Objective:To explore the effect of 3D printing technology on ankle fracture surgery.Methods:This study was a case-control study.Forty five patients with ankle fractures admitted to the Department of Orthopaedics of the Affiliated Hospital of North China University of Science and Technology from January 2017 to May 2022 were selected. Divide into an observation group and a control group using the random number table method. The control group received open reduction and internal fixation of the ankle joint under X-ray assistance, while the observation group used Mimics software modeling and 3D printing models to assist in open reduction and internal fixation of the ankle joint. Compare the surgical time, intraoperative bleeding volume, intraoperative X-ray exposure frequency, postoperative physician fatigue scale 14 (FS-14) score, fracture reduction quality, fracture healing time, and ankle joint function at 6 months after surgery between the two groups of patients. The measurement data is represented by ± s, and the two groups are compared using t-tests with two independent samples; Counting data is represented by examples (%), χ 2 test is used for inter group comparison, and rank sum test is used for inter group comparison of rank data. Results:The observation group had shorter surgical time than the control group [(134.16±25.61) minutes compared to (163.38±41.90) minutes], with less intraoperative bleeding and fewer intraoperative X-ray exposure times than the control group [(46.32±29.29) mL compared to (99.62±77.85) mL, (13.68±3.50) times compared to (18.54±6.09) times], and lower postoperative physician fatigue scores than the control group [(9.77±2.02) points compared to (12.13±1.73) points], The differences between groups were statistically significant (t-values in decibels were 2.69, 3.20, 3.12, and 4.20, all P<0.05). The quality of postoperative fracture reduction in the observation group was excellent in 12 cases, good in 5 cases, and poor in 2 cases; The quality of postoperative fracture reduction in the control group was excellent in 7 cases, good in 16 cases, and poor in 3 cases. Compared between groups, the observation group had better postoperative fracture reduction quality than the control group ( Z=-2.05, P=0.040). At a follow-up of 6 months after surgery, there was no statistically significant difference in bone healing time between the two groups ( P>0.05). The AOFAS score in the observation group was higher than that in the control group (91.63±2.83) compared to (88.92±3.92), and the difference was statistically significant ( t=2.56, P=0.014). Conclusions:Using Mimics software modeling and 3D printing technology to assist ankle fracture surgery can shorten the operation time, reduce the use rate of X-ray, reduce the fatigue of doctors, and improve the quality of joint reduction and ankle function.

目的 探讨Caprini血栓风险模型、D-二聚体、纤维蛋白单体预测老年股骨颈骨折术后并发下肢深静脉血栓(DVT)的临床应用价值.方法 本课题研究对象来自于2020年1月-2022年12月入住唐山市第二医院的老年股骨颈骨折患者,共387例,根据术后超声检查判断是否存在DVT,分为血栓组(128例)及对照组(259例),收集一般资料,比较两组患者Caprini模型评分及D-二聚体(D-D)、纤维蛋白单体水平(FM),并分析Caprini模型评分与D-D、FM水平的相关性,通过绘制ROC曲线评价分析三者单独及联合对老年股骨颈骨折术后发生DVT的预测效能;结果 单因素分析提示:血栓组患者的年龄、LDL-C、手术时长均高于对照组,糖尿病史、既往卒中病史所占比率亦高于对照组;通过多因素logistic回归分析调整混杂因素后提示:Caprini模型评分、D-D、FM均与老年股骨颈骨折术后DVT的发生独立相关;经Pearson相关分析提示:血栓组患者Caprini模型评分与术后D-D、FM水平呈正相关;通过绘制Caprini模型评分、D-D、FM三者单独及联合预测老年股骨颈骨折术后发生DVT的ROC曲线,结果显示三者联合的预测曲线下面积最大,AUC值为0.749,灵敏度、特异度分别为82.81％、74.13％.结论 Caprini模型评分、D-D、FM与老年股骨颈骨折术后DVT密切相关,且三者联合应用对于DVT的发生具有较好的预测效能.

目的 对利用 3D成像打印技术进行股骨远端骨折手术治疗的临床效果进行 Meta分析,评估该方法与常规手术方法相比临床疗效上是否具有优势.方法 利用网络以 3D打印、3D、mimics、股骨远端骨折、股骨髁骨折、Hoffa 骨折为关键词检索中国知网、中国万方数据库、维普网,PubMed、Embase、Cochrane library数据库,检索时间由建库截止到检索日期 2023 年 7 月.所得文献经纳入排除标准筛选后再经 Cochrane 系统评价员手册和 Newcastle-Ottawa Scale(NOS)评分评估,提取文献中资料后由 RevMan 5.4 软件对手术时间、手术出血量、骨折复位满意率、术中 X线曝光次数、骨折愈合时间、术后并发症发生率、术后膝关节 HSS评分优良率、术后切口引流量、住院时间结果进行统计学分析.结果 纳入 10 篇文献,病例数合计为 734例,其中 3D成像打印技术辅助组 397 例,常规组 337 例.Meta 分析结果显示,3D 成像打印组在手术时间(SMD=-2.92,95%CI:-3.94～-1.90,P＜0.00001)、手术出血量(SMD=-2.35,95%CI:-3.43～-1.27,P＜0.0001)、术中 X线曝光次数(SMD=-4.48,95%CI:-5.93～-3.04,P＜0.00001)、骨折愈合时间(SMD=-1.04,95%CI:-1.67～-0.40,P=0.001)、术后切口引流量(SMD=-1.29,95%CI:-1.52～-1.05,P＜0.00001)、住院时间(SMD=-1.97,95%CI:-2.98～-0.96,P=0.0001)均少于常规组;骨折复位满意率(RR =1.14,95%CI:1.05～1.25,P=0.002)、术后膝关节 HSS评分优良率(RR =1.09,95%CI:1.01～1.17,P=0.03)优于对照组、术后并发症发生率(RR =0.43,95%CI:0.28～0.64,P＜0.0001)少于对照组.结论 3D成像打印技术辅助手术治疗股骨远端骨折的临床效果好于对照组,仍需更多高质量外文文献进一步证实该结论.

Objective:To explore the effect of comprehensive accusation intervention on the use of antibacterial drugs and the writing of medical records in elderly patients with closed fracture.Methods:A total of 120 elderly patients (aged ≥60 years) with fracture were enrolled from January 2017 to June 2019 in the department of orthopaedics and traumatology of the Second Hospital of Tangshan University and the Affiliated Hospital of North China University of Technology. According to random number table method, 120 patients were divided into intervention group (61 cases) and non intervention group (59 cases) by computer random number method. The patients in the intervention group received pharmaceutical care and quality control management intervention during the perioperative period; The patients in the non intervention group were routinely treated with antibiotics and wrote medical records. The use effect of antibiotics, the cost of antibiotics and the effect of standardized writing of medical documents were compared between the two groups. Independent sample t-test was used for comparison between measurement data groups with normal distribution, and χ 2 test was used for comparison between counting data groups. Results:Compared with the non-intervention group, the rate of perioperative use of antibiotics (49.2% (30/61)), the rate of drug use without indication (4.9% (3/61)), the rate of irrational drug selection (6.6% (4/61)), the rate of irrational drug use (6.6% (4/61)), and the proportion of irrational combined use of antibiotics (3.3% (2/61)) were significantly lower than that in the non-intervention group (81.4% (48/59), 16.9%(10/59), 22.0% (13/59), 20.3% (12/59), 18.6% (11/59)), the difference was statistically significant (χ 2 values were 13.65, 4.49, 5.91, 4.93 and 7.33, respectively; P values were <0.001, 0.034, 0.015, 0.026 and 0.007,respectively). The cost of antibiotics in the intervention group ((283.86±59.86) yuan) was lower than that in the non intervention group ((820.45±136.27) yuan), and the difference was statistically significant ( t=27.478, P<0.001). The eligible rate of the pre-operative informed consent document signing was 100% (61/61) in the intervention group, and the eligible rate of the operative record completion time was 100% (61/61) higher than that in the non-intervention group (84.7% (50/59), 79.7% (47/59)), the difference was statistically significant (χ 2 values were 7.98 and 13.79; P values were 0.005 and <0.001). The loss rate of preoperative alternative therapy (0) and postoperative communication (0) were significantly lower than those of non-intervention group (11.9% (7/59), 10.2% (6/59)) (χ 2 values were 5.68 and 4.56; P values were 0.017 and 0.033). Conclusion:The implementation of comprehensive quality control intervention mode reduced the application of unreasonable antibiotics and standardized the writing of inpatient medical records. It is of great significance for the rational use of antibiotics and the standardization of medical record writing in the elderly patients with closed fracture.

目的 探讨身痛逐瘀汤加减方联合腰椎牵引疗法治疗急性期腰椎间盘突出症(LDH)的临床疗效.方法 将114例急性期LDH患者按随机数字表法分为观察组与对照组各57例,对照组给予腰椎牵引,观察组在对照组基础上给予身痛逐瘀汤加减方;7 d为1个疗程,共3个疗程.结果 与本组治疗前相比,两组中医证候评分、镇痛效果、运动功能评价均有所改善(P＜0.05或P＜0.01),且观察组改善更为显著(P＜0.05).在临床疗效中总好转与临床症状恢复时间的比较上,观察组的提升更为明显(P＜0.05).结论 采用身痛逐瘀汤加减方联合腰椎牵引疗法治疗急性期LDH的临床疗效显著,且能够有效改善患者急性期的疼痛状态.

Objective:To investigate the risk factors of lower extremity venous thrombosis in elderly patients with femoral neck fracture during perioperative period after artificial bipolar femoral head replacement and the effect of Mailuoshutong in clinical prevention and treatment of thrombosis.Methods:A retrospective case-control study was conducted on the clinical data of 92 elderly patients with femoral neck fracture who were admitted to the Affiliated Hospital of North China University of Technology from January 2015 to January 2020.According to the treatment method, the patients were divided into an observation group (44 cases) and a control group (48 cases). Patients in the observation group were treated with the combination of Mailuoshutong Pill and low molecular weight heparin calcium.The control group was treated with low molecular weight heparin calcium.The patients in both groups started anti-coagulation therapy immediately after admission, and they stopped the drug one day before operation and continued to take the drug on the second day after operation.Venous ultrasound of both lower limbs was recorded at the time of admission, on the 7th day after admission, and 14 days after surgery.The changes in hemoglobin, red blood cell count and drainage volume before and after operation were recorded.Results:The incidence of thrombosis was 2 cases (4.54%) on the 7th day after admission in the observation group and 9 cases (18.75%) in the control group.The difference was statistically significant (χ 2=4.400, P=0.036). The incidence of thrombosis was 3 cases (6.82%) in the observation group and 11 cases (22.92%) in the control group 14 days after operation.The difference was statistically significant(χ 2=4.611, P=0.032). The hemoglobin changes of observation group and control group were (23.73±6.89) g/L and (22.10±5.18) g/L respectively on the first day before operation and 48 hours after operation.The red blood cell count changes were (0.67±0.32) × 1012/L and (0.56±0.36) × 1012/L respectively, and the drainage volume of drainage tube after operation was (100.27±23.73) ml and (102.40±20.90) ml, respectively.There was no significant difference in the above indexes between the two groups (all P>0.05). Multivariate Logistic regression analysis showed that only low molecular weight heparin calcium was used to prevent and treat thrombosis ( OR=10.281, 95% CI: 1.609-65.689, P=0.014); the elderly patients ( OR=1.190, 95% CI: 1.061-1.336, P=0.003) and the thrombosis at the time of admission ( OR=8.346, 95% CI: 1.773-39.281, P=0.007) were the risk factors for lower extremity venous thrombosis on the 14th day after surgery. Conclusion:Mailuoshutong pill combined with low molecular weight heparin calcium can safely and effectively treat lower extremity venous thrombosis in perioperative period of artificial femoral head replacement for femoral neck fracture in elderly patients.Mailuoshutong pill combined with low molecular weight heparin calcium was a protective factor for lower extremity venous thrombosis 14 d after operation, while advanced age and thrombosis at the time of admission were risk factors.

目的 探讨119例中老年人小转子处股骨与髓腔直径比值与骨密度的相关性,预测骨密度值及判断骨质疏松症的准确性.方法 华北理工大学附属医院2014年1月—2020年1月同时行骨盆正位片和骨密度检查的55岁以上中老年人119例.通过骨盆正位X线片,测量得到股骨小转子上缘、中点、下缘股骨直径与髓腔直径的比值.经双能X线骨密度测量仪测量腰椎及股骨颈骨密度.按T值≤-2.5标准差将其分为骨质疏松组40例与非骨.质疏松组79例.比较二组性别、年龄、体重指数.通过Pearson偏相关分析,揭示股骨髓腔直径比值与腰椎和股骨颈骨密度之间的相关性.通过一元线性方程分析股骨髓腔直径比值预测骨密度的准确性.通过接受者工作特征曲线(ROC)确定股骨髓腔直径比值诊断骨质疏松症的最佳值及准确率,预测的灵敏度和特异性.结果 骨质疏松组平均年龄(68.98±6.68)岁,男11例,占27.5％,女29例,占72.5％、小转子处股骨髓腔直径上缘、中点、下缘比值分别为(1.124±0.063)、(1.199±0.058)、(1.263±0.073);非骨质疏松组平均年龄(65.76±6.27)岁,男40例,占50.6％,女39例,49.4％,小转子处股骨髓腔直径上缘、中点、下缘比值分别为(1.187±0.073)、(1.324±0.086)、(1.385±0.074),二组比较,差异均有统计学意义(均P＜0.05).Pearson偏相关分析小转子处上缘、中点、下缘股骨髓腔直径比值与股骨颈骨密度的相关性结果分别为(r=0.173,PP=0.061)、(r=0.310,P=0.001)、(r=0.508,P=0.000),与腰椎骨密度相关性结果分别为(r=0.282,P=0.002)、(r=0.399,P=0.000)、(r=0.507,P=0.000).股骨颈骨密度和腰椎骨密度与小转子下缘股骨髓腔直径比拟合一元线性回归方程结果分别为(调整后R2=0.267,F=43.967,P=0.000),(调整后R2=0.264,F=43.260,P=0.000),方程均有统计学意义;小转子下缘股骨髓腔直径比值每增加0.01,股骨颈骨密度值增加0.00806 g/cm2,腰椎骨密度值增加0.00747 g/cm2.利用ROC曲线进行骨.质疏松症的诊断性分析得知曲线下面积AUC=0.884,预测准确率为63.6％,小转子下缘股骨髓腔比值为1.328,敏感度为0.886、特异度为0.750,以上差异均有统计学意义.结论 小转子下缘股骨髓腔直径比与骨密度呈正相关,通过小转子处股骨髓腔直径比值进行骨质疏松症的筛查具有一定准确性且方便快速,具有普及应用价值.

目的 探讨雾霾对支气管哮喘患者肺功能的影响.方法 选取于2016年1-10月在华北理工大学附属医院门诊及住院的支气管哮喘患者140例,其中男68例,女72例.分别于2016年11月、2016年12月、2017年1月、2017年2月的每月末前后对所有患者进行定期随访及测定进行PEF％ pred、FEV1％ pred等肺功能指标,同时受试者在专门培训过的人员指导下完成哮喘控制评价量表(asthma control test,ACT)测定,同时在随访期间2016年11月及12月、2017年1月及2月记录实时监测的PM2.5峰值及均值,分析每月不同水平PM2.5与肺功能及ACT评分的关系.结果 2016年11-12月、2017年1月及2月实时监测的PM2.5峰值及均值的最大值均出现在2016年12月份,PM2.5均值在各月份之间比较差异有统计学意义(P＜0.05);在不同PM2.5暴露水平下,各月份FEV1％ pred、PEF％ pred及ACT评分之间差异有统计学意义(P＜0.05).结论 雾霾可能造成支气管哮喘患者肺功能及ACT评分降低,进一步加重支气管哮喘病情.

患者,男,66岁,因车祸致全身多发伤,右上肢疼痛、出血并完全性皮肤脱套4. 5 h于2020年5月30日入我院治疗.既往有高血压病史6年,冠心病史3年,未规律服药控制,吸烟饮酒史20 余年.查体:右上肢皮肤脱套伤,皮瓣呈桥状,范围由手腕至腋下,约占全身面积的6. 5％(见图1A).脱套皮瓣边缘存在碾挫伤,内部含有大量泥沙等异物,其血管、淋巴管及皮下组织同深筋膜肌肉层完全离断.肘关节周围肌肉组织挫伤较重,肘部及前臂肌腱、神经、血管组织外露并中度挫伤.肘关节囊开裂,可见关节软骨外露.右腕部尺桡动脉搏动可触及,右手感觉减退明显.X线检查未见明显骨折线.

Objective:To study the clinical effect of Maizhiling tablets combined with salmon calcitonin in the treatment of elderly femoral neck fracture after artificial femoral head replacement and the influencing factors of hip joint function 6 months after operation.Methods:Prospective research methods were used in this article.A total of 84 elderly patients with femoral neck fracture who underwent artificial femoral head replacement in the Affiliated Hospital of North China University of Science and Technology from January 2017 to June 2019 were selected and randomly divided into the treatment group (41 cases) and the control group (43 cases) by the random number table method.The treatment group was treated with Maizhiling tablet and salmon calcitonin nasal spray plus basic calcium; the control group was treated with basic calcium.Independent sample t test was used to compare the visual analogue score (VAS) on the 5th day after operation, the time of complete disappearance of congestion in thigh, and the time of first ambulation after operation between the two groups.The bone mineral density (BMD) of contralateral femoral neck and Harris score of hip joint function were compared between the two groups at 14 days, 3 months and 6 months after operation by repeated measurement variance analysis.Multivariate Logistic regression was used to analyze the influencing factors of hip joint function at 6 months after operation.Results:VAS score on the 5th day after surgery: (6.34±1.54) points in the treatment group and (7.02±1.50) points in the control group.Complete regression time of thigh congestion: (12.12±2.27) d in the treatment group and (13.88±2.58) d in the control group.The first postoperative activity time was (5.93±1.52) d in the treatment group and (7.84±1.05) d in the control group, and the differences of the above indexes between the two groups were statistically significant ( t value was 2.051, 3.313, 6.673, respectively, all P<0.05). The BMD values of the contralateral femoral neck in the treatment group were (0.543±0.123), (0.561±0.119), (0.606±0.105) g/cm 2 at 14 days, 3 months and 6 months after operation, and (0.530±0.092), (0.517±0.089), (0.526±0.090) g/cm 2 in the control group.The results of variance analysis of repeated measurements showed that Fintra-group=55.726, P<0.01; Finter-group=4.206, P<0.05; Finteraction=57.654, P<0.01.There were significant differences between 3 months, 6 months and 14 days after operation in the treatment group (all P<0.01), and between 3 months and 6 months after operation ( P<0.01). In the control group, there was significant difference between 14 days and 3 months ( P<0.01), and between 3 months and 6 months ( P<0.01); 6 months after operation, the difference was statistically significant ( P<0.01). The Harris scores of hip joint in the treatment group were (82.12±8.18), (85.49±6.61), (87.10±6.57) points and (78.91±5.75), (81.44±6.42), (83.67±6.97) points in the control group.The results of repeated measurement ANOVA showed that Fintra-group=64.526, P<0.01; Finter-group=6.529, P<0.05; Finteraction=0.501, P>0.05.There were significant differences between 3 months, 6 months and 14 days after operation (all P<0.01). There were significant differences between 3 months and 6 months after operation ( P<0.05). There were significant differences between the groups 14 days, 3 months and 6 months after operation ( P<0.05 or P<0.01). Multivariate logistic regression analysis showed that age( OR=1.318, 95% CI1.002-1.732, P=0.048) and treatment method ( OR=29.168, 95% CI 1.030-824.623, P=0.048) were risk factors for hip function on the replacement side, and Harris score of hip function 14 days after surgery ( OR=0.624, 95% CI 0.447-0.873, P=0.006) were protective factors for hip function 6 months after surgery. Conclusion:Maizhiling tablets and salmon calcitonin nasal spray have good effects on removing blood stasis, relieving pain, effectively improving bone mineral density and promoting the recovery of joint function after artificial femoral head replacement for senile femoral neck fracture.The younger age of patients, postoperative treatment with Maizhiling tablets combined with salmon calcitonin and good recovery of hip function in 14 days after operation are the protective factors of good hip function in 6 months after operation.

目的 观察痹祺胶囊联合阿仑膦酸钠在老年股骨颈骨折人工关节置换术后的治疗作用.方法 97例均为华北理工大学附属医院骨科于2017年1月—2019年1月收治的老年股骨颈骨折患者,入院后拟行人工双极股骨头置换术治疗,按随机数字表法分为3组.Ⅰ组34例,术后应用痹祺胶囊加碳酸钙/维生素D3片口服;Ⅱ组32例,术后给予阿仑膦酸钠加碳酸钙/维生素D3片口服;Ⅲ组31例,术后给予痹祺胶囊联合阿仑膦酸钠加碳酸钙/维生素D3片口服.3组的疗程均为4个月,术后随访4个月,观察3组术后第7天患肢大腿周径减少值(cm),术后引流管出血量(mL),疼痛视觉模拟评分(VAS),手术后3、7天超敏C-反应蛋白(hs-CRP)数值,术后1、4个月髋关节Harris评分,股骨假体Gruen分区1区骨密度值(BMD)和术后患者在助行器保护下间断下地行走所用时间.结果Ⅲ组患肢周径减少值大于Ⅰ、Ⅱ组(F=142.436,P＜0.01);3组术后出血量差异无统计学意义(F=0.063,P＞0.05);术后第7天Ⅲ组VAS评分低于Ⅰ、Ⅱ组(F=9.081,P＜0.01);hs-CRP值亦低于Ⅰ、Ⅱ组(F=7.304,P＜0.01).术后1个月和4个月Ⅲ组髋关节功能Harris评分较Ⅰ、Ⅱ组高(F分别为9.032,9.524,P＜0.01).术后4个月Ⅲ组股骨假体Gruen分区1区周围应力遮挡造成的BMD值减少在3组中最低(F=8.509,P＜0.01).术后Ⅲ组患者在助行器保护下间断下地行走所用的时间较Ⅰ、Ⅱ组短(F=12.028,P＜0.01).结论 老年股骨颈骨折人工关节置换术后应用痹祺胶囊联合阿仑膦酸钠口服有较好的消肿、消炎、止痛作用,可促进关节功能恢复,且可减少假体置换术后因应力遮挡所导致的骨质疏松.

目的 探讨鲑鱼降钙素和阿仑膦酸钠在股骨颈骨折内固定术后预防和治疗骨质疏松及股骨颈短缩中的作用.方法 2014年1月-2019年6月华北理工大学附属医院收治的采用股骨颈骨折空心钉内固定术治疗的118例老年患者,按简单随机分组法分为二组.第1组56例,给予鲑鱼降钙素治疗,第2组62例,给予阿仑膦酸钠治疗.比较二组患者术后9个月内骨密度值、骨折愈合时间、术后第9个月时股骨颈短缩程度及股骨头坏死率.结果 术后9个月二组骨密度值变化重复测量的方差分析所得分组、时间点、分组×时间点比较结果分别为(F=7.060,P=0.009)、(F=7.560,P=0.000)、(F=0.982,P=0.406);两种治疗方法提升骨密度效果存在差异,阿仑膦酸钠在术后提升骨密度效果较鲑鱼降钙素好,术后骨密度值随时间存在趋势性变化,这种变化与治疗方法不存在交互作用.术后9个月时,二组股骨颈短缩程度结果分别为(7.79±1.78)mm和(8.50±1.68)mm,鲑鱼降钙素组术后股骨颈短缩程度少于阿仑膦酸钠组,差异有统计学意义(P＜0.05).鲑鱼降钙素组与阿仑膦酸钠组术后骨折愈合时间分别为(4.82±1.15)个月和(5.35±1.24)个月,鲑鱼降钙素组愈合时间短于阿仑膦酸钠组,差异有统计学意义(P＜0.05).术后9个月二组髋关节Har-ris评分比较结果为(89.39±5.20)和(86.39±6.99),鲑鱼降钙素组术后髋关节功能较好,差异有统计学意义(P＜0.05).术后9个月时行MRI检查二组股骨头坏死率,鲑鱼降钙素和阿仑膦酸钠术后差异无统计学意义(P＞0.05).结论 股骨颈骨折内固定术后应用鲑鱼降钙素治疗可促进骨折愈合,减少股骨颈短缩,髋关节功能较好;而应用阿仑膦酸钠术后提升骨密度效果较好;术后9个月时,二组股骨头坏死率差异无统计学意义.

Objective:To investigate the effect of Suhuang Zhike Capsule on airway inflammation in patients with acute episode of allergic rhinitis and asthma syndrome.Methods:Eighty patients with allergic rhinitis and asthma syndrome were admitted to North China University of Science and Technology Affiliated Hospital from June 2016 to September 2017.A prospective cohort study was carried out and randomly divided into treatment group and control group with 40 patients in each group.The control group was treated with conventional anti-inflammatory, expectorant and antiasthmatic therapy, while the treatment group was treated with Suhuang Zhike Capsule.The changes of nasal symptoms and asthma clinical symptoms in the two groups were compared before and after treatment, and the changes of nitric oxide in exhaled air, eosinophils in blood and induced sputum were measured.Results:Compared with the control group, there was no significant difference in the number of eosinophils in the exhaled nitric oxide, eosinophil count in blood and induced sputum before treatment in the treatment group ((161.45±4.67)×10 -9 vs.(163.12±4.56)×10 -9, (1.59±0.53)×10 9/L vs.(1.60±0.51)×10 9/L, (1.11±0.06)×10 9/L vs.(1.18±0.09)×10 9/L; t values were 0.10, 0.44, 1.75, respectively, all P>0.05). After treatment, the exhaled nitric oxide, eosinophil count in blood and induced sputum in the treatment group were significantly lower than those before treatment((30.86±5.54)×10 -9 vs. (161.45±4.67)×10 -9; (0.32±0.05)×10 9/L vs. (1.59±0.53)×10 9/L; (0.06±0.02)×10 9/L vs. (1.11±0.06)×10 9/L, t values were 91.32, 41.63, 51.77, respectively, all P<0.01). In the treatment group, the effective rate of nasal symptom control was 85.0% (34/40) significantly higher than 62.5% (25/40) in the control group (χ 2=5.23, P<0.05), and the effective rate of asthma clinical symptom control was significantly higher than that in the control group(90.0%(36/40), 72.5%(29/40), χ 2=4.02, P<0.05). Conclusion:Suhuang Zhike capsule can obviously improve the airway inflammatory response of patients with allergic rhinitis asthma syndrome in the acute attack stage, and the combination of conventional treatment plan is helpful to improve the curative effect.

目的 探讨老年股骨粗隆间骨折合并肺炎患者发生不良预后的危险因素.方法 回顾性分析2015年6月至2018年6月就诊于唐山市第二医院与华北理工大学附属医院的86例老年股骨粗隆间骨折合并肺炎患者的临床资料,按照是否发生不良事件分为预后不良组(17例)和预后良好组(69例).比较两组患者在年龄、受伤机制(摔伤、车祸、其他)、基础疾病(高血压、糖尿病、冠心病)、吸烟、饮酒、受伤至术前时间(<6 h、6～24 h、>24 h)、体质指数(≥28 kg/m2)、贫血史、低蛋白血症、C反应蛋白(CRP)、血清降钙素原(PCT)方面的差异.结果 预后不良组患者的血清CRP与PCT水平均明显高于预后良好组[(28.0±7.0)μg/L比(18.0±3.0)μg/L,(3.5±0.9)μg/L比(2.3±0.6)μg/L](P<0.05).多变量分析结果表明,CRP≥25μg/L与PCT≥3.0μg/L是患者继发不良事件的危险因素.结论 血清CRP≥25μg/L及PCT≥3.0μg/L可作为评估老年股骨粗隆间骨折合并肺炎患者发生不良事件的危险因素.

目的 探讨老年下肢骨折围术期肺部感染的危险因素,为临床治疗提供参考.方法 选取2015年12月至2017年12月在唐山市第二医院、华北理工大学附属医院就诊的下肢骨折围术期肺部感染的27例老年患者作为观察组,另选择资料匹配的27例下肢骨折围术期未并发肺内感染的老年患者作为对照组.收集两组患者资料信息:年龄、性别、吸烟史、饮酒史、心血管病病史、糖尿病病史、高血脂、慢性阻塞性肺疾病(COPD)史、高血压、体质指数(BMI)、骨折类型、手术时间、术中出量、麻醉方式、住院时间等.采用多因素Logistic回归分析老年下肢骨折围术期肺部感染的危险因素.结果 单因素分析显示,两组患者手术时间、术中出血量、住院时间、COPD史比较差异有统计学意义(P均＜0.01).多因素Logistic回归分析结果显示,COPD史为老年下肢骨折围术期肺部感染的危险因素(P＜0.05).结论 患者的COPD史增加了老年下肢骨折围术期肺部感染的几率,是其肺部感染的危险因素.

目的:分析老年骨关节置换术围术期发生脑梗死的危险因素并研究其预防对策.方法:选择2015年1月-2016年6月我院收治的200例行关节置换术患者,对所有患者的性别、年龄、体重、身高、患病情况、置入假体类型、手术时间、术中出血量、术后引流量、切口长度、住院时间、下地时间及高血压、糖尿病、冠心病等合并症情况进行回归分析,明确患者围术期发生脑梗死的危险因素,并提出针对性预防措施.结果:入组200例行骨关节置换术患者,围术期发生脑梗死患者53例.单因素分析结果显示年龄是否超过65岁、吸烟与否、疾病类型、麻醉方式、有无冠心病、糖尿病、高血压等合并症的骨关节置换术患者围术期脑梗死的发生率存在显著性差异(P＜0.05).而进一步lo百stics回归分析显示年龄超过65岁、吸烟、患者股骨颈骨折、手术麻醉为全麻、有冠心病、糖尿病、高血压等合并症是影响行骨关节置换术患者围术期发生脑梗死的独立危险因素(P＜0.05).结论:年龄超过65岁、吸烟、患者股骨颈骨折、手术麻醉为全麻、有冠心病、糖尿病、高血压等合并症的骨关节置换术患者围术期更易发生脑梗死,对有上述特点患者应密切注意预后情况,给予精细的护理措施,防止脑梗死的发生.

背景:目前,高龄患者接受人工髋关节置换围手术期发生脑梗死的相关危险因素尚不明确.目的:分析高龄患者髋关节置换术围手术期发生脑梗死的独立危险因素.方法:选取2008年12月至2018年2月在河北省唐山市第二医院接受髋关节置换的围手术期患者为研究对象.采用1:2比例的病例对照研究方法,对临床资料分别进行单因素分析和多因素Logistic回归分析.结果:收集符合入选标准的病例组68例,对照组136例.病例组:男36例,女32例,年龄61～83岁,平均(70.4±11.0)岁;对照组:男76例,女60例,年龄60～85岁,平均(72.3±10.6)岁.单因素分析:两组在高血压病、房颤、既往卒中史或短暂性脑缺血发作(TIA)病史、术中低血压、术后感染上差异有统计学意义(P＜0.05),而年龄、性别、糖尿病、白细胞计数、全身麻醉、手术持续时间、术后血容量不足比较,差异无统计学意义(P＞0.05).多因素Logistic分析:调整了年龄、性别因素后,术中低血压(OR=3.303,95％CI:1.548～7.047,P=0.002)、高血压病(OR=2.409,95％CI:1.143～5.079,P=0.021)与高龄患者髋关节置换术围手术期脑梗死的发生有关.结论:高血压病史和术中低血压是高龄患者髋关节置换术围手术期发生脑梗死的独立危险因素,对于行髋关节置换术的高龄患者术中发生低血压与围手术期脑梗死的发生关系最为密切.

目的:观察痹祺胶囊联合充气颈托固定治疗颈椎早期病变的临床疗效.方法:选择华北理工大学附属医院就诊的60例颈椎病早期、低年龄段患者按就诊顺序随机分为治疗组和对照组,治疗组以痹祺胶囊(4粒,3次/d)口服,并用充气颈托固定(30min,3次/d),并联合颈部红外线治疗仪理疗15min,2次/d治疗.对照组以洛芬待因缓释片(1片,1次/d)口服并联合充气颈托和颈部红外线治疗仪理疗15min,2次/d治疗,两组疗程均为28d.采用McGill简化量表积分值评价治疗前及治疗后第7、14、21、28天颈部酸痛改善情况.观察治疗期间颈项肌肉僵硬改善时间,颈椎生理曲度变直恢复时间并进行比较.结果:与对照组比较,治疗组治疗过程中McGill简化量表积分变化、颈部肌肉僵硬缓解及生理曲度变直恢复时间均显著减少(P＜0.05),治疗组明显优于对照组.结论:痹祺胶囊联合充气颈托固定是一种简单、快速、有效的治疗颈椎早期病变的临床治疗方法.

目的 比较闭合复位经皮克氏针内固定与旋前方肌部分转位经皮克氏针内固定治疗迟发性下尺桡关节背侧脱位的疗效.方法 回顾性分析自2007-03-2016-06诊治的28例迟发性下尺桡关节背侧脱位,15例采用闭合复位经皮克氏针内固定(对照组),13例采用旋前方肌部分转位经皮克氏针内固定(观察组).比较2组术后16、28、48周腕关节功能Cooney评分,以及并发症情况.结果 28例均获得48周随访.2组术后16周腕关节功能Cooney评分比较差异无统计学意义(P＞0.05).观察组术后28、48周腕关节功能Cooney评分高于对照组,差异有统计学意义(P＜0.05).2组术后并发症发生率比较差异无统计学意义(P=0.430).结论 与闭合复位经皮克氏针内固定比较,采用旋前方肌部分转位经皮克氏针内固定治疗的迟发性下尺桡关节背侧脱位患者腕关节功能恢复快且更满意,而且手术安全、并发症少.

目的 分析探讨伴有低氧血症的肺栓塞症(PE)患者血浆脑钠肽(BNP)浓度水平的变化及其临床意义.方法 选取66例PE患者分为二组,无低氧血症组为对照组,伴有低氧血症组为观察组,分别于入院后确诊PE 24h内及治疗2周后经影像学确诊好转时检测BNP浓度,比较其水平变化情况,分析观察组内氧分压水平与BNP之间的关系.结果 入院后确诊PE 24h内对照组的BNP值为56.2±13.1,观察组的BNP值为179.7±33.6,二组比较差异有统计学意义(P＜0.01);观察组中轻度缺氧组(18例,PaO2在60～90mmHg)的BNP值为119.8±18.5,中重度缺氧组(25例,PaO2 ＜60mmHg)的BNP值为245.6±24.3,二组比较差异有统计学意义(P＜0.05),治疗2周确诊PE好转后轻度缺氧组BNP值为58.2±15.5,中重度缺氧组BNP值为66.4±16.6,二组比较差异无统计学意义(P＞0.05).结论 ①肺栓塞发生低氧血症时可以导致BNP含量进一步升高;②BNP的上升与缺氧严重程度有关;③探讨PE患者氧分压对BNP的影响原因,可能由于氧分压的下降,致肺小动脉平滑肌痉挛收缩使管腔变窄,造成肺动脉内压力上升,促使右心室肌细胞分泌少量BNP,因左心室的心室肌细胞较右心室分泌BNP相对较多,所以PE患者BNP浓度上升数值并不是很高.