Objective To study the indications, methods, and therapeutic effect of absorbable rib-connecting-pins fixation in the treatment of multi ple rib fractures. Methods Between March 2007 and September 2009, 40 patients with multiple rib fractures received internal fixation with absorbable rib-connecting-pins, including 8 one-side flail chest and 1 twoside flail chest. There were 32 males and 8 females with an average age of 39.8 years (range, 25-72 years). The injury was caused by traffic accident in 32 cases, fall ing from height in 6 cases, and blunt hitting in 2 cases. Preoperatively, imaging data of the chest X-ray or spiral CT three-dimensional (3D) examination showed that all patients had multiple ribs fractures and displacement. The number of fractured ribs was 4-10 (median, 6), and the fracture location ranged from the 2nd to the10th ribs. Of them, 28 cases were accompanied by hemathorax, pneumathorax or hemopneumothorax; 5 cases by thoracic organ injury; and 10 cases byother part trauma. The time from injury to hospital ization was less than 1 day in 26 cases, 1-3 days in 12 cases, and 3-6 days in 2 cases, and the time from hospital ization to operation was 3 hours to 3 days (mean, 1.2 days). Results The median fixation rib number was 5 (range, 3-8). The mean operative time, the time in bed, and hospital ization days were 32 minutes (range, 15-50 minutes), 4.5 days (range, 2-7 days), and 11.2 days (range, 5-18 days), respectively. All incisions healed by first intention. No pulmonary infection, pulmonary atelectasis, intrathoracic infection or other compl ications occurred. All cases were followedup 6-12 months (mean, 8 months). PaO2 [(86.6 ± 2.2) mmHg (1 mm Hg=0.133 kPa)] and SpO2 (97.2% ± 0.6%) at 2 hours after operation were obviously improved when compared with preoperative ones [PaO2 (53.6 ± 4.7) mm Hg and SpO2 (86.2% ± 1.8%)], showing significant differences (t=2.971, P=0.005; t=2.426, P=0.020). The chest X-ray films or spiral CT 3D indicated that fracture of rib healed within 3-6 months (mean, 4.5 months) after operation. Conclusion Severe collapsed chest wall orflail chest caused by fracture of multiple ribs should be treated by absorbable rib-connecting-pins, which is a simple, firm, and effective method.
Objective To summarize the probability of pulmonary embolism （PE） induced by lower extremity deep venous thrombosis （DVT） and investigate the role of vena cava filter （VCF） in preventing from PE. Methods The clinical data of 1 058 patients with lower extremity DVT from January 2005 to January 2012 were analyzed retrospectively. Results The PE rate was 3.21% （34/1 058） and the death rate was 1.42% （15/1 058） in 1 058 patients with lower extremity DVT. The VCF was implanted in 171 of 1 058 patients. The VCFs of 151 patients were implanted from femoral vein， 20 patients were implanted from jugular vein. The PE rates were 3.61% （32/887） and 1.17% （2/171） and the death rates were 1.69% （15/887） and 0 （0/171） in patients without VCF and with VCF， respectively. Both of them occurred in the first ten days. PE could keep as long as 35 d. The PE rate and death rate in the patients without VCF were significantly higher than those in the patients with VCF （P＜0.01）. The PE rates and death rates in both lower extremities DVT were higher than those in patients with the right and left ones （P＜0.05）， which in the right lower extremity were higher than those in the left one （P＜0.05）. The PE rate and death rate in the patients with lower extremity DVT combined with vena cava thrombosis were significantly higher than those in the patients with central type （P＜0.05）， which in the central type were significantly higher than those in the peripheral type （P＜0.05）， there were no significant differences between peripheral type and mixed pattern. The follow-up time was from 1 month to 7 years with （39±19） months， the patency rate of VCF was 98.7%. There were no filter migration， declination， and failure of expansion. Conclusions VCF can prevent from PE effectively， but the indications must be controlled.
Transcatheter aortic valve replacement (TAVR) is an emerging alternative for the treatment of aortic stenosis (AS). Evidence from clinical trials sprang up continuously, and guidelines have listed TAVR as an alternative for part of AS patients. Although old guidelines only recommended TAVR for surgical high-risk or in-operable AS patients, the latest guidelines have expanded its indications enormously. Moreover, there are ongoing TAVR studies on low-risk patients, asymptomatic patients, pure aortic regurgitation patients, bicuspid aortic valve patients,etc. It is believed that the indication of TAVR will continue to expand. More and more patients will benefit from TAVR in the foreseeable future.
ObjectiveTo investigate the development and clinical application of the reverse total shoulder arthroplasty. MethodsThe relative publications on reverse total shoulder arthroplasties were extensively reviewed and analyzed. ResultsReverse total shoulder arthroplasty has extensive indications, especially for pseudoparalysis caused by irrepairable rotator cuff tears with forward or upper shift of the humeral head and intact function of deltoid. The clinical research results indicate that the short-term results are satisfactory, but there are some special complications, such as scapular nothching, instability and limities of internal and external rotation. While performing this kind of operation, the selection of the approach, the determination of the prosthetic rotation center should be considered well, and the bone graft should be paid attention to when the bony defect of the glenoid and proximal humerus exists. ConclusionThe using time of the reverse total shoulder arthroplasty is short, so the long-term results should be observed. The development of computer assisted technique is hopeful to be improve the results of the reverse total shoulder arthroplasty.
ObjectiveTo discussion the indications and contradictions of associating liver partition and potal vein ligation for staged hepatectomy (ALPPS) for primary hepatocellular carcinoma patients. MethodsThe date of 15 patients underwent the ALPPS in West China Hospital between Augst, 2014 and March, 2015 were retrospectively analyzed. The efficacy of the treatment was evaluated by blood test, the volume of residual liver growth, and postoperative follow-up. ResultsFourteen cases underwent the complete ALPPS, 1 case lost because it couldn't match the standard for the second step. The median increase in the future liver remnant(FLR) volume was 205.5 cm3[(-7.92)-270.6 cm3] and the median rate of FLR increase was 56.5%[(-1.89%)-134.74%]. One case died in the perioperative period for the liver failure, 2 cases was found recurrence or metastasis and died in 3 and 4 months after operation, respectively. One case's AFP was found rising but no iconography evidence for recurrence. One case with tumor survival about 4 moths. The remaining 10 patients were alive without recurrence and metastasis. ConclusionsALPPS is a feasible strategy in patients with cirrhosis and can improve the resectability of hepatocellular carcinoma to provide a chance of a cure to those who would not otherwise be able to receive surgery. And we put out an indications and contradictions for ALPPS tentatively.
ObjectiveTo summarize the procedures of the shoulder arthroplasty and the evolution of the shoulder prosthesis, and to discuss the indications and contraindications of the several common shoulder arthroplastis. MethodsThe related literature on shoulder arthroplasty was extensively reviewed, summarized, and analyzed. ResultsAt present, shoulder arthroplasties can be classified into shoulder hemiarthroplasty, total shoulder arthroplasty, resurfacing shoulder arthroplasty, stemless shoulder arthroplasty, and reserve shoulder arthroplasty, etc. Each type of the prosthesis has several special indications and contraindications. Mostly, the shoulder arthroplasties achieved the satisfied results, such as pain-relief and restoration of the elevation and adduction of shoulder. The survival rate of the most shoulder prostheses may reach 10 years or more. ConclusionMost shoulder arthroplasties are effective and satisfied to treat the shoulder traumas and diseases in pain-free and functional restoration of shoulders.
ObjectiveTo summarize the clinical experience on primary suture after common bile duct exploration and to investigate its clinical indications and curative effects. MethodsThe clinical data of 137 patients underwent primary closure of common bile duct between February 2006 and June 2010 were analyzed retrospectively. ResultsAll operations were successful. The operative time ranged from 65-213 min (mean 129 min) and the blood loss ranged from 50-350 ml with an average of 148 ml. One hundred and twenty-four patients (90.5%) were discharged from hospital without complications within 7 d after operation. Postoperative bile leakage occurred in 13 patients (9.5%) consisted of 10 early stage cases (18.5%, 10/54) and 3 later stage cases (3.6%, 3/83), which were discharged with improvement by conservative treatment within 3 weeks after operation. Totally 113 patients (82.5%) were followed up for 2-54 months with a median time of 14 months, no residual or retained stone and biliary duct stricture occurred. ConclusionOnly with the strict indication and proficient surgical technology, primary suture after common bile duct exploration is a safe and effective way to choledocholithiasis.
Objective To explore the treatment of the malunited fracture of the tibial plateau. Methods From June 2000 to June 2005, reconstruction was performed on 29 patients (18 males, 11 females; age, 1943 years, average, 31.6 years) with the malunited fracture of the tibial plateau. The injury duration ranged from 2.5 months to 2 years, averaged 9.7 months. After the injury, the plasterexternal fixation was performed on 8 patients and operation was performed on the other 21 patients. The operation was involved in the use of screws in 11 patients, anatomic plates, Golf plates and allotype plates in 8 patients, external fixation braces in 2 patients. A complicating injury to the anterior cruciate ligament (ACL) was found in 4 patients, an injury to the posterior cruciate ligament(PCL) in 2 patients, an injury to both ACL and PCL in 1 patient, and an injury to the meniscus in 6 patients. Reestablishment was performed on 19 patients, high tibial osteotomy on 7 patients, and osteotomy of the half tibial metaphysis on3 patients. Results Base on the followup for 8 months to 3 years(average, 13.6 months), the comprehensively scoring assessment showed that an excellent result was achieved in 8 patients, good in 15, fair in 4, and poor in 1, with an excellent and good rate of 82.1%, according to the Hohl knee joint function assessment on the pain, active movement, motion range, stability, and selfassessment. ConclusionFor the reconstruction of the malunited fracture of the tibial plateau, the satisfactory therapeutic effectiveness can only be achieved if the proper indications are identified and the suitable operative methods are adopted. The total knee replacement is only applicable to the elderly patient, and for the young patient, the reconstruction should be performed.
Objective To investigate the reasonable indication of splenectomy in radical resection for advanced proximal gastric cancer (APGC). Methods Fifty patients with APGC were studied and classified into total gastrectomy with splenectomy (TGS) group (n=18) and total gastrectomy without splenectomy (TG) group (n=32). The operation time, hospitalized duration, complications, and lymphe node metastasis at the spleen hilus were compared between two groups. Results The operation time, hospitalized duration and subphrenic infection rate in the TGS group were significantly higher than those in the TG group (Plt;0.05). The rate of lymph node metasitasis of No.10 and No.11 in the TG group was not different from that in TGS group (Pgt;0.05). Conclusion Direct spleen and its vessel invasion are the reasonable indication of splenectomy in radical resection for APGC.
Transcatheter aortic valve replacement (TAVR) developed rapidly since firstly introduced to clinical practice in 2002. In 2015, Experts Consensus for Transeatheter Aortic Valve Replacement (abbreviated as the Consensus) helped TAVR develop normatively and safely in China. This article interpreted the Consensus in combination of new evolutions of TAVR field: first, the indications of TAVR expand from inoperative and high risk patients to the intermediate risk patients; second, although the Consensus recommended pre-dilation with balloon of modest size, the necessity of pre-dilation is under debate; third, the Consensus pointed out main complications of TAVR, and the main strategies to avoid complications are careful pre-procedural analysis and development of new device; fourth, our experts had made outstanding contribution to TAVR in the treatment of patients with bicuspid aortic valve, which still has many problems to be solved urgently.