Objective:To compare the efficacy of supine position and spoon-shaped medial incision and reverse traction overlapping suture versus that of prone position and percutaneous minimally invasive suture for acute closed Achilles tendon rupture.Methods:A retrospective study was conducted to analyze the clinic data of 43 patients with acute closed Achilles tendon rupture who had undergone surgical treatment at Department of Orthopedics, Zhongshan Hospital Affiliated to Dalian University from October 2019 to December 2022. There were 40 males and 4 females with an age of (82.5±10.9) kg. The patients were divided into 2 groups according to their different treatment methods: group A of 20 cases treated by supine position and spoon-shaped medial incision and reverse traction overlapping suture, and group B of 23 cases treated by prone position and percutaneous minimally invasive suture. The 2 groups were compared in terms of operation time, intraoperative blood loss, incision length, postoperative hospital stay, complications, and ankle-hindfoot score of American Orthopedic Foot and Ankle Society (AOFAS) and Achilles tendon total rupture score (ATRS) at 3 and 6 months after operation.Results:There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P>0.05). The operation time in group A [(36.8±3.7) min] was significantly shorter than that in group B [(43.3±5.2) min], the intraoperative blood loss in group A [(26.1±4.5) mL] significantly more than that in group B [(15.7±2.2) mL], the incision length in group A [(7.5±0.8) cm] significantly longer than that in group B [(3.8±0.8) cm], and the AOFAS ankle-hindfoot score [(85.6±3.7) points] and ATRS [(80.3±0.7) points] in group A at 3 months after operation were significantly higher than that in group B [(81.6±3.5) points and (74.4±2.4) points] (all P<0.05). There were no significant differences between groups A and B in postoperative hospital stay [4 (3, 4) d versus 3 (3, 4) d], AOFAS ankle-hindfoot score [(93.3±1.8) points versus (92.2±1.5) points], or ATRS at 6 months after operation [(93.3±1.1) points versus (93.0±0.5) points] ( P>0.05). The AOFAS ankle-hindfoot score and ATRS were significantly improved at 6 months after operation in all patients ( P < 0.05). In group A, of the 12 patients under general anesthesia, laryngeal discomfort occurred in 1 case. In group B, of the 16 patients under general anesthesia, laryngeal discomfort occurred in 4 cases, chest tenderness in 1 case, and shoulder numbness in 1 case. In group A, there was 1 case of superficial redness and swelling at the incision. In group B, there were 2 cases of superficial redness and swelling at the incision, 1 case of sural nerve injury, and 1 case of Achilles tendon re-rupture. There was significant difference in anesthetic complications or postoperative complications between the 2 groups ( P<0.05). Conclusion:In the treatment of acute closed Achilles tendon rupture, compared with prone position and percutaneous minimally invasive suture, supine position and spoon-shaped medial incision and reverse traction overlapping suture can reduce the incidence of anesthesia and postoperative complications, and promote early functional recovery. Therefore, it can be used as a suitable choice.

Objective:To compare the efficacy of supine position and spoon-shaped medial incision and reverse traction overlapping suture versus that of prone position and percutaneous minimally invasive suture for acute closed Achilles tendon rupture.Methods:A retrospective study was conducted to analyze the clinic data of 43 patients with acute closed Achilles tendon rupture who had undergone surgical treatment at Department of Orthopedics, Zhongshan Hospital Affiliated to Dalian University from October 2019 to December 2022. There were 40 males and 4 females with an age of (82.5±10.9) kg. The patients were divided into 2 groups according to their different treatment methods: group A of 20 cases treated by supine position and spoon-shaped medial incision and reverse traction overlapping suture, and group B of 23 cases treated by prone position and percutaneous minimally invasive suture. The 2 groups were compared in terms of operation time, intraoperative blood loss, incision length, postoperative hospital stay, complications, and ankle-hindfoot score of American Orthopedic Foot and Ankle Society (AOFAS) and Achilles tendon total rupture score (ATRS) at 3 and 6 months after operation.Results:There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P>0.05). The operation time in group A [(36.8±3.7) min] was significantly shorter than that in group B [(43.3±5.2) min], the intraoperative blood loss in group A [(26.1±4.5) mL] significantly more than that in group B [(15.7±2.2) mL], the incision length in group A [(7.5±0.8) cm] significantly longer than that in group B [(3.8±0.8) cm], and the AOFAS ankle-hindfoot score [(85.6±3.7) points] and ATRS [(80.3±0.7) points] in group A at 3 months after operation were significantly higher than that in group B [(81.6±3.5) points and (74.4±2.4) points] (all P<0.05). There were no significant differences between groups A and B in postoperative hospital stay [4 (3, 4) d versus 3 (3, 4) d], AOFAS ankle-hindfoot score [(93.3±1.8) points versus (92.2±1.5) points], or ATRS at 6 months after operation [(93.3±1.1) points versus (93.0±0.5) points] ( P>0.05). The AOFAS ankle-hindfoot score and ATRS were significantly improved at 6 months after operation in all patients ( P < 0.05). In group A, of the 12 patients under general anesthesia, laryngeal discomfort occurred in 1 case. In group B, of the 16 patients under general anesthesia, laryngeal discomfort occurred in 4 cases, chest tenderness in 1 case, and shoulder numbness in 1 case. In group A, there was 1 case of superficial redness and swelling at the incision. In group B, there were 2 cases of superficial redness and swelling at the incision, 1 case of sural nerve injury, and 1 case of Achilles tendon re-rupture. There was significant difference in anesthetic complications or postoperative complications between the 2 groups ( P<0.05). Conclusion:In the treatment of acute closed Achilles tendon rupture, compared with prone position and percutaneous minimally invasive suture, supine position and spoon-shaped medial incision and reverse traction overlapping suture can reduce the incidence of anesthesia and postoperative complications, and promote early functional recovery. Therefore, it can be used as a suitable choice.

Objective:To investigate the safety and efficacy of the modified transcutaneous endoscopic spine system (TESSYS) with full visual foramen plasty and percutaneous endoscopic discectomy (PTED) in the treatment of lumbar disc herniation and lumbar spinal stenosis.Methods:A case-control study was conducted to analyze the clinical data of 68 patients with single segment lumbar disc herniation and lumbar spinal stenosis treated with visual endoscopic foraminal plasty and modified TESSYS technique and intervertebral foraminal fusion from April 2020 to March 2021. According to the operation method, 38 cases were divided into two groups: pted group (38 cases) and TLIF group (30 cases). Independent sample t-test was used to compare the incision length, bleeding volume, operation time, time to go down and hospital stay between the two groups. Visual analog scale (VAS) scores and Oswestry disability index (ODI) scores were measured repeatedly. The differences between preoperative and postoperative 7 days and 1, 3, 6 months were analyzed and compared by generalized estimation equation. Rank sum test was performed in combination with the modified MacNab standard in the last follow-up. The excellent and good rate was compared between groups χ 2. Test and evaluate the curative effect. Results:The postoperative follow-up was 8.5-14.0 months. The incision length (1.25±0.33) cm, operation time (119.45±14.95), blood loss (24.03±8.62) mL, downtime time (1.42±0.50) d, and hospital stay (3.39±0.55) d in the PTED group were all higher than those in the TLIF group ((14.37±2.91) cm, (140.53±16.16) min, (158.00±51.35) mL, (3.20±0.96) d, (7.33±0.55) d) had obvious advantages ( t values were 24.56, 5.57, 14.13, 9.20, and 29.48, respectively; all P<0.001). The VAS scores and ODI scores of the two groups after operation were significantly improved compared with those before operation (all P<0.001), and with the passage of time, the VAS scores and ODI scores of the two groups of patients from 7 days to 6 months after operation by month were significantly decreased ( P<0.001). However, there was no significant difference between the two groups in VAS score from 1 week to 6 months after operation: P7d=0.997, P1 month=0.139, P3 month=0.057, P6 month=0.539, all P>0.05. There was no significant difference in ODI scores between time points (ODI: P7d=0.278, P1 month=0.442, P3 month=0.963, P6 month=0.278, all P>0.05). There was no significant difference between the two groups in terms of clinical efficacy and excellent and good rate evaluated by modified MacNab criteria at the last follow-up ( Z=0.09, P=0.927; χ 2=0.92, P=0.761). Conclusion:The short-term curative effect of full visual endoscopic foraminal plasty and modified TESSYS technique in the treatment of single level lumbar disc herniation and lumbar spinal stenosis is close to that of classical foraminal interbody fusion, and has certain advantages.

BACKGROUND: Lung segmentectomy is increasingly used to resect lung nodules. Video-assisted thoracic surgery (VATS) is widely chosen to performing lung segmentectomy, while robotic assisted thoracoscopic (RATS) was also one useful and practical method. There article was intended to compared the short-time outcomes of RATS and VATS in lung segmentectomy. METHODS: The patients with lung nodules underwent segmentectomy by either RATS or VATS from January 2016 to April 2017 were studied. Baseline characteristics and short-time outcomes (dissected lymph nodes, postoperative duration of drainage, postoperative hospital stay, incidence of pro-longed air leak, atrial fibrillation and pneumonia) were compared. RESULTS: 166 patients were included in this study: 81 patients underwent RATS segmentectomy while 85 underwent VATS segmentectomy. The number of lymph nodes dissected in RATS group was more than in VATS group ［(13.07±5.08) vs (10.81±5.74), P=0.010］. The incidence of some postoperative complications such as pro-longed air leak, atrial fibrillation was not significant different between the two approaches. CONCLUSIONS Compared with VATS, RATS has similar safety and operability, and the number of lymphadenectomy is significantly more than that of VATS.