Case-control study on individual osteotomy instrument and conventional total knee arthroplasty for the treatment of knee osteoarthritis / 中国骨伤

<p><b>OBJECTIVE</b>To compare clinical efficacy of individual osteotomy instrument and total knee arthrolplasty (TKA) in treating patients with knee osteoarthritis.</p><p><b>METHODS</b>From June 2014 to December 2014, 40 patients with unilateral knee osteoarthritis were randomly divided into two groups and 20 cases were in each group. One group (individual group) were treated with TKA with individual osteotomy instrument,including 5 males and 15 females with an average age of (67.3 ± 6.5) years old; 8 cases on the left side and 12 cases on the right side. Another group (conventional group) were treated with conventional TKA , including 6 males and 14 females with an average age of (66.8 ± 7.3) years old; 9 cases on the left side and 11 cases on the right side. Operative time, blood loss, postoperative HSS score at 6 months, and changes of mechanical alignment before and after operation were analyzed.</p><p><b>RESULTS</b>Operative time in individual group was (79.3 ± 4.7) min, and (83.5 ± 3.2) min in conventional group; blood loss in individual group was (287.1 ± 24.9) ml and (363.4 ± 47.2) ml in conventional group, there were statistical differences between two groups in these two items. There was no significant difference in postoperative HSS score at 6 months between individual group (84.8 ± 3.2) and conventional group (84.2 ± 2.5). Postoperative limb alignment in individual group was (2.8 ± 0.6)°, and (2.8 ± 0.6)° in conventional group, with no significant difference between two groups.</p><p><b>CONCLUSION</b>TKA with individual osteotomy instrument could reduce operative time and blood loss, but there was no differences in knee function, changes of mechanical alignment compared with TKA.</p>

Research on the reliability of the Akagi line as a reference axis to guide for rotational alignment of the proximal tibial component in total knee arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To study on the reliability of the Akagi line as a reference axis to guide for rotational alignment of the proximal tibial component in total knee arthroplasty (TKA) the rotational alignment reference bony landmarks of the proximal tibial component on magnetic resonance image (MRI) were measured.</p><p><b>METHODS</b>From January 2010 to December 2013, 80 normal knees of Chinese volunteers including 35 males and 45 females with an average age of (35.4±6.1) years were reviewed. The images of the knees were obtained by MRI. The surgical epicondylar axis (STEA) was identified in the femoral transverse sections and then was projected to the side of tibia, forming the SETA'. A line connecting the medial border of the patellar tendon and the middle of the posterior cruciate ligament insertion (Akagi line) and its vertical line (AK), as well as a line connecting the medial 1/3 of the patellar tendon and the middle of the posterior cruciate ligament insertion and its vertical line (AP), were identified in the tibial transverse sections. The angles were measured between the AK, AP and STEA'.</p><p><b>RESULTS</b>The angle between AK and STEA' was (0.59±2.07)°, and there was no significant difference between the two lines (t=-2.54, P=0.13). The mean angle between AP and STEA' was (3.21±2.04)°, and there was a significant difference between the two lines (t=14.05, P<0.05). There was a significant difference between the AK and AP (t=-11.68, P<0.05).</p><p><b>CONCLUSION</b>The reliability of the Akagi line as a reference axis to guide for rotational alignment of the proximal tibial component in TKA is good.</p>

Arthroscopic treatment of symptomatic anterior cruciate ligament cysts of the knee / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical symptom and effect of arthroscopic treatment of symptomatic anterior cruciate ligament (ACL) cysts of the knee.</p><p><b>METHODS</b>Clinical data from 12 symptomatic ACL cysts patients from January 2005 to December 2010 were retrospectively analyzed,including 8 males and 4 females,with an average age of (33.7±9.5) years old (ranged, 19 to 53 years old). The locations were the left knee in 5 cases and the right knee in 7 cases. The disease duration ranged from 3 to 48 months,with a mean of (15.8±13.2) months. All cysts were arthroscopically resected. Range of motion was measured preoperatively and postoperatively, and Lysholm scoring system was used to evaluate the knee function.</p><p><b>RESULTS</b>All the incisions healed by first intention, and no complications occurred. Twelve patients were followed up for an average of (32.3±6.6) months(ranged, 24 to 48 months). The symptoms of arthralgia,swelling and interlocking of the affected knees disappeared. There was no recurrence during the follow-up. There were significant differences in the range of motion and Lysholm score between pre-operation and post-operation.</p><p><b>CONCLUSION</b>Arthroscopic surgery, showing its advantages of minimal invasion and rapid recovery,is an effective measure in the treatment of ACL cysts.</p>

Application of orientation to the mechanical alignment of lower limbs in operation of high tibial osteotomy / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the effects of orientation to the mechanical alignment of lower limbs in high tibial osteotomy (HTO).</p><p><b>METHODS</b>From March 2005 to July 2010, the data of 57 patients (63 knees) with medial compartment osteoarthritis were retrospectively analyzed. There were 24 males and 33 females with an average age of 52 years (ranged, 34 to 68). HTO was used in all the patients, and with wire the exact orientation to the mechanical alignment of lower limbs was performed in order to obtain good angle of intercepted bone. X-rays of full-length lower limbs were done at the 3rd month after operation and final follow-up, in which femorotibial angle would be observed. Clinical results were evaluated according to Hospital for Special Surgery knee scores (HSS) including pain, function, activities, myodynamia, deformity and instability.</p><p><b>RESULTS</b>All patients were followed up from 24 to 60 months with an average of 36.7 months. All osteotomy site achieved radiographic healing. The femorotibial angle was corrected from preoperative (182.8 +/- 2.9) degrees to postoperative (167.6 +/- 2.5) degrees and (168.1 +/- 2.5) degrees at final follow-up (compared with preoperative data, P < 0.01). Pain relieved and genu valgum recovered. HSS score improved from preoperative 69.5 +/- 7.1 to postoperative 91.1 +/- 4.9 and 92.2 +/- 5.6 at final follow-up. According to HSS standard, 43 knees got excellent results, 18 good and 2 fair.</p><p><b>CONCLUSION</b>The orientation to mechanical alignment of lower limbs using wire during operation of HTO is a good method in correcting femorotibial angle and treating medial compartment osteoarthritis of the knee. Moreover, the method is simple and precise for orthopedist.</p>

Surgical treatment of displaced intra-articular fractures of the calcaneus in elderly patients / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical effects of surgical treatment of displaced intra-articular fractures of the calcaneus in elderly patients, and to discuss the operative indications.</p><p><b>METHODS</b>From January 2000 to December 2007, 24 elderly patients with 26 fractures underwent open reduction and internal fixation for a displaced intra-articular fracture of calcaneus, which included 18 feet of 18 males and 8 feet of 6 female, with an average age of 67 years (range, 60 to 75 years). According to Sanders classification based on CT scanning, 13 fractures were rated as type II, 12 as type III and 1 as type IV. Böhler angle and Gissane angle were measured preoperatively and postoperatively and foot function was assessed with Maryland foot score system.</p><p><b>RESULTS</b>Twenty-four cases with 26 feet were followed up for an average of 18.4 months (range, 12 to 26 months). Mean Böhler angle was (10.4 +/- 8.2) degrees preoperatively and (27.8 +/- 7.4) degrees postoperatively and mean Gissane angle was (136.5 +/- 10.3) degrees preoperatively and (124.3 +/- 4.2) degrees postoperatively. The difference between preoperative and postoperative values was found with statistically significant (P < 0.05). The results were excellent in 5 feet, good in 16 feet, fair in 4 feet and poor in 1 foot. There were 3 cases of wound necerosis, 2 cases of wound infection, 1 case of sural nerve injury and 6 cases of posttraumatic subtalar arthritis complications.</p><p><b>CONCLUSION</b>Good clinical result could be obtained with surgical treatment in elderly patients with displaced intra-articular fractures of the calcaneus. Open reduction appears to be an acceptable method of treatment for displaced calcaneal fractures in elderly patients if they have good general conditions.</p>

Effect of dehydroepiandrosterone on experimental osteoarthritis in rabbits / 中华风湿病学杂志

Objective To observe the effect of intra-articular injection of dehydroepiandrosterone (DHEA)on the experimental osteoarthritis in rabbits and study the mechanism.Methods Forty rabbits un derwent unilateral anterior cruciate ligament transection(ACLT)and then divided into two groups randomly. 100?mol/L DHEA resolved in the dimethylsulphoxide were injected into the knees of experimental rabbits 4 weeks after transection,once a week for five weeks.Rabbits in the control group were treated under the same schedule using dimethylsulphoxide.All rabbits were killed 9 weeks after ACLT and the knee joints were evalu- ated by gross morphology and histology.The mRNA expression of metalloproteinases-3(MMP-3),tissue in- hibitor of metalloproteinases-1(TIMP-1)and interleukin-lbeta(IL-1?)in the cartilage and synovium was analyzed using reverse transcription polymerase chain reaction(RT-PCR).Results Gross morphologic in- spection and histological evaluation showed that the extent and grade of cartilage and synovium damage in the experimental group were less severe than the control group.The mRNA expression of MMP-3 in cartilage and synovium decreased significantly in the experimental group(both P＜0.05).The mRNA expression of TIMP-1 in cartilage and synovium increased significantly in the experimental group compared with that in the control group(both P＜0.05).No significant difference of IL-1?mRNA expression in cartilage was found between the experimental and the control groups(P＞0.05).The mRNA expression of IL-1?in the synovium was signifi- cantly suppressed in the experimental group compared with that in the control group(P＜0.01).Conclusion DHEA protects against cartilage degradation,alleviates synovium inflammation and inhibits the progression of osteoarthritis in the experimental model.Down-regulation of MMP-3 and up-regulation of TIMP-1 in cartilage and synovium and IL-1?in the synovium may be the mechanism of the protective effect of DHEA on os- teoarthritis.