Objective To observe the posterior condylar offset (PCO) changes and anteroposterior femorotibial translation, to investigate the influence of them on the maximum knee range of flexion (ROF) in patients with posterior cruciatesacrificingself al ignment bearing total knee arthroplasty (TKA). Methods The cl inical data were analyzed retrospectively from 40 patients (40 knees) undergoing primary unilateral TC-PLUSTM SB posterior cruciate-sacrificing self al ignment andbearing TKA for osteoarthritis between January 2007 and June 2009. There were 18 males and 22 females with an average age of 70.6 years (range, 56-87 years). The disease duration was 5-14 years (mean, 9.1 years). The locations were the left side in 11 cases and the right side in 29 cases. Preoperative knee society score (KSS) and ROF were 48.0 ± 5.5 and (77.9 ± 9.0)°, respectively. The X-ray films were taken to measure PCO and anteroposterior femorotibial translation. Multi ple regression analysis was performed based on both the anteroposterior femorotibial translation and PCO changes as the independent variable, and maximum knee flexion as the dependent variable. Results All incisions healed by first intention. The patients were followed up 12-19 months (mean, 14.7 months). At last follow-up, there were significant differences in the KSS (91.9 ± 3.7, t=— 77.600, P=0.000), the ROF [(102.0 ± 9.3)°, t=— 23.105, P=0.000] when compared with preoperative values. Significant difference was observed in PCO (t=3.565, P=0.001) between before operation [(31.6 ± 5.5) mm] and at last follow-up [(30.6 ± 5.9) mm]. At ast follow-up, the anteroposterior femorotibial translation was (— 1.2 ± 2.1) mm (95%CI: — 1.9 mm to — 0.6 mm); femoral roll forward occurred in 27 cases (67.5%), no roll in 1 case (2.5%), and femoral roll back in 12 cases (30.0%). By multiple regression analysis (Stepwise method), the regression equation was establ ished (R=0.785, R2=0.617, F=61.128, P=0.000). Anteroposterior femorotibial translation could be introducted into the equation (t=7.818, P=0.000), but PCO changes were removed from the equation (t=1.471, P=0.150). Regression equation was y=25.587+2.349x. Conclusion Kinematics after TC-PLUSTM SB posterior cruciate-sacrificing self al ignment bearing TKA with posterior cruciate l igament-sacrificing show mostly roll forwardof the femur relative to the tibia, which have a negative effect on postoperative range of motion. There is no correlation between PCO changes and postoperative change in ROF in TC-PLUSTM SB posterior cruciate-sacrificing self al ignment bearing TKA.
Central limb spasticity is a common complication after central nervous system injury, in which hand flexion spasticity often leads to the loss of the patient’s ability to move. Reducing muscle tone and relieving spasticity are the prerequisites for restoring limb function. T1 rhizotomy, which has been proposed in recent years, has proven to be effective in the treatment of central hand flexion spasticity. This consensus summarizes the etiology, symptoms, functional assessment of central hand flexion spasticity, and surgical indications for T1 rhizotomy, surgical principles and procedures, and rehabilitation program. The standardized protocol of T1 rhizotomy for the treatment of central hand flexion spasticity is proposed for the reference of clinicians in the process of diagnosis and treatment, with the aim of further improving the treatment level for central hand flexion spasticity.
ObjectiveTo probe into the clinical value of supine cervical vertebra traction with neck flexion in treating cervical spondylotic radiculopathy. MethodsFrom August 2011 to December 2013, 71 patients were divided randomly into a treatment group of 36 cases and a control group of 35 cases. They were treated respectively with supine cervical vertebra traction with neck flexion, and cervical vertebra traction on a sitting position. Both groups had acupuncture, moxibustion, massage and medium frequency electrotherapy. The period of observation was 15 days. We evaluated the results by surveying physiological curvature of the cervical spine on lateral radiograph, and visual analogue scale (VAS), neck disability index (NDI), criteria of diagnosis and therapeutic effect of syndromes in traditional Chinese medicine syndrome and clinical assessment scale for cervical spondylosis (CASCS) were also used. ResultsPhysiological curvature of cervical spine was much improved in both groups after treatment (P<0.05). The distance of cervical vertebra arc between vertebral anterior edge sequences in treatment group before treating was (4.07±3.63) mm and it was (9.03±4.31) mm after treatment. For the control group, those two numbers were respectively (4.13±3.02) and (8.87±3.97) mm. There was no significant difference in the distance of cervical vertebra arc and its increase between vertebral anterior edge between the two groups after treatment. There was significant difference in the efficiency rate between the two groups (P<0.05) (treatment group 100.00%, control group 97.14%). When cured rate and cured-markedly effective rate were added, the treatment group (80.56%) was much better than the control group (51.43%) (P<0.01). As to VAS score, NDI and CASCS scores, both groups got much better after treatment (P<0.01). For VAS, the treatment group decreased from 8.43±0.75 before treatment to 1.40±0.61 after treatment, while the control group from 8.35±0.78 before treatment to 2.55±0.59 after treatment. For NDI, the treatment group decreased from 54.13±7.44 before treatment to 10.78±4.55 after treatment, while the control group from 55.85±8.72 to 12.66±5.48. For CASCS, the treatment group rose from 34.88±5.39 before treatment to 74.65±6.73 after treatment, while the control group from 34.77±4.89 to 69.03±6.21. After treatment, VAS score of the treatment group was much lower than the control group (P<0.01). There was no difference between the two groups on NDI (P>0.05). CASCS score of the treatment group was significantly higher than the control group after the treatment (P<0.01). There was no significant difference in the increase of CASCS score between the two groups after treatment (P>0.05). ConclusionVertebra traction combined with acupuncture, moxibustion, massage and medium frequency electrotherapy is therapeutic for cervical spondylotic radiculopathy and traction at a supine and flexing position is better.
Objective To make a retrospective analysis on an early clinical outcome of total knee arthroplasty (TKA) for the knees with different degrees of flexion-contracture deformities. Methods Ninety-seven knees of 65 patients undergoing total knee arthroplasty with the Scorpio posterior-stabilized knee prosthesis from January 2000 to December 2003 were reviewed, including 51 osteoarthritis patients (74 knees) and 14 rheumatoid arthritis patients (23 knees). Thirtythree patients underwent unilateral TKA, and 32 patients underwent bilateral TKA. The average range of motion (ROM) before operation was 82.8°(range, 5-140°).According to the preoperative flexion-contracture degrees of the knees, these patients were divided into 2 groups, group A and group B. Group A consisted of the patients with flexioncontracture less than 20° (range, 0-15°), and group B consisted of the patients with flexion-contracture not less than 20° (range, 20-60°). In group A, the average flexion-contracture degree, ROM, KSS (knee society score), and function score were 10.7±8.0°, 104.6±20.0°, 29.1±18.0, and 32.6±20.7, respectively. But the corresponding data were much worse ingroup B than in group A, which were 28.2±7.8°, 60.8±26.6°, 12.1±13.2, and 26.8±18.1. All the operations were primary total knee arthroplasty, and they were performed by the same group of surgeons. The time for the prosthesis installed lasted for 25.6 minutes, and the average tourniquet time was 34.7 minutes. Three or four days after operation, the patients began the continuous passive motion (CPM) and active functional exercise of the knee.Results The patients were followed up for an average of 2 years and 7 months(range, 8 mon-3.5 yr). During the follow-up period, the average flexion-contracture degree, ROM, KSS, and function score in group A were 0.4±2.1°, 108.6±19.0°, 82.1±13.8, and 72.3±29.1, respectively; and the corresponding data in group B were 1.3±3.2°, 986±16.4°, 75.9±8.2, and 81.4±26.9, respectively. There was no significant difference between the 2 groups. No revision or deep infection was found. Conclusion The curative effect is mainly determined by the surgeon’s good operational skills, rich clinical experience, and familiarity with the prosthesis, and it is not influenced by severity of the knee flexioncontracture deformity. The knee ROM after TKA, which has a “toward middle ROM”phenomenon, is influenced by many clinical factors. It is very important for the patientto perform a functional exercise of the knee as early as possible after operation.
ObjectiveTo compare the early clinical outcome of GenesisⅡ high-flexion versus standard prostheses in total knee arthroplasty (TKA), and evaluate whether high-flexion prostheses can improve the postoperative range of motion (ROM). MethodsBetween September 2007 and December 2011, 80 patients (85 knees) consecutively underwent posterior cruciate-sacrificing TKA with GenesisⅡ systems. Finally, we reviewed 60 patients (60 knees) including 32 knees in high-flexion group and 28 knees in standard group. The follow-up time was 2.7 years in average. The postoperative knee ROM and the rate of complication of the two groups were evaluated. ResultsThe mean postoperative knee ROM of 32 knees was 112.8° in the high-flexion group and was 108.9° in the standard group. The mean postoperative HSS score was 86.6 and 84.2, respectively. The postoperative knee ROM, hospital for special surgery (HSS) score and the rate of complication did not show significant difference between the two groups. ConclusionThe high-flexion prosthesis is no better than the ordinary prosthesis in terms of the range of motion. We need more mid to long-term studies to do further research.
Objective To analyze the effect of the distal femoral flexion angle (DFFA) on the sagittal al ignment of femoral prosthesis and function recovery after total knee arthroplasty (TKA). Methods Between January 2007 and January 2009, 35 patients (35 knees) whose distal femoral flexion angle (DFFA) was more than 6° underwent TKA. Reference to the method by Oswald for DFFA measurement, 35 patients were divided into 2 groups: group A (n=23, 6° lt; DFFA lt; 12°, longintramedullary rod system) and group B (n=12, DFFA gt; 12°, short intramedullary rod system). Another random 30 osteoarthritis and 10 rheumatoid arthritis patients were selected as control group (group C, DFFA lt; 6°). The postoperative femoral prosthesis flexion angle (FPFA), knee society score (KSS), the femoral notch, and extension dysfunction were analyzed. Results All incisions healed by first intention. Seventy-five patients were followed up 1-3 years (mean, 2.1 years). The X-ray films showed that no signs of loosening, fracture, or infection were observed. There were significant differences in FPFA, the femoral notch, and knee extension dysfunction at 1 year after TKA between 3 groups (P lt; 0.05). The knee extension angle of group B was significantly larger than that of groups A and C (P lt; 0.05). There was no significant difference in the knee flexion angle and KSS score between 3 groups (P gt; 0.05). KSS score of postoperation was increased significantly when compared with preoperative values in 3 groups (P lt; 0.05). Conclusion Long intramedullary rod system in patients with higher DFFA usually leads to anterior femoral notch in TKA, so short intramedullary rods that can effectively avoid the notch should be selected in patients with DFFAgt; 12°. But when the femoral prosthesis would be in flexion position, extension dysfunction usually occurs.
Three-dimensional finite element model of elbow was established to study the effect of medial collateral ligament (MCL) in maintaining the stability of elbow joint. In the present study a three-dimensional geometric model of elbow joint was established by reverse engineering method based on the computed tomography (CT) image of healthy human elbow. In the finite element pre-processing software, the ligament and articular cartilage were constructed according to the anatomical structure, and the materials and contacts properties were given to the model. In the neutral forearm rotation position and 0° flexion angle, by comparing the simulation data of the elbow joint with the experimental data, the validity of the model is verified. The stress value and stress distribution of medial collateral ligaments were calculated at the flexion angles of elbow position in 15°, 30°, 45°, 60°, 75°, 90°, 105°, 120°, 135°, respectively. The result shows that when the elbow joint loaded at different flexion angles, the anterior bundle has the largest stress, followed by the posterior bundle, transverse bundle has the least, and the stress value of transverse bundle is trending to 0. Therefore, the anterior bundle plays leading role in maintaining the stability of the elbow, the posterior bundle plays supplementary role, and the transverse bundle does little. Furthermore, the present study will provide theoretical basis for clinical recognizing and therapy of elbow instability caused by medial collateral ligament injury.
ObjectiveTo compare the knee flexion degree after high-flexion versus standard total knee arthroplasty (TKA). MethodRelevant randomized controlled trials on comparison of knee flexion degree after high-flexion versus standard TKA were identified from Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure from the establishment of these databases until October 2015. A systematic review was performed to compare knee flexion degree, knee function score and complications between the two types of prostheses. Analyses were conducted using RevMan version 5.2.0 software. ResultsTwenty-one studies were included in this Meta-analysis. The results showed that the knee flexion degree was higher in high-flexion group than that in the standard group[WMD=2.71°, 95%CI (0.96, 4.46)°, P=0.002]; while the difference was not significant leaving out six low-quality literatures[WMD=0.72°, 95%CI (-0.15, 1.60)°, P=0.10]. There was no significant difference in knee function score between the two groups[WMD=-0.54, 95%CI (-1.34, 0.25), P=0.18]. There was no significant difference in complications between the two groups[OR=0.99, 95%CI (0.53, 1.84), P=0.98]. ConclusionsThe important finding from the current study is that there is no evidence to support that the use of high-flexion prostheses is superior to the standard prostheses during total knee arthroplasty.
Objective To summarize the clinical characteristics, differential diagnosis, and treatment methods of finger flexion contracture caused by three kinds of forearm flexor diseases. Methods Between December 2008 and August 2021, 17 patients with finger flexion contracture were treated, including 8 males and 9 females, aged 5-42 years, with a median of 16 years. The disease duration ranged from 1.5 months to 30 years, with a median of 13 years. The etiology included 6 cases of Volkmann’s contracture, all of which were flexion deformity of the 2nd to 5th fingers, accompanied by limitation of thumb dorsiflexion in 3 cases and limitation of wrist dorsiflexion in 3 cases; 3 cases of pseudo-Volkmann’s contracture, including 2 cases of flexion deformity of middle, ring, and little fingers, and 1 case of flexion deformity of ring and little fingers; 8 cases of ulnar finger flexion contracture caused by forearm flexor disease or anatomical variations, all of which were flexion deformity of middle, ring, and little fingers. Operations such as slide of flexor and pronator teres origin, excision of abnormal fibrous cord and bony prominence, and release of entrapped muscle (tendon) were performed. Hand function was evaluated according to WANG Haihua’s hand function rating standard or modified Buck-Gramcko classification standard, and muscle strength was evaluated according to British Medical Research Council (MRC) muscle strength rating standard. Results All patients were followed up 1-10 years (median, 1.5 years). At last follow-up, 8 patients with contracture caused by forearm flexor disease or anatomical variations and 3 patients with pseudo-Volkmann’s contracture achieved excellent hand function, with muscle strength of grade M5 in 6 cases and grade M4 in 5 cases. One patient with mild Volkmann’s contracture and 3 patients with moderate Volkmann’s contracture without severe nerve damage had excellent hand function in 2 cases and good in 2 cases, with muscle strength of grade M5 in 1 case and grade M4 in 3 cases. Two patients with moderate or severe Volkmann’s contracture had poor hand function, with 1 case of muscle strength of grade M3 and 1 case of grade M2, which improved when compared with those before operation. The overall excellent and good rate of hand function and the proportion of patients with muscle strength of grade M4 and above were 88.2% (15/17), respectively. ConclusionThe finger flexion contracture caused by different etiology can be differentiated by analyzing the history, physical examination, radiographs, and intraoperative findings. After different surgical treatments, such as resection of contracture band, release of compressed muscle (tendon), and downward movement of flexor origin, most patients have a good outcome.
ObjectiveTo evaluate the effectiveness of spinal wedged osteotomy and total hip arthroplasty (THA) for treatment of kyphosis and severe hip flexion contracture caused by ankylosing spondylitis (AS). MethodsBetween December 2008 and November 2011,25 patients (37 hips) with kyphosis and severe hip flexion contracture caused by AS were treated.There were 22 males and 3 females,aged 29-38 years (mean,35.6 years).The disease duration was 8-16 years (mean,13.2 years).Of them,18 cases had complete limitation of hip motion,and 16 cases had severe spine deformity (Cobb's angel ≥60°).All 25 cases underwent spinal wedged osteotomy at first,and then received THA after 8 weeks.The effectiveness was evaluated by Harris hip score,range of motion (ROM) of the hip,visual analogue scale (VAS) score,Cobb's angle,and information and data exchange system (IDES) criteria for aseptic loosening,respectively. ResultsThe patients were followed up 12-14 months (mean,13 months).Spondylolisthesis (Ⅱ degree) occurred in 1 case spinal after wedged osteotomy,and was corrected after second operation.No vascular injury or spinal cord injury was observed.Bony fusion was obtained at osteotomy ends at 6 months after operation.The Cobb's angle was significantly corrected from (83.5±10.4)° preoperatively to (25.4±5.5)° (t=24.63,P=0.00) 12 months postoperatively.One case had traction injury of the femoral nerve after THA,and the muscle function recovered at 9 months after operation.According to IDES criteria,up-displacement of cup (<5 mm) was observed in 1 patient,who had no obvious clinical symptoms; periacetabular osteolysis occurred in 1 patient,with no displacement of cup.No obvious radiolucent was seen in 37 hips.The Harris hip score was significantly improved from (26.87±4.23) preoperatively to (85.92±6.04) (t=28.72,P=0.00) 3 months postoperatively; the VAS score was significantly decreased from (6.71±1.14) preoperatively to (2.31±0.82) (t=42.26,P=0.00) 3 months postoperatively; and the flexion-extension ROM of the hip was significantly improved to 60-100° (mean,72.0°) at post-operation,and the abduction ROM of the hip was improved to 20-40° (mean,28.7°). ConclusionSpinal wedged osteotomy combined with THA is an efficient treatment for kyphosis and severe hip flexion contracture caused by AS.