ObjectiveTo evaluate the effects of the improved precision alignment method of lower limbs mecha-nical alignment for osteoarthritis of the knee in open wedge high tibial osteotomy (OWHTO).MethodsA retrospective analysis was made on the clinical data of 62 patients (68 knees) with knee osteoarthritis in the medial compartment treated with OWHTO between January 2012 and December 2015 who accorded with the inclusion criteria. The traditional method for positioning lower limb mechanical force line was used in 29 cases (32 knees) (traditional group), and improved method for positioning lower limb mechanical force line in 33 cases (36 knees) (modified group). There was no significant difference in gender, age, side, course of disease, and osteoarthritis grading between two groups (P>0.05) with comparable. The operation time, intraoperative fluoroscopy times, and intraoperative blood loss were recorded in two groups; Before and after operation, the lower limb mechanical force line was observed on the X-ray films, which was expressed by hip-knee-ankle angle (HKA). The clinical efficacy was evaluated by the American Hospital for Special Surgery (HSS) score, and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC).ResultsIncision hematoma occurred in 1 case of traditional group and was cured at 3 weeks after symptomatic treatment; and primary healing was obtained in the other patients, with no early complications. The operation time and intraoperative fluoroscopy times of the modified group were significantly lower than those of the traditional group (t=11.934, P=0.000; t=11.663, P=0.000), but there was no significant difference in blood loss between the two groups (t=0.209, P=0.835). The patients were followed up for 6 to 24 months (mean, 12.7 months) in the traditional group and for 3 to 22 months (mean, 13.2 months) in the modified group. The medial knee pain disappeared in all patients. At last follow-up, the HSS score and WOMAC score were significantly improved when compared with preoperative scores in two groups (P<0.05), but there was no significant difference between the two groups (P>0.05). Postoperative X-ray examination showed that the tibiofemoral angle was corrected in the two groups. The HKA angle at immediate after operation and last follow-up was significantly higher than angle at pre-operation in two groups (P<0.05), but there was no significant difference between at immediate after operation and at last follow-up (P>0.05).ConclusionCompared with the traditional method for positioning lower limb mechanical force line, the improved precision alignment method can reduce the times of intraoperative fluoroscopy and shorten the operation time, which reduces the radiation exposure of both doctors and patients.
Objective To evaluate the application of a surgical method in pancreaticoduodenectomy. Methods All the 211 cases of purse-string invaginated pancreaticojejunostomy performed from Dec.1985 to Dec.2007 were reviewed. Firstly, an accordant plastic tube was put and fastened in main pancreatic duct, and pancreas was ligated at 2-3 cm apart from the pancreatic stump to let secretin flow far away. Furthermore, invaginated pancreaticojejunostomy was performed to get closer between pancreas and jejunum. Results Pancreatic fistula and perioperative death didn’t occur among these 211 cases. The complications included 2 cases of incision dehiscence, 4 cases of biliary fistula and 1 case of scission of superior mesentric artery. Conclusion Purse-string invaginated double-layer anastomosis of pancreaticojejunal would be feasible for pancreaticoduodenectomy preventing pancreatic fistula.
Objective To study the anteromedial cortical morphology of intertrochanteric fracture with CT three-dimensional reconstruction technique, and to provide a reference for further study of cortical buttress reduction theory. Methods CT data of 75 patients with unstable intertrochanteric fracture with complete imaging data treated between January 2016 and January 2019 were retrospectively analyzed, including 32 males and 43 females, aged 65-98 years (mean, 79.8 years). According to AO/Orthopaedic Trauma Association typing of 2018 edition, there were 46 cases of 31-A2.2 type and 29 cases of 31-A2.3 type. The image processing techniques such as segmentation modeling and virtual reset were performed. The thickness of the cortex at the anteromedial corner, the angle between the anterior wall fracture line and the coronal horizontal line, the angle between the medial wall fracture line and the sagittal horizontal line, the width of the cortex supported by the medial wall were measured, and the morphology of the cortical bone at the anteromedial corner were observed. Results The angle between the anterior wall fracture line and the coronal horizontal line was 51.8-72.6°, with an average of 62.4°; the angle between the medial wall fracture line and the sagittal horizontal line ranged from 17.6° to –47.3°, with an average of −15.8°; the thickness of the cortex at the anteromedial angle was 3.6-6.1 mm, with an average of 4.4 mm; and the width of the cortex supported by the medial wall was 14.3-21.2 mm, with an average of 16.8 mm. The morphology of the cortical bone at the anteromedial corner had 3 forms: angle with femoral neck axis >90°, 57 cases (76.0%); perpendicular to femoral neck axis, 7 cases (9.3%); angle with femoral neck axis <90° (including reverse angle), 11 cases (14.7%). Conclusion CT three-dimensional reconstruction can clearly show the cortical morphology and the direction of the fracture line of intertrochanteric fracture, which can indicate the stability of the intertrochanteric fracture after reduction, and has a good guiding on the form of cortical buttress reduction.
ObjectiveAfter using hyaluronic acid (HA) to modify curcumin (CUR), the effects of calcium phosphate cement (CPC) combined with HA/CUR on the proliferation and osteogenesis of osteoblasts were investigated.MethodsFirst, HA and CUR were esterified and covalently combined to prepare HA/CUR, and the characteristics were observed and the infrared spectrum was tested. Then, HA, CUR, and HA/CUR were mixed with CPC according to 5% (W/W) to prepare HA-CPC, CUR-CPC, and HA/CUR-CPC, respectively. Setting time detection, scanning electron microscope observation, injectable performance test, and compression strength test were conducted; and the CPC was used as a control. Osteoblasts were isolated and cultured from the skull of newborn Sprague Dawley rats, and the 2nd generation cells were cultured with the 4 types of bone cement, respectively. The effects of HA/CUR-CPC on the proliferation and osteogenesis of osteoblasts were estimated by the scanning electron microscopy observation, live/dead cell fluorescence staining, cell counting, osteopontin (OPN) immunofluorescence staining, alkaline phosphatase (ALP) staining,and alizarin red staining.ResultsInfrared spectroscopy test showed that HA and CUR successfully covalently combined. The HA/CUR-CPC group had no significant difference in initial setting time, final setting time, injectable rate, and compressive strength when compared with the other 3 groups (P>0.05); scanning electron microscope observation showed that HA/CUR was scattered on CPC surface. After co-culture of bone cement and osteoblasts, scanning electron microscopy observation showed that the osteoblasts, which had normal morphology and the growth characteristics of osteoblasts, clustered and adhered to HA/CUR-CPC. There was no significant difference in cell survival rate between HA/CUR-CPC group and other groups (P>0.05), and the number of cells significantly increased (P<0.05); the degrees of OPN immunofluorescence staining, ALP staining, and alizarin red staining were stronger than other groups.ConclusionHA/CUR-CPC has good biocompatibility and mechanical properties, which can promote the proliferation and osteogenesis of osteoblasts.
Since the outbreak of the coronavirus disease 2019, the incidence and mortality of cardiac arrest have increased significantly worldwide, and the management of cardiac arrest is facing new challenges. The European Resuscitation Council issued the 2021 European Resuscitation Council Guidelines in March 2021 to update the important parts of cardiopulmonary resuscitation and added recommendations for the management of cardiopulmonary resuscitation during the coronavirus disease 2019 epidemic. This article will compare the difference between this guideline and the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care and integrate some key points, review literature and then summarize the latest research progress in cardiopulmonary resuscitation since the outbreak of the coronavirus disease 2019 epidemic. The content mainly involves cardiopulmonary resuscitation during the coronavirus disease 2019 epidemic, early prevention, early recognition, application of new technologies, airway management, extracorporeal cardiopulmonary resuscitation and post-resuscitation treatment.
The treatment of organ function damage secondary to return of spontaneous circulation in patients with cardiac arrest is an important part of advanced life support. The incidence of lung injury secondary to return of spontaneous circulation in patients with cardiac arrest is as high as 79%. Understanding the characteristics and related mechanisms of lung injury secondary to return of spontaneous circulation in patients with cardiac arrest, and early identification and treatment of lung injury secondary to return of spontaneous circulation are crucial to the clinical treatment of patients with cardiac arrest. Therefore, this article reviews the research progress on the characteristics, risk factors, mechanisms and treatment of lung injury secondary to return of spontaneous circulation in patients with cardiac arrest, in order to provide a reference for the research and clinical diagnosis and treatment of lung injury secondary to return of spontaneous circulation in patients with cardiac arrest.
The International Liaison Committee on Resuscitation published the 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations in Circulation, Resuscitation, and Pediatrics in November 2022. This consensus updates and recommends important aspects of cardiopulmonary resuscitation based on recently published resuscitation evidence. Herein, we interpret the consensus focusing on adult cardiopulmonary resuscitation including basic life support (ventilation techniques, compressions pause, transport strategies during resuscitation, and resuscitation procedures in drowning), advanced life support (target temperature management, point-of-care ultrasound as a diagnostic tool during cardiac arrest, vasopressin and corticosteroids for cardiac arrest, and post-cardiac arrest coronary angiography), cardiopulmonary resuscitation education/implementation/team (survival prediction after resuscitation of patients with in-hospital cardiac arrest, basic life support training, advanced life support training, blended learning for life support education, and faculty development approaches for life support courses) and recovery positions on rescue scene. This consensus provides important guidance for clinical practice and clear hints for the development of clinical research.
Aiming at comparing the pre-operative and post-operative gait characteristics and therefore establishing post-operative rehabilitation guidance for patients with end-stage knee osteoarthritis (KOA) merged with varus deformity, this study captured the level walking and sit-to-stand trials of 9 patients with 3-dimensional motion analysis system and after which musculoskeletal multi-body dynamic analysis was conducted. The study indicated that the average range of motion (ROM) of the proposed-surgical knee was 24.4°–57.6° and that of the non-surgical knee was 22.5°–71.5°. The knee ROM of control group during level walking was 7.2°–62.4°. When the unilateral KOA patients stood up from chair to complete the sit-to-stand movement, the ground reaction forces (GRFs) symmetry was 0.72–0.85, which means that the non-surgical limb bear the majority of body weight. The GRFs of the bilateral KOA patients were smallest during the sit-to-stand movement. The strategy that the non-surgical limb dominates in loading bearing taken by the unilateral KOA patients to cover most post-operative daily activities could increase the risk of KOA among non-surgical side joints as a result of long-term excessive loading-bearing. The study, on kinematics and biomechanical characteristics of patients with KOA merged with varus deformity, could help to understand the pathogenesis of KOA merged with varus deformity from the perspective of biomechanics and to provide strong clinic guidance for the pre-operative evaluation, prevention and post-operative recovery for patients.
ObjectiveTo analyze the reasons and the influence of internal fixation about the guide pin eccentricity of helical blade during proximal femoral nail anti-rotation (PFNA) internal fixation for femoral intertrochanteric fractures.MethodsA retrospective analysis of the intraoperative imaging data of 175 patients with femoral intertrochanteric fractures, who underwent closed reduction and PFNA internal fixation between January 2018 and January 2020, was performed. There were 76 males and 99 females with an average age of 79.8 years (mean, 61-103 years). The internal between admission and operation was 12-141 hours (median, 32 hours). According to AO/Orthopaedic Trauma Association (AO/OTA) classification, the fractures were rated as type 31-A1 in 64 cases and type 31-A2 in 111 cases. In the intraoperative fluoroscopy image by C-arm X-ray machine, the caputcollum-diaphysis (CCD) was measured after closed reduction and internal fixation, respectively; the angles between the center line of the head nail hole and the axis of proximal nail and between the axis of guide pin and proximal nail were measured, and the difference between the two angles was evaluated; the quality of fracture reduction was evaluated according to the alignment of the medial cortex, anterior cortex of the head and neck bone block, and femoral shaft cortex; the position of the helical blade in the femoral head was evaluated according to the Cleveland method.ResultsThe CCDs of proximal femur were (134.6±6.8)° after closed reduction and (134.9±4.3)° after internal fixation. There was no significant difference between pre- and post-internal fixation (t=0.432, P=0.766). The angles between the center line of the head nail hole and the axis of proximal nail and between the axis of guide pin and proximal nail were (125.4±2.44)° and (126.3±2.3)°, respectively, showing significant difference (t=2.809, P=0.044). The difference between the two angles was (0.8±2.2)°. The guide pin eccentricity of helical blade occurred in 47 cases. After tapping the helical blade along the eccentric guide pin, 10 cases had fracture reduction loss, and 5 cases had a poor position of the helical blade in the femoral head. ConclusionDuring PFNA internal fixation, a variety of reasons can lead to the eccentric position of the guide pin of helical blade, including unstable fracture, soft tissue inserted, severe osteoporosis, mismatched tool, and fluoroscopic imaging factors. It is possible that the fracture end would be displaced again and the helical blade position may be poor when knocking into the helical blade along the eccentric guide pin. During operation, it should be judged whether the direction of the guide pin needs to be adjusted according to the eccentric angle.
The American Heart Association and other six major associations jointly released AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain for the first report on October 28th, 2021. This guideline stresses the risk stratification and the diagnostic workup of acute chest pain, considers the cost-effectiveness of low-risk chest pain diagnosis and examination, and recommends sharing decisions with patients. This guideline mainly involves the initial evaluation of chest pain, choosing the right pathway with patient-centric algorithms for acute chest pain, and the evaluation of patients with stable chest pain. This review makes a detailed interpretation of the recommended points of the guideline through reviewing the literature.