Dissection and ligation of the lateral circumflex femoral artery is not necessary when using the direct anterior approach for total hip arthroplasty

BACKGROUND Branches of the lateral circumflex femoral artery(LCFA) stretch across the surgical field during a direct anterior total hip arthroplasty. It is an anatomical marker in direct anterior approach. As an important vessel around the hip joint,this vessel was ligated in most situations. Although ligation of the vascular pedicle of the LCFA is a common, traditional procedure used to decrease bleeding, the ligation of the pedicle of the vessel is tedious and time-consuming.AIM To explore whether this ligation is truly necessary in a direct anterior approach to total hip arthroplasty.METHODS This single-center, single-surgeon, prospective study was performed to compare patients' bleeding undergoing ligation of the branches of the LCFA pedicle(group A) vs those treated with electrocautery from the branches of the LCFA(group B). In both groups, the pedicles were identified in the intermuscular plane between the tensor fasciae lata and the rectus femoris muscles. In group A, the pedicles were ligated with a silk ligature. In group B, the branches coming off the LCFA were controlled with electrocautery. We compared preoperative vs postoperative changes in blood hemoglobin levels, intraoperative blood loss,operative time, rates of transfusion, re-bleeding, and hematoma between the two groups.RESULTS The reduction of hemoglobin in group A was 20.9 ± 7.0, and in group B it was 21.2 ± 4.9. There was no statistically significant difference between the two groups(P > 0.05). The actual calculated blood loss in group A was 784 ± 125 mL,and in group B it was 722 ± 153 mL. There was a trend in group A having more blood loss(P = 0.078). The estimated blood loss in group A was 344 ± 88 mL, and in group B it was 346 ± 73 mL. There was no statistically significant difference between the two groups(P = 0.883). In addition, there were no significant differences in the rates of postoperative transfusion(10% vs 6.7%, P > 0.05),postoperative hematomas(6.7% vs 13.3%, P > 0.05), or re-bleeding(13.3% vs 20%,P > 0.05) between the two groups.CONCLUSION Ligation of the pedicle of the LCFA has no advantage in preventing or decreasing bleeding during or after a total hip arthroplasty using the direct anterior approach. Ligation of the pedicle of the vessel is a cumbersome, unnecessary procedure and can be replaced by electrocautery control of the branches off this artery that course through the surgical field.

Is Wound Complication a Deterrent to Lateral Extensile Approach in Calcaneus Fracture?

Introduction: The lateral extensile approach has been a widely accepted surgical approach in treatment of intraarticular calcaneal fracture. It provides good exposure for fixation by correcting the hindfoot varus, fracture reduction and restores calcaneal height but it has a high wound complication rate. Methods and materials: 36 intraarticular calcaneal fractures (Sanders II, III and IV) treated using the lateral extensile approach in 34 patients presenting between 2015 and 2018 were retrospectively reviewed. Wound complication in the early stage (day 1 to day 3), intermediate (2 weeks) and late (6 weeks) were documented. Results: We found early (Day 1 - Day 3) infection rate of 5.6%, intermediate (2 weeks) at 17.6% and late wound complication (6 weeks) at 2.9%. Conclusion: Lateral expansile approach is a reliable surgical exposure for fracture reduction of calcaneal fractures with acceptable wound related complication rate. Minimally invasive techniques and the sinus tarsi approach are being used for less comminuted fractures, but those techniques are technically more demanding. Smoking, long duration of surgery and soft tissue handling also play a role in increasing wound complication rates.

MicroRNA expression in animal models of amyotrophic lateral sclerosis and potential therapeutic approaches

A review of recent animal models of amyotrophic lateral sclerosis showed a large number of mi RNAs had altered levels of expression in the brain and spinal cord,motor neurons of spinal cord and brainstem,and hypoglossal,facial,and red motor nuclei and were mostly upregulated.Among the mi RNAs found to be upregulated in two of the studies were mi R-21,mi R-155,mi R-125 b,mi R-146 a,mi R-124,mi R-9,and mi R-19 b,while those downregulated in two of the studies included mi R-146 a,mi R-29,mi R-9,and mi R-125 b.A change of direction in mi RNA expression occurred in some tissues when compared(e.g.,mi R-29 b-3 p in cerebellum and spinal cord of wobbler mice at 40 days),or at different disease stages(e.g.,mi R-200 a in spinal cord of SOD1(G93 A)mice at 95 days vs.108 and 112 days).In the animal models,suppression of mi R-129-5 p resulted in increased lifespan,improved muscle strength,reduced neuromuscular junction degeneration,and tended to improve motor neuron survival in the SOD1(G93 A)mouse model.Suppression of mi R-155 was also associated with increased lifespan,while lowering of mi R-29 a tended to improve lifespan in males and increase muscle strength in SOD1(G93 A)mice.Overexpression of members of mi R-17~92 cluster improved motor neuron survival in SOD1(G93 A)mice.Treatment with an artificial mi RNA designed to target h SOD1 increased lifespan and improved muscle strength in SOD1(G93 A)animals.Further studies with animal models of amyotrophic lateral sclerosis are warranted to validate these findings and identify specific mi RNAs whose suppression or directed against h SOD1 results in increased lifespan,improved muscle strength,reduced neuromuscular junction degeneration,and improved motor neuron survival in SOD1(G93 A)animals.

Exclusive endoscopic transcanal approach to lateral skull base lesions:Institutional experience of 3 cases

Introduction:Majority of petrous bone and lateral skull base pathologies are benign in nature.The complex anatomy usually warrants an extensive approach with associated morbidity.Case summary:Two cases of petrous bone cholesteatoma(1 congenital cholesteatoma with facial palsy and 1 acquired cholesteatoma)and a case of glomus tympanicum were treated with exclusive endoscopic transcanal approach.The cases of petrous cholesteatoma were addressed with trans-promontorial and infra-cochlear approaches.The mean operative time was approximately 140 min.No CSF otorrhoea was noticed in the post-operative period.The average period of hospital stay was 3.7 days.Conclusion:In the subset of cases with limited benign disease an endoscopic trans-canal approach is a better alternative to an external approach.It decreases operative time,blood loss,chance of meningitis,morbidity and hospital stay.The lack of depth perception is a major hurdle which can be come over by experience in endoscopic middle ear surgery.This approach can create direct access to cochlea/petrous apex/internal auditory canal(IAC)/Supra-geniculate ganglion region.

Lateral epicondyle osteotomy approach for coronal shear fractures of the distal humerus:Report of three cases and review of the literature

BACKGROUND Coronal shear fractures of the distal humerus are rare injuries and are technically challenging to manage.Open reduction and internal fixation(ORIF)has become the preferred treatment because it provides anatomical reduction,stable internal fixation,and early motion,but the optimal surgical approach remains controversial.CASE SUMMARY We report three cases of coronal shear fractures of the distal humerus treated successfully by ORIF via a novel surgical approach,in which lateral epicondyle osteotomy was performed based on the extended lateral approach.We named the novel surgical approach the lateral epicondyle osteotomy approach.All patients underwent surgical treatment and were discharged successfully.All patients had excellent functional results according to the Mayo elbow performance score.The average range of motion was 118°in flexion/extension and 172°in pronation/supination.Only case 2 had a complication,which was implant prolapse.CONCLUSION We demonstrated that the lateral epicondyle osteotomy approach in ORIF is effective and safe for coronal shear fractures of the distal humerus.

Treatment of Single Level Lumbar Spondylolisthesis with Lumbar Interbody Fusion via Oblique Lateral Approach (OLIF)

Objectives: To investigate the effect of lumbar interbody fusion via the oblique lateral approach (OLIF) in the treatment of single level lumbar spondylolisthesis. Methods: Retrospective analysis was made on 32 cases of single level lumbar spondylolisthesis treated by lumbar interbody fusion via the oblique lateral approach from July 2020 to July 2021. 14 males and 18 females;the age was (66.5 ± 11.5) years (55 - 82 years). 1) The operation time, intraoperative blood loss and complications were recorded;2) the scores of visual analog scale. VAS and Oswestry disability index (ODI) of low back pain and lower limb pain were collected before operation and at the last follow-up;by observing the imaging data, the height of the intervertebral space, the anterior convex angle of the intervertebral space, the anterior convex angle of the lumbar spine, the sagittal diameter of the dural sac and the spondylolisthesis were measured. Results: All patients successfully completed the operation, the average operation time was (103.9 ± 21.1) min, the average intraoperative bleeding volume was (72.3 ± 16.4) ml. There was no vascular injury during the operation, no infection occurred in all surgical incisions, and Class I/A healing was achieved. The VAS scores of low back pain and leg pain before operation and at the last follow-up were lower than those before operation, and the difference was statistically significant (P < 0.05);the ODI at the last follow-up was lower than that before operation, and the difference was statistically significant (P < 0.05). At the last follow-up, the height of intervertebral space, the height of intervertebral foramen and the sagittal diameter of dural sac were greater than those before operation, with statistically significant differences (P < 0.05);the spondylolisthesis rate at the last follow-up was lower than that before operation, with a statistically significant difference (P < 0.05). Left thigh surface numbness occurred in 2 cases (6.3%) and disappeared after 1 week;Hip flexion weakness occurred in 1 case (0.03%), which recovered after 12 days;there were no complications such as retroperitoneal hematoma, ureteral injury, retrograde ejaculation, intestinal and lumbar plexus injury. Conclusion: The early clinical effect of OLIF in the treatment of single level lumbar spondylolisthesis is significant. This surgical method is minimally invasive, safe and effective, which can significantly reduce the amount of intraoperative bleeding and reduce the risk of postoperative complications. Its main working principle is to make the annulus fibrosus, posterior longitudinal ligament and ligamentum flavum shrink and recover the height of the intervertebral space through decompression, loosening and stretching of the intervertebral space, so as to achieve the reduction of the slipped vertebral body, increase the height of the intervertebral foramen Enlarge the spinal canal volume and eliminate dynamic compression to play an indirect decompression role, improve the symptoms of low back and leg pain, and reconstruct the stability of the spine through interbody fusion.

Surgical treatment of the thoracic and thoracolumbar disc herniations through the posterior far lateral approach

Objective To evaluate the feasibility,safety and efficacy of surgical treatment of the thoracic and thoracolumbar disc herniations through the posterior far lateral approach.Methods From April 2005 to June 2010,24 consecutive patients

Intention Formation Process for the Use of Tracheostomy and Invasive Ventilation in Patients with Amyotrophic Lateral Sclerosis

Background: Little is known about the intention formation process regarding the use of tracheostomy and invasive ventilation (TIV) in amyotrophic lateral sclerosis (ALS) patients in the course of disease progression. Objective: To clarify the intention formation process in the use of TIV in ALS patients for the purpose of providing decision-making support. Methods: We conducted a follow-up study of 14 patients using semi-structured interviews, participant observation, and medical records review. Results: The patients’ various intentions regarding the use of TIV were formed as their symptoms progressed (e.g., declining motor, swallowing, and respiratory functions). Other factors influencing their decision were their considerations, such as their ability to communicate after receiving TIV treatment, the degree of support they would receive from professionals after TIV treatment, palliative care for physical distress, value of life after TIV treatment, and to what degree they would be a burden on their families. Conclusion: Patients’ intentions regarding the use of TIV were diverse and changeable. The decision of whether or not to use TIV was made out of conviction as well as considering individual experiences of symptom progression and quality of life after TIV use.

Caudal approach to pure laparoscopic posterior sectionectomy under the laparoscopy-specific view

AIM:To study our novel caudal approach laparoscopic posterior-sectionectomy with parenchymal transection prior to mobilization under laparoscopy-specific view.METHODS:Points of the procedure are:(1) Patients are put in left lateral position and posterior sector is not mobilized;(2) Glissonian pedicle of the sector is encircled and clamped extra-hepatically and divided afterward during the transection;(3) Dissection of inferior vena cava(IVC) anterior wall behind the liver is started from caudal.Simultaneously,liver transection is performed to search right hepatic vein(RHV) from caudal;(4) Liver transection proceeds to the bifurcation of the vessels from caudal to cranial,exposing the surfaces of IVC and RHV.Since the remnant liver sinks down,the cutting surface is well-opend;and(5) After the completion of transection,dissection of the resected liver from retroperitoneum is easily performed using the gravity.This approach was performed for a 63 years old woman with liver metastasis close to RHV.RESULTS:RHV exposure is required for R0 resection of the lesion.Although the cutting plane is horizontal in supine position and the gravity obstructs the exposure in the small subphrenic space,the use of specific characteristics of laparoscopic hepatectomy,such as the good vision for the dorsal part of the liver and IVC and facilitated dissection using the gravity with the patient positioning,made the complete RHV exposure during the liver transection easy to perform.The operation time was 341 min and operative blood loss was 1356 mL.Her postoperative hospital stay was uneventfull and she is well without any signs of recurrences 14 mo after surgery.CONCLUSION:The new procedure is feasible and useful for the patients with tumors close to RHV and the need of the exposure of RHV.

Application of p-y approach in analyzing pile foundations in frozen ground overlying liquefiable soils

Two major earthquakes in Alaska, namely the 1964 Great Alaska Earthquake and the 2002 Denali Earthquake, occurred in winter seasons when the ground crust was frozen. None of the then-existing foundation types was able to withstand the force from the lateral spreading of frozen crust. This paper presents results from the analysis of pile foundations in frozen ground overlying lique- fiable soil utilizing the Beam-on-Nonlinear-Winlder-Foundation （BNWF） （or p-y approach）. P-multipliers were applied on tradi- tional sandy soil p-y curves to simulate soil strength degradation during liquefaction. Frozen soil p-y curves were constructed based on a model proposed in a recent study and the frozen soil mechanical properties obtained from testing of naturally frozen soils. Pile response results from the p-y approach were presented along with those from fluid-solid coupled Finite Element （FE） modeling for comparison purpose. Finally, the sensitivity of pile response to frozen soil parameters was investigated and a brief discussion is presented.

Swinging Eyelid Procedure: An Useful Approach for Reduction of Zygomaticomalar Fracture

The swinging eyelid procedure is a versatile technique to approach orbital and periorbital surgical fields with less visible scar. Although mainly used in orbital surgeries, this procedure can also be used to expose the zygomatic arch and periorbital areas. The swinging eyelid procedure, therefore, enables appropriate reduction of zygomaticomalar fracture under direct visualization. We used this technique for a 27 years old man with a displaced zygomaticomalar fracture that pushed on the lateral rectus muscle. Good functional and cosmetic results were obtained postoperatively without ocular motility impairment.

Anteromedial Plating of Humerus—An Easier and Effective Approach

Plate osteosynthesis of humeral shaft fractures is an established surgical procedure. Iatrogenic radial nerve palsy appears to be common complication in treating these fractures. A case series of 20 fracture shafts of humerus were treated with anteromedial plating through anterolateral approach. There was no radial nerve palsy in any of the cases and all achieved fracture union.

侧颈低领切口入路在甲状腺手术中的应用

目的探讨侧颈低领切口入路在甲状腺手术中应用的可行性和优点。方法选取2021年1月至2022年1月宿州市立医院甲状腺肿瘤病人80例,依据手术治疗方式不同分为观察组与对照组,各40例。观察组行侧颈区低领切口入路甲状腺切除术,对照组行传统颈前低领切口中间入路甲状腺切除术。比较两组各临床指标、术后并发症、嗓音和美容满意度的差异。结果两组病人年龄、性别、病理类型及手术方式等一般资料对比差异无统计学意义(P>0.05)。观察组在手术时间、手术出血量、术后拔管时间及术后第3天血清钙值与对照组相比差异无统计学意义(P>0.05),观察组术后疼痛VAS评分[(3.82±0.43)分比(5.55±0.50)分]及围手术期总手术并发症的发生率(7.5%比30.0%)低于对照组,差异有统计学意义(P<0.05),观察组术后嗓音满意度及美容满意度优于对照组,差异有统计学意义(P<0.05)。结论在甲状腺手术中经侧颈低领切口入路,可以减缓术后颈前不适感,手术并发症发生率低,手术切口隐蔽,病人术后嗓音满意度及美容满意度高,可行性好,值得临床推广。

跗骨窦小切口与经外侧“L”形切口术对跟骨骨折患者的疗效

目的 比较跗骨窦小切口与经外侧“L”形切口术治疗跟骨骨折的疗效及对足功能恢复情况的影响。方法 研究对象选取2020年10月至2022年10月收治的跟骨骨折患者88例,按照手术方法分为对照组43例,研究组45例,对照组采用经外侧“L”形切口术,研究组采用跗骨窦小切口手术。检测比较2组手术情况及并发症发生情况、足功能、跟骨解剖结构、骨代谢、炎性因子、应激反应指标水平。结果 与对照组比较,研究组术后引流量、术中出血量较少,手术、住院及骨折愈合时间较短,并发症发生率较低(P<0.05)。与术前比较,术后3个月2组AOFAS评分、Bohler角、Gissane角、跟骨长度、跟骨高度、P1NP、骨特异性碱性磷酸酶(BALP)水平升高,且研究组高于对照组,抗酒石酸酸性磷酸酶(TRAP)、环磷酰胺(CTX)水平降低,且研究组低于对照组(P<0.05)。与术前比较,术后3 d 2组CRP、IL-6、MDA水平升高,但研究组低于对照组,SOD水平降低,但研究组高于对照组(P<0.05)。结论 跗骨窦小切口术治疗跟骨骨折效果理想,可减少手术创伤,减轻炎症及应激反应,且可促进术后足功能、骨代谢恢复,并发症少。

显微镜下经侧裂入路与颞中回造瘘入路血肿清除术治疗脑出血的临床效果

目的:探究显微镜下经侧裂入路与颞中回造瘘入路血肿清除术治疗脑出血的效果。方法:选择2021年1月—2023年1月建瓯市立医院收治86例脑出血患者,应用随机数表法将其分为对照组(颞中回造瘘入路)及观察组(显微镜下经侧裂入路),各43例。比较两组手术时间、出血量、下床活动时间、血肿清除率、炎症因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)、C反应蛋白(CRP)]、神经因子[神经元特异性烯醇化酶(NSE)、神经营养因子(NF)、S100B蛋白、D-二聚体]、应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)、脂质过氧化产物(LPO)、谷胱甘肽过氧化物酶(GSH-Px)]、预后情况。结果:观察组手术时间、出血量、下床活动时间、血肿清除率优于对照组,差异有统计学意义(P<0.05)。术前,两组IL-6、TNF-α、PCT、CRP水平比较,差异无统计学意义(P>0.05);术后,两组IL-6、TNF-α、PCT、CRP水平均升高,但观察组低于对照组,差异有统计学意义(P<0.05)。术前,两组NSE、NF、S100B蛋白、D-二聚体水平比较,差异无统计学意义(P>0.05);术后,两组NSE、NF、S100B蛋白、D-二聚体水平均降低,观察组低于对照组,差异有统计学意义(P<0.05)。术前,两组MDA、SOD、LPO、GSH-Px水平比较,差异无统计学意义(P>0.05);术后,两组MDA、SOD、LPO、GSH-Px水平均升高,但观察组MDA、LPO水平低于对照组,SOD、GSH-Px水平高于对照组,差异有统计学意义(P<0.05)。对照组预后良好率低于观察组,差异有统计学意义(P<0.05);两组死亡率比较,差异无统计学意义(P>0.05)。结论:显微镜下经侧裂入路血肿清除术治疗脑出血,可提升血肿清除率,减轻炎症反应、神经功能损伤,利于患者预后恢复。

颈侧方入路手术在治疗原发性甲状旁腺功能亢进症中的临床研究

目的探讨颈侧方切口经胸锁乳突肌肌间入路手术(SMIA)在治疗原发性甲状旁腺功能亢进症中的可行性及其临床效果。方法回顾性分析2019年1月-2022年6月浙江大学医学院附属第一医院行单侧甲状旁腺手术的64例原发性甲状旁腺功能亢进症患者的临床资料,根据手术切口及入路分为颈侧方切口SMIA组及正中切口颈白线入路组(LACA组)。比较两组间临床特征、手术相关结果及术后颈前区功能的差异。采用EQ-5D-5L量表评估术后颈部不适主观感受,Hollander伤口评估量表评定切口愈合情况。结果两组患者在年龄、性别、术中出血、手术前后甲状旁腺激素及血钙水平等方面均无统计学差异(P>0.05)。SMIA组平均手术时间[(39.77±5.69)min]明显少于LACA组[(54.41±4.66)min]。术后1月及12月,两组在颈前区功能保护方面有统计学差异(1月:84.67±3.74 vs.79.47±5.38,P<0.001;12月:93.80±2.52 vs.89.94±2.39,P<0.001),且SMIA组均优于LACA组;SMIA组术后6月及12月的Hollander切口评估量表得分优于LACA组,差异有统计学意义(6月:1.93±0.58 vs.2.41±0.66,P=0.003;12月:1.03±0.67 vs.1.74±0.62,P<0.001)。结论颈侧方切口经胸锁乳突肌肌间入路行甲状旁腺切除是简便、安全及有效的手术方式,较于传统切口更易寻找甲状旁腺病变,缩短手术时间,且对颈前区功能保护的作用优势明显。

经外侧裂-岛叶入路显微手术与经额叶入路血肿清除术对高血压性基底节区脑出血患者神经功能损伤的影响

目的探讨高血压性基底节区脑出血患者应用经外侧裂-岛叶入路显微手术与经额叶入路血肿清除术对神经功能损伤的影响。方法回顾性分析广西河池市人民医院2019-01—2022-12收治的121例高血压性基底节区脑出血患者的临床资料,分为A组61例(经外侧裂-岛叶入路显微手术)与B组60例(经额叶入路血肿清除术)。比较2组患者神经功能损伤指标水平及其他相关指标。结果2组患者手术时间、住院时间比较无统计学差异(P>0.05);A组术后意识恢复时间(5.11±0.89)h,短于B组的(6.03±0.73)h,术中出血量(37.21±4.27)mL,少于B组的(39.82±4.41)mL,48 h血肿清除率(90.06±3.44)%,大于B组的(88.69±4.02)%,差异均有统计学意义(t=6.178、3.299、2.017,P<0.05);A组临床总有效率98.36%(60/61),高于B组的86.67%(52/60)(χ^(2)=4.460,P=0.035);术后3 d,2组患者S-100β蛋白(S-100β)、神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)水平均较术前下降,且A组低于B组(P<0.05);2组患者术后并发症发生率比较无统计学差异(P>0.05);术后3个月,A组格拉斯哥预后量表(GOS)评分高于B组(P<0.05);2组患者术后6个月GOS评分比较无明显差异(P>0.05)。结论相比于经额叶入路血肿清除术,应用经外侧裂-岛叶入路显微手术可更有效促进高血压性基底节区脑出血患者神经功能损伤恢复,减少术中出血量,提高血肿清除率及临床疗效,且能够显著改善患者近期预后。

探讨额外侧锁孔入路与翼点入路夹闭术在前交通动脉瘤的应用效果

目的探讨于前交通动脉瘤中分别应用额外侧锁孔入路和翼点入路夹闭术的临床效果。方法回顾性选择2020年3月-2023年5月邳州市中医院行开颅动脉瘤夹闭手术的62例前交通动脉瘤破裂患者的临床资料,根据手术入路方式将其分为对照组(n=31)和观察组(n=31)。对照组行翼点入路开颅治疗,观察组行额外侧锁孔入路开颅治疗。比较两组手术情况、术后日常生活能力、神经及认知功能改善程度,统计两组并发症发生情况。结果治疗后,观察组患者的术中出血量(260.16±75.27)mL少于对照组,手术时间(206.78±28.07)min及住院时间(7.34±1.84)d均短于对照组,差异有统计学意义(t=7.578、7.405、7.404,P均<0.05);观察组术中动脉瘤破裂出血率、脑直回切除率均比对照组低,观察组神经功能缺损评分、日常生活能力评分优于对照组,观察组认知功能评分高于对照组,差异有统计学意义(P均<0.05);治疗后,两组患者出现术后新增颅内出血、短暂性缺血、感染、神经症状及脑积水等并发症的总发生率比较,差异无统计学意义(P>0.05)。结论前交通动脉瘤患者分别接受额外侧锁孔入路术和翼点入路夹闭术治疗均具有一定效果,但额外侧锁孔入路术的效果更理想,在改善神经及认知功能、日常生活能力方面存在显著优势,且不会产生严重并发症。

经颈侧方入路甲状腺小切口手术与传统甲状腺手术治疗单侧甲状腺肿瘤的临床效果

目的:分析比较经颈侧方入路甲状腺小切口手术与传统甲状腺手术治疗单侧甲状腺肿瘤的临床效果。方法:选取2022年1月—2023年12月甘肃省肿瘤医院收治的120例单侧甲状腺肿瘤患者为研究对象。根据样本纳入时间分组,其中2022年1—12月60例患者为参照组,实施传统甲状腺手术治疗;2023年1—12月60例患者为研究组,实施经颈侧方入路甲状腺小切口手术治疗。对比两组患者相关治疗指标、疼痛程度、并发症发生情况及术后创面美观满意度。结果:研究组患者切口长度短于参照组,术中出血量少于参照组,手术时间及住院时间短于参照组,差异有统计学意义(P<0.05);研究组患者术后1 d、3 d疼痛程度评分均低于参照组,差异有统计学意义(P<0.05);研究组并发症发生低于参照组,差异有统计学意义(P<0.05);研究组患者术后创面美观满意度总评分高于参照组,差异有统计学意义(P<0.05)。结论:与传统甲状腺手术治疗相比,对单侧甲状腺肿瘤患者实施经颈侧方入路甲状腺小切口手术治疗,可取得更为理想的疗效,有效缩短手术时间及术中出血量等,减轻患者应激反应及疼痛程度,进而可有效减少相关并发症发生,且术后创面美观度相对较高。

不同入路内固定术对胫骨干骨折患者术后功能恢复及并发症的影响

目的分析比较半伸膝位髌旁外侧入路和髌下正中入路内固定术对胫骨干骨折患者术后功能恢复及并发症的影响。方法纳入安阳地区医院2020年1月至2023年1月收治的60例胫骨干骨折患者,采用随机数字表法将患者分成A组和B组,A组接受半伸膝位髌旁外侧入路内固定术治疗,B组接受髌下正中入路内固定术治疗,每组30例。手术后随访5个月,了解患者的骨折愈合情况。比较A组与B组患者手术时间、骨折愈合时间、出血量等手术相关指标;术前及术后5个月时A组与B组患者膝关节功能情况由特种外科医院(HSS)膝关节评分进行评估;观察并记录两组患者手术后并发症发生情况(软组织损伤、反应性水肿、畸形愈合)。结果A组与B组患者手术时间及术前HHS评分比较,差异无统计学意义(P>0.05);与B组相比较,A组住院时间、骨折愈合时间均较短,出血量较少,差异有统计学意义(P<0.05)。术后5个月,A组与B组HSS评分均较术前升高,且A组高于B组,差异有统计学意义(P<0.05)。相较于B组,A组术后并发症总发生率更低,差异有统计学意义(P<0.05)。结论与髌下正中入路比较,半伸膝位髌旁外侧入路可降低胫骨干骨折患者术后并发症发生风险,且膝关节功能恢复效果更为显著。