[Repair of Kuwadaâ ¡and â ¢ Achilles tendon defects through modified medial J-shaped approach with autologous fascia lata transplantation].

OBJECTIVE: To investigate the clinical effect of modified medial J-shaped incision of Achilles tendon combined with fascia lata transplantation in the treatment of Kuwada typeⅡand Ⅲ Achilles tendon defects. METHODS: From January 2016 to August 2018, the clinical data of 15 patients with KuwadaⅡand Ⅲ Achilles tendon defects treated with modified J-shaped approach with autologous fascia lata transplantation were retrospectively analyzed, including 14 males and 1 female, with an average age of 31.7 years old ranging from 24 to 43. There were 9 cases of KuwadaⅡdefect and 6 cases of KuwadaⅢ defect. Postoperative observations were made for incision complications, and the Arner-Lindholm scoring standard was used to evaluate the function of the affected foot at the last follow-up. RESULTS: All 15 cases were followed up from 3 to 16 months with an average of 9.2 months. No skin necrosis or infection occurred after operation, and no Achilles tendon rupture occurred again. According to the Arner-Lindholm scoring standard, 13 cases were excellent, 2 cases were good. CONCLUSION: Modified medial J-shaped incision is a satisfactory approach for repairing Achilles tendon defects. It is helpful to prevent postoperative incision complications, which double-strengthen the Achilles tendon strength, so that patients can perform early rehabilitation and functional exercises with satisfactory clinical results.

Comparison of the Effects of Proximal Humeral Internal Locking System (PHILOS) Alone and PHILOS Combined with Fibular Allograft in the Treatment of Neer Three- or Four-part Proximal Humerus Fractures in the Elderly.

OBJECTIVE: To compare and analyze the clinical outcomes of the proximal humeral internal locking system (PHILOS) alone and the PHILOS combined with fibular allograft in the treatment of Neer three- and four-part proximal humerus fractures (PHF) in the elderly. METHODS: From January 2014 to January 2018, a total of 42 elderly patients with Neer three- or four-part PHF admitted to our hospital were randomly divided into observation group and control group, with 21 patients in each group. The observation group was treated with the PHILOS combined with fibular allograft. The control group was treated with the PHILOS alone. Perioperative parameters and fracture classification were recorded in the two groups. Function results were assessed by Visual Analog Scale (VAS), Constant-Murley score (CMS), American Shoulder and Elbow Surgeons (ASES) score, and the Disability of Arm-Shoulder-Hand (DASH) score. Radiological results were evaluated using the neck-shaft angle (NSA) and humeral head height (HHH), and complications were also recorded in each group. RESULTS: There were no significant differences between the two groups in terms of preoperative status, age, gender, cause of trauma, fracture site, and fracture classification. The average follow-up time was 12 months. At the last follow-up, the VAS and DASH observation groups were lower than the control group, and there was significant difference between the two groups (P < 0.05). The CMS and ASES were higher in the observation group than the control group, and there was significant difference between the two groups (P < 0.05). The mean difference in the NSA and HHH were lower in the observation group than the control group, and there was a significant difference between the two groups (P < 0.05). There was one postoperative complication in the observation group, which was humeral head avascular necrosis (AVN). There were seven postoperative complications in the control group, including three cases of humeral head collapse and three cases of screw cutout and one case of humeral head AVN. The incidence of postoperative complications in the observation group was significantly lower than the control group (P < 0.05), there was a significant difference between the two groups. CONCLUSIONS: For Neer three- or four-part PHF in the elderly patients, PHILOS fixation with fibular allograft shows satisfactory short-term results with respect to humeral head support and maintenance of reduction, and may reduce the incidence of complications associated with fixation using a PHILOS alone.

[Minimally invasive treatment for distal radial fracture and dislocation of type IV based on Fernandez classification].

OBJECTIVE: To investigate the effects of external fixation combined with minimally invasive internal fixation for the treatment of distal radial fracture and dislocation of type IV based on Fernandez classification. METHODS: From January 2007 to October 2012,19 patients with the distal radius fracture and dislocation of type IV according to Fernandez classification were reviewed. There were 14 males and 5 females,ranging in age from 22 to 42 years old,with an average of 36.5 years old. All the patients were treated with minimally invasive reduction, and external fixation with finite internal fixation. The K-wire was used to fix radiolunate articular surface for correcting the instability of dorsal and volar intercalated segment. The radiolunate angle, scapholunate angle, and the length of the radial shorting were measured by the standard X-ray. Gartland and Werley evaluation system was used to evaluate recovery of function. RESULTS: No complications such as injury of blood vessels and radial nerves and pin track infections occurred. After operation, the radiolunate angle, scapholunate angle and the length of the radial shorting time were (9.5 +/- 3.3) degrees, (51.3 +/- 11.2) degrees and (11.2 +/- 1.8) mm by the standard X-ray. On the 3rd month after operation, GW score was 3.02 +/- 3.05. There was no re-displacement and subluxation occurred during the follow-up period. Good functional recovery were improved wrist function significantly. CONCLUSION: External fixation combined with minimally invasive internal fixation can treat distal radial fracture and dislocation of type IV based on Fernandez classification. Wrist joint stability depends on the structure of the bone and ligament around wrist joint. Emphasis on the diagnosis and treatment of carpal instability, and postoperative functional rehabilitation can improve wrist function.

[Application of monitoring phosphocreatine kinase continuously and dynamically in early diagnosis of compartment syndrome].

OBJECTIVE: To determine the efficacy of phosphocreatine kinase in the early diagnosis of compartment syndrome. METHODS: Forty patients with compartment syndrome of limbs were reviewed from 2005 to 2008 including 34 males and 6 females with an average age of (37.03 +/- 13.02) years. Monitoring phosphocreatine kinase continuously and dynamically after injured 2, 24 hours, 1, 2, 3 and 4 weeks later. The concentration of CK were measured by using Japanese Olympus automatic biochemistry analysator. The muscle preparations from affected extremity were taken after operation and 1, 2, 3 weeks later for biopsy. RESULTS: Two hours later after injury, the contents of CK increased sharply and the contents of CK were about 20 times more than the nomal. Twenty-four hours later, the contents of CK reached its maximum,the contents of CK were about 42 times more than the nomal. One week later, the contents of CK recovered to normal level. Pathological changes of muscle were irreversible. CONCLUSION: The change of the contents of CK can reflect the progression of disease objectively. If it increased sharply, the chance of compartment syndrome was high. Monitored it dynamicly and continuously can provide assistant for early diagnosis of compartment syndrome and evaluating pathogenetic condition.

[Surface-replacement total hip arthroplasty in the treatment of the femoral head osteonecrosis].

OBJECTIVE: To evaluate the outcome and indication of surface-replacement total hip arthroplasty in the treatment of the femoral head osteonecrosis. METHODS: The clinical data of 17 patients (21 hips) with femoral head osteonecrosis were reviewed. Among which, 10 cases were male and 7 cases were female, the average age was 36 years old (ranging from 25 to 51 years). There were 8 hips at Ficat stage III and 10 hips at Ficat stage IV. The 17 patients (21 hips) underwent surface-replacement total hip arthroplasty. Gibson posterolateral incision was used and non-cemented prosthesis was implanted. For prosthetic femoral head fixation, a guide pin was inserted into the capital center. After hollow boring hit drilling, a guide pole was inserted, and redundancy of femoral head was rasped off with cutterbar. The bone cement was painted on the femoral head and prosthesis, and the prosthesis was planted into the central axis hole of neck of femur until bone cement solidification. The therapeutic effects were evaluated by Harris hip score and statistical analysis was made. The X-ray was rechecked regularly. RESULTS: The mean duration of follow-up was 32 months (18 to 42 months). The average Harris hip score was improved significantly from preoperative 35.30 +/- 5.23 to postoperative 90.47 +/- 3.14, and the excellent and good rate was 90.5%. There were high statistical differences between preoperative and postoperative Harris score (P < 0.01). The X-ray showed radiolucent line around acetabular prostheses in two patients but without prostheses loosening. CONCLUSION: Surface-replacement total hip arthroplasty is a satisfactory way for the treatment of femoral head osteonecrosis in the middle-late phase, which can help reconstructing normal joint biomechanics and load transmission,improving joint stability and postponing THA without affecting later rebuilding, as well as some advantages such as decreasing surgical wound, convenient and low infection rate. Its indication is Ficat stage III and part Ficat stage IV femur head necrosis with less destroyed neck of femur,especially for young patients having a large amount of activity.

[Effect on wrist joint stability following distal radial fractures].

OBJECTIVES: To investigate the influence of wrist joint stability of patients with diversified fracture of the distal radius, and to find out the difference of the clinical effect between the patients with surgical treatment and non-surgical treatment. METHODS: From January 1999 to September 2006 a total of 200 cases with the fracture of the distal radius were reviewed according to the AO classification, the radiolunate angle, scapholunate angle, palmar tilt angle and the length of the radial shorting and step-off of the articular surface were measured by the standard X-ray. Gartland and Werley as modified by Sarmiento evaluation system was used, and the results were statistically analyzed. RESULTS: The average follow-up period was 5 years and 2 months. The follow-ups revealed 5 types of carpal instability: scapholunate dissociation, volar intercalated segment instability, dorsal intercalated segment instability and palmar or dorsal shift of the carpus. Functional results were excellent and good in 78% of the total patients. The increasing of the length of the radial shorting and step-off of the articular surface was found to be associated with greater risk of carpal instability. CONCLUSIONS: Based on the results of the study, wrist articular surface and radial shortening and palmar tilt angle should be considered as the most important factors of the healing effect after the fracture of the distal radius. Wrist joint stability depends on the structure of the bone and ligament around wrist joint. Carpal instability wound leads to significantly effect on the wrist. And surgery was necessary to severe intra-articular fracture of the distal radius.

[Computer assisted imaging guided total knee arthroplasty: preliminary clinical study of 46 cases].

OBJECTIVE: To discuss the approach and curative effect of total knee arthroplasty by intraoperative digital 3D bone mode. METHODS: 28 patients with bone arthritis, 7 with rheumatoid arthritis, 7 with ankylosing spondylitis, totally 46 patients with 54 knees affected, 29 males and 17 females, aged 48 (31 - 76), underwent total knee arthroplasty by digital 3D bone mode, including osteotomy, adjustment of soft tissue, and rotational positioning of prostheses. The operative time, hemorrhage and drainage 48 h after operation, and complication were observed. The pre-postoperative knee function was evaluated by HISS scoring system. The pre-postoperative range of motion of knee joint, and angle of KNA, variance of angle in exterior and interior stress and separation of joint space in tensile force, and postoperative rotational angle of tibia-femur prostheses were measured. X-ray tangential projection photography of patella was used to evaluate the apposition of patellofemoral joint. The postoperative curative effect was observed for 3 months. RESULTS: No complication as injury of nerves and blood vessel, bone fracture, fat embolism and so on was observed. The operative time was 80 +/- 15 min per knee. The hemorrhage and drainage in 48 h was 550 +/- 60 ml per knee. The Hand Injury Severity Score (HISS) 2 weeks after the operation was (92 +/- 4), significantly higher than that before operation [(46 +/- 6), P < 0.01]. There were statistically significant differences in the KNA angle, variance of angle under exterior stress, interior stress, and separation of joint space in tensile force pre- and postoperatively (all P < 0.01). The postoperative rotational angle of tibia-femur prostheses was (4.2 +/- 0.4) degrees. The X-ray tangential projection photograph of patella showed excellent apposition of patellofemoral joint, and no dislocation and unsteadiness. The postoperative range of motion of knee joint was 120 degrees +/- 9 degrees 3 months after operation. No joint laxity was found. CONCLUSION: Computer assisted imaging guidance actually and dynamically observe the changes of line of force of the lower limbs, knee joint rotational apposition and ligament balance, provides geometrical and morphological data and rebuild the knee joint bio-mechanically and anatomically, thus elevating the reproducibility of total knee arthroplasty and ensuring the safety of the system.