温肾逐瘀壮骨汤对老年股骨粗隆间骨折的治疗效果及对炎症因子的影响

目的:探讨温肾逐瘀壮骨汤在老年股骨粗隆间骨折患者中的临床效果及对炎症因子的影响。方法:选择2017 年5 月—2019 年7 月我院收治的老年股骨粗隆间骨折患者86 例,随机分为对照组(n =43 例)和观察组(n =43 例)。对照组采用股骨近端防旋髓内钉内固定治疗,观察组在对照组基础上联合温肾逐瘀壮骨汤治疗,术后4 周对患者效果进行评估,比较两组髋关节功能、炎症因子、骨代谢指标及治疗预后。结果:观察组术后1 周、2 周、3 周及4 周的Harris 量表评分分别为(74.62±5.76)分、(81.13±5.79 分)、(87.45±6.46)分及(92.14±6.98)分,均高于对照组的(67.81±5.41)分、(74.47±5.63)分、(79.43±5.81)分、(83.45±6.32)分(P<0.05);观察组术后4 周的TNF-a(23.23±4.31)pg/mL、IL-6(18.41±5.37)pg/mL 和IL-10 水平(19.43±3.21)pg/mL 均低于对照组TNF-a(45.41±5.65)pg/mL、IL-6(32.59±10.49)pg/mL 和IL-10 水平(26.49±4.36)pg/mL(P<0.05);观察组手术后4 周的BALP(5.92±0.61)μg/L、BGP(6.42±0.77)μg/L 及PICP 水平(162.14±13.25)μg/L 高于对照组BALP(4.34±0.57)μg/L、BGP(5.69±0.74)μg/L 及PICP 水平(104.39±10.49)μg/L(P <0.05);观察组手术后4 周β-CTX 水平(0.41±0.08)ng/L 低于对照组(0.75±0.11)ng/L(P <0.05);观察组术后感染、深静脉血栓、愈合不良、延迟愈合及非感染性发热发生率合计为4.65% 低于对照组的18.60%,差异有统计学意义(P <0.05)。结论:温肾逐瘀壮骨汤能提高老年股骨粗隆间骨折患者髋关节功能,可降低炎症因子水平,提高患者骨代谢水平,可获得良好的治疗预后,值得推广应用。     

关节镜下克氏针和可吸收螺钉治疗胫骨前髁间棘骨折疗效分析

目的比较关节镜下克氏针和可吸收螺钉治疗胫骨前髁间棘骨折的效果。方法根据治疗时间和不同固定方式将122例胫骨前髁间棘骨折分为2组,均实施关节镜下固定手术。其中观察组(66例)采用克氏针,对照组(56例)使用可吸收螺钉。术后随访8~12个月,比较2组Lysholm膝关节评分改善情况。结果观察组Lysholm膝关节评分由术前(49.37±14.12)分增加至术后(94.52±3.60)分;对照组由前(30.42±12.40)分增加至术后(88.14±2.63)分,2组术后Lysholm膝关节评分改善情况,差异有统计学意义(P0.05)。结论关节镜下行克氏针固定治疗胫骨髁间棘骨折,Lyscholm膝关节评分较好,且手术简便、材料便宜、术后膝关节整体功能良好。     

尿毒症髋部骨折手术患者的中西医结合康复

目的:探讨尿毒症患者髋部骨折手术的中西医结合治疗和护理措施。方法:96例尿毒症髋部骨折手术患者,按随机数字表法分为对照组和观察组,分别采用传统的措施和中西医结合措施治疗和护理,并对治疗结果进行分析比较。结果:术后7 d,观察组VAS评分(0.93±0.53)分,抑郁量表(SDS)评分(33.36±2.13)分,焦虑量表(SAS)评分(36.11±1.88)分,均低于对照组(P 0.05);术后21 d,观察组血红蛋白(91.22±11.1)g/L,白蛋白(39.12±3.71)g/L,均高于对照组(P 0.05);尿素氮(21.86±3.57)mmol/L,肌酐(577.81±91.33)μmol/L,均低于对照组(P 0.05);患者满意度96%,高于对照组的81%(P 0.05);术后3月,髋关节功能恢复优良率88%,高于对照组的73%(P 0.05)。结论:尿毒症髋部骨折采用中西医结合治疗和护理措施,有利于患者的康复。     

唑来膦酸对老年女性骨质疏松性椎体压缩性骨折的疗效分析

目的:探讨唑来膦酸对老年女性骨质疏松性椎体压缩骨折患者骨密度、骨代谢及疼痛的影响。方法:将100例老年女性骨质疏松性椎体压缩骨折患者按照随机数字表法分成观察组和对照组各50例。两组均行经皮椎体成型术治疗,观察组手术后给予唑来膦酸治疗,对照组给予钙剂及维生素D治疗,连续治疗12个月,观察两组治疗前后视觉模拟疼痛评分(VAS)、Oswestry功能障碍指数评分(ODI)、骨密度(BMD)、血清25羟维生素D [(25-OH)D]、骨钙素(BGP)、骨特异性碱性磷酸酶(BALP)和神经生长因子(NGF)、前列腺素E2(PGE2)、神经肽Y(NPY)等指标变化。结果:治疗前两组间VAS和ODI评分比较差异无统计学意义(P 0.05);治疗后3 d及12个月时,两组VAS评分均较治疗前明显降低,观察组治疗后12个月时VAS和ODI评分均明显低于对照组(P0.05);两组治疗前BMD、(25-OH)D、BGP、BALP、NGF、PGE2、NPY各指标含量比较,差异无统计学意义(P 0.05);治疗后12个月,观察组腰椎BMD(L2-4)为(0.685±0.062)g/cm~2,右股骨颈为(0.598±0.058)g/cm~2,均明显高于对照组腰椎(L2-4)(0.659±0.048)g/cm~2和右股骨颈(0.568±0.054)g/cm~2,(P0.05);观察组(25-OH)D为(35.41±10.26)ng/mL,明显高于对照组(28.29±9.13)ng/mL(P0.05);观察组BGP为(10.15±2.01)ng/mL、BALP为(16.26±4.05)ng/mL,均明显低于对照组分别为(12.91±3.04)ng/mL、(18.01±3.75)ng/mL(P0.05);观察组NGF为(261.08±6.51)pg/mL,PGE2为(152.57±7.02)ng/mL,NPY为(142.03±9.68)ng/mL,均明显低于对照组分别为(277.42±9.74)pg/mL、(169.74±6.52)ng/mL、(156.24±8.95)ng/mL,(P0.05)。结论:唑来膦酸能明显增加老年女性骨质疏松性椎体压缩性骨折骨密度,改善骨代谢水平,减轻疼痛,可做为本病的有效治疗药物推广应用。     

关节镜下微骨折联合胫骨高位截骨治疗膝内侧关节炎疗效观察

目的探讨关节镜下微骨折及胫骨高位开放性楔形截骨治疗膝内侧间室关节炎的临床效果,并分析该治疗方案是否具有临床应用价值。方法选择2013年2月至2014年2月期间苏州大学附属第一医院收治的25例膝关节骨关节炎并膝内翻患者,所有患者均采用关节镜下软骨微骨折联合胫骨高位截骨钢板内固定治疗方案,观察截骨处骨性愈合时间和相关并发症,采用膝关节疼痛视觉模拟评分(visual analogue score,VAS)、股胫角(femorotibial angle,FTA)及美国膝关节协会评分(American knee society score,AKS)评价术后效果。结果对25例患者进行为期12个月的随访,所有患者均未出现切口感染、螺钉断裂、骨不愈合等并发症;术后VAS(0.83±0.21)分、AKS(85.1±4.8)分及FTA(171.9±2.2)°较术前VAS(5.34±1.24)分、AKS(85.1±4.8)分及FTA(187.2±2.5)°,差异均有统计学意义(P0.05)。结论关节镜下软骨微骨折联合胫骨高位截骨是治疗膝内侧间室关节炎的一种安全有效的方法。     

2型糖尿病对小鼠骨代谢的影响

目的观察2型糖尿病小鼠的骨代谢及骨微结构的特点。方法采用雄性KK/Upj-Ay/J小鼠(自发性2型糖尿病模型小鼠)10只作为实验组,同时选用10只雄性C57BL/6小鼠作为对照组。两组小鼠均给予常规饲料喂养,确认KK/Upj-Ay/J小鼠发病,继续饲养12周后处死所有小鼠,测定血清骨碱性磷酸酶(BALP)及抗酒石酸酸性磷酸酶(TRAP)活性,并运用MicroCT分析小鼠胫骨微结构定量参数。结果与对照组相比,2型糖尿病小鼠血清BALP活性明显下降(分别为对照组:0.029±0.003μU/min,T2DM组:0.014±0.003μU/min,P0.05),血清TRAP活性明显升高(分别为对照组:0.513±0.034 U/L,T2DM组:0.701±0.054 U/L,P0.05),胫骨平台处骨密度明显下降(对照组:810.000±21.000 mg/cm3,T2DM组:709.000±18.000 mg/cm3,P0.05)。结论 2型糖尿病小鼠的骨吸收加快而骨形成不足,导致其骨量下降及骨折风险增大。     

关节镜微骨折术联合腓骨截骨对内翻性膝关节骨性关节炎疗效及血清IL-1β、IL-6、TNF-α的影响

目的分析关节镜微骨折术联合腓骨截骨对内翻性膝关节骨性关节炎疗效及血清白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)的影响。方法选取自2015-02—2017-05收治的内翻性膝关节骨性关节炎96例,根据治疗方法不同分为2组。对照组给予关节镜微骨折术治疗,观察组给予关节镜微骨折术联合腓骨近端截骨治疗,分析2组治疗后的临床疗效。结果 2组术前IL-1β、IL-6、TNF-α水平组间比较,差异无统计学意义(P0.05)。观察组术后4周时IL-1β、IL-6、TNF-α水平低于对照组,差异有统计学意义(P 0.05)。2组术前美国特种外科医院膝关节评分(HSS)评分、疼痛VAS评分、胫股关节间隙角(JS角)、股骨胫骨角(FT角)组间比较,差异无统计学意义(P0.05)。观察组12个月后HSS评分高于对照组,疼痛VAS评分及JS角、FT角低于对照组,差异有统计学意义(P 0.05)。结论关节镜微骨折术联合腓骨截骨治疗内翻性膝关节骨性关节炎可降低关节液内炎症因子的表达,改善膝关节功能。     

静脉复合抗焦虑药在胫骨骨折术后镇痛中应用

目的:观察静脉复合抗焦虑药在胫骨骨折术后镇痛中的应用及安全性。方法:胫骨骨折手术患者200例,随机分为对照组和观察组(每组100例);对照组采用芬太尼静脉镇痛,观察组采用地佐辛静脉镇痛复合帕罗西汀镇静,采用视觉模拟评分、镇静评分评价两组镇痛前、后镇静、镇痛情况,比较两组术后疼痛及安全性。结果:两组治疗后2 h VAS评分比较差异无统计学意义(P0.05);观察组治疗后6 h评分为(3.7±1.2)分、12 h评分为(2.31±1.06)分、2 h评分为(1.32±0.39)分及48 h VAS评分为(0.83±0.12)分,低于对照组(P0.05);两组治疗后2 h镇静评分比较差异无统计学意义(P0.05);观察组治疗后6 h镇静评分为(3.41±0.32)分、12 h评分为(2.12±0.30)分、24 h评分为(1.83±0.24)分及48 h镇静评分为(0.64±0.12)分,低于对照组(P0.05);两组并发症发生率差异无统计学意义(P0.05)。结论:胫骨骨折手术后采用地佐辛镇痛复合帕罗西汀镇静,效果理想,安全性较高。     

甲状旁腺激素（1-34)联合PKP对老年骨质疏松椎体压缩性骨折患者疗效观察

目的探讨甲状旁腺激素(1-34)(PTH)联合经皮椎体后凸成形术(PKP)治疗老年骨质疏松椎体压缩性骨折的疗效及对患者骨密度、骨代谢的影响。方法 87例老年压缩性骨折患者随机分为治疗组和对照组。两组患者均接受PKP,治疗组术后第一天开始每天皮下注射20μg PTH一次。分别在术前、术后24 h、术后6个月评定两组患者视觉模拟疼痛评分(VAS)及Oswestry功能障碍指数评分(ODI);术前与术后6个月检测患者骨密度及骨碱性磷酸酶骨人交联碱性磷酸酶(BALP),I型胶原N末端肽/肌酐(I型胶原N-端肽)肌酸酐(NTX/Cr)。结果术后24 h、6个月两组患者VAS与ODI评分均较术前明显改善(P0.05),且治疗组患者评分明显低于对照组(P0.05)。术后6个月,治疗组患者腰椎骨密度较术前显著改善(P0.05),血清BALP和NTX/Cr较术前明显上升(P0.05),且均明显优于对照组(P0.05);而对照组治疗前后上述指标无明显变化(P0.05)。结论 PTH联合PKP治疗老年椎体压缩性骨折疗效较好,能增加患者骨密度,提高血清BALP和NTX/Cr水平,安全性好。     

胫骨骨道定位对前交叉韧带单束重建的影响

[目的]探讨胫骨骨隧道定位对前交叉韧带单束重建术后临床疗效的影响.[方法]将60例前交叉韧带断裂患者随机分为对照组和观察组.对照组胫骨骨隧道内口采用外侧半月板游离缘的切线与前后髁间突连线的交点定位;观察组选择原前内侧束和后外侧束中间位置定位.术后矢状位MRI测量胫骨骨道位置、胫骨纵向位移、后交叉韧带指数、膝关节功能评分进行分析评价.[结果]对照组和观察组胫骨骨道分别位于胫骨平台全长的前(38.67±4.23)％和(34.21±2.46)％.胫骨纵向位移为(11.14±2.64)mm和(14.34±2.23)mm,上倾角为(56.2±4.3)°和(44.6±5.2)°,后交叉韧带指数为(3.97±0.45)和(4.78±0.78);两组比较差异均有统计学意义(t检验,P＜0.05).术后1年,对照组与观察组IKDC膝关节主观评分分别为(79.63±4.67)分和(89.76±5.21)分;Lysholm评分分别为(85.61±4.92)分和(92.54±3.22)分,两组比较差异有统计学意义(t检验,P＜0.05).[结论]前交叉韧带单束重建能使患者的关节稳定性与功能均得到显著改善.膝关节MRI测量可较客观、准确地反映胫骨的骨道定位情况.理想的胫骨骨道在矢状位MRI上位于胫骨平台的前(34.21±2.46)％.     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。