Rates of medial and lateral row failure and risk factors for Re-tear in arthroscopic double row rotator cuff repair

A common postoperative complication after rotator cuff repair is re-tear requiring a secondary procedure. Double row and trans-osseous equivalent repair techniques have become increasingly popular in recent years, however repair failure remains a relatively common complication after primary rotator cuff repair. A retrospective observational study of 389 consecutive patients undergoing arthroscopic double-row rotator cuff repair from February 1, 2014 to March 31, 2020 was conducted. Univariate and multivariate statistics were used to assess differences in demographics, comorbidities, and tear characteristics between patients who experienced re-tear and those who did not. Repair failures were confirmed by plain MRI or intraoperatively during repeat surgical treatment. A subgroup analysis of patients who experienced re-tear due to medial row failure was conducted. The overall re-tear rate was 8.2% (32 patients). Six patients (1.5%) experienced medial row failure, while 26 patients (6.7%) experienced lateral row failure. The average time to re-tear was 279.3 ± 291.2 days. On multivariate analysis, patients with Goutallier Classification ≥3 (OR: 4.274, p = 0.046) and 3 anchor repair (OR: 5.387, p = 0.027) were at significantly increased risk for any re-tear after controlling for other tear characteristics. No statistically significant independent risk factors for medial row failure were identified after controlling for confounding variables. Goutallier classification greater than 3 and a primary repair with 3 anchors are significant risk factors for re-tear after double row rotator cuff repair, however they are not associated with increased occurrence of medial row failure. Further evaluation of risk factors for medial row failure is required to avoid this rare but serious re-tear pattern.     

双Endobutton钢板与锁骨钩钢板内固定治疗Rockwood Ⅲ～Ⅴ型肩锁关节脱位的疗效比较

目的比较双Endobutton钢板技术与锁骨钩钢板内固定治疗RockwoodⅢ~Ⅴ型肩锁关节脱位的中期疗效。方法回顾性分析自2009-06—2014-05分别采用双Endobutton钢板与锁骨钩钢板内固定治疗的40例RockwoodⅢ~Ⅴ型肩锁关节脱位。比较2组术后3个月、1年的患肩疼痛视觉模拟评分(VAS)、Constant肩关节功能评分。结果 40例术后均随访满1年。Endobutton钢板组手术时间长于锁骨钩钢板组,差异有统计学意义(P0.05)。术后3个月Endobutton钢板组的Constant评分及VAS评分均优于锁骨钩钢板组,差异有统计学意义(P0.05);但2组术后1年Constant评分及VAS评分比较差异无统计学意义(P0.05)。2组术后1年Constant评分及VAS评分均优于术后3个月,差异有统计学意义(P0.05)。术后1年Endobutton钢板组1例出现复位丢失,1例出现肩部疼痛;锁骨钩钢板组未出现复位丢失,但5例肩部疼痛。结论双Endobutton钢板内固定治疗RockwoodⅢ~Ⅴ型肩锁关节脱位的中期效果与锁骨钩钢板内固定并无明显差异,但Endobutton钢板内固定对肩关节功能影响小、术后肩痛发生率低、内固定不必取出。     

Prenatal Sonography in Suspected Proximal Gastrointestinal Obstructions: Diagnostic Accuracy and Neonatal Outcomes

BackgroundThe purpose of this study was to assess diagnostic accuracy and neonatal outcomes in fetuses with a suspected proximal gastrointestinal obstruction (GIO).MethodsAfter IRB approval, a retrospective chart review was conducted on prenatally suspected and/or postnatally confirmed cases of proximal GIO at a tertiary care facility (2012–2022). Maternal-fetal records were queried for presence of a double bubble ± polyhydramnios, and neonatal outcomes were assessed to calculate the diagnostic accuracy of fetal sonography.ResultsAmong 56 confirmed cases, the median birthweight and gestational age at birth were 2550 g [interquartile range (IQR) 2028–3012] and 37 weeks (IQR 34–38), respectively. There was one (2%) false-positive and three (6%) false-negatives by ultrasound. Double bubble had a sensitivity, specificity, positive predictive value, and negative predictive value for proximal GIO of 85%, 98%, 98%, and 83%, respectively. Pathologies included 49 (88%) with duodenal obstruction/annular pancreas, three (5%) with malrotation, and three (5%) with jejunal atresia. The median postoperative length of stay was 27 days (IQR 19–42). Cardiac anomalies were associated with significantly higher complications (45% vs 17%, p = 0.030).ConclusionsIn this contemporary series, fetal sonography has high diagnostic accuracy for detecting proximal gastrointestinal obstruction. These data are informative for pediatric surgeons in prenatal counseling and preoperative discussions with families.Level of EvidenceDiagnostic Study, Level III.     

眶隔固定切开法重睑术和经典切开法重睑术的效果比较

比较眶隔固定切开法重睑术和经典切开法重睑术的效果。方法 选取2021年1月-2022年12月于我院拟行切开重睑术的60例患者为研究对象,按照随机数字表法分为常规组与观察组,每组30例。常规组予以经典切开法重睑术,观察组予以眶隔固定切开法重睑术,比较两组术后形态改善情况、并发症发生情况及满意度。结果 观察组术后总改善率为100.00%,高于常规组的66.67%（P ＜0.05）;观察组并发症发生率为3.33%,低于常规组的20.00%（P ＜0.05）;观察组满意度为96.67%,高于常规组的66.67%（P ＜0.05）。结论 眶隔固定切开法重睑术可有效改善患者术后重睑形态,提高满意度,是一种安全性较高的术式。     

门静脉主干缩窄法制备SD大鼠门静脉高压症模型时最佳口径的探讨

目的 探讨缩窄门静脉主干法制备SD大鼠门静脉高压症模型时的最佳缩窄口径.方法 SD大鼠70只,随机分为正常组和6个实验组,每组各10只.正常组行假手术.各实验组分别按照5、6、7、8、9、12号针头的缩窄口径行门静脉主干缩窄术.观察各组大鼠术后累积死亡率,术后状态,术前、术后即刻及术后2周时的门静脉压力,术后2周时的食管组织学变化和脾指数.结果 5、6、7、8、9、12号针头缩窄组术后3 d时大鼠的累积死亡率分别为100%、80%、70%、20%、10%、0%,与缩窄程度正相关.8、9、12号组的大鼠存活状态明显好于5、6、7号组.5、6、7、8、9、12号组术后即刻门静脉压力分别为:(5.836±0.275)、(4.557±0.419)、(3.856±0.576)、(3.343±0.433)、(2.708±0.309)、(1.957±0.358)kPa,7、8、9、12号组术后2周时门静脉压力分别为:(2.163±0.424)、(1.956±0.172)、(1.841±0.202)、(1.232±0.154)kPa,均较正常(0.881±0.165)kPa显著升高(P＜0.05).术后2周,7、8、9、12号组大鼠食管下段黏膜下层平均血管数目分别为:(3.94±0.83)、(3.58±0.63)、(3.14±0.64)、(2.02±0.62)个,与正常组(1.65±0.62)个比较,除12号组外均有增多(P＜0.01);固有层平均血管数目分别为:(2.24±0.64)、(2.05±0.29)、(1.52±0.28)、(0.93±0.19)个,与正常组(0.82±0.18)比较,除第12组外均增多(P＜0.01);黏膜下层血管口径分别为:(4.52±1.51)、(4.05±1.23)、(3.75±1.11)、(2.03±0.86)μm,除第12组外均增大(P＜0.01);脾指数分别为:(4.21±0.93)、(4.06±0.68)、(3.84 4±0.71)、(3.31±0.69)除12号组外也较正常增加(P＜0.01).结论 缩窄门静脉主干可成功制成大鼠门静脉高压症模型;其最佳缩窄口径应该是:大鼠体重200 g左右时用8号针头(直径0.8mm),大鼠体重300 g左右时用9号针头(直径0.9 mm).     

Double breasting repair of urethral fistula in a patient with perineal abscess secondary to a large urethral stone

We report here a case of urethral fistula managed successfully following incision and drainage for the urethral abscess secondary to a large urethral stone leading to a large diverticulum (another rare condition) by using the technique of double breasting, where we used the redundant urethra and overlying skin.     

Evaluation of the role of varicocelectomy including external spermatic vein ligation in patients with scrotal pain

OBJECTIVES: The aim of the present study was to assess and compare pre- and postoperative scrotal pain in patients with varicocele who underwent varicocelectomy with different approaches. METHODS: The study included 144 consecutive patients with left-sided varicocele who had left scrotal pain for more than 3 months. All patients underwent varicocele ligation using either a subinguinal or inguinal approach with or without external spermatic vein ligation. We asked the patients to complete an 'Assessment Questionnaire for Scrotal Pain' both before and after the surgery. RESULTS: The surgery was successful in 101 (83.4%) of the 121 patients available for follow up. Seventy-four (61.1%) patients reported the complete resolution of pain while 27 patients (22.3%) reported partial resolution. Symptoms worsened in a single case and pain persisted postoperatively in 19 cases (15.7%). There were no statistically significant differences in the characteristics of the pain and grade of varicocele between postoperative groups. A significant difference was observed in postoperative success between patients who had external spermatic vein ligation and those who did not, regardless of the surgical approach (inguinal or subinguinal). All patients who reported complete or partial resolution of pain stated that they would recommend surgery to relatives with the same problem. CONCLUSIONS: Varicocelectomy using either inguinal or subinguinal approaches is an effective and reasonable treatment option in this patient group and should include external spermatic vein ligation for a satisfactory outcome.     

肛门缝扎器在混合痔黏膜环切吻合术中的应用

将60例混合痔患者随机分为两组,治疗组30例采用自制肛门缝扎器治疗,对照组30例采用普通肛门缝扎器治疗,并对两组进行对比观察。结果两组患者均一次性治愈,但治疗组平均荷包缝合时间、平均需缝扎止血点均少于对照组（P〈0．01,P〈O．05）。结果表明,自制肛门缝扎器做荷包缝合的时间明显缩短,出血点较少,且操作简单,使用方便。     

超声多普勒引导下痔动脉结扎加悬吊术治疗痔14例疗效观察

为观察超声多普勒引导下痔动脉结扎加悬吊术治疗痔的临床疗效及安全性,我们运用痔动脉超声多普勒诊断仪治疗痔患者14例,其中混合痔5例,Ⅰ期内痔3例,Ⅱ期内痔3例,Ⅲ期内痔3例。随访半年,13例患者症状全部消失,1例患者肛门有小皮赘脱出,但无不适感,总有效率100％。术中术后患者基本无疼痛感。结果表明,超声多普勒引导下痔动脉结扎加悬吊术治疗痔安全、有效、疼痛轻、并发症少。     

Varicocele surgery: a decade’s experience at a children’s hospital

OBJECTIVES

To review our experience at a children’s hospital over a 10‐year period with the Palomo, Ivanissevich, subinguinal and laparoscopic techniques for varicocele, assessing the success and complication rates according to specific procedure, and the added effect that the modifications of microsurgery and artery‐sparing has had on these rates. A second objective was to assess the rate of testicular compensatory growth after surgery for testicular hypotrophy.

PATIENTS AND METHODS

Ninety‐two patients with >1 year of follow‐up between 1996 and 2006 were assessed retrospectively. The median (range) age at surgery was 15 (8–21) years. Patients were stratified based on the surgical technique used by eight different urology faculty members. Microsurgery and attempted artery‐sparing were applied to some Palomo, Ivannisevich, and subinguinal cases but not to laparoscopic procedures.

RESULTS

The laparoscopic (100%) and Palomo (93%) techniques had significantly higher success rates than the Ivanissevich approach (69%). The success rate with the subinguinal technique (88%) was intermediate between the more successful supra‐inguinal and less successful inguinal approaches. There was a higher hydrocele rate (32%) in the laparoscopic approach. Artery sparing significantly lowered hydrocele rates but had no effect on success rates. Incorporating microsurgery also had no effect on success rates but resulted in no hydrocele formation. One case of testicular atrophy occurred in a patient undergoing microsurgical artery‐sparing subinguinal spermatic vein ligation. There was compensatory growth in 68% of patients operated on for testicular hypotrophy.

CONCLUSIONS

During our 10‐year experience the laparoscopic and Palomo approaches were the most successful. The subinguinal approach (usually incorporating microsurgery and artery sparing) had an intermediate success rate. The Ivanissevich approach was least successful. Hydroceles did not occur when microsurgery was used, and were significantly less common with artery sparing. The only case of testicular atrophy was with a microsurgical artery‐sparing subinguinal approach. When the spermatic vein was ligated for testicular hypotrophy there was compensatory growth in two‐thirds of testes.