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Objective To report the technique of functional reconstruction for knee joint following destructive injury and its outcome. Methods In the period from June 1991 to April 2001, microsurgery was done for 4 cases to reconstruct functions of the damaged knees. The operations were combined with transplantation of bilateral latissimus dorsi myocutaneous flaps, emergency transplantation of latissimus dorsi myocutaneous flap, emergency transplantation of useless leg composite tissue and emergency rotation- plasty, respectively. Results All the transplants survived completely. The follow- ups, ranging from 4 to 14 years, revealed normal or nearly normal functions in all the repaired knees. Conclusion Whenever possible, a knee with destructive injury should be repaired and reconstructed, and microsurgery may offer an effective solution.
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Objective To investigate and discuss the feasibility and clinical outcome of the minimally invasive two-incision total hip arthroplasty. Methods From February to June 2004, 17 cases of the minimally invasive two-incision total hip arthroplasty were performed. There were 7 males and 10 females with an average age of 69 years from 58 to 75 years. Preoperative diagnosis of the patients included 5 of osteoarthritis, 4 of osteonecrosis and 8 of femoral neck fracture. The operations were performed with Versys cementless prosthesis and minimally invasive instruments provided by Zimmer Company. Operation time, blood loss, length of incisions, average postoperative hospitalization, and operation related complications were analyzed. Blood transfusion was performed while hemoglobin of the patients was less than 8 g. Results The patients were followed up from 6 to 12 months with an average of 8 months. The average operation time was 95 mins (85 to 170 mins). The average blood loss was 280 ml (190 to 450 ml) and blood transfusion was carried out in 4 cases of femoral neck fracture (average, 400 ml). The average length of anterior incision was 5.0 cm (4.6 to 6.5 cm) and that of posterior incision was 3.7 cm (3.0 to 4.2 cm). All the patients were ambulatory the day after surgery. 11 cases were discharged 5 days and 6 cases discharged 7 days after operation. Postoperative measurement on X-ray film showed that the average angles of abduction and anteversion of acetabular cup were 46?(43? to 55?) and 21?(17? to 23?) respectively. Proximal femoral split fracture occurred in one case, in which the fluoroscopy demonstrated the femoral component was stable and well positioned, and the patient walked without weight-wear for 2 months and was found with stable prosthesis evaluated at 3 and 6 months postoperatively. None of infection, dislocation or injury of vessel and nerve happened. Conclusion Anterior and posterior two-incision total hip arthroplasty has the advantages of muscle sparing, minimally invasive, less blood loss, rapid recovery; however, this technique is time consuming, special instruments and fluoroscopy are needed.
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Objective To report the technique and outcome of combined transplantation of bilateral vascularized fibulas to repair the segmental femoral defect Method In the period from October 1984 to May 1992, bilateral vascularized fibula transfer was done to treat femoral defects in 9 cases, in which there were 5 cases of bone tumor, 3 cases of pathological fractures following chronic osteomyelitis and 1 case of posttraumatic bone defect The length of the transferred fibulas ranged from 12 cm to 22 cm and averaged 16.25 cm Result Except 1 case in which thigh amputation was done 6 months after operation because of local recurrence of the chondrosarcoma, all the transferred fibulas united solidly with the host bones 3-6 months after operation The repaired limbs started weight-bearing at the third to seventh postoperative month Conclusion To repair a femoral defect over 10 cm in length, combined transfer of bilateral vascularized fibulas is the treatment of choice with short therapeutic process and good results.
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Objective To analyse the causes of non-union and delayed union in distal femur and assess the clinical outcomes of retrograde intramedullary interlocking nail(RIIN). Methods Between June 1995 and December 1998, 15 cases of non-union and delayed union of distal femur were treated with RIIN. There were 9 males and 6 females, the average age of the patients was 34.5 years(range 23 to 46 years). At surgery, the failed implants were removed in all 15 cases, bone graft was performed in 10 cases, closed reaming was done in 5 cases. 11 patients also received knee adhesion release operation. The X-ray examination and KSS knee functional score were used to evaluate the results. Results The average duration of follow-up was 14.5 months. All patients achieved solid bone union at an average of 6.4 months. There were no malunion, infection and refracture in this series. According to the KSS rating system, the average range of motion(ROM) was 93.5 degrees, increased by 28 degrees(42.7％ ) compared with the preoperation ROM. The average knee score was 96 points. The excellent result was obtained in 13 cases, good in 2 cases. The average knee function score was 90.5 points. Conclusion The main reasons for non-union and delayed union were improper selection of the indications and use of implants. Retrograde intramedullary interlocking nail is one of the effective alteratives for treatment of distal femur non-union and delayed union. It can provide a stable and reliable fixation which is of benefit for early functional exercise. Bone grafting, closed reaming technique and knee joint adhesion release should be considered in order to enhance the bone healing and the improvement of knee ROM and function.
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Objective To observe the patency and the rate of arterial spasm in different time periods following segmental hydrolic dilation during the course of tissue transplantation; also the influence of arterial dilation to arterial structure was studied with histological examinations. Methods Fifty seven patients with thumb or finger defects were treated with thumb reconstruction using thumb nail flap free transplantation in 41 cases, thumb reconstruction using free transplantation of the second toe in 6 cases and 10 cases had finger reconstruction using the second and third toe free transplantation. Following complete tissue isolation, and prior to vascular anastomosis, heparin+normal saline was injected into the dorsal pedal artery, the first metatarsal artery and the digital artery of the big toe or the second for segmental dilation with the pressure of 300 mmHg. The dorsal pedis arteries were taken for histologic studies after hydrolic dilation. Results 1)The temperature of transplanted tissues were 0.16 ℃ higher than the health side. 2)The immediate arterial patency rate was 100% after anastomosis and the rate of spasm was 0. Vascular crisis took place in one case 24 hours after the operation, and was relieved after removal of the hematoma. There was one failure due to the extensive thrombosis formation in the capillaries. 3)Histologic study showed: there were 15% of the arterial endothelium exfoliated following hydraulic dilatation, resulting in looseing of the internal elastic membrane, a basically normal muscular layer of different thickness; without hydraulic dilatation, 7% of the arterial endothelial cells exfoliated, with homogeneous thickness of the internal elastic membrane and intact muscular layer. Conclusion 1)Segmental hydrolic dilation is one of the effective methods to prevent and treat vascular spasm and it is a safe and effective method to increase the successful rate of free tissue transplantation. 2)Hydrolic dilation within a certain range(300 mmHg) had no obvious effect on arterial structure.