The treatmen t of the bone defect of the distal part of the radiu s included repair of the bone defect and resto rat ion of the funct ion of the w rist jo in t. Since 1979, th ree operat ive methods w ere u sed to t reat 13 cases, and they w ere graf t ing of the vascu larized f ibu la by anastom rsis f ibu lar vessels, graf t ing of upper part of f ibu lar w ith lateral inferio rgen icu lar artery and graf t ing vascu larized scapu la f lap. Follow up had been carried ou t from1 to 10 years. The resu lt w as sat isfacto ry. The discu ssion included the repair of the defect of the m iddle o r distal part of the radiu s, the operat ive methods, main at ten t ion s and indications. It was considered that it shou ld be based on the length of bone defect wh ile the operative method was considered.
Objective To identify an evidence-based treatment for an elderly patient with intertrochanteric fractures. Methods Clinical problems were presented on the basis of the patient’s conditions, and evidence was collected from the NGC (2000 to 2009), The Cochrane Library (Issue 4, 2009), TRIP Database, PubMed (1966 to 2009) and CBM (1978 to 2009). Treating strategies were formulated in terms of the three-combination principle (best evidence, the doctor’s professional knowledge and the patient’s desire). Results Three guidelines and sixteen studies were included. The current evidence indicated that surgery was the preferred solution to intertrochanteric fractures of the elderly patient. The sliding hip screw (SHS) appeared superior to others. There was insufficient evidence to support the routine use of closed suction drainage in orthopedic surgeries. Early surgery was associated with shorter hospital stay and improved mortality. Antibiotic prophylaxis significantly reduced infections. In order to lower the risk of venous thromboembolism, pharmacological prophylaxis should be carried out when the patient was admitted to hospital and be assisted with mechanical prophylaxis after surgery. Nutritional supplementation was conducive to the recovery of the patient. Rehabilitation ought to be performed as soon as possible. Considering the patient’s condition, the treatment option was established according to the available evidence and guidelines. Short-term follow-up showed a good outcome. Conclusion Through the evidence-based method, an individual treatment plan could obviously improve the treatment effect and prognosis.
OBJECTIVE: To study the effect of basic fibroblast growth factor (bFGF) and hyaluronic acid gel (HAG) combined with freeze-dried bone allograft in repairing segmental bone defect and to explore their mechanism. METHODS: The 15 mm segmental bone/periosteum defects were created on bilateral radius in 50 New Zealand rabbits and were treated with four different kinds of implants on 25 radius respectively (group A: bFGF and HAG combined with freeze-dried bone; group B: bFGF combined with freeze-dried bone; group C: HAG combined with freeze-dried bone; group D: simple freeze-dried bone as a control). The repair of defect was observed radiologically and histologically and were analyzed by radionuclide bone imaging and measurement of calcium contents at different periods. RESULTS: The new bone formation, bone metabolic activity and calcium contents of defects were higher in group A than in group B (P lt; 0.05), and were higher in group B than in groups C and D (P lt; 0.05). There were no significant difference between groups C and D. The bone defects healed in the 8th week in group A, in the 10th week in group B, but did not healed in the 10th week in groups C and D. CONCLUSION: As an osteogenetic factor, bFGF promotes the new bone formation; as a slow-release carrier, HAG enhances the effectiveness of bFGF. The combination of bFGF, HAG and freeze-dried bone allograft can repair the segmental bone defect more effectively.
OBJECTIVE To investigate the outcome of anterior cruciate ligament (ACL) by free autograft of middle one third of bone-patellar tendon-bone complex which was formed by lower edge of patella, middle one third of patellar tendon, and tibial tubercle. METHODS From April 1994 to August 1996, ACL reconstruction by bone-patellar tendon-bone complex was performed in 8 patients with ACL injury. RESULTS All cases were followed up 5 months to 3 years, averaged 26 months, excellent results were obtained in 4 cases, better in 3 cases and moderate in 1 case. The Lanchman test and/or anterior drawer test were positive in 8 cases preoperatively and only 1 case was positive postoperatively. Instability existed in 5 cases preoperatively were disappeared after operation. All patients could basically meet the demands of daily life. CONCLUSION Reconstruction of ACL by free autograft of middle one third of bone-patellar tendon-bone complex is an effective method for the restoration of stability in knee joint.
Objective To observe the result of reconstructing quadriceps femoris function in the paraplegia rats by using the 7th cervical nerve root (C7) transposition with autologous and allogeneic neural transplantation. Methods Twenty16-week-old SPF male Wistar rats were adopted to prepare frozen sciatic nerve. Thirty-six Wistar rats were divided into 2 groups (group A and group B, n=18). The left paraplegia model was establ ished with left spinal cord hemisection by the micro scissors under the operation microscope. After the model establ ishment, the homolateral autologous sciatic nerve was bridged with the femoral nerve root by the translocation of C7 in group A, while the allogeneic sciatic nerve was bridged with the femoral nerve root by the translocation of C7 in group B. At 16 weeks and 24 weeks after operation, 9 rats in each group were selected for the neuroelectric-physiological test and then the histomorphology of the nerves was observed under the microscope and the electron microscope. The fresh weight recovery rate of quadriceps femoris was calculated. Results At 16 and 24 weeks after operation, the nerve action-evoked potential (NAP) was (1.14 ± 0.07) mV and (1.21 ± 0.07) mV in group A, and (0.87 ± 0.06) mV and (0.99 ± 0.05) mV in group B; the nerve conduction velocity (NCV) was (17.34 ± 2.15) m/s and (19.00 ± 3.02) m/s in group A, and (11.23 ± 1.45) m/s and (12.54 ± 1.59) m/s in group B, respectively, indicating significant differences (P lt; 0.05) between 2 groups. At 16 and 24 weeks after operation, HE staining and Bielschowsky staining showed that group A had a large number of nerve fiber regeneration, with a regular arrange of axons; while group B had l ittle nerve fiber regeneration with a scattered arrange of axons. At 24 weeks after operation, images in TEM showed a large number of regeneration myel inated nerve fibers and a small number of unmyel inated nerve fibers through the transplanted nerve in two groups. At 16 weeks after operation, the number of myel inated nerve fibers in group A and group B was (438 ± 79) and (196 ± 31) / vision, the areas of myel inated nerve fiberswere (5 596.00 ± 583.94) and (4 022.63 ± 615.75) μm2 / vision; after 24 weeks, the number of myel inated nerve fibers in groups A and B were (642 ± 64) and (321 ± 75)/vision, the areas of myel inated nerve fibers were (6 689.50 ± 1 142.10) and ( 4 733.00 ± 982.22) μm2/vision, indicating significant differences between two groups (P lt; 0.05). There was no statistically significant difference (P gt; 0.05) in the wet weight recovery rate of quadriceps between group A and group B at 16 weeks (87.96% ± 4.93% vs. 86.47% ± 7.47%) and at 24 weeks after operation (90.10% ± 4.22% vs. 87.66% ± 3.14%). Conclusion C7 transposition combined with autograft and allograft of sciatic nerve can reconstruct the partial function of the quadriceps femoris in paraplegia rats. The effect of graft is better than that of graft obviously.
The assumption of fixed-effects model is based on that the true effect of the each trial is same. However, the assumption of random-effects model is based on that the true effect of included trials is normal distributed. The total variance is equal to the sum of within-trial variance and between-trial variance under the random-effects model. There are many estimators of the between-trial variance. The aim of this paper is to give a brief introduction of the estimators of between-trial variance in trial sequential analysis for random-effects model.
ObjectiveTo investigate the feasibility of one-stage total spondylectomy by anterior and posterior approaches for treating solitary plasmacytoma (SP) of cervical spine.MethodsBetween June 2000 and March 2015, the clinical data, diagnosis, and treatment of 12 patients with SP of cervical spine were retrospectively analyzed. There were 8 males and 4 females, with a mean age of 46 years (range, 28-74 years). The mean disease duration was 8.4 months (range, 3-15 months). There were 2 cases in C2 segment, 4 cases in C3, 2 cases in C4, 1 recurrent case in C5, C6, and 3 cases in C7. According to WBB (Weinstein-Boriani-Biagini) surgical staging system, the tumor mainly occupied the vertebral body areas and expanded outside to 4 or 9 radiating zone in 8 cases, expanded both outsides to 4 or 9 radiating zones in 4 cases; 7 cases of them affected A to D layers, other 5 cases affected B to D layers. Preoperative Frankel system showed grade B in 1 case, grade C in 6 cases, and grade D in 5 cases. One vertebra segment was involved in 11 cases, and 2 vertebra segments were involved in 1 case. The unilateral vertebral artery was involved in 4 cases and bilateral vertebral artery in 1 case. One-stage total spondylectomy by anterior and posterior approaches for SP of cervical spine was applied in all patients, which all received adjuvant radiotherapy postoperatively. The operation time, intraoperative blood loss, complications, Frankel system, and visual analogue scale (VAS) score were recorded and analyzed.ResultsThe operation time was 6.8-9.3 hours (mean, 7.2 hours), and the intraoperative blood loss was 1 100-2 600 mL (mean, 1 600 mL). Esophageal leakage occurred in 1 patient with C5, C6 recurrent SP at 1 week after operation and 1 case presented with fat liquefaction of wound, who were cured by symptomatic treatment. Other patients showed no neurological deficit, major vascular injury (especially vertebral artery), phrenic nerve injury, superior laryngeal nerve injury, laryngeal nerve injury, respiratory failure, or other complications. All the 12 patients were followed up 27-98 months (mean, 58 months). The symptoms of spinal cord compression disappeared or improved after operation. At last follow-up, the nerve function was recovered to Frankel grade E in all patients; the VAS score decrease to 1.1±0.7, showing significant difference when compared with preoperative value (6.7±2.7) (t=2.485, P=0.014). Two patients had local recurrence at 29 months and 37 months after operation respectively, which were treated with adjuvant chemotherapy. One of them finally progressed to multiple myeloma and died of multiple organ failure after 43 months, the other one survived with residual tumor. One case presented with internal fixator loosening and breaking at 4 years after operation, who was performed revision surgery. The other patients had no tumor recurrence or malignant change during the follow-up, no complication such as internal fixator loosening or breaking occurred.ConclusionFor patients with SP of cervical spine, surgical intervention is an acceptable treatment option. One-stage total spondylectomy by anterior and posterior approaches can decline the local recurrence and relieve the symptoms of spinal cord compression, so as to improve patients’ life quality. However, patients with progression to multiple myeloma should be treated with individualized therapeutic regimen, and the prognosis may be poor.