Objective To evaluate the clinical effect of repair of massive bone defect in tibia by vascularized fibula grafting of either sides. Methods Twenty-four cases of massive bone defect in tibia, among which 14 cases were repaired by vascularized fibula grafting of the other side and another 10 cases were repaired by those of the same side, from 1987 to 1997 were followed up for 3 to 13 years; the functions of the operated limbs were evaluated according to Enneking Score System, and the outcome of the fibula grafts were assessed by radiographic examination with reference to the standard established by International Symposium onLimb Salvage. Results The average recover rate of the operated limbs in those repaired by the other side grafting was 80.7%, and the average healing period ofthe fibula graft was 14 weeks with fracture of the graft in one case which madethe operated lower limb shorten for about 2.5 cm; the fibula grafts were observed thickened in 43 weeks, on average, and the patients could walk independently without a crutch. While in those repaired by the same side grafting, the averagerecover rate of the operated limbs was 68.3%, the average healing period of thefibula graft was 17 weeks with fracture of the graft in 3 cases, in 2 of which the lower limbs were shortened for 2 cm and 4 cm respectively, and in the third one infection occurred and amputation was performed finally; the fibula grafts were observed thickened in 49 weeks, on average, which made it available for the patients to walk without a crutch. All of the data showed that there was a significant difference statistically between the differently treated cases. Conclusion It’s a good choice to repair massive bone defect in tibia by vascularized fibula grafting, and the vascularized fibula graft from the other side could promote the bone healing and accelerate the recover of the function of the operated lower limb.
ObjectiveTo evaluate the effectiveness of Cross-Union surgery for the treatment of pseudarthrosis of the tibia (PT) with neurofibromatosis type 1 (NF1). MethodsThe clinical data of 8 children of PT with NF1 who met the selection criteria between January 2018 and December 2023 was retrospectively analyzed. There were 5 boys and 3 girls, and the operative age ranged from 1.8 to 13.3 years with a median age of 3.5 years. According to Paley classification, there were 2 cases of type 2a, 2 cases of type 3, 2 cases of type 4a, and 2 cases of type 4c. There were 5 cases of first operation and 3 cases of re-fracture after previous operation. Six cases had leg length discrepancy before operation, and 2 of them had shortening over 2.0 cm. Except for 1 case of ankle fusion, the other 7 cases had ankle valgus. Preoperative coronal/sagittal angulation was recorded. Postoperative pseudarthrosis healing and refracture were observed. Leg length discrepancy and tibiotalar angle were measured and recorded before operation and at last follow-up. Inan imaging evaluation criteria was used to evaluate the imaging effect. ResultsAll patients were followed up 12-37 months (mean, 23.5 months). One pseudarthrosis failed to heal at 12 months after operation and healed at 3 months after reoperation, while the other pseudarthrosis healed with a healing rate of 87.5% and a healing time of 4-8 months (mean, 5.3 months). No refracture occurred during the follow-up. At last follow-up, there were 2 new cases with leg length discrepancy, which were 0.7 cm and 1.3 cm, respectively. In 2 cases with the leg length discrepancy more than 2.0 cm before operation, the improvement was from 4.1 cm and 12.6 cm to 2.1 cm and 9.0 cm, respectively. There was no significant difference in leg length discrepancy between pre- and post-operation in 8 cases (P>0.05). At last follow-up, 6 patients still had ankle valgus, and there was no significant difference in the tibiotalar angle between pre- and post-operation (P>0.05); the tibial coronal/sagittal angulation significantly improved when compared with that before operation (P<0.05). According to Inan imaging evaluation criteria, 1 case was good, 6 cases were fair, and 1 case was poor. Conclusion Cross-Union surgery is an effective method for the treatment of PT with NF1 in children, can achieve good bone healing results with a low risk of re-fracture. The surgery may not have significant effects on leg length discrepancy and ankle valgus, and further treatment may be required.
Objective To investigate the effectiveness of arthroscopic anterior cruciate ligament (ACL) reconstruction via transtibial (TT) and transportal (TP) techniques after 10 years follow-up. Methods A clinical data of 103 patients who underwent arthroscopic ACL reconstruction with a single bundle of autologous hamstring tendon between March 2006 and March 2009 was retrospectively analyzed, among which 57 patients were reconstructed with TT technique (TT group) and 46 patients were reconstructed with TP technique (TP group). There was no significant difference in gender, age, cause of injury, interval between injury and operation, preoperative pivot shift test, preoperative International Knee Documentation Committee (IKDC) score, Lysholm score, and KT-2000 side-to-side difference (SSD) between the two groups (P>0.05). At 10 years after operation, Lachman test was used to evaluate the forward joint stability and pivot shift test to evaluate the rotational stability of the knee; KT-2000 SSD was used to measure tibial anterior displacement; IKDC score and Lysholm score were used to evaluate knee function; MRI examination was performed to observe graft healing and measure coronal inclination angles of the tibia and femoral tunnels. The rate of return to sports was also calculated. Results The incisions healed by first intention in the two groups, and no early complication occurred after operation. All patients were followed up 10-13 years, with an average of 11.5 years. During the follow-up period, there was no limitation of knee extension and flexion, no discomfort of donor site or graft failure in either group. MRI examination showed that the graft healed well. The IKDC score, Lysholm score, and KT-2000 SSD in the two groups were significantly improved after 10 years (P<0.05), and there was no significant difference between the two groups at 10 years after operation (P>0.05). There were significant differences in coronal inclination angles of femoral tunnel and tibial tunnel between the two groups (P<0.05). There was no significant difference in Lachman test and pivot shift test between the two groups (P>0.05). The rate of return to sports of patients was 61.40% (35/57) in TT group and 63.04% (29/46) in TP group, showing no significant difference between the two groups (χ2=0.29, P=0.87). Conclusion TT and TP techniques can both achieve good effectiveness in ACL reconstruction.
OBJECTIVE: To provide an anatomical basis for the clinical applications of the medial fascinocutaneous flap of calf and to verify its clinical value. METHODS: In 20 lower limb specimens of adult human cadavers, the number, course, size, position and distribution of septocutaneous branches of the posterior tibial vessels are marked by means of red latex and black ink irrigations through femur artery and septocutaneous branches of the posterior tibial artery respectively. RESULTS: The posterior tibial artery gives off several septocutaneous branches at the upper, middle and lower one-third of the leg respectively. Each septocutaneous artery has one or sometimes two concomitant veins. Based on this result, anterograde or reverse pedicled fasciocutaneous flap can be performed for the purpose of repairing soft tissue defects of leg and foot. The flap was clinically applied to treat leg and foot soft tissue defects in 12 cases with satisfactory results. CONCLUSION: The flap is easy to dissect, the posterior tibial artery can be preserved with high successful rate. Therefore, it offers an useful alternative in the repairing and reconstruction of nonextensive soft tissue defects in the leg and foot.
OBJECTIVE: To investigate the clinical results of the medial multiplex flap pedicled with the posterior tibial vessel. METHODS: Twelve cases with soft tissue defects and bone defects of limbs were treated with the medial multiplex flap pedicled with the posterior tibial vessel from September 1992 to May 1999. Among them, bone and soft tissue defects following opened fracture in 7 cases, chronic ulcer following chronic osteomyelitis in 2 cases, melanoepithelioma in 2 cases, bone and soft tissue defects following osteoma resection in 1 case. The bone defect area was from 2.5 cm x 5.0 cm to 4.5 cm x 11.0 cm. Free graft was performed in 5 cases, bridged transposition in 3 cases and reversal transposition in 4 cases, among them, periosteal myocutaneous flap with autogenous or allogeneic bone grafting in 8 cases, myocutaneous flap in 4 cases. The area of the flaps from 6 cm x 8 cm to 12 cm x 25 cm. RESULTS: All flaps were healed by first intention, but in the distal fragments of bigger flaps were partially necrosed in 2 cases. In 10 cases bone healing were obtained after 16 weeks of operation according to the X-ray photos. All cases were followed up from 6 to 18 months. All cases achieved satisfactory result but 1 case died because of lung metastasis of osteoma. CONCLUSION: The multiplex graft pedicled with the posterior tibial vessel is an ideal graft for repairing the large soft tissue defects and bone defects, because it has such advantages as adequate blood supply, big vascular diameter, long pedicle and big dermatomic area.
Objective To investigate the effect of body mass index (BMI) on the short-term effectiveness of high tibial osteotomy (HTO) in the treatment of varus knee arthritis. Methods The clinical data of 84 patients (84 knees) with varus knee arthritis treated with HTO between May 2016 and August 2020 were retrospectively analyzed. According to BMI, the patients were divided into normal group (32 patients in group A, BMI<25 kg/m2), overweight group (27 patients in group B, BMI>30 kg/m2), and obese group (25 patients in group C, BMI>30 kg/m2). The BMI of groups A, B, and C were (23.35±0.89), (26.65±1.03), and (32.05±1.47) kg/m2, respectively. There was no significant difference (P>0.05) in gender, age, surgical side, disease duration, and preoperative Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, knee range of motion, and hip-knee-ankle angle (HKA) between groups. The operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation were recorded and compared between groups. The improvement of knee joint function and pain status were evaluated by knee joint HSS score, knee range of motion, and VAS score before and after operation, and measuring the HKA of patients on X-ray film. During the follow-up, the X-ray films of the knee joint were reexamined to observe the position of the internal fixator and the healing of osteotomy. Results All patients completed the operation successfully and were followed up 8-40 months (mean, 19.3 months). There was no significant difference in follow-up time, operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation between groups (P>0.05). No operative complications such as severe vascular or nerve injury occurred. After operation, deep venous thrombosis of lower extremities occurred in 1 case in groups A and B respectively, and fat liquefaction of surgical incision occurred in 2 cases in group C. There was no significant difference in the incidence of perioperative complications between groups (3.1% vs. 3.7% vs. 8.0%) (P=0.689). During the follow-up, there was no bone nonunion, plate fracture or loosening. At last follow-up, HSS score, VAS score, knee range of motion, and HKA significantly improved in the 3 groups when compared with those before operation (P<0.05), but there was no significant difference in the differences of the above indexes between groups before and after operation (P>0.05). Conclusion BMI does not affect the short-term effectiveness of HTO in the treatment of varus knee arthritis. HTO can be selected for overweight and obese patients after standard medical treatment is ineffective.
Objective To investigate the effectiveness of a novel lateral tibial plateau annular plate (hereinafter referred to as the novel plate) fixation via fibular neck osteotomy approach for posterolateral tibial plateau fractures. Methods Between January 2015 and December 2018, 22 patients with posterolateral tibial plateau fractures were treated. There were 10 males and 12 females with an average age of 39.0 years (range, 25-56 years). Seven fractures were caused by falls, 10 by traffic accidents, and 5 by falling from height. The time from injury to hospitalization ranged from 3 to 12 days, with an average of 7.0 days. All patients were closed fractures. According to Schatzker classification, the fractures were classified as type Ⅱ in 8 cases, type Ⅲ in 9 cases, type Ⅴ in 1 case, and type Ⅵ in 4 cases. The fractures were fixed with the novel plates after reduction via fibular neck osteotomy approach. The fracture reduction and healing were observed by X-ray film after operation. The range of motion of the knee joint was recorded and the function was evaluated by modified American Hospital for Special Surgery (HSS) score. Results All operations were completed successfully. The operation time was 60-95 minutes (mean, 77.6 minutes). The intraoperative blood loss was 100-520 mL (mean, 214.5 mL). There was 1 case of common peroneal nerve injury during operation and 2 cases of fat liquefaction of incision after operation. All patients were followed up 13-32 months (mean, 19.4 months). Postoperative X-ray films showed that the fracture reduction was good in 17 cases and moderate in 5 cases, and all fractures healed with a healing time of 10-18 weeks (mean, 13.0 weeks). At last follow-up, the range of motion of the knee joint ranged from 100° to 145° in flexion (mean, 125.5°) and from 0° to 4° in extension (mean, 1.2°). The modified HSS score was 82-95 (mean, 86.3). There was no complications such as plate deformation, screw fracture, fracture reduction loss, skin necrosis, and so on. Conclusion For posterolateral tibial plateau fractures, the novel plate fixation via fibular neck osteotomy approach has the advantages of clear intraoperative field, firm fracture fixation, and less postoperative complications, which is beneficial to the recovery of knee joint function.
【Abstract】 Objective To investigate the method and effectiveness of reverse anterolateral thigh flap and muscle flap for repair of wound defects with exposed tibia in the proximal-middle leg. Methods Between October 2005 and April 2010, 16 patients with wound defects with exposed tibia in the proximal-middle leg were treated with reverse anterolateral thigh flap and muscle flap. There were 10 males and 6 females, aged from 16 to 52 years. Injury was caused by traffic accident in 11 cases and by crushing in 5 cases. The disease duration of 1-6 hours (mean, 3 hours) in 10 patients and 6-14 days (mean, 10 days) in 6 patients, who underwent tibial fracture plate fixation in other hospitals. The size of wound ranged from 13 cm × 7 cm to 20 cm × 13 cm. The size of the flap ranged from 16 cm × 10 cm to 23 cm × 15 cm. The donor sites were covered with splite thickness skin grafts. Results Infection occurred in 2 flaps at 5-7 days and was cured after 1 week of dressing change; the other flaps survived and the wounds healed by first intention. The incisions healed well and the skin grafts survived at the donor sites. All cases were followed up 10-23 months (mean, 18 months). The appearance of the flap was slightly overstaffed, but the color and texture were satisfactory. All fractures healed at 8-10 months after operation. Conclusion It is effective to repair wound defects with exposed tibia in the proximal-middle leg with reverse anterolateral thigh flap and muscle flap.
Objective To introduce the free multiple flaps of lowerextremity based on the anterior tibital vascular pedicle for primary repair of the complex burned hand deformities.Methods From September 2000 to February 2003, the lateral leg flap, dosalis pedis flap and trimmed first toe based on the anterior tibial vascular pedicle were utilized to reconstruct the thumb and repair the first web, thenar, wrist or palmar scar contracture simultaneously in 6 patients. The flap size of lateral leg and dosalis pedis ranged from 4 cm×10 cm to 7 cm×10 cm and from 5 cm×10 cm to 9 cm×12 cm, respectively.Resutls Six cases were treated and followed up for 6 weeks to 1 year. The transplanted flaps survived with satisfactory recovery in function and appearance of theburned hand. The function of donor lower extremity was not damaged. Conclusion The procedure of the free multiple flaps of lower extremity based on the anterior tibial vascular pedicle is reliable and effective for primaryrepair of burned hand.
Objective To analyze the excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular for the treatment of flatfoot related with accessory navicular and to evaluate its effectiveness. Methods Between May 2006 and June 2011, 33 patients (40 feet) with flatfoot related with accessory navicular were treated. There were 14 males (17 feet) and 19 females (23 feet) with an average age of 30.1 years (range, 16-56 years). All patients had bilateral accessory navicular; 26 had unilateral flatfoot and 7 had bilateral flatfeet. The disease duration ranged from 7 months to 9 years (median, 24 months). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-midfoot score was 47.9 ± 7.3. The X-ray films showed type II accessory navicular, the arch height loss, and heel valgus in all patients. All of them received excision of accessory navicular and reconstruction of posterior tibial tendon insertion on navicular with anchor. Results All patients got primary wound heal ing without any compl ication. Thirty patients (36 feet) were followed up 6-54 months with an average of 23 months. All patients achieved complete pain rel ief at 6 months after surgery and hadgood appearance of the feet. The AOFAS ankle-midfoot score was 90.4 ± 2.0 at last follow-up, showing significant difference when compared with preoperative score (t=29.73, P=0.00). X-ray films showed that no screw loosening or breakage was observed. There were significant differences in the arch height, calcaneus incl ination angle, talocalcaneal angle, and talar-first metatarsal angle between pre-operation and last follow-up (P lt; 0.01). Conclusion The excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular is a good choice for the treatment of flatfoot related with accessory navicular, with correction of deformity, excellent effectiveness, and less complications.