Objective To assess the effectiveness of a novel minimally invasive Achilles tendon suture instrument in the treatment of fresh closed Achilles tendon rupture. Methods A retrospective study was conducted on 150 patients who underwent surgical intervention for fresh closed Achilles tendon rupture. Eighty patients were treated with the novel minimally invasive Achilles tendon suture instrument (minimally invasive group) and 70 patients with traditional open surgery (traditional group). The two groups were comparable in terms of gender, age, injured side, cause of injury, the interval between injury and operation, and the distance from the fracture end to the calcaneal tuberosity (P>0.05). The operation time, intraoperative blood loss, incision length, hospital stays, hospitalization expenses, and complications were recorded and compared. At 1 year after operation, the ankle joint function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Results The minimally invasive group demonstrated significantly shorter operation time, smaller incision length, and lower intraoperative blood loss when compared with the traditional group (P<0.05). However, there was no significant difference in terms of hospital stays and hospitalization expenses between the two groups (P>0.05). All patients were followed up 12-24 months after operation (mean, 15.5 months). In the traditional group, 6 cases of incision necrosis and 7 cases of Achilles tendon adhesion occurred, while in the minimally invasive group, all incisions healed at first intention and no Achilles tendon adhesion occurred. The differences in the incidences of the two complications between the two groups were significant (P<0.05). At 1 year after operation, the AOFAS ankle-hindfoot score in the minimally invasive group was superior to that of the traditional group (P<0.05). Conclusion In comparison with traditional open surgery, the use of self-designed novel minimally invasive Achilles tendon suture instrument proves to be an ideal technique for treating fresh closed Achilles tendon ruptures. This approach offers the benefits of smaller incisions, fewer complications, and better postoperative functional recovery, without increasing hospital costs.
Objective To explore an effective micro-traumatechnic with small incision for hallux valgus. Methods From August 2002 to June 2004, 136 cases (263 feet) with hallux valgus were treated with micro-trauma technic with small incision and postoperative external elastic fixation. Of all the cases, 7 were males and 129 werefemales. Their ages ranged from 19 to 84 years. According to Coughlin classification, there were 24 gentle cases, 63 medium cases, and 49 severe cases. All the feet were with some degree of pain and flatfoot. Symptom, sign and theresults of X-ray were evaluated. Results Wound healed at stage Ⅰ.All cases were followed up for 8 to 26 months, 19 months on average. Hallux valgus of the 263 feet were completely healed, feet pain disappeared, and no nonunion or osteonecrosis was observed. Xray examination indicated that 105 feet’s hallux valgus angle was less than 12°, inter metatarsal angle less than 9°, and remedy subluxation of the tibial sesamoid less than 50%. Evaluation on the result indicated that there were 84 cases of excellent result, 48 cases of good result, 3 cases of fair result, and 1 case of poor result. The rate of excellent and good was 97%. Conclusion With less injury, less pain, complete restoration, and fewer possibility of relapse, microtrauma technic with small incision is effective in treating hallux valgus.
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.
ObjectiveTo evaluate the short-term effectiveness of percutaneous endoscopic lumbar discectomy (PELD) in treatment of buttock pain associated with lumbar disc herniation.MethodsBetween June 2015 and May 2016, 36 patients with buttock pain associated with lumbar disc herniation were treated with PELD. Of 36 cases, 26 were male and 10 were female, aged from 18 to 76 years (mean, 35.6 years). The disease duration ranged from 3 months to 10 years (mean, 14 months). The location of the pain was buttock in 2 cases, buttock and thigh in 6 cases, buttock and the ipsilateral lower extremity in 28 cases. Thirty-four patients had single-level lumbar disc herniation, and the involved segments were L4, 5 in 15 cases and L5, S1 in 19 cases; 2 cases had lumbar disc herniation at both L4, 5 and L5, S1. The preoperative visual analogue scale (VAS) score of buttock pain was 6.1±1.3. VAS score was used to evaluate the degree of buttock pain at 1 month, 3 months, 6 months, and last follow-up postoperatively. The clinical outcome was assessed by the modified MacNab criteria at last follow-up.ResultsAll patients were successfully operated and the operation time was 27-91 minutes (mean, 51 minutes). There was no nerve root injury, dural tear, hematoma formation, or other serious complications. The hospitalization time was 3-8 days (mean, 5.3 days). All incisions healed well and no infection occurred. Patients were followed up 12-24 months (median, 16 months). MRI examination results showed that the dural sac and nerve root compression were sufficiently relieved at 3 months after operation. Patients obtained pain relief after operation. The postoperative VAS scores of buttock pain at 1 month, 3 months, 6 months, and last follow-up were 1.1±0.6, 0.9±0.3, 1.0±0.3, and 0.9±0.4 respectively, showing significant differences when compared with preoperative VAS scores (P<0.05); there was no significant difference in VAS score between the different time points after operation (P>0.05). At last follow-up, according to the modifed MacNab criteria, the results were excellent in 27 cases, good in 9 cases, and fair in 2 cases, and the excellent and good rate was 94.4%.ConclusionPELD can achieve satisfactory short-term results in the treatment of buttock pain associated with lumbar disc herniation and it is a safe and effective minimally invasive surgical technique.
Objective To evaluate the security and effectiveness of minimal invasive fixation with fluoroscopybased navigation in the management of pelvic fractures. Methods From April 2007 to June 2008, 22 patients with pelvic fractures were treated with percutaneous screw fixation under the guidance of a fluoroscopy-based navigation system after closed reduction. There were 13 males and 9 females, aged 21-65 years old. Fractures were caused by traffic accident in 17 cases, andfall ing from height in 5 cases. According to AO classification, there were 2 cases of A2.2 type, 2 cases of A2.3 type, 7 cases of B1.2 type, 3 cases of B2.2 type, 1 case of B3.3 type, 2 cases of C1.2 type, 3 cases of C1.3 type, and 2 cases of C2.3 type. The interval from injury to hospital ization was 4 hours to 3 days (mean 1.2 days). After 3-13 days of skeletal traction through tibial tubercle, the operation was performed. Results Totally 42 screws were inserted. The average time for operation was 20.4 minutes per screw. Forty-one screws were inserted correctly with a successful insertion rate of 97.6%, only 1 hollow screw was reinserted for deviation. No incision problem and implant failure occurred. All 22 patients were followed up 7 to 21 months with an average of 14.5 months. At last follow-up, fracture union was achieved in all patients with satisfactory screw fixation. According to Majeed functional scoring, the results were excellent in 18 cases and good in 4 cases, with an excellent and good rate of 100%. Conclusion The minimal invasive fixation with fluoroscopy-based navigation makes the surgery for the pelvic fracture more precise and time-saving, and improves cl inical results without an increasing rate of compl ications.
ObjectiveTo explore the effectiveness difference between titanium elastic intramedullary nail internal fixation and bone plate internal fixation in the treatment of adult Galeazzi fracture.MethodsNinety-seven patients of Galeazzi fracture according with the selection criteria were divided into 2 groups by prospective cohort study, who were admitted between January 2012 and November 2015. In the patients, 59 were treated with open reduction and bone plate internal fixation (plate group), and 38 with titanium elastic intramedullary nail internal fixation (minimally invasive group). There was no significant difference in the gender, age, cause of injury, fracture site, type of fracture, and time from injury to operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, fracture healing time, and complications were recorded and compared between 2 groups, and the forearm function was evaluated by Anderson score.ResultsAll the patients were followed up 12-23 months (mean, 17 months). The operation time, intraoperative blood loss, fracture healing time of minimally invasive group were significantly less than those in plate group (P<0.05). There were 1 case of fracture nonunion, 1 case of wound infection in plate group, and 1 case of nail tail slight infection in minimally invasive group, which were all cured after the corresponding treatment. The remaining patients had good fracture healing, and no vascular injury, internal fixation failure, deep infection, or other complications occurred. According to Anderson score at 12 months after operation, the forearm function results were excellent in 46 cases, good in 12 cases, and poor in 1 case, with an excellent and good rate of 98.3% in plate group; and the results were excellent in 26 cases, good in 11 cases, and poor in 1 case, with an excellent and good rate of 97.4% in minimally invasive group; showing no significant difference (χ2=0.10, P=0.75).ConclusionMinimally invasive fixation with titanium elastic nail has such advantages as small damage, quick recovery, no skin scarring, etc. As long as the correct indication is selected, minimally invasive titanium intramedullary nail internal fixation of Galeazzi fractures can also get good effectiveness.
The article focuses on the recent progress in foot and ankle surgery, including the diagnosis of disease, treatment protocols, outcomes, and evaluation tools as well as other innovations. New and accurate diagnostic modalities and measurements have undergone a breakthrough. Diagnostic modalities tend to be simpler and less expensive. Measurement tools also change to simpler and more accurate. The accuracy and efficacy of surgery and the minimally invasive method have become more popular and important. New treatments and basic research have also made breakthroughs.