Incidence and risk factors of early deep venous thrombosis after knee arthroscopy operation under conventional tourniquet / 中国骨伤

<p><b>OBJECTIVE</b>To find out the incidence of early DVT in patients after knee arthroscopic surgery with routine use of tourniquet and discuss the associate risk factors.</p><p><b>METHODS</b>Total 1 561 cases undertaken primary knee arthroscopic surgery was reviewed retrospectively from January 2013 to January 2017, including 651 males and 910 females with a mean age of (65.7±8.7) years old ranging from 62 to 81 years old. The cases were divided into DVT group and non-DVT group according to ultrasonic Doppler after surgery. The DVT occurrence rate was calculated and the basic information was analyzed to filter out the risk factors through univariate analysis and multivariate analysis. The cases of DVT group received 6 months anticoagulation therapy and were undertaken a follow-up of 1, 3, 6 months by ultrasonic Doppler.</p><p><b>RESULTS</b>Out of the 1 561 cases, 226(14.5%) developed early DVTs following surgery, 32(2.0%) cases had the proximal DVTs, and 194(12.4%) cases had the isolated distal DVTs. The risk factors include the age(>=73 years), female sex and gastrocnemius vein dilation (GVD), hypertension, longer tourniquet time(>=74 min). The GVD and the length of tourniquet time was considered to be the best predictor of the early DVTs after surgery, with an odds ratio of 2.337 (95% CI, 1.644-3.611) and 2.112 (95%CI, 1.452-3.301). Twelve isolated distal DVTs(6.6%) and 11 proximal DVTs(36.7%) still showed thrombus at 6-month follow-up, but exhibit decreased size and at various stage of resolution.</p><p><b>CONCLUSIONS</b>The incidence of early DVTs after knee arthroscopic surgery is 14.5%. Out of all risk factors, the GVD and the length of tourniquet time have the best power for prediction of DVTs after surgery. Both proximal and distal DVTs received accepted outcomes after formal therapy.</p>

Postoperative clinical effects of plantar pressure measurement system in treating the first ray hypermobility / 中国骨伤

<p><b>OBJECTIVE</b>To explore plantar pressure measurement system in treating the first ray hypermobility.</p><p><b>METHODS</b>From June 2013 to January 2014, 16 female patients (20 feet) with hallux valgus with unstable of the first sequence were treated by first tarsometatarsal joint fusion, aged from 42 to 52 years old with an average of(46.5±2.9) years old, the course of disease was from 3 to 5 years. Twenty healthy female(20 feet) were chosen as control group, and single side were only choose, aged from 41 to 55 years old with an average of(46.8±4.5) years old. Preoperative and postoperative AOFAS score was used to evaluate feet function. Plantar pressure measurement system were applied to compare peak value of the dynamic pressure and impulse indicators of affected feet and control normal feet from the first to the fifth head of metatarsal bone.</p><p><b>RESULTS</b>All patients were followed up from 24 to 30 months with an average of 27.4 months. Hallux valgus deformity of affected feet were corrected, pain and swelling of the second head of metatarsal bone were disappeared. There were statistical differences in AOFAS score between preoperative (45.55±12.28) and postoperative (85.45±6.76). There were significant differences in peak pressure, pressure between affected feet and normal feet of the first and second head of metatarsal bone. Postoperative peak pressure, pressure of the first affected head of metatarsal bone were increased than that of before operation, but no differences compared with control group(>0.05). Postoperative peak pressure, pressure of the second affected head of metatarsal bone were decreased before operation(<0.05), but no meaning compared with control group(>0.05). There were no significant differences compared between the forth and fifth affected head of metatarsal bone and control group(>0.05).</p><p><b>CONCLUSIONS</b>There were obvious differences in pressure of the first and second head of metatarsal bone patients with unstable of the first sequence, the first tarsometatarsal joint fusing could recover plantar pressure of the first and second head of metatarsal bone by plantar pressure measurement system.</p>

Therapeutic effects of internal drainage by expanding arthroscopic gastrocnemius-semimembranosus bursa and cyst wall resection for the treatment of 41 patients with popliteal cysts / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical curative effects of internal drainage by expanding arthroscopic gastrocnemius-semimembranosus bursa(GSB) and cyst wall resection for the treatment of popliteal cysts.</p><p><b>METHODS</b>A retrospective analysis of patients from May 2011 to December 2015. Arthroscopic treatment for 41 patients with popliteal fossa cysts, 18 males and 23 females, aged from 34 to 67 years old, averaged 42.6 years old. All the patients had preoperative magnetic resonance imagings to confirm the diagnosis and identify the valvular opening(Gastrocnemius-Semimembranosus bursa, GSB), as well as the associated intra-articular pathology. All the popliteal cysts were unilateral, including 26 cases of right knees and 15 cases of left knees. Five patients had recurrent popliteal cysts, and all of them underwent initial open Surgery. The duration from initial surgery to the recurrence ranged from 6 to 17 months(averaged, 11 months). All the patients had underwent arthroscopic treatment of internal drainage by expanding GSB and cyst wall resection. According to the Rauschning and Lindgren classification, 5 cases were grade I , 30 cases were grade II and 6 cases were grade III. Preoperative Lysholm score, 83.19±6.12 (ranged form 73 to 95).</p><p><b>RESULTS</b>The GSB structure was found in all patients with popliteal cysts during operation, including cartilage degeneration in 33 cases, medial meniscus injury in 27 cases, lateral meniscus injury in 7 cases, free body in 8 cases, pigmented villonodular synovitis in 2 cases, and synovial chondromatosis in 3 cases. There were no complications related to vascular, nerve or surgical incision. All the patients were followed up, and the duration ranged from 8 to 27 months, with an average of 18 months. No recurrence of cysts was found. According to the Rauschning and Lindgren classification, there were 9 cases of grade 0, 27 cases of grade I , 4 cases of grade II, 1 case of grade III. Postoperative Lysholm score:91.32±4.26(ranged from 82 to 98).</p><p><b>CONCLUSIONS</b>Arthroscopic internal drainage by expanding GSB and cyst wall resection surgery in the treatment of popliteal cysts has the advantages of less trauma, faster recovery and low relapse rate, which has a good short-term effect.</p>

Treatment of habitual dislocation of patella with reconstruction of medial patellofemoral ligament combined with release of lateral retinaculum and medial transfer and advancement of tibial tuberosity under arthroscopy / 中国骨伤

<p><b>OBJECTIVE</b>To study clinical effects of triad operation including reconstruction of medial patellofemoral ligament, release of lateral retinaculum, Fulkerson tibial tubercle osteotomy, medial transfer and advancement under arthroscopy for the treatment of habitual dislocation of patella.</p><p><b>METHODS</b>From March 2010 to May 2016, 35 patients with habitual patellar dislocation were treated with the triad operation, including 14 males, 21 females, ranging in age from 18 to 38 years old, with an average of 25.8 years old. Twelve patients had dislocations on the left knee, and 23 patients had dislocations on the right knee. The changes of Q angle, TT-TG value and Kujala score were compared before and after operation.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 9 to 35 months (mean, 23 months). The Q angle of male group was improved from preoperative (29.2±2.0)° to postoperative (14.8±1.2)°(<0.05), and the Q angle of female group was improved from preoperative(30.6±2.3)° to postoperative (16.7±1.5)° (<0.05). CT showed that the TT-TG value was improved from preoperative (20.3±2.2) mm to postoperative (10.3±1.2) mm (<0.05). The Kujala score was improved from preoperative 47.8±7.5 to postoperative 88.4±6.2 (<0.05).</p><p><b>CONCLUSIONS</b>The triad operation including reconstruction of medial patellofemoral ligament, release of lateral retinacular, Fulkerson tibial tubercle osteotomy, medial transfer and advancement under arthroscopy for the treatment of habitual dislocation of patella has good short-term clinical effects.</p>

Clinical research on the efficiency of physical examinations used for diagnosis of subacromial impingement syndrome / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the reliability and diagnosis accuracy of 5 special tests used for the diagnosis of subacromial impingement syndrome (SAIS).</p><p><b>METHODS</b>A prospective blinded cohort study was taken,in which 105 patients with shoulder pain were reviewed. All the patients took 5 special syndrome tests including Neer syndrome, Hawkins-Kennedy syndrome, painful arc empty can test and external rotation resistance test, also underwent arthroscopic surgical examination. The Nikolaus's criterion was regarded as a golden standard for SAIS. Data accuracy analysis was calculated through a receiver operating characteristic (ROC) curve, sensitivity, specificity, positive likelihood ratio (+LR) and negative likelihood ratio (-LR). The binary Logistic regression analysis was used to find out the best test combination for ruling in or out SAIS. The interrater reliability was assessed by the Kappa coefficient and percent agreement.</p><p><b>RESULTS</b>The ROC analysis indicated a significant area under the curve (AUC) (AUC=0.62 to 0.73, P<0.05) for all tests except the Hawkins-Kennedy. Tests with a +LR greater or equal to 2.0 were the painful arc,empty can,external rotation resistance, Tests with a-LR less than 0.5 were Neer,painful are ,external rotation resistance. The regression analysis found the painful arc, empty can and external rotation resistance made the best combination for diagnosis SAIS,while the painful are and external rotation resistance made the best combination for ruling out SAIS. The difference of ROC analysis was significant with a cut-off of 3 positive tests out of 5 tests. All tests had moderate to good agreement (Kappa=0.42 to 0.71).</p><p><b>CONCLUSION</b>The single test of painful arc, empty can and external rotation resistance, as well as 3 or more positive tests of the 5 tests can help confirm the diagnosis of SAIS, while the single test of Neer, painful arc and external rotation resistance are help rule out the diagnisis of SAIS. The tests of painful arc, empty can and ex ternal rotation resistance are the best combination for the diagnosis of SAIS (when 2 or more are positive), while the tests of painful arc and external rotation resistance are the best combination for ruling out SAIS (when both are negative)</p>

Clinical observation on plate on the metatarsal side to reconstruction of tarsometatarsal joint dislocations secondary to diabetic charcot foot / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate clinical results of plate on the metatarsal side to reconstruction of tarsometatarsal joint dislocations secondary to diabetic charcot foot.</p><p><b>METHODS</b>Seven patients (9 feet) patients with tarsometatarsal joint dislocations secondary to diabetic charcot foot were treated with plating from April 2012 to December 2014. All patients were male, and 5 cases were on the unilateral side and 2 cases were on the bilateral sides. The age of patients ranged from 45 to 52 with an average of 48 years old. The history of diabetics was from 6 to 15 years. X-ray and CT were used to evaluate fractures healing,and AOFAS was applied to estimate recovery of joint function.</p><p><b>RESULTS</b>All patients were followed up from 12 to 24 months with an average of 19 months. All incisions were healed at stage I . No infection, loosening and breakage of internal fixation, bone nonunion were found after operation. According to postoperative X-ray and CT results, the time of fracture healing ranged from 10 to 20 weeks with an average of 16 weeks. Six feet got excellent results, 2 good and 1 moderate based on AOFAS scoring.</p><p><b>CONCLUSION</b>Tarsometatarsal joint dislocations secondary to diabetic charcot foot treated with plate on the metatarsal side could obtain stable fixation and got satisfied early clinical results.</p>

Treatment of the injury of the plantar plate on the second metatarsophalangeal joint with dorsal approach and Weil osteotomy / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical results of dorsal approach and Weil osteotomy in treating the injury of the plantar plate in second metatarsophalangeal joint.</p><p><b>METHODS</b>Eight feet with plantar plate tear in five cases were treated by plantar plate repairment through dorsal approach and Weil osteotomy from June 2012 to December 2013. The mean age of the patients was 52 years old. All the patients were followed up for 6 to 12 months. American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) were used to evaluate the clinical effect.</p><p><b>RESULTS</b>The second metatarsophalangeal joint stability recovered and the pain released in all patients. Postoperative VAS was lower and AOFAS was higher than preoperative.</p><p><b>CONCLUSION</b>Combined dorsal approach and Weil osteotomy can effectively release the pian of plantar plate, stabilize the metatarsophalangeal joint, decrease the incidence rate of postoperative subluxation and anchylosis in treating plantar plate tears in the second metatarsophalangeal joint.</p>

Analysis of clinical effects of uncovertebral joints resection and decompression for the treatment of cervical spondylotic radiculopathy through anterior approach / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the clinical and radiologic outcomes of bilateral uncovertebral joints resection and decompression in treating cervical spondylotic radiculopathy through anterior approach.</p><p><b>METHODS</b>From January 2007 to December 2009, the clinical data of 56 patients with cervical spondylotic radiculopathy undergoing sugical treatment were retrospectively analyzed. There were 33 males and 23 females with an average age of (58.83 +/- 8.01) years (ranged 41 to 72). The course was from 5 to 48 months with an average of (14.09 +/- 8.54) months. All patients underwent bilateral uncovertebral joints resection, vertebral canal decompression and fusion through anterior approach. Perioperative, radiologic,nerve functional parameters were analyzed before and after operation. Perioperative parameters included hospital stay days and blood loss volume and operative time; radiologic parameters included vertebral height and lordosis angle and fusion rate; and according to JOA score to evaluate the nerve function.</p><p><b>RESULTS</b>All patients were followed up from 12 to 30 months with an average of 18.2 months. Hospital stay days, blood loss volume and operative time were (4.42 +/- 0.25) d, (195.51 +/- 23.67) ml and (145.52 +/- 28.29) min, respectively. Preoperative vertebral height was (5.19 +/- 0.03) cm, and postoperative 1 year arrived to (5.37 +/- 0.29) cm, there was no significant difference between preoperative and postoperative (P > 0.05). Lordosis angle increased from preoperative (1.53 +/- 0.03) degrees to (7.78 +/- 0.66) degrees at the 1 year after operation (P<0.01). Fusion rate was 96.5% at the 1 year after operation. JOA score increased from preoperative 8.69 +/- 2.13 to 15.58 +/- 2.45 at the 1 year after operation (P < 0.001). According to standard of JOA scoring, 20 cases were excellent, 28 good, 7 fair and 1 poor.</p><p><b>CONCLUSION</b>Uncovertebral joints resection and decompression through anterior cervical approach in treating cervical spondylotic radiculopathy is safe and reliable, which can get satisfactory clinical outcomes. This surgical procedure is suitabl oe for the patients of cervical spondylosis, especially combined canal stenosis and osteophytosis of the uncovertebral joint.</p>