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Objective To investigate technical points,risks and advantages of primary total knee arthroplasty (TKA) through subvastus approach.Methods The study involved 68 patients of similar basic conditions who were treated by TKA between September 2008 and August 2010,including 34 patients treated through subvastus approach (Group A) and 34 patients treated through traditional medial parapatella approach (Group B).Clinical parameters between groups were comparatively studied after operation.Results All patients were followed up for 6-25 months (mean 8.7 months).Alignment of lower extremities in both groups was restored.Group A showed significant differences from Group B in aspects of postoperative drainage volume [(124 ± 32.4) ml vs (182 ± 41.3) ml,P ＜ 0.05],requirement of lateral retinacular release (7％ vs 23％,P ＜0.01),time before patients being capable of having active straight-leg-raising movement [(1.3 ± 0.7) d vs (3.2 ± 0.6) d,P ＜ 0.05],and time away from patients being able to bend their leg up to 90° [(3.1 ± 0.6) d vs (5.3 ± 0.5) d,P ＜ 0.05].Conclusion Primary total knee arthroplasty through subvastus approach can hardly intervene in extension knee apparatus and in blood circulation around patellas,promote rapid recovery of knee function and achieve satisfactory early outcomes.
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Objective To observe the distribution of circum-patella nerve fibers in the soft tissue to provide experimental evidence,which is significant in denervation for Total Knee Arthroplasty (TKA).Methods Patella specimens were collected from 4 cadavers (2 cases of diabetic foot,lcase of lower extremity arterial occlusive,and 1case of car accident),all 4 of which were resected soft tissue with a dimension of 0.5cm × 0.5cm and full depth thickness around patella more than 0.5cm for histology and morphology observation.The nerve fibers histology and morphology were observed in all resected specimens with HE staining and silver-gilt glycine staining in the same field of microscopic vision.Results Anatomy found that the vascular network form skins directly involved in the patella nourish hole area and in the 10,2,4,7 clock point have found that blood vessels into the patella.There have a large number of nerve fibers near to the patella under the microscope,but there were no significant difference in the nerve fibers region distribution of all specimens.There were some into patella nerve fiber paths in side of patella soft tissue,which lied in 7,11 and 13 clock point,but outside no this phenomenon.The distribution of circum-patellar nerve fibers were described as distribution of regional concentration,which lied in much more 5,6,7 clock points and 10,11,12,1,2,clock points,in which the quadriceps tendon and patellar tendon have more than the others.In the 13 clock point,the fascia and periosteum of nourish hole area were also found in a large number of nerve fibers,and there were laminar distribution in different soft tissue layers,which were collected much more in synovial layer,fat pad,tendon near to patella.Conclusion There are much more nerve fibers near to the patella and some into patella nerve fiber paths in the medial side and nourish hole area.Nerve fibers distribution of circum-patella can be described as laminar distribution and regional concentration ,which is more in the centre,bottom more than top,outside more than inside,the bipolar more than the others.The patella denervation operation by reducing the number of peripheral nociceptors to achieve desensitization is feasible in TKA.
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Objective To determine the prevalence of pain beyond the osteoporotic vertebral com-pression fracture (OVCF) in patients undergoing percutaneous vertebral augmentation and the response of pain to the treatment. Methods A retrospective study of 104 patients undergoing percutaneous vertebral augmentation (pereutaneous vertebroplasty and pereutaneous kyphoplasty) was performed to examine the lo-cations and severities of pain beyond the OVCF before and after operation. The Visual Analog Sscale (VAS,10-point scale) and Activities of Daily Living (ADL, 5-point scale) were used. Results Of the 104 patients, 48 (46.2%) suffered pain beyond the OVCF. The pain was firstly located in the sacrococeygeal region and buttocks (26.0%), secondly in the abdomen and sub-xiphoid process (10.6%) and thirdly in the flank, ribs and chest (9.6%) . For all the cases, the mean VAS score decreased from 8.9±0. 8 before vertebral augmentation to 2.9±1.4 after augmentation (t=37.410, P=0.000), and the mean ADL score decreased from 4.1±0.6 before operation to 2.0±0.7 after operation (t=25.331, P =0.000) . For the patients suffering pain beyond the OVCF, the mean VAS score decreased from 8.8±0.9 before vertebral augmentation to 2.8±1.5 after augmentation (t=23.722, P=0.000), and the mean ADL score decreased from 4.2±0.7 before operation to 2.0±0. 7 after operation (t=15.373, P=0.000). The decreases in VAS and ADL scores were not affected by the pain. Conclusion The pereutaneous vertebral augmentation can effectively relieve the pain beyond the OVCF.
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Objective To compare the changes of some blood indices after treatment of intertro-chanteric fractures with conventional and minimally invasive dynamic hip scres (DHS) internal fixation so as to understand the influence of minimally invasive technique on physiology of the organism. Meth-ods The elderly patients with intertrochanteric fractures in our department from July 2004 to May 2006 were divided randomly into two groups, ie, conventional DHS internal fixation group(Conventional group, 52 patients)and the minimally invasive DHS internal fixation group(Minimal invasion group, 54 patients). A comparison was done on data including white blood cells (WBC), hemoglobin (Hb), e-rythrocyte sedimentation rate (ESR). C reactive protein (CRP) and creatine kinase (CK) as well as re-cessive blood loss. Results The indices including transfusion, blood loss, recessive blood loss, ESR and CK in minimal invasion group showed less changes compared with conventional group. With statistical difference. But WBC and CRP showed no statisfical difference between both groups. Conclusion Minimally invasive DHS internal fvtation carl reduce operative trauma during treatment of intertrochanterie fractures in the elderly.
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<p><b>OBJECTIVE</b>To compare the effect of using partial median and ulnar nerves for treatment of C(5-6) or C(5-7) avulsion of the brachial plexus with that of using phrenic and spinal accessary nerves.</p><p><b>METHODS</b>The patients were divided into 2 groups randomly according to different surgical procedures. Twelve cases were involved in the first group. The phrenic nerve was transferred to the musculocutaneous nerve or through a sural nerve graft, and the spinal accessary nerve was to the suprascapular nerve. Eleven cases were classified into the second group. A part of the fascicles of median nerve was transferred to be coapted with the motor fascicle of musculocutaneous nerve and a part of fascicles of ulnar nerve was transferred to the axillary nerve. The cases were followed up from 1 to 3 years and the clinical outcome was compared between the two groups.</p><p><b>RESULTS</b>There were 2 cases (16.6%) who got the recovery of M4 strength of biceps muscle in the first group but 7 cases (63.6%) in the second group, and the difference was statistically significant (P<0.025). However, it was not statistically different in the recovery of shoulder function between the two groups.</p><p><b>CONCLUSIONS</b>Partial median and ulnar nerve transfer, phrenic and spinal accessary nerve transfer were all effective for the reconstruction of elbow or shoulder function in brachial plexus injury, but the neurotization using a part of median nerve could obtain more powerful biceps muscle strength than that of phrenic nerve transfer procedure.</p>
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Adolescent , Adult , Humans , Male , Middle Aged , Brachial Plexus Neuropathies , General Surgery , Median Nerve , Transplantation , Nerve Transfer , Methods , Treatment Outcome , Ulnar Nerve , TransplantationABSTRACT
Objective To introduce a new surgical procedure for the treatment of axillary nerve injury:neurotization from one of triceps branches of radial nerve to one of axillary branches Methods To study the anatomical relationship between the nerve branches to triceps and the axillary nerve branches to deltoid muscle by anatomical dissection as well as to measure the diameters of the nerve branches,and to complete the performance in clinic in six patients and follow up for 6～16 months Results The branches to long head of triceps of radial nerve were near to branches of axillary nerve and the difference among the nerve branches are little in diameter,and there were 5 patients who got M4 recovery of the muscle strength and 1 patient M3 Conclusion The new surgical procedure is easy to manipulate,with a satisfactory result,and is suitable for the partial brachial plexus injury patient with axillary nerve dysfunction but the radial nerve function formal
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Objective To treat upper and middle trunks or C 5～7 avulsion of brachial plexus by neurotization using a part of median nerve and ulnar nerve Methods All patients were divided into 2 groups according to the surgical procedures Eleven cases were involved in the first group The phrenic nerve was chosen to anastomose with musculocutaneous nerve or through a sural nerve graft and the spinal accessory nerve was anastomosed with suprascapular nerve Eleven cases from 1997 were classified into the second group A part of the fascicles of median nerve was transferred to coapt with the motor fascicle of musculocutaneous nerve and a part of fascicles of ulnar nerve was transferred to harvest with axillary nerve The cases were followed up from 0 5 to 3 years and the clinical outcome was compared between the two groups Results There were 2 cases(16 6%)who got the recovery of M 4 strength of biceps muscle in the first group and 7 cases(63 6%)in the second group,and the difference was statistically significant( P