ObjectiveTo study the function and effectiveness of self-manufacture osteotomy guide device in osteotomy. MethodsA guide device was manufactured, which could guide the drill and osteotome. Sixty femoral moulds which cover with bubble were used as human femurs, and a 3 cm long, 1 cm wide crack was made in the femoral moulds supracondylar to imitate operation incision. The femoral moulds were divided into 3 groups (n=20): non-guiding group (group A), simple drill guiding group (group B), and drill-osteotome guiding group (group C). The osteotomy time, the variation range of the drill holes (incision side and the contralateral side), the variation range of the osteotome incisions (incision side and the contralateral side), and the match rate of drill holes and osteotome incision were recorded. And between February 2013 and January 2014, the osteotomy guide device was used to guide proximal tibia osteotomy in 6 patients with tibia infected nonunion to excise of infected bones. ResultsThe osteotomy time of groups B and C was significantly less than that of group A, and it was significantly less in group C than group B (P<0.01). The match rate of drill holes and osteotome incision in groups B and C was significantly higher than that of group A, and group C was significantly higher than group B (P<0.05). The variation range of the drill holes in both incision side and contralateral side of groups B and C was 0, which was significantly less than that of group A (P<0.01). The variation range of the osteotome incisions in both incision side and contralateral side of groups B and C was significantly less than that of group A, group C was significantly less than group B (P<0.01). Preliminary clinical results showed that the osteotomy guide device was simple to use, and precise in guidance for drill and osteotome, so it could reduce the time for repeated targeting during drilling and osteoming. The osteotomy time was 8.3-11.2 minutes (mean, 9.5 minutes). The surface of osteotomy was smooth and no split;and there was rich callus formation during bone transport. Six patients were followed up 13-25 months (mean, 16 months). The bone healing index was 0.92±0.13. ConclusionThe osteotomy guide device can reduce the damage to surrounding tissue and bone caused by drill and osteotome, reduce the difficulty of osteotomy, and significantly shorten the cost time.
OBJECTIVE: To study the therapy effect of improved bilateral tibia lengthening. METHODS: From May 1997 to May 2000, 32 patients (varus knee deformity in 8 cases) with low stature were adopted in this study. Among them, there were 26 females and 6 males, aged from 18 to 45 years old. Operative procedures included: 1. tibia osteotomy 1 cm distal from tibia tuberosity and fibula osteotomy 10 cm proximal from lateral malleolus; 2. fixation of the tibia osteotomy with interlocking nail and locking the proximal nail; 3. fixation of the lengthening apparatus; 4. lengthened bilateral tibia 0.7 mm per day; 5. removed the apparatus and locked the distal nail 2 weeks later after limb lengthening was over. RESULTS: The mean distance of lengthening was 8.5 cm (ranged 3.5 to 12.0 cm), the mean duration of lengthening was 128 days(ranged 53 to 180 days), and the mean time of bone union was 180 days (ranged 120 to 270 days). Followed up for 1 to 3 years, 98% patients felt satisfactory in lengthening, gait and joint movement. CONCLUSION: The improved bilateral tibia lengthening technique is recommended for advantage of short time of bone union, less complication and correcting the varus deformity of knee simultaneously.
Objective To find an effective method of surgical treatment of fibrous dysplasia of bone involving the proximal femur. Methods From January 2001 to January 2006, 57 patients with fibrous dysplasia of bone involving the proximal femur were treated. There were 29 males and 28 females, aging 8-50 years (mean 22 years). Thirty-five patients wereinvolved one bone and 22 patients were involved more than two bones. According to Guille’s classification, there were 34 cases of type A, 8 cases of type B, 8 cases of type C and 7 cases of type D. Fourteen cases compl icated by coax varus and the neck-shaft angle of femur was 78° on average (55-100°). The duration of the disease was 2.3 years on average (4 months to 10 years). The choice of the various operative procedures depended on the qual ity of the bone and the extent of the lesion. When the qual ity of the bone was good, then curettage and bone-grafting was performed. When the qual ity of the bone was poor, curettage and bone-grafting combined with internal fixation was performed. Medial displacement valgus or valgus osteotomies were used to treat fibrous dysplasia of bone involving the proximal part of the femur with coax varus. Results All patients were followed up for 6 months to 5 years with an average of 2.8 years. All bone graft were absorbed sl ightly at 3 months and markedly at 10 to 14 months postoperatively. The femoral mechanical al ignments were corrected completely radiologically in patients compl icated by coax varus; the average neck-shaft angle was corrected from 78° (55-100°) preoperatively to 122° (95-130°) postoperatively. The relative length of femur was increased 1.8-3.6 cm (mean 2.7 cm). After operation, 49 patients could walk without support, 5 with claudication, 3 ambulated with the aid of unilateral cane. Pain disappeared in 52 patients and pain was improved in 5 patients. No infections and recurrent fracture and progression of the deformity occurred in all patients. Conclusion Impactionallograft is the key of prompting allograft incorporating fully and preventing pathological fracture. An effective internal fixation must be used when the qual ity of the bone is poor. Medial displacement valgus or varus osteotomies can correct varus deformity, improve function, as well as restore biomechanical axis of femur. It is also able to effectively eradicate lesions and prevent recurrence.
Objective To evaluate the clinical outcomes ofa surgical approach for decompression of lumbar spinal stenosis, which was featured with reconstruction of posterior spinal structures and epidural space by spinous process-splitting, less osteotomy, laminar flap and keeping spinal process, lamina, outer ligmentum flavum intact. Methods From October 2001 to April 2003, 39 patients (19 males and 20 females, aging 36 to 77 years with a mean age of 49.6 years with lumbar stenosis underwent the surgical decompression procedure with reconstruction of posterior canal structures and epidural space. The involved locations were L3,4 to L5S1(5 cases),L4,5 to L5S1(18 cases), L4,5(11 cases) and L5S1(5 cases). The course of disease was 3 months to 16 years (40.4 months on average). The clinical outcomes after 1 year of operation Results All patients were followed up from 18 to 36 months. No intraoperative and postoperative complications were observed and all patients were satisfactory with the surgery. Computerized tomography showed that spinal and nerve root canal were satisfactorily enlarged 1 week postoperatively in all cases. Fusion of lamina and spinous process were detected on CT in 87.2% patients (34/39) 3 months after operation. No patients presented re-stenosis of lumbar spine and all patients presented bony fusion 1 year after surgery. Conclusion The approach of the current study was a reliable and effective method in the management of lumbar stenosis, it preserved thecontinuity of spinal process, interspinous ligaments, lamina and ligmentumn flavum and integrality of posterior spinal structures and epidural space. The integrity of the psoterior spinal structures can prevent the scar formation and improve the stability of lmbar spine postoperatively.
ObjectiveTo summarize the methods and complications of osteotomy in total hip arthroplasty (THA) to treat Crowe type ⅠV developmental dysplasia of the hip (DDH) so as to provide the reference for selection of surgical procedures. MethodsThe literature concerning THA for DDH was reviewed, and the effectiveness and complications were summarized in different methods. ResultsAt present, four osteotomies are commonly used in DDH, including transtrochanteric osteotomy, subtrochanteric osteotomy, lesser trochanteric osteotomy, and distal femoral osteotomy. Transtrochanteric osteotomy and subtrochanteric osteotomy can effectively adjust leg length, correct femoral anteversion and avoid nerve injury, but transtrochanteric osteotomy may cause bone fracture and abductor injury. Lesser trochanteric osteotomy is scarcely used because of its poor effectiveness. Distal femoral osteotomy is usually used in patients with knee deformity. ConclusionFor patients with Crowe type ⅠV DDH complicated by severe femoral dislocation and soft tissue spasm, subtrochanteric osteotomy should be selected, whereas it needs an associated standard focusing on how to select the osteotomy shape and length in subtrochanteric ostetomy, which needs an advanced research.
ObjectiveTo investigate the classification and treatment strategies of symptomatic severe osteoporotic vertebral fracture and collapse. MethodsBetween August 2010 and January 2014, 42 patients with symptomatic severe osteoporotic vertebral fracture and collapse were treated, and the clinical data were retrospectively analyzed. According to clinical symptom and imaging materials, 23 cases were classified as type I (local pain, limitation of motion, no neurological symptom, and no obvious deformity), 12 cases as type II (slight neurological symptom and kyphotic Cobb angle ≤ 30°), and 7 cases as type III (severe neurological symptom and kyphotic Cobb angle <30°). In 23 type I patients, 17 underwent percutaneous vertebral augmentation, 6 underwent posterior pedicle screw fixation strengthened with bone cement combined with percutaneous vertebral augmentation. In 12 type II patients, they were treated with local spinal decompression and internal fixation strengthened with bone cement. In 7 type III patients, 5 underwent posterior osteotomy, and 2 underwent one stage posterior approach of vertebral resection and reconstruction. The visual analogue scale (VAS), Oswestry disability index (ODI), and local kyphotic Cobb angle were used to evaluate the neurological function. The complications were recorded. ResultsThe operation was successfully completed in all patients. Wound infection and ketoacidosis secondary to stress blood glucose rise occurred in 1 case of type III patients respectively, and were cured after corresponding treatment; primary healing of wound was obtained in the other patients. The patients were followed up from 6 to 36 months (mean, 11.6 months). The nerve function was improved in 17 cases, and micturition disability was observed in 2 cases. Asymptomatic cement leakage occurred in 13 cases (30.95%) (7 cases in type I, 4 cases in type II, and 2 cases in type III). No bone cement dislocation and internal fixation failure were found during follow-up. The VAS score, ODI, and the local kyphotic Cobb angle at 1 week and last follow-up were significantly improved when compared with preoperative ones (P<0.05), but no significant difference was found between at 1 week and last follow-up (P>0.05). ConclusionIn order to improve the effectiveness and reduce the risk and complications of operation, individualized strategies should be performed according to different types of severe osteoporotic vertebral fracture and collapse.
Objective To summarize the surgical technique and the effectiveness of Becker V-shaped lateral rotation osteotomy in total hip arthroplasty (THA) for Crowe type IV development dislocation of the hip (DDH). Methods Between January 2000 and December 2009, 18 patients (22 hips) with Crowe type IV DDH underwent THA. There were 3 males and 15 females with an average age of 54 years (range, 41-75 years). The unilateral hip was involved in 14 cases and bilateral hips in 4 cases. All patients had over anteversion of the femoral neck, with the acetabular anteversion angle of (21.28 ± 4.87)°, the femoral neck anteversion angle of (59.06 ± 1.44)°, and combined anteversion angle of (80.33 ± 1.55)°. All the patients had limb-length discrepancy, ranged from 1.0 to 3.5 cm (mean, 2.5 cm). Before operation, gluteus medius muscle strength was grade 2 in 17 hips and grade 3 in 5 hips; severe or moderate claudication was observed in 13 and 5 patients, respectively. Trendelenburg sign was positive in all patients. Preoperative Harris score was 30.00 ± 6.32. Cementless prosthesis was used. Becker V-shaped lateral rotation osteotomy and subtrochanteric shortening with overlapping femoral resection were performed, and proximal femoral shaft splitting was performed on 21 hips having narrow bone marrow cavity. Results All the cases achieved primary healing of incision. No complication of anterior dislocation, deep infection, nerve traction injury, or femoral uncontrolled fracture occurred. All the cases were followed up 3-12 years (mean, 8 years). Postoperative X-ray films showed that the initial fixation result of femoral prosthesis was excellent in 18 hips and good in 4 hips. Bone healing of osteotomy stump was obtained at 3-6 months (mean, 5 months) after operation. Affected limb prolonged for 2.5-3.5 cm (mean, 3.0 cm ) at 1 year after operation; limb-length discrepancy was 0.5-1.5 cm (mean, 1.0 cm). The gluteus medius muscle strength was restored to grade 4 in 5 hips and grade 5 in 17 hips. At last follow-up, 13 patients had no claudication, and 5 patients had mild claudication; Trendelenburg sign was negative in 15 cases and was positive in 3 cases; the Harris score was significantly improved to 91.89 ± 3.22; all showing significant difference when compared with preoperative ones (P lt; 0.05). At last follow-up, the acetabular anteversion angle, the femoral neck anteversion angle, and combined anteversion angle were (19.33 ± 4.49), (13.33 ± 5.70), and (32.67 ± 5.35)°, respectively, all showing significant differences when compared with preoperative ones (P lt; 0.05). No aseptic loosening, osteolysis, or rediolucent line was found around the femoral component. No implant subsidence, stem varus, or revision occurred. Conclusion Becker V-shaped lateral rotation osteotomy is a safe and predictable method to treat type Crowe type IV DDH.
ObjectiveTo evaluate the effectiveness of modified "eggshell" osteotomy for the treatment of thoracolumbar kyphoscoliosis. MethodBetween April 2009 and June 2014, 19 patients with spinal deformity underwent modified "eggshell" osteotomy consisting of preserving posterior bony structures initially and enlarging surgical field for cancellous bone removal. There were 14 males and 5 females with an average age of 37.8 years (range, 18-76 years) and with a median disease duration of 7 years (range, 1-40 years). The disease causes included ankylosing spondylitis in 13 cases, spinal tuberculosis in 3 cases, and chronic vertebral compression fracture in 3 cases. Eleven patients showed single kyphosis and 8 patients had kyphoscoliosis. Preoperative Cobb angle of kyphosis was (64.2±30.1) °, while Cobb angle of scoliosis was (19.9±12.8) °. Apical vertebraes were T10 in 1 case, L1 in 3 cases, L2 in 7 cases, T10, 11 in 2 cases, T12, L1 in 4 cases, T12-L2 in 1 case, and T10-L1 in 1 case. Preoperative visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score were 6.1±1.9 and 15.2±5.6, respectively. According to Frankel criteria for spinal cord function, 16 cases were rated as grade E and 3 cases as grade D before operation. Cobb angle, VAS, and JOA scors were used to assess relief of symptom. ResultsThe operation time was 215-610 minutes (mean, 343 minutes); intraoperative blood loss ranged from 900 to 3000 mL (mean, 1573 mL). All incisions healed primarily. Delayed onset ischemia-reperfusion injury of spinal cord occurred in 1 case at 6 days after operation, and symptoms alleviated after conservative treatments. All 19 cases were followed up 14-76 months (mean, 46 months). No loosening or breakage of internal fixation was observed during follow-up. Cobb angle of kyphosis, Cobb angle of scoliosis, VAS and JOA scores at 1 week after operation and last follow-up were significantly improved when compared with preoperative ones (P<0.05) . VAS and JOA scores at last follow-up were significantly improved when compared with scores at 1 week after operation (P<0.05) , but no significant difference was found in Cobb angle of both kyphosis and scoliosis between at 1 week after operation and at last follow-up (P>0.05) . At 1 week after operation, the correction rate for kyphosis was 34.1%-93.4% (mean, 62.2%), and the correction rate for scoliosis was 42.4%-100% (mean, 68.9%). At 48 months after operation, 3 patients with preoperative impaired spinal cord function achieved full recovery. ConclusionsModified "eggshell" osteotomy owns the advantages of shorter operation time and less intraoperative blood loss, thus it is able to correct thoracolumbar kyphoscoliosis safely and effectively.
ObjectiveTo investigate the feasibility and effectiveness of a personalized distal femoral valgus resection angle for improving postoperative coronal alignment of lower limb in total knee arthroplasty (TKA). MethodsA retrospective analysis was made on the clinical data of 50 patients who received primary TKA between January 2013 and February 2013. There were 11 male and 39 female patients with degenerative knee osteoarthritis. The patients were divided into 2 groups. In test group (n=25), the resection angle was adjusted to the femoral mechanical anatomical angle (FMA); in control group (n=25), a fixed distal valgus resection angle of 5° was used. There was no significant difference in gender, age, body mass index, disease duration, sides, grade, preoperative FMA, mechanical femorotibial angle (MFT), and preoperative Knee Society Score (KSS) between 2 groups (P>0.05). Whole long X-ray film was taken to measure FMA and MFT at 3 days after operation, postoperative KSS was used to evaluate the knee function after 6 and 15 months. ResultsMFT was (-0.20±1.87)° in test group and was (1.71±3.67)° in control group, showing significant difference between 2 groups (t=2.32, P=0.02). The ideal MFT angle (0±3)° was achieved in 22 patients (88%) of test group and in 16 patients (64%) of control group, showing significant difference between 2 groups (χ2=2.32, P=0.02). Primary healing of incision was obtained in all patients of 2 groups. No deep venous thrombosis occurred. The patients of 2 groups were followed up 15 months after operation. There was significant difference in KSS between test and control groups at 6 months (88.23±2.57 vs. 82.92±2.59) (t=7.26, P=0.00) and at 15 months (90.76±2.77 vs. 88.65±1.77) (t=3.20, P=0.02). No sign of prosthesis loosening was observed by X-ray examination. ConclusionCompared with using of a fixed distal femoral resection angle, an individual FMA can significantly improve the postoperative MFT and promote early recovery of the knee function.
Objective To evaluate the surgical treatment and effectiveness of rheumatoid forefoot reconstruction with arthrodesis of the first metatarsophalangeal joint and arthroplasty of lesser metatarsal heads. Methods Between January 2007 and August 2009, 7 patients with rheumatoid forefoot were treated by reconstruction with arthrodesis of the first metatarsophalangeal joint and arthroplasty of lesser metatarsal heads. They were all females with an average age of 62 years (range, 56-71 years) and with an average disease duration of 16 years (range, 5-30 years). All patients manifested hallux valgus, hammer toe or mallet toe of 2-5 toes, 5 feet complicated by subluxation of the second metatarsophalangeal joint. The improved American Orthopaedic Foot amp; Ankle Society (AOFAS) score was 36.9 ± 6.4. The hallux valgus angle was (46 ± 5)°, and the intermetarsal angle was (12 ± 2)° by measuring the load bearing X-ray films preoperatively. Results All incisions healed by first intention after operation. The X-ray films showed bone fusion of the first metatarsophalangeal joint at 3-4 months after operation. Seven patients were followed up 2.9 years on average (range, 2-4 years), gait was improved and pain was rel ieved. The hallux valgus angle decreased to (17 ± 4)° and the intermetarsal angle was (11 ± 2)° at 3 months postoperatively, showing significant differences when compared with preoperative values (P lt; 0.05). The improved AOFAS score was 85.3 ± 5.1 at 2 years postoperatively, showing significant difference when compared with preoperative score (t=4.501, P=0.001). One patient had recurrent metatarsalgia at 4 years after operation. Conclusion Arthrodesis of the first metatarsophalangeal joint and arthroplasty of lesser metatarsal heads for rheumatoid forefoot reconstruction can correct hallux valgus, remodel the bearing surface of the forefoot, and rel ieve pain, so it can be considered as a procedure that provides improvement in the cl inical outcome.