ObjectiveTo investigate the clinical characteristic differences of cementless total hip arthroplasty (THA) between with and without subtrochanteric femoral shortening osteostomy in Crowe type IV developmental dysplasia of the hip (DDH). MethodsBetween January 2006 and March 2012, 21 patients (21 hips) with Crowe type IV DDH who underwent primary THA were enrolled according to inclusion criteria. According to whether subtrochanteric femoral shortening osteostomy was performed during THA or not, the patients were divided into 2 groups: THA with osteostomy group (n=9) and THA without osteotomy group (n=12). There was no significant difference in gender, age, body mass index, and hip Harris score between 2 groups (P>0.05) except leg length discrepancy (t=-3.170, P=0.005). The operation time, blood loss, postoperative drainage, complications, and radiography data were compared to evaluate the clinical characteristics. ResultsThe operation time, blood loss, and postoperative drainage of osteotomy group were all significantly greater than those of no osteotomy group (P<0.05). All patients achieved primary healing of incision; 1 patient (1 hip) had transient sciatic nerve symptom in osteotomy group. The average follow-up time was 53 months (range, 28-88 months). The X-ray films showed good fracture healing at 3-6 months after operation in osteostomy group. No prosthetic loosening or dislocation was found. The hip Harris score was 90.67±4.06 in osteostomy group and 92.17±3.27 in no osteostomy group, showing no significant difference between 2 groups (t=-0.938, P=0.360). The leg length discrepancy was (0.22±0.26) cm in osteostomy group and (0.18±0.27) cm in no osteostomy group, showing no significant difference (t=107.000, P=0.546). The leg length discrepancy was found in 6 patients of osteotomy group and 5 patients of no osteotomy group. One patient complained of thigh pain in osteotomy group; 2 patients had slight limp (Trendelenburg +) in no osteotomy group. ConclusionTHA can improve joint function and increase limb length in the treatment of Crowe type IV DDH. Subtrochanteric shortening osteotomy is an effective treatment which can be performed according to preoperative template measurement, leg length shortening, and the soft tissue tension.
ObjectiveTo summarize the recent progress in prevention of prosthetic joint infection (PJI) so as to provide clinical references. MethodsThe publications concerning the etiology and surgical management of PJI were reviewed, analyzed, and summarized. ResultsThe prevention of PJI is related to preoperative, intraoperative, and postoperative aspects of PJI, comprehensive treatment is considered to be the most common method for PJI. ConclusionThese prevention strategies that may be utilized in all phases of perioperative care, a multifaceted approach to the patient undergoing total joint replacement will have the greatest positive effect
ObjectiveTo introduce the role of three dementional computed tomograph (3D-CT) for patients underwent transcatheter aortic valve implantation (TAVI) procedure in perioperative evaluation. MethodsFrom April 2014 to June 2015, we retrospectively analyzed clinical data of 28 patients with severe aortic stenosis underwent successful TAVI procedure using new second-generation device, who were enrolled in this study including 12 males and 16 females at mean age of 72.8±4.5 years. We used 3D-CT to get the perioperative relative evaluation, including valve morphology and calcification degree, annular diameter, aoronary ostium height, ascending aorta, aortic sinus diameter, left ventricular-aortic angle, optimal intraoperative angiogram projection angle. Based on the evaluation by 3D-CT image, the prosthesis size, balloon size, best intraoperative imaging projection angle and approach of apex were then chosen. ResultsAll patients with severe aortic stenosis underwent successful TAVI procedure with mean logistic Euro-SCORE I:26.2%±7.9%. CT image revealed that mean aortic annular diameter was 24.6±1.8 mm with mean valve prosthesis size 25.8±1.1 mm and pre-dilation balloon size 23.1±1.2 mm and 76.8% patients were of tricuspid aortic valve with severe calcification and 25% patients were of asymmetric calcification. Optimal intraoperative angiogram image was achieved in 92.9% patients with the help of preoperative CT image. There was a statistic difference in mean transvalvular gradient after valve implantation (54.1±15.3 mm Hg vs. 13.1±8.5 mm Hg, P<0.05). And there was no mortality or severe complication postoperatively. Conclusion3D-CT image palys an important role during perioperative evaluation of TAVI procedure and it can be helpful for Chinese doctors to operate TAVI successfully.
Objective To systematically review the effectiveness and safety of total hip arthroplasty (THA) vs. total hip resurfacing arthroplasty (THRA) in patients with osteoarthritis of the hip joint. Methods We electronically searched databases including PubMed, The Cochrane Library (Issue 3, 2012), EMbase, PloS, national institutes of clinical test library of the United States, national joint replacement registration network of Australia, British national joint registration network, British orthopaedic association network (BOA), Canada orthopaedic association (COA), American Academy of Orthopedic Surgeons network (AAOS), German Institute of Medical Documentation and Information network (DIMDI) for randomized controlled trials (RCTs) on the comparison between THA and THRA for osteoarthritis of the hip joint from inception to November, 2012. References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Six RCTs (10 articles) involving 518 cases of surgery (THA: n=259; THRA: n=259) were identified. The risk of bias of 8 articles was moderate and that of the other 2 articles was low. The results of meta-analysis showed that, compared to THRA, THA brings greater improvements of femoral offset within 2 years after surgery (MD=6.60, 95%CI 5.53 to 7.68, P=0.25). There were no significant differences between the two groups in Merle d’Aubigné Postel, WOMAC score, UCLA score, SF-36 Health Survey Questionnaire, walking speed, step length, walking cadence, postoperative leg length discrepancy, and complication rates. All these conclusions are based on early postoperative results. Conclusion Current evidence shows that, THA brings greater improvements of femoral offset than THRA, and no significant differences between the two groups were found in the other indicators.
Objective To explore the effectiveness and safety of exchange of cerebrospinal fluid in the treatment of subarachnoid hemorrhage （SAH）. Methods Sixty SAH patients diagnosed by CT and lumbarpuncture were randomly assigned into a control group （n =30, received conventional treatment） and a treatment group （n =30, received exchange of cerebrospinal fluid plus conventional treatment）. The main complications and effectiveness between the two groups were compared. SPSS 10.0 was used for statistical analysis. Results Compared with the control group, complications of persistent headache （ P =0.002 and 0. 007 respectively）, cerebral vasospasm （ P =0. 028 ） and hydrocephalus （ P =0. 038 ） were fewer in the treatment group. No significant difference in the incidence of rehaemorrhagia was found between the two groups （P = 1. 000）. Better effectiveness was observed in the treatment group （RR. 3.00, 95% CI 1. 014 to 8. 880, P = 0. 044 ）. Conclusions Exchange of cerebrospinal fluid plus conventional treatment is more effective than conventional treatment alone in the treatment of SAH.
Objective To compare the effects of arthroplasty with that of intenal fixation for displaced femoral neck fractures in the elderly. Methods We searched for all randomized controlled trials and quasi-randomized controlled trials of hip arthroplasty versus internal fixation for displaced femoral neck fractures in the elderly by electronically searching MEDLINE( 1966 to September, 2006),EMbase(1966 to September, 2006), Cochrane Library( Issue 4 2006), CBM( up to September, 2006) and CNKI (September, 2006) and handsearching grey literatures. The quality of the trials was assessed and meta-analyses were conducted using The Cochrane Collaboration’s RevMan 4.2.8 software. The quality of the trials was assessed. And meta-analysis was conducted by using RevMan4.2.8 software. Results A total of 228 papers were retrieved, but only 15 published randomized controlled trials involving a total of 2 254 patients were suitable for inclusion in the review. Based on the meta-analyses, hip arthroplasty showed obvious advantages over internal fixation in terms of the incidences of major complications after 2 years (RR 0.15 ; 95%CI 0.09 to 0.23) and after 5 years (RR 0.18 ; 95%CI 0.11 to 0.30) as well as re-operation rate (RR0.12 ; 95%CI 0.08 to 0.18) after 2 years, and after 5 years (RR0.11 ; 95%CI 0.06 to 0.22), there was an advantage to performing hip asthroplasty. After one year, the mortality was the same in both groups with RR 1.05 and 95%CI 0.89 to 1.23. Conclusion There is an evidence base to support arthroplasty as a treatment for displaced femoral neck fractures in the elderly. Arthroplasty can not only decrease the rate of re-operation, but can also reduce the incidence of complications, with similar one-year mortality when compared to internal fixation.
目的 探讨人工髋关节置换术后Vancouver B1型股骨假体周围骨折的治疗方法。 方法 2006年4月－2011年2月采用记忆合金抓握式接骨板固定结合自体髂骨植骨治疗6例Vancouver B1型股骨假体周围骨折。其中男2例，女4例；年龄55～78岁，平均68.5岁。6例均为初次行人工关节置换术后6个月～3年，平均18.4个月发生假体周围骨折；骨折至手术时间为3～6 d，平均4.2 d。 结果 术后切口均Ⅰ期愈合，无深静脉血栓形成、肺部感染、肺栓塞等并发症发生。6例均获随访，随访时间13个月～4年，平均28.6个月。X线片示骨折全部愈合，愈合时间12～20周，平均14.8周。末次随访时Harris评分76～93分，平均83.6分；获优3例，良3例。无1例出现接骨板折断、松动，骨折再移位、骨不连、股骨假体松动等并发症。 结论 记忆合金抓握式接骨板结合自体髂骨植骨治疗Vancouver B1型股骨假体周围骨折具有固定可靠、操作简便的特点，可获满意临床疗效。
目的:探讨术后早期康复护理干预对骨盆恶性肿瘤半骨盆切除、组合式半骨盆+全髋关节置换术后的患肢功能的影响。方法：从2004年9月至2007年5月采用半骨盆切除、组合式半骨盆假体+全髋关节置换术治疗骨盆恶性骨肿瘤8例。其中软骨肉瘤4例，平滑肌肉瘤2例，骨肉瘤1例，恶性骨巨细胞瘤1例。外科分期:ⅠB期6例，ⅡB期2例。术后根据肿瘤切除范围、人工假体置换术后稳定性和骨盆髋周动力肌修复后的平衡程度，决定术后患肢体位、患髋活动范围、是否使用髋部支具；同时指导患者分阶段、渐进地进行患肢足踝、膝、髋关节的主被动训练，以及下床负重时间和步态调整。结果：随访10～32个月，平均15月。1例术后16个月死于恶性肿瘤扩散转移，7例存活。术后8个月患肢功能评定:优2例，良6例。ISOLS评分:15～26分，平均19.47分。结论：①对骨盆恶性骨肿瘤患者积极进行术后早期康复护理干预能有效的防止人工髋关节早期脱位；②患肢各关节分阶段有序的主动康复护理训练能提高骨盆和髋周肌肉肌力及其平衡度，对维持术后患者行走和步态的稳定有重要意义。
目的：探讨毒蕈中毒所致中毒性肝炎的临床表现、治疗与预后关系。方法：对3例急性毒蕈中毒患者进行回顾性临床分析。结果：3例患者均出现中毒性肝炎，2例经治疗后好转，1例因多器官功能衰竭死亡。结论：中毒性肝炎如导致多脏器损害，预后差；及早洗胃，彻底清除毒物是救治关键；血浆置换治疗有一定疗效，肝移植是最有效的治疗手段。