Reconstruction and balance of soft tissue in hemi-shoulder replacement for patients with four-part fracture of the proximal humerus / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the effective skills of reconstruction and balance of soft tissue in hemi-shoulder replacement for patients with four-part fracture of the proximal humerus in order to avoid postoperative complications of joint instability and great tubercle displacement.</p><p><b>METHODS</b>From June 2002 to June 2006, 25 patients with Neer four-part fracture of the proximal humerus were adopted in the study which included 15 females and 10 males, with the mean age of 66 years (ranged from 56 years to 80 years). They were treated with humeral head replacement and should joint reparation simultaneously by modified operation approach and reconstruction and balance skills of soft tissue.</p><p><b>RESULTS</b>The mean duration of follow-up was 2.3 years (ranged from 1 to 4.5 years). No infection, nerve damage and prosthesis loosing were found in all cases. Two cases of infra-forward dislocation or subluxation occurred due to affected limb placed on abduction splint postoperatively. One case occurred prosthesis upward displacement due to early active abduction exercise but no complains. Neither joint instability nor displacement and malunion of great tubercle were found in other patients. According to Neer scoring system, 6 cases were rated as excellent, 15 as good and 5 as fair. The good and excellent rate was 84%.</p><p><b>CONCLUSION</b>In hemi-shoulder replacement for patients with Neer four-part fracture the modified operation approach and reconstruction and balance of soft tissue skills combined with rational rehabilitation exercise can prevent postoperative shoulder joint instability and displacement and malunion of great tubercle.</p>

Release and balance of the soft tissue in total hip arthroplasty for patients with Crowe III and IV type developmental dysplasia of hip / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the surgical experience of release and balance of soft tissues around hip in total hip arthroplasty for patients with severe hip dysplasia.</p><p><b>METHODS</b>From January 2001 to January 2006, 29 patients (31 hips) of adult dysplasia of hip were included in the study. Among them, there were 22 females and 7 males, age from 38 to 65 years with average of 53 years. According to Crowe classification system, there were 22 in type III, 9 in type IV, and Harris score was 42.6 preoperatively. Total hip arthroplasty was performed via lateral approach. All the acetabular cups were reconstructed at the original anatomic location through release of soft tissue around hip to restore limb length, and techniques of balance of soft tissue were applied to extend force arm of hip abductor and improve its function.</p><p><b>RESULTS</b>All the patients had restoration of limb length (ranged from 2.5 cm to 4.5 cm). One case of postoperative dislocation was occurred due to slight large of acetabular obtuse angle. Follow-up for 1-5 years (average 3.2 years) in 29 patients, the Harris score increased to 85.4 postoperatively. All hips had released from pain and functioned well.</p><p><b>CONCLUSIONS</b>In order to restoration anatomic structure and physiologic function of affected hip, the technique of release and balance of soft tissues around hip should be applied and cautioned in arthroplasty of dysplastic hip.</p>

Treatment of thoracolumbar burst fractures with direct reduction and fixation through the pedicle of fractured vertebra / 中华创伤骨科杂志

Objective To evaluate the feasibility and principle of direct reduction and fixation through the pedicle of fractured vertebra in treatment of thoracolumbar burst fractures.Methods Between June 2001 and November 2005,24 cases of one level thoracolumbar burst fracture,16 males and eight females,were treated in our department.Their average age was 32.5 years old.The fractured vertebrae were as follows:T11 in two cases,T12 in nine cases,L1 in 11 cases and L2 in two cases.According to the ASIA(American Spinal Injury Association) neurological function grading system,there were one grade A,two grade B,five grade C,three grade D anti 13 grade E.The vertebral canal area blocked was rated as gradeⅠ(＜1/4)in three cases,gradeⅡ(1/4～1/2)in nine cases,gradeⅢ(1/2～3/4)in 10 cases and gradeⅣ(＞3/4)in two cases.The pedicle-screws were im- planted into the pedicles of the fractured vertebra and its adjacent ones.The connective rod was pre-bent according to the normal sagittal curvature of the fixation segment.After necessary decompression of the vertebral canal,the pedicle-screws stabilized the rod which was rotated to prop open upper and lower pedicle screws and push the burst vertebra so that the kyphosis and lateral dislocation were corrected.The graft bone was implanted between the transverse processes.Results On average,the height of fractured vertebra was restored from 48.3% of the normal value before operation to 93.6% after operation,the lateral dislocation from 17.1% to 0.6%,the Cobb's angle on the sagittal plane from 26.5?to 3.1?,and the Cobb's angle on the frontal plane from 9.5?to 0?.The area of vertebral canal was enlarged from 44.6% of the normal value to 92.1%.There were no complications.For in- complete neurological injuries,improvement of one to two grades was made in neurological functions.Conclusion Direct reduction and fixation through pedicles of fractured vertebrae is a safe and effective therapeutic option to treat the thoracolumbar burst fracture,for it can improve the stabilization and stress distribution.