Effect of early rehabilitation exercise on blood pressure of elderly patients with septic shock: a single-center, prospective, randomized controlled study / 中华危重病急救医学

Objective:To observe the effect of early rehabilitation exercise on blood pressure of elderly patients with septic shock.Methods:A single-center, prospective, randomized controlled study was conducted in elderly patients with septic shock who were hospitalized in the department of critical care medicine of Huangshan Shoukang Hospital (High-tech Zone Central Hospital of Huangshan) from December 2018 to November 2020. According to the principle of simple random, all patients were divided into control group and intervention group. Both groups were treated with lower limb barometry to prevent deep vein thrombosis, 3 times a day, 30 minutes each time. After comprehensive treatment in the intensive care unit (ICU), the severity of patients was gradually improved, the hemodynamics was relatively stable, and the norepinephrine was reduced to 0.5 μg·kg -1·min -1. The control group continued to receive lower limb barometric treatment without rehabilitation training, while the intervention group began rehabilitation training when the dose of norepinephrine was reduced to 0.5 μg·kg -1·min -1. The duration of norepinephrine use, the length of ICU stay, and the occurrence of adverse events during rehabilitation training in intervention group was recorded. Results:Seventy-two patients were included in the final analysis, 35 in intervention group and 37 in control group. There was no significant difference in gender, age, Oxford acute severity of illness score (OASIS), acute physiology and chronic health evaluationⅡ (APACHEⅡ), mean arterial pressure (MAP) of 3 times and underlying diseases between two groups. Compared with control group, the length of ICU stay and duration of dose of norepinephrine ≤0.5 μg·kg -1·min -1 in intervention group were significantly shorter [length of ICU stay (hours): 193.0 (145.5, 312.0) vs. 242.5 (180.0, 483.5), P < 0.05; duration of dose of norepinephrine ≤0.5 μg·kg -1·min -1 (hours): 120.0 (72.0, 144.0) vs. 144.5 (120.0, 192.0), Z = 2.976, P = 0.003]. In intervention group, 35 patients did not show acute myocardial infarction, arrhythmia, syncope, central venous catheter detachment, and gastric tube detachment during the rehabilitation period, except 1 patient suffered from naked hematuria due to urinary catheter traction, which disappeared the next day after symptomatic treatment. Conclusion:The early rehabilitation exercise was beneficial to the recovery of autonomic blood pressure in elderly patients with septic shock, shorten the time of norepinephrine use and ICU stay.

Investigation on iodine nutrition status of pregnant women in Huzhou City, Zhejiang Province in 2017 / 中华地方病学杂志

Objective:To understand the iodine nutrition status of pregnant women in Huzhou City, and to provide a basis for timely targeted prevention and control of the iodine deficiency disorders.Methods:In 2017, five districts (counties) in Wuxing, Nanxun, Deqing, Changxing, and Anji were used as monitoring sites in Huzhou City, and each monitoring site was divided into five areas according to the east, west, south, north, and middle locations. One township (street) in each location was sampled to collect drinking water samples from residents, and the water iodine content was tested; 21 pregnant women (7 each in the early, middle, and late pregnancy periods) were sampled in each township (street), and edible salt samples were collected at home for testing salt iodine and urine samples were collected for testing urinary iodine content.Results:A total of 332 drinking water samples were collected from Huzhou residents, water iodine median was 2.2 μg/L, which belonged to iodine-deficient regions; and there was statistically significant difference in the water iodine median between different regions ( H = 161.0, P < 0.05). And 525 edible salt samples were detected from pregnant women, the salt iodine median was 23.4 mg/kg, the salt iodine coverage was 97.1% (510/525), and the qualified iodized salt consumption rate was 93.0% (488/525). There was a statistically significant difference in salt iodine levels between different regions ( H = 67.7, P < 0.05). Meanwhile, the urinary iodine median of 525 urine samples of pregnant women was 123.1 μg/L, which was at the level of iodine deficiency. From the regional distribution, the urinary iodine median in Deqing County was 154.0 μg/L, which was the highest and at an iodine appropriate level; the other regions were Wuxing District, Nanxun District, Anji County, and Changxing County in order, all of them were at the iodine deficiency level; the urinary iodine median of pregnant women between different regions was statistically significantly different ( H = 14.1, P < 0.05). From the pregnancy periods' distribution, the urinary iodine median in middle pregnancy period was the highest at 172.8 μg/L; there was statistically significant difference between different pregnancy periods ( H = 7.5, P < 0.05). Conclusions:The Huzhou City belongs to the environmental iodine deficiency area. Except for Deqing County, the iodine nutrition status of pregnant women in other districts (counties) is at an iodine deficiency level. Urinary iodine level monitoring and health education of pregnant women should be strengthened to improve iodine nutrition status.

Study on public dose burden in Suzhou from medical exposure in X-ray digital radiography and computed tomography / 中华放射医学与防护杂志

Objective To estimate the effective dose burden to the public in Suzhoui induced by medical exposure from computed tomography (CT) and digital radiography (DR).Methods Twenty-seven hospitals were selected by stratified random sampling.The application information was colleted from picture archiving and communication system (PACS) and radiology information system (RIS).For DR,DAP was measured by the dose-area product meter in different body parts,then the effective dose values were calculated by the DAP.For CT,effective dose was estimated by measuring CT dose index weighted (CTDIw) and scanning parameters in different parts of the body.The public dose burden caused by DR and CT medical exposure in Suzhou was estimated according to the scanning time and effective dose to each part.Results The effective dose due to DR examination was abdomen AP 0.565 mSv,pelvis AP 0.280 mSv,skull LAT 0.016 mSv,skull AP 0.012 mSy,chest LAT 0.111 mSv,chest AP 0.060 mSv,thoracic spine LAT 0.100 mSv,thoracic spine AP 0.102 mSv,lumbar spine LAT 0.307 mSv and lumbar spine AP 0.152 mSv,respectively.The effective doses from CT scanning were 1.33 mSv for head,5.75 mSv for thorax and 7.31 mSv for abdomen,respectively.The annual collective effective dose in Suzhou in 2017 from DR exposures and CT scans was 9 593.07 man · Sv,and the average annual effective dose was 0.898 mSv.Conclusions The contribution of CT medical radiation to the public dose is much greater than that of DR.Controlling the frequency of medical exposure and single scan dose is an effective way to reduce the public dose burden.The public dose burden from DR and CT medical exposure in Suzhou is at a high level and attention needs to be paid by relevant health administrative departments.

Study on public dose burden in Suzhou from medical exposure in X-ray digital radiography and computed tomography / 中华放射医学与防护杂志

Objective@#To estimate the effective dose burden to the public in Suzhoui induced by medical exposure from computed tomography (CT) and digital radiography (DR).@*Methods@#Twenty-seven hospitals were selected by stratified random sampling. The application information was colleted from picture archiving and communication system (PACS) and radiology information system (RIS). For DR, DAP was measured by the dose-area product meter in different body parts, then the effective dose values were calculated by the DAP. For CT, effective dose was estimated by measuring CT dose index weighted (CTDIw) and scanning parameters in different parts of the body. The public dose burden caused by DR and CT medical exposure in Suzhou was estimated according to the scanning time and effective dose to each part.@*Results@#The effective dose due to DR examination was abdomen AP 0.565 mSv, pelvis AP 0.280 mSv, skull LAT 0.016 mSv, skull AP 0.012 mSv, chest LAT 0.111 mSv, chest AP 0.060 mSv, thoracic spine LAT 0.100 mSv, thoracic spine AP 0.102 mSv, lumbar spine LAT 0.307 mSv and lumbar spine AP 0.152 mSv, respectively. The effective doses from CT scanning were 1.33 mSv for head, 5.75 mSv for thorax and 7.31 mSv for abdomen, respectively. The annual collective effective dose in Suzhou in 2017 from DR exposures and CT scans was 9 593.07 man·Sv, and the average annual effective dose was 0.898 mSv.@*Conclusions@#The contribution of CT medical radiation to the public dose is much greater than that of DR. Controlling the frequency of medical exposure and single scan dose is an effective way to reduce the public dose burden. The public dose burden from DR and CT medical exposure in Suzhou is at a high level and attention needs to be paid by relevant health administrative departments.

α7 nicotinic acetylcholine receptor agonist attenuated the lipopolysaccharide-induced inflammatory response via inhibiting the activation of nuclear factor-κB / 中华危重病急救医学

Objective To investigate the effects of α7 nicotinic acetylcholine receptor (α7nAChR) on the inflammatory response induced by lipopolysaccharide (LPS) in RAW264.7 macrophages and its molecular mechanisms. Methods RAW264.7 macrophages were culturedin vitro. Inflammatory cell model was constructed by LPS stimulation. Cells were challenged by LPS (1, 10, 100 and 500μg/L) for 5 hours or 100μg/L LPS for 0, 2, 4, 8, 12, 24, 48 and 72 hours, and the release of tumor necrosis factor-α (TNF-α) was detected by the enzyme linked immunosorbent assay (ELISA). The location of α7nAChR was examined in RAW264.7 macrophages by immunofluorescence. Then the cell proliferation and toxicity kit (CCK-8) was used to detect 1, 10, 100, 1000μmol/L GTS-21, a α7nAchR agonist, on the cell viability after LPS stimulation. ELISA was used to detect 1, 10, 100, 1000μmol/L GTS-21 on the levels of TNF-α, interleukin 1β (IL-1β) after LPS stimulation. Cells were challenged with 100μg/L LPS and 100μmol/L GTS-21, then, the level of high mobility group box 1 (HMGB1) was detected by Western Blot and the intracellular location of HMGB1 and nuclear factor-κB p65 (NF-κB p65) was tested by immunofluorescence.Results LPS increased the level of TNF-α to a peak at the concentration of 100μg/L and at 24 hours after stimulation. Theα7nAChR expressed on the macrophages. The cell viability was decreased in a dose-dependent manner [(96.2±1.0)%, (92.0±1.1)% vs. (86.5±2.2)%, bothP < 0.05]. Compared with the control group, the levels of TNF-α and IL-1βin the supernatant of LPS group were significantly increased [TNF-α (ng/L): 453.0±60.6 vs. 100.8±3.2, IL-1β(μg/L): 8.21±0.31 vs. 0.87±0.16, bothP < 0.05]. TNF-α and IL-1β were significantly decreased by 10μmol/L and 100μmol/L GTS-21 in a dose-dependent manner [TNF-α (ng/L): 227.5±17.5, 81.0±8.8 vs. 453.0±60.6;IL-1β (μg/L): 4.86±0.72, 2.32±0.45 vs. 8.21±0.31, allP < 0.05]. GTS-21 significantly reduced the expression of HMGB1 which was induced by LPS management (gray value: 0.788±0.130 vs. 2.061±0.330,P < 0.05) and reversed LPS-induced HMGB1 cytoplasmic transfer. GTS-21 also reversed LPS-induced nuclear translocation of NF-κB p65. Conclusion GTS-21 reduces the inflammatory response via inhibiting the activation of NF-κB.

Effect of vacuum-assisted closure in the treatment of diabetic foot / 中国综合临床

Objective To explore the effect of vacuum-assisted closure (VAC) in the treatment of diabetic foot.Methods Sixty-seven cases patients with diabetic foot in Chaoyang Central Hospital from January 2010 to January 2016 were recruited successively,according to wagner criteria for 2-5 diabetic foot classification.They were divided into VAC group with 34 cases and control group with 33 cases according to the different treatment methods.Both groups were given debridement treatment.After debridement,the patients in control group were given wound dressing every day or every other day.When fresh granulation tissue on wound surface became well-stacked,skingrafting or skin flap reparation was carried out.After debridement,patients in VAC group were given VAC treatment for 5 days.When fresh granulation tissue on wound surface became wellstacked,skingrafting or skin flap reparation was performed.The wound healing duration,healing rate and amputation rate were compared between the two groups.Results The wound healing time,healing rate and amputation rate of VAC group were (30.91 ± 15.61) d,97.1％ (33/34) and 3％ (1/34) respectively,of the control group were (58.86± 14.23) d,75.8％ (25/33) and 24.2％ (8/33) respectively.There were significant differences between the two groups(P＜0.05).Conclusion VAC treatment of diabetic foot ulcer has significant effect,can promote wound healing,improve the healing rate and reduce the risk of amputation(toe).

Correlation of regulatory B cells and regulatory T cells in patients with chronic hepatitis C / 中国基层医药

Objective To investigate expression and correlation of IL -10 +CD +19 regulatory B cells (Breg)and CD +4CD25high regulatory T cells (Treg)in patients with chronic hepatitis C.Methods 45 patients with chronic hepatitis C and 25 healthy individuals were involved in this study.Flow cytometry was used to analyze the expression of Breg and Treg.ELISA was employed to determine serum IL -10 and TGF -β.Results The expression of Breg in group of HCV was higher than that of the health controls[3.55%(2.40% -4.14%)vs.1.66%(1.24% -2.02%),t =6.78,P <0.001],and Treg in patients with chronic hepatitis C was also higher than that of the health controls[4.55%(3.35% -5.88%)vs.2.05%(1.39% -2.61%),t =7.17,P <0.001].Breg was correlated with Treg positively in group of chronic hepatitis C (r =0.374,P =0.019)and no correlation was found in the health con-trols.Serum IL -10 in patients infected with HCV was significantly higher than that in the health controls[(78.65 ± 17.21)pg/mL vs.(53.21 ±11.47)pg/mL,t =7.51,P <0.001].Conclusion Breg and Treg may play regulatory roles by IL -10 in patients with chronic hepatitis C promote persistence of HCV infection and exhaustion of effector T cells.

Statistics of causes of death and analysis of risk factors in a surgical intensive care unit / 中华危重病急救医学

Objective To summarize the causes of death and to analyze the risk factors in a surgical intensive care unit (SICU).Methods The relevant information of patients died in the SICU of Xijing Hospital of Fourth Military Medical University in past 15 years (from December 1999 to February 2015) was retrospectively analyzed.The gender,age, reason and date of hospitalization, date of transfer SICU, past medical history, whether or not admitted directly from emergency department, or transferred from other department, operated or not, date of death, the main cause of death, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, the history of undergoing mechanical ventilation, continuous renal replacement therapy (CRRT), or antifungal therapy, as well as the ratio of the patients with body temperature higher than 39 ℃, white blood cell (WBC) count higher than 10 × 109/L, platelet (PLT) count below 100 × 109/L, albumin (Alb) below 35 g/L of two periods, namely from December 1999 to July 2007 (the first period),and from August 2007 to February 2015 (the second period) were compared.The above parameters were compared with those of 201 survivors in SICU, and the risk factors leading to death were analyzed by logistic regression.Results From December 1999 to February 2015, 4 317 patients were taken care of in the SICU.Among them, the number of death was 186, and the mortality rate was 4.3％.In the first time period (from December 1999 to July 2007), the total number of patients was 1 356, and the number of death were 109 (the mortality rate was 8.0％).In the second period, i.e.from August 2007 to February 2015, the number of SICU patients was 2 961, and 77 died (the mortality rate was 2.6％).The difference of mortality rate between the two periods was statistically significant (x2 =66.707, P =0.001).The death rate of patients transferred directly from emergency department in tle first period was 79.8％ (87/109), and it was lower in the second period (51.9％, 40/77, x2 =16.181, P =0.001).The death rate of the patients with blood Alb below 35 g/L in the second period (59.7％, 46/77) was higher than that of the first period (41.3％, 45/109, x2 =6.151, P =0.017).The top three causes of death from December 1999 to February 2015 were sepsis (38.2％), trauma (16.7％), and operation for cancer (14.0％).In the first period, the top three causes of death were sepsis (35.8％), trauma (22.0％),and operation for cancer (13.8％).In the second period, the top three causes of death were sepsis (41.6％), damage of the central nervous system (16.9％), and operation for cancer (14.3％).Top three reasons for SICU admission were trauma (29.03％), abdominal pain (20.97％) and other reasons (18.82％).Top three departments from which the patients were transferred were the emergency department (19.35％), orthopedics department (17.20％), and hepatobiliary department (16.13％).Logistic regression analysis showed that age [odds ratio (OR) =2.025, 95％ confidence interval (95％CI) =1.500-2.734, P =0.000], mechanical ventilation (OR =3.514, 95％CI =1.701-7.259, P =0.001), CRRT (OR =5.604,95％CI =3.003-10.459, P =0.000), body temperature higher than 39 ℃ (OR =1.992, 95％CI =1.052-3.771, P =0.034) were the risk factors of death in SICU patients.Conclusion Sepsis and severe trauma are the leading causes of death in severe SICU patients, to whom with risk factors of death enough attention should be given.

The therapy and prognosis of DHS, PFNA and Intertan nail on intertrochanteric fractures of elderly patients / 中国综合临床

Objective To investigate the therapy of DHS,PFNA and Intertan nail for the treatment in elderly patients with intertrochanteric femoral fractures.Methods One hundred and one elderly patients with intertrochanteric fractures were collected.Thirty-four cases of them were undertaken DHS (DHS group),33 cases for PFNA (PFNA group),and 34 cases for Intertan nail (INTERTAN group).Operative time,blood loss and complications were observed.Results The Operative time of patients in DHS,PFNA and Intertan groups were (85.1 ± 8.9) min,(63.1 ± 8.2) min,(57.9 ± 9.2) min respectively and the difference was significant (F=12.761,P＜0.001).The blood loss amount in DHS group were (350.1 ±80.2)ml,lower that those in PFNA and Intertan groups ((137.5 ± 35.4) ml and (125.2 ± 38.2) ml,F =20.462,P ＜ 0.001).Meanwhile,the postoperative drainage in DHS group was (125.3 ± 20.4) ml,significantly higher than PFNA group and INTERTAN group ((69.4 ± 9.2) ml and (74.6 ± 10.4) ml; F =15.871,P ＜0.001).Operative time,blood loss amount in INTERTAN group were less than that in PFNA group,but no significant difference (P ＞0.05).Nonunion in DHS group was significantly higher than the other two groups (8.82％ vs 0％ and 0％,x2 =6.092,P =0.047).Excellent rate in DHS group,PFNA group and Intertan group were 82.3％ (28/ 34),87.8％ (29/33),85.3％ (29/34) respectively,and there was no significant difference (x2 =0.591,P ＞ 0.05).Conclusion Compared with DHS,Intertan nail and PFNA have advantage of shorter operative time,stronger anti-rotation capability and less various postoperative complication rates,thus they are more suitable for elderly osteoporotic intertrochanteric fracture.

A heart failure staging model based on machine learning classification algorithms / 中国组织工程研究

BACKGROUND:Early detection and accurate staging diagnosis of heart failure are the basis of good clinical therapy efficacy. Due to lack of simple and effective staging model for the diagnosis of heart failure, it is difficult to diagnose heart failure in clinics, leading to poor control of heart failure. OBJECTIVE:To establish the disease staging model based on Adaboost and SVM for heart failure, and improve the accuracy of diagnosis and staging of heart failure. METHODS:A total of 194 cases were roled into this study, including heart failure patients and healthy physical examination persons. According to the stage standards formulated by American Colege of Cardiology and American Heart Association, specific clinical feature parameters closely related to heart failure were colected and selected. Based on clinical diagnosis results and using Adaboost model and SVM model, we trained the models for heart failure diagnosis and staging, thus obtaining diagnosis model. RESULTS AND CONCLUSION: The parameters included stroke volume, cardiac output, left ventricular ejection fraction, left atrial diameter, left ventricular internal diameter at end-systole, N-terminal pro-brain natriuretic peptide and heart rate variability. As for the Adaboost model, its sensitivity and specificity was 100% and 94.4%, respectively. At the same time the SVM model had good sensitivity and specificity, 86.5% and 89.4% respectively. Adaboost classification model can be accurate in the diagnosis of heart failure symptoms, the accuracy reached 89.36%. On the basis of the diagnosis of heart failure, the SVM classification model is effective in staging the severity of heart failure, staging accuracy for staging B and C was 86.49% and 81.48%, respectively. The findings indicate that, combining Adaboost and SVM machine learning models could provide an accurate diagnosis and staging model for heart failure.

Analysis of the treatment response and prognosis of severe hand-foot-mouth disease / 中华传染病杂志

Objective To investigate the significance of early diagnosis and intervention in cases with severe hand-foot-mouth disease. Methods Nine severe cases were chosen from 220 hospitalized children with hand-foot-mouth disease for retrospective analysis, including onset, disease progression, the blood and cerebrospinal fluid tests, electroencephalogram data, patients' treatment responses and prognosis. Pearson X2 test and t test were utilized for statistical analysis. Results All cases showed nervous systems involved symptom, including meningeal irritation sign and (or) other pathological signs of nervous system (9 cases), drowsy (7 cases), trembling (6 cases), voiding dysfunction (3 cases), hypersensitivity(3 cases), autonomic nervous system disorders (2 cases), ataxia (1 case), left leg mild paralysis (1 case) and early stage of pulmonary edema (1 case). Early intervention, such as high dose gamma globulin, methylprednisolone, mannitol treatment restriction of fluid input, started before the development of heart and lung failure. No case died but one patient with encephalomyelitis showed hobbling left leg, which didn't recover until 6 weeks later. One case with brainstem encephalitis still showed abnormal electroencephalogram after 8 weeks follow-up but without clinical symptom. Conclusions Enterovirus 71 can cause severe hand-foot-mouth disease complicated by encephalitis, meningitis and pulmonary edema. Early active intervention before the development of neurogenic pulmonary edema can improve the prognosis and reduce the mortality.

Research on relativity between R353Q polymorphism of the coagulation factor Ⅶ gene and cerebral infarction / 中国综合临床

Objective To evaluate the association between R353Q polymorphism of the coagulation factor Ⅶ gene and cerebral infarction in Chinese Han people. Methods Restriction fragment length polymorphism(PCR-RFLP) methods was adopted to detect FⅦR353Q genotype and R、Q allelomorphie gone frequency of 100 cerebral infarction(CI) patients and 106 healthy people. Results There was FⅦR353Q polymorphism in the CI patients and healthy subjects. RR and RQ genotype could be found in the control group and CI group. RR and RQ genotype dis-position consistented with Hardy-weinberg equilibrium. In CI group,RR genotype was in 91 cases,RQ was in 9 cases and QQ in 0 case(the distribution frequencies were 91.00% ,9.00% and 0), and in the healthy subjects, those are 94 cases, 12 cases and 0 case(88.70% ,11.30% and 0). In the control group and CI group,R allele genotype fre-quencies were 94.33% and 95.50%, and Q were 5.67% and 4.50%. There was not significantly different in the R353Q polymorphism (χ20.3027, P=0.5822);Q allele genotype was not significantly different between the cases of control group and CI patients(χ20.2865, P=0.5925). Conclusion There are the FⅦR353Q polymorphism in Han population,however,the idea that the Q allele is a protective factor in CI is not supported.

Retrospective analysis of articular cartilage injuries in 568 patients undergoing arthroscopy of knee joint / 中国矫形外科杂志

[Objective]The purpose of this study is to investigate articular cartilage injuries in patients undergoing arthroscopy of knee joint.[Method]From November 2004 to September 2005,568 patients underwent arthroscopy in the orthopedic department of Chinese PLA General Hospital.[Result]Totally 923 cases of articular cartilage injuries in 389 patients were documented,with the incidence rate of 68%.The main articular cartilage injuries were found on the medial femoral condyle(26%)and patella(25%).The incidence rate had signicant difference between patients over and under 40 years(88% VS 36.5%).Patients between 40 and 60 years were most susceptable to articular cartilage injuries.[Conclusion]Articular cartilage injuries are common in patients after arthroscopy.Early arthroscopy and treatment may benefit the patients.

Treatment of avascular necrosis of femoral head by implanting a composite of autogenous bone marrow and noncelluar tissue engineered bone allograft with BMP / 中华骨科杂志

Objective To investigate the effect of treatment of avascular necrosis of femoral head in adolescence by implanting a composite of autogenous bone marrow, bone morphogenetic protein(BMP), and noncelluar tissue engineered bone allograft. Methods The BMP was partially purified from bovine cortical bone (bBMP) by Urist method. The bone allograft chips were mixed with bBMP and bone marrow. The composite was implanted into the necrotic area of the femoral head after core decompression, then partial deminerallized allograft fibula segments were inserted in the core decompression holes to support the necrotic area in preventing the collapse in 64 adolescent patients (78 hips). Results 55 cases (67 hips) were followed up for 3 months to 6 years(mean 44 months). 28 case(36 hips) in FicatⅠ,Ⅱ were followed up over 3 years, of whom there were no obvious pain and dysfunction in 18 cases(22 hips), high density new bone was shown in core decompression area in CT scanning, and no evidence of progressive necrosis. There was no worsening of the symptoms in 4 cases(6 hips) in Ficat Ⅰand Ⅱ, but the lesion progressed. In 6 cases (8 hips) in Ficat Ⅲ, there were no obvious pain and dysfunction in 2 cases, but 4 cases underwent total hip replacement because of persistent pain and progressive lesion. Conclusion The partial demineralized allograft fibula can provide direct mechanical support to prevent the necrotic femoral head from progress and collapse, autogenous bone marrow and BMP is able to promote new bone formation. The method can be used as an alternative for the treatment of osteonecrosis of femoral head at stage Ⅰ,Ⅱ.

Complication and its prevention during long bone fractures treated with interlocking nail / 中华创伤杂志

Objective To analyze the cause for complications of the long bone fractures treated with the interlocking nail and indicate the prevention and treatment measures. Methods From January 1998 to May 2000,168 patients with long bone fractures were treated with the interlocking nail. Of them, there were 77 cases of femoral fractures, 67 tibial fractures and 24 humeral fractures. Results All patients were followed up for 5-24 months. Complications occurred in 14 cases (8.33%) including 4 cases of infections, 1 lower limb necrosis, 2 internal fixation failure due to incorrect indication, 2 re-fractures during the operation, 2 distal screw misinserted,1 nail into the ankle joint, 1 distal screw broken and 1 distal screw loosening. Conclusions We should attach great importance to the following points during treatment of long bone fractures with interlocking nail:(1) The indications must be correctly handled. (2) The technique for interlocking nail must be performed strictly during operation; close inserting nail is proposed.(3) As for the comminuted fractures, bone continuity should be reconstructed and the time to start weight bearing properly delayed. (4) C-Arm X-ray supervision is necessary during operation.