Objective To explore the effectiveness of Nice knot technique for wound closure in Gustilo type ⅢA and ⅢB open tibial fractures. Methods A retrospective study was performed on 22 patients with Gustilo type ⅢA and ⅢB open tibial fractures, who underwent wound closure using the Nice knot technique and were admitted between June 2021 and June 2022. There were 15 males and 7 females. The age ranged from 18 to 67 years, with an average of 41.9 years. The causes of injury included traffic accident in 11 cases, falling from height in 7 cases, and heavy object injuries in 4 cases. Fractures were located on the left side in 9 cases and on the right side in 13 cases. And 9 cases were type ⅢA fractures and 13 were type ⅢB fractures according to Gustilo classification. All patients had extensive soft tissue injuries, and no vascular or neurological damage was observed. The time from injury to debridement was 3-8 hours (mean, 6.5 hours). The sizes of wounds before operation and at 2 weeks after operation were measured and wound healing rate at 2 weeks after operation were calculated. The wound healing time and wound healing grading were recorded. The Vancouver Scar Scale (VSS) score was used to assess the wound scar after wound healed and the excellent and good rate was calculated. Results The wound area was 21.0-180.0 cm2 (mean, 57.82 cm2) before operation, and it was 1.2-27.0 cm2 (mean, 6.57 cm2) at 2 weeks after operation. The wound healing rate at 2 weeks after operation was 76%-98% (mean, 88.6%). After operation, 2 cases needed to adjust Nice knot due to skin cutting and 1 case occurred soft tissue infection on the wound. The other patient’s wounds healed. The average wound healing time was 27.8 days (range, 18-44 days). And the wound healing were grade A in 13 cases and grade B in 9 cases. VSS score was 2-9, with an average of 4.1; 10 cases were rated as excellent, 10 as good, and 2 as poor, with an excellent and good rate of 90.9%. All patients were followed up 9-24 months (mean, 14.6 months). During follow-up, no deep infection or osteomyelitis occurred. Two cases experienced fracture non-union, and were treated with compression fixation and bone grafting. The fractures of the other patients all healed, with a healing time of 85-190 days (mean, 148.2 days). ConclusionNice knot technique can be used in wound closure of Gustilo type ⅢA and ⅢB open tibial fractures effectively, which is easy to operate.
ObjectiveTo evaluate the value of incision closure device in laparoscopic cholecystolithotomy.
MethodsThe clinical data of 130 patients underwent laparoscopic cholecystectomy from Oct. 2014 to Feb. 2015 were retrospectively analyzed. According to the methods of gallbladder suture, 130 cases were divided into two groups, 72 cases underwent traditional manual suture (MS group), and 58 cases underwent incision closure device (ICD group). The operative time, postoperative gastrointestinal function recovery time, bleeding volume, postoperative hospitalization time, hospitalization expenses, complications, and postoperative 6-12 months follow-up of patients in 2 groups were observed.Results One hundred and thirty cases were performed laparoscopic cholecystolithotomy successfully. The operative time and postoperative gastrointestinal function recovery time of ICD group were significantly shorter than those of MS group, the difference was statistically significant (P < 0.05). The hospitalization expenses of the patients in ICD group were significantly higher than those in the MD group (P < 0.05). There were no significant difference between the two groups in the bleeding volume and postoperative hospital stay (P > 0.05). The patients were followed up for 6-12 months, with an average of 8 months, and no complications occurred and stone recurrence.
ConclusionIncision closure device can shorten the time of laparoscopic cholecystolithotomy and postoperative recovery of gastrointestinal function, but the cost is higher. Next development, still need decrease the expend and strengthen clinical promotion.
ObjectiveTo compare drug clinical trials between China, the United States, Europe and Japan in terms of study type, design, completion and results publication.MethodsWe randomly selected 190 clinical trials that were registered in ClinicalTrials.gov from 2009 to 2014, and followed up to December 31st, 2019. Comparisons were made for the type of sponsor, phase, design, and completion status by the sponsor’s country.ResultsAmong all included clinical trials, trials from the United States, Europe, Japan and China accounted for 50.5%, 34.2%, 9.0% and 6.3%, respectively. Among these trials, 71.1% had been completed and 69.5% disclosed results had been published publicly prior to the end of follow-up, and differences between countries were statistically significant (P<0.05). Two-thirds of the trials in China were phase Ⅲ/Ⅳ trials; in contrast, most of the clinical trials in the United States and Europe were phase Ⅰ/Ⅱ trials. The proportion of using double-blind, randomized controlled trial design was the highest in the United States (46.9%) and the lowest in China (8.3%). Chinese sponsors were mostly hospitals/universities (58.3%), while in other countries drug trials were mostly sponsored by the industry and in Japan the proportion was as high as 94.0%.ConclusionsThe number of drug trials registered in ClinicalTrials.gov from China is small and these trials are less likely to be completed and have results published/disclosed. Pharmaceutical companies in China should pay more attention to the public registration of their clinical trials, particularly those in early phases, and improve trial design and management.
ObjectiveTo evaluate the mid-term safety, efficacy and feasibility of perventricular device closure for subarterial ventricular septal defect.MethodsClinical data of 97 patients diagnosed with subarterial ventricular septal defect through echocardiography in West China Hospital from September 2013 to December 2015 were retrospectively analyzed. There were 66 males and 31 females aged 3 (1.8, 5.9) years. All the patients underwent perventricular device closure under the guidance of transesophageal echocardiography using eccentric occlusion device. Possible complications such as residual shunt, valvular regurgitation, atrioventricular conduction block and arrhythmias were recorded during the 1-year, 3-year and 5-year follow-up.ResultsAll the patients received perventricular device closure successfully except that 1 patient underwent open surgical repair under cardiopulmonary bypass 3 months later because of the migration of device. So the rate of complete closure was 99.0%. No residual shunt, moderate or severe valvular regurgitation, atrioventricular conduction block or arrhythmias were observed 5 years later.ConclusionTreating subarterial ventricular septal defect through perventricular device closure exhibits remarkable mid-term efficacy, safety and feasibility with high success rate.
Objective
To determine the long-term changes in optic disc parameter and the thickness of circumpapillary retinal nerve fiber layer (CP-RNFL) and macular retina after acute primary angle closure.
Methods
Prospective clinical case-control study. A total of 26 patients (30 eyes) with acute primary angle-closure glaucoma (APACG) were in the APACG group, whose intraocular pressure were control after a single episode acute primary angle closure; 30 age-and sex-matched healthy subjects (30 eyes) in the control group. All subjects underwent three dimensional optical coherence tomography (3D-OCT) examination with 3D optic disk scanning or circle optic disk scanning and 6 mm×6 mm macular scanning. The parameters included average thickness of entire CP-RNFL, thickness of nasal, superior, temporal and inferior quadrant of CP-RNFL, disc area, disc cup area, rim area, cup/disc (C/D) area ratio, C/D horizontal diameter ratio and C/D vertical diameter ratio. The foveal retinal thickness, center retinal thickness (≤1 mm from the fovea), 4 quadrants of macular inner-ring ( > 1 mm but≤3 mm from the fovea) retinal thickness, 4 quadrants of macular outer-ring ( > 3 mm but≤6 mm from the fovea) retinal thickness, average thickness of macular retinal thickness and macular volume were measured and analyzed.
Results
The disc area, disc cup area, C/D area ratio, C/D horizontal diameter ratio and C/D vertical diameter ratio in APACG group were significantly bigger than the control group (t=3.22, 4.12, 3.90, 3.00, 3.23; P < 0.05), rim area was smaller than the control group (t=-2.63, P < 0.05). The average thickness (t=-6.68) and the thickness of superior (t=-5.90), temporal (t=-11.64) and inferior (t=-5.06) quadrants of CP-RNFL, center retinal thickness (t=-2.50), 4 quadrants of macular inner-ring retinal thickness (t=-4.91, -4.88, -2.83, -3.59), nasal (t=-2.13) and superior (t=-2.49) quadrants of macular outer-ring retinal thickness as well as average thickness of macular retinal thickness (t=-2.65) were significantly thinner than the control group (P < 0.05), and the macular volume (t=-2.69) was significantly smaller than the control group (P < 0.05). There was no statistically difference at nasal CP-RNFL (t=-0.11), foveal retinal thickness (t=-0.59), temporal (t=-0.67) and inferior (t=-1.02) quadrants of macular outer-ring retinal thickness between two groups (P > 0.05).
Conclusions
In comparison with the healthy subjects, the disc area, disc cup area, C/D area ratio, C/D horizontal diameter ratio, C/D vertical diameter ratio in APACG eyes were bigger, while rim area was smaller; the CP-RNFL and macular retinal thickness were thinner except nasal CP-RNFL, fovea, temporal and inferior quadrants of macular outer-ring retinal.
Objective To discuss the treatment method and effectiveness of Seymour fracture in children and adolescents.
Methods Between January 2013 and November 2015, 26 children and adolescents with Seymour fractures were treated. There were 18 males and 8 females, aged from 1 year and 1 month to 17 years (median, 8.2 years). The injury causes included crush in 14 cases, bruise in 10 cases, and puncture in 2 cases. The thumb was involved in 2 cases, index finger in 1 case, middle finger in 12 cases, ring finger in 6 cases, and little finger in 5 cases. The time from injury to operation was 1-15 hours (mean, 3.2 hours). The patients underwent debridement, nail removal, nail matrix repair, closed reduction and osteosynthesis with Kirschner wires, and splinting in emergency. Kirschner wires and splints were removed at 4 weeks after surgery, and functional exercises were done.
Results All wounds healed by first intention without infection. The follow-up duration was 2-24 months (mean, 12.3 months). The fracture healing was obtained at 1-2 months (mean, 1.4 months) on X-ray film, and no complications of nonunion, malunion, re-displacement, premature epiphyseal closure, or no growth of the nails occurred. Nail deformity developed in 1 case and no re-operation was given. At last follow-up, 1 patient had 10° extension limitation of the distal interphalangeal joint, but the flexion was normal. The motion range of distal interphalangeal joint was 0-75°, showing no significant difference when compared with that of contralateral side (0-78°).
Conclusion The effectiveness for treating Seymour fracture is satisfactory by debridement, nail removal, nail matrix repair, closed reduction and osteosynthesis with Kirschner wires, and splinting in emergency.
摘要:目的:分析微創外科室間隔缺損(ventricular septal defect,VSD)封堵失敗原因,以期提高術前超聲心動圖篩查水平。方法:回顧性分析25例微創外科VSD封堵失敗改行修補術病例,對比超聲表現及手術所見,歸納總結產生并發癥的原因。結果:殘余分流與VSD假性膜部瘤右室面具有多個出口和低估VSD大小密切相關;VSD合并主動脈瓣右冠瓣脫垂是主動脈瓣反流的主要原因;封堵器移位與低估VSD大小且使用偏心封堵器有關;原有三尖瓣反流加重和發生Ⅲ度房室傳導阻滯VSD均位于隔瓣下方;封堵失敗組較封堵成功組缺損偏大,差異具有統計學意義(Plt;0.05)。結論:超聲心動圖對VSD及其毗鄰結構的細致評估,有助于嚴格適應證,提高手術成功率。 Abstract: Objective:To analyze the failure of perventricular closure of ventricular septal defect (VSD), in order to improve the preoperative echocardiography examination. Methods: Twentyfive cases underwent surgical repair after failure of perventricular closure of VSD were included in this study. With combination of echocardiographic and surgical findings, retrospective analysis of the failure of perventricular closure of VSD were attempted to summarize the cause of complications.Results: Residual ventricular communication was due to underestimation of size of VSD and pseudomembranous aneurysm resulting in multiple outlets of VSD on the right ventricle side; preoperative prolapse of rightcoronary cusp was the main reason for mild or greater than mild aortic valve regurgitation after eccentric device closure of VSD; Underestimation of the size of VSD and using eccentric occluder device were responsible for the displacement of VSD occluder device. Postoperative aggravated tricuspid regurgitation and Ⅲ°atrialventricular block (AVB) were attributed to VSDs located under the septal leaflet of tricuspid valve. The size of VSD in group of failed perventricular device closure of VSD was larger than that in group of successful device closure of VSD,and the difference was significant(Plt;0.05). Conclusion: Echocardiography vividly reveals VSD and adjacent structures, which should be used in accessing the anomaly and defect and formulating surgical plans to reduce surgical morbidity and mortality.
ObjectiveTo investigate clinical efficacy and advantages and disadvantages of primary closure with two endoscopes (1aparoscope+choledochoscope) or three endoscopes (laparoscope+choledochoscope+duodenoscope) through the cystic duct for treatment of gallbladder stone with secondary common bile duct (CBD) stones.MethodsThe clinical data of 83 patients with gallbladder stones with secondary CBD stones treated by two or three endoscopes combined with CBD exploration and lithotomy and primary closure through cystic duct from January 2017 to December 2018 in the Chengdu Second People’s Hospital were collected retrospectively. Among them, 41 patients were treated by two endoscopes mode (two endoscopes group), 42 cases were treated by three endoscopes mode (three endoscopes group).ResultsThere were no significant differences in the general conditions such as the gender, age, preoperative diameter of CBD, chronic diseases, etc. between the two and three endoscopes group (P>0.05). All 83 cases underwent the operations successfully and recovered well. The success rate of operation, stone clearance rate, drainage volume of abdominal drainage tube on day 1 after the operation, time of abdominal drainage tube removal after the operation, and hospitalization time had no significant differences between these two groups (P>0.05). The time of operation, intraoperative bleeding volume, and the postoperative pancreatitis rate in the three endoscopes group were significantly more (or higher) than those in the two endoscopes group (P<0.05), but the condition of liver function recovered after the operation was better than that in the two endoscopes group (P<0.05).ConclusionsWith the strict control of the operation indications, it is safe and feasible to use two or three endoscopes through the cystic duct pathway and primary closure of CBD for treatment of gallbladder stone with secondary CBD stones. However, the choice of operative methods of two or three endoscopes should be based on the general situation of the patients before and during the operation.
Objective To observe the effectiveness of disposable skin stretch closure in the treatment of wounds with skin and soft tissue defects that were difficult to close. Methods The clinical data of 13 patients with skin and soft tissue defects that were difficult to close treated with disposable skin stretch closure and met the selection criteria between July 2021 and February 2022 were retrospectively reviewed. There were 9 males and 4 females, the age ranged from 15 to 71 years with a mean of 39.8 years. The causes of injury included falling injury in 5 patients, traffic accident injury in 5 patients, and falling from height injury in 3 patients. The causes of skin soft tissue defects included open fractures in 4 patients, wound infection in 4 patients, osteomyelitis in 3 patients, degloving injury in 1 patient, and necrosis of skin graft in 1 patient. The injury was located at calf in 8 patients, calcaneus in 3 patients, pelvis in 1 patient, and plantar in 1 patient. The skin and soft tissue defects ranged from 5.0 cm×2.0 cm to 10.5 cm×6.5 cm. Wound conditions (wound closure and wound healing) and the presence or absence of complications were recorded. Results All 13 patients were followed up 32-225 days with a median of 164 days. The wound closure time ranged from 5 to 14 days, with a mean of 8.8 days. The wound closure speed ranged from 0.7 to 13.7 cm2/day, with a mean of 3.6 cm2/day. All wounds healed at grade A, and no complication such as skin edge injury, wound necrosis, infection, dehiscence, and edema occurred. No patient complained of pain or discomfort, and no obvious scarring was found during follow-up. The wound healing time ranged from 17 to 28 days, with a mean of 21.7 days. One of them was transferred to other department due to lung cancer condition changes after using disposable skin stretch closure, and the wound had directly healed without suturing at 17 days after operation. Conclusion The effectiveness of disposable skin stretch closure in the treatment of wounds with skin and soft tissue defects that were difficult to close was exact, with short wound closure time, few complications, and easy operation.
ObjectiveTo investigate the efficacy and safety of hybrid perventricular device closure (PVDC) for the treatment of muscular ventricular septal defect (MVSD) in pediatric patients.
MethodsWe retrospectively analyzed clinical data of 35 pediatric patients with MVSD who received hybrid PVDC in West China Hospital between 2009 and 2012. There were 16 males and 19 females with their median age of 3.9 years (range, 1 month to 7 years). There were 10 patients with single MVSD, 12 patients with multiple MVSD, 6 patients with other congenital heart defects, and 7 patients with post-surgical residual MVSD.
ResultsAmong the 35 patients, immediate complete closure was achieved in 28 (80.0%) patients. Residual shunt was noted in 7 (20.0%) patients. Median device size was 5 mm. Cardiopulmonary bypass was avoided in 19 patients. Two (5.7%) patients died postoperatively due to postoperative heart failure resulted from complex congenital heart defect. All survival patients were followed up for a mean duration of 6 months, and there was no late death. Thirty-one (93.9%) patients had good positioning of the closure devices but no residual shunt. Small residual shunt at the apex was noted in 2 (6.1%) patients.
ConclusionHybrid PVDC is an effective treatment for MVSD with relatively high successful rate but low mortality and morbidity, and its short-term results are satisfactory.
