钢丝环固定自体表皮移植治疗白癜风

目的探索特殊部位白癜风自体表皮移植治疗的包扎固定方法。方法试验组移植区边缘用钢丝环绕一周,缝合固定于皮肤上,并留置长线,皮片移植后将包扎敷料打包固定。对照组包扎敷料用胶带封包。结果自体表皮移植治疗眼睑及唇部易活动部位白癜风,采用钢丝环固定包扎,术区护理方便,对正常生活影响小,其治疗效果与传统的包扎方法相比有效率有明显提高(P<0.01)。结论钢丝环固定包扎是一种简单有效的包扎固定方法,可以提高活动大的部位白癜风手术治疗的成功率。     

椎弓根内固定加椎体间植骨融合治疗腰椎间盘突出症伴腰椎不稳

目的 评价椎弓根内固定、椎体间植骨融合术在治疗腰椎间盘突出症伴腰椎不稳中的应用及其临床效果。方法 对75例腰椎间盘突出症伴腰椎不稳的患者行髓核摘除、椎弓根内固定加椎体间植骨融合术，病变节段分别为L3～4、L4～5和L5S1。结果 75例患者随访8～50个月，平均14．5个月。本组4例患者术后出现暂时性神经根牵拉症状，2例术后感染，椎体间植骨融合72例，不融合3例。所有病情均获不同程度缓解，无其他远期并发症出现。结论 椎弓根内固定加后路椎体间植骨融合治疗腰椎间盘突出症伴腰椎不稳，除解除椎间盘源性疼痛外，尚能提供椎间的牢固性，促进椎体间植骨融合，恢复椎体永久稳定性。     

The design of a cervical vertebra titanium plate-interbody fusion cage

Objective： To study the biomechanical feature of a newly designed cervical vertebra internal fixation device and its clinical applications. Methods： Some functional spinal units were fixed respectively with titanium plate, fusion cage and new device designed by ourselves, then a controlled biomechanical study including flexion, extension, torsion and lateral bending was performed and the results were analyzed. Results： As to the mechanical performance, fusion cage showed poor performance in extension test and so did the titanium plate in the distortion test. However, the new device showed good performance in every test. Conclusion： Both simple titanium plate fixation and simple fusion cage fixation have biomechanical defaults, but they are complementary. The titanium plate-interbody fusion cage avoids the defaults and has specific advantages.     

An axotomy model for the induction of death of rat and mouse corticospinal neurons in vivo

To study trophic dependencies of rat and mouse corticospinal neurons (CSN), we established a lesion model for the induction of death of analogous populations of CSN in these rodent species. Before lesion, CSN were retrogradely labeled with Fast Blue (FB). A stereotaxic cut lesion through the entire internal capsule (ICL) was used to axotomize CSN. The extent of axotomy was determined by application of a control tracer. In both species, FB-labeled CSN were localized in three major areas: (1) the sensory motor cortex; (2) the supplementary motor and medial prefrontal cortex; and (3) the somatosensory cortex. ICL does not lead to complete axotomy of CSN of the rat and mouse somatosensory cortex. In rats, ICL results in complete axotomy of CSN of the sensory motor cortex and incomplete axotomy of the caudal portion of the supplementary motor and medial prefrontal cortex. In mice, the area of axotomized CSN extends significantly further frontally. In both species, axotomy-induced death of CSN is observed in the center of the sensory motor cortex. This lesion model is useful for investigations on the response of CSN of the sensory motor cortex to lesion and therapeutic drugs.     

丙磺舒对阿莫西林在家兔体内的药动学影响

目的:观察丙磺舒对阿莫西林在健康家兔体内药动学的影响.方法:采用微生物杯碟法测定兔血清中阿莫西林的浓度.结果:阿莫西林单剂量肌内注射后,吸收迅速,Tmax=(0.78±0.09)h,Cmax=(0.87±0.30)μg·mL-1,其代谢模型为一级速率一房室模型.当阿莫西林和丙磺舒等剂量伍用时丙磺舒对阿莫西林药动学参数的影响达到最大值:阿莫西林的t1/2由(2.06±0.09)h延长至(5.50±0.52)h,AUC由(4.07±0.05)μg·mL-1·h增加至(13.75±3.09)μg·mL-1·h,Cmax由(0.87±0.30)μg·mL-1增加至(6.30±1.46)μg·mL-1,且三者统计学差异极显著(P<0.01).结论:丙磺舒对阿莫西林的药动学参数的影响呈S型,当两者等剂量伍用时影响最大.     

应用AO钢板加螺钉内固定治疗BC型踝关节骨折

目 的 探 讨 Ｂ、Ｃ 型 踝 关节 骨折 的 较佳 治疗 方 法。方 法 本 组 ３２ 例 ，其 中 Ｂ 型骨 折 １７ 例，Ｃ 型 骨折 １５ 例 ，先 将 腓 骨 切开 复 位 ＡＯ 钢 板 内固 定 ，再 将 内 踝 骨折 切 开 复 位拉 力 螺 钉 内固 定 ，注意 联 合 韧 带 的 修 补 ，术后 早期 功 能锻 炼。 结 果 ３２ 例 中 ２９ 例 随访 ４ 个 月～４ 年，疗效 优良 ２７ 例 ，尚 可 ２ 例，无 一 例 疗效 差 。 结 论 Ｂ、Ｃ型 踝 关 节骨 折 均 需 手术 切 开 复 位，而 ＡＯ 钢 板加 螺 钉 固 定牢 固 ，有利 于 术 后 早 期功 能 锻 炼 ，有 利 于 踝 关 节 功 能 的恢 复。     

构建区域医疗机构内训师培训体系的实践探索

为了更好地完成国家基本公共服务标准化试点项目,完善区域医疗机构内部人才培训标准化体系,广州医科大学附属第六医院以地市级三级甲等医院优势为依托,以第三方医院管理咨询公司为主要技术支持,与该区域卫生健康局建立长期合作关系,组建区域医疗机构全面质量管理内训师团队,实施标准化课程培训,构建和应用内训师形成性评价体系。逐步完善了区域医疗机构全面质量管理内训师培训标准化体系,培养了一支规模适当、结构合理、素质优良的内训师资队伍。     

应用锁骨钩钢板治疗Tossy Ⅲ型肩锁关节脱位

目的探讨锁骨钩钢板治疗TossyⅢ型肩锁关节脱位的临床疗效。方法我们对2003年2月～2007年1月间52例TossyⅢ型肩锁关节脱位的患者均采用锁骨钩钢板复位内固定治疗。所有患者均未进行喙锁韧带缝合修复,但缝合损伤的肩锁关节囊及韧带和三角肌、斜方肌附丽。6～9个月后取出内固定。按Lazzcano法评定肩关节功能。结果52例患者得到随访,随访9～12个月,平均10个月。肩关节功能,取内固定前:优40例,良10例,差2例,优良率96%;取内固定后:优45例,良7例,差0例,优良率100%。肩关节功能取内固定前为良或差的病例在取出内固定后均有不同程度的改善。无切口感染、内固定松脱或断裂及再脱位等并发症。结论锁骨钩钢板是治疗TossyⅢ型肩锁关节脱位的最好治疗方法,具有操作简单,手术时间短,创伤小,可保证百分百复位,固定可靠,符合肩锁关节的生物力学要求,术后可早期功能锻炼,功能恢复好等特点。     

Multi‐center Retrospective Study of Factors Affecting Perioperative Transfusion of Packed Red Blood Cells for Pelvic Fracture Patients

ObjectiveTo analyze the use of packed red blood cells (PRBCs) for patients with pelvic fracture and evaluate factors associated with PRBC transfusion for patients with pelvic fracture.MethodsThis retrospective cohort study collected 551 patients with pelvic fractures from six hospitals between September 1, 2012, and June 31, 2019. The age span of patients varied from 10 to 95 years old, and they were classified into two groups based on high‐energy pelvic fractures (HE‐PFs) or low‐energy pelvic fractures (LE‐PFs). The study''s outcome was the use of PRBCs, fresh frozen plasma (FFP), and albumin. Demographic data, characteristics, laboratory tests, clinical treatment details, and clinical outcomes were compared between the two groups. Factors that were statistically associated with perioperative PRBCs in univariate analyses were included to conduct an optimal scale regression to determine the independent factors for perioperative PRBCs.ResultsA total of 551 patients were screened from six hospitals, and after inclusion and exclusion, 319 were finally included and finished the follow‐up from admission to discharge, while four patients died during hospitalization. Three hundred and nineteen patients were classified into two groups by their injury mechanisms. A total of 230/319 (72.1%) patients were classified into the HE‐PF group, and 89/319 (27.8%) patients were classified into the LE‐PF group. Patients in the HE‐PF group were transfused with 4.5 (3–8) units of PRBCs, 300 (0–600) ml of FFP, and 0 (0–30) g of albumin, while patients in the LE‐PF group were transfused with 3.5 (2–4.5) units of PRBCs, 0 (0–295) ml of FFP, and 0 (0–0) g of albumin (all P < 0.001). There were higher proportions of male patients and patients under 65 in the HE‐PF group (all P < 0.001). HE‐PF group patients were more severely injured and likely to take external fixation. The optimal scale regression revealed four significant factors associated with perioperative transfused PRBCs, which were patients on admission with hemorrhagic shock (importance = 0.283, P = 0.004), followed by fracture types identified by Tile classification (importance = 0.156, P < 0.001), hemoglobin levels below 70 g/L on admission (importance = 0.283, P = 0.004), followed by fracture types identified by Tile classification (importance = 0.156, P < 0.001), hemoglobin levels below 70 g/L on admission (importance = 0.148, P = 0.039), and methods of pelvic fixation (importance = 0.008, P = 0.026), ranked by the importance.ConclusionPatients with HE‐PFs had increased transfusions of PRBCs, FFP, and albumin, and hemorrhagic shock on admission, Tile classification, Hb levels, and stabilization methods were found to be associated with perioperative PRBCs.     

Biomechanical Study of Intramedullary Versus Extramedullary Implants for Four Types of Subtrochanteric Femoral Fracture

ObjectivesTo compare the biomechanical performance of proximal femoral nail anti‐rotation (PFNA), the “upside‐down” less invasive plating system (LISS), and proximal femoral locking plate (PFLP) in fixing different fracture models of subtrochanteric fractures.MethodsThirty composite femurs were divided into three equal groups (PFNA, PFLP, and reverse LISS). The implant‐femur constructs were tested under axial compression load (0–1400 N) from models I to IV, which represented the Seinsheimer type I subtrochanteric fracture, type IIIa subtrochanteric fracture with the posteromedial fragment reduced; type IIIa subtrochanteric fracture with the posteromedial fragment lost; and type IV subtrochanteric fracture, respectively. Axial stiffness was analyzed for each group. Each group was then divided into two subgroups, one of which underwent torsional and axial compression failure testing, while the other subgroup underwent axial compression fatigue testing. The torsional stiffness, failure load, and cycles to failure were analyzed.ResultsPFNA had the highest axial stiffness (F = 761.265, p < 0.0001) and failure load (F = 48.801, p < 0.0001) in model IV. The axial stiffness and failure load of the PFLP were significantly higher than those of the LISS (p < 0.0001, p = 0.001). However, no significant difference in axial stiffness was found between models I to III (model I: F = 2.439, p = 0.106; model II: F = 2.745, p = 0.082; model III: F = 0.852, p = 0.438) or torsional stiffness in model IV (F = 1.784, p = 0.187). In fatigue testing, PFNA did not suffer from construct failure after 90,000 cycles of axial compression. PFLP and LISS were damaged within 14,000 cycles, although LISS withstood more cycles than PFLP (t = 3.328, p = 0.01).ConclusionThe axial stiffness of the three implants was similar in models I to III. The biomechanical properties of PFNA were the best of the three implants in terms of axial stiffness, failure load, and fatigue testing cycles in model IV. The axial stiffness and failure load of the PFLP were better than those of the reverse LISS, but PFLP had fewer cycles in the fatigue tests than the reverse LISS.