Objective To compare the effectiveness of one-stage bilateral total hip arthroplasty by direct anterior approach (DAA) and by posterolateral approach, and to investigate the application value of DAA in one-stage bilateral total hip arthroplasty. Methods The clinical data of 65 patients who underwent one-stage bilateral total hip arthroplasty by DAA or posterolateral approach between June 2010 and November 2015 were analyzed retrospectively. DAA was used in 34 cases (group A) and posterolateral approach was used in 31 cases (group B). There was no significant difference in the gender, age, body mass index, preoperative hemoglobin level, etiology, disease duration, preoperative Harris score, and preoperative visual analogue scale (VAS) score between 2 groups (P>0.05) with comparability. The incision length, operation time, intraoperative blood loss, total blood transfusion volume, hospitalization time, early postoperative complications, Harris score, and VAS score were recorded and compared between 2 groups. The simple Likert scale method was applied to evaluate the patient satisfaction, and the imaging evaluation was used. Results The incision length, operation time, intraoperative blood loss, total blood transfusion volume, and hospitalization time of group A were significantly less than those of group B (P<0.05). The patients were followed up 15-48 months (mean, 25.3 months) in group A and 12-51 months (mean, 27.6 months) in group B. The overall incidence of complications related to surgery in group A (10.29%) was significantly lower than that of group B (19.35%) (χ2=8.769, P=0.023). The acetabular anteversion and abduction angle were in the normal range of 2 groups except 1 hip (1.47%) of group A had a higher acetabular anteversion than normal value. Unstable fixed prosthesis happened in 1 hip of groups A and B respectively, and the remaining femoral calcar had no obvious bone resorption and fixed stably. The Harris score and VAS score at each time point after operation of 2 groups were significantly improved when compared with preoperative scores (P<0.05), and the differences between the time points after operation were also significant (P<0.05). The Harris score at 1 and 3 months after operation and the VAS score at 3 days after operation of group A were significantly better than those of group B (P<0.05), but no significant difference was found at last follow-up between 2 groups (P>0.05). According to the simple Likert scale method to analyze patient satisfaction, comprehensive satisfaction of group A (97.1%, 33/34) was significantly higher than that of group B (67.7%, 21/31) (χ2=10.343, P=0.001). Conclusion The application of DAA in one-stage bilateral total hip arthroplasty can significantly relieve the pain, accelerate the recovery of hip joint function, and improve the patient satisfaction. But in clinical application, more attentions should be paid to strictly grasp the indications and prevent the early complications. The long-term effectiveness needs to be further observed.
Objective To analyze the cl inical appl ication and effect of three operation methods in treatment of senile intertrochanteric fracture. Methods From July 2004 to February 2007, 73 patients with intertrochanteric fracture were treated. Of 73 patients, 33 patients were treated by artificial bipolar femoral head (ABFH group), 18 patients by dynamic hip screw (DHS group) and 22 by proximal femoral nail anti-rotation (PFNA group). In ABFH group, there were 19 males and 14 females with age of (72.5 ± 3.8) years. The injury was by tumbl ing in 19 cases, by accident traffic in 7 cases, fall ing from height in 4 cases and others in 3 cases, including 6 cases of type I, 9 cases of type II, 11 cases of type III and 7 cases of type IV accordingto Evans classification. The Harris hip score was 16.8 ± 4.8, and the disease course was (21.2 ± 7.8) hours. In DHS group, there were 10 males and 8 females with age of (69.5 ± 3.2) years. The injury was by tumbl ing in 11 cases, by accident traffic in 5 cases, fall ing from height in 1 case and other in 1 case, including 6 cases of type I, 3 cases of type II, 5 cases of type III and 4 cases of type IV according to Evans classification. The Harris hip score of was 18.6 ± 5.5, and the disease course was (19.8 ± 6.5) hours. In PFNA group, there were 13 males and 9 females with age of (70.3 ± 3.5) years. The injury was by tumbl ing in 11 cases, by accident traffic in 6 cases, fall ing from height in 3 cases and others in 2 cases, including 5 cases of type I, 6 cases of type II, 6 cases of type III and 5 cases of type IV according to Evans classification. The Harris hip score was 20.4 ± 6.6, and the disease course was (20.0 ± 5.8) hours. All fractures were fresh. There were no significant difference in general data between three groups (P gt; 0.05). Results In ABFH group, all incisions healed by first intention, but deep vein thrombosis occurred in 1 case on the postoperative third day. In DHS group, incisions healed by first intention in 16 cases and by second intention in 2 cases, coxa adducta occurred in 2 cases after operation. In PFNA group, all incisions healed by first intention. Cacothesis in pate occurred in 1 case after operation. There were significant differences in operation time, blood loss, and out-of-bed time (P lt; 0.05). The patients were followed up (30.5 ± 6.5) months in ABFH group, (27.6 ± 6.2) months in DHS group, and (24.8 ± 5.4) months inPFNA group. The union time of fracture was (7.5 ± 2.5) months in ABFH group, (8.4 ± 2.2) months in DHS group and (7.2 ± 2.4) months in PFNA group. There were significant differences in Harris score between before operation and after operation and between different time after operation in three groups (P lt; 0.05). Conculsion The three operative methods have some their superiority, but the replacement of artificial bipolar femoral head is more suitable for the senile unstable intertrochanteric fracture because of simply procedure, short operation time, less blood loss and early ambulation.
To evaluate the effectiveness of tumor-segmental resection and autologous il iac bone graft reconstruction combined with internal fixation in treating hand-foot-giant cell tumor of bone. Methods Between August 1997 and April 2008, 8 cases of hand-foot-giant cell tumor of bone were treated, including 3 males and 5 females with an average age of 28.5 years (range, 16-42 years). The locations were metacarpal bones in 3 cases, metatarsal bones in 4 cases, and phalanges of toes in 1 case. According to Campanacci’s gradation of X-ray films, there were 1 case of grade I and 7 cases of gradeII; according to pathological examination before opration, there were 3 cases of grade I to II, 4 cases of grade II, and 1 case of grade II to III; and according to TNM staging, there were 1 case of TisN0M0, 4 cases of T1N0M0, and 3 cases of T2N0M0. There were 2 cases of recurrence, the time from the first operation to recurrence were 11 and 14 months, respectively. The tumor size was 1.8 cm × 1.0 cm to 6.0 cm × 2.0 cm, the cortical bone became thinner, and the boundary between tumor and periosteum was clear. All patients underwent tumor-segmental resection combined with autologous il iac bone graft reconstruction, and miniplate internal fixation by lumbar anesthesia or trachea cannula anesthesia. Results All incision healed by first intention. Eight patients were followed up 10 to 84 months with an average of 46 months. Radiographs showed that fracture union was achieved at 3 to 9 months (mean, 5 months). No significant rotation, angular, and shortening deformity occurred in il iac bone graft. The function of il iac bone donor site recovered excellently. The pathological examination showed giant cell tumor of bone in all cases, including 2 case of grade I-II, 5 cases of grade II, and 1 case of grade II-III. The hand or foot function recovered excellently. No tumor recurrence or lung metastasis occurred during follow-up. Conclusion Tumor-segmental resection combined with autologous il iac bone graft reconstruction plus internal fixation has excellent effectiveness for hand-foot-gaint cell tumor of bone.
【Abstract】Objective To analyze the function of BAG3 in antiapoptosis and chemotherapy resistance induction process of pancreatic cancer.Methods The expressions of BAG-3 in pancreatic cancerous tissues of patients with chemotherapy and those without chemotherapy before resection were determined by immunohistochemistry. The expression difference of BAG-3 protein 18 hours after cultured with chemotherapy drugs (concentration of drugs: 5-FU 50 μg/ml, MMC 0.5 μg/ml, EADM 1.5 μg/ml) of 3 pancreatic cancer cell lines （MIACaPa-2, PANC-1, SW1990） was measured through Western blotting method.Results The median positive rate of pancreatic cancer tissue from patients accepted chemotherapy before resection was higher than those not accepted chemotherapy, but there wasn’t significant difference. Eighteen hours after cultured with drugs, the level of BAG-3 of this three cell lines had significant increased compared with control group (P＜0.05). Conclusion Chemotherapy induces elevation of BAG-3 expression of pancreatic cancer. The upregulate of BAG-3 may associate with the chemotherapy resistance induced by drugs.
【Abstract】 Objective To evaluate the effectiveness of artifical humeral head replacement in treatment of complicatedfractures of the proximal humerus. Method Between January 2005 and January 2011, 18 patients with proximal humerusfracture were treated with artifical humeral head replacement. There were 8 males and 10 females with a mean age of 71 years (range, 52-84 years). Fractures were caused by falling in 11 cases, by traffic accident in 3 cases, and by bruise in 4 cases. The time between injury and admission was 2 hours to 3 days (mean, 1.5 days). According to Neer classification, 8 cases had three-part fracture, 7 four-part fracture, and 3 cleavage fracture of humeral head; 5 cases complicated by shoulder joint subluxation, 2 cases by femoral fracture, 1 case by radial fracture, and 11 cases by osteoporosis. All the patients were treated with modular cemented prostheses. Results The operation time was 60-180 minutes with an average of 80 minutes; the blood loss was 100-400 mL with an average of 200 mL. All incisions healed by first intention without infection or neurovascular injury. Sixteen patients were followed up 3 years on average (range, 1-6 years). No loosening, dislocation of prothesis or heterotopic ossification occurred. According to the Neer scores, the results were excellent in 5 cases, good in 8 cases, moderate in 2 cases, and poor in 1 case at 1 year after operation. The excellent and good rate was 81.2%. Conclusion Artificial humeral head replacement is a good therapy for patients with complicated fractures of the proximal humerus, especially for elderly patients.
目的 探討關節鏡手術聯合口服鹽酸氨基葡萄糖治療膝骨關節炎（KOA）的近期臨床療效。 方法 選取2011年1月－12月具有關節鏡手術指征的KOA患者86例，按手術順序單雙號分成兩組，試驗組（單號）行關節鏡手術聯合口服鹽酸氨基葡萄糖治療，對照組（雙號）行關節鏡手術治療。采用Lequesne指數對兩組患膝術前，術后第4、6周進行評分及療效分析。 結果 兩組患膝術前與術后第4、6周Lequesne指數得分比較，差異有統計學意義（P＜0.05）；兩組術后近期療效比較，差異有統計學意義（P＜0.05）。 結論 關節鏡手術聯合口服鹽酸氨基葡萄糖治療KOA具有良好的近期療效，優于單用關節鏡手術治療者。
目的 了解依托芬那酯凝膠對有疼痛癥狀的輕中度拇外翻畸形的治療效果。 方法 對2010年3月－2011年7月門診收治的輕中度拇外翻患者共65足，隨機分成兩組，治療組采取托芬那酯凝膠局部應用和佩戴夜間支具，對照組佩戴夜間支具，局部應用安慰劑，治療周期1個月。記錄癥狀明顯緩解時間，治療前后對患者進行視覺模擬疼痛評分和美國骨科足踝分會跖趾及趾間關節評分，并測量拇外翻角和第一跖骨間角改變。 結果 全部患者完成治療，疼痛緩解時間治療組為（3.28 ± 1.04）d，對照組（7.03 ± 2.15）d，差異有統計學意義（P＜0.05）,佩戴足矯形器治療1個月，拇外翻角和第一跖骨間角改變無統計學差異（P＞0.05）。 結論 局部應用依托芬那酯凝膠結合足矯形器治療輕中度拇外翻能快速緩解疼痛癥狀，改善活動能力，延緩畸形加重，依托芬那酯凝膠局部給藥患者能良好耐受，可避免口服非甾體抗炎藥（NSAIDs）帶來的副作用。