OBJECTIVE: To investigate the effect of soft tissue repairing at different times on the union of type III b tibial fracture. METHODS: From January 1987 to January 1999, seventy-six type III b tibial fractures were divided into 3 groups: early group(0 to 7 days), subacute group(8 to 30 days), late group(more than 30 days) according to the time of soft tissue repairing. The morbidity rates of complications such as infection, nonunion as well as the time to union were compared respectively. RESULTS: Followed up for 10 to 36 months (averaged 24 months), the infection and nonunion rates of early group were lower than that of subacute and late groups(P lt; 0.01), the average time of fracture union of early group was less than that of subacute and late groups. CONCLUSION: Early soft tissue repairing can decrease the complications and the time to union of Type III b tibial fracture obviously. The time of "early" should be limited in one week and as soon as possible.
ObjectiveTo analyze risk and therapy strategy of tiny gallbladder stones during laparoscopic cholecystectomy (LC).MethodThe clinical data of 932 patients with tiny gallbladder stones performed LC from September 2013 to July 2014 were analyzed retrospectively.ResultsThe LC was successful in all the patients. The gallbladders were ruptured in 86 (9.23%) patients during operation. Following up 1-3 months, there were 26 patients with right upper abdominal pain and with residual small stones in the abdominal cavity, 57 patients without uncomfortable symptoms and without residual gallstone, 2 cases complicated with lesser abdominal abscess, 1 case complicated with incision infection. The incisional hernia and acute pancreatitis were not found.ConclusionsThe gallbladder with full of tiny stones performed LC easily leads to choledocholithiasis or acute pancreatitis. If intraoperative gallbladder rupture, the tiny stones might be residual in the peritoneal cavity and lead to abdominal infection or abscess, and incision infection or trocar site hernia. Specific operation could effectively avoid adverse complications.
【摘要】 目的 探討卵巢兩性母細胞瘤的臨床及病理組織學特征。 方法 觀察總結2004年3月-2008年3月6例卵巢兩性母細胞瘤的臨床及病理學特征，以及免疫組化染色結果。 結果 患者以月經紊亂、閉經、絕經后陰道出血為主要臨床表現。腫瘤含兩種成分，即顆粒細胞和Sertoli-Leydig細胞，兩者均呈成熟性的組織學形態，1例伴有異源性分化成分。6例腫瘤呈α-inhibin和vimentin強陽性，3例呈CD99陽性，5例呈calretinin陽性，2例的Sertoli細胞呈CK陽性。4例患者有隨訪資料，隨訪期14～60個月，均無瘤存活。 結論 兩性母細胞瘤以內分泌異常相關癥狀為主要臨床表現，大部分患者診斷時處于臨床1期，預后較好。對診斷為兩性母細胞瘤的患者應進行長期的臨床隨訪。【Abstract】 Objective To observe the clinical pathologic and immunophenotypic features of gynandroblastoma. Methods The pathologic samples of six patients with gynandroblastoma from March 2004 to March 2008 were observed and analyzed. Immuohistochemistry staining was performed by SP method using antibodies of α-inhibin,CD99,Vimentin,Calretinin,CK,EMA. Results The main clinical features included menstrual disorders, amenorrhea, and postmenopausal bleeding. The tumor was composed of ranulose cells and Sertoli cells, both of which were well differentiated. Strongly positive expression of α-inhibin and vimentin was found in all the patients, while CD99 (+) was in three, calretinin (+) was in five, and CK (+) of Sertoli cells was in two. Four patients were followed up for 14-60 months and all were tumor free. Conclusion The main clinical features of gynandroblastoma are estrogenic or androgenic manifestations. Nearly all the patients are diagnosed in stage 1 and have a good prognosis. Patients with gynandroblastoma should be followed up for a long period.
【Abstract】 Objective To explore the clinical application and outcomes of preoperative second measurement of three-dimensional (3-D) CT reconstruction data for scoliosis orthopedic surgery. Methods Between August 2006 and March 2008, 11 patients with severe rigid scoliosis received surgery treatment, including 4 males and 7 females with an average age of 17.2 years (range, 15-19 years). Preoperative second measurement of 3-D CT reconstruction data was conducted to guide the surgery， including the angle and width of pedicle, the entry point, and the choice of screws whose lengths and diameters were suitable. A total of 197 pedicle screws were implanted. The operation time， blood loss， postoperative nerve function，and Cobb’s angles at sagittal and coronal view were all recorded， and the postoperative CT scan was performed to assess the accuracy of pedicle screw insertion according to Andrew classification. Results Pedicle screws were implanted within 1-11 minutes (mean, 5.8 minutes), and the blood loss was 450-2 300 mL (mean, 1 520 mL). The postoperative X-ray films showed the correction rates of Cobb’s angle were 68.5% in coronal view and 55.5% in sagittal view. The accuracy of pedicle screw insertion was rated as grade I in 77 screws (39.1%)，grade II in 116 screws (58.9%)， and grade III in 4 screws (2.0%) according to postoperative CT scan. All 11 cases were followed up 14 months to 2 years without any complications. Conclusion Preoperative second measurement of 3-D CT reconstruction data can make the surgery process easy and accurate in treatment of severe scoliosis.
ObjectiveTo investigate the job satisfaction, emotional state and related factors of medical staff participating in online consultation of West China Internet Hospital during the COVID-19 epidemic.MethodsThrough literature review and expert consultation (Delphi method), the questionnaire was developed, and the online consulting medical staff of West China Hospital of Sichuan University were invited to conduct the questionnaire survey from 26 January to 19 June 2020, and finally the statistical analysis was summarized.ResultsA total of 132 valid questionnaires were retrieved. Of the 132 subjects, 127 people (96.2%) expressed satisfaction or special satisfaction with the online consulting office format; 103 respondents (78.0%) said that online consulting did not affect or completely did not affect the work and life; 81 people (61.4%) consulted online more than 5 days a week, and 108 people (81.8%) worked within 2 hours a day; the vast majority (97.7%) of the research subjects were satisfied with the content of the training materials and the related support work of the coordination group. Only 29 (22.0%) of the study participants believed that the epidemic caused negative emotions, mainly due to the severity of the epidemic.ConclusionThe online consulting medical staff are satisfied with the office form, training materials and coordination work group of the COVID-19 epidemic, and think that it does not affect their work and life. 22.0% of medical staff have negative emotions, and the severity of the epidemic is the main reason.
Objective To explore the effectiveness of mirrored three-dimensional (3D) printing technology in the treatment of hyperextension-type bicondylar tibial plateau fractures. Methods Retrospective analysis was performed on the clinical data of 11 patients with hyperextension-type bicondylar tibial plateau fractures treated using mirrored 3D printing technology between January 2021 and June 2024. There were 7 males and 4 females, aged 31-67 years (mean, 47.6 years). According to the three-column classification theory of the tibial plateau, all were three-column fractures. Among them, there were 3 cases of pure hyperextension-type injury, 6 cases of hyperextension-varus-type injury, and 2 cases of hyperextension-valgus-type injury. The preoperative tibial plateau posterior slope angle ranged from ?10.7° to 2.1° (mean, ?3.8°). Postoperatively, fracture healing and complications were observed. Reduction quality was assessed using the Rasmussen radiographic scoring system for the tibial plateau. Knee joint function was evaluated using the Hospital for Special Surgery (HSS) knee score. At last follow-up, the tibial plateau posterior slope angle and knee range of motion (ROM) were measured and compared with the contralateral healthy knee. For patients with long-term follow-up (follow-up time ≥2 years), signs of post-traumatic arthritis were observed on weight-bearing anteroposterior and lateral knee X-ray films and assessed using the Kellgren-Lawrence grading criteria. Results All surgeries completed successfully. During the perioperative period, 3 patients developed intermuscular venous thrombosis in the affected limb and 1 patient developed posterior tibial vein thrombosis; these resolved after fluid therapy and anticoagulation. All 11 patients were followed up 18-26 months (mean, 22.6 months). There was no postoperative complications such as incision infection, compartment syndrome, neurovascular injury, implant failure, or fracture redisplacement. One patient with a repaired posterolateral complex injury still had knee instability and underwent secondary posterolateral complex reconstruction at 7 months postoperatively, after which knee stability was restored. All fractures healed within 9-16 weeks (mean, 12.2 weeks). At last follow-up, imaging showed good reduction of the tibial plateau fracture, normal joint congruity, and no significant joint surface irregularity. The Rasmussen score for the affected side was 11-18 (mean, 16.2), with excellent results in 8 cases, good in 2 cases, and fair in 1 case, yielding an excellent-good rate of 90.9%. The posterior slope angle of the affected side was (7.7±1.5)°, showing no significant difference compared to the healthy side (8.1±1.4)° (t=?1.450, P=0.178). The HSS knee score was 80-98 (mean, 89.1), with excellent results in 9 cases and good in 2 cases, resulting in an excellent-good rate of 100%. Knee ROM was (130.4±3.5)°, showing no significant difference compared to the healthy side (131.8±3.4)° (t=?1.399, P=0.192). Five patients were followed up over 2 years. According to the Kellgren-Lawrence grading criteria, 4 cases were grade 0 and 1 case was grade 1, with no moderate or severe osteoarthritis. Conclusion Through preoperative planning and surgical simulation, mirrored 3D printing technology can accurately restore the posterior slope angle and articular surface of hyperextension-type tibial plateau fractures, resulting in satisfactory recovery of knee joint function.
In addition to the typical respiratory symptoms, COVID-19 patients present with clinical manifestations of cardiovascular system damage, and they are at higher risk of intensive care or mortality. The mechanism of COVID-19's impact on the cardiovascular system is still unclear, therefore we need to pay close attention to it. Based on the existing research, this paper focused on the concurrent characteristics of the cardiovascular system diseases, summarized the possible mechanisms of cardiovascular system damage, including the coronavirus invaders directly into cardiomyocytes and its conduction system, with complications or accompanying conditions such as cytokine storm, imbalance of oxygen supply and demand, drug influence, stress and other damage to cardiovascular system. Meanwhile, current clinical manifestations and treatment methods of COVID-19 were summarized.