股骨近端髓腔三维解剖测量

目的测量国人股骨近端髓腔形态,探讨适合国人的股骨近端髓内钉设计方案。方法选取120侧(男性55侧,女性65侧)正常成人单侧股骨近端CT扫描数据,利用Mimics图像分析软件对股骨近端的髓腔内径及髓腔开大指数行三维解剖测量,研究其与身高、年龄之相关性,及性别差异,并与国内外数据进行综合比较。结果以小粗隆中点为参考点(T),男、女性组髓腔内径分别为:T+20(44.79±5.42)mm和(39.79±4.96)mm;T+10(34.00±3.64)mm和(32.06±3.29)mm;T(26.93±3.71)mm和(24.18±3.31)mm;T-20((18.65±2.96)mm和(18.21±2.60)mm;峡部(10.40±1.45)mm和(10.15±1.05)mm。男女组T+20、T+10、T处比较存在显著性差异(P0.001);T-20、峡部处两组间比较无显著性差异(P0.05)。身高与各组间数据存在正相关关系,存在统计学意义(P0.05),与干骺端髓腔开大指数呈负相关,存在统计学意义(P0.05);偏相关分析年龄与髓腔内径参数间存在正相关关系,存在统计学意义(P0.05),而与各组髓腔开大指数间无明显相关性。结论东西方人、男女性之间股骨近端髓腔内径存在显著性差异,在治疗粗隆间骨折时需要充分评估其股骨近端内径,选用合适的内固定器械。     

PFNA与DHS治疗老年股骨粗隆间骨折的疗效比较

目的比较PFNA与DHS治疗老年股骨粗隆间骨折的疗效差异。方法60例老年股骨粗隆间骨折患者均为择期手术病例,其中将30例行PFNA内固定术的患者设立为观察组,另选择同期行DHS内固定术治疗的30例患者作为对照组。结果与对照组比较,观察组手术时间短,术中出血量少,骨折愈合时间快,差异有统计学意义（P〈0．05）。对照组并发症发生率明显高于观察组,差异有统计学意义（P〈0．05）。疗效参照Harris功能评分标准显示,观察组的优良率达90．0％,对照组的优良率达83．3％。两组疗效比较,差异无统计学意义（P〉0．05）。结论PFNA内固定术应用于老年股骨粗隆间骨折具有操作简单,手术时间短,创伤小,术中出血少,能有效改善患者的髋关节功能的优点,值得推广和应用。     

PFNA微创治疗高龄不稳定股骨粗隆间骨折临床观察

目的：探析PFNA微创法对高龄不稳定性股骨粗隆间骨折患者的临床效果。方法：入选112例高龄不稳定性股骨粗隆间骨折患者,随机分入两组各56例,治疗组行PFNA微创治疗,对照组行PFN法治疗,比较两组患者的手术时间、并发症、骨折愈合时间等评价疗效。结果：治疗组优良率显著高于对照组（91％vs．79％,P＜0．05）,并发症发生率显著低于对照组（7％vs．34％,P＜0．05）,预后显著优于对照组（ P＜0．05）。结论：采用微创PFNA治疗高龄股骨粗隆间骨折,容易操作,愈合较快,疗效确切,感染等并发症少,值得临床推广。     

髓外固定系统与髓内固定系统治疗股骨粗隆间骨折的疗效比较

目的比较分析髓外固定系统与髓内固定系统治疗股骨粗隆间骨折的疗效。方法选取2008年1月至2012年3月我院骨科收治的股骨粗隆间骨折患者52例,将其随机分为DHS组和PFNA组,各26例。比较两组优良率、手术时间、术中出血量、骨折愈合时间及术后并发症情况。结果PFNA组优良率为92．3％,DHS组优良率为88．5％,两组优良率相比,差异无统计学意义（P〉0．05）;PFNA组手术时间、术中出血量、骨折愈合时间及术后并发症均显著优于对照组,差异有统计学意义（P〈0．05）。结论PFNA与DHS两种手术治疗股骨粗隆间骨折均能取得较好的治疗效果。与DHS相比,PFNA系统具有手术时间短、术中出血量少、术后恢复快及术后并发症少等优点,更值得在临床上推广应用。     

Occurrence of perfluorinated compounds (PFCs) in drinking water of North Rhine-Westphalia,Germany and new approach to assess drinking water contamination by shorter-chained C4–C7 PFCs

After detection of perfluorooctanoate (PFOA) in drinking water at concentrations up to 0.64 μg/l in Arnsberg, Sauerland, Germany, the German Drinking Water Commission (TWK) assessed perfluorinated compounds (PFCs) in drinking water and set for the first time worldwide in June 2006 a health-based guide value for safe lifelong exposure at 0.3 μg/l (sum of PFOA and perfluorooctanesulfonate, PFOS). PFOA and PFOS can be effectively removed from drinking water by percolation over granular activated carbon. Additionally, recent EU-regulations require phasing out use of PFOS and ask to voluntarily reduce the one of PFOA. New and shorter-chained PFCs (C4–C7) and their mixtures are being introduced as replacements. We assume that some of these “new” compounds could be main contributors to total PFC levels in drinking water in future, especially since short-chained PFCs are difficult to remove from drinking water by common treatment techniques and also by filtration over activated carbon. The aims of the study were to summarize the data from the regularly measured PFC levels in drinking water and in the drinking water resources in North Rhine-Westphalia (NRW) for the sampling period 2008–2009, to give an overview on the general approach to assess PFC mixtures and to assess short-chained PFCs by using toxicokinetic instead of (sub)chronic data. No general increase of substitutes for PFOS and PFOA in wastewater and surface water was detected. Present findings of short-chained PFC in drinking waters in NRW were due to extended analysis and caused by other impacts. Additionally, several PFC contamination incidents in drinking water resources (groundwater and rivers) have been reported in NRW. The new approach to assess short-chained PFCs is based on a ranking of their estimated half-lives for elimination from the human body. Accordingly, we consider the following provisional health-related indication values (HRIV) as safe in drinking water for lifelong exposure: perfluorobutanoate (PFBA) 7 μg/l, perfluoropentanoate (PFPA) 3 μg/l, perfluorohexanoate (PFHxA) 1 μg/l, perfluoroheptanoate (PFHpA) 0.3 μg/l, perfluorobutanesulfonate (PFBS) 3 μg/l, perfluoropentanesulfonate (PFPS) 1 μg/l, perfluorohexanesulfonate (PFHxS) 0.3 μg/l and perfluoroheptanesulfonate (PFHpS) 0.3 μg/l. For all PFCs the long-term lowest maximal quality goal (general precautionary value, PV_g) in drinking water is set to −0.1 μg/l.     

PFNA治疗逆股骨转子间骨折的疗效分析

目的:探讨PFNA治疗逆股骨转子间骨折的临床疗效。方法:应用微创闭合复位防旋型股骨近端髓内钉内固定治疗逆股骨转子间骨折治疗27例。结果:27例患者术后随访时间3～12个月,全部患者均获得一期骨性愈合。按Harris髋关节功能评分标准判断,优16例,良9例,可1例,差l例,优良率为92.59%。结论:PFNA具有操作简单、手术时间短、微创性、创伤小、骨折固定牢固、并发症少、功能恢复好及术后患者可早期离床负重等优点,是一种治疗逆股骨转子间骨折较为理想的方法。     

PFNA与DHS治疗老年股骨粗隆间骨折的疗效比较

目的 比较PFNA与DHS治疗老年股骨粗隆间骨折的疗效.方法 160例老年股骨粗隆间骨折患者随机分为PFNA组及DHS组各80例,比较两组患者的优良率、髋关节功能Harris评分、并发症.结果 PFNA组A22、A23、A3型的优良率达84.2％,与DHS组比较差异有统计学意义（P＜0.05）.PFNA组患者手术时间、骨折愈合时间明显短于DHS组,而手术出血量明显少于对照组（P＜0.05或P＜0.01）.两组患者术后髋关节功能Harris评分分别较术后1个月均明显升高,但PFNA组术后3个月、术后6个月、术后12个月的髋关节功能Harris评分分别与DHS组比较,差异无统计学意义（P＞0.05）.PFNA组的并发症发生率10.0％,明显少于DHS组（P＜0.05）.结论 PFNA与DHS均为治疗老年股骨粗隆间骨折的有效内固定方法之一,但PFNA内固定较DHS更具优势,其具有创伤小、手术时间短、术中出血少、术后并发症少等优点.     

手法复位股骨近端髓内钉一抗螺旋刀片（PFNA）治疗高龄股骨粗隆间骨折的临床观察

目的：观察手法复住股骨近端髓内钉-抗螺旋刀片（PFNA）内固定治疗高龄股骨粗隆间骨折的疗效。方法：运用手法复位PFNA内固定治疗30例高龄股骨粗隆间骨折。结果：30例获得随访5-12个月,全部骨性愈合,未见股骨头切割、髋内翻、股骨骨折等并发症。结论：应用手法复位PFNA治疗高龄股骨粗隆间骨折疗效满意。     

PFNA治疗不稳定股骨转子间骨折的疗效分析

目的探讨PFNA治疗不稳定型股骨转子间骨折的方法及疗效。方法 2006年12月～2008年6月,采用PFNA治疗不稳定型股骨转子间骨折35例,男16例,女19例;年龄62～91岁,平均75.6岁。受伤原因：步行跌伤26例,交通伤9例。AO分型：A2型21例,A3型14例。所有患者均经骨科下肢牵引床牵引闭合复位,微创置入PFNA。结果平均手术时间55min（35～120min）。术中平均失血量130ml（30～500ml）。随访时间9～36个月随访,平均19.6个月。术后部分负重时间2～12d,平均6.8d。35例患者伤口均一期愈合,无一例出现皮缘坏死和伤口感染。骨折愈合时间9～20周,平均13.3周。全部患者的术后功能均恢复到伤前水平。5例患者主诉患侧臀部和大转子区疼痛;无螺旋刀片切出股骨头、髋内翻等并发症。结论 PFNA可以安全有效的固定不稳定型股骨转子间骨折。