Abstract： Objective To compare minimally invasive technique with multiple short incisions and traditional open technique for great saphenous vein (GSV) harvesting in coronary artery bypass grafting (CABG). Methods Fortyseven patients underwent first time CABG between November 2007 to January 2009. These patients included 37 males and 10 females with their age ranged from 43 to 78 years and their average age was 61.3±84 years old. The patients were prospectively randomized into the minimally invasive harvesting group (group A,n=21) and the traditional open harvesting group (group B, n=26). For group A, we adopted the method of minimally invasive technique with multiple short incisions, while for group B, the traditional long incisions were adopted. The incision length, GSV harvesting time, lower limbs suture time and incision complications were compared between the two groups. Results During harvesting, no injury to the saphenous vein trunk or complications related to the quality of venous grafts occurred in both groups. There were no significantly differences in the number of venous grafts and the GSV length between the two groups. Group A had significantly longer GSV harvesting time than group B (51.9±11.5 min vs. 40.3±7.6 min,P=0.000). However, incision length (16.1±4.1 cm vs. 49.2±7.2 cm, P=0.000), incision suture time (11.0±3.0 min vs. 33.6±4.8 min,P=0.000) and lower limbs total operation time (62.6±14.9 min vs.73.8±11.6 min,P=0.006) in group A were much shorter than those in group B. Fortyseven patients were followed up (100%) and the followup time ranged from 3 to 26 months. The rate of leg wound complications such as serous exudates, hematomas and wound infection was 4.8% (1/21) in Group A and 34.6% (9/26) in Group B. These complications were all cured with additional treatments. Group A had lower leg wound complication rate than Group B (Plt;0.05). Conclusion Our study demonstrates that minimally invasive technique for GSV harvesting can be performed at a satisfactory speed and helpful in decreasing the lower limb incision complication rate.
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.
【Abstract】 Objective To investigate the effectiveness of a percutaneous release with L shaped hollow needle knife in treating trigger finger. Methods Between September 2007 and September 2009, 160 patients with trigger fingers (202 fingers) were treated by percutaneous release with L shaped hollow needle knife. There were 47 males and 113 females with a mean age of 55 years (range, 12-68 years). The disease duration was 2 weeks to 1 year. Affected fingers included 58 thumbs, 20 index fingers, 46 middle fingers, 60 ring fingers, and 18 little fingers. According to Quinnell grading, 63 fingers were classified as grade III, 126 fingers as grade IV, and 13 fingers as grade V. A1 pulley was released during operation and steroid was injected after release procedure using the same needle. Results The mean operation time was 8.2 minutes (range, 5-19 minutes), and no complication occurred. All the patients were followed up 1 year to 3 years and 6 months (mean, 1.6 years). The patients still felt pain in 36 fingers at 1 week after operation, which were relieved after oral administration of non-steroidal anti-inflammatory drug. Twenty-five fingers had snapping or locking in flexion-extension motion; 5 fingers recovered at 1 month after operation and 20 fingers had no obvious improvement; of 20 fingers, symptom was alleviated in 10 fingers, and was not alleviated in 10 fingers after re-release with L shaped hollow needle knife. According to Quinnell grading for efficacy evaluation at 6 months after operation, the results were excellent in 165 fingers, good in 27 fingers, poor in 10 fingers with an excellent and good rate of 95.0%. Conclusion The percutaneous release with L shaped hollow needle knife is a safe and effective procedure in treating trigger finger with low complications.
Objective To compare the effectiveness of proximal femoral nail antirotation (PFNA) and reconstruction nail with minimally invasive technique for ipsilateral femoral shaft and extracapsular hip fractures in young and middle-aged patients. Methods Sixty-nine young and middle-aged patients with ipsilateral femoral shaft and extracapsular hip fractures were treated between January 2000 and August 2010, and their data were analyzed retrospectively. Of them, fractures were fixed by reconstruction nail in 44 cases (reconstruction nail group) and by PFNA in 25 cases (PFNA group). There was no significant difference in gender, age, weight, injury cause, fracture type, or disease duration between 2 groups (P gt; 0.05). The operation time, blood loss, fracture healing time, complications, and functional outcomes were compared between 2 groups to evaluate the effectiveness. Results The operation time and blood loss in the PFNA group were significantly less than those in the reconstruction nail group (P lt; 0.05). The follow-up time was 12-38 months (mean, 20 months ) in the PFNA group and was 12-48 months (mean, 22 months) in the reconstruction nail group. No complication occurred as follows in 2 groups: wound infection, deep venous thrombosis, pulmonary embolism, breakage of the implants, avascular necrosis of the femoral head, or serious rotation and shortening deformity of lower limbs. In the PFNA group and the reconstruction nail group, 1 patient underwent technical difficulty in nail implant and 7 patients underwent technical difficulty in proximal locking screw, respectively; 3 patients and 6 patients had intra-operative iatrogenic fracture of femoral shaft, respectively; and delayed union of femoral shaft was observed in 1 patient and 2 patients, respectively. The complication rate was 20% (5/25) in the PFNA group and 34% (15/44) in the reconstruction nail group, showing no significant difference (χ2=1.538, P=0.215). No significant difference was found in fracture healing time between 2 groups (P gt; 0.05). At last follow-up, there was no significant difference in Harris hip score and Evanich knee score between 2 groups (P gt; 0.05). Conclusion PFNA or reconstruction nail with minimally invasive technique is a good method to treat ipsilateral femoral shaft and extracapsular hip fractures, but the PFNA is superior to the reconstruction nail because of simple operation.
Objective To evaluate the surgical method and the results of endoscopic decompression and anterior transposition of the ulnar nerve for treatment of cubital tunnel syndrome. Methods Between May 2008 and August 2009, 13 cases of cubital tunnel syndrome were treated with endoscopic decompression and anterior transposition of the ulnar nerve. There were 4 males and 9 females with an average age of 47.5 years (range, 32-60 years). The injury was caused by fractures of the humeral medial condyle in 1 case, by long working in elbow flexion position with no obvious injury in 10 cases, and subluxafion of ulnar nerve in 2 cases. The locations were the left side in 6 cases and the right side in 7 cases. The disease duration was 4-30 months. The time from onset to operation was 3-20 months (mean, 8.5 months). Ten patients compl icated by intrinsic muscle atrophy. Results The operation was successfully performed in 13 cases, and the operation time was 45-60 minutes. All the wounds gained primary heal ing. All patients were followed up 12-18 months (mean, 14 months). The numbness of ring finger, l ittle finger, and the ulnar side of hand were decreased obviously on the first day after operation. The examination of electromyogram showed that the ulnar nerve conduction increased at 2 weeks, the ampl itude was improved, and recruitment of the intrinsic muscles of hand enhanced. In 10 cases compl icated by intrinsic muscle atrophy, myodynamia was recovered to the normal in 7 cases and was mostly recovered in 3 cases at 3 months after operation. The symptom of cubital tunnel syndrome disappeared and gained a normal function at 12 months after operation. According to the assessment of Chinese Medical Association and Lascar et al. grading criteria, the cl inical results were excellent in 10 cases and good in 3; the excellent and good rate was 100%. Patients recovered to work 12-16 days (mean, 14 days) after operation. No recurrence occurred during followup. Conclusion The surgical method of endoscope and microscope assisted three small incisions for treatment cubital tunnel syndrome has less invasion with small incision and complete decompression. Patients can recover to work early. It is a convenient and efficient procedure for treating cubital tunnel syndrome.
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 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.
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.
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 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.