Objective
To evaluate the results of arthroscopically-assisted closed reduction and percutaneous screw fixation by posterior approach to subtalar joint for calcaneal fractures of Essex-Lopresti tongue type, Sanders IIA, IIB, and IIIAB.
Methods
Sixteen patients with unilateral calcaneal fracture were treated with arthroscopically-assisted closed reduction and percutaneous screw fixation by posterior approach to subtalar joint between June 2012 and June 2015. There were 13 males and 3 females with an average age of 37.8 years (range, 18-65 years). The injury causes included falling from height in 10 cases and traffic accident in 6 cases. Of 16 cases, 4 were classified as Essex-Lopresti tongue type, 5 as Sanders IIA, 4 as Sanders IIB, and 3 as Sanders IIIAB. The interval of injury and operation was 4-8 days (mean, 5.94 days). The B?hler angle, Gissane angle, and width of calcaneus were measured before and after operation. American Orthopaedic Foot and Ankle Society (AOFAS) score was used to evaluate the ankle function at 12 months after operation.
Results
Primary healing of incision was obtained in all cases, and no complications of infection, necrosis, and osseous fascia compartment syndrome occurred. The patients were followed up 12-15 months (mean, 13.63 months). The X-ray films showed that fracture line disappeared at 6 months after operation; the patients had no tenderness or percussion pain, no breakage or loosening of internal fixation, no varus calcaneus tuberosity, no subtalar joint fusion, and no compression symptoms of peroneal tendons. Achilles tendon irritation occurred in 2 cases, and disappeared after removal of internal fixation; traumatic arthritis occurred in 2 cases, and was relieved after removal of internal fixation. The B?hler angle, Gissane angle, and calcaneal width were significantly improved at 3 days and 6 months after operation when compared with preoperative ones (P<0.05). The loss of the above indexes was observed at 6 months, showing no significant difference between at 3 days and 6 months (P>0.05). The AOFAS score results were excellent in 11 cases, good in 3 cases, and fair in 2 cases, and the excellent and good rate was 87.5%.
Conclusion
It has the advantages of little trauma, less complication, and good function recovery to use arthroscopically-assited closed reduction and percutaneous screw fixation by posterior approach to subtalar joint for calcaneal fractures of Essex-Lopresti tongue type, Sanders IIA, Sanders IIB, and Sanders IIIAB.
ObjectiveTo analyze therapeutic effect of ultrasound-guided vacuum-assisted rotary excision with tube irrigation drainage in treatment of granulomatous mastitis (GM).MethodsThe clinical data of 120 patients with GM from January 2018 to December 2018 in the Renmin Hospital of Wuhan University were analyzed. Sixty patients were treated with the ultrasound-guided vacuum-assisted rotary excision with tube irrigation drainage (control group), and the other 60 patients were treated with the metronidazole solution combined with dexamethasone on the basis of the control group (observation group). The therapeutic period, total effective rate, postoperative appearance of breast, and recurrence rate were analyzed. While the pathogenic bacteria was analyzed by the microbial culture and the pathogen gene detection.ResultsThere were no significant differences in the baseline data between the two groups (P>0.05). The ultrasound-guided vacuum-assisted rotary excisions were successfully performed in all 120 patients. The therapeutic period of the observation group was shorter than that of the control group (t=–3.633, P<0.001). The total effective rate and rate of excellent and good of postoperative breast appearance had no significant differences between the two groups (total effective rate: 96.7% versus 90.0%, χ2=1.922, P=0.166; rate of excellent and good of postoperative breast appearance: 96.7% versus 88.3%, χ2=1.205, P=0.272). The recurrence rate of the observation group was lower than that of the control group (χ2=5.175, P=0.023). The positive rates of bacteria were 25.8% and 58.8% in the 120 cases by the microbial culture and 52 cases by the pathogen gene detection, respectively, which had a statistical difference (χ2=16.974, P<0.001), the same conclusions were obtained in the observation group and the control group (χ2=6.691, P=0.010; χ2=9.379, P=0.002).ConclusionsUltrasound-guided vacuum-assisted rotary excision with tube irrigation drainage is well applied in treatment of GM. It could maintain a good shape of breast. Use of metronidazole solution combined with dexamethasone after surgery could shorten therapeutic period and reduce recurrence rate.
Objective
To evaluate the effect of 27G pars plana vitrectomy (PPV) and 25G PPV on idiopathic epiretinal membrane (IMEM).
Methods
Thirty-eight eyes of 38 patients with IMEM were enrolled into this retrospective and comparative study. Eighteen eyes were treated with 27G PPV (group A), 20 eyes underwent 25G PPV (group B) voluntarily. The best corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp microscope, indirect ophthalmoscopy, fundus color photograph, ocular coherence tomography (OCT) and counting of corneal endothelial cells (CEC) were examined before the surgery. BCVA results were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. There was no statistically significant difference between two groups in terms of BCVA, IOP, foveal macular thickness (FMT), the counting of CEC and CEC hexagon rate before the surgery (t=1.627, 0.860, 0.293, 1.238, 0.697;P＞0.05). All operations were performed by the same doctor. Operation time for vitrectomy and peeling membrane was recorded. BCVA, IOP, OCT, FMT, counting of CEC and the improvement of metamorphopsia were observed on 1, 7 days and 1, 3 months after PPV.
Results
The mean operation time for vitrectomy in group A and B were (6.7±2.8), (10.5±3.3) min, respectively. The mean operation time for vitrectomy in group A was significantly longer than that in group B (t=3.084,P＜0.05). The mean operation time for peeling membrane in group A and B were (10.2±5.2), (11.0±5.9) min, respectively. There was no statistically significant difference between two groups in terms of the time for peeling membrane (t=1.970,P=0.187). On 1, 7 days and 1, 3 months after PPV, the difference of BCVA (t=1.463, 0.683, 0.961, 1.226;P=0.833, 0.509, 0.699, 0.744) and IOP (t=1.314, 1.262, 0.699, 1.116;P=0.763, 0.721, 0.534, 0.712) between two groups were not statistically significant. On 1 day after PPV, there were 2 eyes and 5 eyes with ＜9 mmHg (1 mmHg=0.133 kPa) IOP in group A and B. On 7 days and 1, 3 months after PPV, the difference of FMT between two groups were not statistically significant (t=1.257, 1.368, 1.437;P=0.735, 0.745, 0.869). On 3 months after PPV, the difference of CEC between two groups were statistically significant (t=2.276,P＜0.05); the difference of hexagon rate between two groups were not statistically significant (t=1.473,P=0.889).
Conclusion
The efficacy of 27G PPV for IMEM appears similar to 25G PPV. But 27G PPV has a shorter operating time for vitrectomy, a more stable IOP and a minimal damage to CEC.
Objective To investigate the early effectiveness of transiliac-transsacral screws internal fixation assisted by augmented reality navigation system HoloSight (hereinafter referred to as “computer navigation system”) in the treatment of posterior pelvic ring injuries. MethodsA retrospective analysis was made in the 41 patients with posterior pelvic ring injuries who had been treated surgically with transiliac-transsacral screws between June 2022 and June 2023. The patients were divided into navigation group (18 cases, using computer navigation system to assist screw implantation) and freehand group (23 cases, using C-arm X-ray fluoroscopy to guide screw implantation) according to the different methods of transiliac-transsacral screws placement. There was no significant difference in gender, age, body mass index, causes of injuries, Tile classification of pelvic fracture, days from injury to operation, usage of unlocking closed reduction technique between the two groups (P>0.05). The time of screw implantation, the fluoroscopy times, the guide wire adjustment times of each screw, and the incidence of complications were recorded and compared between the two groups. The position of the transiliac-transsacral screw was scanned by CT within 2 days after operation, and the position of the screw was classified according to Gras standard. ResultsThe operation was successfully completed in both groups. The time of screw implantation, the fluoroscopy times, and the guide wire adjustment times of each screw in the navigation group were significantly less than those in the freehand group (P<0.05). There were 2 cases of incision infection in the freehand group, and the incision healed by first intention after active dressing change; there was no screw-related complication in the navigation group during operation and early period after operation; the difference in incidence of complications between the two groups (8.7% vs. 0) was not significant (P=0.495). According to the Gras standard, the screw position of the navigation group was significantly better than that of the freehand group (P<0.05). ConclusionCompared with the traditional freehand method, the computer navigation system assisted transiliac-transsacral screws internal fixation in the treatment of posterior pelvic ring injuries has advantages of improving the accuracy of screw implantation and reducing radiation damage and the time of screw implantation.
ObjectiveTo evaluate the early and mid-term outcomes of total thoracoscopic Box Lesion radiofrequency ablation in patients with atrial fibrillation.MethodsThe clinical data of 31 patients with atrial fibrillation who underwent total thoracoscopic Box Lesion radiofrequency ablation between November 2011 and March 2018 at the Department of Cardiac Surgery in our hospital were retrospectively analyzed, including 23 males and 8 females at an average age of 66.17±8.32 years. All patients did not have concomitant severe organic heart disease which required surgical intervention.ResultsThere were 20 patients with paroxysmal atrial fibrillation, 8 with persistent atrial fibrillation, and 3 with long-standing persistent atrial fibrillation. Twenty-nine patients got the 3-year follow-up, and 2 patients were lost to the follow-up 6 months after the surgery. The procedure was successfully performed in all patients, with an average operation time of 113.00±26.00 min. There was no perioperative death or related complication. All patients were restored to sinus rhythm immediately after surgery. Five patients got atrial fibrillation during postoperative hospitalization, which reverted to sinus rhythm after electrical cardioversion. The rate of sinus rhythm maintenance was 62.9%, 55.9% and 52.4% in postoperative 1, 2 and 3 years, respectively. No patient died during the period, and no procedure-related complication was observed.ConclusionTotal thoracoscopic Box Lesion radiofrequency ablation effectively shortens operation time, and reduces surgical trauma and procedure-related complications, meanwhile, ensures the surgical outcomes.
Objective
To analyze clinicopathologic characteristics of 1 008 patients with gallbladder polyps by minimally invasive gallbladder-preserving surgery, and to explore hemostatic effect of 0–4 ℃ cold saline plus different concentrations norepinephrines in flushing gallbladder mucosa bleeding.
Methods
The clinical data of 1 008 patients with gallbladder polyps by the minimally invasive gallbladder-preserving surgery from 2009 to 2016 in the General Hospital of Xinjiang Military Command were retrospectively analyzed. The clinicopathologic types of gallbladder polyps and the relationship between the operation time and the recurrence of gallbladder polyps were analyzed, the hemostatic effects of 0–4 ℃ cold saline plus different concentrations (0, 16, 24, and 30 mg/L) norepinephrines in flushing gallbladder mucosa bleeding (The hemostatic effect was reflected by the time of flushing gallbladder mucosa bleeding) were compared.
Results
One thousand patients with non-tumorous gallbladder polyps successfully underwent the minimally invasive gallbladder-preserving surgery, another 8 cases patients with tumorous gallbladder polyps underwent the cholecystectomy immediately. There were 128 cases of single polyps and 880 cases of multiple polyps. The polyp diameters of 910 cases were 5–10 mm and 98 cases were 10–15 mm. The pathological analysis indicated that there were 912 (90.5%) cases of the cholesterol polyps, 74 (7.3%) cases of the inflammatory polyps, 14 (1.4%) cases of the adenoid hyperplasia, and 8 (0.8%) cases of the neoplastic polyps ［adenoma 6 cases, adenocarcinoma (T0N0M0) 2 cases］. The gallbladder polyps recurrences were found in 30 (3.0%) cases during 1–8 years of follow-up (average 4 years), all of them were the multiple and cholesterol polyps. The flushing gallbladder mucosa bleeding time of 0–4 ℃ cold saline plus 0, 16, 24, and 30 mg/L concentraions norepinephrine was (44±5) min, (33±6) min, (17±5) min, and (17±4) min in the 125, 230, 555, and 98 patients with gallbladder polyps, respectively. The time of flushing gallbladder mucosa bleeding between the other concentration groups had significant difference (P<0.05) except for between the 24 mg/L concentration group and the 30 mg/L concentration group (P>0.05). The operation time was (62±21) min and (60±19) min of the 30 patients with gallbladder polyps recurrence and the 970 patients without gallbladder polyps recurrence, which had no significant difference (P>0.05).
Conclusions
Cholesterol polyp is a common pathological type of gallbladder polyp, inflammatory polyp and adenomyosis polyp are uncommon, and multiple polyps are common. Hemostatic effects of 0–4 ℃ cold saline plus different concentraions norepinephrine in flushing gallbladder mucosa bleeding are desirable, expecially at a 24 mg/L concentraion norepinephrine is the most effective. No correlation is found between operation time and recurrence of gallbladder polyp.
Objective
To explore safety and efficacy of total laparoscopic radical resection of hilar cholangiocarcinoma.
Methods
From April 2016 and January 2017, 6 patients with hilar cholangiocarcinoma underwent laparoscopic radical resection in the Affiliated Hospital of Xuzhou Medical University were collected. The intra- and post-operative situation and the postoperative complications were analyzed.
Results
The radical resections of hilar cholangiocarcinoma were completed laparoscopically in all the patients. There was no conversion to the laparotomy. The procedure was finished within a time of (231.3±94.5) min and with an intraoperative blood loss of (123.3±46.8) mL. The first postoperative exhausting time and the postoperative hospital stay was (2.7±0.3) d and (11.9±1.7) d, respectively. All the patients had the R0 resection and the numbers of dissected lymph nodes were 9.4±2.7. The postoperative complications occurred in 2 patients, they were all cured spontaneously in one week, and there was no perioperative death. None of patients had a local recurrence and metastasis during an average 8 months of following-up.
Conclusions
Preliminary results of limited cases in this study show that with suitable case and skillful laparoscopic technique, laparoscopic radical resection of hilar cholangiocarcinoma is feasible and safe. Further studies are still needed to confirm benefits of this approach.
ObjectiveTo investigate the application effect of wire reduction technique guided by minimally invasive wire introducer in the treatment of difficult-reducing intertrochanteric fractures.MethodsBetween April 2016 and April 2018, 30 patients with intertrochanteric fractures who had difficulty in closed reduction under the traction bed were treated. There were 17 males and 13 females, aged from 60 to 93 years (mean, 72 years). The causes of injury included falls in 22 cases and traffic accidents in 8 cases. The fractures were classified according to AO/Orthopaedic Trauma Association (AO/OTA) classification: 12 cases of type A1, 12 cases of type A2, and 6 cases of type A3. Intramedullary nail incision and self-made minimally invasive wire introducer were used to assist reduction of intertrochanteric fracture, and then intramedullary nail internal fixation was performed.ResultsThe operation time was 30-70 minutes, with an average of 45 minutes. The intraoperative blood loss was 100-210 mL, with an average of 160 mL. One case died of cerebrovascular accident at 3 months after operation; the remaining 29 cases were followed up 6-18 months, with an average of 8.3 months. Postoperative DR reexamination showed that all patients had a good reduction in the fracture end, no retraction, fracture displacement, hip valgus deformity, and other serious complications occurred. The fracture was completely healed and the healing time was 3-8 months, with an average of 6 months. At 3 months after operation, the visual analogue scale (VAS) score was 1-3, with an averge of 1.7. According to Harris functional score of hip joint, 26 cases were excellent and 3 cases were good.ConclusionFor the difficult-reducing intertrochanteric fractures, minimally invasive wire introducer is used to insert steel wire into the incision of head and neck nail for assisted reduction, which can achieve satisfactory reduction results and improve the effectiveness of intertrochanteric fracture.
ObjectiveTo introduce the method and preliminary experience of robot-assisted bilateral internal mammary arteries (BIMA) harvesting for off-pump coronary artery bypass grafting (OPCAB) with 5 grafts via left anterolateral minithoracotomy.MethodsBIMA were harvested using the da Vinci robotic surgical system, and the right internal mammary artery (RIMA) was pulled out of the thoracic cavity through right second intercostal space. Intercepting the distal part of the RIMA for the BIMA composite Lima-Rima Y graft and anastomosing the great saphenous vein with remaining RIMA end to end. The Y graft anastomosed with left anterior descending (LAD) branch and diagonal branches (DIAG), artery-vein graft sequentially anastomosed with blunt round branch, left ventricular posterior branch and posterior descending branch.ResultsThe operation succeeded without hemodynamic instability and intra aortic balloon pump (IABP) implantation or cardiopulmonary bypass. The blood flow of Y graft was 24 mL/min, and the blood flow of artery-vein graft was 30 mL/min. Ventilator assistance time was 35 hours, ICU staying time was 62 hours, and postoperative myocardial enzymes increased temporarily. Postoperative coronary CTA showed that all the grafts were patency, and cardiac ultrasound indicated that the heart function was normal. The patient cured and discharged from hospital 7 days after operation.ConclusionRobot-assisted bilateral internal mammary artery harvesting for OPCAB with 5 grafts via left anterolateral minithoracotomy is feasible, which can achieve complete revascularization.
ObjectiveTo create a new scleral buckling surgery using noncontact wide-angle viewing system and 23-gauge intraocular illumination for the treatment of rhegmatogenous retinal detachment (RRD), and to evaluate its safety and effectiveness.
MethodsA scleral buckling surgery using noncontact wide-angle viewing system and 23-gauge intraocular illumination was performed in 6 eyes of 6 patients with RRD, including 2 males and 4 females. The mean age was 51 years old with a range from 23 to 66 years old. Proliferative vitreoretinopathy (PVR) were diagnosed of grade B in all 6 eyes. Duration of retinal detachments until surgery was 5.8 days with a range from 2 to 13 days. The mean preoperative intraocular pressure (IOP) was 12 mmHg with a range from 9 to 15 mmHg (1 mmHg=0.133 kPa). A 23-gauge optic fiber was used to provide an intraocular illumination. Fully examination of the ocular fundus and cryoretinopexy of retinal breaks was performed under a noncontact wide-angle viewing system. Subretinal fluid drainage through the sclerotomy and buckling procedure were performed under the operating microscope. Intravitreal injection of sterile air bubble was performed in 4 eyes. Antibiotic eye drops was applied in all eyes postoperatively, and all the eyes were followed up for at least 6 months.
ResultsRetinal reattachment was achieved in all eyes, and the conjunctiva healed well. The best corrected visual acuity (BCVA) increased in all eyes. The mean postoperative IOP was 15 mmHg with a range from 12 to 19 mmHg. No complications were found intra and postoperatively.
ConclusionsThis new scleral buckling surgery using noncontact wide-angle viewing system and 23-gauge intraocular illumination for RRD is safe and effective. Advantages such as higher successful rate, less complication, shorter operating time, and less discomfort of patients were showed comparing with the previous scleral buckling surgery using indirect ophthalmoscope.
