Objective To summarize the therapeutic effects of mesh-plug tension-free hernioplasty in eldly bilateral inguinal hernia.Methods 22 patients were treated by mesh-plug hernia repair in one operation.The operative procedure, postoperative pain,ability recovery, com-plications and recurrence rate were studied. Results All the operativeprocedure were performed smoothly. The postoperative complications included:4 cases of scrotal hydroceles, 3 urinary retention and 2 (subcutaneous) haematoma. 1～23 months follow-up were taken, no recent recurrence was founded.Conclusions Mesh-plug tension-free hernioplasty has the advantages of simple performance, less trauma and fewer recurrence.It is especially suitable to the eldly patients with bilateral inguina hernia.

BACKGROUND: Compound antitumor coral hydroxyapatite (CCHA) has a good delayed-release and anti-tumor effect. However, whether the high-dose drug contained in the CCHA influences normal induction, conduction and growth of bone tissues at the implant site is unclear.OBJECTIVE: To establish an osteogenesis model of CCHA and to investigate the osteogensis effect and rule of self-made CCHA in vivo. METHODS: Implants of CCHA (20%CDDP-CHA w/w) and CHA(control, 0% CDDP w/w) were implanted into the metaphyseal holes of rabbit femur. X-rays and decalcified histological section of rabbit femoral bone with hematoxylin and eosin staining were used regularly to investigate the degradation of CCHA and CHA, and how bone tissues grow at the implant site. RESULTS AND CONCLUSION: After implantation, CHA crystals were faster than CCHA in connecting with surrounding bone tissues and forming bone bridges. The borderlines of implanted CHA became obscure in 4 weeks. Loose connective tissues were found in pores of the CHA and osteoblasts were growing on the surface. Bone tissues of the surrounding gradually grew into the CHA, finally repaired the bone defects. At the beginning of implantation, CCHA mainly inhibited the growth of surrounding tissues until 6-12 weeks later, normal bone tissues gradually grew into pores of CCHAs, and healed bone defects at 26 weeks. CCHA can inhibit the osteogenesis effects at early stage; however, it can achieve bone healing with surrounding bone defect ultimately.

BACKGROUND: Magnalium which is potential to be the medical biodegraded metal implant is more and more interesting,but it must be well biocompatibility to human body.OBJECTIVE: To evaluate the sensitization of magnalium (AZ31B).METHODS: A total of 35 guinea pigs were randomly divided into saline group (negative control group,n=10),5% volume of formaldehyde (positive control group,n=10),and AZ31B group (n=15).Sensitization test at the maximal dosage was performed according to "Biological evaluation of medical devices-Part 10: Tests for irritation and delayed-type hypersensitivity",including intracutaneous induction,local induction,and provocation.Patch was removed after 6,24,48,and 72 hours,and the skin response was classified accordingto Magnusson and Kligman criteria.Patch was removed after 72 hours,and skin was performed with biopsy,stained with FIE staining,and observed under optic microscope.RESULTS AND CONCLUSION: Sensitization response was not tested in both negative control group and AZ31B group at 24,48,and 72 hours after patch removal; however,moderate erythema was observed in the positive control group.Optic microscope demonstrated that criteria of allergy such as spongiosis,edema,and diffuse as well as perivascular mononuclear infiltration was not observed in the AZ31B group,but a few basophilic calls ware observed.This suggested that AZ31B was biologically safe for sensitization.

OBJECTIVETo investigate the influence of non-diabetic hyperglycemia on postoperative complications following laparoscopic colorectal cancer resection.

METHODSClinical data of 636 patients undergoing laparoscopic colorectal cancer resection in The Affiliated Nanhai Hospital of Southern Medical University between 2009 and 2013 were analyzed retrospectively. After excluding cases with diabetes mellitus, the patients were divided into the hyperglycemia group (blood glucose level>7.8 mmol/L at any time during hospitalization period, n=161) and the non-hyperglycemia group (n=309).

RESULTSCompared to non-hyperglycemia group, hyperglycemia group had more intraoperative blood loss [(186±80) ml vs. (158±74) ml, P=0.007] and longer postoperative hospital stay [(14.0±6.8) d vs. (11.2±5.5) d, P=0.013]. The overall rate of postoperative complication was 24.8% and 16.5% respectively (P=0.030), in the hyperglycemia and the non-hyperglycemia groups, and the mortality was 1.2% and 0.6% respectively (P=0.541). Multivariable analysis showed hyperglycemia was an independent risk factor of postoperative complication (RR=2.425, 95% CI:1.210-4.226, P=0.006).

CONCLUSIONSNon-diabetic hyperglycemia may increase the risk of postoperative complications following laparoscopic colorectal cancer resection. Perioperative blood glucose monitoring should be performed, regardless of patients with or without diabetes.

Colorectal Neoplasms ; Diabetes Mellitus ; Digestive System Surgical Procedures ; Humans ; Hyperglycemia ; Laparoscopy ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Risk Factors

Objective To evaluate the biomechanical characteristics and the clinical advantage of transoral atlantoaxial reduction plate(TARP)Ⅲ.Methods Design of TARP-Ⅲ was based on TARP-Ⅱ.The screw hole in the axis was moved 1-2 mm upwards and inwards in a plate which turned a vertebral screw into a pedicle screw or an articular process screw.A polyaxial self-lock ring and polyaxial guiding drill were added to the crew hole of the plate.Finally,the withdrawal resist ence force of the three axis screws was tested and TARP-Ⅲ was used in 44 patients with complicated irreducible atlantoaxial dislocation.The axis was fixed with the pedicle screw or the articular process screw.Results The maximum withdrawal resist ence force of the anterior pedicle screw,the articular process screw and the vertebral screw in the axis was(593.1 ± 97.8)N,(469.9 ± 73.3)N and(395.2 ± 75.1)N respectively,with statistical difference between groups among three fixation methods(P ＜ 0.05).All 44 patients were followed up for 5-38 months(average 18 months),which showed complete anatomic reduction in 36 patients and appropriate anatomic reduction in eight,with basic correction of the angles between the brain stem and the spinal cord and sufficient decompression of the spinal cord.The decompression rate of the cervical spinal cord was average 88.2% according to the Yin evaluating method of cervical cord decompression.The improvement rate of spinal cord function was average 76.6% according to Japanese Orthopaedic Association(JOA)score.Conclusion With the design of polyaxial self-lock mechanism,TARP-Ⅲ with the pedicle screw or the articular process screw surpasses TARP-Ⅱ with vertebral screw in aspect of biomechanics.

Objective To investigate the clinical effect of posterior screw-rod fixation fusion for the treatment of atlantoaxial dislocation due to rheumatoid arthritis.Methods From January 2011 to December 2015,15 patients with atlantoaxial dislocation due to rheumatoid arthritis were treated,including 6 males and 9 females,aged 35 to 75 years (mean 55 years).All cases were evaluated about the difficulty of relocation by extension-flexion X-ray and treated with posterior screw-rod reduction,fixation and autogenous bone grafting under general anesthesia.Atlantodental interval (ADI) was measured and collected before and after surgery.Visual Analogue Scale/Score (VAS),American Spinal Cord Injury Association (ASIA) and Japanese Orthopaedic Association (JOA) scores were comprehensively used to evaluate the clinical effect.1 week,3,6,12 months postoperatively and the annual review of the X-ray and CT were checked,in order to evaluate the reduction,internal fixation and bone graft fusion.Results All patients were reducible dislocation and successfully performed the posterior screw-rod fixation fusion surgery.The patients were followed up for 3 to 24 months (average,15 months).Atlantoaxial solid bony fusion was obtained from 3 to 6 months.ADI reduced from preoperative 6.3±1.7 mm to postoperative 2.2±0.8 mm,VAS score reduced from preoperative 5.4±2.7 to postoperative 1.7±1.0,ASIA motor score improved from preoperative 82.3±15.6 to 95.3±4.5 at 6 months after the surgery,JOA score increased from preoperative 13.8±2.9 to 15.5±1.4 at 6 months after the surgery,and the statistical significance was revealed between preoperation and postoperation.Nine cases were in D grade of ASIA,3 cases improved from D to E grade after surgery,2 cases reached E grade in the other 6 cases after 6 months,2 cases recovered to E grade after 12 months and other 2 cases in D grade got uniformity after surgery.Well internal fixation and no redislocation were found on X-ray and CT during follow-up period.Conclusion Atlantoaxial dislocation because of rheumatoid arthritis was numerously reducible genre.Posterior screw-rod fixation and autogenous bone grafting can gain satisfying clinical efficacy.

Objective:To report our experience in diagnosis and treatment of posterior atlantoaxial dislocation with odontoid retrolisthesis.Methods:A retrospective study was conducted of the 5 patients who had been treated from July 2012 to August 2018 at Department of Orthopaedics, General Hospital of Southern Theater Command for posterior atlantoaxial dislocation. They were 4 men and one woman, aged from 34 to 67 years (average, 47 years). All of them had a history of trauma. Of them, 4 were complicated with odontoid fracture and one with congenital free os odontoideum. Their posterior atlantoaxial dislocation ranged from 3 to 9 mm (average, 6 mm). By the American Spinal Injury Association (ASIA) grading system, their preoperative spinal injury was rated as grade B in one, as grade C in 3 cases and as grade D in one. All the 5 patients underwent skull traction at 10° flexion. Surgical trans-oralpharyngeal atlantoaxial reduction and internal fixation was performed for the one patient whose reduction had not been achieved by traction while posterior atlantoaxial screw-rod fixation or anterior odontoid screwing was conducted for the 4 patients whose reduction had been achieved by traction. The distance of posterior atlantoaxial dislocation was measured to evaluate their reduction and ASIA grade system was used to assess their spinal function after operation.Results:The postoperative distance of posterior atlantoaxial dislocation was 0 mm, showing a reduction rate of 100%. The 5 patients were followed up for 6 to 36 months (average, 15 months). By the ASIA grade system, the postoperative functional recovery of the spine was grade D in 4 cases and grade C in one. No implant loosening or breakage occurred.Conclusion:As a kind of high-energy hyperextension injury, posterior atlantoaxial dislocation is rare in clinic, but an appropriate treatment can be adopted to deal with its different clinical types to achieve good outcomes.