The therapeutic effect between metal augment and impacted bone grafting in the hip revision of acetabular bone defect / 医学研究生学报

Objective The application of metal augments in the revision of total hip arthroplasty(THA)has achieved re-markable results in the treatment of bone defects.However,there are limited studies compared this effective method with the traditional treatment.The purpose of this article is to investigate the curative effect of both metal augmentation and impacted bone grafting in the revision of acetabular bone defect. Methods We retrospectively analyzed 20 patients(20 hips)with bone defects after THA in Au-thority of Nanjing General Hospital of Nanjing Military Region from August 2010 to February 2017.These 20 patients were allocated into 2 groups:impacted bone grafting group(n=11,filling acetabular bone defect with autogenous iliac bone and artificial bone)and metal aug-mentation group(n=9,filling acetabular bone defect with metal aug-ment).The duration of surgery,blood loss and the hospital for special surgery knee score(HSS)were compared between these two groups and the Harris score was applied to evaluate the hip function and full weight bearing. Results The surgery duration and blood loss of impacted bone grafting group were significantly increased when compared with the metal augmentation group(44.5±7.82 min vs 36.22±5.19 min and 431.82±57.76 mL vs 333.33±72.80 mL respec-tively).there were 3 cases showed mild bone resorption in the I regions in the impacted bone grafting group, while only one case showed mild bone resorption in the II region in the metal augmentation group.The HSS scores in the metal augmentation group were higher than those in the impacted bone grafting group at the time of postoperative 2 weeks(43.89±2.76 vs 40.82±4.42), 3 months (49.89±2.03 vs 45.27±3.90)and 6 months(53.44±2.46 vs 50.55±3.67), the differences were statistically significant(P<0.001). The Harris scores in the metal augmentation group were higher than those in the impacted bone grafting group(P<0.01).The metal augmentation group had a shorter time of getting out of bed compared with the impacted bone grafting group(P<0.01). Conclusion For those patients with upper acetabular bone defect,revision surgery using metal augments can save the operation time.Meanwhile, it is also superior to the impacted bone grafting in the early prosthesis stability and bone ingrowth,and thus enables to shorten the time on getting out of bed and promote functional.

Knee arthroscopy-assisted ambulatory surgery:Practice and considerations / 医学研究生学报

Objective Ambulatory surgery(AS),with its simple procedures and efficient utilization of resources,is an ef-fective means of improving medical efficiency.The aim of this study was to improve the daily procedures of AS by analyzing the perform-ance and results of knee arthroscopy-assisted AS. Methods This study included 188 cases of knee arthroscopic surgery performed from March to August 2017,97 of them treated in the Ambulatory Surgery Center(group A)and the other 91 in the conventional ward (group B). We compared the average hospital stay,hospitalization expenses,and postoperative complications between the two groups of patients. Results Compared with group B,group A showed a significantly shorter hospital stay([95.0±41.3]vs[25.5±0.8]h, P<0.05)and lower hospitalization expenses([28 699.6±11331.1]vs[22231.7±7152.2]RMB,P<0.05). No statistically significant difference was observed in the incidence rate of postoperative complications at 1 and 3 days after surgery,1 case of bleeding in group A and 1 case of leg swelling in group B. Conclusion Ambulatory surgery in our hospital needs to be further improved on the basis of accelerated rehabilitation surgery as the core concept,precision medicine as the approach,and individualized treatment as the goal.

Secondary definitive surgery for multiple injuries from Wenchuan earthquake in China / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the opportune time of secondary definitive surgery for patients with multiple injuries from earthquakes based on the acute physiology and chronic health evaluation II (APACHE II) score and the principles of damage control.</p><p><b>METHODS</b>Twenty-one patients with critical earthquake injuries were treated with damage control strategies, followed by medical support and surgical intervention to restore their physical potential in the intensive care unit (ICU). Successive APACHE II scoring was adopted to evaluate the patients'physiological status, and then, internal fixation of fractures and other definitive operations were performed.</p><p><b>RESULTS</b>All the patients were effectively treated with few complications, low deformity rate and no death.</p><p><b>CONCLUSIONS</b>Appropriate evaluation of patients?physiological potential, right decision on surgical time and proper operative method can reduce the rates of complications, disability and death for patients with critical earthquake injuries.</p>

Definitive postponed surgery for the casualties with multiple injuries in the earthquake / 中国骨伤

<p><b>OBJECTIVE</b>To explore the treatment of casualties who suffered from multiple injuries in earthquake and had been treated by damage control (DC) immediately,and the definite postponed surgery time by way of APACHE II score.</p><p><b>METHODS</b>From May to June 2008, 21 casualties who had undergone DC accepted further treatment of medicine and surgery, and recovered physical potentiality in the intensive care unit (ICU). APACHE II score was adopted to evaluate the casualties' physical potentiality. Then, internal fixation of intra-articular fractures and centrum fractures, alternation from external fixation to internal fixation, reconstruction of soft tissue was applied by stages according to the plan.</p><p><b>RESULTS</b>All the patients were effectively cured after definite postponed surgery. There was less complication, low deformity ratio and no death happened.</p><p><b>CONCLUSION</b>Timely evaluation of the casualties' physical potentiality, appropriate surgery time and exact surgery can reduce the casualties' complication, deformity rate and death rate.</p>