金华市区蝇类数量的季节消长

目的：对金华市区的蝇类密度进行分析和研究。方法：笼捕法。结果：金华市区高密度的蝇类有大头金蝇、市蝇、丝光绿蝇和铜绿蝇。数量和季节消长呈双峰型，１９９９年高峰出现在５和８月。结论：园林蝇类密度高于菜场、饮食店，不同调查点蝇密度亦有所差异。     

强化培训质量提升结核病防治能力

目的制订适合乡村医生参与的结核病防治培训方案。方法实验组的乡村医生接受参与式培训,对照组按原要求培训。1年后,问卷调查两组乡村医生对结核病防治知识的知晓情况。结论实验组医生的结核病防治意识比较强,更多医生会主动参与结核病健康宣传。     

Prebending of a Titanium Elastic Intramedullary Nail in the Treatment of Distal Radius Fractures in Children

The aims of this study were to introduce a method to treat distal radius diaphyseal metaphyseal junction fractures by prebending an elastic intramedullary nail and to evaluate the factors influencing fracture apposition. Fifty-two consecutive patients (4 to 15 years old) with a distal radius diaphyseal metaphyseal junction fracture were included. The nail was inserted and advanced into the proximal radial fragment as normal. After bending the nail distally about 90° at the site predetermined to lie at the distal segment, the elastic intramedullary nail was advanced until the prebent part completely entered the marrow cavity. The fracture angular deformity was fully corrected in anterior-posterior and lateral views. The apposition rate was 90% to 100% in lateral view, >50% in anterior-posterior view. The operation time was 16.73 ± 6.253 minutes. The average time of fracture healing was 5 months (range, 4–7 months). During 12 to 19 months of follow-up, firm fracture healing and good remodeling were observed, and there was no impaired forearm rotation function or secondary fracture. Our study showed the treatment of distal radius diaphyseal metaphyseal junction fractures by prebent intramedullary nail could make up for the deficiency of Kirschner wires and steel plates and keep the fracture stable. Fracture type and the anatomical features of the distal radius were associated with fracture apposition.Key words: Distal metaphysealdiaphyseal fractures of radius in children, Titanium flexible nails, PrebendingDistal radius fracture is one of the most common fractures in children,¹ the incidence of which has sustainaned growth.^1,2 To date, closed reduction in combination with plaster immobilization is still the first choice of treatment. However, the rate of fracture displacement is 4% to 39%.^3–6 Because forearm rotation is impaired by angular and rotational deformity, surgery treatment should be employed for those children with unstable or aborted closed reduction.On the basis of the AO Foundation''s The AO Pediatric Comprehensive Classification of Long Bone Fractures,⁷ the metaphysis area is marked by a rectangle containing the diameter of the growth plate of the distal radius and ulna. We make another small square the side of which has the same length as the widest part of the distal radial epiphysis. The segment of radius between these two squares is defined as the distal radius diaphyseal metaphyseal junction (Fig. 1, the green area).Open in a separate windowFig. 1The segment of radius between these 2 squares is defined as the distal radius diaphyseal metaphyseal junction (the area bounded by the two squares on the right [gray]).Steel plates and Kirschner wires are some of the tools that could be used in the surgical treatment of the distal radius diaphyseal metaphyseal junction fracture (DRDMJF). However, steel plates may sometimes result in severe injury, broken internal fixation, infection, bone nonunion, and secondary operation, although they could bring complete anatomical reduction. And crossed Kirschner wires fixed with an acute angle or entry point are very close to the fracture line because of the gradual narrowing of the marrow cavity in this area. De Gheldere⁸ suggested that this would lead to unstable fracture reduction, bone inclination and rotation, and even fracture displacement. Moreover, repeated insertion of Kirschner wires could possibly cause iatrogenic fracture and bring additional difficulty in internal fixation.⁹ The incidence of complications by Kirschner wires is 38% in the treatment of distal radius fracture.⁶The treatment of forearm fracture by elastic intramedullary nail has been accepted and widely used in clinics at present. The advantages, including minimal invasion, greater stability, and less complication, have been described in many reports.^10–14 However, there is no report about its application in the distal radius fracture. The reason is mainly that the elasticity of the intramedullary nail will push the proximal end of the fracture to the opposite side and result in angular deformity and inaccurate reduction. In the current study, we made attempts to improve this method by bending the distal part of the elastic intramedullary nail before pushing it into the marrow cavity, which could make the intramedullary nail maintain its linear state as it passes the fracture line.