老年人桡骨远端骨质疏松性骨折保守治疗策略

目的探讨老年人桡骨远端骨质疏松性骨折手法复位、石膏外固定等保守治疗策略。方法观察两家医院急诊科385例腕骨骨质疏松性骨折保守治疗的老年患者,平均69.22±11.41岁,平均随访3.6±1.55个月,对保守治疗前后、骨折愈合后形态学、腕关节功能恢复情况进行评价。结果保守治疗桡骨远端骨折能够很好的纠正老年人掌倾角和尺偏角,腕关节功能恢复优良率可以达到76.88%。结论保守治疗能够治愈绝大部分老年人桡骨远端骨折。     

斜T形锁定加压钢板治疗老年性桡骨远端骨折

桡骨远端骨折是常见骨折,约占骨折患者的1／6,尤其是老年人的常见骨折之一。由于高龄及骨质疏松,桡骨远端骨质压缩,特别是C型骨折（AO分型）往往不能完全复位或复位后固定不牢．造成桡腕关节创伤性关节炎．影响患者腕关节活动。2006—2008本院采用斜T形锁定加压钢板治疗老年人桡骨远端骨折16例,取得较好疗效。现分析如下。     

桡骨远端骨折手法复位疗效分析

桡骨远端骨折是很多中老年人常见的骨折，多因骨质疏松摔伤后引起，我院自1988～2005年共治疗桡骨远端骨折1022例，现报告如下。     

动态外固定架治疗骨质疏松性桡骨远端骨折疗效分析

桡骨远端骨折是常见的损伤,是指位于距桡腕关节面2～3cm的松质骨骨折,其发生呈双峰年龄分布,多见于儿童和老年人,尤其是老年骨质疏松女性。老年骨质疏松女性的桡骨远端骨折基本属于低能量损伤,但仍能导致严重的关节内粉碎和移位,相当部分属于不稳定型骨折。对于骨质疏松性桡骨远端骨折,如采用闭合复位夹板／石膏固定,治疗中后期难以维持复位,且不能进行早期功能锻炼,易导致腕关节僵硬、功能受限等后遗症。切开复位则创伤大,部分患者还要行二次手术,加重经济负担。动态腕关节外固定架治疗该类型骨折可获得和维持骨折复位,且操作简单。本院自2002年4月至2007年5月,采用闭合复位或有限切开复位单边动态腕关节外固定架治疗骨质疏松性桡骨远端骨折42例,随访观察表明短期疗效满意,现报告如下。     

我国中老年脆性髋部骨折及桡骨远端骨折骨质疏松诊断标准与WHO诊断标准的比较分析

目的评估我国中老年髋部骨折及桡骨远端骨折骨质疏松诊断标准与世界卫生组织(World Health Organization,WHO)诊断标准的不同所产生的骨质疏松人群的数量差异,更加精确地指导临床对适宜骨质疏松人群的筛查及治疗。方法收集2016年8月至2018年2月我院骨科年龄在60～80岁的脆性髋部骨折女性患者110例及桡骨远端骨折女性患者100例及与年龄相仿的正常人女性312名,使用双能X线骨密度仪测量腰1～4、股骨颈、股骨大粗隆骨密度,分别计算骨质疏松率;再按照我国骨质疏松诊断标准及WHO诊断标准进行比较分析。结果脆性髋部骨折女性患者腰1～4、股骨颈、股骨大粗隆骨密度低于对照组,差异具有统计学意义(P0.05);骨质疏松率高于对照组,差异具有统计学意义(P0.05)。脆性桡骨远端骨折女性患者腰1～4、股骨颈骨密度低于对照组,差异具有统计学意义(P0.05);骨质疏松率高于对照组,差异具有统计学意义(P0.05)。股骨大粗隆骨密度低于对照组,骨质疏松率高于对照组,但差异不具有统计学意义(P0.05)。按照我国骨质疏松诊断标准与WHO诊断标准进行比较,我国脆性髋部骨折及桡骨远端骨折骨质疏松人数多于WHO骨质疏松人数,差异具有统计学意义(P0.05)。结论据本文分析,我国脆性髋部骨折及桡骨远端骨折骨质疏松率明显高于正常人,我国骨质疏松诊断标准扩大了骨质疏松人数。呼吁更多研究评估我国骨质疏松骨折,特别是脆性桡骨远端骨折的诊断及治疗,适时调整我国骨质疏松诊断标准。     

老年人桡骨远端骨折后手术处理的目标

桡骨远端骨折占肢体创伤的14%,常见于骨质疏松的老年人。桡骨远端关节内粉碎性骨折处理棘手,高龄骨质疏松患者的处理则更加困难。过去,高龄骨质疏松性桡骨远端骨折通常采用手法复位、石膏固定治疗,多数患者会出现明显的短缩和对线不良。为了得到更好的治疗效果,近来出现了许多新的治疗方法。利用微创技术局部注射磷酸钙骨水泥,如NorianSRS被证明可以加速患者的康复,尽管最终的影像学结果并没有明显改善。最近各种类型的带锁螺钉和内植物迅速普及开来。这些内植物带有直接锁定钢板的螺钉,固定角度的螺栓,可以为骨质疏松性骨折提供良好的固定。今后需要手术处理的骨质疏松性桡骨远端骨折会越来越多,我们已经到了需要反思我们治疗这种常见损伤策略的时候了。     

中老年骨质疏松性桡骨远端骨折的治疗

目的 探讨骨质疏松性桡骨远端骨折中西医结合治疗方法,解决其骨折愈合缓慢问题,并期望降低后继性再骨折的危险.方法 自1997年7月～2007年7月,50岁以上存档完整的76例骨质疏松性桡骨远端骨折分析,了解中西医结合治疗的效果.结果 随访76例,时间1～2.5年,骨折愈合时间6～12周,平均7.5周,按修正Green和OBrien的评分标准,优:32例;良:21例;可:17例;差:6例,优良率70%.结论 ①中老年桡骨远端骨折以女性为多,这与女性绝经后骨质疏松有关.②在治疗骨折的同时,注意配合骨质疏松的治疗,可减少"骨折病"发生,促进骨折愈合,防止再骨折的发生.     

不同分型桡骨远端骨折保守治疗疗效分析

<正>桡骨远端骨折是临床常见的骨折之一,尤其对于老年人,跌倒后多易发生的骨折。虽然目前医疗技术不断进步,手术方式多种多样,但手法复位固定仍是治疗桡骨远端骨折的主要手段,特别是有些老年人由于多种原因而不愿意接受手术。对     

掌侧锁定加压接骨板(LCP)治疗老年桡骨远端骨折

目的评价掌侧入路锁定加压接骨板(LCP)治疗老年人骨质疏松性桡骨远端骨折的疗效。方法对30例Melone分型2B以上的老年骨质疏松患者的桡骨远端骨折采用掌侧入路,LCP钢板固定进行手术治疗。通过对这些患者术后腕关节功能随访、X线片观察等分析,评定该方法的疗效。结果经术后平均2.1年随访,30例患者中26例术后没有腕关节疼痛,能满足日常生活要求,患者对治疗效果满意。2例术后仍存在腕关节疼痛且需服用止痛药。2例存在手指活动障碍。术后X线片显示桡骨远端关节面平均掌倾3.38°,尺倾18.9°,桡骨茎突较尺骨茎突长0.9cm。2例桡骨远端较术后早期X线片缩短0.2cm。未发现其它严重并发症。结论老年人骨质疏松性桡骨远端骨折(Melone2B型以上)采用掌侧LCP内固定是有效的手术方法之一,对恢复并维持桡骨远端高度和关节面不失为一种较好的选择。     

桡骨远端骨折的治疗进展

桡骨远端骨折足指距桡骨远端关节面3cm以内的骨折，是临床上最常见的骨折之一，多见于中老年有骨质疏松的患者，约占急诊骨折病人的1／6。其治疗仍以手法复位、夹板或石膏托外固定为主，此方法对人多数患者可以取得比较满意的效果，但埘不稳定的桡骨远端骨折，特别是伴有严重骨质疏松者，复位后再移位非常多见。目前，针对桡骨远端的各型骨折出现了许多治疗方法，现综述如下。     

Distribution, elimination, and action of d-tubocurarine in neonates, infants, children, and adults

The relation of plasma concentration of d-tubocurarine (dTc) to neuromuscular blockade, and the distribution and urinary excretion of dTc was determined in neonates (n = 4), infants (n = 6), children (n = 8), and adults (n = 8). The plasma concentration-time course curves to 24 hr are best described for all groups by three-compartment models. Both neonates and infants exhibit decreased plasma clearance (CLP), 1.1 +/- 0.08 and 1.0 +/- 0.06 ml X kg-1 X min-1, and in addition a prolonged t1/2 terminal phase, 311 +/- 44 and 306 +/- 35 (mean +/- SEM, min). The neonates' 24-hr urinary excretion, 27 +/- 2 (mean +/- SEM, % total dose) is significantly less than the adult value, 45 +/- 4% total dose. There was no significant difference seen in the log plasma concentration-evoked compound electromyogram (ECEMG) response between 20-80% paralysis for adults, children, infants, and five of the seven neonates studied. Two of the neonates had a significant shift of their log concentration-response curve to the right. There was also no significant difference between any of the groups in the time for 50% return of ECEMG stimulus height or the time required for recovery of the ECEMG from 25 to 75% of control value. for recovery of the ECEMG from 25 to 75% of control value.     

Orthopaedics, ethics, and industry. Appropriateness of gifts, grants, and awards

At the Academic Orthopaedic Society meeting in San Francisco on November 8 and 9, 1996, the membership addressed the issue of ethics and industry in an academic setting. Using a Delphi panel technique, they arrived at a definition of conflict of interest, and 41 separate points of acceptable and unacceptable behavior related to gifts, research awards, and funding of various activities. The Academic Orthopaedic Society Delphi Committee also mailed 191 questionnaires (157 department chairpersons and 34 program directors) to 157 training programs. The respective department chairpersons and program directors were asked to copy and distribute the questionnaires to staff (faculty) and house officers (residents and fellows) to complete anonymously and return them for collation. Ninety-one programs (58%) responded. Three hundred and fifty-two questionnaires were returned (237 from staff, 115 from house officers), each of which expressed agreement or lack of agreement with the Delphi panel report using a Likert scale technique. With only modest (and usually predictable) disagreement on certain items, the final statements by the Delphi panel were supported strongly by the survive results. The Academic Orthopaedic Society believes that the major points arrived at by the panelists should serve as the basis for ethical guidelines in the relation between academic orthopaedic institutions and industry.     

Methotrexate, Azathioprine, Cyclosporine, and Risk of Fracture

We studied the fracture risk associated with use of methotrexate, azathioprine, and cyclosporine. The study was designed as a case-control study. All patients with a fracture (n = 124,655) in the year 2000 in Denmark served as cases. Information on fractures and confounders was retrieved from the National Hospital Discharge Register and a number of other national registers. For each case, three age- and gender-matched controls were randomly drawn from the general population (n = 373,962). Exposure was use of the drugs and a number of covariates including other immunosuppressive drugs, corticosteroids, any cancer, Crohn’s disease, ulcerative colitis, rheumatoid arthritis, psoriasis, liver and kidney disease, prior fracture, and alcoholism. Azathioprine was associated with an increase in overall fracture risk, but besides this, none of the drugs was significantly associated with overall fracture risk or risk of hip, spine, or forearm fracture. Liver [odds ratio (OR) = 1.55, 95% confidence interval (CI) 1.42–1.69] and kidney (OR = 1.26, 95% CI 1.16–1.37) diseases were significantly associated with increased risk of fractures. Azathioprine was associated with an increase in overall fracture risk but not in the risk of spine, hip, or forearm fractures. Methotrexate and cyclosporine were not associated with fracture risk. It thus seems that the underlying disease for which the treatment is administered may be responsible for much of the increase in fracture risk rather than the drugs used to treat the disorder in question.     

Transcapillary exchange and retention of fluoride,strontium, EDTA,sucrose, and antipyrine in bone

Summary The extractions of⁸⁵Sr²⁺,¹⁸F⁻, sucrose-¹⁴C, EDTA-⁵¹Cr, and antipyrine-¹⁴C in bone were determined by the multiple indicator-dilution method. Fluoride and strontium extractions were 18 to 70% during a single transcapillary passage, and those of EDTA and sucrose were from 11 to 59%, whereas extraction of antipyrine was 87%. Injections of⁸⁵Sr²⁺ and¹⁸F⁻ made when perfusion was done alternately with blood and plasma resulted in similar fractional extractions. When flow and extraction were measured simultaneously, extraction was related inversely to flow.     

Oncologic,Functional, and Cost Analysis of Open,Laparoscopic, and Robotic Radical Prostatectomy

ContextAlthough open radical retropubic prostatectomy (ORRP) remains the gold standard, the past years have seen a rise in both laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP), and many patients seem to prefer the so-called minimally invasive procedures despite insufficient data demonstrating superiority over the established standard (ORRP).ObjectiveThis article seeks to review the most recent data on a variety of aspects of the different techniques for performing prostatectomies, such as cost, oncologic outcomes, continence, quality of life, and marketing and propaganda as well as the learning curve for each.Evidence acquisitionA search of the most recent literature was performed using PubMed, and data from lectures and presentations given at international conferences were used.Evidence synthesisThe review showed that, overall, LRP and RARP outcomes have not proved superior to ORRP outcomes or resulted in anticipated benefits to patients. In addition, current data seem to suggest that results of any of the procedures depend more on the surgeon's ability than on the approach, with rates of blood loss, positive surgical margins, incontinence, and erectile dysfunction varying widely from surgeon to surgeon with all three techniques. The aggressive marketing associated with RARP has also led to significantly higher rates of dissatisfaction and regret in patients.ConclusionsConsidering the evidence, ORRP remains the gold standard in radical prostatectomies. Moreover, although the differences among major outcomes are minor and associated with shorter lengths of stay, the costs associated with LRP and RARP are significantly higher than with ORRP. In the absence of solid scientific evidence, patient education, and counselling are crucial parts of the decision-making process, during which patients will opt for one treatment over another.     

The Invention and Development of Enflurane, Isoflurane, Sevoflurane, and Desflurane

Thirty-six halogenated Me Et ethers have been synthesized for evaluation as volatile anesthetics. Eleven of the ethers were too unstable to test, and, of the remaining 25, 13 had promising anesthetic properties in mice and are suitable for study in larger animals. Those ethers having one H with at least 2 halogens other than F or 2 or more H with at least one Br or Cl were the best anesthetics.     

Effects of genes, sex, age, and activity on BMC, bone size, and areal and volumetric BMD.

Quantitative genetic analyses of bone data for 710 inter-related individuals 8-85 yr of age found high heritability estimates for BMC, bone area, and areal and volumetric BMD that varied across bone sites. Activity levels, especially time in moderate plus vigorous activity, had notable effects on bone. In some cases, these effects were age and sex specific. INTRODUCTION: Genetic and environmental factors play a complex role in determining BMC, bone size, and BMD. This study assessed the heritability of bone measures; characterized the effects of age, sex, and physical activity on bone; and tested for age- and sex-specific bone effects of activity. MATERIALS AND METHODS: Measures of bone size and areal and volumetric density (aBMD and vBMD, respectively) were obtained by DXA and pQCT on 710 related individuals (466 women) 8-85 yr of age. Measures of activity included percent time in moderate + vigorous activity (%ModVig), stair flights climbed per day, and miles walked per day. Quantitative genetic analyses were conducted to model the effects of activity and covariates on bone outcomes. RESULTS: Accounting for effects of age, sex, and activity levels, genes explained 40-62% of the residual variation in BMC and BMD and 27-75% in bone size (all p<0.001). Decline in femoral neck (FN), hip, and spine aBMD with advancing age was greater among women than men (age-by-sex interaction; all p 相似文献   

Knowledge,Attitude, and Perception About Renal Transplantation of CKD Patients,Caregivers, and General Population

Introduction

In this study knowledge about kidney disease and the option of transplantation was assessed in chronic kidney disease (CKD) patients and their care givers.