两种不同注射材料治疗老年骨质疏松性椎体压缩性骨折效果观察与护理

目的 探讨传统聚甲基丙烯酸甲酯(PMMA)骨水泥与高黏度骨水泥治疗老年骨质疏松性椎体压缩性骨折效果。方法 选取2016年1月至2017年12月我院收治的老年骨质疏松性椎体压缩性骨折患者62例为研究对象,随机将其等分为研究组和对照组,研究组注射Confidence高黏度骨水泥,对照组注射PMMA传统骨水泥。结果 术前两组患者视觉模拟疼痛(VAS)评分比较差异无统计学意义(P 0. 05),术后VAS评分均低于术前,且研究组低于对照组(P 0. 05);术前两组患者Cobb角比较差异无统计学意义(P 0. 05),术后小于术前,且研究组小于对照组(P 0. 05)。结论 高黏度骨水泥和传统骨水泥对治疗老年骨质疏松性椎体压缩性骨折都有一定效果,但在患者VAS评分和椎体Cobb角研究方面,高黏度骨水泥效果较好。     

经皮椎体后凸成形术治疗伴椎体内裂隙样变的骨质疏松性椎体压缩性骨折的临床效果

目的比较经皮椎体后凸成形术(PKP)治疗伴椎体内裂隙样变的骨质疏松性椎体压缩性骨折(OVCF)的效果。方法随机抽取2014年3月至2015年8月82例OVCF患者,根据影像学检查结果分为研究组(伴椎体内裂隙样变)与对照组(无椎体内裂隙样变),每组41例。两组均行PKP治疗,6个月后随访。对比手术前后两组椎体前缘高度及伤椎后凸角(Cobb)、疼痛评分(VAS)及功能障碍评分(ODI)变化情况。结果术后两组椎体前缘高度及Cobb角均较术前明显改善,差异有统计学意义(P0.05);手术前后两组椎体前缘高度及Cobb角比较差异未见统计学意义(P0.05);手术前后两组VAS评分及ODI评分比较差异未见统计学意义(P0.05),术后两组VAS评分及ODI评分较术前改善,差异有统计学意义(P0.05);两组均未见并发症。结论采用经皮椎体后凸成形术治疗伴椎体内裂隙样变的骨质疏松性椎体压缩性骨折效果显著,可有效恢复伤椎前缘高度及Cobb角,缓解疼痛感,改善机体功能,且安全性较高。     

经皮椎体后凸成形术治疗重度骨质疏松椎体压缩性骨折

目的探讨应用经皮球囊椎体后凸成形术（percutaneous kyphoplasty,PKP）治疗重度骨质疏松性椎体压缩性骨折（osteoporotic vertebral compression fracture,OVCF）的可行性和有效性。方法对33例重度骨质疏松性椎体压缩性骨折患者行PKP术。测量伤椎前缘、中缘及Cobb’s角度术前、术后值,同时应用视觉模拟数字评分（VAS）及功能障碍指数（ODI）综合评估手术疗效。结果33例患者手术均顺利,术后随访14～39个月,平均22．6个月。VAS评分、ODI评分分别由术前的（7．9±0．8）分、（74．2±9．9）分降至术后的（2．9±0．9）分、（36．8±8．6）分,差异有统计学意义（P〈O．05）;末次随访时VAS评分、ODI评分分别为（2．7±1．1）分、（35．6±6．9）分,较术后差异无统计学意义。伤椎前缘、中缘高度由术前的（30．6±8．1）％、（40．5±14．9）％恢复至术后的（66．9±13．5）％、（74．5±10．3）％,差异有统计学意义（P〈0．05）。术前椎体Cobb’s角度（25．3±8．8）°,术后（14．7±7．2）°,差异有统计学意义（P〈0．05）。11例（33％）术中出现骨水泥渗漏,但并未产生临床症状。结论经皮球囊椎体后凸成形术治疗重度骨质疏松椎体压缩性骨折疗效确切,并发症少,术后功能恢复良好。     

不同骨水泥注入量对PKP治疗骨质疏松性椎体压缩骨折疗效的影响

目的：探讨不同骨水泥注入量对经皮椎体后凸成形术（PKP）治疗骨质疏松性椎体压缩骨折（OVCF）疗效的影响。方法：选择2019年1月至2022年1月治疗的60例OVCF患者，按随机数字表法分为对照组和观察组各30例。两组患者均采用PKP治疗，PKP术中对照组骨水泥注入量为4~6 ml，观察组骨水泥注入量＜4 ml。比较两组疼痛程度、日常生活功能、步态分析、伤椎椎体高度、Cobb角及并发症发生情况。结果：两组术后视觉模拟评分法（VAS）评分及Oswestry功能障碍指数（ODI）评分均低于术前，步速、跨步长均大于术前，伤椎椎体高度均大于术前，Cobb角均小于术前，差异有统计学意义（P＜0.05）；两组术前及术后的VAS评分、ODI评分、步速、跨步长、伤椎椎体高度、Cobb角比较，差异无统计学意义（P＞0.05）；观察组并发症发生率（6.67%）低于对照组（30.00%），差异有统计学意义（P＜0.05）。结论：PKP治疗OVCF时注入4~6 ml或＜4 ml骨水泥均能够达到止痛、恢复功能及步态的效果，但骨水泥注入量＜4 ml时并发症更少，可将骨水泥注入量＜4 ml推荐作为PKP治疗OVCF时的一种安全有效剂量。     

比较脊柱节段稳定性训练与传统方法治疗下背痛的效果

目的：比较脊柱节段稳定性训练（SSE）与传统方法治疗下背痛的疗效。方法：下背痛患者56例,分为SSE组31例和对照组25例,均采用传统方法治疗,SSE组同时加用脊柱节段稳定性训练。结果：治疗3个月时SSE组休假天数、数字疼痛评分（NRC）、Oswextry量表（ODI）及生活质量评分量表（SF-36）评分与对照组比较差异无统计学意义,但复发次数明显少于对照组（P〈0．05）。治疗后6及12个月时SSE组的各项指标均优于对照组（P〈0．05）。结论：脊柱节段稳定性训练治疗下背痛能在短期减少复发次数,疗效保持时间长,能有效提高患者生活质量。     

单侧及双侧经皮椎体后凸成形术治疗骨质疏松椎体压缩性骨折的疗效比较

目的：对比单侧及双侧经皮椎体后凸成形术（PKP）治疗骨质疏松椎体压缩性骨折（OVCF）的临床效果。方法68例经PKP治疗的OVCF患者根据手术方式的不同分为2组,采用单侧PKP治疗的患者纳入观察组（n＝30）,采用双侧PKP治疗的患者纳入对照组（n＝38）,比较2组患者手术时间、X线暴露时间及临床疗效。结果2组患者手术均获成功,且术后无神经根和脊髓损伤并发症出现,观察组手术时间及X线暴露时间均明显低于对照组,差异有统计学意义（P＜0．05）;术后VAS、Cobb角、椎体前缘及中部的高度与术前比较,差异均有统计学意义（P＜0．05）,但2组组间比较无显著差异（P＞0．05）。结论单侧与双侧PKP均能明显缓解OVCF患者疼痛症状,具有相同的手术效果,但单侧PKP具有手术时间短、放射暴露时间短优点。     

经皮椎体成形术与椎体后凸成形术治疗骨质疏松性椎体压缩骨折的疗效观察

目的比较经皮椎体成形术（PVP）与经皮椎体后凸成形术（PKP）在治疗骨质疏松性椎体压缩性骨折方面的疗效。方法本科近一年收治的42例骨质疏松性椎体压缩性骨折患者,按家属意愿分别实施PVP（24例,37椎体）、PKP（18例,29椎体）治疗。分别于术前、术后1周及术后6月用疼痛强度视觉类比评分（VAS）对患者疼痛程度进行评估,并通过影像学检查评估Cobb角矫正程度及骨水泥渗漏发生率。结果42例手术均成功完成。无论是PVP组还是PKP组,VAS评分术后1周及术后6月均较术前明显改善（P〈0．05）,术后6月评分较术后1周评分无统计学差异（P〉0．05）。PKP组与PVP组相比,术后6月与术前的VAS评分的改善情况无显著性差异（P〉0．05）。术后PVP组和PKP组Cobb角均有明显改善（P〈0．05）,并且PKP组较PVP组更明显（P〈0．05）。并发症的发生率PVP组为20．8％（5例出现椎体周围骨水泥渗漏）;PKP组为11．1％（2例出现椎体周围骨水泥渗漏,无一例出现肺栓塞）,两组比较差异有显著性（P〈0．05）。结论PVP与PKP均可显著缓解骨质疏松性椎体压缩性骨折患者的疼痛;但是PKP较PVP有更高的畸形矫正率,更低的并发症发生率,对于骨质疏松性椎体压缩性骨折来说,是一种更有效的手术方式。     

经椎弓根椎体内植骨联合短节段内固定术治疗单节段骨质疏松性脊柱骨折的临床效果

目的:探讨经椎弓根椎体内植骨联合短节段内固定术治疗单节段骨质疏松性脊柱骨折的临床效果。方法:选取2015年1月~2017年1月我院收治的86例单节段骨质疏松性脊柱骨折患者作为研究对象,随机分为研究组和对照组,每组43例。对照组采用短节段内固定术治疗,研究组采用经椎弓根椎体内植骨联合短节段内固定术治疗。比较两组的手术时间、术中出血量、住院时间、骨折愈合时间、椎体Cobb角、椎体高度丢失量、VAS评分和内固定松动断裂发生的比例。结果:研究组的手术时间长于对照组,差异有统计学意义,P0.05;两组的术中出血量、住院时间和骨折愈合时间相比较,差异无统计学意义,P0.05;研究组术后和随访末期的椎体Cobb角和椎体高度丢失量均低于对照组,差异均有统计学意义,P0.05;对照组的术后VAS评分和内固定物松动断裂发生比例均高于研究组,差异均有统计学意义,P0.05。结论:经椎弓根椎体内植骨联合短节段内固定治疗单节段骨质疏松性脊柱骨折的临床效果更好。     

运动干预对抑郁症患者生活质量和临床疗效的影响

目的：探讨运动干预对抑郁症患者生活质量和临床疗效的影响。方法将符合抑郁症诊断标准的76例抑郁症患者应用自主选择的方式分为研究组与对照组,将采用配合运动干预的41例抑郁症患者作为研究组,另外选择未进行运动干预的35例抑郁症患者作为对照组,应用汉密尔顿抑郁量表（HAMD）及生活质量综合评定问卷（GQOL-74）比较两组患者的治疗效果。结果两组干预前GQOL-74评分和HAMD评分比较差异均无统计学意义（P＞0．05）。干预后对照组GQOL-74评分为（48．2±3．4）分,优于干预前（36．3±5．0）分,差异有统计学意义（t＝9．214,P＜0．05）,干预后研究组GQOL-74评分为（55．5±4．9）分,优于干预前（34．4±5．2）分,差异有统计学意义（t＝12．364,P＜0．05）,且干预后研究组优于对照组,差异有统计学意义（t＝6．139,P＜0．05）;干预后对照组HAMD评分为（14．2±3．0）分,优于干预前（24．1±1．5）分,差异有统计学意义（t＝4．563,P＜0．05）,干预后研究组HAMD 评分为（11．1±2．6）分,优于干预前（23．6±1．2）分,差异有统计学意义（t＝5．671,P ＜0．05）,干预后两组HAMD评分比较,研究组优于对照组,差异有统计学意义（t＝3．267,P＜0．05）。结论对抑郁症患者采取积极有效的运动干预能够改善患者的不良情绪和行为,提高抑郁症康复护理质量,促进护患关系的和谐。     

经皮单向实心椎弓根钉内固定术与椎弓根螺钉固定术治疗胸腰椎骨折患者的疗效比较

目的比较经皮单向实心椎弓根钉内固定术与椎弓根螺钉固定术治疗胸腰椎骨折患者的疗效。方法选取67例胸腰椎骨折患者,分为微创组35例与常规组32例,微创组使用经皮单向实心椎弓根钉内固定术,常规组使用椎弓根螺钉固定术。比较2组患者手术时间、术中出血量、引流量、肌酸激酶水平、下床时间。比较2组患者不同时点视觉模拟评分法(VAS)评分和功能障碍指数法(ODI)评分,比较2组患者病变椎体前缘高度比较值及Cobb角。结果微创组手术时间、术中出血量、术后引流量、下床时间、术后1 d肌酸激酶水平均显著优于常规组(P 0. 05)。2组患者术前VAS评分无显著差异(P 0. 05)。术后1周时,常规组VAS评分显著高于微创组(P 0. 05)。术后1个月时,常规组VAS评分略高于微创组,差异无统计学意义(P 0. 05)。2组患者均在术前基本丧失行为能力,ODI评分比较差异无统计学意义(P 0. 05)。术后3个月,微创组ODI评分显著低于常规组(P 0. 05)。术后6个月,2组患者均已恢复行为能力,ODI评分比较差异无统计学意义(P 0. 05)。术前、术后6个月,2组患者椎体前缘高度比较值、Cobb角差异均无统计学意义(P0. 05)。术后3个月时,2组患者椎体前缘高度比较值差异无统计学意义(P0. 05),但微创组Cobb角显著大于常规组(P 0. 05)。结论相对于常规椎弓根螺钉固定术,经皮单向实心椎弓根钉内固定术具有手术时间短、出血量少、恢复快等优势,但二者最终疗效无明显差异。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.