ObjectiveTo investigate the clinical features and strategy of diagnosis and treatment of the abdominal trauma in elder people. MethodsClinical data of 68 elderly patients with abdominal trauma were analyzed retrospectively.ResultsDiagnosis in 35 of 68 cases were confirmed within 12 hours after trauma (51.5%). Fiftyeight cases in this group were treated surgically and 10 cases with nonsurgical treament.There were 7 death, the overall mortality was 10.3%. The cause of death was septic shock and multiple organ systemic failure. ConclusionThe elder patient with abdominal trauma has its speciality in clinical and pathophysiological characteristics and is less tolerant to trauma, which easily leads to misdiagnosis or maldiagnosis. The principle of treatment is to choose positive surgery, to streng then the perioperative management, to protect the function of each important organ, and to prevent the occurrence of multiple organ dysfunction syndrome.
ObjectiveTo investigate the effectiveness of individual percutaneous cannulated screws fixation of computer-assisted design combined with three-dimensional (3D) guide plate by comparing with cast immobilization and open internal fixation for treatment of Herbert type Ib scaphoid fracture. MethodsBetween January 2010 and June 2015, 56 patients with fresh Herbert type Ib scaphoid fracture were treated with cast immobilization in 16 cases (external fixation group), with open reduction and internal fixation in 20 cases (open reduction group), and with individual percutaneous cannulated screws fixation of computer-assisted design combined 3D guide plate in 20 cases (minimal invasion group). There was no significant difference in gender, age, injury cause, side, disease duration, and classification of fractures between groups P>0.05).The time of bone union, bone nonunion rate, return-to-work time, wrist range of motion (ROM), and Mayo function score were recorded and compared. ResultsPrimary healing of incision was obtained in open reduction group and minimally invasion group, without related complications. The cases were followed up 10-24 months (mean, 16.6 months). The time of bone union and return-to-work time of minimal invasion group were significantly shorter than those of the other 2 groups (P<0.05), and the rate of bone nonunion was significantly lower than that of the other 2 groups (P<0.05). At last follow-up, the wrist ROM of minimal invasion group[(104.40±3.46)°] was significantly larger than that of external group[(94.20±2.42)°] and open reduction group[(96.40±2.66)°] (P<0.05). According to Mayo function score, the results were excellent in 6 cases, good in 5 cases, fair in 2 cases, and poor in 3 cases in external fixation group, with an excellent and good rate of 69%; the results were excellent in 9 cases, good in 7 cases, fair in 2 cases, and poor in 2 cases in open reduction group, with an excellent and good rate of 80%; the results were excellent in 16 cases, good in 3 cases, and fair in1 case in minimal invasion group, with an excellent and good rate of 95%; there was significant difference in excellent and good rate among groups (P<0.05). ConclusionIndividual percutaneous cannulated screws fixation of computer-assisted design combined with 3D guide plate has satisfactory effectiveness in the treatment of Herbert type Ib scaphoid fractures, with the advantages of mini-invasion, high accuracy, high rate of bone union, less complication, early return-to-work time.
[Abstract]The number of lung transplantation is gradually increasing worldwide, which brings new challenges to the multi-disciplinary team of lung transplantation. The prognosis of lung transplant recipients is seriously affected by the pathophysiological state of specific lung diseases and perioperative risk factors. It is of great significance for these patients to optimize perioperative management according to these factors. Recently, several expert consensus have been published regarding anesthesia management of lung transplantation. Based on the current evidence and clinical practice of West China Hospital, this review summarizes the key points of anesthesia management for lung transplant recipients to guide anesthesiologists' clinical practice.
To investigate the protective effect of propofol on ischemia/reperfusion induced spinal cord injury in rabbits and its influence on excitatory amino acid (EAA). Methods Sixty New Zealand white rabbits weighing 2.0-2.5 kg, half males and half females, were selected. The infrarenal circumaortic clamping model was used. And 6 mL/kg different fluids were continuously infused through a catheter into the aorta distal to the clamping site at a speed of 12 mL/(kg•h) during the 30 minutes ischemia period. According to the different infusing l iquids, the rabbits were randomized into 6 groups(n=10 per group): group A, normal sal ine; group B, 10% intral ipid; group C, propofol 30 mg/kg; group D, propofol 40 mg/kg; group E, propofol 50 mg/kg; group F, propofol 60 mg/kg. At 0, 6, 24, and 48 hours after reperfusion, neurologic outcomes were scored on a Tarlov scale system. At 48 hours after reperfusion, the number of normal neurons in the anterior spinal cord was counted, and concentration of EAA in the lumbar spinal cord was measured by high performance l iquid chromatography. Results The neuroethological score was better in groups C, D, E and F than that of groups A and B (P lt; 0.05), the score of group E was the highest (P lt; 0.05), and there was no significant difference between group A and group B (P gt; 0.05). The number of normal neurons in the anterior spinal cord of groups C, D, E and F was greater than that of groups A and B (P lt; 0.05), and group E was greater than groups C, D and F (P lt; 0.05). The concentration of EAA in groups A, B, C, D, E and F was greater than that of normal tissue, the group E was the lowest (P lt; 0.05), the groups A and B were the highest (P lt; 0.05), and there was no significant difference between group A and group B (P gt; 0.05). Concentrations of glutamate and aspartic acid were negatively correlated to normal neuron numbers in the anterior spinal cord and neuroethological scores 48 hours after reperfusion, and the corresponding correlation coefficient was — 0.613, — 0.536, — 0.874 and — 0.813, respectively (P lt; 0.01). Conclusion Propofol can significantly inhibit the accumulation of EAA in spinal cord and provide a protective effect against the ischemia/reperfusion injury induced spinal cord in rabbits.
Objective To evaluate the effectiveness of spinal canal decompression assisted by unilateral biportal endoscopy (UBE) and percutaneous uniplanar pedicle screw internal fixation in the treatment of lumbar burst fractures with neurological symptoms. Methods Between June 2021 and December 2022, 10 patients with single level lumbar burst fracture with neurological symptoms were treated with spinal canal decompression assisted by UBE and percutaneous uniplanar pedicle screw internal fixation. There were 7 males and 3 females with an average age of 43.1 years (range, 21-57 years). The injured vertebrae located at L1 in 2 cases, L2 in 4 cases, L3 in 3 cases, and L4 in 1 case. There were 7 cases of AO type A3 fractures and 3 cases of AO type A4 fractures. The total operation time, the time of operation under endoscopy, and complications were recorded. Pre- and post-operative visual analogue scale (VAS) score and American Spinal Injury Association (ASIA) scale (grading A-E corresponding to assigning 1-5 points for statistical analysis) were used to evaluate effectiveness. X-ray film and CT were performed to observe the fracture healing, and the ratio of anterior vertebral body height, Cobb angle, and rate of spinal canal invasion were measured to evaluate the reduction of fracture.Results All operations was successfully completed, and the spinal canal decompression and the bone fragment in spinal canal reduction completed under the endoscopy. Total operation time was 119 minutes on average (range, 95-150 minutes), and the time of operation under endoscopy was 46 minutes on average (range, 35-55 minutes). There was no complication such as dural sac, nerve root, or blood vessel injury during operation. All incisions healed by first intention. All patients were followed up 18.7 months on average (range, 10-28 months). The VAS score after operation significantly decreased when compared with that before operation (P<0.05), and further improved at last follow-up (P<0.05). The ASIA scale after operation significantly improved when compared with that before operation (P<0.05), and there was no significant difference (P>0.05) in the ASIA scale between at 1 week after operation and at last follow-up. The imaging examination showed that the screw position was good and the articular process joint was preserved. During follow-up, there was no loosening, fracture, or fixation failure of the internal fixation. The ratio of anterior vertebral body height and Cobb angle significantly improved, the rate of spinal canal invasion significantly decreased after operation (P<0.05), and without significant loss of correction during the follow-up (P>0.05). Conclusion Spinal canal decompression assisted by UBE and percutaneous uniplanar pedicle screw fixation is a feasible minimally invasive treatment for lumbar burst fractures with neurological symptoms, which can effectively restore the vertebral body sequence, as well as relieve the compression of spinal canal, and improve the neurological function.
ObjectiveTo investigate the reconstruction mode selection of acetabular bone defect and the effect on the acetabular cup position in cementless total hip arthroplasty (THA). MethodsA retrospective analysis was made on the clinical data of 78 patients (78 hips) with acetabular bone defect according to the selection criteria who underwent THA between February 2008 and February 2014. In 39 cases having acetabular posterosuperior bone defect with defect area less than 30%, impaction bone grafting was performed (group A); in 24 cases having acetabular posterosuperior bone defect with defect area of 30%-50%, structural bone or tantalum block grafting was performed (group B); in 10 cases having acetabular medial wall bone defect with defect area less than 30%, impaction bone grafting was performed (group C); and in 5 cases having acetabular medial wall bone defect with defect area of 30%-50%, titanium mesh combined with impaction bone grafting was performed (group D). There was no significant difference in gender, age, and side between groups A and B, and between groups C and D (P>0.05). The acetabular abduction angle, anteversion, the horizontal and vertical distances of actual and true rotation center after operation were compared. ResultsThe patients were followed up 7-25 months. Prosthesis loosening occurred in 2 cases of group A, sciatic nerve injury and hip joint dislocation in 1 case of group B, respectively. At immediate after operation and last follow-up, there was no significant differences in the horizontal or vertical distance of actual and the true rotation center between groups A and B (P>0.05); significant difference was found in the horizontal distance between groups C and D (P<0.05), but no significant difference in the vertical distance (P>0.05). Difference was statistically significant in the acetabular abduction angle and anteversion between groups A and B (P<0.05), but difference was not significant between groups C and D (P>0.05). ConclusionIn patients with acetabular posterosuperior bone defect, reconstruction methods will have effect on acetabular abduction and anteversion; early acetabulum prosthesis loosening may be associated with too large acetabular abduction angle and inappropriate reconstruction methods. In patients with acetabular medial wall bone defect, the vertical distances of rotation center will shift upward in varying degrees, and reconstruction methods have effect on the horizontal distances of rotation center.
Objective To observe and evaluate the clinical effect of the new fenestration rammer in the treatment of thoracolumbar burst fracture by posterior internal fixation and reduction of lamina with finite fenestration decompression. Methods Patients with thoracolumbar burst fractures admitted to Zigong Fourth People’s Hospital between September 2017 and January 2020 were retrospectively selected. The patients were divided into observation group and control group according to different surgical methods. The observation group used a new tamping device with finite fenestration rammer of unilateral lamina to reduce the spinal occupying bone mass, and the control group used conventional instruments for reduction of intraspinal fracture masses. The operation time, intraoperative blood loss, CT measurement of sagittal diameter ratio of spinal canal and the number of cases of postoperative vertebral empty shell phenomenon were recorded in the two groups, and Frankel grading evaluation of spinal nerve function was conducted. Results A total of 67 patients were included. There were 33 cases in the observation group and 34 cases in the control group. The patients in both groups were followed up for 12 to 16 months, with an average of (14.45±2.25) months. The improvement rate of Frankel rating in each group was 100%. In the control group and the observation group, except for the sagittal diameter ratio of spinal canal before operation (P=0.616), the operation time [(150.44±26.47) vs. (120.91±20.86) min], the intraoperative blood loss [(244.41±42.97) vs. (183.33±34.56) mL], the sagittal diameter ratio of spinal canal one week after operation [(92.50±2.32)% vs. (93.72±2.40)%], the sagittal diameter ratio of spinal canal at the last follow-up [(91.50±2.96)% vs. (93.17±3.27)%] and the occurrence of empty shell phenomenon (13 vs. 5 cases) were statistically significant (P<0.05). The intragroup comparison showed that the sagittal diameter ratio of spinal canal was improved one week after operation and at the last follow-up compared with that before operation (P<0.05), there was no significant difference in the sagittal diameter ratio of spinal canal between one week after operation and the last follow-up (P>0.05). Conclusions The new fenestration rammer can effectively reduce the spinal occupying bone mass in thoracolumbar burst fracture, effectively restore the volume of the spinal canal, achieve the purpose of decompression, effectively prevent the formation of vertebral shell, maximize the retention of the stable structure of the posterior column, and avoid iatrogenic nerve injury. It is safe and effective.
ObjectiveTo evaluate the safety of photoelectric guided navigation unilateral puncture of the percutaneous kyphoplasty (PKP) in the treatment of thoracolumbar osteoporotic vertebral compression fracture (OVCF).MethodsA randomized controlled clinical research was performed between June 2015 and January 2017. Eighty-five cases of OVCF were treated with photoelectric guided navigation unilateral puncture of the PKP (trial group, 43 cases) or C arm fluoroscopy unilateral puncture of the PKP (control group, 42 cases) respectively. There was no significant difference in gender, age, disease duration, segmental fracture, AO classification, bone mineral density, and preoperative visual analogue scale (VAS) score between 2 groups (P>0.05). The concordance rate of puncture path and design path, the incidence of pedicle wall breaking, the incidence of bone cement leakage, and the rate of bone cement distribution center were observed and calculated on postoperative CT images; the intraoperative X-ray exposure frequency, frequency of puncture, operation time, VAS scores before operation and at 2 days after operation, and postoperative blood vessel or nerve injury were recorded and compared.ResultsThe intraoperative X-ray exposure frequency and puncture frequency in trial group were significantly less than those in control group (P<0.05), but there was no significant difference in operation time between 2 groups (t=0.440, P=0.661). The VAS scores of 2 groups at 2 days after operation were significantly improved when compared with preoperative ones (P<0.05), but there was no significant difference in VAS score at 2 days after operation between 2 groups (t=0.406, P=0.685). All the patients were followed up 6-18 months (mean, 10 months). No blood vessel or nerve injury occurred in 2 groups. The incidence of pedicle wall breaking, the incidence of bone cement leakage, the concordance rate of puncture path and design path, and the rate of bone cement distribution center in trial group were 2.33% (1/43), 2.33% (1/43), 86.05% (37/43), and 88.37% (38/43) respectively, all showing significant differences when compared with those of control group [19.05% (8/42), 21.43% (9/42), 45.24% (19/42), and 50.00% (21/42) respectively] (P<0.05).ConclusionIntraoperative photoelectric guided navigation unilateral puncture of the PKP can improve the success rate of target puncture and reduce the incidence of pedicle wall breaking effectively, and achieve better bone cement distribution and better security.