【摘要】 目的 探讨胸腰椎椎弓根钉内固定并发症原因及预防措施。 方法 回顾性分析2006年12月-2010年12月行胸腰椎经椎弓根钉内固定治疗失败的21例患者临床资料。手术均采用经椎弓根钉内固定。误入椎管或穿出椎弓根外壁4例，螺钉断裂4例，定位失误3例；术后1~23个月内固定松动9例，其中术后1~2个月第1次X线片检查发现松动3例，术后1~3个月内固定松动并感染2例；误诊1例（腰椎肿瘤、病理性骨折诊断为骨质疏松骨折）。19例再次手术。 结果 21例均获随访，随访时间3~34个月，平均18.5个月。12例重新固定、植骨融合患者内固定位置良好，未发现内固定松动、断裂或脱出，植骨获得骨性愈合。8例内固定物取出，5例无腰、背部疼痛，腰部活动正常，3例述偶感腰、背部不适，腰部活动尚好，1例感腰、背部疼痛，影响日常活动。1例死亡。 结论 椎弓根螺钉内固定并发症多方面因素引起的，应充分认识，有效的骨折节段融合、术中仔细操作、预防感染、正确的康复锻炼等，可有效减少胸腰椎椎弓根内固定失败。【Abstract】 Objective To discuss the reasons and preventive measures for complications of thoracolumbar pedicle screw fixation. Methods Retrospective analysis of thoracolumbar pedicle screw fixation failure in 21 cases between December 2006 and December 2010 was carried out in this study. The pedicle screw fixation was used in all operations. Straying into the spinal canal or piercing the outer wall of the pedicle during operations happened in 4 cases, screw breakage in 4 cases, and positioning error in 3 cases. Internal fixation was loosened 1 to 23 months after operation in 9 cases, among which 3 were detected at the first X-ray examination 1 to 2 months after operation, 2 were found with infections 1 to 3 months after operation, and 1 was misdiagnosed (spinal tumor with pathological fracture misdiagnosed as osteoporotic fractures). Reoperation was performed for 19 cases. Results All the patients were followed up for 3 to 34 months with an average time of 18.5 months. In the 12 patients who had undergone refixation, the location of the internal fixation was good without loosening, breakage or extrusion, and the grafts obtained bone healing. Internal fixation was removed in 8 patients, among whom 5 had no pain in the waist or back with normal waist activity, and 3 described waist and back discomfort occasionally with fair lumbar activity. One patient felt waist and back pain affecting daily activities. And one patient died. Conclusions Pedicle screw fixation complications are caused by various factors. Fully understanding of the effective integration of the fracture segments, careful intraoperative management, infection prevention, and proper rehabilitation exercises can effectively reduce the thoracic and lumbar pedicle screw failure.
The large force applied by laparoscopic grasper during clamping operation can cause tissue damage and induce various complications. In this research, the security of graspers with different radii of curvature and teeth were evaluated by using experimental investigation, finite element simulation and tissue damage assessment method based on in vivo compression tests with rabbit large intestines models. Results showed that the most serious tissue damages appeared in areas that were in contact with the jaw edges, which were the regions of stress concentration. The increase in radii of curvature of the edges or teeth could alleviate the tissue damages. The results could provide basic data for choosing and designing noninvasive graspers.
ObjectiveTo evaluate the predictive value of critical illness scores for hospital mortality of severe respiratory diseases in respiratory intensive care unit (ICU).MethodsThe clinical data of the patients who needed intensive care and primary diagnosed with respiratory diseases from June, 2001 to Octomber, 2012 were extracted from MIMIC-Ⅲ database. The Acute Physiology Score (APS) Ⅲ, Simplified Acute Physiology Score (SAPS) Ⅱ, Oxford Acute Severity of Illness Score (OASIS), Logistic Organ Dysfunction System (LODS), Systemic Inflammatory Response Syndrome (SIRS) and Sequential Organ Failure Assessment (SOFA) were calculated according to the requirements of each scoring system. ICU mortality was set up as primary outcome and receiver operating characteristic (ROC) analysis was performed to evaluate the predictive performances by comparing the areas under ROC curve (AUC). According to whether they received invasive mechanical ventilation during ICU, the patients were divided into two groups (group A: without invasive mechanical ventilation group; group B: with invasive mechanical ventilation group). The AUCs of six scoring systems were calculated for groups A and B, and the ROC curves were compared independently.ResultsA total of 2988 patients were recruited, male accounted for 49.4%, median age was 67 (55, 79), and ICU mortality was 13.2%. The AUCs of SAPSⅡ, LODS, APSⅢ, OASIS, SOFA and SIRS were 0.73 (0.70, 0.75), 0.71 (0.68, 0.73), 0.69 (0.67, 0.72), 0.69 (0.67, 0.72), 0.67 (0.64, 0.70) and 0.58 (0.56, 0.62). Subgroup analysis showed that in group A, the AUCs of OASIS, SAPSⅡ, LODS, APSⅢ, SOFA and SIRS were 0.81 (0.76, 0.85), 0.80 (0.75, 0.85), 0.77 (0.72, 0.83), 0.75 (0.70, 0.80), 0.73 (0.68, 0.78) and 0.63 (0.56, 0.69) in the prediction of ICU mortality; in group B, the AUCs of SAPSⅡ, APSⅢ, LODS, SOFA, OASIS and SIRS were 0.68 (0.64, 0.71), 0.67 (0.63, 0.70), 0.65 (0.62, 0.69), 0.62 (0.59, 0.66), 0.62 (0.58, 0.65) and 0.57 (0.54, 0.61) in the prediction of ICU mortality. The results of independent ROC curve showed that the AUC differences between groups A and B were statistically significant in terms of OASIS, SAPSⅡ, LODS, APSⅢ and SOFA, but there were no significant differences in SIRS.ConclusionsThe predictive values of six critical illness scores for ICU mortality in respiratory intensive care are low. Lack of ability to predict ICU mortality of patients with invasive mechanical ventilation should hold primary responsibility.
ObjectiveTo investigate the effectiveness of modified induced membrane technique and pedicled skin (myocutaneous) flap for chronic tibial osteomyelitis in patients with diabetes. Methods A clinical data of 22 diabetic patients with chronic tibial osteomyelitis between January 2017 and March 2019 was retrospectively analyzed. There were 15 males and 7 females with an average age of 52 years (range, 44-65 years). The course of diabetes was 3-12 years (mean, 6.1 years). The course of chronic osteomyelitis was 4 months to 7 years (mean, 3.3 years). The chronic osteomyelitis was rated as type Ⅲ in 9 cases and as type Ⅳ in 13 cases according to the Cierny-Mader classification criteria. Bacterial culture showed 21 cases of single bacterial infection and 1 case of mixed bacterial infection. Preoperative color Doppler ultrasound and CT angiography confirmed that the anterior and posterior tibial arteries were unobstructed. In the first stage of treatment, the bone and soft tissue defects were filled with antibiotic bone cement after the lesion was thoroughly debrided; the length of bone defect was 4-9 cm (mean, 5.6 cm), and the size of soft tissue defect was 5 cm×2 cm to 10 cm×7 cm. After 7-10 days, the bone cement was removed and a new antibiotic bone cement was filled into the bone defect. Meanwhile, the pedicled skin (myocutaneous) flap was performed to repair the wound. After 7-12 weeks, the inflammatory indexes returned to normal, autogenous iliac bone or combined with artificial bone was used to repair the bone defect in the second stage of treatment. The wound healing, bone defect healing, complications, and the number of successful treatments were recorded. The satisfaction of the skin flap efficacy and the function of the affected limb were evaluated. ResultsLocal necrosis of the skin flap occurred in 3 cases after operation, leading to delayed healing of the wound; the other 19 flaps survived successfully, leading to primary healing of the wound. The skin grafts survived completely and the incisions healed by first intention. All cases were followed up 13-28 months with an average of 20 months. The infection recurred in 2 cases within 12 months after operation, and the bone defects healed after treated by modified induced membrane technique. The bone defect healing rate was 100%; the bone healing time was 6-10 months, with an average of 8.9 months; the infection control rate and successful treatment rate were 90.9% (20/22) and 90.9% (20/22), respectively. At 12 months after operation, according to the satisfaction evaluation standard of skin flap efficacy formulated by ZHANG Hao et al., all were satisfied. According to Johner-Wruhs adjacent joint function method, the limb function recovery was excellent in 13 cases, good in 7 cases, and fair in 2 cases, with an excellent and good rate of 90.9%. ConclusionFor the treatment of chronic tibial osteomyelitis in patients with diabetes without vascular occlusion, the modified induced membrane technique and pedicled skin (myocutaneous) flap can repair bone and soft tissue defects, and control the infection at the same time, the short- and medium-term effectiveness are good.
The treatment of patients suffering from both severe coronary artery disease (CAD) and malignancy is different from those who have isolated CAD or tumor, because their body condition is poorer and the lesions of coronary artery are severer, which poses severe challenges to doctors. At present, the surgical treatment for these patients mainly includes staged operation and simultaneous surgery. Staged operation, which separates coronary artery revascularization surgery from tumor resection, has a lower incidence of postoperative complications, but tumor progression may occur during the waiting period. Simultaneous surgery combines heart procedure with tumor resection at the same time, shortens the treatment period of patients, overcomes the defect of tumor progression that may occur during the waiting period of the staged surgery, but the incidence of postoperative complications is higher. The progress of surgical treatment in patients with CAD combined with malignant tumor is summarized.
【Abstract】 Objective To investigate the effectiveness of pedicled sternocleidomastoid muscle flap in repairing defect after parotidectomy by comparing with direct suture. Methods The clinical data were retrospectively analyzed, which were from 73 patients with parotid tumor undergoing parotidectomy between January 2002 and April 2010. After parotidectomy, defects were repaired with pedicled sternocleidomastoid muscle flap in 38 cases (flap group) and with direct suture in 35 cases (control group). There was no significant difference in gender, age, disease duration, tumor location and size between 2 groups (P gt; 0.05). Meanwhile the complications, such as local introcession deformity, Frey’s syndrome and parotid gland fistula were observed. Results In flap group, the flaps were all alive and incisions healed by first intention; in control group, all incisions healed by first intention. All patients were followed up 6-98 months and no tumor recurred. There was significant difference in local introcession deformity between 2 groups (χ2=53.202, P=0.000). The parotid gland fistula was found in 1 case (2.6%) of the flap group and in 8 cases (22.8%) of the control group, Frey’s syndrome was found 1 case (2.6%) of the flap group and in 20 cases (57.1%) of the control group, showing significant differences between 2 groups (P lt; 0.05). Conclusion The use of pedicled sternocleidomastoid muscle flap for defect repair after parotidectomy can avoid the complications of local introcession deformity, Frey’s syndrome, and parotid gland fistula.
ObjectiveTo explore the association between a single nucleotide polymorphism in PALB2 rs249954 and breast cancer.MethodsStudies regarding the association between a single nucleotide polymorphism in PALB2 rs249954 and breast cancer were searched from CNKI, WanFang, CBM, PubMed, Embase, Cochrane Library, Science Direct, and Web of Science. The eligible studies were screened based on the inclusion, exclusion criteria, and principle of quality evaluating. Meta-analysis and the assessment of published bias were performed by Stata 14.0 software.ResultsA total of 7 studies were eligible for this study, including 3 247 cumulative cases of breast cancer and 3 294 controls. Through the comparison of a variety of genetic models, we found that there was no significant for the OR of additive model〔T vs C: OR=1.14, 95% CI was (0.95, 1.37), P=0.156〕 , dominant gene model〔CT+TT vs CC: OR=1.22, 95% CI was (0.97, 1.54), P=0.088〕 , recessive gene model〔TT vs CT+CC: OR=1.11, 95% CI was (0.84, 1.45), P=0.464〕 , codominant gene model CC vs TT and TT vs CT〔 OR=0.79, 95% CI was (0.54, 1.15), P=0.226; OR=0.95, 95% CI was (0.82, 1.11), P=0.523〕 ; there was significant difference for codominant gene model CC vs CT〔OR=0.82, 95% CI was (0.67, 1.00), P=0.048〕 , but the conclusion was different after sensitivity analysis. Besides, there was notable difference for overdominant model〔CC+TT vs CT: OR=0.85, 95% CI was (0.77, 0.94), P=0.001〕 .ConclusionThe mutant genotype heterozygous (CT) of rs249954 in PALB2 will increase the breast cancer risk.
As one of the traditional computer simulation techniques, molecular simulation can intuitively display and quantify molecular structure and explain experimental phenomena from the microscopic molecular level. When the simulation system increases, the amount of calculation will also increase, which will cause a great burden on the simulation system. Coarse-grained molecular dynamics is a method of mesoscopic molecular simulation, which can simplify the molecular structure and improve computational efficiency, as a result, coarse-grained molecular dynamics is often used when simulating macromolecular systems such as drug carrier materials. In this article, we reviewed the recent research results of using coarse-grained molecular dynamics to simulate drug carriers, in order to provide a reference for future pharmaceutical preparation research and accelerate the entry of drug research into the era of precision drug design.
目的 探讨经皮穿刺椎体成形术治疗老年性骨质疏松性椎体压缩骨折的临床疗效。 方法 2006年1月-2009年1月收治患者147例（214个椎体）脊柱骨折者，男56例，女91例；年龄61～80岁，平均69岁。脊柱骨折部位为T8~L3，其中胸椎98个，腰椎116个。采用C形X线机透视引导下于俯卧位或侧卧位进行经皮穿刺椎体成形术，注射聚甲基丙烯酸甲酯（PMMA，骨水泥）。测量并计算术前和术后椎体前/后缘高度比值，疗效评价按WHO标准。 结果 118例获随访，随访时间3～7个月，平均4个月。147例214个椎体均手术成功，骨水泥注射量1.0～8.0 mL/椎体。术后2～4 h疼痛开始缓解，无显著危害性并发症发生，术前和术后椎体前/后缘高度比值无显著性差异，118例随访3～7个月疗效评价按WHO标准完全缓解加部分缓解率为100%。 结论 经皮穿刺椎体成形术是一种治疗老年性骨质疏松性椎体压缩骨折的微创手术，能够有效缓解骨质疏松性椎体骨折引起的疼痛，维持椎体稳定性，恢复椎体的高度，是一种简单、安全、有效的方法。