Objective To evaluate the effect of self-designed antirotation reduction internal fixator(ARRIF) on treating different spine segment fracture.Methods From August 1999 to March 2003, 76 patients(48 males and 28 females, aged from 22 to 59 with an average of 34.1) with thoracolumbar fracture were operatively treated by ARRIF. The follow-up period ranged from 6 to 21 months(15 months in average). Classification according to injury segment: flexion compression racture 27 cases, burst fracture 42 cases, flexion distraction injury 3 cases, flexion revolving type fracture dislocation 2 cases, shear force type dislocation 2 cases. Classification according Frankel’s grade:A grade 16 cases, B grade 15 cases, C grade 27 cases, D grade 10 cases, E grade 8 cases.Operation duration, volume of bleeding, incidence postoperation complication and effect of reduction fixation were observed. Results The operation duration of ARRIF was 1.2 h in average, and there was about 200 ml volume of bleeding during operation. The nerve function showed one Frankel’s grade improvement after operation were as follows:A grade 8 cases(50%), B grade 11 cases (73.3%), C grade20 cases(74.1%), D grade 3 cases (30%); 2 Frankel’s E cases have no nerve function changes.The nerve function damage have no aggravation in all the patients,the postoperation Cobb’s angle was averagely corrected 22°. The horizontal displacement of dislocation vertebrae was averagely corrected 28% in sagittal plane, the statistical analysis had significant variance(Plt;0.01).ARRIF had no complications of the breakage of screws and rods. Conclusion ARRIF proves to be a valid internal fixator in reducing and fixing different thoracic lumbar segment spine fracture.
Objective To compare the effectiveness of autologous implantation between bone marrow stem cells and peripheral blood stem cells for treatment of lower limb ischemia. Methods From December 2004 to December 2005, 42 patients with unilateral lower limb ischemia were treated with both autologous bone marrow stem cell implantation(group A, n=21)and autologous peripheral blood stem cell implantation (group B, n=21). Fortytwo patients included 32 males and 10 females. The age ranged from 34 to 80 years, with a mean of 65.6 years. Of the patients, there were 28, 8 and 6 patients suffered from diabetic lower limb ischemia, Burger’s disese and atherosclotic occlusion, respectively. Ischemic history was from 3 months to 5 years, with amean of 2.1 years. A series of subjective indexes (such as improvement of pain, cold sensation and numbness) and objective indexes such as increase of ankle brachial index (ABI), transcutaneous oxygen pressure (TcPO2), angiography, amputation rate, and improvement of foot wound healing, were used to evaluate the effect. Results After 4 weeks of implantation, the rate of pain relief was 88.2% in group A and 89.5% in group B (Pgt;0.05) ; the rate of cold sensation relief was 94.4% in group A and 94.7% in group B（Pgt;0.05）; improvement of numbness was 69.2% and 66.7% respectively in groups A and B（Pgt;0.05）. Increaseof ABI was 38.1% in group A and 33.3% in group B（Pgt;0.05）; increase of TcPO2 was 85.7% and 90.5% respectively in groups A and B（Pgt;0.05）; angiography was performed in 12 patients (group A) and 9patients (group B), and the new formed collateral vessel rate was 83.3% in group A and 77.8% in group B（Pgt;0.05）; the amputation rate was 9.1% in groups A and B（Pgt;0.05）; the rate of improvement of foot wound healing was 60.0% in group A and 66.7% in group B(P＞0.05). Forty patients were followed up 3-15 months(mean 8 months). The improvement rate of subjective symptoms was 75.0% in group A and 70.0% in group B (Pgt;0.05); increase of ABI was 60.0% in group A and 65.0% in group B; increase of TcPO2 was 80.0% and 75.0% respectively in groups A and B; the new formed collateral vessel rate was 90.0% in group A and 84.6% in group B. All ulcers healed except 1 case in group B. Conclusion Bone marrow stem cell graft and peripheral blood stem cell graft are all effective in treatingower limb ischemia.
ObjectiveTo compare the effect of problem-based learning (PBL) and traditional teaching method (lecture-based learning) on clinical practical teaching of orthopedic surgery.
MethodsBetween May 2012 and December 2013, 55 orthopedic interns were chosen to be divided into two groups: PBL group (n=29) and traditional lecture group (control group, n=26). Case report and examination on a completion of orthopedic surgery were used to assess the teaching outcomes.
ResultsPerformance differences in content of presentation and capability of answers to questions were significant between PBL group and the traditional group in the report test (P<0.05). The test scores of case analysis examination in PBL group were significantly higher than those in the traditional lecture group (P<0.05). There was no significant difference between the two groups in other types of questions (P>0.05).
ConclusionThe participants in PBL group have performed significantly better in culturing clinical thinking and comprehensive analysis, competence and in no circumstance did they perform worse than traditional lecture method.
OBJECTIVE: To compare the clinical results of repairing bone defect of limbs with tissue engineering technique and with autogeneic iliac bone graft. METHODS: From July 1999 to September 2001, 52 cases of bone fracture were randomly divided into two groups (group A and B). Open reduction and internal fixation were performed in all cases as routine operation technique. Autogeneic iliac bone was implanted in group A, while tissue engineered bone was implanted in group B. Routine postoperative treatment in orthopedic surgery was taken. The operation time, bleeding volume, wound healing and drainage volume were compared. The bone union was observed by the X-ray 1, 2, 3, and 5 months after operation. RESULTS: The sex, age and disease type had no obvious difference between groups A and B. all the wounds healed with first intention. The swelling degree of wound and drainage volume had no obvious difference. The operation time in group A was longer than that in group B (25 minutes on average) and bleeding volume in group A was larger than that in group B (150 ml on average). Bone union completed within 3 to 7 months in both groups. But there were 2 cases of delayed union in group A and 1 case in group B. CONCLUSION: Repair of bone defect with tissue engineered bone has as good clinical results as that with autogeneic iliac bone graft. In aspect of operation time and bleeding volume, tissue engineered bone graft is superior to autogeneic iliac bone.
ObjectiveTo evaluate the curative effect of laparoscopic assisted and open D2 radical resection in treatment of advanced gastric cancer.
MethodsThe clinical data of 76 cases performed by laparoscopic assisted D2 radical resection (laparoscopic group) and 104 cases performed by open operation (open group) from October 2010 to October 2012 in our center were retrospective analized.Operation related index, postoperative recovery, and extent of radical resection of tumor of 2 groups were compared.
ResultsThe operative time of the laparoscopic group[(192.5±14.8) min]was longer than that open group[(171.5±16.5) min, P < 0.05].But the blood loss, postoperative drainage, length of incision, and hospital stay of the laparoscopic group were significantly less or shorter than those of open group (P < 0.05).There were no significant difference in postoperative complications and extent of radical resection of tumor between the 2 groups (P > 0.05).There were no residual tumor in distal margin and operatiive death case in both 2 groups.
ConclusionComparing with open operation, the laparoscopic assisted surgery for advanced gastric cancer could achieve the same clinical outcomes, and obvious advantage of minimal invasion.
To investigate an effect of tranexamic acid on blood loss associated with total knee arthroplasty (TKA).Methods From June 2005 to June 2006, 102 patients (43 males, 59 females; aged 59-77 years, averaged 68 years) underwent TKA. Of the 102 patients, 59 had osteoarthritis, 23 had rheumatoid arthritis, and 20 had traumatic arthritis.The illness course ranged from 2 to 12 years. They were randomized divided into Group A and Group B of 51 patients each. The patients in Group A received tranexamic acid, and the patients in Group B received an equal volume of normal saline. In Group A, 1 g of tranexamic acid dissolved in 250 ml of normal saline was intravenously infused before deflation of the tourniquet; another intravenous administration of the same drug of the same dosage was given 3 hours later. In Group B, only 250 ml of normal saline was infused intravenously. The amounts of blood loss and blood transfusion during operation and after operation in all the 102 patients were recorded. They were also observed for whether they had deep vein thrombosis. D-dimeride, fibrinogen, prothrombin time, and activated partial thromboplastin time were also examined before operation, during operation (deflation of the tourniquet), and 3 hours after operation.Results The blood loss was 256±149 ml in Group A and 306±214 ml in Group B during operation; there was no significant difference between the two groups（P＞0.05）. The postoperative drainage volume was 478±172 ml in Group A and 814±156 ml in Group B, and the total blood loss was 559±159 ml in Group A and 1.208±243 ml in Group B; there were significant differences between the two groups (P＜0.05). The averaged amount of blood transfusion was 556±174 ml in Group A and 1 024± 278 ml in Group B; there was a significant difference between the two groups (P＜0.05). The postoperative hemoglobin concentration was higher in GroupA than that in Group B (1.0-1.1 g/dL vs. 0.6-0.8 g/dL). The ostoperative follow-up for 612 months revealed that no deep vein thrombosis was found in both lower limbs of the patients by the color Doppler ultrasonography. The level of D-dimeride was significantly higher 3 hours after operation than before operation (0.92±0.56 mg/L vs. 0.35±0.13 mg/L in Group A; 1.32±0.79 mg/L vs. 0.37± 0.21 mg/L in Group B) (P＜0.05). The D-dimeride level 3 hours after operation was significantly higher n Group B than in Group A（P＜0.05）. There were no significant differencesin the levels of fibrinogen, prothrombin time, and activated partial thromboplastin time between the two groups（P＞0.05）.Conclusion During and after the TKA operation, a shortterm use of tranexamic acid can significantly decrease blood loss and blood transfusion with no increasing risk for venous thrombosis.
Objective To explore the difference of cardiovascular risk factors and coronary artery lesion between Hui nationality and Han nationality patients with premature coronary heart disease. Methods A total of 316 patients with premature coronary heart disease were divided into two groups, including the Hui group (78 cases) and the Han group (238 cases). Eight risk factors for premature coronary heart disease (including age, gender, body mass index, familial heredity, diabetes, hypertension, dyslipidemia and smoking history) and coronary artery lesion characteristics were compared between the two groups. Results Compared with the Han group, the Hui group had a higher prevalence of smoking history and myocardial infarction, but a lower prevalence of angina (Plt;0.05). Type A disease was the major type in both Hui and Han groups. Compared with the Han group, the rate of type C were higher. Single-vessel lesion was the major lesion in both Hui and Han groups. The incidence of three-vessel lesion in the Han group was significantly lower than that in the Hui group. Gensini score in the Hui group was higher than that in the Han group, with a significant difference (Plt;0.05). Conclusion Hui patients with premature coronary artery disease are more than Han patients with premature coronary artery disease in proportions of smoking, diabetes, and the lesions of the left anterior descending artery, the right coronary artery disease, three-vessel disease rate, and C-type lesions. The coronary artery disease of the Hui group is more serious.
Objective To evaluate short-term effects of percutaneous microwave coagulation therapy（PMCT） combined with chemotherapy in patients with advanced non-small cell lung cancer（NSCLC）.Methods Eighty cases with advanced NSCLC were randomly assigned to underwent chemotherapy plus PMCT(PMCT group，n=40) or single chemotherapy(chemotherapy group，n=40).The chemotherapeutics regimen was Taxotere plus Cisplatin.The preliminary results and quality of life score of two groups were compared.Results In PMCT group and chemotherapy group，the 3-month relieve rate was 52.5% and 32.5%，and the half-year survival rate was 87.5% and 62.5%，respectively.The differences between the two groups were both significant(Plt;0.05).The quality of life score in PMCT group was significantly higher than that in chemotherapy group (Plt;0.05).Conclusion PMCT combined with chemotherapy is effective and safe in the treatment of advanced NSCLC.
Objective To evaluate the treatment results of LCP and locked intramedullary nailing for tibial diaphysis fractures.MethodsFrom October 2003 to April 2006, 55 patients with tibial diaphysis fractures ( 58 fractures) were treated. Of them there were 39 males and 16 females with an average of 39 years years ( 14 to 62 years). The fractures were on the left side in 27 patients and on the right side in 31 patients (3 patients had bilateral involvement). Thirtyfour fractures were treated by intramedullary nailing (intramedullary nailing group) and 24 fractures by LCP fixation (LCP group). The average disease course was 3 days (intramedullary nailing group) and 3.1 days(LCP group). The operation time, the range of motion of knee and ankle joints, fracturehealing time, and complications were evaluated. Results The patients were followed up 8-26 months(13 months on average). The operation time was 84.0±9.2 min (intramedullary nailing group) and 69.0±8.4 min (LCPgroup)； the average cost in hospital was￥19 297.78 in the intramedullary nailing group and ￥14 116.55 in the LCP group respectively, showing significant differences(P＜0.05). The flexion and extension of knee joint was 139.0±3.7° and 4.0±0.7° in intramedullary nailing group and 149.0±4.2° and 0±0.4° in LCP group, showing no significant difference(Pgt;0.05). The doral flexion and plantar flexion of ankle joint were 13.0±1.7° and 41.0±2.6° in intramedullary nailing group, and 10.0±1.4° and 44.0±2.3° in LCP group, showing nosignificant differences(Pgt;0.05). The mean healing time was 3.3 months in intramedullary nailing group, and 3.1 months in LCP group. Length discrepancy occurred in 1 case (2.5 cm), delayed union in 1 case and nailing endtrouble in 3 cases in intramedullary nailing group; moreover rotation deformityoccurred 1 case and anterior knee pain occurred in 6 cases(17.1%). One angulation and open fracture developed osteomyelitis in 1 case 1 week postoperatively and angulation deformity occurred in 1 case of distalthird tibial fractures in LCP group. Conclusion LCP and locked intramedullary nailing can achieve satisfactory results in treating tibial diaphysis fracture LCP has advantages in less complication, operation time and cost in hospital.
Objective To compare the short-term result between the high-flex (HF) and conventional posteriorstabil ized (PS) prosthesis in total knee arthroplasty (TKA). Methods From April 2005 to October 2007, 23 cases (27 knees) underwent TKA by HF prosthesis (HF group), and 35 cases (41 knees) underwent TKA by PS prosthesis (PS group).In HF group, there were 2 males (3 knees) and 21 females (24 knees) aged (64.3 ± 5.6) years, including 20 cases (23 knees) of osteoarthritis and 3 cases (4 knees) of rheumatoid arthritis; body mass index (BMI) was 27.3 ± 3.9; the course of disease was (5.3 ± 5.6) years; the Hospital for Special Surgery Scoring System (HSS) score was 58.4 ± 7.9; the Western Ontario and McMaster universities osteoarthritis index (WOMAC) score was 49.4 ± 6.9; the maximum knee flex degree was (107.6 ± 8.3)°; and the range of knee motion was (103.5 ± 7.7)°. In PS group, there were 3 males (3 knees) and 32 females (38 knees) aged (65.1 ± 5.9) years, including 33 cases (39 knees) of osteoarthritis and 2 cases (2 knees) of rheumatoid arthritis; BMI was 27.1 ± 4.1; the course of disease was (5.1 ± 4.9) years; HSS score was 60.1 ± 10.4; WOMAC score was 47.9 ± 7.2; the maximum knee flex degree was (108.4 ± 9.7)°; and the range of knee motion was (105.9 ± 11.4)°. There were no significant differences in general data between two groups (P gt; 0.05). Results All incisions achieved heal ing by first intention. No compl ication of ankylosis, blood vessel and nerve injuries, and prosthesis loosening occurred. All patients were followed up for 24-54 months (average 32.8 months). There were no significant differences in the HSS score, WOMAC score, the maximum knee flex degrees, and the range of knee motion at 3, 12, and 24 months after operation between two groups (P gt; 0.05), but there were significant differencesbetween pre- and post-operation (P lt; 0.05). Anterior knee pain occurred in 1 case of HF group and 4 cases of PS group after 24 months, the incidence rates were 3.70% in HF group and 9.76% in PS group, showing significant difference (P lt; 0.05). The X-ray films showed that no lucent zone around prosthesis and no patella baja were observed, and the force l ine was excellent. Conclusion There is no significant difference in the range of knee motion and cl inical scores between the HF prosthesis and the PS prosthesis, but the former’s incidence rate of anterior knee pain is lower.
