This study aimed to introduce a novel mini-open pedicle screw fixation technique via Wiltse approach, and com- pared it with the traditional posterior open method. A total of 72 cases of single-segment thoracolumbar f...This study aimed to introduce a novel mini-open pedicle screw fixation technique via Wiltse approach, and com- pared it with the traditional posterior open method. A total of 72 cases of single-segment thoracolumbar fractures without neurologic injury underwent pedicle screw fixation via two different approaches. Among them, 37 patients were treated using posterior open surgery, and 35 patients received mini-open operation via Wiltse approach. Crew placement accuracy rate, operative time, blood loss, postoperative drainage, postoperative hospitalization time, radiation exposure time, postoperative improvement in R value, Cobb＇s angle and visual analog scale （VAS） scores of the two methods were compared. There were no significant differences in the accuracy rate of pedicle screw placement, radiation exposure and postoperative R value and Cobb＇s angle improvement between the two groups. However, the mini-open method had obvious advantages over the conventional open method in operative time, blood loss, postoperative drainage, postoperative hospitalization time, and postoperative improvement in VAS. The mini-open pedicle screw technique could be applied in treatment of single-segment thoracolumbar fracture without neurologic injury and had advantages of less tissue trauma, short operative and rehabilitative time on the premise of guaranteed accuracy rate and no increased radiation exposure.展开更多
BACKGROUND Rotator cuff(RC)tears are one of the most frequent pathologies within the shoulder girdle.Hand dominance and older age are associated with RC tears.Two different surgical procedures,the mini-open(MO)and all...BACKGROUND Rotator cuff(RC)tears are one of the most frequent pathologies within the shoulder girdle.Hand dominance and older age are associated with RC tears.Two different surgical procedures,the mini-open(MO)and all-arthroscopic(AA)approach,represented the standard of treatment.AIM To compare the clinical and biomechanical outcomes of two surgical techniques(AA vs MO procedure)performed to address the painful shoulder syndrome with partial or total supraspinatus tendon tear.METHODS Eighty-eight participants,50 following RC repair with AA and 38 with MO approach,were recruited in the present cross-sectional case-control study(ORTHO-SHOULDER,Prot.0054602).All patients underwent postoperative clinical evaluation for pain(Visual analogic scale),impairment,and disability(disability of the arm,shoulder,and hand)and limitation in daily activity(Constant-Murley score).Patients’shoulder mobility was also assessed in our Laboratory of Functional Movement through a wearable inertial sensor and surface electromyography to monitor kinematics and muscle activity during the movement on the frontal(abduction/adduction)and sagittal(flexion-extension)planes.RESULTS No statistically significant differences between the two procedures were observed in either main clinical score or range of motion.A significant increase in velocity during the movement execution and a higher contribution of upper trapezius muscles were found in the AA group compared with MO patients.CONCLUSION In terms of clinical scores,our findings were in line with previous results.However,the use of technology-based assessment of shoulder mobility has revealed significant differences between the two techniques in terms of mean velocity and pattern of muscle activation.展开更多
BACKGROUND Femoroacetabular impingement(FAI)is a predisposing factor for secondary osteoarthritis of the hip joint.The two extensively described impingement mechanisms of FAI are CAM and Pincer-type.Initially managed ...BACKGROUND Femoroacetabular impingement(FAI)is a predisposing factor for secondary osteoarthritis of the hip joint.The two extensively described impingement mechanisms of FAI are CAM and Pincer-type.Initially managed conservatively,operative intervention should be offered to the persistently symptomatic patient.The measurement of the alpha angle is considered a standard method of assessing the severity of pathology in Cam-type FAI on pre-operative plain radiographs.The radiological correction of the alpha angle has not been previously compared between different surgical approaches.We hypothesize that there is no difference in alpha angle correction between Ganz surgical hip dislocation and the anterior mini-open approach.AIM To compare the magnitude of alpha angle correction achieved by using the Ganz surgical hip dislocation and the anterior mini-open approach.METHODS This is a retrospective study assessing seventy-nine patients identified in a 5-year period.These patients had preoperative radiographic evidence of FAI and underwent surgery by a single surgeon at our institution,a tertiary care center.Patients with missing radiographic documentation,radiographs with insufficient quality which then precluded accurate measurement of the angleα,a diagnosed congenital condition,isolated type II pathology(Pincer),and history of prior surgery were excluded from the study.Either the Ganz surgical hip dislocation or the anterior mini open approach was used.Postoperative radiographic evaluation of the alpha angle between the two surgical methods was done and corrected for age and gender using two-sample t-tests and Chi-square analyses.RESULTS A total of 79 patients met the inclusion and exclusion criteria.Forty-seven males(mean age of 35.3,range 16-53)and 32 females(mean age 36.7,range 16-60)were enrolled.Forty-seven patients underwent the anterior mini-open approach,and 32 underwent the Ganz surgical hip dislocation.There were no significant differences in age between the two surgical groups or in pre-and post-operative alpha angles based on patient gender.The mean pre-operative alpha angle for the Ganz surgical hip dislocation group was 88.0 degrees(SD 12.3)and 99.4 degrees(SD 7.2)for the anterior mini-open group.Mean post-operative angles were 49.9 degrees(SD 4.3)for the Ganz surgical hip dislocation and 43.8(SD 4.3)degrees for the anterior mini-open group.There was a statistically significant difference in patient’s pre-operative and post-operative angles(P=0.000)with both surgical approaches.CONCLUSION Statistically significant decreases in alpha angle were noted for both surgical techniques,with larger decreases seen in the anterior mini-open group.展开更多
Objective: To evaluate the results of neurolysis of the median nerve to the carpal tunnel in patients operated by the mini-open technique. Methods: The prospective study included 68 patients (16 men and 52 women) aged...Objective: To evaluate the results of neurolysis of the median nerve to the carpal tunnel in patients operated by the mini-open technique. Methods: The prospective study included 68 patients (16 men and 52 women) aged 43 to 80 years (mean age: 64 years). Patients were evaluated in pre- and post-operative by a questionnaire. The mini open technique with cutaneous approach to the heel of the hand following the 4th ray was performed in all patients under local, locoregional or general anesthesia. Results: The results were evaluated in 3 consultations, in the 1st, 3rd and 6th month. We obtained very good results in 54.4% of the cases (n = 37) and 30.9% (n = 21) of good results and 14.70% (n = 10) of poor results. No vascular, tendinous or neurological complications were noted. Two patients were reoperated for incomplete resection of the carpal ring ligament. The mini-open technique has achieved good results in all neurolysis despite the delay in surgical management. Conclusion: The results of the surgical treatment of the carpal tunnel syndrome depend on the precocity of the diagnosis and the surgical indication.展开更多
目的对全关节镜及小切口两种方法修复肩袖损伤的疗效进行Meta分析。方法计算机检索Ovid Medline和PubMed Medline(1966～2008.5),Embase(1980～2008.5),Cochrane Central Register of Controlled trials(2008)和中国生物医学文献数据库(...目的对全关节镜及小切口两种方法修复肩袖损伤的疗效进行Meta分析。方法计算机检索Ovid Medline和PubMed Medline(1966～2008.5),Embase(1980～2008.5),Cochrane Central Register of Controlled trials(2008)和中国生物医学文献数据库(1990～2008.5),搜集到所有的已发表的用于论证这些问题的对照研究,且采用RevMan 4.2.10进行Meta分析。结果共纳入10例对照研究,Meta分析显示这两组肩关节功能评分(SMD=-0.04,95%CI=-0.24～0.16,P=0.68)、患者满意度(OR=0.7,95%CI=0.35～1.40,P=0.32)、肩袖翻修率(OR=0.75,95%CI=0.40～1.41,P=0.37)、关节僵硬发生率(OR=0.48,95%CI=0.22～1.06,P=0.07)没有统计学意义。结论肩袖损伤全关节镜术后2年随访肩关节功能、病人满意度、肩袖翻修率及关节僵硬发生率等方面没有明显优势,但是它有较少的软组织损伤、极低的三角肌劈开风险、较少的早期切口疼痛及更快的功能恢复等潜在优势,可明显改善术后肩关节外展、外旋功能。而有趋势表明关节僵硬发生率与小切口相关,由于目前缺乏随机化对照试验证据,进一步比较仍须要大样本的多中心的随机化对照试验研究。展开更多
基金supported by the National Natural Science Foundation of China(Grant No.30973058, 81171694,and 81371968)the Program for Development of Innovative Research Team in the First Affiliated Hospital of NJMU(No.IRT-015)A Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions
文摘This study aimed to introduce a novel mini-open pedicle screw fixation technique via Wiltse approach, and com- pared it with the traditional posterior open method. A total of 72 cases of single-segment thoracolumbar fractures without neurologic injury underwent pedicle screw fixation via two different approaches. Among them, 37 patients were treated using posterior open surgery, and 35 patients received mini-open operation via Wiltse approach. Crew placement accuracy rate, operative time, blood loss, postoperative drainage, postoperative hospitalization time, radiation exposure time, postoperative improvement in R value, Cobb＇s angle and visual analog scale （VAS） scores of the two methods were compared. There were no significant differences in the accuracy rate of pedicle screw placement, radiation exposure and postoperative R value and Cobb＇s angle improvement between the two groups. However, the mini-open method had obvious advantages over the conventional open method in operative time, blood loss, postoperative drainage, postoperative hospitalization time, and postoperative improvement in VAS. The mini-open pedicle screw technique could be applied in treatment of single-segment thoracolumbar fracture without neurologic injury and had advantages of less tissue trauma, short operative and rehabilitative time on the premise of guaranteed accuracy rate and no increased radiation exposure.
文摘BACKGROUND Rotator cuff(RC)tears are one of the most frequent pathologies within the shoulder girdle.Hand dominance and older age are associated with RC tears.Two different surgical procedures,the mini-open(MO)and all-arthroscopic(AA)approach,represented the standard of treatment.AIM To compare the clinical and biomechanical outcomes of two surgical techniques(AA vs MO procedure)performed to address the painful shoulder syndrome with partial or total supraspinatus tendon tear.METHODS Eighty-eight participants,50 following RC repair with AA and 38 with MO approach,were recruited in the present cross-sectional case-control study(ORTHO-SHOULDER,Prot.0054602).All patients underwent postoperative clinical evaluation for pain(Visual analogic scale),impairment,and disability(disability of the arm,shoulder,and hand)and limitation in daily activity(Constant-Murley score).Patients’shoulder mobility was also assessed in our Laboratory of Functional Movement through a wearable inertial sensor and surface electromyography to monitor kinematics and muscle activity during the movement on the frontal(abduction/adduction)and sagittal(flexion-extension)planes.RESULTS No statistically significant differences between the two procedures were observed in either main clinical score or range of motion.A significant increase in velocity during the movement execution and a higher contribution of upper trapezius muscles were found in the AA group compared with MO patients.CONCLUSION In terms of clinical scores,our findings were in line with previous results.However,the use of technology-based assessment of shoulder mobility has revealed significant differences between the two techniques in terms of mean velocity and pattern of muscle activation.
文摘BACKGROUND Femoroacetabular impingement(FAI)is a predisposing factor for secondary osteoarthritis of the hip joint.The two extensively described impingement mechanisms of FAI are CAM and Pincer-type.Initially managed conservatively,operative intervention should be offered to the persistently symptomatic patient.The measurement of the alpha angle is considered a standard method of assessing the severity of pathology in Cam-type FAI on pre-operative plain radiographs.The radiological correction of the alpha angle has not been previously compared between different surgical approaches.We hypothesize that there is no difference in alpha angle correction between Ganz surgical hip dislocation and the anterior mini-open approach.AIM To compare the magnitude of alpha angle correction achieved by using the Ganz surgical hip dislocation and the anterior mini-open approach.METHODS This is a retrospective study assessing seventy-nine patients identified in a 5-year period.These patients had preoperative radiographic evidence of FAI and underwent surgery by a single surgeon at our institution,a tertiary care center.Patients with missing radiographic documentation,radiographs with insufficient quality which then precluded accurate measurement of the angleα,a diagnosed congenital condition,isolated type II pathology(Pincer),and history of prior surgery were excluded from the study.Either the Ganz surgical hip dislocation or the anterior mini open approach was used.Postoperative radiographic evaluation of the alpha angle between the two surgical methods was done and corrected for age and gender using two-sample t-tests and Chi-square analyses.RESULTS A total of 79 patients met the inclusion and exclusion criteria.Forty-seven males(mean age of 35.3,range 16-53)and 32 females(mean age 36.7,range 16-60)were enrolled.Forty-seven patients underwent the anterior mini-open approach,and 32 underwent the Ganz surgical hip dislocation.There were no significant differences in age between the two surgical groups or in pre-and post-operative alpha angles based on patient gender.The mean pre-operative alpha angle for the Ganz surgical hip dislocation group was 88.0 degrees(SD 12.3)and 99.4 degrees(SD 7.2)for the anterior mini-open group.Mean post-operative angles were 49.9 degrees(SD 4.3)for the Ganz surgical hip dislocation and 43.8(SD 4.3)degrees for the anterior mini-open group.There was a statistically significant difference in patient’s pre-operative and post-operative angles(P=0.000)with both surgical approaches.CONCLUSION Statistically significant decreases in alpha angle were noted for both surgical techniques,with larger decreases seen in the anterior mini-open group.
文摘Objective: To evaluate the results of neurolysis of the median nerve to the carpal tunnel in patients operated by the mini-open technique. Methods: The prospective study included 68 patients (16 men and 52 women) aged 43 to 80 years (mean age: 64 years). Patients were evaluated in pre- and post-operative by a questionnaire. The mini open technique with cutaneous approach to the heel of the hand following the 4th ray was performed in all patients under local, locoregional or general anesthesia. Results: The results were evaluated in 3 consultations, in the 1st, 3rd and 6th month. We obtained very good results in 54.4% of the cases (n = 37) and 30.9% (n = 21) of good results and 14.70% (n = 10) of poor results. No vascular, tendinous or neurological complications were noted. Two patients were reoperated for incomplete resection of the carpal ring ligament. The mini-open technique has achieved good results in all neurolysis despite the delay in surgical management. Conclusion: The results of the surgical treatment of the carpal tunnel syndrome depend on the precocity of the diagnosis and the surgical indication.
文摘目的对全关节镜及小切口两种方法修复肩袖损伤的疗效进行Meta分析。方法计算机检索Ovid Medline和PubMed Medline(1966～2008.5),Embase(1980～2008.5),Cochrane Central Register of Controlled trials(2008)和中国生物医学文献数据库(1990～2008.5),搜集到所有的已发表的用于论证这些问题的对照研究,且采用RevMan 4.2.10进行Meta分析。结果共纳入10例对照研究,Meta分析显示这两组肩关节功能评分(SMD=-0.04,95%CI=-0.24～0.16,P=0.68)、患者满意度(OR=0.7,95%CI=0.35～1.40,P=0.32)、肩袖翻修率(OR=0.75,95%CI=0.40～1.41,P=0.37)、关节僵硬发生率(OR=0.48,95%CI=0.22～1.06,P=0.07)没有统计学意义。结论肩袖损伤全关节镜术后2年随访肩关节功能、病人满意度、肩袖翻修率及关节僵硬发生率等方面没有明显优势,但是它有较少的软组织损伤、极低的三角肌劈开风险、较少的早期切口疼痛及更快的功能恢复等潜在优势,可明显改善术后肩关节外展、外旋功能。而有趋势表明关节僵硬发生率与小切口相关,由于目前缺乏随机化对照试验证据,进一步比较仍须要大样本的多中心的随机化对照试验研究。
