Objective To assess the safety and efficacy of holmium laser resection for superficial bladder cancer (HoLRBT) compared with electrocautery transurethral resection of bladder tumor (TURBT). Methods Such databases as MEDLINE, EMbase, CBM, and The Cochrane Library were searched by computer to include the randomized controlled trials (RCTs) about holmium laser and transurethral electroresection for treating superficial bladder cancer. Meta-analyses were performed by RevMan 5.0 software after the data were abstracted and the quality was evaluated. Results Nine RCTs involving 1 323 patients were included. The results of meta-analyses showed in comparison with the TURBT, there were significant differences in HoLRBT for less intraoprative bleeding volume (WMD= –6.04, 95%CI –6.90 to –5.19), shorter mean bladder irrigating time (WMD= –14.99, 95%CI –17.58 to –12.40), shorter time of indwelling urethral catheter (WMD= –2.46, 95%CI –3.59 to –1.34), fewer postoperative complications such as the obturator nerve reflex (OR=0.03, 95%CI 0.01 to 0.09), fewer events of bladder perforation (OR=0.12, 95%CI 0.05 to 0.31) and lower postoperative recurrence rate (OR=0.70, 95%CI 0.52 to 0.96). Conclusions The current evidence shows that HoLRBT is a feasible, safe, and effective alternative for the management of superficial bladder cancer because of few damages to bladder tissues and less operation bleeding.
Objective To repair the defects in articular cartilage with collagen complex gradient TCP in vivo andto study the regenerated cartilage histomorphologically. Methods The models of defects in articular cartilage were madeartificially in both condylus lateral is femoris of mature rabbits, male or female, with the weight of 2.0-2.5 kg. The right defects were implanted with the material of Col/TCP as the experimental group and the left defects were untreated as the control group. The rabbits were killed at 4, 6, 8, 12 and 24 weeks after operation, respectively, with 6 ones at each time, and the macroscopic, histological, ultrastructural examinations and semi-quantity cartilage scoring employing Wakitanifa repaired cartilage value system were performed. Results Four weeks after operation, the defects in the experimental group were partly filled with hyal ine cartilage. Twelve weeks after operation, the defects in the experimental group were completely filled with mature hyal ine cartilage. Twenty-four weeks after operation, regenerated cartilage had no ataplasia. However, fibrous tissues were seen in the control group all the time. At 4, 6, 8, 12 and 24 weeks ostoperatively, the Wakitanifa cartilage scores were 7.60 ± 0.98, 5.69 ± 0.58, 4.46 ± 0.85, 4.35 ± 0.12 and 4.41 ± 0.58, respectively, in the experimental group and 10.25 ± 1.05, 9.04 ± 0.96, 8.96 ± 0.88, 8.88 ± 0.68 and 8.66 ± 0.54, respectively, in the control group. At 4, 6, 8, 12 and 24 weeks postoperatively, the collagen II contents were 0.28% ± 0.01%, 0.59% ± 0.03%, 0.68% ± 0.02%, 0.89% ± 0.02% and 0.90% ± 0.01%, respectively, in the experimental group, while 0.08% ± 0.02%, 0.09% ± 0.04%, 0.11% ± 0.03%, 0.25% ± 0.03% and 0.29% ± 0.01%, respectively, in the control group. Differences between the control group and the experimental group were significant (P lt; 0.05). By then, typical chondrocyte was observed by transmission electron microscope in the experimental group and much fiber with less fibrocyte was observed in the control group. Conclusion Three-dimensional scaffold collagen complex gradient TCP may induce cartilage regeneration to repair the defects of articular cartilage in vivo.
Objective To investigate the effectiveness and the advantage of fixation with percutaneous cannulated screws assisted by robot navigation in the treatment of femoral neck fractures by comparing with the conventional surgery. Methods Between January 2013 and December 2014, 20 patients with femoral neck fracture were treated by internal fixation with percutaneous cannulated screws assisted by robot navigation (navigation group), another 18 patients undergoing conventional surgery with manual positioning were chosen as the control group. There was no significant difference in gender, age, cause of injury, the injury side, time from injury to operation, and the classification of fractures between 2 groups (P > 0.05). The operation time, X-ray fluoroscopy time, blood loss, frequency of guide pin insertion, and healing time were recorded. At 1 week after operation, the parallel degree of screws was measured on the anteroposterior and lateral X-ray films; the Harris score was used to evaluate the hip function. Results All incisions of 2 groups healed by first intention after operation. There was no significant difference in operation time between 2 groups (t= -1.139, P=0.262). The blood loss, frequency of guide pin insertion, and X-ray fluoroscopy time of navigation group were significantly less than those of control group (P < 0.05). There were 2 screws penetrating into the joint cavity in control group. The patients were followed up 12-24 months with an average of 18 months. The navigation group got significantly better parallel degree of screws than control group on the anteroposterior and lateral X-ray films (t=25.021, P=0.000; t=18.659, P=0.000). Fractures healed in all patients of navigation group (100%), and the healing time was (21.8±2.8) weeks; fracture healed in 16 patients of control group (88.9%), and the healing time was (24.0 ± 3.7) weeks. There was no significant difference in healing rate and healing time between 2 groups (χ2=2.346, P=0.126; t=1.990, P=0.055). The Harris score of navigation group (87.1±3.7) was significantly higher than that of control group (79.3±4.7) at last follow-up (t= -5.689, P=0.000). Conclusion Cannulated screw fixation assisted by robot navigation is a good method to treat femoral neck fractures, which has the advantages of more accurate positioning, better hip function recovery, less surgical trauma, and shorter X-ray exposure time.
Objective To explore the effect of fast track rehabilitation in patients with gastric cancer during perioperative period. Methods Eighty patients were randomly divided into conventional method group （n=40） and fast track rehabilitation group （n=40）, and to compare the levels of total lymphocyte count （TLC） , C-reaction protein （CRP），IgG， IgM， IgA， CD3＋， CD4＋， CD8＋， and CD4＋/CD8＋ in serum on the days of 1 d before operation and 1 and 3 d after operation，and to record the duration of fever，first ventilation time of flatus， postoperative hospital stay time，and the postoperative complications. Results The first ventilation time after operation was advanced in patients of fast track rehabilitation group， and the postoperative fever time and hospital stay time after operation of patients was shorter in fast track rehabilitation group than that in conventional method group （P＜0.05）. The incidence difference of complications in two groups had not statistic significance （P＞0.05）. The TLC on 1 d after operation were lower than that on 1 d before operation in two groups, and the CRP values of 1 d after operation were higher than that of 1 d before operation in two groups （P＜0.01）. Compared with 1 d before operation, the CRP value on 3 day after operation in fast track rehabilitation group was lower than that in conventional method group, and the levels of IgG, IgM， IgA， CD3＋， CD4＋， CD8＋， and CD4＋/CD8＋ were higher than that in conventional group （P＜0.05）. Conclusions Fast track surgery applied to patients with gastric cancer during perioperative period is safe and efficient， which can mitigate the immunologic impairment of patients and accelerate postoperative rehabilitation．
ObjectiveTo explore the effectiveness and advantage of three-dimensional (3D) printing technology in treatment of internal or external ankle distal avulsed fracture.MethodsBetween January 2015 and January 2017, 20 patients with distal avulsed fracture of internal or external ankle were treated with the 3D guidance of shape-blocking steel plate fixation (group A), and 18 patients were treated with traditional plaster external fixation (group B). There was no significant difference in gender, age, injury cause, disease duration, fracture side, and fracture type between 2 groups (P>0.05). Recording the fracture healing rate, fracture healing time, the time of starting to ankle functional exercise, residual ankle pain, and evaluating ankle function recovery of both groups by the American Orthopaedic Foot and Ankle Society (AOFAS) score.ResultsAll patients were followed up 8-24 months, with an average of 15.5 months. In group A: all incisions healed by first intention, the time of starting to ankle functional exercise was (14±3) days, fracture healing rate was 100%, and the fracture healing time was (10.15±2.00) weeks. At 6 months, the AOFAS score was 90.35±4.65. Among them, 13 patients were excellent and 7 patients were good. All patients had no post-operative incision infection, residual ankle pain, or dysfunction during the follow-up. In group B: the time of starting to ankle functional exercise was (40±10) days, the fracture healing rate was 94.44%, and the fracture healing time was (13.83±7.49) weeks. At 6 months, the AOFAS score was 79.28±34.28. Among them, 15 patients were good, 2 patients were medium, and 1 patient was poor. During the follow-up, 3 patients (16.67%) had pain of ankle joint with different degrees. There were significant differences in the postoperative fracture healing rate, fracture healing time, the time of starting to ankle functional exercise, and postoperative AOFAS score between 2 groups (P<0.05).ConclusionApplication of 3D printing technology in treatment of internal or external ankle distal avulsed fracture is simple, safe, reliable, and effective. In particular, it is an ideal treatment for avulsed fracture.
ObjectiveTo evaluate the effectiveness of unstable pelvic fractures treated with minimally invasive percutaneous bridge internal fixator or traditional external fixator.MethodsThe clinical data of 45 patients with unstable pelvic fractures who met the selection criteria between January 2013 and February 2018 were retrospectively analyzed. According to the different surgical methods, they were divided into two groups. In the observation group (25 cases), minimally invasive percutaneous bridge internal fixators were used, and three-dimensional printing pelvic models were used to simulate the reduction and fixation before operation to develop individual reduction strategies. In the control group (20 cases), external fixators were used. There was no significant difference between the two groups in gender, age, cause of injury, fracture type (according to Tile classification), and time from injury to operation (P>0.05). The operation time, intraoperative blood loss, fracture healing time, and complications were recorded and compared between the two groups. The reduction quality was evaluated according to the Matta standard, and functional recovery was evaluated according to the Majeed scoring standard.ResultsAll patients were followed up 12-20 months (mean, 15 months). The operation time of the observation group was significantly longer than that of the control group (t=2.719, P=0.009); no significant difference in intraoperative blood loss was found between the two groups (t=0.784, P=0.437). There was no significant difference between the two groups in fracture healing time (t=0.967, P=0.341). According to the Matta standard, the excellent and good rate of the observation group was 92%, and that of the control group was 70%, showing no significant difference between the two groups (χ2=3.748, P=0.053). At last follow-up, according to the Majeed scoring standard, the excellent and good rate of the observation group was 88%, and that of the control group was 60%, showing significant difference between the two groups (χ2=4.717, P=0.030). The incidences of incision and nailway infection, secondary displacement of fracture, and malunion in the observation group were significantly lower than those in the control group (P<0.05); the differences in incidences of iatrogenic injury of lateral femoral cutaneous nerve, deep vein thrombosis, and loosening of fixation between the two groups were not significant (P>0.05).ConclusionMinimally invasive percutaneous bridge internal fixator is a safe and effective method for the treatment of unstable pelvic fractures. It has the advantages of minimal trauma, stable fixation, less interference to patients’ daily life, early functional exercise, and quickly recovery after operation.
Objective To compare the clinical results of locking compress plate (LCP) as an external fixator and standard external fixator for treatment of tibial open fractures. Methods Between May 2009 and June 2012, 59 patients with tibial open fractures were treated with LCP as an external fixator in 36 patients (group A), and with standard external fixator in 23 patients (group B). There was no significant difference in gender, age, cause of injury, affected side, type of fracture, location, and interval between injury and surgery between 2 groups (P gt; 0.05). The time of fracture healing and incision healing, the time of partial weight-bearing, the range of motion (ROM) of knee and ankle, and complications were compared between 2 groups. Results The incidence of pin-track infection in group A (0) was significantly lower than that in group B (21.7%) (P=0.007). No significant difference was found in the incidence of superficial infection and deep infection of incision, and the time of incision healing between 2 groups (P gt; 0.05). Deep vein thrombosis occurred in 5 cases of group A and 2 cases of group B, showing no significant difference (χ2=0.036, P=0.085). All patients were followed up 15.2 months on average (range, 9-28 months) in group A, and 18.6 months on average (range, 9-47 months) in group B. The malunion rate and nonunion rate showed no significant difference between groups A and B (0 vs. 13.0% and 0 vs. 8.7%, P gt; 0.05); the delayed union rate of group A (2.8%) was significantly lower than that of group B (21.7%) (χ2=5.573, P=0.018). Group A had shorter time of fracture healing, quicker partial weight-bearing, greater ROM of the knee and ankle than group B (P lt; 0.05). Conclusion The LCP external fixator can obtain reliable fixation in treating tibial open fracture, and has good patients’ compliance, so it is helpful to do functional exercise, improve fracture healing and function recovery, and reduce the complication incidence.
Objective To evaluate the results of operative treatment of complex acetabular fractures and to investigate its influence factors. Methods From June 2000 to August 2006, 54 patients with complex acetabular fractures were treated, including 44 males and 10 females aged 20-75 years old (average 39.1 years old). Fractures were due to traffic accidentin 40 cases, fall ing from high places in 8 cases and crush by heavy objects in 6 cases. All cases were fresh and close fractures and the time from injury to operation was 5-72 days. There were 5 cases of posterior column and posterior wall fracture, 25 of transverse and posterior wall fracture, 2 of T-type fracture, and 22 of double column fracture. During operation, Kocker- Lagenbach approach was used in 23 cases, anterior il ioinguinal approach was appl ied for 3 cases and the combination of anterior and posterior approaches was performed on 28 cases. AO reconstructive plate and screw internal fixation were used in all the cases. Results Fifty-two cases were followed up for 12-74 months (average 31.3 months). Anatomical reduction was achieved in 23 cases, satisfactory reduction in 19 cases, poor reduction in 10 cases, and the excellent and good rate reached 80.77%. During operation, 1 case suffered from a tear in the external il iac vein and healed after vein repair; 2 cases had sciatic nerve injury and took mecobalamin as oral administration, one of them fully recovered, and the other had incomplete recovery at 18-month follow-up. At the final follow-up, there were 6 cases of severe heterotopic ossification, one of them received heterotopic bone resection and the rest 5 patients received conservative treatment; there were 9 cases of traumatic osteoarthritis, one of them received total hip replacement and the rest 8 patients received conservative treatment; there were 5 cases of avascular necrosis of the femoral head, two of them received total hip replacement, 1 received no further treatment because the femoral head didn’ t collapse, and the rest 2 patients gave up total hip replacement; 75.00% patients were graded as excellent and good according to the modified Merled’Aubigné-Postel hip score system. Patients’ qual ity of l ife was compared with local population normsmatched for age and sex by using SF-36 scales, their overall score were below the local population norms, and their general health, vital ity, role l imitation due to emotional problems and mental health were comparable to the local population norms. Logistic regression analysis revealed the time to reduce hip dislocation, qual ity of fracture reduction nd traumatic arthritis were independent risk factors affecting postoperative functional outcomes. Conclusion Applying open reduction and internal fixation in the treatment of displaced complex acetabular fractures has a satisfying therapeutic effect. Time to reduce hip dislocation, qual ity of fracture reduction as well as traumatic arthritis are independent risk factors affecting postoperative functional outcomes.