Search

An estimate of about 50% of new liver cancer cases worldwide occur in China every year.Surgical resection is still the major treatment choice for longer survival of patients with hepatocellular carcinoma. Blocking hepatic blood flow and reducing intraoperative bleeding ensure the success of the operation. Anatomic separation of hepatic hilar region is the precondition of hepatic inflow occlusion. The hepatic hilar plate system involves a thick layer of connective tissue covering the hepatic inflow ducts of hepatic hilar region. The descending part of hilar plate assists in reducing the anatomical difficulty of the hepatic hilar region. The "forth porta hepatis" that is hidden in the hepatic hilar plate system involves the accumulation area of "short hepatic portal veins" .The communicating branch vessels between the hepatic inflow vessels form the anatomical basis in reducing the indocyanine green fluorescence stain effect.The relatively fixed position of the hepatic portal plate is considered as a positioning marker for accurate liver resection. The intrahepatic Glisson sheath is connected with thick connective tissue of the hepatic portal panel system, and is regarded as the physical barrier in limiting the proliferation and hypertrophy of hepatocytes and continuation of hepatic portal panel system in the liver.This paper summarizes the anatomy and application of hepatic hilar plate system during hepatobiliary surgery.

Objective: To explore the clinical effect of total hip replacement with soft tissue release and true acetabulum reconstruction on treating osteoarthritis secondary to severe development dysplasia of the hip.
 Methods: From January 2005 to January 2011, 23 hips in 21 patients with osteoarthritis secondary to Crowe III development dysplasia of the hip underwent total hip arthroplasty with soft tissue release and true acetabulum reconstruction. There were 18 females and 3 males. The age was (45.1±13.2) years. Two patients underwent bilateral total hip arthroplasty (THA) and 19 cases underwent unilateral hip. The Harris hip score was 39.7±5.6.
 Results: The duration of follow up was (110±46) months. The symptoms of patients were relieved, and all the patients' femur head recovered to the true acetabulum after soft tissue released. Sciatic nerve paralysis occurred in one patient, who recovered after 3 months. All patients showed restoration of limb length, while the limb-length discrepancy was (11.0±3.5) mm. The post-operation Harris hip score was 87.2±5.9.
 Conclusion: Total hip arthroplasty with soft tissue release and true acetabulum reconstruction was an effective method in treating osteoarthritis secondary to Crowe III development dysplasia of the hip and was a challenging work to the orthopedic surgeon. It was critical the surgeon to plan the operative intervention carefully.

Objective: To explore the effective skills of reconstruction and balance of soft tissue in hemi-shoulder replacement for patients with four-part fracture of the proximal humerus in order to avoid postoperative complications of joint instability and great tubercle displacement., Methods: From June 2002 to June 2006, 25 patients with Neer four-part fracture of the proximal humerus were adopted in the study which included 15 females and 10 males, with the mean age of 66 years (ranged from 56 years to 80 years). They were treated with humeral head replacement and should joint reparation simultaneously by modified operation approach and reconstruction and balance skills of soft tissue., Results: The mean duration of follow-up was 2.3 years (ranged from 1 to 4.5 years). No infection, nerve damage and prosthesis loosing were found in all cases. Two cases of infra-forward dislocation or subluxation occurred due to affected limb placed on abduction splint postoperatively. One case occurred prosthesis upward displacement due to early active abduction exercise but no complains. Neither joint instability nor displacement and malunion of great tubercle were found in other patients. According to Neer scoring system, 6 cases were rated as excellent, 15 as good and 5 as fair. The good and excellent rate was 84%., Conclusion: In hemi-shoulder replacement for patients with Neer four-part fracture the modified operation approach and reconstruction and balance of soft tissue skills combined with rational rehabilitation exercise can prevent postoperative shoulder joint instability and displacement and malunion of great tubercle.

Objective: To assess clinical result of soft tissue balancing in primary total hip arthroplasty for severe developmental dysplasia of the hip in adults., Methods: From December 2000 to August 2006, 26 primary cementless total hip arthroplasties combined with soft tissue balancing were performed in 21 cases for the treatment of severe developmental dysplasia of the hip. Patients were classified as type III (20 hips) and type IV (6 hips) according to Crowe classification. All acetabular cups were placed in their original anatomic location by soft tissue releasing and subtrochanteric shortening osteotomy. Thereafter, postoperative clinical and radiological results were evaluated., Results: The mean length of follow-up was 4.8 years (range, 13 months-7 years). Limp improved by at least one grade in 62% of the cases. Leg-length discrepancy was corrected significantly and osteotomy was undertaken in 13 hips with a mean decrease length of 0.9 cm by effective releasing. Harris scores improved significantly from a mean of 41.2 preoperatively to 89.6 postoperatively. No dislocations, infections and prosthesis loosening were found at the final follow-up evaluation., Conclusion: Soft tissue balancing in total hip arthroplasty can facilitate acetabular reconstruction to normalize the hip center in severe developmental dysplasia of the hip, as a result, satisfactory short-term result can be obtained by restoring normal function and anatomic structure.

Objective: To summarize the surgical experience of release and balance of soft tissues around hip in total hip arthroplasty for patients with severe hip dysplasia., Methods: From January 2001 to January 2006, 29 patients (31 hips) of adult dysplasia of hip were included in the study. Among them, there were 22 females and 7 males, age from 38 to 65 years with average of 53 years. According to Crowe classification system, there were 22 in type III, 9 in type IV, and Harris score was 42.6 preoperatively. Total hip arthroplasty was performed via lateral approach. All the acetabular cups were reconstructed at the original anatomic location through release of soft tissue around hip to restore limb length, and techniques of balance of soft tissue were applied to extend force arm of hip abductor and improve its function., Results: All the patients had restoration of limb length (ranged from 2.5 cm to 4.5 cm). One case of postoperative dislocation was occurred due to slight large of acetabular obtuse angle. Follow-up for 1-5 years (average 3.2 years) in 29 patients, the Harris score increased to 85.4 postoperatively. All hips had released from pain and functioned well., Conclusions: In order to restoration anatomic structure and physiologic function of affected hip, the technique of release and balance of soft tissues around hip should be applied and cautioned in arthroplasty of dysplastic hip.

The aim of the present study was to investigate the effect of removal of the adventitia on vascular remodeling and vasoconstriction of the carotid artery in New Zealand rabbit. Adventitia of carotid artery was removed mechanically. The histology, morphology and reactivity of the carotid artery was observed by immunohistochemistry and measurement of carotid ring tension immediately, 1 week and 2 weeks after removal of the adventitia. No damage of intima and media was observed after removing the adventitia. Removal of the adventitia caused a remarkable proliferation of the vascular media and formed the neointima. Compared with the control ring, norepinephrine (NE)-induced vasocontraction in adventitia-denuded carotid artery was significantly reduced immediately and 1 week after the operation (P<0.05). Adventitia removal promoted the neointima formation and decreased vasoconstriction of the carotid artery, indicating that the adventitia is involved in the regulation of vascular remodeling and vasoconstriction.