PFN与PFNA内固定治疗老年骨质疏松性股骨粗隆间骨折的比较研究

目的比较股骨近端髓内钉(PFN)及股骨近端防旋髓内钉(PFNA)内固定治疗老年骨质疏松性股骨粗隆间骨折的临床疗效。方法收治股骨粗隆间骨折44例,随机采用PFN内固定治疗21例,PFNA治疗23例。对两组手术时间、术中出血量、骨折愈合时间、术后并发症及髋关节功能评分进行评估。结果 PFNA组手术时间明显比PFN组缩短;术中出血量、骨折愈合时间、髋关节功能评分方面,两组比较无显著性差异(P0.05)。PFNA组术后并发症较PFN组减少。结论 PFN和PFNA治疗老年骨质疏松性股骨粗隆间骨折均具有创伤小、固定牢靠、可早期活动、并发症少等优点,但PFNA在缩短手术时间、减少术后并发症方面优于PFN。     

PFNA治疗老年股骨粗隆间骨折的回顾性分析

目的评价PFNA治疗老年股骨粗隆间骨折的临床疗效。方法采用PFNA治疗39例老年股骨粗隆间骨折,回顾性分析手术情况、骨折愈合及髋关节功能恢复情况。结果经2～24个月随访,随访期内35例骨折达临床愈合,髋关节功能评价总优良率为92.1%。3例矮小女性患者全负重时大腿疼痛,骨折愈合取出PFNA后疼痛消失。结论 PFNA治疗老年股骨粗隆间骨折固定牢稳、微创、并发症少,但不适用于身材矮小的女性患者。     

PFNA结合抗骨质疏松药物治疗老年股骨粗隆间骨折临床观察

目的探讨PFNA结合抗骨质疏松药物治疗老年股骨粗隆间骨折的临床疗效。方法将60例老年骨质疏松性股骨粗隆间骨折分成两组,分别采用PFNA结合抗骨质疏松药物治疗和单纯PFNA治疗。结果术后随访6～24个月,平均18个月。两组间骨痂平均出现时间和骨折平均愈合时间,差异有统计学意义(P<0.05)。髋关节功能疗效,差异无统计学意义(P>0.05)。结论 PFNA适用于老年骨质疏松性股骨粗隆间骨折的治疗,同时应用抗骨质疏松药物治疗,可取得更加满意的疗效。     

老年骨质疏松股骨粗隆间骨折髓内固定选择对比研究

目的分析老年骨质疏松股骨粗隆间骨折患者在内固定选择方面,防旋型股骨近端髓内钉 (PFNA)和新型股骨近端髓内钉（丨NTERTAN)临床治疗效果。方法自2010年11月~ 2012年04 月,在我院手术治疗的61例患者中37例使用PFNA固定,24例使用Intertan固定,比较两组平均手术 时间、术中出血量、骨折愈合时间、部分负重时间、完全负重时间、术后内固定失败例数、髋关节Harris 功能评分。结果全部患者均获6-24个月随访,平均13.3个月,髋关节功能评分以末次随访的情 况计人资料。PFNA组手术操作时间、术中出血量较Intertan组少（P < 0. 05 ),两组骨折愈合时间、术 后内固定失败例数、髋关节Harrisa能评分均无明显差异（P>0.05)。结论 PFN A和Intertan均设 计合理,在老年骨质疏松股骨粗隆间骨折患者中均能起到很好的固定效果,达到临床愈合。     

股骨近端防旋髓内钉内固定治疗老年骨质疏松性股骨粗隆间骨折48例临床分析

目的分析股骨近端防旋髓内钉(PFNA)内固定治疗老年骨质疏松性股骨粗隆间骨折的效果。方法收集2016-10-2018-10间在宝丰县人民医院接受PFNA内固定术的48例老年骨质疏松性股骨粗隆间骨折患者的临床资料,进行回顾性分析。结果本组手术时间(56.26±4.24)min,术中出血量(145.24±22.24)mL。术后发生切口血清肿、下肢深静脉血栓形成及肺部感染各1例,并发症发生率为6.25%,均经对症处理后痊愈。住院时间(14.46±1.12)d。术后随访12个月,下床负重时间(2.28±0.68)个月,骨折愈合时间(3.66±0.46)个月。其间未发生内固定松动或断裂、髋内翻及骨折畸形愈合等其他并发症。末次随访,依据Harris评分标准,优良率为95.83(46/48)。结论 PFNA内固定治疗老年骨质疏松性股骨粗隆间骨折,创伤小、并发症发生率低,有利于骨折愈合和髋关节功能恢复。     

不同内固定方法治疗老年骨质疏松性股骨粗隆间骨折的效果比较

目的观察不同内固定方法治疗老年骨质疏松性股骨粗隆间骨折的效果。方法随机将68例老年骨质疏松性股骨粗隆间骨折患者分为2组,各34例。观察组实施股骨近端防旋髓内钉(PFNA)内固定治疗,对照组实施动力髋螺钉(DHS)内固定治疗。比较2组的治疗效果。结果观察组手术时间、术中出血量、骨性愈合时间及并发症发生率均低对照组,Harris髋关节评分高于对照组。差异均有统计学意义(P0.05)。结论与DHS内固定相比,PFNA治疗老年骨质疏松性股骨粗隆间骨折,创伤小、恢复快、髋关节功能恢复效果佳,且术后并发症少。     

PFNA治疗老年不稳定性股骨粗隆间骨折的疗效分析

目的分析PFNA治疗老年不稳定性股骨粗隆间骨折的手术效果,评价其临床疗效及手术操作注意事项。方法对29例老年不稳定性股骨粗隆间骨折应用PFNA内固定手术治疗。结果术后骨折愈合良好,髋关节功能良好,患者满意度良好。结论 PFNA具有操作简单、创伤小、骨折固定稳定、符合生物学固定原则等优点,对老年不稳定性股骨粗隆间骨折是一种良好的内固定方法。     

两种不同内固定在老年股骨粗隆间骨折中的应用比较

目的 探讨动力髋螺钉(DHS)与防旋股骨近端髓内钉(PFNA)在老年股骨粗隆间骨折中的治疗选择和临床疗效.方法 53例老年股骨粗隆间骨折患者,31例行DHS固定,22例行PFNA固定.比较两组手术时间、术中出血量、术后引流量和术后骨折愈合时间与功能恢复情况.结果 PFNA治疗组平均手术时间、术中失血量和术后引流量较DHS治疗组明显减少.两组骨折愈合时间和髋关节功能比较差异无统计学意义.结论 PFNA是治疗老年股骨粗隆间骨折的理想内固定选择.     

PFNA内固定治疗股骨粗隆间骨折的疗效分析

目的总结股骨近端防旋髓内钉（PFNA）内固定治疗股骨粗隆间骨折的效果。方法自2011-01—2013-07采用PFNA内固定治疗股骨粗隆间骨折54例。结果本组手术时间平均45min,出血量平均70ml,住院时间平均15d,骨折愈合时间平均5．6个月。54例术后获得随访2～25个月,髋关节功能恢复良好,无并发症出现。术后6个月髋关节功能Harris评分85～95分,平均91分。结论股骨粗隆间骨折采用PFNA内固定治疗能有效减少手术创伤,尤其对于老年骨质疏松患者更适用,临床疗效较为满意。     

PCCP与PFNA治疗高龄股骨粗隆间骨折临床疗效比较

目的探讨经皮加压钢板（percutaneous compression plating,PCCP）与股骨近端防旋髓内钉（proximalfemoral nail antirotation,PFNA）治疗老年股骨粗隆间骨折的临床疗效。方法回顾性分析2009年9月至2011年6月我院收治资料完整、均获得随访的92例股骨粗隆间骨折患者,根据手术方式不同,将患者分为PCCP组40例,PFNA组52例。比较两种术式对手术时间、术中出血量、术后伤口引流量、术后下地负重时间、骨折愈合时间、并发症及Harris髋关节功能评分等指标。结果所有患者均获得随访,随访7～16个月,平均8.3个月。PCCP组在术中出血量、术后伤口引流量上优于PFNA组（P〈0.05）;而PFNA组术后下地时间优于PCCP组（P〈0.05）,内固定后两组Harris髋关节功能评分较治疗前明显改善,PFNA组优良率更高,但差异无统计学意义（P〉0.05）,在手术时间、骨折愈合时间、术后并发症上无明显区别。结论 PCCP和PFNA均是治疗高龄股骨粗隆间骨折的内固定材料,在稳定型骨折类型中均可获得满意的临床疗效。PCCP更适合于高龄股骨粗隆31A1,31A2的稳定性骨折;对于不稳定的31A2型骨折和严重骨质疏松的骨折,应选用PFNA髓内固定,以获得更佳的力学稳定性。     

Rules for allocation of livers for transplantation

Previous rules of allocation of livers for transplantation were based mainly on local priorities, with final management left to the local team. This created substantial regional disparities. A prospective survey of waiting list deaths and dropouts due to aggravation of liver disease (2003-2005) validated the MELD (Model for End-stage Liver Disease) score on French data. A new allocation score (Liver Score) for liver transplants, based on specific variables for each liver disease, was introduced in March 2007. An initial evaluation, based on the first 5 months of practice, clearly shows that the Liver Score reduces the rates of deaths, dropouts, and futile transplantations; it also accelerates access to transplantation for the sickest patients. Several points remain unresolved: both the MELD and Liver scores may be improved. The variability of the MELD score related to different laboratory assay methods requires harmonization between laboratories.     

Risk factors for osteoporosis for residents of Kiwa

We evaluated 207 individuals (49 men and 158 women) living in a small town in central Japan to identify the risk factors for, and the etiology of, osteoporosis. Female sex, advanced age, short stature, low body weight, and deficiencies in calcium and protein intake were associated with an increased risk of osteoporosis. Nutrition appeared to be strongly related to a decrease in bone mass, because subjects who lived solitary lives were more likely to have decreased bone mass and bone mass was similar between husbands and wives.     

Survey of arrangements for anaesthesia for interventional neuroradiology for aneurysmal subarachnoid haemorrhage

The management of patients with subarachnoid haemorrhage following rupture of an intracranial aneurysm is changing. The recent introduction of endovascular occlusion of the aneurysm using detachable coils offers an alternative to craniotomy and clipping of the aneurysm for the prevention of recurrent aneurysmal haemorrhage. The aim of this survey was to evaluate the current provision of peri-operative care for patients with an aneurysmal subarachnoid haemorrhage in the United Kingdom and Republic of Ireland. A survey was conducted of the 34 neuroscience centres which provide an adult neurosurgery service in the United Kingdom and Republic of Ireland. Most centres reported an increasing role for coiling, and a decreasing role for clipping in the management of aneurysmal subarachnoid haemorrhage. The provision of peri-operative care for patients undergoing interventional neuroradiology procedures varied greatly between centres. Neurovascular services in the UK are being reorganised and adequate staff and facilities should be available for the peri-operative care of patients undergoing interventional neuroradiology procedures.     

昏迷患者气管切开术后气管套管的选择

目的探讨昏迷患者气管切开术后应用不同类型气管套管预防肺部感染的效果。方法将102例昏迷气管切开患者按入院时间分为对照组（50例）和观察组（52例），对照组采用不带气囊的金属气管套管；观察组采用一次性低压气囊气管套管，均予气管切开术后常规护理。两组分别在气管切开后第3天、第15天，从气管套管内留取痰标本进行细菌培养。结果两组气管切开术后第15天细菌阳性率比较，差异有显著性意义（P〈0．01）；观察组气管切开术后15d总菌株少于对照组（P〈0．01）；第3天与第15天总菌株比较，对照组差异有显著性意义（P〈0．01），观察组差异无显著性意义（P〉0．05）。观察组肺部感染率显著低于对照组（P〈0．05）。结论采用一次性低压气囊气管套管能有效降低昏迷气管切开术患者的肺部感染率。     

Criteria for selection of patients for bariatric surgery

Because of the high prevalence of co-morbid conditions and poor life expectancy a Body Mass Index (BMI) of 40 kg/m(2) or more is an indication for surgery in a fully informed, consenting adult in optimal medical condition to tolerate general anaesthesia. Patients with BMI of 35-40 kg/m(2) and the existence of one or more serious obesity-related conditions ameliorated by weight loss, such as hypertension, pulmonary insufficiency, non-insulin-dependent diabetes mellitus etc., are also candidates for surgical treatment. The bariatric surgeon should use these international criteria as guidelines only, not strict rules. Attempts on the part of internists and more frequently insurance carriers to require documented failure of previous non-operative treatment is not meaningful.