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Objective To evaluate the efficacy of distal radioulnar joint (DRUJ) dorsal ligament reconstruction using extensor retinaculum transposition with triagular fibrocartilage complex (TFCC) repair and dorsal capsuloplasty for chronic DRUJ dorsal instability.Methods From October 2007 to July 2016,data of 18 patients (11 men and 7 women with a mean age of 37.4 years) were retrospectively analyzed who underwent DRUJ dorsal ligament reconstruction with extensor retinaculum transposition,DRUJ dorsal capsuloplasty,and TFCC repair for DRUJ dorsal instability.The tissue flap of extensor retinaculum was fixed at the ulnar edge of distal radius by two micro anchors after TFCC repair and dorsal capsuloplasty of the DRUJ capsule.X-ray examination of wrist was performed for all the patients after operation to identify the reduction of DRUJ.The wrist range of flexion and extension,the forearm range of rotation,and the grip strength of hand were measured.Modified Mayo wrist scores,DASH scores and visual analogue scale (VAS) were used to evaluate the function and pain of wrist and upper extremity.Results 18 patients were followed up for 12-70 months with an average period of 34 months.The stability of the DRUJ was restored in 16 patients.The other 2 cases wore long arm splint for 6 weeks after operation due to the residual instability of the DRUJ,after that the instability of DURJ were improved to grade I.The flexion and extension of wrist,the rotation of forearm were improved,but there were no significant difference comparing to those of pre-operation.The VAS,modified Mayo and DASH scores,grip strength of hand were significantly improved from preoperative 4.2±1.1,67.4±11.2,51.3±14.2,16.3±3.7 kg to postoperative 0.2±0.5,83.9±11.6,15.9±3.2,24.9±6.4 kg at the latest follow-up.Conclusion Extensor retinaculum transposition with TFCC repair and DRUJ dorsal capsuloplasty can effectively relieve pain and recovery stability of DRUJ,which was an effective method for chronic DRUJ dorsal instability.
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Objective To investigate the bettertherapeutic method and clinical efficacy of discoid meniscus injury under arthroscope.Methods Forty-one patients with discoid meniscus injury were selected as our subjects from Nov.2011 to Feb.2013,who were treated by arthroscopic surgery and performed with meniscus plasty.Thirt-eight patients were received ultra Fast-fix meniscal repair system.Joint function exercises were performed on bed within 1 month after operation.Incomplete weight bearing were performed after 1 month postoperation.After 3 month postoperation,they were permitted for full weight bearing.Results All patients were treated successfully with surgery and no postoperative complications occurred.The patients were followed up from 3.0 to 18.0 months and average was 10.5 months.The preoperative Lysholm scores were(68.28 ±8.04)) lower than that at the postoperation (88.17 ± 7.49)) and the difference were significant (t =11.59,P ＜ 0.05).Furthermore,according to Ikeuchi criterion,the outcomes were 28 cases with excellent,10 cases with good and 3 cases with general rank.Conclusion Discoid meniscus plasty and suture under arthroscope is proved to be a better approach with less trauma,recovery quickly and fewer complications.It should be a preferred method for discoid meniscus injury.
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Objective:To explore the surgical techniques in posterolateral mini-incision total hip arthroplasty and clinical effcacy. Methods:A total of 94 patients (98 hips) had posterolateral mini-incision total hip arthroplasty, from December 2006 to December 2008, and were randomly divided into a posterolateral mini-incision total hip arthroplasty group (Group A) and a conventional group of posterolateral incision for total hip arthroplasty (Group B). Forty-nine patients (50 hips) in Group A had posterolateral small incision total hip arthroplasty [26 males, 23 females, between 37.0 and 95.0 years (average 68.9 years), body mass index (BMI) between 20.3 and 29.7 (average BMI 25.4)]. Forty-ifve patients (48 hips) in Group B had the conventional posterolateral incision [27 males, 18 females, between 45.0 and 92.0 years (average 69.7 years), BMI between 18.7 and 34.1 (average BMI 26.9)]. The incision length, blood loss, drainage, operation time, and postoperative Harris scores were compared between the 2 groups. Results:The incision length was 6.0~10.5 (average length 7.4) cm, average blood loss was 387.6 (140.0~1000.0) mL, average drainage was 143.1 (63.0~375.0) mL, average blood transfusion was 77.6 (0~400.0) mL, average operation time was 84.6 (63.0~130.0) min, and vitalock abduction angle imaging after the operation was 41.6° (averagely 38.0°~57.0°) in Group A. The incision length was 15.0~23.0 (average length 20.0) cm, average blood loss was 513.1 (210.0~1350.0) mL, average drainage was 152.3 (70.0~520.0) mL, average blood transfusion was 142.2 (0~800.0) mL, average operation time was 84.0 (71.0~115.0) min, and postoperative radiographic acetabular cup abduction angle was 42.3° (37.0°~54.0°) in Group B. The follow-up showed that the prosthesis of the 2 groups was in a good position, Harris score was significantly improved with no complications after total hip arthroplasty in the 2 groups. Conclusion:With the correct selection of indications and adept operation skills and other circumstances, posterolateral mini-incision total hip arthroplasty may do little damage to the soft tissue with a small scar on the skin. The imaging evaluation after the operation and the Harris score show no difference between the 2 groups. Patients are satisfied with their joint function and postoperative recovery.
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Objective To explore the stress changes of C7/T1 intervertebral space pre-and post C5/6 discectomy and artificial disc replacement.Method Eleven healthy adult fresh muhisegmental cadaveric cervical spine segments were utilized in this investigation and biomechanically evaluated under the following C5/6 conditions:intact spine,discectomy,and Bryan Disc prosthesis implantation.The load,of neutrality and pure moments of axial,flexion,extension,and lateral bending were applied on each group.The stress changes of the inferior (C7/T1)interverlebral space was detected by modified cyclo-shaped miniature transducer.Result Under axial,anteflexion,and lateral bending loading,the discectomy indicated a significant increase in the stress of the inferiorer(C7/T1)intervertebral space,compared to intact condition and CADR(P＜0.05).Under extension loading,the discectomy indicated an increase in the stress of the inferiorer(C7/T1)intervertebral space,compared to intact condition(P＞0.05).Under axial,flexion,extension and lateral bending loading,the Bryan Disc prosthesis implantation indicate minor increase of the stress in the inferior(C7/T1)intervertebral space to intact condition(P＞0.05).Conclusion There was no difference between the C5/6 ADR and intact spine group.The discectomy of the Cs/6 can increase the stress of the C7/T1 intervertebral spaoe.