The Impact of COVID-19 on Future Orthopaedic Practice

No single event hitherto has stumped the world more significantly than the present Corona pandemic. In a short span of a few months, the world economy, healthcare, livelihood, and human survival have been direly threatened by the rapid increase in the number of COVID-19 cases and fatalities. While dispensations across the world are finding ways to tackle the pestilence, the medical fraternity faces a unique conundrum. On the one side, the health care team is at the forefront fighting the disease and saving patients from the grip of death. On the other side, the healthcare industry is facing a crisis in terms of safety of healthcare personnel, difficulties in online tele-healthcare, economic sustainability, challenges in healthcare education and other problems in safe health care delivery. The authors provide a broad perspective at the current pandemic and its implications on orthopaedic practice in the near future.     

外科导航技术在创伤骨科的应用

随着计算机及图像技术的迅猛发展,我们可借助计算机进行越来越多的外科手术。尤其在创伤骨科,医生可借助术前或术中所获得的影像进行骨折复位与固定。影像的来源可包括CT图像、术中实时透视图像或内窥镜影像。在临床实践中结合使用计算机和其它信息技术将无疑是未来的发展趋势。在这期的《中华创伤骨科杂志》专刊中我们将着重介绍外科导航技术在创伤骨科的应用。     

Current concepts on functional appliances and mandibular growth stimulation

The mode of action of functional appliances, particularly in relation to stimulating mandibular growth, is a controversial subject. Many of the reports concerning growth effects of functional appliances have been characterized by poor methodology. In assessing functional appliances, results from prospective randomized clinical trials should be given prominence. On the basis of available evidence, it cannot be concluded that functional appliances are effective in stimulating and increasing mandibular growth in the long term. Although favourable growth changes have been reported following phase 1 therapy, they are generally not substantial and long term stability appears to be poor.     

骨科抗生素应用情况调查分析

目的:了解骨科抗生素的使用情况,提高医院合理用药水平。方法:随机抽取2006年6月骨科病历153份,通过统计骨折部位、抗生素用药品种、使用时间、联合用药等情况分析抗生素使用的合理性。结果:153份病历中使用至少1种抗生素的病历有152份,抗生素使用率达99.35%,所应用的主要药品集中在头孢哌酮钠/舒巴坦钠、甲硝唑、洛美沙星、头孢噻肟钠等几个品种,联合用药99例,占63.94%,仍存在术前过早用药,术后用药时间过长、高起点等不合理现象。结论:骨科抗生素使用存在不合理现象,医院应加大监管力度,规范用药,提高医院整体用药水平。     

骨保护素及其配体在牙正畸中作用的研究进展

骨保护素(OPG)是生理性的抑制破骨细胞性骨吸收的因子,而骨保护素配体(OPGL)是能直接诱导破骨细胞分化发育并参与破骨细胞功能调节的细胞因子。牙周膜细胞可表达OPG和OPGL,揭示了在正畸牙移动中,牙周膜细胞可能是通过OPG/OPGL系统来调节牙槽骨代谢的。OPG和OPGL在多种骨病和牙正畸的治疗中具有很大潜力,具有良好的临床应用前景。     

骨科患者伤口分泌物病原菌分布及药敏277例分析

[目的]分析骨科患者伤口分泌物病原菌分布及药敏试验,为骨科临床医生合理治疗及控制医院感染提供依据。[方法]将2009年1月至2013年12月我院277例门诊和住院骨科患者的伤口分泌物标本接种于血平板、巧克力平板,按《全国临床检验操作规程》3版要求分离纯菌,用法国生物梅里埃公司API鉴定和K-B法做药敏试验。[结果]185株伤口分泌物病原菌中检出前5位的病原菌是阴沟肠杆菌36株占19.5%,金黄色葡萄球菌32株占17.3%,表皮葡萄球菌29株占15.7%,大肠埃希菌26株占14.1%,铜绿假单胞菌20株占10.8%。大肠埃希菌26株,产ESBLs阳性占26.9%（7/26株）,主要革兰阴性杆菌对氨苄西林和头孢唑林的耐药率最高;未发现革兰氏阴性杆菌对头孢哌酮/舒巴坦和亚胺培南耐药。耐甲氧西林金黄色葡萄球菌检出率为21.9%,耐甲氧西林表皮葡萄球菌检出率为20.7%,且对青霉素的耐药率较高,未发现耐万古霉素的葡萄球菌。[结论]阴沟肠杆菌和金黄色葡萄球菌是创伤患者伤口优势菌种,而且细菌耐药性高;临床医生应合理制定治疗方案,选择使用有效的抗菌药物。     

Orthopaedic issues in sports for persons with haemophilia

Summary.  Persons with haemophilia should not feel limited in their ability to participate in sports. After consultation with a physician or other health-care provider and with a proper understanding of the risks involved and the strategies for managing these risks, patients with haemophilia can – and should – enjoy physical activities. We have analysed numerous reports of sports injury statistics and used them to rank a variety of sports according to their degree of injury risk. In addition, we have developed a brief orthopaedic examination and a five-item fitness check that evaluates the level of physical fitness of patients with haemophilia. Using these tools, we can appropriately recommend specific sports activities best suited for each patient. In addition, we recommend that patients who regularly participate in sports maintain adequate levels of clotting factor through the use of regular prophylaxis. With proper physical evaluation and preparation, patients with haemophilia can realize the physical and emotional benefits of participation in sports.     

影响血液流变学检测的护理相关因素分析及对策

目的探讨影响血液流变学检测检验误差的护理相关因素。方法将60例骨科患者随机分为三组各20例,第1组分别采集3管血标本,于1h内检测;第2组分别采集4管血标本,15℃下放置1、4、8、24h后检测;第3组用成人血压袖带束缚左右两臂,分别空气加压至40、110mmHg后采集血标本,于1h内检测。结果全血切变率、血浆黏度检测结果比较,第1组第3管显著高于第1管;第2组放置8、24h显著高于1h;第3组110mmHg束臂压力显著高于40mmHg(P<0.05,P<0.01)。结论血液流变检测结果受采样顺序、时间,束臂压力因素影响;建议采集多管标本时首先采集血液流变学,于4h内检测,止血带压力不宜过大。