Real-time updates of metrical data can not generally be realized in the commonly used methods for calculating the pulse wave of blood oxygen saturation. Based on the hardware platform of pulse wave signal from NJL5501R, and high linear correlation of the red laser and infrared light collected in pulse wave signal measurement, an approach to determine the value of the blood oxygen saturation is proposed in the present paper by establishing the linear regression model of the red laser and infrared light. The effect of the sampling number of pulse wave signal in calculation on the characteristic parameters of pulse wave is also analyzed. The experimental results showed that the approach could guarantee the measuring accuracy and realize the fast updates of blood oxygen saturation data. This paper provides an effective method for real-time and accurate monitoring of pulse blood oxygen saturation in human body.
ObjectiveTo explore the causes and management of the complications in diabetic foot treated with tibial transverse transport (TTT). MethodsBetween September 2015 and September 2019, 196 patients with diabetic foot were treated with TTT. There were 109 males and 87 females, with an average age of 67.6 years (range, 45-86 years). According to Wagner’s classification, there were 124 cases of grade 3, 62 cases of grade 4, and 10 cases of grade 5; the course of disease was 1-12 months, with an average of 2.6 months. All patients underwent the minimally invasive tibial osteotomy. The osteotomy site was the middle and lower tibia in 62 cases and the middle and upper tibia in 134 cases. The area of osteotomy was 20 cm2 in 83 cases and 7.5 cm2 in 113 cases. The osteotomy block was moved back and forth once in 92 cases and twice in 104 cases. The complications were recorded, including secondary fracture at tibial osteotomy, skin necrosis in osteotomy area, and pin tract infection. ResultsAmong 196 patients, 41 cases (20.9%) had complications. Nine cases (4.6%) had secondary fracture at tibial osteotomy, among which 6 cases (9.6%) of middle and lower segment osteotomies and 3 cases (2.2%) of middle and upper segment osteotomies. The incidence between the patients with different osteotomy sites was significant (χ2=5.354, P=0.021). The area of osteotomy was 20 cm2 in 5 cases (6.0%) and 7.5 cm2 in 4 cases (3.5%). There was no significant difference in the incidence between patients with different areas (χ2=0.457, P=0.499). Skin necrosis occurred in the osteotomy area in 12 cases (6.1%), all of which were moved back and forth once. There was a significant difference in the incidence between patients who were treated with transport once and twice (P=0.001). There were 18 cases (9.1%) with pin tract infection, including 12 cases (6.1%) with mild infection and 6 cases (3.0%) with severe infection. There was no significant difference in the incidence between the patients with mild and severe infections (P=0.107).ConclusionTTT is an effective method to treat diabetic foot, but there are complications such as secondary fracture at tibial osteotomy, skin necrosis in osteotomy area, and pin tract infection during transport. Preoperative evaluation of indication, standardization of osteotomy mode, size and position of osteotomy block, establishment of individualized removal plan, and strengthening of pin track nursing after operation can effectively reduce complications.
Objective To systematically search for evidence related to the prevention and management of kinesiophobia in patients undergoing total knee arthroplasty at home and abroad, evaluate and integrate the evidence, and to provide reference for clinical nursing practice. Methods Domestic and international evidence-based resource databases, including UpToDate, BMJ (British Medical Journal) Best Practice, National Institute for Health and Clinical Excellence guidelines network, JBI (Joanna Briggs Institute) evidence-based healthcare center database, Cochrane Library, Registered Nurses’ Association of Ontario website, China guidelines network, Web of Science, PubMed, SinoMed, China National Knowledge Infrastructure, and Wanfang were searched. Evidence related to the prevention and management of kinesiophobia after total knee arthroplasty was collected, and the search period was until June 30, 2023. The evidence extraction and integration were conducted on the literature that meets the requirements. Results A total of 10 papers were ultimately included, including 1 guideline, 1 expert consensus, 2 systematic evaluations, 4 randomized controlled studies, and 2 cohort studies. A total of 17 pieces of evidence were extracted from 5 aspects, including risk assessment, health education, intraoperative pain management, rehabilitation exercise, and patient participation. Conclusion The prevention and management of kinesiphobia after total knee arthroplasty include evidence from multiple aspects, which can provide evidence-based basis for orthopedic and rehabilitation medical staff to develop intervention plans for kinesiphobia and promote rapid recovery of patients with total knee arthroplasty.
目的 探討空心拉力螺釘聯合鋼絲張力帶治療髕骨骨折的臨床療效。 方法 2005年6月－2010年9月采用空心拉力螺釘聯合鋼絲張力帶治療髕骨骨折38例，男29例，女9例；年齡32～69歲，平均42.2歲。其中髕骨中份橫行骨折18例，斜行骨折15例，髕骨縱行骨折3例，髕骨下極骨折2例。骨折塊移位0.6～3.2 cm，平均1.7 cm。受傷至手術時間1～7 d，平均2.1 d。末次隨訪時評估雙側膝關節主觀感受、視覺模擬評分（VAS）、患側膝關節活動度（ROM）、Lysholm評分及影像學變化。 結果 患者隨訪13～54個月，平均19.5個月。康復期內未出現皮膚刺痛、滑囊炎、切口延期愈合或不愈合等臨床并發癥。末次隨訪時疼痛VAS評分（1.5 ± 0.9）分，患側膝ROM為健側的85.2%。術后2.1～3.2個月，平均2.8個月達到臨床骨性愈合。 患側Lysholm評分優27例、良8例、可1例、差2例，優良率92.1%；健側膝關節Lysholm評分優35例、良1例、可0例、差2例，兩側比較差異無統計學意義（P＞0.05）。 結論 空心拉力螺釘聯合鋼絲張力帶治療髕骨骨折可獲得較好臨床療效，且術后循序漸進的康復鍛煉是膝關節功能得到最大恢復的關鍵。
目的 比較克氏針張力帶與鎖骨鉤鋼板治療RockwoodⅢ型肩鎖關節脫位的臨床療效。 方法 1999年1月－2007年3月，收治肩鎖關節脫位患者29例，分別采用克氏針張力帶聯合喙鎖韌帶重建（克氏針組10例）和鎖骨鉤鋼板（鋼板組19例）治療。其中男18例，女11例；年齡19～50歲，平均38.2歲。患者均為新鮮RockwoodⅢ型肩鎖關節脫位，受傷至手術時間1～16 d，平均3 d。兩組患者性別、年齡、受傷至手術時間等一般資料比較差異無統計學意義（P＞0.05）。進行兩組患者術后臨床及影像學評估比較。 結果 25例患者（克氏針組10例，鋼板組15例）獲隨訪，隨訪時間2～12年，平均6年。術后克氏針組發生克氏針彎曲5例、斷裂1例；鋼板組切口淺表感染2例，經換藥后治愈，其余患者切口Ⅰ期愈合。兩組患者肩鎖關節均獲得良好功能，組間比較差異無統計學意義（P＞0.05）。影像學方面：與克氏針組相比，在患肢負重位時鋼板組喙鎖間隙間距增加了23%（P＜0.05），非負重位兩組間距差異無統計學意義（P＞0.05）。術后8～12周出現喙鎖韌帶鈣化，鋼板組12例、克氏針組2例（P＜0.05）。術后6個月出現肩鎖關節骨性關節炎，鋼板組2例、克氏針組1例（P＞0.05）。肩關節功能與影像學結果無相關性（r=0.096，P＞0.05）。 結論 克氏針張力帶聯合喙鎖韌帶重建和鎖骨鉤鋼板固定治療RockwoodⅢ型肩鎖關節脫位均可獲得良好的臨床功能。與克氏針張力帶相比，鎖骨鉤鋼板固定具有手術操作簡便、療效確切、并發癥少、能夠早期康復鍛煉等優點。
Objective To explore the clinical efficacy of external fixation combined with autogenous periosteal iliac bone for repairing cartilage injury of the talus. Methods The data of 18 patients with talus cartilage injury treated in Mianyang Central Hospital between January 2018 and January 2022 were retrospectively analyzed. All patients received autogenous periosteal iliac bone transplantation and external fixation brackets. The Visual Analogue Scale (VAS), joint range of motion, and the American Orthopedic Foot and Ankle Society (AOFAS) ankle posterior foot score were assessed before surgery and 6 months after surgery. The changes of cartilage damage of the talus on MRI before and after surgery were compared. The complications related to the operation were recorded. Results The patients included 5 males and 13 females, with an average age of (50.7±5.4) years. There were 6 cases injured on the left side and 12 cases injured on the right side. The Hepple’s classification was type Ⅲ in 8 cases and type Ⅳ in 10 cases. The average follow-up time was (17.6±8.2) months. The preoperative VAS score, ankle range of motion, and AOFAS score were 5.5±1.5, (48.0±10.5)°, and 54.9±11.1, respectively. Six months after surgery, the VAS score, ankle range of motion, and AOFAS score were 2.1±0.9, (64.8±7.8)°, and 82.6±8.7, respectively, and the differences from preoperative scores were all statistically significant (P<0.05). The preoperative MRI showed that the area of talus cartilage injury was (2.6±0.6) cm2, and the depth was (10.0±0.4) mm; the 1-year follow-up MRI showed that the area of talus cartilage injury was (0.6±0.2) cm2, and the depth was (5.5±0.3) mm, which statistically differed from those before surgery (P<0.05). By the last follow-up, no postoperative complications such as incision infection, bone graft fracture, and nonunion of the inner ankle were found. Conclusions Autogenous periosteal iliac bone graft can repair cartilage injury of the talus. External fixation stent provides early joint stability, avoiding uneven joint compression or joint impact.
【摘要】 目的 總結應用經皮微創鋼板固定（minimally invasive percutaneous plate osteosynthesis，MIPPO）技術治療2型糖尿病患者脛骨遠端骨折的臨床經驗及治療效果。 方法 2007年5月-2010年11月，采用MIPPO技術治療2型糖尿病合并脛骨遠端骨折15例。其中男9例，女6例；年齡38~70歲，平均60歲。左側脛骨遠端骨折 4例，右側 11例。單發骨折10例，多發骨折5例。根據 AO分型:A1型2例，A2型1例，A3型5例，B1型3例，B3型3例，C1型1例。傷后至手術時間為2~14 d。 結果 15例患者隨訪時間8~12個月，平均10個月。手術時間平均89 min，術中失血量平均285 mL。術后1年采用Johner-Wruhs方法評估療效:優4例，良5例，中3例，差3例；總體滿意率80%。X線片示13例患者骨折均獲骨性愈合，愈合時間4~8個月，平均6個月，無再發骨折。3例發生泌尿系統感染，1例發生呼吸系統感染，感染率26.7%。 結論 MIPPO技術治療2型糖尿病脛骨近端骨折具有對骨折周圍軟組織剝離少、符合生物學固定概念、內固定牢靠、切口較小等優點，降低了切開復位內固定術后并發癥的發生率。【Abstract】 Objective To summarize the clinical experiences and effects of minimally invasive percutaneous plate osteosynthesis (MIPPO) technique for type 2 diabetic patients with fractures of distal tibia. Methods From May 2007 to November 2010, 15 type 2 diabetic patients with distal tibia fractures including 9 males and 6 females were treated with minimally invasive percutaneous plate osteosynthesis. Their age ranged from 38 to 70 years old averaging at 60. Left distal tibia fracture occurred to 4 cases, and right distal tibia fracture occurred to 11 cases. Ten patients had single fracture, and 5 had multiple fractures. According to AO fracture classification, there were two cases of A1, one cases of A2, five cases of A3, three cases of B1 and B3 respectively, and two cases of C1. The time from the occurrence of fracture to operation was ranged from 2 to 14 days. Results The patients were followed up for 8 to 12 months with an average period of ten months. The average operation time was 89 minutes and perioperative blood loss was (285±38) mL. Johner-Wruhs method was used to evaluate the efficacy. Four cases were excellent, 5 were good, 3 were fair, and 3 were poor, with an overall satisfaction rate of 80%. X-ray showed that 13 patients were healed. The healing time was 4 to 8 months, averaging 6 months, and no further fractures occurred. There were 3 cases of urinary tract infection and 1 case of respiratory infection with an infection rate of 26.7%. Conclusion Minimally invasive percutaneous plate osteosynthesis technique for fractures of distal tibia in diabetic patients is a safe method with better mechanical stability, less intervention of blood supply, less soft tissue complications and smaller incisions.
ObjectiveTo evaluate the long-term effectiveness of vascularized fibula flap in radiocarpal joint reconstruction following excision of Campanacci grade Ⅲ giant cell tumor (GCT) of distal radius.MethodsBetween December 2010 and December 2014, 10 patients with Campanacci grade Ⅲ GCT of distal radius were treated with en bloc excision and inradiocarpal joint reconstruction using vascularized fibula flap. They were 6 males and 4 females, with an average age of 39.9 years (range, 22-65 years). The disease duration was 1.5-6.0 months (mean, 2.6 months). The length of distal radius defect was 6.0-12.5 cm (mean, 8.4 cm) after en bloc excision of GCT. Vascularized fibula flap with inferior lateral genicular vessels were performed in 6 patients and with inferior lateral genicular vessels and peroneal vessels in 4 cases.ResultsAll incisions healed by first intention. All patients were followed up 4.4-8.3 years (mean, 6.0 years). There was no tumor recurrence during follow-up. At last follow-up, the mean ranges of motion of wrist joint were 55.0° (range, 25-85°) in extension, 26.5° (range, 15-40°) in flexion, 12.0° (range, 5-25°) in radial deviation, 19.6° (range, 10-30°) in ulnar deviation, 50.5° (range, 5-90°) in pronation, and 66.5° (range, 20-90°) in supination. The mean grip strength of effected wrist was 75% (range, 60%-85%) of the healthy wrist. The mean Musculoskeletal Tumor Society (MSTS) score was 82.7% (range, 75%-90%). X-ray films showed that the fibula flap healed at 12-16 weeks after operation (mean, 14.1 weeks) and there were 9 cases of radiological complications.ConclusionFor Campanacci grade Ⅲ GCT of distal radius, application of the vascularized fibula flap in radiocarpal joint reconstruction after en bloc excision of GCT can obtain good wrist function.
Objective To analyze clinical characteristics and treatment experience of 143 tibetan victims of China Yushu earthquake, so as to provide reference for emergency preparation for earthquake disasters. Methods A retrospective study from April 16th to April 22th, 2010 was designed. A total of 143 injured Tibetans (74 men, 69 women) of the magnitude 7.1 Yushu earthquake were included in this study. Data from victims was collected retrospectively as follows: age, gender, cause of injury, place and time of rescue, chief complaint, primary diagnosis, onsite treatment, transfer, psychological crisis intervention and so on. Results The 143 tibetan victims contained 67 fracture cases (4 open fracture, 63 closed fracture), 5 joint dislocation cases and 3 neural injury cases. 62 victims with fracture were treated by Tibetan-Chinese therapy combined with external fixation, 5 victims were operated with emergency surgery, 6 victims refused to the surgical debridement and suture, and no dead case reported. All patients were given 3 to 11 psychological intervention treatments. As to the aspect of the wounded transferring, 48 cases among 54 supposed evacuating victims were transferred to Xinin hospitals, and the other six refused to be transferred and kept staying in the original place for treatment. Conclusion The clinical characteristics of the tibetan victims are outstanding. The medical rescue for disaster in ethnic region should be appropriate for features of disaster areas.Both the individualized remedy and early psychological intervention are regarded as the important measures for improving the general level of earthquake medical rescue in ethnic regions.
ObjectiveTo summarize the injury characteristics and therapeutic strategy of patients injured in " 8·8” Jiuzhaigou earthquake.MethodsThe clinical data of 48 patients injured in " 8·8” Jiuzhaigou earthquake who were admitted to Mianyang Central Hospital were analyzed retrospectively. There were 25 males and 23 females with an average age of 36 years (range, 5-87 years). The average interval from injury to admission was 30 hours (range, 3-53 hours). The patients from Sichuan province accounted for 45.8% (22 cases), from other province for 52.1% (25 cases), and from abroad for 2.1% (1 case). Patients were primarily hurted by collapsing houses and flying stones. Thirty-seven patients (77.1%) had single injury, mainly involving 36 patients (75.0%) in limbs, and the other 11 patients (22.9%) had multiple injuries. Ten patients (20.8%) had open fractures, including 1 case rated as typeⅠ, 2 as typeⅡ, 3 as type Ⅲa, 2 as type Ⅲb, and 2 as type Ⅲc according to Gustilo classification criteria. The abbreviated injury scale (AIS) score was 2-3 in 37 patients of single injury, and the injury severity score (ISS) was 8-22 (mean, 13.2) in 11 patients of multiple injuries. Sixteen patients (33.3%) were diagnosed as mental disorders by Hamilton rating scale for anxiety (HAMA), including 8 cases had their anxiety scores≥29, 4 cases of 21-28, 3 cases of 14-20, and 1 case of 7-13. Of the 16 patients, 2 showed suicidal tendency.ResultsExcept 2 referrals, 30 patients received operation［28 patients (93.3%) for orthopaedic surgeries］and 16 patients received conservative treatment. The procedures included internal fixation, soft tissue debridement, external fixation, bipolar femoral head replacement, embolization of carotid cavernous sinus arteriovenous fistula, and amputation. Among the 46 patients treated in this hospital, 21 discharged from hospital at 2-12 days (mean, 6.7 days) after admission, the others received further rehabilitation in this hospital or local hospital. No undesirable consequence occurred in 16 patients with mental disorders. Five cases of infection occurred out of hospital were cured after debridement. No dead and nosocomial infection case reported.ConclusionIntensive treatment, specialist management, multidisciplinary team, and early intervention of nosocomial infection and deep venous thrombosis are the key to improve the general level of successful earthquake medical rescue.