不同入路小切口髋关节置换对老年股骨颈骨折的比较研究

目的:探讨前外侧与后外侧路小切口髋关节置换术治疗老年股骨颈骨折临床疗效。方法:选取我院创伤骨科老年股骨颈骨折患者92例,随机分为两组,A组46例,予以后外侧路小切口髋关节置换术治疗;B组46例,予以前外侧小切口髋关节置换术治疗。记录并比较两组患者手术临床资料、术后并发症情况,采用Harris评分评价术后关节功能,调查问卷调查术后满意度。结果:1A组患者手术切口长度、手术时间、术中出血量和术后引流量明显小于B组患者,差异有统计学意义(P0.05);然两组患者住院时间相比无明显差异(P0.05);2A组术后关节功能与B组相比较,无明显差异(P0.05);而A组术后并发症发生率明显低于B组,差异有统计学意义(P0.05);3A组的患者术后满意率明显高于B组,差异有统计学意义(P0.05)。结论:前外侧和后外侧路小切口髋关节置换术治疗老年股骨颈骨折临床疗效相似,但后外侧路小切口操作简便,能够缩短手术时间、减少手术出血量、降低术后并发生症发生,患者满意度较高,对老年股骨颈骨折治疗临床价值较高。     

不同手术方式治疗老年股骨粗隆间骨折的疗效分析

目的：回顾分析应用动力髋螺钉（dynamic hip screw,DHS）、股骨近端锁定钢板（locking proximal femur plate,LPFP）、防旋型 股骨近端髓内钉(proximal femoral nail antirotation,PFNA)和人工股骨头置换术（femoral head replacement,FHR）治疗老年股骨粗 隆间骨折的临床疗效。方法：分别应用DHS、LPFP、PFNA、FHR内固定方法治疗112 例老年股骨粗隆间骨折,从手术时间、术中平 均出血量、术后并发症、术后髋关节功能评分方面进行分析。结果：从手术时间,术中出血量和术后并发症上,PFNA 组较其他组 少,差异有统计学意义(P<0.05);DHS 组,LPFP 组和FHR 组间比较差异无统计学意义(P>0.05)。Harris 髋关节功能评分上,PFNA 及人工关节组较其他2 组为优,差异有统计学意义(P<0.05);但PFNA 组和FHR组比较差异无统计学意义(P>0.05)。结论：4 组内 固定方式都有其优点和缺点,应根据骨折的不同类型选择合理的内固定方式。     

全髋关节置换术与人工股骨头置换术治疗老年股骨颈骨折的疗效比较

目的:探讨全髋关节置换术与人工股骨头置换术治疗老年股骨颈骨折的疗效。方法:选择在我院的82例行手术置换治疗的老年股骨颈骨折患者,随机分为观察组和对照组,每组41例。观察组采用全髋关节置换术,而对照组实施人工股骨头置换术。观察并比较两组患者的手术时间、术中出血量、血压、术后引流及髋关节功能等。结果:观察组手术时间、术中出血量及收缩压均显著高于对照组,差异具有统计学意义(P<0.05);术后引流量及并发症的发生率,两组比较无显著性差异(P>0.05)。观察组患者术后Harris评分为(93.25±4.51),对照组患者Harris评分为(82.76±3.82),观察组显著优于对照组,差异具有统计学意义(P<0.05)。结论:与人工股骨头置换术相比,全髋关节置换术用于治疗老年股骨颈骨折具有创伤小,恢复快的临床效果,患者术后髋关节功能恢复情况良好,值得在临床推广应用。     

四磨汤口服液对稳定性胸腰椎骨折胃肠功能障碍的临床研究

目的：探究四磨汤口服液对稳定性胸腰椎骨折胃肠功能障碍病患的治疗效果。方法：选择2011 年1 月至2013 年7 月在我 院接受治疗的稳定性胸腰椎骨折后伴有腹胀和（或）腹痛的病患134 例。以数字法随机分为观察组和对照组各67 例。其中观察组 口服四磨汤口服液,对照组注射甲基硫新斯的明注射液进行穴封。记录所有病患第一次肛门排气时间、腹胀等临床症状出现频 率,并对比两组治疗后肠功能恢复情况。结果：观察组治疗后显效率以及总有效率达到40.30%、94.03%,显著高于对照组的 16.42%、71.64%。并且观察组肛门第一次排气时间以及肠功能恢复时间均低于对照组。而观察组治疗后存在腹胀等临床症状的病 患仅占5.97%,少于对照组的22.39%。差异均有统计学意义（均P＜0.05）。结论：四磨汤口服液和甲基硫新斯的明均能对稳定性胸 腰椎骨折胃肠功能障碍病患起到缓解作用,但四磨汤口服液治疗效果更显著,它能加快病患肠胃功能的恢复,降低治疗后不良症 状的发生率。     

丝棉木的引种及繁殖

丝棉木(Chorisia speciosa St.)是原产南美洲热带及亚热带地区的木棉科植物。落叶乔木,树干挺拔,树形优美,花期长,花朵大而绚丽,美国、秘鲁等国广泛用于道路及庭园绿化。一般认为只能通过种子繁殖。70年代末至80年代初我国广东和海南地区曾少量试种,表明植株长势及观赏效果甚佳。但一直不能自然结实,因而难     

Femoral to cerebral arterial blood flow redistribution and femoral vein distension during orthostatic tests after 4 days in the head-down tilt position or confinement

The first objective of this study was to confirm that 4 days of head-down tilt (HDT) were sufficient to induce orthostatic intolerance, and to check if 4 days of physical confinement may also induce orthostatic intolerance. Evidence of orthostatic intolerance during tilt-up tests was obtained from blood pressure and clinical criteria. The second objective was to quantify the arterial and venous changes associated with orthostatic intolerance and to check whether abnormal responses to the tilt test and lower body negative pressure (LBNP) may occur in the absence of blood pressure or clinical signs of orthostatic intolerance. The cerebral and lower limb arterial blood flow and vascular resistance, the flow redistribution between these two areas, and the femoral vein distension were assessed during tilt-up and LBNP by ultrasound. Eight subjects were given 4 days of HDT and, 1 month later, 4 days of physical confinement. Tilt and LBNP test were performed pre- and post-HDT and confinement. Orthostatic intolerance was significantly more frequent after HDT (63%) than after confinement (25%, P<0.001). Cerebral haemodynamic responses to tilt-up and LBNP tests were similar pre- and post-HDT or confinement. Conversely, during both tilt and LBNP tests the femoral vascular resistances increased less (P<0.002), and the femoral blood flow reduced less (P<0.001) after HDT than before HDT or after confinement. The cerebral to femoral blood flow ratio increased less after HDT than before (P<0.002) but remained unchanged before and after confinement. This ratio was significantly more disturbed in the subjects who did not complete the tilt test. The femoral superficial vein was more distended during post-HDT LBNP than pre-HDT or after confinement (P<0.01). In conclusion, 4 days of HDT were enough to alter the lower limb arterial vasoconstriction and venous distensibility during tilt-up and LBNP, which reduced the flow redistribution in favour of the brain in all HDT subjects. Confinement did not alter significantly the haemodynamic responses to orthostatic tests. The cerebral to femoral blood flow ratio measured during LBNP was the best predictor of orthostatic intolerance. Accepted: 12 December 1997     

穴位贴敷联合阶段性康复功能训练对股骨颈骨折术后患者功能康复、血清疼痛因子和骨代谢标志物的影响

摘要 目的：探讨穴位贴敷联合阶段性康复功能训练对股骨颈骨折术后患者功能康复、血清疼痛因子和骨代谢标志物的影响。方法：纳入四川省骨科医院2021年1月~2021年10月期间收治的股骨颈骨折患者150例。根据信封抽签法将患者分为对照组（75例）和观察组（75例）,对照组接受阶段性康复功能训练,观察组接受穴位贴敷联合阶段性康复功能训练,两组均干预3个月。3个月后,观察两组功能康复、视觉疼痛模拟评分法（VAS）评分、血清疼痛因子和骨代谢标志物情况,记录两组术后并发症发生率。结果：两组干预3个月后Barthel指数和Harris髋关节评分均较干预前升高,且观察组高于对照组（P<0.05）。两组干预1个月后、干预2个月后、干预3个月后视觉疼痛模拟评分法（VAS）评分逐渐下降,且观察组低于对照组（P<0.05）。两组干预3个月后骨特异性碱性磷酸酶（BALP）、骨保护素（OPG）升高,且观察组高于对照组;抗酒石酸盐酸性磷酸酶异构体（TRACP-5b）、Ⅰ型胶原羧基端肽β特殊序列（βCTX）水平降低,且观察组低于对照组（P<0.05）。两组干预3个月后缓激肽（BK）、前列腺素E2（PGE2）、5-羟色胺（5-HT）、脑内神经肽Y（NPY）水平降低,且观察组低于对照组（P<0.05）。两组术后并发症发生率组间对比无统计学差异（P>0.05）。结论：穴位贴敷联合阶段性康复功能训练可促进对股骨颈骨折患者术后功能恢复,减轻术后疼痛,可能与调节骨代谢相关标志物水平有关。     

独圣活血片联合微创单一手术入路在股骨头坏死治疗中的临床疗效观察

摘要 目的：探讨独圣活血片联合微创单一手术入路在股骨头坏死治疗中的临床疗效观察，为治疗该病症提供方法。方法：选取2016年1月-2018年6月我院收治的98例ARCOⅡA-ⅢB分期股骨头坏死的患者作为研究对象，依据治疗方式分为A组（传统入路治疗组）、B组（微创单一入路治疗组）和C组（单一入路+独圣活血片组）。比较三组患者的临床疗效，术中和术后相关的临床指标，术后炎症指标、红细胞沉降率和骨代谢指标，NRS 疼痛评分及治疗期间的不良反应，术后1月、6月、12月的Harris 髋关节功能评分、生活质量量表及36 项健康调查简表评分（SF-36），肝肾功能、凝血功能指标及术后并发症发生情况。结果：C组治疗有效率为91.84%，明显高于A组治疗有效率70.00%和B组治疗有效率71.88%，差异有统计学意义（P＜0.05）；B组患者的卧床时间少于A组患者，C组患者的术区血肿吸收时间少于A组和B组患者，差异有统计学意义（P＜0.05）；三组术后不同时间段Harris 和SF-36评分比较有差异，随着时间推移，Harris 和SF-36评分逐渐降低差异有统计学意义（P＜0.05）；三组术后不同时间段NRS评分比较有差异，随着时间推移，NRS评分逐渐降低差异有统计学意义（P＜0.05）；三组术后不同时间段CRP、TNF-α、红细胞沉降率、CTX、TRACP-5b，比较有差异，随着时间推移，CRP、TNF-α、红细胞沉降率、CTX、TRACP-5b均逐渐降，低差异有统计学意义（P＜0.05）；C组患者的CRP、TNF-α、红细胞沉降率、CTX、TRACP-5b均明显低于A组患者和B组患者，差异有统计学意义（P＜0.05）。三组患者术后不同时间段肝肾功明、凝血功能及术后并发症发生率差异均无统计学意义（P＜0.05）。结论：独圣活血片联合微创单一入路法治疗早中期股骨头坏死具有较好的疗效和安全性，创伤小，恢复快，有助于缓解患者疼痛，促进术后血肿吸收，改善髋结节功能，帮助患者提早恢复日常生活，具有一定临床应用价值。     

限制性液体复苏对多发性骨折合并创伤失血性休克患者凝血功能、心肌损害指标及预后的影响

摘要 目的：研究限制性液体复苏对多发性骨折合并创伤失血性休克患者凝血功能、心肌损害指标及预后的影响。方法：选择2020年6月至2022年5月的90例多发性骨折合并创伤失血性休克患者进行本次研究，按照随机数表法分为研究组（n=47）和对照组（n=43），对照组采用常规液体复苏治疗，研究组采用限制性液体复苏治疗。对比两组输液量、失血量、输血量，复苏前及复苏后1 h凝血功能指标（PT、APTT、TT）水平，心肌损害指标（CK、CK-MB、CTnT）水平，并发症发生率。结果：研究组输液量、失血量、输血量均显著低于对照组[（2106.87±135.62）mL vs（2950.39±139.57）mL，（1049.31±160.07）mL vs（1390.18±135.89）mL，（1465.02±191.78）mL vs（1860.23±198.59）mL]（P＜0.05）；研究组PT、 APTT、 TT水平均显著高于对照组[（19.06±1.80）s vs（15.82±1.26）s，（42.03±3.85）s vs（37.02±3.19）s，（21.03±3.86）s vs（15.80±3.27）s]（P＜0.05）；研究组CK、CK-MB、CTnT水平均显著低于对照组[（20.85±2.72）U/L vs（32.97±3.69）U/L，（23.06±3.28）U/L vs（35.97±3.70）U/L，（2.07±0.36）ng/mL vs（2.90±0.38）ng/mL]（P＜0.05）；研究组并发症发生率显著低于对照组[10.64%（5/47）vs27.91％（12/43）]（P＜0.05）。结论：多发性骨折合并创伤失血性休克患者采用限制性液体复苏可有效改善的其凝血功能，保护心肌细胞，提高患者预后。     

Electron microscopic 3D-reconstruction of dendritic spines in cultured hippocampal neurons undergoing synaptic plasticity

Dendritic spines are assumed to constitute the locus of neuronal plasticity, and considerable effort has been focused on attempts to demonstrate that new memories are associated with the formation of new spines. However, few studies that have documented the appearance of spines after exposure to plasticity-producing paradigms could demonstrate that a new spine is touched by a bona fida presynaptic terminal. Thus, the functional significance of plastic dendritic spine changes is not clearly understood. We have used quantitative time lapse confocal imaging of cultured hippocampal neurons before and after their exposure to a conditioning medium which activates synaptic NMDA receptors. Following the experiment the cultures were prepared for 3D electron microscopic reconstruction of visually identified dendritic spines. We found that a majority of new, 1- to 2-h-old spines was touched by presynaptic terminals. Furthermore, when spines disappeared, the parent dendrites were sometime touched by a presynaptic bouton at the site where the previously identified spine had been located. We conclude that new spines are most likely to be functional and that pruned spines can be transformed into shaft synapses and thus maintain their functionality within the neuronal network.