3D打印技术在单侧粉碎性颧骨颧弓骨折治疗中的应用

目的 探讨3D打印技术在粉碎性颧骨颧弓骨折治疗中的应用价值。方法 选择2014年1月—2017年4月期间在西安交通大学口腔医院就诊的单侧粉碎性颧骨颧弓骨折21例。术前行薄层CT扫描,并将CT数据导入计算机辅助设计软件;进一步在计算机中将健侧颧骨颧弓镜像至患侧,最终打印出“复位”理想的患侧颧骨颧弓形态模型。在此模型上,进行内固定钛板预成型。术中利用预成型的内固定钛板引导骨段复位并最终完成内固定。术后行CT复查,三维测量颧骨颧弓位置并与术前设计位置进行比较,评估手术效果。采用SPSS 25.0软件包对测量数据进行配对t检验。结果 术后关键标志点间距同术前设计差异无统计学意义,手术效果满意。结论 3D打印技术有助于术前设计和植入物精确塑形,能有效提高单侧粉碎性颧骨颧弓骨折复位的精确性。     

内固定联合不同植骨方式治疗老年胸腰段椎体压缩性骨折

骨质疏松性椎体骨折是老年性骨折最为常见的一类骨折,暴力、外伤等是引起胸腰椎骨折的主要因素[1]。经皮椎体成形术(PVP)与经皮椎体后凸成形术(PKP)是目前临床用于老年胸腰段椎体压缩性骨折的主要手术方式,年龄、骨质疏松程度都是影响PVP及PKP手术治疗效果的主要因素[2]。对于老年胸腰椎压缩性骨折来说,尽可能恢复其稳定的脊柱解剖结构,并提供一定的伤椎骨性愈合是治疗的主要目的[3]。     

Target‐ and input‐dependent organization of AMPA and NMDA receptors in synaptic connections of the cochlear nucleus

We examined the synaptic structure, quantity, and distribution of α‐amino‐3‐hydroxy‐5‐methylisoxazole‐4‐propionic acid (AMPA)‐ and N‐methyl‐D‐aspartate (NMDA)‐type glutamate receptors (AMPARs and NMDARs, respectively) in rat cochlear nuclei by a highly sensitive freeze‐fracture replica labeling technique. Four excitatory synapses formed by two distinct inputs, auditory nerve (AN) and parallel fibers (PF), on different cell types were analyzed. These excitatory synapse types included AN synapses on bushy cells (AN‐BC synapses) and fusiform cells (AN‐FC synapses) and PF synapses on FC (PF‐FC synapses) and cartwheel cell spines (PF‐CwC synapses). Immunogold labeling revealed differences in synaptic structure as well as AMPAR and NMDAR number and/or density in both AN and PF synapses, indicating a target‐dependent organization. The immunogold receptor labeling also identified differences in the synaptic organization of FCs based on AN or PF connections, indicating an input‐dependent organization in FCs. Among the four excitatory synapse types, the AN‐BC synapses were the smallest and had the most densely packed intramembrane particles (IMPs), whereas the PF‐CwC synapses were the largest and had sparsely packed IMPs. All four synapse types showed positive correlations between the IMP‐cluster area and the AMPAR number, indicating a common intrasynapse‐type relationship for glutamatergic synapses. Immunogold particles for AMPARs were distributed over the entire area of individual AN synapses; PF synapses often showed synaptic areas devoid of labeling. The gold‐labeling for NMDARs occurred in a mosaic fashion, with less positive correlations between the IMP‐cluster area and the NMDAR number. Our observations reveal target‐ and input‐dependent features in the structure, number, and organization of AMPARs and NMDARs in AN and PF synapses. J. Comp. Neurol. 522:4023–4042, 2014. © 2014 Wiley Periodicals, Inc.     

Effectiveness of vitamin K in anticoagulation reversal for hip fracture surgery – A prospective observational study

Introduction

Vitamin K antagonists are often used for anticoagulant treatment in hip fracture patients. The optimal handling with such anticoagulants is unclear.We aimed to determine when anticoagulation reversal occurred after vitamin K administration and how often prothrombin complex concentrates (PCCs) were administered. We compared patients’ treatments and outcomes with those of a control group not receiving treatment for anticoagulation.

Patients and Methods

A total of 402 geriatric hip fracture patients were included in this observational study. We collected data on treatment for anticoagulation, time to surgery, and reasons for delay of surgery. In patients taking vitamin K antagonists, we measured the INR (international normalized ratio) on admission and prior to surgery, along with the frequency of PCC administration. Finally, we compared in-hospital mortality and complications between patient groups.

Results

A total of 62 (15%) patients received phenprocoumon prior to their fractures. Surgery was delayed in these patients compared to controls (27 h; 95%CI 23–31 vs. 16 h; 95%CI 19–19; p = 0.001), but surgery delay > 48 h (n = 5; 8%) was not due to a failure of INR reversal. The main reason for these delays was a lack of capacity for surgery. The average INR on admission was 2.1 (± 0.7; range 1.0-3.5) in patients taking phenprocoumon, which decreased to 1.3 (± 0.3; range 1.0-1.6) until surgery. PCCs were administered to 19% of patients. We found no differences in the in-hospital mortality (6.2% vs. 8.1%, p = 0.575) or complication rates (12.9% vs. 9.4%, p = 0.364).

Conclusion

The use of vitamin K seemed to be sufficient for anticoagulation reversal in geriatric hip fracture patients, and it generally led to timely surgery; despite this success, PCCs were sometimes administered for logistical reasons.     

The risks of red cell transfusion for hip fracture surgery in the elderly

Background and Objectives The benefits and indications for blood transfusion among surgical patients are controversial. There is evidence which suggests that blood transfusion is associated with poor clinical outcomes and risks of infection, but there are few data in the elderly population. Materials and Methods Data were collected on haemoglobin concentrations and transfusions in 919 patients undergoing hip fracture repair at a university hospital over a 2‐year period. 28‐day and 180‐day mortality were specified as primary outcomes. A composite infection outcome (chest infections, urinary tract infections and wound infections) was the main secondary outcome. Preoperative, operative and/or postoperative transfusions were the main exposure variable. Regression analyses were used to explore the associations between transfusion and outcomes, adjusting for pre‐defined preoperative variables. Results 300 patients (32·6%) were transfused at least once during their admission. There was no evidence of a significant difference in either 28‐day survival or 180‐day survival between transfused and non‐transfused hip fracture patients. The transfused group had higher adjusted composite infection rate (HR, 1·91; 95% CI, 1·41–2·59, P < 0·001) and prolonged length of stay in hospital than the non‐transfused group (HR, 1·15; 95% CI, 1·07, 1·23, P < 0·001). Anaemia at the time of admission, extra capsular fracture and using walking aids in an indoor setting were preoperative variables, which predicted the need for transfusion. Conclusion Among an elderly population with hip fracture, blood transfusion was not associated with changes in mortality, but was associated with an increased rate of postoperative infection. These data add to the wider literature about adverse clinical outcomes in patients receiving blood transfusions and emphasises the need for prospective trials to evaluate the role of transfusion in the elderly.