动态锁定螺钉在肱骨干骨折中的临床应用

目的:比较动态锁定螺钉与普通螺钉在治疗肱骨干骨折的临床疗效。方法 :回顾性分析2016年1月至2018年10月诊治的46例肱骨干骨折患者的临床资料,根据内固定物不同分为动态锁定螺钉内固定组(治疗组)和普通螺钉内固定组(对照组)。其中治疗组24例,男14例,女10例,年龄20～61(36.8±10.9)岁;对照组22例,男13例,女9例,年龄19～60(35.9±12.8)岁。比较两组患者手术切口长度、手术时间、出血量、骨折愈合时间及并发症情况,并于术后3、9个月采用肩关节Constant-Murley评分和肘关节功能Mayo评分进行临床评价。结果:46例患者获得随访,时间9～43(18.6±7.9)个月。两组切口长度、手术时间、术中出血量比较差异无统计学意义(P0.05);治疗组骨折愈合时间为(12.2±3.2)周,对照组为(15.6±4.7)周;治疗组优于对照组(P0.05)。治疗组术后3个月肩关节Constant-Murley评分、Mayo评分分别为(84.9±5.9)分、(81.8±6.7)分,对照组分别为(74.6±9.2)分、(71.5±10.7)分;两组比较差异有统计学意义(P0.05)。两组术后9个月肩关节Constant-Murley评分、Mayo评分比较差异无统计学意义(P0.05)。治疗组桡神经麻痹1例;对照组延迟愈合1例,骨不连2例,断钉1例;两组比较差异无统计学意义。结论:动态锁定螺钉和普通螺钉均能有效治疗肱骨干骨折,前者在骨折愈合时间方面具有优势,早期肩肘功能恢复更好,但此项技术在国内开展时间不长,还需进一步观察大样本的远期疗效。     

Reconstruction of the severe Achilles tendon and soft-tissue loss with the bi-pedicled conjoined flap and vascularized fasciae latae: A consecutive case series of 15 patients

BackgroundHistorically, the segmental loss of the Achilles tendon with overlying soft-tissue defects had been frequently reconstructed with the composite anterolateral thigh (ALTP) flap, including the iliotibial tract or fasciae latae. This study aimed to present our modified combination using the bi-pedicled conjoined flap with vascularized fasciae latae, for the approximately total reconstruction of the Achilles tendon and extensive soft tissue.MethodsFrom May 2015 to March 2018, 15 patients (9 male and 6 female) with a mean age of 36 years (ranged, 18–52 years) underwent microvascular Achilles tendon reconstruction. Harvested on the abdomen and groin, the conjoined flap was chimeric with the vascularized fasciae latae. Primary donor-site closure was accomplished in all patients. A standard assessment of the functional and esthetical outcomes was completed.ResultsMean follow-up time was 42 months (ranged, 32–48 months). The average dimension of the conjoined flap was 25 × 14 cm (ranged, 18 × 10–35 × 18 cm), and the average size of the folded fasciae latae was 15 × 6 cm (ranged, 12 × 5–25 × 8 cm). At the last follow-up, the Thompson test was negative in all patients. The mean American Orthopedic Foot and Ankle Society (AOFAS) score was 91.0. The mean Achilles tendon total rupture score (ATRS) was 18.5. The mean Vancouver Scar Scale (VSS) score was 3.0.ConclusionsThe composite bi-pedicled flap including vascularized fasciae latae provides an alternative approach with great functional and esthetic outcomes, in selected patients who suffered severe Achilles tendon and skin defects. The one-stage procedure facilitates better rehabilitation postoperatively.     

专业学位研究生心理健康特点调查研究

目的　 探讨专业学位研究生心理健康状况及特点。方法　2016年1月整群抽取重庆地区三所高校专业学位研究生326人为研究对象,采用症状自评量表（symptom checklist 90,SCL-90）对专业学位研究生进行心理健康状况测评。发放调查问卷326份,回收326份,剔除填写不全、漏答、前后答案矛盾等无效问卷11份,有效问卷315份,回收有效率96.6%。采用SPSS 19.0对问卷数据进行卡方检验、独立样本t检验、方差分析,两两比较用LSD/T2法。结果　①专业学位研究生心理症状筛查阳性率为11.11%,心理问题检出率从高到低依次为：强迫、人际关系敏感、抑郁、敌对、躯体化、偏执、焦虑、恐怖、精神病性。②除恐怖因子外,不同年龄段研究生SCL-90各因子得分和总均分差异都有统计学意义（P<0.05）。其中,“≥30岁”组研究生SCL-90中躯体化、强迫、人际敏感、焦虑、敌对、偏执、精神病性因子得分和总均分高于“≤24岁”组和“25~29岁”组（P<0.05）,“≥30岁”组抑郁因子得分高于“≤24岁”组（P<0.01）。③博士研究生SCL-90躯体化（P=0.038）和强迫因子得分（P=0.043）高于硕士。④不同年级研究生SCL-90强迫、抑郁、焦虑、敌对、偏执因子得分和总均分差异有统计学意义（P<0.05）;其中,三年级组各因子得分和总均分高于一年级组,三年级组敌对、偏执因子得分和总均分高于二年级组,差异有统计学意义（P<0.05）。⑤除恐怖因子外,“和睦安宁”组研究生SCL-90各因子得分和总均分低于“争吵”组（P<0.05）。⑥除躯体化和偏执因子外,“导师关心”组研究生SCL-90各因子得分和总均分低于“导师不关心”组（P<0.05）。结论　专业学位研究生心理健康因年龄、学历层次和年级不同而存在差异,且受集体氛围和导师态度影响。相关心理健康教育应充分考虑人群特点差异,细化教育目标、内容和形式,以提升专业学位研究生心理健康水平。