目的 调查分析训练伤导致的腰椎峡部裂的发生原因,为降低腰椎峡部裂发生率提供理论依据.方法 对2016年1月—2021年3月解放军总医院第七医学中心收治的因训练导致腰椎峡部裂的234例患者进行问卷调查,记录患者身高、体质量、日常训练项目、训练强度、受伤时姿势、受伤时从事的训练项目、骨折部位等资料,并进行统计学分析,总结腰椎峡部裂的好发部位、危险因素等.结果 训练导致的腰椎峡部裂好发于L5(发生率为85.0％),发生率显著高于L3、L4,差异均有统计学意义(P<0.05).负重行进和负重蹲起造成腰椎峡部裂的发生率显著升高.受伤瞬间腰部姿势:后伸102例(43.6％),前屈49例(20.9％),旋转39例(16.7％),侧曲12例(5.1％),不确定32例(13.7％),训练中腰椎在后伸状态下更容易发生峡部裂.结论 腰椎在后伸状态下峡部剪切力增大,负重会造成峡部剪切力进一步增大而导致骨折,负重行进及负重蹲起是最易造成腰椎峡部裂的训练项目.

Objective:To explore the repairing effects of 3D-printed nano-β-tricalcium phosphate (β-TCP) scaffolds loaded with vancomycin and bone morphogenetic protein-2 (BMP-2) for seawater -soaked tibial bone defects in rabbits. Methods:A total of 27 male New Zealand White rabbits were assigned to the normal group using a random number table method, with each group consisting of 9 rabbits. The rabbit tibial bone defect model was created using the osteotomy surgical method. Eight hours after operation, the wounds in the control group and seawater group were immersed in seawater for 2 hours, and those in the normal group were not immersed. After an observation period of 5-7 days, no significant redness or purulent discharge was observed in the wound appearance, then debridement was performed followed by corresponding implantations: the control group with gelatin sponges loaded with vancomycin and BMP-2, and the other two groups with 3D-printed nano-β-TCP scaffolds loaded with vancomycin and BMP-2. After filling the bone defects with the respective materials, all groups underwent layer-by-layer suturing of the wound, followed by disinfection with iodine and injection of gentamicin to prevent infection. The affected limbs were then immobilized using a plaster cast. The affected limbs were imaged using anteroposterior X-ray at 4, 8 and 16 weeks after operation, and the repair effects were evaluated using the Lane-Sandhu X-ray scoring system. At 16 weeks after operation, the bone defect tissues were collected for HE staining to observe bone tissue growth.Results:At 4 weeks after operation, the Lane-Sandhu X-ray score in the control group was significantly lower than that in the normal group [(2.8±1.1)points vs. (1.1±0.9)points] ( P<0.05), and that in the seawater group [(2.2±1.0)points] was not significantly different from those in the other two groups (all P>0.05). At 8 weeks after operation, the seawater group [(6.1±0.9)points] and the control group [(2.8±1.0)points] exhibited lower Lane-Sandhu X-ray score compared to the normal group [(8.2±1.0)points] (all P<0.05), and the seawater group showed a higher score compared to the control group ( P<0.05). At 16 weeks after operation, the control group [(3.8±1.0)points] exhibited a lower Lane-Sandhu X-ray score compared to the normal group [(10.0±1.3)points] and the seawater group [(9.3±1.2)points] (all P<0.05), while no significant difference was noted between the latter two ( P>0.05). At 16 weeks after operation, histological observations revealed varying degrees of bone tissue formation in three groups, with the normal group showing the best bone defect repair effect, followed by the seawater group. Conclusion:The 3D-printed nano-β-TCP scaffolds loaded with vancomycin and BMP-2 are effective for the treatment of seawater -soaked bone defects, which can promote bone tissue repair.

目的 探讨新型组合式锁定钢板治疗股骨开放性粉碎性骨折的临床效果.方法 选取自2015年2月至2019年2月联勤保障部队908医院收治的24例Gustilo分型ⅢA、ⅢB型股骨开放性粉碎性骨折患者为研究对象.记录手术时间、出血量、骨折愈合时间及相关并发症情况.临床疗效评估采用Harris评分法.结果 随访24例患者,平均随访时间(14.75±1.89)个月.手术时间(78.75±6.12)min,术中出血量(341.67±58.36)ml.所有骨折全部愈合,愈合时间(7.13±1.68)个月.未发生内固定失败及骨不愈合,1例患者出现术后感染,给予负压封闭引流冲洗引流后治愈.术后12个月Harris评分为(86.33±5.87)分,高于术后6个月的(79.80±6.40)分及术后1个月的(74.33±6.31)分,且术后6个月评分高于术后1个月,差异有统计学意义(P<0.05).结论 新型组合式锁定钢板内固定系统治疗股骨开放性粉碎性骨折效果显著,具有操作简单、骨折愈合快的优点.

日间诊疗作为一种先进的诊疗模式在国外广泛开展,近年来也被我国医疗卫生行业逐步重视并得到大力推广.本文通过对我院开展的日间诊疗运营模式进行探讨,旨在构建与运营管理深度融合的日间诊疗管理体系,为日间诊疗模式在全军乃至全国的推广发展提供借鉴.

目的 探讨国产16排移动CT在救护车运载条件下进行头部扫描成像的可行性.方法 选取陆军某部训练基地的志愿者健康官兵95人,随机分为3组:Ⅰ组(77人),救护车在停止行驶状态下进行头部扫描;Ⅱ组(11人),救护车在行驶状态下进行头部扫描;Ⅲ组(7人),设置电磁波干扰环境.分析对比3组受检者在不同状态下,移动CT扫描成像质量、运动伪影、数据采集及信息传输情况.结果 骨窗成像:3组受检者颅骨、眼眶、鼻蝶窦等成像清晰.脑组织窗成像:3组受检者均可清晰显示眼球、视神经、脑干、脑皮质及脑白质等结构,但颅底部分层面均存在不同程度的运动伪影,其中Ⅰ组16.88%(13/77)受检者有较轻微的线状运动伪影,Ⅱ组81.82%(9/11)受检者有较明显的运动伪影;Ⅲ组14.29%(1/7)受检者有轻微线状运动伪影.经χ2检验,Ⅰ组、Ⅲ组分别与Ⅱ组比较,差异均有统计学意义(χ2=21.645、7.901,均P＜0.05);Ⅰ组与Ⅲ组比较,差异无统计学意义(χ2=0.031,P＞0.05).在电磁干扰状态下,移动CT数据采集及信息传输正常,3组辐射剂量CTDIvol均为36.27 mGy.结论 16排移动CT在救护车行驶及电磁干扰状态下扫描成像稳定安全,数据采集及信息传输正常.

目的 探讨国产16排移动CT在直升机运载条件下进行头部扫描成像的可行性.方法 选取空军某部服役的健康官兵88人,随机分为飞行组与对照组.飞行组为直升机在空中飞行状态下进行头部扫描,对照组为直升机在着陆状态下进行头部扫描.分析对比2组扫描成像质量、运动伪影、数据采集及信息传输情况.结果 骨窗成像:2组受检者颅骨、眼眶、鼻蝶窦等成像清晰;脑组织窗成像:2组受检者均可清晰显示眼球、视神经、脑干、脑皮质及脑白质等结构,但在颅底部分层面存在运动伪影,其中飞行组88.89％的受检者有较明显的运动伪影,而对照组26.58％的受检者有较轻微的线状运动伪影,2组的运动伪影比较差异有统计学意义(χ2=14.196,P=0.001).飞行状态下,移动CT数据采集及信息传输正常,2组辐射剂量CTDIvol均为36.27 mGy.结论 16排移动CT在飞行状态下扫描成像稳定,数据采集及信息传输正常.

目的 探讨依帕司他联合黄连素治疗糖尿病足的效果.方法 选取2015年6月～2016年6月本院收治的62例糖尿病足患者,随机分为观察组与对照组,各31例.两组均在常规治疗的基础上予以依帕司他治疗,观察组联用黄连素治疗,比较两组的疗效及治疗前后的踝肱血压指数(ABPI).结果 观察组的总有效率为100.0％,显著高于对照组的87.1％(P＜0.05).两组治疗前的ABPI值比较,差异无统计学意义(P＞o.05);两组治疗后的ABPI值显著高于治疗前,且观察组治疗后的ABPI值显著高于对照组(P＜0.05).结论 采用依帕司他联合黄连素治疗糖尿病足可以明显提高糖尿病足的临床治愈率,值得临床推广应用.

目的:观察左旋多巴/卡比多巴联合恩他卡朋(levodopa/carbidopa combined with entacapone,LC+E)治疗帕金森病(Parkinson's disease,PD)的临床效果.方法:选择我院2013年1月～2014年6月收治的112例PD患者,随机分为两组.其中对照组52例采用左旋多巴/卡比多巴(LC)治疗,观察组60例采用左旋多巴/卡比多巴联合恩他卡朋(LC+E)治疗.观察并比较两组治疗前后帕金森病评分量表(Unified Parkinson's Disease Rating Scale,UPDRS)的评分变化情况.结果:与治疗前比较,治疗后两组UP-DRS-Ⅱ日常生活能力评分,UPDRS-Ⅲ运动能力评分显著下降,而UPDRS-Ⅵ SCHWAB&ENGLAND日常活动能力评分显著上升,差异有统计学意义(P＜0.05);观察组各项变化情况比对照组明显,差异有统计学意义(P＜0.05).两组UPDRS-Ⅰ精神、行为、情绪和Hoehn与Yahr分级均无显著改善,差异无统计学意义(P＞0.05).结论:左旋多巴/卡比多巴联合恩他卡朋可明显缓解PD症状,疗效优于左旋多巴/卡比多巴治疗,且安全性高,值得临床推广.

Purpose: Based on rapid modeling 1 year after intramedullary nailing, personalized finite element modeling analysis was performed to predict whether the broken ends of fractured bones would break again after nail dislodgement. Methods: A total of 10 male volunteers with femur fractures who had undergone intramedullary nailing were selected 1 year after fixation and were divided into healing ([Formula: see text][Formula: see text]5) and non-healing ([Formula: see text][Formula: see text]5) groups based on X-ray analysis. We modeled each femoral fracture and performed finite element analyses after the intramedullary nail was dislodged. Static loads and constraints were applied to each model to simulate a person standing on one leg. Results: In the healing group, the von Mises stress concentrations and stress concentration point distribution were located outside the bone healing area, indicating that the stress was not concentrated at the fracture site. In the non-healing group, the maximum von Mises stress for various materials was located in the broken ends of the fractured bone, indicating that the stress was concentrated at the fracture site. Conclusion: Personalized modeling can be used to analyze bone healing before removal of a fixator to predict the stability of the fractured bone after fixator removal and to rapidly decide whether slow walking could refracture the broken ends.

Objective To investigate the cognition and attitude of nursing students for violence in workplace.Methods The status of cognition and attitudeof 152 nursing students for violence in workplace from three Hospitals in Beijing city were investigated by questionnaire.Results Among 152 nursing students, 38.2%of them had never heard of violence in workplace, 88. 4% of them thought that the job training should include the prevention strategies of violence in workplace, and 95.4% of them wanted to take part in. Nursing students thought the main strategies to prevent or reduce violencein workplace were legislation related to violence in workplace ( 96. 0%) , correct media guidance ( 90. 1%) , improve the skill of communication, strengthen ability of dealing with violence in workplace ( 88. 8%) . Conclusions Nursing schools and hospitals should positively constructthe prevention strategies for violence workplace and provide training for nursing students,so as to improve their cognition degree and skills, and prevent or reduce the incidence of violence in workplace.

近年来医患冲突不断发生,一系列由伦理道德而引发的医疗纠纷事件反映了我国医院管理存在的问题.患者及家属的观念偏移、医患双方信息不对等、医务人员态度不佳以及医疗资源分配不均等问题均是医患冲突的影响因素.我们通过分析患者的道德权利在医患关系中重要地位,认为医务人员应当树立“以人为本”的服务理念,重视患者及家属的社会心理需求,促进医学道德的发展,构建和谐的医患关系.

随着我国法治社会的发展及医疗体制的改革,医疗风险成为军队医院管理面临的难题和挑战.目前,我国现有的医疗法规不够完善,医务人员与患者的医疗风险防范意识不足,社会舆论导向性偏移等问题制约着我国医疗系统的发展.作为医疗卫生系事业的重要力量,军队医院要加强医疗风险管理,制定风险评估方法,完善风险管理体系以及加强风险教育,进一步提高医疗服务质量,从而有利维护军队医院在群众心中的信誉和形象.

心内科医疗纠纷调查与分析的研究，目前国内公开发表的较少，本文拟结合国内部分文献报道及某三级医院近10年的心内科纠纷统计数据对纠纷成因及对策综合阐述，供心内科医护人员工作中参考。

目的:探讨溃疡性结肠炎患者外周血和肠组织中卵泡抑素样蛋白1 (FSTL1)的表达及其临床意义.方法:选取2013年3月-2014年3月我院收治的溃疡性结肠炎患者为研究组(n=60),另选取病理和肠镜均正常者为对照组(n=60).采用酶联免疫吸附试验(ELISA)法检测两组患者外周血中FSTL1水平,采用免疫组织化学染色法检测两组肠粘膜组织中的FSTL1水平,应用Pearson相关性分析来分析溃疡性结肠炎活动指数(DAI)评分和FSTI1水平的相关性.结果:研究组血浆FSTL1高于对照组,差异具有统计学意义(t=11.063,P=0.025);研究组肠粘膜组织中FSTL1阳性表达率高于对照组,差异具有统计学意义(x2=12.987,P=0.019);研究组DAI评分和FSTI1水平呈正相关关系(r=0.719,P=0.023).结论:溃疡性结肠炎患者FSTL1表达水平升高,并且和疾病的活动性呈正相关关系.

Objective To investigate the clinical value of monostratified spiral CT three-dimensional reconstruc-tion in treatment of traumatic fractures during large-scale military exercises. Methods Images of 96 patients with osteal arthrotraumas undergoing DR (direct radiography) plain film, monostratified spiral CT scanning and three-dimensional reconstruction during military training and exercises from May to September 2014, were retrospectively analyzed. Results Spiral CT and 3D reconstruction images of the 96 patients showed clear fractures. Among the 96 patients, 87 patients were diagnosed as having fracture by DR plain films, and the accuracy rate was 90. 6%. Conclusion The monostratified spiral CT three-dimensional reconstruction in treatment of officers and soldiers with traumatic fractures during large-scale military exercises may show lesions rapidly, accurately and comprehensively, and play an very important role in diagnosis of small fractures of bone joints.

Objective To explore the stress distributions on a new assembly of locking compression plate (NALCP) in 3 schemes of sliding plate by finite element analysis (FEA) in the treatment of comminuted femoral fracture.Methods A male volunteer received CT scanning with a slice thickness of 0.625 mm.The CT data were converted to FEA models of comminuted femoral fracture by software Mimics 10.0 and Geomagic Studio 12.0.The femoral fracture was fixated by NALCP in 3 schemes of sliding plate respectively.The sliding plate contacted the main plate by a mini arc plane in scheme A,by an inside groove in scheme B,and by a middle groove in scheme C.Loads were applied on NALCP in the 3 schemes when a person slowly walking by one leg and torsion were simulated.The stress distributions on NALCP and the femur were analyzed in the 3 schemes.Results Under the slowly walking and torsion loads,the 3 schemes led to similar change tendency in the stress distribution.The stress centered around the fracture ends.The maximum stress was situated at the lateral border of NO.5 countersink of the plate.The maximum stress of the main plate was the smallest in scheme A(529.20 MPa & 617.20 MPa).The maximum stress of the sliding plate was the smallest in scheme C (372.10 MPa & 814.70 MPa) and the second in scheme A (938.80 MPa & 1,059.00 MPa).The maximum stress and the maximum displacement of bone blocks were the smallest in scheme A (28.68 MPa & 2.411 mm under slowly walking load;34.52 MPa & 3.209 mm under torsion load).Conclusions Scheme A of NALCP in which the sliding plate contacts the main plate by a mini arc plane may provide adequate mechanical stability for comminuted femoral fracture and reduce stress concentration on plates,promoting fixation and thus bone union.

目的:探讨不同严重程度溃疡性结肠炎患者血清TNF-α、IL-6及IL-8的表达及意义.方法:选择2011年1月～2014年7月我院收治的溃疡性结肠炎患者47例,根据严重程度将患者分为轻度组、中度组和重度组.另选取同期在我院接受健康体检的志愿者80例作为对照组.采用酶联免疫吸附试验(ELISA)检测各组患者血清TNF-α、IL-6及IL-8的水平.结果:溃疡性结肠炎患者血清TNF-α、IL-6及IL-8水平高于对照组,差异有统计学意义(P＜0.05);不同严重程度溃疡性结肠炎患者的TNF-α、IL-6及IL-8水平呈显著差异(P＜0.05).结论:检测溃疡性结肠炎患者血清TNF-α、IL-6及IL-8的水平变化有利于预测病情进展.

目的:评价早期肠内营养联合谷氨酰胺对老年重症急性胰腺炎(SAP)营养状况的影响效果.方法:将我院收治的106例老年SAP患者随机分为观察组与对照组.观察组给予早期肠内营养联合谷氨酰胺营养支持,对照组给予完全胃肠外营养支持.观察并比较两组患者治疗前后的血淀粉酶(AMY)、尿淀粉酶(UAMY)、APACHE-Ⅱ评分、Ranson评分、血清白蛋白(ALB)、血清前白蛋白(PA)、转铁蛋白(TRF)及体重的变化情况;比较两组患者住院天数及并发症的发生率.结果:与治疗前比较,两组患者治疗后AMY、UAMY、APACHE-Ⅱ评分及Ranson评分均显著下降,且观察组低于对照组,差异具有统计学意义(P＜0.05);与治疗前比较,两组患者治疗后ALB、PA、TRF及体重均显著提高,且观察组高于对照组,差异具有统计学意义(P＜0.05);与对照组比较,观察组住院时间短,并发症发生率低,差异具有统计学意义(P＜0.05).结论:早期肠内营养联合谷氨酰胺营养支持干预较完全胃肠外营养在治疗老年SAP中能有效缓解机体高分解代谢,明显改善患者营养状况,减少并发症的发生率.

手术是一种应激源，接受肝胆外科手术的患者在术后往往会为机体受到伤害性刺激而引起不良的身心反应，而这会对手术预后造成十分不利的影响，并且可能会降低患者术后生活满意度。音乐是一种强有力的感觉刺激形式和多重感觉体验，不同的音乐可以使人的生理和心理产生不同的反应［1］。多项研究发现，音乐通过听觉系统作用于大脑皮质下的非特殊反射系统和脑干网状结构，进而协调大脑皮质各部分功能间的关系，促进身心健康。相关研究发现，体感音乐疗法具有缓解躯体疾病引起的焦虑、抑郁以及疼痛等功效。近年来，我们对结石性胆囊炎患者术后采用体感音乐疗法治疗，患者术后生活满意度提高。现将结果报告如下。

目的 通过收集整理某特种作战部队往年驻训期间训练伤统计资料,分析训练伤影响因素,针对性地制定健康管理干预措施,并尝试性地指导特种部队各项训练,以期提高特种部队的训练水平,科学合理地减少卫生经费的开支.方法 整理某特种部队2013年野外驻训期间训练伤资料,进行统计分析、归纳总结,针对训练伤发生原因制定健康管理干预措施,将干预措施应用到该特种部队2014年野外驻训中,统计驻训期间训练伤发生情况,结果与2013年比较.结果 经过健康管理干预措施,2014年该部队军事训练伤发病率明显降低.结论 通过针对性的健康管理干预措施指导特种部队军事训练,能明显降低军事训练伤发病率.期望在不断摸索中制定成型的健康管理模式,应用到军事训练中,节约医疗资源,减少卫生经费的开支,有效巩固和提升部队战斗力.