老年股骨近端骨折患者并发症的预见性护理

目的总结老年股骨近端骨折患者并发症的预防和护理对策。方法将192例患者分成对照组96例与观察组96例。对照组使用常规护理方法,观察组在常规护理基础上强化并发症的预防护理。观察、记录两组患者并发症的发生率和满意度。结果观察组患者住院期间并发症的发生率均低于对照组,满意度高于对照组,差异均有统计学意义(P0.05)。结论实施预见性护理对降低老年股骨近端骨折患者的并发症、提高满意度有较好的临床效果,预见性护理策略和精细的护理工作模式是今后护理工作方向。     

Parapharyngeal space tumors: Fifty-one cases managed in a single tertiary care center

Conclusions: Pre-operative planning for parapharyngeal tumors must include meticulous analysis. Factors such as tumor size, distance to cranial base, and relation to neurovascular structures must guide the selection of a surgical approach. Objective: To summarize experience in diagnosis and surgical management of parapharyngeal tumors, analyzing the frequencies of various tumoral types, clinical presentation, choice of surgical approach and outcomes. This study also compares the results with the most relevant case series in the literature. Methods: A retrospective review was performed of the records of 51 patients treated by the team, from 1984–2012. Only primary tumors were included, excluding invasion from adjacent spaces and metastatic disease. All patients underwent imaging studies and surgical resection of the neoplasm. Cytological analysis and arteriography were used on an individualized basis. Surgical excision was performed via different approaches, predominantly through a cervicoparotid route. Results: Benign neoplasms were predominant (80%), and the most frequent tumor was pleomorphic adenoma. FNAC had a 100% accuracy to differentiate benign vs malignant tumors. The most common post-operative sequel was compromise of a cranial nerve, and three patients presented local complications after surgery. After follow-up, only three of 41 patients with benign tumors had recurring disease.     

Antiresorptive treatment,when initiated after a first hip fracture,may not protect of a second contralateral episode in elderly population: A study with 685 patients

IntroductionOsteoporosis predisposes for a higher risk of hip fracture and its treatment is frequently underprescribed. Our purpose was to assess the relation between having a second hip fracture and receiving osteoporosis treatment. Also to assess the relation between this second fracture and using central nervous system drugs or being institutionalised.Patients and methodsWe reviewed all the patients that were admitted to our hospital with an osteoporotic proximal femoral fracture between September 2009 and February 2011. We identified 685 patients, 74 of which presented a contralateral fracture. We evaluated if they were receiving osteoporosis treatment or taking any medication that could affect the central nervous system and if they were institutionalised.ResultsA 10.8% of patients had a second fracture and the mean time between the two of them was 20 months (1–122). There was a clear female predominance (76.35%). The mean age at occurrence of the primary fracture was 83.02 years and 85 for the second. A 90.8% did not follow any type of osteoporosis medication before the first fracture. A 50.9% did not receive central nervous system drugs and 79.1% lived at home at the time of the first fracture. 12.8% of the patients that did not follow the osteoporosis treatment, had a contralateral fracture, 3% more than those that did follow some kind of treatment, but this difference was not significant (p = 0.2).DiscussionWe identified a similar number of patients undergoing osteoporotic treatment as registered in literature. There was no significant difference between suffering a second hip fracture and following osteoporosis treatment, using psychotropic drugs or being institutionalised.     

乳酸亚铁治疗股骨粗隆间骨折隐性失血的疗效分析

目的：探讨股骨粗隆间骨折术后隐性失血的原因及乳酸亚铁治疗隐性失血对术后功能的影响。方法将182例股骨粗隆间骨折患者随机分组。试验组口服乳酸亚铁8周，对照组未进行干预。均采用手术治疗，在入院当天,术后前3 d，出院时及手术后第1、3、6个月检测血红蛋白和血清铁蛋白，并用股四头肌功能恢复及下床时间评价患者功能情况。结果182例患者有2例失访，试验组89例、对照组91例进入最终研究分析。手术前试验组和对照组血红蛋白分别为（121.3±6.7）g/L和（120.5±7.0）g/L，差异无统计学意义（P=0.472）；手术前试验组和对照组血清铁蛋白分别为（13.2±0.5）μg/L和（12.9±0.7）μg/L，差异无统计学意义（P=0.472）。手术3 d后两组的血红蛋白和血清铁蛋白较术前明显下降，但两组之间的差异无统计学意义（P﹥0.05）。术后第1、3、6个月试验组血红蛋白增加量均明显高于对照组（P〈0.05）；术后第1、3、6个月试验组FIM评分增加值均明显高于对照组，差异有统计学意义（P〈0.05）。本研究中Evans各型之间术后3 d内血红蛋白下降量之间的差异无统计学意义。结论股骨粗隆间骨折不同Evans类型间术后隐性失血量无明显差异。口服乳酸亚铁能有效防治隐性失血，加快患者术后功能恢复。     

骨折治疗仪辅助外固定治疗开放性骨折的临床疗效观察

目的探讨骨折治疗仪辅助外固定治疗开放性骨折的临床疗效。方法将我院近期收治的66例开放性骨折患者按照人院先后顺序分为观察组和对照组，每组各有33例患者，对照组患者给予常规清创、复位、外固定及功能锻炼指导等治疗，观察组患者在此基础上采用骨折治疗仪治疗，随访观察两组患者的骨折愈合时间及运动功能情况。结果观察组患者骨折平均愈合时间为（9．2±1．9）周，愈合时间短于对照组患者的（10．4±2．2）周，差异有统计学意义（P〈0．05）。观察组患者疗效优良率为90．9％，显著高于对照组患者的69．7％，差异有统计学意义（P〈0．05）。结论骨折治疗仪辅助外固定治疗开放性骨折的临床疗效较好，值得临床借鉴应用。     

口腔科首诊颈侧区无痛性肿块175例回顾性分析

目的:总结颈侧区非涎腺、非甲状腺无痛性肿块的临床分布规律及与年龄的关系。方法:对2005～2012年6月收治的175例颈侧区无痛性肿块临床资料进行回顾性分析。结果:175例颈侧区无痛肿块,40岁以下各组良性肿块多见,40岁以上各组恶性肿块多见。肿块中肿瘤107例,炎症40例,畸形28例。结论:颈侧区非涎腺、非甲状腺无痛性肿块性质与年龄存在关系,40岁以下良性肿块多见,40岁以上恶性肿块多见。本组病例中,肿瘤多见,肿瘤中恶性肿瘤多见,其中40岁以下患者恶性肿瘤以淋巴瘤占首位,40岁以上患者以转移癌多见。     

单节段内固定术治疗胸腰椎骨折的手术方法与临床疗效分析

目的 研究单节段内固定术治疗胸腰椎骨折的手术方法与临床疗效.方法 将90例胸腰椎骨折患者按随机数字表法分为观察组（单节段内固定术）和对照组（双节段内固定术）,每组45例,比较两组手术情况、术后疼痛程度、矫正情况、伤椎相邻椎关节病变情况等.结果 观察组手术时间、出血量、切口长度、术后疼痛发生率、上节段和下节段间盘退变发生率明显少于对照组[（107.93±2.75） min比（132.68±2.81） min、（198.44±9.17）ml比（314.18±8.73）ml、（8.36±1.15）cm比（12.33±1.08） cm、8.89％（4/45）比26.67％（12/45）、6.67％（3/45）比22.22％（10/45）和4.44％（2/45）比20.00％（9/45）],差异有统计学意义（P＜0.01）.两组矫正情况比较差异无统计学意义（P＞0.05）.结论 在症状适宜的情况下,单节段内固定术治疗胸腰椎骨折效果突出,术后患者恢复状况好,术后并发症少,远期不良影响轻微,建议在临床中推广应用.     

Good radiological and functional results after intramedullary nailing of distal radius fractures

Abstract

To evaluate the results after fixation of distal radius fractures using Micronail® internal fixation, a prospective cohort study was performed, including displaced fractures of the distal radius (AO type A 2.2, A3.1, and A3.2). In total, 60 patients were included and 44 patients were available for 1-year follow-up (radiological and clinical examination) and 39 for 5-year follow-up (telephone interview). It was found that all fractures healed, with an average radial volar tilt of 2°, radial length of 11 mm, and a radial inclination of 22°. The functional result was excellent-to-good in 93% of the patients. Thirteen patients (30%) reported paraesthesia of the superficial branch of the radial nerve at the 1-year follow-up. In four patients the paraesthesia of the radial nerve was persistent. No other complications or reoperations were reported by the patients at the 5-year follow-up and only one implant had been removed. The study confirms that the Micronail® is a minimal invasive method that can provide a stable fixation of selected distal radius fractures and provide a good functional outcome with a very low need of implant removal after fracture healing with few complications related to the operation, the main complication being permanent damage to the radial nerve.     

Papillomavirus humain et cancer ORL

Head and neck cancer is frequently associated with alcohol and tobacco consumption but there is an increasing incidence of oropharyngeal carcinoma associated with oncogenic type-16 human papillomavirus (HPV). The clinical profile of these patients is distinct from that of other patients, with an earlier onset, 1/1 male to female sex ratio, cystic cervical nodes. Detection of intratumoral viral DNA is essential to confirm the role of HPV. According to several reports, the prognosis in terms of survival and locoregional control is better in HPV-positive oropharyngeal carcinoma than in HPV-negative oropharyngeal carcinoma or associated with tobacco consumption. The future lies in vaccination of women against cervical cancer but vaccination of boys will be certainly necessary.