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Objective To investigate the clinical efficacy and influencing factors of arterial switch operation (ASO) in the treatment of complete transposition of great arteries (TGA).Methods Totally 156 children with TGA who underwent ASO surgery from January 2005 to December 2011 were selected as the subjects.The clinical curative effect and prognosis of all patients were observed,and the relationship be tween clinical features and prognosis was analyzed.Results Totally 156 cases of TGA children were successfully completed the operation,and 29 patients died during the 5 year follow-up period,the mortality rate was 18.59％.Univariate analysis showed that the death in children with TGA after ASO was closely related to coronary artery abnormality,cardiopulmonary bypass time,aortic occlusion time,postoperative low cardiac output syndrome and reoperation (P ＜ 0.05).Multivariate logistic regression analysis showed that coronary artery abnormalities,and low cardiac output syndrome were independent outcome factors leading to postoperative death in patients.Conclusions The postoperative death of ASO in TGA children is closely related to the incidence of coronary artery abnormalities,the time of cardiopulmonary bypass,the time of oc clusion of aorta and the occurrence of postoperative low cardiac output syndrome,which should be pay attention to and take relevant measures.
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Objective To assess the effectiveness of osteoperiosteal decortication and extracortical bone-bridging in the treatment of atrophic humeral nonunions.Methods Nineteen patients with atrophic humeral nonuninon were treated by osteoperiosteal decortication and extracortical bone-bridging between March 2008 and April 2016.They were 12 men and 7 women,aged from 23 to 68 years (mean,36.6 years).The fracture was located at the left side in 10 cases and at the right side in 9.Before admission to our hospital,8 had received surgery once,6 twice and 5 thrice.The time from fracture to hospitalization ranged from 12 to 106 months (average,26.3 months).Shoulder function was evaluated by Neer scoring and elbow function by Mayo elbow performance score (MEPS) at final follow-ups.Results All incisions healed by first intention.Two cases reported transient radial nerve symptoms of numbness.All the 19 patients were followed up for 28.9 months on average (range,from 13 to 78 months).Radiographic examinations showed signs of bone remodeling,disappearance of fracture lines and formation of extracortical bone bridge at 6 to 8 weeks after operation.All of them achieved radiographic union within 10 to 46 weeks (16.8 weeks on average).The Neer scores averaged 82.5 (range,from 70 to 98),giving 12 excellent cases,5 good ones and 2 fair ones.The MEPS averaged 84.4 (range,from 70 to 96),giving 11 excellent cases,5 good ones and 3 fair ones.Conclusion Osteoperiosteal decortication and extracortical bone-bridging in treatment of atrophic humeral nonunions can effectively induce osteogenesis and increase stability of broken ends,promoting bone healing.
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Objective To explore the effect of traumatic brain injury on the fracture healing and its related mechanism by observing the expression of platelet-derived growth factors (PDGF) in serum and bone callus in rats with bone fracture and cerebral trauma.Methods One hundred and forty-four SD rats were randomized into 4 equal groups (n =36) which were subjected respectively to:no treatment (group N),traumatic brain injury (group TBI),bone fracture (group F) and bone fracture and cerebral trauma (group TBI + F).The animals were sacrificed at 3 days,1,2,3 and 4 weeks after modeling.In all the 4 groups,ELISA was used to detect the expression of PDGF in serum.In groups F and TBI + F,the callus growth was observed at the right tibial fracture site by X-ray,the callus growth and morphology were also observed by HE staining,the expression of PDGF in the callus tissue was measured by immunohistochemieal analysis,and the expression of PDGF mRNA in the callus tissue was measured by RT-PCR.Results X-ray showed that fracture healing was accelerated in group TBI + F compared with group F.The serum expression of PDGF in group TBI + F was significantly higher and the peak time was significantly earlier than in the other 3 groups (P ＜ 0.05).H-E staining showed that osteoblastic activity at the fracture ends in group TBI + F was stronger than in group F.Inmunohistochemica[staining showed that the expression of PDGF in the local callus was significantly higher at 3 days and 1 week in group TBI + F and the peak time was significantly earlier than in group F (P ＜ 0.05).RT-PCR showed that the expression of PDGF mRNA in the local callus was significantly higher at 3 days and 1 week in group TBI + F than in group F (P ＜0.05).Conclusions Traumatic brain injury can promote fracture healing in rats,which is probably related to increased expression of PDGF after cerebral trauma.
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Objective To assess the effectiveness of pedicled iliac periosteal flap graft for treatment of old femoral neck fracture in adolescents.Methods Between June,2005 and December,2013,15 patients (15 hips) of old femoral neck fracture in adolescents treated with vascular pedicled iliac periosteal.There were 11 males and 4 females with an average age of 15.8(range 12 to 18) years.Based on the location of fracture,there was 5 cases of subcapital,8 cases of transcervical and 2 cases of basal.6 cases were treated with lower limb traction,3 cases with internal fixation and 6 just without any treatment.The average duration from injury to the second operation was 4.8 (range 1 to 19) months.There were 2 cases of femoral head necrosis after femoral neck fracture.Open reduction,pedicled iliac periosteal flap grafting and cannulate screw fixation were performed.Results All incisions healed by first intention.All patients were followed up 12 to 90 months (mean,46 months).The HHS was increased from (48.7 ± 8.3) pre-operation to (91.3 ± 6.1) at last followed-up,indicating a significant difference between before and after operation (P ＜ 0.01).One patient underwent total hip arthroplasty at 10 months after operation because of fracture nonunion and femoral head necrosis.Fracture healed successfully in 14 cases and the average time of fracture healing was 4 (range 3 to 6) months.Certain extent of remodelling and bulge of the head were observed in 2 cases of collapsed heads.Conclusion Pedicled iliac periosteal flap graft can provide good osteogenesis and vascular reconstruction for femoral head and promote fracture healing in treatment for old femoral neck fracture in adolescents.
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Objective To explore and solve the problem of insufficiency and malformation due to cripple hand and defect of digital bone resulted of innate and injured. Evaluation to the methods of bone autografting combinated with flaps to reconstruct the deficient hand and digits. Methods Vascularized iliac bone or metatarsophalangeal joints (MPJ) or toes transplantation incorporated with flaps were used to reconstruct the defected bone in palm or fingers. Combined with tendon absence in such cases should be repaired or restituted by tendon autografting in one stage or by stages. Results Total 16 cases were treated by the methods metioned above. Except 1 of 16 was failure resulted in severe infection, the others were reconstructed successfully. 13 of 16 were followed up 8 months to 2 years, the evalution of the group from motion,sensation and appearance shew that the fine rate of motion was 53.8 percent, the rate of appearance and sensation were both 69 percent. Conclusion Vascularized iliac bone or metatarsophalangeal joints (MPJ) or toes transplantation incorporated with flaps are available to reconstruct the defected bone in palm or fingers, and can reduce disability effectively while obtain a satisfactory outlook and proper functions by those methods.