ABSTRACT
Objective:To investigate the clinical effect and short-term and long-term effect of total hip replacement (THA) and hemiarthroplasty of hip (HA) in elderly patients with femoral neck fracture (FNF).Methods:59 elderly patients with FNF in South District of Guang′anmen Hospital, Chinese Academy of Traditional Chinese Medicine from March 2017 to January 2019 were retrospectively analyzed. The observation group ( n=29) was treated with THA; The control group ( n=30) was treated with HA. The operation related indexes, short-term and long-term clinical effect (average follow-up of 24.1 months), hip function improvement, pain and complications were compared between the two groups. Short term and long-term clinical effects: the short-term and long-term clinical effects of the two groups were observed by the Harris Hip Score (HHS) of the first month, the third month, the sixth month, the ninth month and the first year after operation. Results:Both THA and HA were effective on elderly FNF, but the effective rate of THA (96.6%) was significantly higher than that of HA (90.0%), with statistically significant difference ( P<0.05); in terms of operation related indicators, compared with the control group, the observation group had longer operation time [ (104.46±3.24)min vs (84.34±3.64)min], more amount of bleeding [(296.64±15.16)ml vs (281.44±12.16)ml], lower postoperative drainage volume [(101.24±4.15)ml vs (74.56±3.24)ml], while the functional recovery of the observation group was better than the control group by HHS ( P<0.05); the postoperative complications and HHS score of observation group were significantly lower than the control group ( P<0.05). Conclusions:THA has the advantages of low complication, fast functional recovery and better effect. The clinical decision should be based on the patient′s physical condition. THA should be used for elderly patients with good basic condition, good surgical tolerance and more daily activities. HA should be used for elderly patients with poor basic condition, low surgical tolerance and less daily activities.
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Objective To evaluate the safety and efficacy of 192Ir intraluminal brachytherapy for the prevention of urethral re-stricture after transurethral incision or transurethral resection of scar. Methods From Mar. 2004 to Jun. 2006,48 patients aging 18-81 years were treated by 192Ir intraluminal brachytherapy. The length of stricture(0.5-5.5 era) was≤3.0 cm in 90% of the patients. The stricture was caused by trauma in 23 patients and prostate hyperplasia operation in 19 patients. The cause of remaining 6 patients was unclear. All patients were diagnosed by urethra photograph or endoscopy. Radiotherapy was the initial treatment in 26 patients and the second time treatment in 22. The irradiation dose was from 14 Gy to 18 Gy.Results The median follow up was 10 months,and the total response rate was 98%. Only one patient recurred and received transurethral incision again. The uresis was fluency in 47 patients and the maximum flow rate was 13.9-36.4(19.2±10.3) ml/s. No secondary urethral bleeding or urethral cancer was observed.Conclusions Being a safe and feasible treatment, ,192Ir intraluminal brachytherapy following transurethral incision or transurethral resection of scar can effectively prevent urethral re-stricture.
ABSTRACT
[Objective]To observe the bone repairing efficacy of large segmental femur defects in rabbits with calcium phosphate cement(CPC)combined with bone morphogenetic protein(BMP)and massive bone allograft,which may benefit the clinical application of large segmental bone allograft transplantation.[Method]Fifty-four New Zealand white rabbits were divided into three groups and a 2 cm femur defect was created on one side of each rabbit,followed by implantation with:CPC combined with BMP and massive bone allograft(Group A),bone allograft only(Group B)and autograft transplantation(Group C).Intramedullary nails with a 3 mm diameter fixed all the grafts transplanted.The bone defect repair efficacy was evaluated by radiology and histology exam at 4,8 and 12 weeks after operation.[Result]The bone reparation capacities of allograft with CPC/BMP complex was better than that of the allograft alone after 4 ~8 weeks of transplantation,which were similar to the result of autograft transplantation.Complete bone union was achieved for all the groups after 12 weeks of operation,with better bone remodeling for group A and group C transplantation.The healing process of CPC/BMP combined with allograft transplantation was featured with large amount of bone callus forming surrounding the graft-host bone union area and the surface of allograft,which composd the extra cortical bone bridge and ingrowth(EBBI).Bone invasion,resorption as well as new bone genesis were seen in the surface of bone allograft at early stage,companied by expansion of Haversians canal,with more lanner cells,osteoblasts,osteoclasts and blood cells inside the allograft.CPC was slowly biodegraded with the bone graft resorption and new bone regeneration.[Conclusion]CPC combined with BMP can improve the bone reparation and substitution process in massive bone allograft transplantation for the treatment of large segmental bone defects.