ObjectiveTo investigate the clinical significance of Q-angle measuring under different conditions in female recurrent patellar dislocation female patients. MethodsBetween August 2012 and March 2013, 10 female patients (11 knees) with recurrent patellar dislocation were collected as trial group; 20 female patients (20 knees) with simple meniscus injury were collected as control group at the same time. Q-angle was measured in extension, 30° flexion, 30° flexion with manual correction, and surgical correction in the trial group, and only in extension and 30° flexion in the control group. Then the difference value of Q-angle between extension and 30° flexion (Q-angle in extension subtracts Q-angle in 30 flexion) were calculated. Independent sample t-test was used to analyze Q-angle degrees in extension, 30° flexion, and the changed degrees of 2 groups. The Q-angle between manual correction and surgical correction of the trial group was analyzed by paired t-test. ResultsThe Q-angle in extension, Q-angle in 30° flexion, and difference value of Q-angle between extension and 30° flexion were (17.2±3.6), (14.3±3.0), and (2.9±1.9)° in the trial group and were (15.2±3.4), (14.4±3.5), and (0.8±1.7)° in the control group. No significant difference was found in Q-angle of extension or Q-angle of 30° flexion between 2 groups (P>0.05), but the difference value of Q-angle between extension and 30° flexion in the trial group was significantly larger than that in the control group (t=3.253, P=0.003). The Q-angle in 30° flexion with manual correction and surgical correction in the trial group was (19.8±3.4)° and (18.9±3.8)° respectively, showing no significant difference (t=2.193, P=0.053). ConclusionWhen a female patient's Q-angle in 30° flexion knee changes obviously compared with Q-angle in extension position, recurrent patellar dislocation should be considered. For female patients with recurrent patellar dislocation, the preoperative Q-angle in 30° flexion with manual correction should be measured, which can help increasing the accuracy of evaluation whether rearrangement should be performed.
Objective To evaluate the effects of cold provoca tion on optic dise blood flow and retinal light sensitivity of primary open-angle glaucoma (POAG) patients,and explore the relationship between the changes of optic disc blood flow and retin al light sensitivity. Methods A total 33 POAG patients (33 eyes)and 13 normal controls (13 eyes) were tested by usin g th e Heidelberg retinal flowmetry (HRF) and Topcon automatic perimeter,and the optic disc blood flow and retinal light sensitivity of POAG patients and normal cont rols were measured at normal conditions and after cold provocation. Results The mean optic disc blood flow,volume and the mean retinal light sensitivity of POAG patients decreased significantly (Plt;0.05) after cold provocation.There was a linear and significant relationsh ip between the decrease of mean optic disc blood flow and mean retinal light sen sitivity of POAG patients (r=0.615,P＜0.001). The optic disc blood flow of POAG patients with a history of migraine were more likely to r educe in response to cold provocation and reduced much more than those without such history (Plt;0.05). Conclusion Cold provocation can significantly reduce both the optic disc blood flow and retinal light sensitivity in POAG patients.A close correlation was fo und between the amount of mean optic disc blood flow decrease and the volume of mean retinal light sensitivity decline. (Chin J Ocul Fundus Dis, 2001,17:37-40)
ObjectiveTo systematically review the efficacy and safety of phacoemulsification combined with trabeculectomy versus simple phacoemulsification for primary angle closure glaucoma with cataract.MethodsDatabases including PubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data were searched to collect randomized controlled trials (RCTs) about phacoemulsification combined with trabeculectomy vs. simple phacoemulsification for primary angle closure glaucoma with cataract from inception to May 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.3 software.ResultsA total of eight studies involving 679 patients were included. The results of meta-analysis showed that: there were no significant differences between two groups in postoperative visual acuity (MD=0.00, 95%CI –0.10 to 0.09, P=0.98), postoperative anterior chamber depth (MD=0.14, 95%CI –0.17 to 0.45, P=0.37) and adverse reactions rates (optic nerve injury: RR=1.56, 95%CI 0.70 to 3.47, P=0.28; visual field defect: RR=1.43, 95%CI 0.70 to 2.92, P=0.33; corneal edema: RR=0.57, 95%CI 0.25 to 1.32, P=0.19).ConclusionCurrent evidence shows that phacoemulsification combined with trabeculectomy and simple phacoemulsification has the similar efficacy and safety for primary angle closure glaucoma with cataract. Due to limited quantity and quality of the included studies, the above conclusions still need to be verified by more high quality studies.
Objective To investigate ideal screw implant angle in reconstruction of tibiofibular syndesmosis injury by using a biomechanical test. Methods A total of 24 ankle specimens from adult cadavers were used as the tibiofibular syndesmosis injury model. According to the angle of screw placement, the tibiofibular syndesmosis injury models were randomly divided into groups A (0°), B (10°-15°), C (20°-25°), and D (30°-35°), and the screws were placed at a level 2 cm proximal to the ankle joint. The displacement of fibula was measured by biomechanical testing machine at neutral, dorsiflexion (10°), plantar flexion (15°), varus (10°), and valgus (15°) positions, with axial load of 0-700 N (pressure separation test). The displacement of fibula was also measured at neutral position by applying 0-5 N·m torque load during internal and external rotation (torsional separation test). Results In the pressure separation test, group C exhibited the smallest displacement under different positions and load conditions. At neutral position, significant differences were observed (P<0.05) between group A and group C under load of 300-700 N, as well as between group B and group C under all load conditions. At dorsiflexion position, significant differences were observed (P<0.05) between group A and group C under load of 500-700 N, as well as between groups B, D and group C under all load conditions, and the displacements under all load conditions were significantly smaller in group A than in group B (P<0.05). At plantar flexion position, significant differences were observed (P<0.05) between group D and group C under all load conditions. At valgus position, significant differences were observed (P<0.05) between group A and group C under load of 400-700 N, as well as between groups B, D and group C under all load conditions. In the torsional separation test, group C exhibited the smallest displacement and group B had the largest displacement under different load conditions. During internal rotation, significant differences were observed (P<0.05) between group B and group C under all load conditions, as well as between group D and group C at load of 3-5 N·m. During external rotation, significant differences were observed between groups B, D and group C under all load conditions (P<0.05). No significant difference was detected between groups at the remaining load conditions (P>0.05). ConclusionThe ideal screw implant angle in reconstruction of tibiofibular syndesmosis injury was 20°-25°, which has a small displacement of fibula.
ObjectiveTo evaluate the effectiveness of very low profile/variable angle locking plate (VLP) internal fixation for posterior Pilon fractures extending to the medial malleolus by posteromedial approach. MethodsA retrospective analysis was made on the clinical data from 13 patients with posterior Pilon fractures extending to the medial malleolus between December 2011 and August 2012. There were 4 males and 9 females with an average age of 48.9 years (range, 23-68 years). Fractures were caused by falling in 9 cases and by traffic accident in 4 cases. The locations were the left ankle in 6 cases and the right ankle in 7 cases. According to the Orthopedic Trauma Association (OTA) classification, 6 cases were rated as type 43B1, 4 cases as type 43B2, and 3 cases as type 43B3. Twelve cases had fibular fractures, including 11 cases of Denis-Weber type B, 1 case of Denis-Weber type C. The interval of injury and operation was 7-14 days (mean, 11.4 days). Open reduction was performed and VLP internal fixation was used for posterior malleolar fracture by posteromedial approach. ResultsPrimary healing of incision was obtained in all patients. Tibial nerve palsy was observed in 2 cases, and was cured after oral administration of mecobalamin. Twelve cases were followed up 12-18 months (mean, 14.5 months). According to the Burwell-Charnley's radiological evaluation system, 11 cases achieved anatomical reduction, 1 case achieved fair reduction. The fracture union time was 3-6 months (mean, 3.7 months). No loosening or breakage of internal fixation occurred during follow-up. According to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, the results were excellent in 7 cases, good in 4, and fair in 1; the excellent and good rate was 91.7%. ConclusionVLP internal fixation for posterior Pilon fractures extending to the medial malleolus by posteromedial approach can achieve good short-term effectiveness. The high quality of reduction is acquired under direct vision with low rate of soft tissue complications.
Purpose To examine the change of optic disc blood flow in primary open angle glaucoma(POAG) patients after cold provocation test and nifedipine administration． Methods Using Heidelberg retinal flowmetry (HRF),the blood flow of optic disc of glaucoma patients and normal control subjects were measured under basal condition, after cold provocation test,and after nifedipine administration. Results The mean optic disc blood volume and flow of POAG patients reduced from 27.1 and 545.4 to 22.3 and 452.4 after cold provocation test (Plt;0.05),and increased to 29.0 and 579.5 after nifedipine adminstration(Plt;0.05).The changes of mean optic disc blood flow of patients with a history of cold extremities show statistic significance compared with whom without such history (Plt;0.05)). Conclusion The changes of blood flow of optic disc in POAG patients may be influenced by cold stimuli and administration of nifedipine,and the history of cold extremities might be connected with the change of optic disc blood flow in POAG patients. (Chin J Ocul Fundus Dis,2000,16:85-87)
ObjectiveTo investigate the feasibility and effectiveness of a personalized distal femoral valgus resection angle for improving postoperative coronal alignment of lower limb in total knee arthroplasty (TKA). MethodsA retrospective analysis was made on the clinical data of 50 patients who received primary TKA between January 2013 and February 2013. There were 11 male and 39 female patients with degenerative knee osteoarthritis. The patients were divided into 2 groups. In test group (n=25), the resection angle was adjusted to the femoral mechanical anatomical angle (FMA); in control group (n=25), a fixed distal valgus resection angle of 5° was used. There was no significant difference in gender, age, body mass index, disease duration, sides, grade, preoperative FMA, mechanical femorotibial angle (MFT), and preoperative Knee Society Score (KSS) between 2 groups (P>0.05). Whole long X-ray film was taken to measure FMA and MFT at 3 days after operation, postoperative KSS was used to evaluate the knee function after 6 and 15 months. ResultsMFT was (-0.20±1.87)° in test group and was (1.71±3.67)° in control group, showing significant difference between 2 groups (t=2.32, P=0.02). The ideal MFT angle (0±3)° was achieved in 22 patients (88%) of test group and in 16 patients (64%) of control group, showing significant difference between 2 groups (χ2=2.32, P=0.02). Primary healing of incision was obtained in all patients of 2 groups. No deep venous thrombosis occurred. The patients of 2 groups were followed up 15 months after operation. There was significant difference in KSS between test and control groups at 6 months (88.23±2.57 vs. 82.92±2.59) (t=7.26, P=0.00) and at 15 months (90.76±2.77 vs. 88.65±1.77) (t=3.20, P=0.02). No sign of prosthesis loosening was observed by X-ray examination. ConclusionCompared with using of a fixed distal femoral resection angle, an individual FMA can significantly improve the postoperative MFT and promote early recovery of the knee function.
ObjectiveTo review the researches of the role of the facet joint orientation (FJO) in degenerative spondylolisthesis (DS). MethodsRelated literature concerning the FJO in patients with DS was extensively reviewed and comprehensively analyzed in 4 terms of the basic concepts, measurement methods, the controversial etiology, and the clinical significance. ResultsThe multiplanar reformation of spiral CT is expected to become a new method of studying the FJO. The causal relationship between the sagittal FJO and DS is still controversial, but further prospective studies are needed to resolve this issue. The sagittal FJO is very important in the prevention of DS and the choice of surgery plan. ConclusionThe etiologic relationship between the FJO and DS need to be further studied.
Objective To explore the reliability and accuracy of the arbitrary point method for measuring the anteversion angle of acetabular prosthesis after total hip arthroplasty (THA) based on pelvic X-ray films. Methods The clinical data of 23 patients (25 hips) who underwent THA between December 2018 and September 2023 and met the selection criteria were retrospectively analyzed. Among them, there were 16 males and 7 females, with an average age of 57.6 years (range, 34-81 years); 13 hips had THA on the left side and 12 on the right side. There were 19 cases (21 hips) of osteonecrosis of the femoral head, 2 cases (2 hips) of femoral neck fractures, 1 case (1 hip) of developmental dysplasia of the hip, and 1 case (1 hip) of osteoarthritis. After THA, all patients underwent X-ray examination and CT scan. Three physicians measured the anteversion angle of acetabular prosthesis using the arbitrary point method and the CT measurement method respectively, and repeated the measurements three times. The results of the two measurement methods were compared, and the intraclass correlation coefficient (ICC) was employed to assess the reproducibility of the methods. Results The anteversion angles of acetabular prosthesis were (15.87±7.73)° measured by the arbitrary point method, and (15.31±7.89)° measured by CT measurement method. There was no significant difference between the two methods (t=1.515, P=0.143). The ICC of the measurement results by the arbitrary point method for the three physicians were 0.97 (P<0.001), 0.96 (P<0.001), and 0.96 (P<0.001), respectively; and the ICC of the measurement results by CT method were 0.93 (P<0.001), 0.93 (P<0.001), and 0.94 (P<0.001), respectively. Conclusion The arbitrary point method for measuring the anteversion angle of acetabular prosthesis after THA based on pelvic X-ray film is easy to operate, accurate, and has high reproducibility.
Objective To study the correlation between the cervical posture in the cervical disc replacement (CDR) and the cervical curve restoration in neutral position after surgery. Methods Between January 2008 and August 2010, 51 patients underwent single segmental PRESTIGE LP replacement, and the clinical data were retrospectively analyzed. During the surgery, the patient was supinely placed and the lordosis of the cervical spine was mantained with a pillow placed beneath the neck. Of them, 28 were male and 23 were female, aged 30-64 years (mean, 45 years); 32 were diagnosed as having cervical spondylotic myelopathy, 7 having radiculopathy, and 12 having myelopathy and radiculopathy. The disease duration was 3-48 months (mean, 15 months). CDR was performed at C4, 5 in 5 cases, at C5, 6 in 42 cases, and at C6, 7 in 4 cases. The Cobb angles of the cervical alignment, targeted functional spinal unit (FSU), and targeted disc were measured by sagittal X-ray film of the cervical spine in neutral position before and after surgery, as well as the intraoperative C-arm fluroscopy of the cervical spine. Linear correlation and regression were performed to analyze the relation between cervical Cobb angle difference at intraoperation and improvement of the Cobb angles at 3 months after operation. Results The cervical Cobb angles at intraoperation and 3 months after operation were larger than those at preoperation (P lt; 0.05). The difference of the Cobb angle between intra- and pre-operation was (6.72 ± 9.13)° on cervical alignment, (2.10 ± 5.12)° on targeted FSU, and (3.33 ± 3.75)° on targeted disc. At 3 months after operation, the Cobb angle improvement of the cervical alignment, targeted FSU, and targeted disc was (6.30 ± 7.28), (3.99 ± 5.37), and (4.29 ± 5.36)°, respectively. There was no significant difference in the Cobb angle improvement between the targeted FSU and the targeted disc (t= — 0.391, P=0.698), and between the targeted disc and the cervical alignment (t= — 1.917, P=0.061), but significant difference was found between the targeted FSU and the cervical alignment (t= — 2.623, P=0.012). The linear correlation between the Cobb angle difference and the Cobb angle improvement of the cervical spine was observed (P lt; 0.05). Conclusion A slightly lordotic cervical posture during CDR is an important factor to maintaining normal physiological lordosis of the cervical spine after surgery.