Objective To evaluate the security and effectiveness of minimal invasive fixation with fluoroscopybased navigation in the management of pelvic fractures. Methods From April 2007 to June 2008, 22 patients with pelvic fractures were treated with percutaneous screw fixation under the guidance of a fluoroscopy-based navigation system after closed reduction. There were 13 males and 9 females, aged 21-65 years old. Fractures were caused by traffic accident in 17 cases, andfall ing from height in 5 cases. According to AO classification, there were 2 cases of A2.2 type, 2 cases of A2.3 type, 7 cases of B1.2 type, 3 cases of B2.2 type, 1 case of B3.3 type, 2 cases of C1.2 type, 3 cases of C1.3 type, and 2 cases of C2.3 type. The interval from injury to hospital ization was 4 hours to 3 days (mean 1.2 days). After 3-13 days of skeletal traction through tibial tubercle, the operation was performed. Results Totally 42 screws were inserted. The average time for operation was 20.4 minutes per screw. Forty-one screws were inserted correctly with a successful insertion rate of 97.6%, only 1 hollow screw was reinserted for deviation. No incision problem and implant failure occurred. All 22 patients were followed up 7 to 21 months with an average of 14.5 months. At last follow-up, fracture union was achieved in all patients with satisfactory screw fixation. According to Majeed functional scoring, the results were excellent in 18 cases and good in 4 cases, with an excellent and good rate of 100%. Conclusion The minimal invasive fixation with fluoroscopy-based navigation makes the surgery for the pelvic fracture more precise and time-saving, and improves cl inical results without an increasing rate of compl ications.
Objective To investigate an effect of the minimally-invasive locking compression plate (LCP) under the anterior humeral approach to treat the complex humeral shaft fracture. MethodsEleven patients (6 males, 5 females; age, 3266 years) with a humeral shaft fracture were treated with the minimally-invasive LCP under the modified anterior humeral approach from March 2005 to February 2006. Five of the patients were injured in a traffic accident and the remaining 6 were wounded in a fall. All the patients had an unstable fracture. The multiple segment fracture was found in 2 patients, the obligue line fracture in 1 patient, and the long segment comminuted fracture in 8 patients, of whom the radial nerve injury was found in 1 patient, who had an emergency treatment by the loosening of the radial nerve and the internally fixing with LCP. As for the fracture site, the middle and/or the upper-part fracture of the humerus was found in6 patients, and the middle and/or lower-part fracture of the humerus was foundin 5 patients. The patients underwent the operation in the period from 48 hours to 4 days after the injuries. Results All the patients had a complete healing of their fractures 2-4 months after operation. One patient underwent the loosening of the radial nerve and the internally-fixing with LCP, and his function recovered 3 days after operation.The follow-up for 6-12 months revealed that all the patients’ function recovered. According to the Neer Scoring System for the shoulder function evaluation, 7 patients had an excellent result, 3 had a good result, and 1 had a fair result. According to the HSS Scoring System, 9 patients had an excellent result and 2 had a good result. Conclusion The minimally-invasive locking compression plate under the anterior humeral approach to treat the complex humeral shaft fracture is an effective and safe method of treating the complex humeral shaft fracture.
ObjectiveTo evaluate the early effectiveness of the robot-assisted total hip arthroplasty (THA) via direct superior approach (DSA).MethodsBetween March 2021 and April 2021, 11 patients (11 hips) were treated with a robot-assisted THA via DSA. There were 7 males and 4 females, with an average age of 55 years (range, 26-73 years). There were 5 patients of osteoarthritis secondary to hip dysplasia and 6 patients of osteonecrosis of femoral head. Preoperative hip Harris score was 55.8±6.3. The operation time, volume of blood loss, length of incision, postoperative blood transfusion and hospital stay, and the incidence of surgical complications were recorded. The visual analogue scale (VAS) score and Harris score were used to evaluate hip joint pain and function. The leg length discrepancy (LLD) was measured on the X-ray films. The inclination angle and anteversion angle of the acetabular component were also measured, and the difference between the planned and actual values were compared.ResultsOne THA was performed via conventional posterolateral approach finally because of poor exposure. The rest of 10 THAs were performed with assistance of robotic arm via DSA. The average operation time was 89 minutes (range, 65-120 minutes); the average length of incision was 10.5 cm (range, 9-13 cm); and the average blood loss was 400 mL (range, 110-740 mL). One patient was given a blood transfusion for 2 unit. All incisions healed by first intention and no neurovascular injury, deep vein thrombosis, or fracture occurred. The length of hospital stay after operation was 2-6 days (mean, 4.4 days). The duration of follow-up was 1-3 months (mean, 2.1 months). The VAS score was 0 in 9 patients and 2 in 1 patient at the day of discharge. At last follow-up, the hip Harris score was 84.9±6.7, showing significant difference when compared with that before operation (t=−8.717, P=0.000). The inclination and anteversion angles were (37.4±2.0)° and (17.1±4.5)°, respectively, and there was no significant difference when compared with the planned values [(38.2±1.6)°, (16.6±3.7)°] (t=1.809, P=0.104; t=–1.103, P=0.299). The LLD ranged from –2 to 4 mm. No complication such as dislocation, aseptic loosening, or periprosthetic joint infection occurred. ConclusionThe robot-assisted THA via DSA has encouraged early effectiveness.
Objective To review our experience of minimally invasive direct coronary artery bypass grafting （MIDCAB） via a lower median ministernotomy in 72 cases. Methods Via a lower median ministernotomy,the left internal mammary artery was harvested to bypass the left anterior descending coronary artery. Saphenous vein was resected and used for single - or multi-vessel coronary revascularization on the beating heart. Results There were 1 operative death （1.4 % ）. Complications occurred in 3 patients （4.2%）. The operative duration was 195.6 ± 50. 6 min. The number of distal anastomoses was 2.3±0. 8（1-4）. The median time to tracheal extubation, and lengths of postoperative ICU and hospital stays were 11 hours, 3 and 9 days, respectively. Total chest drainage was 8. 54±5.9 ml/kg and 47 patients needed blood transfusion with an amount of 1 091.3±636.2 ml. The incision on the chest wall was 9 to 11 cm long in all cases. Sixty-six patients （92.9%, 66/71） were followed-up for a duration of 36.2±17.6 months. There were no late death and 43 patients （65.2%） were free from angina. Eighteen patients （27.3%, 18/ 66） experienced marked relief of their symptoms. Conclusions MIDCAB is possible via a lower ministernotomy for single - or multi-vessel coronary revascularization. The small incision reduces the risk of infection and blood loss. It is safe, easy and requires no special operative instruments.
ObjectiveTo summarize the clinical experiences of minimally invasive cardiac surgery (MICS) for cardiac atrioventricular valve reoperation.MethodsPerioperative data of 32 patients who underwent MICS for cardiac atrioventricular valve reoperation from 2009 to 2019 in the First Affiliated Hospital of Anhui Medical University were retrospectively reviewed, including 13 males and 19 females with a mean age of 51.0±12.6 years. All patients were given combined intravenous and inhalation anesthesia, and a double-lumen tube for mechanical ventilation. Cardiopulmonary bypass was established in all patients by femoral artery and venous cannulation or combined with percutaneous superior vena cava cannulation, without aortic cross-clamping. The MICS approaches included right anterolateral small incision surgery, thoracoscopic assisted small incision surgery and total thoracoscopic surgery. The clinical data of the 32 patients were compared with the perioperative indicators of 24 patients undergoing reoperation with conventional median thoracotomy during the same period.ResultsAmong them, 21 patients underwent isolated tricuspid valve replacement, 4 isolated tricuspid valvuloplasty, 1 combined tricuspid valve replacement and atrial septal defect repair and 6 combined mitral valve replacement and tricuspid valvuloplasty. Twenty-seven patients completed the operation in a beating heart, and 5 under the condition of ventricular fibrillation. Operation time (3.23±1.56 h vs. 5.46±2.13 h, P<0.001), postoperative mechanical ventilation time (9.19±5.40 h vs. 43.23±21.74 h, P<0.001), ICU stay (35.03±18.26 h vs. 79.15±22.43 h, P<0.001) and hospital stay of patients with minimally invasive surgery (9.35±6.43 d vs. 15.85±7.56 d, P=0.001) were shorter than those with median thoracotomy. And the extracorporeal circulation time was not significantly prolonged. There were 4 perioperative complications in patients with minimally invasive surgery, and 1 died in hospital after operation.ConclusionMICS for cardiac atrioventricular valve reoperation can avoid the risk of median sternotomy and separation of cardiac scar adhesion. Especially, total thoracoscopic surgery has more advantages when compared with other operations, including less trauma, less myocardial ischemia reperfusion injury, more rapid recovery and fewer postoperative complications. Total thoracoscopic surgery may be the development direction of MICS for cardiac atrioventricular valve reoperation. However we should take effective and feasible measures to solve the problems caused by cardiopulmonary bypass.
Objective To monitor surgical quality and analyze learning curve of minimally invasive totally thoracoscopic cardiac surgery. Methods We retrospectively analyzed the clinical data of 150 consecutive patients who underwent minimally invasive totally thoracoscopic cardiac surgery in the Guangdong General Hospital between January 2013 and December 2015. There were 60 males and 90 females at age of 43.1 years. There were 60 patients with atrial or ventricular septal defect repair, 12 patients with cardiac tumor resection, 53 patients with mitral valve replacement and 25 patients with mitral valve repair. According to the surgical sequence, all the patients were divided into 3 groups including a group A, group B, and group C with 50 patients in each group (every 10 patients as a sequence, every 5 sequence as a group). Surgical outcomes were compared among the 3 groups, and surgical quality was analyzed with descriptive statistics. Results Surgical failure rate was 6.7% (10/150). There was no in-hospital mortality. Aortic cross-clamp time, cardiopulmonary bypass time and duration of mechanical ventilation, duration of ICU stay, duration of hospital stays of the group C were significantly shorter than those of the group A and group B. Analysis showed a significant learning curve effect in totally thoracoscopic cardiac surgery. When surgical cases reached about 100 cases, cardiopulmonary bypass and aortic cross-clamp time was shorter than the average value stably. Conclusion Totally thoracoscopic cardiac surgery is safe and reliable. For the beginners, it needs about 100 patients of surgery to master the totally thoracoscopic cardiac surgery.