踝关节骨折伴下胫腓分离疗效的相关因素分析

目的：探讨影响踝关节闭合性骨折伴下胫腓联合分离手术疗效的相关因素，并提出对策。方法：分析1998年2月～2004年8 月手术治疗43例踝关节骨折伴下胫腓联合分离患者的临床资料，男性29例，女性14例；平均年龄45． 6岁。根据 Lauge-Hansen 分 类：旋后外旋型21例；旋前外旋型15例；旋前外展型7例。28例未行下胫腓联合固定。急诊手术17例；伤后3～7d 手术24例，2例 为陈旧性骨折(伤后3个月手术)。结果：术后随访8～35个月，平均18个月。下胫腓固定15例中，10例在术后8～12周取钉；3例因 术后1～2年断钉而取出。另2例在术后2年内取钉。使用可吸收性螺钉中2例发生再分离，未固定者均未出现骨性连接和再分离。 术中应力位(Mortise)发现下胫腓分离6例，外旋侧位发现3例后踝小骨片。根据 Baird-Jackson 系统评分：优20例、良17例、可3例、 差3例，优良率86． 05%。结论：影响踝关节骨折伴下胫腓联合分离手术疗效的相关因素有骨折类型与软组织损伤程度、术中判断与 内固定物选择、下胫腓联合固定与否、陈旧性骨折及术后功能锻炼等因素。     

Can we assess healing of surgically treated long bone fractures on radiograph?

Purpose

To determine the frequency and causes for limitations in the radiographic evaluation of surgically treated long bone fractures.

“一带一路”倡议下中医药贸易在东盟现状分析及发展策略思考

“一带一路”倡议的实施,给我国中医药对外贸易合作带来发展机遇。以“东盟”“东南亚”“中医药”“中药贸易”等为主题词,检索CNKI、MEDLINE、万方等数据库和相关研究报告,分析近10年来我国与东盟各国中医药贸易的市场发展与需求情况,结合“一带一路”的政策背景,梳理东盟各国现行的中医药政策,提出进一步推动与东盟中医药贸易的发展策略。     

Time‐dependent changes in bone healing capacity of scaphoid fractures and non‐unions

The scaphoid is the most frequently fractured carpal bone and prone to non‐union due to mechanical and biological factors. Whereas the importance of stability is well documented, the evaluation of biological activity is mostly limited to the assessment of vascularity. The purpose of this study was to select histological and immunocytochemical parameters that could be used to assess healing potential after scaphoid fractures and to correlate these findings with time intervals after fracture for the three parts of the scaphoid (distal, gap and proximal). Samples were taken during operative intervention in 33 patients with delayed or non‐union of the scaphoid. Haematoxylin and Eosin (HE ), Azan, Toluidine, von Kossa and Tartrate‐resistant acid phosphatase (TRAP ) staining were used to characterise the samples histologically. We determined distribution of collagen 1 and 2 by immunocytochemistry, and scanning electron microscopy (SEM ) was used to investigate the ultrastructure. To analyse the samples, parameters for biological healing status were defined and grouped according to healing capacity in parameters with high, partial and little biological activity. These findings allowed scoring of biological healing capacity, and the ensuing results were correlated with different time intervals after fracture. The results showed reduced healing capacity over time, but not all parts of the scaphoid were affected in the same way. For the distal fragment, regression analysis showed a statistically significant correlation between summarised healing activity scores and time from initial fracture (r  = ?0.427, P  = 0.026) and decreasing healing activity for the gap region (r  = ?0.339, P  = 0.090). In contrast, the analyses of the proximal parts for all patients did not show a correlation (r  = 0.008, P  = 0.969) or a decrease in healing capacity, with reduced healing capacity already at early stages. The histological and immunocytochemical characterisation of scaphoid non‐unions (SNU s) and the scoring of healing parameters make it possible to analyse the healing capacity of SNU s at certain time points. This information is important as it can assist the surgeon in the selection of the most appropriate SNU treatment.     

Latent typologies of posttraumatic stress disorder in World Trade Center responders

Posttraumatic stress disorder (PTSD) is a debilitating and often chronic psychiatric disorder. Following the 9/11/2001 World Trade Center (WTC) attacks, thousands of individuals were involved in rescue, recovery and clean-up efforts. While a growing body of literature has documented the prevalence and correlates of PTSD in WTC responders, no study has evaluated predominant typologies of PTSD in this population. Participants were 4352 WTC responders with probable WTC-related DSM-IV PTSD. Latent class analyses were conducted to identify predominant typologies of PTSD symptoms and associated correlates. A 3-class solution provided the optimal representation of latent PTSD symptom typologies. The first class, labeled “High-Symptom (n = 1,973, 45.3%),” was characterized by high probabilities of all PTSD symptoms. The second class, “Dysphoric (n = 1,371, 31.5%),” exhibited relatively high probabilities of emotional numbing and dysphoric arousal (e.g., sleep disturbance). The third class, “Threat (n = 1,008, 23.2%),” was characterized by high probabilities of re-experiencing, avoidance and anxious arousal (e.g., hypervigilance). Compared to the Threat class, the Dysphoric class reported a greater number of life stressors after 9/11/2001 (OR = 1.06). The High-Symptom class was more likely than the Threat class to have a positive psychiatric history before 9/11/2001 (OR = 1.7) and reported a greater number of life stressors after 9/11/2001 (OR = 1.1). The High-Symptom class was more likely than the Dysphoric class, which was more likely than the Threat class, to screen positive for depression (83% > 74% > 53%, respectively), and to report greater functional impairment (High-Symptom > Dysphoric [Cohen d = 0.19], Dysphoric > Threat [Cohen d = 0.24]). These results may help inform assessment, risk stratification, and treatment approaches for PTSD in WTC and disaster responders.     

高能冲击波对骨组织代谢及愈合影响的实验及临床研究

目的了解高能冲击波对骨组织ＤＮＡ的影响，以及其治疗骨折延期愈合、骨折不连接的疗效。方法通过新西兰种兔肢体实施体外高能冲击波治疗，取骨膜组织进行体外培养Ｈ３—ＴｄＲ掺入放射性自显影研究。临床应用其治疗骨不连接１８例，骨折延迟愈合２０例。结果证实冲击后１～２周实验侧骨膜组织Ｈ３ＴｄＲ标记率明显高于对照侧（Ｐ＜０．０５），表明实验侧骨膜成骨细胞有丝分裂明显增强，骨膜成骨作用增强。临床冲击治疗后１６周，２０例骨折延迟愈合均愈合；冲击后１６周，１８例骨不连接，１５例愈合。结论该法可促进骨膜形成、骨细胞ＤＮＡ代谢，是治疗骨折延迟愈合、骨不连接的有效方法，其作用机理仍有待于进一步研究。     

Conversion to hypertrophic vertebral pseudarthrosis following percutaneous vertebroplasty

To determine the role of percutaneous vertebroplasty (PVP) in bone formation and the union of vertebral pseudarthrosis, we analyzed 14 patients with an average follow-up duration of 21 months. Evaluation methods included back pain (visual analog scale: VAS), wedge angle, dynamic mobility, radiographic remodeling including callus and spur formation, and union status. The Student's t test was used for statistical analysis and a probability of less than 0.05 was determined as a significant difference. Back pain improved in all 14 patients with a VAS score of 57.8 ± 23.5 mm (average ± standard deviation) preoperatively and 14.7 ± 16.4 mm at the final follow-up (P < 0.001). The wedge angle decreased from 21.6° ± 8.3° (average ± standard deviation) preoperatively to 13.2° ± 6.9° at the final follow-up (P < 0.001). Callus formation was seen in four patients. Bony spurs were seen in the affected vertebra in preoperative radiographs in all patients, and were further developed to a solidified form during follow up after PVP. Dynamic mobility of the affected vertebrae was 6.9 ± 2.9 mm preoperatively, which decreased to 1.1° ± 0.7° at the final follow-up (P < 0.001). Notably, all patients showed the dynamic vertebral mobility of 2 mm or less. Nevertheless, only two patients exhibited the dynamic vertebral mobility of 0 mm at the final follow-up, which is referred to as bone union. These findings indicate that PVP serves as a mechanical stabilizer for vertebral pseudarthrosis, which leads to immediate pain relief and segmental bony responses.     

法人治理结构在区域性医疗联合体中的实施路径探析

通过分析区域性医疗联合体在新医改中提出的背景,总结了上海在前期开展实践中的经验,阐述了完善法人治理结构在打造区域性医疗联合体中的重要性和可行性,并结合上海在崇明地区开展的医疗联合体的试点工作,研究了区域性医疗联合体法人治理结构的实施路径,指出在实践中要先易后难,循序渐进,沿着先转机制,再建体制的路线,经过＂松散式＂、＂紧密型＂和＂一体化＂三个不同的联合体发展阶段,最后构建科学合理的法人治理结构。     

简论微积分中的四种数学哲学思想

简要论述了隐含于微积分中的四种数学哲学思想,即:数形结合思想、定性定量思想、特殊一般思想、映射思想。对这四种思想在微积分中的体现均进行了理论分析和举例说明。     

新型药品流通组织——“社区医药服务共同体”初探

目的：为中小型医药商业企业的生存和发展提供思路。方法：在介绍新型药品流通组织——＂社区医药服务共同体＂形成背景和现状后,重点论证共同体所具备的竞争优势和存在的缺陷,并就其发展提出对策。结果与结论：社区医药服务共同体创造了药品流通新模式,将在未来医药流通领域占据重要地位,中小型医药商业企业应顺势加入,尽早走集中化的发展道路。