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Objective:To evaluate the Ganz approach in the internal fixation of Pipkin Ⅳ femoral head fracture.Methods:The data of 7 patients with Pipkin Ⅳ femoral head fracture were retrospectively analyzed who had been admitted to Department of Orthopaedics, Xijing Hospital from March 2013 to April 2019. They were 5 males and 2 females, aged from 23 to 66 years (average, 40.5 years). The time from injury to operation ranged from 5 to 13 days (average, 7.3 days). In all the 7 patients, the Ganz approach was adopted in the internal fixation with double-head compression screws for femoral head fracture and in the internal fixation with screws plus a reconstruction plate for acetabular fracture. Their operation time, intraoperative bleeding, fracture reduction, hip functional recovery and complications were recorded. The hip function was assessed by Harris hip score.Results:Their operation time ranged from 155 to 235 min (mean, 197.9 min) and their intraoperative bleeding from 450 to 765 mL (mean, 590.0 mL). This cohort was followed up for 12 to 86 months (mean, 34.4 months). According to the Letournel recommended criteria for reduction quality of acetabular fractures, anatomical reduction was achieved in 6 cases and satisfactory reduction in one; according to the Thompson-Epstein clinical and imaging evaluation, the reduction of femoral head fracture was excellent in 6 cases and good in one. Their Harris hip scores at the last follow-up ranged from 92 to 97 (mean, 93.0). Traumatic arthritis developed in one case which was still under observation and muscular vein thrombosis developed in the affected limb in 2 cases but was organized after standard treatment.Conclusion:In the treatment of Pipkin Ⅳ femoral head fracture, the Ganz approach can lead to good reduction quality and fine functional recovery of the hip.
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Blood control technology and determination of hepatectomy plane are the core techniques of liver resection, which not only affect the operative performance, but also affect the prognosis of patients.The concept of pre-control the blood vessels in the hepatic segment which should be resected can effective control of bleeding during hepatectomy.A comprehensive application of the ischemic line guidance, the intraoperative ultrasound, the segmental portal staining, fluorescent staining, the hepatic vein-oriented technique, and three-dimensional technique are helpful to precisely determine the boundary of hepatic segment to be resected and guide the hepatectomy plane.
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Objective To evaluate the clinical efficacy of a single ilioinguinal approach in the surgical treatment of both-column acetabular fractures in which the anterior column was fixated by a reconstruction plate and the posterior column fixated by lag screws.Methods Between May 2013 and August 2016,a total of 23 patients with acetabular both-column fracture were treated through a single lioinguinal approach for fixation of both acetabular columns at Department of Orthopaedics,Jiangyin Hospital Affiliated to Medical College,Southeast University.They were 11 males and 12 females,aged from 20 to 71 years (mean,47.6 years).Operation time,amount of intraoperative blood loss,postoperative fracture reduction,union time and relevant postoperative complications were recorded.At the final follow-up,the function of affected hip was evaluated by Merie d'Aubigne-Postel scoring system.Results All the patients underwent the operation successfully.The operation time ranged from 120 to 210 minutes (mean,165.4 minutes).The intraoperative blood loss ranged from 320 to 1,120 mL (mean,554.8 mL).The 23 patients were followed up for 12 to 40 months (mean,28.1 months).All the fractures united well after 2 to 5 months (mean,3.7 months).According to the Matta's criteria,anatomic reduction was achieved in 17 cases,satisfactory reduction in 5 and unsatisfactory reduction in one,giving a satisfactory reduction rate of 95.7％;by the modified Merle d'Aubigne and Postel functional scores for the affected hip,13 cases were excellent,6 good,3 fair and one poor,giving an excellent and good rate of 82.6％.The complication rate during follow-up was 8.7％ (2/23).One case suffered from palsy of the lateral femoral cutaneous nerve but the symptom was relieved one month postoperatively without any treatment.One patient developed deep venous thrombosis at a lower extremity which responded to anticoagulant therapy.Conclusion Surgical treatment of acetabular double column fractures through a single ilioinguinal approach for fixation of the anterior column with a reconstruction plate and fixation of the posterior column with lag screws can achieve excellent control of reduction and fixation,which is less traumatic but leads to satisfactory clinical effects.
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Objective@#The purpose of this study was to a new operative approach for sagittal condylar fractures via a preauricular small incision-based technique and to examine the effectiveness of this approach. @*Methods@#Fifteen patients (19 sides) with sagittal condylar fractures were included in the study. The incision length was approximately 4 cm through the tragus, exposing the superficial temporal vessels, which was then pulled forward. Next, the deep temporal superficial fascia was cut, and the surface of the zygomatic arch and the articular capsule of the temporomandibular joint were exposed. Joint capsule incision was performed, with mandibular condylar fracture fixation under direct vision. We followed up with the patients postoperatively for 6 months with clinical and radiographic examinations. @*Results @#All patients had 1 week postoperation before being discharged, during which 2 cases of mild facial paralysis (with lateral temporal level Ⅱ facial paralysis, with lateral temporal branch level Ⅲ facial paralysis and level Ⅱ zygomatic branch of facial nerve paralysis after treatment) were observed, after given nerve nutrition agents, 2 cases returned to normal within 3 months. No patient exhibited a postoperative delayed fistula infection or other serious complications. Intraoperative occlusion relationships recovered well, and postoperative CTs suggested that the fracture ends and condyles were in good condition. The occlusion relationship was normal for 3 months after surgery, with a degree of opening greater than 30 mm, no play in the joints and no oblique openings being observed, and reexamination 6 months after the surgery revealed no obvious scars.@*Conclusion@#This surgical method involves a small incision and clear anatomic structures and avoids damage to the facial nerve. This method provides better surgical vision for treatment of sagittal condylar fractures, is safe and convenient, and deserves clinical recommendation.
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<p><b>OBJECTIVE</b>To investigate the clinical effect of absorbable screw fixation by anterolateral approach (McFarland and Osborne approach) for the treatment of Pipkin type I and type II fractures.</p><p><b>METHODS</b>From March 2008 to February 2016, 8 cases of femoral head fractures were treated by absorbable screw fixation through anterolateral approach (McFarland and Osborne approach) including 5 males and 3 females with an average age of 36 years old ranging 23 to 58 years old. The course of the disease was 3 to 12 days (means 5 days). The symptoms at admission included hip pain, deformity and dysfunction. The X-ray and CT image showed femoral head fracture and posterior femoral dislocation. There were 2 cases of Pipkin type I and 6 cases of Pipkin type II. All patients received emergency reduction (Allis) of the posterior dislocation of the hip under the combined intravenous anesthesia. Bone traction was performed after successful reduction. The operation through McFarland and Osborne approach, the Thompson-Epstein system used to evaluate the curative effect postoperative.</p><p><b>RESULTS</b>All the patients had primary healing after operation without other complications occurred. The 8 patients were followed up for 12 to 36 months with an average of 30 months. All of the patients review of X-ray and CT 6 months postoperative showed fractures consolidated, and the healing time was 3 to 6 months with an average of 4 months. According to Thompson-Epstein scoring system, hip function was excellent in 5 cases, good in 2 cases and fair in 1 case.</p><p><b>CONCLUSIONS</b>The anterolateral approach of hip joint can not only retain the residual blood supply of femoral head, but also fully expose the acetabulum and femoral head. It is a relatively ideal surgical approach for the treatment of Pipkin type I and type II fractures.</p>
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Objective To introduce a method of functional reparation for cleft lip with mini-approach.Methods We designed triangle flap in junctional zone between skin and mucosa,combined with intraoral incision approach,by means of repairing the orbicularis oris muscle,to obtain the reconstruction of labial arch,philtrum column and nasal wing.Results All cases in this study obtained perfect healing,with good augmentation at floor of the nose.Eight cases presented with good looking of philtrum and improvement in the shape of nostril.Conclusions Use of the method of functional reparation for cleft lip with mini-approach can decrease scar on skin,and hence decrease the contraction deform,as well as nice reconstruction of labial arch,philtrum column and nasal wing.
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Objective To discuss the surgical skills and clinical value of laparoscopic splenectomy with a safe approach to the splenic hilum through first mobilizing the lower pole of the spleen.Methods A total of 88 patients with hypersplenism secondary to liver cirrhosis who underwent laparoscopic splenectomy in our department from September 2015 to September 2016 were selected into this study.And these patients were divided into two groups based on whether to take the safe approach to the splenic hilum through first mobilizing the lower pole of the spleen in laparoscopic splenectomy.The control group included 40 cases who underwent the traditonal laparoscopic splenectomy,while the observation group included 48 cases who took the safe approach to the splenic hilum through first mobilizing the lower pole of the spleen in laparoscopic splenectomy.The clinical data were collected retrospectively by medical clinical records review.Results There was no mortality occurred in this study.The blood loss of the observation group was (247.50±135.89)mL,which was obviously lower than (361.75±144.43)mL of the control group,and the difference was statistically significant (P0.05).Conclusion It is very crucial for a safe approach to the splenic hilum through first mobilizing the lower pole of the spleen to establish a tunnel behind the splenic hilum in laparoscopic splenectomy.It is safe and feasible to perform a safe approach to the splenic hilum through first mobilizing the lower pole of the spleen in laparoscopic splenectomy.The technique is generalized in clinics,especially for freshmen.
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Objective To investigate the effect of super-aged multilevel cervical spondylosis different surgical treatment op tions Abstract Objective.Methods Selected July 2010 Ultra old multilevel cervical spondylosis March 2015 in our hospital 80 ca ses,the anterior cervical corpectomy and fusion (ACCF) and by anterior discectomy and fusion (ACDF) included anterior group,the posterior laminoplasty (PCL) included in the posterior group,the clinical efficacy of two groups were compared,and postoperative conditions and cervical spinal cord injury rates before and after treatment (JOA score),cervical Disability index (NDI index),lordosis and cervical spine.Results Anterior group of 43 cases,including 28 cases of excellent(65.12％),5 cases of good (11.63％),7 cases of moderate(16.28％),3 cases of poor(6.98％),the good rate was 76.74％;posterior group 37 cases,including 24 cases of excellent(64.86％),3 cases of good(8.l1％),6 cases of moderate(16.22％),4 cases of poor(10.81％),the good rate was 72.97 ％.The difference has no statistically significant (P＞0.05) in good rate.Anterior operative time was significantly higher than the posterior group (P＜0.05),blood loss,hospital stay was significantly lower than the posterior group (P＜0.05),the time of symptoms disappeared has no significant difference in two groups(P＞0.05).After treatment,patients in posterior group,the JOA score,cervical activity significantly were higher than the anterior group,lordosis anterior group were significantly higher than the posterior group,the difference was statistically significant (P＜0.05).Conclusion Anterior super aged multilevel cervical disease,posterior approach has achieved good clinical efficacy but greater advantage posterior surgery in patients with long term im provement in the cervical spine function.
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[Summary] Adult female presacral space tumor involves in different disciplines .It could be typing according to the tumor location, size, mobility and the relationship with surrounding tissues .Understanding the classification of the tumor is helpful to select a suitable operative approach that lead to a better result .After the strict preoperative evaluation , transvaginal approach should not be neglected in adult female patients with presacral space tumor .
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Objective@#To evaluate the feasibility and strategy of the lesser omentum approach for laparoscopic pancreatic enucleation.@*Methods@#Between June 2011 and October 2013, 6 laparoscopic pancreatic enucleations were performed by lesser omentum approach.The average age was 42 years, including 1 male and 5 female.The preoperation diagnosis of 6 cases were pancreatic islet cell tumors determined by abdominal CT/MRI, ultrasound and digital subtraction angiography.The tumors of 3 cases located in pancreatic neck, 2 tumors located in neck and body of pancreas, and 1 tumor located in pancreatic body.Their biggest tumor diameter were 0.8-2.5 cm.@*Results@#Among the 6 cases, all laparoscopic pancreatic enucleations were successfully performed.None of the patients were converted to open operation.Eestimated blood loss was (26.7±18.6)ml, operating time was (82.5±19.4)minutes, and postoperative length of stay was (5.17±1.17)days.Additionally, postoperative complication included grade A pancreatic fistula in 1 case.After 36-64 months followed-up, there was no tumor recurrence and clinical symptom disappeared.@*Conclusion@#For the islet cell tumors located in pancreatic neck and body, the lesser omentumapproach may contribute to good surgical view and operative space, which can make pancreatectomy safer and easier for clinical application.
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Objective To compare the clinical effect between olecranon osteotomy and bilateral triceps brachii approach combined with bilateral locking plate in the treatment of type C3 distal humerus fracture.Methods Forty-five patients with type C3 distal humerus fracture were performed with operation and follow-up in Department of Osteology of the First People's Hospital of Xinxiang City from July 2006 to February 2016.The patients were divided into olecranon osteotomy group (n =25) and bilateral triceps brachii approach group (n =20).The patients in olecranon osteotomy group were treated with olecranon osteotomy combined with bilateral locking plate,and the patients in bilateral triceps brachii approach group were treated with bilateral triceps brachii approach combined with bilateral locking plate.The incision length,operation time,hospitalization time,fracture healing time,postoperative complications and the score of elbow joint function were compared between the two groups.Results There was no significant difference in the mean follow-up time between the two groups (P ＞ 0.05).The incision length in olecranon osteotomy group was significantly shorter than that in bilateral triceps brachii approach group(P ＜ 0.05).There was no significant difference in the operation time,hospitalization time and fracture healing time between the two groups (P ＞ 0.05).There was one case of infection and two cases of heterotopic ossification in the olecranon osteotomy group,and the incidence of postoperative complications was 12.0％ (3/25).There was one case of heterotopic ossification,one case of fracture delayed union and one case of elbow joint stiffness in the bilateral triceps brachii approach group,and the incidence of postoperative complications was 15.0％ (3/20).There was no significant difference in the incidence of postoperative complications between the two groups (x2 =0.087,P ＞ 0.05).At the end of the follow-up,the excellent rate of the Mayo score of elbow joint function in the olecranon osteotomy group and bilateral triceps brachii approach group was 88.0％ (22/25) and 55.0％ (11/20) respectively,the excellent rate in the olecranon osteotomy group was significantly higher than that in the bilateral triceps brachii approach group (x2 =6.188,P ＜ 0.05).Conclusion Compared with the bilateral triceps brachii approach,the olecranon osteotomy combined with bilateral locking plate fixation is more beneficial to the recovery of elbow joint function in patients with type C3 distal humerus fracture.
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<p><b>OBJECTIVE</b>To explore the early clinical efficacy of a posteromedial inverted "L" shape approach combined an assisted antero lateral assisted approach for the treatment of complex fractures of tibial plateau.</p><p><b>METHODS</b>From March 2011 to June 2014, the posteromedial inverted "L" shape approach combined with the antero lateral assisted approach in the treatment of Schatzker type IV, V, VI tibial plateau fracture were performed in 34 cases. There were 23 males and 11 females, ranging in age from18 to 67 years old, averaged 34.9 years old; 19 patients had fractures on the left and 15 patients had fractures on the right. According to Schatzker classification, 11 cases of type IV, 15 cases of type V and 8 cases of type VI. According to the three column classification, 23 cases of double column fractures, 11 cases of three column fractures. The X-ray healing time and knee joint mobility were recorded. The mean tibial plateau angle(TPA) and the mean posterior slope angle (PA) were measured and recorded immediately after operation, 6 and 12 months after operation. The knee function was evaluated using the Hospital for Special Surgery Score(HSS) 3, 6 and 12 months after operation.</p><p><b>RESULTS</b>Among all the patients, 28 patients were followed up, and the duration time ranged from 8 to 39 months with a mean of(21.6±8.7) months. All the fractures were healed. The healing time in terms of X-ray ranged from 12 to 24 weeks, with a mean of (14.5±3.6) weeks. The range of knee activity ranged from 105° to 135°, with a mean of (121.5±5.5)°. Immediately after operation, 6 and 12 months after operation, the mean tibial plateau angle (TPA) was (84.3±1.8)°, (85.1±1.3)°, (85.6±1.6)°, and the mean posterior slope angle (PA) was (7.8±1.6)°, (7.8±1.3)°, (7.7±2.3)°, respectively, showing no significant difference between the 3 time points. The mean HSS score at 3, 6 and 12 months after operation was 71.4±1.4, 76.7±1.7, 81.6±1.2 respectively, showing no significant differences between the 3 time points. One patient with early knee joint stiffness had 6° of the restricted straight range after the active functional exercise, 1 year after operation. Anterolateral wound dehiscence occurred in 1 cases but was cured by dressing without deep wound infection occurred. The pain occurred in 4 cases when the weather changed. At the end of follow-up, no case of knee joint instability, knee valgus, loosening or breakage occurred.</p><p><b>CONCLUSIONS</b>The posteromedial inverted "L" shape approach combined assisted anterior lateral approach for the treatment of complex fractures of tibial plateau can expose the operation area, repair the fracture under the direct vision, and implant a full amount of bone graft for the collapse of the platform.Thus, the smoothness of the articular surface is restored, and the fixation is firm, which is beneficial to the early functional exercise, less complications, and satisfactory clinical curative effects.</p>
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<p><b>OBJECTIVE</b>To discuss the suitable surgical approach and the internal fixation of unstable pelvic pelvic fractures.</p><p><b>METHODS</b>From May 2010 to May 2015, 45 patients with unstable pelvic fractures were treated with different approaches and fixations, including 38 males and 7 females with an average age of 45 years ranging from 21 to 61 years. The course was within 2 weeks. According to Young-Burg classification, 23 patients were lateral compression injuries, 6 patients were vertical shearing injuries, 16 patients were anterior-posterior compression injuries. All patients had hip pain and limitation of motion, the X-rays showed the pelvic ring fracture.</p><p><b>RESULTS</b>All wounds healed well without complications, 45 cases were followed up for a mean period of 13 months (ranged 9 to 21 months). Patients with hip pain had a good postoperative pain relief. The post-operative X-rays showed the reduction was satisfied and the pelvic ring shaped well. According to Majeed standards, the final follow-up score was 93.5±11.6, 35 cases got excellent results, 8 were good, 2 were fare.</p><p><b>CONCLUSIONS</b>The unstable pelvic and acetabular fractures are always with compound injury. Beside the reduction, to decrease the second surgery trauma should take into consideration as well, the intra-articular reduction and the stability of the pelvic were especially valued, so combined the different approach with minimal invasive technique can get good clinical result.</p>
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<p><b>OBJECTIVE</b>To explore the clinical curative effect of anterolateral acromial approach in treating two-and three-part of proximal humeral fractures.</p><p><b>METHODS</b>Forty-two patients of proximal humeral fractures from January 2010 to June 2014 were analyzed retrospectively, including 23 males and 19 females with a mean age of 61.5 years old ranging from 40 to 76 years old. Among them, 22 cases were treated with anterolateral acromial approach and 20 cases were treated with deltopectoral approach. The operation time, intraoperative blood loss, postoperative hospitalization days, fracture healing time of two groups were compared. The shoulder pain after 1 week was assessed by the VAS score. The postoperative shoulder joint function was evaluated after 3 months and more than 6 months by Constant score.</p><p><b>RESULTS</b>The follow-up time was at final 14 months. There were significant differences in operation time(=0.003), intraoperative blood loss(=0.001), postoperative hospital day(=0.013), postoperative shoulder pain after 1 week(=0.026), postoperative Constant score after 3 months(=0.014) between the anterolateral acromial approach group and the deltopectoral approach group. There were no significant differences in clinical union time of bone(=0.462), postoperative constant score after more than 6 months(=0.204) between the anterolateral acromial approach group and the deltopectoral approach group. There were no breakage of the internal fixation and humeral head osteonecrosis.</p><p><b>CONCLUSIONS</b>It has some advantages with anterolateral acromial approach to treat Neer two-and three-part of proximal humeral fractures, such as short operation time, less intraoperative bleeding, lighter postoperative pain, quicker recovery of function.</p>
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Objective To evaluate the clinical results of limited Smith-Petersen approach in the treatment of posterior dislocation of hip with femoral head fracture (Pipkin fracture of types Ⅰ and Ⅱ).Methods From February 2008 to July 2013,21 patients with Pipkin fracture of types Ⅰ and Ⅱ were treated at our department.They were 16 men and 5 women,with an average age of 39.2 years (range,from 19 to 56 years).The left hip joint was affected in 8 cases and the right in the other 13.The interval between injury and surgery varied from 2 to 7 days (mean,4 days).According to the Pipkin classification,there were 11 cases in type Ⅰ and 10 in type Ⅱ.All the fractures were fixated via the limited Smith-Petersen approach.Results The patients were followed up for 11 to 29 months (mean,17.4 months).All the fractures healed after an average of 15 weeks (from 12 to 19 weeks).According to their Thompson-Epstein scores of clinical and radiological outcomes at the final follow-ups,7 cases were excellent,9 good and 5 fair,giving a rate of excellent to good of 76.2％.Avascular necrosis of the femoral head occurred in 3 cases and osteoarthritis in 2.No infection or limb deep vein thrombosis was observed.Conclusion For Pipkin fractures of types Ⅰ and Ⅱof,limited Smith-Petersen approach can provide satisfactory exposure which leads to reduced soft tissue injury,better reduction and fixation,and fewer complications as well.
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Objective To investigate the efficacy and safety of laparoscopic surgery versus open resection for large renal cell carcinoma. Methods The clinical data of 60 patients with renal tumor who underwent tumor resection by laparoscopic surgery during January 2009 and January 2015 were reviewed. They were divided into two groups (30 each) according to the surgical approach. Patients in group 1 underwent the operation via intraperitoneal approach, and those of group 2 via retroperitoneal approach. Thirty patients who received laparotomic resection of renal tumor served as control group during the same period. The preoperative examination, perioperative data and postoperative recovery were compared among the three groups. Results The preoperative scan showed that there was no statistical difference in tumor location and its relationship with surrounding tissues among three groups (P>0.05). The operative time was significantly longer in the two laparoscopic groups (groups 1 and 2) than in control group, with a statistically significant difference (P0.05). The postoperative duration of hospital stay was shorter in the two laparoscopic groups than that in open surgery group, with a statistically significant difference (P0.05). The operative pathological results showed that the TNM stage was higher in group 1 than in group 2, with a statistically significant difference (P0.05). Conclusion Laparoscopic surgery is safe and feasible for large renal cell carcinoma.
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The posterior tibial plateau fracture is drawing increasing attention from orthopedists in recent years. Due to the particularity and severity of posterior tibial plateau fracture, there is still controversy in its classification and treatment. It is very difficult to achieve the ideal reduction and fixation by conventional techniques and approaches. The modified posterior approach is favorable for posterior tibial plateau fracture, but disadvantages remain. The commonly used inner fixations to treat posterior tibial plateau fracture are lag-screws, compressing plate, locking plate and T-shaped plate. This paper summarizes the classification, approaches and internal fixations of posterior tibial plateau fractures.
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<p><b>OBJECTIVE</b>To study the clinical therapeutic effects of posterior medial approach inverted L-shaped incision combined with reconstruction plate fixation in treating posterior tibial plateau condylar fracture.</p><p><b>METHODS</b>From February 2011 to February 2015, 19 patients that were clearly diagnosed with combined posterior tibial plateau condylar fracture were treated with internal fixation of reconstruction plate through the posterior medial approach L-shaped incision under direct vision, involved 14 males and 5 females with an average age of 45.5 years ranging from 28 to 71 years. The intervals between injury and operation ranged from 6 to 15 days with a mean of 9.2 days. According to Schatzker Classification, there were 6 cases in type II, 2 in type IV, 7 in type V, 4 in type VI In accordance with the three-column theory proposed by Luo Congfeng, 2 cases were medial column combined with posterior column fracture, 6 were lateral column combined with posterior column fracture, and 11 were three-column fracture. The major clinical symptoms before treatment were swelling and deformity of the knee, as well as limitation of motion. X-ray and CT examination were completed. The American Hospital for Special Surgery score(HSS) was used to evaluate clinical effect.</p><p><b>RESULTS</b>One case developed skin infection in the posteromedial incision postoperatively, but other complications, such as neurovascular injury, deep venous thrombosis of lower limb, cracking and failure of internal fixation, and fracture re-displacement were not seen. The patients were followed up for an average of 12.5 months (10 to 24 months). The fracture healing time ranged from 5 to 11 months with a mean of 8.2 months. According to HSS, the total score was 82.1±7.3, 9 patients got an excellent result, 7 good, 2 poor and 1 bad. Regular postoperative re-check X-ray indicated that all fracture showed stage I healing. The difference was not significant on varus angle, post-dip angle and femorotibial angle between 3 days and 1 year after operaiton.</p><p><b>CONCLUSIONS</b>Treating the posterior tibial plateau condylar fracture through the posterior medial approach L-shaped incision of the knee rendered sufficient exposure, little injury, as well as convenient and effective installation of internal fixation. Reconstruction plate possessed the advantages of good plasticity, strong supportability, small implant volume, together with low cost;and the structural and functional recovery of the knee could achieve satisfying clinical therapeutic effects as combined with appropriate postoperative rehabilitation training.</p>
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Objective To investigate the clinical efficacy of fixation of distal radius fracture with dorsal instability with locking compression plate (LCP) via radial approach.Methods From September 2009 to October 2012, 21 cases underwent LCP fixation of the distal radius fracture with dorsal instability via radial approach.The study included 14 males and 7 females (mean age, 54.5 years;range, 38-81 years).Twelve cases were injured in traffic accidents, 7 in falls and 2 in high falls.Fracture AO classification was type A3 in 10 cases, type C1 in 8 cases and type C2 in 3 cases.Two cases (one type A3 and one type C1) had malunion.When the lateral column, intermediate column, radial edge and dorsal plane were exposed by radial incision, LCP fixation with bone grafting was performed to restore the height of radial styloid process, ulnar deviation and palmar tilt.According to the GartlandWerley score, wrist joint function was evaluated.Results Mean duration of follow-up was 13.5 months (range, 12 to 24 months).Stage Ⅰ bone union was shown on X-rays, with the healing time of 7.5 weeks.Based on the X-rays at postoperative 6 months, 1 year and 2 years, the shortening of radial styloid process was ≤ 2 mm, mean volar tilt was 12.5°(range, 8°-17°) , mean ulnar tilt was 20.5° (range, 15°-26°), and step-off or gap of the articular surface was ≤ 2 mm.In postoperative wrist motion assay, mean volar flexion was 60°(range, 30°-70°), mean dorsal flexion was 55° (range, 30°-65°), mean radial deviation was 17°(range, 10°-20°), mean ulnar deviation was 25.5° (range, 20°-30°),pronation was 65.5° (range, 60°-70°) , and mean supination was 75.5° (range, 60°-80°).Mean grip strength was 75％ (60％-95％)of the contralateral side.Two cases suffered from pain (one complained of moderate pain and one minor pain occasionally).According to the Gartland-Werley score, 16 cases were rated excellent, 2 good, 2 fair and 1 poor, with the excellent rate of 86％.No complication was found as injury of the superficial branch of radial nerve, infection, nonunion, nail loosening, medium neuritis and tendon injury.Conclusions Lateral column, intermediate column, radial edge and dorsal plane can be shown via the radial approach.LCP fixation combined with bone grafting contributes to fracture anatomical reduction.
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Objective To investigate the best models of esophageal cancer surgical approaches,lymphadenectomy ranges and postoperative comprehensive treatment.Methods From January 1998 to December 2007 in 10 years,1 162 cases of different parts with esophageal cancer were analysized which were treated with surgically adopting sequential abdomen,chest,neck three-incision approaches.Taking three-step screening way of preoperative imaging,preoperative ultrasound localigation fineneedle aspiration biopsy cytology and intraoperative rapid fieezing pathological examination were applied to make the selectivity of the first-times cervico-thoraco-abdominal three-field lymph node dissection (3FLND),first-times standard thoracoabdominal two-field lymph node dissection (2FLND) and second-times third-field cervical lymphadenectomy.Meanwhile,we implemented actively postoperative comprehensive treatment and observed the overall clinical efficacy and long-term survival.Results In the group of 1 162 cases with esophageal cancer surgery.The operating resection rate was 100 ％,Radical resection of 97.6 ％ (1 134/1 162).Perioperative overall complication rate was 16.4 ％ (191/1 162).Anastigmatic fistula was 0.6 ％ (7/1 162).Five cases dead in 30 days after surgery.The whole group of lymph node metastasis rate was 52.6 ％ (611/1 162),lymph node metastasis degree in 12.1％ (3 092/25 564).Full group of the first-times 3FLND was 348 cases.The positive rate was 94.8 ％ (330/348),Implementing the first-times 2FLND was in 814 cases and the second-times thirdfield cervical lymph node dissection was performed in 89 cases.The postoperative complications of the 3FLND was significantly higher than that of 2FLND (23.6 ％ vs 13.4 ％).The difference was statistically significant (x2 =18.37,P ＜ 0.001).However,The difference was not statistically significant between 3FLND and 2FLND (P ＞ 0.05).There is no significant difference between the first-times 3FLND with the second-times 3FLND accumulating survival (P ＞ 0.05).But different degree of lymph node metastasis determined prognosis.The difference was significant (x2 =35.57,P ＜ 0.001).In our group the postoperative comprehensive treatment application rate was 87.2 ％.Surgery combined with comprehensive treatment overall 1,3,5 years survival rates were 92.1％,69.2 ％,49.6 ％ respectively.Conclusions The sequential three-incision approaches and selectivity of lymph node dissection have the radical nature thoroughly,fewer complications,high quality of life and the long-term survival advantages.It should be a widely used method in the clinical surgery of the esophageal cancer.Implementing the three-step screening way to selecting the first-times 3FLND,the firsttimes 2FLND and the second-times third-field cervical lymphadenectomy that have targeted strongly and high accuracy,a definite object in view and avoiding patient excessive trauma.Applying the comprehensive treatment after surgery and the re-treated of patients with recurrence that can further more improve the longterm survival of patients.The comprehensive treatment should be the target direction of the future development of esophageal cancer.