骨一方联合低分子肝素对人工全髋关节置换术后深静脉血栓形成的预防作用

【目的】探讨骨一方联合低分子肝素对人工全髋关节置换(THR)术后深静脉血栓形成(DVT)的预防作用。【方法】采用前瞻随机对照临床试验设计方法,根据性别、年龄、病患部位、就诊时间将100例THR术后病例分成试验组48例和对照组52例。根据《中国骨科大手术静脉血栓栓塞症预防指南》,2组均给予皮下注射低分子肝素,同时试验组给予骨一方治疗,每日1剂,连续7 d。分别观察2组受试对象试验前后凝血功能、血液流变学指标及伤肢彩色多普勒超声检查结果的变化情况。【结果】(1)试验后,2组全血粘度高切、全血粘度中切、全血粘度低切、血浆粘度等血液流变学指标均显著改善(P<0.05),且试验组的改善作用均优于对照组(P<0.05)。(2)试验后,试验组的凝血酶原时间(PT)、活化部分凝血酶时间(APTT)相对缩短,D-二聚体(D-D)水平显著升高(P<0.05);而对照组的PT、APTT相对延长,D-D水平显著升高(P<0.05);组间比较差异均有统计学意义(P<0.05)。说明骨一方能在一定程度上拮抗低分子肝素对凝血功能的影响而降低诱发出血的可能性。(3)2组试验后伤肢彩色多普勒超声检查结果显示,试验组的伤肢DVT发生率显著低于对照组(P<0.05)。【结论】骨一方联合低分子肝素能够改善人工全髋关节置换术后血液高凝状态,激活纤溶系统,调节血液流变学状态,预防伤肢深静脉血栓形成,同时又能降低诱发出血的可能性,是有效、安全的治疗方案,值得临床推广应用。     

丹酚酸B和高氧液对兔肢体缺血再灌注氧化应激损伤的影响

目的探讨高氧液和丹酚酸B对肢体缺血再灌注损伤的影响。方法选用健康新西兰家兔24只,随机分为4组,在缺血前从耳缘静脉推注等量的生理盐水(A组)、高氧液(B组)、丹酚酸B(C组)或高氧液加丹酚酸B(D组),夹阻股动、静脉,建立肢体缺血再灌注损伤模型,在缺血前和再灌注4h抽血检测MDA、SOD,取腓肠肌作病理检测。结果血清丙二醛浓度较前明显升高,高氧液和丹酚酸B可以抑制其升高(P<0.01),两者有协同作用(P<0.01);血清超氧化物歧化酶活性较前明显降低,高氧液和丹酚酸B可以抑制其降低(P<0.01),两者有协同作用(P<0.01)。骨骼肌HE染色见:相对于对照组其他组骨骼肌损伤程度较轻,以联合用药组最轻。结论高氧液和丹酚酸B能抑制肢体缺血再灌注氧化应激损伤,而且两者有协同作用。     

丹酚酸B和高氧液对兔肢体缺血再灌注损伤代谢酶的影响

目的探讨高氧液和丹酚酸B对肢体缺血再灌注损伤的影响。方法选用健康新西兰家兔24只,随机分为4组,在缺血前从耳缘静脉推注等量的生理盐水(A组)、高氧液(B组)、丹酚酸B(C组)或高氧液加丹酚酸B(D组),夹阻股动静脉,建立肢体缺血再灌注损伤模型,在缺血前和再灌注4h抽血检测LDH、CK,取腓肠肌作LDH酶组织化学染色。结果再灌注4h,血清肌酸激酶活性较前明显升高,高氧液和丹酚酸B可以抑制其升高(P0.01),两者有协同作用(P=0.05);血清乳酸脱氢酶活性较前明显升高,高氧液和丹酚酸B可以抑制其升高(P0.01),两者有协同作用(P0.01)。LDH酶组织化学显色见:相对于对照组其他组组织织LDH酶活性较低,以联合用药组最低。结论高氧液和丹酚酸B对缺血再灌注损伤起预防作用,而且两者有协同作用。     

中药内服外敷联合内固定术治疗胫骨平台骨折的疗效观察

【目的】探讨中药内服外敷联合内固定术治疗胫骨平台骨折的临床疗效。【方法】将112例胫骨平台骨折患者随机分为观察组和对照组,每组各56例。对照组给予内固定术和术后康复锻炼治疗,观察组在对照组的基础上加用身痛逐瘀汤加味方口服联合伤科黄水外敷治疗,疗程为8周。观察2组患者治疗前后美国纽约特种外科医院(HSS)膝关节功能评分、疼痛视觉模拟量表(VAS)评分、肿胀程度以及血清肿瘤坏死因子α(TNF-α)、超敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)、骨钙素(BGP)、碱性磷酸酶(BALP)、Ⅰ型胶原交联C端肽(β-CTX)水平的变化情况,比较2组患者的骨折愈合时间、完全负重时间、膝关节功能优良率和术后并发症发生情况。【结果】(1)术后6个月,观察组的膝关节功能优良率为96.4%(54/56),明显高于对照组的80.4%(45/56),差异有统计学意义(P<0.05)。(2)治疗后及术后6个月,2组患者的HSS评分均较治疗前明显升高(P<0.05),且观察组的HSS评分均明显高于对照组(P<0.05)。(3)治疗14 d、28 d后,2组患者的VAS评分及膝关节肿胀程度均较治疗前明显降低(P<0.05),且观察组的VAS评分及膝关节肿胀程度均明显低于对照组(P<0.05)。(4)观察组的影像学骨折愈合时间、临床功能愈合时间及完全负重时间均明显短于对照组(P<0.05)。(5)治疗后,2组患者血清TNF-α、hs-CRP、IL-6、β-CTX水平均较治疗前降低(P<0.05),血清BGP、BALP水平均较治疗前升高(P<0.05),且观察组治疗后血清TNF-α、hs-CRP、IL-6、β-CTX水平均明显低于对照组,血清BGP、BALP水平均明显高于对照组(P<0.05)。(6)经术后6个月随访,观察组的术后并发症发生率为5.4%(3/56),低于对照组的12.5%(7/56),差异有统计学意义(P<0.05)。【结论】中药内服外敷联合内固定术治疗胫骨平台骨折疗效确切,可以有效促进骨折愈合,改善膝关节功能,抑制炎症反应,促进骨代谢,减少术后并发症。     

骨一方对胫骨平台骨折早期血液流变学的影响

目的：从血液流变学角度观察骨一方治疗胫骨平台骨折早期的临床疗效。方法：采用前瞻随机对照临床试验设计方法。将60例胫骨平台骨折早期病例按照分层随机化的方法以1∶1比例分成治疗组、对照组。两组在予以相同的常规基础治疗上,治疗组予骨一方每日1剂,连续7d。分别观察两组受试对象治疗前、治疗后临床症状体征计分与气滞血瘀证证候积分,血液流变学结果变化。结果：两组患者一般情况及Schatzker分型比较差异均无统计学意义（P〉0.05）.两组患者治疗前临床症状体征计分与气滞血瘀证证候积分,血液流变学指标比较,差异均无统计学意义（P〉0.05）;治疗后比较,差异均有统计学意义（P〈0.05）.结论：骨一方能降低胫骨平台骨折早期临床症状体征计分与气滞血瘀证证候积分,改善血液流变学状态,是治疗胫骨平台骨折早期十分有效的方剂之一。     

机器学习分析肱骨近端内侧柱不稳定骨折术后失效的风险因素

BACKGROUND: Internal fixation and open reduction with locking plate is the main treatment for proximal humeral fractures with medial column instability. However, reduction failure is one of the main postoperative complications, and accurate risk factor assessment is beneficial for screening high-risk patients and clinical decision selection. OBJECTIVE: To construct four types of prediction models by different machine learning algorithms, compare the optimal model to analyze and sort the risk variables according to their weight scores on the impact of outcome, and explore their significance in guiding clinical diagnosis and treatment. METHODS: 262 patients with proximal humeral fractures with medial column instability, aged (60.6±10.2) years, admitted to Foshan Hospital of Traditional Chinese Medicine between June 2012 and June 2022 were included. All patients underwent open reduction with locking plate surgery. According to the occurrence of reduction failure at 5-month follow-up, the patients were divided into a reduction failure group (n=64) and a reduction maintenance group (n=198). Clinical data of patients were collected, and model variables and their classification were determined. The data set was randomly divided into a training set and a test set according to a 7:3 ratio, and the optimal hyperparameters were obtained in the training set according to a 5-fold cross-over test. Four machine learning prediction models of logistic regression, random forest, support vector machine, and XGBoost were constructed, and the performance of different algorithms was observed in the test set using AUC, correctness, sensitivity, specificity, and F1 scores, so as to comprehensively evaluate the prediction performance of the models. The best-performing model was evaluated using SHAP to assess important risk variables and to evaluate its clinical guidance implications. RESULTS AND CONCLUSION: (1) There were significant differences between the two groups in deltoid tuberosity index, fracture type, fracture end with varus deformity before operation, fragment length of inferior metaphyseal of humerus, postoperative reduction, cortical support of medial column of proximal humerus, and insertion of calcar screw (P < 0.05). (2) The best-combined performance of the four machine models was XGBoost. The AUC, accuracy, and F1 scores were 0.885, 0.885, and 0.743, respectively; followed by random forest and support vector machine, with both models performing at approximately equal levels. Logistic regression had the worst combined performance. The SHAP interpretation tool was used in the optimal model and results showed that deltoid tuberosity index, medial humeral column cortical support, fracture type, fracture reduction quality, and the status of the calcar screw were important influencing fators for postoperative fracture reduction failure. (3) The accuracy of using machine learning to analyze clinical problems is superior to that of traditional logistic regression analysis methods. When dealing with high-dimensional data, the machine learning approach can solve multivariate interaction and covariance problems well. The SHAP interpretation tool can not only clarify the importance of individual variables but also obtain detailed information on the impact of dummy variables in each variable on the outcome. © 2024, Publishing House of Chinese Journal of Tissue Engineering Research. All rights reserved.     

急性有机磷中毒致中枢性高渗血症1例

患者 ,女 ,37岁 ,因服“敌敌畏”后不省人事 0 5ｈ ,入我院急诊科救治。查体 :ＢＰ 14 9/7 9ｋＰａ ,浅昏迷状态 ,呼吸急促 ,呼出气体可闻及大蒜味 ,口唇紫绀 ,口吐白沫 ,面部肌肉震颤 ,双侧瞳孔等大等圆 ,直径约 1ｍｍ ,对光反射存在 ;ＨＲ 96次 /ｍｉｎ ,律齐 ,未闻及杂音 ;双肺满布湿罗音 ,四肢肌张力增强 ;血胆碱脂酶 380Ｕ/Ｌ。诊断 :重度急性有机磷中毒。入院时检测 :血Ｎａ+ 14 7 4ｍｍｏｌ/Ｌ、Ｋ+ 2 2 9ｍｍｏｌ/Ｌ、血糖 12 3ｍｍｏｌ/Ｌ、尿素氮 2 7ｍｍｏｌ/Ｌ ,血浆渗透压为 30 9 8ｍｍｏｌ/Ｌ。入院后经洗胃、气管插管、…     

同种异体肌腱重建膝关节前交叉韧带：效果及免疫排斥反应

BACKGROUND: Problems can occur at the donor site where the autologous tendon graft is taken. Allogenic tissue has become an important graft option for the reconstruction of the anterior cruciate ligament.     

锁定加压钢板治疗复杂性胫骨平台骨折

目的报告锁定加压钢板治疗复杂性胫骨平台骨折的方法及临床疗效。方法 2006年1月～2009年1月,采用开放复位、锁定加压钢板内固定治疗复杂性胫骨平台骨折39例,其中男22例,女17例;年龄18～50岁,平均37岁。骨折按Schatzker分型法,Ⅳ型14例,Ⅴ型19例,Ⅵ型6例。术后随访时间12～18个月,平均14个月,根据影像学检查结果、膝关节屈伸活动度及Rasmussen评分标准进行临床疗效评定。结果术后12个月按Rasmussen膝关节评分标准,优26例,良7例,可4例,差2例,优良率84.6%。发生人工骨反应1例,皮瓣坏死1例,开放性骨折感染1例。无螺丝钉松动、断裂及内固定失败发生。结论锁定加压钢板治疗复杂性胫骨平台骨折复位满意,固定牢靠,操作简单,创伤较少,具有疗效佳、康复快、功能好等优点,是手术治疗复杂性胫骨平台骨折安全、有效的内固定方法之一。     

股骨骨折钢板取出后再骨折的病理学观察

目的:探讨股骨骨折术后再骨折的原因及治疗方法。方法:选取2004年至2008年股骨骨折钢板取出术后发生再骨折的病例10例,女4例,男6例;年龄19～48岁,平均33岁;原骨折根据Müller分型:A型4例,B型3例,C型3例。采用切开复位带锁髓内针进行固定治疗,并应用病理切片方法观察骨折端骨组织。结果:所有患者均获得随访,时间10～18个月,平均14个月。10例伤口均Ⅰ期愈合,无并发症发生,均恢复下肢行走和负重功能。病理切片显示原骨折端部分骨质坏死,骨结构紊乱,毛细血管阻塞,可见新生血管和哈弗小管长入坏死骨质,并形成切割圆锥,证实原骨折端处于新生骨爬行替代坏死骨的过程。结论:普通钢板内固定术后极大地破坏骨质血运,骨质坏死,影响骨质重建,造成骨力学性能下降,钢板取出后容易发生再骨折,应用切开复位带锁髓内针内固定的方法进行治疗,可达到较好的疗效。