三柱分型方法指导手术治疗胫骨平台骨折的疗效

目的探讨三柱分型方法指导手术治疗胫骨平台骨折的疗效。方法对80例胫骨平台骨折患者按照三柱分型方法进行分型,并以三柱分型方法指导手术治疗,观察患者的手术疗效。结果患者均获得12个月的随访。与单、双、三柱骨折比较,单纯压缩性骨折的手术时间最短,术中出血量最少,骨折愈合时间最短,术后10个月HSS评分最高,差异均有统计学意义(P 0. 05)。单、双、三柱骨折的骨折愈合时间两两比较差异均无统计学意义(P 0. 05)。患者均无骨折延迟愈合、神经损伤、内固定失败以及骨不连等严重并发症。14例三柱骨折患者中术后1例切口感染、2例关节僵硬; 23例双柱骨折患者中术后2例关节僵硬; 32例单柱骨折患者中术后1例关节僵硬; 11例单纯压缩性骨折患者中术后无切口感染及关节僵硬发生;并发症发生率各型两两比较差异均有统计学意义(P 0. 05)。结论三柱分型方法指导手术治疗胫骨平台骨折疗效确切。     

Barriers and facilitators of implementing child injury surveillance system

Purpose: Child injuries are a global public health problem and injury surveillance systems (ISS) can be beneficial by providing timely data. However, ISS implementation has challenges. Opinions of stakeholders of ISS implementation barriers and facilitators are a good source to understand this phenomenon. The aim of this study is to investigate barriers and facilitators of implementing ISS in Iran. Methods: This is a qualitative study. Data were gathered through interviews with 14 experts in the field of child injury and prevention from Iranian Ministry of Health and Medical Education (MOHME), medical universities, pediatrics hospitals, general hospitals and health houses during January 2017 to September 2017. Data collection and analysis continued until data saturation. Data were analyzed using content analysis through identifying meaning units. Results: Barriers were classified in three main categories and nine subcategories including management barriers (including performance, coordination and cooperation, supervision and attitude), weakness in data capture and usage (including data collection, data recording and data dissemination) and resource limitation (including human and financial resources). Facilitators identified in three areas of policy making (including empowerment and attitude), management (including organization, function and cooperation and coordination) and data recording and usage (including data collection/distribution and data recording). Conclusion: The most important barrier is lack of national policy in child injury prevention. The most important facilitator is improving MOHME function through passing supportive regulations. Effective data usage and dissemination of information to those requiring data for policy making can help reduce child injuries. Coalition of stakeholders helps overcome existing barriers.     

髋臼假体置入角度对髋关节功能的影响

目的探讨全髋关节置换术后髋臼假体安放角度对髋关节功能的影响。方法回顾性分析2015年4月至2018年4月在山西医科大学第二医院行单侧全髋关节置换术的432例患者临床资料。随访评价患者末次改良Harris评分及髋关节活动度。比较不同组间的髋关节活动度、改良Harris评分及其优良率。结果外展角35°～45°组、45°～55°组Harris评分及其优良率比≤35°组、55°组高,外展角各组的髋关节活动度从大到小依次为45°～55°组、35°～45°组、≤35°组与55°组。前倾角各组Harris评分比较,15°～25°组高于5°～15°组高于≤5°组,前倾角各组的髋关节活动度从大到小依次为15°～25°组、5°～15°组、≤5°组与25°组。结论在全髋关节置换术后的早期随访中,外展角重建于35°～55°比重建于≤35°、55°术后髋关节功能恢复要好,但重建于45°～55°可获得最优的髋关节活动度;髋臼前倾角重建于15°～25°可能为全髋关节置换髋臼假体置入的最佳选择,但仍需进一步验证。     

程丑夫运用升阳益胃汤辨治气虚湿热型病理性疲劳经验

临床上,疲劳分为生理性疲劳和病理性疲劳。生理性疲劳可通过适当休息而缓解;病理性疲劳还可分为伴有慢性消耗性疾病和慢性疲劳综合征两类,两者都不能通过休息而缓解。程丑夫教授认为病理性疲劳表现的最主要证候为气虚湿热型,临床运用升阳益胃汤加减治疗疗效颇佳。     

层级护理管理在控制血液净化静脉留置导管患者感染率中的应用

目的探讨层级护理管理在控制血液净化静脉留置导管患者感染率中应用的效果。方法选取2017年4月至2018年3月我院接收的血液净化静脉留置导管患者25例作为研究组,采用层级护理管理;另选取我院2016年4月至2017年3月接收的血液净化静脉留置导管患者25例作为对照组,采用常规护理管理。比较管理前后护理质量评分情况,比较两组护理管理效果、感染发生率。结果研究组护理管理效果好于对照组,差异有统计学意义(P 0. 05);研究组感染发生率低于对照组,差异有统计学意义(P 0. 05);层级管理后护理质量各指标评分高于管理前,差异有统计学意义(P 0. 05)。结论在控制血液净化静脉留置导管患者感染率的过程中应用层级护理管理,效果明显,值得临床推广应用。     

胫骨平台后内侧骨折的两种手术入路比较

目的探讨两种手术入路内固定术对胫骨平台后内侧骨折(PMF-TP)的疗效影响。方法选取2014年3月至2017年3月本院收治的PMF-TP患者80例,依据完成手术的不同路径,每组40例,常内组给予常规膝关节后内侧入路手术治疗,改内组给予改良髌旁内侧入路手术治疗,比较两组手术、并发症、骨折复位、膝关节功能情况。结果改内组术中出血量、手术、住院、负重锻炼、骨折愈合时间明显低于常内组,差异有统计学意义(P0.05);改内组并发症率明显低于常内组,差异有统计学意义(P0.05);改内组术后6个月骨折复位、膝关节功能优良率明显高于常内组,差异有统计学意义(P0.05)。结论改良髌旁内侧入路较常规的后内侧入路相对简单且安全。