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Objective To analyze the status quo of joint surgeons' research level,explore possible influence factors for their research capacity.Methods A total of 140 joint surgeons from third grade hospital andsecondary hospital in Beijing were selected.The self-rating scale of scientific research was used for evaluation.Subjects were divided into two groups according to the high and low level of scientific research ability.In the middle and low level group,factors including age,working years,job title,education level,training opportunities,team situation,research activity time,hospital level,and job satisfaction were analyzed.Results The total scores of the research subject were distributed from 12 to 115,with a median of 69.5 (40～90).The four dimensions,accounted from low to high were statistical knowledge,software operation,scientific research basis and thesis writing.According to the single factor analysis,age,education level,chance of training,presence or absence of team,time of scientific research activities,hospital level,satisfaction with work were related to the level of scientific research capacity of joint surgeons (P＜0.05);multiple regression results shows that the impact level of scientific research,from large to small,is whether there are scientific research teams,job satisfaction,and time for scientific research activities.These three factors can explain the change of scientific research ability by 60.5％ (R2 =0.605).Conclusions The joint surgeon's research capacity is at a relatively high level,while the statistical knowledge and software operation scores are low,which calls for more study and mastery.Increasing the construction of scientific research teams,improving job satisfaction,and increasing the time for scientific research activities can improve the scientific research capacity.
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Objective:To describe the surgical technique of direct anterior approach to total hip arthroplasty and to report the early clinical outcomes.Methods: A series of 100 consecutive,unselected patients who had 116 primary total hip arthroplasty surgeries (16 bilateral) done through direct anterior approach from March 11 2015 to June 21 2016 was reviewed.There were 50 male patients and 50 female patients.The average patient age was 51 years,and the average body mass index was 24.69 kg/m2.The preoperative diagnosis included avascular necrosis of femoral head,hip osteoarthritis,osteoarthritis se-condary to acetabular dysplasia,sequelae of hip old infection,ankylosing spondylitis,rheumatoid arthritis and avascular necrosis of femoral head after cannulated screws fixation of femoral neck fracture.There were 7 hips which had surgical history prior to the index hip arthroplasty,including 3 cases with bone graft treatment for avascular necrosis of femoral head through Smith-Peterson approach,2 cases with acetabular shelf procedures for acetabular dysplasia through Smith-Peterson approach,and 2 cases with cannulated screws fixation for femoral neck fracture (internal fixation residual).All were uncemented hips.The stems used in this study included 67 Triloc stems (DePuy company,USA),45 Corail stems (DePuy company,USA),2 Accolade stems (Stryker company,USA),1 Synergy stem (Smith-Nephew company,USA) and 1 Polarstem (Smith-Nephew company,USA).Results: The average follow up period was 8.5 months,the average incision scar length was 10 cm,and the average postoperative Harris score was 93.62.There was 95％ postoperative leg length discrepancy within 3 mm.The average cup inclination angle was 38.7°with 94.8％ in the range of 30° to 50°.The average cup anteversion angle was 14.3° with 94.2％ within the target range of 5° to 25°.The were 15 (12.9％) operative complications,including two femoral perforations (changing stem from Triloc to Corail),three calcar fractures (treated with cerclage wires),four greater trochanter fractures (2 were treated wire tension band,and 2 nondisplaced fractures untreated),one deep infection (debridement and retaining of the prothesis),one superficial infection (debridement),one hematoma and three wound healing complications (debridement).All the complications were successfully treated without any sequelae at the end of the latest follow-up.There was no postoperative dislocation.There was no major nerve and vascular injuries.There were 35 cases (30.2％) reporting symptoms of lateral femoral cutaneous nerve palsy.Conclusion: Direct anterior approach to total hip arthroplasty allows accurate and reproducible cup orientation positioning and leg length restoration and decreases the risk of postoperative dislocation,which is helpful for early rapid postoperative recovery.
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Objective To investigate the risk factors of acute exacerbation of chronic obstructive pulmonary disease(AECOPD) combined with respiratory failure.Methods The clinical data of 120 patients with AECOPD combined with respiratory failure were retrospectively analyzed.The patients were divided into disease improved group (96 cases) and disease serious group (24 cases,including death) according to the treatment outcome.Risk factor and treatment strategies of the two groups were statistically analyzed.Results There was no significant difference in age,sex,disease course and arterial blood oxygen partial pressure(P ＞ 0.05).The body mass index,albumin,pH,successful cough and expectoration rate,nutritional support rate,and noninvasive mechanical ventilation rate in disease improved group was higher than that in disease serious group[(28.5 ± 9.8) kg/m2 vs.(23.3 ± 7.4) kg/m2,(21.4 ± 7.9) g/L vs.(19.3 ± 6.8) g/L,7.23 ± 0.20 vs.7.11 ± 0.17,79.2％ (76/96) vs.25.0％ (6/24),58.3％ (56/96) vs.33.3％ (8/24),81.2％ (78/96) vs.62.5％ (15/24)],arterial blood carbon dioxide partial pressure,mild consciousness obstacle rate,multiple drug-resistant infections rate,fungal infection rate,nasal feeding rate,hormone use time and the incidence of heart failure,pulmonary encephalopathy,hepatorenal function damage and upper gastrointestinal bleeding in disease improved group was lower than that in disease serious group [(10.08 ±1.71) kPa vs.(11.98 ± 2.03) kPa,13.5％ (13/96) vs.58.3％ (14/24),22.9％ (22/96) vs.41.7％ (10/24),0 vs.29.2％ (7/24),50.0％(48/96) vs.75.0％(18/24),(5.3 ± 1.3) d vs.(11.3 ± 3.8) d,8.3％(8/96) vs.25.0％(6/24),13.5％(13/96) vs.70.8％(17/24),28.1％(27/96) vs.41.7％(10/24),5.2％(5/96) vs.12.5％(3/24)],and there was significant difference (P ＜ 0.05).Conclusion Complicating disease,nutritional status,consciousness,capability of sputum exclusion,the degree of respiratory infection,treatment with noninv asive positive pressure ventilation,arterial gas analysis index are the correlated factors of prognosis in AECOPD combined with respiratory failure.