检测工作回顾及检测周期 优化设想

本文对近年北京地区高压电缆局部放电带电检测工作进行回顾,并对已检出缺陷及历年故障进行统计分析,在此基础上提出优化现行检测周期的设想。