Ten cases of neurotmesis of posterior interosseous nerve of the forearm were treated with mierosurgical technique from Aug, 1988 to Oct. 1990, of which, 4 cases by autogenous nerve graft and 6 cases by direct neurosuture. Eight cases have been followed-up from 4 months to 1 year after operation concerning with satisfactory results. Some questions the diagnosis, the points for attention in operation, and the relation of the results and the time when the operation done were discussed. The comparison of the results and the recovery time between the autogenous-nerve graft and direct neurosuture was made.
Objective To evaluate the clinical effects of surgical treatment for 30 patients with discogenic low back pain. Methods A total of 30 patients with 36 intervertebral discs were treated with posterior approach lumbar discectomy and interbody fusion with internal fixation by strict criteria. All patients were followed up for one year. The low back pain before and one year after surgery was evaluated by Japanese Orthopaedic Association (JOA) score and Visual Analogue Scale (VAS) score. Results The patients’ JOA score increased from 14.6±2.3 (before operation) to 27.1±0.9 (one year after operation) (t=–26.936, P<0.001), while the patients’ VAS score decreased from 6.2±1.6 (before operation) to 1.4±0.9 (one year after operation) (t=16.335, P<0.001), and the differences were significant. Conclusion When the conservative treatment is invalid, the operation of posterior lumbar intervertebral fusion is an effective method for the patinets with discogenic low back pain.
Objective To assess the curative effect of the subtalararthrodesis on the serious subtalar joint with the posterior tibial tendon dysfunction.Methods From October 2000 to February 2006, 31 patients (18 males, 13 females; age 23-62 years, averaged 36.4years) with serious subtalar joint osteoarthrisis and stage Ⅱ posterior tibial tendon dysfunction were treated by the subtalar arthrodesis. The tibial tendon dysfunction involved 15 right and 16 left lower extremities, which were caused by retrograde osteoarthritis in 14 patients,sequel of an injury in 8 patients, infection in 7 patients, and anatomic structural abnormity in 2 patients. The treatment course averaged 9.5 months (range, 6-30 months). Before the subtalar arthrodesis, the injured tendons were repaired, and then the bone grafting was performed in the tarsus sinus. All of the patients were assessed before and after operation according to the Hindfoot scores system (American Orthopedics Foot and Ankle Society, AOFAS). Results Among the patients, 28 were followed up on an average of 23.6 months (range, 8-61 months). The AOFAS scores ranged from 45.30±1.08 before operation to 79.60±2.14 afteroperation. The pain indexes ranged from 15.40±2.23 before operation to 38.50±2.61 after operation. The functional indexes of the foot and ankle joint ranged from averaged 21.60±3.01 before operation to averaged 37.40±2.83 after operation. The statistical analysis of the t-test on all the above data showed that there was a significant difference between beforeoperation and after operation (P＜0.01). The angles between the longitudinal line of the talar and the calcaneal bone were 43.70±1.06° before operation and 29.40±0.98° after operation, and the deviation angles between the calcanealline and the talus were 48.20±0.85° before operation and 39.40±1.02° after operation. There was a significant difference between before operation and after operation (P＜0.01). Conclusion The subtalar arthrodesis combined with the bone grafting in the tarsus sinus and the repair of the injured tendons can effectivelycorrect the deformity of the deformity of the metapodium, relieve the pain, retin the adjacent joint motion ability, and this method can be recommended for the adult patient who suffers from serious subtalar osteoarthritis and stage Ⅱ osterior tibial tendon dysfunction.
ObjectiveTo explore the clinical outcomes of open reduction and internal fixation by posterolateral and posteromedial approaches for treating posterior Pilon fractures in elderly patients. MethodsBetween August 2009 and August 2014, 20 elderly patients with posterior Pilon fractures were treated with open reduction and internal fixation by posterolateral and posteromedial approaches. There were 14 males and 6 females, aged from 66 to 83 years (mean, 72.7 years). The causes were falling injury in 11 cases and traffic accident injury in 9 cases. All the patients had lateral malleolus and medial malleolus fractures. The time from injury to operation was 7-14 days (mean, 8.6 days). The posterolateral incision was made to expose the posterolateral bone fragments of posterior malleolus and lateral malleolus fracture, and the posteromedial incision was made to expose the posteromedial fracture fragments of posterior malleolus and medial malleolus fracture. After reduction, fracture was fixed with locking plate or cannulated screw. All the patients began to functional exercise at 1 day after operation. ResultsThe operation time was 60-110 minutes (mean, 92 minutes). The incisions healed primarily in all patients. There were no complications of incision dehiscence, infection, implant exposure, and nerve damage. No irritation sign of tendon was observed. All 20 cases were followed up for 12-18 months (mean, 13 months). The X-ray films showed that fracture healed at 3-9 months, with an average of 5.2 months. During follow-up period, no loosening or breakage of the implant was observed. The other patients could walk normally except 2 patients (over 80 years old) who could walk with crutch. According to American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the results were excellent in 12 cases, good in 4 cases, and fair in 4 cases; the excellent and good rate was 80%. ConclusionA combination of posterolateral approach and posteromedial approach for open reduction and fixation of posterior Pilon fractures can achieve satisfactory effect in elderly patients. It has the advantages of protecting ankle blood supply and avoiding the soft tissue necrosis and implants exposure.
Objective To analyse the results of posterior cruciate l igament-retained mobile-bearing total knee arthroplasty (TKA) in treatment of rheumatoid arthritis (RA) and to solve the problems often encountered during surgery. Methods From February 1999 to August 2005, the cl inical data from 73 patients with RA undergoing TKA were analysed retrospectively. In 73 patients, 38 patients were treated with posterior cruciate l igament-retained mobile-bearing prosthesis (group A), while 35 patients were treated with posterior stabil ized fixed-bearing prosthesis (group B). Another 70 patients with osteoarthritis (OA) treated with an posterior cruciate l igament-retained mobile-bearing prosthesis served as controls (group C). In group A, there were 8 males and 30 females with an average age of 56.5 years and an average diseasecourse of 16.8 years. In group B, there were 6 males and 29 females with an average age of 57.3 years and an average disease course of 17.1 years. In group C, there were 37 males and 33 females with an average age of 65.4 years and an average disease course of 10.8 years. There was no significant difference (P gt; 0.05) in general data between groups A and B, but there were significant differences (P lt; 0.05) when compared with group C. Results In groups A and B, 2 cases (5.3%) and 1 case (2.9%) had poor heal ing of incision, respectively; in group C, all cases had good heal ing of incision. There were significant differences in heal ing rate of incision between groups A, B and group C (P lt; 0.05). All patients were followed up 7.6 years on average (range, 3.5-10.5 years). Deep infection occurred in 1 case respectively in 3 groups, showing no significant difference (P gt; 0.05). Posterior instabil ity occurred in 1 case (2.6%) 5 years after operation in group A and 2 cases (2.9%) 9 years after operation in group C, and no posterior instabil ity occurred in group B; showing significant differences between groups A, C and group B (P lt; 0.05). There were significant differences (P lt; 0.05) in knee score, Feller patellar score, and anterior knee pain score between pre- and postoperative values among groups A, B, and C. There were significant differences (P lt; 0.05) in the function scores between pre- and post-operative values in 3 groups, between groups A, B and group C pre- and post-operatively. Conclusion Posterior cruciate l igament-retained mobile-bearing TKA can yield satisfactory cl inical results in treatment of RA at intermediate-term followup. This mobile-bearing prosthesis has a low prevalence of posterior instabil ity and a good outcome for anterior knee function without patellar resurfacing.
OBJECTIVE: To explore a new surgical approach to repair skin and soft tissue defect of hands. METHODS: Based on the anatomical study of the origin, course, branch, distribution, and anastomosis of the posterior interosseous artery and its recurrent branches in 40 upper limbs of cadavers, the posterior forearm serial flap, pedicled with the posterior interosseous artery and its recurrent branches, was designed and applied clinically in 17 cases to repair the skin and soft tissue defect of hands from August 1998 to July 2000. The size of flaps ranged from 7 cm x 5 cm to 15 cm x 10 cm. All of the cases were followed up for 3 weeks to 6 months. RESULTS: The anatomy study showed that the posterior forearm serial flap had long vascular pedicle, suitable thickness and large skin area. The clinical application indicated that the flaps survived in 16 cases. But flap necrosis at the distal end, sized 2 cm x 3 cm, was observed in one case, in which the defect was repaired by delayed skin grafting, CONCLUSION: The posterior forearm serial flap pedicled with the posterior interosseous artery and its recurrent branch have the character of avoidance of sacrificing the major arteries of the extremity, longer vascular pedicle, larger area and suitable thickness. The posterior forearm serial flap is a safe and easily manipulated surgical approach to repair the skin and soft tissue defect of the hands, especially of the thumb, palm, and proximal part of the fingers.
ObjectiveTo observe the medium-term clinical and radiological outcomes of anterior release internal distraction in treatment of severe and rigid scoliosis. MethodsBetween March 2009 and March 2012, 26 patients with severe and rigid scoliosis were treated with anterior release, posterior internal distraction, and two stage posterior spinal fusion. There were 11 males and 15 females with an average age of 19.6 years (range, 14-25 years). The average disease duration was 13.6 years (range, 3-24 years). All cases were idiopathic scoliosis. Of 26 cases, 2 cases were rated as Lenke type I, 8 as type Ⅱ, 13 as type IV, 1 as type V, and 2 as type VI. The apical vertebrae located at T6 in 1 case, at T7 in 3 cases, at T8 in 7 cases, at T9 in 13 cases, and at T10 in 2 cases. The average 4 vertebral bodies were released by anterior approach, and average 14 vertebral bodies were fused after posterior surgery. Fourteen patients received 2 times distraction. Scoliosis Research Society-22 (SRS-22) questionnaire was used to access health-related quality of life. The radiological parameters were measured, including coronal plane Cobb angel of major curve, apical vertebral translation (AVT), C7 plumb line-center sacral vertical line (C7PL-CSVL), sagittal vertical axis (SVA), and thoracic kyphosis (TK) at pre-and post-operation. ResultsThe average total operation time was 592.7 minutes; the average total blood loss volume was 1 311.2 mL; and total hospitalization cost was (14.7±1.4)×104 yuan RMB. The coronal plane Cobb angle of major curve was (55.7±16.5)°, and the TK was (43.2±16.2)° after first distraction. The patients were followed up 2-5 years (mean, 3.8 years). Temporary dyspnea and pleural effusion occurred in 1 case respectively after distraction, and symptoms disappeared after symptomatic treatment. Screw loosening and pseudoarthrosis formation was observed in 1 case at 6 months after fusion, good recovery was achieved after revision. No infection or neurological complication was found. The coronal plane Cobb angel of major curve, TK, and AVT after fusion and at last follow-up were significantly lower than preoperative ones (P<0.05), but no significant difference was found between at post-fusion and last follow-up (P>0.05). There was no significant difference in C7PL-CSVL and SVA between at pre-and post-operation (P>0.05). At last follow-up, SRS-22 questionnaire scores were 4.32±0.42 for active degree, 4.54±0.58 for mental health, 3.97±0.76 for self-image, 4.09±0.64 for pain, and 4.03±0.83 for satisfaction degree. ConclusionAnterior release internal distraction can provide satisfactory correction results for severe and rigid scoliosis with higher safety and lower incidence of complication.
Objective To investigate the cl inical appl ication and efficacy of lumbar vertebral canal expansion withpreservation of posterior l igaments complex, and to study its biomechanical properties. Methods Eight fresh lumbosacralcadaveric samples were divided into 3 groups. In group A, 8 intact lumbosacral cadaveric samples were used for biomechanical test. In group B, L3-5 laminectomy were, after the test in group A, performed and the posterior l igaments complex was preserved. In group C, the posterior l iagments complex was excised after the test in group B. In all 3 groups, the axial compression test, three-point bending test and torsional test were conducted. From June 2000 to June 2006, 309 patients (152 males and 157 females, aged 20-80 years with the average of 57.2 ) with lumbar canal stenosis received operation of the lumbar vertebral canal expansion with preservation of posterior l igaments complex. The course of disease was 3 months to 41 years. There were 55 patients suffering from pure lumbar canal stenosis, and 254 from lumbar canal stenosis combined with lumbar disc herniation, among which 105 were at L4, 5 level, 56 at L4-S1 level, 86 at L5, S1 level, and 7 at L2, 3 level. The therapeutic effect was assessed based on the JOA low back pain scoring system, the satisfaction degree of patient and radiographical observation. Results The axial compression test was performed. In the position of forward bending, stress, strain and axial displacement were smaller in groups A, B than those in group C, and axial stiffness in groups A, B was higher than those in group C, and the difference was significant(P lt; 0.01). In the position of backward extension, there was no significant difference among 3 groups (P gt; 0.05). Concerning the three-point bending test, under the same bending moment, there was a significant difference in deflection, dip and bending rigidity between group A and group C, and also between group B and group C (P lt; 0.01), but no significant difference between group A and group B (P gt; 0.05). In the torsional test, under the same torsional angle, the torque in group B was bigger than that in group C (P lt; 0.01). Under the same torque, the torsional angle in group B was smaller than that in group C (P lt; 0.01), and the torsional stiffness in group B was higher than that in group C (P lt; 0.01). The compl ications included 7 cases of distraction of nerve root, 5 leakage of cerebrospinal fluid and 4 wound infection. All compl ications were treated and restored completely. All patients were followed up for 1-7 years. According to the JOA low back pain scoring system, the improvement rate averaged 86.0%. Of all the 309 cases, 163 were excellent, 112 good, 34 fair, and the choiceness rate was 89%. The satisfaction rate of patient was 87%. There was no radiographic vertebral instabil ity postoperatively. Conclusion The lumbar vertebral canal expansion with preservation of posterior l igaments complex is conducive to maintaining the stabil ity of lumbar spine and have good cl inical outcomes.
Objective To evaluate surgical results of the titanium screwplate internal fixation in treatment of the lower cervical fracture dislocation. Methods From September 2001 to March 2006, 31 patients(24 males, 7 females; age range, 2063 years) with the lower cervical fracturedislocation were treated in our department. The injuries were caused by a road accident in 25 patients, a high crash in 4, and a heavy object crash in 2. The fracture dislocation occurred in the following cervical segments:C3(1 patient),C4(5 patients), C5(12 patients), C6(10 patients), and C7(3 patients). The disease course ranged from 1 to 23 days. The associated spinal nerve root injury occurred in 29 patients. The Frankle scaling revealed that 14 patients were at Grade A, 3 at Grade B, 7 at Grade C, 3 at Grade D, and 2 at Grade E (associated nerve root injury with hand and shoulder numbness). The 29 patients underwentthe spinal cord decompression, the grafting fusion of the small joints, and thelateral mass titanium screwplate internal fixation; 2 patients without nerve injury underwent only the grafting fusion of the small joints and the lateral mass titanium screwplate internal fixation. The bone fusion, cervical vertebra movement, and internal fixation condition were observed by the X-ray examinations postoperatively. The nerve function recovery was evaluated by the Frankle scaling system. Results The followedup in all the patients for 6months to 4 years revealed that the small joint fusion time was 36 months, with an average of 3.6 months. The cervical X-ray films showed that there was no instability or fracture looseness of the internal fixation at 6 months. Among the 29 patients with the spinal nerve root injury, 14 were at Grade A preoperatively but 13 were improved at Grade B and 1 at Grade C postoperatively; 3 were at Grade B preoperatively but 2 were improved at Grade C and 1 at Grade D postoperatively; 7 were at Grade C preoperatively but 3 were improved at Grade D and 4 at Grade E postoperatively; 3 at Grade D preoperatively but all the 3 were improvedat Grade E postoperatively; 2 were at Grade E preoperatively and remained unchanged postoperatively. In the 2 patients with only the nerve root injury, numbness disappeared soon after operation. Conclusion This posteriorapproach has two advantages: the mobility range of the cervical vertebra can preserved to the greatest extent because of the short segment fixation; the betterstability can obtained because of the titanium screwplate internal fixation on the cervical jointcolumn to prevent the hyperextension and hyperflexion. Therefore, the titanium screwplate internal fixation on the cervical lateral massis an effective treatment of the lower cervical fracture dislocation.
ObjectiveTo evaluate the biomechanical characteristics and effectiveness of repairing anteroinferior tibiofibular ligament and fixing the posterior malleolar fracture in reconstructing syndesmotic stability after ankle fracture of pronation-external rotation type (PER) stage IV. MethodsTwenty-four normal lower extremity cadaver specimens were collected and made into intact ankle specimens. A MTS Bionix 858 test system was used to measure the maximum rotation of the foot under a static axial load of 150 N, internal rotation torque to the tibia at a rate of 1°/second and 4 N·m torque. Then a fracture of PER stage IV model was established in each specimen. Internal fixation of lower tibiofibular ligament union was performed by screws in group A, fixation of posterior malleolar fractures in group B, fixing posterior malleolar fracture combined with repairing anteroinferior tibiofibular ligament in group C (8 specimens each group). Then the maximum rotation of the foot was measured under the same condition, and the syndesmotic stability was calculated. Between July 2009 and September 2012, 32 patients with ankle fracture of PER stage IV were treated. There were 19 males and 13 females with an average age of 35 years (range, 20-63 years). The locations were the left ankle in 14 cases and the right ankle in 18 cases. The time from injury to admission was 3.5 hours on average (range, 1-72 hours). Open reduction and plate compression internal fixation were performed in fibula, and medial malleolus was fixed by conpression screws, then anteroinferior tibiofibular ligament was mended and posterior malleolar fracture was fixed by screws. ResultsThe preservation rates of syndesmotic stability after repair were 46.2%±12.3%, 62.6%±10.7%,and 66.5%±12.6% in groups A, B,and C, respectively; groups B and C were significantly superior to group A (P<0.05),but no significant difference was found between groups B and C (P>0.05). All patients achieved wound healing by first intention, and were followed up 12-24 months (mean,15 months). All fractures healed,with an average healing time of 11.2 weeks (range, 10-14 weeks) on the X-ray films. No seperation of inferior tibiofibular syndesmosis was observed during the follow-up period. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 88.4 on average (range, 61-98) at last follow-up; the results were excellent in 13 cases,good in 15 cases, and fair in 4 cases, with an excellent and good rate of 87.5%. ConclusionIn patients with ankle fracture of PER stage IV, a combination of fixing the posterior malleolar fracture and repairing anteroinferior tibiofibular ligament can reconstruct syndesmotic stability effectively.