手术治疗复杂髋臼骨折疗效的评价

目的探讨手术治疗复杂髋臼骨折的临床疗效。方法对我院1996年4月～2002年3月收治的19例复杂髋臼骨折的患者进行切开复位重建钢板固定术,并对术后疗效进行回顾性分析。结果19例患者中15例达到解剖复位,14例疗效优,4例疗效良,术后均无严重并发症发生。结论:手术治疗复杂髋臼骨折效果良好,及时手术和尽可能解剖复位并予以可靠的固定是影响预后的关键。     

新时期军区总医院SWOT分析与战略定位

本文运用SWOT分析方法,阐明新时期军区总医院既有品牌、文化、技术、人才、环境和管理优势,又存在外部政策、人才培养、对外交流、病源网络、经营意识等方面的劣势,在建设研究型医院、坚持内生性发展、打造核心竞争力上存在机遇,同时也面临转型、竞争、发展三大挑战。在SWOT分析的基础上,认为需进一步明确新时期军区总医院的功能定位、发展定位、服务定位、战略定位和形象定位,确保医院的科学发展。     

三维记忆内固定系统与重建钛板治疗髋臼骨折合并髋臼关节后脱位的临床对比研究

目的 探讨三维记忆内固定系统（ATMFS）与重建钛板治疗髋臼骨折合并髋臼关节后脱位的临床疗效。方法 搜集2014年1月~2015年1月笔者医院收治的74例髋臼骨折合并髋臼关节后脱位患者为研究对象,根据所使用内固定物不同分为ATMFS组（34例）和重建钛板组（40例）,对比两组临床疗效及预后情况。结果 ATMFS组手术时间为85.16±10.52min,明显少于重建钛板组手术时间102.72±14.26min,差异有统计学意义（P<0.05）,ATMFS组术中出血量为836.74±136.15ml,明显少于重建钛板组术中出血量1003.47±216.38ml,差异有统计学意义（P<0.05）;术后7天,采用X线标准对骨折复位进行评估,ATMFS组：优15例,良13例,一般4例,差2例,优良率为82.35%,重建钛板组：优15例,良14例,一般7例,差4例,优良率为72.50%,ATMFS组优良率高于重建钛板组,但差异无统计学意义（P>0.05）;术后24个月末次随访,采用d''Aubigné髋关节评估系统进行临床疗效评定,ATMFS组优良率为91.18%,明显高于重建钛板组优良率72.50%,差异有统计学意义（P<0.05）;随访6、12、24个月,ATMFS组Harris评分均明显高于重建钛板组,差异有统计学意义（P<0.05）。结论 ATMFS治疗髋臼骨折合并髋臼关节后脱位手术时间短,术中出血量较少,更有利于髋关节功能恢复。     

Inclined position is associated with improved first pass success and laryngoscopic view in prehospital endotracheal intubations

Purpose

In hospital-based studies, patients intubated by physicians while in an inclined position compared to supine position had a higher rate of first pass success and lower rate of peri-intubation complications. We evaluated the impact of patient positioning on prehospital endotracheal intubation in an EMS system with rapid sequence induction capability. We hypothesized that patients in the inclined position would have a higher first-pass success rate.

Public transit generates new physical activity: Evidence from individual GPS and accelerometer data before and after light rail construction in a neighborhood of Salt Lake City,Utah, USA

Poor health outcomes from insufficient physical activity (PA) are a persistent public health issue. Public transit is often promoted for positive influence on PA. Although there is cross-sectional evidence that transit users have higher PA levels, this may be coincidental or shifted from activities such as recreational walking. We use a quasi-experimental design to test if light rail transit (LRT) generated new PA in a neighborhood of Salt Lake City, Utah, USA. Participants (n=536) wore Global Positioning System (GPS) receivers and accelerometers before (2012) and after (2013) LRT construction. We test within-person differences in individuals’ PA time based on changes in transit usage pre- versus post-intervention. We map transit-related PA to detect spatial clustering of PA around the new transit stops. We analyze within-person differences in PA time based on daily transit use and estimate the effect of daily transit use on PA time controlling for socio-demographic variables. Results suggest that transit use directly generates new PA that is not shifted from other PA. This supports the public health benefits from new high quality public transit such as LRT.     

不同通气方法对全麻俯卧位脊柱手术老年患者围术期呼吸功能的影响

目的观察不同通气方法对老年全麻俯卧位脊柱手术患者围术期呼吸功能的影响。方法选择拟在全麻俯卧位下行腰骶椎手术的老年患者60例,ASAⅠ或Ⅱ级,性别不限,年龄65~75岁,体重50~80 kg,体重指数≤25 kg/m2;采用随机法,将其分为3组,每组20例:C组(Vt:10 m L/kg)、LV组(Vt:6 m L/kg)和LV+PEEP组(Vt:6 m L/kg,PEEP:5 cm H2O)。记录麻醉前(T0)、气管插管后仰卧位机械通气10 min(T1)、气管插管后俯卧位机械通气10 min(T2)、气管插管后俯卧位机械通气60 min(T3)、气管拔管后脱氧30 min(T4)的血流动力学指标、血气分析指标及呼吸力学指标。结果三组患者HR、MAP比较差异无统计学意义(P>0.05);与LV组同时点比较,C组及LV+PEEP组机械通气期间Ppeak、Pmean较高(P<0.05),但LV+PEEP组与C组比较,差异无统计学意义(P>0.05);LV组及LV+PEEP组Cldyn明显高于同时点C组(P<0.05),但三组患者Cldyn均随着通气时间延长呈下降趋势,其中LV组与LV+PEEP组差异无统计学意义(P>0.05);在T4时点,LV+PEEP组Pa O2/Fi O2明显高于C组及LV组,A-a DO2低于C组及LV组,差异有统计学意义(P<0.05)。结论小潮气量联合低水平PEEP(6 m L/kg+5 cm H2O PEEP)通气能够有效改善全麻俯卧位脊柱手术老年患者术后氧合,提高肺的顺应性,有利于此类手术老年患者呼吸功能的恢复,而且对血流动力学无明显影响。     

The effect of body position on developing ultrasound criteria for the assessment of the internal jugular vein

Recent studies investigating chronic cerebrospinal venous insufficiency highlighted that intracranial venous return has not yet been routinely investigated by ultrasound in the normal population. This creates an absence of a reference standard and raises concerns that the approach introduces variations into the results. The primary objective of this study was to develop reference standards for the assessment of the internal jugular vein in a normal population. A prospective small-scale study was conducted. Internal jugular veins of 31 normal candidates were examined using B-Mode and PW Doppler. Measurements at proximal and mid-point internal jugular vein were taken in sitting (90°) and supine (0°) positions. Area measurements were taken during passive respiration in cm². Time average velocity measurements were taken during passive respiration over a 3-second period. Reflux measurements were taken after apnoea and reflux was recorded from any reversed flow. Measurements were taken three times; an average was calculated and statically analysed. Of the 31 participants, one was excluded from the study and 30 were suitable. The Mann-Whitney U test was used to analyse the results; all results (area, time average velocity and reflux) showed that there was a significant difference between the two positions with p < 0.05 (two-tailed). This pilot study does suggest that there is a significant difference in area, time average velocity and reflux measurements of the internal jugular vein when taken in the sitting and supine position, which could affect the outcome of chronic cerebrospinal venous insufficiency. A further large-scale study is required to validate and standardise the assessment of the internal jugular vein.     

前后联合入路配合移动窗技术治疗复杂髋臼骨折的疗效观察

【摘要】〓目的〓探讨髂腹股沟入路联合K-L入路配合移动窗技术治疗复杂型髋臼骨折的方法和疗效。方法〓对本院18例复杂型髋臼骨折患者采用髂腹股沟入路联合K-L入路配合移动窗技术行重建钢板手术内固定治疗。应用Matta法评定骨折复位情况,D’Aubigine法评定髋关节功能,Brooker法评价异位骨化的发生,同时观察并发症的发生率。结果〓解剖复位12例,满意复位6例,无不满意复位;关节功能优良率达94.4%;并发异位骨化1例(1级);术后并发创伤性关节炎1例,股骨头坏死1例。结论〓采用前后联合入路配合“移动窗”技术治疗复杂髋臼骨折可尽可能全面暴露术野,提高复位固定的效果,促进患者髋关节的稳定性提升和髋关节功能的改善,同时减少并发症发生。