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Objective:To explore the clinical manifestations, diagnostic characteristics, treatment strategies and outcomes of patients with brucellaperi prosthetic joint infection (PJI).Methods:The medical records of 6 patients with brucella PJI in the First Medical Center of Chinese PLA General Hospital and the Third Hospital of Hebei Medical University from January 2010 to December 2018 were retrospectively analyzed, including 5 males and 1 female, aged 61.5±11.5 years (range 45-79 years) with body mass index 23.0±2.8 kg/m 2 (range 18.4-26.1 kg/m 2). Five cases lived in the countryside, 1 in the city. Four cases were farmers, while two cases were herder and unemployed. One case had contact history in the epidemic area, and 1 case had been in the slaughter industry. Three cases were with knee PJI, of which 1 patient underwent total knee arthroplasty due to knee joint villous nodular synovitis and 2 patients due to knee osteoarthritis. Three patients had hip PJI of which 1 patient underwent total hip arthroplasty due to spondylitis and hip ankylosis and 2 cases due to femoral head necrosis. Three cases were with acute PJI, while other 3 cases were with chronic PJI. Three cases showed fever, while 5 cases had local wounds swelling. A total of 4 cases were complicated with sinus tracts. Five cases had laboratory examinations on the day of admission of which 3 cases had elevated blood C-reactive protein (CRP) and 5 cases with increased erythrocyte sedimentation rate (ESR). Five cases were with increased blood interleukin-6 (IL-6), 2 cases with increased blood alanine transaminase (alanine transaminase, ALT). All cases had varying degrees of restricted movement of the affected joints. The normal range of motion of the hip joint was from 10° to 130°. The average range of motion of 3 patients with hip joint involvement was from 0° to 75°. The normal range of motion of the knee joint was 10°-135°. Three patients with knee joint involvement had an average range from -8° to 67°. One case showed loosening of the right hip prosthesis with infection and 1 case showed local soft tissue swelling. Other cases showed no obvious abnormalities in X-rays. Two patients who underwent frozen pathological examination during the operation had positive pathological neutrophilcounts. Four cases had positive Brucella culture in joint tissues or synovial fluid (1 case with mixed infection) and 2 cases had blood Brucella antibody positive. Results:Among the 3 cases of acute PJI, two of them were treated with debridement, antibiotics, irrigation and retention. One case was treated with two-stage revision. Among the 3 cases of chronic PJI, one was treated with two-stage revision and 2 were treated with one-stage revision. Brucella-specific antibiotics such as rifampicin and doxycycline were used in the antibiotic treatment with the course of antibiotics 3 to 12 weeks. At the time of discharge, the CRP and ESR dropped to the normal range (CRP 0-0.8 mg/dl, ESR 0-20 mm/1 h) in all cases except for the second case. Interleukin 6 was not tested in the sixth case before discharge. In the remaining 5 patients, the blood interleukin 6 fell to the normal range (0-5.9 pg/ml) in 2 cases, and the blood ALT was in the normal range (0-40 U/L) in 4 cases. The body temperature of the second case was 37.3 ℃, while the other cases dropped below 37.3 ℃. In the second case, fever occurred intermittently after surgery. Thus, the incisionwas reddened and swollen and exuded 2 months after the operation. The patient recovered after intravenous infusion of levofloxacin. Until the last follow-up, all patients had no recurrence of infection. Imaging examination comfirmed that the prosthesis was in good position.Conclusion:For patients with Brucella PJI, Brucella culture positive and Brucella antibody positive have specific diagnostic significance. Different surgical strategies will be adopt based on the patient's symptoms and the duration of infection. Surgery combined with Brucella specific antibiotic treatment can usually achieve satisfied therapeutic outcomes.
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Objective To study the effects of propofol exposure during pregnancy on space cognitive and exploration abilities and expression of phosphorylated tau protein ( P-tau) and beta-amyloid protein[ Aβ(1-42) ] in hippocampus of the offspring. Methods Sprague-Dawley female (n=24) and male rats (n=8) of three months old were mated at the same cage at the ratio of 3:1. Pregnant rats were randomly divided into early group (group E), medium group (group M), late group (group L) and control group ( group C) , with 6 rats in each group. Groups E, M and L received propofol 80 mg · kg-1 · d-1 for 7 consecutive days. Propofol was replaced with equal volume of physiological saline in group C. Learning and memory of the 30-day offspring rats were assessed by using Morris water maze test. Then offspring rats were sacrificed to determine the expression of P-tau and Aβ(1-42) in the hippocampus by ELISA and immunohistochemistry. Results The learning and memory abilities were declined significantly in group E (51. 20±8. 11) s, group M (36. 00±6. 44) s and group L (47. 20±12. 30) s, as compared with group C (65. 60± 7. 23) s (all P<0. 05). The result of immunohistochemistry and ELISA showed that expression of Aβ(1-42) and P-tau in hippocampus was significantly higher in group M than in groups E, L and C[(immunohistochemistry: Aβ(1-42), (27. 38±5. 90) vs. (12. 65± 2. 08), (13. 79±3. 37), and (65. 60±7. 23); P-tau, (26. 35±5. 83) vs. (13. 65±3. 46), (14. 56±3. 82), and (8. 49±1. 20);ELISA:Aβ(1-42) , (88. 6±7. 43) vs. (71. 60±6. 79), (13. 79±3. 37), and (65. 80±6. 28);P-tau, (230. 13±8. 22) vs. (210. 42± 2.20), (210.95±1. 75), and (200. 65±1. 57)] (all P<0.05). Conclusion Multiple propofol injections may impair rat offspring’ s space cognitive abilities and exploration abilities, and the impairment is especially obvious in second trimester of pregnancy, which may be associated with over-expression of P-tau and Aβ(1-42) .
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Objective To summarize the clinical experiences of coronary artery bypass grafting ( CABG) in the treatment of coronary artery disease. Methods CABG were performed on 395 consecutive cases from January 2002 to December 2012,including 299 male and 96 female with a mean age of 62. 3 years old. All the operation were performed under cardiopulmonary bypass (CPB ) with moderate hypothermi-a. Left ventricular aneurysm plasty operation were performed in 18 patients. Results The mean number of grafts was 3. 2,the mean CPB time was 88 min( 62~170 min) ,aortic cross-clamping time was 68 min( 25~102 min) ,mean ventilation time was 18 h( 12~72 h) . There were 8 deaths with a mortality of 2. 0%. Six patients died of multiple organ failure,1 patients died of ventricular fibrillation after operation,1 patients died of acute myocardial infarction. Postoperative follow up was carried out on 280 cases,follow-up time was from 8 months to 11 years. Five of them died of unknow causes. The heart function of the rest was significantly improved. 195 patients were free of angina. 85 pa-tients’ s symptom got better. Conclusion CABG performed under cardiopulmonary bypass ( CPB ) with moderate hypothermia is safe and effective for the treatment of coronary artery disease.
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Objective To observe the clinical effects of open kinetic chain and closed kinetic chain exercise in the early period of anterior cruciate ligament reconstruction rehabilitation,provide the theoretical and clinical experiences for the early rehabilitation of the anterior cruciate ligament reconstructed knee.Methods From February 2009 to June 2010,60 patients undergoing single-bundle anterior cruciate ligament reconstructions by using hamstring tendon allograft were enrolled in the study,and were divided into two groups:open kinetic chain group(30 cases,30 knees)and closed kinetic chain group(30 cases,30 knees).In accordance with the rehabilitation procedures for six months,no statistically significant differences were found between the two groups in Lysholm scores,International Knee Documentation Committee(IKDC)scores and one-leg hop test preoperative.The active and passive range of notion,Lysholm scores,IKDC scores,one-leg hop test and KT-1000 were evaluated three and six months after surgery.Results Three months after surgery,no significant differences were found in passive range of motion,Lysholm scores,IKDC scores,but significant differences were found in active range of motion,one-leg hop test and KT-1000,and the closed kinetic chain group was significantly better than the open kinetic chain group.Six months after surgery,no significant differences were found in active range of motion,passive range of motion,one-leg hop test,Lysholm scores,IKDC scores,but significant difference in KT-1000,and the closed kinetic chain group was significantly better than the open kinetic chain group.Conclusion Closed kinetic chain exercise is benefit for recovery of muscles strength,proprioception and protect the graft in the early rehabilitation period after anterior cruciate liganent reconstruction.
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Objective To investigate the role of rotational alignment reference landmarks of the proximal tibia in total knee arthroplasty.Methods Fifteen healthy adult volunteers were enrolled in this study,including 10 males and 5 females,aged from 21 to 38 years (average,28.1±6.0).CT scans of 26 knees were taken as the knees were placed in full extension.Two anteroposterior axes were drawn on the CT images:one line connected the middle of the posterior cruciate ligament insertion site and the medial edge of the patellar tendon,and another line connected the middle of the posterior cruciate ligament insertion site and the middle-medial 1/3 of the patellar tendon.The surgical epicondylar axis was also drawn on the CT images.Angles were measured between a line perpendicular to the surgical epicondylar axis and the two anteroposterior axes,and the angles were compared with the ideal tibial rotational alignment reference axis (0°).Results Angles between the line perpendicular to the surgical epicondylar axis and the line connecting the middle of the posterior cruciate ligament insertion site and the medial edge of the patellar tendon averaged 0.7°±2.8° (range,-5.1°-5.8°),there was no significant difference compared with 0°.Angles between the line perpendicular to the surgical epicondylar axis and the line connecting the middle of the posterior cruciate ligament insertion site and the middle-medial 1/3 of the patellar tendon averaged 6.9°±5.3° (range,-3.4°-14.1°),there was significant difference compared with 0°.Significant difference existed in angles between the two anteroposterior axes and the line perpendicular to the surgical epicondylar axis.Conclusion The line connecting the middle of the posterior cruciate ligament insertion site and the medial edge of the patellar tendon is a more reliable reference axis for the tibial component rotational alignment,which makes the femoral and tibial components in a more matching rotational position.
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Objective To investigate the impact of graft position shift on anterior cruciate ligament reconstruction induced by femoral fixation of interference screw. Methods Nineteen fresh cadaveric knees were used and assigned to three groups. 1) Study of graft position shift: 5 knees were randomly selected, interference screws of 7 mm, 8 mm and 9 mm were used in autologous tendon fixation, then the graft position shift were measured. 2) Study of isometry: 7 knees were randomly divided into the isometric reconstruction group (D group). In the D group, Retrobutton, interference screw and interference screw in location-corrected bone tunnel were used respectively as fixation. The isometry of grafts was evaluated. 3) Study of tibia anterior translation: 7 knees were randomly divided into the anatomic reconstruction group (J group). In the J group,the tibia anterior translation was measured in four different conditions in the same joint: intact knee joint,knee joint without ACL, ACL anatomic reconstruction by interference screw fixation, and ACL anatomic reconstruction by interference screw fixation with corrected bone tunnel location. Results 1) With 7 mm, 8mm and 9 mm interference screw fixation, graft position shift were (2.36±0.11) mm, (2.72±0.06) mm and (3.00±0.06) mm respectively. 2) Graft length change: graft length change in Retrobutton group and corrected bone tunnel group were less than 3 mm, while graft length change in those fixed with interference screw were stretched in more than 3 mm. 3) Study of tibia anterior translation: there was no difference among the intact group, the anatomic group and the corrected group at 0° and 15°. However, the difference was found between the intact group and other groups at 30°、60° and 90° of flexion, as well as between these two reconstructed methods at 20° joint flexion (P＜0.05). Conclusion In both isometric and anatomic ACL reconstruction with interference screw, the graft is pushed tightly toward the femoral tunnel wall, which shifts the graft away from the desired position. In our study we find out that the corrected location of the femoral bone tunnel significantly improves the isometry of ACL reconstruction and anatomic reconstruction.
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Objective To study the effect of the high molecular weight polyethylene on the periprosthetic tissue in diabetic model and investigate the effect of TNF-α in periprosthetic tissue.Methods Induction of experimental diabetes in rabbit with streptozotocin was performed successfully,every rabbit's lower limb was implanted a kirschner wire plug in femur by intereondylar notch.In experimental group,15 mg polyethylene particles,dispersed in 1.5 ml normal saline solution,were injected into one knee joint.The other knee joint was injected 1.5 ml normal saline solution ag control.This procedure was repeated for 2,4,6,8,10,and 12 weeks after the implantation.All animals were killed on the 2nd week after the last injection.Knee joint capsule tissues and periprosthetie tissues were examined by optical microscope.ELISA was used for determing the concentration of TNF-α.Results The results showed that kirschner wire were surrounded by multinueleated foreign-body giant cells and osteoclagt in the experimental group.Synovial membrane proliferation was obvious in the control group.There were no polyethylene particles and multinucleated foreign-body giant cells around plug in the marrpw.New bone wag found,kitschner wire was surrounded by suosteoblast,and normal synovial membrane was appeared.The concentration of TNF-α in experimental group was higher than that in control group.Conclusion Maximal ultra high molecular weight polyethylene and diabetic mellitus can restrain diabetic rabbit pefiprosthetic bone formation and increase the secretion of TNF-α.which may play an important role in the periprosthetic osteolysis.
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Objective To investigate the influence of calcitonin on bone mineral density and biomechanics around the artificial pros-thesis in ovariectomized diabetic rabbit model. Methods Fourteen femina New Zealand white rabbits at the age of 5 months old were select-ed, which weight 2.24 -2.65kg, averaging 2.26kg. First, the model of rabbit with diabetic osteoporosis was successfully established by the compound method of ovariectomy plus streptozotocin. Osteotomy in the middle part of femur was performed in both groups, fixation of artifi-cial prosthesis was done with 3.0 kirschner wire. After that, Rabbit models with diabetic osteoporosis were randomly divided into experimen-tal group and control group. Rabbits in the experimental group were treated with calcitonin 6U intramuscular injection once every other day. In control group, intramuscular injection of normal saline solution 1.5ml once every three days. Rabbit models of two groups were sacrificed in the 24th week. The BMD of the region of interest (ROI) around the prosthesis were detected before experiment and 8, 16 and 24 weeks after injection. After rabbits were killed, experimental femurs in both groups were complete removal and soft tissues were rejected. Determi-nation of the pull-out and torsion bone biomechanics experiments of prosthesis was done in both groups respectively. Results The BMD of ROI in the experimental group before operation was (0.1863±0.004)g/cm2 and (0.1753±0.005)g/cm2 in 24 weeks after operation, in control group before operation was (0.1865±0.002)g/cm2 and (0.1638±0.005)g/cm2 in 24 weeks after operation. There were significant difference between the two groups(P < 0.05). Biomechanical show that the pull-out strength in the experimental group was (312.68±8.73 )N/cm2 and (205.43±12.45 ) N/cm2 in control group. There were significant difference between the two groups(P < 0.05). The tor-sion strength in experimental group was (80.47±2.51) N/cm2 and (38.52±0.64) N/cm2 in control group. There were significant differ-ence between the two groups(P < 0.05). Conclusion Salmon calcitonin can reduce the bone turnover rate around prosthesis and decrease bone absorption in the rabbit of diabetic osteoporosis models, accelerate the bone formation around prosthesis, and increase the BMD. It can ameliorate the quality of bone around prosthesis, improve its biomechanics property, and increase the holding power between prosthesis and body mass. It is of clinical significance for the prevention and treatment of aseptic loosening artificial prosthesis.
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Objective To investigate the clinical epidemiological features of femoral neck frac-tures. Methods The clinical data of patients with femoral neck fractures admitted to Third Affiliated Hospital of Hebei Medical University from 2003 to 2007 were retrospectively analyzed. All patients were divided into children group (age < 16 years) , adult group (age ranged from 16 to 60 years) and older group (>60 years). The types of the femoral neck fractures included 31-B1, 31-B2 and 31-B3 according to AO classification. The gender, age, fracture type and injury causes were analyzed. Results A total of 2 064 patients (971 males and 1 093 females) with femoral neck fractures were involved in the study.There were 356, 381, 397, 454 and 476 patients respectively in 2003, 2004, 2005, 2006 and 2007.There were 74 patients (3.59%) in the children group, 979 (47.43%) in the adult group and 1 011 (48.98%) in the older group. There were 960 patients (46. 51%) with type 31-B1 fractures, 860 (41. 67%) with type 31-B2 fractures and 244 (11. 82%) with 31-B3 fractures. Conclusions Form 2003 to 2007, the incidence of femoral neck fracture shows a trend of increase, with the highest incidence in the old persons. The male patients with femoral neck fractures are more than female patients in adult group, while the female patients with femoral neck fractures are less than male patients in older group.The dominant fractures type according to AO classification are type 31-B2 fractures in children and adult groups, but type 31-B1 fractures in older group.
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BACKGROUND: After acute spinal cord injury (SCI), edema of spinal cord is an important factor for inducing and deteriorating pathological changes of spinal cord tissue. After injury, noradrenaline (NE) instantly causes microvascular contraction, endothelial injury, increase of arterial permeability and participation in edema. Recently, many researches suggest that excitatory amino acids (EAA) are related to cellular edema.OBJECTIVE: To study the effect and mechanism of selective phenol aminergic neuron, 6-hydroxy dopamine (6-OHNA)and aspartic acid (ASP) on edema after acute SCI.DESIGN: Randomized controlled study.SETTING: Department of Spine Surgery, the Third Hospital of Hebei Medical University.MATERIALS: The experiment was carried out at the Experimental Animal Center of the Third Hospital of Hebei Medical University from March to September 2003. A total of 160 Wistar rats weighing 300-350 g of both genders were randomly divided into three groups: 6-OHNA group (n =60), MK-801 group (n =50) and control group (n =50).METHODS: Acute SCI was induced at the level of T13 vertebral body with the static lcad technique. Rats in 6-OHNA group were injected with 6-OHNA into subarachnoid space; rats in MK-801 group were injected with MK-801 into caudal vein; rats in control group did not receive any treatment. The extent of edema was compared in the three groups by means of neurological scoring, water content measurement, light microscopy and electron microscopy.MAIN OUTCOME MEASURES: Neurological scores and water content.RESULTS: All 160 rats were involved in the final analysis. ① After SCl, content of NE in 6-OHNA group was decreased from (217.45±4.26) ng/g to (29.37±2.61) ng/g, and the difference was significant (P＜ 0.01). Edema in spinal cord tissue was effectively inhibited for 24 hours. At 12 hours after SCl, function recovered remarkably and vascular-derived edema was the mildest. ② In MK-801 group, there was no significant suppression of the edema until 24 hours after injury. Early recovery of neurological function was not significantly different from that in control group (P ＞ 0.05), but functional recovery was obvious until 24 hours after injury (P＜0.05). The degree of cytotoxic edema was the lightest.CONCLUSTON: NE can inhibit vascular-derived edema at early phase of SCI, and EAA can inhibit cytotoxic edemas,which develops at a relatively later stage.
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There is mounting evidence that vascular pathology plays a role in the initiation and/or progression of the major disease of joints: osteoarthritis(OA).Potential mechanisms are:episodically reduced blood flow through the small vessels in the subchondral bone at the ends of long bones,and related to this,reduced interstitial fluid flow in subchondral bone and compromised nutrient and gas exchange into the articular cartilage,a potential initiator of degradation changes in the cartilage.The second is apoptosis of osteocytes in regions of the subchondral bone,which would initiate osteoclastic resorption of that bone and at least temporarily reduce the bony support for the overlying cartilage.It may be important to recognize these potential aetiological factors in order to develop more effective treatments to inhibit the progression of OA.
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[Objective] To investigate all-inside techniques for repairing lateral meniscus anterior horn tear with cysts.[Methods]Nineteen patiants with lateral meniscus anterior horn tear with cysts were collected from August 2006 to May 2008 with 7 males and 12 females.Five cases of isolated memberane cysts and 14 of lateral meniscus anterior horn tear with cysts were analyzed by MRI.Fifteen cases of lateral meniscus anterior horn tear with cysts and 4 of isolated memberanes cysts were finally diagnozed by arthoscopy.The apparatus of shoulder arthoscopy to sutured lateral injuried meniscus anterior horn were used after sheared cysts.Lysholm scores before and after operation were compared.Re-arthoscopy evaluation was performed for 13 patients.[Results]No case had complication after operation during short-term follow-up.Preoperative Lysholm scores was(64?5)points,postoperative scores was(94?7)ponits.Lysholm scores had significance between preoperation and postoperation(P
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[Objective]To explore the "acute angle" of femur,and evaluate the bone tunnel technique in posterior cruciate ligament reconstruction.[Method]Using the porcine flexor digitorum tendon as graft,the author reconstructed posterior cruciate ligament.The bone tunnel was established with the angle of 80?,90?and 100?comparison the tunnel and intercondylar fossa of femur side wall,and press sensitive film was set between the edge of tunnel and graft.The pressure between was used to represent abrasion.The bigger the pressure was,the larger the abrasion was.The difference of pressure between bone tunnel technique group and the control group was compared.[Result]The pressure of angle 100?was lowest(3.55?0.21 MPa).And the pressure of burnishing group(3.29?0.19 MPa)was lower than that of the control group(3.55?0.21 MPa).[Conclusion]The bone tunnel technique can reduce the femoral;"acute angle" of femur in posterior cruciate ligament reconstruction.
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[Objective]To observe the effect of preemptive analgesia with continuous epidual anesthesia in total knee arthroplasty.[Methods]Fifty-four patients who were treated in author's hospital were randomly assigned into two groups with 27 patients in each.One group was treated with 0.125% ropivacaine 2 ml/h through epidual catheter since 12 hours before the operation.The other group was given saline at the same rate.All the patients received general anaesthesia in the operation.The use of patient controlled analgesia(PCA) with epidual anesthesia was initiated 48 hours after operation.PCA was used as a supplement when the patients comldn't bear the pain.The following variations were compared between these two groups:visual analog score(VAS),the incidences of complication,deep vein thrombosis(DVT),the time of the ability to actively reach 90 degree knee flexion,the range of motion(ROM) and the chronic pain after operation.[Results]The following variations were statistically significantly lower in ropivacaine group than that in the saline group:VAS,DVT,the time to reach 90 degree knee flextion,while ROM 6 months and 1 year after operation were significant higher.There were no statistically significant differences between groups in the incidence of the side effects during the two days after the operation and the chronic pain for a longer time.[Conclusion]Preemptive analgesia with continuous epidual anesthesia can alleviate the early stage of the pain after total knee arthroplasty,decrease the incidence of the complication and increase the rang of motion without obvious side effects.
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45.0?5.4)was higher than those who underwent omnidistance tourniquet technology.The incidence rate of hematoma and venous thrombus of lower extremity had no obvious difference.[Conclusion]The postoperative blood loss can be reduced and early postoperative clinical effect and affected limb function can be improved by halfway tourniquet technology for patients who underwent TKA.
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0.05) at preoperatively and postoperatively the total knee score,preoperatively and postoperatively pain score,preoperatively and postoperatively patient function score,and preoperatively and postoperatively Patellar score.The postoperative maximum flexion of the fixed-bearing group and the mobile-bearing group was 108??9.3? and 99.5??10.1? respectively.There was significant difference between the 2 groups for the postoperative maximum flexion (P0.05) at the femoral valgus angle,the tibial angle,the tibial slope angle,and preoperatively and postoperatively the patellar height (Install-Salvati ratio).[Conclusion]The short-term results of the fixed-bearing posterior stabilized prosthesis and the mobile-bearing prosthesis TKA were successful.There was no significance difference between the two groups for the total knee score,function score,pain score,patellar score and radiographic results.The postoperative maximum flexion in fixed-bearing group was higher than that in mobile-bearing group.
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[Objective]To evaluate efficacy and method of arthroscopic meniscoplasty for horizontal tear of discoid lateral meniscus in a short follow-up term. [Method]A series of 27 patients (27 knees) (mean age 32 years, range 6 years to 42 years) who underwent arthroscopic evaluation and treatment of a discoid lateral meniscus between 2002 and 2006 was reviewed. All the patients who were selected had the horizontal type of tear. Of those discoid menisci classified intraoperatively (n=27), 85.2% (n=23) were complete discoid lateral menisci and 14.2% (n=4) were incomplete discoid lateral menisci. No Wrisberg type was noted. Arthroscopic meniscoplasty was performed in all cases. The horizontal tear meant meniscus was divided into two leaves. The auther removed the unstable leaf to the peripheral rim and preserved the stable one. Arthroscopic meniscoplasty was performed in the stable leaf.[Result]All the patients were evaluated at follow-up according to the Lysholm knee Scoring Scale. At follow-up, patients were reviewed to recognize possible of retear and requirement of arthroscopic revision. The knee score of these patients improved from 72.48?4.64 points preoperatively to 92.18?4.52 points postoperatively. Recurrence of tear or requirement of arthroscopic revision was not noted at the final follow-up. [Conclusion]Arthroscopic meniscoplasty of the horizontal tear of discoid meniscus is an effective method.
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0.05).Twelve months after TKA, the pain score of HO group was 15.56,lower than 2 weeks and comparison group in 12 months(P
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[Objective]To clarify the precise displacement of the popliteal artery(PA) during knee flexion using magnetic resonance imaging(MRI).[Method]MRI was used in 16 knees at 0? and 90? of flexion to measure the distance between the popliteal artery and the posterior tibial cortex(bone to artery distance,BAD)at two levels corresponding to the levels of osteotomy in total knee arthroplasty(TKR) and in high tibial osteotomy(HTO).The results were analysed using paired-samples t test.[Result]At the level of TKR(0.5 to 1 cm below the tibial articular surface),the mean posterior movement of BAD from extension to 90? of flexion was 1.8 mm(-2～+5 mm) with a statistical significance(P=0.005).At the level of HTO(1.5 to 2 cm below the tibial articular surface),the mean change in BAD 1.4mm(-2～+4mm)was also statistically significant(P=(0.005)).At the two levels,the artery moved toward the tibia in 2 cases,respectively.[Conclusion]Knee flexion may be considered to be a safer position,still there is possible potential popliteal artery injury.
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[Objective]To assess the functional outcome,influence factors and its management of lateral wedge high tibial osteotomy(HTO)in patients with symptomatic lateral thrust and varus malalignment.[Method]The results of 19 lateral closing wedge HTOs in patients with a symptomatic hyperextension-varus thrust were evaluated from 2000 to 2004.The average age of the patients at the time of surgery was 49 years(ranged,47~54 years).Radiographs were analyzed to compare changes in femorotibial angle,tibial slope,and the height of the fibular head pre-and postoperatively.Functional results were evaluated according to the scoring system of HSS.The varus stress test was used to evaluated the posterolateral knee injury.We used a 5-point visual analogue scale to assess change in knee stability.[Result]Patients were followed for an average of 21 months.Femorotibial axis alignment was 184.5?～197?preoperatively and 167?～176?postoperatively;Posterior tibial slope was 2?～17?preoperatively and-4?～13?postoperatively;The height of fibular head was 7.7～18.5 mm preoperatively and-3.5～10.7 mm postoperatively(P=0.00).All patients had an increase in their HSS score postoperatively.Sixteen patients had Grade 1 posterolateral injuries and 3 patients had Grade 2 injures preoperatively,9 patients had Grades 1 injures and 10 patients had Grade 2 injures(P