Objective To observe the effect of Shengyu decoction on perioperative hidden blood loss in elderly patients with intertro-chanteric femoral fracture(IFF)treated with proximal femoral nail antirotation(PFNA),and to explore its effectiveness and safety.Methods The elderly patients with IFF hospitalized in the Department of orthopedics and traumatology of the Second Affiliated Hospi-tal of Henan University of Chinese Medicine from January 2021 to December 2021 were selected as the research objects.Sixty-six pa-tients were randomly divided into control group and observation group,with 33 cases in each group.The control group completed the examination,underwent PFNA surgical treatment and postoperative symptomatic treatment.The observation group took one dose of Shengyu decoction every day on the basis of the control group.The clinical effect of Shengyu decoction was judged by statistical analy-sis of the recessive blood loss and TCM syndrome score of 2 groups of cases.The adverse reactions and complications and judge its safety were observed.Results Compared with the control group,the observation group had less recessive blood loss and lower TCM syndrome score in perioperative period,the difference was statistically significant(P＜0.05).No adverse reactions or complications oc-curred in the two groups during the study period.Conclusion Shengyu decoction can reduce the recessive blood loss in the periopera-tive period of elderly IFF patients,improve the qi and blood deficiency syndrome,and help the early recovery of patients.

Skin flap transplantation is one of the most common tissue transplantation methods for wound repair and organ reconstruction in plastic surgery. During the transplantation process, the inflammatory response of transplanted flap and angiogenesis are critical to the successful rate of skin flap transplantation. In recent years, to improve the biocompatibility and cell affinity of biomedical materials, the modified biomaterials have gradually become a popular subject in scientific researches. In our study, the IL-4 modified expanded polytetrafluoroethylene (e-PTFE) surgical patch IL4-e-PTFE was prepared, and the rat skin flap transplantation model was constructed. The results of cell experiment prove that IL-4 has potentiation in the angiogenesis of human umbilical vein endothelial cell (HUVEC) induced by monocyte, and IL-4 can also promote angiogenesis by inducing the M2 macrophages. According to the results of in vivo experiment, the apoptosis level of transplanted flap cells of rats in the IL4-e-PTFE group was lower than that in the e-PTFE group, and in the IL4-e-PTFE group, the expression levels of pro-inflammatory cytokines IL-1β, IL-6 and TNF-α showed significantly decline compared to the e-PTFE group, while the expression levels of anti-inflammatory cytokines IL-1Ra, IL-10 and TGF-β presented significant increase compared to the e-PTFE group; the immunofluorescence staining results show that the number of M2 macrophages in transplanted flap area of rats in the IL4-e-PTFE group was significantly higher than that in the e-PTFE group, and the angiogenesis level was remarkably improved. In this study, by preparing IL4-e-PTFE and carrying out the cell and in vivo experiments, a reference method is proposed, which can reduce the inflammatory response during skin transplantation process using e-PTFE and optimize the long-term effects of flap blood vessels, hoping to provide a broader space for the applications of e-PTFE in medicine.

目的:观察十全大补汤对老年股骨转子间骨折术后贫血的影响.方法:选取河南省中医院骨科收治的老年股骨转子间骨折患者80例,采用随机数字表法随机分为治疗组和对照组.方法:对照组40例采用股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)手术和常规术后抗炎防血栓治疗.治疗组40例在对照组治疗基础上,入院后即刻开始服用十全大补汤至术后第14天.分别记录术前1天、术后第1,2,3,5,7天的血红蛋白、血清白蛋白变化、输血率及输血量、输白蛋白率及白蛋白量,记录围术期并发症.结果:两组均在入院48 h内手术治疗,术中出血量不多.术后第1,2,3,5天两组的血红蛋白与术前相比均明显下降,第7天基本恢复正常.治疗组第2,3天的血红蛋白升高更明显,与对照组对比,差异有统计学意义(P<0.05).治疗组的输血率、输血量、输白蛋白率、输白蛋白量与对照组对比明显减少,差异有统计学意义(P<0.01).对照组的肺部感染、深静脉血栓病例高于治疗组,但差异无统计学意义(P>0.05).结论:十全大补汤能有效提高PFNA术后的血红蛋白、血清白蛋白含量,减少输血量和血清白蛋白量,改善患者围术期整体状况.

[目的]评价单侧双通道内镜治疗重度脱垂型腰椎间盘突出症的临床疗效.[方法] 2020年4月-2020年12月,在本科行单侧双通道内镜治疗的重度脱垂型腰椎间盘突出症患者19例.总结围手术期、随访与影像学结果.[结果]所有患者手术均顺利完成,无严重并发症,手术时间(75.37±13.62) min,出血量(61.84±20.45) ml,透视次数(2.84±0.83)次.术后患者腰部及下肢VAS评分显著持续下降(P＜0.05),至术后30 d患者疼痛基本消失.随时间推移,患者改良ODI评分显著下降,而JOA评分显著增加(P＜0.05).按改良Macnab标准,末次随访时的临床疗效:优16例,良2例,可1例,优良率94.74％.至末次随访时,MRI显示手术节段无突出复发.[结论]单侧双通道内镜是治疗重度脱垂型腰椎间盘突出症的有效方法.

[目的]探讨经皮内镜下清创冲洗术治疗腰椎间隙非特异性感染的临床疗效.[方法]回顾性分析2016年9月～2019年9月在本科行经皮内镜下清创冲洗术治疗腰椎间隙非特异性感染的17例患者资料,其中男11例,女6例;年龄51～82岁,平均(66.94土9.37)岁;病变节段:L2/33例,L3/44例,L4/57例,L5S13例;7例患者有既往侵入性操作史.总结围手术期、随访与辅助检查结果.[结果]所有患者手术均顺利完成,无严重并发症.术后患者VAS评分和体温显著下降(P＜0.05),至术后14d患者疼痛基本消失,体温恢复正常或接近正常.随时间推移,患者改良ODI评分显著下降,而JOA评分显著增加(P＜0.05).至末次随访时,无原椎间隙感染复发.辅助检查方面,病理检查显示组织炎细胞浸润伴肉芽组织增生.17例患者中12例检出病原菌.随时间推移17例患者WBC、中性粒细胞分类、ESR和CPR均显著下降(P＜0.05).末次随访时MRI检查显示,病变椎间隙清晰,邻近椎体信号均匀,无混杂信号.[结论]经皮内镜下清创冲洗术是治疗腰椎间隙非特异性感染的有效方法,且手术创伤小,治疗效果可靠.

中医骨伤科学是一门研究骨关节及其周围筋肉损伤与疾病的课程,是中医临床专业核心课程,其基础理论内容丰富,包含筋伤、骨病、内伤、病因病机等,同时具有直观性、实践性、操作性强的知识分布特点,如手法复位、骨折固定、牵引、专科检查、功能锻炼等 [1],不仅需要学生具备扎实的理论基础,而且需要与实践紧密结合,掌握基本的专业操作技能.传统的以说教为主的单一教学模式,往往以"教师为中心",进行灌输式理论教学,学生缺乏对骨折、脱位的形象化认知,无法高效学习 [2];另外由于传统课堂教学时间、地点的限制,学生们往往是走马观花,对抽象的技能操作难以深入理解,只会说不会做,临床实践能力差.随着高等教育教学改革的深入及社会的高速发展,单一说教为主的传统教学模式已不能满足临床对于复合型骨伤科人才的培养需求,因此,探索一种合适的骨伤科学教学模式显得尤为重要.我们根据教学大纲要求和本课程的特点,在骨伤科学教学中积极开展在线视频课程,以优化中医骨伤科学教学模式,帮助学生理解和掌握教学内容,提高教学效率,现将其应用情况总结如下.

目的:采用清热解毒、理气通腑中药灌肠,观察其对脑出血后发热以及神经功能的影响.方法:80例保守治疗的脑出血后发热患者,按随机数字表法分为治疗组和对照组,每组40例.在常规治疗的基础上,对照组应用温盐水400 mL灌肠,治疗组应用中药400 mL保留灌肠,每晚灌肠1次,共14次.观察周期为两周.治疗后评价退热效果、格拉斯哥昏迷评分.结果:治疗组、对照组退热起效时间分别为(2.20±0.61)h和(3.93±0.82)h,完全退热时间分别为(5.42±1.32)d和(7.14±1.62)d.两组比较,差异有统计学意义(P＜0.05).退热疗效方面,治疗组有效率为97.30％,对照组为78.95％,两组比较,差异有统计学意义(P＜0.05).治疗14 d后,格拉斯哥昏迷评分,治疗组、对照组分别为(13.72±1.39)分和(12.65±1.64)分,两组比较,差异有统计学意义(P＜0.05).结论:清热解毒、理气通腑中药灌肠干预脑出血发热患者,能有效退热,促进神经功能恢复.

本科教育是高等学校教育教学工作的重中之重,是各高校常抓不懈的工作.为提高本科生的教学质量,提高本科课程建设质量是重要环节.2019年《教育部关于一流本科课程建设的实施意见》明确提出,有关部门和高校要充分认识一流本科课程建设的重要意义,积极开展一流本科课程的建设,打造"金课"、淘汰"水课".在此背景下,我们开展了省级线上线下混合式一流课程——中医骨伤科学的建设和实施,现总结如下.

目的 探究雷公藤多苷对IL-1β诱导的软骨细胞损伤的作用及其潜在的分子机制.方法 密度梯度分离法分离SD大鼠软骨细胞.软骨细胞随机分为对照组、模型组、雷公藤多苷组(10、50 μg/mL雷公藤多苷)、LiC1组(50 μg/mL雷公藤多苷+20 mmol/L LiC1),加入10 ng/mL IL-1β诱导软骨细胞24 h,各给药组加入相应药物继续处理24 h.CCK-8检测细胞存活率,试剂盒检测LDH释放量及GAG水平,流式细胞仪检测细胞凋亡,ELISA检测细胞培养上清液中COX-2、iNOS水平,RT-PCR检测MMP13、Acan、Sox-9 mRNA表达,Westem blot检测Wnt通路Wnt3a和β-catenin蛋白的表达.结果 雷公藤多苷单独作用对软骨细胞存活率及LDH释放无影响.与对照组比较,模型组细胞存活率降低,LDH释放量增加,细胞凋亡率增加,GAG水平及Acan、Sox-9 mRNA表达降低,COX-2、iNOS水平及MMP13 mRNA表达升高(P＜0.05);经雷公藤多苷(50 μg/mL)干预后,细胞存活率升高、LDH释放量降低,细胞凋亡率降低,GAG水平及Acan、Sox-9 mRNA表达升高,COX-2、iNOS水平及MMP13 mRNA表达降低(P＜0.05);而将Wnt通路激活剂作用之后,雷公藤多苷对IL-1β诱导的软骨细胞上述作用全部被反转.结论 雷公藤多苷通过抑制Wnt/β-catenin通路缓解IL-1β诱导的软骨细胞损伤.

Ⅱ度烧伤多表现为以疼痛、肿胀、渗出、水疱形成为主的创面损伤;若治疗不当瘀久入里化热或热毒内攻脏腑,致使脏腑功能失调,则可进一步加重热毒损害.因此,对于小面积Ⅱ度烧伤创面的治疗应尽早清除其创面的火热毒邪之象,使创面尽快地进入一种顺变之势,则毒邪不复进一步酿生和传变,故治疗应以清热解毒、活血化瘀为基本原则.通过本案例介绍,希望拓宽小面积Ⅱ度烧伤中医诊疗思路,以飨同道.

目的 研究西红花酸对白细胞介素1β(IL-1β)诱导的人膝关节原代软骨细胞分解代谢及炎症应答的影响.方法 西红花酸0.5,1,5,10和20μmol·L-1处理人膝关节原代软骨细胞12 h,MTT检测细胞存活率.西红花酸0.5,1,5,10和20μmol·L-1处理人膝关节原代软骨细胞12 h后,再加IL-1β10μg·L-1处理24 h;实时荧光定量PCR(qRT-PCR)检测基质金属蛋白酶3(MMP-3)、MMP-13及Ⅱ型胶原(CollⅡ)mRNA水平;ELISA检测MMP-3、MMP-13、前列腺素E2(PGE2)、IL-6和肿瘤坏死因子α(TNF-α)水平;试剂盒检测一氧化氮(NO)含量;Western印迹法检测磷脂酰肌醇3激酶(PI3K)P85、磷酸化PI3K P85(p-PI3K P85)、蛋白激酶B(Akt)、p-Akt、P65 NF-κB和p-P65 NF-κB蛋白表达水平.结果 MTT结果显示,西红花酸对人膝关节原代软骨细胞存活率无影响.qRT-PCR和ELISA检测结果显示,与IL-1β处理组相比,西红花酸处理可抑制IL-1β诱导的MMP-3和MMP-13 mRNA和蛋白表达(P<0.05),上调CollⅡmRNA表达水平(P<0.05).西红花酸还可抑制IL-1β诱导的NO和PGE2释放(P<0.05),降低IL-1β处理组炎症因子IL-6和TNF-α的产生(P<0.05).此外,IL-1β可显著上调人膝关节原代软骨细胞中p-Akt,p-P65 NF-κB,PI3K P85和p-PI3K P85蛋白表达,而西红花酸处理后可显著抑制IL-1β诱导的p-Akt,p-P65 NF-κB和p-PI3K P85蛋白表达(P<0.05).结论 西红花酸可抑制IL-1β诱导的人膝关节原代软骨细胞过度分解代谢及炎症应答,PI3K/Akt/NF-κB信号通路参与该过程,提示西红花酸可能具有潜在的抗骨关节炎的功效.

目的?探讨外固定架早期动力化对桡骨远端骨折愈合情况的影响.方法?选取2015年1月—2019年1月河南省中医院收治的80例桡骨远端骨折患者,按照随机数字表法将其分为对照组与观察组,每组各40例.患者入院后均接受闭合复位治疗,复位后应用可伸缩式外固定架手术治疗.对照组术后给予常规围术期用药及康复指导,观察组在对照组基础上进行早期动力化干预.对比两组患者骨折愈合情况,并观察两组治疗前后相关血清因子检测水平.结果?观察组住院时间及骨折愈合时间均短于对照组,差异有统计学意义(P<0.05);观察组骨折愈合不良事件及并发症合计发生率明显低于对照组,差异有统计学意义(P<0.05);治疗前及术后4周时两组患者血清骨钙素(BGP)、骨特异性碱性磷酸酶(BALP)水平相比差异无统计学意义(P>0.05);术后6周及8周时(观察组动力化干预后2周及4周)两组血清BGP、BALP水平较前有所升高,其中观察组血清BGP、BALP水平的升高幅度明显大于对照组.结论?行外固定架早期动力化可有效促进桡骨远端骨折愈合,缩短骨折愈合时间,减少术后并发症,改善骨质疏松情况,有利于病情康复,值得临床应用.

Objective To explore the clinical efficacy of multiple debridement, vacuum suction and sensitive antibiotics in the treatment of community-acquired MRSA infection in soft tissue. Methods The clinical data of 20 patients with community-acquired MRSA infection in soft tissues, whcih were collected from Henan traditional Chinese medicine hospital during the periods of January 2017 to June 2018. were retrospectively analyzed. The clinical treatment, bacterial culture results, and antibiotic usage were analyzed and summarized. Results Among the 12 cases with limited infection range, lower sensitive antibiotics were selected, and 8 cases with larger infection range selected vancomycin. All the patients healed within 3 ~ 4 weeks, the wound scar was not serious, and the limb function recovered well. All the patients were followed up for more than half a year, and there were no recurrence cases. Conclusion For patients with mild soft tissue community acquired MRSA, low sensitive antibiotics can be selected on the basis of multiple debridement, vacuum suction, but vancomycin is the first choice for severe infection.

目的 观察黄连紫草膏对小面积深二度烧伤创面愈合的治疗效果.方法 收集2018年1～7月我院烧伤科收治的深二度烧伤成年患者60例,深二度烧伤面积为1％～3％TBSA.按随机数字表法将患者分为黄连紫草膏治疗组(观察组)和银离子抗菌凝胶治疗组(对照组),每组30例.创面清创后,观察组用黄连紫草膏涂抹,油纱覆盖包扎,对照组用银离子抗菌凝胶涂抹,银离子敷料覆盖包扎,每日换药1次.观察两组患者创面愈合时间,第21、28天创面愈合率;分别在第1、4、7、14、21天进行换药时视觉模拟评分(VAS)、创面细菌培养;记录创面过敏反应等指标.结果 观察组创面愈合时间短于对照组,第21、28天创面愈合率高于对照组,差异有统计学意义(P<0.05).除第1天外,之后观察组的VAS评分均低于对照组,差异有统计学意义(P<0.05).不同时间点的创面细菌培养,两组间差异无统计学意义(P>0.05).观察组3例、对照组2例出现轻微创面过敏反应,无其它明显不良反应.结论 对比银离子抗菌凝胶,黄连紫草膏更有利于小面积深二度烧伤的治疗,明显减轻换药时的疼痛,促进创面愈合.

BACKGROUND: Patients with hip instability due to cerebral palsy, hemiplegia, infantile paralysis and extensive damage in gluteus medius, appear with high dislocation rate after arthroplasty, which is a great challenge for clinicians.OBJECTIVE: To investigate the reconstruction of the hip joint stability with the dual-mobility acetabular cup, and to prevent the dislocation after replacement in patients with hip neuromuscular lesions.METHODS: Twelve cases of hemiplegia, infantile paralysis, developmental dysplasia of the hip and recurrent dislocation after hip arthroplasty admitted in the Orthopedic Treatment Center, the Second Affiliated Hospital of Henan University of Chinese Medicine from January 2010 to July 2014 were enrolled, then underwent joint replacement or revision with dual-mobility cup, and the dynamic stability of the hip was achieved by adjusting the abductor lever arm.RESULTS AND CONCLUSION: (1) The followed-up time was from 20 to 60 months. (2) One year later, one case suffered Vancouver A right femoral fracture and received conservative treatment at 1 year postoperatively; one case of dislocation at postoperative 1 week, and dislocation, infection and loosening occurred in none cases. (3) These results manifest that those patients with neuromuscular disease and hip instability treated with hip joint arthroplasty using dual-mobility acetabular cup can reconstruct the stability of the hip joint and prevent the occurrence of postoperative dislocation.

住院医师规范化培训的首要任务是通过培训提高住院医师的临床技能,在培训过程中,根据实际情况制定相应的实施细则.该院在住院医师规范化培训中引入一对一“导师制”取得良好效果.通过一对一“导师制”,密切了带教老师与培训学员的联系,激发了学员的学习热情,提高了学员的临床诊疗水平与科研素养.

目前住院医师规范化培训全面实施,但临床带教中存在很多的问题,由于中医骨伤科技能培养的特殊性有别于其他专科培训,笔者以自己在医师规范化培训中的具体举措及心得体会,探索当前形势下中医骨伤住院医师规范化培训临床带教的方法和思路.

目的 探讨提高自我效能感对新建科室护士和队伍建设的作用.方法 运用外部强化、高峰体验、加强业务训练、树立榜样、创作宽松工作环境等方法,促进护士自我效能感的提高,观察自我效能感与新建科室护士的成长、护理队伍建设的关系.结果 经过1年的培训和实施,明显的提高了新建科室全体护士自我效能感,提高了护士的积极主动性和工作效率、理论水平和专业技能、沟通能力和协调能力,增强了团队意识和协作能力,稳定了新建科室的护理队伍,促进了新建科室护理队伍人才阶梯合理建设,使其健康快速成长起来,避免了护理差错的发生,减少了医患纠纷,提高了新建科室护士和病人的满意度.结论 在医院新建科室护理队伍中,自我效能感的提高与护士的成长密切相关.

Objective:To investigate the clinical efficacy of adjustable external fixator treatment of complex fractures of the distal radius.Methods:30 cases of adjustable external fixator treatment of complex fractures of the distal radius.Results:30 cases of imaging evaluation::Excellent 24 cases,good 4 cases,pass 2 cases,the excellent and good rate was 93%.30 cases of functional evaluation:Excellent 23 cases,good 4 cases,pass 3 cases,the excellent and good rate was 90%.Conclusion:Adjustable external fixation can recover and maintain the distal radius palmar inclination,ulnar deviation and correction of radial shortening degormity,benefit of complex fractures of the distal radius function recovery,easy to operate.

Objective To analyze the occurrence of complications of tantalum rod insertion in treating osteonecrosis of the femoral head.Methods Retrospective analysis of the complications of 3 patients with osteonecrosis of the femoral head treated with tantalum rod insertion was performed.The complications were treated in time.Results One case of fracture around tantalum rod was treated with proximal femoral locking plate fixation,which got bone union 9 months after surgery.One case of right hip had serious pyogenic infection,which was controlled 2 months after the treatment,and didn't happen during one year's follow-up.One case did histological examination showing squamous-cell epithelioma metastasis.Conclusion Although the probability of occur fracture around tantalum rod,infection,misdiagnosis and mistreatment is not high,it also should be vigilant.