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Objective:To introduce the concept and procedures of precise flap surgery in construction of knee defects and to report the preliminary clinical outcomes.Methods:The data of 16 patients with knee defects at 17 sides were retrospectively analyzed who had been treated under the guidance of the concept of precise flap surgery at Department of Orthopedic Surgery, The 920th Hospital of Joint Logistic Support Force of PLA from August 2014 to March 2022. There were 12 males and 4 females, aged 44(34, 54) years. The wounds were at the left side in 8 cases, at the right side in 7 ones and at bilateral sides in one, and their sizes ranged from 5 cm×3 cm to 15 cm×11 cm. The time from injury to surgery was 8.5(6.0, 13.0) days. Optimal repair protocols were chosen after the donor and recipient sites were evaluated according to the methods of precise flap surgery: a retrograde anterolateral thigh flap in 7 sides, a descending genicular artery perforator flap in 3 ones, a saphenous artery flap in 2 ones, and a superior genicular lateral artery perforator flap, a popliteal artery perforator flap, a medial sural perforator propeller flap, a peroneal artery perforator propeller flap, and a randomized flap in one, respectively. The flap sizes ranged from 10 cm×6 cm to 15 cm×15 cm. The outcomes and complications of skin flap repair, and functional recovery of the affected limb were recorded.Results:All the flaps at 17 sides survived after surgery; 3 cases developed distal edge necrosis which responded to dressing change. The follow-ups for the 16 patients were 14.5(10.0, 28.0) months. All the flaps presented with good color, texture and contour. Flap bulking, local osteomyelitis, and scar ulcer was found in one case respectively. According to the revascularization assessments in the digital replantation criteria by Hand Surgery Society, Chinese Medical Association, all the flaps at 17 sides were excellent. Accoding to the knee functional evaluation of Hospital for Special Surgery (HSS) at the last follow-up, the 17 affected limbs scored 86(80,91) points, yielding 9 excellent, 7 good and 1 fair sides.Conclusion:Although the defects and donor sites around the knee vary greatly, precise flap surgery may lead to effective control of the variations, choice of an optimal reconstruction protocol, and precise wound repair.
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Objective:To explore the clinical efficacy of modern rehabilitation techniques combined with Traditional Chinese Medicine (TCM) external application in the treatment of knee stiffness.Methods:Prospective cohort study. A total of 80 patients with knee stiffness meeting the entry criteria admitted to the People's Hospital of Bozhou from January 2019 to December 2021 were selected and divided into the observation group ( n=40) and the control group ( n=40) according to the random ball touching method. Both groups were given routine physiotherapy. The control group was treated with TCM external application on the basis of the physiotherapy, and the observation was treated with modern rehabilitation techniques on the basis of the treatment of the control group. The goniometer was used to measure the knee flexion and extension before and after treatment, and the VAS scale was used to assess the knee pain. Fug l-Meyer motor function score was used to evaluate lower extremity motor function. Results:After treatment, the knee flexion [(96.43 ± 4.63) ° vs. (89.58 ± 4.67) °, t=6.59] in the observation group was higher than that of the control group ( P<0.01), and the extension [(8.32 ± 2.03) ° vs. (11.69 ± 2.37) °, t=6.83] in the control group was lower than that of the control group ( P<0.01); VAS score (2.06 ± 0.49 vs. 3.65 ± 0.76, t=11.12) was lower than that of the control group ( P<0.01), and Fugl Meyer motor function score (28.97 ± 3.76 vs. 20.43 ± 3.04, t=11.17) was higher than that of the control group ( P<0.01). Conclusion:The application of modern rehabilitation techniques combined with TCM external application in the treatment of knee stiffness can improve the range of motion of the knee joint, reduce the VAS score of pain, and improve the motor function.
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Objective:To discuss the surgical strategies for anteromedial tibial plateau compression fracture complicated with posterolateral corner injury.Methods:From 2015 January to 2020 July, 18 patients with anteromedial tibial plateau compression fracture complicated with posterolateral corner injury were admitted to Department Ⅲ of Orthopaedics, Zhongshan Hospital of Traditional Chinese Medicine. They were 11 males and 7 females, aged from 28 to 57 years (average, 38.6 years). By the CT three-column theory, all their fractures were medial column ones; by the Fanelli classification, there were 5 cases of type B and 13 cases of type C. Seventeen patients with fresh fracture were treated with arthroscopic ligament reconstruction and meniscus repair followed by primary reduction and fixation of tibial plateau fracture. The one patient with obsolete injury was treated with high tibial osteotomy around the knee joint and reconstruction of the anterior cruciate ligament. Recorded were the patients' fracture healing time, knee Lysholm score, joint range of motion and complications.Results:The 17 patients with fresh injuries were followed up for 12 to 24 months (average, 18.4 months). Their fracture healing time ranged from 12 to 24 weeks (average, 17.7 weeks). By one year after surgery, their knee extension reached 0° and their knee flexion from 120° to 135° (average, 131.9°); their knee Lysholm scores ranged from 88 to 95 points (average, 91.2 points). The one patient with old injuries was followed up for 18 months, with fracture healing time of 18 weeks, knee range of motion from 0° to 120° and knee Lysholm score of 86 points by one year after operation. None of the patients reported such complications as neurovascular injury, wound infection, internal fixation failure or nonunion.Conclusion:For anteromedial tibial plateau compression fracture complicated with posterolateral corner injury, primary repair and reconstruction can restore knee joint stability, leading to fine therapeutic outcomes.
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Background: The Medial and Lateral Menisci have very important roles in knee joint stability, functioning anddynamic loading and are thus important in maintaining proper joint health and stability.Purpose: To estimate the incidence of various shapes of the Lateral and Medial Menisci which can throw light onits clinical significance on ligament injuries of knee joint.Results: 50% 0f the Medial Menisci were crescent- shaped,37% were sided V-shaped and the remaining 13% weresided U-shaped. 72% of the Lateral Menisci were found to be C-shaped and 26% were crescent-shaped. Onepartial discoid lateral meniscus (2%) was observed.Conclusion: The various morphological variants of Menisci determined in the study revealed that most commonsubgroup of the Medial Meniscus was crescentic type and that of Lateral Menisci was C shaped. A singlespecimen of partial Discoid Lateral Meniscus was observed which is of rare occurrence.Implications: The present study contributes to proper understanding of anatomy of both Medial and LateralMenisci which can be helpful in planning various surgical procedures including meniscal transplantation. Thisknowledge also helps in understanding degenerative diseases affecting knee joint Menisci. Discoid LateralMeniscus, a rare anomaly which was reported in the present study is clinically important because of its higherincidence of meniscal tears.
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Objective To establish a model of knee joint extension contracture in New Zealand white rab-bits, and to lay the experimental foundation for further studies on the pathogenesis and treatment of joint contractures. Methods Thirty male New Zealand white rabbits with mature bones were randomly divided into 6 groups. The left knee joints of the immobilization groups ( 5 groups of 5 rats each) were fixed in extension for 1, 2, 4, 6 or 8 weeks. There was also a control group. At the end of each period the plaster was demolished and the level of transforming growth factor-β1 ( TGF-β1) in joint cavities, the degree of total contracture, myogenic contracture, arthrogenic con-tracture, and the thickness of the posterior joint capsules were measured. The significance of the differences between the immobilized groups and the control group was compared using one-way analysis. Results The level of TGF-β1 in the joint fluid differed significantly among the 6 groups. The differences in the degree of total contracture among the control group, one-week, two-week and four-week groups were also significant. The average degree of the myogenic contracture in the one-week group was significantly different from the other 5 groups' averages. The average myogenic contracture was also of significantly different between the two-week group and the control group. The degree of arthro-genic contracture was significantly different among the groups except for between the 6-week and 8-week groups. The average joint capsule thickness was significantly different among all of the groups except for between the control group and the one-week group. Conclusion This technique for modeling knee extending contracture using New Zealand white rabbits is simple and practical. It provides a better animal model for studying the mechanism of knee joint con-tracture and related treatment strategies and can be used for further exploration of the occurrence and recovery of knee contractures.
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Objective To propose a concept of irreducible tibial shaft fractures and to discuss their imaging characteristics and clinical significance.Methods A retrospective study was performed in 21 patients with tibial shaft fracture who had received intraoperative intramedullary nailing after limited open reduction at Department of Orthopaedics,The Second Affiliated Hospital to Anhui Medical University from November 2013 to June 2018.They were 14 males and 7 females,aged from 21 to 66 years (average,34.9 years).There were 15 left and 6 right sides.Firstly,closed reduction was performed followed by traction,folding and rotation,but repeated attempts failed to achieve smooth reduction or insertion of guide wire.Next,local limited open reduction had to be performed for intramedullary nailing.The X-ray and CT images of the tibial fractures were collected to analyze their imaging characteristics.The imaging manifestations were characterized into 4 types:single-segment type with intact fibula,multiple-segment type,interlocking type where the distal and proximal ends interlock commonly seen in short spiral and short oblique fractures,and incarceration type where the fracture interspace is blocked by a bone fragment.The therapeutic efficacy was evaluated at the final follow-up by knee scores of The Hospital for Special Surgery (HSS) and Kofoed ankle scores.Results Of the 21 patients,2 were single-segment type,4 multiple-segment type,13 interlocking type and 2 incarceration type.They were followed up for 7 to 50 months (average,22.7 months).The fractures united after 5 to 16 months (average,7.3 months).Postoperative knee pain was observed in 3 cases and delayed fracture union in 2.Osteomyelitis,superficial wound infection,implant breakage or malunion occurred in none of the patients.The therapeutic efficacy evaluated at the final follow-up by HSS knee scores and Kofoed ankle scores revealed 15 excellent,4 good and 2 fair cases,yielding an excellent to good rate of 90.5％.Conclusion The concept of irreducible tibial shaft fractures may lead to preoperative awareness on the part of the surgeons so that ineffective repeated reductions can be spared and the damage to the blood supply to the fracture ends and the operation time can be reduced.
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[Objective]To investigate the prophylactic effects of intra-articular injection of salvia miltiorrhiza on joint adhesion. [Methods]Twenty-four Japanese male rabbits were randomly divided into 3 groups.All right hind knees were made in this way: the auterior wall of suprapatellar bursae was scraped, the posterior wall of suprapatellar bursae and the infrapatellar fat pad were cut off. Each knee was injected with physiological saline 0.3 ml for group A, sodium hyaluronate injection 0.3 ml for group B, and salvia miltiorrhiza injection 0.3 ml for group C. All right hind knees were immobilized in the extension position with a long leg plaster cast for 4 weeks, and injected weekly.[Results]After 4 weeks, the joint movement range in group B or C was larger than that in group A (P<0.01), and there was no significant difference (P>0.05)compared to group B and group C. The scoring of joint adhesions in group B or C was smaller than that in group A (P<0.01), and there was no significant difference(P>0.05)compared to group B and group C. The scoring of histological changed of the synovial membrane in group B or C was smaller than that in group A (P<0.01), and there was no significant difference(P>0.05)compared to group B and group C.Total collagens content of the synovial membrane in group B or C was smaller than that in group A (P<0.01), while that of group C was less than in group B(P<0.01). [Conclusion]Similarly to sodium hyaluronate, salvia miltiorrhiza can effectively prevent joint adhesions.
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Objective To investigate the feasibility,operation design and postoperative rehabilitation in ankylosing spondylitis patients with bilateral hips and knees bony ankylosis,who were operated on the 4 joints during one hospitalization period. Method Two operations were performed in one hospitalization period in three ankylosing spondylitis patients on the 2 hip joints and 2 knee joints respectively.One case,the left hip replacement was operated in the first operation,and the right hip and the double knees were operated in the second operation;the other two cases,unilateral hip and knee were operated in two operations respectively.Patients began to contract their lower limbs’ muscles initiatively after narcosis.The limbs were put on the CPM,the hips and knees were bent and extended repeatedly on the third day after operations.The patients began to leave bed and learned to walk 2 weeks after operations.They could walk 100 steps with aids when they leaft hospital. Result In six-month follow-up,the range of hip motion(degree)were 105?~145?(average 135?);the range of knee motion(degree)was 45?~60?(average 54?).The hip’ function score adopted Harris score system:the average of 83 and were all good;the knee’ function score adopted American Association of Knee Surgery score system in 1989:all were excellent except a good one(left knee of first case,the score was 74/75). Conclusion Performing operations on the 2 bony ankylosis hips and 2 bony ankylosis knees in the ankylosing spondylitis patients in one hospitalization period can shorten the treatment cycle,release the distress,and lighten the economic load,meanwhile it is convenient for operation and postoperative rehabilitation.It is better to do the unilateral hip and knee in a single operation.
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[Objective] To investigate the treatment in the use of allograft bone grains combined with autograft bone grafting in giant cell tumor.[Method]From March 1996 to March 2006,24 cases of giant cell tumor closed to knee were verified by pathology in this department,including 11 on thighbone and others on tibia.Before operation allografts was sheared to grains after antigen extracted by repeat freeze thawing and mechanical methods.Giant cell tumor of bone was completely erased in surgical fringe and the defect was thoroughly closed-up with allograft grains combined with cancellous bone autografts.The knee joints exercise was made for 12 weeks with external orthosis fixation.[Result]No severe complication occurred in early stage after operation in the 24 patients.All of them were followed up for 1 to 6 years with an average of 2 years and 8 months.None of them recidivated after the operation,and no insert was taken off for severe rejection,one case showed tolerant pathologic fracture.All the transplantations showed ideal appearance in X-ray photograph and the motion of joints had no significant difference than before.Curative effects were evaluated by Mankin criteria.The outcome was excellent in 20 cases,good in 4 cases.[Conclusion]Bone allograft grains combined with autograft is an effective and few rejection in filling of giant bone defect in surgical operation of giant cell tumor near knee joints.
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VACTERL association is occuring in conjuction with vertebral anomalies, anal atresia, cardiac abnormalities, tracheoesophageal fistula, renal agenesis and limb defects. Additional abnormalities may include microphthalmia, abnormal lung lobulation and spleen defects. We describe a infant born to consanguineous healthy parents with multiple congenital anomalies of the skeleton and internal organs. A woman at 25 weeks gestaion was transferred to our hospital due to abnormal antenatal sonographic finding(molded calvarium, huge mass in abdomen, hyperechoic intestine and femur bowing). She admitted to our hospital due to decreased fetal movement 3 weeks later. Fetal death in uterus was diagnosed by sonogram. Its phenotype displays imperforated anus, absence of genital organ, absence of utrethral opeining, disunion of maxilla and mandible, varus deformity of bilateral knee joints, widening of interphalangeal space in right foot. The diagnosis was confirmed by clinical features, radiological findings, and autopsy. We reported this case of VACTERL association with review of literatures.