Objective To detect the operative technique and aesthetic problem of reconstruction to deformity of bilateral cleft lip． Methods From March 2003 to December 2004, 26 patients with bilateral cleft lip were treated, aged 10 months to 11 years. Of 26 patients, there were 13 bilateral complete cleft lip and palate, 9 bilateral incomplete cleft lip and 4 mixed cleft lip with unilateral complete cleft palate. The chief design principle was keeping the length of prolabium. During operation, sufficient dissociation was made in the base of the ala base and orbicularis oris muscle to reconstruct these structures．The circle suture was made for the bilateral orbicularis oris muscle. The shape of vermilion was achieved by lateral red lip muscle flap and simultaneous simple rhinoplasty was performed. Results Primary healing of the incisions was achieved in all cases. After the 10 days-3 months follow-up, the results were satisfactory in thewidth and chubbiness of the nose bottom,the shapes of nostril and Cupid’s bow were good without whistle deformity. Theapperance of upper lip was good in either dynamic or static state． Conclusion Excellent shapes and function of the nose and lip， and opportunity for twostage repair could be obtained with this method，which being believed important methods for the primary repair of bilateral cleft lip．
ObjectiveTo investigate the effect of unilateral rotator cuff repair on the contralateral shoulder in patients with bilateral rotator cuff tears.MethodsA clinical data of 46 patients with bilateral rotator cuff tears met the criteria between May 2016 and May 2019 was retrospectively analyzed. Of 46 patients, 23 patients underwent bilateral conservative treatment (conservation group), 23 patients underwent unilateral arthroscopic rotator cuff repair, and conservative treatment on the contralateral side (operation group). There was no significant difference in gender, age, disease duration, degree of rotator cuff tear, and comorbidities between 2 groups (P>0.05). Before operation and at 6 and 12 months after operation, the degree of the rotator cuff tear was measured by MRI, and the shoulder function was evaluated by the visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM) (forward flexion, external rotation, external rotation at 90° of abduction, and internal rotation). The evaluation results of the non-surgical side of shoulders in the operation group were compared with one side of shoulders in the conservation group.ResultsAll incisions healed by first intention without any complication after operation. All patients were followed up 12 months. MRI reexamination showed that the degree of rotator cuff tear of the contralateral shoulder in the operation group increased significantly after operation (P<0.05). There was no significant difference between the operation group and the conservation group before operation (P>0.05), but the rotator cuff tear of the contralateral shoulder in the operation group was more serious than that of the conservation group at 6 and 12 months after operation (P<0.05). At 6 and 12 months after operation, the VAS score, UCLA score, and ASES score significantly improved when compared with the preoperative scores in 2 groups (P<0.05). There was no significant difference in the VAS score, UCLA score, and ASES score between 2 groups before operation (P>0.05). The function scores in the conservation group were better than those in the operation group at 6 and 12 months after operation (P<0.05). There were significant differences in the ROM of shoulder between pre- and post-operation in 2 groups (P<0.05). And there was no significant difference between 2 groups at pre- and post-operation (P>0.05).ConclusionFor patients with bilateral rotator cuff tears, the unilateral rotator cuff repair can aggravate the rotator cuff tear of contralateral shoulder.
ObjectiveTo summarize the use of harmonic scalpel to harvest bilateral internal mammary artery in coronary artery bypass grafting (CABG). MethodsThe clinical data of 54 patients of bilateral skeletonized internal mammary artery harvesting for CABG in our hospital from January 2016 to May 2020 were analyzed retrospectively. There were 51 males and 3 females with a mean age of 62.37±9.56 years. ResultsAll patients went through the procedure unevently and discharged from hospital. The number of grafts was 4.07±0.85 per patient, the operation time was 267.21±47.00 min, mechanical ventilation time was 342.43±132.17 min and hospital stay was 12.21±4.43 d. ConclusionIt is safe and effective to use harmonic scalpel to harvest skeletonized bilateral internal mammary artery in CABG.
Objective To investigate the optimal surgical approach for bilateral inguinal hernias and complex (recurrent and compound) inguinal hernia. Methods Data of eighty patients with bilateral inguinal hernias and (or) complex inguinal hernias treated by tension less hernia repair between Feb. 2007 and Jun. 2010 in Sichuan Provincial People’s Hospital were analyzed. Preperitoneal approach through inferior abdominal median incision was applied in the repair with local, lumbar or epidural anesthesia. Results Operation time was （30±10.2） min in unilateral hernia, （50±17.5） min in bilateral hernia. There was no ischemic orchitis or pain case after operation. Within 3 months following up, no recurrence occurred. Conclusion The preperitoneal approach through inferior abdominal median incision for inguinal hernia repair is proved to be effective, safe, and convenient, and especially fit for bilateral hernias and complex hernia.
Objective To evaluate the effectiveness and safety of minimally invasive treatment for bilateral tibial plateau fractures using the double reverse traction reducer. Methods The clinical data of 4 patients with bilateral tibial plateau fractures who met the selection criteria and treated between January 2016 and April 2024 were retrospectively analyzed. The cohort included 3 males and 1 female, aged 30-65 years (mean, 52.5 years). Injury mechanisms comprised traffic accidents (2 cases) and falls (2 cases). According to the Schatzker classification, 2 limbs were type Ⅱ and 6 were type Ⅵ. The time from injury to surgery ranged from 5 to 9 days (mean, 7 days). All patients underwent minimally invasive reduction using the double reverse traction reducer. Surgical duration, intraoperative blood loss, and hospitalization time were recorded. Functional outcomes were assessed at last follow-up using the Hospital for Special Surgery (HSS) knee score and range of motion (ROM), while fracture reduction quality was evaluated using the Rasmussen radiological score. Results All 4 patients successfully completed the procedure without conversion to open reduction. The total mean operation time was 80.25 minutes (range, 73-86 minutes), with a mean total intraoperative blood loss of 132.5 mL (range, 100-150 mL). The mean hospitalization time was 13.5 days (range, 11-16 days). All incisions healed primarily without neurovascular complications. X-ray film at 1 day after operation confirmed satisfactory reduction and articular surface alignment. Follow-up time ranged from 12 to 26 months (mean, 17.0 months). Fractures achieved clinical union at an average of 13 weeks (range, 12-16 weeks). No complication, such as deep vein thrombosis, joint stiffness, post-traumatic arthritis, or implant failure, was observed. At last follow-up, the mean HSS score was 92.9 (range, 90-97), mean knee ROM was 128.1° (range, 115°-135°), and mean Rasmussen radiological score was 16.4 (range, 15-19), with 2 limbs rated as excellent and 6 as good. Conclusion The double reverse traction reducer facilitates minimally invasive treatment of bilateral tibial plateau fractures with advantages including minimal trauma, shorter surgical duration, precise reduction, and fewer complications, effectively promoting fracture healing and functional recovery of the knee joint.
ObjectiveTwitch transdiaphragmatic pressure is used to evaluate the diaphragm function of mechanical ventilated chronic obstructive pulmonary disease patients before weaning in the intensive care unit, and compared with healthy normal values.MethodsPatients were recruited if they were with acute exacerbation of chronic obstructive pulmonary disease, admitted between May to November in 2013 and December 2014 to February 2016 to the intensive care unit in the First Affiliated Hospital of Guangzhou Medical University, intubated and mechanical ventilated more than 72 hours, and recovered to the clinical stability states after passing the readiness to wean, getting ready for spontaneous breathing test. The newly designed esophageal electrode catheter and bilateral anterolateral magnetic phrenic nerves stimulation were utilized to detect the twitch transdiaphragmatic pressure. At the same time, the function of diaphragm was detected in 10 healthy adults for comparison.ResultsTwenty-two patients were recruited in this study. Two cases had no twitch signals. In the rest 20 cases, the twitch transdiaphragmatic pressure was (7.6±2.5) cm H2O. In 10 healthy adults, twitch transdiaphragmatic pressure was (26.7±4.9) cm H2O. There was significant difference between the patients and the health control subjects (P<0.05).ConclusionTwitch transdiaphragmatic pressure is significantly decreased in weaning chronic obstructive pulmonary disease patients compared with healthy adults.
Objective To explore the advantage of transection the cervical muscles at sternal end and flip fixed in therapeutic bilateral huge thyroid surgery. Methods The transection of the cervical muscles at sternal end and flip fixed in 53 cases was observation group， 44 cases of the neck white line incision thyroid surgery completed for the control group. The completion of the surgery by the same group of physicians. The operative time， operation field of exposing effect， amount of bleeding in operation， postoperative complications， and postoperative drainage volume were compared between two groups. Results There was no statistically differences of sex， age， disease composition， and tumor size between two groups （P＞0.05）. Operative time， amount of bleeding， and postoperative drainage volume in observation group were shorter （less） than that in control group （P＜0.01）. The postoperative complication rate in observation group was lower than that in control group（P=0.04）. Surgical field exposure in observation group was better than that in control group （P＜0.01）. Conclusions The huge bilateral thyroid surgery with the sternal end approach is feasible and simple. The operation field exposure is better than the white line neck incision， complications after operation is less. It is worthy of clinical application.
ObjectiveTo evaluate the long-term effect of unilateral versus bilateral screw placement on thoracolumbar single vertebral fracture by means of meta-analysis.MethodsThe data of China National Knowledge Infrastructure, Wangfang Database, SinoMed, VIP Database for Chinese Technical Periodicals, PubMed, Elsevier Science Direct, EBSCO, Web of Science, and Springer Link were searched by computer, and the literatures related to effect comparison between unilateral and bilateral pedicle screw fixation in thoracolumbar single vertebral fracture were collected, including domestic and foreign published journal literatures and grey literatures such as academic conference reports and dissertations. The retrieval time was from their inception to August 17, 2019. After literature screening, quality evaluation, and data extraction, Stata 12.0 and RevMan 5.0 softwares were used for data analysis.ResultsA total of 12 articles were included, including 7 in English and 5 in Chinese, with a total of 848 patients (424 in the unilateral pediclescrew fixation group and 424 in the bilateral pedicle screw fixation group). The results of meta-analysis showed that: there was no significant difference in any of the main outcome indicators between the two groups, including the ratio of anterior height of fractured vertebra [mean difference (MD)= ?0.16%, 95% confidence interval (CI) (?1.20%, 0.88%), P=0.76], postoperative follow-up Cobb angle [MD=?0.17°, 95%CI (?0.50, 0.15)°, P=0.29], postoperative follow-up Visual Analogue Scale score [MD=?0.06, 95%CI (?0.16, 0.04), P=0.24], postoperative follow-up Oswestry Disability Index score [MD=?0.28, 95%CI (?0.66, 0.11), P=0.15], and incidence of complications [relative risk=0.81, 95%CI (0.57, 1.15), P=0.23], but two secondary outcome indicators namely operation time [MD=?33.26 minutes, 95%CI (?51.72, ?14.80) minutes, P=0.000 4] in the unilateral pedicle screw fixation group were smaller than those in the bilateral pedicle screw fixation group, whlie there were no statistically significant difference in postoperative length of hospital stay [MD=?1.59 days, 95%CI (?4.53, 1.36) days, P=0.29] and intraoperative blood loss [MD=?74.09 mL, 95%CI (?155.96, 7.77) mL, P=0.08] between the two groups.ConclusionUnilateral and bilateral screw placement of thoracolumbar single vertebral fracture has the same long-term effect, and unilateral screw placement can reduce the number of screw implantation, and shorter operation time, which is more in line with the actual clinical needs.
Objective To study the effect of simultaneous bilateral total hip arthroplasty in a single procedure. Methods From October 1999 to March 2004, 15 patients (30 hips) underwent simultaneous sequential bilateral total hip arthroplasty (THAs) in a single procedure. Of the 15 patients, 11 were male (22 hips) and 4 were female (8 hips). Their ages ranged from 35 to 70 years. Their courses of disease ranged from 1 year to 50 years (4.8 years on average). The Harris scores of the joint function before the operation ranged from 12 to 45 points (27 points on average). Five were done with Smith-Peterson and 10 were done with Moore. Results The operative time was 3 hours and 25 minutes to 5 hours (4 hours and 10 minutes on average). The volume of blood transfusion during operation was 400 to 2 400 ml (1 160 mlon average). All the 15 patients were followed up for 3 to 35 months (18 monthson average). The Harris scores of the joint function after the operation rangedfrom 70 to 100 points (86 points on average). There was significant difference in the scores between before and after operations (Plt;0.05). There was only 1death within 1 months of the operation and no serious between complications such as infection, pulmonary embolism, and deep vein plug. All the patients were still ambulant in the community and gained significant pain relief. Conclusion Simultaneous bilateral total hip arthroplasty in a single procedure is a safe and effective method. However, the decision of performing singlestage bilateral total hip arthroplasty should be carefully made and preoperative preparation should be sufficiently made.
Accurate segmentation of pediatric echocardiograms is a challenging task, because significant heart-size changes with age and faster heart rate lead to more blurred boundaries on cardiac ultrasound images compared with adults. To address these problems, a dual decoder network model combining channel attention and scale attention is proposed in this paper. Firstly, an attention-guided decoder with deep supervision strategy is used to obtain attention maps for the ventricular regions. Then, the generated ventricular attention is fed back to multiple layers of the network through skip connections to adjust the feature weights generated by the encoder and highlight the left and right ventricular areas. Finally, a scale attention module and a channel attention module are utilized to enhance the edge features of the left and right ventricles. The experimental results demonstrate that the proposed method in this paper achieves an average Dice coefficient of 90.63% in acquired bilateral ventricular segmentation dataset, which is better than some conventional and state-of-the-art methods in the field of medical image segmentation. More importantly, the method has a more accurate effect in segmenting the edge of the ventricle. The results of this paper can provide a new solution for pediatric echocardiographic bilateral ventricular segmentation and subsequent auxiliary diagnosis of congenital heart disease.