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BACKGROUND:At present,there is still controversy in clinical practice about the choice of internal fixation of Pauwels type Ⅲ femoral neck fracture,and the selection of internal fixation that provides stable fixation strength is the key basis for achieving Pauwels type Ⅲ fracture fixation. OBJECTIVE:The three-dimensional finite element analysis method was used to test the difference in biomechanical strength of three types of internal fixation in Pauwels type Ⅲ femoral neck fracture,which provided a reference for its clinical treatment. METHODS:Using the CT data of the left femur of a healthy male volunteer,a complete femur and its cancellous bone were reconstructed in Mimics software,and Geomagic studio software was used for reverse modeling.Cannulated compression screw,dynamic hip screw,and femoral neck system were created in UG-NX software.Three kinds of internal fixation models were assembled on the femur model,and Pauwels type Ⅲ femoral neck fracture was simulated by Hypermesh software.Finally,Abaqus software was used to carry out finite element experimental analysis to analyze and compare the stress distribution,stress peak,strain,and displacement distribution caused by fixed femoral neck fracture of different internal fixation systems. RESULTS AND CONCLUSION:(1)The stress of the proximal femur bone mass was mainly distributed in the area below the femoral neck near the fracture end,with the highest stress peak in the dynamic hip screw group and the smallest in the femoral neck system group.(2)The stress distribution of the internal fixation device was mainly concentrated on the screw surface near the fracture line,with the highest stress peak in the femoral neck system group and the smallest in the dynamic hip screw group.(3)The main strain field of the proximal femur bone mass was distributed in the upper surface area where the bone and screw contacted,and the yield strain was the smallest in the femoral neck system group and the largest in the cannulated compression screw group.(4)The main strain field of the internal fixation device model was distributed on the upper surface of the femoral neck screw,with the yield strain being the smallest in the femoral neck system group and the largest in the cannulated compression screw group.(5)The displacement distribution values of femur,proximal bone mass,distal bone block,internal fixation device and internal fixation with the femur as a whole in the three femoral neck fracture internal fixation models decreased gradually from proximal to distal,and the peak displacement of the femoral neck system group was the largest and the lowest in the dynamic hip screw group.(6)The results showed that when the Pauwels type Ⅲ femoral neck fracture was fixed,the stress distribution of femoral neck system was more uniform,the mechanical conduction characteristics were better,and it was subjected to lower yield strain,higher stress and higher displacement.It has relatively better biomechanical stability and can provide a superior mechanical environment for fracture healing.
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Objective To set up a standardized examination system for clinical internship at the de-partment level, and to evaluate the system using educational measurement method. Methods All the 327 clinical five-year and eight-year intern trainees who took clinical internship in the spinal orthopedics de-partment of a teaching hospital from July 1, 2014 to June 30, 2016 were selected as the research subjects. All the subjects took the standardized examination, educational and measurement methods such as general descriptive analysis, project relevance analysis and grader consistency analysis were executed to assess the content validity of the system, the relevance of the project and the consistency of the scorers. Statistical calculation was executed by SPSS 23.0 software. Results The average score of all 312 trainees included was controlled at (80.07±4.67), the lowest score was 70.01, and the highest score was 90.01, which reflected that the overall difficulty was moderate, the difference was reasonable and the scores were evenly distributed. To the theory, skills, medical records, teachers' score and the reward plus, normalized regression coeffi-cients were 0.479, 0.473, 0.118, 0.135 and 0.364 respectively, which were in good agreement with the scores of each item in the total score. To the theory, skills and teacher evaluation, the analysis of variance of the total score showed that the P values were both ≥0.05 with no significant difference between the groups, so the consistency of the scorers were satisfactory. The P values of variance analysis of the two items of the medical record and bonus points were 0.000 and 0.002 respectively, with significant differences among the groups, the scorers were less consistent. Conclusion The standardized examination system can meet the requirements of comprehensive, full-scale, quantitative and stable feedback teaching effect. The system of internship practice examination must be able to withstand continuous implementation and repeated correc-tion over many years, so as to ensure the teaching quality.
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Clinical tutor system is a unique exploration and practice with characteristics of our school,which has been carried out in the process of clinical course learning and clinical practice among eight-year-program clinical majors.Through analyzing and summarizing the implementation among 2005 and 2006 grade students,we found that the clinical tutor played an active role in cultivating students' clinical thoughts and personal ethics and in improving clinical ability and scientific ability.However,some problem were existed in tutors themselves-specialized major,busy,unclear cultivation objective,etc.Therefore,further improvement of the system was needed in order to better meet the needs of the eight-year-program medical talent training and to provide related references.
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In order to investigate the application of standard score in the examination of eight-year program's clinical practice and to keep consistency of learning level among groups, we translate the original scores into standard scores and discuss the results and how to define the excellent grade so that the scores may have more comparability.
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The authors of this paper confirm the goal, factors and principles in arrangement of clinical practice, design a transplacement algorithm to solve the model, and after estimating the capacity to interns of affiliated hospital, make the schedule by that algorithm so as to relieve the relative short supply of good clinical education resourses.
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A questionnaire survey was conducted among undergraduate international students to investigate the effects of stomatology teaching.The effects of stomatology teaching had been proved to be fair, while some shortcomings had also emerged. In further teaching adjustments have to be made to teaching plans and teachers' Enghsh abilities are expected to be improved.
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Objective To investigate how to improve teaching achievement of specified trained doctors with vascular skill. Methods Specified trained doctors were divided into groups(two doctors for one group) and expected vascular surgeon was appointed as majored teacher. Teaching revolution was proceeded with self-made vascular training platform,projected questions according with teaching content,cultivation of solidificatism and refined schema of check. Results After revolution,operative skills of specified trained doctors were improved significantly,basal operative procedures during operations were smooth,skill related theory was solid and compounding during operation was initiative. Conclusion Teaching revolutions of vascular skill can improve basal operative skill of specified trained doctors and develop habits of solidificatism.