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Despite the fact that the patency rate of saphenous vein graft(SVG) is less than those of arterial grafts,SVG is fully appreciated by cardiac surgeons and remains the most widely-used conduit for coronary artery bypass grafting(CABG).Recently,thanks to the growing understanding of the pathogenesis of vein graft failure(VGF),the emergence of new drugs and the improvement of surgical techniques,the patency rate of SVG has been well improved.This article reviews the history and the current understanding of SVG,the pathogenesis of VGF,the clinical strategies that may improve the patency rate and the research prospects in this filed.
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Objective Off-pump coronary artery bypass (OPCAB),minimally invasive direct coronary artery bypass (MIDCAB) and robotic-assisted coronary artery bypass (RA-CAB) are all used to treat isolated left anterior descending artery (LAD) disease.The aim of this study is to compare the early outcomes after these three procedures.Methods From February 2009 to May 2012,102 consecutive patients underwent revascularization of LAD.31 patients were treated by OPCAB,45 by MIDCAB and 26 by RA-CAB.Patients received sternotomy in the OPCAB procedures.The MIDCAB procedures were performed through a 10-cm anterolateral muscle-sparing minithoracotomy.In the RA-CAB procedures,left internal mammary arteries (LIMA) were harvested with the aid of da Vinci surgical system and sewing of the anastomoses was performed under direct vision by a 3-cm anterolateral minithoracotomy.Results No significant difference was observed in graft flow,pulse index,renal failure,reoperation for hleeding,new onset of arterial fibrillation and deep wound infection between these three groups.There was also no significant difference in peri-operative mortality,major adverse cerebro-cardiovascular events (MACCE) between these three groups.Compared with OPCAB,MIDCAB and RA-CAB significantly reduced the need of blood transfusion (4.4％ vs.32.3％,P＜ 0.05; 7.7％ vs.32.3％,P＜0.05).The patients receiving RA-CAB had shorter length of postoperative stay than whom receiving OPCAB[(8.8 ± 3.2) days vs.(12.4 ± 7.7) days,P ＜ 0.05)].There is no significant difference between the outcomes of MIDCAB and RA-CAB.Conclusion These findings indicated that MIDCAB and RA-CABwere feasible,effective and safe options for revascularization of isolated LAD disease.MIDCAB and RA-CAB showed the advantage of less invasive and faster recovery,compared with OPCAB.Therefore,MIDCAB and RA-CAB should be the routine treatment for patients with isolated LAD disease.In some advanced centers,RA-CAB will be the preferred method.The mid-and long-term outcomes of these three methods should be further investigated.
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Objective To explore the clinical application and follow-up results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in treating proximal humeral fractures. Methods From December 2006 to September 2008, MIPPO using locking plate was employed to treat 36 patients (23 males and 13 females) with proximal humeral fracture. According to AO classification, there were four patients with type A2 fractures, 10 with type A3 fractures, five with type B1 fractures, 11 with type B2 fractures, three with type C1 fractures and three with type C2 fractures. Longitudinal or transverse incision was made through anterolateral acromial approach to separate the deltoid muscle and expose the fracture fragments. The direct and indirect reduction of the fractures were performed under direct vision. The locking plate was inserted distally beneath the deltoid muscle and a longitudinal incision was made at the lateral end of the plate. Locking screws were inserted to the proximal and distal plates. Postoperative follow-up was done to provide guidance to functional exercise and evaluate the clinical results. Results The operation lasted for (50.1±11.3) minutes, with intra-operative blood loss of(76±18.7) ml and average operative incision of (4.5±0.8) cm. All the patients were followed up for 12-17 months (average 14 months), which showed that the time of bone healing was (10. 1 ±1.2) weeks. Neer scoring standards showed the total excellence rate of 86%. Conclusion MIPPO is an ideal method for treatment of proximal humeral fractures, for it has the advantages such as safety, minor trauma, short bone healing time, alleviation of pain and good X-ray reduction.
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Objective To explore the therapeutic effect and application value of the self-made spinal positioning equipment and percutaneous pedicle screw fixation system in the treatment of thoracic and lumbar fracture. Methods To determine the fractured vertebra and pedicle screws entrance point with spinal positioning equipment, 67 patients with thoracic and lumbar fractures were performed percutaneous pedicle screw fixation by using self-made percutaneous pedicle screw fixation system. By contrasting the perioperative indicators, and imaging indicators, to evaluate the therapeutic effect and application value of the system. Results For the spinal positioning equipment, the location time were (15.85±2.45) min and the location accuracy were 95.03%±3.27%. But for the open reduction internal fixation, the location time were (35.46±5.39) min and the location accuracy were 94.02%±2.95%. There was no significant difference in location accuracy, but were significant differences in location time (P＜0.05). Percutaneous pedicle screw fixation had the same effect on three sides with open reduction internal fixation in vertebral height restore,kyphosis deformity and correction and lumbar spinal stenosis's correction. The perioperative indicators of the preoperative and postoperative grope had significant difference (P＜0.05). There were significant differences in all perioperative indicators between the percutaneous pedicle screw fixation and the open reduction internal fixation (P＜0.05). Conclusion The spinal positioning equipment is helpful to determine the fractured vertebra and pedicle screws entrance point accurately and reduce the radiation. The percutaneous pedicle screw fixation system has the advantage of convenient manipulation and accurate implantation. The system can not only reduce surgical damage and post-operation reaction but also make patients recover quickly and face less complications.
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[Objective]To evaluate the clinical application and results of the anterolateral acromial approach with minimal incision in the treatment of proximal humerus fracture.[Method]From December 2006 to December 2008,42 patients with proximal humeral fracture were treated by the anterorlateral acromial approach using locking plate.There were 25 males and 17 females.All the fractures were classified with AO/OTA classification.There were 5 A2-fractures,11A3-fractures,7 B1-fractures,12 B2-fractures,3 C1-fractures,4 C2-fractures.Anterolateral acromial approach with minimal incision was applied and the deltoid muscle was seperated to expose the fracture fragments.Under direct vision the direct and indirect reduction of the fractures were performed.The locking plate was inserted distally beneath the deltoid muscle and between the distal plate and the humeral shaft was adjusted through another small skin incision on the lateral upper arm.Locking screws were inserted to the proximal and distal plate.Operation time,incision length,blood loss,reduction,Neer scores at 1 year were analyzed in different time points.[Result]All the cases were completed with minimal incision.There were significant differences(P
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[Objective]To explore the clinical indication and effectiveness of anterolateral mini-incision for the total hip replacement (THR).[Method]A retrospective analysis of the 34 cases of anterolateral mini-incision was conducted from May 2002 to March 2005,among the patients 23 suffered from displaced femoral neck fractures and 11 suffered from femoral head aseptic necrosis.[Result]All the patients were followed up for 12～36 months with an average of 18 months.The obvious advantages of anterolateral mini-incision for the total hip replacement were as following:less blood loss in operation,less post-operative pain and complications,and early rehabilitation training,without cinch and subsidence in X-ray.Harris score was 92.1 point.[Conclusion]Anterolateral mini-incision for the total hip replacement can be used as an effective method to treat the patients who were extenuation,without abnormalities of hip joint,deossification and osteoporis.Appropriate incision combined with precise procedure can reduce the operative trauma and speed up functional recovery.
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Objective To report the clinical outcomes of arthroscopic internal fixation by using anchor for tibial eminence fracture.Methods From January 2004 to January 2005,12 cases of tibial eminence were treated by arthroscopy with anchor fixation.Rehabilitation therapy was carried out after the operation.Results The mean operation time was 41 minutes(range 37 to 47).No patient had postoperative complications.They were followed up for 15 to 27 months(mean,23 months).The postoperative Lysholm score ranged from 91 to 98 with a mean of 93.The patients could extend the knee in a normal range,without pain or locking.Conclusion Arthroscopic internal fixation using anchor is a safe,simple,and effective treatment for patients with tibial eminence fracture.