Objective To investigate the effectiveness of reconstructing medial patellofemoral l igament with hamstring tendon autografts for the treatment of recurrent patellar dislocation under arthroscopy. Methods Between January 2005 and January 2010, 22 cases of recurrent patellar dislocation were treated by lateral retinacular release and reconstructionof the medial patellofemoral ligament with hamstring tendon autografts under arthroscopy. There were 5 males and 17 females, aged 15-19 years (mean, 17.3 years). The average number of dislocation was 4 (range, 3-8). The main cl inical symptoms were pain and swell ing of knee joint, weakness in the leg, and limited range of motion (ROM). The patellar tilt test, pressing pain of patellofemoral ligament insertion, and apprehension sign showed positive results. According to International Knee Documentation Committee (IKDC) scoring criteria, the subjective IKDC score was 36.7 ± 4.7, and the Lysholm score was 69.3 ± 3.8. X-ray films showed that the patella inclined outwards. Results All incisions healed by first intention. Twenty-two cases were followed up 18-49 months (mean, 34 months). Pain and swelling of knee joint and weakness were improved obviously. No recurrence was found during follow-up. The ROM of knee in flexion and extension was improved when compared with preoperative ROM. The subjective IKDC score was 92.4 ± 5.3 and the Lysholm knee score was 91.7 ± 5.2, showing significant differences when compared with preoperative scores (P lt; 0.05). Conclusion Reconstruction of the medial patellofemoral ligament with hamstring tendon autografts under arthroscopy is an effective method to treat recurrent patellar dislocation.
Objective
To explorer the application value of the inferior vena cava filter (IVCF) implantation in the prevention of recurrent pulmonary embolism (PE).
Methods
Clinical data of 265 inpatients with PE admitted from November 2014 to November 2016 were retrospectively analyzed. The patients were divided into an IVCF treatment group (55 cases) and an anticoagulant therapy group (210 cases) according to treatment measure. All patients were followed up for 3 months to 2 years through regular review. The one-year PE and deep vein thrombosis (DVT) recurrence rates, one-year mortality and two-year mortality were compared between two groups.
Results
The PE and DVT recurrence rates were 9.1% and 21.8% in the IVCF treatment group, and were 18.6% and 11.0% in the anticoagulant therapy group, respectively. The PE recurrence rate was lower and the DVT recurrence rate was higher in the IVCF treatment group compared with the anticoagulant therapy group, the differences were statistically significant (P<0.05). The one-year mortality (29.1% vs. 12.9%) and two-year mortality (34.5% vs. 14.8%) were significantly higher in the IVCF treatment group than those in the anticoagulant therapy group (P<0.05).
Conclusions
IVCF without anticoagulation can reduce incidence of pulmonary embolism caused by the lower extremity DVT, but will increase DVT recurrence rate. It may be an alternative option for prevention of PE in patients with contraindications to anticoagulant therapy or recurrent PE patients after regular anticoagulant therapy.
ObjectiveTo observe the effectiveness of arthroscopic reconstruction of medial patellofemoral ligament (MPFL) with a single bundle of autogenous half peroneal longus tendon, and medial displacement of lateral hemitibial tuberosity for the treatment of recurrent dislocation of patella.Methods Retrospectively analyse the clinical data of 24 patients (24 knees) with recurrent patellar dislocation with tibial tuberosity-trochlear groove distance (TT-TG) values more than 15 mm who were admitted between September 2014 and September 2018. Of which 7 were male and 17 were female; aged 16-35 years old with an average of 25.8 years. The disease duration ranged from 15 to 46 months, with an average of 26.7 months. All patients had a history of knee trauma, and a positive result of apprehension test on the affected knee. All patients underwent the surgery of arthroscopic reconstruction of MPFL with a single bundle of autogenous half peroneal longus tendon, and medial displacement of lateral hemitibial tuberosity. Before and after operation, Kujala score was used to evaluate patellofemoral joint function, Lysholm score was used to evaluate knee joint function; CT and MRI were used to measure and compare the changes of congruence angle (CA), patellar tilt angle (PTA), and lateral patella displacement (LPD) in order to evaluate patella stability.ResultsAll incisions healed by first intention, and no infection or neurovascular injury occurred. Deep vein thrombosis of the lower extremities occurred in 2 cases at 4 and 7 days after operation respectively, and the thrombosis disappeared after symptomatic treatment. All the 24 patients were followed up 12-14 months (mean, 12.9 months). During follow-up, no patellar dislocation reoccurred in the affected knee. At last follow-up, the apprehension test was negative in every patients. The TT-TG, CA, PTA, and LPD were significantly improved when compared with those before operation (P<0.05). The Kujala score and Lysholm score at 1 month and last follow-up were significantly better than those before operation, and the above scores at last follow-up were significantly better than those at 1 month after operation (P<0.05). According to Lysholm score, the patients’ knee joint functions were excellent in 13 cases, good in 10 cases, and fair in 1 case, and the excellent and good rate was 95.8%.ConclusionArthroscopic reconstruction of MPFL with a single bundle of autogenous half peroneal longus tendon combined with medial displacement of lateral hemitibial tuberosity has the advantages of minimal invision and reliable effectiveness. It can be used as one of the effective surgical methods for the treatment of recurrent dislocation of patella.
ObjectiveTo determine the feasibility and effectiveness of percutaneous endoscopic transforaminal discectomy (PETD) for recurrent lumbar disc herniation (RLDH).
MethodsBetween June 2009 and December 2011, 56 patients with RLDH underwent PETD after local anesthesia, including 30 males and 26 females, with a mean age of 50 years (range, 24-70 years). The involved segments were L3, 4 in 3 cases, L4, 5 in 34 cases, and L5-S1 in 19 cases. Of 56 patients, 48 suffered from ipsilateral re-herniation, and 8 suffered from contralateral re-herniation. All the patients had a mean pain-free interval of 5.5 years (range, 6 months to 27 years). The visual analogue scale (VAS) score for back pain was 6.18±1.44 and the VAS score for leg pain was 7.66±1.03. Postoperative effectiveness was assessed based on the VAS score and modified MacNab criteria.
ResultsThe mean operation time was 60.4 minutes (range, 30-100 minutes) and the mean duration of hospital stay was 5.1 days (range, 3-6 days). All patients were followed up 28.2 months on average (range, 24-56 months). Patients obtained immediate pain relief postoperatively. The postoperative VAS scores of back and leg pain at 1 month, 3 months, 12 months, and last follow-up were significantly decreased when compared with preoperative score (P<0.05). Based on the modified MacNab criteria, the results were excellent in 39 cases, good in 9 cases, fair in 5 cases, and poor in 3 cases at 12 months after operation, and the excellent and good rate was 85.7%. Surgery-related complications were found in 5 cases (8.9%); one patient (1.8%) suffered from recurrence at 18 months postoperatively, and the symptom was relieved after open lumbar discectomy and intervertebral fusion surgery.
ConclusionPETD has several advantages in treating RLDH, such as avoiding from the old scar tissue, decreasing operation-related complications, shortening operation time, reducing trauma, and obtaining rapid postoperative recovery. This technique is feasible and effective for RLDH.
Objective To compare the advantages and disadvantages of using the harmonic scalpel and bipolar coagulation forceps versus harmonic scalpel and conventional clamp-and-tie technique in open thyroid surgery.Methods One hundred patients indicated for thyroid surgery were randomly divided into two groups：the bipolar coagulation forceps group underwent surgery with harmonic scalpel and bipolar coagulation forceps，and the conventional clamp-and-tie group with harmonic scalpel and conventional clamp-and-tie technique，respectively.All operations were performed by the same group of doctors.The total operation time，intraoperative bleeding，mass diameter，postoperative drainage，and surgical complications （postoperative bleeding， postoperative recurrent laryngeal nerve paralysis，seroma，and permanent postoperative hypoparathyroidism） were compared.Results There were 48 valid cases in the bipolar coagulation forceps group， and 49 cases in the conventional clamp-and-tie group. There were no significant differences between two groups patients of age，gender，disease composition，and mass diameter（P＞0.05）.With the same operative approach， the total operation time，intraoperative bleeding，and the incidence of transient postoperative hypoparathyroidism in the bipolar coagulation forceps group were significantly lower than those in the conventional clamp-and-tie group （P＜0.001）.The postoperative drainage in the bipolar coagulation forceps group was more than that in the conventional clamp-and-tie group （P＜0.05）.There was no single case of postoperative bleeding，postoperative recurrent laryngeal nerve paralysis，seroma，and permanent postoperative hypoparathyroidism in both groups.Conclusions The combination of harmonic scapel with bipolar coagulation forceps provides significant advantages over the combination of harmonic scapel with conventional clamp-and-tie technique in open thyroid surgery.
Objective To analyze the clinical features， common etiologies， prevention measurements of recurrent acute pancreatitis （AP）. Methods The clinical characteristics and imaging examination data of 43 patients with recurrent AP were analyzed retrospectively， which was compared with the results of 258 patients with primary AP. The recurrence etiologies were analyzed. Results There were no significant differences on the fever， jaundice， abdominal pain relief time， pancreatic local complications， and ratio of severe AP between two groups （P＞0.05）. Comparion of etiologies between recurrent AP and primary AP， cholecystitis and diet factor （alcoholic） had priority in patients with primary AP （P=0.038， P=0.006， respectively）， but the hyperlipidemic， duodenal nipple disease， and small stone in the common bile duct were the major etiologies in patients with recurrent AP （P=0.007， P=0.008， respectively）. No relapse was found within the follow up for 3 months to 2 years （the average time was 14.2 months）. Conclusion Find out the exact etiology and performe correct therapy are the key to the treatment and prevention of recurrent AP.
Objective To review the development and research progress of suture button fixation Latarjet procedure. Methods A comprehensive literature review was conducted to summarize the development and related modified techniques of the suture button fixation Latarjet procedure. Results Since the Latarjet procedure was first introduced by French scholar Latarjet in 1954, it has undergone three key transformations, resulting in suture button fixation Latarjet procedure, which has shown satisfactory outcomes in treatment of recurrent shoulder dislocation. However, there are still drawbacks such as the risk of impingement of the graft on surrounding tissues, and the surgical disruption of anatomical structures like the coracoclavicular ligament and the pectoralis minor muscle. The scholars have proposed several modified techniques based on the suture button fixation Latarjet procedure to further reduce complications from impingement of the graft, to lower the glenohumeral contact pressure, and to eliminate the impact of surgery on the physiological structures of the shoulder joint. The modified techniques include the arthroscopic suture button fixation Latarjet procedure using FiberTape Cerclage, reconstruction of the coracoacromial ligament during congruent-arc Latarjet procedures, and limit unique coracoid osteotomy suture button Latarjet procedure (LU-tarjet procedure). These modified techniques have also shown good clinical outcomes. Additionally, other related modified techniques for reconstruction of the glenoid, such as Chinese unique Inlay Bristow procedure (Cuistow procedure), arthroscopic glenoid bone grafting with soft fixation, and all-arthroscopic modified Eden-Hybinette procedure, have also demonstrated favorable efficacy. However, there is still a lack of long-term follow-up results for these techniques and comparative studies between them. Conclusion Suture button fixation Latarjet procedure is an effective method for the treatment of recurrent shoulder dislocation. There are various techniques, but there is no recognized gold standard, and further clinical and basic research is needed.
ObjectiveTo evaluate clinical efficacy of mannatide for recurrent respiratory tract infection (RRTI) and its influence on immune function.
MethodsThe Cochrane Library (Issue 12, 2013), PubMed, EMbase, CNKI, CBM, VIP and WanFang Data were searched for the randomized controlled trials (RCTs) that investigated the clinical and immune effect of mannatide in RRTI from inception to December 2013. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of included studies. Then meta-analysis was performed using the software RevMan 5.1.0.
ResultsA total of 18 studies involving 1 481 patients were included. The results of meta-analysis showed that compared with the placebo group, the mannatide group was superior in total effectiveness and improving the levels of T-lymphocyte subsets and antibody (P < 0.05); compared with the levomisole group, the mannatide group was superior in total effectiveness and improving the level of T-lymphocyte subsets (P < 0.05), but not in improveming antibody level.
ConclusionMannatide improves clinical efficacy in the treatment of RRTI and patients' immune function.
ObjectivesTo systematically review the association between the level of blocking antibody and recurrent spontaneous abortions.MethodsPubMed, CNKI, CBM, WanFang Data and VIP databases were searched online to collect case-control studies on the association between the level of blocking antibody and recurrent spontaneous abortions from inception to May, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 12 case-control studies involving 3 413 patients were included. The results of meta-analysis showed that: there was a strong association between the blocking antibody negative and recurrent spontaneous abortions with statistical significance (OR=6.10, 95%CI 2.40 to 15.51, P=0.000 1).ConclusionsCurrent evidence shows that the blocking antibody negative is a risk factor for recurrent spontaneous abortions. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To explore effectiveness of arthroscopic Eden-Hybinette procedure with Triple-Pulley and four point anti-rotation fixation technique in the treatment of recurrent anterior dislocation of shoulder joint. Methods A clinical data of 14 patients with recurrent anterior dislocation of shoulder joint and glenoid bone defect, who were met the selective criteria and admitted between February 2021 and February 2022, was retrospectively analyzed. All patients were treated with arthroscopic Eden-Hybinette procedure and the bone blocks were fixed by using Triple-Pulley and four point anti-rotation fixation technique. There were 9 males and 5 females with an average age of 31.2 years (range, 22-40 years). Shoulder dislocation occurred 4-10 times (mean, 6.8 times). The time from the initial dislocation to the admission was 1-6 years (mean, 3.3 years). The Instability Severity Index Score (ISIS) was 7.2±0.8, the Beighton score was 2.9±2.4, and the width ratio of glenoid bone defect was 26.64%±1.86%. Pre- and post-operative visual analogue scale (VAS) score, the University of Califonia-Los Angeles (UCLA) shoulder score, Constant score, and American Association of Shoulder and Elbow Surgeons (ASES) score were used to evaluate shoulder pain and function. The position, healing, resorption, and remodeling (glenoid area) of the bone blocks were evaluated by CT of shoulder joint. ResultsAll patients underwent surgery successfully without any serious complications. All patients were followed up 11.5-13.8 months (mean, 12.0 months). The VAS scores of shoulder joint after operation decreased compared to preoperative levels, while the UCLA score, Constant score, and ASES score all increased, with significant differences (P<0.05). And with the prolongation of time, the above indicators further improved, and the differences between different time points were significant (P<0.05). Imaging reexamination showed that the bone block completely filled the glenoid defect, with good position and no significant displacement. Over time, the bone block healed and partially absorbed and remodelled. The postoperative glenoid area increased significantly compared to preoperative area (P<0.05). With the prolongation of time, the glenoid area significantly decreased, but the difference was not significant between different time points (P>0.05). Conclusion For the recurrent anterior dislocation of shoulder joint, Triple-Pulley and four point anti-rotation fixation technique in Eden-Hybinette procedure can effectively prevent bone rotation, make fixation more reliable, and easy to operate and achieve good effectiveness.
