股骨近端空心锁定板内固定治疗股骨颈骨折临床疗效观察

目的：：研究股骨近端空心锁定板内固定治疗股骨颈骨折的临床效果。方法：对2008年2月至2010年4月我院入院治疗的108例股骨颈骨折患者进行了研究，随机分为两组，对照组给与空心钉进行治疗，观察组采用股骨近端空心锁定板内固定治疗，比较两组治疗方案的手术时间、出血量、住院时间以及下床时间，比较两组治疗方案的手术并发症发生率，并比较两组患者三年期临床疗效。结果：观察组患者手术出血量明显少于对照组，手术时间、住院时间以及下床时间明显短于对照组，两组比较差异明显，有统计学意义( P<0.05)；两组患者手术并发症均以疼痛、骨不连以及感染为主，其中观察组上述并发症的发生率为13.0％，明显低于对照组33.3％，两组比较差异有统计学意义( P<0.05)；观察组患者三年临床总有效率为79.6％，对照组患者三年期临床总有效率为51.9％，两组比较差异明显，有统计学意义( P<0.05)。结论：股骨近端空心锁定板内固定治疗股骨颈骨折临床效果显著，可以明显缩短手术时间以及住院时间，降低手术并发症，并且三年临床总有效率更高，值得临床推广应用。     

不同手术方法治疗复杂胫骨平台骨折临床疗效观察

目的探讨不同手术方法治疗复杂胫骨平台骨折临床疗效。方法选择2016年1月—2018年12月84例复杂胫骨平台骨折患者,随机分组。单侧锁定钢板内固定组选择单侧锁定钢板内固定手术,双侧切口双侧解剖钢板内固定组选择双侧切口双侧解剖钢板内固定。分析手术操作时间、手术失血、平均住院天数以及复杂胫骨平台骨折愈合时间;治疗前后患者视觉模拟评分和Rasmussen膝关节功能评分;膝关节僵硬发生率。结果双侧切口双侧解剖钢板内固定组视觉模拟评分和Rasmussen膝关节功能评分、手术操作时间、手术失血、平均住院天数以及复杂胫骨平台骨折愈合时间、膝关节僵硬发生率和单侧锁定钢板内固定组比较有优势,P<0.05。结论复杂胫骨平台骨折患者实施双侧切口双侧解剖钢板内固定可获得较好效果。     

Infective Endocarditis Due to Treponema pallidum: A Case Diagnosed Using Polymerase Chain Reaction Analysis of Aortic Valve

Syphilis is a sexually transmitted disease caused by Treponema pallidum. Syphilitic aortitis might coexist in a dysfunctional aortic valve, but the etiology remains unclear, because microbiological diagnosis is difficult. A 62-year-old man with low-grade fever was diagnosed with aortitis and infective endocarditis, due to Treponema pallidum infection, using polymerase chain reaction analysis. This case suggests that syphilis might cause infective endocarditis.     

Diagnostic sensitivity of electrophysiology and ultrasonography in ulnar neuropathies of different severity

ObjectiveTo assess the diagnostic performance of electrophysiology and nerve ultrasound in ulnar neuropathies of varying clinical severity in 135 consecutive patients.MethodsClinical severity of ulnar neuropathy was graded on a 4 point scale from very mild (symptoms only) to severe (marked atrophy of intrinsic hand muscles). Sensitivity and localization ability of electrophysiology and nerve ultrasound were assessed for each point of the scale.ResultsUltrasound had higher sensitivity than electrophysiology in clinically very mild (20% and 3% for ultrasound and electrophysiology, respectively) and mild (62% and 47% for ultrasound and electrophysiology, respectively) neuropathies, had greater localizing ability in axonal ulnar neuropathies, and identified nerve hypermobility.Ultrasound nerve cross-sectional area had strong positive correlation with both clinical and electrophysiological severity scores, but with significant overlap across the severity groups.ConclusionThe diagnostic work-up of ulnar neuropathies was improved by using both electrophysiology and ultrasound at all levels of clinical severity. Ultrasound increased the diagnostic yield in very mild and mild neuropathies, localized all the ulnar neuropathies with abnormal non-localizing electrophysiology and identified nerve hypermobility.SignificanceThis is the first detailed analysis of the diagnostic performance of electrophysiology and ultrasound in ulnar neuropathies of varying severity.     

Bayesian estimation of a random effects heteroscedastic probit model

Summary Bayesian analysis is given of a random effects binary probit model that allows for heteroscedasticity. Real and simulated examples illustrate the approach and show that ignoring heteroscedasticity when it exists may lead to biased estimates and poor prediction. The computation is carried out by an efficient Markov chain Monte Carlo sampling scheme that generates the parameters in blocks. We use the Bayes factor, cross‐validation of the predictive density, the deviance information criterion and Receiver Operating Characteristic (ROC) curves for model comparison.     

导航在长骨干骨折髓内钉固定中的应用

目的阐述透视导航技术在长骨干(股骨和胫骨)骨折,特别是在术中远端交锁髓内钉固定中的应用。探索在导航条件下术中应用髓内钉图像库开展远端交锁固定的可行性。此外,医用机器人的开发旨在被进一步用来改善手术程序的精确性。方法导航手术下,55例行股骨远端交锁钉固定和36例行胫骨远端交锁钉固定。其中13例术中应用图像库开展远端交锁固定。结果远端交锁固定成功率为97%。结论透视导航在长骨干骨折术中,使远端髓内交锁钉固定成功率增高。图像库的应用可以进一步减少患者和手术人员的X线辐射剂量。     

颈椎前路钢板在脊髓型颈椎病前路手术中的作用

目的 评价内固定在脊髓型颈椎病前路减压中的作用。方法 143例脊髓型颈椎病患者经前路减压后自体髂骨植骨，带锁钢板内固定。获得随访病例132例，随访时间平均20个月，观察术后神经功能恢复情况，植骨融合率，椎间高度及颈椎生理曲度恢复情况。结果 单节段与两节段病变者术后3月均获得骨性愈合，融合率为100％，16例3节段病变者融合体为81．3％，内固定并发症为5／132(3．8％)。术后椎间高度与生理曲度均获得满意重建。JOA记分平均改善率65．8％。结论 在脊髓型颈椎病前路减压手术中应用带锁钢板内固定可有效维持椎间高度和生理曲度，并有助于后路间接减压。     

Cross talk in surface electromyograms of human hamstring muscles.

Signals generated from muscles other than the muscle(s) of interest (cross talk) can confound the interpretation of surface electromyograms (EMGs). In this study, the amount of cross talk in surface EMGs of human hamstring muscles was estimated using a protocol in which the quadriceps femoris was electrically stimulated via the femoral nerve. EMGs were recorded from the vastus lateralis and the medial and lateral hamstring muscle groups. The amplitude of the EMG response of the vastus lateralis to electrical stimulation was adjusted to match that of its maximum voluntary effort (MVE) under isometric conditions. Subsequent power density spectrum analysis showed that the median frequencies of the signals generated by electrical stimulation and MVE were not significantly different. In conventional bipolar recordings, cross talk in lateral hamstring EMGs averaged 17.1% MVE and in medial hamstring EMGs 11.3% MVE (average-rectified values). The double differential technique significantly reduced cross talk to 7.6% MVE for the lateral hamstrings, and to 4.2% MVE for the medial hamstrings. The double differential technique appears to be more selective than the bipolar technique when recording EMGs from muscles with highly active neighbors and thus should be used in such situations. Software simulations of the double differential technique also appear to be more selective than the bipolar technique and may be used when the number of amplifiers available is limited.