血清同型半胱氨酸与头颈部动脉粥样硬化的关系研究

目的 探讨血清同型半胱氨酸（HCY）与头颈部动脉粥样硬化关系。方法 选择2016年1月至2016年12月合肥市第二人民医院行头颈部CT血管造影术（CTA）明确有动脉粥样硬化病变患者119例，根据头颈部动脉CTA结果，将轻度及轻度以上狭窄的106例患者纳为试验组，将无动脉狭窄的13例患者纳为对照组，比较两组患者的血清HCY水平。再根据头颈部动脉狭窄程度，分为轻度狭窄组（28例）、中度狭窄组（29例）与重度狭窄组（49例），比较3组患者血清HCY水平。结果 试验组患者血清HCY水平为（17.76±15.14）μmol/L，对照组为（10.95±2.73）μmol/L，两组差异有统计学意义（P<0.05）。轻度狭窄组血清HCY水平（12.77±8.05）μmmol/L，中度狭窄组为（16.01±8.39）μmmol/L，重度狭窄组为（22.20±20.29）μmmol/L，重度狭窄组与中度狭窄组、轻度狭窄组的血清HCY水平比较，差异有统计学意义（P<0.05）。结论 HCY在头颈动脉粥样硬化中起着一定作用，HCY对头颈部动脉粥样硬化的作用机制及长期影响有待深入研究。     

新型防旋支具在中西医结合保守治疗胫腓骨骨折中的应用

[目的]探讨新型防旋支具在中西医结合保守治疗胫腓骨骨折中的临床应用效果。[方法]2015年9月—2017年1月行保守治疗的胫腓骨骨折患者64例,随机分为试验组(32例)和对照组(32例)。两组患者入院后均行跟骨牵引术,中医正骨手法复位联合小夹板固定,辅以中药外敷内服。试验组术后采用新型防旋支具固定患肢,防止足部外旋;对照组术后采用传统的方法防止足部外旋。定期进行疼痛视觉模拟评分法(VAS法)评分,应用Kolcaba舒适状况量表(GCQ)检测舒适度改善状况,计算机断层扫描(CT)检查测量骨折旋转移位角度,随访记录骨折愈合时间及并发症情况,采用Johener-Wruhs评分系统对患肢功能进行评价。[结果]试验组骨折旋转移位角度小于对照组,牵引术后第1、3、7天的VAS疼痛评分均低于对照组,舒适度GCQ总分和其中的生理、心理精神维度单项得分均高于对照组,骨折愈合时间短于对照组,肢体功能Johner-Wruhs评分优良率高于对照组。两组间差异具有统计学意义(P0.05)。[结论]中西医结合保守治疗胫腓骨骨折过程中应用新型防旋支具,可以有效维持足部中立位,纠正成角及旋转畸形,辅助复位,减轻疼痛,提高患者舒适感受,缩短骨折愈合时间,有利于患肢功能恢复,且不增加并发症的发生,便于护理,安全可靠。     

Minimally invasive plate osteosynthesis using posterolateral approach for distal tibial and tibial shaft fractures

ObjectiveThe objective of the study was to evaluate the effectiveness of the posterolateral minimally invasive plate osteosynthesis (MIPO) method for managing distal tibial or tibial shaft fractures with severe anterior and medial soft tissue injuries.Materials and methodsFive consecutive patients with three distal tibial and two tibial shaft fractures (three open fractures) at a level-1 trauma and tertiary referral center were retrospectively reviewed. All patients were definitively treated and followed to bone union. Main outcome was measured by American Orthopaedic Foot and Ankle Society (AOFAS) ankle–hindfoot score, complications, and bone union on radiographs.ResultsThe average follow-up period was 15.8 months (range, 12–24 months). The average AOFAS score was 88.2 (range, 81–90). There were no complications, such as incision breakdown, deep infection, or impingement of the flexor hallucis longus tendon. Bone union was achieved in all cases.ConclusionsPosterolateral MIPO is a feasible option when treating these fractures, especially in cases with severe anterior and medial soft tissue injuries.     

Management of Chronic Paronychia

Chronic paronychia is an inflammatory disorder of the nail folds of a toe or finger presenting as redness, tenderness, and swelling. It is recalcitrant dermatoses seen commonly in housewives and housemaids. It is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens. Repeated bouts of inflammation lead to fibrosis of proximal nail fold with poor generation of cuticle, which in turn exposes the nail further to irritants and allergens. Thus, general preventive measures form cornerstone of the therapy. Though previously anti-fungals were the mainstay of therapy, topical steroid creams have been found to be more effective in the treatment of chronic paronychia. In recalcitrant cases, surgical treatment may be resorted to, which includes en bloc excision of the proximal nail fold or an eponychial marsupialization, with or without nail plate removal. Newer therapies and surgical modalities are being employed in the management of chronic paronychia. In this overview, we review recent epidemiological studies, present current thinking on the pathophysiology leading to chronic paronychia, discuss the challenges chronic paronychia presents, and recommend a commonsense approach to management.