Artificial hip replacement is the most universal and effective means for treating terminal stage disease of hip joint. At present, the metal, ceramic, organic polymer and composite materials used in hip prosthesis have various problems. Metal ions or particles which released from metal materials can increase the wear rate and have potential toxicity to human. Polymers results in arthroplasty failure by bone resorption with macrophages. Bioceramic has poor mechanical property, and cause bioactivity decrease at over high temperature. Accordingly, the biocompatibility of hip prosthesis materials can be enhanced by improving design and manufacturing technology, increasing abradability and mechanical property, enhancing associativity, decreasing stress shielding, which can prolong serve life of the prosthesis.

Objective To study the effect of topical application of tranexamic acid(TXA)in total hip arthroplasty(THA).Methods A total of 63 patients with unilateral THA were enrolled in this study from November 2014 to March 2016.All patients were randomly divided into group A(n=37)and group B(n=26).Group A was injected with 2.0 g TXA(dissolved in 10 mL saline)in the joint cavity tube after the end of the surgical dressing.Group B injected the same amount of saline.The hemoglobin,hematocrit,postoperative blood loss,blood transfusion,blood transfusion and replacement of 24,48,72 h after the replacement,24,48 and 72 h after fibrinogen,prothrombin time and activation of part of the thromboplastin time,lower extremity deep vein ultrasound between the two groups were compared.Results The hemoglobin,hematocrit,postoperative blood loss,blood transfusion and blood transfusion were significantly better in group A than those in group B at 24,48 and 72 h after replacement(P<0.05).There was no significant difference in fibrinogen,prothrombin time and activated partial thromboplastin time between the two groups before and after replacement for 24,48,72 h(P>0.05).Conclusion The local application of TXA group can significantly reduce the THA perioperative blood loss without the increase of the risk of deep vein thrombosis.

Objective:To explore Toll-like receptor 2 (TLR2) and TLR4 polymorphism in Han people from Hunan region and its association with coronary atherosclerotic heart disease.Methods:Sanger sequence and statistical analysis were performed to identify the polymorphism of TLR2 and TLR4 genes in 347 unrelated Hunan Han subjects,including 180 healthy people (control group) and 167 patients with coronary atherosclerotic heart disease (coronary atherosclerotic heart disease group).Results:There was no significant difference in the genotype frequency and allelic frequency for TLR2 SNP2258G＞A and TLR4 SNP896A＞G between the 2 groups (P＞0.05),while there was significant difference in the TLR4 SNP1196C＞T between the 2 groups (P＜0.05).Conclusion:TLR4 SNP 1196C ＞T polymorphism is associated with coronary atherosclerotic heart disease in Chinese Han populationin in Hunan region.

OBJECTIVE: To explore the indications and the effective treatment methods of laryngeal function preserva tion in aged patients with hypopharyngeal carcinoma. METHOD: Clinical data about 41 patients with hypopharygeal carcinoma were analysed. These patients were more than or equal to 60 and were treated from January 2006 to December 2011. Among them, 25 cases were treated with laryngeal functions preserved and the hypopharynx defect was immediately re paired by the adjacent tissue flap or (and) the pactoralis major myocutaneous flap according to the size of defect after tumor resecting. The survival rate was calculated by Kaplan-Meier method. RESULT: In 25 patients with laryngeal function preservation, 16 cases were 60-69 years old, 6 cases were 70-79 years old and 3 cases were 80-88 years old. The tumour located at lateral wall of pyriform sinus in 14 cases, at anterior wall of pyriform sinus in 3 cases, at inside wall of pyriform sinus in 3 cases, at upper side wall of hypopharynx invading tonsil or tongue base in 3 cases, at posterior hypopharyngeal wall in 2 cases. The average length of post-operation stay was 22.2 days. Eight cases suffered from post-operative complications (32%), including of pharyngeal fistula in six cases and pulmonary infection in two cases. The respiratory function and pronunciation were all restored, in 25 cases, among which 20 cases removed tracheostomy tube about 3 months after surgery. 2 cases were missed after 1-year followed up. 2 cases died of local tumor recurrence. 4 cases died of neck recurrence. 8 cases died of pulmonary matastasis. The 1-year and 3-year survival rate of the disease in the group was 67.5% and 43.9% respectively. CONCLUSION As the aged cases of hypopharygeal carcinoma are choosed appropriately and repaired feasibly, surgery for the disease with laryngeal function retention may be safe and effective.
Aged ; Aged, 80 and over ; Female ; Humans ; Hypopharyngeal Neoplasms ; physiopathology ; surgery ; Larynx ; physiology ; surgery ; Male ; Middle Aged ; Organ Sparing Treatments ; methods

OBJECTIVE: To explore the methods of the larygeal recurrent nerve dissection in different and difficult thyroid surgery, so as to minimize damage and improve the safety of the operation. METHOD: The process and methods in different laryngeal recurrent nerve dissection about 52 hospitalized patients from 2010 to 2012 were retrospectively analyzed. These cases include large nodular goiter, nodular goiter behind the sternum or located in the lower pole of the thyroid gland, thyroid cancer, tumors of parathyroid gland, etc. We studied the conditions of lesions involving the laryngeal recurrent nerve and the defensive measures to protect the nerve. RESULT: The laryngeal recurrent nerve was dissected successfully in 50 cases, except 2 cases whose laryngeal recurrent nerve were violated by thyroid cancer. CONCLUSION When we dissect the laryngeal recurrent nerves in different and difficult thyroid, the glands and tumors were mostly needed to be freed and turned inward and forward. After that, the laryngeal recurrent nerves can be dissected successfully with the markers of tracheoesophageal groove, inferior thyroid artery and/or angle under the thyroid cartilage.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Recurrent Laryngeal Nerve ; surgery ; Retrospective Studies ; Thyroid Gland ; surgery

Objective To investigate the safe and effective method for laryngeal microsurgery in difficult la‐ryngeal exposure cases .Methods We selected 62 patients’ clinical data who had received laryngeal microsurgery with difficult laryngeal exposure and could not exposure by normal self -retaining laryngoscope between July 2012 and June 2015 .There were 42 cases of vocal cord polyp ,9 cases of the vocal cyst ,5 cases of the vocal amyloidosis , 4 cases of severe atypical hyperplasia of vocal cords and 2 cases of vocal cord high differentiated squamous carcino‐ma .We completed all kinds of laryngeal microsurgery to expose the glottis by adjusting the postures of patients ,in‐creasing the anesthesia depth ,using self -retaining laryngoscope with endoscopy which can be adjusted and pressing the throat .Results In 62 patients ,58 patients were successfully operated with adjustable self -retaining laryngo‐scope with endoscopy ,the success rate was 93 .55% .And 25 cases was exposed the glottis completely by increasing the anesthesia depth ,however ,when we increased the anesthesia depth ,there were 10 cases needed to combined with pressing the throat to expose .Five patients had retropharyngeal injure with different levels .One case with small jaw deformity of the vocal cord polyp surgery was not successful ,the success of electronic endoscopic under surface anesthesia surgery .The other one case with teeth unkempt and porcelain teeth and two cases of intraoperative frozen tip vocal cord cancer completed the operation of the open throat under the non trachea incision .Conclusion Most of difficult exposed laryngeal can be safely and effectively exposed through using the adjustable self -retaining laryngo‐scope with endoscopy while normal self -retaining laryngoscope can not .When necessary ,we can put 30°endoscope into the side channel of self -retaining laryngoscope to complete all kinds of laryngeal microsurgery .

OBJECTIVE: To systematically evaluate the efficacy and safety of harmonic scalpel in neck dissection. METHOD: Available literatures of PubMed, EMBASE, Cochrane Library, Google Scholar, CBM, CNKI, WangFang and VIP published before June 2014 were searched. Inclusion criteria and quality assessment were performed. All data were analyzed by using RevMan 5.2 software. RESULT: Fourteen studies including 632 cases were enrolled. Among them, 319 cases were in harmonic scalpel group and 313 cases in conventional resection group. Compared with conventional resection group, the harmonic scalpel group showed shorter surgery time(weighted mean difference [95% confidence intetval]: -28.01 [-36.83, -19.19], Z = 6.22, P < 0.01)and less intra-operative blood loss (weighted mean difference [95% confidence intetval]: -46.68 [-57.25, -36.12], Z = 8.66, P < 0.01). The number of cervical lymph nodes dissected and the incidence of postoperative chylous leakage were similar in both groups. CONCLUSION Using the harmonic scalpel in neck dissection was as efficient and safe as that of the conventional technique with the advantage of shorter time of surgery and less intraoperative blood loss.
Blood Loss, Surgical ; Humans ; Lymph Nodes ; Neck ; surgery ; Neck Dissection ; instrumentation ; Postoperative Period ; Surgical Instruments

OBJECTIVE: To describe the most appropriate treatment to parapharyngeal space tumors with skull base involved. METHOD: From March 2000 to July 2004, a retrospective review of 36 patients with tumors of parapharyngeal space with skull base involved and treated surgically procedure was performed. Analyze the clinical characteristics of different tumors of parapharyngeal space with skull base involved. To the various tumors in this series, several surgical approaches were selected: the transcervical (n=15) and transcervical-transparotid approaches (n=10) were the most commonly performed surgical procedures followed by the transmaxillary swing approach (n=5), the transmandible swing approach (n= 4), and transorbitozygomatic-middle fossa approach (n=2). RESULT: In the 36 cases, 5 cases were malignant carcinoma and the others (n=31) were benign. All benign tumors in 31 cases had complete resection with no recurrence. Of the 5 patients with malignant tumors, 2 had SCC (squamous cell carcinoma) of nasopharynx infra-mucous membrane with metastasis in the parapharyngeal space and skull base lesions, after the pathologic identification by the surgical management of transcervical approach, both had undergone post-operative radiotherapy, 1 had disease free with a 3-year follow-up; the other after a follow-up of 5 years, was still alive with disease. Of the other 3 patients, 1 patient with the skull base lesions of malignant neurofibroma had recurrence after a 3-year follow-up, died without therapy at the end; 1 with malignant schwannomas and skull base lesions was alive with no evidence of disease after a follow-up of 2 years; 1 patient with mucoepidermoid carcinoma in deep lobe of parotid gland had operation done 3 months ago, was still under followed. In the 36 cases, post-operative hoarseness occurred in 3 cases; Horner's syndrome occurred in 4 cases; 2 patients had glossal deviation, and it had recovered 3 months later. CONCLUSION Different tumors of parapharyngeal space with skull base involved have different clinical characteristics. Therefore, we should depend on its characteristics to choose the most appropriate treatment.
Adult ; Female ; Humans ; Male ; Middle Aged ; Pharyngeal Neoplasms ; pathology ; surgery ; Pharynx ; pathology ; Retrospective Studies ; Skull Base ; surgery ; Skull Base Neoplasms ; pathology ; surgery

Objective:To explore the clinical value of extra-long subcutaneous tunnel ventricular drainage in patients with hydrocephalus.Methods:From March 2016 to March 2020, 33 patients who were not suitable for ventriculoperitoneal shunt, who would have expected time of external ventricular drainage longer than 7 d, who had external ventricular drainage reaching for 7 d and still could not expect for drainage tube drawing for the next 7 d, or who had hydrocephalus after external ventricular drainage were chosen in our study. These patients accepted extra-long subcutaneous tunnel ventricular drainage. The curative effects in the patients were analyzed retrospectively.Results:The drainage tube was kept for a maximum of 24 months and the shortest time was 13 d, with average of 69.3 d; 32 patients (97%) had drainage time longer than 14 d. There was no secondary infection after operation.Conclusion:Extra-long subcutaneous tunnel extraventricular drainage tube has a long duration of catheter placement, could avoid multiple drainage and secondary intracranial infection, so it is a safe and effective new technology for hydrocephalus.