BACKGROUND Minimally invasive surgery(MIS)and craniotomy(CI)are the current treatments for spontaneous supratentorial cerebral haemorrhage(SSTICH).AIM To compare the efficacy and safety of MIS and CI for the treatment...BACKGROUND Minimally invasive surgery(MIS)and craniotomy(CI)are the current treatments for spontaneous supratentorial cerebral haemorrhage(SSTICH).AIM To compare the efficacy and safety of MIS and CI for the treatment of SSTICH.METHODS Clinical and imaging data of 557 consecutive patients with SSTICH who underwent MIS or CI between January 2017 and December 2022 were retrospectively analysed.The patients were divided into two subgroups:The MIS group and CI group.Propensity score matching was performed to minimise case selection bias.The primary outcome was a dichotomous prognostic(favourable or unfavourable)outcome based on the modified Rankin Scale(mRS)score at 3 months;an mRS score of 0–2 was considered favourable.RESULTS In both conventional statistical and binary logistic regression analyses,the MIS group had a better outcome.The outcome of propensity score matching was unexpected(odds ratio:0.582;95%CI:0.281–1.204;P=0.144),which indicated that,after excluding the interference of each confounder,different surgical modalities were more effective,and there was no significant difference in their prognosis.CONCLUSION Deciding between MIS and CI should be made based on the individual patient,considering the hematoma size,degree of midline shift,cerebral swelling,and preoperative Glasgow Coma Scale score.展开更多
AIM To analyze how various implants placement variables affect sacroiliac(SI) joint range of motion. METHODS An experimentally validated finite element model of the lumbar spine and pelvis was used to simulate a fusio...AIM To analyze how various implants placement variables affect sacroiliac(SI) joint range of motion. METHODS An experimentally validated finite element model of the lumbar spine and pelvis was used to simulate a fusion of the SI joint using various placement configurations of triangular implants(iF use Implant System~?). Placement configurations were varied by changing implant orientation, superior implant length, and number of implants. The range of motion of the SI joint was calculated using a constant moment of 10 N-m with a follower load of 400 N. The changes in motion were compared between the treatment groups to assess how the different variables affected the overall motion of the SI joint. RESULTS Transarticular placement of 3 implants with superior implants that end in the middle of the sacrum resulted in the greatest reduction in range of motion(flexion/extension = 73%, lateral bending = 42%, axial rotation = 72%). The range of motions of the SI joints were reduced with use of transarticular orientation(9%-18%) when compared with an inline orientation. The use of a superior implant that ended mid-sacrum resulted in median reductions of(8%-14%) when compared with a superior implant that ended in the middle of the ala. Reducing the number of implants, resulted in increased SI joint range of motions for the 1 and 2 implant models of 29%-133% and 2%-39%, respectively,when compared with the 3 implant model.CONCLUSION Using a validated finite element model we demonstrated that placement of 3 implants across the SI joint using a transarticular orientation with superior implant reaching the sacral midline resulted in the most stable construct. Additional clinical studies may be required to confirm these results.展开更多
BACKGROUND Superior vena cava(SVC)aneurysms are a relatively uncommon disease that has not been widely reported.The conventional surgical approach for treating SVC aneurysms includes open thoracotomy and mid-sternotom...BACKGROUND Superior vena cava(SVC)aneurysms are a relatively uncommon disease that has not been widely reported.The conventional surgical approach for treating SVC aneurysms includes open thoracotomy and mid-sternotomy.However,in this case,the aneurysm could be safely resected by thoracoscopic simultaneous lateral and subxiphoid access methods.CASE SUMMARY A 58-year-old male presented with intermittent chest pain and persistent discomfort in the chest area.A chest computed tomography scan revealed a 6.2 cm aneurysm in the left innominate vein and SVC junction.For surgical resection,simultaneous lateral and subxiphoid access were planned to achieve optimal proximal and distal aneurysm control.The approach site was 1 cm below the xiphoid process,the fifth mid-axillary line and the seventh anterior axillary line on the right side.The aneurysm was resected using a stapler.The patient was discharged on the third day after chest tube removal on the second postoperative day with no particular issues.CONCLUSION Aneurysms located within the mediastinum can be accessed through thoracoscopic approach without open surgery and safely resected using vascular staples.展开更多
Background It is well accepted that the minimally invasive surgery （MIS） for total hip arthroplasty （THA） should combine with less or no muscle damage and is different from mini-incision technique and MIS should h...Background It is well accepted that the minimally invasive surgery （MIS） for total hip arthroplasty （THA） should combine with less or no muscle damage and is different from mini-incision technique and MIS should have better outcomes than mini-incision surgery. The aim of current analysis was to apply an explicitly defined sub-group analysis to confirm whether this hypothesis is true. Methods A computerized literature search was applied to find any data concerning MIS or mini-incision THAs. A multistage screening was then performed to identify randomized studies fulfilling the inclusive criteria for the analysis. The data were extracted, and sub-group analyses of MIS or mini-incision surgery for different kinds of outcomes were carried out. The P（sub） value for difference between MIS sub-group and mini-incision sub-group was also calculated. Results Eleven studies that fulfilling the inclusion criteria were included, with 472 cases in the study group （MIS or mini-incision） and 492 cases in the conventional group. The overall analysis showed the study group would achieve less surgical duration （P=0.037）, intraoperative blood （P 〈0.001） and incision length （P 〈0.001） than conventional group. The difference between sub-groups showed, the MIS would achieve shorter incision length （P（sub） 〈0.05） and bigger cup abduction angle （P（sub） 〈0.05）, and cause more blood loss （P （sub） 〈0.05） than mini-incision technique. Other indexes were comparable between the two sub-groups. Conclusions Though further high quality studies are still needed, the result of current analysis offered an initial conclusion that MIS THA failed to achieve a better clinical outcome than mini-incision technique. The exact definition of MIS still needs to be improved.展开更多
目的:对国内外有关腰椎间盘突出症微创治疗的相关文献进行计量学分析,并总结其研究现状、热点与发展趋势。以期为相关学者和医务工作者了解该领域的研究热点和趋势提供有用的参考。方法:以腰椎间盘突出症微创治疗以及相关词汇为检索主题...目的:对国内外有关腰椎间盘突出症微创治疗的相关文献进行计量学分析,并总结其研究现状、热点与发展趋势。以期为相关学者和医务工作者了解该领域的研究热点和趋势提供有用的参考。方法:以腰椎间盘突出症微创治疗以及相关词汇为检索主题,检索中国知网(CNKI)和Web of Science(WOS)核心合集数据库。运用CiteSpace和VOSviewer软件对2013—2023年收录的相关文献进行知识图谱的可视化分析,对关键词、突现词和时间趋势图谱等进行数据分析。结果:共纳入1065篇来自CNKI的文献和602篇来自WOS的文献。通过可视化分析后于CNKI可得腰椎间盘突出症和经皮椎间孔镜手术等10个聚类结果,在WOS中可得危险因素、腰椎间盘突出症和椎管狭窄等9个聚类结果。结论:CNKI中研究热点主要集中在腰椎功能、复发率、经椎板孔入路、临床疗效、疼痛、并发症等关键词,而在WOS中研究热点主要集中在并发症、复发率、治疗结果、经椎间孔入路、疼痛、学习曲线等关键词。近两年在CNKI中研究热点主要集中在疼痛和经皮椎间孔镜椎间盘切除术等关键词,而在WOS中主要集中在并发症和复发率等关键词。目前国内外学者对于该领域的研究热点既有重叠也有不同的关注方向。展开更多
Background Transforaminal lumbar interbody fusion （TLIF） through a minimally invasive approach （mTLIF） was introduced to reduce soft tissue injury and speed recovery. Studies with small numbers of patients have be...Background Transforaminal lumbar interbody fusion （TLIF） through a minimally invasive approach （mTLIF） was introduced to reduce soft tissue injury and speed recovery. Studies with small numbers of patients have been carried out, comparing mTLIF with traditional open TLIF （oTLIF）, but inconsistent outcomes were reported.展开更多
As a novel minimally invasive technique,percutaneous endoscopic transforaminal lumbar interbody fusion(PETLIF)has been widely used in the treatment of lumbar degenerative diseases.The purpose of this study was to anal...As a novel minimally invasive technique,percutaneous endoscopic transforaminal lumbar interbody fusion(PETLIF)has been widely used in the treatment of lumbar degenerative diseases.The purpose of this study was to analyze these two operation types’biomechanical performances of PE-TLIF and traditional minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)using the finite element(FE)method.The intact FE models of L4-L5 were established and validated based on the CT images.On this basis,the FE models of MIS-TLIF and PETLIF were established and analyzed.It is demonstrated that for lumbar interbody fusion with the oblique asymmetrically implanted cage under bilateral pedicle screws and rods fixation,such as MIS-TLIF and PE-TLIF,different degrees of articular process resection have no significant effect on the cage subsidence,and the surgical segment can achieve similar stability.In addition,the maximum stress of the L4 inferior endplate of MIS-TLIF and PE-TLIF is greater than that of the L5 superior endplate,which indicates that MIS-TLIF and PE-TLIF can cause cage subsidence in the L4 inferior endplate.展开更多
目的比较机器人与胸腔镜手术治疗前纵隔肿物的近期临床疗效,探讨机器人辅助前纵隔肿物切除的优势。方法采用回顾性队列研究的方法,收集2016年10月至2018年9月陆军军医大学(第三军医大学)大坪医院收治的111例行微创前纵隔肿物切除手术患...目的比较机器人与胸腔镜手术治疗前纵隔肿物的近期临床疗效,探讨机器人辅助前纵隔肿物切除的优势。方法采用回顾性队列研究的方法,收集2016年10月至2018年9月陆军军医大学(第三军医大学)大坪医院收治的111例行微创前纵隔肿物切除手术患者的临床病理资料。111例患者中,56例行达芬奇机器人手术,设为机器人组;55例行电视胸腔镜手术,设为胸腔镜组。对两组患者的病变直径、直径≥5 cm例数、手术时间、术中失血量、中转开胸率、术后引流量、术后胸引天数、联合扩大切除例数、术后住院日、并发症发生率和住院费用进行比较分析。结果全组患者均顺利完成手术,无围术期死亡。机器人组对比胸腔镜组,在病变直径[(4.6±2.2)vs(3.3±1.6)cm,P=0.002]、直径≥5 cm比例(22/56 vs 11/55,P=0.026)、术中失血量[(54.1±51.6)vs(89.9±91.0) mL,P=0.013]、联合扩大切除率(8/56 vs 1/55,P=0.04)、住院费用[(7.5±2.0)vs(4.2±1.4)万元,P<0.001]方面差异有统计学意义;两组在手术时间、中转开胸率、术后引流量、术后胸引天数、术后住院日、并发症发生率上差异均无统计学意义(P>0.05)。结论机器人辅助前纵隔肿物切除术安全可行,但费用较高;与胸腔镜手术比较出血更少,在大血管周围和深部狭小空间内操作有一定优势,对直径较大或有明显外侵需联合大血管切除的前纵隔肿瘤更为适用。展开更多
基金Supported by The Technology Innovation Guidance Programme of Science and Technology,Department of Hunan Province,No.2020SK51708The Scientific Research Programme of Hunan Provincial Health Commission,No.B2019110 and No.20201959The Hunan Nature Science Foundation,No.S2023JJMSXM1898.
文摘BACKGROUND Minimally invasive surgery(MIS)and craniotomy(CI)are the current treatments for spontaneous supratentorial cerebral haemorrhage(SSTICH).AIM To compare the efficacy and safety of MIS and CI for the treatment of SSTICH.METHODS Clinical and imaging data of 557 consecutive patients with SSTICH who underwent MIS or CI between January 2017 and December 2022 were retrospectively analysed.The patients were divided into two subgroups:The MIS group and CI group.Propensity score matching was performed to minimise case selection bias.The primary outcome was a dichotomous prognostic(favourable or unfavourable)outcome based on the modified Rankin Scale(mRS)score at 3 months;an mRS score of 0–2 was considered favourable.RESULTS In both conventional statistical and binary logistic regression analyses,the MIS group had a better outcome.The outcome of propensity score matching was unexpected(odds ratio:0.582;95%CI:0.281–1.204;P=0.144),which indicated that,after excluding the interference of each confounder,different surgical modalities were more effective,and there was no significant difference in their prognosis.CONCLUSION Deciding between MIS and CI should be made based on the individual patient,considering the hematoma size,degree of midline shift,cerebral swelling,and preoperative Glasgow Coma Scale score.
文摘AIM To analyze how various implants placement variables affect sacroiliac(SI) joint range of motion. METHODS An experimentally validated finite element model of the lumbar spine and pelvis was used to simulate a fusion of the SI joint using various placement configurations of triangular implants(iF use Implant System~?). Placement configurations were varied by changing implant orientation, superior implant length, and number of implants. The range of motion of the SI joint was calculated using a constant moment of 10 N-m with a follower load of 400 N. The changes in motion were compared between the treatment groups to assess how the different variables affected the overall motion of the SI joint. RESULTS Transarticular placement of 3 implants with superior implants that end in the middle of the sacrum resulted in the greatest reduction in range of motion(flexion/extension = 73%, lateral bending = 42%, axial rotation = 72%). The range of motions of the SI joints were reduced with use of transarticular orientation(9%-18%) when compared with an inline orientation. The use of a superior implant that ended mid-sacrum resulted in median reductions of(8%-14%) when compared with a superior implant that ended in the middle of the ala. Reducing the number of implants, resulted in increased SI joint range of motions for the 1 and 2 implant models of 29%-133% and 2%-39%, respectively,when compared with the 3 implant model.CONCLUSION Using a validated finite element model we demonstrated that placement of 3 implants across the SI joint using a transarticular orientation with superior implant reaching the sacral midline resulted in the most stable construct. Additional clinical studies may be required to confirm these results.
文摘BACKGROUND Superior vena cava(SVC)aneurysms are a relatively uncommon disease that has not been widely reported.The conventional surgical approach for treating SVC aneurysms includes open thoracotomy and mid-sternotomy.However,in this case,the aneurysm could be safely resected by thoracoscopic simultaneous lateral and subxiphoid access methods.CASE SUMMARY A 58-year-old male presented with intermittent chest pain and persistent discomfort in the chest area.A chest computed tomography scan revealed a 6.2 cm aneurysm in the left innominate vein and SVC junction.For surgical resection,simultaneous lateral and subxiphoid access were planned to achieve optimal proximal and distal aneurysm control.The approach site was 1 cm below the xiphoid process,the fifth mid-axillary line and the seventh anterior axillary line on the right side.The aneurysm was resected using a stapler.The patient was discharged on the third day after chest tube removal on the second postoperative day with no particular issues.CONCLUSION Aneurysms located within the mediastinum can be accessed through thoracoscopic approach without open surgery and safely resected using vascular staples.
文摘Background It is well accepted that the minimally invasive surgery （MIS） for total hip arthroplasty （THA） should combine with less or no muscle damage and is different from mini-incision technique and MIS should have better outcomes than mini-incision surgery. The aim of current analysis was to apply an explicitly defined sub-group analysis to confirm whether this hypothesis is true. Methods A computerized literature search was applied to find any data concerning MIS or mini-incision THAs. A multistage screening was then performed to identify randomized studies fulfilling the inclusive criteria for the analysis. The data were extracted, and sub-group analyses of MIS or mini-incision surgery for different kinds of outcomes were carried out. The P（sub） value for difference between MIS sub-group and mini-incision sub-group was also calculated. Results Eleven studies that fulfilling the inclusion criteria were included, with 472 cases in the study group （MIS or mini-incision） and 492 cases in the conventional group. The overall analysis showed the study group would achieve less surgical duration （P=0.037）, intraoperative blood （P 〈0.001） and incision length （P 〈0.001） than conventional group. The difference between sub-groups showed, the MIS would achieve shorter incision length （P（sub） 〈0.05） and bigger cup abduction angle （P（sub） 〈0.05）, and cause more blood loss （P （sub） 〈0.05） than mini-incision technique. Other indexes were comparable between the two sub-groups. Conclusions Though further high quality studies are still needed, the result of current analysis offered an initial conclusion that MIS THA failed to achieve a better clinical outcome than mini-incision technique. The exact definition of MIS still needs to be improved.
文摘目的:对国内外有关腰椎间盘突出症微创治疗的相关文献进行计量学分析,并总结其研究现状、热点与发展趋势。以期为相关学者和医务工作者了解该领域的研究热点和趋势提供有用的参考。方法:以腰椎间盘突出症微创治疗以及相关词汇为检索主题,检索中国知网(CNKI)和Web of Science(WOS)核心合集数据库。运用CiteSpace和VOSviewer软件对2013—2023年收录的相关文献进行知识图谱的可视化分析,对关键词、突现词和时间趋势图谱等进行数据分析。结果:共纳入1065篇来自CNKI的文献和602篇来自WOS的文献。通过可视化分析后于CNKI可得腰椎间盘突出症和经皮椎间孔镜手术等10个聚类结果,在WOS中可得危险因素、腰椎间盘突出症和椎管狭窄等9个聚类结果。结论:CNKI中研究热点主要集中在腰椎功能、复发率、经椎板孔入路、临床疗效、疼痛、并发症等关键词,而在WOS中研究热点主要集中在并发症、复发率、治疗结果、经椎间孔入路、疼痛、学习曲线等关键词。近两年在CNKI中研究热点主要集中在疼痛和经皮椎间孔镜椎间盘切除术等关键词,而在WOS中主要集中在并发症和复发率等关键词。目前国内外学者对于该领域的研究热点既有重叠也有不同的关注方向。
文摘Background Transforaminal lumbar interbody fusion （TLIF） through a minimally invasive approach （mTLIF） was introduced to reduce soft tissue injury and speed recovery. Studies with small numbers of patients have been carried out, comparing mTLIF with traditional open TLIF （oTLIF）, but inconsistent outcomes were reported.
基金the National Natural Science Foundation of China(No.11972242,11632013)China Postdoctoral Science Foundation(2020M680913)Shanxi Province Medical Science and Technology Innovation Team Construction Plan(2020TD13).
文摘As a novel minimally invasive technique,percutaneous endoscopic transforaminal lumbar interbody fusion(PETLIF)has been widely used in the treatment of lumbar degenerative diseases.The purpose of this study was to analyze these two operation types’biomechanical performances of PE-TLIF and traditional minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)using the finite element(FE)method.The intact FE models of L4-L5 were established and validated based on the CT images.On this basis,the FE models of MIS-TLIF and PETLIF were established and analyzed.It is demonstrated that for lumbar interbody fusion with the oblique asymmetrically implanted cage under bilateral pedicle screws and rods fixation,such as MIS-TLIF and PE-TLIF,different degrees of articular process resection have no significant effect on the cage subsidence,and the surgical segment can achieve similar stability.In addition,the maximum stress of the L4 inferior endplate of MIS-TLIF and PE-TLIF is greater than that of the L5 superior endplate,which indicates that MIS-TLIF and PE-TLIF can cause cage subsidence in the L4 inferior endplate.
文摘目的比较机器人与胸腔镜手术治疗前纵隔肿物的近期临床疗效,探讨机器人辅助前纵隔肿物切除的优势。方法采用回顾性队列研究的方法,收集2016年10月至2018年9月陆军军医大学(第三军医大学)大坪医院收治的111例行微创前纵隔肿物切除手术患者的临床病理资料。111例患者中,56例行达芬奇机器人手术,设为机器人组;55例行电视胸腔镜手术,设为胸腔镜组。对两组患者的病变直径、直径≥5 cm例数、手术时间、术中失血量、中转开胸率、术后引流量、术后胸引天数、联合扩大切除例数、术后住院日、并发症发生率和住院费用进行比较分析。结果全组患者均顺利完成手术,无围术期死亡。机器人组对比胸腔镜组,在病变直径[(4.6±2.2)vs(3.3±1.6)cm,P=0.002]、直径≥5 cm比例(22/56 vs 11/55,P=0.026)、术中失血量[(54.1±51.6)vs(89.9±91.0) mL,P=0.013]、联合扩大切除率(8/56 vs 1/55,P=0.04)、住院费用[(7.5±2.0)vs(4.2±1.4)万元,P<0.001]方面差异有统计学意义;两组在手术时间、中转开胸率、术后引流量、术后胸引天数、术后住院日、并发症发生率上差异均无统计学意义(P>0.05)。结论机器人辅助前纵隔肿物切除术安全可行,但费用较高;与胸腔镜手术比较出血更少,在大血管周围和深部狭小空间内操作有一定优势,对直径较大或有明显外侵需联合大血管切除的前纵隔肿瘤更为适用。
