Objective To investigate the clinical effects of repairing massive bone defects in limbs by using vascularized free fibular autograft compoundingmassive bone allografts. Methods From January 2001 to December 2003, large bone defects in 19 patients (11 men and 8 women, aging from 6 to 35 years) were repaired by vascularized free fibular transplant with a monitoringflap compounding massive deep frozen bone allografts. The length of bone defects were 12 to 25 cm (16.6 cm on average), of vascularized free fibular 15 to 28 cm (18.3 cm on average), and of massive bone allografts 11 to 24 cm (16.1 cm on average). Thelocation of massive bone defects were humerus in 1 case, femur in 9 cases and tibia in 9 cases. Results After followup of 5 to 36 onths (18.2 months on average), wounds of donor and recipient sites were healed at Ⅰstage, monitoringflaps were alive, no obvious eject reaction of massive bone allografts was observed and no complications occurred in donor limbs. The radiographic evidence showed union in 15 patients 3 months and 3 patients 8 months after operation. One case of malignant synovioma of left lower femur recurred and amputation was performed 2.5 months after surgery. Internal fixation was removed in 5 patients, and complete bone unions werefound 1 year postoperatively. No massive bone allografts was absorbed or collapsed. Conclusion With strict indication, vascularized free fibular autograft compounding massive bone allografts, as an excellent method of repairing massive bone defects in limbs, can not only accelerate bone union but also activate and changer the final results of massive bone allografts from failure.
From 1984 to 1994, 196 patients with massive upper gastrointestinal hemorrhage (hemorrhagic gastritis 137 cases, gastric ulcer 59 cases) caused by acute gastric mucosal lesions were treated in our hospital. As soon as the diagnosis was established, the stress factors in relation to acute gastric mucosal lesions and the factors damaging gastric mucosal barrier should he dispeled and hypovolemia should he corrected. In this group, the operative mortality were as follow: stress ulcer 6.3%, hemorrhagic gastritis 33.3%. According to this result, we consider that in cases of hemorrhagic gastritis the surgical operation must be considered with great care, but for stress ulcer with massive bleeding energetic surgical operation should be taken.
Massive cerebral infarction with malignant brain edema has poor prognosis with very high mortality, despite aggressive medical treatment. Surgical decompression is recommended by Chinese and international clinical guidelines for patients with massive cerebral infarction, however, there is no standardized diagnosis and treatment protocol in clinical practice. Following the principle of evidence-based medicine and based on the diagnosis and treatment norms of the participating hospitals of Severe Ischaemic Stroke Collaboration in recent years, we recommend this consensus statement of the standardized surgical decompression for malignant brain edema in massive cerebral infarction.
ObjectiveTo investigate the clinical efficacy and mechansim of massive hepatocarcinoma with different imaging appearance after transcatheter arterial chemoembolization(TACE). MethodsThe image data of 38 patients with massive hepatocarcinoma were collected and analized retrospectively. According to the tumor edge situation on CT images before TACE treatment, the patients were divided into two groups:the sharp-edged tumor group and indistinct-edged tumor group. The efficacy were evaluated according to the imaging appearance after treatment. ResultsThe differences of the positive cases of HbsAg and AFP, Child-Pugh class, maximum tumor diameter, and dosage of lipiodol between the two groups before procedure were not statistic significance(P > 0.05). Six months after TACE, the maximum tumor diameter of the sharp-edged tumor group and indistinct-edged tumor group was(8.2±1.48) cm and(12.2±1.67) cm, respectively, the difference between the two groups was statistic significance(P < 0.05). In accordance with lipiodol deposition, ⅠandⅡtype were found in the sharp-edged tumor group withoutⅢandⅣtype. Most wereⅡandⅢtype with lessⅠtype and severalⅣtype in the indistinct-edged tumor group. According to the size of tumor six months after TACE, the total effective rate(CR+PR) was 92.9% and 62.5%, respectively in the sharp-edged tumor group and indistinct-edged tumor group. There were significantly difference between the two groups in iodized oil distribution and tumor size after procedure(P < 0.05). No statistical difference was found between the incidence rate of complications in two groups(P > 0.05). ConclusionThe efficacy of massive hepatocarcinoma in patients with sharp-edged tumor on CT images is better than those with indistinct-edged tumor.
ObjectiveTo improve the diagnosis and treatment of the disease, the clinical symptoms, pathological features, diagnosis and differential diagnosis, treatment and prognosis of massive lung inflammatory myofibroblastic tumor (IMT) were analyzed.MethodsA case, admitted to the Department of Respiratory and Critical Care Medicine of Xiangya Hospital, Central South University, diagnosed as massive lung IMT, was retrospectively analyzed. His clinical and chest radiological data were collected and literature which searched through CNKI, WanFang Med online and PubMed on this subject were reviewed.ResultsThe patient, middle-age male, was presented with cough, dyspnea and weight loss, whose chest radiology was characterized by a large thoracic cavity occupation. He was confirmed with massive lung IMT by several lung biopsy. From above databases, 8 cases were retrieved, including 6 articles in English and 2 articles in Chinese. In 9 cases of massive lung IMT, there were 4 males and 5 females. The age was from 1.5 to 75 years old and the average age was 28 years old. The clinical symptoms were non-specific, and chest imaging was characterized by a large thoracic occupation. One case had distant metastases with bone, adrenal gland and lymph node, and one case had distant metastasis with brain after complete surgery.ConclusionsLung massive IMT has no characteristic clinical and radiological features. And a definite diagnosis depends on pathological biopsy and immunohistochemical analysis. It needs to be differentiated from other thoracic giant tumors. The preferred treatment is complete surgical resection. The prognosis after complete resection is usually good, and probably affected by size.
Objective To review the progress in the treatment and research of massive rotator cuff tears. Methods Recent l iteratures about the treatment and research of massive rotator cuff tears were reviewed. Results Treatment options of massive rotator cuff tears include nonoperative treatment, debridement, direct repair, tendon transfer, and repair with various substitutes, but the outcome is unpredictable. Recently, many experimental studies on the treatment of massive rotator cuff tears, such as gene therapy, cell therapy, and tissue engineering techniques, can provide cl inicians with new treatment strategies. Conclusion The treatment of massive rotator cuff tears pose a distinct cl inical challenge for the orthopaedist, depending on the overall presentation. The effect of traditional operation method to repair massive rotator cuff tears is limited. The treatment and research of massive rotator cuff tears still need to be studied.
Severe/massive ischaemic stroke is difficult to treat and has poor prognosis. There are limited studies for specific treatment of these conditions and no consensus on their definitions. This proposal suggests definitions and a flowchart for the diagnosis and treatment of these conditions. We focus on predicting and preventing malignant oedema at an early stage, monitoring the level of consciousness and vital signs, and the prevention and management of complications (eg. pulmonary infections). We particularly provide suggestions for the treatment with intravenous thrombolysis, endovascular treatment, antiplatelet and anticoagulation. More studies are warranted to support individualised management of infarct swelling, intracranial hypertension and early rehabilitation for severe/massive ischaemic stroke.
ObjectiveTo investigate effectiveness of arthroscopic superior capsular reconstruction using a “sandwich” patch combined with platelet-rich plasma (PRP) injection in treating massive irreparable rotator cuff tears. Methods A clinical data of 15 patients (15 sides) with massive irreparable rotator cuff tears, who were admitted between September 2020 and March 2023 and met the selective criteria, was retrospectively analyzed. There were 8 males and 7 females with an average age of 62.1 years (range, 40-80 years). The rotator cuff tears were caused by trauma in 7 cases and other reasons in 8 cases. The disease duration ranged from 5 to 25 months, with an average of 17.7 months. According to the Hamada grading, the rotator cuff tears were rated as grade 1 in 2 cases, grade 2 in 8 cases, and grade 3 in 5 cases. All patients were underwent superior capsular reconstruction using the “sandwich” patches (autologous fascia lata+polypropylene patch+autologous fascia lata) combined with PRP injection on patches. The pre- and post-operative active range of motion (ROM) of the shoulder joint, American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, University of California, Los Angeles Shoulder Rating Scale (UCLA) score, and visual analogue scale (VAS) score were recorded. The subacromial space was measured on the imaging and rotator cuff integrity was assessed based on Sugaya grading. Results All incisions healed by first intention after operation without any complications such as infection. All patients were followed up 12-18 months (mean, 14.4 months). At last follow-up, the active ROMs of flexion, abduction, external rotation, internal rotation of the shoulder joint, subacromial space, ASES score, Constant-Murley score, and UCLA score increased, and VAS score decreased, showing significant differences when compared with preoperative values (P<0.05). There was no significant difference in the Sugaya grading between last follow-up and immediately after operation (P>0.05). Conclusion For massive irreparable rotator cuff tears, arthroscopic superior capsular reconstruction using the “sandwich” patches combined with PRP injection can restore stability of the shoulder joint, relieve pain, promote rotator cuff healing, and achieve good short-term effectiveness.
Objective To evaluate the safety and efficacy of transcatheter angiographic embol ization (AE) in the control of massive haemorrhage from large wound due to crush syndrome after Wenchuan earthquake. Methods From May 12 to May 26, 2008, 11 injured persons in Wenchuan earthquake with massive haemorrhage from large wound due to crush syndrome were treated, including 6 males and 5 females aged 16-36 years old (average 21 years old). All 19 wounds were infected.The hemorrhage was from the hip in 7 cases, the thigh stump in 3 cases, and the shoulder in 1 case. Six patients had hemorrhagic shock. All patients underwent arteriography to locate the bleeding artery, and transcatheter AE was performed according to the result of arteriography. Contrast-enhanced spiral CT scan and three-dimensional angiography were performed 48 hours after AE to evaluate leakage of contrast media and collapse of distal artery of embol ism site. Results Angiography for 11 injured persons after AE showed no occurrence of contrast media leakage, faint shadow to the distal branch artery of embol ic level, and significant increase of blood pressure of the bleeding artery, indicating the embol ization was successful. No active hemorrhage was evident in the wounds 48 hours after AE. For the 6 patients with hemorrhagic shock, obvious decrease of hemorrhage was observed after AE, gradual recovery of blood pressure and vital signs, and stabil ity of their condition were evident after supportive therapy. During the first 24 hours after AE, total volume of infusion was 6 750-19 600 mL (average 8 740 mL), and total volume of blood and plasma transfusion was 1 800-6 400 mL (average 3 500 mL). In 6 cases, contrast-enhanced spiral CT scan demonstrated faint shadow of the distal artery without contrast media leakage, and three-dimensional CT angiography showed collapse of the distal artery; in the rest 5 cases, contrast-enhanced spiral CT scan demonstrated shadow of the distal artery without contrast media leakage, and three-dimensional CT angiography displayed the full-fill ing of distal artery with obviously decreased vascular cavity. No severe compl ications such as muscle necrosis in the buttock and hip, bladder necrosis,dysuria, fecal incontinence, and impotence occurred. Conclusion The transcatheter AE is a safe, fast, effective and miniinvasive method of controll ing massive haemorrhage from large wound caused by crush syndrome after Wenchuan earthquake.
ObjectiveTo review the research progress of treatment for massive rotator cuff tears. MethodsThe domestic and foreign literature about the treatment of massive rotator cuff tears was reviewed. The methods and effectiveness were extensively summarized.ResultsThe treatment of massive rotator cuff tears still needs long-term research to promote its continuous improvement. The main goal of treatment is to relieve the symptoms and improve the shoulder joint function. With the development of arthroscopic technique, arthroscopic repair of rotator cuff tears has become a mature surgical protocol. Among these techniques, superior capsule reconstruction and patch augmentation for massive rotator cuff tears acquire more attention in recent years. As for rotator cuff arthropathy, reverse shoulder arthroplasty is considered to be a final choice. ConclusionSurgical treatment is the main choice for massive rotator cuff tears. Patients’ age and muscle condition should be taken into consideration to decide the surgical technique.