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Objective: To compare the clinical and radiographic results between primary total knee arthroplasty (TKA) via mini-subvastus or conventional approach through a prospective randomized controlled study.
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Objective To study the clinical efficacy of Bikini incision minimally invasive total hip arthroplasty on elder patients with femoral head necrosis and its effect on bleeding.Methods Seventy-six elder patients with femoral head necrosis in Sanmenxia Central Hospital from January 2015 to December 2016 were randomly divided into the study group(38 cases)and the control group(38 cases).The patients in the study group were treated with Bikini incision minimally invasive total hip arthroplasty by anterior approach,while the control group underwent total hip arthroplasty by anterolateral approach.Harris score and WOMAC score were used to evaluate the clinical function of hip joint.The operation time,length of incision,intraoperative blood loss, blood transfusion,hospitalization time,hemoglobin level at 72 h after surgery,the first ambulation time,the lower limb length discrepancy,postoperative complication were recorded and compared between two groups.Results The Harris scores at 1,2,4 months after operation in the two groups were significantly improved(P<0.05), while WOMAC scores of patients at 1,2,4 months after operation were significantly lower than those before treatment(P<0.05).However,there were no significant differences at different time between the groups(P>0.05).The hospitalization time and the first ambulation time in the study group were significantly shorter than those in the control group((6.1±2.8)d vs.(7.9±3.2)d,P=0.011;(5.3±1.5)d vs.(6.4±1.7)d,P=0.004).After 4 months of treatment,the lower limb length discrepancy in the study group was less than that of the control group((6.5 ± 2.3)mm vs.(10.4 ± 3.5)mm,P<0.01).In addition,there were no significant differences between two groups in the operation time,length of incision,complication occurrence,intraoperative blood loss and blood transfusion(P>0.05).Conclusion Treating femoral head necrosis with Bikini incision minimally invasive total hip arthroplasty can achieve favorable effectiveness,with no increase in intraoperative blood loss and rapid recovery of postoperative joint function,but further follow-up is needed.
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Objective To study the clinical efficacy of Bikini incision minimally invasive total hip arthroplasty on elder patients with femoral head necrosis and its effect on bleeding.Methods Seventy-six elder patients with femoral head necrosis in Sanmenxia Central Hospital from January 2015 to December 2016 were randomly divided into the study group(38 cases)and the control group(38 cases).The patients in the study group were treated with Bikini incision minimally invasive total hip arthroplasty by anterior approach,while the control group underwent total hip arthroplasty by anterolateral approach.Harris score and WOMAC score were used to evaluate the clinical function of hip joint.The operation time,length of incision,intraoperative blood loss, blood transfusion,hospitalization time,hemoglobin level at 72 h after surgery,the first ambulation time,the lower limb length discrepancy,postoperative complication were recorded and compared between two groups.Results The Harris scores at 1,2,4 months after operation in the two groups were significantly improved(P<0.05), while WOMAC scores of patients at 1,2,4 months after operation were significantly lower than those before treatment(P<0.05).However,there were no significant differences at different time between the groups(P>0.05).The hospitalization time and the first ambulation time in the study group were significantly shorter than those in the control group((6.1±2.8)d vs.(7.9±3.2)d,P=0.011;(5.3±1.5)d vs.(6.4±1.7)d,P=0.004).After 4 months of treatment,the lower limb length discrepancy in the study group was less than that of the control group((6.5 ± 2.3)mm vs.(10.4 ± 3.5)mm,P<0.01).In addition,there were no significant differences between two groups in the operation time,length of incision,complication occurrence,intraoperative blood loss and blood transfusion(P>0.05).Conclusion Treating femoral head necrosis with Bikini incision minimally invasive total hip arthroplasty can achieve favorable effectiveness,with no increase in intraoperative blood loss and rapid recovery of postoperative joint function,but further follow-up is needed.
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Objective To compare the clinical effectiveness between the channel-assisted mini-invasion and open Achilles shortening for treatment of the elongated Achilles tendon following previous rupture.Methods The clinical data of 19 patients admitted from Dec. 2013 to Dec. 2015 and met the inclusion criteria were analyzed retrospectively. Eight patients were treated with shortening operation by channel-assisted minimally invasive repair system, while 11 patients received dissection of Krackow Achilles tendon shortening. There was no significant difference between the two groups in gender, age, injury to operation time, preoperative calf circumference and preoperative AOFAS (American Orthopaedic Foot & Ankle Society) score (P>0.05).Results The operation time, incision length and postoperative hospital days were significantly less in min-invasion group than in incision group (P0.05).ConclusionChannel-assisted minimally invasive Achilles tendon shortening operation has not only similar effectiveness to the incision shorting operation for the treatment of elongated Achilles tendon following previous rupture, but also has the advantages of shortening operation time and stay in hospital and avoidance of sural nerve injury.
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Objective To compare the effect of ultrasound-guided Mammotome minimally invasive operation and traditional surgery in treating benign breast tumor.Methods Eighty patients with benign breast tumor admitted to People's Hospital of Beijing Daxing District from October 2015 to April 2016 were randomly divided into group A and group B.Patients in group A accepted ultrasound-guided Mammotome minimally invasive operation (n =40),while patients in Group B accepted traditional surgery (n =40).Operation time,incision length,blood loss,patient satisfaction,postoperative pain,and the occurrence rates of complications were compared between the two groups.Results All the tumors in two groups were removed.Patients in group A had shorter operation time (10.4 ± 1.0) min,less blood loss (4.1 ± 0.5) ml,smaller length of incision (0.34 ± 0.04) cm (P ＜ 0.05 or P ＜ 0.01);also had less occurrence of complication (P ＜ 0.05);and patients in group A had better patient's satisfaction (95％) (P ＜ 0.01).Conclusions Ultrasound-guided Mammotome minimally invasive operation is helpful to shorten operation time and incision length,and reduce blood loss,also improve satisfaction.It is valuable for application and popularization in primary hospital.
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Objective:To investigate the diagnosis and treatment significance of invasive and noninvasive operation for ventilator?as?sociated pneumonia ( VAP ) . Methods:A total of 80 cases of VAP suspected patients who had received mechanical ventilation at least 48 hours in ICU from Jun 2014 to Mar 2015 were enrolled. Patients were randomly divided into four groups including noninvasive operation group ( F) , invasive operation group ( Q) , mix group 1 ( H1) and mix group 2 ( H2) . VAP diagnosis rate between groups as well as living time, antibiotic use time, survival rate, calcitonin levels and APACHE II score, oxygenation index were analyzed. Results:Specimen from invasive operation had higher specimens to cultivate positive rate than that from noninvasive operation ( P<0?05), but there was no statistic significant difference in VAP diagnosis rate between two methods (P>0?05). Conclusion:Noninva?sive operation collecting samples for VAP diagnosis is also accurate as invasive one. Collecting specimens from sputum suction tube in the clinical treatment on airway suction is a low cost and simple noninvasive operation.
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Objective: To investigate the safety and efficacy of transthoracic minimally invasive patent ductus arteriosus (PDA) occlusion in infants and young children. Methods: We retrospectively analyzed 105 infants and young children who received the transthoracic minimally invasive PDA occlusion in our hospital from 2012-10 to 2014-10. According to PDA diameter, patients were divided into 2 groups:Group A, the patients with PDA diameter ≥ 4 mm,n=64 and group B, the patients with 2 mm ≤ PDA diameter Results: All 105 patients had successfully implanted PDA occluders. The patients’ gender, age, body weight, tracheal intubation time and the in-hospital time were similar between 2 groups,P>0.05. Compared with Group B, Group A had the larger diameters of PDA (5.7 ± 1.4) mm vs (2.7 ± 0.6) mm, P Conclusion: Transthoracic minimally invasive PDA occlusion is a safe and effective method to treat the relevant infants and young children, while the post-operative residual shunt and thrombocytopenia should be closely observed in patients with large PDA.
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Objective To explore the effect of craniotomy operation and keyhole minimally invasive opera-tion in the treatment of patients with cerebral hemorrhage .Methods 90 patients with cerebral hemorrhage were ran-domly divided into control group and observation group .45 cases in the control group were given conventional cranioto-my to clear hematoma ,45 cases in the observation group received keyhole minimally invasive operation .The operation time,blood transfusion amount , hematoma clearance rate , residual hematoma volume , GOS scale were recorded and compared between the two groups.Postoperative follow-up for one year,the rehospitalization rate,mortality,the Barthel index score,curative effect were compared .Results The operation time and blood transfusion amount of the observa-tion group were (92.5 ±18.1) min,(125.0 ±23.4) mL,which were significantly less than (125.6 ±20.3) min, (325.0 ±104.5)mL of the control group (P0.05).The effective rate of the ob-servation group(91.1%) was obviously higher than that of the control group (62.2%),the difference was statistically significant(P<0.01).The patients were followed up for one year postoperation ,the rehospitalization rate and mortali-ty of the observation group were 20.0% and 5.0%,which were significantly lower than those of the control group (42.1%,15.8%)(P<0.05).While the Barthel index score of the observation group was higher than that of the control group,the difference was significant (P<0.05).Conclusion Keyhole minimally invasive operation in the treatment of cerebral hemorrhage has good clinical curative effect ,with advantages of simple operation ,less trauma, good surgery prognosis ,which is worthy of further clinical promotion .
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Objective To study the perioperative nursing care of minimally invasive operation in the neurosurgical treatment of laterial flexure spasmodic torticollis (LaFST).Methods Minimally invasive operation was used to treat LaFST.The relationship of inducing factors and emotional factors with clinical manifestation of LaFST was investigated.To give perioperative psychological nursing,operation nursing and rehabilitation training and instruction.Results 72 cases were recovered (81.8％) among 88 cases.12 cases(13.6％) were markedly effective.4 cases(4.6％) showed progress.Conclusions The minimally invasive surgical treatrnent of selective resection of cervical spasmodic muscles and selective neurotomy of cervical nerve for LaFST is safe and effective.Strengthening of perioperative nursing and postoperative rehabilitation instruction is very important for patients' early recovery.
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Objective To evaluate the characteristics and efficacy of microscope-assisted bilateral decompression via unilateral approach for the treatment of lumbar stenosis. Methods From June 2007 to June 2010, Sixty case lumbar stenosis with bilateral decompression were treated via unilateral approach under microscopy. Patients were followed up from 6 to 24 months, average (12 ± 4.7) months. Results The pain level of each patient was assessed both before and after the opeartion, using a visual analogue scale (VAS). Intermittent claudication was completely relieved in 57 out of 60 cases, moderately relieved in 3 cases. VAS score decreased from pre-operational 9.08 ± 0.76 to post-operational 2.33 ± 1.43, and there was significantly difference between them. There was no recurrent case during the whole follow-up. Conclusion Bilateral decompression via unilateral approach under microscope is proved to be an effective and safe procedure for the treatment of lumbar stenosis, and have the advantages of minimal invasion, less pain, quick recovery, better effect, little influence on the spinal stability.
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Objective To discuss the surgical outcome of fenestration assistant by microscopy for single-level lumbar disc protrusion (LDH), compared with tradition laminotomy and discectomy. Methods From January 2008 to January 2010, forty-eight patients underwent traditional open discectomy and 40 underwent microscopy surgery. The lumbar disc protrusion involved L3- L4 level in 12 cases, L4-L5 level in 46 cases, and L5-S1 level in 30 cases; preoperative JOA score was 8-19 points (average 12.9 points) for traditional open discectomy patients and 7-19 points (average 12.7 points) for microscopy surgery patients. Results Cauda equina injury was occurred and repaired in 2 cases in traditional surgery group. The follow-up period was 10-34 months (average 18 months) for all patients. No complications such as wrong orientation, nerve root injury, and infection occurred. The JOA score 10 months after operation was (24.0 ± 2.6) for traditional surgery patients with 87.5% success rate and (24.2 ± 2.8) for microscopy surgery patients with 90% success rate. Conclusion Two methods have similar clinical outcomes, but microscopy assistant fenestration for LDH has advantages of minimal invasion, shorter operative time, shorter length of hospital stay and less intraoperative blood loss. It is one of ideal minimally invasive operations for single-level lumbar disc protrusion.
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Objective To observe the therapeutic effect of minimally invasive evacuation of intracerebral hematoma in dog model of cerebral hemorrhage by using Purdy score, serum levels of neuron-specific-enolase (NSE) and numbers of perihematomal apoptotic cells. Method Twenty dogs were selected to prepoxe the model of cerebral hemorrhage, and they were randomly divided( random number) into minimally invasive treatment group and control group. Minimally invasive procedures were performed to evacuate the hematoma in minimally invasive treatment group in 6 hours after the models were established. The dogs of control group only received medical treatment. Purdy score and serum levels of neuron-specific-enolase were determined on 1,3,5,7 days after the evacuation of the hemotoma and apoptotic cells were counted after the dogs were sacrificed at 7 days after operation. All the results were compared with control group. Purdy score and serum levels of neuron-specific-enolase were compaired with variance analysis of repeated measurement design and apoptotic cells was compared with variance analysis of factorial design,the difference of the two groups showed with q test. P <0.01 showed the difference was significant. Results The Purdy scores in minimally invasive treatment group were 6.3 ± 1.702, 5.8 ± 1. 685,4.2 ± 1.762 and 4.1 ± 1.875 on 1,3,5 and 7 day after evacuation of the hematoma, significant difference was observed as compared with the control group(8.9 ± 1.632, 8.6± 1.342, 7.8±1.335, 7.9±1.468, P <0.01).The serum levels of neuron-specific-enolase were 0.632 ± 0.077, 0.721±0.771, 0.549±0.124 and 0.430 ±0.136 respectively in minimally invasive treatment group, while in the control group were 0.934 ± 0. 064, 0. 997 ±0.075, 0.986 ± 0.042, 0.874 ± 0.165, significant differences in serum levels of neuron-specific-enolase were found between the two groups(P < 0.01). The perihematomal apoptotic cells in minimally invasive treatment group(37.4 cells) was decreased significantly as compared with the control group(88.6 cells), with P < 0.01.Conclusions Minimally invasive procedures for evacuation of intracerbral hematoma might significantly reduce the neurological deficit score and decrease the serum neuron-specific enolase levels and numbers of apeptotic neurons.
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Objective To compare the surgical outcomes between microsurgery lumbar discectomy and microendoscopic discectomy for lumbar disc herniation. Methods A prospective study was conducted on the surgical procedures for lumbar disc herniation.The target of our study was a group of 33 patients who underwent surgery by microsurgery lumbar discectomy(MSLD group)and 36 patients who underwent surgery by microendoscopic discectomy(MED group).The items investigated were the operation time,amount of bleeding,duration of hospitalization,pre-and postoperative scores based on judgment criteria for treatment of lumbar spine disorders established by the Japanese Orthopaedic Association score,visual analog scales (VAS,0 to 10) for lumbago and sciatica before surgery and at discharge,perioperative complications.Results The mean duration of follow-up was 2 years and 2 months (11 months to 4 years).There were no significant differences between the 2 surgical procedures in the frequency of the pre-and postoperative Japanese Orthopaedic Association scores or postoperative VAS for lumbar pain and sciatica,operation time and duration of hospitalization. Statistically significant differences were observed in amount of bleeding and operation time,but the differences were not large, and may not have been clinically significant.Conclusion Both microsurgery lumbar discectomy and microendoscopic discectomy are appropriate for lumbar disc herniation.
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Objective To investigate the surgical operation technique,clinical curative effect and the choice of the indication in the treatment of cervical spondylosis by radiofrequency nucleoplasty.Methods From January to July in 2006,the ArthroCare system 2000 radio frequency instrument that the American ArthroCare company produce were odopted,to treat 20 patients with cervical spondylosis by radiofrequency nucleoplasty under the leading of the C form grill X-ray fluoroscopic machine.Among them,there were 9 males and 11 females with age from 38 to 62 years,equally 45.12 years old,the average course of illness was 2 years. 15 cases with lumbar disc herniation,4 cases with nerve-root cervical sDandylosis and 1 case with spinal cervical spondylosis.Single segment affection in 4 cases,double or multistage segment affection in 16 cases.Among those multistage segment eases,all choose 2 segments for research according to fixed physical sign the body advertise for and the MRI image.After the operation all cases underwent follow-up.with follow-up time for 1-6 months.Results The results shown an effect among those 20 sufferers of excellence in 16 cases,valid in 4 cases,efficient power reach to 100%in short term.Ahhough this case was limited.the early case choice compares strictly,the subjective satisfaction of sufferer was higher.Conclusion Application of radiofrequency nucleoplasty in the treatment of cervical sDondylosis has advantages of small wound,safety and high efficacy in short term.However, its indication still need further research.
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OBJECTIVE To investigate the risk factors for vancomycin-resistant Enterococcus(VRE) infections and their effective isolation measures.METHODS The data of 21 cases of VRE nosocomial infections were analyzed from Jul 2003 to Dec 2005 in Beijing Chaoyang Hospital;28 cases of antibiotic-sensitive Enterococcus infection were randomized as control.T test,chi-square test and Logistic regression analysis were used for statistics.Strict measures were taken to all of the VRE infected patients.RESULTS According to univariate analysis,the factors associated with the development of VRE nosocomial infection were age,in ICU,accepted invasive operation,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ),live in hospital more than 30 days,co-infection with other pathogens,and fluoroquinolone and vancomycin/norvancomycin use 15 days before isolation of VRE.Multivariate Logistic regression analysis identified two independent factors: accepted invasive operation and previous vancomycin/norvancomycin use.Spreading of VRE had not occurred.CONCLUSIONS Accepted invasive operation and previous vancomycin/norvancomycin use are independent risk factors for VRE infection.Effective measures can prevent the spread of VRE.
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Objective To investigate the clinical effect of minimally invasive surgery via basisylvian fissure approach in the treatment of severe hypertensive cerebral hemorrhage in basal ganglia. Methods The Study Group included 28 patients who received a minimally invasive surgery via basisylvian fissure approach, while the Control Group had 26 patients who underwent a traditional hematoma removal. Comparisons were made between the two groups on short-term (1 month) and long-term (6 months) effects. Results The rates of excellent or good short-term outcomes and mortalities were 53.6% (15/28) and 17.9% (5/28) in the Study Group, and 46.2% (12/26) and 15.4% (4/26) in the Control Group, respectively, without significant differences between the two groups (?2=0.297, P=0.586; ?2=0.000, P=1.000). However, the activity of daily life (ADL) grade I~Ⅲ accounted for 63.2% (12/19) of long-term survivors in the Study Group, which was superior to the Control Group (23.6%, 4/17) (z=-2.189, P=0.029). Conclusions Minimally invasive surgery for severe hypertensive cerebral hemorrhage in basal ganglia provides better life quality of survivors after operation than traditional hematoma removal.
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Objective To explore the factors affecting the prognosis of patients with hypertensive cerebral hemorrhage after treatment with minimally invasive operation Methods Clinical data from 50 patients diagnosed as hypertensive cerebral hemorrhage after treatment with minimally invasive debridement were retrospectively analyzed Risk factors affecting the prognosis of patients were analyzed with logistic regression Results The fatality rate of patients was 24 0% and rate of vegetative state and handicap was 36 0% Factors such as the amount of bleeding, bleeding site, preoperative GCS value, changes in pupils and light reaction were associated with the prognosis of patients undergoing minimally invasive debridement for the treatment of hypertensive cerebral hemorrhage The time between bleeding and operation was statistically correlated with the short term prognosis Conclusion The prognosis of patients with hypertensive cerebral hemorrhage is associated with multiple factors The amount of bleeding, bleeding site, preoperative GCS value, changes in pupils and light reaction can be used as the important indexes for the prognosis of patients with hypertensive cerebral hemorrhage after treatment of minimally invasive operation
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0.05). VAS and ODI were significantly improved in the 2 groups compared with those before operation (P
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PURPOSE: Submucosal gastric carcinomas metastasize to lymph nodes more often than the intramucosal gastric carcinomas. The objectives of this study are to clarify the characteristics of submucosal gastric carcinomas, especially in reference to the status of lymph node metastasis, and to explore the possibility of a minimally invasive operation. MATERIALS AND METHODS: The clinicopathologic features of 88 patients with submucosal gastric carcinoma, all of whom were treated with a D(2)(+)alpha gastrectomy between January 1994 and December 1999, were examined retrospectively with respect to the status of lymph nodes. The size, depth of submucosal invasion, histologic differentiation, location, and macroscopic finding of the tumor were investigated in association with the presence or the absence of lymph node metastasis. RESULTS: Among the 88 patients, 15 (17.05%) had lymph node metastasis, and the status of metastasis was significantly correlated with tumor size and depth of submucosal invasion. The frequency of metastasis was 0% (0/7) of up to 1.0cm and 18.5% (15/81) over 1.0 cm in size (P=0.034) and 6.1% (2/33) of up to 1.0 mm and 23.6% (13/55) over 1.0 mm in depth of submucosal invasion (P=0.042). CONCLUSION: The tumor size and depth of submucosal invasion are useful indicators of lymph node metastasis in submucosal gastric carcinoma. A minimally invasive operation can be applied for submucosal gastric carcinoma up to 1.0 cm in size. Further studies are needed to limited surgery for depth of submucosal invasion.
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Humans , Gastrectomy , Lymph Nodes , Neoplasm Metastasis , Retrospective StudiesABSTRACT
Objective To estimate the efficacy of super-early minimal invasive evacuation of hematoma via keyhole for treating hypertensive basal ganglionic hemorrhage. Methods 36 patients with hypertensive basal ganglionic hemorrhage(9 cases in grade Ⅱ, 17 in grade Ⅲ and 10 in grade Ⅳ) were treated by minimal invasive evacuation of hematoma via keyhole at super-early stage, and their efficacy was statistically compared with 35 patients with hypertensive cerebral hemorrhage underwent conservative therapy or lateral ventriculopuncture. Results In the 36 patients underwent minimal invasive evacuation of hematoma via keyhole, 22 cases had a good prognosis(61.1%), 9 had a poor prognosis(25.0%), and 5 died(13.9%). Among the 35 patients underwent conservative therapy or lateral ventriculopuncture, 5 cases had a good prognosis(14.3%), 22 had a poor prognosis(62.9%), and 8 died(22.9%). There was a significant difference in good and poor prognostic rate between the two groups(P