Efficacy comparison between iliosacral screw fixation of the posterior pelvic ring fracture with the assistance of modified percutaneous three-dimensional printing guide template and conventional fluoroscopy / 中南大学学报(医学版)

Objective:The effect of three-dimensional(3D)printed bone-attached guide plate assisted cannulated screw fixation of pelvic fracture is reliable,but extensive soft tissue dissection is still required when installing the guide plate.This study aims to compare the efficacy of posterior pelvic ring fracture fixation with iliosacral screw insertion between the assistance of modified percutaneous patient specific 3D printed guide template and conventional fluoroscopy. Methods:From May,2019 and September 2021,28 patients sustained posterior pelvic ring fractures were randomized into 2 groups:A guide template group,in which the iliosacral screw was inserted for fixation of the posterior pelvic ring fracture with the assistance of modified percutaneous patient specific 3D printed guide template,and a fluoroscopy group,in which the iliosacral screw was inserted under the guidance of conventional fluoroscopy.The operation time,fluoroscopic frequency,intraoperative blood loss,and incision length were recorded for each screw insertion.Fracture reduction was evaluated according to the Matta criteria.The screw position was evaluated according to the modified Gras classification,and the functional outcome was evaluated according to Majeed score.The parameters of both groups were compared,and statistical analysis was performed. Results:All the 28 patients were followed up for 12-24 months.Of them,15 iliosacral screws were inserted in 14 patients in the guide template group,and 14 iliosacral screws were inserted in 14 patients in the fluoroscopy group.The operation time,fluoroscopic frequency,screw deviation,incision length,and blood loss in the guide template group were 20-30(25.8±2.8)min,9-15(12.2±1.9),2-4(2.6±0.7)mm,4-5(4.6±0.5)cm,and 5-10(7.8±1.7)mL,respectively,whereas those in the fluoroscopy group were 30-60(48.1±7.5)min,40-96(64.7±16.3),3-6(4.2±0.9)mm,0.8-1.2(1.0±0.1)cm,and 2-5(3.1±1.3)mL,respectively,and there were statistical significance(all P<0.001).Fracture reduction was evaluated according to the Matta criteria,and all the patients reached excellence and good(P=0.584)in the 2 groups.According to modified Gras classification,there were 12 Grade Ⅰ screws,3 Grade Ⅱ screws,and 0 Grade Ⅲ screws in the guide template group,and 10 Grade Ⅰ screws,3 Grade Ⅱ screws,and 1 Grade Ⅲ screw in the fluoroscopy group,with no statistical significance(P=0.334).The functional outcome was evaluated according to Majeed score at the last follow-up,without significant difference between the guide template group and the fluoroscopy group(P=0.908). Conclusion:Compared with the conventional fluoroscopy,it would cost less operation time,less fluoroscopic frequency and increase more accurate screw insertion to fixate the posterior pelvic ring fracture with the assistance of modified percutaneous patient specific 3D printed guide template.

High tibial osteotomy assisted by a 3D printed composite template for genu varum / 中华创伤骨科杂志

Objective:To explore the efficacy of a 3D printed personalized composite template in the high tibial osteotomy for genu varum.Methods:A retrospective analysis was conducted of the 12 patients with genu varum who had been treated by high tibial osteotomy assisted by a 3D printed composite template at Department of Orthopaedics, The Third Hospital of Changsha between May 2016 and March 2019. They mere 2 men and 10 women, with a mean age of 55.1 years(range, from 46 to 65 years). Before operation, 3D printing technology was used to design and print a personalized composite osteotomy template for each patient. All patients underwent knee arthroscopy before osteotomy. The personalized 3D printed composite template was used to assist the high tibial osteotomy. The therapeutic outcomes were evaluated by comparison of posterior tibial slope angle (PTS), patellar height (Insall-Salvatti index), femorotibial angle, weight-bearing line (WBL) and medial proximal tibial angle (MPTA) on X-ray radiographs, American Hospital for Special Surgery (HSS) knee score and visual analogy scale (VAS) between pre-operation and 12 months after operation.Results:The 12 patients were followed up for 15 to 36 months after operation, with an average of 14.7 months. All wounds healed at the first stage after operation with no complications like infection, nerve injury, deep vein thrombosis at lower limbs, delayed fracture union or nonunion. Follow-ups revealed no such complications as plate breakage or internal fixation loosening. The values of femorotibial angle (181.09°±3.94°), WBL (19.11%±17.61%), MPTA (81.20°±1.15°), HSS (87.6±7.1) and VAS[0(0, 1)] at 12 months after operation were significantly improved compared with those before operation[171.79°±2.77°, 61.71%±2.14%, 88.06°±1.44°, 64.6±12.9 and 4 (3,5) , respectively] (all P<0.05). There was no significant difference in PTS or Insall-Salvatti index between pre-operation and 12 months post-operation ( P>0.05). According to the HSS scores at the last follow-up, the efficacy was excellent in 10 knees, good in one and fair in one. Conclusion:A 3D printed composite osteotomy template can lead to precise correction of alignment of lower limbs in the high tibial osteotomy for genu varum, resulting in good short-term outcomes.

Clinical characteristics of plastic bronchitis after pneumonia in children and the value of bronchoscopy in diagnosis and treatment / 中华实用儿科临床杂志

Objective:To explore the clinical characteristics of plastic bronchitis (PB) in children after pneumonia and the value of electronic bronchoscopy in diagnosis and treatment of PB after pneumonia.Methods:A total of 3 865 children with lower respiratory infectious diseases who had been treated by bronchoscope and met the diagnosis and treatment criteria of bronchoscope in the Department of Respiratory, Children′s Hospital Affiliated to Soochow University from June 2017 to May 2019 were studied.The children were divided into 3 groups, the PB group, the phlegm embolism blockage group, and the control group [including children with no secretion blocking the bronchial cavity under bronchoscope and no plastic secretion found in bronchoalveolar lavage fluid (BALF)]. The results of laboratory examinations such as clinical characteristics, etiology, immune function and imaging were compared and analyzed.Results:There was no significant difference in the gender distribution among the 3 groups ( P=0.382). The average age of the PB group and phlegm embolism blockage group was significantly older than that of the control group.All the 3 groups had cough.The proportions of coughing children with asthma in the control group and phlegm embolism blockage group [25.06% (924/3 687 cases) and 21.00% (21/100 cases), respectively] were significantly larger than that in the PB group [5.13% (4/78 cases)]. The PB group had the highest ratio of children with fever [93.59% (73/78 cases)], followed by the phlegm embolism blockage group [83.00% (83/100 cases)] and the control group [71.93% (2 652/3 687 cases)] successively.The difference among the 3 groups was significant( χ2=23.571, P<0.05). The fever peaks of the PB group, phlegm embolism blockage group and control group were (39.65±0.6)℃, (39.57±0.64)℃ and (39.27±0.76)℃, respectively; the fever duration of the above 3 groups were (10.32±3.87) days, (9.46±5.13) days and (6.89±4.06) days, respectively.The PB group had a higher fever peak and longer fever duration than the control group (all P<0.01). Before the electronic bronchoscopy, 3 865 children′s chest imaging examination showed pneumonia.The proportions of patients with lobar pneumonia and pleural effusion were the highest in the PB group [79.49% (62/78 cases) and 41.03% (32/78 cases), respectively], followed by the phlegm plug group [65% (65/100 cases) and 27% (27/100 cases), respectively]. C reactive protein (CRP) and D-dimer levels were the highest in the PB group, followed by the phlegm embolism blockage group and the control group successively.The difference was significant.In T lymphocyte subsets, the PB group had a significantly lower percentage of CD4 + lymphocytes and a significantly higher percentage of CD8 + lymphocytes than the control group.The first pathogen detected in the 3 groups was Mycoplasma pneumonia (MP), but the detection rate of MP in the PB group [84.62% (66/78 cases)] was significantly higher than that in the phlegm embolism blockage group [60% (60/100 cases)] and that in the control group [55.68% (2 053/3 687 cases)]. Conclusions:Older children are prone to PB after pneumonia and fever in the course of disease.The imaging manifestations are lobar pneumonia, pleural effusion, atelectasis, elevated CRP and D-dimer in venous blood laboratory examinations.MP is the first pathogen detected in children with PB after pneumonia.Bronchoscopic alveolar lavage is an effective and safe treatment for PB in clinical practice.

Value of Glasgow prognostic score in patients with adenocarcinoma of esophagogastric junction / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the prognosis and predictive values of preoperative Glasgow prognostic score (GPS) for adenocarcinoma of esophagogastric junction(AEG) patients.</p><p><b>METHODS</b>A retrospective study of 322 AEG patients who received operation between January 2007 and March 2010 in Henan Provincial People's Hospital was performed. Clinical data, pathological characteristics, laboratory parameters and survival data were collected. The GPS was calculated based on C-reactive protein(CRP) and serum albumin(ALB) levels. Univariate and multivariate analysis were used to evaluate the prognostic value of GPS.</p><p><b>RESULTS</b>Among 322 patients, 0, 1, 2 of GPS were 192, 104 and 26 patients respectively. The median follow-up was 37 (4-73) months. In Kaplan-Meier analysis, median diseases-free survival (DFS) of GPS 0, 1, 2 was 47.0 (95% CI: 31.6-62.4), 15.0 (95% CI: 11.8-8.2) and 4.7 (95% CI: 3.8-5.6) months (P<0.01), and median overall survival (OS) was out of reach, 20.6 (95% CI: 15.8-25.4) and 7.0 (95% CI: 5.8-8.2) months (P<0.01). Univariate and multivariate analysis revealed that GPS was an independent predictor of DFS (P<0.01) and OS (P<0.01) of AEG.</p><p><b>CONCLUSION</b>GPS is an effective predictor of survival in AEG.</p>

Bacteria detected from sputum and its antibiotic resistance in childhood pneumonia in Suzhou area / 临床儿科杂志

Objectives To investigate the bacterial pathogens and their antibiotic resistance in children with pneumonia in Suzhou area. Methods Sputum specimens of 8179 hospitalized children with pneumonia from October 2005 to September 2011 were collected by sterile negative pressure aspirator and then cultured. The incidence of positive bacteria was tested by Kirby-Bauer method and broth dilution method, and their antibiotics resistances were analyzed. Results A total of 2391 of 8179 children were infected with positive rate of 29.23%. A total of 2552 strains of bacteria were detected with Streptococcus pneumoniae (42.40%), Haemophilus inlfuenzae (14.81%), Moraxelle catarrhalis (11.01%), Staphylococcus aureus (8.50%) and Escherichia coli (5.02%) as the most common strains. The infection rate of different bacterium was related to age, season and the type of pneumonia (all P<0.001). The tendency of antibiotic resistances in 2 140 bacterial isolates was found increased by the susceptibility test. Conclusions Streptococcus pneumonia and Haemophilus inlfuenzae are the most common bacterial pathogens in children with pneumonia in Suzhou area. The positive rate of different bacterium was related to age, season and the type of pneumonia. Attention must be paid to the rational use of antibiotics to reduce drug resistance.