危重患者院内转运集束化策略应用效果分析

目的 观察集束化干预在院内危重患者转运中的临床效果.方法 以危重患者院内转运的时间段分组,其中2015年1-3月院内转运患者设为对照组,采用传统方法;2015年4-6月的院内转运患者设为观察组,应用集束化转运策略.以5％的比例随机抽样,抽样结果为对照组110例,观察组116例.分别观察比较两组患者转运不良事件发生情况.结果 两组患者转运前状态比较差异无统计学意义(P＞0.05);观察组转运过程中不良事件发生率和等级低于对照组,两组比较差异有统计学意义(P＜0.05);两组患者不良事件原因分析中人员因素、设备因素、病情因素、流程因素比较,差异有统计学意义(P＜0.05).结论 通过集束化干预可以减少重症患者院内转运不良事件的发生,提高转运安全性.     

The significance of three-dimensional MR-defined neurovascular compression for the pathogenesis of trigeminal neuralgia

Three-dimensional MR tomography was used to examine the relationship between symptoms of trigeminal neuralgia and neurovascular compression of the nerve in 18 patients. The intensity of neurovascular interaction was classified according to neuroradiological criteria. We found that a radiologically defined compression or dislocation of the nerve by an artery was always associated with symptoms of trigeminal neuralgia. A simple contanct between vessel and nerve, however, was also observed on the asymptomatic sides of 10 out of 18 patients. In 6 of 18 patients, in contrast, trigeminal neuralgia was present in spite of the absence of neurovascular contact. In accordance with a cited study based on autopsy and intraoperative findings, our findings indicate that, in a certain proportion of cases, trigeminal neuralgia may be caused by neurovascular compression alone, whereas in other cases, other pathogenetic factors may be involved to a varying degree or be even exclusively responsible for the development of trigeminal neuralgia. The possible significance of the method for a preoperative estimation of the success of microvascular decompression of the trigeminal nerve is discussed.     

中西医结合治疗股骨头缺血性坏死

股骨头缺血性坏死是世界骨科难题之一。作者致力于中草药治疗本病的研究三十多年，近来又在手术治疗方面倾注心血，对该病的防治、康复创立了一整套中西医结合新方法，取得了满意效果。自１９８２年以来，共治疗各种股骨头坏死１１０１例，其中单纯中医治疗４３３例，手术配合中药治疗６６８例。按作者制定的百分评分法，总有效率９８％，优良率８４％，无一例需再作人工关节置换术。     

经肘前血管神经间隙入路结合微型钢板治疗冠状突骨折

目的介绍一种经肘前入路结合微型锁定钢板用于治疗尺骨冠状突骨折的手术方法。 方法选取上海中冶医院骨科2014年1月至2016年1月收治的单侧尺骨冠状突闭合性骨折患者15例,男9例、女6例,年龄17~65岁,平均32岁。根据Regan-Morrey分类：II型5例、III型10例。通过肘前肱动脉、正中神经间隙入路,采用微型钢板对骨折进行解剖复位和固定。对伴有肘关节明显不稳患者,取另一个切口修复外侧副韧带。 结果所有患者均获随访,随访时间12~36个月,平均23个月。所有患者骨折均愈合,末次随访肘关节屈伸弧为137°±14°,前臂旋前/旋后恢复至127°±13°,与正常侧比较,功能性结果差异无统计学意义（P>0.05）。根据Regand-Morrey分级,损伤臂功能恢复优14例,良1例,优良率100%。轻度异位骨化1例,肘关节功能未受损。 结论经肘前血管神经间隙入路结合微型钢板固定冠状突骨折简单、安全、创伤小、暴露率高、预后满意。     

显微血管减压治疗三叉神经痛和面肌痉挛的近期疗效观察

经后颅窝入路对7例三叉神经痛、5例面肌痉挛行显微血管减压手术治疗。7例三叉神经痛患者中有6例发现三叉神经根受小动脉压迫,1例受静脉压迫。7例病人于血管减压后疼痛完全消失,且无任何神经缺陷遗留。5例面肌痉挛患者中4例面神经根受小动脉压迫,血管减压后症状都获得明显缓解。1例在面神经根部未发现血管压迫,此例术后疗效不佳。微血管对神经根的压迫是三叉神经痛和面肌痉挛的一种重要病因。显微血管减压治疗这两种疾病的近期疗效甚佳,远期疗效尚待进一步观察。     

跟腱损伤修复术后局部软组织缺损的处理

目的探讨跟腱损伤修复后局部软组织坏死致跟腱外露的处理方法。方法1996年4月-2006年4月,共收治24例跟腱修复术后因局部软组织坏死致跟腱外露的患者。其中男17例,女7例;年龄16-59岁。损伤原因开放性损伤8例,其中机器绞伤2例,重物砸伤3例,车轮绞伤3例;闭合性损伤16例,均为运动损伤。单纯行皮神经营养血管修复软组织缺损11例,其中腓肠神经营养血管皮瓣移位修复8例,隐神经营养血管皮瓣移位修复3例;跟腱修复加上述皮神经营养血管皮瓣移位修复软组织缺损13例。伤后至本次手术时间为9-76d,跟腱外露至本次手术修复的时间为3-65d。结果术后所有移位皮瓣均成活良好,质地好,外露跟腱被覆盖。其中4例皮瓣边缘少许黄色分泌物经2-3周换药后痊愈,6例行二期皮瓣修薄术。18例获6-24个月随访,皮瓣无破溃,不影响穿鞋,两点辨别觉为12-20mm。踝关节功能按AOFAS（美国足踝外科协会）标准评分,优8例,良6例,可3例,差1例,优良率为77.8%。13例提踵功能良好,3例能完成提踵功能,力量较健侧差,2例不能提踵。结论跟腱损伤修复术,若处理不当,易导致局部软组织坏死,跟腱外露。应尽早视情况行单纯皮神经营养血管皮瓣移位修复,或跟腱修复加皮神经营养血管皮瓣移位术。软组织修复及跟腱修复应力争同期进行。     

Implementing the severe sepsis care bundles outside the ICU by outreach

Sepsis is not a new challenge facing the health care team, it remains a complex disease, which is difficult to identify and treat. Mortality from sepsis remains high and continues to be a common cause of death among critically ill patients, despite advances in critical care. Sepsis accounts for an estimated 27% of all intensive care admissions in England, Wales and Northern Ireland, and accounted for 46% of all intensive care bed days. Recent research studies and the surviving sepsis campaign have shown that identifying and providing key interventions to patients with severe sepsis and septic shock prior to their admission to the intensive care unit significantly improve outcomes. The aim of this paper was to identify how the Critical Care Outreach Team at one local hospital implemented the severe sepsis resuscitation care bundle for patients in the emergency department (ED) and on the general wards. It will include a presentation on the various ways the team raised the profile of severe sepsis and the care bundle at hospital and at national level. It also includes audit data that have been collected. The results showed that if the resuscitation care bundle was implemented within the first 24 h of hospital admission, mortality was 29%, whereas if the care bundle was instigated after this time mortality was more than at 49%. Audit data showed that the commonest sign of severe sepsis seen in patients in the ED and on wards was tachypnoea. This article discusses the successful implementation of the severe sepsis resuscitation care bundle and the positive impact an Outreach team can have in changing practice in the way patients are managed with severe sepsis. The audit data support the need for regular physiological observations and the use of a Patient At Risk Trigger scoring tool to identify patients at risk of deterioration. This allows referral to the Outreach team, who assess the patient and if appropriate initiate the care bundle.     

Experimental evaluation of 3-dimensional kinematic behavior of the cruciate ligaments

PURPOSE: The purpose of this study was to evaluate a low-cost and easily reproducible technique for biomechanical studies in cadavers. In this kind of study, the natural effect of loading of the joint and shear forces are not taken into account. The objective is to describe the plastic deformation of the ligaments into 3-dimensional space. METHOD: For 18 intact human cadaver knees, the cruciate ligaments were divided into 3 fiber bundles, the tibial or femoral fixation points were marked, and 2 perpendicular different x-ray exposures were performed, thus obtaining radiographs of spatial projections of the bundle in 3 anatomic planes (frontal, sagittal, and transversal). From the measurements made on the x-ray films, we obtained the average distance between the 2 fixation points of the cruciate ligaments on the tibia and the femur at 4 different flexion angles. RESULTS: The distance between the fixation points of the medial and lateral fiber bundles of the cruciate ligaments did not change significantly during movement. There were, however, significant variations (P < .05) in the distance between the fixation points of the posterior fiber bundles of the anterior cruciate ligament and the anterior fiber bundles of the posterior cruciate ligament. CONCLUSIONS: This technique was efficient for demonstrating the plastic deformability of the cruciate ligaments. The results proceeding from this type of study can assist in the planning of physical rehabilitation programs.