骨质疏松骨折与非骨质疏松骨折治疗比较

目的:对比骨质疏松骨折与非骨质疏松骨折的临床特点和治疗方式,为骨折的临床诊治提供依据。方法:选取2010年12月至2013年12月在我院接受治疗的骨折患者186例。根据骨质疏松情况,将所选患者分为骨质疏松骨折组和非骨质疏松骨折组,每组各93例。分析并比较两组患者的治病原因、治疗方法以及临床效果。结果:非骨质疏松骨折组患者交通事故和砸伤致伤率均显著高于骨质疏松骨折组,而跌倒伤致伤率低于骨质疏松骨折组,差异具有统计学意义(P0.05);两组患者手术治疗方式差异无统计学意义(P0.05);骨质疏松骨折组患者保守治疗的临床疗效优于非骨质疏松骨折组,差异具有统计学意义(P0.05);两组手术治疗的临床疗效比较,差异无统计学意义(P0.05)。结论:在临床治疗的实践中,应根据患者骨质疏松病情实施针对性的治疗,从而提升治疗的针对性和有效性。     

镍钛形状记忆合金环抱器内固定术对多发性肋骨骨折患者术后疼痛、呼吸功能及肺部感染的影响

目的:探讨多发性肋骨骨折患者采用镍钛形状记忆合金环抱器内固定术治疗的临床效果。方法:选取2016年1月-2018年1月期间我院收治的97例多发性肋骨骨折患者。按照不同的治疗方法将患者分为对照组(n=47)和研究组(n=50),对照组患者给予胸部护板外固定术,研究组患者给予镍钛形状记忆合金环抱器内固定术。比较两组患者术后7 d的临床疗效,比较两组术前、术后7 d疼痛程度及呼吸功能情况,记录两组术后并发症发生情况。结果:研究组患者治疗后总有效率为92.00%(46/50),高于对照组患者的76.60%(36/47)(P0.05)。两组患者术后7 d视觉疼痛模拟评分量表(VAS)评分均较术前降低,且研究组低于对照组(P0.05)。两组患者术后7 d最大自主通气量占预计值百分比(MVV%)较术前升高,且研究组高于对照组(P0.05);两组患者术后7 d第1秒用力呼气肺活量占预计值百分比(FEV1%)比较无差异(P0.05)。研究组患者术后并发症总发生率8.00%(4/50),低于对照组的23.40%(11/47)(P0.05)。结论:多发性肋骨骨折经镍钛形状记忆合金环抱器内固定术治疗安全、有效,可明显减轻患者术后疼痛及改善呼吸功能,临床应用价值较高。     

动力髋螺钉与股骨近端髓内钉内固定治疗股骨粗隆间骨折患者的疗效及安全性和关节功能对比观察

目的:比较动力髋螺钉(DHS)与股骨近端髓内钉(PFNA)内固定治疗股骨粗隆间骨折患者的疗效及安全性和关节功能。方法:选取滁州市第一人民医院于2013年3月～2018年4月期间收治的160例股骨粗隆间骨折患者,根据内固定方式的不同将患者分为DHS组(n=80,采用DHS内固定)和PFNA组(n=80,采用PFNA内固定),比较两组临床疗效,采用髋关节功能Harris评分评价所有患者关节功能恢复情况,比较两组患者术前及术后相关指标,并观察患者术后并发症发生情况。结果:PFNA组患者临床总有效率为90.00%,高于DHS组患者的68.75%(P0.05)。两组患者Harris评分的优良率比较差异无统计学意义(P0.05)。PFNA组患者手术时间、卧床时间、骨折愈合时间、切口长度均短于DHS组(P0.05),术中出血量、术后引流量均少于DHS组(P0.05)。两组患者术后并发症总发生率比较无统计学差异(P0.05)。结论:DHS与PFNA内固定治疗股骨粗隆间骨折在术后关节功能恢复、安全性方面效果相当,但与DHS内固定治疗比较,PFNA内固定治疗的临床疗效更佳,手术时间更短,出血量更少,患者术后恢复更快,是治疗股骨粗隆间骨折较理想的手术方式。     

双侧股神经阻滞用于双膝关节置换术患者的麻醉效果和对血清炎性因子水平的影响

目的:研究双侧股神经阻滞术用于双膝关节置换术患者麻醉效果和对患者血清炎性因子水平的影响。方法:选择2015年10月～2018年10月在我院进行双膝关节置换术的110例患者,按照其入院顺序经随机数字表法分为两组,每组55例。对照组采用全身麻醉,研究组采用双侧股神经阻滞联合全身麻醉。比较两组的麻醉情况,治疗前后血清炎性因子白介素6(IL-6)、C反应蛋白(CRP)、舒张压(DBP)、收缩压(SBP)、心率(HR)水平的变化。结果:两组麻醉时间比较差异无统计学意义(P0.05);研究组拔管、恢复室停留和苏醒时间均显著短于对照组(P0.05)。两组术后24 h、48 h血清炎性因子IL-6、CRP水平均高于术前,但研究组以上指标均显著低于对照组(P0.05);两组术中DBP、SBP、HR水平均较术前显著降低(P0.05),但研究组DBP、SBP、HR水平均显著高于对照组(P0.05),两组术后DBP、SBP、HR水平比较差异均无统计学意义(P0.05)。结论:与单纯采用全身麻醉相比,双侧股神经阻滞可有效改善双膝关节置换术患者的麻醉效果,并降低其血清炎症因子和稳定其血流动力学。     

Possible risk factors for keel bone damage in organic laying hens

Keel bone damage (KBD) in laying hens is an important welfare problem in both conventional and organic egg production systems. We aimed to identify possible risk factors for KBD in organic hens by analysing cross-sectional data of 107 flocks assessed in eight European countries. Due to partly missing data, the final multiple regression model was based on data from 50 flocks. Keel bone damage included fractures and/or deviations, and was recorded, alongside with other animal based measures, by palpation and visual inspection of at least 50 randomly collected hens per flock between 52 and 73 weeks of age. Management and housing data were obtained by interviews, inspection and by feed analysis. Keel bone damage flock prevalences ranged from 3% to 88%. Compiled on the basis of literature and practical experience, 26 potential associative factors of KBD went into an univariable selection by Spearman correlation analysis or Mann–Whitney U test (with P<0.1 level). The resulting nine factors were presented to stepwise forward linear regression modelling. Aviary v. floor systems, absence of natural daylight in the hen house, a higher proportion of underweight birds, as well as a higher laying performance were found to be significantly associated with a higher percentage of hens with KBD. The final model explained 32% of the variation in KBD between farms. The moderate explanatory value of the model underlines the multifactorial nature of KBD. Based on the results increased attention should be paid to an adequate housing design and lighting that allows the birds easy orientation and safe manoeuvring in the system. Furthermore, feeding management should aim at sufficient bird live weights that fulfil breeder weight standards. In order to achieve a better understanding of the relationships between laying performance, feed management and KBD further investigations are needed.     

超声引导下髂筋膜神经阻滞联合全麻对老年股骨近端骨折患者术后血清疼痛介质PGE2、SP和认知功能及睡眠质量的影响

摘要 目的：观察超声引导下髂筋膜神经阻滞联合全麻对老年股骨近端骨折患者术后血清疼痛介质前列腺素E₂（PGE₂）、P物质（SP）和认知功能及睡眠质量的影响。方法：选取2018年8月~2021年9月期间我院收治的择期行手术治疗的老年股骨近端骨折患者80例,根据随机数字表法分为对照组（40例,常规全麻方案）和观察组（40例,超声引导下髂筋膜神经阻滞联合全麻方案）,对比两组麻醉效果、血流动力学、疼痛情况、认知功能和睡眠质量,观察不同模式麻醉下的安全性。结果：观察组的苏醒及拔管时间均短于对照组,丙泊酚使用量少于对照组（P<0.05）。两组置入喉罩时（T1）~术毕时（T3）心率（HR）先升高后下降,平均动脉压（MAP）先下降后升高（P<0.05）;观察组T1~T3时点HR低于对照组,MAP高于对照组（P<0.05）。两组术后24 h血清PGE₂、SP水平和视觉疼痛模拟量表（VAS）评分均升高,但观察组低于对照组（P<0.05）。两组术后1 d、2 d、3 d 蒙特利尔认知评估量表（MoCA）评分较术前先下降后升高（P<0.05）;观察组术后2 d、3 d MoCA评分高于对照组（P<0.05）。两组术后1 d、2 d、3 d匹兹堡睡眠质量评估量表（PSQI）评分较术前先升高后下降（P<0.05）;观察组术后1 d、2 d、3 d PSQI评分低于对照组（P<0.05）。两组不良反应发生率对比无差异（P>0.05）。结论：老年股骨近端骨折患者术中选用超声引导下髂筋膜神经阻滞联合全麻,镇痛效果显著,可稳定机体血流动力学,减少对认知功能和睡眠质量的影响,且安全性良好。     

TLR4-dependent upregulation of the platelet NLRP3 inflammasome promotes platelet aggregation in a murine model of hindlimb ischemia

Platelets play a critical role in the pathophysiology of peripheral arterial disease (PAD). The mechanisms by which muscle ischemia regulates aggregation of platelets are poorly understood. We have recently identified the Nod-like receptor nucleotide-binding domain leucine rich repeat containing protein 3 (NLRP3) expressed by platelets as a critical regulator of platelet activation and aggregation, which may be triggered by activation of toll-like receptor 4 (TLR4). In this study, we performed femoral artery ligation (FAL) in transgenic mice with platelet-specific ablation of TLR4 (TLR4 PF4) and in NLRP3 knockout (NLRP3^?/?) mice. NLRP3 inflammasome activity of circulating platelets, as monitored by activation of caspase-1 and cleavage of interleukin-1β (IL-1β), was upregulated in mice subjected to FAL. Genetic ablation of TLR4 in platelets led to decreased platelet caspase 1 activation and platelet aggregation, which was reversed by the NLRP3 activator Nigericin. Two weeks after the induction of FAL, ischemic limb perfusion was increased in TLR4 PF4 and NLRP3^?/? mice as compared to control mice. Hence, activation of platelet TLR4/NLRP3 signaling plays a critical role in upregulating platelet aggregation and interfering with perfusion recovery in muscle ischemia and may represent a therapeutic target to improve limb salvage.     

Paleoepidemiology,healing, and possible treatment of trauma in the medieval cemetery population of St. Helen-on-the-Walls,York, England

Traumatic lesions are commonly found in the archeological record and have potential to provide insight into the lives of past populations. This paper examines patterns of long bone fractures in the British medieval population of St. Helen-on-the-Walls from York (approximately 1100–1550) in an effort to determine patterns of healing and evidence for treatment. Long bones were macroscopically and radiologically examined. Clinical data were used to assess whether a fracture had successfully or unsuccessfully healed. The results indicate that fractures of the radius and ulna were most common. Males displayed more fractures than women. Most fractures were healed, well aligned, and without substantial deformity. Lack of evidence for deformity in bones likely to be severely affected by fracture implied that immobilization and possibly reduction was practiced on even the poorest residents of the medieval city. © 1996 Wiley-Liss, Inc.     

A possible balance of magnesium accumulations among bone, cartilage, artery, and vein in single human individuals

It is known that a large quantity of magnesium contains bones, and the magnesium contents in spongy bones decrease gradually with advancing age. To elucidate the relationships between a decrease of mineral contents in human bones and an accumulation of minerals in the other human tissues, the content of magnesium was analyzed by inductively coupled plasma-atomic emission spectrometry among human bones, arteries, veins, and cartilages in 27 subjects (17 men and 10 women). These were resected from the subjects who died in the age range 40–98 yr. Calcanei were chosen for analysis of magnesium contents in contrast with femoral, popliteal, and common carotid arteries, internal jugular and femoral veins, superior and inferior venae cavae, and pubic symphyses. The magnesium contents in the calcanei decreased gradually with aging, whereas they increased progressively in the arteries, veins, and pubic symphyses with aging. It was found that as the magnesium contents decreased in the calcanei, they increased in the arteries, such as the femoral, popliteal, and common carotid arteries, whereas they decreased inversely in the veins, such as the internal jugular and femoral veins and superior and inferior venae cavae. Furthermore, as the magnesium contents decreased in the calcanei, they hardly changed in the pubic symphyses. These suggest that magnesium released from bones is accompanied by accumulation of magnesium in the arteries.     

Correlations of calcium accumulations in arteries, veins, cartilages, ligaments, and bones in single humans

To show the relationships of calcium accumulation in the thoracic aorta to the other tissues, calcium contents were determined with a microwave-induced plasma-atomic emission spectrometer on arteries, veins, cartilages, ligaments, and bones. These tissues were resected from 18 individuals, consisting of 11 men and 7 women who died in the age range 59–91 yr. As thoracic and abdominal aortas are routinely used for radiographic examination of arterial calcification, they appear to be standard tissues of the calcium accumulation. The calcium accumulations were determined in the femoral artery, the superior and inferior venae cavae, the internal jugular vein, cartilages of the articular disk of the temporomandibular joint and the intervertebral disk, both the ligaments of the anterior cruciate ligament and the ligamentum capitis femoris, and the calcaneus, in contrast with the thoracic aorta. As calcium increased in the thoracic aorta, it increased in the femoral artery, the articular disk of the temporomandibular joint, the intervertebral disk, both ligaments of the anterior cruciate ligament, and the ligamentum capitis femoris, but it did not increase in veins, such as the superior and inferior venae cavae and the internal jugular vein. In contrast, it decreased in the calcaneus.