Clinical observation of high tibial osteotomy for knee osteoarthritis:10 years follow-up / 中国骨伤

OBJECTIVE@#To explore long-term following-up clinical effects of lateral closed high tibial osteotomy for the treatment of knee osteoarthritis.@*METHODS@#Twenty patients with medial unicompartmental knee osteoarthritis were treated with lateral closed high tibial osteotomy and screw fixation from June 2005 to December 2015. Among them, including 17 females and 3 males, aged from 43 to 76 years old with an average of (57.80±8.05) years old. VAS score and KSS score were applied to evaluate recovery degree of pain and function before operation and after operation at 1, 5 and 10 years, and postoperative complications were observed.@*RESULTS@#Sixteen patients were followed-up, the time ranged from 9 to 11(10.0±0.8) years, 4 patients were loss to follow-up. Preoperative VAS score was 7.88±1.15 and decreased to 3.19±0.91, 3.44±0.96, 3.69±1.20 at 1, 5 and 10 years after operation, and there were statistical differences in VAS score between before and after operation at different time points (<0.05). Clinical score of KSS increased from 61.94±5.74 before opertaion to 75.50±4.62, 80.13±3.97, 77.38±6.40 at 1, 5 and 10 years after operation, and there were statistical differences in clinical score of KSS between before and after operation at different time points(<0.05); functional score of KSS increased from 62.81±13.03 before operation to 77.50±8.56, 81.88±6.55, 76.88±10.78, and there were statistical differences in functional score of KSS between before and after operation at different time points(<0.05). All incisions healed well without complications such as fibula nerve injury and fracture nonunion.@*CONCLUSIONS@#Lateral closed high tibial osteotomy and screw fixation for knee osteoarthritis could receive good clinical results, stop and delay progress of knee osteoarthritis, and long-term following-up could achieve the same effect as total knee arthroplasty.

Narrow Intercondylar Notch and Anterior Cruciate Ligament Injury in Female Nonathletes with Knee Osteoarthritis Aged 41-65 Years in Plateau Region / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Few data are available concerning intercondylar notch dimensions in female nonathletes with knee osteoarthritis (OA) in plateau region. The aim of this study was to assess the relation of intercondylar notch morphology to anterior cruciate ligament (ACL) injuries in female nonathletes with knee OA aged 41-65 years from the Chinese Loess Plateau.</p><p><b>METHODS</b>The study was conducted on 330 patients with ACL injury (aged 31-65 years; 159 males, 171 females), 141 patients with OA (aged 31-65 years; 59 males, 82 females), and 89 female healthy controls (aged 41-65 years), and this evaluation included identifying the distribution of patients with OA or ACL injury and measuring the intercondylar notch width indexes (NWIs).</p><p><b>RESULTS</b>There was a significant rising trend in patients with OA (the Kellgren and Lawrence grade = 3) with ACL injury (OA-S + ACL) aged 41-65 years, especially in females. We found that the notches of OA-S + ACL had a smaller NWI compared with control and OA without ACL injury (OA-S-only, P = 0.000, 95% confidence interval [CI] = -0.059--0.030; P = 0.000, 95% CI = -0.049--0.016). A similar trend was found in notch shape index (NSI), but not in notch depth index and the cross-sectional area. The cutoff of NWI and NSI value was 0.26, and 0.65, and area under the receiver operating characteristic curve was 0.82, and 0.79, respectively. Further study displayed a significant correlation between a reduced NWI and NSI and OA-S + ACL (P = 0.000, χ2 = 14.012; P = 0.000, χ2 = 14.286).</p><p><b>CONCLUSION</b>A narrower intercondylar notch and a plateau environment are risk factors of predisposing female nonathletes with knee OA to ACL injury aged 41-65 years.</p>

Relationship between coronal intercondylar notch width index and osteoarthritis / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the relationship between knee osteoarthritis (OA) and intercondylar notch narrowing based on the notch width index.</p><p><b>METHODS</b>Magnetic resonance (MR) images were collected from middle-aged and elderly patients with a definite diagnosis of knee OA, including 42 with mild OA and 37 with moderate to severe OA, with 70 healthy individuals serving as the control group. The notch width indexes NWI, NWI-A, and NWI-P on the coronal images at different levels were calculated, and the intercondylar notch was classified, according to the features on axial MR images, into types A, U, and W. The association of OA with NWI, NWI-A, NWI-P, and notch type was determined, and the cutoff values were obtained based on the ROC curves at different levels as indicators for diagnosis of intercondylar notch stenosis.</p><p><b>RESULTS</b>In the control, mild OA, moderate to severe OA groups, the NWI value on coronal MR images were 0.252±0.019, 0.251±0.017, and 0.240±0.020, NWI-A were 0.261±0.024, 0.259±0.023, and 0.245±0.023, and NWI-P were 0.271±0.026, 0.270±0.024, and 0.254±0.022, respectively. Patients with moderate to severe OA had significantly smaller NWI, NWI-A, and NWI-P than the other two groups (P<0.05), and a significant association was found between NWI values at each level and the occurrence of moderate to severe OA (P<0.01). A NWI value<0.248, NWI-A<0.256, and NWI-P<0.266 supported a diagnosis of intercondylar notch narrowing. Type A intercondylar notch was found in the majority of patients with intercondylar notch narrowing (P<0.05).</p><p><b>CONCLUSION</b>Patients with moderate to severe OA have significant intercondylar notch narrowing, and patients with a type A intercondylar notch are more likely to have intercondylar notch narrowing than those with type U notch.</p>

Early open reduction of acute incarceratied metacarpophalangeal dislocation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the mechanism and the treatment of acute incarcerated metacarpophalangeal dislocation.</p><p><b>METHODS</b>Seven patients (6 male and 1 female) with acute incarcerated metacarpophalangeal dislocation admitted from 1997 to 2006 were studied retrospectively. The age ranged from 8 to 33 years(mean 17 years). All the types were the dorsal dislocation. The dislocation were occurred on index finger in 3 cases, thumb in 2 cases, middle finger in 1 case and small finger in 1 case.</p><p><b>RESULTS</b>All the patients were followed up from 3 to 42 months with an average time of 21 months. Operative finding revealed the rupture of volar capsule and entrapment of metacarpal head. The joint function and postoperative X-ray showed anatomical reduction were good in all the patients.</p><p><b>CONCLUSION</b>Repeated manipulative reduction should not be advocated if the close reduction was not successful. In order to avoid influencing the joint function,early open reduction of acute complex metacarpophalangeal dislocation is necessary.</p>