Therapeutic effects of comprehensive surgery for recurrent patellar instability in adults / 局解手术学杂志

Objective To analyze the clinical effect of medial patellofemoral ligament(MPFL)reconstruction combined with the com-prehensive surgery of anteromedial tibial tubercle transfer and distal shift in the treatment of recurrent patellar instability.Methods The clin-ical data of 60 patients(60 affected knees)with recurrent patellar instability who were admitted to the orthopedics department of Mianyang central hospital in Sichuan Province from April 2012 to September 2016 were retrospectively analyzed.All the patients were examined with knee arthroscopy,lower extremity X-ray,CT and MRI,and they were treated with MPFL reconstruction combined with anteromedial tibial tu -bercle transfer and distal shift comprehensive surgery.All patients were followed up for at least 1 year after operation.The physical indexes, imaging examination indexes and evaluation results of knee function were analyzed before operation and at the last follow -up.Results The follow-up of 60 patients showed that the results of fear test were negative,results of patellar tilt test were symmetrical,and the Q angle re-turned to normal.The activities of flexion and extension were significantly improved,and there was no fractures or dislocation of the patella. Imaging examination showed that the patellofemoral joint was well positioned.At the last follow-up,the patellofemoral congruence angle,de-gree of patellar out-shift and lateral patellar angle of the 60 patients were significantly decreased,and the tibial tuberosity-trochlear groove dis-tance(TT-TG)was also significantly decreased,the differences were significant(P<0.05),and they basically returned to the normal range. At the last follow-up,the Lysholm score and Kujala score were significantly higher than those before operation,the differences were significant (P<0.05).Conclusion The clinical effect of MPFL reconstruction combined with anteromedial tibial tubercle transfer and distal shift com -prehensive surgery is satisfying in the treatment of recurrent patellar instability,which has great significance for relieving symptoms and resto-ring the function of the knee.

Capsular-enhanced repair with suture anchors in bipolar hemiarthroplasty for the treatment of femoral neck fractures in elderly patients / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the efficacy of capsular-enhanced repair with suture anchors in bipolar hemiarthroplasty for the treatment of femoral neck fractures in elderly patients.</p><p><b>METHODS</b>A retrospective study was designed. From June 2009 to June 2016, 53 senile patients (54 hips)with femoral neck fracture were treated operatively in Mianyang central hospital (Sichuan, China). There were 21 males and 32 females, ranging in age from 80 to 97.5 years old (mean, 84.7 years old). There were 11 hips of Garden type II, 26 hips of Garden type III and 17 hips of Garden type IV. All the patients underwent bipolar hemiarthroplasty with enhanced repair of hip capsular. The hip joint was opened by a T shaped incision over posterior capsule. The posterior hip capsular and short external rotators were repaired particularly after the bipolar prostheses were implanted. Surgical time, intra-operative blood loss, mean hospitalization time, deep venous thrombosis, mortality, hip dislocation, pain, periprosthetic fracture, and other complications were recorded. The functional outcome was evaluated using the Harris Hip Score at the last follow-up.</p><p><b>RESULTS</b>The 53 patients (54 hips) were evaluated during the hospitalization period and a mean follow-up period of 11.5 months(ranged, 3 to 36 months). No dislocation, incision infection and periprosthetic fracture appeared in this group. The mean surgical time was 65 minutes(ranged, 50 to 95 min). The mean intra-operative blood loss was 213 ml(ranged, 100 to 420 ml) and the mean hospitalization time was 13.3 days(ranged, 5 to 27 days). Two patients with deep vein thrombosis, one patient with pulmonary embolism and 10 patients with venous plexus thrombosis of calf muscle were diagnosed postoperatively. The rate of venous thrombosis was 24.53% (13/53). The patient with pulmonary embolism died 8 days after operation and the other 3 patients died from heart failure 4, 6 and 7 months after operation respectively. The mortality during first year after hemiarthroplasty was 7.55% (4/53). At the latest follow-up, 42 patients (43 hips)had no pain, 9 patients had mild pain, and 2 patients had moderate pain. No patients were non-ambulatory. The mean Harris Hip Score was 91.25±8.39, functional outcome was excellent in 44 hips, good in 5, and fair in 5.</p><p><b>CONCLUSIONS</b>The bipolar hemiarthroplasty with capsular-enhanced repair with suture anchors is effective in reducing postoperative complications of prosthesis dislocation.</p>

Double minimally invasive incisions for surgical repair of the acute closed Achilles tendon rupture / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effect of a new surgical approaches for repairing the acute Achilles tendon rupture.</p><p><b>METHODS</b>From January 2009 to January 2014, 21 patients with Achilles tendon rupture were treated by 2 minimally invasive incisions and remaining skin bridge of achilles tendon end including 16 males and 5 females with an average age of 44.3 years old ranging from 21 to 57 years old. Postoperative complications, the range of movement of affected ankle joint, the circumference calf and ankle on both side, time of reture to work and sports activity were observed and recorded. The American Orthopaedic Foot and Ankle Society (AOFAS) score was used to evaluate the functional recovery.</p><p><b>RESULTS</b>All patients were followed up for 6 to 36 months with an average of 13.5 months. No skin necrosis, wound infection, deep vein thrombosis,re-rupture and sensory disturbance with the ankle or foot in the sural nerve distribution were found. At 1 year after operation, there was no significant difference in the range of movement between affected foot (55.4 ± 6.5)° and unaffected foot (56.3 ± 3.7)° (t = 0.872, P = 0.325). There was significant difference in AOFAS between preoperative (65.1 ± 6.9) and postoperative (94.3 ± 5.5) (t = 7.672, P = 0.013). All patients returned to work and study at an average of 10 weeks (ranged from 6 to 15 weeks) and 15 patients returned to normal sports activities at 21 weeks (ranged from 18 to 24 weeks). Calf and ankle circumferences decreased by 0.45 cm (0.3 to 0.8 cm) and increased by 0.4 cm (0.2 to 0.7 cm), respectively in the injured leg as compared with the contralateral leg.</p><p><b>CONCLUSION</b>The simplicity of the technique of minimally invasive incision and skin bridge for acute closed Achilles tendon reconstruction is an effective and reliable method with low complication.</p>

Surgical treatment of unstable pelvic fractures combined with acetabular fractures / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the treatment strategy of acetabular fractures and unstable pelvic fracture of the hip and to evaluate its outcome.</p><p><b>METHODS</b>Retrospective analysis of clinical data in 32 patients with unstable pelvic fracture and acetabular fractures from January 2007 to June 2013 were collected. There were 18 males and 14 females aged from 18 to 62 years old (means 38 years old). According to Tile classification of pelvic fracture, 11 cases were type B1, 8 were type B2.1, 7 were type B2.2, 3 were type C1.1, 2 were type C1.2, 1 was type C3. According to Judet-Letournel classification, anterior column fracture was in 1 case, transverse fracture in 8, transverse plus posterior wall fracture in 6, T-type fracture in 1, anterior column plus half transverse fractures in 5, double column fracture in 11. Other combined injuries were treated early, the surgical operation were performed after stable condition. The hip joint function and the fracture reduction were assessed during follow-up.</p><p><b>RESULTS</b>The operative time was from 1.8 to 6.5 hours (averaged 3 hours). Two fat patients' incision occurred in fat liquefaction and healed after dressing, no incision infection happened. Only 1 case was lost to follow-up, 31 patients were followed up with a mean time of 23 months (6 to 42 months). The healing time of pelvic fracture was from 8 to 18 weeks (averaged in 10.6 weeks). The hip function was evaluated according to the Matta and Tornetta standard postoperatively, the result was excellent in 15 cases, good in 14 cases, fair and poor in 1 case respectively. The Majeed score of the hip function was 83.65? 7.67, the result was excellent in 15 cases, good in 12 cases and fair in 4 cases. The healing time of acetabular fractures was from 8 to 16 weeks (averaged in 10.2 weeks). The fracture reduction was assessed by Matta standard, the result was excellent in 15 cases, good in 12 cases and fair in 4 cases. The heterotopic ossification was evaluated by Brooker standard, 4 cases were grade I, 1 case was grade II . There were no infection, nonunion and necrosis of the femoral head in all patients. The nerve damage symptoms in 5 patients disappeared during 4 to 6 months after operation.</p><p><b>CONCLUSION</b>Patients with unstable pelvic fractures and acetabulum fractures were in a critical condition early, using the concept of damage control to save lives in a timely manner. Grasp the operation time in the late treatment, acetabulum fractures reach anatomical reduction as far as possible, pelvic fractures are given priority to stable reconstruction. The operation order was fixed pelvic ring first, according to the condition to choose the appropriate surgical approach and fixed mode.</p>