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1.
Article in Chinese | WPRIM | ID: wpr-910058

ABSTRACT

Objective:To characterize the biomechanical performance of our self-designed novel blocking screws in the treatment of distal tibial fractures.Methods:Thirty artificial composite tibial bones were used to create models of unstable distal tibial fracture (AO type 43-A3) which were randomized into 3 even groups ( n=10) according to modes of fixation. Group A was subjected to fixation with intramedullary nails only with merely preset holes reserved for the blocking screws, group B to fixation with intramedullary nails plus conventional anteroposterior blocking screws, and group C to fixation with intramedullary nails plus novel lateral blocking screws. In all the 3 groups, a lateral bending stress test was conducted to record the maximum transversal displacement of the intramedullary nail, a fatigue test to observe the structural abnormality in the model and an axial stress test to record the maximum axial displacement of the intramedullary nail-bone structure. The 3 groups were compared in structural abnormality, the maximum transversal displacement of the intramedullary nail and the maximum axial displacement of the intramedullary nail-bone structure. Results:The lateral bending stress tests showed the maximum transversal displacements were (5.02±1.03) mm; (4.19±0.64) mm and (4.18±0.65) mm in groups A, B and C; compared with group A, the maximum transversal displacement decreased by 16.6%( P=0.027) in group B and decreased by 16.8%( P=0.025) in group C, showing significant differences but there was no significant difference in the maximum transversal displacement between groups B and C ( P=0.978). In the fatigue test, all models showed no structural abnormality under cyclic loading. In the axial stress test, the maximum axial displacements of the intramedullary nail-bone structure were, respectively, (5.69±0.75) mm, (5.31±0.61) mm and (5.51±0.65) mm in groups A, B and C, showing no statistically significant difference among the 3 groups ( P>0.05). Conclusion:Our self-designed novel blocking screws can be a new means in clinical application, because they are similar to conventional blocking screws in increasing the stability of nail-bone construct and other biomechanical performance.

2.
Article in Chinese | WPRIM | ID: wpr-910039

ABSTRACT

Objective:To evaluate short-term clinical efficacy of femoral neck system (FNS) for treatment of femoral neck fractures in young and middle-aged patients.Methods:A retrospective analysis was conducted of the 70 middle-aged and young patients who had been surgically treated for femoral neck fractures at Department of Trauma Orthopaedics, Honghui Hospital from January to November 2020. Of them, 32 cases were fixated by FNS; they were 16 males and 16 females, with an age of (49.4±11.0) years, including 10 cases of type Ⅱ, 12 cases of type Ⅲ and 10 cases of type Ⅳ by the Garden classification. The other 38 patients were fixated by cannulated compression screws (CCS); they were 19 males and 19 females, with an age of (48.8±10.1) years, including 12 cases of type Ⅱ, 15 cases of type Ⅲ and 11 cases of type Ⅳ by the Garden classification. The 2 groups were compared in terms of operation time, intraoperative blood loss, fracture reduction, fracture union time, weight-bearing time, complications, Barthel index at 3 months after surgery, and hip function at 6 months after surgery.Results:There was no statistically significant difference in preoperative general information or follow-up time between the 2 groups, showing comparability between groups ( P>0.05). There was no significant difference in operation time, intraoperative blood loss or fracture reduction quality between the 2 groups ( P>0.05). In the FNS group, weight-bearing time [(11.4±3.4) weeks] and fracture healing time [(3.1±0.9) months] were significantly shorter than those in the CCS group [(16.4±3.9) weeks and (3.6±0.9) months], rate of complications (12.5%, 4/32) was significantly lower than that in the CCS group (34.2%, 13/38), Barthel index at 3 months after operation (98.1±2.8) and Harris hip score at 6 months after operation (96.8±4.0) were significantly higher than those in the CCS group (93.8±4.1 and 93.6±6.7) ( P<0.05). Conclusion:In the treatment of femoral neck fractures in young and middle-aged patients, compared with CCS fixation, FNS fixation can obtain better short-term curative effects, due to its advantages of shorter bone union and weight-bearing time, a decreased rate of complications and early functional recovery of daily activities.

3.
Article in Chinese | WPRIM | ID: wpr-908253

ABSTRACT

Objective:To explore the effects of perceived stress and self-efficacy on patients′ compliance with rehabilitation exercise after total hip replacement (THR).Methods:Perceived Stress Scale, General Self-Efficacy Scale, Harris Hip Function Score Scale and Rehabilitation Exercise Compliance Scale for patients after total hip arthroplasty were used to investigate 118 cases THR patients in the Second Affiliated Hospital of Inner Mongolia Medical University from August 2019 to November 2019.Results:Self-efficacy had a direct positive predictive effect on rehabilitation compliance of patients after THR ( r value was 0.215, P<0.05), and perceived pressure had a direct negative predictive effect ( r value was -0.665, P<0.05). Conclusion:In the nursing intervention for patients after total hip arthroplasty, in addition to improving the patient's compliance with rehabilitation exercise, the relevant nursing staff also need to pay attention to the relief of patient's perceived pressure and the improvement of self-efficacy.

4.
Article in Chinese | WPRIM | ID: wpr-906470

ABSTRACT

Objective:To systematically sort out and summarize the medication rules of clinical prescriptions for coronary heart disease with heart failure of Qi deficiency and blood stasis syndrome,and to provide reference for selecting prescriptions and medications for the treatment of coronary heart disease (CHD) with traditional Chinese medicine (TCM). Method:All relevant literature concerning the treatment of CHD with compound TCM prescriptions for Qi deficiency and blood statis syndrome from 2000 to 2020 were retrieved from the China National Knowledge Network (CNKI),WanFang database (WanFang),and VIP journal database (VIP),and the names of prescriptions and drug components were extracted,followed by the frequency of drug use and drug category. Association rules of high-frequency drugs were analyzed by SPSS 18.0,and systematic clustering analysis was conducted by SPSS 21.0. Result:Finally,41 qualified literature articles covering 35 prescriptons and 66 drugs were included in the study. The total frequency of the drugs was 433 times. Among them,there were a total of 25 traditional Chinese medicines with a frequency of ≥5 times. The top 3 frequently used Chinese medicines were Astragali Radix (8.8%),Salviae Miltiorrhizae Radix et Rhizoma (7.2%),Chuanxiong Rhizoma (5.8%). A total of 15 types of drugs were involved,among which tonic drugs (31.4%),blood promoting and blood stasis drugs (28.2%),and hydration and dampening drugs (7.6%) were used most frequently. The association rule analysis of traditional Chinese medicines with frequency of ≥ 5 showed that there were 13 pairs of binomial associations in 25 traditional Chinese medicines,with Astragali Radix in combination with Salviae Miltiorrhizae Radix et Rhizoma,Chuanxiong Rhizoma,Carthami Flos,et al. There were 8 groups of three associations,with Astragali Radix,Salviae Miltiorrhizae Radix et Rhizoma,and Chuanxiong Rhizoma as the main combinations. A systematic clustering analysis showed that the clustering effect was best when the 25 traditional Chinese medicines were clustered into 5 categories. Conclusion:The treatment of coronary heart disease with heart failure of Qi deficiency and blood stasis syndrome is based on replenishing qi and activating blood circulation,supplemented by warming yang,diuresis,and phlegm-resolving drugs,which can enhance the clinical efficacy. Two basic prescriptions of Buyang Huanwutang and Si junzitang are extracted. Other combinations of prescriptions and drugs can provide references for the clinical treatment of coronary heart disease with heart failure.

5.
International Journal of Surgery ; (12): 97-102,F4, 2021.
Article in Chinese | WPRIM | ID: wpr-882447

ABSTRACT

Objective:To analyze the clinical outcomes of tibial bone transport over an intramedullary nail in combination with antibiotic-loaded calcium sulphate for treatment of segmental bone defect.Methods:A retrospective analysis was conducted by enrolling 11 surgically treated patients with tibial segmental bone defect after the debridement for tibial infection or osteomyelitis who were admitted in Lower Limb Surgery Ward of Traumatic Orthopedic Department, Xi′an Honghui Hospital Affiliated to Xi′an Jiaotong University from Jan. 2018 to Jan. 2020. The collected clinical materials and data included gender, age, injury mechanism, smoke or alcohol, comorbidities, intraoperative bleeding loss, bone defect length, resorption time of calcium sulphate, bone transport time, external fixation time, external fixation index, complications and Paley bone and functional criteria. SPSS 24.0 software was used to analyze the data.Results:Eleven patients were followed up for 8 to 31 months (average 23.2 months). All patients achieved bone healing and the infection was eradicated with no sign of recurrence. The mean length of defect was (8.1±1.6) cm, mean resorption time of calcium sulphate was (6.6±2.6) months, bone transport time was (11.4±2.8) weeks, external fixation time was (4.7±1.2) months, external fixation index was (0.58±0.07) month/cm and full weight bearing time was (6.1±1.4) months. The complication rate was 36.4% including deep vein thrombosis, delayed union of the docking site, pin tract infection and sterile draining of the wound. Paley bone evaluation results were excellent and good in 10 patients (90.9%) and functional results were excellent and good in 11 patients (100%).Conclusion:Tibial bone transport over an intramedullary nail in combination with antibiotic-loaded calcium sulphate is a safe, reliable and successful method for segmental bone defect and eradication of infection which reduces external fixation time and complication rate, allows patients perform weight bearing and return to daily life earlier.

6.
Article in Chinese | WPRIM | ID: wpr-867951

ABSTRACT

Objective:To explore the efficacy of our novel reduction technique in the surgical treatment of complicated tibial plateau fractures.Methods:From May 2016 to September 2018, 50 fractures of tibial plateau (Schatzker types Ⅴ and Ⅵ) were treated at Department of Orthopaedics and Traumatology, Hong Hui Hospital. They were 34 males and 16 females, aged from 27 to 56 years (average, 42.3 years). They were divided into 2 groups according to the reduction techniques. In the group of novel reduction ( n=23), bone fragments were reduced one by one from the distal to the proximal until the compression fracture was reduced and fixated. In the conventional reduction group ( n=27), the articular surface was reduced first before fixation of articular fragments with distal ends of tibial fracture. The 2 groups were compared in terms of intraoperative bleeding, operation time, tibial plateau angle (TPA) on the knee anteroposterior X-ray film taken on the second day after operation, and rate of acceptable TPA (±5°). Results:There were no significant differences between the 2 groups in general preoperative data, showing comparability ( P>0.05). There were no significant differences between the 2 groups in either operation time (2.7 h ± 0.4 h versus 3.0 h ± 0.6 h) or intraoperative bleeding (215 mL ± 56 mL versus 221 mL ± 52 mL) ( P>0.05). The novel reduction group had a significantly higher rate of acceptable TPA [78.2% (18/23)] than the conventional reduction group [48.1%(13/27)]( P<0.05). Conclusion:In the surgical treatment of complicated tibial plateau fractures, compared with conventional reduction technique, our novel reduction technique can increase the rate of acceptable reduction but not operation time nor intraoperative bleeding.

7.
Article in Chinese | WPRIM | ID: wpr-867940

ABSTRACT

Objective:To explore the clinical efficacy of proximal femoral anatomical locking plate and autogenous iliac graft for failed primary internal fixation in treatment of femoral intertrochanteric fracture.Methods:A retrospective analysis was conducted of the 29 patients with femoral intertrochanteric fracture who had been treated after failed primary internal fixation at Department of Orthopaedics and Trauma, Xi'an Honghui Hospital between January 2014 and March 2017. They were 17 men and 12 women, aged from 35 to 83 years (mean, 68.7 years). Their primary internal fixation involved dynamic hip screw in 12 cases, proximal femoral locking plate in 13 cases, and intramedullary nail in 4 cases. The causes for their internal fixation failure included head cutting in 8 cases, fracture nonunion in 10 cases, plate or screw breakage in 6 cases, intramedullary nail breakage in 3 cases, and hip varus in 2 cases. Their revision surgery was performed with anatomical proximal femoral locking plate and autogenous iliac bone graft. Their fracture union time, and visual analogue scale (VAS), hip Harris score, SF-36 health survey scale and complications at the final follow-ups were recorded.Results:All the 29 patients were followed up for 12 to 24 months (18 months on average). Bony union was eventually achieved in all the 29 patients after an average time of 4.5 months (from 3 to 7 months). There were no such complications as nonunion, re-fracture or internal fixation failure. The VAS pain score at the final follow-up(4.6±1.6) was significantly lower than that before surgery(7.1±2.1), and the Harris hip score(85.2±8.2) and SF-36 score(75.9±15.5) at the final follow-up were significantly higher than those before surgery (48.0±12.7 and 48.7±18.8) (all P<0.05). According to their hip Harris scores at the final follow-ups, the therapeutic efficacy was rated as excellent in 9 cases, as good in 15 cases and as poor in one, yielding an excellent and good rate of 82.8%. Conclusion:For patients with femoral intertrochanteric fracture whose primary internal fixation has failed, especially those with fine femoral head and neck and hip joint, proximal femoral anatomic locking plate and autogenous iliac bone graft can result in satisfactory clinical efficacy.

8.
Article in Chinese | WPRIM | ID: wpr-867880

ABSTRACT

Objective:To investigate the effects of surgical revision for humeral shaft nonunion on health-related quality of life.Methods:The data of 62 patients were studied retrospectively who had been hospitalized at Department of Orthopaedics and Traumatology, Hong-Hui Hospital for humeral shaft nonunion from March 2013 to September 2018. They were 43 males and 19 females, aged from 20 to 73 years (average, 42.3 years). Their nonunions belonged to the atrophic type in 19 cases, to the ischemic type in 14 cases and to the hypertrophic type in 29 cases. Their demographic and clinical data, imaging manifestations and treatment methods were recorded and analyzed. The 12-item short form health survey (SF-12) and brief pain inventory (BPI) were used to evaluate their health-related quality of life and the Mayo elbow performance score (MEPS) was used to evaluate their elbow function.Results:Upon admission, their physical component summary (PCS) scored 24.3±5.2, mental component summary (MCS) 26.3±3.8, brief pain inventory- severity (BPI-S) 6.5±1.9, and brief pain inventory-interference (BPI-I) 6.7±2.5. At 1-year follow-up, their PCS averaged 43.6±8.1, MCS 34.7±4.4, BPI-S 4.9±1.2, and BPI-I 4.4±1.4. There were statistically significant differences between preoperation and postoperation in the above 4 groups of indicators ( P<0.05). Their MEPS at the last follow-up revealed a 95.2% rate of excellent elbow function (59/62). By comparison with the literature data, their postoperative PCS scores were not significantly different from those for the patients with Barrentt's esophagus, primary hypertension, chronic obstructive pulmonary disease and silicosis ( P>0.05). There was no significant difference either in the postoperative MCS scores between them and stroke patients ( P>0.05). Conclusions:As a destructive chronic disease, humeral shaft nonunion has negative effects on physical and mental health and quality of life of the patients. Although the pain effect on the limb can be alleviated by surgical revision, the entire treatment may cause permanent psychological trauma to the patients.

9.
Article in Chinese | WPRIM | ID: wpr-867869

ABSTRACT

Objective:To report our experience in the admission and perioperative management of 88 patients with lower extremity fracture in a mildly affected area in the epidemic of COVID-19.Methods:A retrospective analysis was conducted of the 88 patients with 97 lower extremity fractures who had been admitted to Department of Orthopedic Trauma, Honghui Hospital Affiliated to Xi'an Jiaotong University College of Medicine from 23rd January, 2020 to 22nd February, 2020. They were 43 males and 45 females, aged from 15 to 95 years (average, 65.5 years). The patients underwent screening for COVID-19 infection before admission. Their fractures were located at the femoral neck in 33 cases and at the femoral trochanter in 26. Open reduction and internal fixation was performed for 29 cases, internal fixation with proximal femoral nail anti-rotation (PFNA) for 25 and hip replacement for 28. The time from injury to admission, time from admission to surgery, operation time, fracture reduction, hospital stay, and perioperative deep venous thrombosis (DVT) of lower limbs were recorded. COVID-19 infection was observed in the medical staff and patients as well.Results:All the 88 patients were COVID-19 negative in the screening before admission. The time from injury to admission averaged 4.5 days, the time from admission to surgery 3.7 days and hospital stay 6.6 days. The prostheses were all well located in the 28 patients undergoing hip replacement. The rate of functional and anatomic reduction was 94.2%(65/69) in the 69 patients undergoing internal fixation. Peri-operatively, DVT occurred in 25 cases (28.4%). High temperature was observed in 7 patients within 3 days after operation, which was diagnosed as absorption fever. No medical staff or patients were infected by COVID-19.Conclusion:In the epidemic of COVID-19, orthopedic surgeons in a medical institute in a mildly affected area can still provide effective and safe medical services for fracture patients and reduce nosocomial infection, as long as they comprehend the diagnosis and treatment guidelines for the epidemic, strictly screen the patients accordingly, stick to operative indications, protect against possible infection cautiously, and carry out the procedures in a standard manner.

10.
Article in Chinese | WPRIM | ID: wpr-867865

ABSTRACT

Objective:To compare the effects of external fixation as a terminal versus staged treat-ment on the health-related quality of life and function in patients with open tibiofibular fracture.Methods:From March 2017 to October 2018, 52 patients with open tibiofibular fracture were admitted to Department of Orthopaedic Surgery, Honghui Hospital.They were 37 males and 14 females, aged from 19 to 62 years(mean, 39.9 years).They were assigned into 2 groups subjected to 2 different treatment plans.In group A of 35 cases primary external fixation was replaced by terminal internal fixation while in group B of 17 cases primary ex-ternal fixation continued to the end.The 2 groups were compared in terms of the physiological total score (PCS) and mental component summary (MCS) in the 12-item short-form health survey (SF-12) at 1, 3, 6, 9 and 12 months postoperation, fracture healing time, time for external fixation, incidence of complications, and the lower extremity functional scale (LEFS).Results:The 2 groups were compatible due to insignificant differences in the general clinical data ( P>0.05).The follow-ups for the 2 groups were all beyond 12 months.PCS and MCS peaked both at 12 months postoperation in group A, but peaked respectively at 6 and 3 months postoperation in group B.Compared with group B, group A showed significantly higher PCS and MCS at 6, 9 and 12 months postoperation, significantly shorter fracture healing time (19.2 weeks ± 4.6 weeks versus 23.3 weeks ± 5.6 weeks), significantly shorter time for external fixation (15.6 days ± 4.2 days versus 270.0 days ± 15.4 days), significantly lower incidence of complications[5.7%(2/35) versus 35.3%(6/17)], significantly higher LEFS scores (88.3±7.2 versus 78.5 ± 5.2), and significantly higher the excellent and good rate by the Johner-Wruh scoring [94.3%(33/35) versus 70.6%(12/17)] (all P< 0.05). Conclusion:Compared with external fixation as a terminal treatment, external fixation followed by internal fixation can significantly improve the health-related quality of life and function in patients with open tibiofibular fracture and effectively reduce the incidence of postoperative complications.

11.
Chinese Journal of Trauma ; (12): 68-74, 2020.
Article in Chinese | WPRIM | ID: wpr-867673

ABSTRACT

Objective To investigate the safety and effect of tranexamic acid combined with drainage tube clamping to reduce perioperative blood loss of Schatzker Ⅴ and Ⅵ tibial plateau fracture.Methods A prospective case-control study was performed on 87 patients with Schatzker Ⅴ and Ⅵ tibial plateau fracture admitted from March 2018 to January 2019 in Honghui Hospital,including 53 males and 34 females,aged 24 to 69 years [(39.05 ± 2.7) years].All patients underwent tibial plateau reduction and internal fixation.According to the random number table method,the patients were divided into intravenous group (27 cases),articular cavity group (30 cases) and control group (30 cases).The intravenous group were given a total of 1 g of tranexamic acid intravenously 5-10 minutes before loosening the tourniquet,the joint cavity group were perfused with 1 g of tranexamic acid before closing the incision,and the control group were given the same amount of normal saline.The drainage tube was temporarily clamped for 4 hours in the three groups.Data were recorded and compared among the groups,including the surgical limb side,tourniquet use time,hemoglobin (Hb),D-dimer level,drainage,total blood loss,number of allogeneic blood transfusions,postoperative complications,and presence or absence of deep vein thrombosis (DVT) of the lower extremities at 72 hours after discharge.Results There was no significant difference in baseline data between the three groups (P > 0.05).There were no significant differences in the extremity side,tourniquet use time,and number of allogeneic blood transfusions among the three groups (P > 0.05).At postoperative 24 hours,the Hb was (112.7 ± 11.8) g/L in the intravenous group,(107.7 ± 16.1) g/L in the articular cavity group,At (100.0 ± 10.4) g/L in the control group.At postoperative 24 hours,the D-dimer vein was (5.5 ± 2.9) mg/L in the intravenous group,(5.9 ± 2.5) mg/L in the joint cavity group,and (7.5 ± 3.6) mg/L in the control group.At postoperative 24 hours,the drainage volume was (62.8 ± 20.5) ml in the intravenous group,(60.2 ± 17.4) ml in the articular cavity group,and (81.2 ± 21.1)ml in the control group.The hidden blood loss was (577.1 ± 212.1)ml in the intravenous group,(634.2 ± 139.8)ml in the articular cavity group,(750.3 ±124.1)ml in the control group.The total blood loss was (950.1 ± 170.5)ml in the intavenous group,(1 005.4 ± 179.8)ml in the articular cavity group,and (1 148.8 ± 129.1)ml in the control group.The incidence of postoperative wound swelling and exudation was 1 case (4%) in the intravenous group,0 cases in the articular cavity group,5 cases (17%) in control group.The above indexes showed significant differences between the three groups (P < 0.05 or 0.01),but there was no significant difference between the intravenous group and the articular cavity group (P > 0.05).The Hb at 72 hours postoperatively,total drainage,number of allogeneic blood transfusions,lower extremity DVT and incidence of skin ecchymosis had no significant difference among the three groups (P > 0.05).No pulmonary embolism occurred after the operation.Conclusions For patients with Schatzker Ⅴ and Ⅵ tibial plateau fracture,tranexamic acid combined with drainage tube clamping is safe and effective when used perioperatively.Either intravenous infusion or local joint cavity injection of tranexamic acid can effectively reduce the drainage volume at 24 hours postoperatively,hidden blood loss and total blood loss without increasing the risk of postoperative DVT.Tranexamic acid can reduce the and exudation after operation.

12.
Article in Chinese | WPRIM | ID: wpr-865301

ABSTRACT

Objective:To analyze the value and difference of the optic nerve sheath pulse dynamic deformation index (DI) in normal-tension glaucoma (NTG) and high-pressure primary open angle glaucoma (POAG).Methods:A cross-sectional study was conducted to collect clinical data at the Eye Center of Beijing Tongren Hospital from June 2016 to March 2017, 32 patients with NTG and 35 patients with high-pressure POAG were sampled.For all subjects, their basic information, body mass index (BMI), mean arterial blood pressure (MAP), 24 hours intraocular pressure, and ophthalmologic examinations required for diagnosis were recorded.All subjects underwent transorbital ultrasonography and for each 15 seconds of consecutive ultrasound images were taken.The dynamic post-processing technique was used to calculate the DI.The difference in DI between the two groups and the correlation of DI with other variables were analyzed.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital.Written informed consent was obtained from all subjects prior to their entering the study cohort and receiving the transorbital ultrasound examination.Results:The median level of DI in the NTG group was 0.51 (0.48, 0.54), which was higher than that in the high-pressure POAG group (0.23[0.20, 0.25]), exhibiting a significant difference ( Z=-7.01, P<0.01). The mean BMI in the NTG group was lower than that in the high-pressure POAG group([21.29±4.64]kg/m 2vs. [23.53±3.40]kg/m 2), the mean MAP in the NTG group was lower than that in the high-pressure POAG group([91.44±14.30]mmHg vs. [104.05±13.96] mmHg), the differences between the two groups were statistically significant ( t=-2.30, P<0.05; t=-3.65, P<0.01). There was no statistical association between the two groups of DI and age, MAP, BMI, mean intraocular pressure and maximum intraocular pressure (all at P>0.05). Conclusions:The DI of the NTG patient is higher than that of the POAG patient, which indicates that the optic nerve sheath subarachnoid pressure and optic nerve sheath stiffness in NTG patients are lower than those in POAG patients.Therefore, the DI is a potential indicator of non-invasive intracranial pressure and translaminar cribrosa pressure difference detection in ophthalmology.

13.
International Journal of Surgery ; (12): 489-493, 2020.
Article in Chinese | WPRIM | ID: wpr-863353

ABSTRACT

Tibial fracture is a kind of common long bone fracture of extremities, most of which are complex tibial fractures caused by high energy. Because of the special anatomical structure of tibia, the incidence of postoperative complications such as malunion and nonunion is higher. This brings some difficulties to the treatment. With the patient′s higher requirements for function, doctors have a deeper understanding of biomechanics, which promotes the further development of internal fixation materials. The indications of intramedullary nails have been expanded and gradually replaced the steel plate internal fixation for the treatment of tibial fractures and achieved good therapeutic effect. This article focuses on the application and new development of intramedullary nail in the treatment of proximal, middle, distal and open tibial fractures, providing more reference for the future clinical treatment.

14.
Chinese Journal of Trauma ; (12): 68-74, 2020.
Article in Chinese | WPRIM | ID: wpr-798624

ABSTRACT

Objective@#To investigate the safety and effect of tranexamic acid combined with drainage tube clamping to reduce perioperative blood loss of Schatzker V and VI tibial plateau fracture.@*Methods@#A prospective case-control study was performed on 87 patients with Schatzker V and VI tibial plateau fracture admitted from March 2018 to January 2019 in Honghui Hospital, including 53 males and 34 females, aged 24 to 69 years [(39.05±2.7)years]. All patients underwent tibial plateau reduction and internal fixation. According to the random number table method, the patients were divided into intravenous group (27 cases), articular cavity group (30 cases) and control group (30 cases). The intravenous group were given a total of 1 g of tranexamic acid intravenously 5-10 minutes before loosening the tourniquet, the joint cavity group were perfused with 1 g of tranexamic acid before closing the incision, and the control group were given the same amount of normal saline. The drainage tube was temporarily clamped for 4 hours in the three groups. Data were recorded and compared among the groups, including the surgical limb side, tourniquet use time, hemoglobin (Hb), D-dimer level, drainage, total blood loss, number of allogeneic blood transfusions, postoperative complications, and presence or absence of deep vein thrombosis (DVT) of the lower extremities at 72 hours after discharge.@*Results@#There was no significant difference in baseline data between the three groups (P>0.05). There were no significant differences in the extremity side, tourniquet use time, and number of allogeneic blood transfusions among the three groups (P>0.05). At postoperative 24 hours, the Hb was (112.7±11.8)g/L in the intravenous group, (107.7±16.1) g/L in the articular cavity group, At (100.0±10.4) g/L in the control group. At postoperative 24 hours, the D-dimer vein was (5.5±2.9)mg/L in the intravenous group, (5.9±2.5)mg/L in the joint cavity group, and (7.5±3.6)mg/L in the control group. At postoperative 24 hours, the drainage volume was (62.8±20.5)ml in the intravenous group, (60.2±17.4)ml in the articular cavity group, and (81.2±21.1)ml in the control group. The hidden blood loss was (577.1±212.1)ml in the intravenous group, (634.2±139.8)ml in the articular cavity group, (750.3±124.1)ml in the control group. The total blood loss was (950.1±170.5)ml in the intavenous group, (1 005.4±179.8)ml in the articular cavity group, and (1 148.8±129.1)ml in the control group. The incidence of postoperative wound swelling and exudation was 1 case (4%) in the intravenous group, 0 cases in the articular cavity group, 5 cases (17%) in control group. The above indexes showed significant differences between the three groups (P<0.05 or 0.01), but there was no significant difference between the intravenous group and the articular cavity group (P>0.05). The Hb at 72 hours postoperatively, total drainage, number of allogeneic blood transfusions, lower extremity DVT and incidence of skin ecchymosis had no significant difference among the three groups(P>0.05). No pulmonary embolism occurred after the operation.@*Conclusions@#For patients with Schatzker V and VI tibial plateau fracture, tranexamic acid combined with drainage tube clamping is safe and effective when used perioperatively. Either intravenous infusion or local joint cavity injection of tranexamic acid can effectively reduce the drainage volume at 24 hours postoperatively, hidden blood loss and total blood loss without increasing the risk of postoperative DVT. Tranexamic acid can reduce the and exudation after operation.

15.
International Journal of Surgery ; (12): 754-757, 2019.
Article in Chinese | WPRIM | ID: wpr-801573

ABSTRACT

Objective@#To explore the effect of bone transport external fixation combined with locking bone plate internal fixation technology in the treatment of segmental tibial defects.@*Methods@#The clinical data of 12 patients with segmental tibial defects treated with annular external fixator and long locking plate in the Honghui Hospital, Xi′an Jiaotong University College of Medicine from January 2013 to March 2017 were analyzed retrospectively. There were 10 males and 2 females with an average age of 45 years (aged range from 20 to 65 years). External fixation time, external fixation index, healing time, mean healing index and complications were recorded. The follow-up time was 12-48 months, and the Paley bone and functional scores were used to evaluate the efficacy at the last follow-up.@*Results@#All the patients achieved union at the distraction callus and docking site. The average external fixation time was 112.1 d, the average external fixation index was 16.5 d/cm, the average healing time was 299.5 d, and the average healing index was 44.9 d/cm. Seven cases had pain and 4 cases had pin-site infections as minor complications. The bony outcomes were excellent in all patients. The functional outcomes were excellent in eight cases and good in four.@*Conclusion@#Bone transport with external fixation combined with locking plate internal fixation in the treatment of segmental bone defects of tihia can shorten external fixation time and is beneficial to functional rehabilitation after operation.

16.
Article in Chinese | WPRIM | ID: wpr-756395

ABSTRACT

Objective To summarize the clinical experience of artificial vascular sleeve-like inverted suture in proximal part of ascending aorta, and to explore the effectiveness of the method. Methods A retrospective study was performed. From August 2017 to April 2018, 10 patients with Stanford type A aortic dissection with surgical indications for ascending aortic re-placement were treated with artificial vascular sleeve-like inverted suture for proximal part of ascending aorta, 9 cases of emer-gency operation, 8 cases of males and 2 females, aged 43-69 years, mean(51 ± 6) years old. The specific method for opera-tion is to invert the artificial blood vessel 2 cm outward and then insert it into the ascending aorta, suture the inverted part of the artificial blood vessel and the ascending aorta continuously. If there is obvious bleeding, stitch strips made of artificial blood vessel or pericardium with theanastomosis ring. The drainage in 24 hours after operation and early postoperative outcome were observed. Results There was no intraoperative death in the whole group, and there was no second thoracotomy for hemostasis. The drainage volume was 150-880 ml, average(260 ± 55) ml in 24 hours after surgery. One patient developed gastrointestinal hemorrhage after operation, and healed after two times of hemostasis by bedside gastroscopy. Two patients had transient neuro-logical dysfunction( TND) . All of the 10 patients were cured and discharged after treatment. All patients were followed up for 1-6 months. All patients underwent transthoracic echocardiography. Eight of them underwent CT angiography, no new aortic regurgitation, and no obvious sinus widening. Conclusion The artificial blood vessel sleeve-like inverted suture is a simple and reliable operation in reinforcement for proximal part of ascending aorta. The anastomosis circle and the suture pinprick are not directly in contact with the blood flow, reducing the chance of bleeding. Even if there is tinybleeding, it will be easy to find and repair. In conclusion, this method is convenient and effective, and it is worthy of clinical promotion.

17.
Article in Chinese | WPRIM | ID: wpr-734415

ABSTRACT

Objective To explore the effect of single level lumbar disc herniation on the morphology and diameter of sciatic nerve,and to identify the correlation between the diameter change in sciatic nerve and severity of clinical symptoms,as well as the prognosis of surgical treatment in patients with lumbar disc herniation.Methods From January 1,2017 to December 31,2017,Seventy lumbar disc herniation (LDH) patients who underwent single-level posterior lumbar spine surgery were recruited in this retrospective analysis study.Specific data including age,gender,the level of a disc herniation,the type of disc herniation,symptomatic side,surgical procedure were recorded respectively.In addition the morphological changes and the diameter of bilateral sciatic nerve were recorded preoperatively and postoperatively by B-mode ultrasound.Furthermore,the pain in patients and neurological function were evaluated by visual analogue scale (VAS,back pain and leg pain),Japanese orthopaedic association scores-lumbar (JOA) and Oswestry disability index (ODI).The correlation between the diameter of sciatic nerve and clinical features,as well as clinical prognosis of patients were identified in the present study.Results For patients with acute lumbar disc herniation,the diameter of sciatic nerve in affected side was 5.19±1.03 ram,which is significantly higher than that in the unaffected side (4.57±0.64 mm,t=6.735,P=0.000).In addition,preoperative ratio of the affected side to the healthy side of the sciatic nerve showed strong correlation with the VAS of leg pain (r=0.838,P=0.001),JOA (r=-0.857,P=0.001),and ODI score(r=0.881,P=0.000),but not with the VAS of back pain (r=-0.061,P=0.614).Three months after surgery,the diameter of sciatic nerve in the affected side decreased to 4.58±0.63 mm (t=6.865,P=0.000),while the unaffected side showed no significant change(t=0.300,P=0.765).Clinical improvement was observed in all the patients postoperatively.The changes in the diameter of sciatic nerve postoperatively in affected side showed strong correlation to the rate of improvement in VAS of leg (r=0.624,P=0.003),JOA(r=0.615,P=0.003) and ODI scores (r=0.722,P=0.002),but not to the rate of improvement in VAS of back (r=-0.025,P=0.836).Conclusion Single root compression in patients with single level disc herniation might cause morphological changes such as thickening and edema in sciatic nerve,which were closely related to the severity of clinical symptoms and the prognosis of surgical treatment.

18.
International Journal of Surgery ; (12): 754-757, 2019.
Article in Chinese | WPRIM | ID: wpr-823522

ABSTRACT

Objective To explore the effect of bone transport external fixation combined with locking bone plate internal fixation technology in the treatment of segmental tibial defects.Methods The clinical data of 12 patients with segmental tibial defects treated with annular external fixator and long locking plate in the Honghui Hospital,Xi'an Jiaotong University College of Medicine from January 2013 to March 2017 were analyzed retrospectively.There were 10 males and 2 females with an average age of 45 years (aged range from 20 to 65 years).External fixation time,external fixation index,healing time,mean healing index and complications were recorded.The follow-up time was 12-48 months,and the Paley bone and functional scores were used to evaluate the efficacy at the last follow-up.Results All the patients achieved union at the distraction callus and docking site.The average external fixation time was 112.1 d,the average external fixation index was 16.5 d/cm,the average healing time was 299.5 d,and the average healing index was 44.9 d/cm.Seven cases had pain and 4 cases had pin-site infections as minor complications.The bony outcomes were excellent in all patients.The functional outcomes were excellent in eight cases and good in four.Conclusion Bone transport with external fixation combined with locking plate internal fixation in the treatment of segmental bone defects of tihia can shorten external fixation time and is beneficial to functional rehabilitation after operation.

19.
Chinese Journal of Lung Cancer ; (12): 520-525, 2019.
Article in Chinese | WPRIM | ID: wpr-775597

ABSTRACT

Lung cancer is the malignant tumor with the highest morbidity and mortality in China. Non-small cell lung cancer is the main pathological type. Lymph node metastasis is the most common and primary metastatic pathway in non-small cell lung cancer. Acknowledged as the major factor determining tumor staging and prognosis. Unfortunately, it's presently hard to make an accurate preoperative judgment on the lymph node metastasis of early stage non-small cell lung cancer. Consequently, there has been a long-standing controversy on lymph node sweeping for early stage non-small cell lung cancer, especially for those clinical stage I. The regularity of non-small cell lung cancer lymph node metastasis and the ways of lymph node sweeping will be reviewed in this paper.
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20.
Article in Chinese | WPRIM | ID: wpr-797971

ABSTRACT

Objective@#To summarize the clinical experience of artificial vascular sleeve-like inverted suture in proximal part of ascending aorta, and to explore the effectiveness of the method.@*Methods@#A retrospective study was performed. From August 2017 to April 2018, 10 patients with Stanford type A aortic dissection with surgical indications for ascending aortic replacement were treated with artificial vascular sleeve-like inverted suture for proximal part of ascending aorta, 9 cases of emergency operation, 8 cases of males and 2 females, aged 43-69 years, mean(51±6) years old. The specific method for operation is to invert the artificial blood vessel 2 cm outward and then insert it into the ascending aorta, suture the inverted part of the artificial blood vessel and the ascending aorta continuously. If there is obvious bleeding, stitch strips made of artificial blood vessel or pericardium with theanastomosis ring. The drainage in 24 hours after operation and early postoperative outcome were observed.@*Results@#There was no intraoperative death in the whole group, and there was no second thoracotomy for hemostasis. The drainage volume was 150-880 ml, average(260±55) ml in 24 hours after surgery. One patient developed gastrointestinal hemorrhage after operation, and healed after two times of hemostasis by bedside gastroscopy. Two patients had transient neurological dysfunction(TND). All of the 10 patients were cured and discharged after treatment. All patients were followed up for 1-6 months. All patients underwent transthoracic echocardiography. Eight of them underwent CT angiography, no new aortic regurgitation, and no obvious sinus widening.@*Conclusion@#The artificial blood vessel sleeve-like inverted suture is a simple and reliable operation in reinforcement for proximal part of ascending aorta. The anastomosis circle and the suture pinprick are not directly in contact with the blood flow, reducing the chance of bleeding. Even if there is tinybleeding, it will be easy to find and repair. In conclusion, this method is convenient and effective, and it is worthy of clinical promotion.

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