OBJECTIVETo assess the effect of the different treatments targeted at different types of radial head fracture and radial neck fracture.

METHODSA retrospective study was performed in 87 patients from February 2006 to March 2007. Fifty-four patients with radial head fractures included 36 males and 18 females, aged from 18 to 65 years (the average age was 33); Forty of them resulted from crashing, 8 from traffic injury and 6 from falling injury. According to Mason classification system, there were 15 type I, 23 type II and 16 type III. Thirty-three patients with radial neck fractures included 21 males and 12 females, aged from 9 to 17 years (the average age was 13), 29 of them resulted from crashing, 1 from traffic injury and 3 from falling injury. According to O'Brien classification system, there were 8 type I, 14 type II and 11 type III. Type I of radial head fractures and radial neck fractures were immobilization with cast, the patients with type II of radial head fractures were treated with open reduction and micro-screw or T-trapezoid and bridge-shaped plate fixation and type III had operations to fix with bridge-shaped locked plate and repair the broken annular ligament, or replace heads with prosthesis. All patients with type II and type III of radial neck fractures were treated with closed reduction by leverage and percutaneous intra-medullary nailing.

RESULTSThe patients were followed up for 4-12 months (mean 7.2 months). The functional recovery degrees were evaluated with Wheeler's evaluation system. In group of radial head fractures, the results were excellent in 26 patients, good in 20, fair in 6 and poor in 2, the excellent and good rate was 85.2%. In group of radial neck fractures, the results were excellent in 20 patients, good in 9, fair in 4 and poor in no patient, and the excellent and good rate was 87.9%.

CONCLUSIONSDifferent types of fractures should choose different surgical methods according to their characters. The excellent functional recovery depend on anatomical reduction, retaining the head of radius, early repairing and protecting the broken annular ligament of radius, and early functional training.

Adolescent ; Adult ; Aged ; Arthroplasty, Replacement ; Bone Plates ; Bone Screws ; Child ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Radius Fractures ; surgery ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVETo assess the effect of the autologous venous external stents on intimal hyperplasia of the vein grafts in rabbits.

METHODSThirty-six male New Zealand white rabbits, aged 5 months and weighing 2.8 to 3.0 kg, were randomly divided into 3 groups: group A, group B and group C, with 12 rabbits in each group. First, a section about 6 cm long of vein was cut from the right external jugular vein of each rabbit and severed to have 3 equal-length segments. Next, each distal segment prepared for anastomosis. The proximal segment invaginating middle segment in group A and only middle segment in group B were used for the external stent. Later, the left common carotid artery was separated from surrounding tissue, from it a section about 0.5 cm long was cut away. Finally, the vein graft was inverted and end-to-end anastomosed to the two ends of the artery with a 9-0 suture. After bloodstream re-established, the diameter of each vein graft was measured. At 2 and 4 weeks postoperative, the graft veins were cut off and histologically examined by the means of HE staining and Masson staining. The smooth muscle cells (SMC) proliferation was studied by the immunohistochemical detection of proliferating cell nuclear antigen.

RESULTSAfter bloodstream re-established, the diameters of vein graft of group A and group B and group C were (1.6 +/- 0.3) mm, (2.2 +/- 0.4) mm and (2.6 +/- 0.6) mm respectively (P < 0.05). At 4 weeks postoperative, the data of the ratio of intima to media thickness and the index of the proliferating cells of the intima were as follow: group A (1.01 +/- 0.07 and 6.84 +/- 1.98), group B (1.32 +/- 0.08 and 11.01 +/- 2.61), group C (1.55 +/- 0.03 and 14.96 +/- 4.14). Both the data of group A were obviously less than that in group B, and that of group B was less than group C (P < 0.05).

CONCLUSIONThe autologous venous two-layer external stents inhibit intimal hyperplasia of the vein grafts.

Animals ; Hyperplasia ; pathology ; prevention & control ; Male ; Rabbits ; Stents ; Transplantation, Autologous ; Tunica Intima ; pathology ; Veins ; pathology ; transplantation

BACKGROUNDUnstable pelvic fractures are complex and serious injuries. Selection of a fixation method for these fractures remains a challenging problem for orthopedic surgeons. This study aimed to compare the stability of Tile C pelvic fractures fixed with two iliosacral (IS) screws and minimally invasive adjustable plate (MIAP) combined with one IS screw.

METHODSThis study was a biomechanical experiment. Six embalmed specimens of the adult pelvis were used. The soft tissue was removed from the specimens, and the spines from the fourth lumbar vertebra to the proximal one-third of both femurs were retained. The pubic symphysis, bilateral sacroiliac joints and ligaments, bilateral hip joints, bilateral sacrotuberous ligaments, and bilateral sacrospinous ligaments were intact. Tile C pelvic fractures were made on the specimens. The symphysis pubis was fixed with a plate, and the fracture on the posterior pelvic ring was fixed with two kinds of internal fixation in turn. The specimens were placed in a biomechanical machine at a standing neutral posture. A cyclic vertical load of up to 500 N was applied, and displacement was recorded. Shifts in the fracture gap were measured by a grating displacement sensor.

STATISTICAL ANALYSIS USEDPaired-samples t-test.

RESULTSUnder the vertical load of 100, 200, 300, 400, and 500 N, the average displacement of the specimens fixed with MIAP combined with one IS screw was 0.46, 0.735, 1.377, 1.823, and 2.215 mm, respectively, which was significantly lower than that of specimens fixed with two IS screws under corresponding load (P < 0.05). Under the vertical load of 500 N, the shift in the fracture gap of specimens fixed with MIAP combined with one IS screw was 0.261 ± 0.095 mm, and that of specimens fixed with two IS screws was 0.809 ± 0.170 mm. The difference was significant (P < 0.05).

CONCLUSIONThe stability of Tile C pelvic fractures fixed with MIAP combined with one IS screw was better than that fixed with two IS screws.

Adult ; Bone Screws ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Pelvic Bones ; surgery

BACKGROUNDPostoperative knee soft tissue irritation is a common complication after retrograde nail fixation of femoral fractures. Distal locking screw prominence is one of the causes for soft tissue irritation. This study aimed to determine whether the use of the femoral condyles tangential views improve the diagnostic accuracy compared with anteroposterior (A-P) view in detecting distal locking screw penetrations during retrograde femoral nailing.

METHODSThe angle between the sagittal plane and lateral aspect of the condyle and the angle between the sagittal plane and medial aspect of condyle were measured on computed tomography (CT) images. After the angles were measured and recorded, cadaveric femurs were used in a simulated surgical procedure. The retrograde femoral nail was inserted into the femur and placed distal locking screws, which were left 2, 4, and 6 mm proud of the medial and lateral condyles for each femur. A-P view, lateral condyle tangential view and medial condyle tangential view were obtained. All fluoroscopic images were recorded and sent to three observers blinded to the experimental procedure to determine whether screws penetrated the condyle cortex or not.

RESULTSAccording to the results of CT scan, the lateral condyle view was 20.88 ± 0.98° and the medial condyle view was 40.46 ± 3.14°. In the A-P view, we detected 0% at 2 mm penetration, 16.7% (lateral condyle screw) and 25.0% (medial condyle screw) at 4 mm, and 41.7% (lateral condyle screw) and 58.3% (medial condyle screw) at 6 mm. In the lateral tangential view, we detected 91.7% at 2 mm penetration of the lateral condyle and 100% at 4 mm and 6 mm. In the medial tangential view, we detected 66.7% at 2 mm penetration of the medial condyle and 100% at 4 mm and 6 mm. The femoral condyle tangential views provided significant improvement in detecting screw penetrations at all lengths (2, 4, and 6 mm) compared with the A-P view (P < 0.05).

CONCLUSIONSThe femoral condyles tangential views increased the accuracy of detecting screw penetrations on the medial and lateral condyles. Routine clinical use of the femoral condyles tangential views has the potential to increase accuracy in detecting distal locking screw penetration during retrograde femoral nailing.

Bone Screws ; Femoral Fractures ; diagnostic imaging ; surgery ; Fracture Fixation, Internal ; Fracture Fixation, Intramedullary ; Humans ; Tomography, X-Ray Computed

Complex segmental femoral fractures are usually not amenable to closed reduction. The purpose of this study was to evaluate a series of patients who had undergone four pins assisted reduction and intramedullary nail fixation to determine the therapeutic effect of this closed reduction technique. Between December 2010 and January 2013, 15 consecutive patients with segmental femoral fractures were treated with four pins assisted reduction at our hospital. The patient was placed in a supine position on a radiolucent fracture table and a gentle traction was attempted on the limb. Usually, the proximal fracture segment exhibited the typical deformity of flexion, external rotation, and abduction, the middle segment exhibited adduction and distal fracture segment exhibited flexion. Four Schanz pins were placed percutaneously to fix one cortex and did not penetrate into the medullary cavity, and the "T" sharp handles were fixed on the Schanz pins. The fragments were then reduced by reversing the deforming forces for segmental fractures by two assistants. And then, the reduction could be easily achieved and intramedullary nail fixation was performed. Radiographs were evaluated for the quality of the reduction and fracture union. Closed reduction was achieved in all patients using the four pins technology. All 15 fractures united uneventfully. No patient had a rotational malunion or limb length discrepancy at the time of the last follow-up. Thirteen of the fifteen (86.7%) patients had anatomic reduction and two of them (13.3%) had minor varus alignment of 3° and 5°. Knee stiffness was observed in 2 patients and no implant failure was observed. Surgical treatment of complex segmental femoral fractures with four pins assisted reduction and intramedullary nail fixation techniques can result in excellent reductions and a high union rate.
Adult ; Bone Nails ; Femoral Fractures ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Radiography

Objective To evaluate the efficacy of recombinant human TNK tissue-type plasminogen activator and adenosine injection through guiding in treating acute ST-segment elevation myocardial infarction(ASTEMI)in emergency primary percutaneous coronary intervention(PPCI).Methods Patients with ASTEMI who chose to receive emergency PPCI were randomly divided into control group and treatment group according to a digital random table method.The control group received conventional treatment of PPCI.If the infarct-related artery(IRA)reached TIMI flow grade 3 after PPCI,the operation was terminated.If TIMI flow was &le;2,then a guide catheter to inject sodium nitroprusside,nitroglycerin,and tirofiban into the coronary artery to improve coronary microcirculation dysfunction(CMD)was applied until the IRA reached TIMI flow grade 3.The treatment group received the conventional treatment of PPCI,and after opening of the IRA during the operation,a guide catheter to inject recombinant human TNK tissue-type plasminogen activator(8 mg)and adenosine(200 pg)into the coronary artery was applied.If the IRA reached TIMI flow grade 3,the operation was terminated.If TIMI flow was &le;2,then adenosine injection was re-applied to improve CMD until the IRA reached TIMI flow grade 3.Observation indicators were as follows:① myocardial injury indicators:cardiac troponin Ⅰ(cTnⅠ),creatine kinase isoenzyme(CK-MB),and N-Terminal pro-brain natriuretic peptide(NT-pro BNP)levels before and 12 h,24 h,36 h,and 48 h after surgery;② myocardial perfusion indicators:corrected TIMI frame count(CTFC)after surgery and ST segment regression value(STR)at 90 min after surgery;③ degree of myocardial ischemia:rest D-SPECT+adenosine stress D-SPECT examination at day 3 after surgery,observation of myocardial perfusion total score under 17 segment distribution and myocardial ischemia total segment number;@adverse drug reactions at day 30 after surgery:subcutaneous ecchymosis,gingival bleeding,gastrointestinal bleeding,urinary bleeding,hemoglobin decline,and cerebral hemorrhage;⑤ major adverse cardiovascular events(MACE)at day 30 after surgery:cardiac death,myocardial infarction,heart failure,and target vessel revascularization.Results ① Myocardial injury indicators:There was no significant difference in the levels of cTnⅠ,CK-MB,or NT-pro BNP before surgery between the two groups(all P＞0.05).The myocardial injury indicators were significantly lower in the treatment group than in the control group at 12 hours after surgery(all P＜0.05),and then showed a downward trend.There was no significant difference between the two groups at 48 hours after surgery(all P＞0.05).② Myocardial perfusion indicators:CTFC in the treatment group was significantly better than that in the control group after surgery(P＜0.05).Using the rank sum test,the STR was significantly better in the treatment group than in the control group at 90 minutes after surgery(Z=2.437,P=0.014).③ myocardial ischemia:Both groups underwent rest D-SPECT+adenosine stress D-SPECT examination at 3 days after surgery.Under the distribution of 17 myocardial segments,the total score of myocardial perfusion and the total number of myocardial ischemia segments in the treatment group were significantly better than those in the control group(all P＜0.05).④ Adverse drug reactions 30 days after surgery:There was no significant difference in subcutaneous ecchymosis,gingival bleeding,gastrointestinal bleeding,urinary system bleeding,hemoglobin decline,or cerebral hemorrhage between the two groups(P＞0.05).⑤ MACE 30 days after surgery:There was no significant difference in cardiac death,myocardial infarction,heart failure,target vessel revascularization,or total MACE between the two groups(P＞0.05).Conclusion The intra-coronary injection of recombinant human TNK tissue-type plasminogen activator and adenosine injection through a guiding catheter in emergency PPCI is safe and effective for the treatment of ASTEMI.It can improve myocardial injury,myocardial perfusion,and myocardial ischemia.

OBJECTIVELaparoscopic colorectal surgery is a skill-dependent procedure. The present study aims to analyze the learning curve of a properly trained surgeon, with basic laparoscopic techniques, to become skillful in performing laparoscopic colorectal operations.

METHODSA series of non-selective, consecutive 189 cases of laparoscopic colorectal surgery were accomplished, from December 2009 to February 2012, by one surgeon with years of skilled technique in laparoscopic cholecystectomy, rich experience in assisting laparoscopic colorectal surgery, and experience of approximately 180 procedures of gastric and colorectal surgery annually. 170 out of 189 procedures were radical operations for colorectal neoplasma, including right colectomies in 28 cases, left colectomies in 5 cases, sigmoidectomies in 28 cases, high Dixon procedures in 45 cases, low Dixon (total mesorectal excision, TME) procedures in 41 cases and Miles procedure in 23 cases. 19 other patients underwent combined procedures for multi-primary tumors or inflammatory enteritis. All these procedures were analyzed according to time span (the earlier half and later half) in respect to length of surgery, intraoperative blood loss, number of lymph nodes retrieved, intraoperative events and postoperative complications.

RESULTSFor radical right colectomy, the D2 dissection conducted in the earlier phase (n = 8) had the similar length of surgery, more blood loss and less LN retrieval, compared with the D3 dissection conducted in recent phase (n = 20). The earlier performed high Dixon procedures (n = 22) consumed longer time than the later procedures (n = 23) consumed, but with similar blood loss and LN retrieval. Low Dixon (TME) procedures showed significant differences in length of surgery and blood loss relative to time span. Recently performed simoidectomy and Miles procedures showed a trend of shorter time consumed compared with earlier performed procedures. Conversion ratio to open surgery was 1.05%. Adverse effects occurred in 8 cases of surgeries, including intestinal injury (3/189), insufficient distal margin (2/189), intraoperative bleeding (2/189) and vaginal injury (1/76). There was no operative death. Chief complications included urinary retention 5.82%, ileus 4.76%, anastomotic leak 4.24%, perineal infection 23.08% (6/26), wound dehiscence 2.65%, gastrointestinal bleeding 1.59%, peritoneal infection 1.06%. Surgery for distal rectum tended to have more complications, such as urinary retention, anastomotic leak and perineal infection. The later performed low Dixon procedures produced insignificantly fewer anastomotic leaks than those in the earlier phase.

CONCLUSIONSFor a trained surgeon with basic laparoscopic techniques, there are at least 15 - 25 cases of different procedures needed for him/her to become skilled to perform laparoscopic surgery. The learning curve should also depend on the annual number of colorectal surgeries.

Aged ; Colonic Diseases ; surgery ; Colorectal Neoplasms ; surgery ; Colorectal Surgery ; methods ; Female ; Humans ; Laparoscopy ; methods ; Learning Curve ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; Treatment Outcome

BACKGROUNDThe long term prognosis of unprotected left main coronary artery (LMCA) stenting is controversial. This study was conducted to evaluate the immediate and long term outcomes of LMCA stenting in Chinese patients and to determine which factors affect the outcomes.

METHODSFrom May 1997 to March 2003, 224 patients in 23 hospitals underwent elective unprotected LMCA stenting with bare metal stents. Their clinical records were analysed to ascertain immediate and long term outcomes of LMCA stenting as well as factors influencing the prognosis.

RESULTSStents were implanted into LMCA successfully in 223 cases (99.6 %). One death (0.5%) and one case of non-Q wave nonfatal myocardial infarction (MI) occurred in hospital. The mean follow-up time was (15.6 +/- 12.3) months. Cardiac death developed in 10 cases (4.5%), noncardiac death in 2 cases (0.9%), nonfatal MI in 4 cases (1.8%), target lesion revascularization (TLR) of LMCA in 26 cases (11.7%) and TLR of nonLMCA in 37 cases (16.5%). Univariate analysis showed that cardiac death correlated with left ventricular ejection fraction (LVEF < 40%), female gender and LMCA combined with multivessel disease; that major adverse cardiac events (MACE) correlated with LVEF < 40%, bifurcation lesion and incomplete revascularization. Logistic regression analysis revealed that LVEF < 40% and female gender were independent predictors of cardiac death and MACE. Follow-up angiography was performed in 102 cases (45.7%). The restenosis rate was 31.4%.

CONCLUSIONSLong-term outcomes of stenting for selected patients with unprotected LMCA stenosis is acceptable. It should be performed in inoperable or low risk patients with LVEF > or = 40% and isolated LMCA disease or LMCA combined with multivessel diseases in whom complete revascularization can be obtained.

Adult ; Aged ; Aged, 80 and over ; Coronary Angiography ; Coronary Disease ; therapy ; Coronary Restenosis ; etiology ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stents ; adverse effects ; Treatment Outcome

[Objective] To explore the safety and effectiveness of provisional stenting (PS) applied in patients with unprotected simple left main bifurcation lesions, and to observe the impact of this procedure on cardiac function, myocardial injury, and myocardial perfusion. [Methods] A retrospective analysis was made on 82 patients with unprotected simple left main bifurcation lesions who underwent elective stenting and completed a 3-month follow-up in the Department of Cardiology, Hebei Medical University First Hospital. All the patients underwent preoperative examinations, including rest dynamic single-photon emission computed tomography (D-SPECT) and regadenoson stress D-SPECT before and 3 months after surgery. The safety evaluation indicators for the surgery included immediate success rate of stent implantation, acute stent thrombosis, coronary no-reflow, branch involvement, branch acute occlusion, acute left heart failure, heart block, cardiac tamponade, major bleeding, and mortality. The effectiveness evaluation indicators included the minimum lumen area (MLA) of the left main trunk of coronary artery measured by intravenous ultrasound (IVUS) before and after surgery, as well as cardiac function indicators [brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD)] and myocardial injury indicators [creatine kinase isoenzyme-MB (CK-MB), cardiac troponin Ⅰ (cTn Ⅰ)] at day 1, day 7, 1 month, and 3 months before and after surgery. The myocardial perfusion evaluation indicators included the total myocardial perfusion score and total ischemic segment number under the 17-segment distribution of myocardial perfusion using rest D-SPECT and regadenoson stress D-SPECT before and 3 months after surgery. [Results] Safety indicators: immediate success rate of stent implantation (100%), 19 cases (23.1%) of circumflex branch involvement that underwent balloon anastomosis dilation, 1 case of acute branch occlusion, followed by double stent surgery using provisional stenting-T stenting (PS-T) technique. There were no cases of acute stent thrombosis, coronary reflow, acute left heart failure, cardiac block, cardiac tamponade, major bleeding, or death. Effectiveness indicators: the MLA of the left main trunk measured by postoperative IVUS showed significant improvement compared to the preoperative. BNP, CK-MB, and cTnⅠ showed significant improvement from day 7 after surgery compared to before. Myocardial perfusion indicators: the total score of myocardial perfusion and the total number of ischemic segments in the 17-segment distribution of the myocardium after 3 months of surgery were significantly better than before. [Conclusion] PS can improve heart function, myocardial injury, and myocardial perfusion in patients with unprotected simple left main bifurcation lesions.

Child ; Cord Blood Stem Cell Transplantation ; Hematopoietic Stem Cell Transplantation ; Humans ; Primary Myelofibrosis/therapy* ; Thiotepa ; Transplantation Conditioning