ABSTRACT
Objective To investigate the mid-and long-term effects of metal-on-metal hip resurfacing arthroplasty (HRA),and to analyze its related factors.Methods A total of 64 patients (81 hips) who underwent metal-on-metal HRA from June 2005 to January 2013 were recruited in the present study.There were 35 males (44 hips) and 29 females (37 hips) with the mean age of 48.26±10.45 years (20-65 years),including 47 unilateral and 17 bilateral HRAs.The cohort consisted of osteoarthritis secondary to the developmental dysplasia of the hip (23 cases,29 hips),necrosis of the femoral head (19 cases,22 hips),osteoarthritis (8 cases,10 hips),rheumatoid arthritis (5 cases,9 hips),ankylosing spondylitis (6 cases,8 hips),pigmented villonodular synovitis (2 cases,2 hips) and Otto's disease (1 case,1 hip).During the follow-up duration,radiographic features,including acetabular inclination angle,stem-femoral shaft angle,component loosening,osteolysis,femoral neck narrowing and heterotopic ossification,were evaluated by hip X-rays in straight and froglike position.The size and type of pseudotumor were assessed by MRI and ultrasonography.Clinical efficacy was evaluated by Harris hip score and the University of California at Los Angeles (UCLA) hip score.Considering revision surgery as the end point,the component survivorship was calculated.Results The mean follow-up was 7.98±2.21 years,ranging from 5.0 to 12.8 years.The mean postoperative Harris hip score (92.01 ±5.69) was higher than the preoperative score (41.93 ±9.09).The mean postoperative UCLA pain,walking,function,activity scores (9.37±0.86,9.14± 1.01,8.77± 1.09,6.47± 1.27,respectively) were improved when compared with the preoperative UCLA scores (3.57± 1.23,5.99± 1.30,5.00± 1.01,3.84± 1.41,respectively).The postoperative flexion,abduction and adduction,medial and lateral rotation of the hip was larger than the preoperative ones.Complications occurred in 10 hips (12.3％,10/81).Seven patients (8 hips) experienced early and intermediate complications,including one intraoperative femoral nerve injury,one deep femoral artery and saphenous nerve injuries during the same surgery,one unexplained pain of hip,one femoral neck fracture,three hips of heterotopic ossification,and one pseudotumour.There were mid-and long-term complications in two hips,including one narrowing of the neck and one pseudotumour which was occurred at 9 years.There was one patient (2 hips) underwent revision surgery twice at 5 months and 9 years.The former cause of revision was femoral neck fracture and the latter one was pseudotumour.The Kaplan-Meier survivorship was 98.8％ at five years,and 95.0％ at ten years.Conclusion Patients who underwent metal-on-metal HRA could obtain good mid and long-term results.Pseudotumour and unexplained pain of the hip are critical factors which can affect the mid-and long-term results and survivorship of metal-on-metal HRA.
ABSTRACT
Objective To evaluate the safety and efficacy of transcatheter arterial chemoembolization (TACE) combined with transjugular intrahepatic portosystemic shunt (TIPS) in the patients with primary liver cancer complicating cirrhosis portal hypertension.Methods Twenty-two cases of TACE combined with TIPS due to decompensation of liver cancer complicating cirrhosis portal hypertension in this hospital from January 2011 to January 2015 were collected as the combined group and 28 cases of liver cancer complicating cirrhosis portal hypertension treated only by TACE without conducting TIPS were screened out as the control group.The curative effect and prognosis of the two groups were observed.Results The success rate of TIPS was 100％,the preoperative portal pressure was (38.4±7.6) cm H2O and the postoperative portal pressure was (28.4±7.7)cm H2O,the difference was statistically significant (P＜ 0.05);the preoperative portal vein diameter was (16.2 ±2.5)mm and postoperative portal vein diameter was (13.3±1.8)mm,the difference was statistically significant (P＜0.05).The postoperative 1-year stent patency rate was 95％ and 2-year stent patency rate was 90％.The postoperative 1-year and 2-year re-bleeding rates in the control group were 60.7 ％ and 78.5 ％ respectively,which in the combined group were 9.1％ and 13.6 ％ respectively,the differences were statistically significant (P＜0.05).The 1-year accumulated survival rate in the combined group was 81％,2-year accumulated survival rate was 68％,and the median survival time was 53 months,while the 1-year accumulated survival rate in the control group was 78 ％,2-year accumulated survival rate was 15 ％,and the median survival time was 17 months,the differences were statistically significant (P＜0.05).Conclusion Conducting TACE combined with TIPS in the patients with primary liver cancer complicating cirrhosis portal hypertension can safely and effectively control the tumor development,reduce and even eliminate the portal hypertension syndrome,and increase the life quality and survival rate.
ABSTRACT
Objective To investigate the correlation of oxygen extraction rate (ERO2) with blood lactate clearance rate and cardiac output (CO) in the early stage of post-restoration of spontaneous circulation (ROSC) in patients resuscitated from cardiogenic cardiac arrest,and to analyze the relationship between the ERO2 and prognosis.Methods Fourteen patients successfully resuscitated from in-hospital cardiogenic cardiac arrest in the emergency ICU from October 2012 to January 2014 were retrospectively analyzed.These patients were assigned to survival group (n =5) or death group (n =9) as per the outcome at 72 h after ROSC.At admission (0 h),3,6 and 12 h after ROSC,arterial blood and venous blood were drawn to detect ERO2 and lactate clearance rate.Cardiac output (CO) was measured by thoracic impedance method,APACHE Ⅱ scores were assessed,and survival time was recorded.Results The patients in the death group died during the period of 12-72 hours after ROSC.The significantly decreased ERO2 at 6 h and 12 h after ROSC,and decreased blood lactate clearance rate and decreased CO at 3 h,6 h and 12 h after ROSC were found in the death group compared with the survival group (all P ＜ 0.05).The ERO2 at 6 h and 12 h after ROSC was significantly positively related to blood lactate clearance rate (r =0.857,r =0.947,both P ＜ 0.05) and CO (r =0.968,r =0.936,both P ＜ 0.05) at 3 h,6 h and 12 h after ROSC.The ERO2 at 6 h and 12 h after ROSC was significantly negatively related to APPACHE Ⅱ score (r =-0.970,r =-0.973,both P ＜ 0.05);APPACHE Ⅱ scores were significantly negatively correlated with blood lactate clearancerates (r=-0.880,r=-0.899,r=-0.850,all P＜0.05) and CO (r=-0.876,r=-0.922,r=-0.916,all P＜0.05) at 3 h,6 h and 12 h after ROSC.Conclusions The ERO2 at 6h after ROSC may be used to assess the severity and prognosis of patients resuscitated from cardiogenic cardiac arrest.