From July 1978 to July 1990, 11 operative methods for reconstruct the gluteal motors were performed in 733 cases. The result was satisfactory. The authors first introduced the Clinical material, then discussed principally how to selecte the operative type and some technical points to improve the result. It was thought that Obers operation was simple, easy and its result was reliable. So, it was taken as the method of priority in restoring the gluteal motors in this hospital.
摘要:目的:探讨老年人股骨粗隆间骨折不同手术方式的选择。方法:我院2004年1月至2007年12月间应用不同术式治疗老年股骨粗隆间骨折110例,其中动力髋螺钉(DHS)25例, 股骨近端髓内钉(PFN)41例,人工股骨头置换44例。术后所有患者均获随访,平均12.6个月。对术后并发症和按照Kuderna 改良 Merli D’Aubigne标准得到的髋关节功能恢复优良数(率)进行评价。结果:术后出现并发症3例,其中PFN术式2例;人工股骨头置换术式1例。围手术期内无伤口感染,无死亡病例。三种术式总体优良数(率)为:107(97.3%)。结论:三种手术方式各有其优缺点,没有一种术式能普遍适用于各种类型粗隆间骨折,临床上,为了最大限度降低手术风险,我们没有必要专注或偏好于某一种手术方式,要根据患者的个体差异及每种术式的优缺点,灵活地为每例股骨粗隆间骨折患者制定出其最适宜的手术方式,大都能取得满意的疗效。Abstract: Objective: To investigate the chosen of 3 different surgical methods in the treatment of intertrochanteric femoral fractures in the elderly. Methods:From January, 2004 to December, 2007, 110 cases with the femoral intertrochanteric fractures in the elderly were treated with the followed 3 kinds of operations respectively:dynamic hip screw (25 cases), proximal femoral nail (41 cases), hip hemiarthroplasty (44 cases). After surgery all patients were followed up; Followedup period range from 6 months to 18 months(average 12.6 months). The good and excellent number (rate) of 3 surgical methods with Merli D’Aubigne evaluation criteria were evaluated, and compared in the postoperative complications. Results: 3 complications occurred postoperatively ( 2 with PFN,1 with hip hemiarthroplasty), none wound infection or died in Perioperatie. The total good successful number (rate) was 107(97.3%). Conclusion:Each has its advantages and its disadvantages. None of three kinds of surgical methods can be used generally all kinds of the femoral intertrochanter fracture. In clinical work, we don not need to focus on or prefer to the only one of them in order to minimize the risk. The good response to treatment will be get if we can choose the appropriate method according to the individual differences of the advantages and disadvantages of each method.
Objective To compare the effectiveness between SuperPATH approach and posterolateral approach in total hip arthroplasty (THA). Methods Between January 2016 and December 2016, 84 patients with hip disease were included in the study and randomly divided into 2 groups. Forty patients were treated with THA via SuperPATH approach (SuperPATH group), and 44 patients were treated with THA via posterolateral approach (PSA group). There was no significant difference in gender, age, body mass index, the type of disease, the complicating diseases, and preoperative thrombosis of lower extremity and Harris score between 2 groups (P>0.05). The operation time, intraoperative blood loss, length of incision, postoperative drainage volume, unloaded activity time, Harris score, and short-form 36 health survey scale (SF-36) score were compared. The postoperative X-ray films were used to observe the position of joint prosthesis. Results All patients were followed up 6-18 months (mean, 10.3 months). The operation time, intraoperative blood loss, length of incision, postoperative drainage volume, and unloaded activity time in SuperPATH group were significantly superior to those in PSA group (P<0.05). The Harris score at 2 weeks and 1 month after operation were significantly higher in SuperPATH group than that in PSA group (P<0.05). But there was no significant difference in the Harris scores at 3 and 6 months after operation between 2 groups (P>0.05). At last follow-up, the SF-36 scores were higher in SuperPATH group than those in PSA group (P<0.05). Postoperative X-ray films showed the joint prosthesis was in good position. Conclusion THA via SuperPATH approach has the advantages of minimal invasion, safe, and rapid recovery, which is better than THA via posterolateral approach.
ObjectiveTo review the advance of the first tarsometatarsal joint fusion (Lapidus operation) in treating hallux valgus. MethodsThe relevant literature about Lapidus operations in recent years was reviewed and analyzed. ResultsLapidus operation is used to correct deformities through three steps of osteotomy, fusion, and fixation. With the development of this operation and its diversities, surgeons can make adjustment according to the individual differences of state of illness in patients. ConclusionLapidus operation is the final choice for the hallux valgus, with the operation technology becoming more and more mature and the fixation materials and operative instruments more and more advanced. Lapidus operation will be diversified with the constantly appearance of new technologies like arthroscopy.
目的 探讨胰头部肿块型慢性胰腺炎的诊断要点与个体化术式的选择原则。方法 回顾性分析2000年4月至2011年9月期间我院收治的10例胰头部肿块型慢性胰腺炎患者的临床资料。结果 本组平均发病年龄47.3岁，平均病程69.1d，平均总胆红素99.4µmol/L，CA19-9 55～78U/ml。10例B超检查示肝内胆管及胆总管扩张，5例CT检查报告胰头部占位性病变伴主胰管不规则扩张或钙化灶，2例MRCP检查诊断胆总管下段占位。3例术中多点穿刺快速活检后行胆胰管引流术，7例术前误诊为胰头癌或壶腹癌均行胰十二指肠切除，术后出现并发症8例，死亡1例，9例平均随访44.2个月无复发和癌变。结论 把握发病年龄、病程、波动性黄疸等临床特征和CA19-9水平及CT、MRCP等影像检查要点是胰头部肿块型慢性胰腺炎与胰头癌鉴别诊断的关键，用个体化术式合理实施胰十二指肠切除、胆胰管内外引流术是胰头部肿块型慢性胰腺炎外科处理明智的选择。
Objective To present method and experiences in using the buccal mucosa with the Snodgrass procedure for repair of hypospadias. Methods Between August 2012 and April 2015, 55 boys with hypospadias were treated with Snodgrass procedure combined with buccal mucosa. The age ranged from 1 to 7 years (mean, 4 years). There were 32 cases of distal penile type, 14 cases of proximal penile type, and 9 cases of coronal sulcus type. The buccal mucosa taking from inner cheek was fixed into the incised urethral plate. The urethral plate was tubularized over a catheter. Results All the patients were followed up 3-25 months (mean, 11 months). After operation, 1 patient had urethral stricture and fistula after repaired urethra was infected, and 5 patients had fistula. For the others, the urination was smooth, the appearance of penis was satisfying, the urethral stricture did not occur, and the penis was straightened completely. Conclusion Compared with traditional Snodgrass procedure, the application of buccal mucosa can increase the reconstruction material of urethral and reduce the stricture of the repaired urethra after operation.
ObjectiveTo analyze the changes in myocardial injury markers and cardiac function in patients with hypertrophic obstructive cardiomyopathy (HOCM) after Liwen surgery. MethodsA retrospective analysis was conducted on the clinical data of HOCM patients who underwent Liwen surgery at the Department of Cardiac Surgery, Wuhan Asia Heart Hospital from December 2019 to April 2023, mainly including preoperative and postoperative dynamic follow-up laboratory test results and echocardiograms. ResultsA total of 42 patients were included, with 25 males and 17 females, aged (44.76±17.72) years, and a postoperative follow-up time of (15.02±6.97) months. The myocardial troponin level of the patients decreased from preoperative 0.03 (0.02, 0.06) ng/mL to postoperative 0.02 (0.01, 0.05) ng/mL (P=0.006), and the N-terminal pro-brain natriuretic peptide level decreased from preoperative 748.95 (337.40, 1600.75) ng/L to postoperative 367.15 (126.93, 1030.25) ng/L (P<0.001). After surgery, the left atrial diameter of the patients decreased from preoperative (4.18±0.57) cm to postoperative (3.93±0.55) cm (P=0.004), the end-diastolic interventricular septum thickness decreased from preoperative 2.25 (1.90, 2.75) cm to postoperative 1.70 (1.50, 1.90) cm (P<0.001), the left ventricular mass index decreased from preoperative 211.73 (172.28, 261.54) g/m2 to postoperative 156.78 (132.34, 191.36) g/m2 (P<0.001), the left ventricular weight decreased from preoperative 368.89 (292.34, 477.72) g to postoperative 266.62 (224.57, 326.04) g (P<0.001), the end-diastolic posterior wall thickness of the left ventricle decreased from preoperative 1.30 (1.20, 1.60) cm to postoperative 1.20 (1.18, 1.40) cm (P<0.001), the relative wall thickness decreased from preoperative 0.78 (0.78, 1.02) to postoperative 0.63 (0.56, 0.72) (P<0.001), the end-systolic inner diameter of the left ventricle increased from preoperative (2.91±0.50) cm to postoperative (3.19±0.53) cm (P=0.001), and the end-diastolic inner diameter of the left ventricle increased from preoperative (4.41±0.48) cm to postoperative (4.66±0.52) cm (P=0.005). The left ventricular outflow diameter increased from preoperative (1.28±0.46) cm to postoperative (1.57±0.32) cm (P=0.001), the left ventricular outflow pressure gradient decreased from preoperative 58.50 (40.75, 92.50) mm Hg to postoperative 11.50 (7.75, 20.50) mm Hg (P<0.001), the left ventricular ejection fraction increased from preoperative 60.00% (56.75%, 65.00%) to postoperative 63.00% (62.00%, 66.00%) (P=0.024), and the degree of systolic anterior motion of the mitral valve leaflets decreased (P＜0.001). ConclusionThe cardiac function of patients with HOCM is improved after Liwen surgery, myocardial injury marker levels are decreased, cardiac reverse remodeling occurres, and the surgical outcome is good.
Objective To analyze the current status of day surgery in West China Hospital of Sichuan University and compare it with the Recommended Catalogue of Day Surgery (2022 Edition), in order to provide reference for the update and expansion of day surgery procedures in hospitals. Methods The day surgical procedures carried out in West China Hospital of Sichuan University from October 2009 to July 2023 were collected. The day surgical procedures were classified based on surgical specialties, types of procedures, methods of operation, and surgical grading, etc. The day surgical procedures in West China Hospital of Sichuan University were compared with those in the Recommended Catalogue of Day Surgery (2022 Edition). Results A total of 576 types of daytime surgeries were carried out in West China Hospital of Sichuan University, involving 15 specialties. A total of 662 types of day surgeries were recommend in the nationally recommended catalogue for daytime surgery, involving 11 specialties. Among the nationally recommended surgical procedures, West China Hospital of Sichuan University had carried out 233 types of surgical procedures, and 26 additional types of surgical procedures were carried out as outpatient surgeries. According to the classification of surgical difficulty, the Level Ⅱ and Ⅲ surgeries were mainly carried out in West China Hospital of Sichuan University, and the Level Ⅱ surgeries were mainly recommend in the nationally recommended catalogue for day surgery. Conclusions The high-quality development of day surgery in China should not be limited to the supplement of surgical procedures. It is necessary to strive to increase the proportion of minimally invasive and fourth-level surgeries while ensuring medical quality and safety, and improve the overall medical level of day surgery.
ObjectiveTo evaluate the safety and advantages of modified Bacon one-time operation in laparoscopic radical resection for ultra-low rectal cancer.MethodsThe medical records of all patients who underwent laparoscopic modified Bacon procedure for ultra-low rectal cancer treated by Professor SONG Junmin Medical Group of our department from August 2018 to June 2020 were analyzed retrospectively. According to the different methods during the operation, the patients were divided into a modified Bacon one-time operation group (modified Bacon group, n=26) and a Bacon secondary operation group (traditional Bacon group, n=33). The perioperative period data and follow-up results were observed and compared.ResultsA total of 59 ptients were collected, including 26 cases in the modified Bacon group and 33 cases in the traditional Bacon group. There were no significant differences in gender composition, age, etc. baseline data between the two groups (P>0.05). All surgery were successfully completed. There were no conversion to laparotomy, intraoperative or postoperative massive bleeding, severe infection and other serious complications and perioperative period death. The incidence of anastomotic leakage in the modified Bacon group was lower than that of the traditional Bacon group [0.0% (0/26) versus 18.2% (6/33), P=0.030]. There were no significant differences in the incidences of postoperative anastomotic bleeding, anastomotic stricture, rectal irritation, and external intestinal necrosis between the two groups (P>0.05). And the number of dissected lymph nodes, operation time, intraoperative blood loss, the first exhaust time, and postoperative hospital stay had no significant differences between the two groups (P>0.05). There were no significant differences in the severity degree and total score of low anterior rectectomy syndrome (LARS) between the two groups at 3 and 6 months after operation (P>0.05). However, the total LARS score at 6 months after operation was lower than that at 3 months in the same group (P<0.001). By the end of the last follow-up (January 2021), there was no obvious difference in the anal shape between the two kinds of surgery. There was no recurrence or death during the follow-up period.ConclusionModified Bacon one-time operation for ultra-low rectal cancer is safe and feasible, which could achieve natural orififice specimen extraction surgery and ultra-low limit sphincter preservation, reduce occurrence of postoperative anastomotic leakage and external intestinal necrosis, times of operation, and shorten total length of stay and reduce total cost of hospitalization.