单切口配合拉力螺钉技术在复杂髋臼骨折中的应用

目的:评价单切口配合拉力螺钉技术在复杂髋臼骨折中的应用。方法:2004年2月～2010年3月,收治31例复杂髋臼骨折患者。按Letournel的分类方法,双柱骨折19例,T形骨折8例,前方伴后方半横行4例。病例中21例行髂腹股沟入路,10例行Kocher-Langenbeck入路。结果:按Matta标准评价髋臼复位质量:解剖复位9例,满意复位16例,不满意复位6例,优良率80.6%。髋关节功能参照改良的Merled,Aubigne标准:优8例,良15例,可3例,差5例,优良率74.2%。并发症:坐骨神经损伤2例、创伤性关节炎2例、异位骨化2例,股动脉血栓1例。结论:单切口配合拉力螺钉技术创伤相对较小,固定满意,在处理复杂髋臼骨折中是一种可行的方法。     

耻骨上支髓内螺钉固定的应用解剖学研究

目的研究耻骨上支的解剖学基础,为耻骨上支髓内螺钉固定提供参数。方法取半骨盆标本30个,用游标卡尺依次测量骨盆的外径、内径、矢状径,耻骨上支上下径及前后径,同时沿耻骨上支长轴以层距1mm作螺旋CT横断面扫描,确定最小横断面的上下径及前后径为可打入螺钉的最大安全直径。耻骨结节内缘进针点为A点,置入直径为2mm的克氏针,髋臼外上缘出针点为B点,测量A8的距离、克氏针与矢状面和横断面的角度、B点至坐骨大切迹外上缘（C点）的距离。AB距离为耻骨上支螺钉钉道的长度。置钉后进行CR拍片及螺旋CT扫描,应用图像处理软件进行分析,观察钉道与髋臼及盆腔的关系。结果耻骨上支前后径及匕下径游标卡尺测量值与螺旋CT影像学测量值比较差异均无统计学意义（P〈0.05）,耻骨上支的最细部位在髋臼内侧壁内缘处,即髂耻粗隆内侧,该截面为近似为水滴状。AB距离左侧骨盆为（118．3±1.22）mm,右侧骨盆为（117．9±1.36）mm;BC左侧为（36．63±1．43）mm,右侧为（37.21±1．21）mm.最佳置钉点在耻骨结节内侧缘,克氏针与躯体矢状面成角40（°）～45（°）,与横断面成角20（°）～35（°）。顺行置钉角度与逆行置钉角度相反,但是数值相同。螺钉的安全直径可达72mm,最大长度可达110．0mm。结论临床应用耻骨上支髓内钉内固定是可行的,术前一定要进行螺旋CT虚拟置钉评估,置钉点和置钉角度要有个体化差异。     

应用MIMICS软件对髋臼后柱顺行螺钉骨性通道参数的测量

目的 运用MIMICS软件重建骨盆3D模型,研究髋臼后柱骨性结构,测量髋臼后柱顺行拉力螺钉骨性通道参数,为临床安全置入髋臼后柱螺钉提供理论依据。方法 随机收集2017年1月~12月我院CT 室健康成人的完整骨盆图像数据30例,男女各15例,应用Mimics软件重建骨盆3D模型。以坐骨结节为出钉点在髋臼后柱顺行置入虚拟螺钉,测量后柱顺行拉力螺钉骨性通道安全区的参数,比较各个参数在不同性别间的差异。结果 螺钉 AB及AC的长度、与矢状面夹角及与冠状面夹角在不同性别之间比较,差异有统计学意义（P＜0.05）。螺钉 AD的长度、与矢状面夹角在不同性别之间比较,差异有统计学意义（P＜0.05）;螺钉 AD的长度与冠状面的夹角在不同性别之间比较,差异无统计学意义（P＞0.05）。结论 在髋臼后柱存在一个近似“四面体”的安全骨性通道,安全入钉点区域呈“三角形”。在安全骨性通道内置入6.5 mm的拉力螺钉在矢状面及冠状面可以有一定的调整角度。利用MIMICS软件有助于髋臼后柱拉力螺钉骨性通道的解剖学研究,为临床安全置钉提供理论依据。     

可调节人工晶状体预留度数设计的临床观察

Objective To observe the vision circumstance and the change of accommodation after implantation of preserved degrees of accommodative intraocular lens. Methods Thirty cases (60 eyes) were implanted with accommodative intraocular lens, among which the SRKT for the research group, 15 cases (30 eyes), was theoretically over-corrected 0.5D in the major visual eyes and over 1.0D in the minor visual eyes; the SRKT for the control group, 15 cases (30 eyes) randomly chosen, was equal to the theoretical value for both the major and minor visual eyes. After the implantation, follow-up visits were above 3 months to observe the distant vision, near vision, optimal corrected distant and near visions, to determine the accommodation by objective and subjective methods and to test the combined distant and near visions of both eyes. Results In the research group, the diopter (D) of the major and minor visual eyes was 0.512±0.15 and 1.13± 0.12 respectively.The distant visions of the naked major visual eyes and the optimal corrected distant visions of the research and the control groups were 0.89± 0.11 and 0.91± 0.12, 0.97± 0.23 and 0.99± 0.14 respectively, exerting no significant difference. The 33 cm near visions of the major visual eyes and the optimal corrected near visions of the major visual eyes were 0.63± 0.16 and 0.48± 0.23, 0.97±0.25 and 0.86± 0.14, exerting significant difference. The optimal corrected near visions of the minor visual eyes are 0.99± 0.15 and 0.89± 0.14, having significant difference. For the accommodation (D) of two groups by the subjective method, it was 3.35± 0.71 and 3.27± 1.32 respectively without significant difference; while by the objective method, it was 0.38± 0.12 and 0.37±0.08 without significant difference. The distant vision of the combined eyes of two groups was 0.99±0.11 and 0.98± 0.21, exerting no significant difference. The near vision of the combined eyes of two groups was 0.91± 0.20 and 0.61± 0.17, exerting very significant difference. Conclusions There is no significant difference of implanting preserved degrees of accommodative intraocular lens on aspects of major visual eye's distant vision, optimal corrected vision, and distant vision of combined two eyes. As for 33 cm near vision and the optimal corrected near vision of the major and minor eyes, they both have significant difference. There is very significant difference on the near vision of the combined two eyes. To preserve some certain degrees of the accommodative intraocular lens on the basis of self-adjustment can obviously improve the visual function of the near vision.     

Changes in dynamics of accommodation after accommodative facility training in myopes and emmetropes

This study evaluates the effect of accommodative facility training in myopes and emmetropes. Monocular accommodative facility was measured in nine myopes and nine emmetropes for distance and near. Subjective facility was recorded with automated flippers and objective measurements were simultaneously taken with a PowerRefractor. Accommodative facility training (a sequence of 5 min monocular right eye, 5 min monocular left eye, 5 min binocular) was given on three consecutive days and facility was re-assessed on the fifth day. The results showed that training improved the facility rate in both groups. The improvement in facility rates were linked to the time constants and peak velocity of accommodation. Some changes in amplitude seen in emmetropes indicate an improvement in facility rate at the expense of an accurate accommodation response.     

两种拟调节型人工晶状体植入术后视功能对比分析

目的 比较超声乳化术后植入可调节人工晶状体和多焦点人工晶状体的视功能.方法 30例白内障患者按自愿原则,采用非随机对照方式分成两组,试验组①10例患者(10只眼)植入Tetraflex可调节人工晶状体.试验组②20例患者(30只眼)植入+3.0D ReSTOR多焦点人工晶状体.术后6个月以ETDRS视力表检测患者最佳矫正远视力及在最佳矫正远视力基础上获得的近视力、中距离视力,综合验光仪检测近点及调节幅度.结果 随访期间所有患者均无明显的术后并发症.试验组①最佳矫正远视力为(-0.21±0.06)LogMAR,近视力为J3/40cm,试验组②为(-0.23±0.09)LogMAR,近视力为J1/35cm,两组比较近视力差异有统计学意义(P=0.035).试验组①术后主观近点为(39±10)cm,试验组②为(35±9)cm,两组比较差异无统计学意义(P=0.80).试验组①术后调节幅度为(1.94±0.13)D,试验组②为(2.08±0.63)D,两组比较差异有统计学意义(P=0.048).结论 可调节人工晶状体与多焦点人工晶状体植入术后均可使患者的视近困难得以改善.医生应根据患者情况为其选择合适的人工晶状体.

Abstract：

Objective To compare the visual performance of accommodative IOLS and that of multifocal IOLs implantation after phacoemulsification. Methods A total of 40 eyes from 30 patients undergoing phacoemulsification received intraocular lens based on the principle of voluntary. Ten eyes from 20 patients who had implantation of Tetraflex accommodative intraocular lens were randomized into group 1. Thirty eyes from 20 patients who had implantation of +3.0 aspheric ReSTOR multifocal intraocular lens were randomized into group 2. Main outcome measures included best corrected distance visual acuity, distance corrected near vision, near point, intermediate vision, and the accommodation amplitude. All the clinical data were obtained at 6months postoperatively. Results No patients had undergone any complications. At 6 months postoperatively,best corrected distance visual acuity were similar between the groupl and group2 (-0.23± 0.09LogMAR versus-0.14 ± 0.08LogMAR, P =0.085). Distance corrected near vision were similar between the two groups (J3/40cm versusJ1/35cm, P =0.035). Subjective near point were similar between the two groups [(39± 10) cm versus (35± 9) cm F=0.065, P=0.80]. The accommodation amplitude were similar between the two groups [(1.94± 0.13)D versus (2.08± 0.63)D, P =0.093]. The defocus line showed a double-peak in group 2 and single peak in group 1 which declined at intermediate distance. Conclusions Both accommodative IOLs and multifocal IOLs can correct presbyopia effectively after operation. It is best to prefer the proper IOLs for patients.     

广州市炎热指数对早产滞后效应的时间序列分析

目的了解广州市炎热指数对早产的滞后效应。方法以广州市白云区、越秀区2004年1月1日至2011年12月31日间分娩的产妇为研究对象,符合纳入标准的共293 849人,其中发生早产者22 702例。收集该时期产妇分娩数据、气象资料和空气污染物数据。采用分布滞后非线性模型,以广州市年均炎热指数为参照,建立炎热指数在滞后0~20 d内对逐日早产例数的回归模型,分析产妇暴露于不同炎热指数后0~20 d内发生早产的相对危险度。结果研究期间广州市白云区、越秀区的早产发生率为7.70%;炎热指数波动区间为45~136℉,年均炎热指数为(101±20)℉,以炎热指数101℉为参照,炎热指数升高20℉时,滞后第5~7日的早产发生危险性升高,其中第6日风险最高(RR=1.014,95%CI:1.005~1.023);第10~12日、19日的早产发生危险性降低,其中第19日风险最低(RR=0.985,95%CI:0.974~0.997)。炎热指数降低20℉时,滞后第5~7日的早产发生危险性降低,其中第6日风险最低(RR=0.986,95%CI:0.978~0.995);第10~12日、19日的早产发生危险性升高,其中第19日风险最高(RR=1.015,95%CI:1.003~1.027)。结论广州市炎热指数对早产的发生呈非线性滞后影响。炎热指数升高时,早产相对危险度先增加后降低;炎热指数降低时,早产相对危险度先降低后增加。     

In situ contouring of cranial bone grafts

Summary A technique of in situ contouring of cranial bone grafts after fixation to the recipient site is presented. This technique has evolved from increasing experience with miniplate fixation in the craniofacial skeleton. This method is particularly quick and useful in onlay augmentation of supraorbital, infraorbital, malar and lateral orbital rim recession regardless of etiology.     

双柱拉力螺钉固定治疗横断髋臼骨折

目的　回顾分析双柱拉力螺钉固定治疗横断髋臼骨折的疗效。方法　 1 3例髋臼横断骨折分别采用Smith Peterson入路或者后外侧K -L入路结合前侧髂腹股沟入路行切开复位 ,前后柱拉力螺钉沿其功能轴固定。术后平均随访 4年 2个月 ,按照美国矫形外科医师协会 (AAOS)标准评估患髋功能。结果　 1 3例中 1 2例获解剖复位 ,1例复位欠佳。术中、术后无严重并发症。患髋术后功能优良率为 85 %。结论　双柱拉力螺钉固定技术是一种治疗髋臼横断骨折的有效方法 ,但技术要求较高 ,应严格掌握手术适应证     

双眼分光同时视装置在AC/A测定中的应用

目的 :探索一种可用于临床测试的简便可行的双眼分光同时视装置 ,评价这种装置在AC/A测定中的应用。方法 :自制分光式验光镜架和双眼分光同时视装置 ,作 2 3只正视眼AC/A的测量 ;同时运用直接法、同视机法作AC/A测定 ,运用直接法作AC/A测定时一并作 1/ 3米反应调节的测定。结果 :①双眼分光同时视法测定所得AC/A高于直接法 ,而直接法所得AC/A高于同视机法 ,三者差别有意义 (F =8.15 ,P <0 .0 5 ) ;②直接法 1/ 3米反应调节不等同于刺激调节。结论 :双眼分光同时视装置是一种可靠而又简便可行的AC/A测定装置 ;直接法所采用的刺激性调节可能不可靠