Prevalence of Preoperative Lower Extremity Deep Vein Thrombosis in Bilateral Calcaneal Fractures

There are no studies on epidemiologic characteristics of deep vein thrombosis (DVT), when specified at in patients with bilateral calcaneal fractures. This study aimed to address the preoperative DVT in bilateral calcaneal fractures. Between October 2014 and December 2018, adult patients presenting with bilateral calcaneal fractures and having preoperative Duplex ultrasound (DUS) of bilateral lower extremities for detection of DVT were included. Their medical data were collected, with regards to demographics, comorbidities, injury-related data and biomarkers. Baseline characteristics between patients with and without DVT were compared using bivariate tests. The further multivariate logistics regression analysis was conducted to identify independent factors associated with DVT. In total, 258 patients with bilateral calcaneal fractures were included, with 21 (8.1%) having preoperative DVT, diagnosed at 7.7 ± 4.2 days after injury. The prevalence rate of proximal DVT was 1.9% and of distal DVT was 6.2%. Thirty five thrombi were found, with 6 (17.1%) in proximal veins and 29 (82.9%) in distal veins. Nine patients had DVTs in multiple veins, and 2 patients had bilateral DVTs. The multivariate analyses showed history of allergy (odds ratio [OR] = 2.17), concurrent other fractures (OR = 4.53), prolonged time since injury (for each day, OR = 1.16), elevated plasma D-dimer level (≥1.73 vs <1.73 mg/L, OR = 3.74) and reduced albumin level (<34.2 g/L vs ≥34.2 g/L, OR = 2.92) were independent factors associated with DVT. Multiple factors were identified to be associated with DVT and greater consideration should be given to the use of pharmacologic prophylaxis in patients involving these factors, to reduce DVT occurrence.     

后路截骨矫形治疗低龄先天性脊柱后凸畸形的疗效分析

目的:评价经后路截骨内固定术治疗低龄(10岁以下)先天性脊柱后凸畸形的临床效果。方法:2009年10月~2013年5月采用经后路截骨椎弓根螺钉内固定治疗先天性脊柱后凸患者17例,男6例,女11例,手术时年龄64±21个月(37~109个月)。根据Winter分型:Ⅰ型8例,Ⅱ型4例,Ⅲ型5例。后凸顶椎均位于T10~L2之间。5例伴神经系统畸形。8例行后路椎体切除(PVCR),5例行经椎弓根截骨(PSO),4例行Ponte截骨,截骨后均采用后路自体骨或同种异体骨植骨椎弓根螺钉内固定。统计手术时间、术中出血量及手术并发症,观察矫形效果、内固定并发症、椎体融合情况等。结果:手术时间210±46min(130~300min),出血量650±330ml(200~1300ml);固定融合节段4.9±0.8个(4~6个)。随访34.7±10.4个月(24~51个月),矢状面节段性后凸Cobb角由术前61.5°±14.3°(42°~92°)矫正至术后20.7°±9.0(5°~42°),矫正率为(66.3±8.7)%,末次随访时为17.5°±9.5°(1°~36°),矫正率为(71.5±10.7)%,手术后Cobb角得到显著性改善(P0.01);矢状面平衡术前为-41.3±31.8mm,术后为-43.5±30.4mm,与术前比较无显著性变化(P0.05),末次随访时为-25.6±26.7mm,较术前明显改善(P0.05)。术后出现双下肢无力1例,排尿困难1例,术后2周恢复。术前腰背痛5例、排尿异常1例,术后6个月症状好转。1例患者术后7个月出现近端交界性后凸。随访期间未发现假关节及内固定相关并发症。结论:对低龄先天性脊柱后凸畸形患者早期行后路截骨、椎弓根螺钉内固定可显著改善后凸畸形,但术后不能立即达到脊柱矢状面平衡,而是在术后随生长发育逐渐恢复矢状面平衡。     

鲍曼不动杆菌Ⅰ类整合子和ISCR1的检测及其结构分析

目的了解鲍曼不动杆菌中Ⅰ类整合子与ISCR1分布情况及其所携带耐药基因的种类,从而分析其结构及其与耐药性的关系。方法采用煮沸法提取鲍曼不动杆菌基因组DNA,设计引物进行PCR反应,扩增产物用1.2%琼脂糖凝胶电泳检测并记录结果,根据Ⅰ类整合子可变区扩增产物图谱进行RFLP分型,最后进行产物的序列分析。结果PCR扩增51株鲍曼不动杆菌,Ⅰ类整合酶基因intⅠ扩增阳性45株,其中包括可变区阳性32株。并且Ⅰ类整合子的可变区扩增出的目的片段大小各不相同,有28株扩增片段约为2.3kb,2株扩增片段约为2.4kb,2株扩增片段为3kb;ISCR1扩增阳性22株,其下游扩增阳性5株,扩增片段大小约为3kb。同时携带Ⅰ类整合子和ISCR1扩增阳性菌目的片段大小约为2kb。酶切图谱显示,大小为2.3kb的Ⅰ类整合子可变区产物为同一带型;序列分析显示,大小不同的Ⅰ类整合子的可变区各片段所含的基因盒各不相同;耐药基因序列分析显示,5株ISCR1的下游扩增片段为qnrA1-ampR。同时显示Ⅰ类整合子和ISCR1两种元件以串联的形式存在于鲍曼不动杆菌中。结论Ⅰ类整合子与ISCR1大多以串联形式同时存在于骨髓炎患者感染的鲍曼不动杆菌中,该结构对耐药基因在不同鲍曼不动杆菌菌株间的水平传播可能起介导作用。     

股骨颈骨折术中空心加压螺纹钉螺纹部分陷入盆腔成功取出1例报道并文献复习

目的：报道1例股骨颈骨折术中空心加压螺纹钉螺纹部分突入盆腔并成功取出的经验,结合文献复习,对空心加压螺纹钉治疗股骨颈骨折的手术原则、注意事项等内容进行归纳总结,为临床医师提供参考。方法：1例股骨颈骨折术中空心加压螺纹钉螺纹部分突入盆腔,将尖端拐弯呈钩状的不锈钢丝插入空心内六角改锥,然后进入空心加压螺纹钉,通过倒钩状尖端钩住螺纹钉并施加适当的牵引力,不锈钢丝钩状尖端抓住空心加压螺纹钉;再以适当的力量牵拉不锈钢丝,逆时针方向转动空心内六角改锥,将其顺利旋出。结果：通过带倒钩的不锈钢丝辅助牵引、内六角改锥反转退钉,成功取出螺纹部分突人盆腔的空心的加压螺纹钉,患者无并发症,骨折顺利愈合。结论：老年患者因骨质疏松,股骨近端外侧骨皮质较薄弱,拧人空心拉力螺纹钉时钉尾易陷入骨皮质;在拧人空心加压螺纹钉的过程中,应在x线透视监视下进行,在最上方的空心加压螺纹钉尾端应安装垫片。     

指动脉背侧支逆行筋膜蒂岛状皮瓣修复手指皮肤缺损

目的介绍一种修复手指皮肤缺损的指动脉背侧支逆行筋膜蒂岛状皮瓣的临床应用。方法2001年9月～2002年12月以近节或中节指固有动脉背侧支为蒂,切取掌骨头背侧或近节手指背侧皮瓣,逆行修复近节指间关节或以远的皮肤缺损35例42指,同时对伴有骨、关节、肌腱等损伤者进行修复。皮瓣切取范围1.0cm×2.5cm～1.5cm×3.5cm。结果术后35例42指获3个月～1年随访,皮瓣全部成活;两点辨别觉6～10mm,指外形及功能佳。结论此皮瓣具有手术操作简便、不损伤指固有动脉及神经,血管蒂长、旋转弧大和成功率高等优点,是修复手指皮肤缺损较理想的方法。     

神经高位端端与低位端侧或侧侧缝合相结合提高神经修复能力的实验研究

目的对无缺损的周围神经高位损伤，提出高位端端与低位端侧或侧侧缝合相结合的新方法，观察神经再生和靶器官的恢复情况。方法SD大鼠80只，高位切断左侧胫神经。随机分为5组：A组：胫神经两断端行端端缝合，远端于膝关节水平与腓神经干行侧侧缝合。B组：断端处理同A组，远端移植正中神经作胫腓神经干之间的端侧桥接缝合。C组：单纯作断端的端端吻合。D组：胫神经干近端结扎并固定，远端与腓神经干行侧侧缝合。E组：近端处理同D组，远端切除部分神经段后，与腓神经干行端侧缝合。术后行肌电图检查及组织学观察并作统计学分析。结果术后早期（4周）D、E组有神经再生，术后12周A、B组的神经再生、传导功能及靶肌肉和运动终板的恢复情况均优于C、D、E组。结论高位端端与低位端侧或侧侧缝合相结合的方法，可尽早恢复对靶组织的营养和神经再支配，为高位缝合处高质量神经的长入赢得时间，提高了有效功能的恢复。     

The effects of increasing occlusal vertical dimension on the deep masseter of rat at different ages

ObjectiveTo investigate the influence of increasing the occlusal vertical dimension (iOVD) on the fibre-type distribution and ultrastructure of deep masseter of rat at different ages.DesignA total of forty-eight male Wistar rats were divided into two groups according to age: ‘teenage’ group (n = 24, 1.5 months) and ‘young adult’ group (n = 24, 8 months). Both the teenage and the young adult rats were then randomly divided into the control group (n = 12) and the experimental group (n = 12). The occlusal vertical dimensions of the rats in the experimental groups were increased by placing composite resin on all maxillary molars. The fibre-type distribution and ultrastructure of the deep masseter were subsequently observed on day 7 and day 14 after iOVD.ResultsIn the teenage experimental group, the proportion of type IIa fibres increased, while the proportion of type IIb and type IIx fibres decreased by day 7 after iOVD (P < 0.05). However, no significant fibre phenotype transformation was observed in the young adult experimental group until day 14 after iOVD. In addition, the proportion of type IIa in the teenage experimental group was higher than that of the young adult experimental group on day 7 and 14 (P < 0.05). Under the transmission electron microscope, muscle fibre reconstruction and the compensatory increase in the number and volume of mitochondria appeared earlier in the teenage experimental group. The cellular traumatic reaction was less than that in the young adult experimental group.ConclusionThe teenage rat alters masseter muscle structure to a slower phenotype earlier and to a greater degree than that of the young adult rat when increasing the occlusal vertical dimension.     

糖尿病大鼠治疗后膀胱和腰骶背根神经节中神经生长因子的表达及超微结构研究

目的通过动物实验研究糖尿病大鼠治疗后膀胱和腰骶背根神经节中神经生长因子（NGF）的表达和超微结构变化及意义。方法参照Schmeichel等方法制备糖尿病大鼠模型,造模成功后4周应用NGF和胰岛素治疗4周,然后应用免疫组织化学方法检测大鼠膀胱和背根神经节中NGF的表达情况,利用透射电镜观察膀胱和腰骶背根神经节的超微结构变化。结果糖尿病大鼠经NGF和胰岛素治疗后膀胱和腰骶背根神经节中NGF的含量明显增加,差异有统计学意义（P〈0.05）,并且其形态学明显改善。结论 NGF的异常在糖尿病膀胱病变（DC）的发病中可能具有重要作用,给予外源性NGF可能有助于DC病变减轻和功能改善。     

桡骨远端关节内骨折对腕关节影响的生物力学研究

目的研究桡骨远端关节内骨折对桡腕关节的影响。方法12只成人上肢标本于距关节面3cm处截骨去除1cm骨块,于桡骨远端关节面舟骨窝与月骨窝交界处纵形劈开桡骨,使桡尺侧骨块可分别向近端移动,制作桡骨远端关节内骨折模型,利用压敏片测试随关节面移位,桡腕关节面的应力分布和受力面积改变情况。结果桡舟关节面移位≥2mm时,月骨接触面积及接触应力增加,舟骨接触面积及接触应力减少(P<0.01);桡月关节面移位≥2mm时,舟骨接触面积及接触应力增加(P<0.01),月骨接触面积无明显变化(P>0.01)而及接触应力减少(P<0.01)。结论桡骨远端关节内骨折关节面移位≥2mm以上时,桡腕关节面的应力分布和受力面积发生改变,影响腕关节功能。     

2型糖尿病骨质疏松大鼠骨重建研究

目的通过建立2型糖尿病骨质疏松大鼠模型,探讨其骨重建特点。方法 雌性Wistar大鼠分为假手术组(NS组);去卵巢组(NOVX组);2型糖尿病假手术组(DS组)和2型糖尿病去卵巢组(DOVX组)。糖尿病组大鼠造模成功后行双侧卵巢切除术,0、4、8和12周测血糖(FPG)、胰岛素(FINS)、雌激素(E2)及血清骨特异性碱性磷酸酶(B-ALP)和抗酒石酸酸性磷酸酶(TRACP5b),同期测定骨密度(BMD)并行成骨和破骨细胞培养。结果 0周时DOVX组的血糖(13.1±4.9)mmol/L明显高于NS组的(4.4±0.6)mmol/L(P<0.05)。4周时DOVX组的BMD为(0.073±0.012)g/cm2明显低于NS组的(0.098±0.016)g/cm2(P<0.05)。4、8和12周时DOVX组的B-ALP与NS组均无差异,而4和8周时DOVX组的TRACP5b明显高于NS组(P<0.05)。4、8和12周时DOVX组的成骨细胞活力与NS组均无差异,而DOVX组的破骨细胞计数明显高于NS组(P<0.05)。结论 2型糖尿病骨质疏松大鼠骨重建特点为骨吸收活跃而骨形成相对减慢。