Objective To detect the operative technique and aesthetic problem of reconstruction to deformity of bilateral cleft lip． Methods From March 2003 to December 2004, 26 patients with bilateral cleft lip were treated, aged 10 months to 11 years. Of 26 patients, there were 13 bilateral complete cleft lip and palate, 9 bilateral incomplete cleft lip and 4 mixed cleft lip with unilateral complete cleft palate. The chief design principle was keeping the length of prolabium. During operation, sufficient dissociation was made in the base of the ala base and orbicularis oris muscle to reconstruct these structures．The circle suture was made for the bilateral orbicularis oris muscle. The shape of vermilion was achieved by lateral red lip muscle flap and simultaneous simple rhinoplasty was performed. Results Primary healing of the incisions was achieved in all cases. After the 10 days-3 months follow-up, the results were satisfactory in thewidth and chubbiness of the nose bottom,the shapes of nostril and Cupid’s bow were good without whistle deformity. Theapperance of upper lip was good in either dynamic or static state． Conclusion Excellent shapes and function of the nose and lip， and opportunity for twostage repair could be obtained with this method，which being believed important methods for the primary repair of bilateral cleft lip．
ObjectiveTo investigate the effectiveness of modified Stoppa approach with medial wall spring plate (MWSP) for involving quadrilateral of acetabulum fracture. MethodsBetween March 2008 and September 2013, 38 patients with involving quadrilateral of acetabulum fracture were treated, including of 23 males and 15 females with an average age of 36.08 years (range, 19-56 years). The causes included traffic accidents injury (21 cases), crash injury of heavy object (10 cases), and falling injury from height (7 cases). The interval of injury and admission was 3 hours to 2 days (mean, 11 hours). There were 12 cases of anterior column fracture (type D), 5 cases of transverse fractures (type E), 8 cases of T shaped fractures (type H), 6 cases of anterior column fracture with posterior transverse fractures (type I), and 7 cases of double column fractures (type J) according to Letournel-Judet classification. Based on fracture types, MWSP was used to fix fracture by modified Stoppa approach in 19 cases or combined with the ilioinguinal approach in 10 cases or combined with Kocher-Langenbeck approach in 9 cases. The operation time, blood loss, and complications were recorded. The effectiveness of reduction and the hip function were evaluated according to Matta score system and Merled' Aubigne and Postel score system. ResultsThe operation time was 85-210 minutes (mean, 130 minutes).The intra-operative blood loss was 450-900 mL (mean, 650 mL). There were 1 case of vascular avulsion, and 1 case of bladder injury during operation; there were 8 cases of venous thrombosis and 2 cases of fat liquefaction of incision after operation. Screw was implanted into the articular joint in 1 case on CT after operation. Matta X-ray assessment showed anatomical reduction in 9 cases, satisfactory reduction in 24 cases, and unsatisfactory reduction in 5 cases, and the satisfaction rate of reduction was 86.84%. Three patients had limb shorting of 0.8-1.0 cm when compared with normal limb. All patients were followed up for 7 to 18 months with an average of 10 months. Fractures healed well within 13-16 weeks with an average of 14 weeks. At 1 year after operation, the results were excellent in 9 cases, good in 21 cases, general in 5 cases, and poor in 3 cases, and the excellent and good rate was 78.95% according to the Merled'Aubigne and Postel hip score standards. ConclusionInvolving quadrilateral of acetabulum fracture can be fixed with MWSP by modified Stoppa approach or combined with other approaches to obtain good exposure, less invasion, satisfactory reduction, stable fixation, and low complications.
ObjectiveTo evaluate the feasibility and effectiveness of proximal femoral nail anti-rotation (PFNA) combined with curettage and bone graft through Watson-Jones approach in the treatment of proximal femur benign tumors and tumor like lesions.MethodsThe clinical data of 38 patients with benign tumors and tumor like lesions in the proximal femur who were treated through the Watson-Jones approach with PFNA combined with curettage and bone graft between January 2008 and January 2015 were retrospective analysed. There were 24 males and 14 females with an average age of 28 years (range, 15-57 years). Pathological types included 20 cases of fibrous dysplasia, 7 cases of bone cyst, 5 cases of aneurysmal bone cyst, 3 cases of giant cell tumor of bone, 2 cases of enchondroma, and 1 case of non-ossifying fibroma. Before operation, hip pain occurred in 19 patients, pathological fracture occurred in 12 patients, limb shortening and coxa varus deformity was found in 4 patients, and 3 patients received surgery for the local recurrence. The operation time, intraoperative blood loss, and full-weight bearing time after operation were recorded. Patients were followed up to observe union of bone graft and the position of internal fixator on X-ray films and CT images. Visual analogue scale (VAS) score was used to evaluate the level of pain. The Musculoskeletal Tumor Society (MSTS93) score was used to evaluate lower limb function. Harris hip score was used to evaluate hip joint function.ResultsThe operation time was 130-280 minutes (mean, 182 minutes) and the intraoperative blood loss was 300-1 500 mL (mean, 764 mL). After operation, 3 cases of fat liquefaction of incision healed successfully by carefully dressing, and the rest incisions healed by first intention. All patients started partially weight-bearing exercise at 2-4 weeks after operation. The total weight-bearing time was 3-6 months (mean, 4.2 months). All the patients were followed up 24-108 months (median, 60 months). Imaging examination showed that the bone graft fused and the fusion time was 8-18 months (mean, 11.4 months). During the follow-up period, there was no complication such as pathological fracture, femoral head ischemic necrosis, hip joint dislocation, internal fixation loosening and fracture, and no tumor recurrence or distant metastasis occurred. At last follow-up, the VAS score, MSTS93 score, and Harris score were significantly improved when compared with preoperative ones (P<0.05).ConclusionThe treatment of proximal femoral benign lesions by PFNA combined with curettage and bone graft through the Watson-Jones approach is safe and effective, with advantages of better mechanical stability, less residual tumor, and less postoperative complications.
Objective To measure the anatomical parameters related to lumbar unilateral transverse process-pedicle percutaneous vertebral augmentation, and to assess the feasibility and safety of the approach. Methods A total of 300 lumbar vertebral bodies of 60 patients were randomly selected, and vertebral augmentation were simulated 600 times on X-ray and CT image with unilateral conventional transpedicle approach (control group) and unilateral transverse process-pedicle approach (experimental group). The distance between the entry point and the midline of the vertebral body, the puncture inner inclination angle, the safe range of the puncture inner inclination angle, and the puncture success rate were measured and compared between the left and right with the same approach, and between the two approaches. Results The distance between the entry point and the midline gradually increased from L1 to L5 on both sides in the 2 groups. In the control group, the right sides distance of L1 and L2 was much longer than the left sides, and the right sides distance of L1, L2, and L5 was much longer than the left sides in the experimental group (P<0.05); the distance of the experimental group between the entry point and the midline was much longer than the control group regardless of the sides from L1 to L5 (P<0.05). In the experimental group, the right maximum inner inclination angle from L1 to L5, the right middle inner inclination angle from L1 to L5, and the right minimum inner inclination angle from L1, L2, L4, L5 were significantly larger than the left side (P<0.05). The maximum inner inclination angle and the middle inner inclination angle presented increased tendency, the tendency of minimum inner inclination angle was ambiguous, however, the all inner inclination angles were much larger than those in control group among the different lumbar levels(P<0.05). There was no significant difference of the safe range of the puncture inner inclination angle between 2 sides in 2 groups at L1 to L5 (P<0.05); the safe range angle in experimental group at L5 was significantly smaller than that in control group (P<0.05). The difference in total puncture success rate of all lumbar levels was significant between the experimental group and the control group (χ2=172.252, P=0.000); the puncture success rates of the experimental group were higher than those in the control group form L1 to L4 (P<0.05), but no significant difference was found in the puncture success rate between 2 groups at L5 (P>0.05). Conclusion Compared with the unilateral conventional transpedicle approach, the entry point of the unilateral transverse process-pedicle approach is localized outside, the puncture inclination angle is wider, and the puncture success rate is higher. It shows that the unilateral transverse process-pedicle approach is safer and more reliable than the unilateral conventional transpedicle approach.
Objective To explore the effectiveness and related issues in the treatment of multiple segments of thoracolumbar tuberculosis through posterior unilateral debridement with bone graft and internal fixation. Methods The clinical data of 29 patients with multiple segments of thoracolumbar tuberculosis who met the selection criteria were retrospective analyzed between January 2012 and July 2015. There were 17 males and 12 females, with age of 21-62 years (mean, 37.4 years). Lesions contained 3-8 vertebral segments, including 3 segments in 6 cases, 4-6 segments in 17 cases, and 7-8 segments in 6 cases. The center lesions located at thoracic spine in 8 cases, lumbar spine in 10 cases, and thoracolumbar segment in 6 cases, and thoracic lumbar skip lesions in 5 cases. The complications included vertebral abscess in 7 cases, psoas major abscess in 6 cases, sacral spine muscle abscess in 7 cases, iliac fossa and the buttocks abscess in 1 case, spinal canal abscess in 2 cases. Preoperative neurological function was assessed according to the American Spinal Injury Association (ASIA) classification: 1 case of grade B, 3 cases of grade C, 8 cases of grade D, and 17 cases of grade E. The disease duration was 6-48 months (mean, 19.3 months). All the patients were treated with posterior unilateral transpedicular or transarticular debridement with bone graft fusion and internal fixation under general anesthesia. Pre- and post-operative visual analogue scale (VAS) score, Oswestry disability index (ODI), and sagittal Cobb angle were recorded and compared. Bridwell classification standard was used to evaluate bone graft fusion. According to the number and the center of the lesion, the necessity to placement of titanium mesh cage was analyzed. Results All the patients were followed up 18-30 months (mean, 24 months). Cerebrospinal fluid leakage occurred in 3 cases, intercostal neuralgia in 2 cases, wound unhealed and fistula formation in 1 case, and ofiliac fossa abscess recurred in 1 case, and all recovered after symptomatic treatment. During follow-up, no fracture or loosing of internal fixation was found and all the lesions were cured at last follow-up. According to Bridwell classification standard, bone graft achieved bony fusion during 4-9 months after operation. The VAS score, ODI, and Cobb angle at immediate after operation and at last follow-up were significantly improved when compared with preoperative ones (P<0.05). At last follow-up, the neural function of all patients improved significantly when compared with preoperative one (Z= –3.101, P=0.002). The ratio of no placement of titanium mesh cage was significantly higher in patients with more than 6 lesion segments (6/6, 100%) than in patients with less than 6 lesion segments (4/23, 17.4%) (χ2=14.374, P=0.000). And the ratio of placement of titanium mesh cage was not significantly different between the patients with the different locations of center focus (χ2=0.294, P=0.863). Conclusion For treating multiple segments of thoracolumbar tuberculosis, the method of posterior unilateral debridement with bone graft and internal fixation can decrease the damage of posterior spinal structures and surgical trauma.
ObjectiveTo explore the safety and feasibility of the uncinate-process-first superior mesenteric artery (SMA) right posterior approach in laparoscopic pancreaticoduodenectomy (LPD). MethodsThe clinical data of 5 patients admitted to the Second Affiliated Hospital of Chongqing Medical University from December 2022 to May 2023 were retrospectively analyzed, all patients underwent uncinate-process-first SMA right posterior approach during LPD. ResultsAll 5 cases of LPD with uncinate-process-first SMA right posterior approach were successfully completed. The operative time was (366±51) min, the intraoperative blood loss was (140±42) mL, and the postoperative hospital stay was (11±2) days. All the postoperative pathological findings reached R0 resection. None of the 5 patients suffered from biliary leakage, bleeding, or gastrointestinal empties, and 2 patients suffered from biochemical fistula, the postoperative follow-up time was (7±2) months, and there was no recurrence during the follow-up period. ConclusionThe uncinate-process-first SMA right posterior approach is a safe and feasible surgical approach, especially for tumors with no obvious vascular invasion and diameter ≤2 cm.
Objective To evaluate the effect of the modified extended iliofemoral approach on treatingcomplex acetabular fractures. Methods Thirty-six cases of complex acetabular fractures were treated by the open reposition and internal fixation by a modified extended iliofemoral approach. Results Thirty-sixcases were followed up for 7-46 months, with an average of 23.8 months. According to the Matta standard, anatomical reposition was performed in 24 cases, perfect reposition in 8 cases, and unsatisfactory reposition in 4 cases. By the modified d’Aubignepostel score, among the 36 cases, 22 had an excellent result, 9 had a good result, and 5 had a poor result. Conclusion Themodified extended iliofemoral approach facilitates the operative exposure of the anterior and posterior walls and both columns of the acetabulum in the surgically-treated acetabular fractures by the open reposition and internal fixation.Because of the reconstruction, the functions of the abductor muscle mass managed by the lagscrew-fixed osteotomies of the iliac crest, and greater trochanter, the patients can achieve a rapid rehabilitation of the joint.
ObjectiveTo evaluate the effectiveness of percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fractures with or without intravertebral clefts by unilateral approach and the impact of intravertebral clefts on the effectiveness. MethodsThe clinical data of 65 patients who met the inclusion criteria of osteoporotic vertebral compression fracture were retrospectively analyzed. According to having intravertebral clefts or not, the patients were divided into 2 groups: cleft group (group A, n=25) and non-cleft group (group B, n=40). There was no significant difference in gender, age, cause of injury, the level of fracture vertebrae, degree of damage, and interval of injury and operation between 2 groups (P gt; 0.05). All patients were given PVP procedure by unilateral approach. The operation time, the injected volume of bone cement, time to ambulate, complications, and adjacent vertebral re-fracture were recorded. The height of anterior and middle column and the posterior convex Cobb angle of injured spine were measured on the lateral X-ray film in standing position at preoperation and 1, 48 weeks after operation. The visual analogue scale (VAS) score and Oswestry disability index (ODI) system were used to evaluate the pain relief and improvement of daily activity function respectively at preoperation and 1, 4, and 48 weeks after operation. ResultsThere was no significant difference in the operation time and time to ambulate between 2 groups (P gt; 0.05). The injected volume of bone cement in group B was significantly less than that in group A (t=1.833, P=0.034). Asymptomatic cement leakage occurred in 6 patients (4 in group A and 2 in group B), in group A including 1 case of venous leakage, 2 cases of paravertebral leakage, and 1 case of intradiscal leakage; in group B including 2 cases of venous leakage. No symptomatic pulmonary embolism was observed. The vital sign was stable during operation and postoperatively. All patients were followed up 12-30 months (mean, 18.5 months). No re-fracture of the vertebrae occurred during the follow-up. The postoperative VAS score, ODI, the height of anterior and middle column, and the posterior convex Cobb angle of injured spine were improved significantly when compared with the preoperative ones in 2 groups (P lt; 0.05), but no significant difference was found between 2 groups at pre- and post-operation (P gt; 0.05). ConclusionPVP by unilateral approach is safty and efficacy in the treatment of osteoporosis vertebral compression fracture combined with intravertebral clefts. Intravertebral clefts have no significant impact on the effectiveness in the pain relief and function improvement.
Thyroid disease is more common in young women. Traditional surgical scars may affect the appearance of patients and cannot fully meet the cosmetic needs of patients. With the advancement of surgical techniques, endoscopic thyroid surgery has developed rapidly. Trans oral endoscopic thyroidectomy vestibular approach is feasible and safe to achieve no scar on the body surface, but there are some unavoidable limitations, such as postoperative numbness and discomfort in the center of the chin region. As a new approach to thyroid surgery, trans oral endoscopic thyroidectomy submental access has the same advantages as the trans oral vestibular approach from top to bottom, and can reliably and thoroughly dissect lymph nodes in the central area (especially area Ⅶ), allowing larger specimens to be taken out and expands the indications for surgery, minimizes flap detachment, and avoids jaw pain and numbness. Trans oral endoscopic thyroidectomy submental access is an innovation in the concept of thyroid surgery, which achieves minimally invasive and aesthetic results on the premise of ensuring the quality of the surgery and curing the disease. We reviewed the history, advantages and disadvantages of trans oral endoscopic thyroidectomy submental access.
To evaluate the efficacy and the surgical procedures of submandibular sialoadenectomy by a modified retroauricular approach. Methods Between October 2008 and April 2009, 8 patients with benign submandibular gland disorders underwent removal of benign submandibular gland lesions using a retroauricular approach. There were 4 males and 4 females with an average age of 38.5 years (range, 32-54 years), including 3 pleomorphic adenoma and 5 chronic sialadenitis with sialol ithiasis. The disease duration was from 2 months to 5 years. The anterior facial vein and the facial artery were reserved only by the l igation of branching vessels in the submandibular gland. Results Submandibular sialoadenectomy were successfully performed in 8 cases. The operative time was 45-75 minutes (mean, 60 minutes). All incisions obtained heal ing by first intention. No nerve paralysis occurred, including marginal mandibular branch of the facial nerve, the l ingual nerve, and hypoglossal nerve. One patient had poor blood circulation of flap due to excessive traction during operation, but it returned normal after 24 hours without special treatment. Other flaps had good blood circulation. All patients were followed up 1-6 months (mean, 3 months). The incision scars were hidden with satisfactory appearance. Conclusion The modified retroauricular approach has some advantages such as simple operation, better cosmetic outcome, and no compl ication.