疼痛管理在创伤骨科护理管理中的应用价值

目的探究创伤骨科护理管理中疼痛管理的应用价值。方法 82例患者选取于2017年6月-2018年6月,所有患者均来源于本院骨科收治的住院患者,数字表为患者分组原则,常规组41例,疼痛组41例,分别予以常规护理、常规护理+疼痛管理,比较满意度、疼痛评分及平均住院时间。结果疼痛组满意度92.68%比常规组73.17%高,差异具有统计学意义(χ^2=5.513,P <0.05),患者干预后的疼痛评分低于常规组,平均住院时间短于常规组,差异存在统计学意义(P<0.05)。结论疼痛管理用于创伤骨科护理管理中,患者疼痛明显减轻,患者满意度高,缩短了患者的平均住院时间。     

Damage control orthopaedics in polytraumatized patients- current concepts

The principles of fracture management in patients with multiple injuries continue to be of crucial importance. Early treatment of unstable polytraumatized patients with head, chest, abdomen or pelvic injuries, with blood loss followed by immediate fracture fixation (Early Total Care -ETC) may be associated with secondary life threatening posttraumatic systemic inflammatory response syndrome (SIRS). Development of SIRS is typically a function of the type and severity of the initial injury (the “first hit”). Immediate Fracture fixation, using reamed nails or plates, in such unstable patients with multiple injuries is subsequently defined as the “second hit” and may be associated with development of acute respiratory distress syndrome (ARDS) and multiple organ failure (MOF), with relatively high morbidity and mortality.The other alternative for long bone fracture fixation in unstable polytraumatized patients is based on immediate treatment of life threatening conditions related to the injuries, followed by the initial use of minimally invasive modular external frames for long bone fractures and is called Damage Control Orthopedics (DCO) and is widely accepted. In order to refine the DCO concept and to avoid an overuse of external fixation, the “Safe Definitive Surgery” (SDS) concept has been introduced, which is a dynamic synthesis of both strategies (ETC and DCO). The SDS strategy employs clinical parameters and includes repeated assessment of patients. The following paper is going to summarize historical backgrounds and recent concepts in treatment of polytraumatized patients.     

(i) Managing polytrauma: picking a way through the inflammatory cascade

Care of polytraumatized patients has changed dramatically in the last three decades. The establishment of major trauma centres has specialized their care and the use of injury severity scoring systems allows comparison between methods of care and institutions.Improved understanding of systemic inflammatory response syndrome has highlighted inflammatory markers such as Interleukins 6 and 10, as well as markers of antigen presentation that correlate with morbidity and mortality following injury. Advances in resuscitation and the adoption of standard operating procedures by intensive care units have improved outcome for this vulnerable patient group and reduced rates of adult respiratory distress syndrome.Markers of resuscitation, especially lactate, are currently our most valuable tools in identifying patients who should undergo temporary fracture stabilization (damage control orthopaedics) or have definitive stabilization postponed. However, it is safe to proceed with definitive stabilization of axial skeleton and long-bone fractures if resuscitative measures demonstrate an improving lactate (<4.0 mmol/L) and correction of acidosis (pH ≥ 7.25). Adoption of protocols of ‘early appropriate care’ using these parameters results in lower rates of damage control surgery, shorter lengths of stay and also confers economic benefits.     

Outcome measures in trauma and orthopaedics: a guide to evaluating your practice

Improvements in health-related quality of life (HRQoL) are key in orthopaedic surgery, however appropriate, timely and meaningful measurement of HRQoL can be challenging. This paper provides an overview of the different types of commonly used outcome measures along with their characteristics and key properties used in trauma and orthopaedics. Orthopaedic surgeons are provided a basis to select the most appropriate measure to evaluate their clinical practice.     

SP联合CBL在骨外科临床实践教学中的应用研究

目的探讨标准化病人(standard patient,SP)结合案例式教学(case-based learning,CBL)在骨外科临床实践教学中的应用效果。方法选取2018—2019学年于我院骨科实习的南京医科大学2014级临床医学专业学生50人作为研究对象。随机将其均分为试验组和对照组两组,每组各25人。试验组采用SP+CBL相结合教学方法;对照组采用传统CBL授课方法。在教学结束后,请所有参与试验的学生对课程进行评价,并从理论和操作两方面对学生进行考核。结果两组学生的理论考试成绩无明显差异,不具统计学意义(P>0.05)。但试验组学生的临床技能操作考核成绩高于对照组(P<0.01)。试验组学生对SP+CBL教学在激发学习兴趣、增强解决实际问题能力及提高骨外科实践教学质量等方面的满意度显著高于对照组(P<0.01)。结论SP+CBL教学优于传统CBL教学,可以显著提高学习的积极性,有助于提高骨外科临床实践教学的效果。     

浅述计算机技术在中医骨伤中的应用

随着科学技术发展的突飞猛进,计算机技术也得到了前所未有的高速发展,作为高科技领域的代表,计算机技术已渗透到医学及其管理的各个领域,可利用计算机获取、存储、传输、处理和利用医学及医学管理的各种信息。尤其近十年来,电子计算机技术悄然进入了中医中药领域,并迅速得到传播推广,极大地促进了中医药事业的发展。而作为最具中医特色的中医骨伤科学,在诊断、治疗等方面,也随处可见计算机的身影。     

Effects of orthopaedic manual therapy in knee osteoarthritis: a systematic review and meta-analysis

Objective

This systematic review to aimed to evaluate the effects of orthopaedic manual therapy (OMT) on pain, improving function, and physical performance in patients with knee osteoarthritis (OA).

秦艳虹教授治疗小儿遗尿症脾肾两虚型经验

秦艳虹教授根据小儿生理病理特点,并结合其多年的儿科临床经验,认为小儿遗尿症的病机为脾肾两虚、膀胱失约,故治宜温补脾肾、固摄止遗、先后天同治。秦教授以其自拟经验方止遗散配合艾灸、叫醒疗法内外结合治疗小儿遗尿症脾肾两虚型,临床疗效显著。附案例1则,以资验证。