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find Author "李国庆" 15 results
  • 儿童胸腔内巨大间叶性软骨肉瘤一例

    Release date:2016-08-30 05:59 Export PDF Favorites Scan
  • 改良Ravitch 手术治疗成人复发性漏斗胸

    摘要: 目的 观察改良Ravitch手术治疗成人复发性漏斗胸的效果。 方法 回顾性分析2007年7月至2010年1月新华医院收治的8例成人复发性漏斗胸患者的临床资料,均为男性;年龄18~26岁,平均年龄21.5岁。 所有患者均采用改良Ravitch手术治疗。对术前症状、术中资料、术后结果进行分析。 结果 手术均顺利完成,术中无并发症发生,无死亡。患者胸廓畸形得到纠正,左右对称。术后发生左侧气胸2例,其中1例有胸腔积液,经胸腔闭式引流后治愈。无切口感染、浮动胸壁和反常呼吸等并发症发生。8例患者随访1~20个月,5例胸痛消失,1例胸痛明显缓解。呼吸急促等症状明显好转;无胸廓凹陷和浮动胸骨发生,无畸形复发。复查肺功能6例患者最大呼气中段流速(FEF)均gt;80%,但用力肺活量(FVC)、一秒率(FEV1%)略有改善。 结论 成人复发性漏斗胸患者采用改良Ravitch手术再次矫正后可获得较满意的效果。

    Release date:2016-08-30 06:03 Export PDF Favorites Scan
  • EFFECTIVENESS OF Y-SHAPED OSTEOTOMY FOR DEVELOPMENTAL COXA VARA IN CHILDREN

    Objective To investigate the effectiveness of Y-shaped osteotomy for treatment of developmental coxa vara in children. Methods Between January 2008 and October 2011, 10 cases (14 hips) of developmental coxa vara were treated. There were 4 boys (5 hips) and 6 girls (9 hips), aged 5-12 years (mean, 7.8 years). All the children had obvious lameness and limitations of hip abduction, adduction, and rotation. The anteroposterior pelvic X-ray films showed that the collodiaphysial angle ranged from 46 to 110° (mean, 87°); Hilgenreiner-epiphyseal angle (HE) ranged from 36 to 93° (mean, 57°); and the articulotrochanteric distance (ATD) ranged from — 25 to 6 mm (mean, — 3 mm). The subtrochanteric Y-shaped osteotomy was performed and angle steel plate was used for internal fixation. Results All incisions healed by first intention without surgery-related complication. All cases were followed up 14-40 months (mean, 18 months). The symptom of lameness disappeared or obviously alleviated; the range of motion of hip abduction, adduction, and rotation were increased. Postoperative X-ray films showed that the vertical epiphyseal plate of proximal femur was returned to the horizontal. After operation, the collodiaphysial angle was 130-153° (mean, 137°); HE angle was 23-35° (mean, 27°); and the ATD was 3-22 mm (mean, 14 mm). According to LIU Jiande’s assessment standards, the results were excellent in 5 hips, good in 8 hips, and fair in 1 hip, and the excellent and good rate was 92.8%. The other children had no recurrence of coxa vara except 1 case after 30 months. Conclusion The Y-shaped osteotomy is a simple and effective method to treat developmental coxa vara in children, which can fully correct the deformity, and patients can exercise early because of firm internal fixation.

    Release date:2016-08-31 04:07 Export PDF Favorites Scan
  • 手掌侧小切口在腕管区指屈肌腱损伤修复中的应用

    目的 总结腕管区指屈肌腱损伤后采用手掌侧小切口寻找肌腱远断端的方法及修复肌腱疗效。 方法 2002 年1 月- 2007 年10 月,收治锐器切割伤致腕管区指屈肌腱损伤38 例。男29 例,女9 例;年龄22 ~ 48 岁,平均35 岁。伤后1 ~ 12 h 入院。损伤肌腱:拇长屈肌腱12 例,示指深、浅屈肌腱10 例,中指浅屈肌腱3 例,环指屈肌腱3 例,示、中指深、浅肌腱10 例。腕部均为横形伤口。合并正中神经损伤21 例,桡动脉损伤6 例,尺动脉、尺神经损伤3 例。术中于掌侧腱鞘区与手掌区间远侧掌横纹处作一横形长约0.5 cm 切口,寻找回缩肌腱远断端并逆行原路回送,与其近断端进行端端吻合。同时处理合并损伤。 结果 术后切口均Ⅰ期愈合,未出现手指缺血坏死,尺、桡动脉搏动均可触及。36例获随访,随访时间12 ~ 36 个月,平均14 个月。术后2 ~ 4 个月根据美国手外科学会推荐的总主动活动度法评价术后疗效,优23 例,良9 例,可2 例,差2 例,优良率83.3%。21 例正中神经损伤者功能均恢复;3 例尺神经损伤者中1 例尺神经功能改善,2 例尺神经功能未恢复。 结论 腕管区指屈肌腱损伤后,采用手掌侧小切口寻找回缩的屈肌腱远断端手术操作简便可行,且不影响肌腱修复效果。

    Release date:2016-09-01 09:08 Export PDF Favorites Scan
  • Short-term effectiveness of MAKO robot assisted complex total hip arthroplasty

    ObjectiveTo investigate the short-term effectiveness of MAKO robot assisted complex total hip arthroplasty (THA). Methods The clinical data of 15 patients (17 hips) underwent MAKO robot assisted complex THA between May 2020 and June 2021 were analyzed retrospectively. There were 5 males and 10 females with the age ranged from 19 to 70 years (median, 49 years), included 9 cases (9 hips) of developmental dysplasia of the hip (Crowe type Ⅱ in 5 hips, type Ⅲ in 1 hip, and type Ⅳ in 3 hips), 1 case (2 hips) of rheumatoid arthritis, 2 cases (3 hips) of ankylosing spondylitis, 3 cases (3 hips) of secondary arthritis with a history of acetabular fracture and internal fixation. The acetabular cup abduction angle and anteversion angle were measured at 3 months after operation, and compared with those measured by MAKO robot system before and immediately after operation. The femoral offset and leg length discrepancy (LLD) were measured at 3 months after operation, which were compared with those before operation. Harris hip score (HHS) and visual analogue scale (VAS) score were used to evaluate hip function before operation and at 3 months after operation. Results All 15 patients (17 hips) completed the operation successfully. The operation time was 75-175 minutes, with an average of 116.3 minutes; the intraoperative blood loss was 100-800 mL, with an average of 381.3 mL. Two patients were not included in the statistics because of intraoperative and postoperative complications, the remaining 13 patients (15 hips) had no serious complication such as vascular and nerve injuries, and 3 patients had intermuscular vein thrombosis. The 13 patients (15 hips) were followed up 3-15 months, with an average of 8 months. At last follow-up, the position of prosthesis did not change and there was no signs of loosening. There was no significant difference in acetabular abduction angle at immediate and 3 months after operation when compared with preoperative one (P>0.05), and the acetabular anteversion angle was significantly lower than that before operation (P<0.05). There was no significant difference in acetabular abduction angle and anteversion angle between at immediate and 3 months after operation (P>0.05). The LLD, offset, HHS score, and VAS score were significantly improved at 3 months after operation when compared with preoperative ones (P<0.05). Conclusion MAKO robot assisted complex THA can achieve good short-term effectiveness, improve the hip range of motion, reduce the length difference between bilateral lower limbs, and improve the quality of patients’ life.

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  • Surgical treatment of 190 adults with pectus excavatum by newly modified orthopedic steel plate

    Objective To summarize the clinical experience of treating adults with pectus excavatum by newly modified orthopedicsteel plate and Nuss procedure. Methods The clinical data of 190 adults with pectus excavatum treated by newly modified Nuss procedure in Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine from January 2011 to June 2016 were collected. There were 151 males and 39 females aged 21.80±3.96 years ranging from 18 to 45 years. The therapeutic efficacy, Haller index and the lung function index were also analyzed. Results All patients recovered well after the operation. Two orthopedic steel plates were implanted in 12 patients. Pneumothorax was found in 7 patients postoperatively and 2 of them was treated by puncture extraction. There were 5 patients with poor healing of incision and all of them were healed after the debridement. Other complications such as steel plate shift was found in 2 patients. Both of them recovered after the reoperation. The duration of operation was 36–65 min. The intraoperative blood loss was 5–20 ml. Postoperative hospital stay was 4–7 days. Haller and lung function index improved after the operation (P<0.001). Conclusion It is effective and safe to treat the pectus excavatum by newly modified orthopedic steel plate and Nuss procedure in adult patients.

    Release date:2018-07-27 02:40 Export PDF Favorites Scan
  • Summary of best evidence for prevention of deep vein thrombosis in lower limbs of patients with spinal cord injury

    Objective To summarize the best evidence for prevention of deep vein thrombosis (DVT) in lower limbs of patients with spinal cord injury (SCI), and provide a basis for medical staff to develop evidence-based prevention and management measures for DVT in the lower limbs of patients with SCI. Methods UpToDate, BMJ Best Practice, Guidelines International Network, National Institute for Health and Clinical Excellence, Registered Nurses’ Association of Ontario, National Guideline Clearinghouse, Scottish Intercollegiate Guidelines Network, New Zealand Guidelines Group, JBI evidence-based healthcare center database, Web of Science, Embase, Cochrane Library, CINAHL, Medlive, China guidelines network, SinoMed, China National Knowledge Infrastructure, and Wanfang were systematically searched. Evidence related to the prevention of DVT in lower limbs of patients with SCI has been collected. The search period was from January 1, 2019 to June 30, 2024, and the literature was screened, quality evaluated, evidence extracted, and summarized. Results Finally, 22 articles were included, including 3 guidelines, 2 clinical decision-making articles, 4 best practices articles, 7 evidence summaries, 4 expert consensus articles, and 2 systematic reviews. A total of 32 pieces of evidence were ultimately formed in six aspects of risk assessment, diagnosis and screening, prevention principle, drug prevention, mechanical prevention, and health education. Conclusions There is a lot of evidence involved in the prevention of DVT in lower limbs of patients with SCI. In the clinical implementation process, medical staff can carefully choose prevention plans based on the patients’ clinical condition to reduce the incidence of DVT in patients with SCI during hospitalization.

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  • Surgical design and novel modified Nuss procedure for pectus excavatum

    ObjectiveTo explore the surgical design and efficacy of novel modified Nuss procedure for pectus excavatum (PE).MethodsWe retrospectively analyzed the clinical data of 903 patients with PE who were treated by the new kind of steel bar and the novel modified Nuss procedure. There were 716 males and 187 females at mean age of 2-45 (12.1±6.8) years. Preoperative chest CT scans Haller index (HI) was 3.1-15.2 (4.6±1.3), with 38 patients of mild PE (HI<3.2), 302 patients of moderate PE (HI 3.2-3.5), 521 patients of severe PE (HI 3.6-6.0), and 42 patients of extremely severe PE (HI>6.0). The operative time, operative blood loss, hospital stay time as well as postoperative complications were reviewed and analyzed.ResultsAll of the 903 patients successfully completed the surgery. The mean operative time was 20-45 (25.2±2.6) min for primary PE and that for special type of PE (including recurring PE, PE patients after heart disease operation and those corrected by 2 bars) was 48-150 (63.5±28.1) min. Blood loss was less than 10 mL for primary PE and 15-50 (23.5±5.5) mL for special type of PE. Postoperative hospital stay was 3-15 (4.5±1.6) d. A total of 845 patients (93.6%) required 1 steel bar insertion, 58 patients (6.4%) required 2 steel bars. Postoperative evaluation of the surgery outcomes revealed the following: excellent in 805 patients, good in 84 patients, fair in 14 patients and poor in 0. The good quality rate was 98.4%.ConclusionNovel modified Nuss procedure can simplify and optimize the surgical design with good short and mid-term effects.

    Release date:2020-07-30 02:32 Export PDF Favorites Scan
  • A novel modified Nuss procedure without plate turnover for treatment of adult recurrent pectus excavatum

    ObjectiveTo summarize the experience of treating adult recurrent pectus excavatum without plate turnover.MethodsTwenty-seven patients with recurrent pectus excavatum treated by thoracoscopy-assisted placement without plate turnover from 2010 to 2019 in our hospital were enrolled. There were 23 males and 4 females with the age of 3-29 (12.81±7.79) years at the first operation, and 18-29 (21.74±3.56) years at this operation. Incision of 2-3 cm at bilateral axillary midline of the deepest point of pectus excavatum was made, and an auxiliary incision under xiphoid process was adopted according to the intraoperative situation.ResultsAll patients underwent thoracoscopy-assisted correction of pectus excavatum without bar turnover, and subxiphoid incision was performed in 11 patients. Twenty-five patients had one bar placed, and two patients required two bars. The operation time was 28-45 (33.00±6.44) min. Postoperative Haller index (2.95±0.40) was improved compared with preoperation (4.63±1.03). The postoperative hospital stay was 4-6 (4.00±0.32) day. All patients were followed up for 1-8 years. Complications included poor wound healing in 1 patient, and steel wire fracture and displacement in 1 patient. There was no plate rotation or bar displacement. Fourteen patients removed the bar 29-84 (40.36±13.93) months after the placement. Haller index was improved to 2.43-3.61 (2.86±0.35) during removal of steel plate. Untill June 2020, there was no recurrence of pectus excavatum.ConclusionThe treatment of adult recurrent pectus excavatum without plate turnover is satisfactory, and the protection of intercostal muscle and firm fixation is the key to ensure the success of operation and long-term effects.

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  • Comparison of effectiveness of total knee arthroplasty with tantalum monoblock tibial component and cemented tibial plateau prosthesis in patients of different ages

    Objective To investigate the difference of total knee arthroplasty (TKA) with tantalum monoblock tibial component (TMT) and cemented tibial plateau prosthesis in patients of different ages. Methods The clinical data of 248 patients (392 knees) who underwent primary TKA between May 2014 and May 2019 and met the selection criteria were retrospectively analyzed. There were 54 males (98 knees) and 194 females (294 knees). Of the 122 patients (183 knees), less than 65 years old, 52 (75 knees, group A1) were treated with TMT and 70 (108 knees, group B1) were treated with cemented tibial plateau prosthesis; of the 126 patients (209 knees), more than 65 years old, 57 (82 knees, group A2) were treated with TMT and 69 (127 knees, group B2) were treated with cemented tibial plateau prosthesis. The baseline data of patients, perioperative indicators [hemoglobin (Hb), hematocrit (Hct), total blood loss, unilateral operation time], effectiveness evaluation indicators [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, visual analogue scale (VAS) score, Knee Society Scoring System (KSS) score, active flexion and extension range of motion (ROM) of the knee joint], complications, and imaging indicators [tibial prosthesis varus angle (β angle), tibial prosthesis posterior slope angle (δ angle), tibio-femoral angle, occurrence of radiolucent line, prosthesis survival rate] were recorded and compared. Results There was no significant difference in gender, age, height, weight, body mass index, Kellgren-Lawrence grading, the length of hospital stay, and follow-up time between groups A1, B1 and groups A2, B2 (P>0.05). The unilateral operation time in groups A1 and A2 was significantly shorter than that in the corresponding groups B1 and B2 (P<0.05). There was no significant difference in differences of pre- and post-operative Hb and Hct and total blood loss between groups A1, B1 and groups A2, B2 (P>0.05). There was no significant difference in preoperative effectiveness evaluation indicators between groups A1, B1 and groups A2, B2 (P>0.05). There were significant differences in the differences of pre- and post-operative WOMAC activity and pain scores, KSS function and pain scores, and VAS scores between groups A1 and B1 (P<0.05); there was no significant difference in WOMAC stiffness score and ROM (P>0.05). There was no significant difference in the above indicators between groups A2 and B2 (P>0.05). There was no significant difference in the incidence of complications (2.7% vs 6.5%, 3.7% vs 3.1%) and prosthesis survival rate (100% vs 97.2%, 100% vs 99.2%) between groups A1, B1 and groups A2, B2 (P>0.05). During follow-up, there was no significant difference in β angle, δ angle, and tibio-femoral angle between groups A1, B1 and groups A2, B2 (P>0.05). In the evaluation of knee X-ray radiolucent line, 2 knees of group A1 and 2 knees of group A2 had radiolucent line at prosthesis-bone interface immediately after operation, and the radiolucent line was gradually filled by new bone, without new radiolucent line. During follow-up, 1 knee of group B1 and 1 knee of group B2 had prosthesis-bone interface radiolucent line, without radiolucent line widening or prosthesis loosening. Conclusion TMT is recommended in patients less than 65 years old, and the two types of prostheses are available for patients nore than 65 years old. However, the long-term effectiveness of the two types of prosthesis in patients of different ages needs further follow-up.

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