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.     

一期病灶清除联合后路椎弓根内固定治疗胸腰椎布鲁杆菌病性脊椎炎

目的探讨布鲁杆菌病性脊椎炎有效的外科治疗方法及临床效果。方法 2002年1月-2010年10月,对78例具有手术指征的胸腰椎布鲁杆菌病性脊椎炎患者采用一期病灶清除联合后路椎弓根内固定治疗。男42例,女36例;年龄24～65岁,平均45岁。病程8～29个月,平均12个月。2个椎体受累70例,3个椎体受累8例。均合并不同程度神经功能损伤。术后随访行疼痛视觉模拟评分(VAS)、神经功能Frankel分级、临床疗效评价以及X线片、MRI影像学观察。结果术后78例均获随访,随访时间12～30个月,平均26个月。无窦道形成及复发。术前及术后1、3、6、12个月VAS评分分别为(9.2±0.6)、(2.4±0.3)、(1.0±0.2)、(0.5±0.4)及0分,术后各时间点均较术前显著改善(P<0.05)。术后各时间点神经功能Frankel分级均较术前显著改善,差异均有统计学意义(P<0.05),其中C、D级改善最为显著。临床疗效评价:术后12个月内均无加重患者;随时间推移,改善及无变化患者逐渐转向痊愈,术后12个月改善率和痊愈率分别为100%和91.03%。影像学评价:术前及术后1、3、6、12个月影像学盲测评价指标评分分别为(0.17±0.03)、(4.11±0.09)、(4.68±0.04)、(4.92±0.08)及5分,术后各时间点均较术前显著改善(P<0.05)。结论一期病灶清除联合后路椎弓根内固定治疗胸腰椎布鲁杆菌病性脊椎炎,在解除疼痛、稳定脊柱、恢复神经功能及早期康复方面均有明显优势。     

微创经椎间孔椎体间融合联合单侧椎弓根螺钉固定术治疗椎间盘源性腰痛

目的探讨微创经椎间孔椎体间融合(transforaminal lumbar interbody fusion,TLIF)联合单侧椎弓根螺钉固定术(unilateral pedicle screw fixation,UPSF)治疗椎间盘源性腰痛(discogenic low back pain,DLBP)的临床疗效。方法 2006年3月-2009年7月,采取微创TLIF联合UPSF治疗57例单节段DLBP患者。其中男27例,女30例;年龄38～61岁,平均45.6岁。病程9个月～11年。病变节段L2、32例,L3、45例,L4、529例,L5、S121例。记录手术时间、切口长度、术中出血量、术后引流量、住院时间、植骨融合率及手术并发症。采用Oswestry功能障碍指数(ODI)及疼痛视觉模拟评分(VAS)评估临床疗效,并根据造影剂诱发一致性疼痛压力大小及椎间盘封闭敏感性高低对患者手术疗效进行分组比较。结果患者手术时间(84.6±37.4)min,切口长度(3.4±0.6)cm,术中出血量(132.5±23.2)mL,术后引流量(58.7±21.4)mL,住院时间(6.5±0.8)d。患者均获随访,随访时间2年2个月～5年4个月,平均3.2年。末次随访时ODI及VAS评分均较术前明显改善(P<0.05);ODI评分改善率获优27例,良22例,可6例,差2例,优良率为86.0%;均获得坚强椎间融合。末次随访时,造影剂注射低压力敏感组的ODI及VAS评分优于高压力敏感组(P<0.05);椎间盘封闭高敏感组的ODI及VAS评分优于低敏感组(P<0.05)。结论微创TLIF联合UPSF治疗DLBP手术创伤小,对腰椎后部结构破坏小,并发症少,疗效确切,但必须严格掌握手术适应证;造影剂注射低压力敏感或椎间盘封闭高敏感患者手术疗效较好。     

C4副神经移位重建斜方肌功能的实验研究

目的探讨以C4神经前支主干作为动力神经移位修复副神经重建大鼠斜方肌功能的可行性,为临床用于副神经缺损的动力性修复提供理论依据。方法取36只成年雄性SD大鼠,体重200～250 g;随机分为实验组与对照组(n=18)。实验组左侧行C4副神经移位重建术,对照组左侧行副神经切除术;两组右侧不做任何处理,作为正常对照。术后1、2、3个月实验组行复合肌肉动作电位(compound muscle action potential,CMAP)及肌肉功能检测,计算潜伏期延迟率、最大波幅恢复率及肌张力恢复率;取两组斜方肌行HE染色,计算肌细胞截面积恢复率;取实验组神经吻合口远端神经行甲苯胺蓝染色,计算吻合口远端有髓神经纤维恢复率。并于术后1、3个月取实验组斜方肌及神经行透射电镜观察。结果随时间延长,实验组斜方肌CMAP最大波幅逐渐增加,潜伏期缩短,肌张力逐步恢复;神经吻合口远端有髓纤维逐渐增加。至术后3个月肩、背斜方肌CMAP最大波幅恢复率为63.61%±9.29%、73.13%±11.85%,潜伏期延迟率为130.45%±37.27%、112.62%±19.57%,肌张力恢复率为77.27%±13.64%、82.47%±22.94%,有髓纤维通过率为82.55%±5.00%。随神经支配恢复,实验组肌细胞截面积亦逐渐增大,且各时间点与对照组比较差异均有统计学意义(P<0.05)。术后1个月时斜方肌肌节排列紊乱,3个月时逐步趋于整齐。结论 C4副神经移位重建术可有效重建大鼠斜方肌的运动功能。     

Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) in Chinese patients with congenital bilateral absence of vas deferens

BackgroundGenetic testing of the cystic fibrosis transmembrane conductance (CFTR) gene is currently performed in patients with congenital bilateral absence of vas deferens (CBAVD). This study was conducted to investigate the role of mutations in the CFTR gene in CBAVD-dependent male infertility.Methods73 Chinese patients diagnosed with CBAVD were studied. The entire coding regions and splice sites of 27 exons of the CFTR gene were sequenced in 146 chromosomes from the 73 CBAVD patients. Screening was carried out using PCR, gel electrophoresis and DNA sequencing to identify novel variants of the entire coding regions and boundaries of the 27 exons.ResultsFive novel nonsynonymous mutations, three novel splice site mutations and one deletion were identified by sequencing. Apart from the novel variants, we also found 19 previously reported mutations and polymorphism sites. Thirty-four patients (46.57%) had the 5T variant (6 homozygous and 28 heterozygous) and in two of them it was not associated with any detectable mutation of the CFTR gene. All potential pathogenic mutations are not contained in the 1000 Genome Project database. In total, the present study identified 30 potential pathogenic variations in the CFTR gene, 9 of which had not previously been described.ConclusionsMost patients with CBAVD have mutations in the CFTR gene. A mild genotype with one or two mild or variable mutations was observed in all the patients. These findings improve our understanding of the distribution of CFTR alleles in CBAVD patients and will facilitate the development of more sensitive CFTR mutation screening.     

A comparative study on screw loosening in osteoporotic lumbar spine fusion between expandable and conventional pedicle screws

Introduction  

The aim of this study is to compare the rate of screw loosening and clinical outcomes of expandable pedicle screws (EPS) with those of conventional pedicle screws (CPS) in patients treated for spinal stenosis (SS) combined with osteoporosis.     

成人创伤后肘内翻畸形的矫形及双柱固定

目的探讨肱骨髁上截骨双钢板固定治疗成人创伤后肘内翻的方法及疗效。方法回顾性分析2007年6月-2010年12月手术治疗22例成人创伤后肘内翻畸形患者的临床资料。其中男16例,女6例;年龄18～29岁,平均21岁。既往均有肱骨髁上骨折病史;初次骨折后3个月～1年,平均6个月出现肘内翻畸形;出现畸形后4～17年,平均8年入院手术。术前患侧肘关节提携角为肘内翻16～25°,平均20.6°。肘关节功能采用Flynn评分均为差。术中行肱骨外侧闭合楔形截骨,以2块重建钢板塑形后分别置于肱骨内外侧柱以固定截骨断端。术后无需外固定,早期行功能锻炼。结果术后切口均Ⅰ期愈合。22例均获随访,随访时间6～24个月,平均13个月。末次随访时患侧肘关节提携角为肘外翻0～10°,平均7.5°。患者截骨处均骨性愈合,愈合时间8～13周,平均10周。术后无感染,神经、血管损伤,内固定物松动、断裂等并发症发生,无肘内翻复发。末次随访时Flynn评分优17例,良3例,中2例,优良率91%。结论采用肱骨髁上截骨加双钢板固定治疗成人创伤后肘内翻畸形,固定坚强,骨折愈合率高,术后能早期功能锻炼,肘关节功能恢复满意。     

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。     

Transient receptor potential vanilloid 1 activation enhances gut glucagon-like peptide-1 secretion and improves glucose homeostasis

Type 2 diabetes mellitus (T2DM) is rapidly prevailing as a serious global health problem. Current treatments for T2DM may cause side effects, thus highlighting the need for newer and safer therapies. We tested the hypothesis that dietary capsaicin regulates glucose homeostasis through the activation of transient receptor potential vanilloid 1 (TRPV1)-mediated glucagon-like peptide-1 (GLP-1) secretion in the intestinal cells and tissues. Wild-type (WT) and TRPV1 knockout (TRPV1(-/-)) mice were fed dietary capsaicin for 24 weeks. TRPV1 was localized in secretin tumor cell-1 (STC-1) cells and ileum. Capsaicin stimulated GLP-1 secretion from STC-1 cells in a calcium-dependent manner through TRPV1 activation. Acute capsaicin administration by gastric gavage increased GLP-1 and insulin secretion in vivo in WT but not in TRPV1(-/-) mice. Furthermore, chronic dietary capsaicin not only improved glucose tolerance and increased insulin levels but also lowered daily blood glucose profiles and increased plasma GLP-1 levels in WT mice. However, this effect was absent in TRPV1(-/-) mice. In db/db mice, TRPV1 activation by dietary capsaicin ameliorated abnormal glucose homeostasis and increased GLP-1 levels in the plasma and ileum. The present findings suggest that TRPV1 activation-stimulated GLP-1 secretion could be a promising approach for the intervention of diabetes.