ABSTRACT
Objective To explore the effectiveness of ipsilateral autologous semitendinosus ten don graft in treatment of lateral ankle ligament injuries and ankle instability. Methods Two patients including one male (25 years old) and one female (17 years old) with chronic lateral instability of the ankle were enrolled in the study. Both patients had the history of repeated ankle sprain in supination position and had grade Ⅲ injury of the lateral ankle ligament according to the American College of Foot and Ankle Surgeons Grading System. Anterior drawer test and talar tilt test were all positive. The stress-inversion radiograph demonstrated the average inclination of the talus for 21 ° and the lateral radiograph demonstrated anterior dislocation of the talus. The chronic ankle instabilities in two patients were treated by using the ipsilateral autologous semitendinosus tendon graft to reconstruct the lateral ankle ligament. Results The two patients were followed up for mean eight months, which revealed that the active and passive range of motion was good, with no pain or swelling. The anterior drawer test and talar tilt test were all negative. The stress-inversion radiograph demonstrated that the average inclination of the talus was less than 5°, with no anterior dislocation of the talus. According to the Mazur grading system, the clinical outcome was excellent in one patient and good in one. The two patients were satisfied with the stability of the ankle. Conclusions ( 1 ) Lateral ankle ligament injury is a common cause of chronic ankle instability,even the ankle osteoarthritis. ( 2 ) Brostr(o)m method can attain satisfactory result for fresh lateral injury of the ankle, but not for the old injuries. ( 3 ) Ipsilateral autologous semitendinosus tendon graft is simpleand effective for treatment of lateral ankle ligament injuries and chronic ankle instability and may play an important role in the treatment of lateral ankle instability and prevention of the occurrence of ankle osteoarthritis.
ABSTRACT
Objective To introduce the technique of OCM hospital (Orthopadische Chirurgie Munchen) in total hip arthroplasty (THA). Methods From January 2005 to January 2006, 20 cases of THA were done in our department with the technique of OCM hospital. The operative approach was through the anterior interval of gluteus medius, and a "V" shaped capsulatomy and a twice-osteotomy of femoral neck were conducted. Specialized acetabular saws and positioners of cup were applied to fix the prosthesis and a table was used to allow the posterior part to be removed. The affected femur was then further externally rotated so that the lower extremity could be placed in the sterilized bag beside the table. In order to achieve better position of the femoral stem, an extensive capsule release was done. Results BMI (body mass index) averaged 27. 4% , the length of skin incision 9. 3 cm, and blood transfusion two units for all the patients. The blood loss and the drainage were 130 mL and 80 mL respectively. In the mean follow up of 4. 3 months, 15 cases recovered completely but five still needed crutches. The mean VAS (visual analog scale) evaluation decreased from the preoperative 5. 1 to 3. 6 (one month later), 1. 7 (three months later ) and 0. 8 (six months later). The mean Harris scores of hip for all the cases increased from the 45. 4 to 88. 4 postoperatively. Conclusions OCM THA owns many advantages, such as small skin incision, less injury to gluteus medius and rapid recovery of patients, but compared with a conventional THA it needs a long learning and special instruments. Its indications are patients who are not over-weighted and have their first THA. Therefore, it is suggested that only qualified hospital and surgeons are allowed to perform the operation.
ABSTRACT
Objective To evaluate the effects of Burch-Schneider(BS) acetabular reinforcement ring applied in primary or revision total hip arthroplasties in 9 patients with combined or cavitary acetabular bone defects. Methods A retrospective follow up that averaged 3.8 years was performed with a special scoring system comprising the patients symptoms, signs and function. Results The excellent and good function were achieved in 89% of all cases. Conclusion 1)BS reinforcement ring could be effectively and reliably applied in primary or revision total hip arthroplasty or in patients with severe acetabular bone defects. 2)BS reinforcement ring shows the biological fixation feature, so as to provide good foundation for long-term satisfactory function of hip. 3)The lower ear of BS ring need not to be fixed to ischium with screws as usual, but be inserted in obturator foramen above transverse ligament, thus imparting some elastic resilience to it. 4)The upper ear should be folded through such a curve that its curvature was in compliance with that of ilium, which would be better performed in one session. 5)The appropriate amount of 0.8 cm?0.8 cm?0.8 cm morcellized allografting bone was used to snugly fill the space, which would be conducive to desirable incorporation between prosthesis and bone, and the authors propose that the patients should be allowed weight-bearing earlier.