ObjectiveTo evaluate the effectiveness of elbow arthrography through lateral approach in the treatment of elbow fractures in infants.MethodsThe clinical data of 24 infants with elbow fractures admitted between May 2016 and May 2018 were retrospectively analyzed. There were 14 boys and 10 girls with an average age of 1.8 years (range, 2 months to 3 years). The time from injury to admission ranged from 1 hour to 7 days, with an average of 6.7 hours. The preoperative carrying angle was (30.8±4.5)° (range, 24°-41°), and the elbow range of motion was (128.5±4.5)° (range, 125°-134°). Elbow arthrography through lateral approach was used in all cases, including 10 cases of humeral lateral condylar fracture, 6 cases of distal humeral epiphysis fracture, 3 cases of fresh Monteggia fracture, and 5 cases of radial neck fracture. According to fracture types, open reduction with Kirschner wire fixation, closed reduction with plaster cast fixation, or closed reduction with percutaneous Kirschner wire fixation were used.ResultsNone of the children had adverse reactions such as drug allergy. All patients were follow-up 14-38 months, with an average of 19.6 months. The skin irritation around the needle tail occurred in 2 cases after operation, and the symptoms disappeared after the Kirschner wire was pulled out. The anteroposterior and lateral X-ray films of elbow joint showed that the fractures healed well and no mulunion at the fracture site or premature epiphysis closure was observed. At last follow-up, the carrying angle was (5.2±1.9)° (range, 2°-8°) and the elbow range of motion was (137.1±4.7)° (range, 133°-141°), which were significantly improved when compared with those before operation (t=22.670, P=0.000; t=11.910, P=0.000). According to Flynn clinical function evaluation standard of elbow joint, 22 cases were excellent, 1 case was good, and 1 case was fair. The excellent and good rate was 95.8%.ConclusionElbow arthrography through lateral approach can clearly judge the cartilage damage of the elbow joint surface in infants, and minimize the occurrence of misdiagnosis and missed diagnosis, and can guide the choice of treatment.
ObjectiveTo investigate the effectiveness of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) assisted with microscope in treatment of lumbar spondylolisthesis. MethodsBetween January 2011 and June 2012, 52 patients with lumbar spondylolisthesis underwent MI-TLIF assisted with microscope. There were 29 males and 23 females with an average age of 46 years (range, 32-67 years). The median disease duration was 3.2 years (range, 3 months to 6 years). There were 38 cases of lumbar isthmic spondylolisthesis and 14 cases of degenerative spondylolisthesis; 12 cases had stenosis secondary to lumbar spondylolisthesis. The affected segments were L4, 5 (29 cases) and L5, S1 (23 cases). According to the Meyerding evaluating system, 24 cases were classified as degree I and 28 cases as degree Ⅱ. The visual analogue scale (VAS) score and Oswestry disability index (ODI)were used for clinical assessment, and the clinical effects were also analyzed by Macnab criterion at last follow-up. The radiographic data were used to evaluate reduction of spondylolisthesis, including slipping degree, slipping angle, and intervertebral space height. The fusion rate was assessed by Suk criterion. ResultsThe operations were performed successfully in all patients. No dural tear or cerebrospinal fluid leakage occurred during operation. The average operation time was 105 minutes; the average intraoperative blood loss was 225 mL; the average postoperative drainage volume was 75 mL; and the average hospitalization days were 5.5 days. Superficial infection of incision occurred in 1 case and was cured after change dressing, and primary healing of incision was obtained in the others. All patients were followed up 12-26 months (mean, 18 months). No loosening, breakage, and displacement of pedicle screw and no Cage dislocation occurred by X-ray films after operation. The lumbar spondylolisthesis all got good correction. The three-dimensional CT showed continuous bone trabecula between centrums. The VAS score, ODI, and the slipping degree, slipping angle, and intervertebral space height were significantly improved at last follow-up when compared with preoperative ones (P<0.05). According to Macnab criterion at last follow-up, the results were excellent in 20 cases, good in 29 cases, and fair in 3 cases; the excellent and good rate was 94.2%. According to Suk criterion for fusion, 49 cases obtained complete fusion and 3 cases got possible fusion. ConclusionAs long as indications are seized, MI-TLIF assisted with microscope is safe and reliable for treatment of lumbar spondylolisthesis (Meyerding dergee I or Ⅱ), and it has the advantage of less injury, less blood loss, less complications, and definite short-term effectiveness.
Objective To compare effectiveness of injecting platelet-rich plasma (PRP) with different concentrations of leukocytes under ultrasound in treatment of supraspinatus tendon injury. Methods A clinical data of 30 patients with supraspinatus tendon injury, who met the selection criteria and were admitted between December 2022 and December 2023, was retrospectively analyzed. Thirty patients were treated with 4 injections of leukocyte-poor PRP (LP-PRP, n=10), leukocyte-rich PRP (LR-PRP, n=11), and triamcinolone (n=9), with an interval of 7-10 days between each injection. There was no significant difference between groups (P>0.05) in the age, gender, disease duration, affected shoulder side, Ellman classification, preoperative visual analogue scale (VAS) score, Constant score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and American Shoulder and Elbow Surgeons (ASES) score. At 1, 3, and 6 months after injection, the shoulder pain and function were evaluated by using the VAS score, Constant score, DASH score, and ASES score. MRI was conducted to observe supraspinatus tendon healing. Results No severe adverse reactions was observed in all groups. All patients were followed up 6-7 months, with an average of 6.5 months. After injection, the ASES score and Constant score gradually increased in the LR-PRP group and LP-PRP group, while the VAS score and DASH score decreased, with significant differences compared to before injection (P<0.05). Except for no significant difference between 3 and 6 months after injection in LR-PRP group (P>0.05), the above scores showed significant differences between different time points (P<0.05). At 1 month after injection, the Constant score in triamcinolone group significantly increased compared to before injection, while the VAS score significantly decreased (P<0.05). There was no significant difference in all scores between other time points in the triamcinolone group (P>0.05). Except for 1 month after injection, there was no significant difference in Constant score and VAS score between groups (P>0.05). At all other time points, the LR-PRP group and LP-PRP group had better scores than the triamcinolone group (P<0.05). There was no significant difference between the LR-PRP group and the LP-PRP group (P>0.05). MRI showed that only 4 patients in the LP-PRP group had signs of repair at the supraspinatus tendon injury site at 6 months after injection, while no significant tendon repair sign was observed in the other patients. Conclusion Compared with triamcinolone treatment, multiple injections of LP-PRP and LR-PRP under ultrasound can promote the recovery of shoulder joint function and significantly relieve pain in patients with supraspinatus tendon injury, and imaging improvement can be seen after LP-PRP treatment.
Objective To evaluate the effects of two filtration fraction formulas on extracorporeal circulation life of continuous renal replacement therapy (CRRT) under regional citrate anticoagulation. Methods Patients with acute kidney injury who received CRRT treatment with regional citrate anticoagulation and the estimated CRRT duration was greater than 24 h at West China Hospital of Sichuan University between June 2022 and April 2023 were selected. They were randomly divided into continuous veno-venous hemofiltration (CVVH), continuous veno-venous hemodialysis (CVVHD) and continuous veno-venous hemodiafiltration (CVVHDF) groups using Prismaflex machines. The life of the CRRT extracorporeal circulation in the three groups of patients was compared, and the reasons for replacing the extracorporeal circulation after 72 h were not used, and the filtration fraction score of the three groups was calculated according to the two filtration score calculation formulas (Formula 1 and Formula 2) currently used in the world. The filtration value obtained by the two filtration fraction calculation formulas was taken as the test variable, and whether the median life of the group with the longest extracorporeal circulation life was taken as the state variable, and the receiver operating characteristic curve was drawn, and the area under the curve was calculated. Results A total of 121 patients were included, including 40 patients in the CVVH group, 40 patients in the CVVHD group, and 41 patients in the CVVHDF group. The extracorporeal circulation life of CVVH group, CVVHD group and CVVHDF group was 64 (46, 71) h, 47 (31.5, 54) h and 70 (65, 72) h, respectively, with statistical difference (log-rank P=0.036). A total of 94 cases were replaced due to filter or venous pot clotting after 72 h after the filter was not used, including 30 cases in the CVVH group, 39 cases in the CVVHD group, and 25 cases in the CVVHDF group. The difference between the three groups was statistically significant (χ2=15.83, P<0.001). According to Formula 1, the filtration fraction of CVVH group, CVVHD group and CVVHDF group was 15.8% (15.2%, 17.0%), 1.1% (0.7%, 2.1%) and 16.2% (14.9%, 17.6%), respectively, and the difference among the three groups was statistically significant (H=69.402, P<0.001). According to Formula 2, the filtration fraction of CVVH group, CVVHD group and CVVHDF group was 33.1% (32.4%, 35.7%), 4.0% (3.6%, 4.9%) and 19.1% (17.7%, 20.7%), respectively, and the differences among the three groups and pairwise comparison between groups were statistically significant (P<0.001). The area under the receiver operating characteristic curvec calculated by the Formula 1 and 2 for the influence of filtration fraction on extracorporeal circulation life were 0.539 and 0.668, the sensitivity were 43.18% and 82.22%, and the specificity were 80.65% and 56.25%, respectively. Conclusions When using Prismaflex machine, the filter life of CVVHD is shorter than CVVH and CVVHDF modes. The filtration fraction calculated by Formula 2 is more sensitive but less specific in predicting CRRT extracorporeal circulation life. Filtration fraction as a CRRT extracorporeal circulation risk assessment has limitations, especially for the CVVH model with pre and post replacement.
Objective To investigate the level and influencing factors of perceived HIV stigma and discrimination among people living with HIV/AIDS (PLWHA). Methods By using convenience sampling method, 123 patients were recruited from the department of infectious diseases in a tertiary hospital in Chengdu from April to May in 2017. Berger HIV stigma scale was used to measure the level of perceived HIV stigma. Results The mean score of Berger HIV stigma scale was 113.72±17.890, which revealed a middle to upper level. Among the four subscales, the score of disclosure concerns (3.07±0.462) was the highest, while the score of negative self-image (2.70±0.494) was the lowest. Multiple regression analysis showed that gender and self-perceived health status were the influencing factors of perceived HIV stigma. Conclusions The level of perceived HIV stigma among PLWHA is from middle to upper level. Female gender and poor self-perceived health status are associated with a higher level of perceived HIV stigma. Individualized interventions are required in order to reduce the level of HIV stigma.
ObjectiveTo explore the effectiveness percutaneous monoaxial screw combined with polyaxial pedical screw for treating thoracolumbar fracture by comparing with simple polyaxial pedicle screw fixation. MethodsBetween January 2012 and June 2014, 56 cases of thoracolumbar fractures were treated by percutaneous pedicle screw fixation, the clinical data were retrospectively analyzed. Of 56 cases, 30 were treated with percutaneous monoaxial screw combined with percutaneous polyaxial pedical screw fixation (group A), 26 patients with only percutaneous polyaxial pedicle screw fixation (group B). There was no significant difference in gender, age, body mass index, injury causes, time from injury to admission, involved segments, fracture type, and preoperative American Spinal Injury Association (ASIA) stage, visual analogue scale (VAS), the anterior height of the injured vertebrae, Cobb angle, and sagittal index between 2 groups (P>0.05). The operation time, intraoperative blood loss, and complications were recorded and compared between the 2 groups. The VAS score was used to evaluate the improvement of the pain. The sagittal kyphosis Cobb angle, the anterior height of the injured vertebrae, sagittal index, and the average correction (difference between 3 days after oeration and preoperation) and loss degrees (difference between last follow-up and 3 days after operation) were measured on the X-ray films at preoperation, 3 days after operation, and last follow-up. ResultsIncision healing at stage I was obtained, no related complications occurred. The operation time and intraoperative blood loss showed no significant difference between 2 groups (P>0.05). The patients were followed up 20-42 months (mean, 32 months) in group A and 21-44 months (mean, 30 months) in group B. VAS score of group A was significantly lower than that of group B at 3 days after operation (t=-2.277, P=0.027), but no significant difference was found at last follow-up (t=-0.289, P=0.774). X-ray examination showed good position of internal fixation, with no broken nails or exit of nail. There were significant differences in the anterior height of the injured vertebrae, Cobb angle, and sagittal index between at preoperation and at 3 days and last follow-up, and between at 3 days and last follow-up in 2 groups (P<0.05). The anterior height of the injured vertebrae, Cobb angle, and sagittal index of group A were significantly better than those of group B at 3 days and last follow-up (P<0.05), and correction degree were significantly higher than those of group B (P<0.05), but loss degree was not significant between 2 groups (P>0.05). ConclusionPercutaneous monoaxial screw combined with polyaxial pedicle screw fixation is better than simply polyaxial pedicle screw in effects of treating thoracolumbar fracture under the premise of strictly holding indications.