儿童发育性髋脱位术后吸收热的监测及临床意义

目的了解和掌握儿童发育性髋脱位术后吸收热的特点,为医疗诊治和护理提供依据,同时避免患儿家长产生不安情绪。方法对儿童发育性髋脱位的患儿进行术后连续7d3个时间段的体温监测,同时记录患儿的个人一般状况和相关资料,经计算机软件处理及非参数统计检验进行分析。结果儿童发育性髋脱位术后吸收热与传统的吸收热比较,不仅体温高,而且持续时间长,高峰值在术后第2天下午;患儿体重和年龄因素与吸收热有显著的相关性;季节和性别因素与吸收热未见有相关性。结论科学分析专科疾病的特殊症状,能够保证专科疾病诊治效果及促进专科护理的发展,提高患方对专科医疗、护理技术水平的认可度,促进患者康复。     

Hip: Anatomy and US technique

Ultrasound (US) has always had a relatively limited role in the evaluation of the hip due to the deep location of this joint. However, many hip diseases are well detectable at US, but before approaching such a study it is necessary to be thoroughly familiar with the normal anatomy and related US images. The study technique is particularly important as optimization of various parameters is required, such as probe frequency, focalization, positioning of the probe, etc. Also the patient’s position is important, as it varies according to the area requiring examination. For the study of the anterior structures, the patient should be in the supine position; for the medial structures, the leg should be abducted and rotated outward with the knee flexed; for the lateral structures, the patient should be in the controlateral decubitus position; for the posterior structures the patient must be in the prone position. US study of the hip includes assessment of the soft tissues, tendons, ligaments and muscles, and also of the bone structures, joint space and serous bursae. The purpose of this article is to review the normal anatomy of the hip as well as the US anatomy of this joint.     

Effects of a Thin-Sized Lead Body of a Transvenous Single Coil Defibrillation Lead on ICD Implantation

SCHUCHERT, A., et al. : Effects of a Thin‐Sized Lead Body of a Transvenous Single Coil Defibrillation Lead on ICD Implantation. In the interest of patients receiving implantable cardioverter defibrillators (ICDs), the clinical benefits of newer and thinner transvenous defibrillation leads have to be determined. The aims of this study were to evaluate the ICD procedure duration and the frequency of lead dislocation at the 3‐month follow‐up of a new defibrillation lead with a thin‐sized lead body and its conventionalsized predecessor. The thin‐sized single coil defibrillation lead (Kainox RV, Biotronik; lead body 6.7 Fr) was implanted in 61 patients and the conventional‐sized defibrillation lead (SPS, Biotronik; lead body 7.8 Fr) in 60 patients. Both leads were connected to a left‐sided, prepectorally implanted Phylax ICD (Biotronik) with active housing. The lead implantation time and total procedure duration were determined. Lead implantation time was defined as the time from lead insertion to the end of the pacing measurements. The total procedure duration spanned skin incision to closure. The incidence of lead repositioning during the lead implantation time and during ventricular fibrillation conversion testing was also assessed. The frequency of lead dislocations was recorded at the 3‐month follow‐up. Mean lead implantation time and total procedure duration of the thin‐sized lead (23 ± 22 minutes 76 ± 37 minutes ) were not statistically different from the time needed for the conventional‐sized lead (22 ± 20 minutes 81 ± 34 minutes ). The number of lead repositionings during the lead implantation time was similar (thin‐sized lead: 1.4 ± 2.4 ; conventional‐sized lead: 1.1 ± 1.9 ). An additional lead repositioning was not necessary during ventricular fibrillation conversion testing in 93.4% of the patients with thin‐sized and in 94.4% with conventional‐sized leads (not significant). At the 3‐month follow‐up, there were four (6.6%) lead dislocations in the thin‐sized and four (6.7%) in the conventional‐sized lead group. In conclusion, the downsized lead body of the new defibrillation lead influenced neither ICD procedure duration nor the incidence of lead dislocation during follow‐up.     

髋关节置换术治疗老年股骨颈骨折患者的护理

目的:探讨老年股骨颈骨折患者行髋关节置换术的临床护理措施。方法:我院2010年6月～2011年6月共收治股骨颈骨折老年患者208例,根据患者心理特点,术前实施积极抗感染治疗,并给予心理护理,术后给予科学合理的康复护理。结果:102例存在心理问题的患者在手术后焦虑、忧郁及恐惧等症状消失。手术后24例患者出现并发症,占11.54%,其中肺部感染7例,脑梗死4例,心肌缺血4例,泌尿系统感染3例,深静脉血栓3例,浅度压疮3例。无死亡病例。随访6～48个月,平均随访(24.2±9.5)个月。采用Harris评分标准进行功能评定,其中优128例,良67例,可13例,优良率为93.75%。结论:对老年股骨颈骨折患者实施术前和术后护理,可提高患者术后功能恢复。     

西安地区髋部骨折流行病学调查

目的了解西安地区髋部骨折的分布情况与流行病学特点,为区域性骨质疏松的防治、健康教育等工作提供依据。方法通过调取西安地区34所医院全部髋部骨折住院患者的信息资料,进行髋部骨折发生情况的回顾性调查,分析髋部骨折流行病学分布特征。结果西安地区2004-2006年共收治髋部骨折病例3033例,50岁以上女性发病数明显多于男性;男性发病高峰呈现40～49岁、70～79岁两个年龄段,女性发病高峰出现在60～79岁年龄段;年龄大于60岁的病例中70～79岁年龄组人数最多;冬春季节发病人数较夏秋季节多。结论西安地区髋部骨折发生情况显示,中老年人应重点预防,特别是50岁以上女性。     

Perceived self‐efficacy gained from,and health effects of,a rehabilitation program after hip joint replacement

Objective

To examine whether a routine multidisciplinary inpatient rehabilitation program can increase patient self‐efficacy, and to investigate the effects of high self‐efficacy at admission, and increases in self‐efficacy, on health changes in patients who undergo such rehabilitation after hip joint replacement.

Methods

Participants in this longitudinal study were 1,065 patients who underwent inpatient rehabilitation after hip joint replacement. Questionnaires were administered at admission, discharge, and 6‐month followup. The main outcome variables were disability, pain, depressive symptomatology, and self‐efficacy to cope with disability and pain.

Results

Significant improvements from admission to discharge from the inpatient rehabilitation program in disability, pain, depressive symptoms, and self‐efficacy were found. In addition, higher levels of self‐efficacy at admission and larger increases in self‐efficacy over the course of the program predicted larger health changes (i.e., greater decreases in disability, pain, and depressive symptoms). Results were generally similar for health changes from discharge to 6‐month followup.

Conclusion

A routine multidisciplinary inpatient rehabilitation program after hip joint replacement can result in enhanced self‐efficacy.

     

疏血通对髋部骨折患者凝血-纤溶功能影响的临床研究

目的:评估疏血通对髋关节手术患者术后凝血-纤溶系统的影响.方法:选择2002年7月～2003年4月髋部手术患者共57例,根据入院时间(单双日)分为治疗组(34例)和对照组(23例),手术前3d开始分别采用疏血通和低分子肝素治疗,共10d,于用药前、术前、术后第1天、术后第3天、术后第7天,测定白陶土部分凝血活酶时间(KPTT)、凝血酶原时间(PT)、组织型纤溶酶原激活剂(t-PA)、组织型纤溶酶原激活剂抑制剂(PAI)、D-dimer、血小板聚集率,怀疑有深静脉血栓(DVT)者行静脉造影检查.结果:两组治疗前后KPTT,PT明显延长;治疗组t-PA活性明显增强(P＜0.05),D-dimer升高,PAI无明显变化,并抑制血小板聚集.结论:疏血通在预防和治疗髋关节术后静脉血栓形成中,不仅有抗凝作用,而且能激活纤溶系统,抑制血小板聚集,是一种安全有效的药物.     

Different risk profiles for hip fractures and distal forearm fractures: A prospective study

In a prospective cohort of elderly persons, aged 70 years and over, we examined risk indicators for which data could be easily obtained, to construct risk profiles for hip fractures and distal forearm fractures. Participants lived independently, in apartment houses for the elderly or in homes for the elderly. At baseline, information was obtained in 2578 subjects on age, gender, residence, mobility and the frequency of going outdoors. Mobility was measured using a walking score ranging from 1 (not able to walk independently) to 3 (able to walk independently for a fair distance). During the study period (median duration 3.5 years, maximum 4 years) 106 participants sustained a hip fracture and 60 participants suffered a distal forearm fracture. Women compared with men, adjusted for age, had a higher risk of hip fracture (adjusted relative risk (RR)=2.4, 95% confidence interval (CI) 1.3–4.3) and distal forearm fracture (RR=3.7, 95% CI 1.5–9.2). Age, adjusted for gender, was related to hip fractures only: the relative risk of fracture for those in the highest age category (>85 years) was 9.5 (95% CI 4.3–21.2) compared with those in the lowest age category (70–75 years). Moderately impaired walking ability compared with normal walking ability, adjusted for age and gender, was associated with a higher risk of hip fracture (RR=1.8, 95% CI 1.2–2.7) but with a lower risk of distal forearm fracture (RR=0.4, 95% CI 0.2–0.8). The outdoor score, adjusted for age and gender, was associated with distal forearm fractures only: going outdoors less than once a week, compared with three times or more, was associated with a lower risk of fractures (RR=0.3, 95% CI 0.1–0.9). In those living in homes for the elderly the risk of hip fracture was higher compared with those living independently (RR=2.4, 95% CI 1.4–4.2), adjusted for age and gender. Risk profiles were constructed using stepwise Cox's proportional-hazards regression. The risk profile predicted probabilites of sustaining a hip fracture in a 4-year period ranging from 0.4% to 25.9%, and of distal forearm fractures ranging from 0.2% to 4.5%, depending on the subject's characteristics as defined by the risk indicators. We conclude that easily obtainable risk indicators can be used in the prediction of fractures and can discriminate among fracture types.     

TossyⅢ型肩锁关节脱位治疗中带袢钢板重建喙锁韧带应用的可行性分析

目的 分析带袢钢板重建喙锁韧带治疗TossyⅢ型肩锁关节脱位的临床可行性。方法 回顾性分析近两年来我院骨科就诊的TossyⅢ型肩锁关节脱位患者共72例,随机数表法分为两组,观察组采用带袢钢板重建喙锁韧带治疗,对照组采用锁骨钩钢板内固定,术后随访18个月,分别统计肩关节JOA评分及肩锁关节VAS评分。结果 所有患者术后3、6个月JOA及VAS评分均明显改善(P＜0.05);观察组患者JOA评分升高幅度及VAS评分下降幅度均明显优于对照组(P＜0.05)。结论 带袢钢板重建喙锁韧带治疗TossyⅢ型肩锁关节脱位操作简单,创伤小,并发症相对较少,可早期功能锻炼,推荐临床推广应用。     

CT Evidence for Subchondral Trabecular Injury of the Femoral Head in Transient Osteoporosis of the Hip: A Case Report

A 28-yr-old woman presented with both hip pain that started sequentially during the peripartum period. Diagnosis of transient osteoporosis of the hip (TOH) was made based on typical findings of plain radiographs and magnetic resonance images. The subchondral trabeculae of the femoral head were evaluated on serially taken coronal multiplanar reformation computerized tomogram images. At 4 weeks after pain onset, marked decrease in the sclerotic density with irregular discontinuation was observed in the primary compression trabeculae. At 12 weeks, a focal area of irregular thickening of trabeculae was observed. At 20 weeks, sclerotic density of trabeculae recovered markedly and the focal area of irregular trabecular thickening disappeared. At 1 yr, subchondral trabeculae recovered almost completely. The evidence of subchondral trabecular injury was observed in the femoral heads of TOH.