ObjectiveTo analyze the treatment of Gartland type Ⅱ and Ⅲ supracondylar fracture of the humerus in children.MethodsBetween January 2015 and January 2017, 45 cases of Gartland type Ⅱ and Ⅲ supracondylar fracture of the humerus were treated. There were 28 boys and 17 girls with an age of 1-13 years (mean, 5.7 years). The causes of injury included sports injury in 43 cases and falling from height in 2 cases. Fractures were classified as type Ⅱ in 12 cases and type Ⅲ in 33 cases according to Gartland classification. The time from injury to operation was 2-12 hours (mean, 4.6 hours). All fractures were treated with closed reduction first, and 12 cases of Gartland type Ⅱ fracture were successful in closed reduction; 20 cases of Gartland type Ⅲ fracture were successful in closed reduction, 11 cases with reduction failure and 2 cases with radial nerve injury underwent assisted anterior transverse approach reduction. Then percutaneous crossed Kirschner wires fixation was performed.ResultsThe operation time was 16-52 minutes (mean, 32 minutes). The perspective frequency was 4-17 times (mean, 6.7 times). The hospitalization time was 3-7 days (mean, 4 days). All the 45 cases were followed up 8-20 months (mean, 12 months). The ulnar nerve paralysis occurred in 3 cases of Gartland type Ⅲ fracture that were treated with closed reduction, and recovered after 1-3 months. All fractures healed after operation, and the healing time was 2-3 months. No incision infection, Volkmann muscle contracture, and other complications occurred. The elbow joint function score at 6 months after operation showed that the results of closed reduction was excellent in 16 cases, good in 12 cases, and fair in 4 cases, with the excellent and good rate of 87.5%; in which Gartland type Ⅱ fracture was excellent in 9 cases and good in 3 cases, with an excellent and good rate of 100%, and Gartland Ⅲ was excellent in 7 cases, good in 9 cases, and fair in 4 cases with an excellent and good rate of 80%. The results of assisted anterior transverse approach reduction was excellent in 7 cases, good in 5 cases, and fair in 1 case, and the excellent and good rate was 92.3%.ConclusionGartland type Ⅱ and Ⅲ supracondylar fractures of the humerus can be treated with closed reduction or combined with the assisted anterior transverse approach reduction, then fixed by percutaneous crossed Kirschner wire, which is operational, smaller invasive, and less radiation exposure during operation, while postoperative function is good.
ObjectiveTo explore the short- and mid-term efficacy of Castor single branch aortic stent combined with subclavian artery bypass grafting for the aortic arch lesions. MethodsA retrospective analysis of the clinical data of patients with proximal anchor zone insufficiency aortic arch lesions treated with Castor stent combined with carotid-subclavian bypass at the Department of Cardiac Surgery, Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from August 2020 to November 2023 was performed. ResultsA total of 22 patients were included, including 19 males and 3 females, with an average age of 56±16 years. There were 18 patients of aortic dissection and 4 patients of aortic arch tumors. The success rate of surgical technique was 100.0%, and the average postoperative hospital stay for patients was 10±4 days. The median follow-up time was 20 months. During the follow-up period, there were no major complications such as endoleak, paraplegia, cerebral infarction, renal insufficiency, etc., and all patients had no readmissions. ConclusionFor proximal anchor zone insufficiency aortic arch lesions, the treatment method of using a Castor stent branch placed in the left common carotid artery can effectively extend the anchor zone, avoid the huge trauma of open chest surgery, and achieve good short- and mid-term efficacy.
ObjectiveTo evaluate the clinical efficacy of tricuspid valve re-operation after left cardiac valve surgery. MethodsWe retrospectively analyzed the clinical data of 23 patients underwent tricuspid valve re-operation in the Affiliated Drum Tower Hospital of Medical School, Nanjing University from January 2009 to November 2014. There were 3 males and 20 females with a mean age 53.48±10.79 years ranging from 34 to 71 years. The average body mass index of the 23 patients was 21.77±2.42 kg/m2. We followed up all the patients in outpatient department or through telephone for 3 months to 5 years. ResultsAll surgeries were operated under cardiopulmonary bypass. There were 15 patients underwent operation through medisternal incision and 8 patients underwent operation through the fourth intercostal incision of right anterolateral side. The mean operation time was 284.35±56.16 minutes and the mean time of cardiopulmonary bypass was 138.61±46.91 minutes. One patient died postoperatively and 2 patients chose to discharge automatically after operation. The other 20 patients recovered and discharged uneventfully. We followed up the patients for 3 months to 5 years. One patient underwent permanent pacemaker therapy for atrioventricular block, 3 patients accepted pharmaceutical therapy for atrial arrhyttmia, 1 patient underwent re-operation for infectious endocarditis of left cardiac artificial valve. and the follow-up conditions of the rest patients were well. Besides, the follow-up data showed that there was a mild regurgitation in 3 patients underwent tricuspid valve plasty. ConclusionTricuspid valve re-operation after left cardiac valve surgery can take multiple surgical pathways and strategies. The clinical effect has been proved and the midterm follow-up condition is well, but we still need the long-term follow-up for the further effect.
ObjectiveTo evaluate the in-hospital and long-term outcomes of patients receiving mitral valve replacement with mechanical or biological prosthesis.MethodsThe clinical data of patients undergoing mitral valve replacement in our center between January 2005 and August 2018 were retrospectively analyzed. Patients with emergency, reoperation, bleeding or embolic events or incomplete clinical data were ruled out.ResultsTotally 569 patients were enrolled, including 325 with mechanical prosthesis (a mechanical prosthesis group, 111 males and 214 females with a mean age of 55.54±4.09 years) and 244 bioprosthesis (a bioprosthesis group, 90 males and 154 females with a mean age of 60.02±4.28 years). There was no significant difference in the in-hospital mortality between the two groups (P=0.250). The survival rate at postoperative 15 years of the bioprosthesis group was higher than that of mechanical prosthesis group (78.69% vs. 66.25%, χ2=8.844, P=0.003). No remarkable differences were found in prosthesis failure (P=0.183) and thromboembolism events (P=0.505) between the two groups. Bleeding occurred more frequently in the mechanical prosthesis group (P=0.040). After the propensity-score matched analysis based on the age, the survival rate was still higher in the bioprosthesis group than in the mechanical prosthesis group (P=0.032).ConclusionBiological prosthesis can be considered as the preferable choice in mitral valve replacement procedure in order to improve the long-term survival and decrease the frequent of bleeding events.