Mini-open versus extended open release for severe carpal tunnel syndrome

Background

This study aims to compare surgical outcomes of severe carpal tunnel syndrome (CTS) treated with mini-incision versus extensile release.

Methods

The method employed in this study was a retrospective review of patients with severe CTS, defined by electrophysiologic studies showing non-recordable distal sensory latency of the median nerve. Patients underwent either a mini-incision (2 cm) release of the transverse carpal ligament (group 1) or extensile release proximal to the wrist flexion crease (group 2). Exclusion criteria included prior carpal tunnel release, use of muscle flap, multiple concurrent procedures, or a prior diagnosis of peripheral neuropathy. Group 1 included 70 wrists (40 females, 30 males). Group 2 included 64 wrists (35 females, 29 males). Reported outcomes included pre- and post-operative grip strength as well as Boston Carpal Tunnel Questionnaires (BCTQ).

Results

Patients in group 1 had a 22.6 % increase in grip strength postoperatively (4.5 months ± 5.0), while patients in group 2 had a 59.3 % increase (10.0 months ± 6.9). BCTQ surveys from group 1 (n = 46) demonstrated a symptom severity score of 12.93 and functional status score of 9.39 at an average follow-up of 41.9 ± 10.6 months. Group 2 (n = 42) surveys demonstrated averages of 12.88 and 9.10 at 43.1 ± 11.6 months. One patient in the mini-incision cohort required revision surgery after 2 years, while no patient in the extended release cohort underwent revision.

Conclusion

No significant differences between the two procedures with regard to patient-rated symptom severity or functional status outcomes were found. Both techniques were demonstrated to be effective treatment options for severe CTS.     

基层医院颈部小切口在甲状腺切除术中的应用可行性分析

目的 探讨基层医院颈部小切口在甲状腺良性肿瘤手术中的疗效及安全性.方法 总结我科2010年2月至2014年1月248例甲状腺良性疾病行甲状腺切除术的患者,其中传统手术62例,颈部小切口186例,分析两组患者的手术时间、出血量及并发症发生情况.结果 62例传统手术患者手术时间平均为(57±19.3) min,前20例小切口手术患者手术时间平均为(70±17.1)min,后166例小切口手术患者手术时间平均为(51-22.2) min.两组喉返神经损伤各1例,传统手术组甲状旁腺功能减退1例,两组均无喉上神经损伤、术后出血及短期复发.结论 颈部小切口手术方式在甲状腺切除术中有良好效果,不增加手术并发症,切口小、达到美容效果,适合在基层医院推广.     

Mini-incision total hip arthroplasty: a quantitative assessment of laboratory data and clinical outcomes

In this study, we used laboratory data and clinical outcomes to evaluate the degree of approach-related trauma in mini-incision arthroplasty. In 94 patients (8 male and 86 female), a total of 100 osteoarthritic joints were replaced using total hip arthroplasty (THA). The level of serum C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) were measured 1 week postoperatively in both the standard group and a mini-incision group. The serum CRP level (mean ± standard deviation) was 3.3 ± 2.6mg/dl in the standard incision group compared to 1.8 ± 1.2 in the mini-incision group. The ESR level was 66 ± 22mm/h in the standard incision group and 52 ± 20mm/h in the mini-incision group. The ratio of the level of creatine phosphokinase (CPK) measured postoperatively/preoperatively was 4.7 on the first postoperative day in the standard incision group and 3.6 in the mini-incision group. On the basis of the CRP and ESR levels, the mini-incision THA was considered to be less invasive. However, there was no significant difference in the day 1 CPK ratios between the two groups, suggesting that the degree of muscle trauma was similar.     

小切口小开窗治疗腰椎间盘突出症临床研究

目的探讨治疗腰椎间盘突出症有效的手术方法并总结其优点。方法对108例腰椎间盘突出症患者行病变椎间后路正中4-5cm长小切口,显露一侧椎板,在相邻椎板间隙开一直径约1.5cm×1.5cm小窗,摘除间盘髓核。并与传统全椎板切除手术方法进行比较。结果随访3个月-7年9个月,平均3年10个月。用侯树勋[1]评定标准进行评定,开窗组优良率为93.5%,明显高于传统手术组(59.1%)(P<0.01)。结论小切口小开窗手术方法治疗腰间盘突出症,具有手术简便、创伤小、出血少、住院时间短、费用低、短期内可恢复原工作等优点。     

微型切口行阑尾切除术的临床应用

目的 探讨微型切口行阑尾切除术的手术方法和价值。方法 对我院2003年3月至2003年12月住院的25例慢性阑尾炎和28例急性单纯性阑尾炎患者行微型切口阑尾切除术,分析其临床资料。结果 微型切口行阑尾切除术平均手术时间(36.9±11.2)min,平均住院时间(3.8±1.7)d;5例患者因阑尾暴露困难而改为常规切口完成手术,所有患者术后24h内恢复胃肠功能,并下床活动,全组患者无伤口感染或其他并发症。伤口愈合美观。结论 微型切口行阑尾切除术创伤小,患者恢复快,伤口美观,患者满意,有较大的临床应用价值。     

外侧小切口全髋关节置换术疗效的初步评价

目的评价外侧小切口全髋关节置换术的临床疗效。方法将2003年8月至2006年2月进行外侧小切口全髋关节置换术的36例患者(40髋,小切口组)与同期进行外侧传统全髋关节置换术的40例患者(40髋,传统手术组)作对比研究,评估损伤程度、术后恢复情况及并发症发生情况。结果小切口组切口长度、手术时间和下地负重时间均显著短于传统手术组(P值分别<0.01、0.05),术中失血量、输血量、术后引流量及术后1周疼痛发生率均明显小于传统手术组(P值均<0.05)。小切口组术后1、6个月患髋Harris评分均明显高于传统手术组(P值均<0.05)。传统手术组术后发生切口延迟愈合2例,下肢深静脉栓塞1例,假体脱位1例;小切口组无任何并发症发生。结论与传统全髋关节置换术比较,外侧小切口全髋关节置换术具有外形美观、创伤小、出血量少、术后恢复快和术后并发症少等优点,但需注意选择合适的患者。     

小切口阑尾切除术73例分析

目的:观察小切口阑尾切除术的手术疗效。方法:对2004年至2006年我院收治的阑尾炎患者采用低位小切口三针缝合法,观察手术效果。结果:小切口阑尾切除手术效果满意,随访半年未见任何并发症。结论:小切口阑尾切除术手术创伤小,时间短,患者恢复快,并发症少,是一种良好的阑尾炎的治疗方法。     

小切口辅助电视胸腔镜治疗32例胸外伤手术分析

目的　探讨应用小切口辅助电视胸腔镜治疗胸外伤的可行性。方法　对 32例胸外伤患者使用小切口辅助电视胸腔镜进行肺楔形切除术、肺破裂修补术、膈肌破裂修补术。结果　 32例治愈出院。术后恢复快 ,住院天数 4～ 13d ,平均 8 7d。切口甲级愈合 ,术后无并发症。结论　小切口辅助能完成电视胸腔镜与常规开胸探查术同等质量的胸部手术 ,使诊治同步进行 ,扩展了电视胸腔镜的手术适应范围     

腹腔镜辅助小切口肾盂成形术治疗小婴儿肾盂输尿管连接部梗阻

目的:总结腹腔镜辅助小切口离断性肾盂成形术治疗小婴儿肾盂输尿管连接部梗阻的手术方法与经验。方法:回顾分析2009年10月至2012年8月为16例小婴儿行腹腔镜辅助小切口离断性肾盂成形术的临床资料。其中男13例,女3例;平均(3.9±1.4)个月;左侧12例,右侧4例。结果:16例手术均顺利完成。手术时间平均(74.7±10.6)min;术后无一例发生尿漏。术后均获随访,术后1、3、6个月定期B超检查,肾积水均有一定程度改善,肾盂宽度较术前明显改善。结论:与开放手术相比,腹腔镜辅助小切口离断性肾盂成形术治疗小婴儿肾盂输尿管连接部梗阻具有患儿创伤小、出血少、住院时间短、术后康复快等优点;与腹腔镜肾盂成形术相比,具有缝合技术方面的优势,手术时间缩短,并发症发生率低。     

54例胸外伤辅助小切口电视胸腔镜手术报告

目的　通过辅助小切口配合电视辅助腔镜手术 (VidoAssistedThoracospicSurgery ,VATS) ,扩大VATS手术适应范围。　方法　对 5 4例胸外伤患者使用VATS辅以小切口进行肺叶切除术、肺楔形切除术、肺破裂修补术、膈肌破裂修补术。　结果　 5 4例治愈出院。术后恢复快 ,住院天数 8天～ 12天 ,平均 10天。切口甲级愈合 ,术后无并发症。　结论　辅助小切口配合VATS能完成与常规开胸术同等质量的胸部手术 ,使诊治同步进行 ,扩展了VATS的手术适应范围。