Progress on femorotibial mechanical axis of total knee arthroplasty / 中国骨伤

Femorotibial mechanical axis (FTMA) is one of important factors influencing clinical effect after total knee arthroplasty (TKA). It is generally believed that the range of lower limb alignment after TKA is controlled within neutral FTMA ± 3 °, which has more advantages in improving joint function, prolonging prosthesis survival rate and reducing revision rate, and obtain better clinical results. Therefore, neutral FTMA is also considered to be the gold standard for TKA. However, with the application of computer-assisted surgery and other technologies, the alignment of FTMA is more accurate than before, but the clinical effect after surgery has not significantly improved. Some scholars have begun to question the necessity of neutral alignment of FTMA, and proposed alignment methods such as kinematics and retained residual deformity, which could achieve better clinical effects. In recent years, it has been reported that FTMA might not be the most important factor influencing postoperative clinical effects, and it is suggested that the arrangement and measurement of lower limbs and the effects on adjacent joint functions could affect clinical effect after TKA. The paper reviews neutral FTMA alignment is still an important factor for success of TKA. After a thorough evaluation according to the patient's condition, it should be appropriately applied in the case of neutral FTMA alignment; the operator should explore other factors which affect clinical outcome after TKA, and improve it to achieve the best therapeutic effect.

Effect of hip fracture at different sites in elderly patients on prognosis / 中国骨伤

<p><b>OBJECTIVE</b>To determine the effect of site of fracture on the prognosis for patients of elderly hip fracture.</p><p><b>METHODS</b>From January 2012 to December 2014, 667 patients with hip fractures were divided into femoral neck fracture group and intertrochanteric fracture group according to the site of fracture. There were 304 cases of intertrochanteric fracture, including 96 males and 208 females, with an average age of (80.33±7.94) years old. There were 217 cases of femoral neck fracture, including 74 males and 143 females, with an average age of (79.82±9.33) years old. Patients' data, mortality and activities of daily living were compared between two groups.</p><p><b>RESULTS</b>There were no significant differences in age, gender, comorbidity, ASA classification, and anesthesia between two groups, but the time of admission to surgery, duration of operation, blood loss of intra-operative, volume of drainage, and the average of transfusion were shown to have significant differences. The levels of White blood cell count (WBC) for intertrochanteric fracture group were shown to be higher than that of femoral neck fracture patients at admission, 1, 3 and 5 days after operation. The levels of hemoglobin, and albumin for intertrochanteric fracture were lower than that of femoral neck fracture patients at all period of time. The mortality of intertrochanteric fracture group during hospitalization, 1, 3, 6, and 12 months were higher than that of femoral neck fracture, but did not reach significant difference. In patients who survived, the scores of ADL for femoral neck fracture were higher than that of intertrochanteric fracture at discharge, 1, 3 months after operation, but there was no significant difference for ADL at 6 and 12 months between two groups.</p><p><b>CONCLUSIONS</b>The response of stress for intertrochanteric fracture were more than femoral neck fracture, but the mortality was similar than that of femoral neck fracture after excluding the influence of age, sex, comorbidity, and other factors. Compared to intertrochanteric fracture, the femoral neck fracture patients had a better functional recovery during early stage, and the two groups reached a similar functional recovery at 1 year after operation.</p>

Factors influencing postoperative mortality one year after surgery for hip fracture in Chinese elderly population / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Disability and death following hip fracture is becoming more common as the population ages. Previous reports have focused on the selection of internal fixation methods and the analysis of the perioperative therapeutic results in the Chinese population. Few studies have focused on factors influencing medium and long term survival after surgery for hip fracture. We conducted a retrospective study on the factors influencing survival one year after hip fracture surgery in our elderly Chinese population to provide a reference for improved treatment and to enhance efficacy.</p><p><b>METHODS</b>Records from patients undergoing treatment for hip fracture at our hospital from October 2009 through June 2011 were retrospectively reviewed. Through telephone follow-up, the health condition of each patient was surveyed, and the 1-year postoperative mortality was analyzed. The patients' age, gender, fracture type, pre-injury health condition, mobility, complications, surgical timing, surgical types, methods of anesthesia, and postoperative complications were analyzed. Univariate and multivariate regression analysis was performed on relevant influencing factors.</p><p><b>RESULTS</b>A total of 184 patients had complete data and were followed-up for 12-23 months (average, 16.5 months). There were 30 deaths (16.3%) at one-year. Univariate analysis revealed that factors such as age, gender, fracture-type, number of co-existing diseases, complications such as chronic obstructive pulmonary disease or sequelae of stroke, American society of Anesthesiology (ASA) scores, anesthesia methods, pre-injury activity, and post-operative complications were significantly different between survival versus mortality groups (P < 0.05). Multivariate regression analysis revealed that age, ASA score, pre-injury mobility and combined chronic obstructive pulmonary disease were independent risk factors for death.</p><p><b>CONCLUSION</b>Full consideration of medium-/long-term risk factors in the treatment of hip fracture in the elderly, selection of appropriate anesthesia and treatment methods, and improved pre-surgical health conditions would reduce postoperative mortality and enhance surgical efficacy.</p>

VSD combined with fascio-cutaneous flap transferation staging operation to treat post-traumatic osteomyelitis / 中国骨伤

<p><b>OBJECTIVE</b>To explore the therapeutic effects of VSD combined with fascio-cutaneous flap transferation staging operation for the treatment of post-traumatic osteomyelitis.</p><p><b>METHODS</b>From December 2007 to December 2009, 14 patients were treated with the technology of VSD combined with fascio-cutaneous flap transferation staging operatinon. Nine patients were males and 5 patients were females, and mean age was 36 years. All the patients were postoperative wound infection. Osteomyelitis of the tibia was in 9 cases, calcaneus in 3 cases, femur in 1 case, radius and ulna in 1 case; infection of time were from 2 to 96 weeks, an average time of 32 weeks.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 12 to 36 months, with an average of 19.2 months. All the patients were treated with debridement and VSD for 1 to 3 times, with an average of 1.57 times. The wounds of 13 cases healed well after flaps transferation, but of 1 case leakaged and healed after 3 weeks with the therapy of drainaging and changing dressings. Due to delayed healing or defects of bone, 8 patients had autologous bone grafted on the second stage. All wounds and fractures healed without recurrence of postoperative infection.</p><p><b>CONCLUSION</b>VSD combined with flap transferation is an effective treatment of post-traumatic osteomyelitis, which can shorten the treatment time and have better security and reliability than traditional methods.</p>

Treatment of vertical unstable pelvic fracture by percutaneous iliosacral screws fixation / 中国骨伤

<p><b>OBJECTIVE</b>To retrospectively analyze the patients of vertically unstable pelvic fractures treated with percutaneous iliosacral screws fixation and to explore the operative techniques and its therapeutic efficacy.</p><p><b>METHODS</b>From June 2002 to August 2009, 54 patients with vertical unstable pelvic fracture were fixed with percutaneous iliosacral screws. After operation, 46 patients were followed up more than 18 months. Among them, 32 patients were male and 14 patients were female, the average age was 36.4 years old (ranged from 19 to 64 years). The average time from injury to operation was 8.5 days (ranged from 7 to 11 days). All pelvic fractures had vertical dislocation ranging from 8 to 40 mm (averaged 28.5 mm). After admitted, all patients were applied bone traction. After recuction, the fractures were fixed with percutaneous iliosacral 7.3 mm cannulated screws, which crossed the iliac and sacral-iliac joint and sacral promontory to S(1)vertebrae. After operation, all patients took X-ray examination. The reduction and the fracture reduction were judged according to Matta criterion and clinical function was judged according to Majeed functional scoring.</p><p><b>RESULTS</b>Forty-six patients were followed up from 1.5 to 3 years with an average of 29 months. Fracture uninon was achieved in all patients. All patients got clinical recovery at mean time of 5.2 months and returned to normal daily life. According to Matta criterion for fracture reduction, the results were excellent in 40 cases and good in 6 cases. According to Majeed functional scoring, 32 patients were excellent, 12 good and 2 normal. There were no serious complications of vascular damage.</p><p><b>CONCLUSION</b>Percutaneous iliosacral screw fixation is an effective technique with advantages of minimal invasive and faster recovery in the management of vertically unstable pelvic fractures.</p>

The surgical separation of pygopagus conjoined twins / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the program of preoperative evaluation, preoperative preparation and separation operation of pygopagus conjoined twins.</p><p><b>METHODS</b>Clinical data of one case of pygopagus (male, gestational age 37 weeks, uterine-incision delivery, 3.5 months old; twins of triplets; total body weight 8.0 kg. The twins have self-governed extremities, anus, penis. Four limbs can move independently). Separated successfully were analyzed. The auxiliary examination of X-rays, MRI, ultrasound, CT and 3D reconstruction, sensory evoked potential showed that there were process hypoplasia and lamina bifid of lumbosacral vertebrae below L3. Dural sac connected below L3 and conus medullaris located at L3. There were no conjunction of spinal cord and cauda equine. The decision of direct suture of dural sac was made by preoperative evaluation through measurement of circumference and area of conjoined dural sac. The separation surgery program was decided through team debate and sham operation. Separation operation was performed under the general anaesthesia. Crossing V-shaped skin flap was used to cover the wound surface. The dura of conjoined twins were sutured directly. The tension of skin flap was normal postoperative with continuing negative pressure drainage under the flap and pressure sterilized dressing.</p><p><b>RESULTS</b>Successful separation of pygopagus conjoined twins was achieved. Lower extremities movements of separated twins were normal 6 h after operation. The drainage was removed 1 day postoperative, blood supplies of skin flap were normal. There were no complications of infection, cerebrospinal fluid leakage and neurological deficit. The healing of the skin flap was good. With 6 months follow-up, the growth and neurological function were normal.</p><p><b>CONCLUSION</b>Consummate preoperative preparation, accurate preoperative investigations, meticulous operative management, careful postoperative administration and good team cooperation are the keys to successful separation of pygopagus conjoined twins.</p>

Factors associated with response to lamivudine: retrospective study of 233 patients with chronic hepatitis B / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To identify factors associated with response to lamivudine in chronic hepatitis B patients.</p><p><b>METHODS</b>Clinical data of 233 chronic hepatitis B patients treated with lamivudine 100mg daily (91 patients were switched to Adefovir 10mg daily or Adefovir 10mg in combination with lamivudine 100mg daily) were retrospective. HBV DNA level and serum HBV markers were detected by polymerase chain reaction and enzyme-linked immunosorbent assay. Kaplan-Meier, long-rank, t test were conducted to evaluate the data.</p><p><b>RESULTS</b>(1) The rates of HBV DNA loss, ALT normalization, viral breakthrough(VB), HBeAg loss and seroconversion were 63.4% , 83.8%, 30.9%, 30.9%, and 14.3%, respectively, in HBeAg(+) patients; and these were 84.6%, 81.3%, 14.3%, respectively in HBeAg(-) patients.(2) The rates of HBV DNA loss, HBeAg loss, HBeAg seroconversion, viral breakthrough (VB) were 55% and 66.7% (P more than 0.05), 55.0%, and 66.7% (P less than 0.05), 17.5% and 33.3% (P less than 0.05), 50% and 34.3% (P less than 0.05) in HBeAg(+) patients with baseline ALT less than 2.5 ULN and HBeAg(+) patients with baseline ALT is more than or equal to 2.5 ULN, respectively. (3) For HBeAg(+) patients, viral breakthrough rate was significantly lower in patients with baseline HBV DNA less than 10(6) copies/ml than that in patients with baseline HBV DNA more than 10(6) copies/ml patients (23.4% VS 46.3%, P less than 0.05) among HBeAg(+) patients. (4) The rate of HBV DNA loss, HBeAg loss, HBeAg seroconversion and viral breakthrough for the patients with IVR at week 24 were 76.3%, 72.3%, 40.8% and 28.9% compared to 47.6% (P less than 0.01), 46% (P less than 0.01), 12.7% (P less than 0.01) and 47.6% (P less than 0.05) for those without IVR. (4) For the 44 patients with viral breakthrough, 32 were switched to Adefovir monotherapy or adefovir in combination with lamivudine therapy, and 12 continued to receive lamivudine monotherapy. HBV DNA loss, HBeAg seroconversion were 40.6%, 21.9% for those switch/add group compare to 16.7%, 16.7% for the lamivudine monotherapy group. There were no significant differences in the background factors (sex, diagnosis, antiviral period, pre-tx ALT, pre-tx HBV DNA) between these two groups.</p><p><b>CONCLUSION</b>Both the baseline ALT and HBV DNA are associated with the efficacy of lamivudine in chronic hepatitis B patients. Patients with baseline ALT is more than or equal to 2.5*ULN and (or) HBV DNA level of less than 1*10(6) copies/ml have better efficacy and lower rate of breakthrough rate. IVR at week 24 is an important predictive factor of a favorable response to lamivudine therapy. For the patients with viral breakthrough, those switched to/added on Adefovir have a favorable result.</p>

Value of imaging in the preoperative diagnosis of pygopagus conjoined twins / 中华儿科杂志

<p><b>OBJECTIVE</b>To explore the value of imaging in the preoperative evaluation of pygopagus conjoined twins (PCT), and analyze the significance of imaging for separation surgery plan and prognosis.</p><p><b>METHODS</b>Imaging data of a case with PCT, including ultrasound, X-ray, CT, MRI were collected from the case with PCTs treated in our hospital. The features of the images were analyzed for identification of the conjoined region, size, and structures and for judgement of other organ malformation and general body state.</p><p><b>RESULTS</b>The conjoined region located at the lumbosacral spine of which anteroposterior diameter was 7.9 cm, and 6.0 cm for cranial-caudal diameter. Spina bifida were found below L3 in bilateral twins. There were no bone structures but cartilage fusion in spine and pelvis. The neural structure such as spinal cord and cauda equina, lower GI tract and anus, and urinary tract were separated. The dural sac were fused. There were cryptorchidism in one twin, patent ductus arteriosus in both twins. The intraoperative finding matched with imaging results. Crossing V-shaped skin flap was used to cover the wound surface. The dura of conjoined twins were sutured. Successful separation of the PCT was achieved. There were no complications of infection, cerebrospinal fluid leakage and neurological deficit. The healing of the skin flap was good. With 6 months follow-up, the growth and neurological function were normal.</p><p><b>CONCLUSIONS</b>Imaging methods were selected according to the type of conjoined twins and the clinical symptoms and signs. The radiologic investigation can reveal the structure and size of conjunction area. Imaging investigation has important significance for the prediction of difficulty in surgery, selection of surgical procedures, and evaluation of prognosis.</p>

Flexor digitorum (hallucis) longus muscle tendon transfer in the repair of old rupture of the Achilles tendon / 中国骨伤

<p><b>OBJECTIVE</b>To explore the operative technique of repair and its curative effect of old rupture of the Achilles tendon with flexor digitorum (hallucis)longus tendon transfer.</p><p><b>METHODS</b>From Nov 2001 to May 2005, 13 patients who had old rupture of the Achilles tendon were treated with this operative technique. Five of them were treated with flexor digitorum longus tendon transfer and 8 with flexor hallucis longus tendon. All patients had the history of closed injury of Achilles tendon(9 male and 4 female, 8 left feet and 5 right feet). The age ranged from 32 to 69 years(mean 41 years).</p><p><b>OPERATIVE TECHNIQUE</b>flexor digitorum (hallucis)longus tendon was cut down alternatively. The distal end of flexor digitorum longus tendon should be sutured to flexor hallucis longus tendon if the flexor digitorum longus tendon was cut. The distal end of flexor hallucis longus tendon should be sutured to flexor digitorum longus tendon if the flexor hallucis longus tendon was cut. The proximal end of tendon to be cut down was sew up a suture line and pulled out from the incision to reveal the Achilles tendon. A transverse hole was drilled through the anterior aspect of the insertion of the tendon of the calcareous, and then drilled upward perpendicularly. The two holes were cross-connected by towel clamp. The flexor digitorum (hallucis)longus tendon to be transferred was pulled through the first hole from wall outward and upward, and then pulled through superior extremity of the second hole. The end of tendon was sutured firmly with the Achilles tendon.</p><p><b>RESULTS</b>All patients have no infection or re-rupture during follow-up (average 24 months;range 11 to 54 months). There was no subsequent hammer-toe deformity. Dorsiflexion at least to neutral and normal plantar flexion were obtained in all patients. According to Arner-Lindholm standard,the final results were excellent in 9 patients(6 cases were used flexor hallucis langus tendon, and 3 cases were used flexor digitorum longus tendon),good in 3 patients(2 cases were used flexor hallucis longus tendon and 1 case was used flexor digitorum longus tendon) and poor in 1 patient used with flexor digitorum longus tendon.</p><p><b>CONCLUSION</b>The repair of old rupture of the Achilles tendon with flexor digitorum (hallucis) longus tendon transfer is an ideal and effective method. Furthermore, the use of flexor hallucis longus muscle tendon tends to be more reasonable.</p>

A long-term observation and follow-up for patients with HBeAg/Anti-HBe seroconversion after lamivudine treatment / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To observe the resulting change in patients who achieved HBeAg/Anti-HBe seroconversion after lamivudine treatment.</p><p><b>METHODS</b>68 patients were observed for over 24 months. They were HBeAg/Anti-HBe with a seroconversion time > or = 6 months and the course of lamivudine treatment was > or = 18 months.</p><p><b>RESULTS</b>After lamivudine treatment, the rate of HBeAg/Anti-HBe seroconversion was 25.19%, the rate of YMDD mutations was 20.59%, and the rate of relapse was 27.94% for these patients that achieved HBeAg/Anti-HBe seroconversion in observation and in the follow-up period. Lamivudine was still an effective drug for these patients with relapses. The rate of relapse was in correlation to the patients' age and the ALT level before treatment. The rate of relapse was not correlated to the HBV DNA level before the course of treatment. YMDD mutations were not correlated to the relapses.</p><p><b>CONCLUSION</b>Even with a HBeAg/Anti-HBe seroconversion time > or = 6 months, the rate of relapse was still higher in patients with chronic hepatitis B that received lamivudine. The patients with long-term lamivudine treatment should be observed and have frequent follow-up visits.</p>