侧向拉力螺钉技术治疗髁突囊内矢状骨折

目的　探讨应用侧向拉力螺钉技术治疗髁突囊内矢状骨折的方法与疗效。方法　对11例患者 ( 13侧 )髁突囊内矢状骨折经耳前途径行髁突游离复位 ,用 2颗钛螺钉依照拉力螺钉技术操作规范从外侧固定 ,术后行临床与影像学追踪观察。结果　平均追踪 12个月 ,全部患者疗效满意 ,9例痊愈 ,2例轻微错畸形 ,均无关节症状 ,影像检查 3例有髁突轻微骨质吸收和形态异常。结论　侧向拉力螺钉固定髁突囊内矢状骨折的方法简便可靠 ,疗效确切 ,并发症少     

Screening and Selection of Plants by Positive Pharmacologic Effect on Jejunum Muscular Contractility

Eight medicinal plant extracts (Bidens pilosa Linn, Eysenhardtia polystachya Sarg, Lepidium virginicum L., Litsea glaucescens H.B.K., Mirabilis jalapa Linn., Satureja macrostema Brieq., Sophora secundiflora Lag, and Tagetes micrantha Cav.) were tested for their effect on jejunum muscular contractility. All showed inhibitory activity and extracts of M. jalapa and S. macrostema exhibited highest activity with inhibitory concentrations (IC₅₀) of 18 and 73?µg/mL, respectively. Thus, we could corroborate some common traditional uses afforded to these plants. Flowers (petals, calices, and buds) of M. jalapa were the most active part of the plant. We obtained a semipurified sample of the flowers that was more or less five times more active than the crude extract. Furthermore, β-sitosterol, a compound reported as constitutive of M. jalapa, showed no effect on jejunum contractility.     

Fully threaded sacroiliac lag screws have higher load to failure when compared to partially threaded screws: A biomechanical study

The purpose of this study is to compare biomechanical properties of fully and partially threaded iliosacral screws. We hypothesise that fully threaded screws will have a higher yield force, and less deformation than partially threaded screws following axial loading. Twenty sawbone blocks were uniformly divided to simulate vertical sacral fractures. Ten blocks were affixed with fully threaded iliosacral screws in an over-drilled, lag-by-technique fashion whilst the remaining ten were fixed with partially threaded lag-by-design screws. All screws measured 7.3-mm x 145 mm, and were inserted to a 70% of calculated maximal insertional torque, ensuring uniform screw placement throughout across models. Continuous axial loads were applied to 3 constructs of each type to failure to determine baseline characteristics. Five hundred loading cycles of 500 N at 1 Hz were applied to 4 constructs of each type, and then axially loaded to failure. Force displacement curves, elastic, and plastic deformation of each construct was recorded. Fully threaded constructs had a 428% higher yield force, 61% higher stiffness, 125% higher ultimate force, and 66% lower yield deformation (p < 0.05). The average plastic deformation for partially threaded constructs was 336% higher than fully threaded constructs (p = 0.071), the final elastic deflection was 10% higher (p = 0.248), and the average total movement was 21% higher (p = 0.107). We conclude from this biomechanical study that fully threaded, lag-by-technique iliosacral screws can withstand significantly higher axial loads to failure than partially threaded screws. In addition, fully threaded screws trended towards exhibiting a significantly lower plastic deformation following cyclical loading.     

Chronic pain acceptance and affective well‐being: A coping perspective

This study examined the relationship between chronic pain acceptance and affective well‐being from a coping perspective. One hundred‐fifty patients from a multidisciplinary pain centre provided self‐report data including measures of pain acceptance, positive and negative affect, and accommodative flexibility. The bivariate and multiple correlation patterns were consistent with the assumption that pain willingness (the attitudinal component of pain acceptance including the recognition of the uncontrollability of pain) primarily reduces negative affect, whereas activity engagement (the behavioural component of pain acceptance including the pursuit of life activities despite pain) additionally produces positive affect. The data furthermore suggested activity engagement as a mediating link between pain willingness and positive affect. Moderation analyses showed that accommodative flexibility (the general readiness to adjust personal goals to situational constraints) facilitates both pain willingness and activity engagement – especially when average pain intensity is high. In sum, the results support the view that chronic pain patients’ well‐being is closely tied to the maintenance of life activities which presupposes an accepting attitude towards pain.     

中文简体与繁体引起的眼调节反应和近距离工作致暂时性近视回退的比较

背景近视的流行病学研究发现,中国香港和台湾地区的近视发病率高于中国大陆。中国台湾、香港地区的通用文字为中文繁体字,而大陆使用的则是中文简体字,通用阅读文字的不同是否与近视发生率的差异有关,繁体字和简体字阅读状态是否与近视发生存在关联值得关注。目的检测同种字体随着字号增大所引起调节反应的量和近距离工作导致暂时性近视（NITM）回退水平的变化规律,探讨因中文字构架差异所诱导的调节发生的异同及其内在的关系。方法选取22名受试者,其中男15名,女7名;年龄24～29岁;等效球镜屈光度为＋O．50—-6．00D,平均等效球镜屈光度为（-1．86＋2．34）D。采用快速序列视觉呈现方式（150字／min）（RSVP）软件提供9pt、12pt的中文简体和繁体阅读视标,GRANDSEIKO—WV5500型红外自动验光仪测量受试者的调节反应;受试者配戴全矫等效球镜随机阅读眼前（角膜平面）33cm处计算机显示屏上的中文简体字与繁体字（调节刺激为3D）,字号包括9pt和12pt,在阅读2min时测量调节反应,阅读每种文字10rain测量调节反应,阅读10rain后闭眼休息10s测远用屈光度数,再间隔58、10s继续测远用屈光度数。采用单因素方差分析比较不同字体和不同字号对于调节反应和NITM的影响。结果中文简体与中文繁体引起的调节反应量均表现为调节滞后,滞后量分别为（1．11±0．38）、（0．95±0．43）、（1．18±0．33）、（1．06±0．28）D,其中简体12pt与繁体9pt引起的调节滞后量差异有统计学意义（t=5．56,P=0．02）。4种视标均引起一定的NITM,分别为（-0．45±0．45）、（-0．47±O．46）、（0．45±O．82）、（-0．46＋0．78）D,各视标引起的NITM回退水平的总体差异无统计学意义（F：0．01,P=0．99）。结论短时间阅读简体中文与繁体中文因在调节滞后机制方面存在差异,可能与地区近视发生率的差异有关,而在NITM回退机制上可能与地区近视发生率差异无关。     

儿童远视性弱视眼调节幅度及调节灵活度的研究

目的　比较不同程度远视性弱视眼与正视眼之间调节幅度及调节灵活度的差别.方法　临床病例对照研究.对2009年1～12月在河北大学附属医院眼科门诊能配合检查的远视性弱视儿童50例92只眼,按弱视程度分为中度弱视组(A组),轻度弱视组(B组),弱视治愈组(C组).正常儿童组(对照组)20人40只眼,采用改良移近法测量调节幅度(AMP),正负球镜翻转测量调节灵活度.结果　A组、B组、C组及对照组AMP平均值分别为(13.07±1.72)D、(14.17±1.60)D、(15.55±1.26)D、(16.09±1.11)D,调节灵活度平均值分别为(5.77±2.00)次/分、(5.13±1.67)次/分、(5.06±1.56)次/分、(5.45±2.19)次/分,结果显示A组和B组AMP均分别显著低于C组及对照组(P＜0.05).C组与对照组差异无统计学意义(P =0.247).各组调节灵活度差异无统计学意义(P=0.723).A组及B组中AMP与矫正视力呈正相关(r=0.487,P=0.007),AMP与屈光度无显著相关性(r=-0.236,P=0.218).结论　与同年龄正常眼相比,远视性弱视儿童眼调节幅度降低,调节幅度与弱视程度有显著相关性.调节灵活度差异无统计学意义.     

Increasing response variability in children with autism spectrum disorder using lag schedules of reinforcement

Individuals with autism spectrum disorder (ASD) often present with deficits in variability in responding across multiple repertoires. However, research to date has resulted in little empirical evaluation of remediation strategies for such deficits. We investigated the effects of lag schedules of reinforcement on response variability using a computer-based task designed for the purpose of the study. The U-value statistic was used as a measure of variability in responding to determine if increasing the lag criterion would correspondingly increase levels of variability. Participants included children with ASD (Group 1) and neurotypical children (Group 2). Results showed that U-values were higher when reinforcement was contingent on increased variability, indicating the effectiveness of higher lag values on response variability. A significant difference in response variability between groups provided evidence for the disparity in such responding in children with ASD compared to their neurotypical peers. Group 1 showed consistently lower U-values than Group 2 indicating lower response variability. However, data from this study clearly show that lag schedules of reinforcement may be employed to increase response variability in ASD.     

分叉钢板和拉力螺钉治疗髋臼后壁骨折疗效比较分析

目的：探讨采用分叉钢板和拉力螺钉治疗髋臼后壁骨折临床疗效。方法回顾性分析我院骨科2006年7月至2013年10月收治的髋臼后壁骨折患者87例,其中49例采用分叉钢板治疗的患者为观察组,38例采用拉力螺钉治疗的患者为对照组。通过术后matta评分结果及并发症的比较评定两组的疗效。结果观察组内固定优良率为72．91％,对照组优良率为94．73％,两组差异有统计学意义（χ2＝7．82,P＜0．05）;观察组并发症发生率为33．34％,对照组为13．15％,差异有统计学意义（χ2＝6．76,P＜0．05）。结论采用拉力螺钉的固定效果好且并发症少,有较高的临床推广价值。     

Computed tomographic evaluation of the proximal femur: A predictive classification in displaced femoral neck fracture management

Background:

Femoral neck fracture is truly an enigma due to the high incidence of avascular necrosis and nonunion. Different methods have been described to determine the size of the femoral head fragment, as a small head has been said to be associated with poor outcome and nonunion due to inadequate implant purchase in the proximal fragment. These methods were two dimensional and were affected by radiography techniques, therefore did not determine true head size. Computed tomography (CT) is an important option to measure true head size as images can be obtained in three dimensions. Henceforth, we subjected patients to CT scan of hip in cases with displaced fracture neck of femur. The study aims to define the term small head or inadequate size femoral head” objectively for its prognostic significance.

Materials and Methods:

70 cases of displaced femoral neck fractures underwent CT scan preoperatively for proximal femoral geometric measurements of both hips. Dual energy X-ray absorptiometry scan was done in all cases. Patients were treated with either intertrochanteric osteotomy or lag screw osteosynthesis based on the size of the head fragment on plain radiographs.

Results:

The average femoral head fragment volume was 57 cu cm (range 28.3-84.91 cu cm; standard deviation 14 cu cm). Proximal fragment volume of >43 cu cm was termed adequate size (type I) and of ≤43 cu cm as small femoral head (type II). Fractures which united (n = 54) had a relatively large average head size (59 cu cm) when compared to fractures that did not (n = 16), which had a small average head size (49 cu cm) and this difference was statistically significant. In type I fractures union rate was comparable in both osteotomy and lag screw groups (P > 0.05). Lag screw fixation failed invariably, while osteotomy showed good results in type II fractures (P < 0.05).

Conclusion:

Computed tomography scan of the proximal femur is advisable for measuring true size of head fragment. An objective classification based on the femoral head size (type I and type II) is proposed. Osteosynthesis should be the preferred method of treatment in type I and osteotomy or prosthetic replacement is the method of choice for type II femoral neck fractures.