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.
ObjectiveTo investigate the effectiveness of retroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis.
MethodsA retrospective analysis was made on the cl inical data of 22 patients with lumbar spine tuberculosis undergoing focus clearance, fusion, and internal fixation by retroperitoneal laparoscopic approach combined with anterolateral mini-incision between June 2006 and June 2012. There were 14 males and 8 females, with an average age of 42.6 years (range, 26-57 years) and with a mean disease duration of 7.3 months (range, 3-10 months). There were 17 patients with single-level spinal tuberculosis (L1, 2 in 3, L2, 3 in 6, L3, 4 in 4, L4, 5 in 2, and L5 in 2) and 5 patients with double-level spinal tuberculosis (L1-3 in 2 and L2-4 in 3). The preoperative Cobb's angle of lumbar spine was 5-28° (mean, 20°). In 6 patients having compression symptom, 4 cases were rated as grade D and 2 as grade C according to Frankel classification. The operative time, intraoperative blood loss, and postoperative complications were recorded. At last follow-up, the neurologic function was assessed according to Frankel grade, the Cobb's angle after operation was measured on lumbar lateral X-ray film; the efficacy was evaluated according to Nakai criteria, and the fusion was evaluated according to Suk criteria.
ResultsAll operations were successfully completed. The operation time was 110-250 minutes (mean, 140 minutes), and intraoperative blood loss was 120-280 mL (mean, 180 mL). The symptoms of femoral nerve injury and sympathetic nerve injury occurred in 1 case respectively and was relieved at 1-3 weeks after operation. All incisions healed by first intention. The patients were followed up 16-50 months (mean, 21 months). During the follow-up period, no loosening or breakage of implants and no tuberculosis recurrence were found. At last follow-up, the nerve function was recovered to grade E in the others except 1 case at grade D. The Cobb's angle was 2-16° (mean, 7.8°). According to Nakai criteria for efficacy evaluation, the results were excellent in 9 cases, good in 10 cases, and fair in 3 cases, with an excellent and good rate of 86.4%. The bony fusion rate was 95.5% (21/22) according to Suk criteria.
ConclusionRetroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis is a safe and effective approach with minimal invasion and less complications.
Objective To investigate the role of cardiac rehabilitation program in the early recovery after minimally invasive incision coronary artery bypass grafting with general anesthesia. MethodsA retrospective study was performed on the patients who underwent minimally invasive incision coronary artery bypass grafting from January 2015 to January 2020 with general anesthesia in our hospital. The patients were divided into a cardiac rehabilitation group and a control group. The clinical data of the patients were collected in 6 months and 12 months after the beginning of cardiac rehabilitation program and were analyzed by propensity score-matching analysis with a ratio of 1∶1. The main outcomes were the peak oxygen uptake (VO2 peak) of cardiopulmonary function test and the number of patients attending cardiovascular specialties in tertiary hospitals during the follow-up period (20 months). ResultsA total of 600 patients were enrolled, including 200 patients in the cardiac rehabilitation group [137 males and 63 females, aged 61.00 (56.00, 65.00) years] and 400 patients in the control group [285 males and 115 females, aged 60.00 (56.00, 65.00) years]. After matching, 176 patients were included in each group, and the basical clinical data of the pateints were comparable (P>0.05). The VO2 peak of the cardiac rehabilitation group after 6 months and 12 months of cardiac rehabilitation was significantly different from that of the control group [6 months: 1.96 (1.59, 2.38) L/min vs. 1.72 (1.38, 2.12) L/min, P<0.001; 12 months: 2.40 (2.21, 2.63) L/min vs. 2.12 (1.83, 2.45) L/min, P<0.001]. During the follow-up period, there was a statistical difference in the cardiovascular specialist visits in tertiary hospitals (P=0.004). ConclusionCardiac rehabilitation program has a positive effect on the recovery of minimally invasive incision coronary artery bypass grafting with general anesthesia, and can improve the exercise ability of patients.
Objective To review the clinical experience of Heller myotomy for treatment of achalasia through a small thoracotomy. Methods Twenty-five patients with achalasia (9 moderate, 16 severe) underwent Heller myotomy without concomitant antireflux procedure through a small incision. A left thoracotomy was carried out through either the seventh or eighth intercostals space. The length of skin incision was 6 to 8 cm. Results There was no hospital death and severe postoperative complications. The mean operating time was 50 minutes. Mean hospital stay was 10 days. There was one intraoperative perforation and repaired successfully. All patients reported good to excellent relief of dysphagia and no symptom of gastroesophageal reflux after surgery. Eight patients were subsequently studied with a 24-hour esophageal pH monitoring and no evidence of pathologic reflux found. Conclusions Transthoracic Heller myotomy with a small incision is effective and safe method for treatment of achalasia with minimal invasion, quick recovery, less postoperative complication and shorter hospital stay. Proper extent of the myotomy may decrease the risk of subsequent gastroesophageal reflux in the postoperative period.
