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Objective:To investigate the early clinical effects of orthopedic surgery robot-assisted double Endobutton titanium plate internal fixation in the treatment of fresh acromioclavicular joint dislocation.Methods:Thirty-nine patients with fresh acromioclavicular joint dislocation were included from January 2020 to January 2022. A total of 19 patients were treated with double Endobutton suspension internal fixation assisted by the domestic third-generation orthopaedic surgical robot (TiRobot ? 2.0) Dimensity system. There were Rockwood type III in 11 cases, type IV in 8 cases. Twenty cases were treated with conventional incision double Endobutton internal fixation, with Rockwood type III in 13 cases, type V in 7 cases. The operation duration, blood loss volume, incision length and hospitalization time were compared between the two groups. The following CT parameters of acromioclavicular joint at 2 days and 1 year after operation, distance between distal inferior cortex of clavicle and subacromial cortex, distance between upper and lower endobuttons, horizontal distance between anterior edge of distal clavicle and anterior edge of acromion and diameter of coracoid process and diameter of clavicular tunnel were measured. The visual analogue score (VAS), Constant-Murley shoulder function score and shoulder abduction activity were also evaluated before and at 12 months after operation. Results:The follow-up duration was 10.8±2.4 months in the robot group and 11.5±3.1 months in the routine group. The VAS score of the robot group decreased from 5.3±2.1 to 0.3±0.2 at 12 months after operation ( t=10.46, P=0.014). The Constant-Murley score increased from 55.6±6.4 to 92.0±4.2. The range of shoulder abduction increased from 42.2°±5.4° to 172.6°±6.1° ( t=17.24, P<0.001). The operation duation of the robot group was 74.4±6.6 min, which was longer than that of the conventional group 61.7±7.2 min ( t=5.43, P=0.037). There was no significant difference in VAS score, Constant-Murley score, shoulder abduction activity or CT measurement between the two groups ( P>0.05). During the follow-up, two cases in the robot group had cortical osteolysis on the supraclavicular surface, one case in the conventional group had loss of reduction, one case in the supraclavicular cortical osteolysis, and 4 cases in the cortical defect on the side of the coracoid process tunnel. Conclusion:Orthopedic robot-assisted and conventional incision with double Endobutton titanium plate internal fixation in treating fresh acromioclavicular joint dislocation can achieve satisfied early clinical effects. Accurate establishment of clavicle and coracoid bone tunnel assisted by robot can overcome the defects of bone tunnel deviation in conventional incision operation and can prevent reduction and bone loss. However, robot-assisted and conventional incision Endobutton internal fixation could enlarge bone tunnel.
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Objective:By comparing the clinical effect of minimally invasive hollow screw internal fixation Assisted by orthopedic robot (TiRobot) and O-arm navigation in the treatment of pelvic fractures, and practicability and security of both treatments were evaluated.Methods:Retrospective analysis of data of 42 cases of Tile C type pelvic fractures was employed during June 2017 to June 2020. Among them, 32 cases, twenty-four men, eight women, aged 34±6.2 years (range 24-68 years), were treated with percutaneous screw fixation guided by O-arm X wire instrument. According to Tile classification, there were 3 cases of C1.1 type, 8 cases of C1.2 type and 21case of C1.3 type. According to the Denis classification of sacral fractures, 17 cases were in zone I, and 8 cases in zone II. Ten patients, eight males and two females, aged 36±5.2 years (range 19-62 years) were treated by percutaneous screw fixation assisted by orthopedic robot. According to Tile classification, there were 1 case of C1.1 type, 2 cases of C1.2 type and 7 cases of C1.3 type. According to the Denis classification of sacral fractures, there were 5cases in zone I, 2 cases in zone II. For those who got obviously displaced pelvic fractures, Starr frames were used and then internal fixation was used to fix pelvic anterior ring and posterior ring injury respectively. Based on the times of needle adjustments, intraoperative fluoroscopy time, good screw position and incidence of complications two groups were statistically analysed. Matta score was employed to evaluate the quality of fracture reduction, while the Majeed score was employed to evaluate the clinical efficacy. Through the two groups of cases guide needle adjustment times, intraoperative fluoroscopy time, screw position excellent and good rate and the incidence of complications, which were statistically analyzed.Results:All screw positions were confirmed by CT scan after operation. The average time required for each screw placement of the O-arm group was 7.36±2.63 s, of the robot group was 6.80±3.20 s, so difference was not statistically significant ( P<0.05). An average of screw adjustments per one screw was 1.56±0.02 times by O-arm, and by the robot group was 0.34±0.06 times, so differences between the two groups were statistically significant ( P>0.05). The average operating time of O-arm group was 53.86±15.06 min, while the robot group was 52.52±15.14 min, so differences between the two groups were not statistically significant ( P>0.05). Position distribution of screw placement in two groups, all screws in O-arm group of position evaluations were excellent, excellent rate was 100%, all screw position evaluations by robot were excellent, excellent rate was 100%, so difference in screw distribution between the two groups was not statistically significant ( P>0.05). All cases were followed up for 6-12 months. Fracture healing time: 34.6±8.6 weeks for O-arm group, 33.4±9.4 weeks for robot group. Comparison between the two groups was not statistically significant ( P>0.05). Majeed score of O-arm group was 55-87, including Excellence of 17 cases, goodness of 9, fairness of 6. The rate of excellence and goodness was 81.2%, while robot group was 76-95, and that were excellent 7 cases,1 good, and the excellent and good rate was 80%, there was no significant difference between Matta and Majeed score between the two groups ( P>0.05). The incidence of complications between the two groups were no statistically significant ( P>0.05). Conclusion:Orthopedic robot system and O-arm navigation system assisted by percutaneous hollow screw fixation treatment of pelvic anterior and posterior ring injury, which are accurate, safe, minimally invasive, can reduce radiation damage to patients and surgeons. The efficacy were satisfactory. Both treatments are ideal for minimally invasive treatment of pelvic fractures, and the orthopedic robot have advantages of being programmed, standardized, stable and it’s learning curve is shorter.
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Objective To explore the feasibility and clinical value of Ilizarov bone transport technique combined with bone graft and internal fixation at the docking site in the treatment of large segmental bone defect of the lower limbs.Methods Thirty patients with large lower limbs bone defects were prospectively divided into two groups according to the random number table:pure bone transport group (Ilizarov bone transport technique alone,n=lS,10 males and 5 females,average age 34.4±4.6 years old,2 cases bone defect of femur,13 cases tibia,and the length of bone defect 6.2±2.4 cm),and combined bone transport group (Ilizarov bone transport technique with bone graft and internal fixation at the docking site,n=lS,12 males and 3 females with the average age of 33.8±5.2 years,1 case of bone defect and 14 tibia,and the length of bone defect 6.5±2.2 cm).The preoperative hospital for special surgery (HSS) knee functional scores,Baird-Jackson ankle function scores,external fixation time,external fixation index,bone union time,bone union index,postoperative ASAMI scores and incidence of complications were compared between the two groups.Results All patients were followed up for 9 to 24 months (mean 16.2 months).Pure bone transport group was followed up for 9 to 24 months (mean 16.2 months),and combined bone transport group was 10 to 24 months (mean 16.4 months).In pure bone transport group,the external fixation time was 17.6±5.4 months,and the bone union time was 11.2±3.1 months with the average bone union index 42.4±4.6 d/cm.While in combined bone transport group,the external fixation time of group B was 8.4± 2.1 months,and the bone union time was 7.2±2.1 months with the average bone union index 21.1±2.7 d/cm.The external fixation index of pure bone transport group was 32.4±2.1 d/cm,while in combined bone transport group it was 32.1±2.5 d/cm,and there was no significant difference between these two groups (t=0.812,P=0.884).According to the bone and function score of the ASAMI,in pure bone transport group,bone healing:excellent 6 cases,good 6 cases,fair 2 cases,poor 1 case,excellent rate was 80％.While in combined bone transport group:excellent in 8 cases,good 6 cases,fair 1 case,excellent rate was 93.3％.The difference between the two groups was statistically significant (X2=10.6,P=0.032).The lower limb function in pure bone transport group:excellent in 5 cases,good in 5,fair in 4,poor in 1,excellent rate was 66.7％;while in combined bone transport group:excellent in 6 cases,good in 7,fair in 2,excellent rate was 86.7％.There was also a significant difference in the incidence of complications between the two groups.Conclusion Both the pure Ilizarov bone transport technique and the Ilizarov technique with bone graft and internal fixation at the docking site could satisfactorily treat the large bone defect and shortening of the lower limb.But the latter technique had shorter healing time,higher healing rates,better limb function and fewer complications.
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Objective To explore treatment of bile duct variation in Laparoscopic Cholecystectom.Methods The author retrospectively analyzed the clinical data of 7 cases with bile duct variation in 2 000 patients performing Laparoscopic Cholecystectomy.Among the 7 cases,2 cases had small hepatic duct openings in the gallbladder bed;2 cases had cystic duct openings in the right hepatic duct;2 cases had accessory right hepatic duct;and one case had rare variation whose right hepatic bile duct and the jejunum connect together.2 cases of the first variation had no bile leakage,adopting the suture method in LC.Among 2 cases of the second variation(all found in LC),one case had bile spillage in the junction of the cystic duct and the right hepatic duct,so the operator converses to laparotomy,cuts the gallbladder,sutures the break,and the patient had no bile leakage at last;The other one case was anatomized clearly under the cavity mirror.Among 2 cases of the third variation,one had no bile leakage,whose accessory hepatic duct was ligated in LC.The other one case had bile leakage after LC,so the operator converses to laparotomy,clips the accessory hepatic duct,and extract the drainage tube until there was no bile drainage.The last case was mistaken and cut it,the next day biliary peritonitis appeared,so the bile leakage was sewed up under the laparoscope.Results The seven cases were followed 1 ~3 years,they had no jaundice and their liver function was normal.Conclusion Careful-ly dissect Calot's triangle in LC,observe bile leakage after LC;improve the level of understanding and dealing bile duct variation in LC,don't cut the duct which is known to us.We should treat differently according to particular case.
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Objective To study the effects of Aralia chinesis on the proliferation and viability of fibroblasts and on the production of the hyaluronic acid(HA)in the cultured supernatant,and to explore its anti-hepatofibrosis mechanism.Methods NIH3T3 fibroblasts,which were cultured in vitro by routine method and were used as the substitutive model of hepatic stellate cells(HSC),were cultured with the rats serum containing Aralia chinese.The effects of Aralia chinesis serum on the cell proliferation was measured by methabenzthiazuron(MTT)assay and the HA content in cultured supernatant was detected by radioimmunoassay.Results Aralia chinesis serum showed no significant toxicity on NIH3T3 fibroblasts.5 %concentration serum of Aralia chinesis inhibited the cell proliferation and the synthesis of HA significantly(P