ABSTRACT
Objective To study the superiority of severe multiple trauma treatment model based on damage control strategy. Methods In the intergrated injury first-aid mode, the intensive care unit-guided damage control strategy was used to treat severe multiple trauma. Results A total of 789 severe multiple damage patients were treated with damage control strategies in our hospital from December 2018 to December 2018. Sixty-nine patients died and the survival rate was 91.25％. Conclusions The intensive care unit-guided trauma control strategy has a satisfactory clinical effect in the treatment of patients with severe multiple trauma.
ABSTRACT
Muscle atrophy caused by nerve injury is a common and difficult clinical problem. The development of stem cell researches has opened up a new way for the treatment of nerve injury-induced muscle atrophy. The induced pluripotent stem cells(iPSCs)can differentiate into various types of cells and have more advantages than embryonic stem cells (ESCs). After being transplanted into the damaged area, iPSCs are guided by neurogenic signals to the lesion sites, to repair the damaged nerve, promote generation of axon myelination, rebuild neural circuits and restore physiological function. Meanwhile, iPSCs can also differentiate into muscle cells and promote muscle tissue regeneration. Therefore, it would be possible to attenuate muscle atrophy caused by nerve injury with iPSCs treatment.
Subject(s)
Animals , Humans , Disease Models, Animal , Embryonic Stem Cells , Induced Pluripotent Stem Cells , Cell Biology , Transplantation , Muscular Atrophy , TherapeuticsABSTRACT
BACKGROUND:Microtubule-associated protein-2 is a kind of important regulatory factor in regulating tubulin assembly. As one of the main members of microtubule-associated proteins, microtubule-associated protein-2 plays an important role in the repairing and development of the nervous system function. It has been found that microtubule-associated protein-2 can promote the repair and rebuilding of injured nerves. OBJECTIVE:To summarize the relationship between microtubule-associated protein-2 and nerve injury as wel as the mechanism of action. METHODS:The PubMed database and CNKI database were retrieved by the fist author for the articles related to microtubule-associated protein-2 published from January 1976 to January 2015. The key words were“microtubule-associated protein-2 (MAP-2), nerve injury, progress”in English and Chinese, respectively. In the same field, articles published recently or in authorized journals were preferred. Repetitive or old articles were excluded, and final y 82 articles were included in result analysis. RESULTS AND CONCLUSION:Microtubule-associated protein-2 is involved in nerve repair, and plays a promoting role in neuronal morphology and plasticity. To increase the concentration of microtubule-associated protein-2 contributes to the recovery of neurologic function in the early stage after nerve injury.
ABSTRACT
BACKGROUND:Nonunion is a common clinical problem of bone fracture. For decades, with the help of internal/external fixation materials, popularization of microsurgical technique, innovation of bone graft materials, especial y molecular biology techniques, breakthrough progress has been made in the treatment of nonunion. OBJECTIVE:To summarize the research progress of treatment in nonunion and to provide better technology theory and choices of method for the treatment of nonunion in future. METHODS:The PubMed database and CNKI database were retrieved by the first author for the articles related to reason and treatment method of nonunion published from January 1990 to May 2013. The key words were “fracture nonunion, treatment, progress”. For the articles in the same field, those published recently or in authorized journals were selected. RESULTS AND CONCLUSION:The repetitive and old articles were eliminated, and final y 48 articles were selected for further analysis. At present, two methods can be used in the treatment of nonunion, including nonsurgical method and surgical method, the surgical method is utilized more frequently and more efficiency in clinic. Fracture healing is the complex process involving various aspects, and once the nonunion occurred, different patients should be treated with different methods, and the combination of various surgical and nonsurgical methods can be used if necessary to obtain satisfactory effect. But al the treatment methods should pay attention to soft tissue protection.
ABSTRACT
Objective To evaluate and compare the clinical effects of proximal femoral nail antirotation blade (PFNA) with reverse less invasive stabilization system-distal femur (LISS) in the treatment of proximal femoral fractures associated with coxa vara. Methods From June 2007 to June 2010, A retrospective study with more than 10 months follow-up of 46 patients with proximal femoral fractures associated with coxa vara underwent PFNA or reverse LISS were carried out, including 24 with PFNA and 22 patients with reverse LISS. The physical status of patient was evaluated according to the American Society of Anesthesiologists (ASA) score. After the operation, the operation duration and volume of blood loss were assessed in the two groups, respectively. At the last follow-up, full weight bearing time, fracture healing time, and neck-shaft angle discrepancy related to contralateral side without fracture of the each group were assessed, respectively.Functional recovery was evaluated according to Parker and Palmer mobility score. Results The average follow-up period was 11.2 months (range, 10-12). All the fractures healed successfully and reached bony union.There were no significant differences between PFNA group and reverse LISS group for the average ASA score, the average operating time, the average volume of intraoperative bleeding and Parker and Palmer mobility score. The patients were allowed full weight-bearing from 9.33 weeks after surgery in PFNA group and from 16.95 weeks in reverse LISS group. The patients reached bony union after 17.21 weeks after surgery in PFNA group and from 30.73 weeks in reverse LISS group. Comparing with PFNA group, neck-shaft angle discrepancy decreased in reverse LISS group. Conclusion The results of PFNA and reverse LISS in the treatment of proximal femoral fracture were satisfactory. The fracture treated by PFNA allowed earlier weight bearing. Reverse LISS could provide better support for neck-shaft angle to avoid coxa vara more effectively.
ABSTRACT
BACKGROUND: Internal fixations with plate and screw or K-wira tension band are widely used in treating olecranon fracture; however, the internal fixations need to remove by a second surgery. OBJECTIVE: To retrospective analyze the therapeutic effect of treating olecranon fracture using biodegradable tension band. METHODS: Nine olecranon fracture patients received at the Shanghai East Hospital of Tongji University from July 2006 to April 2009 were selected. All patients were treated by biodegradable tension band fixation which comprises absorbable screw and absorbable suture. Elbow joint functional exercises were performed at 3 weeks after plaster extema! fixation. The patients were followed up for 12 months, and the therapeutic effect was measured by X-ray films and Mayo score of elbow joint function. RESULTS AND CONCLUSION: Imaging examination showed that the fracture healing well in all cases, and the fracture line was blurred. No ulnar nerve compression, fracture, or fracture displacement could be seen. Biodegradable tension band fixation can provide adequate intensity for functional exercises, which has the virtue of effective fixation without a second surgery to remove fixation. It is believed to be a good method for the treatment of olecranon fractures.
ABSTRACT
Objective To investigate the necessity of releasing the distal holdfast fibers of the flexor retinaculum(DHFFR) during endoscopic carpal tunnel release(ECTR).Methods The Experiment Group included 16 cases.The operation was conducted under brachial plexus anesthesia without the use of tourniquet.A 1 cm skin incision was made.The USE system(Universal Subcutaneous Endoscope System) was employed.Both flexor retinaculum(FR) and distal holdfast fibers of the flexor retinaculum were cut off.Postoperative outcomes were compared with another 16 cases of flexor retinaculum release only(Control Group).Results Follow-up evaluation was carried out at 6 postoperative months.According to the Kelly's criteria,there were 13 cases of excellent results and 3 cases of good results in the Experiment Group,and 8 cases of excellent,5 cases of good,and 3 cases of fair results in the Control Group.Significant difference was obser red in flameda Ⅱ or Ⅲ grade patients between the two groups in carative effects(?~2=6.278,P=0.043).No serious complications or postoperative recurrence occurred.Conclusions Flexor retinaculum is not the only structure existing in the carpal canal to be released.More attention should be paid to complete decompression of both flexor retinaculum and distal holdfast fibers of the flexor retinaculum,especially in those who have serious symptoms.
ABSTRACT
<p><b>BACKGROUND</b>To evaluate the clinical significance of predicting post-operative respiratory failure in patients with lung cancer using cardiopulmonary exercise test (CPET).</p><p><b>METHODS</b>Before operation, 260 patients with lung cancer underwent CPET with incremental protocol. W%, VO₂%P, VO₂/kg, AT, MET, O₂ pulse, VTe, BF and VE were measured in the end of load exercise.</p><p><b>RESULTS</b>(1) In patients after pneumonectomy, the values of the above indexes of CPET in the respiratory failure group were significantly lower than those in the non-respiratory failure group ( P < 0.05 or P < 0.01) except VTe. In patients after lobectomy, the values of 9 indexes of CPET in the respiratory failure group were similar to those in the non-respiratory failure group ( P > 0.05). However, when the patients after lobectomy were further divided into groups of upper and lower lobectomy, W% in the respiratory failure group was remarkably lower than that in the non-respiratory failure group after lower lobectomy ( P < 0.05). (2) Chi-Square test showed that abnormality of CPET indexes in different degrees was related to the morbidity of respiratory failure after pneumonectomy. Logistic regression showed that O₂ pulse < 80% and BF < 30/min correlated with the morbidity of post-operative respiratory failure. (3) For predicting post-operative respiratory failure, the sensitivity and specificity of VO₂%P < 60%, BF < 30/min, VE < 35 L/min were all more than 60% and their negative predictive values were all more than 90%.</p><p><b>CONCLUSIONS</b>CPET is suitable to predict post-pneumonectomy respiratory failure. As a comprehensive index indicating cardiopulmonary function during exercise, VO₂%P < 60% should be selected to predict respiratory failure and evaluate indication of lung resection for patients with lung cancer.</p>
ABSTRACT
<p><b>BACKGROUND</b>To explore the characteristics of exercise cardio-pulmonary function and its possible influencing factors in patients with lung cancer.</p><p><b>METHODS</b>The pulmonary function, ECG and exercise cardio-pulmonary function were measured in 198 patients with lung cancer and 20 healthy controls.</p><p><b>RESULTS</b>1. Compared with healthy group, VO₂%P, VO₂/kg, AT, VO₂/HR%, VE and VT/VC significantly decreased in lung cancer patients with normal resting pulmonary ventilation, however, BR remarkably increased (P < 0.05 or P < 0.01). 2. In patients with normal resting pulmonary ventilation, there was no significant difference of exercise cardio-pulmonary function between the central and peripheral lung cancer groups. 3. The exercise cardio-pulmonary function was closely related to the TNM stages (P < 0.05 or P < 0.01). 4. W%, VO₂%P , AT and VO₂/HR% in patients with great vessel invasion were remarkably lower than those without great vessel invasion (P < 0.05 or P < 0.01).</p><p><b>CONCLUSIONS</b>The results suggest that exercise ventilation is impaired in lung cancer patients with normal resting ventilation. And the decrease of exercise cardio-pulmonary function may be related to TNM stage and to great vessel involvement.</p>
ABSTRACT
Objective To introduce a new technique--Carpal tunnel release by Okutsu's technique Methods A 1cm skin incision was made under local anaesthesia without tourniquet. The procedure was performed by system (Universal Subcutaneous Endoscope System). Postoperative functional assessment was done by Kelly's standards. Follow-up was conducted in the first, third and twelve month after the operation. Results One hundred and forty-nine sides of 126 cases of CTS were treated with this method. And seventy eight sides of 69 cases of CTS were followed up. 54 cases were excellent; 19 cases good; 3 cases fair; 2 cases poor. The average time of the operation was ten minutes. There was less blood lost in the procedure. Complication occurred in one case. Conclusions As compared with open procedure, the method has advantage of minimal incision,less tissue damage, shorter operation time, less skin scar and no postoperatioven plastic splint. The therapeutic results was as efficient as routine procedure.
ABSTRACT
Objective To study the ulnar nerve and its adjacent structures in the forearm and understand the anatomic basis for endoscopic harvesting of the ulnar nerve for the treatment of brachial plexus avulsion injury. Methods Ulnar nerves and their adjacent structures in 6 formaldehyde solution fixed upper limb specimen and 26 fresh upper limb specimens were carefully dissected and observed and measured. The entry path and implementation were designed according to the observations. Simulated operation was performed in 6 fresh autopsy specimens Results In the forearm, ulnar nerve passes through the flexor carpi ulnaris under the medial epicondyle of the humerus and the dorsal branch of the hand passes between the ulnar bone and flexor carpi ulnaris. Also the ulnar nerve descends through intermuscular space, accompaning the ulnar artery in the distant part of the forearm and the artery lies laterally along the nerve. The simulated operations were successfully done in all the 6 specimens. Conclusions The anatomy of the ulnar nerve in the forearm is fairly fixed with no crossing with important structures in its path, incisions of 1～2cm are made above the pisiform bone and under the medial epicondyle of the humerus 3～5cm respecitvely, After isolation of the ulnar nerve's two crosses from the muscle, the remaining part of the ulnar nerve and its adjacent structures are easily dissected. It is concluded that it is safe and reliable to harvest the ulnar nerve in the forearm with endoscopy.
ABSTRACT
Objective To introduce our surgical experience and techniques of endoscopic carpal tunnel release (ECTR) by Chow technique (two-portal technique). Methods A total of 30 endoscopic procedures in 25 patients with carpal tunnel syndrome (CTR) were performed. Results Follow-up evaluations for 1～12 months were made in all the patients. The sensibility of radial 3 fingers and a half returned to normal at postoperative 4～6 weeks in 20 sides of 18 patients. The greater thenar atrophy and opposition dysfunction in 10 sides of 7 patients disappeared at 8～12 postoperative weeks. No serious complications occurred in this series. Conclusions ECTR by Chow method has advantages of short incision, minimal invasion and rapid recovery, being an easy, safe and reliable minimally invasive procedure.
ABSTRACT
Objective To evaluate the endoscopic tendon sheath release for stenosing tenovaginitis (trigger finger). Methods Five patients with stenosing tenovaginitis (2 in thumbs, 1 in middle finger, and 2 in ring fingers) underwent operations by Smith & Nephew Endoscopic Trigger Finger Release system. After two 3.0mm transverse incisions were made, the window cannula assembly was inserted subcutaneously along the sheath from the proximal portal and advanced until it passed through the distal portal. Then a 2.7 mm endoscope was passed into from the proximal portal and a retrograde knife was introduced into the operative site from the distal portal. Finally the entire length of sheath was sectioned under direct endoscopic vision. Results All operations were successfully completed. Finger's flexion and extension function recovered immediately after the operations. All the patients restarted their employment one week postoperatively. There were no complications such as distinct pain or delayed wound healing in these patients. Conclusions This method has the advantages of minimal invasion, safety, effectiveness and quick recovery, especially suited to diabetic patients or multiple trigger fingers.