Objective To investigate the application of transverse fascia in inguinal hernia repair. Methods In this study, 617 patients underwent inguinal hernia repair between January 1990 and December 2005 in our hospital were included, which were divided into two groups according to different operative ways: transverse fascia method group (n=337) and Bassini method group (n=280). Then intraoperative results, postoperative complications, and rehabilitated results of patients in two groups were compared. Results Compared with Bassini method group, the patients in transverse fascia method group did not show significant difference in operative time and blood loss during operation (Pgt;0.05). The differences of severe postoperative pain, testicular swelling, the time of the body’s restore for normal activities, and recurrence rate of patients between two groups were significant (Plt;0.05), while the difference of hematoma of scrotum and infection of incisional wound (Pgt;0.05). Conclusion The strengthening of posterior wall by transverse fascia and reconstruction of inner ring is a simple and effective method for inguinal hernia repair.
Objective To summarize the research progress of surgical treatment for anterior shoulder dislocation and combined injuries. Methods The related literature was reviewed, and the surgical treatment options for the anterior shoulder dislocation and its combined injuries were summarized. Results Anterior shoulder dislocation can combine with anteroinferior capsular ligament complex injury (Bankart injury), bony Bankart defect, and Hill-Sachs lesion. For Bankart and bony Bankart injuries, arthroscopic repair or coracoid osteotomy combined with bony graft reconstruction can be performed. For Hill-Sachs lesion, conservative treatment, soft tissue repair, or bony reconstruction should be selected based on the extent of the bone defect. For bipolar injury, the Bankart repair, Remplissage, or arthroplasty should be selected based on the extent of the glenoid defect. Conclusion With the development of arthroscopy and the improvement of the surgical concept, there is a complete set of surgical options for various injuries of the anterior shoulder dislocation. When choosing a surgical procedure, the patient’s specific injury and age, exercise level, and other relating factors should be comprehensively assessed in order to achieve the best results.
ObjectiveTo systematically review efficacy of endoscopic ultrasonography guided biliary drainage (EUS-BD) and percutaneous transhepatic biliary drainage (PTBD) on patients with malignant obstructive jaundice.MethodsThe PubMed, EMbase, The Cochrane Library, CBM, WanFang Data, and CNKI were searched online to collect the randomized controlled trials or cohort studies of EUS-BD versus PTBD on the patients with malignant obstructive jaundice from inception to November 30, 2018. Two reviewers independently screened the literatures, extracted the data and assessed the risk of bias of included the studies, then the meta-analysis was performed by using the RevMan 5.3 software.ResultsThree randomized controlled trials and 6 cohort studies involving 496 patients were included. The results of meta-analysis showed that: compared with the PTBD, the EUS-BD had the lower occurrence of complications [OR=0.30, 95% CI (0.20, 0.47), P<0.000 01], lower rate of reintervention [OR=0.11, 95% CI (0.06, 0.22), P<0.000 01], shorter hospital stay [MD=–3.42, 95% CI (–6.72, –0.13), P=0.04], and less hospital costs [SMD=–0.83, 95% CI (–1.16, –0.49), P<0.000 01]. There were no significant differences in the technical success rate [OR=0.88, 95% CI (0.20, 3.85), P=0.86] and clinical effective rate [OR=1.73, 95% CI (0.97, 3.11), P=0.06] between the two groups.ConclusionsCurrent evidence shows that EUS-BD has some advantages of lower occurrence of complications, lower rate of reintervention, shorter hospital stay, and less hospital costs in treatment of patients with malignant obstructive jaundice as compared with PTBD. There are no significant differences between two groups in technical success rate and clinical effective rate. Due to limited quality and quantity of included studies, more high quality studies required to be verified above conclusions.
Objective To discuss and evaluate the diagnose and surgical techniques of rotator cuff tear with arthroscopic repair and its cl inical results. Methods From November 2006 to April 2008, 22 patients with rotator cuff tear were treated by arthroscopic repair using 5 different methods. There were 13 males and 9 females, aged 28-51 years old (mean37.9 years old). The locations were left shoulder in 6 cases and right shoulder in 16 cases. Eleven cases underwent shoulder joint injury and other 11 cases had no inducement. According to Bigl iani acromion classificatioin, there were 12 cases of type II and 10 cases of type III. There were 5 bursa-side tear, 3 articular-side tear, and 14 full thickness tear. The disease course was 5 months to 6 years (mean 16.6 months). After all the patients underwent acromioplasty, 4 cases were treated by debridement of rotator cuff, 7 cases by single roll suture anchor, 4 cases by double suture anchors, 3 cases by trible suture anchors, and 4 cases by transosseous technique suture. Results Incision healed by first intention and no compl ications occurred in all patients. Twenty-two cases were followed up 12-26 months (mean 15.6 months). The active forward flexion and abduction at the last follow-up were over 150° in 21 cases, 90-l20° in 1 case. Postoperatively, the forward flexion strength was grade 5 in 20 cases and grade 4 in 2 cases. The score of University of Cal ifornia Los Angeles, the pain score, the function score, the forward flexion score, the forward flexion strength were improved significantly when compared with preoperation (P lt; 0.05). The results were excellent in 13 cases and good in 9 cases, the excellent and good rate was 100%. Conclusion Depending on the correct diagnoses, 5 different methods of rotator cuff repair are used according to the different changes of shoulders, the outcome is good in all cases.
Objective To investigate the medium-term clinical outcome of encircled suture for repair of medial meniscus bucket-handle tear (BHT). Methods Between March 2011 and June 2013, 78 patients (78 knees) with medial meniscus BHT were treated with encircled suture under arthroscopy. There were 57 males and 21 females with a mean age of 28.3 years (range, 16-39 years). The causes included sports injury in 61 cases, traffic accident injury in 12 cases, and other trauma in 5 cases. Of 78 cases, 35 were acute injury and 43 were chronic injury; 65 cases had combined injury of anterior cruciate ligament rupture. International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner score were 48.2±6.3, 43.6±4.7, and 2.5±0.6, respectively. Barrett’s assessment standard, MRI, and arthroscopy examination were used for assessment of meniscus healing. IKDC score, Lysholm score, and Tegner score were used for assessment of knee function. Results Primary healing of incisions were achieved in all patients, and no complications occurred. All patients were followed up 26-63 months (mean, 42.8 months). BHT recurrence was observed in 2 patients within 1 year. Clinical healing of meniscus tear was obtained in 72 cases (92.3%) according to Barrett’s assessment standard. The IKDC score, Lysholm score, and Tegner score were significantly improved to 81.5±5.1, 86.9±3.9, and 6.2±0.5 respectively (t=–14.598,P=0.000;t=–18.478,P=0.000;t=–3.362,P=0.002). MRI results showed complete healing in 56 cases, incomplete healing in 15 cases, and unhealing in 7 cases at last follow-up, with a total healing rate of 91.0% (71/78) and a complete healing rate of 71.8% (56/78). In 21 cases undergoing arthroscopy at 18-49 months after operation, complete healing and incomplete healing were observed in 17 cases and 4 cases respectively, with a total healing rate of 100% (21/21) and a complete healing rate of 81.0% (17/21). No re-tear occurred. Conclusion Encircled suture for repair of medial meniscus BHT owns the advantage of firm suturing and good blood supply which can obtain satisfactory medium-term clinical results.
ObjectiveTo summarize research progress of imaging methods in postoperative efficacy evaluating of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE).MethodsThe related literatures of imaging methods in postoperative efficacy evaluating of HCC after the TACE were searched in the PubMed, Web of Science, CNKI, and Wanfang Data databases, etc. The clinical efficacy, advantages and problems of different imaging were analyzed and summarized.ResultsThe contrast-enhanced ultrasound (CEUS) had the higher value in diagnosing of residual or recurrent lesion, but the observation of the multiple or larger lesion was limited on the CEUS. The contrast-enhanced computed tomogaphy (CECT) had the lower diagnostic value for the residual or recurrent lesions as compared with the CEUS due to the artifact of iodine oil deposition. However, the CT perfusion and gemstone spectral imaging parameters could help to predict postoperative efficacy, tumor residue, and tumor recurrence after the TACE. The combination of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), functional and perfusion imaging had the better diagnostic value, and the liver function could be predicted by the DCE-MRI. The PET/CT had the excellent value in diagnosing of the residual or recurrent lesion and could be used in predicting of the patient’s survival after the TACE. The DSA was the reference standard in diagnosing of the residual or recurrent lesion after the TACE for the HCC patients, however, it had the disadvantages of invasiveness and side effect and the high operational requirements should be emphasized.ConclusionsImaging examinations including ultrasound, CT, MRI, PET/CT, and DSA are widely applied to evaluate curative effect and residual or recurrent lesion of HCC after TACE. However, principles and imaging methods of mentioned above diagnostic methods are inconsistent, as well as results of research are quite different, therefore, clinician should choose the best imaging method according to patient’s condition in diagnosis and treatment.
Objective To evaluate the values of magnetic resonance imaging (MRI) in the diagnosis of acetabular labral tears (ALT) by meta-analysis. Methods The studies concerning the diagnosis of ALT tears by using MRI from January 1990 to October 2016 were searched in the databases such as CBM, VIP, WanFang Data, CNKI, PubMed, EMbase, The Cochrane Library and Web of Science. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies by using the QUADAS-2 tool. Then, meta-analysis was performed by using Stata 12.0 software. The pooled sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (–LR) and the diagnostic odds ratio (DOR) were calculated, and the summary receiver operating characteristic curve (SROC) was drawn and the area under the carve was calculated. Results A total of 25 studies from 21 articles were included, involving 1 123 hips from 1 099 patients. The results of meta-analysis showed that, the pooled Sen, Spe, +LR, –LR, DOR and area under SROC curve of MRI for diagnosing ALT were 0.66 (95% CI 0.38 to 0.86), 0.72 (95% CI 0.47 to 0.89), 2.37 (95% CI 1.18 to 4.67), 0.48 (95% CI 0.25 to 0.92), 4.97 (95% CI 1.60 to 15.47), 0.75 (95% CI 0.71 to 0.79). The pooled Sen, Spe, +LR, –LR, DOR and area under SROC curve of MRA for diagnosing ALT were 0.86 (95% CI 0.80 to 0.90), 0.71 (95% CI 0.55 to 0.83), 2.91 (95% CI 1.77 to 4.80), 0.20 (95% CI 0.13 to 0.32), 14.44 (95% CI 5.80 to 35.95), 0.87 (95% CI 0.84 to 0.90), respectively. Conclusion MRI is efficiency diagnostic method for acetabular labral tears.
Objective To testify the spatial relationship between the subscapularis muscle splitting window and the axillary nerve in modified arthroscopic Latarjet procedure, which could provide anatomical basis for the modification of the subscapularis muscle splitting. MethodsA total of 29 adult cadaveric shoulder specimens were dissected layer by layer, and the axillary nerve was finally confirmed to walk on the front surface of the subscapularis muscle. Keeping the shoulder joint in a neutral position, the Kirschner wire was passed through the subscapularis muscle from back to front at the 4 : 00 position of the right glenoid circle (7 : 00 position of the left glenoid circle), and the anterior exit point (point A, the point of splitting subscapularis muscle during Latarjet procedure) was recorded. The vertical and horizontal distances between point A and the axillary nerve were measured respectively. Results In the neutral position of the shoulder joint, the distance between the point A and the axillary nerve was 27.37 (19.80, 34.55) mm in the horizontal plane and 16.67 (12.85, 20.35) mm in the vertical plane. Conclusion In the neutral position of the shoulder joint, the possibility of axillary nerve injury will be relatively reduced when radiofrequency is taken from the 4 : 00 position of the right glenoid (7 : 00 position of the left glenoid circle), passing through the subscapularis muscle posteriorly and anteriorly and splitting outward.
ObjectiveTo investigate the morphological characteristics of the glenohumeral joint (including the glenoid and coracoid) in the Chinese population and determine the feasibility of designing coracoid osteotomy based on the preoperative glenoid defect arc length by constructing glenoid defect models and simulating suture button fixation Latarjet procedure. MethodsTwelve shoulder joint specimens from 6 adult cadavers donated voluntarily were harvested. First, whether the coracoacromial ligament and conjoint tendon connected was anatomically observed and their intersection point was identified. The vertical distance from the intersection point to the coracoid, the maximum allowable osteotomy length starting from the intersection point, and the maximum osteotomy angle were measured. Next, the anteroinferior glenoid defect models of different degrees were randomly constructed. The arc length and area of the glenoid defect were measured. Based on the arc length of the glenoid defect of the model, the size of coracoid oblique osteotomy was designed and the actual length and angle of the coracoid osteotomy were measured. A limited osteotomy suture button fixation Latarjet procedure with the coracoacromial ligament and pectoralis minor preservation was performed and the position of coracoid block was observed. ResultsAll shoulder joint specimens exhibited crossing fibers between the coracoacromial ligament and the conjoint tendon. The vertical distance from the tip of the coracoid to the coracoid return point was 24.8-32.2 mm (mean, 28.5 mm). The maximum allowable osteotomy length starting from the intersection point was 26.7-36.9 mm (mean, 32.0 mm). The maximum osteotomy angle was 58.8°-71.9° (mean, 63.5°). Based on the anteroinferior glenoid defect model, the arc length of the glenoid defect was 22.6-29.4 mm (mean, 26.0 mm); the ratio of glenoid defect was 20.8%-26.2% (mean, 23.7%). Based on the coracoid block, the length of the coracoid osteotomy was 23.5-31.4 mm (mean, 26.4 mm); the osteotomy angle was 51.3°-69.2° (mean, 57.1°). There was no significant difference between the arc length of the glenoid defect and the length of the coracoid osteotomy (P>0.05). After simulating the suture button fixation Latarjet procedure, the highest points of the coracoid block (suture loop fixation position) in all models located below the optimal center point, with the bone block concentrated in the anteroinferior glenoid defect position. ConclusionThe size of the coracoid is generally sufficient to meet the needs of repairing larger glenoid defects. The oblique osteotomy with preserving the coracoacromial ligament may potentially replace the traditional Latarjet osteotomy method.
ObjectiveTo clarify the value of the cortical endo-button as an internal fixator in Latarjet procedure through biomechanical analysis.MethodsTen pairs of shoulder joints from 6-7 months old male pigs were selected. Each pair was randomly divided into screw group and endo-button group. A 25% glenoid defect model was created, and the porcine infraspinatus tendon and its associated bone were used to simulate conjoint tendon and coracoid process in human body. The bone grafts were fixed with two 3.5 mm screws and double cortical endo-buttons with high-strength sutures in screw group and endo-button group, respectively. The prepared glenoid defect model was fixed on a biomechanical test bench and optical markers were fixed on the glenoid and the bone block, respectively. Then fatigue test was performed to observe whether the graft or internal fixator would failed. During the test, the standard deviations of the relative displacement between the graft and the glenoid of two groups were measured by optical motion measure system for comparison. Finally the maximum failure load comparison was conducted and the maximum failure loads of the two groups were measured and compared.ResultsThere was no tendon tear, bone fracture, and other graft or internal fixation failure in the two groups during the fatigue test. The standard deviation of the relative displacement of the screw group was (0.007 87±0.001 44) mm, and that of the endo-button group was (0.034 88±0.011 10) mm, showing significant difference between the two groups (t=7.682, P=0.000). The maximum failure load was (265±39) N in screw group and (275±52) N in endo-button group, showing no significant difference between the two groups (t=1.386, P=0.199). There were 3 ways of failure: rupture at bone graft’s tunnel (6/10 from screw group, 3/10 from endo-button group), tendon tear at the cramp (2/10 from screw group, 2/10 from endo-button group), and tendon tear at the internal fixator interface (2/10 from screw group, 5/10 from endo-button group), showing no significant difference between the two groups (P=0.395).ConclusionAlthough the endo-button fixation fails to achieve the same strong fixation stability as the screw fixation, its fixation stability can achieve the clinical requirements. The two fixation methods can provide similar fixation strength when being used in Latarjet procedure.