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[转载]【动作】【创伤 A Certain Justice (2014)】【美国】
lcj2212916 2014-4-9 20:19
导演 : Giorgio Serafini / James Coyne 编剧 : James Coyne 主演 : Dolph Lundgren / Cung Le / Vinnie Jones 类型: 剧情 / 动作 制片国家/地区: 美国 语言: 英语 上映日期: 2014-06-03(荷兰) 片长: 97分钟 又名: Puncture Wounds IMDb链接: tt2909476 After returning home from a traumatic tour of duty in Iraq, John findshimself struggling with PTSD. What little peace he had managed to buildaround him is shattered one fateful day when he rescues a local callgirl from a group of violent Aryan Brotherhood pimps. Having killedseveral of the high-ranking brotherhood during the rescue, John and hisfamily are now when he rescues a local callgirl from a group of violent Aryan Brotherhood pimps. Having killedseveral of the high-ranking brotherhood during the rescue, John and hisfamily are now the prime targets of Hollis, the ruthless criminal leaderof the group. 下载地址: http://www.400gb.com/file/62170439
1620 次阅读|0 个评论
地震后"创伤后压力症候群(PTSD)”研究论文
WileyChina 2013-4-24 13:50
地震发生后,受灾者的生活与心理状况很受关注,以下四篇由中国作者撰写的针对 2008 年汶川地震后受灾者有关创伤后压力症候群(PTSD)的研究很值得借鉴: -------------------------------------------------------------------------------------------- Symptoms of posttraumatic stress disorder among adult survivors three months after the Sichuan earthquake in China 作者: Li Wang( 中科院物理所 ), Yuqing Zhang( 中科院物理所 ), Wenzhong Wang( 中科院物理所 ), Zhanbiao Shi( 中科院物理所 ), Jianhua Shen(University of Toronto) Ming Li( 北京林业大学 ) Yong Xin( 西南科技大学 ) 摘要: The study investigated the symptoms of posttraumatic stress disorder (PTSD) and associated risk factors among adult survivors 3 months after the 2008 Sichuan earthquake in China. One thousand five hundred sixty-three earthquake survivors in two communities participated in the study. The prevalence of probable PTSD was 37.8% and 13.0%, respectively, in the two communities that were affected differently by the earthquake. The significant predictive factors for the severity of PTSD symptoms were female gender, subnationality, lower educational level, lower social support, and higher initial exposure level. The results indicate that PTSD is also a common mental health problem among earthquake survivors in China. Given inadequate knowledge and practices concerning the mental health of disaster victims in China, the information provided by this study is useful for directing, strengthening, and evaluating disaster-related mental health needs and interventions after the earthquake. -------------------------------------------------------------------------------------------- Post-earthquake quality of life and psychological well-being: Longitudinal evaluation in a rural community sample in northern China 作者: Xiangdong Wang MD (Kobe University School of Medicine), Lan Gao MD ( 北京大学医学部 ), Huabiao Zhang MD ( 张家口市沙岭子医院 ), Chengzhi Zhao MD ( 张家口市沙岭子医院 ), Yucun Shen MD, Ph D( 北京大学医学部 ), Naotaka Shinfuku MD, Ph D(Kobe University School of Medicine) 摘要: This study aims to observe longitudinal change of quality of life (QOL) and psychological wellbeing in a community sample affected by an earthquake and to examine the relationship between QOL and disaster exposure, post-disaster support and other related variables. The subjects, from two villages at different distances from the epicenter, were assessed using the brief version of the World Health Organization Quality of Life Assessment (WHOQOL-BREF) and three subscales of a symptoms checklist at 3 months (n = 335) and 9 months (n = 253) after the earthquake, respectively. Exposure to the earthquake was associated with multidimensional impairment in QOL, including physical, psychological and environmental domains at 3 months, and psychological and environmental domains at 9 months. The victims also suffered significantly more psychological distress in terms of depression, somatization and anxiety. At both assessment points the group that experienced lower initial exposure but then received less post-disaster help reported poorer QOL and psychological well-being. The two victim groups also differed significantly in changing trend along time. The group that received more support showed a general improvement in post-disaster well-being from 3 months to 9 months. The results confirm that post-disaster variables could be as important to post-disaster psychosocial outcomes as variables of predisaster vulnerability and disaster per se. A comprehensive and prospective assessment of disaster effects is imperative for the better organization of disaster relief programs and psychosocial interventions. -------------------------------------------------------------------------------------------- Symptoms of posttraumatic stress disorder, depression, and anxiety among adolescents following the 2008 Wenchuan earthquake in China 作者: Fang Fan( 华南师范大学 ), Ying Zhang(Florida State University), Yanyun Yang(Florida State University), Lei Mo( 华南师范大学 ), Xianchen Liu( 华南师范大学 ) 摘要: This study examined the symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression among 2,250 adolescents 6 months after the 2008 Wenchuan earthquake in China. Results showed that 15.8%, 40.5%, and 24.5% of participants reported clinical symptoms of PTSD, anxiety, and depression, respectively. Posttraumatic stress disorder, anxiety, and depression were highly comorbid. Risk factors for symptoms of the 3 disorders were female gender, older age, and earthquake disaster exposure. In addition, the interaction effects of residence (urban/rural) and number of siblings of study subjects on symptoms of the 3 disorders were examined. Implications of findings on intervention and prevention of mental health problems among adolescents after experiencing earthquake disasters are discussed. -------------------------------------------------------------------------------------------- Testing the dimensionality of posttraumatic stress responses in young Chinese adult earthquake survivors: further evidence for “dysphoric arousal” as a unique PTSD construct 作者: Li Wang Ph.D.( 中科院心理所 ), Zhongquan Li Ph.D.( 南京大学 ), Zhanbiao Shi Ph.D.( 中科院心理所 ), Jianxin Zhang Ph.D.( 中科院心理所 ), Kan Zhang Ph.D.( 中科院心理所 ), Zhengkui Liu Ph.D.( 中科院心理所 ), Jon D. Elhai Ph.D.( University of Toledo) 摘要: Background: This study investigated an alternative five-factor diagnostic model for posttraumatic stress disorder (PTSD) symptoms, and tested external convergent and discriminant validity of the model in a young Chinese sample of earthquake survivors. Methods: A total of 938 participants (456 women, 482 men) aged 15–20 years were recruited from a vocational school originally located in Beichuan County Town which was almost completely destroyed by the “Wenchuan Earthquake.” The participants were administrated with the PTSD Checklist and the Hopkins Symptoms Checklist-25 12 months after the earthquake. Results: The results of confirmatory factor analysis showed that the five-factor intercorrelated model (intrusion, avoidance, numbing, dysphoric arousal, and anxious arousal) fit the data significantly better than the four-factor numbing model proposed by King et al. (1998: Psychol Assess 10:90–96) and the four-factor dysphoria model proposed by Simms et al. (2002: J Abnorm Psychol 111:637–647). Further analyses indicated that four out of five PTSD factors yielded significantly different correlations with external measures of anxiety versus depression. Conclusions: The findings provide further empirical evidence in favor of the five-factor diagnostic model of PTSD, and carry implications for the upcoming DSM-5. --------------------------------------------------------------------------------------------
个人分类: Social Scence and Humanities|4881 次阅读|0 个评论
[转载]徐医附院创伤骨科,多项技术开创我市先河
GaoXurenKnee 2013-4-12 17:30
徐州都市晨报电子版原文链接: http://epaper.cnxz.com.cn/dscb/html/2013-03/27/content_128502.htm 徐医附院创伤骨科,多项技术开创我市先河 骨科微创手术,让高龄患者获得安全治疗机会 日期: 版次: 版名: 字体:【 放大 缩小 默认 】 徐医附院骨科教学查房   为老年患者做骨科手术   诊疗患者   指导患者进行关节康复   ▲   ▼ 对于高龄老人来说,不慎摔倒造成髋部、腿部的骨折,往往会给自己和家人带来极大的心理压力。“年龄太大,手术时间长,万一出现啥意外怎么办?”考虑到传统手术方式,许多人摇头,投了“弃权票”。而对于年轻人来说,传统的骨科手术可能留下的巨大疤痕则成为其内心耿耿于怀的事情…… 高龄老人真的就不能接受骨折手术了吗?动手术真的就会留下巨大、丑陋的疤痕吗?近日,记者走访徐医附院创伤骨科专家了解:他们凭借精湛的医疗技术开展的一系列微创手术,在我市称得上首屈一指!其治疗的骨科患者年龄最大者为93岁!手术时间短,往往在半小时以内;手术伤口小,有的仅0.5公分!他们究竟是怎样做到的呢? 案例之一 82岁老人不慎滑倒导致转子间骨折 市民王大爷,今年82岁。不久前,他去家里的厨房拿东西,因为地面湿滑,一不小心摔倒在地,接着他感觉髋部疼痛难忍。之后,王大爷被家人紧急送往徐医附院骨科进行检查。得知自己的转子间骨折,这让王大爷很是不安,“年龄这么大了,还要动手术实在是太受罪了!”对此,家人也是犹豫不决,“不动手术的话,老人也许就将瘫痪在床了。但若是动手术,岁数这么大,万一有啥风险怎么办? 接下来,徐医附院骨科医生给王大爷介绍的手术方式,让他和家人彻底放下心来。“转子间骨折多发生在高龄老人身上,像滑倒、扭伤都有可能导致这种情况发生。”徐医附院创伤骨科主任王业华介绍,该老年患者骨质严重疏松加之年龄较大,这为手术带来几个难题。 “骨质疏松导致普通钢板不易固定,这是技术方面的难题。另外,对于老年患者来说,他们往往还有脑血管、心脏病等合并症,其心肺代偿能力较弱,这就造成手术中的麻醉风险较大。” 王业华主任说,在经过全科会诊后,决定对该患者施行微创手术。 “微创手术让患者获得安全治疗机会” 对于采用的微创手术,王业华主任详细介绍了其手术流程。“先在受伤部位进行牵引复位,然后在X光的透视下打入髓内钉,之后用锁钉进行固定。”王主任告诉记者,类似的手术,一般在半小时内就可完成,而自己此项手术的最快纪录是13分钟! 短短时间内完成的手术,让王大爷和家人都有种不可思议的感觉:在这之前如果采用传统的手术方式,手术至少需要1—2小时;传统手术至少会在患者身体上留下30公分长的切口,创伤较大,而眼前的2个1公分长、1个3公分长的小切口,三个加起来才不过5公分! 在经过两个多月的康复锻炼后,王大爷又能开始走路了,这让他对徐医附院的医术称赞不已,“没想到我还能重新站起来!真是太感谢徐医附院骨科医生了!” 对于这次微创手术中使用的“髓内钉”,记者很感兴趣,这到底是一种什么东西呢?“髓内钉是由一种钛合金材料做成的。其生物相融性很好,可以与人体骨质长期共存,一生都不取。 另外,它的弹性模量与人体骨骼的弹性模量一致,与普通钢板相比,因为避免了钢板产生的遮挡效应,因此更有利于骨头生长。”王业华主任介绍,采用微创手术最大的优势在于,让高龄患者能够获得安全治疗的机会,极大降低手术风险。 采访中记者了解,在徐医附院创伤骨科医生的精湛医术下,他们所收治患者当中岁数最大者为93岁! 案例之二 淘宝店主因注射导致“臀肌挛缩症” 在创伤骨科,每天都会接触到患有各种不同骨类疾病的患者。22的睢宁小伙儿小刘就是其中一位。小刘是家淘宝店店主,他小时候因为患病经常注射,导致患上了“臀肌挛缩症”。 “所谓的臀肌挛缩症(gluteal muscle contracture,GMC)与反复的肌肉注射等原因有关。”王主任解释,其临床表现为坐位及下蹲受限,行走下肢呈外“八字”步态。下蹲时双膝分开才能蹲下,髋部可闻及弹响或触及弹动感,不能翘二郎腿。由于臀肌挛缩带影响臀肌发育,臀部一般均出现挛缩带和凹陷沟,下蹲时臀部变尖呈锥形,称为“尖臀”。 走路时八字步、下蹲时两腿“画圈儿”等等, 此病除了让小刘二十多年来深感不便外,怪异的姿态还常常惹得别人注目,这让他非常苦恼,之后他慕名来到了徐医附院创伤骨科。 徐州首例“臀肌挛缩症”关节镜微创术 “如果采用传统开放手术,其创伤大,切口长、术后组织反应重、渗出多,有的形成血肿,影响伤口愈合或并发感染。有的以切口为中心形成新的索条状疤痕束带。”高绪仁博士介绍,之后他们对小刘实施了关节镜监控下臀肌挛缩松解手术。 手术后,患者的身体上仅留下两个0.5厘米的小口。创伤小且出血少。术后第四天,患者的肢体行为就有了显著改善。看到“神奇的手术”解决了困扰自己多年的病症,这让小刘又惊又喜,为此他特意给参与自己手术的每位医生发了条淘宝体短信,“谢谢啊,亲!” 这项手术也标志着徐医附院在骨科运动创伤疾病的微创诊断治疗上又有了新突破,开创徐州臀肌挛缩症关节镜微创手术治疗之先河! 成就 多项新技术为市内首创、苏北地区领先 采访当中,王业华主任及高绪仁博士都频频提起“关节镜”这个词,它在手术中究竟发挥着怎样的作用呢? “关节镜是一种观察关节内部结构的直径5mm左右的棒状光学器械,是用于诊治关节疾患的内窥镜。它在一根细管的端部装有一个透镜,将细管插入关节内部,关节内部的结构便会在监视器上显示出来。因此,可以直接观察到关节内部的结构。关节镜手术是一种微创手术。”王主任介绍。 通过引进先进的医疗仪器以及背后实力强大的医疗团队,使得创伤骨科近年来在微创诊断治疗方面不断涌现新突破,多项手术在徐州市尚属首例,在苏北地区也处于领先地位。 关节镜下膝关节腔360度微创游离体取出术 新突破之一 关节内游离体,又称“关节鼠”,是指关节内有可移动的软骨或骨软骨碎片,是一种常见的膝关节病。由于较小的游离体被夹挤在关节面之间,则出现突发关节交锁现象。出现时,患者会有剧烈疼痛,会因膝关节滑膜受到机械刺激而出现关节肿胀、积液,膝部软弱无力,或因游离体游到表浅部而触及到可移动的包块。此外,在交锁解锁时,患者可以听到或感到响声、错动感,有的还可能引起跪跌现象。 膝关节镜微创手术技术取膝关节游离体是目前国际上最被推崇的方法。但是由于手术技术要求高,大多数的关节镜医师仅能取出膝关节髁间窝、髌上囊、内外侧胫股间室、内外侧沟里面的游离体。而徐医附院开展的膝关节腔360度微创游离体取出术不但能够取出上述的游离体,而且通过膝关节后内侧入路和后外侧入路,器械进入膝关节后内侧室和后外侧室,从而轻松取出最难取到的后内侧室和后外侧室游离体,从而达到膝关节360度全关节腔游离体的清理,创伤小、效果好。 关节镜下胫骨平台骨折微创手术技术 新突破之二 膝关节胫骨平台骨折属于临床上常见的关节内骨折。传统方法多采用切开复位内固定手术,但因大切口暴露膝关节,对膝关节内各种组织的损伤大、手术创伤大、术后并发症多,常存在关节面复位欠佳、关节粘连、关节僵硬,易形成创伤性骨性关节炎、住院时间长、术后恢复慢、花费高等弊端,严重影响膝关节的功能恢复。 “我院采用的关节镜微创治疗膝关节胫骨平台骨折技术可以最大可能地保护膝关节,减少或避免上述不良反应的发生。通过关节镜监视,可以直观地看到关节内骨折处复位的程度,并可以及时对膝关节内的半月板损伤、交叉韧带损伤、滑膜病变等进行微创修整或重建。”王业华主任介绍,这项手术不仅标志着徐医附院在骨科运动创伤疾病的微创诊断治疗上又有了新突破,而且翻开了徐州关节内骨折微创诊疗的新篇章。 新突破之三 肩关节镜下360度松解治疗肩关节粘连手术 近日,在创伤骨科王业华主任的支持下,由李洪伟、高绪仁、葛保健三位博士联手主刀,成功完成了徐州首例肩关节镜下360度松解治疗肩关节粘连手术。肩关节镜手术成功解决了患者的肩关节粘连(冻结肩、肩周炎)所导致的左肩关节疼痛、活动受限的问题,手术切口是3个约0.5厘米的小微创切口,并且手术操作时间不到1小时。 采访中记者了解,上述手术在徐州都属于首例,除此之外,他们开展的关节镜下的腕关节、肘关节、踝关节手术以及关节镜辅助下青少年肌性斜颈微创矫形手术等多项手术亦在我市开创先河甚至在苏北地区位居领先水平…… 这一切,创伤骨科是如何做到的? “徐医附院创伤骨科一个重点的发展方向就是关节镜微创技术治疗骨科运动创伤。”王业华主任说,为了更好提升医生们的技术水平,科室经常公派医生前往日本、美国、德国等地跟随世界第一流的关节镜专家学习最新的关节镜技术和理念。 “我们希望,通过科室人员的共同努力,让徐医附院骨科微创治疗水平不断得到提升,努力推动徐淮地区外科腔镜事业的不断向前发展,力争为更多的患者造福。”王业华主任表示。 记者 沈琦 文 记者 任中华 摄
个人分类: 学会、杂志、名院、名科、网站|2127 次阅读|0 个评论
2013年3月18日江苏徐州骨科运动创伤、关节镜Journal club预告
GaoXurenKnee 2013-3-11 23:27
2013年3月18日周一江苏徐州骨科运动创伤、关节镜Journal club内容预告 Sports Med Arthrosc Rehabil Ther Technol. 2012 Dec 14;4(1):48. doi: 10.1186/1758-2555-4-48. Management of degenerative rotator cuff tears: a review and treatment strategy. 退变性肩袖撕裂损伤的处理:文献综述和治疗策略 Clement ND , Nie YX , McBirnie JM . Source Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, Scotland. Julie.McBirnie@luht.scot.nhs.uk. Abstract The aim of this review was to present an over view of degenerative rotator cuff tears and a suggested management protocol based upon current evidence. Degenerative rotator cuff tears are common and are a major cause of pain and shoulder dysfunction. The management of these tears is controversial, as to whether they should be managed non-operatively or operatively. In addition when operative intervention is undertaken, there is question as to what technique of repair should be used. This review describes the epidemiology and natural history of degenerative rotator cuff tears. The management options, and the evidence to support these, are reviewed. We also present our preferred management protocol and method, if applicable, for surgical fixation of degenerative rotator cuff tears. Clin Sports Med. 2012 Oct;31(4):589-604. doi: 10.1016/j.csm.2012.07.001. Epub 2012 Aug 30. Epidemiology, natural history, and indications for treatment of rotator cuff tears . Tashjian RZ . Source Shoulder and Elbow Surgery, Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA. Robert.Tashjian@hsc.utah.edu Abstract The etiology of rotator cuff disease is likely multifactorial, including age-related degeneration and microtrauma and macrotrauma. The incidence of rotator cuff tears increases with aging with more than half of individuals in their 80s having a rotator cuff tear. Smoking, hypercholesterolemia, and genetics have all been shown to influence the development of rotator cuff tearing. Substantial full-thickness rotator cuff tears , in general, progress and enlarge with time. Pain, or worsening pain, usually signals tear progression in both asymptomatic and symptomatic tears and should warrant further investigation if the tear is treated conservatively. Larger (1-1.5 cm) symptomatic full-thickness cuff tears have a high rate of tear progression and, therefore, should be considered for earlier surgical repair in younger patients if the tear is reparable and there is limited muscle degeneration to avoid irreversible changes to the cuff , including tear enlargement and degenerative muscle changes. Smaller symptomatic full-thickness tears have been shown to have a slower rate of progression, similar to partial-thickness tears , and can be considered for initial nonoperative treatment due to the limited risk for rapid tear progression. In both small full-thickness tears and partial-thickness tears , increasing pain should alert physicians to obtain further imaging as it can signal tear progression. Natural history data, along with information on factors affecting healing after rotator cuff repair, can help guide surgeons in making appropriate decisions regarding the treatment of rotator cuff tears . The management of rotator cuff tears should be considered in the context of the risks and benefits of operative versus nonoperative treatment. Tear size and acuity, the presence of irreparable changes to the rotator cuff or glenohumeral joint, and patient age should all be considered in making this decision. Initial nonoperative care can be safely undertaken in older patients (70 years old) with chronic tears ; in patients with irreparable rotator cuff tears with irreversible changes, including significant atrophy and fatty infiltration, humeral head migration, and arthritis; in patients of any age with small (1 cm) full-thickness tears ; or in patients without a full-thickness tear. Early surgical treatment can be considered in significant (1 cm-1.5 cm) acute tears or young patients with full-thickness tears who have a significant risk for the development of irreparable rotator cuff changes. Med Sport Sci. 2012;57:153-67. doi: 10.1159/000328893. Epub 2011 Oct 4. Treatment options for chronic retracted degenerative rotator cuff tears . 慢性回缩性退变性肩袖撕裂损伤的治疗选择 Deering SJ , Mair SD , Lattermann C . Source Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY 40536, USA. Abstract Degenerative , retracted, massive rotator cuff tears present surgeons with distinct challenges. Patient selection is key to a successful outcome. Treatment strategies range from non-operative to progressively more complex surgical options, including debridement, partial repair, complete repair utilizing margin convergence and interval slides, tendon transfers, arthrodesis, and arthroplasty. The rationale behind each of these options and more are discussed along with guidance for selecting the appropriate treatment strategy for individual patients. Outcomes of various treatment approaches are discussed as well to facilitate surgeons to successfully manage patients with retracted and degenerative tears of the rotator cuff . Sports Health. 2010 Nov;2(6):503-8. Early Results of Concurrent Arthroscopic Repair of Rotator Cuff and Type II Superior Labral Anterior Posterior Tears . 肩关节镜下修复肩袖损伤合并 II 型SLAP损伤的早期临床疗效 Strickland JP , Fleckenstein CM , Ducker A , Hasan SS . Source Physician's Clinic of Iowa, Cedar Rapids, Iowa. Abstract BACKGROUND: Recent reports on concurrent arthroscopic rotator cuff and type II superior labral anterior posterior (SLAP) repair have raised concerns over postoperative stiffness and patient satisfaction. However, it is unclear if the observed stiffness relates to the repair of degenerative SLAP tears in older adults, the surgical technique, the postoperative rehabilitation, or to a combination of these factors. PURPOSE: The purpose of this study was to evaluate the outcome and repair integrity of concurrent arthroscopic rotator cuff and type II SLAP repair. STUDY DESIGN: Case series. METHODS: Of 11 patients identified, 7 had a full-thickness rotator cuff tear and 4 had a high-grade partial thickness tear that was completed. A cannula placed through the rotator cuff tear improved the trajectory for posterior suture anchor placement during SLAP repair. Postoperative rehabilitation employed continuous passive motion to prevent stiffness. RESULTS: At minimum of 1-year follow-up, mean yes responses on the Simple Shoulder Test improved from 5.4 to 10.7 (out of 12; P .01), and mean American Shoulder and Elbow Surgeons scores improved from 40 to 87 (out of 100; P .01). Mean forward elevation improved from 148° to 161° (P .01) and external rotation from 58° to 67° (P .01). Magnetic resonance imaging, obtained at most recent follow-up in 10 patients, demonstrated a healed SLAP tear in all patients and a persistent rotator cuff defect in 1 patient. CONCLUSIONS: Arthroscopic rotator cuff repair can be successfully combined with type II SLAP repair in relatively young patients who have sustained traumatic injury to their shoulders. Allowing early passive motion may help prevent postoperative stiffness without compromising rotator cuff healing. Orthop Traumatol Surg Res. 2010 Apr;96(2):175-9. Clinical practice guidelines for the surgical management of rotator cuff tears in adults. 成人肩袖撕裂损伤手术治疗临床实践指南 Beaudreuil J , Dhénain M , Coudane H , Mlika-Cabanne N . Source Service de rhumatologie, hôpital Lariboisière, AP-HP, université Paris 7, 2, rue Ambroise-Paré, 75010 Paris, France. Abstract CONTEXT: Rotator cuff tears are very common. In 2005, about 45 000 patients in France underwent surgery. Surgical techniques and indications have evolved over recent years with the development of arthroscopic procedures. The lack of visibility on current practice and a request by the French Ministry of Health to assess the fixation devices used in arthroscopic surgery prompted the drafting of these guidelines. OBJECTIVES: To produce guidelines on the indications and limitations of open surgery and arthroscopic surgery. METHODS: A systematic review of the literature (2000-2007) was performed. It was submitted to a multidisciplinary working group of experts in the field (n = 12) who drafted an evidence report and clinical practice guidelines, which were amended in the light of comments from 36 peer reviewers. MAIN RECOMMENDATIONS: (i) Medical treatment (oral medication, injections, physiotherapy) is always the first option in the management of degenerative tears of rotator cuff tendons. Surgery is a later option that depends on clinical and morphological factors, and patient characteristics.(ii) Surgery can be considered for the purpose of functional recovery in cases of a painful, weak or disabling shoulder refractory to medical treatment. (iii) Arthroscopy is indicated for nonreconstructive surgery or debridement, and for partial tear debridement or repair. (iv) Open surgery, mini-open surgery or arthroscopy can be used for a full-thickness tear accessible to direct repair by suture. (v) A humeral prosthesis or total reversed prosthesis is indicated for cuff tear arthropathy. (vi) The fixation devices used for bone reinsertion (anchors, screws, staples,and buttons) are indispensable for fully arthroscopic repair. No studies have determined the number of fixation devices to be used according to tear size. Korean J Pain. 2011 Jun;24(2):69-73. doi: 10.3344/kjp.2011.24.2.69. Epub 2011 Jun 3. Partial-thickness rotator cuff tears . 部分肩袖撕裂损伤 Shin KM . Source Department of Anesthesiology and Pain Medicine, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea. Abstract Although the incidence of partial-thickness rotator cuff tears (PTRCTs) was reported to be from 13% to 32% in cadaveric studies, the actual incidence is not yet known. The causes of PTRCTs can be explained by either extrinsic or intrinsic theories. Studies suggest that intrinsic degeneration within the rotator cuff is the principal factor in the pathogenesis of rotator cuff tears . Extrinsic causes include subacromial impingement, acute traumatic events, and repetitive microtrauma. However, acromially initiated rotator cuff pathology does not occur and extrinsic impingement does not cause pathology on the articular side of the tendon. An arthroscopic classification system has been developed based on the location and depth of the tear. These include the articular, bursal, and intratendinous areas. Both ultrasound and magnetic resonance image are reported with a high accuracy of 87%. Conservative treatment, such as subacromial or intra-articular injections and suprascapular nerve block with or without block of the articular branches of the circumflex nerve, should be considered prior to operative treatment for PTRCTs. 主讲人:高绪仁 Speaker :Xuren Gao 时间:2013年3月18日周一 晚上19:00-20:00 Time: 19:00-20:00 Monday March 18th 2013 地点:江苏省徐州市淮海西路99号徐州医学院附属医院新病房大楼9楼北区骨科医生办公室 Place:The orthopaedic surgeons'office ,North district ,9th floor,the newest inpatient building, the affiliated hospital of Xuzhou medical college, 99 West Huaihai road,Xuzhou,Jiangsu province 欢迎徐州及周边地区骨科医师、研究生、进修生、实习生等参加!
个人分类: 肩关节|4313 次阅读|0 个评论
[转载]2013年2月25日江苏徐州骨科运动创伤、关节镜Journal club预告
dongzg101 2013-2-19 02:05
2013年2月25日江苏徐州骨科运动创伤、关节镜Journal club预告 已有 40 次阅读 2013-2-18 23:11 | 个人分类: 读书读杂志 | 系统分类: 论文交流 | 关键词:2013年2月25日江苏徐州骨科运动创伤、关节镜Journal club预告 Arthroscopy: The Journal of Arthroscopic Related Surgery Add to my Quick Links Volume 29, Issue 2, Pages A1-A36, 191-398 (February 2013) ||| Open all previews articles 1 - 36 1 Masthead Page A2 Show preview | Related articles | Related reference work articles Purchase$31.50 2 Editorial Board Page A6 Show preview | PDF (31 K) | Related articles | Related reference work articles 3 Contents Pages A9,A10,A12,A14,A16,A18,A20 Show preview | PDF (95 K) | Related articles | Related reference work articles 4 Cover Image Page A9 Show preview | Supplementary content | Related articles | Related reference work articles Purchase$31.50 5 Instructions for Authors Pages A22,A24,A26,A28,A30,A32 Show preview | Related articles | Related reference work articles Purchase$31.50 6 Suggested Guidelines for the Practice of Arthroscopic Surgery Page A35 Show preview | Related articles | Related reference work articles Purchase$31.50 Editorial 7 Good Things Come in a Green Package Pages 191-192 James H. Lubowitz, Matthew T. Provencher, Gary G. Poehling Show preview | Related articles | Related reference work articles Purchase$31.50 Letters to the Editor 8 Measurement of Bone Mineral Density in Anterior Cruciate Ligament–Injured Patients by Computed Tomography Scan Page 193 Xingzuo Chen, Hua Feng, Hui Zhang, Guanyang Song Show preview | Related articles | Related reference work articles Purchase$31.50 9 Authors' Reply Pages 193-194 Liaobin Chen, Kai Tie, Hua Wang, Xin Wang Show preview | Related articles | Related reference work articles Purchase$31.50 Original Articles 10 Comparison of Tunnel Orientation Between Transtibial and Anteromedial Portal Techniques for Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Using 3-Dimensional Computed Tomography Original Research Article Pages 195-204 Yoshitsugu Takeda, Toshiyuki Iwame, Tomoya Takasago, Kenji Kondo, Tomohiro Goto, Koji Fujii, Akira Naruse Show preview | Related articles | Related reference work articles Purchase$31.50 11 Tensile Forces on Repaired Medial Meniscal Root Tears Original Research Article Pages 205-212 Christian Strke, Sebastian Kopf, Roland Lippisch, Christoph H. Lohmann, Roland Becker Show preview | Related articles | Related reference work articles Purchase$31.50 12 Immediate Postoperative Anterior Knee Stability: Double- Versus Triple-Bundle Anterior Cruciate Ligament Reconstructions Original Research Article Pages 213-219 Tatsuo Mae, Konsei Shino, Norinao Matsumoto, Kenji Yoneda, Hideki Yoshikawa, Ken Nakata Show preview | Related articles | Related reference work articles Purchase$31.50 13 Ten-Year Survivorship After Knee Arthroscopy in Patients With Kellgren-Lawrence Grade 3 and Grade 4 Osteoarthritis of the Knee Original Research Article Pages 220-225 J. Richard Steadman, Karen K. Briggs, Lauren M. Matheny, Henry B. Ellis Show preview | Related articles | Related reference work articles Purchase$31.50 14 Second-Look Arthroscopic Findings After Open-Wedge High Tibia Osteotomy Focusing on the Posterior Root Tears of the Medial Meniscus Original Research Article Pages 226-231 Kyung-Wook Nha, Yong Seuk Lee, Dae-Hee Hwang, Jae Ho Kwon, Dong Ju Chae, Young Jee Park, Jong In Kim Show preview | Related articles | Related reference work articles Purchase$31.50 15 Does Obesity Negatively Affect the Functional Results of Arthroscopic Partial Meniscectomy? A Retrospective Cohort Study Original Research Article Pages 232-237 Mehmet Erdil, Kerem Bilsel, Mustafa Sungur, Goksel Dikmen, Nejat Tuncer, Gokhan Polat, Nuh Mehmet Elmadag, Ibrahim Tuncay, Mehmet Asik Show preview | Related articles | Related reference work articles Purchase$31.50 16 Femoral Tunnel Length in Primary Anterior Cruciate Ligament Reconstruction Using an Accessory Medial Portal Original Research Article Pages 238-243 Marc Tompkins, Matthew D. Milewski, Eric W. Carson, Stephen F. Brockmeier, Joshua C. Hamann, Joseph M. Hart, Mark D. Miller Show preview | Related articles | Related reference work articles Purchase$31.50 17 Survival Analysis of Microfracture in the Osteoarthritic Knee—Minimum 10-Year Follow-up Original Research Article Pages 244-250 Dae Kyung Bae, Sang Jun Song, Kyoung Ho Yoon, Dong Beom Heo, Tae Jin Kim Show preview | Related articles | Related reference work articles Purchase$31.50 18 Effect of Different Irrigation Fluids on Human Articular Cartilage: An In Vitro Study Original Research Article Pages 251-256 Abhinav Gulihar, David J. Bryson, Grahame J.S. Taylor Show preview | Related articles | Related reference work articles Purchase$31.50 19 Femoral Tunnel Drilling Angles for the Posterolateral Corner in Multiligamentary Knee Reconstructions: Computed Tomography Evaluation in a Cadaveric Model Original Research Article Pages 257-265 Pablo Eduardo Gelber, Juan Ignacio Erquicia, Gustavo Sosa, Gonzalo Ferrer, Ferran Abat, Alfonso Rodriguez-Baeza, Cristobal Segura-Cros, Juan Carlos Monllau Show preview | Related articles | Related reference work articles Purchase$31.50 20 Clinical Outcome in All-Arthroscopic Versus Mini-Open Rotator Cuff Repair in Small to Medium-Sized Tears: A Randomized Controlled Trial in 100 Patients With 1-Year Follow-up Original Research Article Pages 266-273 Peer van der Zwaal, Bregje J.W. Thomassen, Marc J. Nieuwenhuijse, Ruud Lindenburg, Jan-Willem A. Swen, Ewoud R.A. van Arkel Show preview | Related articles | Related reference work articles Purchase$31.50 21 Sensitivity of Preoperative Magnetic Resonance Imaging and Magnetic Resonance Arthrography in Detection of Panlabral Tears of the Glenohumeral Joint Original Research Article Pages 274-279 Eric T. Ricchetti, Michael C. Ciccotti, Michael G. Ciccotti, Gerald R. Williams Jr., Mark D. Lazarus Show preview | Related articles | Related reference work articles Purchase$31.50 22 Clinical and Ultrasonographic Outcomes of Arthroscopic Suture Bridge Repair for Massive Rotator Cuff Tear Original Research Article Pages 280-289 Jin-Young Park, Sang-Hoon Lhee, Kyung-Soo Oh, Sung Gyu Moon, Jung-Taek Hwang Show preview | Related articles | Related reference work articles Purchase$31.50 23 Shoulder Stiffness After Rotator Cuff Repair: Risk Factors and Influence on Outcome Original Research Article Pages 290-300 Seok Won Chung, Cao Ba Huong, Sae Hoon Kim, Joo Han Oh Show preview | Related articles | Related reference work articles Purchase$31.50 24 Comparison of Mesenchymal Stem Cells (Osteoprogenitors) Harvested From Proximal Humerus and Distal Femur During Arthroscopic Surgery Original Research Article Pages 301-308 Knut Beitzel, Mary Beth R. McCarthy, Mark P. Cote, Thomas J.S. Durant, David M. Chowaniec, Olga Solovyova, Ryan P. Russell, Robert A. Arciero, Augustus D. Mazzocca Show preview | Supplementary content | Related articles | Related reference work articles Purchase$31.50 25 Classic Versus Congruent Coracoid Positioning During the Latarjet Procedure: An In Vitro Biomechanical Comparison Original Research Article Pages 309-316 Harm W. Boons, Joshua W. Giles, Ilia Elkinson, James A. Johnson, George S. Athwal Show preview | Related articles | Related reference work articles Purchase$31.50 26 Tendon Graft Fixation Sites at the Coracoid Process for Reconstruction of the Coracoclavicular Ligaments: A Kinematic Evaluation of Three Different Surgical Techniques Original Research Article Pages 317-324 Kaywan Izadpanah, Martin Jaeger, Dirk Maier, Peter Ogon, Matthias Honal, Marco Vicari, Jürgen Hennig, Norbert P. Südkamp, Matthias Weigel Show preview | Related articles | Related reference work articles Purchase$31.50 27 Simple Versus Horizontal Suture Anchor Repair of Bankart Lesions: Which Better Restores Labral Anatomy? Original Research Article Pages 325-329 Lindsey S. Hagstrom, John M. Marzo Show preview | Related articles | Related reference work articles Purchase$31.50 28 Return to Play After Hip Arthroscopy With Microfracture in Elite Athletes Original Research Article Pages 330-335 John E. McDonald, Mackenzie M. Herzog, Marc J. Philippon Show preview | Related articles | Related reference work articles Purchase$31.50 29 Effect of Radiofrequency Use on Hip Arthroscopy Irrigation Fluid Temperature Original Research Article Pages 336-342 Frank McCormick, Kyle Alpaugh, Benedict U. Nwachukwu, Siyan Xu, Scott D. Martin Show preview | Related articles | Related reference work articles Purchase$31.50 Meta-analyses 30 Arthroscopic Single-Row Versus Double-Row Rotator Cuff Repair: A Meta-analysis of the Randomized Clinical Trials Original Research Article Pages 343-348 Shahin Sheibani-Rad, M. Russell Giveans, Steven Paul Arnoczky, Asheesh Bedi Show preview | Related articles | Related reference work articles Purchase$31.50 31 Accuracy of Magnetic Resonance Imaging in Grading Knee Chondral Defects Pages 349-356 Ming Zhang, ZhiGang Min, Netra Rana, HongJuan Liu Show preview | Related articles | Related reference work articles Purchase$31.50 32 Outcomes of Anterior Cruciate Ligament Reconstruction Using Single-Bundle Versus Double-Bundle Technique: Meta-analysis of 19 Randomized Controlled Trials Original Research Article Pages 357-365 Mai Xu, Shuguang Gao, Chao Zeng, Rui Han, Jinpeng Sun, Hui Li, Yilin Xiong, Guanghua Lei Show preview | Related articles | Related reference work articles Purchase$31.50 Systematic Reviews 33 An Evidenced-Based Examination of the Epidemiology and Outcomes of Traumatic Rotator Cuff Tears Original Research Article Pages 366-376 Nathan A. Mall, Andrew S. Lee, Jaskarndip Chahal, Seth L. Sherman, Anthony A. Romeo, Nikhil N. Verma, Brian J. Cole Show preview | Supplementary content | Related articles | Related reference work articles Purchase$31.50 34 Transosseous-Equivalent Rotator Cuff Repair: A Systematic Review on the Biomechanical Importance of Tying the Medial Row Review Article Pages 377-386 Nathan A. Mall, Andrew S. Lee, Jaskarndip Chahal, Geoffrey S. Van Thiel, Anthony A. Romeo, Nikhil N. Verma, Brian J. Cole Show preview | Related articles | Related reference work articles Purchase$31.50 35 Current Concepts in the Treatment of Acromioclavicular JointDislocations Review Article Pages 387-397 Knut Beitzel, Mark P. Cote, John Apostolakos, Olga Solovyova, Christopher H. Judson, Connor G. Ziegler, Cory M. Edgar, Andreas B. Imhoff, Robert A. Arciero, Augustus D. Mazzocca Show preview | Supplementary content | Related articles | Related reference work articles Purchase$31.50 36 Announcements Page 398 Show preview | PDF (32 K) | Related articles | Related reference work articles 本文引用地址: http://blog.sciencenet.cn/blog-394169-662984.html
个人分类: 科研应用|1481 次阅读|0 个评论
今日高绪仁骨科运动创伤关节镜门诊经典病例:踝关节外侧韧带损伤
热度 2 GaoXurenKnee 2012-12-7 20:13
今日高绪仁骨科运动创伤关节镜门诊经典病例:踝关节外侧韧带损伤
2012年12月07日周五高绪仁骨科运动创伤、关节镜专科门诊接诊挂号刷卡就诊32人,其他7人,合计39人。 今日高绪仁骨科运动创伤、关节镜专科门诊经典病例:踝关节扭伤之踝关节外侧韧带损伤Lateral Ligament Injury of the Ankle。 江苏省徐州医学院附属医院骨科  关节镜、膝肩肘踝关节外科、骨科运动创伤方向 高绪仁 高绪仁:每天以解决膝、肩、肘、踝关节问题为乐:) 每天努力提高自己的技术和服务水平 不仅仅是解决其膝、肩、肘、踝关节问题,更是给其带来希望、未来和新生!
个人分类: 骨科膝关节门诊|6200 次阅读|2 个评论
在北京积水潭医院创伤骨科跟李庭主任学习了《肱骨髁间骨折》
GaoXurenKnee 2012-11-27 20:40
在北京积水潭医院创伤骨科跟李庭主任学习了《肱骨髁间骨折》
2012年11月27日在北京积水潭医院创伤骨科跟李庭主任学习了《肱骨髁间骨折》。
个人分类: 肘关节|2628 次阅读|0 个评论
在北京积水潭创伤骨科跟公茂琪学习《肘关节创伤的影像学检查》
GaoXurenKnee 2012-11-27 20:38
在北京积水潭创伤骨科跟公茂琪学习《肘关节创伤的影像学检查》
2012年11月27日在北京积水潭医院创伤骨科跟公茂琪主任学习了《肘关节创伤的影像学检查》。
个人分类: 肘关节|2301 次阅读|0 个评论
在北京积水潭创伤骨科跟李莹学习《肘关节的功能解剖及手术入路》
GaoXurenKnee 2012-11-27 20:33
在北京积水潭创伤骨科跟李莹学习《肘关节的功能解剖及手术入路》
2012年11月27日在北京积水潭医院创伤骨科跟李莹主任学习《肘关节的功能解剖及手术入路》。
个人分类: 肘关节|3353 次阅读|0 个评论
下午研学北医三院郑卓肇《踝关节创伤的MRI应用》讲座
GaoXurenKnee 2012-11-25 19:05
下午研学北医三院郑卓肇《踝关节创伤的MRI应用》讲座
为了进一步提高自己进行踝关节创伤MRI核磁共振精准读片的能力,下午研学了北京大学第三医院影像科郑卓肇主讲的《踝关节创伤的MRI应用》。受益匪浅!感谢郑卓肇教授的辛勤总结和精彩讲课! 江苏省徐州医学院附属医院骨科  关节镜、膝肩肘踝关节外科、骨科运动创伤方向 高绪仁 高绪仁:每天以解决膝、肩、肘、踝关节问题为乐:) 每天努力提高自己的技术和服务水平 不仅仅是解决其膝、肩、肘、踝关节问题,更是给其带来希望、未来和新生!
个人分类: 足踝损伤与疾病|4827 次阅读|0 个评论
2012年11月23日高绪仁关节镜、骨科运动创伤门诊接诊36人
GaoXurenKnee 2012-11-23 18:00
2012年11月23日高绪仁关节镜、骨科运动创伤门诊接诊36人
个人分类: 骨科膝关节门诊|1800 次阅读|0 个评论
<膝关节创伤教程 如何采用前外侧手术入路治疗股骨远端髁间骨折>
GaoXurenKnee 2012-10-23 23:31
<膝关节创伤教程  如何采用前外侧手术入路治疗股骨远端髁间骨折>
傍晚,去骨科病房进行晚查房。见我的膝关节患者都恢复良好,在进行逐步康复锻炼中。 绕道值班室,和一研究生和一住院医师聊天。 该值班研究生问了我个问题: 股骨远端髁间骨折如何采用前外侧手术入路? 为更好地回答该研究生的问题,今晚总结制作了《膝关节创伤教程:如何采用前外侧手术入路治疗股骨远端髁间骨折?》演讲教学课件。该课件图文并茂,详细阐释了股骨远端前外侧手术入路的:患者体位、体表标志、切口、神经界面、浅层手术分离、深层手术分离、手术风险、如何保护腓总神经、如何扩大入路、如何向近侧延伸、如何向远侧延伸等。 江苏省徐州医学院附属医院骨科  关节镜、膝肩肘关节外科、骨科运动创伤方向 高绪仁 高绪仁:每天以解决膝、肩、肘关节问题为乐:) 每天努力提高自己的技术和服务水平 不仅仅是解决其膝、肩、肘关节问题,更是给其带来希望、未来和新生!
个人分类: 膝关节骨折|3732 次阅读|0 个评论
2012年9月21周五高绪仁膝肩关节、关节镜、运动创伤门诊接诊33人
GaoXurenKnee 2012-9-21 23:41
2012年9月21日周五高绪仁膝关节肩关节、关节镜、运动损伤专科门诊接诊挂号刷卡就诊27人,其他6人,合计33人。 今日膝关节、肩关节门诊经典病例:肩袖损伤Rotator Cuff Injury。 江苏省徐州医学院附属医院骨科  关节镜、 膝关节外科、 骨科运动医学 方向 高绪仁 高绪仁:每天以解决膝、肩关节问题为乐:) 每天努力提高自己的技术和服务水平 不仅仅是解决其膝、肩关节问题,更是给其带来希望、未来和新生!
个人分类: 骨科膝关节门诊|2361 次阅读|0 个评论
2012年9月7日高绪仁膝关节 关节镜 运动创伤门诊接诊30人
GaoXurenKnee 2012-9-7 16:45
今日经典病例:肩关节肩峰撞击综合征。
个人分类: 骨科膝关节门诊|2003 次阅读|0 个评论
关于创伤、精神打击后机体抵抗力下降原因推测
热度 1 blz0533 2012-2-6 15:49
有研究表明,在机体受到重大打击或刺激的情况下,在一定时间范围内机体的抵抗力出现大幅下降的现象,表现之一是血液中的有效免疫细胞绝对数量减少 20-50% ,由此得出结论认为,创伤患者死亡原因,一是不可医治的创伤本身,二是的抵抗力下降导致感染而死亡。 经对有关资料复习发现,血液中白细胞或淋巴细胞的绝对数量的降低,并不意味着机体损伤部位局部环境内免疫功能的降低,原因在于,发挥免疫功能的是结合到损伤或病变组织的免疫细胞,不是随血液一起流动的细胞。理由很简单,免疫细胞只有锚定到病变组织或病菌表面,才能发挥免疫功能,而在血液中滚动的细胞,如果没有结合免疫对象,便不能发挥其功能。 已有明确研究,机体在受到创伤等打击后,血液中的免疫细胞数量会有应激性增高,即血管内血细胞池中的细胞会迅速释放到血液中去,结合到血管表面或组织的细胞减少,这个时窗内机体的抵抗力迅速下降。由此,也可以解释为什么在人们情绪剧烈波动,特别是生活中一些不愉快事件等,机体表现出一些不适或临床症状,例如:疲乏、头晕、心慌、失眠等,有精力耗尽的感觉。同时,机体长时间处于负面情绪,容易诱发不良疾病,这也已经是定论。 创伤后免疫细胞的降低,可能有多重机制,其中之一是,创伤初期,血管细胞池过度释放(本身是动态平衡),尔后过度消耗,在一段时间内免疫细胞处于负平衡状态。这里有一个时间窗问题,可以设想,创伤、情绪等刺激刚发生时,细胞池细胞释放,随后免疫细胞游走到病变位置,免疫细胞发挥作用并消耗,此时如果机体不能有效的提供免疫细胞,细胞池出现“入不敷出”负平衡状态,虽然各种细胞总数不一定减少,流动的血液所含免疫细胞将减少,机体的抵抗力就会明显下降。如果机体能够迅速有效的补充细胞池,机体发病的可能性就会大幅降低,不表现临床症状或症状轻微。 应激发生时,血液细胞池的释放,是细胞的自主行为,且这种行为受体内多种信号机制的综合调控。机体接收到刺激信号,神经合成或释放某些激素或分子物质,与免疫细胞膜上的配体或配基结合,配体或配基空间构象发生活化型改变,暴露活性位点,迅速解除与血管壁细胞的锚定作用状态,释放入血。 应激后一定时间内,这种信号被“消化”后,即应激刺激峰值过后,另外的信息物质或信号发挥作用,诱导免疫细胞向“信号源”集中,此时,在病变部位会检测到大量的免疫细胞,有的甚至已经活化或功能结构改变。由于细胞池容量有限,细胞被消耗后,如果得不到迅速及时的补充,血液中细胞的数量将进一步减少。 当创伤等刺激逐渐消退,如创面结痂、情绪稳定等,细胞不再消耗,细胞池中细胞也将逐渐恢复到正常动态平衡状态,即机体产生 — 进出细胞池的动态平衡状态。 创伤、情绪剧烈波动往往伴随感染事件的发生,症状表现为发烧、脓痰等,中性粒细胞甚至脓细胞打量出现,免疫功能为主的淋巴细胞相对降低,尔后淋巴细胞、白细胞等逐渐恢复。实际上,中性粒细胞的生成比淋巴细胞更高效,补充时间更短。这是个时间差问题,重度颅脑创伤、重大精神打击状态下, 2 周内易发生重度感染,多数颅脑创伤患者也容易在这个时间窗内死亡,是临床的危险期, 2 周后,患者无论是否昏迷,生存率逐渐提高。 所以,创伤、精神打击等应激刺激发生后,可能不仅仅是免疫抑制问题,可能还有免疫储备耗尽所表现的问题。
7091 次阅读|3 个评论
两种灵魂创伤在中国
热度 7 LintaoLiu 2011-10-26 14:29
占绝大多数的劳苦大众当家作主是中国史无前例的一种现象,它发生于仆人(地富反坏右 + 干部)处于极少数的情况下,从建国一直持续到改革前夕。对曾经是主仆关系的这两类人群予以灵魂考察,有利于理解和治疗全体中国人的灵魂创伤。 不可否认的是:毛泽东及其政党确确实实: 1 )在理论上给予了劳苦大众崇高的政治地位(即主人); 2 )在实际中给予了劳苦大众强有力的经济基础(即土地)。建国后,劳苦大众切实感觉自己得到了解放,得到了尊敬,因而也就切实感觉成了国家的主人。考察那时劳苦大众的灵魂,你会发现那里面充满了对毛泽东及其政党的感恩,而毛泽东就是其中唯一神灵。因此,那时占绝大多数的劳苦大众确实过得很单纯,也很快乐,尽管他们是贫穷的,尽管他们中的三千万人因贫穷而丧生。 不可否认的又是:占绝大多数的劳苦大众当家作主既非民主,亦非文明,更非理智。 1 民主主要体现在民众拥有选举权和被选举权而不是大家一起当所谓的主人。因此占绝大多数的劳苦大众当家作主与民主本意不相符。事实上, 我们一直提倡的“人民当家作主”应是中国人的首创,只是中文“民主”的字面意思,而非民主的真谛。进而言之,民主注重平等,而“人民当家作主”本身就有不平等的含意。 2 劳苦大众当家作主的主要资格就是贫穷,这就为当了主人之后的劳苦大众提出难题:维持贫穷才有资格继续当主人,而走向富足意味着主人资格消失。因此,为了维护千载难逢的主人资格,他们宁愿选择继续贫穷。这显然是不文明的,除非认定贫穷是文明的一部分。 3 占绝大多数的劳苦大众当家做了主人,却发现很难找到仆人。占极少数的地富反坏右 + 干部不愿意成为他们的仆人,于是便被认作了敌人,这是一种不可理喻的认定。于是,秋风扫落叶式打击敌人的各种政治运动开始了 …… 这些政治运动尽管是毛泽东凭个人意志而发动的,但毫无疑问的是,占绝大多数的劳苦大众是运动的主角,他们在这些运动中继续保持着主人的感觉并由此快乐。天安门前红卫兵的狂欢并不是伪装出来,而从他们灵魂深处发出的。占绝大多数的劳苦大众不可能理智地承认:能够领导中国文明的并非占绝大多数的他们,而是占极少数的所谓敌人。他们更不可能从已经被毛泽东占据的灵魂深处认识到:建立在贫穷有理和造反有理基础上的快乐是不文明的,尽管它是一种快乐,尽管它属于绝大多数人。 考察那时占极少数的地富反坏右 + 干部(其中大多数为知识分子)的灵魂,那里面充满了迷茫、自卑和恐怖,但是毛泽东依然是其中的神灵。他们为了迎合这一神灵而拼命唾弃自己! 这是一种怎样的灵魂创伤呀!他们中只有极少数人的灵魂里没有毛泽东。林昭和张志新是例子。她们的灵魂没有迷茫、没有自卑更无恐怖,其中的信念是耶稣和真理。 改革开放之后,毛泽东的神圣地位被动摇,占绝大多数的劳苦大众的主人感觉及由此引发的快乐消失了,他们原本朴素的灵魂变得空洞,变得迷茫。这种空洞与迷茫至今依然持续在中国大多数国民心中,这是中华民族在经历愚昧之后转向文明所必须付出的代价,也是中华民族在转向文明的过程中必须救治的一种灵魂创伤。切莫轻视这种创伤,大家想想,把西方人灵魂中的耶稣抽去,结果会怎样? 改革开放之后,占极少数的地富反坏右 + 干部(其中大多为知识分子)的一部分开始承担起领导中国文明的责任,这是中国走向文明的标志。 但是,这并不意味着他们曾经的灵魂创伤已经痊愈而不需要救治,他们越来越清晰地感觉到:毛泽东是他们灵魂中挥之不去的梦魇,至少是个幽灵。 当前,两种截然不同的灵魂创伤,传染并折磨着中国。这两种灵魂创伤之剧,与中国经济发展之快形成鲜明的对照! 救治曾经的仆人的灵魂创伤,应始终:解放思想,倡导自由。 救治曾经的主人的灵魂创伤,应始终: 1 )激励国民自强自立并保证国民通过自强自立过上有尊严的生活; 2 )关注和帮助国民中的弱势群体。 救治这两种灵魂创伤必须建立在弘扬和创造人类优秀文化的共同基础之上。
个人分类: 生活|3066 次阅读|15 个评论
不知觉的损失
sstone2009 2010-12-28 20:23
科里住了一个患者,刚刚从一家县医院转来。十天前,患者左小腿被撞伤、胫腓骨骨折。受伤后第三天,装了外固定支架,固定骨折;在伤后第四天,患者一直发烧近39,不退;昨天做了切开减压手术。晚上转到我们科里。 上午查房,大概了解了情况,接下来的治疗计划是:防范可能存在的需要减压室间隔,防治肾功能损伤,改善患者的全身状况(血色素9.7、蛋白低、转氨酶高),继续换药、引流3~5天然后做一次清创手术(没有切除干净的坏死肌肉切除干净),5~7天后关闭创口,然后进行必要的功能康复和等候骨折愈合。患者的肢体应该可以保住,可是功能会很受损。 在作病例讨论的时候,我提出:这个患者,如果受伤后及时(争取6小时内)进行室间隔切开减压,应该可以避免大量肌肉组织坏死。 这是十分可惜的一个结果。 治疗的方案不同,导致的医疗费用相差很大,导致最后的预后也有很大的差别。
个人分类: 医疗实践|2788 次阅读|0 个评论
被预购的未来与第N次创伤
jlpemail 2009-11-9 15:06
马立克哈桑高中毕业应征入伍,在被陆军送入院校学习。当时他和羡慕过他的人可能会以为,诺大的一笔求学开支节省下来了。并且在毕业后还可以有不错的工作。 实际上,没有意识到的是:哈桑的未来已经被廉价预购了。从高中毕业到 40 岁,人生最富于活力和创造力的阶段被收购了,想提前解除合同都不能。 面向现役、退伍军人的心理咨询,不是什么好职业。那些遭受到战斗创伤的人,把自己的伤口和经历,不断展示和讲述给心理医生,其实是对于心理创伤的不断移植过程。在感受许多次创伤,也伤害了自己的同时,还要耐心地安慰那些受了伤害的人。心理医生们,不是机器人,他们在从业中,实际上经受了比咨询者多若干倍的创伤。因为他们自身是医生,自身的心理咨询问题法,反而无法解决了。 心理医生自杀的现象不鲜见。哈桑其实就是进行了变相的自杀。他无法摆脱恶梦一般的职业,只好以下策行事,走了极端。在崇尚强权、杀戮、暴虐的社会里,这不是很正常的现象吗?以暴力反对暴力以掠夺战胜掠夺,是符合老妈同志的观点的。 创伤后应激障碍(PTSD)不仅害苦了 现役、退伍军人,也害苦了作为心理咨询师的同样为现役的军中心理医生。只要 创伤后应激障碍的产生机制不消除,类似的情况还可能出现。因为 军中心理医生也是人,心理承受也有限度。 麻烦制造者其实是受害者。真正制造麻烦的是那些制造伤害的人员或者机构;他们在幕后躲藏,是揪不出来的。
个人分类: 科学书场|3674 次阅读|0 个评论

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