Journal Detail Information

1

Cite

Share

Video-assisted high anterior transcervical approach for spinal lesions of the craniovertebral junction

Feng LI ; Wei XIONG ; Fan ZHANG ; Tie LIU ; Zhong FANG ; Yang LIN ; Anmin CHEN

Chinese Journal of Orthopaedics.2011;31(3):213-218. doi:10.3760/cma.j.issn.0253-2352.2011.03.003

Objective To assess the feasibility and clinical results of video-assisted high anterior transcervical approach (Smith-Robinson) in treatment of spinal lesions of the craniovertebral junction. Methods Between April 2007 to October 2009, nineteen consecutive patients with spinal lesions of the craniovertebral junction were included in the study. There were 9 males and 10 females aged from 16 to 62 years old with a mean of 32 years. The primary pathologies included 4 cases with chronic odontiod fracture, 2 cases with purely irreducible atlantoaxial dislocation, 6 cases with os odonteideum, 1 case with Marfan synd rome, 1 case with primary basilar invagination from Kippel-Feil syndrome, 3 case with axis tumor and 1 case with irreducible rheumatoid atlantoaxial dislocation. All of the patients underwent combined video-assisted high anterior transcervical procedure and posterior fixation at one-stage. The anterior procedure included atlantoaxil release and reduction (8 cases), odontoidectomy (8 cases), and intralesional extracapsular excision and reconstruction (3 tumor cases). The posterior technique were C1-C2 pedicle screw fixation (13 cases), C1-C3 pedicle screw fixation (2 cases), and occipitalcervical fusion (4 cases). Results Anatomical reduction was achieved in eight cases with anterior release and reduction. Tumors were completely removed in three cases with axial tumor. The mean follow-up was 14 months (6-36 months). All of them achieved solid bone fusion. In the 14 patients with symptoms of spinal cord dysfunction, the average Japanese Orthopaedic Association (JOA)score had improved from 9.1±3.3 preoperatively to 14.1±2.9 postperatively. The improvement rate was excellent for 7 cases, good for 5 cases, fair for lcase and poor for 1 case. One patient experienced leakage of cerebrospinal fluid which was resolved by bioprotein gelatin blocking and lumbar subarachnoid continuous drainage within 1 week. Dysphagia which occurred in 3 cases responded well to dexamethason and mannitol.No infection and hardware failure were observed. Conclusion Video-assisted high anterior transcervical procedure is a safe and effective alternative for treating spinal lesions in the craniovertebral junction.

2

Cite

Share

Experimental study of improved arthroscopic reconstruction of posterior cruciate ligament using tibial Inlay technique

Xuefeng JIANG ; Huiguang YANG ; Yunqing ZHANG ; Jun XU ; Guowei HUANG ; Yajun REN ; Huiqing SUN

Chinese Journal of Orthopaedics.2011;31(3):260-264. doi:10.3760/cma.j.issn.0253-2352.2011.03.012

Objective To improve the arthroscopic posterior cruciate ligament (PCL) reconstruction using tibial Inlay technique. Methods The special arthroscopic device and related fixation technique were designed. Five cadaveric knees were used to simulate the process of arthroscopic posterior cruciate ligament reconstruction using tibial Inlay technique. The knees were cut open to observe whether the outlet of the tibial tunnel shape and location met the design requirements. Thirty normal MRI films were measured to identify tunnel angle and localizer angle. Results The inner outlet of tunnel was conical shape(14 mm×7 mm×15 mm) and the outer outlet was cylinder-shaped (a diameter of 7 mm). The tibial drill was designed into a split structure and could be assembled in vitro. According to the data obtained from MRI films, the angle between the plane of posterior cruciate ligament and horizontal place was 36°-47°, and the localizer was fixed at 50°.The achilles tendon was used as implant and the allogft bones were designed into conical shape to fit the inner outlet of tunnel. The other end of implant to the proximal tibia was fixed with button plate. All reconstruction operations were performed under arthroscopy. The outcomes of procedure were satisfactory. There were no vascular or peripheral nerve injuries in the cadaveric knees The tunnel position was accurate and the shape of tunnel had met the design requirements. Conclusion Our results imply that improved arthroscopic of posterior cruciate ligament using tibial Inlay technique is simple, accurate, rapid and stable fixation.

3

Cite

Share

Articulating spacer in the two-stage revision for severe infected knee arthroplasty

Xusheng QIU ; Xu SUN ; Dongyang CHEN ; Zhihong XU ; Dongquan SHI ; Qing JIANG

Chinese Journal of Orthopaedics.2011;31(3):249-254. doi:10.3760/cma.j.issn.0253-2352.2011.03.010

Objective To investigate the efficiency and safety of articulating spacer for severe infected knee arthroplasty in patients with medical comorbidities and local sinus tracts. Methods Ten consecutive patients with medical comorbidities (rheumatoid arthritis, diabetes mellitus, etc) or local sinus tracts,who were complicated with late infected TKA, were included in the study. All the patients underwent twostage revision using articulating spacers. All of the patients were debridement thoroughly and followed by implantation of an antibiotic-loaded cement articulated spacer. Two-stage revisions were not followed untill the infection were controlled. The hospital for special surgery (HSS) knee scoring system and range of motion were used to evaluate the outcomes. Results One patient underwent knee fusion because the infection was not controlled after first-stage surgery. The other 9 patients had no evidence of infection. The mean follow-up was 50 months (range, 24-90 months), no recurrent infection developed for these 9 patients. The mean modified HSS score had improved from 48 points (range, 32-63) before the resection surgery to 79 points (range,62-91) at the end of the spacer period. At the latest follow-up, the modified HSS score averaged 89 points (range, 74-95). The good and excellent rate was 0, 80% and 100%, respectively. The average range of motion had increased from 13°-70° preoperatively to 8°-93° prior to the revision. And at the latest follow-up, the range of motion averaged 3° to 110°. Conclusion The delayed two-stage revision using an articulating spacer is effective in the treatment of chronically infected TKA characterized by simple, good reproducible, high rate of infection control, better joint function after surgeries

4

Cite

Share

A comparison of open reduction and internal fixation and primary total elbow arthroplasty for type C inter-condylar fractures of the distal humerus in the elderly

Cong HUANG ; Xieyuan JIANG ; Manyi WANG

Chinese Journal of Orthopaedics.2011;31(3):243-248. doi:10.3760/cma.j.issn.0253-2352.2011.03.009

Objective To compare the clinical outcomes of open reduction and internal fixation (ORIF) with total elbow arthroplasty (TEA) for type C inter-condylar fractures of the distal humerus in the elderly. Methods Twenty-two patients who were treated with ORIF or TEA from April 2003 to September 2009 were included in the study. All fractures were OTA classification 13C. Among them, 10 patients who were treated with ORIF were follow up for 8-56 months, while 12 patients who were treated with TEA were followed up for 15-54 months. The Mayo elbow performance score (MEPS) and the complications were compared. Results Using the MEPS, there were 2 in excellent, 4 in good, 4 in fair in the patients treated with ORIF. Complications included heterotopic ossifications (2 cases) and ulnar nerve dysfunction (2 cases).There were 6 in excellent, 4 in good, 2 in fair in the patients treated with TEA. Complications included 1heterotopic ossification (1 case), ulnar nerve dysfunction (1 case), the weakness of musculus triceps brachii (1 case). The patients treated with TEA had significantly better range of motion (107.5° vs 84.5°, P=0.007),also had better MEPS (87.9 vs 75.5, P=0.047) than those with ORIF had ones. Conclusion TEA is a liable option for type C inter-condylar fractures of the distal humerus in the elderly.

5

Cite

Share

Treatment of posterior condylar tibial plateau fractures

Hongwei CHEN ; Gangsheng ZHAO ; Genfu ZHANG ; Jun PAN ; Lijun WU ; Xuhong CHEN ; Guohua JIN ; Xin CHEN ; Shengchun ZHAO ; Feng BAO

Chinese Journal of Orthopaedics.2011;31(3):224-228. doi:10.3760/cma.j.issn.0253-2352.2011.03.005

Objective To discuss the operative procedures and clinical result of posteromedial and posterolateral approaches in treatment of posterior condylar tibial plateau fractures. Methods From January 2006 to June 2008, 21 patients of posterior condylar tibial plateau fractures were treated by posteromedial and posterolateral knee approaches. There were 12 males and 9 females. The age ranged from 28 to 68 years, with a mean of 39.5 years. Of the patients, 13 had resulted from a traffic accident and 8 had caused by a fall. As for the state of posterior condylar tibial plateau fractures, 7 patients had a medial condylar.fracture, 8 patients had a lateral condylar fracture and 6 patients had a bilateral condylar fracture. Results A follow-up lasted 12-24 months (mean 16.2 months ) in 21 patients. There was no infection, no varus or valgus of the knee, no nerve injuries and loosening or breakage of the screw. All cases had attained bone union. According to the Rasmussen functional scoring, the results were excellent in 12, good in 7 and fair in 2. The excellent and good rate of clinical results was 90.5%. Radiologic results were graded with the Rasmussen score to evaluate the reduction of fracture. There were excellent in 13, good in 7 and fair in 1. The excellent and good rate of clinical results was 95.2%. Conclusion Posteromedial and posterolateral approaches can facilitate the reduction and fixation for posterior condylar tibial plateau fractures. It has many advantages such as good exposure, less invasion and the excellent clinical results.

6

Cite

Share

Bracing treatment for girls with adolescent idiopathic scoliosis: clinical outcomes and predictive factors

Xu SUN ; Bin WANG ; Yong QIU ; Zezhang ZHU ; Feng ZHU ; Yang YU ; Bangping QIAN ; Weiwei MA ; Zhen LIU ; Saihu MAO

Chinese Journal of Orthopaedics.2011;31(3):201-206. doi:10.3760/cma.j.issn.0253-2352.2011.03.001

Objective To analyze the outcomes of bracing treatment for girls with adolescent idiopathic scoliosis (AIS), and to investigate the predictive factors of the protocol. Methods This study included 142 girls with AIS who finished standardized bracing treatment from July 2003 to July 2009. These patients had a mean age of 13.1±1.5 years, a mean main curve of 29.6°±5.4°, and a mean Risser grade of 2.0±1.5 before bracing treatment. Curve progression was defined that Cobb angle was greater than 6° compared to bracing initiation or was aggravated to more than 45° (indicative for surgery). The outcomes of bracing treatment were assessed based on the ratio of curves of progression or indicative for surgery. Chi-square and Logistic regression Analyses were performed to investigate the predictive factors of bracing treatment. Results The duration of bracing treatment averaged 2.5±1.0 years. Twenty-seven girls with curve progression (19%)and 115 girls (81%) with non-progression were found. Final curve which was greater than 45° was found in 18 girls (13%) who need a correction surgery, the remaining 124 girls (87%) had completed bracing treatment and avoided surgery. Chi-square analyses revealed that curve progression were more common in younger girls with lower Risser grade, with initial larger Cobb angle and with a main thoracic curve pattern.Logistic regression analyses found that premenarchal status and a main thoracic curve pattern were the independent risk factors of curve progression despite bracing. While initial Cobb angle which was greater than 30° was the additional independent risk factor of progression requiring surgery. Conclusion Bracing treatment could effectively prevent curve progression in most girls with AIS. The degree of growth maturity, the pattern and grade of curve are the influencing factor for bracing treatment.

7

Cite

Share

Digital measurement of bone tumor volume by CT three-dimensional reconstruction technology

Yongcheng HU ; Yanxi CHEN ; Dengxing LUN ; Hongchao HUANG ; Linsen WANG ; Jiong MEI ; Guangrong YU

Chinese Journal of Orthopaedics.2011;31(1):1-6. doi:10.3760/cma.j.issn.0253-2352.2011.01.001

Objective To discuss the measurement of bone tumor volume on the basis of three dimensional images segmentation technology. Methods Twenty patients with lacunar bone tumor from Tianjin hospital and Tongji hospital were included in the study from January 2010 to August 2010. There were 11 males and 9 females. Each patient was exposed to spiral CT preoperatively. Then these primitive CT dates were imported into digital orthopedics clinical research platform (SuperImage orthopedics edition 1.1, Cybermed Ltd). The volume and maximum diameter of bone tumor were measured before operation by three-dimensional reconstruction technology. The actual tumor volume was measured during the operation. The tumor volume was also calculated from plain X-rays and CT scans as ellipsoidal or cylindrical depending on the tumor configuration and presence or absence of a soft tissue component. Results The tumor volume was measured to be (14.92±7.34) mm3, (16.65±6.95) mm3 and (34.29±15.70) mm3 using three-dimensional reconstruction technology, intraoperative elevation, and traditional radiograph measurement separately. It was found that there was no difference regarding the outcomes of measurement between three-dimensional reconstruction technology and gross intraoperative measurement. But obvious difference was detected between gross intraoperative measurement and traditional radiograph measurement. Coefficient of correlation between diameter and volume of bone tumor was 0.325 (P=0.162). Conclusion Digital measurement is a precise, efficient,convenient and repeatable method for bone tumor measurement.

8

Cite

Share

Study on reconstruction of afferent pathway after repairing transected dorsal root

Xiaojun TANG ; Guitao LI ; Wangyang XU ; Yong QI ; Dixin LUO ; Xunjie JIN

Chinese Journal of Orthopaedics.2011;31(2):175-183. doi:10.3760/cma.j.issn.0253-2352.2011.02.013

Objective To provide the morphological evidence for sensory pathway by the repair of dorsal root (DR) in which received transected and anastomosed with central processes (DR) and peripheral processes (spinal nerve) respectively. Methods 74 SD rats were divided into three groups randomly. Group A: the distal ending of L6 DR was sutured to the proximal ending of the L4 DR in right side. Group B: the postganglionic spinal nerve of L4 was cut at a point 2 mm to intervertebral foramen and its proximal stump was reconnected to the distal ending of L6 DR in right side. Group C: under the same operative manipulation on group B, but no anastomosis was performed to serve as the sham operation group. The left side was kept intact and served as a normal control in all groups. The repairing results of DR axonal regeneration were evaluated at 3 months after operation by retrograde tracing, the density of positive Calcitonin gene-related peptide (CGRP) axon in dorsal root entry zone (DREZ), survival rate of neurons in DR ganglia and posterior horn, light and transmission electron microscope. Results HRP retrograde tracing demonstrated axonal axoplasmic transport of regenerative nerve recovered well in group B. Regenerative fibers were found. There was no difference between group A or B and normal control with regard to the number of myelinated axons and the thickness of myelin. Regenerating axon stop at the DREZ in group A and the density of positive CGRP were lower than those in group B and normal control. Survival rate of neurons in L6 DR ganglia had no difference among all groups. However, in posterior horn, a significant increase in death was seen in group A and sham group. Conclusion The ability of axonal regeneration was effective and with no disservice to neurons in posterior horn following anastomosis of postganglionic spinal nerve and dorsal root, by which axoplasmic transport across the DREZ into the spinal cord.

9

Cite

Share

The clinical application of distal musculocutaneous perforators in the anterolateral thigh flap transplantation

Aiguo WANG ; Yong QIU

Chinese Journal of Orthopaedics.2011;31(3):255-259. doi:10.3760/cma.j.issn.0253-2352.2011.03.011

Objective To investigate the anatomical characteristics and clinical application of the distal musculocutaneous perforators derived from the descending branch of lateral circumflex femoral artery in the anterolateral thigh flap transplantation. Methods From July 2007 to December 2009, the anatomic variations of musculocutaneous perforator were investigated in 96 cases who received anterolateral thigh flap and 10 preserved cadavers. Thirty-five cases who received the anterolateral thigh flap using the distal musculocutaneous perforators were included in the study. There were 19 males and 16 females. The age ranged from 28-55 years old, with an average of 38.5 years old. Single flap was used in 20 cases while lobulated flap in 15 cases. Single flap area ranged from 7 cm×15 cm to 9 cm×25 cm, lobulated flap ranged from 5 cm×7 cm to 8 cm×20 cm. Results The cadaver study found that the most musculocutaneous perforators were concentrated in the far fourth of the anterolateral thigh region. The musculocutaneous perforators commonly arose from the the lateral femoral circumflex artery. The perforator arose directly from the femoral artery or the deep femoral artery in one case separately. In the clinical study, 2-5 musculocutaneous perforators were found in 94 cases but not in the other 2 cases. The descending branch of lateral circumflex femoral artery became the direct m musculocutaneous perforator. The proximal intermuscularseptum perforator was found in 2 cases. Postoperative follow-up time ranged from 6-11 months. All flaps survived in the follow-up.Marginal necrosis was found in 3 cases. Only 1 case had complained of knee joint instability. Conclusion The results of this study suggest that the vascular anatomy of the distal musculocutaneous perforator was reliable. The perforator may serve as an option for proximal one in anterolateral thigh flap transplantation.

10

Cite

Share

Operative treatment of talar body fractures

Jinquan HE ; Baotong MA ; Guigen PANG ; Hengsheng SHU ; Yafei ZHANG ; Xin CHEN ; Xiantie ZENG

Chinese Journal of Orthopaedics.2011;31(3):233-237. doi:10.3760/cma.j.issn.0253-2352.2011.03.007

Objective To investigate the results and related key points in operative treatment of talar body fractures. Methods From April 2002 to July 2008, 44 patients with talar body fractures underwent the operation. There were 3 females and 41 males. The mean age of the patients was 31.7 years. The fractures occurred on the left side in 26 patients and on the right side in 18 patients. According to Sneppen classification, 24 type Ⅱ, 20 type V. Eleave cases were open fractures, according to the Gustilo-Anderson classification, there were 3 cases in type Ⅰ , 7 in type Ⅱ, 1 type in Ⅲ A. The mean interval between injury and surgical treatment for open fractures and close fractures was 5.3 hours and 8.9 days. The mechanism of injury was a fall from the height in 18 patients, a traffic accident in 13 patients, a crush injury in 8 patients, a sprain injury in 4 patients and a cut injury in 1 patient. Anteromedial approach was used for 15 close fractures, anterolateral approach for 3 and combined anteromedial-anterolateral approach for 15. K-wires fixation were utilized for 3 fractures, screws and temporary K-wires fixation for 5 cases, bioabsorbable screws for 2fractures, cannulated screws for 30 fractures and cannulated screws and threaded cancellous screws for 4cases. Results Thirty-five patients were followed up 21 to 89 months (average, 44.5 months). Necrosis of incision was found in 4 cases, wound infection occurred in 1 case. All fractures had achieved bone union;the average healing time was 22 weeks. Functional results were assessed according to AOFAS score, the average score was 77.3, There were 11 patients in excellent results, 13 in good, 10 in fair and 1 in poor. The overall excellent and good rate was 68.6%. Avascular necrosis occurred in 5 cases. Traumatic arthritis occurred in 19 cases. Arthrodesis was needed in 5 cases. Conclusion The timing and approach of surgery is determined by the condition of the talar fractures and soft tissue. Anatomical reduction, preservation of the blood supply and early active pain-free mobilization are key points in the treatment of the talar body fractures.

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share