After freatment of prosthesis replacement for 12 malignant tumer of the proximal humoral werereported. The operation were performed after the indications and methods of treatment had beendefined. All of the 12 cases were followed-up, in the average of 8 yeare. On functional evaluation , 8cases had satisfactory result , but per in 1 cases and 3 cases died from recurrence or metastasis withinfive years. The indieation of the procthetic replantation, the complications, and revision weredisecused.
Abstract The fracture of the prosthetic stem after prosthetic replacement of femoral head is not rare. In this study, the photoeastic instrument was used to study the stress distribution on the prosthetic stem following its insertion and to analyse the factors influencing the fracture of the stem. Through the examination of 9 places in 8 cases, it was found that:(1) The removal of femoral calcar and the inframedullary filling of the bone cement directly influenced the stress distribution. (2) The valgus or varus condition of the prosthesis would lead to stress concentration on the stem. (3) Once lossening of the prosthesis occured it would change the preliminary installingstress distribution in the upper femur which would lead to fatigue fracture. Ths experimental data and clinical observation would provide scientific basis forthe prevention of fracture of prosthetic stem following prosthetic replacement of femoral head.
ObjectiveTo review the current development in therapy of congenital funnel chest. MethodsRecent literature concerning the development of the treatment method for congenital funnel chest was extensively reviewed and summarized. ResultsThe main therapies for congenital funnel chest are thoracoplasty (Ravitch sternum elevation procedure and minimal invasive Nuss procedure) and prosthesis implantation. The magnetic mini-mover procedure and the vacuum bell are still in the research phase. ConclusionBesides the improvement in function, the requirement in appearance after surgery is also improved in the treatment of congenital funnel chest. The minimally invasive surgery and non-invasive procedures could be expected in the future.
Abstract: Objective To evaluate myocardial protection effect of different myocardial protective strategies for patients undergoing double valve replacement （DVR）?. Methods From Jun. 2005 to Dec. 2005, 32 patients with predominant aortic valve stenosis undergoing DVR in Xinqiao Hospital were included in this study. These patients were randomly divided into four groups with 8 patients in each group： （1） antegrade perfusion group：Cold-blood cardioplegia was delivered antegradely through aortic root, and mitral valve replacement （MVR）was performed. Then cold-blood cardioplegia was delivered antegradely through left and right coronary ostia, and aortic valve replacement （AVR） was performed； （2）retrograde perfusion group：Cold-blood cardioplegia was delivered retrogradely and intermittently through coronary sinus, and DVR was performed； （3）antegrade＋retrograde perfusion group：The route of cold-blood cardioplegic infusion was antegrade during MVR procedure first and then retrograde during AVR procedure；and （4）beating heart group：Oxygenated blood from cardiopulmonary bypass machine was delivered retrogradely and continuously through coronary sinus, and DVR was performed with beating heart. Early clinical outcomes were observed. Serum cardiac troponin I （cTnI） was measured by enzyme-linked immunosorbent assay（ELISA）. Serum creatine kinase-MB （CK-MB） and myocardial lactic acid release rate were measured by Hitachi7150 Automatic Chemistry Analyzer. Myocardial mitochondria malondialdehyde （MDA） level was measured through thiobarbituric acid reagent species analysis. Results All the 32 patients survived their surgery and were discharged successfully. Myocardial lactic acid release rate at 80 min after aortic cross-clamping, serum cTnI and CK-MB on the first postoperative day, myocardial mitochondria MDA levels of beating heart group were 13.59%±6.27%,（1.17±0.25） ng/ml, （56.43±16.50） U/L and（2.18±1.23） nmol/（ng.prot）respectively, all significantly lower than those of retrograde perfusion group ［（33.49%±8.29%, （1.82±0.58 ）ng/ml, （78.31±21.27） U/L （5.07±2.35） nmol/（ng.prot），P＜0.05］ and antegrade＋retrograde perfusion group［20.87%±7.22%, （1.49±0.23） ng/ml,（66.67±19.13） U/L,（4.34±1.73） nmol/（ng.prot），P＜0.05］, but not statistically different from those of antegrade perfusion group ［18.83%±5.97%, （1.41±0.32） ng/ml, （63.21±37.52） U/L, （3.46±1.62） nmol/?（ng.prot），P＞0.05］. Conclusion All the four myocardial protective strategies are effective myocardial protection methods for DVR patients. Continuous retrograde perfusion with beating heart and intermittent antegrade perfusion can provide better myocardial protection, and therefore are preferred for DVR patients. The combination of antegrade and retrograde perfusion is easy to administer and does not negatively influence surgical procedures. Retrograde perfusion is also effective as it takes only a short time.
Abstract: Objective To investigate the in vivo effective orifice area (EOA) and whether prosthesispatient mismatch (PPM) is going to happen after 19mm St.Jude Regent valves replacement were performed. Methods Twentythree patients with valvular heart diseases were divided into 2 groups according to aortic annular diameter. 19mm St. Jude Regent valves were replaced in aortic valve place (Regent valve group), and 21mm other doubleleaflet mechanical valves were replaced in aortic place (other valves group). All of the operations were accomplished under cardiopulmonary bypass in West China Hospital. All of the patients were followed up in 3 to 6 months after their surgery processes. Color Doppler echocardiography was used to measure the hemodynamic parameters in their followup. Then left ventricular mass (LV mass), EOA and effective orifice area index (EOAI) etc. were calculated and compared by using SPSS 12.0. Results No cardiac episodes were detected during the perioperative period and 36 months after operation. LVmass reduced in 36 months after operation in both groups. No statistical significance of EOA, EOAI and LVmass reduction were detected between the two groups. Conclusions (1)The EOA and in vivo hemodynamic effects of 19mm Regent valve are similar to 21mm other double leaflet mechanical valve. (2)It is safe to use 19mm Regent valve in those patients whose aortic annular diameter are small and need double valve replacement. Using 19mm Regent valve will not cause short time cardiac episodes and PPM. (3)More further works should be done to make sure what is the standard of PPM in Chinese people, such as enlarging the patients number and prolonging the followup time. (4) Further clinical and followup works should be done to make St.Jude Regent valve’s feature out.
OBJECTIVE There are various methods used to treat the Kienbock’s disease with various outcomes. This study investigated the effect of combining acrylic lunate prosthesis replacement with resection of articular branches to wrist from anterior and dorsal interosseous nerve. METHODS From January 1992 to January 1997, six cases were included. All of the patients were in stage III according to Lichtman’s classification. Besides replacement of the acrylic lunate prosthesis, segment of the pure sensory branches from anterior and posterior interosseous nerves were resected. RESULTS Follow-up for 10 to 54 months (an average of 32 months) the pain was relieved in all patients except one. The range of movement of wrists were as followings: The extension of the wrist was 20 to 35 degrees (an average of 26 degrees) and flexion was 20 to 35 degrees (an average of 32 degrees). There was no improvement in radial and ulnar deviation. CONCLUSION Lunate prosthesis replacement combined with resection of articular branches to wrist resulted in a painless wrist and was a satisfactory method.
Objective To study the operative effect and complication of the prosthesis replacement of the proximal humerus with malignant tumor. Methods From October 1998 to August 2003, the prosthesis replacement was performed to treat the proximal femur with malignant tumor in 4 patients, including 2 patients with osteosarcoma (Enneking staging,ⅡA) and 2 patients with giancell tumor of the bone (ⅡA,ⅡB). By the International Society of Limb Salvage(ISOLS) criterion, the 2 cases of osteosarcoma were preoperatively scored as 4 and 5 points, and 2 cases of giant cell tumor of the bone were scored as 9 and 11 points. The patients’ psychological conditions as well as their limb pain, shape, locality, activity, and function werealso observed. Results The follow-up for 24-58 months (mean, 44 months) showed that there was no local recurrence or infection in all the patients except onepatient who had the loosening of the screws for the fixation 17 months after operation and had no treatment. After operation, all the patients had a better postoperative extention angle from 22° to 41°(mean, 25°), bending angle from 29° to 80°（mean, 35°）, abduction angle from 5° to 28°, and circumgyrate angle from 15° to 22° in their shoulder joints. However, the shoulder joint function was still unstable to some extent and the joints had a decreased strength. By the criterion formulated by the ISOLS, the postoperative score for assessing the 2 patientswith osteosarcoma was increased by 16 points when compared with the preoperative score; the score for the 2 patients with giant cell tumor of the bone was increased by 9.5 points.Conclusion The prosthesis replacement to treat the malignant tumor of the proximal humerus is the good method of choice and has a good therapeutic result; however, there are more complications and so the method should be cautiously employed in the clinical practice.
ObjectiveTo evaluate the clinical value of multi-slice CT in the diagnosis of complications due to breast augmentation. MethodsWe collected the imaging data of 32 female patients who accepted multi-slice CT examination in the second People's Hospital of Chengdu after breast augmentation between February 2010 and February 2015. The position, shape, edge, internal density, leakage, rupture and hard nodules of the prosthesis were observed and analyzed carefully. ResultsIn the 32 patients with breast augmentation, 12 were normal with bilateral symmetry and without abnormal shape or density. Among the other 20 patients, 11 had capsular contracture, 5 had prosthesis leakage, rupture and hard nodules, 4 had breast infection, 1 had fibroadenoma, 1 had cystoma, and 5 had little calcified nodules in the breast tissue. ConclusionThe multi-slice CT scan can clearly and accurately show the position, shape and size of the breast prosthesis as well as the existence of leakage, rupture and hard nodules in the prosthesis. It plays a very important role in the diagnosis of the complications due to breast augmentation and can be effective guidance for clinical operation.
Objective To probe a satisfactory surgical management of the limbsalvage for osteogenic malignant tumors around the knees. Methods From January1989 to December 2001, 42 patients (19 males and 18 females, aged 12-46) with osteogenic malignant tumors around the knees underwent surgical management of the limb salvage, including prosthesis replacement, allogenous bone grafting, and bone cement with adriamycin filled. Based on the pathological examination, osteosarcoma was found in 11 patients, synoviosarcoma in 4 patients, malignant fibrous histiocytoma in 3 patients, and giant cell tumor of the bone in 19 patients. All the patients underwent neoadjuvant chemotherapy for 1-2 courses before operatioexcept the patients with giant cell tumor of the bone. The patients underwent prosthesis replacement, allogenous bone grafting, bone cement with adriamycin filled, and postoperative chemotherapy. By the Enneking evaluating system, the patients were assessed on their reconstructed limb functions after the reconstructive operation for the musculoskeleta malignant tumors. Of the patients, 37 were followed up after operation. Results According to the follow-up for 3-11 years (mean, 5.6 years) in the 37 patients, 2 patients had recurrence and metastasis of the tumor, and died 3 and 4 years after operation, respectively. One patient underwent amputation of the limb for local recurrence of the tumor. One patient had amputation of the limb for the preoperative radiotherapy and the infection and necrosis of the operative wound after the limb-salvage surgery. Two patients had amputation of the limb for the rejection of the allogenous bone graft and theformation of the fistula.Thirty-one patients had good wound healing andgood functions of the limb. The results were evaluated by the Enneking evaluating system as follows: excellent in 7 patients, good in 14, fair in 10, and poor in 6. Conclusion Making an early diagnosis, recognizing the operative indication, choosing the operative method, and performing the preoperative and postoperative chemotherapy and/or radiotherapy are the keys to achieving an ideal limb-salvage surgery for osteogenic malignant tumors around the knees.
ObjectiveTo investigate the effect of preoperative valgus or varus deformity on the prosthesis installation and alignment restoration in total knee arthroplasty (TKA). MethodsBetween January 2012 and December 2013, 198 patients (245 knees) with osteoarthritis underwent primary TKA, and the clinical data were retrospectively analyzed. There were 23 males and 175 females, with the average age of 67 years (range, 43-90 years). Single knee and double knees were involved in 151 and 47 cases respectively. The disease duration was from 1 month to 30 years (mean, 8.99 years). The anteroposterior X-ray films of whole lower limbs were taken, and the femorotibial angle (FT) was measured before operation and at 1 week after operation; the mechanical femoral angle (MF) and the anatomical tibial angle (AT) at 1 week after operation were measured. The correlation analysis was made for pre-and post-operative FT, MF, and AT. According to the valgus or varus deformity before operation, all patients were divided into 5 groups:≥20° varus (group A), 10-20° varus (group B), ≤10° varus (group C), < 10° valgus (group D), and≥10° valgus (group E), and the above indicators were compared between groups. And the rate of the good limb alignment was recorded after operation. ResultsThe pre-and post-operative FT were (171.53±9.12) and (177.38±3.57)° respectively, and postoperative MF and AT were (89.00±2.68) and (88.62±2.16)° respectively. Preoperative FT was associated with postoperative FT and MF (r=0.375, P=0.000; r=0.386, P=0.000), but it was not correlated with AT (r=0.024, P=0.710). Postoperative FT was associated with MF and AT (r=0.707, P=0.000; r=0.582, P=0.000). Postoperative FT was significantly increased when compared with preoperative FT in each group (P < 0.05). There were significant differences in preoperative FT between groups (P < 0.05). There were significant differences in postoperative FT when compared group A with groups B, C, D, and E (P < 0.05), and when compared groups B and C with groups D and E (P < 0.05), but there was no significant difference between groups B and C, and between groups D and E (P>0.05). The rate of good alignment was 70.2% (172/245); it was 27.8% (5/18), 66.0% (62/94), 74.4% (67/90), 88.9% (32/36), and 85.7% (6/7) in groups A, B, C, D, and E respectively, showing significant differences between groups (P < 0.05). There was no significant difference in postoperative AT between groups (P>0.05). Except for between group D and group E (P>0.05), significant difference in MF was shown between the other groups (P < 0.05). ConclusionThe more severe deformity of lower limb before TKA, the higher risk of deviation for prosthesis installation and poor alignment in TKA.