成人锁骨中段有移位骨折手术与保守治疗的病例对照研究

目的:比较手术与保守方法治疗锁骨中段移位骨折。方法:回顾性分析2002年9月至2011年9月收治成人锁骨中段有移位骨折254例,男188例,女66例;年龄19～62岁,平均39.3岁;横行骨折38例,斜行骨折71例,粉碎性骨折145例;均为新鲜单一骨折。其中保守治疗组127例,男96例,女31例,平均年龄(40.1±6.02)岁,采用手法复位"∞"形绷带外固定;手术治疗组127例,男92例,女35例,平均年龄(39.0±5.11)岁,采用切开复位重建钢板内固定。对比两组外观满意度、治疗费用和并发症的发生率,根据韩良平等制定的标准进行疗效评定。结果:所有病例获得随访,时间8～10个月,平均9.8个月。手术治疗组中优110例,良12例,可3例,差2例;保守治疗组中优62例,良28例,可37例;手术治疗组疗效优于保守治疗组。保守治疗组外观满意度高于手术治疗组,保守治疗组治疗费用及并发症低于手术治疗组。结论:成人锁骨中段移位骨折应该综合分析选择治疗方案,首先选择非手术治疗,严格把握手术指征。     

肩关节后脱位2例临床报道

肩关节脱位在临床上极为常见,北京积水潭医院根据肩、肘、髋、膝关节脱位339例患者统计,肩关节脱位占40.1%,其中,肩关节后脱位在临床上极为少见,据资料统计约占肩关节脱位的1.5%～3.8%,其     

非手术疗法治疗踝部骨折脱位

目的:总结非手术疗法治疗踝部骨折脱位的临床疗效,为踝部骨折脱位的治疗提供一种比较好的保守疗法。方法:回顾分析1990年4月至2010年6月收治的踝关节骨折脱位53例,其中男32例,女21例;年龄24～60岁,平均42.5岁;右侧30例,左侧23例。53例均采用中医正骨手法复位,配合小夹板外固定与中药辨证内服,并结合早期功能锻炼治疗,治疗后采用Mazur标准评定踝关节功能。结果:根据Mazur等评分标准,本组53例治疗后平均分(90.11±8.40)分,优36例,良11例,可3例,差3例。结论:以手法复位加夹板固定为主的非手术综合疗法治疗踝部骨折脱位具有操作简便、损伤小的优点。     

仰卧位按压复位法治疗胸椎小关节紊乱

胸椎小关节紊乱是临床常见病,是由于外伤或长期姿势不良造成胸椎小关节突关节错位甚至滑膜嵌顿而引起明显疼痛,往往伴有内脏功能紊乱的临床表现。正骨复位对其有独到的治疗效果,自2003年开始采用仰卧位按压复位法治疗胸椎小关节紊乱43例,现将治疗结果报告如下。1临床资料本组43例,男23例,女20例;年龄21～46岁,平均32.4岁;病程1周～2年,平均3.2个月;均为单节椎体受累,棘突偏左15例,偏右28例。受累部位:T33例,T45例,T56例,T68例,T79例,T89例,T93例。症状:所有的病例均表现出单侧或双侧背肌痉挛、疼痛,深呼吸时疼痛加剧,兼有胸闷、胸痛的37例,     

手法复位辅助手术治疗跟骨骨折

目的:探讨跟骨骨折手法复位对消肿、简化内固定手术操作的临床意义。方法:2005年12月至2010年11月,采用先手法复位待消肿后再行延期手术治疗跟骨骨折42例。男25例,女17例;年龄18～74岁,平均41.4岁;左侧20例,右侧22例。23例采用切开复位钢板固定,19例采用克氏针和空心钉固定。随访评价患者的平均术前、术后消肿时间,手术时间,关节功能及并发症发生情况。结果:本组均获随访,时间3～18个月,平均8.3个月。复位次日疼痛明显缓解,3～5d肿胀基本消退。术中复位简便,手术时间平均90min,术后4～7d消肿,术后未出现皮瓣坏死。术后B觟hler角平均(31±3.2)°,Gissane角(112±5.3)°,跟骨宽度(30.2±0.89)mm。按Maryland足部评分系统评价,优16例,良18例,中6例,差2例。结论:即时手法复位配合延期内固定治疗跟骨骨折可加快术前、术后消肿,简化手术操作。     

Fluctuations between sleep and wakefulness: Wake-like features indicated by increased EEG alpha power during different sleep stages in nightmare disorder

Although a growing body of research indicates that frequent nightmares are related to impaired sleep regulation, the pathophysiology of nightmare disorder is far from being fully understood. We examined the relative spectral power values for NREM and REM sleep separately in 19 individuals with nightmare disorder and 21 healthy controls, based on polysomnographic recordings of the second nights’ laboratory sleep. Nightmare subjects compared to controls exhibited increased relative high alpha (10–14.5 Hz) and fronto-central increases in high delta (3–4 Hz) power during REM sleep, and a trend of increased fronto-central low alpha (7.75–9 Hz) power in NREM sleep. These differences were independent of the confounding effects of waking emotional distress. High REM alpha and low NREM alpha powers were strongly related in nightmare but not in control subjects. The topographical distribution and spectral components of REM alpha activity suggest that nightmare disordered subjects are characterized by wake-like electroencephalographic features during REM sleep.     

REM and NREM power spectral analysis on two consecutive nights in psychophysiological and paradoxical insomnia sufferers

The objectives of the study were to examine EEG activities using power spectral analysis (PSA) of good sleepers (GS), psychophysiological (PsyI) and paradoxical (ParI) insomnia sufferers on two consecutive nights. Participants completed three nights of PSG recordings in a sleep laboratory following a clinical evaluation. Participants were 26 PsyI, 20 ParI and 21 GS (mean age = 40 years, SD = 9.4). All sleep cycles of Nights 2 and 3 were retained for PSA. The absolute and relative activity in frequency bands (0.00 to 125.00 Hz) were computed at multiple frontal, central and parietal sites in REM and NREM sleep. Mixed model ANOVAs were performed with absolute and relative PSA data to assess differences between groups and nights. Over the course of the two nights, more absolute delta activity at F3, C3, and P3 was observed in ParI compared with PsyI suggesting deactivation of the left hemisphere in ParI and/or hyperactivation in PsyI. Further analysis on absolute PSA data revealed that differences between groups relate mostly to NREM. In REM, lower relative activity in slower frequency bands was found in ParI in comparison with GS and less relative theta activity was found in PsyI compared with GS implying higher activation in insomnia. In addition, between nights variability has been found in absolute powers of faster frequency bands (beta to omega). Signs of decreased cortical activity in absolute PSA in NREM combined with increased relative cortical activation in REM were found in ParI which might contribute to the misperception of sleep in ParI.     

Temporal dynamics of event‐related potentials related to goal conduciveness and power appraisals

The Component Process Model hypothesizes that appraisal—the mechanism that elicits and differentiates emotion—is processed sequentially. It predicts that the goal conduciveness check (motivational valence evaluation) is evaluated before the power check (evaluation of the degree of power to act on events). To test this prediction, we recorded event‐related potentials (ERPs) during a gambling task in response to feedback that simultaneously presented the goal conduciveness (outcome: win, loss, or break‐even) and the power check (options to act on the outcome) information. In line with the sequence hypothesis, mean amplitudes of subsequent ERPs were differentially modulated by the appraisal information. The feedback‐related negativity was sensitive to the goal conduciveness check, and the P300 yielded main effects of both appraisal checks. Results suggest that neural evaluative processes associated with appraisal processing are sequential.     

Interferon-γ release assays in the diagnosis of active tuberculosis disease in a low-incident setting: a 5-year review of data

The role of interferon-γ release assays in the diagnosis of active tuberculosis disease is uncertain, and recent guidelines do not support their routine use. We reviewed the clinical records of 415 patients who had a QuantiFERON-TB Gold In-Tube assay between 29 June 2005 and 28 October 2010 to determine its performance in the diagnosis of active tuberculosis disease in a low prevalence setting, specifically in human immunodeficiency virus (HIV) -positive and HIV-negative patients, those of UK and non-UK origin, and those with pulmonary and extrapulmonary disease. For the diagnosis of active tuberculosis disease the overall sensitivity of QuantiFERON-TB Gold In-Tube assay was 71.4% (95% CI 59.3–81.1), specificity was 81.0% (95% CI 75.5–85.6) and negative predictive value was 92.6% (95% CI 88.2–95.5). No significant difference in sensitivity was seen in culture-positive and culture-negative tuberculosis, in pulmonary and extrapulmonary disease, or with HIV infection. Specificity and negative predictive value were significantly higher in patients of UK origin compared with those of non-UK origin (89.3% (95% CI 83.3–93.3) and 97.1% (95% CI 92.7–98.9) versus 66.3% (95% CI 55.6–75.5) and 83.3% (95% CI 72.6–90.4)). Our study suggests that there may be a role for interferon-γ release assays in excluding active tuberculosis disease, particularly extrapulmonary disease, in patients originating from areas of low tuberculosis incidence, with a negative test highly predictive of a lack of active tuberculosis disease in this group. We cannot support the use of these assays in the diagnosis of active tuberculosis infection in patients from areas of higher incidence.