Objective To discuss the feasibility and safety of early enteral nutrition (EN) on treatment of severe acute pancreatitis (SAP) and its influence. Methods The advancement about application of early EN on treatment of SAP in recent years were reviewed. Results In patients with SAP, early EN via catheter placed in the jejunum could protect the integrity of intestinal barrier and reduce infectious complications. But no consensus had been reached about the starting time, ingredient and infusion mode yet. Conclusion Early EN may have positive effects on treatment of SAP, but further researches are still needed.
Objective To investigate the safety and accuracy of robot-assisted pedicle screw implantation in the adolescent idiopathic scoliosis (AIS) surgery. Methods The clinical data of 46 patients with AIS who were treated with orthopedics, bone graft fusion, and internal fixation via posterior approach between June 2018 and December 2019 were analyzed retrospectively. Among them, 22 cases were treated with robot-assisted pedicle screw implantation (robot group) and 24 cases with manual pedicle screw implantation without robot assistance (control group). There was no significant difference in gender, age, body mass index, Lenke classification, and preoperative Cobb angle of the main curve, pain visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score between the two groups (P>0.05). The intraoperative blood loss, pedicle screw implantation time, intraoperative pedicle screw adjustment times, and VAS and JOA scores after operation were recorded. The Cobb angle of the main curve was measured on X-ray film and the spinal correction rate was calculated. The screw position and the accuracy of screw implantation were evaluated on CT images. Results The operation completed successfully in the two groups. The intraoperative blood loss, pedicle screw implantation time, and pedicle screw adjustment times in the robot group were significantly less than those in the control group (P<0.05). There was 1 case of poor wound healing in the robot group and 2 cases of mild nerve root injury and 2 cases of poor incision healing in the control group, and there was no significant difference in the incidence of complications between the two groups (P=0.667). All patients in the two groups were followed up 3-9 months (mean, 6.4 months). The VAS and JOA scores at last follow-up in the two groups were superior to those before operation (P<0.05), but there was no significant difference in the difference of pre- and post-operative scores between the two groups (P>0.05). The imaging review showed that 343 screws were implanted in the robot group and 374 screws in the control group. There were significant differences in pedicle screw implantation classification and accuracy between the two groups (89.5% vs 79.1%)(Z=−3.964, P=0.000; χ2=14.361, P=0.000). At last follow-up, the Cobb angles of the main curve in the two groups were significantly lower than those before operation (P<0.05), and there was significant difference in the difference of pre- and post-operative Cobb angles between the two groups (t=0.999, P=0.323). The spinal correction rateswere 79.82%±5.33% in the robot group and 79.62%±5.58% in the control group, showing no significant difference (t=0.120, P=0.905). Conclusion Compared with manual pedicle screw implantation, robot-assisted pedicle screw implantation in AIS surgery is safer, less invasive, and more accurate.
ObjectiveTo summarize the research progress of femoral neck system (FNS) in the treatment of femoral neck fracture in young and middle-aged patients. Methods The literature on FNS at home and abroad in recent years was extensively reviewed, and the results of mechanical and clinical studies on FNS were summarized based on clinical experience. Results FNS has good mechanical stability, which can reduce complications such as femoral neck shortening, internal fixation failure, and varus caused by mechanical instability. At present, FNS is mainly selected for comparison with cannulated compression screws and dynamic hip screws in clinical research. The results show that FNS has the advantages of minimally invasive, short operation time, less intraoperative fluoroscopy, earlier postoperative weight-bearing and fracture healing, and better hip function recovery. Conclusion As a new internal fixator, FNS has achieved satisfactory results in the current research. FNS has good mechanical advantages, which is beneficial to fracture healing and the recovery of hip joint function after operation. However, whether FNS can reduce the incidence of nonunion and osteonecrosis of the femoral head remains to be further clarified.
ObjectiveTo explore the risk factors for osteonecrosis of the femoral head (ONFH) after treatment of femoral neck fractures with femoral neck system (FNS). MethodsBetween January 2020 and February 2021, 179 patients (182 hips) with femoral neck fractures treated by FNS fixation were selected for retrospective analysis. There were 96 males and 83 females with an average age of 53.7 years (range, 20-59 years). There were 106 cases of low-energy-induced injury and 73 cases of high-energy-induced injury. The fractures were classified as type Ⅱ in 40 hips, type Ⅲ in 78 hips, and type Ⅳ in 64 hips according to Garden classification standard, and as typeⅠin 23 hips, type Ⅱ in 66 hips, and type Ⅲ in 93 hips according to Pauwels classification standard. There were 21 patients with diabetes. Patients were divided into ONFH group and non-ONFH group according to whether ONFH occurred at last follow-up. The data of the patients were collected, including age, gender, body mass index (BMI), trauma mechanism, bone mineral density, having diabetes or not, Garden classification and Pauwels classification of fractures, fracture reduction quality, femoral head retroversion angle, and removal of internal fixator or not. The above factors were analyzed by univariate analysis, and then multivariate logistic regression analysis was used to identify risk factors. Results Total 179 patients (182 hips) were followed up 20-34 months (mean, 26.5 months). Of these, 30 cases (30 hips) developed ONFH at 9-30 months after operation (ONFH group), and the incidence of ONFH was 16.48%. And 149 cases (152 hips) had no ONFH at last follow-up (non-ONFH group). The univariate analysis showed that there were significant differences between groups in bone mineral density, having diabetes or not, Garden classification, femoral head retroversion angle, and fracture reduction quality (P<0.05). The multivariate logistic regression analysis showed that the Garden type Ⅳ fracture, reduction quality of grading Ⅲ, femoral head retroversion angle >15°, complicated with diabetes were the risk factors for ONFH after FNS fixation (P<0.05). ConclusionFor the patients with Garden type Ⅳ fracture, poor quality of fracture reduction, femoral head retroversion angle >15°, and diabetes, the risk of ONFH after FNS fixation increases.