髋关节置换术治疗老年患者的严重粉碎移位的股骨粗隆间骨折的临床研究

目的：观察使用髋关节置换术治疗严重粉碎移位的股骨粗隆间骨折老年患者的临床疗效。方法：选取严重粉碎移位股骨粗隆间骨折老年患者103例,他们均是2018年4月-2020年4月期间被我院收治入院实施手术治疗。将患者分成两组施行手术,其中研究组53例,该组患者接受髋关节置换术治疗,对照组50例,该组患者接受内固定术治疗。患者治疗后进行3个月的随访,观察患者的治疗效果以及症状的改善程度、症状体征恢复情况,包括骨折愈合时间、手术后关节可活动时间,记录好患者治疗后出现的不良反应类型。结果：研究组骨折愈合时间(31.8±8.59)天、术后可活动时间(6.9±2.69)天,均显著少于对照组,而Harris评分(92.7±1.88)分明显高于对照组,差异具统计学意义(P<0.05)。研究组治疗后总有效率(96.2%)明显高于对照组(76.0%),差异具统计学意义(P<0.05)。研究组不良反应发生率(9.43%)明显低于对照组(20%),差异具统计学意义(P<0.05)。结论：运用髋关节置换术治疗老年患者严重粉碎移位的股骨粗隆间骨折,可达到创口小、疼痛低的效果,症状得到更好的改善,骨折愈合时间更短、不良反应少,安全性和预后良好。     

The Association between Reasons for a Rapid Response Team Alert and Immediate Patient Management in Total Hip Arthroplasty Patients

BackgroundThe purpose of this study is to evaluate the value and efficacy of rapid response teams (RRTs) for different triggering events in total hip arthroplasty (THA) patients.MethodsA retrospective review of all RRT events at a single, tertiary referral center from 2014 to 2016 was performed. Inclusion criteria were defined as patients >18 years old that underwent primary or revision THA. Information queried included demographics, primary reason for RRT, Charlson Comorbidity Index (CCI), underlying etiology, whether any changes in management occurred, and whether the patient was uptriaged.ResultsIn total, 168 RRTs were called on 153 hip arthroplasty patients (mean age 65.2 ± 14.1 years; mean body mass index 32.3 ± 4.8, 66% female). Length of stay in RRT for primary and revision THA was 3.4 and 6.2 days, respectively. This was significantly longer than the length of stay for primary THA patients (2.4 days, P < .001) and revision THA patients (4.6 days, P = .005) that did not require an RRT. There were no mortalities. RRTs for hypotension/presyncope (11%) and for syncope (11%) resulted in significantly fewer changes in management (P < .01) than tachycardia (77%), hypoxia (57%), AMS (79%), and other (47%). RRTs for hypotension/presyncope (28%), syncope (15%), and hypoxia (30%) resulted in significantly fewer patients being uptriaged (P < .001) than tachycardia (81%). Hypotension/presyncope was found to be significantly more commonly due to volume depletion (67%) (P < .001) than other etiologies. Hypoxia was significantly more commonly due to atelectasis (57%) and opioids/oversedation (30.4%) (P = .037). AMS/delirium was also significantly more commonly caused by opioids/over-sedation (71%) (P < .001).ConclusionIn patients undergoing THA, RRTs for hypotension/presyncopal symptoms and syncope were significantly less likely to result in changes in management or uptriaging compared to tachycardia. The most common etiologies were potentially preventable, including volume depletion and opioid use.     

伤寒论PBL教学法提高中医八年制学生中医临床思维构建的应用

中医临床思维是中医专业学生临床能力的关键。《伤寒论》是培养中医学生建立中医临床思维的核心课程。中医八年制较传统的中医博士研究生培养模式而言,培养时间大大缩短、教学要求高。为进一步提高中医八年制学员的临床思维能力,我们在《伤寒论》的教学过程中,分别在理论授课、临床实践中采用了PBL教学方法,教学效果良好。现介绍自己教学方法以及教学体会,以供同行参考交流。     

住院医师规范化培训制度对临床医学生就业的影响

目的通过对2019年2月-2019年6月在西安交通大学第二附属医院实习的大学四年级及大学五年级的临床医学专业的医学生就业意向及就业情况的分析,研究住院医师规范化培训制度对医学生就业的影响。方法运用自制的问卷进行匿名填写的方式对大学四年级、大学五年级的临床医学本科生及5+3模式的规范化培训医学生进行调查。结果大部分医学生选择继续升学,选择就业的学生多愿意留在大城市就业,选择住院医师规范化培训的学生只占极少数。结论做好住院医师规范化培训政策的宣传,落实各项优惠政策,鼓励学生进行住院医师规范化培训及到基层工作,引导学生理性考研,是目前社会及医学院校就业指导中的重要内容。     

Exercise and Lifestyle Education program for Brazilians living with prediabetes and diabetes: A pilot randomized trial

AimsTo test the Diabetes College Brazil Study feasibility, the acceptability of study interventions and their preliminary effectiveness, and describe the study protocol modifications due to the COVID-19 pandemic.MethodsSingle-center, double-blinded pilot randomized trial with two parallel groups, Exercise and Lifestyle Education (ExLE; 12-week exercise and educational interventions) and Exercise (Ex; 12-week exercise intervention only) involving patients with prediabetes or diabetes. Feasibility (eligibility, recruitment, retention, completeness of variables measures and participation rates), acceptability (satisfaction), and preliminary effectiveness of interventions (variables: functional capacity, physical activity (PA), exercise self-efficacy, diabetes knowledge, health literacy, adherence to Mediterranean food pattern, glycated hemoglobin (HbA1c), anthropometric measures, cardiac autonomic control, depression, and quality of life (QofL)).ResultsEligibility, recruitment, retention, participation in exercise sessions, and education classes rates were 17%, 93%,82%, 76%, and 71%, respectively. Missing data in the post-intervention assessment (PA, HbA1c, cardiac autonomic control, anthropometric measures, depression, and QofL) were mainly related to research procedure modifications. The interventions were highly acceptable, and most variables improved farther in the ExLE, with moderate effect sizes for PA, diabetes knowledge, health literacy, cardiac autonomic control, and QofL.ConclusionsThe Diabetes College Brazil Study is feasible, and the ExLE may benefit Brazilians living with prediabetes and diabetes.     

Emerging Racial Disparities in Outpatient Utilization of Total Joint Arthroplasty

BackgroundRacial and ethnic disparities within the field of total joint arthroplasty (TJA) have been extensively reported. To date, however, it remains unknown how these disparities have translated to the outpatient TJA (OP-TJA) setting. The purposes of this study were to compare relative OP-TJA utilization rates between White and Black patients from 2011-2019 and assess how these differences in utilization have evolved over time.MethodsWe conducted a retrospective review from 2011-2019 using the National Surgical Quality Improvement Program (NSQIP). Differences in the relative utilization of OP (same-day discharge) versus inpatient TJA between White and Black patients were assessed and trended over time. Multivariable logistic regressions were run to adjust for baseline patient factors and comorbidities.ResultsDuring the study period, Black patients were significantly less likely to undergo OP-TJA when compared to White patients (P < .001 for both outpatient total knee arthroplasty and outpatient total hip arthroplasty [OP-THA]). From 2011 to 2019, an emerging disparity was found in outpatient total knee arthroplasty and OP-THA utilization between White and Black patients (eg, White versus Black OP-THA: 0.4% versus 0.6% in 2011 compared with 10.2% versus 5.9% in 2019, P_trend < .001). These results held in all adjusted analyses.ConclusionIn this study we found evidence of emerging and worsening racial disparities in the relative utilization of OP-TJA procedures between White and Black patients. These results highlight the need for early intervention by orthopaedic surgeons and policy makers alike to address these emerging inequalities in access to care before they become entrenched within our systems of orthopaedic care.     

髋关节镜下盂唇修补术治疗髋臼盂唇损伤的疗效评价

目的:探讨髋关节镜下盂唇修补术治疗髋臼盂唇损伤的临床疗效。方法:选择2018年11月至2019年5月在广东省中医院诊断为髋臼盂唇损伤并在髋关节镜下行盂唇修复术的患者,所有患者术前术后采用X线片、三维CT和核磁共振等检查,选择改良Harris髋关节评分(mHHS)、体育运动专用髋关节评分(HOS-SSS)、日常活动的髋关节功能评分(HOS-ADL)和VAS疼痛评分,评定患者的临床疗效。结果:共纳入患者30例,其中男10例,女20例,年龄(37.8±10.6)岁(17~55岁)。所有患者均获随访,随访时间为6~12个月,平均8.2个月。患者术前H0S-ADL,HOS-SSS,mHHs评分分别为53.8±10.6,44.2±9.6,62.2±11.6;术后6个月时分别为77.6±10.2,72.8±7.3,79.3±9.1,均较术前显著提高(P<0.01);术前VAS评分为6.5±2.3,术后6个月时为2.6±1.3,较术前显著降低,差异有统计学意义(P<0.01)。结论:髋关节镜下盂唇修补术治疗髋臼盂唇损伤,能缓解症状,其近期临床疗效良好。     

不同髋关节骨病晚期“异病同证”临证探析

"异病同证"是中医学对病证关系的特殊认识,起初是指不同的病具有相同的病机,从而表现出相同的证候,反映了中医学辨证论治的特点,在临证中主要体现在一方用于治疗多种病证。随着病证结合诊疗模式的形成,"异病同证"的含义也发生了变化,多指西医诊断不同疾病在其发展的过程中出现了相同的病机,从而表现出相同的证候。股骨头坏死、髋骨关节炎、类风湿性髋关节炎是发于髋关节骨骼、软骨及滑膜的3个不同解剖组织的3种疾病,在疾病的晚期出现了髋关节疼痛、活动受限的症状和腰膝酸软、行走无力的证候,无论是症状体征或中医证候,均表现出其相似性,体现着中医学"异病同证"的思想,本文从临床症状、影像变化、中医证候特点、病因病机及临床治疗方面探析3种疾病的趋同性和差异性,结果发现,除了临床症状体征相似,3种髋关节骨病晚期均见关节软骨退变、关节间隙狭窄、关节积液、滑膜增厚、骨质增生及软骨下骨囊变等相似X射线表现;肾藏精、主骨生髓,只有肾精充足,筋骨方可得以骨髓充养,肝藏血、主筋,肝血充足筋骨才能濡养,病至晚期,3种疾病与肝肾脏腑功能失常密切相关,肝肾不足、经脉筋骨失养是3种髋关节骨病晚期的共同病机,肝肾亏虚、腰膝酸软、行走无力亦成为其共同证候。不仅为"同证"提供理论依据,也有助于"异病"的鉴别诊断、提高髋关节疾病的诊断水平、丰富中医学"异病同证"的内涵。