Clinical outcomes of total hip arthroplasty for treatment of end-stage hip joint with pigmented villonodular synovitis / 局解手术学杂志

Objective To study the clinical efficacy of total hip arthroplasty for treatment of end-stage hip with pigmented villonodular synovitis(PVNS).Methods From January 2000 to March 2015,a total of 34 patients with hip PVNS were treated by total hip arthroplasty (THA) combined with synovectomy.Pelvic X-ray,CT and MRI examinations were performed before the surgery,and Harris hip joint function score was performed before and after surgery.Systematic rehabilitation training was performed after the operation,and the hip joint X-ray films were regularly reviewed.Results All the 34 patients were reviewed and observed for an average of 5.2 years (ranged from 1.5 to 7 years).The position of the prosthesis was good and the motion of the joint was satisfactory.The mean preoperative Harris hip scores improved from (45.0 ± 6.4) perioperatively to (90.2 ± 3.2) postoperatively,with statistically significant difference (t =0.468,P ＜ 0.05).None of the patients had clinical or radiographic evidence of recurrent PVNS.Conclusion Total hip arthroplasty combined with synovectomy is an effective therapeutic choice for end-stage hip with pigmented villonodular synovitis,which can improve the clinical results and prevent the disease recurrence.

Effect of extended release of posterior clearance on flexion clearence and range of motion of the knee in total knee arthroplasty / 中华外科杂志

<p><b>OBJECTIVE</b>To observe the change of clearance and range of joint improved situation during total knee arthroplasty (TKA) by operating extended release manipulation of the posterior knee clearance.</p><p><b>METHODS</b>A total of 120 patients with knee osteoarthritis undergoing unilateral TKA from March 2010 to March 2012 were equally randomized prospectively assigned to the experimental group and control group, each 60 cases. There were 46 male and 74 female patients, the mean age was 63.6 years (range from 49 to 75 years). After the osteotomy of the tibia and the femoral condyle and before the release of soft tissue intraoperation, patients in experimental group were taken the extended release manipulation of the posterior knee clearence while the control group were cleaned the osteophyte of the posterior condyle only, 2-sided paired t test was used to compare the clearence intraoperation and the time to flexion angle of 90° and 120° and the maximum angle after 3 months' follow-up.</p><p><b>RESULTS</b>There was no significant difference of the index between the experimental group and control group (P > 0.05). Between experimental group and control group, the difference was significant in extention clearance ((18.9 ± 1.5) mm vs. (17.9 ± 1.6) mm, t = 3.53, P < 0.01) intraoperation, and no significant difference in flexion clearance ((20.7 ± 1.8) mm vs. (20.2 ± 1.9) mm, t = 1.48, P > 0.05). It took longer time for the knee flexion range of motion to 90°(t = 10.2399, P < 0.01) or 120°(t = 11.142, P < 0.01) of the control group than that of the experimental group, and the difference of the maximum range of motion between experimental group and control group was significant statistically at the 3-months follow-up (t = 4.4255, P < 0.01). All the patients were followed up for 3 - 24 months, average of 14.6 months, no femoral component loosening happened.</p><p><b>CONCLUSIONS</b>Extended release of the posterior knee clearance benefits the knee extension clearence intraoperation and functional exercise of range of motion postoperation, while it is no meaning to the flexion clearence.</p>

The use of uncemented extensively porous-coated femoral components in the management of Vancouver type B2 periprosthetic femoral fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the outcome of patients with Vancouver type B2 periprosthetic fractures treated with femoral revision using an uncemented extensively porous-coated implant.</p><p><b>METHODS</b>From October 2002 to May 2007, a retrospective clinical and radiographic assessment of 10 patients with Vancouver type B2 periprosthetic fractures treated with femoral revision was evaluated, among which 4 was cement fixation, 6 was non-cement fixation in the index procedure.</p><p><b>RESULTS</b>The mean follow-up for these patients was 44 months (range, 12 to 67 months). The mean Harris hip score was 87.6 points. All 10 reconstructions showed solid fracture union and a stable prosthesis, 8 was bone ingrowth, 2 was fibrous ingrowth. Complications in 4 patients included thigh pain in 1, stress shield in 3.</p><p><b>CONCLUSIONS</b>Vancouver type B2 periprosthetic fractures treated with uncemented extensively porous-coated femoral stems incorporate distally allowing stable fixation.</p>

Effect of total hip replacement on lumbago in unilateral developmental hip dysplasia / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the effect of total hip replacement on lumbago in patients with unilaterally developmental hip dysplasia.</p><p><b>METHODS</b>From January 2001 to January 2006, 39 adult patients with unilateral developmental hip dysplasia co-exiting lumbago were included. Among them, there were 32 females and 7 males, age from 38 years to 73 years. According to Crowe classification system, there were 4 in type I, 20 in type II,8 in type III and 7 in type IV. They were performed total hip replacement. The Harris Hip Score and the Oswestry Disability Index were used to evaluate hip and spine symptoms in same patient before and 3, 24 months after operation.</p><p><b>RESULTS</b>Thirty-nine patients were evaluated, both hip and spinal pain and function were significant improved. The mean Harris score increased from 44 to 84 (P < 0.01). The mean Oswestry Scores dropped from 36 to 25 (P < 0.01).</p><p><b>CONCLUSION</b>Spinal function and lumbago is improved after total hip replacement in patients with unilateral developmental hip dysplasia at 3 months, which is maintained and enhanced in 2 years.</p>

Diagnosis, treatment and long-term following up of 223 patients with hyperphenylalaninemia detected by neonatal screening programs / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the incidence of hyperphenylalaninemia (HPA) caused by different etiologic factors in China and the relationship between the phenylalanine and mental development of patients with HPAs who were diagnosed by neonatal screening and early treated.</p><p><b>METHODS</b>Two hundred and twenty-three patients with HPA detected by neonatal screening programs were refered to us at the age of (41 +/- 27) days after birth. The differential diagnosis was performed by BH(4) (20 mg/kg) loading test, urinary pterin analysis and dihydropteridine reductase (DHPR) activity determination respectively. The control of phenylalanine (Phe) metabolism, growth and mental development were evaluated in all treated patients. Related gene mutation analysis was performed in some patients</p><p><b>RESULTS</b>One hundred and twenty-nine of 223 patients (57.8%) were diagnosed as phenylalanine hydroxylase deficiency (PAHD), 64 patients (28.7%) as BH(4) responsive PAHD, 30 patients (13.5%) as 6-pyruvoyl tetrahydropterin synthase deficiency (PTSD). One hundred and forty-nine patients were followed at age of 4 m - 2 y in our clinic. The 136 of 149 patients were treated according to different etiology at the age of 1.6 m (0.5 - 3.5 m) after birth. Thirteen patients were followed up without the need for treatment. All patients had normal growth development. One hundred and eight (79.4%) of 136 treated patients had normal mental development. The negative correlation (r = -0.439, P < 0.01) between IQ and average Phe levels were observed in 58 patients. Twenty-eight patients were able to go to primary school or even university. Nine kinds of PTS gene mutations were found in 9 cases with PTSD, among which 286G-->A and 259C-->T were most commonly seen, accounting for 45%. Seven kinds of PAH gene mutations were found in 13 cases with BH(4) responsive PAHD with the R241C (43.8%) mutation being the most frequent one.</p><p><b>CONCLUSION</b>The differential diagnosis should be quickly made in all HPA patients detected by neonatal screening. Near 80% patients early treated had normal mental development. The good control of blood Phe level is a key factor for mental development.</p>

Patella reshaping versus resurfacing in total knee arthroplasty: a prospective randomized study / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the differences in the clinical outcome of total knee arthroplasty according to patellar reshaping or resurfacing.</p><p><b>METHODS</b>From January 2002 to December 2002, 60 patients (60 knees) undergoing primary total knee arthroplasty for the treatment of osteoarthritis were enrolled in a prospective, randomized study. All patients received the same posterior-cruciate-substituting total knee prosthetic components. Patients were randomized to the treatment with reshaping or resurfacing of the patella, and the results were followed up for a mean of 54 months (40-60 months). Evaluations consisted of the determination of a Knee Society Score, range of motion for knees, patient satisfaction, and radiographs.</p><p><b>RESULTS</b>With the numbers available for study, no significant difference was found between the knees that had patellar resurfacing and those that had patellar reshaping with regard to the overall score (P=0.12), the subscore for pain (P=0.90), and patient satisfaction (P=0.22). The results showed that the same prevalence of any anterior knee pain in two groups was 10%, and it did not represent a significant difference. The two groups showed statistical difference with regard to the total function score and range of motion.</p><p><b>CONCLUSIONS</b>It has shown that total knee arthroplasty with patella reshaping or resurfacing dramatically relieves pain and improves the function. It seems that postoperative anterior knee pain is related either to the component design or to the details of the surgical technique, rather than to whether or not the patella is resurfaced.</p>

Radiographic analysis of rotational malalignment between tibial component and femoral component in total knee arthroplasty / 中华外科杂志

<p><b>OBJECTIVE</b>To identify possible reasons of rotational mismatch between tibial component and femoral component in total knee arthroplasty and choose a right reference axis for placing the components in the operation and to decrease the complications.</p><p><b>METHODS</b>Forty normal Chinese knees were studied. There were 20 men and 20 women, and average age was 34 years (range, 18 - 42 years). The images of cross sections of the distal femur were obtained by spiral CT scanning (0.5 mm thickness). Scan direction was aligned to be in the plane perpendicular to the mechanical axis of the tibia. On the images of the distal femur and the proximal tibia, three baselines for the anteroposterior axis of the femoral component were drawn based on the clinical epicondylar axis and the surgical epicondylar axis and 3 degrees lateral rotated to the posterior condylar surfaces of the femur separately, and a baseline for the anteroposterior axis of the tibial component was drawn based on the medial 1/3 of the tibial tuberosity. The rotational mismatch angles were measured between each component by using the Autocad software.</p><p><b>RESULTS</b>The mean rotational mismatch angle between tibial component and femoral component is 2.94 degrees for the clinical epicondylar axis, 6.50 degrees for the surgical epicondylar axis and 6.83 degrees for 3 degrees lateral rotation of the femoral component referenced to the posterior condylar axis separately.</p><p><b>CONCLUSIONS</b>Landmarks of each bone were the intrinsic cause of the rotational mismatch in total knee arthroplasty. The clinical epicondylar axis can be chosen for the ideal reference to rotational alignment of the femoral component because of its minimal rotational mismatch between each component.</p>

The use of a closed-suction drain in total knee arthroplasty: a prospective, randomized study / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the value of using a closed-suction drain in cemented knee arthroplasty.</p><p><b>METHODS</b>One hundred patients were prospectively randomized into two groups, one group underwent cemented total knee replacement with a single deep closed-suction drain, and the other group (n = 50) no drain.</p><p><b>RESULTS</b>The total blood loss was significantly greater in those with a drain although those without lost more blood into the dressings. There was no statistical difference in the postoperative swelling or pain score, ecchymosis, deep vein thromboses (DVT), time at which flexion was regained or the incidence of infection at a minimum of two years after surgery in the two groups.</p><p><b>CONCLUSION</b>There is no evidence to support the use of a closed-suction drain in cemented knee arthroplasty.</p>

Proximal humeral fractures treated with arthroplasty / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To explore arthroplasty in treating 3- and 4-part fractures of the proximal humerus.</p><p><b>METHODS</b>A total of 132 patients with proximal humeral fractures were treated in our hospital from July 1997 to February 2003. According to Neer's classification, the fractures of 45 patients (14 males and 31 females, aged 31-78 years, 56.1 years+/-7.8 years on an average) belonged to 3- or 4-part fractures (10 patients with 4-part fracture and 35 with 3-part comminuted fracture) and they were treated with shoulder joint arthroplasty. Unipolar prosthesis replacement of the head of humerus was made in 28 cases, while bipolar prosthesis replacement in 2 cases and total shoulder joint replacement in 15 cases.</p><p><b>RESULTS</b>During the follow-up period (range: 12-72 months, mean: 37.3 months+/-4.1 months), among the 45 patients who suffered from fractures of the proximal humerus and underwent arthroplasty surgery, 44 patients (97.8%) had no postoperative pain and were satisfied with the active range of motion and with the whole treatment results. And radiography showed that the prostheses were at their good position. One patient had postoperative pain because he had so narrow medullary cavity that the humeral prosthesis could not be put deeply enough and the prosthesis head was a little higher over the anatomic level. He did not have good postoperative active range of motion, either. Then he received a review surgery and got satisfied results. Temporary shoulder stiffness was observed in one patient. Manual release of these adhesions improved the shoulder function. No evidence of nonunion of the fracture segments around the humeral prosthesis stem was found.</p><p><b>CONCLUSIONS</b>Shoulder arthroplasty is a dependable method to restore the comfort and function of the shoulder joints of the patients with 3- or 4-part fractures of the proximal humerus.</p>