目的:对比掌指关节周围骨折采用克氏针内固定或微型钢板内固定治疗后的临床疗效.方法:回顾性分析2019年8月～2022年12月期间江南大学附属医院收治的掌指关节周围骨折97例患者的临床资料.按照不同的内固定方式将患者分为A组(克氏针内固定治疗,47例)和B组(微型钢板内固定,50例).对比两组治疗指标[手术时间、骨折愈合时间、住院时间、功能锻炼开始时间]、术后指标[指关节总活动度、手总主动活动度评分]、手功能[手指总主动屈曲度量表(TAFS)评分]、手部疼痛,同时观察两组术后并发症发生情况.结果:B组的功能锻炼开始时间、骨折愈合时间均短于A组,手术时间长于A组(P＜0.05),两组住院时间组间对比无差异(P＞0.05).B组的指关节总活动度大于A组,手总主动活动度评分高于A组(P＜0.05).治疗3个月后,两组手部疼痛视觉模拟量表(VAS)评分下降,且B组低于A组(P＜0.05).B组手功能TAFS评分优良率为92.00％,高于A组74.47％(P＜0.05).B组的术后并发症发生率低于A组(P＜0.05).结论:相对于克氏针内固定治疗,微型钢板内固定治疗掌指关节周围骨折,可缩短愈合时间、功能锻炼开始时间,提高手功能,指关节总活动度以及手总主动活动度评分,减轻手疼痛,降低并发症发生率,但其手术时间更长.

目的 了解分析广东省产科资源配置的公平性现况,为卫生行政部门制定相关的妇幼卫生决策和措施提供依据.方法 调查收集广东省所有助产机构产科资源相关数据,利用洛伦茨曲线(Lorenz curve)和基尼系数(Gini coefficient)分析评价产科资源,按分娩量、常住人口和土地面积分布的公平性,并以贡献系数作为判断不公平因子的依据,分析全省不公平因子分布的空间差异性.结果 2015年广东省助产机构、母婴保健技术考核合格人员、产科医生、护士及床位各产科资源按土地面积分布的基尼系数均在0.6以上;按常住人口和分娩量分布,均仅助产机构的基尼系数＞0.4.深圳和东莞母婴保健技术考核合格人员、产科医生、护士和床位的土地面积贡献系数,以及深圳助产机构、顺德母婴保健技术考核合格人员、产科护士的土地面积贡献系数最小(＜0.25),单位面积配置的资源较多,梅州、河源、韶关、清远和肇庆的母婴保健技术考核合格人员、产科医生、护士和床位土地面积贡献系数,以及清远和河源的助产机构土地面积贡献系数、云浮产科医生以及阳江产科护士、母婴保健技术考核合格人员的土地面积贡献系数最大(≥1.75),这些地区单位面积配置的资源较少.结论 广东省母婴保健技术考核合格人员、产科医生、护士和床位按常住人口和分娩量分布公平性较好,但助产机构均处于警戒状态;各产科资源按土地面积分布的公平性较差.深圳、东莞、顺德、梅州、河源、韶关、清远、肇庆、云浮和阳江产科资源分布的差异是引起全省产科资源按土地分布不公平的主要原因.

目的 探讨跟骨骨折经皮微创撬拨复位内固定手术治疗对患者术后并发症发生的影响.方法 选取2017年9月-2019年3月我院收治的跟骨骨折患者102例,随机分为两组,每组均为51例,对照组应用切开复位内固定手术实施治疗,研究组应用经皮微创撬拨复位内固定手术实施治疗.结果 研究组的AOFAS及VAS评分均优于对照组(P<0.05),研究组术后的Bohler和Gissane角度数优于对照组(P<0.05),研究组术后并发症的发生率低于对照组(P<0.05).结论 应用经皮微创撬拨复位内固定手术对跟骨骨折患者实施治疗,术后患者的跟骨活动好、术后功能可以很快恢复、创伤小、疼痛较轻微,并发症的发生率较低,手术效果极为理想,术后患者的生活质量更佳,可以推广应用.

Background/Aim: Early delivery (<39 gestational weeks), including early-term and preterm birth, is related to higher infant mortality and neonatal morbidity. Previous studies have shown that extreme temperatures increase the risk of early delivery, however the effect of unstable weather conditions remains unclear. This study aimed to investigate the association between temperature variability (TV) and early delivery in Shenzhen, China. Methods: We obtained records of 293,463 spontaneous early deliveries from Shenzhen Obstetric Data Reporting System during 2003-2012. Meteorological and air quality data were collected from meteorological bureau. TV during 6 exposure windows (preceding 2 days, 3 days, up to 7 days) , was separately calculated from the standard deviation of minimum and maximum temperatures (Yuming Guo, 2016). A time-stratified case-crossover analysis with conditional Poisson regression models was used to assess the relationship between TVs and early delivery, adjusting for mean temperature, humidity and air quality index. Results: TV ranged from 0 to 6 °C. The elevated TV0-1, TV0-2 and TV0-3 significantly increased the risk of overall early delivery, especially for preterm birth, and the effect of TV0-1 was the most obvious. Compared with the median of TV0-1 (0.5 °C), the relative risks for early delivery and preterm birth were 1.005 (95%CI: 1.000-1.011) and 1.019 (95%CI: 1.006-1.032) at 99th percentile of TV0-1 (2.74°C), respectively. TV0-1 effect was modified by delivery season, maternal education and parity. Low educated mothers, multiparae or those deliveried in spring and winter were more likely to delivery early due to TV. By stratified analyses, the TV0-1 increased the early delivery risk due to preterm labor, while the risk of early delivery following premature rupture of membrane declined. Conclusions: Temperature variability may trigger spontaneous early delivery due to preterm labor, especially during spring and winter. Pregnant women with lower education and multi-parity should pay more attention to unstable weather.

目的 评估双侧髂内动脉球囊封堵技术在凶险型前置胎盘孕妇剖宫产中的应用效果.方法 回顾性分析74例凶险型前置胎盘产妇的临床资料,其中56例合并胎盘植入(植入组),18例未见胎盘植入(未植入组),并进行对比分析.结果 植入组的术中出血量、产后24 h出血量、术后住院时间和产后出血例数显著高于未植入组,差异有统计学意义(P＜0.05).两组均无产妇子宫切除.早产在植入组与未植入组的发生率分别为83.9％、88.9％,差异无统计学意义(P=0.894).结论 双侧髂内动球囊封堵技术能有效减少凶险型前置胎盘剖宫产术的术中出血、输血量和子宫切除率.对于合并胎盘植入的患者,预置球囊后仍有出血风险,必要时联合子宫动脉栓塞术.

目的 运用Robson分类法对剖宫产进行统计分类,了解该院近五年剖宫产率变化情况.方法 收集2011-2015年该院分娩的50363名产妇信息,依据5个产科特征分为10组,分别计算每组剖宫产率.结果 五年平均剖宫产率为46.14%,五年剖宫产率呈下降趋势(Z=15.06,P<0.01).各组剖宫产率经Cochran-Armitage趋势检验,除G4(Z=1.32,P=0.09)、G9(Z=0.60,P=0.27)和G10(Z=-0.32,P=0.37)组外,其余七组均呈下降趋势(Z=15.16,5.27,7.70,15.21,3.04,2.04,4.07;P<0.01).结论 该院剖宫产率与同类型医院相持平并呈现下降趋势.

目的 探讨基于互联网的移动远程胎心监护的实现及与传统胎心监护结果的一致性.方法 利用多普勒超声探头采集胎心信号,通过蓝牙通讯技术将监测信号传输至智能手机APP客户端,数据通过互联网通讯技术与胎心监护中心互联以实现远程胎心监护,对476例孕晚期孕妇随机进行远程和传统胎心监护,自身前后配对,采用Bland-Altman LoA方法进行两种监护方法的一致性评价,并采用MOVER方法对95％ LoA进行可信区间估计.结果 远程和传统胎心监护得分的均差为-0.09,两种监护方法95％一致限LoA为(-0.72,0.54),按MOVER法计算的95％一致限LoA可信区间为(-0.78,0.60).结论 基于互联网的移动远程胎心监护实现可行,与传统胎心监测结果一致,是孕期常规保健的有效补充.

Objective There is a high occurrence rate of thalassaemia in Guangdong Province .Major and intermedia thalas-saemia bring severe burden for patients , families, and societies.This study aimed to reveal the economic burden of thalassaemia major and intermedia thalassaemia in Guangdong Province . Methods Eight areas of Guangdong Province were selected as the sampling ar-eas.Patients with major or intermedia thalassaemia were enrolled in the study .The patients′economic burden of this disease , inclu-ding direct economic burden , indirect economic burden and intangible economic burden was calcultated .The direct economic burden was estimated by outpatient fee , hospitalization expense , nutrition and transportation fees , indirect economic burden was evaluated u-sing disability adjusted life years ( DALY) combined with human capital , and intangible economic burden was calculated using method of willingness. Results Per average annual direct economic burden of 45 patients with major or intermedia thalassaemia was 43 058.66 yuan, per average annual indirect economic burden was 20 474.51 yuan, and per person intangible economic burden was 302 466.67 yuan. Conclusion Economic burden of major and intermedia thalassaemia is huge and most patients do not receive standardized treatment .More effective way should be taken to reduce the economic burden of thalassaemia and help the patients to re -ceive standardized treatment .

OBJECTIVE:To compare the effect of three β-thalassemia prenatal screening strategies in Guangdong province. METHODS:A total of 13 284 hospital-delivered couples and 13 369 newborns were recruited from 91 hospitals in 21 counties or districts of Guangdong province from June to December 2012. Mean cell volume (MCV), mean corpuscular hemoglobin (MCH) and hemoglobin A2 (Hb A2) were tested for all the couples, and all the couples and newborns were detected by 17 types of β-globin gene mutations. The effect of three β-thalassemia prenatal screening strategies were compared as following: (1) MCV/MCH with Hb A2 serial screening (SS): Hb A2 was tested if the woman's MCV < 82 fl and (or) MCH < 27 pg. If the woman's Hb A2 > 3.5, it meant positive. And if the woman was β-thalassemia carrier and her husband's Hb A2 > 3.5, it meant couple positive. (2) MCV/MCH with Hb A2 parallel screening (PS): if the woman's MCV < 82 fl and (or) MCH < 27 pg and (or) Hb A2 > 3.5 pg, it meant couple positive. And the husband would be tested for β-globin gene mutations if the woman was β-thalassemia carrier. (3) MCV/MCH with Hb A2 serial screening for couples (SSC): if one of the couple or both of them had MCV < 82 fl and (or) MCH < 27 pg, the couple would be tested for Hb A2, and if one of the couple got Hb A2 > 3.5, it meant couple positive. RESULTS:(1) For the SS strategy, the sensitivity was 92.69% (583/629); the specificity was 99.87% (12 638/12 655); the positive predictive value was 97.17% (583/600); and the negative predictive value was 99.64% (12 638/12 684). The results of β-globin gene mutations tested showed that the rate of β-thalassemia carriers was 4.74% (629/13 284) in the 13 284 pregnant women, and it was 4.29% (570/13 284) in their husbands. (2) The SS strategy detected 27 (0.20%, 27/13 284) β-thalassemia carrier couples. For the SS strategy detecting β-thalassemia carrier couples, the missed diagnosis rate was 11.11% (3/27); the sensitivity was 88.89% (24/27); the specificity was 100.00% (27/27); the positive predictive value was 100.00% (24/24); and the negative predictive value was 99.98% (13 257/13 260). (3) When using the SS strategy for 13 369 offsprings, there were 582 β-thalassemia carriers (4.35%, 582/13369), including 578 (99.31%, 578/582) minor β-thalassemia, 3 (0.52%, 3/582) intermedia β-thalassemia and 1 (0.17%, 1/582) major β-thalassemia. The SS strategy detected 25 fetuses who needed β-thalassemia prenatal diagnosis. (4) For the PS strategy, the sensitivity was 98.09% (617/629); the specificity was 88.73% (11 229/12 655); the positive predictive value was 30.20% (617/2 043); and the negative predictive value was 99.89% (11 229/11 241). (5) When using the PS strategy for the β-thalassemia carrier couples, the sensitivity was 100.00% (27/27); the specificity was 95.55% (12 667/13 257); the positive predictive value was 4.38% (27/617); and the negative predictive value was 100.0% (12 667/12 667). (6) The PS strategy detected 28 fetuses who needed β-thalassemia prenatal diagnosis in 13 369 offsprings. (7) For the SSC strategy, the sensitivity was 93.80% (590/629); the specificity was 95.75% (12 117/12 655); the positive predictive value was 52.30% (590/1 128); and the negative predictive value was 99.68% (12 117/12 156). When the SSC strategy was used for the husbands, the sensitivity was 92.28% (526/570); the specificity was 95.27% (12 112/12 714);the positive predictive value was 46.63% (526/1 128); and the negative predictive value was 99.64% (12 112/12 156). (8) When the SSC strategy was used in β-thalassemia carrier couples, the sensitivity was 100.00% (27/27); the specificity was 91.69% (12 156/13 257); the positive predictive value was 2.39% (27/1 128); and the negative predictive value was 100.00% (12 156/12 156). (9) The SSC strategy detected 28 fetuses who needed β-thalassemia prenatal diagnosis. CONCLUSIONS:All the three β-thalassemia prenatal screening strategies had good effect in clinical practice and public health. While in the high-prone area of β-thalassemia, MCV/MCH with Hb A2 parallel screening and MCV/MCH with Hb A2 serial screening for couples stratigies were better.

Through utilizing electronic nursing records, designing new modules, a nursing administrative group and a information engineer cooperated to establish a information system to managing nursing quality indicator. With its function of inputting, searching and computing data, the system effectively improved the integrity, flexibility, timeliness of data, which provided a foundation for the hospital to make scientific decisions based on facts.

目的：揭示河源市以家庭为基础的α-地中海贫血和β-地中海贫血基因异常检出率。方法采用地中海贫血液相芯片的技术对河源市4家医院的789户家庭夫妇外周血及其胎儿脐带血进行地中海贫血基因诊断。结果孕产妇22.3％，丈夫18.7％，新生儿21.0％是地中海贫血基因α-珠蛋白和β-珠蛋白基因突变的携带者。在α-珠蛋白基因点突变频率中，东南亚缺失（--SEA）占的比例最高，其次是-α3.7和-α4.2/αα。在β-珠蛋白基因点突变频率中，β41-42/β突变的比例最高，其次是β654/β和β-28/β。河源市以家庭为基础的总地中海贫血基因携带率为2.4％，α-地中海贫血和β-地中海贫血基因携带率分别为2.3％和0.1％。结论在河源市α-地中海贫血和β-地中海贫血基因突变率高，这项研究将有助于河源市地中海贫血的预防和控制策略的发展。

OBJECTIVE:To dicuss the application and therapeutic effect of middle-forearm flap based on perforator of ulnar artery for electrical burn wound on the wrist.METHODS:From Oct. 2009 to Oct. 2012, 10 cases of electrical burn wounds on the wrist were treated. A line from radialis medial epicondyle of humerus to the interior radialis pisiform bone was connected as flap axis. At the midpoint of the line, Doppler flow imaging meter was used to detect the emerging point of perforator vessel. The flap was designed and harvested. The flap was transferred reversely, with superficial vein retaining which was anastomosed with vein at recipient sites in 3 cases. The wounds in the donor sites were closed directly in 2 cases, and with skin graft in 8 cases.RESULTS:All the 10 flaps survived completely. 7 cases without vein anastomosis underwent obvious flap edema during 2-4 days postoperatively, which resovled 1 week later. Sub-flap tissue necrosis and infection happened in 2 cases, which healed after dressing and drainage. Patients were followed up for 3-36 months with satisfactory results.CONCLUSIONS:The middle-forearm flap based on perforator of ulnar artery has a stable and reliable blood supply. It offers a new choice for the electric burn wound on the wrist, especially at the ulnar side.

腹股沟部及大粗隆部软组织缺损,常因褥疮或电击伤所致,深部组织或骨关节外露,且常合并感染,治疗上较困难,必需用皮瓣或肌皮瓣修复.我科于2006年5月-2010年11月应用阔筋膜张肌肌皮瓣修复同侧腹股沟部及大粗隆部软组织缺损1 1例,临床效果满意.

目的运用眼压计对植入后的皮肤扩张器进行测压,防止过度注水后造成皮肤血运不良。方法 65只小白鼠背部皮下植入扩张器后分别注不同量水后测压,按压力区间分成5组,观察扩张部位皮肤的生长情况。结果随张力区间的上升,动物皮肤扩张部位的伤口生长情况愈差。结论有望设计一种运用于整形外科的测压系统,对每次注水后的扩张器进行测压,防止局部皮肤过度扩张后各种并发症的发生。

手指末节脱套伤是手外科常见损伤之一,其中部分脱套指体可以通过再植的方法,获得满意的疗效[1].但对于部分末节脱套指体损伤重、无原位再植条件,远节仅残留指骨、肌腱的脱套伤患者,我科自2008年6月至2010年6月,对10例末节脱套伤采用同指近、中节逆行岛状皮瓣瓦合修复,取得了满意的效果.资料与方法一、临床资料本组10例11指,男7例8指,女3例3指;年龄15 ～ 48岁,平均33岁.其中示指5指,中指4指,环指2指.缺损范围:指腹缺损均未超过远节,指背缺损均在伸肌腱止点以远,骨和肌腱外露.缺损面积1.5 cm×5.0 cm ～ 2.0×6.0 cm.致伤原因:撕脱伤7例8指,压砸伤2例2指,烧伤1例1指.急诊手术7例8指,二期手术(伤后1 ～3d)3例3指。

1临床资料患者男,41岁.因车轮压榨伤致右足拇趾离断出血2h,于2010年2月27日急诊人无锡市第三人民医院.检查:生命体征平稳,右足拇趾于第1跖跗关节平面完全断离,并伴有跖骨底及内侧楔骨骨折,第1、2跖骨间肌肉挫灭失活,拇展肌、拇屈肌于断面撕裂,足背皮肤逆行撕脱,并散在淤斑.X线片见第1跖骨及足拇趾缺损,内侧楔骨及第2趾骨基底部骨折移位.诊断:①右足拇跖跗关节平面离断伤;②右足背撕脱伤并右足第2趾骨基底骨折(图1)。

手部结构精细、功能特殊,一旦发生深度烧伤常累及肌腱、神经、骨关节等组织,且易出现继发性出血和感染,治疗难度较大;创面愈合后往往因瘢痕增生挛缩出现较严重手部功能障碍,给患者生活、工作造成极大痛苦和心理负担.治疗时除修复创面外更应注重功能重建,早期清除坏死组织、运用各种类型皮瓣修复是行之有效的方法,既能保护间生态组织、防止继发性感染和出血,也有利于功能恢复和重建,可以有效降低伤残率和截肢(指)率.2007年7月-2010年6月,笔者单位对部分手部深Ⅱ~Ⅳ度烧伤患者实行急诊清创即刻皮瓣移植修复,现对其疗效进行分析总结.

目的评价脱套皮肤修薄冷藏、延期回植法治疗全足脱套伤疗效。方法 2007年3月-2010年9月,收治全足脱套伤7例。男5例,女2例;年龄20～55岁,平均35岁。致伤原因:机器挤压撕脱伤4例,车轮碾压撕脱伤2例,重物砸伤1例。均从踝关节平面以远皮肤脱套,其中4例趾根部分皮肤未完全脱套。一期行足清创、持续封闭式负压引流治疗,脱套皮肤修薄冷藏;待引流量<10 mL/d行二期皮肤回植。结果术后7例皮肤成活50%～95%;根据贾金鹏等的皮肤成活评价标准,优4例,良2例,中1例。其中4例经去痂换药后创面愈合,3例行切痂植皮术后愈合。患者均获随访,随访时间7～24个月,平均15个月。术后1年1例发生足底溃疡不愈;其余患者足部外形均满意,足底感觉恢复至S3～S3+,足背为S2～S3,行走功能正常。结论脱套皮肤冷藏延期回植法操作简便,回植皮肤成活率较高,是治疗全足皮肤脱套伤的一种较好方法。

目的 报告邻指带蒂双叶瓦合皮瓣修复手指掌、背侧软组织缺损的方法与疗效.方法 2007年5月至2010年5月,对11例肌腱或骨组织外露的手指中远节掌、背侧软组织缺损的患者,应用邻指带蒂双叶瓦合皮瓣修复手指掌、背侧软组织缺损.取邻指皮瓣修复指掌侧创面,带指固有神经指背支,蒂宽约1.0～1.5 cm;邻指筋膜蒂皮瓣修复指背侧创面,蒂宽8.0 mm.结果 术后瓦合皮瓣及植皮均顺利存活,术后随访时间为6～18个月,平均10个月.皮瓣质地柔软,掌侧皮瓣恢复两点分辨觉为6～9mm,背侧皮瓣恢复保护性感觉.近指间关节活动正常.结论 邻指带蒂双叶皮瓣具有手术简便、不牺牲指动脉、不加重患指创伤的优点,是一种修复手指掌、背侧皮肤软组织缺损的较好方法,尤其是在近节指体损伤无法采用岛状皮瓣修复的情况下.

OBJECTIVE: To assess the efficacy of the extra long scapular-lateral thoracic-ilioinguinal siamese flap to repair the contracture deformity of perineal scar caused by burn and to discuss its characteristics. METHODS: From January 2008 to August 2009, 9 patients with contracture deformity of perineal scar after deep II degree to III degree burn were treated. There were 7 males and 2 females aged from 22 to 54 years (35.4 years on average). The course of disease ranged from 8 months to 5 years. All cases had central type of perineal scar. Among the cases, 3 cases were complicated by abdominal scar, 4 cases by legs scar, and 2 cases by abdominal and legs scar. Scar ulcer was observed in 2 cases. The opening-closing angle of bilateral lower extremities was (29.4 +/- 8.8) degrees. And anus could not expose entirely so that squatting and relieving the bowels were difficult in 6 cases. Defect areas after scar resection ranged from 20 cm x 6 cm to 28 cm x 8 cm. The size of extra long scapular-lateral thoracic-ilioinguinal siamese flap ranged from 35 cm x 12 cm to 58 cm x 15 cm. The donor sites were sutured directly. RESULTS: Blister and necrosis occurred in 1 case and was cured after dressing changed, and others flaps survived with wounds primary healing. Incision at donor site healed by first intention. All cases were followed up 6-12 months. The perineal function improved and the partial deformities were corrected. The opening-closing angle of bilateral lower extremities increased to (75.6 +/- 11.3) degrees, showing significant difference between pre- and post-operation (P < 0.05). The functions of squatting and relieving the bowels recovered well. The perineal scar adhesion recurred in 2 cases after 6 months of operation and were cured after scar resection and expanding flaps transposition. CONCLUSION: In view of large donating region, great facility for transposition, stable and sufficient blood supply, reutilization as expanded flap, it was an effective treatment and a beneficial trial by applying the transposition of the extra long scapular-lateral thoracic-ilioinguinal siamese flap for contracture deformity of perineal scar caused by burn.