Objective To evaluate the effectiveness of flexor hallucis longus tendon harvested using a minimally invasive technique in reconstruction of chronic Achilles tendon rupture. Methods Between July 2006 and December 2009, 22 patients (22 feet) with chronic Achilles tendon rupture were treated, including 16 males and 6 females with a median age of 48 years (range, 28-65 years). The disease duration was 27-1 025 days (median, 51 days). Twenty-one patients had hoofl ikemovement’s history and 1 patient had no obvious inducement. The result of Thompson test was positive in 22 cases. The score was 53.04 ± 6.75 according to American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system. MRI indicated that the gap of the chronic Achilles tendon rupture was 4.2-8.0 cm. A 3 cm-long incision was made vertically in the plantar aspect of the midfoot and a 1 cm-long transverse incision was made in a plantar flexor crease at the base of the great toe to harvest flexor hallucis longus tendon. The flexor hallucis longus tendon was 10.5-13.5 cm longer from tuber calcanei to the end of the Achilles tendon, and then the tendon was fixed to the tuber calcanei using interface screws or anchor nail after they were woven to form reflexed 3-bundle and sutured. Results Wound healed by first intention in all patients and no early compl ication occurred. Twenty-two patients were followed up 12-42 months (mean, 16.7 months). At 12 months after operation, The AOFAS ankle and hindfoot score was 92.98 ± 5.72, showing significant difference when compared with that before operation (t= —40.903, P=0.000). The results were excellent in 18 cases, good in 2 cases, and fair in 2 cases with an excellent and good rate of 90.9%. No sural nerve injury, posterior tibial nerve injury, plantar painful scar, medial plantar nerve injury, and lateral plantar nerve injury occurred. Conclusion Chronic Achilles tendon rupture reconstruction with flexor hallucis longus tendon harvested using a minimally invasive technique offers a desirable outcome in operative recovery, tendon fixation, and complications.
【Abstract】 Objective To evaluate the effectiveness of percutaneous fixation of pelvic fracture by Acutrak full thread headless hollow compression screw. Methods Between March 2008 and April 2010, 31 patients with pelvic fracture underwent percutaneous fixation surgery with Acutrak full thread headless hollow compression screw (surgical group). The effectivenss was compared with those of 14 patients with pelvic fracture treated conservatively (control group). There was no significant difference in age and sex between 2 groups (P gt; 0.05). The injury was more severe in surgical group than in control group. The standard of short-term recovery was active turning over and walking for 5 steps with walking aids. The standard of long-term recovery was pain, gait, fracture healing, and function recovery. Results In surgical group, the other patients reached the standard of short-term recovery at 1-4 days after injury except 1 patient who had sacral plexus injury; in control group, the patients could turn over at 9-13 days (Tile type A2) and 17-25 days (Tile type B2) respectively, and could walk at 17-21 days (Tile type A2) and at 45-57 days (Tile type B2) respectively. The patients of 2 groups were followed up 6-19 months. The time of fracture healing was 2-6 months. The long-term results were excellent in 29 cases and good in 2 cases in surgical group, and were excellent in 8 cases and good in 6 cases in control group, showing significant difference between 2 groups (χ2=6.636, P=0.017).Conclusion Percutaneous internal fixation combined with Acutrak full thread headless hollow compression screw can provide more effective treatment. It can alleviate patients, pain quickly, improve life quality, and has better long-term effectiveness.
ObjectiveTo summarize recent progress of minimally invasive diagnosis and treatment of patients with choledocholithiasis.Method The literatures relevant to progress of minimally invasive diagnosis and treatment of patients with choledocholithiasis at home and abroad in recent years were summarized and reviewed. ResultsThe preoperative diagnosis of patients with choledocholithiasis was very important, and it still needed to combine with the clinical symptoms, biochemical indicators, and imaging examination and so on. Combined or single application of laparoscopy, endoscopy, biliary endoscopy to reflect their respective advantages in the treatment of choledocholithiasis, it had become the most important minimally invasive treatment method. ConclusionEarly diagnosis and proper minimally invasive approach are important for good therapeutic efficacy, and realize modern surgical idea for damage control and rapid recovery.
ObjectiveTo evaluate the changes of left ventricular structure and function by echocardiography and its grading of left ventricular diastolic function in patients with mitral valve prolapse treated by minimally invasive mitral valve repair.MethodsBy retrospective analysis, 37 patients including 25 males and 12 females aged 53.49±11.02 years with mitral valve prolapse who underwent minimally invasive mitral valve repair were as an operation group, and 34 healthy persons including 19 males and 15 females aged 54.26±8.33 years matched by age and sex were selected as a control group. Ultrasound parameters of every participant were routinely collected before operation, 1 month, 3 months, 6 months and 1 year after operation, and left ventricular diastolic function was graded. The ultrasound parameters between the two groups were compared.ResultsThe diameters of left ventricular end systolic and diastolic phase, left atrial diameter and left ventricular volume in the operation group were significantly smaller than those before operation. The diameters of left ventricle and left atrium after operation were significantly shorter than those before operation, but they were still larger than those of the control group. The ejection fraction value decreased significantly at one month after the operation and then returned to normal level. The incidence of left ventricular diastolic dysfunction at 6 months and 1 year after operation was significantly lower than that before operation (P<0.05).ConclusionMinimally invasive repair for patients with mitral valve prolapse can significantly improve systolic and diastolic functions of left ventricle while reconstructing left atrial and left ventricular structures.
Objective To compare the effectiveness of two minimally invasive methods: minimally invasive plating osteosynthesis (MIPO) and expandable intramedullary nail ing technique in treatment of middle third humeral shaft fractures. Methods The cl inical data were retrospectively analyzed and compared from 33 cases with middle third humeral shaft fractures between May 2004 and December 2008. All the patients were divided into 2 groups: 14 patients were treated with MIPOtechnique (group A) and 19 with expandable intramedullary nail ing technique (group B). In group A, there were 10 males and 4 females with an average age of 35 years (range, 21-51 years). The disease cause was traffic accident in 5 cases, tumbl ing in 6 cases, machine related trauma in 2 cases, crushed by a heavy object in 1 case. Six fractures were classified as AO type A, 6 as type B, and 2 as type C. The time from injury to operation was 3 to 11 days with an average of 5.9 days. In group B, there were 12 males and 7 females with an average age of 40 years (range, 19-68 years). The disease cause was traffic accident in 7 cases, tumbl ing in 8 cases, fall ing from height in 3 cases, crush injury in 1 case. Ten fractures were classified as AO type A, 8 as type B, and 1 as type C. The time from injury to operation was 2 to 6 days with an average of 4.2 days. There was no significant difference in general data between 2 groups (P gt; 0.05). Results The operation time was (104.6 ± 25.8) minutes in group A and (85.0 ± 35.7) minutes in group B, showing no significant difference (P gt; 0.05). Incision healed by first intention without iatrogenic radial nerve palsy in 2 groups. The patientswere followed up 21.4 months on average (range, 12-37 months) in group A and 20.5 months on average (range, 22-35 months) in group B. The X-ray films showed bony heal ing in all patients. The fracture union time was (16.4 ± 6.1) weeks in group A and (15.0 ± 2.5) weeks in group B, showing no significant difference (P gt; 0.05). The University of Cal ifornia Los Angeles (UCLA) End- Result scores were 34.1 ± 1.1 in group A and 31.8 ± 2.6 in group B and the Mayo Elbow Performance scores were 100 in group A and 97.6 ± 3.9 in group B; all showing significant differences (P lt; 0.05). Conclusion Good cl inical outcomes could be obtained when middle third humeral shaft fractures are treated by either MIPO or expandable intramedullary nail ing techniques. However, MIPO technique could offer better shoulder and elbow functional results.
ObjectiveTo investigate the application and technical essentials of computer-assisted navigation in the surgical management of periacetabular fractures and pelvic fractures. MethodsBetween May 2010 and May 2011, 39 patients with periacetabular or anterior and posterior pelvic ring fractures were treated by minimally invasive fixation under computer-assisted navigation and were followed up more than 2 years, and the clinical data were analyzed retrospectively. There were 21 males and 18 females, aged 15-64 years (mean, 36 years). Fractures were caused by traffic accident in 23 cases, crush injury in 6 cases, and falling from height in 10 cases. Of them, 6 cases had acetabular fractures; 6 cases had femoral neck fractures; 18 cases had dislocation of sacroiliac joint; and 15 cases had anterior pelvic ring injuries. All patients were treated with closed or limited open reduction and screw fixations assisted with navigation. ResultsEighty-nine screws were inserted during operation, including 8 in the acetabulum, 18 in the neck of the femur, 33 in the sacroiliac joint, and 30 in the symphysis pubis and pubic rami. The mean time of screw implanted was 20 minutes (range, 11-38 minutes), and the average blood loss volume was 20 mL (range, 10-50 mL). The postoperative pelvic X-ray and three dimensional CT scan showed good reduction of fractures and good position of the screws. No incision infection, neurovascular injury, or implant failure occurred. All patients were followed up 27-33 months with an average of 29.6 months. The patients could walk with full weight loading at 6-12 weeks after operation (mean, 8 weeks); at last follow-up, the patients could walk on the flat ground, stand with one leg, and squat down, and they recovered well enough to do their job and to live a normal life. ConclusionMinimally invasive fixation under computer-assisted navigation may be an excellent method to treat some specific types of periacetabular and anterior and posterior pelvic ring fractures because it has the advantages of less trauma and blood loss, lower complication incidence, and faster recovery.
Objective To compare the clinical outcomes and safety of minimally invasive and routine mitral valve repair or replacement for patients with single mitral valve disease. Methods We retrospectively analyzed the clinical data of 67 patients with single mitral valve disease （without aortic valve and tricuspid valve lesion or other heart diseases including atrial septal defect） who underwent mitral valve repair or replacement in the First Affiliated Hospital of China Medical University between January and July 2011. The patients were divided into two groups according to different surgical approaches：the minimally invasive surgery group （n=29，8 males and 21 females，age 51.4±9.4 years） underwent minimally invasive mitral valve repair or replacement via right mini-thoractomy；and the routine surgery group （n=38，11 males and 27 females，age 53.6±11.9 years） underwent mitral valve repair or replacement via middle sternotomy. In the minimally invasive surgery group，9 patients underwent mitral valve repair while the other 20 patients underwent mitral valve replacement. And no patient underwent transition to routine operation. In the routine surgery group，15 patients underwent mitral valve repair and 23 patients underwent mitral valve replacement. Clinical outcomes and safety of the operations were compared between the two groups. Results There was no statistical difference in operation time between the two groups （207.9±18.1 min versus 198.4±27.5 min，P=0.076）. The amount of postoperative drainage （126.7±34.5 ml versus 435.6±87.2 ml，P=0.000） and blood transfusion （red blood cell 1.4±0.8 U versus 2.3±1.1 U，P=0.000；blood plasma 164.3±50.4 ml versus 405.6±68.9 ml，P=0.000） of the minimally invasive surgery group were significantly lower than those of the routine surgery group. The cardiopulmonary bypass time （81.7±23.9 min versus 58.7±13.6 min，P=0.000） and aortic-clamping time （51.6±12.7 min versus 38.4±11.7 min，P=0.000） of the minimally invasive surgery group were significantly longer than those of the routine surgery group. The length of ICU stay （22.5±3.6 h versus 31.7±8.5 h，P=0.000），mechanical ventilation （7.4±3.2 h versus 11.2±5.1 h，P=0.000） and postoperative hospitalization （7.1±1.6 d versus 13.5±2.4 d，P=0.000） of the minimally invasive surgery group were significantly shorter than those of the routine surgery group. There was no statistical difference in postoperative complications between the two groups. Minimally invasive surgery group patients were followed up for 5.3±2.4 months with a follow-up rate of 72.4%（21/29）. Routine surgery group patients were followed up for 5.5±3.8 months with a follow-up rate of 71.0%（27/38）. There was no significant complication during follow-up in both two groups. Conclusion Minimally invasive mitral valve operation via right mini-thoracotomy is effective and safe with a good cosmetic result. Compared with routine operation，patients undergoing minimally invasive operation recover better and faster.
ObjectiveTo evaluate the clinical efficacy of domestic minimally-invasive percutaneous screw system for thoracolumbar fractures without neurological damage. MethodsSixty patients suffering from unstable thoracolumbar fractures without obvious neurologic deficits treated from January 2011 to April 2012 were studied retrospectively. The patients were divided into two groups:group A (domestic minimally-invasive percutaneous screw system) and group B (imported minimally-invasive percutaneous screw system). Perioperative parameter, pre-and post-operative imaging indexes, visual analog scale (VAS) and modified MacNab evaluation standard were studied for comparison. ResultsAll the patients were followed up from 6 to 18 months with an average of (12.2±3.0) months. The Cobb's angle and anterior height of the fracture vertebral body changed significantly in each group (P<0.05). There was no significant difference in incision size, surgical time, postoperative improvement of Cobb's angle, anterior height of the fracture vertebral body and accuracy of pedicle screw placement between the two groups (P>0.05). ConclusionDomestic minimally-invasive percutaneous screw system is reliable with minimal invasion, which is comparable to imported minimally-invasive percutaneous screw system.
ObjectiveTo summarize our initial experience in robot-assisted left upper lobectomy for non-small cell lung cancer. MethodsFour patients with non-small cell lung cancer underwent robot-assisted left upper lobectomy with da Vinci S surgical system (Intuitive Surgical, California) in General Hospital of Shenyang Military Area Command between March and August 2013. There were 3 male and 1 female patients, and their age was 58.8 years (range:49-67 years). We used general anesthesia with double lumens trachea cannula. The patients set in right lateral decubitus position with jackknife. We used 3 arms of the robot system. A single direction lobectomy procedure or an anatomic lobectomy procedure was used according to the differentiation of fissure. Systemic lymph node dissection was performed for all patients. ResultsFour patients with left upper lobectomy were completed with total robotic procedure without conversion. Postoperative pathological examination showed all the patients were of all adenocarcinoma with 2 patients inⅠA stage and 2 patients inⅢA stage. The range of operating time was 100-150 min, intraoperative blood loss was 30-80 ml and no blood transfusion was needed for the patients. The drainage time was 6-20 days. All of the 4 patients were discharged smoothly. The patients were followed up for 10-15 months without recurrence or metastasis. ConclusionRobot-assisted left upper lobectomy is safe and feasible for non-small cell lung cancer.
ObjectiveTo compare the short-term outcomes of surgical repair for atrial septal defect (ASD) with a robotic (da Vinci Si) approach versus a conventional open procedure.MethodsClinical data of 140 patients undergoing ASD closure in the First Affiliated Hospital of Anhui Medical University from January 2016 to May 2020 were retrospectively analyzed. The patients were divided into a robotic group and a sternotomy group according to different surgical methods. In the robotic group, there were 67 patients including 20 males and 47 females at a median age of 40.0 (25.0) years, and in the sternotomy group there were 73 patients including 23 males and 50 females at a median age of 41.0 (29.0) years. Multivariate linear regressions were used to produce risk-adjusted analysis of pertinent clinical characteristics. Kaplan-Meier analysis was performed to compare the speed of sternotomy versus robotic group returning to exercise or daily life.ResultsRobotic-assisted surgery was associated with significantly shorter 24 h postoperative drainage volume [220.0 (210.0) mL vs. 345.0 (265.0) mL, P<0.001], mechanical ventilation [6.0 (11.0) h vs. 8.0 (11.0) h, P=0.024], intensive care unit length of stay (LOS) [19.0 (19.0) h vs. 22.0 (25.0) h, P=0.005], postoperative hospital LOS [9.0 (5.0) d vs. 10.0(6.0) d, P=0.003], and a lower rate of perioperative blood transfusion (28.36% vs. 84.93%, P<0.001). After controlling for patient comorbidity in the multiple regression model, there remained a trend toward decreased 24 h postoperative drainage volume (β=–115.30, 95%CI–170.78 to –59.82, P<0.001), mechanical ventilation (β=–4.96, 95%CI –8.33 to –1.59, P=0.004) and postoperative hospital LOS (β=–2.31, 95%CI –3.98 to –0.63, P=0.007) in the robotic group. Kaplan-Meier analysis revealed that patients returned to exercise or daily life earlier in the robotic group [35.0 (32.0) d vs. 90.0 (75.0) d, P<0.001].ConclusionClosure of ASD can be performed safely and effectively via robotic approach. And the minimally invasive technique is beneficial to postoperative recovery.