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@#Objective To summarize the surgical experience of infants with transposition of the great arteries (TGA) and intramural coronary artery (IMCA) in our center, and analyze the early and mid-term outcomes. Methods We retrospectively analyzed the clinical data of 384 infants with TGA undergoing arterial switch operation (ASO) from June 2010 to December 2018 at Fuwai Hospital. According to operative records, 21 (5.5%) infants had IMCA, among whom 20 were males, with a median age of 33 (9-319) d. Coronary transfer using double coronary buttons with unroofed intramural course was performed in all 21 infants. Results There was no statistical difference in the early mortality after ASO between infants with IMCA and infants with normal coronary anatomy (9.5% vs. 3.0%, P=0.15). In the IMCA group, 2 dead patients presented inadequate coronary artery perfusion after first aortic unclamping. In addition, 1 patient underwent extracorporeal membrane pulmonary support for myocardial dysfunction. The follow-up was available for all 19 survivors, with an average follow-up time of 29.0-120.0 (74.8±27.3) months. During the follow-up, all patients had no obvious symptoms, death, reoperation, or coronary complications. One patient developed moderate pulmonary valve regurgitation and another patient developed distal stenosis of the right pulmonary artery. Conclusion For infants with TGA and IMCA, coronary transfer using double coronary buttons with unroofed intramural course is a safe and reliable technique, with satisfactory early and mid-term outcomes.
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@#Objective To summarize the clinical characteristics and outcome of tricuspid valve replacement (TVR) in children aged no more than 14 years, and to discuss the selection of prosthesis. Methods From September 2002 to August 2019, 14 patients aged no more than 14 years who received TVR were included in our study. There were 9 males and 5 females, with a mean age of 9.8±4.3 years. Results Mechanical prosthesis was implanted in 8 patients, and bioprosthesis in 6 patients. The mean cardiopulmonary time and aortic-clamp time was 170.3±109.8 min and 95.1±63.1 min, respectively. The mortality within 30 days after surgery was 21.4% (3/14), and all 3 patients died of severe low cardiac output syndrome. Eleven patients were followed up for 34-199 (100.1±57.4) months. During the follow-up, mechanical prosthesis dysfunction occurred in 3 patients, 2 of whom received secondary TVR. One patient died during the follow-up. Conclusion The bioprosthesis is the first choice for TVR in children. Some long-term complications may occur after TVR, and close follow-up and timely intervention are needed.
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Objective Preparing platelet rich gel through two-times centrifugal technique and co-culturing chondrocytes with PRG, then observing the proliferation and gene expression of chondrocytes, in order to provide a favorable way to prepare tissue engineering cartilage. Methods Centrifugating venous blood of rabbit through two-times centrifugal technique to obtain platelet rich plasma( PRP) ,then detecting the concentration of various growth factor in PRP. Admixing PRP with chondrocytes of rabbit and activating them with activator. After co-culti-vation,the proliferation of chondrocytes through MTT method and expression of ACAN,CollagenⅡand SOX-9 through realtime-PCR were ob-served,and compared with common cultured chondrocytes. Results The concentrations of PDGF-AB,TGF-β1,IGF-1 and VEGF in PRG were significantly higher than those in blood(P<0. 05). After co-cultivation, the proliferation rate of chondrocytes and the expression of ACAN,Collagen Ⅱ and SOX-9 were significantly higher than that of common cultured chondrocytes(P<0. 05). Conclusion Co-culturing chondrocytes with PRG is able to promote the proliferation and gene expression of chondrocytes. We considered that it is a excellent method to construct tissue engineering cartilage.
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Objective To compare the long term efficacy of total hip arthroplasty and half hip arthroplasty in the treatment of elderly patients with femoral neck fracture .Methods 70 elderly patients with femoral neck fracture who needed hip replacement were randomly divided into the observation group and control group ,35 cases in each group.The observation group was given total hip arthroplasty ,while the control group was given half hip arthroplasty . The postoperative long term effect was compared between the two groups .Results The overall incidence rate of post-operative infection of the observation group was higher than the control group ,the postoperative revision rate of the ob-servation group was lower than the control group ,but the differences between the two groups were not statistically sig-nificant(P>0.05).The overall incidence rate of postoperative chronic pain in the control group was 22.86%,which was higher than 2.28%of the observation group,the difference was statistically significant (χ2 =5.130,P<0.05). The postoperative Harris score of the observation group was (93.25 ±4.51)points,which was significantly higher than (82.76 ±3.82)points of the control group,the difference was statistically significant (t=6.973,P<0.05).The ex-cellent and good rate of the observation group was 91.43%,which was significantly higher than 71.43%of the control group,the difference was statistically significant (χ2 =6.492,P<0.05).Conclusion Total hip arthroplasty in the treatment of femoral neck fracture can reduce the incidence of postoperative pain ,improve hip function of the patients , and its long-term effect is better than single hip replacement surgery ,which should be widely applied in clinical .
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BACKGROUND: Limb salvage operations with preservation of the epiphysis (LSPPE) had been used clinically in order to overcome discrepancy of affected limb and poorer limb function, but more post-operation complications existed, including infection, grafting bone resorption, fracture and internal fixation cinch.OBJECTIVE: To study the clinical related matters of inactivated bone replantation with preservation of the epiphysis in children limb salvage with osteosarcoma.DESIGN: Clinical observation regularly.SETTING: General Hospital of Jinan Military Area Command of Chinese PLA.MATERIALS: Eleven patients corresponded selected standard and accepted treatment from January 1999 to January distal metastasis was found with lung X-ray check and CT scanning, the patient would be excluded this study. There were 5 males, 6 females, and the mean age of (8±2) years old (4-11 years). The disease history was 1-6 months.FO) were adopted. After 2 weeks of chemotherapy, the operations of inactivated bone replantation with preservation of the epiphysis were performed. The operation was performed under epidural or general anesthesia. The patient lied on operating table. The knee anteriomedialis incision was adopted. Firstly, femur periosteum was opened beyond proximal end 2-3 cm from tumor, subperiosteum stripping was done to the proximal femur, descend femur with wire saw, separated and disconnected aboral periosteum, blunt dissecting femur aboral blood vessel and nerves to the popliteal fossa,deligating blood vessel around the tumor. Attachment of gastroenemius was cut off. Epiphyseal plate was identified carefully. According to pre-operation MR, the distal femur descend level was determined and the femur was descend with electro-saw. It was determined with cytology that no tumor cell existed in descend level, and reconstruction of bone de-fect with inactivated tumor-bone shell with 95% alcohol and bone cement containing ADR (20 g bone cement: 10 mg ADR), the diaphysis was fixed by intramedullary nail and screws were inserted in the residual epiphysis for the osteosynthesis of the distal osteotomy. One drainage tube was placed into and closed incision The affected limb was protected with plaster cast. Post-operative treatment: Regular usage of antibiotics was adopted to prevent infection. The drainage tube was pulled out when drainage amount ＜ 50 Ml/24 hours. The progressive passive exercise was initiated during the protection of affected limb with plaster cast for 8 weeks. Twelve to 14 days after operation, stitches were taken out. The postoperative chemotherapy then initiated, drug and dosage were identified on the response to the preoperative chemotherapy. Eight weeks after operation, patients were permitted to walk with the protection of double crutches and ery analysis: To observe ncision healing and existing of nerve and blood vessel injure, or not. During follow-up, patient recoveries were determined with affected knee function, limb length, distal metastasis, post-operative complications and dynamic imaging inspection of bone healing.imaging inspection of bone healing.MAIN OUTCOME MEASURES: ① The response to chemotherapy was evaluated with tumor cell necrosis rate. ② Post-operative recovery was determined with parameters such as knee function, limb length, distal metastasis, etc. ③ Dynamic imaging inspection of bone healing.MAIN OUTCOME MEASURES: ① The response to chemotherapy was evaluated with tumor cell necrosis rate. ② Post-operative recovery was determined with parameters such as knee function, limb length, distal metastasis, etc. ③ Dynamic imaging inspection of bone healing.RESULTS:All patients in this study were done follow-up.①The histological response of 11 patients to preoperative chemotherapy were classified as 7 in gradeⅣ,4 ingrade Ⅲ.②Post-operation recovery:No nerve and blood vessel injury existed and all incision healed well,there was not incision infection and healing.Eleven patients were followed-up from 10 to 72 months.Three patients could flexed affected knee joint ≥110,90-110 in 3 cases,60-90 in 4 cases,＜60 in one patient .The length of both lower extremity equaled in 4 cases,the length of affected limb was shorter than 2.0 cm in 5 cases,2.0-3.0 cm in 2 cases. One patient with recurrence,two with metastasis,three died.Screw cinch in one patient and one patient with inactivated bone fracture. ③Dynamic imaging inspection: No recurrence was found around epiphysis. Essential bone healing existed between the inactivated bone and epiphysis,callus formation between the inactivated bone and diaphysis at 2 months after operation; more callus formed and 4 months; 6 months after operation,bone complete healing was found between the inactivated bone and diaphysis.④Post-operation recovery:During follow-up, a screw cinch was found in one patient, and dislodged the screw because of bone healing well. One patient underwent open reduction, bone grafting and internal fixation with encircle device because of inactivated bone fracture.four months of the operation, grafting bone healed well. At post-operative 24 months, the length of both lower extremities equaled and the affected knee flexed to 110°.CONCLUSION: Inactivated bone replantation with preserving epiphysis for osteosarcoma in children was propitious to recover limb function and keep limb length.