简介：AbstractPurpose:To avoid potential problems of double-bundle anterior cruciate ligament reconstruction (ACLR), various modifications have been reported. This study analyzed a novel technique of modified double-bundle (MDB) ACLR without implant on tibial side in comparison to single-bundle (SB) ACLR.Methods:Eighty cases of isolated anterior cruciate ligament tear (40 each in SB group or MDB group) were included. SB ACLR was performed by outside in technique with quadrupled hamstring graft fixed with interference screws. In MDB group, ACLR harvested tendons were looped over each other at the center and free ends whipstitched. Femoral tunnel was created by outside in technique. Anteromedial tibial tunnel was created with tibial guide at 55°. The anatomic posterolateral aiming guide (Smith-Nephew) was used to create posterolateral tunnel. With the help of shuttle sutures, the free end of gracillis was passed through posterolateral tunnel to femoral tunnel followed by semitendinosus graft through anteromedial tunnel to femoral tunnel. On tibial side the graft was looped over bone-bridge between external apertures of anteromedial and posterolateral tunnel. Graft was fixed with interference screw on femoral side in 10° knee flexion. International Knee Documentation Committee (IKDC), Tegner score, Pivot shift and knee laxity test (KLT, Karl-Storz) were recorded pre- and post-surgery. At one year magnetic resonance imaging (MRI) was done. Statistical analysis was done by SPSS software.Results:Mean preoperative KLT reading of (10.00 ± 1.17) mm in MDB group improved to (4.10 ± 0.56) mm and in SB group it improved from (10.00 ± 0.91) mm to (4.80 ± 0.46) mm. The mean preoperative IKDC score in MDB group improved from (49.49 ± 8.00) to (92.5 ± 1.5) at one year and that in SB group improved from (52.5 ± 6.9) to (88.4 ± 2.6). At one-year 92.5% cases in MDB group achieved their preinjury Tegner activity level as compared to 60% in SB group. The improvement in IKDC, KLT and Tegner scale of MDB group was superior to SB group. MRI confirmed graft integrity at one year and clinically at 2 years.Conclusion:MDB ACLR has shown better outcome than SB ACLR. It is a simple technique that does not require fixation on tibial side and resultant graft is close to native ACL.

简介：摘要目的调查ICU护士对脓毒症一小时bundle的知信行现状及影响因素，同时了解临床上脓毒症一小时bundle执行延迟可能的原因。方法便利抽取ICU护士为研究对象，采用自行设计的问卷调查ICU护士的一般资料、对脓毒症一小时bundle知信行的现状，以及可能导致脓毒症bundle延迟的原因。描述性统计ICU护士的一般情况、知识需求与来源现状，单因素方差、线性回归分析脓毒症bundle知信行的影响因素。结果共调查了全国17个省市，1521名ICU护士。脓毒症一小时bundle中知识维度得分为（9.57±2.70）分，信念维度得分为（27.96±5.35）分，行为维度得分为（53.04±6.90）分，总分均值为（90.58±10.60）分。单因素方差分析显示，不同年资、学历及能级的护士在知识、信念和行为得分上存在显著差异（P<0.05）。临床上导致bundle延迟的原因主要是取药不及时、不能及时接到通知等。结论ICU护士对脓毒症一小时bundle知识、信念、行为总体状况较好，但尚存在一些不足。应加强理念的更新，对于经验少、学历低的护士是重点培训对象。