Watson-Jones Anatomical Approach for Open Reduction and Internal Fixation of Proximal Femoral Fractures without Image Intensifier in a Low-Resource Setting

Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified technique, the Watson Jones approach (WJA) without image intensifier nor traction table, can allow open reduction and internal fixation (ORIF) of PFF using Dynamic hip screw (DHS), with satisfactory outcome. Patients and methods: Forty one consecutive patients (mean age 59.5 ± 21.6 years, 61% males) who were followed in a Teaching Hospital for PFF treated by ORIF using the WJA and DHS from January 2016 to December 2020 were reassessed. The outcome measures were the quality of the reduction, the positioning of the implants, the tip-apex distance (TAD), the rate and delay of consolidation, the functional results using Postel Merle d’Aubigné (PMA) score, the rate of surgical site infection (SSI) and the overall mortality. Logistic regression was used to determine factors associated with mechanical failure. Results: The mean follow-up period was 33.8 ± 15.0 months. Fracture reduction was good in 31 (75.6%) cases and acceptable in 8(19.5%) cases. Implant position was fair to good in 37 (90.2%) patients. The mean TAD was 26.1 ± 3.9 mm. Three patients developed SSI. Consolidation was achieved in 38 (92.6%) patients. The functional results were good to excellent in 80.5% of patients. The overall mortality rate was 7.3%. There were an association between mechanical failure and osteoporosis (p = 0.04), fracture reduction (p = 0.003), and TAD (p = 0.025). In multivariate logistic regression, no independent factors were predictive of mechanical failure. Conclusion: This study shows that ORIF using DHS for PFF via the Watson-Jones approach without an image intensifier can give satisfactory anatomical and functional outcomes in low-resource settings. It provides and validates a reliable and reproducible technique that deserves to be diffused to surgeons in austere areas over the world.

Induced pluripotent stem cell-related approaches to generate dopaminergic neurons for Parkinson's disease

The progressive loss of dopaminergic neurons in affected patient brains is one of the pathological features of Parkinson's disease,the second most common human neurodegenerative disease.Although the detailed pathogenesis accounting for dopaminergic neuron degeneration in Parkinson's disease is still unclear,the advancement of stem cell approaches has shown promise for Parkinson's disease research and therapy.The induced pluripotent stem cells have been commonly used to generate dopaminergic neurons,which has provided valuable insights to improve our understanding of Parkinson's disease pathogenesis and contributed to anti-Parkinson's disease therapies.The current review discusses the practical approaches and potential applications of induced pluripotent stem cell techniques for generating and differentiating dopaminergic neurons from induced pluripotent stem cells.The benefits of induced pluripotent stem cell-based research are highlighted.Various dopaminergic neuron differentiation protocols from induced pluripotent stem cells are compared.The emerging three-dimension-based brain organoid models compared with conventional two-dimensional cell culture are evaluated.Finally,limitations,challenges,and future directions of induced pluripotent stem cell–based approaches are analyzed and proposed,which will be significant to the future application of induced pluripotent stem cell-related techniques for Parkinson's disease.

Enhancing perianal disease management with integrated physical and psychological approaches

This article provides a comprehensive analysis of the study by Hou et al,focusing on the complex interplay between psychological and physical factors in the postoperative recovery(POR)of patients with perianal diseases.The study sheds light on how illness perception,anxiety,and depression significantly influence recovery outcomes.Hou et al developed a predictive model that demonstrated high accuracy in identifying patients at risk of poor recovery.The article explores the critical role of pre-operative psychological assessment,highlighting the need for mental health support and personalized recovery plans in enhancing POR quality.A multidisciplinary approach,integrating mental health professionals with surgeons,anesthesiologists,and other specialists,is emphasized to ensure comprehensive care for patients.The study’s findings serve as a call to integrate psychological care into surgical practice to optimize outcomes for patients with perianal diseases.

改良Watson-Jones入路微创全髋关节置换术的初步临床应用

目的探讨改良Watson-Jones入路微创全髋关节置换术（THA）的技术要点和临床效果。方法对22例患者行改良Watson-Jones入路微创THA,观察切口长度、手术时间、术中出血量、输血量、术后引流量、术后住院天数及假体位置,并进行随访。结果手术切口长7-9 cm,平均8 cm;手术时间70-120 min,平均92.1 min;术中出血量60-610 ml,平均210.5 ml;引流量60-640 ml,平均220.5 ml;输血量0-800 ml,平均318.2 ml。患者术后第2天在医生指导下下床活动,术后平均住院7.9 d。无1例发生感染、脱位、血管神经损伤等并发症。随访假体位置良好,髋关节活动度为优,Harris评分90-96分,平均92.1分。结论改良Watson-Jones入路是经臀中肌和阔筋膜张肌肌间隙显露髋关节,具有不损伤周围肌肉、创伤小、术后恢复快、并发症少、几乎无后脱位的优点。

以改良Watson-Jones入路微创行全髋关节置换与改良Gibson后侧入路全髋关节置换的近期疗效比较

背景:采用改良Watson-Jones入路的微创全髋关节置换近年来在国内外得到广泛的应用。目的:比较改良Watson-Jones入路微创全髋关节置换与改良Gibson后侧入路全髋关节置换的近期疗效。方法:52例接受单侧髋关节置换患者,根据入院日期单双号,随机分为2组,实验组22例接受改良Watson-Jones入路微创人工全髋关节置换;对照组30例接受改良Gibson后侧入路人工全髋关节置换。结果与结论:两组患者完整随访至置换后18个月49例,实验组失访1例,对照组失访2例。实验组手术时间多于对照组(P<0.05),实验组切口长度、术中出血量、输血量、住院天数少于对照组(P<0.05)。两组置换后出血量、Harris评分相比差异无显著性意义。两组患者均未发生感染、脱位、血管神经损伤、深静脉血栓形成等并发症。近期随访结果表明,改良Watson-Jones微创入路全髋关节置换创伤小,髋关节功能恢复好,能够有效预防并发症的发生。

经改良Watson-Jones入路行全髋置换术80例分析

目的 :介绍一种经改良Watson Jones入路的全髋置换术 ,并探讨其优点。方法 :对Watson Jones入路的手术切口、进路均做改良 ,从臀中肌与阔筋膜张肌的间隙进入 ,切断部分阔筋膜张肌 ,将阔筋膜张肌近侧部、臀肌保持为一体从髂翼前部外侧面剥离向外下方牵开 ,阔筋膜张肌远侧部、缝匠肌等向内侧牵开 ,使髋臼及粗隆的基底部得到充分显露。应用改良Watson Jones入路行全髋关节置换术 (THR) 80例 92髋 ,术后随访68例 73髋 ,随访时间 8个月至 6年 ,平均 4.1年。结果 :按Harris髋关节评分标准评分 ,疗效满意。较传统术式 ,此入路损伤小 ,暴露好 ,操作方便 ,并发症少。结论 :经改良Watson Jones入路行全髋置换术具有术野暴露好、定位准确、操作方便、并发症少的优点 。

SuperPath入路和Watson-Jones入路全髋关节置换术治疗创伤性股骨颈骨折的临床对比分析

目的对比SuperPath入路和Watson-Jones入路全髋关节置换术治疗创伤性股骨颈骨折的临床效果。方法创伤性股骨颈骨折病人120例,均行全髋关节置换术,根据治疗方法不同分为两组,观察组77例,采取SuperPath入路全髋关节置换术治疗;对照组43例,采取Watson-Jones入路全髋关节置换术治疗。比较两组临床疗效、围手术期指标、Harris评分及并发症发生率。结果观察组术后住院时间短于对照组,术后7天、1个月、12个月Harris评分高于对照组,差异有统计学意义(P<0.05)。观察组病人切口延迟愈合率低于对照组,差异有统计学意义(P<0.05)。结论 SuperPath入路治疗创伤性股骨颈骨折创伤更小,术后髋关节功能恢复更好,且延迟愈合发生率低。

28例改良Watson-Jones入路微创全髋关节置换术的护理体会

目的探讨改良Watson-Jones入路微创全髋关节置换术(THA)的护理体会。方法对28例接受改良Watson-Jones入路微创THA患者实施精心的术前、术后护理和观察、预防并发症的产生。在术后指导患者早期下床活动和康复锻炼。结果患者术后平均住院7.9d。无1例发生感染、脱位、血管神经损伤等并发症。随访6个月～3年,髋关节功能良好,效果满意。结论围手术期护理,使患者密切配合治疗和护理,个体化渐进式指导早期康复训练,能够有效预防并发症的产生,使全髋关节置换术患者恢复快、康复效果满意。

改良Watson-Jones手术入路行人工股骨头置换术

目的 :探索一种简便、有效的手术入路行人工股骨头置换术。方法 :采用改良的Watson -Jones手术入路 ,即在原Watson -Jones手术入路基础上 ,皮肤切口向后弧度加大 ,不通过切断臀中肌及股外侧肌来显露术野 ,而是将其连同两者的腱性连接部向前侧翻转直至转子间线 ,来充分显露股骨大、小粗隆及髋关节。作者从 1994年 1月至 1998年10月采用此入路行人工股骨头置换术 86例。结果 :全组患者无手术死亡及术后感染。术后随访 6～ 12月 ,总优良率为 91.9%。其中有 17例患者术后发生轻度跛行 ,7例患者患肢缩短超过 2cm。无术后髋关节脱位病例。结论 :作者认为此手术入路有操作简便、安全、创伤小、暴露好 ,有利于假体定位、固定以及术后外展肌功能恢复快等优点 ,是一种较为理想的手术入路。

改良Watson-Jones微创入路与Gibson后侧入路全髋关节置换术的比较研究

目的观察改良Watson-Jones微创入路与Gibson后侧入路全髋关节置换术的临床疗效。方法选择在本院接受全髋关节置换术治疗的132例股骨颈骨折患者作为研究对象,随机分为观察组和对照组各66例,观察组患者接受改良Watson-Jones微创入路手术,对照组患者则接受Gibson后侧入路手术,比较两组患者的手术相关指标、C-反应蛋白、血沉及大腿周径增加值、髋关节功能评分等差异。结果 (1)观察组患者接受治疗后的手术时间、总住院时间、手术切口长度均短于对照组,术中及术后出血量明显少于对照组(P<0.05);(2)观察组患者接受治疗后的C-反应蛋白、血沉及大腿周径增加值等均明显小于对照组患者(P<0.05);(3)观察组患者接受治疗后各个时期的Harris评分均明显高于对照组患者(P<0.05)。结论改良Watson-Jones微创入路全髋关节置换术可以优化手术过程、减少手术创伤,提升远期患肢功能。

改良Watson-Jones微创入路与改良Gibson后侧入路全髋关节置换术的临床疗效对比观察

目的:观察采用改良Watson-Jones微创入路,以及改良Gibson后侧入路应用于全髋关节置换术的效果对比。方法:采用随机平行对照法将我院2014年9月-2015年10月期间113例需行全髋关节置换患者,依据手术入路方式的不同分为对照组56例及观察组57例,对照组患者采用改良Gibson后侧入路,观察组患者采用改良WatsonJones微创入路,对比两组患者术中相关指标及术后髋关节功能恢复情况。结果:观察组术中出血量、切口长度、术后引流量、住院时间均低于对照组,手术时间长于对照组(P<0.05);观察组术后3、6、12、18个月Harris评分均高于对照组(P<0.05)。结论:经改良Watson-Jones微创入路行髋关节置换术,不会对关节的周围肌肉造成损伤,术后恢复快,可显著改善髋关节功能,值得临床推广应用。

Complication rates after direct anterior vs posterior approach for hip hemiarthroplasty in elderly individuals with femoral neck fractures

BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with no consensus regarding the superiority of any single approach.AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches(PL)for hip hemiarthroplasty after femoral neck fractures.METHODS This is a comparative,retrospective,single-center cohort study conducted at a university hospital.Between March 2008 and December 2018,273 patients(a total of 280 hips)underwent bipolar hemiarthroplasties(n=280)for displaced femoral neck fractures using either the PL(n=171)or the minimally invasive direct anterior approach(DAA)(n=109).The choice of approach was related to the surgeons’practices;the implant types were similar and unrelated to the approach.Dislocation rates and other complications were reviewed after a minimum followup of 6 mo.RESULTS Both treatment groups had similarly aged patients(mean age:82 years),sex ratios,patient body mass indexes,and patient comorbidities.Surgical data(surgery delay time,operative time,and blood loss volume)did not differ significantly between the groups.The 30 d mortality rate was higher in the PL group(9.9%)than in the DAA group(3.7%),but the difference was not statistically significant(P=0.052).Among the one-month survivors,a significantly higher rate of dislocation was observed in the PL group(14/154;9.1%)than in the DAA group(0/105;0%)(P=0.002).Of the 14 patients with dislocation,8 underwent revision surgery for recurrent instability(posterior group),and one of them had 2 additional procedures due to a deep infection.The rate of other complications(e.g.,perioperative and early postoperative periprosthetic fractures and infection-related complications)did not differ significantly between the groups.CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate(<1%)than the PL.

A FLEXIBLE OBJECTIVE-CONSTRAINT APPROACH AND A NEW ALGORITHM FOR CONSTRUCTING THE PARETO FRONT OF MULTIOBJECTIVE OPTIMIZATION PROBLEMS

In this article, a novel scalarization technique, called the improved objective-constraint approach, is introduced to find efficient solutions of a given multiobjective programming problem. The presented scalarized problem extends the objective-constraint problem. It is demonstrated that how adding variables to the scalarized problem, can lead to find conditions for (weakly, properly) Pareto optimal solutions. Applying the obtained necessary and sufficient conditions, two algorithms for generating the Pareto front approximation of bi-objective and three-objective programming problems are designed. These algorithms are easy to implement and can achieve an even approximation of (weakly, properly) Pareto optimal solutions. These algorithms can be generalized for optimization problems with more than three criterion functions, too. The effectiveness and capability of the algorithms are demonstrated in test problems.

空心钉联合锚钉治疗胫骨结节骨骺Watson-JoneⅡ、Ⅲ型骨折

2009年3月～2012年5月，我科采用空心钉联合带线锚钉治疗10例胫骨结节骨骺Watson—JoneⅡ、Ⅲ刹骨折患者，取得满意疗效，报道如下。

改良Watson-Jones切口在人工股骨头置换术中的应用

方法为髂前上棘向后约4～5cm之骼嵴缘处有三角形棘,在棘尖下2.5cm处开始弧形向下向后,经过股骨大转子及股骨干之外侧面,至大转子基底部以远5cm处止。然后在臀中肌与阔筋膜张肌之间纵行切开髂胫束,钝性剥离此层深面。

Laparoscopic left hemihepatectomy guided by indocyanine green fluorescence: A cranial-dorsal approach

BACKGROUND Advancements in laparoscopic technology and a deeper understanding of intra-hepatic anatomy have led to the establishment of more precise laparoscopic hepatectomy(LH)techniques.The indocyanine green(ICG)fluorescence navi-gation technique has emerged as the most effective method for identifying hepatic regions,potentially overcoming the limitations of LH.While laparoscopic left hemihepatectomy(LLH)is a standardized procedure,there is a need for innova-tive strategies to enhance its outcomes.important anatomical markers,surgical skills,and ICG staining methods.METHODS Thirty-seven patients who underwent ICG fluorescence-guided LLH at Qujing Second People's Hospital between January 2019 and February 2022 were retrospectively analyzed.The cranial-dorsal approach was performed which involves dissecting the left hepatic vein cephalad,isolating the Arantius ligament,exposing the middle hepatic vein,and dissecting the parenchyma from the dorsal to the foot in order to complete the anatomical LLH.The surgical methods,as well as intra-and post-surgical data,were recorded and analyzed.Our hospital’s Medical Ethics Committee approved this study(Ethical review:2022-019-01).RESULTS Intraoperative blood loss during LLH was 335.68±99.869 mL and the rates of transfusion and conversion to laparotomy were 13.5%and 0%,respectively.The overall incidence of complications throughout the follow-up(median of 18 months;range 1-36 months)was 21.6%.No mortality or severe complications(level IV)were reported.CONCLUSION LLH has the potential to become a novel,standardized approach that can effectively,safely,and simply expose the middle hepatic vein and meet the requirements of precision surgery.

Which approach of total hip arthroplasty is the best efficacy and least complication?

BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications of hip approaches remains inconclusive.This study conducted an umbrella review to systematically appraise previous meta-analysis(MAs)including conventional posterior approach(PA),and minimally invasive surgeries as the lateral approach(LA),direct anterior approach(DAA),2-incisions method,mini-lateral approach and the newest technique direct superior approach(DSA)or supercapsular percutaneouslyassisted total hip(SuperPath).AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials(RCTs).METHODS MAs were identified from MEDLINE and Scopus from inception until 2023.RCTs were then updated from the latest MA to September 2023.This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score(HHS),dislocation,intra-operative fracture,wound compliData were independently selected,extracted and assessed by two reviewers.Network MA and cluster rank and surface under the cumulative ranking curve(SUCRA)were estimated for treatment efficacy and safety.RESULTS Finally,twenty-eight MAs(40 RCTs),and 13 RCTs were retrieved.In total 47 RCTs were included for reanalysis.The results of corrected covered area showed high degree(13.80%).Among 47 RCTs,most of the studies were low risk of bias in part of random process and outcome reporting,while other domains were medium to high risk of bias.DAA significantly provided higher HHS at three months than PA[pooled unstandardized mean difference(USMD):3.49,95%confidence interval(CI):0.98,6.00 with SUCRA:85.9],followed by DSA/SuperPath(USMD:1.57,95%CI:-1.55,4.69 with SUCRA:57.6).All approaches had indifferent dislocation and intraoperative fracture rates.SUCRA comparing early functional outcome and composite complications(dislocation,intra-operative fracture,wound complication,and nerve injury)found DAA was the best approach followed by DSA/SuperPath.CONCLUSION DSA/SuperPath had better earlier functional outcome than PA,but still could not overcome the result of DAA.This technique might be the other preferred option with acceptable complications.

Minimalistic approach to left atrial appendage occlusion guided by cardiac computed tomography angiography

OBJECTIVE To assess the feasibility and safety of the minimalistic approach to left atrial appendage occlusion(LAAO) guided by cardiac computed tomography angiography(CCTA).METHODS Ninety consecutive patients who underwent LAAO, with or without CCTA-guided, were matched(1:2). Each step of the LAAO procedure in the computed tomography(CT) guidance group(CT group) was directed by preprocedural CT planning. In the control group, LAAO was performed using the standard method. All patients were followed up for 12 months, and device surveillance was conducted using CCTA.RESULTS A total of 90 patients were included in the analysis, with 30 patients in the CT group and 60 matched patients in the control group. All patients were successfully implanted with Watchman devices. The mean ages for the CT group and the control group were 70.0 ± 9.4 years and 68.4 ± 11.9 years(P = 0.52), respectively. The procedure duration(45.6 ± 10.7 min vs. 58.8 ± 13.0 min,P < 0.001) and hospital stay(7.5 ± 2.4 day vs. 9.6 ± 2.8 day, P = 0.001) in the CT group was significantly shorter compared to the control group. However, the total radiation dose was higher in the CT group compared to the control group(904.9 ± 348.0 m Gy vs.711.9 ± 211.2 m Gy, P = 0.002). There were no significant differences in periprocedural pericardial effusion(3.3% vs. 6.3%, P = 0.8) between the two groups. The rate of postprocedural adverse events(13.3% vs. 18.3%, P = 0.55) were comparable between both groups at 12 months follow-up.CONCLUSIONS CCTA is capable of detailed LAAO procedure planning. Minimalistic LAAO with preprocedural CCTA planning was feasible and safe, with shortened procedure time and acceptable increased radiation and contras consumption. For patients with contraindications to general anesthesia and/or transesophageal echocardiography, this promising method may be an alternative to conventional LAAO.

Virtual source approach for maximizing resolution in high-penetration gamma-ray imaging

High-energy gamma-ray radiography has exceptional penetration ability and has become an indispensable nondestructive testing(NDT)tool in various fields.For high-energy photons,point projection radiography is almost the only feasible imaging method,and its spatial resolution is primarily constrained by the size of the gamma-ray source.In conventional industrial applications,gamma-ray sources are commonly based on electron beams driven by accelerators,utilizing the process of bremsstrahlung radiation.The size of the gamma-ray source is dependent on the dimensional characteristics of the electron beam.Extensive research has been conducted on various advanced accelerator technologies that have the potential to greatly improve spatial resolution in NDT.In our investigation of laser-driven gamma-ray sources,a spatial resolution of about 90μm is achieved when the areal density of the penetrated object is 120 g/cm^(2).A virtual source approach is proposed to optimize the size of the gamma-ray source used for imaging,with the aim of maximizing spatial resolution.In this virtual source approach,the gamma ray can be considered as being emitted from a virtual source within the convertor,where the equivalent gamma-ray source size in imaging is much smaller than the actual emission area.On the basis of Monte Carlo simulations,we derive a set of evaluation formulas for virtual source scale and gamma-ray emission angle.Under optimal conditions,the virtual source size can be as small as 15μm,which can significantly improve the spatial resolution of high-penetration imaging to less than 50μm.

Debate on direct-anterior vs posterior approach for hip hemiarthroplasty:The authors’insights

We read and discussed the study entitled“Complication rates after direct anterior vs posterior approach for Hip Hemiarthroplasty in elderly individuals with femoral neck fractures”with great interest.The authors have done justice to the topic of comparison of anterior and posterior surgical approaches for bipolar hemiarthroplasty which has been an everlasting debate in the existing literature.However,there are certain aspects of this study that need clarification from the authors.