目的 探讨前路小切口顶椎切除联合后路矫形手术治疗重度僵硬性脊柱侧凸的可行性及疗效。 方法 2009 年7月－2010年9月，采用前路小切口顶椎切除联合后路矫形手术治疗重度僵硬性脊柱侧凸18例。其中男9例，女9例，年龄10～24岁，平均14.5岁。其中15 例特发性脊柱侧凸（Lenke 2型6例，Lenke 3型1例，Lenke 4型8例），2 例脊髓空洞合并脊柱侧凸，1 例Chiari畸形合并脊柱侧凸。术前剃刀背高度（6.8 ± 2.3）cm，主胸弯Cobb角（99.6 ±10.0）°，主胸弯顶椎偏距（7.3 ± 1.3）cm。 结果 前路手术切口10～13 cm，平均（11.4 ± 1.0）cm；前路手术时间170～300 min，平均（215.3 ± 36.8）min；失血量300～1 300 mL，平均（662.5 ± 274.8） mL。所有患者随访25～39个月，平均30.7个月。末次随访时，剃刀背高度（1.0 ± 0.6）cm，矫正率86.7%；主胸弯Cobb角（31.4 ± 11.4）°，矫正率68.7%；主胸弯顶椎偏距（2.2 ± 0.9） cm，矫正率69.6%。上胸弯、胸腰弯/腰弯的Cobb 角及顶椎偏距亦明显矫正，冠状面及矢状面平衡与术前相比，差异无统计学意义（P＞0.05）。未发生神经系统并发症，1例患者在前路手术后入ICU行呼吸支持治疗12 h，1例患者出现椎弓根螺钉穿透椎弓根上壁，2例患者出现钛网位置不佳，随访未见钛网位置改变。 结论 采用前路小切口顶椎切除联合后路矫形治疗重度僵硬性脊柱侧凸安全可行，矫形效果满意。
目的 探讨胸部正中小切口在婴幼儿先天性心脏病手术治疗中的可行性及效果。 方法 将我院 2016 年 5 月至 2016 年 10 月 170 例行手术治疗的常见先天性心脏病婴幼儿患者分为两组：常规组，85 例，男42例、女43例，年龄（6.9±2.1）个月，采用常规胸部正中切口；小切口组，85 例采用胸部正中小切口，男43例、女42例，年龄（6.4±1.8）个月。小切口手术切口于平第 3 肋间切开，止于剑突起始处上 0.5 cm，刚好放入小胸骨撑开器为好。 结果 两组患儿体外循环时间差异无统计学意义（P>0.05）。小切口组手术时间略长（P<0.05）。两组预后没有差别，但是小切口组伤口长度显著缩短[（7.8±0.8） cmvs. （4.0±0.5）cm，P<0.05]。 结论 正中小切口基本具有胸骨正中切口的优点，可显露心脏各部位，满足绝大部分心脏探查和手术操作需要，必要时仍可向上延长切口使心内操作不受限制等优点，故认为正中小切口在婴幼儿心脏手术中具有良好的安全性和美观性。
Objective To explore the effect of minimally invasive and mini-incision surgery (MIS) in total hip arthroplasty (THA) on late osteonecrosis of femoral head (ONFH). Methods From March 2003, Eighteen patients (22 hips) with ONFH underwent MIS in THA. Their ages ranged from 24to 57 years, including 13 males and 5 females. The mean body mass index ranged from 17.1 to 30.1(24.6 on average). The Harris hip score was 46 points before operation. Modified posterior-lateral approach was adopted, and the MIS THA was performed by cementless prosthesis. As a comparison, 18 patients (22 hips) were performed by conventional THA at the same period. The data, including bleeding volume during operation, incision length, operative time, and postoperative function recovery, were compared. Results Follow-ups were done for 6 to 20 months (11 months on average). Dislocation occurred in one patient that underwent conventional THA 2 days after operation. No complication occurred in MIS THA group. The incision lengths ranged from 8.7 to 10.5 cm (9.3 cm on average) in MIS THA group, being statistically different (Plt;0.01). There was no significant difference in Harris scoring of the function between the two groups both before the operation and after the operation (Pgt;0.05). The operative time was almost the same, but the bleeding volume in MIS THA group was less (Plt;0.05). The function recovery was faster in MIS THA group.Conclusion The MIS THA is an alternative to the treatment of late ONFH. The advantages of MIS THA are fewer trauma, less bleeding volume, and faster recovery. The MIS THA should be performed by surgeons with rich experiences in THA and hospitals with necessary instruments.
Objectives To compare the clinical therapeutic effect of arthroscope and mini-open in treating rotator cuff impairment with Meta-analysi. Methods We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (Jun 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2007), MEDLINE, EMBASE, and CBM, conference proceedings and reference lists of articles. Selection criteria: Randomized or comparative studies on all arthroscopic rotator cuff repairs and mini-open repairs. Results There were no randomized controlled trials (Level I) was found. Pooled results from all 12 trials showed that postoperative shoulder pain in all arthroscope group was statistically less than in the mini-open group (RR=0.94, 95%CI 0.28 to 1.60). Meanwhile, another evaluates outcomes such as ROM-Forward flexion (RR=0.17, 95%CI –0.10 to 0.45), patient’s satisfaction (RR=1.03, 95%CI 0.98 to 1.08), complication (RR=1.11, 95%CI 0.54 to 2.27), and shoulder functional score (RR=0.04, 95%CI –0.10 to 0.19) indicated no statistical difference in two groups. Conclusions According to Limited evidence, there are some findings as follows: comparing with mini-open treatment of rotator cuff impairment, all arthroscopic surgery can reduce the shoulder pain. Moreover, we found no statistical difference in shoulder functional score, ROM-Forward flexion, patient’s satisfaction and complication. Attention should be paid to outcome assessment in future trials.
目的探讨小切口胆总管末端结石的治疗。方法对110例胆总管末端结石患者采用小切口术中胆道镜、气囊导管等治疗的临床资料进行回顾性总结。结果术中采用胆道镜、气囊导管等清除末端结石86例（78.2%）。术后用胆道镜取出结石10例（9.1%），胆道镜联合内镜乳头括约肌切开技术清除结石14例（12.7%）。术中18例(16.4%）并发胆总管末端医源性损伤，其中1例术后并发消化道大出血死亡，其余病例经2~20年随访无远期并发症。结论胆总管末端结石采用小切口术中胆道镜、气囊导管等相结合能清除多数结石，难以取出的末端结石于术后经内镜处理为妥。
Objective To investigate the surgical approach and efficacy of reconstruction of the isolated left vertebral artery (ILVA) in single upper hemisternotomy for total aortic arch replacement. Methods From March 2017 to October 2023, patients who underwent total aortic arch replacement under single upper hemisternotomy in General Hospital of Northern Theater Command were selected. According to the presence of ILVA, they were divided into a conventional group and an ILVA group. All the ILVA group underwent intraoperative ILVA reconstruction. The perioperative clinical data between two groups were compared. Results A total of 504 patients were collected, including 471 males and 31 females, with an average age of 50.4±11.4 years. There was no increase in the duration of cardiopulmonary bypass or postoperative hospitalization in the ILVA group (n=31) compared to the conventional group (n=473), and the rates of perioperative complications and in-hospital mortality were not significantly different between the two groups. There were 2 (6.45%) patients of acute cerebral infarction and 2 (6.45%) patients of perioperative death in the ILVA group, with no spinal cord injuries. Conclusion ILVA reconstruction during total aortic arch replacement in single upper hemisternotomy is feasible, safe, and effective, and prioritizing off pump ILVA-left common carotid artery transposition.
目的:报告电视胸腔镜辅助小切口(VATM)动脉导管(PDA)结扎手术的体会。方法:2004年元月至2008年12月,共施行VATM下PDA结扎术36例。手术采用传统右侧卧位,胸壁6cm长左右小切口,胸腔镜插入与操作切口为同一个切口。分离结扎PDA不需特殊器械,用10号慕丝线4根交叉作垫结扎。术毕不安置胸腔引流管。结果:手术平均时间为(71.3±12.5)min,术中出血量lt;20mL,术后4~7日出院。术后随访心脏杂音消失,无残余分流体征,全部恢复健康。结论:VATM结扎PDA具有创伤小,术后患者疼痛轻,恢复快,显著减少镇痛药和其它用药剂量及用药时间,缩短住院日,降低医药费,胸壁不留大的瘢痕,有较好美容效果等优点。