Minimally invasive uncemented total hip arthroplasty through an anterolateral approach with a shorter skin incision

Total hip arthroplasty using a short skin incision has been associated with great controversy. It has still not yet been demonstrated that a shorter skin incision is efficient or safe for patients. Here, we review 212 cases of uncemented total hip arthroplasty performed since 1999 using the anterolateral approach and a shorter skin incision. Patients were divided into three groups according to the length of the incision at the end of surgery; incisions of 10cm or less were defined as mini (n = 115) and incisions of 10–15cm as short (n = 70); these two groups were defined as shorter skin incision groups. Incisions longer than 15cm in patients undergoing the standard procedure were defined as conventional and served as the controls (n = 27). Statistically significant differences were found with regard to operative duration and intraoperative blood loss: the shorter the length of the incision, the shorter the operative duration and the smaller the intraoperative blood loss. There was no significant difference in postoperative bleeding or in the incidence of complications among the three groups. Total blood losses in the shorter groups were each statistically significant less than that in the conventional group. Comparing the mini group to the short group, the length of the skin incision was influenced by the body mass index (BMI) and gender. For those with a high BMI and for male patients, a slightly longer incision was necessary. We concluded that total hip arthroplasty through a mini or short incision was indeed efficient for patients compared with total hip arthroplasty using a conventional incision.     

Large sphenocavernous meningiomas: Is there still a role for the intradural approach via the pterional-transsylvian route?

Summary.  Background: Large-sized sphenocavernous meningiomas represent a surgical challenge. Although the role of skull base techniques with combined extra- and intradural steps has been recently emphasized, pure intradural resection tactics via the pterional route constitute the traditional microsurgical approach for resection of such tumours.  Method: We report the application of the pterional-transsylvian approach in 13 patients with sphenocavernous meningiomas. This series is unique because it includes only patients with tumours exceeding 5 cm in their greatest dimension.  Findings: A gross total resection was accomplished in 10 patients (77%). Eight patients had a good outcome, one had a persistent mild hemiparesis, and one died. No recurrences occurred in this group. Three patients (23%) had subtotal resections owing to invasion of the cavernous sinus in one instance and encasement of the middle cerebral artery in the others. Two had a good outcome and one died. In these patients minimal asymptomatic tumour progression was seen 3 and 6 years after surgery. The overall surgical outcome was good in 10 patients (77%), fair in one, and death in two.  Interpretation: In our experience, large sphenocavernous meningiomas may be operated on adopting pure intradural resection tactics via the pterional-transsylvian route with rates of gross total removal and surgical complications related to brain retraction or vascular manipulation comparable to those of extensive skull base approaches. The traditional intradural pterional transsylvian approach continues to have a place in the treatment of these lesions. Published online April 28, 2003 RID="*" ID="*"  This paper was supported in part by Grant “Piano B008 – P.R. 2” from M.U.R.S.T. and European Community.  Correspondence: Domenico d'Avella, M.D., Neurosurgical Clinic, Department of Neuroscience, Psychiatric and Anesthesiolgical Sciences, Policlinico Universitario, via Consolare Valeria 1, 98122 Messina, Italy.     

改良Hardinge入路在非骨水泥全髋置换术中的应用

目的：对改良Hardinge入路行全髋置换进行评价。方法：对经改良Hardinge入路行非骨水泥全髋置换（THR－CL）术并获术后6个月以上随访的32例病人进行总结。结果：优良28例（88％），很好4例（12％），其中轻度跛行6例（19％），下肢不等长＞2cm1例（3％），改良Trendelenburg试验阳性3例（10％）。结论：此入路创伤小，暴露好，利于假体定位，易于控制下肢长度，术后外展肌功能恢复快。     

胸腰椎骨折伴脊髓损伤前后路手术适应证的选择

目的 通过107例胸腰椎骨折伴脊髓损伤病例的治疗,探讨前、后路手术适应证的选择。方法 31例经前路减压植骨,采用Z-Plate等内固定。76例经后路采用短节段椎弓根钉内固定。结果 两组均获得了满意的疗效。结论 选择前或后路手术,应综合考虑脊髓损伤程度、手术时机与技巧、骨折的部位、骨折类型和影像结果等,才能确实做到减压、恢复脊柱序列和坚强固定的目的。     

绕肝提拉法前入路肝切除术(附6例临床报告)

目的　绕肝提拉法 (liverhangingmaneuver)进一步提高前入路肝切除术 (anteriorapproach)的安全性。方法　钝性分离肝后下腔静脉前间隙而形成肝后隧道。通过该隧道安放绕肝带 ,前入路肝切除时拉紧绕肝带 ,配合自行设计的止血板 ,完成 6例复杂肝切除术。结果　 6例成功安放绕肝带 ,未发生与该操作有关的并发症 ,前入路肝切除时肝正中裂界面内管道显露清楚 ,绕肝带具有指示作用。结论　复杂肝切除时使用绕肝带和止血板 ,有助于提高前入路肝切除的安全性。保证断肝能在最短的界面上进行。     

后外侧联合内侧手术切口治疗三踝骨折的疗效分析

目的:探讨后外侧联合内侧入路手术治疗三踝骨折的临床疗效。方法:回顾性分析2006年5月-2012年11月因三踝骨折来本院治疗者43例,手术均采用后外侧联合内侧入路切开复位钢板螺钉内固定,骨折端均未植骨。分析患者骨折愈合情况、内固定稳定性和美国足踝外科AOFAS评分。结果:所有患者均获得随访,随访时间10~21个月,平均15个月;所有患者均获得骨性愈合,愈合时间11~18周,平均13周;术后1例患者出现皮肤愈合不良、1例切口感染,保守治疗后好转,无内固定松动断裂等并发症;踝关节功能AOFAS评分(92.2±5.4)分。结论:采用后外侧联合内侧入路手术治疗三踝骨折,可以使踝关节尽量获得解剖复位,有利于早期功能锻炼,避免后期创伤性关节炎。     

单侧经椎体侧方后上角穿刺入路在经皮穿刺椎体成形术中的应用

目的探讨单侧经椎体侧方后上角穿刺入路在经皮穿刺椎体成形术中的应用。方法选取2014 年1 月-2016 年3 月针对伤椎椎弓根直径细小、椎弓根外展角度较小的老年性骨质疏松椎体压缩性骨折患者18例,采用单侧经椎体侧方后上角穿刺入路行经皮穿刺椎体成形术治疗,分别记录术前1 天,术后3 d、1 个月和3 个月的视觉模拟评分（VAS）及Oswestry 功能障碍指数（ODI）以评估治疗效果。结果所有患者均顺利完成手术,骨水泥注入通道尖端可顺利到达椎体中线,椎体内骨水泥填充满意。无血管、神经损伤等严重并发症发生。术后患者疼痛症状均有减轻,随访3～12 个月,术后VAS 评分及ODI 值较术前均降低（P <0.05）。结论在伤椎椎弓根直径细小及椎弓根外展角度较小时,采用单侧经椎体侧方后上角穿刺入路行经皮穿刺椎体成形术可行、有效。     

Stoppa入路结合髂窝入路治疗髋臼前柱或双柱骨折患者的疗效评价

目的：探讨Stoppa入路结合髂窝入路治疗髋臼前柱或双柱骨折患者的疗效和安全性,为推广Stoppa入路结合髂窝入路治疗髋臼骨折患者提供科学依据。方法：选择髋臼前柱或双柱骨折患者63例,随机分为采用Stoppa入路结合髂窝入路治疗组（Stoppa组）32例和采用髂腹股沟入路治疗组（对照组）31例,评价2组患者术中出血量、手术时间、术后骨折复位质量及术后髋关节功能等情况。结果：与对照组比较,Stoppa组患者术中出血量明显减少（P<0.05）,手术时间减少（P<0.05）,骨折复位质量优者所占比例高（P<0.05）,临床功能评分明显提高（P<0.05）。结论：Stoppa入路结合髂窝入路是治疗髋臼前柱或双柱骨折患者的一种有效方法,其具有手术视野显露充分、组织损伤小、手术时间短、失血量少、解剖复位率高和临床功能好等优势。     

手术入路对髋关节置换术后髋关节功能恢复的影响

目的探讨手术入路对髋关节置换术后髋关节功能恢复的影响。方法对386例(392髋)髋关节疾病患者行髋关节置换术,分别采用不同手术入路,并且于术前,术后2周、4周、8周、24周进行Harris评分,分析髋关节功能恢复情况。结果前外侧入路组、外侧入路组、后外侧入路组、后侧入路组及小切口入路组总有效率分别为91%、94%、97%、100%、100%。结论不同手术入路对髋关节置换术后髋关节功能恢复有一定的影响。创伤小、对髋关节干预性较小的后侧入路及小切口手术入路是髋关节功能恢复较满意的选择。     

Stoppa入路在骨盆髋臼骨折中的初步应用

目的 探讨在骨盆髋臼骨折中采用耻骨联合上缘横形或下腹正中切口,真骨盆内操作(Stoppa人路)的初步临床经验. 方法对2008年3月至11月问应用Stoppa入路治疗的10例骨盆髋臼骨折患者进行总结.5例骨盆患者均为Tile C型,Stoppa入路复位同定前环的高位耻骨支骨折.髋臼骨折为横行2例,双柱、T型及后柱(四边体粉碎骨折伴中心脱位)骨折各1例,单纯Stoppa入路2例,联合Kocher-Langenbeck及髂腹股沟入路3例. 结果所有骨盆骨折均复位优,所有髋臼骨折均解剖复位.Stoppa入路平均切口长度10 cm(9～12 cm),平均手术时间88 min(75～105 min),半均出血560 mL(250～800 mL),无手术并发症.7例获得4～8个月随访,功能结果均满意. 结论 Stoppa入路可以替代髂腹股沟入路治疗高位耻骨支骨折,也可单独或联合其他入路治疗髋臼骨折,具有操作简单、并发症少的优点.