ObjectiveTo evaluate the safety and effectiveness of one-stage posterior surgery via unilateral musculussacrospinalis iliac flap approach in treatment of lumbosacral tuberculosis.MethodsBetween August 2011 and October 2014, 13 patients with lumbosacral tuberculosis were treated by one-stage posterior reserved posterior ligament complex, lesion debridement, bone graft fusion, and internal fixation via unilateral musculussacrospinalis iliac flap approach. There were 8 males and 5 females, aged from 22 to 57 years, with an average age of 35 years. The disease duration ranged from 2 to 19 months, with an average of 6.7 months. According to the American Spinal Injury Association (ASIA) classification criteria, the patients were graded as grade B in 2 cases, grade C in 4 cases, grade D in 5 cases, and grade E in 2 cases before operation. The preoperative Oswestry disability index (ODI) was 36.4±5.7; the preoperative lumbosacral angle was (20.7±0.7)°; the preoperative erythrocyte sedimentation rate (ESR) was (63.4±8.4) mm/1 h; and the preoperative C-reactive protein (CRP) was (38.8±5.2) mmol/L. The operation time and intraoperative blood loss were recorded. The ODI, ASIA grade, lumbosacral angle, and ESR were recorded at last follow-up. Bridwell criterion was used to judge the interbody fusion.ResultsThe operation time was 150-240 minutes (mean, 190 minutes), and the intraoperative blood loss was 420-850 mL (mean, 610 mL). No major blood vessel, dural sac, nerve root, and lumbosacral plexus injuries occurred during the operation. Delayed wound healing occurred in 3 cases, and primary wound healing achieved in the other patients. No wound infection or sinus formation was found. All 13 patients were followed up 1.5-6.1 years (mean, 2.8 years). During the follow-up period, there was no tubercular symptom, cerebrospinal fluid leakage, loosening and rupture of internal fixator; and no complications such as retrograde ejaculation and erectile dysfunction occurred in 8 male patients. Solid spinal fusion obtained in all patients with the mean fusion time of 6.4 months (range, 4.2-9.9 months); and all iliac osteotomies healed. At last follow-up, the ODI was 7.2±3.5, the lumbosacral angle was (31.2±0.5)°, and ESR was (9.8±2.5) mm/1 h, all of which improved significantly when compared with pre-operative ones (P<0.05). The patients were classified as grade D in 2 cases and grade E in 11 cases, which improved significantly when compared with preoperative ones (Z=–3.168, P=0.002).ConclusionOne-stage posterior surgery via unilateral musculussacrospinalis iliac flap approach in treatment of lumbosacral tuberculosis is effective and safe.
ObjectiveTo evaluate the effectiveness of proximal femoral nail anti-rotation (PFNA) in treatment of high plane intertrochanteric femur fractures.MethodsA retrospective analysis was performed on 33 patients who underwent closed reduction and PFNA fixation for high plane intertrochanteric femur fracture between January 2016 and June 2019. There were 12 males and 21 females with an average age of 75.1 years (mean, 47-89 years). The fractures were caused by falling from height in 21 cases, by traffic accident in 7 cases, and by other injuries in 5 cases. Fractures were classified as type A in 14 cases and type B in 19 cases according to self-defined fracture classification criteria; and as type 31-A1.2 in 14 cases and as type 31-A2.2 in 19 cases according to AO/Orthopedic Trauma Association (AO/OTA) classification criteria. The time from injury to operation was 2-5 days (mean, 2.7 days). The operation time, intraoperative blood loss, hospital stay, fracture reduction quality, fracture healing time, internal fixation failure, and Parker-Palmer score were recorded.ResultsThe operation time was 40-75 minutes (mean, 55 minutes). The intraoperative blood loss was 50-150 mL (mean, 64 mL). The hospital stay was 5-15 days (mean, 8.7 days). All incisions healed by first intention. Twenty-eight patients were followed up 12-18 months with an average of 13.6 months. The fracture reduction quality was rated as excellent in 9 cases (32.1%), good in 17 cases (60.7%), and poor in 2 cases (7.1%) by Chang’s criteria. Parker-Palmer score was 6-9 (mean, 7.9) at last follow-up.ConclusionHigh plane intertrochanteric femur fracture is a special type of intertrochanteric fracture, which can be diagnosed by imaging examination. PFNA fixation can achieve satisfactory results and prevent the occurrence of internal fixation failure effectively.
Objective To clarify the views of healthcare providers on the current vascular access shared decision-making model under the daytime chemotherapy mode, and to determine improvement measures to promote the conventional implementation of the daytime chemotherapy vascular access shared decision-making model. Methods Based on the SWOT model, an interview outline was developed. Using purposive sampling method, 7 doctors and 6 intravenous therapy nurses working at Tianjin Medical University Cancer Institute & Hospital from April to June 2023 were selected for semi-structured interviews, and content analysis method was used for data analysis. Results Four themes were extracted for internal advantages: alleviating the pressure of diagnosis and treatment and decision-making for doctors, ability and willingness of specialized intravenous therapy nurses to implement, promoting the rational selection of vascular pathways, enhancing the recognition of vascular pathways in daytime chemotherapy patients, and enhancing communication stickiness between nurses and patients. Four themes were extracted for internal weaknesses: increased workload, impractical decision support tools, unsmooth implementation processes, and incomplete informatization. Three themes were extracted for external opportunities: national policy support, willingness of daytime chemotherapy patients to participate in decision-making, and sufficient evidence-based evidence. Three themes were extracted for external threats: poor communication between healthcare providers under daytime chemotherapy mode, cognitive differences related to intravenous therapy among healthcare providers, and insufficient confidence in nurse leadership. Conclusions The vascular pathway shared decision-making led by intravenous therapy nurses has certain advantages in the daytime chemotherapy mode. In the future, we should seize existing opportunities, avoid our own weaknesses, face external threats, and develop a standardized vascular access shared decision-making model led by intravenous therapy nurses under the daytime chemotherapy mode, promoting the best evidence-based practice for vascular access decision-making during daytime chemotherapy.
目的 探讨静脉留置针封管用肝素诱导的血小板减少症（HIT）的临床特点。 方法 分析2010年1月－2011年12月，在1 215例静脉留置针肝素封管患者中发生的14例HIT患者的临床表现，血小板（PLT）、HIT抗体的变化，氯吡格雷、阿加曲班、地塞米松等治疗的结果。 结果 1 215例患者中：发生HIT 14例，发生率1.15%；HIT并血栓形成综合征4例，发生率0.33%。14例HIT患者中：经典型12例，占85.7%。出血7例，发生率50.0%，其中1级、2级出血发生率分别为42.9%（6/14）、7.1%（1/14），分别占出血的85.7%（6/7）、14.3%（1/7）。血栓形成4例，发生率28.6%，其中静脉血栓3例，占血栓形成的75.0%。14例均发生于肝素封管后第1～14天，其中第6～7天8例，占57.1%。PLT降低到最低值的时间为肝素封管后2～10 d内，其中2～5 d内13例，占92.9%。PLT降低的最低值为（1.81～101）×109/L，其中PLT（20～70）×109/L12例，占85.7%；PLT降至最低时下降的比值为51.1%～90.1%，其中50%～80%10例、占71.4%。1例至28 d死亡时血小板没有恢复至肝素封管前水平，其余13例患者PLT减少持续时间5～13 d，其中5～10 d 10例，占76.9%。14例（100%）HIT患者HIT抗体阳性，其中13例（92.9%）在PLT开始减少时即阳性，1例在PLT减少2周后呈阳性。14例HIT患者中12例（85.8%）痊愈，1例（7.1%）脑血栓后遗症，1例（7.1%）死于急性肺栓塞。 结论 静脉留置针封管用肝素可导致HIT，PLT减少及血栓、HIT抗体是诊断的可靠依据。及时停用肝素，必要时抗凝、抗PLT、类固醇激素治疗效果好，部分患者进展快，死亡率高。
Accurately evaluating the local biomechanics of arterial wall is crucial for diagnosing and treating arterial diseases. Indentation measurement can be used to evaluate the local mechanical properties of the artery. However, the effects of the indenter’s geometric structure and the analysis theory on measurement results remain uncertain. In this paper, four kinds of indenters were used to measure the pulmonary aorta, the proximal thoracic aorta and the distal thoracic aorta in pigs, and the arterial elastic modulus was calculated by Sneddon and Sirghi theory to explore the influence of the indenter geometry and analysis theory on the measured elastic modulus. The results showed that the arterial elastic modulus measured by cylindrical indenter was lower than that measured by spherical indenter. In addition, compared with the calculated results of Sirghi theory, the Sneddon theory, which does not take adhesion forces in account, resulted in slightly larger elastic modulus values. In conclusion, this study provides parametric support for effective measurement of arterial local mechanical properties by millimeter indentation technique.