[Effectiveness of Tang's arthroscopy approach for anterior and posterior ankle impingement syndrome].

OBJECTIVE: To investigate the effectiveness of Tang's arthroscopy approach in treatment of anterior and posterior ankle impingement syndrome. METHODS: Between August 2010 and September 2017, 92 patients with anterior and posterior ankle impingement syndrome were retrospectively analyzed. There were 58 patients were treated with Tang's arthroscopy approach under floating decubitus (group A) and 34 patients were treated with standard anterior and posterior approaches (group B). There was no significant difference in gender, age, body mass index, side, disease duration, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, and preoperative visual analogue scale (VAS) score between the two groups ( P>0.05).The operation time, AOFAS score, VAS score, and Roles-Maudsley score were recorded to evaluated the pain and function of the ankle, and patient subjective satisfaction. The X-ray film and MRI at 12 months were used to observe the ankle impingement. RESULTS: Median operation time of group A was 50.5 minutes ï¼»95%CI (49.3, 54.6)ï¼½, which was significantly shorter than that of group B ï¼»88.5 minutes, 95%CI (76.5, 92.8)ï¼½ (Z=-4.685, P=0.000). All incisions in group A healed by first intention; while the incisions of 2 cases in group B delayed healed after debridement. The follow-up time of group A was (54.7±18.8) months, while that of group B was (55.4±17.9) months, and there was no significant difference between the two groups ( t=-0.178, P=0.859). The lateral X-ray films at 12 months showed that the talus process was removed incompletely in 2 cases (3.4%) of group A and 1 case (2.9%) of group B. There was no significant difference in the incidence between the two groups (χ 2=0.014, P=0.699). At last follow-up, the AOFAS scores were 83.1±6.6 in group A and 85.2±6.4 in group B; the VAS scores were 1.3±1.1 in group A and 1.6±1.0 in group B. The AOFAS and VAS scores at last follow-up were superior to preoperative ones ( P<0.05), but there was no significant difference between the two groups ( P>0.05). The median subjective satisfaction score of group A was 2.0 ï¼»95%(1.4, 1.7)ï¼½, which was better than that of group B ï¼»2.0, 95%(1.6, 2.2)ï¼½ ( Z=-2.480, P=0.013). CONCLUSION: Arthroscopic treatment of anterior and posterior ankle impingement syndrome through Tang's approach can shorten the operation time, simplify the procedures, and obtain good effectiveness and patient satisfaction.

Effect of recombinant human bone morphogenetic protein 2/poly-lactide-co-glycolic acid (rhBMP-2/PLGA) with core decompression on repair of rabbit femoral head necrosis.

OBJECTIVE: To observe the effect of recombinant human bone morphogenetic protein 2/poly-lactide-co-glycolic acid (rhBMP-2/PLGA) with core decompression on repair of rabbit femoral head necrosis. METHOD: Bilateral femoral head necrosis models of rabbit were established by steroid injection. A total of 48 rabbits (96 femoral head necrosis) were randomly divided into 4 groups: Group A, control group with12 rabbits, 24 femoral head necrosis; Group B, treated with rhBMP-2/PLGA implantation after core depression, with 12 rabbits, 24 femoral head necrosis; Group C, treated with rhBMP-2 implantation after core depression, with 12 rabbits, 24 femoral head necrosis; Group D treated with core depression group without implantation, with 12 rabbits, 24 femoral head necrosis. All animals were sacrificed after 12 weeks. The ability of repairing bone defect was evaluated by X-ray radiograph. Bone mineral density analysis of the defect regions were used to evaluate the level of ossification. The morphologic change and bone formation was assessed by HE staining. The angiogenesis was evaluated by VEGF immunohistochemistry. RESULTS: The osteogenetic ability and quality of femoral head necrosis in group B were better than those of other groups after 12 weeks by X-ray radiograph and morphologic investigation. And the angiogenesis in group B was better than other groups. Group C had similar osteogenetic quality of femoral head necrosis and angiogenesis with group D. CONCLUSION: The treatment of rhBMP-2/PLGA implantation after core depression can promote the repair of rabbit femoral head necrosis. It is a promising and efficient synthetic bone material to treat the femoral head necrosis.

[Arthroscopic surgery for severe elbow osteoarthritis and ankylosis].

OBJECTIVE: to investigate the clinical efficacy of arthroscopic debridement, shaping and soft tissue releasing in the treatment of severe elbow osteoarthritis and ankylosis. METHODS: arthroscopies were performed in 34 patients with severe elbow osteoarthritis. Among them, 13 were accompanied by ankylosis. In arthroscopic surgery, articular cavity was cleared. And loose bodies, osteophytes of coronoid process and olecranon of ulna were excised, the coracoid fossa and olecranon fossa shaped and joint capsules and collateral ligaments severely contracted properly released. Rehabilitation training was guided postoperatively. Arthralgia and range of motion of elbow were scored by Mayo's scoring criteria in contrast with that preoperatively. RESULTS: the pain and range of motion (ROM) of elbow improved obviously in 34 patients. Angle of extension postoperatively increased by 30° ± 16° and angle of flexion increased by 34° ± 19°. Postoperative ROM of elbow show significant difference with the preoperative status (P < 0.01). According to the Mayo's scoring criteria, the excellent and good rate was 85.3%. CONCLUSION: arthroscopic treatment of severe osteoarthritis and ankylosis of elbow is reliable. Trauma of arthroscopy is minimal and complications are rare.