Objective To explore the feasibility and safety of non-gastrointestinal decompression after esophagectomy and the necessity of gastric tube or the time to remove gastric tube. Methods Thirty patients with esophageal cancer who underwent surgical treatment in the Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, were included in the trial from June to October 2017. The patients were randomly and equally assigned to a trial group (non-gastrointestinal decompression) or a control group (gastrointestinal decompression). There was no significant difference in age (P=1.000), sex (P=1.000), tumor location (P=0.732), pathological type (P=1.000), pathological stage (P=0.507), and operation time (P=0.674) between the two groups. The clinical effect between the two groups were compared. Results There was no statistical difference in incidences of anastomotic leakage (P=1.000), anastomotic bleeding (P=1.000), gastroesophageal reflux (P=1.000) between the two groups. And there was no statistical difference in time of the first flatus (P=0.629) and the first bowel movement (P=0.599) after operation between the two groups. Conclusion Without gastrointestinal decompression after Ivor Lewis esophagectomy does not increase the incidences of anastomotic leakage, anastomotic bleeding and gastroesophageal reflux, and has no significant effect on the recovery of gastrointestinal function. Without gastrointestinal decompression after Ivor Lewis esophagectomy is safe and feasible. Removing gastric tube on the second day after operation is reasonable and feasible.
OBJECTIVE: To investigate the effect of intermittent pneumatic compression on prevention of deep venous thrombosis after operation of lower limbs. METHODS: From Oct. 1997 to Aug. 1998, forty cases were received Doppler examination preoperatively, which showed no deep venous thrombosis in all the lower limbs of 40 cases. Among them, 24 cases were received total hip arthroplasties, 4 cases were received total knee arthroplasties and 12 cases were received dynamic hip screw. Postoperatively, every case were continuously received intermittent pneumatic compression for 14 to 21 days (2 hours, qid), and venography were performed on the operated lower limb on the 7th day after operation to check the presence of deep venous thrombosis. RESULTS: Among the 40 cases, there were 4 cases of deep venous thrombosis without symptom of pulmonary embolism, the incidence rate was 10%. CONCLUSION: Intermittent pneumatic compression can significantly reduce the incidence rate of deep venous thrombosis after the operation of the lower limbs.
ObjectiveTo evaluate the effectiveness of internal fixation with headless compression hollow embedding screws in the treatment of intraarticular fracture of elbow.MethodsBetween March 2012 and September 2018, 12 patients with intraarticular fracture of elbow were treated with internal fixation with headless compression hollow embedding screws. There were 7 males and 5 females with an average age of 50.3 years (range, 22-65 years). Cause of injury included falling in 7 cases, falling from high places in 4 cases, and traffic accident in 1 case. Ten patients were distal humerus fractures which were classified as type 13-B3 in 8 cases and type 13-C3 in 2 cases according to the International Association of Internal Fixation Research (AO/ASIF). Two patients were radial head fractures which were classified as type Ⅲ according to the modified Mason classifications. The preoperative visual analogue scale (VAS) score was 8.25±0.83. The time from injury to operation was 3-5 days (mean, 3.7 days).ResultsAll incisions healed by first intention. All 12 patients were followed up 6-15 months, with an average of 8.4 months. The results of X-ray films and CT examination showed that the fracture ends were anatomic reduction, and the fractures healed at 6-11 months after operation, with an average of 7.8 months. One patient had heterotopic ossification at 4 months after operation. The VAS scores were 5.17±0.79 at 2 weeks after operation and 0.50±0.50 at last follow-up. There were significant differences between the time points (P<0.05). At last follow-up, the Mayo elbow function score was 68-95, with an average of 83.9. The activity of elbow joint recovered.ConclusionThe intraarticular fracture of elbow can be firmly fixed by the headless compression hollow embedding screw, which can allow the early functional training of the elbow joint, reduce the incidence of heterotopic ossification, and obtain good effectiveness.
Objective To observe and measure the approach next to the erector spinae in the thoracic and lumbar segments of the spine and adjacent anatomical structures by the topographic method, to clarify the positioning method and safe range so as to provide the anatomical basis of the approach for spinal canal decompression. Methods Twelve formaldehyde-treated adult cadaver specimens were selected, including 6 males and 6 females with an average age of 43 years (range, 27-52 years) and with an average height of 166 cm (range, 154-177 cm). The related data of the approach at T1-S1 levels were respectively measured: the distance between the lateral edge of the erector spinae and the spinous process, the length of the approach, the angle between the approach and the horizontal plane, the size of intervertebral foramen, and the vertical distance between the segmental artery and the upper edge of the vertebrae. Results The distance between the lateral edge of the erector spinae and the spinous process ranged from (41.75 ± 3.29) mm to (74.54 ± 7.08) mm. The length of the approach ranged from (66.75 ± 10.81) mm to (97.13 ± 13.35) mm. The angle between the approach and the horizontal plane ranged from (38.38 ± 6.16)° to (53.67 ± 4.40)°. The vertical distance between the segmental artery and the upper edge of the vertebrae ranged from (9.50 ± 0.60) mm to (18.30 ± 1.56) mm. The size of foraminal was also measured. The spinal canal could reach when iliocostalis lateral edge was used as the starting point in the lumbar segments, and longissimus lateral edge as the starting point in the thoracic segments. It was confirmed that there was enough safe space for the spinal decompression without the resection of the articular process. Conclusion The approach next to the erector spinae can reach spinal canal to achieve the purpose of decompression through the intervertebral foramen. The minimally invasive approach is feasible and safe. It has the value of the operative application.
Objective To investigate the effects of different puncture levels on bone cement distribution and effectiveness in bilateral percutaneous vertebroplasty for osteoporotic thoracolumbar compression fractures. Methods A clinical data of 274 patients with osteoporotic thoracolumbar compression fractures who met the selection criteria between December 2017 and December 2020 was retrospectively analyzed. All patients underwent bilateral percutaneous vertebroplasty. During operation, the final position of the puncture needle tip reached was observed by C-arm X-ray machine. And 118 cases of bilateral puncture needle tips were at the same level (group A); 156 cases of bilateral puncture needle tips were at different levels (group B), of which 87 cases were at the upper 1/3 layer and the lower 1/3 layer respectively (group B1), and 69 cases were at the adjacent levels (group B2). There was no significant difference in gender, age, fracture segment, degree of osteoporosis, disease duration, and preoperative visual analogue scale (VAS) score, and Oswestry disability index (ODI) between groups A and B and among groups A, B1, and B2 (P>0.05). The operation time, bone cement injection volume, postoperative VAS score, ODI, and bone cement distribution were compared among the groups. Results All operations were successfully completed without pulmonary embolism, needle tract infection, or nerve compression caused by bone cement leakage. There was no significant difference in operation time and bone cement injection volume between groups A and B or among groups A, B1, and B2 (P>0.05). All patients were followed up 3-32 months, with an average of 7.8 months. There was no significant difference in follow-up time between groups A and B and among groups A, B1, and B2 (P>0.05). At 3 days after operation and last follow-up, VAS score and ODI were significantly lower in group B than in group A (P<0.05), in groups B1 and B2 than in group A (P<0.05), and in group B1 than in group B2 (P<0.05). Imaging review showed that the distribution of bone cement in the coronal midline of injured vertebrae was significantly better in group B than in group A (P<0.05), in groups B1 and B2 than in group A (P<0.05), and in group B1 than in group B2 (P<0.05). In group A, 7 cases had postoperative vertebral collapse and 8 cases had other vertebral fractures. In group B, only 1 case had postoperative vertebral collapse during follow-up. ConclusionBilateral percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures can obtain good bone cement distribution and effectiveness when the puncture needle tips locate at different levels during operation. When the puncture needle tips locate at the upper 1/3 layer and the lower 1/3 layer of the vertebral body, respectively, the puncture sites are closer to the upper and lower endplates, and the injected bone cement is easier to connect with the upper and lower endplates.
Objectives To systematically review the preventive effects of different pressure relief devices. Methods Databases including PubMed, The Cochrane Library, Web of Science, EMbase, CBM, CNKI, VIP and WanFang Data were searched to collect randomized control trials (RCTs) on the preventive effects of pressure relief devices for the surgical pressure sore from inception to December 2017. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Network meta-analysis was then performed using gemtc package of R 3.5.0 software, Stata 13.0 and JAGS 3.4.0 software. Results A total of 20 RCTs involving 4 183 patients were included. The network meta-analysis showed that micropulse dynamic pad was superior to standard pad. The gel pad was superior to sponge pad. The standard pad and cotton gauze pad. The foam dressing was superior to gel pad. All of the differences were statistically significant. The results of the ranking probability plot suggested foam dressing as an optimal resolution for preventing surgical pressure sore. Conclusions According to the network meta-analysis and rankings, foam dressing is superior to other decompression devices in preventing surgical pressure sores.
ObjectiveTo evaluate the effectiveness of comprehensive management for early stage avascular necrosis of the femoral head (ANFH) by arthroscopic minimally invasive surgery by comparing with closed core decompression. MethodsBetween January 2007 and March 2010, 28 patients (33 hips) with early stage ANFH were treated with the procedure of arthroscopic core decompression combined with autogenous cancellous bone graft and bone morphogenetic protein (BMP) in 18 cases (21 hips, trial group) or with simple closed core decompression in 10 cases (12 hips, control group). No significant difference was found in gender, age, disease duration, etiology, and staging between 2 groups (P gt; 0.05). ResultsIncision healed primarily in all patients, and no infection occurred. All patients were followed up 2.5 years on average (range, 1-3 years). Pain relief and improvement of hip function were obtained in all patients at 6 months after operation. At last follow-up, the Harris scores were 85.67 ± 4.78 in trial group and 81.33 ± 7.03 in control group, showing significant difference between 2 groups (t= —2.10, P=0.04). Collapse of the femoral head was observed in 1 hip (Ficat stage II) of trial group, and in 2 hips (Ficat stage I ) and 2 hips (Ficat stage II) of control group; hip arthroplasty was performed. Significant difference in total effective rate was found between trial group and control group (95.24% vs. 66.67%; χ2=4.85, P=0.03). ConclusionArthroscopic core decompression combined with autogenous cancellous bone graft and BMP is more effective than traditional closed core decompression for treatment of early stage ANFH in pain relief, improvement of hip function, slowing-down the process of femoral head necrosis, reduction of hip joint replacement by accurate location of the lesions, and thoroughly debridement of necrotic bone.
ObjectiveTo compare the effectiveness of robot assisted and C-arm assisted percutaneous kyphoplasty (PKP) in the treatment of single/double-segment osteoporotic vertebral compression fracture (OVCF).MethodsThe clinical data of 108 cases of single/double-segment OVCF who met the selection criteria between May 2018 and October 2019 were retrospectively analyzed. There were 65 cases of single-segment fractures, of which 38 cases underwent “TiRobot” orthopedic robot-assisted PKP (robot group), 27 cases underwent C-arm X-ray machine fluoroscopy-assisted PKP (C-arm group). There were 43 cases of double-segment fractures, including 21 cases in robot group and 22 cases in C-arm group. There was no significant difference in gender, age, T value of bone mineral density, fracture segment distribution, time from injury to operation, and preoperative visual analogue scale (VAS) score, vertebral kyphosis angle (VKA), and height of fractured vertebra (HFV) in the patients with single/double-segments fractures between robot group and C-arm group (P>0.05). The operation time, the fluoroscopy frequency of the surgeons and the patient, the fluoroscopy exposure time of the surgeons and the patient, the radiation dose of the C-arm; the VAS scores, VKA, HFV before operation, at 1 day and 6 months after operation; and the complications in the two groups were recorded and compared.ResultsAll patients underwent surgery successfully. The operation time of the single-segment robot group was significantly longer than that of the C-arm group (t=5.514, P=0.000), while the operation time of the double-segment robot group was not significantly different from that of the C-arm group (t=1.892, P=0.205). The single/double-segment robot group required three-dimensional scanning, so the fluoroscopy frequency, fluoroscopy exposure time, and radiation dose of C-arm received by the patient were significantly higher than those of the C-arm group (P<0.05); the fluoroscopy frequency and the fluoroscopy exposure time received by the surgeons were significantly less than those of the C-arm group (P<0.05). There was no infection, embolism, neurological injury, and adjacent segmental fractures. The single/double-segment robot group showed lower rate of cement leakage when compared with the C-arm group (P<0.05), all the cases of cement leakage happened outside the spinal canal. The VAS score, VKA, and HFV of the single/double-segment robot group and the C-arm group were significantly improved at 1 day and 6 months after operation (P<0.05), and the VAS score at 6 months after operation was further improved compared with that at 1 day after operation (P<0.05). At 1 day and 6 months after operation, there was no significant difference in VAS score between the single/double-segment robot group and the C-arm group (P>0.05). The VKA and HFV of robot group were significantly better than those of the C-arm group (P<0.05).ConclusionFor single/double-segment OVCF, robot assisted PKP has more advantages in correcting VKA and HFV, reducing fluoroscopy exposure of surgeons and bone cement leakage rate; C-arm assisted PKP has more advantages in reducing the operation time of single-segment OVCF and fluoroscopy exposure of patients during operation.
ObjectiveTo investigate the early effctiveness of oblique lateral interbody fusion (OLIF) combined with pedicle screw fixation via small incision Wiltse approach for the treatment of lumbar spondylolisthesis.MethodsBetween January 2016 and December 2016, 21 patients with lumbar spondylolisthesis were treated with OLIF and pedicle screw fixation via small incision Wiltse approach. There were 9 males and 12 females, aged 57-73 years, with an average age of 64.5 years. The disease duration was 24-60 months, with an average of 34.6 months. All cases were spondylolisthesis at L4 (15 cases of degreeⅠ, 6 cases of degreeⅡ); 1 case had vertebral arch isthmus, and 20 cases had spinal stenosis. Japanese Orthopaedic Association (JOA) scoring system was used to evaluate the effectiveness before operation and at last follow-up. Before operation and at 2 days after operation, anteroposterior and lateral X-ray films and CT were taken to measure the sagittal diameter and cross-sectional area of the spinal canal, and calculate the intervertebral height and degree of spondylolisthesis. At 6 months after operation, the intervertebral fusion was evaluated by CT.ResultsThe operation time was 120-180 minutes, with an average of 155 minutes; the intraoperative blood loss was 100-340 mL, with an average of 225.5 mL. One patient had slight injury of lower endplate, 1 patient had numbness of thigh and weakness of hip flexion after operation, 1 patient had sympathetic nerve trunk injury. All the cases were followed up 12-18 months, with an average of 14.3 months. The symptoms of low back pain, leg pain, and numbness of lower limbs significantly relieved after operation, and there was no complication such as protrusion of fusion cage, screw breakage, and endplate collapse. At 2 days after operation, the intervertebral height, degree of spondylolisthesis, sagittal diameter of spinal canal, and cross-sectional area of spinal canal significantly improved compared with preoperative ones (P<0.05). At 6 months after operation, CT showed that 1 patient had poor interbody fusion (grade Ⅲ), the other 20 patients had good interbody fusion (grade Ⅰ and Ⅱ), and the interbody fusion rate was 95.2%. At last follow-up, JOA score of lumbar spine significantly increased compared with that before operation (t=24.980, P=0.000).ConclusionOLIF combined with pedicle screw fixation via small incision Wiltse approach for the lumbar spondylolisthesis has minimally invasive features, such as less trauma, fewer complications, and higher intervertebral fusion rate. It is a safe and effective method.
Objective To review the application and progress of different minimally invasive spinal decompression in the treatment of lumbar spinal stenosis (LSS). Methods The domestic and foreign literature on the application of different minimally invasive spinal decompression in the treatment of LSS was extensively reviewed, and the advantages, disadvantages, and complications of different surgical methods were summarized. ResultsAt present, minimally invasive spinal decompression mainly includes microscopic bilateral decompression, microendoscopic decompression, percutaneous endoscopic lumbar decompression, unilateral biportal endoscopy, and so on. Compared with traditional open surgery, different minimally invasive spinal decompression techniques can reduce the operation time, intraoperative blood loss, and postoperative pain of patients, thereby reducing hospital stay and saving treatment costs. Conclusion The indications of different minimally invasive spinal decompression are different, but there are certain advantages and disadvantages. When patients have clear surgical indications, individualized treatment plans should be formulated according to the symptoms and signs of patients, combined with imaging manifestations.