TossyⅢ型肩锁关节脱位

目的探讨不修复喙锁韧带仅用锁骨钩钢板固定治疗急性Tossy型肩锁关节脱位的效果。方法2004年9月至2007年8月共收治12例急性Tossy型肩锁关节脱位患者,对其使用AO/ASIF锁骨钩钢板复位固定肩锁关节,均未修复喙锁韧带,手术后早期开展功能锻练,平均手术后8个月（6～9个月）取出锁骨钩钢板。结果12例均获随访,随访时间2～5个月,平均3个月。按Karlsson疗效评价标准,优75%,良17%,差8%,优良率92%。所有病例均无脱钩等术后并发症,内固定锁骨钩钢板取出后无一例发生再脱位。结论AO/ASIF锁骨钩钢板是目前治疗Tossy型肩锁关节脱位的有效方法,对于急性脱位可不必修复喙锁韧带,如术后早期开展功能训练,愈合后及时取出锁骨钩钢板可获得十分满意的效果。     

聚酯缝线联合锁骨钩钢板1期治疗肩锁关节脱位疗效分析

[目的]探讨5号聚酯缝线联合锁骨钩钢板治疗肩锁关节脱位的临床疗效.[方法] 2010年9月～2012年9月间收治RockwoodⅢ～Ⅴ型肩锁关节脱位患者32例,应用锁骨钩钢板复位肩锁关节,4股5号聚酯缝线经锁骨、喙突,无张力状态下缝合喙锁韧带残端.所有患者采用视觉类比评分(VAS)、HSS肩关节评分系统及Constant -Murley评分.[结果]术后切口愈合好,无臂丛神经损伤、感染及内固定物断裂等并发症的出现.32例获得随访,随访时间6 ～ 20个月,平均16个月,VAS评分为(0.94±0.88)分;HSS评分为(86.44±8.94)分;Constant-Murley评分为(87.72±5.21)分.本组优17例,良13例,一般2例.[结论]5号聚酯缝线联合锁骨钩钢板治疗肩锁关节脱位,可以有效避免喙锁韧带断端缝合后张力过大和缝线骨道内磨损,有利于喙锁韧带无张力下愈合.     

锁骨钩钢板治疗新鲜 NeerⅡ型锁骨远端骨折及Tossy Ⅲ型肩锁关节脱位

目的 总结锁骨钩钢板内固定治疗新鲜Neer Ⅱ型锁骨远端骨折及Tossy Ⅲ型肩锁关节脱位的手术方法及临床疗效.方法 2004年8月～2008年10月,应用锁骨钩钢板治疗28 例Neer Ⅱ型锁骨远端骨折和21 例 Tossy Ⅲ型肩锁关节脱位,术中仅行锁骨钩钢板固定,未刻意修复喙锁韧带、喙肩韧带.术后X光片评估锁骨骨折愈合及肩锁关节脱位的复位,根据Constant-Murley 评分系统评价肩关节功能康复情况.结果 手术后复查X 线片示锁骨远端骨折及肩锁关节均完全复位.患者均获随访,随访12～48月,平均14.9月,均提示锁骨远端骨折愈合、无螺钉松动、钢板或钩部折断.术后8～18月内固定取出后,无肩锁关节再脱位.2例术后4个月患肩活动过大时明显感肩部酸痛不适,8月后取出钢板后症状消失.随访终末,所有患者Constant-Murley 评分平均为89.6分(83～92分).结论 采用锁骨钩钢板内固定治疗新鲜NeerⅡ型锁骨远端骨折及Tossy Ⅲ型肩锁关节脱位,具有复位简单、固定确切、肩关节可以早期活动、肩关节功能恢复好等优点.     

Atlas钛缆与钩钢板治疗完全性肩锁关节脱位的前瞻性对照研究

[目的]使用双股Arias钛缆和锁骨钩钢板治疗完全性肩锁关节脱位，并对其治疗效果进行比较。[方法]采用双股Atlas钛缆和锁骨钩钢板治疗Allman Ⅲ型肩锁关节脱位52例，均为单侧。其中双股Atlas钛缆组28例，锁骨钩钢板组24例。男38例，女14例，年龄22—65岁，平均38．5岁。新鲜脱位39例，陈旧性13例。钛缆固定采用喙突根部钻孔，从喙突上方偏内1．5cm处的锁骨干孔道中穿过，锁骨钩钢板均为6孔。术中常规作喙锁韧带修补。[结果]所有患者均获随访，随访时间6～42个月，平均18．8个月。对2组患者进行术后功能恢复及影像学评价，按照Lazcano标准对术后上肢肌力、肩部疼痛和关节功能进行评定。钩钢板组优14例，良6例，差4例，治疗优良率83％；钛缆组优22例，良5例，差1例，治疗优良率96％，与钩钢板组无显著差异。[结论]双股钛缆治疗完全性肩锁关节脱位的效果与锁骨钩钢板相当，且具有术后肩痛发生率低、利于早期功能锻炼的优点，此外钛缆生物相容性佳，可在体内长期存留而不必取出。     

钛缆结合钛网板与锁骨钩钢板治疗完全性肩锁关节脱位临床疗效观察

[目的]观察钛缆结合钛网板与锁骨钩钢板治疗完全性肩锁关节脱位临床疗效。[方法]RockwoodⅢ型肩锁关节脱位48例,均为新鲜脱位。男36例,女12例,年龄19~56岁,平均35.4岁,采用钛缆结合钛网板治疗22例,采用锁骨钩钢板治疗26例,所有患者均作喙锁韧带修补。[结果]所有患者均获随访,随访时间12~35个月,平均16.6个月。按照Karlsson标准对术后肩关节功能进行评定。钩钢板组优18例,良5例,差3例,治疗优良率88.46%;钛缆结合钛网板组优17例,良4例,差1例,治疗优良率95.45%,与钩钢板组无显著差异。[结论]钛缆结合钛网板治疗完全性肩锁关节脱位的效果与锁骨钩钢板相当,且具有术后肩痛发生率低、利于早期功能锻炼的优点,此外钛缆生物相容性佳,可在体内长期存留而不必取出。     

锁骨钩钢板治疗Tossy Ⅲ型肩锁关节脱位的疗效

目的 探讨锁骨钩钢板治疗Tossy Ⅲ型肩锁关节脱位的疗效及术中修补喙锁韧带和脱位愈合后取出钢板的必要性. 方法自2002年3月～2006年1月使用AO/ASIF锁骨钩钢板治疗41例Tossy Ⅲ型肩锁关节脱位患者,其中15例术中修补了喙锁韧带,18例在平均术后1年取出钢板.按照Constant & Murley评分系统评定肩关节功能,并对喙锁韧带修补组和未修补组以及内固定取出前后进行对比分析. 结果本组获得1年以上随访者共37例,随访时间12～45个月,平均27个月.术后1年所有随访患者肩关节总体评分平均为82.0分,喙锁韧带修补组(15例)评分平均为81.3分,喙锁韧带未修补组(22例)评分平均为82.5分,两组差异无统计学意义(t=1.097,P＞0.05).内固定取出患者取出前、后肩关节评分平均分别为80.4分和90.5分,差异有统计学意义(t=3.79,P＜0.05).结论 AO/ASIF锁骨钩钢板是治疗Tossy Ⅲ型肩锁关节脱位的一种有效方法.锁骨钩钢板治疗急性肩锁关节脱位可不必常规修复喙锁韧带,锁骨钩钢板长期留存于体内可能影响肩关节活动,有必要在脱位愈合后取出内固定.     

肩锁关节脱位的锁骨钩钢板治疗

目的探讨肩锁关节脱位的锁骨钩钢板治疗方法 ,并评价其临床效果。方法应用锁骨钩钢板治疗肩锁关节完全脱位17例,采用臂丛麻醉,锁骨外侧段上方入路,修复肩锁韧带、喙锁韧带,锁骨钩钢板于锁骨上方固定。结果所有病例均获得随访,按Karlsson标准评定:优15例,良2例。结论锁骨钩钢板治疗肩锁关节脱位,方法简单,疗效可靠。     

锁骨钩钢板配合喙肩韧带转移治疗青壮年新鲜TossyⅢ型肩锁关节脱位的病例对照研究

目的:探讨喙肩韧带转移修补喙锁韧带及肩锁韧带治疗青壮年新鲜TossyⅢ型肩锁关节脱位的临床疗效。方法:2005年1月至2007年1月,将52例TossyⅢ型肩锁关节脱位患者分成2组:Ⅰ组30例,男17例,女13例,年龄19～40岁,平均31.0岁;Ⅱ组22例,男12例,女10例,年龄20～42岁,平均33.6岁。所有损伤为新鲜损伤,X线表现为TossyⅢ型肩锁关节脱位,损伤至手术时间2～17d,平均7.6d。所有患者受伤前肩关节活动正常。2组均采用锁骨钩钢板固定,Ⅰ组行喙肩韧带转移以修补喙锁韧带及肩锁韧带,Ⅱ组行常规韧带缝合术。治疗后按Karlsson标准评定疗效。结果:2组患者切口均Ⅰ期愈合。取出内固定后6个月随访,Ⅰ组优24例,良6例;Ⅱ组优17例,良5例。2组疗效差异无统计学意义。Ⅰ组26例及Ⅱ组19例于取出内固定后随防3～5年,平均4.5年,Ⅱ组3例取出内固定后肩锁关节脱位复发。Ⅰ组优20例,良6例;Ⅱ组优9例,良7例,差3例。Ⅰ组疗效优于Ⅱ组。结论:青壮年新鲜TossyⅢ型肩锁关节脱位采用锁骨钩钢板固定后,喙肩韧带转移修补喙锁韧带及肩锁韧带可以提高修复后肩锁关节稳定性,预防脱位再复发。     

AO锁骨钩钢板固定与改良Weaver法治疗急性肩锁关节脱位（Ⅲ～Ⅵ型）

目的探讨AO锁骨钩钢板固定与改良Weaver法治疗急性Ⅲ～Ⅵ型肩锁关节脱位的疗效。方法55例Ⅲ～Ⅵ型肩锁关节脱位患者采用AO锁骨钩钢板固定或改良Weaver法进行治疗,其中23例（Ⅲ型7例,Ⅳ型11例,Ⅴ型4例,Ⅵ型1例）应用一期修复喙锁韧带锁骨钩钢板治疗,32例（Ⅲ型2例,Ⅳ型9例,Ⅴ型17例,Ⅵ型4例）应用改良Weaver法一期重建喙锁韧带,回顾性分析其效果及预后。结果根据Karlsson标准,总体优良率96．3％,修复喙锁韧带锁骨钩钢板固定组总体优良率95．6％;改良Weaver法喙锁韧带重建组总体优良率96．8％。结论一期修复喙锁韧带锁骨钩钢板固定及改良Weaver法一期重建喙锁韧带对于治疗急性Ⅲ～Ⅵ型肩锁关节脱位均能取得满意的疗效。     

不修复喙锁韧带的锁骨钩钢板固定治疗肩锁关节脱位

目的探讨锁骨钩钢板(CHP)固定但不修复喙锁韧带治疗急性TossyⅢ型肩锁关节脱位的效果。方法对12例急性TossyⅢ型肩锁关节脱位,使用CHP复位固定肩锁关节,均未修复喙锁韧带,手术后早期功能训练,平均术后8个月取出CHP。结果 12例取出CHP后平均随访3个月。按Karlsson疗效标准:优9例,可2例,差1例。所有病例均无脱钩等术后并发症。结论 CHP是目前治疗TossyⅢ型肩锁关节脱位的有效方法,急性脱位可不必修复喙锁韧带,愈合后及时取出CHP可获得十分满意的效果。     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Recognition and management of phaeochromocytoma and paraganglioma

Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in perioperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist and nabilone, a synthetic cannabinoid.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist, and nabilone, a synthetic cannabinoid.     

Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines

Background:

Controversy continues regarding the best treatment for compression and burst fractures. The axial distraction reduction utilizing the technique employing the long straight rod or curved short rod without derotation to reduce fracture are practised together with short segment posterolateral fusion (PLF). Effects of the early postoperative mobilization without posterolateral fusion on reduction maintenance and fracture consolidation were not evaluated so far. The present prospective study is designed to assess the effectiveness of i) reduction and restoration of sagittal alignment, ii) no posterolateral fusion on the reduced, fractured vertebral body and injured disc, iii) fracture consolidation and iv) the fate of the unfused cephalad and caudal injured motion segments of the fractured vertebra.

Materials and Methods:

The study includes 15 Denis burst and two Denis type D compression fractures between T₁₂ and L₃. The lordotic distraction technique was used for ligamentotaxis utilizing the contoured short rods and pedicle screw fixator. Three vertebrae including the fractured one were fixed. The patients after surgery were braced for ten weeks with activity restriction for 2-4 weeks. The patients were evaluated for change in vertebral body height, sagittal curve, reduction of retropulsion, improvement in neural deficit. The unfused motion segments, residual postoperative pain and bone and metal failure were also evaluated.

Results:

The preoperative and postreduction percentile vertebral heights at, zero (immediate postoperative), at three, six and 12 months followup were 62.4, 94.8, 94.6, 94.5 and 94.5%, respectively. The percentages of the intracanal fragment retropulsion at preoperative, and postoperative at zero, 3, 6 and 12 months followup were 59.0, 36.2,, 36.0, 32.3, and 13.6% respectively.The preoperative and postreduction percentile loss of the canal dimension and at zero, three, six and 12 months were 52.1, 45.0, 44.0, 41.0 and 29% respectively suggesting that the under-reduced fragment was being resorbed gradually by a remodeling process. The mean initial kyphosis of 33° became mean 2° immediately after reduction and mean 3° at the final followup. The fractured vertebral bodies consolidated in an average period of ten weeks (range 8-14 weeks). The restored disc heights were relatively well maintained throughout the observation period. All paraparetic patients recovered neurologically. There were no postoperative complications.

Conclusion:

Instrument-aided ligamentotaxis for compression and burst fractures utilizing the short contoured rod derotation technique and the instrumented stabilization of the fractured spine are found to be effective procedures which contribute to the fractured vertebral body consolidation without recollapse and maintain the motion segment function.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

---

Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.

     

动静脉穿刺网络课件的开发及其应用

目的:确保护理教学效果,提高教学水平。方法:应用多项信息技术将动静脉穿刺技术制作成教学网络课件,并用于临床教学。结果:该课件在本校园网上运行半年余,2000余人次对其进行访问,受到师生好评。结论:该课件能及时反映动静脉穿刺的最新研究进展及具体操作步骤和使用方法,实现护理教学的直观性和交互性,对护理教学和临床带教指导有一定的借鉴作用。     

Physiology and pharmacology of nausea and vomiting

The physiology of nausea and vomiting is poorly understood. The initiation of vomiting varies and may be due to motion, pregnancy, chemotherapy, gastric irritation or postoperative causes. Once initiated, vomiting occurs in two stages, retching and expulsion. The muscles responsible for this sequence of events are controlled by either a vomiting centre or a central pattern generator, probably in the area postrema and the nearby nucleus tractus solitarius. Drugs which induce vomiting include ipecacuanha, a gastric irritant, and apomorphine, a dopamine-receptor agonist. Opioid drugs also induce vomiting, but opioid antagonists are not useful to treat nausea and vomiting. Anti-emetic drugs consist of a variety of neurotransmitter antagonists and may act in the periphery, the central nervous system or both sites. The most important drugs are antagonists at muscarinic, dopamine D₂, 5-HT₃, histamine H₁ and neurokinin NK₁ receptors. These drugs are discussed with particular attention to post-operative nausea and vomiting (PONV).