目的 探讨氨甲环酸(TXA)鸡尾酒疗法在高龄股骨转子间骨折闭合复位近端防旋髓内钉(PFNA)内固定围术期中的应用效果.方法 选择股骨转子间骨折行闭合复位PFNA内固定术患者90例,采用随机数表法分为对照组(不使用TXA)、A组(术前静脉滴注TXA)及B组(术前静脉滴注TXA,术中局部注射"TXA鸡尾酒"),各30例.比较3组围术期情况、凝血功能及疼痛情况.结果 A、B组失血量、隐性失血量及术后引流量均明显低于对照组(均P＜ 0.05);B组总失血量、隐性失血量及术后引流量均低于A组(均P＜ 0.05);3组输血率差异无统计学意义(P＞0.05).3组术后1、3d凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及纤维蛋白原(Fib)差异均无统计学意义(均P＞ 0.05).A、B组术后1、3d疼痛数字评分(NRS)均低于对照组(均P＜0.05),且B组低于A组(P＜0.05);3组术后7d NRS评分差异无统计学意义(P＞0.05).结论 TXA鸡尾酒疗法可明显降低高龄股骨转子间骨折闭合复位PFNA内固定围术期输血量、引流量,降低术后疼痛,且不影响患者凝血功能.

目的:研究基于产出导向法(POA)理念的混合式带教措施在骨科临床教学中的应用效果.方法:选择2020年7月至2021年7月在我院骨科的28名实习生和22名规培生进行研究,按照随机数表法,将其均分为对照组和实验组.对照组给予传统教学,实验组给予基于POA理念的混合式带教措施进行教学.比较两组的教学成绩和满意度.结果:实验组实践成绩和理论成绩均显著高于对照组(P＜0.05).实验组满意度显著高于对照组(P＜0.05).结论:基于POA理念的混合式带教措施在骨科临床教学中的应用效果显著,能提高教学成绩和满意度.

目的 对比MRI与CT多平面重建对骨质疏松性椎体压缩性骨折(OVCF)疼痛责任椎体的临床诊断价值.方法 对71例OVCF患者的临床资料进行回顾性分析,其中OVCF急性期50例,OVCF亚急性期21例.所有患者均接受MRI和CT多平面重建检查,且行经皮椎体后凸成形术(PKP).对比两种方法诊断OVCF急性期和亚急性期责任椎体的准确性,同时观察并总结MRI和CT多平面重建骨折区域形态类型.结果 两种检查方法诊断OVCF急性期责任椎体差异无统计学意义(P＞0.05);Kappa值为0.803,一致性较高.两种检查方法诊断OVCF急性期责任椎体差异无统计学意义(P＞0.05);Kappa值为0.719,一致性较高.71例OVCF患者119个椎体中嵌插型78个(65.55％),裂隙型41个(34.45％).结论 MRI和CT多平面重建在确定OVCF患者急性期和亚急性期疼痛责任椎体中均具有较高的一致性.

Objective To analyze the comprehensive intervention effect of post -traumatic stress disorder (PTSD) in patients with acute hand injury,and its correlation with hand function recovery.Methods A total of 120 patients with hand trauma admitted to Wenzhou Hospital of Traditional Chinese Medicine from April 2016 to April 2018 were selected.The patients were randomly divided into observation group (60 cases) and control group (60 cases) according to the digital table .The observation group received routine treatment and comprehensive intervention .The control group was given routine treatment .The PDST scale ( CAPS) ,depression self-rating scale ( SDS) and Hamilton anxiety scale (HAMA) rating scale used by clinicians were used to assess the psychological status ,depression and anxiety of patients with PTSD,and to evaluate the upper limb function of patients.Results After intervention,the scores of CAPS,SDS and HAMA in the control group were (24.51 ±8.43)points,(50.61 ±7.59)points and (10.63 ± 2.11)points,respectively,which were significantly higher than those in the observation group [(16.53 ±7.62)points, (40.26 ±4.18)points,(8.24 ±1.86)points](t=5.61,5.59,4.73,all P<0.05).The CAPS,SDS and HAMA scores of the two groups were significantly improved compared with before intervention ( t=4.11,5.04,3.98,5.18, 3.86,4.72,all P<0.05).After intervention,the upper limb function scale (DASH) scores of the observation group and the control group were (89.27 ±6.08)points and (82.11 ±7.92)points,respectively.The DASH scores of the two groups were significantly higher than those before intervention (t=6.14,5.28,all P<0.05).The DASH score of the observation group was superior to the control group (t=3.96,P<0.05).The DASH score of patients with hand injury was negatively correlated with CAPS score and SDS score (r =-0.362,-0.425,P =0.012,0.008). Conclusion Comprehensive intervention for PTSD in patients with acute hand injury can significantly improve the degree of depression and anxiety ,and improve the upper limb function of patients .

目的 分析肢体外伤感染患者致病菌的分布及耐药情况.方法 选择浙江中医药大学附属温州中医院2013年1月至2017年12月收治肢体外伤感染患者624例为研究对象,对其细菌分布、药物敏感试验结果及耐药情况进行分析.结果 624例患者共检出97种共641株细菌,排名前十位细菌共412株,占64.27%;前十位细菌中占比最高的是铜绿假单胞菌,占12.01%(77／641),其次分别为金黄色葡萄球菌占11.23%(72／641),表皮葡萄球菌占10.14%(65／641),阴沟肠杆菌占10.14%(47／641),大肠埃球菌占5.15%(33／641),粪肠球菌占4.37%(28／641),鲍曼醋酸钙复合不动杆菌占3.74%(24／641),肺炎克雷伯菌占3.59%(23／641),厌氧菌占3.43%(22／641),产酸克雷伯菌占3.28%(21／641).耐甲氧西林金黄色葡萄球菌(MRSA)检出率为18.97%,耐甲氧西林表皮葡萄球菌( MRSE)检出率为74.05%,其中MRSA敏感程度＞90%的抗菌药物为万古霉素、利奈唑胺以及复方磺胺甲噁唑,MRSE敏感程度＞90%的抗菌药物为万古霉素、利奈唑胺、利福平以及替考拉宁;鲍曼醋酸钙复合不动杆菌耐药发生率为26.89%,铜绿假单胞菌对阿米卡星、头孢吡肟、头孢噻肟、头孢他啶、庆大霉素、亚胺培南、美罗培南、左氧氟沙星、哌拉西林、哌拉西林／他唑巴坦敏感性均＞80%;阿米卡星和哌拉西林对产ESBL大肠埃希的敏感性＞90%,阿米卡星、头孢吡肟、亚胺培南、美罗培南、左氧沙星、他唑巴坦对阴沟肠杆菌的敏感性＞80%,阿米卡星、氨曲南、头孢吡肟、头孢他啶、亚胺培南、美罗培南、他唑巴坦、复方磺胺甲噁唑对产酸克雷伯菌的敏感性＞80%.结论 肢体外伤易感染的细菌种类多,其中粪肠杆菌的药物敏感性高于屎肠球菌;铜绿假单胞药物敏感性高;不动杆菌药物敏感性低.

目的 观察甲状旁腺激素辅助股骨近端防旋髓内钉(PFNA)手术治疗老年性骨质疏松性股骨转子间骨折的疗效.方法 选择2014年6月-2017年12月老年骨质疏松股骨转子间骨折患者共76例,对照组行内固定手术治疗,术后行骨质疏松基础治疗.实验组加用甲状旁腺激素治疗.观察恢复状况及骨代谢指标.结果 与对照组相比,实验组自由活动、疼痛缓解、骨折愈合时间明显缩短(P＜0.05);实验组治疗后骨密度(BMD)、骨钙素(BGP)比对照组上升(P＜0.05);碱性磷酸酶(ALP)、总Ⅰ型胶原氨基端前肽(PI NP)和β-胶原降解产物(β-CTX)比对照组下降(P＜0.05).实验组治疗后Harris评分优良率显著高于对照组(P＜0.05).结论 老年性骨质疏松性股骨转子间骨折术后应用甲状旁腺激素能够改善骨质疏松,促进骨折愈合及髋关节功能恢复.

Objective To investigate the clinical application of fourth dorsal metatarsal artery retrograde island flap of second toe and finger reconstruction after donor toe web skin defect. Methods In 2007 January 2009 December, the clinical data were cut from the second toe and finger reconstruction with dorsal metatarsal flap area ranging from 13 patients were analysed. Results 13 cases were al flaps survived, and fol ow-up time ranged from 3 months to 16 months, the skin texture, feel good, toe web satisfactory appearance, for walking foot function satisfied. Conclusion Maximize the protection of the donor foot function, reducing the complications after skin grafting, is the ideal operation method.