Pub Date : 2020-04-01DOI: 10.3760/CMA.J.CN121113-20200225-00103
Xian-Xiang Xiang, Chungang Zhang, Weiming Wang
Objective To investigate the finite element analysis and early-stage clinical effects of double bundle anterior cruciate ligament (ACL) reconstruction with femoral direct fiber insertion. Methods From June 2016 to June 2017, a total of 26 cases of ACL reconstruction were analyzed retrospectively, including 15 males and 11 females, mean age 30.5±4.6 years. All the patients underwent ACL reconstruction by the same operator. The early-stage clinical effects were evaluated by the finite element analysis, pivot shift test, Lachman test, preoperative and postoperative IKDC score, Lyshlom score, KT-2000, 3D-CT and MRI. Results The finite element analysis confirmed theoretically that the double bundle ACL reconstruction with femoral direct fiber insertion could restore the stability and biomechanics of knee effectively. The results of pivot shift test were negative, and the Lachman test were negative except one first-stage positive after operation. 3D-CT showed that the bone tunnel was located in the direct fiber area. MRI showed clearly the ACL of double bundle after operation. Lysholm score increased from 56.5±3.6 pre-operation to 61.9±3.2 at three months after operation, and up to 88.5±2.0 two years after operation with statistically significant difference (F=824.72, P<0.001). IKDC score increased from 48.3±2.8 before operation to 58.0±2.0 at three months after operation, and to 92.5±2.6 at two years after operation with statistically significant difference (F=2 256.66, P<0.001). KT-2000 side-side difference decreased from 5.6±0.7 mm to 1.6±0.5 mm at three months after operation, and to 1.5±0.6 mm at two years after operation with statistically significant difference (F=389.14, P<0.001). Conclusion The double bundle ACL reconstruction with femoral direct fiber insertion can effectively restore the stability and the biomechanical environment of knee joint with satisfied early-stage clinical effects. Key words: Anterior cruciate ligament; Reconstructive surgical procedures; Finite element analysis
{"title":"The mechanical characteristics and early-stage clinical effects of double bundle anterior cruciate ligament reconstruction with femoral direct fiber insertion","authors":"Xian-Xiang Xiang, Chungang Zhang, Weiming Wang","doi":"10.3760/CMA.J.CN121113-20200225-00103","DOIUrl":"https://doi.org/10.3760/CMA.J.CN121113-20200225-00103","url":null,"abstract":"Objective \u0000To investigate the finite element analysis and early-stage clinical effects of double bundle anterior cruciate ligament (ACL) reconstruction with femoral direct fiber insertion. \u0000 \u0000 \u0000Methods \u0000From June 2016 to June 2017, a total of 26 cases of ACL reconstruction were analyzed retrospectively, including 15 males and 11 females, mean age 30.5±4.6 years. All the patients underwent ACL reconstruction by the same operator. The early-stage clinical effects were evaluated by the finite element analysis, pivot shift test, Lachman test, preoperative and postoperative IKDC score, Lyshlom score, KT-2000, 3D-CT and MRI. \u0000 \u0000 \u0000Results \u0000The finite element analysis confirmed theoretically that the double bundle ACL reconstruction with femoral direct fiber insertion could restore the stability and biomechanics of knee effectively. The results of pivot shift test were negative, and the Lachman test were negative except one first-stage positive after operation. 3D-CT showed that the bone tunnel was located in the direct fiber area. MRI showed clearly the ACL of double bundle after operation. Lysholm score increased from 56.5±3.6 pre-operation to 61.9±3.2 at three months after operation, and up to 88.5±2.0 two years after operation with statistically significant difference (F=824.72, P<0.001). IKDC score increased from 48.3±2.8 before operation to 58.0±2.0 at three months after operation, and to 92.5±2.6 at two years after operation with statistically significant difference (F=2 256.66, P<0.001). KT-2000 side-side difference decreased from 5.6±0.7 mm to 1.6±0.5 mm at three months after operation, and to 1.5±0.6 mm at two years after operation with statistically significant difference (F=389.14, P<0.001). \u0000 \u0000 \u0000Conclusion \u0000The double bundle ACL reconstruction with femoral direct fiber insertion can effectively restore the stability and the biomechanical environment of knee joint with satisfied early-stage clinical effects. \u0000 \u0000 \u0000Key words: \u0000Anterior cruciate ligament; Reconstructive surgical procedures; Finite element analysis","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"397-407"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45394613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.3760/CMA.J.CN121113-20200225-00099
Yue Li, Hui Zhang
Objective To compare the objective and subjective clinical outcomes of recess procedure versus popliteal tendon reconstruction in patients with posterolateral corner injury. Methods From January 2012 to January 2017, patients who were eligible for inclusion in this study if they 1) had acute posterolateral rotational instability (PLRI) and were treated surgically in our institution, 2) were followed for a minimum of 2 years with examination under anesthesia results. The mean age was 34.5±7.4 years (range 20-45 years). According to Fanelli's classification, there were 31 type A, 17 type B and 6 type C cases. There were 26 patients in reconstruction group and 28 patients in recess group. Outcomes included subjective scoring systems (Lysholm score, Tegner score and International Knee Documentation Committee (IKDC) subjective score), knee stability examinations (the side-to-side difference (SSD) of tibial external rotation angle by dial test, posterior and varus stress radiograph) and second-look arthroscopic lateral gutter drive-through test during hardware removal operation. Results The mean follow-up duration was 30.2±4.9 months in reconstruction group and 32.2±9.9 months in recess group. At the final follow-up, there were no significant differences in Lysholm scores (reconstruction group: 70.1±15.5, recess group: 70.0±10.2; t=0.089, P=0.926), Tegner scores (reconstruction group: 3(2, 5), recess group: 2(1, 4); U=395.522, P=0.156), or IKDC subjective scores (reconstruction group: 74.8±19.3, recess group: 71.2±17.6; t=0.381, P=0.722) between the groups. No significant difference in SSD on posterior stress radiography (reconstruction group: 4.1±3.4 mm, recess group: 4.7±2.6 mm; t=0.918, P=0.345) or medial stress radiography (reconstruction group: 4.0±1.7 mm, recess group: 3.8±1.9 mm; t=0.208, P=0.820) was observed. There was no significant difference on SSD of dial test (reconstruction group: 1.5°±4.2°, recess group: 1.1°±4.0°, t=0.586, P=0.565). No positive lateral gutter drive-through test was observed in all groups. Conclusion Both recess procedure and popliteal tendon reconstructions significantly improve the knee stability and subjective outcomes of patients with PLRI. In a comparison with popliteal tendon reconstruction, the recess procedure has similar subjective and objective clinical outcomes. Key words: Collateral ligaments; Tendon injuries; Arthroscopy; Reconstructive surgical procedures
{"title":"The comparison of clinical outcomes of popliteal tendon recess and reconstruction technique","authors":"Yue Li, Hui Zhang","doi":"10.3760/CMA.J.CN121113-20200225-00099","DOIUrl":"https://doi.org/10.3760/CMA.J.CN121113-20200225-00099","url":null,"abstract":"Objective \u0000To compare the objective and subjective clinical outcomes of recess procedure versus popliteal tendon reconstruction in patients with posterolateral corner injury. \u0000 \u0000 \u0000Methods \u0000From January 2012 to January 2017, patients who were eligible for inclusion in this study if they 1) had acute posterolateral rotational instability (PLRI) and were treated surgically in our institution, 2) were followed for a minimum of 2 years with examination under anesthesia results. The mean age was 34.5±7.4 years (range 20-45 years). According to Fanelli's classification, there were 31 type A, 17 type B and 6 type C cases. There were 26 patients in reconstruction group and 28 patients in recess group. Outcomes included subjective scoring systems (Lysholm score, Tegner score and International Knee Documentation Committee (IKDC) subjective score), knee stability examinations (the side-to-side difference (SSD) of tibial external rotation angle by dial test, posterior and varus stress radiograph) and second-look arthroscopic lateral gutter drive-through test during hardware removal operation. \u0000 \u0000 \u0000Results \u0000The mean follow-up duration was 30.2±4.9 months in reconstruction group and 32.2±9.9 months in recess group. At the final follow-up, there were no significant differences in Lysholm scores (reconstruction group: 70.1±15.5, recess group: 70.0±10.2; t=0.089, P=0.926), Tegner scores (reconstruction group: 3(2, 5), recess group: 2(1, 4); U=395.522, P=0.156), or IKDC subjective scores (reconstruction group: 74.8±19.3, recess group: 71.2±17.6; t=0.381, P=0.722) between the groups. No significant difference in SSD on posterior stress radiography (reconstruction group: 4.1±3.4 mm, recess group: 4.7±2.6 mm; t=0.918, P=0.345) or medial stress radiography (reconstruction group: 4.0±1.7 mm, recess group: 3.8±1.9 mm; t=0.208, P=0.820) was observed. There was no significant difference on SSD of dial test (reconstruction group: 1.5°±4.2°, recess group: 1.1°±4.0°, t=0.586, P=0.565). No positive lateral gutter drive-through test was observed in all groups. \u0000 \u0000 \u0000Conclusion \u0000Both recess procedure and popliteal tendon reconstructions significantly improve the knee stability and subjective outcomes of patients with PLRI. In a comparison with popliteal tendon reconstruction, the recess procedure has similar subjective and objective clinical outcomes. \u0000 \u0000 \u0000Key words: \u0000Collateral ligaments; Tendon injuries; Arthroscopy; Reconstructive surgical procedures","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"417-423"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45780495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.3760/CMA.J.CN121113-20200224-00094
Tong Zheng, H. Feng, Hui Zhang, Guan-yang Song, Yue Li, ZhiJun Zhang, Qian-kun Ni, Yan-wei Cao
Objective To evaluate the clinical, radiological and arthroscopic outcomes after surgical repair for chronic lateral meniscus posterior root (LMPR) avulsion combined with anterior cruciate ligament (ACL) reconstruction. Methods From July 2015 to June 2017, a total of 33 patients who underwent transtibial pull-out suture repair for chronic LMPR avulsion combined with anatomic single-bundle ACL reconstruction with hamstring graft were retrospectively reviewed. There were 30 males and 3 females with an average age of 27.7±7.5 years (range 17-45 years) and a mean BMI of 25.2±3.7 kg/m2 (range 19.4-36.7 kg/m2). All patients were available for at least two years of follow-up. A second-look arthroscopy was performed to evaluate the healing status of the repaired meniscus. Subjective knee function was assessed through Lysholm and Tegner scores. Objective knee stability was evaluated using KT-1000 arthrometer side-to-side difference (SSD) and pivot shift test under anesthesia. The tibiofemoral relationship was evaluated by anterior tibial subluxation (ATS) measured on axial MRI. Between patients with preoperative ATS ≥6 mm (18 patients in the ATS positive group) and <6 mm (15 patients in the ATS negative group), the postoperative ATS and the reduction of ATS was also compared. Results After a mean follow-up of 27.5±4.0 months (range 24-39 months), the LMPR avulsion completely healed in 23 (70%) cases, partially healed in 9 (27%) cases, failed to heal in 1 (3%) case on second-look arthroscopy. The Lysholm score was increased from 60.4±13.6 to 82.7±11.1 at 1 year and to 91.4±9.1 at 2 years operatively (F=155.996, P<0.001). The Tegner score was increased from 3(2, 5) to 4(3, 5) at 1 year and 6(4, 6) at 2 years postoperatively (χ2=47.791, P<0.001). The KT-1000 SSD was decreased from 9.1±3.3 mm to 2.0±1.7 mm (t=11.197, P<0.001). The result of pivot shift test was also improved (10 grade I, 20 grade II, 3 grade III, preoperatively vs 30 grade 0, 3 grade I, postoperatively, U=5.161, P<0.001). The ATS was reduced from 5.7±3.9 mm to 3.5±3.2 mm (t=3.530, P=0.001). However, there was no statistically significant decrease in the ATS of the ATS negative group (t=0.400, P=0.695). The ATS of the ATS positive group was reduced from 8.7±1.8 mm to 5.0±3.3 mm (t=4.765, P<0.001), and the ATS reduction of the ATS positive group was greater than that of the ATS negative group (3.7±3.3 mm vs 0.3±2.8 mm, t=3.115, P=0.004). Conclusion In patients undergoing ACL reconstruction, the transtibial pull-out suture repair for chronic LMPR avulsion yielded meniscus healing rate of 97% with improved subjective knee function and objective knee stability and better restored the tibiofemoral relationship for patients with excessive ATS. Key words: Anterior cruciate ligament reconstruction; Menisci, tibial; Treatment outcome; Arthroscopy
目的评价慢性外侧半月板后根撕脱伤联合前交叉韧带重建术后的临床、放射学和关节镜检查结果。方法回顾性分析2015年7月至2017年6月共33例接受经胫骨拔出缝合修复慢性LMPR撕脱伤并应用腘绳肌移植物重建前交叉韧带的患者。共有30名男性和3名女性，平均年龄27.7±7.5岁（范围17-45岁），平均BMI为25.2±3.7 kg/m2（范围19.4-36.7 kg/m2）。所有患者都可以接受至少两年的随访。再次进行关节镜检查以评估修复半月板的愈合状态。主观膝关节功能通过Lysholm和Tegner评分进行评估。目的应用KT-1000型侧差关节测量仪（SSD）和枢轴移位试验对麻醉状态下膝关节稳定性进行评价。通过轴向MRI测量胫骨前半脱位（ATS）来评估胫股关系。在术前ATS≥6mm（ATS阳性组18例）和<6mm（ATS阴性组15例）的患者之间，还比较了术后ATS和ATS减少的情况。结果经平均27.5±4.0个月（24～39个月）随访，LMPR撕脱伤完全愈合23例（70%），部分愈合9例（27%），复视关节镜检查1例（3%）未愈合。Lysholm评分从术后1年的60.4±13.6增加到82.7±11.1，术后2年的91.4±9.1（F=155.96，P<0.001）。Tegner评分从术前1年的3（2，5）增加到4（3，5），术后两年的6（4，6）（χ2=47.791，P<0.001（术前I级10例，II级20例，III级3例，与术后0级30例，I级3例相比，U=5.161，P<0.001）。ATS从5.7±3.9 mm减少到3.5±3.2 mm（t=3.530，P=0.001）。然而，ATS阴性组的ATS没有统计学意义的减少（t=0.400，P=0.695）。ATS阳性组的ATS从8.7±1.8 mm减少到5.0±3.3 mm（t=4.765，P<001），ATS阳性组的ATS减少量大于ATS阴性组（3.7±3.3 mm vs 0.3±2.8 mm，t=3.115，P=0.004），经胫骨拔出缝线修复慢性LMPR撕脱伤的半月板愈合率为97%，改善了主观膝关节功能和客观膝关节稳定性，并更好地恢复了ATS过度患者的胫股关系。关键词：前交叉韧带重建；半月板，胫骨；治疗结果；关节镜检查
{"title":"Short-term outcomes after lateral meniscus posterior root repairs in patients undergoing anterior cruciate ligament reconstructions","authors":"Tong Zheng, H. Feng, Hui Zhang, Guan-yang Song, Yue Li, ZhiJun Zhang, Qian-kun Ni, Yan-wei Cao","doi":"10.3760/CMA.J.CN121113-20200224-00094","DOIUrl":"https://doi.org/10.3760/CMA.J.CN121113-20200224-00094","url":null,"abstract":"Objective \u0000To evaluate the clinical, radiological and arthroscopic outcomes after surgical repair for chronic lateral meniscus posterior root (LMPR) avulsion combined with anterior cruciate ligament (ACL) reconstruction. \u0000 \u0000 \u0000Methods \u0000From July 2015 to June 2017, a total of 33 patients who underwent transtibial pull-out suture repair for chronic LMPR avulsion combined with anatomic single-bundle ACL reconstruction with hamstring graft were retrospectively reviewed. There were 30 males and 3 females with an average age of 27.7±7.5 years (range 17-45 years) and a mean BMI of 25.2±3.7 kg/m2 (range 19.4-36.7 kg/m2). All patients were available for at least two years of follow-up. A second-look arthroscopy was performed to evaluate the healing status of the repaired meniscus. Subjective knee function was assessed through Lysholm and Tegner scores. Objective knee stability was evaluated using KT-1000 arthrometer side-to-side difference (SSD) and pivot shift test under anesthesia. The tibiofemoral relationship was evaluated by anterior tibial subluxation (ATS) measured on axial MRI. Between patients with preoperative ATS ≥6 mm (18 patients in the ATS positive group) and <6 mm (15 patients in the ATS negative group), the postoperative ATS and the reduction of ATS was also compared. \u0000 \u0000 \u0000Results \u0000After a mean follow-up of 27.5±4.0 months (range 24-39 months), the LMPR avulsion completely healed in 23 (70%) cases, partially healed in 9 (27%) cases, failed to heal in 1 (3%) case on second-look arthroscopy. The Lysholm score was increased from 60.4±13.6 to 82.7±11.1 at 1 year and to 91.4±9.1 at 2 years operatively (F=155.996, P<0.001). The Tegner score was increased from 3(2, 5) to 4(3, 5) at 1 year and 6(4, 6) at 2 years postoperatively (χ2=47.791, P<0.001). The KT-1000 SSD was decreased from 9.1±3.3 mm to 2.0±1.7 mm (t=11.197, P<0.001). The result of pivot shift test was also improved (10 grade I, 20 grade II, 3 grade III, preoperatively vs 30 grade 0, 3 grade I, postoperatively, U=5.161, P<0.001). The ATS was reduced from 5.7±3.9 mm to 3.5±3.2 mm (t=3.530, P=0.001). However, there was no statistically significant decrease in the ATS of the ATS negative group (t=0.400, P=0.695). The ATS of the ATS positive group was reduced from 8.7±1.8 mm to 5.0±3.3 mm (t=4.765, P<0.001), and the ATS reduction of the ATS positive group was greater than that of the ATS negative group (3.7±3.3 mm vs 0.3±2.8 mm, t=3.115, P=0.004). \u0000 \u0000 \u0000Conclusion \u0000In patients undergoing ACL reconstruction, the transtibial pull-out suture repair for chronic LMPR avulsion yielded meniscus healing rate of 97% with improved subjective knee function and objective knee stability and better restored the tibiofemoral relationship for patients with excessive ATS. \u0000 \u0000 \u0000Key words: \u0000Anterior cruciate ligament reconstruction; Menisci, tibial; Treatment outcome; Arthroscopy","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"424-432"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43382823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.3760/CMA.J.CN121113-20200225-00101
Kaiyuan Liu, Dong Yang, Tianyang Xu, L. Fan, Junjie Jiang, Chi Wang, Hengli Lu
Objective To compare the effects of patellar position on the balance of soft tissue during the operation and the postoperative outcomes in minimally invasive total knee arthroplasty via a midvastus approach. Methods From December 2018 to February 2019, a total of 55 patients were enrolled for primary total knee arthroplasty via a midvastus approach. All patients were randomly divided into 2 groups by random number table. During the operation, the gap balance technique was used with patella reduced or subluxated to complete the osteotomy and balance of soft tissue. The changes of gap and varus-valgus angle were compared between the patellar reduction group and the patellar subluxation group in both extension and flexion position. These data were also compared before and after reducing patellar in the patellar subluxation group. Furthermore, the differences of femoral prosthesis rotation, mechanical femoral axis to tibial axis angle, Knee Society score (KSS), visual analogue scale (VAS) and range of motion (ROM) were compared between the two groups. Results All patients finished 6 months follow-up, including 27 patients in the patellar reduction group and 28 patients in the patellar subluxation group. After osteotomy and soft tissue balance during the operation, there was no significant difference in gap and varus-valgus angle between two groups in either extension or flexion position. While in the patellar subluxation group, the flexion gap was 10.5±0.3 mm with patella subluxated, less than 11.0 ± 0.3 mm after reducing the patella. The varus-valgus angle was 1.5±0.3 with patella subluxated, less than 2.3±0.4 degree after reducing the patella. The difference was statistically significant (t=4.180, P 0.05). The rotation angle of the femoral component in the patellar subluxation group was -0.49°±1.2°, and the external rotation angle was smaller than that in the patellar reduction group (0.24°±1.3°). The difference was statistically significant (t=2.116, P=0.039). At one month after operation, ROM of the patellar reduction group was 109.6°±8.5° which was higher than that of the patellar subluxation group (104.9°±8.6°, t=2.048, P=0.046). There was no significant difference in ROM between the two groups at 3 and 6 months (P>0.05). Moreover, there was no significant difference in KSS and VAS at 1, 3 and 6 months after operation (P>0.05). Conclusion In the minimally invasive total knee arthroplasty, it is suggested to balance the soft tissue as much as possible with the patellar reduced. Otherwise, the consequence of increased flexion space, increased varus and increased internal rotation of femoral prosthesis should be considered. The patients undergoing soft tissue balance with patella reduced have better ROM in the early stage postoperatively. Key words: Arthroplasty, replacement, knee; Patella; Treatment outcome
{"title":"Influence of patella position on soft tissue balance and clinical outcomes in patients undergoing total knee arthroplasty via a midvastus approach","authors":"Kaiyuan Liu, Dong Yang, Tianyang Xu, L. Fan, Junjie Jiang, Chi Wang, Hengli Lu","doi":"10.3760/CMA.J.CN121113-20200225-00101","DOIUrl":"https://doi.org/10.3760/CMA.J.CN121113-20200225-00101","url":null,"abstract":"Objective \u0000To compare the effects of patellar position on the balance of soft tissue during the operation and the postoperative outcomes in minimally invasive total knee arthroplasty via a midvastus approach. \u0000 \u0000 \u0000Methods \u0000From December 2018 to February 2019, a total of 55 patients were enrolled for primary total knee arthroplasty via a midvastus approach. All patients were randomly divided into 2 groups by random number table. During the operation, the gap balance technique was used with patella reduced or subluxated to complete the osteotomy and balance of soft tissue. The changes of gap and varus-valgus angle were compared between the patellar reduction group and the patellar subluxation group in both extension and flexion position. These data were also compared before and after reducing patellar in the patellar subluxation group. Furthermore, the differences of femoral prosthesis rotation, mechanical femoral axis to tibial axis angle, Knee Society score (KSS), visual analogue scale (VAS) and range of motion (ROM) were compared between the two groups. \u0000 \u0000 \u0000Results \u0000All patients finished 6 months follow-up, including 27 patients in the patellar reduction group and 28 patients in the patellar subluxation group. After osteotomy and soft tissue balance during the operation, there was no significant difference in gap and varus-valgus angle between two groups in either extension or flexion position. While in the patellar subluxation group, the flexion gap was 10.5±0.3 mm with patella subluxated, less than 11.0 ± 0.3 mm after reducing the patella. The varus-valgus angle was 1.5±0.3 with patella subluxated, less than 2.3±0.4 degree after reducing the patella. The difference was statistically significant (t=4.180, P 0.05). The rotation angle of the femoral component in the patellar subluxation group was -0.49°±1.2°, and the external rotation angle was smaller than that in the patellar reduction group (0.24°±1.3°). The difference was statistically significant (t=2.116, P=0.039). At one month after operation, ROM of the patellar reduction group was 109.6°±8.5° which was higher than that of the patellar subluxation group (104.9°±8.6°, t=2.048, P=0.046). There was no significant difference in ROM between the two groups at 3 and 6 months (P>0.05). Moreover, there was no significant difference in KSS and VAS at 1, 3 and 6 months after operation (P>0.05). \u0000 \u0000 \u0000Conclusion \u0000In the minimally invasive total knee arthroplasty, it is suggested to balance the soft tissue as much as possible with the patellar reduced. Otherwise, the consequence of increased flexion space, increased varus and increased internal rotation of femoral prosthesis should be considered. The patients undergoing soft tissue balance with patella reduced have better ROM in the early stage postoperatively. \u0000 \u0000 \u0000Key words: \u0000Arthroplasty, replacement, knee; Patella; Treatment outcome","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"433-440"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42997664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.3760/CMA.J.CN121113-20190322-00117
N. Zhou
Distal femoral fracture is one of the difficult fractures to treat due to the complex types and varies complications after operation. The concept about closed reduction to deal with fracture has been accepted widely with the innovation of surgical technology and internal fixation. Some tissue, including joint capsule, ligaments, muscles and tendons, surround femoral condyle, which indicates they may tract the fractured bone to deformity. In addition, the difficulty of reduction during operation may be increased with combined other injuries. At present, the idea of using different methods to reduce the re-injury before the closed reduction of distal femoral fracture has been recognized and popularized. A kind of appropriate reduction and internal fixation can not only reduce the difficulty of operation but also shorten the operation duration and reduce the incidence of postoperative complications. In addition to the common reduction method of manual reduction, plate can not only be taken as internal fixation, but also achieve reduction reviewing literatures about the methods of reduction in recent years. However, it is not suitable for some complex fractures. The traction table is not widely used at present due to varies complications. Distractors like AO distractor or other kinds of femoral distractors can achieve reduction by providing reverse force. However, it should be noticed that some risk factors such as vascular and nerve injury can occur during the surgery. The present study summarized different ways that were adopted during the closed reduction and internal fixation of distal femoral fractures. The appropriate method chose by surgeons to improve the efficiency and reduce risks should be used based on the need of surgery.
{"title":"Assisting technical development in closed reduction for distal femoral fractures","authors":"N. Zhou","doi":"10.3760/CMA.J.CN121113-20190322-00117","DOIUrl":"https://doi.org/10.3760/CMA.J.CN121113-20190322-00117","url":null,"abstract":"Distal femoral fracture is one of the difficult fractures to treat due to the complex types and varies complications after operation. The concept about closed reduction to deal with fracture has been accepted widely with the innovation of surgical technology and internal fixation. Some tissue, including joint capsule, ligaments, muscles and tendons, surround femoral condyle, which indicates they may tract the fractured bone to deformity. In addition, the difficulty of reduction during operation may be increased with combined other injuries. At present, the idea of using different methods to reduce the re-injury before the closed reduction of distal femoral fracture has been recognized and popularized. A kind of appropriate reduction and internal fixation can not only reduce the difficulty of operation but also shorten the operation duration and reduce the incidence of postoperative complications. In addition to the common reduction method of manual reduction, plate can not only be taken as internal fixation, but also achieve reduction reviewing literatures about the methods of reduction in recent years. However, it is not suitable for some complex fractures. The traction table is not widely used at present due to varies complications. Distractors like AO distractor or other kinds of femoral distractors can achieve reduction by providing reverse force. However, it should be noticed that some risk factors such as vascular and nerve injury can occur during the surgery. The present study summarized different ways that were adopted during the closed reduction and internal fixation of distal femoral fractures. The appropriate method chose by surgeons to improve the efficiency and reduce risks should be used based on the need of surgery.","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"445-452"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42070781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.3760/CMA.J.CN121113-20200227-00106
Guang-Bo Liu, Y. Mei, Hai-yang Ma, Qiang Lu, H. Meng, Qi Quan, Yuxuan Zhang, Jun Zhao, H. J. Li, Ai-yuan Wang, Hai Xin, Duanduan Chen, Shibi Lu, Jiang Peng
Objective To investigate effects of bone-resorptive lesion on stress distribution of femoral head and on progression in patients with osteonecrosis of the femoral head (ONFH). Methods From April 2014 to September 2018, a total of 155 femoral heads from 94 patients diagnosed with ARCO stage II and III ONFH were retrospectively reviewed, including 77 males and 17 females with aged 39.90±10.45 years old (ranged from 18-64 years). The hips were divided into two groups according to whether there were bone-resorptive lesions. Further, we compared whether there was statistical difference between the two groups in staging. Then, a case of ARCO II hip joint without bone-resorptive lesion was selected from the included patients. Six femoral head with different diameters of spherical bone-resorptive lesion of 5 mm, 7 mm, 10 mm, 14 mm, 18 mm, and 23 mm were simulated. The influence of bone-resorptive lesion on the stress distribution of necrotic area and a spherical shell extending 1 mm radially around the bone-resorptive lesion was investigated by finite element method in slow walking conditions. Results Of the 155 ONFH hips, 67 hips are complicated by bone-resorptive lesions, of which 17 were ARCO II, 50 were ARCO III. A total of 88 hips did not contain bone-resorptive lesions, of which 58 were ARCO II, ARCO III 30 cases. The proportion of ARCO stage II in the group with bone-resorptive lesions was significantly higher than that in the group without bone-resorptive lesions (χ2=25.03, P=0.000). The finite element stress distribution cloud diagram showed that there was a stress concentration area around the bone-resorptive lesions. The maximum von Mises stress around bone-resorptive lesions in the models that contained a synthetic bone-resorptive lesions were significantly higher than those reported in the matched, non-synthetic bone-resorptive lesions finite element models (t=3.139, P=0.026). The values for maximum von Mises stress around bone-resorptive lesions were 6.94±1.78 MPa and 5.01±0.35 MPa for the group with synthetic bone-resorptive lesions and the group non-synthetic bone-resorptive lesions, respectively. There was a positive correlation between the diameter of bone-resorptive lesions and the maximum and mean von Mises stress of necrotic areas as well as the maximum von Mises stress around bone-resorptive lesions. Conclusion Bone-resorptive lesions can increase the maximum stress and average stress in the necrotic area. The larger the bone-resorptive lesion, the more the stress increases. There is a stress concentration area around the bone-resorptive lesions, which may accelerate the collapse of the femoral head. Key words: Femur head necrosis; Bone resorption; Finite element analysis
{"title":"Effects of bone-resorptive lesion on stress distribution of the femoral head and on progression in patients with osteonecrosis of the femoral head","authors":"Guang-Bo Liu, Y. Mei, Hai-yang Ma, Qiang Lu, H. Meng, Qi Quan, Yuxuan Zhang, Jun Zhao, H. J. Li, Ai-yuan Wang, Hai Xin, Duanduan Chen, Shibi Lu, Jiang Peng","doi":"10.3760/CMA.J.CN121113-20200227-00106","DOIUrl":"https://doi.org/10.3760/CMA.J.CN121113-20200227-00106","url":null,"abstract":"Objective \u0000To investigate effects of bone-resorptive lesion on stress distribution of femoral head and on progression in patients with osteonecrosis of the femoral head (ONFH). \u0000 \u0000 \u0000Methods \u0000From April 2014 to September 2018, a total of 155 femoral heads from 94 patients diagnosed with ARCO stage II and III ONFH were retrospectively reviewed, including 77 males and 17 females with aged 39.90±10.45 years old (ranged from 18-64 years). The hips were divided into two groups according to whether there were bone-resorptive lesions. Further, we compared whether there was statistical difference between the two groups in staging. Then, a case of ARCO II hip joint without bone-resorptive lesion was selected from the included patients. Six femoral head with different diameters of spherical bone-resorptive lesion of 5 mm, 7 mm, 10 mm, 14 mm, 18 mm, and 23 mm were simulated. The influence of bone-resorptive lesion on the stress distribution of necrotic area and a spherical shell extending 1 mm radially around the bone-resorptive lesion was investigated by finite element method in slow walking conditions. \u0000 \u0000 \u0000Results \u0000Of the 155 ONFH hips, 67 hips are complicated by bone-resorptive lesions, of which 17 were ARCO II, 50 were ARCO III. A total of 88 hips did not contain bone-resorptive lesions, of which 58 were ARCO II, ARCO III 30 cases. The proportion of ARCO stage II in the group with bone-resorptive lesions was significantly higher than that in the group without bone-resorptive lesions (χ2=25.03, P=0.000). The finite element stress distribution cloud diagram showed that there was a stress concentration area around the bone-resorptive lesions. The maximum von Mises stress around bone-resorptive lesions in the models that contained a synthetic bone-resorptive lesions were significantly higher than those reported in the matched, non-synthetic bone-resorptive lesions finite element models (t=3.139, P=0.026). The values for maximum von Mises stress around bone-resorptive lesions were 6.94±1.78 MPa and 5.01±0.35 MPa for the group with synthetic bone-resorptive lesions and the group non-synthetic bone-resorptive lesions, respectively. There was a positive correlation between the diameter of bone-resorptive lesions and the maximum and mean von Mises stress of necrotic areas as well as the maximum von Mises stress around bone-resorptive lesions. \u0000 \u0000 \u0000Conclusion \u0000Bone-resorptive lesions can increase the maximum stress and average stress in the necrotic area. The larger the bone-resorptive lesion, the more the stress increases. There is a stress concentration area around the bone-resorptive lesions, which may accelerate the collapse of the femoral head. \u0000 \u0000 \u0000Key words: \u0000Femur head necrosis; Bone resorption; Finite element analysis","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"408-416"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48743375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-16DOI: 10.3760/CMA.J.CN121113-20200221-00086
Jiang-tao Feng, Xiong-Gang Yang, Feng Wang, Kun-Chi Hua, D. Lun
Objective To investigate the effects of different particle sizes on the collagen structure of demineralized bone matrix (DBM) and the effectiveness of dry ice as an irradiation protectant in the procedure of gamma irradiation. Methods DBM samples with different particle sizes (0.5-1.0 mm, 1.2-2.8 mm, 3.3-4.7 mm and 5.7-7.0 mm) were prepared, and sterilized with several doses of gamma irradiation (0 kGy, 15 kGy and 25 kGy) at room temperature. Additionally, another group of DBM samples were sterilized with 25 kGy gamma irradiation with protective agent. Changes in surface and characteristics of collagen were observed by using scanning electron microscope (SEM), Sodium dodecyl sulfatepolyacrylamide gel electrophoresis (SDS-PAGE), differential scanning calorimetry (DSC) and carbonyl content. Results The color of collagen extract indicated that oxidative damage is directly related to irradiation dose. SEM showed that the gamma irradiation caused collagen structure disorder and fiber breakage. As the irradiation doses increased, the damage area significantly increased. When the particle size increased, the damage area tended to decrease. The DSC showed that the thermal denaturation temperature of 5.7-7 mm, 3.3-4.7 mm, 1.2-2.8 mm and 0.5-1.0 mm were 142.8℃, 97.3℃,84.3℃ and 83.9℃, respectively. The differences of the thermal denaturation temperatures among the four particle sizes were statistically significant (F=0.560, P=0.650). Collagen structure was destroyed by gamma irradiation, resulting in a decrease in collagen molecular weight. While, large particle DBM had a tendency to resist radiation damage. There was a significant difference on the contents of carbonyl in collagen from same particle sizes of DBM with different irradiation dose. The carbonyl content gradually decreased with the increase of particle size, but the difference was not statistically significant (F=0.560, P=0.650). Conclusion The gamma irradiation and collagen oxidative damage have obvious dose-response relationship. With the increase of gamma irradiation dose, the degree of collagen damage increases. The sizes of DBM could affect the sensitivity of collagen to gamma irradiation. With the decrease of particle sizes, DBM particles are more susceptible to gamma irradiation damage. Additionally, dry ice, as a radiation protection agent, has a certain degree protection effect against radiation. Key words: Bone matrix; Collagen; Radiation; Gamma rays
{"title":"The effect of gammairradiation for collagen in demineralized bone matrix particles with differences size","authors":"Jiang-tao Feng, Xiong-Gang Yang, Feng Wang, Kun-Chi Hua, D. Lun","doi":"10.3760/CMA.J.CN121113-20200221-00086","DOIUrl":"https://doi.org/10.3760/CMA.J.CN121113-20200221-00086","url":null,"abstract":"Objective \u0000To investigate the effects of different particle sizes on the collagen structure of demineralized bone matrix (DBM) and the effectiveness of dry ice as an irradiation protectant in the procedure of gamma irradiation. \u0000 \u0000 \u0000Methods \u0000DBM samples with different particle sizes (0.5-1.0 mm, 1.2-2.8 mm, 3.3-4.7 mm and 5.7-7.0 mm) were prepared, and sterilized with several doses of gamma irradiation (0 kGy, 15 kGy and 25 kGy) at room temperature. Additionally, another group of DBM samples were sterilized with 25 kGy gamma irradiation with protective agent. Changes in surface and characteristics of collagen were observed by using scanning electron microscope (SEM), Sodium dodecyl sulfatepolyacrylamide gel electrophoresis (SDS-PAGE), differential scanning calorimetry (DSC) and carbonyl content. \u0000 \u0000 \u0000Results \u0000The color of collagen extract indicated that oxidative damage is directly related to irradiation dose. SEM showed that the gamma irradiation caused collagen structure disorder and fiber breakage. As the irradiation doses increased, the damage area significantly increased. When the particle size increased, the damage area tended to decrease. The DSC showed that the thermal denaturation temperature of 5.7-7 mm, 3.3-4.7 mm, 1.2-2.8 mm and 0.5-1.0 mm were 142.8℃, 97.3℃,84.3℃ and 83.9℃, respectively. The differences of the thermal denaturation temperatures among the four particle sizes were statistically significant (F=0.560, P=0.650). Collagen structure was destroyed by gamma irradiation, resulting in a decrease in collagen molecular weight. While, large particle DBM had a tendency to resist radiation damage. There was a significant difference on the contents of carbonyl in collagen from same particle sizes of DBM with different irradiation dose. The carbonyl content gradually decreased with the increase of particle size, but the difference was not statistically significant (F=0.560, P=0.650). \u0000 \u0000 \u0000Conclusion \u0000The gamma irradiation and collagen oxidative damage have obvious dose-response relationship. With the increase of gamma irradiation dose, the degree of collagen damage increases. The sizes of DBM could affect the sensitivity of collagen to gamma irradiation. With the decrease of particle sizes, DBM particles are more susceptible to gamma irradiation damage. Additionally, dry ice, as a radiation protection agent, has a certain degree protection effect against radiation. \u0000 \u0000 \u0000Key words: \u0000Bone matrix; Collagen; Radiation; Gamma rays","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"353-361"},"PeriodicalIF":0.0,"publicationDate":"2020-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44538349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-16DOI: 10.3760/CMA.J.CN121113-20200220-00082
Li-cheng Song, Hua-feng Zhang, W. Cheng, Ya Li, Dong Li, Ya-fei Qin, Xin Wan, Ruixin Li, Hui Li, Xi-zheng Zhang
Objective To establish a hypergravity loading model with a high-acceleration centrifugal loading device and to investigate the effects of different hypergravity loading and icariin on osteoblast adhesion and cytoskeleton. Methods MC3T3-E1 cells were seeded in the dishes of cell culture at a density of 2×105/cm2. And the experiment was divided into 6 groups: control group (without icariin and loading); simple administration group (only icariin); 10 G loading group (only loading); 10 G administration group (with icariin and loading); 40 G loading group (only loading); 40 G administration group (with icariin and loading). The experimental loading group was loaded with MC3T3-E1 cells using a high-acceleration centrifugal loader. And continuous loading for 3 d, 30 min per d. The control group and the simple administration group were exposed to normal gravity, and the remaining conditions were not different from the experimental group. Icariin was used at a concentration of 10-7 mol/L in all administration groups, and the experiments were carried out according to the method of preventive administration. At the same time, the related molecular biological techniques such as alizarin red staining, alkaline phosphatase (ALP) activity measurement, CCK-8 cell proliferation experiment, cytoskeleton phalloidin staining, qPCR and Western Blot were used to detect the effects of icariin on osteoblasts adhesion protein integrin α5 and integrin β1 and cytoskeleton protein F-actin under hypergravity extreme mechanical environment. Results All models were successfully prepared. The alizarin red staining: The icariin could significantly promote the formation of osteoblastic calcified nodules. And the 10 G loading could also promote the mineralization of osteoblasts and increase the number of mineralized nodules, while the mineralization and the number of mineralized nodules of osteoblasts are significantly reduced in 40 G loading. ALP activity test: The OD values of simple administration group, 10 G loading group and 40 G loading group were 0.246, 0.331 and 0.163, respectively. Compared with 0.207 in the control group, the differences were statistically significant (P<0.05). The 10 G administration group and the 40 G administration group were 0.373 and 0.180, and the differences were statistically significant (P<0.05). The results of CCK-8 proliferation experiments: The OD value of simple administration group were 0.650, which was statistically significant compared with 0.551 of control group (P=0.031). The 10 G loading group and 40 G loading group were 1.193 and 0.245, and their differences with the control group were both statistically significant (P<0.05). The OD value of 10G administration group and the 40 G administration group were 1.300 and 0.310, which were significantly different from the respective loading groups (P<0.05). Phalloidin staining: 10 G loading significantly increased the number of cells, but the changes in cells morphology and skele
{"title":"Effects of icariin on adhesion and cytoskeleton of osteoblasts in response to the extreme mechanical environment of hypergravity","authors":"Li-cheng Song, Hua-feng Zhang, W. Cheng, Ya Li, Dong Li, Ya-fei Qin, Xin Wan, Ruixin Li, Hui Li, Xi-zheng Zhang","doi":"10.3760/CMA.J.CN121113-20200220-00082","DOIUrl":"https://doi.org/10.3760/CMA.J.CN121113-20200220-00082","url":null,"abstract":"Objective \u0000To establish a hypergravity loading model with a high-acceleration centrifugal loading device and to investigate the effects of different hypergravity loading and icariin on osteoblast adhesion and cytoskeleton. \u0000 \u0000 \u0000Methods \u0000MC3T3-E1 cells were seeded in the dishes of cell culture at a density of 2×105/cm2. And the experiment was divided into 6 groups: control group (without icariin and loading); simple administration group (only icariin); 10 G loading group (only loading); 10 G administration group (with icariin and loading); 40 G loading group (only loading); 40 G administration group (with icariin and loading). The experimental loading group was loaded with MC3T3-E1 cells using a high-acceleration centrifugal loader. And continuous loading for 3 d, 30 min per d. The control group and the simple administration group were exposed to normal gravity, and the remaining conditions were not different from the experimental group. Icariin was used at a concentration of 10-7 mol/L in all administration groups, and the experiments were carried out according to the method of preventive administration. At the same time, the related molecular biological techniques such as alizarin red staining, alkaline phosphatase (ALP) activity measurement, CCK-8 cell proliferation experiment, cytoskeleton phalloidin staining, qPCR and Western Blot were used to detect the effects of icariin on osteoblasts adhesion protein integrin α5 and integrin β1 and cytoskeleton protein F-actin under hypergravity extreme mechanical environment. \u0000 \u0000 \u0000Results \u0000All models were successfully prepared. The alizarin red staining: The icariin could significantly promote the formation of osteoblastic calcified nodules. And the 10 G loading could also promote the mineralization of osteoblasts and increase the number of mineralized nodules, while the mineralization and the number of mineralized nodules of osteoblasts are significantly reduced in 40 G loading. ALP activity test: The OD values of simple administration group, 10 G loading group and 40 G loading group were 0.246, 0.331 and 0.163, respectively. Compared with 0.207 in the control group, the differences were statistically significant (P<0.05). The 10 G administration group and the 40 G administration group were 0.373 and 0.180, and the differences were statistically significant (P<0.05). The results of CCK-8 proliferation experiments: The OD value of simple administration group were 0.650, which was statistically significant compared with 0.551 of control group (P=0.031). The 10 G loading group and 40 G loading group were 1.193 and 0.245, and their differences with the control group were both statistically significant (P<0.05). The OD value of 10G administration group and the 40 G administration group were 1.300 and 0.310, which were significantly different from the respective loading groups (P<0.05). Phalloidin staining: 10 G loading significantly increased the number of cells, but the changes in cells morphology and skele","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"362-371"},"PeriodicalIF":0.0,"publicationDate":"2020-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41672920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-16DOI: 10.3760/CMA.J.CN121113-20190625-00279
Lei Yuan, Xinling Zhang, Yan Zeng, Xiaoxi Yang, Zhongqiang Chen
Distal junctional problem (DJP) is one of the severe complications after spinal correction, fixation and fusion. As the number of patients receiving spinal surgery increased recently, the incidence of DJP also increased dramatically. Compared with proximal junctional problem, the incidence of DJP is low. However, the clinical symptoms are severe, and the rate of surgical revision is high in patients with distal junctional problems. DJP include distal junctional kyphosis (DJK) and distal junctional failure(DJF). The definition of DJK is confusing, however, and the most commonly used was that the distal junction Angle at the last follow-up was greater than 10° and increased by 10° compared with that before surgery. There are 6 DJF modes: progressive loss of lumbar lordosis,acute wedging in the disc below the instrumentation, fracture of LIV, osteoporotic fracture below the long rigid fixation, failure of the instrumentation at LIV, spinal stenosis and or segmental instability underneath the instrumentation. Possible risk factors for DJP include weight, age, type of spinal deformity, osteoporosis, choice of LIV, hip disease, deformity location, surgical approach, surgical procedure, fusion segments, fixation devices, LIV at L5, fixed to S1 with no iliac screws, poor restoration of spinal alignment, et al. Currently, there are some controversies in DJP, mainly including the incidence, risk factors whether needs to and how to revise. The review intends to conduct a simple literature review of the current DJP diagnostic criteria, incidence, risk factors, and other research progress, in order to improve the understanding of the distal junction problem.
{"title":"Advance in the study of distal junctional problem after thoracolumbar surgery","authors":"Lei Yuan, Xinling Zhang, Yan Zeng, Xiaoxi Yang, Zhongqiang Chen","doi":"10.3760/CMA.J.CN121113-20190625-00279","DOIUrl":"https://doi.org/10.3760/CMA.J.CN121113-20190625-00279","url":null,"abstract":"Distal junctional problem (DJP) is one of the severe complications after spinal correction, fixation and fusion. As the number of patients receiving spinal surgery increased recently, the incidence of DJP also increased dramatically. Compared with proximal junctional problem, the incidence of DJP is low. However, the clinical symptoms are severe, and the rate of surgical revision is high in patients with distal junctional problems. DJP include distal junctional kyphosis (DJK) and distal junctional failure(DJF). The definition of DJK is confusing, however, and the most commonly used was that the distal junction Angle at the last follow-up was greater than 10° and increased by 10° compared with that before surgery. There are 6 DJF modes: progressive loss of lumbar lordosis,acute wedging in the disc below the instrumentation, fracture of LIV, osteoporotic fracture below the long rigid fixation, failure of the instrumentation at LIV, spinal stenosis and or segmental instability underneath the instrumentation. Possible risk factors for DJP include weight, age, type of spinal deformity, osteoporosis, choice of LIV, hip disease, deformity location, surgical approach, surgical procedure, fusion segments, fixation devices, LIV at L5, fixed to S1 with no iliac screws, poor restoration of spinal alignment, et al. Currently, there are some controversies in DJP, mainly including the incidence, risk factors whether needs to and how to revise. The review intends to conduct a simple literature review of the current DJP diagnostic criteria, incidence, risk factors, and other research progress, in order to improve the understanding of the distal junction problem.","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"381-388"},"PeriodicalIF":0.0,"publicationDate":"2020-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44789343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-16DOI: 10.3760/CMA.J.CN121113-20200220-00084
Hui-jun Kang, Yike Dai, S. Li, Jiangfeng Lu, Faquan Li, G. Ji, Y. Niu
Objective To establish a model of patellar dislocation by femoral osteotomy or surgical release of medial retinaculum in immature rabbits, and observe morphological and trabecular microarchitectural changes in the trochlea. Methods Forty rabbits at 3 months of age were included. All right knees underwent surgery, 20 knees were treated with femoral osteotomy and internal rotation of distal femur to increase femoral anteversion angle (Osteotomy group, OS group), and another 20 knees were treated with surgical release of medial retinaculum and overlap suture of lateral retinaculum (Soft tissue group, ST group). All left knees were acting as internal controls. Micro-CT scans for distal femur were acquired after 4 months post surgery. the height of Medial, central, and lateral trochlear, sulcus angle, and lateral and medial trochlear slope were measured to describe the trochlear morphology, and bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular spacing (Tb.Sp), and bone mineral density (BMD) were calculated to evaluate the microarchitectural structure. All parameters were compared between groups. Results In OS group, one rabbit sustained a hip dislocation without patellar dislocation. Three knees developed complete patellar dislocation in daily flexion position, and the remaining 16 patellae were dislocated when the knee was placed in the maximal extension position. In ST group, 15 knees were complete patellar dislocation in daily flexion position, and 5 knees were without dislocation. A local boss was formed proximal to the entrance of the groove and the articular cartilage was smooth, and no obvious osteoarthritis was observed in OS group. In ST group no boss was formed, while obvious cartilage degeneration and defect was seen. Compared to the control group, the central trochlear height and sulcus angle were greater in both groups, but without significant difference between the two groups. The Tb.Th was increased in both medial and lateral condyle, and Tb.N was decreased in medial condyle compared with its control knees in OS group. The BV/TV, Tb.Th, Tb.N and BMD were decreased and Tb.Sp was increased in both medial and lateral condyle compared with its control knees in ST group. Compared to the OS group, the BV/TV, Tb.Th, Tb.N and BMD were smaller and Tb.Sp was greater in both medial and lateral condyle in ST group, with significant differences. Conclusion The model of patellar dislocation could be successfully achieved by femoral rotational osteotomy to increase femoral anteversion or surgical release of medial retinaculum and overlap suture of lateral retinaculum, and subsequent morphological and trabecular microarchitectural changes in the trochlea are different. Different bony and soft tissue factors should be addressed for different patients with patellar dislocation in clinical practice. Key words: Patellar dislocation; Femur; Patellar ligament; Osteotomy
{"title":"Experimental research on the trochlear dysplasia with bony and soft tissue model of patellar dislocation","authors":"Hui-jun Kang, Yike Dai, S. Li, Jiangfeng Lu, Faquan Li, G. Ji, Y. Niu","doi":"10.3760/CMA.J.CN121113-20200220-00084","DOIUrl":"https://doi.org/10.3760/CMA.J.CN121113-20200220-00084","url":null,"abstract":"Objective \u0000To establish a model of patellar dislocation by femoral osteotomy or surgical release of medial retinaculum in immature rabbits, and observe morphological and trabecular microarchitectural changes in the trochlea. \u0000 \u0000 \u0000Methods \u0000Forty rabbits at 3 months of age were included. All right knees underwent surgery, 20 knees were treated with femoral osteotomy and internal rotation of distal femur to increase femoral anteversion angle (Osteotomy group, OS group), and another 20 knees were treated with surgical release of medial retinaculum and overlap suture of lateral retinaculum (Soft tissue group, ST group). All left knees were acting as internal controls. Micro-CT scans for distal femur were acquired after 4 months post surgery. the height of Medial, central, and lateral trochlear, sulcus angle, and lateral and medial trochlear slope were measured to describe the trochlear morphology, and bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular spacing (Tb.Sp), and bone mineral density (BMD) were calculated to evaluate the microarchitectural structure. All parameters were compared between groups. \u0000 \u0000 \u0000Results \u0000In OS group, one rabbit sustained a hip dislocation without patellar dislocation. Three knees developed complete patellar dislocation in daily flexion position, and the remaining 16 patellae were dislocated when the knee was placed in the maximal extension position. In ST group, 15 knees were complete patellar dislocation in daily flexion position, and 5 knees were without dislocation. A local boss was formed proximal to the entrance of the groove and the articular cartilage was smooth, and no obvious osteoarthritis was observed in OS group. In ST group no boss was formed, while obvious cartilage degeneration and defect was seen. Compared to the control group, the central trochlear height and sulcus angle were greater in both groups, but without significant difference between the two groups. The Tb.Th was increased in both medial and lateral condyle, and Tb.N was decreased in medial condyle compared with its control knees in OS group. The BV/TV, Tb.Th, Tb.N and BMD were decreased and Tb.Sp was increased in both medial and lateral condyle compared with its control knees in ST group. Compared to the OS group, the BV/TV, Tb.Th, Tb.N and BMD were smaller and Tb.Sp was greater in both medial and lateral condyle in ST group, with significant differences. \u0000 \u0000 \u0000Conclusion \u0000The model of patellar dislocation could be successfully achieved by femoral rotational osteotomy to increase femoral anteversion or surgical release of medial retinaculum and overlap suture of lateral retinaculum, and subsequent morphological and trabecular microarchitectural changes in the trochlea are different. Different bony and soft tissue factors should be addressed for different patients with patellar dislocation in clinical practice. \u0000 \u0000 \u0000Key words: \u0000Patellar dislocation; Femur; Patellar ligament; Osteotomy","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"372-380"},"PeriodicalIF":0.0,"publicationDate":"2020-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46603230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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