可吸收螺钉内固定治疗骨折的疗效及临床优势分析

目的分析可吸收螺钉内固定治疗内踝关节骨折的疗效及临床优势。方法研究对象选取2012年6月至2014年5月86例内踝关节骨折患者,根据随机原则分成对照组和实验组。其中对照组患者采用金属螺钉内固定治疗,实验组患者采用可吸收螺钉内固定治疗。术后随访1年,对比两组患者踝关节功能恢复情况的差异。结果经过数据统计发现,对照组患者术后1年时踝关节功能为优22例、良15例、可4例、差2例,优良率为86.05%;实验组患者术后1年时踝关节功能为优26例、良16例、可1例,优良率为97.67%。实验组患者术后踝关节功能优良率明显高于对照组,组间有显著的统计学差异(P0.05)。结论可吸收螺钉内固定治疗骨折的疗效确切,且避免了二次手术的创伤,可将其作为内踝关节骨折治疗的有效方案推广应用。     

腕关节镜辅助复位经皮克氏针内固定的临床疗效

目的探讨桡骨远端经关节面骨折腕关节镜辅助复位经皮克氏针内固定的疗效。方法对普宁市人民医院2011年5月至2013年12月期间收治的50例桡骨远端经关节面骨折的骨折患者,关节镜辅助复位经皮克氏针内固定,对疗效进行分析。结果在50例患者中,术后随访3~36个月,平均为(16.1±3.2)个月。对患者的疗效进行分析,其中优25例,良16例,优良率达82%。所有患者经过治疗后,其中10例患者出现并发症,包括5例为穿克氏针处感染,经加强换药后好转;3例患者为克氏针退针,但不影响位置和骨折愈合,1例患者出现并发腕管综合征,行腕横韧带切断及正中神经松解术,术后随访后,1例患者出现创伤性骨关节炎。结论腕关节镜辅助复位经皮克氏针内固定治疗桡骨远端经过关节面骨折,能够更清晰的显示骨折块,对于患者来说,疗效高,并发症少,值得临床推广应用。     

两种不同治疗股骨远端骨折方法的疗效比较

目的比较两种内固定方式治疗股骨远端骨折的疗效,为临床应用提供依据。方法对2010年8月至2013年9月本院收治的90例C型股骨远端骨折患者资料进行回顾性分析,根据内固定方式不同随机分为两组:微创内固定系统(LISS)组和动力髁螺钉(DCS)组各45例,比较两组患者手术切口大小、手术时间、术中出血量、住院天数、骨折愈合天数。按照Kolment疗效标准对患膝肢体功能进行评估。结果 90例患者术后获得12~36个月,平均18.3个月随访。观察组切口(12.8±3.6)cm,出血量(212.6±31.3)m L,骨折愈合时间(12.8±0.7)d,均明显优于对照组,两组间差异具有统计学意义(P0.05);在手术时间以及住院天数方面,两组差异不具有统计学意义(P0.05);骨折愈合后按照Kolment疗效标准对患膝进行功能评定。优良率:观察组88.89%,明显优于对照组73.33%,两组间差异具有统计学意义(P0.05)。结论 LISS系统可减少组织创伤,保护局部血运,降低不愈合和延迟愈合的风险,减少术后感染的发生率。是一种值得临床推广和使用治疗股骨远端骨折的方法。     

前、后路手术治疗颈脊髓损伤的效果比较

目的比较前、后路手术治疗颈脊髓损伤的临床效果。方法选取78例颈脊髓损伤患者,抽签随机分为两组,其中39例采用前路手术治疗患者记为前路术组,另外39例采用后路手术治疗记为后路术组,观察两组手术相关指标并结合术后有效随访比较治疗综合效果。结果前路术组手术时间(75.4±10.2)min、术中出血量(206.3±31.5)m L较后路术组明显较低,术后1年颈椎功能JOA评分(14.4±1.8)分较后路术组显著较高(P0.05);前路术组不良结果发生率5.13%较后路术组低(P0.05)。结论同后路手术相比,前路手术具有手术时间短、术中出血量少的特点,且能有效减少术后不良结果的发生,对病情康复和改善预后具有重要意义。     

K-L入路切开复位内固定治疗髋臼骨折伴股骨头脱位的临床疗效

目的研究K-L入路切开复位内固定治疗髋臼骨折伴股骨头脱位的临床疗效。方法回顾性分析2013年3月至2014年3月到湖北省孝感市中心医院行K-L入路切开复位内固定术的30例髋臼骨折伴股骨头脱位患者临床资料,采用改良Merled,Aubigne与Postel评分系统评价手术后髋关节功能恢复情况,采用Matta标准评定骨折复位效果,同时随访1年,观察术后并发症发生情况。结果末次随访时髋关节功能评分为(16.4±1.6)分,显著高于治疗前的(12.3±1.5)分,差异具有统计学意义(P0.05)。末次随访时患者优良率为76.67%,解剖复位19例,满意复位9例,复位较差2例。术后并发症总发生率为43.33%。结论 K-L入路切开复位内固定治疗髋臼骨折伴股骨头脱位效果显著,但并发症较多,应严格操作,降低并发症发生率。     

经皮中空螺钉内固定与张力带内固定内踝骨折的临床疗效观察

研究探讨经皮置入中空螺钉内固定治疗闭合性内踝骨折(Ashurst和Bromer分类的内翻内收型骨折Ⅰ度)的临床实用性,收集60例闭合性内踝骨折的患者,随机分为两组各30例。A组予传统切开复位张力带内固定术治疗,B组予闭合复位经皮置入中空螺钉内固定治疗。术后采用Takakura踝关节评分系统来评价疗效,并对结果进行分析。     

MSCT评估胸腰椎骨折术后愈合及功能康复的研究

本研究探讨多层螺旋CT(MSCT)在检测评估胸腰椎骨折后椎体内植骨成形术患者骨折愈合及功能康复方面的价值。选取采取切开复位椎体内植骨成形术治疗的102例胸腰椎爆裂骨折患者进行临床研究,根据患者术后6个月的改良Prolo功能评分将患者分为优良组(72例)和一般组(30例),对比两组的植骨区域CT值、脊柱椎体影像学参数变化趋势。术后3个月、6个月,优良组患者的伤椎前缘压缩率、Cobb角测定值均小于一般组(P<0.05);术后3个月、6个月,优良组患者的CT值大于一般组,优良组患者的Oswestry功能障碍指数值低于一般组(P<0.05)。胸腰椎骨折后椎体内植骨成形术患者植骨区CT值变化可以反映骨折愈合的效果。     

40例幼儿肱骨髁上骨折临床治疗观察

目的分析切开复位克氏针内固定方法和手法复位外固定方法治疗幼儿肱骨髁上骨折的临床疗效。方法收集2013年1月到2014年1月东莞市中堂镇医院收治40例幼儿肱骨髁上骨折患者临床资料,按照不同的治疗方法,分为治疗组与对照组,各20例。治疗组采取切开复位克氏针内固定方法,对照组采取手法复位外固定方法,最后分析两组患儿临床治疗效果。结果治疗组患儿治疗总有效率为95%,明显高于对照组的80%,差异显著P0.05;治疗组患儿UCLA评分和ASAES评分明显高于对照组,差异显著P0.05;治疗组并发症的发生率为5%,明显低于对照组的25%,差异显著P0.05。结论切开复位克氏针内固定治疗于幼儿肱骨髁上骨折患者,治疗有效率较高,促进术后康复,有利于改善患儿预后情况,值得临床推广。     

胸腔镜辅助下微创Nuss手术矫治漏斗胸的临床观察

目的总结分析胸腔镜辅助下微创Nuss手术在矫治漏斗胸治疗中的应用价值。方法选择2010年6月—2011年11月期间广东省江门市中心医院收治的30例漏斗胸患者为研究对象,均给予胸腔镜辅助下微创Nuss手术治疗,观察手术情况、手术疗效以及术后并发症等情况。结果 30例患者均顺利完成矫治手术治疗,手术时间(32.5±5.6)min;术中出血量(52.5±6.7)m L;术后2~4周均恢复正常生活和工作,运动量逐渐增加,且症状得到缓解。术后胸廓外观平坦且对称,X线胸片明显改善。Nuss疗效优良率86.67%,并发症发生率为6.67%,复发率为3.33%。结论在漏斗胸矫治中胸腔镜辅助下微创Nuss手术安全可靠,对患者创伤小,术后恢复快,值得推广使用。     

组合式外固定支架在四肢创伤骨科手术中的应用

目的就组合式外固定支架在四肢创伤骨科手术中的应用进行分析与探讨。方法选择佛山市高明区中医院自2013年10月至2015年9月期间收治的行四肢创伤骨科手术患者88例,所有患者均接受组合式外固定支架,其后对应用效果进行分析和总结,并比较治疗前后的肘关节功能评分。结果 88例患者接受组合式外固定支架治疗后,骨折愈合优良率为96.6%,并发症发生率为3.4%,治疗后的肘关节功能评分优于治疗前,经比较后,治疗前后存在显著性差异。结论在四肢创伤骨科手术中应用外固定支架,其治疗效果显著,同时促进患者早日康复,具有重要的临床应用价值。     

Association of Paraoxonase 1 (PON1) polymorphisms with osteoporotic fracture risk in postmenopausal Korean women

There is increasing evidence of a biochemical link between lipid oxidation and bone metabolism. Paraoxonase 1 (PON1) prevents the oxidation of low-density lipoprotein (LDL) and metabolizes biologically active phospholipids in oxidized LDLs. Here, we performed association analyses of genetic variation in PON1 to ascertain its contribution to osteoporotic fractures (OFs) and bone mineral density (BMD). We directly sequenced the PON1 gene in 24 Korean individuals and identified 26 sequence variants. A large population of Korean postmenopausal women (n=1,329) was then genotyped for eight selected PON1 polymorphisms. BMD at the lumbar spine and femoral neck was measured using dual-energy X-ray absorptiometry. Lateral thoracolumbar (T4-L4) radiographs were obtained for vertebral fracture assessment, and the occurrence of non-vertebral fractures (i.e., wrist, hip, forearm, humerus, rib, and pelvis) was examined using self-reported data. Multivariate analyses showed that none of the polymorphisms was associated with BMD at either site. However, +5989A>G and +26080T>C polymorphisms were significantly associated with non-vertebral and vertebral fractures, respectively, after adjustment for covariates. Specifically, the minor allele of +5989A>G exerted a highly protective effect against non-vertebral fractures (OR=0.59, P=0.036), whereas the minor allele of +26080T>C was associated with increased susceptibility to vertebral fractures (OR=1.73, P=0.020). When the risk for any OFs (i.e., vertebral or non-vertebral) was considered, the statistical significance of both polymorphisms persisted (P=0.002-0.010). These results suggest that PON1 polymorphisms could be one of useful genetic markers for OF risk in postmenopausal women.     

Iminium carbonic acid derivative salts. XII . electrophilic reactions of 2-methylthio-4,5-dihydrothiazolium iodides, 5-methyl-2-methylthiothiazolium iodides and 2-methylthio-5,6-dihydro-1,3-thiazinium iodides. part III. With Vinylogous and Phenylogous Active Methylene Compounds

3-Benzyl-2-memyltmo-4,5-dmydrothiazolium iodide ( 1 ), 5-metlyl-2-methylthio-3-phenethylthiazolium iodide ( 4 ) and 3-methyl and 3-benzyl-2-methylthio-5,6-dihydro-1,3-thiazinium iodides 7a, b were reacted with the vinylogous doubly activated CH-acidic compounds 2a-d and the phenylogous doubly activated components 8, 11, 16, 19 and 21 to yield new types of S, N-heterocycles 3, 5, 6, 9, 10, 12, 13, 14, 15 with the partial structure of push-pull substituted butadienes and 17, 18, 20, 22, 23 and 24 with the character of push-pull substituted phenyl ketene S, N-acetals.     

Association of ADIPOR1 polymorphisms with bone mineral density in postmenopausal Korean women

Adiponectin may affect bone through interactions with two known receptors, adiponectin receptors (ADIPOR) 1 and 2. We examined the association between polymorphisms of ADIPOR1 and ADIPOR2 and bone mineral density (BMD) in postmenopausal Korean women. Six polymorphisms in ADIPOR1 and four polymorphisms in ADIPOR2 were selected and genotyped in all study participants (n = 1,329). BMD at the lumbar spine and femur neck were measured using dual-energy X-ray absorptiometry. Lateral thoracolumbar (T4-L4) radiographs were obtained for vertebral fracture assessment and the occurrence of non-vertebral fractures examined using self-reported data. P values were adjusted for multiple testing using Bonferroni correction (P(corr)). ADIPOR1 rs16850799 and rs34010966 polymorphisms were significantly associated with femur neck BMD (P(corr) = 0.036 in the dominant model; P(corr) = 0.024 and P(corr) = 0.006 in the additive and dominant models, respectively). Subjects with the rare allele of each polymorphism had lower BMD, and association of rs34010966 with BMD showed a gene dosage effect. However, ADIPOR2 single nucleotide polymorphisms and haplotypes were not associated with BMD at any site. Our results suggest that ADIPOR1 polymorphisms present a useful genetic marker for BMD in postmenopausal Korean women.     

Uber hexagonale Perowskite mit Kationenfehlstellen. VI. Strukturbestimmung an Ba8Re2W3□3O24 – der ersten hexagonalen Perowskitstapelvariante vom 24 L-Typ

On Hexagonal Perovskites with Cationic Vacancies. VI. Structure Determination on Ba₈Re₂W₃□₃O₂₄ – the First Hexagonal Stacking Polytype with 24 Layers For the hexagonal stacking polytype of rhomboedral 24 L type, Ba₈Re₂W₃□₃O₂₄, eight sequences are possible: (6)(2); (4)1(2)1; (5)1(1)1; (5)(3); (3)11(1)11; (1)21(1)12 (all space group R3m) and 4211; 3221 (all space group R3m). By vibrational spectroscopic investigations the sequences (6)(2); (5)(3) and 4211 could be eliminated. By means of intensity calculations the sequence (1)21(1)12 or chhhhchh respectively can be selected out of the remaining five. The structure contains groups of three and five face-connected octahedra which are linked with another by common corners. In the ideal structure, vacant lattice sites are found in the centres of the second and fourth octahedra of the block of five face-sharing octahedra and in the central octahedron of the block of three face-sharing octahedra. The remaining positions are occupied by the Re and W atoms. According to this distribution an direct contact of occupied face-sharing octahedra is absent. In the real structure, lattice defects are introduced by partial redistribution of atoms between occupied and vacant lattice positions in the blocks of three and five face-sharing octahedra. The occupation factor of one vacancy is about 8%. The refined, intensity related R′ value is 15.2%.     

软产道血肿的观察和护理体会

为探讨软产道血肿发生的原因,预防和减少阴道分娩的并发症,对12例软产道血肿发生的情况及相关因素进行了分析。结果表明,软产道血肿的形成与有无妊娠合并症、产程长短、助产技术密切相关。提示做好围产期保健工作,提高助产技术,加强产后的观察与护理,是防止软产道血肿的关键。     

Mixture diffusion in nanoporous adsorbents: equivalence of Fickian and Maxwell-Stefan approaches

Nanopore diffusion in multicomponent adsorption is described using different macroscopic theories: Onsager irreversible thermodynamics, Maxwell-Stefan, and Fickian approaches. A new equivalence between Fickian and Maxwell-Stefan formulations is described by [D]=[n(s)][B](-1)[Gamma][n(s)](-1). The elements of D and B are explicitly related to the Fickian and Maxwell-Stefan diffusivities, respectively. Only when the saturation loadings ni(s) for different components are the same can the matrix be reduced to the generally accepted equation [D]=[B](-1)[Gamma]. On the basis of the relationship between the irreversible thermodynamics and Maxwell-Stefan approaches, an equation is derived for a binary system with the symmetric form (1/Eth1 + theta2/Eth12)(1/Eth2 + theta1/ Eth21)=(L11L22)/(L12L21)(theta1theta2)/(Eth12Eth21) The Maxwell-Stefan binary exchange coefficients Ethij are shown to depend not only on the Maxwell-Stefan diffusivities, Ethi, but also on the Onsager coefficients. For a strong molecular interaction, that is, Ethi>Ethij , the ratio of Onsager coefficients will approach unity, giving the commonly used relation L12=square root L11L22 . In addition, the Maxwell-Stefan diffusivities, Ethi, are shown to depend on the interaction effects in mixtures, and Ethi in mixtures will not generally be equal to pure component values evaluated at the same total fractional loading.     

A model for the enzyme-catalyzed,coenzyme B12-dependent interconversion of β-methylaspartate with glutamate

A novel rearrangement promoted by vitamin B_12s of diethyl 1-keto-2-bromomethyl-2-methylsuccinate 10 to diethyl 4-methyl-2-ketoglutarate 11 has been discovered. This can serve as a partial model for the coenzyme B₁₂ dependent enzyme catalyzed interconversion of β-methylaspartate and glutamate. The Schiff base corresponding to 10 does not react with vitamin B_12s , but it does rearrange readily under free radical conditions when treated with tri-n-butyltin hydride.     

exo-closo-Rhodacarboranes: synthesis and characterisation of [{exo-(R3P)2Rh}(closo-CB11H12)] [R3P=P(OMe)3, PCy3, 1/2dppe]

Addition of H₂ to CH₂Cl₂ solutions of [(diene)Rh(L)₂][closo-CB₁₁H₁₂] (diene=norbornadiene, cyclooctadiene, L=PCy₃, P(OMe)₃, 1/2dppe) results in the formation of the exo-closo complexes [(PR₃)₂Rh(closo-CB₁₁H₁₂)]. These have been characterised in solution by ¹H- and ¹¹B-NMR spectroscopy, and for L=PCy₃ by a single crystal X-ray diffraction study. This suggests that the metal fragment is bound with the cage through the 7,8- and not the 7,12-{BH} vertices. DFT calculations on a model system where L=PMe₃ show that there is only a negligible energy difference between these two isomers (1 kcal mol⁻¹), suggesting that both represent stable structures. The salient spectroscopic markers that indicate an interaction of [closo-CB₁₁H₁₂]⁻ with a metal fragment are discussed and compared across a range of metal complexes. Large upfield shifts in the ¹¹B-NMR spectrum and a small downfield shift of the CH vertex in the ¹H-NMR spectrum are shown to the most reliable indicators of borane interaction in solution.