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Objective:To evaluate the feasibility and clinical outcomes of navigation-assisted total knee arthroplasty (TKA) using adjusted restricted kinematic alignment (arKA).Methods:Data of 14 consecutive cases of OrthoPilot navigation-assisted TKA using arKA from October 2019 to September 2021 were retrospectively analyzed, including 3 males and 9 females. The average age was 67.71±8.96 years with mean body mass index (BMI) 25.94±3.12 kg/m 2. 27 consecutive patients who underwent navigation-assisted TKA using aMA during the same period were assessed as the control group. There were no significant differences in gender, age or BMI between the two groups. Intraoperative parameters including operative duration, tibia resection angle, frontal femoral angle, axial femoral angle, joint line translation, medial and lateral gap in extension and flexion position were recorded. Radiographic parameters including hip-knee-ankle (HKA) angle, coronal femoral component angle (cFCA), coronal tibial component angle (cTCA), sagittal femoral component angle (sFCA) and sagittal tibial component angle (sTCA) were measured. Functional outcomes were assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Hospital for Special Surgery (HSS) score. Surgery-related complications were recorded. Results:All cases were followed up. The mean follow-up of arKA group was 18.57±6.98 months and follow-up of aMA group was 22.15±4.91 months. The intraoperative tibial resection was 3.07°±1.00° in arKA group versus 0.67°±0.56° in aMA group ( P<0.05). The lateral cutting height of tibia was 9.07±1.82 mm in arKA group versus 6.89±2.94 mm in aMA group ( P<0.05). The lateral gap in flexion was 1.71±0.83 mm in arKA group versus 1.04±0.71 mm in aMA group ( P<0.05). The difference of medial-lateral flexion laxity was 1.14±0.86 mm in arKA group versus 0.41±0.75 mm in aMA group ( P<0.05). The postoperative HKA angle was 174.10°±1.63° in arKA group versus 177.12°±2.07° in aMA group ( P<0.05). The cTCA was 87.58°±0.85° in arKA group versus 89.14°±1.23° in aMA group ( P<0.05). The cFCA was 93.10°±1.75° in arKA group versus 90.41°±3.01° in aMA group ( P<0.05). There was no statistical difference between the two groups in sFCA (1.30°±0.82° vs. 1.56°±1.19°), sTCA (87.16°±0.95° vs. 87.79°±1.04°) and femoral notching (7.1% vs. 11.1%). The preoperative HSS score in arKA group was 46.07±4.68 and HSS score at 1 month postoperatively was 73.86±3.48 ( P<0.05). The preoperative HSS score in aMA group was 47.04±4.52 and HSS score at 1 month postoperatively was 74.04±3.57 ( P<0.05). There was no statistical difference between the two groups in WOMAC score (12.93±2.37 vs. 12.63±2.34) and HSS score (86.86±2.74 vs. 86.11±2.95) at 6 months postoperatively. 2 cases (14.3%) in arKA group and 5 cases (18.5%) in aMA group had deep venous thrombosis (χ 2=0.12, P=0.733). Conclusion:Navigation-assisted TKA using arKA offers the surgeons a new alignment option for severe knee deformity with satisfactory clinical outcomes, the arKA technique has advantages in soft tissue protection and gap balance regulation compared to aMA technique.
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Objective:To explore the early learning curve of OrthoPilot navigation assisted total knee arthroplasty (TKA).Methods:Data of 40 consecutive cases of OrthoPilot navigation assisted TKA completed by the same surgical team in our department were retrospectively analyzed. According to the operation order, 40 cases were divided into the original phase group (the first 20 cases) and the subsequent phase group (the second 20 cases). In original phase group, the average age was 69.85±6.86 years with mean body mass index 24.10±2.88 kg/m 2, preoperative HSS score 48.80±5.33, preoperative knee ROM 87.05°±11.02° and preoperative alignment deviation of 7.40°±5.59°. In subsequent phase group, the average age was 66.65±7.92 years with mean body mass index 22.85±3.15 kg/m 2, preoperative HSS score 49.00±5.47, preoperative knee ROM 85.80°±11.65° and preoperative alignment deviation of 8.22°±5.21°. Perioperative data such as operative duration, incision length, hemoglobin drop and postoperative hospital stay, radiographic outcomes including hip-knee-ankle angle (HKAA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), sagittal femoral component angle (sFCA), sagittal tibial component angle (sTCA), joint line convergence angle (JLCA), and functional scores were compared between the two groups. Results:All 40 cases were followed up for 24-33 months (mean, 27.38± 2.73 months). No severe postoperative complications such as infection and loosening occurred during the follow-up. The mean operative duration was 112.35±25.49 min in original phase group versus 82.10±10.96 min in subsequent phase group ( P< 0.05). The durations of tibial cutting was 11.95±3.27 min in original phase group versus 7.35±2.23 min in subsequent phase group ( P< 0.05); the femoral planning + cutting time was 20.95±6.91 min in original phase group versus 16.60±4.78 min in subsequent phase group, and trial + prosthesis implantation time was 39.65±7.72 min in original phase group versus 25.10±5.72 min in subsequent phase group,which was significantly higher in original phase group. There was no significant difference in other perioperative data such as incision length, hemoglobin drop and postoperative hospital stay between the two groups. As for radiographic outcomes, there was no statistical difference between the two groups in the postoperative angular deviation of HKAA (0.70°±0.80° vs. 0.80°±1.06°), mLDFA (0.89°±0.91° vs. 1.00°±0.86°), mMPTA (0.77°±0.53° vs. 0.76°±1.03°), sFCA (0.73°±0.48° vs. 0.87°±1.06°), sTCA (0.95°±0.58° vs. 1.16°±1.14°) and JLCA (0.27°±0.25° vs. 0.39°±0.18°). In original phase group, the HSS scores preoperative and 3 days postoperative were 48.80±5.33 and 60.05±5.10 respectively, and those in subsequent phase were 49.00±5.47 and 60.75±4.47 respectively, and both groups showed satisfactory functional recovery. There was no significant difference in HSS scores at all follow-up time points between two phases, as well as ROM (113.20°±9.82° vs. 113.50°±12.44°) and FJS-12 scores (78.00°±10.98° vs. 76.65°±10.29°) at 2 years postoperatively. Conclusion:In this study, we described a time-related early learning curve for OrthoPilot navigation-assisted TKA, in which the operative duration tended to be shorter after the first 20 cases. However, benefiting from good operative accuracy and repeatability, satisfactory radiographic and functional outcomes can be obtained in early stage of the learning curve.
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Objective:To compare the prosthesis locations and postoperative hip functions between supercapsular percutaneously-assisted total hip (SuperPATH) approach and traditional posterolateral approach (PLA) in total hip arthroplasty.Methods:A retrospective analysis was conducted of the 107 patients who had undergone unilateral total hip arthroplasty at Department of Orthopedic Surgery, The First Affiliated Hospital to Soochow University from August 2016 to February 2019. They were divided into 2 groups according to their surgical approaches. In the SuperPATH group of 54 cases, there were 20 males and 34 females with an age of (64.3±9.1) years; in the PLA group of 53 cases, there were 20 males and 33 females with an age of (62.2±10.6) years. The 2 groups were compared in terms of abduction angle, ratio of abduction angle to safety zone, anteversion angle, ratio of anteversion angle to safety zone, retroversion angle, incidence of retroversion, and differences in eccentricity and lower limb length on the first day after operation, and Harris hip scores at 1 week, 3 months and the last follow-up postoperatively. Their complications were also recorded as well.Results:There were no statistically significant differences in the preoperative general data between the 2 groups, showing comparability ( P>0.05). The postoperative imaging data were complete for the 107 patients who had been followed up satisfactorily for 14 to 36 months (average, 25 months). The SuperPATH group had significantly larger retroversion angle (13.6°±9.6°) and incidence of retroversion (18.5%, 10/54), significantly smaller difference in eccentricity [0.26 (0.13,0.49) cm], and significantly higher Harris hip score [(74.8±7.8) points] at one week after surgery than those in the PLA group [3.0°±1.0°; 5.7%, 3/53; 0.38 (0.13,0.70) cm; (72.0±6.7) points] ( P<0.05). There were no statistically significant differences between the 2 groups in abduction angle, ratio of abduction angle to safety zone, anteversion angle, ratio of anteversion angle to safety zone, difference in lower limb length, or Harris hip scores at 3 months or the last follow-up postoperatively (all P>0.05). Follow-ups in both groups observed no more than one case of dislocation which responded to manual reduction. Conclusion:The minimally invasive SuperPATH approach may obtain better femoral eccentricity and higher early hip function scores than the traditional posterolateral approach, but may lead to a higher incidence of retroversion after prosthesis placement.
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[Objective]To research professor ZHANG's clinical experience in treatment of metrorrhagia. [Methods] By following professor ZHANG diagnosis long time, it summarizes ZHANG's experience of Chinese medicine treatment on uterine bleeding and academics from the etiology and pathogenesis.[Results] ZHANG thinks that the pathogenesis of metrorrhagia, both cold and heat, will cause Chong Ren imbalance, so the method to reconstruct the menstrual cycle as the fundamental purpose, comprehensive use of TCM and western medicine adjuvant hormonal therapy. In the acute hemorrhage, the use of clearing heat and bleeding, liver-spleen -harmonizing remission with artificial cycle therapy according to syndrome differentiation and treatment of hemorrhage, clarifying the source and rectifying the primary on the basis of syndrome making a better clinical effect during the remission. [Conclusion] Professor ZHANG's treatment of uterine bleeding experience, unique, has a strong clinical significance, with learning and promotion of application value.
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[Objective] To sum up the clinical experience of famous veteran doctor LI Rongzhen in treating the fundus oculi disease. [Methods] By learning from Professor LI Rongzhen, recording the relevant cases and analyzing the typical cases, to summarize the academic idea and the clinical experience according to the viscera syndrome differentiation and treatment characteristics, as well as list two proved cases. [Results] Professor LI Rongzhen holds that this disease is closely related with the viscera, origins from heart, involving liver, lung and kidney. In the clinical treatment, Professor LI is good at using the classical prescriptions and the therapy with syndrome differentiation with the permit addition and subtraction, according to the pattern of the fundus oculi disease, which has received the remarkable effect: patients with the deficiency of both heart and spleen of sudden blind, using the principle of nourishing qi to stop bleeding with Guipi Decoction, patients with hyper-action of liver yang, using Zhengan Xifeng Decoction to nourish yin for suppressing hyperactive yang, patients with qi stagnation and blood stasis are treated by Xuefu Zhuyu Decoction to remove stasis and stopp blood;patients with deficiency of kidney-yin of vitreous opacity, using the treatment of tonifying kidney for improving eyesight, with Six Ingredient Rehmannia Pill to nourish the liver and kidney, syndrome with the disharmony of liver and spleen, using Xiaoyao Powder to replenish vital energy ,deficiency of qi and blood, applying Bazhen Decoction to invigorate qi and blood. All of the cases verify her clinical experience. [Conclusion] While treating the fundus oculi disease, Professor LI pays attention to the relation between the eyes and the viscera, using the therapy with syndrome differentiation, with the flexible application of the ancient prescriptions and the traditional Chinese medicine, her experience in treating the fundus oculi disease is well worth learning and using.
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BACKGROUND:Total knee arthroplasty has matured in clinical treatment. LPS-Flex Mobile Bearing System (Zimmer, USA) artificial knee prosthesis is the high-flexion rotating platform type knee prosthesis. The time of its clinical application in China is short, so its advantages have not been reported. OBJECTIVE:To investigate the preliminary clinical outcome of the total knee arthroplasty with LPS-Flex Mobile Bearing system artificial knee prosthesis (Zimmer, USA), and to assess the biocompatibility of artificial prosthesis and host using range of motion of knee and function after replacement. METHODS:We retrospectively analyzed 37 patients (42 knees) undergoing total knee arthroplasty using Zimmer LPS-Flex Mobile Bearing prostheses (high-flexion rotating platform type knee prosthesis) in The First Hospital Affiliated to Soochow University from February 2012 to March 2014, including 9 males (10 knees) and 28 females (32 knees), aged 47-78 years, averagely 63.7 years. Bone cement fixation was used, and the patel a was not treated with replacement. Postoperative complications were observed. Ranges of motion of knee joint preoperatively and postoperatively were compared. The recovery of knee joint function was evaluated using Hospital for Special Surgery Knee Score. RESULTS AND CONCLUSION:A total of 34 cases (38 knees) were fol owed up for 6-28 months. Range of motion of knee joint improved from 88.5° before operation to 124.2° after operation on average. Hospital for Special Surgery Knee Score improved from 52.5 before replacement to 91.1 after replacement, showing significant differences (P<0.01). Therapeutic effects were assessed according to Hospital for Special Surgery Knee Score:excel ent in 20 cases, good in 16 cases, average in 2 cases, with an excel ent and good rate of 95%. The incidence of various complications was low. These data suggested that short-period clinical outcomes of high-flexion rotating platform type knee prosthesis replacement are satisfactory. This prosthesis has advantages in its design, which is more close to the physical structure of knee joint, but its long-period outcomes deserve further investigations.
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Postoperative X-ray films showed that the fracture healing time was averagely 5.4 months. Al of the fractures were recovered wel that subtrochanteric fractures, intertrochanteric fractures and femoral shaft fractures were al healed. There was no fracture displacement, internal fixation loosening and varus deformity. Only one case showed difficulties in nail insertion. Excellence rate of Harris hip functional scores was 88.2%postoperatively. Proximal femoral nail antirotation is a reasonable design, and the helical blade can resist the rotation and stabilize the angle. The proximal femoral nail antirotation has better effects, which is an ideal internal fixation for subtrochanteric femoral fractures.
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Objective To investigate the preliminary results and complications of a tapered proximal femur modular stem in total hip arthroplasty (THA).Methods From October 2010 to December 2011,tapered proximal femur modular stems were used for THA in 50 patients (56 hips).There were 14males and 36 females,at a mean age of 61 years (range,25-82 years).Forty-four patients had unilateral THA and six bilateral THA.Hip osteoarthritis secondary to developmental dysplasia of the hip occurred in 15 patients,femoral neck fractures in 12,avascular necrosis of the femoral head in 10,primary hip osteoarthritis in nine,rheumatoid hip arthritis in two,malunion of femoral neck fracture in one,and femoral head fracture combined with posterior dislocation of the hip in one.The adopted femoral component was a tapered proximal femur modular stem.Femoral head-acetabulum interface composed metal-polyethylene in 34 hips,ceramics-polyethylene in 12 hips,and ceramics-ceramics in 10 hips.There were 48 hips with standard femoral head (28 mm) and eight hips with non-standard femoral head (＞28 mm).Results Mean period of follow-up was 11 months (range,6-19 months) and two patients (two hips) were lost to follow-up.Harris hip score improved from 36 points (range,4-71 points) preoperatively to 89 points (range,55-98 points) at the final follow-up.There was one patient with mild pain in the thigh,one moderate pain,but none severe or critically severe pain at the final follow-up.At the final follow-up,no migration or loosening of the implanted prostheses occurred; periprosthetic bone ingrowth fixation on the femoral side was achieved in 53 hips and fibrous stable fixation in one hip ; apart from one hip of ＜ 2 mm prosthetic subsidence,the remained revealed no subsidence of the prostheses.Intraoperative complications included acetabulum perforation in one hip and periprosthetic femoral fracture in one hip.Conclusion The short-term results are satisfactory,but the potential risk of fretting/corrosion and even breakage at the modular stem junction remains.
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Objective To compare the outcome of proximal femoral nail antirotation (PFNA)and third generation of Gamma nail (TGN) in the treatment of femoral intertrochanteric fracture in the elderly. Methods From January 2007 to June 2008, the patients with intertrochanteric fractures were divided into PFNA group ( n = 55 ) and TGN group ( n = 52 ) randomly. The two treatment groups were comparable in aspect of general data. The clinical data of surgical trauma, complications and postoperative function of the two groups were compared in our study. Results The mean operation time was (66.6 ± 15.4) min in PFNA group and (73. 1 ± 20.8 ) min in TGN group (P ＞ 0. 05 ). The mean intraoperative blood loss differed significantly, (219.5 ± 107.5 ) ml in PFNA group compared with (269.0 ±123.9) ml in TGN group ( P ＜ 0. 05 ). The mean fluoroscopy time was ( 2.97 ± 1.14 ) min in PFNA group and (3.43 ± 1.18) min in TGN group (P＜0.05). Unilateral femoral shaft splits at the distal end of the nail was observed intra-operatively in four patients of the PFNA group and in one of the TGN group,with no statistical difference between two groups. Of all, 91 patients ( n =46 in the PFNA group and n =45 in the TGN group) were followed up for a duration of ( 17.5 ±3.69) months. There was one re-fracture and one implant failure during the follow up period in PFNA group, which was not found in TGN group. Fiftyone patients recovered to normal activity status, including 27 in the PFNA group and 24 in the TGN group,with no statistical differences. Conclusions Intertrochanteric fracture can be treated successfully with PFNA and TGN. There is no significant difference in complications and functional outcome between the two groups. However, PFNA takes advantages of less blood loss, less operative time and less fluoroscopy time over TGN.
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BACKGROUND:There are a variety of surgical approaches for minimally invasive total hip replacement,such as anterolateral,posterolateral and two-incision.However,it is unknown which one is more in line with the concept of minimally invasive and easy to carry out.OBJECTIVE:To observe the clinical application effect of total hip replacement using anterlateral modified Watson-Jones approach.METHODS:From January 2005 to December 2006,35 patients were performed total hip replacement with the new anterlateral approach at the Department of Orthopaedics,the First Affiliated Hospital of Soochow University,including 16 males and 19 females,aged 52-78 years,mean aged 65.9 years;the average body mass index was 24.4 kg/m~2 (19.3-30.1 kg/m~2).The length of incision,operative duration,transfusion,complications,postoperative movement,postoperative hospital stay,prosthesis position and Harris score after operation were observed.RESULTS AND CONCLUSION:The patients were followed up 6-24 months,with an average of 17.3 months.The average length of incision was 8.3 cm (7-12 cm).The mean operative duration was 92.1 minutes (70-120 minutes).The average blood transfusion was 300 mL (0-800 mL).All the patients were practice their limb muscles immediately after the operation and they were activity the day after operation under the guidance of doctor.The average postoperative hospital stay was 7.9 days (5-15days).Eleven hip pains occurred at 3 months,9 cases at 6 months and 5 cases at 12 months,the Harris scores were (79.5±4.4)points,(84.0±3.6) points,and (85.4±3.0) points,respectively.No infection,dislocation,vessel or nerve injury happened.From the follow up,all of the patients had good prosthesis position and rang of hip motion.The results revealed that the new anterolateral approach is minimally invasive total hip replacement,and the patients can recover faster via some proper exercise.
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Objective To investigate the advantages, indications, operative techniques and pre-liminary curative effect of proximal femoral nail antirotation(PFNA) in surgical treatment of intertrochan-teric fractures. Methods From March 2006 to June 2007, PFNA fixation was done on 38 patients with intertrochanteric fractures including 17 males and 21 females, at an average age of 65. 4 years(35-93 years). According to AO/ASIF classification, there were 10 patients with type 31-A1 fractures, 21 with type 31-A2 and 7 with type 31-A3. All patients were reduced through longitudinal traction on the traction table, with implantation of PFNA via a mini-incision. Results The mean operation duration was 50 minutes(35-105 minutes)and mean blood loss 100 ml(50-300 ml). All patients were successful except for 1 patient with split lateral cortical bone of distal shaft of the femur during operation. All pa-fients were followed up for average 13 months(4-19 months), which showed long-team bed stay due to severe complieations in 1 patient. Function recovery in 32 and deterioration of the injured limbs in 5. Cer-ebral infarction was found 6 months after operation in 1 patient, who was able to walk under support. Pri-mary bone union was achieved in all patients, with average healing time of 9. 5 weeks. There were no complications such as infection of incisional wound, pulmonary infection, phlebothrombosis, over incision or coxa adducta, except that 2 patients had perioperative respiratory system disease. According to Harris hip rating scale system. The result was excellent in 20 patients, good in 13, common in 4 and poor in 1, with total excellence rate of 89%. Conclusions As a new technique, PFNA has advantages of litth trauma. Early get-out-of-bed exercise, few complications, rigid fixation and high bone union rate and is suitable for all kinds of intertrochanteric fractures especially for old patients with osteoporosis.
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[Objective]To evaluate the efficacy and disc degeneration of the SF pedicle screw internal fixators in the treatment of thoracolumbar fractures.[Method]Thirty-six patients were treated by SF pedicle screw intemal fixators from July 2001 to July 2003.[Result]Thirty-six patients were followed-up for 2～5 years(average 3.72 years),Compared with preoperation,the Cobb's angle,anterior and posterior heights of compressed vertebral bodies of postoperation and final follow-up were significantly corrected(P
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Objective: To explore the effect of Sijunzi decoction(SJZD) at different time points on gastrin(GAS) gene expression level in spleen-qi deficiency rats.Methods: Spleen-qi deficiency syndrome was induced in rats by compound methods which including rhubarb,exhaust and hunger.Spleen-qi deficiency rats were randomly divided into the model control group and SJZD group.Reverse transcriptase polymerase chain reaction was applied to observe the GAS mRNA of gastric antrum in rats treated by SJZD.Results: Serum gastrin and GAS mRNA were both decreasing significantly in the model control group.After being treated by SJZD,serum gastrin and GAS mRNA of spleen-qi deficiency rats began to recover.Especially,after 21 days' treatment,GAS mRNA and serum gastrin were both increasing significantly when compared with those in the model control group.Conclusion: The regulation on GAS mRNA is one of the mechanisms of SJZD for spleen-qi deficiency.
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Objective: To explore the effect of modified HuangqiJianzhong decoction(MHQJZD) with various concentrations at different time points on gastrin(GAS) gene expression level in spleen-qi deficiency rats.Methods: Spleen-qi deficiency syndrome was induced in rats by compound methods which including Radix et Rhizoma Rhei, exhausting and hunger.Spleen-qi deficiency rats were randomly divided into the model control group and the low,medium and high dosage of MHQJZD group.Reverse transcriptase polymerase chain reaction was used to observe the effect of MHQJZD on the GAS mRNA of gastric antrum in rats treated at different time points(7,14,21d).Results: As compared with that in model control group,the GAS gene expression level were both significantly higher in the medium and high dosage groups(P
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Objective: To explore the effect of buzhong yiqi decoction(BZYQD) with various concentrations at different time points on gastrin(GAS) gene expression level in spleen-qi deficiency rats.Methods: The spleen-qi deficiency rats were randomly divided into the model control group and the low,medium and high dosage of BZYQD groups.Reverse transcriptase polymerase chain reaction was used to observe the effect of BZYQD on the GAS mRNA of gastric antrum in rats treated at different time points(7,14,21d).Results: As compared with that in model control group,the GAS gene expression level were significantly higher both in the medium and high dosage groups(P