Research progress of rapid surgery for hip fracture in elderly patients / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress of rapid surgery for hip fracture in elderly patients.@*METHODS@#The published studies, expert consensus, and guidelines at home and abroad were systematically summarized from the aspects of the characteristics of aging population, the benefits of rapid surgery, the disadvantages of delayed surgery, and the recommendations of current guidelines, so as to further guide clinical practice.@*RESULTS@#Hip fracture is a common fracture type in the elderly population. As elderly patients generally have poor physique and often have a variety of underlying diseases, such as hypostatic pneumonia, bedsore, lower limb vein thrombosis, and other complications in conservative treatment, its disability rate and mortality are high, so surgical treatment is the first choice. At present, most relevant studies and expert consensus and guidelines at home and abroad support rapid surgery, that is, preoperative examination should be started immediately after admission, and adverse factors such as taking anticoagulant drugs, serious cardiovascular diseases, and severe anemia should be clearly and actively corrected, and surgery should be completed within 48 hours after admission as far as possible. Rapid surgery can not only significantly reduce the mortality of patients, but also reduce the length of hospital stay and the incidence of perioperative cognitive impairment, which is conducive to the recovery of patients with pain during hospitalization and postoperative function, and improve the prognosis of patients.@*CONCLUSION@#In order to avoid many problems caused by delayed surgery, the elderly patients with hip fracture should be operated as soon as possible under the condition of actively correcting the adverse factors. Comprehensive evaluation and preparation, the development of an individualized surgical plan, and the formation of a multidisciplinary medical team can reduce surgical risks and improve effectiveness.

Effect of vitrectomy timing on long-term efficacy in patients with vitreous hemorrhage due to proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the timing and efficacy of vitrectomy for patients with vitreous hemorrhage(VH) due to proliferative diabetic retinopathy(PDR).METHODS:Retrospective analysis.Patients who presented to our hospital between Feburary 2012 and May 2014 with VH secondary to PDR treated with vitrectomy were included.All patients were divided into three groups according to the duration of VH.A group was less than 1mo for 22 eyes, B group was 1-3mo for 23 eyes, C group was more than 3mo for 25 eyes.All patients underwent intravitreal injection of ranibizumab 1-2wk before vitrectomy, and supplemented or finished panretinal photocoagulation (PRP) intraoperatively or postoperatively.Patients with cataract accepted phacoemulsification and intraocular lens implantation.Eyes filling silicone oil were implanted intraocular lens in the second phase.All patients were followed up 24 to 42mo (mean:28.7mo).We assessed the intraoperative complications such as hemorrhage, iatrogenic retinal hole, and postoperative complications such as vitreous hemorrhage, neovascular glaucoma.Macular edema and best corrected visual acuity were observed at every follow-up.RESULTS:There was no significant difference for other baseline data (P>0.05) but DR stage between three groups (P=0.033).There was significant difference of last follow up visual acuity between three groups (P0.05).The percentage of visual acuity was 0.5 and above in the three groups were:41%, 23%, 0 respectively.The patients with visual acuity of less than 0.1 were 5%, 26% and 40% respectively.Silicone oil filling rate of three groups were:9%, 26%, 40% respectively and there was no significantly difference between three groups on postoperative complications (P>0.05).CONCLUSION:Patients with VH due to proliferative diabetic retinopathy undergoing early vitrectomy may get better visual acuity than who accepting delayed vitrectomy.

A study on the surgery timing for adhesive small bowel obstruction / 中华普通外科杂志

Objective To evaluate the surgery timing for adhesive small bowel obstruction (ASBO).Methods A retrospective analysis was made on the clinical data of ASBO patients admitted to our hospital between January 2003 and December 2012 who received surgical treatment.According to surgery timing,patients were divided into three groups,early surgery group (＜ 36 h),mid-term surgery group (36-72 h) and late surgery group (≥ 72 h).The mortality,surgical site infection (SSI) rate and systemic infection rate were compared between groups.Result In this study,33,56 and 27 patients received early,middle and late surgery,respectively.The SSI rate in early surgery group was significantly lower than that in middle (6％ vs.25％,x2 =5.05,P =0.025) and late surgery group(6％ vs.30％,x2 =5.94,P =0.015).Though of not significant difference,the mortality and systemic infection rate in early surgery group were also lower than both middle and late surgery groups.Conclusions Early surgery might reduce the postoperative infectious complications and improve the outcome of patients with ASBO.

A study on the optimal surgical timing for rib internal fixation / 中国医师进修杂志

Objective To investigate the optimal surgical timing for rib internal fixation.Methods The clinical data of 143 patients with rib fracture were retrospectively analyzed.The patients were divided into early phase fixation group (62 cases) and late phase fixation group (81 cases) according to the time from trauma to internal fixation.The ratio blood lose and body surface area,pulmonary complications and the changes of C reactive protein level before and 5 days after operation were recorded and compared.Results All the patients were healing.The median C reactive protein before operation in late phase fixation group was 45 mg/L,in early phase fixation group was 23 mg/L,there was statistical difference (P ＜ 0.01).The ratio blood lose and body surface area in early phase fixation group was (334.19 ± 37.53) ml/m2,the rate of pulmonary complications was 22.6％(14/61),in late phase fixation group was (438.99 ± 55.24) ml/m2 and 38.3％ (31/81),there were statistical differences (P ＜ 0.01 or ＜ 0.05).The median C reactive protein 5 days after operation in early phase fixation group was 189 mg/L,in late phase fixation group was 258 mg/L,there was statistical difference (P ＜ 0.05).Conclusion Early phase (72 hours) rib internal fixation is expected to reduce patient trauma of systemic reactions,reduce the incidence of bleeding and pulmonary complications.