对《可吸收线张力带治疗髌骨骨折的生物力学研究及其临床意义》一文的不同意见及作者答复

贵刊在第 7期发表“可吸收线张力带治疗髌骨骨折的生物力学研究及其临床意义”一文 ,本人对此有不同看法。该文临床意义似乎不大。单纯张力带的髌骨固定方法本身已淘汰 ,而改用克氏针垂直固定骨块 ,再用钢丝张力带固定。如果作者所指的是单纯使用可吸收线作张力带固定而未使用克氏针 ,则这种固定方法强度肯定不够。如果使用克氏针固定 ,则仍需取内固定。而单取2枚克氏针的切口和取克氏针加钢丝的切口没有太大差别。对于克氏针退针可能刺激皮肤 ,无论采用钢丝或可吸收线都可能发生。从作者本身的研究看 ,可吸收线弹性比钢丝大 ,对克氏针的固…     

可吸收线张力带治疗髌骨骨折的生物力学研究及其临床意义

目的 探讨可吸收线张力带治疗髌骨骨折的生物力学特性及临床应用可行性。方法 取12具新鲜尸体膝关节标本制成髌骨横断骨折模型，分2组各6个膝关节，分别用双股“薇乔”l-0可吸收线和直径0．8mm钢丝做张力带固定，将标本安置在MTS试验机上，行拉力试验和疲劳试验，测量各种试验前后的骨折端分离程度。结果 在0～300N之间可吸收线张力带比钢丝张力带抗疲劳性能强，在300～500N之间两者效果相当；可吸收线张力带比钢丝张力带固定具有更好的弹性。结论 可吸收线张力带治疗髌骨骨折的生物力学性能比钢丝张力带好，完全可替代钢丝应用于临床。     

髌前多枚克氏针钢丝张力带并钢丝环扎内固定治疗严重粉碎性髌骨骨折

目的:探讨髌前多枚克氏针钢丝张力带并钢丝环扎内固定治疗严重粉碎性髌骨骨折方法与效果.方法:2012年2月～2015年2月期间我院收治的40例严重粉碎性髌骨骨折患者采用髌前纵行切口,3枚或3枚以上平行克氏针纵向穿入大多数骨折块,再分别将相邻2枚克氏针经髌前“8”字钢丝捆绑,形成多组张力带.然后用1.2mm的钢丝,沿髌骨由内向外水平穿过,在髌骨外上方作捆绑式加压环扎.结果:随访38例,随访时间9-18月,骨折均达骨性愈合,髌骨关节面平整,9-12个月拆除内固定.功能依据Lysholm膝关节功能评分标准:优35例,良3例.结论:临床治疗严重粉碎性髌骨骨折采用多枚克氏针钢丝张力带并钢丝环扎内固定治疗的效果显著,值得在临床治疗中推广应用.     

应用张力带治疗髌骨骨折24例体会

髌骨骨折在临床上较常见,传统的钢丝环扎法固定不牢,术后需长期外固定,容易导致膝关节僵直。近十余年来广泛应用张力带内固定,固定牢,甚至对粉碎性骨折也取得较好疗效。自2000年10月至2004年5月我院收治髌骨骨折患者24例,均为新鲜骨折,均行克氏针钢丝张力带治疗,疗效满意。     

改良克氏针张力带钢丝手术治疗髌骨骨折的改进

对67例髌骨骨折采用改良克氏针张力带钢丝行内固定术治疗,在针尾处理、钢丝捆扎方式方面做了改进.本组膝关节功能恢复优良率97%.     

复杂踝关节骨折的手术治疗

复杂踝关节骨折是指临床上较难处理的、踝关节较多结构破坏并严重影响踝穴稳定性的一类骨折,包括骨、软骨、韧带和关节囊的损伤。我院自2005-03-2009-12收治复杂踝关节骨折47例,应用AO技术,克氏针张力带钢丝、1／3环形钢板、重建钢板、腓骨远端解剖板、胫骨远端前外侧或前内侧解剖板、可吸收螺丝钉等内固定材料用结合内固定的方法进行手术治疗,取得了较满意的效果,现总结报告如下。     

髌骨骨折张力带内固定的手术改进

目前髌骨骨折普遍采用张力带固定手术治疗,针对术中存在的不足,在针尾处理、钢丝环扎方式、克氏针打入位置等方面做了改进,通过62例临床应用,收到了满意的临床效果,随访1～3年,优良率96%.     

针尾带孔克氏针张力带固定治疗单纯尺骨鹰嘴骨折37例

尺骨鹰嘴骨折在临床上较常见,传统的克氏针钢丝张力带固定方法是将克氏针自尺骨鹰嘴尖部打人尺骨髓腔内,针尾折弯,而钢丝一端横行穿过尺骨远端,“8”字形固定于克氏针与尺骨近端问,这种方法的缺点是随着固定时间的延长,克氏针易松动,露于骨折近端的针尾易形成滑囊炎,甚至刺破皮肤造成局部感染。2010年以来我们应用针尾带孔克氏针张力带固定治疗单纯尺骨鹰嘴骨折37例,取得满意效果,现报告如下。     

改良张力带钢丝治疗髌骨骨折78例疗效观察

髌骨骨折较常见,治疗髌骨骨折的方法亦很多。我们自1988年2月至1994年2月共收治髌骨骨折142例,采用改良张力带钢丝固定治疗78例,取得满意效果,现报告如下。     

空心拉力螺钉结合钢丝张力带技术治疗髌骨骨折体会

髌骨骨折是常见的关节内骨折,其发生率约占全身骨骼损伤的1％。传统采用张力带固定治疗髌骨骨折效果虽然满意,但也存在一定的缺点。我院于2004年1月～2008年3月采用空心拉力螺钉钢丝张力带技术治疗髌骨骨折23例,取得满意疗效,现报道如下。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.