我院医联体管理模式的实践现状

通过分析我院早期医联体模式的雏形、目前医联体的组织架构及紧密型医联体的三三三一管理模式,以及已经获得的初步成效,为推进其他地区医联体建设及组织管理提供参考。     

手足口病密切接触儿童预防用药后病原体阳性检出率分析

目的：分析手足口病（HFMD）密切接触儿童预防用药后病原体阳性检出率的变化,为HFMD的预防提供科学依据。方法：将HFMD密切接触儿童1106例分为预防1组（用中药）、预防2组（用中药加干扰素）、预防3组（用干扰素）、对照组（空白对照）,统计各组HFMD发病率,并从中随机抽取282例儿童采集大便标本,进行EV71和CoxA16病毒PCR检测。结果：（1）发病率各预防组与对照组比较差异有统计学意义（P〈0．001）,各预防组之间差异无统计学意义（P〉0．05）。（2）各组间、各组内发病与未发病儿童大便标本Ev71和CoxA16病毒PCR总阳性率比较差异均无统计学意义（P〉0．05）。结论：预防用药能显著降低HFMD发病率,但不能降低EV71和CoxA16病毒PCR总阳性检出率,其原因可能与投药剂量或其他因素有关。     

涂阳肺结核患者家庭密切接触儿童感染发病及预防的研究

目的观察涂阳肺结核患者家庭密切接触儿童感染发病情况,探讨儿童感染者预防性治疗方法。方法将涂阳肺结核患者家庭密切接触儿童与非涂阳肺结核患者密切接触儿童感染发病情况进行比较,对儿童感染者分组给予6H、12H、3HR、2HRZ等4种不同的方案进行预防性治疗,随访观察10年发病情况。结果涂阳肺结核患者家庭密切接触儿童感染率为63.6%,非涂阳肺结核患者家庭密切接触儿童感染率为10.4%,两组差异有统计学意义(P<0.05)。儿童结核感染者预防性治疗组完成治疗率达85%以上,经10年随访患病率为2.2%(4/182),4种方案平均药物不良反应发生率为8.6%。儿童结核感染者非预防性治疗组患病率达45.2%(47/104),两组差异有统计学意义(P<0.05)。结论涂阳肺结核患者家庭密切接触儿童属于结核病高危人群。早期发现涂阳肺结核患者并给予正规的抗结核治疗,积极动员其家庭成员尤其是儿童及时进行结核病筛查,是结核病管理的一个重要环节。儿童感染者预防性治疗可减少95.1%的结核病发病,是一种可靠预防结核感染的方法,在总体减轻结核病的影响可起到关键性作用。     

闭合复位交叉克氏针固定治疗儿童闭合性Gartland Ⅲ型肱骨髁上骨折合并血管神经损伤58例

目的：观察闭合复位交叉克氏针固定治疗儿童闭合性Gartland Ⅲ型肱骨髁上骨折的临床效果。方法对58例GartlandⅢ型小儿肱骨髁上骨折合并血管神经损伤患儿采用闭合手法复位交叉克氏针固定,辅以石膏夹板固定2周,4周后拔除克氏针,行肘关节伸屈功能锻炼。结果56例患儿获得随访6～24个月。按照Flynn临床功能评定标准,优40例,良14例,差2例,优良率为96.4%。结论儿童闭合型GartlandⅢ型肱骨髁上骨折合并血管神经损伤采用闭合复位交叉克氏针固定创伤小,操作简单,临床效果肯定,值得推广。     

Fracture Union in Closed Interlocking Nail in Humeral Shaft Fractures

Background:

Fracture shaft humerus is a major cause of morbidity in patients with upper extremity injuries. The aim of this study was to evaluate the outcome of interlocking nail in humeral shaft fractures.

Methods:

This study was conducted in the Department of Orthopedic Surgery in SMS and R Sharda University from January 2010 to November 2013. Seventy-eight patients were recruited from emergency and out-patient department having a close fracture of humerus shaft. All patients were operated under general anesthesia and closed reamed interlocking nailing was done. All patients were followed for 9 months.

Results:

Out of 78 patients, 69 patients underwent union in 90–150 days with a mean of 110.68 days. Complications found in four patients who had nonunion, and five patients had delayed union, which was treated with bone grafting. All the patients were assessed clinically and radiologically for fracture healing, joint movements and implant failure. The results were excellent in 88.46% and good in 6.41% patients. Complete subjective, functional, and clinical recovery had occurred in almost 100% of the patients.

Conclusions:

The results of the present study indicates that in the presence of proper indications, reamed antegrade intramedullary interlocked nailing appears to be a method of choice for internal fixation of osteoporotic and pathologic fractures.     

Percutaneous K-wire fixation in paediatric Supracondylar fractures of humerus: A retrospective study

Background:

Supracondylar fractures are the commonest elbow injury in children. Most displaced Supracondylar fractures are manipulated and held with a medial/lateral entry or two lateral Kirschner wires. It was the purpose of this study to investigate the treatment of this injury in this unique patient population.

Materials and Methods:

This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2005 to July 2010. One hundred seventy patients were recruited from Emergency and outpatient department having closed displaced Supracondylar fractures of humerus in children. They were treated either with medial-lateral pin fixation (n = 85) or with 2-lateral pin fixation (n = 85). All patients were operated under general anaesthesia. All patients were followed for 6 months. Results were analysed using Flynn''s criteria.

Statistical Analysis Used:

Chi Square Test. Chi Square calculator was used as a software.

Results:

All children achieved union in a mean time of 4 weeks (range: 3-6 weeks). Post-operatively, eight patients (4.70%) got ulnar nerve injury and six (3.52%) patients got pin tract infection. Comparison between two groups such as cross K-wire group (85) and lateral K-wire group (n = 85) by using the Chi Square Test showed that in case of 8 weeks with (P-values = 0.89), in 16 weeks (P = 0.91) and 24 weeks (P = 0.85) with respective excellent, good, fair and poor categories were not found statistically significant.

Conclusion:

The lateral percutaneous pinning technique of displaced Supracondylar fractures of the humerus offers a viable alternative to the crossed pinning group as it offers the same stability without the incipient risk of iatrogenic ulnar nerve injury.     

股骨头干三维互动闭合复位内固定治疗老年嵌插型股骨颈骨折

目的：探讨应用股骨头干三维互动闭合复位内固定治疗老年嵌插型股骨颈骨折的临床疗效。方法2011年1月至2012年3月对收治的老年嵌插型股骨颈骨折患者进行髋关节CT三维重建,筛选出股骨头有后倾移位的嵌插型骨折患者23例,其中男18例,女5例;年龄65~84岁,平均（71.5±3.9）岁;所有骨折均采用股骨头干三维互动闭合复位技术复位,复位满意后行内固定治疗。术中利用Garden对线指数对股骨颈骨折复位质量进行评价,对骨折愈合率、术后股骨头缺血坏死率及患者髋关节功能情况进行总结分析。结果术中所有病例均达到Ⅰ级复位,所有患者术后均获随访,随访时间11~26个月,平均（14.5±2.8）个月,骨折愈合22例,占95.65%（22/23）,其中1例出现股骨头缺血性坏死,占4.35%（1/23）。Harris髋关节评分为89~100分。结论应用股骨头干三维互动闭合复位技术可以将嵌插型股骨颈骨折更好的复位,术后髋关节功能恢复良好。     

气管插管致环杓关节脱位10例报告

目的:探讨气管插管致环杓关节脱位的原因、治疗与预防。方法:总结2000年5月～2010年12月收治的10例环杓关节脱位患者应用喉异物钳复位的临床资料。结果:10例患者中9例行1次治疗,1例行第2次治疗,复位效果满意。结论:了解环杓关节脱位的可能因素,有利于采取预防措施、及时治疗。     

闭合复位经皮克氏针固定治疗GartlandⅢ型儿童肱骨髁上骨折

目的评价几种常用的穿针方式在治疗GartlandⅢ型儿童肱骨髁上骨折的稳定性和安全性。方法选择近6年来经我院手术治疗的GartlandⅢ型儿童肱骨髁上骨折病例74例,均经闭合复位克氏针固定,依据穿针方式分为三组。通过对各组正位平片中Baumann角进行比较,评价各种穿针方式的稳定性,并应用Flynn评分对肘关节功能进行评价。结果经比较,各组术中及骨愈合时正位片的Baumann角的差异均无统计学意义;肱骨小头骨化中心与侧位片肱骨干的关系亦均未发生变化;各组末次随访时的肘关节评分差异亦均无统计学意义;各组均未发生医源性神经损伤。结论闭合复位经皮克氏针固定是治疗GartlandⅢ型儿童肱骨髁上骨折的有效方法之一     

患者知情同意权代为行使的案例分析及启示

以医疗典型纠纷案例为例,通过厘清相关法律对患者知情同意权行使及代为行使的相关规定,探讨知情同意权代为行使行为的界定。启示如下:知情同意权代为行使应设前置条件进行限制和约束;代为行使主体包括近亲属或关系人、委托代理人;患者本人意见具有首要优先性,委托代理人意见应优先于近亲属意见。