Objective To summarize the treatment method and to analyze short-term therapeutic effect of Pipkin fracture. Methods From January 2002 to January 2007, 14 cases of Pipkin fracture were treated. There were 10 males and 4 females with an average of 33.5 years (ranged from 28 to 52 years). Fractures were caused by traffic accident. According to Pipkin’s classification, there were 4 cases of type I, 6 cases of type II, 2 cases of type III and 2 cases of type IV. The time from injury to operation was 24 hours to 8 weeks. All patients received open reduction under Kocher-Langenbeck approach, mel iorative posterior-lateral approach or combined approaches. Absorbable screws and suture l ine internal fixation wereperformed in fracture of the femoral head, titanium cannulated screws were used to fix the femoral intertrochanteric fracture in type III, and acetabular tridimensional memory fixation systems were used to fix the posterior acetabular fractur in type IV. Results All cases had one-stage wound heal ing, no compl ications of deep infection and thrombosis of deep vein of lower l imb occurred. All the patients were followed up for 12 - 48 months (mean 26 months). One case of type III fracture for Pipkin had necrosis of femoral head after 1 year of reduction and fixation, and received total hip replacement; other patients achieved bony heal ing after 6-10 months (mean 8 months). According to D’Aubigue-Postel score, the results were excellent in 5 cases, good in 6 cases, fair in 2 cases and poor in 1 case; the excellent and good rate was 78.6%. Conclusion It is important for the patients with Pipkin fracture to early diagnose, to select proper operation approach, to stably fix fracture and to manage after operation in reducing compl ication and recovering hip joint function.
ObjectiveTo investigate the short-term effectiveness of minimally invasive percutaneous plate osteosynthesis (MIPPO) in treatment of anterior pelvic ring fractures. MethodsBetween January 2012 and October 2013, 16 patients with anterior pelvic ring fractures were treated with MIPPO. There were 10 males and 6 females at the age of 20-63 years (mean, 41 years). The causes of injury were traffic accident in 9 cases and falling from height in 7 cases. The duration of injury to admission was 2 hours to 5 days (mean, 1 day). According to Tile classification, 8 cases were rated as type B2, 4 cases as type B3, 2 cases as type C1, and 2 cases as type C2. Of them, 2 cases had iliac wing fracture, and 4 cases had pelvic posterior ring fracture. The time from admission to operation was 3-12 days (mean, 6 days). ResultsThe bleeding volume was 60-120 mL (mean, 70 mL). All wounds healed by first intention. No postoperative complication of deep venous thrombosis or long-term continuous pain occurred. All cases were followed up 5-27 months (mean, 11.5 months). No clinical manifestation of lateral femoral cutaneous nerve injury or spermatic cord injury was found, and cremasteric reflex existed in males. All cases obtained bony union, and the healing time was 12-16 weeks (mean, 13 weeks). During the follow-up period, no loss of fracture reduction and no internal fixation loosening or broken were observed. According to Matta radiological evaluation criterion, 16 cases had anatomical reduction, and 3 cases had satisfactory reduction; according to Majeed scoring system of pelvic fracture, the results were excellent in 12 cases and good in 4 cases. ConclusionMIPPO for treatment of anterior pelvic ring fractures has the advantages of less intraoperative blood loss, few soft tissue complications, and low infection rate, and can get satisfactory short-term effectiveness.
Objective To investigate the short-term effectiveness of reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach for complex acetabular fractures. Methods Between January 2015 and January 2020, 30 patients with complex acetabular fractures were treated with reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach. There were 20 males and 10 females with an average age of 52.1 years (range, 25-71 years). The cause of injury included traffic accident in 17 cases and falling from height in 13 cases. Among them, 14 cases were left acetabular fractures and 16 cases were right acetabular fractures. According to Letournel classification, there were 16 cases of double column fractures, 2 cases of transverse fracture with posterior wall fracture, 4 cases of anterior column and posterior hemi-transverse fractures, 8 cases of T-shaped fracture. The displacement distance of fracture ranged from 6 to 30 mm (mean, 11.6 mm). The time from injury to operation was 6-14 days (mean, 8.7 days). Results The operation time was 2.0-4.5 hours (mean, 3.0 hours). The intraoperative blood loss was 200-800 mL (mean, 450.0 mL). All patients were treated with autologous blood transfusion during operation. All incisions healed by first intention after operation, and no infection occurred. All patients were followed up 12-15 months (mean, 13.4 months). The drainage tube was removed at 2-3 days after operation. After extubation, X-ray film and three-dimensional CT were performed to recheck the fracture reduction. According to Matta score system, 20 cases were excellent, 5 were good, and 5 were poor, the excellent and good rate was 83.3%. All fractures healed with the healing time of 16-25 weeks (mean, 17.7 weeks). According to Merle d’Aubigne-Postel score system, the hip function at 1 year after operation was rated as excellent in 18 cases, good in 6 cases, and fair in 6 cases, and the excellent and good rate was 80.0%. Two cases suffered from sciatic nerve injury due to traction during operation, 7 cases had heterotopic ossification, 2 cases had traumatic hip arthritis, and no other complications occurred. Conclusion For complex acetabular fractures, the reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach can obtain good short-term effectiveness with good reduction and hip joint function, and less complications.
ObjectiveTo investigate the feasibil ity and short-term effectiveness of percutaneous endoscopic spine surgery for treatment of lumbar disc herniation with posterior ring apophysis separation. MethodsBetween July 2008 and January 2013, 57 patients with lumbar disc herniation and posterior ring apophysis separation were treated. There were 39 males and 18 females, aged from 13 to 46 years (mean, 26.7 years). Of 57 cases, 29 had a clear trauma history. All patients had single segmental unilateral lumbar disc herniation, and the location was at L4, 5 in 22 cases and at L5, S1 in 35 cases; there were 25 cases of lateral bone fragments and 32 cases of central cortical and cancellous fragments. While fracture located at posterior inferior edge of the vertebrae at L4 level in 9 cases and at L5 level in 8 cases, at posterior superior edge at L5 level in 13 cases and in S1 level in 27 cases. Percutaneous endoscopic surgeries were performed via interlaminar or transforaminal approach from unilaterally symptomatic side for discectomy of lumbar disc herniation and partial or complete resection of free bone fragments. ResultsAccurate positioning was obtained in all patients during operation, and no complication of nerve root injury, hematoma formation, or dural tear occurred. The operation time was 20-85 minutes; the intraoperative fluoroscopy times were 2-15 times, and the blood loss was 3-10 mL. Postoperative radiographic examination showed that bone fragment was not removed in 16 cases, was partly removed in 32 cases, and was completely removed in 9 cases. Disc was completely removed. All patients were followed up 10-64 months (median, 16 months). According to modified Macnab criteria for the evaluation of effectiveness, the results were excellent in 48 cases, good in 6 cases, and fair in 3 cases, and the excellent and good rate was 94.7%. ConclusionPercutaneous endoscopic spine surgery through unilaterally symptomatic approach has advantages of small tissue damage and lumbar structure damage, less bleeding, and shorter recovery time. It has a good short-term effectiveness, but long-term effectiveness need further follow-up.
Objective To discuss whether age has an influence on short-term effect of intersphincteric resection (ISR) for elderly (≥75 years old) patients with ultra-low rectal or canal cancer or not. Methods From February 2016 to February 2017, 196 patients with ultra-low rectal or canal cancer received ISR in the Gastrointestinal Surgery Center of West China Hospital were eligible to include in this study, then they were divided into ≥75 years old group and <75 years old group according to the patients’ age. The intraoperative index, postoperative index, and complications rate were compared between these two groups. Results There were 113 cases in the ≥75 years old group, 83 cases in the <75 years old group, the baselines such as the gender composition, body mass index, tumor histology type, differentiation degree, tumor size, and distance from the anal margin had no significant differences ( P>0.05), but the preoperative anaesthetized ASA grade, proportions of pulmonary insufficiency, hypoproteinemia, anemia, hypertension, diabetes, and cardiac insufficiency of the ≥75 years old group were significantly higher than those of the <75 years old group (P<0.05). The operative time, intraoperative bleeding, and total complications rate had no differences between these two groups (P>0.05), the first exhaust time, the first eating time, the first defecation time, the first ambulation time, and hospitalization time of the ≥75 years old group were significantly longer than those of the <75 years old group (P=0.023, 0.037, 0.019, 0.020, and 0.012, respectively). There were no significant differences in the incidences of the anastomotic leakage, perianal infection, intestinal obstruction, and wound infection between these two groups (P>0.05). All the 196 patients were followed-up with an average follow-up of 7 months, there were 4 cases of recurrent patients, of which 3 were in the ≥75 years old group and 1 in the <75 years old group; there were 3 cases of death, of which 2 were in the ≥75 years old group and 1 in the <75 years old group. Conclusions Short-term recovery of elderly patients with ultra-low rectal or canal cancer is slower than younger patients because of poor preoperative conditions. ISR surgery is still safe and effective for elderly patients with ultra-low rectal or canal cancer and postoperative complications rate has no obvious increase, but it needs a surgeon’s skilled operation technology and multi-disciplinary team cooperation.
Objective To investigate the surgical technique and short-term effectiveness of anterior cruciate l igament (ACL) reconstruction with LARS artificial l igament. Methods Between November 2008 and April 2010, eighty patients withACL injury were treated with LARS artificial l igament under arthroscope and successfully followed up. There were 51 males and 29 females, aged from 17 to 43 years with an average of 29.2 years. The injuries were caused by sport in 63 cases, traffic accident in 14 cases, and bruise in 3 cases. There were 43 left knees and 37 right knees. The disease duration ranged from 10 days to 11 months. The anterior drawer test, Lachman test, and pivot shift test for all cases were rated as positive. The preoperative Lysholm score was 55.4 ± 5.7, Irgang score was 48.3 ± 6.2, and Larson score was 54.8 ± 7.4; and the International Knee Documentation Committee (IKDC) score was lower than normal level in all cases. Obl ique coronal MRI showed ACL injury in all cases. Residual ACL and synovium were preserved during surgery. Results All incisions healed by first intention without compl ication of infection or deep venous thrombosis. All patients were followed up 7 to 24 months with an average of 16.8 months. There were 3 cases of screws exposure toward femoral cortical bone, 2 cases of loosening tibial screw, and 1 case of knee extension l imitation, and they were cured after symptomatic treatment. No LARS artificial l igament rupture and joint fibrosis occurred during followup. At last follow-up, the results of anterior drawer test, Lachman test, and pivot shift test were positive in 2, 3, and 3 patients,respectively. There were significant differences in Lysholm, Irgang, and Larson scores of affected knees between preoperation and 6 weeks postoperatively, last follow-up, respectively (P lt; 0.05). The normal rate of IKDC score were 43.75% (35/80) and 97.50% (78/80) at 6 weeks postoperatively and last follow-up, respectively. Conclusion The viscoelastic properties of LARS artificial l igament is different from that of biological materials. The graft should be fixed at a relatively extension position to avoid knee extension l imitation and sl ight loosening of graft tension is permitted at flexion position. Good cl inical result could be achieved if the technique is well appl ied.
ObjectiveTo evaluate the safety and short-term outcome of laparoscopic total mesorectal excision (TME) for the middle-lower rectal cancer in municipal hospital.MethodsThe pathological data of 94 patients with middle-lower rectal cancer (49 cases underwent laparoscopic TME, while 45 cases received open TME), who treated in The First People’s Hospital of Ziyang from Jan. 2015 to Jun. 2017, were retrospectively collected and analyzed.ResultsTwo patients (4.1%) in laparoscopy group were converted to open surgery. Compared with the laparotomy group, the laparoscopic group had significantly less volume of intraoperative bleeding, shorter abdominal incision, earlier time to the first flatus and liquid diet, and lower rate of 30-day postoperative complication (P<0.05), but had longer operative time (P=0.033). While there were no significant difference on postoperative stay, the specimen length, distal margin, and number of harvested lymph nodes between the 2 groups (P>0.05).ConclusionLaparoscopic TME is a feasible, safe, and minimally invasive technique for middle-lower rectal cancer, and produce more favourable short-term outcome than open surgery in municipal hospital.
目的 探讨Prolift系统全盆底重建术在治疗盆腔脏器脱垂疾病中的应用价值及疗效。 方法 回顾性分析四川大学华西第二医院妇科2010年1月－2011年5月收治的119例盆腔脏器脱垂患者的临床资料，其中47例应用Prolift系统进行全盆底重建术（A组），51例应用曼氏手术治疗（B组），21例应用经阴道全子宫切除术+阴道前后壁修补术治疗（C组）。分析比较各组的临床近期疗效。术后随访1年。 结果 A、B、C组在手术时间、术中出血量、术后安置尿管天数、术后住院天数间差异均无统计学意义（P＞0.05）。A组1例、B组11例、C组4例复发，A组与B、C组复发率比较差异有统计学意义（P＜0.05）。 结论 Prolift系统全盆底重建术安全性高，不增加脏器损伤的几率，且明显降低了患者的术后复发率，近期疗效肯定，是治疗盆腔脏器脱垂的一种理想术式。