Objective To evaluate the clinical and follow-up results of the surgical treatment for hypertrophic obstructive cardiomyopathy associated with aortic stenosis. Methods We retrospectively analyzed the clinical data of the patients with hypertrophic obstructive cardiomyopathy plus aortic stenosis in our hospital from February 2008 to October 2015. There were 4 males and 3 females aged 55.6 ± 7.5 years. All the patients were received concomitant aortic valvulopasty at the time of modified extended Morrow procedure. Echocardiographic data and major complications were recorded through the outpatient clinic and telephone. Results The postoperative ventricular septal thickness, left ventricular outflow tract gradient and aortic gradient were significantly lower than those in preoperation with statistical differences (P<0.05). During the mean follow-up 25.6 ± 28.2 months period, 1 patient died of cerebral hemorrhage, 1 patient was implanted a permanent pacemaker, and 1 patient had a postoperative new-onset atrial fibrillation. All patients had a satisfied prosthetic valve function and the left ventricular outflow tract gradient. The patient's symptoms and heart function significantly improved postoperatively. Conclusion For patients with hypertrophic obstructive cardiomyopathy associated with moderate to severe aortic stenosis, concomitant aortic valvulopasty at the time of modified extended Morrow procedure is an appropriate and effective treatment, which can significantly alleviate the clinical symptoms, and improve quality of life with a satisfied prognosis.
The treatment of acute Stanford type A aortic dissection has always been extremely challenging. Organ malperfusion syndrome is a common severe complication of acute aortic dissection, which can cause organ ischemia and internal environment disorder. Malperfusion increases early mortality, and impacts the long-term prognosis. In recent years, many scholars have done some studies on aortic dissection complicated with malperfusion. They explored the pathogenesis, proposed new classification, and innovated new treatment strategies. However, at present, the treatment strategies of acute Stanford type A aortic dissection complicated with organ malperfusion are different at different centers and consensus on its treatment is still lacking. Therefore, this review summarized the pathogenesis, classification, treatment strategy, and prognosis of acute Stanford type A aortic dissection complicated with malperfusion.
Objective To review the surgical treatment progress in repair and reconstruction of acquired auricle defects. Methods The related literature concerning the surgical methods and techniques for acquired auricle defects was reviewed and summarized. Results In order to attain an aesthetic ear with a clear structure, the location, size, and condition of surrounding skin must be taken into account when planning excision and repair. The application of tissue engineering and digital technology for acquired auricle defects can achieve a satisfactory effectiveness. Conclusion The surgical programs for acquired auricular defects have been constantly improved in recent years, and the emerging medical technologies also play a promoting role in the process, which providing a great deal of reference for obtaining structurally clear and stereoscopic auricle.
ObjectiveTo summarize the research status and new directions of surgical treatment of hepatic alveolar echinococcosis (HAE) in clinic, and to provide reference for further research in improving the rate of radical surgery.MethodThe recent literatures on the studies of HAE were reviewed.ResultsAlthough the biological behavior of HAE was similar to that of malignant tumor, the clinical symptoms appeared late as the intrahepatic lesions often grow slowly. At present, the treatment of this disease was mainly surgical operation, among which radical resection was the first choice. Drug therapy was also of great value in controlling disease progression and recurrence. In recent years, with the progress of surgical technology, the surgical method had gradually developed to the direction of multi-mode combination, especially for those cases that had not been able to perform conventional radical surgery before.ConclusionThe treatment concept of clinical multi-mode combination can benefit more patients, even achieve clinical radical resection, and improve the rate of radical resection.
ObjectiveTo review the progress of hip fracture treatment in children.MethodsLiterature about the hip fracture treatment in children was extensively reviewed and summarized in terms of anatomy and blood supply, fracture classification, surgical treatment principles, and complications.ResultsThe anatomical structure of children’s hips and the characteristics of peripheral blood supply constantly change with age. Delbet classification is the most classic classification of hip fracture in children. Children’s age and Delbet classification have significant effects on surgical treatment strategies and post-fracture complications. The timing of surgical treatment, accurate anatomical reduction, and appropriate internal fixation can effectively improve the prognosis and reduce the incidence of complications. Common complications include osteonecrosis of the femoral head, coxa vara, premature physeal closure, and nonunion. Conclusion There are still some controversies on the treatment concept and internal fixation choice for children’s hip fracture. So it is necessary to further study the anatomy and blood supply characteristics of children’s hip, improve the selection and application skills of internal fixation devices, so as to avoid serious complications.
Objective To analyze the clinical effect of TINAVI robotic system-assisted pedicle screw internal fixation for thoracolumbar fracture with a Thoracolumbar Injury Classification and Severity Score (TLICS) of 4. Methods A total of 38 patients with TLICS 4 thoracolumbar fracture treated between January 2019 and January 2021 who met the selection criteria of Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital were retrospectively analyzed. According to the results of doctor-patient communication, 18 cases were treated with robot-assisted minimally invasive surgery (robot group), and 20 cases were treated with traditional conservative treatment (non-surgical group). Complications during hospitalization were observed. After discharge, the patients in the two groups were followed up by telephone and outpatient clinic. The Visual Analogue Scale (VAS) score at admission, at discharge, and 3 and 6 months after discharge, and the Oswestry Disability Index (ODI) score 3 and 6 months after discharge were compared between the two groups. Results There were no statistically significant difference in age, sex, body mass index or distribution of injured vertebrae segment between the two groups (P>0.05). No serious complication occurred in any group during hospitalization. The difference in the length of hospital stay between the two groups was not statistically significant (P>0.05). The bed rest in the robot group was shorter than that in the non-surgical group [(4.83±0.92) vs. (43.05±2.70) d, P<0.05]. The VAS scores at discharge (2.50±0.51 vs. 5.05±1.00), 3 months after discharge (1.83±0.71 vs. 3.10±0.72) and 6 months after discharge (1.50±0.51 vs. 1.90±0.79) in the robot group were lower than those in the non-surgical group (P<0.05). The ODI scores 3 months after discharge (21.89±1.41 vs. 30.40±3.00) and 6 months after discharge (10.72±2.37 vs. 12.10±2.29) in the robot group were significantly lower than those in the non-surgical group (P<0.05). Conclusion For patients with TLICS 4 thoracolumbar fracture, the early clinical effect of robot-assisted surgical treatment is better than that of non-surgical treatment.
We reported a patient intubated for more than 30 d following brain injury, transferred to our department with tracheocutaneous fistula and a 2 cm fistula between the trachea and the esophagus. We performed tracheal resection and esophageal closure with a latissimus dorsi myocutaneous flap interposed between suture lines. The patient continued mechanical ventilation after surgery and the tracheotomy was achieved 14 d after the beginning of surgical treatment. The patient was started oral feeding and discharged on the 10 d after tracheotomy and referred to a neuromotor recovery clinic for treatment of post-traumatic sequelae.
ObjectiveTo review the research progress on the lower limb biomechanical characteristics of patients with discoid lateral meniscus (DLM) injury after surgery. MethodsBy searching relevant domestic and international research literature on DLM, the postoperative characteristics of knee joint movement biomechanics, tibiofemoral joint stress distribution, lower extremity force line, and patellofemoral joint changes in patients with DLM injury were summarized. ResultsSurgical treatment can lead to varying degrees of changes in the lower limb biomechanical characteristics of patients with DLM injury. Specifically, the kinematic biomechanics of the knee joint can significantly improve, but there are still problems such as extension deficits in the affected knee joint. The peak stress of the tibiofemoral joint decreases with the increase of the residual meniscus volume, and the degree of change is closely related to the residual meniscus volume. Preserving a larger volume of the meniscus, especially the anterior horn volume, helps to reduce stress concentration. The lower extremity force line will deviate outward after surgery, and the more meniscus is removed during surgery, the greater the change in the lower extremity force line after surgery. There are conditions such as cartilage degeneration, position and angle changes in the patellofemoral joint after surgery. ConclusionThe changes in the lower limb biomechanical characteristics after DLM injury are closely related to the choice of surgical methods and rehabilitation programs. However, the mechanisms of biomechanical changes in multiple lower limb joints and individual differences still need to be further studied and clarified.
Objective To explore the clinical effect of combining medial and lateral canthoplasty with blepharoptosis correction at onestage for congenital blepharophimosis syndrome. Methods From January 2002 to May 2006, 26 patients(52 sides) with congenital blepharophimosis syndrome were treated. There were 16 males and 10 females, aging from 3 to 35 years (mean 8.5 years). They were all bilateral blepharoptosis significantly. The palpebral muscle force was 03 mm; the transverse dimension and vertical dimension of the palpebral fissue were 13-22 mm and 2-4 mm; the intercanthal distance was 33-44 mm; the levator function was 1-3 mm. Results Twenty-six patients underwent medial canthoplasty and blepharoptosis correction, of them, 12 patients were also given lateral canthoplasty at one-stage. The postoperative transverse dimension and vertical dimension of the palpebral fissue were 6-8 mm and 24-32 mm, respectively. The intercanthal distance was 29-34 mm. The levator function was 46 mm. The supratarsal fold in the upper lid was natural. With a follow up of 3 months to 4 years，all patients were satisfied with their results. Conclusion One-stage surgical treatment of combining medial and lateral canthoplasty with blepharoptosis correction can achieve good result for blepharophimosis syndrome with a shortened treatment time.
Objective To summarize the latest developments in neurosurgical treatments for neurofibromatosis type 1 (NF1) and explore therapeutic strategies to provide comprehensive treatment guidelines for clinicians. Methods The recent domestic and international literature and clinical cases in the field of NF1 were reviewed. The main types of neurological complications associated with NF1 and their treatments were thorough summarized and the future research directions in neurosurgery was analyzed. Results NF1 frequently results in complex and diverse lesions in the central and peripheral nervous systems, particularly low-grade gliomas in the brain and spinal canal and paraspinal neurofibromas. Treatment decisions should be made by a multidisciplinary team. Symptomatic plexiform neurofibromas and tumors with malignant imaging evidence require neurosurgical intervention. The goals of surgery include reducing tumor size, alleviating pain, and improving appearance. Postoperative functional rehabilitation exercises, long-term multidisciplinary follow-up, and psychosocial interventions are crucial for improving the quality of life for patients. Advanced imaging guidance systems and artificial intelligence technologies can help increase tumor resection rates and reduce recurrence. Conclusion Neurosurgical intervention is the primary treatment for symptomatic plexiform neurofibromas and malignant peripheral nerve sheath tumors when medical treatment is ineffective and the lesions progress rapidly. Preoperative multidisciplinary assessment, intraoperative electrophysiological monitoring, and advanced surgical assistance devices significantly enhance surgical efficacy and safety. Future research should continue to explore new surgical techniques and improve postoperative management strategies to achieve more precise and personalized treatment for NF1 patients.