Primary spinal primitive neuroectodermal tumor: A single center series with literature review

Context: Primary spinal primitive neuroectodermal tumor (PNET) of the central nervous system has a low incidence. The intraspinal case is very rare. Around 30 cases have been reported so far. We summarized the cases of primary spinal PNET available in the database of our institute, either intramedullary or extramedullary cases. Then we did literature review of the same disease.Findings: There were eight cases of primary spinal PNET available in our database, with one intramedullary case and seven extramedullary cases. Surgical resection was performed. The histology diagnosis was PNET. Peri-operative image examinations of the whole central nervous system (CNS) were performed to exclude tumors other than spinal cord origin. Then during literature review, 33 reports of the disease were included. The pre-operative diagnosis rate was low. The disease had a high recurrence rate and poor prognosis given available treatment.Conclusion: Primary spinal primitive neuroectodermal tumor is of high malignancy. Little is known due to its quite low incidence. The prognosis is poor due to lacking of effective treatment strategy. Present treatment strategy is referred to other common CNS malignancies like glioma. Further investigation of the disease is necessary.     

锁定钢板联合带锁髓内钉治疗胫骨多段骨折

正2008年2月~2014年7月,我科采用锁定钢板联合带锁髓内钉治疗22例胫骨多段骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组22例,男13例,女9例,年龄25~64岁。均为闭合骨折,多节段骨折。12例为胫骨上段并胫骨中段骨折,10例为胫骨平台并胫骨中段骨折。受伤至手术时间为2~17 d。1.2治疗方法硬膜外麻醉。膝关节外侧入路,弧形切口,长约5 cm,胫骨骨     

Investigation of perioperative hidden blood loss of unstable intertrochanteric fracture in the elderly treated with different intramedullary fixations

ObjectiveOur aim was to investigate perioperative hidden blood loss (PHBL) of unstable intertrochanteric fracture (UIF) in the elderly treated with different intramedullary fixations.Patients and methods120 consecutive elderly patients with UIF treated by intramedullary nails between January 2013 and September 2016 were enrolled in the retrospective study, including 52 patients (mean age 79.6 ± 6.3) for the Third generation Gamma Nail (TGN), 51 patients (mean age 79.3 ± 7.4) for the Proximal Femoral Nail Anti-rotation (PFNA), 17 patients (mean age 76.2 ± 5.8) for the Intertrochanteric Antegrade Nail (InterTan). The PHBL and total blood loss (TBL) were calculated based on the haematocrit change from admission to 72 h after the operation. The differences of perioperative visible blood loss (PVBL), PHBL, and TBL among TGN, PFNA, and InterTan were compared. The statistical analysis was made using One-way ANOVA for comparison among groups, and Mann-Whitney U test was conducted to a direct comparison between two procedures.ResultsThe mean TBL of all patients was 911.3 mL (range, 446.8-1697.3 mL), whereas the mean PHBL was 771.8 mL (range, 331.5–1756.5 mL), being about 84.5% of TBL. The PVBL in the TGN group was 201.4 ± 101 mL, the TBL was 871.3 ± 196.1 mL, the PHBL was 709.4 ± 181 mL. In the PFNA group, the PVBL was 147.3 ± 81.6 mL, the TBL was 892.6 ± 234.8 mL, and the PHBL was 787.7 ± 250.9 mL. The InterTan group had a PVBL of 246.5 ± 89.7 mL, the TBL was 1086.1 ± 198.1 mL where the PHBL was 910 ± 167.9 mL. The patients in the InterTan group had the largest amount of PHBL and TBL among three groups (P < 0.01), there was no difference between TGN and PFNA group (P = 0.2141).ConclusionsElderly patients with UIF treated by intramedullary fixations always have a significant amount of PHBL, which is much greater than that observed intra-operatively. Regular perioperative measurements of full blood count are necessary to avoid anaemia. InterTan nail is associated with a significantly higher PHBL than that of TGN and PFNA, which needs to be monitored carefully in usual clinical practice.     

髓内钉和钢板治疗肱骨近端骨折的Meta分析

目的比较髓内钉和钢板两种内固定治疗肱骨近端骨折的安全性、有效性及差异性。方法计算机检索Pub Med、CENTRAL、EMbase、the ISI Web of Knowledge Databases、VIP、CNKI、CBM和万方数据库,查找所有比较髓内钉和钢板钢板治疗肱骨近端骨折的随机对照试验(RCT)及临床对照试验(CCT),检索时限均为建库至2015年12月31日。同时手检纳入文献的参考文献。按纳入排除标准由两人独立进行筛选、资料提取和质量评价后,采用Rev Man5.3软件进行Meta分析。结果共纳入14个研究,1010例患者。Meta分析结果显示:与钢板相比,髓内钉治疗手术时间更短[MD=-23.04,95%CI(-28.47,-17.60),P0.1]、术中出血量较少[SMD=-3.14,95%CI(-4.21,-2.08),P0.1]、骨折愈合时间更短[SMD=-3.03,95%CI(-3.77,-2.28),P0.1],总的并发症无统计学意义[RR=0.38,95%CI(0.25,0.57),P=0.24];然而,ASES评分显示钢板组优于髓内钉组[SMD=-0.63,95%CI(-0.98,-0.28),P0.1],Costant-Murley评分差异无统计学意义[SMD=-0.05,95%CI(-0.21,0.11),P0.1],末次随访时颈干角差异无统计学意义[MD=0.09,95%CI(-0.22,0.40),P0.1],末次随访时Neer征差异无统计学意义[RR=0.51,95%CI(0.25,1.03),P0.1]。结论本系统研究发现,总体而言,治疗肱骨近端骨折时,髓内钉优于钢板。但这一结论仍然需要大样本、高质量的研究及采用关键性指标,进行进一步的论证。     

股骨近端抗旋髓内钉治疗老年股骨转子间骨折

正2014年6月~2015年6月,我科采用股骨近端抗旋髓内钉(PFNA)治疗24例老年股骨转子间骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组24例,男9例,女15例,年龄60~85(69.6±5.7)岁。骨折按Evans-Jensen分型:Ⅰ型2例,Ⅱ型5例,Ⅲ型11例,Ⅳ型6例。入院至手术时间2~10(6±2.3)d。1.2治疗方法患者入院后予以患肢股骨髁上牵引,早期行低分子肝素皮下注射结合患肢主动踝泵锻炼,高血压、高血糖患者术前调整血压、血糖等。手术采用全身麻醉或腰硬联合麻醉。在C     

Treatment of ingrown nail with a special device composed of shape‐memory alloy

Ingrown nail is a common nail problem resulting in pain and disability in daily life. Recently, a new treatment modality for an ingrown nail was reported that used a device composed of shape‐memory alloy, K‐D. The aim of the present study was to determine the efficacy, recurrence rate and complications of K‐D. Between June 2010 and September 2012, 24 patients (31 nails) underwent treatment of symptomatic incurved nails with a K‐D. Patients were evaluated at pretreatment and during every visit. The mean age of the patients involved was 43.4 years. The mean period of follow up was 161 days. The mean maintenance period was 41 days. The right first toenail was the most common site. Almost ingrown nails healed and the nail deformity was corrected after the procedure. Among the 31 nails, seven of the ingrown nails recurred during follow up (22.6% recurrence rate). The recurrence rate of the patients with stage 1, 2 and 3 ingrown nails was 22.2%, 33.3% and 14.2%, respectively. The majority of patients were very satisfied. There were no side‐effects in most patients except loss of nail in one patient. K‐D has some advantages such as simple application steps, no deformity after the procedure, high patient satisfaction and obvious effect compared to other non‐invasive and invasive methods.     

Surgical management of ingrown toenails – an update overdue

For decades, every year sees a wide number of articles about treatment of ingrown toenails. There is still a debate about the cause of this painful condition. Surgical treatments rely on two main approaches: either narrowing the nail plate or debulking the soft tissues. It is up to the surgeon to select the most appropriate approach in each case. All procedures cited in this article have high cure rates as long as they are properly performed. As with all surgical procedures, they are operator dependent. Chemical cautery is the easiest and most versatile technique that may help in almost all instances for lateral ingrowing. For distal embedding and very hypertrophic and exuberant lateral folds, debulking with secondary intention healing is the most effective and easy to perform, with great results.     

骨不连治疗的研究与技术应用进展*

背景：骨不连是骨折晚期常见的临床问题，数十年来，在各种新式内外固定材料、普及的显微外科技术、创新的植骨材料，尤其是分子生物学技术的全面帮助下，骨不连的治疗取得了突破性进展。
　　目的：总结骨不连治疗的研究进展，为以后更好地治疗骨不连提供技术理论和方法选择。
　　方法：由第一作者运用计算机检索系统检索1990年1月至2013年5月发表的有关骨不连原因及治疗方法的文献，以“fracture nonunion，treatment，progress”或“骨不连，治疗方法，进展”为检索词。同一领域则选择近期发表或者发表在权威杂志的文章。
　　结果与结论：排除重复性研究及时间跨度大的文献，从检索结果中共选择了48篇文章进一步分析。骨不连治疗手段主要有两种：非手术方式和手术方式，目前临床上以手术方式为主且高效。骨折愈合是多环节参与的复杂过程，一旦骨不连发生，应具体问题具体分析，根据患者的实际情况采取个体化治疗原则，重视软组织的保护，必要时联合运用多种手术及非手术方法，才能取得满意的疗效。