动力髋螺钉内固定与半髋关节置换治疗老年人股骨转子间骨折临床对比分析

目的对比动力髋螺钉内固定与半髋关节置换治疗老年人股骨转子间骨折的临床效果,并分析优缺点。方法 2006年1月至2009年12月用动力髋螺钉(DHS)内固定治疗49例,半髋关节置换治疗31例,对手术时间、术中和术后出血量、下床活动时间、早期Harris评分及6个月、1年Harris评分、术后并发症进行比较。结果 80例全部得到随访,时间12～48个月,平均20.6个月。2组间在手术时间和出血量比较差异无统计学意义(P>0.05)。半髋关节置换组的术后卧床时间较动力髋螺钉(DHS)内固定组短;半髋关节置换组术后早期Harris评分较动力髋螺钉(DHS)内固定组高,2组间比较差异有统计学意义(P<0.05)。6个月、1年Harris评分2组间比较差异无统计学意义(P>0.05)。术后并发症发生率半髋关节置换组较动力髋螺钉(DHS)内固定组发生率低,2组间比较差异有统计学意义(P<0.05)。结论对于A1.1、A1.2、A1.3、A2.1型老年人股骨转子间骨折患者首选动力髋螺钉(DHS)内固定;骨折粉碎及骨质疏松严重的患者应选择半髋关节置换。     

全髋置换术和空心钉内固定术治疗股骨颈骨折的疗效比较

目的比较全髋置换术和空心钉内固定术治疗老年有移位新鲜股骨颈骨折的临床疗效。方法回顾性分析68例老年股骨颈骨折患者的临床资料,分为全髋置换组33例,空心钉内固定组35例,比较两种术式的临床疗效。结果68例随访12～72个月,平均36个月。经统计学分析两组在住院时间、手术时间、出血量、输血量和术后平均下地时间方面差异有统计学意义(P<0.05);在髋关节功能方面差异也有统计学意义(P<0.05);在术后并发症上差异无显著性(P>0.05)。最终随访时Harris评分全髋置换术组平均为(86.7±6.4)分,空心钉内固定术组平均(81.3±5.8)分,差异有统计学意义(P<0.05)。结论空心钉内固定术治疗老年股骨颈骨折的患者在住院时间、手术时间、出血量和输血量优于全髋置换术,但全髋置换术具有卧床时间短,术后恢复快,并发症少,功能恢复好等优点。对于老年有移位的新鲜股骨颈骨骨折首选全髋置换术。     

全髋关节和人工股骨头置换术治疗老年股骨颈骨折的疗效比较

目的比较全髋关节置换术和人工股骨头置换术治疗老年股骨颈骨折患者的临床疗效。方法将来我科进行治疗的107例老年股骨颈骨折患者随机分为髋关节置换组和股骨头置换组,其中髋关节置换组55例,进行全髋关节置换术,股骨头置换组52例,行人工股骨头置换术,比较2组患者手术持续时间、术中出血量、术后引流量、早期并发症及远期疗效。结果 2组患者手术持续时间、术中出血量、术后引流量、早期并发症等情况相比较,差异无统计学意义(P>0.05);随访观察第1年2组患者Harris评分及优良率差异不显著(P>0.05);第3年及第5年髋关节置换组Harris评分和优良率明显优于股骨头置换组,2组比较差异有统计学意义(P<0.05)。结论全髋关节置换术和人工股骨头置换术治疗老年股骨颈骨折近期疗效均显著,但在远期疗效上,全髋关节置换术的疗效比人工股骨头置换术好。     

人工全髋关节置换36例临床体会

目的探讨人工全髋关节置换治疗髋关节疾病的疗效。方法回顾性分析36例43髋股关节疾病患者选择全髋关节置换的治疗病历。结果对43髋进行Harris评分,优良以上38髋(88.3%),中等4髋(9.3%),较差1髋(2.3%),松动2髋(4.6%),假体下沉1髋(2.3%)。结论人工全髋关节置换是目前重建髋关节功能较为有效的手术方式之一,值得临床推广和应用。     

经皮加压钢板与DHS治疗股骨转子间骨折的临床疗效比较

目的 探讨经皮加压钢板(PCCP)与动力髋螺钉(DHS)治疗股骨转子间骨折的临床疗效。方法 将80例股骨转子间骨折患者随机分入对照组与观察组,每组各40例。对照组患者接受DHS内固定,给予观察组患者经皮加压钢板内固定,比较2组手术时间、出血量、术后VAS疼痛评分及髋关节功能评分。结果 观察组手术时间及出血量显著少于对照组,差异具有统计学意义(P<0.01);2组VAS疼痛评分及髋关节功能评分无显著差异(P>0.05)。结论 PCCP与DHS治疗股骨转子间骨折疗效确切,但PCCP手术时间短、出血量少,对机体损伤小,值得在临床推广。     

改良Salter截骨术治疗先天性髋关节脱位的临床研究

目的对比观察改良Salter手术与经典Salter手术治疗先天性髋关节脱位的疗效。方法60例、76髋、1～6岁的先天性髋关节脱位患儿分为2组:(1)改良Salter手术组,3例、41髋。(2)经典Salter手术组,30例、35髋,完全按Salter手术进行治疗。(3)术后均采用改良贝氏石膏固定,不固定髋关节。结果随访时间1～10年,平均7年。按先天性髋关节脱位疗效评定标准,改良组髋的优良率为90%,经典组为76.3%。2组比较,差异有显著性(P<0.05)。结论改良Salter手术治疗先天性髋关节脱位明显优于经典Salter手术。     

腹腔镜下子宫肌瘤剔除术临床疗效分析

目的探讨腹腔镜下子宫肌瘤剔除术的临床疗效情况。方法治疗组采用腹腔镜下子宫肌瘤剔除术,对照组采用传统开腹方式行肌瘤剔除术。观察比较2组的临床疗效及术中出血量、手术时间、术后通气时间、起床活动时间、术后住院天数情况。结果治疗组的总有效率为93.3%,明显优于对照组的总有效率(76.7%),差异有统计学意义(P<0.05)。治疗组术中出血量、手术时间、术后通气时间、起床活动时间、术后住院天数与对照组相比明显缩短,经统计学分析,差异有显著性(P<0.05)。结论腹腔镜下子宫肌瘤剔除术疗效较好,值得临床推广和应用。     

髋关节置换治疗结果40例分析

目的探讨髋关节置换治疗股骨颈骨折、股骨头坏死的疗效。方法对40例股骨颈骨折及股骨头坏死。选择髋关节置换治疗作回顾性分析总结。结果股骨骨折2例,异位骨化2例,l例术后第六天因急性肾衰死亡,35例Harris评分优良率87.5%。结论髋关节置换治疗股骨颈骨折、晚期股骨头坏死能够取得满意疗效,提高患者生活质量。     

骨质疏松性股骨颈骨折的治疗效果观察

目的 观察分析骨质疏松性股骨颈骨折的治疗方法及临床疗效。方法 回顾性分析48例骨质疏松性股骨颈骨折患者为研究对象,根据手术方法分为半髋组27例行人工股骨头置换术治疗及全髋组21例行人工全髋关节置换术治疗,分析2组患者一般资料、手术方法及临床疗效。结果 2组患者优良率无差异(P>0.05),手术时间、术中输血、住院费用及并发症发生率差异有统计学差异(P<0.05)。结论 人工股骨头置换术对于老年骨质疏松性股骨颈骨折治疗效果满意,有效地缩短了手术时间,降低了术后早期并发症,安全性更高,值得临床推广使用。     

腹式与阴式子宫切除术临床疗效比较

目的比较腹式子官切除术与阴式子宫切除术2种手术方法的临床疗效。方法选择我院2007年1月至2009年12月48例阴式子宫切除术患者(阴式组),同时随机抽取腹式子宫切除术48例腹式组,对2组患者手术时间、术中出血量、术后排气时间、术后切口感染例数、住院时间进行比较。结果阴式组的手术时间、术中出血量、术后排气时间、术后感染例数、术后并发症、术后疼痛评分、住院时间都明显少于腹式组.差异具有统计学意义(P<0.01)。结论阴式子宫切除术具有对患者损伤小、腹部无瘢痕、术后恢复快,并发症少、住院时间短等优点。     

应用陶瓷型人工髋关节治疗中青年髋关节伤病

目的比较陶瓷型与生物固定型人工髋关节治疗中青年髋关节创病的中短期应用结果，以探讨陶瓷型人工髋关节假体的临床应用价值。方法对人工全髋关节置换术132例164髋进行随访，其中生物固定型超高分子聚乙烯-钻铬钼合金全髋假体97例99髋，陶瓷-陶瓷非骨水泥型假体35例35髋，应用Harris评分进行功能评价，应用Gruen股骨分区与髋臼Delee—charnly分区方法进行影像学评价。结果Harris功能评分两组患者之间未见显著性差异，但是影象学上，超高分子聚乙烯-钻铬钼合金假体的松动范围或程度要大于陶瓷假体。结论对于年轻患者，陶瓷-陶瓷假体中短期效果良好，影象学松动率明显低于超高分子聚乙烯-钻铬钼合金假体。但是由于其价格昂贵，使用范围受到限制，而且远期结果有待于临床观察。     

不同自体输血技术在单侧初次髋关节置换术的应用体会

目的探讨几种自体输血方法在单侧初次人工全髋关节置换围手术期的作用和临床意义。方法将118例单侧初次全髋关节置换病人按使用自体血回输方法不同分成5组,分别为:(1)未使用自体血组19例;(2)单纯使用术前预存自体血组(术前预存组)27例;(3)单纯使用术中血液回输组(术中回输组)28例;(4)术前预存自体血结合术中血液回输组(术前中组)34例;(5)联合使用术前预存自体血、术中血液回输及术后引流血回输组(术前中后组)共10例。分析各组患者在围手术期输异体血比例和输血量方面有无统计学差异。结果未使用自体血组,64.8%(13/19)输异体血浆平均140mL;89.5%(17/19)输异体压积红细胞平均460mL。术前预存组,14.8%(4/27)输血浆平均61.5mL,14.8%(4/27)输压积红平均61.5mL。术中回输组,78.6%(22/28)输血浆平均192.9mL,85.7%(24/28)输压积红平均278.6mL。术前中组,11.8%(4/34)输血浆平均23.5mL,11.8%(4/34))输压积红平均35.3mL。术前中后组无一例输异体血液(0/10)。未用自体血组与术中回输组在输血例数与输血量方面差异无显著性,而这两组与其他3组比较差异有显著性。结论(1)单纯使用术中自体血回输在单侧初次髋关节置换手术中应用未能有效减少异体血液的输入;(2)联合使用术前预存自体血、术中血液回输及术后引流血回输3种方法,在单侧初次髋关节置换手术中应用能最大限度的减少异体血液的输入;(3)综合各种因素分析在单髋初次置换病例中,术前预存自体血技术最为经济,同时又可减少患者输入异体血的机会。     

Ceramics for Prosthetic Hip and Knee Joint Replacement

The most commonly used bearing couple in prosthetic hip or knee joint replacements consists of a cobalt–chrome (CoCr) metal alloy articulating against ultrahigh-molecular-weight polyethylene. Ceramics have been used as an alternative to metal-on-polyethylene in joint replacement surgery of arthritic hips and knees since the 1970s. In prosthetic hip and knee bearings, ceramic surfaces offer a major benefit of drastically reduced wear rates and excellent long-term biocompatibility, which can increase the longevity of prosthetic hip and knee joints. This benefit is important clinically because hip and knee replacement has become a very common surgical procedure, particularly in the United States, and because these procedures are being increasingly performed in younger patients who place greater demands on the prosthetic bearings. However, ceramics are brittle and the risk of catastrophic bearing failure in vivo , while rare, is a major concern. Improvements in material quality, manufacturing methods, and implant design have resulted in a drastic reduction of the incidence of such failures, so that modern ceramic bearings are safe and reliable if used with components of proven design and durability. Future material improvements are actively being investigated to reduce the risk of ceramic-bearing failures even further. The purpose of this article is to review the structure, properties, applications, and limitations of the ceramics that have been used in orthopedic bearings, and to describe the new ceramic composite materials and surface treatments that will be available for joint replacement surgery in the near future.     

Multi-objective regulation in autohydrolysis process of corn stover by liquid hot water pretreatment

Increasing reducing sugars (xylose and glucose) yield for bioethanol from corn stover depends strongly on optimization of pretreatment conditions. The optimumreaction conditions of two-stage liquid hotwater (LHW) pretreatment based on total sugars yield were investigated. Under optimal conditions, the recovery of glucose of corn stover after two-stage LHWpretreatment and 72 h enzymatic digestion, reached 89.55%. In addition, acetic acid-rich spent liquor pretreatment and one-stage LHW pretreatment have been carried out to make comparisons with two-stage LHWtreatment. Glucose yield 89.55% is superior to the recovery 83.38% using acetic acidrich spent liquor pretreatment or 80.58% using one-stage LHW pretreatment. The production of total sugars was increased by 7.8% when compared with one-stage pretreatment. Moreover, the structural features of the treated corn stover solid residueswere also investigated by XRDand SEMtechnology in order to clarify the effects of the reaction on corn stover. The results indicated that the two-stage LHWpretreatment was an effective pretreatmentmethod of corn stover to get most massive resource utilization, and it could be successfully applied to corn stover.     

氯气冷却流程的经济性分析

综合分析和比较一段和二段氯气冷却流程的初期投资和运行费用,得出从长期运行以及节能减排角度考虑,二段冷却流程更为经济合理的结论。     

骨科髋膝关节置换术临床路径实施体会

目的总结临床路径在骨科髋膝关节置换术中的实施体会。方法选取我院2009年11月至2010年12月收治的102例实施髋膝关节置换术的患者,按入院的先后顺序随机分为对照组和实验组,对照组仅采用传统模式,实验组在传统模式基础上实施临床路径。统计2组在住院天数、医疗费用、术后首次下床时间、术后首次功能锻炼时间、并发症发生情况以及患者满意度方面的相关数据,并比较其差异。结果所有方面的数据显示,实施临床路径的实验组明显比对照组有优势。结论骨科髋膝关节置换术实施临床路径的效果显著,值得在临床中加以推广应用。     

Preparation and characteristics of rice-straw-based porous carbons with high adsorption capacity

To prepare porous carbons with high adsorption capacity from rice straws, two different kinds of precursors, i.e. one as the raw rice straws (one-stage process) and the other as pre-carbonized rice straws (two-stage process), were activated with KOH of various impregnation ratios. The two-stage process was found very effective for manufacturing porous carbons with high surface area and adsorption capacities for MB and I₂. For example, the porous carbon that was carbonized at 700°C and subsequently activated at 900°C exhibited the surface area of 2410 m²/g, the adsorption capacities of 800 and 1720 mg/g for MB and I₂, respectively, and the total pore volume of 1.4 ml/g. In the two-stage method, there was a preferential optimum impregnation ratio of KOH to a precursor carbon, i.e. 4:1, with which high surface area of porous carbons could be achieved. The formation of uni- and bidentate carboxylic salt structure, induced by reaction between KOH and oxygen containing carbon, that facilitates the formation of azo group (-NN-) on a subsequent heat treatment was considered as one of the key factors for the presence of optimum impregnation ratio of KOH. In contrast, the porous carbons of only moderate adsorption capacity could be obtained from the one-stage method. The original morphology of rice straw was sustained during the two-stage process, yet not during the one-stage process.     

脱盐水站扩能改造技术总结

介绍脱盐水站的扩能改造.为提高脱盐水站的水质和处理能力,将一级制水工艺改为二级制水工艺,并将固定床离子交换器改为双室固定床离子交换器.出水达到二级处理质量指标,并可满足废热锅炉及HRS系统的用水要求.对运行中存在的问题进行了分析并提出改进建议.     

eNAMPT Is Localised to Areas of Cartilage Damage in Patients with Hip Osteoarthritis and Promotes Cartilage Catabolism and Inflammation

Obesity increases the risk of hip osteoarthritis (OA). Recent studies have shown that adipokine extracellular nicotinamide phosphoribosyltransferase (eNAMPT or visfatin) induces the production of IL-6 and matrix metalloproteases (MMPs) in chondrocytes, suggesting it may promote articular cartilage degradation. However, neither the functional effects of extracellular visfatin on human articular cartilage tissue, nor its expression in the joint of hip OA patients of varying BMI, have been reported. Hip OA joint tissues were collected from patients undergoing joint replacement surgery. Cartilage explants were stimulated with recombinant human visfatin. Pro-inflammatory cytokines and MMPs were measured by ELISA and Luminex. Localisation of visfatin expression in cartilage tissue was determined by immunohistochemistry. Cartilage matrix degradation was determined by quantifying proteoglycan release. Expression of visfatin was elevated in the synovial tissue of hip OA patients who were obese, and was co-localised with MMP-13 in areas of cartilage damage. Visfatin promoted the degradation of hip OA cartilage proteoglycan and induced the production of pro-inflammatory cytokines (IL-6, MCP-1, CCL20, and CCL4) and MMPs. The elevated expression of visfatin in the obese hip OA joint, and its functional effects on hip cartilage tissue, suggests it plays a central role in the loss of cartilage integrity in obese patients with hip OA.     

股骨颈骨折行人工髋关节置换45例的临床分析

目的探讨老年性股骨颈骨折行人工髋关节置换术的相关要点及临床效果。方法回顾性分析45例行人工髋关节置换术的老年性股骨颈骨折患者的临床资料。结果根据Harris评分标准评定:总优良率95.56%。随访期间出现髋关节脱位2例;髋关节疼痛2例;假体松动1例。无一例出现感染、骨折及神经损伤等并发症。结论老年性股骨颈骨折行人工髋关节置换术的优势在于术后可以早期下地活动并恢复功能锻炼,术后症状和功能恢复更加确切,再手术率较低,其手术成功的关键是重建股骨偏心距。