Objective To analyze risk factors for pulmonary vein obstruction(PVO) after cardiac-type total anomalous pulmonary venous connection (TAPVC) repair. Methods A retrospective analysis of clinical and echocardiography data of 169 patients with cardiac-type TAPVC who underwent surgery at our center from April 2009 to April 2019 was conducted. Kaplan-Meier curves were used to assess the risk of postoperative pulmonary vein obstruction. Logistic regression analysis was used to identify relevant risk factor for postoperative pulmonary vein obstruction. ResultsThe median age at surgery was 89 days, and the median weight at surgery was 4.8 kg. Post-repair pulmonary vein obstruction occurred in 8.9% (15/169) of cases. The subtype of coronary sinus/right atrium did not significantly affect the risk of PPVO (P=0.33). Relevant risk factors included preoperative pulmonary vein obstruction (P<0.001) and the ratio of left ventricular end-diastolic diameter to right ventricular diameter (P=0.025). ConclusionSurgical repair of cardiac-type TAPVC has achieved satisfactory results in our center, but the long-term risk of obstruction should not be underestimated. An increased ratio of left ventricular end-diastolic diameter to right ventricular diameter and preoperative pulmonary vein obstruction were associated with post-repair pulmonary vein obstruction.
ObjectiveTo investigate the effectiveness of proximal femoral nail anti-rotation (PFNA) and cerclage fixation for complicated femoral subtrochanteric fractures.MethodsA clinical data of 74 patients with complicated femoral subtrochanteric fractures, who were admitted between March 2016 and March 2019 and met the criteria, was retrospectively analyzed. Among them, 39 patients were treated with limited open reduction and PFNA combined with cerclage fixation (observation group) and 35 patients were treated with closed reduction and PFNA fixation (control group). There was no significant difference in gender, age, cause of injury, side and type of fracture, and the time from injury to operation (P>0.05). The ratio of postoperative hemoglobin (1, 3, and 5 days) to the preoperative hemoglobin, the operation time, the first weight-bearing time after operation, and the hospital stay were recorded. X-ray films were taken to observe fracture healing in the two groups and bone resorption around the cerclage in the observation group, and the fracture healing time was recorded. Hip function was evaluated by Harris scoring. ResultsThe operation time of the observation group was significantly longer than that of the control group (P<0.05), but the first weight-bearing time and hospital stay were significantly shorter (P<0.05). All patients were followed up 12 months. There was no significant difference in the ratios of post- to pre-operative hemoglobin (1, 3, and 5 days) between the two groups (P>0.05). X-ray film reexamination showed that the fractures of the two groups healed smoothly, and the fracture healing time of the observation group was significantly shorter than that of the control group (t=−12.989, P=0.000). No bone resorption around the cerclage occurred in the observation group. The Harris scores of the observation group were better than those of the control group at 7 days and 1, 2, and 3 months after operation (P<0.05), and there was no significant difference between the two groups at 6 months after operation (t=1.329, P=0.180).ConclusionCompared with PFNA fixation, PFNA combined with cerclage fixation for the complicated femoral subtrochanteric fractures has a shorter operation time, and can obtain immediate stability after fixation, which can meet the needs of patients for early functional exercise.