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旋髂深血管蒂骨瓣移植治療青壯年股骨頸骨折

目的 總結旋髂深血管蒂骨瓣移植治療青壯年股骨頸骨折的手術方法及臨床療效。 方法 2003 年1 月－ 2006 年12 月，收治28 例青壯年股骨頸骨折患者。男21 例，女7 例；年齡17 ～ 48 歲，平均34 歲。致傷原因：車禍傷19 例，高處墜落傷9 例。新鮮骨折20 例，陳舊性骨折8 例。傷后至手術時間1 ～ 42 d。根據Garden 骨折分型：Ⅲ型12 例，Ⅳ型16 例。術前Harris 髖關節功能評分為（14.6 ± 6.2）分。采用手術切開復位、空心加壓螺釘固定后，取大小為4.0 cm × 1.5 cm × 1.5 cm 的旋髂深血管蒂骨瓣植骨治療。 結果 28 例術后切口均Ⅰ期愈合，無感染等并發癥發生。患者術后均獲隨訪，隨訪時間12 ～ 48 個月，平均21 個月。27 例股骨頸骨折愈合，愈合時間3 ～ 5 個月，平均3.7 個月；1 例發生骨折不愈合。3 例術后2 年發生股骨頭壞死，行保守治療。術后Harris 髖關節功能評分為（89.3 ± 10.4）分，與術前比較差異有統計學意義（P lt; 0.05）。 結論 旋髂深血管蒂骨瓣移植治療青壯年股骨頸骨折可改善骨折端的血運，促進骨折愈合，降低股骨頭壞死的發生率。

Analysis of Standard Nursing Psogtam in Emergency Department

目的:討論規范急診科儀器設備的管理，提高護士搶救患者的質量和效率。方法:對監護室的急救儀器設備定點定位放置，規范管理；設計操作保養維修流程圖，規范護士的行為；加強培訓考核力度，使護士熟練掌握急救技能。結果:急救儀器設備地完好率、患者搶救的成功率、醫生對護士的滿意度均有所提高。結論:規范了急救設備的管理，有效的提高了護理質量，及時杜絕了護理隱患的發生。

急性視網膜壞死并發GATA2綜合征一例

Effect of warfarin on the risk of postoperative bleeding complications after tooth extractions: a meta-analysis

Objective To systematically review the effect of discontinuous warfarin on the risk of postoperative bleeding complications after tooth extractions. Methods PubMed, EMbase, The Cochrane Library (Issue 9, 2016), CNKI, VIP, WanFang Data, China Food and Drug Administration and the ADR supervision system of FDA were electronically searched to collect randomized controlled trials (RCTs) and cohort studies about the effect of discontinuous warfarin on risk of postoperative bleeding complications after tooth extractions in patients until September 30th, 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of 8 studies were included, involving 3 RCTs and 5 cohort studies. The results of meta-analysis showed that: there was no significant difference between the discontinuous or reduced warfarin group and the continuous warfarin group (RCTs: RR=0.86, 95%CI 0.49 to 1.51,P=0.60; cohort studies: RR=0.67, 95%CI 0.45 to 1.01,P=0.06). Conclusions Current evidence indicates that there is no statistically significant correlation between whether discontinuous warfarin and the risk of postoperative bleeding complications after tooth extractions. Due to the limited quantity and quality of included studies, the above conclusions are needed to be further verified by more high quality studies.

Causes and precautions of drug dispensing errors in hospital pharmacy

Objective To analyze the causes of drug dispensing errors and reduce the error rate through scientific precautions, and improve the quality of pharmaceutical service. Methods According to the PDCA cycle, existing problems were found in dispensing between January and June 2013, and the causes were analyzed. Then, from July 2013, strategies were developed to decrease the dispensing error rate. The variation trend of dispensing error rate from January 2013 to June 2017 were observed. Result The dispensing error rate decreased since the beginning of PDCA cycle, from 0.042‰ (the first quarter of 2013) to 0.003‰ (the second quarter of 2017). Conclusion The PDCA cycle is an effective intervention to detect the errors during drug delivery in inpatient pharmacy, which could improve the quality of pharmaceutical service and insure the patients’ safety.

創傷性室間隔缺損的診斷和治療

摘要 目的　總結3例創傷性室間隔缺損診斷和治療的經驗。　方法　1992年5月～1997年5月先后收治3例創傷性室間隔缺損，并施行了修補術。　結果　3例患者術后均恢復順利，無并發癥發生。　結論　在心臟開放傷中，應注意創傷性室間隔缺損的診斷，傷后8～12周是進行修補術的最好時機。

早期康復護理預防腰椎間盤突出癥術后神經根粘連

目的　總結防治腰椎間盤突出癥術后神經根粘連的有效方法。 方法　將2005年3月－2008年4月收治的腰椎間盤突出癥手術患者82例隨機分為早期康復組（A組，44例）和常規對照組（B組，38例），兩組患者一般資料比較差異無統計學意義（P＞0.05），有可比性。A組采用康復護理功能鍛煉，B組采用常規護理方法。療效采用日本骨科學會（JOA）下腰痛功能評定表評分，并計算功能改善率。 結果　術后2周，兩組各時間點JOA評分均較術前明顯提高，差異有統計學意義（P＜0.05）；兩組術前JOA評分比較差異無統計學意義（P＞0.05）；治療后各時間點A組評分均高于B組（P＜0.05）。治療后2周A、B組JOA改善率比較差異無統計學意義（P＞0.05）；治療后3、6、12、24個月A組改善率均高于B組（P＜0.01）。 結論　早期康復護理預防腰椎間盤突出癥術后粘連療效顯著、安全。

Spinal metastases and metastatic spinal cord compression: interpretation for National Institute for Health and Care Excellence (NICE) 2023 guideline

Spine is a common site of metastasis in patients with malignant tumors, and tumor metastasis to the spine can lead to pain, pathological fractures, and nerve compression. In order to optimize the diagnosis and management of patients with spinal metastases and metastatic spinal cord compression (MSCC), the National Institute for Health and Care Excellence (NICE) in the UK proposed the first diagnostic and treatment guidelines for patients with MSCC (or at risk of MSCC) in 2008. In recent years, with the rapid advancement of spinal surgery and radiotherapy technology, the standardized process of MSCC diagnosis and treatment urgently needs to be updated. In 2023, NICE launched new guidelines for spinal metastases and MSCC. Based on a thorough study of the guidelines, this article discusses and interprets pain management, corticosteroid treatment, application of bisphosphonates and denosumab, tools for assessing spinal stability and prognosis, radiation therapy, surgical timing and approach, etc., providing reference for clinical diagnosis and treatment in China.

Research progress on the correlation between parameters related to blood routine examination and acute cerebral infarction

Acute cerebral infarction is characterized by high incidence rate, high recurrence rate, high disability rate and multiple complications. Early evaluation and treatment of acute cerebral infarction is particularly important to improve the survival rate and prognosis of patients. As an easily available clinical laboratory indicator, blood routine test can reflect the pathological changes in the body to a certain extent. In recent years, many studies have shown that the indicators such as red cell volume distribution width, mean platelet volume, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in blood routine examination have important values in the onset, severity and prognosis of acute cerebral infarction. This article reviews the correlations of the above parameters and ratio parameters with acute cerebral infarction, in order to provide some reference and basis for clinical diagnosis, treatment and prognosis evaluation of acute cerebral infarction.

101例心臟粘液瘤的外科治療體會

目的總結101例心臟粘液瘤的診斷和治療經驗，以提高療效。方法回順性分析101例心臟粘液瘤患者的臨床資料，其中左心房粘液瘤94例，右心房粘液瘤6例，雙心房粘液瘤1例，均在體外循環下行粘液瘤摘除術；同期行二尖瓣成形術5例，二尖瓣機械瓣置換術1例，三尖瓣成形術32例，冠狀動脈旁路移植術1例，激光心肌打孔血運重建術1例。結果術后死亡1例，100例患者經治療痊愈出院。隨訪84例，隨訪率84％（84／100）；隨訪時間3個月～5年，復發1例。結論心臟粘液瘤術前超聲心動圖檢查診斷準確率高，一經確診應盡早手術；手術的關鍵是保持瘤體完整，將瘤體連同蒂部周圍部分組織一并切除。