ObjectiveTo evaluate the mid- and long-term effectiveness of total hip arthroplasty (THA) with Ribbed femoral stem prosthesis.MethodsA clinical data of 354 patients (384 hips) with hip disease who underwent THA with Ribbed femoral stem prostheses between October 2006 and May 2016 was retrospectively analyzed. There were 171 males and 183 females, with an average age of 53.4 years (range, 20-82 years). There were 324 cases of single hip and 30 cases of bilateral hips. The cause of THA included the avascular necrosis of the femoral head in 151 cases (159 hips), hip osteoarthritis in 134 cases (136 hips), rheumatoid arthritis in 43 cases (43 hips), ankylosing spondylitis in 20 cases (40 hips), and trauma in 6 cases (6 hips). The Harris score of total 354 patients before operation was 42.34±8.89. Harris scores were used to evaluate hip function after operation. X-ray films were used to determine the length of the lower limb, the radiolucent line on the femur side, the stability of the prosthesis, and the occurrence of stress shielding.ResultsThe incisions healed by first intention. All patients were followed up 2-11 years with an average of 7.4 years. The Harris score at last follow-up was 80.52±7.61, which significantly increased when compared with preoperative score (t=134.804, P=0.000). Two cases (2 hips) of prosthetic infections, 3 cases (3 hips) of prothesis loosening, and 4 cases (4 hips) of periprosthetic fractures, and 48 cases (48 hips) of mild to moderate thigh pain occurred after operation. X-ray films showed 76 cases (78 hips) with radiolucent lines on the femur side and stress shielding. According to the Engh’s method, there were 364 hips of bone ingrowth, 15 hips of fibrosis ingrowth, and 5 hips of prosthesis instability. The femoral stem subsidence occurred in 25 cases (25 hips), and the difference in leg length discrepancy was more than 10 mm in 5 patients.ConclusionTHA with Ribbed femoral stem prosthesis can achieve satisfactory effectiveness with good initial stability and rapid bone growth. The incidence of stress shielding is relatively high, but the stress shielding has no significant impact on the mid- and long-term survival rate and effectiveness of femoral prosthesis.
OBJECTIVE: To compare the effect of several types of rib rings with intercostal muscles for the replacement of trachea in thorax. METHODS: The surface layer of the third rib of dogs were ripped off and curved into triangular, quadrilateral and polygonal form. These three types of rib rings with intercostal muscles were used to replace a segment of trachea in thorax. RESULTS: The stability of triangular rib ring was very well, but stricture of ring were often happened because of its smaller internal diameter. These stability of quadrilateral rib ring was the worst. The polygonal rib ring presented the biggest diameter and good stability compared to the other two kinds of rings. If silicone tube was supplemented in the polygonal rib ring, the quality of artificial trachea was excellent. CONCLUSION: The rib rings with intercostal muscles are successfully used for replacing the defect of trachea in canine thorax. The polygonal rib rings have the best quality in the three types of rib ring for tracheal replacement.
Riboflavin-ultraviolet A (UVA) collagen cross-linking has not only achieved good clinical efficacy in the treatment of corneal diseases such as dilatation keratopathy, bullae keratopathy, infectious keratopathy, and in the combined treatment of corneal refractive surgeries, but also its efficacy and safety in scleral collagen cross-linking have been initially confirmed. To better promote the application of cross-linking in the clinical treatment of corneal and scleral diseases, exploring controllability and predictability of the surgical efficacy are both important for evaluating the surgical efficacy and personalized precision treatment. In this paper, the progress on the cross-linking depth of riboflavin-UVA collagen cross-linking, and its relationship with the cross-linking effect will be reviewed. It will provide the reference for further application of this procedure in ophthalmology clinics.
Objective To formulate an evidence-based treatment plan for a patient with hepatitis C after kidney transplantation with combination of interferon-α and ribavirin. Methods Based on an adequate assessment of the patient’ s condition and using the principle of PICO, we searched The Cochrane Library (Issue 1, 2009), PubMed (1995 to March 2009), and CHKD (1995 to 2008.12). Results Eighteen studies were identified including 17 in English (5 case reports, 11 cohort studies, and 1 meta–analysis) and 1 in Chinese. According to the current evidence as well as the patient’ s clinical condition and preference, PEG-IFNα-2b 50 µg /week plus ribavirin 600 mg/day was given to the patient for 6 months. Conclusion Evidence-based approaches help us to prepare the anti-viral therapy plan and will improve the assessment of the efficacy and safety in kidney transplantation.
ObjectiveTo compare clinical outcomes between video-assisted thoracoscopic surgery (VATS) and conventional surgery for the treatment of multiple rib fractures. MethodsA total of 173 consecutive patients with multiple rib fractures were admitted to Dujiangyan People's Hospital from January 2010 to December 2012. There were 122 males and 51 females with their age of 19-71 (41.3±7.1) years. According to different treatment strategies, all the patients were divided into 3 groups:conservative treatment group (83 patients with a mean of 4.9±1.3 fractured ribs, including 20 patients with flail chest), conventional surgery group (41 patients with a mean of 5.2±1.1 fractured ribs, including 11 patients with flail chest) and VATS group (49 patients with a mean of 5.3±1.5 fractured ribs, including 14 patients with flail chest). Length of hospital stay, duration of postoperative pain, incision length, operation time, chest drainage duration and morbidity were compared among the 3 groups. ResultsThe incision length (5.2±1.5 cm vs. 8.5±2.3 cm, P=0.031), operation time (1.1±0.3 hours vs. 1.8±0.2 hours, P=0.003), chest drainage duration (0.3±0.0 day vs. 3.2±1.1 days, P=0.007) and length of hospital stay (13.7±1.5 days vs. 17.3±2.3 days, P=0.017) of VATS group were significantly shorter than those of the conventional surgery group. A total of 159 patients were followed up, and chest x-ray was examined at 1, 3 and 6 months after discharge. After 3 months, bone callus formation was evident around the rib fractures in chest x-ray in patients undergoing surgery, while bone union with deformity was shown in some patients of the conservative group. ConclusionWith the development of various internal fixation materials, surgical internal fixation has become a trend for patients with multiple rib fractures, and VATS internal fixation is minimally invasive with satisfactory clinical outcomes.
ObjectiveTo evaluate the effect of autoantibody on the efficacy and safety of pegylated interferonα-2a (Peg-IFNα-2a) and ribavirin on chronic hepatitis C (HCV). MethodsWe enrolled 106 chronic HCV infected patients, who were divided into autoantibody-positive group and negative group based on the baseline autoantibody detection. The patients were treated for 48 weeks. The anti-viral response and adverse effects were observed. Data analyses were reported using the SPSS 20.0 statistical package. ResultsThe prevalence of any autoantibody in chronic hepatitis C patients amounted to 31.1%, and serum anti-nuclear antibody was positive in 24 patients. Difference in age, sex, serum alanine transaminase level, aspartate transaminase level, total bilirubin level, thyroid function and HCV RNA level between autoantibody-positive group and negative group was not significant (P > 0.05). The level of hemoglobin in autoantibody-positive group was significantly lower than the negative group (P=0.018). Of the 106 patients, 82 patients achieved sustained virological response (SVR), 56 achieved rapid virological response (RVR), 98 achieved ealy virological response (EVR) and 8 were non-responders. There were no significant differences between RVR, EVR and SVR in autoantibody-positive group and negative group (P > 0.05). The most common adverse effects in this study were fatigue, weight loss, hair loss and fever, and no significant differences in adverse effects were observed between the two groups (P > 0.05). ConclusionAutoantibody positivity may not affect the treatment response and is safe in chronic HCV infected patients with combination therapy of pegylated interferonα-2a plus ribavirin.
ObjectiveTo provide geometric morphometric parameters for anatomical plate design by measuring the geometry of the 3rd to 9th ribs of adults using X-ray computed tomography (CT). MethodsTwenty patients receiving chest CT scan in Hebei Province General Hospital from May to July of 2012 were recruited in this study. There were 10 Han males and 10 Han females with their height of 167-180 (173±8) cm and age of 16-58 (37±18) years. None of the patients had thoracic trauma history or other disease which might influence the shape or density of ribs. After general chest CT scan, three-dimensional images of thoracic bones were constructed. The geometric shape of the ribs was analyzed and measured. ResultsThe ribs were divided into 3 sections as followed, from rib head to-37.5% of rib (section 1), 25%-75% (section 2), and 50%-100% (section 3). The maximum curvature of general curved ribs on long axis occurred in section 1 of the ribs. The third rib had the largest curvature (20.24±2.86/m). Section 2 of the 8th rib had the smallest curvature (6.14±0.96/m). The curvature of section 2 of 7th to 9th ribs was smaller than that of other 2 sections. The smallest curvature appeared in section 3 of 3rd to 6th ribs. Each rib had a retroversion angle along its longitudinal axis, and its numerical value was 30-50 degrees. The rib unrolled angle decreased firstly and then increased gradually. The cross-sectional area of marrow cavity ranged from 27.59 mm2 at the rear to 55.91 mm2 in the front. ConclusionMulti-slice spiral CT three-dimensional reconstruction of ribs can accurately measure the morphological characteristics of ribs, and provide a practical method for designing internal rib fixation plates.
The effect of proximal subtotal or total gastrectomy by choosing abdominal median incision plus left 7-9 ribs resection in 32 cases of upper gastric cancer had been studied. There was 1 case of residual tumor cells at the esophageal margin, 1 case of hydrothorax and hydrops of costal bed, no costal chondritis, pneumothorax and fistula formation. We consider that it is better to choose abdominal median incision plus left ribs resection in patients with upper gastric cancer in which subphrenic esophageal invasion is under 2cm of length and the function of heart or lung is severely damaged.
ObjectiveTo investigate the feasibility and effectiveness of fast track surgery (FTS) in rib fracture fixation. MethodsFifty-two patients with chest trauma who underwent rib fracture fixation surgery in Mingji Affiliated Hospital of Nanjing Medical University from October 2010 to June 2013 were enrolled in this study. All the patients were divided into FTS group and control group. In the FTS group, there were 26 patients including 22 males and 4 females with their age of 45.62±8.20 years, who received FTS strategies. In the control group, there were 26 patients including 21 males and 5 females with their age of 46.42±7.60 years, who received traditional treatment strategies. Postoperative visual analogue scale (VAS), gastrointestinal function recovery time, postoperative hospital stay and hospitalization cost were compared between the 2 groups. ResultsVAS at 6 hours, 24 hours and 48 hours postoperatively of FTS group (4.5±0.3, 4.2±0.2, 3.2±0.1) were significantly lower than those of the control group (6.5±0.1, 6.1±0.3, 4.8±0.2) respectively (P < 0.05). Gastrointestinal function recovery time of FTS group (0.8±0.2 days) was significantly shorter than that of the control group (1.5±0.5 days, P < 0.05). Length of hospital stay (21.0±2.6 days) and hospitalization cost (5.18±0.75 ten thousand yuan) of FTS group were significantly shorter or lower than those of the control group (26.2±3.4 days and 5.78±0.64 ten thousand yuan) respectively (P < 0.05). ConclusionFTS strategies can effectively reduce postoperative VAS, shorten length of hospital stay, decrease hospitalization cost, and promote postoperative recovery of rib fracture patients.
Objective To explore the cl inical appl ication of rib autograft for reconstructing il iac crest by anterior approach of thoracic and lumbar vertebrae, and to observe the short-term and long-term effects. Methods From September 2004 to September 2007, 54 cases of thoracic and lumbar injuries were treated by the surgery of anterior approach of thoracic and lumbar vertebrae.There were 39 males and 15 females with an average age of 42 years old (range, 27-59 years old), including 4 cases of tuberculosis of spine and 50 cases of thoracic and lumbar vertebrae bursting fracture. All cases underwent the surgery of anterior approach of thoracic or lumbar and il iac crest was used as autograft. Fifty-four patients wererandomized into the reconstruction group (RG, n=25) and the non-reconstruction group (NRG, n=29). The patients of RGgroup were treated with rib autograft for reconstructing il iac crest. There were no statistically significant differences in general data between two groups (P gt; 0.05). The visual analogue scores (VAS) was used to estimate pain degree of treated hip after 2 weeks, and 3, 12 months. The extenion satisfaction grade of il iac crest and the comfort degree of action while bundl ing waist belt were estimated after 12 months. It was observed whether or not anterior superior il iac spine avulsion fracture occurred on the premise of non-accidental trauma within 1 year. The occurrence of fracture and the union status of reconstructed il iac crest were observed by X-ray after 1 year. Results All wounds achieved primary heal ing. No compl ication was found at early stage. All patients were followed up 1 year. There was no significant difference in the VAS of the treated hip under conditions of cl inostatism rest between two groups after 2 weeks and 3 months (P gt; 0.05). But there was significant difference in the VAS under conditions of action after 2 weeks and 3 months, under conditions of cl inostatism rest after 12 months (P lt; 0.05), and the VAS of RG was lower than that of NRG. The exterior satisfaction grade of il iac crest and comfort degree of action while bundl ing waist belt in RG were higher than those in NRG after 1 year, showing significant differences (P lt; 0.05). No anterior superior il iac spine avulsion fracture occurred after 1 year. And in RG group no fracture of reconstructed il iac crest occurred after 1 year. The X-ray film showed that the two ends of rib reconstructed by il iac crest were blur, and that the rib healed well with il iac bone. Conclusion Rib autograft for reconstruction of il iac crest by anterior approach of thoracic and lumbar vertebrae was economic and convenient. It could improve local appearance, reduce the local pain, and improve patients’ l ife quality.