Objective To investigate the effectiveness of Y-shaped osteotomy for treatment of developmental coxa vara in children. Methods Between January 2008 and October 2011, 10 cases (14 hips) of developmental coxa vara were treated. There were 4 boys (5 hips) and 6 girls (9 hips), aged 5-12 years (mean, 7.8 years). All the children had obvious lameness and limitations of hip abduction, adduction, and rotation. The anteroposterior pelvic X-ray films showed that the collodiaphysial angle ranged from 46 to 110° (mean, 87°); Hilgenreiner-epiphyseal angle (HE) ranged from 36 to 93° (mean, 57°); and the articulotrochanteric distance (ATD) ranged from — 25 to 6 mm (mean, — 3 mm). The subtrochanteric Y-shaped osteotomy was performed and angle steel plate was used for internal fixation. Results All incisions healed by first intention without surgery-related complication. All cases were followed up 14-40 months (mean, 18 months). The symptom of lameness disappeared or obviously alleviated; the range of motion of hip abduction, adduction, and rotation were increased. Postoperative X-ray films showed that the vertical epiphyseal plate of proximal femur was returned to the horizontal. After operation, the collodiaphysial angle was 130-153° (mean, 137°); HE angle was 23-35° (mean, 27°); and the ATD was 3-22 mm (mean, 14 mm). According to LIU Jiande’s assessment standards, the results were excellent in 5 hips, good in 8 hips, and fair in 1 hip, and the excellent and good rate was 92.8%. The other children had no recurrence of coxa vara except 1 case after 30 months. Conclusion The Y-shaped osteotomy is a simple and effective method to treat developmental coxa vara in children, which can fully correct the deformity, and patients can exercise early because of firm internal fixation.
ObjectiveTo investigate the short-term effectiveness of MAKO robot assisted complex total hip arthroplasty (THA). Methods The clinical data of 15 patients (17 hips) underwent MAKO robot assisted complex THA between May 2020 and June 2021 were analyzed retrospectively. There were 5 males and 10 females with the age ranged from 19 to 70 years (median, 49 years), included 9 cases (9 hips) of developmental dysplasia of the hip (Crowe type Ⅱ in 5 hips, type Ⅲ in 1 hip, and type Ⅳ in 3 hips), 1 case (2 hips) of rheumatoid arthritis, 2 cases (3 hips) of ankylosing spondylitis, 3 cases (3 hips) of secondary arthritis with a history of acetabular fracture and internal fixation. The acetabular cup abduction angle and anteversion angle were measured at 3 months after operation, and compared with those measured by MAKO robot system before and immediately after operation. The femoral offset and leg length discrepancy (LLD) were measured at 3 months after operation, which were compared with those before operation. Harris hip score (HHS) and visual analogue scale (VAS) score were used to evaluate hip function before operation and at 3 months after operation. Results All 15 patients (17 hips) completed the operation successfully. The operation time was 75-175 minutes, with an average of 116.3 minutes; the intraoperative blood loss was 100-800 mL, with an average of 381.3 mL. Two patients were not included in the statistics because of intraoperative and postoperative complications, the remaining 13 patients (15 hips) had no serious complication such as vascular and nerve injuries, and 3 patients had intermuscular vein thrombosis. The 13 patients (15 hips) were followed up 3-15 months, with an average of 8 months. At last follow-up, the position of prosthesis did not change and there was no signs of loosening. There was no significant difference in acetabular abduction angle at immediate and 3 months after operation when compared with preoperative one (P>0.05), and the acetabular anteversion angle was significantly lower than that before operation (P<0.05). There was no significant difference in acetabular abduction angle and anteversion angle between at immediate and 3 months after operation (P>0.05). The LLD, offset, HHS score, and VAS score were significantly improved at 3 months after operation when compared with preoperative ones (P<0.05). Conclusion MAKO robot assisted complex THA can achieve good short-term effectiveness, improve the hip range of motion, reduce the length difference between bilateral lower limbs, and improve the quality of patients’ life.
Objective To summarize the clinical experience of treating adults with pectus excavatum by newly modified orthopedicsteel plate and Nuss procedure. Methods The clinical data of 190 adults with pectus excavatum treated by newly modified Nuss procedure in Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine from January 2011 to June 2016 were collected. There were 151 males and 39 females aged 21.80±3.96 years ranging from 18 to 45 years. The therapeutic efficacy, Haller index and the lung function index were also analyzed. Results All patients recovered well after the operation. Two orthopedic steel plates were implanted in 12 patients. Pneumothorax was found in 7 patients postoperatively and 2 of them was treated by puncture extraction. There were 5 patients with poor healing of incision and all of them were healed after the debridement. Other complications such as steel plate shift was found in 2 patients. Both of them recovered after the reoperation. The duration of operation was 36–65 min. The intraoperative blood loss was 5–20 ml. Postoperative hospital stay was 4–7 days. Haller and lung function index improved after the operation (P<0.001). Conclusion It is effective and safe to treat the pectus excavatum by newly modified orthopedic steel plate and Nuss procedure in adult patients.
ObjectiveTo explore the surgical design and efficacy of novel modified Nuss procedure for pectus excavatum (PE).MethodsWe retrospectively analyzed the clinical data of 903 patients with PE who were treated by the new kind of steel bar and the novel modified Nuss procedure. There were 716 males and 187 females at mean age of 2-45 (12.1±6.8) years. Preoperative chest CT scans Haller index (HI) was 3.1-15.2 (4.6±1.3), with 38 patients of mild PE (HI<3.2), 302 patients of moderate PE (HI 3.2-3.5), 521 patients of severe PE (HI 3.6-6.0), and 42 patients of extremely severe PE (HI>6.0). The operative time, operative blood loss, hospital stay time as well as postoperative complications were reviewed and analyzed.ResultsAll of the 903 patients successfully completed the surgery. The mean operative time was 20-45 (25.2±2.6) min for primary PE and that for special type of PE (including recurring PE, PE patients after heart disease operation and those corrected by 2 bars) was 48-150 (63.5±28.1) min. Blood loss was less than 10 mL for primary PE and 15-50 (23.5±5.5) mL for special type of PE. Postoperative hospital stay was 3-15 (4.5±1.6) d. A total of 845 patients (93.6%) required 1 steel bar insertion, 58 patients (6.4%) required 2 steel bars. Postoperative evaluation of the surgery outcomes revealed the following: excellent in 805 patients, good in 84 patients, fair in 14 patients and poor in 0. The good quality rate was 98.4%.ConclusionNovel modified Nuss procedure can simplify and optimize the surgical design with good short and mid-term effects.
ObjectiveTo summarize the experience of treating adult recurrent pectus excavatum without plate turnover.MethodsTwenty-seven patients with recurrent pectus excavatum treated by thoracoscopy-assisted placement without plate turnover from 2010 to 2019 in our hospital were enrolled. There were 23 males and 4 females with the age of 3-29 (12.81±7.79) years at the first operation, and 18-29 (21.74±3.56) years at this operation. Incision of 2-3 cm at bilateral axillary midline of the deepest point of pectus excavatum was made, and an auxiliary incision under xiphoid process was adopted according to the intraoperative situation.ResultsAll patients underwent thoracoscopy-assisted correction of pectus excavatum without bar turnover, and subxiphoid incision was performed in 11 patients. Twenty-five patients had one bar placed, and two patients required two bars. The operation time was 28-45 (33.00±6.44) min. Postoperative Haller index (2.95±0.40) was improved compared with preoperation (4.63±1.03). The postoperative hospital stay was 4-6 (4.00±0.32) day. All patients were followed up for 1-8 years. Complications included poor wound healing in 1 patient, and steel wire fracture and displacement in 1 patient. There was no plate rotation or bar displacement. Fourteen patients removed the bar 29-84 (40.36±13.93) months after the placement. Haller index was improved to 2.43-3.61 (2.86±0.35) during removal of steel plate. Untill June 2020, there was no recurrence of pectus excavatum.ConclusionThe treatment of adult recurrent pectus excavatum without plate turnover is satisfactory, and the protection of intercostal muscle and firm fixation is the key to ensure the success of operation and long-term effects.
Objective To investigate the difference of total knee arthroplasty (TKA) with tantalum monoblock tibial component (TMT) and cemented tibial plateau prosthesis in patients of different ages. Methods The clinical data of 248 patients (392 knees) who underwent primary TKA between May 2014 and May 2019 and met the selection criteria were retrospectively analyzed. There were 54 males (98 knees) and 194 females (294 knees). Of the 122 patients (183 knees), less than 65 years old, 52 (75 knees, group A1) were treated with TMT and 70 (108 knees, group B1) were treated with cemented tibial plateau prosthesis; of the 126 patients (209 knees), more than 65 years old, 57 (82 knees, group A2) were treated with TMT and 69 (127 knees, group B2) were treated with cemented tibial plateau prosthesis. The baseline data of patients, perioperative indicators [hemoglobin (Hb), hematocrit (Hct), total blood loss, unilateral operation time], effectiveness evaluation indicators [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, visual analogue scale (VAS) score, Knee Society Scoring System (KSS) score, active flexion and extension range of motion (ROM) of the knee joint], complications, and imaging indicators [tibial prosthesis varus angle (β angle), tibial prosthesis posterior slope angle (δ angle), tibio-femoral angle, occurrence of radiolucent line, prosthesis survival rate] were recorded and compared. Results There was no significant difference in gender, age, height, weight, body mass index, Kellgren-Lawrence grading, the length of hospital stay, and follow-up time between groups A1, B1 and groups A2, B2 (P>0.05). The unilateral operation time in groups A1 and A2 was significantly shorter than that in the corresponding groups B1 and B2 (P<0.05). There was no significant difference in differences of pre- and post-operative Hb and Hct and total blood loss between groups A1, B1 and groups A2, B2 (P>0.05). There was no significant difference in preoperative effectiveness evaluation indicators between groups A1, B1 and groups A2, B2 (P>0.05). There were significant differences in the differences of pre- and post-operative WOMAC activity and pain scores, KSS function and pain scores, and VAS scores between groups A1 and B1 (P<0.05); there was no significant difference in WOMAC stiffness score and ROM (P>0.05). There was no significant difference in the above indicators between groups A2 and B2 (P>0.05). There was no significant difference in the incidence of complications (2.7% vs 6.5%, 3.7% vs 3.1%) and prosthesis survival rate (100% vs 97.2%, 100% vs 99.2%) between groups A1, B1 and groups A2, B2 (P>0.05). During follow-up, there was no significant difference in β angle, δ angle, and tibio-femoral angle between groups A1, B1 and groups A2, B2 (P>0.05). In the evaluation of knee X-ray radiolucent line, 2 knees of group A1 and 2 knees of group A2 had radiolucent line at prosthesis-bone interface immediately after operation, and the radiolucent line was gradually filled by new bone, without new radiolucent line. During follow-up, 1 knee of group B1 and 1 knee of group B2 had prosthesis-bone interface radiolucent line, without radiolucent line widening or prosthesis loosening. Conclusion TMT is recommended in patients less than 65 years old, and the two types of prostheses are available for patients nore than 65 years old. However, the long-term effectiveness of the two types of prosthesis in patients of different ages needs further follow-up.
Objective To compare the short-term outcomes of small thoracotomy and thoracoscopic approach for pediatric lobectomy. Methods From June 2011 to June 2016, 42 patients with lung diseases undertook lobectomy in Xinhua Hospital. There were 24 males and 18 females with an average age of 7.13±5.00 years, ranging from 4 months to 16 years. According to different operation methods, they were divided into a thoracoscopy group (n=22) and a small incision group (n=20). Duration of operation, intraoperative blood loss, duration of postoperative drainage, and postoperative hospital stay and complications between the two groups were recorded and compared. Results There was no significant difference in the age, body weight between the two groups (8.44±4.99 yearsvs. 5.68±4.69 years,t=1.84,P=0.07; 34.18±16.52 kgvs. 25.03±18.06 kg,t=1.72,P=0.09). Two patients (9%) undergoing thoracoscopy required conversion to small thoracotomy. Perioperative outcomes, including operation time (151.64±74.59 minvs. 136.40±50.36 min,t=0.77,P=0.45), intraoperative blood loss (43.41±45.91 mlvs. 79.50±131.00 ml,t=–1.21,P=0.23), drainage duration (5.00±1.79 dvs. 4.90±2.36 d,t=0.23,P=0.82), length of hospital stay (8.41±3.11 dvs. 8.65±2.66 d,t=–0.27,P=0.79) showed no significant differences between the two groups. One patient suffered pneumonia in thoracoscopy group after operation and the rest patients recovered well without severe complications such as atelectasis, active bleeding and bronchopleural fistula. Conclusion Lobectomy via small thoracotomy and thoracoscopic approach is effective and safe for pediatric patients with equivalent short-term outcomes. While thoracoscopic surgery with relatively small incision achieves good cosmetic outcome.
Objective To introduce the surgical and perioperative strategy for giant mediastinal mass. Methods The clinical data of 21 patients with giant mediastinal mass who underwent surgical treatment in Xinhua Hospital of Shanghai from January 2007 to July 2016 were retrospectively reviewed. There were 14 males and 7 females, with a mean age of 34.62 ± 22.95 years (range: 11 months to 79 years), and mean weight of 58.07±22.24 kg (range: 10.8 to 90.5 kg). Their clinical manifestation, anesthesia methods, surgical treatment and the prognosis were analyzed. Results The tumor volume ranged from 8 cm×6 cm×6 cm to 25 cm×25 cm×8 cm. For surgical approach, 12 patients received median sternotomy, 5 anterior lateral incision, 1 posterior lateral incision, 2 "L"-shape sternotomy, 1 cervical and thoracic "]"-shape incision. All patients were given mass radical resection, except one patient with two-stage resection. Twelve patients needed other tissues resection besides the single tomor resection. The operation time was 55-480 (207.86±87.67) min, blood loss volume 700 (10-4 000) ml, intraoperative blood transfusion 800 (0-4 100) ml, postoperative mechanical ventilation time 4.75 (0-87) h, postoperative drainage time 3-12 (7.43±2.66) d, the total drainage volume 295-4 940 (1 584.76±1 173.98) ml, average daily drainage volume 62-494 (204.90±105.76) ml, and postoperative hospital stay 7-47 (11.86±8.51) d. The postoperative complications included pericardial effusion in 1 patient, Horner syndrome in 1, left recurrent laryngeal nerve injury with the left phrenic nerve injury in 1, right phrenic nerve injury in 1 and delayed wound healing in 1. The remaining patients recovered well. All patients were followed up for 1 month to 9 years. Till September 1, 2016, 5 patients died and 2 suffered recurrent tumor. Conclusion It is safe to perform surgical treatment after comprehensive evaluation of patients with giant mediastinal mass, perioperative mortality is low, and prognosis in patients with benign tumor is good.
Objective To explore the feasibility and efficacy in therapy of pectus excavatum using novel modified Nuss procedure after congenital heart disease (CHD) operation. Methods Thirty-six children (including 22 males and 14 females with an average age of 4.5±2.2 years ranging 2.8-18.0 years) with pectus excavatum after CHD operation from January 2011 to March 2015 were selected as an observation group. Thirty-eight pectus excavatum children (including 24 males and 14 females with an average age of 4.0±2.5 years ranging 2.8-20.0 years) without CHD from July to September 2013 were selected as a control group. The novel modified Nuss procedure was performed on the patients in both groups. The operation time, intraoperative blood loss, hospital stay as well as postoperative complications between two groups were reviewed and analyzed. Results In the observation group, the operation time was 50-72 (60.50±3.60) min and hospital stay was 4-6 (4.41±0.80) d. Meanwhile, the intraoperative blood loss was 5-10 (5.82±0.35) ml. In the control group, the operation time was 12-45 (20.15±0.68) min, hospital stay was 4-7 (4.61±0.63) d and the intraoperative blood loss was 3-8 (4.62±0.28) ml. The operation time was significantly longer in the observation group than that in the control group (P<0.05). But there was no significant difference in intraoperative blood loss or hospital stay between the two groups (P>0.05). No cardiac rupture happened in the two groups. Conclusion The novel modified Nuss procedure is safe and feasible for pectus excavatum after CHD operation with optimal outcomes.
Objective To share the experience of single-stage bilateral pulmonary resections by video-assisted thoracic surgery (VATS) for multiple nodules. Methods Clinical records of patients undergoing one-stage bilateral resections of multiple pulmonary nodules between January 2015 and December 2016 in our institution were retrospectively reviewed and analyzed. There were 9 males and 15 females, aged from 33 to 69 (55.0±8.0) years. Two patients underwent bilateral lobectomy. Lobar-sublobar (L/SL) resection and bilateral sublobar resection (SL-SL) were conducted in 9 patients and 13 patients respectively. Results All operations completed successfully. Operation time was 135–330 (231.4±59.1) min, duration of use of chest drains was 2–17 (5.4±3.1) days. Overall duration of hospitalization after surgery was 5–37 (8.6±6.3) days. There was no perioperative death. Postoperative course was uneventful in 17 (70.8%) patients. The postoperative complications included one patient of incision infection and one patient of pulmonary infection. Persistent air leak for >3 days duration and unilateral pleural drainage for more than 200 ml/d were observed in 3 patients and 2 patients respectively. Conclusion Single-stage bilateral surgery in selected patients with synchronous bilateral multiple nodules is feasible and associated with satisfactory outcomes.