空心针治疗股骨颈骨折的体会

目的 探索空心针治疗股骨颈骨折的效果.方法 早期闭合复位空心钉内固定术加皮牵引术治疗股骨颈骨折.结果 术后无一例发生血管和神经损伤等并发症,全部骨折均骨性愈合.结论 空心针治疗股骨颈骨折对促进骨折的愈合,降低股骨头缺血坏死发生率起到重要作用.     

TGF-β及其受体对胚胎着床的影响

TGF—β（transforming growth factor—β,TGF—β）是一类在结构上相对保守的生长因子,是细胞增殖、分化、细胞外基质合成和细胞凋亡的主要调节因子之一。近年来也发现,该家族成员的部分因子如TGF—β、骨形态形成蛋白（bone morphogeneticp rotein,BMP）／生长分化因子（growth and differentiation factor,GDF）、激活素／抑制素（Activin／Inhibin）也参与胚胎着床过程,且这些生长因子的表达表现出时空特异性。     

企业实施逆向物流的关键因素分析

本文借助"鱼刺图"对企业成功实施逆向物流的关键因素展开分析,在分析的基础上提出了成功实施逆向物流的概率模型,该理论模型为今后研究逆向物流成功实施提供了理论框架。     

手术在治疗跟骨关节内骨折28例的临床效果

目的探讨手术治疗根骨关节内骨折的临床疗效。方法本选取2009年12月～2011年12月我院收治的跟骨关节内骨折患者28例的临床资料。按其来院顺序,将其随即分为两组,切开复位内固定组(A组)和改良式复合外固定支架固定组(B组),每组患者均为14例。比较两组的临床疗效。结果 A组治疗在SandersⅡ型上,其优良率好于B组,且差异具有统计学意义(x2=8.45,P<0.05)。两组在SandersⅢ型-Ⅳ型的治疗上,B组好于A组,差异具有显著统计学意义(x2=14.36,P<0.01)。结论切开复位内固定和改良式复合外固定支架固定治疗根骨关节内骨折临床疗效均较好,且操作简单,并发症少,值得在临床中广泛应用。     

Injuries,inequalities and health in Europe

Injuries account for a significant burden of mortality, morbidity, disability and health care costs. They differentially affect age and sex groups and reveal massive inequalities in occurrence within and between countries in Europe. Within countries, the poor suffer most and have least ability to change their exposures to risk. Addressing inequalities in injury occurrence would play a valuable role in reducing the differential burden of ill-health between rich and poor. Despite the evidence for many effective injury-related interventions, limited attention has been devoted to addressing injuries as a public health priority. This paper questions why attention has been limited to date and suggests policy action to support injuries being addressed as a mainstream concern by national and international health policy-makers. The paper briefly highlights the public health burden of injuries and violence; illustrates the range of inequalities that characterise their occurrence; highlights the scope for public health action and considers the extent to which policies that reduce the overall burden of injuries may also reduce inequalities in their occurrence; and finally examines why there has been a limited policy response to date and suggests ways of advancing the agenda.     

Reoperations in intramedullary fixation of pertrochanteric hip fractures

Objective: This study evaluated the frequency of reoperation within 1 year of initial intramedullary fixation for patients with pertrochanteric hip fracture and compared 1-year healthcare resource utilization and cost burden for patients with and without reoperation.

Methods: This is a retrospective evaluation of medical claims from the US Centers for Medicare and Medicaid Standard Analytic File. Patients aged ≥65?years who underwent fixation with an intramedullary implant for a pertrochanteric fracture between 2013 and 2015 were included. Healthcare resources that were evaluated included skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), readmissions, and outpatient hospital visits. All-cause payments for these services comprised overall cost burden. Generalized Linear Models were used to evaluate healthcare resources and cost burden over 1-year post-surgery and to adjust for confounding between patients with and without a reoperation.

Results: A total of 6,423 Medicare patients were included in the analysis. Mean (SD) age was 82.4 (7.8) years, 76.0% were female, and 93.3% were white. A second hip surgery within 1 year after the index fixation procedure was performed in 414 patients (6.4%): 121 (29.2%) contralateral, 115 (27.8%) ipsilateral, and 178 (43.0%) without specified laterality. After adjusting for confounding factors, Medicare patients with ipsilateral reoperations had statistically significantly higher readmissions (100% vs 32.5%, p?p?=?0.018), admissions to a SNF (88.5% vs 80.4%, p?=?0.024), and admissions to an IRF (38.8% vs 22.0%, p?p?Conclusions: Patients who require a second hip surgery after initial fixation with an intramedullary implant for pertrochanteric hip fractures have significantly higher 1-year healthcare resource utilization and 63.5% higher costs than patients without reoperation.     

Cost of fractures commonly associated with osteoporosis in a managed-care population

Objective: To examine direct costs of hip, vertebral, and non-hip non-vertebral (NHNV) fractures, and to estimate the rate of osteoporosis (OA) diagnosis and treatment in the fracture population.

Methods: Subjects ≥ 45 years with a new hip, vertebral, or NHNV fragility (closed) fracture between June 30, 2002 and June 30, 2006 were studied retrospectively. All-cause and fracture-specific medical costs were calculated from medical claims in the 12-month baseline and follow-up periods. Total healthcare costs included pharmacy and medical costs. Diagnosis for OA and OA treatment were identified in both the baseline and follow-up period from diagnosis codes on medical claims for OA, and from pharmacy claims for treatment. Analyses were performed separately for commercial (COM) and Medicare Advantage (MA) populations and stratified by fracture type. Generalized linear models were estimated for total follow-up healthcare cost.

Results: The study sample included 36,521 COM and 10,160 MA subjects. Hip fracture subjects had the highest follow-up medical costs in unadjusted and adjusted analyses (COM: mean $35,898; median $22,945; MA: mean $32,919; median $26,047). Follow-up costs were much higher than baseline costs. Fracture-related costs accounted for a large proportion of follow-up medical costs. Although rates of osteoporosis diagnosis and treatment increased from baseline to follow-up, the majority of both COM and MA subjects had no evidence of osteoporosis diagnosis or treatment in either period.

Conclusions: Despite limitations of this study, including conventional generalizability issues, and sensitivity and specificity of claims-based diagnoses, results are consistent with other research and provide compelling results of substantial cost burden of fractures related to osteoporosis. Low rates of osteoporosis diagnosis and treatment among patients with costly fragility fractures underscore the opportunity for managed care organizations to initiate comprehensive disease management programs in osteoporosis.     

年股骨颈骨折骨牵引术后的护理体会

总结了30年老年股骨颈骨折单纯骨牵引治疗的临床护理体会，探讨了老年股骨颈骨折患者的异常心态及针对性护理方法，阐述了治疗阶段配合医生的临床护理要点及康复期的护理指导。     

数字减影/血管造影在骨盆肿瘤诊断及治疗中的应用研究

文章选取97例骨盆肿瘤行介入治疗，治疗前均行髂内动脉、髂外动脉造影，研究了血管造影在骨盆肿瘤诊疗上的应用。结果显示：①提示造影中恶性骨盆肿瘤的染色程度大于良性肿瘤。②造影中染色明显的肿瘤往往术中出血较多（〉3000mL），而无或轻度染色的肿瘤出血比较少。结论：骨盆肿瘤血管造影可显示肿瘤血供、侵犯范围和程度，有助于良恶性的判断，为随后肿瘤栓塞、灌注化疗、手术切除及术后疗效评价等提供客观依据，对骨盆肿瘤的临床诊断和治疗具有重要的指导意义。     

畜禽骨的综合利用研究现状与发展趋势

我国畜禽骨骼资源丰富,畜禽骨中含有优质的蛋白质、比例合理的脂肪酸、丰富的矿物质及多种生物活性物质,故深度开发和利用畜禽骨资源对提高经济效益和社会效益有着重要的现实意义。本文介绍了畜禽骨的资源概况、骨的组成和营养价值、国内外的应用现状,并展望了我国畜禽骨高值化开发应用的前景,以期为畜禽骨资源的深度开发提供参考。