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OBJECTIVE:To provide reference for safe application of antibiotic drugs in single or inter-medical institution ser-vices. METHODS:An antibiotic drug safety evaluation index system was established by reference to literatures. Medical records tracing method was adopted to obtain the medical records of children with respiratory infectious diseases under the medical consor-tium model. The medical records were matched and evaluated by experts to analysis the safety of antibiotic drug use in single medi-cal institution and the connection between two medical institutions with respect to the safety of antibiotic drug use. RESULTS:248 effective medical records had been obtained. Under the medical consortium model,the rate of the combination of antibiotic drugs in large hospitals was 86.29%,higher than the community hospitals of 77.02%(χ2=5.49,P<0.05). The error rate of antibiotic drug use by children in large hospitals was 14.52%,lower than the community hospitals of 25.81%(χ2=9.733,P<0.05). There were many contradictions in antibiotic drug use between the medical institution where children received treatment initially and the medi-cal institution which the children were referred to and hospitalized in. There were totally 128 cases of unsafe antibiotic drug use, with the overall incidence of 51.61%. CONCLUSIONS:Under the medical consortium model,the safety of antibiotic drug use by the hospitalized children in single medical institution is worrying,and the connection between two medical institutions with respect to the safety of antibiotic drug use by children who are referred and hospitalized is less reliable.
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BACKGROUND: There are a lot of controversies regarding the choice of short versus long segment pedicle screw fixation for the treatment of isthmic spondylolisthesis and degenerative spondylolisthesis treatment. OBJECTIVE: To investigate clinical efficacy of short versus long segment pedicle screw fixation in treatment of lumbar spondylolisthesis.METHODS: A total of 146 spondylolisthesis patients were included in this study, 36 males and 110 females, aged 22-73 years at a mean of 53 years; disease duration was from 1 to 18 years at a mean of 5 years. These patients were treated with lumbar spinal window-opened decompression or laminectomy decompression, a short or long segment pedicle screw internal fixation, transverse interbody fusion.RESULTS AND CONCLUSION: Among 146 involved patients, 72 cases were treated with four pedicle screw fixation (short segments), while 74 cases with six pedicle screw fixation (long segments). Interbody graft was performed in 101 cases, while intertransverse fusion given in 45 cases. Totally 134 cases were followed up for postoperative 1.5-14 years. According to clinical grading standards of Steffee system, the clinical efficacy was assayed excellent in 74 cases, good in 41 cases, mild in 13 cases and poor in 6 cases, with good rate of 85.8%. 77 cases achieved a complete reduction, including 32 cases using a short segment fixation and 45 cases using a long segment fixation. 69 cases achieved partial reduction, including 40 cases using a short segment fixation and 29 cases using a long segment fixation. Pedicle screws ruptures were found in 13 screws of eight patients undergoing short segment fixation, while no pedicle screw fracture was found in long segment fixation. Choice of short or long segment for the fixation is based on the analysis of spondylolisthesis type, severity, duration of disease, emergence of adjacent segment disc degeneration and instability.
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A total of 64 patients with lumbar spondylolisthesis were enrolled from Department of Bone Surgery in the People's Hospital of Haian Province between January 2002 and December 2007, including 19 males and 45 females. They aged 26-73 years with a mean of 48.5 years. Their disease course was 1-15 years with a mean of 4 years. All patients complained about the repeated low back pain accompanied with lower limb radiating pain and intermittent claudication (50-300 m). Fifty-nine patients suffered from lumbar spondylolysis, including L3 Ⅰ degree in 3 cases, L4 Ⅰ degree in 31 cases,L4, Ⅱ degree in 13 cases, Ls Ⅰdegree in 9 cases and L5 Ⅱ degree in 3 cases. The remaining 5 cases were present with lumbar degenerative pseudo-spondylolysis. All patients were processed into whole laminectomy for decompression or vertebral canal decompression by fenestration, domestic vertebral internal fixation, reduction and interbody fusion. Fifty-five patients were followed up for an average of 3.1 years whereas 9 patients were lost. According to Steffee clinical effect grading, the curative effect was evaluated as excellent in 28 cases and good in 19 cases, the rate of excellence and good accounted for 85.5%. Within one week following bone graft, all patients were rechecked with X-ray plain film, 28 of them had shown complete reduction and 36 cases were present with part reduction. The fusion rate of interbody graft was 100%. These findings demonstrated that vertebral internal fixation system possesses a simple structure, convenient operation and solid fixation, resets the slipped vertebral body and significantly increases the fusion rate of vertebral graft.
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Pedicle screw loosening and axial dislocation are main reasons for spinal internal fixation failure. Screw loosening and dislocation is caused by screw extraction force,and the screw withdrawl force is related to screw diameter,screw thread design,bone density,and operation skills. Withdrawl intensity is increased with screw diameter and length. Pedicle screw stability can be decreased by osteoporosis. For osteoporotic patients,it is difficult to increase screw diameter alone,so polymethyl methacrylate bone cement is used to enhance screw stability and anti-flexion intensity. However,polymerization heat may induce tissue injury,and long-term stay may produce toxicity and exhibit cancerogenesis. Novel additive materials with good biocompatibility such as hydroxyapatite and calcium phosphate bone cement are gradually replacing polymethyl methacrylate bone cement. In addition,screw entrance point,direction and exact location during screw implantation can decrease pullout strength reducation caused by screw re-twisting and improve screw extraction intensity and stability.
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This paper introduces the structure and principle of a novel low-frequency electronic pulse therapeutic apparatus. Based on a novel single -chip microprocessor, the device can generate multiple special pulse signals and output bi -directional electronic pulse. At the same time, it can detect the impedance automatically and thus its security is improved.