Objective To investigate the short-term effectiveness of reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach for complex acetabular fractures. Methods Between January 2015 and January 2020, 30 patients with complex acetabular fractures were treated with reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach. There were 20 males and 10 females with an average age of 52.1 years (range, 25-71 years). The cause of injury included traffic accident in 17 cases and falling from height in 13 cases. Among them, 14 cases were left acetabular fractures and 16 cases were right acetabular fractures. According to Letournel classification, there were 16 cases of double column fractures, 2 cases of transverse fracture with posterior wall fracture, 4 cases of anterior column and posterior hemi-transverse fractures, 8 cases of T-shaped fracture. The displacement distance of fracture ranged from 6 to 30 mm (mean, 11.6 mm). The time from injury to operation was 6-14 days (mean, 8.7 days). Results The operation time was 2.0-4.5 hours (mean, 3.0 hours). The intraoperative blood loss was 200-800 mL (mean, 450.0 mL). All patients were treated with autologous blood transfusion during operation. All incisions healed by first intention after operation, and no infection occurred. All patients were followed up 12-15 months (mean, 13.4 months). The drainage tube was removed at 2-3 days after operation. After extubation, X-ray film and three-dimensional CT were performed to recheck the fracture reduction. According to Matta score system, 20 cases were excellent, 5 were good, and 5 were poor, the excellent and good rate was 83.3%. All fractures healed with the healing time of 16-25 weeks (mean, 17.7 weeks). According to Merle d’Aubigne-Postel score system, the hip function at 1 year after operation was rated as excellent in 18 cases, good in 6 cases, and fair in 6 cases, and the excellent and good rate was 80.0%. Two cases suffered from sciatic nerve injury due to traction during operation, 7 cases had heterotopic ossification, 2 cases had traumatic hip arthritis, and no other complications occurred. Conclusion For complex acetabular fractures, the reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach can obtain good short-term effectiveness with good reduction and hip joint function, and less complications.
ObjectiveTo compare the short-term efficacy of laparoscopic transanal pull through surgery and conventional laparoscopic surgery for rectal cancer.MethodsRelevant literatures were retrieved from databases including PubMed, Cochrane Library databases, Embase, CNKI, CBM, Wan-fang database, and VIP databases from Jan. 2009 to Jul. 2019, all the relevant trial documents ［included randomized controlled trial and non randomized controlled trial］ were collected for comparison of laparoscopic transanal pull through surgery and conventional laparoscopic surgery on the clinical efficacy of rectal cancer patients, the qualified literatures were screened in strict accordance with inclusion and exclusion criteria, and Stata12.0 software was used for statistical analysis.ResultsA total of 19 articles were included in the literature with 2 683 patients were included among them. Meta analysis results showed that, compared with the conventional laparoscopic surgery group, in laparoscopic transanal pull through surgery group, operation time [WMD=–6.78, 95% CI was (–11.96, –1.60), P<0.01], intraoperative blood loss [WMD=–14.94, 95% CI was (–23.48, –6.40),P<0.01], postoperative exhaust time [WMD=–13.55, 95% CI was (–18.24, –8.85), P<0.01], postoperative hospitalization time [WMD=–1.60, 95% CI was (–2.00, –1.21), P<0.01], incidence of postoperative overall complication [OR=0.50, 95% CI was (0.38, 0.67), P<0.01], and incidence of incision infection [OR=0.19, 95% CI was (0.08, 0.45), P<0.01] reduced. Those differences were not significant, such as intraoperative lymph node resection [WMD=–0.02, 95% CI was (–0.44, 0.40), P=0.92], incision margin distance of tumor [WMD=0.13, 95% CI was (–0.30, 0.55), P=0.56], and incidence of anastomotic fistula [OR=0.97, 95% CI was (0.62, 1.50), P=0.87].ConclusionsLaparoscopic transanal pull through surgery has more safe, effective, and reliable effects than conventional laparoscopic surgery for rectal cancer. It has further research value, but there may be inevitable bias and other effects in the included literatures, so more randomized controlled clinical trials are needed in the future.
Objective To evaluate short-term effectiveness of staged management for complex tibial plateau fracture with severe soft tissue injury. Methods A clinical data of 12 patients with complex tibial plateau fractures and severe soft tissue injuries between July 2017 and March 2021 and met the selection criteria was retrospectively analyzed. There were 7 males and 5 females with an average age of 43.1 years (range, 33-58 years). All patients were traffic accident injuries and admitted to hospital within 24 hours after injury. The tibial plateau fractures were closed fractures. According to the Schatzker classification standard, the fractures were rated as type Ⅳ in 3 cases, type Ⅴ in 4 cases, and type Ⅵ in 5 cases. According to the Tscherne classification standard, the soft tissue injuries were rated as grade Ⅱ in 4 cases and grade Ⅲ in 8 cases. The treatment of all patients was divided into 3 stages. In the first stage, emergency trans-articular fracture fixation with external fixator was performed; in the second stage, the fracture reduction and internal fixation were performed and bone cement was implanted to fill the bone defect; in the third stage, the bone cement was removed and the bone graft was performed to repair defect. All patients performed joint function exercise after operation as early as possible. Results There was no neurological symptom after all staged managements, the incisions healed by first intention, and no complications such as incision infection or necrosis occurred. All patients were followed up 6-32 months (mean, 16.9 months). The fractures were all anatomical reduction confirmed by the X-ray films after operation. During follow-up, there was no obvious loss of reduction, loosening and rupture of internal fixator, or collapse of the articular surface. All fractures healed after 14-20 weeks (mean, 17.6 weeks). The posterior slope angle of the tibial plateau was (9.7±2.3)° and the varus angle was (3.9±1.9)° immediately after bone grafting, and were (8.5±2.9)° and (4.3±1.9)° respectively at 6 months after operation. There was no significant difference between the two time points (t=0.658, P=0.514; t=?1.167, P=0.103). At last follow-up, the Hospital for Special Surgery (HSS) score was 85-96 (mean, 91.2), and the range of motion of knee was 110°-135° (mean, 120.9°). Conclusion The staged management for complex tibial plateau fracture with severe soft tissue injury can obtain good short-term effectiveness, but the long-term effectiveness needs to be further followed up.
Objective To investigate the surgical technique and short-term effectiveness of anterior cruciate l igament (ACL) reconstruction with LARS artificial l igament. Methods Between November 2008 and April 2010, eighty patients withACL injury were treated with LARS artificial l igament under arthroscope and successfully followed up. There were 51 males and 29 females, aged from 17 to 43 years with an average of 29.2 years. The injuries were caused by sport in 63 cases, traffic accident in 14 cases, and bruise in 3 cases. There were 43 left knees and 37 right knees. The disease duration ranged from 10 days to 11 months. The anterior drawer test, Lachman test, and pivot shift test for all cases were rated as positive. The preoperative Lysholm score was 55.4 ± 5.7, Irgang score was 48.3 ± 6.2, and Larson score was 54.8 ± 7.4; and the International Knee Documentation Committee (IKDC) score was lower than normal level in all cases. Obl ique coronal MRI showed ACL injury in all cases. Residual ACL and synovium were preserved during surgery. Results All incisions healed by first intention without compl ication of infection or deep venous thrombosis. All patients were followed up 7 to 24 months with an average of 16.8 months. There were 3 cases of screws exposure toward femoral cortical bone, 2 cases of loosening tibial screw, and 1 case of knee extension l imitation, and they were cured after symptomatic treatment. No LARS artificial l igament rupture and joint fibrosis occurred during followup. At last follow-up, the results of anterior drawer test, Lachman test, and pivot shift test were positive in 2, 3, and 3 patients,respectively. There were significant differences in Lysholm, Irgang, and Larson scores of affected knees between preoperation and 6 weeks postoperatively, last follow-up, respectively (P lt; 0.05). The normal rate of IKDC score were 43.75% (35/80) and 97.50% (78/80) at 6 weeks postoperatively and last follow-up, respectively. Conclusion The viscoelastic properties of LARS artificial l igament is different from that of biological materials. The graft should be fixed at a relatively extension position to avoid knee extension l imitation and sl ight loosening of graft tension is permitted at flexion position. Good cl inical result could be achieved if the technique is well appl ied.
ObjectiveTo investigate the feasibil ity and short-term effectiveness of percutaneous endoscopic spine surgery for treatment of lumbar disc herniation with posterior ring apophysis separation. MethodsBetween July 2008 and January 2013, 57 patients with lumbar disc herniation and posterior ring apophysis separation were treated. There were 39 males and 18 females, aged from 13 to 46 years (mean, 26.7 years). Of 57 cases, 29 had a clear trauma history. All patients had single segmental unilateral lumbar disc herniation, and the location was at L4, 5 in 22 cases and at L5, S1 in 35 cases; there were 25 cases of lateral bone fragments and 32 cases of central cortical and cancellous fragments. While fracture located at posterior inferior edge of the vertebrae at L4 level in 9 cases and at L5 level in 8 cases, at posterior superior edge at L5 level in 13 cases and in S1 level in 27 cases. Percutaneous endoscopic surgeries were performed via interlaminar or transforaminal approach from unilaterally symptomatic side for discectomy of lumbar disc herniation and partial or complete resection of free bone fragments. ResultsAccurate positioning was obtained in all patients during operation, and no complication of nerve root injury, hematoma formation, or dural tear occurred. The operation time was 20-85 minutes; the intraoperative fluoroscopy times were 2-15 times, and the blood loss was 3-10 mL. Postoperative radiographic examination showed that bone fragment was not removed in 16 cases, was partly removed in 32 cases, and was completely removed in 9 cases. Disc was completely removed. All patients were followed up 10-64 months (median, 16 months). According to modified Macnab criteria for the evaluation of effectiveness, the results were excellent in 48 cases, good in 6 cases, and fair in 3 cases, and the excellent and good rate was 94.7%. ConclusionPercutaneous endoscopic spine surgery through unilaterally symptomatic approach has advantages of small tissue damage and lumbar structure damage, less bleeding, and shorter recovery time. It has a good short-term effectiveness, but long-term effectiveness need further follow-up.
ObjectiveTo analyze the perioperative safety and the short-term prognosis of non-small cell lung cancer (NSCLC) patients with preoperative arrhythmia. MethodsThe clinical data of NSCLC patients treated in the Department of Cardiothoracic Surgery, the First Affiliated Hospital of Chongqing Medical University from August 2020 to March 2021 were collected and observed. The patients were divided into an arrhythmia group and a control group according to whether there was arrhythmia in the 24 h ambulatory electrocardiogram examination report before operation. The incidence of intraoperative and postoperative cardiovascular events and short-term prognosis were compared between the two groups. Results A total of 466 patients were included in this study, including 338 patients in the arrhythmia group, 176 males and 162 females, with a median age of 68.0 (63.0, 72.0) years, and 128 patients in the control group, 59 males and 69 females, with a median age of 66.5 (60.0, 72.0) years. A total of 26 patients (7.7%) in the arrhythmia group were placed with temporary pacemakers before operation. There was no significant difference in the incidence of cardiovascular related events between the two groups [100 (29.6%) vs. 28 (21.9%), P=0.096]. The incidence of postoperative arrhythmia events in the arrhythmia group was higher than that in the control group [112 (33.1%) vs. 11 (8.6%), P<0.001]. The average postoperative ICU stay in the arrhythmia group was longer than that in the control group (1.1±0.7 d vs. 1.0±0.6 d, P=0.039). ConclusionPreoperative arrhythmia does not increase the risk of intraoperative cardiovascular events in NSCLC patients, but increases the incidence of postoperative arrhythmia events and prolongs ICU stay.