Repair of KuwadaⅡand Ⅲ Achilles tendon defects through modified medial J-shaped approach with autologous fascia lata transplantation / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of modified medial J-shaped incision of Achilles tendon combined with fascia lata transplantation in the treatment of Kuwada typeⅡand Ⅲ Achilles tendon defects.@*METHODS@#From January 2016 to August 2018, the clinical data of 15 patients with KuwadaⅡand Ⅲ Achilles tendon defects treated with modified J-shaped approach with autologous fascia lata transplantation were retrospectively analyzed, including 14 males and 1 female, with an average age of 31.7 years old ranging from 24 to 43. There were 9 cases of KuwadaⅡdefect and 6 cases of KuwadaⅢ defect. Postoperative observations were made for incision complications, and the Arner-Lindholm scoring standard was used to evaluate the function of the affected foot at the last follow-up.@*RESULTS@#All 15 cases were followed up from 3 to 16 months with an average of 9.2 months. No skin necrosis or infection occurred after operation, and no Achilles tendon rupture occurred again. According to the Arner-Lindholm scoring standard, 13 cases were excellent, 2 cases were good.@*CONCLUSION@#Modified medial J-shaped incision is a satisfactory approach for repairing Achilles tendon defects. It is helpful to prevent postoperative incision complications, which double-strengthen the Achilles tendon strength, so that patients can perform early rehabilitation and functional exercises with satisfactory clinical results.

Minimally invasive treatment for distal radial fracture and dislocation of type IV based on Fernandez classification / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effects of external fixation combined with minimally invasive internal fixation for the treatment of distal radial fracture and dislocation of type IV based on Fernandez classification.</p><p><b>METHODS</b>From January 2007 to October 2012,19 patients with the distal radius fracture and dislocation of type IV according to Fernandez classification were reviewed. There were 14 males and 5 females,ranging in age from 22 to 42 years old,with an average of 36.5 years old. All the patients were treated with minimally invasive reduction, and external fixation with finite internal fixation. The K-wire was used to fix radiolunate articular surface for correcting the instability of dorsal and volar intercalated segment. The radiolunate angle, scapholunate angle, and the length of the radial shorting were measured by the standard X-ray. Gartland and Werley evaluation system was used to evaluate recovery of function.</p><p><b>RESULTS</b>No complications such as injury of blood vessels and radial nerves and pin track infections occurred. After operation, the radiolunate angle, scapholunate angle and the length of the radial shorting time were (9.5 +/- 3.3) degrees, (51.3 +/- 11.2) degrees and (11.2 +/- 1.8) mm by the standard X-ray. On the 3rd month after operation, GW score was 3.02 +/- 3.05. There was no re-displacement and subluxation occurred during the follow-up period. Good functional recovery were improved wrist function significantly.</p><p><b>CONCLUSION</b>External fixation combined with minimally invasive internal fixation can treat distal radial fracture and dislocation of type IV based on Fernandez classification. Wrist joint stability depends on the structure of the bone and ligament around wrist joint. Emphasis on the diagnosis and treatment of carpal instability, and postoperative functional rehabilitation can improve wrist function.</p>

Application of monitoring phosphocreatine kinase continuously and dynamically in early diagnosis of compartment syndrome / 中国骨伤

<p><b>OBJECTIVE</b>To determine the efficacy of phosphocreatine kinase in the early diagnosis of compartment syndrome.</p><p><b>METHODS</b>Forty patients with compartment syndrome of limbs were reviewed from 2005 to 2008 including 34 males and 6 females with an average age of (37.03 +/- 13.02) years. Monitoring phosphocreatine kinase continuously and dynamically after injured 2, 24 hours, 1, 2, 3 and 4 weeks later. The concentration of CK were measured by using Japanese Olympus automatic biochemistry analysator. The muscle preparations from affected extremity were taken after operation and 1, 2, 3 weeks later for biopsy.</p><p><b>RESULTS</b>Two hours later after injury, the contents of CK increased sharply and the contents of CK were about 20 times more than the nomal. Twenty-four hours later, the contents of CK reached its maximum,the contents of CK were about 42 times more than the nomal. One week later, the contents of CK recovered to normal level. Pathological changes of muscle were irreversible.</p><p><b>CONCLUSION</b>The change of the contents of CK can reflect the progression of disease objectively. If it increased sharply, the chance of compartment syndrome was high. Monitored it dynamicly and continuously can provide assistant for early diagnosis of compartment syndrome and evaluating pathogenetic condition.</p>

Effect on wrist joint stability following distal radial fractures / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the influence of wrist joint stability of patients with diversified fracture of the distal radius, and to find out the difference of the clinical effect between the patients with surgical treatment and non-surgical treatment.</p><p><b>METHODS</b>From January 1999 to September 2006 a total of 200 cases with the fracture of the distal radius were reviewed according to the AO classification, the radiolunate angle, scapholunate angle, palmar tilt angle and the length of the radial shorting and step-off of the articular surface were measured by the standard X-ray. Gartland and Werley as modified by Sarmiento evaluation system was used, and the results were statistically analyzed.</p><p><b>RESULTS</b>The average follow-up period was 5 years and 2 months. The follow-ups revealed 5 types of carpal instability: scapholunate dissociation, volar intercalated segment instability, dorsal intercalated segment instability and palmar or dorsal shift of the carpus. Functional results were excellent and good in 78% of the total patients. The increasing of the length of the radial shorting and step-off of the articular surface was found to be associated with greater risk of carpal instability.</p><p><b>CONCLUSIONS</b>Based on the results of the study, wrist articular surface and radial shortening and palmar tilt angle should be considered as the most important factors of the healing effect after the fracture of the distal radius. Wrist joint stability depends on the structure of the bone and ligament around wrist joint. Carpal instability wound leads to significantly effect on the wrist. And surgery was necessary to severe intra-articular fracture of the distal radius.</p>

Surface-replacement total hip arthroplasty in the treatment of the femoral head osteonecrosis / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the outcome and indication of surface-replacement total hip arthroplasty in the treatment of the femoral head osteonecrosis.</p><p><b>METHODS</b>The clinical data of 17 patients (21 hips) with femoral head osteonecrosis were reviewed. Among which, 10 cases were male and 7 cases were female, the average age was 36 years old (ranging from 25 to 51 years). There were 8 hips at Ficat stage III and 10 hips at Ficat stage IV. The 17 patients (21 hips) underwent surface-replacement total hip arthroplasty. Gibson posterolateral incision was used and non-cemented prosthesis was implanted. For prosthetic femoral head fixation, a guide pin was inserted into the capital center. After hollow boring hit drilling, a guide pole was inserted, and redundancy of femoral head was rasped off with cutterbar. The bone cement was painted on the femoral head and prosthesis, and the prosthesis was planted into the central axis hole of neck of femur until bone cement solidification. The therapeutic effects were evaluated by Harris hip score and statistical analysis was made. The X-ray was rechecked regularly.</p><p><b>RESULTS</b>The mean duration of follow-up was 32 months (18 to 42 months). The average Harris hip score was improved significantly from preoperative 35.30 +/- 5.23 to postoperative 90.47 +/- 3.14, and the excellent and good rate was 90.5%. There were high statistical differences between preoperative and postoperative Harris score (P < 0.01). The X-ray showed radiolucent line around acetabular prostheses in two patients but without prostheses loosening.</p><p><b>CONCLUSION</b>Surface-replacement total hip arthroplasty is a satisfactory way for the treatment of femoral head osteonecrosis in the middle-late phase, which can help reconstructing normal joint biomechanics and load transmission,improving joint stability and postponing THA without affecting later rebuilding, as well as some advantages such as decreasing surgical wound, convenient and low infection rate. Its indication is Ficat stage III and part Ficat stage IV femur head necrosis with less destroyed neck of femur,especially for young patients having a large amount of activity.</p>