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Objective:To explore the safety, efficacy and preliminary clinical application of the single plantar approach or in combination with the dorsalis pedis approach in the treatment of Lisfranc injury with poor dorsalis pedis soft tissue, metatarsal avulsion fracture or complicated multi-column lesions.Methods:(1) Six fresh cadaveric specimens of adult foot were collected and dissected through the plantar approach in order to determine the skin incision of the plantar approach and the safe area for plate-screw internal fixation, including start-stop points and courses of plantar nerves, blood vessels, tendons and ligaments, followed by plate-screw fixation on the specimens. (2) After feasibility of the plantar approach was confirmed by our anatomical study, it was used to treat the 3 patients who were admitted to Department of Orthopedics, The Third Hospital Affiliated to Southern Medical University between September 2020 and November 2021 for Lisfranc injury with severe necrosis due to dorsalis pedis skin contusion or metatarsal base avulsion fracture. They were 2 males and one female, with an average age of 51 years (from 34 to 68 years). The preliminary clinical efficacy was evaluated in terms of visual analogue scale (VAS), midfoot score of American Orthopaedic Foot and Ankle Surgeons (AOFAS), Maryland score, Kofoed score, fracture healing at the last follow-up and postoperative complications.Results:(1) Regarding the anatomical exposure range, the metatarsal side of the first metatarsal wedge joint was exposed medially and the metatarsal side of the third metatarsal wedge joint was exposed laterally; the peroneus longus tendon, Lisfranc plantar ligament and interosseous ligament were explored. X-ray films after the simulated operation showed satisfactory plate positions. (2) As for the preliminary clinical application, all patients were followed up for 6 to 14 months (mean, 11 months). At the last follow-up, the VAS score ranged from 0 to 1 (mean, 0.5), AOFAS score from 85 to 92 (mean, 89), Maryland score from 93 to 96 (mean, 95), and Kofoed score from 92 to 95 (mean, 94). There were no early complications such as fascial compartment syndrome, skin necrosis or infection. All fractures got united, with no complications like traumatic arthritis, muscle atrophy or screw loosening.Conclusion:Testified by the anatomical study, the plantar approach can be used to treat Lisfranc injury with poor dorsalis pedis soft tissue, metatarsal avulsion fracture or complicated multi-column lesions, leading to safe, effective and satisfactory clinical outcomes.
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Objective@#To compare the short-term efficacy of robotic distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP) in treatment of pancreatic body and tail cancer, and to explore the feasibility of RDP.@*Methods@#The clinical data of 11 patients who received RDP and 26 patients who received LDP from January 2014 to May 2018 in the First Hospital of Shanxi Medical University were retrospectively analyzed. The operation indexes and the hospitalized cost of both groups were compared.@*Results@#There were no significant differences in spleen-preserving rate, postoperative hospital stay, postoperative pain, intraoperative or postoperative blood transfusion, postoperative bleeding and pancreatic fistula between the two groups (all P > 0.05), but the amount of intraoperative bleeding in RDP group was less than that in LDP group, and the difference was statistically significant [(144±51) vs. (199±65) ml, t = -2.530, P = 0.016]. Compared with LDP group, the total hospitalization cost and operation cost of RDP group was increased [(75 000±14 000) yuan vs. (107 000±12 000) yuan; (21 000±9 000) yuan vs. (39 000±16 000) yuan; both P < 0.01].@*Conclusion@#Both RDP and LDP are safe and feasible. LDP has the advantages of relative low cost and wide range of operations. RDP has obvious advantages in controlling intraoperative bleeding, but the high cost limits its further clinical promotion.
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Objective To analyze the clinical feasibility and effectiveness of the "G"-shaped surgical approach in robotic pancreatoduodenectomy. Methods The clinical data of 17 patients who were undergoing robotic pancreatoduodenectomy at the First Hospital of Shanxi Medical University from June 2017 to March 2018 was analyzed. Results All the 17 robotic pancreatoduodenectomy operations via the "G"-shaped surgical approach were successful. The operationtime was (499 ±146) min (350-825 min), and the blood loss was (119±38) ml (20-500 ml). All surgical margins were negative. All patients recovered well after surgeries, and the postoperative hospital stay was (21 ±6) (14-36 days). However, one patient experienced secondary surgery due to bilioenteric anastomosis fistula, fortunately the surgical process went successfully. This patient had pancreatic leakage (class B) after surgery and was discharged with tubes after a conservative treatment, another patient had gastroplegia and recovered completely after conservative treatment. Conclusion It is a safe and feasible procedure to use the robotic pancreatoduodenectomy with the"G"-shaped surgical approach.
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Objective To compare the short-term efficacy of robotic distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP) in treatment of pancreatic body and tail cancer, and to explore the feasibility of RDP. Methods The clinical data of 11 patients who received RDP and 26 patients who received LDP from January 2014 to May 2018 in the First Hospital of Shanxi Medical University were retrospectively analyzed. The operation indexes and the hospitalized cost of both groups were compared. Results There were no significant differences in spleen-preserving rate, postoperative hospital stay, postoperative pain, intraoperative or postoperative blood transfusion, postoperative bleeding and pancreatic fistula between the two groups (all P>0.05), but the amount of intraoperative bleeding in RDP group was less than that in LDP group, and the difference was statistically significant [(144±51) vs. (199±65) ml, t= -2.530, P= 0.016]. Compared with LDP group, the total hospitalization cost and operation cost of RDP group was increased [ (75000±14000) yuan vs. (107000±12000) yuan;(21000±9000) yuan vs. (39000±16000) yuan;both P<0.01]. Conclusion Both RDP and LDP are safe and feasible. LDP has the advantages of relative low cost and wide range of operations. RDP has obvious advantages in controlling intraoperative bleeding, but the high cost limits its further clinical promotion.
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With its excellent biocompatibility,good biomechanics and biodegradability,magnesium zinc alloy has been widely used in biomaterials,and its antineoplastic effect has attracted more and more attention recently.Osteosarcoma is the most common primary malignant bone tumor.With the improvement of the diagnosis and treatment,the rate of 5-year survival has been greatly improved,which is nearly 60％ ～ 70％.However,local recurrence and metastasis after operation are still main risk factors on the survival quality and clinical function of patients.This paper reviews previous researches concerned the antineoplastic effect about magnesium,zinc and its alloys,and summarized the anti-tumor mechanism of magnesium,zinc and its alloys,and its research value in the field of osteosarcoma.
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Objective To investigate the feasibility and safety of "G"-shaped surgical approach in laparoscopic pancreaticoduodenectomy.Methods The clinical data of 33 patients who received " G"-shaped laparoscopic pancreaticoduodenectomy in the First Hospital of Shanxi Medical University from April 2015 to March 2018 were retrospectively analyzed.Results All patients underwent surgery successfully.The time required for surgery ranged from 340 to 498 min,the blood loss ranged from 150 to 800 ml,and the specimen resection time ranged from 135 to 270 min.There were 10 cases of biochemical leakage,3 cases of B grade pancreatic fistula and 1 case of bile leak.Postoperative pathology confirmed lower bile duct adenocarcinoma in 17 cases,duodenal papillary adenocarcinoma in 11 cases and poorly differentiated adenocarcinoma of the pancreatic head in 5 cases.Conclusions " G"-shaped approach as a simple,effective and safe way for LPD,is particularly helpful for inexperienced hands.
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Objective To explore the surgical techniques in laparoscopic distal pancreatectomy for benign and low malignant tumors in the body or tail of the pancreas.Methods The clinical data of 21 cases of benign and low-malignant tumors in the body or tail of the pancreas undergoing LDP from Jan 2015 to Mar 2017 in the First Hospital of Shanxi Medical University were analyzed retrospectively.Results One patient was converted to open surgery(4.76％),13 patients underwent laparoscopic spleen-preserving distal pancreatectomy (Kimura procedure).The other 7 patients underwent LDP with splenectomy.The average size of the tumor was (6.0 ±3.1)cm;the operation time was 190 to 421 mins with mean time of (288.4 ± 56.9)min;the intraoperative blood loss was 30 to 800 ml with the mean volume of(235.7 ± 202.6)ml;Postoperative hospital stay was 6 to 17 days with the mean time of (8.9 ± 3.1) days.Six patients suffered from type A pancreatic fistula,and were cured by conservative treatment.Conclusions Laparoscopic spleen-preserving pancreatectomy for benign or low-grade malignant body and tail pancreatic tumors is feasible and safe.