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Objective To explore the key initiatives and effective methods for preparing the constructions of emergency-oriented hospitals under COVID-19 pandemic. Methods The wartime mechanism was strengthened by adhering to unified leadership, trengthening the top-level design and clarifying the division of responsibilities. Objective management was used as a means to take into account the key of personnel allocation and training, prevention and control of hospital infection, transformation of contagious ward, logistic support, equipment and material supply and construction of system and process. Results The preparations and constructions of the emergency-oriented hospitals were completed in 72 hours，which passed the acceptance and inspections from infection control experts，who appraised our work to be “the highest in difficulty, the fastest in project progress and the highest in quality". Totally, upon to the preparations，14 medical teams were set up and the layout process reestablishment of 14 wards was completed, the installation and preparation of nearly 10000 sets/pieces of medical equipment and medical materials were completed as well and more than 80 work systems and process systems for 9 major modules were established. Conclusion The preparations and constructions of emergency-oriented hospitals should be performed upon the thorough implementation of the decisions and arrangements by the municipal Party committee and the municipal government, insisting on the wartime thinking and establishment of high-quality management team and effective goal management focusing on details and actual needs of medical staff.
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Objective@#To explore the impacts of the imaging positions on the sagittal tilt of the pelvis and the imaging parameters of the hip joint.@*Methods@#From December 2015 to October 2016, a total of 78 female DDH patients (DDH group) who received Bernese periarticular osteotomy were enrolled, aged 28.41±9.91 years (range 18-49 years) with 135 hips. There were 21 cases on one side and 57 cases on both sides. Another 26 female volunteers without spinal and hip disease were enrolled as the control group, aged 23.54±5.58 years (range 18-49 years) with 52 hips. X-ray films of the anterior and posterior pelvis were performed in both groups. The pelvic sagittal tilt was evaluated by measurement (pubic symphysis to sacrococcygeal distance, PSSC), with lateral center-edge angle of Wiberg (LCEA), Tönnis angle (TA), and Sharp angle (angle of Sharp, SA) assessed the degree of hip dysplasia and assessed the horizontal positional relationship between the femoral head and the acetabulum using tear drop distance (TD). All data were measured twice by two measurers independently. The correlation between hip parameters and X-ray position was analyzed.@*Results@#The average PSSC in the supine and standing positions of the control group were 53.73±16.22 mm and 36.45±14.21 mm, respectively with significant difference-17.28±8.07 mm (t=-10.913, P=0.000). The PSSC of the supine and standing positions of the DDH group were 56.76±13.54 mm and 48.62±15.44 mm, respectively with significant difference-8.13±13.02 mm (t=-5.516, P=0.000). The PSSC of the standing DDH group was larger than that in the control group. There was no significant difference in the PSSC between the two groups in the supine position. Furthermore, there were no significant difference in the supine and standing PSSC between the unilateral and bilateral DDH patients (P>0.05). In the control group, the hip in supine and standing position, LCEA averaged 30.33°±4.69° and 29.70°±3.83° (P>0.05), and TA averaged 4.05°±3.51° and 4.36°±3.07° (P>0.05), respectively. SA averaged 40.53°±4.34° and 41.79°±3.16° (P>0.05), and TD averaged 6.80±0.98 mm and 6.65±1.30 mm (P>0.05), respectively. In the DDH group, the hip in supine and standing positions, LCEA averaged 3.07°±12.07° and 1.69°±12.11° (P<0.05), and TA averaged 22.62°±9.31° and 23.82°±9.45° (P>0.05), respectively. SA averaged 48.01°±4.68° and 48.49°±4.74° (P>0.05), respectively, and TD averaged 10.51±3.51 mm and 10.93±4.23 mm (P>0.05), respectively.@*Conclusion@#From supine to standing, the pelvis backward is the main trend in sagittal plane. In standing, the pelvis of female DDH patients is forward contrast with normal women. There was no difference in pelvic tilt between unilateral and bilateral DDH patients. Female DDH patients from the supine to standing, hip coverage decreased, while the femoral head appeared horizontally outward. The hip joint of DDH patients is unstable.
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Objective To explore the impacts of the imaging positions on the sagittal tilt of the pelvis and the imaging pa?rameters of the hip joint. Methods From December 2015 to October 2016, a total of 78 female DDH patients (DDH group) who received Bernese periarticular osteotomy were enrolled, aged 28.41±9.91 years (range 18-49 years) with 135 hips. There were 21 cases on one side and 57 cases on both sides. Another 26 female volunteers without spinal and hip disease were enrolled as the control group, aged 23.54±5.58 years (range 18-49 years) with 52 hips. X?ray films of the anterior and posterior pelvis were per?formed in both groups. The pelvic sagittal tilt was evaluated by measurement (pubic symphysis to sacrococcygeal distance, PSSC), with lateral center?edge angle of Wiberg (LCEA), T?nnis angle (TA), and Sharp angle (angle of Sharp, SA) assessed the degree of hip dysplasia and assessed the horizontal positional relationship between the femoral head and the acetabulum using tear drop dis?tance (TD). All data were measured twice by two measurers independently. The correlation between hip parameters and X?ray posi?tion was analyzed. Results The average PSSC in the supine and standing positions of the control group were 53.73±16.22 mm and 36.45±14.21 mm, respectively with significant difference-17.28±8.07 mm (t=-10.913, P=0.000). The PSSC of the supine and standing positions of the DDH group were 56.76± 13.54 mm and 48.62± 15.44 mm, respectively with significant difference -8.13±13.02 mm (t=-5.516, P=0.000). The PSSC of the standing DDH group was larger than that in the control group. There was no significant difference in the PSSC between the two groups in the supine position. Furthermore, there were no significant differ?ence in the supine and standing PSSC between the unilateral and bilateral DDH patients (P＞0.05). In the control group, the hip in supine and standing position, LCEA averaged 30.33°±4.69°and 29.70°±3.83°(P＞0.05), and TA averaged 4.05°±3.51°and 4.36°± 3.07°(P＞0.05), respectively. SA averaged 40.53°±4.34°and 41.79°±3.16°(P＞0.05), and TD averaged 6.80±0.98 mm and 6.65± 1.30 mm (P＞0.05), respectively. In the DDH group, the hip in supine and standing positions, LCEA averaged 3.07°±12.07°and 1.69°±12.11°(P<0.05), and TA averaged 22.62°±9.31°and 23.82°±9.45°(P＞0.05), respectively. SA averaged 48.01°±4.68°and 48.49°±4.74°(P＞0.05), respectively, and TD averaged 10.51±3.51 mm and 10.93±4.23 mm (P＞0.05), respectively. Conclusion From supine to standing, the pelvis backward is the main trend in sagittal plane. In standing, the pelvis of female DDH patients is forward contrast with normal women. There was no difference in pelvic tilt between unilateral and bilateral DDH patients. Female DDH patients from the supine to standing, hip coverage decreased, while the femoral head appeared horizontally outward. The hip joint of DDH patients is unstable.
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Objective To investigate the clinical characteristics of posterior malleolar ankle fracture, and the selection of the surgical approach. Methods From January 2013 to September 2015, 83 cases of posterior malleolar fractures were retrospectively analyzed. Haraguchi typing was performed based on the three-dimensional CT. There were 54 cases with HaraguchiⅠtype, 16 cases with HaraguchiⅡtype, and 13 cases with HaraguchiⅢtype. The patients who were HaraguchiⅠand Haraguchi Ⅲtypes accepted the operation with posterolateral approach. The patients who were HaraguchiⅡtype and combined medial malleolus fracture accepted the operation with medial approach. The HaraguchiⅡpatients who were not combined medial malleolus fracture were used the medial paraachilles approach. Images of the ankle joint were filmed 2 weeks, 4 weeks, 12 weeks, 6 months and 12 months after the surgery. The healing time, complications and corresponding record outcome were determined by X-ray and clinical examination. At the last follow-up, ankle function and quality of life of patients were evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and SF-36. Results Eighty-three patients were follow-up for 6-24 (mean 15.4± 6.2) months. The fractures healed on X-ray. The average X-ray healing time was from 12 to 24 (mean 18.6±4.2) weeks. AOFAS score was 71 to 100 (mean 88.4±8.4) points. Sixty-seven cases were excellent, 14 cases were good, 2 cases were moderate, and good rate was 97.59%. SF-36 physiological score was 31.6-69.2 points(mean 48.4 ± 4.8 points);SF-36 psychological score 28.6-64.5 points(mean 45.8 ± 3.5 points). Chronic ankle pain was complained by one patient. He was diagnosed traumatic arthritis, oral non-steroidal drugs was used to relief his ankle pain. One patient wound infected, and healed after treatment. No instrument failure and fracture displacement were found. Conclusion According to fracture morphology and clinical features after posterior malleolar ankle fracture, different surgical approaches are selected, which will be satisfied with the outcome.
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Objective To explore the early clinical efficacy of posteromedial approach for treatment of posterior bicondylar tibial plateau fractures.Methods From October 2010 to December 2013,data of 13 patients of posterior bicondylar tibial plateau fracture who were treated with plate and screw fixation through posteromedial approach were retrospectively analyzed.There were8 males and 5 females,in which 7 cases located in the left knee and 6 cases located in the right knee,with an average age of 41.5±6.6 years.An inverted L shaped posteromedial incision was made in the operation.If the fracture line was involving the posteromedial condyle,a locking anatomical plate or L shaped compression plate was used.A 3.5 mm T shaped plate was used to support the posterolateral condyle.Allogeneic bone was used to support the articular surface in the cases with obvious bone defect.Rasmussen score was used for radiological assessment,and HSS knee score was used for efficacy assessment 12 months postoperative.An anteroposterior view and lateral view of the knee were obtained 2,4,12 weeks,6 months and 12 months postoperation.The fracture healing time was judged by X-ray and clinical examinations,additionally,the complications and corresponding outcomes were also recorded.Results All 13 patients had obtained an average of 20.8±9.4 months follow-up (range,8-34 months),and all fractures were healed.The healing time in terms of X-ray was 12 to 24 weeks (mean,15.6±5.2 weeks).After surgery,the Rasmussen score was 1-18 points (mean 15.8 points).7 cases achieved excellent results,4 good,and 2 fair.The excellent and good rate was 84.6％.HSS knee score improved significantly from 38.2±7.8 points (range,26-48 points) to 85.2±7.8 points (range,56-92 points) 12 months postoperation,and the results was excellent in 9 cases,good in 2,fair in 1 and poor in 1,with total excellence and good result of 84.6％.The range of knee activity was 95°-130°.None of the skin and soft tissue complications such as infection,breakage of screw loosening occurred at the time of the latest follow-up,but two cases got chronic pain in the knee postoperation.In the follow-up period,a mild knee gap narrows had been observed in one patient and traumatic arthritis was diagnosed.The pain was partial relieved by oral non-steroidal drugs and intra-articular injection of Sodium Hyaluronate.The other one's pain was significantly relieved by oral non-steroidal drugs,and X ray film shows the knee joint gap has no obvious narrow.Conclusion Posteromedial approach for treatment of posterior bicondylar tibial plateau fractures can obtain a satisfactory therapeutic effect.
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Objective To explore the initial effects of the treatment of proximal femoral nail-helical blade (PFNA) in elderly patients with intertrochanteric fracture of the incomplete lateral wall type. Methods A total of 25 patients were enrolled in this study including 8 cases of type A2, 17 cases of type A3 according to AO classification. All patients under-went three-dimensional CT scan. In all patients with type A2 fracture, there were 6 cases with coronal plane fracture on the greater trochanter, and PFNA was used instead of DHS when an iatrogenic fracture occurred in 2 patients. All other patients were treated with closed reduction and fixed with PFNA. Results All patients healed and the average healing time was 11 weeks, one patient fell down once again and the fracture occurred on the shaft, when a long PFNA was used, both of the frac-tures healed 14 weeks after surgery. In all of the 25 patients,1 patient died due to cerebral hemorrhage 13 months after sur-gery;2 patients needed walking aids due to the presence of osteoarthritis of the knee and calf muscular venous thrombosis was diagnosed in 3 cases. No complications were found in the other patients, such as infection, nonunion and fixation failure. According to the Harris hip score system, there were 14 cases of“excellent”,8 cases of“good”,2 cases of“fair”and1 pa-tient of“poor”.Conclusion The PFNA treatment can provide a good fixation for intertrochanteric fractures of incomplete lateral wall type, which allow patients to do exercise early and achieve an excellent initial outcome.
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Objective To explore the recent clinical efficacy of closed reduction and cannulated screws internal fixation for the treatment of Ideberg Ⅲ type glenoid fractures.Methods From October 2005 to January 2012,9 cases of Ideberg Ⅲ type gleuoid fractures with closed reduction and cannulated screws internal fixation were studied retrospectively,including 6 males and 3 females,4 cases on the left and 5 on the right,with the average age of 42.2 years (range,28-56).There were three cases combined with clavicle fractures,take S-shaped incision reset for clavicle reconstruction and plate fixation.Three cases combined with acromioclavicular joint dislocation were used the hook plate fixation,and 3 cases with combined acromion fracture were used tension band wire fixation.Suspension structures in the reconstruction of the shoulder glenoid fracture underwent closed reduction and cannulated screw internal fixation.After giving adjustable shoulder abduction brace,rehabilitation exercises were performed under the guidance of doctors.After 1,6 weeks,and 3,6,12 months,X-ray examinations at anteroposterior shoulder view were conducted.By X-ray and clinical examination to determine the fracture healing time,to assess shoulder function with the American Shoulder and Elbow Society (ASES) scoring system,and recorded complications and corresponding outcome.Results Nine cases were obtained from 12 to 46 months,the average (30.8±9.1) months follow-up all fractures healed,with an average healing time of X-rays 12 to 24 weeks,mean (16.8±4.8) weeks.After 12 months surgery,row ASES scores was 82.3 (range,57-95),compared with the preoperative difference was statistically significant.ASES scores were excellent in 5 cases,good in 2,fair in 1 and poor in 1.One patient with traumatic arthritis obtained satisfactory clinical results through oral nonsteroidal drugs and intra-articular injection of sodium hyaluronate.No screw loosening,fracture fixation failure complications were observed.Conclusion Closed reduction and cannulated screws internal fixation of Ideberg Ⅲ type glenoid fractures recently obtained satisfactory results.
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BACKGROUND:There are many reports on the clinical effect of total knee arthroplasty in the treatment of advanced rheumatoid arthritis, but the reports on the effect of total knee arthroplasty on the disease activity in patients with rheumatoid arthritis are rare. Therefore, the more clinical evidences are needed for supporting. OBJECTIVE:To explore the effect of total knee arthroplasty on disease activity in patients with rheumatoid arthritis. METHODS:109 patients with rheumatoid arthritis were included;48 cases in the replacement group, and received total knee arthroplasty combined with internal medicine medications;the 61 cases in the drug treatment group were treated with simple internal medicine medications. The rheumatoid factor, blood sedimentation rate and C-reactive protein levels of the patients in two groups were measured before treatment, 1 and 2 years after treatment, and the Ishikawa joint function scoring criteria was used to assess the functions. RESULTS AND CONCLUSION:There were no significant differences in the rheumatoid factor, blood sedimentation rate and C-reactive protein levels between two groups before treatment (P>0.05). At 1 and 2 years after treatment, the indicators in the drug treatment group were higher than those in the replacement group (P<0.05);the indicators in the two groups at 2 years after treatment were significantly lower than those before treatment (P<0.05). The rheumatoid arthritis symptom scores of the affected joints of the patients in two groups were significantly improved, especial y the pain, swel and subjective attitudes, and the replacement group was better than the drug treatment group (P<0.05). The total knee arthroplasty can affect the disease activity of rheumatoid arthritis in short-term, and the effect of total knee arthroplasty is better than simple drug treatment.