Chest wall surgery used to be a subspecialty of traditional thoracic surgery, which has an ancient history of research and clinical practice. It has gradually become an independent professional field in recent years. With the change of concept and the progress of interdisciplines, we have deepened our understanding of related diseases, and the treatment of chest wall surgical diseases has also acquired new characteristics. This article reviews the progress in the treatment of chest wall surgical diseases including chest wall trauma, chest wall deformity, chest wall tumor, chest wall infection and chest wall defect from the perspective of chest wall surgery.
Objective To introduce a new approach of neurotization to treatment of the shoulder syndrome after the radical neck dissection by using transpositional anastomosis of C7 posterior root and the spinal accessory nerve to reconstruct the function of trapezius muscle. Methods From March 1999 to February 2001, 10 patients underwent the neurotization during the radical neck dissection. In the operation, the apo-cranial part of spinal accessory nerve was preserved from the trapezius muscle (gt;3.0 cm in length) and anastomosed to C7 posterior root. Objective physical examinations and electromyography were conducted before and after operation.One, 6 and 12 months after operation the trapezius muscle function after the transpositional anastomosis was evaluated. Results One, 6 and 12 months after operation, the recovery rates of each part were as follows: 9.8%, 68.9% and 73.5% in upper part; 4.7%, 73.6% and 69.4% in middle part; and 6.2%, 70.5% and 70.3% in lower part. The range of abduction motion of upper arm in 7 cases (70%) exceeded 90°. The mean maximal abduction angle was more than 95°. Evaluation of the shoulder function showed that myoatrophy was mild and the disability of abduction was classified as grade Ⅱ in 7 cases and grade Ⅲ in 3 cases. Conclusion Transpositional anastomosis of the C7 posterior root to thespinal accessory nerve after radical neck dissection can well reconstruct the function of trapezius muscle. This approach provides a wide indication in comparison with the functional neck dissection without impairment of arm function afterthe cutting of C7.
Objective To compare the effectiveness of simultaneous and delayed repair of combined full-thickness rotator cuff rupture in proximal humerus fracture. Methods Between January 2015 and January 2017, 44 patients with proximal humerus fractures complicated with full-thickness rotator cuff injuries were included. Twenty-four patients underwent open reduction and internal fixation (ORIF) and rotator cuff repair simultaneously (simultaneous operation group), and 20 patients underwent delayed arthroscopic rotator cuff repair more than 90 days after ORIF (delayed operation group). There was no significant difference in gender, age, cause of injury, and side of injury between the two groups (P>0.05). The fracture healing was observed by X-ray films. The shoulder function was assessed at 3, 6, and 12 months after operation by using the University of California at Los Angeles (UCLA) score. Results All incisions healed by first intention. All patients were followed up 12-24 months (mean, 17 months). Fractures all healed at 3 months after operation in simultaneous operation group. According to UCLA score, the patients had achieved significantly better outcomes in function, active forward flexion, strength of forward flexion, and subjective satisfaction in simultaneous operation group than in delayed operation group at 3, 6, and 12 months after operation (P<0.05). However, there was no significant difference in pain between the two groups (P>0.05). Conclusion For patients with proximal humerus fracture complicated with full-thickness rotator cuff rupture, performing ORIF and simultaneous repair of rotator cuff can improve shoulder function and achieve better effectiveness when compared with delayed repair of rotator cuff.
Objective To explore the shortcomings of the traditional clinical probation teaching mode, propose and implement the interactive teaching mode, so as to stimulate the students’ interest in knowledge and achieve better teaching effects. Methods The students of Grade 2017 who had clinical probation in the Orthopaedic Trauma Center of West China Hospital of Sichuan University from September 2020 to December 2021 were selected. Students were randomly divided into traditional clinical probation teaching mode group and interactive teaching mode group according to random number table method. Wechat mini program anonymous questionnaire survey was used to evaluate students’ satisfaction with the interactive teaching model of orthopaedic trauma and the teaching effect. Results A total of 110 students were enrolled, 55 in the traditional clinical probation teaching mode group and 55 in the interactive teaching mode group. There was no significant difference in gender or age between the two groups (P>0.05). The students in the interactive teaching mode group were better than those in the traditional clinical probation teaching mode group in orthopedic theory test (90.13±3.65 vs. 88.39±3.74; t=2.469, P=0.015) in the orthopedic theory test, teacher evaluation (89.15±2.94 vs. 87.56±3.12; t=2.751, P=0.007) and student self-evaluation (89.07±3.18 vs. 87.41±2.89; t=2.865, P=0.005). The teaching satisfaction of the interactive teaching group was higher than that of the traditional teaching group (96.36% vs. 87.27%; Z=−2.159, P=0.031). Conclusion Interactive teaching mode can effectively stimulate students’ interest in knowledge seeking, improve the enthusiasm and interaction of clinical probation, and effectively improve the satisfaction of undergraduate orthopaedic trauma clinical probation teaching.