ABSTRACT
Objective:In order to compare the effect of ascending medial open-wedge high tibial osteotomy and descending medial open-wedge high tibial osteotomy on patellar height.Methods:Our group analyzed 77 patients of medical cases which were closely associated with medial open-wedge high tibial osteotomy for the treatment of knee varus deformity and medial compartment osteoarthritis from May 2011 to December 2018 and 77 cases were effectively followed up, including 36 males and 41 females with an average age of 59.4±10.5. By the way, there are 51 cases of ascending osteotomy and 26 cases of descending osteotomy. During these treatment, we adopted some scientific methods full-length standing anteroposterior radiograph,Miniaci method, Insall-Salvati index (ISI), Caton-Deschamps index (CDI) and Blackburne-Peel Index (BPI) to measure the corresponding parameters and changes in patellar height (PH) at different stages.Results:77 patients were enrolled, the mean follow-up time was 20.6 months (range, 12-60 months), ascending and descending high tibial osteotomy (HTO) show the average degree of varus correction (10.43°±2.67° and 11.16°± 2.80°) respectively. And at the same time, in these cases of ascending HTO, PH decreased by 8.1% (CDI method), 2 cases of low PH (the patellar height decreased by 10%, which is the low patellar) were measured (ISI method), 7 cases of low PH occurred (CDI and BPI). Instead, PH decreased by 4.5% (CDI method) in descending HTO,the difference was significant ( t=2.101, P=0.040). 22 cases of ascending HTO with varus correction less than 10 degrees, the PH decreased by 6.9%. By the way, the ISI method did not detect the occurrence of low PH, but we found one by CDI and BPI. The 29 cases with varus correction of more than 10 degrees in ascending HTO, and PH decreased by 10.4%. There were 2 low PH (ISI method), and 6 low PH (CDI and BPI), the difference was significant ( t=2.310, P=0.028). Conclusion:In ascending HTO, the low PH is closely related to the degree of varus correction. Conversely, The descending HTO did not influence PH.
ABSTRACT
Objective:To evaluate the clinical significance of our self-designed three-column scoring system for postoperative X-ray stability of intertrochanteric fracture after intramedullary nailing.Methods:A retrospective study was conducted of the 378 patients with intertrochanteric fracture who had been treated between January 2015 and June 2019 at Department of Orthopaedics, Linyi People's Hospital by internal fixation with proximal femoral nail antirotation (PFNA). They were 161 males and 217 females, aged from 60 to 97 years (average, 72.5 years). By the AO classification, there were 109 cases of type 31-A1, 188 cases of type 31-A2 and 81 cases of type 31-A3. Anteroposterior and lateral X-ray examinations of the hip were performed immediately after internal fixation to evaluate the fracture stability using our self-designed three-column scoring system by which the medial column is given 4 points, middle column 2 points and lateral column 2 points. A single column scoring full points is rated as stable, 3-column stability as excellent, 2-column stability as good, one-column stability as fair, and 3-column unstability as poor. Rehabilitation programs were carried out according to the results of stability evaluation: full weight bearing at an early stage was indicated for excellent patients, partial weight bearing at an early stage for good patients and weight bearing at an early stage contraindicated for fair or poor patients. Fracture union time and failure of internal fixation were recorded. The relationship between internal fixation failure and our three-column scoring system was calculated.Results:The 378 patients were followed up for 6 to 24 months (mean, 10.4 months). Of them, 365 obtained fracture union after an average time of 4.3 months (from 3 to 7 months). Internal fixation failure occurred in 13 patients, giving a failure rate of 3.4%(13/378).Of the 129 excellent patients by our three-column scoring system for post-operative X-ray stability of intertrochanteric fracture, none failed in internal fixation; of the 193 good patients, 4 failed; of the 56 fair patients, 9 failed. Internal fixation failure was closely related to our three-column scoring system for postoperative X-ray stability of intertrochanteric fracture ( r=-0.986, P=0.006), as well as to the column stability ( r=-1.000, P=0.033). Conclusion:Our self-designed three-column scoring system for postoperative X-ray stability of intertrochanteric fracture after intramedullary nailing can accurately reflect the fracture stability so that it can be used to guide rehabilitation programs for the patients and judge their prognosis.
ABSTRACT
Objective To prove the prophylactic function of absorbable gelatin sponge and bioprotein glue for prevention of epidural and nerve root scar adhesions after laminectomy. Methods We excised the L6 vertebral plates of 36 adult New Zealand male rabbits,to make vertebral plate excision model and to find nerve root. Then divided them into 3 groups based on different materials:gelatin sponge and bioproten glue (group A),gelatin sponge (group B) and saline solution (group C). The morphological changes of the scars were observed grossly and histologically at 2 and 8 weeks after operation. We also measured the orbit of the nerve root. Results Gelatin sponge combining with bioprotein glue can reduce adhesion obviously(P