Double-pulley combined with suture bridge technique for fixation of comminuted fractures of distal patella pole / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of double pulley combined with suture bridge in the treatment of comminuted fracture of the lower pole of the patella.@*METHODS@#From January 2018 to June 2020, 15 patients with comminuted fracture of the lower pole of the patella were treated with double pulley and suture bridge technology, including 9 males and 6 females, aged 28 to 68 years old with an average of (42.4±9.6) years old. All patients had obvious knee joint pain and limited movement after injury. All knee joints were examined by X-ray and CT, which confirmed that they were all comminuted fractures at the lower level of the patella. After operation, X-ray films of the knee joint were taken regularly to understand the fracture healing, the Insall Salvati index was measure, the range of motion of the joint was recorded, and the function of the knee joint was evaluateed by the Bostman scoring system.@*RESULTS@#All the 15 patients were followed up for 7 to 24 months with an average of (11.4±4.2) months, and there was no obvious anterior knee pain. At the last follow-up, the knee joint range of motion of the affected limb was 105° to 140° with an average of (128.5±12.8) °, and the Insall Salvati index was 0.79 to 1.12 with an average of (0.92±0.18). The X-ray film showed that the patella was bone healing, and no anchor fell off, broken, or displaced fracture block was found. Bostman patellar fracture function score was 27.85±2.06, 13 cases were excellent, 2 cases were good.@*CONCLUSION@#Double pulley technique combined with suture bridge technique is reliable for reduction and fixation of comminuted fracture of the lower pole of patella, and patients can start functional exercise early after operation.

Coronal curvature of tibial leads to malalignment of tibial prosthesis after total knee arthroplasty / 中国骨伤

OBJECTIVE@#To investigate the effect of tibial coronal curvature on the alignment of tibial prosthesis in patients undergoing total knee arthroplasty (TKA).@*METHODS@#From July 2019 to April 2021, 100 patients with knee osteoarthritis were treated with total knee arthroplasty. Before operation, the full-length films of lower limbs were taken and the tibial bowing angle(TBA) was measured. TBA more than 2° was tibial bending, which was divided into tibial bending group and non bending group. There were 40 cases in tibial bending group, 9 males and 31 females, aged 56 to 84 years old with an average of (69.22±7.10) years. There were 60 cases in the non bending group, 19 males and 41 females, aged from 51 to 87 years old with an average of (70.80±7.21) years. The preoperative tibial length (TL) and medial proximal tibial angle (MPTA) were measured and compared between the two groups. The full-length X-rays of the lower limbs were taken again 3 days to 1 week after operation. The medial angle of the tibial component coronal aligement angle (TCCA) and the outilier rate of force line of the tibial prosthesis were measured and compared between the two groups. Pearson method was used to analyze the correlation between TCCA and age, TCCA and height, TCCA and weight, TCCA and BMI, TCCA and TBA, TCCA and TL, TCCA and MPTA; Spearman method was used to analyze the correlation between TCCA and gender, TCCA and Kellgren-Lawrence(K-L) grade.@*RESULTS@#All 100 patients successfully completed the operation and obtained satisfactory full-length X-rays in standing position. There was no significant difference in TL, MPTA and TCCA between bending group and non bending group(P>0.05). The outilier rate of force line in tibial bending group was 22.5%, and that in non bending group was 6.67%, the difference was statistically significant(P<0.05). The correlation study found that TCCA was strongly correlated with TBA(r=-0.702, P<0.01), weakly correlated with MPTA(r=0.311, P<0.01), and had no correlation with other parameters(P>0.05).@*CONCLUSION@#In patients with knee osteoarthritis undergoing total knee arthroplasty, tibial bending will lead to poor force line of tibial prosthesis. During operation, attention should be paid to osteotomy of proximal tibial vertical tibial mechanical axis and correct installation of prosthesis to avoid poor alignment of prosthesis.

Analysis of influence of sarcopenia on early postoperative function of femoral neck fracture by hip arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To determine the association of sarcopenia with short-term postoperative function after hip replacement for femoral neck fractures.</p><p><b>METHODS</b>A prospective study of 181 consecutive patients with femoral neck fractures who underwent hip replacement from May 2014 to January 2017 were performed, including 58 males and 123 females aging from 53 to 92 years old. The general conditions were collected before surgery, skeletal muscle index(ASMI), handgrip strength were measured. Clinical outcomes were followed up including postoperative complications, time of on-site, Harris score (postoperative 2 weeks, 3, 6 months), hospitalization costs, and hospital stay. According to handgrip strength and ASMI, the patients were divided into the sarcopina group and the non-sarcopina group; according to the Harris score at the 6-month follow-up, the patients were divided into good prognosis group and poor prognosis group. Univariate analysis and binary logistic regression analysis were used to investigate whether sarcopenia was a risk factor for poor postoperative hip joint surgery.</p><p><b>RESULTS</b>All patients were followed up at 2 weeks, 3 and 6 months, postoperative early complication included wound infection in 16 cases, thrombus of lower extremity veins in 14 cases, no dislocation, prosthetic loosening and prosthesis related infections occurred. Sarcopenia was present in 82 of 181 patients(45%), Compared with non-sarcopenic patients, sarcopenic patients had a higher risk of postoperative complications, longer postoperative hospital stay, more hospital costs and lower harris scores. In Binary logistic analysis revealed that sarcopenia(=0.08), hemiarthroplasty(<0.001), diabetes(=0.016) and infection(=0.018) were important predictors of unsatisfactory postoperative function.</p><p><b>CONCLUSIONS</b>Sarcopenia is an important predictor of poor postoperative prognosis in patients with femoral neck fractures after hip replacement. The treatment for sarcopenia maybe an important way to protect patients with femoral neck fractures from poor prognosis after hip replacement.</p>