Correction osteotomy of distal radius malunion stabilised with dorsal locking plates without grafting

The purpose of this study was to evaluate the results of our correction osteotomies of distal radial malunions without a bone graft. Eleven consecutive patients (mean age 52 years, range 18–71) were treated. A dorsal approach was utilised to perform an opening-wedge osteotomy which then was stabilised with two dorsal columnar plates without filling the osteotomy gap. All patients went on to radiographic union with a filling of the osteotomy gap within a mean period of 3 months (range 2–6 months). All patients had satisfactory results in terms of function and pain. Correction osteotomy and stabilisation with bicolumnar locked plate fixation without a bone graft provides sufficient stability to allow the highly vascularised metaphysis to heal. In patients without risk factors predisposing to non-union, this procedure is safe and feasible.     

Influence of cerclages on primary stability of tumor megaprostheses subjected to distal femur defects

BackroundPurpose of this experimental study was to investigate the influence of cerclages on the primary stability of the MUTARS^® system using distally fractured synthetic femora.Methods4 MUTARS^® prostheses were implanted in synthetic femora respectively. Groups consisted of 4 intact bones, 4 fractured with cerclages and 4 fractured bones without cerclages. Spatial micromovements were measured with a high-precision rotational setup.FindingsThe order from the weakest to the strongest torque transmission of the intact bones was rm₁-rm₄-rm₂-rm₃ (p = 0.011) and of the fractured bones with cerclages rm₄-rm₁-rm₃-rm₂ (p = 0.013). The MUTARS^® stems broke out of the fractured femoral shaft by removing cerclages (p < 0.001) and by the influence of bone defect A (p < 0.001). Overall micromovements of the intact bones were lower than those of the fractured bones without cerclages (p < 0.001) and overall micromovements of the fractured bones with cerclages were lower than those of bones without cerclages (p < 0.001).InterpretationDue to high press-fit at the proximal and distal isthmus region fissural fractures of the femur may occur. This should always be taken into account. It is advisable to secure them and provide a prophylaxis for these fissural fractures by means of cerclages.     

胃大部切除术后合并胆汁瘘7例教训分析

目的通过回顾性分析胃大部切除术后并发胆汁瘘的患者资料，总结临床经验。方法本院7例行毕罗I式胃大部分切除术的患者术后第1—5天并发胆汁瘘，根据患者临床体征及腹部超声检查诊断为胆汁瘘，行胆囊切除胆肠Roux—en—Y吻合术。结果所有患者平均住院（19．2±3．7）d后痊愈出院，无一例患者死亡。结论胃大部切除术操作较为复杂，因此掌握手术适应证、优化手术技术、术后定期胃镜检查，早期发现并治疗并发症可避免发生严重不良后果。     

Gut microbiota after Roux‐en‐Y gastric bypass and sleeve gastrectomy in a diabetic rat model: Increased diversity and associations of discriminant genera with metabolic changes

Recent work with gut microbiota after bariatric surgery is limited, and the results have not been in agreement. Given the role of the gut microbiota in regulating host metabolism, we explored the effect of Roux‐en‐Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on the modifications of gut microbiota with regard to the potential influence of food intake and/or weight loss and examined their links with host metabolism. Zucker diabetic fatty rats were divided into the following groups: RYGB; sham‐operated with pair‐fed as RYGB; sham‐operated fed ad libitum ; and SG. The metabolic effects and gut microbiota profile were analyzed 10 weeks postoperatively. Associations between discriminating genera and metabolic markers after RYGB were explored. The 2 procedures induced similar glucose improvement and increased flora diversity after 10 weeks compared with sham‐operated groups. RYGB induced a marked higher relative abundance of Proteobacteria/Gammaproteobacteria and Betaproteobacteria and increased emergence of Fusobacteria and Clostridium, whereas SG resulted in more abundant Actinobacteria compared with other groups. Most of the 12 discriminant genera correlated with changes in metabolic phenotype, but only 28.6% of these correlations were independent of weight, and 4 discriminant genera still negatively correlated with serum insulin level independent of food intake and weight loss after RYGB. These data demonstrate that RYGB and SG surgery produced similar diversity but different microbiota compositions changes in Zucker diabetic fatty rats. These findings stimulate deeper explorations of functions of the discriminate microbiota and the mechanisms linking postsurgical modulation of gut microbiota and improvements in insulin resistance.     

胃癌全胃切除术后肠内营养支持的护理效果分析

目的探讨分析胃癌全胃切除术后肠内营养支持的护理效果。方法选取2013年3月~2014年3月到我院进行胃癌全胃切除术患者共60例,按照随机方法分成观察组和对照组,每组30例。观察组实施肠内营养,对照组患者实施肠外营养,观察患者血总蛋白、白蛋白及血红蛋白三个营养指标的变化。结果两组患者在治疗前TP、Alb、Hb水平差异无统计学意义(P0.05),治疗一周后,两组患者的TP、Alb、Hb水平均明显高于治疗前,且观察组的上升幅度显著高于对照组,差异均有统计学意义(P0.05)。结论胃癌全胃切除术后肠内营养支持不仅可以给患者提供营养,还可以促进肠道功能的快速恢复,降低并发症发生率,有利于患者的早日康复。