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Objective@#To investigate the mid-term outcomes of the dual mobility total hip prosthesis in primary total hip arthroplasty.@*Methods@#A total of 101 patients who underwent primary total hip arthroplasty with dual mobility total hip prosthesis from May 2010 to March 2013 were enrolled in the present study with complete follow-up information. There were 56 females and 45 males with the mean age of 66.36 years (rang from 58 to 77 years). There were 35 patients with femoral neck fracture, 33 patients with femoral head necrosis, 10 patients with hip osteoarthritis, 18 patients with secondary osteoarthritis to hip dysplasia and 5 patients with ankylosing spondylitis. The dual mobility total hip prosthesis was used for all 101 patients by the posterior-lateral approach of hip joint. Harris hip score was used to evaluate the clinical effects. Radiographic analysis was also performed to evaluate the biological fixation effects of the prosthesis, dislocation of the prosthesis, osteolysis and migration of the acetabular cup.@*Results@#The mean operation duration was 80.68±6.59 min (range from 70 to 90 min). The average blood loss during the operation was 180.67±18.76 ml (range from 150 to 200 ml). All incisions were healed at the first stage. All patients were followed up with an average of 65±3 months (range from 62 to 75 months). Harris hip score improved from 56.70±16.71 before surgery to 94.26±1.91 at the last follow-up. The differences among different follow-up times were of statistical significance. The Hip flexion and extension, adduction and abduction, and internal and external rotation improved from 86.67°±16.70°, 34.06°±7.05°, 34.53°±7.45° preoperatively to 141.73°±6.56°, 57.06°±3.83°, 75.18°±4.00° at the last follow-up, respectively. At 3 months after the operation, the X-ray showed satisfied bone integration. There were no acetabular and femoral shaft fractures, sciatic nerve, femoral artery and vein injuries during the operation, and no joint dislocation, prosthesis loosening, infection and deep venous thrombosis of lower limbs during the postoperative and follow-up duration.@*Conclusion@#The dual mobility total hip prosthesis has the advantages in good initial and middle stability, rapid bone growth, low dislocation rate and repid recovery of postoperative motion range. It is suitable for patients over 65 years old or younger patients with postoperatively high dislocation.
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Objective To investigate the mid?term outcomes of the dual mobility total hip prosthesis in primary total hip arthroplasty. Methods A total of 101 patients who underwent primary total hip arthroplasty with dual mobility total hip prosthe?sis from May 2010 to March 2013 were enrolled in the present study with complete follow?up information. There were 56 females and 45 males with the mean age of 66.36 years (rang from 58 to 77 years). There were 35 patients with femoral neck fracture, 33 patients with femoral head necrosis,10 patients with hip osteoarthritis, 18 patients with secondary osteoarthritis to hip dysplasia and 5 patients with ankylosing spondylitis. The dual mobility total hip prosthesis was used for all 101 patients by the posterior?lat?eral approach of hip joint. Harris hip score was used to evaluate the clinical effects. Radiographic analysis was also performed to evaluate the biological fixation effects of the prosthesis, dislocation of the prosthesis, osteolysis and migration of the acetabular cup. Results The mean operation duration was 80.68±6.59 min (range from 70 to 90 min). The average blood loss during the op?eration was 180.67±18.76 ml (range from 150 to 200 ml). All incisions were healed at the first stage. All patients were followed up with an average of 65 ± 3 months (range from 62 to 75 months). Harris hip score improved from 56.70 ± 16.71 before surgery to 94.26±1.91 at the last follow?up. The differences among different follow?up times were of statistical significance. The Hip flexion and extension, adduction and abduction, and internal and external rotation improved from 86.67°±16.70°, 34.06°±7.05°, 34.53°± 7.45°preoperatively to 141.73°±6.56°, 57.06°±3.83°, 75.18°±4.00°at the last follow?up, respectively. At 3 months after the opera?tion, the X?ray showed satisfied bone integration. There were no acetabular and femoral shaft fractures, sciatic nerve, femoral ar?tery and vein injuries during the operation, and no joint dislocation, prosthesis loosening, infection and deep venous thrombosis of lower limbs during the postoperative and follow?up duration. Conclusion The dual mobility total hip prosthesis has the advantag?es in good initial and middle stability, rapid bone growth, low dislocation rate and repid recovery of postoperative motion range. It is suitable for patients over 65 years old or younger patients with postoperatively high dislocation.
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Objective To evaluate the risk factors related to the failure of internal fixation for intertrochanteric fracture in Chinese patients.Methods A comprehensive Meta analysis of the clinical research from January 2005 to August 2016 on the failure of internal fixation for intertrochanteric fracture in Chinese patients was conducted after Pubmed,CNKI,Wanfang Data,et al.,had been searched.Revman5.0 was used to perform the heterogeneity test and calculate the OR value and 95％ CI after quality assessment and retrieval of the qualified data.Results Included for this analysis were 23 studies involving 4,031 patients of whom 588 failed.The factors related to the failure of internal fixation for intertrochanteric fracture included patient age [OR =0.51,95％ CI (0.30,0.90),P ＜ 0.05],osteoporosis [OR =1.91,95％ CI (1.05,3.47),P ＜0.05],fracture pattern[OR=0.23,95％ CI (0.18,0.30),P ＜0.05],quality of fracture reduction [OR =0.25,95％ CI (0.17,0.35),P ＜0.05],tip-apex distance (TAD) [OR =0.13,95％ CI (0.05,0.32),P ＜0.05],time for full weight bearing [OR=5.32,95％ CI (1.71,16.57),P ＜ 0.05],and associated internal diseases [OR =3.76,95％ CI (1.19,11.91),P ＜0.05].The relationship was not determined between the failure of internal fixation for intertrochanteric fracture and the following factors:gender [OR=0.78,95％ CI (0.54,1.11),P ＞ 0.05],injury cause [OR=1.68,95％ CI (0.66,4.25),P＞ 0.05] or type of internal fixation [OR=0.37,95％CI (0.06,2.14),P＞0.05].Conclusions High age,concomitant osteoporosis,complicated fracture pattern,unsatisfactory fracture reduction,TAD ≥ 25 mm,time for full weight bearing ＜ 6 weeks,and concomitant internal diseases may be the risk factors closely related to the failure of internal fixation for intertrochanteric fracture in Chinese patients.There has been no sufficient evidence to show that gender,injury cause or type of internal fixation may be associated with the failed internal fixation for intertrochanteric fracture.
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Objective To analyze the effect of the fracture healing by using selective sensory radicotomy before and after the ganglion.Methods From September,2014 to August,2015,120 rats were averagely divided into 3 groups,which was the sham operate group(SO),the anterior injury of ganglion rhizotomy group (AGR) and the posterior injury of ganglion rhizotomy group (PGR).Tibial transverse fracture was performed on right or left randomly and the fracture was fixed with intramedullary.In coordination with the fractured-side,the selective radicotomy from L4 to L6 was made.The mRNA level of collagen-Ⅰ and collagen-Ⅱ in bony callus was quantified at 3,7 days and 2 weeks after the operation by RT-PCR(n=5).The histological examination,X-ray,biomechanical testing were performed at 4 and 8 weeks.The quantitative data of iconography and biomechanics was acquired by using the relative ration which resulted from fractured-side data dividing the unfractured-side one for every pair tibia in same rat.Results At 3 days after surgery,the mRNA of collagen-Ⅰ were 81.3±11.1,37.5±8.2 and 24.7±9.2,the mRNA of collagen-Ⅱ were 2.4±0.5,2.1±1.0 and 2.9±1.2 in SO,AGR and PGR group respectively;At 7 days after surgery,the mRNA of collagen-Ⅰ were 17.9±5.8,7.2±1.8 and 6.7±2.4,the mRNA of collagen-Ⅱ were 12.5±3.4,2.8±1.3 and 1.2±0.4 in SO,AGR and PGR group respectively.The SO group had significantly upregulation of collagen-Ⅰ and collagen-Ⅱ mRNA compared with the AGR and PGR groups at 3 days and 7 days respectively after surgery(P＜0.05).There was a significant difference of the collagen-Ⅱ between AGR group (2.8±1.3) and PGR group (1.2±0.4) at 7 days after injury(P＜ 0.05).The fracture bony callus in PGR group was a significantly larger and less ossified than that in the AGR group.The mechanical load of fracture in SO group was larger than that of the other 2 groups (P＜0.05).Conclusion Sensory denervation negatively affects fracture-healing.The ganglion of sensory nerve plays an important role in bone fracture healing and normal innervation is essential for the fracture repair.
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Objective To compare the efficacy of quadratus femoris muscle pedicle bone flap transplantation combined with hollow compression screw fixation versus hollow compression screw fixation in the repair of femoral neck fracture for young and middle-aged patients.Methods Case-controll studies comaring the quadratus femoris muscle pedicle bone flap transplantation with hollow compression screw fixation in the repair of femoral neck fracture were retrieved from CNKI,Chinese Biomedical Database,Wanfang Data and manually (from January,2005 to December,2014).Methodological quality of the trials was critically assessed,and relevant data were extracted.Statidtical software Revman 5.0 was used for data-analysis.Results Eight articles were included in the meta-analysis.The results showed that,compared the efficacy of quadratus femoris muscle pedicle bone flap transplantation combined with hollow compression screw fixation with hollow compression screw fixation,there were statidtical significance in the rate of fracture healing [OR =5.43,95％CI(2.89,10.20),P ＜ 0.05],the rate of good function of hip joint [OR =5.12,95％ CI(3.21,8.17),P ＜ 0.05],the rate of femoral head necrosis [OR =4.21,95％CI(2.02,8.76),P ＜ 0.05],the time of fracture healing [WMD =-46.85,95％CI(-65.13,-28.56),P ＜ 0.05].Conclusion The transplantation of quadratus femoris muscle pedicle bone flap combined with hollow compression screw fixation is superior to the hollow compression screw fixation in the repair of femoral neck fracture for young and middle-aged patients in regards to the rate of fracture healing,the rate of good function of hip joint,the rate of femoral head necrosis,the time of fracture healing.
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Objective To investigate the procedures and effects of surgical treatment for double disruption of the superior shoulder suspensory complex (SSSC).Methods Twenty-nine cases of double disruption of SSSC treated from January 2007 to October 2011 were enrolled in the study.There were 19 males and 10 females,at a mean age of 36 years (range,25-49 years).Injury causes included traffic injury in 25 cases and fall from height in 4.An open reduction and internal fixation was performed in 18 cases of scapular neck fracture combined with clavicular fracture,2 cases of scapular neck fracture combined with acromion fracture,2 cases of distal clavicular fracture combined with acromion and glenoid cavity fracture; hook plate fixation and ligament repair were performed in 3 cases of complete dislocation of acromioclavicular joint combined with complete disruption of coracoclavicular ligament ; open reduction and internal fixation and ligament repair were performed in 3 cases of scapular neck fracture combined with acromioclavicular joint dislocation and 1 case of clavicular fracture combined with coracoclavicular ligament disruption.Results All cases were followed up for a mean period of 11.5 months (range,6-30 months).Anatomic reduction of fractures was achieved for all cases and mean healing time was 8.4 weeks (range,7-12 weeks).Mean Constant-Murley score was 91 points (range,72-100 points),which indicated excellent results in 13 cases,good in 11,fair in 5,with excellence rate of 83％.ConclusionBased on the complex anatomic structure of the double disruption of SSSC,surgical management should focus mainly on respective fixation of the double injuries,which leads to good stability and therapeutic outcome.
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Objective To evaluate the method and curative effect of reconstruction with vascularized or nonvascularized autogenous fibular transplantation of radiocarpal joint after en bloc excision of giant cell tumor of distal radius.Methods Seventeen cases with giant cell tumor of distal radius bone were treated by en bloc resection and reconstruction of wrist joint with vascularized or non-vascularized autogenous fibular transplantation.Postoperative wrist joint function and radiographic outcomes were evaluated.Results Seventeen cases were followed up from 2.0 to 5.5 years (average 3.6 years).Three cases were treated by peroneal artery anastomosis and other 3 cases by inferior lateral genicular artery anastomosis.All cases achieved primary healing of incision and the radial average length that was en bloc excised was 7.6 cm.All of the transplanted fibulas were healed well.The bone healing average time of the vascularized fibular graft was 3.7 months,while that of the non-vascularized fibular graft was 7.9 months.No tumor recurrence or lung metastases was observed during the follow-up,but 1 wrist joint was narrowed and another had degeneration of the wrist.After 2 years of surgery,the average range of motion of the wrist joint was as follows:dorsiflexion 47°,flexion 30°,ulnar deviation 23°,radial deviation 14°,pronation 55°,supination 62°.The grip force was from 40％ to 80％ of the contralateral upper limb.The MSTS score averaged 87.6 ％ with 6 excellent,eight good and 3 satisfactory results.Disabilities of the Arm,Shoulder,and Hand (DASH) questionnaire score averaged 3.48.Conclusion The method of autogenous fibular transplantation and reconstruction of radiocarpal joint after en bloc excision of giant cell tumor of distal radius can save the wrist joint function in a certain extent.It is an effective method of the wrist joint function reconstruction and beneficial to bone healing with vascularized transplantation which has less complications.
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Objective To analysis the medium and long term effects of the quadratus femoris muscle pedicle bone graft with screw internal fixation for the treatment of femoral neck fractures in adults.Methods From March 2003 to December 2008,sixty-two patients with femoral neck fractures were operated.There were 50 males and 12 females,with an average age of 39 years (ranged from 16 to 62 years).Fifteen cases suffered from traffic accidents and 47 from falling injury.There were 8 cases which fracture site was infer-head in Garden type Ⅱ,twenty-nine cases in type Ⅲ and 25 cases in type Ⅳ.The average time were 12 hours (2-96 hours) from injured to hospital admission and 4 days (2-8 days) from injured to operation.Partial weight bearing started on 3 months postoperatively and full weight bearing on 6 months.The postoperative duration of follow up was 3 to 5 years in 39 cases.Healing of fractures and avascular necrosis of the femoral head were evaluated based on the X-ray results or MRI if necessary.The pain,function,deformity,range of motion were evaluated based on Harris joint function scores.Results Nonunion of fracture was noted in 2 cases during the follow-up period.The fracture healing rate was 96.8％.The avascular necrosis of the femoral head was noted in 6 cases (15.4％).There were statistical significant differences between 3 months of postoperation and 3 years of postoperation in the pain,function,deformity,range of motion.After 3 years of postoperation,there were excellent in 29 cases,good in 6 cases,general in 1 case,poor in 3 cases according to Harris joint function scores.Conclusion This technique is relatively simple and has high rate of fracture healing.The avascular necrosis of the femoral head rate is low.The medium-and long-term results are satisfactory.