1.Effectiveness of modified single patellar tunnel medial patella femoral ligament reconstruction for recurrent patellar dislocation.
Guoliang WANG ; Li LI ; Fan WANG ; Yixiang DAI ; Hua LI ; Qinglü SHI
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(1):20-25
OBJECTIVE:
To investigate the effectiveness of modified single patellar tunnel medial patella femoral ligament (MPFL) reconstruction in the treatment of recurrent patellar dislocation.
METHODS:
Between January 2023 and June 2023, a total of 61 patients with recurrent patellar dislocation who underwent MPFL reconstruction with autologous semitendinosus were enrolled and divided into 2 groups using random number table method. In the patellar anchor group, 31 patients were treated with MPFL reconstruction with double medial patellar anchors, and 30 patients in the patellar tunnel group were treated with MPFL reconstruction with single patellar tunnel. The femoral ends of both groups were fixed with absorbable compression screws. There was no significant difference in baseline data such as gender, age, side, tibial tubercle-trochlear groove (TT-TG), Q angle, Caton-Deschamps index, number of dislocation, and preoperative Kujala score, preoperative patellar inclination angle ( P>0.05). Patellar tunnel, patellar anchor position, patellar reduction, and the patellar inclination angle were measured by CT scan after operation. Kujala score was used to evaluate the function of knee joint before operation, at 2 weeks and 1, 3, 6, 12 months after operation. Incision aesthetic satisfaction score was performed at 3 months after operation. The signal-to-noise quotient (SNQ) of the transplanted tendon was measured by knee MRI at 12 months after operation to compare the maturity of the graft between the two groups.
RESULTS:
There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). Knee CT reexamination showed that the patellar tunnel and the patellar anchor position were consistent with the intraoperative fluoroscopy. There was no significant difference in the difference of the patellar inclination angle between the two groups before and after operation ( P>0.05). All patients were followed up 12-14 months (mean, 12.8 months). There was 1 case of patellar anchor suture rejection in patellar anchor group, and the wound healed after debridement and dressing change. During the follow-up, there was no complication such as recurrence of patellar dislocation, infection and postoperative stiffness. The Kujala scores of the two groups significantly improved at each time point after 1 month of operation when compared with those before operation ( P<0.05), and the Kujala scores of the two groups returned to normal levels at 3 months after operation. The Kujala score in the patellar tunnel group was significantly higher than that in the patellar anchor group in the very early stage (2 weeks) ( P<0.05), and there was no significant difference between the two groups at other time points ( P>0.05). Patients in the patellar tunnel group were significantly better than those in the patellar anchor group in the score of incision aesthetic satisfaction at 3 months after operation and the SNQ at 12 months after operation ( P<0.05).
CONCLUSION
Modified single patellar tunnel MPFL reconstruction was used to treat patients with recurrent patellar dislocation without pathological TT-TG. The slide-fixation structure formed by single patellar tunnel positioning provides a variable degree of freedom for the reconstructed MPFL, which shows good effectiveness in the very early stage of the rehabilitation process.
Humans
;
Patellar Dislocation/surgery*
;
Male
;
Female
;
Plastic Surgery Procedures/methods*
;
Adult
;
Patellar Ligament/surgery*
;
Recurrence
;
Treatment Outcome
;
Young Adult
;
Adolescent
;
Patella/surgery*
;
Suture Anchors
;
Hamstring Tendons/transplantation*
;
Knee Joint/surgery*
;
Transplantation, Autologous
2.Study on Salter osteotomy combined with subtrochanteric shortening and derotational osteotomy in treatment of Tönnis type Ⅲ and Ⅳ developmental dysplasia of the hip in children.
Timin YANG ; Ping LI ; Jinlei ZHOU ; Haibo SI
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(2):168-173
OBJECTIVE:
To investigate the effectiveness of Salter osteotomy combined with subtrochanteric shortening and derotational osteotomy in treating Tönnis type Ⅲ and Ⅳ developmental dysplasia of the hip (DDH) in children and explore the urgical timing.
METHODS:
A retrospective collection was performed for 74 children with Tönnis type Ⅲ and Ⅳ DDH who were admitted between January 2018 and January 2020 and met the selection criteria, all of whom were treated with Salter osteotomy combined with subtrochanteric shortening and derotational osteotomy. Among them, there were 38 cases in the toddler group (age, 18-36 months) and 36 cases in the preschool group (age, 36-72 months). There was a significant difference in age between the two groups ( P<0.05), and there was no significant difference in gender, side, Tönnis typing, and preoperative acetabular index (AI) ( P>0.05). During follow-up, hip function was assessed according to the Mckay grade criteria; X-ray films were taken to observe the healing of osteotomy, measure the AI, evaluate the hip imaging morphology according to Severin classification, and assess the occurrence of osteonecrosis of the femoral head (ONFH) according to Kalamchi-MacEwen (K&M) classification criteria.
RESULTS:
All operations of both groups were successfully completed, and the incisions healed by first intention. All children were followed up 14-53 months, with an average of 27.9 months. There was no significant difference in the follow-up time between the two groups ( P>0.05). At last follow-up, the excellent and good rates according to the Mckay grading were 94.73% (36/38) in the toddler group and 83.33% (30/36) in the preschool group, and the difference between the two groups was significant ( P<0.05). The imaging reexamination showed that all osteotomies healed with no significant difference in the healing time between the two groups ( P>0.05). There was no significant difference in AI between the two groups at each time point after operation ( P>0.05), and the AI in the two groups showed a significant decreasing trend with time extension ( P<0.05). The result of Severin classification in the toddler group was better than that in the preschool group at last follow-up ( P<0.05). There was no significant difference in the incidence of ONFH between the two groups ( P>0.05). In the toddler group, 2 cases were K&M type Ⅰ; in the preschool group, 3 were type Ⅰ, and 1 type Ⅱ. There was no dislocation after operation.
CONCLUSION
Salter osteotomy combined with subtrochanteric shortening and derotational osteotomy is an effective way to treat Tönnis type Ⅲ and Ⅳ DDH in children, and surgical interventions for children aged 18-36 months can achieve better results.
Humans
;
Osteotomy/methods*
;
Developmental Dysplasia of the Hip/diagnostic imaging*
;
Retrospective Studies
;
Male
;
Child, Preschool
;
Female
;
Infant
;
Femur/surgery*
;
Child
;
Treatment Outcome
;
Hip Dislocation, Congenital/surgery*
3.Research progress on pathological changes of glenohumeral capsule in patients with recurrent shoulder anterior dislocation.
Pai CHEN ; Daqiang LIANG ; Bing WU ; Hao LI ; Haifeng LIU ; Zeling LONG ; Yuwei LIU ; Wei LU
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(2):243-249
OBJECTIVE:
To review the research progress of pathological changes of glenohumeral capsule in patients with recurrent shoulder anterior dislocation (RSAD).
METHODS:
The literature on shoulder capsules, both domestic and international, was reviewed. The anatomy, histology, and molecular biology characteristics of the glenohumeral capsule in RSAD patients were summarized.
RESULTS:
Anatomically, the glenohumeral capsule is composed of four distinct parts: the upper, lower, anterior, and posterior sections. The thickness of these sections is uneven, and the stability of the capsule is further enhanced by the presence of the glenohumeral and coracohumeral ligaments. Histologically, the capsule tissue undergoes adaptive changes following RSAD, which improve its ability to withstand stretching and deformation. In the realm of molecular biology, genes associated with the regulation of structure formation, function, and extracellular matrix homeostasis of the shoulder capsule's collagen fibers exhibit varying degrees of expression changes. Specifically, the up-regulation of transforming growth factor β 1 (TGF-β 1), TGF-β receptor 1, lysyl oxidase, and procollagen-lysine, 2-oxoglutarate 5-dioxygenase 1 facilitates the repair of the joint capsule, thereby contributing to the maintenance of shoulder joint stability. Conversely, the up-regulation of collagen type Ⅰ alpha 1 (COL1A1), COL3A1, and COL5A1 is linked to the recurrence of shoulder anterior dislocation, as these changes reflect the joint capsule's response to dislocation. Additionally, the expressions of tenascin C and fibronectin 1 may play a role in the pathological processes occurring during the early stages of RSAD.
CONCLUSION
Glenohumeral capsular laxity is both a consequence of RSAD and a significant factor contributing to its recurrence. While numerous studies have documented alterations in the shoulder capsule following RSAD, further research is necessary to confirm the specific pathological anatomy, histological, and molecular biological changes involved.
Humans
;
Joint Capsule/metabolism*
;
Shoulder Dislocation/metabolism*
;
Recurrence
;
Shoulder Joint/metabolism*
;
Tenascin/metabolism*
;
Transforming Growth Factor beta1/genetics*
;
Collagen Type I/genetics*
;
Extracellular Matrix/metabolism*
4.Partial translocation of flexor carpi radialis tendon for treatment of traumatic dislocation of first carpometacarpal joint.
Yaolin CHEN ; Yong YANG ; Zhenzhong WANG ; Yang WANG
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(6):668-672
OBJECTIVE:
To explore the effectiveness of partial translocation of flexor carpi radialis tendon in the treatment of traumatic dislocation of the first carpometacarpal joint.
METHODS:
The clinical data of 6 patients with traumatic dislocation of the first carpometacarpal joint who met the selection criteria between March 2020 and June 2024 were retrospectively analyzed. There were 3 males and 3 females with an average age of 33.5 years (range, 16-42 years). All the 6 cases were treated with plaster immobilization for 4-6 weeks, and the time from injury to operation was 6-12 weeks, with an average of 8.8 weeks. All patients underwent reconstruction of the metacarpophalangeal anterior oblique ligament and dorsal posterior oblique ligament of the first carpometacarpal joint with partial translocation of flexor carpi radialis tendon. The pain relief was evaluated by visual analogue scale (VAS) score before and after operation, and the pinch force, palmar abduction and radial abduction angles of the affected side and the healthy side were recorded before and after operation, and the ratio of the above indexes between the affected side and the healthy side was calculated to evaluate the effectiveness.
RESULTS:
All the incisions healed by first intention after operation, and there was no complication related to operation such as neurovascular injury. All patients were followed up 6-19 months (mean, 12.7 months). The range of motion of the thumb on the affected side was the same as that on the healthy side, the first carpometacarpal joint was stable without recurrent dislocation and pain. At last follow-up, the VAS score, the pinch force of the affected side, the abduction angle of the palmar side of the affected thumb, the abduction angle of the radial side of the affected thumb, and the pinch force ratio, the palmar abduction angle ratio of the thumb, and the radial abduction angle ratio of the thumb of the affected side to the healthy side significantly improved when compared with those before operation ( P<0.05).
CONCLUSION
Partial translocation of the flexor carpi radialis tendon to reconstruct the metacarpophalangeal and dorsal radial ligaments for the treatment of traumatic dislocation of the first carpometacarpal joint is a reliable surgical method.
Humans
;
Carpometacarpal Joints/surgery*
;
Male
;
Female
;
Adult
;
Adolescent
;
Retrospective Studies
;
Joint Dislocations/surgery*
;
Young Adult
;
Tendons/surgery*
;
Tendon Transfer/methods*
;
Plastic Surgery Procedures/methods*
;
Treatment Outcome
;
Range of Motion, Articular
;
Ligaments, Articular/injuries*
5.Early effectiveness of transosseous suture fixation in treatment of recurrent acute patellar dislocation with patellar osteochondral fractures.
Junliang LIU ; Longxiang ZHAI ; Zhenmu XU ; Aoqiu WU ; Ding ZHOU ; Yuchen HE ; Qian LIU ; Qi TANG ; Weihong ZHU
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(7):831-836
OBJECTIVE:
To evaluate the early effectiveness of transosseous suture fixation in treating recurrent acute patellar dislocation with patellar osteochondral fractures (OCFs).
METHODS:
A retrospective analysis was conducted on 19 patients with recurrent acute patellar dislocation and patellar OCFs, who underwent transosseous suture fixation between January 2018 and December 2022 and were followed up 2 years. The cohort included 8 males and 11 females, aged 13-21 years (mean, 16.2 years). Patients experienced 2-5 times of patellar dislocation (mean, 3.2 times). The interval from the last dislocation to operation ranged from 3 to 15 days (mean, 9.6 days). Preoperative imaging revealed the intra-articular osteochondral fragments and medial patellofemoral ligament (MPFL) injury. Clinical outcomes were evaluated using the visual analogue scale (VAS) score for pain, the International Knee Documentation Committee (IKDC) score, the Hospital for Special Surgery (HSS) knee score, the Lysholm score, and the Tegner score. Postoperative complications were recorded. During follow-up, the knee X-ray films, CT, and MRI were taken to evaluate fragment healing, displacement, and the morphology and tension of the MPFL reconstruction graft.
RESULTS:
All incisions healed primarily, and no complication occurred such as infection, joint stiffness, patellofemoral arthritis, or redislocation. Patients were followed up 24-60 months (mean, 43.5 months). At 12 months postoperatively and the last follow-up, significant improvements ( P<0.05) were observed in VAS, Lysholm, IKDC, HSS, and Tegner scores compared to preoperative values. Further improvements were observed at last follow-up compared with the 12 months postoperatively, and the differences were significant ( P<0.05). Imaging studies demonstrated satisfactory osteochondral fragment positioning with stable fixation. At last follow-up, all fragments had healed, and MPFL reconstruction grafts exhibited optimal morphology and tension. No joint adhesion or fragment displacement occurred.
CONCLUSION
For recurrent acute patellar dislocation with patellar OCFs, transosseous suture fixation proves to be both safe and effective, achieving satisfactory early effectiveness.
Humans
;
Male
;
Female
;
Patellar Dislocation/surgery*
;
Adolescent
;
Young Adult
;
Retrospective Studies
;
Patella/surgery*
;
Suture Techniques
;
Treatment Outcome
;
Recurrence
;
Fracture Fixation, Internal/methods*
;
Fractures, Bone/surgery*
;
Follow-Up Studies
6.Application value of hinge position design of Ilizarov circular external fixator for correcting clubfoot deformity in preventing ankle dislocation.
Dongfeng ZHANG ; Siyu YANG ; Bingke SHI ; Shuliang LI ; Lei ZHEN ; Yushun WANG ; Yingqi ZHANG ; Sihe QIN ; Qi PAN
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(8):989-993
OBJECTIVE:
To summarize the methods of ankle hinge position design in the correction of clubfoot deformity by Ilizarov method, and to explore its application value in the prevention of ankle dislocation.
METHODS:
A retrospective study was conducted including 28 patients with rigid clubfoot deformity (34 feet) who met the selection criteria and admitted between September 2021 and December 2024. There were 19 males and 9 females with an average age of 31.8 years (range, 19-47 years). According to Dimeglio classification, there were 21 feet of degree Ⅲ and 13 feet of degree Ⅳ. The causes were traumatic sequelae in 9 cases, congenital foot deformity in 15 cases, spina bifida sequelae in 1 case, peripheral neuropathy in 1 case, and cerebral palsy sequelae in 2 cases. The malformation lasted from 6 to 46 years, with an average of 29.3 years. All patients were treated with Ilizarov circular external fixator, and the hinge position of ankle joint was planned according to the standard lateral X-ray film of foot and ankle and the principle of Ilizarov limb deformity correction center of rotation angulation (CORA) before operation. The 2008 International Clubfoot Study Group (ICFSG) scoring system was used to evaluate the efficacy.
RESULTS:
The deformity of rigid clubfoot was completely corrected in all patients, and the patients could walk with plantar weight-bearing, and the ankle weight-bearing walking significantly improved when compared with that before operation. There was no complication such as ankle dislocation, talus impact or extrusion, local skin necrosis, needle tract infection, or numbness of extremities during the correction process. All patients were followed up 5-39 months, with an average of 18.1 months. At last follow-up, according to the ICFSG scoring system, 23 feet were excellent, 10 feet were good, and 1 foot was fair, and the excellent and good rate was 97%.
CONCLUSION
Designing the position of the ankle hinge according to the principle of CORA can effectively avoid ankle dislocation, talus impingement, tibiotalar joint extrusion, and other ankle adverse events in the process of correcting clubfoot deformity, which has good application value in clinical practice.
Humans
;
Male
;
Female
;
Clubfoot/diagnostic imaging*
;
Ilizarov Technique/instrumentation*
;
Adult
;
Retrospective Studies
;
External Fixators
;
Ankle Joint/diagnostic imaging*
;
Middle Aged
;
Joint Dislocations/prevention & control*
;
Treatment Outcome
;
Young Adult
7.Comparative study on effectiveness of clavicular hook plate fixation in treatment of acromioclavicular joint dislocation and distal clavicle fractures.
Shengkai WU ; Jiehan LIU ; Hongxiang WEI ; Kaibin FANG ; Yun XIE ; Lifeng ZHENG ; Jianhua LIN ; Jinluan LIN
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(8):1037-1044
OBJECTIVE:
To compare the effectiveness of clavicular hook plate fixation in the treatment of acromioclavicular joint dislocation and distal clavicle fractures.
METHODS:
A clinical data of 90 patients, who underwent clavicular hook plate fixation between January 2014 and June 2023, was retrospectively analyzed. There were 40 patients with distal clavicle fractures (fracture group) and 50 with acromioclavicular joint dislocations (dislocation group). There was no significant difference in the baseline data of gender, age, cause of injury, side of injury, time from injury to operation, and constituent ratio of osteoporosis patients between the two groups ( P>0.05). The time to remove the internal fixators and the occurrence of complications were recorded. Before removing the internal fixator and at 3 months after removing, the visual analogue scale (VAS) score was used to evaluate the degree of pain, and the mobility of the shoulder joint in forward flexion, elevation, and abduction was measured. Before removing the internal fixators, the Constant-Murley score and the University of California, Los Angeles (UCLA) score were used to evaluate the function of the shoulder joint. X-ray films of the shoulder joint were taken during follow-up to observe the occurrence of subacromial osteolysis, acromioclavicular joint osteoarthritis, and distal clavicle bone atrophy. Subgroup comparison was conducted between patients with and without subacromial osteolysis in the two groups.
RESULTS:
All incisions healed by first intention in both groups. All patients were followed up 1-9 years, with a median of 5 years; the difference in follow-up time between the two groups was not significant ( P>0.05). During follow-up, subacromial osteolysis occurred in 74 cases, including 41 cases of typeⅠand 33 cases of type Ⅱ, distal clavicle bone atrophy in 15 cases, and acromioclavicular joint osteoarthritis in 8 cases. There were significant differences in the removal time of internal fixators, the incidence of bone atrophy, and the incidence of osteoarthritis between the two groups ( P<0.05). There was no significant difference in the incidence of subacromial osteolysis ( P>0.05). Before removing the internal fixators, there was no significant difference in VAS score, UCLA score, and Constant-Murley score between the two groups ( P>0.05), while there were significant differences in shoulder joint range of motion in all directions ( P<0.05). After removing the internal fixators, only the difference in elevation was significant ( P<0.05). Within the group comparison, the VAS score and mobility of shoulder joint in abduction and elevation after removing the internal fixators were significantly superior to those before removing ( P<0.05). In the fracture and dislocation groups, there was only a significant difference in plate length between the subgroup with and without subacromial osteolysis ( P<0.05), while there was no significant difference in the above other indicators ( P>0.05).
CONCLUSION
Clavicular hook plate is a good choice for treating acromioclavicular dislocation or distal clavicle fractures, but the incidence of subacromial osteolysis is higher, and the degree of bone resorption is more severe in fracture patients. After removal of the internal fixator, the shoulder functions significantly improve. It is recommended to remove the internal fixator as soon as possible within the allowable range of the condition.
Humans
;
Clavicle/surgery*
;
Acromioclavicular Joint/surgery*
;
Bone Plates
;
Fracture Fixation, Internal/instrumentation*
;
Fractures, Bone/surgery*
;
Male
;
Retrospective Studies
;
Female
;
Adult
;
Middle Aged
;
Treatment Outcome
;
Joint Dislocations/surgery*
;
Aged
;
Range of Motion, Articular
;
Young Adult
;
Postoperative Complications
8.Effectiveness of composite loop plate around coracoid process for reconstructing coracoclavicular ligament in treatment of Rockwood type Ⅲ acute acromioclavicular joint dislocations.
Hongqing HE ; Ningkai LI ; Meng LIU ; Hua WANG ; Qiang WANG ; Yinchang ZHANG
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(11):1402-1408
OBJECTIVE:
To compare the effectiveness of using a composite loop plate to reconstruct the coracoclavicular ligament around the coracoid process and using a clavicular hook plate for fixation in treatment of Rockwood type Ⅲ acute acromioclavicular joint dislocation.
METHODS:
A retrospective analysis was conducted on the clinical data of 60 patients with Rockwood type Ⅲ acute acromioclavicular joint dislocation who were admitted between June 2022 and September 2023 and met the selection criteria. Among them, 30 patients were treated with the composite loop plate to reconstruct the coracoclavicular ligament around the coracoid process (loop plate group) and 30 with clavicular hook plate fixation (hook plate group). There was no significant difference in baseline data between the two groups ( P>0.05), including gender, age, injured side, cause of injury, disease duration, preoperative visual analogue scale (VAS) score for pain, and Constant-Murley score. The incision length, operation time, length of hospital stay, and the occurrence of complications during follow-up were recorded. The Constant-Murley score and VAS score were used to evaluate shoulder joint function and pain, and the differences (change values) of the indicators between before operation and at 6 months after operation were calculated for inter-group comparison. In the loop plate group, the coracoclavicular distance (CCD) on the anteroposterior X-ray films of the acromioclavicular joint was measured at 1 day and 6 months after operation to assess the loss of acromioclavicular joint reduction.
RESULTS:
The incision length of the loop plate group was significantly shorter than that of the hook plate group ( P<0.05). There was no significant difference in the operation time and the length of hospital stay between the two groups ( P>0.05). All incisions healed by first intention after operation. All patients were followed up 12-18 months (mean, 16.3 months). There was no significant difference in the follow-up time between groups ( P>0.05). The Constant-Murley scores and VAS scores of both groups significantly improved at 6 months after operation when compared with those before operation ( P<0.05); the differences in the change values of the two indicators between groups were significant ( P<0.05). The CCD of the loop plate group were (10.40±0.83) mm at 1 day and (10.70±0.68) mm at 6 months and no repositioning loss was observed. Three cases in the hook plate group had residual shoulder joint pain after operation. The difference in the accidence of complications between groups was not significant ( P>0.05).
CONCLUSION
For Rockwood type Ⅲ acute acromioclavicular joint dislocation, compared with the clavicular hook plate fixation, the composite loop plate for reconstructing the coracoclavicular ligament around the coracoid process has the advantages of simple operation, safety, minimally invasive, good functional recovery, and fewer complications. Moreover, it avoids the need for a second surgery to remove the internal fixation device, and the patient acceptance and satisfaction are higher.
Humans
;
Acromioclavicular Joint/surgery*
;
Bone Plates
;
Male
;
Retrospective Studies
;
Female
;
Adult
;
Ligaments, Articular/injuries*
;
Joint Dislocations/surgery*
;
Coracoid Process/injuries*
;
Treatment Outcome
;
Middle Aged
;
Plastic Surgery Procedures/instrumentation*
;
Fracture Fixation, Internal/instrumentation*
;
Young Adult
;
Clavicle/surgery*
9.Eccentric kyphotic distraction reduction technique for treatment of lower cervical dislocation with locked facet joints.
Yuwei LI ; Xiuzhi LI ; Bowen LI ; Xiaoyun YAN ; Ruijuan DING ; Wei CUI ; Haijiao WANG
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(12):1568-1573
OBJECTIVE:
To evaluate the effectiveness of the single-stage anterior eccentric kyphotic distraction reduction technique (EKD-RT) for treating lower cervical dislocation with locked facet joints, assessing its reduction success rate, neurological improvement, and safety.
METHODS:
A retrospective analysis was conducted on 67 patients with lower cervical dislocation and locked facet joints (21 unilateral, 46 bilateral) treated between January 2015 and January 2024. There were 39 males and 28 females, with an average age of 49.5 years (range, 22-75 years). The injured segments included C 3, 4 in 4 cases, C 4, 5 in 13 cases, C 5, 6 in 22 cases, and C 6, 7 in 28 cases. The interval between injury and admission ranged from 2 hours to 2 days (mean, 5.6 hours). Preoperative Frankel grading included grade A in 9 cases, grade B in 28 cases, grade C in 17 cases, grade D in 11 cases, and grade E in 2 cases. Japanese Orthopaedic Association (JOA) score was 7.0±1.4. All patients underwent single-stage anterior cervical discectomy and fusion. Following discectomy at the dislocated level, the EKD-RT was applied to unlock and reduce the locked facet joints, followed by internal fixation. Operation time, blood loss, reduction success rate, and complications were recorded. Interbody fusion status was evaluated using Bridwell criteria. Neurological status was assessed pre- and post-operatively using Frankel grading. Spinal cord function was scored using the 17-point JOA score, and the improvement rate was calculated.
RESULTS:
Successful reduction of the locked facet joints achieved in all cases. The operation time was 41-85 minutes (range, 63.3 minutes), and intraoperative blood loss was 50-360 mL (range, 125.0 mL). Complications included cerebrospinal fluid leakage in 2 cases; no severe complications such as major vascular injury or recurrent laryngeal nerve injury occurred. All patients were followed up 12-24 months (mean, 17.9 months). At last follow-up, radiological examination confirmed interbody fusion in all patients, with no implant failure or migration. The Frankel grading included grade A in 3 cases, grade B in 9 cases, grade C in 13 cases, grade D in 16 cases, and grade E in 26 cases; the JOA score reached 13.7±2.3; all of which significantly improved compared to preoperative levels ( P<0.05). The improvement rate of JOA score was 66.1%±24.7%.
CONCLUSION
The EKD-RT is an effective surgical approach for lower cervical dislocation with locked facet joints. It enables safe and efficient reduction of the locked facet joints via a single incision, resulting in significant neurological improvement with a low complication rate.
Humans
;
Male
;
Middle Aged
;
Female
;
Cervical Vertebrae/diagnostic imaging*
;
Retrospective Studies
;
Adult
;
Aged
;
Zygapophyseal Joint/injuries*
;
Joint Dislocations/diagnostic imaging*
;
Treatment Outcome
;
Spinal Fusion/methods*
;
Young Adult
;
Kyphosis/surgery*
10.Arthroscopic high strength suture fixation of iliac bone mass for the treatment of shoulder joint forward instability with high risk of dislocation.
China Journal of Orthopaedics and Traumatology 2025;38(3):252-257
OBJECTIVE:
To explore clinical effect of iliac bone graft fixed with high strength suture arthroscopy in treating shoulder joint forward instability with high risk of dislocation.
METHODS:
The clinical data of 22 patients with shoulder forward instability with high risk of dislocation treated with iliac bone graft fixed with high-strength suture arthroscopy from January 2021 to January 2023 were retrospectively analyzed, including 14 males and 8 females, aged from 17 to 46 years old with an average of (26.50±8.26) years old;the times of dislocation ranged from 4 to 22 (11.08±5.82) times;7 patients on the left side and 15 patients on the right side. American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) score and Constant-Murley score were to evaluate the improvement of shoulder joint function before operation and 12 months after operation. Three-dimensional CT reconstruction was performed to evaluate the repair of glenoid bone defect, bone remodeling and bone healing before operation, immediately after and 12 months after operation.
RESULTS:
All patients were followed up for 12 to 24 months with an average of (18.68±3.92) months. No further dislocation or subluxation occurred in all patients. Scores of ASES, UCLA and Constant-Murley were improved from (69.50±2.26), (23.86±2.27), (75.64±3.58) before operation to (91.09±1.57), (32.27±2.03), (91.95±3.00) at 12 months after operation (P<0.05). The defect of glenoid bone was (12.41±7.55) %, (-37.23±3.75) %, (-22.41±3.58) % before opertaion, immediately and 12 months after operation, respectively, and the difference was statistically significant (P<0.05). Bone healing of iliac bone graft was achieved at 12 months after operation.
CONCLUSION
High strength suture arthroscopy to fix iliac bone graft for the treatment of shoulder forward instability with high dislocation risk is a safe and effective method, which could effectively restore shoulder stability and reduce surgical injury.
Humans
;
Male
;
Female
;
Adult
;
Arthroscopy/methods*
;
Middle Aged
;
Ilium/transplantation*
;
Adolescent
;
Joint Instability/physiopathology*
;
Shoulder Dislocation/surgery*
;
Shoulder Joint/physiopathology*
;
Young Adult
;
Retrospective Studies
;
Bone Transplantation
;
Sutures

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