Efficacy comparison of standardized incision and conventional incision for reduction and internal fixation of multiple rib fracture / 中华创伤杂志

Objective:To compare the efficacy of standardized incision and conventional incision for reduction and internal fixation of multiple rib fracture.Methods:A retrospective cohort study was conducted to analyze the clinical data of 192 patients with multiple rib fracture treated in 909th Hospital of Joint Logistics Support Force (Affiliated Dongnan Hospital of Xianmen University Medical College) from January 2020 to January 2022. There were 101 males and 91 females; aged 32-94 years [(51.5±16.6)years]. The patients underwent open reduction and internal fixation with nickel-titanium shape memory alloy embracer via standard incision such as anterior axillary longitudinal incision (standard incision group, n=96) or conventional incision such as posterolateral incision (conventional incision group, n=96). The incision length, operation time, intraoperative blood loss, number of fixed fractures, indwelling time of closed thoracic drainage tube, postoperative thoracic drainage volume, postoperative spontaneous ambulation time and length of hospital stay were compared in the two groups. The visual analogue scale (VAS) was used to evaluate pain at 1 month after operation. Postoperative complications were recorded. Results:All patients were followed up for 1-16 months [4.0(3.0, 10.5)months]. The operation time, intraoperative blood loss, indwelling time of closed thoracic drainage tube, postoperative thoracic drainage volume, postoperative spontaneous ambulation time, length of hospital stay and VAS at postoperative 1 month in standard incision group [(12.1±1.6)cm, (51.4±13.0)minutes, (191.5±16.8)ml, (2.8±0.6)days, (568.9±109.0)ml, (4.1±0.7)days, (11.4±1.7)days, (2.5±0.7)points] were better than those in conventional incision group [(13.7±1.9)cm, (62.0±8.8)minutes, (248.9±65.4)ml, (4.8±1.1)days, (655.9±121.9)ml, (5.2±0.9)days, (15.3± 1.7)days, (3.5±0.7)points] ( P<0.05 or 0.01). There was no statistical difference in the number of fixed fractures between standard incision group and conventional incision group (5.1±0.8 vs. 5.4±0.9) ( P>0.05). In standard incision group, there were 3 patients with poor wound healing, 5 with pulmonary infection, 3 with atelectasis and 3 with small pleural effusion. In conventional incision group, there were 11 patients with poor wound healing, 9 with pulmonary infection, 7 with atelectasis and 7 with small pleural effusion. The incidence of postoperative complications was 14.6% (14/96) in standard incision group and 35.4% (34/96) in conventional incision group ( P<0.01). Conclusion:For multiple rib fracture, standard incision is superior to conventional incision reduction in shortening the incision length, operation time, indwelling time of drainage tube, postoperative spontaneous ambulation time and length of hospital stay, reducing the intraoperative blood loss and postoperative thoracic drainage volume, alleviating the pain and reducing the postoperative complications.

The clinical application of the open supraclavicular approach in thyroidectomy / 中国肿瘤临床

Objective: To analyze the clinical application of the open supraclavicular approach in thyroidectomy. Methods: The clinical practicability of open supraclavicular thyroidectomy was explored by comparing the traditional anterior low arc incision thyroidectomy procedure with open supraclavicular thyroidectomy in terms of patients'aesthetic satisfaction, effectiveness of the operation, operation time, and so on. Result: Twenty-two cases of open supraclavicular thyroidectomy (group B) had better aesthetic satisfaction than 29 cases of traditional incision thyroidectomy (group A)(P<0.05), and had the same operative effect with traditional incision. Open supraclavicular thyroidectomy is associated with good aesthetic satisfaction, and has the same effect as the traditional incision does. Conclusions: Open supraclavicular thyroidectomy has good clinical value for benign thyroid tumors and some malignant tumors that require unilateral lobectomy, and even for tumors larger than the incision diameter. It has good aesthetic value while ensuring the curative effect of surgery.

Analysis of 75 cases of unilateral thyroid through small incision approach under the ill side necklace / 中国综合临床

Objective To investigate the feasibility and advantages of the treatment of the unilateral thyroid through small incision approach under the ill side necklace. Methods A retrospective analysis was performed on the clinical data of seventy?five patients with unilateral benign thyroid tumor from January 2015 to October 2017 treated in People's Hospital of Jishan with the small incision approach under the ill side necklace. The exposure of recurrent laryngeal nerve and superior laryngeal nerve and related complications after operation were statistically analyzed. Results The exposure rate of recurrent laryngeal nerve was 86. 7％ ( 65/75),and the exposure rate of the superior laryngeal nerve was 69. 3％ (52/75). All the patients had no incision bleeding,laryngeal edema,aspiration or permanent hoarseness and other complications. Conclusion Unilateral thyroidectomy is a safe and feasible treatment with small incision,small injury and easy operation.

Comparison of the efficacy and safety of anterior small incision approach and modified Miccoli endoscope assisted thyroidectomy in the treatment of benign thyroid tumor / 临床外科杂志

Objective To compare and analyze the clinical efficacy and safety of anterior small incision approach and modified Miccoli endoscope assisted thyroidectomy in the treatment of benign thyroid tumor.Methods A total of 66 cases with benign thyroid tumor were enrolled in our hospital from Apiil 2014 to April 2017,and divided into two groups according to different surgical methods.The 31 patients who underwent modified Miccoli endoscope assisted surgery was made as the observation group and the 35 patients who underwent anterior neck small incision approach was made as the control group.The operation,cosmetic satisfaction,visual analogue scale (VAS) at 6 hour,12 hour and 24 hour after operation,the incidence of postoperative complications and the voice handicap index (VHI) of the two groups were recorded and analyzed.Results ①The operation time,hospitalization time,intraoperative blood loss in the observation group were(44.68 ± 23.30) mins,(3.28 ± 1.69) dsys and (43.57 ± 23.73) mL,respectively,which were lower than those[(59.43 ± 30.61) mins,(4.36 ± 1.42) days and (59.43 ±30.61)mL] in the control group(P ＜ 0.05).The hospitalization expense in the observation group was (9.73 ± 1.22) KRMB,which was higher than that [(5.83 ± 1.35) KRMB] in the control group (P ＜0.05).②The degree of cosmetic satisfaction in the observation group was 96.77％,which was significantly higher than 80％ in control group(P ＜0.05).③The score of VAS at 12 hour and 24 hour in the observation group were(3.11 ± 0.55)and (1.63 ± 0.21)respectively,which were significantly lower than those [(4.17 ± 0.73) and (2.59 ± 0.36)] in the control group (P ＜ 0.05).④The incidence of postoperative complications in the observation group was 6.45％,which was statistically insignificant when compared with that (11.43 ％) in the control group (P ＞ 0.05).⑤The VHI in the observation group was (0.70 ±0.45),which was statistically insignificant when compared with that(0.65 ± 0.39) in the control group (P ＞ 0.05).Conclusion For patients with benign thyroid tumors,the modified Miccoli endoscope assisted surgery and anterior small incision approach are both safe and effective.The former has the advantages in shortening the operation time and hospitalization time,reducing the blood loss and promoting the cosmetic effect,but it may increase the hospitalization expenses.

Application of Segmental Design Principles in the Small Incision Approach Rigid Internal Fixation for the Treatment of Maxillofacial Fractures / 医学研究杂志

Objective To explore the application effects of segmental design principles in the small incision approach rigid internal fixation for the treatment of maxillofacial fractures.Methods With a retrospective study,from September 2012 to April 2016,172 patients with maxillofacial fractures were selected as the research object in our hospital.All the patients were divided into the observation group of 100 patients and control group of patients according to the different treatment methods.Two groups were treated with mall incision approach rigid internal fixation.The observation group were given the preoperative design based on the segmental design principles.The other operation process were similar with the control group.Results All patients were completed the operation,the fracture were healed by Ⅰ stage.The postoperative 3months of total effective rates of the observation group and the control group were 98.0％ and 83.3％.The total effective rate of the observation group was significantly higher than that of the control group (P ＜ 0.05).The postoperative 3months of infection,nerve injury,salivary fistula,screw loosening and complication rate in the observation group was 3.0％,so that was 20.8％ in the control group,the observation group was significantly lower than the control group (P ＜ 0.05).The postoperative 3months of occlusal relationship and normal rates of the observation group were 99.0％ and 98.0％,respectively.The control group was 93.1％and 90.3％,respectively.There were between the two groups statistically significance difference(P ＜ 0.05).Conclusion The segmental design principles in the small incision approach rigid internal fixation for the treatment of maxillofacial fractures can improve the therapeutic effect,reduce the incidence of postoperative complications,improve the occlusal relationship with normal mouth opening rate.It is an ideal method for the treatment of maxillofacial fracture.

Natural orifice transluminal endoscopic surgery：a preliminary fresh cadaver experiment in dogs model / 重庆医学

Objective The optimal access for natural orifice transluminal endoscopic surgery is still uncertain .This study was designed to compare the practicability and maneuverability of transgastric ,transunmbilical ,and transrectal approach in abdominal surgery in a canine model .Methods Three dogs were used in this research .Three approach :trangastric ,transunmbilical and tran-srectal approach were carried out for abdominal exploration ,liver biopsy ,bladder biopsy and an attempted cholecystectomy .The ma-neuverability ,endoscopic image ,performer′s perception ,and spatial orientation were evaluated .Results The maneuverability of trangastric ,and transrectal approach NOTES were better than transunmbilical NOTES .Abdominal exploration ,live biopsy ,and bladder biopsy were completed successfully .The cholecystectomy was failed because of poor exposure and difficulty of separating the around tissure .Conclusion The optimal approach for upper abdomen NOTES is transrectal route .For lower abdomen NOTES , the trangastric approach is superior to other accesses .Further study is needed to develop more flexible and precise equipment for NOTES and to evaluate more feasible access approach .

Treatment of Shatzker Type VI Tibia Plateau Fracture Using Lateral and Posteromedial Dual Incision Approach and Dual Plating

PURPOSE: To evaluate the radiologic and clinical results of treatment of the Shatzker type 6 tibia plateau fracture using the lateral and posteromedial dual incision approach and dual plating. MATERIALS AND METHODS: Twelve cases in eleven patients of Shatzker type 6 tibia plateau fracture which has been treated using the lateral and posteromedial dual incision approach and dual plating were analyzed with an average follow-up of 16 months. Times to union, alignment and reduction loss on radiograph and postoperative clinical outcome with checking the range of motion of the knee joint, Knee Society Score and UCLA activity scale were analyzed and evaluated. RESULTS: In all cases, bony union was obtained in an average fifteen weeks after the operation, and there was no reduction loss. The arc of motion of the knee joint at the latest follow-up was 132 degrees on average. Average of Knee Society Score was 85 and UCLA activity scale was decreased from 9.6 points preoperatively to 5.7 points postoperatively. CONCLUSION: The treatment of Shatzker type 6 tibia plateau fracture using the lateral and posteromedial dual approach and dual plating have shown clinically preferable results of excellent recovery of joint motion and good knee society score by early range of motion exercise after firm fixation. However, it was high energy injury, so the sports activity of patients was significantly decreased.