查看更多>>摘要：Purpose:By comparing the outcomes of total hip arthroplasty with hemiarthroplasty in elderly patients with a femoral neck fracture to investigate the one-year mortality,dislocation,infection,reoperation rate,and thromboembolic event.Methods:The PubMed,EMBASE databases,and Cochrane library were systematically searched from the inception dates to April 1,2020 for relevant randomized controlled trials in English language using the keywords:"total hip arthroplasty","hemiarthroplasty" and "femoral neck fracture" to identify systematic reviews and meta-analyses.Two reviewers independently selected articles,extracted data,assessed the quality evidence and risk bias of included trials using the Cochrane Collaboration'stools,and discussed any disagreements.The third reviewer was consulted for any doubts or uncertainty.We derived risk ratios and 95％ confidence intervals.Mortality was defined as the primary outcome.Secondary outcomes were other complications,dislocation,infection,reoperation rate,and thromboembolic event.Results:This meta-analysis included 10 studies with 1419 patients,which indicated that there were no significant differences between hemiarthroplasty and total hip arthroplasty in reoperation,infection rate,and thromboembolic event.However,there was a lower mortality and dislocation rate association with total hip arthroplasty at the one-year follow-up.Conclusion:Based on our results,we found that total hip arthroplasty was better than hemiarthroplasty for a hip fracture at one-year follow-up.
查看更多>>摘要：The treatment of severe trauma,especially multiple injuries,requires multidisciplinary collaboration.The current study aims to highlight the challenges of consultation mode for severe trauma in general hos-pitals and emphasizes the need to create a new temporary-sustainable team.It suggests developing an information consultation mode and enforcing the fine management to improve the quality and safety of the medical treatment.The management mode of a temporary-sustainable team will reduce the cost and improve the treatment efficiency.Overall,a temporary-sustainable team has significant advantages over a traditional multidisciplinary team for severe trauma treatment.
查看更多>>摘要：Subtalar dislocation is defined as a separation of the talocalcaneal and talonavicular articulations,commonly caused by high-energy mechanisms,which include falls from height,motor vehicle crashes,and twisting leg injuries.The dislocations are divided into medial,lateral,anterior,and posterior types on the basis of the direction in which the distal part of the foot has shifted in relation to the talus.The most common type is medial dislocation resulted from inversion injury.Subtalar dislocation may accompany with other fractures.Physical examination must be performed carefully to assess for neurovascular compromise.Most of the subtalar dislocations can be treated with closed reduction under sedation.If this is not possible,open reduction without further delay should be conducted.After primary treatment,X-ray and computed tomography scan should be performed to evaluate the alignment and the fractures.We report a 37-year-old male patient sustained a subtalar dislocation without any bony injury when he was playing football.The patient was successfully treated by closed reduction,and a good alignment was observed at the last follow-up.The pathogenesis and treatment method of this case were analyzed,and the related literature were reviewed,which provided a reference for future clinical treatment.
查看更多>>摘要：Holmium laser lithotripsy(HLL)is one of the common surgical methods for urolithiasis.It causes minor surgical trauma,but complications are not rare.Extracorporeal membrane oxygenation(ECMO)treat-ment of sepsis is common,but venoarterial(VA)-ECMO treatment of urosepsis has not been reported yet.In this article,we reported a 67-year-old female patient with refractory septic shock caused by HLL under percutaneous nephroscope,involving breathing,heart,kidney and other organs,and organs support treatment was ineffective for the patient.Finally,we successfully treated the patient under VA-ECMO with continuous renal replacement therapy(CRRT).Combined ECMO and CRRT may provide a solu-tion for addressing refractory sepsis.Here we present the case and review relevant literature,so as to provide a treatment strategy for patients with refractory urogenic sepsis and to reduce the mortality rate.
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