手术治疗肩锁关节脱位38例分析

目的探讨重度肩锁关节脱位的手术治疗方法.方法对38例重度肩锁关节脱位采用交叉克氏针加喙锁关节的肌腱线固定术.结果按照Karl sson的术后疗效评价标准,优(A级)35例,良(B级)3例.结论交叉克氏针加喙锁关节的肌腱线固定术,使肩锁关节获得牢固的固定,术后功能恢复满意,是治疗重度肩锁关节脱位的有效手术方法.     

Association between prenatal dietary methyl mercury exposure and developmental outcomes on acquisition of articulatory-phonologic skills in children in the Republic of Seychelles

Methyl mercury (MeHg) is a neurotoxicant that with sufficient exposure can seriously impair the central nervous system and cause mental retardation, cerebral palsy, and neuromotor dysfunction. The level of exposure needed to adversely affect the nervous system is unknown. Human exposure to low levels of MeHg is common from consumption of fish. We examined the relationship between MeHg exposure and development of articulatory-phonologic speech skills in children whose mothers consumed a diet high in fish during pregnancy to determine whether any adverse associations could be detected. A total of 544 children from the Republic of Seychelles were given a speech assessment when they were 66 months of age. Exposure level was determined by measuring MeHg in maternal hair growing during pregnancy. No adverse associations between articulatory- phonologic speech skills and prenatal MeHg exposure were detected. The findings of this investigation are compatible with previous developmental assessments of Seychellois children that have indicated no adverse effects of prenatal MeHg exposure from fish consumption.     

Designs and decisions: The creation of informal measures for assessing speech production in children

Abstract

Speech-language pathologists (SLPs) frequently assess children's speech to diagnose and identify areas of difficulty, then determine appropriate intervention goals. Formal measures are available for assessment; however, many SLPs use informal measures within clinical practice. The purpose of this two-part mixed methods study was to describe informal measures created to assess children's speech. Study 1 involved a systematic review of 39 informal measures identified via journal database and internet searches, scanning of reference lists, and submission by SLPs and researchers. The measures were reviewed in terms of their conceptualization (content and format) and operationalization (evaluation and validation). Common conceptual features included assessment of consonant singletons, single words, computer format, and picture-naming. Few measures provided information addressing operational criteria; in particular, they lacked evaluation of their effectiveness. Study 2 involved an inductive thematic analysis of journal entries from eight creators of informal measures that explored key considerations in the development process. Informal measures were created due to the absence of measures which were sufficiently comprehensive and culturally appropriate, plus a desire to incorporate technology. Considerations in the creation of informal measures included sourcing research and existing measures to inform the measures’ development, maximizing children's engagement, and utility. SLPs must be cautious when using informal measures due to their lack of operationalization. However, these measures often address SLPs’ needs and so operationalization of informal measures would be beneficial for the profession.     

AO锁骨钩钢板治疗肩锁关节脱位和锁骨远端骨折的疗效评价

目的比较AO锁骨钩钢板与传统手术治疗TossyⅢ型肩锁关节脱位和NeerⅡ型锁骨远端骨折的临床疗效。方法将我院1990年10月~2005年10月期间治疗的TossyⅢ型肩锁关节脱位和NeerⅡ型锁骨远端骨折130例,分为锁骨钩钢板治疗组（A组,56例）与传统手术（克氏针或联合张力带、螺钉固定等）治疗组（B组,74例）;A组再分为喙锁韧带、喙肩韧带修复组（A1组,30例）和未修复组（A2组,26例）。按照Herscovici标准,观察各组疗效及并发症,分别比较各分组组间疗效的优良率。结果A组与B组优良率分别为94.6%和86.5%;A1组与A2组优良率分别为93.3%和96.2%,A组与B组差异有统计学意义（P〈0.05）,A1组与A2组差异无统计学意义。结论AO锁骨钩钢板治疗肩锁关节脱位和锁骨远端骨折,固定确切,创伤小,不损伤关节面,可早期行功能锻炼,无需刻意修复喙锁韧带、喙肩韧带。     

Lumbar stiffness but not thoracic radiographic changes relate to alteration of lung function tests in ankylosing spondylitis

Involvement of the costovertebral (CV) and costotransverse (CT) as well as the sacroiliac (SI) joints is known to occur in patients with ankylosing spondylitis (AS). The functional significance of these changes is not clear. We have performed clinical and radiological evaluations and assessed the effect of joint involvement on pulmonary function. We detected radiologic evidence of involvement of the CV joint in 80% of patients and of the CT joint in 60 %. We found a direct relation between the severity of CV, CT and SI joint affliction, and the severity of CV and SI joints were related to time of evolution of the disease. Pulmonary function tests revealed neither restrictive nor obstructive defects. No relation was found between pulmonary function and CV and CT joint affliction. Patients with stiffer spines had a tendency to have pulmonary function tests within the lower limit of the normal range. In patients with AS diaphragmatic breathing might compensate the chest respiration to some extent. Received: 2 July 2001 / Accepted: 1 January 2002     

极重度聋儿声母发音清晰度的状况分析

[目的]通过分析极重度聋儿声母获得情况及易出现的错误,提出针对性的临床言语康复矫治方案和发音训练建议,为提高聋儿的语音获得、言语清晰度,更科学地开展语训工作提供一定依据. [方法]采用三级人员评估法对杭州聋儿康复中心的12名平均年龄7岁且佩戴助听器的无器质性构音障碍、无智力障碍的极重度聋儿进行声母发音清晰度测试.[结果]被试聋儿最先掌握的声母为/b.d.m.n.1/等,其次为/j.zh.sh.r/等,较差的是/c.ch.k/.7岁极重度聋儿的言语康复等级为三级,所达到的语言年龄为3岁.[结论] 以发音方法对声母进行分析,边音正确率最高,塞音送气音正确率低.以发音部位分析,唇齿音正确率最高,舌根音正确率低.声母的替代、缺失错误较多.     

Dissociation of the metal inlay from the polyethylene liner in an uncemented threaded cup

We describe a case of spontaneous dissociation of the metal inlay from the polyethylene cup of a sandwiched metal-on-metal total hip prosthesis manufactured from Co-28Cr-6Mo SM 21 alloy. The patient, a 51-year-old active woman, started to feel groin pain 50 months postoperatively. The pain progressed after a slight trauma and led to final revision after 66 months in situ. No signs of impingement were observed. The polyethylene cup showed an approximately 2 mm-deep groove in the superior wall, and the head was heavily worn on the lateral side. In addition to the typically observed abrasive wear patterns, several types of severe wear defects were noticed. Extensive metallosis and necrosis were observed histologically. This unusual case of substantial deformation of the head and the cup was presumed to have occurred as a result of the increased friction and consequent high wear of the metal head.     

Nasalance,nasality, voice,and articulation after uvulopalatopharyngoplasty

OBJECTIVES/HYPOTHESIS: The main purpose of the study was to determine the impact of uvulopalatopharyngoplasty (UPPP) on nasalance and nasality. It was hypothesized that nasalance would change from the presurgical to the postsurgical condition because the surgical protocol involves removal of palatal tissue. An additional objective of the study was to provide objective and subjective data about changes in voice and articulation after UPPP. Because the surgical procedure of UPPP does not involve laryngeal tissue, it was hypothesized that the voice characteristics remain relatively stable. Because of removal of effective velar length, articulation problems of the uvular /R/ can occur in the Dutch language. STUDY DESIGN: Prospective study in which 26 men were studied before (1 week before UPPP) and after (3 weeks after UPPP) surgery. METHODS: The Nasometer was used to obtain nasalance scores. The mirror-fogging test, a perceptual evaluation of each subject's readings, and the Gutzmann and the Bzoch hypernasality tests were used for the assessment of nasality. For the assessment of articulation, a phonetic analysis was performed. Voice assessment included a perceptual rating of the voice and a determination of fundamental frequency. RESULTS: No significant differences were found between the conditions before and after surgery regarding nasalance (except for the vowel /i/), nasality, and voice. Regarding articulation, only 1 patient showed a derhotacized /R/. CONCLUSIONS: The findings of the study indicate that UPPP does not have an impact on nasality, voice, and articulation. Regarding nasalance, no significant nasalance change occurred after UPPP, except for the high vowel /i/.