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临床制取准确印模和模型的经验体会
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作者 余占海 刘斌 《广东牙病防治》 1995年第S1期64-65,共2页
临床制作义齿,要进行一系列工艺加工过程,其中有大量的工作,如支架弯制、蜡型制作、锤造、铸造、焊接以及装盒、填胶、热处理等,均很难或不能在人体上进行。因此,为了制作义齿,完成修复任务,就必须制作一个与患者口腔或颌面部缺损部位... 临床制作义齿,要进行一系列工艺加工过程,其中有大量的工作,如支架弯制、蜡型制作、锤造、铸造、焊接以及装盒、填胶、热处理等,均很难或不能在人体上进行。因此,为了制作义齿,完成修复任务,就必须制作一个与患者口腔或颌面部缺损部位十分相似的模型。制取模型,须先印取一个阴性形态的印模。 展开更多
关键词 弹性印模材料 印模 修复体 灌注模型 牙列缺损 口腔修复学 义齿 确性 托盘 取准
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短期高效率产生定著力缘故法选取准保户
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作者 邱徵毅 《上海保险》 1997年第1期41-41,共1页
大部份的新人不晓得从哪里开始做推销,或者,应该先拜访哪些人,哪些人应该后访,拜访时谈些什么?怎么开口?怎么说?“茫茫然.害怕、不安、不好意思”是新进行销人员的共同心理.以成功带动信心主管如果任由新人自行摸索,惨遭“三阵出局”的... 大部份的新人不晓得从哪里开始做推销,或者,应该先拜访哪些人,哪些人应该后访,拜访时谈些什么?怎么开口?怎么说?“茫茫然.害怕、不安、不好意思”是新进行销人员的共同心理.以成功带动信心主管如果任由新人自行摸索,惨遭“三阵出局”的机会将无法避免.有些主管不察,误以为此等新人关系不好、缘故不佳、不适用缘故法.最明显的现象有下列三点:一、从未举绩.先是兴致高昂地拜访一阵子,然后士气低落,一味推拖、婉辞,不能胜任工作.二、举绩一、二件后,就开始产生冷淡、没信心.三、看来很适合做保险,但就是签不到保单.这其中仍有其他重要原因,最重要的是“辅导失败”.所以“成功的第一件”、“顺利的前十件”、“短期间多件成功率”就成为帮助新人定著的首要课题,同时也是本文主题:如何帮助新人选取准保户.三种提高新人推销成功率的方法缘故法选取准保户,决定於新人与准保户缘故层次,以下提供判定缘故的参考指标,就缘故群体之中选择符合指标层次的准保户,期能提高新人推销成功率: 展开更多
关键词 推销成功率 高效率 心理距离 取准 影响力 垂直距离 首要课题 经验平均值 共同心理 人格特质
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精准肝切开取石联合球囊扩张治疗右肝段胆管狭窄伴结石临床研究
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作者 沈志宏 冯刚 +2 位作者 鲁葆春 郑军 邵惠江 《浙江创伤外科》 2018年第3期417-419,共3页
目的对右肝段胆管狭窄伴结石患者进行精准肝切开取石联合球囊扩张治疗,探讨其临床疗效。方法选取2013年1月至2017年1月绍兴市人民院及诸暨市人民医院收治的右肝段胆管狭窄伴结石患者30例,对其进行精准肝切开取石联合球囊扩张治疗,将其... 目的对右肝段胆管狭窄伴结石患者进行精准肝切开取石联合球囊扩张治疗,探讨其临床疗效。方法选取2013年1月至2017年1月绍兴市人民院及诸暨市人民医院收治的右肝段胆管狭窄伴结石患者30例,对其进行精准肝切开取石联合球囊扩张治疗,将其作为研究组,另选取同期医院收治的行肝叶切除治疗的右肝段胆管狭窄伴结石患者30例,将其作为对照组,术后对两组患者手术相关情况、肝功能、术后并发症及结石复发情况进行观察比较。结果与对照组比较,研究组患者术中出血量、术后住院时间及术后并发症发生率均明显降低,差异具有统计学意义(P<0.05);在肝功能各指标(谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TBIL))水平方面,两组患者术后均降低至正常水平,与治疗前比较均具有统计学意义(P<0.05);对两组患者进行1年时间随访,研究组术后结石复发率3.3%与对照组结石复发率26.7%比较明显降低,差异具有统计学意义(P<0.05)。结论对右肝段胆管狭窄伴结石患者进行精准肝切开取石联合球囊扩张治疗能够取得良好临床效果,可使术后并发症及结石复发率显著降低,预后良好,具有微创、安全、有效等优势,值得临床进一步推广应用。 展开更多
关键词 肝切开 球囊扩张 胆管狭窄 结石 临床疗效
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取料机精准取料研究 被引量:1
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作者 唐兴华 《四川冶金》 CAS 2021年第5期59-62,共4页
从物料产生破坏滑移的源头分析,创新提出一种实现取料机精准取料的思路。创建了取料深度和精准取料的数学模型,揭示了精准取料量和俯仰机构拉力的关系,阐述精准取料的具体实施路径,通过控制俯仰缠绕角度变化量来实现精准取料。整个分析... 从物料产生破坏滑移的源头分析,创新提出一种实现取料机精准取料的思路。创建了取料深度和精准取料的数学模型,揭示了精准取料量和俯仰机构拉力的关系,阐述精准取料的具体实施路径,通过控制俯仰缠绕角度变化量来实现精准取料。整个分析过程为取料机精准取料控制提供重要的理论指导。 展开更多
关键词 散粒体 散体力学 料机
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微创经皮肾镜碎石取石术和标准通道经皮肾镜碎石取石术治疗肾结石的疗效对比 被引量:6
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作者 晏增亚 《现代诊断与治疗》 CAS 2016年第18期3441-3442,共2页
收集我院在2014年4月~2015年4月收治的肾结石患者100例,将所有患者随机分为观察组和对照组,各50例。对照组患者实施标准通道经皮肾镜碎石取石术治疗,观察组患者实施微创经皮肾镜碎石取石术治疗,比较两组患者的疗效差异。观察组患者的治... 收集我院在2014年4月~2015年4月收治的肾结石患者100例,将所有患者随机分为观察组和对照组,各50例。对照组患者实施标准通道经皮肾镜碎石取石术治疗,观察组患者实施微创经皮肾镜碎石取石术治疗,比较两组患者的疗效差异。观察组患者的治疗总有效率(96%)明显高于对照组患者的治疗总有效率(74%),同时观察组患者的并发症发生率(6%)明显低于对照组患者的并发症发生率(22%),差异均为显著性差异(P<0.05),有统计学意义。在对肾结石患者实施手术治疗的过程中,通过对患者进行微创经皮肾镜碎石取石术治疗,其治疗安全性以及治疗效果明显优于标准通道经皮肾镜碎石取石术,值得推广应用。 展开更多
关键词 微创经皮肾镜碎石石术 通道经皮肾镜碎石石术 肾结石
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超声引导精准穿刺经皮肾镜取石术治疗老年肾结石的疗效及安全性 被引量:1
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作者 刘伟平 《基层医学论坛》 2021年第32期4640-4641,共2页
目的研究超声引导精准穿刺经皮肾镜取石术治疗老年肾结石的疗效及安全性。方法回顾2017年10月—2020年10月于萍乡市湘东区中医院就诊的60例肾结石老年患者,按手术方法分为观察组32例和对照组28例。对照组接受传统开放性手术治疗,观察组... 目的研究超声引导精准穿刺经皮肾镜取石术治疗老年肾结石的疗效及安全性。方法回顾2017年10月—2020年10月于萍乡市湘东区中医院就诊的60例肾结石老年患者,按手术方法分为观察组32例和对照组28例。对照组接受传统开放性手术治疗,观察组接受超声引导精准穿刺经皮肾镜取石术治疗,观察2组手术情况、结石清除率、并发症。结果观察组出血量低于对照组,手术时长、首次下床活动时间、住院天数均短于对照组(P<0.05);2组结石清除率比较,差异无统计学意义(P>0.05);观察组并发症发生率为3.13%,低于对照组的25.00%(P<0.05)。结论超声引导精准穿刺经皮肾镜取石术与传统开放性手术相比,手术时间更短,出血量更少,术后患者恢复速度更快,能够有效降低术后并发症的发生。 展开更多
关键词 肾结石 老年患者 超声引导精穿刺经皮肾镜石术 结石清除率 并发症
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多值Lukasiewicz逻辑公式的范式表示和计数问题 被引量:4
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作者 王庆平 王国俊 《软件学报》 EI CSCD 北大核心 2013年第3期433-453,共21页
将符号化计算树逻辑中的Shannon展开式做了推广,在n值ukasiewicz逻辑系统n中,研究了由逻辑公式导出的n值McNaughton函数的展开式,给出了m元n值McNaughton函数的准析取范式和准合取范式.在此基础上,给出了m元n值McNaughton函数的计数问题... 将符号化计算树逻辑中的Shannon展开式做了推广,在n值ukasiewicz逻辑系统n中,研究了由逻辑公式导出的n值McNaughton函数的展开式,给出了m元n值McNaughton函数的准析取范式和准合取范式.在此基础上,给出了m元n值McNaughton函数的计数问题,并在n值ukasiewicz逻辑系统n中,给出了m元逻辑公式的构造方法及其逻辑等价类的计数问题. 展开更多
关键词 Shannon展开式 n值McNaughton函数 析(合)范式 逻辑等价类 计数问题
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Tactical planning and optimization of a milk run system of parts pickup for an engine manufacturer 被引量:1
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作者 伊俊敏 周晶 +1 位作者 高晓亮 施挺 《Journal of Southeast University(English Edition)》 EI CAS 2007年第S1期99-104,共6页
A real-life milk run system designing problem of an engine manufacturer adopted JIT(just-in-time)production is studied.In the process of milk run system planning and design,the supply base is identified and a supplier... A real-life milk run system designing problem of an engine manufacturer adopted JIT(just-in-time)production is studied.In the process of milk run system planning and design,the supply base is identified and a supplier site map is plotted for an arrangement of routes on which parts are periodically collected in a JIT manner from many scattered suppliers.With unit load designing,vehicle choosing and fleet sizing,pickup routing,vehicle assigning and scheduling problems are studied.Among these problems,a CVRP problem is identified and formulated as the key optimization in designing this milk run system,and it is solved through an optimization process.This tactical planning and optimization process gives a good solution to the real problem,and may shed light on the planning of similar systems. 展开更多
关键词 milk run vehicle routing problem JUST-IN-TIME system planning
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柘城县加强生猪屠宰税征管
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作者 李玉正 赵成彦 《财税与会计》 1995年第9期48-49,共2页
根据省政府豫政[1994]84号文件《河南省屠宰税征收办法》,柘城县制定了《关于加强生猪税收征收管理的通知》,出台了八项措施: 1、整顿生猪税收秩序。凡在本县从事生猪收购业务和屠宰生猪的单位和个人,必须持有营业证和税务登记证。各乡... 根据省政府豫政[1994]84号文件《河南省屠宰税征收办法》,柘城县制定了《关于加强生猪税收征收管理的通知》,出台了八项措施: 1、整顿生猪税收秩序。凡在本县从事生猪收购业务和屠宰生猪的单位和个人,必须持有营业证和税务登记证。各乡镇要充分发挥国有食品站的主渠道作用,坚决取缔无证经营。对偷漏屠宰税的单位和个人,一经发现,视情节轻重,依法惩处。 展开更多
关键词 生猪屠宰 食品站 屠宰税 国有 协税员 地方税务局 养猪户 取准 乡镇 县政府
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论医学心理学实践的医德基础
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作者 魏来临 张岩 《山东医科大学学报(社会科学版)》 1990年第4期43-44,共2页
作为医务工作者的职业道德,医德与医学心理学的关系十分密切。医德并非仅是医务人员的工作态度表现,医学心理学的许多内容都是完美医德得以体现的有机要素。离开这一点,就难免在对医德的认识上流于表面形式和庸俗化。同时,医务工作者要... 作为医务工作者的职业道德,医德与医学心理学的关系十分密切。医德并非仅是医务人员的工作态度表现,医学心理学的许多内容都是完美医德得以体现的有机要素。离开这一点,就难免在对医德的认识上流于表面形式和庸俗化。同时,医务工作者要将医学心理学的知识成功地运用于临床实践,也离不开必须具备良好医德这个基础和前提。 1.良好的医德对于获取准确病史具有决定性的意义。病史在疾病的诊断治疗中起着非常重要的作用。获取准确的病史,不但需要具备医学心理学的有关知识和技巧。 展开更多
关键词 医德 医学心理学 医务工作者 新型医患关系 取准 病史 心理治疗 医生 现代医学模式 心理反应
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A 16 bit Stereo Audio ΣΔ A/D Converter
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作者 陈雷 赵元富 +3 位作者 高德远 文武 王宗民 朱小飞 《Journal of Semiconductors》 EI CAS CSCD 北大核心 2006年第7期1183-1188,共6页
A 16 bit stereo audio novel stability fifth-order ∑△ A/D converter that consists of switched capacitor ∑△ modulators, a decimation filter, and a bandgap circuit is proposed. A method for the stabilization of a hig... A 16 bit stereo audio novel stability fifth-order ∑△ A/D converter that consists of switched capacitor ∑△ modulators, a decimation filter, and a bandgap circuit is proposed. A method for the stabilization of a high order single stage ∑△ modulator is also proposed. A new multistage comb filter is used for the front end decimation filter. The ∑△ A/D converter achieves a peak SNR of 96dB and a dynamic range of 96dB. The ADC was implemented in 0. 5μm 5V CMOS technology. The chip die area occupies only 4. 1mm × 2.4mm and dissipates 90mW. 展开更多
关键词 ∑△ A/D converter switched capacitor STABILITY decimation filter bandgap circuits
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Modified Benes network architecture for WiMAX LDPC decoder 被引量:1
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作者 徐勐 吴建辉 张萌 《Journal of Southeast University(English Edition)》 EI CAS 2011年第2期140-143,共4页
A modified Benes network is proposed to be used as an optimal shuffle network in worldwide interoperability for microwave access (WiMAX) low density parity check (LDPC) decoders, When the size of the input is not ... A modified Benes network is proposed to be used as an optimal shuffle network in worldwide interoperability for microwave access (WiMAX) low density parity check (LDPC) decoders, When the size of the input is not a power of two, the modified Benes network can achieve the most optimal performance. This modified Benes network is non-blocking and can perform any sorts of permutations, so it can support 19 modes specified in the WiMAX system. Furthermore, an efficient algorithm to generate the control signals for all the 2 × 2 switches in this network is derived, which can reduce the hardware complexity and overall latency of the modified Benes network. Synthesis results show that the proposed control signal generator can save 25.4% chip area and the overall network latency can be reduced by 36. 2%. 展开更多
关键词 worldwide interoperability for microwave access(WiMAX) quasi-cycle low density parity check (QC-LDPC) LDPC decoder Benes network
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A Quasi-steady-state Model for Numerical Simulation of Batch Extractive Distillation 被引量:2
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作者 方静 李春利 +1 位作者 王洪海 孙立军 《Chinese Journal of Chemical Engineering》 SCIE EI CAS CSCD 2010年第1期43-47,共5页
Batch extractive distillation(BED)is a special method used in the distillation process by adding a solvent into the batch distillation column to alter the relative volatility of the components and improve the separati... Batch extractive distillation(BED)is a special method used in the distillation process by adding a solvent into the batch distillation column to alter the relative volatility of the components and improve the separation. A comprehensive design and simulation method is required due to the complexity of BED.In this study,a quasi-steady-state model for BED is proposed,the derivation and solution of the model are presented.This shortcut model can be used to simulate the composition and temperature of the reboiler,the top and other plates of the column in a batch extractive distillation operation.The calculated values are in good agreement with the experimental data.The results show that the quasi-steady-state model is a practical method because of some advantages such as high precision and fast calculation. 展开更多
关键词 batch distillation extractive distillation SIMULATION MODEL
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Giant choledocholithiasis treated by mechanical lithotripsy using a gastric bezoar basket 被引量:7
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作者 Hyun Jung Chung Seok Jeong +7 位作者 Don Haeng Lee Jung Il Lee Jin-Woo Lee Byoung Wook Bang Kye Sook Kwon Hyung Kil Kim Yong Woon Shin Young Soo Kim 《World Journal of Gastroenterology》 SCIE CAS CSCD 2012年第25期3327-3330,共4页
Mechanical lithotripsy (ML) is usually considered as a standard treatment option for large bile duct stones. However, it is impossible to retrieve oversized stones because the conventional lithotripsy basket may not... Mechanical lithotripsy (ML) is usually considered as a standard treatment option for large bile duct stones. However, it is impossible to retrieve oversized stones because the conventional lithotripsy basket may not be able to grasp the stone. However, there is no es- tablished endoscopic extraction method for such gi- ant stone removal. We describe a case of successful extraction of a 4-cm large stone using a gastric bezoar basket. A 78-year-old woman had suffered from upper abdominal pain for 20 d. Contrast-enhanced computed tomogram revealed a 4-cm single stone in the distal common bile duct (CBD). Endoscopic stone retraction was decided upon and endoscopic papillary balloon dilation was performed using a large balloon. An at- tempt to capture the stone using a standard lithotripsy basket failed due to the large stone size. Subsequently, we used a gastric bezoar basket to successfully capturethe stone. The stone was fragmented into small pieces and extracted. The stone was completely removed after two sessions of endoscopic retrograde cholangio- pancreatography; each of which took 30 rain. No com- plications occurred during or after the procedure. The patient was fully recovered and discharged on day 11 of hospitalization. ML using a gastric bezoar basket is a safe and effective retrieval method in select cases, and is considered as an alternative nonoperative option for the management of difficult CBD stones. 展开更多
关键词 Giant choledocholithiasis Mechanical litho-tripsy Bezoar basket Common bile duct stone Endo-scopic papillary balloon dilatal^ion
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Puff-by-puff Transfer Ratios of Some Added Flavors in Cigarettes 被引量:1
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作者 ZHANG Ting ZONG Yong-li +3 位作者 JIA Yu-guo PENG Shu-hai JIANG Cheng-yong SONG Yu-bing 《Chinese Food Science》 2012年第1期47-50,共4页
[Objecdve] The aim was to observe the puff-by-puff transfer ratios of some flavors in cigarettes. [Method] Based on national stand- ards, the puff-by-puff transfer of tobacco of carbonyl flavors was analyzed. In the m... [Objecdve] The aim was to observe the puff-by-puff transfer ratios of some flavors in cigarettes. [Method] Based on national stand- ards, the puff-by-puff transfer of tobacco of carbonyl flavors was analyzed. In the meantime, by dint of simultaneous distillation and extraction equip- ment coupled to GC and GC/MS, the puff-by-puff transfer ratios to TPM of smoke were expounded and compared. [ Result] The puff-by-puff deliv- ery profiles of NFDPT,nicotine and carbon monoxide increased with increasing puff number. This trend was similar to that of particulate matters. The transfer ratio of flavored tobacco was increasing in general, but partial flavors augmented to the maximum value and then decreased slowly. [ Conclusion] The study provided reference for the application of carbonyl compounds in tobacco. 展开更多
关键词 TOBACCO Aldehydes and ketones Added flavors Puff-by-puff Transfer ratios
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搬运好帮手——一款能自主识别物件的搬运机器人
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作者 张婷逸 毕徐府 《传感器技术与应用》 2022年第3期482-490,共9页
这是一款能自主识别物件并搬运指定物件的机器人,是能够在解放人的同时提高工作效率的搬运好帮手。装置的核心是单片机控制系统、寻迹模块和机械臂模块,其次还包括红外距离传感器、爪钩、触摸屏、电池模块和若干传输控制线等元器件。该... 这是一款能自主识别物件并搬运指定物件的机器人,是能够在解放人的同时提高工作效率的搬运好帮手。装置的核心是单片机控制系统、寻迹模块和机械臂模块,其次还包括红外距离传感器、爪钩、触摸屏、电池模块和若干传输控制线等元器件。该搬运机器人在接收到任务指令后,通过灰度条传感器依次扫描地面上的循迹线,按照循迹线所在的既定路线行走;用摄像头对不同形状、颜色、大小的物体进行图像识别判断是否为所需货物;用单片机驱动板控制舵机转动及红外距离传感器,实现对不同形状的物品的精确抓取。该机器人可以用在物流仓库、网购商城、医院、工厂、果园等涉及到物品识别与搬运的场所中使用。该装置操作简单、智能且精准,可极大地减少人力物力的消耗,提高工作效率,解决传统运输模式“速度慢、效率低、损耗大”的难题。 展开更多
关键词 自主识别 高效搬运
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Quasi-classical Trajectory Study of the Intramolecular Isotope Effect in the Reaction O(3p)+H2/HD 被引量:1
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作者 Qiang Wei Xing Li Tie Li 《Chinese Journal of Chemical Physics》 SCIE CAS CSCD 2009年第5期523-528,I0002,共7页
Theoretical studies of the dynamics of the reactions O(3p)+H2/HD(ν=0, j=0)→OH+H have been performed with quasi-classical trajectory method (QCT) on an ab initio potential surface for the lowest triplet elect... Theoretical studies of the dynamics of the reactions O(3p)+H2/HD(ν=0, j=0)→OH+H have been performed with quasi-classical trajectory method (QCT) on an ab initio potential surface for the lowest triplet electronic state of H2O(aA"). The QCT-calculated integral cross sections are in good agreement with the earlier time-dependent quantum mechanics results. The state-resolved rotational distributions reveal that the product OH rotational distributions for O+HD have a preference for populating highly internally excited states compared with the O+H2 reaction. Distributions of differential cross sections show that directions of scattering are strongly dependent on the choice of quantum state. The polarization dependent generalized differential cross-sections and the distributions were calculated and a pronounced isotopic effect is revealed. The calculated results indicate that the product polarization is very sensitive to the mass factor. 展开更多
关键词 Quasi-classical trajectory Isotope effect ALIGNMENT ORIENTATION
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Comparison between sequential and single extraction procedures for metal speciation in fresh and dried Sedum Plumbizincicola 被引量:4
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作者 宋祖威 仲兆平 +2 位作者 钟道旭 吴龙华 骆永明 《Journal of Central South University》 SCIE EI CAS CSCD 2015年第2期487-494,共8页
Sequential and single extraction procedures were applied to both fresh and dried Sedum Plumbizincicola leaves and stems.The extractants, different from those of soil, sediment or sewage sludge metal fractions, were wa... Sequential and single extraction procedures were applied to both fresh and dried Sedum Plumbizincicola leaves and stems.The extractants, different from those of soil, sediment or sewage sludge metal fractions, were water, 80%(v/v) ethanol, 1 mol/L Na Cl,2% HAc and 0.6 mol/L HCl. Zn, Cd and Cu in the extracts and samples were measured by flame atomic adsorption spectrometry. In sequential extraction procedures, water soluble form and ethanol soluble form are the main fractions for Zn, while water soluble form and Na Cl soluble form for Cd, and comparatively uniform distribution for Cu with the residue form most and HCl soluble form second. Single extraction procedures are used to compare the extraction efficiencies of the five reagents to screen appropriate extractants and operating conditions for liquid extraction to deal with large amount of harvested metal-contained biomass, which will pose a threat to the environment if treated improperly. The sequences of extraction efficiencies are HCl>Na Cl≈HAc>Water≈Ethanol for Zn and HCl≈Na Cl≈HAc>Water>Ethanol for Cd. As for Cu, all the five extractants cannot effectively extract Cu, but HCl achieves a higher efficiency(>70% in fresh samples, and 45%-60% in dried samples). Besides, extraction efficiencies for most extractants in fresh samples are higher than those in dried samples, and extraction efficiencies of stems and leaves for the five extractants are close. The two extraction procedures can obtain high degree of accuracy with the relative standard deviation(RSD)lower than 10%, and metal recoveries are controlled between 80%-120% with most of 90%-110%. 展开更多
关键词 Sedum Plumbizincicola liquid extraction biomass disposal heavy metals
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现场录井技术及油气层综合解释
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作者 陈金海 《科技与企业》 2013年第13期146-146,共1页
本文重点阐述现场录井技术的重要性,尤其在油气发现及卡准取心层位上的运用;针对性突出应用录井资料进行油气层综合解释中应该把握的几项原则,总结现场录井技术及利用录井资料综合解释油气层的优越性和局限性。
关键词 现场录井技术 钻时放大法 MAS录井仪 心层位 油气综合解释 评价原则
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髂骨精准截骨肩盂植骨治疗复发性肩关节前脱位的临床研究
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作者 王昌兵 赵立连 +3 位作者 许挺 李彦锦 张朝鸣 刘泳坚 《中华肩肘外科电子杂志》 2023年第4期313-320,共8页
目的研究髂骨精准截骨肩盂同心圆植骨治疗严重骨缺损的复发性肩关节前脱位的临床疗效并评估髂骨骨块弧度与肩盂弧度匹配情况。方法对2020年12月至2022年6月,佛山市中医院运动医学科收治的复发性肩关节前脱位合并严重骨缺损的患者进行回... 目的研究髂骨精准截骨肩盂同心圆植骨治疗严重骨缺损的复发性肩关节前脱位的临床疗效并评估髂骨骨块弧度与肩盂弧度匹配情况。方法对2020年12月至2022年6月,佛山市中医院运动医学科收治的复发性肩关节前脱位合并严重骨缺损的患者进行回顾性研究,随访资料完整的共32例,其中男30例、女2例;左侧12例、右侧20例;年龄16~41岁,平均28.65岁。术前脱位次数5~30次,术前通过双侧肩关节CT测量肩盂弧度、骨缺损大小及弧度,与正常侧肩盂比较,缺损宽度为20.2%~33.4%(平均26.7%)。所有病例均行取自体髂骨肩盂植骨结合盂唇修补术,通过同侧髂骨CT测量髂骨外板与肩盂缺损弧度一致的区域,进行髂骨精准取骨。术后通过CT测量骨块与肩盂弧度匹配情况。随访肩关节功能采用美国肩肘外科评分(Amreican shoulder and elbow surgenons,ASES)、Constant-Murley评分、Rowe评分。结果所有患者术后均获得随访,术后随访时间12~26个月,平均随访(20.37±6.20)个月,所有患者术后均未发生术后感染、再发脱位及髂骨取骨部位骨折、神经损伤等并发症,术后即刻CT测量肩关节弧度与髂骨骨块弧度一致,骨块与关节盂无台阶形成,术后1年骨块塑形完成,所有患者在最后随访时骨块均骨性愈合,无主观不稳定,恐惧试验阴性。术前与末次随访时平均体侧位外旋(60.25±10.57)°vs.(59.34±7.69)°,差异无统计学意义(P>0.05),外展90°外旋(40.30±14.57)°vs.(60.20±16.49)°,差异有统计学意义(P<0.05),术后末次随访时ASES评分、Constant-Murley评分、Rowe评分较术前明显改善,ASES评分为(72.43±10.42)分vs.(94.44±5.35)分(P<0.05),Constant-Murley评分为(80.24±15.40)分vs.(96.55±2.64)分(P<0.05),Rowe评分为(43.47±8.82)分vs.(92.45±3.20)分(P<0.05)。结论通过髂骨取骨区域与肩盂弧度匹配,能够精准髂骨取骨,肩盂植骨后能够较好匹配骨块与肩盂弧度,降低因骨块位置偏内或偏外造成的术后并发症,减少髂骨骨折风险,术后早中期疗效好。 展开更多
关键词 肩关节脱位 髂骨精 关节盂植骨 关节镜
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