ABSTRACT
Esophagogastric variceal bleeding (EGVB) is one of the main complications of decompensated portal hypertension, especially in patients with liver cirrhosis, and it often has a high mortality rate. Medication combined with endoscopy is the main prevention and treatment method for EGVB, while transjugular intrahepatic portosystemic shunt (TIPS) combined with variceal embolization can also be selected for some high-risk patients, and individualized diagnosis and treatment of portal hypertension based on hepatic venous pressure gradient should become the latest consensus and the main strategy. This article mainly reviews endoscopic therapy and TIPS for the prevention and treatment of EGVB patients with decompensated portal hypertension in terms of selection of indications, incidence rate of complications, and respective advantages and disadvantages.
ABSTRACT
Objective To evaluate the effect of external fixation at first stage combined with intr-amedullary nail internal fixation at second stage on treating open fracture of tibial shaft. Methods A total of 80 patients with open fracture of tibial shaft treated in our hospital from April 2016 to April 2017 were selected as the subjects. According to the treatment methods,they were divided as control group and obser-vation group with 40 cases in each group. The control group was given intramedullary nail internal fixation and the observation group was given external fixation at first stage combined with intramedullary nail inter-nal fixation at second stage. The general operation condition of the two groups was observed and the frac-ture reduction,healing and Rasmussen score were compared between the two groups. The difference of the circumference and pain degree between the two groups after 1,3 and 7 days were compared. Results The operative excellence rate of the observation group was significantly higher than that of the control group, and there was no difference in circumference and pain between the two groups after 1 day. The circumfer-ence and pain in the observation group was lower than that of the control group after 7 days postoperative-ly,and there was no difference in the Rasmussen score between the two groups after 1 month. The Rasmus-sen scores in the observation group were higher than those in the control group after 3 and 6 months post-operatively. The healing time and the time of callus formation in the observation group were shorter than those in the control group. Conclusion External fixation at first stage combined with intramedullary nail-ing internal fixation at second stage has better therapeutic effect on treating open fracture of tibial shaft.
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Objective To investigate the effect of minimally invasive plate osteosynthesis combined with locking compression plate fixation on postoperative fracture healing and serum levels of and serum nerve growth factor (NGF),vascular cell adhesion molecule (s VCAM),alkaline phosphatase (ALP) in patients with limb comminuted fracture.Methods From January 2014 to May 2016,seventy-four patients with limb comminuted fracture in the Eighth People's Hospital of Shanghai were enrolled in this study and randomly divided into the control group (37 cases) and the study group (37 cases).The traditional incision and reduction fixation were used in the control group.The study group was treated with locking compression plate internal fixation combined with minimally invasive plate bone grafting technique.The patients were followed up for 1 ～ 4 months after operation.The clinical efficacy,perioperative indicators (operation time,intraoperative blood loss,fracture healing time),serum (nerve growth factor,vascular cell adhesion molecule,alkaline phosphatase) levels change at the time of admission and after first D and complications rate were statistically compared.Results The total effective rate of the study group was 97.30％ (36/37),higher than that in the control group (78.38％ (29/37)),and the difference was statistically significant (x2 =4.554,P＜0.05).The operation time of the study group was (84.76 ± 11.08) min,longer than that of the control group ((71.89 ± 10.54) min),the intraoperative blood loss of the study group ((108.52 ± 21.33) ml) was less than that of the control group ((245.30±24.61) ml),and the fracture healing time of the study group ((9.04 ± 1.81) weeks) was shorter than that of the control group ((12.79 ±2.02) weeks),and the difference was statistically significant (t =5.119,t =25.547,t =8.410,P＜ 0.05).The levels of serum NGF,s VCAM and ALP in the two groups after operation were higher than those before operation,and the levels of serum NGF ((1.33±0.19) ng / L) and ALP ((312.04±31.07) U/L) in the study group were higher than those in the control group ((0.85 ± 0.22) ng/L,(181.28±30.45) U/L),and the level of serum s VCAM ((502.18±40.07) μg/L) was lower than that in the control group ((579.28 ± 41.15) μg/L),and the difference was statistically significant (t =10.044,18.283,8.165,P＜0.05).The incidence of complications in the study group was 8.11％ (3/37),lower than that in the control group (27.03％ (10/37)),the difference was statistically significant (x2 =4.573,P ＜ 0.05).Conclusion Minimally invasive plate osteosynthesis combined with locking compression plate fixation in the treatment of limb comminuted fracture can shorten the healing time of the fracture,improve the treatment effect,improve the levels of serum NGF,s,VCAM and ALP,and it have lower complication rate with higher safety.
ABSTRACT
Objective To observe the efficacy of anatomical locking plate combined with anchor nail internal fixation and clavicular hook plate in the treatment of Neer Ⅱ distal clavicle fracture and their impact on shoulder function.Methods Eighty patients with Neer Ⅱ distal clavicular fracture treated in the Eighth People's Hospital in Shanghai from January 2015 to December 2016 were divided into observation group and control group,each group 40 cases.The observation group was treated with anatomical locking plate combined with anchor nail,the control group was treated with clavicular hook plate.The efficacy,operation time,intraoperative blood loss,fracture healing time,postoperative hospital stay,shoulder function score and incidence of complication were observed in the two groups.Results The excellent rate was in the observation group was higher than that in the control group (97.50%(39/40) vs.80.00%(31/40),χ2=2.477,P0.05);the fracture healing time in the observation group was longer than that of the control group ((23.65±2.19) w vs.(26.9±3.46) w,P<0.01).The shoulder joint Constant-Murley score in the observation group was (86.02±5.19) points,control group (68.46± 6.94) points,the difference was statistically significant (P<0.01).Observation group showed 2 cases of pain around acromion,the incidence rate of complications was 5.00%(2/40);7 cases in the control group had pain around acromion,2 cases suffered from impingement syndrome and 1 cases had delayed union,the incidence rate of complications was 25.00% (10/40).Conclusion Anatomical locking plate combined with anchor nail internal fixation is effective in the treatment of Neer II distal clavicle fracture.It has the advantages of fast fracture healing,good functional recovery of shoulder joint and less complications.