Arthroscopic Treatment of Osteochondral Lesions of the Talus Utilizing Juvenile Particulated Cartilage Allograft: A Case Series

The treatment options for osteochondral lesions of the ankle are scarce, and newer modalities are becoming available. We describe a minimally invasive arthroscopic approach with implantation of juvenile particulated allograft to facilitate the growth of true hyaline cartilage in patients with osteochondral lesions of the talus. The purpose of this study was to subjectively review clinical outcomes using the validated Foot and Ankle Outcomes Score in patients who underwent this technique. Our technique was performed on 82 consecutive patients with average follow-up of 24 (range 9 to 86) months. We found that 28 (88%) of 32 patients who responded to the questionnaire had good or excellent results for activities of daily living; 26 (82%) of 32 patients had at least a good result for both pain and symptoms; and 25 (78%) of 32 had at least a fair result for functional sports and quality of life.     

The two-stage excision of huge acoustic neurinomas.

Total removal of huge acoustic neurinomas was carried out in 23 patients by means of a two-stage suboccipital transmeatal approach with microsurgical technique. There was no operative mortality. Good results were obtained in 18 (78%) of the patients who have returned to normal activities or full-time employment. Five patients (22%) have residual preoperative neurological deficits causing a reduced level of activity. All of these, except one, are able to care for themselves. None of the patients has had any further significant neurological deficit caused by the operative procedures. Anatomical integrity of the facial nerve was maintained in 17 patients (74%). Surgical technique, operative morbidity, and results are thoroughly discussed. The potential advantages of this technique are stressed.     

Patient and technique survival among an urban population of peritoneal dialysis patients: an 8-year experience

Estimates of patient and technique survival are given for 146 peritoneal dialysis (PD) patients who underwent dialysis between January 1, 1981 through December 31, 1989. In all, 33 patients died and 44 patients changed treatment. Patient survival was 92% at 1 year, 80% at 2 years, and 55% at 4 years, while technique survival was 85% at 1 year, 74% at 2 years, and 47% at 4 years. Cox's proportional hazards regression model was used to assess the effects of sex, age, diabetes, cardiovascular disease (CVD), education, and training time on both patient and technique survival. Both patient age (P = 0.001) and CVD (P = 0.03) had a significant impact on patient survival. On the average, for every 10 years' increase in age, the risk of death increased by a factor of 1.71. Patients with CVD had a risk of death 2.57 times higher than the risk of death among patients without CVD. With respect to technique or method survival, black patients had a risk of changing treatment 2.24 times higher than that for white patients. Our patient and technique survivals are similar to that reported in the national CAPD registry over a comparable period (1981 to 1988).     

Comparative morbidity of axillary lymph node dissection and the sentinel lymph node technique: implications for patients with breast cancer

OBJECTIVE: To assess our long-term complications from complete axillary lymph node dissection (AXLND) in patients with breast cancer. SUMMARY BACKGROUND DATA: Complete AXLND as part of the surgical therapy for breast cancer has come under increased scrutiny due the use of the sentinel lymph node (SLN) biopsy technique to assess the status of the axillary nodes. As the enthusiasm for the SLN technique has increased, our impression has been that the perceived complication rate from AXLND has increased dramatically while the negative aspects of the SLN technique have been underemphasized. METHODS: Female patients seen in routine follow-up over a 1-year period were eligible for our retrospective study of the long-term complications from AXLND if they were a minimum of 1 year out from all primary therapy; ie, surgery, radiation, and/or chemotherapy. All patients had previously undergone either a modified radical mastectomy (MRM) or a segmental mastectomy with axillary dissection and postoperative radiation (SegAx/XRT). All patients had a Level I-III dissection. Objective measurements, including upper and lower arm circumferences and body mass index (BMI), were obtained, and a subjective evaluation from the patients was conducted. RESULTS: Ninety-four patients were eligible for our study; 44 had undergone MRM, and 50 had undergone SegAx/XRT. The average number of nodes removed was 25.6 (standard deviation, 8). Thirty-three percent of the patients had positive nodal disease, 95% of the patients had an upper arm circumference within 2 cm of the unaffected side, and 93.3% had a lower arm circumference within 2 cm of the unaffected side. Subjectively, 90.4% of the patients had either no or minimal arm swelling, and 96.8% of the patients had "good" or "excellent" overall arm function. The most common long-term symptom was numbness involving the upper, inner aspect of the affected arm (25.5%). CONCLUSIONS: Our data indicate that a complete AXLND can be performed with minimal long-term morbidity. The lower the morbidity of AXLND, the less acceptable are the unique complications of the SLN technique.     

Simultaneous carotid endarterectomy and coronary revascularization

BACKGROUND: Combined cardiac operation and carotid endarterectomy using our technique is an acceptable approach to simultaneous correction of both carotid and cardiac disease. METHODS: From August 1989 to March 1998, 121 consecutive patients underwent combined operations. Of these patients, 112 had coronary artery bypass grafting and carotid endarterectomy, and 9 had coronary artery bypass grafting, carotid endarterectomy, and valve repair or replacement. All patients had a critical stenosis of 85% or more of the carotid artery. Mean age of the patients was 69.2 years; 80 patients were 65 years old or older. There were 88 men and 33 women. Notable risk factors included chronic obstructive pulmonary disease (19.8%), congestive heart failure (28%), preoperative myocardial infarction and unstable angina (66.9%). Of the patients, 20.7% had a stenosis of greater than 50% of the left main coronary artery. The technique used was correction of both the carotid and coronary lesions during a single aortic cross-clamp period using retrograde continuous blood cardioplegia for myocardial protection. Systemic hypothermia to 25 degrees C was used for cerebral protection. RESULTS: Mean cross-clamp time was 118 minutes. Seven patients (5.8%) sustained perioperative cerebrovascular accidents. Two patients had transient ischemic attacks. The procedure-related mortality rate was 5.8%. CONCLUSIONS: The described technique is a good method for simultaneous repair of coronary and carotid lesions in a high-risk group of patients with concomitant disease. We will continue to use it.     

Transabdominal total fundoplication gastroplasty to control reflux: a preliminary report

Transthoracic total fundoplication gastroplasty has been reported as having a low mortality and a 1.1% recurrence rate and to produce excellent results in 93.1% of patients, moderate results in 3.7% and poor results in only 2.8% of patients. In approximately 7.0% intercostal neuritis is a serious residual problem. The transabdominal total fundoplication gastroplasty uses the identical repair technique but avoids the chest-wall pain. Previous esophageal or gastric surgery and major esophageal shortening are contraindications to an abdominal approach. The authors report their results with 50 patients who underwent transabdominal total fundoplication gastroplasty and were followed up for 6 to 20 months. There was no mortality or major morbidity. Clinical follow-up was complete, 94% of patients were assessed by roentgenography and 72% by manometry. None had anatomic recurrence, 46 (92%) were asymptomatic and 4 (8%) had minor residual gastric symptoms of fullness or occasional epigastric pain. All were much improved and none had wound pain. Long-term follow-up of transabdominal total fundoplication gastroplasty is necessary; however, since the technique of repair is identical to the thoracic approach, the results should be similar.     

Fluorine-18 fluorodeoxyglucose-position emission tomography: a highly accurate imaging modality for the diagnosis of chronic musculoskeletal infections

BACKGROUND: The noninvasive diagnosis of chronic musculoskeletal infections remains a challenge. Recent studies have indicated that fluorine-18 fluorodeoxyglucose-positron emission tomography is a highly accurate imaging technique and is significantly more accurate than the combination of a bone scan and a white blood-cell scan for the diagnosis of chronic infection in the central skeleton (p < 0.05). However, patients who had had surgery within the previous two years were excluded from study. It was our aim to evaluate the technique in an unselected, clinically representative population. METHODS: Sixty patients with a suspected chronic musculoskeletal infection involving the central skeleton (thirty-three patients) or the peripheral skeleton (twenty-seven patients) were studied with fluorine-18 fluorodeoxyglucose-positron emission tomography. Thirty-five patients had had surgery within the previous two years. The fluorine-18 fluorodeoxyglucose-positron emission tomography studies were read in a blinded, independent manner by two experienced readers. The final diagnosis was based on histopathological studies or microbiological culture (eighteen patients) or on clinical findings after at least six months of follow-up (forty-two patients). RESULTS: On the final composite assessment, twenty-five patients had infection and thirty-five did not. All twenty-five infections were correctly identified by both readers. There were four false-positive findings; in two of these cases, surgery had been performed less than six months prior to the study. The sensitivity, specificity, and accuracy were 100%, 88%, and 93% for the whole group; 100%, 90%, and 94% for the subgroup of patients with a suspected infection of the central skeleton; and 100%, 86%, and 93% for the subgroup of patients with a suspected infection of the peripheral skeleton. Interobserver agreement was excellent (kappa = 0.97). CONCLUSIONS: Fluorine-18 fluorodeoxyglucose-positron emission tomography is highly accurate as a single technique for the evaluation of chronic musculoskeletal infections. It is especially valuable in the evaluation of the central skeleton, where white blood-cell scans are less useful. Because of its simplicity and high degree of accuracy, it has the potential to become a standard technique for the diagnosis of chronic musculoskeletal infections. Further studies are needed to assess its ability to identify infections at the sites of total joint replacements and to distinguish infection from aseptic loosening of these prostheses.     

U-stitching splenorraphy technique: experimental and clinical study

BACKGROUND: The aim of the present study was to describe the laboratory development and the subsequent clinical utility of the U-stitching technique for splenorraphy over the recent years in a general non-trauma hospital. Patients with splenectomies and patients treated conservatively during the same time period, are also presented. METHODS: In the 15-year period from September 1988 until September 2003, 65 patients were diagnosed with splenic injury following admission to 2nd Department of Surgery, Democritus University Hospital, after blunt abdominal trauma. During the first 3 years, 14 patients were admitted; one of them was treated conservatively and 13 had splenectomies. Because computed tomography (CT) was not available at that time, these 14 patients form a control group. During the remaining 12-year period, 51 patients (39 male and 12 female; age, 4-82 years; mean, 31.1 years; SD, 19.7 years) were treated conservatively or surgically, either with splenectomy or with splenorraphy. Splenorraphy was performed using the U-stitching technique. This alternative splenorraphy technique was first tested on experimental models at 2nd Department of Surgery, Democritus University Hospital, then followed by successful clinical application. The medical records for these patients were reviewed to extract the data for the present study. RESULTS: Thirty-six patients (70.6% of 51 patients) were treated surgically; of these, 21 (41.2% of 51 patients) had splenectomy and 15 (29.4% of 51 patients) had splenorraphy. Non-operative treatment was initially given to 15 patients (29.4% of 51 patients). Two of them had delayed rupture of the spleen and underwent splenectomy (at 8 and 40 days). The total number of preserved spleens was 28 of 51 (54.9%). None of the patients with conservative treatment or splenorraphy died. One patient with splenectomy died later from overwhelming sepsis. CONCLUSIONS: Splenic salvage is now a treatment goal. If the patient is haemodynamically unstable and splenorraphy is possible, the U-stitching technique is a promising approach.     

The simplified single patch repair of complete atrioventricular septal defect

Between May 1995 and November 2003, 88 consecutive patients referred to 2 consultant cardiac surgeons (GN and IN) for repair of complete AVSD had this technique used. The mean age at operation was 8.3 months (median 3.3 months, range 1 to 40 months). The mean weight at operation was 5.7 kg (range 2.3 to 16.8). Down syndrome was present in 63 patients (71.6%).The size of the ventricular septal defect was graded on preoperative echocardiography by cardiology review as restrictive (14 patients), moderate (21 patients), or large (47 patients). All patients had the described technique performed with no modifications, regardless of the size of the ventricular component.Nine patients had associated tetralogy of Fallot or pulmonary atresia anatomy. These patients were all initially treated with modified Blalock Taussig GoreTex shunts. Later repair of tetralogy (2 patients) or construction of RV-PA conduit (7 patients) at the time of AVSD repair was performed.Four patients had pulmonary artery banding due to small size and later had debanding and complete AVSD repair.There were 3 early deaths (3.4%). All 3 had other associated surgery at the time of AVSD repair (1 tetralogy repair, 1 RV-PA conduit for pulmonary atresia, and one aortic and pulmonary valvotomy for aortic stenosis and pulmonary stenosis).Of the survivors, post procedure echocardiography revealed mild or less mitral regurgitation in 73 patients (86%), moderate regurgitation in 7 (8%), and severe in 1 patient. Follow-up was performed on 78 of the 85 survivors at a median of 30 months (mean 36 months, range 0 to 97 months). Two patients required mitral valve replacement (2.5%). One of these patients had severe and one moderate mitral regurgitation recorded at initial post AVSD repair echocardiography. Of the remaining patients, 73 had mild or less mitral regurgitation (93.5%) and 3 had moderate regurgitation (4%).In general, this technique has lead to reduced cross clamp times and overall bypass time in our hands. It effectively eliminates an extra suture line used in other techniques. We have had good mitral valve function postoperatively and have not seen significant left ventricular outflow tract obstruction despite our initial theoretical concerns. We have applied this simplified technique to all of our AVSD patients regardless of size of ventricular defect.     

Evaluation of direct versus non-refluxing technique and functional results in orthotopic Y-ileal neobladder after 12 years of follow up

OBJECTIVES: We report on the long-term functional results of the orthotopic Y-ileal neobladder and compare the outcome of the antireflux technique for ureteral implantation versus direct anastomosis. PATIENTS AND METHODS: Between 1990 and 2002, 120 patients underwent cystoprostatectomy and orthotopic Y-shaped ileal neobladder for invasive bladder carcinoma. The direct Nesbit technique for ureteral reimplantation was applied in 58 patients (group 1) and in 62 patients the ureters were reimplanted using the Le Duc antirefluxing technique (group 2). The mean follow-up period was 72 months (range, 36-144 months). RESULTS: Of 62 patients who underwent the Le Duc technique, six (9.7%) had unilateral uretero-ileal anastomotic stricture and four (6.5%) had reflux. Of 58 patients who underwent direct anastomosis, six (10.3%) patients had unilateral reflux, four of them had dilated ureters preoperatively and no patient had uretero-ileal anastomotic stricture. The incidence of stricture formation in the Le Duc technique is significantly higher than direct anastomosis (P = 0.04). There was no significant difference in the overall incidence of reflux in both groups. However, the incidence of reflux in preoperatively dilated ureters was significantly higher in direct ureteral anastomosis than Le Duc technique (40% in group 1 vs 16.7% in group 2; P = 0.045). The incidence of stone formation, azotemia, pyelonephritis and bacteriuria was comparable in both groups. The urodynamic findings showed a mean increase in the neobladder capacity at 6 and 18 months after surgery by 340 and 560 mL, respectively. The mean of the maximum pressure was 22 +/- 10 cm H2O, 18 months after surgery. Daytime and nighttime continence was good or satisfactory in 93.3% and 85.5% of the patients, respectively, after 3 years of follow-up. CONCLUSIONS: The functional and voiding results of a Y-shaped neobladder pouch using 40 cm of ileum are similar to the more sophisticated larger pouches. Direct uretero-ileal anastomosis in orthotopic bladder replacement is more reasonable than the Le Duc antireflux technique in non-dilated ureters. The benefit of the antireflux technique has been overestimated despite of the frequency of stricture formation.     

Comparison of Stamey and Pereyra-Raz bladder neck suspensions

Endoscopic bladder neck suspension has become one of the more popular methods of surgical treatment of stress incontinence. The Pereyra technique was first described in 1959 and modified by Raz in 1981. Stamey first described his technique in 1973 and this has been modified in a number of ways. The reported cure rates are 54 to 94% for the Pereyra-Raz procedure and 61 to 92% for the Stamey procedure. We present a comparative review of the technical results of treatment of 30 patients with a modified Stamey procedure and 17 patients with a modified Pereyra-Raz technique. The age range of the 2 groups was comparable. A successful result, with either complete continence or only minor occasional leaks after surgery, was achieved in 80% with the Stamey techniques and 76% with the Pereyra technique. Those patients not helped by the procedure had nearly all undergone previous surgery for incontinence. The Pereyra technique was used more frequently in patients who had failed previous incontinence surgery (including the Stamey technique). Complications were minor; 5 buffer infections occurred (3 buffers were removed). Both techniques offer a significant improvement in continence, but previous surgery is associated with a higher failure rate.     

Surgical therapy of cystic echinococcosis of the liver

This study analyses the results of a surgical deroofing technique that was used for the treatment of cystic echinococcosis of the liver in our institution during the last 18 years. The deroofing technique was used on 106 of 132 patients from January 1981 to December 1998. Other operative techniques (pericystectomy, hemihepatectomy) were performed on 26 patients. In 12 cases (9%) the operative procedure was completed by interventions at the extrahepatic bile ducts. 99 patients (75%) showed one or two cysts, and the remaining 33 patients (25%) had three or more cysts in the liver. 18 (14%) patients had to be reoperated on account of complications: in 5 cases a postoperative hemorrhage, in 11 cases a bile duct leakage and in 2 cases an intraabdominal abscess had to be treated operatively. The follow-up of 74 patients (81%) revealed recurrent disease in 14 (19%) cases. Surgical deroofing of cystic echinococcosis of the liver is easy to perform and in contrast to other minor surgical interventions universally applicable. The recurrence rate and the rate of postoperative complications are comparable to other minor surgical techniques. Therefore in our view this procedure represents the therapy of choice.     

Open versus arthroscopic treatment of chronic rotator cuff impingement

We report the results of 238 consecutive patients who underwent in total 261 acromioplasties because of chronic rotator cuff impingement. The procedure was performed either in conventional open technique (80) or arthroscopically (181). Two years (1–10) after the operation 68% of the patients treated with the open technique had an excellent or good result compared 82% of the patients treated arthroscopically by an experienced arthroscopic surgeon. Compared to the open technique, the arthroscopic procedure had a statistically significant superior result concerning outcome, operating time and hospital stay. Arthroscopic procedures performed by less experienced surgeons had inferior results. Received: 3 July 2000     

Fontan type operation for complex lesions. Surgical considerations to improve survival

Twenty-five of 49 patients who underwent a Fontan type operation had complex lesions other than tricuspid atresia with ventriculoarterial concordance. Three patients had significant subaortic stenosis. Thirty-four palliative operations, including nine Glenn shunts, were performed before the Fontan operation. Direct atriopulmonary anastomosis was performed in 21 patients. In four, valved conduits were used. Twelve patients had right atrioventricular valve patch closure (three had running and nine had interrupted suture technique). On the basis of the presence of increased or decreased pulmonary blood flow before any surgical intervention, patients were divided into Group 1 (previous pulmonary artery banding, N = 8) and Group II (pulmonic stenosis, N = 17). Postoperatively, in Group I, 87% had significant effusions, mean right atrial pressure was higher (20.6 +/- 6.5 torr), and hospital stay longer (31 days). In Group II, 40% had significant effusions, mean right atrial pressure was lower (16.5 +/- 4.3 torr), and hospital stay shorter (15 days). Significant atrioventricular valve patch disruption occurred in three patients (two had running suture technique), and conduit occlusion occurred in two. Four patients (three with subaortic stenosis and pulmonary artery banding) without an established Glenn shunt required Fontan takedown for persistent low cardiac output, two of whom died (2/25 or 8%). There were three late deaths (3/23 or 13%). Nineteen of 20 surviving patients observed from 2 months to 6 years are doing well. We believe that early Fontan takedown in patients with persistent low cardiac output, interrupted suture technique for atrioventricular valve closure, avoidance of valved conduits, and a preliminary Glenn shunt in patients with pulmonary artery banding and/or subaortic stenosis can further improve the results with the Fontan operation for complex lesions.     

Total hip arthroplasty in adult patients who had developmental dysplasia of the hip

This study evaluated the hypothesis that the clinical results are equivalent in the group of patients with dysplasia, low dislocation, and high dislocation types using a contemporary technique for hip arthroplasty. The mean age of patients at the time of the index operation was 49.5 years (range, 29-61 years). Thirty patients (40 hips, 35%) had dysplasia, 22 (34 hips, 29%) had a low dislocation, and 24 (42 hips, 36%) had a high dislocation. The mean follow-up was 9.7 years (range, 6-14 years). In the high dislocation group, 7 hips (17%) had a revision of one or both component. In low dislocation group, 3 hips (9%) had a revision of one or both components. In the dysplastic group, 2 hips (5%) had a revision of one or both components.     

Placard-shaped in situ vaginal wall sling for the treatment of stress urinary incontinence

PURPOSE: To evaluate the efficacy of a simple and economic procedure using a placard-shaped in situ anterior vaginal wall sling for the treatment of stress urinary incontinence, with or without cystocele repair. METHODS: From July 2003 to July 2004, 14 female patients (mean age 45.21 years, range 37-57) were operated upon because of stress urinary incontinence (SUI) with the placard-shaped in situ anterior vaginal wall sling technique. The average follow-up period was 11 months (range 4-14.5 months). Twelve patients were operated primarily with this technique and only two patients had undergone previous surgeries for the treatment of SUI (one patient had had two previous surgeries and the other had had one previous surgery). In all patients urethral hypermobility or/and bladder prolapse were observed. Filling cystometry showed sufficient bladder capacity with no detrusor overactivity. RESULTS: No urinary retention was observed in any patient in the postoperative period. While 11 patients have 100% cure of incontinence, three patients started leakage of urine after 1-2 months after the operation (one patient had been operated upon twice before (and who was diabetic and obese) and two patients were primarily repaired by our technique). In two patients, suprapubic tenderness and redness were observed, and were treated by oral antibiotic and anti-inflammatory drugs. CONCLUSION: The placard technique is simple, cost-effective and has low incidence of urinary retention in the post-operative period. The success rate seems to be satisfactory and it can be applicable to patients who are primary cases of SUI with average body mass index. Yet longer term follow up and larger number of patients are needed before final conclusion can be drawn.     

Clinical efficacy of lumbar and lumbosacral fusion using the Boucher facet screw fixation technique

The clinical outcome of posterolateral lumbar and lumbosacral fusions with facet screw fixation using the Boucher technique is reviewed retrospectively. The Boucher technique uses AO cortical screws that traverse the facet joint at an angle from the superior lamina, in a medial to lateral direction, to enter the respective inferior pedicle. The procedure was performed on 57 consecutive patients who had a degenerative disk disease. The pre-operative diagnosis was based on a physical examination and radiographs with myelography performed when deemed necessary. Surgery had been indicated and performed on patients with unresolved pain after 6 months of conservative therapy; radiographic signs of disk space narrowing, facet arthrosis, degenerative spondylolisthesis or instability on flexion and extension views. No prior history of spinal surgery, no involvement in any litigation or Workers Compensation process, and no detected psychiatric disturbances were also inclusion criteria for this study. Eighteen consecutive male and 39 consecutive female patients were included in the study. The average age at the time of surgery was 41.8 years. The mean active clinical follow-up (office visits) time was 5.06 months with the minimum follow-up time of 3 months. Two years after their surgery, all the patients were asked to fill out a questionnaire from which their progress was evaluated. All questionnaires were completed and returned. Postoperatively, patients were placed in either a lumbosacral corset, short rigid lumbosacral molded polypropylene brace or body cast. Overall clinical results for single level fusions showed that 91.2% of patients (31 of 34) had excellent results and 8.8% (3 of 34) had poor results. Of the multiple level fusions, 86.4% of patients (19 of 22) had excellent or good results and 9.1% (2 of 22) had poor results. Post-operative complications included only three wound infections at the iliac crest donor site. This study demonstrates that facet screw fixation using the Boucher technique has advantages. The technique not only is easy to implement by placing a small screw through a facet joint and it's respective pedicle, but produces excellent clinical results that are comparable to the other more bulky spinal instrumentation systems.     

90°以上脊柱侧凸的手术策略及方法

目的　探讨使用后路三维矫正技术治疗90°以上脊柱侧凸的手术策略,并评价其疗效。　方法　自1997年起治疗90°以上脊柱侧凸72例,其中特发性侧凸48例,非特发性侧凸24例。62例先行一期前路脊柱松解或支撑性融合或骨骺阻滞,术后Halo牵引14d,行二期后路三维矫正术（CD、CD-Horizon和TSRH）。另10例直接行一期后路矫正术。在后路手术中,对前突型胸椎侧凸,先从凹侧开始纠正;对腰椎侧凸、胸腰椎侧凸或后突型胸椎侧凸,则从凸侧开始纠正,按标准化去旋转原理或水平横向原理矫正32例,采用多棒分段技术矫正40例。　结果　72例患者无1例死亡;1例出现暂时性神经功能障碍,9例术中横突或关节突骨折。随访7～34个月,均未出现假关节或脱钩断棒,2例发生失偿。72例冠状面平均矫正58％,40例有术前矢状面形态异常者有32例完全达矢状面重建,余8例有56％纠正,术后身高增加4～15　cm。随访时间在1年以上的47例平均冠状面纠正丢失6°,矢状面无纠正丢失。　结论　后路三维矫正技术对严重脊柱侧凸可达到满意的纠正,对躯干平衡的重建更优;适当前路松解和多棒分段矫正技术以及SEP监护可减少神经并发症的发生。     

结石嵌顿性胆囊炎腹腔镜手术的临床体会

目的：探讨不同病理状态下结石嵌顿性胆囊炎腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）的临床应用价值。方法：回顾分析1999年3月至2007年2月427例结石嵌顿性胆囊炎患者行腹腔镜手术的临床资料。结果：腹腔镜手术成功409例,成功率95．78％,中转开腹18例,中转率4．22％。术中出血1例,术后并发胆漏2例,胆道残余结石3例,切口感染3例,并发症发生率2．11％,无胆道损伤,无死亡病例。结论：LC治疗结石嵌顿性胆囊炎是安全、可行的。须严格掌握适应证、手术时机、手术技巧,适时中转手术是提高手术成功率、降低并发症的关键。     

Laparoscopic Treatment of Nonparasitic Liver Cysts: Adequate Selection of Patients and Surgical Technique

Results of laparoscopic fenestration in patients with a highly symptomatic solitary liver cyst (17 patients) or polycystic liver disease (PLD) (9 patients) were prospectively evaluated in a multicenter practice of general surgeons. Conversion to laparotomy was required in two patients because of inaccessible deep liver cyst in one and a diffuse form of PLD in the other. There was no mortality or major morbidity. Mean postoperative hospital stay was 4.6 days after successful laparoscopic procedures. During a mean follow-up of 9 months, 23% of the patients had recurrence of symptoms and 38% had radiographic reappearance of cysts. Factors predicting failure included previous surgical treatment, deep-sited cysts, incomplete deroofing technique, location in the right posterior segments of the liver, and a diffuse form of PLD with small cysts. Adequate selection of patients and type of cystic liver disease and meticulous and aggressive surgical technique are recommended.