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Objective To investigate the comparative analysis between single-port access laparoscopic Miles surgery with jackknife position and laparoscopic Miles surgery with lithotomy position for low rectal cancer.Methods Retrospectively analyzed 36 patients with low rectal cancer (TNM stage:Ⅱ-Ⅲ) undergoing laparoscopic abdominoperineal excision.Patients were divided into two groups.Lithotomy position group:laparoscopic Miles surgery with lithotomy position.Jackknife position group:single-port access laparoscopic Miles surgery with jackknife position.The operation time,blood loss,postoperative recovery,postoperative complication,postoperative recurrence and survival rate were observed.Results Blood loss of perineal position in jackknife position group was less than that in lithotomy position group [(31.5 ± 22.4) ml vs.(53.5 ± 25.6) ml] (P =0.01),and removal of drainage tube in jackknife position group was earlier than that in lithotomy position group [(6.7 ± 1.9) d vs.(9.8 ± 1.7) d] (P ＜ 0.01).However,the operation time,blood loss in abdomen,blood loss,postoperative out-of-bed activity time,recovery of gastrointestinal function time,dermal sutures out time,postoperative hospital stay,complication,postoperative recurrence in 2 years and survival rate between two groups had no significant difference (P ＞0.05).Conclusions Single-port access laparoscopic Miles surgery is safe and feasible with better surgical outcome and cosmetic benefits.Furthermore,the blood loss and postoperative exudation at perineal region is less than that in traditional lithotomy position.
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BACKGROUND: Previous researches suggested that correction of scoliosis of patients with Marfan syndrome (MFS) has a high incidence of complication and loss of corrective rate; however, there were seldom reports on using spinal three-dimensional orthopaedic internal fixation system to treat scoliosis of MFS patients.OBJECTIVE: To observe the corrective effect of CD and TSRH, the third generation of spinal three-dimensional orthopaedic internal fixation system, on scoliosis of MFS patients.DESIGN: Retrospective analysis.SETTING: Second Department of Orthopaedics, First People's of Hefei.PARTICIPANTS: From September 1997 to July 2003, 10 MFS patients with scoliosis were selected and corrected at posterior site with CD and TSRH system; meanwhile, confluence operation of auto-bone transplantation was undergone.Eight cases had bilateral scoliosis, 2 curvature of thoracic spine towards right side, 3 posterior curvature of thoracic spine, and 2 posterior curvature of thoracic waist.METHODS: X-ray film was imaged at standing position before operation, 1 week after operation and during follow-up;meanwhile, X-ray film was also imaged at left and right curved positions and sling position to evaluate ductility of scoliosis before operation. Angle of scoliosis was measured with Cobb technique and stable and neutral mallets were recorded. Among 10 cases, 2 were internally fixed with CD system and other 8 with TSRH system. Material of bone transplantation was derived from auto-posterior superior iliac spine and remained for 3 months after operation.MAIN OUTCOME MEASURES: Corrective rate and complication of scoliosis after operation.RESULTS: The follow up lasted for 12-60 months. Corrective rate of 8 cases with bilateral scoliosis was 48% and lost rate was 20%; corrective rate of 2 cases with lumbar curvature was 56% and lost rate was 16%; corrective rate of 2 cases with single thoracic curvature was 61% and lost rate was 8%. Body balance of all patients was improved. No one had nerve complication; 2 had junctional posterior curvature of lumbar vertebra; 1 had delayed union of incisions.CONCLUSION: It is satisfactory for spinal three-dimensional orthopaedic intemal fixation system to treat scoliosis of MFS patients. Statuses of heart and lung of patients are evaluated before operation; in addition, during operation, a great effect is obtained through prolonging confluence segments, avoiding over correction, decreasing soft tissue injury and paying much attention on confluence of transplanted bone.
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Objective To explore the methods of internal fixation for femoral neck fractures and evaluate the biomechanical characteristics of the interlocking expanding compressive screw (IECS)of Type HZS. Methods Based on the special biomechanical characteristics of the femoral neck fracture, the device of internal fixation was designed to consist of main screw, bifurcate screw, boost screw cap, washer, compressive screw cap, oblique interlocking screw and main screw cap. Its biomechanical performances were evaluated through comparison with those of the dynamic compressive screw (DCS), twin compressive screw (2CS) and three cannulated screws (3CS) respectively. Results The mechanical performances of the femoral neck fracture fixed with the interlocking expanding compressive screw were superior to those of the others in displacement ,axial and level stiffness, torsional strength and stiffness and terminal loading. Conclusion Interlocking expanding compressive screw can efficiently withstand the splitting, torsional, shearing, tensional and compressive forces in the fracture, and is simple, safe and easy to use. [