ObjectiveTo compare the short-term effectiveness of unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) in the treatment of medial compartment osteoarthritis (OA) of the knee so as to provide a reference for clinical selection of appropriate treatment. MethodsBetween January 2010 and June 2011, 28 cases of medial compartment OA of the knee underwent UKA in 16 cases (UKA group) and HTO in 12 cases (HTO group). Biomet Oxford phase Ⅲ unicompartmental knee prosthesis was used in UKA group, and closing wedge osteotomy in HTO group. There was no significant difference in gender, age, course of disease, side, body mass index, articular cartilage degeneration classification, preoperative knee range of motion (ROM), Lysholm knee score, Tegner activity score, and femorotibial angle (FTA) between the 2 groups (P>0.05). The patients of UKA group began weight-bearing walking with walking aids within 48 hours after operation, and the patients of HTO group began weight-bearing walking with walking aids at 6 weeks after operation, and gradually began full weight-bearing walking at 8-12 weeks. ResultsThere was no significant difference in operation time and intraoperative blood loss between 2 groups (t=0.406, P=0.688; t=-1.552, P=0.133). All incision healed primarily in both groups. No complications occurred in 2 groups. All patients were followed up 3.5 years on average (range, 3.0-4.5 years) in UKA group and 3.6 years on average (range, 3-4 years) in HTO group. There were significant differences in Lysholm knee score, Tegner activity score, and FTA in the 2 groups between before and after operation (P<0.05), but there was no significant difference in knee ROM (P>0.05). At last follow-up, there was no significant difference in all above indexes between 2 groups (P>0.05). The postoperative X-ray showed that all force lines of the lower limbs were corrected, and the prosthesis and internal fixation were fixed reliably. During follow-up, Kellgren-Lawrence Ⅱ degeneration of the lateral compartment was observed in 1 case of 2 groups respectively; Kellgren-Lawrence Ⅱ degeneration of the patellofemoral joint was observed in 1 case of the HTO group, there was no significant difference between the 2 groups (χ2=0.778, P=0.378). ConclusionBoth UKA and HTO have good short-term effectiveness for treating unicompartmental OA; however, the long-term effectiveness need further study and follow-up.
ObjectiveTo compare the biomechanical differences between the kidney-shaped nano-hydroxyapatite/polyamide 66 (n-HA/PA66) Cage and the bullet-shaped n-HA/PA66 Cage. MethodsL2-L5 spinal specimens were selected from 10 adult male pigs. L2, L3 and L4, L5 served as a motor unit respectively, 20 motor units altogether. They were divided into 4 groups (n=5):no treatment was given as control group (group A); nucleus pulposus resection was performed (group B); bullet-shaped Cage (group C), and kidney-shaped Cage (group D) were used in transforaminal lumbar interbody fusion (TLIF) through left intervertebral foramen and supplemented by posterior pedicle screw fixation. The intervertebral height (IH) and the position of Cages were observed on the X-ray films. The range of motion (ROM) was measured. ResultsThere was no significant difference in the preoperative IH among 4 groups (F=0.166, P=0.917). No significant change was found in IH between at pre- and post-operation in group B (P>0.05); it increased after operation in groups C and D, but difference was not statistically significant (P>0.05). There was no significant difference in the postoperative IH among groups B, C, and D (P>0.05). The distance from Cage to the left margin was (3.06±0.51) mm in group C (close to the left) and (5.68±0.69) mm in group D (close to the middle), showing significant difference (t=6.787, P=0.000). The ROM in all directions were significantly lower in groups C and D than in groups A and B (P<0.05), and in group A than in group B (P<0.05). The right bending and compression ROM of group C were significantly higher than those of group D (P<0.05), but no statistically significant difference was found in the other direction ROM (P>0.05). ConclusionThe bullet-shaped and kidney-shaped Cages have similar results in restoring IH and maintaining the stability of the spine assisted by internal fixation. Kidney-shaped Cage is more stable than bullet-shaped Cage in the axial compression and the bending load opposite implant, it can be placed in the middle and back of the vertebral body more ideally.
ObjectiveTo investigate the effectiveness of distraction therapy assisted by arthroscope in the treatment of ankle traumatic osteoarthritis. MethodsBetween October 2013 and October 2014, 13 patients with ankle traumatic osteoarthritis were treated, including 8 males and 5 females with an age range of 44-63 years (mean, 55.2 years). The left ankle and the right ankle were involved in 4 and 9 cases respectively. The disease duration was 1.5-10.0 years (median, 5 years). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot scale score was 51.00±7.09; the short-form 36 health survey scale (SF-36) score was 40.82±4.62. According to Scranton grade system, 9 cases were rated as grade II and 4 cases as grade III. First, ankle hyperplasia osteophytes was removed under arthroscope, then Ilizarov apparatus was used to maintain distraction of 5-10 mm ankle space for 3 months. ResultsOne case had postoperative pin tract infection after removing the external fixation, and infection was controlled by dressing treatment; no related complications occurred in the other patients. All patients got follow-up of 12-18 months (mean, 14.7 months). Patients achieved disappearance of ankle swelling, pain relief, and were able to walk after rehabilitation. The ankle activity was obviously improved. At last follow-up, AOFAS ankel-hind foot scale score and SF-36 score were significantly increased to 85.23±6.41 and 56.29±6.20 respectively (t=20.756, P=0.025; t=11.647, P=0.018). According to AOFAS scores, the results were excellent in 4 cases, good in 8 cases, and fair in 1 case; the excellent and good rate was 92.3%. Postoperative X-ray film showed normal ankle position and alignment, osteophytes at the edges of the tibia and talus, articular surface sclerosis, normal joint space, and no joint swelling. ConclusionDistraction therapy assisted by arthroscope is an effective method for treating ankle traumatic osteoarthritis.
ObjectiveTo assess the efficacy and safety of percutaneous nephrolithotomy (PCNL) versus ureteroscopic lithotripsy (URL) in the treatment of impacted proximal ureteral stones>1 cm. MethodsWe electronically searched PubMed, Cochrane library, Embase, WanFang, Chinese National Knowledge Infrastructure and VIP database (by the end of July 2015) to collect randomized controlled trials involving PCNL vs. URL for the treatment of impacted proximal ureteral stones> 1 cm. The quality of those trials were assessed. Data were extracted and analyzed with RevMan 5.3 software. ResultsSix randomized controlled trials were finally obtained after screening. A total of 487 patients were included for a Meta-analysis. The results showed that, as compared with the control group (URL), the patients in the trial group (PCNL) had the following features: ① There was a remarkable improvement of stone clearance rate [RR=1.20, 95% CI (1.09, 1.33), P=0.000 3].② There was no statistical difference in postoperative fever rates, urinary tract perforation rates [RR=1.73, 95%CI (0.43, 7.00), P=0.45; RR=1.02, 95%CI (0.11, 9.37), P=0.99], but the incidence of hematuria was higher [RR=1.99, 95%CI (1.09, 3.62), P=0.03], and the mean operative duration was longer [WMD=30.03 minutes, 95%CI (10.04, 50.02) minuntes, P=0.003].③ The mean hospitalization stay was delayed by an average of 3.73 days [WMD=3.73 days, 95%CI (3.02, 4.44) days, P<0.000 01]. ConclusionPCNL is better than URL in the stone clearance rate, while patients in the PCNL group have to stay in the hospital much longer, and should bear longer mean operative duration.
The present study is aimed to investigate the early clinical effects of nano-hydroxyapatite/polyamide 66 intervertebral fusion cage (n-HA/PA66 cage) for the treatment of lumbar degenerative diseases. We selected 27 patients with lumbar degenerative diseases who were managed by posterior decompression or reset operation combined with n-HA/PA66 cage intervertebral fusion and internal fixation from August 2010 to January 2012. The oswestry disability index (ODI), low back and leg pain visual analogue score (VAS), and intervertebral height (IH) were evaluated at preoperation, 1 week postoperation and the last follow-up period, respectively. Intervertebral bony fusion was evaluated at the last follow-up time. The patients were followed up for 12-24 months (averaged 19 months). The ODI, VAS and IH were significantly improved at 1 week postoperation and the last follow-up time compared with those at preoperative period (P<0.05). But there was no significant difference between 1 week postoperative and the last follow-up time (P<0.05). Brantigan's standard was used to evaluate fusion at the last follow-up time. There were 19 patients with grade 5 fusion, 8 with grade 4 fusion, with a fusion rate of 100%, and none with grade 1-3 fusions. There was no cage translocation and internal fixation breakage. These results suggested that n-HA/PA66 cage was an ideal biological material in the posterior lumbar interbody fusion and internal fixation operation for treatment of lumbar degenerative diseases. It can effectively maintain the intervertebral height and keep a high rate of bony fusion. The early clinical effect has been satisfactory.
ObjectiveTo systematically review the safety and efficacy of greenlight laser photoselective vaporization (PV) for nonmuscle-invasive bladder tumors (NMIBTs). MethodsSuch databases as PubMed, EMbase, The Cochrane Library (Issue 2, 2016), CNKI, CBM, VIP and WanFang Data were systemically searched from inception to February 2016, to collect randomized controlled trials (RCTs) investigating the efficacy and safety of greenlight PV for NMIBTs. Two reviewers independently screened literature, extracted data, assessed the risk of bias of included studies. Then RevMan 5.3 software was used for meta-analysis. ResultsA total of 11 RCTs involving 921 patients met the predefined criteria. The results of meta-analysis showed that: Compared with electrocautery transurethral resection and plasmakinetic resection in treating NMIBTs, greenlight PV could significantly shorten indwelling catheter time and hospital stay, decrease bladder perforation, obturator nerve reflex, blood loss rate and tumor recurrence rate; but the operative time between the greenlight PV group and the routine surgery group was not statistically different. ConclusionCurrent evidence shows that greenlight PV is safe and effective in treating NMIBTs. Due to the limited quality and quantity of the included studies, more large-scale high-quality studies are warranted to further assess these results.
ObjectiveTo investigate the clinical significance of applying digitalis preparations after pneumonec-tomy. MethodsWe retrospectively analyzed the clinical data of 78 patients who underwent pneumonectomy in the Tangdu Hospital of The Fourth Military Medical University from August 2010 to August 2013. The patients were divided into a control group (39 patients with 27 males and 12 females at a mean age of 56.8±14.8 years) and a trial group (39 patients with 24 males and 15 females at a mean age of 57.4±10.1 years). After pneumonectomy, the trial group received low dose of digitalis treatment. On 3, 5, and 7 days, the arterial partial pressure of oxygen (PaO2), systolic pulmonary artery pressure (SPAP), mean arterial pressure (MAP), diastolic pulmonary artery pressure (DPAP), and the rate of complications were examined. ResultsAfter treatment with the low dose of digitalis, the SPAP, MAP, DPAP of the trial group were statistically lower than those of the control group (P < 0.05). Incidence of arrhythmia in the trial group was statistically lower than that of the control group (P < 0.05). There was no statistical difference between the two groups in the PaO2, the incidence of pulmonary infection, and circulation disorder (P > 0.05). ConclusionLow dose of digitalis preparations can improve cardiac function after pneumonectomy.
ObjectiveTo systematically review the efficacy and safety of laparoscopic versus open nephrectomy in the treatment of autosomal dominant polycystic kidney disease (ADPKD). MethodsWe searched databases including MEDLINE, EMbase, The Cochrane Library (Issue 1, 2015), Web of Science, CBM and WanFang Data to collect relevant clinical studies comparing the efficacy and safety of laparoscopic versus open nephrectomy for ADPKD from inception to Jan, 2015. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies. Then, RevMan 5.4 software was used for meta-analysis. ResultsA total of six retrospective cohort studies involving 182 patients were included. The results of the meta-analysis showed that:compared with the open nephrectomy group, the average hospitalization time was shorter (MD=-4.38 days, 95%CI -5.93 to -2.83, P=0.000 01) and the blood transfusion risk was lower (OR=0.25, 95%CI 0.10 to 0.62, P=0.003) in the laparoscopic nephrectomy group. However, there was no significant difference between two groups in the incidence of overall complications (OR=0.51, 95%CI 0.24 to 1.06, P=0.07). ConclusionThe application of laparoscopic nephrectomy for ADPKD can reduce the hospitalization time and blood transfusion risk when compared with the open nephrectomy, but the two operations have similar overall complication rate. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To systematically review the effect of bariatric surgery for male’s erectile function. Methods We electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 5, 2016), CNKI, VIP and WanFang Data from inception to May 30th 2016, to collect randomized controlled trials and before-after studies about bariatric surgery therapies for erectile function in obese male. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies. Then RevMan 5.3 software was used for meta-analysis. Results A total of 7 before-after studies involving 270 patients were included. The results of meta-analysis showed that: compared with before treatment, bariatric surgery could significantly improve 1-year erectile function score (MD=5.05, 95%CI 3.52 to 6.59, P < 0.000 01), 1-year sexual desire score (MD=0.99, 95%CI 0.47 to 1.51, P=0.000 2), 1-year contact satisfaction score (MD=2.70, 95%CI 0.21 to 5.19, P=0.004) and 1-year total satisfaction score (MD=1.68, 95%CI 0.27 to 3.09, P=0.002), but there was no significant difference in orgasm function score (MD= –0.21, 95%CI –0.74 to 0.33, P=0.45) between before and after treatment. Conclusion Bariatric surgery is effective in improving the erectile function, sexual desire and sexual satisfaction in morbidly obese male. Due to the limited quality and quantity of the included studies, the above conclusion needs to be verified by more large-scale high-quality studies.