Ludloff截骨术与Cheveron截骨术治疗足拇外翻的疗效对比

目的 对比Ludloff截骨术与Cheveron截骨术治疗足拇外翻(HV)的疗效.方法 选取我院2017年1月～2020年6月收治的80例HV患者,将实施Cheveron截骨术治疗的患者归为观察组(41例,45足),将实施Ludloff截骨术治疗的患者归为对照组(39例,43足).对比两组术前、术后3个月足踝功能、影像...     

下颌骨放射性骨坏死截骨术后缺损游离腓骨肌皮瓣修复重建

放射治疗是头颈部恶性肿瘤主要的治疗手段之一,随着鼻咽癌根治性放射治疗和头颈部恶性肿瘤术前、术后放射治疗的广泛应用,颌骨放射性骨坏死（osteoradionecrosis,ORN）发生率也逐渐增多。局部疼痛、死骨外露甚至病理性骨折给患者身体、精神带来极大痛苦。颌骨ORN的临床治疗比较困难,特别对于广泛的软组织、骨组织坏死者的治疗更难以达到满意的治疗效效果。     

10例半面短小症患儿行下颌骨截骨延长术后的护理

总结10例半面短小症患儿行下颌骨截骨延长和内固定牵引器植入术的术后护理经验。术后护理要点包括:密切观察病情,监测体温;保持舒适体位,加强呼吸道管理;做好口腔护理,保持口腔内伤口处清洁,防止继发感染;采用复尔凯经鼻胃管鼻饲进行营养支持,减少术后并发症发生;保持面颊后伤口清洁干燥以及引流管妥善固定和通畅,防止伤口出血及继发感染;采用程序化镇静镇痛,在镇痛的基础上镇静,优化镇静,使患儿处于安静舒适的状态。10例患儿均如期进入下一个治疗阶段,术后监护阶段未发生感染及危及患儿的不良事件,无术后并发症发生。     

口内进路下颌升支矢状截骨术病人的护理48例

我院对48例患者施行口腔内进路行下颌升支矢状截骨术,避免了以往由口外进路术后在面部遗留瘢痕,使手术效果更加完善,使颅、颌、面重新获得平衡协调,现将护理体会报告如下。1 临床资料本组48例均采用口内进路下颌升支矢状截骨术,其中男22例,女26例,年龄16～32岁,以20～25岁最多,有35例。畸形分类:下颌前突25例,上、下颌骨偏颌畸形12例,下颌前突伴开颌畸形8例,下颌后缩3例。本组对上、下颌     

口内进路下颌升支矢状截骨术病人的护理48例

我院对 48例患者施行口腔内进路行下颌升支矢状截骨术 ,避免了以往由口外进路术后在面部遗留瘢痕 ,使手术效果更加完善 ,使颅、颌、面重新获得平衡协调 ,现将护理体会报告如下。1　临床资料本组 48例均采用口内进路下颌升支矢状截骨术 ,其中男 2 2例 ,女 2 6例 ,年龄 16～ 32岁 ,以 2 0～ 2 5岁最多 ,有35例。畸形分类 :下颌前突 2 5例 ,上、下颌骨偏颌畸形 12例 ,下颌前突伴开颌畸形 8例 ,下颌后缩 3例。本组对上、下颌骨偏颌畸形 ,及部分下颌前突伴开颌畸形的患者行口内进路下颌升支矢状截骨结合Le-FortⅠ型截骨加骨移植术。2　护理2 1…     

下颌角肥大弧形截骨术中在下颌骨颊侧骨板表面定位截骨线的临床应用解剖

目的:通过对40具(80侧)正常成人离体下颌骨截面有关数据的测量,总结其规律性,为下颌角肥大弧形截骨术等临床操作提供参考。方法:40具(80侧)正常成人离体下颌骨标本,在下颌骨下缘最低线取6个等分点(下颌孔至颏孔),沿下颌骨长轴横断,共形成6个冠状剖面,从每个冠状剖面上分别测出下颌管内缘至下颌骨舌侧骨板的距离及下颌管外缘至下颌骨颊侧骨板的距离;将每侧下颌骨矢状剖开,分别测出下颌骨下缘最低点6个等分点至下颌管下缘的距离。结果:下颌骨左右两侧各组数据无明显差别(P>0·05);下颌管内缘至下颌骨舌侧骨板的距离比下颌管外缘至下颌骨颊侧骨板距离短,两者差别有显著性(P<0·01);下颌管在下颌骨内成弧线形贴近下颌骨下缘走行。结论:下颌管在下颌骨内走行位置有一定规律性,测量所得数据可为下颌角肥大弧形截骨术在下颌骨颊侧骨板表面定位截骨线提供重要的解剖学基础。     

下颌骨外板截除术与下颌角全层截骨术用于下颌角肥大整形——附12例报告

目的:探讨下颌骨外板截除术与下颌角全层截骨术用于下颌角肥大整形的疗效.方法:因美容需要而要求进行下颌角整形手术患者12例,术前根据头颅X线正侧位片、下颌骨CT及三维重建检查对患者的下颌骨形态进行分析,并征求患者求美需要分别采用不同手术方法,其中采用下颌骨外板截除术9例,下颌骨外板截除术加下颌角全层截骨术3例.结果:所有患者手术均顺利,术中出血100～150 mL,手术时间2～2.5小时.均未发生手术并发症.其中3例患者术后出现单侧下唇麻木的现象,均在2个月内自行恢复.经过3个月～2年的随访,所有患者面部轮廓明显改观,下面部宽度明显缩小,下颌角角度变小,颏中线无偏移,咬合关系正常,疗效明显.结论:通过术前CT加三维重建检查结合患者自身要求,选用下颌骨外板截除术或结合下颌角全层截骨术,对下颌角肥大有较好的疗效.     

下颌骨部分切除后自体植骨术病人的口腔护理

目的：下颌骨部分切除后自体植骨术预防感染的口腔护理。方法：对36例下颌骨部分切除自体植骨术病人采用术前漱口和机械清理口腔，术后口腔冲洗和擦洗等措施。结果：36例均移植成功，无植骨感染。结论：加强手术前后的口腔护理是预防感染、植骨成活的关键。     

应用截骨术治疗髋关节骨性关节炎

Mcmurry在1935年首先采用截骨术治疗髋关节骨性关节炎,早在50年代以前截骨术已有了很大发展,并成为外科治疗髋关节骨性关节炎的主要手段。近年来随着人工假体的发展和骨水泥技术的应用,采用髋关节置换治疗髋关节骨性关节炎取得满意效果,从而导致保留自身关节的手术迅速减少。但随着时间的推移,对关节置换术后长期疗效     

改良式吸水围巾的设计及在面部冷疗患者中的应用

目的 探讨改良式吸水围巾在面部冷疗患者中的应用效果。方法 选取2017年3月—2018年3月在武汉市某医院皮肤科门诊进行面部冷疗的400例患者为研究对象,按照时间顺序将2017年3月—9月进行面部冷疗的患者作为试验组,2017年10月—2018年3月进行面部冷疗的患者作为对照组。试验组采用自行设计的改良式吸水围巾,对照组采用传统的棉质毛巾。观察两组在进行面部冷疗治疗后衣物浸湿程度、毛巾松动情况和患者的满意度。结果 试验组衣物浸湿发生率及浸湿面积、毛巾脱落发生率明显低于对照组,差异具有统计学意义（P<0.05）;试验组满意度高于对照组,差异具有统计学意义（P<0.05）。结论 改良式吸水围巾使用简便、吸水性好、固定性强、舒适度高,有助于提升患者面部冷疗时的治疗舒适度及满意度。     

Comparison of continuous versus intermittent furosemide administration in postoperative pediatric cardiac patients.

OBJECTIVE: To compare the effects of furosemide administered by intermittent iv infusion vs. continuous iv infusion on urine output, hemodynamic variables, and serum electrolyte concentrations. DESIGN: Prospective, randomized trial. SETTING: Pediatric ICU. PATIENTS: Postoperative pediatric cardiac patients. INTERVENTIONS: Patients were assigned to either the continuous iv infusion or the intermittent infusion groups. The intermittent group received 1 mg/kg iv of furosemide every 4 hrs to be increased by 0.25 mg/kg iv every 4 hrs to a maximum of 1.5 mg/kg iv if the urine output was less than 1 mL/kg.hr. The continuous infusion group received an initial furosemide dose of 0.1 mg/kg iv (minimum 1 mg) followed by an iv infusion rate of 0.1 mg/kg.hr of furosemide to be doubled every 2 hrs to a maximum of 0.4 mg/kg.hr if the urine output was less than 1 mL/kg.hr. MEASUREMENTS AND MAIN RESULTS: Demographic variables, fluids, electrolyte and inotropic requirements were the same in both groups. A significantly (p = .045) lower daily dose of furosemide (4.90 +/- 1.78 vs. 6.23 +/- 0.62 mg/kg.day) in the continuous iv infusion group produced the same 24-hr urine volume as that of the intermittent group. There was more variability in urine output in the intermittent group as well as more urinary losses of sodium (0.29 +/- 0.15 vs. 0.20 +/- 0.06 mmol/kg.day, p = .0007) and chloride (0.40 +/- 0.20 vs. 0.30 +/- 0.12 mmol/kg.day, p = .045). CONCLUSION: Furosemide administered by continuous iv infusion is advantageous in the post-operative pediatric patient because of a more controlled and predictable urine output with less drug requirement and less urinary loss in sodium and chloride.     

Pharmacokinetics of meropenem during intermittent and continuous intravenous application in patients treated by continuous renal replacement therapy

OBJECTIVE: The clinical effect of beta-lactam antibiotics depends on the time of drug concentration above the minimal inhibitory concentration (MIC) for a susceptible bacterium. Continuous infusion (CI) of beta-lactams such as meropenem may therefore be a more rational approach than intermittent bolus injections (IB). The aim of this study was to test whether CI of meropenem achieves effective drug concentrations comparable to IB in patients treated by continuous renal replacement therapy (CRRT). DESIGN: Prospective, randomised cross-over study. SETTING: Twelve-bed medical intensive care unit (ICU). PATIENTS AND INTERVENTIONS: Six ICU patients were randomised to receive either meropenem 1 g IB every 12 h or a 0.5 g i.v. loading dose followed by 2 g i.v. CI over 24 h. After 2 days, regimens were crossed over. Meropenem pharmacokinetics were determined on days 2 and 4. MEASUREMENTS AND RESULTS: Peak serum concentration [median (25% and 75% quartiles)] after short infusion of 1 g meropenem were 62.8 (51.4; 85.0) mg/l, trough levels at 12 h were 8.1 (4.5; 18.7) mg/l, and serum half-life was 5.3 (5.1; 7.0) h. Steady-state concentrations during CI were 18.6 (13.3; 24.5) mg/l. The AUCs during either treatment were comparable and determined as 233 (202; 254) mg/l*h (IB) and 227 (182; 283) mg/l*h (CI), respectively. Four hours after IB, drug concentrations dropped below CI steady-state concentrations. CONCLUSION: Appropriate antibacterial concentrations of meropenem in patients with CRRT are easily achievable with CI. CI may be an effective alternative dosing regimen to IB. A prospective comparison of the clinical efficacy of the two dosage regimens is warranted.     

Role of TRPM8 and TRPA1 for cold allodynia in patients with cold injury

Local cold injury often induces hypersensitivity to cold and cold allodynia. Sensitisation of TRPM8 or TRPA1 could be the underlying mechanisms. This was evaluated by psychophysics and axon-reflex-flare induction following topical menthol and cinnamaldehyde application in cold injury patients and healthy subjects. The patients had no signs of neuropathy except cold allodynia. We applied 20% cinnamaldehyde and 40% menthol solutions in the cold-allodynic area of the patients and in a corresponding area in healthy subjects and obtained sensory ratings during application. Thermotesting and Laser Doppler Imaging were performed before and after exposure to the compounds. Menthol did not induce axon-reflex-erythema in patients or in controls. After menthol cold pain threshold was decreased in healthy subjects; however, no further sensitisation was observed in the patients moreover in some patients an amelioration of their cold allodynia was observed. Cinnamaldehyde-induced pain sensation did not differ between patients and controls. Heat pain thresholds following cinnamaldehyde were lowered to a similar extent in patients and controls (43-39.8 and 44-39 degrees C) and also the axon-reflex-flare responses were comparable. No evidence for sensitisation of responses to TRPM8 or TRPA1-stimulation was found in patients with cold injury-induced cold allodynia. The lack of TRPM8 induced axon-reflex indicates that also de-novo expression of TRPM8 on mechano-insensitive C-nociceptors does not underlie cold allodynia in these patients. We conclude from these data that the mechanisms for the induction of cold allodynia in the patients with cold injury are independent of TRPM8 or TRPA1 and differ therefore from neuropathic pain patients.     

连续性肾脏替代治疗与间歇性血液透析治疗重症急性肾功能衰竭的比较

目的比较连续性肾脏替代治疗(CRRT)与间歇性血液透析治疗(IHD)对重症急性肾功能衰竭的治疗效果.方法收集我科自2001年12月至2002年12月重症急性肾功能衰竭患者52例.每次治疗前、后采血测肾功能、离子,透析前、透析后及透析中每隔2小时测量血压、心率,记录肾功能恢复时间,并记录治疗结束后APACHE-Ⅱ评分.结果 CRRT组与IHD组透析中低血压的发生次数、心律失常发生次数分别为(1.93±0.35)、(3.88±1.23),P<0.05;(1.39±2.37)、(3.75±3.39),P<0.01;24小时尿量达到600毫升的时间分别为(15.44±5.29)天、(22.93±8.44)天,P<0.05.治疗后两组APACHE-Ⅱ评分分别为(14.20±5.56)、(17.30±4.37),P<0.05.结论重症急性肾功能衰竭用CRRT治疗在血流动力学稳定性、溶质清除率及预后方面优于IHD.     

Effects on serum lipid profiles of continuous 17beta-estradiol, intermittent norgestimate regimens versus continuous combined 17beta-estradiol/norethisterone acetate hormone replacement therapy

OBJECTIVE: To compare the effects of a daily oral 1-mg dose of continuous 17beta-estradiol (E2) plus intermittent (3 days off, 3 days on) norgestimate (NGM) 90 microg (n = 221), an oral 2-mg dose of continuous E2 plus intermittent NGM 180 microg (n = 219), and an oral 2-mg dose of continuous E2 plus continuous norethisterone acetate (NETA) 1 mg (n = 217) on blood lipids and lipoproteins in postmenopausal women. BACKGROUND: The present study was undertaken because some progestins have adverse effects on lipid profiles, thereby negating the favorable effects of estrogens. METHODS: This was a multicenter, randomized, parallel-group trial that focused primarily on the 2 marketed regimens--E2 1 mg/NGM 90 microg and E2/NETA. Both subjects and investigators were blinded to the intermittent regimens; the continuous combined regimen was administered open-label. After a minimum 12-hour overnight fast, blood samples were collected at baseline and during months 7 and 12 to determine lipid and lipoprotein concentrations using validated methods. RESULTS: E2 1 mg/NGM 90 microg was associated with significant (ie, the 95% CI did not include 0) increases in high-density lipoprotein cholesterol (HDL-C) (6.8% [95% CI = 4.7%, 9.0%] and 4.8% [2.3%, 7.2%] at months 7 and 12, respectively) and high-density lipoprotein 2 cholesterol (HDL2-C) (10.8% [6.2%, 15.3%] and 24.1% [18.9%, 29.4%]) concentrations, and decreases in total cholesterol (-7.7% [-9.0%, -6.3%] and -9.2% [-10.5%, -7.9%]), low-density lipoprotein cholesterol (-14.3% [-16.3%, -12.4%] and -14.9% [-16.7%, -13.2%]), and lipoprotein(a) (-30.6% [-41.4%, -20.0%] at month 12) concentrations. A significant difference (P < 0.001 by analysis of variance) between the E2 1-mg/NGM 90-microg and NETA regimens was seen for HDL-C and HDL2-C concentrations, which were elevated in subjects receiving E2 1 mg/NGM 90 microg but reduced (-9.1% [-11.1%, -7.1%] and -12.3% [-14.3%, -10.3%] for HDL-C at months 7 and 12, respectively; -14.2% [-18.0%, -10.4%] and -2.5% [-7.8%, +2.8%] for HDL2-C at months 7 and 12, respectively) in those receiving E2/NETA. CONCLUSIONS: In the present study, continuous E2 1 mg/NGM 90 microg was associated with beneficial effects on lipids and lipoproteins in healthy postmenopausal women, effects that were greater at least for HDL-C and HDL2-C than those observed with continuous combined E2/NETA. The applicability of the study results to women with preexisting cardiovascular disease or dyslipidemia, or those who are overweight, remains to be investigated.     

Physiotherapeutic methods of treatment of mandibular distal occlusion and the progress of therapy: A case report

BackgroundStudies have demonstrated a relationship between dental malocclusion and posture defects. The aims of the study were to present (1) the effect of a physiotherapeutic approach to a patient with a distal occlusion defect with the use of a set of exercises to strengthen the muscles responsible for mandibular protrusion, and (2) a non-invasive and easy-to-use method to monitor the effects of therapy.MethodsFive year old girl with a distal occlusion and with a low basic postural tone was referred to physiotherapy. A therapeutic program i.a. concerning a strengthening of the temporomandibular joint muscles with the use of a flexible tape was proposed. To assess the functional changes of the masticatory apparatus a photoanthropometric method was used. In side-face photos, proportions of 2 linear measurements and values of two angles on the first day of therapy, after 2 and after 4 months of exercises, with the mandible located freely and in the maximum protrusion were compared.ResultsA comparison of indices and angles showed a marked improvement in mandibular mobility already after two and four months of the exercises. Using the elastic resistance tape in addition to general developmental exercises allowed for increasing the mobility in the temporomandibular joint.ConclusionMalocclusion should not be considered separately, without taking into account the body posture. The work of the physiotherapist can benefit the orthodontist, correcting postural defects and consequently affecting malocclusion. A comparison of linear measurements and angles can be used to assess the progress of the therapy.     

局部冷敷预防腔镜甲状腺手术后并发症的研究

目的 探讨局部冷敷对腔镜甲状腺次全切除术后减轻切口疼痛、出血等并发症的影响.方法 腔镜下甲状腺次全切除术病人63例随机分为两组,对照组33例,观察组30例;观察组术后在颈部及胸前区(第二肋以上,避开心前区)予以间歇性冷敷.对照组不冷敷,分别观察两组患者术后疼痛、颈部肿胀程度及颈部胸前皮瓣区局部皮肤颜色、引流量等,进行统计学比较比较.结果 两组术后引流量、颈部肿胀程度、颈部胸前皮瓣区皮肤瘀斑等比较,差异有显著意义(P<0.05);两组患者体温、脉搏差异无显著意义(P>0.05).结论 冷敷疗法可有效控制或减轻腔镜手术后伤口疼痛、切口渗血、肿胀,预防或减少术后并发症发生.     

持续加温湿化氧疗在气管切开患者脱机中的应用

目的 观察气管切开患者脱机后使用持续加温湿化氧疗的效果.方法 选择2010年3～8月30例气管切开患者为试验组.采用持续加温湿化氧疗进行气道湿化;2009年9月至2010年2月30例气管切开患者为对照组,采用人工鼻进行气道湿化.结果 试验组患者痰液黏稠度、二氧化碳分压、呼吸频率、肺部感染率明显低于对照组,气道湿化效果优于对照组,差异有统计学意义(P<0.01).结论 持续加温湿化氧疗在气管切开患者脱机中湿化效果满意,痰液黏稠度较稀薄,肺部感染率较低.     

运动引导想象训练在脑卒中患者中的应用研究

目的 探讨运动引导想象训练对脑卒中患者睡眠障碍和疼痛的影响。方法 选取2017年8月—2018年6月某三级甲等医院神经内科脑卒中患者150例,随机分为运动引导想象训练组、音乐组和对照组。运动引导想象训练组在听音乐的基础上进行运动引导想象训练,音乐组实施音乐干预,对照组实施神经内科常规护理措施,分别于干预前、干预后2周、干预后6周采用匹兹堡睡眠质量指数量表评价3组患者睡眠质量,采用视觉模拟评分法评价患者疼痛程度。结果 干预后2周、6周,3组匹兹堡睡眠质量指数量表评分和视觉模拟评分的比较,差异有统计学意义（P<0.05）,两两比较显示,运动想象训练的干预效果优于音乐组,重复测量方差分析结果显示,时间效应、组间效应及交互效应均有统计学意义（P<0.05）。结论 运动引导想象训练可改善脑卒中患者的睡眠障碍,缓解其疼痛。