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Objective:By comparing the clinical effect of minimally invasive hollow screw internal fixation Assisted by orthopedic robot (TiRobot) and O-arm navigation in the treatment of pelvic fractures, and practicability and security of both treatments were evaluated.Methods:Retrospective analysis of data of 42 cases of Tile C type pelvic fractures was employed during June 2017 to June 2020. Among them, 32 cases, twenty-four men, eight women, aged 34±6.2 years (range 24-68 years), were treated with percutaneous screw fixation guided by O-arm X wire instrument. According to Tile classification, there were 3 cases of C1.1 type, 8 cases of C1.2 type and 21case of C1.3 type. According to the Denis classification of sacral fractures, 17 cases were in zone I, and 8 cases in zone II. Ten patients, eight males and two females, aged 36±5.2 years (range 19-62 years) were treated by percutaneous screw fixation assisted by orthopedic robot. According to Tile classification, there were 1 case of C1.1 type, 2 cases of C1.2 type and 7 cases of C1.3 type. According to the Denis classification of sacral fractures, there were 5cases in zone I, 2 cases in zone II. For those who got obviously displaced pelvic fractures, Starr frames were used and then internal fixation was used to fix pelvic anterior ring and posterior ring injury respectively. Based on the times of needle adjustments, intraoperative fluoroscopy time, good screw position and incidence of complications two groups were statistically analysed. Matta score was employed to evaluate the quality of fracture reduction, while the Majeed score was employed to evaluate the clinical efficacy. Through the two groups of cases guide needle adjustment times, intraoperative fluoroscopy time, screw position excellent and good rate and the incidence of complications, which were statistically analyzed.Results:All screw positions were confirmed by CT scan after operation. The average time required for each screw placement of the O-arm group was 7.36±2.63 s, of the robot group was 6.80±3.20 s, so difference was not statistically significant ( P<0.05). An average of screw adjustments per one screw was 1.56±0.02 times by O-arm, and by the robot group was 0.34±0.06 times, so differences between the two groups were statistically significant ( P>0.05). The average operating time of O-arm group was 53.86±15.06 min, while the robot group was 52.52±15.14 min, so differences between the two groups were not statistically significant ( P>0.05). Position distribution of screw placement in two groups, all screws in O-arm group of position evaluations were excellent, excellent rate was 100%, all screw position evaluations by robot were excellent, excellent rate was 100%, so difference in screw distribution between the two groups was not statistically significant ( P>0.05). All cases were followed up for 6-12 months. Fracture healing time: 34.6±8.6 weeks for O-arm group, 33.4±9.4 weeks for robot group. Comparison between the two groups was not statistically significant ( P>0.05). Majeed score of O-arm group was 55-87, including Excellence of 17 cases, goodness of 9, fairness of 6. The rate of excellence and goodness was 81.2%, while robot group was 76-95, and that were excellent 7 cases,1 good, and the excellent and good rate was 80%, there was no significant difference between Matta and Majeed score between the two groups ( P>0.05). The incidence of complications between the two groups were no statistically significant ( P>0.05). Conclusion:Orthopedic robot system and O-arm navigation system assisted by percutaneous hollow screw fixation treatment of pelvic anterior and posterior ring injury, which are accurate, safe, minimally invasive, can reduce radiation damage to patients and surgeons. The efficacy were satisfactory. Both treatments are ideal for minimally invasive treatment of pelvic fractures, and the orthopedic robot have advantages of being programmed, standardized, stable and it’s learning curve is shorter.
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Objective To explore the clinical efficacy of minimally invasive posterior reconstructive plating by parallel Kirschner wires in the treatment of unstable posterior pelvic fractures.Methods From January 2013 to December 2016,29 patients with unstable posterior pelvic fracture were treated at Trauma Center,Liuzhou Workers' Hospital.They were 22 men and 7 women,aged from 19 to 65 years (mean,44.2 years).By the Tile classification,10 cases were classified as type B and 19 as type C.The delay from injury to surgery ranged from 4 to 14 days (mean,8.7 days).All the patients received minimally invasive posterior fixation with a U-shaped reconstructive plate and parallel Kirschner wires.The length of incision,intraoperative bleeding,operation time,quality of fracture reduction,curative effects and complications at the last follow-up were recorded.Results The length of intraoperative unilateral incision ranged from 2.3 to 3.4 cm (average,2.99 cm);the volume of intraoperative bleeding ranged from 47 to 88 mL (average,69.9 mL);the average operation time ranged from 17 to 34 min (average,25.2 min).One patient was lost to the follow-up.The other 28 patients were followed up for 14 to 26 months (average,18.3 months).The fracture healing time ranged from 8 to 15 months (average,10.1 months).According to the Matta criteria for fracture reduction,17 cases were rated as excellent at the last follow-up,9 as good,one as fair and one as poor,giving an excellent to good rate of 92.9％.According to the Pohlemann functional scoring,14 cases were rated as excellent,11 as good,2 as fair and one as poor,giving an excellent to good rate of 89.3％.Conclusion In the treatment of unstable posterior pelvic fractures,minimally invasive posterior reconstructive plating by parallel Kirschner wires presents advantages of high security,limited surgical trauma,good curative effects and limited postoperative complications.
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Objective To compare the outcomes of percutaneous Kirschner wire assisted reduction with minimally invasive plate osteosynthesis and open reduction with locking plate in treatment of Robinson type 2B midshaft clavicular fractures.Methods A retrospective case control study was conducted to analyze the clinical data of 96 patients with Robinson type 2B midshaft clavicular fracture from June 2009 to October 2016.There were 70 males and 26 females with an average age of 34.5 years.The patients were divided into two groups according to the different surgical methods:49 patients were treated with percutaneous Kirschner wire assisted reduction and minimally invasive locking plate osteosynthesis (minimally invasive group);47 patients were treated with open reduction with locking plate internal fixation (open plating group).According to the Robinson fracture typing,there were 28 patients with type 2B1 and 21 with type 2B2 in the minimally invasive group;there were 23 patients with type 2B1 and 24 with type 2B2 in open plating group.The length of incision,operation time,visual analog scale (VAS) 2 days after surgery,length of hospital stay,time of fracture healing,Constant score results of postoperative 6 months,1 year,and at the last follow-up,feedbacks on incision and functional satisfaction,and complications were compared between the two groups.Results The average follow-up was (19.6 ± 5.5)months in minimally invasive group and (20.3 ± 6.2)months in open plating group.The incision lengths of the minimally invasive group and the open plating group were (4.8 ±0.7)cm and (8.3 ± 1.6) cm,respectively.The minimally invasive group had significantly longer operation time [(75.5 ±21.6)minutes] compared with open plating group [(60.2 ± 19.1)minutes] (P ＜0.0l).In the minimally invasive group and open plating group,the VAS 2 days after surgery was (2.9 ± 1.5) points and (3.9 ± 1.7) points;the hospitalization time was (7.1 ± 2.6) days and (9.5 ± 2.9) days;the fracture healing time was (11.7 ± 2.2) weeks and (13.4 ± 2.9) weeks;patients' satisfaction with the appearance of the incision was 84％ and 60％,respectively.There were no significant differences in the Constant score and functional satisfaction between the two groups at postoperative 6 months,l year,and the last follow-up (P ＞ 0.05).The incidence of postoperative incisional hypertrophic scar was 8％ and 30％,and the incidence of local skin numbness or sensory loss was 10％ and 32％ in minimally invasive group and open plating group,respectively (P ＜ 0.0l).No significant differences in nonunion,internal fixation failure,incision infection,subcutaneous prominent plate or revision rate were found between the two groups (P ＞ 0.05).Conclusion Percutaneous Kirschner wire assisted reduction with minimally invasive locking plate and open reduction with locking plate internal fixation can both achieve good clinical outcomes in the treatment of Robinson 2B midshaft clavicular fracture;but the former shows more advantages in terms of incision length,incision appearance,operation time,pain 2 days after surgery,fracture healing time,and local skin sensory disturbances.
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Objective To discuss the application and effect evaluation of the standard operation procedure ( SOP ) teaching method during applying surgical practice teaching in local medical college . Method 123 undergraduate students from Grade 2011 clinical medical major in Medical College of Shaoguan University were selected as objects of study. The students were divided into test (odd) group and control (even) group by draw. The two groups were taught by the same teachers, while the SOP method was applied to the test group (n=62) and the traditional surgical clinical teaching method was applied to the control group (n=61). Meanwhile, we used a combined method of the formative assessment and final assess-ment to compare and analyze the teaching feedback. After their graduate internship, we compared their autonomous study capability, clinical evaluation thought, normativity of the operation and capability in their intern positions as well as the degree of satisfaction of the test of two groups by doing a survey among them. All these were analyzed by SPSS 18.0 software, and t test was used to compare two groups' measurement in-formation and count data with chi-square. Results The comprehensive evaluation scores of the test group were significantly higher than the control group, in which the margin was of statistical value [(79.394 ± 8.049) vs. (71.703±10.462), t=39.632, P=0.000]. The percentage of excellence of the test group was signif-icantly higher than the control group, in which the margin was of statistical value (59.68% vs. 39.35%, χ2=5.082, P=0.024). The percentage of failure of the test group was lower than the group taught by the tradi-tional method, in which the margin was of statistical value (3.22%vs. 16.39%, χ2=4.652, P=0.031). Its for-mative assessment result on the evaluation of the experimental teaching process and summative assessment scores were higher than the control group, and the difference was statistically significant [formative scores points: (46.018 ±5.749) vs. (42.771 ±6.459), t=19.445, P=0.000; summative scores: (33.659 ±3.437) vs. (29.063±4.366), t=36.249, P=0.000]. As far as their clinical graduate internship adaptation capabilities were concerned, students from the test group had more satisfaction on the teaching feedback over 4 perspectives than the other group, in which the margin was of statistical value. Experimental groups' satisfaction showed that: 93.55% of students thought the standard operation procedure (SOP) teaching method was beneficial to improving their clinical practice skills, 91.94%thought that it improved their surgical clinical work ability to adapt, 85.48% thought it helped to cultivate their surgical clinical thinking and innovation ability. Conclusions The SOP teaching method in surgical practice teaching helps to enhance students' clinical operation and adaptation capability and promote the teaching quality.
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<p><b>OBJECTIVE</b>To study the efficacy and safety of thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma.</p><p><b>METHODS</b>Based on hospitalization data from March 2011 to March 2014, 62 cases of esophageal carcinoma treated with thoracoscopic and laparoscopic esophagectomy (minimally invasive group, with 45 male patients) and other 62 cases treated with open esophagectomy (open esophagectomy group, with 45 male patients) were analyzed in a retrospective cohort. The mean age of two groups were (62±9) years and (62±8) years, respectively. Quantitative data were analyzed using t-test, whereas qualitative variables were tested with χ2 test. There were no significant difference in age, tumor location, pathological type, tumor staging between two groups (P>0.05). Perioperative data and three-year clinic outcome were collected. The three-year survival curve were calculated with the Kaplan-Meier method and compared by the log-rank test between the two groups.</p><p><b>RESULTS</b>Compared with open esophagectomy group, minimally invasive group has less amount of bleeding during operations ((231±40) ml vs. (302±37) ml, t=4.63, P=0.000), pleural drainage after operations ((490±41) ml vs. (1 090±43) ml, t=-79.59, P=0.000), and postoperative hospital stay ((16±4) days vs. (17±4) days, t=-2.61, P=0.010). Meanwhile, minimally invasive group has more operation time ((272±39) minutes vs. (242±45) minutes, t=3.97, P=0.000) and total and thoracic cavity retrieved lymph nodes (30±5 vs. 28±4, t=2.39, P=0.018; 15±4 vs. 14±3, t=2.59, P=0.011). Nineteen and 31 patients had postoperative complications and statistical significance difference was found between two groups (χ2=4.83, P=0.028). The three-year survival rate was 73.2% in minimally invasive group and 71.4% in open esophagectomy group. There was no significance difference between two groups (χ2=0.170, P>0.05).</p><p><b>CONCLUSION</b>Thoracoscopic and laparoscopic esophagectomy had the advantages of amount of bleeding, postoperative hospital stay and complications, and had the same three-year survival rate with open esophagectomy.</p>
Subject(s)
Aged , Humans , Male , Middle Aged , Carcinoma , General Surgery , Esophageal Neoplasms , General Surgery , Esophagectomy , Methods , Laparoscopy , Length of Stay , Lymph Node Excision , Lymph Nodes , Neoplasm Staging , Operative Time , Postoperative Complications , Retrospective StudiesABSTRACT
Research-oriented study is a comprehensive learning method focusing on the experimental process deriving from a main issue.Given our clinical teaching experience in years,we incorporated the research-oriented studies into the undergraduate Clinical Medicine course for grade 2009,integrating the trait of the clinical skills education and our local professional training objectives.In the studies,students selected their own topic,designed and did their experiments,searched for the information,processed and analyzed the experiment result and finally completed the thesis.Practice showed that after the strict implementation of research learning plan,students' learning interest,innovative thinking,practical skills,research ability and cooperation spirit all significantly enhanced.
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@#ObjectiveTo observe the effect of cognitive therapy and acupuncture on insomnia. Methods72 insomnia sufferers were divided into two groups averagely. 36 sufferers were treated with cognitive therapy and acupuncture (treatment group), and other 36 sufferers were treated with acupuncture (control group) only.ResultsA month after treatment, ,15 sufferers were cured, 18 sufferers were obviously improved, 2 sufferers were improved and one did not show any improvement in the treatment group.Otherwise, 6 sufferers were cured, 12 sufferers were obviously improved, 12 sufferers were improved and 6 did not show any improvement in the control group. (P<0.05)ConclusionCognitive therapy and acupuncture used together shows more efficacy on insomnia compared with acupuncture alone.
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@#ObjectiveTo observe the effect of traction combined with exercise on the cervical vertebra disease of the nerve root type. Methods50 cases were divided in treating group and control. The cases in treating group (30 cases) were treated with cervical vertebra traction and exercise, and those in control group were treated with cervical vertebra traction only.ResultsIn treating group, 12 cases were cured,11 were very effective, 8 were effective, 1 was ineffective, while those in control, 6 cases were cured, 5 were very effective, 4 were effective, 5 were ineffective(P<0.05).ConclusionCombined exercise with traction is more effective than traction alone on cervical vertebra disease of the nerve root type.
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Objective To study the mechanism of multicellular drug resistance of pulmonary adenocarcinoma cell line A549 mediated by cell-cell adhesion. Methods We compared the sensitivity of monolayer cells (MCs) to adriamycin (ADM) with that of multicellular spheroids (MCSs) which was employed as a three dimensional cell culture model. Transmission electron microscopy was applied to observe the cellular ultrastructure. Bcl-2, Bcl-xL, and Bax expression levels were detected by flow cytometry and indirect immunofluorescent staining. Results Compared with MCs, MCSs had more than two layers of cells, more extensive and compact cell adhesion, and inlay junctions were found within them. MCSs were more resistant to ADM. At the same time, Bcl-2 and Bcl-xL expressions in MCSs were much higher. After treatment with ADM, expressions Bcl-2 and Bcl-xL increased markedly in MCSs. Conclusion MCSs could simulate the solid tumors in vivo and has multicellular drug resistance mediated by cell-cell adhesion. The possible mechanisms may be associated with the upregulation of Bcl-2 and Bcl-xL.
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Objective To find an effective method for the treatment of mitomycin C extravasation injuries. Methods The rabbit model of mitomycin C extravasation was made and managed by different methods. The therapeutic efficacy in each group was assessed by using regression index and regression time. Results The therapeutic efficacy in ice compress group and ice compress plus amifostine group was better than that in other groups and the regression time was the shortest. There was no inflammation and necrosis in skin in ice compress group. Conclusion Ice compress, which can prevent inflammation and necrosis in skin, is one of the most effective treatment methods for mitomycin C extravasation injuries.
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Objective To explore an optimal model of three dimensional in vitro cell culture for simulating solid tumors in vivo . Methods The model of three dimensional cell culture was constructed under the conditions of inhibiting the cell wall attachment and stirring the medium. Multicellular spheroids (MCS) were cultured using microcarriers (CutiSpher). Drug sensitivity of monolayer cells (MC) and MCS was tested by MTT staining and cytometry, respectively. Ultrastructures of the MC and MCS were observed by transmission electron microscopy. Results Cells in three dimensional cell culture model without microcarriers were compacted into mass at 4 d while cells in MCS were found to attach to the microcarriers at 0.5 h. MCS had more than two layers of cells growing within it at 5 d. Compared with MC, MCS was more resistant to the anticancer drug, and had more plenty of organell and microvilli with more extensive and compact cell adhesion. Conclusion MCS has strong developmental properties and can simulate the cell cell interactions in vivo , especially cell adhesion, which may contribute to the drug resistance of MCS.
