Clinical effect of arthroscopic combined with open release in the treatment of severe and extremely severe post-traumatic elbow stiffness / 中华骨科杂志

Objective:To investigate the therapeutic effect of arthroscopic combined with open release in the treatment of severe post-traumatic elbow stiffness.Methods:Data of 32 patients with severe post-traumatic elbow stiffness treated by arthroscopy combined with open release from January 2016 to September 2019 were retrospectively analyzed, including 13 males and 19 females. Age: 38.5±15.6 years (range, 17-66 years). For the original trauma, there were 12 cases of distal humeral fractures, 8 cases of radial head fractures, 8 cases of horrible triad of elbow, 2 cases of anterior dislocation of elbow through olecranon fracture, 1 case of Monteggia fracture, and 1 case of olecranon fracture. The range of motion (ROM), Mayo elbow performance score (MEPS) and visual analogue scale (VAS) of elbow joint at pre-operation, 6 months post-operation and the last follow-up were recorded and compared to evaluate the clinical effect of this operation on severe post-traumatic elbow stiffness.Results:The average operation time was 114.1±27.5 min (range, 70-170 min). Two patients developed mild ulnar nerve symptoms after operation, which were relieved after oral mecobalamin. The follow-up time was 38.5±14.4 months (range, 25-69 months). For elbow extension to flexion ROM, it was 47.66°±12.05° at pre-operation, 93.75°±12.89° at 6 months post-operation, and 106.88°±17.68° at the last follow-up, the differences were statistically significant ( F=148.87, P<0.001). For elbow rotation ROM, it was 132.19°±22.68° at pre-operation, 141.88°±21.91° at 6 months post-operation and 149.38°±23.27° at the last follow-up, and the differences were statistically significant ( F=4.64, P=0.012). At 6 months post-operative, the extension to flexion ROM of the elbow was significantly higher than that of pre-operation ( P<0.05); The rotation ROM was higher than that of pre-operation, but the difference was not statistically significant. At the last follow-up, the extentsion to flexion ROM and the rotation ROM were both significantly higher than those of pre-operation ( P<0.05). At the last follow-up, the VAS and MEPS were 1.38±0.94 and 93.44±5.15 respectively, which were significantly improved compared with those of pre-operation 3.91±1.09 and 37.97±7.71 ( P <0.001). Conclusion:Arthroscopic combined with open release in the treatment of severe post-traumatic elbow stiffness can significantly increase the elbow ROM and functional score as well as significantly relieve the pain of the elbow. It can effectively release the elbow while keeping it minimal invasive, and maintain the stability of the elbow to the maximum, with reliable efficacy.

Modified Chevron osteotomy in the treatment of moderate and severe hallux valgus / 中国骨伤

OBJECTIVE@#To investigate the method and clinical effect of modified Chevron osteotomy of the distal end of the first metatarsal in the treatment of moderate and severe hallux valgus.@*METHODS@#From January 2015 to January 2019, 28 patients(30 feet) with moderate and severe hallux valgus were treated with modified Chevron osteotomy combined with lateral soft tissue release of the first metatarsophalangeal joint, including 2 males (2 feet) and 26 females (28 feet). The age ranged from 35 to 74 (57.3±9.3) years;10 feet on the left, 16 feet on the right, 2 cases on both sides(4 feet);the course of disease was 3 to 12 (9.32±3.89) years. The changes of hallux valgus angle(HVA), intermetatarsal angle(IMA) between the first and second metatarsals and distal metatarsal articular angle(DMAA) of the first metatarsal were measured and compared before and 6 months after operation. The American Orthopaedic Foot and Ankle Society(AOFAS) thumb joint scoring system was used to evaluate the curative effect.@*RESULTS@#All 28 patients were followed up for 8 to 16 (11.28±3.42) months. The incision healed well in all patients, and there were no complications such as incision infection and metatarsal head necrosis. The healing time of osteotomy site was 6 to 10(7.12±1.34) weeks. Preoperative HVA, IMA, DMAA and AOFAS were (36.06±6.02) °, (21.78±4.16) °, (8.21±2.65) ° and (52.90±10.97) respectively, at six months after operation, they were (8.87±2.46) °, (11.66±2.84) °, (3.65±1.00) ° and (87.45±10.55) respectively, there was significant difference between preoperative and 6 months after operation(P<0.05). At 6 months after operation, AOFAS score was excellent in 20 feet, good in 7 feet and poor in 3 feet. Among the 3 patients with poor scores, 2 were excellent after revision, and 1 was significantly improved after using custom insoles.@*CONCLUSION@#Modified Chevron can effectively correct HVA, IMA and DMAA and improve functional recovery. The modified Chevron osteotomy increases the moving distance and the contact of the osteotomy surface. It can be fixed with multiple screws, has strong correction ability, and can exercise early. It is one of the optional methods for the treatment of moderate and severe hallux valgus.

Comparison of mid-term clinical outcomes between traumatic stiff shoulder and frozen shoulder after arthroscopic capsule release combined with subacromial space recovery / 中华创伤骨科杂志

Objective:To compare the mid-term clinical outcomes between traumatic stiff shoulder and frozen shoulder after arthroscopic capsule release combined with subacromial space recovery.Methods:From January 2014 to December 2019, 55 patients were treated at Sports Medicine Center, The First Affiliated Hospital, Army Medical University for limited range of shoulder motion. Of them, 22 suffered from traumatic stiff shoulder (7 males and 15 females) (group A) and 33 from frozen shoulder (10 males and 23 females) (group B). All patients were treated with arthroscopic 270° capsule release combined with subacromial space recovery. Shoulder pain was evaluated by visual analogue scale (VAS) and shoulder function by Constant score before operation and at the final follow-up. The 2 groups were compared in improvements in flexion, abduction, external rotation and internal rotation of the shoulder.Results:No significant difference was observed between the 2 groups in gender, age, course of disease, preoperative internal rotation or external rotation of the shoulder ( P>0.05). Preoperative VAS score [2.5(2.0, 3.3) points] and Constant score [(33.7±9.6) points] in group A were significantly lower than those in group B [4.0(3.0,5.5) points and (45.8±12.3) points] ( P<0.05). No complication like infection or nerve injury was found during follow-ups. All the incisions healed at the first stage. The follow-up time averaged 37.0 months (from 20 to 79 months). At the last follow-up, VAS scores [1.0(1.0, 1.0) points and 1.0(1.0, 1.0) points] and Constant scores [(87.0±3.2) points and (85.7±4.3) points] for both groups were significantly improved compared with their preoperative values [2.5(2.0,3.3)分points and 4.0(3.0,5.5) points for VAS; (33.7±9.6) points and (45.8±12.3) points for Constant score] ( P<0.05). Compared with preoperation, the improvements at the last follow-up were 99.3°±19.9° and 83.3°±27.7° in shoulder anteflexion and 102.0°±21.5° and 83.9°±32.8° in abduction for groups A and B, with greater improvements in group A; the improvements in VAS score for groups A and B were 1.0(1.0, 2.3) points and 3.0(2.0, 4.5) points, with greater improvements in group B; the improvements in Constant score were (53.3±9.5) points and (39.8±12.9) points for groups A and B, with greater improvements in group A. The above comparisons all showed a significant difference between the 2 groups ( P<0.05). Conclusions:Arthroscopic 270° capsule release combined with subacromial space recovery can lead to good mid-term clinical outcomes similar for both traumatic stiff shoulder and frozen shoulder. However, the improvements in flexion, abduction and Constant score may be greater for traumatic stiff shoulder than for frozen shoulder.

Effect of combined administration of intravenous and topical tranexamic acid on perioperative blood loss in elbow arthrolysis / 中华创伤骨科杂志

Objective:To explore the effect of combined administration of intravenous and topical tranexamic acid on perioperative blood loss in elbow arthrolysis.Methods:A retrospective analysis was conducted of 31 patients who had undergone elbow arthrolysis due to elbow stiffness from April 2019 to November 2020 at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. An observational group of 15 patients were subjected to combined administration of intravenous and topical tranexamic acid while a control group of 16 patients to no administration of tranexamic acid. In the observational group, 15 mg/kg of tranexamic acid was injected intravenously 5 to 10 minutes before surgery and 1.0 g of tranexamic acid was injected locally in the area of anterior and posterior joint capsules after incision was closed while drainage tubes were clamped for 2 hours before release. In the control group, there was no special operative procedure while drainage tubes were also clamped for 2 hours before release. The 2 groups were compared in terms of blood loss on day 1 and day 3 after operation, drainage volume on day 1 after operation, total drainage volume, time for indwelling drainage tube, complications, and Mayo elbow performance score (MEPS) at 3 months after operation.Results:There were no statistically significant difference in preoperative general data between the 2 groups, showing they were comparable ( P>0.05).On day 1 and day 3 after operation, the blood loss was respectively (533.4±318.3) mL and (792.0±375.6) mL in the observational group, and respectively (866.4±480.5) mL and (1,403.0±636.5) mL in the control group, showing significantly differences between the 2 groups ( P<0.05). The drainage volume on day 1 after operation was (151.3±90.1) mL in the observational group and (235.0±126.1) mL in the control group, showing a significant difference between the 2 groups ( P<0.05). There was no statistically significant difference in total drainage volume or time for indwelling drainage tube between the 2 groups ( P>0.05). There were no such complications as thromboembolic events in either group. There was no significant difference in MEPS between the 2 groups at 3 months after operation ( P>0.05). Conclusions:Combined administration of intravenous 15 mg/kg and topical 1.0 g tranexamic acid may reduce blood loss on day 1 and day 3 after operation and drainage volume on day 1 after operation, and may not increase the risk of thromboembolic events, but cannot reduce total drainage volume or time for indwelling drainage tube. Application of tranexamic acid may not affect early elbow joint function after operation.

High tibial osteotomy combined with lateral retinacular release for the treatment of knee varus osteoarthritis with lateral patellar compression syndrome / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of high tibial osteotomy combined with arthroscopic lateral retinacular release in the treatment of knee varus osteoarthritis.@*METHODS@#From October 2017 to April 2019, a retrospective analysis was performed on 43 patients with knee varus osteoarthritis and lateral patellar compression syndrome treated by high tibial osteotomy combined with arthroscopic lateral retinacular release. There were 15 males and 28 females, aged 53 to 72(62.05±5.17) years. The visual analogue scale(VAS), Lysholm, and the knee range of motion were used to evaluate knee pain and functional recovery before operation, 2 weeks, 3 months and 12 months after operation. And the congruence angle (CA), patellar tilt angle (PTA), and femala-tibial angle (FTA) were measured respectively before and 12 months after operation to evaluate the congruence of patellar joint, and the improvement of line of gravity of lower limb.@*RESULTS@#All 43 patients were followed up for more than 12 months, with a follow-up time of 14 to 28 (19.60±4.50) months. The VAS scores decreased from 6.65±0.65 before operation to 2.16±0.95, 0.51±0.77 and 0.33±0.64 at 2 weeks, 3 months and 12 months after operation, and the difference was statistically significant (@*CONCLUSION@#High tibial osteotomy combined with arthroscopic lateral retinacular release can relieve weight-bearing pain in frontal axis and improve the function of knee in sagittal axis.

Surgical Treatment of Post-traumatic Elbow Stiffness by Wide Posterior Approach / Tratamento cirúrgico da rigidez pós-traumática do cotovelo por via posterior ampla

Abstract Objective To demonstrate the clinical outcomes and complication rates of the surgical release with a single posterior approach in the treatment of post-traumatic elbow stiffness. Methods A prospective study with patients submitted to surgery between May 2013 and June 2018 in a single center. The access to the elbow was made through the posterior approach. The patients were followed up by an occupational therapy team, and were submitted to a standardized rehabilitation protocol, with static progressive orthoses and dynamic orthoses. The primary outcome was the range of flexion-extension of the elbow after 6 months. Results A total of 26 patients completed the minimum follow-up of 6-months. The mean range of flexion-extension of the elbow at the end of 6 months was of 98.3 ± 22.0°, with an amplitude gain of 40.0 ± 14.0° in relation to the pre-operative period (p< 0.001). The average flexion-extension gain at the end of 6 months was of 51.7% ± 17.1% (p< 0.001). The mean pronosupination at the end of 6 months was of 129.0 ± 42.7° (p< 0.001). Half of the cases had moderate and severe stiffness in the pre-operative period, compared with 7.7% at 6 months post-operatively (p< 0.001). The mean score for the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) instruments was 74.4 ± 16.8 points and 31.7 ± 21.9 points respectively (p< 0.001 for both). The visual analogue scale (VAS) score presented no statistically significant difference compared to the pre-operative period (p= 0.096). Complications were observed in 6 (23%) patients, and no new surgical procedures were necessary. Conclusions The surgical release of the elbow associated with a rehabilitation protocol is a safe technique, with satisfactory results and low rate of complications.

Resumo Objetivo Demonstrar os resultados clínicos e a taxa de complicações da liberação cirúrgica por via única posterior no tratamento da rigidez pós-traumática de cotovelo. Métodos Estudo prospectivo, com pacientes submetidos a cirurgia entre maio de 2013 e junho de 2018 em um único centro. Foi realizado acesso ao cotovelo por via posterior. O seguimento dos pacientes foi feito por uma equipe de terapia ocupacional, e eles foram submetidos a um protocolo de reabilitação padronizado, com órteses estáticas progressivas e dinâmicas. O desfecho primário foi a amplitude de flexoextensão do cotovelo após 6 meses. Resultados Um total de 26 pacientes completaram o seguimento mínimo de 6 meses. A média de flexoextensão do cotovelo, ao final de 6 meses, foi de 98,3° ± 22,0°, com um ganho de amplitude de 40,0° ± 14,0° em relação ao pré-operatório (p< 0,001). A média de ganho relativo de flexoextensão, ao final de 6 meses, foi de 51,7% ± 17,1% (p< 0,001). A média de pronossupinação, ao final de 6 meses, foi de 129,0° ± 42,7° (p< 0,001). Metade dos casos apresentava rigidez moderada e grave no pré-operatório, contra 7,7% aos 6 meses de pós-operatório (p< 0,001). A pontuação nos instrumentos Mayo Elbow Performance Score (MEPS) e Disabilities of the Arm, Shoulder and Hand (DASH) apresentou melhora estatisticamente significativa em relação ao pré-operatório, atingindo 74,4 ± 16,8 pontos e 31,7 ± 21,9 pontos, respectivamente. A escala visual analógica (EVA) não apresentou diferença estatisticamente significativa em relação ao pré-operatório (p= 0,096). Complicações foram observadas em 6 (23%) pacientes, não sendo necessária nova abordagem cirúrgica em nenhum paciente. Conclusões A liberação cirúrgica do cotovelo associada a protocolo de reabilitação é técnica segura, com resultados satisfatórios e baixa taxa de complicações.

Treatment of rotator cuff tear in global stiff shoulder by arthroscopic 360° capsular release with concomitant rotator cuff repair / 中国骨伤

OBJECTIVE@#To evaluate the clinical effect of arthroscopic 360° capsular release with concomitant rotator cuff repair for patients with rotator cuff tears in global stiff shoulder.@*METHODS@#From December 2016 to December 2018, 247 patients full-thickness rotator cuff tear were treated with arthroscopic rotator cuff repair. Among them, 42 patients (17%) with global limitation of shoulder movement were treated with arthroscopic 360° capsular release operation at the same time of rotator cuff repair. The function of shoulder was evaluated by Constant-Murley score and visual analogue scales (VAS), flexion, abduction and external rotation on body side before and after operation. Sugaya classification was used to evaluatethe healing of rotator cuff. The number of shoulder dislocations during follow-up was recorded.@*RESULTS@#Thirty nine of the 42 patients were followed up for 12 to 36 (22±6) months. The patients were 43 to 73 (57±7) years old at the time of operation. The Constant- Murley score increased from (43.6±6.3) before operation to (87.5±2.8) at final follow-up (<0.001). VAS score decreased from (7.2±1.5) before operation to (1.0±0.9) at final follow-up (<0.001). The flexion of shoulder increased from (46±14)° before operation to (148±11)° after operation (<0.001), the abduction from (36±6)° before operation to (121±10)° after operation (<0.001), and the external rotation on body side from (5±10)° before operation to (42±8)° after operation(<0.001). One year after the operation, MRI showed thatⅠ-Ⅲ of Sugaya classification was clinical healing, 38 cases in total.@*CONCLUSION@#Arthroscopic 360° capsular release with concomitant rotator cuff repair was used to treat rotator cuff tear in global stiff shoulder. Themain observation indexes were improved after operation, and the clinical effect was definite.

Clinical application of wide awake technique in carpal tunnel syndrome / 中国骨伤

OBJECTIVE@#To explore the application and clinical effect of wide awake local anesthesia no tourniquet technique in the surgery of bilateral carpal tunnel syndrome.@*METHODS@#From March 2016 to August 2018, 20 patients (40 sides) with bilateral carpal tunnel syndrome were treated by wide awake technique. All patients were female, aged from 32 to 56 (50.8±6.4) years old. The anesthetic, intraoperative and postoperative pain and anxiety were evaluated, operative field bleeding in operation were assessed, postoperative skin healing of surgical area and anesthetic complications were observed, and Kelly grading were used to evaluate recovery of function.@*RESULTS@#Twenty patients were followed up from 6 to 9 months with an average of 7.8 months. There was light anxiety before injection (NRS score rangedfrom 1 to 3), slight pain occurred during injection on the first poke (NRS ranged from 2 to 3);no pain and anxiety during operation (NRS score was 0);mild or moderate pain (NRS score ranged from 1 to 6) without anxiety(NRS score was 0) after operation was occurred. Surgical skin healed well at the stageⅠwithout side effect of anesthetic. At final follow-up, according to Kelly grading, 30 sides got excellent results, 8 sides good and 2 sides fair.@*CONCLUSION@#Wide awake technique is safe and effective in treating neurolysis of bilateral carpal tunnel syndrome, and could receive good clinical effects.

Comparison of clinical efficacy of two different arthroscopic release methods for the treatment of primary frozen shoulder / 中国骨伤

OBJECTIVE@#To compare clinical effects of inside-out technique and outside-in technique for the treatment of idiopathic frozen shoulder under arthroscopy.@*METHODS@#From April 2015 to July 2019, 65 patients with primary frozen shoulder were divided into observation group and control group according to different treatment methods. In observation group, there were 32 cases, including 14 males and 18 females, aged 48 to 64 (54.82±5.35) years old, 18 cases on the right side and 14 cases on the left side. The course of disease was 4 to 10 (7.76±1.19) months. The patients were treated with outside in technique. In control group, there were 33 cases, 16 males and 17 females, aged 45 to 62 (54.64±4.16) years old, 18 cases on the right side and 15 cases on the left side. The course of disease was 5 to 9 (7.65±1.24) months. The patients were treated with inside out technique. The operation time, hospitalization days and treatment cost were compared between the two groups. Constant-Murley function score before and after the operation andthe shoulder joint range of motion one month after operation were compared to evaluate the clinical efficacy.@*RESULTS@#All 65 patients were followed up for 9 to 17 months with an average follow up time of (11.34±2.24) months. Compared with control group, operation time in observation group was shorter[(55.53± 10.23) min vs (85.58±13.39) min], and functional scores of Constant-Murley after surgery were significantly changed in both groups compared with that before surgery(@*CONCLUSION@#The two arthroscopic release schemes have achieved satisfactory results for thetreatment of primary frozen shoulder, and the shoulder joint function and pain degree have been effectively improved. Compared with the inside-out technique, the outside in release technique is more direct, the operation is simpler and the operation time is shorter. It has certain advantages in releasing operation for primary frozen shoulder.

Application of percutaneous pie-crusting deep medial collateral ligament release for posterior horn surgery of medial meniscus / 中国骨伤

OBJECTIVE@#To explore clinical and radiographic effects of percutaneous pie-crusting deep medial collateral ligament release in patients with posterior horn tear of medial meniscus combined with tight medial compartment.@*METHODS@#From January 2012 to December 2016, 35 patients with medial meniscus posterior horn injury were treated with percutaneous pie crusting deep medial collateral ligament release technique, including 21 males and 14 females, aged from 21 to 55 years old with an average of (39.1±6.5) years old. Degree of meniscus extrusion were recorded before and 24 months after operation. The knee valgus stress test was performed to evaluate stability of medial collateral ligament, and compared difference between healthy and affected side. Lysholm and IKDC functional scores were compared before and 24 months after operation.@*RESULTS@#All patients were followed up from 27 to 60 months with an average of (36.7±6.8) months. All patients were underwent operation, the wound healed well without complications. Operative time ranged from 0.5 to 1.2 h with an average of (0.8±0.4) h. Nineteen patients were performed partial meniscectomy, 16 patients were performed repair suture. Convex of meniscus before operation was (1.5±0.7) mm, and (1.7±0.4) mm after operation;had no statistical difference(@*CONCLUSION@#For patients with medial meniscus tear of posterior horn combined with tight medial compartment, percutaneous pie-crusting deep medial collateralligament release could improve medial compartment space, and Knee valgus instability and meniscus extrusion are not affected.

Posterior atlantoaxial joint axial release, bone grafting and internal fixation for irreducible atlantoaxial dislocation with partial reduction / 中华创伤杂志

Objective@#To investigate the efficacy of posterior atlantoaxial joint axial release, bone grafting and internal fixation for the treatment of irreducible atlantoaxial dislocation (IAAD) with partial reduction.@*Methods@#A retrospective case-control study was conducted to analyze the clinical data of 42 patients with IAAD admitted to Henan Provincial People's Hospital from January 2014 to October 2017. There were 17 males and 25 females, aged from 12 to 72 years [(47.2±11.3) years]. After more than 50% reduction by high weight skull traction, 18 patients underwent posterior atlantoaxial joint axial release, reduction, bone grafting and fusion with internal fixation (Group A), and 24 patients underwent anterior transoral or retropharyngeal release, reduction, posterior bone grafting and fusion with internal fixation (Group B). The operation time, intraoperative blood loss, preoperative and postoperative anterior atlantodental interval (ADI), clivus-canal angle (CCA), cervicomedullary angle (CMA), and Japanese Orthopaedic Association (JOA) scores between the two groups were compared. The improvement rate of JOA scores at the last follow-up of the two groups and the atlantoaxial joint fusion rate at 3 months and 6 months after surgery were calculated and compared. The complications were recorded.@*Results@#All patients were followed up for 12 to 40 months with an average of 24.6 months. Group A had significant decreases in operation time [(138.1±25.6) minutes ∶(242.8±38.1) minutes] and intraoperative blood loss [(179.3±48.7)ml ∶(218.2±42.6)ml] compared with Group B (P<0.05). There were significant differences between the ADI, CCA, CMA and JOA scores before operation and during the last follow-up in both Group A and Group B (P<0.05), but there was no significant difference between the two groups in terms of these scores (P>0.05). The JOA scores in Group A were excellent in eight patients, good in eight patients, and fair in two patients, with the improvement rate of 89%. The JOA scores in Group B were excellent in 13 patients, good in eight patients, and fair in three patients, with the improvement rate of 87% (P>0.05). In Group A, the atlanto-axial joint fusion rate was 83% at 3 months and 100% at 6 months postoperatively; in Group B, the fusion rate was 79% at 3 months and 100% at 6 months postoperatively (P > 0.05). There was no failure of internal fixation or loss of reduction in both groups.@*Conclusion@#Posterior atlantoaxial joint axial release, bone grafting and fusion with internal fixation can be used to treat the partially reducible IAAD through a single approach. The reduction effect was comparable to that of anterior transoral or retropharyngeal release, bone grafting and fusion, with less operation time and intraoperative blood loss.

Posterior atlantoaxial joint axial release, bone grafting and internal fixation for irreducible atlantoaxial dislocation with partial reduction / 中华创伤杂志

Objective To investigate the efficacy of posterior atlantoaxial joint axial release,bone grafting and internal fixation for the treatment of irreducible atlantoaxial dislocation (IAAD) with partial reduction.Methods A retrospective case-control study was conducted to analyze the clinical data of 42 patients with IAAD admitted to Henan Provincial People's Hospital from January 2014 to October 2017.There were 17 males and 25 females,aged from 12 to 72 years [(47.2 ± 11.3) years].After more than 50％ reduction by high weight skull traction,18 patients underwent posterior atlantoaxial joint axial release,reduction,bone grafting and fusion with internal fixation (Group A),and 24 patients underwent anterior transoral or retropharyngeal release,reduction,posterior bone grafting and fusion with internal fixation (Group B).The operation time,intraoperative blood loss,preoperative and postoperative anterior atlantodental interval (ADI),clivus-canal angle (CCA),cervicomedullary angle (CMA),and Japanese Orthopaedic Association (JOA) scores between the two groups were compared.The improvement rate of JOA scores at the last follow-up of the two groups and the atlantoaxial joint fusion rate at 3 months and 6 months after surgery were calculated and compared.The complications were recorded.Results All patients were followed up for 12 to 40 months with an average of 24.6 months.Group A had significant decreases in operation time [(138.1 ±25.6) minutes ∶ (242.8 ± 38.1) minutes] and intraoperative blood loss [(179.3 ± 48.7) ml ∶ (218.2 ± 42.6) ml] compared with Group B (P ＜0.05).There were significant differences between the ADI,CCA,CMA and JOA scores before operation and during the last follow-up in both Group A and Group B (P ＜ 0.05),but there was no significant difference between the two groups in terms of these scores (P ＞ 0.05).The JOA scores in Group A were excdlent in eight patients,good in eight patients,and fair in two patients,with the improvement rate of 89％.The JOA scores in Group B were excellent in 13 patients,good in eight patients,and fair in three patients,with the improvement rate of 87％ (P ＞0.05).In Group A,the atlanto-axial joint fusion rate was 83％ at 3 months and 100％ at 6 months postoperatively;in Group B,the fusion rate was 79％ at 3 months and 100％ at 6 months postoperatively (P ＞ 0.05).There was no failure of internal fixation or loss of reduction in both groups.Conclusion Posterior atlantoaxial joint axial release,bone grafting and fusion with intemal fixation can be used to treat the partially reducible IAAD through a single approach.The reduction effect was comparable to that of anterior transoral or retropharyngeal release,bone grafting and fusion,with less operation time and intraoperative blood loss.

Ulna osteotomy and joint capsule release and tight for old Monteggia's fracture in children / 中国骨伤

<p><b>OBJECTIVE</b>To explore the experience and effect of surgical treatment in old Monteggia fracture in children.</p><p><b>METHODS</b>From January 2013 to December 2017, 32 cases of old Monteggia's fracture were treated including 18 males and 14 females with an average age of(5.3±1.2) years old ranging from 2 to 9 years old. No symptoms of radial nerve injury were found. The preoperative symptoms of the patients were the pain and deformity of the elbow joint, the flexion and extension and the limited forearm rotation. The X-ray showed the union of the ulna or the "arched sign", the dislocation of the radial head or the subluxation of the head. The posterior incision of the ulna ridge was performed in the operation, and the long oblique osteotomy was performed at the most obvious point of the ulna angle deformity. Then the Boyd incision was used to expose the humeral and radial joint and the upper ulnar radial joint. The scar tissue in the joint was cleaned and the radial head was repositioned. On the premise of maintaining the stability of the elbow joint, the ulna osteotomy was treated with plate and screw internal fixation.</p><p><b>RESULTS</b>All 32 cases were followed up for 12 to 24 months with an average of 14.8 months, of which 1 case had incision infection. There were no pain symptoms of elbow and wrist in 32 patients after operation, 29 patients with elbow joint flexion and extension (130±5)°/0°, forearm pronation and supination 90°/(85±5)°; 2 patients with elbow flexion and extension(119°/8°, 121°/7°), forearm pronation and supination (90°/75°, 85°/60°); 1 patient with elbow flexion and extension 90°/10°, forearm pronation and supination 80°/60°. According to Mackay criteria, the result was excellent in 29 cases, good in 2 cases, medium in 1 case.</p><p><b>CONCLUSIONS</b>Ulna osteotomy, elbow posterior capsular release, anterior capsule contraction is a effective method in the treatment of old Monteggia's fracture in children.</p>

Clinical effect modified Chevron osteotomy combined with lateral tissue loosening in treating mild-moderate hallux valgus through internal signal approach / 中国骨伤

<p><b>OBJECTIVE</b>To explore clinical effect of modified Chevron osteotomy combined with lateral tissue loosening for the treatment of mild-moderate hallux valgus through internal signal approach.</p><p><b>METHODS</b>From July 2015 to June 2016, 26 patients with mild-moderate hallux valgus treated with modified Chevron osteotomy combined with lateral tissue loosening through internal signal approach, including 2 males and 24 females aged from 45 to 65 years old with an average of(54.6±4.8) years old;the courses of diseases ranged from 1 to 5 months with an average of (7.5±3.3) months. Hallux valgus angle(HVA), inter metatarsal angle(IMA) were measured at 12 months after operation, and AOFAS score was applied to evaluate clinical effect before and after operation.</p><p><b>RESULTS</b>All incisions were healed at stage I. No incision occurred infection, metatarsal necrosis and recurrence of hallux valgus deformity. Two patients occurred skin numbness caused by musculocutaneous nerve injury. Twenty-six patients were followed up from 6 to 12 months with an average of(9.12±2.06) months. HVA, IMA were(30.01±3.71)°, (14.00±1.50)° before operation and(9.41±4.16)°, (7.00±0.60)° after operation, which had significant difference. There was statistical significance in AOFAS score before operation 54.77±9.59 and after operation 92.73±5.47, and 19 cases obtained excellent results and 7 moderate.</p><p><b>CONCLUSIONS</b>Modified Chevron osteotomy combined with full thread headless pressure screw fixation and lateral tissue loosening for the treatment of mild-moderate hallux valgus has advantages of excellent exposure, simple operation, stable fixation, rapid recovery. Akin osteotomy with internal capsulorrhaphy were used with lateral loosening and could recover soft tissue balance between lateral and internal, and could receive satisfied clinical effects.</p>

Percutaneous dynamic release in stress position by acupotomy in treating severe scapulohumeral periarthritis / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical efficacy of acupotomy stress position percutaneous dynamic release for severe shoulder periarthritis.</p><p><b>METHODS</b>From April 2012 to August 2016, 160 patients with severe shoulder periarthritis were randomly divided into treatment group and control group. Among them, 80 patients in treatment group were treated with acupotomy stress position percutaneous dynamic release including 32 males and 48 females with an average of(52.47±9.04)years old ranging from 40 to 74 years old;the courses of disease was(20.72±9.55)months on average. The other 80 patients in control group were treated with simple joint loosening according to Maitland technique in grade III-IV therapy, once a day, 15 to 20 min each time, and 10 d for 1 course, for a total of 2 courses, including 33 males and 47 females with an average of (53.19±10.18) years old ranging from 42 to 75 years old; the average course of disease was (21.98 ±8.99) months. After operation, the shoulder muscles training and shoulder joint activity training were routinely conducted, the treatment lasted for 3 weeks. The visual analogue scale(VAS) and Constant-Murley shoulder function score were observed and compared between the two groups before treatment and 3 weeks, 3, 6 months after treatment.</p><p><b>RESULTS</b>The VAS scores of the treatment group at 3 weeks, 3 and 6 months after treatment were all lower than those of the control group(<0.05). The shoulder joint function Constant-Murley scores of the treatment group at 3 weeks, 3 and 6 months after treatment were higher than those of the control group (<0.05); the result was excellent in 59 cases, good in 18 cases, fair in 3 cases in the treatment group; excellent in 15 cases, good in 31 cases, fair in 23 cases, poor in 11 cases in the control group, and the difference between the two groups was statistically significant(<0.01).</p><p><b>CONCLUSIONS</b>Treatment of severe shoulder periarthritis with acupotomy stress position percutaneous dynamic release can obviously improve the shoulder joint function and pain, according to the different parts of the shoulder joint pain and function limitation, the corresponding shoulder stress and body position should be designed and maintained during the treatment process, and the angle of stress position gradually increased by loosening the adhesion, which is the key to ensure the curative effect.</p>

Mid-long term results of manipulation and arthroscopic release in frozen shoulder / Resultados a médio e longo prazo da manipulação e liberação artroscópica de ombro congelado

ABSTRACT Objective: Surgical treatment options should be discussed in cases of frozen shoulder, which is usually treated in a conservative manner. In this study, we evaluated the efficacy of manipulation and arthroscopic release in cases of frozen shoulder which resisted conservative treatment. Methods: A total of 32 patients who underwent manipulation and arthroscopic capsular release in 34 shoulders were included in the study. The average follow-up period was 49.5 months (range: 24-90 months). No reason for onset could be found in 8 (25%) patients, who were classified as primary frozen shoulder; twenty-four (75%) patients were classified as secondary frozen shoulder due to underlying pathologies. The average pre-operative complaint period was 11 months (range: 3-24 months). After arthroscopic examination, manipulation was performed first, followed by arthroscopic capsular release. The range of motion in both shoulders was compared before the procedure and in the last follow-up visit. Constant and Oxford classifications were used to assess functional results, and the results were assessed statistically. Results: Patient values for passive elevation, abduction, adduction-external rotation, abduction-external rotation, and abduction-internal rotation increased in a statistically significant manner between the preoperative assessment and follow-up evaluation (p<0.01). The average change of 47.97±21.03 units observed in the patients' values obtained in the control measurements against the pre-op Constant scores was determined to be statistically significant (p<0.01). According to the Oxford classification, 29 shoulders were sufficient. Conclusion: Successful results can be obtained with arthroscopic release performed after manipulation in patients with frozen shoulder resistant to conservative treatment. Level of Evidence IV, Case Series.

RESUMO Objetivo: As opções de tratamento cirúrgico devem ser discutidas nos casos de ombro congelado que, em geral, são tratadas de modo conservador. Neste estudo, avaliamos a eficácia da manipulação e da liberação artroscópica nos casos de ombro congelado refratário ao tratamento conservador. Métodos: Um total de 32 pacientes submetidos a manipulação e liberação capsular artroscópica em 34 ombros foram incluídos no estudo. O período médio de acompanhamento foi de 49,5 meses (faixa: 24 a 90 meses). Não foi possível determinar o motivo do início da afecção em 8 (25%) pacientes, que foram classificados como ombro congelado primário; 24 (75%) pacientes foram classificados como ombro congelado secundário, devido a patologias subjacentes. O período médio de queixa pré-operatória foi de 11 meses (faixa: 3 a 24 meses). Depois do exame artroscópico, realizou-se manipulação, seguida por liberação capsular artroscópica. A amplitude de movimento em ambos os ombros foi comparada antes do procedimento e na última visita de acompanhamento. As classificações de Constant e Oxford foram usadas para avaliar os resultados funcionais, e os resultados foram avaliados estatisticamente. Resultados: Os valores dos pacientes para elevação, abdução, adução-rotação externa, abdução-rotação externa e abdução-rotação interna aumentaram de modo estatisticamente significante entre a avaliação pré-operatória e a do acompanhamento (p < 0,01). A mudança média de 47,97 ± 21,03 unidades observada nos valores dos pacientes, obtidos nas medidas de controle com relação aos escores de Constant no pré-operatório foi determinada como estatisticamente significante (p < 0,01). De acordo com a classificação de Oxford, 29 ombros foram suficientes. Conclusão: Os resultados bem-sucedidos podem ser atingidos com liberação artroscópica realizada depois da manipulação dos pacientes com ombro congelado, resistentes ao tratamento conservador. Nível de Evidência IV, Série de Casos.

Lateral retinacular release and patella ligament reconstruction under arthroscopy for recurrent patellar dislocations / 中国组织工程研究

BACKGROUND:Arthroscopy can observe the involutive relation of patelofemoral joint directly and dynamicaly, which can be used to judge whether the patelofemoral joint abnormalities can be completely corrected. OBJECTIVE:To analyze the clinical effect of lateral retinacular release and ligament reconstruction under arthroscope for patela recurrent dislocation. METHODS: A total of 58 patients diagnosed as having recurrent patelar dislocations were divided randomly into control and experimental groups, with 29 cases in each group. Patients in the control group received lateral retinacular release and ligament reconstruction under common operation and those in the experimental group received lateral retinacular release and ligament reconstruction under arthroscopy. RESULTS AND CONCLUSION:There was no significant difference in the Lysholm and Kujala scores before treatment in the two groups (P > 0.05), but at 12 months after treatment, the Lysholm and Kujala scores were both increased in the two groups, especialy in the treatment group (P 0.05), and CT measurement values of the congruence angle and lateral patelofemoral angle were both decreased in the two groups, especialy in the experimental group, at 12 months after treatment. In addition, the operation time, healing time, and total effective rate were better in the experimental group than the control group (P < 0.05). These results indicate that the lateral retinacular release and ligament reconstruction under arthroscopy has a better effect on recurrent patelar dislocation.

Open release combined with hinged external fixator repairs extremely severe elbow stiffness / 中国组织工程研究

BACKGROUND:Once traumatic arthritis appears, degeneration of the joints wil be inevitable. In the clinical treatment of moderate or less stiff elbow, traditional elbow stiffness release is the preferred repair method. However, its therapeutic effect is controversial in the clinical treatment of very severe elbow stiffness. The focus on conflict is articular surface damage after the implementation of the traditional release of elbow stiffness. OBJECTIVE: To observe the repair effect of open release combined with hinged external fixator on extremely severe elbow stiffness. METHODS:A total of 52 patients with extremely severe elbow joint stiffness were selected from the Third Department of Orthopedics, Yuebei People’s Hospital from May 2012 to July 2014. Al patients signed the informed consent. In accordance with the approval of Hospital Ethics Committee, they were divided into control and study groups (n=26). Control group received the traditional elbow stiffness release. Study group received open release combined with hinged external fixator. The changes in flexion-extension range-of-motion and Mayo elbow joint function score were compared between the two groups. RESULTS AND CONCLUSION:After treatment with open release combined with hinged external fixator, significant differences in excelent and good rate, range-of-motion of flexion-extension and Mayo elbow joint function score were detected between the study group [96%, (117.5±20.5)°, (88.5±11.5) points] and the control group [77%, (93.5±18.5)°, (76.5±9.5) points] (P < 0.05). These results indicated that open release combined with hinged external fixator significantly improved elbow joint function in patients with extremely severe elbow stiffness, facilitated postoperative rehabilitation exercise activities, and had high value of clinical application.

Arthroscopic treatment of adhesive capsulitis of the shoulder with minimum follow up of six years

OBJECTIVE: To evaluate the results of the arthroscopic treatment of adhesive capsulitis of the shoulder with six to nine years of follow up. METHODS: From August 2002 to December 2004, ten patients underwent arthroscopic capsular release for adhesive capsulitis refractory to conservative treatment. An interscalene catheter was used for postoperative analgesia, before the procedure. All were in stage II, with a minimum follow up of six years. The mean age was of 52.9 years old (range, 39 to 66), with female predominance (90%) and six left shoulders. The time between the onset of symptoms and surgery varied from six to 20 months. There were four patients in the primary form (40%) and six in the secondary (60%). RESULTS: In the preoperative evaluation, the mean active anterior elevation was 92°, 10.5° of external rotation, and internal rotation level L5. Postoperatively, the mean active elevation was 149°, 40° of external rotation and internal level T12, respectively. Thus, the average gains were 57° in forward active elevation, 29.5° in external rotation and six spinous processes, these values being statistically significant (p <0.001). According to the Constant functional score (arc of movements), the value increased from 13.8 (preoperative mean) to 32 points (postoperative mean). CONCLUSION: Arthroscopic treatment of adhesive capsulitis of the shoulder refractory to conservative treatment allows effective gain of range of motion of this joint. Level of Evidence IV, Retrospective Study (Case Series).

Arthrolysis and a hinged external fixator for posttraumatic elbow stiffness / 中国医师进修杂志

Objective To explore the clinical effect of arthrolysis and a hinged external fixator for treatment of posttraumatic elbow stiffness.Methods From April 2007 to April 2012,26 cases of posttraumatic elbow stiffness patients were treated with arthr o lysis and a hinged external fixator after operation,and the effect was observed.Results After operation,26 patients were followed up for 15(8-24) months,the ranges of elbow joint motion increased from (42 ± 17) ° to (119 ± 17) ° after operation.There was significant difference (t =152.85,P＜ 0.05).The MEPS scores increased from (36 ± 13) points to (82 ± 14) points after operation,15 cases were excellent,5 cases were good,3 cases were fair and 3 cases were poor,the rate of excellent and good cases was 76.9％ (20/26).Twenty-three cases (88.5％,23/26)elbow function improved.Postoperative infective complication occurred in 1 case,postponed incision healing occurred in 1 case and 1 patient had cubital nerve paralysis,the symptom disappeared after 3 months and the patient showed no instability in elbow joint.Conclusion Arthrolysis and a hinged external fixator can deep stabe the elbow and its specific position,allowing early rehabilitation to promote functional recover of the elbow.