Objective To analyze contribution of varus knee with osteoarthritis and investigate the role of soft tissue balance in total knee replacement ( TKR) of that. Methods One hundred cases (145 varus knees) were operated with TKR. There were 18 males (25 knees) and 82 females (120 knees), with the average age of 64.6 years, from 45 to 80 years old. During the operation, accurate osteotomy and soft tissue balance was made to correct the varus knee joint. The contribution angles of varus knee was measured on weight bearing X ray images pre and postoperatively, in order to evaluate the results of the combination of the osteotomy and soft tissue balance. Results The gross varus angle was average 9.2? ? 3.1? , ranging from 5? to 30? preoperatively. In the total angle, the varus angle caused by soft tissue imbalance was 53.2% , the osseous varus angles caused by the tibia varus was 22.8% , the osseous varus angles caused by tibia plateau destruction was 24.0% . The measurement of the postoperative X ray films suggested that the average angle of the tibia plateau osteotomy was 4.3? , obtaining the correction of 27.9% of the total varus angle, and the angles corrected by soft tissue balance was 10.7? ,getting the correction of 72.1% of the total varus angle. According to HSS score system, the preoperative score was 38 points, ranging from 5 to 57, and postoperative scores was 87 points, ranging from 75 to 90. Conclusion The contribution of varus knee with osteoarthritis were include: 1) Bony structural varus angle composed of tibial varus and tibial plateau destruction; 2) Collateral ligaments and soft tissue imbalance around the knee. Articular surface destruction and soft tissue imbalance are the main contribution of varus knee. For TKR of varus knees like this, besides accurate osteotomy, correct soft tissue balance is the key of the operation. [

Objective To realize the value of magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) in diagnosing vertebral arterial insufficiency of cervical spondylosis. Methods From Nov. 2001 to Feb. 2004, 35 vertebral arterial insufficiency of cervical spondylosis was diagnosed clinically. There were 11 males and 24 females with a mean age of 58.3 years(range, 23 to 76 years). All the patients were examined by MRA and DSA to investigate the tracks, diameters, and stenosis locations of vertebral articles. Results DSA was positive in 32 patients with 19 ipsilateral and 13 bilateral. Meanwhile, MRA positive were in 29 patients, 14 ipsilateral and 15 bilateral. Among MRA positive patients, excepted 5 cases, all the others were also positive with DSA. Accordance of both methods in the diagnosis of thin veterbral artery was 100%. DSA was better than MRA in the diagnosis of localized stenosis and unilateral veterbral artery absence. MRA was much more useful than DSA in the diagnosis of veterbral artery twisting caused by vertebral instability and bone spurs. Conclusion 1) DSA had more accuracy in diagnosis and distinguishing the source of veterbral artery localized stenosis. Posture changing didn't disturb the examination. Its disadvantages, however, were invasive detection, side-effect and dose limitation of contrast medium. 2) As a non-invasive method, MRA was a useful tool in diagnosing diffused, long segmental artery stenosis and obstruction, and especially available for diagnosing the cervical spondylosis combinated with other type. MRA can scan vertebral disc, spinal cord and other vessels at the same time. The indication of MRA was indefinite diagnosis, aged patients with bad tolerance to DSA. The disadvantage of MRA was its low sensitivity in detecting mild stenosis, non-obstruction artery disease, and posture demand during examination.

Objective To investiga te the relationship,diagnosis and thera peutic meth ods of degener-ative diseas es of lumbar and lower extremity joints in middle and aged patients.Methods Fr omNovember1997to May2002,50patients suffering from lum bar and hip or knee degenerative diseases concur rently were reviewed.In this group,there w ere14males and36females,ag ing from45to76years old(with an average of 60.5years).In lumbar degenerative disease,13cases were diagnosed as spi nal stenosis of lumbar,and12cases were diagnosed as spinal stenosis of lumb ar accompanied by degenerative spondylolisthesis,25cases spinal stenosis of lumbar accompanied by degenerative scoliosis.While in the degenerative diseases of joints,ostoarthritis was involved in58knee joints of 40cases,10hip joints of 6cases,and both6knee and5hip joints of 4cases.Results Allof the patients were operated upon;anterior lumbar decompression,bone grafting and Z-plate fixation to L1in5cases,posterior decompression and pedicle screws f ixation for insta-bility of spine in45cases.Of 50patients,11cases(1 4joints)underwent arthroscopy or joint replacement prior to lumbar operat ion,with an average interval period of 9.7months(1.5to29months);3ca ses(3knees)underwent joint replacements after lumbar operation,with an ave rage duration of 17.3months(4to36months);3cases(3hip joints)had hi p joint replacement simultaneously with lumbar operation in one setting.For the other33cases no articular operation was performed,and12cases had relief of the symptoms of osteoarthitis after lumbar opera tion;21cases were tre ated with conservative therapy for degenerative dis-eases of joint and allev iated the conditions satis factorily.The average follow-up period was14.2m onths(3to45months).Compared to pre-operation,the average HSS,Harris sco re of joint and JOA score of lumbar were improved by48.2,42.5and14 .3respectively.Conclusion In middle and aged patients with both lumbar and jo int degenerative dis eases,it is very important to make definite diagnosis an d distinguish symp-toms caused by lumbar or joint disease.The major diseas e portions should be treated firstly;if necessary,both joint and lumbar opera tion could be carried out in one surgical setting.

Objective To investigate the clinical results of the primary total hip replacement (THR) and the secondary THR after failed internal fixation in the elderly patients with displaced femoral neck fracture so as to find the optimal treatment for displaced femoral neck fractures in the elderly patients. Methods From April 2001 to April 2007,16 patients (Study Group) treated with a secondary THR after failed internal fixation and 20 patients (Control Group) treated with a primary THR were enrolled in the study and followed up. There were seven males and nine females, at average age of 66. 5 years (50-85 years) and with mean follow-up period of 58. 25 months (24-96 months) in the Study Group. There were six males and 14 females, at average age of 68.1 years (51-83 years) and with mean follow-up period of 49.50 months (24-70 months) in the Control Group. All patients were active and lucid before they suffered fractures. Blood loss and operation duration in THR were compared. Hip function (Harris score) and health-related quality of life (HRQoL, KPS index score) were assessed during the follow-up after THR. Results Operative duration was (115.63 ±34.35) minutes in Study Group and (91.25 ±15.80) minutes in Control Group (P<0.05). Blood loss was (546.86 ±377.04) ml in Study Group and (320.00 ±155.94) ml in Control Group (P<0.05). At follow up, Harris score and KPS index score were (87. 25 ±7. 53) points and (95. 00 ±5. 16) points respectively in Study Group, and (90.20±5.46) points and (96.00 ±0.73) points respectively in Control Group (P>0.05). There were no infections or re-operations in two groups, but with one death in each group during the follow-up. Conclusions THR is the optimal treatment for displaced femoral neck fractures in the elderly patients.The secondary THR after failed internal fixation has higher risks in operation compared with the primary THR for a displaced femoral neck fracture in the elderly patient.

Objective To observe the clinical outcomes of the surgical management of periprosthetic femoral fractures following hip arthroplasty.Methods Twelve consecutive patients (6 male and 6 female) with the average age of 66.4± 15.0 years old (35 to 86 years old) undergoing surgical operation for periprosthetic femoral fractures between September 2009 and May 2016 were followed up at our center.Nine cases were fractured secondary to the primary hip arthroplasty while the others were patients with earlier revision surgery.The previous fixations of femoral components of 10 cases were cementless while the other two were cemented fixation.The enrolled patients were determined as Vancouver type B 1 (n=2),type B2 (n=7),type B3 (n=1) and type C (n=2) respectively.The occurrences of the fractures were observed at 3 weeks to 17 years post-operation (average 9.0±7.0 years).The patients were treated individually according to different Vancouver types.Type B 1 patients received simple cerclage fixation,as well as revisions with long-stem femoral implants and cerclage band were chosen for type B2 patients.In addition to the treatment for type B2 patients,allogenic cortical bone graft was also required for type B3 patients.Open reduction with locking plate internal fixations were options for patients with Vancouver type C fractures.The following-up included the X-ray images of the hips,Harris hip score and the visual analogue scale (VAS) for the pain of fracture site.The unions of the fractures were determined by both X-ray images and pain intensity of the fracture sites.Results The mean follow-up period was 41.6±26.0 months (range,12-92 months),without patient lost to follow up.VAS scores were 0,implying the clinical union of the fractures.One patients received multiple debridement post-operatively due to the periprosthetic infection.The VAS score of this patient was 6 at the follow up and the X-ray image indicated the nonunion of the fracture.The fracture union rate was 91.7％ (11/12).The Harris hip score was 23-92 (mean score,74.8±18.8),excellent for 2 cases,good for 6 cases,fair for 3 cases and poor for 1 case.The excellent and good rate was 66.7％ (8/12).Post-operative complications were observed in 4 patients (33.3％,4/12).One drainage tube was misplaced and sutured subcutaneously required a further exploration surgery.One periprosthetic infection occurring post-operatively induced the nonunion of the fracture.Aseptic loosing of femoral stem was observed in 2 cases and subsequent revision surgeries were conducted.Conclusion High incidence of complications is observed after the surgical treatment of periprosthetic femoral fractures following hip arthroplasty.Individually customized management regarding to the Vancouver type of periprosthetic femoral fractures leads to the clinical fracture union in 91.7％ of the patients in this case series.The excellent and good rate of the hip function in the early and mid-term stage after operation is 66.7％.