ObjectiveTo summarize the related research results of open wedge high tibial osteotomy (OWHTO) complicated with lateral hinge fracture. MethodsTo review the relevant literature of OWHTO at home and abroad in recent years and summarize and analyse the clinical experience. ResultsThe lateral hinge rupture may occur during the OWHTO, which may lead to the loss of correction angle after operation, delayed healing or non-union of osteotomy and so on. The lateral hinge plays an important role in the stability of the osteotomy. During the operation, the " safe zone” internal osteotomy can be used to protect the bone. Once the lateral hinge breaks, the TomoFix plate can be used to obtain the sufficient stability. For patients with lateral hinge rupture, functional exercise and full weight loading time should be guided by hinge breakage classification. ConclusionThe intact lateral hinge is beneficial to the healing and rehabilitation of OWHTO. The lateral hinge should be paid enough attention by clinicians.
Objective To explore the effectiveness of triple osteotomy in correcting severe hallux valgus with the first metatarsal pronation deformity. Methods A retrospective analysis was conducted on the clinical data of 29 patients (40 feet) with severe hallux valgus accompanied by the first metatarsal pronation deformity, who were admitted between January 2022 and December 2023 and met the selection criteria. There were 8 males (10 feet) and 21 females (30 feet), with an average age of 50.0 years (range, 44-62 years). The disease duration ranged from 5 to 9 years (mean, 6.5 years). All patients underwent triple osteotomy to correct the deformity. The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were used to evaluate joint function and pain before and after operation. Based on pre- and post-operative X-ray films, hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were measured to evaluate the correction of hallux valgus; the shape classification of the lateral edge of the first metatarsal and the pronation of first metatarsal angle (PFMA) were observed to assess the correction of the first metatarsal pronation deformity. Results A superficial infection occurred in 1 foot and the incison healed after dressing change; the remaining incisions healed by first intention. All patients were followed up 12-18 months (mean, 12.6 months). Three cases (4 feet) experienced limited movement of the metatarsophalangeal joint after operation, and the joint function recovered after strengthening functional exercises. During follow-up, no recurrence of deformity or secondary metatarsal pain occurred. Compared with preoperative scores, the AOFAS score increased and the VAS score decreased at last follow-up, and the differences were significant (P<0.05). Radiographic examination showed that the osteotomy achieved bony healing, with the healing time of 2.5-6.2 months (mean, 4.1 months). The hallux valgus deformity was corrected, and the IMA, HVA, and DMAA were significantly smaller at last follow-up when compared with those before operation (P<0.05). The first metatarsal pronation deformity was also corrected; there was no R-type (R-type for pronation deformity) on the lateral edge of the first metatarsal at last follow-up, and the PFMA decreased compared with preoperative levels (P<0.05) and was corrected to the normal range. Conclusion Triple osteotomy can achieve good effectiveness for correcting severe hallux valgus with the first metatarsal pronation deformity. The functional training of the first metatarsophalangeal joint needs to be strengthened.
ObjectiveTo investigate the impact of the Salter innominate osteotomy on the acetabular morphology and direction and the relationship between them in children with developmental dislocation of the hip (DDH) by three-dimensional CT. MethodsBetween January 2013 and January 2015, 51 patients with unilateral DDH were treated. All patients were females with an average age of 2 years and 5 months (range, one year and 6 months to 5 years). All the patients underwent open reduction of the hip, Salter innominate osteotomy, proximal femoral osteotomy, and hip cast immobilization for treatment. The data of three-dimensional CT before surgery and at 1 week after surgery were measured and collected as follows:the anterior acetabular index (AAI), posterior acetabular index (PAI), axial acetabular index (AxAI), acetabular anteversion angle (AAA) of the acetabulum, and the distances of the forward, outward, and lateral rotation of the distal osteotomy fragments. The differences of AAI, PAI, AxAI, AAA between before and after surgeries were compared and the difference values of the data with significant difference results were calculated. The relationship between the difference values and the distances of three different rotation directions before and after surgeries were tested by Spearman correlation analysis. ResultsThere were significant differences in the AAI, PAI, and AAA between before and after surgery (P<0.05), but no significant difference was found in the AxAI between before and after surgery (t=0.878, P=0.384). The difference values of AAI, PAI, and AAA were (4.518±4.601), (4.219±6.660), and (3.919±4.389)° respectively. The distances of the outward, lateral, and forward rotation of the distal osteotomy fragments after surgery were (0.420±0.339), (2.440±0.230), and (0.421±0.311) cm. There was a significant correlation between the three different rotation directions and AAI difference (P<0.05), especialy the outward rotation (r=0.981). There was a correlation between the outward, forward rotation and PAI, AAI differences (P<0.05), and no significant correlation between the lateral rotation and PAI, AAA was found (P>0.05). There was a significant correlation between the forward rotation and AAA difference (r=0.841). ConclusionSalter innominate osteotomy can increase the curvature of the anterior wall of the acetabulum in DDH, but reduce the curvature of the rear wall. At the same time, it can also change the direction of the acetabulum, significantly decrease the acetabular anteversion, but it can not change the depth of the acetabulum. The main factors of the curvature change after Salter innominate osteotomy of DDH is attributable to outward rotation, followed by forward rotation, and the main factor of the acetabular direction change is attributable to forward rotation.
ObjectiveTo review the imaging evaluation, treatment progress, and controversy related to developmental dysplasia of the hip (DDH) in adolescents and adults. Methods The domestic and abroad hot issues related to adolescents and adults with DDH in recent years, including new imaging techniques for assessing cartilage, controversies over the diagnosis and treatment of borderline DDH (BDDH), and the improvement and prospect of peracetabular osteotomy (PAO) were summarized and analyzed. ResultsDDH is one of the main factors leading to hip osteoarthritis. As the understanding of the pathological changes of DDH continues to deepen, the use of delayed gadolinium-enhanced MRI of cartilage can further evaluate the progress of osteoarthritis and predict the prognosis after hip preservation. There are still controversies about the diagnosis and treatment of BDDH. At the same time, PAO technology and concepts are still being improved. ConclusionCartilage injury and bony structure determine the choice of surgical methods and postoperative prognosis of hip preservation surgery. The hip preservation of adolescent and adult DDH patients will move towards the goal of individualization and accuracy.
ObjectiveTo investigate the effectiveness of local subcutaneous pedicled fat flap filling and separation of the synostosis area associated with radial shortening osteotomy and plate internal fixation for the treatment of congenital radioulnar synostosis.MethodsBetween February 2014 and June 2018, 36 patients (41 sides) with congenital radioulnar synostosis were analyzed retrospectively, including 21 males and 15 females, aged 2.5-4.5 years with an average of 3.1 years. The fixed pronation deformity of the forearm ranged from 30° to 90° with an average of 71.6°, and the range of motion of the elbow flexion was 120°-135° with an average of 128.2°. According to the Cleary-Omer classification, there were 8 sides of type Ⅱ, 17 sides of type Ⅲ, and 16 sides of type Ⅳ. All patients were treated by local subcutaneous pedicled fat flap filling and separation of the synostosis area associated with radial shortening osteotomy and plate internal fixation. The range of motion of the elbow, muscle strength, joint stability, and patient discomfort were evaluated by using the Broberg and Morrey elbow scoring system preoperatively and postoperatively. In addition, the ability for daily living of the affected limb was evaluated by using the Failla grading standard.ResultsRadial nerve palsy occurred in 3 cases, and nerve function recovered at 2-4 weeks after operation. All the 36 cases were followed up 6-52 months, with an average of 38 months. All osteotomy sites healed, the healing time was 5-12 weeks (mean, 6.3 weeks), and the pedicled fat flap between the radius and ulna survived when the internal fixation was taken. At last follow-up, the flexion range of motion of elbow joint was not decreased, and the pronation and supination range of motion of forearm were improved. The elbow flexion range of motion was 125°-135° with an average of 132.4°. The pronation range of motion of forearm was 15°-45° with an average of 30.1°, and the supination range of motion of forearm was 10°-40° with an average of 22.6°. At last follow-up, the Broberg and Morrey elbow scores increased from the preoperative 85.6±1.0 to 91.8±1.8, showing significant difference (t=25.593, P=0.000). Moreover, the results were good in 3 sides, fair in 9 sides, and poor in 29 sides according to the Failla grading standard before operation, with an excellent and good rate of 7.3%. At last follow-up, the results were excellent in 6 sides, good in 28 sides, and fair in 7 sides, with an excellent and good rate of 82.9%, showing significant difference when compared with preoperative value (Z=−5.781, P=0.000).ConclusionThe application of local subcutaneous pedicled fat flap filling and separation of the synostosis area associated with radial shortening osteotomy and plate internal fixation is an effective surgical method for the treatment of congenital radioulnar synostosis. It can restore the partial rotation function of the forearm and improve the quality of life of children.
Crouzon s syndrome is one of the craniofacial dysostosis. It not only presents midface retrusion but also obstructs the air way. There were much more effective changes on speech and velopharyngeal function following LeFort Ⅲ maxillary advancement. In our study, 9 cases underwent maxillary advancement in the last seven years. All patients in this series underwent serial cephalometric study before and after maxillary advancement. The results showed that the distance from the posterior nasal spine to the posterior pharyngeal wall on the posterior pharyngeal wall on the lateral cephalograms reached 18.89mm which was 9.30mm more larger than that of the preoperative distance in average.The angle formed by the soft palate and the hard palate reached 159.4 degree which was 16 degree larger than the preopertive angle 144.6 degree. Clinically, improvement of phonation was very obvious.
Objective To evaluate the effect of sensory disturbance after the sagittal split ramus osteotomy (SSRO）on quality of life. Methods From September2004 to September 2005, 21 patients undergoing SSRO were studied by using questionnaires. There were 12 males and 9 females, aging 1927 years(mean 22.6 years).The patients were followed up at 4 weeks and 24 weeks after operation. The subjective questionnaire was completed by patient to evaluate the degree of living quality descending. Results At 4 weeks,19(90.48%) patients’ living quality descended because of postoperative sensory disturbance. Among them, 7(33.33%) patients had severe descending of living quality. The average effecting time of living accounted for total time 26.9%(about 6.5 h/d). At 24 weeks, 12(6316%) patients’ living quality descended because of postoperative sensory disturbance, 7(36.84%) patients could achieve preoperative living quality. The average effecting time of living accounted for total time 15.5%(about 3.7 h/d). Conclusion Most patients have descending of living quality after SSRO because of sensory disturbance. However, this condition can be improved during the followup and more than 1/3 patients canachieve their preoperative living quality.
ObjectiveTo compare the changes of scoliosis and kyphosis angles after Halo-pelvic traction with posterior spinal osteotomy versus simple posterior spinal osteotomy for severe rigid spinal deformity.MethodsA clinical data of 28 patients with severe rigid spinal deformity between January 2015 and November 2017 was retrospectively analyzed. Sixteen patients were treated by Halo-pelvic traction with posterior spinal osteotomy (group A) and 12 patients were treated with posterior spinal osteotomy only (group B). There was no significant difference between the two groups (P>0.05) in gender, age, body mass index, and preoperative pulmonary function, coronal and sagittal Cobb angles, and flexibility. The operation time, intraoperative blood loss, and complications were recorded. The coronal and sagittal Cobb angles were measured on X-ray films before operation (before traction in group A), at 10 days after operation, at last follow-up in the two groups and after traction in group A. The improvement rate of deformity after traction in group A, the correction rate of deformity after operation, and the loss rate of correction at last follow-up were calculated.ResultsAll patients were followed up 24-30 months (mean, 26.5 months). The operation time and intraoperative blood loss were significantly less in group A than in group B (t=7.629, P=0.000; t=8.773, P=0.000). In group A, 1 patient occurred transient numbness of both legs during continuous traction and 2 patients needed ventilator support for more than 12 hours. In group B, 7 patients needed ventilator support for more than 12 hours, including 1 patient with deep incision infection. The incidence of complications was 18.75% (3/16) in group A and 58.33% (7/12) in group B, and the difference between the two groups was significant (χ2=4.680, P=0.031). The coronal and sagittal improvement rates of deformity after traction in group A were 40.47%±3.60% and 40.70%±4.20%, respectively. There was no significant difference between the two groups (P>0.05) in the coronal and sagittal Cobb angles at 10 days after operation and at last follow-up, in the correction rate of deformity after operation, and in the loss rate of correction at last follow-up.ConclusionFor the severe rigid spinal deformity, Halo-pelvic traction with posterior spinal osteotomy and simple posterior spinal osteotomy can obtain the same orthopedic effect and postoperative deformity correction. However, the Halo-pelvic traction can shorten operation time, reduce blood loss and incidence of perioperative complications.
ObjectiveTo investigate the early effectiveness of artificial intelligence (AI) assisted total hip arthroplasty (THA) system (AIHIP) in the treatment of patients with Crowe type Ⅳ developmental dysplasia of the hip (DDH).MethodsThe clinical data of 23 patients with Crowe type Ⅳ DDH who met the selection criteria between May 2019 and December 2020 were retrospectively analyzed. There were 3 males and 20 females, the age ranged from 44 to 74 years, with an average of 52.65 years. The absolute value of the lower limbs discrepancy before operation was (15.17±22.17) mm. The preoperative Harris score was 62.4±7.2. The AIHIP system was used for preoperative planning, and the operations were all performed via conventional posterolateral approach. Thirteen patients with difficulty in reduction during operation underwent subtrochanteric shortening osteotomy (SSOT). The operation time, hospital stay, and adverse events were recorded; Harris score was used to evaluate the function of the affected limb at 1 day before operation and 1 week and 6 months after operation; pelvic anteroposterior X-ray film was taken at 1 day after operation to evaluate the position of the prosthesis. The matching degree of prosthesis was evaluated according to the consistency of intraoperative prosthesis model and preoperative planning.ResultsThe matching degree of acetabular cup model after operation was 16 cases of perfect matching, 4 cases of general matching (1 case of +1, 3 cases of –1), and 3 cases of mismatch (all of them were +2), the coincidence rate was 86.96%. The matching degree of femoral stem model was perfect matching in 22 cases and general matching in 1 case of –1, and the coincidence rate was 100%. One patient had a periprosthesis fracture during operation, and was fixed with a wire cable during operation, and walked with the assistance of walking aid at 6 weeks after operation; the rest of the patients walked with the assistance of walking aid at 1 day after operation. The operation time was 185-315 minutes, with an average of 239.43 minutes; the hospital stay was 8-20 days, with an average of 9.96 days; and the time of disengagement from the walking aid was 2-56 days, with an average of 5.09 days. All patients were followed up 6 months. All incisions healed by first intension, and there was no complication such as infection, dislocation, refracture, and lower extremity deep venous thrombosis; X-ray films at 1 day and 6 months after operation showed that the acetabular and femoral prostheses were firmly fixed and within the safe zone; the absolute value of lower limbs discrepancy at 1 day after operation was (11.96±13.48) mm, which was not significantly decreased compared with that before operation (t=0.582, P=0.564). All osteotomies healed at 6 months after operation. The Harris scores at 1 week and 6 months after operation were 69.5±4.9 and 79.2±5.7 respectively, showing significant differences between pre- and post-operation (P<0.05). At 6 months after operation, the hip function was evaluated according to Harris score, and 13 cases were good, 9 cases were fair, and 1 case was poor.ConclusionAIHIP system-assisted THA (difficult to reposition patients combined with SSOT) for adult Crowe type Ⅳ DDH has high preoperative planning accuracy, easy intraoperative reduction, early postoperative landing, and satisfactory short-term effectiveness.