Objective To investigate the cl inical appl ication effect of the new bone harvester. Methods Between August 2006 and October 2009, 112 patients underwent autogenous il iac bone graft and were followed up. There were 71 males and 41 females with a median age of 42 years (range, 11-71 years), including 45 cases of comminuted fracture of the l imbs, 47cases of bone nonunion, and 20 cases of benign bone tumor. According to different methods of bone harvesting, the patients were divided into 5 groups: group A (n=32, with new bone harvester), group B (n=29, with tricortical bone harvester), group C (n=15, with internal lamina harvester), group D (n=23, with external lamina harvester), and group E (n=13, with bicortical il iac bone by saw). There was no significant difference in general data of 5 groups (P gt; 0.05). The incision length, operation time, and peri-operative bleeding volume were compared. At 4 days, 7 days, 60 days, and 1 year postoperatively, the pain degree was assessed using visual analogue scale (VAS), and the incidence rates of peri pheral nerve injury, fracture, haematoma, ventral hernia, il iac crest sag, and chronic pain were observed. Results The incision length and the operation time in group A was shorter than those in other groups, the peri-operative bleeding volume in group A was less than in other groups, the VAS in group A was the lowest among 5 groups, showing significant differences (P lt; 0.05). The occurrence rates of chronic pain and il iac crest sag in group A were lower than those in group B, showing significant differences at 1 year after operation (P lt; 0.01). There was no significant difference in the incidence rates of peripheral nerve injury, fracture, haematoma, ventral hernia, il iac crest sag, and chronic pain between group A and groups C, D, E (P gt; 0.05), and in the incidence rates of peri pheral nerve injury, fracture, haematoma, and ventral hernia between group A and group B (P gt; 0.05). The total compl ication in group A was the lowest among 5 groups, showing significant difference (P lt; 0.05). Conclusion The new bone harvester is minimally invasive bone harvester,which has the advantages of short operation time and incision length, less bleeding volume, low VAS and complications.
Objective To compare the therapeutic effect of new “One-Stitch” ureterovesical anastomosis to that of the classic Lich-Gregoir method. Methods From January 2002 to December 2004, 445 patients suffering from uremia due to chronic nephritis were treated with renal transplantation. Among them, 121 patients were operated with our new modified ureteroneocystostomy technique (the new One-Stitch group), and 324 patients were operated with Lich-Gregoir technique (the Lich-Gregoir group). In the new One-Stitch group, there were 79 males and 42 females, aged 20-62 years (35.7 years on average). The course of the disease was 2-11 years (2.7 years on average). In the Lich-Gregoir group, there were 211 males and 113 females, aged 19-65 years (33.9 years on average). The disease course was 1-14 years (2.3 years on average). There was no significant difference between the two groups in age, proportion of genders, primary diseases and course of the disease (P gt; 0.05). The operative time, the ureteral compl ications and non-ureteral compl ications were compared between the two groups after the renal transplantation. Results The operative time for the new One-Stitch and Lich-Gregoir techniques was (8.7 ± 1.1) minutes and (22.4 ± 5.1) minutes, indicating the difference was significant (P lt; 0.05). All recipients were followed up for 3-5 years. In the new One-Stitch group, there were 5 patients with leakage of urine, 15 with gross hematuria, 4 with ureteral obstruction and 28 with urinary system infection. Symptomatic vesicoureteral reflux and stone formation were not observed in this group. In the Lich-Gregoir group, there were 17 patients with leakage of urine, 12 with gross hematuria, 13 with ureteral obstruction, 86 with urinary system infection, 6 with symptomatic vesicoureteral reflux and 2 with stones. In the new One-Stitch group, the incidence rate of compl ications of gross hematuria was 12.4%, which was significantly different from 3.7% in the Lich-Gregoir group (P lt; 0.05). The incidence rates of ureteral compl ications in the Lich-Gregoir and the new One-Stitch groups were 19.8% and 15.4%, respectively. The difference was not significant (P gt; 0.05). There was no significant difference between the two groupsin incidence rate of urinary system infection, delayed recovery of kidney function after kidney transplantation and rejectionreaction (P gt; 0.05). Conclusion The new One-Stitch group has no significant difference in ureteral compl ications ompared with the Lich-Gregoir group, and has become a preferential ureterovesical reimplantation technique because of its simple and has convenient operation.
Objective To investigate the causes and managements of acetabular fracture during primary total hip arthroplasty (THA). Methods Between May 2005 and July 2008, 9 patients (9 hi ps) suffered from acetabular fractures during primary THA. There were 1 male and 8 females with an average age of 63.3 years (range, 41-73 years), including 4 cases of developmental dysplasia of the hip, 2 cases of rheumatoid arthritis, 1 case of old femoral neck fracture, 1 case of avascular necrosis of femoral head, and 1 case of ankylosing spondyl itis. Three left hips and 6 right hips were involved. The preoperative Harris score was 40.4 ± 2.9. All the patients underwent cementless THA. Among nine acetabular fractures, 8 fractures were stable (2 anterior wall fractures and 6 posterior wall fractures), which were fixed by additional augmentation screws in 7 cases and accepted no special treatment in 1 case; 1 fracture was unstable (posterior wall fracture with posterior column incomplete fracture), which was treated by bone grafting and additional screws. Results The postoperative X-ray films showed that the position of the prosthesis were favorable. All incisions healed by first intention without early compl ication. Nine patients were followed up 1-4 years (mean, 2 years and 7 months). The Harris score was 87.8 ± 3.9 at last follow-up, showing significant difference when compared with the preoperative score (t=44.904, P=0.000). The X-ray films showed fracture heal ing at 8 weeks. No loosening occurred. Conclusion When primary THA is performed, the preoperative X-ray film should be studied and measured carefully, operation should be accurate and violence should be avoided. The diameter of the acetabular component should be equal to the diameter of a drill or not larger than 2 mm. In patients with severe osteoporosis, the diameter of the acetabular components should be the same diameter as a drill and additional screws are used to fix, or cemented cup is used. Once an acetabular fracture occurs during the primary THA, additional screw or bone grafting with additional screws should be chosen according to the fracture type and stabil ity, and good cl inical results can be expected.
Objective To analyze the causes and managing methods of long bone fracture nonunion after allogeneic bone transplantation. Methods From December 1995 to December 2000, 43 cases of postoperative nonunion of long bone fracture were treated. These cases included 31 males and 12 females at the age of 19-57 years (40 years on average). The locations were femur in 11 cases, tibia in 21 cases, humerus in 8 cases and forearm in 3 cases. Bone nonunionafter allogeneic bone transplantation was caused by extensive soft tissue contusion and poor cover around bone fractue site in 6 cases, by incomplete debridement in 8 cases of osteomyel itis (including 6 without continual lavage and 4 only skin flap transfer), by secondary infection of wounds in 3 cases, by severe primary injury or secondary scar covering bone in 12 cases, instable internal fixation in 7 cases, and by earl ier weight bearing in 7 cases. Accroding to Weber classification, there were 4 cases of hypertrophic type and 39 cases of atrophic type. Basing on the type of nonunion, the methods such as refixation, bone retransplantation and transferring tissue flap were chosen to manage the cases. Results Incision healed by first intention in 37 cases, superficial infection occurred and cured after 2 weeks of dressing change in 5 cases, and sinus formed and cured after 2 months of dressing change and drainage in 1 case. All transferring tissue flap survived, and partial necrosis occurred at flap edge in 4 cases and cured after dressing change. All patients were followed up for 38-91 months with an average of 54.6 months. All the nonunion cases achieved bone union 5-11 months with an average of 7.6 months. But low extreme shorten monstrosity occured in 4 cases, malunion in 2 cases, functional l imitation near joints in 7 cases, and rotational l imitation of forearm in 1 case. Conclusion Fracture nonunion after allogeneic bone transplantation mainly shows atrophic type with overall or partial absorption of the allograft bone. The preconditions to guarantee fracture nonunion heal ing include stabil ity of fracture fixation, using transferring tissue flaps, controll ing infection, and adequate bone transplantion.
Objective To investigate the donor-site compl ications of the anterolateral thigh flap and its influencing factors. Methods Between July 1988 and July 2007, 427 patients were treated with anterolateral thigh flap. Among them, 33 patients had postoperative donor-site compl ications and their cl inical data were analyzed retrospectively. There were 21 malesand 12 females aged 14-47 years old (average 32.7 years old). The size of the wound defect ranged from 16 cm × 7 cm to 28 cm × 13 cm. The area of the flap harvested during operation ranged from 16 cm × 7 cm to 30 cm × 13 cm. The donor sites were treated by direct suture in 7 cases; free spl it-thickness skin graft in 23 cases, and reverse superficial epigastric artery flap repair in 3 cases. The size of graft in the donor site ranged from 10 cm × 5 cm to 18 cm × 8 cm. The occurrence of short-term (within 4 weeks) and long-term (over 6 months) compl ications were analyzed. Results All patients were followed up for 8-54 months (average 21 months). There were 26 patients (78.8%) with short-term and long-term compl ications and 7 patients (21.2%) with long-term compl ications. The short-term compl ications included skin graft necrosis in 23 cases (69.7%), wound infection in 17 cases (51.5%), and muscle necrosis in 2 cases (6.1%). The long-term compl ications included non-heal ing wounds in 21 cases (63.6%), serious scar in 28 cases (84.8%), discomfort in 25 cases (75.8%), and dysfunction of the quadriceps femoris in 16 cases (48.5%). Conclusion The occurrence of anterolateral thigh flap donor-site compl ications is related to the anatomical structure of the anterolateral thigh region, the surgical procedure, and the patient’s physique.
Objective To investigate the etiology, diagnosis, revascularization of upper l imb ischemia and the compl ications. Methods From March 2003 to February 2008, 72 cases of upper l imb ischemia were treated. There were 44males and 28 females, aged 19-90 years old (median 63 years old). The duration of the disease was 1 hour to 2 years. All cases had symptoms of l imb ischemia such as paleness, coldness, paralysis. According to individual condition, 72 patients accepted revascularizations including thromboembolectomy, reconstruction after traumatic injuries, pseudoaneurysm excision and angioplasty, balloon dilatation and stent implant, arterial repair, patch, vascular prosthesis or vein bypass/transplantation, and l igation or coarctation of fistula. Results Sixty patients (83.3%) recovered well after operation. Re-occlusion following thromboemboletomy was found in 6 patients (8.3%). And there were 4 patients (5.6%) with l imbs disturbance and muscles contracture and 2 patients (2.8%) with compartment syndrome in this series. The affected l imb had to be amputated in 2 patients (2.8%). And 1 patient (1.4%) died of cerebral hemorrhage because of anticoagulation 3 days after operation. All patients were followed up 1-6 years (mean 52 months) after operation. Four patients recurred and got improved after retreatments. The others got a good result with normal skin color and temperature, restoration of the radial and ulnar pulses, normal saturation of blood oxygen of finger ti p (gt; 90%) and patent blood flow of affected arteries was shown by color Doppler ultrasound. Conclusion The study indicates that identifying the etiology of upper l imb ischemia before operation and active revascularizations consistent with different causes are the key to treat the upper l imb ischemia.
Objective To summarize the experience of the prevention of early arterial compl ications after hepatic artery (HA) reconstruction in adult-to-adult l iving donor l iver transplantation (A-A LDLT). Methods Between January 2002and March 2008, 127 patients underwent A-A LDLT. Of the 131 donors (127 cases of right lobe graft, 4 cases of left lobe graft), there were 69 males and 62 females with a mean age of 36.2 years (range, 19-65 years); in 127 recipients, there were 109 males and 18 females with a mean age of 41.9 years (range, 18-64 years). All patients underwent microsurgical reconstruction of HA between grafts and recipients. The artery of graft was anastomosed to the right HA in 62 cases, to the proper HA in 34 cases, to the left HA in 7 cases, to the common HA in 6 cases, and aberrant right HA rising from superior mesenteric artery in 8 cases. Interposition bypass using great saphenous vein (GSV) was performed between the donor right HA and recipient common HA in 5 cases. Bypass was performed between the donor right HA and recipient abdominal aorta using GSV in 2 cases, or using cryopreserved cadaveric il iac vessels in 3 cases. Results Of these 127 cases, hepatic artery thrombosis (HAT) occurred in 2 recipients (1.6%) at 1 day and 7 days following A-A LDLT, which were successfully revascularized with GSV between right HA of donor and abdominal aorta of recipient, HAT in 1 patient occurred on the 46th postoperative day with no symptom. No other arterial compl ication such as HA stenosis and aneurysm occurred in recipients. All patients were followed up 9-67 months. At 1, 2, and 3 years, actual survival rateswere 82.2%, 64.7%, and 59.2%. No death was related to HA compl ication in peri-operative period. Conclusion The anatomic structure and variation of HA, the pathological changes, as well as surgical technique in HA reconstruction, have direct impact on the risk of postoperative compl ications of HA reconstruction.
Objective To explore a surgical method for chronic osteomyel itis of sternum after thoracotomy. Methods From January 2006 to February 2009, 11 cases of chronic osteomyelitis after thoracotomy (2 cases of coronary bypass, 6 cases of mitral valve replacement, and 3 cases of ventricular defect repair) were admitted. Of them, there were 6 males and 5females, aged from 6 to 62 years (median 34 years), including 6 cases of simple osteomyelitis of sternum, 2 cases of osteomyelitis of sternum with suppurative infection of mediastinum, and 3 cases osteomyel itis of sternum with costal chondritis. Necrotic sternum were excised and defect was from 4 cm × 3 cm to 7 cm × 4 cm. Greater pectoral muscle flap was designed from 8 cm × 5 cm to 10 cm × 6 cm on one side and was transferred to defect. Negative drainage and sensitive antibiotics were administered after operation. Results Healing by first intention was achieved in 10 patients except 1 patient who had a few discharge at the drainage outlet and whose incision healed 1 week later. The follow up was from 3 to 10 months with an average of 6 months. The formed scars were flat with soft texture in 8 patients and moderately hypertrophy in 3 patients. The wounds healed without pain, relapse or abnormal function of donor upper limb. Conclusion Transplantation of greater pectoral muscle flap is an effective way to repair chronic osteomyelitis of sternum after thoracotomy.
Objective To compare the difference of anterior knee pain between mobile-bearing prosthesis and fixedbearing prosthesis after total knee arthroplasty (TKA). Methods Between January 2008 and October 2008, 72 patients withosteoarthritis were treated with primary TKA. All patients were randomly divided into fixed-bearing prosthesis group (n=37)and mobile-bearing prosthesis group (n=35). In fixed-bearing prosthesis group, there were 8 males and 29 females with an average age of 69.6 years (range, 57-76 years), weighing from 55 to 92 kg (mean, 66.7 kg); the locations were the left knee in 20 cases and the right knee in 17 cases; the body mass index (BMI) ranged from 17.6 to 37.3 (mean, 26.2); the disease duration was 3-22 years; the Knee Society Score (KSS) knee score, function score, patellar score, and pain score were 29.4 ± 15.3, 33.4 ± 16.8, 7.2 ± 2.5, and 2.5 ± 2.2, respectively; and the Insall-Salvati (I-S) index was 1.6 ± 0.3. In mobile-bearing prosthesis group, there were 9 males and 26 females with an average age of 68.2 years (range, 58-73 years), weighing from 50 to 86 kg (mean, 67.9 kg); the locations were the left knee in 30 cases and the right knee in 5 cases; the BMI ranged from 18.4 to 34.4 (mean, 25.6); the disease duration was 6-18 years; the KSS knee score, function score, patellar score, and pain score were 30.9 ± 14.7, 31.4 ± 14.4, 6.8 ± 3.1, and 2.0 ± 2.3, respectively; and the I-S index was 1.6 ± 0.2. There was no significant difference in general data between 2 groups (P gt; 0.05). Results All incisions healed by first intention; no deep vein thrombosis of lower l imbs or pulmonary embol ism occurred. All patients were followed up 12-16 months. In mobile-bearing prosthesis group, knee infection occurred in 1 case, dislocation of the knee in 1 case, and cl icking of the knee in 3 cases; in fixed-bearing prosthesis group, cl icking of the knee occurred in 1 case. There was no significant difference in KSS knee score, function score, patellar score, or pain score between 2 groups (P lt; 0.05) at last follow-up; and there was no significant difference in congruence angle, lateral patellofemoralangle, patellar tilt angle, lateral patellar displacement, patellar displacement, or I-S index between 2 groups at last follow-up (P gt; 0.05). Anterior knee pain occurred in 7 cases (18.9%) of the fixed-bearing prosthesis group and in 5 cases (14.3%) of the mobilebearing prosthesis group, showing no significant difference (χ2=0.227, P =0.634). There were significant differences in KSS knee score, function score, patellar score, and I-S index between patients with anterior knee pain and patients without anterior knee pain (P lt; 0.05). Conclusion Fixed-bearing prosthesis and mobile-bearing prosthesis have the same short-term effectiveness and the incidence of anterior knee pain.
Objective To compare the early compl ications of carotid stenting (CAS) and carotid endarterectomy (CEA) in treatment of carotid artery stenosis. Methods Between January 2005 and December 2007, 63 patients with carotid artery stenosis were treated with CEA in 36 cases (CEA group) and with CAS in 27 cases (CAS group). There were 42 males and 21 females with an average age of 67.5 years (range, 52-79 years). The locations were the left side in 28 cases and the rightside in 35 cases. The carotid stenosis was 60%-95% (mean, 79%). The major cl inical symptoms were stroke and transient ischemic attack. The cranial CT showed old cerebral infarction in 24 cases, lacunar infarction in 22 cases, and no obvious abnormal change in 17 cases. The encephalon, heart, and local compl ications were compared between 2 groups within 7 days after operation. Results In CEA group, encephalon compl ications occurred in 3 cases (8.3%), heart compl ications in 2 cases (5.6%), and local compl ications in 5 cases (13.9%); while in CAS group, encephalon compl ications occurred in 8 cases (29.6%), heart compl ications in 1 case (3.7%), and local compl ications in 3 cases (11.1%). The encephalon compl ication ratio of CAS group was significantly higher than that of CEA group (χ2=4.855, P=0.028); and there was no significant difference in other compl ications ratios between 2 groups (P gt; 0.05). Conclusion CEA is the first choice to treat carotid artery stenosis.