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Objective To explore the clinical characteristics and outcome of correction with Ilizarov fixator for the knee deformities.Methods From May 2003 to April 2010,21 patients (22 knees) underwent knee deformity correction with Ilizarov fixator,including 12 males and 9 females with an average age of 20.3 years (range,8-48).Causes of the deformities included poliomyelitis in 4,burn in 2,osteomyelitis in 2,trauma in 9,Blount diseases in 2,and multiple osteochondromatosis in 2.Five patients had fixed flexion contracture due to soft tissue,they were corrected through a combination of Ilizarov's frame crossover the joint with a pair of hinges by gradual posterior distraction.Eight patients (9 limbs) had one way bony deformities and 7 patients had complex deformations.The frame with 4 hinge-posts was used for correction by restoring the alignment firstly,and then gradual lengthening to correct bone shortening.Additionally,an overlay frame of the above mentioned combinations was applied for correction of bony deformity combined with soft tissue contracture for 1 patient.Results The average time in frame was 22.3 weeks (range,12-36).At the time of removing frame,satisfactory alignment was achieved in all of the affected knees,and solid bony healing was obtained in osteotomy or bone lengthening area in 16 patients (17 limbs) with bony correction.All patients were followed up for an average of 32.1 months (range,6-86).The range of motion was improved from 102.14°±49.36° preoperatively to 126.90°±24.31° at the final follow-up.Additionally,the Japanese Orthopaedic Association knee score was also increased from 50.24±23.64 before operation to 85.71±10.52 at the final follow-up.All of them were able to walk without crutches,deal with daily life independently.Only 2 patients with the range of motion of the knee less than 90° were not able to squat.Conclusion Ilizarov fixator has advantages of minimal intervention to local tissue in operation and nimble adjustment at any time,and disadvantages related to a longer time in frame.
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Objective To evaluate the skill and outcome of arthroscopic reconstruction of posterior cruciate ligament (PCL) with retention of PCL remnant. Methods From April 2004 to June 2006, 38 patients (38 knees) with PCL deficiency were verified by clinical and arthroscopic examinations. Of them, there were 9 knees combined with disruption of the posterolateral comer, 6 with rupture of the posteromedial corner, 8 with lateral meniscus tear and 4 with medial meniscus tear. With reservation of PCL remnant and synovium, all the impaired PCLs were reconstructed with single bundle of autogenous quadrupled hamstring tendons under arthroscopy. Interference screws were used for direct anatomic fixation of the reconstructed ligament. Results No severe comphcations occurred at early stage after operation in all 38 patients who were followed up for 12-37 months (average 20.79 months). Lysholm score was improved significandy from 40-70 points (mean 51.32 pints) before operation to 70-100 pints (mean 92.37 points) at the latest follow up (t=-30.14, P<0.01). According to International Knee Documentation Committee (IKDC) score, there was a remarkable improvement from 16 abnormal knees (grade C) and 22 severely abnormal knees (grade D) preoperatively to 18 normal knees ( grade A), 18 nearly normal knees (grade B) and 2 abnormal knees at the latest follow up (Z=-6.00, P <0.01). Of 38 patients, 36 returned to normal sports level but 2 degraded level of sports. Conclusions Arthroscopic PCL reconstruction with retention of PCL remnants is a feasible technique, with satisfactory outcome. Preservation of PCL remnants and synovium may be beneficial to biological incorporation and reinnervation of the reconstructed ligament.
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Two types of elbow arthroplasties are used in current clinial practice:interpositional and implant arthroplasty.Interposition elbow arthroplasty neither completely eliminates pain nor restores full function.It may be indicated for young active patients with severe inflammatory or posttraumatic arthritis,especially those with limited elbow motion.Current implant arthroplasty has come a long way in the past three decades.Elbow implant survival data nearly approach those of knee arthroplasty.The majority of patients have significant improvement in function and marked pain relief after total elbow replacement.However,the complication rate is higher than that for total hip and knee arthroplasty,is likely inherent in the anatomic uniqueness of the elbow itself.Greater caution must be paid to prevention of the complications of total elbow replacement.This article reviews the types,indications,contraindications and results of elbow arthroplasty.
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[Objective]Two high-risk complications following artificial joint replacement were investigated in an attempt to improve medical quality and ensure medical safety.[Method]By searching relative reference database,the author investigated the incidence of two high risk complications following artificial hip or knee joint replacement in China during the past 3 years.Preventive measures were discussed.[Result]A total of 840 cases of artificial hip or knee joint replacement were reported in 6 key orthopedic periodicals from 2005 to 2007.One hundred cases of deep vein thrombosis(DVT) were found with an incidence of 11.9%.in all 6 periodicals,the lowest incidence was 8.06% and the highest one was 20%.Six cases of pulmonary embolism(PE) were reported by 3 periodicals,of which 3 had a successful emergency rescue and 3 died.In the same period,10 orthopedic periodicals reported 171 cases(172 joints) of prosthesis infection after artificial hip or knee joint replacement.[Conclusion]With rapid development of urban/rural construction and transportation,and the increase of elderly people,severe osteoarticular injury cases have increased relatively.Artificial joint replacement has been wider performed in the clinical practice.Although the success rate has been greatly improved benefited from the upgrades of prosthesis technique and surgical instrument,the complications such as PVT,PE and infection are still risk factors.Relevant preventive measures should be taken to keep safety and advance of artificial replacement technique.
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[Objective]To explore the clinical characteristic of combined posterior cruciate ligament (PCL) with posterolateral corner (PLC) injuries,and evaluate the technique and outcome of arthroscopic single bundle reconstruction of PCL and reconstruction of PLC with posterior half of biceps femoris tendon.[Method]From Dec. 2001 to Dec. 2004,14 patients (14 knees) with severe posterior and posterolateral rotatory instability were treated surgically in our department,all of them presented III degree positive results of posterior drawer test,positive varus stress test and more than 10 degree of external rotation of the affected knees compared with the intact knees.PCL tear and abnormal opening of posterolateral compartment were seen in all of the 14 knees under arthroscopy.Of them,2 knee were combined with common peroneal nerve injury.All the damaged PCLs were reconstructed with single bundle of autogenous quadrupled hamstring tendons under arthroscopy,and PLCs were reconstructed with the posterior half of biceps femoris tendon tenodesis.[Result]No severe complications occurred in early stage after operation in the 14 patients.All of them were followed up from 12 to 33 months with an average of 21.14?7.26 months.Posterior stabilities were recovered significantly,varus stress test was negative at 30 degree of flexion and full extension,less than 10 degree of external rotation compared with the intact knee in all of the patients.Lysholm score was remarkable improved from 40~60 (mean 47.1?8.25) preoperatively to 70~95 ( mean 86.79?7.23) at follow up(P