A comparative study of the therapeutic effect between long and short intramedullary nails in the treatment of intertrochanteric femur fractures in the elderly / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To compare the clinical effects of long vs. short intramedullary nails in the treatment of intertrochanteric fractures in old patients more than 65 years old.</p><p><b>METHODS</b>A retrospective analysis of 178 cases of intertrochanteric fractures of the femur (AO type A1 and A2) in the elderly was conducted from January 2008 to December 2013. There were 85 males (47.8%) and 93 females (52.2%) with the age of 65e89 (70.2±10.8) years. The patients were treated by closed reduction and long or short intramedullary nail (Gamma 3) fixation. The length of short nail was 180 mm and that for long nail was 320e360 mm. The general data of patients, operation time, intraoperative blood loss, length of hospital stay, preoperative hemoglobin level, blood transfusion rate, postoperative periprosthetic fractures, infections, complications, etc were carefully recorded.</p><p><b>RESULTS</b>There were 76 cases (42.7%) in the long intramedullary nail group and 102 cases (57.3%) in the short nail group. All the cases were followed up for 12e48 (21.3±6.8) months, during which there were 21 deaths (11.8%), mean (13.8±6.9) months after operation. The intraoperative blood loss was (90.7±50.6) ml in short nail group, greatly less than that in long nail group (127.8±85.9) ml (p=0.004). The short nail group also had a significantly shorter operation time (43.5 min±12.3 min vs. 58.5 min±20.3 min, p=0.002) and lower rate of postoperative transfusion (42.3% vs. 56.7%, p=0.041). But the length of hospital stay showed no big differences. After operation, in each group there was 1 case of periprosthetic fracture with a total incidence of 1.1%, 1.3% in long nail group and 0.9% in short nail group. At the end of the follow-up, all patients achieved bony union. The average healing time of the long nail group was (6.5±3.1) months, and the short nail group was (6.8±3.7) months, revealing no significant differences (p=0.09). Postoperative complications showed no great differences either.</p><p><b>CONCLUSION</b>Both the intramedullary long and short nail fixation has a good clinical effect in treating intertrochanteric femur fractures in the elderly. They showed no significant difference in terms of therapeutic effect, hospital stay and postoperative complications. The incidence of periprosthetic fractures treated by either length of nails was low. But short intramedullary nailing can obviously decrease the intraoperative blood loss, operation time and postoperative blood transfusion.</p>

A meta-analysis of clinical outcomes after laparoscopic operation for rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical outcomes after laparoscopic surgery for rectal cancer.</p><p><b>METHODS</b>A systematic literature search (Medline, Embase, Cochrane Library) as of March 2010 was performed to identify all eligible studies. Two reviewers independently screened and extracted the data. Differences in short-term and long-term clinical outcomes after laparoscopic resection (LR) and open resection (OR) were analyzed using RevMan 5.</p><p><b>RESULTS</b>A total of 1042 abstracts were retrieved and 16 clinical controlled studies finally included. The total number of patients was 2850. There were 1145 patients received LR and 1705 received OR. The analyses showed that LR had longer operative time (WMD=42.50, 95%CI: 29.27 to 55.74, P<0.05), less harvested lymph nodes (WMD=-0.94, 95%CI: -1.47 to -0.41, P<0.05), and less blood loss (WMD=-158.46, 95%CI: -221.08 to -95.84, P<0.05) as compared to OR. LR was superior to OR in terms of surgical mortality (OR=0.40, 95%CI: 0.18 to 0.92, P=0.03), postoperative complications (OR=0.73, 95%CI: 0.61 to 0.87, P<0.05), and 5-year overall survival rate (OR=1.56, 95%CI: 1.21 to 2.02, P<0.05). There was no significant difference in positive rate of circumferential resection margin between the two groups (OR=1.00, 95%CI: 0.45 to 2.20, P=1.00).</p><p><b>CONCLUSION</b>Compared to open surgery, short-term and long-term clinical outcomes after laparoscopic surgery are favorable.</p>