Effect of Preventive Nursing on Male Children with Hypospadias in Preventing Postoperative Complications.

OBJECTIVE: To determine the clinical impact of preventive nursing on children with hypospadias and the intervention effect on postoperative complications. STUDY DESIGN: Comparative study. Place and Duration of the Study: Department of Urology Surgery, Beijing Children's Hospital Affiliated to Capital Medical University Baoding Hospital, Hebei, China, from August 2019 to July 2021. METHODOLOGY: Children with hypospadias who received elective surgery were randomly divided into two groups of forty cases each. The control group received traditional specialised nursing care during the perioperative period, the study group administered preventive care on the control basis. The postoperative rehabilitation, VAS, anxiety and depression score, postoperative complications, and nursing satisfaction were compared between the two groups. RESULTS: The time of first bowel movement, extubation, and hospitalisation in the study group were significantly shorter than in the control group, with statistically significant value (p<0.001). After intervention, the SAS and SDS in the study group were significantly lower than those in the control group, and the difference was statistically significant (p<0.05). The incidence of complications in the study group was 7.50%, lower than the 25% of control group (p = 0.034). The postoperative VAS scores of the study group were significantly lower than those of control group at 6 and 24 hours (p<0.05). Besides, nursing satisfaction in the study group was 97.50%, higher than the 82.50% of the control group (p = 0.025). CONCLUSION: Preventive nursing had a reliable nursing effect on children undergoing hypospadias surgery, which can reduce postoperative complications, alleviate postoperative pain, improve postoperative anxiety and depression, enhance nursing experience, and promote postoperative recovery. KEY WORDS: Preventive care, Hypospadias in male children, Urethroplasty, Complication, Clinical effect.

Comparison of clinical effects between microscopic surgery and conventional surgery in children with penile hypospadias and difference analysis of postoperative urodynamics.

Objective: To compare and analyze the clinical effects of microscopic surgery and conventional surgery in children with penile hypospadias and the differences in postoperative urodynamic indexes. Methods: It was a clinical comparative study. A total of 80 children with penile hypospadias admitted to Beijing Children's Hospital Affiliated to Capital Medical University Baoding Hospital from July 2018 to September 2022 were selected and randomly divided into two group. The experimental group were treated with microscopic urethroplasty, while the control group were treated with traditional urethroplasty. The operative effect, operation time, total intraoperative blood loss, postoperative hospital stay and incidence of surgical complications were compared and analyzed between the two groups. All the children were followed up for two years, and the changes in urodynamic parameters including maximum urine flow rate (Qmax), average urine flow rate (Qavc), urine flow time (FT), peak time (TQmax) and residual urine (PVR) were compared before, two weeks after, six months after and two years after surgery. Results: The efficacy of the experimental group was significantly higher than that of the control group (p=0.013). The intraoperative blood loss and postoperative hospital stay in the experimental group were significantly better than those in the control group (p=0.000). The incidences of urinary leakage and urethral stricture in the experimental group were lower than those in the control group (p<0.05). The Qmax level in the experimental group was higher than that in the control group at six months and two years after surgery, while the FT level was lower than that of the control group (p<0.05). Conclusion: Microscopic surgery is a method with significant clinical value in the treatment of penile hypospadias.

[The diagnosis and treatment of rotational unstable nonunion of femoral shaft fracture after interlocking nailing].

OBJECTIVE: To evaluate the principle and treatment of rotational unstable nonunion of the femoral shaft fracture after interlocking nailing. METHODS: From April 2003 to June 2007, 18 cases of rotational unstable nonunion of femoral shaft fractures after interlocking nailing were treated with exchanged reamed nailing and/or LCP fixation and iliac bone graft. The average age was 40 years old (from 22 to 52). RESULTS: All patients were followed up for an average time of 28 months (from 12 to 58). All the fractures were united in an average time of 7 months (from 6 to 8). There were no perioperative complications occurred and no wound infection were observed. No loosening was found around the implant till the last follow-up. CONCLUSIONS: Rotational instability is one of the reasons of nonunion of femoral shaft fracture after interlocking nailing. Reaming and nail exchanging or LCP fixation with iliac bone graft are the appropriate methods which can achieve a great clinic results.

[Comparative study of antegrade and retrograde intramedullary nailing for the treatment of humeral shaft fractures].

OBJECTIVE: To compare therapeutic effects between antegrade intramedullary nailing and retrograde intramedullary nailing for the treatment of humeral shaft fractures. METHODS: From March 1999 to October 2006, 105 patients with humeral shaft fractures were treated with locked intramedullary nail and were adequately followed up. There were 82 antegrade nailing and 23 retrograde nailing. The follow-up parameters included operation time, blood loss,fracture healing rate, healing time, complications, Constant-Murley shoulder score and Mayo elbow performance score. RESULTS: The mean follow-up period was 31.2 months. Antegrade intramedullary nailing had significantly less blood loss than that in retrograde intramedullary nailing (P=0.002). The differences in operation time, complications, healing time and bone healing rate between he two groups had no statistical significance. Complications in the antegrade intramedullary nail group included 4 patients with nonunions, 1 patient with radial nerve palsy, and 8 patients with shoulder pains and decrement in shoulder range of motion. Complications in the retrograde intramedullary nail group included 1 patient with radial nerve palsy and 3 patients with iatrogenic fractures. For shoulder joints,the difference in the average Constant-Murley shoulder score between the two groups was statistically significant (P=0.04). For elbow joints, the average postoperative Mayo elbow performance score between these two approaches did not differ significantly. CONCLUSION: Both the antegrade intramedullary nailing and the retrograde intramedullary nailing are good alternatives for the treatment of humeral shaft fractures. Because of higher incidence of iatrogenic fractures, the insertion point of retrograde intramedullary nailing should be carefully prepared. With antegrade insertion, it important to bury the humeral nail below the rotator cuff to prevent the subacromial impingement, and the rotator cuff should be carefully repaired to avoid shoulder pain and improve shoulder function.

[Antibiotic-PMMA beads combined with external fixator for treating the infected fracture nonunion].

OBJECTIVE: To investigate the effects of antibiotic-PMMA (polymethyl-methacrylate) beads combined with external fixator in treatment of infected fracture nonunion. METHODS: Twenty-two cases of infected fracture-nonunions were reviewed involving 20 male and 2 female with an average age of 34.68 years (ranging 21 to 74 years). The data consisted of 9 cases of tibial fractures, 2 distal fractures of the femur, 6 femoral shaft fractures, 3 intertrochanteric fracture of the femur and 2 humeral shaft fractures. The procedure included thorough debridement to wipe out dead bone and granulation tissue, then antibiotic-PMMA bead chains imbedded into the dead space. One week later, secondary debridement was performed, antibiotic-PMMA bead chains were changed according to result of bacterial culture and susceptibility test, and fractures were stabilized with external fixator. Three months after debridement, antibiotic-PMMA bead chains were taken out and bone graft with autogenous iliac cancellous bone chips was performed. RESULTS: The mean follow-up period was 19.98 months (ranging 15 to 28 months). Infection was controlled in 20 cases. One tibial fracture and 1 intertrochanteric fracture of the femur needed repeated debridement 2 and 3 months after bone grafting respectively,because of infection recurrence and sinus formation. All 22 cases achieved bony union averaged 15.09 weeks after bone grafting with a range of 8 to 24 weeks. CONCLUSION: Thorough debridement, imbedding antibiotic-PMMA bead chains combined with external fixator and staged bone grafting has proven to be effective and simple for treatment of infected fracture nonunion. The antibiotic bead delivers high tissue levels,obliterates dead space, aids bone repair.

[Clinical study on the rotational deformity after interlocking nailing in femur shaft fracture].

OBJECTIVE: To explore the approach to accurately judge the degree of rotational deformity in femur shaft fracture. METHODS: 110 patients with femur shaft fracture were divided into 3 groups: Group A (n = 62) with the distal end of the fractured femur at the traumatic side at neutral position so as to fix the fracture, Group B (n = 27), with both the distal and proximal ends of the fractured femur at the neutral position so as to fix the femur at an antiversion angle of 15 degrees d, and Group C (n = 21), with the degree of antiversion angle to be controlled to that on the intact side. X ray examination and CT scanning were conducted 3 days after intramedullary nailing to measure the degree of the antiversion angle on both sides. The difference between the degrees of antiversion angle at the 2 sides was considered the rotational deformity of the femur shaft after the nailing. The antiversion angles of the femurs at both sides of 11 healthy persons were measured as controls. RESULTS: The biggest value of antiversion angle was 26 degrees , the smallest value was 8 degrees , the average value at the left side was 12.8 degrees , and the average value at the right side was 12.45, and the biggest difference between the 2 side was 7 degrees in the control group. The average antiversion angle of the femur was 14.67 degrees , the biggest value was 51 degrees , and the smallest value was -24 degrees at the traumatic side; and the average antiversion angle of the femur was 14.27 degrees , the biggest value was 40 degrees , and the smallest value was -23 degrees at the intact side in the treatment groups. 53% and 52% of the patients in Groups A and B showed a rotational deformity < 10 degrees , and 9% and 11% of them showed a rotational deformity > 20 degrees , significantly different from those in the control group (all P < 0.05). The rotational deformity was < 10 degrees in all patients of Group C, not significantly different from that of the control group (P > 0.05). CONCLUSION: Clinically about half of the femur shaft fractures are fixed in the position of rotational deformity > 10 degrees after nailing. The rotational deformity of femur shaft fracture should be prevented by comparing the antiversion angle on the intact side so as to achieve more reliable adequate reduction.

[Surgical treatment of shotgun injuries of the sciatic nerve].

OBJECTIVE: To explore the clinical characteristics and the effect of surgical therapy for shotgun injuries of the sciatic nerve. METHODS: From 1996 to 2000, 19 sciatic nerve injuries resulted from shotgun were observed. Among 19 cases of shotgun sciatic nerve wounds, the gluteal wound was in 2 cases, thigh wound in 15 cases, and knee wound in 2 cases. The firing distance was between 0.5-9 m. According to Shermen classification of shotgun injury, 4 cases belonged to type I injury, 11 cases type II, 4 cases type III. The time from injury to admission was between 2 months-14 months except 1 patient who underwent emergency operation 4 hours after injury, and 1 patient was treated with debridement and epineurial neurorrhaphy, 7 cases with nerve trunk grafting, 6 cases with nerve cable grafting, 4 cases with neurolysis, 1 case with arthrodesis of ankle. RESULTS: Nineteen cases were followed-up for 0.8-3.5 years (mean, 19 months). The excellent and good nerve functional recovery was found in 52.6% according to MCRR. CONCLUSIONS: Shotgun injuries of the sciatic nerve are very severe and complicated, and injuries in most patients were usually complicated by open fracture, vascular injury, soft-tissue loss and infection; the character of nerve injury was classified as 4-5 degree according to Sunderland Standard, nerve transfer is effective in the treatment of shotgun injuries of the sciatic nerve, but outcome is poor; the recovery of the sciatic nerve should be observed continually after injury; selecting correct initial treatment after injury, strict minimally invasive surgical procedure, physical therapy and reasonable preoperative and postoperative medication can improve the surgical results.