Coca-Cola consumption vs fragmentation in the management of patients with phytobezoars:A prospective randomized controlled trial

BACKGROUND Gastric phytobezoars(GPBs)are very common in northern China.Combined therapy involving carbonated beverage consumption and endoscopic lithotripsy has been shown to be effective and safe.Existing studies on this subject are often case reports highlighting the successful dissolution of phytobezoars through Coca-Cola consumption.Consequently,large-scale prospective investigations in this domain remain scarce.Therefore,we conducted a randomized controlled trial to examine the effects of Coca-Cola consumption on GPBs.AIM To evaluate the impact of Coca-Cola on GPBs,including the dissolution rate,medical expenses,ulcer rate,and operation time.METHODS A total of 160 consecutive patients diagnosed with GPBs were allocated into two groups(a control group and an intervention group)through computer-generated randomization.Patients in the intervention group received a Coca-Cola-based regimen(Coca-Cola 2000-4000 mL per day for 7 d),while those in the control group underwent emergency fragmentation.RESULTS Complete dissolution of GPBs was achieved in 100% of the patients in the intervention group.The disparity in expenses between the control group and intervention group(t=25.791,P=0.000)was statistically significant,and the difference in gastric ulcer occurrence between the control group and intervention group(χ^(2)=6.181,P=0.013)was also statistically significant.CONCLUSION Timely ingestion of Coca-Cola yields significant benefits,including a complete dissolution rate of 100%,a low incidence of gastric ulcers,no need for fragmentation and reduced expenses.

舒适型下肢抬高垫的研究设计与临床应用

目的研制舒适型下肢抬高垫应用于胫腓骨骨折抬高消肿,评估其临床应用价值。方法根据人体工程学及临床实际研究设计舒适型下肢抬高垫,收集2016年9月—2017年10月中国人民解放军联勤保障部队第920医院(原成都军区昆明总医院创伤骨科研究所)需住院消肿治疗的胫腓骨骨折患者90例,随机分为抬高垫组、布朗氏架组,各45例。抬高垫组患者给予半圆弧状下肢抬高垫抬高消肿,布朗氏架组患者患肢置于布朗氏架面上抬高消肿,评估并记录两组患者入院当天、第3、6天的VAS评分,舒适度,肢体周径差值(患肢周径与健侧对应部位周径)。结果入院第6天抬高垫组VAS评分较布朗氏架组低[(2.67±0.80)分vs.(3.22±0.93)分,P=0.003],表明舒适型下肢抬高垫减轻疼痛作用优于布朗氏架;入院第3天抬高垫组舒适度较布朗氏架组高[(23.62±2.42)分vs.(22.29±3.38)分,P=0.034)]、第6天抬高垫组舒适度较布朗氏架组高[(25.82±1.56)分vs.(24.96±1.64)分,P=0.012],提示舒适型下肢抬高垫较布朗氏架可明显提高患者舒适度;抬高垫组第3天[(3.27±0.70)cm vs.(3.60±0.78)cm,P=0.038]及第6天[(1.75±0.39)cm vs.(1.99±0.54)cm,P=0.022)]肢体周径差值均低于布朗氏架组,表明舒适型下肢抬高垫消肿效果较布朗氏架好。结论在胫腓骨骨折抬高消肿治疗中,舒适型下肢抬高垫可有效抬高消肿、减轻疼痛、提高患者的舒适度,具有良好的临床应用价值。

Ghost Imaging Lidar via Sparsity Constraints in Real Atmosphere

We present a series of results acquired at a 2-kilometer distance using our lidar system under several weather conditions, clear, cloudy, light rain, moderately foggy, and night. The experimental results show that ghost imaging lidar via spar-sity constraints can realize imaging in all these weather conditions.

最小化内固定结合Ilizarov技术在胫骨平台骨折术后膝关节内翻畸形中的应用

目的探讨最小化内固定结合Ilizarov技术在胫骨平台骨折术后膝关节内翻畸形中的治疗方法及临床疗效。方法回顾性分析2013年9月—2015年10月中国人民解放军联勤保障部队第九二○医院骨科收治的胫骨平台骨折术后膝关节内翻畸形患者8例,8例患者胫骨平台骨折内固定术后逐渐出现膝关节内翻畸形改变,伴屈伸障碍,行走不便。男性6例,女性2例;年龄23~50岁,平均37.1岁。道路交通伤4例,高处坠落伤1例,摔伤1例,重物砸伤2例。患者均行最小化内固定结合Ilizarov技术治疗,使用螺钉内固定后再结合Ilizarov外固定。通过比较膝内翻偏移角度、术后并发症以及应用改良Karlstrom-Olerud功能评估系统对平均功能恢复情况进行评分。结果患者获平均12.1个月(10~14个月)随访,截骨后的植骨均成骨愈合,内翻畸形改善,未出现感染及骨不连等并发症。术前评估膝内翻偏移角度(26.13±3.29)°,术后第1天再次评估偏移角度(2.13±1.83)°,矫正度数为(24.00±3.39)°,术前术后膝内翻偏移角度比较差异有统计学意义(P<0.05)。改良Karlstrom-Olerud功能评估系统评分(29.1±3.2)分,功能状态满意。结论最小化内固定结合Ilizarov技术治疗胫骨平台骨折术后膝关节内翻畸形,在此研究病例中确实避免了胫骨结节高位截骨矫形内固定等关节内截骨矫正畸形方法因内固定所带来的并发症,可以减小手术创伤,术后早期负重且矫形效果满意,膝关节功能良好,降低并发创伤性关节炎的风险,是一种有效创新的保膝治疗方式。

跟骨骨折外固定技术的发展

20世纪以来,足踝外科领域对于跟骨骨折的处理逐渐成熟,但是内固定技术一直存在内植物占位以及切口皮肤感染等问题。外固定技术为上述问题提供了解决方案,使用外固定处理开放性跟骨骨折以及软组织条件差的闭合性跟骨骨折具有诸多优势。临床上应用外固定技术对跟骨骨折的治疗早已开展,然而外固定治疗跟骨骨折的相关文献却很少。本文就跟骨骨折应用外固定技术治疗的历史及方法作一综述,理清其优劣,便于临床医师选择及制定手术方案、治疗策略。

小腿双针可控便携式一体化牵引装置的临床应用

目的探讨小腿双针可控便携式一体化牵引装置的临床应用价值。方法前瞻性研究2018年1月—2018年12月联勤保障部队第九二〇医院骨科收治高能量胫腓骨远端骨折30例,男性19例,女性11例;年龄22~51岁,平均35.9岁;道路交通伤9例,高处坠落伤6例,摔伤7例,重物砸伤8例;骨折AO分型:43A型3例,43B型14例,43C型13例。术前均应用小腿双针可控便携式牵引装置行骨牵引术,双针牵引位置分别是胫骨结节牵引、跟骨牵引部位。按随机分组法分为A、B两组,各15例。A组行小腿双针可控便携式一体化牵引装置,牵引患肢置于舒适型下肢抬高垫上抬高消肿;B组行小腿双针可控便携式牵引装置+布朗氏架,牵引患肢置于布朗氏架上抬高消肿。记录并应用独立样本t检验比较分析两组患者牵引当天、牵引后第3、6天的肢体周径差值(患肢周径-健侧对应部位周径)和制动舒适度问卷(ICQ)评分。结果A、B组牵引当天、牵引后第3、6天肢体周径差值比较差异无统计学意义(P>0.05),但A组牵引后第3、6天的肢体周径差值(4.55±1.44)cm、(2.21±0.73)cm均小于B组(4.75±1.12)cm、(2.29±0.72)cm,认为高能量胫腓骨远端骨折的术前牵引治疗中,舒适型下肢抬高垫抬高消肿效果与布朗氏架相似,结果显示小腿双针可控便携式一体化牵引装置具有有效的抬高消肿作用。患者ICQ评分两组间比较差异有统计学意义(P=0.043),A组ICQ评分高于B组,表明小腿双针可控便携式一体化牵引装置在术前牵引治疗可显著高患者舒适度。结论小腿双针可控便携式一体化牵引装置具有有效牵引、消肿、提高患者舒适度的临床应用价值,是一种有效的一体化牵引装置。

Laboratory simulation of soil respiration response to environmental conditions in intertidal zones of Jiangsu Province,China

As major contributor to the blue carbon sink,intertidal zones play a crucial role in the global carbon cycle.In recent years,more attention has been given to the carbon cycle in intertidal wetlands.However,due to highly variable and uncertain environmental conditions,it is difficult to clarify the quantitative relationship between soil respiration and environmental factors through in-situ experiments.In this study,the response of soil respiration characteristics to variations in the temperature and water table was investigated using a monitoring apparatus of CO_(2)flux at the soil-air interface in the intertidal zone.The results showed that soil respiration flux was significantly correlated with temperature,and the correlation best fitted the DoseResp function.Meanwhile,the respiration flux was enhanced with the descent of water table,a relationship could be described by a quadratic function.The effect of the water table on soil respiration became more pronounced with the rise of temperature.These results provide significant clarification of the impact of human activities on the carbon cycle in bare intertidal zones and as well as support for numerical simulations of the carbon cycle in bare intertidal zones.

6G无线覆盖扩展技术

根据国际电信联盟关于IMT-2030愿景,第6代移动通信系统(the 6th generation mobile networks,6G)的覆盖服务需求将从单场景覆盖向多场景覆盖扩展,6G基础设施的部署也将逐步从2D覆盖向3D覆盖扩展、从局部覆盖向全球覆盖扩展、从中低频段融合使用向更高频段按需开启.上述需求使得6G在提升容量的同时,需要进一步考虑无线覆盖扩展需求.本文针对如何在6G网络结构时空尺度跨度大、全场景业务需求差异大、超密集覆盖能耗大等关键挑战下实现容量和能效约束下的覆盖能力扩展这一重大科学问题,首先提出了面向6G无线覆盖扩展的智能柔性组网架构;其次研究了面向6G无线覆盖扩展的关键技术,包括面向6G广域覆盖的多维立体空天地覆盖扩展技术、面向深度覆盖的超密集异构覆盖扩展技术和面向6G平滑度覆盖的超高速移动覆盖扩展技术;接着分析了基于语义通信的覆盖扩展技术;最后给出了6G全场景无线覆盖扩展仿真验证,通过定义6G无线覆盖扩展技术指标体系,进行了典型场景的覆盖性能仿真验证.

胫骨结节下微创弧形截骨术联合Ilizarov技术治疗膝关节内侧间室骨关节炎

目的:探讨胫骨结节下微创弧形截骨术联合Ilizarov技术矫正患者下肢力线来治疗膝关节内侧间室骨关节炎的临床疗效。方法:回顾性分析2018年2月至2022年5月收治的13例(19膝)膝关节内侧间室骨关节炎患者,男8例,女5例,年龄33~56岁,平均(36.0±10.8)岁。对患者行胫骨结节下微创弧形截骨术联合Ilizarov技术,记录环形外固定器拆除时间、术前与术后患侧髋-膝-踝角(HKA)、胫骨近端内侧角(MPTA)、膝关节活动度(ROM)、疼痛视觉模拟评分(VAS)和髌骨高度(ISI)来评估临床疗效。结果:所有患者均顺利完成手术,手术时间38~55 min,平均(45.2±11.6)min;住院时间5~8 d,平均(6.4±1.6)d。患者术后均获得随访,随访时间12~36个月,平均(17.4±6.7)个月,所有患者HKA、MPTA、ROM、VAS评分较术前比较差异有统计学意义(P<0.01),ISI术前与术后比较差异无统计学意义(P>0.05)。术后环形外固定器留置期间有3例患者出现针道红肿,予以换药、酒精湿敷,拆除环形外固定器1周内针道均愈合良好。结论:通过胫骨结节下微创弧形截骨术联合Ilizarov技术治疗膝关节内侧间室骨关节炎,能够有效矫正患者的下肢力线,从而缓解膝关节疼痛。

Hidden Genetic Regulation of Human Complex Traits via Brain Isoforms

Alternative splicing exists in most multi-exonic genes,and exploring these complex alternative splicing events and their resultant isoform expressions is essential.However,it has become conventional that RNA sequencing results have often been summarized into gene-level expression counts mainly due to the multiple ambiguous mapping of reads at highly similar regions.Transcript-level quantification and interpretation are often overlooked,and biological interpretations are often deduced based on combined transcript information at the gene level.Here,for the most variable tissue of alternative splicing,the brain,we estimate isoform expressions in 1,191 samples collected by the Genotype-Tissue Expression(GTEx)Consortium using a powerful method that we previously developed.We perform genome-wide association scans on the isoform ratios per gene and identify isoform-ratio quantitative trait loci(irQTL),which could not be detected by studying gene-level expressions alone.By analyzing the genetic architecture of the irQTL,we show that isoform ratios regulate edu-cational attainment via multiple tissues including the frontal cortex(BA9),cortex,cervical spinal cord,and hippocampus.These tissues are also associated with different neuro-related traits,including Alzheimer’s or dementia,mood swings,sleep duration,alcohol intake,intelligence,anxiety or depression,etc.Mendelian randomization(MR)analysis revealed 1,139 pairs of isoforms and neuro-related traits with plausible causal relationships,showing much stronger causal effects than on general diseases measured in the UK Biobank(UKB).Our results highlight essential transcript-level biomarkers in the human brain for neuro-related complex traits and diseases,which could be missed by merely investigating overall gene expressions.

牛鼻子引流技术结合Ilizarov环形外固定一期治疗Gustilo ⅢA 型Pilon骨折

目的探讨牛鼻子引流(nose ring drain,NRD)技术结合Ilizarov环形外固定一期治疗GustiloⅢA型Pilon骨折的疗效。方法2017年3月—2019年12月,收治GustiloⅢA型Pilon骨折患者17例。其中男11例,女6例;年龄24~63岁,平均38.2岁。交通事故伤3例,高处坠落伤13例,贯通伤1例。急诊入院13例,骨折手术治疗后创面感染4例。合并腓骨骨折2例、外踝骨折3例。采用NRD技术结合Ilizarov环形外固定一期治疗。结果患者均获随访,随访时间8~12个月,平均9.9个月。创面均Ⅰ期愈合,4例术前感染患者随访期间无复发。17例患者术后3~7个月(平均4.5个月)骨折愈合后拆除外固定物。末次随访时,踝关节Kofoe评分中疼痛评分40~50分,平均44分;功能评分17~27分,平均25分;活动度评分8~18分,平均14分;获优8例,良7例,可1例,差1例。结论NRD技术结合Ilizarov环形外固定一期治疗GustiloⅢA型Pilon骨折,骨折固定及引流效果良好,大大降低了传统治疗方案并发症发生风险,减少了手术次数。

后跟部形态学测量及解剖型跟骨外固定器的设计

目的测量并计算正常后跟部形态学数据,依此设计解剖型跟骨外固定器。方法随机抽取100名符合选择标准的正常人群,获得200足后足数据,其中男45例,女55例;年龄19~67岁,平均43.9岁。根据人体工程学和局部解剖学原理,以直接测量模式分别测量负重站立位及平卧位后跟部形态学数据。负重站立位采用游标卡尺骨性标志测量法,测量后跟长、后跟宽、后跟高、内踝高、外踝高及后跟倾斜角(calcaneal pitch angle,CPA),并进行男女分组及左右足分组比较;平卧位采用3D点阵倒模测量法,测量平卧位后跟部形态。根据后跟部综合解剖形态立体数据,以AutoCAD 2019等三维工业设计软件设计解剖型跟骨外固定器。结果站立位游标卡尺测量法示,男性鞋码、后跟长、后跟宽、后跟高、内踝高、外踝高、CPA均显著大于女性(P<0.05)。除左足内踝高明显小于右足(t=?2.827,P=0.005)外,其余各指标左右足间比较差异均无统计学意义(P>0.05),从形态上基本可认为左右足为镜像对称关系。平卧位3D点阵倒模测量法测量示,后跟部为非正圆弧边,多组弧边总体在一个有限范围内波动。以上述数据为基础设计出一种解剖型跟骨外固定环,理论上能贴合解剖弧度,以便灵活构型。在此基础上分别设计出普通构型、加压构型及正畸构型,以满足不同程度足踝损伤的治疗需求。普通构型适用于关节内骨折块无移位或轻度移位的SandersⅠ、ⅡA、ⅡB型跟骨骨折患者,以简单固定为主;加压构型适用于关节内骨折块中度移位的SandersⅡC、ⅢA、ⅢB型以及舌型和撕脱型跟骨骨折患者,该构型以橄榄针斜拉固定方式来固定移位骨块;正畸构型适用于关节内骨折块严重移位或跟骨骨质重度缺损的SandersⅢC、Ⅳ型跟骨骨折患者,以多模块设计兼顾稳固固定骨折和任意调节关节固定角度。结论后跟形态特殊,因此根据游标卡尺测量法和3D点阵倒模测量法测量数据设计的跟骨外固定器为解剖型,其构型理论上能满足临床上稳定固定、灵活构型的需要。

单纯Ilizarov环形外固定技术治疗合并骨筋膜室综合征的胫骨平台骨折

目的探讨单纯Ilizarov环形外固定技术治疗合并骨筋膜室综合征的胫骨平台骨折的疗效。方法2013年9月—2017年3月,收治30例合并骨筋膜室综合征的胫骨平台骨折患者,采用单纯Ilizarov环形外固定技术治疗。男23例,女7例;年龄23~43岁,平均34.4岁。致伤原因:交通事故伤12例,高处坠落伤4例,摔伤8例,重物砸伤6例。受伤至入院时间1~12 h,平均4.8 h。骨折Schatzker分型:Ⅱ型1例、Ⅲ型3例、Ⅳ型10例、Ⅴ型7例、Ⅵ型9例。30例均因骨筋膜室综合征行切开减压;切开减压至手术时间为10~15 d,平均12.5 d。治疗后采用膝关节学会评分系统(KSS)及Ilizarov方法研究与应用协会(ASAMI)协议评价膝关节功能。结果手术时间110~155 min,平均123.1 min;术中出血量100~500 mL,平均245 mL;术后住院时间3~5 d,平均3.8 d。患者均获随访,随访时间20~24周,平均22.7周。除2例患者出现针道感染征象外,无其他并发症发生。X线片复查显示骨折均愈合,愈合时间10~20周,平均14.6周。末次随访时,膝关节KSS临床评分总分为70~95分,平均87.5分;功能评分总分为70~90分,平均79.0分。参照ASAMI协议评价获优24例、良3例、可2例、差1例。结论对于合并骨筋膜室综合征的胫骨平台骨折,单纯Ilizarov环形外固定技术治疗后患者关节功能可以基本恢复且并发症少,是一项相对安全、有效的治疗方法。

Ilizarov微循环重建技术在创伤后缺血性肢体创面修复中的初步应用

目的评估Ilizarov微循环重建技术治疗创伤后缺血性肢体创面的疗效。方法2016年1月—2019年7月,收治7例创伤后缺血性肢体创面。其中男5例,女2例;年龄29~66岁,平均42.4岁。创面形成时间1个月~2年,平均7.7个月。创面部位:小腿3例,足踝部4例。皮肤缺损范围为4.0 cm×2.2 cm^12.0 cm×7.1 cm。伴胫骨内翻1例、马蹄足3例、皮肤硬化1例、伏克曼缺血性挛缩2例。创面清创后,使用外固定支架行胫骨横向骨搬移或胫骨内翻畸形矫正、马蹄内翻足矫形治疗。结果患者术后均获随访,随访时间8~20个月,平均13个月。7例患者创面感染均得到控制,肉芽组织生长良好;5例创面直接临床愈合,2例植皮后愈合;创面愈合时间1~3个月,平均1.7个月。随访期间患者创面无复发。6例肢体畸形全部得到矫正。结论对于经久难愈的创伤后缺血性肢体创面,使用Ilizarov微循环重建技术可明显改善局部肢体血供,促进创面肉芽增生和愈合。

小腿双针可控便携式牵引装置的研制与临床应用

目的探讨小腿双针可控便携式牵引装置的设计及其在胫腓骨骨折中的牵引效果。方法根据牵引目的及目前胫腓骨骨折牵引过程中存在的问题,设计小腿双针可控便携式牵引装置。该装置通过调节M8宽螺母牵开骨折端,牵开速度可控,可在术前缓慢牵引,也可在术中快速牵引。2017年1月至12月期间将此装置应用于解放军联勤保障部队第九二〇医院骨科收治的30例患者,收集牵引前、牵引后3、6 d X线片,观察骨折端重叠部分和骨折间隙的变化,测量重叠骨折端的牵开长度;术中有限切开复位,观察骨折端间隙及周围软组织张力情况。结果30例患者牵引前、后X线片显示重叠、移位骨折端不同程度地牵开,牵开长度为7~46mm,平均23.1mm;其中6例牵开长度<15mm,18例牵开15~30mm,5例牵开31~45mm,1例牵开长度>45mm。牵引后6d关节间隙撑开较牵引后3d更为明显。术中有限切开复位骨折,手术切口小,术中可见骨折端间隙增大,周围软组织有效松弛,骨折重叠部分小,周围软组织及骨膜剥离少,各类型骨折复位强度明显降低。在近关节或累及关节面的骨折中,关节间隙增大。30例患者术后获1~16个月(平均5.8个月)随访。未出现针道感染、牵引部位骨折、骨髓炎等并发症。结论小腿双针可控便携式牵引装置构型简单、操作简便、牵引速度可控、便携,是一种有效的牵引装置。

Predictors of functional independence, quality of life, and return to work in patients with burn injuries in China's Mainland

Background:Burn injury may be associated with long-term rehabilitation and disability,while research studies on the functional performance after injuries,quality of life(QOL),and abilities to return to work of burn patients are limited.These outcomes are related not just to the degree and nature of injuries,but also to the socio-economical background of the society.This study aimed to identify the factors which might affect burn patients’abilities to reintegrate back to the society based on a sample in China's Mainland.Methods:A retrospective study was conducted to collect data of demographic characteristics,medical data about burn injuries,physical and psychological status,and self-perceived QOL at the initial phase and upon discharge from a rehabilitation hospital,timing of rehabilitation,and duration of rehabilitation intervention.Four hundred fifteen patients with burn injuries were recruited in the study.Multiple linear regression and logistic regression were used to obtain a model to predict the functional abilities and the perceived QOL at discharge and their changes during rehabilitation,as well as the post-injury work status within 6 months after discharge.Results:The functional performance at discharge and its change were significantly predicted by the functional abilities and QOL at the admission,duration of treatment,timing of rehabilitation,payer source,and total body surface area burned.The perceived QOL at discharge and its change were significantly predicted by the baseline QOL at admission and duration of treatment.The significant predictors of work status within 6 months post-discharge included age,education,payer source,total body surface area burned,perceived QOL,and bodily pain at admission.Conclusions:The present study identified a number of factors affecting the rehabilitation outcomes of people with burn injuries.Identification of these predictors may help clinicians assess the rehabilitation potential of burn survivors and assist in resource allocation.Policy makers should ensure that resources are adequate to improve the outcomes based on these factors.

Lensless Wiener–Khinchin telescope based on second-order spatial autocorrelation of thermal light

The resolution of a conventional imaging system based on first-order field correlation can be directly obtained from the optical transfer function. However, it is challenging to determine the resolution of an imaging system through random media, including imaging through scattering media and imaging through randomly inhomogeneous media, since the point-to-point correspondence between the object and the image plane in these systems cannot be established by the first-order field correlation anymore. In this Letter, from the perspective of ghost imaging, we demonstrate for the first time, to the best of our knowledge, that the point-to-point correspondence in these imaging systems can be quantitatively recovered from the second-order correlation of light fields, and the imaging capability, such as resolution, of such imaging schemes can thus be derived by analyzing second-order autocorrelation of the optical transfer function. Based on this theoretical analysis, we propose a lensless Wiener–Khinchin telescope based on second-order spatial autocorrelation of thermal light, which can acquire the image of an object by a snapshot via using a spatial random phase modulator. As an incoherent imaging approach illuminated by thermal light, the lensless Wiener–Khinchin telescope can be applied in many fields such as X-ray astronomical observations.

Experimental study on the impact of temperature on the dissipation process of supersaturated total dissolved gas

Water temperature not only affects the solubility of gas in water but can also be an important factor in the dissipation process of supersaturated total dissolved gas （TDG）. The quantitative relationship between the dissipation process and temperature has not been previously described. This relationship affects the accurate evaluation of the dissipation process and the subsequent biological effects. This article experimentally investigates the impact of temperature on supersaturated TDG dissipation in static and turbulent conditions. The results show that the supersaturated TDG dissipation coefficient increases with the temperature and turbulence intensity. The quantitative relationship was verified by straight flume experiments. This study enhances our understanding of the dissipation of supersaturated TDG. Furthermore, it provides a scientific foundation for the accurate prediction of the dissipation process of supersaturated TDG in the downstream area and the negative imp）acts of high dam projects on aquatic ecosystems.

解剖型跟骨外固定装置治疗跟骨骨折的近期疗效分析

目的探讨解剖型跟骨外固定装置治疗跟骨骨折的近期疗效。方法回顾性分析2019年9月至2020年3月期间解放军联勤保障部队第九二〇医院骨科收治的9例跟骨骨折患者资料。男7例,女2例;年龄为23~66岁,平均41.3岁。致伤原因:高处坠落伤6例,交通伤3例。骨折按Sanders分型:ⅡB型2例,ⅢAC型2例,ⅢAB型3例,ⅢBC型1例,Ⅳ型1例。闭合性骨折8例,按AO闭合软组织损伤分级:Ⅰ级5例,Ⅱ级3例;开放性骨折1例,按Gustilo-Anderson分型为Ⅲb型,该患者清创后行皮瓣修复创面。所有患者均在一期(8例)或二期(1例)手术过程中应用解剖型跟骨外固定装置治疗。记录患者的骨折愈合时间,末次随访时根据美国足踝外科协会(AOFAS)踝-后足评分、Ilizarov方法研究与应用协会(ASAMI)协议评定疗效等。结果9例患者术后获6~18个月(平均9.8个月)随访。本组患者的骨折愈合时间为2~4个月,平均2.8个月。末次随访时AOFAS踝-后足评分男性患者为79~93分(平均84.7分),优6例,良1例;女性患者为82~91分(平均86.5分),优1例,良1例。末次随访时根据ASAMI协议评定疗效:优6例,良2例,可1例。闭合性骨折患者术后3 d即可下床行康复锻炼。随访期间无一例患者出现针道感染、骨髓炎等并发症。结论解剖型跟骨外固定装置治疗跟骨骨折的近期疗效良好,其具有解剖构型、内置物占位少、术后第3天即可下地部分负重进行康复锻炼等优点。

自行设计Mini-Ilizarov外固定架在虎口挛缩中的应用

目的评价自行设计的Mini-Ilizarov外固定架在虎口挛缩中的应用及治疗效果。方法自2015年10月至2018年8月我院收治虎口挛缩患者6例,应用自行设计组装的Mini-Ilizarov外固定架固定,术后通过调整装置,缓慢撑开并矫正虎口挛缩。随访采用Tada评分系统,比较术前、术后虎口挛缩矫正效果及拇指对掌,外展、握持及握拳功能恢复情况。结果术后6例患者均获得随访,手术前、后虎口挛缩均得到改善,外观矫正,且拇指对掌,外展等功能得到一定程度恢复,但其中2例因外固定架固定时间不够,随访中发现轻度反弹复发。结论使用自行设计的Mini-Ilizarov外固定架固定,结合改进的瘢痕松解术及恰当的植皮、皮瓣转移覆盖术治疗,可以有效治疗及改善虎口挛缩,在一定程度上恢复拇指相关功能,且不易复发。