Objective To compare the differences between volar and dorsal plate positions in the treatment of unstable fracture of distal radius. Methods From June 2000 to December 2006, 61 cases with fracture of distal radius weretreated, 27 males and 34 females aged 22-70 years (55.5 years on average), among which 18 cases were caused by traffic accidents and 43 cases falls. All cases were fresh closed fractures. All patients had AP and lateral X-ray films of the wrist preoperatively and 30 cases experienced CT scan. According to AO, there were 25 cases for B1, 18 for B2, 7 for B3, 7 for C1, and 4 for C2. All the cases were randomized into 2 groups: the wrist palmar group (group A, n=34) and dorsal group (group B, n=27), to perform volar and dorsal plate fixation, respectively. As to the measurement of fortune for the preoperative ruler and incl ination angle, group A were (—45.0 ± 53.0)o and (8.6 ± 3.1)o, respectively, and group B were (—40.0 ± 30.0)o and (7.3 ± 5.6)o, respectively. Preoperative radial shortened (12.0 ± 5.3) mm in group A, and (10.3 ± 4.2) mm in group B. Joint surface level was (4.3 ± 2.2) mm in group A, and (4.1 ± 3.3) mm in group B. Results All of the 61 cases were followed up for 6-27 months (16 months on verage). All the fractures were healed, the time to heal ing in group A was (8.2 ± 1.6) weeks, and in group B was (8.1 ± 1.2) weeks, and the difference was not significant (P gt; 0.05). As for the wrist function by Cartland-Werley scoring at the 8th week after operation, 7 cases were excellent, 10 good, and 17 poor in group A with the choiceness rate of 50.0%, while 7 cases were excellent, 11 good and 9 poor in group B with the choiceness rate of 66.7%. There was significant difference between the two groups (P lt; 0.01). And at the 24th week after operation, 21 cases were excellent, 9 good, and 4 poor in group A with the choiceness rate of 88.2%, while 18 cases were excellent, 5 good, and 4 poor in group B with the choiceness rate of 85.2%. There was no significant difference between the two groups (P gt; 0.05). As for radiological assessment by Sarmiento, device and palm incl ination angles in group A were (9.5 ± 3.1)o and (18.0 ± 8.2)o, respectively, and in group B were (11.0 ± 4.7) o and (16.0 ± 7.6)o, respectively. No radial shortening was found either in group A or in group B, and joint surface level in both groups were less than 1 mm. There was no significant difference between group A and group B in terms of all indicators postoperatively (P gt; 0.05), but there was significant difference when compared with preoperation (P lt; 0.001). With regard to comparison of postoperative compl ications between the two groups, there was no significant difference (P gt; 0.05) in early postoperative compl ications, but there was in long-term compl ications (P lt; 0.01). Conclusion The volar and dorsal plate positions may offer effective stabil ity for unstable distal radial fracture and early functional exercise. The volar plate position may influence the pronation function of the wris joint in the short run, while the dorsal plate position may cause more compl ications in the long run.
ObjectiveTo compare the incidence of chondral injury using Rigidfix femoral fixation device via the anteromedial approach and the tibial tunnel approach during anterior cruciate ligament (ACL) reconstruction. MethodsEighteen adult cadaver knees were divided randomly into 2 groups, 9 knees in each group. Femoral tunnel drilling and cross-pin guide insertions were performed using the Rigidfix femoral fixation device through the anteromedial approach (group A) and the tibial tunnel approach (group B). ACL reconstruction simulation was performed at 0, 10, 20, 30, 45, 60, 70, 80, and 90°in the horizontal position. The correlation between incidence of chondral injury and slope angles was analyzed, and then the incidence was compared between the 2 groups. ResultsThe correlation analysis indicated that the chondral injury incidence increased with the increasing of the slope angle (r=0.611, P=0.000; r=0.852, P=0.000). The incidence of chondral injury was 69.1% (56/81) and 48.1% (39/81) in groups A and B respectively, showing significant difference (χ2=7.356, P=0.007). The sublevel analysis showed that the chondral injury incidence of group A (36.1%, 13/36) was significantly higher than that of group B (0) at 0-30°(χ2=15.864, P=0.000), but no significant difference was found between group A (95.6%, 43/45) and group B (86.7%, 39/45) at 45-90°(P=0.267). ConclusionIt has more risk of chondral injury to use Rigidfix femoral fixation device via the anteromedial approach than the tibial tunnel approach to reconstruct ACL.
Objective To explore the anatomic basis for theanterior approach screw fixation through the C2 vertebral body into the C1 lateral mass and toinvestigate its primary clinical application. Methods Twenty-one adult corpse specimens were anatomically measured. The minimum lateral angle α, the maximum lateral angle β, and the maximum posterior angle γ were calculated based on the data from the anatomic measurement. All the specimens were given an X-ray examination, the minimum lateral angle α, the maximum lateral angle β, and the maximum posterior angle γ were measured. The statistical analysis was made on the data obtained from the calculation in the specimens and the measurement in the X-ray films. The simulation of the approach was made onthe specimen. From October 2004 to July 2006, the simulated approach was used in 5 patients (3 males, 2 females; age, 30-55 years; illness course, 3 months-2 years) with the old atlanto-axial joint dislocation . The Frankel grading system revealed the spinal cord injury degree as follows: 1 patientwas in Grade B, 2 in Grade C, and 2 in Grade D. All the patients were treated with this surgical approach. The postoperative X-ray and CT examinations were performed. Results Angle α was 14.0±1.6°, β was 30.0±2.3°, γ was 29.0±2.9°. No significant difference existed between the angles calculated in the specimens and measured in the X-ray films (Pgt;0.05). The angles for the practical application during operation were as follows: α was 11.2±1.6°, β was 28.8±2.3°, and γ was 29.3±2.9°. The follow-up for an average of 14 months revealed that 1 patient recovered to Grade C, 1 to Grade D2, and 3 to Grade D3 in the spinal cord function according the modified Frankel grading system.Conclusion The anterior approach screw fixation through the C2 vertebral body into the C1 lateral massis feasible and safe in treatment of the old atlantoaxial joint dislocation ifthe screw insertion is exact in direction. This technique only makes the atlas temporarily stable, and so the posterior bone graft should be added into the atlantoaxial joint immediately in the one- or two-stage operation so as to achieve a long-lasting stability.
ObjectiveTo compare the short- and long-term efficacy of artery-first approach pancreatico-duodenectomy (AF-PD) and standard approach pancreaticoduodenectomy (S-PD).MethodsThe PubMed, EMbase, The Cochrane Library, Web of Science, CBM, WanFang, and CNKI databases were searched, relevant literatures were included, and relevant data were extracted for meta-analysis.ResultsA total of 30 articles were included, including 2 750 cases underwent pancreaticoduodenectomy. The results of meta-analysis showed that in terms of short-term efficacy when compared with S-PD group, the AF-PD group had less intraoperative blood loss (WMD=–175.87, P<0.001), lower intraoperative blood transfusion rate (OR=0.36, P=0.002), higher R0 resection rate (OR=1.83, P<0.001), lower postoperative pancreatic leakage rate (OR=0.71, P=0.005), and shorter postoperative hospital stay (WMD=–2.69, P=0.007). However, there were no statistically significant differences in the operation time and overall postoperative complication rate between the two groups (P>0.05). In terms of long-term efficacy when compared with S-PD group, the AF-PD group had lower tumor local recurrence rate (OR=0.43, P=0.004) and tumor liver metastasis rate (OR=0.60, P=0.010), but had higher 1-year (OR=1.95, P=0.007), 2-year (OR=2.04, P<0.001), 3-year (OR=2.09, P=0.001), and 5-year (OR=2.06, P=0.003) overall survival rates, and there were no significant differences in the rates of lung metastasis and peritoneal metastasis between the two groups (P>0.05).ConclusionsAF-PD is better than S-PD in some short-term and long-term outcome indicators such as R0 resection rate, pancreatic leakage rate, overall survival rate, and so on. However, due to the limited quality of the included literatures, more high-quality studies are still needed to verify in the future.
ObjectiveTo summarize the clinical application of the minimally invasive step-up approach in the treatment of severe acute pancreatitis (SAP), and to explore the clinical indications, timing for the minimally invasive step-up approach, and to make comparison with open necrosectomy. MethodsThe literatures about the treatment of SAP in recent years were collected to make a review. ResultsThe minimally invasive step-up approach, comparing with open necrosectomy, was more effective to treat SAP, however, itself had its own limitations. In the treatment process, the optimal method was minimally invasive step-up approach, but also did not exclude open necrosectomy. ConclusionsThe treatment of SAP can not rely on a single method, it needs a comprehensive treatment which is relate with multidisciplinary management and highly individual choice. In addition, it needs further study to explore the timing and indications for transforming minimally invasive step-up approach into open necrosectomy.
Objective To review the feature, biomechanics, and cl inical appl ication of percutaneous 360 degree axial lumbar interbody fusion (AxiaLIF) technique. Methods Recent l iterature on investigation and appl ication of percutaneous360 degree AxiaLIF technique was reviewed. Results Percutaneous 360 degree AxiaLIF technique mainly contained operative approach, axial technique, and posterior fixation. It was obviously different from other lumbar interbody fusion techniques due to its capabil ity of maintaining the integrity of the bilateral facet joints, the anterior/posterior longitudinal l igament, and the annulus fibrosus. Three-dimensional AxiaLIF RodTM provided axial support and firmly fixation, thereby rel ieving stenosis of lumbar intervertebral foramen and restoring the intervertebral disc height and the whole height and physiological curvature of the lumbar spine. The recovery of the intervertebral disc height could restore the folded or crumpled flavum, the posterior longitudinal l igament, and the herniated annulus, resulting in the improvement of stenosis symptoms of nerve root canal or central vertebral canal. Conclusion Percutaneous 360 degree AxiaLIF technique achieves satisfying therapeutic effects, although it has fairly narrow indication and needs long-term follow-up observation.
ObjectiveTo investigate the clinical application of laparoscopic right hemihepatectomy via anterior approach. MethodThe clinical data of 32 patients underwent laparoscopic right hemihepatectomy via anterior approach from June 2017 to May 2019 were retrospectively analyzed.ResultsThe laparoscopic right hemihepatectomies via anterior approach were successfully completed in the 32 patients, no one converted to laparotomy. The operation time was (315.5±36.7) min, the intraoperative bleeding was (340.8±105.4) mL, and the postoperative hospital stay was (8.9±1.7) d. The postoperative complications occurred in 6 cases, including 1 case of peritoneal effusion, 1 case of intraabdominal infection, 2 cases of bile leakage and 2 cases of pleural effusion combined with pulmonary infection, who were discharged after receiving the conservative treatment according to the symptoms. The results of postoperative pathology: 13 cases of hepatocellular carcinoma, 6 cases of intrahepatic cholangiocarcinoma, 7 cases of hepatic angioleiomyoma, 6 cases of intrahepatic bile duct stones. The average follow-up time was 12 months (range 1 to 24 months). During the follow-up period, 7 cases of hepatic angioleiomyoma and 6 cases of hepatolithiasis survived after operation. The intrahepatic metastases were found in 1 patient with hepatocellular carcinoma at 12 months and 2 cases of intrahepatic cholangiocarcinoma at 9 months and 11 months, respectively. The rest patients survived free tumor.ConclusionLaparoscopic right hemihepatectomy via anterior approach is safe and feasible, and has a satisfactory short-term efficacy.
Objective To explore the feasibility and safety of removal of benign substernal goiter through cervical approach and summarize the operation skill. Methods The clinical data of 85 cases diagnosed as benign substernal goiter from August 2002 to October 2011 in this hospital were analyzed retrospectively. Results The removal of benign substernal goiters in all 85 cases were performed through cervical approach without perioperative death，respiratory tract obstruction，massive haemorrhage，pneumothorax，hemothorax，chylus leakage，permanent impairment of recurrent laryngeal nerve，and permanent hypoparathyroidism. Three cases of hoarseness were found on 1-3d after operation，which returned to normal after symptomatic treatment. Four cases of numbness in the extremities and one case of mild convulsion happened，the symptoms were relieved through intravenous and oral administration of calcium treatment in 3-7d. The drainage volume was 35-220ml with （68±4.9） ml. The drainage tube was removed on postoperative 2-6d with an average 4.2d. Eighty-two patients were followed-up in 2 years after operation，no low calcium，low parathyroid hormone，hoarseness，and local goiter recurrence occurred. Two cases of hypothyroidism returned to normal after oral thyroxine dose adjustment. Conclusions Removal of the downward benign substernal goiter through cervical approach is safe and feasible. Sufficient exposure，stepwise procedure，blunt dissection in the precise gap，and combination of lifting with upbearing are the surgical skills for success.
ObjectiveTo explore the effectiveness of non-absorbable suture or suture anchor fixation by anterior approach in the treatment of anteromedial facet fractures of the ulnar coronoid process. MethodsBetween February 2007 and February 2012,16 cases of anteromedial facet fractures of the ulnar coronoid process were treated with operation.There were 9 males and 7 females,aged 20-80 years (mean,43.5 years).The causes of injury were traffic accident injury in 7 cases,tumble injury in 5 cases,and falling injury from height in 4 cases.The time from injury to operation was 6.8 days on average (range,2-8 days).All cases had closed fractures.According to O'Driscoll classification,there were 4 cases of type Ⅱ a,7 cases of type Ⅱ b,and 5 cases of type Ⅱ c.Among 16 patients,7 had simple anteromedial facet fractures of the ulnar coronoid process,and 9 had associated injury,including terrible triad in 3,Monteggia fractures in 4,and olecranon fractures in 2.All fractures were fixed with non-absorbable suture in 10 cases,and with suture anchor in 6 cases.The Mayo Elbow Performance Score (MEPS),range of motion (ROM),and complications were used to assess the elbow function. ResultsThe incisions all healed by first intension,without neurovascular injury.Fifteen patients were followed up 10-48 months (mean,25.3 months).The X-ray films showed that all fractures healed,with the mean healing time of 17.5 weeks (range,11-30 weeks).At last follow-up,the mean MEPS score was 88.5(range,55-100);the results were excellent in 10 cases,good in 3 cases,fair in 1 case,and poor in 1 case,with an excellent and good rate of 86.7%.The mean ROM of flexion and extension was 118°(range,35-145°),and the mean ROM of forearm rotation was 138°(range,85-165°).One case had elbow instability,and 3 had slight pain.No heterotopic ossification and traumatic arthritis occurred during the follow-up. ConclusionThe anteromedial facet fractures of the ulnar coronoid process can be clearly exposed through anterior approach,and the fracture fixation using non-absorbable suture and suture anchor fixation usually can restore the elbow function.
Objective Based on the acquirable and optimized evidences at present, to explore the challenge and countermeasures for the development of nursing discipline in China, and to provide suggestions for promoting the construction of nursing discipline, platform, and talent team. Methods The study materials were searched in the following electronic databases including PubMed, EMbase, Web of Science, CNKI, VIP and CBM, as well as in the official websites of World Health Organization (WHO), International Council of Nurses (ICN), World Bank, the Ministry of Health (MOH) and the Ministry of Education (MOE) of China, and the domestic universities, colleges or technical secondary schools. Then the statistical analysis was conducted using SPSS 13.0 and Microsoft Excel software. Results a) By 2012, there were 855 nursing schools, 38 212 nursing undergraduates enrolled in universities, and 130 837 nursing students enrolled in junior colleges and senior vocational schools; b) The doctor-to-nurse ratio was 1 to 0.9 in 2010. The actual demand for doctors was 2.6 million, and there were still lack of 346 000 nurses; c) The age of nurses younger than 35 years old accounted for 50%. Those with primary professional title accounted for 64% to 69%, while less than 2.5% with advanced professional title; d) The training cost for a doctor and nurse/midwife in China only accounted for 2/5 of that in India and 1/5 to 1/4 in the sub-Sahara Africa; and e) To date, only 30.1% of disaster nursing studies in China provided research data, 30.6% were clinical experience and 38.3% were review. Conclusion Education and health systems need to be extensively reformed. It is necessary to train nursing students with core competencies using transformative learning. It is necessary to update textbooks and teaching methods, and funding should be appropriately increased. Nursing should cooperate with other disciplines, and apply evidence-based nursing methods to improve the quality of healthcare services and patient satisfaction.