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.
Objective To explore and summarize the application of minimally invasive technique to every stage of severe acute pancreatitis (SAP). Methods The treatment of 101 SAP patients admitted to our hospital between January 1995 and December 2008 were retrospectively analyzed. After calculi were removed by endoscopic retrograde cholangiopancreatograpy (ERCP) and endoscopic sphincterotomy (EST), endoscopic nasobiliary drainage (ENBD) were applied, then rhubarb liquid was perfused into gut with a nutrient canal and ultrasound-guided abdominal drainage tube were simultaneously placed at the early stage. Some patients received continuous renal replacement therapy (CRRT) at the same time. Laparoscopic cholecystectomy (LC) was performed at the subacute stage, and choledochoscope was introduced to remove parapancreatic necrotic tissues at the late stage of SAP.Results Of all the 101 cases treated by the method mentioned above, 75 cases received ERCP (or EST) and ENBD, and 31 cases underwent rhubarb liquid perfusion with a nutrient canal. Eight cases underwent continuous renal replacement therapy (CRRT). Forty-eight cases underwent LC and ultrasoundguided abdominal drainage. Thirtysix cases with infected peripancreatic tissue or abscess underwent debridement under choledochoscope 3 to 14 times at the later stage. Five cases died of multiple organ failure (MOF) and acute respiratory distress syndrome (ARDS). The hemobilia ocurred in 2 patients during choledochoscopy and was cured under direct visualization by electric coagulation. Intestinal fistula happened in 3 cases and cured by drainage. Pancreatic pseudocyst was latterly seen in 3 cases and treated by the anastomosis of cyst with jejunum through selective operation. After the hospitalization of 9-132 d (mean 24 d), 96 cases completely recovered. Conclusion Timely application of minimally invasive technique to every stage of SAP can avoid the defects of traditional operations, decrease the injury and interference to the maximum, and raise the cure rate.
Objective To summarize the cl inical appl ication of minimally invasive percutaneous locking compression plate (LCP) internal fixation in the treatment of tibial fractures and to evaluate its cl inical effects. Methods From September 2005 to September 2007, 13 patients with tibial fractures were treated with indirect reduction and minimally invasive percutaneous LCP internal fixation, 8 males and 5 females, aged 18-35 years old (27 on average). Among them, the fractures were caused by traffic accidents in 3 cases, by fall ing in 5 cases, by fall ing from height in 4 cases and by bruise in 1 case. The fractures were located at 1/3 upper tibia in 2 cases, at 1/3 medium tibia in 6 cases and at 1/3 lower tibia in 5 cases. All fracture were closed ones. According to the AO classification, 4 cases were type A, 7 type B and 2 type C. The time between fractures and operation was from 3 hours to 5 days (2.5 days on average). Results All incisions obtained heal ing by first intention. All patients were followed up for 10-18 months (13 months on average). All fractures reached cl inical heal ing, and the heal ing time was 12-20 weeks (16 weeks on average). There was no delayed fracture heal ing, nonunion, infection and internal fixation failure. No compl ications such as rotation, crispatura deformity and internal fixation loosening were found. According to the HSS scoring, the function of the knee joint was graded 85-95 (90 on average), and the range of motion was 100-130° (120° on average). According to the AOFAS Ankie Hindfoot Scoring, the function of the ankle joint was graded 80-95 (92.4 on average). Nine cases were excellent, 4 good, and the choiceness rate was 100%. Conclusion Minimally invasive percutaneous LCP internal fixation is in accord with biological set principles and beneficial for tibial fracture heal ing and reconstruction of soft tissues.
ObjectiveTo investigate the therapeutic evaluation of catheter-directed thrombolysis combined with multiple minimally invasive techniques of endovascular in the treatment of lower extremity atherosclerotic occlusive disease (ASO). MethodsClinical data of 64 ASO patients who were treated in our hospital from June 2011 to October 2014 were analyzed retrospectively. These patients were divided into two groups according to the therapies:33 patients were treated by catheter-directed thrombolysis combined with multiple minimally invasive techniques of endovascular (combination group), and the other 31 patients were only treated by multiple minimally invasive techniques of endovascular (intervention group). Comparison of the clinical indexes was performed between the 2 groups, including vascular patency rate, stent implantation rate, operation time, ankle-brachial index (ABI), saturation of blood oxygen (SO2) of toes, temperature of foot skin, amputation rate, and hospitalization expense. ResultsIn the same group (combination group and intervention group), compared with the time point of before operation, the clinical indexes of the ABI, SO2 of toes, and temperature of foot skin were higher after operation (P<0.05). At the same time point of before or after operation, there were no significant difference between the 2 groups in ABI, SO2 of toes, and temperature of foot skin (P>0.05). The vascular patency rate of combination group was higher than that of intervention group[97.0% (32/33) vs. 83.9% (26/31)], P<0.05. But the stent implantation rate[18.2% (6/33) vs. 64.5% (20/31)], amputation rate[3.0% (1/33) vs. 16.1% (5/31)], operative time[(2.0±0.5) h vs. (4.0±1.1) h], and hospitalization expense of patients who got successful limb salvage[(8 500±1 200) yuan vs. (34 000±2 100) yuan] of combination group were all lower or shorter than those of intervention group (P<0.05). After operation, there were no complication happened in the patients who got successful limb salvage of combination group (n=32) and intervention group (n=26). In postoperative 6 months, the lower extremity arteries in patients who got successful limb salvage of combination group and intervention group were all examined by color ultrasonography, and they were unblocked. The lower extremity arteries of the patients with stent implantation in the 2 groups suffered with no obvious stenosis or occlusion. ConclusionsCatheter-directed thrombolysis combined with multiple minimally invasive techniques of endovascular can become one of the surgical treatment methods for ASO, which characterized by minimally invasive operation, effective treatment, and low cost.
ObjectiveTo evaluate the effectiveness of transforaminal lumbar interbody fusion (TLIF) via Luxor retractor associated with Mantis pedicle screw for the treatment of moderate or severe lumbar spondylol isthesis (LSL). MethodsA retrospective analysis was made on the cl inical data of 32 patients with LSL treated with TLIF via Luxor retractor associated with Mantis pedicle screw between June 2010 and June 2012. There were 20 males and 12 females, with the mean age of 48 years (range, 36-69 years). LSL occurred at the L4, 5 in 17 patients and at the L5, S1 in 15 patients. Of them, 18 cases were rated as Meyerding grade Ⅱ, and 14 cases as grade Ⅲ. The disease duration was 8 months to 6 years (mean, 3.5 years). The operation time, intraoperative blood loss, and preoperative and postoperative (1 week and 1 year) intervertebral height and sl ipping angle were recorded, and the sl ipping rate was calculated; Japanese Orthopaedic Association (JOA) score was used for cl inical efficacy assessment. ResultsThe operation time was 90-130 minutes (mean, 110 minutes); intraoperative blood loss was 120-300 mL (mean, 210 mL). Incisions healed by first intention. All patients were followed up 24-36 months (mean, 28 months), and no complications of leakage of cerebrospinal fluid and nerve root injury occurred; X-ray films showed satisfactory reduction of spondylolisthesis and good position of pedicle screw and interbody fusion cage. The mean bone fusion time was 4.0 months (range, 3.8-6.0 months). The JOA score, sl i pping rate, sl i pping angle, and intervertebral height at 1 week and 1 year after operation were significantly improved when compared with preoperative ones (P<0.05), but no significant difference was found between at 1 week and at 1 year after operation (P>0.05). ConclusionTLIF via Luxor retractor associated with Mantis pedicle screw fixation is a safe and effective minimally invasive technique in treating moderate or severe LSL.
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 determine the feasibility and effectiveness of percutaneous endoscopic transforaminal discectomy (PETD) for recurrent lumbar disc herniation (RLDH). MethodsBetween June 2009 and December 2011, 56 patients with RLDH underwent PETD after local anesthesia, including 30 males and 26 females, with a mean age of 50 years (range, 24-70 years). The involved segments were L3, 4 in 3 cases, L4, 5 in 34 cases, and L5-S1 in 19 cases. Of 56 patients, 48 suffered from ipsilateral re-herniation, and 8 suffered from contralateral re-herniation. All the patients had a mean pain-free interval of 5.5 years (range, 6 months to 27 years). The visual analogue scale (VAS) score for back pain was 6.18±1.44 and the VAS score for leg pain was 7.66±1.03. Postoperative effectiveness was assessed based on the VAS score and modified MacNab criteria. ResultsThe mean operation time was 60.4 minutes (range, 30-100 minutes) and the mean duration of hospital stay was 5.1 days (range, 3-6 days). All patients were followed up 28.2 months on average (range, 24-56 months). Patients obtained immediate pain relief postoperatively. The postoperative VAS scores of back and leg pain at 1 month, 3 months, 12 months, and last follow-up were significantly decreased when compared with preoperative score (P<0.05). Based on the modified MacNab criteria, the results were excellent in 39 cases, good in 9 cases, fair in 5 cases, and poor in 3 cases at 12 months after operation, and the excellent and good rate was 85.7%. Surgery-related complications were found in 5 cases (8.9%); one patient (1.8%) suffered from recurrence at 18 months postoperatively, and the symptom was relieved after open lumbar discectomy and intervertebral fusion surgery. ConclusionPETD has several advantages in treating RLDH, such as avoiding from the old scar tissue, decreasing operation-related complications, shortening operation time, reducing trauma, and obtaining rapid postoperative recovery. This technique is feasible and effective for RLDH.
ObjectiveTo share the experience of treating special cardiac malformations by applying minimally invasive techniques.MethodsEight children with special cardiac malformations admitted to our hospital from July 2014 to September 2020 were recruited, including 3 males and 5 females, aged 0.8-1.2 (1.1±0.4) years, and weighted 7.8-11.5 (9.6±2.9) kg. There were 2 patients of huge muscular ventricular septal defect (VSD), 3 perimembranous cribriform VSD, 1 right coronary-right atrial fistula, 1 right coronary-right ventricular fistula, and 1 young, low-weight child with large aortopulmonary. All were treated with minimally invasive techniques using transesophageal echocardiography (TEE) as a guiding tool. All children received intraoperative TEE immediately to evaluate the curative effect of the surgery, and all went to outpatient clinic for reexamination of echocardiography, electrocardiogram and chest X-ray after discharge.ResultsEight children underwent minimally invasive surgery successfully without any incision infection, intracardiac infection, arrhythmia or pericardial effusion. None of the 8 children were lost to follow-up, and the results of all reexaminations were satisfactory.ConclusionThe application of minimally invasive techniques is a bold and innovative attempt for the treatment of a few special types of cardiac malformations. It has significant advantages in reducing trauma and medical costs in some suitable patients, and has certain clinical reference values.
Objective To review the application progress of minimally invasive technique in the treatment of calcaneus fractures and to analyze the advantages and disadvantages of each method as well as to predict the trend of development in the field. Methods Domestic and abroad literature concerning the minimally invasive technique applied in calcaneus fractures in recent years was reviewed extensively and analyzed thoroughly. Results There are both advantages and limitations of each minimally invasive technique including percutaneous reduction and fixation, limited incision, external fixator, arthroscopic assisted reduction, and balloon expansion reduction. But every technique is developing rapidly and becoming more and more effective. Conclusion A variety of minimally invasive technique can not only be used independently but also can be applied jointly to complement one another. It needs further study how to improve the effectiveness and expand the indications. And the theoretical basis of evidence-based medicine needs to be provided more.
ObjectiveTo investigate the early effectiveness of arthroscope for femoroacetabular impingement (FAI). MethodsBetween February 2012 and June 2014, 17 patients (17 hips) with FAI were treated under arthroscope. Of 17 patients, 12 were male and 5 were female, aged 18-60 years (mean, 37.2 years); 9 left hips and 8 right hips were involved. All patients had pain in groin for 12-24 months (mean, 15 months), no limited activity of the hip and obvious provocative pain in full flexion and internal rotation. The results of impingement test and the Faber test were all positive. According to X-ray examination, 8 cases were at early stage, 8 cases at middle stage, and 1 case at late stage; according to anatomical morphology, 6 cases were rated as cam-type impingement, 3 cases as pincer-type impingement, and 8 cases as mixed type. Based on impingement type, arthroscopic femoroplasty, arthroscopic acetabuloplasty, and a combination of arthroscopic femoroplasty and acetabuloplasty were performed on 6, 3, and 8 patients respectively. ResultsPrimary healing of incision was obtained. One patient had numbness in the lateral thigh, and symptom disappeared after 2 weeks. All cases were followed up 1-2 years (mean, 1.3 years). All patients obtained obvious hip pain relief. The postoperative Harris scores were significantly increased to 91.44±1.98 at 6 weeks, 95.83±0.53 at 3 months, and 95.33±2.43 at 1 year from preoperative 79.01±3.20(P＜0.05), and the scores at 3 months and at 1 year were significantly higher than that at 6 weeks (P＜0.05), but there was no significant difference between at 3 months and at 1 year (P>0.05). ConclusionArthroscope treatment of FAI can obviously relief hip pain. The key points for acquiring satisfactory early effectiveness are definite diagnosis, early detection, and minimally invasive treatment.