全髋关节表面置换进展及若干问题的思考

全髋关节表面置换术与传统的全髋关节置换术相比有众多优点,然而随着研究的深入,全髋关节表面置换的缺点不断暴露,其中牵涉到很多矛盾的思想观点,如骨水泥在假体固定中的应用与否,髋臼臼杯变形与臼杯厚度、植入技术的复杂关系等.分析存在的矛盾且深入探索,从而发现解决矛盾的办法.     

老年糖尿病患者人工髋关节置换术的围手术期处理体会

探讨老年糖尿病患者人工髋关节置换术围手术期的治疗方法。对2000年1月~2006年3月54例糖尿病患者行人工髋关节置换术进行术后随访,利用临床关节功能及放射学检查进行分析。54例手术患者血糖控制满意且顺利度过围手术期。按Harris评分标准,术后髋关节功能优良率分别为人工股骨头置换组74%(14/19),人工全髋关节置换组91%(32/35)。未发现感染及假体松动现象等并发症。老年糖尿病患者如果有髋关节置换手术指征,没有严重的并发疾病,在重视围手术期处理的情况下,可以行人工髋关节置换术,且疗效肯定。     

南京市某三甲医院人工全髋关节置换术住院费用分析

了解该院人工全髋关节置换术开展情况,明确其住院费用的结构和影响住院费用的主要因素,为合理控制住院费用提供参考依据。本研究收集2012年~2013年人工全髋关节置换术患者的住院病历信息,分析住院费用的变化趋势和结构比例,并分析其主要影响因素。结果显示该院住院费用总体呈上升趋势,且结构不尽合理,人工假体的使用是影响住院费用的主要因素。应该控制人工假体价格虚高,合理使用不同类型的人工假体,积极探索按病种付费模式,从而控制住院费用增长。     

人工髋关节置换术后翻修治疗体会

近年来,随着我国开展人工关节置换术,临床取得了较好的效果,为老年股骨颈骨折、股骨头无菌性坏死、成人先天性髋关节脱位等患者解除痛苦。随着人工髋关节置换术的广泛开展,因手术人员的技术原因,以及假体的长期使用,术后并发症也随之增多,翻修术也成为必然。针对我院30例人工髋关节术后翻修适应证选择及假体选择。谈一些治疗体会。     

人工全髋关节置换术肢体长度调定方法的前瞻性研究

探讨人工全髋关节置换术预防双下肢不等长的方法。综合采用术前X线片模板测量股骨头运动中心指导选择假体颈长;术中根据股骨头运动中心是否与大粗隆尖端平齐、侧卧位测量双髌骨下缘是否在同一平面、牵拉患肢根据软组织张力调整患肢长度等方法来确定术中股骨颈假体的长度。本组44例患者分为2组：A组术前肢体等长（21例）;B组术前肢体不等...     

腰-硬联合麻醉在高海拔高龄患者髋关节置换术中的应用

探讨腰-硬联合麻醉及全身麻醉用于高海拔高龄低氧患者行人工髋关节置换的临床优势。分析2010年1月～2013年11月来我院进行人工髋关节置换术的高龄（年龄＞69岁）低氧患者86例,其中全麻31例,腰-硬联合麻醉55例,记录麻醉后5min、15min、30min及术毕血压、心率,术中低血压发生率,术后转ICU比例等指标。与全麻相比,腰-硬联合麻醉组血流动力学稳定、术中低血压发生率降低（P＜0．05）、入住ICU几率显著降低（P＜0．05）。在高海拔高龄低氧患者行人工髋关节置换术中采用腰-硬联合麻醉可以使患者麻醉效果突出,血流动力学平稳,安全有效,比全麻更有临床应用优势。     

髋关节置换术治疗股骨颈骨折围手术期应用整体护理途径与常规护理的对照研究

在利用人工髋关节置换术治疗股骨颈骨折的围手术期,应用整体护理途径与常规护理模式进行对照研究,发现整体护理途径能显著减少住院、手术等待时间,降低卧床并发症。在股骨颈骨折的围手术期应用整体护理途径这一治疗策略体现了哲学之事物的整体辩证观、发展观、因果论。     

“生产力和生产关系的辩证法”的再思考

"生产力决定生产关系,生产关系反作用于生产力"是人们耳熟能详的历史唯物主义的基本原理之一。问题是,人们长期以来对于这一矛盾运动本身的内在作用机制重视不够,大都停留在抽象认识和表面讨论中,较少有人去做深入的分析和研究。一般而言,我们对于生产力与生产关系的研究往往局限于     

蒜臼里的旧光阴

正蒜臼是用来制作蒜泥之用,在北方,蒜臼可谓居家必备的生活器具。对蒜臼的记忆最早是在童年,农村生活困苦,没什么新鲜蔬菜可吃,田野里采摘来的灰灰菜、马齿苋、荠菜、婆婆丁,抖掉泥巴,清洗择干净,在热水里焯一焯,捞起后,用蒜臼砸好的蒜泥拌匀,便成了下饭的美味。或到逢年过节吃饺子时,用大蒜来提味,蒜臼才派上用场。在那时的农村,家家户户都少不了蒜臼子。蒜臼子,在我们老家,俗称"敲蒜窝",用来制作蒜泥之用,     

成人股骨头坏死的治疗进展

股骨头坏死（ONFH）是一种进展性和致残性疾病,保存自身股骨头是临床治疗所追求的最理想目标,早中期的治疗方案主要采用非手术疗法和保髋的姑息性手术,目前为止还没有一种治疗方法能达到理想的治疗效果。近年来,骨髓间充质于细胞（MSCs）移植治疗ONFH是目前研究热点之一,有望成为一种有效的治疗方法,晚期行人工髋关节置换术是唯一的和最佳的选择。因此,早期诊断,采用综合性治疗方案保全自身髋关节是治疗本病的主要方向。     

Implantologie orale et responsabilité : à propos du choix du dispositif implantaire

Dental implants are medical devices designed to create stable, strong, non-iatrogenic and durable anchors in the maxilla or mandible to which a removable or fixed dental prothesis fits, to replace one or more missing teeth. From the 1970s to 2000, these medical devices experienced changes in shape and materials before a consensus was reached on a type of implant that responded to the standard of care. This raises the question of the medical liability of healthcare professionals who use different implant systems in their practices. The present article proposes to highlight the choice of the dental implant by dental practitioner, its design and the materials used, on the field of the medical liability, through a retrospective study of judicial decisions in France. The “Brånemark-type” endosseous cylindrical-conical screw implant is considered as standard of care in France. The dental surgeon has the possibility to use other types of dental implants when the clinical situation strictly contraindicates the use of cylindrical-conical screw implants. In case of litigation, he must be able to justify his choices.     

口腔种植诊疗实践中的思考

口腔种植现已经出现在人们的视线里,它具有一定的特殊性和优越性,能够解决常规修复手段不能解决的问题,然而在临床应用中,需要考虑和处理的问题往往很复杂。因此有必要在临床实践中运用辩证思维及循证医学的思想,在诊断中全面考虑、周密计划;在治疗中处理问题、解决难点;在随访中发现问题,促进发展。     

The mathematical abilities of children with cochlear implants

Research has shown that cochlear implants give rise to improvements in speech recognition and production in children with profound hearing loss but very few studies have explored mathematical abilities in these children. The current study compared the mathematical abilities of 24 children with cochlear implants (mean age 10 years 1 month) to a control group of 22 hearing children (mean age 9 years 8 months). The math questions were categorized into questions that tapped into arithmetic or geometrical reasoning. It was predicted that the cochlear implant group would perform below the hearing group on the arithmetic questions but not the geometrical reasoning questions. Unexpectedly, the results showed that the cochlear implant group performed significantly below the hearing group on both types of math questions, but that this difference was mediated by language skill as assessed by vocabulary knowledge. The clinical implications of these results and possible future research results are considered.     

老龄患者人工关节置换术时骨水泥反应综合征的危害及其应对策略

人工关节置换术在老龄化社会中的客观需求性愈来愈突出,而老龄患者在人工关节置换术时发生的骨水泥反应综合征是一个不容忽视的严峻问题。笔者指出了老龄患者人工关节置换术时骨水泥反应综合征的严重危害性,剖析了这种并发症的可能原因,并且对它的有效预防措施和急救处理策略进行了深刻的思考。     

大转子延长截骨在THR术后感染一期翻修中的临床应用

评价大转子延长截骨并行单纯钢丝捆扎在人工髋关节置换（THR）术后感染一期翻修中的作用及对翻修假体的影响.选取2010年10月~2013年10月期间30例髋关节置换术后假体感染性松动并行一期翻修术的患者,随访时间（34.8＆#177;13.2）月,对患者手术时间、截骨长度和愈合时间、术前术后Harris评分及术后感染控制情况进行统计.30例患者髋关节术后评分明显高于术前,手术时间为（132.4＆#177;23.6）min,经大转子截骨长度为（11.4＆#177;2.6）cm,截骨愈合时间（3.8＆#177;1.3）个月.术后感染未见复发.因此THR术后感染的一期翻修术中应用大转子延长截骨方法能缩短手术时间,髋关节功能较术前明显改善.     

Emotional Distress Associated with Surgical Treatment and its Relationship with Coping Profiles Among Chronically ill Older Patients

The study determines the patterns of coping styles among older patients with hip osteoarthritis and assesses the derived profiles in terms of perceived stress and anxiety before and after arthroplasty. Sixty-one hospital patients (mean age 70.3 years) were analysed one day before arthroplasty and three months after. The participants were assessed with the Brief-COPE (coping style), PSS-10 (perceived stress) and STAI (anxiety) psychometric tests. Four coping patterns were yielded using data clustering: rational, enterprising (resourceful), potentially maladaptive and flexible. Repeated measures ANOVA indicated a main effect within subjects but did not indicate that decreases of stress and anxiety varied differently between groups. Cluster 1 (a coping profile characterised by high helplessness, low active coping, high avoidance) reported significantly greater stress and anxiety than all other groups before and after hip replacement, while clusters 2 (flexible), 3 (resourceful) and 4 (rational) were characterised by similar levels of anxiety and stress. Older patients with osteoarthritis might differ in terms of emotional response to surgical treatment. Screening for coping styles at admission to hospital may indicate more vulnerable individuals.     

Monkey see, monkey plan, monkey do: the end-state comfort effect in cotton-top tamarins (Saguinus oedipus)

The way human adults grasp objects is typically influenced by their knowledge of what they intend to do with the objects. This influence is reflected in the end-state comfort effect: Actors adopt initially uncomfortable postures to accommodate later task demands. Although many experiments have demonstrated this effect, to the best of our knowledge its phylogenetic roots have not been investigated. In two experiments, we tested whether 9 cotton-top tamarin monkeys would show the end-state comfort effect. We did so by presenting the monkeys with a small cup containing a marshmallow. The cup was suspended in different orientations. The monkeys inhibited their natural grasping tendencies and adopted unusual grasping postures to accommodate subsequent task requirements, thus demonstrating the end-state comfort effect. This outcome provides evidence for more sophisticated motor planning than has previously been ascribed to this and related species.