Cost consequences due to reduced ulcer healing times – analyses based on the Swedish Registry of Ulcer Treatment

Resource use and costs for topical treatment of hard‐to‐heal ulcers based on data from the Swedish Registry of Ulcer Treatment (RUT) were analysed in patients recorded in RUT as having healed between 2009 and 2012, in order to estimate potential cost savings from reductions in frequency of dressing changes and healing times. RUT is used to capture areas of improvement in ulcer care and to enable structured wound management by registering patients with hard‐to‐heal leg, foot and pressure ulcers. Patients included in the registry are treated in primary care, community care, private care, and inpatient hospital care. Cost calculations were based on resource use data on healing time and frequency of dressing changes in Swedish patients with hard‐to‐heal ulcers who healed between 2009 and 2012. Per‐patient treatment costs decreased from SEK38 223 in 2009 to SEK20 496 in 2012, mainly because of shorter healing times. Frequency of dressing changes was essentially the same during these years, varying from 1·4 to 1·6 per week. The total healing time was reduced by 38%. Treatment costs for the management of hard‐to‐heal ulcers can be reduced with well‐developed treatment strategies resulting in shortened healing times as shown in RUT.     

经皮椎体成形术并发症的预防及处理

目的探讨预防和处理经皮椎体成形术常见并发症的经验。方法回顾性分析56例接受经皮椎体成形术治疗椎体压缩性骨折（共75个椎体）患者的资料。结果55例患者术后疼痛症状消失或缓解,优良率达98.22%。共21例出现术中及术后并发症,占37.50%;其中骨水泥向椎体外周软组织渗漏、椎旁静脉内渗漏、椎间盘内渗漏各4例,椎管内渗漏及肋骨骨折各1例,其他并发症7例。结论经皮椎体成形术治疗椎体压缩性骨折临床疗效好,同时要重视对并发症的预防和处理。     

Eccentric Mastectomy and Zigzag Periareolar Incision for Gynecomastia

Background  Gynecomastia is enlargement of the male breast caused by gland proliferation. Surgery is performed for symptom relief or for cosmetic reasons. The authors used a modified operative procedure, then evaluated the results and safety. Methods  Between 2001 and 2005, 22 men (median age, 26 years; range, 13–63 years) with gynecomastia underwent surgery. The operative procedure included a zigzag periareolar skin incision, eccentric subcutaneous mastectomy, and liposuction, with postoperative compression. Results  All the patients were satisfied with the results of the surgery, which produced a chest contour resembling a normal male chest rather than simply a smaller breast. The only complication was a hematoma. One patient was found to have breast cancer. Conclusions  The normal male chest contour can be restored by the described method of eccentric subcutaneous mastectomy.     

Magnamosis: magnetic compression anastomosis with comparison to suture and staple techniques

Purpose

An ideal anastomosis between hollow viscera should be easily performed, strong, and operator independent. We hypothesized that transluminal attraction between magnets in the intestine could be harnessed to create an intestinal compression anastomosis (magnamosis) with these characteristics. We further hypothesized that variation of attraction force and geometry of compression would affect the quality of the intestinal anastomosis.

Methods

We designed a self-orienting device composed of 2 neodymium-iron-boron magnets affixed to polytetrafluoroethylene moldings. Two topologies were evaluated: one designed with ‘uniform’ compression and the other with ‘gradient’ compression. Sixteen young adult pigs (Sus scrofa) underwent laparotomy with creation of a magnetic side-to-side anastomosis: 8 with the uniform device and 8 with the gradient device. Each also had a stapled anastomosis, and 5 had an additional hand-sutured anastomosis. Animals were euthanized at 1, 2, and 3 weeks after operation, then anastomoses were compared on the basis of gross appearance, histology, functional radiography, and mechanical integrity.

Results

All magnetic devices formed patent anastomoses without leak. One stapled anastomosis resulted in a contained leak. Mechanical integrity of magnetic anastomoses was not statistically significantly different from staple or suture counterparts, and there was a trend toward greater strength with magnetic anastomoses. Comparison between device types revealed the gradient device trended toward greater strength and earlier patency (67% vs 33% at 1 week). There was no evidence of stenosis, and histologic examination demonstrated tissue remodeling with mucosal and serosal apposition across the magnamoses.

Conclusions

The magnetic compression anastomosis (magnamosis) device is a safe and effective means of sutureless full-thickness intestinal anastomosis with serosal apposition in a pig model. Gradient compression is superior to uniform compression. This technique is compatible with endoscopic and natural orifice approaches.     

电极放置位置对表面肌电信号特征的影响

目的:探讨不同电极放置位置对表面肌电(sEMG)信号特征的影响。方法:健康男性大学生14名,分别采用50%、70%和90%最大随意收缩力量(MVC)强度静态屈肘运动诱发肱二头肌疲劳,同步采集肱二头肌上三个不同电极位置上的sEMG信号,采用线性和非线性信号分析方法,计算线性指标平均肌电值(AEMG)和平均功率频率(MPF)以及非线性指标C(n)和DET%。结果:电极位置只对sEMG的四个测试指标的均值产生影响,对其变化斜率无明显影响,而四个指标的变化斜率中,除AEMG变化斜率对负荷强度无明显区分度外,其余三个指标对负荷强度均有良好区分度。结论:采用MPF、C(n)和DET%变化斜率作为评价局部肌肉疲劳的客观指标,既可以忽略电极放置位置对sEMG的影响,又对不同负荷强度有良好区分度。     

经皮椎体成形术治疗骨质疏松性椎体骨折疗效观察

目的探讨经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的临床疗效及应用价值。方法36例骨质疏松性压缩性骨折患者45个椎体，在C型臂X线透视下，取俯卧位，经皮穿刺，在病椎注入聚甲基丙烯酸甲酯。术前及术后3d进行疼痛视觉类比评分（VAS评分），并进行统计学分析。结果治疗后36例患者疼痛较治疗前有明显好转，VAS评分差异有统计学意义（P〈0．001）；活动能力也有不同程度改善；部分椎体的前缘和椎体中部高度有一定恢复。结论经皮椎体成形术治疗骨质疏松性椎体压缩骨折止痛效果明显，能很快改善患者的活动能力，早期下床活动。该手术属微创手术，在骨科临床有一定的应用前景。     

大鼠脊髓慢性压迫及减压后神经细胞凋亡及其相关基因的表达

目的：观察慢性压迫性脊髓损伤后及减压后神经细胞凋亡和Bcl-2mRNA，P53mRNA,CASPASE-3神经功能恢复的影响。方法：将55只同龄Wistar大鼠，置入后路渐进式压迫装置，制作成慢性压迫性脊髓损伤模型。随机分为假手术对照组（A组5只），慢性脊髓压迫组（B组25只），减压组（C组25只）。应用原原位末端脱氧核糖核苷酸转移酶介导dUTP标记（TUNEL）技术及原位杂交检测方法，观察各组细胞凋亡率及细胞凋亡相关基因Bcl-2mRNA、P53mRNA、CASPASE－3在慢性压迫性脊髓损伤后及减压后的表达，分别于损伤后及减压后1、3、7、14、28d对慢性脊髓损伤区进行细胞凋亡及原位杂交检测。结果：A、B、C三组均发现神经细胞凋亡及细胞凋亡相关基因Bcl-2mRNA、P53mRNA，CASPASE－3的表达，A、B、C三组细胞凋亡率及阳性细胞灰度值比较，差异有显著性意义（P＜0．05）。阳性细胞表达程度与细胞凋亡的减少及神经功能的恢复相一致。结论：慢性压迫性脊髓损伤可导致大量的神经细胞凋亡，同时激活内源性保护机制，使脊髓发生适应性改变，减压可能通过激活此机制而减轻神经细胞凋亡，起到保护作用。     

不同证型功能性消化不良患者胃容受性及胃排空功能差异的临床研究

目的 通过液体营养餐负荷实验结合B超检查,探讨分析不同证型功能性消化不良（FD）患者胃容受性舒张及排空功能的差异。方法 入选74例研究对象,健康者14例（HS组）,FD患者60例（脾虚气滞型33例,脾虚湿阻型16例,脾阳虚型11例）。所有研究对象均进行液体营养餐负荷实验,结合VAS视觉评分,记录阈值和最大饮入量;并且通过超声测量,比较不同证型的胃排空率及半排空时间。结果 FD组3种证型最大饮入量均低于HS组(P<0.05~0.01),脾虚湿阻型最大饮入量低于脾虚气滞、脾阳虚型(P<0.05);FD组3种证型与HS组比较,脾阳虚型餐后90min远端胃排空率低于HS组(P<0.05);脾虚湿阻型远端胃半排空时间较HS组、脾虚气滞型和脾阳虚型均延长(P<0.05)。结论 不同证型FD患者胃肠运动功能有差异,辨证为脾虚湿阻型患者减退更显著,为中医辨证施治提供理论依据。      

上肢神经卡压646例分析

目的 报道上肢神经卡压手术治疗的临床效果.方法 对646例上肢神经卡压患者行神经松解术或神经受损段切除重新吻合术,术后部分病例给予康复治疗.分析其临床特点、术中表现、治疗方法及预后效果.结果 术后405例经过6个月～3年随访.神经支配区麻木感消失、运动功能正常或接近正常252例,占全部随访病例的62.2%;神经支配区麻木感和运动功能较术前明显改善124例,占全部随访病例的30.6%;神经支配区麻木感和运动功能无改善或较术前加重29例,占全部随访病例的7.2%.经过规范性康复治疗134例中有121例获得随访,神经功能获得改善率为93%.结论 上肢神经卡压后,患肢感觉、运动功能丧失程度为手术方式提供参考,与神经恢复效果密切相关,应加强和重视术前对受损神经感觉、运动功能丧失程度的评估;术后系统的康复治疗对患肢畸形的发生有良好的预防作用,并且对神经功能的恢复具有促进作用.     

冲击载荷作用下骨盆三维有限元分析及其生物力学意义

目的:探讨骨盆受到冲击载荷作用的力学行为特征,为临床分析及判断骨盆骨折类型、力学分布、冲击载荷影响提供力学基础。方法:采用计算机仿真模拟方法,将所构建骨盆三维实体模型导入三维有限元分析软件AN-SYS7.0,计算单侧髂前上棘和单侧髂骨正后方部位冲击载荷作用下骨盆的力学行为表现,冲击载荷为0～8000N,峰值8000N,时间自0～40ms,分析主应力值、应力分布情况以及主应力方向上骨盆单元的位移。结果:冲击载荷作用于单侧髂前上棘时,0～10ms主要的应力沿髂后上棘到髂前上棘分布,在冲击后期10ms以后,骶髂关节、髋臼和耻骨支都会产生较大的应力分布;作用于单侧髂骨正后方部位时,0～20ms主要的应力沿髂骨纵行传导,应力分布并没有在冲击峰值10ms时达到最大,而是从20ms之后,应力开始向骶髂关节、双侧耻骨支、坐骨支以及髋臼等部位传导并可见到明显的应力分布。结论:分析冲击载荷作用下骨盆各部位应力分布以及骨盆各个单元在应力作用下的位移变化,有助于临床上进行骨盆损伤内固定力点的选择以及进一步明确骨盆内在应力值分布。