[Estimation of acetabular cup prosthesis coverage rate in total hip arthroplasty based on X-ray films].

Objective: To explore the method of accurately estimating the acetabular cup prosthesis coverage rate (hereinafter referred to as "cup coverage rate") in total hip arthroplasty (THA) based on X-ray films, and to determine the effective parameters that can be used to estimate the cup coverage rate. Methods: The three-dimensional printed pelvic models were established based on CT data of 16 healthy pelvis, and the acetabular prosthesis were implanted according to conventional THA procedure. The length and width of the uncovered area of the acetabular cup prosthesis were measured by a modified X-ray recording method with a rotating C-arm X-ray machine, and the cup coverage rate was calculated. Then the differences among the traditional anteroposterior X-ray recording method, the modified method, and actual measurement on pelvic model were statistically analyzed. The correlation between the area of the uncovered area of the prosthesis and its width and length was analyzed by using multiple linear regression analysis. Results: The cup coverage rates of traditional method, modified method, and actual measurement were 78.22%±3.36%, 86.74%±3.61%, and 89.62%±2.62%, respectively, with significant differences ( P<0.05). The results of multiple linear regression analysis showed that the width and length were positively linear with the uncovered area of the prosthesis, and the regression equation was as follows: uncovered area of the prosthesis=-21.192+0.248×width+0.140×length, and the coefficient of determination R 2=0.857, P<0.001. Conclusion: Compared with the traditional method, the modified method can more accurately evaluate the cup coverage rate during THA, and the width of the uncovered area of the prosthesis can be used as an effective reference for the cup coverage rate.

Modified Stapled Transanal Rectal Resection Procedure for Limited Rectal Prolapse: A Viable Alternative to the Delorme Operation.

Purpose. The optimal surgical approach for full-thickness rectal prolapse (FTRP) remains controversial. In China, patients with limited FTRP (<5 cm in length) are usually managed by perineal surgery. We retrospectively assessed the outcome of Delorme's procedure and compared it with modified stapled transanal rectal resection (STARR). Methods. The study was conducted in 2 public tertiary referral centers in China with modified STARR or Delorme's procedure performed by experienced surgeons. Outcomes assessed recurrence, operative times, blood loss, complications, length of hospital stay, and continence and constipation scoring. Results. Between December 2012 and May 2019, 65 patients were assessed, including 48 with modified STARR (group 1) and 17 with Delorme's procedure (group 2). The median follow-up was 22 months (range, 3-86 months). The mean operative time for group 1 was 37.4 ± 17.5 minutes vs 74.3 ± 30.6 minutes for group 2 (P < .001). The blood loss for group 1 was significantly lower than that for group 2 (17.4 ± 15.9 mL vs 27.8 ± 16.7 mL, respectively; P = .028). There was no significant difference between groups in recurrence (group 1 18.8% vs group 2 23.5%; P = .944) with no effect of operation type. Both procedures showed improvement in constipation and continence scoring with a similar impact. Conclusions. Modified STARR and the Delorme operation are comparable in managing limited FTRP with superior results in operative time and blood loss for STARR.

Network meta-analysis of randomized controlled trials comparing the procedure for prolapse and hemorrhoids, Milligan-Morgan hemorrhoidectomy and tissue-selecting therapy stapler in the treatment of grade III and IV internal hemorrhoids(Meta-analysis).

BACKGROUND: Hemorrhoids are one of the most common conditions in the world, and grade III and IV internal hemorrhoids are mainly treated with surgery. However, there are many different surgical methods, and many postoperative complications occur. Therefore, we aimed to update and expand our previous work to compare the safety and efficacy of the procedure for prolapse and hemorrhoids (PPH), Milligan-Morgan hemorrhoidectomy (MMH) and tissue-selecting therapy stapler (TST) in the treatment of grade III and IV internal hemorrhoids. METHODS: We performed a network meta-analysis. We searched the Cochrane library, Embase, PubMed, Medline, Web of Science, CNKI, Wangfang, and VIP databases up to May 20, 2019. All randomized controlled trials (RCTs) comparing PPH, MMH and TST in the treatment of grade III and IV internal hemorrhoids were included. We performed a Bayesian network meta-analysis to integrate the adverse events of all treatments. This work is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines. This study was registered with PROSPERO, number CRD42019137270. RESULT: Twenty-two RCTs that recruited 3511 patients were identified. Among these patients, 1379 patients underwent PPH, 805 patients underwent TST, and 1327 patients underwent MMH. In terms of adverse events, TST presented the lowest urinary retention rates and fecal incontinence rates. TST exhibited fewer incidences of anal stenosis than PPH and MMH. Importantly, PPH showed the weakest effects on reducing recurrence rates in hemorrhoid patients. CONCLUSIONS: The current study indicated that TST showed optimal potential superior clinical effects for grade III and IV hemorrhoids compared to PPH and MMH. However, high-quality large sample RCTs are still expected.

Outcomes in patients with Fournier's gangrene originating from the anorectal region with a particular focus on those without perineal involvement.

BACKGROUND AND AIM: Fournier's gangrene (FG) is a fulminant infection in the external genital region and perineum. The present study explored the clinical features of FG originating from the anorectal region, from primary conditions such as anal fistulas and abscesses. METHODS: A retrospective analysis was performed in order to identify the factors associated with clinical outcomes in FG patients derived from two hospitals-the Sixth Affiliated Hospital of Sun Yat-sen University and People's Hospital Affiliated to Fujian University of Traditional Chinese-over the period from May 2013 to April 2017. RESULTS: Sixty FG patients were included in this study. The common causative microorganisms cultured were Escherichia coli species. Genital and perirectal regional involvement was evident in 52 and 59 cases, respectively, although the perineum was unaffected in 7 cases (12%), as confirmed by imaging examination and surgical exploration. Management with early radical debridement and broad-spectrum antibiotic therapy is effective with an acceptably sepsis mortality (1.7%). Ten patients underwent protective colostomy. No patient underwent an orchidectomy and required urinary diversion. CONCLUSIONS: FG originating from the anorectal region can be rapidly progressive and life-threatening. Infection can spread superiorly to the genital region without the involvement in perineal tissue. An aggressive surgical debridement of non-viable tissue is essential for satisfactory outcomes and a protective colostomy is not mandatory.