钛钢板内固定治疗跟骨关节内骨折

目的:评价开放复位内固定对跟骨骨折的治疗效果,分析手术并发症并提出有效对策。方法:骨折分型采用Sanders分型法,对跟骨骨折行切开复位钢板内固定的121例155侧患者,并进行随访,随访时间8～38个月,平均15.2个月。结果:切开复位钢板内固定可作为治疗跟骨关节内骨折的主要方法,术后9例出现切口愈合延迟,皮缘坏死2例,2例出现异体骨排斥反应,畸形愈合13例;按AOFAS后足踝关节评分标准,平均84.3分。结论:注意术前、术中、术后的操作细节可有效减少并发症。     

钢板内固定治疗跟骨骨折12例分析

目的探讨钢板内固定治疗跟骨骨折的临床疗效。方法钢板内固定治疗跟骨骨折12例,按Sanders分型方法,Ⅱ型为4例,Ⅲ型为6例,Ⅳ型为1例,术中均用钢板内固定。结果本组随访7～30个月,平均11.5个月,根据Marylangd足部评分系统评价术后功能,优3例(25%),良5例(41.7%),可3例(25%),差1例(8.7%),优良率为66.7%。结论钢板内固定治疗跟骨骨折临床效果满意,选择好适应证能取得较好疗效,减少并发症发生。     

解剖钢板内固定治疗SandersⅢ、Ⅳ型跟骨骨折29例分析

目的:评价开放复位解剖钢板内固定治疗SandersⅢ、Ⅳ型跟骨骨折疗效。方法:对29例34足SandersⅢ、Ⅳ型跟骨骨折采用解剖钢板内固定。按踝-后足评分评价足部功能。结果:29例34足跟骨骨折随访时间4~36个月,其中优28足(82.4%),良4足(11.8%),可2足(5.9%),优良率94.1%。结论:解剖钢板能够有效支撑塌陷的跟骨关节面,是一种合理的跟骨骨折内固定器。     

跟骨骨折CT及3D重建的评价

目的 评价跟骨骨折CT检查及3D重建的价值。方法 CT检查101侧跟骨，3D重建61侧。结果 ①关节外跟骨骨折7侧，关节内骨折44侧。伴后跟距下关节面骨折43侧，按Sanders氏分型为：Ⅰ型14侧，Ⅱ型19侧，Ⅲ型7侧，Ⅳ型3侧。②3D重建跟距下关节面骨折呈斜线形、“Y”字形、倒“Y”字形、不规则形及塌陷或移位形改变。跟骰关节面骨折呈线形、凹陷或粉碎性改变。③采用1mm准直SCT扫描3D重建效果明显优于3mm及5mm者。④SCT及3D重建能较好地显示可塑型跟骨钢板与跟骨间的关系。结论 CT检查及3D重建对判断跟骨骨折的严重程度及术后随访方面有重要价值。     

跗骨窦“八”字形切口入路钢板内固定手术治疗SandersⅡ、Ⅲ型跟骨骨折的效果

目的探讨跗骨窦"八"字形切口入路钢板内固定术治疗SandersⅡ、Ⅲ型跟骨骨折的临床效果。方法回顾性分析接受内固定手术治疗的82例跟骨骨折患者的临床资料,骨折Sanders分型为Ⅱ、Ⅲ型,均保留完整的临床手术资料和术后至少12个月的随访资料。根据手术入路方法的不同将患者分为微创组(n=37)和常规组(n=45),微创组接受跗骨窦"八"字切口入路钢板内固定治疗,常规组接受经典外侧"L"形切口复位钢板内固定治疗,比较2组手术相关指标、并发症和术后12个月踝关节功能恢复等情况。结果 2组手术时间、住院时间比较,差异无统计学意义(P 0.05);微创组手术出血量(37.82±10.04) m L少于常规组的(62.29±13.20) m L,切口并发症发生率10.81%低于常规组的31.11%,差异均有统计学意义(P 0.05);术后12个月随访资料显示,2组患者均未发生内固定失败、骨折不愈合或畸形愈合等严重并发症; 2组间术后12个月跟骨Bohler角、Gissane角、Maryland足部功能评分和骨折愈合时间比较,差异均无统计学意义(P0.05)。结论与外侧"L"形切口入路复位钢板内固定术相比,跗骨窦"八"字形切口入路钢板内固定术治疗SandersⅡ、Ⅲ型跟骨骨折能减少手术出血量,降低切口并发症发生率,而2种术式的骨折愈合和足部功能恢复效果均较好。     

Y-形钢板治疗移位的跟骨关节内骨折

目的:分析Y-形钢板治疗移位的跟骨关节内骨折的疗效。方法:手术治疗SandersⅡ、Ⅲ、Ⅳ型跟骨骨折患者42例共50足,采用外侧切口切开复位、植骨加Y钢板内固定。术后定期随访,采用Maryland评分标准对术后功能进行评价,了解疗效。结果:所有42例(50足)全部得到随访,术后功能优22足,良25足,中3足,优良率94%。结论:Y-形钢板形状和跟骨一致,支撑效果理想,对于移位的跟骨骨折采用切开复位、植骨加Y-形钢板内固定治疗的疗效良好,值得推广应用。     

钛质跟骨钢板内固定治疗粉碎性跟骨骨折

目的探讨切开复位可塑形钛质跟骨钢板治疗粉碎性跟骨骨折的疗效。方法对24例30足跟骨粉碎性骨折行切开复位钛质跟骨钢板内固定加一期植骨术。按Sanders分型:Ⅱ型10例,Ⅲ型12例,Ⅳ型8例。结果全部病例均随访6~30个月,平均15个月,按M argland足部评分标准评价:优10足,良13足,中5足,差2足,优良率76.7%。结论切开复位可塑形钛质跟骨钢板内固定加植骨治疗粉碎性跟骨骨折疗效肯定,治疗结果与软组织的损伤程度、骨折类型、复位质量有关。     

切开复位跟骨钢板内固定治疗累及关节面的跟骨骨折

目的 探讨手术切开复位跟骨钢板内固定治疗累及关节面的跟骨骨折的疗效.方法 对27例跟骨骨折患者的临床资料进行回顾性分析.结果 27例均为闭合性跟骨关节内骨折,SandersⅡ型18例、Ⅲ型9例.6例(22.2%)发生切口处皮缘坏死;Bohler角术前平均7.5°,术后平均27.54°.20例获平均16.8个月随访,所有患者均恢复正常行走,无活动受限和影响穿鞋主诉.结论 切开复位跟骨钢板内固定治疗累及关节面的跟骨骨折,能够获得满意的解剖复位,疗效可靠.     

改良“L”形切口结合跟骨锁定钢板治疗跟骨关节内骨折23例分析

目的探讨应用改良"L"形切口结合跟骨锁定钢板治疗跟骨关节内骨折的疗效。方法对23例25足累及距下关节的跟骨关节内骨折采用改良"L"形切口结合跟骨锁定钢板治疗。结果 23例经8~25个月随访,均获得骨性愈合。采用Marryland足部评分系统评价手术效果,优11例,良9例,可2例,差1例,优良率86.9%。结论采用改良"L"形切口结合跟骨锁定钢板治疗跟骨关节内骨折,能有效减少局部并发症,骨折固定可靠,可早期功能锻炼,符合生物力学稳定性要求,减少了创伤性距下关节炎的发生率。     

106例跟骨关节内骨折的手术治疗

目的 探讨跟骨关节内骨折的手术治疗效果及其并发症防治措施.方法 对106例(135足)跟骨关节内骨折患者采用切开复位跟骨钢板内固定治疗,骨折按Sanders 分型,Ⅱ型51足,Ⅲ型62足,Ⅳ型22足,术后随访5～20个月,观察有无并发症发生,术后功能恢复情况等,对治疗效果进行总结评价.结果 106例患者骨折均愈合,功能恢复良好,其中优58例,良38例,优良率为90.57%.4例切口愈合延迟,2例伤口发生感染,4例术后持续性疼痛,并发症发生率为9.43%.结论 切开复位跟骨钢板内固定术是治疗跟骨关节内骨折的有效治疗方法.     

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.     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.