医源性血管损伤的预防和术中处理

目的：总结手术中发生医源性血管损伤的处理经验。方法：10例在外科手术中损伤血管的患者,其中门静脉,下腔静脉、髂总静脉损伤各2例,股总静脉、颈总动脉、腋静脉、腘动脉损伤各1例。行血管修补术5例,行端-端吻合术1例,自体静脉移植术1例,人工血管移植1例,钳夹止血1例,血管结扎1例。结果：本组痊愈8例;死亡2例,其中下腔静脉损伤止血失败死亡1例,颈总动脉损伤结扎死亡1例。结论：医源性血管损伤重在预防,一旦发生血管损伤,迅速有效地控制出血是手术成功的关键,血管修补或吻合术疗效良好。     

足筋膜间隙综合征相关肌肉磁刺激运动诱发电位的临床研究

目的:探讨足筋膜间隙综合征患者相关肌肉的磁刺激运动诱发电位(MEP)的特征及其临床意义.方法:对21例确诊为单侧足筋膜间隙综合征患者,在双侧腘窝上缘用磁刺激坐骨神经,同心圆针电极插入双侧足部各筋膜间隙内相应的肌肉中,记录各自MEP的潜伏期及波幅变化,并计算其比值,分析该比值与足筋膜间隙综合征发生的相关性.结果:正常足部各筋膜间隙内相应的肌肉磁刺激MEP先正后负,潜伏期相对恒定,但波幅不够稳定;当间隙内压大于30mmHg时,间隙内相应肌肉MEP潜伏期明显延长,为健侧的(1.9l±0.23)倍.统计学分析显示,筋膜间隙综合征的发生与磁刺激MEP波幅比值降低之间无相关性(P＞0.05),而与相应肌肉MEP潜伏期比值的变化之间存在着明显相关性(P＜0.01).结论:磁刺激MEP作为诊断足筋膜间隙综合征的客观指标具有重要的价值.     

骨髓间充质干细胞与自体腹膜联合修复盆腔自主神经损伤的实验研究

目的观察骨髓间充质干细胞(BMSC)与自体腹膜桥接管联合移植修复盆腔自主神经损伤的效果.方法建立比格犬盆腔自主神经损伤模型,实验组以自体腹膜管填充胶原蛋白海绵+BMSC桥接于缺损神经两端;对照组改BMSC为生理盐水.正常对照组为自体神经移植.术后12周取材,标本切片行HE染色和神经纤维(NF)免疫组化染色.应用图像分析系统对选定数据进行测量.透射电镜观察实验组再生神经纤维超微结构.结果实验组与对照组比较再生神经纤维总数[(1742±185)根比(1131±262)根,P<0.01]、密度[(168±14)根/104μm2比(124±17)根/104μm2,P<0.01]、直径[3.83±0.22)μm比(3.28±0.41)μm,P<0.05]、面积百分比(0.32±0.07比0.21±0.08,P<0.05)差异均有统计学意义,与正常对照组比较差异均无统计学意义(P>0.05).实验组再生神经纤维结构清晰,形态接近正常.结论 BMSC与自体腹膜桥接管联合移植修复盆腔自主神经缺损再生神经纤维生长好,方法可行,与自体神经移植修复效果相当.     

Morphomechanics of the humero-ulnar joint: II. Concave incongruity determines the distribution of load and subchondral mineralization

Background: A deeper joint socket (concave incongruity) is found at most angles of flexion of the humero-ulnar joint and maintained over a wide range of physiological loading. It is, however, unclear how far this incongruity affects the distribution of load and subchondral mineralization of this joint as compared with a congruous configuration. Methods: Two nonlinear, axisymmetrical finite element models with two cartilage layers were constructed, one congruous and one incongruous, with a joint space of realistic magnitude. The distribution of subchondral mineralization was determined by computed tomography osteoabsorptiometry in the same six specimens that were investigated in the first part of the study, and compared with the biomechanical data obtained there and the predictions of the models. Results: In the congruous case, the center of the socket is highly loaded, whereas the periphery does not experience mechanical stimulation. A central bone density maximum is predicted. With concave incongruity the position of the contact areas shifts from the joint margin towards the center as the load increases, and the peak stresses are considerably lower. A bicentric ventro-dorsal distribution pattern of subchondral mineralization is predicted, and this is actually found in the six specimens. Conclusions: Concave incongruity is shown to determine load transmission and subchondral mineralization of the humero-ulnar joint. It is suggested that this shape leads to a more even distribution of stress, provides intermittent stimulation of the cartilaginous tissue, and has beneficial effects on the metabolism, nutrition, and lubrication of the articular cartilage during cyclic loading. © 1995 Wiley-Liss, Inc.     

闭合性颅脑外伤患者事件相关电位的研究

目的：研究ERP对闭合性颅脑外伤患者脑认知功能变化的评估作用。方法：应用Medicid-03E脑诱发电位仪测定168例闭合性颅脑外伤患者的视觉（图像）、听觉诱发的P3波之潜伏期和波幅，并与正常对照组作比较，54例患者进行复测比较。结果：病人组P3潜伏期较正常对照组明显延长（P＜0．001），波幅降低；P3波潜伏期、波幅与患者病情严重程度相关；有原发昏迷者改变尤为突出；随着病情的好转，P3潜伏期逐渐缩短，波幅亦逐渐增高。结论：ERP是测定闭合性颅脑外伤患者脑认知功能变化的一项客观指标。     

Effects of Creep and Cyclic Loading on the Mechanical Properties and Failure of Human Achilles Tendons

The Achilles tendon is one of the most frequently injured tendons in humans, and yet the mechanisms underlying its injury are not well understood. This study examines the ex vivo mechanical behavior of excised human Achilles tendons to elucidate the relationships between mechanical loading and Achilles tendon injury. Eighteen tendons underwent creep testing at constant stresses from 35 to 75 MPa. Another 25 tendons underwent sinusoidal cyclic loading at 1 Hz between a minimum stress of 10 MPa and maximum stresses of 30–80 MPa. For the creep specimens, there was no significant relationship between applied stress and time to failure, but time to failure decreased exponentially with increasing initial strain (strain when target stress is first reached) and decreasing failure strain. For the cyclically loaded specimens, secant modulus decreased and cyclic energy dissipation increased over time. Time and cycles to failure decreased exponentially with increasing applied stress, increasing initial strain (peak strain from first loading cycle), and decreasing failure strain. For both creep and cyclic loading, initial strain was the best predictor of time or cycles to failure, supporting the hypothesis that strain is the primary mechanical parameter governing tendon damage accumulation and injury. The cyclically loaded specimens failed faster than would be expected if only time-dependent damage occurred, suggesting that repetitive loading also contributes to Achilles tendon injuries. © 2003 Biomedical Engineering Society. PAC2003: 8719Rr     

Magnetic resonance imaging of femoral head development in roentgenographically normal patients

Magnetic resonance images (MRI) of 22 patients with roentgenographically normal hips were reviewed retrospectively and the findings categorized according to age. With increasing maturity, the MR intensity of the femoral heads on spin echo images increased, as marrow fat became a dominant tissue in the head. The femoral head pattern was relatively inhomogeneous, with a broad band of diminished intensity extending in a posteromedial to anterolateral direction, corresponding to the pattern of trabecular bone. The femoral capital epiphyses were visible in younger patients as structures of bright intensity which remained evident through early adulthood. The articular cartilage of the hip joint was noted as a distinctive halo around the femoral head. An understanding of the MR pattern of the normal hip will aid in the early recognition of pathologic conditions, such as osteonecrosis.     

2014—2019年江西省伤害死亡情况及疾病负担分析

目的 了解江西省居民伤害死亡流行情况及其疾病负担,为科学制定本省伤害防制策略和措施提供依据。方法 利用中国死因登记报告信息系统2014—2019年江西死因监测数据,应用Excel 2007和SPSS 17.0软件进行数据整理和分析。采用死亡数、粗死亡率、标化死亡率、构成比、潜在减寿年数（PYLL）、减寿率（PYLLR）和平均潜在减寿年数(AYLL)等指标进行统计学描述,趋势变化采用年度变化百分比（APC）进行分析。结果 2014—2019年江西报告伤害死亡25 638人,年均粗死亡率为 50.81/10万,年均标化死亡率为 49.55/10万。男性死亡率高于女性、城市死亡率高于农村。伤害死亡前5位死因分别为道路交通事故、跌落、溺水、自杀和中毒。溺水、交通事故、跌落分别是0～14岁、15～44和45～64岁、≥65岁的首位伤害死因。2014—2019年江西省前5位伤害死因中,跌落粗死亡率呈上升趋势（APC = 8.22%）,中毒粗死亡率均呈下降趋势。2014—2019年伤害PYLL为692 196.73人年,PYLLR为14.24‰,AYLL 为 33.77年。PYLL及PYLLR 交通事故最高,AYLL最高的为溺水。15～44岁年龄组PYLL最高。结论 江西省伤害死亡负担较重,应根据不同人群的伤害死亡特征制定相应的防控策略和措施。     

产后妇女盆底肌损伤发生情况调查研究

目的 探讨产后妇女盆底肌功能情况并分析造成妇女产后盆底肌损伤的相关因素,为预防妇女因生产造成盆底肌损伤提供科学依据。方法 以2019年1月至2020年11月在湖南省长沙市和株洲市各1家医院产科进行6~8周产后复查的产妇为研究对象进行资料收集及盆底肌力测定,采用描述流行病学分析方法进行盆底肌力异常情况分析,并采用单、多因素分析方法对产后妇女盆底肌异常影响因素进行分析。结果 本研究共对1 628名产妇进行调查,年龄22~38岁,平均（29.68±5.36）岁;孕次1~5次,平均孕次（2.43±1.16）次;产次1~5次,以1~2次为主,占72.4%。检出1 142例产后6~8周产妇为盆底肌力异常,异常率为70.2%。年龄30~38岁（OR=3.766）、产次≥3次（OR=2.633）、阴道分娩（OR=7.478）、孕期增重过多（OR=1.597 ）及胎儿出生体重≥4 kg（OR=5.078）的产后妇女盆底肌力异常的风险较高。结论 湖南省产后妇女盆底肌力异常率较高,年龄、产次、分娩方式、孕期增重及胎儿体质量是造成产妇产后发生盆底肌损伤的重要原因,应采取相应措施,降低产后妇女发生盆底肌损伤风险。     

伤病比在医院维权中的运用

为了保证民法的公平原则,避免医疗纠纷赔偿案件审理中忽视患者本身病情所致的不良后果的情况,对损伤与疾病对患者预后的影响进行了研究.介绍了伤病比的来源,论述了伤病比在医疗纠纷处理中的适用 范围,伤病比的级别与医院承担的赔偿额度.指出应增强伤病比意识,促进医与法的完美结合.