全国著名骨伤专家梁铁民教授学术思想和正骨经验

总结了全国著名骨伤专家梁铁民教授的学术思想和正骨经验,简述了梁老生平。梁老学术思想表现在突出整体观念,主张辨证施术;注重调理气血,强调药物接续;重视望问切触量法五诊结合等三个方面。对于梁老正骨经验先进行了综合论述,进一步佐证其学术思想;后分别从小儿桡骨头半脱位、颈椎错位、胸腰椎小关节错位、肋骨骨折等梁老研究较深入和比较擅长的几个方面进行了阐述。特别是颈椎错位这种高难度高风险的手法操作,体现出梁老高超的手法技艺。     

急性心肌梗塞静脉溶栓治疗冠脉再通者早期ST段再抬高的临床意义

急性心肌梗塞早期静脉溶栓治疗后，一些溶栓再通患者中，可见早期降低的ＳＴ段再度出现抬高现象。本文回顾溶栓成功者８１例，其中早期出现ＳＴ段再度抬高者２１例（占３５％），与ＳＴ段非再度抬高者相比，ＣＰＫ、ＣＰＫ－ＭＢ峰值，心功能及院内死亡率等无显著差异。笔者认为，此现象也为再通的标志之一。因此，急性心肌梗塞溶栓治疗的早期连续监测心电图对确认再通与否非常重要     

冲击伤肺肋面的平行出血条纹

本文采用部分肋骨切除术,切除15只家兔双侧5、6、7、8肋中任一肋距脊柱约2cm处一段长约1cm的肋骨。一周后对受冲击波致伤的肺肋面的出血情况进行解剖观察,发现肺肋面的出血条纹呈“工”字形,从而为冲击伤肺肋面的平行出血条纹是肋间压痕这一观点找到了直接的实验证据。     

Further delineation of the Beemer–Langer syndrome using concordance rates in affected sibs

Six familial cases of the Beemer–Langer syndrome (BLS) were analyzed to further elucidate the spectrum and frequency of anomalies observed in this disorder. Preaxial polydactyly was found in 3/6 affected sibs, and, therefore, its frequency previously may have been underestimated. Some patients, described as infants affected with the Majewski syndrome (MS) or “atypical” short rib-poly-dactyly conditions, may indeed have BLS. A high frequency of brain defects (16/26) and cleft tongue, oral frenula, and/or natal teeth (13/29) widens the list of typical findings in this syndrome. The specific type of tibial defect seems to be the most important discrimination of the MS and the BLS. © 1994 Wiley-Liss, Inc.     

急性ST段抬高型心肌梗死患者提前肝素化的疗效评价及风险观察

目的探讨急性ST段抬高型心肌梗死(STEMI)患者提前肝素化的疗效及风险。方法选取2019年5月至2020年5月我院收治的160例STEMI患者作为研究对象,随机分为两组各80例。治疗组给予提前肝素化PCI术治疗,对照组给予常规肝素化PCI术治疗。比较两组的TIMI血流分级、不良事件发生率以及治疗前后的症状评分、 LVEF。结果术后,治疗组的TIMI血流0~1级率低于对照组,3级率高于对照组(P <0.05)。治疗后,两组的症状评分均低于治疗前,LVEF水平均高于治疗前(P<0.05);治疗组的症状评分低于对照组,LVEF水平高于对照组(P <0.05)。治疗组的不良事件发生率低于对照组(P <0.05)。结论 PCI术提前肝素化可以提高灌注效果,有效缓解STEMI患者的病情,改善患者心功能,改善预后,且具有较高的安全性。     

2011—2017年中国心肌梗死治疗质量的趋势与变异

目的分析2011—2017年急性ST段抬高型心肌梗死(STEMI)治疗质量评价指标使用率变化趋势;计算急性心肌梗死治疗质量综合得分,获得综合质量变化趋势及变异,为改善STEMI治疗质量提供依据。方法选择STEMI治疗指南Ⅰ类推荐的STEMI治疗质量评价指标12项,提取单病种监测系统中STEMI患者的数据;计算STEMI评价指标使用率;利用分母权重法获得治疗质量综合得分及变异,并进行趋势性检验。结果与2011年相比,12项治疗质量指标中,到医院90 min内实施经皮冠状动脉介入治疗使用率增幅最大,到达医院后即刻使用β受体阻滞剂使用率下降最大,趋势性检验有统计学意义;2011年至2017年间,医院综合得分中位数随时间变化不明显,四分位数间距随时间有增大趋势。结论我国STEMI的多数治疗质量指标使用率显著改善;医院综合治疗得分趋势稳定,但医院间变异扩大。     

Single-stage medial plateau elevation and metaphyseal osteotomies in advanced-stage Blount’s disease: a new technique

PurposeSurgical treatment in advanced-stage infantile Blount’s disease with medial plateau (MP) depression is challenging. Several osteotomies and fixation methods have been described with no established benchmark. We conducted this study to evaluate the efficacy and safety of a new single-stage technique for acute medial condyle elevation and metaphyseal osteotomies with internal fixation.MethodsA prospective case series of 19 consecutive patients (21 knees) with severe infantile Blount’s disease underwent a single-stage MP elevation and metaphyseal osteotomies, with internal fixation. The mean age was 10.3 years (8.2 to 13.6) and the mean follow-up was 5.1 years (3.2 to 8.3). The outcome measures included clinical and radiological parameters and patient-reported pediatric outcomes data collection instrument (PODCI) score.ResultsThe mean PODCI score improved significantly from 50% to 88%. The mean internal tibial torsion improved from -27° to 11°. All cases maintained full knee extension, no limitation in flexion range of movement and no signs of instability or lateral thrust gait. All the radiographic parameters improved significantly; the mean tibiofemoral angle improved from -29° to 7°, the metaphyseal-diaphyseal angle improved from 33.4° to 4.7° and the angle of depressed MP improved from 38.3° to 2.4° (p < 0.001). At the latest follow-up, no cases of deformity recurrence were identified, the final limb-length discrepancy was < 1 cm in all patients.ConclusionSingle-stage MP elevation and metaphyseal osteotomies with internal fixation significantly improved the clinical and radiographic parameters and PODCI score in advanced infantile Blount’s disease and precluded the use of external immobilization, with no evidence of deformity recurrence.Level of evidenceIV     

肋骨肿瘤X线诊断(附50例报告)

目的：探讨肋骨肿瘤的X线诊断。方法：回顾性分析50例经病理证实的肋骨肿瘤的X线表现。结果：肋骨肿瘤基本X线征象是骨破坏,良性肋骨肿瘤呈膨胀性骨破坏,边界清楚,骨皮质完整、变薄。恶生骨肿瘤表现为侵蚀样骨破坏,边界不清,呈虫蚀状,溶骨性一扫光样改变或成骨样改变。结论：肋骨肿瘤可在肺野内形成异常影像,易误诊为肺及纵隔病变,阅胸片时需注意观察,分析肋内改变。