缝合及重建喙锁韧带在锁骨钩钢板治疗肩锁关节脱位中的必要性探讨

：目的：比较肩锁关节脱位LINK钩钢板内固定术中缝合与不缝合喙锁韧带及喙锁韧带重建三种方法治疗肩锁关节脱位的临床疗效。方法 单纯应用肩锁钩内固定治疗肩锁关节脱位29例，应用肩锁钩内固定并同时修复喙锁韧带治疗肩锁关节脱位25例，应用肩锁钩内固定并同时采用改良 Weaver法重建喙锁韧带组均治疗肩锁关节脱位20例，随访12－24月，平均16.5个月，比较三组治疗方法临床疗效的差异。结果 74例病人获得随访，按照Karlsson疗效标准，不韧带缝合组优23例（79.3％），良6例（20.7％）; 缝合喙锁韧带组优20例（80%），良5例（20%）；改良 Weaver法重建喙锁韧带组优16例（80%），良4例（20%）。三组比较无显著性差异 结论 在肩锁关节脱位的钢板内固定治疗中喙锁韧带的缝合或重建不是必要的。     

锁骨钩钢板联合喙肩韧带转位重建喙锁韧带治疗重度肩锁关节脱位

目的 探讨锁骨钩钢板联合喙肩韧带转位重建喙锁韧带治疗重度肩锁关节脱位的临床效果.方法 运用锁骨钩钢板联合喙肩韧带转位重建喙锁韧带方法将喙肩韧带转移固定于锁骨、锁骨钩钢板固定治疗重度肩锁关节脱位18例,术后随访6～14个月,平均10个月.结果 优15例,占83.3%;良2例,占11.1%;差1例,占5.6%.结论 锁骨钩钢板联合喙肩韧带转位重建喙锁韧带治疗重度肩锁关节脱位是一种固定可靠、疗效确切的方法.     

锁骨钩钢板治疗锁骨肩峰端骨折和肩锁关节脱位

目的：评价锁骨钩钢板治疗锁骨肩峰端骨折和肩锁关节脱位的效果。方法：对总共23例新鲜的Neer Ⅲ型锁骨肩峰端骨折或Ⅲ度肩锁关节脱位的患者，采用AO的锁骨钩钢板进行切开复位内固定．不同时修补喙锁韧带。术后平均随访1年，采用Poigenfruit标准进行临床评价。结果：优18例，良5例，优良率达到100％。结论：锁骨钩钢板是治疗锁骨肩峰端骨折和肩锁关节脱位的理想内固定材料。     

肩锁关节Ⅲ型脱位喙锁韧带修复与否的对照观察

目的探讨Ⅲ型肩锁关节脱位锁骨钩钢板固定后喙锁韧带修复与否的必要性。方法 60例Ⅲ型肩锁关节脱位患者,随机分为三组。锁骨钩钢板内固定并直接缝合修复喙锁韧带22例,并喙肩韧带移位修复喙锁韧带18例,不修复喙锁韧带20例,比较三组术后疗效。结果三组疗效差异无统计学意义(P>0.05)。结论对于Ⅲ型肩锁关节脱位,不修复喙锁韧带并不影响锁骨钩钢板固定术后的疗效。     

锁骨钩钢板内固定联合阔筋膜"V"形重建喙锁韧带治疗重度肩锁关节脱位

目的:研究锁骨钩钢板内固定联合阔筋膜"V"形重建喙锁韧带治疗重度肩锁关节脱位的疗效。方法:Tossy分型中Ⅲ型肩锁关节脱位57例采用锁骨钩钢板内固定后,在喙锁韧带附着点两侧各1cm处各钻骨孔,用直角钳贴喙突根部于下内侧穿至外侧夹持筋膜条,一端拉出,并将筋膜条两端各穿入锁骨上的骨孔,拉紧筋膜条,将筋膜两端重叠缝合,重建喙锁韧带,形成"V"字形结构,同时缝合断裂的喙锁韧带。所有病例均随访,随访时间为6个月～3年,平均15个月。结果:按Karlsson标准进行评价,优48例,占84.2%,良9例,占15.8%,无一例差。结论:锁骨钩钢板内固定联合阔筋膜"V"形重建喙锁韧带治疗重度肩锁关节脱位固定可靠,疗效确切,是目前较理想的治疗方法。     

微创喙锁韧带重建与锁骨钩钢板置入内固定治疗TossyⅢ型肩锁关节脱位：功能恢复的对照比较

背景：以往采用交叉克氏针固定、克氏针张力带固定、喙锁螺钉、桥接技术等治疗TossyⅢ型肩锁关节脱位的效果都不是很满意。目的：分析微创喙锁韧带重建与锁骨钩钢板置入内固定治疗TossyⅢ型肩锁关节脱位的疗效差异。方法：将63例TossyⅢ型肩锁关节脱位患者随机分为两组,分别采用微创喙锁韧带重建与锁骨钩钢板置入内固定治疗。结果与结论：微创喙锁韧带重建组治疗后第1个月Karlesson疗效评价肩锁关节功能优质率为92%,第3个月为88%;锁骨钩钢板置入内固定组治疗后1个月Karlesson疗效评价肩锁关节功能优质率为79%,第3个月为76%。微创喙锁韧带重建组治疗后第1,3个月肩锁关节功能恢复优质率高于锁骨钩钢板置入内固定组（P〈0.05）。说明运用微创喙锁韧带重建治疗TossyⅢ型肩锁关节脱位较锁骨钩钢板置入内固定操作方便,创伤较小,疗效更加安全可靠。     

锁骨钩钢板治疗锁骨远端骨折或肩锁关节脱位——附29例报告

目的：探讨锁骨钩钢板治疗锁骨远端骨折（NeerⅡ型）或肩锁关节脱位（TossyⅢ型）的临床疗效。方法：自2004年6月—2009年6月,应用国产锁骨钩钢板治疗锁骨远端骨折及肩锁关节脱位29例。术中复位骨折及肩锁关节,锁骨钩钢板固定后,修复关节囊、肩锁韧带、重叠缝合三角肌及斜方肌,但不进行喙锁韧带修复。术后7 d后进行肩关节功能锻炼。结果：2例术后肩外展疼痛及外展上举受限,取出内固定症状消失,无其它术后并发症。29例随访3～62个月,平均20个月,按Herscovici标准评定术后肩关节功能恢复情况,优良率达100％。结论：锁骨钩钢板在治疗锁骨远端骨折及肩锁关节脱位具有操作简单,固定确切、不损伤关节面、无需修复喙锁韧带、可早期功能锻炼等优点,是一种较理想的治疗方法。     

锁骨钩钢板治疗肩锁关节脱位和锁骨远端骨折的临床研究

目的 评估锁骨钩钢板治疗肩锁关节脱位与锁骨远端骨折的临床疗效。方法 采用锁骨钩钢板治疗Ⅲ度肩锁关节脱位9例，锁骨外端骨折16例。结果 术后X线复查骨折或关节脱位复位率100％。疗效优18例，占72％；良7例，占28％。无其他并发症，骨折全部愈合，肩锁关节无再脱位。结论 锁骨钩钢板治疗肩关节脱位和锁骨远端骨折具有固定确实，符合生物力学要求，不损伤关节面，可以早期功能锻炼等优点，值得推广。术中仍需注意修复喙锁韧带。     

锁骨钩钢板治疗肩锁关节脱位18例临床研究

目的探讨锁骨钩铜板治疗锁骨肩峰端骨折和肩锁关节脱位的临床疗效。方法32例肩锁关节脱位患者其中18例为锁骨钩铜板治疗组，采用锁骨钩铜板进行内固定，对肩锁关节脱位者同时修补韧带，其余14例为常规手术组，应用其它常规手术方法治疗，两组患者术后均随访1～3年。结果锁骨钩铜板治疗组治疗结果评定：优10例，良8例。优良率为100．00％。常规手术组治疗结果评定：优5例，良6例，优良率为78，57％。两组治疗疗效比较，差异有统计学意义（P〈0．05）。结论锁骨钩铜板符合锁骨的“S”形结构，肩峰下关节外安置不干扰肩锁关节的正常生理结构。操作简单，固定可靠，术后活动早，并发症少，是治疗肩锁关节脱位较理想的内固定材料。     

锁骨钩钢板内固定与联合肌腱转位喙锁韧带重建术治疗肩锁关节脱位术后的功能恢复比较

1资料与方法 1．1一般资料 将2001-2005年在我院治疗的37例Allmanm度肩锁关节脱位患者分为两组，A组23例，采用锁骨钩钢板内固定加喙锁韧带修复手术；B组14例．采用锁骨远端切除缝合锚内固定加喙锁韧带重建手术。两组患者一般资料见表1。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.