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.     

髋部定量CT骨密度与髋螺钉置入位置分析

目的对髋部不同空间位置骨松质作定量CT骨密度测定,从骨密度的角度来分析内固定手术治疗老年股骨粗隆间骨折时髋螺钉的合理安放位置。方法选择年龄大于60岁的老年妇女共66例行双侧髋部CT扫描,其中股骨粗隆间骨折35例（骨折组）,无骨折的正常老年妇女31例（对照组）。测定从髋螺钉入口到股骨头的CT值。同时对股骨头内密度较高的压力骨小梁（PCT）及其内、外、前、后侧5个区域的骨松质作定量CT骨密度测定。结果骨折组从髋螺钉人口内侧到股骨头下区域的CT值为负值。骨折组PCT及其内、外、前、后侧的定量CT骨密度分别为（229．71±55．58）、（64．58±25．31）、（39．50±22．56）、（79．85±24．89）、（79．08±19．99）mg／cm^3,而对照组分别为（296．36±40．48）、（85．31±26．99）、（69．49±20．88）、（99．96±27．62）、（98．57±29．38）mg/cm^3。两组PCT的骨密度均明显高于其周围4个区域,差异有统计学意义（P〈0．01）。两组间比较,骨折组5个区域骨密度均明显低于对照组,差异有统计学意义（P〈0．01）。结论从骨密度角度来讲,自髋螺钉人口到股骨头下这一区域的组织密度低于软组织密度,对置入的髋螺钉无锚定力量。PCT是髋部密度最高的骨松质,对髋螺钉锚定起主要作用。在股骨头的外上、前方和后方3个区域内,骨松质的密度远低于压力骨小梁,为髋螺钉发生切割的危险区。老年人存在严重的骨小梁退变,因此正确放置髋螺钉尤其重要。     

伸膝迟滞测量评价骨关节炎患者伸膝装置功能系统的应用价值

背景：伸膝迟滞是伸膝装置系统的病变或其他原因引起的主动完全伸膝表现延迟的现象。对于伸膝迟滞的检查和测量，临床上通常采用目测的方法进行。 目的：通过对骨关节炎患者伸膝迟滞情况进行测量，评估其伸膝装置系统的功能。 设计、时间及地点：对比观察，于2004-10/2005-03在北京协和医院完成。 对象：选择在北京协和医院就诊的人工全膝关节置换围手术期的膝关节骨关节炎患者47例，共66患膝，所有患者对治疗及试验方案均知情同意。 方法：通过目测法和Cybex NormTM770系统检查测试。根据测量方法，将患者分为3组。应用目测法观察明显伸膝迟滞的患者18例36膝设为目测组；目测法观察无伸膝迟滞，应用Cybex NormTM770系统检测出伸膝迟滞的患者22例23膝设为Cybex系统组；应用目测法观察以及通过Cybex NormTM770系统均未检出伸膝迟滞的患者7例7膝设为无伸膝迟滞组。由同一位临床医生分别为每位患者填写手术前膝关节HSS评分表，并记录术后下地时间和术后出院时间。 主要观察指标：平均伸膝迟滞的角度、平均伸膝装置的扭力、膝关节HSS评分的平均值、术后下地时间及术后出院时间。 结果：47例患者的66个膝关节全部施行人工全膝关节置换治疗，置换后无并发症、合并症出现。手术切口均为一期愈合。3组患者的平均伸膝迟滞角度与HSS评分比较差异具有显著性意义(P < 0.05)。目测组及Cybex系统组患者的平均伸膝迟滞角度、平均膝关节屈/伸肌力比值及术后平均下地时间差异具有显著性意义(P < 0.05)。 结论：与目测法相比，Cybex NormTM770测量系统可以获得在临床检查中表现不明显的伸膝迟滞症状学诊断。在骨关节炎患者的人工全膝关节置换围手术期，应用伸膝迟滞测量评价伸膝装置的功能状态，及时对症治疗，有助于恢复膝关节功能。     

Mortality effects of average education in current and earlier municipality of residence among internal migrants, net of their own education

Many researchers have shown an association between a person's health or mortality and the socio-economic resources in the community, net of the person's own resources. The focus has typically been on the current community of residence or one where the person lived a few years earlier. Only a few authors have tried to establish whether there is an additional effect of earlier community exposures, and they have not made a distinction between migrants and non-migrants, which there are good reasons to do. The results from these earlier investigations have been rather mixed. In the present study, a discrete-time hazard model for mortality between ages of 60–89 over the period 1991–2002 was estimated from register data that included the entire Norwegian population. For each person, and for each of these years, municipalities of residence during the previous 20 years were known. There was also information on each person's educational level. For the relevant years and each of the 433 municipalities, measures of average education in the population were constructed by aggregating over the individual data. The analysis was focused on the subgroup who had moved across a municipality border only once during the previous 20 years, among whom there were 29,843 deaths during 839,113 person-years of follow-up. The population sizes of the municipalities were included as control variables. Among those who had moved within the last 10 years, the current socio-economic context was not important for mortality. The earlier context had an effect, but this was restricted to men. Those who had lived longer in the current municipality of residence were influenced only by the average education in that municipality. The findings support the idea that neighbourhood socio-economic effects need some time to build up, and that they do not dissipate soon after the person has moved to a new environment.     

Risk evaluation of impurities in topical excipients: The acetol case

Pharmaceutical excipients for topical use may contain impurities, which are often neglected from a toxicity qualification viewpoint. The possible impurities in the most frequently used topical excipients were evaluated in-silico for their toxicity hazard. Acetol, an impurity likely present in different topical pharmaceutical excipients such as propylene glycol and glycerol, was withheld for the evaluation of its health risk after dermal exposure.An ex-vivo in-vitro permeation study using human skin in a Franz Diffusion Cell set-up and GC as quantification methodology showed a significant skin penetration with an overall K_p value of 1.82×10⁻³ cm/h. Using these data, limit specifications after application of a dermal pharmaceutical product were estimated. Based on the TTC approach of Cramer class I substances, i.e. 1800 µg/(day∙person), the toxicity-qualified specification limits of acetol in topical excipients were calculated to be 90 µg/mL and 180 µg/mL for propylene glycol and glycerol, respectively.It is concluded that setting specification limits for impurities within a quality-by-design approach requires a case-by-case evaluation as demonstrated here with acetol.     

个体化验光配镜治疗屈光不正性调节性视疲劳的疗效观察

目的观察个体化验光配镜治疗因屈光不正造成调节性视疲劳的临床疗效。方法对视疲劳患者108例（210只眼）,采用个体化验光配镜的方法进行治疗。包括客观、主观验光,结合患者的症状、年龄、调节检查、心理需求、工作性质、用眼习惯等。结果治愈90例176只眼（83.3%）,有效15例28只眼（13.9%）,无效3例6只眼（2.8%）,总有效率97.2%。结论个体化验光配镜治疗屈光不正造成的调节性视疲劳效果显著,具有良好的眼保健作用,能有效缓解患者心理、精神上的痛苦,提升视觉质量和生活质量。     

Effects of visual disorders on the academic achievement of French secondary school students

PurposeThis study aimed to determine the relationship between the presence of visual problems and academic success, in a population of students aged 15–22 years.MethodsThis was a prospective, nonrandomized study involving clinical testing and structured interviews. At recruitment (September 2012 to April 2013), participants were asked to answer a questionnaire consisting of 28 questions aiming to identify symptoms commonly related to visual disorders. Each question was graded from 0 (no symptoms) to 2 (frequent). This questionnaire was followed by a visual screening including binocular function. If a problem was identified, participants were referred to an ophthalmologist for a comprehensive examination and an orthoptic work-up (September 2012 to June 2013). Participants returned in September 2013 for a follow-up. The findings were analyzed regarding academic grades and the scores obtained during national examinations in June 2014.ResultsMany participants in this study had visual disorders and the presence of these disorders was not associated with the expression of visual discomfort: 24.3% of participants expressed visual discomfort while 86.5% had visual disorders. More than half of the participants had hyperopia often associated with binocular vision problems, which they were not aware of because both their distance and near visual acuity were good.ConclusionAlthough the results of this study cannot be extrapolated to all young people aged 15–22 years, the study confirms the link between visual problems and academic achievement while emphasizing the high prevalence of such problems in the population studied.     

Clinical evaluation of accommodative intraocular lens implantation in high myopic eyes

PURPOSE: To compare the clinical outcome of AT-45 implantation between high myopic eyes and non-high myopic eyes. METHODS: Retrospective, non-randomized, comparative trial. The medical charts of 28 patients with 35 eyes who had phacoemulsification and AT-45 implantation were retrospectively reviewed. 13 eyes of 10 patients were included in the high myopic group (axial length > or = 26.0 mm) and 22 eyes of 18 patients were included in the non-high myopic group. The clinical data included unilateral best-corrected visual acuity (BCVA) and distance-corrected near visual acuity (DCNVA) at 6 months follow-up after the surgery. The results were compared between the two groups. RESULTS: In the non-high myopic group, 22 eyes (100%) and 19 eyes (86.4%) achieved a BCVA of 20/25 and 20/20 or better respectively. For the high myopic group, the results were 13 eyes (100%) and 12 eyes (92.3%) respectively, at 6 months after the surgery. In the non-high myopic group, 21 (95.4%) and 7 eyes (31.8%) achieved a DCNVA of 20/40 and 20/25 or better. For the high myopic group, the results were 13 (100%) and 4 eyes (30.8%) respectively, at 6 months after the surgery, the differences between the two groups for a BCVA of 20/25 or better and 20/20 or better and a DCNVA 20/40 or better and 20/25 or better were not statistically significant. CONCLUSIONS: Six months clinical outcome of cataract surgery with an AT-45 for the high myopic eyes was satisfactory; it was not significantly different from that of the non-high myopic eyes.