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PROGRESS IN SOFT TISSUE RECONSTRUCTION OF ADULT-ACQUIRED FLATFOOT DEFORMITY

Objective To review the progress in clinical and biomechanical study on soft tissue reconstruction of adult-acquired flatfoot deformity (AAFD). Methods The recent original articles of soft tissue repair and tendon transfer for AAFD were extensively reviewed. Results The soft tissue procedures for AAFD can be divided into two components: static restoration of medial column stability and dynamic reconstruction of the posterior tibial tendon. The most important static structure to be repaired for AAFD is the spring ligament. On the other hand, various methods can be used for dynamic reconstruction. The flexor digitorum longus transfer is widely used, but results of biomechanical studies do not support the advantage of this method. For patients having normal function of the posterior tibial muscle, the Cobb procedure may be more suitable. Conclusion The soft tissue reconstruction procedures of AAFD should be chosen individually based on the stage and type of the deformity.

Diagnosis and Treatmsnt of TypeⅠ Choledochal Cysts in Adults

目的探讨成人Ⅰ型胆总管囊肿的诊断和治疗。方法回顾性分析1997年1月至2004年7月期间收治的8例成人Ⅰ型胆总管囊肿的临床资料。结果5例行胆总管囊肿全切除、RouxenY肝管空肠吻合术； 2例行囊肿部分切除、RouxenY囊肿空肠吻合术； 1例行囊肿部分切除、 RouxenY肝管空肠吻合术，术中常规行胆道镜检查，无一例手术死亡。8例患者术后平均随访2．8年(1~7年)，未发现胆道恶性肿瘤。1例行囊肿部分切除的患者，在术后出现3次右上腹绞痛，1次急性胆管炎表现，均经支持、对症、抗感染等治疗后好转。 结论 成人Ⅰ型胆总管囊肿的诊断主要依靠B超、逆行胰胆管造影(ERCP)或磁共振胆胰管造影（MRCP）检查，囊肿全切除、RouxenY肝管空肠吻合是安全、有效的手术方式，其疗效比较满意； 囊肿部分切除、RouxenY囊肿空肠吻合术虽疗效不及完整囊肿切除令人满意，但对于在技术上难以作到囊肿完全切除者，部分囊肿切除是明智的选择，建议术中常规胆道镜检查。

成人孟氏骨折的手术治疗

【摘要】目的总结成人盂氏骨折的手术治疗方法及疗效。方法2003年3月2009年3月,收治21例成人孟氏骨折。男16例,女5例;年龄18～52岁,平均年龄25岁。致伤原因:车祸伤12例, 摔伤6例,砸伤3例。根据Bado分型标准:Ⅰ型6例,Ⅱ型11例,Ⅲ型3例,Ⅳ型1例。受伤至手术时间1 h～10 d,平均25 d。均采用手术治疗,行骨折脱位解剖复位内固定、环状韧带修复重建、损伤神经探查修复处理。结果手术后21例均获随访,随访时间6～48个月,平均随访时间264个月。骨折均于手术后6个月骨性愈合,无畸形及桡骨小头再脱位发生。肘关节及前臂功能按照Anderson评分标准:优14例,良4例,可2例,差1例,优良率857%。结论成人孟氏骨折应尽早手术治疗,骨折脱位的解剖复位、可靠固定及环状韧带的修复重建是手术成功的关键,同时注重受累神经的处理及早期功能锻炼,以最大程度地恢复肘关节及前臂的功能。

17例重症胰腺炎并发成人呼吸窘迫综合征诊治体会

Application Analysis of Acute Phase Reaction Index in Adult onset Still’s Disease

目的:观察急性时相反应指数在成人Still病中的变化规律。方法：以32例成人Still病患者为观察组，以50例门诊体检者为对照组，检测其血清铁蛋白和C反应蛋白水平。结果：观察组检测结果在SF、CRP和APRI三项较对照组均有显著的差异（Plt;0.05），其中APRI最为显著（Plt;0.001）。结论：急性时相反应指数在成人Still病的诊断中有较高的应用价值。

Selection of Appropriate Graft Directed by Venous Drainage Types of Median Hepatic Lobe in Adult-to-Adult Living Donor Liver Transplantation

Objective To discuss venous drainage types of median hepatic lobe and their guiding significances on the selection of grafts. Methods Between April 2005 and March 2009, 109 potential living donors underwent 3-dimensional reconstruction of computed tomography (CT) and the volume of graft was determined in the center of organ transplantation of Ruijin Hospital. The venous drainage types of median hepatic lobe of each donor were analyzed by the computer-based liver operation-planning system in detail to assign middle hepatic vein (MHV) types according to Marcos classification and venous types of Ⅳb segment according to Nakamura classification. Results The branching pattern of MHV was divided into 3 types: Type Ⅰ and Ⅱwere relatively more accounting for 44.0% （48/109）, 37.6% （41/109）, and type Ⅲ was fewest 〔18.3% （20/109）〕. There were no significant differences in volume of whole liver, volume of left liver or left liver/total liver volume ratio among various types of MHV of the donor (Pgt;0.05). Ⅳb vein was also divided into 3 types: The most common was type Ⅰ, accounting for 72.4% (79/109); Type Ⅱ 〔12.8% （14/109）〕, type Ⅲ 〔14.7% （16/109）〕 were relatively fewer. At last, 37 donors provided right liver, for Marcos Ⅰ, Ⅱ, and Ⅲ type of donors, donors remained with MHV was 12/17, 8/11, and 5/9; for Nakamura Ⅰ, Ⅱ, and Ⅲ type of donors, those number were 16/26, 4/6, and 5/5. Conclusion In adult-to-adult living donor liver transplantation, there may be great significances in accordance with Marcos and Nakamura typing results to harvest right lobe liver graft with or without MHV.

Effects of femoral offset and mechanical axis of the lower extremity on hip after osteotomy for adult developmental dysplasia of the hip

Objective To investigate the effects of femoral offset and mechanical axis of the lower extremity on hip after osteotomy for adult developmental dysplasia of the hip (DDH). Methods A clinical data of 62 adult patients with DDH (62 hips), who underwent periacetabular osteotomy combined with femoral osteotomy between January 2016 and May 2019 and met selective criteria, was retrospectively analyzed. There were 6 males and 56 females. The age ranged from 18 to 38 years, with an average of 24.4 years. Body mass index ranged from 15.8 to 31.8 kg/m2, with an average of 21.8 kg/m2. There were 44 cases of Hartofilakidis typeⅠ and 18 cases of typeⅡ. According to the modified Tönnis osteoarthritis staging, 46 cases were stage 0 and 16 cases were stageⅠ. There were 13 cases with pelvic anteversion, 40 cases with normal pelvis, and 9 cases with pelvic retroversion. Intraoperative blood loss, length of hospital stay, and complications were recorded. Postoperative hip function was evaluated by Harris score and International Hip Outcome Tool (iHOT) score. The femoral offset, collo-diaphyseal angle, hip-knee-ankle angle (HKA), knee valus angle, CE (Wiberg central-edge angle), anterior CE angle, and acetabular index angle were measured and the osteotomy healing was observed on X-ray films. Patients were grouped according to postoperative femoral offset (≥48 mm or <48 mm) and HKA [varus group (HKA<177°), normal group (HKA 177°-183°), and valgus group (HKA>183°)]. Harris score and iHOT score were compared between groups. Results Intraoperative blood loss ranged from 200 to 1 550 mL, with an average of 476 mL. The length of hospital stay ranged from 8 to 21 days, with an average of 13.3 days. All incisions healed by first intention. All patients were followed up 2.0-4.5 years, with an average of 2.8 years. At 1 year after operation, the Harris score and iHOT score of the hip joint significantly increased when compared with those before operation (P<0.05); there were significant differences in the femoral offset, collo-diaphyseal angle, HKA, knee valus angle, CE angle, anterior CE angle, and acetabular index angle between pre- and post-operation (P>0.05). According to the modified Tönnis osteoarthritis staging, 38 cases were stage 0 and 24 cases were stageⅠ; and there was no significant difference between pre- and post-operation (χ2=2.362, P=0.124). There were 11 cases with pelvic anteversion, 38 cases with normal pelvis, and 13 cases with pelvic retroversion, showing no significant difference when compared with that before operation (χ2=0.954, P=0.623). The pubic branch osteotomy did not heal in 9 cases, proximal femur osteotomy did not heal in 2 cases, and inferior pubic ramus stress fracture occurred in 5 cases. There were significant differences (P<0.05) in the Harris score and iHOT score between femoral offset≥48 mm group (n=10) and femoral offset<48 mm group (n=52). There was no significant difference (P>0.05) in Harris score and iHOT score between varus group (n=13), normal group (n=40), and valgus group (n=9). Conclusion Periacetabular osteotomy combined with femoral osteotomy can improve the femoral offset and mechanical axis of the lower extremity of patients with DDH, and improve the functional score of the hip. However, excessive increase of femoral offset during femoral osteotomy is not desirable, resulting in low postoperative functional score.

The prevalence of asthma among adults in China: a meta-analysis

ObjectivesTo systematically review the prevalence of asthma in adults (>14 years old) in China.MethodsPubMed, Web of Science, CENTRAL, CINAHL, WanFang Data, CBM, CNKI, and VIP databases were electronically searched to collect cross-sectional studies on the prevalence of asthma in Chinese adults from January 2000 to December 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 15.0 software.ResultsA total of 67 cross-sectional studies, involving 1 381 673 subjects and 19 871 adult asthma patients were included. The results of meta-analysis showed that the prevalence rate of asthma in adults in China was 1.81% (95%CI 1.59% to 2.01%). The subgroup analysis showed that the prevalence rates of asthma in males and females were 1.87% and 1.76%, respectively. The prevalence rates were 2.16% in the northeast region, 1.34% in the central region, 1.63% in the eastern region and 2.23% in the western region. The prevalence rates were 0.73%, 1.53%, and 2.81% in 15-40 years old, 41-60 years old, and >60 years old, respectively. The prevalence rates were 3.07% in illiteracy population, 1.69% in primary school population, 1.46% in junior middle school population, 1.01% in senior high school population and 0.98% in college and above population. The prevalence rates were 2.23%, 2.10%, 1.17%, 1.45%, 1.09%, and 1.41% in agriculture, forestry and animal husbandry personnel, workers, public officials, business and service personnel, military personnel, and other occupations, respectively. The prevalence rates were 1.41% and 1.59% in Han and other ethnic populations, respectively. The prevalence rates were 2.03% in cities and 1.99% in rural areas. And the prevalence rates were 1.22% in 2000 to 2005, 2.07% in 2006 to 2010, 2.25% in 2011 to 2015, and 2.62% in 2016 to 2019.ConclusionsThe prevalence rate of asthma in Chinese adults is higher, which is different due to the influence of age, sex, region, education, and occupation.

婴幼儿与成人体外循环管理比较

目的 为了婴幼儿心内直视手术顺利进行，探讨其体外循环(ECC)的特点。方法 对近3年来施行的59例10kg以下婴幼儿ECC进行总结，并与同期205例成人ECC进行比较。结果 婴幼儿组死亡5例，成人组死亡5例。两组术中均未发生ECC意外和与其相关的并发症。其中成人组在转流时间、阻断时间、预充液用量、钾用量、碳酸氢钠用量、库血用量、转流中尿量等方面明显高于婴幼儿组(P＜0.05和P＜0.01)；而转流中流量和使用库血例数则较婴幼儿组明显减少(P＜0.01)，整个ECC期间婴幼儿组血气改变较大，特别是在转流20分钟时较明显(P＜0.05)；两组对血钾的影响差别无显著性意义。结论 对婴幼儿ECC应采用高流量灌注，应用高质量膜肺，并注意心肌保护，酸碱平衡和电解质平衡，预充液应选择不含糖溶液。

57例成人破伤风的急救护理

【摘要】　目的　总结成人破伤风的急救护理经验，以降低破伤风并发症及其病死率。　方法　对2009年9月-2010年8月期间收治的57例破伤风患者，采用破伤风抗毒素治疗、伤口清创、气道护理、控制痉挛和镇静、维持水电解质平衡等急救护理过程及治疗效果进行回顾性分析，总结急救护理经验，探讨护理技术重点。　结果　56例破伤风患者经过急诊监护室、观察室或住院治疗治愈/好转出院，1例死亡，总病死率为1.8%。　结论　重视伤口处理、毒素中和、气道护理，控制痉挛，营养支持等为主的急救护理措施，对于减少成人破伤风患者并发症、降低病死率有十分重要的作用。