A meta-analysis of total hip arthroplasty and hemiarthroplasty outcomes for displaced femoral neck fractures

Background

Total hip arthroplasty or hemiarthroplasty are used to treat displaced femoral neck fractures. However, the optimal treatment of these fractures remained controversial.

Objective

To assess the effects that compare total hip arthroplasty with hemiarthroplasty for the treatment of femoral neck fractures in the elderly.

Methods

We searched MEDLINE (January 1980 to 2010), EMBASE (January 1980 to 2010), and the Cochrane Library 2010; issue 1. Only prospective randomized controlled trials (RCTs) that compare total hip arthroplasty with hemiarthroplasty for the treatment of femoral neck fracture in the elderly were included. The analysis was performed with software RevMan5.0 from the Cochrane Collaboration.

Results

We identified seven relevant randomized controlled trials with a total of 828 participants. The meta-analysis showed relative risk of re-operation was 0.40 (95% CI?=?0.24–0.67, P?=?0.0004), the dislocation was 2.02 (95% CI?=?1.26–3.25, P?=?0.002), the mobility as functional outcome was 1.70 (95% CI?=?1.21–2.38, P?=?0.002). It was reported that the average operating room times and blood loss volumes in total hip arthroplasty were more than in hemiarthroplasty (P?Conclusions Total hip arthroplasty is associated with better functional outcome and lower reoperation rate than hemiarthroplasty in treatment of displaced femoral neck fractures in the elderly patients.     

Dynamic changes of indoleamine 2,3-dioxygenase of Kupffer cells in rat liver transplant rejection and tolerance

Aims

To study the dynamic changes and the immunologic role of indoleamine 2, 3-dioxygenase (IDO) in Kupffer cells (KCs) after rat liver transplantation.

Methods

Animals were randomly divided into two groups: a rejection group (REJ; LEW to BN) and a tolerance group (TOL; BN to LEW). Liver morphological changes were observed optically with hematoxylin/eosin staining. KCs were isolated from recipients. mRNA and protein expressions of IDO were detected by real-time polymerase chain reaction and Western blotting at 1, 3, 5, and 7 days after transplantation.

Results

The levels of IDO mRNA and protein in KCs of TOL groups were similar to those in REJ groups at day 1 posttransplantation. However, the expression of IDO mRNA and protein time-dependently increased to much higher levels in the TOL than the in REJ groups at 3, 5, and 7 days posttransplantation (P < .05). The peak was observed at 7 days.

Conclusions

The IDO level of KCs was closely associated with immune tolerance induction. IDO-mediated immune modulation appears to be an attractive means to assess transplant tolerance induction.     

腓骨近端肿瘤切除术后膝关节稳定性重建的临床研究

目的探讨腓骨近端肿瘤切除术后重建膝关节稳定性的方法及临床疗效。方法回顾分析2008年1月-2009年12月行近端腓骨切除并重建腓侧副韧带和股二头肌肌腱骨性止点的16例腓骨近端肿瘤患者(试验组)临床资料,与同期5例未行韧带骨性重建患者(对照组)进行比较。两组患者性别、年龄、病程、肿瘤发生部位等一般资料比较,差异无统计学意义(P>0.05),具有可比性。术后行膝外侧方应力试验;摄X线片测量关节间隙,与健侧比较间隙增大程度并分级;参照美国骨与软组织肿瘤协会(MSTS)功能评分标准对关节功能进行评分。结果术后两组切口均Ⅰ期愈合。两组采用MalawerⅡ型手术切除者均发生医源性完全腓神经功能丧失。患者术后均获随访,随访时间12～36个月,平均30个月。试验组中1例纤维母细胞性骨肉瘤患者发生局部复发,12个月后死于肺部及全身转移;其余患者肿瘤均无复发。末次随访时,试验组膝外侧方应力试验均为阴性,关节间隙增大分级为A级;对照组应力试验均为阳性,分级为D级。试验组MSTS评分为(97.5±3.5)分,对照组为(87.5±3.5)分,两组比较差异有统计学意义(t=2.85,P=0.01)。结论腓骨近端肿瘤切除术后重建腓骨近端腓侧副韧带及股二头肌肌腱的骨性附着点,恢复了膝关节稳定性,利于关节功能重建。     

封闭式负压引流联合反植皮一期闭合开放性创伤截肢创面的临床分析

目的对比观察封闭式负压引流技术(vacuum sealing drainage,VSD)联合反取皮和直接反取皮治疗开放性创伤截肢创面的疗效。方法 2005年3月-2010年6月,应用随机单盲法对收治的60例四肢开放性骨折截肢患者分别采用一期VSD联合反取中厚皮片植皮(试验组,30例)与一期单纯反取中厚皮片植皮覆盖截肢创面(对照组,30例)治疗。两组患者性别、年龄、致伤原因、截肢部位、皮肤缺损面积、术前白蛋白指数及受伤至就诊时间等一般资料比较差异均无统计学意义(P>0.05)。试验组截肢后剪除多余残肢皮肤应用皮鼓取皮制成中厚交错筛网状皮片,植于截肢创面,表面用VSD覆盖,24 h不间断吸引持续7～10 d;对照组截肢后直接行反取中厚皮片覆盖创面,术后常规换药。结果试验组患者于术后平均8 d去除VSD装置。试验组皮片存活率(90.0%)、创面感染率(3.3%)及再截肢率(0)、换药次数[(2.0±0.5)次]、住院时间[(12.0±2.6)d],均显著优于对照组[分别为63.3%、20.0%、13.3%、(8.0±1.5)次、(18.0±3.2)d],比较差异均有统计学意义(P<0.05)。两组患者均获随访,随访时间1～3年,平均2年。末次随访时,试验组瘢痕面积、瘢痕分级及创面两点辨别觉均优于对照组,差异有统计学意义(P<0.05)。两组患者残肢均未见明显肿胀;术后试验组患肢疼痛发生率、残肢长度均优于对照组(P<0.05),而患肢残端形状比较差异无统计学意义(P>0.05)。两组残肢与健侧相比较,均存在肌肉废用性萎缩、肌力下降,各组健侧与患侧肌力比较差异均有统计学意义(P<0.05),但两组患侧间比较差异无统计学意义(P>0.05)。结论与单纯反取中厚皮片比较,VSD联合反取中厚皮片能够一期关闭截肢创面并对创面进行引流,降低感染发生,促进皮片与创面良好贴附,提高了皮片存活率,降低了截肢平面,利于假肢佩戴,是一期处理截肢创面的理想方法之一。     

Timing of transesophageal echocardiography in diagnosing patent foramen ovale in patients supported with left ventricular assist device

Left ventricular assist devices unload the left ventricle and decrease left atrial pressure. This hemodynamic change may cause a right to left atrial shunt and hypoxemia in patients with patent foramen ovale. We prospectively studied the best time for performing diagnostic transesophageal echocardiography in left ventricular assist device patients. Intraoperative transesophageal echocardiography was performed in 14 patients before cardiopulmonary bypass was initiated and after left ventricular assist device was implanted. No patent foramen ovale was detected when transesophageal echocardiography was done before bypass, but a patent foramen ovale was found in 3 patients when transesophageal echocardiography was performed after left ventricular assist device was activated. Patent foramen ovale was confirmed by inspection in all three patients and surgically closed during the same procedure. There were no patent foramen ovale closure-related complications.     

一次性和反复性力竭运动后不同时相大鼠心肌Kir6.1的表达

目的:探讨力竭运动后不同时相大鼠心肌Kir6.1基因表达的变化特点.方法:健康雄性SD大鼠80只,分为一次力竭游泳运动组和2周反复力竭游泳运动组及相应安静对照组.依据Thomas实验方案,建立不同程度的运动性心肌微损伤实验动物模型.力竭运动后,分时相取材,采用RT-PCR定量反转录方法分析心肌离子通道亚基Kir6.1在mRNA表达水平的变化.结果:(1)一次性力竭运动和反复力竭运动后24小时,心房肌中Kir6.1基因表达均显著下降(P＜0.05).(2)一次性力竭运动和反复力竭运动后4、12、24小时,心室肌中Kir6.1基因表达均显著升高(P＜0.01).结论:(1)力竭运动后,心室肌Kir6.1基因的表达水平总体呈上调变化,心房肌Kir6.1基因的表达水平在运动后24小时呈下调变化.(2)心室肌Kir6.1基因表达的上调对运动心肌有保护作用,而心房肌Kir6.1基因表达下调是心房肌易损伤的机制之一.     

Establishment and evaluation of bone mineral density reference databases appropriate for diagnosis and evaluation of osteoporosis in Chinese women

 This study was designed to establish Bone Mineral Density (BMD) Reference Databases for multiple skeletal sites appropriate for the diagnosis and evaluation of osteoporosis (OP) in Chinese women. We recruited 2702 healthy Chinese women, 5–96 years of age, for BMD assessment. BMD values at multiple skeletal sites including anteroposterior (AP) and lateral (Lat) lumbar spine, hip, and forearm were measured by dual-energy X-ray absorptiometry (DXA) using a QDR 4500A device; results were analyzed according to age group using eight regression models. BMD Reference Databases (CWD) were established according to the best regression equation and compared with Hologic reference databases for “Oriental Women” (OWD). Results indicated that the cubic regression model was superior to the quadratic, linear, logarithmic, and exponential regression models, etc. for our purpose, with a determinate coefficient (R ²) of 0.363–0.650 (P = 0.000). We included 1636 female patients, aged 35–86 years, in our tests. In comparison with Hologic Reference Databases, the mean detection rate of OP in the newly established BMD Reference Databases for Chinese Women (CWD) was 16.0% ± 2.68% lower (range, 13.7%–20.5%) at the AP spine, 16.8% ± 11.0% lower (range, 3.5%–32.8%) at the Lat spine (except for L4), 18.7% ± 4.6% lower (range, 12.6%–24.2%) at the hip, and 14.3% ± 6.9% higher (range, 4.7%–24.3%) at the forearm. The difference in detection rates for OP was significant between the two reference databases (P = 0.000), which was consistent with the differences in peak BMD values and the biological variability between them. Based upon our data, we confirmed that the Hologic BMD Reference Databases for Oriental Women (OWD) were not suitable for the diagnosis of OP in Chinese women; the BMD Reference Databases for Chinese Women (CWD) established in this study would provide reliable diagnostic standards for detection of OP in the women of South China. Received: July 9, 2002 / Accepted: December 5, 2002 Offprint requests to: X.-P. Wu     

The clinical observation of difficult laryngoscopy and difficult intubation in infants with cleft lip and palate

BACKGROUND: The aims of this study were to evaluate the incidence of difficult laryngoscopy in infants with cleft lip and palate and to observe its relationships with age, sites, and degrees of deformities. METHODS: A total of 985 infants aged 1 month to 3 years, undergoing repair of cleft lip and palate were included in this study. The infants suffering from unilateral cleft lip, simple cleft palate, and combined bilateral cleft lip and palate were 465, 421, and 79 respectively. They were divided into three groups according to age; 1-6 months group, 6-12 months group and 1-3 years group. RESULTS: The total incidence of difficult laryngoscopy was 4.77%. The incidence of difficult laryngoscopy was closely related to age, sites and degrees of deformities, and micrognathia. The incidence of difficult laryngoscopy was 7.06% in 1-6 months group, 2.90% in 6-12 months group, and 3.13% in 1-3 years group, and was greatest for infants with combined bilateral cleft lip and palate, less for those with left cleft lip and least for those with right cleft lip and simple cleft palate. The incidences of difficult laryngoscopy in infants with and without micrognathia were 50% and 3.83% respectively. The incidences of moderately difficult, difficult, and failed intubations were 1.02%, 0.91%, and 0.102% respectively. CONCLUSIONS: Infants with cleft lip and palate, left cleft lip and alveolus, combined bilateral cleft lip and palate, micrognathia, and age <6 months were the important risk factors for difficult laryngoscopy. Difficult intubation occurred mainly in infants with laryngoscopic views of grade III and IV.