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@#The implant-supported prosthesis has gradually become the preferred treatment for patients with partial edentulous or complete edentulous. Causes for the implant failure have been discussed in the majority of studies conducted in recent years, while their risk factors are still controversial. Patient factors (gender, age, smoking, osteoporosis, diabetes, medication, periodontitis and bruxism), clinical parameters (implant area, bone quality, implant size) and doctor factors (surgical-related factors, prosthesis-related factors) will all affect implant failure. This article presents typical clinical cases and reviews the potential risk factors for dental implant failure, in order to provide guidance for clinical practice.
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Objective:To explore the clinical effects of arthroscopic treatment of intraarticular displaced fractures of the calcaneus in children.Methods:The clinical data were analyzed retrospectively of the 11 children who had been treated for intraarticular displaced fractures of the calcaneus at Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University from January 2015 to June 2018. They were 6 boys and 5 girls, aged from 8 to 12 years (average, 10.6 years) and involving the left foot in 7 cases and the right foot in 4. By the Sanders classification, there were 10 cases of type Ⅱ and one of type Ⅲ. Preoperative evaluation of the injury was conducted by X-ray examination and three-dimensional CT reconstruction of the calcaneus. After arthroscopic prying reduction, internal fixation with mere Kirschner wire was performed for 8 cases and internal fixation with Kirschner wire plus hollow screws for 3. The affected feet were fixated with plaster bracket or brace for one month after operation. The Kirschner wires were removed 4 to 6 weeks after operation when X-ray films revealed fracture union. The clinical effects were evaluated by anatomic recovery of the calcaneus in terms of preoperative and postoperative B?hler and Gissane angles and functional recovery of the calcaneus in terms of ankle-hindfoot scores of American Orthopedic Foot Ankle Society (AOFAS) scale.Results:All the 11 pediatric patients were followed up for 12 to 19 months (average, 14 months). No bone grafting was applied. Their operation time averaged 63 min (from 50 to 75 min). Their incisions healed at one stage without infection. All their fractures healed within 2 to 3 months without any delayed union or nonunion. The B?hler angle (28.4°±2.9°) and Gissane angle (125.6°±3.1°) at the final follow-up were significantly improved than the preoperative values (11.8°±5.4° and 138.8°±6.3°) ( P< 0.05). The AOFAS ankle-hindfoot scores were 89.6 points at the final follow-up. Conclusion:Arthroscopic percutaneous prying reduction combined with internal fixation with Kirschner wire and hollow screws can effectively reduce and fixate the intraarticular displaced fracture of the calcaneus in children, leading to limited surgical trauma and fine curative effects.
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Objective To investigate clinical value of ankle arthroscopy in diagnosis of type Danis-Weber B ankle fracture with the distal tibiofibular syndesmosis injury.Methods From August 2014 to January 2018,a total of 52 cases of type Danis-Weber B ankle fractures with an average age of 35.37± 11.19 years,including 31 males and 21 females were treated.Each patient underwent preoperative assessment,according to the patient's clinical manifestations and imaging examination before operation.The Cotton test and the external rotation test were conducted in the C arm X-ray to evaluate whether there is the distal tibiofibular syndesmosis injury.All fractures were treated with open reduction and internal fixation.Repair was conducted with 3.5 mm wire anchor and nail for triangular ligament injury.The Cotton test and external rotation test were performed under ankle arthroscopy.The injury of the lower tibiofibular syndesmosis was observed and evaluated by cotton test and external rotation test in patients who were found to be associated with lower tibiofibular joint injury.After internal fixation of fracture and repair of tibiofibular syndesmosis injury with TightRope,the repair effects of tibiofibular syndesmosis injury was observed under direct vision of ankle arthroscopy.The VAS score,AOFAS score and Baird-Jackson score was used as an index to observe the pain and ankle function before and after operation for 12 months follow-up.Results Preoperative X-ray showed 19 cases of lower tibiofibular joint injury.Preoperative CT showed 28 cases of lower tibiofibular joint injury.Preoperative MRI showed 39 cases of lower tibiofibular joint injury.A total of 36 cases of joint injury of lower tibiofibular syndesmosis were confirmed under arthroscopy of ankle.After repair of tibiofibular syndesmosis injury with TightRope,complete reduction and stability of inferior tibiofibular syndesmosis were confirmed under ankle arthroscopy.At 12 months after operation,the VAS score decreased from 8.13 ± 1.32 points preoperation to 0.75±0.73 points after operation.The AOFAS and Baird-Jackson scores increased from 26.59±3.35 points,16.44±3.63 points preoperation to 94.36±3.03 points,90.29±6.45 points after operation,respectively.There was significant difference before and after operation (P＜0.05).The postoperative VAS score,AOFAS score and Baird-Jackson score of 16 patients without lower tibiofibular ligament injury were confirmed in the ankle arthroscopy group,namely 0.58±0.67 points,95.27±4.67 points,91.98±9.23 points.Conclusion Ankle arthroscopy can be used to observe the injury of tibiofibular syndesmosis under direct vision.The positive rate of diagnosis of inferior tibiofibular syndesmosis injury was 69.2％ (36/52).It can provide reliable evidence for correct diagnosis and treatment of type Danis-Weber B ankle fracture with lower tibiofibular joint injury with significant meaning in selecting operative methods and in evaluating the effect of lower tibiofibular ligament repair.
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Objective To report the therapeutic effects of transfer of flexor hallucis longus tendon on the treatment of obsolete Achilles tendon rupture with a defect greater than 5 cm.Methods The clinical data were retrospectively analyzed of the 39 patients with obsolete Achilles tendon rupture who had been treated at Department of Bone and Joint Surgery,Affiliated Hospital of Southwest Medical University from September 2010 to January 2017.They were 33 males and 6 females,aged from 15 to 46 years(average,31.6 years).All the defects of Achilles tendon were greater than 5 cm.The duration between injury and operation ranged from 5 to 32 weeks(mean,16 weeks).All the 39 patients underwent transfer of flexor hallucis longus tendon to reconstruct their Achilles tendons.The tendons were harvested using double incisions in 23 patients and using a single incision in 16.The functional recovery of the ankle was evaluated according to ankle-hindfood score of American Orthopaedic Foot and Ankle Society(AOFAS),Achilles tendon total rupture score(ATRS),visual analogue scale(VAS),dorsal extension and plantar flexion of the ankle and patient's satisfaction as well.Results Healing by the first intention was achieved in 38 cases.Delayed healing occurred in one patient due to wound infection.One patient had postoperative numbness in the medial plantar region which disappeared 3 months later with no special treatment.All the 39 patients were followed up for 24 to 91 months(mean,32 months).None of the tendons was re-ruptured during the follow-up.The AOFAS scores at postoperative 3 months,one year and last follow-up were significantly higher than the preoperative one(P<0.05);the postoperative VAS scores were significantly lower than the preoperative one(P<0.05);the postoperative ranges of dorsal extension and plantar flexion of the ankle were all significantly larger than the preoperative ranges(P<0.05).At the last follow-up,31 patients expressed great satisfaction,7 satisfaction,and one neutral attitude.Conclusion Reconstruction of the Achilles tendon with transfer of flexor hallucis longus tendon is an effective surgical option for obsolete rupture of Achilles tendon with a defect greater than 5 cm.
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Objective@#To investigate clinical value of ankle arthroscopy in diagnosis of type Danis-Weber B ankle fracture with the distal tibiofibular syndesmosis injury.@*Methods@#From August 2014 to January 2018, a total of 52 cases of type Danis-Weber B ankle fractures with an average age of 35.37±11.19 years, including 31 males and 21 females were treated. Each patient underwent preoperative assessment, according to the patient's clinical manifestations and imaging examination before operation. The Cotton test and the external rotation test were conducted in the C arm X-ray to evaluate whether there is the distal tibiofibular syndesmosis injury. All fractures were treated with open reduction and internal fixation. Repair was conducted with 3.5 mm wire anchor and nail for triangular ligament injury. The Cotton test and external rotation test were performed under ankle arthroscopy. The injury of the lower tibiofibular syndesmosis was observed and evaluated by cotton test and external rotation test in patients who were found to be associated with lower tibiofibular joint injury. After internal fixation of fracture and repair of tibiofibular syndesmosis injury with TightRope, the repair effects of tibiofibular syndesmosis injury was observed under direct vision of ankle arthroscopy. The VAS score, AOFAS score and Baird-Jackson score was used as an index to observe the pain and ankle function before and after operation for 12 months follow-up.@*Results@#Preoperative X-ray showed 19 cases of lower tibiofibular joint injury. Preoperative CT showed 28 cases of lower tibiofibular joint injury. Preoperative MRI showed 39 cases of lower tibiofibular joint injury. A total of 36 cases of joint injury of lower tibiofibular syndesmosis were confirmed under arthroscopy of ankle. After repair of tibiofibular syndesmosis injury with TightRope, complete reduction and stability of inferior tibiofibular syndesmosis were confirmed under ankle arthroscopy. At 12 months after operation, the VAS score decreased from 8.13±1.32 points preoperation to 0.75±0.73 points after operation. The AOFAS and Baird-Jackson scores increased from 26.59±3.35 points, 16.44±3.63 points preoperation to 94.36±3.03 points, 90.29±6.45 points after operation, respectively. There was significant difference before and after operation (P<0.05). The postoperative VAS score, AOFAS score and Baird-Jackson score of 16 patients without lower tibiofibular ligament injury were confirmed in the ankle arthroscopy group, namely 0.58±0.67 points, 95.27±4.67 points, 91.98±9.23 points.@*Conclusion@#Ankle arthroscopy can be used to observe the injury of tibiofibular syndesmosis under direct vision. The positive rate of diagnosis of inferior tibiofibular syndesmosis injury was 69.2% (36/52). It can provide reliable evidence for correct diagnosis and treatment of type Danis-Weber B ankle fracture with lower tibiofibular joint injury with significant meaning in selecting operative methods and in evaluating the effect of lower tibiofibular ligament repair.
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Objective To evaluate the clinical value of ankle arthroscopy in diagnosis and treatment of Danis-Weber type B ankle fracture associated with injury to the distal tibiofibular syndesmosis.Methods A retrospective study was conducted of the 35 patients who had been treated at Department of Orthopaedics,Ruijin Hospital North for Danis-Weber type B ankle fracture from February 2014 to December 2016.They were 23 males and 12 females,with an average age of 43.1 years (from 18 to 65 years).Each of them underwent 4 examinations to detect whether injury to the distal tibiofibular syndesmosis was complicated or not:preoperative CT and MRI,C-ann roentgenography and ankle arthroscopy before and after internal fixation of the ankle.The diagnostic rates of the complicated injury by the 4 examinations were compared.The patients complicated with injury to the distal tibiofibular syndesmosis received surgical repair of the injury using TightRope in addition to internal fixation of the ankle,and injury to the deltoid ligament was repaired simultaneously using 3.5 mm anchor nails in case the injury was concomitant.The repair and stability of the distal tibiofibular syndesmosis were observed using ankle arthroscopy again.Results The Cotton and external rotation tests under C-arm roentgenography before surgery and after internal fixation of the ankle demonstrated that 13 cases were complicated with injury to the distal tibiofibular syndesmosis.Of the other 22 patients who had not been diagnosed with the injury by C-arm roentgenography,6,13 and 11 were diagnosed with the injury respectively by CT,MRI and ankle arthroscopy.The diagnostic rates of Danis-Weber type B ankle fracture associated with injury to the distal tibiofibular syndesmosis were 37.1％ (13/35),54.3％ (19/35),74.3％ (26/35) and 68.6％ (24/35) respectively by C-arm roentgenography,CT,MRI and ankle arthroscopy.In the sensitivity to the injury,MRI ＞ ankle arthroscopy ＞ CT ＞ C-arm roentgenography,with significant differences between them (P ＜ 0.05).The ankle arthroscopy confirmed the repair efficacy in the 24 patients complicated with injury to the distal tibiofibular syndesmosis and negative results of Cotton and external rotation tests in them.Additionally,ankle arthroscopy revealed 16 cases of injury to the deltoid ligament at the medial ankle.Conclusions Ankle arthroscopy can provide evidence for correct diagnosis and treatment of Type B ankle fracture complicated with injury to the distal tibiofibular syndesmosis,because it allows direct observation of the medial deltoid ligament of the ankle and the distal tibiofibular syndesmosis.It can be also used to assess the stability of the tibiofibular syndesmosis after repair of the injury.
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Objective To explore the effects of open reduction and internal fixation plus primary subtalar arthrodesis for the treatment of severely comminuted calcaneal fractures of Sanders type Ⅳ.Methods From January 2012 to December 2016,23 patients with severely comminuted calcaneal fracture of Sanders type Ⅳ were treated by open reduction and internal fixation plus primary subtalar arthrodesis at our department.They were 16 men and 7 women with an average age of 39.6 years (range,from 32 to 67 years).Auto-iliac bone graft was performed in 18 cases and allo-bone graft in the other 5 cases.B(o)hler and Gissane angles were measured preoperatively,postoperatively and at the last follow-up to evaluate anatomical morphology of the calcaneus;the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used to evaluate the functional recovery.Results All the 23 cases were followed up successfully for an average time of 21 months (range,from 6 to 39 months).The operations lasted from 40 to 100 minutes with an average of 60 minutes;the intraoperative bleeding ranged from 10 to 40 mL with an average of 20 mL.No one suffered from wound infection but partial epidermal necrosis happened in only one case.Union and fusion of the fractures was achieved after 3 to 5 months with an average of 3.5 months.At the last follow-up,no failed fusion of the subtalar joint happened.Anatomical morphology of the calcaneus was improved obviously.The B(o)hler angles were respectively 12.47° ± 1.61°,30.58° ± 5.34° and 30.09° ± 5.78° preoperatively,postoperatively and at the last follow-up;the Gissane angles were respectively 86.21° ±7.70°,127.44°± 7.61° and 129.07°± 5.47° preoperatively,postoperatively and at the last follow-up.There were significant differences between preoperation versus postoperation and the last follow-up in the above 2 values (P ＜ 0.05);there were no significant differences between postoperation and the last follow-up in the above 2 values (P ＞ 0.05).The AOFAS ankle-hindfoot scoring at the last follow-up showed 8 excellent,11 good and 4 fair cases,giving an excellent to good rate of 82.6％.Conclusion Open reduction and internal fixation plus primary subtalar arthrodesis is a safe alternative for the treatment of severely comminuted calcaneal fractures of Sanders type Ⅳ.
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Objective To study the clinical effect of Longniu Bubi Granule on prevention and treatment of bone loss caused by premenopausal ovarian function suppression (OFS) combined with breast cancer aromatase inhibitor (AIs).Methods Forty patients with postmenopausal and high risk of breast cancer treated with OFS combined with aromatase inhibitors were divided into treatment group (n=23) and control group (n=17).The two groups were treated with calcium VitD3125IU,1 tablet per day.The treatment group received the additional of Longniu Bugu Decoction,2 doses daily,with continuous medication for 6 months.The bone mineral density (BMD) level,bone mineral density (T) and serum bone alkaline phosphatase (BALP) were measured before and 6 months after treatment.Results There were significant differences in lumbar (L2-4) and femoral neck bone mineral density,bone mineral density (T) and serum bone alkaline phosphatase (P＜0.05) between the two groups after treatment,and the treatment group was superior to the control group.Conclusion Longniu Bugu Decoction can reduce bone loss in patients with premenopausal breast cancer caused by OFS combined with AIs therapy and improve patients' life quality.
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Objective To investigate and analyze the surgical site infection rate,clinical characteristics,risk factors and pathogens in patients after type Ⅰ incision orthopedic foot and ankle surgery,which may provide a basis for preventing surgical site infection in foot and ankle surgery.Methods Patients undergoing type Ⅰ incision orthopedic foot and ankle surgery from Jun.2011 to Jun.2015 were investigated retrospectively.Clinical data of cases with surgical site infection were collected and analyzed.Incidence of surgical site infection,clinical features,risk factors and pathogen distribution were studied.Results Seven hundred and sixty-one patients were undergoing type Ⅰ incision orthopedic foot and ankle surgery,surgical site infection occurred in 42 patients with an infection rate of 5.5％.In terms of age,gender,anesthesia,smoking,drinking,rheumatoid arthritis,gout,number of incisions and recovery after open injuries,no significant difference of surgical site infection rate were found.Diabetes mellitus complicated with peripheral neuropathy increased the risk of surgical site infection compared with nondiabetic patients.Patients who had an operative time more than 3 hours had a greater risk of surgical site infection compared with those less than 1 hours.The presence of intra-operative implants increases the risk of surgical site infection compared with patients with external fixations or without implants.Conclusions Surgical site infection is a common complication for the patients after type Ⅰ incision orthopedic foot and ankle surgery.Diabetes mellitus complicated with peripheral neuropathy,long operation time and intra-operative implants may be the high risk factors for surgical site infection.
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Objective To discuss causation and clinical treatment of complication in anterior decompression and fixation technique (ADFT) for thoracolumbar fractures with associated paraplegia. Methods A total of 204 cases that had thoracolumbar fractures with paraplegia were operated with ADFT from 1998 to 2004. Of all, 51 times (34 cases) of complication took place. Change of Cob angle was measured according to X-film of thoracolumbar spine before and after operation. Meanwhile, sensation and motion of patients was evaluated. Results There was incision infection leading to septic cerebo-meningtis in one case, CSF leakage in seven, pneumothorax in eight, rib nerve-root injure in five, lumbar nerve-root injure in two, genitofemoral nerve injure in three, lateral femoral cutaneous nerve injure in two, kyphosis in three, deep venous thrombosis in three and eight times of skin-temperature change. X-film that was taken after operation for all patients showed scolisis in five cases. A follow up for 3-6 years (average 2.5 years) was performed in 84 cases, of which seven cases had chronic low-back pain, six scolisis and five kyphosis. No patient showed complications such as screw breakage, plate breakage, fixation device loosening and pseudo-articulation in thoracolumbar spine. Conclusions Many complications can be avoided if we master well anterior decompression and fixation technique of thoracolumbar fracture, reduce surgical trauma and give appropriate and rational guide for rehabilitation.