Arthroscopic heel spur fasciotomy for treatment of elderly refractory plantar fasciiti / 第二军医大学学报

Objective To evaluate the efficacy of arthroscopic heel spur fasciotomy for the treatment of refractory plantar fasciitis in elderly patients. Methods Twenty-two patients with plantar fasciitis diagnosed from Jan. 2014 to Jun. 2017 in the Department of Orthopedics of Changzheng Hospital of Navy Medical University (Second Military Medical University) were enrolled. All the patients aged≥70 years old, with the course lasting for more than 6 months and incurable pain after a variety of treatment, and received arthroscopic heel spur removal and partial iliac fascia lysis. The time for the recovery of daily walking was recorded. The visual analogue scale (VAS) score and the calcaneodynia score (CS) at 1 month after surgery and the 12-item short-form health survey questionnaire (SF-12) score at 6 months after surgery of the patients were analyzed and compared with the preoperative data to evaluate the curative effect. Results The average time for recovery of daily walking in the 22 patients was (12.4±5.5) d. Two patients with bilateral plantar fasciitis were lost to followup after surgery, and a total of 20 patients (22 feet) were followed up. Compared with pre-operation, the VAS score and CS of patients were significantly improved at 1 months after surgery (0.7 [0.0-3.2] vs 5.3 [3.8-7.0], Z＝2.1, P<0.01; 87.0±11.3 vs 38.9±10.1, t＝14.2, P<0.01). The physiological and psychological scores of SF-12 of patients were significantly increased at 6 months after operation versus pre-operation (50.9±10.7 vs 45.3±9.6, 47.2±9.2 vs 34.2±10.6; t＝4.3 and 4.1, both P<0.01). Conclusion Arthroscopic heel spur removal with partial iliac fascia lysis can effectively relieve the symptoms of patients with plantar fasciitis, without serious complications.

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>

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>

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>

The effect of rotational alignment of the femoral components on the patellofemoral biomechanics in total knee arthroplasty / 中华外科杂志

<p><b>OBJECTIVE</b>To study the effect of rotational alignment of the femoral components on the patellofemoral biomechanics in total knee arthroplasty (TKA) demonstrated on autopsy specimens, as the guide for surgeons to choose the correct reference axis for rotational alignment of the femoral components and to reduce the patellofemoral joint complications.</p><p><b>METHODS</b>Select 9 frozen fresh human cadaver knees without gross deformities or instabilities and mount specimens on a patellofemoral joint testing jig connected to a Model 8501 Instron machine (Instron Corporation, Canton, MA). The study simulated the action of squatting from the standing position with the foot firmly planted. Standard TKA was performed in each specimen by the same senior surgeon using Nexgen LPS total knee system (Zimmer Corporation, Warsaw Indiana). Alter rotational alignment of the femoral components referenced to the transepicondylar axis and the Whiteside's line respectively. Measure biomechanics of the patellofemoral joints using Fuji prescale film at 30 degrees , 60 degrees , 90 degrees , 120 degrees of knee flexion respectively. The digital values were obtained by the handheld pressure measurement systems (FPD-305E, FPD-306E) and Autocad software.</p><p><b>RESULTS</b>The rotational alignment of the femoral components paralleled to the transepicondylar axis had the best results of the peak value of the patellofemoral contact pressure (P < 0.05). There were no statistically significant differences in patellofemoral contact area (P > 0.05). But the patellofemoral contact area had the close correlations to the angles of the knee flexion and the specimens.</p><p><b>CONCLUSIONS</b>Rotational alignment of the femoral components has a great influence on the patellofemoral contact pressure in total knee arthroplasty. It is reliable for surgeons to choose the transepicondylar axis as the reference axis to rotate femoral components.</p>

Mid-term follow-ups of hydroxyapatite extensively-coated femoral prosthesis for elderly patients / 中华创伤骨科杂志

Objective To evaluate the effects of hydroxyapatite (HA) extensively-coated prosthesis on elderly patients undergoing hip arthroplasty.Methods From February 1997 to May 1999,96 patients Were treated with hydroxyapatite (HA) coated prosthesis and followed up for their hip arthroplasty.Their results were studied clinically and roentgengraphically to evaluate chiefly their Harris scores,complications and thigh pain.The survival of prosthesis was evaluated according to Kaplan-Meier methods.Results The 60 cases were followed up for eight years on average(range,sevon to nine years).Their mean Harris scores were improved from 42 preoperatively to 90 postoperatively.Fifty-eihgt cases felt no pain at their hip,but two did at their thigh.No radiolucent lines were observed.All the prostheses achieved bony stabilization and remolding.Conclusions HA coated prosthesis can achieve fine fixation,because it helps bone conduction,resists axial force and torsion,and reduces operative risks.