ObjectiveTo investigate the effectiveness of the treatment under the guidance of “diamond concept” for femoral shaft fractures nonunion after intramedullary fixation.MethodsBetween January 2014 and December 2016, 21 cases of femoral shaft fractures nonunion after intramedullary fixation were treated with auxiliary plate fixation combined with autogenous iliac graft, and autologous bone marrow concentrate and platelet-rich plasma (PRP) gel under the guidance of the “diamond concept”. There were 13 males and 8 females, with an average age of 32.5 years (range, 17-48 years). All fractures were closed femoral shaft fractures. Four patients underwent internal fixation with plate and resulted in nonunion, then they were fixed with intramedullary nails, but did not heal either. The rest 17 patients were fixed with intramedullary nailing. Fracture nonunion classification: 4 cases of hypertrophic nonunion, 17 cases of atrophic nonunion; the length of bone defect was 1-3 mm; the duration from the last treatment to the current treatment was 10-23 months (mean, 14.3 months). The operation time, intraoperative blood loss, the time between operation and full loading, fracture healing time, and complications were recorded. The visual analogue scale (VAS) score and the imaging system of fracture healing of the extremities (RUST) of patients before operation and at last follow-up were recorded to evaluate the fracture healing; the function of the affected limb was evaluated according to the Schatzker-Lambert efficacy score standard at last follow-up.ResultsThe operation time was 105-160 minutes, with an average of 125.6 minutes; the intraoperative blood loss was 160-580 mL, with an average of 370.5 mL. All incisions healed by first intention, without vascular or nerve injury. All patients were followed up 22-46 months (mean, 26.5 months). All the fractures healed, with a fracture healing time of 3-7 months (mean, 4.8 months). During the follow-up, there was no infection, loosening, implant breakage, re-fracture, and other complications. The VAS score at last follow-up was 0.8±0.3, showing significant difference (t=7.235, P=0.000) when compared with preoperative score (5.2±3.7); the RUST score was 3.4±0.3, which was significantly higher than the preoperative score (1.5±0.7) (t=8.336, P=0.000). According to the Schatzker-Lambert effectiveness evaluation standard, the limb function was excellent in 16 cases, good in 4 cases, fair in 1 case, and the excellent and good rate was 95.42%.ConclusionNonunion after intramedullary fixation of femoral fracture treated with auxiliary plate combined with autogenous iliac graft, autogenous bone marrow concentration and PRP gel in accordance with the “diamond concept” can not only restore the stability of the fracture ends, but also improves the biological environment of the fracture site, and can improve the rate of fracture healing.
Objective To summarize the optimal evidence for improving the management of chronic wounds exudate, so as to provide evidence-based references for medical professionals, therapists, patients, and their caregivers. Methods PubMed, Wanfang, CNKI, Medlive, UpToDate, etc., were searched by computer for literature about chronic trauma exudate management. The retrieval time limit was from 1998 to 2023. Two researchers trained in evidence-based practice evaluated the quality of the included literature and finally extracted evidence from the literature that met the quality evaluation criteria. Results A total of 11 articles were included, including 2 expert consensuses, 7 systematic reviews, 1 randomized controlled trial, and 1 guideline, covering 7 aspects of the assessment of the nature of chronic wounds exudate, selection of exudate assessment tools, management of antimicrobial concerns, selection and application of wound dressings, negative pressure wound drainage therapy, wound drainage bags, and affected limb elevation or compression therapy for patients with venous leg ulcers. A total of 13 best evidences were extracted. Conclusions When applying evidence, medical professionals should fully evaluate and combine the individual circumstances of the patient, make full use of existing resources, new treatment concepts and technologies, and carry out comprehensive integrated management. This can optimize the management of chronic wounds exudate and improve the quality of life of patients.
The article summarized the national and international history and current situation of healthcare-associated infection control, and analyzed the tendency of new technique and progress in healthcare-associated infection control according to the experience in research and practice.
The shoulder joint is the most prone to dislocation in the whole body, and more than 95% of them are anterior dislocation. Improper treatment after the initial dislocation is easy to lead to recurrent anterior dislocation or anterior shoulder instability, and the outcomes following conservative treatment is poor. Anterior shoulder instability can damage the soft tissue structure and bone structure that maintain the stability of shoulder joint, among which bone structure is the most important factor affecting the stability of shoulder joint. Diagnosis should be combined with medical history, physical examination, and auxiliary examination. Currently, three-dimensional CT is the most commonly used auxiliary examination means. However, various bone defect measurement and preoperative evaluation methods based on three-dimensional CT and the glenoid track theory have their own advantages and disadvantages, and there is still a lack of gold standard. Currently, the mainstream treatment methods mainly include Bankart procedure, coracoid process transposition, glenoid reconstruction with free bone graft, Bankart combined with Remplissage procedure, and subscapular tendon binding tamponade, etc. Each of these procedures has its own advantages and disadvantages. For the diagnosis and treatment of anterior shoulder instability, there are still too many unknown, further research and exploration need to be studied.
Acute pancreatitis is a common surgical acute abdomen in clinical practice. With the development of minimally invasive technology, more and more treatment methods are being applied to acute pancreatitis, especially for severe acute pancreatitis and acute biliary pancreatitis. At present, the efficacy of integrated traditional Chinese and Western medicine in the treatment of acute pancreatitis has been widely recognized. In terms of minimally invasive diagnosis and treatment of acute pancreatitis, the “SELECT” concept of integrated traditional Chinese and Western medicine minimally invasive diagnosis and treatment has emerged. Based on the severity and etiology of acute pancreatitis, the optimal combination of multiple endoscope (Spyglass, encoscopic retrograde cholangiopancreatography, laparoscopy, endoscopic ultrasound, choledochoscopy) is selected, and combined with traditional Chinese medicine treatment. With a patient-centered approach, we have achieved minimally invasive, individualized, and precise treatment of acute pancreatitis through the integration of traditional Chinese and Western medicine.
Objective To investigate the safety and feasibility of hysteroscopic treatment for retained products of conception (RPOC) combined with enhanced myometrial vascularity (EMV) in ambulatory surgery mode. Methods A retrospective analysis was conducted on the clinical data of patients who underwent hysteroscopic treatment for RPOC combined with EMV in ambulatory surgery mode at West China Second University Hospital between May 2021 and May 2024, including their basic information and surgical related conditions. Results A total of 54 patients were included, with an average age of (33.37±4.54) years and an average number of pregnancies of 3.14±1.56. The preoperative blood level of human chorionic gonadotropin was 11.45 (5.00, 82.96) mU/mL. Color Doppler ultrasound showed an average size of pregnancy residue (2.47±0.77) cm. The average peak systolic velocity was (55.13±18.55) cm/s. The intraoperative blood loss was 17.63 (1.00, 300.00) mL. The average surgical time was (30.07±20.64) minutes. The hospital stay was 0.69 (0.50, 1.00) days. There was 1 case of postoperative complications (incidence rate 1.9%), which had the second hysteroscopy to remove retained pregnancy tissue one month after the first surgery due to RPOC. There were 6 cases of postoperative re pregnancy. Conclusion Hysteroscopic treatment for RPOC combined with EMV in ambulatory surgery mode is safe and feasible, and is worth promoting.
China is in the best period of development since modern times, and in the face of the “great changes” in the world, China’s medical and health field needs to reconstruct the medical service model actively. Under the guidance of the “Healthy China” strategy in the new era of socialism with Chinese characteristics, full life cycle health service emerged as the times require. The whole life cycle health service is based on the two focuses of the whole population and the whole life cycle, with the main characteristics of “system continuity” and “fair accessibility”, aiming to achieve the overall improvement of the health level of the whole people. This article reviews the concept, connotation and research progress of whole life cycle health service, aiming to implement the strategy of “Healthy China”, so as to provide reference for carrying out the whole life cycle health service with Chinese characteristics in the new era.
ObjectiveTo improve the comprehensive service ability of the hospital, improve the satisfaction of medical care, implement the requirements of fine management, and enrich the connotation of hospital internal performance improvement.MethodsIn July 2017, based on the concept of approach-deployment-learning-integration, the internal performance improvement model of Children’s Hospital Affiliated to Fudan University was constructed to form a management closed loop.ResultsFrom 2016 to 2019, the average length of hospital stay was reduced from 6.90 d to 6.47 d, the patient satisfaction was elevated from 92.89% to 93.80%, the proportion of drugs was reduced from 35.25% to 30.44%, the proportion of materials was reduced from 23.35% to 18.55%, and the proportion of difficult operations of grade Ⅲ and Ⅳ was elevated from 66.98% to 67.68%.ConclusionThe improvement of key performance indicators depends on the implementation of external policies, the integration of scientific management elements, the cooperation of multiple subjects, and the construction of information system.
ObjectiveTo explore the effect of a new rehabilitation intervention model based on International Classification of Functioning, Disability and Healthy (ICF) concept in perioperative treatment on patients with adolescent idiopathic scoliosis (AIS).MethodsFrom June 2017 to January 2019, AIS patients with Cobb angle below 80° were randomly divided into experimental group and control group by the method of randomized block design. The patients in the control group received routine perioperative rehabilitation intervention, while the patients in the experimental group received rehabilitation mode intervention based on ICF concept. The therapeutic effect of the two groups including functional and activity dimensions was observed.ResultsA total of 40 patients were included, with 20 in each group. Two patients withdrew the control group. On the fourth day after surgery, the total score of Modified Barthel Index (50.55±8.87 vs. 18.99±5.63; t=13.264, P<0.001) and Scoliosis Research Society-22 (SRS-22) (3.68±0.13 vs. 3.27±0.11; t=10.355, P<0.001) in the experimental group were all better than those in the control group. In the SRS-22 scores, statistically significant differences in comparison of function (2.79±0.29 vs. 1.90±0.48; t=6.884, P<0.001), and self image (3.91±0.27 vs. 3.38±0.32; t=5.539, P<0.001) between the two groups were found. There was no statistically significant difference in pain indicators and muscle strength between the two groups in the two postoperative evaluations (P>0.05). ConclusionsThe treatment based on the concept of ICF can improve the daily living ability in the short term with the safe and acceptable premise. The concept of stimulating patient autonomy, improving patient independence, and promoting social treatment, may improve the overall state of the patients.
Objective To review the characteristics and deficiencies of various liposuction methods to provide reference for choosing more suitable liposuction in clinic and ideas for the improvement and development of liposuction equipment. Methods The literature related to liposuction in recent years was consulted, and the principle, indications as well as existing problems were reviewed. Results Liposuction can be divided into two categories according to the principles of fat separation. The first type relies on physical cutting to separate fat, including suction-assisted liposuction (SAL), power-assisted liposuction (PAL), and water-assisted liposuction (WAL). SAL and PAL are simple to operate and low in price, but the effect of liposuction mainly depends on the experience of the surgeon, and complications such as uneven appearance, hematoma, and ecchymosis may occur. WAL saves time and effort, but has lower cost performance. The second type relies on energy destruction to separate fat, including ultrasound-assisted liposuction, laser-assisted liposuction, and radiofrequency-assisted liposuction. This type of surgery has the advantages of less trauma, fast postoperative recovery, and skin tightening. However, the equipment is more expensive, and has a risk of skin burns. Conclusion Liposuction can effectively reduce local fat accumulation, but it still has limitations. Equipment improvement and fat transplantation are important directions for liposuction’s future development.