Objective To summarize the assessment methods of anal function after low/ultralow rectal anastomosis in patients with rectal cancer. Methods Domestic and international publications on the study of evaluation of anal function after low/ultralow rectal anastomosis in patients with rectal cancer were collected and reviewed. Results Anal function of patients with rectal cancer was usually evaluated by feeling of discharge, continence, perceptual function of rectum, defecate frequency, and defecation time, anal manometry and three-dimensional vector manometry were used as well. Recovery of anal function in patients with rectal cancer after low/ultralow rectal anastomosis depended on the integrity of anal canal, length of remaining rectum, level of anastomosis, and integrity of mucosa. Conclusions Subjective assessment methods and auxiliary measuring instruments are the common means to evaluate the rectal-anal function. Subjective assessment method is simple and direct, but its accuracy is low; Auxiliary measuring instruments have high accuracy, while their examination costs are high and that of costs are not popular, the new assessment methods are needed for further research.
目的 探讨医生的专业化程度对直肠癌根治性切除术质量的影响。 方法 纳入2007年7月－2009年12月收治且确诊为直肠癌的手术患者共679例，分为专业组（470例）和非专业组（209例），收集患者年龄、体质量指数（BMI）、肿瘤TNM分期、手术持续时间、术中出血量、术后胃肠功能恢复时间、术后并发症等围手术期指标，进行相关统计学分析。 结果 两组患者手术持续时间相当（P=0.322），但在专业组中患者术中出血量较非专业组少（P=0.008）。专业组患者术后拔除胃管时间（P=0.000）、拔除引流管时间（P=0.000）、首次进流质食物时间（P=0.002）、首次排便时间（P=0.007）和下床活动时间（P=0.001）均较非专业组提前，术后住院时间（P=0.152）与住院总时间（P=0.983）两组差异无统计学意义，且专业组术后并发症总发生率较低（P＜0.05）。 结论 医生的专业化程度对直肠癌根治术患者围手术期的管理有显著影响，专业化程度高的直肠癌外科医生可为患者带来更好的手术效果。
ObjectiveTo evaluate the long-term effectiveness of patients received surgical treatment under the guidance of “West China Classification” of desmoid-type fibromatosis (DTF) in the shoulder girdle.MethodsThe clinical data of 32 patients with DTF in the shoulder girdle admitted between June 2003 and December 2016 were retrospectively analyzed, including 14 males and 18 females, aged 14-56 years with an average age of 36.8 years. The maximum diameter of the tumor was 7-19 cm, with an average of 11.1 cm. According to the “West China Classification” of DTF in the shoulder girdle, there were 4 cases of region Ⅰ, 3 cases of region Ⅱ, 6 cases of region Ⅲ, 3 cases of region Ⅳ, 5 cases of regions Ⅰ+Ⅱ, 5 cases of regions Ⅱ+Ⅲ, and 6 cases of regions Ⅰ+Ⅱ+Ⅲ. In addition, the involvement of blood vessels and nerves was also taken into consideration for choosing a surgical approach. Finally, 12 cases were operated via anteroposterior approach (group A), 14 via posterior approach (group B), and 6 via combined anterior-posterior approach (group C). The 1993 Musculoskeletal Tumor Society (MSTS93) score (including pain, limb function, satisfaction, hand position, hand flexibility, and lifting ability), Japanese Orthopedic Association (JOA) score, range of motion (ROM) of shoulder joint (including flexion, extension, abduction, and adduction), and complications of patients in the 3 groups were recorded and compared.ResultsAll the 32 patients were followed up 30-190 months, with an average of 94.6 months. At last follow-up, complications occurred in 5 cases (15.6%), including 2 cases (16.6%) in group A, 2 (14.3%) in group B, and 1 (16.6%) in group C. There was no significant difference in the incidence of complications among the 3 groups (P=1.000). Tumor recurrence occurred in 5 (15.6%) cases, including 1 (8.3%) case in group A, 2 (14.3%) in group B, and 1 (16.6%) in group C. No significant difference was found in the recurrence rate among the 3 groups (P=1.000). At last follow-up, MSTS93 score of pain, limb function, satisfaction, hand flexibility, and hand position in groups A and B were significantly better than those in group C (P<0.05), even though no significant difference existed between group A and group B (P>0.05). The lifting ability score in group C was significantly lower than in group A (P<0.05), and no significant difference was found between other groups (P>0.05). The JOA score and flexion, extension, abduction, and adduction activities of shoulder in groups A and B were significantly better than those in group C (P<0.05). The extension activity in group A was significantly better than that in group B (P<0.05), the flexion activity in group B was significantly better than that in group A (P<0.05). There was no significant difference in other indexes between groups A and B (P>0.05).ConclusionTaking a rational approach to fully expose and completely remove the tumor is the key point of surgical treatment for patients with DTF in the shoulder girdle. At the same time, preservation of vital structures and reconstruction of soft tissues should also be taken into consideration. Overall, surgical treatment under the guidance of “West China Classification” of DTF in the shoulder girdle has achieved satisfactory long-term effectiveness.
Objective To evaluated the application effect of reverse digital modeling combined with three-dimensional (3D)-printed disease models in the standardized training of orthopedic residents focusing on pelvic tumors. Methods From August 2022 to August 2023, 60 orthopedic residents from West China Hospital, Sichuan University were randomly assigned to a trial group (n=30) and a control group (n=30). The trial group received instruction using reverse digital modeling and 3D-printed pelvic tumor models, while the control group underwent traditional teaching methods. Teaching outcomes were evaluated and compared between groups through knowledge tests, practical skill assessments, and satisfaction surveys. Results Before training, there was no statistically significant difference in knowledge tests or practical skill assessments between the two groups (P>0.05). After training, the trial group showed significantly better performance than the control group in knowledge tests (90.5±5.2 vs. 78.4±6.8, P<0.05), skill assessments (92.7±4.9 vs. 81.3±6.2, P<0.05), and satisfaction surveys (9.40±1.10 vs. 7.60±1.20, P<0.05). One month after training, the trial group still showed significantly better performance than the control group in knowledge tests (88.1±6.4 vs. 72.3±7.1, P<0.05) and skill assessments (90.3±5.8 vs. 75.6±6.9, P<0.05). Conclusions Reverse digital modeling combined with 3D printing offers an intuitive and effective teaching approach that improves comprehension of pelvic tumor anatomy and strengthens clinical and technical competencies. This method significantly enhances learning outcomes in standardized residency training and holds promise for broader integration into medical education.
ObjectivesTo compare the role of problem-based learning (PBL) combined with team-based learning (TBL) methods with traditional lecture-based learning in the clinical probation teaching of bone tumor and explore which teaching method is more suitable for clinical probation teaching of bone tumor.MethodsThe 60 students of the 2013 grade five-year program medical students in West China Clinical College of Sichuan University who were undergoing clinical probation teaching in the orthopedic bone tumor subspecialty of West China Hospital of Sichuan University in April 2017 were randomly divided into 2 groups. The trial group adopted PBL combined with TBL teaching method, the control group adopted traditional teaching method. The general situation of the two groups of students were compared. After the end of the probation, the two groups of students’ knowledge mastery, comprehensive ability and satisfaction were compared.ResultsThere was no significant difference in the gender composition and the assessment scores of the last semester diagnostics course of the two groups of students (P>0.05). After the probation, in terms of knowledge mastery, the trial group’s theoretical test scores (89.13±3.47 vs. 87.03±2.99; t=2.511, P=0.015), teacher evaluation (88.33±4.48 vs. 85.90±3.96; t=2.231, P=0.030) and student evaluation (89.83±2.97 vs. 87.47±2.91; t=3.117, P=0.003) were better than those of the control group. In terms of comprehensive ability, the trial group’s ability in reasoning and induction, information management, goal completion, and communication (17.90±1.09, 18.00±0.91, 18.00±1.02, 17.90±1.13) were better than those of the control group (17.20±1.13, 17.13±1.20, 17.10±1.24, 16.83±1.29), the differences were statistically significant (P<0.05). There was no statistically significant difference in satisfaction between the two groups of students (P>0.05).ConclusionsPBL combined with TBL methods can improve the effect of clinical probation of bone tumors, deepen mastery of professional knowledge, improve comprehensive ability, and improve teaching quality.
Objective To review the methods of repair and reconstruction of the large segmental bone tumor defect in distal tibia. Methods The related literature of repair and reconstruction of the large segmental bone tumor defect in disatal tibia was reviewed and analyzed in terms of the reserved ankle joint and the non-reserved ankle joint. Results For large segmental bone tumor defect in distal tibia, the conventional allograft bone transplantation, vascularized autologous fibular transplantation, vascularized fibular allograft, inactivated tumor regeneration, distraction osteogenesis, and bone transport techniques can be selected, and the membrane-induced osteogenesis, artificial tumor stem prosthesis, three-dimensional printed metal trabecular prosthesis, ankle arthrodesis, artificial tumor ankle joint placement surgery are gradually to be applied to repair the bone defect. Moreover, due to its long survival time, the function of reconstructed bone tumor defect in the distal tibia has also received increasing attention. Conclusion Although the ideal methods has not yet been developed, great progress has been achieved in repair and reconstruction of the large segmental bone tumor defect in the distal tibia. Recently, with the appearance of three-dimensional printing and various preoperative simulation techniques, personalized and precise therapy could become ture, but therapies for the large segmental bone tumor defect in the distal tibia still need to be further explored.
The orthopedic bone tumor section is a difficult and key point in clinical teaching. 3D disease models have become a new tool for teaching clinical difficulties due to their intuitive and visual advantages. At present, in the standardized residents training clinical teaching of bone tumors, diversified teaching modes have accumulated a lot of experience, and the combination of 3D disease models can provide new strategies for clinical teaching of bone tumors. Therefore, this article introduces the current situation of clinical teaching in orthopedics, the current situation and challenges of bone tumor teaching, and the exploration and practice of using diversified teaching modes combined with 3D disease models at West China Hospital of Sichuan University, aiming to improve the quality of standardized residents training bone tumor teaching.
ObjectiveTo analyze the correlation between the trabecular microstructure and the clinical imaging parameters in the fracture region of osteoporotic hip so as to provide a simple method to evaluate the trabecular microstructure by a non-invasive way. MethodsBetween June 2012 and January 2013, 16 elderly patients with femoral neck fracture underwent hip arthroplasty were selected as the trial group; 5 young patients with pelvic fracture were selected as the control group. The hip CT examination was done, and cancellous bone volume/marrow cavity volume (CV/MV) was analyzed with Mimics 10.01 software in the control group. The CT scan and bone mineral density (BMD) measurement were performed on normal hips of the trial group, and cuboid specimens were gained from the femoral necks at the place of the tensional trabeculae to evaluate the trabecular microstructure parameters by Micro-CT, including bone volume fraction (BV/TV), trabecular number (Tb. N), trabecular spacing (Tb.Sp), trabecular thickness (Tb.Th), connect density (Conn.D), and structure model index (SMI). The correlation between imaging parameters and microstructure parameters was analyzed. ResultsIn the trial group, the BMD value was 0.491-0.698 g/cm2 (mean, 0.601 g/cm2); according to World Health Organization (WHO) standard, 10 cases were diagnosed as having osteoporosis, and 6 cases as having osteopenia. The CV/MV of the trial group (0.670 1±0.102 0) was significantly lower than that of the control group (0.885 0±0.089 1) (t=-4.567, P=0.000). In the trial group, CV/MV had correlation with BV/TV, Tb.Th, and SMI (P<0.05); however, CV/MV had no correlation with Tb.N, Tb.Sp, or Conn.D (P>0.05). BV/TV had correlation with Tb.Th, Tb.N, Tb.Sp, and SMI (P<0.05), but it had no correlation with Conn.D (P=0.075). There was no correlation between BMD and microstructure parameters (P>0.05). ConclusionCV/MV obviously decreases in the osteoporotic hip, and there is a correlation between CV/MV and the microstructure parameters of BV/TV, Tb.Th, and SMI, to some extent, which can reflect the variety of the microstructure of the trabeculae. There is no correlation between BMD of femoral neck and microstructure parameters.
ObjectiveTo investigate the clinical efficiency of pelvic and sacrum tumor surgery using sizing balloon occlusion of the lower abdominal aorta. MethodsFrom January 2005 to June 2011, 156 patients were diagnosed to have sacrum or pelvic tumor and underwent surgery in our institution. Temporary balloon occlusion of abdominal aorta was used in 51 patients during the resection of sacrum and pelvic tumors (balloon group). Another 105 patients received the traditional surgery resection (control group). The results of the whole operation time, the volume of blood loss and transfusion, the complication and the total days of stay in hospital in the two groups were compared with each other. ResultsAfter the abdominal aorta was occluded, 92.2% of the patients in the balloon group had holistic resection or edge resection, while the number was 86.7% for the control group. In the balloon group, the average operation time was (171.96±65.16) minutes, the average intraoperative blood loss was (746.86±722.73) mL, and the blood transfusion was (411.76±613.73) mL. The postoperative lead flow was (294.50±146.09) mL, and the postoperative tube removal was within (2.98±1.07) days. Improvement of patients'condition was significantly better than the control group (P<0.05). No significant difference was found in the total days of stay in hospital and the postoperative complications between the two groups (P>0.05). ConclusionUsing abdominal aorta occlusion can effectively control intraoperative hemorrhage, and show the operation field clearly. It also can reduce operation time and control the blood transfusions. Appropriately extended balloon blocking time can obviously improve the tumor removal rate and the safety of the operation.