Osteoporosis and vertebral fracture / 中华创伤骨科杂志

Fracture is the most serious complication caused by osteopor osis. Vertebral fracture in osteoporosis is a strong risk factor for new fractur es as well as an important parameter in prognosticating new fractures. As a stro ng risk factor, vertebral fracture reflects the degeneration of the structure of bone and the reduction of bone mineral density (BMD). Therefore, it is more val uable in predicting the risk of refracture when the reduction of BMD and vertebr al fracture is reflected. It is more convenient and easier to evaluate vertebral fracture by radiographic grading and semiquantitative grading scheme without me asuring the vertebral height. To evaluate the drugs for osteoporosis objectively and accurately, their effects on both BMD and vertebral fracture should be take n into consideration. The ideal drug should be one that can increase BMD and red uce the risk of vertebral fracture.

Total hip replacement in patients with congenital dislocation of hip / 中华骨科杂志

Objectiv e To evaluate the mid-term and long-term clinical outcome of total hip re-pl ace ment in patients with hip congenital dislocation.Methods From June198 3to Decem ber1998,36hips in32patients di agnosed as congenital disloca tion of hip(CDH),aged22to69years old(with the mean of 48.5years), were treated with total hip replacement (THR).Thirty-one hips of 28patient s were fol lowed-up with the duration of 9.5years(3.5to18years).Ac c ording to our system,the congen ital dys-pla sia of hip was divid ed into th ree degrees:the first degree was subluxation in15hips,the second degree was in termedi ate dislo cation in11hips,and the third degree was high dislocatio n in5hips.The fixation of the prosthetic compo nents was as follows :10cup s and12stems with cement,21cups and19stems with un-cement.In acetab ula r preparation,most of the patients with subluxation(13hips)underwent deep ening of the acetabu lum and were installed with larger cups;deepening of the acetabulum,smaller cup and auto femoral grafting on the su perior lip fixed w ith screws were performed in2hips with subluxation and all of hips with interm e di ate and high dislocation.Results The complications included intra operativ e lesser trochanter fracture in1case,deep vein thrombosis and thromboembolism of femoral artery in1case re spec-tively,limb discrepancy in3cases,asepti c loosening in4cases(1with trochanteric nonunion and migration,1with stem l oosening and2with both stem and cup loosening).The Harrisscore was85in th e other27hips(48scores before surgery).Con clusion Total hip replacement in patients with congenital dislocation of hip could be some what difficult be cause of the liability to complications.The techni cal difficulties en coun-t ered during surgery in cluded the correction of the length of bilateral lower extremi ty,the balance of the abductor muscles,the re lease of the soft tis sue,the dealing of the su perior segmental defect of acetabulum and selectio n of the compo nents.

Long-term results of condylar reconstruction using pedicled-patella in the treatment of giant cell tumor of bone of lower femur / 中华骨科杂志

Objective To study the long term results of condylar reconstruction using pedicled patella in the treatment of giant cell tumor of lower femur. Methods From August 1964 to December 1996, 6 patients with giant cell tumor in the lateral condyle of femur were treated with unicondylar resection curettage and reconstruction with pedicled patella autograft. There were 3 males and 3 females. The average age of the pateints was 30.5 years. The operative indications were as the following: tumor was located in one condyle, complicated with pathological fracture or the tumor had invaded underneath cartilage which was difficult for curettage. Surgical procedure included: Lateral condyle resection according to X ray or CT image, curettage of the possible remaining tumor tissues in the medial condyle. A muscle pedicle of 2.5 cm wide from the quadriceps was raised with the patella, then the articular surface of patella was used to reconstruct the articular surface of femoral condyle, ilium graft(sometimes allograft) was used to fill the defect proximal to the patella. The grafts was fixed by screws and(or) plates. Anterior cross ligament was fixed to the patella. Results 6 patients were followed up for a mean period of 136 months. There were no infection, recurrence, metastasis and instability. All patients could walk for a long distance. The range of motion of the involved knees was between 80? and 120?. There was no varus deformity under stress test, but about 5 degrees valgus deformity under stress test could be found in some, muscle strenth was 5 grade. Conclusion Pedicled patella autograft is a good method for the treatment of giant cell tumor that invades unilateral condyle of lower femur, it is specially suitable to the patients with pathological fracture or severe destruction underneath the cartilage. Thorough resection and curretage of the tumor, preserving the blood supply of patella, refixing the cross ligament, and lower placement of patella are the key points to obtain the satisfactory results.

Hallux valgus treated by Reverdin operation / 中华骨科杂志

Objective To describe the Reverdin technique for treatment of hallux valgus (HV) based on correction of proximal articular set angle (PASA). Methods Thirty-one Reverdin osteotomies (in 31 feet of 17 female patients)were performed between 1992 and 1998. Reverdin operation is unique among the surgical procedures for its ability to correct large PASA with a medial wedge-type osteotomy of the metatarsal head. Results On the follow-up of 1 to 8 years, patients rated outcomes as excellent or good in 96％ (30 feet). There was no complication of delayed union or avascular necrosis of the metatarsal head. Radiographical follow-up: PASA averaged 19 degrees(range 30-12 degrees), had a postoperative averaged value of 1.95 degrees, HV angles averaged 30 degrees(range 41-23 degrees), had a postoperative value of 14.3 degrees. Intermetatarsal angles averaged 10.9 degrees (range 16-4 degrees), had a postoperative value of 5.8 degrees. Conclusion The preoperative PASA value is the most important factor in hallux valgus evaluation, as well as the selection of operative techniques. The normalization of PASA safegurds more successes and less recurrences.