外踝骨折的治疗(附40例分析)

目的探讨外踝骨折的治疗。方法回顾分析40例有移位的外踝骨折的病历资料。25例行切开复位内固定术,其中合并有内侧三角韧带扭伤的外踝骨折21例均行手术治疗,不合并内侧结构损伤的单纯外踝骨折19例有4例行手术治疗,有15例选择手法整复石膏固定。结果手术组与非手术组治疗结果优良率分别为84．0％、86．7％。结论合并内侧三角韧带扭伤的外踝骨折切复内固定手术治疗、不合并内侧结构损伤的单纯外踝骨折非手法治疗,两者均可获得优良疗效。     

Femur fracture during abdominal breech delivery

BACKGROUND: While vaginal breech delivery, although rare, can cause femur fracture, abdominal breech delivery is not expected to cause it. CASE: A 2,490-g female infant was delivered at term by elective cesarean section for breech presentation. She sustained a fracture of the femur shaft. A simple splinting led to a complete healing of the fracture without sequelae. CONCLUSION: Although abdominal breech delivery reduces the risk of birth trauma, we must be aware that femur fracture can occur regardless of the mode of delivery.     

Pilon骨折的手术治疗体会

目的回顾性分析治疗P ilon骨折的适宜手术方法、最佳手术时机及其手术疗效。方法对2001年至2004年接受手术治疗的52例单侧P ilon骨折患者进行随访,平均年龄36.5岁,伤后至手术时间平均6.8 d。骨折类型:Ⅰ型4例、Ⅱ型36例、Ⅲ型12例。40例行切开复位三叶型(或T型)钢板内固定;12例行有限切开内固定并辅以外固定,其中应用外固定支架者2例,辅以石膏托者10例。术后平均随访16个月。结果采用Mazur评分系统评估手术疗效,52例患者中,优43例,良6例,可3例。术后并发症包括创面不愈合4例,感染2例,延迟愈合1例和关节退行性变7例。结论正确选择手术时机,根据骨折类型和条件灵活选择固定方式是取得良好手术效果的关键。     

社会支持及文化程度对四肢骨折患者治疗态度及心理应激情况的影响

目的探讨社会支持及文化程度对四肢骨折患者治疗态度及心理应激情况的影响。方法选取2011年10月至2012年9月于本院进行治疗的105例四肢骨折患者为研究对象,将患者中不同社会支持程度及文化程度患者的临床依从性及90项症状自评量表评估结果进行比较。结果大专学历及以上、高社会支持患者的临床依从性较佳率分别为95.45%和91.11%,均高于高中及以下、一般及低社会支持的患者,且大专学历及以上90项症状自评量表各项目评分均低于高中及以下患者,高社会支持者均低于一般及低社会支持的患者,以上数据经统计学处理,其差异均具有统计学意义(P<0.05)。结论社会支持及文化程度对四肢骨折患者治疗态度及心理应激情况的影响较大,在对患者进行干预的过程中应给予充分重视。     

一种“新”的不稳定性胸腰椎压缩劈裂骨折

本文报道9例在CT 和X 线平片上都有同一类型病理变化、发病机理和临床过程的胸腰椎压缩劈裂骨折.CT 上的共同病理变化为:(1)骨折椎的上椎间盘损伤;(2)椎体上1/2的压缩骨折:(3)椎体下1/2的矢状劈裂骨折:(4)椎管前部出现椎体中柱骨折块:(5)椎板骨折.通过对本类骨折的力学分析,作者认为这是—种独立的不稳定性爆裂骨折,且有神经性不稳定的特征.临床治疗应切开复位,并使用有撑开效应的固定器.     

早期手术治疗胸腰椎爆裂性骨折的临床研究

目的：探讨早期手术对胸腰椎爆裂性骨折的治疗价值,以选择最佳手术时机。方法：回顾性分析我院2006年4月～2008年4月手术治疗的新鲜胸腰椎爆裂性骨折68例,按伤后接受手术时间（72 h以内及72 h以后）将患者分为A、B两个治疗组,进行术前及术后影像学观察指标与神经损伤恢复程度比较。通过影像学检查观察伤椎高度恢复、Cobb角及椎管占位情况,脊髓损伤的神经功能按ASIA2000标准进行分级及评分。结果：68例随访12～24个月,平均15个月。术后68例患者的伤椎高度、Cobb角及椎管占位均获得明显改善;组间比较,A组患者的改善情况较B组明显,差异有统计学意义（P＜0.05）。神经损伤恢复结果提示,A、B两组术后均有不同程度的恢复,A组患者的恢复程度较B组明显,差异有统计学意义（P＜0.05）。结论：手术治疗胸腰椎爆裂性骨折疗效显著,伤后手术时间越早,术后脊髓神经功能恢复越好;在全身情况允许时,对脊髓损伤患者尽可能在早期行内固定减压手术,以最大程度地恢复脊髓神经功能。     

Fatigue Analysis and Defect Size Evaluation of Filled NBR including Temperature Influence

The fatigue behavior of a filled non-crystallizing elastomer was investigated on axisymmetric dumbbell specimens. By plotting relevant Wöhler curves, a power law behavior was found. In addition, temperature increases due to heat build-up were monitored. In order to distinguish between initiation and crack growth regimes, hysteresis curves, secant and dynamic moduli, dissipated and stored energies, and normalized minimum and maximum forces were analyzed. Even though indications related to material damaging were observed, a clear trend to recognize the initiation was not evident. Further details were revealed by considering a fracture mechanics. The analysis of the fracture surfaces evidenced the presence of three regions, associated to initiation, fatigue striation, and catastrophic failure. Additional fatigue tests were performed with samples in which a radial notch was introduced. This resulted in a reduction in lifetime by four orders of magnitude; nevertheless, the fracture surfaces revealed similar failure mechanisms. A fracture mechanics approach, which considered the effect of temperature, was adopted to calculate the critical defect size for fatigue, which was found to be approximately 9 μm. This value was then compared with the particle size distribution obtained through X-ray microcomputed tomography (μ-CT) of undamaged samples and it was found that the majority of the initial defects were indeed smaller than the calculated one. Finally, the evaluation of J-integral for both unnotched and notched dumbbells enabled the assessment of a geometry-independent correlation with fatigue life.     

Experimental-Numerical Study on the Flexural Ultimate Capacity of Prestressed Concrete Box Girders Subjected to Collision

Precise evaluation for flexural ultimate capacity of bridges which are subjected to the collision of over-height trucks is essential for making decisions on corresponding maintenance, strengthening or replacement. When the span of a cross-line continuous bridge with a double-box girder was hit by an overly high vehicle, the concrete floor of one girder was severely damaged, and part of the prestressed strands and reinforcements in the girder were broken. After the double-box girder was removed and separated into two single box girders, the ultimate flexural capacity of both box girders was studied by destructive tests, and a comparison was made between the damaged and undamaged girders. Moreover, finite element analysis was conducted to simulate the failure process. The results show that the flexural bearing capacity of the damaged box girder decreased by 33%, but it was still 1.07 times greater than the design bearing capacity, which basically meets the design requirements. Also, the damaged box girder showed a desirable serviceable limit state for three-axle vehicles and five-axle vehicles, but showed an undesirable serviceable limit state for six-axle vehicles. This study shows that repairing or strengthening the damaged span may be better than demolishing and rebuilding the whole superstructure bridge.     

四肢开放性骨折使用外固定器的治疗与护理

目的探讨四肢开放性骨折使用外固定器治疗术后护理的措施与对康复的效果。方法 2010-01/2012-01商水县人民医院使用单侧外固定器进行四肢开放性骨折治疗的患者100例,术中术后采取一般性护理的心理护理、环境护理、自体护理;患肢血液灌注护理;预防针孔感染;防止交叉感染;营养支持;功能锻炼等综合护理措施。结果 100例患者骨折均愈合良好,随访2年,患者骨折愈合时间平均为（10.3±5.2）月,未发生感染、骨不连接等并发症。结论四肢开放性骨折使用外固定器治疗术,配合系统护理可有效增进患者的康复。     

Fracture Mode Transition during Assembly of TC4 High-Lock Bolt under Tensile Load: A Combined Experimental Study and Finite Element Analysis

Fracture during the assembly process is an important failure mode for high-lock bolts used in the aviation industry, which greatly increases the potential of unpredictable accidents during service. In the current study, the underlying reasons for fracture during the assembly of a TC4 high-lock bolt was investigated using a tensile test and finite element analysis (FEA). The microstructure of the as-received bolt consisted of a high proportion of α phase, some β phase, and a small amount of α′ phase formed via martensite phase transformation during the rammer process. The experimental force–displacement curves revealed an average yield load of 55.9 kN and a breaking load of 67.65 kN. The corresponding yield strength was calculated to be 0.9 GPa, which was smaller than the standard value of TC4. This was attributed to the preload-induced stress concentration on the thread surface, leading to obvious strain hardening, which can lead to crack initiation. The effect of preload was further confirmed by the fractographies in which the initial crack was observed on the thread surface. The fractographies suggested that hybrid fracture occurred on the tensile loaded bolt. The initial failure was brittle fracture on the thread surface, transforming into ductile fracture in the screw. The results can contribute to understanding the effect of preload on the load carry capacity of high-lock bolts and provide a strategy to design its assembly specification.