In recent years, target temperature management (TTM) has been increasingly applied to cardiac arrest patients, and programs and strategies for TTM are in a constant state of update and refinement. This paper analyzes and proposes relevant strategies from the concept of TTM, its clinical application status for cardiac arrest patients in domestic and international medical institutions, its deficiencies in the clinical practice, and factors affecting the development of TTM, with a view to providing a realistic basis for the development of high-quality TTM in medical institutions.
Objective To study the effectiveness of anterior cruciate l igament (ACL) reconstruction using autologous periosteum wrapping tendon allograft by comparing with using simple tendon allograft. Methods Between March 2008 and November 2008, 68 patients with ACL injury were treated, who were in accordance with the inclusion criteria. They were divided into 2 groups randomly according to different treatment methods: ACL was reconstructed with autologous periosteum wrapping tendon allograft in 31 patients (test group) and with simple tendon allograft (control group) in 37 patients. There was no significant difference in gender, age, disease duration, the cause of injury, and functional score preoperatively between 2 groups (P gt; 0.05). Anatomic single-bundle ACL reconstruction was performed in 2 groups. Results Little exudation at tibial tunnel incision was found in 1 case respectively in both groups at 2 weeks after operation and was cured by dressing change and antibiotics. The other incisions healed by first intention. The patients were followed up 24-29 months (mean, 26 months) in the test group and 24-32 months (mean, 27 months) in the control group. CT showed bone tunnel enlargement in both groups at 2 years after operation, but the rate of the tunnel enlargement was less inthe test group (5/31, 16.1%) than in the control group (14/37, 37.8%), showing significant difference (χ2=3.948, P=0.047). At 2 years after operation, the results of Lachman test and pivot shift test were negative in 23 cases (74.2%) and 25 cases (80.6%) of the test group, and in 26 cases (70.3%) and 30 cases (81.1%) of the control group, respectively. KT-1000 examination showed the displacement of the test group [(1.74 ± 0.88) mm] was less than that of the control group [(2.36 ± 0.83) mm], showing significant difference (t= —2.979, P=0.004). There was no significant difference in Lysholm score, Hospital for Special Surgery (HSS) score, Tegner score, and International Knee Documentation Committee (IKDC) score between 2 groups at 2 years after operation (P gt; 0.05). Conclusion Compared with simple tendon allograft, ACL reconstruction with autologous periosteum wrapping tendon allograft can improve tendon-bone heal ing, and decrease the rate of bone tunnel enlargement, so it has good short-term outcome.
Objective To compare the recovery of proprioception between autograft and allograft for anterior cruciate l igament (ACL) reconstruction. Methods Between January 2008 and January 2010, 40 patients underwent ACL reconstruction with autologous tendon (autograft group, n=20) and allogeneic tendon (allograft group, n=20). No significant difference was found in gender, age, disease duration, and function scores between 2 groups (P gt; 0.05). All the patients underwent the ACL reconstruction with single-bundle technique. The knee range of motion (ROM), International Knee Documentation Committee (IKDC) score, and Lysholm score were measured after operation. The proprioception was assessedby the joint position sense (JPS) at 3 and 12 months postoperatively. The normal knee was used as control. Results Thepatients of 2 groups achieved heal ing of incision by first intention without compl ication of infection or haemarthrosis. Allpatients were followed up 12-18 months (mean, 13.5 months). There were significant differences in knee ROM, IKDC score, and Lysholm score between preoperation and 12 months postoperatively in 2 groups (P lt; 0.05). There was no significant difference in JPS 30°, JPS 60°, and JPS 90° between affected knees and normal knees in autograft group at 3 months postoperatively (P gt; 0.05). No significant difference was found in JPS 30° between affected knees and normal knees in allograft group at 3 months postoperatively (P gt; 0.05); but significant differences were found in JPS 60° and JPS 90° between affected knees and normal knees in allograft group at 3 months postoperatively (P lt; 0.05). There was no significant difference in JPS 30°, JPS 60°, and JPS 90° between affected knees and normal knees in 2 groups at 12 months postoperatively (P gt; 0.05). Significant differences were also found in JPS 60° and JPS 90° between affected knees of 2 groups (P lt; 0.05) at 3 months postoperatively, whereas no significant difference was found in JPS 30° between affected knees of 2 groups (P gt; 0.05). No significant difference was found in JPS 30°, JPS 60°, and JPS 90° between affected knees of 2 groups at 12 months postoperatively (P gt; 0.05). Conclusion Autologous andACL reconstruction is better than allogeneic ACL reconstruction in the recovery of proprioception at early time after surgery.
Objective To evaluate the tendon regeneration after anterior cruciate ligament (ACL) reconstruction with semitendinosus tendon and gracilis tendon autografts by MRI. Methods Between September 2007 and September 2009, 52 patients undergoing ACL reconstructions with semitendinosus tendon and gracilis tendon autografts were enrolled. There were 29 males and 23 females with an average age of 31.6 years (range, 19-42 years). The left knees were involved in 34 cases and the right knees in 18 cases. The injury was caused by traffic accident in 11 cases, by sports in 38 cases, by heavy pound injury in 2 cases, and by other in 1 case. The time between injury and operation was 6 days to 31 months (median, 11.4 months). Joint pain occurred in 19 cases, joint instability in 28 cases, and joint swelling in 5 cases. The physical examination on admission showed thigh amyotrophy in 7 cases (thigh circumference side-to-side difference gt; 1 cm) and limitation of joint motion in 2 cases. The results of floating patella test, Lachman test, pivot shift test, and anterior drawer test were positive in 5, 51, 49, and 52 cases, respectively. The range of motion of knee was (127.77 ± 5.73)°, International Knee Documentation Committee (IKDC) score was 49.50 ± 4.08, and Lysholm score was 52.40 ± 3.45. Of the patients, 23 were accompanied with medial meniscus tear, 6 with lateral meniscus tear, 2 with plica synovialis, and 1 with loose body. Results All incisions healed by first intention. All the patients were followed up 12-18 months (mean, 14.9 months). At 12 months postoperatively, the results of Lachman test and pivot shift test were positive in 1 case, respectively; the results of anterior drawer test were negative in 52 cases. The range of motion of knee was (131.91 ± 1.81)°, Lysholm score was 94.98 ± 2.77, IKDC score was 93.65 ± 2.42; and there were significant differences when compared with the preoperative ones (P lt; 0.05). At 12 months postoperatively, at 90° resisted flexion of the knee, a very distinct fibrous band could be identified on the posteromedial aspect of the knee in 39 cases. MRI showed that both semitendinosus tendon and gracilis tendon regeneration in 10 cases, only semitendinosus tendon regeneration in 29 cases, only gracilis tendon regeneration in 2 cases, and no tendon regeneration in 11 cases. The regeneration rate of the semitendinosus tendon was 75.0% (39/52); the regeneration rate of the gracilis tendon was 23.1% (12/52); and the regeneration rate of the semitendinosus tendon and gracilis tendon was 78.8% (41/52). Conclusion MRI results suggest that some of the semitendinosus tendon and gracilis tendon could regenerate after harvested for ACL reconstruction.
This article introduces the emergent measures and approaches that West China Hospital has taken to ensure the supply of water, electricity, gas and oxygen during the May 12th Wenchuan earthquake.