Objective To retrospectively compare short-term outcomes and health economics of PHS versus UHS for inguinal hernia repair. Methods We included 105 patients suffering from reducible inguinal hernia hospitalized in the First Affiliated Hospital of Lanzhou University from September, 2007 and September, 2012. The referred hernia types involved direct and indirect hernia (unilateral and bilateral). Based on different repair materials, the patients were divided into two groups, PHS group (n=53) and UHS group (n=52). Outcome parameters for comparison included incidences of seroma and scrotum edema, hospital duration, costs, etc. Results There were no differences in age, sex, hernia type, incidences of seroma and scrotum edema after surgery, hospital duration and costs between the two groups. However, the patients in the PHS group spent less money than those in the UHS group regarding the costs of materials and hospitalization, with significant differences. Conclusion For inguinal hernia repair, PHS and UHS are alike in reducing short-term complications, but PHS can significantly reduce patients’ economic burden due to less costs.
ObjectiveTo investigate the CT presenting rate and features of gastric bare area (GBA, including the area posterior to GBA and the adipose tissue in the gastrophrenic ligament) without pathologic changes.MethodsThirty cases with superior peritoneal ascites, but without pathological involvement of GBA were included into the study to show the normal condition of GBA, including the presenting rate and CT features. We selected some cases with GBA invasion by inflammation or neoplasm to observe their CT features. ResultsAll cases with superior peritoneal ascites showed the GBA against the contrast of ascites with the presenting rate of 100%. The GBA appeared at the level of gastricesophageal conjunction and completely disappeared at the level of hepatoduodenal ligament and Winslow’s foramen. The maximum scope of GBA presented at the level of the sagital part of the left portal vein with mean right to left distance of （4.39±0.08）cm (3.8~5.7 cm) (distance between the left and right layer of the gastrophrenic ligament). In acute pancreatitis, the width of GBA increased, in which local hypodensity area could be seen. In gastric leiomyosarcoma invading GBA, the mass could not separate from the crus of the diaphragm. In lymphoma and metastasis invading GBA, the thickness of GBA increased and the density was heterogeneous, in which lymph nodes presenting as small nodes or fused mass. ConclusionThe results of this study show that it is helpful to use contrast enhanced spiral CT scanning to observe the change of GBA and to diagnose retroperitoneal abnormalities that involving GBA comprehensively and accurately.
Objective To evaluate the short-term results of discectomy combined with Isobar non-fusion internal fixation. Methods Between May 2006 and May 2008, 65 cases of single segment lumbar disc protrusion were random surgically treated by discectomy combined with Isobar non-fusion internal fixation (34 cases, group A) and single discectomy (31 cases, group B), respectively. In group A, there were 18 males and 16 females with an average age of 38.8 years (range, 23-51 years); the involved segments were L2,3 (1 case), L3,4 (4 cases), L4,5 (20 cases), and L5, S1 (9 cases), including 11 cases of protrusion type, 16 cases of prolapsed-type, and 7 cases of sequestered type; and the mean disease duration was 7.2 months (range, 1-66 months). In group B, there were 19 males and 12 females with an average age of 39.2 years (range, 21-49 years); the involved segments were L3,4 (2 cases), L4,5 (24 cases), and L5, S1 (5 cases), including 13 cases of protrusion type, 15 cases of prolapsed-type, and 3 cases of sequestered type; and the mean disease duration was 6.5 months (range, 3 weeks to 72 months). There was no significant difference in the general data between 2 groups (P gt; 0.05). The surgical results were assessed by visual analogue scale (VAS) for back/leg pain and the Oswestry disabil ity index (ODI). The height of involved intervertebral space was measured dynamically after operation. Results The patients of two groups were followed up 32 months on average (range, 24-49 months). All cl inical symptoms of the patients were notably improved in 2 groups. One patient in group B experienced postoperative cerebral fluid leakage, and was cured after extubation, changing posture, and other measures. There was no implant failure, such as pedicle fracture, screw loosening, or screw malposition during the follow-up. The ODI and VAS were significantlyimproved after operation. The back and leg pain VAS scores at each time point were decreased significantly when compared with
Objective To investigate the clinical characteristics and death risk factors of patients with community acquired pneumonia and sepsis. Methods Data of 350 patients with community-acquired pneumonia and sepsis admitted to the Intensive Care Unit of Third Xiangya Hospital of Central South University from January 2015 to October 2021 were retrospectively analyzed, and their basic characteristics, laboratory results and treatment were analyzed. Results The absolute value of white blood cell, neutrophil ratio, absolute value of neutrophil, inflammatory index, liver and kidney function, coagulation function, cardiac enzymology, lactic acid and sequential organ failure evaluation score of patients with community acquired pneumonia sepsis in the non-survival group were higher than those in the survival group. Logistic regression analysis showed that respiratory rate, heart rate, mean arterial pressure, blood oxygen saturation, C-reactive protein, D-dimer, lactic acid, creatinine and lymphocyte ratio may be independent risk factors for 28-day death in patients with community-acquired pneumonia and sepsis.The receiver operating characteristic curve shows that the combination of the above indicators to predict the risk of death of patients has the best sensitivity, specificity and maximum area under the curve, which is superior to the prediction value of individual variables. Conclusions Patients in the non-survivor group of community-acquired pneumonia sepsis had more severe inflammatory response and organ function impairment. Respiratory rate, heart rate, mean arterial pressure, blood oxygen saturation, C-reactive protein, D-dimer, lactic acid, creatinine, lymphocyte ratio and other indicators are independent risk factors for death of patients with community-acquired pneumonia and sepsis, which have better prognostic value when combined.
目的 分析和总结采用双靶点伽玛刀治疗三叉神经痛术后疼痛缓解时间规律，为伽玛刀的临床治疗提供参考。 方法 2005年1月－2011年1月，共147例原发性三叉神经痛患者于四川大学华西医院接受Leksell C型伽玛刀治疗。使用4 mm准直器在三叉神经根制作2个等中心靶点，中心剂量80~90 Gy，控制脑桥照射剂量＜20 Gy。术后定期对患者进行随访，对疼痛缓解时间进行统计分析。 结果 130例患者获得随访，随访时间11～64个月，平均28.7个月。术后疼痛完全缓解95例（73.1%），部分缓解29例（22.3%），无效6例（4.6%）。疼痛缓解时间4 h～12个月，平均3.6周，其中疼痛完全缓解患者的疼痛缓解时间明显短于部分缓解患者（P＜0.05）。53例（40.8%）患者于术后出现术侧轻度面部麻木。 结论 患者术后疼痛缓解时间可能是预测伽玛刀治疗效果的重要因素，但疼痛缓解时间个体差异大，应进行长期随访观察。
Objective To explore the value of endoscopic retrograde cholangiopancreatograph (ERCP) and extracorporeal shock wave lithotripsy (ESWL) in the treatment of pancreatic duct stones. Methods A retrospective collection of 28 patients with chronic pancreatitis and pancreatic duct stones admitted to the Department of Gastroenterology from January 2010 to August 2021 was performed. According to the treatment of patients, they were divided into ERCP direct stone extraction group and ESWL combined ERCP stone extraction group. We compared the treatment effects of the two groups of patients, including the success rate of stone extraction, postoperative complications of ERCP, postoperative symptom improvement, and so on. Results Among the 28 patients, 19 cases underwent ERCP direct stone extraction, and 9 cases underwent ESWL combined with ERCP stone extraction. In the ERCP direct stone extraction group, 7 cases (36.84%) were completely extracted, 1 case was partially extracted (5.26%), and 11 cases (57.89%) failed to extract and only placed stents and drained; 5 cases (26.32%) had elevated white blood cells at 6 hours postoperatively, C-reactive protein increased in 4 cases (21.05%), 3 cases (15.79%) were diagnosed as ERCP-related pancreatitis, and 2 cases (10.53%) were diagnosed as hyperamylaseemia. The abdominal pain symptoms were completely relieved in 14 cases (73.68%) during a follow-up period of 3 to 6 months. The body mass of 17 cases (89.47%) increased in the 6 months after stone extraction. ESWL combined with ERCP had complete stone extraction in 5 cases (55.56%), partial stone extraction in 3 cases (33.33%), and failure in stone extraction and only stent drainage in 1 case (11.11%). One case (11.11%) had elevated white blood cells at 6 hours postoperatively, and 1 case (11.11%) had elevated C-reactive protein . One case (11.11%) was diagnosed with ERCP-related pancreatitis. One case (11.11%) got abdominal pain and transient hematuria during ESWL, which resolved spontaneously 3 days later. After 3 to 6 months of follow-up, 9 patients (100%) had complete relief of abdominal pain symptoms, and the body mass of 9 patients (100%) increased in the 6 months after stone extraction. The stone clearance rate of the ESWL combined with ERCP stone extraction group was higher than that of the ERCP direct stone extraction group (P=0.033), but there was no statistically significant difference between the two groups in terms of ERCP-related complications, relief of abdominal pain, and weight gain (P>0.05). Conclusion ESWL combined with ERCP in the treatment of chronic pancreatitis complicated with pancreatic duct stone extraction is more effective than ERCP direct stone extraction.
Objective To investigate the effect of the anterior cruciate l igament (ACL) rupture on the biomechanics of the lateral collateral l igament (LCL). Methods The specimens in this experiment were knee joints from 6 normal fresh adult male cadavers which was donated voluntarily, aged of 26-35 years with an average of 31.4 years. The knee joints were dissymmetry with 3 in left and right sides respectively. At first, all the 6 specimens lying on the self-made movement tooting, whose LCL straining were measured by strain gauges at different angles (0, 30, 60 and 90°) under axial loads of 400 N by e-testing machine for simulation of the normal knee joint force, were regarded as the intact ACL group. Then, the ACL in all 6 specimens were cut off completely as the deficiency group and did the same step. Results The strain of the LCL were as follows at 0, 30, 60 and 90°: (0.00 ± 1.63), (—17.2 ± 8.57), (—24.00 ± 4.80) and (26.50 ± 4.65) με in intact ACL group; (0.75 ± 8.22), (— 52.75 ± 3.33), (24.30 ± 4.99) and (26.30 ± 4.27) με in deficiency group. There was no significant difference at 0° and 90° flexion (P gt; 0.05), but significant difference at 30° and 60° flexion (P lt; 0.05) between the two groups. Conclusion The rupture of the ACL has significantly effect on the strain of the LCL which suffering abnormal load in the state at 30° and 60° flexion. At 30° flexion the relaxation of the LCL increased, which means the possibil ity of the injury of the LCL is rare; and at 60° flexion the LCL become very tense and thereby at the high risk of instabil ity.
方法 2008年9月-2009年11月，将20例颅脑外伤后颅内感染患者分为脑脊液外引流组和抗生素组各10例，外引流组进行持续腰池置管脑脊液外引流，定期取引流脑脊液进行常规和生化检查；抗生素组采用静脉抗生素治疗。对两组颅内感染情况进行对比分析。 结果 外引流组经持续腰池置管脑脊液外引流治疗后，颅内感染临床症状明显缓解，脑脊液有核细胞数和脑脊液微量蛋白含量显著降低、脑脊液葡萄糖和氯化物浓度升高（Plt;0.05）。治疗10 d后，外引流组体温、脑脊液有核细胞数、脑脊液微量蛋白含量、脑脊液葡萄糖和氯化物浓度的改善程度明显优于抗生素组（Plt;0.05）。 结论 持续腰池置管脑脊液外引流治疗颅内感染具有安全性高、操作简便、观察颅内感染情况方便的优点，可作为颅内感染可靠治疗手段。【Abstract】 Objective To observe the efficacy of continuous lumbar drainage of cerebrospinal fluid via a lumbar catheter in treating intracranial infection. Methods From September 2008 to November 2009, 20 patients with intracranial infection after head trauma were enrolled in this study. Ten of them, classified as the external drainage group, sustained continuous external lumbar drainage of cerebrospinal fluid. The cerebrospinal fluid was obtained regularly for routine and biochemical examination. The other 10 patients were categorized as the antibiotics group. They only accepted intravenous antibiotic therapy. Results For the patients in the external drainage goup, after continuous external lumbar drainage of cerebrospinal fluid, their clinical symptoms of intracranial infection were significantly alleviated and the number of nucleated cells and protein content in the cerebrospinal fluid decreased significantly, while the glucose and chloride concentrations increased significantly (Plt;0.05). After 10 days of treatment, the patients in the external drainage group were superior to those in the antibiotics group in improvement of the body temperature, the number of nucleated cells and protein content, glucose and chloride concentrations in the cerebrospinal fluid (Plt;0.05). Conclusion Continuous lumbar drainage of cerebrospinal fluid is simple and safe. It provides an easy way of monitoring the intracranial infection and can be a reliable treatment.
ObjectiveTo evaluate the surgical technique and the effectiveness of the free superficial palmar branch of the radial artery flap to repair soft tissue defect of fingers.MethodsBetween June 2014 and June 2017, 10 cases (10 fingers) of soft tissue defects of fingers were repaired with the free superficial palmar branch of the radial artery flaps. There were 8 males and 2 females with an average age of 29.8 years (range, 23-42 years). The causes of injury included the chainsaw cutting injury in 6 cases, the machine crush injury in 2 cases, and the glass scratching in 2 cases. The time from injury to admission was 1-8 hours with an average of 3 hours. The locations were the volar of the middle of index finger in 3 cases, the volar of the distal of index finger in 1 case, the volar of the distal of middle finger in 3 cases, the ulnar side of distal interphalangeal joint of ring finger in 1 case, and the volar of the distal of the little finger in 2 cases. The area of soft tissue defect ranged from 1.8 cm×0.9 cm to 2.8 cm×2.1 cm, and the area of flap ranged from 2.0 cm×1.0 cm to 3.0 cm×2.3 cm. The donor sites were sutured directly.ResultsAll flaps survived after operation, and the wounds healed by first intention. The incisions of donor site also healed by first intention with a linear scar. All cases were followed up 6-12 months (mean, 9 months). The appearance and texture of the flaps were satisfactory. The pain sensation, warm sensation, and touch sensation of the flap recovered. At last follow-up, the two-point discrimination of the flap was 6-13 mm (mean, 7.5 mm). According to the assessment of the upper limb function issued by tha Hand Surgery Society of Chinese Medical Association, the results were graded as excellent in 8 cases and good in 2 cases.ConclusionThe free superficial palmar branch of the radial artery flap is easy to harvest and anastomose and has small injury. It is an ideal method in repairing of soft tissue defects of fingers.
ObjectiveTo investigate the effectiveness and advantages of skeletal tractor in closed reduction and proximal femoral nail antirotation (PFNA) internal fixation of intertrochanteric fracture compared with traction table.MethodsThe clinical data of 86 patients with intertrochanteric fractures, who were treated with closed reduction and PFNA internal fixation between October 2016 and March 2018 and met the selection criteria, was retrospectively analysed. Among them, 44 cases were treated with skeletal tractor (trial group) and 42 cases were treated with traction table (control group). There was no significant difference between the two groups in gender, age, cause of injury, fracture side, AO classification, and degree of osteoporosis (P>0.05). The preoperative position time, operation time, intraoperative fluoroscopy times, intraoperative blood loss, fracture healing time, intraoperative and postoperative complications, and postoperative Harris score were compared between the two groups.ResultsThe operation was successfully completed in both groups. Compared with the control group, the patients in the trial group had shorter preoperative position time and operation time, fewer intraoperative fluoroscopy times, and less intraoperative blood loss (P<0.05). The patients were followed up 12-21 months in trial group (mean, 14.2 months) and 12-22 months in control group (mean, 14.3 months). Venous thrombosis of lower extremity occurred in 8 patients (3 cases of trial group and 5 cases of control group) after operation. Internal fixation failure occurred in 5 patients (2 cases of trial group and 3 cases of control group) during 1 year after operation. All fractures healed except for those with internal fixation failure, the fracture healing time was (11.6±2.9) weeks in trial group and (12.4±3.6) weeks in control group; and there was no significant difference between the two groups (t=1.250, P=0.214). At 1 year after operation, Harris score of the trial group was 86.2±5.9 and that of the control group was 84.1±6.1. There was no significant difference between the two groups (t=1.768, P=0.080).ConclusionCompared with traction table, skeletal tractor in closed reduction and PFNA internal fixation of intertrochanteric fracture can significantly shorten the preoperative position time and operation time, reduce the intraoperative fluoroscopy times, improve the operation efficiency, and have similar effectiveness.