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Modified unilateral laminotomy for bilateral decompression of lumbar spinal stenosis

Xinyu LIU ; Suomao YUAN ; Yonghao TIAN ; Yanping ZHENG ; Lei WANG ; Jianmin LI

Chinese Journal of Orthopaedics.2013;33(10):984-989. doi:10.3760/cma.j.issn.0253-2352.2013.10.002

Objective To describe the technique and therapeutic effect of modified unilateral laminotomy for bilateral decompression (M-ULBD) for lumbar spinal stenosis (LSS).Methods A total of 56 patients with LSS were randomly divided into group A and B.The 27 patients in group A (15 males and 12 females,with an average age of 59.4 years) underwent M-ULBD.The other 29 patients in group B (18 males and 11 females,with an average age of 61.6 years) received conventional laminectomy.JOA score of low back pain,VAS,CPK three days after operation,pre-and post-operative cross-sectional areas of multifidus were used to evaluate the clinical results.Results A total of 45 patients (21 in group A and 24 in group B) completed 2 years of follow-up.The preoperative VAS of low back pain,leg pain,numbness,JOA score and cross-sectional areas of multifidus were 5.6±1.7,7.1±0.4,11.6±2.6,5.8±1.8 cm2 in group A and 6.2±1.2,7.9±1.3,10.9±1.0,6.1±2.0 cm2 in group B.There was no significant difference in preoperative data between both groups.The union of split spinous process was observed in all cases 6months later according to computed tomography.The postoperative CPK was lower in group A.The postoperative JOA and VAS scores in both groups were improved significantly compared with the corresponding preoperative ones.The VAS of leg pain,numbness,JOA score,and JOA recover rate in latest follow-up were 1.3±0.2,1.5±0.7,26.7±2.1,86.1％±3.1％ in group A,and 1.7±0.3,2.0±1.3,24.3±2.5,83.6％±6.4％ in group B,respectively.All these data have no difference between group A and B.The VAS of low back pain and atrophy rate of multifidus were 1.0±0.5,6.4％±1.2％ in group A,and 2.6±0.7,15.7％±3.0％ in group B respectively.All these data are lower in group A.Conclusion Our two years follow-up shows that this method is efficient for lumbar spinal stenosis treatment,however,it still need long term follow-up and to compare with other modified methods.

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The effect of lateral malleolar malrotational deformity on ankle stability-a study of 3D CT reconstruction

Chen WANG ; Xin MA ; Xu WANG ; Jiazhang HUANG ; Chao ZHANG ; Li CHEN ; Yijun ZHANG

Chinese Journal of Orthopaedics.2013;33(10):1058-1064. doi:10.3760/cma.j.issn.0253-2352.2013.10.014

Objective To evaluate the ankle stability on lateral malleolar rotational models based on three-dimensonal CT reconstruction and volume rendering technique.Methods Eighteen cadaveric specimens were utilized in the study (male 11;female 7; 68.2 years in average) and were divided into 2 groups in which the first group only cut the anterior tibiofibular ligament and defined as intact deltoid ligament group.Another group additionally cut the deltoid ligament and defined as deltoid ligament injured group.Fibular transverse osteotomy was performed at 3 cm proximal to the ankle joint and lateral malleolar rotational malunion model of 5°,10°,15° and 30° were built in every specimen.CT scanning was performed for each model then and all CT data were imported into Mimics 10.01 software.The structures of distal syndesmosis,ankle mortise as well as talus in the mortise were outlined by automatic dense identifying and manually modified later.Three-Dimensional models of these structures and their volume were outputted in the software.The volume of ankle clear space was calculated as the difference value of ankle mortise and talus in the mortise.Ankle stability was reflected by comparison of these volumes to the normal condition.Results With the rising of malrotational degree,the volume of inferior syndesmosis and mortise were increased and the volume of talus in the mortise was reduced.In the deltoid ligament intact group,10° of malrotation would significantly enlarged the volume of distal syndesmosis and ankle clear space when compared to normal condition.However,in the deltoid ligament injured group,5° of rotational deformity would significantly enlarge the volume of ankle clear space and distal syndesmosis.Conclusion The condition of deltoid ligament has significant impact on ankle stability in cases of lateral malrotional deformity.Distal syndesmosis and ankle clear space were significantly enlarged at 10° malrotation deformity.However,additional deltoid ligament injury can significantly reduce ankle stability at just 5° of distal fibular rotational deformity.

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Operative treatment of floating hip injuries

Gang WANG ; Hongfen CHEN ; Bin CHEN ; Hui ZHAO ; Fuming WANG

Chinese Journal of Orthopaedics.2013;33(10):1024-1030. doi:10.3760/cma.j.issn.0253-2352.2013.10.008

Objective To discuss the mechanism of injury,treatment decisions,complications and surgical results of the floating hip injuries (FHI).Methods Thirty-three patients with FHI were retrospectively analyzed in our hospital from June 2001to June 2011.There were 25 males and 8 females,with an average age of 34.6 years (range,4-73 years).The mechanism of injury was motor vehicle collision for 20 patients,fall down from a height for 11,crushed injury for 1,and sports-related injury for 1.According to Liebergall classification for the floating hip injuries,there were 7 cases for type Ⅰ (21.2％),9 for type Ⅱ (27.2％)and 17 for type Ⅲ (51.6％).All patients had associated injuries,the average injury severity score (ISS) was 28.9.Thirty-two of the femoral fractures underwent surgical stabilization of their femoral fractures.Surgical stabilization methods included ORIF or intramedullary nailing (29 cases),external fixation (1 case),total hip arthroplasty (2 cases).Acetabular fractures were treated with open reduction and internal fixation (ORIF) in 16 cases.Thirteen patients suffered pelvic fractures underwent surgical stabilization for at least one component of ring disruption.Results Twenty-eight cases (84.8％) were followed up for 2.3 to 10.1 years (average,3.5 years).Thirteen patients were followed up in the 16 patients who suffered type Ⅰ or Ⅱ fractures.According to Majeed functional evaluation,the results were excellent in 8 cases,good in 3 and fair in 2,with the excellent and good rate being 84.6％.Fifteen patients with type Ⅲ were followed up,according to D'Aubigné and Postel evaluation criterion.The joint functions were excellent in 7 cases,good in 4,fair in 3,and poor in 1,with the excellent and good rate being 73.3％.According to Ma Yuanzhang functional evaluation,the knee functions of the all patients were excellent in 23 cases,good in 3,and fair in 2,with the excellent and good rate being 92.9％.Complications seen in these patients included post-traumatic osteoarthritis of the hip developed in one hips,2 patients developed heterotopic ossification (HO),one case of avascular necrosis of the femoral head,and two femoral nonunions.The most severe complication was traumatic sciatic nerve palsy,which was found in 5 patients.Conclusion Ipsilateral injuries to the femur and the pelvis or acetabulum (floating hip) are severe injuries usually caused by high-energy trauma.The femur fracture will most commonly be addressed first,and surgeons should be aware of the high incidence of sciatic nerve palsy as well as treatment options and potential complications associated with this devastating combination of injuries.

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Closed reduction and cannulated screws fixation of Ideberg Ⅲ type glenoid fractures

Guoyue YANG ; Jian JIA ; Yinguang ZHANG ; Haibin ZHANG ; Han JIANG

Chinese Journal of Orthopaedics.2013;33(11):1084-1090. doi:10.3760/cma.j.issn.0253-2352.2013.11.003

Objective To explore the recent clinical efficacy of closed reduction and cannulated screws internal fixation for the treatment of Ideberg Ⅲ type glenoid fractures.Methods From October 2005 to January 2012,9 cases of Ideberg Ⅲ type gleuoid fractures with closed reduction and cannulated screws internal fixation were studied retrospectively,including 6 males and 3 females,4 cases on the left and 5 on the right,with the average age of 42.2 years (range,28-56).There were three cases combined with clavicle fractures,take S-shaped incision reset for clavicle reconstruction and plate fixation.Three cases combined with acromioclavicular joint dislocation were used the hook plate fixation,and 3 cases with combined acromion fracture were used tension band wire fixation.Suspension structures in the reconstruction of the shoulder glenoid fracture underwent closed reduction and cannulated screw internal fixation.After giving adjustable shoulder abduction brace,rehabilitation exercises were performed under the guidance of doctors.After 1,6 weeks,and 3,6,12 months,X-ray examinations at anteroposterior shoulder view were conducted.By X-ray and clinical examination to determine the fracture healing time,to assess shoulder function with the American Shoulder and Elbow Society (ASES) scoring system,and recorded complications and corresponding outcome.Results Nine cases were obtained from 12 to 46 months,the average (30.8±9.1) months follow-up all fractures healed,with an average healing time of X-rays 12 to 24 weeks,mean (16.8±4.8) weeks.After 12 months surgery,row ASES scores was 82.3 (range,57-95),compared with the preoperative difference was statistically significant.ASES scores were excellent in 5 cases,good in 2,fair in 1 and poor in 1.One patient with traumatic arthritis obtained satisfactory clinical results through oral nonsteroidal drugs and intra-articular injection of sodium hyaluronate.No screw loosening,fracture fixation failure complications were observed.Conclusion Closed reduction and cannulated screws internal fixation of Ideberg Ⅲ type glenoid fractures recently obtained satisfactory results.

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Histological and morphological observations on the distribution of circum-patella nerve fibers

Rui CHENG ; Xinghua GAO ; Zhiqi HOU

Chinese Journal of Orthopaedics.2013;33(11):1120-1125. doi:10.3760/cma.j.issn.0253-2352.2013.11.009

Objective To observe the distribution of circum-patella nerve fibers in the soft tissue to provide experimental evidence,which is significant in denervation for Total Knee Arthroplasty (TKA).Methods Patella specimens were collected from 4 cadavers (2 cases of diabetic foot,lcase of lower extremity arterial occlusive,and 1case of car accident),all 4 of which were resected soft tissue with a dimension of 0.5cm × 0.5cm and full depth thickness around patella more than 0.5cm for histology and morphology observation.The nerve fibers histology and morphology were observed in all resected specimens with HE staining and silver-gilt glycine staining in the same field of microscopic vision.Results Anatomy found that the vascular network form skins directly involved in the patella nourish hole area and in the 10,2,4,7 clock point have found that blood vessels into the patella.There have a large number of nerve fibers near to the patella under the microscope,but there were no significant difference in the nerve fibers region distribution of all specimens.There were some into patella nerve fiber paths in side of patella soft tissue,which lied in 7,11 and 13 clock point,but outside no this phenomenon.The distribution of circum-patellar nerve fibers were described as distribution of regional concentration,which lied in much more 5,6,7 clock points and 10,11,12,1,2,clock points,in which the quadriceps tendon and patellar tendon have more than the others.In the 13 clock point,the fascia and periosteum of nourish hole area were also found in a large number of nerve fibers,and there were laminar distribution in different soft tissue layers,which were collected much more in synovial layer,fat pad,tendon near to patella.Conclusion There are much more nerve fibers near to the patella and some into patella nerve fiber paths in the medial side and nourish hole area.Nerve fibers distribution of circum-patella can be described as laminar distribution and regional concentration ,which is more in the centre,bottom more than top,outside more than inside,the bipolar more than the others.The patella denervation operation by reducing the number of peripheral nociceptors to achieve desensitization is feasible in TKA.

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The study of near and long term changes of bone cement and cancellous bone after percutaneous vertebroplasty

Renfu QUAN ; Yueming NI ; Xuan ZHENG ; Shangju XIE ; Changming LI

Chinese Journal of Orthopaedics.2013;33(11):1155-1163. doi:10.3760/cma.j.issn.0253-2352.2013.11.014

Objective To observe the research of the biologically performance,interface micro-structure and nano-indentation situation when polymethyl methacrylate bone cement-PMMA injected into rabbit in the near future and far future individually.Methods New Zealand white rabbits were used ovariectomy plus dcxamethasone intramuscular injection to establish osteoporosis animal model.All animal models were divided into 3 groups with 35 in each osteoporosis group,testing group,and normal group.Execute the lumbar centrum of New Zealand rabbit as osteoporosis bone defect model,injected bone cement,with the help of material dynamo experiment machine to do the axial compression tests,three point bending test,and torsion test in order to observe the biological dynamic changes.Optical microscope,fluorescence microscope and scanning electron microscope were used to observe the changes of micro bone cement and the changes of bone looseness.Nano-indentation testing was applied by the triboindenter to study the critical load.Results PMMA can rapidly establish the strong support with stable function in the near future.Biomechanical experiments showed that biomechanical properties of bone cement group was significantly higher than those in the other two groups.Biomechanical properties of bone cement group may decline with the time,but which were still better than those of OP in the control group.Histo-morphological observation result shows that under osteoporosis state the bone grows slower,bone's rebuilding time also extended.And in the later period,main bone's continuous osteoporosis had some impact on the interface.Nano-indentation testing showed that the young modulus and stiffness of the interface among bone,material and interface were significantly differences.Bone cement had showen the best nano indentation hardness,then was interface and bone tissue.Conclusion The polymethyl methacrylate bone cement llⅢ has a good effect in filling,on account of it has great plasticity and liquidity and can penetrate into the minuteness aperture between trabecula,then after solidifying,it will combine firmly with the host bone.PMMA can rapidly establish the strong support with stable function after operation.The performance is decreasing in the far future but still with satisfaction.

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Reverse radial side of dorsal artery the fascial pedicle island bone flap in repairing defect of thumb composite tissue defects

Xiao ZHOU ; Yongjun RUI ; Mingyu XUE ; Yajun XU ; Kuishui SHOU

Chinese Journal of Orthopaedics.2013;33(11):1104-1108. doi:10.3760/cma.j.issn.0253-2352.2013.11.006

Objective To introduce the surgical method of reverse radial side of dorsal artery the fascial pedicle island bone flap for the treatment of thumb composite tissue defects,and to evaluate its short term clinical outcome.Methods From May 2010 to March 2012,9 cases with composite tissue defects at thumb were treated with reverse radial side of dorsal artery the fascial pedicle island bone flap,including 5 males and 4 female with an average age of 38 years (range,13-68).All injuries were caused by planer.The time of injury to operation was 3-8 hours,all patients showed in both thumb root plane beyond volar or dorsal,skin and soft tissue defect accompanied by distal phalanx defect.Skin and soft tissue of thumb defect size was 1.0 cm ×1.8 cm to 2.0 cm × 2.2 cm.Preoperative hands anteroposterior and lateral X-ray were routine taken.Imaging findings were associated with the thumb base beyond the distal phalanx fractures,bone defect length was 0.4-0.7 cm.We cut thumb radial side of the dorsal artery fascia flap during surgery operation according to the thumb side wound defect case.The size of the bone flap was 0.2 cm× 0.6 cm to 0.4 cm × 0.8 cm,properly inserting intramedullary distal phalanx fixed base,9-0 line will flap inside the dorsal nerve and a nerve suture flap reconstruction feeling.Results All bone flaps were survived completely,no case occur venous disorders,flap blood circulation was stable,donor skin graft was survival in stage Ⅰ.This group of patients incision were healing 2 weeks after surgery.All the patients were followed up as scheduled,and the follow-up time was 6-12 months.All flaps survived,and the colors,texture,contour of the flaps were good.The two-points discrimination distance was 7.0-10.0 mm on the flap,Thumb distal phalanx healing time was 1.0-1.5 months.Bone absorption was not observed in graft.The thumb function was assessed as excellent in 7 fingers,good in 2 fingers,no complication occurred in donor site.Conclusion The main artery and nerve will not be sacrifice,when the bone flap is used.There are blood into the backbone of the first metacarpal nearly 1/3 of the bone to reconstruct thumb bone defect,the operative procedures is available and easy to be performed,which is a new method for the treatment of thumb composite tissue defects.

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The role of roentgen stereophotogrammetric analysis in assessing early migration of femoral implant after total hip arthroplasty with modular prostheses

Junjie ZHOU ; Chengfu CAO ; Jinhui PANG ; Wenwu GAO ; Qianqi CHEN

Chinese Journal of Orthopaedics.2013;33(9):881-887. doi:10.3760/cma.j.issn.0253-2352.2013.09.001

Objective To investigate the value of roentgen stereophotogrammetric analysis (RSA) in assessing early migration of femoral implant after total hip arthroplasty (THA) with modular prostheses.Methods From May 2009 to April 2010,37 patients underwent THA with modular prostheses inour hospital,including 25 males and 12 females,aged from 58 to 72 years (average,60.23±5.64 years).There were 32 cases of degenerative osteoarthritis,3 cases of femoral neck fracture and 2 cases of developmental dysplasia of the hip.The Harris hip score and RSA were used to assess the clinical results and the migration of femoral implant at 3,6,12,24 months postoperatively,respectively.Results The average Harris hip score improved from preoperative 26.36 ±10.56 to 78.24±12.72,84.51±16.05,86.72±9.34,and 87.55±8.97 at 3,6,12,and 24 months after operation,respectively,and the differences between pre-and post-operative Harris score were significant.There was no prosthetic revision,and slight thigh pain occurred in 3 patients.According to RSA,the degree of initial migration of femoral implant had large individual differences,and the initial migration was higher from 3 to 6 months after operation.Clinical and biological stabilization was achieved in 36 patients,while progressive migration was found in 1 patient.There was a positive correlation between the distal migration and posterior migration within 24 months after operation (r=0.3,P=0.01).The distal migration and posterior migration/rotation mainly occurred within 3 months after operation.There was no correlation between prosthetic size/offset and degree of migration of implant.Conclusion RSA provides an objective reference for assessing the migration of femoral implant after THA with modular prostheses,which is a reliable method to evaluate early implant stability.

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Total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe Ⅳ developmental dysplasia of the hip

Shuhua YANG ; Weihua XU ; Shunan YE ; Xianzhe LIU ; Jing WANG ; Yong FENG ; Wenbin HUA

Chinese Journal of Orthopaedics.2013;33(9):888-894. doi:10.3760/cma.j.issn.0253-2352.2013.09.002

Objective To evaluate the clinical efficacy of total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe Ⅳ developmental dysplasia of the hip.Methods From September 2003 to September 2012,21 patients (24 hips) underwent total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe Ⅳ developmental dysplasia of the hip in our hospital.There were 3 males and 18 females,aged from 28 to 71 years (average,54±10 years).The ceramicpolyethylene articulation was used in 17 patients (20 hips),and metal-polyethylene articulation in 4 patients (4 hips).The osteotomy site was treated with autologous bone graft in 18 patients (21 hips) and allogeneic bone graft in 3 patients (3 hips).The Harris hip score was used to assess the clinical results.Results A total of 18 patients were followed up for 0.5 to 9 years (average,3.5 years).The Harris hip score was improved from preoperative 47.9±9.1 to 88.4±3.5 at 6 months postoperatively.For most patients,hip pain relieved significantly; range of motion of the hip was improved,and the gait returned to normal.Sciatic nerve palsy occurred in 1 patient.There was no wound infection.X-rays 6 months after operation showed that the position of prostheses was satisfactory,without loosening of prostheses and bone block resorption.Conclusion Total hip arthroplasty with subtrochanteric femoral shortening osteotomy can achieve good clinical effect in Crowe Ⅳ developmental dysplasia of the hip.Moreover,it can improve leg length discrepancy and decrease the risk of sciatic nerve injury.

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Medium-and long-term results of one-stage debridement and total hip arthroplasty for advanced active tuberculosis of the hip

Yongqing WANG ; Hongbin BI ; Zhihui ZHAO ; Ying ZHAN ; Zhiqiang YANG ; Jingsheng WANG

Chinese Journal of Orthopaedics.2013;33(9):895-900. doi:10.3760/cma.j.issn.0253-2352.2013.09.003

Objective To observe the medium-and long-term results of one-stage debridement and total hip arthroplasty (THA) for advanced active tuberculosis of the hip.Methods From January 2002 to December 2008,8 patients (9 hips) with advanced active tuberculosis of the hip underwent one-stage debridement and THA in our hospital.There were 5 males and 3 females,aged from 18 to 59 years (average,39.6 years).According to Babhuulkar and Pande imaging classification,there were 1 case of grade Ⅲ and 7 cases of grade Ⅳ.All patients had hip pain,which got serious during active and passive motion.All patients had dysfunction in stretch,abduction,rotation and flexion of the hip,and the flexion deformity ranged from 30° to 70° (average,46°).Thomas sign were positive in all patients.The erythrocyte sedimentation rate ranged from 45 to 125 mrr/1 h.The results of tuberculin test were all positive.X-rays showed osteoclasia,narrowing or disappearance of the joint space and surrounding abscess in all patients.The diagnosis of hip joint tuberculosis was confirmed by postoperative pathological examination in all patients.All patients were treated with antituberculous medications for 12 to 18 months,including preoperative IRES (≥ 2 weeks) and postoperative IRES (3 months),IRE (6 to 9 months) and IR (3 to 6 months).Results All patients were followed up for 50 to 150 months (average,88.8 months).One-stage healing of incision was obtained in all patients.X-rays showed no signs about loosening of prosthesis and recurrence of tuberculosis.The erythrocyte sedimentation rate returned to normal range within 6 months after operation.The average Harris score improved from preoperative 25.78±16.15 to 94.78±2.91 at final follow-up,and the difference was significant.Conclusion Under the standard antituberculosis chemotherapy,the one-stage debridement and THA are safe and feasible for advanced active tuberculosis of the hip,which can result in satisfactory medium-and long-term resuits.

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