Objective To analyze the treatment of the sternoclavicular joint dislocation by clavicular hook plate and investigate its cl inical value to find a theropy with more safety and stabil ity. Methods Between January 2003 and January 2007, 15 patients with sternoclavicular joint dislocation were involved, among whom there were 12 males and 3 females, aged 28-45 years old (34 on average). There were 12 cases of fall ing injury and 3 cases of vehicle accident injury. The course of disease was 1-12 hours. A total of 2 cases were on the left side and 13 were on the right side. There were 14 casesof anterior dislocation and 1 of posterior dislocation. Two patients were compl icated by acromioclavicular joint dislocationwith no pneumothorax, and 2 patients had a l ittle pleural effusion without any special treatment. As to the damage degree,according to the Grade system, there were 2 cases of type II and 13 cases of type III. Results All patients’ incisionsobtained heal ing by first intention after operation. The X-ray films showed that the reduction of joint dislocation and thelocation of internal fixation were good. All the 15 patients were followed up for 6-18 months (14 months on average). All cases were scored by Rockwood after the operation to assess the curative effect, with 12 excellent, 2 good and 1 fair. There was no wound infection, neurovascular injury, hemopneumothorax, internal fixation failure, redislocation or other side injuries. The anatomical structure as well as appearances and functions were restored. Conclusion The fixation of clavicular hook plate in treating ternoclavicular joint dislocation has superiority over other methods with more stabil ity, less risk and small chances of cardiovascular injury. Besides, the patients can do functional exercises early and the shoulder joint function can be improved to the maximal degree.
Objective To analyze the safety of surgical treatment and optimal surgical procedure for lung cancer patients with prior history of lung resection. Methods The medical records of 69 lung cancer patients with history of lung resection was retrospectively collected. There were 53 males and 16 females with a median age of 68 years ranging from 45 to 80 years. The risk factors for postoperative complications were analyzed using one-way ANOVA and logistic regression analysis. By comparing the data between the lobectomy and sublobectomy groups, the best surgical procedure was chosen. Results The 90-day mortality rate was 4.3%. Postoperative complication rate was 24.6%. Results of one-way ANOVA showed that blood loss during operation (P=0.020), tumor size (P=0.007), smoking (P=0.028) and FEV1%pre (P=0.018) were associated with increased major postoperative complications. Logistic regression analysis showed that FEV1%pre<77.0% (OR=0.935, 95%CI 0.888 to 0.984, P=0.010) and tumor size≥2 cm (OR=4.288, 95%CI 1.375 to 13.373, P=0.012) were independent risk factors for major postoperative complications. Lobectomy and sublobectomy groups had similar postoperative mortality and complication rate (P=0.063). Conclusion Surgical resection for selected lung cancer patients with history of lung resection is safe with low postoperative mortality and complication rate. Lobectomy with lymph node resection is the first choice if cardiopulmonary function permits. Pneumonectomy is not recommended.
目的 探讨 2 cm 单孔胸腔镜肺叶切除术的可行性及安全性。 方法 回顾性分析 2016 年 3～8 月我院胸外科行 2 cm 单孔胸腔镜下解剖性肺叶切除术 8 例肺癌患者的临床资料，其中男 5 例、女 3 例，年龄41～75（58.5±10.1）岁。在腋前线第 3 肋间做 2 cm 切口置入胸腔镜及手术器械行解剖性肺叶切除术。 结果 8 例均顺利完成手术，无中转开胸。手术时间（191.6±41.9）min，术中出血量（186.3±175.0）ml，术后胸腔引流时间（4.5±1.7）d，术后住院时间（5.5±1.7）d。术后病理均为 ⅠA 期非小细胞肺癌。 结论 2 cm 单孔胸腔镜下解剖性肺叶切除术治疗早期肺癌安全、可行，减小了胸腔镜手术对患者的创伤，其进一步的推广应用需更多研究的支持。
We developed a three-dimensional finite element model of the pelvis. According to Letournel methods, we established a pelvis model of T-shaped fracture with its three different fixation systems, i.e. double column reconstruction plates, anterior column plate combined with posterior column screws and anterior column plate combined with quadrilateral area screws. It was found that the pelvic model was effective and could be used to simulate the mechanical behavior of the pelvis. Three fixation systems had great therapeutic effect on the T-shaped fracture. All fixation systems could increase the stiffness of the model, decrease the stress concentration level and decrease the displacement difference along the fracture line. The quadrilateral area screws, which were drilled into cortical bone, could generate beneficial effect on the T-type fracture. Therefore, the third fixation system mentioned above (i.e. the anterior column plate combined with quadrilateral area screws) has the best biomechanical stability to the T-type fracture.
Objective To explore the safety and feasibility of preferential manual bronchoplasty in single-port video-assisted thoracoscopic surgery (VATS) upper lobectomy. MethodsThe clinical data of 457 patients with non-small cell lung cancer who underwent single-port VATS lobectomy in the Department of Thoracic Surgery of Peking University First Hospital from March 2020 to March 2022 were retrospectively analyzed. The patients were divided into a preferential manual bronchoplasty group and a traditional single-port VATS lobectomy group with a 1 : 1 propensity score matching for further research. Results A total of 204 patients were matched, and there were 102 patients in each group. There were 50 males and 52 females aged 62.2±10.1 years in the preferential bronchoplasty group, and 49 males and 53 females aged 61.2±10.7 years in the traditional single-port VATS group. The preferential bronchoplasty group had shorter surgical time (154.4±37.0 min vs. 221.2±68.9 min, P<0.01), less bleeding (66.5±116.9 mL vs. 288.6±754.5 mL, P=0.02), more lymph node dissection (19.8±7.5 vs. 15.2±4.7, P<0.01), and a lower conversion rate to multi-port or open surgery (2.3% vs. 13.8%, P=0.04) in left upper lobe resection. In the right upper lobe resection surgery, there was no statistical difference in postoperative results between two groups. There was no perioperative death or occurrence of bronchopleural fistula in both groups. ConclusionCompared with traditional single-port VATS upper lobectomy, preferential bronchoplasty has similar safety and feasibility. In addition, priority bronchoplasty in left upper lobectomy has the advantages of shorter surgical time, less bleeding, more lymph node dissection, and lower conversion rate to multi-port or open surgery.