经皮冠状动脉成形术后卧位调整对患者舒适度影响的研究

目的改善经皮冠状动脉成形术后患者卧位舒适度。方法采用抽签随机分为两组,采取空白对照法,常规护理组60例病人按常规进行护理,伤口用弹性绷带压迫18h,期间保持平卧位。观察组60例病人采用护理干预,弹性绷带压迫2h后病人的卧位变动。运用自行设计的舒适程度评估表对两组病人进行评估。结果观察组穿刺点出血、血肿与常规护理组相比无显著性差异(P>0.05);干预组病人烦躁,排尿困难,腰酸背痛,失眠等不适情况与常规护理组相比明显减轻,有显著性差异P=0.000。护理干预组与常规护理组舒适程度比较有显著性差异,经Wilcoxon秩和检验P=0.000,护理干预组病人舒适度优于常规护理组病人。结论经皮冠状动脉成形术后的病人拔鞘管2h后,伤口在包扎弹性绷带下,可根据病人的需要给予适当调节卧位,提高病人的舒适度,减少并发症。     

标准外伤大骨瓣减压并环池引流治疗重型颅脑损伤脑疝的效果

目的探讨标准外伤大骨瓣减压并环池冲洗引流治疗重型颅脑损伤脑疝病人的效果。方法回顾性分析比较重型颅脑损伤脑疝病人行标准外伤大骨瓣减压并环池冲洗引流术和单纯标准外伤大骨瓣减压术的疗效。两组术前、术后均进行脱水、预防感染、止血、脑保护等处理。结果治疗组疗效明显优于对照组（u=5.6,P〈0.05）。结论标准外伤大骨瓣减压并环池冲洗引流术可以有效提高重型颅脑损伤脑疝病人的疗效,改善预后。     

Posterior Inferior Tibiofibular Ligament Release to Achieve Anatomic Reduction of Posterior Malleolar Fractures

We assessed the clinical and radiographic outcomes of posterior inferior tibiofibular ligament (PITFL) release to achieve anatomic reduction of posterior malleolar fractures (PMFs). Nineteen PMFs (>25% of tibial plafond) that could not be reduced after anatomic reduction of distal fibula fractures were managed by PITFL release. The syndesmosis was stressed intraoperatively and by 2 surgeons unaware of the postoperative measurements to increase reliability. The pre- and postoperative fracture gaps and articular step-offs were measured on lateral radiographs of all patients and computed tomography (CT) scans of 12. Tibiofibular clear space and overlap measures at the final follow-up visit were used to evaluate postoperative syndesmotic stability. Postoperative function was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) scale score. The mean pre- and postoperative fracture gap and step-off of the PMFs was 4.9?mm and 0.4?mm and 2.8?mm and 0.4?mm, respectively. On CT scan, the mean pre- and postoperative fracture gap and step-off was 5.2?mm and 0.5?mm and 3.3?mm and 0.6?mm, respectively. The preoperative and final follow-up tibiofibular clear space and overlap did not differ significantly. The mean follow-up period was 26.7 months, and the mean AOFAS scale score was 90.6 points at the final follow-up. Direct visualization and reduction of PMFs through PITFL release led to satisfactory clinical and radiographic outcomes without causing ankle instability.     

Quantification of the Learning Curve for Arthroscopic Os Trigonum Excision

The purpose of the present study was to quantify the learning curve for arthroscopic os trigonum excision using the log-linear model. Twenty-three consecutive feet underwent arthroscopic os trigonum excision and release of the flexor hallucis longus. The required time from the beginning of shaving of the soft tissue until completion of os trigonum excision and release of the flexor hallucis longus (van Dijk time) was recorded. Regression analysis was applied to predict the required time on the basis of the cumulative case volume after logarithmic transformation of both statistics. The mean required time was 35.2 (range 9 to 90) minutes. After logarithmic transformation, a significant linear correlation was observed between the required time and the cumulative case volume (p?=?.0043). The best-fit linear equation was calculated as log (y, estimated required time)? = ?0.41 log (x, case volume) + 1.86, resulting in an estimated learning rate of 75.3% (= 2^?0.41). The results showed an overall time reduction in arthroscopic os trigonum excision in support of a learning curve effect with an ~75% learning rate, indicating that the required time for arthroscopic os trigonum excision can decrease by ≤25% when the cumulative volume of cases has doubled.     

特殊体位护理对枕后位及枕横位产妇分娩效果的影响

目的对产程中通过改变产妇体位矫正枕后位及枕横位的效果进行观察。方法在第一产程进入活跃期后取诊断为枕后位及枕横位而无明显头盆不称的产妇120例，随机分为研究组和对照组，每组60例。对研究组产妇实施特殊体位护理以纠正胎位；对照组产妇常规护理。结果研究组在缩短产程、提高自产率、降低手术产率、减少产后出血、降低胎儿及新生儿的窒息发生率方面均优于对照组，两组比较有显著性差异（P〈0．01）。结论在产程中指导产妇采取特殊体位对纠正枕后位及枕横位是有效的，可降低手术产率，提高产科的分娩质量，且方法简单，易于在临床推广使用。     

功能性电刺激对成人下肢解痉术后肌力恢复的影响

目的观察下肢痉挛患者术后应用肌兴奋治疗仪的疗效。方法将 49例接受手术治疗的下肢痉挛患者术后分为治疗组 (2 1例 )和对照组 (2 8例 )。两组患者术后均进行常规康复训练 ,但治疗组患者加用肌兴奋治疗仪治疗。于肌兴奋治疗仪治疗前及术后 3个月、6个月时分别对两组患者相应肌肉平均肌力进行评定。结果治疗组患者肌力提高和运动功能改善情况均优于对照组 (P <0 .0 5 ,P <0 .0 1)。结论下肢痉挛患者术后进行康复训练时 ,应用肌兴奋治疗仪可加快肌力恢复和运动功能改善。     

Laparoscopic anterior and posterior native tissue repair: a new pelvic floor approach

Introduction: Traditionally, a cystocele caused by a midline defect of the pelvic fascia is treated by vaginal fascia duplication, also known as anterior colporraphy. The rectocele is managed by suturing the posterior fascia and, frequently, the levator ani muscles. We developed the approach of laparoscopic anterior and posterior fascia repair by native tissue.

Material and methods: The methods were based on anterior and posterior exposure of pelvic fascia similar to the preparation of an extended sacral colpopexy. The fascia was compressed and narrowed by absorbable woven sutures, size 1. Twenty-seven patients were followed up for 6–13?months. All patients received additional apical fixation by pectopexy.

Results: In the examination group, 13 patients underwent anterior laparoscopic fascia repair and 23 had posterior repair. We detected one apical and one posterior relapse, and also one in the anterior repair group. The patient with the apical relapse reported pain and de novo urgency. Anatomical reconstruction was achieved in all other patients.

Summary: Laparoscopic anterior and posterior native tissue repair appears to be a feasible method for the treatment of midline cystocele and rectocele. No new risks were observed. The technique leaves no scar in the vagina and is well accepted.

Abbreviations: POPQ: Pelvic Organ Prolapse Quantification System; FDA: Food and Drug Association; US: United States; Fig: Figure; ICIQ: International Consultation on Incontinence Questionnaire     

全新世女性颏孔、下颌孔的位置特征及时代间比较*

目的：探讨全新世女性群体颏孔位置、颏孔开口方向、下颌孔位置等在不同时代的表现特点,并探讨可能 存在的时代间变异。方法：对中国全新世201 例女性下颌骨的颏孔、下颌孔的体质特征进行分类和记录,然后用 SPSS 19.0 软件进行出现率统计及时代间差异显著性检验。结果：所比较的性状在不同时代间的表现特点具有一 定相似性：颏孔位置主要在下颌第2 前臼齿（P4）下面,颏孔开口方向主要为“后上”,下颌孔位置（ 水平方向） 主要为“下颌支中点之后”,下颌孔位置（ 垂直方向）主要为“齿槽面之上”。同时,不同时代间也存在一些差异, 近代人群颏孔位置相对靠后、下颌孔位置相对较高。结论：从青铜铁器时代到近代,女性的颏孔位置有相对后移 趋势;这些变化可能与该时段内下颌骨尺寸变小有一定的相关性。下颌孔位置时代间差异较小。