目的:探讨股骨近端解剖型钢板治疗股骨粗隆间骨折的临床疗效。方法:自2005年1月至2009年1月,采用切开复位,股骨近端解剖型钢板治疗股骨粗隆间骨折46 例。结果: 术后随访6个月～3年,平均18个月,所有病例均在术后3～55个月获得骨性愈合,髋关节功能根据Harris评分标准进行评定,优32 例,良4 例。结论: 股骨近端解剖型钢板适用于治疗大多数类型的股骨粗隆间骨折,能达到良好的骨折复位和坚强的固定,促进关节早期功能锻炼,骨折愈合率高,是治疗股骨粗隆间骨折的理想选择。
【摘要】 目的 探讨介入治疗股骨头无菌性坏死（ANFH）的疗效。 方法 纳入1996-2009年间确诊的ANFH患者15例，采用经外周动脉穿刺插管的方法，经血管造影明确供血血管的位置，经导管向其内灌注扩张血管药、舒筋活血中药和溶栓药物，以改善股骨头供血状况；并追踪随访1~3年，根据杨白明评定标准从疼痛、功能、X线片3个方面进行判定，观察其临床症状的改善。 结果 Ⅰ~Ⅲ期ANFH患者的临床症状减轻，甚至消失；痊愈50%，显效25%，有效15%。 结论 介入治疗Ⅰ~Ⅲ期ANFH的疗效显著。【Abstract】 Objective To investigate the curative effects of interventional therapy in aseptic necrosis of the femoral head (ANFH). Methods Fifteen patients with ANFH diagnosed from 1996 to 2009 were respectively analyzed. With peripheral arterial puncture methods from peripheral artery, the feeding artery was clarified by using angiography and infused the angiectasia agent, traditional Chinese medicine which could distend blood vessel and thrombolysin to improve blood supply of femoral head. All patients were followed up for one to three years to observe improvement of clinical symptoms. Results Clinical symptom of ANFH in stage Ⅰ-Ⅲ were alleviated or even disappeared, among whom 50% were removed, 25% were markedly effective, and 15% were effective. Conclusion Interventional therapy has significant curative effect in treating ANFH, especially for stage Ⅰ-Ⅲ.
ObjectiveTo explore the biological mechanisms of tibial transverse transport (TTT) for promoting microcirculation and tissue repair.MethodsThe clinical application and animal model study of TTT were reviewed.ResultsThe possible biological mechanisms of TTT for promoting microvascular network formation and tissue repair: ① Tibial corticotomy reduces intramedullary pressure and improves microcirculation; ② Tension stress stimulation promotes microvascular regeneration and accelerates the formation of new “transcortical vessels” network; ③ Systemic mobilization of stem cells, mediating local inflammation, etc.ConclusionTTT has been clinically proven to be effective for the management of lower limb ischemia and diabetic foot ulcers. The surgical procedure is relatively easy with little adverse effects on bone structures. The TTT has good application prospects despite the biological mechanisms of which still need further exploration.
Objective To summarize the efficacy and clinical experiences of emergent coronary artery bypass grafting (E-CABG) in patients with acute myocardial infarction (AMI) and to discuss the operative opportunity and procedures. Methods We retrospectively analyzed the clinical data of 21 patients with AMI undergoing E-CABG in Sun Yatsen Cardiovascular Disease Hospital between June 1999 and December 2009. Among the patients, there were 14 males and 7 females with their age ranged from 24 to 81 years (63.9±12.4 years). Six patients were operated within 6 hours after the onset of AMI, 7 patients were operated from 6 hours to 3 days after the onset of AMI, and 8 patients were operated from 3 days to 30 days after the onset of AMI. Eight patients had the cardiogenic shock after AMI, one had rupture of ventricular septum and cardiogenic shock, two had rupture of coronary artery after percutaneous transluminal coronary angioplasty, eight had unstable angina and frequent ventricular arrhythmia, one had ventricular fibrillation and cardiac arrest, and one had cardiac trauma. Ten patients were treated with intraaortic balloon pump (IABP). Conventional CABG was performed for 12 patients, off-pump CABG for 5 patients, and on-pump-beating CABG for 4 patients. Results Five patients died after E-CABG with a mortality of 23.8% which was obviously higher than the overall CABG mortality (23.8% vs. 3.1%, χ2=21.184, P＜0.05). There were respectively 2, 2 and 1 deaths with a mortality of 33.3%, 28.6% and 12.5% respectively for operations within 6 hours, 6 hours to 3 days and 3 to 30 days after the onset of AMI. The mortality of those patients who were operated within 3 days after AMI was obviously lower (P＜0.05). The primary causes of death were low cardiac output syndrome, perioperative acute myocardial infarction after CABG and sapremia. There was one death each for patients operated with off-pump and on-pump-beating CABG. Sixteeen patients were discharged from the hospital. The follow-up was from 6 months to 10 years. There were 6 late deaths among which 5 died of cardiac failure accompanied by pulmonary infection, one died of noncardiac factor. Ten patients survived at present, and the quality of life among 5 patients was unsatisfactory. Conclusion The mortality of E-CABG is obviously higher in patients operated within 3 days of AMI. With the support of IABP, if the operation can be carried out 3 days after the onset of AMI, the surgical success rate will be greatly improved by adopting proper offpump and onpumpbeating procedures.
Abstract： Objective To compare individualized protamine with protamine based on weight in terms of postoperative bleeding and blood transfusion dose, in order to reduce postoperative bleeding complications. Methods Forty adult patients scheduled to elective open heart surgery under cardiopulmonary bypass （CPB） were randomly divided into two groups. For patients in the experimental group, we gave them protamine based on heparinprotamine titration result, while patients in the control group received the same amount of protamine as the heparin administered before operation. Pleural drainage and required transfusion were recorded at 1, 2 and 24 hours after surgery. Results Protamine dose given to the experimental group was significantly higher than the control group (Plt;0.05), while pleural drainage was significantly lower at 1 h(180±83 ml vs. 285±156 ml,P=0.012), 2 h (74±31 ml vs. 114±44 ml，P=0.002), and 24 h (465±167 ml vs. 645±207 ml，P=0.004) than that in the control group after surgery, and the required red blood cell suspension was also significantly lower than the control group (0.15±0.27 U vs.0.80±0.96 U,P=0.018). Conclusion Compared with protamine dose based on heparin administered before CPB, individualized protamine based on titration can reduce postoperative pleural drainage (blood loss) and red blood cell suspension requirement.
Abstract: Objective To summarize the clinical experience of 13 patients of tricuspid valve replacement and to investigate the indication and method. Methods From January 1994 to December 2005, the clinical datum of the thirteen patients suffering from tricuspid valve disease were reviewed, including rheumatic heart disease 6 cases, congenital heart disease 3 cases, infective endocarditis 3 cases and right ventricular tumor 1 case. All the cases underwent tricuspid valve replacement. Results Two reoperative rheumatic heart disease patients died early after operation and their cardiac function was New York Heart Association (NYHA) class Ⅳ before operation. The followup interval was 3 months to 12 years in 11 cases. There were 2 late death, one died of recurrence of infective endocarditis, and another died of the recurrence of the tumor. One Ebstein anomaly case’s NYHA functional recovered to class Ⅲ, eight cases’s recovered to NYHA classⅠ-Ⅱ. Conclusion The tricuspid valve disease may be a secondary lesion from many causes. Indication of tricuspid valve replacement must be strictly commanded. The late results of tricuspid valve mechanical prostheses replacement is satisfactory.
Objective To investigate whether combining use of platelet-rich plasma (PRP) and decalcified bone matrix (DBM) has synergistic action on promoting bone consol idation and heal ing. Methods Forty male New Zealand rabbits (weighing 2.2-2.8 kg) were randomly divided into 4 groups (n=10). The whole blood was extracted from the central aural artery and PRP was prepared with the Landesberg’s method. An 1 cm-defect was made below the tibiofibular joint of the lefttibia through osteotomy. In group A, defect was repaired by distraction osteogenesis (1 cm); in group B, defect was repaired with 0.5 cm DBM and then by distraction osteogenesis (0.5 cm); in group C, defect was repaired by distraction osteogenesis (1 cm) and local injection of 1 mL PRP; in group D, defect was repaired by 0.5 cm DBM combined with 1 mL PRP and then by distraction osteogenesis (0.5 cm). Then lengthening started at 7 days after operation, at a rate of 1 mm/day and 0.5 mm every time for 10 days (groups A and C) or for 5 days (groups B and D). After the lengthening, the consolidation was performed. The X-ray films were taken at 0, 12, 17, 27, and 37 days after operation. At 37 days after operation, the tibial specimens were harvested for Micro-CT scanning, three-dimensional reconstruction and biomechanical test. Results The X-ray films showed that new bone formation in groups B and C was obviously better than that in groups A and D at 37 days. The bone mineral density (BMD), bone mineral content (BMC), and bone volume fraction (BVF) of groups B and C were significantly higher than those of groups A and D (P lt; 0.05); the BMD and BMC of group C were significantly higher than those of group B (P lt; 0.05); the BVF had no significant difference between groups B and C (P gt; 0.05). There was no significant difference in BMD, BMC, and BVF between groups A and D (P gt; 0.05). The trabecula number (Tb.N) of group C was significantly more than that of other groups (P lt; 0.05), and the trabecula spacing (Tb.Sp) of group C was significantly smaller than that of other groups (P lt; 0.05), but no significant differencewas found among other groups (P gt; 0.05). There was no significant difference in the trabecula thickness among 4 groups (P gt; 0.05). The ultimate angular displacement had no significant difference among 4 groups (P gt; 0.05). The maximum torque of groups B and C was significantly higher than that of groups A and D (P lt; 0.05); the maximum torque of group C was significantly higher than that of group B (P lt; 0.05); no significant difference was found between groups A and D (P gt; 0.05). Conclusion In the rabbit bone defect/lengthening model, local injection of PRP can enhance bone consol idation effectively during consol idation phase. In normal distraction rate, DBM can promote bone consol idation during distraction osteogenesis. In the early stage of distraction osteogenesis, combining use of DBM and PRP can not further promote bone consolidation and healing.
Objective To investigate the effect of the neuromuscular pedicle transplantation in prevention against atrophy in the denervated muscle. Methods Fortyeight SD rats were used to establish the right side tibialis anterior muscle denervation model. The long peroneal muscle neuromuscular pedicle was made as a treatment in 12 rats (Group A); the nerve shaft embedding was used in 12 rats (Group B); no treatment was used in 12 rats(Group C); the remaining 12 rats were used as normal controls (Group D). The gait analysis, electromyogram，muscle wet weight, and muscle fiber crosssectional area were used to determine and compare the effect of the operation at 6 and 12 weeks postoperatively. ResultsAt 6 weeks postoperatively, the parameters tested in Group A about the gait analysis (peroneal function index, PFI, －47.20±12.30), electromyogram, muscle wet weight (0.384 0±0.024 6 g)and muscle fiber cross-sectional area (1 040.98±120.54 μm2) were significantly better than those in Group C (PFI, -114.40±14.84; muscle wet weight, 0.173 0±0.019 1 g; muscle fiber cross-sectional area, 585.08±182.93 μm2,Plt;0.05), and the final two parameters were significantly better than those in Group B (0.294 0±0.056 4 g,763.92±82.68 μm2,Plt;0.05). At 12 weeks postoperatively, the musclefiber crosssectional area in Group A(1 360.10±261.45 μm2) had no significant difference from that in Group D (1 544.57±266.92 μm2，Pgt;0.05)，and most of the parameters tested in Group A were better than those in Groups B and C. Conclusion Neuromuscular pedicle transplantation has an excellent effect in prevention against atrophy in the denervated muscle, and the effect of neuromuscular pedicle transplantation is better than that of the nerve shaft embedding.
Objective To evaluate the efficacy and safety of Shengmai injection for hypoxic-ischemic encephalopathy (HIE). Methods We searched MEDLINE (1966 to February 2007), EMBASE (1980 to February 2007), CBM (1978 to 2006), CNKI (1979 to February 2007), VIP (1989 to February 2007), and handsearched five Journals on Pediatrics. We evaluated features of quality of included studies, including randomization, blinding, allocation concealment and loss of follow-up. Meta-analyses were performed using The Cochrane Collaboration’s RevMan 4.2.8. Results Seven randomized controlled trials were included. The cure rate on day 5 in the Shengmai injection group was higher than in the control group (RR 1.55, 95%CI 1.25 to 1.93), but this rate was similar on day 10 (RR 0.74, 95%CI 0.43 to 1.29). No significant difference in cure rate was noted between the Shengmai injection group and naloxone group (RR 0.88, 95%CI 0.53 to 1.46). No significant differences were observed in mortality (RR0.44, 95%CI 0.16 to 1.19) and mutilation rate (RR 0.58, 95%CI 0.21 to 1.56) between the Shengmai injection group and the control group. For those babies suffering from HIE combined with myocardial damage, Shengmai injection could speed up the recovery of ECG (WMD=–2.02, 95%CI –2.76 to –1.28) and myocardial enzymogram (CK-MB: WMD= –4.78, 95%CI –6.77 to –2.79; CK-BB: WMD=–2.68, 95%CI –4.58 to –0.78). Significant differences in NBNA score were noted between the Shengmai injection group and the control group on day 5 (WMD=4.05, 95%CI 2.47 to 5.63) and day 10 (WMD=3.50, 95%CI 2.26 to 4.74). No fatal side effects were reported. Conclusions Shengmai injection has certain therapeutic values in treating HIE. Shengmai injection can speed up the recovery ECG, CK-BM and CK-BB of HIE patients, especially in those who have myocardial damage. Shengmai injection can also improve the NBNA score. However, because of the low statistical power and high risks for selection bias, performance bias and measurement bias in the included trials, these conclusions need to be interpreted cautiously.
Objective To establish a cooperative decision-making model of county-level public hospitals, so as to freely select the best partner in different decision-making units and promote the optimal allocation of medical resources. Methods The input and output data of 10 adjacent county-level public hospitals in Henan province from 2017 to 2019 was selected. Based on the traditional data envelopment analysis (DEA) model, a generalized fuzzy DEA cooperative decision-making model with better applicability to fuzzy indicators and optional decision-making units was constructed. By inputting index information such as total number of employees, number of beds, annual outpatient and emergency volume, number of discharged patients, total income and hospital grade evaluation, the cooperation efficiency intervals of different hospitals were calculated to scientifically select the best partner in different decision-making units.Results After substituting the data of 10 county-level public hospitals in H1-H10 into the model, taking H2 hospital as an example to make cooperative decision, among the four hospitals in H1, H2, H7 and H10 of the same scale, under optimistic circumstances, the best partner of H2 hospital was H7 hospital, and the cooperation efficiency value was 1.97; in a pessimistic situation, the best partner of H2 hospital was H10 hospital, and the cooperation efficiency value was 0.98. The model had good applicability in the cooperative decision-making of county-level public hospitals. Conclusion The generalized fuzzy DEA model can better evaluate the cooperative decision-making analysis between county-level public hospitals.