Influence of femoral neck area on larger anteversion angle of lag screw guide pin initial placement in proximal femoral intramedullary nail fixation / 中国骨伤

OBJECTIVE@#To invstigate the influence of femoral neck area on larger anteversion angle of lag screw guide pin initial placement in proximal femoral intertrochanteric fracture treated with intramedullary nail.@*METHODS@#From June 2014 to June 2016, 60 patients with femoral intertrochanteric fractures were treated with intramedullary nail, including 27 males and 33 females with an average age of 75 years old ranging from 49 to 88 years old. The lateral images of femoral neck were divided into areas during operation. The anteversion angle of lag screw guide pin of proximal femoral nail was observed at the time of initial insertion. The incidence of normal and larger was counted and the angle index of influencing factors was recorded.@*RESULTS@#Among 60 patients, the screw guide pins of 23 cases were in the central region of the femoral neck and the anteversion angle was normal;screw guide pins of 37 cases were in the front area of the femoral neck, leading to larger anteversion angle. The single factor analysis showed that the independent variables influence factors of larger anteversion were internal collection of the affected limb, internal rotation of the affected limb, hip elevation and screw guide pin level(<0.05). The multi-factor regression analysis showed that the anteversion angle larger was significantly related to the internal rotation of the affected limb and screw guide pin level, and the screw guide pin level was the most relevant(=0.030).@*CONCLUSIONS@#The internal rotation of the affected limb and screw guide pin level may affect the anteversion angle of femoral neck when lag screw guide pin initial insertion, cause it to be too large and the screw guide pin level is the main influencing factor.

Stage therapy for the treatment of fractures of tibia plateau with osteofascial compartment syndrome / 中国骨伤

OBJECTIVE@#To study the operative methods and clinical effects of stage therapy for the treatment of fractures of tibia plateau with osteofascial compartment syndrome according to its clinical characteristics.@*METHODS@#From April 2014 to May 2017, 22 patients with fractures of tibia plateau with osteofascial compartment syndrome were treated by stage therapy, including 16 males and 6 females, ranging in age from 22 to 56 years old, with an average of 39 years old. Fifteen patients had injuries on the left and 7 patients had injuries on the right. Open fracture occurred in 2 cases, and closed fracture occurred in 20 cases. According to its characteristics, all the patients were divided into the window period (window period), the open decompression period (decompression period), the evaluation period of soft tissue (evaluation period) and the fixed recovery period of fracture terminal (recovery period). All the patients were treated with incision and decompression.@*RESULTS@#All fractures healed. The healing time ranged from 3 to 9 months, with an average of 6 months. According to the Merchant knee function score to evaluate the curative effects: 18 cases got an excellent result, 3 cases good and 1 case fair.@*CONCLUSIONS@#Stage therapy is effective to find early, diagnose early and treat early for fascia compartment syndrome, as well as to observe the soft tissue of the affected limb all the way, so as to avoid misdiagnosis, missed diagnosis, mistaken treatment and out of treatment of fascia compartment syndrome. It is a convenient, effective and worthy-of-promotion method.

Tumour length is an independent prognostic factor of esophageal squamous cell carcinomas / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The latest version of the American Joint Committee on Cancer (AJCC) TNM staging system has not comprehensively evaluated the impact of tumour length on survival in patients with esophageal squamous cell carcinoma. Our study explored the relationship between tumour length and clinicopathological characteristics as well as long-term survival.</p><p><b>METHODS</b>All 202 cases of esophageal resections done from January 1, 2004 to December 31, 2008 in Huashan Hospital, Fudan University were reviewed and followed up.</p><p><b>RESULTS</b>Patients with tumour length = 3 cm were related to more advanced tumour stage (χ(2) = 55.9, P < 0.001), more metastatic lymph nodes (χ(2) = 14.6, P < 0.001), increased metastatic lymph node ratio χ(2) = 16.1, P < 0.001) and worse overall TNM stage (χ(2) = 48.1, P < 0.001). Univariate and multivariate analyses indicated that tumour length was a significant prognostic risk factor (95% CI 0.235 - 0.947, P = 0.035). Subgroup analyses disclosed that tumour length was a valuable prognostic predictor in patients with lower T stage, absence of metastatic lymph nodes and lower TNM stage.</p><p><b>CONCLUSIONS</b>Esophageal tumour length is a predictive factor for long-term survival especially for lower tumour stage, absence of metastatic lymph nodes and lower TNM stage patients. Tumour length should be incorporated in the staging system as an important grouping factor for better prognostic evaluation.</p>

Surgical treatment of severe scoliosis and kyphoscoliosis by stages / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although previous reports had reported the use of temporary internal distraction as an aid to correct severe scoliosis, two-stage surgery strategy (less invasive internal distraction followed by posterior correction and instrumentation) has never been reported in the treatment of patients with severe spinal deformity. This study aimed to report the results of the surgical treatment of severe scoliosis and kyphoscoliosis by two-stage and analyse the safety and efficacy of this surgical strategy in the treatment of severe spinal deformities.</p><p><b>METHODS</b>A total of 15 patients with severe scoliosis, kyphoscoliosis or kyphosis who underwent two-stage surgeries (less invasive internal distraction followed by posterior correction and instrumentation) were studied based on hospital records. Pretreatment radiographs and radiographs taken after first surgery (internal distraction by two small incisions), before second surgery (posterior correction, instrumentation and fusion), one week after second surgery and final follow-up were measured. Subjects were analyzed by age, gender, major coronal curve magnitude, flexibility of major curve, major sagittal curve magnitude before first surgery, after first surgery, before second surgery, after second surgery and at final follow-up. Complications related to two-stage surgeries were noted in each case.</p><p><b>RESULTS</b>The average major curve magnitude was 129.4° (range, 95° to 175°), reduced 58.9° or 45.4% after first stage surgery and reduced 30.6° or 24.6% after second stage surgery. The loss of correction during the interval between two surgeries was 7.1%. The total major coronal curve correction was 81.4° or 62.9%. At the final follow up, the average loss of correction of major coronal curve was 3.9° and the final average correction rate was 59.7%. The average major sagittal curve magnitude was 80.3° (range, 30° to 170°), and the total major sagittal curve correction was 48.2°. Loss of correction averaged 4.0° for major sagittal curve and the final correction averaged 42.2°. Clinical complications were noted in the peri-operative and long-term periods.</p><p><b>CONCLUSIONS</b>Two-stage surgery was a safe and effective surgical strategy in this difficult population. Using two-small-incision technique, the first stage surgery was less invasive. No permanent neurologic deficit was noted in this series.</p>

Analysis of neurological deficits complications in the treatment of spinal deformity with posterior spinal osteotomy / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the incidence and causes of neurologic deficits complications in the treatment of spinal deformity with posterior spinal osteotomy.</p><p><b>METHODS</b>From January 2007 to December 2010, 321 cases of scoliosis or kyphosis patients were treated with posterior spinal osteotomy. There were 124 male and 197 female with an average age of (19 ± 11) years (2 - 56 years). The average preoperative main Cobb angle was 108° ± 33° (48° - 175°), the average kyphotic angle was 74° ± 29° (53° - 170°) before operation. Pedicle subtraction osteotomy was used in 226 cases, 95 cases with vertebral column resection. Pedicle screw-rod system was used for fixation. The patients were monitored by Somatosensory-evoked potentials monitoring and Stagnara wake-up test.</p><p><b>RESULTS</b>There were 11 cases with varying degrees of new neurologic deficits and the total incidence was 3.4%. The causes were as followed, spinal translation in 2 cases, compromised by close of resected areas in 2 cases, residual bone compression in 1 case, inadvertent operation in 2 cases, screw malposition in 1 case, hematoma compression in 1 case and spine elongation in 2 cases. There was significant difference between the patients with preexisting neurologic deficits (20.0%) and the patients with intact neurologic function (2.6%) (χ(2) = 13.060, P = 0.011), no significant differences in different classes of the age, etiology, deformity, osteotomy type and surgical type (P > 0.05). But the incidence of neurologic deficits was 4.6% in congenital scoliosis, 7.1% in neuromuscular scoliosis, 5.1% in kyphosis, 5.9% in adult deformity and 5.9% in Cobb angle more than 100°, which was higher than other classes. All the 11 cases were given emergent Methylprednisolone, neurotrophic drugs and hyperbaric oxygen therapy, 4 cases were underwent surgical exploration again. After treatment, 7 cases recovered completely, 2 cases recovered partially and 2 cases failed to improve at the last follow-up.</p><p><b>CONCLUSIONS</b>Severe spinal deformity could be effectively treated with posterior spinal osteotomy. But the procedure is technical demanding and risky for neurologic deficits. The high risk factor is preexisting neurologic deficits.</p>

Analysis of results on minimum 4-year follow-up of modified posterior lumbar interbody fusion for the treatment of isthmic spondylolisthesis / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the long-term results of modified Jaslow technique to treat isthmic spondylolisthesis.</p><p><b>METHODS</b>From April 2000 to January 2002, 75 patients with isthmic spondylolisthesis (Meyerding grade I had 24 cases, grade II had 35, grade III had 16)were treated with a modified Jaslow technique using one single fusion cage on the symptomatic side. There were 35 males and 40 females with an average age of 40 years old, ranging from 23 to 71 years. Clinical symptoms included intermittent claudication, radicular pain and low back pain. Pre- and postoperative percentage slip, lumbar lordosis, height ratio of intervertebral space and the fusion ratio were analyzed according to radiographic conditions; Visual Analogue Pain Score (VAS), Oswestry Disability Index (ODI), Houshuxun criterion were applied to assess the pain and the conventional functions.</p><p><b>RESULTS</b>All patients were followed up from 48 to 62 months with an average of 50.2 months. The percentage slip reduced from 35.6% preoperative to 9.7% at the last follow-up (corrected 72.8%), lumbar lordosis from (53.6 +/- 15.7) degrees to (51.2 +/- 17.1) degrees and the height ratio increased from (58.6 +/- 12.3)% to (91.5 +/- 11.2)%, the rate of fusion was 97.3% (73/75) at the last follow-up. The mean VAS and ODI before operation was (6.2 +/- 2.5) scores and (47.8 +/- 10.3)%, respectively, decreased to (2.5 +/- 1.9) scores and (10.3 +/- 3.0)% at the last follow-up. There was statistical significance in all items except for lumbar lordosis. According to Houshuxun criterion, the results was excellent in 53 cases, good in 12, fair in 8 and poor in 2, the rate of excellent and good was 86.7%. Complication included 2 case internal fixation failure, 3 cases transient neurologic deficits and 3 cases pseudoarticulation formation.</p><p><b>CONCLUSION</b>The modified Jaslow technique is suitable for isthmic spondylolisthesis (Meyerding I - III), which has advantage of sufficient decompression, solid fixation and can obtain satisfactory clinical results with long-term follow-up.</p>

Clinical observation on the treatment of atrial fibrillation with amiodarone combined with Shenmai Injection (参麦注射液) / 中国结合医学杂志

<p><b>OBJECTIVE</b>To observe the therapeutic efficacy and safety of amiodarone combined with Shenmai Injection (参麦注射液) on atrial fibrillation.</p><p><b>METHODS</b>A total of 351 patients with atrial fibrillation caused by cardiovascular diseases and idiopathic atrial fibrillation were assigned to amiodarone group (control group, 128 cases) and amiodarone combined with Shenmai Injection group (treatment group, 223 cases). The patients in the control group received intravenous injection of 150 mg amiodarone in 10 min, followed by intravenous drip infusion at 1 mg /min and 6 h later at 0.5 mg /min until 48 h or cardioversion. The patients in the treatment group received the same treatment of amiodarone, while in addition, they received an injection of Shenmai Injection of 100 mL simultaneously. Blood pressure, ventricular rate, and cardioversion were observed.</p><p><b>RESULTS</b>The total efficiency rate was 98% (control group) and 99% (treatment group) (P>0.05). The mean ventricular rate decreased 23% and 31% in the control group and the treatment group, respectively (P<0.05). The mean cardioversion time of the two groups was 570±211 min and 351±123 min, respectively (P<0.05). Only mild side effects were observed in both groups.</p><p><b>CONCLUSION</b>Compared with amiodarone, amiodarone combined with Shenmai Injection takes effect more quickly with low side effects on the treatment of atrial fibrillation.</p>

Selection of surgical procedure for the treatment of idiopathic scoliosis / 中华外科杂志

<p><b>OBJECTIVES</b>To discuss and evaluate the selection of surgical procedure for the treatment of idiopathic scoliosis according to the location and degree of the deformity.</p><p><b>METHODS</b>175 patients with idiopathic scoliosis underwent surgical treatment with correction and fusion. The patients were divided into four groups according to the location and degree of the deformity and four different procedures were used for each group. For each group, the blood loss, surgery time, correction rate, loss of correction at final follow up and complications were compared and analyzed.</p><p><b>RESULTS</b>All patients underwent surgery safely and no neurological complication occurred. The correction rate was 81% for Group I, 86% for Group II, 68% for Group III and 72% for Group IV. All patients were followed up at least 2 years and the average time was 38 months (24 approximately 52).</p><p><b>CONCLUSION</b>Proper selection of surgical procedure according to the location and degree of the scoliotic deformity, satisfactory results can be achieved in the treatment of idiopathic scoliosis.</p>