OBJECTIVETo study the applied value of double joystick technique in reduction-internal fixation for femoral shaft fracture in adults.

METHODSThirty-four patients (24 males and 10 females) with femoral shaft fractures were treated with reduction assisted by double joystick technique and internal fixation with interlocking intramedullary nail from September 2010 to June 2013. The average age of the patients was 41 years old, ranged from 17 to 65 years old. The duration of the disease course ranged from 3 to 7 days, with a mean of 5 days. The fractures belonged to AO types 32A (5 cases), 32B (20 cases) and 32C (9 cases) and located in left femur for 18 patients and right femur for 16 patients. The patients were followed up, and fracture healing and complications were observed. The curative effect were evaluated according to Thorsen femur fracture evaluation standard.

RESULTSThe operative time ranged from 40 to 110 min (mean 75 min) and intraoperative blood loss ranged from 200 to 300 ml (mean 250 ml). All the patients obtained a good fracture reduction and were followed up for 12 to 24 months (mean 18 months) after the surgery. All the fractures united between 4 and 8 months with a mean of 5 months. No complications such as breakage of nail, infection, osteofascial compartment syndrome, refracture and fracture malunion were found. According to Thorsen femur fracture evaluation standard, 30 patients obtained an excellent result, 3 good and 1 fair.

CONCLUSIONIn surgery of reduction-internal fixation for femoral shaft fracture in adults, the use of double joystick technique obtains good reduction result, short operative time, less injury, high healing rate of bone fractures, less complications and good limbs function, so it is worthy of popularizing in clinic.

Adolescent ; Adult ; Aged ; Bone Nails ; Female ; Femoral Fractures ; physiopathology ; surgery ; Fracture Fixation, Intramedullary ; instrumentation ; methods ; Fracture Healing ; Humans ; Male ; Middle Aged ; Young Adult

Adult ; Faculty ; Female ; Humans ; Lipoproteins ; blood ; Lipoproteins, HDL ; blood ; Lipoproteins, LDL ; blood ; Male ; Middle Aged ; Multivariate Analysis ; Regression Analysis ; Sampling Studies ; Surveys and Questionnaires ; Universities

OBJECTIVETo compare the efficacy of internal fixation (including PFNA and PFN) versus hip replacement (including FHR or THA) in the treatment of trochanteric fractures in adults.

METHODSReports of studies using randomized controlled trials (RCT) to compare internal fixationg with hip replacement in the management of intertrochanteric fractures were retrieved (up to January 1, 2013) from the Cochrane Library, PUBMED Data, CNKI (China National Knowledge infrastructure), Elsevier, the Chinese Biomedical Database, Wanfang Data, and manually. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software RevMan 5.0 was used for data-analysis.

RESULTSSeven articles were included in the meta-analysis. The results showed that,compared internal fixation with hip replacement,there were statistical significance in the duration of surgery time [WMD = -2.66, 95% CI (-5.25,-0.06), P = 0.05], intra-operative blood loss [WMD = -24.20, 95% CI (-30.38, -18.02), P < 0.000 01], hospital stays time [WMD = -4.72, 95% CI (-5.18, -4.25), P < 0.000 01], bearing load time [WMD = -29.54, 95% CI (-30.77, -28.31), P < 0.000 01], total complications rate [WMD = 0.15, 95% CI (0.11, 0.22), P < 0.000 01], the good rate of Harris scores [WMD = 1.09, 95% CI (0.54,1.32), P < 0.05]. However, there were no statistical significance in the rate of deep venous thrombosis [WMD = 1.09, 95% CI (0.47, 2.55), P > 0.05]. CON- CLUSION: Hip replacement (containing FHR or THA) for the treatment of intertrochanteric fractures is superior to internal fixa- tion in regards to the duration of surgery time, the mean duration of hosipital stays, mean post-operative down time, intra-opera- tive blood loss, the rate of post-operative good Harris scores. But there is not enough evidence to show any difference between hip replacement (containing THA or FHR) and internal fixation in regards to the rate of deep venous thrombosis. However, internal fixation for the treatment of intertrochanteric fractures is superior to hip replacement (containing FHR or THA) in regards to total complications rate.

Arthroplasty, Replacement, Hip ; methods ; Fracture Fixation, Internal ; methods ; Hip Fractures ; surgery ; Humans

Acute respiratory failure (ARF) after operation for esophageal carcinoma is a serious challenge to medical management and usually accompanied by a high mortality rate. This paper present author's experience on the management of 10 such cases. It is emphasized that advanced age, long-history of smoking, COPD are predisposing factors and in-trathoracic surgery and its complication may trigger the ARF,which usually occurs within 48-72 hours after operation. Besides assist mechanical ventilation, thorough clearance of the secretion from the respiratory tract, control of pulmonary infection and early eradication of the intrathoracic complications are the key points of the successful treatment. Preoperative pulmonary functional studies with careful analysis in correlation with patients condition is mandatory especially in elderly patients. Prevention is more important and valuable than treatment for the patients with postoperative acute respiratory failure.

Objective To explore the effect and safety of transcranial approach for spheno-orhital meningioma. Design Retro- spective case series. Participants Thirty-two patients being operated with transcranial approach. Twenty-four cases were meningothelial meningiomas, 3 cases were fibrous meningiomas, 1 case was psammomatous meningioma, 2 cases were atypital meningiomas, 2 case were malignant meningiomas. Methods All patients underwent frontal-temporal craniotomy, the involved sphenoid wing bone and peri- orbit were removed to prevent recurrence. The superior orbital fissure and optic canal were decompressed, the dural and periorbital de- feet were repaired by autogenous temporal fascia or artificial dura. Main Outcome Measures Preoperative and postoperative exoph- thalmus and eyeball movement, the extent of tumor resection, the ratio of recurrence. Results The extent of tumor resection: 8 cases were Simpson gradeⅡ, 20 cases Simpson gradeⅢ, 4 cases Simpson grade IV. After surgery, proptosis were improved in all patients, ophthalmoplegia was found in 6 eases. There was no operation-related death or other significant complication. Tumor recurred in 6 cas- es. Conclusions Adequate exposure of the tumor and bony decompression of the cranial nerves can result from transcranial approach, all the involved bone should be removed in order to prevent recurrence. This approach is relatively safe and the ptoptosis are improved significantly. Complete surgical resection is difficult because of the involvement of the orbital apex, superior orbital fissure and cav- ernous sinus.

Objective To sum up the therapeutic results of 125 cases of tetralogy of Fallot(TOF),and ex- plore the optimal time and risk factors of opration,as well as perioperative management.Methods One hundred and thirth-one consecutive cases of TOF underwent corrective surgery.There were simple stenosis of infundibular portion in right ventricular outflow tract in 37 cases,stenosis of infundibulum and pulmonary valve in 14 cases,main pul- monary trunk and left/right pulmonary arteries stenosis in 74 cases,and pulmonary atresia in 5 cases.Autologousper- icardial conduit,or with waived were used for right ventricular outflow tract and right ventriculo-pulmonary artery connection.Other anomalies were corrected.Results The surgicalmortality was 4.0 %.The cause of death were se- rious low cardiac output syndrome(3 patients),respiratory function failure(1 patient),pericadial infection(1 pa- tient).Conclusion It is necessary to profonn corrective opration on younger TOF patients.Effetive prophylaxis and control of low cardiac output syndrome and pulmonary complication is a useful strategy.

OBJECTIVETo study the clinical characteristics and the treatment of periorbital injuries.

METHODS61 cases were treated, including 30 cases orbitozygomatic fracture, 6 cases of frontal-orbital fracture, 8 cases of naso-ethmoid-orbital fracture, 7 cases of blow -out fracture and 10 cases of complicated fracture. The patients were diagnosed after physical examination and other examination, like CT. Through bicoronal or local mini incision at the end of eyebrow, combined with subciliary incision and local wound approach, the fractured sites were exposed completely. Then the fractured fragments were repositioned and fixed rigidly. The orbital wall was reconstructed with titanium net and Medpor.

RESULTSThe wounds healed primarily. Good cosmetic and functional results achieved in most of the patients. 4 cases underwent second-stage ophthalmectomy. 2 patients had diplopia after operation, but improved gradually. 3 cases of blepharoptosis needed further treatment.

CONCLUSIONSEarly diagnosis and treatment is very important for periorbital injuries. Fracture reposition and orbital wall reconstruction should he performed at early period.

Adolescent ; Adult ; Aged ; Child ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Orbital Fractures ; surgery ; Skull Fractures ; surgery ; Young Adult

OBJECTIVETo explore the feasibility and effect of percutanuous cannulated pedicle screw AF system fixation for the treatment of thoracolumbar flexion-distraction fracture without neurologic impairment.

METHODSFrom June 2008 to June 2010,21 patients with thoracolumbar flexion-distraction fracture were treated with percutanuous cannulated pedicle screw fixation. There were 16 males and 5 females with the mean age of 32.7 years ranging from 23 to 55 years. Injured levels 5 cases was in T12, 13 was in L1, 3 was in L2. According to classification of AO, B1 was in 13 cases, B2 was in 8 cases. ASIA grade of all the patients were grade E. The mean operative time, bleeding volume, lengths of stay were evaluated. All the patients took the X-ray and three-dimensional CT reconstruction to observe the fracture healing and to measure the height of the anterior border of fracture vertebral body and the Cobb angle of kyphosis. The visual analogue scales (VAS) were compared preoperation and postoperation. The clinical effects were analyzed according to Oswestry Disability Index (ODI) from 10 aspects, including pain intensity, personal care, lifting, walking, sitting, standing, sleeping, sex life, social life, traveling.

RESULTSAll the operations were successful and the mean time was (109.0+/-16.0) min, blood loss was (90.0+/-15.0) ml, lengths of stay was (7.7+/-2.3) d. No postoperative neurological deficits or wound infection occured. One case occurred subcutaneous fluid of incision and 1 case occurred delayed healing of incision. Fifteen patients were followed up with an average of 16.7 months (12-33 months). The VAS score improved from preoperative 8.3+/-1.7 to 1.8+/-1.2 at final follow up (P<0.05). The ODI of last follow-up was (10.0+/-1.2)%. Three-dimensional CT reconstructions and X-rays showed the height of vertebral body increased from preoperative (54.0+/-17.1)% to (82.7 - 3.5)% at 12 months after operation (P<0.05). Cobb angle of kyphosis changed from preoperative (23.0+/-13.1) to (6.9+/-5.1) degrees at 12 months after operation (P<0.05). The healing time of fracture was (4.7+/-0.3) months. There were no significant loss of vertebral height or kyphosis correction between postoperative 1 months and last follow-up (P>0.05). There were satisfactory fracture reduction and good position of internal fixation,and no loss of reduction within 12 months and no fixation failure in follow-up.

CONCLUSIONThe minimally invasive percutaneous cannulated pedicle screw fixation technique is feasible in treatment of thoracolumbar flexion-distraction fracture without neurologic impairment. This technique can avoid re -injury of posterior ligaments and bone structure, and may rebuild posterior tension band structure with the advantages of less trauma, less bleeding,shorter operative time, rapid postoperative recovery and so on.

Adult ; Bone Screws ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; methods ; Fracture Healing ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries ; surgery

OBJECTIVETo explore the intersection and regulation mechanism of "efficacy-toxicity network" of Glycyrrhizae Radix et Rhizoma, Zingiberis Rhizoma and Aconiti Lateralis Radix Praeparata's action gene in the combination environment of Sini decoction with the network pharmacological method.

METHODThe gene interaction network of Aconiti Lateralis Radix Praeparata, Glycyrrhizae Radix et Rhizoma, Zingiberis Rhizoma were mined and established with Cytoscape software and Agilent literature search plug-in. The "efficiency-toxicity network" intersection of Aconiti Lateralis Radix Praeparata was formed according to its effects in anti-heart failure, neurotoxicity and cardiotoxicity. The target genes were clustered with Clusterviz plug-in. And the possible pathways of the "efficacy-tox- icity network" intersection of Glycyrrhizae Radix et Rhizoma, Zingiberis Rhizoma and Aconiti Lateralis Radix Praeparata were forecasted in DAVID database.

RESULTThere were five genes related to neurotoxicity, cardiotoxicity and anti-heart failure function of Aconiti Lateralis Radix Praeparata, namely AKT1, BAX, HCC, IL6 and IL8, which formed 47 nodes genes in the "efficiency-toxicity network" intersection of Aconiti Lateralis Radix Praeparata. There were 29 and 27 coincident genes in the "efficiency-toxicity network" of Glycyrrhizae Radix et Rhizoma, Zingiberis Rhizoma and Aconiti Lateralis Radix Praeparata. There were 23 and 17 possible regulatory pathways.

CONCLUSIONIn the combination environment of Sini decoction, Glycyrrhizae Radix et Rhizoma and Zingiberis Rhizoma may regulate the efficiency-toxicity network of Aconiti Lateralis Radix Praeparata by influencing immune-inflammatory signaling pathway, apoptosis-autophagy signaling pathway, nerve cell and myocardial ischemia and hypoxia protection signaling pathways.

Aconitum ; chemistry ; toxicity ; Drugs, Chinese Herbal ; chemistry ; toxicity ; Gene Regulatory Networks ; drug effects ; Humans ; Rhizome ; chemistry ; toxicity