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Objective To explore the home-made U-shaped retractor ’ s effect on reducing the traction injury of recurrent laryngeal nerve in the video-assistance thyroidectomy . Methods The patients with unilateral and unifocal papillary thyroid microcarcinoma , which were diagnosed by ultrasound preparation and by pathological postoperation , were enrolled .They all underwent the ipdilateral lobectomy , isthmus resection and the clearance of central lymph nodes with video-assistance technology .From January 2013 to June 2014, 79 cases ( control group ) were received conventional method , by which the thyroid lobe was elevated onto the trachea surface.From January 2015 to March 2016, 71 cases (U-shaped group) accepted the procedure which adopted home-made U-shaped retractor to pull the thyroid lobe to carotid artery horizontally .The operations were completed by the same surgeon .There were no significant differences between the two groups in age , gender and lesion size , which is comparable .The incidence rate of hoarseness was compared postoperation . Results Postoperative hoarseness of the U-shaped group occurred in 6 cases (8.5%) and the control group in 17 cases (21.5%), which show a significantly statistical difference (χ2 =4.919, P=0.027).And there was no significant difference in voice recovery time [median:16.5 d (8-31 d) vs.18 d (4-50 d), Z=-0.246, P=0.806]. Conclusion In the video-assisted thyroidectomy , using the U-shaped retractor to pull the thyroid lobe laterally and horizontally will be beneficial to reduce the recurrent laryngeal nerve tension and the incidence of the retract injury .
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Objective To explore the feasibility of tibial nerve motor branches transfer to the deep fibular nerve in an anatomical study.Methods Twenty-three sides lower limbs from 12 adult cadavers which preserved in Formalin were used for dissection of the tibial nerve and its all motor branches,and the proximal deep and superficial fibular nerve.Experimental measurement were performed for the parameters of each branch such as length,diameter,the location of original point relative to the level of the fibular head.The diameter of proximal part of the deep fibular nerve was measured simultaneously.Finally,the length from original point of each branch to the fibular neck was also measured during simulation of nerve transfer procedure.Results The average length of motor branches to the flexor digitorum longus muscle,to the flexor hallucis longus muscle and the superficial branches to the soleus muscle were (95.70 ± 13.40)mm,(96.90± 13.60)mm and (73.60 ± 12.00)mm respectively.Their average diameter were (0.63 ± 0.16)mm,(0.65 ±0.20)mm and ( 1.56 ± 0.26)mm respectively.The average diameter of proximal deep fibular nerve was (2.54± 0.26)mm.Based on length,branches to the flexor digitorum longus muscle and flexor hallucis longus muscle were adequate for direct nerve transfer to the deep fibular nerve in all specimens without interpositional grafr.And in 22 specimens (95.7 percent),the superficial branches to the soleus muscle were long enough to directly transfer.Other branches of the tibial nerve were not adequate for direct nerve transfer Conclusion This study confirmed the anatomical feasibility of using motor branches from tibial nerve for direct transfer to restore the deep fibular nerve.The superficial branches to soleus muscle were the best donor nerve if considering the branches,length,diameter and the difficulty of surgical procedures.
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[Objective]To discuss incidence of nerve root stretch injury and threshold value of traction injury in lumbar interbody fusion from posterior rout approach. [Method]Totally patients were treated by lumbar interbody fusion performed with posterior approach using the safe nerve root retractor,the force of dragging nerve root and the retracting time were showed on the display device,while the latency and amplitude of the DSEP wave were measured with Keypoint to monitor the status of the neural function.JOA scores were followed up 10 days,1 month,3 months and 12 months after operation respectively.[Result]Nineteen cases occurred latency prolongation and wave amplitude digression during the operation,when the tensile strength to nerve root was(4.1? 0.45) N and accumulating strength was(42.89?2.96) N*min.The tensile force of aggravation groups exceed stable and improvement groups obviously,incidence of FBSS was higher than the other two groups.[Conclusion]Stretch injury of nerve root during operation is the main cause of earlier period FBSS after interbody fusion.Master single tensile force less than(4.1? 0.45) N or accumulating strength less than(42.89?2.96) N*min is presumed safety.
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Twenty three patients with isthmic spondylolisthesis were operated on from December 1993 to June 1995. There were 14 female and 9 male patients and the average age of the patients was 50(ranging 20-67) years old. Symptoms in the lower extremities had been present for 3 months to 10 years, although varying degrees of back pain had existed for longer periods. Disability was caused mainly by claudication in 20 patients. Diagnostic studies included plain films, tomography, CT scaning, and MRI. Single interspace was involved in 18 patients, and in five patients, two interspaces were involved. After wide decompression and discectomy, stabilization was reestablished by segmental pedicular screw fixation device(Diapason(R) pedicular system) and interbody fusion using posterior movable segment as graft material. Between 6 to 24 months postoperatively, all patients exhibited radiographic fusion. The results were excellent in 12 cases, good in 8 cases and fair in 3 cases. The authors believe that full four nerve roots decompression, pedicular screw fixation. Posterior lumbar interbody fusion using movable segment as graft material, and prevention of nerve root traction injury during insertion of graft bone are important points to get good post-operative results.