Résumé
A 65-year-old woman who had been diagnosed with a thoracic aneurysm was admitted to our hospital because of loss of consciousness. Brain CT revealed that the left corticomedullary junction is obscured. Contrast-enhanced CT demonstrated an acute type A aortic dissection with right internal carotid artery occlusion, left internal carotid artery stenosis, and severe pectus excavatum. Although the consciousness level at the time of admission was JCS200, it gradually improved and she regained spontaneous movement of the right side of her body. Repair of the acute type A dissection was indicated because her neurological deficit had improved. The surgery was performed via an L-shaped approach consisting of a median sternotomy and a left 5th intercostal thoracotomy with moderate hypothermic circulatory arrest and selective cerebral perfusion. An entry was found in the aortic arch between the origins of the brachiocephalic artery and the left common carotid artery, and a partial arch replacement was performed using a four-branched artificial graft. Although the right hemiparesis remained, she recovered well and was transferred to a rehabilitation hospital at 45 days postoperatively. The L-incision approach obtained a good surgical field in a patient with a type A dissection and severe pectus excavatum.
Résumé
BACKGROUND: Intra-calcaneal fractures involving subtalar joints account for about 75% of all calcaneal fractures. Surgical treatment of displaced intra-articular calcaneal fractures is superior to non-surgical treatment. However, the timing of treatment, surgical indications, incision selection, and bone grafting are still controversial. The classical “L” approach is gradually replaced by minimally invasive internal fixation because of its high incision complications. OBJECTIVE: To compare the clinical effect of minimally invasive internal fixation and “L” incision for the treatment of Sanders II and III calcaneal fractures. METHODS: Sixty patients with Sanders II or III calcaneal fractures from January 2016 to January 2019 in the Second Department of Orthopedics, Shantou Hospital of Traditional Chinese Medicine were randomly divided into minimal invasion group (n=32) and “L” incision group (n=28). The patients in the minimal invasion group and “L” incision group received percutaneous reduction by leverage combined with minimally invasive internal fixation and “L” incision internal fixation treatment, respectively. At 6 months after operation, the curative effect of the two groups was evaluated according to the American Orthopedic Foot and Ankle Society score. Preoperative waiting days, the operation time, the length of stay and the complication incidence were compared between the two groups. Bfihler angle and Gissane angle were measured and compared preoperatively, postoperatively and during the final follow-up. RESULTS AND CONCLUSION: (1) The excellent and good rate of American Orthopedic Foot and Ankle Society score was 91% in the minimal invasion group and 93% in the “L” incision group (P > 0.05). (2) The postoperative Bohler angle and Gissane angle were significantly improved in both groups (P 0.05). Bohler angle was better in the “L” incision group than in the minimal invasion group (P 0.05). (3) The preoperative waiting days and the length of stay were longer in the “L” incision group than those in the minimal invasion group (P < 0.05). The operation time was shorter in the “L” incision group than in the minimal invasion group (P < 0.05). (4) The incidence of complications was lower in the minimal invasion group (9%) than in the “L" incision group (32%) (P < 0.05). (5) Compared with the traditional “L” incision open reduction and internal fixation, the treatment of Sanders II and III calcaneal fractures with percutaneous reduction by leverage combined with minimally invasive internal fixation are satisfactory, with less trauma and complications. It is worth being recommended in clinic.
Résumé
Objective To explore the clinical effect of subcutaneous negative pressure suction cosmetic suture with anti L incision in liver surgery.Methods A total of 140 patients who received liver surgery in general surgery department of our hospital from March 2015 to April 2016 were randomly selected,of which 70 cases received cosmetic suture with negative pressure drainage (observation group),the other 70 cases treated with conventional suture(control group).The repair times,the healing of the incision of two groups were observed and analyzed.Results Compared with the control group,the repair time and hospital stays of patients in observation group were significantly shorter than those of the control group,and the differences were statistically significant (P ＜ 0.01).Conclusion Cosmetic suture with negative pressure drainage is effective to shorten the repair time,reduce the incidence of incision fat liquefaction and infection,while ensuring the aesthetic level of the incision.