ABSTRACT
Objective To explore the effect of primary exchange reamed nailing (ERN) and augmentation compression plating (ACP) combined with autogenous bone grafting (ABG) on health-related quality of life in patients with dystrophic or atrophic nonunion of femoral shaft after intramedullary nailing. Methods The study used a prospective study method. Sixty- two patients with femoral shaft nonunion after intramedullary nailing from August 2010 to October 2016 were selected, and the patients were divided into ERN group (group A, 32 cases) and ACP group (group B, 30 cases) by random digits table method. In group A, isthmus nonunion was in 18 cases (56.2％), and non-isthmus nonunion in 14 cases (43.8％); in group B, isthmus nonunion was in 16 cases (53.3％), and non-isthmus nonunion in 14 cases (46.7％ ). The health- related quality of life was compared between 2 groups, including physical component summary (PCS) and mental component summary (MCS) in the- 12- item short form health survey (SF- 12), brief pain inventory- severity (BPI- S) and brief pain inventory- interference (BPI- I). Results Fifty-four patients were followed-up for more than 1 year, and the mean follow-up time was 18.3 (13 to 37) months. All patients successfully achieved bone union, and the mean time was 5.8 (4 to 8) months. Significant improvements in terms of SF-12 PCS and SF-12 MCS score were noted after operation for patients with isthmus nonunion in both groups (t=3.148, 2.156, 2.456 and 2.559; P < 0.05), but there were no significant differences before and after operation in group A with non-isthmus nonunion (P >0.05). At the last follow-up, SF-12 PCS and SF-12 MCS in group B were significantly improved compared with those in group A: (45.2 ± 5.8) scores vs. (33.6 ± 4.7) scores and (48.8 ± 6.5) scores vs. (39.4 ± 5.6) scores, and there were statistical difference (P<0.05); SF-12 BPI-S and BPI-I showed obvious relief: (4.6 ± 2.1) scores vs. (6.2 ± 2.5) scores and (5.2 ± 1.9) scores vs. (6.8 ± 2.7) scores, and there were statistical differences (P<0.05); however there were no statistical difference in SF-12 PCS, SF-12 MCS, BPI-S and BPI- I between 2 groups (P>0.05). Conclusions Compared with ERN combined with ABG, ACP combined with ABG can significantly improve the quality of life in patients with dystrophic or atrophic nonunion of femoral shaft after intramedullary nailing. It has greater advantage on the improvement of health-related quality of life, especially for patients with non-isthmus nonunion.
ABSTRACT
Objective To investigate the effect of vascular endothelial growth factor (VEGF) on the leukocyle function in a rat denervated infect flap model and to investigate the action mechanison of VEGF in the flap anti-infection .Methods An island pedicle flap measured 2 cm × 2 cm was raised on the right abdomen of sixty wister rats ,which were divided into three groups .All flaps re-ceived intradermal inoculation of 107 Staphylococcus aureus ,and the animals were observed for 96 h .The indexes of the leukocyte count ,leukocyte vitality ,hemiluminescence of neutrophils ,tissue bacterial count ,naked eyes observation of falptissue and the light microscope observation were detected .Results The leukocyte count in the exudation at postoperative 96 h had no statistical differ-ences among 3 groups(P>0 .05);while in the indexes detection of the leukocyte vitality ,chemiluminescence of neutrophils ,tissue bacterial count ,etc .,the comparison between the chronic denervated group and the control group showed very significantly differ-ences(P<0 .01);the differences between the VEGF treatment group and the chronic denervated group was very significant (P<0 .01) .The falp pathological change in the control group and the VEGF treatment groups was slight .Conclusion The soft issue af-ter losing the innervation decreases the leukocyte function .VEGF might improve the flap micro circulation and play an important role in improving the leukocyte function .