ABSTRACT
Objective:To investigate the clinical effect of locking plate combined with large autologous iliac bone implantation in treatment of complex proximal humeral fractures with comminuted proximal humerus and bone defect.Methods:A retrospective case-control study was conducted to analyze the clinical data of 52 elderly patients with proximal humeral fracture accompanied by comminuted and bone defect admitted to General Hospital of Jizhong Energy Xingtai Mining Group from January 2014 to March 2017. including 24 males and 28 females, aged 65-79 years, with an average age of 69 years. There were 36 patients with Neer's three-part fracture and 16 four-part fracture. Twenty-two patients were treated using locking plate combined with large autologous iliac bone graft (plate+ bone graft group), and 30 patients were treated using locking plate alone (plate group). The deltoid-pectoralis major approach was used in both groups. Operation time, bleeding volume and bone healing time were recorded. neck-trunk angle and shoulder joint range of motion were measured at the last follow-up . MOS 36-item short-form health survey (SF-36) score and visual analog scale (VAS) score were used to evaluate shoulder joint function and pain at last follow-up. Complications were observed as well.Results:All patients were followed up for 6-24 months, with an average of 17. 8 months. Operation time was (120.3±12.5)minutes in plate+ bone graft group, and (115.6±5.8)minutes in plate group ( P<0.01). Intraoperative bleeding volume was (400.8±15.8)ml in plate+ bone graft group and (300.2±16.2)ml in plate group ( P<0.05). Bone healing time was (2.2±0.5)months in plate+ bone graft group and (2.5±0.5)months in plate group ( P>0.05). At last follow-up, the neck-trunk angle was (132.3±10.6)°in plate+ bone graft group and (121.1±4.5)° in plate group ( P<0.01); the uplift and external rotation of shoulder joint was (149.2±3.7)° and (35.2±2.9)° in plate+ bone group, better than that in plate group [(135.1±2.1)°, (27.8±4.5)°] ( P<0.05). Meanwhile, the abduction and extension of shoulder joint was (118.4±13.9)°and (36.1±1.8)°in plate+ bone graft group, not significantly different from that in plate group [(110.8±21.9)°, (32.8±1.3)°] ( P>0.05). SF-36 score and VAS score in plate+ bone graft group was (87.3±4.7)points and (1.3±0.6)points, with significant difference from that in plate group [(70.9±7.2)points, (2.1±0.7)points]( P<0.05 or 0.01). One year after operation, 3 patients with humeral head varus and 1 patient with humeral head necrosis were observed in plate group, with the complication incidence of 13% (4/30); while 1 patient with absorption of humeral greater tuberosity in plate+ bone graft group, with complication incidence of (5%, 1/22) ( P<0.05). Conclusion:For complex proximal humeral fractures with comminuted proximal humerus and bone defect, locking plate combined with large autologous iliac bone implantation can maintain intraoperative reduction, avoid loss of neck-shaft angle, improve shoulder joint range of motion, promote function recovery, attenuate pain and reduce incidence of complications.
ABSTRACT
Objective This research examined the effect ofmicrobubble contrast agent plus ultrasound on the permeability of blood-brain barrier,and explored whether it affects the efficacy of chemotherapeutic drugs on cerebral glioblastoma.Methods Wistar rats were divided into three groups to find the optimal concentration of ultrasonic contrast agent.To identify the best ultrasound mode that affected the permeability of blood brain barrier,we employed transmission electron microscopy for study of brain ultrastructure.Western blotting was used to detect the tight junction protein claudin-5.Evans blue staining of brain tissues was utilized to identify the best ultrasonic contrast agent concentration and mode.Rat glioma cells (line 9L) were injected into Wistar rats.After temozolomide chemotherapy,the tumor size was measured and the tumor marker GFAP in serum was detected by ELISA.Results The best contrast agent concentration which increases permeability of BBB in rats was found to be lml/kg and the best ultrasound mode was intermittentlytriggered pulses lasting for 10min (with interval was set at 400ms).More Evans blue passed the blood-brain barrier in ultrasonic cavitation effect group than in control group (P＜0.05).After temozolomide chemotherapy,more tumor marker GFAP was detected in ultrasonic cavitation effect group than in control group (P＜0.05).Conclusion The permeability of BBB was increased and more temozolomide went through BBB when the rats were subjected to intermittently triggered ultrasonic pulses and were injected at contrast agent at lml/kg,which could help to achieve better therapeutic efficacy for glioblastoma.
ABSTRACT
Objective To study the value of echocardiogram in preoperative examination for the diagnosis of silent myocardial is-chemia in patients before surgery .Methods 172 patients with surgical preoperative suspected diagnosis of coronary heart disease , were divided into heart valve surgery group (72 cases) and non heart valve surgery group (100 cases) .All of the patients had echo-cardiography and coronary angiography before 2 weeks of operation .We drew a series of analysis to assess the sensitivity、specialty and accuracy of diagnosis of silent myocardial ischemia with regional wall motion abnormality (RWMA) and wall motion score in-dex (WMSI) .Results Coronary angiography as the gold standard of coronary heart disease diagnosis .The sensitivity of RWMA for the diagnosis of silent myocardial ischemia in patients undergoing heart valve surgery group and non heart valve surgery group was 85 .7% and 100 .0% ,while the specificity of RWMA was 100 .0% and 80 .0% ,respectively ,the differences between the two groups had no statistical significance (P>0 .05) .We also drew the ROC curve of WMSI for the diagnosis of silent myocardial ische-mia ,maximum area under the ROC curve of WMSI were 2 .20 and 2 .05 .In patients undergoing cardiac surgery and non-cardiac sur-gery ,the curves indicated that the sensitivity were 79 .7% and 75 .9% ,the specificity were 83 .0% and 67 .7% ,respectively .Area under the ROC curve was 0 .832 and 0 .702 ,but the difference was not statistically significant (P>0 .05) .Conclusion Using RW-MA and WMSI as reference indicators ,surgical preoperative echocardiography in the diagnosis of patients with silent myocardial is-chemia has good sensitivity ,specific ,and accurate ,there is no statistically significant difference between heart valve surgery and non heart valve surgery .