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Objective:To evaluate the efficacy and safety of ultrasound-guided high intensity focused ultrasound(HIFU)on pain intensity,pain sensation and overall survival in patients with advanced pancreatic cancer. Methods:Clinical data of advanced pancreatic cancer patients treated by HIFU were collected from the patients enrolled during August 2020 to September 2022 at the second department for oncology of Yueyang Hospital of Integrated Chinese and Western Medicine affiliated to Shanghai University of Traditional Chinese Medicine.In this study,SPSS 26.0 software was used for the statistical analysis of NRS score and BPI score.The Kaplan-Meier survival analysis method was applied to calculate the median overall survival(OS)and then the survival curve was drawn.At the same time,the incidence of related adverse reactions during and after HIFU treatment was counted. Results:(1)Among the 45 patients,30 patients received HIFU combined with chemotherapy,and the other 15 patients only received HIFU.(2)Among the 45 patients,32 patients had pain relief after HIFU treatment,and the NRS score kept decreased across 1 week,2 weeks,3 weeks and 1 month after HIFU treatment(P<0.05).The pain sensation score of BPI scale also decreased correspondingly,and the difference was statistically significant(P<0.05).(3)The median OS of 45 patients was 11.1 months(95%Cl:9.30-1 2.90),of which 30 patients treated with HIFU combined chemotherapy had a median OS of 12.4 months(95%Cl:9.1 8-15.62),and 15 patients treated with HIFU only had a median OS of 4.6 months(95%Cl:1.11-8.10).(4)No serious adverse events were observed in all patients during and after HIFU treatment.Only 5 patients had asymptomatic mild elevation of blood amylase,and the incidence of mild adverse reactions was 11.1%. Conclusion:HIFU can effectively relieve pain and prolong the median survival time in patients with advanced pancreatic cancer.
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Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.
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Objective:To investigate the efficacy and safety of the "frame and buttress" fixation in the treatment of acetabular quadrilateral fractures.Methods:A total of 26 patients with acetabular quadrilateral fractures treated with the "Frame and buttress" fixation strategy (reconstructing frame and providing buttress for quadrilateral surface) from January 2017 to January 2021 were retrospectively analyzed in the Department of Orthopaedics, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, including 17 males and 9 females, aged 47.7±16.5 years, (range, 25-71 years). There were 13 cases from car accidents, 8 cases from falls, and 5 cases from heavy objects. Quadrilateral fractures were classified according to whether the anterior column (A) and posterior column (P) of the acetabulum were fractured and whether the quadrilateral plate (Q) was partially (1) or completely (2) separated from the two columns. Among these cases, there were 5 cases of type AQ1, 1 case of type AQ2, 1 case of type PQ2, 14 cases of type APQ1 and 5 cases of type APQ2. The "frame and buttress" fixation strategy was used to perform open reduction and internal fixation. The Matta scale was used to assess the quality of resurfacing based on pelvic radiographs, and the Matta modified Merle d'Aubigne and Postel scores were referenced to evaluate hip function.Results:All the 26 patients successfully completed the operation, the operation time was 88.1±57.8 min (range, 90-320 min), the intraoperative bleeding was 753.8±309.5 ml (range, 400-1 400 ml). There were 14 cases of anatomical reduction, 8 cases of satisfactory reduction and 4 cases of unsatisfactory reduction with an excellent rate of 85% (22/26), the excellence rate was 85% (22/26). All patients were followed up for 16.3±4.3 months (range, 12-24 months). The hip function score after operation was higher than that before operation, and the difference was statistically significant ( F=19.80, P<0.001). The hip function score was 13.1±2.2 at 3 months postoperatively, increased to 15.9±2.3 at 6 months postoperatively, and increased to 16.6±1.9 at the last follow-up, with a statistically significant difference ( P<0.001). After operation, 5 patients showed symptoms of lateral femoral cutaneous nerve injury such as hypoesthesia and numbness in the anterolateral thigh. During the follow-up, there was no ectopic ossification, traumatic arthritis, necrosis of the femoral head and central dislocation of the femoral head. Conclusion:The "frame and buttress" fixation strategy based on quadrilateral fracture typing for acetabular quadrilateral fracture open reduction internal fixation provides strong fixation, satisfactory reduction quality, and facilitates joint function recovery after operation.
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Accurate classification of the acetabular injuries and appropriate treatment plan are great challenges for orthopedic surgeons because of the irregular anatomical structure of the acetabulum and aggregation of important vessels and nerves around it. Letournel-Judet classification system has been widely applied to classify acetabular fractures. However, there are several limitations, including incomplete inclusion of fracture types, difficulty in understanding and insufficient guidance for surgical treatment, etc. Serious complications such as traumatic arthritis are common due to wrong classification and diagnosis and improper selection of surgical strategy, which brings a heavy burden to the society and families. Three-column classification, based on anatomic characteristics, has advantages of containing more fracture types and being easy to understand, etc. To solve the problems existing in the diagnosis and treatment process based on Letournel-Judet classification, achieve accurate diagnosis and treatment of patients with acetabular fractures, and obtain satisfactory prognosis, the Orthopedic Trauma Emergency Center of Third Hospital of Hebei Medical University and the Trauma Orthopedic Branch of the Chinese Orthopedic Association organized experts from relevant fields to formulate the Expert consensus on the accurate diagnosis and treatment of acetabular fractures based on three-column classification ( version 2023) in terms of principles of evidence-based medicine. Based on the three-column classification, 15 recommendations were proposed, covering the diagnosis, treatment, complication prevention and management, etc, so as to provide reference for accurate diagnosis and treatment of acetabular fractures.
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Objective:To evaluate the efficacy of infra-acetabular screw placement assisted by orthopedic navigation robot in the treatment of acetabular fractures.Methods:The data of 34 patients who were treated and followed up from September 2021 to September 2022 were retrospectively analyzed. According to the fixation method, the patients were divided into the robot group (robot assisted placement of infra-acetabular screws) and the control group (placement of the pubis-ischium plate manually). There were 16 patients in the robot group, 7 males and 9 females, aged 57.00±6.00 years (range, 51-70 years). According to Letournel classification, there were 8 cases of both-column fractures, 4 cases of anterior column and posterior hemitransverse fractures, and 4 cases of T-shaped fractures. There were 18 cases in the control group, 8 males and 10 females, aged 54.22±8.95 years (range, 38-69 years). According to Letournel classification, there were 10 cases of both-column fractures, 6 cases of anterior column and posterior hemitransverse fractures, and 2 cases of T-shaped fractures. The intraoperative fluoroscopy times, total operation time, exposure time and screw placement (plate) time, blood loss, Matta evaluation, Majeed score, and screw placement accuracy rate (the degree of screw cutting-out was evaluated according to Lonstein criteria) were compared between the two groups.Results:All patients were followed up for 12.21±3.62 months (range, 6-17 months). In the robot group, the fluoroscopy frequency was 9.69±0.95 times (range, 8-11 times), the screw placement time was 34.32±5.28 min (range, 21-45 min), and the blood loss was 461.88±228.71 ml (range, 200-800 ml). The control group was 10.11±1.41 times (range, 7-13 times), 42.89±4.38 min (range, 36-55 min), 674.44±220.65 ml (range, 420-1,100 ml), respectively. There were significant differences in screw (plate) placement time ( t=5.18, P<0.001) and blood loss ( t=2.76, P<0.001). The accuracy of robot screw placement was 100%. According to Lonstein evaluation, there were 14 cases of grade 0 (87.5%, 14/16) and 2 cases of grade I (12.5%, 2/16). At 30 days of follow-up, all patients had good fracture ends and no internal fixation failure occurred. One week after surgery, the results of Matta evaluation in robot group were excellent in 11 cases, good in 3 cases, and poor in 2 cases, with an excellent and good rate of 87.5%. In the control group, 11 cases were excellent, 4 cases were good, and 3 cases were poor, with an excellent and good rate of 83.3%. There was no significant difference in the excellent and good rate of Matta evaluation between the two groups (χ 2=0.23, P=0.892). At last follow-up, the Majeed score of robot group was 87.81±8.82 (range, 71-98), including excellent in 10 cases, good in 5 cases, and fair in 1 case. The score of the control group was 86.22±6.85 (range, 70-95), including 12 cases of excellent, 4 of good, and 2 of fair. There was no significant difference in Majeed score between the two groups ( t=0.59, P=0.551). No complications related to the use of robot-assisted navigation or plate fixation were observed in both groups. Conclusion:Through the navigation planning and assistance of the robot, the infra-acetabular screws can be accurately and safely placed, which avoids the shortcomings of excessive exposure and bleeding during the application of the pubis-ischium plate, the outcome was similar to that of plate treatment.
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Objective:To summarize the clinical characteristics and efficacy of hemorrhage resulted from cortical venous infarction with seizure as the first symptom after craniotomy.Methods:Eleven patients with hemorrhage resulted from cortical venous infarction with seizure as the first symptom after craniotomy admitted to Neurosurgical Center, 988 th Hospital of PLA Joint Logistic Support Force from June 2011 to September 2019 were chosen in our study; primary diseases included meningioma in 7 patients, contusion and laceration of frontal lobe in 2, hypertensive cerebral hemorrhage in 1, and obsessive-compulsive disorder in 1 patient. Epilepsy was the first symptom after craniotomy. Clinical characteristics and efficacy of these patients were analyzed retrospectively; seizure control efficacy was evaluated by Engel grading. Results:First seizure occurred 4 h-7 d after craniotomy in these 11 patients, including 2 with focal sensory retention seizure, 3 with focal bilateral tonic-clonic seizure, and 6 with general tonic-clonic seizure. Follow-up cranial CT revealed hematoma in surgical region, adjacent cortex or subcortex in 9 patients (hematoma volume: 15-50 mL); emergency craniotomy (hematoma clearance) and decompressive craniectomy was performed in 5 patients; only emergency craniotomy (hematoma clearance) was performed in 3 patients; conservative treatment was performed in 1 patient. A small amount of diffuse bleeding with severe cerebral edema in the surgical region appeared in 2 patients, and the transient limb paralysis gradually recovered after 2 months of conservative treatment. Follow-up was performed for (4.5±1.7) years ([2.3-7.0] years). During the last follow-up, 4 patients were normal, 5 patients had mild to moderate hemiplegia, 1 had mild decreased vision in the right eye, and 1 had long-term coma. Epileptic control efficacy analysis indicated that 8 had Engel grading I and 3 grading II.Conclusion:Complete removal of hematoma and inactivated brain tissues can effectively control seizures and rebleeding in patients with hemorrhage resulted from cortical venous infarction.
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Objective:To explore the safety and efficacy of the minimally invasive treatment of unstable pelvic fractures with the blunt head technique of Kirschner wire and 3D-printed external template technique.Methods:A retrospective study was conducted of the clinical data of 21 patients with unstable pelvic fracture who had undergone minimally invasive treatment at Department of Orthopaedics, Union Hospital from May 2016 to July 2018 using 3D-printed external templates and the blunt head technique of Kirschner wire. There were 7 males and 14 females with an age of 43.6 years (from 19 to 65 years). According to the Tile classification, there were 3 cases of B1, 7 ones of B2, 6 ones of C1 and 5 ones of C2. The intraoperative fluoroscopy, operation time, postoperative fracture reduction and functional recovery of the pelvis at the last follow-up were recorded.Results:The 21 patients were followed up for an average of 16.3 months (from 12 to 24 months). A total of 33 wires were inserted in the 21 patients, including 15 S 1 ones and 18 S 2 ones. The intraoperative fluoroscopy ranged from 13 to 27 times, averaging 21.8 times. The operation time ranged from 65 to 130 min, averaging 88.6 min. The anterior subcutaneous internal fixation was used to fix the anterior ring in 9 patients. No vascular injury occurred during the operation. By the Matta criteria, the postoperative fracture reduction was assessed as excellent in 14 cases, good in 5, and fair in 2, giving an excellent to good rate of 90.5% (19/21). By the Majeed scoring system, the pelvic function at the last follow-up was assessed as excellent in 10 cases, good in 8, and fair in 3, giving an excellent to good rate of 85.7% (18/21). Lateral femoral cutaneous nerve injury occurred in 2 patients but was recovered by the 3-month follow-up. No other complications were follwed up. Conclusion:The minimally invasive treatment of unstable pelvic fractures with the blunt head technique of Kirschner wire assissted by 3D-printed external templates is safe and effective, showing advatages of reduced fluoroscopic frequency and operation time.
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Objective:To summarize the clinical characteristics and prognosis of acute hyperextension spinal cord injury (SCI) in children, and to provide some recommendations for the treatment and prevention of this disease.Methods:Reviewed the data of children of SCI after sustained or repeated hyperextension of the spine at Wuhan Union Hospital and Wuhan Children's Hospital from September 2010 to September 2020. According to the American Spinal Injury Association impairment scale (AIS grade), the patients were divided into complete SCI group and incomplete SCI group. The age, symptoms and evolution after injury, neurological level of injury, imaging data, laboratory examination data, prognosis and complications of the two groups were analyzed. Retrospectively summarize the characteristics of this type of injury.Results:Forty-four cases of acute hyperextension SCI in children were included. Their age ranged from 3 to 10 years old, 95% of them were under 8 years old and 95% of them were female. There was no significant difference in age at injury and time of dance training between children with complete SCI and incomplete SCI. Back and leg pain, lower limb weakness or paresthesia, and rapidly progress to complete or incomplete SCI in a short period were typical symptoms. All blood test results anddiagnostic analysis of cerebrospinal fluid were unremarkable or negative. There was no fracture or dislocation in the whole spine. Magnetic resonance imaging showed a longitudinally extended intramedullary high-intensity signal in the thoracolumbar spinal cord. Complete SCI accounted for 60% of all cases, and the prognosis was poor with spinal cord atrophy and various complications.Conclusion:Children younger than 10 years old after sustained or repeated hyperextension of the spine may suffer acute hyperextension SCI. Children with complete SCI have poor prognosis and serious complications. Therefore, prevention of this type of injury is the best strategy.
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Objective:To investigate the imaging and electrophysiological characteristics, surgical methods and efficacies of preschoolers with refractory temporal lobe epilepsy.Methods:A retrospective data study was conducted on 27 patients with refractory temporal lobe epilepsy accepted surgical treatment in our hospital from June 2014 to January 2019. By combined with clinical manifestations, preoperative epileptogenic zones were evaluated by imaging data, such as MR imaging, MR spectroscopy and positron emission tomography-CT, and interictal and ictal video-electroencephalogram (VEEG) data. During the surgery, cortical electroencephalography (ECoG) and deep electrode monitoring were used to monitor and locate the abnormal discharge areas to guide the surgical excision of epileptic zone. Engel grading was used to evaluate the efficacy after surgery.Results:All children had typical clinical manifestations of temporal lobe epilepsy; abnormal signal images were found in one side of the temporal lobe and the hippocampus in MR imaging; epileptic discharges were originated from one side frontotemporal region in interictal and ictal VEEG. Obviously persistent or paroxysmal spike waves, spike waves and slow spikes and spike composite waves were intraoperatively discovered by ECoG and depth electrode electroencephalography in the temporal lobe. All patients accepted standard anterior temporal lobectomy+lesion resection+peripheral abnormal discharge resection of the temporal lobe cortex; partial insular lobe was excised and frontal cortex was performed low power thermal coagulation in two patients. Follow-up was performed for 6 months; Engel grading I was reported in 22 patients (81.5%), Engel grading II in 3 patients (11.1%), and Engel grading III in 2 patients (7.4%).Conclusion:Early surgery and moderate extension of resection under intraoperative ECoG and deep electrode monitoring are the key factors to improve the surgical efficacy of preschoolers with refractory temporal lobe epilepsy.
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Objective:To investigate the advantages and disadvantages and clinical effects of integrated acetabular quadrilateral surface buttress plate in the treatment of acetabular both column fractures.Methods:From September 2017 to March 2019, 14 patients with acetabular both column fractures were treated with integrated quadrilateral acetabular buttress plate and were followed up. The clinical data were retrospectively analyzed. There were 10 males and 4 females with an average age of 53.2 years (range, 26-75 years). Fracture classification were both column fractures according to the Letournel-Judet classification system, including 11 cases of combined posterior wall without posterior dislocation. The time from injury to operation was 8-19 days, with an average of 10.3 days. All operations were performed with a supra-ilioinguinal approach. After satisfactory reduction, the integrated acetabular quadrilateral surface buttress plate was used to fix the anterior and posterior column and quadrilateral fractures at the same time. After operation, Matta criteria was used to evaluate the quality of fracture reduction on postoperative images, and modified Merle d'Aubigné-Postel score to evaluate hip joint function.Results:The average operation time was 180 min (range, 120-320 min), and the intraoperative average blood loss was 980 ml (range, 700-1 600 ml). Operations were performed successfully with none intraoperative reshaping conducted, and the plate could fit into the bone surface well. All 14 patients were followed up with an average of 15.6 months (range, 9-20 months). During the follow-up, all fractures healed with an average of 3 months (range, 2.5-5 months). The reduction quality evaluated by the Matta criteria were 7 anatomical, 5 satisfactory, and 2 unsatisfactory, with an excellent and good rate of 85.7% (12/14). The hip joint function at the last follow-up was in accordance with the modified Merle d'Aubigné-Postel score was 12-18 points, with an average of 16.9 points, of which 8 excellent, 4 good, and 2 fair. The excellent and good function rate was 85.7% (12/14). During the operation, 1 patient had a rupture of about 1 cm of the peritoneum during the separation of the spermatic cord, which was immediately sutured and repaired. One patient had obturator nerve paralysis after the operation, without special treatment, and the paralysis symptoms were relieved during the 6th-month follow-up. There were no other operation-related complications.Conclusion:For both-column fractures characterized by central dislocation of the femoral head, the integrated acetabular quadrilateral buttress plate can simultaneously fix the anterior and posterior columns and quadrilateral surface at the same time. Satisfactory reduction and functional outcomes could be achieved by the novel plates.
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Objective:To explore the feasibility, safety and clinical efficacy of using the self-developed acetabular posterior wall and column integrative anatomical plate to treat various types of posterior wall/column fractures.Methods:Between January 2016 and January 2019, 21 patients involving acetabular posterior wall and/or column were treated with the novel acetabular posterior wall and column integrative plate, the data were collected and retrospectively analyzed. There were 11 males and 10 females, with an average of 48 years old (range, 18-65 years old). According to the classification of AO/OTA, there were 6 simple fractures, 9 comminuted fractures, and 6 associated with joint surface compression of posterior wall; and there were 16 simple acetabular posterior wall fractures and 5 cases associated with acetabular posterior column fractures. Before operation, the CT data of each patient was collected and imported into Mimics software to reconstruct and print a 3D model of pelvis and injured and mirrored side to simulate operation. All patients were treated with a single Kocher-Langenbeck approach for posterior acetabular fractures, and fixed with the novel integrated anatomical plate after satisfactory reduction was achieved. Matta score was used to evaluate the quality of fracture reduction, and the modified Merle D'Aubigné-Postel score was adopted to evaluate functional recovery of hip joint.Results:21 patients involved in this study, the average time of plate insertion after successful reduction was 20 min (range, 15-30 min); the mean time of operation was 180 min (range, 90-300 min); the intraoperative mean bleeding volume was 700 ml (range, 300-1 500 ml). All the incisions healed by level 1 classification, and no incisions infection and sciatic nerve injury occurred. The patients included in the study have been followed up for at least one year and the imaging data was intact, the mean follow-up time was 19 month (range, 12-26 month). The fracture reduction was evaluated according to the Matta score: 16 cases were anatomical reduction, 3 cases were satisfactory reduction, 2 cases were unsatisfactory reduction, the satisfactory rate of reduction was 90.5% (19/21); the modified Merle D'Aubigné-Postel score at 3 month was 13.0±2.2 (range, 9-16), 6 month was 15.8±2.4 (range, 10-18) and last follow up was 17.0±1.8 (range, 13-18), respectively; the difference was statistically significant ( F=15.38, P < 0.001). At the last follow-up, 15 cases were excellent, 3 cases were good and 3 cases were fair, the total excellent and good rate was 85.7% (18/21). One case developed symptoms of sciatic nerve injury after operation, but the symptoms resolved after treating with neurotrophic drug by 6 months. 2 cases developed arthritis related pain after operation, receiving symptomatic treatment with oral painkillers. During the follow-up period, no complications such as plate broken and screw loosen occurred. Conclusion:The use of an integrative anatomical plate for treating posterior wall/column fractures of acetabulum achieved satisfactory fixation and postoperative functional recovery.
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Objective:To explore the effects of endoscopic reprocessing on disinfection and its influential factors under the coronavirus disease 2019 (COVID-19) pandemic.Methods:A total of 450 endoscopes cleaned and disinfected according to Technical Specifications for Cleaning and Disinfection of Endoscopes from November 2019 to January 2020, and 450 endoscopes cleaned and disinfected according to The recommended procedure for cleaning and disinfection of gastrointestinal endoscopes during COVID-19 epidemic by Chinese Society of Digestive Endoscopology from February to April 2020 in the Second Affiliated Hospital of Chongqing Medical University were enrolled in the control group and observation group respectively by random number method. Both the control group and the observation group contained 200 gastroscopes, 200 enteroscopes and 50 ultrasound endoscopes. ATP fluorescence detection method and pour plate technique were used to evaluate the disinfection effect of endoscopes. Single factor analysis and multiple logistic regression were used to analyze the risk factors for unqualified sterilization after endoscopic reprocessing. Results:The disinfection pass rates of gastroscopes, enteroscopes and ultrasound endoscopes in the observation group were not significantly different compared with those of the control group ( P>0.05). The sterilization pass rates and ATP test pass rates of gastroscopes, enteroscopes and ultrasound endoscopes in the observation group were significantly higher than those in the control group (all P<0.05). Multivariate logistic regression analysis showed that non-strict implementation of endoscopic reprocessing ( OR=7.96, 95% CI: 4.55-22.84, P<0.001), non-standard operation ( OR=2.26, 95% CI: 1.24-5.63, P<0.001), insufficient concentration of disinfectant ( OR=5.43, 95% CI: 2.52-9.02, P<0.001), insufficient concentration ratio of multi-enzyme solution ( OR=4.38, 95% CI: 1.95-8.61, P<0.001), non-timely cleaning ( OR=2.86, 95% CI: 1.33-6.42, P<0.001), incomplete cleaning ( OR=3.75, 95% CI: 1.61-7.49, P<0.001) and improper endoscopic preservation ( OR=2.12, 95% CI: 1.36-4.12, P<0.001) were independent risk factors for unqualified sterilization after endoscopic reprocessing. Conclusion:In COVID-19 pandemic, endoscope reprocessing can significantly improve the disinfection effect of endoscopes, worthy of further clinical promotion. The failure to strictly implement the reprocessing procedure is an important factor that may lead to unqualified sterilization.
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Objective:To investigate the value and feasibility of early goal directed sedation (EGDS) in patients with acute brain injury.Methods:A total of 110 patients with acute brain injury who were admitted to intensive care unit (ICU) of the Third Medical Center of the Chinese People's Liberation Army General Hospital from January 2015 to March 2019 were included and randomly divided into EGDS group and standard sedation group (STD) using the random number table. Patients in the EGDS group were sedated by continuous intravenous infusion of dexmedetomidine (initial dose of 0.2 μg·kg -1·min -1) for 72 consecutive hours. Patients in the STD group received intravenous bolus of propofol as appropriate clinically. Richmond agitation-sedation score (RASS) and electroencephalogram bispectral index (BIS) were used to continuously monitor the level of sedation. All patients were given sufentanil for analgesia. Routine treatments such as dehydration and reduction of intracranial pressure with mannitol, hemostasis or antiplatelet therapy were given according to the patients' condition. Vital signs, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, Glasgow coma scale (GCS) score, BIS value, artery blood gas analysis, duration of mechanical ventilation, analgesic dosage and adverse events were recorded in two groups before and 24, 48, and 72 hours after sedation. Results:① Among the 110 patients, patients who received the second surgery due to cerebral hemorrhage, had worsening of cerebral hernia, withdrew during the course of the study, or whose family members abandoned treatment were excluded from the study. Finally, 105 patients were enrolled in the study, including 56 patients in the EGDS group and 49 in the STD group. There was no significant difference in gender, age, types of brain injury, baseline APACHEⅡ or GCS score or rate of mechanical ventilation between the two groups. ② Compared with before sedation, heart rate (HR) significantly decreased till 72 hours after sedation in both groups, and the decrease in the EGDS groups was more obvious as compared with the STD group (bpm: 70.49±7.53 vs. 79.83±9.48, P < 0.05). Besides HR, significant improvement was found in the APACHEⅡ and GCS scores in the STD group at 72 hours of sedation as compared with before sedation, and no significant difference was found in other indicators. Compared with before sedation, arterial partial pressure of carbon dioxide (PaCO 2) was significantly increased from the 24th hour of sedation, mean artery pressure (MAP) was decreased significantly and GCS score, BIS value were increased significantly from the 48th hour of sedation, till 72 hours, which were all improved significantly as compared with the STD group [72-hour PaCO 2 (mmHg, 1 mmHg = 0.133 kPa): 40.30±5.98 vs. 31.57±8.20, 72-hour MAP (mmHg): 85.01±8.26 vs. 89.54±9.41, 72-hour GCS score: 8.62±3.34 vs. 7.89±2.74, 72-hour BIS: 60.87±24.79 vs. 56.68±33.43, all P < 0.05]. APACHEⅡ score was significantly lower only at the 72nd hour of sedation as compared with before sedation in the EGDS group, and no significant difference was found as compared with the STD group (17.10±7.05 vs. 18.90±3.32, P > 0.05). Oxygenation index (PaO 2/FiO 2) was significantly increased only at the 24th hour of sedation in the EGDS group as compared with the STD group (mmHg: 261.05±118.45 vs. 226.45±96.54, P < 0.05). ③ The duration of mechanical ventilation was significantly shorter in the EGDS group than that in the STD group (hours: 20.56±9.03 vs. 27.75±11.23, P < 0.05), and the total administered dose of sufentanil was significantly lower in the EGDS group than that in the STD group (μg: 79.16±26.76 vs. 102.46±35.48, P < 0.05). ④ Compared with the STD group, the incidence of bradycardia in the EGDS group was increased significantly [10.71% (6/56) vs. 6.12% (3/49), P < 0.05], while the incidence of tachycardia was decreased significantly [14.29% (8/56) vs. 38.78% (19/49), P < 0.05], but no significant difference was found in the incidence of hypotension [5.36% (3/56) vs. 4.08% (2/49), P > 0.05]. The incidence of unexpected extubation in the STD group was 4.08% (2/49), which did not occurre in the EGDS group. Conclusion:EGDS can improve the GCS score and BIS value of patients with acute brain injury, suggesting that the EGDS is safe and feasible, which can help improve neurological function in patients with acute brain injury.
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The incidence of fragility fractures of the pelvis (FFP) in elderly patients has been gradually increased. FFP has become another type of injury that threatens the lives of elderly patients because of high disability rate and mortality. The special physical condition of the elderly patients such as osteoporosis, chronic medical diseases and disability determines the specialty in diagnosis and treatment of FFP. The perioperative treatment is more difficult than other patients. FFP in elderly patients is different from the high violent mechanism of pelvis fractures in young patients, and its fracture morphology and classification are also varied. Surgical treatment is to stabilize the mechanical transmission structure of the pelvic ring, improve clinical symptoms, reduce long-term bed-related complications and restore painless daily self-care. In recent years, the surgical treatment of the pelvic fractures has made significant progress. However, there still remains controversy in treating FFP in elderly patients. The authors discuss the perioperative hot issues on FFP in elderly patients, hoping to realize the standard management of FFP.
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Objective:To construct a Nomogram model in predicting recurrence-free survival (RFS) and overall survival (OS) at six months, one year and two years after hepatocellular carcinoma (HCC) resection by using inflammatory markers combined with other routine clinical indicators.Methods:The data of 314 patients with HCC who underwent first time hepatectomy at Beijing Chaoyang Emergency Rescue Center and Air Force Characteristic Medical Center from January 2013 to January 2018 were analyzed. HCC patients who underwent hepatectomy at the First Medical Center of PLA General Hospital from January 2011 to January 2016 ( n=106) were used as the external validation group. Univariate and multivariate Cox proportional risk model was used to analyze independent risk factors of recurrence and death in HCC patients. A Nomogram model was constructed based on independent risk factors. Validation of the efficacy of the Nomogram model was done based on external data. Results:In the experimental group, 174 patients relapsed. The median RFS was 26 months. The 6 months, 1 year and 2 years RFS were 26.8%, 43.9%, and 68.8%, respectively. A total of 142 patients had died. The median survival time was 30 months. The 6 months, 1 year and 2 years OS were 5.9%, 23.6% and 63.1%, respectively. In the external validation group, 63 patients had developed recurrence, with a median RFS time of 28 months. The 6 months, 1 year and 2 years RFS were 26.4%, 45.3%, 54.7%, respectively. The median survival time was 31 months. The 6 months, 1 year and 2 years OS were 7.5%, 25.5%, 46.6%, respectively. Tumor size (>6.0 cm, HR: 1.447), vascular invasion ( HR: 1.408), TBil (>0.94 mg/dl, HR: 1.949), NLR (>2.54, HR: 2.843), AGR (≤0.88, HR: 2.447) were independent risk factors of HCC recurrence ( P<0.05). Tumor size (>6.0 cm, HR: 2.207), vascular invasion ( HR: 1.529), and NLR (>2.54, HR: 2.708) were independent risk factors of death for HCC patients ( P<0.05). The C-indexes of half-year, one-year and two-year RFS were 0.764 (95% CI: 0.677-0.854), 0.710 (95% CI: 0.615-0.824) and 0.673 (95% CI: 0.601-0.786), respectively. The C-indexes of half-year OS, one-year OS and two-year OS were 0.729 (95% CI: 0.648-0.841), 0.708 (95% CI: 0.608-0.813) and 0.664 (95% CI: 0.618-0.771), respectively. Conclusion:In this study, the construction of a Nomogram model in predicting prognosis of HCC patients was helpful to guide clinicians in improving preoperative treatment plans and in providing ideas for individualized treatment of patients.
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Objective:To introduce a novel anatomical supra-pectineal quadrilateral surface buttress plate, and explore its advantages, disadvantages and clinical efficacy in the treatment of complex acetabular fractures.Methods:Data of eighteen cases of acetabular fractures treated in our department from March 2017 to March 2019were retrospectively analyzed. There were 15 males and 3 females with an average age of 49.6 years (range, 27-62 years). According to the Letournel-Judet’s classification, there were 3 cases of anterior column fractures (involving quadrilateral surface), 2 cases of "T" shaped, 8 of cases anterior column and posterior hemi-transverse (ACPHT) and 5 cases of double columns fractures. The time from injury to operation was 5-14 days (mean, 7 days). Before operation, all patients were taken pelvic anterior-posterior X-ray and CT scan. All patients were adopted supra-ilioinguinal approach and fixed by supra-pectineal quadrilateral surface buttress plate. Surgical time, intraoperative blood loss and postoperative complications were collected. After operations all patients were taken pelvic X-ray in anterior-posterior and Judet position, as well as CT scan. The radiographic quality of reduction was evaluated by Matta criteria and hip functions were evaluated by Matta Modified Merle d’Aubigné-Postel scoring system.Results:The average surgical time was 130 min (range, 100-200 min). The average blood loss was 560 ml (range, 400-900 ml). An additional shaping was unnecessary in 18 patients who were implanted with the anatomical supra-pectineal quadrilateral surface buttress plate and all patients were operated successfully. All patients were followed up for an average time of 9 months (range, 6-15 months). The quality of fracture reduction was evaluated according to Matta standard, of which there were 11 cases excellent, 4 cases good, and 3 cases poor, with an excellent rate of 83.3% (15/18). At the latest follow-up, the function of the hip joint was evaluated according to the Matta Modified Merle d’Aubigné-Postel scoring system for a mean of 15.8 scores (range, 12-18 scores), of which there were 10 cases excellent, 6 cases good, 2 cases fair, with an excellent rate of 88.9% (16/18). All patients recovered well, and there were 2 cases of lateral femoral cutaneous nerve injury postoperative who had recovered one month later. There was no other postoperative complications.Conclusion:The anterior and posterior column and quadrilateral surface could be stabilized simultaneously by the anatomical supra-pectineal quadrilateral surface buttress plate without intraoperative shaping. Moreover, it is more likely to obtain a satisfactory clinical outcome by using this special plate with lower complications and rigid fixation. Therefore, it is a kind of internal fixation method worthy of promotion in the treatment of complex acetabular fractures.
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Objective To evaluate the efficacy and safety of 3D printing patient-specific external guide template in assisting minimally invasive screwing for treatment of pelvic and acetabular fractures.Methods The clinical and follow-up data of 39 pelvic or acetabular fractures were retrospectively analyzed which had been treated from June 2016 to February 2018 at Department of Orthopaedics,Wuhan Union Hospital.The patients were divided into a template group and a freehand group.In the template group,there were 14 men and 7 women with an age of 46.3 ± 18.2 years and 17 pelvic fractures and 4 acetabular fractures;in the freehand group,there were 12 men and 6 women with an age of 43.8 ± 12.2 years and 14 pelvic fractures and 4 acetabular fractures.The 2 groups were compared in terms of operation time,fluoroscopic frequency,guide wire adjustments,fracture reduction,screw penetration rate,function evaluation and adverse events.Results All the 39 patients were followed up for 9 to 13 months (average,11.6 months).A total of 42 screws were placed in the template group and 35 screws in the freehand group.The values of operation time (43.8 ± 22.2 min),fluoroscopic frequency (29.6 ± 10.7 times) and guide wire adjustments (1.8 ± 1.2 times) in the external guide template group were all significantly lower than those in the freehand group (73.8 ±22.6 min,54.6 ± 16.5 times and 9.8 ±2.8 times,respectively) (P <0.05).There were no significant differences between the 2 groups in screw penetration rate,rate of satisfactory reduction,Majeed scores for pelvic function or modified Merle d'Aubigné scores at the last follow-ups (P > 0.05).One case in the freehand group experienced numbness after operation on unilateral dorsi pedis which disappeared at 3-month follow-up.Conclusion The 3D printing patient-specific external guide template can reduce fluoroscopic frequency,save operation time and improve accuracy of screw insertion,providing a new means for minimally invasive treatment of pelvis and acetabular fractures.
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Objective To explore the clinical efficacy of combined plates through superior?ilioinguinal approach for ace?tabular fractures involving anterior wall and anterior column. Methods Data of twelve patients with acetabular fractures involv?ing anterior column and anterior wall who were treated by combined plates from June 2015 to August 2017 were retrospectively an?alyzed. Among them 9 cases were males and 3 cases were females, with an average age of 55.4 years old (range, 22-69 years old). Three cases were combined with posterior hemitransverse fractures. Six cases were combined with posterior column fractures. The mean time from injury to operation was 7.2 d (range, 5-12 d). Simultaneous management of anterior wall and anterior column frac?tures were achieved through single superior?ilioinguinal approach using the novel combined plates in all patients. The image re?sults were evaluated by Matta’s standard and the functional outcome was evaluated by the Matta's improved Merle d'Aubigné?Pos?tel scores system at the final follow?up. Results All 12 patients were followed up for average 18.3 months (range, 12-24 months). Average blood loss was 560 ml (range, 200-1 200 ml) and average operative time was 102 min (range, 88-190 min). The mean time of bony union was 2.9 months (range, 2.5-4.5 months). The quality of postoperative fracture reduction was evaluated accord?ing to Matta’s standard, of which there were 7 cases anatomic, 3 cases satisfactory, and 2 cases unsatisfactory, with an anatomic or satisfactory rate of 83.3%(10/12). The average Matta’s improved Merle d’Aubigne?Postel score was 16.1 (range, 12-18), and there were 8 cases excellent, 2 cases good, 1 case fair and 1 case poor, with an excellent or good rate of 83.3%(10/12). Rupture of the peritoneum occurred in one patient during the surgery which was repaired immediately. One patient suffered obturator nerve palsy and was fully recovered in one year. No inguinal hernia, surgical site infection and femoral head avascular necrosis occurred. Con?clusion The combined plates could provide simultaneous fixation for anterior column and anterior wall fractures firmly through single superior?ilioinguinal approach. Satisfactory reduction and functional outcomes could be achieved by the novel plates.
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Objective To compare the therapeutic effects between anterior internal fixator (INFIX) and external fixator (EXFIX) for anterior pelvic ring fracture.Methods A retrospective study was conducted on the 66 patients with anterior pelvic ring fracture who had been treated surgically from January 2016 to June 2017 at Department of Spinal Surgery,Hospital Affiliated to Southwest Medical University and at Department of Orthopedics,Union Hospital Affiliated to Tongji Medical College.They were divided into an observation group and a control group according to their fixation of the anterior pelvic ring.In the observation group of 33 cases fixated with INFIX,there were 20 males and 13 females,aged from 32 to 47 years (38.8 ±4.8 years).By the Tile's classification,15 of them belonged to type B and 18 to type C.In the control group of another 33 patients fixated with EXFIX,there were 19 males and 14 females,aged from 33 to 48 years (39.5 ±4.6 years).By the Tile's classification,14 of them belonged to type B and 19 to type C.The 2 groups were compared in terms of postoperative fracture reduction,pelvic function and complications.Results The 66 patients were followed up for an average of 13.7 months(from 12 to 18 months).According to the Matta criteria for fracture reduction,21 cases were excellent,9 good,2 fair and one poor in the observation group (excellent and good rate:90.9%);18 cases were excellent,8 good,5 fair and 2 poor in the control group (excellent and good rate:78.8%).The difference was statistically significant between the 2 groups (P < 0.05).The pelvic function assessed by the Majeed criteria at the final follow-up was excellent in 21 cases,good in 10,fair in one and poor in one in the observation group (excellent and good rate:93.9%);it was excellent in 17 cases,good in 9,fair in 4 and poor in 3 in the control group (excellent and good rate:78.8%).The difference was also statistically significant between the 2 groups (P < 0.05).The incidence of injury to the lateral femoral cutaneous nerve was 9.1% (3/33) for the observation group and 6.1% (2/33) for the control group,showing no significant difference between the 2 groups (P > 0.05).The incidences of screw loosening and pin track infection were significantly lower in the observation group than in the control group[0 versus 24.2% (8/33) and 0 versus 18.2% (6/33),respectively] (both P < 0.05).Conclusion Compared with EXFIX,INFIX can lead to better clinical outcomes and fewer operative complications in the treatment of anterior pelvic ring fractures.
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Objective@#To explore the clinical efficacy of combined plates through superior-ilioinguinal approach for acetabular fractures involving anterior wall and anterior column.@*Methods@#Data of twelve patients with acetabular fractures involving anterior column and anterior wall who were treated by combined plates from June 2015 to August 2017 were retrospectively analyzed. Among them 9 cases were males and 3 cases were females, with an average age of 55.4 years old (range, 22-69 years old). Three cases were combined with posterior hemitransverse fractures. Six cases were combined with posterior column fractures. The mean time from injury to operation was 7.2 d (range, 5-12 d). Simultaneous management of anterior wall and anterior column fractures were achieved through single superior-ilioinguinal approach using the novel combined plates in all patients. The image results were evaluated by Matta’s standard and the functional outcome was evaluated by the Matta's improved Merle d'Aubigné-Postel scores system at the final follow-up.@*Results@#All 12 patients were followed up for average 18.3 months (range, 12-24 months). Average blood loss was 560 ml (range, 200-1 200 ml) and average operative time was 102 min (range, 88-190 min). The mean time of bony union was 2.9 months (range, 2.5-4.5 months). The quality of postoperative fracture reduction was evaluated according to Matta’s standard, of which there were 7 cases anatomic, 3 cases satisfactory, and 2 cases unsatisfactory, with an anatomic or satisfactory rate of 83.3%(10/12). The average Matta’s improved Merle d’Aubigne-Postel score was 16.1 (range, 12-18), and there were 8 cases excellent, 2 cases good, 1 case fair and 1 case poor, with an excellent or good rate of 83.3%(10/12). Rupture of the peritoneum occurred in one patient during the surgery which was repaired immediately. One patient suffered obturator nerve palsy and was fully recovered in one year. No inguinal hernia, surgical site infection and femoral head avascular necrosis occurred.@*Conclusion@#The combined plates could provide simultaneous fixation for anterior column and anterior wall fractures firmly through single superior-ilioinguinal approach. Satisfactory reduction and functional outcomes could be achieved by the novel plates.