加压滑动鹅头钉治疗股骨转子间骨折的临床与实验研究

探讨加压滑动鹅头钉在治疗股骨转子间骨折中的作用。临床应用４５例。男３４例，女１１例。平均年龄６１岁。稳定型１３例，不稳定型３２例。经临床应用和生物力学实验测定，结果表明：（１）对不稳定型转子间骨折，恢复小转子区内后侧皮质骨的连续性在骨折的稳定中具有重要作用。（２）内后侧骨折块解剖复位，加压螺丝钉固定或大转子骨折端加压螺丝钉固定能显著增强加压滑动鹅头钉的固定作用，明显提高不稳定型转子间骨折的术后稳定性。（３）该装置设计合理，性能坚固，对转子间骨折具有很强的固定作用，能有效地达到早期下床和避免长期卧床的目的，是目前临床最理想的内固定装置。     

1951—2020年南京市猩红热时间变化特征及趋势分析

目的 分析南京市1951—2020年猩红热发病率时间序列,了解其变化特征及趋势。方法 运用移动平均、滑动T检验和小波时频分析方法,对南京市1951—2020年猩红热年发病率进行分析。结果 猩红热在南京市呈春夏季和冬季2个发病高峰,年发病率整体呈下降趋势,下降率为0.144 8（发病率/5年）。滑动t检验显示4个下降突变点和3个上升突变点。Morlet小波法时频分析呈现3个中心尺度和周期,分别在4、16和25尺度上,高低发病周期分别为4、8和13年;第1主周期在25尺度。周期分析2014年起猩红热发病呈上升势态。2020年初突发公共卫生应急响应一、二级时,发病明显下降,在三级响应时发病回升。结论 依据猩红热发病的周期性和趋势分析,应该加强对猩红热的监测,及时做好疫情处置,以控制其在人群中的传播。     

腹股沟脐内侧韧带滑动性疝的治疗体会(附13例报告)

目的:探讨腹股沟脐内侧韧带滑动性疝的诊断及治疗方法。方法:回顾性分析2018年1月至2020年1月收治的13例腹股沟脐内侧韧带滑动性疝患者的临床资料,患者均行腹腔镜经腹腹膜前疝修补术,观察治疗效果。结果:13例患者均成功实施腹腔镜经腹腹膜前疝修补术,手术时间36~56 min,平均(43.4±20.3)min;住院2~3 d,平均(2.5±1.2)d;术后随访8个月~2年,未损伤膀胱、精索等疝囊周围器官,术后未出现血清肿、术区慢性疼痛及复发等情况。结论:腹股沟脐内侧韧带滑动性疝只要术前仔细查体,术中细致解剖,可避免脏器损伤,但术者需具备腹腔镜疝修补的手术经验,熟悉解剖结构,术中及时作出诊断。     

Analysis of factors among 30-day and 1-year mortality rates in patients with borderline stable-unstable intertrochanteric hip fracture

ObjectiveThis study aimed to evaluate the possible effects of surgical procedures on mortality and to identify the possible risk factors for mortality in the management of geriatric hip fractures.MethodsA total of 191 patients (105 women and 86 men; mean age 82.26±9.681 [60–108] years) with AO/OTA 31A2.2 intertrochanteric fractures and treated with sliding hip screw, proximal femoral nail, or hemiarthroplasty were included in this retrospective cohort study. The treatment type was decided by the responsible surgeon according to the patients’ pre-injury activity level, bone quality, and features of the fracture. Age, sex, type of fracture, type of surgery performed, American society of anesthesiology (ASA) grade, type of anesthesia, time to surgery, type of physical therapy, length of hospital stay, and number of comorbidities were documented. We evaluated the 30-day and 1-year mortality of patients treated with sliding hip screw (SHS), proximal femoral nail antirotation (PFN-A), or hemiarthroplasty and identified the possible risk factors for mortality.ResultsA total of 49 patients underwent SHS, 58 underwent PFN-A, and 84 underwent hemiarthroplasty. Of these, 2 patients with SHS, 2 with PFN-A, and 11 with hemiarthroplasty died within 30 days after surgery, whereas 7 patients with SHS, 15 with PFN-A, and 23 with hemiarthroplasty died 1 year after surgery. The 30-day and 1-year overall mortality rates were 7.9% and 23.6%, respectively. Both the 30-day and 1-year mortality risks were higher in patients undergoing hemiarthroplasty than in patients undergoing SHS (p=0.068 versus 0.058). The 30-day mortality was higher in patients receiving general anesthesia than in those receiving combined spinal and epidural anesthesia (p=0.009). The 1-year mortality risk was higher in patients with ASA grade 4 than in those with grade 1 and 2 (p=0.045). Advanced age (p=0.022) and male sex (p=0.007) were also found to be the risk factors for 1-year mortality.ConclusionWe demonstrated that higher ASA grade, male sex, general anesthesia, and hemiarthroplasty procedures are associated with higher mortality rates in elderly patients with hip fractures. Thus, we highly recommend orthopedic surgeons to consider all these factors in the management of intertrochanteric hip fractures in the geriatric population.Level of EvidenceLevel IV, Prognostic Study     

Sliding contact fracture of dental ceramics: Principles and validation

Ceramic prostheses are subject to sliding contact under normal and tangential loads. Accurate prediction of the onset of fracture at two contacting surfaces holds the key to greater long-term performance of these prostheses. In this study, building on stress analysis of Hertzian contact and considering fracture criteria for linear elastic materials, a constitutive fracture mechanics relation was developed to incorporate the critical fracture load with the contact geometry, coefficient of friction and material fracture toughness. Critical loads necessary to cause fracture under a sliding indenter were calculated from the constitutive equation, and compared with the loads predicted from elastic stress analysis in conjunction with measured critical load for frictionless normal contact—a semi-empirical approach. The major predictions of the models were calibrated with experimentally determined critical loads of current and future dental ceramics after contact with a rigid spherical slider. Experimental results conform with the trends predicted by the models.     

Sliding contact wear and subsurface damage of CAD/CAM materials against zirconia

ObjectiveMost previous work conducted on the wear behavior of dental materials has focused on wear rates and surface damage. There is, however, scarce information regarding the subsurface damage arising from sliding contact fatigue. The aim of this study was to elucidate the wear mechanisms and the subsurface damage generated during sliding contact fatigue in 5 contemporary CAD/CAM materials against a zirconia indenter.MethodsForty discs (Ø12 mm, 1.55 mm thick) were cut out of IPS e.max CAD (e.CAD), Suprinity PC (SUP), Enamic (ENA), Vitablocs Mark II (VMII) and Lava Ultimate (LU) blocks and mirror polished. After cementation onto a dentin-like composite, off-axis mouth-motion cycling was conducted with a spherical zirconia indenter (r = 3.18 mm) in water (200 N load, 2 Hz frequency) for 5 different cycling periods (10², 10³, 10⁴, 10⁵, 10⁶ cycles, n = 8). Analysis of the wear scars was conducted using light-microscopy, scanning-electron-microscopy and optical profilometry. Subsurface damage was assessed using sagittal and transverse sections of the samples.ResultsFatigue wear mechanisms predominated in glassy materials (e.CAD, SUP, VMII), accompanied by extensive subsurface damage, whereas abrasive wear mechanisms were responsible for the large wear craters in the resin composite (LU) with an absolute absence of subsurface fracture. A combination of both mechanisms was observed in the polymer-infiltrated reinforced-glass (ENA), displaying large wear craters and severe subsurface damage.SignificanceWell-controlled laboratory simulation can identify wear and subsurface damage susceptibility of various classes of restorative materials. Both wear and subsurface fracture are determining factors for the long-term success of restorations.     

Diagnostic ultrasound assessment of deep fascia sliding mobility in vivo: A scoping review – Part 1: Thoracolumbar and abdominal fasciae

BackgroundFailure of fascial sliding may occur in cases of excessive or inappropriate use, trauma, or surgery, resulting in local inflammation, pain, sensitization, and potential dysfunction. Therefore, the mechanical properties of fascial tissues, including their mobility, have been evaluated in vivo by ultrasound (US) imaging. However, this seems to be a method that is not yet properly standardized nor validated.ObjectivesTo identify, synthesize, and collate the critical methodological principles that have been described in the literature for US evaluation of deep fascia sliding mobility in vivo in humans.MethodsA systematic literature search was conducted on ScienceDirect, PubMed (Medline), Web of Science and B-On databases, according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. The OCEBM LoE was used to evaluate the level of evidence of each study.ResultsFrom a total of 104 full-text articles retrieved and assessed for eligibility, 18 papers were included that evaluate the deep fasciae of the thoracolumbar (n = 4), abdominal (n = 7), femoral (n = 4) and crural (n = 3) regions. These studies addressed issues concerning either diagnosis (n = 11) or treatment benefits (n = 7) and presented levels of evidence ranging from II to IV. Various terms were used to describe the outcome measures representing fascial sliding. Also, different procedures to induce fascial sliding, positioning of the individuals being assessed, and features of US devices were used. The US analysis methods included the comparison of start and end frames and the use of cross-correlation software techniques through automated tracking algorithms. These methods had proven to be reliable to measure sliding between TLF, TrA muscle-fascia junctions, fascia lata, and crural fascia, and the adjacent epimysial fascia. However, the papers presented heterogeneous terminologies, research questions, populations, and methodologies.This two-part paper reviews the evidence obtained for the thoracolumbar and abdominal fasciae (Part 1) and for the femoral and crural fasciae (Part 2).ConclusionThe US methods used to evaluate deep fascia sliding mobility in vivo in humans include the comparison of start and end frames and the use of cross-correlation software techniques through automated tracking algorithms. These seem reliable methods to measure sliding of some fasciae, but more studies need to be systematized to confirm their reliability for others. Moreover, specific standardized protocols are needed to assess each anatomical region as well as study if age, sex-related characteristics, body composition, or specific clinical conditions influence US results.     

A case report of Progressive subluxation leading to an anterior dislocation of the hip following sliding hip screw fixation for pertrochanteric Extracapsular 4 part fracture neck of femur

Unstable 4 part pertrochanteric fractures without lateral cortical support presents considerable technical problem in treatment with high risk of failure with any implant. Anatomical or slight valgus reduction and subchondral central position of the lag screw (TAD <25 mm) reduces the chance of screw cut out and other complications.