Influence of Tirofiban maintenance duration on patients with acute myocardial infarction treated by percutaneous coronary intervention

ObjectiveTo evaluate the efficacy and short term prognosis of Tirofiban in different treatment duration in patients with acute ST segment elevation myocardial infarction (STEMI) and percutaneous coronary intervention (PCI) combined with intracoronary injection.MethodsA total of 125 patients with acute STEMI were enrolled in this study. They were randomly divided into two groups: control group (n = 61) and Tirofiban group (n = 64). The Tirofiban was used by intracoronary and intravenous administration in Tirofiban group which was randomly divided into three sub-groups according to the duration of Tirofiban by persistent intravenous injection for 12 hours, 24 hours or 36 hours. Thrombolysis in myocardial infarction flow and myocardial perfusion grades were recorded immediately after PCI. The adverse cardiac events and cardiac death within 180 days of PCI, and the adverse effects (hemorrhage and thrombocytopenia) were compared between the two groups and within Tirofiban sub-groups.ResultsGrade 3 in myocardial perfusion was significantly better in Tirofiban group than control group (85.94% vs. 72.13%, P = 0.03) after PCI. There was one cardiac death in control group in 180 days after PCI. The adverse cardiac event rates between two groups was significant difference (16 patients in control group and only 8 in Tirofiban group, P = 0.047). There was no significant difference in incidence of hemorrhage complications and platelet counts between two groups. Nevertheless, hemorrhage complications in the 12- and 24-hour subgroups were less than 36-hour subgroup (P = 0.01).ConclusionsIntravenous Tirofiban treatment reduced the adverse cardiac events and improved short term prognosis without increasing the adverse reactions of the drugs in patients undergoing PCI. The less rate of hemorrhage complication can be achieved in short-duration of Tirofiban by intravenous injection after PCI.     

股骨近端防旋髓内钉与滑动加压髋螺钉治疗股骨粗隆间骨折临床分析

目的探讨股骨近端防旋髓内钉与滑动加压髋螺钉治疗股骨粗隆间骨折的临床效果。方法选取2011年3月至2014年3月本院收治的112例股骨粗隆间骨折患者为研究对象,按治疗方法不同分为治疗组(采用股骨近端防旋髓内钉治疗)和对照组(采用滑动加压髋螺钉治疗),每组各56例。比较两组患者治疗效果。结果两组患者优良率比较差异无显著性(P>0.05);两组Ⅰ、Ⅱ型稳定型骨折患者优良率比较差异无显著性(P>0.05);治疗组Ⅲ、Ⅳ、Ⅴ型不稳定型骨折患者优良率高于对照组(P<0.05)。结论股骨近端防旋髓内钉与滑动加压髋螺钉对Ⅰ、Ⅱ型稳定型骨折的治疗效果相当,但股骨近端防旋髓内钉对Ⅲ、Ⅳ、Ⅴ型不稳定型骨折的治疗效果明显优于滑动加压髋螺钉。     

股骨近端空心锁定板内固定治疗股骨颈骨折临床疗效观察

目的：：研究股骨近端空心锁定板内固定治疗股骨颈骨折的临床效果。方法：对2008年2月至2010年4月我院入院治疗的108例股骨颈骨折患者进行了研究，随机分为两组，对照组给与空心钉进行治疗，观察组采用股骨近端空心锁定板内固定治疗，比较两组治疗方案的手术时间、出血量、住院时间以及下床时间，比较两组治疗方案的手术并发症发生率，并比较两组患者三年期临床疗效。结果：观察组患者手术出血量明显少于对照组，手术时间、住院时间以及下床时间明显短于对照组，两组比较差异明显，有统计学意义( P<0.05)；两组患者手术并发症均以疼痛、骨不连以及感染为主，其中观察组上述并发症的发生率为13.0％，明显低于对照组33.3％，两组比较差异有统计学意义( P<0.05)；观察组患者三年临床总有效率为79.6％，对照组患者三年期临床总有效率为51.9％，两组比较差异明显，有统计学意义( P<0.05)。结论：股骨近端空心锁定板内固定治疗股骨颈骨折临床效果显著，可以明显缩短手术时间以及住院时间，降低手术并发症，并且三年临床总有效率更高，值得临床推广应用。     

Technique Tip: Medial prominence bone spur resection in the third-generation percutaneous Chevron-Akin Osteotomy Technique (PECA) for hallux valgus correction

The third-generation percutaneous chevron and Akin osteotomy (PECA) technique for surgical management of hallux valgus has shown improvement in clinical and radiographic outcomes. During this procedure, lateral translation and fixation of the first metatarsal head results in the formation of a bony prominence on the medial side of the distal aspect of the first metatarsal which can cause pain and discomfort to the patient. We describe two techniques to address this bony prominence; either i) excision osteotomy and removal of the fragment or ii) a dorsal closing wedge osteotomy retaining the bony fragment.Level of EvidenceLevel V, expert opinion     

经皮肾镜碎石术与经输尿管镜（联合封堵器）碎石术治疗输尿管上段结石的临床比较

目的比较经皮肾镜碎石术（PCNL）与经输尿管镜（联合封堵器）碎石术（URL）治疗输尿管上段结石的疗效及安全性。方法回顾性分析93例输尿管上段结石患者的临床资料。根据手术方式不同将患者分为两组，A组（53例）采用PCNL治疗，B组（40例）采用URL联合封堵器治疗，比较两组患者在结石清除率、术中出血量、手术并发症发生率、住院时间及住院费用等方面的差别。结果两组患者一般资料比较均无统计学差异（均P＞0.05）。A组患者较B组结石清除率高（98.11%vs85.00%，P＜0.05），而术中出血量、住院时间、住院费用亦均高于B组（均P＜0.05）；两组患者手术并发症发生率比较，差异无统计学意义（P＞0.05）。结论PCNL及URL联合封堵器治疗输尿管上段结石各有优缺点；可根据医院实际情况（如器械条件）、术者习惯、患者意愿等情况选择术式。