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Objective:To compare the medium-term clinical effects of arthroscopic double row repair between traumatic and degenerative medium supraspinatus tear.Methods:A retrospective study was conducted to analyze the clinical data of 23 patients who had been treated for traumatic or degenerative medium supraspinatus tear by the same arthroscopic double row repair and postoperative rehabilitation at Sports Medicine Center, The First Hospital Affiliated to Army Medical University between January 2015 and August 2020. They were assigned into 2 groups according to different tears. In the traumatic group of 8 cases of traumatic medium supraspinatus tear, there were 5 males and 3 females with an age of (46.1±4.3) years and a tear size of (1.3±1.0) cm 2. In the degenerative group of 15 cases of degenerative medium supraspinatus tear, there were 4 males and 11 females with an age of (59.9±8.1) years and a tear size of (4.1±1.1) cm 2. At preoperation and the last follow-up, the shoulder pain was evaluated by visual analogue scale (VAS), and the shoulder function by American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score and Simple Shoulder Test (SST); the improvements in active range of motion (ROM) of the shoulder were recorded at the last follow-up. Results:The 2 groups were comparable because there was no significant difference between them in the general clinical data ( P>0.05). The traumatic and degenerative groups were followed up for (40.3±11.2) and (36.4±12.4) months, respectively. At the last follow-up, the improvements in range of anterior flexion and internal rotation vertebral rank in the degenerative group [55.3°±33.6° and (4.1±1.3) ranks] were significantly greater than those in the traumatic group [27.5°±22.5° and (2.3±1.9) ranks] ( P<0.05). At the last follow-up, the VAS, ASES, Constant-Murley, and SST scores in the degenerative group were improved respectively by (3.7±0.8), (40.9±14.0), (38.4±9.4), and (6.5±1.4) points compared with their preoperative values, significantly greater than those in the traumatic group [(2.3±0.7), (19.6±14.6), (19.2±7.9), and (3.8±0.7) points] ( P<0.05). Conclusion:Arthroscopic double row repair can achieve significant medium-term improvements in shoulder function for both traumatic and degenerative medium supraspinatus tears, but the improvements may be grater for the degenerative ones.
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Objective:To investigate the mid-term clinical outcomes of arthroscopic vertical mattress suturing for shoulder recurrent anterior dislocation combined with joint laxity.Methods:A retrospective case series study was performed on the clinical data of 11 patients with recurrent anterior shoulder dislocation combined with joint laxity admitted to the First Affiliated Hospital, Army Medical University from January 2018 to September 2021. The patients included 10 males and 1 female, aged 18-38 years [(22.8±5.5)years]. All the patients received treatment with arthroscopic vertical mattress suturing. The Oxford shoulder instability score, Rowe shoulder instability score, and simple shoulder test (SST) score were compared before operation, at 6 months after operation and at the final follow-up. The degree of joint capsule laxity and length of capsular redundancy (evaluated by MRI) were compared before operation and at the final follow-up. The results of the supine apprehension test, re-dislocation and postoperative complications such as iatrogenic vascular and nerve injuries were observed at the final follow-up. Also, the correlation between the radiological changes in the joint capsule and the shoulder function was analyzed by Spearman correlation coefficient.Results:All the patients were followed up for 20-64 months [(40.7±18.6)months]. Before operation, at 6 months after surgery and at the final follow-up, the values of Oxford shoulder instability score were (41.2±4.7)points, (49.5±3.0)points and (57.6±3.0)points; the values of Rowe shoulder instability score were (28.6±9.5)points, (77.7±7.2)points and (94.1±10.9)points; and the values of SST score were (7.6±1.3)points, (9.8±1.0)points and (11.6±0.9)points, respectively. The Oxford shoulder instability score, Rowe shoulder instability score and SST at 6 months after operation and at the final follow-up were significantly better than those before operation, and those at the final follow-up were significantly better than those at 6 months after operation (all P<0.05). The MRI showed that the degree of joint capsular laxity and length of capsular redundancy were 1.5±0.2 and (19.7±2.5)mm before operation and were 1.3±0.2 and (12.9±3.7)mm at the final follow-up, respectively ( P<0.05 or 0.01). The supine apprehension test was negative at the final follow-up, with no re-dislocation or postoperative complications such as iatrogenic vascular or nerve injuries. Correlation analysis showed a negative correlation between the degree of joint capsular laxity and the Oxford shoulder instability score ( r=-0.62, P<0.05) and that of the length of capsular redundancy with the Oxford shoulder instability score ( r=-0.80, P<0.01), the Rowe shoulder stability score ( r=-0.73, P<0.01) and the SST score ( r=-0.75, P<0.01). Conclusions:Arthroscopic vertical mattress suturing has good mid-term clinical outcome for recurrent shoulder anterior dislocation combined with joint laxity, improving the shoulder function and reducing complications, wihch is associated with decreased joint capsule laxity and length of capsular redundancy.
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As the main stabilizing structure of the medial ankle joint, deltoid ligament plays a role in counteracting excessive eversion of the hindfoot and external rotation of the talus during ankle movement so as to maintain the biomechanical stability of ankle joint. Although the incidence of deltoid ligament injury is low, improper diagnosis and treatment can affect the path of talus motion and eventually lead to chronic medial instability or traumatic arthritis of the ankle joint, seriously affecting the normal life and motor function of the patients. The diagnosis of deltoid ligament injury needs to be based on the characteristics of the injury, physical examination and imaging, among which X-ray, MRI and ultrasonography are most frequently used. There are various methods to treat deltoid ligament injury according to the type of injury, and thus the choice of treatment has been a hot topic in the field of foot and ankle surgery. The choice of non-surgical or surgical treatment for acute deltoid ligament injury remains controversial. For the treatment of chronic deltoid ligament injury, there is no consensus on direct repair or deltoid ligament reconstruction. In addition, the choice of autologous or allograft tendon or wire anchors for deltoid ligament reconstruction is also disputed. The rehabilitation of deltoid ligament injury is crucial to the early restoration of motor function of the ankle joint, but the related guidelines or consensus are scarce. In order to fully understand the characteristics of deltoid ligament injury, make accurate diagnosis and formulate reasonable treatment and rehabilitation programs, the authors review the research progress in deltoid ligament injury from aspects of anatomical characteristics, biomechanical mechanism of injury, diagnosis, treatment and postoperative functional rehabilitation, hoping to provide a reference for the clinical diagnosis and treatment of deltoid ligament injury.
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Peroneal tendon plays an important role in maintaining the alignment of the hindfoot and stabilizing the arch of the foot. It is also the main tendon against ankle varus injuries, and is of great significance in maintaining lateral ankle stability. As an infrequent disease, peroneal tendon spondylolisthesis can be easily misdiagnosed in clinical diagnosis and treatment which results in pain and instability of the lateral ankle and weakness in eversion of the affected foot. Improper diagnosis or treatment can affect patient quality of life. Peroneal tendon spondylolisthesis is mainly treated by non-surgical and surgical treatments, among which surgical treatments mainly include superior peroneal retinaculum repair, superior peroneal retinaculum augmentation, peroneal bone block procedure, peroneal groove deepening technique, and peroneal rearrangement. Surgical indications for different surgical treatments remain controversial. Moreover, there are no rehabilitation guidelines for peroneal tendon spondylolisthesis at home or abroad, and postoperative rehabilitation is generally based on the experience of clinicians. On the basis of related literature, the authors review the research progress in treating peroneal tendon spondylolisthesis from aspects of anatomical characteristics, injury mechanism, diagnosis, treatment and rehabilitation, so as to provide a reference for accurate and effective diagnosis, treatment and rehabilitation of peroneal tendon spondylolisthesis.
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Objective:To compare the mid-term clinical outcomes between traumatic stiff shoulder and frozen shoulder after arthroscopic capsule release combined with subacromial space recovery.Methods:From January 2014 to December 2019, 55 patients were treated at Sports Medicine Center, The First Affiliated Hospital, Army Medical University for limited range of shoulder motion. Of them, 22 suffered from traumatic stiff shoulder (7 males and 15 females) (group A) and 33 from frozen shoulder (10 males and 23 females) (group B). All patients were treated with arthroscopic 270° capsule release combined with subacromial space recovery. Shoulder pain was evaluated by visual analogue scale (VAS) and shoulder function by Constant score before operation and at the final follow-up. The 2 groups were compared in improvements in flexion, abduction, external rotation and internal rotation of the shoulder.Results:No significant difference was observed between the 2 groups in gender, age, course of disease, preoperative internal rotation or external rotation of the shoulder ( P>0.05). Preoperative VAS score [2.5(2.0, 3.3) points] and Constant score [(33.7±9.6) points] in group A were significantly lower than those in group B [4.0(3.0,5.5) points and (45.8±12.3) points] ( P<0.05). No complication like infection or nerve injury was found during follow-ups. All the incisions healed at the first stage. The follow-up time averaged 37.0 months (from 20 to 79 months). At the last follow-up, VAS scores [1.0(1.0, 1.0) points and 1.0(1.0, 1.0) points] and Constant scores [(87.0±3.2) points and (85.7±4.3) points] for both groups were significantly improved compared with their preoperative values [2.5(2.0,3.3)分points and 4.0(3.0,5.5) points for VAS; (33.7±9.6) points and (45.8±12.3) points for Constant score] ( P<0.05). Compared with preoperation, the improvements at the last follow-up were 99.3°±19.9° and 83.3°±27.7° in shoulder anteflexion and 102.0°±21.5° and 83.9°±32.8° in abduction for groups A and B, with greater improvements in group A; the improvements in VAS score for groups A and B were 1.0(1.0, 2.3) points and 3.0(2.0, 4.5) points, with greater improvements in group B; the improvements in Constant score were (53.3±9.5) points and (39.8±12.9) points for groups A and B, with greater improvements in group A. The above comparisons all showed a significant difference between the 2 groups ( P<0.05). Conclusions:Arthroscopic 270° capsule release combined with subacromial space recovery can lead to good mid-term clinical outcomes similar for both traumatic stiff shoulder and frozen shoulder. However, the improvements in flexion, abduction and Constant score may be greater for traumatic stiff shoulder than for frozen shoulder.
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Objective To explore the surgical skill and curative effect of Scarf combined with modified Mcbride osteotomy for treating moderate to severe hallux valgus.Methods Thirty-eight patients (47 feet) with moderate to severe hallux valgus in the Southwest Hospital of Army Military Medical University from July 2014 to June 2015 were selected and treated by Scarf combined with modified Mcbride osteotomy,among them,31 cases(38 feet) were followed up.The cases of phalanx proximal articular angle(PAA) enlargement were added with Akin osteotomy hallex proximal phalanx,and 2,3 plantar Weil osteotomy was used in the patients with 2,3 plantar bone metastasis pain.The hallux valgus angle (HVA),1,2 intermetatarsal angle (IMA),distal metatarsal joint fixed angle(DMAA),PAA were compared between before and after surgery by the erect position,anteroposterior position and lateral X-ray films.The therapeutic effects were assessed by adopting the American Orthopedic Foot and Ankle Society(AOFAS) scoring system.Results The follow-up time was 12～18 months(average 16.42 months).HVA was decreased from preoperative(41.82±5.28)° to postoperative(17.03±4.04)°,IMA was decreased from preoperative(19.00 ± 3.78)°to postoperative(9.24 ± 1.98)°,DMAA was decreased from preoperative(19.42±5.65)°to postoperative(8.71±2.74)°,PAA was decreased from preoperative (5.66± 3.27) ° to postoperative (3.82 ± 2.09) °,and AOFAS score was increased from preoperative (41.47 ± 6.29) to postoperative (84.82 ± 6.43),the differences were statistically significant (P＜0.05).Conclusion Scarf combined with modified Mcbride osteotomy has satisfactory effect for treating moderate to severe hallux valgus.
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Objective To evaluate the clinical effect of treating the medial osteochondral lesions of the talus (OLTs) using the malleolar osteotomy and bone grafting with periosteum.Methods A total of 28 patients who underwent medial malleolar osteotomy,lesions debridement and bone grafting with periosteum between January 2014 and August 2015 were reviewed retrospectively.The oblique medial mal leolar osteotomy was performed to expose the talar lesion,followed by cyst debridement and bone grafting with periosteum,then the medial malleolus fracture was fixed.X-rays and MRI examination were conducted before and after the operation.MRI was used for the measurement of radiographic parameters such as the length,width and depth of the edema area.The patients were also evaluated using the American orthopaedic foot and ankle society (AOFAS)-ankle and hindfoot score questionnaires.Results Twenty-three subjects completed the follow-up over a mean period of 15 months (range,10～28 months).According to X-rays,the mean time for osseous union was 11 weeks (range,9-14 weeks).MRI results showed significant reduce in the bone marrow edema area after the operation,except for one case of fibrous cartilage higher than the surrounding articular cartilage,and two with the chondro cyst not disappearing completely.The arthroscopy of 6 patients revealed 5 good integrations with similar color and smoothness.The AOFAS ankle-hindfoot scores increased significantly after the surgery (P＜0.05).No wound pain,infection,and failure of internal fixation were observed during the follow-up period.Conclusions The combination of medial malleolar osteotomy,lesions debridement and bone grafting with periosteum can be used to treat patients with stage Ⅲ～Ⅴ OLTs,as this technique can effectively relieve pain and enhance the joint function.
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Objective To compare the early curative effects of arthroscopic modified suture bridge and single-row modified Mason-Allen suture in repair of supraspinatus tendon tears.Methods A retrospective case-control analysis was made on 28 patients with supraspinatus tendon tears admitted between June 2012 and June 2015.There were 16 males and 12 females,aged 43-63 years (mean,54.2 years).Thirteen patients (13 shoulders) were repaired using the arthroscopic modified suture bridge technique (Group A),and 15 patients (15 shoulders) were treated using the single-row modified Mason-Allen technique (Group B).Operation time and intraoperative blood loss were recorded.American shoulder and elbow surgeons (ASES) score,Constant score and visual analogue score (VAS) were used to evaluate the function and subjective outcomes preoperatively.Meanwhile,MRI was used for analysis of tendon integrity postoperatively.Results The operation time of Group A and B were (56.1 ± 23.2) minutes and (36.1 ± 15.6) minutes,respectively (P ＜ 0.05).The intraoperative blood loss was (30.3 ± 20.5) ml and (28.5 ± 18.2) ml,respectively (P ＞ 0.05).The average follow-up time for Groups A and B were 12 months and 12.6 months,respectively.The symptoms of 28 cases were alleviated after surgery,and the functions were obviously recovered.In Group A,thc VAS was decreased significantly from (7.0 ± 0.8) points preoperatively to (0.8 ± 0.8) points at final follow-up,ASES score was improved from (39.8 ± 3.1) points to (88.1 ± 4.8) points,and Constant score was improved from (54.8 ± 2.7) points to (88.2 ± 3.1) points (all P ＜ 0.05).In Group B,the VAS was decreased significantly from (6.8 ± 0.8) points preoperatively to (0.9 ± 0.8) points at final follow-up,ASES score was improved from (40.7 ± 2.5) points to (89.5 ± 3.2) points,and Constant score was improved from (56.0 ± 4.5) points to (89.3 ± 3.4) points (all P ＜ 0.05).There was no significant difference in the clinical outcomes between the two groups (P ＞ 0.05).The retear rate in Group B was 20％ (3/15),while no retear was presented in Group A (P ＜ 0.05).Conclusion Arthroscopic modified suture bridge technique and single-row modified Mason-Allen technique are both clinically effective for function recovery and pain relief in patients with supraspinatus tendon tears,but the former associated with lower incidence of tendon re-tear is preferred for moderate to large rotator cuff injury or rotator cuff injury with large insertion avulsion.
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Objective To investigate the long-term effects of modified Bristow-Latarjet operation for treatment of recurrent inferoanterior shoulder dislocation.Methods A retrospective case series study was done on 90 patients with recurrent inferoanterior shoulder dislocation treated by modified Bristow-Latarjct procedure from January 2001 to January 2016.There were 72 males and 18 females,with an average age of 36.8 years.There were 59 fight shouders and 31 left shoulders,with dislocation for 4-32 times (mean,13 times).Shoulder instability severity index score (ISIS) was 3-10 points (mean,6.4 points).The duration of disease was 6-26 months (mean,13 months).The operation methods were coracoid lateral incision with modification,rotator cuff interval approach,double hollow compression screw fixation,and bone congruent-arc technique in standing position.Clinical evaluation was done on postoperative recurrence of shoulder joint dislocation/subluxation,bone healing evaluated by X-ray and CT,Rowe score,simple shoulder function Test (SST) score,shoulder osteoarthritis score (Samilson-Prieto),bodv side shoulder external rotation angle and the subscapularis muscle strength.Results All patients were followed up for 1-15 years (mean,5.6 years).The rate of redislocation or subluxation during follow-up was zero.All transpositions of the coracoid got bone healing at postoperative 3-6 months.The Rowe score was increased significantly from (45.6 ± 9.4) points preoperatively to (92.6 ± 3.5) points postoperatively (P ＜0.01);SST score was increased significantly from (5.6 ± 1.2)points preoperatively to (9.6 ± 2.8) points postoperatively at final follow-up) (P ＜ 0.01).Samilson-Prieto score was mild in 2 patients (2％).The body side shoulder external rotation angles were (56.7 ± 13.9) ° preoperatively and (54.6 ±14.1) ° postoperatively (P ＞ 0.05).With regards to subscapularis strength,the lift-off and belly-press in injured side were (4.9 ± 0.9) kg and (4.4 ± 1.0) kg,respectively (P ＞ 0.05).Lift-off and belly-off in normal side were (5.1 ± 0.5) kg and (4.7 ± 1.1) kg,respectively (P ＞ 0.05).Conclusion The modified Bristow-Latarjet operation is a reproducible and effective technique that can restore shoulder stability,with advantages of sound bone healing,free shoulder external rotation,low incidence of shoulder joint osteoarthritis,remaining of myodynamia under scapula and hence has long-term effects and is worth of clinical applicaiton.
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Objective To investigate the clinical outcomes of the medial displacement calcaneal osteotomy with reconstruction of posterior tibial tendon insertion on navicular for the flatfoot related with accessory navicular.Methods From March 2009 to October 2011,13 patients (16 feet) with flatfoot related with accessory navicular received treatment by the medial displacement calcaneal osteotomy with reconstruction of posterior tibial tendon insertion on navicular.There were 4 males and 9 females,with an average age of 41.3 years (range,18-64 years).All patients had obvious valgus calcaneus,the angle of which was 11.3°± 1.4°.According to AOFAS ankle-hindfoot scores,the arch height,calcaneus inclination angle (CI),talocalcaneal angle (TC),talar first metatarsal angle (TMT) on the lateral weight-bearing radiograph of foot,and the talocalcaneal angle (TC),talar first metatarsal angle (TMT) on the AP view of the weight-bearing radiograph of foot,and the heel valgus alignment on axial radiographs of the hindfoot were measured on the X-ray film.Results All patients were followed up for 12 to 31 months,with the average of 16.8 months.Eleven patients (13 feet) felt no pain 6 months after operation,while 2(3 feet) felt pain after long walking.There was no complication,including infection,nerve injury,un-union,and so on.The average AOFAS ankle-hindfoot score improved from 56.4-±6.4 preoperatively to 88.1±2.8 at the last follow-up.Radio graphically,all parameters were statistically significant between pre-operation and the last follow-up,including the arch height,CI,TC,TMT modifying from 3.8±0.3 mm,9.5°±1.1°,47.3°±2.5°,17.6°±1.6° to 12.0±1.1 mm,20.1°±1.5°,32.3°±2.5°,6.8°±1.0° respectively on the lateral weight-bearing view; TC improving from 39.5°±2.3° to 26.2°±2.0°and TMT improving from 15.2°±1.7° to 6.3°±1.0° on the AP weight-bearing view.Conclusion The medial displacement calcaneal osteotomy with reconstruction of posterior tibial tendon insertion on navicular is a good choice for the treatment of flatfoot related with accessory navicular with excellent clinical outcomes.
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ObjectiveTo evaluate the clinical results of minimally invasive ankle arthrodesis with percutaneous cannulated screws.MethodsBetween April 2005 and October 2010, 12 patients with the ankle arthrodesis for unilateral severe arthritis (Kellgren-Lawrence class Ⅲ) were prospectively analyzed, including 2 cases of rheumatoid arthritis, 8 cases of post-traumatic arthritis, and 2 cases of osteoarthritis. There were 7 males and 5 females with an average age of 42.0 years(range, 25-7 1). The average disease duration was 7.3 years (range, 1-21). The anterior median incision of 3.0-5.0 cm was made to explore the ankle joint.The cartilage of tibial-talus joint was completely debrided. Two guide pins were inserted from posterosuperior to anteroinferior, and cannulated screws were implanted to fix ankle joint. All patients were physically examined with an extended protocol of questionnaires and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot Scales. Ankle fusion in all patients was evaluated by clinical examination, and conventional radiography including anterior-posterior, lateral and mortise views of the ankle. ResultsAll 12 patients were followed up postoperatively for an average of 21.5 months(range, 6-55), and were proved be bone union by clinical examination and radiology with a mean of 13.5 weeks (range, 9-21). The AOFAS rating scale improved from a mean of 42.8±8.6 points at pre-operation to a mean of 66.6±5.4 points at post-operation 6 months,showing significant difference(t=-3.075, P=O.012), and to a mean of 72.3±4.6 at the final follow-up, also showing significant difference with pre-operation (t=-8.595, P=-0.006). There was no infection,local skin necrosis, screw loosing, and so on. ConclusionThe minimally invasive ankle arthrodesis with percutaneous cannulated scews is a recommend procedure, with mini-invasion, short surgery time, high fusion rate, good clinical outcomes, few complications.
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ObjectiveTo investigate the effect of different cyclic strengths on expressions of phospholipase A2 (PLA2) and cyclooxygenase (COX) in human tenocytes.MethodsHuman tenocytes were uniaxially stretched with different stretching intensity (4％, 8％ and 12％) under 0.5 Hz for four hours.Non-stretched tenocytes were applied to the control group.The expressions of cytosolic PLA2(cPLA2), COX1 and COX2 were measured by Western blot and RT-PCR.The secretion of secretory PLA2 (sPLA2) was measured by ELISA.Results The mRNA expressions of cPLA2, COX1 and COX2 in control group, 4％, 8％ and 12％ stretch groups showed an increase trend.But protein expressions of cPLA2 and COX1 in 4％ stretch group were increased insignificantly compared with the control group (P ＞ 0.05).Protein expressions of cPLA2 and COX1 in 8％ and 12％ stretch groups were increased more significantly compared with the control group (P ＜ 0.01).The COX2 expression in 4％,8％ and 12％ stretch groups showed statistical difference compared with that in the control group (P ＜0.01) and the difference increased with stretch intensity.There was no different expression of sPLA2 between 4％ stretch group and control group (P = 0.260).However, expression of sPLA2 was increased markedly in 8％ and 12％ stretch groups (P ＜ 0.01).ConclusionsThe expressions of human tendnocytes PLA2, COX1 and COX2 in vitro are positively correlated with stretch intensity.PLA2/COX system may be a new molecule target in clinical treatment of tendinopathy.
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Objective To investigate method of in vitro measurement of adult Chinese scapula glenoid version angle with MSCT postprocessing technique. Methods Fifty dry scapula specimens and 50 wet anticorrosive shoulder specimens of adult Chinese were scanned with Siemens Somatom Sensation 16 scanner. The scapula glenoid version angle was measured with postprocessing technique of thick or thin multiplanner reformation (MPR), and the data were analyzed statistically. Results The scapula glenoid version angle of dry scapula specimens and wet anticorrosive shoulder specimens was (-0.40±4.10)°, (-3.00±4.49)° with thick MPR, and (-0.34±4.21)°, (-2.70±4.54)° measured with thin MPR, respectively. There was significant difference of the scapula glenoid version angles between the dry scapula specimens and wet anticorrosive shoulder specimens (P0.05). Conclusion Measuring the scapula glenoid version angle with thick MPR of MSCT is simple and fast. The scapula glenoid version angle is markedly variable between the dry scapula specimens and wet anticorrosive shoulder specimens. The retroversion angle of scapula glenoid is about 3°, which should be considered in the design of shoulder prosthesis.
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Objective To investigate the clinical outcome of arthroscopic percutaneous cannulated screw fixation with subtalar fusion in the treatment of post-traumatic subtalar arthritis. Methods The study involved 12 patients (five males and seven females) with severe post-traumatic subtalar arthritis admitted to our hospital from April 2006 to December 2009. The patients were at age range of 28-68 years ( mean 45.6 years). All patients had the history of conservative treatment but failed in pain alleviation.Then, the percutaneous cannulated screw fixation plus subtalar fusion was selected. The ande and hind foot of all patients were evaluated preoperatively and postoperatively by the American Orthopedic Foot and Ankle Society (AOFAS) scoring system. Imaging assessment was carried out by X-ray examination.Results The patients were followed up for mean 21.2 months (range 6-48 months), which showed thatthe mean AOFAS ankle-hindfoot scale was increased from (54.67 ± 5.28 ) points (range 43-61 points)preoperatively to (89.17 ±3.56) points (range 78-95 points) at final follow-up, with excellence rate of 93%. Eleven patients got good fusion with the mean time of 12.4 weeks (range 9-15 weeks). Only one patient had nonunion, with the pain in the lateral malleolus. The subtalar joint of the patient got union after plaster immobilization for three months, which was proved by X-ray examination. Conclusions The arthroscopic percutaneous cannulated screw fixation and subtalar fusion can acquire good clinical outcomes and hence is a recommended procedure for post-traumatic subtalar arthritis.
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Objective To retrospectively analyze the clinical results of peroneal tendon insertion and reconstruction with suture anchors in the treatment of avulsion fractures of the fifth metatarsal base.Methods Five patients (three males and two females) with the fifth metatarsal base fractures were in zone 1, with average seven days of duration before surgery. The result of radiological examination confirmed that all fractures were in zone 1 of the fifth metatarsal base, with some small, comminuted and obviously displaced pieces. After removal of the small comminuted fracture pieces, the peroneal tendon insertion was dissociated and sutured to the fifth metatarsal base by suture anchors (5 mm in diameter) with line. The feet were immobilized by plaster in the vagus position. The patients began to walk with weightbearing six weeks after operation. Results All patients were followed up for at least six months, which showed no deformity of the feet. The function of forefoot valgus and abduction restored to normal. There was no any loss in muscle force compared with the normal side. Conclusions Peroneal tendon insertion and reconstruction by suture anchors is very helpful to solve the problem in the fixation of the small fracture fragments. The function of the peroneal tendon recovers very well. The surgery has the advantages of easy manipulation and small area of dissection, without requirement of secondary surgery.
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Objective To discuss the application value and improvement of principle of multi-echelon medical care in emergent rescue of the injured in Chinese Wenchuau earthquake. Methods The author analyzed and evaluated the medical rescue that was done at disaster site, in the front line hospital and higher level hospitals during earthquake. Results A total of 4 689 patients were treated at disaster site, including 413 patients with severe injury, of whom 3 died. Different kinds of operations including debridement were performed at disaster site, with infection incidence of open wound was nearly 80%. In the front hne hospital, 1 400 patients were treated, with 200 operations done. Of all, 110 patients with severe trauma were treated emergenfly, with an amputation rate of 3.0% and postoperative infection incidence of 66.8%. In the station hospitals, 125 patients received definite surgeries, with 1-5 surgeries per injury site. There was no postoperative cross infection, amputation or death. Conclusions The multi-echelon medical care is the basic mode for medical rescue of large number of patients in natural disaster rescue. First aid at disaster site should be performed as early as possible. Transportation is crucial for successful rescue and an improved patient grading system can help increase the efficiency of rescue. The front line hospitals should mainly provide life support, debridement and fixation of simple fracture, while the specific treatment and definite surgery should be carried out in the station hospitals.
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Objective To describe a new technique with mini-open reconstruction of lateral ligaments of ankle with partial tendon of its peroneus brevis and evaluate its effect in treatment of chronic lateral ankle instability. Methods A total of 11 cases of chronic lateral ankle instability;at mean age of 27.6 years(16-42 years),were treated with mini-open reconstruction of the lateral ligaments of the ankle with partial tendon of its peroneus brevis.The mean delay between the initial episode of ankle sprain and the surgery was 10.3 months(4-32 months).Postoperatively,all cases were examined with MRI,stress X-rays and comparative stability of bilateral ankle inspection at clinical follow-up.The function of the ankle were evaluated bv American Orthopaedic Foot & Ankle Society (AOFAS)score and ankle-hind foot scale. Results The average duration of follow-up was 17.5 months(12-37 months).The mean AOFAS ankle-hindfoot score was 88.3 points(72-96 points)at the time of the latest follow-up,including excellent result in 6 cases(55%),good in 4(36%)and fair in 1(9%).MRI results showed that the ruptured lateral collateral ligaments of the ankle were repaired and remodeled very well in all patients.There was no recurrence of the ankle instability or other complications. Conclusion Mini-open reconstruction of the lateral ligaments of ankle with partial tendon of its peroneus brevis is safe and effective for treatment of chronic lateral ankle instability.
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Objective To discuss how to reduce the incidence of postoperative infection and am-putation of patients after earthquake.Methods The wound infection and corresponding therapeutic outcome were analyzed in 592 patients in front line hospitals and station hospitals.Results The inci-dence of infection was 30. 7% in patients treated in front hospital within 8 hours post-trauma but 79. 9% after 8 hours post-trauma. There included 1 patient(0. 2%) with amputation due to clostridial myonecro-sis and 5(1. 2%)with amputation due to serious infection. Incidelice of postoperative wound infection was 7. 1% after selective operation for close injury. The incidence of infection in patients in station hospi-tals was 50. 8%, with no amputation, because they received debridement and antibiotics in site or front line hospitals. No postoperative infection was found in patients with close injury treated with selective op-eration in station hospitals. The major bacteria of wound infection in either front line hospitals or station hospitals were enterococcus faecalis and Eschrichia Coli. Incidence of combined infection was higher than that of single infection. And Gram-Negative bacillus infection exceeded Gram-Positive bacillus infection. The major wound infection obrained effective control through treatment with sensitive antibiotics.Con-clusions After earthqiale, the incidence of infection in patients with open injury is high, with high am-putation rate due to serious infection. Therefore, we propose performing as soon as possible debridement and external fixation with antibiotic treatment but reducing internal fixation. The postoperative infection late of patients with close injury in front line hospitals is much higher than that in station hospitals;their-fore, patients with stable vital signs should be transported to station hospitals as early as possible in order to reduce incidenee of infection.
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Objective To evaluate the clinical results of proximal humeral internal locking sys-tem(PHILOS)self-locking plates in treatment of proximal humeral fractures. Methods There were 35 patients including 19 males and 16 females(at mean age of 53.5 years,ranging from 29 to 92 years)with proximal humeral fractures treated with PHILOS plate.According to the Neer's classification sys-tem,there were two-part fractures in 19 patients,three-part fractures in 15 and four-part fractures in 1.Surgery was performed with PHILOS serf-locking plate via dehopectoral approach.All patients were fol-lowed up for mean 18.9 months(6-46 months)and evaluated by using Constant score and X-rays. Re-suits X-rays proved that all fractures got good reduction and complete healing during 8-12 weeks.The latest Constant scores was mean 89.5 points(82-94 points).There were no complications including plate loosing.humenral head necrosis or gleno-humeral ioint osteoarthritis. Conclusion PHILOS plate is a good choice for treatment of proximal humeral fractures because of its advantages including easy operation,stable fixation,good clinical results and few complications.
ABSTRACT
Objective To introduce a new modified Bristow operation with mini-open incision and evaluate jts clinical outcomes in treatment of recurrent anteroinferior shoulder dislocation. Methods A total of 11 patients with recurrent anteroinferior shoulder dislocation were treated with modified Bristow op-eration with mini-open incision.The anterior skin incision with 3-5 mm was made to explore the coracoid process with"moving window"technique.Then.the coracoid process and its short head of biceps were os-teotornjed.transferred and fixed on the anteroinferior potion of scapular neck through the rotator cuff inter-space.All patients were followed up for an average period of 15.8 months(6-48 months)by using modified Rowe score. Results The average operation time was 45 minutes(40-65 minutes).The modified Rowe 8core ranged from 80 to 95 points.excellent in all patients, with SUCCESS rate of 100% and without any re-currence or complication. Conclusions Compared with traditional operation.the modified Bristow oper-ation has smaller incision,less trauma.shorter operation duration and better clinical results.