Preliminary application of a novel distraction reductor in the surgical treatment of unstable distal radius fractures with metaphyseal volar comminution / 中华创伤骨科杂志

Objective:To evaluate a novel distraction reductor in the surgical treatment of unstable distal radius fractures with metaphyseal volar comminution.Methods:From January 2019 to December 2020, 27 patients with unstable distal radius fracture complicated with metaphyseal volar comminution were treated at Department of Orthopaedics, Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences. They were 6 males and 21 females, with an age of (69.4±9.4) years. All fractures were unilateral and closed, involving the right side in 17 cases and the left side in 10 cases. All patients were treated by internal fixation with an anatomical locking plate through the volar approach and the novel distraction reductor was used to reduce the fracture ends. Regular imaging examinations were performed to evaluate the reduction, maintenance and union of fractures after surgery. One year after operation, the curative efficacy was assessed by evaluation of the range of wrist motion, Disabilities of the Arm, Shoulder and Hand (DASH) score, Gartland-Werley score and Bartra radiology score.Results:All the operations went on successfully with a duration of (92.3±8.9) min. All the incisions healed primarily. The follow-up time was (15.9±2.9) months. The radial height, palmar tilt, ulnar inclination and articular surface step-off immediately after operation [(11.23±1.51) mm, 12.10°±3.44°, 20.54°±3.44°, and (0.95±0.42) mm] were not significantly lost compared with those one year after operation [(11.22±1.55) mm, 12.07°±3.44°, 20.51°±3.33°, and (0.93±0.40) mm] (all P>0.05). One year after operation, the range of wrist motion was good with dorsiflexion of 59.7°±5.5°, palm flexion of 63.0°±9.1°, pronation of 66.5°±5.5°, supination of 61.2°±5.6°, radial deviation of 22.7°±4.8°, and ulnar deviation of 30.3°±6.1°; DASH score was 13.5±5.5; Bartra radiology score was 88.6±6.5, giving an excellent and good rate of 88.9% (24/27);Gartland-Werley score was 2.7±2.1, giving an excellent and good rate of 92.6% (25/27). Follow-ups observed no poor fracture healing, internal fixation failure, tendon or nerve injury or traumatic arthritis. Conclusion:In the surgical treatment of unstable distal radius fractures with metaphyseal volar comminution, the novel distraction reductor can lead to ideal reduction of displaced fractures and effectively correct the shortening caused by volar cortex comminution to achieve satisfactory functional effects in clinic.

School environment and campus bullying behavior of hunior high school students / 中国学校卫生

Objective@#To understand the relationship between school environment and campus bullying behavior of junior high school students, and to provide scientific basis for the intervention of campus bullying behavior.@*Methods@#Based on the data of "China Education Panel Survey" from 2014 to 2015, the school environment and self reported campus bullying behaviors of 9 300 junior high school students were analyzed.@*Results@#The two level mixed effect linear regression model showed that the frequency of boys campus bullying behavior was higher than girls( B =0.356, P <0.01). Junior high school students in the school with higher student teacher ratio and school average class status had higher frequency of campus bullying behavior( B =-0.007, -0.004, P < 0.05 ). The negative correlation between school average class status and the frequency of bullying behavior of boys was greater than girls( B = -0.006 , P <0.01).@*Conclusion@#Prevention and treatment of junior high school students campus bullying not only needs to start from the individual students, families and peer groups, but also needs to pay attention to the school environment, reduce the school socioeconomic segregation, and pay more attention to boys campus bullying behavior.

Changes of surgical interventions on necrotizing pancreatitis / 中华外科杂志

Objective@#To investigate the changes of surgical invitations on necrotizing pancreatitis in recent 14 years by reviewing single center data.@*Methods@#One thousand and eighty patients with necrotizing pancreatitis who received surgical invitation were involved in the study.All the patients were treated at Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to December 2018. Six hundred and seventy-eight were males and 402 were females. The median (range) age of the study patients was 45 (20-76) years.The etiology of the disease was related to cholelithiasis in 335 cases(31.02%), hyperlipemia in 302 cases(27.96%), alcohol in 226 cases(20.93%), endoscopic retrograde cholangiopancreatography in 28 cases(2.59%), pregnancy in 50 cases(4.63%), idiopathic factors in 72 cases(6.67%) and other causes in 67 cases(6.20%). The patients were divided into two groups according to the time of admission. Group 1 included 1 475 patients that admitted from January 2005 to December 2010, and group 2 included 1 539 patients that admitted from January 2011 to December 2018. The surgical interventions, morbidity and mortality of the two group were compared, and χ2 test was used for the statistical test.@*Results@#Two hundred and sixty-six among the 1 080 cases were treated with drainage procedures because of the pseudocyst.One hundred and seventy-five drainage procedures were performed between January 2005 and December 2018, which account for 11.87%(175/1 475) of all patients of necrotizing pancreatitis; 91 drainage procedures were performed between January 2011 and December 2018, which account for 5.91%(91/1 539) of all patients of necrotizing pancreatitis. Eight hundred and fourteen cases received surgical intervention for infection of necrotizing tissues. Of these cases, 410 cases received percutaneous catheter drainage(PCD) of retroperitoneal fluid or residual infection. Debridement of necrotic tissues was performed on 756 cases. Of these cases, 32 cases received minimal invasive retroperitoneal debridement with/without denotes video assistant, 4 cases received transluminal endoscopic debridement, 21 cases received laparoscopic debridement, and 709 cases received open laparotic debridement.Three hundred and sixty-five cases were admitted to our institute during January 2005 to December 2010, and the other 391 cases were admitted to our institute from January 2011 to December 2018. Of the first period, all debridement were performed with open laparotic procedures. Of the second period, debridement were performed with open laparotic procedures and minimal invasive procedures. The average times of surgical invasion, morbidity of principal local complications and mortality of the two periods were 1.27 and 1.34,28.22%(103/365) and 29.92%(117/346), and 6.03%(23/365) and 6.91%(27/346), respectively.@*Conclusions@#Minimal invasive procedures can be considered for debridement in patients with necrotizing pancreatitis in some selected conditions.The involvements of minimal invasive procedures in treatment of necrotizing pancreatitis don′t decrease the morbidity of principal local complications and mortality in recent years. Rational surgical procedures and appropriate surgical timing are the keys to improve the efficacy of necrotizing pancreatitis.

Bundles of care prevents postoperative delirium in elderly patients with hip fractures / 中华创伤杂志

Objective To evaluate the effect of bundles of care on the prevention of postoperative delirium among elderly patients with hip fractures.Methods A prospective randomized case control study was conducted on 80 patients (≥65 years old) with hip fractures from March 2017 to June 2017.The patients were divided into experimental group (n =43) and control group (n =37) according to the random number table method.The experimental group received bundles of care,while the control group received routine nursing.The patients in both groups were all surgically treated,and the confusion assessment method (CAM) was applied to diagnose delirium after surgery.Gender,age,fracture type,duration from injury to operation,internal fixation type,operation time,total amount of bleeding,visual analogue scale (VAS),incidence of delirium,complications,and adverse events were compared between the two groups.Results Among the 80 patients,there were 11 males and 69 females,aged averagely 79.3 years (range,65-95 years).No significant differences were found between experiment group and control group in terms of gender (male:6 cases vs.5 cases,females:37 cases vs.32 cases),age [(79.8 ± 7.8) years vs.(78.7 ± 8.9) years],cause of injury (traffic injuries:7 cases vs.4 cases;falling injuries:36 cases vs.33 cases),duration from injury to operation [(66.1 ±14.3)hours vs.(63.4 ±14.9) hours],fracture type (femoral neck:13 cases vs.10 cases;intertrochanteric:26 cases vs.24 cases;subtrochanteric:4 cases vs.3 cases),internal fixation type (artificial total hip:5 cases vs.5 cases;artificial femoral head:8 cases vs.5 cases;PFNA:29 cases vs.27 cases),operation time [(55.5 ± 16.8) minutes vs.(51.6 ± 17.0) minutes],total blood loss [(114.4 ± 73.9) ml vs.(108.1 ±72.0) ml] (P ＞ 0.05).After bundles of care intervention,the postoperative VAS [(2.2 ± 0.8) points vs.(4.3 ± 1.2) points],postoperative delirium incidence (9％ vs.32％),incidence of complications and adverse events (2％ vs.19％) in experimental group were significantly lower than those in control group (P ＜ 0.05).Conclusion Bundles of care can relieve the pain and effectively reduce the incidences of postoperative delirium,complications,and adverse events in elderly patients with hip fracture.

Comparison of percutaneous compression plate and cannulated compression screw in treatment of undisplaced femoral neck fracture in the elderly / 中华创伤杂志

Objective To compare the efficacy between percutaneous compression plate (PCCP) and cannulated compression screw for undisplaced femoral neck fracture among the elderly.Methods A retrospective case-control study was made on 46 elderly patients with undisplaced femoral neck fracture between August 2011 and September 2015.There were 14 males and 32 females,with the age of (76.9 ± 12.1) years (range,60-85 years).The fracture types included Garden Ⅰ in 12 patients and Garden Ⅱ in 34.These patients were divided into PCCP group (PCCP for undisplaced femoral neck fracture in 23 patients) and cannulated screw group (three cannulated compression screws for undisplaced femoral neck fracture in 23 patients),according to different surgical fixations.The following data were compared between two groups,namely,operation time,intraoperative blood loss,postoperative hemoglobin decline,postoperative length of hospital stay,postoperative partial time of weight-bearing and full weight-bearing,fracture healing time,Harris hip score (HHS) as well as postoperative complications.Results All 46 patients were followed up,with follow-up duration for (34.6± 15.3)months (range,12-60 months) in PCCP group and for (32.9 ±17.3) months (range,12-60 months) in cannulated screw group (P ＞ 0.05).There were no statistically significant difference between two groups in terms of operation time,intraoperative blood loss,postoperative hemoglobin decline,postoperative length of hospital stay,fracture healing time,and postoperative full weight-bearing time (P ＞ 0.05).The partial weight-bearing time of patients in PCCP group was earlier than that in cannulated screw group (P ＜ 0.05).The HHS of patients at postoperative 3 months in PCCP group was better than that in cannulated screw group (P ＜ 0.05),but the HHS at the final follow-up had no statistically significant difference between two groups (P ＞ 0.05).There was no statistically significant difference in the incidence of postoperative complications between PCCP group (9％) and the cannulated screw group (13％) (P ＞ 0.05).Conclusions Usage of PCCP or cannulated compression screw can obtain satisfactory clinical results for the undisplaced femoral neck fracture among the elderly.But PCCP has the advantages of earlier partial weight-bearing time and faster recovery.

Nursing experience of ventricular intracranial pressure monitoring after craniotomy / 中国中西医结合急救杂志

Objective To summarize the nursing experience of post-craniotomy patients using continuous intracranial pressure (ICP) monitoring. Methods Fifty post-craniotomy patients using ICP monitoring admitted to the Department of Neurosurgery of the First People's Hospital of Huzhou from March 2015 to March 2016 were enrolled. All patients were given the following nursing measures: maintaining the ICP monitoring device performance efficient and accurate, timely removing the factors associated with the increase of ICP and meanwhile, the dynamic changes of ICP and prognosis were observed. Results Fifty patients in this group all had elevated ICP, and the number of patients with mild, moderate, and severe ICP elevation was 26, 18, and 6 respectively. In this group of patients, 46 cases recovered well, 1 case was in a vegetative state, 2 cases gave up the treatment and 1 case died. None of the 50 patients had any complications and the detachment of tubing. The therapeutic program was adjusted in time based on ICP monitoring results. Conclusion Adopting correct intervention measures can effectively reduce the occurrence of complications, ensure that ICP monitoring can reflect the condition of ICP, and timely discover brain edema or recurrence of intracranial hematoma.

The effect of percutaneous kyphoplasty combined with Xianling Gubao capsule in treatment of osteoporotic vertebral compression fractures / 中华内分泌外科杂志

Objective To explore the effect of percutaneous kyphoplasty (PKP) combined with Xianling Gubao capsule on treatment of osteoporotic vertebral compression fractures(OVCF).Methods 118 postmenopausal women diagnosed as OVCF and meeting the standard were collected from Mar.2012 to Jul.2016 in our hospital.They were randomly divided into two groups:observation group and the control group.General information of the two groups were comparable.The patients of the control group received PKP combined with traditional anti-osteoporosis therapy.The patients of observation group received Xianling Gubao capsule on the basis of the control group.The lumbar bone density (BMD,greater trochanter BMD,femoral neck BMD,Ward triangle BMD,the Japanese orthopaedic association(JOA)score,the visual analogue score (VAS) score,the serum levels of osteoprotegerin (OPG),receptor activator of nuclear factor-κB ligand (RANKL)and adverse reactions were recorded during the treatment.Results The lumbar BMD,greater trochanter BMD,femoral neck BMD,Ward triangle BMD of observation group at 6-month after operation were higher than those before operation and those of control group (P＜0.05).The VAS score and JOA score of the observation group were superior to those of the control group at 6-month after operation (P＜0.05).The serum levels of OPG of observation group were higher than those of control group,while the serum levels of RANKL of observation group were lower than those of control group at 6-month after operation (P＜0.05).No severe adverse reactions occurred in the two groups during the treatment.Conclusion Xianling Gubao capsule can significantly improve bone metabolism of postmenopausal women with osteoporotic vertebral compression fractures after percutaneous kyphoplasty,increasing BMD,improving lumbar function,relieving pain,without increasing complication rates.

The potential clinic value of the changes of BAEP and S-100 in the serum as early diagnosis of the bilirubin encephalopathy of newborns / 中国基层医药

Objective To explore the potential clinic value of NSE and S-100 in the serum as early diagnosis in the Bilirubin Encephalopathy(BE)of newborns.Methods 46 neborns were choosed as group A with TSB≥342μmol/L;48 with TSB(256-342)μmol/L as group B;and 30 full term deliveries newborns as normal control group C.Their TSB,NSE and S-100 in the serum were measured.Meanwhile,the BAEP scores were carried out.Results The concentrations of NSE,S-100 and the BAEP scores in newborns of group A and B had significant differences as compared with group C (P <0.05 ).Correlation analysis showed that there was a significant positive correlation between serum NSE,S-100 protein and TSB(P <0.05),while there was a negative correlation between serum NSE, S-100 protein and BAEP scores(P <0.05).Conclusion Serum NSE and S-100 protein can use as early diagnosis targets for the the Bilirubin Encephalopathy(BE)of newborns clinically.