Since 1988, with the aid of the microsurgical technique, circle invagination suture method was adopted to carry out primary repair of injury of the flexor tendon of hand in 30 cases, 54 fingers. The rehabilitative exercises were carried out early after operation. The patients were followed up postoperatively more than 6 months. According to the grading method of TAM for evaluation of the results, the excellentfair rate was 83.3%. This suture method and its advantages were introduced. The importance of atraumatic technique in operation and early ehabilitative excercises in order to prevent tendon adhesion were emphasized .
ObjectiveTo evaluate the continuous half-thickness suture outside of the pectinate muscles in the right atrium incision in adult patients undergoing cardiac surgery. MethodsA total of 1 040 consecutive adult patients undergoing cardiac surgery by the right atrium incision with cardiopulmonary bypass (CPB) were randomly divided into a control group (n=518 with 236 males and 282 females at mean age of 44.55 years) and a trial group (n=522 with 242 males and 280 females at mean age 45.75 years) between January 2010 and June 2014. The right atrium incision was sutured by continuous full-thickness suture in the control group and sutured by continuous half-thickness suture in the trial group. After the suture, the bleeding in the right atrium incision was recorded. ResultsAll patients underwent the open-heart operation. Seven patients died of postoperative low cardiac syndrome including four patients in the control group and 3 patients in the trial group. The heart incision was inspected before suturing the pericardium. A total of 203 patients of local active bleeding were stitched again in the right atrium incision in the control group. Only 26 patients were stitched again in the trial group (P<0.001). In the cases of re-exploration for bleeding or tamponade after cardiac operation, 3 patients of bleeding due to the right atrium incision were confirmed in the control group, and no one was confirmed in the trial group. ConclusionThe continuous half-thickness suture in the right atrium incision can prevent the incision bleeding, and avoid locally stitching again in adult patients undergoing cardiac surgery.
ObjectiveTo compare the effectiveness between micro-anchor repair and modified pull-out suture in the treatment of mallet fingers. MethodsBetween June 2010 and March 2011, 33 patients with mallet fingers were treated by micro-anchor repair method (n=18, group A) and by modified pull-out suture method in which the broken tendons were sutured with double metal needle Bunnell’s suture and a knot was tied palmarly (n=15, group B). There was no significant difference in age, gender, and disease duration between 2 groups (P gt; 0.05). ResultsThe operation time was (62.5 ± 3.1) minutes in group A and (65.0 ± 4.6) minutes in group B, showing no significant difference (t=1.85, P=0.07). The treatment expense in group A [(8 566.2 ± 135.0) yuan] was significantly higher than that in group B [(5 297.0 ± 183.5) yuan] (t=58.92, P=0.00). Incision infection occurred in 2 cases of group A and 1 case of group B; the other patients obtained healing of incision by first intention. Relapsed mallet finger was observed in 1 case of group B. All patients in 2 groups were followed up 12-21 months. According to the Crawford functional assessment system, the results were excellent in 5 cases, good in 10 cases, fair in 2 cases, and poor in 1 case at the last follow-up with an excellent and good rate of 83.3% in group A; the results were excellent in 4 cases, good in 9 cases, fair in 1 case, and poor in 1 case with an excellent and good rate of 86.7% in group B. There was no significant difference in the excellent and good rate between 2 groups (χ2=0.23, P=0.97). ConclusionBoth micro-anchor repair and modified pull-out suture are simple and effective methods in the treatment of mallet finger. But compared with micro-anchor repair, pull-out suture has lower expense.
To prove and improve the technique of fibrin glue adhesion repair peripheral nerve, 20 male rats were chosen. All the rats was randomly divided into two groups: Suture group (n = 10) and glue adhesion group (n = 10). Left sciatic nerves of the rats were cut with knife and repaired by suture or adhesion methods separately according to their groups. When adhesive method being used, the epineurial was fixed with a suture method similar to anchor suture for preventing suture line broken. Immediatly after the repair and 8 weeks after the surgery, the histologic and electrophysiologic changes of the repaired nerve were observed. The result showed: The axonal copation was soon improved in glue adhesion group. At the eighth week, nerve fiber alignment of the adhesion group was more regular than that of the suture group. Moreover, there were great improvement of axon cross rate and the recovery rate of sectional area of nerve fiber at the distal end in glue adhesion group (P lt; 0.05, P lt; 0.01). It was concluded that glue adhesion was prior to suture in repair of peripheral nerve, and anchor suture could improve the technique of glue adhesion method.
Objective To explore the research progress of the coracoid transfer surgery using suture button fixation, particularly focusing on the technique known as Chinese unique Inlay Bristow (Cuistow surgery).MethodsExtensive literature review was conducted to summarize and analyze the utilization of suture button fixation in the Cuistow surgery, comparing its biomechanical and clinical outcomes with those of traditional screw fixation.Results Utilizing suture button fixation in coracoid transfer surgery helps circumvent certain metal-related complications associated with traditional screw fixation. While its biomechanical stability and effectiveness have been preliminarily confirmed, debates persist regarding its graft healing rate and postoperative recurrence rate compared to traditional screw fixation. The Cuistow surgery based on the Inlay structure is a solution to improve the healing rate of graft after suture button fixation. Conclusion Suture button fixation, as a novel approach in coracoid transfer surgery, remains to have its advantages and disadvantages compared to traditional screw fixation not entirely elucidated, underscoring the need for further in-depth clinical and fundamental research. Cuistow surgery is the Chinese experience of coracoid transfer surgery, and its biomechanical stability and clinical advantages have been preliminarily confirmed.
ObjectiveTo investigate the effectiveness of interrupted suture under exercise position in total knee arthroplasty (TKA).MethodsEighty-four patients with osteoarthritis who were treated with TKA between July 2015 and July 2016 were enrolled in the study. All patients were randomly divided into control group and observation group with 42 cases in each group. There was no significant difference in gender, age, side, body mass index, and osteoarthritis grading between 2 groups (P>0.05). The incisions were interrupted sutured at the knee flexion position in control group and at the exercise position in observation group. Preoperative and postoperative treatments of 2 groups were same. The incision length, suture time, total tramadol usage, intraoperative blood loss, stitches removal time, hospitalization time, incidence of postoperative complication, the incision healing score (HWES), and satisfaction score of incisional self evaluation (Liktert score) were recorded and compared between 2 groups. The visual analogue scale (VAS) score was used to evaluate the incision pain at pre- and post-operation. The hospital for special surgery (HSS) score and range of motion (ROM) were also used to assess the knee function.ResultsThere was no significant difference in incision length, incidence of postoperative complication, HWES score, stitching time, and hospitalization time between 2 groups (P>0.05). The suture time, intraoperative blood loss, and Likter score were significantly lower in control group than those in observation group (P<0.05), but the total tramadol usage was significantly higher in control group than that in observation group (P<0.05). All patients were followed up. The follow-up time ranged from 12 to 24 months (mean, 14.7 months) in control group and from 12 to 23 months (mean, 15.3 months) in observation group. There was no significant difference in VAS scores between 2 groups before operation, before going to bed at the 1st day, and after suture removal (P>0.05). The VAS score of observation group after flexion and extension exercises at the 1st day was significantly lower than that of control group (P<0.05). There was no significant difference in HSS score and ROM between 2 groups before operation and at 12 months after operation (P>0.05). The HSS score and ROM in observation group at discharge and at 1, 3, and 6 months after operation were superior to those in control group (P<0.05).ConclusionCompared with interrupted suture at flexion knee position, the application of interrupted suture at exercise positon in TKA had the advantages of less postoperative pain and good incision healing, and can get satisfactory early joint function recovery. But significant difference in the long-term effectiveness of the two methods was not found.
Objective To investigate the feasibility and patient selection of T-tube free laparoscopic common bileduct exploration through mini-incision in confluence of common bile duct （CBD） and cystic duct. Methods The clinical data of 52 patients who underwent CBD exploration from January 2009 to December 2011 were retrospectively analyzed. A 3-4mm longitudinal incision of anterior wall of CBD was made along the confluence of CBD and cystic duct， and then the choledochoscope was inserted into CBD through this mini-incision for the exploration and treatment by laparoscopy and choledochoscopy， the incision was sewed up by T-tube free primary suture. Results All 52 cases were cured and stone clearance rate was 100% as revealed by choledochoscopy and cholangiography. The time of operation， intraoperativecholangiography， removal of stones with help of choledochoscope， and removal drainage tube after operation was from 90 to 200 min with an average of 100min， 3 to 10min with an average of 6min， 5 to 15 min with an average of 8 min，and 3-5d with an average of 3.5d ， respectively. The drainage flow was 20-60mL/d with an average of 30mL/d. No biliary leakage， abdominal pain， and choloplania or infection of incision was observed following operation. The hospital stay was 5 to 12d with an average of 6.5d after operation. No calculus regeneration or bile duct stricture occurred during following-up of 3 to 40 months with an average of 20 months. Conclusion With proper patient selection， T-tube free laparoscopic CBD exploration through mini-incision in confluence of CBD and cystic duct is safe and feasible by proficient surgeons in laparoscopy and choledochoscopy.
Objective To summarize mid-term effectiveness of modified arthroscopic suture button fixation Latarjet procedure for treatment of recurrent anterior shoulder dislocations. Methods Between January 2018 and October 2020, 30 patients with recurrent anterior shoulder dislocations were treated with modified arthroscopic suture button fixation Latarjet procedure. There were 19 males and 11 females with an average age of 27.3 years (range, 18-41 years). The shoulder dislocation occurred 3-7 times, with an average of 4.9 times. The time from the last dislocation to operation was 3-10 days, with an average of 4.1 days. Glenoid defects exceeded 20% in all cases. There were 27 cases of Hill-Sachs lesions. The joint pain and function were estimated by visual analogue scale (VAS) score, University of California, Los Angeles (UCLA) score, Rowe score, American Association for Shoulder and Elbow Surgery (ASES) score, Walch-Duplay score, and the range of external rotation at 0° and external rotation at 90° abduction of shoulder before operation and at 1 month, 6 months, and last follow-up. The X-ray film, CT scan and three-dimensional reconstruction were reviewed to observe the position, healing, and absorption of the coracoid graft, correction of glenoid defect, and joint degeneration.Results The operation time ranged from 51 to 79 minutes, with an average of 68.4 minutes. All incisions healed without complications such as nerve or blood vessel injury. All patients were followed up 36-60 months with an average of 44.6 months. The VAS score, UCLA score, Rowe score, ASES score, Walch-Duplay score, and the range of external rotation at 0° and external rotation at 90° abduction after operation significantly improved when compared with preoperative values (P<0.05). All indicators further improved with time, and the differences between different time points after operation were significant (P<0.05). Imaging review showed that the coracoid graft was located in the anteroinferior glenoid at 1 day after operation, and no occurrence of shoulder osteoarthritis was found during follow-up. The anatomical structure of the glenoid was normal, and no delayed healing or non-union of the coracoid graft occurred. At 20 months after operation, arthroscopic re-exploration was performed in 1 case due to fracutre caused by falling injury revealed the good shaping of the coracoid graft, smooth glenoid, and no bone resorption or osteoarthritis. ConclusionFor recurrent anterior shoulder dislocations, the modified arthroscopic suture button fixation Latarjet procedure can obtain good recovery of shoulder function and low incidence of complications and has a good mid-term effectiveness.
Objective To compare the early effectiveness of arthroscopic repair of moderate rotator cuff tears with single-row modified Mason-Allen technique and double-row suture bridge technique. MethodsThe clinical data of 40 patients with moderate rotator cuff tears who met the selection criteria between January 2021 and May 2022 were retrospectively analyzed. Among them, 20 cases were repaired with single-row modified Mason-Allen suture technique (single-row group) and 20 cases with double-row suture bridge technique (double-row group). There was no significant difference in gender, age, disease duration, rotator cuff tear size, and preoperative visual analogue scale (VAS) score, Constant-Murley score, and T2* value between the two groups (P>0.05). The VAS score, Constant-Murley score (including subjective influence, pain, flexion, internal rotation, external rotation, abduction, and muscle strength score) were compared between the two groups before operation and at 6 weeks, 3, 6, and 12 months after operation. Functional MRI and ultrashort-echo-time (UTE)-T2* technique were performed to calculate T2* value and quantitatively evaluate the healing of rotator cuff tissue; and the healing of rotator cuff was evaluated by Sugaya classification at 12 months after operation. ResultsPatients in both groups were followed up 1 year. There was no complication such as muscle atrophy, joint stiffness, or postoperative rotator cuff tear. The intra-group comparison showed that the scores of pain, subjective influence, flexion, abduction, and muscle strength in Constant-Murley scores at each time point after operation in the two groups were significantly higher than those before operation, while VAS scores were significantly lower than those before operation (P<0.05). Internal rotation, external rotation, and total score of Constant-Murley score in the two groups were lower at 6 weeks due to abduction immobilization within 6 weeks after operation, and gradually increased at 6 months after operation, with significant differences at 3, 6, and 12 months after operation when compared with those before operation and at 6 weeks after operation (P<0.05). The T2* values of the two groups showed a downward trend over time, and there were significant differences between the two groups at other time points (P<0.05), except that there was no significant difference between at 6 and 12 months after operation in the single-row group and between at 3, 6, and 12 months after operation in the double-row group (P>0.05). The comparison between groups showed that the VAS score and T2* values of the double-row group were significantly lower than those of the single-row group at 6 weeks, 3 months, 6 months, and 12 months after operation (P<0.05). The scores of subjective influence, flexion, abduction, and internal rotation in the double-row group were significantly better than those in the single-row group at 6 weeks and 3 months after operation (P<0.05), and the external rotation score and total score in the double-row group were significantly better than those in the single-row group at 3 months after operation (P<0.05), but there was no significant difference at 6 and 12 months after operation (P>0.05). There was no significant difference in muscle strength and pain scores between the two groups at 6 weeks, 3 months, 6 months, and 12 months after operation (P>0.05). There was no significant difference in the results of Sugaya classification between the two groups at 12 months after operation (Z=1.060, P=0.289). Conclusion The effectiveness of arthroscopic repair of moderate rotator cuff tears with modified Mason-Allen technique and double-row suture bridge technique is satisfactory, but suture bridge technique is helpful to the early rehabilitation training of shoulder joint and the recovery of motor function of patients.
ObjectiveTo compare the early effectiveness of arthroscopic suture bridge technique and conventional double tunnel suture technique in the treatment of avulsion fracture of posterior cruciate ligament (PCL) insertion.MethodsBetween June 2013 and December 2018, 62 patients with tibial avulsion fracture of PCL insertion that met the criteria were selected and randomly divided into trial group (using arthroscopic suture bridge technique) and control group (using conventional double tunnel suture technique), 31 cases in each group. There was no significant difference in gender, age, injured side, cause of injury, time from injury to operation, Meyers & McKeever classification, Kellgren-Lawrence classification, and preoperative knee range of motion, difference of posterior relaxation of bilateral knee joints, International Knee Documentation Committee (IKDC) score, and Lysholm score between the two groups (P>0.05). The operation time and IKDC score, Lysholm score, knee range of motion, the difference of posterior relaxation of bilateral knee joints (measured by KT-2000 under knee flexion of 90° and 30 lbs) were recorded and compared between the two groups before operation and at 3 and 12 months after operation.ResultsBoth groups successfully completed the operation, and the operation time of the trial group and the control group were (61.81±6.83) minutes and (80.42±4.22) minutes respectively, showing significant difference between the two groups (t=12.911, P=0.000). All the incisions healed by first intention, and there was no wound infection and other early postoperative related complications. All patients were followed up 13-18 months (mean, 14.6 months). The fractures in both groups healed at 3 months after operation. No knee pain, limited movement, or other complications occurred. At 3 and 12 months after operation, the IKDC score, Lysholm score, knee range of motion, and the difference of posterior relaxation of bilateral knee joints in both groups were significantly improved when compared with preoperative ones, and further improved at 12 months after operation when compared with at 3 months after operation (P<0.05). At each time point after operation, the above indexes and the grade of the difference of posterior relaxation of bilateral knee joints in the trial group were significantly better than those in the control group (P<0.05).ConclusionArthroscopic suture bridge technique in the treatment avulsion fracture of PCL insertion is simple and reliable, which can significantly improve the function and stability of the knee joint and obtain satisfactory early effectiveness.