Object ive To explore the ef fect s of di f ferent surgical methods on plantar ulcer s in leprosy. Methods The cl inical data of 71 patients with leprosy plantar ulcers and treated with different surgical methods between October 1950 and October 2006 were analyzed retrospectively. In group A, 34 cases underwent debridement, including 26 males and 8 females aged 53-88 years old (average 72.4 years old); the course of ulcer averaged 29.0 years; the size of ulcer ranged from 5 cm × 3 cm × 2 cm to 11 cm × 7 cm × 3 cm; the disabil ity degrees of the affected foot was mild in 25 cases andsevere in 9 cases according to the self-designed evaluation system. In group B, 22 cases received foot pressure rebuilding surgery, including 19 males and 3 females aged 48-83 years old (average 69.8 years old); the course of ulcer averaged 33.5 years; the size of ulcer ranged from 5 cm × 3 cm × 2 cm to 12 cm × 7 cm × 3 cm; the disabil ity degrees of the affected foot was mild in 12 cases and severe in 10 cases. In group C, 15 cases were repaired with the transposition of toe flap, foot arch flap, acrotarsium flap, or medial tibia flap, including 11 males and 4 females aged 43-73 years old (average 64.6 years old); the course of ulcer averaged 29.3 years; the size of ulcer ranged from 6 cm × 3 cm × 2 cm to 11 cm × 5 cm × 3 cm; the disabil ity degrees of the affected foot was mild in 9 cases and severe in 6 cases. No significant differences were evident among three groups in terms of the general information (P gt; 0.05), except for the difference between group A and group C on age (P lt; 0.05). Results Group A: 19 out of 34 cases healed and the average heal ing time was 46.8 days; all patients were followed up for 2-45 years (average 17.2 years); the rate of ulcer heal ing 1 year after operation was 55.9% (19/34); 12 healed ulcer patients relapsed at average 1.5 years after operation; the rate ofulcer heal ing at last follow-up was 20.6% (7/34). Group B: 18 out of 22 cases healed and the average heal ing time was 29.2 days; all patients were followed up for 2-50 years (average 13.3 years); the rate of ulcer heal ing 1 year after operation was 81.8% (18/22); 7 healed ulcer patients relapsed at average 3.3 years after operation; the rate of ulcer heal ing at last follow-up was 50.0% (11/22). Group C: 14 out of 15 cases healed and the average heal ing time was 27.1 days; all patients were followed up for 3-12 years (average 8.8 years). The rate of ulcer heal ing 1 year after operation was 93.3% (14/15); 7 healed ulcer patients relapsed at average 4 years after operation; the rate of ulcer heal ing at final follow-up was 46.7% (7/15). For the rate of ulcer heal ing 1 year after operation, there was a significant difference between group A and group B, and between group A and group C (P lt; 0.05), but no significant difference was evident between group B and group C (P gt; 0.05). For the rate of ulcer heal ing at the final follow-up visit, there was a significant difference between group A and group B (P lt; 0.05), but no significant difference was evident between group A and group C, and between group B and group C (P gt; 0.05). Conclusion The surgical treatment of plantar ulcers in leprosy should include the alleviation of the plantar high-pressure zone and the transposition of the flaps, providing good short-term and long-term therapeutic effect.
ObjectiveTo investigate the effects of large trauma craniotomy on severe traumatic brain injury. MethodsA total of 132 cases of severe traumatic brain injury adopted large trauma craniotomy between July 2008 and August 2013, and the clinical data were retrospectively analyzed. ResultsAccording to the results of GOS assessment at discharge, 67 patients (50.75%) were satisfied, 26 (19.70%) were mildly disable, 10 (7.58%) were severely disable, 12 (9.09%) were in vegetative state, and 17 (12.88%) were dead. ConclusionCorrect use of large trauma craniotomy on severe brain injury cases will help to improve the treatment outcome, reduce complications and improve quality of survival.
Objective To evaluate the therapeutic effect and safety of Bupropion hydrochloride sustained-release tablets in the treatment of depression. Methods A total of 48 patients meeting the diagnostic criteria of depression of CCMD-3 were randomly treated with Bupropion hydrochloride sustained-release tablets or Fluoxetine tablets for 42 days. Hamilton depression rating scale, Hamilton anxiety rating scale, clinical global impression and treatment emergent symptom scale were used to evaluate the therapeutic effect. Blood routine test, urine routine test and electrocardiogram were examined before and after the treatment. Results The effective rate of Bupropion hydrochloride sustained-release tablets [83% (20/ 24) ] was higher than that of Fluoxetine tablets [63% (15/ 24)], with a P value of 0.104. The incidence of adverse reactions was 46% (11/24) in both groups. Conclusion The therapeutic effect of Bupropion hydrochloride sustained-release tablets on depression is similar to that of Fluoxetine tablets, with mild adverse reactions to both treatments.
Objective To study the indications, methods, and therapeutic effect of absorbable rib-connecting-pins fixation in the treatment of multi ple rib fractures. Methods Between March 2007 and September 2009, 40 patients with multiple rib fractures received internal fixation with absorbable rib-connecting-pins, including 8 one-side flail chest and 1 twoside flail chest. There were 32 males and 8 females with an average age of 39.8 years (range, 25-72 years). The injury was caused by traffic accident in 32 cases, fall ing from height in 6 cases, and blunt hitting in 2 cases. Preoperatively, imaging data of the chest X-ray or spiral CT three-dimensional (3D) examination showed that all patients had multiple ribs fractures and displacement. The number of fractured ribs was 4-10 (median, 6), and the fracture location ranged from the 2nd to the10th ribs. Of them, 28 cases were accompanied by hemathorax, pneumathorax or hemopneumothorax; 5 cases by thoracic organ injury; and 10 cases byother part trauma. The time from injury to hospital ization was less than 1 day in 26 cases, 1-3 days in 12 cases, and 3-6 days in 2 cases, and the time from hospital ization to operation was 3 hours to 3 days (mean, 1.2 days). Results The median fixation rib number was 5 (range, 3-8). The mean operative time, the time in bed, and hospital ization days were 32 minutes (range, 15-50 minutes), 4.5 days (range, 2-7 days), and 11.2 days (range, 5-18 days), respectively. All incisions healed by first intention. No pulmonary infection, pulmonary atelectasis, intrathoracic infection or other compl ications occurred. All cases were followedup 6-12 months (mean, 8 months). PaO2 [(86.6 ± 2.2) mmHg (1 mm Hg=0.133 kPa)] and SpO2 (97.2% ± 0.6%) at 2 hours after operation were obviously improved when compared with preoperative ones [PaO2 (53.6 ± 4.7) mm Hg and SpO2 (86.2% ± 1.8%)], showing significant differences (t=2.971, P=0.005; t=2.426, P=0.020). The chest X-ray films or spiral CT 3D indicated that fracture of rib healed within 3-6 months (mean, 4.5 months) after operation. Conclusion Severe collapsed chest wall orflail chest caused by fracture of multiple ribs should be treated by absorbable rib-connecting-pins, which is a simple, firm, and effective method.
Objective To investigate the influence of spinal cord decompression on posterior surgical treatment of thoracolumbar fracture, and to provide the practical basis for the indications of posterior spinal cord decompression Methods The cl inical data were retrospectively analyzed from 170 cases of thoracolumbar fracture treated with posterior surgical treatment between January 2005 and January 2009. There were 119 males and 51 females with an average age of42.7 years (range, 17-68 years). The fracture locations included T11 in 22 cases, T12 in 30 cases, L1 in 57 cases, and L2 in 61 cases. According to Denis classification system, there were 65 cases of compression fractures, 44 cases of burst fractures, 25 cases of flexion-distraction injuries, and 36 cases of fracture-dislocations. The time from injury to operation was 3-8 days (mean, 4.4 days). All the cases were divided into 4 groups according to space-occupying rates of spinal cord: group A, ≤20% (n=32); group B, 21%-40% (n=68); group C, 41%-60% (n=37); and group D, ≥ 61% (n=33). Through statistical analysis, the correlation between space-occupying rates and spinal cord function (Frankel grade) was evaluated, and the necessities of spinal cord decompression was studied in the patients who had neurological symptoms with space-occupying rates under 40%. Results There was no positive correlation between the degree of spinal cord injury and the space-occupying rates of bone fragments broken into the spinal canal. All patients were followed up 13-41 months (mean, 23.5 months). During the follow-up period, no secondary neurological damage occurred in the patients who were not given posterior spinal cord decompression with space-occupying rates under 40% (28 cases). And also in the cohort of patients with neurological symptoms whose space-occupying rates were under 40%, the posterior spinal cord decompression (65 cases) could improve the spinal cord function significantly when compared with no decompression cohort (7 cases), (P lt; 0.05). Conclusion The relative indications of posterior spinal cord decompression for thoracolumbar fracture are as follows: the cases having neurological symptoms with space-occupying rates under 40% and the ones having the neurological symptoms or not with space-occupying rates above 40%.
Objective To investigate the value of using Footscan system to evaluate the therapeutic effect of two internal fixation methods on calcaneus fractures. Methods From February 2006 to September 2006, 64 patients with fresh unilateral closed calcaneus fractures were randomly divided into two groups. The experimental group: 32 patients underwentminimally invasive open reduction and internal fixation with improved compressing plate and screw, including 28 males and 4 females aged 20-53 years old (average 36.7 years old); the course of disease was 3-14 days; there were 19 cases of type II, 11 of type III, and 2 of type IV according to Sanders fracture classification system. The control group: 32 patients underwent internal fixation of standard AO plate via L-shaped incision, including 29 males and 3 females aged 18-56 years old (average 37.1 years old); the course of disease was 4-15 days; there were 18 cases of type II, 11 of type III and 23 of type IV according to Sanders fracture classification system. No significant difference was noted between two groups in the general information (P gt; 0.05). At 1 and 2 years after operation, dynamic plantar pressure was measured using Footscan system, Maryland foot scores of two groups was compared, and statistical analysis was performed. Results All patients were followed up for 2 years. No infection, cuticular border necrosis, and sural nerve distal end injury occurred in the experimental group, whereas in the control group, 3 patients suffered from cuticular border necrosis and recovered after dressing, and 1 patient had sural nerve distal end injury with decreased sensation in local skin. At 1 and 2 years after operation, in the control group, there were significant differences between the injured foot and the normal foot in terms of impulse, instep index, motion range of subtalar joint, lateral displacement of footplate pressure center, and calcaneal width when patients stood on both feet (P lt; 0.05), whereas in the experimental group, no significant differences were noted between the injured foot and the normal foot in terms of the above parameters (P gt; 0.05). Significant differences were noted between two groups in terms of the above parameters (P lt; 0.05). The Maryland score 1 yearafter operation was (86.74 ± 8.56) points for the experimental group and (71.24 ± 10.06) points for the control group; at 2 years after operation, it was increased to (87.35 ± 8.49) points and (72.41 ± 9.69) points, respectively, indicating there was a significant difference between two groups (P lt; 0.05). Conclusion Operative outcomes of internal fixation with improved compressing plate are superior to those of standard AO plate. Footscan system can provide a quantitative assessment on the operative effect of calcaneus fractures.
Objective?To compare the double dorsal phalangeal flap (DDPF) with the combination of digital neurovascular island flap (NVIF) and first dorsal metacarpal artery flap (FDMA) in terms of repairing digit degloving injury.?Methods?From October 2005 to March 2008, DDPF was used to repair 9 patients (9 fingers) with degloving injury of the thumb and index finger and completely amputated thumb and index finger (group A). From August 1996 to June 2007, NVIF and FDMA were used to repair 13 patients (13 fingers) with the thumb degloving injury and completely amputated or necrotic thumb (group B). In group A, there were 7 males and 2 females aged 19-48 years old, there were 4 cases of thumb and index finger degloving injury repair and 5 cases of completely amputated thumb and index finger reconstruction, the skin defect ranged from 6.0 cm × 3.5 cm to 7.0 cm × 4.5 cm, and the interval between injury and operation was 3-10 hours. The size of DDPF harvested during operation was 4.0 cm × 3.5 cm-5.0 cm × 4.0 cm. In group B, there were 10 males and 3 females aged 18-50 years old, there were 5 cases of thumb degloving injury repair and 8 cases of completely amputated or necrotic thumb reconstruction, the skin defect ranged from 6.0 cm × 3.0 cm to 7.0 cm × 4.5 cm, and the interval between injury and operation was 3 hours-5 days, and the size of NVIF and FDMA harvested during operation was 3.5 cm × 3.0 cm-5.0 cm × 4.0 cm. The donor site was repaired with the full-thickness skin graft.?Results?All the flaps survived uneventfully except for 1 case in group A suffering from venous crisis 1 day after operation and 2 cases in group B suffering from FDMA artery crisis 4-12 hours after operation. Those flaps survived after symptomatic treatment. All the wounds healed by first intention. All patients in two groups were followed up for 1-12 years (average 3.2 years). All the donor sites were normal except for 3 cases in group B suffering from flexion contracture deformity of the proximal interphalangeal joint due to the scar contracture in the margin of NVIF donor site. According to Allen test, the skin temperature and color of the donor fingers in two groups were normal under room temperature; 1 case of group A and 6 NVIF donor fingers of group B were pale and cold under ice water. According to sensory recovery evaluation system, 16 fingers in group A were graded as S4, 1 as S3+, and 1 as S2; while in group B, 3 NVIF fingers were graded as S3, 6 NVIF fingers as S2, 4 NVIF fingers as S1, and 13 FDMA fingers as S4. The appearance of the recipient flap was satisfactory and the color was similar to the surrounding skin. The skin temperature and color of the flaps in two groups were normal under room temperature; 2 cases of group A and 4 recipient fingers of group B were pale and cold under ice water. In group A, all the palmar flap of the recipient finger achieved the reorientation of the recipient flap sensation; while in group B, 8 cases achieved the reorientation of the recipient flap sensation, and 5 cases had double sensation. For the two-point discrimination of the flap, group B was superior to that of group A in terms of the palmar aspect (P lt; 0.05), no significant difference was evident between two groups in terms of the dorsal aspect (P gt; 0.05), and the palmar aspect of each group was superior to the dorsal flap (P lt; 0.05).?Conclusion?DDPF is less invasive to donor finger, easy to be operated, able to partially restore the sensory of the injured finger, and suitable for the repair of the degloving injury of the thumb and the index finger. Combination of NVIF and FDMA can restore the fine sensory of recipient palmar flap better and is applicable for those patients suffering from digital nerve defects from the proximal phalanx and with high demand for the recovery of thumb sensory.
ObjectiveTo evaluate the changes of left ventricular morphology and contractile function of patients with mitral stenosis and small left ventricle after mitral valve replacement. MethodsStudies on the changes of left ventricular morphology and contractile function of patients with mitral stenosis and small left ventricle after mitral valve replacement were searched from the databases of Wangfang, VIP, CNKI, PubMed, Elsevier Science Direct, and Cochrane Library from establishment to January 2015. Quality of articles was evaluated. Relevant data were extracted from eligible studies to conduct meta-analysis. Mean differences (MD) of left ventricle end-diastolic volume index (LVEDVI), left ventricle end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and left ventricular fraction shortening (LVFS) between the preoperative and the postoperative value from eligible studies were analyzed and pooled, and their 95% confidence intervals (CI) were calculated. R2.15.3 software was applied for statistical analysis. ResultsEight eligible studies involving 446 patients were analyzed in the study. The quality of included literature was high. The results of meta-analysis showed that LVEDVI and LVEDD increased by 14.51 ml/m2 with 95%CI -22.78 to -6.25 (P<0.01) and 4.88 mm with 95%CI -10.85 to 1.09 (P=0.11) respectively at 2 weeks postoperatively compared with preoperative value. LVEF decreased by 3.05% with 95%CI -3.02% to 9.12% (P=0.32) while LVFS increased by 1.16% with 95%CI -4.83% to 2.50% (P=0.53) at 2 weeks postoperatively. Compared with preoperative value, LVEDVI and LVEDD markedly increased by 16.11 ml/m2 with 95%CI -20.32 to -11.90 (P<0.01) and 10.56 mm with 95%CI -11.52 to -9.60 (P<0.01) respectively at 6 months postoperatively. LVEF and LVFS increased by 7.69% with 95%CI -17.18% to 1.8% (P=0.11) and 6.21% with 95%CI -10.07% to -2.36% (P<0.01) respectively at 6 months postoperatively compared with preoperative value. ConclusionLeft ventricular morphology and contractile function of patients with mitral stenosis and small left ventricle recovers well after mitral valve replacement.
Objective To investigate the treatment methods and the cl inical therapeutic effects of symptomatic cervical vertebral hemangioma associated with cervical spondylotic myelopathy. Methods A retrospective analysis was performed in 18 patients (10 males and 8 females, aged 30-62 years with an average age of 45.3 years) with cervical vertebral hemangioma associated with cervical spondylotic myelopathy between January 2006 and September 2008. The disease duration was 10-26 months (mean, 15.6 months). All patients had single vertebral hemangioma, including 2 cases at C3, 3 cases at C4, 5 cases at C5, 5 cases at C6, and 3 cases at C7. The X-ray films showed a typical “pal isade” change. According to the cl inical and imaging features, there were 13 cases of type II and 5 cases of type IV of cervical hemangioma. The standard anterior cervical decompression and fusion with internal fixation were performed and then percutaneous vertebroplasty (PVP) was used. The cervical X-ray films were taken to observe bone cement distribution and the internal fixation after operation. The recovery of neurological function and the neck pain rel ief were measured by Japanese Orthopaedic Association (JOA) score and visual analogue scale (VAS) score. Results All operations were successful with no spinal cord and nerves injury, and the incisions healed well. Anterior bone cement leakage occurred in 2 cases without any symptoms. All cases were followed up 24-28 months (mean, 26 months) and the symptoms were improved at different degrees without fracture and collapse of vertebra or recurrence of hemangioma. During the follow-up, there was no implant loosening, breakage and displacement, and the mean fusion time was 4 months (range, 3-4.5 months). The JOA score and VAS score had a significant recovery at 3 months and at last follow-up when compared with preoperative values (P lt; 0.05). Based on JOA score at last follow-up, the results were excellent in 9 cases, good in 6 cases, fair in 2 cases, and poor in 1 case. Conclusion The anterior cervical decompression and fusion with internalfixation combined with PVP treatment is one of the ideal ways to treat symptomatic cervical vertebral hemangioma associated with cervical spondylotic myelopathy, which could completely decompress the spinal cord and effectively alleviate the cl inical symptoms caused by vertebral hemangioma.
ObjectiveTo summarize the clinical characteristics and mid-long term efficacy of children under 15 years with mechanical valve replacement. Methods We retrospectively analyzed the clinical data of 51 children aged 1 to 15 years underwent mechanical valve replacement in Xinhua Hospital between January 2006 and January 2014. There were 32 males and 19 females with mean age of 9.6±4.0 years (ranged 1-15 years). ResultsThe average cardiopulmonary bypass time was 120.50±61.02 minutes, and average aortic cross-clamping time was 68.35±42.68 minutes. One patient died in hospital. There were 6 patients (11.8%) with complications including mitral paravalvular leakage in 1 patient, malignant ventricular arrhythmia in 1 patient, respiratory failure in 1 patient, acute renal failure in 2 patients, and delayed thoracic close in 1 patient. All the children cured and were followed up for 1-96 months. One patient died during the follow-up time. No other redo-valve replacement or complications correlated to anticoagulant occurred. ConclusionsMechanical valve replacement may be necessary in children with extremely dysplastic valves and severe hemodynamic impairment or after failed repair. With appropriate selection of the prosthetic valve and intensive care therapy during the peroperative period, the mid to long term efficacy is optimistic.