经椎弓根椎体椎间隙截骨脊柱短缩术治疗脊柱后凸畸形临床价值分析

目的研究经椎弓根椎体椎间隙截骨脊柱短缩术治疗脊柱后凸畸形的临床价值。方法选取2017年1月~2018年12月我院收治的脊柱后凸畸形患者70例,根据不同治疗方法划分为对照组和观察组各35例。对照组予行椎板和小关节突截骨术治疗,观察组予行经椎弓根椎体椎间隙截骨脊柱短缩术治疗,对比两组手术治疗效果。结果观察组平均手术时间、术中出血量、引流量、早期下床活动时间均优于对照组,差异有统计学意义(P<0.05);观察组Cobb角度、椎间隙高度均优于对照组,差异有统计学意义(P<0.05);观察组术后初始尿意、强烈尿意和残余尿量均优于对照组,差异有统计学意义(P<0.05);观察组优良率高于对照组,差异有统计学意义(P<0.05)。结论经椎弓根椎体椎间隙截骨脊柱短缩术治疗脊柱后凸畸形的临床效果显著,可推广。

Solute trapping model based on solute drag treatment

A solute trapping model is developed based on a so-called solute drag treatment.By adopting a basic approach of phase-field models,and defining the free energy density in the interfacial region,a suitable interface shape function is introduced to derive the current model,in which the equilibrium and non-equilibrium interface behaviours can be described using a dimensionless parameter L (i.e.an important parameter in the present interface shape function).When applying the current model to Si-9%As (molar fraction) alloy with L=0.5,a good prediction of the steeper profile for high interface velocity,which is analogous to that using a phase-field model of DANILOV and NESLTER,has been obtained.

Postoperative redislocation of the hip in a patient with congenital insensitivity to pain with anhidrosis： A case report and review of literature

Pelvic osteotomy is commonly used to adjust acetabula dysplasia for congenital dislocation of the hip, whereas congenital insensitivity to pain with anhidrosis(CIPA) is a rare hereditary disease that often has the characteristics of joint development deformity and easy fracture. This article reports the case involving a CIPA patient who was surgically treated by Chiari pelvic osteotomy and proximal femoral rotation osteotomy for congenital dislocation of the left hip joint and was provided long-term follow-up for redislocation and bilateral femoral head absorption.

Effects of a flexible net barrier on the dynamic behaviours and interception of debris flows in mountainous areas

Flexible net barriers are a new type of effective mitigation measure against debris flows in valleys and can affect the kinematic energy and mass of debris flows. Here, ten flume tests were performed to study the dynamic behaviours of debris flows with differences in volumes, concentrations(solid volume fraction), and travel distances after interception by a uniform flexible net barrier. A high-speed camera was used to monitor the whole test process, and their dynamic behaviours were recorded. A preliminary computational framework on energy conversion is proposed according to the deposition mechanisms and outflow of debris flow under the effects of the flexible net barrier. The experimental results show that the dynamic interaction process between a debris flow and the flexible net barrier can be divided into two stages:(a) the two-phase impact of the leading edge of the debris flow with the net and(b) collision and friction between the body of the debris flow and intercepted debris material. The approach velocity of a debris flow decreases sharply(a maximum of 63%) after the interception by the net barrier, and the mass ratio of the debris material being intercepted and the kinetic energy ratio of the debris material being absorbed by the net barrier are close due to the limited interception efficiency of the flexible net barrier, which is believed to be related to the flexibility. The energy ratio of outflow is relative small despite the large permeability of the flexible net barrier.

CHANGES IN AIRWAY SPACE FOLLOWING MANDIBULAR SETBACK USING SAGITTAL SPLIT OSTEOTOMY AND RIGID INTERNAL FIXATION

The changes in airway space following mandibular setback using sagittal split osteotomy and rigid internal fixation were studied in 28 Japanese patients with mandibular prognathism. The correlation between the amount of mandibular setback and airway space changes,as well as the correlation between the amount of airway space changes and relapse of pognion point during the following-up period were also studied. Lateral cephalometric radiographs were taken immediately before and shortly after surgery as well as 5 to 12 months postoperation. The cephalometric evaluations of airway space width and area were based on stable craniofacial landmarks. The mean setback of mandible was 8.3 mm in the right side,and 8. 2 mm in the left side. The mean amount of relapse of pogonion point during the following-up period was 0. 52 mm horizontally,and 0. 92 mm vertically. A significant decrease in airway space width and area,especially in the lower part of airway space was found following mandibular setback shortly after surgery. Although there was some increase both in airway space width and area during the following-up period,they did not increase to their original values. This suggests that the narrowing of airway space following mandibular setback using sagittal split osteotomy can be permanent. No significant correlation was found between the amount of mandibular setback and airway space changes. Since the relapse of pogonion point during the following-up period was too small,there is no significant correlation between it and the amount of airway space changes.

Place of the reposition flap in the treatment of distal amputations of the fingers

Purpose： Distal finger amputations pose a therapeutic problem with the distal fragment quality. Reimplantation remains the reference treatment for functional and aesthetic recovery of the hand. The interest of this study is to propose the reposition flap as an alternative to different hedging techniques in the proximal stump, in many situations where revascularization is impossible. It consists in osteosynthesis of the bone fragment and its coverage by a pedicled local flap. Methods： The technique of reposition flap was evaluated retrospectively between 2003 and 2016 through a study of 13 patients compiled in Nabeul orthopedic department. For each patient, the sensitivity, the pulp trophicity, the interphalangeal mobility, the digital length, the appearance of the nail and radiological consolidation were evaluated. Results： The reposition flap keeps more than 80% of the length of p3. This procedure improves nail aesthetics in comparison with the regularizations. There is no significant difference in sensitivity of the pulp or of the mobility of the distal inter-phalangeal （DIP） joint as a function of the technique studied. However there is a significant difference in average test of the Quick Dash （350 against 500 for regularizations）. Conclusion： The reposition flap seems to be a good alternative to regularization in the context of trans-p3 fingers amputations, in which the distal fragment is not revascularizable. It allows better aesthetic and functional results.

Diagnosis and treatment of spinal fractures combined with paraplegia and diaphragm injury

Objective: To study the mechanism and treatment principle of spinal fractures combined with paraplegia and diaphragm injury. Methods: A total of 16 patients (14 males and 2 females, aged from 18 to 50 years) with spinal fractures combined with paraplegia and diaphragm injury, receiving emergency treatment and admitted to our hospital in the past 20 years, were retrospectively analyzed in this study. Results: The injuries were caused by direct or indirect violence. Six cases were of fractures of cervical spine combined with paraplegia and diaphragm injury, 2 of fractures of thoracic vertebra combined with paraplegia and diaphragm injury, and 8 of thoracolumbar fractures combined with paraplegia and diaphragm injury. Six cases received non operative treatment, but died finally. Ten cases received spine surgical treatment, of which 4 died and 6 were improved. The total mortality rate was 62.5 %. Conclusions: Spinal fractures combined with paraplegia and diaphragm injury are one of the most severe traumas in departments of orthopaedics. Paraplegia can be found easily, but diaphragm injury is often neglected and missed. When a patient suffers from both of them, he is in danger of death. What measures should be taken to rescue the patients life depends on the severity of the wounds.