交锁髓内钉断钉与骨不连的力学研究及临床意义

目的:分析交锁髓内钉断钉和骨不连的力学机理,探讨其临床意义和预防方法。方法:将静力外带锁髓内钉远端的圆形锁孔改为长形锁孔,近端改为尾翼状,在粉碎、横断、斜型骨折模型上测量髓钉与锁钉间的剪力和骨折断端间的压力并与静力固定比较。临床随访、分析86例股骨和胫骨骨折静力交锁钉固定的相关并发症。结果:静力固定必然产生髓钉与锁钉间的剪力,其大小约等于正压力;改良交锁钉消除了髓钉与锁钉间剪力对骨折端的应力遮挡;86例中,骨延迟愈合、骨不愈合和断钉分别为7例(8.14％)、3例(3.49％)、2例(2.34％)。结论:骨不连是应力遮挡和血供障碍的必然结果;钉-钉间剪力、骨不连又是造成断钉的重要原因。预防方法是使用动力交锁内固定。     

交锁髓内钉断钉与骨不连的力学研究及临床意义

目的:分析交锁髓内钉断钉和骨不连的力学机理,探讨其临床意义和预防方法.方法:将静力外带锁髓内钉远端的圆形锁孔改为长形锁孔,近端改为尾翼状,在粉碎、横断、斜型骨折模型上测量髓钉与锁钉间的剪力和骨折断端间的压力并与静力固定比较.临床随访、分析86例股骨和胫骨骨折静力交锁钉固定的相关并发症.结果:静力固定必然产生髓钉与锁钉间的剪力,其大小约等于正压力;改良交锁钉消除了髓钉与锁钉间剪力对骨折端的应力遮挡;86例中,骨延迟愈合、骨不愈合和断钉分别为7例(8.14%)、3例(3.49%)、2例(2.34%).结论:骨不连是应力遮挡和血供障碍的必然结果;钉-钉间剪力、骨不连又是造成断钉的重要原因.预防方法是使用动力交锁内固定.     

动静力性交锁髓内钉的力学性能及其临床意义

目的　比较动、静力性交锁髓内钉的力学性能 ,探讨其临床意义。方法　将外带锁髓内钉远端的圆形锁孔改为长形锁孔 ,近端改为尾翼状自带锁设计 ,在粉碎、横断、斜形骨折模型上测量长形锁孔的动力加压作用、尾翼的抗短缩作用和防旋转能力 ,并与静力固定比较。结果　静力固定必然产生髓钉与锁钉间的剪力 ,其大小约等于正压力 ;动力固定消除了髓钉与锁钉间剪力对骨折端的应力遮挡 ,其剪力小而折端压力大 ,与前者比较有显著差异 (P <0 0 1) ;齿状尾翼的防旋转能力可达 10 39Nm ,抗短缩剪力在 2 6 79 1N以上。结论　动力固定的折端加压作用和轴向稳定性较静力固定更具优越性 ,有利骨折愈合 ,可以用于各种类型的骨折     

交锁髓内钉治疗股骨骨折并发症的处理及原因分析

[目的]探讨交锁髓内钉治疗股骨骨折术后并发症的发生原因和处理方法。[方法]本院1999年1月～2004年12月对243例股骨骨折行交锁髓内钉治疗，发生并发症14例，其中骨延迟愈合2例、骨不愈合3例、锁钉失败6例（锁钉松动退出4例，锁钉折弯1例，锁钉断钉1例）、主钉断钉伴骨不愈合1例、术后再骨折1例、膝关节僵直1例。2例骨延迟愈合及时改静力交锁为动力交锁；3例骨不愈合行植骨治疗；主钉断钉和再骨折行扩髓、换钉、植骨治疗；1例锁钉松动退出伴骨不愈合行换钉、植骨治疗；膝关节僵直行股四头肌成形术。[结果]14例患者经过对症治疗，骨延迟愈合、骨不愈合均骨愈合，膝关节功能恢复满意。[结论]交锁髓内钉治疗股骨骨折虽有一定并发症，比其他内固定具有较明显的优势。出现并发症后，及时采取正确有效的处理方法，能达到满意的效果。     

交锁髓内钉治疗下肢长骨骨折并发症分析及对策

目的 研究交锁髓内钉治疗下肢长骨骨折并发症原因，提出防治措施。方法 我院1996年1月～2002年1月对239例下肢长骨骨折行交锁髓内钉治疗，发生骨延迟愈合、骨不连、锁钉断裂、深部感染、小腿外旋畸形、肢体不等长、会阴神经损伤等并发症共21例。6例骨延迟愈合及时改静力交锁为动力交锁；4例骨不连行拔钉、扩髓、换钉、植骨等治疗；5例深部感染予引流、抗生素治疗，骨折部分愈合后拔钉闭式引流、冲洗；小腿外旋畸形1例再次手术矫正；单纯锁钉断裂2例、不等长畸形2例、会阴神经损伤1例未特殊处理。结果 骨延迟愈合6例和骨不连4例均骨愈合；深部感染5例感染控制和骨折愈合；单纯锁钉断裂2例、小腿外旋和不等长畸形3例骨折均骨愈合；会阴神经损伤1例3个月后神经功能恢复。结论 交锁髓内钉是治疗下肢长骨骨折的有效手段，严格掌握手术指征、适当选材、适时掌握静力与动力固定、彻底清创是减少并发症的有效措施。     

交锁髓内钉与微动

交锁髓内钉作为四肢管状骨骨折治疗的主流器械，使用方法有动力性固定和静力性固定，前者骨折端应力遮挡效应小，但稳定性差，后者恰相反。所以临床上常选用交锁髓内钉静力性固定作为手术常规。因应力遮挡造成的各种并发症时常发生，本文意在阐明微动与骨折愈合的关系，并且展望一种具有微动功能的交锁髓内钉。     

交锁髓内钉治疗胫骨骨折

目的 探讨交锁髓内钉治疗胫骨骨折中的治疗效果。方法 对66例胫骨骨折采用交锁髓内钉内固定治疗，闭合性骨折47例，开放性骨折19例。动力型固定16例，静力型变为动力型固定50例。结果 66例随访10～30个月，平均18个月。骨折均愈合，平均愈合时间16周。术后迟发性感染1例，锁钉偏孔7个孔，大隐静脉损伤1例。根据Johner—Wruh评分标准：优47例，良14例，可差1例，总优良率92．43％。结论 交锁髓内钉内固定术是治疗胫骨骨折的一种理想方法，具有创伤小、固定可靠、应力遮挡小、骨折愈合率高、能早期活动等优点。     

静力型交锁髓内钉动力化治疗下肢骨干骨折延迟愈合

目的 探讨静力型交锁髓内钉动力化治疗下肢骨干骨折延迟愈合的效果。方法 对27例骨折应用静力型交锁髓内钉固定后的股骨和胫骨骨干延迟愈合患者，行近侧或远侧锁钉取出术进行动力化治疗。其中股骨干延迟愈合17例，胫骨干延迟愈合10例。结果 随访7—48个月，平均19．5个月。术后3—7个月(平均3．3个月)获临床愈合。无感染、断钉、关节损伤和内固定取出后再骨折。结论 静力型改为动力型是治疗交锁髓内钉固定后股骨和胫骨骨干延迟愈合的有效方法。应用时注意选择适当的手术时机，选择取出锁钉也要得当。     

交锁髓内钉静力型固定动力化治疗胫骨骨折

目的 探讨应用交锁髓内钉治疗胫骨骨折提高愈合率、防止并发症发生的方法 .方法 对56例胫骨骨折采用交锁髓内钉静力型固定治疗,根据骨折稳定情况,3～8周取出一端锁钉,改为动力型固定.结果 56例均获随访.骨折均愈合,术后迟发性感染1例,大隐静脉损伤1例,骨折短缩移位2例.根据Johner-Wruh评分标准:优43例,良8例,可4例,差1例,总优良率91%.结论 交锁髓内钉静力型固定动力化是治疗胫骨骨折的一种理想方法 ,应力遮挡小、骨折愈合率高、并发症少.     

小切口复位带锁髓内钉治疗股骨干骨折

目的：分析使用小切口复位带锁髓内钉治疗股骨干骨折的临床疗效。方法：本组38例40侧股骨干骨折，均采用小切口开放复位逆行钻孔置入髓内钉及I期静力交锁固定。结果：本组38例均获随访，随访时间为13～32个月．平均23．5个月，骨折全部愈合，平均愈合时间为4．8个月，无术中再发骨折．术后感染及髓内钉弯曲断裂。3例锁钉失败，1例发生锁钉断裂，3例在术后12周改为动力固定。远期疗效按马元璋评分标准，优29例，良8例，可1例，优良率为97.4％。结论：小切口开放复位逆行钻孔置入髓内钉可正确地确定髓内钉的插入位置，减少术中再发骨折，且扩大了手术范围，缩短了手术时间，易在基层医院推广应用；术中适当扩髓和Ⅰ期行静力交锁固定并不影响骨折愈合，在骨折未愈合前，应避免完全负重。     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.