ObjectiveTo explore the causes and surgical strategies of completion thyroidectomy for thyroid cancer. Method The clinical data of 35 patients with thyroid cancer who underwent completion thyroidectomy in Guizhou Provincial People’s Hospital from January 2020 to July 2022 were analyzed retrospectively. Results There were 23 females and 12 males, aged from 17 to 68 years (median 42 years). The nature of thyroid nodules in 22 patients was not determined at preoperative fine needle aspiration cytology or intraoperative frozen pathological examination, but the paraffin section examination after operation indicated thyroid cancer. Pathological examination after the first operation showed that 11 patients had a large number of lymph node metastasis in the central area (more than 5), and 2 patients were confirmed as medullary thyroid carcinoma. All the 35 patients underwent completion thyroidectomy at 5–93 days after the initial operation, among which 3 patients underwent resection of the affected side residual glandular lobe and isthmus ± ipsilateral CLN dissection, 18 patients underwent contralateral lobectomy and CLN cleaning, and 14 patients underwent contralateral lobectomy and lymph node dissection of the affected side cervical region (Ⅲ–Ⅳ region). The operative time was 45–135 min (median 105 min). Intraoperative blood loss was 10–50 mL (median 20 mL). One patient suffered from temporary recurrent laryngeal nerve injury after operation, and voice had returned to normal at 5 months after operation. Six patients showed temporary hypoparathyroidism, and serum parathyroid hormone returned to normal level in 1–3 months after symptomatic treatment. Nineteen patients were treated with iodine-131 after operation, and were followed-up for 1–16 months (median 12 months). No signs of tumor recurrence or metastasis were found. Conclusions Accurate preoperative and intraoperative evaluation of thyroid nodules and standardized surgery can reduce the incidence of completion thyroidectomy. For patients who really need completion thyroidectomy, adequate doctor-patient communication during the perioperative period, early response measures and appropriate completion thyroidectomy can reduce the probability of postoperative tumor recurrence and improve the survival of patients.
【Abstract】 Objective To summarize techniques of the total hi p arthroplasty (THA) in the treatment of developmental dysplasia of the hi p (DDH) with severe osteoarthritis in adults. Methods From March 2000 to January 2006, 24 patients (27 hips) with DDH were treated by THA with an cementless cup. There were 7 males and 17 females, withthe average age of 49.6 years (ranging from 26 years to 63 years). Unilateral DDH occurred in 21 patients and bilateral DDH occurred in 3 patients. Based on the Crowe classification, there were 16 hips in 15 patients of type I, 4 hips in 4 patients of type II, 4 hips in 3 patients of type III, 3 hips in 2 patients of type IV. Except for 3 patients with bilateral DDH, the other patients’ ill lower l imbs were 2-7 cm shorter than the healthy lower ones. Results All the patients were followed up from 9 months to 6.5 years and no one had infection, dislocation, femur fracture and so on after the operation. In 18 patients, the pain was completely rel ieved and the function of the hip joints was good. After the gluteus medius exercise, the claudication of 3 patients after the operation disappeared. In 3 patients, the ill lower l imbs were more than 1 cm shorter than the healthy lower ones and the other patients’ ill lower l imbs were less than 1 cm shorter than the healthy lower ones. Two patients’ lower l imbs were been lengthened 4-5 cm. All the patients’ sciatic nerves were not injured. The Harris scores were 46.5 ± 7.2 preoperatively and 84.0 ± 5.7 postoperatively (P lt; 0.05). Conclusion THA with deepening the medial wall of the acetabulum at the true acetabulum and choosing small cementless cup in adult could obtain favorable results.
Objective To investigate the effectiveness of subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip (DDH). Methods Between January 2004 and December 2010, 37 patients (44 hips) with Crowe type IV DDH underwent subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty with cementless prosthesis. There were 15 males (18 hips) and 22 females (26 hips) with an average age of 42 years (range, 24-46 years). Unilateral hip was involved in 30 cases and bilateral hips in 7 cases. Preoperative X-ray films showed complete dislocation of the femoral head and hypoplasia of the acetabulum and proximal femur. Before operation, the leg discrepancy was (5.5 ± 1.1) cm, and the Harris score was 32.1 ± 5.2. Results The mean operation time was 4.3 hours (range, 3-6 hours); the mean blood loss was 760 mL (range, 600-1 000 mL). All patients obtained primary healing of incision. The patients were followed up 1-8 years (mean, 6.7 years). Pain relief was achieved; 6 cases had mild claudication; 3 cases had femoral nerve palsy; and no stretch injury of sciatic nerve was observed. X-ray films showed that acetabular cups were in normal position. The healing time of fracture was 3-6 months (mean, 3.7 months). The leg discrepancy was (1.5 ± 1.0) cm at 1 day after operation, showing significant difference when compared with preoperative one (t=16.45, P=0.00). The Harris score was 94.3 ± 3.8 at 3 months after operation, showing significant difference when compared with preoperative score (t=59.15, P=0.00). No revision of acetabular and femoral prostheses was performed during follow-up. Conclusion Subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty is a safe method of restoring the anatomic hip center in Crowe type IV DDH in adults. It can avoid reduction difficulty caused by soft tissue contracture and injuries of sciatic nerve and femoral nerve caused by limb lengthening.
Objective To investigate the effectiveness of cementless total hip arthroplasty (THA) in treatment of avascular necrosis of the femoral head (ANFH) in patients with human immunodeficiency virus (HIV) infection. Methods The clinical data of 22 patients (35 hips) with HIV infection and ANFH (positive group), who were treated with cementless THA between February 2014 and January 2017, was retrospectively analyzed. Tirty-three cases (43 hips) without HIV infection, who were treated with cementless THA during the same period, were collected as control (negative group). There were significant differences in the age, gender, incidence of bilateral ANFH, and disease duration between 2 groups (P<0.05). There was no significant difference in the Ficat stage of ANFH between 2 groups (P>0.05). The operation time, intraoperative blood loss, rate of blood transfusion, postoperative complications, and hospitalization time were recorded. The hip joint function was evaluated by Harris score and X-ray film was performed to observe the position of the prosthesis. Results The follow-up time was 13-24 months (mean, 20.2 months) in positive group and 14-25 months (mean, 21.6 months) in negative group. The operation time of negative group was significantly shorter than that of positive group (t=3.677, P=0.001). However, there was no significant difference in intraoperative blood loss, rate of blood transfusion, and hospitalization time between 2 groups (P>0.05). There was no significant difference in Harris score between 2 groups before operation and at 1, 3, 6, and 12 months after operation (P>0.05). There were 2 cases of superficial infection of incision and 1 case of pulmonary infection during hospitalization in positive group, and 1 case of superficial infection of incision and 1 case of venous thrombosis of lower extremity in negative group. No death or loosening and sinking of the prosthesis occurred in both groups during follow-up. Conclusion Cementless THA is a safe and effective method for ANFH in patients with HIV infection.