Objective
To investigate the method and effectiveness of coracoplasty with mini-incision for subcoracoid impingement syndrome.
Methods
Between May 2006 and September 2011, 4 patients with subcoracoid impingement syndrome were treated, including 3 cases of congenital dysplasia of the coracoid process and 1 case of anterior glenohumeral instability. There were 3 males and 1 female with an average age of 36 years (range, 20-56 years). The disease duration was 6-22 months (mean, 11.2 months). The patients had a history of chronic pain and click of the anterior should, which was aggravated in adduction, internal rotation, and flexion. The results of the coracoid impingement test were positive by Neer and Hawkins-Kennedy impingement sign. The axial CT in adduction position showed that the coracohumeral interval decreased and coracoid index increased. The 2 cm lateral coracoid incision was made and the 0.5-1.5 cm coracoid neck was revealed and cut by osteotomy. The coracoplasty was performed by amputating the conjoined tendon insertion of the short head of the biceps and the coracobrachialis muscle and suturing to proximal coracoid osteotomy surface. Shoulder was fixed with the external braces for 6 weeks.
Results
Healing of incision by first intention was observed in all cases without any complication. All the 4 patients were followed up from 8 months to 5 years. At last follow-up, pain and click disappeared. The mean visual analogue scale (VAS), University of California at Los Angeles (UCLA), Constant, and simple shoulder test (SST) scores were significantly improved from 7.75, 10.25, 65.50, and 9.75 at preoperation to 0.25, 34.25, 91.25, and 0.25 at last follow-up respectively. The axial CT in adduction position and MRI showed that long coracoid process was removed; the coracohumeral interval was increased to 13.38 mm from 4.16 mm at preoperation; and the coracoid index was decreased to 0.28 mm from 13.08 mm at preoperation.
Conclusion
Coracoplasty with mini-incision is an effective method to relieve clinical symptoms of subcoracoid impingement, which has less complications and faster recovery.
Objective To investigate the operative procedure and the therapeutic effects of minimally invasive incision and percutaneous pinning in operative treatment of Gartland type III humeral supracondylar fracture in children. Methods From September 2002 to July 2009, 189 patients with Gartland type III humeral supracondylar fracture were treated with minimally invasive incision and percutaneous pinning. There were 137 males and 52 females, aged from 1 to 13 years (6.2 years on average). Injury was caused by sports in 173 cases, by traffic accident in 9 cases, by fall ing from height in 5 cases, and by earthquake in 2 cases. All fractures were closed fractures, compl icating others fracture in 11 cases, radial nerve injury in 36 cases, median nerve injury in 5 cases, ulnar nerve injury in 2 cases, and brachial artery injuryin 2 cases. The time from injury to hospital ization was 1 hour to 10 days. Neurovascular repair was performed at the same period. Results All incisions healed by first intention, no related compl ications occurred. A total of 143 patients were followed up 5 months to 5 years (12 months on average). X-ray films showed fracture healed within 2-4 months (2.5 months on average). Cubitus varus occurred in 6 cases, but the functions of elbow flexion and extension were good; 2 cases were given distal humeral wedge osteotomy and 4 cases continued keeping the functional training. According to the Flynn et al criteria, the results were excellent in 121 cases, good in 15 cases, and fair in 7 cases; the excellent and good rate was 95.1%. Only a small incision scar was found, the function returned to normal in the cases compl icated by nerve and blood vessel injury. Conclusion Minimally invasive incision and percutaneous pinning for operative treatment of Gartland type III humeral supracondylar fracture in children is a safe and effective surgical procedure, which has minimal trauma, short surgery time, quick recovery, simple operation, and can be effective in reducing the compl ications.
ObjectiveTo compare clinical outcome between single-incision laparoscopic subtotal gastrectomy (SILSG) versus laparoscopy-assisted subtotal gastrectomy (LASG) in treatment of benign gastric ulcer and duodenal ulcer.
MethodsClinical data of 37 patients with benign gastric ulcer or duodenal ulcer who underwent laparoscopic subtotal gastrectomy between Jan. 2008 and Feb. 2015 at Shengjing Hospital of China Medical University was collected retrospectively. Among them, 15 patients underwent SILSG and 22 patients underwent LASG. Demographic, intraoperative, and postoperative data was analyzed and compared between the 2 groups.
ResultsThe operative time of SILSG group was significantly longer than that of LASG group (P < 0.050). However, the postoperative hospital stay was significantly shorter (P < 0.050), and the total patient scar assesment scale (PSAS) score was significantly lower (P < 0.050) in the SILSG group than those of LASG group. There was no significant difference between the 2 groups with respect to other variables (P > 0.050), such as conversion rate, intraoperative blood loss, postoperative exhaust time, incidence of complication, and visual analog scale score of pain. All patients received postoperative follow up, and the period ranged from 6 months to 25 months, with a median of 11 months. During the follow up period, no one suffered from incision hernia and recurrence of ulcer.
ConclusionCompared with LASG, SILSG is a technically feasible procedure with better cosmesis and equivalent curability.
