ObjectiveTo investigate the clinical application of laparoscopic right hemihepatectomy via anterior approach. MethodThe clinical data of 32 patients underwent laparoscopic right hemihepatectomy via anterior approach from June 2017 to May 2019 were retrospectively analyzed.ResultsThe laparoscopic right hemihepatectomies via anterior approach were successfully completed in the 32 patients, no one converted to laparotomy. The operation time was (315.5±36.7) min, the intraoperative bleeding was (340.8±105.4) mL, and the postoperative hospital stay was (8.9±1.7) d. The postoperative complications occurred in 6 cases, including 1 case of peritoneal effusion, 1 case of intraabdominal infection, 2 cases of bile leakage and 2 cases of pleural effusion combined with pulmonary infection, who were discharged after receiving the conservative treatment according to the symptoms. The results of postoperative pathology: 13 cases of hepatocellular carcinoma, 6 cases of intrahepatic cholangiocarcinoma, 7 cases of hepatic angioleiomyoma, 6 cases of intrahepatic bile duct stones. The average follow-up time was 12 months (range 1 to 24 months). During the follow-up period, 7 cases of hepatic angioleiomyoma and 6 cases of hepatolithiasis survived after operation. The intrahepatic metastases were found in 1 patient with hepatocellular carcinoma at 12 months and 2 cases of intrahepatic cholangiocarcinoma at 9 months and 11 months, respectively. The rest patients survived free tumor.ConclusionLaparoscopic right hemihepatectomy via anterior approach is safe and feasible, and has a satisfactory short-term efficacy.
Objective To compare the differences in acetabular position during total hip arthroplasty (THA) between by direct anterior approach and by posterolateral approach. Methods Between December 2008 and December 2015, 102 patients undergoing THA were included in the study. THA was performed by anterior approach in 51 cases (anterior group) and by posterolateral approach in 51 cases (posterolateral group). There was no significant difference in gender, age, body mass index, side, and cause of illness between 2 groups (P>0.05), with comparability. The acetabular abduction angle and anteversion angel were measured on the X-ray film at 1 day after operation to evaluate whether the acetabular prosthesis was displaced in the safe zone. Results The acetabular abduction angle was (42.28±5.77)° in the anterior group and was (43.93±7.44)° in the posterolateral group, showing no significant difference (t=1.30, P=0.19). The acetabular anteversion angle was (21.14±5.17)° in the anterior group and was (21.05±4.10)° in the posterolateral group, showing no significant difference (t=0.05, P=0.96). The ratio in the target safe zone of the acetabular abduction angle in the anterior group and the posterolateral group were 88.2% (45/51) and 84.3% (43/51) respectively, showing no significant difference (χ2=0.33, P=0.56). The ratio in the target safe zone of the acetabular anteversion was 80.4% (41/51) in the anterior group and was 82.4% (42/51) in the posterolateral group, showing no significant difference between 2 groups (χ2=0.06, P=0.79). The ratio in the target safe zone of both the abduction and anteversion angel was 70.6% (36/51) in the anterior group and was 68.6% (35/51) in the posterolateral group, showing no significant difference (χ2=0.05, P=0.82). Conclusion There is no differences in the acetabulum position during THA between by direct anterior approach and posterolateral approach.
ObjectiveTo systematically review the efficacy of total hip arthroplasty by direct anterior approach (DAA) and direct lateral approach (DLA). MethodsCNKI, WanFang Data, VIP, CBM, EMbase, PubMed, The Cochrane Library, ClinicalTrials.gov and PROSPERO databases or websites were electronically searched to collect randomized controlled trials (RCTs) of DAA and DLA for THA from inception to August 6th, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. ResultsA total of 9 RCTs were included. The results of meta-analysis showed that at 3 months post-operation, the Harris hip score (HHS) of the DAA group was higher than the DLA group (MD=4.83, 95%CI 2.09 to 7.56, P=0.000 5). Besides, compared with the DLA group, the DAA group showed shorter incision length (MD=?2.35, 95%CI ?3.90 to ?0.79, P=0.003), less intraoperative bleeding (MD=?68.24, 95%CI ?119.07 to ?17.41, P=0.009), and shorter hospital stay (MD=?0.84, 95%CI ?1.54 to ?0.15, P=0.02). However, no significant differences were found between DLA and DAA in operation duration and HHS at 6 weeks after operation. ConclusionsCurrent evidence shows that DAA can provide better HHS at 3 months post-operation, shorter incision length, less intraoperative bleeding, and shorter hospitalization length than DLA. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
ObjectiveTo explore the feasibility and effectiveness of total hip arthroplasty (THA) with acetabulum structural bone grafting using autogenous femoral head through direct anterior approach (DAA) in lateral decubitus position in the treatment of Crowe type Ⅲ and Ⅳ developmental dysplasia of the hip (DDH). Methods Between June 2016 and July 2020, 12 patients with Crowe type Ⅲ and Ⅳ DDH were treated with THA with acetabulum structural bone grafting using autogenous femoral head through DAA in lateral decubitus position. There were 2 males and 10 females with an average age of 60.2 years (range, 50-79 years). Crowe classification was type Ⅲ in 10 hips and type Ⅳ in 2 hips. The preoperative Harris score of hip joint was 48.8±7.5, the difference in length of both lower extremities was (3.0±0.7) cm, and the visual analogue scale (VAS) score during activity was 7.2±0.9. The surgical incision length, operation time, intraoperative blood loss, and complications were recorded; the position and press-fitting of acetabulum and femoral prosthesis were observed after operation, and the difference in length of both lower extremities was measured; the horizontal coverage of acetabular cup and bone graft were measured, the healing with the host bone and the loosening of the prosthesis were evaluated; Harris score was used to evaluate hip joint function, and VAS score was used to evaluate patients’ pain during activity. Results The average surgical incision length was 9.3 cm, the average operation time was 117 minutes, and the average intraoperative blood loss was 283 mL. Two patients (16.7%) received blood transfusion during operation. There was no acetabular and femoral fractures during operation. All incisions healed by first intention, without dislocation, periprosthetic infection, sciatic nerve injury, deep venous thrombosis, and other complications. One patient had lateral femoral cutaneous nerve injury after operation. X-ray films at discharge showed a total acetabular cup level coverage of 93%-100%, with an average of 97.8%, and a bone graft level coverage of 25%-45%, with an average of 31.1%. All the 12 patients were followed up 22-71 months, with an average of 42.2 months. At last follow-up, the Harris score of hip joint was 89.7±3.9, the difference in length of both lower extremities was (0.9±0.4) cm, and the VAS score during activity was 1.1±0.6, which were significantly different from those before operation (P<0.05). During follow-up, there was no patient who needed hip revision surgery because of prosthesis loosening. At last follow-up, there was no translucent line between the graft and the host bone, the graft was fused, the position was good, and there was no obvious movement. One patient had one screw fracture and bone resorption at the outer edge of the graft, but the bone graft did not displace and healed well. ConclusionTHA with acetabulum structural bone grafting using autogenous femoral head through DAA in lateral decubitus position in the treatment of Crowe type Ⅲ and Ⅳ DDH is safe and reliable, and has satisfactory short-term effectiveness.
Objective To investigate the effectiveness of MAKO robotic-arm assisted total hip arthroplasty (THA) via direct anterior approach (DAA) for bony fused hips in ankylosing spondylitis (AS). Methods Between June 2021 and January 2022, MAKO robotic-arm assisted THA via DAA was applied to treat 10 cases (12 hips) of AS with bony fused hips. There were 7 males and 3 females; the age ranged from 30 to 71 years, with an average age of 42.4 years. The duration of AS was 12-35 years, with an average of 21.4 years. The preoperative hip was ankylosed in flexion in 3 cases, with a flexion angle of 20°, 30°, 35°, respectively; 9 cases were ankylosed in extension. The operation time and complications were recorded; the visual analogue scale (VAS) score, Harris score, and Oxford hip scale (OHS) score before and after operation, and postoperative range of motion (flexion, extension, internal rotation, external rotation, adduction, and abduction) were used to evaluate the recovery of joint function; according to the postoperative anteroposterior X-ray film and CT scan of both hip joints, the abduction angle, anteversion angle, the difference between bilateral combined off-set and the lower limb length discrepancy were measured. Results The operation time ranged from 80 to 190 minutes (mean, 134.6 minutes). All 10 patients were followed up 5-11 months (mean, 7.4 months). There was no serious adverse events such as incision infection, deep vein thrombosis of lower extremities, hip redislocation, aseptic loosening of the prosthesis, or death. At 5 months after operation, the acetabular prosthesis angle of abduction was 37°-45° (mean, 40.3°), anteversion angle was 9°-20° (mean, 15.8°). The difference between bilateral combined off-set was 0-10 mm (mean, 4.3 mm); the lower limb length discrepancy was 0-12 mm (mean, 3.5 mm). At last follow-up, the average range of motion of the hip joint was 89.2° in flexion (range, 80°-100°), 1.7° in extension (range, –5°-10°), 7.1° in internal rotation (range, 0°-15°), 20.4° in external rotation (range, 10°-30°), 7.9° in adduction (range, 0°-20°), and 16.5° in abduction (range, 10°-25°). At last follow-up, the VAS score, Harris score, and OHS score significantly improved when compared with those before operation (P<0.05). ConclusionThe MAKO robotic-arm assisted THA via DAA can achieve satisfactory results in the treatment of AS with bony fused hip, which has the advantages of accurate prosthesis installation, soft tissue release, and less trauma during operation.
ObjectiveTo discuss the effectiveness of the modified Hueter direct anterior approach in treatment of Pipkin typeⅠ and Ⅱ femoral head fractures.MethodsBetween September 2014 and May 2016, 12 patients with Pipkin type Ⅰ and Ⅱ femoral head fractures were treated with the modified Hueter direct anterior approach. There were 8 males and 4 females, aged from 32 to 60 years (mean, 40.2 years). The disease causes included traffic accident injury in 9 cases and falling from height injury in 3 cases. According to Pipkin typing, 8 cases were rated as type Ⅰ and 4 cases as type Ⅱ. The interval of injury and admission was 2-28 hours (mean, 7.2 hours). Reduction was performed in all patients within 6 hours after admission, and then bone traction was given. The operation was performed in 3-7 days (mean, 4.3 days) after redution. The modified Hueter direct anterior approach was applied to expose and fix femoral head fractures by Herbert screws compressively. The operation time and intraoperative blood loss were recorded, and the effectiveness was evaluated according to the Thompson-Epstein scale at last follow-up.ResultsThe operation time was 80-130 minutes (mean, 97.5 minutes), and the intraoperative blood loss was 100-200 mL (mean, 130.2 mL). All fractures achieved anatomical reduction and successful fixation. All 12 patients were followed up 12-32 months (mean, 24.3 months). All patients achieved bone union in 15-20 weeks (mean, 16.3 weeks) and no wound infection, lateral femoral cutaneous nerve injury, osteonecrosis of the femoral head, or heterotopic ossification occurred. Traumatic arthritis occured in 3 patients. According to the Thompson-Epstein scale at last follow-up, the results were excellent in 5 cases, good in 5 cases, fair in 2 cases, and the excellent and good rate was 83.3%.ConclusionThe modified Hueter direct anterior approach has the advantages of clear anatomic structure, less trauma, and shorter operation time, and it can effectively expose and fix the Pipkin typeⅠ and Ⅱ femoral head fractures.
ObjectiveTo understand the location characteristics of the lumbosacral autonomic nerve plexus and the morphological changes so as to provide the anatomic theoretical basis for the protection of autonomic nerve during the lower lumbar anterior approach operation. MethodsA random anatomic investigation was carried out on 19 formalin-treated adult cadavers (15 males and 4 females; aged 44-78 years, mean 64 years). The anterior median line (connection of suprasternal fossa point and the midpoint of the symphysis pubis) was determined, and the characteristics of abdominal aortic plexus (AAP), inferior mesenteric plexus (IMP), and superior hypogastric plexus (SHP) were observed. The relationship between the autonomic nerve and the anterior median line was measured and recorded. ResultsAPP and IMP were found to be located chiefly in front of the abdominal aorta in a reticular pattern, and the nerve fibers of the two nerve plexuses were more densely at the left side of abdominal aorta than at the right side. Superior hypogastric plexus showed more distinct main vessel variations, including 4 types. The main vessel length of the SHP was (59.38±12.86) mm, and the width was (11.25±2.92) mm. The main vessels of SHP were mainly located at the left side of the ventral median line (10, 52.6%) and anterior lumbar vertebra (13, 68.4%). The main vessels extended down to form the left and right hypogastric nerves. ConclusionIt is applicable to expose the nerve from the right side of centrum and move the autonomic nerve and blood vessel as a whole during anterior lower lumbar operation. In this way, the dissection to separate nerve plexus is not needed, thus nerve injury can be avoided to the largest extent.
ObjectiveTo explore the effectiveness of minimally invasive clamp reduction technique via anterior approach in treatment of irreducible intertrochanteric femoral fractures.MethodsBetween January 2015 and January 2019, 59 patients with irreducible intertrochanteric femoral fractures were treated with minimally invasive clamp reduction technique via anterior approach. There were 29 males and 30 females with an average age of 77.9 years (range, 45-100 years). The causes of injury included falling in 46 cases, traffic accident in 6 cases, smashing in 2 cases, and falling from height in 5 cases. The time from injury to operation was 1-14 days (mean, 3.8 days). The fractures were classified as AO type 31-A1 in 12 cases, type 31-A2 in 25 cases, type 31-A3 in 22 cases.ResultsAll fractures were reduced well and the fracture reduction took 10 to 30 minutes, with an average of 19 minutes. All patients were followed up 13-25 months, with an average of 17.6 months. Among them, 2 cases of pronation displacement of proximal fracture segment died for infection or falling pneumonia after internal fixation failed. Six patients with reversed intertrochanteric femoral fractures experienced re-pronation and abduction displacement of the lateral wall after internal fixation, but the fractures all healed. The rest of the patients had no fracture reduction loss, and the fractures healed with an average healing time of 5.9 months (range, 3-9 months). Except for 2 patients who died, the Harris score of hip joint function of the remaining 57 patients was excellent in 49 cases and good in 8 cases at last follow-up.ConclusionThe minimally invasive clamp reduction technique via anterior approach for irreducible intertrochanteric femoral fractures is simple and effective. For irreducible intertrochanteric femoral fractures related to lateral wall displacement, after clamp reduction and intramedullary nail fixation, the lateral wall should be reinforced in order to avoid reduction loss and internal fixation failure.
ObjectiveTo investigate the feasibility and safety of single utility port Da Vinci robot-assisted lung resection via anterior approach.MethodsThe clinical data of 21 patients who underwent single utility port Da Vinci robot-assisted lung resection from February to March 2021 were retrospectively analyzed. There were 10 males and 11 females, with a median age of 50 (34-66) years. The operation time, blood loss, postoperative hospitalization time, postoperative complications and other indicators were analyzed.ResultsAll patients completed the operation successfully with no transition to thoracotomy or perioperative death. Overall surgery time was 103 (70-200) min, Docking time was 5 (3-10) min, operation time was 81 (65-190) min. The blood loss was 45 (20-300) mL. All patients had malignant tumors, the number of dissected lymph node station was 3 (1-6), and the number of lymph nodes was 5 (2-16). The postoperative indwelling time was 3 (2-5) d. The postoperative hospitalization time was 5 (3-7) d. The pain score for the first 3 days after surgery was 3±1 points.ConclusionSingle utility port robot-assisted lung resection via anterior approach is safe, less traumatic, more convenient and effective, which can be gradually promoted and applied to clinical trials.
ObjectiveTo investigate the accuracy of preoperative digital-template planning in total hip arthroplasty (THA) via direct anterior approach (DAA) and its effect on the short-term effectiveness.MethodsThe clinical data of 77 patients (109 hips) with osteonecrosis of femoral head who underwent THA via DAA between January 2016 and May 2018 was retrospectively analyzed. According to the type of template, patients were divided into digital-template group (group A, 40 patients, 56 hips) and conventional-template group (group B, 37 patients, 53 hips). There was no significant difference in age, gender, body mass index, the stages of osteonecrosis of femoral head, and preoperative Harris hip score (HHS) (P>0.05). The operation time, intraoperative blood loss, frequencies of intraoperative fluoroscopy, and complications were recorded. Otherwise, the consistency rate of preoperative planning and practical prosthesis size was analyzed. Position of acetabular prosthesis and femoral prosthesis alignment were measured on anteroposterior X-ray film of the pelvis at 3 months after operation. HHS was used to evaluate clinical function.ResultsThe consistency rate of preoperative planning and practical acetabular prosthesis size was significantly higher in group A (80.4%, 45/56) than that in group B (62.3%, 33/53), showing significant difference (χ2=4.38, P=0.04). But there was no significant difference in the consistency rate of preoperative planning and practical femoral prosthesis size between group A (83.9%, 47/56) and group B (79.2%, 42/53）(χ2=0.40, P=0.53). The prosthesis abductions were (40.7±6.4)° in group A and (38.8±7.3)° in group B; the femoral prosthesis alignment deviations were (0.1±1.8)° in group A and (0.3±1.7)° in group B. There was no significant difference in the prosthesis abduction and femoral prosthesis alignment deviation between 2 groups (P>0.05). No prosthesis sinking or loosening occurred during follow-up. The operation time and frequencies of intraoperative fluoroscopy were less in group A than those in group B (P<0.05). But there was no significant difference in intraoperative blood loss between 2 groups (t=1.92, P=0.06). The complication occurred in 1 hip of group A and 6 hips of group B, with no significant difference (P=0.06). All patients were followed up 6-22 months (mean 13.8 months) in group A and 6-24 months (mean, 14.6 months) in group B. At last follow-up, the HHS scores were 91.8±3.1 in group A and 92.6±4.2 in group B, and the difference was not significant (t=1.14, P=0.26).ConclusionPreoperative digital-template planning in THA via DAA is accurate, which can reduce the operation time and frequencies of intraoperative fluoroscopy without enhancing the risk of complication.