OBJECTIVETo study the effect of prosthetic replacement in treatment of femoral neck fractures on the hemiplegia side in the elderly.

METHODSFrom May 1990 to May 2000, 189 elderly patients with femoral neck fractures were treated with prosthetic replacement in my hospital. Twenty-nine hemiplegia patients, who suffered from stroke previously, had Garden type III and type IV femoral neck fractures on the hemiplegia side. Thirty non-hemiplegia patients were chosen randomly. The two groups were followed-up for 27-98 months (average: 59 months). The age, hospitalization days, operating time, blood loss, blood transfusion, complications during perioperative period and long-term complications were compared between the two groups and the results of femoral head replacement and total hip replacement in the hemiplegia group were also compared.

RESULTSAll the patients of the two groups survived the perioperative period. No significant difference was found in the age, hospitalization days, operation time, blood loss and blood transfusion and long-term complications between the two groups (P>0.05). However there was significant difference in complications during perioperative period between the two groups (P<0.05). Five patients died in the hemiplegia group with the mortality of 17.2% and two died in the non-hemiplegia group with the mortality of 6.7% 11 months to 5 years after operation. There was significant difference in long-term complications between the femoral head replacement and the total hip replacement in the hemiplegia group (P<0.05). The result of the total hip replacement was better than that of the femoral head replacement.

CONCLUSIONSProsthetic replacement is a reliable method in treatment of Garden type III and type IV femoral neck fractures on the hemiplegia side in the elderly, and patients are safe during perioperative period. More complications during perioperative period occur in the hemiplegia group, and long-term complications are insignificantly different between the two groups. The mortality rate is higher in the hemiplegia group than in the non-hemiplegia group within 5 years after operation. Since the result of the total hip replacement is better than that of the femoral head replacement, total hip replacement should be chosen firstly to treat Garden type III and type IV femoral neck fractures on the hemiplegia side in the elderly if the muscular strength of the hip is beyond IV degree.

Aged ; Arthroplasty, Replacement, Hip ; Female ; Femoral Neck Fractures ; etiology ; surgery ; Hemiplegia ; complications ; Humans ; Male

With China's aging society, the number of patients with hemiplegia caused by cerebrovascular accident is increasing gradually. The risk of hip fracture in the first year after the onset of this kind of patients is 4 times higher than that of ordinary people, and most of them occur in the side of hemiplegia. For senile femoral neck fracture, artificial joint replacement is almost the first choice of treatment, with mature operation technology and good curative effect. At present, it is considered that if the muscle strength of hemiplegic side can reach grade III after cerebral vascular accident, hip arthroplasty can be the first choice for hemiplegic patients with hemiplegic femoral neck fracture. However, the situation of hemiplegic patients is different from that of ordinary people. The hemiplegic limbs may have muscle atrophy, muscle strength imbalance, osteoporosis and other problems, which brings difficulties to the formulation of surgical plan. This paper mainly discusses the choice of surgical approach, the use of total hip arthroplasty or hemiarthroplasty, the use of cemented prosthesis or cementless prosthesis, and how to reduce the incidence of postoperative dislocation The purpose is to provide more reference evidence for orthopedic doctors in clinical decision-making.
Arthroplasty, Replacement, Hip ; Femoral Neck Fractures/surgery* ; Hemiarthroplasty ; Hemiplegia ; Hip Prosthesis ; Humans ; Treatment Outcome

The purpose of this study was to evaluate how soft tissue surgery for correcting equinus deformity affects the kinematic and kinetic parameters of the ankle and proximal joints. Sixteen children with spastic hemiplegic cerebral palsy and equinus deformities (age range 3-16 years) were included. Soft tissue surgeries were performed exclusively on the ankle joint area in all subjects. Using computerized gait analysis (Vicon 370 Motion Analysis System), the kinematic and kinetic parameters during barefoot ambulation were collected preoperatively and postoperatively. In all 16 children, the abnormally increased ankle plantar flexion and pelvis anterior tilting on the sagittal plane were significantly improved without a weakening of push-off (p < 0.05). In a group of 8 subjects with a recurvatum knee gait pattern before operation, the postoperative kinematic and kinetic parameters of the knee joint were significantly improved (p < 0.05). In a group of 8 subjects with ipsilateral pelvic external rotation before operation, the postoperative pelvic deviations on the transverse plane were significantly decreased (p < 0.05). These findings suggest that the soft tissue surgery for correcting equinus deformity improves not only the abnormal gait pattern of the ankle, but also that of the knee and pelvis.
Male ; Kinetics ; Joints/physiopathology/surgery ; Humans ; Hemiplegia/*surgery ; Gait/physiology ; Female ; Equinus Deformity/*surgery ; Child, Preschool ; Child ; Cerebral Palsy/*surgery ; Biomechanics ; Ankle Joint/physiopathology/surgery ; Adolescent

In this report, we describe a case of brain abscess due to odontogenic infection. A 53-year-old female who had been suffering from headache and trismus for two weeks visited the Department of Oral and Maxillofacial Surgery at the Sun Dental Hospital (Daejeon, Korea). Even after several routine tests, we still could not make a diagnosis. However, after the combined multidisciplinary efforts of oral surgeons and neurosurgeons, the patient was treated for odontogenic infection and made an uneventful recovery. Therefore, patients with infections in the head and neck region showing symptoms such as headache, changes in mental state, nausea, vomiting, seizures, hemiplegia, speech disturbance, and visual disturbance, a brain abscess should be included in the list of differential diagnoses.
Brain Abscess* ; Diagnosis ; Diagnosis, Differential ; Female ; Head ; Headache ; Hemiplegia ; Humans ; Middle Aged ; Nausea ; Neck ; Seizures ; Solar System ; Surgery, Oral ; Trismus ; Vomiting

OBJECTIVE: To investigate the clinical effects of dual mobility total hip prosthesis in treating femoral neck fracture patients with hemiplegia. METHODS: A retrospective analysis was performed on 18 patients with femoral neck fracture combined with hemiplegia who underwent dual mobility total hip prosthesis replacement from March 2014 to December 2016. The follow up data of these patients was complete. There were 5 males and 13 females, aged 65 to 70 years old with an average of (66.50±1.38) years. The left side was involved in 12 cases, while the right side in 6 cases. There were 4 cases with Garden Ⅲ type and 14 cases with type Ⅳ. Limb muscle strength of hemiplegia were in grade Ⅳ. The posterior-lateral approach of hip joint was used in surgery for all patients. The implant position, dislocation and loosening of the prosthesis were evaluated by X-ray examination. Harris hip score and the Merle D'aubigne score were used to assess the hip function in the follow up. RESULTS: The operation duration was for 70-90 (81.56±7.48) min and the blood loss during the operation was for 160-200 (170.32± 12.56) ml. No blood was transfused during the operation. Postoperative incisions were healed at the first stage. The follow-up time was for 28-60(36.0±3.5) months. Harris hip score increased from 16.94±0.73 preoperatively to 96.19±1.27 at the final follow-up(<0.05). Merle D 'Aubigne score increased from 3.96±0.06 preoperatively to 16.81±0.63 at the final follow-up(< 0.05). No fracture or nerve or vascular injury were found during the operation. The postoperative X-ray showed that the prosthesis was in good position. No complications such as joint dislocation, dislocation of prosthesis, loosening of prosthesis, fracture around the prosthesis, pain in the front of thethigh, fracture of the self tapping screw in the ilium, and delayed infection occurred in the patients after operation. CONCLUSION Dual mobility total hip prosthesis has the advantages of both good initial stability and low dislocation rate of the prosthesis, and the clinical application of total hip replacement in hemiplegic femoral neck fracture is satisfactory.
Aged ; Arthroplasty, Replacement, Hip ; Female ; Femoral Neck Fractures ; surgery ; Follow-Up Studies ; Hemiplegia ; Hip Prosthesis ; Humans ; Male ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo explore the effectiveness of modified hemispherectomy for intractable epilepsy in patients with infantile hemiplegia.

METHODSEighteen cases of patients were treated with modified hemispherectomy and the effectiveness was studied and followed up.

RESULTSThe seizures in all 18 cases of patients were controlled effectively and stopped completely in 16 cases of them, without nervous disfunction worsened. The patients' cerebral peduncles on healthy side were much thicker than those on sick side (t = 58.32, P < 0.001) and healthy peoples' (t = 14.63, P < 0.001) and the patients' cerebral peduncles on sick side were much thinner than those of healthy peoples' (t = 51.27, P < 0.001).

CONCLUSIONThe modified hemispherectomy can effectively control the seizures of patients with infantile hemiplegia without superficial cerebral hemosiderosis happened.

Adolescent ; Adult ; Child ; Child, Preschool ; Epilepsy ; complications ; surgery ; Female ; Follow-Up Studies ; Hemiplegia ; complications ; surgery ; Hemispherectomy ; adverse effects ; methods ; Hemosiderosis ; etiology ; prevention & control ; Humans ; Male ; Postoperative Complications ; etiology ; prevention & control

To analyze two common factors for perioperative ischemic stroke in patients with concomitant carotid and coronary artery severe stenosis and to improve the therapeutic effect.
 Methods: A total of 44 patients with multi-vessel coronary artery disease combined with carotid stenosis, who admitted to the Department of Cardiac Surgery, the First Affiliated Hospital of Xiamen University from 2008 to 2014, were enrolled in this study. Among them, 32 cases were male, 12 cases was female. All patients received coronary artery bypass grafting after treatment of neck diseases. The surgical outcomes and follow-up results were analyzed retrospectively.
 Results: One patient received carotid endarterectomy suffered hemiplegia, whose symptoms were improved after positive clinical treatment. One patient suffered transient ischemic attack, and 5 patients displayed the cerebrovascular syndromes a week later after surgery. Twelve patients suffered nerve function damage 48 hours later after surgery. Nine patients received intra-aortic ballon pump, 1 patient received thoracotomy hemostasis, 3 patients suffered sternal dehiscence; 27 patients showed atrial fibrillation. Two patients died after surgery. The follow-up duration ranged from 1-7 years and the follow-up rate was 90%. The ischemic symptoms were improved in 44 patients. Six patients complained the recurrence of angina, but no abnormalities were found in coronary angiography or computed tomography angiography. One patient died of malignant tumor during the follow-up duration.
 Conclusion: For patients with concomitant carotid and coronary artery severe stenosis, it is more likely to suffer ischemic cerebral stroke. However, carotid stenosis is not the only factor, other key factors relevant to ischemic cerebral stroke shouldn't be ignored either.
Atrial Fibrillation ; epidemiology ; Blood Loss, Surgical ; statistics & numerical data ; Carotid Stenosis ; complications ; surgery ; Cerebrovascular Disorders ; epidemiology ; Comorbidity ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Bypass ; adverse effects ; mortality ; Coronary Artery Disease ; complications ; surgery ; Coronary Stenosis ; complications ; surgery ; Endarterectomy, Carotid ; adverse effects ; Female ; Hemiplegia ; epidemiology ; Humans ; Intra-Aortic Balloon Pumping ; adverse effects ; Intraoperative Complications ; epidemiology ; Ischemic Attack, Transient ; epidemiology ; Male ; Nervous System Diseases ; Peripheral Nerve Injuries ; epidemiology ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stroke ; epidemiology ; Surgical Wound Dehiscence ; epidemiology ; Thoracotomy ; adverse effects

Atrial fibrillation is one of the most common cardiac arrhythmias requiring treatment. About 60% of patients with mitral valvular disease have atrial fibrillation and one third of the patients with atrial fibrillation may have the past history of thromboembolic events. Between April 1994 and June 1995, 20 patients with organic heart diseases combined with atrial fibrillation underwent open heart surgery including Cox-maze III procedure. There were 6 men and 14 women with an average age of 48 years (range, 31 to 66 years). Nineteen patients had valvular heart diseases and 1 ventricular septal defect (VSD). Mean duration of atrial fibrillation was 36 months (+/-42 months) (range, 1 to 132 months). The past medical history of thromboembolic events was positive in 7 patients (35%) and left atrial thrombi was detected in 9 patients (45%). The concomitant procedures were mitral valve replacement (MVR) and aortic valve replacement (AVR) in 5 patients, MVR in 4, MVR and tricuspid annuloplasty (TAP) in 4, mitral valvuloplasty (MVP) in 3, MVP and TVP in 1, MVP and coronary artery bypass surgery in 1, AVR in 1, and patch closure of VSD in 1. Mean aortic cross-clamping time was 175 minutes (range, 116 to 270 minutes). Atrial fibrillation recurred in 16 patients (80%) during the early postoperative period, however, the recurrent atrial fibrillation converted to regular rhythm at postoperative forty-first day in average. There was no early or late death in this series of 20 patients and postoperative complications were inappropriate tachycardia in 5 patients (25%), low cardiac output syndrome in 3 (15%), aggravated hemiplegia in 1, and acute renal failure in 1. Mean follow-up interval of the patients was 16.5 months (range, 10.5 to 24 months) and all the patients are currently in regular rhythm. Seventeen patients (85%) are in sinus rhythm and 3 (15%) in junctional rhythm. Right atrial contraction was detected in 95% of patients and left atrial contraction in 63% on postoperative transthoracic echocardiogram. The surgical treatment of atrial fibrillation concomitant with open heart surgery is warranted in the recent clinical setting of improved myocardial protection technique, considering the untoward side-effects of atrial fibrillation.
Acute Kidney Injury ; Aortic Valve ; Arrhythmias, Cardiac ; Atrial Fibrillation* ; Cardiac Output, Low ; Coronary Artery Bypass ; Female ; Follow-Up Studies ; Heart Diseases ; Heart Septal Defects, Ventricular ; Heart Valve Diseases ; Heart* ; Hemiplegia ; Humans ; Male ; Mitral Valve ; Postoperative Complications ; Postoperative Period ; Tachycardia ; Thoracic Surgery*