Research on the reliability of the Akagi line as a reference axis to guide for rotational alignment of the proximal tibial component in total knee arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To study on the reliability of the Akagi line as a reference axis to guide for rotational alignment of the proximal tibial component in total knee arthroplasty (TKA) the rotational alignment reference bony landmarks of the proximal tibial component on magnetic resonance image (MRI) were measured.</p><p><b>METHODS</b>From January 2010 to December 2013, 80 normal knees of Chinese volunteers including 35 males and 45 females with an average age of (35.4±6.1) years were reviewed. The images of the knees were obtained by MRI. The surgical epicondylar axis (STEA) was identified in the femoral transverse sections and then was projected to the side of tibia, forming the SETA'. A line connecting the medial border of the patellar tendon and the middle of the posterior cruciate ligament insertion (Akagi line) and its vertical line (AK), as well as a line connecting the medial 1/3 of the patellar tendon and the middle of the posterior cruciate ligament insertion and its vertical line (AP), were identified in the tibial transverse sections. The angles were measured between the AK, AP and STEA'.</p><p><b>RESULTS</b>The angle between AK and STEA' was (0.59±2.07)°, and there was no significant difference between the two lines (t=-2.54, P=0.13). The mean angle between AP and STEA' was (3.21±2.04)°, and there was a significant difference between the two lines (t=14.05, P<0.05). There was a significant difference between the AK and AP (t=-11.68, P<0.05).</p><p><b>CONCLUSION</b>The reliability of the Akagi line as a reference axis to guide for rotational alignment of the proximal tibial component in TKA is good.</p>

Arthroscopic treatment of symptomatic anterior cruciate ligament cysts of the knee / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical symptom and effect of arthroscopic treatment of symptomatic anterior cruciate ligament (ACL) cysts of the knee.</p><p><b>METHODS</b>Clinical data from 12 symptomatic ACL cysts patients from January 2005 to December 2010 were retrospectively analyzed,including 8 males and 4 females,with an average age of (33.7±9.5) years old (ranged, 19 to 53 years old). The locations were the left knee in 5 cases and the right knee in 7 cases. The disease duration ranged from 3 to 48 months,with a mean of (15.8±13.2) months. All cysts were arthroscopically resected. Range of motion was measured preoperatively and postoperatively, and Lysholm scoring system was used to evaluate the knee function.</p><p><b>RESULTS</b>All the incisions healed by first intention, and no complications occurred. Twelve patients were followed up for an average of (32.3±6.6) months(ranged, 24 to 48 months). The symptoms of arthralgia,swelling and interlocking of the affected knees disappeared. There was no recurrence during the follow-up. There were significant differences in the range of motion and Lysholm score between pre-operation and post-operation.</p><p><b>CONCLUSION</b>Arthroscopic surgery, showing its advantages of minimal invasion and rapid recovery,is an effective measure in the treatment of ACL cysts.</p>

Application of orientation to the mechanical alignment of lower limbs in operation of high tibial osteotomy / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the effects of orientation to the mechanical alignment of lower limbs in high tibial osteotomy (HTO).</p><p><b>METHODS</b>From March 2005 to July 2010, the data of 57 patients (63 knees) with medial compartment osteoarthritis were retrospectively analyzed. There were 24 males and 33 females with an average age of 52 years (ranged, 34 to 68). HTO was used in all the patients, and with wire the exact orientation to the mechanical alignment of lower limbs was performed in order to obtain good angle of intercepted bone. X-rays of full-length lower limbs were done at the 3rd month after operation and final follow-up, in which femorotibial angle would be observed. Clinical results were evaluated according to Hospital for Special Surgery knee scores (HSS) including pain, function, activities, myodynamia, deformity and instability.</p><p><b>RESULTS</b>All patients were followed up from 24 to 60 months with an average of 36.7 months. All osteotomy site achieved radiographic healing. The femorotibial angle was corrected from preoperative (182.8 +/- 2.9) degrees to postoperative (167.6 +/- 2.5) degrees and (168.1 +/- 2.5) degrees at final follow-up (compared with preoperative data, P < 0.01). Pain relieved and genu valgum recovered. HSS score improved from preoperative 69.5 +/- 7.1 to postoperative 91.1 +/- 4.9 and 92.2 +/- 5.6 at final follow-up. According to HSS standard, 43 knees got excellent results, 18 good and 2 fair.</p><p><b>CONCLUSION</b>The orientation to mechanical alignment of lower limbs using wire during operation of HTO is a good method in correcting femorotibial angle and treating medial compartment osteoarthritis of the knee. Moreover, the method is simple and precise for orthopedist.</p>

Current state and development in surgical treatment for children with spinal tuberculosis / 中国骨伤

This article reviews a large number of recent years' literatures about surgical treatment for children with spinal tuberculosis on the characteristics of children with spinal tuberculosis, and analyzes the development of surgical treatment for children with spinal tuberculosis. Then it summarizes the indications of surgical treatment for children with spinal tuberculosis, and analyzes the clinical effect of various surgical methods of spinal tuberculosis, assesses that anterior debridement combined with anterior and posterior interbody autografting can be a good growth rate and deformity correction. Pedicle fixation on the children with spinal tuberculosis is safe and feasible. The positive early surgery can control children kyphosis. Minimally invasive surgery is the development direction of treatment for children spinal tuberculosis.