目的 分析总结严重挤压伤导致四肢创伤性截肢各种生化指标的动态变化及对临床中治疗的指导意义。 方法 2000年3月－2011年3月对23例由于严重挤压导致创伤性截肢的患者各项生化指标检测结果进行实时监控，根据监控结果及时调整治疗方案。 结果 伤后患者电解质，血、尿肌红蛋白，尿比重，尿pH值，血肌酸激酶、肌酸激酶同工酶、羟丁酸脱氢酶、白蛋白、血红蛋白、血小板等指标均有明显改变，据此作为救治的依据进行精细化治疗。术后随访7个月～10年，23例患者均得到康复，肾功能良好。 结论 对于严重挤压伤导致四肢创伤性截肢的各种生化指标实时监控并同步制定精细化治疗，才能确保患者成功救治并得以康复。
Objective To explore the application of enhanced recovery after surgery (ERAS) in pain management after knee arthroplasty (TKA). Methods Doctor-nurse pain management team was established based on ERAS between June and July 2016, and the pain management was carried out after training the doctors and nurses. According to the formula of two-sample mean comparison and inclusion and exclusion criteria, 60 TKA patients admitted to the hospital from March to May 2016 were assigned into the control group (before intervention) and 60 TKA patients admitted from August to October 2016 were assigned into the trial group (after intervention). The patients in the control group received routine pain management. In the trial group, preventive analgesia was performed, pain health education paths were built and ISBAR communication mode was made preoperatively; anesthesia protocols were optimized intraoperatively; multimodal analgesia based on time-demand was used postoperatively; continuing analgesia program was provided at the discharge. The pain score, Hospital for Special Surgery (HSS) knee score, average length of stay (ALOS) and average hospitalization cost (excluding materials) were compared between the two groups. Results The pain scores between the two groups at the admission and 6 hours after surgery were not statistically different (P>0.05), and the pain scores in the trial group 24, 48, 72 hours after surgery were significantly lower than those in the control group (P<0.05). The HSS scores between the two groups at the admission were not statistically different (P>0.05), and the HSS scores in the trial group 3 days, 1 week, and 1 month after surgery were significantly higher than those in the control group (P<0.05). And ALOS and average hospitalization cost (excluding materials) in the trial group were significantly lower than those in the control group (P<0.05). Conclusion The application of ERAS in pain management after TKA can effectively alleviate the postoperative pain, improve the patients’ knee function, shorten the ALOS, and decrease the average hospitalization cost.
Objective To investigate the risk factors of childhood leukaemia. Methods Questionnaire about risk factors of childhood leukaemia was devised and used. We surveyed and analyzed the relevant risk factors of 143 cases of leukaemia children in Children’s Hospital of Chongqing Medical University from May 2008 to February 2009, comparing with 108 hospitalized cases without leukaemia during the same period. The significant factors were identified by single factor analysis. Then multi-factors conditional logistic regression analysis was conducted. Results In the single factor analysis, 12 of 26 indexes were statistically significant (Plt;0.05), while in the multi-factors logistic regression analysis, there were 8 of 12 indexes with significance (Plt;0.05), which of those are frequent infection history, house decoration, family history of cancer, maternal childbearing age, and history of contact with paint, leather shoes, radiation and pesticides. Conclusion The 8 indexes as listed above are closely related to the pathogeny of leukaemia and may be the distinguished risk factors of childhood leukaemia.
ObjectiveTo investigate the effectiveness of tibial transverse transport (TTT) combined with nose ring drain (NRD) in the treatment of severe diabetic foot ulcer.MethodsThe clinical data of 60 patients with severe diabetic foot (Wagner grade 3 or 4) ulcer who were admitted between April 2017 and August 2020 and met the selection criteria were retrospectively analyzed. Among them, 30 cases were treated with TTT combined with NRD (TTT+NRD group), and 30 cases were treated with TTT (TTT group). There was no significant difference in gender, age, diabetes duration, preoperative glycated hemoglobin, comorbidities, wound area, and duration, side, and grade of diabetic foot (P>0.05). The wound healing time, wound healing rate, amputation rate, recurrence rate, duration of antibiotic therapy, hospital stay, number of hospitalizations, and number of operations were recoreded and compared between the two groups.ResultsNo obvious surgical complications occurred in the two groups. Patients in both groups were followed up 3-13 months, with an average of 5.7 months. The duration of antibiotic therapy and hospital stay in the TTT+NRD group were significantly shorter than those in the TTT group (P<0.05). There was no significant difference in wound healing time, wound healing rate, number of hospitalizations, and number of operations between the two groups (P>0.05). During follow-up, there was no recurrence of ulcer in the TTT+NRD group while 2 recurrent cases (6.7%) in the TTT group. The difference in recurrence rate was not significant (P=0.492). One case (3.3%) in the TTT+NRD group underwent amputation due to acute lower extremity vascular embolism, and 1 case (3.3%) in the TTT group underwent amputation due to secondary necrosis. The difference in amputation rate was not significant between the two groups (P=1.000).ConclusionTTT combined with NRD is an effective method for the treatment of severe diabetic foot ulcers with deep infections or relatively closed cavities or sinuses. It can shorten the time of antibiotic use and the length of hospitalization; and the NRD has a good drainage effect without obvious comorbidities, procedure and the postoperative care are simple and easy to obtain materials.
Objective To evaluate the coronary artery ostium obstruction caused by the commissure of transcatheter heart valve (THV) with the markers on THV under X-ray, which was identified by observing the position relationship between the commissure of THV and the coronary artery ostium from analyzing aortic root computed tomographic angiography (CTA) images after transcatheter aortic valve replacement (TAVR). Methods A retrospective analysis was performed on 25 patients undergoing TAVR who were checked with electrocardiographically gated CTA for the aortic root after the TAVR procedure between January 2020 and December 2021 in General Hospital of Northern Theater Command. The images of THV with the lowest position of non-coronary sinus and the right anterior oblique and caudal in most cases were observed when the THVs were deployed. The position relationships of the three markers on the THV after valve release were recorded, which were divided into three conditions, namely the three markers being averagely distributed, the middle marker being close to left, and the middle marker being close to right. Postoperative CTA images of the patients were analyzed. The angle between the commissure of THV and the coronary artery ostium was measured, and the angles in each group were presented as medium (lower quartile, upper quartile). Results A total of 17 patients were finally included. The angles between the commissure of THV and the left coronary artery ostium were 19.0 (16.0, 31.0)°, 36.0 (15.0, 44.0)°, and 3.0 (3.0, 5.0)° in the markers averagely distributed group (n=7), the middle marker close to left group (n=6), and the middle marker close to right group (n=4), respectively, which were significantly different (P=0.033). The angles between the commissure of THV and the right coronary artery ostium were 43.0 (25.0, 51.0)°, 47.0 (41.0, 57.0)°, and 13.0 (7.5, 21.0)° in the markers averagely distributed group, the middle marker close to left group, and the middle marker close to right group, respectively, which were significantly different (P=0.017). There was significant difference in the obstruction degrees of left coronary artery ostium by the commissure of THV (P=0.008), and no significant difference in the obstruction degrees of right coronary artery ostium (P=0.062). When the middle marker was close to right, there was no more than moderately obstruction on the right coronary artery ostium and no any obstruction on the left coronary artery ostium. When the middle marker was close to left, the obstruction rate of the left coronary artery ostium with more than moderate degree was 4/6 (66.7%) and it was 6/6 (100.0%) for the right coronary artery ostium. Conclusions The degree of coronary artery ostium obstruction by the commissure of THV can be accurately evaluated by using markers on THV. Among them, when the middle marker is close to right, the commissures of THV are least likely to block the coronary artery ostium.
Lumbar disc herniation (LDH) is one of the most important causes of back and leg pain, which seriously affects the quality of life of patients. As the first-line treatment for LDH, non-operative treatment can relieve 80% to 90% of symptoms among the patients with LDH. This guideline followed Guidelines for the Formulation/Revision of Clinical Treatment Guidelines in China (2022 edition) and WHO handbook for guideline development (2014 edition) to set up guideline working group. This guideline identified fourteen clinical questions through the literature review and clinical experts’ consensus. We drafted the recommendations after systematically searching and evaluating the evidence; delphi method was adopted for expert consensus on the preliminary recommendations, finally, 19 recommendations were made to guide non-operative treatments for LDH. This guideline can provide guidance for the clinical practice of Chinese and western orthopedics practitioners.