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Objective:To evaluate the efficacy and safety of non-osteotomy total hip arthroplasty (THA) in the treatment of Crowe IV developmental dysplasia of the hip (DDH).Methods:From Jan 2013 to Sep 2021, 46 patients (46 hips) in our department who underwent total hip arthroplasty without osteotomy for unilateral Crowe IV DDH were retrospectively analyzed, including 6 males and 40 females, with an average age of 41.2±7.2 years (25-61 years). The reduction of the femoral head was achieved successfully through moderate upward-posterior displacement of the movement center, gradual osteotomy of the calcar femorale, proper sinking of the femoral prosthesis and sufficient soft tissue release. The evaluation indexes included the basic condition of the operation (operation time, blood loss, blood transfusion, volume), clinical evaluation (Harris score of hip joint function, patient satisfaction, Trendelenburg sign), imaging evaluation (measurement of limb length and pelvic inclination) and incidence of complications.Results:The mean follow-up time was 72.2±8.8 months (8-101 months). The operation time was 97.2±12 min (84-112 min). The average intraoperative bleeding volume was 550±60 ml (350-850 ml). No patient had periprosthetic infection or fracture, no periprosthetic osteolysis or prosthesis loosening, and no patient needed revision surgery at the last follow-up of all cases. The average HHS score of patients increased from 42.5±12.3 points before surgery to 89.2±10.8 points at the last follow-up, and the difference was statistically significant ( t=19.35, P<0.001). Patient self-rated satisfaction: none was very dissatisfied, 1 patient were less satisfied (2%, 1/46), 4 patients were average (9%, 4/46), 19 patients were relatively satisfied (41%, 19/46), and 22 patients were very satisfied (48%, 22/46). The Trendelenburg sign of 46 cases was positive before operation, and all were negative at the last follow-up. The patients' true leg length discrepancy (LLD) measurement was -2.5±0.6 mm before surgery and 11.5±3.2 mm at the last follow-up ( t=29.17, P<0.05). Patients' perceived LLD was 28.2±5.1 mm before surgery and 3.4±1.4 mm at the last follow-up ( t=32.18, P<0.05). The length of the residual calcar femorale was 3.2±0.4 mm after THA. The limb extended distance of affected limb was 45.2±4.6 mm. The preoperative iliolumbar angle was -6.5°±2.3°, which returned to -0.5°±1.3° at the last follow-up ( F=651.97, P<0.05). Conclusion:For patients with unilateral type IV DDH, non-osteotomy THA is a safe and effective surgical method with simple operation and few complications. It can quickly correct pelvic tilt and lumbar compensatory scoliosis postoperatively.
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Objective:To investigate the safety and efficacy of a combined anterior and posterior approach in total hip arthroplasty (THA) for fused/ankylosed hip.Methods:37 patients who underwent THA for fused/ankylosed hip from January 2015 to December 2020 were retrospectively analyzed, including 28 males and 9 females, with an average age of 47.9±12.0 years (range, 26-72 years). Etiologies included 23 cases of ankylosing spondylitis, 9 cases of infectious arthritis of the hip in youth, and 5 cases of traumatic arthritis after acetabulum or femoral neck fracture. All patients underwent THA with combined anterior and posterior approach. These factors include operation time, blood loss, amount of transfused blood, blood transfusion rate, preoperative and postoperative Harris score, postoperative range of motion of the hip, and perioperative complications, etc. were evaluated. Postoperative radiography of the hip was performed to evaluate acetabular abduction angle, anterior inclination angle, the prosthesis fixation, osteolysis and heterotopic ossification around the hip.Results:A total of 37 patients were enrolled. The mean operative time was 147.6±16.8 min (range, 129-190 min); the mean estimated blood loss (EBL) was 850.0±10.8 ml (range, 600-1,200 ml); the blood transfusion rate was 59% (22/37), and the mean blood transfusion was 420±45.0 ml (range, 0-800 ml). All patients were followed up for 4.2±0.9 years (range, 1.2-7.2 years). The average abductor angle of the acetabular was 43.7°±5.4° (range, 31°-55°), and the average inclination angle was 20.9°±6.7° (range, 10°-35°); the preoperative Harris score was 47.1±9.9 (range, 40-55) and the mean Harris score at the last follow-up was 83.4±12.4 (range, 75-90). The preoperative range of motion of the hip in all directions was 0°. Postoperative hip range of motion was good, with a mean hip flexion of 95.5°±12.2° (range, 80°-110°), mean extension of 10.5°±3.4° (range, -10°-25°), and mean abduction of 38.0°±8.2° (range, 10°-50°). Postoperative complications were minor, including 2 case with poor wound healing, 2 cases with paresthesia or tingling sensation in the anterior or anterolateral thigh, which returned to normal within 3 months after surgery, and no deep infection or dislocation occurred. The acetabular cup was in poor position in 2 cases and the femoral stem was varus in 1 case, but the prosthesis was stable and no treatment was needed. All the acetabular cups and femur stems were confirmed with bone ingrowth on the last follow-up radiographs, and one patient had heterotopic ossification (Brooker grade 1). No osteolysis or wear of the acetabular liner was observed.Conclusion:Combined anterior and posterior approach (Gibson posterolateral approach + modified Hardinge approach) in THA for fusion/ankylosed hip can fully expose the operative field and sufficiently release the soft tissue, and the function of hip recovered well postopratively.
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Objective:To explore the impact of a modified blood management strategy on blood loss and transfusion rates during outpatient total hip arthroplasty(THA).Methods:The retrospective research was performed in a total of 125 patients (125 hips) who underwent outpatient primary THA from January 2019 to December 2021 at a medical center. According to whether a modified blood management protocol was used or not, all patients were divided into two groups. Group A was used the original perioperative blood management strategies (1 g tranexamic acid, intravenously, 10 minutes before skin incision), and group B was used the modified perioperative blood management strategy (on the basis of the original protocol, 2 g tranexamic acid was sprayed locally in the joint cavity before the incision was closed, 1 g tranexamic acid was injected intravenously 3 hours after surgery, and 1 g tranexamic acid was injected intravenously again on the first day after surgery). There were 52 cases in group A, including 32 males and 20 females, aged 58.5±9.8 years (range, 39-69 years), 13 cases were developmental hip dysplasia (Crowe I°-II°), 24 cases were avascular necrosis of the femoral head, 10 cases were hip osteoarthritis, 3 cases were ankylosing spondylitis involving hip joint, and 2 cases were femoral neck fracture. Among the 73 patients in group B, there were 43 males and 30 females, aged 55.8±10.4 years (range, 42-67 years), including 17 cases of developmental hip dysplasia (Crowe I°-II°), 32 cases of avascular necrosis of the femoral head, 16 cases of hip osteoarthritis, 7 cases of ankylosing spondylitis involving hip joint, and 1 case of femoral neck fracture. Intraoperative blood loss, transfusion, deep vein thrombosis (DVT) events (vascular ultrasound, 2w Postop.), the hemoglobin (Hb) drop, the hematocrit (Hct) drop and other complications were recorded.Results:After using the modified strategy, the intraoperative blood loss was significantly reduced (305.6±38.6 ml vs. 416.2±88.3 ml, t=9.51, P<0.001), and the drop of hemoglobin was significantly decreased (18.1±4.0 g/L vs. 22.3±5.8 g/L, t=4.97, P<0.001). The drop of Hct also decreased significantly (7.3%±0.7% vs. 9.6%±1.3%, t=10.21, P<0.001), and total blood loss decreased significantly (720.6±57.4 ml vs. 919.6±86.3 ml, t=15.49, P<0.001). The hidden blood loss was also significantly lower than that in group A (414.9±71.1 ml vs. 503.5±96.4 ml, t=5.91, P<0.001). One patient (in group A) developed intra-articular hemorrhage 2 h after surgery and was transferred back to the inpatient ward for treatment after transfusion. Three patients (2.4%, 1 in group A and 2 in group B) developed symptomatic anemia and were discharged successfully after conservative treatment. Calf muscular venous thrombosis occurred in 3 patients (2.4%), but no symptomatic deep vein thrombosis occurred in all patients. Conclusion:According to this retrospective research, the use of modified blood management strategy during outpatient THA can further reduce intraoperative blood loss, hidden blood loss and postoperative hematocrit drop, and does not increase the occurrence of perioperative thrombosis-related complications.
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BACKGROUND:Signal transducer and activator of transcription 3 (STAT3) is an important cytokine signaling pathway, which plays an important role in inflammatory diseases. However, it is unclear whether gene polymorphism of STAT3 is associated with rheumatoid arthritis in the Chinese Han population. OBJECTIVE: To explore the association of gene polymorphism of STAT3 with rheumatoid arthritis in the Chinese Han population. METHODS:Four tag-single-nucleotide polymorphisms (tag-SNPs) in STAT3 were selected from the Chinese Han population of HapMap database. The study was performed with 228 rheumatoid arthritis cases and 228 normal controls. Four tag-SNPs (rs12601982, rs2293152, rs8078731 and rs9912773) were examined by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry. RESULTS AND CONCLUSION:The frequency of GG genotype at rs9912773 was 18.9% and 10.5% respectively in rheumatoid arthritis and control groups, and there was a significant difference between the two groups (P < 0.05). These results indicate the possible association between the STAT3 gene polymorphism at rs9912773 and the susceptibility of rheumatoid arthritis in the Chinese Han population.
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Objective This article is aim to test the safety and the in vitro antibacterial activity of the Lentiviral-nedicated humanβ-defensin 3 (hβD-3) transfecion synovium-derived mesenchymal stem cells (SMSCs).Methods Tissues with SMSCs were obtained by surgical operations.Cells were explant cultured and purified by magnetic cell separation system.Cells were identified by microscopic observation, immunofluorescence and cell surface markers.Through inducing the cells into fat, osteoblasts and chondroblasts to respectively determine the multi-directional differentiation potential.Construct a hβD-3 contained lentivirus and transfected into SMSCs.Got the cell growth curve and determine the DNA content by using flow cytometry.The NOD/SCID mice were applied to verify the tumorigenicity of SMSCs.Agar diffusion test was applied to doing antibacterial activity test of posttransfecton SMSCs.The rabbit model of knee joint in staphylococcus aureus infections verify its bacteriostatic action in vivo.Results: Purified SMSCs had the structure and surface signatures of MSCs.It had the potential of multi-differentiation.Immunofluorescence had verified that SMSCs transfected by lentivirus could stably express hβD-3.Cell proliferation kinetics, karyotype analysis and Tumorigenic type analysis verified the safety of SMSCs after transfection.The in vivo and vitro antibacterial activity test of the recombinant SMSCs showed that after cell passages, the subcultured SMSCs (P5 cells were used in this article) could express hβD-3 stably and had antibacterial activity.The result of the antibacterial circle showed that low concentration group inhibit bacterial activity while the medium and high group could enlarge compared with the negative and positive control group.Conclusion Lentiviral-medicated hβD-3 gene express SMSCs could successfully subcultured and stably express hβD-3, meanwhile it had apparent in vitro antibacterial activity.
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<p><b>BACKGROUND</b>It has rarely been reported about the changes of hemoglobin (Hb) and hematocrit (Hct) in elderly patients receiving total knee arthroplasty (TKA) or total hip arthroplasty (THA). This study aimed to evaluate the changes of Hb and Hct after TKA or THA in elderly patients, and analyze its relationship with sex and type of arthroplasty.</p><p><b>METHODS</b>This is a prospective cohort study, including 107 patients receiving TKA or THA without allogeneic blood transfusion. There were 54 males and 53 females, with a mean age of 69.42 years. Levels of Hb and Hct were examined preoperatively and during the 6 months follow-up after operation.</p><p><b>RESULTS</b>Levels of Hb and Hct decreased postoperatively and reached their minimum points on postoperative day 4. Thereafter, Hb and Hct recovered to their preoperative levels within 6-12 weeks. No significant differences in the levels of Hb and Hct were noticed between different sexes. THA patients showed significantly greater drop in Hb and Hct than TKA patients in the first 4 days postoperatively (P < 0.05).</p><p><b>CONCLUSIONS</b>Levels of Hb and Hct decreased during the first 4 days after arthroplasty and gradually returned to their normal levels within 6-12 weeks postoperatively. THA may be associated with higher postoperative blood loss than TKA.</p>
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Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artroplastia , Métodos , Transfusão de Sangue , Hematócrito , Hemoglobinas , Metabolismo , Quadril , Cirurgia Geral , Joelho , Cirurgia Geral , Estudos ProspectivosRESUMO
BACKGROUND:Prosthesis friction interface is a hot focus in the study of total hip joint. Polyethylene wear particles induced inflammatory reaction, resulting in osteolysis surrounding the prosthesis and prosthesis loosening. To reduce polyethylene wear, ceramics-ceramics and ceramices-polyethylene friction interfaces were selected. High cross-linked polyethylene material with high intensity was selected. In young patients with large activity amount, the application of ceramic head is a great progress. OBJECTIVE:To assess the safety of large-diameter alumina ceramic matrix composites (BIOLOX? delta) bal on third-generation highly cross-linked polyethylene (Trident X3, Stryker, Mahwah, NJ) total hip arthroplasty in young patients, and to perform radiological measurements of high cross-linked polyethylene wear rate in the shortest two years after fol ow-up. METHODS:From July 2008 to June 2010, wear analysis of 30 cases aged less than 60 years with 32 hips with 36-mm BIOLOX ? delta ceramic femoral heads (CeramTec, Plochingen, Germany) on highly cross-linked polyethylene was performed in the 455 Hospital of Chinese PLA using Roman software (Robert Jones&Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom). The mean age of patients was 56.8 ± 6.5 years. RESULTS AND CONCLUSION:Fol ow-up was conducted from 2 to 3.7 years old. There were no imaging evidences, such as dislocation, the bal head fracture or joint loosening or osteolysis. Mean Harris score was increased from (19.9±7.3) (11-36) before replacement to (35.3±5.4) at 6 months after replacement. The mean wear rate was (0.022±0.11) mm/year after run-in period. These data indicated that large-diameter ceramic head articulation against highly cross-linked polyethylene in young patients would have high safety for joint dislocation, prosthesis fragmentation and low wear rates.
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Objective To investigate the biosecurity and biocompatibility of small intestinal submucosa (SIS) as scaffold for tissue engineering and to explore the possibility to induce synovial mesenchymal stem cells (SMSCs) differentiate into cartilage with SIS as the scaffold and SMSCs as the seed cells. Methods The SMSCs were isolated and cultured from the synovial mem-brane of knee joints of rabbits by a conventional method. The SIS was harvested from pigs according to the physical method and Abraham's method. 4 rabbits are divided into the experimental group and control group. The biosecurity of SIS as scaf-folds were investigated in pyrogen test, skin sensitization test and systemic toxicity test. The SMSCs and SIS were co-cultured in vitro and induced to differentiate into cartilage to explore the biocompatibility of SMSCs and SIS, the proliferation and differ-entiation ability of SMSCs on the scaffold of SIS. The varietyies were identified by the microscope. Results The SIS isolated with the physical method and Abraham's method is a milky and translucent membrane with a smooth surface. Under the electron microscope, SIS presented a porous Stereoscopic three-dimensional network structure, which is formed by fibrous tissues' intertex-ture. Its' porosity was about 80%and its aperture was 100-200μm. Meanwhile, the biosecurity and biocompatibility of SIS were also fine. In the trial that the SMSCs and SIS were co-cultured in vitro, the SMSCs can grow, adhere to and differentiate on the sur-face of SIS and into the hollows very well. It can also secrete extracellular matrix. Through scanning microscope observation, cells contact with each other by their neuritis, or adhered to the wall of hole by cellular protrution. On the surface of SIS, the SMSCs maintain the property that it can easily differentiate into the chondrogenic lineage in the chondrogenic medium. Immunochemistry staining showed positive expression of type II collagen post 21 days of co-cultrue. Conclusion SIS can be used as the scaffold to construct tissue engineering meniscus as it has good biosecurity and biocompatibility with SMSCs without disturbing the cell form or inhibiting the growth and function of SMSCs.
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Objective To assess the clinical significance of modular femoral component in restoring femoral offset after total hip arthroplasty.Methods Data of 75 patients,who had undergone THA with modular femoral component from June 2009 to June 2012,were retrospectively analyzed.There were 42 males and 33 females,aged from 44 to 83 years (average,64.7±12 years).There were 40 cases of left hip and 35 cases of right hip.The average Harris hip score was 54±6 (range,32 to 65) before operation.The Zimmer M/L Taper hip prosthesis with Kinectiv technology was used in all patients.Preoperative templating was utilized to accurately predict the prosthetic size and the femoral offset.During the surgery,the femoral offset was measured accurately,and the appropriate femoral neck prosthesis was selected in order to restore the femoral offset and reconstruct hip abductor moment arm.The femoral offset and leg length were measured according to X-rays after operation.The Harris hip score was used to assess the clinical results.Results The femoral offset was reconstructed in all patients,ranging from-3.0 to 3.0 mm (average,1.3±0.3 mm).The average leg length discrepancy was improved to 3.0±0.8 mm.All patients were followed up for 6 to 36 months (average,19.7 months).The average hip abduction angle was 40°±10° at 12 weeks after operation.The average Harris hip score was 86±13 (range,65-94) at 12 weeks after operation and 95±15 (range,78 to 98) at final follow-up.There was no hip dislocation and femoral acetabular impingement syndrome.Conclusion Modular femoral component can restore femoral offset without changing the leg length,which can result in good hip abductor strength,range of motion of the hip and stability,as well as less complications.
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BACKGROUND:Smal intestinal submucosa is characterized as antimicrobial activity, good biocompatibility, bio-mechanical properties, and rapid degradation in vivo, similar to the extracellular matrix of meniscal fibrochondrocytes. OBJECTIVE:To observe whether there exists a good histocompatibility between smal intestinal submucosa and synovial mesenchymal stem cells. METHODS:Smal intestinal submucosa was treated with physical and chemical treatment. And hematoxylin-eosin staining and scanning electron microscopy observation were performed. Then, smal intestinal submucosa extracts were prepared for the fol owing experiments. (1) Pyrogenic test:smal intestinal submucosa extracts were injected into the ear vein of New Zealand white rabbits. (2) Skin sensitization test:smal intestinal submucosa extracts, paraformaldehyde solution and normal saline were respectively injected intradermal y into New Zealand white rabbits. (3) General toxicity test:smal intestinal submucosa extracts and normal saline were respectively injected into the ear vein of New Zealand white rabbits. Smal intestinal submucosa was co-cultured with osteogenic rabbit synovial mesenchymal stem cells, and smal intestinal submucosa cultured alone served as control. RESULTS AND CONCLUSION:There were some intestinal mucosal epithelial cells, fat cells and other cells adhered onto the surface of smal intestinal submucosa after physical treatment. While, the amount of residual cells decreased sharply after chemical treatment. But the main structure and the component had not been changed. The surface of smal intestinal submucosa was smooth and no cells remained, and there was a three-dimension network spatial structure. The porosity was 80%. Smal intestinal submucosa is a non-toxic, nonirritating, non-immunogenic biomaterial with very good biocompatibility, which has a good histocompatibility with rabbit synovial mesenchymal stem cells.
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BACKGROUND:A large amount of studies have confirmed that synovial mesenchymal stem cells have the similarity in cellmorphology, immune phenotype, colony forming ability and differentiation potential with bone marrow mesenchymal stem cells. But bone marrow mesenchymal stem cells are better than synovial mesenchymal stem cells in the ability to differentiate into cartilages. OBJECTIVE:To discuss the possibility of using synovial mesenchymal stem cells as seed cells for meniscal tissue engineering. METHODS:The synovial mesenchymal stem cells were isolated from rabbit synovial tissues with limiting dilution monoclonal culture method, and then the cells were purified. The morphology, ultrastructure, molecular phenotype, proliferation kinetics, karyotype and tumorigenicity of the in vitro cultured cells were analyzed. RESULTS AND CONCLUSION:The synovial mesenchymal stem cells isolated from the rabbit synovial cells had high proliferation capacity during in vitro monolayer culture. The synovial mesenchymal stem cells grew to peak at 6 days, and the doubling time was (30.2±2.4) hours. Flow cytometry results showed the synovial mesenchymal stem cells could express some molecular makers of mesenchymal stem cells, such as CD44 and CD90. DNA contents check, karyotype test and oncogenicity test confirmed isolated and purified synovial mesenchymal stem cells were the normal diploid cells without tumorigenicity, so the cells can be used as seed cells for meniscal tissue engineering.
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BACKGROUND:Differentiation of growth factor-induced cells into fibrocartilage is the hot topic in the research of meniscus tissue engineering. The in vitro construction and in vivo reconstruction of menisci are closely related with the effect of growth factors. OBJECTIVE:To review the current development of growth factors in meniscus tissue engineering, and to investigate the mechanism. METHODS:The VIP database (http://lib.cqvip.com), CNKI database (www.cnki.net) and PubMed database (http://www.ncbi.nlm.nih.gov/pubmed) were retrieved for the related articles from January 2008 to March 2013 with the key words of“meniscus tissue engineering, cartilage, growth factors”. A total of 53 articles on the research of growth factors in meniscus tissue engineering were included. RESULTS AND CONCLUSION:There were various growth factors in cartilage tissue engineering research, and the new growth factors have been found in the constant. The research on the regulation effect of growth factors on cartilage was changed from the research of single growth factor model to the research of the interactions between multiple growth factors;the molecular mechanisms of growth factors in regulating the cartilage have also been extensively studied. Growth factors have good application prospects in tissue engineering, but there are stil many problems to be solved, such as during the healing of menisci, the expressions and the effect of different growth factors are different in different time points. So how to play the interaction between growth factors timely and appropriately thus stimulating the in vivo microenvironment, investigating the molecular mechanisms of growth factors in regulating the cartilage, as wel as finding the new growth factors are the research focus in meniscus tissue engineering.
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Objective To explore the differences of the joint function and the patient's satisfaction between two different methods to reconstruct limb length for unilateral Crowe Ⅳ developmental dysplasia of the hip (DDH).Methods The clinical controlled study were used.21 cases with unilateral DDH Crowe Ⅳ treated with total hip arthroplasty were divided into 2 groups randomly.The patients in the first group were reconstructed the limb with the compensatory length and those in the second group were did with the real length.The patients were followed up 10 years.Two independent sample t-test was used to compare these two operations.Harris scores and SF-36 scores were used in the test.Survival analysis with Kaplan-Meier method was involved in the survival of the prosthesis and then test with Log-rank test.X-ray films of different period were compared to confirm the prosthetic loosening.Results Seventeen patients were followed up 8-10 years.There were no significant differences both in Harris score and most of the SF-36 scores at the median follow-up of 10 years.The item mental healthy of SF-36 expressed significant difference.Five patients required revision.There were 10 cases suffered with polyethylene wear,6 cases with severe osteoporosis in greater trochanter,and 3 cases with osteolytic reaction.Conclusion There are no significant differences between the two surgical method in the survival rate of prosthesis and the joint function in the median follow up.The satisfaction of the control groups is lower than the trial groups both at the early stage after the operation and the median follow up.The revision rate between the two groups is similar but the reason is different.
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BACKGROUND:Some overseas searchers have shown that,the midvastus approach in total knee arthroplasty(TKA)can reserve the complete medial structure of quadriceps femoris,improve the functional recovery of knee extension apparatus,but also preserve the blood supply of medial knee joint and maintain proprioceptive sense of knee joint.OBJECTIVE:To evaluate the early functional outcome of midvastus approach and standard medial parapatellar approach in TKA.DESIGN:A prospective,randomized,double-blind,comparative study.SETTING:Changzheng Hospital Affiliated to the Second Military Medical University of Chinese PLA.PARTICIPANTS:From March 2004 to March 2006,34 patients undergoing bilateral TKA simultaneOusly were admitted to the Changzheng Hospital Affiliated to the Second Military Medical University of Chinese PLA,including 7 males and 27 females.They aged 56-78 years with a mean of 70.5 years,and consisted of 24 cases with osteoarthritis,and 10 cases with rheumatoid arthritis;24 cases with bilateral genu varum,9 cases with bilateral enu valgum,and 1 case with lateral genu varum and contralateral genu valgum.Informed consents were obtained from all the included patients.Materials:Press Fit Condylar(PFC)Sigma knee prosthesis(DUPUY Company),the central tibial pad was added with a polyethylene prominence,while the corresponding femoral prosthesis was treated with anterioposterior steotomy,identical with the remained prosthesis.METHODS:The surgical approach of 34 patients was randomized into a midvastus approach in one knee and a standard medial parapatellar approach in the other knee.The comparison included the surgical parameters and clinical parameters.mevemnt,the time of performing an active straight leg raise,the time of reaching 90°knee flexion,range of motion and complications.RESULTS:All of 34 patients were involved in the result analysis.There was no significant difference in the surgical time botween the two roups.The assessment revealed significantly less blood loss[(286±29.8)Ml,(368±35.8)Ml,P＜0.05],fewer lateral release in valgus knee(20%,50%,P＜0.05),less pain in the first week(P＜0.05),earlier return of active straight-leg raise[(1.8±0.3)days,(4.5±0.8)days,P＜0.01],earlier reach of 90° knee flexion [(3.2±0.8)days.(7.1±1.2)days,P＜0.01]and greater range of motion at 45 day[(107±20)°,(98±12)°,P＜.05]in the midvastus approach group.CONCLUSION:The midvastus approach,which is based on diminished disruption of extensor mechanism and peripatellar pIexus of vessels,relieves pain and improves range of motion in the early rehabilitation period following TKA.
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BACKGROUND: Previous artificial ligament is easy to break for material fatigue and to appear synonitis for materialbiocompatibility.OBJECTIVE: To observe the application effect of ligament advanced reinforcement system (LARS) artificial ligament inreconstruction of anterior cruciate ligament via follow-up.DESIGN, TIME AND SETTING: An own control, follow-up observation was performed between August 2004 andJanuary 2007 at the Department of Orthopedics and Joint Surgery, Shanghai Changzheng Hospital, Shanghai, China.PARTICIPANTS: Twenty-eight patients with anterior cruciate ligament injury, including 16 with sport injury and 12 withvehicle accident injury.MATERIALS: The main component of LARS artificial ligament (Laboratoire d'Applieation et de Recherche Scientifique,France) is the high-tenacity polyester fiber polyethylene terephthalate.METHODS: Twenty-eight patients with anterior cruciate ligament injury were performed arthroscopic reconstruction of theligament with LARS artificial ligament and were averagely followed up for 20 months.MAIN OUTCOME MEASURES: Patients' anterior drawer test, Lysholm score, range of motion prior to transplantationand in follow-up.RESULTS: The knee unstable symptom of 28 patients disappeared, anterior drawer test was negative, joint function wasgood with the flexion of 5.71 to 129.64 degrees. Average Lysholm score raised from (45.7±9.82) points prior totransplantation to (86.5±6.44) points after transplantation (P < 0.001). All patients resumed normal activities at 2 monthsafter transplantation, without acute or chronic synovitis and host response to materials.CONCLUSION: LARS artificial ligament is a relatively safe transplantation material and especially suitable to reconstructanterior cruciate ligament with sport injury. Mid-/short-term follow-up shows good result.
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[Objective]The patellar tendon lengths were compared in the knees with a history of patellar instability and in normal knees in Chinese,and the significance of patellar tendon length measurement in the knees of patellar instability was discussed.[Method]Totally 49 knees of 43 patients with patellar instability were reviewed from Jan.2003 to Dec.2005,including 15 males and 28 females and 6 paients with both instahle patellas.The mean age was 21.4 yrs(from 18~28 yrs),and the mean height was 163 cm(155~173 cm).And,50 normal control knees of 50 volunteers including 16 males and 34 females.The mean age was 24.2 yrs(from 18~35 yrs),and the mean height was 165cm(154~177 cm).The patellar tendon length,the distance between tibial tubercle and the anterior edge of tibial plateau and Insall-Salvati index on the lateral X-ray plain with 30? flexion of keens were measured and analyzed.[Result]The patellas tendon length of patients was longer than that of normal volunteers(53.3?2.7mm,47.3?3.3 mm,P0.05)of the distance from tibial tubercle to the anterior edge of tibial plateau between patients and volunteers.However,difference of Insall-Salvati index between patients and volunteers was significant(1.33?0.17,1.06?0.14,P