ObjectiveTo summarize the current status and progress of the treatment of chronic lateral ankle instability (CLAI). MethodsThe literature about the anatomical repair of CLAI at home and abroad was reviewed and summarized. ResultsBroström and its modified operations are the most common surgical treatment of CLAI. The operations showed satisfactory clinical outcomes in the short-, medium-, and long-term follow-up and low complication rate. Suture anchor technique and arthroscopic techniques are gradually used in Broström and its modified operations with satisfactory short-term effectiveness, but long-term effectiveness needs further observation because of the limitation of the short clinical application time. ConclusionBroström and its modified operations are effective, convenient, and safe to treat CLAI. Based on the researches of biomechanics and dynamic anatomy, the more personalized design of the rehabilitation program is the further research direction.
Objective To evaluate the clinical results of bioabsorbable interference screw in knee ligament reconstruction. Methods From April 2002 to August 2004, 39 patients with knee ligament injury were treated, including 33 males and6 females with a median age of 25 years (15 to 65 years). The involved ligament included 29 anterior cruciate ligament of knee(ACL), 6 posterior cruciate ligament of knee(PCL)，4 combined ACL and PCL, 3 medial collateral or lateral collateral ligaments of knee point and 1 posterolateral complex injury of knee. All of patients underwent anatomic ligament reconstructions under arthroscopy or open surgery by autografts and fixation with bioabsorbable interference screw. Results All 34 patients were followed up 6 to 28 months (mean 13.7months). The patients were evaluated by Lysholm knee functional scales, the knee scores were 43.6±13.4 before operation and 85.4±16.3 after operation, showing significant difference (Plt;0.05). There was no limitation of rangeof motion and loosening of the screw. However, one case suffered from infection, and 3 cases suffered from effusion and synovitis after surgery and recovered after management. Conclusion Bioabsorbable interference screw fixation is a reliable method in knee ligament reconstruction and is effective to restore knee joint stability.
Objective To compare the short-term effectiveness of repairing distal tibiofibular syndesmosis with metal screws and absorbable screws. Methods A retrospective analysis was performed on the clinical data of 63 patients with ankle fracture combined with injury of the distal tibiofibular syndesmosis admitted between January 2017 and January 2020. Among them, 31 patients were treated with absorbable screw fixation of the distal tibiofibular syndesmosis (research group) and 32 patients were treated with metal screw fixation of the distal tibiofibular syndesmosis (control group). There was no significant difference in gender, age, cause of injury, surgical side, time from injury to operation, fracture type, preoperative visual analogue scale (VAS) score, and American Orthopaedic Foot & Ankle Society (AOFAS) score between the two groups (P>0.05). The operation time and fracture healing time were recorded and compared between the two groups. X-ray film was taken to evaluate the effect of ankle joint reduction and fixation. Olerud-Molander ankle fracture efficacy score (short for OM score), AOFAS score, and VAS score were used to evaluate the effectiveness. Results There was no significant difference in operation time between the two groups (t=−0.683, P=0.497). In the control group, 1 case of delayed healing and 1 case of poor healing occurred in the lateral incision after operation, which healed after dressing change; the rest of the patients had primary healing of the incision. Patients in both groups were followed up 12-24 months, with an average of 13.8 months. In the control group, 1 patient with fracture of pronation and external rotation walked with full weight bearing after removing the metal screw of the distal tibiofibular syndesmosis at 8 weeks after operation, the anatomical plate of the lateral malleolus was broken, and the lateral malleolus was fixed again and recovered after 5 months; 1 patient had mild ankle pain after operation, and the pain disappeared after removing the metal screw of the distal tibiofibular syndesmosis at 8 weeks. No complication such as nerve and blood vessel injury occurred in all patients. There was no significant difference in fracture healing time between the two groups (t=−1.128, P=0.264). The AOFAS and VAS scores significantly improved in both groups at 12 months after operation (P<0.05). There was no significant difference between the two groups in the OM scores, and the difference of AOFAS and VAS scores between before and after operation (P>0.05). Conclusion Using absorbable screws to repair the distal tibiofibular syndesmosis can effectively restore the ankle acupoint structure, prevent ankle instability, and restore good ankle function. There is no significant difference in effectiveness between absorbable screws and metal screws, and there is no need for secondary operation to remove screws.
ObjectiveTo summarize research progress on programmed death 1 (PD-1) and programmed death-ligand 1 (PD-L1) inhibitors and their combination therapies in colorectal cancer and to provide a new treatment direction for colorectal cancer.MethodThe relevant literatures on the application of the PD-1/PD-L1 inhibitors in the colorectal cancer in recent years were collected and reviewed.ResultsThe clinical trials of anti-PD-1/PD-L1 signaling pathway antibodies had made some achievements in the colorectal cancer, especially in the patients with high frequency microsatellite instability. And the combination therapy of multiple antibodies and the combination with chemotherapy and targeted therapies were more effective.ConclusionPD-1/PD-L1 inhibitors have some certain curative effects on survival of colorectal cancer with high frequency microsatellite instability, especially combination shows a better effect.
The shoulder joint is the most prone to dislocation in the whole body, and more than 95% of them are anterior dislocation. Improper treatment after the initial dislocation is easy to lead to recurrent anterior dislocation or anterior shoulder instability, and the outcomes following conservative treatment is poor. Anterior shoulder instability can damage the soft tissue structure and bone structure that maintain the stability of shoulder joint, among which bone structure is the most important factor affecting the stability of shoulder joint. Diagnosis should be combined with medical history, physical examination, and auxiliary examination. Currently, three-dimensional CT is the most commonly used auxiliary examination means. However, various bone defect measurement and preoperative evaluation methods based on three-dimensional CT and the glenoid track theory have their own advantages and disadvantages, and there is still a lack of gold standard. Currently, the mainstream treatment methods mainly include Bankart procedure, coracoid process transposition, glenoid reconstruction with free bone graft, Bankart combined with Remplissage procedure, and subscapular tendon binding tamponade, etc. Each of these procedures has its own advantages and disadvantages. For the diagnosis and treatment of anterior shoulder instability, there are still too many unknown, further research and exploration need to be studied.
ObjectiveTo evaluate the effectiveness of modified Ilizarov hip reconstruction in the treatment of hip instability.MethodsThe clinical data of 13 young patients with hip diseases treated with modified Ilizarov hip reconstruction between January 2010 and March 2018 were retrospectively analyzed. There were 2 males and 11 females, aged from 14 to 34 years, with an average age of 24.2 years. There were 1 case of hip dysplasia and dislocation due to spinal bifida, 3 cases of hip dysplasia after pyogenic arthritis of the hip, 2 cases of developmental dysplasiaof the hip (DDH) accompanying femoral head necrosis who rejected hip replacement, 6 cases of young DDH refused to undergo hip replacement, and 1 case of bilateral hip dysplasia with dislocation due to sputum cerebral palsy. The disease duration was 2-20 years, with an average of 8.5 years. Preoperative Trendelenburg sign was positive in 12 cases and negative in 1 case. The preoperative Harris score of hip joint was 53.5±8.9 and the unequal length of lower limbs was (46.08±15.73) mm. Postoperative Harris hip score and patients' satisfaction with effectiveness evaluated according to their self scoring were used to assess the effectiveness.ResultsAll 13 patients were followed up 1-5 years, with an average of 2.6 years. Five patients developed postoperative needle infection, which improved after dressing change; 7 patients had limited knee joint activity and improved after knee joint function training. The Trendelenburg sign was negative at 1 year after operation, and the patient’s hip pain symptoms were relieved or disappeared. The Harris hip score of patients at 1 year after operation was 84.5±6.1, which was significantly improved when compared with preoperative one (t=－10.538, P=0.000). According to Harris hip score, the effectiveness results were excellent in 4 cases, good in 5 cases, and fair in 4 cases, with an excellent and good rate of 69.2%. The unequal length of lower limbs was (15.38±7.27) mm, which was significantly better than that before operation (t=11.826, P=0.000). At last follow-up, the patients' satisfaction score was 80%-95%, with an average of 88%.ConclusionModified Ilizarov hip reconstruction can be used to treat young patients with hip disease who are unsuitable or refuse to undergo artificial hip replacement. Its effectiveness is reliable, and it has unique advantages in limb limp improvement and limb shortening correction.
Objective To assess the effectiveness of suture button fixation Latarjet procedure under total arthroscopy for anterior shoulder instability with severe bone defects. MethodsThe clinical data of 15 patients with severe bone defects and anterior shoulder instability treated with suture button fixation Latarjet procedure under total arthroscopy between June 2020 and February 2023 was retrospectively analyzed, including 11 males and 4 females, with an average age of 31.1 years (range, 20-54 years). Three-dimensional CT showed that the average glenoid bone defect was 24.4% (range, 16.3%-35.2%). The average number of shoulder dislocation was 4.2 times (range, 3-8 times). The disease duration ranged from 6 to 21 months with an average of 10.6 months. The operation time and intraoperative blood loss were recorded. The pain relief was evaluated by visual analogue scale (VAS) score, and the functional recovery of shoulder joint was evaluated by Rowe score, Walch-Duplay score, and American Association for Shoulder and Elbow Surgery (ASES) score before and after operation. The range of motion (ROM) of the shoulder joint was assessed, including active flexion, lateral external rotation, abduction 90° external rotation, and internal rotation. Three-dimensional CT was performed at 6 months after operation and at last follow-up to observe the absorption of bone graft, the position of bone graft and glenoid, and the healing of bone graft. Results The operation was successfully completed in all patients. The operation time was 85-195 minutes, with an average of 123.0 minutes. The intraoperative blood loss was 20-75 mL, with an average of 26.5 mL. All patients were followed up 13-32 months, with an average of 18.7 months. During the follow-up, there was no serious complication such as shoulder joint infection, joint stiffness, or vascular and nerve injury. One patient had partial absorption of the transplanted bone and bone nonunion at 3 months after operation, but the pain of the shoulder joint relieved at last follow-up, and no redislocation of the shoulder joint occurred; no obvious bone fracture or dislocation of the shoulder joint was found in the other patients. Bone union was achieved at 6 months during follow-up. At last follow-up, the VAS score, Rowe score, Walch-Duplay score, and ASES score significantly improved when compared with those before operation (P<0.05), while the ROM of active flexion, lateral external rotation, abduction 90° external rotation, and internal rotation of the shoulder joint was not significantly different from those before operation (P>0.05).ConclusionSuture button fixation Latarjet procedure under total arthroscopy can improve shoulder joint function in patients with severe anterior shoulder instability caused by bone defects, and imaging also indicates satisfactory placement of transplanted bone blocks.
Objective To discuss the effectiveness of operation technique for antero-medial rotatory instability (AMRI) of the knee joint caused by motorcycle. Methods Between June 2007 and December 2009, 32 cases of AMRI caused by motorcycle were treated. There were 28 males and 4 females with an average age of 35.5 years (range, 20-50 years). The interval between injury and surgery was 5-10 days (mean, 7 days). The anterior cruciate ligament (ACL) was injured at the attachment point of the condyles crest; the medial collateral ligament (MCL) was injured at central site in 19 cases, at medial condyles of femur in 10 cases, and at medial condyles of tibia in 3 cases, which were all closed injuries. The bone avulsion of condyles crest was fixed by steel wire and MCL was repaired. Results Red swelling and a little effusion occurred at the incision in 1 case, and the other incisions healed by first intention. Traumatic arthritis of the knee occured in 5 cases. Thirty-two cases were followed up 16-22 months (mean, 18.5 months). The X-ray examination showed that the fracture union time was 5-8 weeks (mean, 6 weeks) after operation. At last follow-up, the extension of knee joint was 0° and the flexion of the knee joint was 110-170° (mean, 155°). According to the synthetic evaluating standard of International Knee Documentation Committee, 24 cases were rated as A level, 6 cases as B, 1 case as C, and 1 case as D at last follow-up. Lysholm knee score was 85.93 ± 3.76 at last follow-up, which was significantly higher (t=53.785, P=0.000) than preoperative score 37.54 ± 3.43. Conclusion In patients with AMRI caused by motorcycle, steel wire is used to fix the bone avulsion of condyles crest and MCL should be repaired simultaneously as far as possible. And associating with the early postoperative functional exercise, the short-term effectiveness is satisfactory, but long-term effectiveness still need further follow-up observation.
ObjectiveTo investigate the effect of body mass index (BMI) on the outcome of posterior 360° fusion for single-level lumbar degenerative diseases. MethodsA retrospective study was carried on 302 cases of singlelevel lumbar degenerative diseases treated with posterior 360° fusion between September 2009 and September 2013. All patients were divided into 3 groups according to BMI: normal weight (BMI<24 kg/m2) in 105 cases (group A), overweight (24 kg/m2≤BMI< 28 kg/m2) in 108 cases (group B), and obese (BMI≥28 kg/m2) in 89 cases (group C). There was no significant difference in gender, age, disease duration, disease patterns, affected segments, preoperative Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) among 3 groups (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, and complications were recorded. The lumbar function was assessed by JOA score and ODI at pre- and post-operation (at 3, 6, and 24 months). ResultsThe operation time, intraoperative blood loss, and postoperative hospital stay of group C were significantly more than those of groups A and B (P<0.05), but no significant difference was found between group A and group B (P>0.05). The patients were followed up 24-45 months. Postoperative JOA score and ODI showed significant improvements in each group when compared with preoperative ones (P<0.05), but there was no significant difference among groups at each time point after operation (P>0.05). There was no significant difference in the incidence of total complications among 3 groups (χ2=3.288, P=0.193). The incidence of incision-related complications (infection and poor healing) in group C was significantly higher than that of groups A and B (P<0.05), but no significant difference was shown between group A and group B (P>0.05). However, there was no significant difference in cerebrospinal fluid leak, pseudarthrosis formation, and revision among 3 groups (P>0.05). ConclusionPosterior 360° fusion for single-level lumbar degenerative diseases can obtain good effectiveness in patients with different BMI, but patients whose BMI was ≥28 kg/m2 have longer operation time, more intraoperative blood loss, longer hospital stay, and higher incidence of postoperative incision-related complications.
ObjectiveTo evaluate the stability of the fixation technique for the crossed rods consisting of occipital plate and C2 bilateral lamina screws by biomechanical test.MethodsSix fresh cervical specimens were harvested and established an atlantoaxial instability model. The models were fixed with parallel rods and crossed rods after occipital plate and C2 bilateral laminae screws were implanted. The specimens were tested in the following sequence: atlantoaxial instability model (unstable model group), under parallel rods fixation (parallel fixation group), and under crossed rods fixation (cross fixation group). The range of motion (ROM) of the C0-2 segments were measured in flexion-extension, left/right lateral bending, and left/right axial rotation. After the test, X-ray film was taken to observe the internal fixator position.ResultsThe biomechanical test results showed that the ROMs in flexion-extension, left/right lateral bending, and left/right axial rotation were significantly lower in the cross fixation group and the parallel fixation group than in the unstable model group (P<0.05). There was no significant difference between the cross fixation group and the parallel fixation group in flexion-extension and left/right lateral bending (P>0.05). In the left/right axial rotation, the ROMs of the cross fixation group were significantly lower than those of the parallel fixation group (P<0.05). After the test, the X-ray film showed the good internal fixator position.ConclusionThe axial rotational stability of occipitocervical fusion can be further improved by crossed rods fixation when the occipital plate and C2 bilateral lamina screws are used.