硝酸盐类联合恬尔心治疗心绞痛的临床护理分析

目的分析硝酸盐类联合恬尔心治疗心绞痛的临床护理效果。方法选择我院2012年1月至2012年12月收治的108例新绞痛患者为研究对象,将其随机分成观察组和对照组,每组54例,两组患者君给予药物硝酸盐类联合恬尔心治疗,其中给予观察组患者综合干预护理,给予对照组常规护理手段。结果治疗后,观察组患者的心电图改善有效率、心绞痛发作改善有效率分别分别为81.5%、77.8%,明显高于对照组的2个指标数据59.2%、55.6%,数据差异显著,P<0.05;观察组患者的病死率低于对照组。结论采用病情监护、生活护理以及健康教育等综合干预护理措施,能有效促进患者病情的缓解,应予以推广。     

两种麻醉方法在老年患者髋关节部位手术中应用比较

目的对比腰硬联合麻醉和全身麻醉用于老年患者髋关节部位手术的影响。方法选择髋关节部位手术老年患者40例,随机分成腰硬联合麻醉组和全身麻醉组各20例,观察麻醉前后、手术开始前后、手术中、手术后的血压（收缩压）、动脉血氧分压和心率的变化,以及手术后的患者转归。结果两组均能完成手术,全身麻醉组麻醉前后血流动力学变化、血氧变化大于腰硬联合麻醉组,手术中腰硬联合麻醉组变化大于全身麻醉组,全身麻醉组手术后并发症多于腰硬联合麻醉组。结论全身麻醉有利于手术中血流动力学管理,腰硬联合麻醉有利于手术后患者恢复。     

安徽省某市2011-2013年高三学生颞下颌关节紊乱综合征筛查分析

目的：调查蚌埠地区高三学生颞下颌关节紊乱综合征（ TMD）发病情况,分析引发疾病的有关原因。方法2011-2013高考体检中,连续三年对蚌埠地区4650名高三学生进行颞下颌关节体检。结果男生患病率为19.79％,女生患病率26．49％,女生患病率明显高于男生;精神紧张、不良习惯者TMD患病率高,差异有显著性（ P＜0.05）。结论 TMD在高三学生中有较高的发病率,发病因素与精神心理因素及不良习惯关系密切。     

下颈椎骨折脱位伴关节突交锁35例临床治疗分析

目的：探讨下颈椎骨折脱位伴关节突交锁安全、有效的治疗方法。方法回顾性分析2009年10月至2013年4月35例下颈椎骨折脱位伴关节突交锁患者的临床资料。术前均完善X射线、CT平扫及重建、磁共振成像等影像学资料及美国脊髓损伤协会（ASIA）神经功能评估,对35例下颈椎骨折脱位伴关节突交锁患者行持续颅骨闭合牵引复位,据复位情况早期选择后路、前路或前后联合手术减压、植骨融合、内固定手术治疗,观察治疗效果。结果35例患者均闭合复位成功,其中3例在手术室全身麻醉下加大牵引质量复位成功。术后颈椎即获稳定,术后X射线随访提示：颈椎序列、椎体高度得到良好重建及维持。治疗后ASIA神经功能评级平均约提高1级以上。植骨4-6个月融合,无内置物松脱、断裂等并发症。结论对下颈椎骨折脱位伴关节突交锁患者行持续颅骨闭合牵引,根据复位情况及损伤类型择期选择后路、前路或前后联合手术减压、植骨融合内固定手术,可以获得满意疗效。     

改进 Blair 术治疗终末期踝关节炎的临床观察

目的 探讨运用改进Blair术治疗终末期踝关节炎临床疗效.方法 2009 年11月-2012年6月,采用改进Blair术治疗28例保守治疗无效的终末期踝关节炎患者.男13例,女15例;年龄23～67 岁,平均49.4岁.11例有明显足内翻畸形,17例外观大致正常.主要临床症状为踝关节肿胀、疼痛,活动受限.采用美国足踝外科协会（AOFAS）踝与后足评分及视觉模拟评分（VAS）评价术前及术后1年随访时足踝关节功能.结果 28例患者均获得随访,随访时间为1～2年,平均19.8个月.术后出现3例切口浅表感染,经清创后愈合.其余患者切口均Ⅰ期愈合,无早期并发症发生.术后1年随访时踝关节均融合,患者关节疼痛完全缓解,无内固定失败、畸形愈合等并发症发生.AOFAS评分平均为（83.13±3.76）分,与术前（45.38±3.21）分比较,差异有统计学意义（P＜0.01）;VAS评分平均为（2.31±1.05）分,与术前（8.01±0.63）分比较,差异有统计学意义（P＜0.01）.结论 运用改进Blair术治疗终末期踝关节炎,手术操作简便,经济,固定强度可靠,可明显缓解疼痛.     

骨性后缩青年下颌前伸引导过程中颞下颌关节的MRI所见

目的运用磁共振影像学技术观察青年人颞下颌关节在安放Forsus矫治器前后的髁突改建以及关节窝位置变化情况。方法 12例安氏Ⅱ类骨性错牙合下颌后缩青年患者,在安置Forsus矫治器后分别在治疗前、治疗中、治疗后拍摄双侧颞下颌关节的MRI片进行观察分析和测量。结果 12例患者MRI结果显示在髁突后上部发生了髁突软骨的增生,有髁突改建的表现;2例可见到关节窝发生不同程度的改建,改建部位在关节后结节的前缘下方,治疗前后髁突在关节窝中位置无明显改变。结论 Forsus矫治器主要刺激髁突产生适应性改建,关节窝改建不明显,且矫治结束后髁突在关节窝内的位置无明显变化,Forsus应用于青年人不会对颞下颌关节功能产生不利影响。     

Muscle transfers in children and adults improve external rotation in cases of obstetrical brachial plexus paralysis: a comparative study

Purpose

Latissimus dorsi and teres major transfers to the lateral side of the humerus with lengthening of the pectoralis major and subscapularis muscles for residual shoulder deformity were compared in children and skeletally mature patients.

Methods

Fifteen patients (nine children, six skeletally mature patients aged three to 30 years, follow-up one to 22 years) were treated for internal shoulder contracture after birth plexus lesions: C5–C6 (seven patients); C5–7 (five patients); C5-C8-T1 (three patients, respectively). Range of movement, Mallet shoulder function score and radiographs were assessed.

Results

Pre-operatively, shoulder function restrictions were comparable in all patients. Postoperatively, external rotation, abduction and Mallet function score improved significantly (p < 0.05) in all patients except one. There were no differences in improvement between children and skeletally mature patients (p = 0.24–1.0).

Conclusions

This technique improves external rotation and abduction of the shoulder for daily living activities in children and young, skeletally mature, patients.     

Modified subpectoral biceps tenodesis

Purpose

The proximal part of the long head of the biceps muscle has become a recognized cause of significant shoulder pain. Tenodesis of the long head of the biceps has been advocated as a treatment for pain resulting from biceps tendonopathy, biceps instability, and biceps tendon tears. All of these pathologies may be encountered during rotator cuff, SLAP or Bankart surgery, or in isolation. Several techniques have been described for this tenodesis, including various arthroscopic and subpectoral methods.

Methods

We present a modified bone bridge technique of Mazzocca et al., for subpectoral biceps tenodesis. In this technique we tenodese the tendon through two bone tunnels back over the muscle itself without implants.

Results

Application of this technique on 30 patients (ages 25–48 years) with short-term follow-up of 12–18 months showed statistically significant improvement (P value < 0.05) of the mean Constant and Oxford shoulder scores (pre-operative mean scores were 39.03 and 21.3, respectively, while postoperative mean scores were 76.43 and 44.8, respectively).

Conclusion

This technique has potential advantages as it allows the possibility of adjusting the tension of the biceps tendon before final suturing, in addition to quicker soft tissue healing.     

Human osteoblast damage after antiseptic treatment

Purpose

Antiseptics are powerful medical agents used for wound treatment and decontamination and have a high potential for defeating joint infections in septic surgery. Both chlorhexidine and polyhexanide are frequently used in clinical practice and have a broad antimicrobial range, but their effect on human osteoblasts has not been sufficiently studied. Our objective was to investigate the toxic effects of polyhexanide and chlorhexidine on human osteoblasts in vitro to evaluate their clinical applicability in septic surgery.

Methods

We isolated and cultivated human osteoblasts in vitro and assayed the toxic effects of chlorhexidine 0.1 % and polyhexanide 0.04 %, concentrations commonly applied in clinical practice. Toxicity analysis was performed by visualisation of cell structure, lactate dehydrogenase (LDH) activity and evaluation of vital cells. Toxicity was evaluated by microscopic inspection of cell morphology, trypan blue staining and determination of LDH release.

Results

Damaged cell structure could be shown by microscopy. Both antiseptics promoted LDH activity after incubation with osteoblasts. The evaluation of vital osteoblasts showed a significant decrease of vital cells.

Conclusions

Both antiseptics induced significant cell death of osteoblasts at optimum exposure. We therefore recommend cautious use of polyhexanide and chlorhexidine in septic surgery to avoid severe osteoblast toxicity.