Acetabular revision using acetabular reinforcement cages with a hook / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effects of cementless revising cup or acetabular reinforcement cages for reconstructing the massive acetabular deficiency.</p><p><b>METHODS</b>From September 2001 to September 2008, 22 loosening acetabular cases (24 hips) were revised using cementless revising cup or acetabular reinforcement cases for reconstructing massive bone defect after particulate bone grafting. There were 2 cases (2 hips) using Lima cementless revising cup, 2 cases (2 hips) using Kerboull ring, and 18 cases (20 hips) using restoration GAP cages. Six cases (6 hips) were male, and 16 cases (18 hips) were female. The mean age was 62 years old (34 - 79 years old). Septic loosening was in 2 cases (2 hips), and aseptic loosening in 20 cases (22 hips). The mean follow-up was 48 months (18 - 84 months).</p><p><b>RESULTS</b>There was no clinical or radiological evidence of loosening for the revising acetabular components at the last follow-up point. The mean Harris hip score was improved significantly from 56 points (44 - 75) before revision to 89 points (78 - 94) at the last follow-up after revision. Excellent and good rate was 95.5% (21/22 cases). The average abduction angle of the three types of acetabular reconstructive cages were 50.1 degrees (39.0 degrees - 66.0 degrees), and almost all cases of the hip rotation center were restored after revision surgery. At the last follow-up, the reinforcement cages were no immigration and breakup, and there was no radiolucent line around the acetabular components. The bone graft integrated well into surrounding acetabular bone.</p><p><b>CONCLUSION</b>The method of revising the massive acetabular bone defect by cementless revising cup and acetabular reinforcement cages restores the normal hip rotation center, supplies the primary stability of the revising component, and protects the bone graft from mechanical overload during its revascularization phase, which is a reliable method for revising the massive acetabular deficiency after total hip arthroplasty.</p>

Repair and re-establishment to traumatic upper cervical instability / 中国骨伤

<p><b>OBJECTIVE</b>To summarize and analyze the therapeutic effect of traumatic upper cervical instability and investigate therapeutic methods and effect.</p><p><b>METHODS</b>There were 19 patients with traumatic upper cervical instability (male 16, female 3), aged from 21 to 56 years,included 3 cases of atlas fracture, 10 cases of dens fracture, 3 cases of axis pedicle fracture, 3 cases of atlanto-axial subluxation. Among them, 6 cases included 1 case of dens fracture, 1 case of dens fracture affiliated with atlas fracture, 1 case of axis pedicle fracture, 3 cases of atlanto-axial subluxation were treated conservatively and the other 13 cases were treated by operations.</p><p><b>RESULTS</b>Nineteen cases were followed up for 1.8 years in average (6 months to 6 years). According to JOA standard for evaluation, the rate of improvement was 42.5% and 87.0% for conservative treatment and operation respectively.</p><p><b>CONCLUSION</b>Traumatic super cervical unsteadiness should be diagnosed and treated early. Under the condition of upper cervical vertebra being completely fixed,the function of cervical vertebra to maximum extent could be reserved when choosing operation method. Especially, the precise fusion of upper cervical vertebra plays a vital role of long-term efficacy.</p>

Change in the joint line after total knee arthroplasty / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the change in joint line after knee arthroplasty.</p><p><b>METHODS</b>A total of 43 patients had 25 primary cruciate-retaining total knee replacements (Link Gemini MKII) and 25 rotational knee replacements (Link Endo-Model Rotational Knee System) sacrificing collateral ligaments and cruciate ligaments. Lateral radiographs were made both preoperatively and postoperatively. The change in the relative position of the joint line preoperatively and postoperatively was defined as the difference between the perpendicular distance from the weight-bearing surface of the tibial plateau to the tibial tubercle of the natural tibia (JL) and perpendicular distance from the weight-bearing surface of the prosthetic tibial component to the tibial tubercle (JL'). This distance was JL'-JL. The statistical differences between 2 groups were analyzed.</p><p><b>RESULTS</b>The distance of JL'-JL was 2.0 mm (-1.3 - 7.2 mm) in 22 patients with Gemini replacement, whereas the distance was 3.1 mm (-1.5 - 12.3 mm) in the other patients with rotational knee system. The difference was significant.</p><p><b>CONCLUSIONS</b>If the collateral ligaments and cruciate ligaments are removed during the knee replacement operations, the prosthetic joint line is likely to be malpositioned proximally. The fibular styloid and medial or lateral epicondylar reference points can be used to determine proper position of the joint line during operation.</p>