目的 研究冠肺炎疫情期间PBL模式联合微信平台在神经外科见习教学中的应用效果.方法 选取2020年5月-2021年6月期间在西南医科大学附属医院神经外科见习的临床医学本科生120名作为研究对,采用随机数字表法分为对照组和实验组,各组60名.对照组采用PBL教学方法,实验组在对照组基础上联合应用微信群教学,观察比较两组见习生理论、技能考核成绩、不同性别见习生理论和技能考核成绩以及见习生教学满意度.结果 实验组理论考核成绩、技能考核成绩均高于对照组(P<0.05);男生技能考试成绩高于女生(P<0.05),理论考试成绩与女生对比(P>0.05);实验组见习生教学满意度评分均高于对照组(P<0.05).结论 新冠肺炎疫情期间PBL模式联合微信平台在神经外科见习教学中的应用显著,可提高见习生理论、技能考核成绩,提高见习生教学满意度,是一种有效、可行的临床带教方法.

Objective To investigate the clinical effectiveness of stromal vascular fraction gel (SVF-gel) containing human adipose derived stem cells (ADSCs) in the treatment of adherent scar. Methods A retrospective analysis was carried out on the patients with adherent scars meeting our inclusion criteria and undergoing the treatment of gel injection during June 2018 and June 2020. The SVF-gel was prepared from the lipoaspirates sucked from the abdomen or the thigh followed by filtration, centrifugation and emulsion, and then injected into the adherent scars (at an interval of 2 mm for every needle puncture, SVF-gel 0.02 mL for every dose). Small amount of granular adipose tissues and SVF-gel were digested, cultured and identified. The scar hardness and thickness were measured for every patient preoperatively and 6 months postoperatively. Patient and observer scar assessment scale (POSAS) was used to evaluate scar condition, and patient satisfaction was investigated. Results There were 8 patients enrolled in this study, with a total of 10 adherent scars and the area of depression of 5.56±4.50 cm2. The injection volume of SVF-gel under the adherent scar was 3.90±3.00 mL. The results of morphological observation showed that short spindle cells grew in both SVF-gel and granular fat after digestion, and the over 95% obtained cells expressed the specific markers of mesenchymal stem cells, CD73, CD90 and CD105. At the same time, the number of primary cells cultured in same volume of SVF-gel was larger than the number from the granular fat tissue. Differentiation study found the growth of adipose-like cells in vitro, which were positive to oil red O staining. The scar hardness was decreased from 48.13±20.59 shore units preoperatively to 30.96±15.66 shore units in 6 months postoperatively(P < 0.05), and the scar skin thickness was increased from 2.00±0.60 mm to 2.72±0.63 mm (P < 0.05). In 6 months after operation, the appearance and activity of scar skin were significantly improved, and no complications were observed. The scores of patient scar assessment scale (PSAS) and observer scar assessment scale (OSAS) were 12.0±2.8 and 13.7±3.9 respectively, and the patient satisfaction score was 4 to 5, with an average of 4.6. Conclusion Our prepared SVF-gel contains more active ADSCs. Its injection can improve the local depression and scar texture in the adherent scar and achieve good satisfaction in the patients.

背景:有研究显示,不同内固定方式固定髋臼后柱骨折的生物力学存在差异.目的:模拟髋臼后柱骨折,评估3种固定方式固定髋臼后柱骨折后的稳定性.方法:取36个尸体半骨盆标本,建立髋臼后柱骨折模型,随机分3组固定:A组以髂坐短钢板固定,B组以传统后柱钢板固定,C组以髂坐长钢板固定,每组12个模型.模拟人体站立及坐立位时垂直方向加载力学载荷,采用图像位移法评估骨折断端的位移及生物力学稳定性.结果与结论:①站立位时,3组模型骨折断端相对位移与载荷大小呈正相关,相同载荷下3组间相对位移比较差异无显著性意义(P>0.05);加载1800 N载荷时,各组模型相对位移均未超过3 mm;②坐立位时,3组模型骨折断端相对位移与载荷大小呈正相关,相同载荷下3组间相对位移比较差异有显著性意义(P<0.05);相同载荷下,B组相对位移大于A、C组;A组100-500 N载荷下的相对位移大于C组,600 N载荷下的相对位移小于C组;③结果表明,髂坐钢板固定髋臼后柱骨折时能提供与传统后柱钢板同样的生物力学稳定性,固定结构刚度高,可满足术后康复需求.

目的 对比单髁置换术治疗膝关节自发性骨坏死与膝关节内侧骨关节炎的临床疗效.方法 回顾性分析我科2017年1月至2019年1月使用单髁关节置换术治疗符合诊断的膝关节自发性骨坏死(spontaneous osteonecro-sis of the knee,SONK)患者20例20膝(SONK组),男4例,女16例,年龄61～83岁,平均(71.9±8.2)岁.根据年龄、性别、身体质量指数筛选出相匹配的同期使用单髁置换术治疗膝关节内侧骨关节炎(medial compartment osteoar-thritis,MOA)患者20例20膝(MOA组),男4例,女16例,年龄63～79岁,平均(72.5±8.2)岁.记录两组术后并发症发生情况、术前及末次随访时美国特种外科医院膝关节评分(hospital for special surgery,HSS)、牛津大学膝关节评分(Oxford knee score,OKS)、膝关节最大活动度(range of motion,ROM)、股胫角、髋膝踝角.结果 40例均获随访,随访时间12～32个月,平均(24.2±17.4个)个月,骨坏死组1例出现假体松动,骨关节炎组1例出现不明原因疼痛,两组患者皆无感染、深静脉血栓形成等并发症发生.两组患者末次随访时膝关节OKS评分、KSS评分、膝关节活动度均较术前明显改善,差异有统计学意义(P＜0.05),但组间对比差异无统计学意义(P＞0.05);SONK组股胫角、髋膝踝角均较术前明显改善,差异有统计学意义(P＜0.05).结论 单髁置换术治疗膝关节自发性骨坏死具有创伤小、术后恢复快、术后本体感觉存在等优点,中短期疗效满意,与治疗膝关节内侧骨关节炎具有相似的临床疗效.

目的 探讨老年患者开腹术后疼痛对谵妄发生的影响.方法 选取行开腹手术的老年患者180例,采用数字评定量表评估患者术后疼痛情况,采用意识模糊评估量表评估患者术后谵妄发生情况,并分为谵妄组和非谵妄组,比较两组的一般资料,分析术后疼痛类别、疼痛程度及疼痛缓解时间对谵妄发生的影响.结果 谵妄发生率为10.6％.谵妄组年龄大于非谵妄组,睡眠少于非谵妄组、麻醉分级及术后第1天C反应蛋白水平高于非谵妄组,有配偶者的比例低于非谵妄组(P<0.05).老年患者开腹手术术后疼痛是谵妄发生的危险因素,与活动性疼痛相比,静息性疼痛与谵妄发生风险间的关系更密切,术后静息性疼痛缓解需1d内、2～3d、4d及以上者,谵妄发生率依次升高.以静息性疼痛缓解时间≥4d为最佳截断点,其预测谵妄发生的灵敏度和特异度分别为73.7％和74.5％,曲线下面积为0.750.Logistic回归分析结果显示,静息性疼痛持续时间越长,谵妄发生的风险越大(P<0.05).结论 老年患者开腹术后疼痛是谵妄发生的独立危险因素,且静息性疼痛与谵妄发生风险间的关系更密切,静息性疼痛评分越高,持续时间越长,谵妄发生的风险越大.