镍钛合金抓握式接骨板治疗胸外肋骨骨折96例

目的分析镍钛合金抓握式接骨板不损伤肌肉神经手术治疗胸部外伤肋骨骨折的手术方法和临床疗效。方法选取我院2011年2月~2014年7月收治的96例胸部外伤肋骨骨折患者,按照将患者分为试验组和对照组各48例,给予试验组患者应用镍钛合金抓握式接骨板不损伤肌肉神经手术治疗,对照组患者则应用记忆合金接骨板行内固定术治疗。对两组患者的手术时间、胸管引流时间、术后首次下床时间、住院时间、失血量、并发症发生率进行对比分析。结果试验组患者的手术时间、胸管引流时间、术后首次下床时间、住院时间明显短于对照组(P<0.05),失血量明显低于对照组(P<0.05),且试验组患者的并发症发生率亦显著低于对照组(P<0.05)。结论镍钛合金抓握式接骨板不损伤肌肉神经手术治疗胸部外伤肋骨骨折具有良好的临床疗效。     

镍钛合金环抱器内固定术对多发性肋骨骨折患者术后疼痛程度及骨折愈合时间的影响

目的探讨镍钛合金环抱器内固定术对多发性肋骨骨折患者术后疼痛程度及骨折愈合时间的影响。方法选取多发性肋骨骨折患者81例,按照随机数字表法将其分为两组,对照组40例,观察组41例。对照组40例予以常规保守治疗,观察组41例予以镍钛合金环抱器内固定术治疗,观察比较两组患者治疗效果、下床活动、出院及骨折愈合时间,并统计两组视觉模拟(VAS)评分及并发症发生率。结果观察组治疗优良率为92.68%(38/41),高于对照组[62.50%(25/40)],差异有统计学意义(P0.05);观察组患者下床活动、出院、骨折愈合时间及VAS评分均小于对照组,差异有统计学意义(P0.05);观察组并发症发生率为4.88%(2/41),低于对照组[22.50%(9/40)],差异有统计学意义(P0.05)。结论镍钛合金环抱器内固定术治疗多发性肋骨骨折可缩短骨折愈合、下床活动及出院时间,减轻机体疼痛度,提高疗效,减少并发症的发生。     

镍钛环抱式接骨板内固定治疗多发性肋骨骨折临床分析

目的探讨镍钛合金环抱式接骨板治疗多肋骨折内固定的临床效果。方法 35例多发生肋骨骨折患者使用镍钛合金环抱式接骨板行内固定治疗,并对其治疗效果进行分析总结。结果本研究35例多肋骨折患者术后胸痛显著减轻,胸廓形状恢复正常,反常呼吸消失,呼吸困难显著改善。所有患者均获随访8～34个月,平均(14.6±1.2)个月;术后随访胸片骨折愈合,愈合时间(5.3±1.6)个月;内固定无松动、脱落及断裂,胸廓无畸形。无严重并发症出现。结论应用镍钛合金环抱式接骨板内固定治疗多肋骨折,手术操作简单方便、创伤小、组织相容性好,固定牢靠,并发症少,临床效果满意。     

记忆镍钛合金环抱器治疗多发性肋骨骨折24例围术期护理

目的:探讨记忆镍钛合金环抱器治疗多发性肋骨骨折的围术期护理方法。方法:对24例多发性肋骨骨折患者采用镍钛形状记忆合金环抱器治疗,并给予精心围术期护理。结果:本组24例患者切口均Ⅰ期愈合,无一例并发症发生。随访3～6个月,X线片复查示骨折临床愈合。结论:应用记忆镍钛合金环抱器治疗多发性肋骨骨折具有创伤小、操作简便、安全、固定可靠、组织相容性好及并发症少等优点,利于促进骨折愈合和呼吸功能改善,精心围术期护理是患者康复的保证。     

镍钛合金环抱式肋骨接骨器治疗 26 例多发性肋骨骨折效果分析

目的分析镍钛合金环抱式接骨器治疗多发性肋骨骨折的效果。方法26例多发性肋骨骨折患者应用镍钛合金环抱式肋骨接骨器，行小切口选择性内固定术治疗的临床资料，回顾性分析其治疗效果。结果本研究26例多发性肋骨骨折患者，手术时间21～88min，平均（48．4±10．8）min；住院10～23d，平均（17．6±3．5）d；随访1—3个月，复查CT肋骨三维重建显示骨折线模糊或消失。结论镍钛合金环抱式肋骨接骨器治疗多发性肋骨骨折效果确切，具有操作简单、创伤较小、固定牢靠和骨折愈合快等优点，值得临床推广使用。     

记忆合金环抱接骨板治疗肋骨骨折分析

目的:探讨肋骨骨折患者应用记忆合金环抱接骨板治疗的临床效果。方法:选取2011年6月²013年6月本院收治的肋骨骨折患者63例,随机将其分为观察组31例和对照组32例。观察组采用记忆合金环抱接骨板治疗,对照组采用可吸收肋骨钉治疗,对比分析两组患者的手术时间、骨折愈合时间、VAS疼痛评分、住院时间及术后松动、滑落、感染等发生情况。分别于术后1个月、3个月、6个月、12个月应用QOL生存质量评分表进行评分。结果:观察组患者手术时间、骨折愈合时间、住院时间均短于对照组,差异有统计学意义(P<0.05);观察组患者治疗后第3天VAS评分显著低于治疗前及对照组(P<0.05),而对照组患者治疗后第5天VAS评分显著低于治疗前(P<0.05),但高于观察组;对两组患者随访1年,观察组患者术后骨折不愈合、内固定松动、固定滑落发生率及并发症发生率显著低于对照组,差异有统计学意义(P<0.05);两组患者术后1个月QOL生存质量评分无统计学意义(P>0.05),观察组患者术后3个月QOL生存质量显著优于对照组,差异有统计学意义(P<0.05)。结论:对肋骨骨折患者应用记忆合金环抱接骨板治疗具有操作简单、创伤性小、术后疼痛感轻、固定可靠、术后并发症发生率低以及组织相容性好等优点,能有效促进骨折愈合及改善患者呼吸功能,有助于提高患者生存质量。     

电视胸腔镜联合肋骨接骨板治疗多发性肋骨骨折合并血胸的临床研究

目的探究电视胸腔镜联合肋骨接骨板治疗多发性肋骨骨折合并血胸的临床研究。方法拟选取我院2016年1月～2018年6月收治的多发性肋骨骨折合并血胸患者70例,按数字表法将其随机分为对照组和观察组各35例。对照组给予使用单独传统经胸内固定术治疗,观察组给予电视胸腔镜联合肋骨接骨板治疗;观察比较两组患者胸痹缓解时间、手术时间、术后出血量、下床活动时间、拔除引流管时间等临床指标情况,并观察两组患者肺不张、胸腔感染、伤口感染等术后并发症情况。结果观察组胸痹缓解时间、手术时间以及术后出血量均优于对照组,差异有统计学意义(P0.05);观察组患者下床活动时间、拔除引流管时间明显少于对照组,差异有统计学意义(P0.05);观察组患者术后肺不张、胸腔感染、伤口感染并发症总发生率低于对照组,差异有统计学意义(P0.05)。结论电视胸腔镜联合肋骨接骨板治疗多发性肋骨骨折并血气胸者疗效显著,可缩短手术时间、胸痹缓解时间,降低术后出血量,且安全性高,并发症少。     

环抱式接骨板内固定治疗多发性肋骨骨折临床效果分析

目的观察环抱式接骨板内固定治疗多发性肋骨骨折的临床效果。方法对采用环抱式接骨板内固定治疗的多发性肋骨骨折69例的临床资料进行回顾性分析。结果本组手术时间50~180 min;术中出血量30~200 ml;术后胸痛明显得到缓解,反常呼吸消失,胸廓畸形得到恢复,呼吸困难也明显改善;按照Johner Wruhs标准对胸部功能进行评定,优51例,良16例,可2例,优良率97.1%。8例术后切口有红肿,术后9 d拆线后红肿消退;1例术后发生切口感染,给予相应治疗切口愈合。所有患者均得到随访,术后随访时间7~22(10.6±1.2)个月,骨折愈合时间12~23(16±0.5)周。结论环抱式接骨板内固定治疗多发性肋骨骨折手术操作简单、损伤小、固定可靠,且患者呼吸功能恢复快,并发症少。     

镍钛爪型钢板内固定治疗多发肋骨骨折14例分析

目的：探讨应用镍钛爪型钢板治疗多发性肋骨骨折的方法和疗效。方法：采用该种环抱器治疗14例连枷胸患者,观察术后住院时间、骨折愈合及相关并发症情况,并定期随访。结果：均获临床愈合,住院及骨折愈合时间都明显缩短,且无明显并发症发生。结论：镍钛爪型钢板治疗多发性肋骨骨折具有创伤小、操作简便、安全、并发症少等优点,是一种治疗多发性肋骨骨折较好的方法。     

记忆合金环抱式接骨板治疗股骨骨折32例并发症分析

目的探讨镍钛记忆合金环抱式接骨板治疗股骨骨折的临床效果。方法对32例股骨骨折患者采用镍钛记忆合金环抱式接骨板治疗的临床资料进行回顾性分析。结果镍钛记忆合金环抱式接骨板治疗32例股骨骨折,接骨板断裂2例,骨折延迟愈合5例,取接骨板后再骨折1例。结论镍钛记忆合金环抱式接骨板慎用于治疗股骨骨折。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.