Operative treatment for separation of distal tibiofibular syndesmosis / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study the influence of separation of distal tibiofibular syndesmosis on ankle joint and to compare various operative methods so as to find suitable stabilization for separated distal tibiofibular syndesmosis.</p><p><b>METHODS</b>From July 1997 to July 2002, we treated 87 patients (64 males and 23 females, aged 18-54 years) with separation of distal tibiofibular syndesmosis, among whom, 79 were combined with fracture of malleolus. Manipulative reduction, internal fixation with cancellous screws and external fixation with plaster support were performed on 37 patients, fixation with plate and screws for fibular fracture and fixation with cancellous screws for distal tibiofibular syndesmosis on 34 patients, and repair of the distal tibiofibular ligaments with tendon of peroneus longus, reduction of the separated distal tibiofibular syndesmosis, and fixation with cancellous screws on 16 patients. The ankle joint had been dorsiflexed for 30 degrees when the distal tibiofibular syndesmosis was fixed with cancellous screws. And the cancellous screws were taken out at 8-10 weeks after operation.</p><p><b>RESULTS</b>These patients were followed up for at least two years. The curative effects were assessed according to the complaints of the patients and the contour, function and radiogram of the ankle joint: excellent in 55 patients (63%), good in 18 patients (21%), and fair in 14 patients (16%). Separation of distal tibiofibular syndesmosis recurred in 2 patients, who underwent a reoperation for repairing the distal tibiofibular ligaments with tendon of peroneus longus and recovered. One cancellous screw was broken off. No necrosis developed in the anterior skin of the ankle mortise.</p><p><b>CONCLUSIONS</b>Separation of distal tibiofibular syndesmosis can be treated with various reasonable operations. Repair with tendon of the peroneus longus can get excellent outcomes for complete separation of the distal tibiofibular syndesmosis.</p>

Surgical treatment of scoliosis caused by neurofibromatosis type 1 / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To retrospectively analyze the relationship between curve types and clinical results in surgical treatment of scoliosis in patients with neurofibromatosis type 1 (NF-1).</p><p><b>METHODS</b>Forty-five patients with scoliosis resulting from NF-1 were treated surgically from 1984 to 2002. Mean age at operation was 14.2 years. There were 6 nondystrophic curves and 39 dystrophic curves depended on their radiographic features. According to their apical vertebrae location, the dystrophic curves were divided into three subgroups: thoracic curve (apical vertebra at T8 or above), thoracolumbar curve (apical vertebra below T8 and above L1), and lumber curve (apical vertebra at L1 and below). Posterior spine fusion, combined anterior and posterior spine fusion were administrated based on the type and location of the curves. Mean follow-up was 6.8 years. Clinical and radiological manifestations were investigated and results were assessed.</p><p><b>RESULTS</b>Three patients with muscle weakness of low extremities recovered entirely. Two patients with dystrophic lumbar curve maintained their low back pain the same as preoperatively. The mean coronal and sagittal Cobb's angle in nondystrophic curves was 80.3 degrees and 61.7 degrees before operation, 30.7 degrees and 36.9 degrees after operation, and 32.9 degrees and 42.1 degrees at follow-up, respectively. In dystrophic thoracic curves, preoperative Cobb's angle in coronal and sagittal plane was 96.5 degrees and 79.8 degrees, postoperative 49.3 degrees and 41.7 degrees, follow-up 54.1 degrees and 45.3 degres, respectively. In thoracolumbar curves, preoperative Cobb's angle in coronal and sagittal plane was 75.0 degrees and 47.5 degrees, postoperative 31.2 degrees and 22.8 degrees, follow-up 37.5 degrees and 27.8 degrees, respectively. In lumbar curves preoperative Cobb's angle in coronal plane was 55.3 degrees, postoperative 19.3 degrees, and follow-up 32.1 degrees. Six patients with dystrophic curves had his or her curve deteriorated more than 10 degrees at follow-up. Three of them were in the thoracic subgroup and their kyphosis was larger than 95 degrees, and three in lumbar subgroup. Hardware failure occurred in 3 cases. Six patients had 7 revision procedures totally.</p><p><b>CONCLUSIONS</b>Posterior spinal fusion is effective for most dystrophic thoracic curves in patients whose kyphosis is less than 95 degrees. Combined anterior and posterior spinal fusion is stronger recommended for patients whose kyphosis is larger than 95 degrees and those whose apical vertebra is located below T8. Patients should be informed that repeated spine fusion might be necessary even after combined anterior and posterior spine fusion.</p>

Biomechanical evaluation of stiffness of long-segment instrumented spine / 中国医学科学院学报

<p><b>OBJECTIVE</b>To test the changes of the stiffness of the intact, released, and instrumented spines in an in vitro porcine model.</p><p><b>METHODS</b>Twelve porcine spines (12 segments each) were harvested for the biomechanical tests with Material Test System. Stiffness during flexion, extension, lateral bending, and axial rotation were recorded; then the specimen was released with intervertebral discs and the facet joints removed, followed by repeating the biomechanical tests for stiffness; and finally, a double-rod titanium construct was applied for internal fixation to each released spine and stiffness tests were repeated again.</p><p><b>RESULTS</b>Compared with the intact porcine spines [stiffness during flexion, extension, lateral bending, and axial rotation was 52.89 +/- 15.98, 105.43 +/- 56.38, 42.09 +/- 14.73, and (16.94 +/- 4.85) N x mm/degrees, respectively], the stiffness of the released porcine spines [stiffness during flexion, extension, lateral bending, and axial rotation was 44.04 +/- 13.73, 41.46 +/- 10.80, 31.75 +/- 7.23, and (9.10 +/- 2.07)N x mm/degrees, respectively] significantly decreased (P < 0.05), while significantly increased stiffness was found in the instrumented porcine spines [stiffness during flexion, extension, lateral bending, and axial rotation was 385.96 +/- 143.25, 138.96 +/- 59.41, 152.56 +/- 87.15, and (55.91 +/- 16.49) N x mm/degrees, respectively] (P < 0.05).</p><p><b>CONCLUSION</b>Higher instant stiffness was found in instrumented spine than the intact one during flexion, extension, lateral bending and axial rotation.</p>

Patellofemoral replacement for severe patellofemoral osteoarthritis: a 2-10 years follow-up study / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the therapeutic effects of patellofemoral replacement for severe patellofemoral osteoarthritis.</p><p><b>METHODS</b>Patellofemoral replacement was performed in 30 patients (36 knee joints) with severe patellofemoral osteoarthritis, among whom were 5 males and 25 females. The patients ranged in age from 36 to 74 years old (mean +/- s, 55.8 +/- 8.5) and were followed up for 2-10 years.</p><p><b>RESULTS</b>Significant improvement was made in both the knee score and functional score after the patellofemoral replacement. The effective rate was 88.9% and 91.7% evaluated with knee score and functional score respectively.</p><p><b>CONCLUSION</b>Patellofemoral replacement is effective in treating severe patellofemoral osteoarthritis in appropriate cases.</p>

Complications associated with the technique of pedicle screw fixation / 中国医学科学院学报

<p><b>OBJECTIVE</b>To analyze the causes of the complications associated with the pedicle screw fixation during and after operation, as well as the methods for prevention and treatment.</p><p><b>METHODS</b>From January 1988 to December 1999, 475 patients who underwent pedicle screw fixation for various spinal disorders were reviewed retrospectively with statistical analysis.</p><p><b>RESULTS</b>Four hundred and twenty-eight patients (90.1% of all) were followed up for (6.0 +/- 3.7) years. Complications of CD, DRFS, Dick, RF and steffee among 72 cases (80% of all) occurred during the operation of pedical screw fixation in 26 cases with the incidence of 5.5% and after the operation in 64 cases with the incidence of 15%. The incidence of operative/postoperative complications were 0-12.9% in CD, 6.8%-11.9% in DRFS, 7.3%-12.7% in Dick, 2.4%-19.5% in RF, and 10.1%-21.5% in Steffee respectively. The main complications included pseudoarthrosis, pedicle screw broken, pedicle screw malposition and so on. The complications were mainly due to unskilled technique of pedicle screw fixation, implant defect in design and so on.</p><p><b>CONCLUSIONS</b>The complications associated with the technique of pedicle screw fixation must not be neglected. The main causes are laid on unskilled technique of pedicle screw fixation and implant defect in design.</p>

Surgical treatment of spine metastatic tumor / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the value of surgical treatment on spine metastatic tumor.</p><p><b>METHODS</b>31 cases of spine metastatic tumor with severe pain or/and neurological deficit were selected and treated with various operative methods.</p><p><b>RESULTS</b>Except for 4 cases, all the patients survived from 3 months to 7 years (average 17.6 months). The patients had no complication during treatment. The symptoms and neurological functions recovered with various extent after operation.</p><p><b>CONCLUSIONS</b>Surgical treatment should cautiously be adopted. When the spine metastatic tumor with severe pain and neurological deficit has no response to the conservative methods, the surgical treatment with decompression and internal fixation should be performed to improve the life quality for the patients.</p>