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Objective@#To evaluate the composite external fixation in the treatment of children with fracture of lower extremity metaphysis.@*Methods@#A retrospective analysis was conducted of the 42 children with fracture of lower extremity metaphysis who had been admitted to Zhengda Shaoyang Orthopaedic Hospital between September 2016 and September 2018. They were 24 boys and 18 girls, aged from 3 to 14 years (mean, 8.3 years). Open injury occurred in 10 cases, with type Ⅰ in 2, type Ⅱ in 7 and type Ⅲ in one according to the Gustilo-Anderson classification, and closed injury in the other 32 ones. The fracture happened at distal femur in 12, at proximal tibia in 9 and at distal tibia in 21 cases. All the patients were fixated with composite external brackets. Fracture healing, functional recovery of the knee and ankle joints, and complications were recorded.@*Results@#All the 42 patients were followed up for 12 to 18 months (mean, 15.8 months). All fractures healed well by the first intention with no malunion or no alignment change on the full length X-ray films of both lower limbs. Irritant growth within 1.5 cm was observed in 2 cases. No loosening occurred in the external fixation which was removed 3 to 5 months after surgery (mean, 3.8 months). Functional recovery of the knee and ankle joints was good at the last follow-up. For the patients with distal femoral metaphysis fracture, the knee function by the Merchan scoring was excellent in 3 cases, good in 7 cases, fair in one and poor in one; for the patients with proximal tibial metaphysis fracture, the knee function by the Merchan scoring was excellent in 3, good in 4 and fair in 2 cases; for the patients with distal tibial metaphysis fracture, the ankle function by the Kofoed scoring was excellent in 11, good in 7 and fair in 3 cases, giving an excellent and good rate of 83.3%. Of a total of 228 needle channels in the 42 patients, 58 were infected mildly or moderately, giving an infection rate of 25.4%. All the infections responded to active dressing change.@*Conclusion@#The composite external fixation brackets are a good choice for the treatment of children with fracture of lower extremity metaphysis, because they are easy in manipulation and stable in configuration, and can reduce the iatrogenic injury to the epiphyseal plate, spare cross-articular fixation and allow early functional exercise.
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Objective To evaluate the composite external fixation in the treatment of children with fracture of lower extremity metaphysis.Methods A retrospective analysis was conducted of the 42 children with fracture of lower extremity metaphysis who had been admitted to Zhengda Shaoyang Orthopaedic Hospital between September 2016 and September 2018.They were 24 boys and 18 girls,aged from 3 to 14 years (mean,8.3 years).Open injury occurred in 10 cases,with type Ⅰ in 2,type Ⅱ in 7 and type Ⅲ in one according to the Gustilo-Anderson classification,and closed injury in the other 32 ones.The fracture happened at distal femur in 12,at proximal tibia in 9 and at distal tibia in 21 cases.All the patients were fixated with composite external brackets.Fracture healing,functional recovery of the knee and ankle joints,and complications were recorded.Results All the 42 patients were followed up for 12 to 18 months (mean,15.8 months).All fractures healed well by the first intention with no malunion or no alignment change on the full length X-ray films of both lower limbs.Irritant growth within 1.5 cm was observed in 2 cases.No loosening occurred in the external fixation which was removed 3 to 5 months after surgery (mean,3.8 months).Functional recovery of the knee and ankle joints was good at the last follow-up.For the patients with distal femoral metaphysis fracture,the knee function by the Merchan scoring was excellent in 3 cases,good in 7 cases,fair in one and poor in one;for the patients with proximal tibial metaphysis fracture,the knee function by the Merchan scoring was excellent in 3,good in 4 and fair in 2 cases;for the patients with distal tibial metaphysis fracture,the ankle function by the Kofoed scoring was excellent in 11,good in 7 and fair in 3 cases,giving an excellent and good rate of 83.3％.Of a total of 228 needle channels in the 42 patients,58 were infected mildly or moderately,giving an infection rate of 25.4％.All the infections responded to active dressing change.Conclusion The composite external fixation brackets are a good choice for the treatment of children with fracture of lower extremity metaphysis,because they are easy in manipulation and stable in configuration,and can reduce the iatrogenic injury to the epiphyseal plate,spare cross-articular fixation and allow early functional exercise.
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Objective To report the efficacy of closed pry reduction and cross Kirschner wiring in the treatment of refractory flexion-type fracture of supracondylar humerus in children.Methods A retrospective analysis was done of 19 children who had been treated for refractory flexion-type fracture of supracondylar humerus by closed pry reduction and cross Kirschner wiring at Department of Orthopaedics,Shaoyang Orthopaedic Hospital from March 2015 to March 2017.They were 9 boys and 10 girls,aged from 2 to 12 years (mean,6.37 years);10 left and 9 right sides were involved.According to the severity of fracture displacement,11 cases had rotational displacement with their broken ends obviously inserted into one another,and 8 cases complete displacement with no contact of the broken ends.All the fractures were closed,treated with closed reduction by leverage and cross fixation with Kirschner wire.Postoperative complications were recorded and the elbow function was evaluated by the Flynn assessment system at the last follow-up.Results The operation time for the 19 patients ranged from 15 to 60 minutes,with an average of 30 minutes.The patients were followed up for 12 to 24 months (average,18.0 months).All the fractures united after 2 to 4 months (average,2.8 Months).At the last follow-up,according to the Flynn system,the elbow function was evaluated as excellent in 10 cases,good in 7,and fair in 2.No ossifying myositis,cubitus varus or iatrogenic injury to the ulnar nerve was observed in any patient.Nails had to be removed in one case due to implant loosening after pin-hole infection.Conclusion Closed reduction and Kirschner wire cross fixation is an ideal surgical treatment for refractory flexion-type supracondylar fracture of humerus in children,because its intraoperative closed pry reduction can reduce the rate of incision.
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In recent years,medical colleges have generally accepted the higher education assessment(evaluation).How to put the good practices and experience we obtained during the educational assessment into the daily teaching management and achieve normalization of teaching evaluation is of great significance to continuously improving the teaching quality.It is the primary condition to establish the evaluation index system for evaluating clinical teaching quality by regular teaching assessment. In this paper,the author constructed a clinical teaching quality evaluation index system through systematic research and exploration.
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In line with the new WHO definition for health and reference of comprehensive health assessments of elderly overseas, the paper screened and set the weight for comprehensive health assessment indicators for military officers, establishing a general health assessment model as a result 402 military officers were subject to Comprehensive Health Assessments, and the outcomes were compared with subjective assessment of experts. The results of both methods are highly coincidental. It proves Comprehensive Health Assessment as a scientific quantitative health assessment method, with promising perspectives in health management in the future.
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Objective of the study is to explore how to apply ARIMA model in prediction of outpatients headcount,describe the modeling process,build the prediction model,and verify its applicability to serve decision making for hospital management.Methods Data originates from the outpatient statements of the HIS integrated statistics and management decision making support system.The data collection ranges from the monthly outpatients headcount from 1999 to 2005,in which the monthly data from 1999 to 2004 were used to build the time sequence model,and those of 2005 to verify the model so built.The statistic software was programmed with SPSS13.0.Results The ARIMA(1,0.1)(0,1,1)12 model was built by megns of model identification,parameter estimate.inspection/diagnosis,and model appraisal.This model features high fitting precision,as the relative error or outpatients headcount for the year is 6.85%,and that for the months ranges from-3.15%to-9.80%,with the actual values falling within the 95%upper and lower thresholds of the prediction results.Conclusion This study proves that ARIMA model fits the purpose of outpatients headcount prediction.In the meantime,prediction of such headcount should also take into account such factors as the data volume,hospital environment and patient satisfaction.
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Objective To explore the effective methods for analyse and manage of medical quality information. Methods Based on the feasibility and necessity of medical quality information management, the designs of conceptual model, logical model, and physical model, and the process and methods of data transfer were expounded. Results The data warehouse was established. Conclusion The established data warehouse, the important component in the hospital information system, will be helpful in hospital decision-support and hospital administration.
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Renal transplantation was performed successfully in five cases with high risk. All are alive with functioning grafts at the time of report.The first patient was suffering from cardiac failure, and he was operated on immediately after an implantation of a pace-maker. The second patient was having malignant hypertention before and after transplantation, and bilateral nephrectomy through a mid-line abdominal incision was done, resulting in gradual decline of blood pressure to within normal range. The third patient suffered from chronic pye-litis, and renal transplantation was done immediately after bilateral nephrectomy. The fourth patient suffered from chronic renal failure and leukopenia (total white count 2900-4000/mm3), and the total white count became normal (5000-7500/mm3) despite the use of immunosuppressive drugs after renal transplantation. The fifth case, ages 50, developed stress ulcers with repeated massive hematemesis and bloody stools 12 days after transplantation, and a subtotal gastrectomy was performed to save the patient.It is the opinion of the author that the renal transplantation may be considered to be a life-saving operation, and the key of success is that the quality of the graft should be good.