Hip arthroscopy for different types of femoroacetabular impingement syndrome / 中华创伤骨科杂志

Objective:To investigate the short-term efficacy of hip arthroscopy for different types of femoroacetabular impingement syndrome (FAI).Methods:A retrospective analysis was conducted of the 85 FAI patients who had been treated by hip arthroscopy at Department of Orthopaedic Surgery, General Hospital of Southern Theater Command of PLA from January 2016 to December 2018. They were 52 males and 33 females, aged from 19 to 59 years (average, 36.9 years). According to the anatomical morphology of the acetabulum and proximal femur, there were 26 cases of cam type, 16 cases of pincer type and 43 cases of mixed type. Routine hip arthroscopy was performed to remove the proliferative synovium. Femoral head and neck plasty was conducted for the cases of cam type, resection of the overly covered acetabulum followed by labral suture for those of pincer type, and resection of overly covered acetabulum and labral suture followed by femoral head and neck plasty for those of mixed type. Hip function was assessed one year after surgery using the modified Harris hip score (mHHS), nonarthritic hip score(NAHS), and hip outcome score activity of daily living scale (HOS-ADL); the alpha angle and central edge(CE) angle were measured after CT reconstruction.Results:The 85 patients were successfully followed up for an average of 21 months (range, from 12 to 48 months). The mHHS, NAHS and HOS-ADL for all the patients were improved significantly from preoperative 63.1±7.9, 62.5±7.5 and 62.3±7.9 to 83.4±8.7, 82.9±8.2 and 83.6±8.8 one year after surgery, respectively (all P<0.05) while the mHHS, NAHS and HOS-ADL for the patients of cam, pincer and mixed types were all significantly improved compared to their preoperative values (all P<0.05). The preoperative alpha angles for the cam and mixed types (67.3°±5.2° and 64.2°±5.2°) were significantly reduced to 50.3°±2.9° and 49.6°±2.8° one year postoperatively ( P<0.05); the preoperative CE angles for the pincer and mixed types (52.9°±4.6° and 50.9°±3.6°) were significantly reduced to 33.1°±4.5° and 31.3°±4.3° one year postoperatively ( P<0.05). Conclusion:Hip arthroscopy can effectively treat FAI of cam, pincer and mixed types, leading to good short-term efficacy.

Arthroscopic treatment of recurrent posterior subluxation of shoulder joint by folding suture the posterior glenoid labial capsule / 中华骨科杂志

Objective:To explore the short-term effect of arthroscopic posterior suture of the glenoid labial capsule in the treatment of recurrent posterior subluxation (RPS) of shoulder joint.Methods:A retrospective study was conducted on 16 RPS patients who had undergone arthroscopic posterior glenoid capsule folding suture from January 2016 to December 2018, including 12 males and 4 females, with an average age of 22 years (range, 18-37 years). 11 had full-thickness posterior glenoid tear (2 with SLAP injury, 7 with posterior capsular laxity), and 5 had partial posterior glenoid tear (5 with posterior capsular laxity). All 16 patients had active shoulder pain and had undergone arthroscopic posterior glenoid capsule folding suture with suture anchors. After surgery, shoulder abduction was fixed with a sling for 6 weeks to prevent internal rotation of the shoulder; full range of active and passive activities were performed 2-3 months after surgery, and normal movement was resumed 6 months after surgery. Shoulder function was assessed using the American Society of Shoulder and Elbow Surgery (ASES) score and the University of California at Los Angeles (UCLA) end-result score, and shoulder stability was assessed using the instability score in the ASES score.Results:All 16 patients were followed up for 19 months (range, 12-36 months). The shoulder instability score was reduced from 7.6±1.6 preoperatively to 2.0±1.2 postoperatively ( t=5.562, P< 0.001); the ASES score was improved from 45.9±9.8 preoperatively to 85.8±6.1 ( t=39.937, P< 0.001); the pain score was increased from 18.9±5.4 preoperatively to 40.9±4.2 ( t=22.063, P< 0.001); the daily life score was improved from 27.0±7.8 preoperatively to 44.9±3.4 ( t=17.875, P< 0.001), and the UCLA score was improved from 16.1±4.5 preoperatively to 31.9±2.6 ( t=15.813, P< 0.001). One patient had pain during boxing 12 months after surgery, and all patients had significant improvement in shoulder weakness and instability. No patient had instability recurrence. Magnetic resonance showed sutured posterior labrum tearhealed. Conclusion:Arthroscopic posterior glenoid capsule folding suture can repair the labrum injury and restore the tension of the posterior capsule. The glenoid capsule complex healed can increase the posterior obstruction of the scapula. This method can effectively treat RPS with good short-term efficacy.

Early efficacy study of matrix-induced autologous chondrocyte implantation repairing knee joint cartilage injury / 中华骨科杂志

Objective To study the feasibility and early efficacy of matrix?induced autologous chondrocyte implantation repairing knee joint cartilage injury. Methods The Matrix?induced autologous chondrocyte implantation was used to repair knee joint cartilage injury in 13 cases (11 males and 2 females) with knee joint cartilage injury from April 2012 to March 2013. The av?erage age was 27.5 years old. All cases were suffering from unilateral focal cartilage defect of knee joint with International Carti?lage Repair Society (ICRS) chondral defect classification system grade III or IV, visual analogue scale (VAS)>3, and all of which had corresponding pain symptoms. The average defect area was 4.2 cm2. Standardized rehabilitation exercise was carried out after matrix?induced autologous chondrocyte implantation. Patients were followed up for 1 years, and knee injury and use osteoarthritis outcome score(KOOS), International Knee Documentation Committee (IKDC), subjective knee form and Lysholm score were col?lected to assess the function. Meanwhile, magnetic resonance observation of cartilage repair tissue (MOCART) score was used to assess the magnetic resonance imaging. Results All patients had been followed?up for 1 year. One patient had meniscus repair under arthroscopy for the meniscus injury caused by downstairs sprain in 6.5 months postoperative, so the score of 12 months post?operative was excluded. The knee range of motion was decreased in 3 months postoperative (123.1°±8.0°) compared to preopera?tive one (135.4°±5.7°), and has no difference in 6 months (136.1°±6.1°) and 12 months postoperative (135.1°±3.6°) compared to preoperative one. The 5 subsets of KOOS score were decreased in 3 months compared to preoperative one, and were significantly increased in 6 months and 12 months. The IKDC has no difference in 3 months (26.1±3.9) compared to preoperative one (43.5± 6.5), and were significantly increased in 6 months (53.3±5.8) and 12 months (62.8±7.2) compared to preoperative one. The magnet?ic resonance observation of cartilage repair tissue (MOCART) score was increased in 12 month(73.3±17.9)compared to preopera?tive one(51.5 ± 12.6). Conclusion MACI is a good technology for knee joint cartilage injury. It has a good clinical effect on re? pairing cartilage injury effectively and restoring the function of knee joint.

Articular cartilage defect treated with biological osteochondral xenogenic graft transplantation / 中国组织工程研究

BACKGROUND:The methods used to repair articular cartilage defects currently have the cons and pros. Fibrocartilages are commonly used to repair tissues, and the fibrocartilage lacks of the tissue biomechanical properties and chemical properties of normal hyaline cartilage. OBJECTIVE:To investigate the feasibility of biological osteochondral xenogenic graft transplantation to repair articular cartilage defects. METHODS:The normal goats were randomly divided into two groups. The donor pig knee joints were the experimental group. Cylindrical osteochondral with the diameter of 4.5 mm and length of 10 mm were col ected with the Smith&Nephew osteochondral transplantation device, and the patented technology was used for deantigen. The donor goat knee joint osteochondrals were the control group and preserved with cryopreservation. The lesions on femoral trochlea and weight-bearing surface of medial condyle were selected respectively for osteochondral implantation, and the animals were sacrificed at 16 and 32 weeks after operation for the general and pathological section observation. RESULTS AND CONCLUSION:General observation in the experimental showed that the lesions were covered by fibroid tissue;some cartilage of the grafts turned yel ow and there was clear boundary between the surface and the peripheral cartilages;the general and section observation under microscope showed that lesions of the control group were covered by the grafts basical y, and cracks could be seen on the edge of the transplant part. The results show that there is difference between effects of biological osteochondral xenogenic graft transplantation and osteochondral al ograft transplantation for the repairing of articular cartilage defects, and osteochondral al ograft transplantation bas better effect.

Meniscus injury repair by xenogenic or tissue-engineered meniscus replacement therapy / 中国组织工程研究

BACKGROUND: Meniscus injury is a common sports injury of knee joint. Severe meniscus injury is difficult for clinical treatment due to the blood supply features. Effective repair of meniscus injury can prevent osteoarthritis of knee joint. OBJECTIVE: To review meniscus injury repair and transplantation replacement treatment of meniscus injury.METHODS: A computer-based online search of CNKI (www.cnki.net) and Medline database (www.pubmed.com) was performed for related articles published between January 2000 and March 2009, with the keywords "meniscus, repair, transplanted replacement therapy" in Chinese and English. Unrelated and repetitive studies were excluded. A total of 29 articles were included.RESULTS AND CONCLUSION: There are a number of treatment for meniscus injury, and indications and appropriate repair methods are very important. Xenogenic meniscus transplantation and tissue-engineered meniscus provide novel approach for meniscus injury repair, in particular the repair of avascular zone. However, the two methods require validation of immunology,epidemiology, anatomy, biomechanics, and clinical effect.

Posterior cruciate ligament reconstruction by double bundle-double tunnel Y-shape of the anterior tibialis tendon allograft / 中华骨科杂志

Objective To investigate the clinical results of posterior cruciate ligament (PCL) reconstruction by double bundle-double tunnel Y-shape of the anterior tibialis tendon allograft. Methods From March 2001 to January 2008, 47 patients underwent PCL reconstruction were included. The allogeneic adult anterior tibialis tendon was prepared into the Y-shape double bundles with the length of 130 mm; A bundle was defined as A-side; B-side was two short bundle (B1, B2 bundle). A bundle was 70 mm in length with a diameter of 10-12 mm. B1 bundle (anterolateral bundle) was 55 mm long with a diameter of 6 mm; B2 bundle(posteromedial bundle) was about 50 mm with a diameter of 6 mm. The allograft ligament was installed through the antero-medial approach. Absorbable interface screws were fixed in the tibial tunnel firstly, and then in the femoral tundles. When being fixed, anterolateral bundle was in flexion of 90°, postero-medial bundle was in 30°. Assisted exercise with knee an angle-locked walking aid had continued for 8-10 weeks. Results The average operating time were 45 min. The average follow-up time was 49.5 months. Preoperative Lachmann was positive in all cases while Lachmann was negative in 39 cases, weakly positive in 5 cases, and positive in 4 cases postoperatively. Post-operative KT-1000 testing, Lysholm score and Tegner activity levels has improved significantly compare with the pre-operative ones. Conclusion The double folded bundles of adult anterior tibialis tendon has sufficient length and diameter for posterior cruciate ligament reconstruction with power tension. The methods of ligament passing through the tunnel has improved to ease the procedure.

Application of computer-aided technique in pelvic precise model preparation and individualized prosthesis implantation / 中国组织工程研究

BACKGROUND:Bone tumors around the Ⅱ section of pelvis are difficult to treat due to complicated anatomic structures.Using computer-aided technique,the excision range and prosthesis preparation can be individualized,which may obtain notable therapeutic efficacy in treating pelvic fractures in the clinic.OBJECTIVE:To discuss the application and the clinic effect of computer-aided technique in bone tumors therapy around the Ⅱsection of pelvis.METHODS:The pelvis model was generated with its CT data by rapid prototyping.Simulated bone resection and reconstruction were performed on the models.Then we designed surgical extension and made hemi-pelvic.Eight cases received resection of pelvic tumor and reconstruction based on computer-aided technique.RESULTS AND CONCLUSION:The resection of tumor and implantation of prosthesis were easily accessible.Two cases relapsed and 1 case loosened at 2 years after operation.According to Harris scoring criteria after total hip replacement,the scores of cases were well.The simulated resection and reconstruction of bone tumors around the Ⅱ section of pelvis based on computer-aided technique makes the operation easy and reconstruction precise,which produces good clinic results and offers a good promise for the application.

Length changes of knee lateral collateral ligaments following anterior cruciate ligament injury / 中国组织工程研究

BACKGROUND: Lateral collateral ligaments play an important role in maintaining knee stability.Motion reduction of knee joint can be realized and the changes laws of medial and lateral collateral ligaments' length after anterior cruciate ligament(ACL)injury during weight-bearing flexion can be obtained via 2D/3D image registration technique.OBJECTIVE: To study in vivo stability of length changes of the medial and lateral collateral ligaments of ACL injury knee during weight-bearing flexion.METHODS: Eight volunteers with unilateral ACL rupture and contralateral normal knees,was captured CT images and 2orthogonal images of the knee at 0,15°,30°,60°,and 90° of weight-bearing flexion.These orthogonal images were used to recreate the in vivo knee positions at each of the targeted flexion angles by the method of 2D/3D image registration.Through the bone insertion of medial and lateral collateral ligaments,the elongation changes of medial and lateral collateral ligaments were obtained.RESULTS AND CONCLUSION: At 0°,15° and 30°,the length of medial collateral ligament of ACL injury knees was longer than normal knees,but the lateral collateral ligaments length of ACL injury knee was shorter than that of normal knees.All the differences have statistical significances(P < 0.05).The findings demonstrated that,at 0°,15° and 30°,the medial collateral ligament length of ACL injury knees was longer than normal knees,but lateral collateral ligaments length of ACL injury knees was shorter than normal knees.

A comparative study on arthroscopic posterior cruciate ligament reconstruction using bone-patellar tendon-bone allograft, bone-patellar tendon-bone autograft and semitendinosus tendon autograft / 中国组织工程研究

BACKGROUND: There are many methods for posterior cruciate ligament (PCL) reconstruction, which is involved in many graft materials, but few studies aim to compare the differences in outcomes of different grafts for PCL reconstruction. OBJECTIVE: To compare the clinical results of arthroscopic PLC reconstruction with bone-patellar tendon-bone (B-PT-B) autograft, B-TP-B allograft and semitendinosus tendon autograft. DESIGN, TIME AND SETTING: A retrospective case analysis was completed in the Department of Orthopedics, Guangzhou General Hospital of Guangzhou Area Military Command of Chinese PLA from January 2000 to September 2005. MATERIALS: Totally 76 patients underwent arthroscopic PLC reconstruction from January 2000 to September 2005, with the use of B-TP-B autograft in 21 patients, B-TP-B allograft in 27 patients, semitendinosus tendon autograft in 28 patients. METHODS: A retrospective analysis was performed in 76 patients underwent arthroscopic PCL reconstruction, with the use of B-TP-B autograft in 21 patients, B-TP-B allograft in 27 patients, semitendinosus tendon autograft in 28 patients. Postoperative body temperature was examined duration hospitalization. The follow-up parameters included International Knee Documentation Committee (IKDC) scores, Lysholm knee joint scores, and KT-1000 evaluation.MAIN OUTCOME MEASURES: ①Range of motion. ②joint stability: posterior draw test and KT-1000 test. ③overall function of knee: IKDC scores and Lysholm scores; ④complications and side effect. RESULTS: The time of follow-up visit was 26-79 months. Differences were no statistically significant among the IKDC scores, Lysholm scores, KT-1000 side-side difference, the positive rate of posterior draw test in three groups of patients with PCL reconstruction using B-TP-B autograft, B-TP-B allograft and semitendinosus tendon graft (P > 0.05); 10° flexion limitation was found in 3 cases of B-TP-B autograft, 5° flexion limitation in 1 case of B-TP-B allograft and flexion limitation in 2 case of semitendinosus tendon graft. There was no significant difference in the ratio of knee joint flexion limitation among three groups. No synarthrophysis, wound infection, implant disrupture, screw loose, patellar fracture or vascular nerve injury was observed in three groups of patients; There were 12 cases presenting anterior knee pain in the B-TP-B autograft group and 5 cases presenting posterior knee pain in the semitendinosus tendon graft group. The difference of peal-knee pain incidence was statistically significant among three groups (P=0), the highest in B-TP-B autograft group, then semitendinosus tendon graft group and the lowest in B-TP-B allograft group. The time of post-operative fever in B-TP-B autograft group was earlier than that in the B-TP-B allograft and semitendinosus tendon graft groups (P=0). There was no significant difference between allogreft group and semitendinosus tendon autograft group (P=0.844). The rejections appeared in 4 cases of B-TP-B allograft with the manifestations of the sustained jam-like liquid outflow from tibial tunnel. After dressing, hormones or indomethacln, the rejection was healed. CONCLUSION: The arthroscopic B-TP-B autograft, B-TP-B autograft and semitendinosus tendon autograft have the same clinical curative effect in PCL reconstruction.

Surgical treatment of pelvic malignant tumors with individualized hemi-pelvic / 中国矫形外科杂志

[Objective]To discuss the surgical extension and clinical effects of CAD custom-made hemipelvic for treating malignant pelvic tumors.[Method]The pelvis model was generated with its CT data by rapid prototyping.Simulated bone resection and prosthesis design were performed on the models.Surgical extension and made hemi-pelvic were designed.Nine patients received resection of pelvic tumor and reconstruction by individualized hemi-pelvic from June 2003 to June 2007.The series comprised three males and six females,four were diagnosed having giant cell tumor,two having chordoma,two having chondrosarcoma and one having osteosarcoma.According to Enneking's division,region Ⅱ(n=3),the region Ⅱ and Ⅲ(n=5),involved region Ⅰ,Ⅱand Ⅲ(n=1).[Result]The resection of tumor the implantation of prosthesis was easily accessible.The amount of bleeding was 5700 ml on an average.One patient suffered from infection and recovered after debridement.All patients began non-weight bearing walk with double crutches 4～6 weeks after operation and gradually abandoned crutches in 4 months.Three patients had local relapse,one osteosarcoma patient died of lung metastasis at 18 months after operation,one chondrosarcoma patient relapsed locally at 13 months after operation and died at 17 months after operation.One chordoma patient relapsed locally at 6 months operation and received the second operation.It was relapsed again at 6 months after the second operation and died at 3 months.Bolt was loosened in one patient,but the patient can walk with one crutch.No loosening was found in the 5 patients.The position of bilateral hips was symmetric.[Conclusion]The surgical extension of tumor designed by computer aided technical makes thorough resection possible.The custom-made hemi-pelvic is highly similar to the pelvis of patient in appearance,which makes the operation easy and produces good clinic results.The custom-made hemi-pelvic offers a good promise for the reconstruction of pelvic malignant tumors.

Arthroscopy plus radiotherapy in the treatment of pigmented villonodular synovitis of the knee / 中国矫形外科杂志

[Objective]To explore the technique of arthroscopy plus radiotherapy in the treatment of pigmented villonodular synovitis of the knee and to evaluate its clinical value.[Method]A total of 14 cases of pigmented villonodular synovitis of the knee were treated from January 2000 to July 2003.Intra-articular excision under arthroscope with a combined application of routine intrusments and Bipolar radiofrequency was performed on all these 14 cases,and postoperative radiotherapy for diffused pigmented villonodular synovitis of the knee,13 patients were followed up for 10~45 months,and were evaluated for range of motion,pain,swelling effusion.[Result]Thirteen cases according to the International Knee Documentation Committee(IKDC)criteria,subjective knee score was (58.7+6.4) and (86.5 ?5.7) respectively before surgery and at the last follow-up.[Conclusion]In case of pigmented villonodular synovitis of the knee joint,arthroscopical synovectomy can make good surgical results,and postoperative radiotherapy is an effective treatment for diffused pigmented vilionoclular synovitis of the knee.

Production of antisense-vascular endotheilal growth factor (VEGF) 165 adenovirus and observation of the secreatory down-regulation by the infection of the antisense-VEGF165 adenovirus / 中华风湿病学杂志

Objective To observe the inhibition of vascular endotheilal growth factor (VEGF) gene transcribition and translation with antisense VEGF165 adenovirus vector transfection. Method To transfect the synovial cells with antisense VEGF165 adenovirus and detect the gene translation level with northern-blot method. Result The Northern-blot showed that: the transcription of VEGF gene were inhibited markedly after the antisense VEGF165 gene transfection for 3 days and the inhibition efficiency was obivious in 4th day. In the 5th day, the VEGF translation signal was hardly detected. Conclusion The antisense VEGF165 adenovirus gene transfection can inhibite not only the transcription but the translation of VEGF gene in synovial cells. Thus it can inhibit the secretion of VEGF in synovial cells with high efficiency.

Mosaicplasty osteochondral grafting to repair cartilaginous defects under arthroscopy / 中华外科杂志

<p><b>OBJECTIVE</b>To study mosaicplasty a as method of autogenous osteochondral transplantation in the treatment of cartilaginous defects.</p><p><b>METHODS</b>The technique involves obtaining small cylindrical grafts from the non-weight bearing periphery of the femur at the patellar femoral joint, and transporting them to the prepared recipient site by arthroscopy.</p><p><b>RESULTS</b>Fifteen patients with defects cartilaginous received mosaicptasty osteochondral grafting. Follow up for 12 to 21 months (mean 15 months) showed good results.</p><p><b>CONCLUSION</b>The treatment is indicated for patients with focal cartilaginous defects under the age of 45.</p>

Arthroscopic reconstruction of posterior cruciate ligament using hamstring tendon transfer and e-val uation of its clinical evaluation / 中华骨科杂志

Objective The present was to report the methods of arthroscopic reconstruction of poste-rior cruciate ligament by a two-strand semitendinosus tendon autograft and evaluate its clinical results.Method From June1998through June2002,28cases had undergone arthroscopic restoration of a torn pos-terior cruciate ligament,including22female and6male patients with an average age of21years(range,18to31years).The time-interval between the sustained injury and the surgery was25days to3months.The causes of injury of posterior cruciate ligament were sport activity in6cases,traffic accident in18cases and fall down in4cases.All of the patients suffered from knee pain,knee laxity and atrophy of quadriceps femoris.The posterior drawer test was positive in26cases preoperatively,in which6cases were associated with positive anterior drawer test.The Lachmans test was positive in all of28cases preoperatively.The piv-ot shift test was positive in12cases preoperatively.The concomitant injuries consisted of anterior cruciate ligament injury in6cases,meniscal tear in8cases and medial collateral ligament injury in5cases.Results Follow-up period extended from27to48months (mean,33months).According to the international knee documentation committee(IKDC)activity grades,grade D were26cases,and grade C were2cases preoper-atively,while postoperatively,grade A were9cases,grade B16cases,and grade C3cases at the last fol-low-up.The clinical assessment judging by Lysholm knee functional scoring system,the average scores be-fore operation was65.5?3.6;however the scores increased to an average of92.7?3.6postoperatively.Con-clusion Arthroscopic reconstruction of injured posterior cruciate ligament using hamstring tendon transfer passes through the tunnel more smoothly than the bone-patellar tendon-bone because of no bone blocks,furthermore,the tunnel disappears after the screw is absorbed to avoid the impact of the ligament the inside tunnel and prevent the tunnel extending gradually to cause the ligament laxity and knee instability.The at-tachment of the tendon on the outlet of tibial tunnel and the rigid anchoring of ligament on the outlet of femoral tunnel could provide enough strength for constructed posterior cruciate ligament.So the patients could begin postoperative rehabilitation as soon as possible and recover functional activity earlier.