Imageology and significances of rotational axes of distal femur on Chinese adults with total knee arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To explore clinical significance of rotational axis of distal femur on Chinese adults in total knee arthroplasty (TKA).</p><p><b>METHODS</b>There were 86 Chinese adults (106 normal knees) including 47 males (53 knees) and 39 females (53 knees), 54 knees were on left and 52 on right. The CT scan was employed in the distal femur. The scan direction was aligned to be on the plane perpendicular to the mechanical axis of the femoral. The CT images of cross sections across lateral and medial femoral epicondyle were moved to personal computer,lateral angle between anterior posterior line (APL) and surgical transepicondylar axis (STEA) (ATA),lateral angle between posterior condylar line (PCL) and APL (APA), angle between perpendicularity of APL and PCL (A-PA), posterior condylar angle (PCA), condylar twist angle (CTA), angle between clinical transepicondylar axis (CTEA) and STEA (CSA) were measured. These values were divided into different groups according to gender and side, the values of CTA, PCA, A-PA, angle PT (varus of tibia plateau), constant 3, ATA, APA and constant 90° were compared by statistically. A-PA and PCA, and CTA were analysed statistically with the liner regression, the relationship among CTEA, STEA ,PCL, APL and PLP were performed to assess by liner regression.</p><p><b>RESULTS</b>ATA was (89.79 ± 1.22)°, APA was (84.84 ± 1.83)°, A-PA was (5.16 ± 1.83)°, PCA was (4.80 ± 1.23)°, CTA was (8.23 ± 1.40), CSA was (3.45 ± 0.68)°. All the parameters had no differences on sex and side,but CSA had difference on male and female. There was no difference among angle PT, PCA, A-PA. There was significant difference in CAT, constant 30 and angle PT, PCA,A-PA. There was no difference between ATA and constant 90°, but there was difference between APA and constant 90°. There was relativity between PCA and CTA, and also PCA and A-PA, CTA and A-PA. There was significant relativity between STEA and CTEA, between STEA and APL, between STEA and PCL, and also between APLP, APL and PCL, but there was no significant relativity between PCL and CTEA.</p><p><b>CONCLUSION</b>TKA for Chinese, the section of femoral posterior condyle should be external 5° to obtain the optimum rotational orientation. The property is different entirely between STEA and CTEA, the rotational alignment is not performed according to parallel to the CTEA in distal femur. Among STEA, APL, PCL, the STEA is the most reliable mark ofrotational alignment of the distal femur, and the PCL is the less reliable mark.</p>

Analysis of perioperation complications of total hip arthroplasty in treating Crowe type IV developmental dysplasia of the hip / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of total hip arthroplasty (THA) for Crowe type IV developmental dysplasia of the hip (DDH) and analyze perioperative complications.</p><p><b>METHODS</b>From March 2000 to March 2010, 19 patients (23 hips, of them, 4 patients with bilateral hips) with Crowe type IV DDH underwent THA. There were 5 males and 14 females, with average age of 61.3 years (ranged, 41 to 72 years). All hips were treated with small acetabular components combined with medial protrusion technique in acetabular reconstruction, as well as subtrochanteric shortening osteotomy in femur. Joint function of hips were evaluated according to Harris scoring.</p><p><b>RESULTS</b>All patients were followed up with an average of 4.2 years (ranged, 1 to 8 years). Postoperative X-ray films showed all acetabular prosthesis were in true acetabulum. No loosening and nonunion were found in all patients. Harris scoring improved from preoperative 34.0 +/- 6.9 to postoperative 85.0 +/- 7.5. Complications occurred in 11 cases in the patients, including femoral split fracture in 3 cases, nerve injury in 3 cases, delayed union in 2 cases, dislocation in 3 cases.</p><p><b>CONCLUSION</b>Total hip arthroplasty using small acetabular component, medial protrusion, femoral subtrochanteric shortening osteotomy technique for the Crowe type IV DDH can effectively restore hip function and leg length. But incidence of complications is high. The long-term follow-up is necessary for further study.</p>

Total hip replacement for the treatment of Crowe IV congenital hip dislocation using small acetabular components combined with medial protrusio technique / 中国骨伤

<p><b>OBJECTIVE</b>To summarize the surgical technique and the clinical results of small acetabular components combined with medial protrusio technique in primary total hip arthroplasty (THA) for the treatment of Crowe type IV congenital hip dislocation (CHD).</p><p><b>METHODS</b>From January 2000 to December 2005, total 14 patients (16 hips) of Crowe type IV CHD underwent cementless THA (12 unilateral, 2 bilateral) with this new technique. There were 2 males and 12 females with an average age of 49 years (range, 38 to 75 years). The indications for surgery was severe hip pain and leg length discrepancy with difficulty in walking and activating. Cup design: Duraloc (Depuy, Warsaw, USA) in 10 hips, Pressfit S II (LINK, Germany) in 6 hips. The outside diameter of the cup was 42 to 44 mm; and the thickness of the polyethylene liner was 6 to 7 mm. Total hip replacement were performed with the medial protrusion technique to stabilize the fit of a hemispherical metal cup in the acetabulum. The hip functions were evaluated by Harris hip score. The muscle strength of the gluteus medius and gait were respectively evaluated in accordance with the standards of five and four classes.</p><p><b>RESULTS</b>The X-ray showed that the average superolateral bone coverage in these 16 hips (none of which had bone graft) was more than 98 percent. The cup was an average of (5.8 +/- 1.2) mm medial and (6.2 +/- 1.7) mm superior to the Ranawat triangle. The follow-up period ranged from 3 to 9 years. The Harris hip score improved from 25 to 32 preoperatively to 90 to 98 1 year postoperatively. X-ray showed that perforated area of the medial acetabulum were repaired with healed bone mud 4 to 8 months after operation. The rate of linear wear of the polyethylene liner averaged (0.10 +/- 0.03) mm each year. Until now, no aseptic loosening or osteolysis was identified around the acetabulum components, no acetabular components were revised for loosening or other reasons.</p><p><b>CONCLUSION</b>Small acetabular components combined with medial protrusio technique is a simple, reliable and flexible surgical technique. Early and mid-term result in total hip arthroplasty with this technique for the treatment of Crowe type IV CHD is satisfactory.</p>

Total hip surface replacement arthroplasty: report of 31 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To introduce the technique of total hip surface replacement, evaluate the early results and review the factors which affect the results.</p><p><b>METHODS</b>From October 2000 to January 2005, 31 patients (37 hips) with osteonecrosis, osteoarthritis, hip dysplasia, ankylosing spondylitis were treated with the total hip surface replacement. Among them, 15 were male, and 16 were female, with an average age of 42 years (range from 23 - 65 years). All the 31 patients had the indications for hip surface replacement. Standard operation technique which was brought forth by Amstutz and Nelson was employed, and all patients were followed up after operation.</p><p><b>RESULTS</b>Patients were followed up for an average period of 42 months (3 - 51 months). There were no femoral neck fracture, no dislocation, no infection in all patients. Radiolucent line existed around acetabular prosthesis in 1 hip and another hip had been revised because the prosthesis of femoral head was in incorrect situation. The average Harris hip score improved significantly from 30 to 90, and the score was 93 in the latest follow-up. Based on Harris system, 35 hips were excellent, 1 hip good, and 1 hip fail.</p><p><b>CONCLUSIONS</b>The total hip surface replacement is an effective solution for the problem of the patients with osteonecrosis of the femoral head, osteoarthritis, hip dysplasia and ankylosing spondylitis. The short-term results are satisfied.</p>

The effect of different times of He-Ne laser irradiation on healing of rabbit achilles tendons / 中华物理医学与康复杂志

Objective To evaluate the influence of duration of laser irradiation on histomorphometric meas- urements in experimentally tenotomized and repaired rabbit Achilles tendons and to explore the best irradiation time. Methods A total of 20 male New Zealand rabbits aged 10-12 weeks were used and randomly divided into 4 groups:a control group and three experimental groups.All the animals underwent surgical excised and then repair of their Achillis tendon.The animals in the control group were then treated with sham laser irradiation,while those in the three experimental groups were treated with 10,20 and 30 minutes of He-Ne laser irradiation(632.8 nm, 18.9 mW)daily,respectively,for 14 days.On the 28th day after surgical operation,the animals were sacrificed and their Achilles tendons were sampled.HE stain and Van Geison stain were used to observe morphometric changes of tendons.The SDS-PAGE electrophoresis method and CS-930 photodensity scan instrument were employed to measure the content of typesⅠandⅢcollagen.Results it was shown that laser irradiation enhanced cell proliferation,cel- lular content,granulation tissue formation and collagen deposition in laser-treated tendons,especially in those irradia- ted for 20 minute daily,as compared to the control group.TypeⅠand typeⅢcollagen levels were significantly in- creased at the 28th day in the healing tendons and the ratio of collagenⅢtoⅠincreased in all the 3 experimental groups,and the increase of both collagen content and ratio of collagen typeⅢtoⅠwas significantly greater in those ir- radiated 20 minutes daily(P