Objective To evaluate the short-term effectiveness of minimally invasive total hip arthroplasty (THA) by direct anterior approach (DAA). Methods Between January and August 2014, THA was performed on 48 patients (60 hips) by DAA (group A), and on 72 patients (92 hips) by posterolateral approach (group B). There was no significant difference in gender, age, etiology, course, and preoperative visual analogue scale (VAS), Harris hip score (HHS), and hip range of motion (ROM) between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospitalization time, incision healing, and complications were recorded and compared. The acetabular abduction and anteversion were measured on the X-ray films; prosthesis loosening was observed. The VAS score, HHS score, and hip ROM were used to evaluate the hip function. Results The operation time and intraoperative blood loss of group A were significantly higher than those of group B, and the hospitalization time was significantly lower than group B (P<0.05), but no significant difference was found in postoperative drainage between 2 groups (t=0.71,P=0.46). The patients were followed up 2-2.5 years (mean, 2.2 years) in group A, and 2-2.5 years (mean, 2.1 years) in group B. In group A, 3 cases had lateral femoral cutaneous nerve traction injury and 1 case had swelling and exudate, and primary healing of incision was obtained in the other cases of group A and all cases of group B. No periprosthetic joint infection occurred in the others of groups A and B except 1 case of group A at 2 months after operation, and infection was controlled after debridement, irrigation, and intravenous infusion of Vancomycin for 1 month. The X-ray films showed good position of prosthesis and no obvious radiolucent line or prosthesis loosening. There was no significant differences in acetabular abduction and anteversion between groups A and B at last follow-up (P>0.05). The VAS score, HHS score, and hip ROM at 3 months and last follow-up were significantly better than preoperative ones in 2 groups (P<0.05), but no significant difference was found between at 3 months and last follow-up (P>0.05). The VAS score, HHS score, and hip ROM in group A were significantly better than those in group B at 3 months postoperatively (P<0.05). At last follow-up, the hip ROM in group A was significantly better than that in group B (P<0.05), and there was no significant difference in VAS and HHS scores between group A and group B (P>0.05). Conclusion The short-term effectiveness of minimally invasive THA by DAA is satisfactory, with the advantage of little trauma, short hospital stay, and rapid postoperative recovery.
Objective To explore the feasibility and the effectiveness of the accurate placement of lumbar pedicle screws using three-dimensional (3D) printing navigational templates in Quadrant minimally invasive system. Methods The L1-5 spines of 12 adult cadavers were scanned using CT. The 3D models of the lumbar spines were established. The screw trajectory was designed to pass through the central axis of the pedicle by using Mimics software. The navigational template was designed and 3D-printed according to the bony surface where the soft tissues could be removed. The placed screws were scanned using CT to create the 3D model again after operation. The 3D models of the designed trajectory and the placed screws were registered to evaluate the placed screws coincidence rate. Between November 2014 and November 2015, 31 patients with lumbar instability accepted surgery assisted with 3D-printing navigation module under Quadrant minimally invasive system. There were 14 males and 17 females, aged from 42 to 60 years, with an average of 45.2 years. The disease duration was 6-13 months (mean, 8.8 months). Single segment was involved in 15 cases, two segments in 13 cases, and three segments in 3 cases. Preoperative visual analogue scale (VAS) was 7.59±1.04; Oswestry disability index (ODI) was 76.21±5.82; and the Japanese Orthopaedic Association (JOA) score was 9.21±1.64. Results A total of 120 screws were placed in 12 cadavers specimens. The coincidence rate of placed screw was 100%. A total of 162 screws were implanted in 31 patients. The operation time was 65-147 minutes (mean, 102.23 minutes); the intraoperative blood loss was 50-116 mL (mean, 78.20 mL); and the intraoperative radiation exposure time was 8-54 seconds (mean, 42 seconds). At 3-7 days after operation, CT showed that the coincidence rate of the placed screws was 98.15% (159/162). At 4 weeks after operation, VAS, ODI, and JOA score were 2.24±0.80, 29.17±2.50, and 23.43±1.14 respectively, showing significant differences when compared with preoperative ones (t=14.842,P=0.006;t=36.927,P=0.002;t=–36.031,P=0.001). Thirty-one patients were followed up 8-24 months (mean, 18.7 months). All incision healed by first intention, and no complication occurred. During the follow-up, X-ray film and CT showed that pedicle screw was accurately placed without loosening or breakage, and with good fusion of intervertebral bone graft. Conclusion 3D-printing navigational templates in Quadrant minimally invasive system can help lumbar surgery gain minimal invasion, less radiation, and accurate placement.
The replantation of amputated finger (or limb) and the reconstruction of the thumb and fingers started in 1960s in China. With the development of microsurgical techniques, both finger replantation and reconstruction achieved worldwide significant success. And now it is not the survival rate but the function of replanted finger that attracted more attention. Moreover, the breakthrough of particular type of digital replantation has broadened its indications. In terms of reconstruction, not only that a great deal of experiences in dealing with different types of thumb defects was accumulated, but also more micro-surgeons focus on minimal invasion and reducing the damage to the donor area.