Leg length discrepancy after total hip arthroplasty: a comparison between robotic-assisted and coventional implantation / 中华骨科杂志

Objective:To compare the difference of LLD (leg length discrepancy) between robot-assisted and conventional methods of total hip arthroplasty (THA).Methods:Data of 38 patients who had THA performed by robot-assisted or conventional methods from January 2019 to May 2020 were retrospectively analyzed. There were 38 cases (54 hips) in robot-assisted THA group (robot group) with 18 males and 20 females (age 53.5±13.6 years, BMI 26.2±3.4 kg/m 2), and there were 21 cases (32 hips) with osteonecrosis of the femoral head, 17 cases (22 hips) with Crown typeⅠandⅡdevelopmental dysplasia of the hip. There were 38 cases (54 hips) in conventional THA group (conventional group), with 19 males and 19 females, (age 52.3±14.7 years old, BMI 25.7±2.9 kg/m 2), and there were 19 cases (30 hips) with developmental dysplasia of the hip, and 19 cases (24 hips) with osteonecrosis of the femoral head. The operative time, postoperative LLD, Harris score, forgotten joint score-12 (FJS-12) and the difference between preoperative and postoperative LLD between the two groups were compared, and the correlation between surgical methods and the change of hip length was also evaluated. Results:The operation time of the robot group was 73.3±14.1 min and which was 59.3±12.6 min in conventional THA group ( t=2.732, P=0.003). In the robot group, the postoperative LLD was 2.3±3.4 mm, which was less than that of the conventional group 6.7±5.4 mm ( t=3.521, P < 0.001). When the absolute value of LLD was larger than 5 mm as an abnormal value, it was 2.6% (1/38) in the robot group and 47.3% (18/38) in the conventional group. The difference of hip length (HL) in planning and post-operation in the robot group was 2.8±2.2 mm, which was smaller than that in the conventional THA group 7.9±5.3 mm ( t=2.357, P < 0.001). In addition, there was a correlation between the change of hip length results and the postoperative measurement of hip length in the robot group ( r=0.983, P < 0.001). At the last follow-up, Harris score and FJS-12 were recorded in the robot group and coventional group. The scores were 83.1±5.3 and 32.5±4.9 respectively in the robot group, 82.9±7.2 and 31.9±6.7 in the conventional group, respectively. There was no significant difference between the two groups ( t=0.221, 0.356; P=0.819, 0.731). Postoperative bleeding occurred in 1 case in the robot group with postoperative suture healed well. The fracture of the posterior wall of the acetabulum was found in the conventional group and the patient avoids weight bearing 4 weeks after operation. The postoperative recovery was good and no other related complications were found. Conclusion:Robot-assisted THA can accurately restore the length of both legs and reduce LLD compared with conventional THA. The real-time monitoring of LLD during robot operation can give the operator an accurate reference.

Application of damage control surgery concept application in 22 cases of pancreas trauma / 中国医师进修杂志

Objective To investigate the application of damage control surgery (DCS) concept in treatment of pancreas trauma. Methods The clinical data of 22 cases of pancreas trauma from January 2009 to June 2016 were analyzed retrospectively, including degree of injury, therapies and effect. Results Following DCS concept, 3 cases were given conservative treatment, and 19 cases were treated by operation, including debridement, hemostasis, suture, simple drainage and preserved pancreas function;21 cases were cured and 1 died;pancrestic fistula occurred in 11 cases, abdominal infection occurred in 6 cases and injured pancreatitis occurred in 1 cases by conservative treatment;false cyst occurred in 1 cases 6 weeks after operation. All patients were followed up for 12-36 months, with an average of (25.1 ± 1.7) months, and No significant impact was seen on the lives or work of 21 patients after surgery. Conclusions Pancreas trauma needs early-stage diagnosis and active treatment. Rational application of dcs concept can reduce the mortality and improve the outcome effectively.

Application of damage control surgery concept application in 22 cases of pancreas trauma / 中国医师进修杂志

Objective To investigate the application of damage control surgery (DCS) concept in treatment of pancreas trauma. Methods The clinical data of 22 cases of pancreas trauma from January 2009 to June 2016 were analyzed retrospectively, including degree of injury, therapies and effect. Results Following DCS concept, 3 cases were given conservative treatment, and 19 cases were treated by operation, including debridement, hemostasis, suture, simple drainage and preserved pancreas function;21 cases were cured and 1 died;pancrestic fistula occurred in 11 cases, abdominal infection occurred in 6 cases and injured pancreatitis occurred in 1 cases by conservative treatment;false cyst occurred in 1 cases 6 weeks after operation. All patients were followed up for 12-36 months, with an average of (25.1 ± 1.7) months, and No significant impact was seen on the lives or work of 21 patients after surgery. Conclusions Pancreas trauma needs early-stage diagnosis and active treatment. Rational application of dcs concept can reduce the mortality and improve the outcome effectively.

Radioactive probe-guided parathyroidectomy for secondary hyperparathyroidism / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The value of gamma probes in the surgical treatment of secondary hyperparathyroidism (sHPT) was determined. The aim of this study was to enhance the rate of successful total parathyroidectomy in patients with sHPT using intraoperative gamma probe investigations.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 48 sHPT patients between May 2007 and September 2011. Preoperative (99)Tc(m)- methoxyisobutyl isonitrile (MIBI) scintigraphy and high-frequency ultrasonography were used for parathyroid localization. Thirty-five patients (group I) underwent conventional neck exploration and open parathyroidectomy. Thirteen patients (group II) underwent gamma probe-guided total parathyroidectomy and parathyroid transplantation. The two groups were compared in terms of the number of parathyroid resections, operative time, and postoperative changes in the blood levels of parathyroid hormone (PTH), calcium, and phosphate.</p><p><b>RESULTS</b>The clinical manifestations, PTH and calcium levels, age distribution, and clinical characteristics did not differ between the two groups. The accuracy of preoperative (99)Tc(m)-MIBI scintigraphy (89.74%) for the diagnosis of hyperparathyroidism did not differ from that of ultrasonography (81.25%). However, the accuracy of (99)Tc(m)-MIBI scintigraphy (66.67%) for localizing hyperfunctioning parathyroids was significantly lower than that of ultrasonography (76.86%). The operation time was significantly longer in group I ((120 ± 25) minutes) than in group II ((90 ± 30) minutes). The accuracy of parathyroid identification was significantly higher in group II (92.59%) than in group I (80.39%). On average, significantly fewer parathyroid specimens were obtained in group I (2.5 ± 0.5) than in group II (3.5 ± 0.5). Compared with group I, group II showed a significant increase (15.4%) in the number of parathyroid resections. The PTH, calcium, and phosphate levels significantly decreased postoperatively in all patients.</p><p><b>CONCLUSIONS</b>Intraoperative gamma probe examination confirmed that the excised specimen was parathyroid tissue and improved the accuracy of parathyroid resection. The parathyroidectomy rate was increased by 15.4% due to the use of these probes. However, the probes did not detect all ectopic parathyroids, and further research is required to clarify the underlying reasons.</p>

Efficacy of ganciclovir combined with Bacillus Calmette-Guerin polysaccharide nucleic acid for the treatment of herpes zoster / 中国医师进修杂志

Objective To investigate the clinical efficacy of ganciclovir combined with Bacillus Calmette-Guerin polysaccharide nucleic acid (BCG-PSN) for the treatment of herpes zoster. Methods Eighty-six cases with herpes zoster were randomly divided into study group and control group, 43 cases in each group. Patients of control group received simple ganciclovir treatment; while patients of the study group received BCG-PSN on this basis, then to observe and compare the efficacy, the repair time of skin lesions (herpes stopping, surface deposition), odynolysis time, remained neuralgia incidence and adverse reactions of two groups. Results Patients of two groups all completed the experiment successfully, no one withdraw from this trial because of no tolerance of drugs. The herpes stopping and surface deposition time and odynolysis time of study group were significantly shorter than those of control group, the difference was statistically significant (P＜0.05 ); the remained neuralgia incidence was significantly lower than that of control group,the difference was statistically significant (P＜0.05); the effective rate of study group in 14 days after treatment was 90.7% (39/43) and significantly higher than that of control group [74.4% (32/43)], the difference was statistically significant (P ＜ 0.05);there were no serious adverse reactions occurred in two groups. Conclusion Application of ganciclovir combined with BCG-PSN for the treatment of herpes zoster has certain efficacy, it is feasible and safe.

Relationships of ?-AR and GRK2 in lung,lung injury in rats with severe acute pancreatitis and therapeutic effect by methlyprednisolone / 中国病理生理杂志

AIM: To investigate the variation of ?-AR in pulmonary microvascular endothelial cells and variation of GRK2 in lung and to explore the therapeutic effect of methlyprednisolone in severe acute pancreatitis-associated lung injury model in rats.METHODS: 36 rats were divided into three groups randomly: the control group,the experimental group,and the intervention group.In the experimental group,severe acute pancreatitis-associated lung injury model was induced in SD rats by retrograde injection of 5% sodium taurocholate into biliopancreatic duct.In the control group,laparotomy was performed,duodenum and pancreas were flipped only.In the intervention group,methlyprednisolone(30 mg/kg) was injected into rump muscle of rats after model developed.At 6 and 12 h after model was developed,the maximum binding capacity(Bmax) and the Kd value of ?-AR were detected in lung by means of radioactive ligand binding assay.GRK2 expression was detected in lung by means of immunofluorescence.RESULTS: The scores of the severity of pancreatitis and the severity of lung injury in the experimental group were obviously higher than those in control group.In the experimental group,Bmax was obviously lower,Kd and GRK2 were obviously higher than those in control group and the intervention group.CONCLUSION: The ?-AR in lung is lower down and GRK2 expression in lung is up-regulated in severe acute pancreatitis-associated lung injury model in rats.The therapeutic effect of methlyprednisolone to severe acute pancreatitis-associated lung injury is positive.

Effects of lipopolysaccharide,IL-6 and TNF? on the tissue factor expression of astrocytes / 中国病理生理杂志

AIM:To study the effects of lipopolysaccharide(LPS), interleukin-6(IL-6)and tumor necrosis factor ? (TNF?) on tissue factor(TF) expression of astrocytes. METHODS:Astrocytes were identified with anti-glial fibrillary acidic protein antibody. The TF activity of cell lysate was measured with one stage clotting assay. RESULTS:TF activity of astrocytes of LPS,IL-6,TNF? groups were obviously higher than that of the control group( P