肱骨头骨折伴肩关节脱位的外科治疗

目的分析不同手术方法治疗肱骨头骨折伴肩关节脱位的近期临床效果.方法采用可吸收螺钉结合减张缝合线固定修复、肱骨近端锁定钢板固定、人工肱骨头置换等治疗12例肱骨头骨折伴肩关节脱位患者。结果12例均获随访,时间10-16（13±1．8）个月.10例术后3个月骨折基本愈合,1例12个月出现假体松动伴骨融解,1例10个月出现肩关节半脱位.肩关节活动范围：屈129°±26°．伸32°±9°,展121°±16°,采用Neer评分标准评定治疗效果达（80±5）分.结论肱骨头骨折伴肩关节脱位需根据患者年龄、骨质条件、骨折类型等采用个体化的外科治疗,术后早期功能练习,可获得满意的近期临床效果.     

间断气囊压迫法预防下肢术后深静脉血栓

目的探讨间断气囊压迫法对老年患者髋部骨折术后深静脉血栓形成（DVT）的预防效果。方法83例髋部骨折患者术后当天开始患肢间断气囊压迫治疗,并作足踝被动屈伸和环转运动。24h后鼓励患者主动功能锻炼。术后2周作超声多普勒检查有无下肢静脉血栓。结果随访3～6个月,8例患者出现DVT,发生率为9.6%。近端DVT3例,其中2例出现肢体肿胀症状;远端DVT5例,均无明显临床症状。未出现肺栓塞患者,无伤口及其他部位异常出血发生。结论老年患者髋部骨折术后进行下肢间断气囊压迫治疗并主动功能锻炼可以有效减少DVT的发生,没有增加出血的危险,安全可靠。     

Magnetic Resonance Imaging Findings in Patients with Tarsal Tunnel Syndrome

Tarsal tunnel syndrome (TTS) is a common entrapment syndrome whose diagnosis can be difficult. We compared preoperative magnetic resonance imaging (MRI) and operative findings in 23 consecutive TTS patients (28 sides) whose mean age was 74.5 years. The 1.5T MRI sequence was 3D T2* fat suppression. We compared the MRI findings with surgical records and intraoperative videos to evaluate them. MRI- and surgical findings revealed that a ganglion was involved on one side (3.6%), and the other 27 sides were diagnosed with idiopathic TTS. MRI visualized the nerve compression point on 23 sides (82.1%) but failed to reveal details required for surgical planning. During surgery of the other five sides (17.9%), three involved varices, and on one side each, there was connective tissue entrapment or nerve compression due to small vascular branch strangulation. MRI studies were useful for nerve compression due to a mass lesion or idiopathic factors. Although MRI revealed the compression site, it failed to identify the specific involvement of varices and small vessel branches and the presence of connective tissue entrapment.     

良性肝脏肿瘤肝移植相关进展

肝脏肿瘤分为良性和恶性,其中良性肝脏肿瘤较为常见,治疗以随访观察、介入治疗为主,仅少数情况下需要进行外科手术切除治疗。肝移植可有效治疗终末期肝病,但通常不作为良性肝脏肿瘤的治疗手段,仅存在巨大占位压迫、合并肝衰竭、肿瘤破裂出血风险或恶变风险的良性肝脏肿瘤才考虑进行肝移植治疗。与恶性肿瘤及慢性肝衰竭肝移植相比,良性肝脏肿瘤肝移植手术风险相当,预后及远期生存较为理想。但良性肝脏肿瘤肝移植术前应充分谨慎评估,同时注意新形势下供肝匹配难度。本文对良性肝脏肿瘤包括肝血管瘤、多囊肝、肝细胞腺瘤、肝脏间叶错构瘤等肝移植相关研究进展进行总结,旨在为肝移植治疗良性肝脏肿瘤提供参考。     

Pathogenesis of Terson syndrome

Purpose:The aim of this experimental study was to investigate the pathogenesis of Terson syndrome (TS), which currently is controversial.Methods:The central retinal artery (in 39 orbits), posterior ciliary arteries (in 8 orbits), and central retinal vein (CRV in 21 orbits) were occluded in rhesus monkeys by exposing them to lateral orbitotomy. Fundus examination and fluorescein fundus angiography were performed before and immediately after cutting the vessels and serially thereafter during the follow-up period. The rationale of the experimental study design is discussed.Results:In eyes with central retinal artery occlusion, retinal hemorrhages were seen soon after the procedure in 7 eyes, and on follow-up in a total of 15 eyes. In posterior ciliary artery occlusion, retinal hemorrhages were seen soon after the procedure in one eye, and on follow-up in a total of three eyes. In eyes with CRV, all eyes had extensive scattered retinal hemorrhages.Conclusion:The findings of this experimental study, and my basic, experimental, and comprehensive clinical studies on CRVO, suggest the following concept of the pathogenesis of TS: Compression of the CRV plays a crucial role in the development of TS. The CRV is compressed, as it lies in the subarachnoid space of the optic nerve sheath, by raised cerebrospinal fluid pressure and/or accumulated blood. This results in retinal venous stasis and raised venous pressure in the retinal veins, leading to venous engorgement, rupture of the retinal capillaries and retinal hemorrhages. The clinical importance of compression of the CRV and not occlusion of CRV in TS is that optic nerve sheath decompression by opening it and releasing the blood and raised cerebrospinal fluid (CSF) pressure, would result in immediate decompressing of the CRV in the subarachnoid space and restoration of normal circulation and prevent visual loss.     

DXA椎体骨折评估联合腰椎侧位骨密度诊断老年性骨质疏松的临床研究

目的研究双能X线吸收检测法（DXA）椎体骨折评估（VFA）联合腰椎侧位骨密度诊断老年性骨质疏松的效能。方法选取我院DXA同时检测髋部、腰椎前后位、腰椎侧位骨密度及VFA的老年受检者86例,根据DXA骨密度低下或VFA有脆性骨折诊断骨质疏松。比较腰椎侧位骨密度联合VFA与常规DXA检测髋部及腰椎前后位骨密度诊断骨质疏松的检出率。检出率的比较采用χ2检验。结果所有受检者中,常规DXA检测髋部及腰椎前后位诊断出骨质疏松患者58例（58/76,76.3%）,侧位骨密度联合VFA诊断出骨质疏松患者76例（76/76,100%）,二者检出率差异有统计学意义（χ2=10.617,P < 0.001）。其中,股骨颈骨密度诊断骨质疏松疏检出率（55.3%）高于髋部整体（34.2%）,二者差异有统计学意义（χ2=6.812,P < 0.05）;髋部骨密度、腰椎前后位骨密度、腰椎侧位骨密度和VFA诊断骨质疏松症检出率分别为60.5%、47.4%、84.2%和78.9%,腰椎侧位骨密度与VFA的骨质疏松检出率比较,差异无统计学意义（χ2=0.700,P>0.05）,但二者均高于髋部骨密度的骨质疏松检出率（χ2=10.66、6.110,均P < 0.05）。结论DXA检测腰椎侧位骨密度联合VFA对老年性骨质疏松的诊断具有重要价值,能够避免骨质疏松的漏诊。     

The Role of Intramedullary Nailing for Proximal Humerus Fractures: What Works and What Does Not

Purpose of ReviewThe evaluation of proximal humerus fractures (PHFs) should be aimed to answer the following four questions: (1) does the fracture need surgery in each particular patient? (2) if surgery is recommended, is it better to proceed with internal fixation or shoulder arthroplasty, (3) if internal fixation is recommended, what is the ideal fixation device strategy, and (4) how can outcomes be optimized? This review article tries to answer these questions and provides some clarity regarding what works and what does not in PHFs treated with intramedullary nailing.Recent FindingsAccording to published articles on the treatment of PHFs with intramedullary nails, it is difficult to draw conclusions about outcomes and complications due to great variation in age, type of fracture, and nail designs included in the studies. However, the literature seems to support the use of modern nail designs for PHFs, especially in fractures of the surgical neck as well as varus posteromedial and valgus fractures with no tuberosity involvement.SummaryAlthough the results of IMN in PHF seem to be better in two-part fractures, in more complex fractures, the quality of the reduction achieved seems to influence functional outcomes. Tuberosity malreduction leads to poor clinical outcomes, high rate of complications, and an increased risk of avascular necrosis. Malreduction of the humeral head increases the risk of postoperative loss of reduction, especially for varus posteromedial impacted fractures. A medial nail entry point decreases the risk of postoperative varus malunion, preserves the rotator cuff tendon, and avoids iatrogenic fractures of the GT. To decrease the risk of postoperative stiffness, fracture fixation should be stable enough to allow early mobilization.     

Handgrip strength is correlated with activities of daily living,balance, and body composition in patients with thoracolumbar compression fracture

This study assessed the relationship between handgrip strength (HGS) and activities of daily living, balance, walking speed, calf circumference, body muscle, and body composition in elderly patients with thoracolumbar vertebral compression fracture (VCF). A cross-sectional study in a single hospital was performed with elderly patients diagnosed with VCF. After admission, we evaluated HGS, 10-meter walk test (speed), Barthel Index, Berg Balance Scale (BBS), numerical rating scale of body pain, and calf circumference. We examined skeletal muscle mass, skeletal muscle mass index, total body water (TBW), intracellular water, extracellular water (ECW), and phase angle (PhA) in patients with VCF using multi-frequency direct segmental bioelectrical impedance analysis after admission. A total of 112 patients admitted for VCF were enrolled (26 males, 86 females; mean age 83.3 years). The prevalence of sarcopenia according to the 2019 Asian Working Group for Sarcopenia guideline was 61.6%. HGS was significantly correlated with walking speed (P < .001, R = 0.485), Barthel Index (P < .001, R = 0.430), BBS (P < .001, R = 0.511), calf circumference (P < .001, R = 0.491), skeletal muscle mass index (P < .001, R = 0.629), ECW/TBW (P < .001, r = −0.498), and PhA (P < .001, R = 0.550). HGS was more strongly correlated with walking speed, Barthel Index, BBS, ECW/TBW ratio, and PhA in men than women. In patients with thoracolumbar VCF, HGS is associated with walking speed, muscle mass, activities of daily living measured using the Barthel Index, and balance measured using BBS. The findings suggest that HGS is an important indicator of activities of daily living, balance, and whole-body muscle strength. Furthermore, HGS is related to PhA and ECW/TBW.     

Influence of Processing Parameters on the Mechanical Properties of Peek Plates by Hot Compression Molding

Thermoplastic components are gaining more and more attention due to their advantages which include high specific strength, high toughness, and low manufacturing costs. Despite the fast development of such materials in engineering applications, the major challenge for the wider use of thermoplastic components is the diverse mechanical properties that are caused by uncertain factors during the molding process. In this paper, the effects of processing parameters on the mechanical properties of PEEK plates by hot compression molding are systematically investigated, including the temperature, pressure, and compression time. It was found that both temperature and time can sensitively change the mechanical properties; however, a pressure larger than 1.5 MPa showed a limited impact on the mechanical behaviors of PEEK plates. The optimal process parameters include a hot compression temperature of 400 °C, a compression time of 30 min, and a pressure of 2.5 MPa.