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find Keyword "早期疗效" 25 results
  • Early Outcome of Open Heart Surgery for Congenital Heart Diseases in Low Birth Weight Infants and Premature Infants

    Abstract: Objective To analyze the early outcomes of open heart surgery for congenital heart diseases in sixty low birth weight infants and premature infants. Methods Sixty low birth weight infants (body weight<2 500 g) and premature infants with congenital heart diseases undergoing surgical repair from May 2003 to October 2011 were studied retrospectively in Guangdong Cardiovascular Institute. There were 43 male patients and 17 female patients with their mean gestational age of 33.5±4.1 weeks (ranging from 26 to 42 weeks) and mean age at operation of 24.9±12.5 d(ranging from 4 to 55 d). Among them there were 47 premature infants with their mean birth weight of 1 729.3±522.5 g(ranging from 640 to 2 500 g)and mean weight at operation of 1 953.2±463.6 g (ranging from 650 to 2 712 g). All the patients received preoperative treatment in newborn intensive care unit(NICU) and underwent surgical repair under general anesthesia, including 29 patients without cardiopulmonary bypass (CPB)and 31 patients with CPB . All surviving patients received postoperative monitoring and treatment in NICU, and their postoperative complications and in-hospital death were reported. Results A total of 13 patients died during hospitalization with a total in-hospital mortality of 21.7%(13/60), including 4 intra-operative deaths, 6 early deaths (within 72 h postoperatively) and 3 patients giving up postoperative treatment. CPB time was 121.0±74.7 min, aortic clamp time was 74.8±44.7 min, and postoperative mechanicalventilation time was (136.9±138.1)h. Thirteen patients underwent delayed sternal closure. Eight patients underwentreexploation for postoperative bleeding. Ten patients had severe pneumonia, 2 patients had pulmonary hypertensive crisis, and 8 patients had low cardiac output syndrome. All the postoperative complications were resolved or improved after proper treatment. Follow-up was complete in 47 patients from 2 to 12 monthes, and all the patients were alive during follow-up. Conclusion Early surgical repair for low birth weight infants and premature infants with congenital heart diseases is safe and effective.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • 体外循环和非体外循环冠状动脉旁路移植术的早期疗效比较

    目的 比较非体外循环冠状动脉旁路移植术(OPCAB) 与体外循环冠状动脉旁路移植术(CABG)的早期疗效,探讨OPCAB的安全性和有效性。 方法 对2007年1月至2008年8月我院收治的41例不合并有心脏瓣膜病、室壁瘤等其它心脏病的冠心病患者按照随机抽签的方法分成两组,OPCAB组:21例, 年龄65.30±3.10岁;CABG组:20例,年龄61.80±3.20岁;比较两组患者术后并发症发生率及左心室射血分数(LVEF)等临床指标。 结果 两组患者旁路移植血管支数、手术时间、二次开胸止血、肾功能不全及早期心功能改善(术后2周EF)等指标比较差异无统计学意义(Pgt;0.05),但 CABG组呼吸机辅助时间(14.52±4.34 h vs.6.32±1.38 h,t=8.237, P=0.001),24 h 胸腔引流量(526.56±90.21 ml vs. 321.45±102.31 ml,t=6.796,P=0.001),24 h输血量(679.50±182.60 ml vs.310.30±168.30 ml,t=6.736,P=0.001),心房颤动发生率(15% vs. 5%,χ2=5.334,P=0.025),使用正性肌力药(40% vs. 14%,χ2=0.222,P=0.586)及脑部并发症发生率(10% vs.0%,χ2=7.221,P=0.008)等均高于OPCAB组。 结论 两种手术方式均安全、有效;但对合并有慢性肺部疾病和颈动脉有斑块或曾经有脑血管意外的患者,OPCAB可做为首选手术方法。

    Release date:2016-08-30 06:02 Export PDF Favorites Scan
  • 人工全髋关节置换术治疗股骨近端骨肿瘤早期疗效

    目的 总结人工全髋关节置换术治疗股骨近端骨肿瘤的临床疗效。 方法 2000 年1 月- 2009 年6 月,采用广泛切除肿瘤后人工全髋关节置换术治疗17 例股骨近端骨肿瘤患者。男11 例,女6 例;年龄38 ~ 65 岁,平均52.6 岁。病程3 ~ 485 d,中位时间18 d。骨肉瘤2 例,软骨肉瘤2 例,骨转移性肿瘤3 例,骨巨细胞瘤6 例,动脉瘤样骨囊肿1 例,骨囊肿2 例,骨囊肿复发1 例。肿瘤大小范围为4 cm × 3 cm ~ 8 cm × 4 cm。 结果 患者手术时间100 ~ 180 min,平均138 min;术中输血量600 ~ 1 500 mL,平均923 mL;住院时间14 ~ 22 d,平均16.5 d。 术后切口均Ⅰ期愈合,无感染、脱位、脂肪栓塞、深静脉血栓形成发生。17 例均获随访,随访时间11 ~ 60 个月,平均47.4 个月。3 例骨转移性肿瘤、1 例骨肉瘤于出院后11 ~ 37 个月因肿瘤肝、肺转移死亡。术后1 年存活的16 例根据Harris 评分标准评定关节功能:获优5 例,良8 例,中2 例,差1 例。X 线片均未见肿瘤复发、髋臼磨损、髋关节脱位、假体松动与假体周围骨折。 结论 人工全髋关节置换术治疗股骨近端骨肿瘤早期疗效满意,可以重建髋关节功能,肢体功能恢复快,并发症少。

    Release date:2016-08-31 05:41 Export PDF Favorites Scan
  • EARLY CLINICAL OUTCOME OF TOTAL KNEE ARTHROPLASTY FOR FLEXIONCONTRACTURE DEFORMITY KNEES OFDIFFERENT DEGREES

    Objective To make a retrospective analysis on an early clinical outcome of total knee arthroplasty (TKA) for the knees with different degrees of flexion-contracture deformities. Methods Ninety-seven knees of 65 patients undergoing total knee arthroplasty with the Scorpio posterior-stabilized knee prosthesis from January 2000 to December 2003 were reviewed, including 51 osteoarthritis patients (74 knees) and 14 rheumatoid arthritis patients (23 knees). Thirtythree patients underwent unilateral TKA, and 32 patients underwent bilateral TKA. The average range of motion (ROM) before operation was 82.8°(range, 5-140°).According to the preoperative flexion-contracture degrees of the knees, these patients were divided into 2 groups, group A and group B. Group A consisted of the patients with flexioncontracture less than 20° (range, 0-15°), and group B consisted of the patients with flexion-contracture not less than 20° (range, 20-60°). In group A, the average flexion-contracture degree, ROM, KSS (knee society score), and function score were 10.7±8.0°, 104.6±20.0°, 29.1±18.0, and 32.6±20.7, respectively. But the corresponding data were much worse ingroup B than in group A, which were 28.2±7.8°, 60.8±26.6°, 12.1±13.2, and 26.8±18.1. All the operations were primary total knee arthroplasty, and they were performed by the same group of surgeons. The time for the prosthesis installed lasted for 25.6 minutes, and the average tourniquet time was 34.7 minutes. Three or four days after operation, the patients began the continuous passive motion (CPM) and active functional exercise of the knee.Results The patients were followed up for an average of 2 years and 7 months(range, 8 mon-3.5 yr). During the follow-up period, the average flexion-contracture degree, ROM, KSS, and function score in group A were 0.4±2.1°, 108.6±19.0°, 82.1±13.8, and 72.3±29.1, respectively; and the corresponding data in group B were 1.3±3.2°, 986±16.4°, 75.9±8.2, and 81.4±26.9, respectively. There was no significant difference between the 2 groups. No revision or deep infection was found. Conclusion The curative effect is mainly determined by the surgeon’s good operational skills, rich clinical experience, and familiarity with the prosthesis, and it is not influenced by severity of the knee flexioncontracture deformity. The knee ROM after TKA, which has a “toward middle ROM”phenomenon, is influenced by many clinical factors. It is very important for the patientto perform a functional exercise of the knee as early as possible after operation. 

    Release date:2016-09-01 09:26 Export PDF Favorites Scan
  • 医用臭氧联合应用胶原酶与单纯应用胶原酶治疗腰椎间盘突出症早期疗效的比较

    目的 研究医用臭氧(O3)对胶原酶治疗腰椎间盘突出症早期疗效的影响。 方法 回顾性分析2009年-2013年108例腰椎间盘突出症患者,将其分为单纯应用胶原酶组(A组)和O3联合应用胶原酶组(B组)。两组患者均经椎板间孔入路穿刺,并将针尖调整至病变椎间盘突出物内,A组单纯注入胶原酶溶液1 mL(含胶原酶600 U);B组先注入50 mg/L O3 15 mL,15 min后再注入胶原酶溶液1 mL(含600 U)。根据视觉模拟评分(VAS)及改良MacNab法比较术后3 d、1周及1个月患者疼痛的程度及疗效。 结果 B组术后3 d及1周VAS评分显著低于A组(P<0.05),术后1个月VAS评分无统计学意义(P>0.05);B 组术后3 d及1周有效率分别为71.2%和88.5%,明显高于A组51.7%和71.4%,而术后1个月有效率无统计学意义(P>0.05)。 结论 O3联合应用胶原酶治疗腰椎间盘突出症早期疗效明显优于单纯应用胶原酶。

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  • Short-term effectiveness analysis of one-stage bilateral total hip arthroplasty by direct anterior approach

    Objective To compare the effectiveness of one-stage bilateral total hip arthroplasty by direct anterior approach (DAA) and by posterolateral approach, and to investigate the application value of DAA in one-stage bilateral total hip arthroplasty. Methods The clinical data of 65 patients who underwent one-stage bilateral total hip arthroplasty by DAA or posterolateral approach between June 2010 and November 2015 were analyzed retrospectively. DAA was used in 34 cases (group A) and posterolateral approach was used in 31 cases (group B). There was no significant difference in the gender, age, body mass index, preoperative hemoglobin level, etiology, disease duration, preoperative Harris score, and preoperative visual analogue scale (VAS) score between 2 groups (P>0.05) with comparability. The incision length, operation time, intraoperative blood loss, total blood transfusion volume, hospitalization time, early postoperative complications, Harris score, and VAS score were recorded and compared between 2 groups. The simple Likert scale method was applied to evaluate the patient satisfaction, and the imaging evaluation was used. Results The incision length, operation time, intraoperative blood loss, total blood transfusion volume, and hospitalization time of group A were significantly less than those of group B (P<0.05). The patients were followed up 15-48 months (mean, 25.3 months) in group A and 12-51 months (mean, 27.6 months) in group B. The overall incidence of complications related to surgery in group A (10.29%) was significantly lower than that of group B (19.35%) (χ2=8.769, P=0.023). The acetabular anteversion and abduction angle were in the normal range of 2 groups except 1 hip (1.47%) of group A had a higher acetabular anteversion than normal value. Unstable fixed prosthesis happened in 1 hip of groups A and B respectively, and the remaining femoral calcar had no obvious bone resorption and fixed stably. The Harris score and VAS score at each time point after operation of 2 groups were significantly improved when compared with preoperative scores (P<0.05), and the differences between the time points after operation were also significant (P<0.05). The Harris score at 1 and 3 months after operation and the VAS score at 3 days after operation of group A were significantly better than those of group B (P<0.05), but no significant difference was found at last follow-up between 2 groups (P>0.05). According to the simple Likert scale method to analyze patient satisfaction, comprehensive satisfaction of group A (97.1%, 33/34) was significantly higher than that of group B (67.7%, 21/31) (χ2=10.343, P=0.001). Conclusion The application of DAA in one-stage bilateral total hip arthroplasty can significantly relieve the pain, accelerate the recovery of hip joint function, and improve the patient satisfaction. But in clinical application, more attentions should be paid to strictly grasp the indications and prevent the early complications. The long-term effectiveness needs to be further observed.

    Release date:2017-09-07 10:34 Export PDF Favorites Scan
  • Comparison of short-term effectiveness of staged bilateral total hip arthroplasty via different approaches

    Objective To compare the short-term effectiveness of staged bilateral total hip arthroplasty via different approaches. Methods Thirty-two patients (64 hips) with bilateral hip disease were treated with total hip arthroplasty between January 2012 and December 2014. There were 20 males and 12 females with the mean age of 45.3 years (range, 30-67 years). There were avascular necrosis of femoral head in 14 cases, developmental dislocation of the hip in 12 cases, ankylosing spondylitis in 4 cases, osteoarthritis in 2 cases. All patients were treated with total hip arthroplasty; and the direct anterior approach (DAA) or direct lateral approach (DLA) was chosen for the unilateral hip randomly. The length of incision, operation time, total blood loss volume, the time of first postoperative activity, and the acetabular anteversion angle were compared. The Harris score, visual analogue scale (VAS) score, and incidence of complication were compared between 2 groups. Results All incisions healed at stage Ⅰ. All patients were followed up 20-53 months (mean, 39.6 months). The length of incision, total blood loss volume, the time of first postoperative activity were significantly shorter in DAA group than in DLA group (P<0.05). The operation time was significantly longer in DAA group than in DLA group (P<0.05). There was no significant difference in acetabular anteversion angle between 2 groups (t=1.122, P=0.266). The incidence of complication were 25.00% and 15.63% in DAA group and DLA group, respectively, showing no significant difference (χ2=0.869, P=0.536). The Harris score in DAA group significantly increased at 3 and 9 months after operation than in DLA group (P<0.05); there was no significant difference at 18 months after operation between 2 groups (P>0.05). The VAS score was significantly lower in DAA group than in DLA group at 1 day, 3 days, and 1 week after operation (P<0.05); there was no significant difference at 4 and 8 weeks between 2 groups (P>0.05). The prosthesis did not loosen and sink during the follow-up. Conclusion Total hip arthroplasty via DAA can reduce operation related complication and speed up the recovery of hip function at the early stage after operation. However, the lateral cutaneous nerve injury is the most common complication.

    Release date:2017-11-09 10:16 Export PDF Favorites Scan
  • Preliminary effectiveness of laminated bevel suturing technique for treating acute closed Achilles tendon rupture

    Objective To introduce a modified technique for treating acute closed Achilles tendon rupture and evaluate the preliminary effectiveness. Methods Between March 2011 and September 2015, 8 cases (8 sides) with acute closed Achilles tendon rupture were repaired with the laminated bevel suturing technique. All of the patients were male with an average age of 39.3 years (range, 22-58 years), injured in nonprofessional sports. The diagnosis was confirmed by typical signs of positive heel-lift test and Thompson test; the complete rupture of Achilles tendon was determined by color Doppler ultrasound or MRI, and the distance between the stump and calcaneus was 2-5 cm (mean, 3.3 cm). The time from injury to operation was 2-12 days (mean, 4.1 days). With the patient in prone position, a posterior longitudinal incision medial to the tendon was made, the broken stumps of Achilles tendon were divided into 3 layers on the coronal plane, fibers made into strips. The strips were staggered and stacked, stitched side to side with absorbable suture. The ankle joint at the plantar flexion position was fixed with plaster, and early rehabilitation exercise was carried out. Results The operation time was 70-135 minutes (mean, 99 minutes); the intraoperative blood loss was 5-30 mL (mean, 15.6 mL). All the incisions healed by first intention without infection, except for 1 case who need dressing exchange because of partial delayed healing. All the patients were followed up 6-50 months (mean, 30.5 months). There was no complication of surgical site infection, sural nerve injury, or deep vein thrombosis. The patients could walk normally with powerful raising heels and return to previous sports, without complication of re-rupture. Compared with the contralateral side, the activity of ankle joint dorsiflexion reduced 0-6° (mean, 3°); plantar flexion reduced 1-5° (mean, 2°). At last follow-up, according to Arner-Lindholm score, the surgical results were excellent in 7 cases and good in 1 case, with an excellent and good rate of 100%. Conclusion Laminated bevel suturing technique is simple for repairing acute closed Achilles tendon rupture without the need of special surgical instruments. It provides enough tensile strength for early rehabilitation exercise to rapid and good recovery.

    Release date:2017-12-11 12:15 Export PDF Favorites Scan
  • Early outcomes of 203 neonates with low birth weight undergoing cardiac surgery and analysis of death causes

    ObjectiveTo analyze the early outcomes of 203 neonates with low birth weight (<2 500 g) undergoing cardiac surgery, and to analyze the causes of death during hospitalization.MethodsFrom June 2003 to June 2017, medical records of 203 neonates with low birth weight undergoing congenital heart surgery in Guangdong General Hospital were reviewed retrospectively. There were 124 males and 79 females, including 151 premature infants. The average birth weight was 1 719±515 g, the average age at operation was 32.7±20.2 d and the average weight at operation was 1 994±486 g. The causes of death during hospitalization (including neonates given up on treatments) were analyzed.ResultsTotally 103 patients had pneumonia, 98 patients needed mechanical ventilation to support breathing and 26 patients needed emergency operation before operation. All patients undergoing congenital heart surgery were treated with general anesthesia with tracheal intubation, including 107 patients under non cardiopulmonary bypass (CPB) and 96 patients under CPB with a mean CPB time of 96.5±71.7 min and a mean aorta cross-clamp time of 51.8±45.5 min. The average postoperative mechanical ventilation time was 9.1±21.5 d and the average postoperative length of stay was 26.7±19.3 d. The major postoperative complications included pneumonia, anemia, atelectasis, septicemia, intrapleural hemorrhage, diaphragm paralysis and cardiac dysfunction. Twenty-nine patients died during hospitalization and the overall mortality rate was 14.3%. Four patients died in the operation room, 14 patients died 72 hours after operation and 2 patients were given up. The main causes of hospitalized death were low cardiac output syndrome, severe infection, disseminated intravascular coagulation disorder, acute renal failure and pulmonary hypertension crisis.ConclusionOverall, early cardiac surgery for low birth weight neonates is safe and effective. The difficulty of the cardiac surgery is the key to the prognosis. Strengthening perioperative management can improve the quality of operation and reduce the risk of mortality and morbidity during hospitalization.

    Release date:2018-11-02 03:32 Export PDF Favorites Scan
  • Comparison of early effectiveness and safety of simultaneous and staged bilateral unicompartmental knee arthroplasty for bilateral anteromedial compartment osteoarthritis

    ObjectiveTo compare the early effectiveness and safety of simultaneous bilateral and staged bilateral unicompartmental knee arthroplasty (UKA) in treatment of anteromedial compartment osteoarthritis.MethodsThe clinical data of 31 patients with bilateral anteromedial compartment osteoarthritis who underwent bilateral UKAs between January 2015 and January 2017 was retrospectively analyzed. Of them, 17 patients were treated with simultaneous bilateral UKAs (simultaneous group) and 14 patients with staged bilateral UKAs (staged group). There was no significant difference in gender, age, body mass index, osteoarthritis grading, and preoperative hip-knee-ankle angle, knee society score (KSS), visual analogue scale (VAS) score, and range of motion (ROM) of knee between the two groups (P>0.05). The operation time, blood loss, hospitalization stay, minimum hemoglobin value during 10 days after operation, and hospitalization cost were recorded. The staged group was compared by the sum of two operations. The effectiveness was evaluated by KSS score, VAS score, ROM at 3, 6, 12 months after operation, and patient satisfaction scores were recorded at 12 months after operation.ResultsThe operation time, hospitalization stay, and hospitalization cost of the simultaneous group were significantly lower than those of the staged group (P<0.05). There was no significant difference in blood loss and the minimum hemoglobin value during 10 days after operation between the two groups (P>0.05). Superficial infection occurred in 1 side of 1 case (7.1%) in staged group. Postoperative delirium occurred in 1 case (5.9%) in simultaneous group. There was no significant difference in incidence of postoperative complications between the two groups (P=1.000). Patients in both groups were followed up 12-32 months (mean, 24.7 months). There was no significant difference in KSS score between the two groups at 3 months after operation (t=0.896, P=0.392). KSS scores were significanly higher in simultaneous group than in staged group at 6 and 12 months after operation (P<0.05). There was no significant difference in ROM and VAS scores between the two groups at 3, 6, and 12 months after operation (P>0.05). At 12 months after operation, the patient satisfaction scores were significantly higher in simultaneous group than in staged group (P<0.05). X-ray films showed no loosening of the prosthesis in the two groups.ConclusionSimultaneous bilateral UKAs has the same security as staged bilateral UKAs. Meanwhile knee function recovery was better, hospitalization stay and hospitalization cost reduced, and patient satisfaction was higher in simultaneous bilateral UKAs.

    Release date:2019-06-20 03:12 Export PDF Favorites Scan
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