ObjectiveTo compare the efficacy and safety of mitral valvuloplasty via minimally invasive approach with those of mitral valvuloplasty via traditional median sternotomy.MethodsA total of 1 221 patients undergoing mitral valvuloplasty from January 2015 to August 2018 in Guangdong Provincial People's Hospital were analyzed retrospectively, including 721 males and 500 females, with an average age of 47.2±15.1 years. According to the different surgical methods, they were divided into a study group (n=654), who received mitral valvuloplasty via the totally thoracoscopic approach, and a control group (n=567), who received mitral valvuloplasty via traditional median sternotomy. Clinical data, surgical results, and perioperative outcomes of the two groups were compared.ResultsThere was no significant difference in preoperative general data between the two groups (P>0.05). Compared with the control group, the study group had longer cardiopulmonary bypass time and aortic cross-clamping time (146.7±42.4 min vs. 122.7±30.6 min, 96.2±32.7 min vs. 78.3±23.8 min, both P=0.000), and shorter total operation time (227.4±55.3 min vs. 238.1±56.4 min, P=0.001). There was no significant difference in the incidence of secondary cross-clamping and mitral valve replacement between the two groups (3.7% vs. 2.6%, P=0.312; 1.7% vs. 1.4%, P=0.690). The blood transfusion rate and the incidence of respiratory tract infection and postoperative poor wound healing were lower (13.0% vs. 24.5%, 2.1% vs. 18.0%, 1.5% vs. 5.3%, all P=0.000) and the postoperative hospital stay was shorter (6.2±4.4 d vs. 11.5±8.8 d, P=0.000) in the study group. There was no significant difference in hospitalization expense between the two groups (95 847.9±31 322.0 yuan vs. 99 673.1±47 930.3 yuan, P=0.149). Within 30 d after surgery, 1 patient died in the study group and 4 patients died in the control group. Before discharge, there were 4 and 5 patients with severe mitral valve regurgitation in the study group and the control group, respectively.ConclusionCompared with mitral valvuloplasty via traditional median sternotomy, minimally invasive mitral valvuloplasty is superior in shortening operation time and postoperative hospital stay, lowering blood transfusion rate, and reducing postoperative complications, which can achieve better clinical outcomes.
ObjectiveTo investigate the effectiveness of posterior minimally invasive approach for internal fixation of displaced scapula fractures. MethodsBetween January 2006 and December 2011,16 patients with scapular fractures underwent surgical fixation by a minimally invasive approach,including 11 cases of displaced glenoid fractures and 5 cases of unstable scapular neck/body fractures.There were 12 males and 4 females,aged 35-69 years (mean,53 years).The causes of injury were traffic accident in 10 cases,falling from height in 4 cases,and tumble in 2 cases.In 11 cases of displaced glenoid fractures,6 were rated as Ideberg type Ⅱ,2 as Ideberg type Ⅲ,1 as Ideberg type IV,and 2 as Ideberg type V,with a fracture displacement of more than 3 mm.In 5 cases of unstable scapular neck/body fractures,there were 3 cases of scapular neck fractures and 2 cases of scapular body fractures,with a fracture end angulation of more than 20°;3 cases had floating shoulder injury.The interval of injury and operation was 4-14 days (mean,6 days). ResultsThe mean operation time was 105.8 minutes;the mean intraoperative blood loss was 105.8 mL,and the mean hospitalization time was 17.6 days.Three patients had inflammation around the surgical incision,which was controlled by change dressing;primary healing of incision was obtained in the others.The patients were followed up 12-36 months (mean,24 months);all fractures healed within 12-19 weeks (mean,15.8 weeks).There was no implant failure or deep infection.Constant shoulder score,disability of the arm,shoulder,and hand (DASH) score,and visual analogue scale (VAS) score at post-operation had a significant improvement when compared with scores at pre-operation (P<0.05),but no significant difference was found between different time points at post-operation (P>0.05).Shoulder joint activities were gradually restored during the follow-up;the shoulder range of motion in elevation,abduction,internal rotation,and external rotation at 12 months after operation and last follow-up were significantly higher than those at 6 months after operation (P<0.05),but difference was not significant between at 12 months and last follow-up (P>0.05). ConclusionPosterior minimally invasive approach for internal fixation has good effectiveness in treating displaced scapula fractures,with the advantages of no need for a large subcutaneous flap and an extensive Judet incision or creation of muscular flaps.
With the growing demand for total knee arthroplasty (TKA) in patients with end-stage knee osteoarthritis, the integration of minimally invasive surgical concepts with high-conformity personalized prosthesis design has become an important strategy for improving surgical precision and postoperative outcomes. However, standardized clinical pathway guidance for this combined approach remains lacking. Therefore, based on the current body of evidence and through multicenter expert collaboration, this consensus aims to establish a standardized clinical application protocol. The consensus focuses on the technical characteristics of high-conformity prostheses and the principles of mechanical alignment, and systematically develops a comprehensive clinical pathway covering preoperative digital planning, intraoperative precision techniques, and postoperative rehabilitation and follow-up. By standardizing patient selection criteria, refining imaging-based modeling and individualized prosthesis design procedures, optimizing osteotomy accuracy and soft tissue preservation under minimally invasive conditions, and establishing a follow-up system centered on functional baseline comparison and image-based matching verification, this consensus ultimately proposes a closed loop quality management framework spanning preoperative assessment, intraoperative implementation, and postoperative evaluation. It is expected to provide practical guidance for the safe and effective clinical application of high-conformity TKA performed through minimally invasive approaches.