目的 探讨CT导航下经皮骶髂螺钉固定技术治疗骨盆环损伤的安全性及临床疗效。 方法 对2009年1月－2011年3月期间我科收治的16例骨盆后环骨折脱位患者资料进行回顾性分析，所有患者均在计算机导航系统辅助下采用经皮骶髂螺钉固定技术进行治疗。 结果 16例患者骶1平面共植入18枚骶髂螺钉，其中14例单侧植入1枚螺钉。14例患者获得随访，随访时间14～49个月，平均19个月。根据Majeed临床效果评定标准：满意8例，良好5例，差1例。所有随访患者均无神经、血管损伤、骶髂螺钉松动、断裂等并发症。 结论 经皮骶髂螺钉固定技术是恢复骨盆后环稳定性的一种安全、有效的方法，具有创伤小、临床效果好、并发症少、手术操作简便、性价比高等优势，值得临床推广。
Objective To investigate the change of the femoral offset and hip center of rotation (COR) after using Jumbo cups in total hip arthroplasty (THA) revision. Methods The clinical data of 23 patients who underwent THA revision using Jumbo cups between January 2010 and May 2015 were retrospectively analyzed. Morselized bone graft was performed on 8 cases, morselized bone graft combined with structural bone graft on 10 cases. There were 10 males and 13 females, aged 65.4 years on average (range, 51-77 years). The disease duration was 1-24 years (mean, 8.57 years). The reasons for revision included aseptic loosening in 21 cases and periprosthetic infection in 2 cases. The Harris hip score and visual analogue scale (VAS) were 43.04±5.05 and 5.70±0.97 before operation respectively. According to the Paprosky acetabular defect classification, there were 5 cases of type I, 5 cases of type II A, 3 cases of type II B, 6 cases of type II C, and 4 cases of type III A. The X-ray films showed that the femoral offset was (40.65±4.09) mm for normal side and was (44.04±5.08) mm for affected side at preoperation, showing significant difference (t=4.098,P=0.000). Ten patients underwent femoral offset reconstruction (43.48%) but 13 patients did not (56.52%) before operation. The COR was reconstructed in 10 cases (43.48%); COR elevation was observed in 11 cases (47.83%), and COR decline in 2 cases (8.69%) before operation. Results Primary healing of incision was obtained in all patients, with no complication of infection, vascular injury, deep vein thrombosis, dislocation of the joint, or fracture around prosthesis. All the patients were followed up 12-76 months (mean, 22.48 months). The Harris hip score and VAS were 82.09±4.53 and 0.74±0.62 at 1 year after operation respectively, showing significant differences when compared with preoperative scores (t=37.831,P=0.000;t=22.318,P=0.000). The X-ray films showed that the femoral offset was (43.87±3.57) mm for affected side at 1 year after operation, showing no significant difference when compared with preoperative one (t=0.250,P=0.805), but significant difference was found between affected side and normal side (t=5.591,P=0.000). The femoral offset was restored in 16 patients (69.57%) and was not restored in 7 patients (30.43%) after operation. The COR was restored in 15 patients (65.22%) and was not restored in 8 patients (34.78%). Conclusion Using Jumbo cups or combined with morselized or structural bone graft is effective in restoring hip COR and femoral offset at the maximum limit in THA revision, with good short-term outcome and improved stability of acetabular prosthesis.
Objective To investigate whether or not posterolateral rotatory instabil ity of the elbow is due to type-I and type-II coronoid process fracture together with anterior bundle of medial collateral l igament (AMCL) injury so as to provide a theoretic basis for its cl inical treatment. Methods Ten fresh-frozen upper extremities were collected from cadavera which was donated voluntarily with no evidence of fracture, dislocation, osteoarthritis, mechanical injury of the surrounding l igament and joint capsule. They included 9 males and 1 female with an average age of 25.1 years (range, 19-40 years), including 3 cases at left sides and 7 cases at right sides. All specimens were transected at the upper midhumeral and carpal levels preserving the distal radioulnar joints to get the bone-l igament specimens. An axial load of 100 N compressing the elbow joint was appl ied along the shaft of the forearm in the sagittal plane through the biomechanical study system. The load-displacement plot was measured and analyzed at elbow flexion of 90, 60, and 45° and under four conditions (intact elbow, type-I coronoid process fracture, type-I coronoid process fracture with AMCL deficient, and type-II coronoid process fractures with AMCL deficient). Results The posterior displacements were maximum at 90° elbow flexion. Hence, the results at 90° elbow flexion were analyzed: under condition of intact elbows, the posterior displacement was the smallest (2.17 ± 0.42) mm and the posterolateral rotatory stabil ity was the greatest; under condition of type-I coronoid process fracture, the posterior displacement was (2.20 ± 0.41) mm, showing no significant difference compared with that of the intact elbow (P gt; 0.05); under condition of type-I coronoid process fracture with AMCL deficient, the posterior displacement was (2.31 ± 0.34) mm, showing no significant difference compared with that of intact elbow (P gt; 0.05); and under condition of type-II coronoid process fracture with AMCL deficient, the posterior displacement was (2.65 ± 0.38) mm, showing a significant difference compared with that of intact elbow (P lt; 0.05). There was no macroscopic ulnohumeral dislocation or radial head dislocation during the experiment. Conclusion An simple type-I coronoid process fracture or with AMCL deficient would not cause posterolateral rotatory instabil ity of elbow and may not need to be repaired. But type-II coronoid process fractures with AMCL deficient can cause posterolateral rotatory instabil ity of elbow, so the coronoid process and the AMCL should be repaired or reconstructed to restore posterolateral rotatory stabil ity as well as valgus stabil ity.
Since the public clinical trial registration system was launched twelve years ago in China, as the primary register of the WHO International Clinical Trial Registry, the Chinese Clinical Trial Registry (ChiCTR) has largely promoted the development of clinical trial registration in China, particularly in recent three years. The quantity of registered trials has increased rapidly and 3939 studies were registered in ChiCTR in 2017. An increasing number of investigators, Institutional Review Boarders and funding agencies were taking the trial registration into account in the medical research ethics issues these years. Considering the large number of workforce in public health, limited researchers knew clinical trial registration very well, even with misunderstandings. For instance most of them do not know the purpose of trial registration and the principle of local registration. A lot of Chinese medical journals editors have been working together with us to promote the development of clinical trial transparency in last ten years, and they have made outstanding contributions. We would like to appeal more medical journals to join the great revolution of medical research.
Objectives To explore potential important factors that impacts the quality of Chinese trials. Methods We randomly selected clinical studies registered in the Chinese Clinical Trial Registry during March 15th, 2016 to December 31st, 2016. The randomized controlled trials protocols were retrieved to assess the quality based on the SPIRIT guideline, their data management plan and statement of sharing individual participant data were also investigated. Results 457 studies were randomly selected from 2 205 studies by a rate of 1∶4. Among them, 393 were randomized controlled trials. Pre-market trials of new medicines conducted by the State Clinical Study Bases had better quality of protocols. In total, 4 protocols were rated as high quality (1.02%) and 21 as higher quality (5.34%). 129 studies in 457 (28.23%) described a correct data management system including a paper case record form and an electronic data capture. 392 studies (85.77%) stated that public sharing IPD will be available. Conclusions Poorly developed protocol and lack of professional data management system are common issues in some Chinese clinical studies. We feel confident that most Chinese investigators are good in learning considering that they are willing to share the IPD of their studies. Providing education and technical support focus on three technical aspects are crucial: introducing SPIRIT for developing protocol, providing standardized data management system, and introducing the concept of transparency include sharing IPD which is an essential requirement of clinical study ethics.
Objective To study the correlation of preoperative hemoglobin amount with venous thromboembolism (VTE) after surgical treatment of bronchiectasis and the clinical significance. Methods A retrospective study was performed on patients with bronchiectasis who underwent surgical treatment in our center from June 2017 to November 2021. The differences in blood parameters between the VTE patients and non-VTE patients were compared. The relationship between preoperative hemoglobin and VTE was confirmed by quartile grouping and receiver operating characteristic (ROC) curve. Results A total of 122 patients were enrolled, including 50 males and 72 females, with a mean age of 52.52±12.29 years. The overall incidence of VTE after bronchiectasis was 9.02% (11/122). Preoperative hemoglobin amount (OR=0.923, 95%CI 0.870-0.980, P=0.008) and D-dimer amount (OR=1.734, 95%CI 1.087-2.766, P=0.021) were independent influencing factors for VTE after bronchiectasis. The incidence of VTE after bronchiectasis decreased gradually with the increase of preoperative hemoglobin amount. The area under the ROC curve (AUC) of postoperative D-dimer alone was 0.757, whereas the AUC of postoperative D-dimer combined with preoperative hemoglobin amount was 0.878. Conclusion Low preoperative hemoglobin is an independent risk factor for postoperative VTE. Postoperative D-dimer combined with preoperative hemoglobin amount has a better predictive performance compared with postoperative D-dimer alone for postoperative VTE.