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Objective:To investigate the early clinical outcomes of a minimally invasive anterolateral approach (Orthopadische chirurgie munchen, OCM) versus a conventional (posterolateral approach, PLA) hemiarthroplasty in the treatment of senior femoral neck fractures.Methods:A retrospective analysis was performed on 90 elderly patients with femoral neck fractures who received anterolateral and posterolateral approaches for hemiarthroplasty in the Second Affiliated Hospital of Soochow University from December 2019 to June 2021 and were followed up. In the OCM group, there were 45 cases, including 18 males and 27 females, aged 83.33±5.29 years (range, 76-96 years); In the PLA group, there were 45 cases, including 13 males and 32 females, aged 81.87±5.00 years (range, 75-94 years). Postoperative, surgical indices, perioperative bleeding, and soft tissue injury were assessed; pain was assessed using the visual analogue scale (VAS), and hip function was evaluated using the Harris score and the University of California at Los Angeles (UCLA) score.Results:The incision length, postoperative hospital stay, hemoglobin reduction, and occult blood loss were lower in the OCM group than in the PLA group ( P<0.05), but there was no significant difference in intraoperative bleeding and postoperative transfusion rate ( P>0.05). Serum creatine kinase and C-reactive protein levels (232.98±83.70 IU/L and 81.67±48.85 mg/L) were lower in the OCM group than in the PLA group (296.93±124.58 IU/L and 104.79±36.75 mg/L) 1 day after surgery, and the differences were statistically significant ( t=2.86, P=0.005; t=2.54, P=0.013). Postoperative pain was significantly improved in all patients, and VAS scores were lower in the OCM group than in the PLA group at 12 h, 24 h, and 48 h postoperatively ( P<0.05). The time to get out of bed after surgery was 20.73±4.99 h in the OCM group compared with 41.69±13.58 h in the PLA group, with a statistically significant difference ( t=9.71, P<0.001). Harris scores (63.31±6.21 and 75.76±4.91) and UCLA scores (1.84±0.42 and 3.69±0.76) were higher in the OCM group on the day of discharge and at 1 month postoperatively than in the PLA group (52.69±10.01 and 71.33±3.66); (1.62±0.54 and 3.16±0.80) points, all with statistically significant differences ( P<0.05). However, the differences in Harris score and UCLA score between the two groups at 6 months postoperatively were not statistically significant ( P>0.05). There were two cases of intermuscular vein thrombosis in the OCM group, with a complication rate of 4% (2/45), and one case of dislocation in the PLA group, with a complication rate of 2% (1/45), there was no significant difference between the two groups ( P=1.000). Conclusion:The minimally invasive anterolateral approach is a more ideal procedure for elderly patients with femoral neck fractures undergoing hemiarthroplasty. It has the advantages of a short incision, small soft tissue damage, low occult blood loss, early removal from bed, a short postoperative hospital stay, an improvement in pain, and a good early recovery of hip function.
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Objective:To explore the risk factors for death within 1 year after hip fracture surgery in the elderly.Methods:A case control study was made on the clinical data of 551 elderly patients with hip fracture treated in Second Affiliated Hospital of Soochow University from January 2019 to December 2020, including 182 males and 369 females; aged 65-100 years [80(73,86)years]. Joint replacement, cannulated screw fixation or proximal femoral nail fixation were performed. The patients were divided into survival group ( n=494) and death group ( n=57) based on the death within 1 year after surgery recorded at postoperative telephone follow-up. The gender, age, hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, neurological diseases, chronic renal failure, anemia on admission, fracture types, American anesthesiologist Association (ASA) classification, operative methods, preoperative waiting time, duration of operation and perioperative blood transfusion were recorded in two groups. Univariate Cox regression was used to analyze the correlation between the above indexes and death within 1 year after surgery. All indexes with P<0.2 in the univariate analysis were included in multivariate Cox regression analysis to clarify the independent risk factors for death within 1 year after surgery. Results:Univariate Cox regression analysis showed that death within 1 year after surgery correlated with gender, age chronic respiratory diseases, chronic renal failure and anemia on admission (all P<0.01), but not with hypertension, diabetes, cardiovascular diseases, neurological diseases, fracture types, ASA classification, operative methods, preoperative waiting time, duration of operation or perioperative blood transfusion (all P>0.05). Multivariate Cox regression analysis showed that male ( HR=2.08, 95% CI 1.20, 3.61, P<0.01), age ≥ 80 years ( HR=2.22, 95% CI 1.15, 4.28, P<0.05), chronic respiratory diseases ( HR=2.54, 95% CI 1.19, 5.40, P<0.05), chronic renal failure ( HR=4.57, 95% CI 1.27, 16.44, P<0.05), anemia on admission ( HR=2.82, 95% CI 1.38, 5.76, P<0.01) were significantly associated with death within 1 year after surgery. Conclusion:Male age≥ 80 years, chronic respiratory disease, chronic renal failure and anemia on admission are independent risk factors for death within 1 year after hip fracture surgery in the elderly.
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The specimens of femur from wild-type mice(WT) of 6 months and Hepcidin-knockout(KO) mice of 6 months ( iron accumulation model ) were obtained for Micro-CT examination. Western blot and co-immunoprecipitation were used to detect the changes of related parameters in Wnt signaling pathway. Compared with wild-type mice, the bone mass in Hepcidin-KO mice was significantly decreased, the binding ofβ-catenin to FOXO3a increased, and binding of β-catenin to TCF4/TCF7L2 decreased in bone tissue, without significant changes in the expression ofβ-catenin, TCF4/TCF7L2, and FOXO3a. These results suggest that iron accumulation may affect bone formation through interfering with canonical Wnt/β-catenin signaling pathway, finally leading to osteoporosis.[Summary] The specimens of femur from wild-type mice(WT) of 6 months and Hepcidin-knockout(KO) mice of 6 months ( iron accumulation model ) were obtained for Micro-CT examination. Western blot and co-immunoprecipitation were used to detect the changes of related parameters in Wnt signaling pathway. Compared with wild-type mice, the bone mass in Hepcidin-KO mice was significantly decreased, the binding ofβ-catenin to FOXO3a increased, and binding of β-catenin to TCF4/TCF7L2 decreased in bone tissue, without significant changes in the expression ofβ-catenin, TCF4/TCF7L2, and FOXO3a. These results suggest that iron accumulation may affect bone formation through interfering with canonical Wnt/β-catenin signaling pathway, finally leading to osteoporosis.
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The specimens of femur from wild-type mice(WT) of 6 months and Hepcidin-knockout(KO) mice of 6 months(iron accumulation model) were obtained for Micro-CT examination. Western blot and co-immunoprecipitation were used to detect the changes of related parameters in Wnt signaling pathway. Compared with wild-type mice, the bone mass in Hepcidin-KO mice was significantly decreased, the binding of β-catenin to FOXO3a increased, and binding of β-catenin to TCF4/TCF7L2 decreased in bone tissue, without significant changes in the expression of β-catenin, TCF4/TCF7L2, and FOXO3a. These results suggest that iron accumulation may affect bone formation through interfering with canonical Wnt/β-catenin signaling pathway, finally leading to osteoporosis.
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Objective To investigate the diurnal rhythms of fetal heart rate in third trimester of pregnancy. Methods From June 2014 and October 2017,97 cases of low-risk pregnancy women who received antenatal care and deliveried in Peking University Third Hospital were collected. Totally 130 cases of fetal heart rate and maternal holter monitoring data were analyzed. All cases were singleton pregnancy, cephalic position and had normal perinatal outcome. They were divided into three groups based on gestational age, 29 cases(22.3%,29/130)in pregnancy 28-33+6weeks, 37 cases(28.5%,37/130)in 34-36+6weeks, and 64 cases (49.2%, 64/130)in 37-40+6weeks. Fetal heart baseline (FHB), fetal heart baseline variation (FHBV), fetal heart rate acceleration area and maternal heart rate were acquired by computer, their diurnal rhythms and the differences among three groups were analyzed. Results FHB、FHBV、fetal heart rate acceleration area and maternal heart rate all presented diurnal rhythms.(1)FHB rose in daytime and decreased at night with the minimum value at 2:00-5:00, and didn′t decline further at night with the advancing of gestational age(P=0.548).(2)FHBV was similar to FHB, which rose in daytime and decreased at night, but declined smaller at night with the advancing of gestational age, especially after 37 weeks (P<0.01).(3)Fetal heart rate acceleration area reduced in daytime and enlarged at night, and enlarged more with the advancing of gestational age.(4)The diurnal rhythm of maternal heart rate was consistent with fetal heart rate. FHB lagged behind maternal heart rate for 1-2 hours when declining to the nocturnal nadir but been basically in sync with maternal heart rate when recovered. Conclusion The basic characteristics of fetal heart rate in normal pregnancy exist obviously diurnal rhythms, and change in different trends with the advancing of gestational age.
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Objective To analyze the characteristics of long-range monitoring of fetal heart rate in the third trimester fetuses with atypical non-stress test (NST).Methods Long-range monitoring of fetal heart rate was performed in low-risk pregnant women who received antenatal care between April 2014 and October 2015 in Peking University Third Hospital.All subjects underwent NST from the 36th gestational week,and divided into normal NST (30 cases) and atypical NST (36 cases) groups according to the results of NST.The clinical data,including maternal age,gestational age at delivery,termination of pregnancy,neonatal asphyxia,hospitalization rate and umbilical cord blood peak-systolic/diastolic ratio value were collected.The data of long-range monitoring were analyzed by specially designed computer software.T test and Chi-square test were applied for statistical analysis.Results There were no differences in maternal age,gestational age at delivery,mode of delivery and incidence of neonatal asphyxia between the two groups (all P＞0.05).In atypical NST group,fetal heart rate baseline was higher [(138.05±5.65) vs (135.10±5.39) bpm] (t=-2.170,P＜0.05),and fetal heart rate baseline variability was lower than in normal NST group [(5.19±1.07) vs (6.28±1.15) bpm] (t=3.960,P＜0.001).Compared with normal NSTs,the percentage of mild baseline variability was significantly increased in atypical NST group [(40.79±9.97) vs (51.17± 10.84)％],while that of moderate variability was significantly decreased [(56.57±8.86) vs (46.72± 10.24)％] (t=-4.018 and 4.133,both P ＜ 0.001).In atypical NSTs,the average ratio of time of acceleration/the whole time of monitoring [(37.41 ±4.60)％] and acceleration area per unit time[(1.42±0.48) cm2/20 min] were decreased compared with normal NSTs [(40.78±4.23)％ and (2.03±0.67) cm2/20 min] (t=3.079 and 4.359,both P＜0.05).Conclusions Long-range monitoring of fetal heart rate in the third trimester fetuses with atypical NST is characterized by the declined fetal heart rate baseline variability,increased proportion of mild variability and unit time acceleration area;but these are not associated with pregnancy outcomes and short-term prognosis.
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OBJECTIVE@#To analyze the long-term efficacy of nasal endoscopic opticnerve decompression for traumatic optic neuropathy(TON) and to explore its possible influencing factors.@*METHOD@#To summarize the clinical data of 39 cases underwent transnasal decompression, which were followed-up for more than 1 year. The data, including optic canal CT scanning, flashed-elicited visual-evoked potential (FVEP), preoperational vision and visual field examination were reviewed. Nasal endoscopic optic nerve decompression was preformed. Whether or not optic nerve sheath incision decided to perform was according to preoperative CT and situations in operation. Postoperative follow-up including vision, visual field, funduscopy, nasal endoscopy were performed.@*RESULT@#Total efficacy rate was 30. 77% (12/39), inefficacy rate was 69. 23%(27/39). The efficacy rate was 85. 71% with better than nolight perception, and the efficacy rate was 18. 75% with nolight perception, the clinical effect in the group of preoperative better than nolight perception was better than that of nolight perception, the difference was statistically significant (P 0. 05). The efficacy rate was 26. 32% with optic nerve sheathincision, while the efficacy rate was 35. 00% without optic nerve sheath incision, and there was no statistically significant difference (P>0. 05); Postoperative vision tended to stabilize until about 6 months post-operation, without complications.@*CONCLUSION@#The long-term efficacy of nasal endoscopic opticnerve decompression for TON was certain; The efficacy with preoperative residual vision was better than that of nolight perception, the factor of long or short duration from the trauma point to the operation point and the factor of optic nerve sheath incision didn't influence long curative effect. To avoid the secondary damage to the optic nerve after trauma was the key to increase long curative effect in TON.
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Humanos , Descompresión Quirúrgica , Endoscopía , Procedimientos Neuroquirúrgicos , Nariz , Cirugía General , Nervio Óptico , Cirugía General , Traumatismos del Nervio Óptico , Cirugía General , Periodo Posoperatorio , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Agudeza VisualRESUMEN
OBJECTIVE@#To discuss the clinical efficacy of adenoidectomy and tonsillectomy for the OSAHS children with sinusitis.@*METHOD@#Reviewing 112 cases of children with OSAHS, in which the 80 patients without chronic sinusitis, 32 ones with chronic sinusitis. Among them, 103 cases of children with adenoidectomy, tonsil resection, 9 cases adenoidectomy only. We did questionnaire survey before and after surgeryand also did post-surgery clinical follow-up.@*RESULT@#The effective rate was 90.0% for the OSAHS children without sinusitis after adenoid and tonsil ectomy surgery, while the effective rate was 46.9% for the ones with sinusitis, the efficiency was significant different in the two groups after surgery; the 16.1% children after tonsil ectomy surgery complained the incidence of pharyngeal foreign body sensation and pharyngeal lymphoid hyperplasia in children was 23.2%.@*CONCLUSION@#The efficiency was aviable for the OSAHS children without sinusitis after surgery; The efficiency was not aviable enough for the OSAHS children with sinusitis after surgery, so the latter one need adjuvant drug treatment; We also should be attention to the pharyngeal foreign body sensation and the lymphoid hyperplasia in children after tonsillectomy.
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Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Adenoidectomía , Estudios Retrospectivos , Sinusitis , Terapéutica , Apnea Obstructiva del Sueño , Cirugía General , Tonsilectomía , Resultado del TratamientoRESUMEN
OBJECTIVE@#To investigate the feasibility and safety of lingual tonsil excision by endoscopic assisted coblation.@*METHOD@#Twenty seven cases with lingual tonsil hypertrophy were recruited in this study. Preoperative fibrolaryngoscope and CT and (or) MRI examination of the base of the tongue, lingual tonsil was removed by 70 degrees nasal endoscopy-assisted plasma radiofrequency after nasotracheal intubation. The tongue wound healing and post-operative bleeding were observed after operation, the advantages of the endoscopic-assisted plasma radiofrequency on lingual tonsil removal were analyzed, and its feasibility and safety were summarized.@*RESULT@#During the surgery the base of the tongue and epiglottis had satisfaction exposure in the same operative field. No complications happened in the surgery and endotracheal tube was plucked safely after operation. There was no primary bleeding, and the number of secondary bleeding were 4 cases, accounting for 14.81% (4/27), respectively occurred on the sixth, seventh, tenth and twelfth day with the amount of bleeding of 30-70 ml. The bleeding were cured after conservative treatment or re-application applicating of radiofrequency; 27 patients had no taste disturbance, and they were followed up for 6-30 months without recurrence.@*CONCLUSION@#Lingual tonsil excision by nasal endoscopic-assisted coblation has enough exposure, complete resection and low recurrence rate. Stopping bleeding should be attentioned to prevent postoperative bleeding.