scholarly journals Comparison of Minimally Invasive Reduction Combined With Medial and External Fixation in the Treatment of Intra-articular Calcaneal Fractures

Author(s):  
wang jianchuan ◽  
Liu jibin ◽  
wang zongpu

Abstract BackgroundComparison of percutaneous minimally invasive replacement joint inside external fixation technique and tarsal sinus approach to treat Sanders Ⅱ and Ⅲ clinical effect of intra-articular calcaneal fractures.MethodsThe clinical data of 64 cases of calcaneal fracture admitted to our hospital from January 2010 to January 2016 were retrospectively analyzed.According to different surgical methods,they were divided into the percutaneous minimally invasive reduction and internal and external fixation group (30 cases) and the tarsal sinus approach (34 cases).Comparison of two groups of patients with operation time,intraoperative blood loss,hospital stay, postoperative complications and radiographic evaluation including heel bone length,width,height,Bohler Angle,Angle of Gissane,calcaneal varus Angle,clinical efficacy evaluation including the American Orthopaedic Foot and Ankle Society (AOFAS),the visual analogue score for pain(VAS) score,health survey profiles (SF - 36) score and score Maryland ankle function.ResultsPatients in both groups were followed up for 12 to 50 months,an average of 24.8 months.All fractures obtained bone union.The waiting time,hospital stay,intraoperative blood loss and incision complications in the percutaneous minimally invasive medial and external fixation group were lower than those in the tarsal sinus group,and the differences were statistically significant (P<0.01).At the last follow-up,the length,width,height,Angle of Bohler,Angle of Gissane,and Angle of calcaneal varus were significantly increased in both groups (P<0.01),the calcaneal width was significantly lower than that before surgery (P<0.01),and the difference between the two groups was not statistically significant (P > 0.05).Clinical efficacy evaluation The AOFAS,VAS,SF-36 and Maryland scores were (85.28±8.21),(0.84±1.21),(82.95±3.25) and (83.56±3.32) at the last follow-up in the percutaneous minimally invasive medial and external fixation group.The AOFAS, VAS, SF-36 and Maryland scores of the tarsal sinus group were (83.32 ± 7.69),(1.85 ± 1.32),(80.71 ± 5.42),(81.85 ± 2.41) points,and there was no significant difference between the two groups (P > 0.05).ConclusionUnder the condition of having a good command of surgical indications and surgical skills,the use of calcaneoplastic forceps for percutaneous minimally invasive reduction combined with medial and external fixation for treatment of intra-articular calcaneoplasty fractures can achieve similar clinical effects as the tarsal sinus approach.However,the use of calcaneoplastic forceps for percutaneous minimally invasive reduction combined with internal and external fixation has advantages such as fewer complications, less blood loss,and shorter operation time,etc,which is of good safety and worthy of clinical promotion.

2021 ◽  
Vol 15 ◽  
Author(s):  
Huan-Guang Liu ◽  
De-Feng Liu ◽  
Kai Zhang ◽  
Fan-Gang Meng ◽  
An-Chao Yang ◽  
...  

Background: The Ommaya reservoir implantation technique allows for bypass of the blood-brain barrier. It can be continuously administered locally and be used to repeatedly flush the intracranial cavity to achieve the purpose of treatment. Accurate, fast, and minimally invasive placement of the drainage tube is essential during the Ommaya reservoir implantation technique, which can be achieved with the assistance of robots.Methods: We retrospectively analyzed a total of 100 patients undergoing Ommaya reservoir implantation, of which 50 were implanted using a robot, and the remaining 50 were implanted using conventional surgical methods. We then compared the data related to surgery between the two groups and calculated the accuracy of the drainage tube of the robot-assisted group.Results: The average operation time of robot-assisted surgery groups was 41.17 ± 11.09 min, the bone hole diameter was 4.1 ± 0.5 mm, the intraoperative blood loss was 11.1 ± 3.08 ml, and the average hospitalization time was 3.9 ± 1.2 days. All of the Ommaya reservoirs were successful in one pass, and there were no complications such as infection or incorrect placement of the tube. In the conventional Ommaya reservoir implantation group, the average operation time was 65 ± 14.32 min, the bone hole diameter was 11.3 ± 0.3 mm, the intraoperative blood loss was 19.9 ± 3.98 ml, and the average hospitalization time was 4.1 ± 0.5 days. In the robot-assisted surgery group, the radial error was 2.14 ± 0.99 mm and the axial error was 1.69 ± 1.24 mm.Conclusions: Robot-assisted stereotactic Ommaya reservoir implantation is quick, effective, and minimally invasive. The technique effectively negates the inefficiencies of craniotomy and provides a novel treatment for intracranial lesions.


2019 ◽  
Vol 47 (12) ◽  
pp. 6129-6138 ◽  
Author(s):  
Lei Sun ◽  
Zhigang Kong ◽  
Ming Xu

Objective This study was performed to introduce a new method of minimally invasive subtalar arthrodesis (MISA) and assess its clinical effects on traumatic subtalar arthritis (TSA). Methods Fifteen patients (8 male and 7 female; age range, 36–56 years; mean age, 48.67 years) with TSA who underwent MISA were included. All patients were treated using a series instrument. The intraoperative and postoperative indexes were recorded. Results Among all patients, the mean operation time was 59.67 ± 16.31 minutes and the mean intraoperative blood loss was 43.33 ± 52.87 mL. Four patients underwent iliac crest bone graft surgery, and one patient developed a complication involving fat liquefaction of the iliac crest wound. The mean bony fusion time among all patients was 3.5 months. According to the American Orthopaedic Foot and Ankle Society standard, an excellent outcome was obtained in eight patients and a good outcome was obtained in seven patients. The operation time and intraoperative blood loss were significantly different between patients who did and did not undergo iliac crest bone graft surgery. Conclusion MISA is a simple and effective method for the treatment of TSA.


2020 ◽  
Author(s):  
Wei Shui ◽  
Youyin Yang ◽  
Xinling Pi ◽  
Gang Luo ◽  
Bo Qiao ◽  
...  

Abstract Background: Faster, easier, more economical and more effective versions of the minimally invasive reduction procedure for femoral shaft fractures need to be developed for use by orthopaedic surgeons. In this study, a fracture table was used to restore limb length, and long, curved haemostatic forceps and the lever principle were utilized to achieve minimally invasive reduction and intramedullary nail fixation of femoral shaft fractures.Methods: A retrospective analysis involving 20 patients with femoral shaft fractures reduced with a fracture table; long, curved haemostatic forceps; and the lever principle was conducted. The operative effect was evaluated on the basis of the operative time, reduction time, fluoroscopy time, and intraoperative blood loss.Results: All 20 cases were reduced in a closed fashion, and no conversions to open reduction were needed. The average operative time and fracture reduction time for all patients were 69.1±13.5 minutes (range, 50–100 minutes) and 6.7±1.9 minutes (range, 3–10 minutes). The fluoroscopy exposure time during the reduction process was 5–15 seconds, with an average time of 8.7±2.7 seconds. The average intraoperative blood loss was 73.5±22.5 mL (range, 50–150 mL). The patients exhibited excellent alignment in the injured limb after intramedullary nailing. Seventeen patients successfully completed a follow-up after fracture healing. The healing time ranged from 4 to 6 months.Conclusions: Displaced femoral shaft fractures in adults can be treated by a labour-saving lever technique involving fragments, 2 haemostatic forceps and soft tissue envelope-assisted closed reduction and intramedullary nail fixation. This technique is easy to perform; reduces blood loss, the fluoroscopy time and the surgical time for intraoperative reduction; and leads to excellent fracture healing.


2021 ◽  
Author(s):  
Kun He ◽  
Chunke Dong ◽  
Hongyu Wei ◽  
Feng Yang ◽  
Haoning Ma ◽  
...  

Abstract Background: Revision surgery of adjacent segment degeneration (ASD) commonly need to expose and remove the original fixation. In order to minimize the trauma, reduce the operation time and blood loss, we introduce a minimally invasive lumbar revision technique using cortical bone trajectory (CBT) screws assisted by three-dimensional(3D) printed navigation templates.Methods: From April 2017 to October 2019, 18 patients with ASD underwent revision surgery with CBT screws assisted by 3D-printed templates in our hospital. All the operation data, including operation time, blood loss, incision length were recorded. We evaluated the clinical efficacy using the visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the Japanese Orthopedic Association (JOA) score. X-ray and Computed Tomography (CT) scans were used to evaluate the stability of CBT screws fixation, the accuracy of screws, and the fusion rate.Results: The mean follow-up was 22.4±4.7 months (12-31m), the VAS, ODI, and JOA score were analyzed by SPSS 21.0 and showed significant improvement at 2-weeks and the last follow-up compared with preoperative data(P<0.05). 76 CBT screws were inserted with navigation templates, 2 screws were Grade B, other screws were all Grade 0 or A. Changes of intervertebral height showed good stability of CBT screws fixation(P>0.05). All the patients had satisfactory fusion results.Conclusion: Revision surgery of ASD with CBT screws assisted by 3D-printed navigation templates has satisfactory clinical efficacy with advantages of the short operation time, small incision, and less blood loss.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Wei Shui ◽  
Youyin Yang ◽  
Xinling Pi ◽  
Gang Luo ◽  
Bo Qiao ◽  
...  

Abstract Background Faster, easier, more economical and more effective versions of the minimally invasive reduction procedure for femoral shaft fractures need to be developed for use by orthopaedic surgeons. In this study, a fracture table was used to restore limb length, and long, curved haemostatic forceps and the lever principle were utilized to achieve minimally invasive reduction and intramedullary nail fixation of femoral shaft fractures. Methods A retrospective analysis involving 20 patients with femoral shaft fractures reduced with a fracture table; long, curved haemostatic forceps; and the lever principle was conducted. The operative effect was evaluated on the basis of the operative time, reduction time, fluoroscopy time, and intraoperative blood loss. Results All 20 cases were reduced in a closed fashion, and no conversions to open reduction were needed. The average operative time and fracture reduction time for all patients were 69.1 ± 13.5 min (range, 50–100 min) and 6.7 ± 1.9 min (range, 3–10 min), respectively. The fluoroscopy exposure time during the reduction process was 5–15 s, with an average time of 8.7 ± 2.7 s. The average intraoperative blood loss was 73.5 ± 22.5 mL (range, 50–150 mL). The patients exhibited excellent alignment in the injured limb after intramedullary nailing. Seventeen patients successfully completed a follow-up after fracture healing. The healing time ranged from 4 to 6 months. Conclusions Displaced femoral shaft fractures in adults can be treated by a labour-saving lever technique involving fragments, 2 haemostatic forceps and soft tissue envelope-assisted closed reduction and intramedullary nail fixation. This technique is easy to perform; reduces blood loss, the fluoroscopy time and the surgical time for intraoperative reduction; and leads to excellent fracture healing.


Author(s):  
Yuan-Wei Zhang ◽  
Xin Xiao ◽  
Wen-Cheng Gao ◽  
Yan Xiao ◽  
Su-Li Zhang ◽  
...  

Abstract Background This present study is aimed to retrospectively assess the efficacy of three-dimensional (3D) printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity. Material and methods Twenty-five patients (15 males and 10 females) with the cubitus varus deformity from June 2014 to December 2017 were included in this study and were enrolled into the conventional group (n = 11) and 3D printing group (n = 14) according to the different surgical approaches. The operation time, intraoperative blood loss, osteotomy degrees, osteotomy end union time, and postoperative complications between the two groups were observed and recorded. Results Compared with the conventional group, the 3D printing group has the advantages of shorter operation time, less intraoperative blood loss, higher rate of excellent correction, and higher rate of the parents’ excellent satisfaction with appearance after deformity correction (P < 0.001, P < 0.001, P = 0.019, P = 0.023). Nevertheless, no significant difference was presented in postoperative carrying angle of the deformed side and total complication rate between the two groups (P = 0.626, P = 0.371). Conclusions The operation assisted by 3D printing osteotomy guide plate to correct the adolescent cubitus varus deformity is feasible and effective, which might be an optional approach to promote the accurate osteotomy and optimize the efficacy.


BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chunxiao Wang ◽  
Yao Zhang ◽  
Xiaojie Tang ◽  
Haifei Cao ◽  
Qinyong Song ◽  
...  

Abstract Background The area which located at the medial pedicle, posterior vertebral body and ventral hemilamina is defined as the hidden zone. Surgical management of hidden zone lumbar disc herniation (HZLDH) is technically challenging due to its difficult surgical exposure. The conventional interlaminar approach harbors the potential risk of post-surgical instability, while other approaches consist of complicated procedures with a steep learning curve and prolonged operation time. Objective To introduce microscopic extra-laminar sequestrectomy (MELS) technique for treatment of hidden zone lumbar disc herniation and present clinical outcomes. Methods Between Jan 2016 to Jan 2018, twenty one patients (13 males) with HZLDH were enrolled in this study. All patients underwent MELS (19 patients underwent sequestrectomy only, 2 patients underwent an additional inferior discectomy). The nerve root and fragment were visually exposed using MELS. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. Results The mean follow-up period was 20.95 ± 2.09 (18–24) months. The mean operation time was 32.43 ± 7.19 min and the mean blood loss was 25.52 ± 5.37 ml. All patients showed complete neurological symptom relief after surgery. The VAS and ODI score were significantly improved at the final follow-up compared to those before operation (7.88 ± 0.70 vs 0.10 ± 0.30, 59.24 ± 10.83 vs 11.29 ± 3.59, respectively, p < 0.05). Seventeen patients (81%) obtained an “excellent” outcome and the remaining four (19%) patients obtained a “good” outcome based the MacNab criteria. One patient suffered reherniation at the same level one year after the initial surgery and underwent a transforaminal endoscopic discectomy. No major complications and postoperative instability were observed. Conclusions Our observation suggest that MELS is safe and effective in the management of HZLDH. Due to its relative simplicity, it comprises a flat surgical learning curve and shorter operation duration, and overall results in reduced disturbance to lumbar stability.


BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shou-qian Dai ◽  
Rong-qing Qin ◽  
Xiu Shi ◽  
Hui-lin Yang

Abstract Background Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat neurologically intact osteoporotic Kümmell’s disease (KD), but it is still unclear which treatment is more advantageous. Our study aimed to compare and investigate the safety and clinical efficacy of PVP and PKP in the treatment of KD. Methods The relevant data that 64 patients of neurologically intact osteoporotic KD receiving PVP (30 patients) or PKP (34 patients) were analyzed. Surgical time, operation costs, intraoperative blood loss, volume of bone cement injection, and fluoroscopy times were compared. Occurrence of cement leakage, transient fever and re-fracture were recorded. Universal indicators of visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated separately before surgery and at 1 day, 6 months, 1 year, 2 years and the final follow-up after operation. The height of anterior edge of the affected vertebra and the Cobb’s angle were assessed by imaging. Results All patients were followed up for at least 24 months. The volume of bone cement injection, intraoperative blood loss, occurrence of bone cement leakage, transient fever and re-fracture between two groups showed no significant difference. The surgical time, the operation cost and fluoroscopy times of the PKP group was significantly higher than that of the PVP group. The post-operative VAS, ODI scores, the height of the anterior edge of the injured vertebrae and kyphosis deformity were significantly improved in both groups compared with the pre-operation. The improvement of vertebral height and kyphosis deformity in PKP group was significantly better than that in the PVP group at every same time point during the follow-up periods, but the VAS and ODI scores between the two groups showed no significant difference. Conclusion PVP and PKP can both significantly alleviate the pain of patients with KD and obtain good clinical efficacy and safety. By contrast, PKP can achieve better imaging height and kyphosis correction, while PVP has the advantages of shorter operation time, less radiation volume and operation cost.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jianbiao Xu ◽  
Leiming Zhang ◽  
Rongqiang Bu ◽  
Yankang Liu ◽  
Kai-Uwe Lewandrowski ◽  
...  

Abstract Background Spondylodiscitis is an unusual infectious disease, which usually originates as a pathogenic infection of intervertebral discs and then spreads to neighboring vertebral bodies. The objective of this study is to evaluate percutaneous debridement and drainage using intraoperative CT-Guide in multilevel spondylodiscitis. Methods From January 2002 to May 2017, 23 patients with multilevel spondylodiscitis were treated with minimally invasive debridement and drainage procedures in our department. The clinical manifestations, evolution, and minimally invasive debridement and drainage treatment of this refractory vertebral infection were investigated. Results Of the enrolled patients, the operation time ranged from 30 minutes to 124 minutes every level with an average of 48 minutes. Intraoperative hemorrhage was minimal. The postoperative follow-up period ranged from 12 months to 6.5 years with an average of 3.7 years. There was no reactivation of infection in the treated vertebral segment during follow-up, but two patients with fungal spinal infection continued to progress by affecting adjacent segments prior to final resolution. According to the classification system of Macnab, one patient had a good outcome at the final follow-up, and the rest were excellent. Conclusions Minimally invasive percutaneous debridement and irrigation using intraoperative CT-Guide is an effective minimally invasive method for the treatment of multilevel spondylodiscitis.


2014 ◽  
Vol 20 (2) ◽  
pp. 150-156 ◽  
Author(s):  
Petr Vanek ◽  
Ondrej Bradac ◽  
Renata Konopkova ◽  
Patricia de Lacy ◽  
Jiri Lacman ◽  
...  

Object The main aim of this study was to compare clinical and radiological outcomes after stabilization by a percutaneous transpedicular system and stabilization from the standard open approach for thoracolumbar spine injury. Methods Thirty-seven consecutive patients were enrolled in the study over a period of 16 months. Patients were included in the study if they experienced 1 thoracolumbar fracture (A3.1–A3.3, according to the AO/Magerl classification), had an absence of neurological deficits, had no other significant injuries, and were willing to participate. Eighteen patients were treated by short-segment, minimally invasive, percutaneous pedicle screw instrumentation. The control group was composed of 19 patients who were stabilized using a short-segment transpedicular construct, which was performed through a standard midline incision. The pain profile was assessed by a visual analog scale (VAS), and overall satisfaction by a simple 4-stage scale relating to performance of daily activities. Working ability and return to original occupation were also monitored. Radiographic follow-up was defined by the vertebral body index (VBI), vertebral body angle (VBA), and bisegmental Cobb angle. The accuracy of screw placement was examined using CT. Results The mean surgical duration in the percutaneous screw group was 53 ± 10 minutes, compared with 60 ± 9 minutes in the control group (p = 0.032). The percutaneous screw group had a significantly lower perioperative blood loss of 56 ± 17 ml, compared with 331 ± 149 ml in the control group (p < 0.001). Scores on the VAS in patients in the percutaneous screw group during the first 7 postoperative days were significantly lower than those in the control group (p < 0.001). There was no significant difference between groups in VBI, VBA, and Cobb angle values during follow-up. There was no significant difference in screw placement accuracy between the groups and no patients required surgical revision. There was no significant difference between groups in overall satisfaction at the 2-year follow-up (p = 0.402). Working ability was insignificantly better in the percutaneous screw group; previous working position was achieved in 17 patients in this group and in 12 cases in the control group (p = 0.088). Conclusions This study confirms that the percutaneous transpedicular screw technique represents a viable option in the treatment of preselected thoracolumbar fractures. A significant reduction in blood loss, postoperative pain, and surgical time were the main advantages associated with this minimally invasive technique. Clinical, functional, and radiological results were at least the same as those achieved using the open technique after a 2-year follow-up. The short-term benefits of the percutaneous transpedicular screw technique are apparent, and long-term results have to be studied in other well-designed studies evaluating the theoretical benefit of the percutaneous technique and assessing whether the results of the latter are as durable as the ones achieved by open surgery.


Sign in / Sign up

Export Citation Format

Share Document