Objective To investigate the feasibility and effectiveness of high tibial osteotomy (HTO) in treatment of chronic multi-ligament knee injury (MLKI) associated with lower extremity malalignment. Methods A clinical data of 14 patients (14 knees) of chronic MLKI associated with lower extremity malalignment, who were treated with HTO between January 2016 and September 2020, was retrospectively analyzed. There were 10 males and 4 females, with an average age of 30.5 years (range, 22-48 years). The causes of injury included traffic accident in 8 cases, bruising by a heavy object in 3 cases, falling from height in 2 cases, and twisting in 1 case. According to Schenck classification of knee dislocation (KD), there were 4 cases of KD-Ⅰ [2 cases of anterior cruciate ligament (ACL) and posterolateral complex (PLC) injuries and 2 cases of posterior cruciate ligament (PCL) and PLC injuries], 7 cases of KD-Ⅲ (all of ACL, PCL, and PLC injuries), and 3 cases of KD-Ⅳ. The preoperative hip-knee-ankle angle (HKA) was (167.1±4.7)°, and the posterior tibial slope angle (PTSA) was (16.3±2.7)°. The knee joint was severely unstable and the patients could not stand and walk normally. Among them, 5 cases of medial compartment cartilage were severely worn out (3 cases of Kellgren-Lawrence grading Ⅱ, 2 cases of grading Ⅲ) causing pain. After admission, 2 cases of KD-Ⅰ underwent HTO and ligament reconstruction in the first stage, 1 case of KD-Ⅲ and 1 case of KD-Ⅳ underwent HTO in the first stage and ligament reconstruction in the second stage; the remaining 10 patients only underwent HTO. Results All patients were followed up 12-50 months, with an average of 30 months. The incisions healed by first intention after operation, and no complications such as infection and deep vein thrombosis of the lower extremities occurred. At 12 months after operation, knee range of extension was –5°-0° (mean, –1.2°) and range of flexion was 110°-140° (mean, 125.5°). The Lachman test was negative in 11 cases and positive in 3 cases. The posterior drawer test was negative in 9 cases and positive in 5 cases. The 0/30° varus stress test was negative in 10 cases and positive in 4 cases. The 0/30° valgus stress test was negative in 13 cases and positive in 1 case. The visual analogue scale (VAS) score was significantly lower than that before operation (P<0.05), and the International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner score were all significantly higher than those before operation (P<0.05). The X-ray film reexamination at 12 months after operation showed that the HKA was (178.2±3.8)° and the PTSA was (8.6±2.4)°, which were significantly different from those before operation (P<0.05). All osteotomies achieved bone union, and the healing time was 3-11 months, with an average of 6.8 months. Conclusion For chronic MLKI associated with lower extremity malalignment, HTO can restore normal lower extremity alignment and improve knee joint function, which is a feasible salvage operation.
OBJECTIVE: To introduce the operation method of treatment of nonunion of scaphoid bone by transfer of pedicled radial periosteal bone flap. METHODS: From Match 1986, 26 cases with old nonunion of scaphoid bone were treated by transfer of radial periosteal bone flap pedicled with recurrent branch of radial artery, the size of bone flap was 1.0 cm x 0.4 cm x 0.5 cm. RESULTS: All patients with old nonunion of scaphoid bone were healed by first intention, bone union was occurred after 2 to 3 months of operation, and wrist joint almost recovered normal function. CONCLUSION: It is an effective operation method to treat nonunion of scaphoid bone.
Objective To observe the effectiveness of the combination of dynamic and static stabil ity in the treatment of old knee medial collateral l igament injury. Methods Between March 2004 and June 2008, 26 cases of old knee medial collateral l igament injury were treated, including 19 males and 7 females with a mean age of 38 years (range, 21-48 years). Injury was caused by traffic accident in 6 cases, by sprains in 12 cases, by fall ing from height in 8 cases. The location was left knee in 15 cases and right knee in 11 cases. Of them, 24 patients showed the positive result of knee valgus test, 2 cases showed sl ightly relaxed knee tendon. The knee X-ray films of valgus stress position showed that the medial joint space differences between both knees were 3-5 mm in 2 cases and 5-12 mm in 24 cases. The injuries included avulsion of the medial femoral condyle starting point in 19 cases, central laceration in 6 cases, and tibial point laceration concomitant meniscus injury in 1 case. The time from injury to hospital ization was 3-14 months (mean, 6.4 months). Gracil is muscle was used to repair knee medial collateral l igament and the sartorius muscle transfer to reconstruct the medial rotation of knee stabil ity function. Results All incisions healed by first intention. No joint infection, deep vein thrombosis, or other postoperative compl ications occurred. Twentysix cases were followed up 12-58 months with an average of 30 months. The results of knee valgus stress test were negative with no joint tenderness. At 3 months after operation, the knee X-ray films of valgus stress position showed the medial joint space differences between both knees were less than 1 mm. According to the modified Lysholm-Scale score, the results were excellent in 18 cases, good in 7 cases, and fair in 1 case with an excellent and good rate of 96% at last follow-up. Conclusion A combination of dynamic and static stabil ity in repairing old knee medial collateral l igament injury is easy-to-operate and has the advantages to perform the operation in the same incision, so it can avoid the shortcomings of single repair method and achieve better effectiveness.
Objective To investigate effects of the autologous bone mesenchymal stem cells (MSCs) enriched by the small intestinal submucosa (SIS) film implantation on the myocardial structure, cardiac function, and compensator y circulation after myocardial infarction in the goats. Methods Sixteen black goats were selected and divided randomly into the control group (n=8)and the experimental group (n=8). The chronic myocardial infarction models were made by the ligation of the far end of the left anterior desc ending coronary artery. At the same time, MSCs were aspired from the thigh bone of the goats in the experimental group. MSCs were isolated by the centrifu gation through a percoll step gradient and purified by the plating culture and depletion of the non-adherent cells. Primary MSCs were cultured in the DMEM me dium supplemented with the fetal bovine serum in vitro. After that, the cultures were labeled by 5- BrdU. The active cells were transplanted into the SIS film. Six weeks after the ligation, the MSCs-SIS film was implanted by its being sutured onto the infarction area; whereas, the control group underwent a shamoperation. In both groups, echocardiographic measurements were performed before infarction, 6 weeks after infarction and 6 weeks after the MSC-collagen mplantion, respectively, to assess the myocardial structure and ca rdiac function. The left coronary artery angiography was performed with the digi tal subtraction angiography. Results In an assessment of the left ventricular function, at 6 weeks after operation, t he stroke volume and the ejection fraction of the control group and the experim ental group were 42.81±4.91, 37.06±4.75 ml and 59.20%±5.41%, 44.56%±4.23%, respectively (Plt;0.05). The enddisatolic volume and the endsystolic volume of the control group and the experimental group were 72.55±8.13, 83.31±8.61 ml and 29.75±5.98, 46.25±6.68 ml, respectively (Plt;0.05). The maximal velocity of peak E of contral group and experimental group were 54.8 5±6.35 cm/s and 43.14±4.81cm/s (Plt;0.01); and the maximal velocity of peak A o f control group and experimental grouop were 52.33±6.65 cm/s and 56.91±6.34 cm/s (Pgt;0.05). Echocowdiogr aphy sho wing a distinctly dilatation of left ventricle with the ventricular dyskinesia i n contral group, but without the ventricular dyskinesia in experimental group. T he selective-coronary evngiography revealed that the obvious compensatory circu l ation established between the anterior descending branch and the left circumflex branch in the experimental group. Conclusion Implantation of the autologus MSCs enriched by the SIS film can prevent dilatation of the left ventricular chamber and can improve the contractile ability of the myocardium, cardiac function, and collateral perfusion.
Old achilles tendon rupture accompanied by skin defect was a common amp; annoying problem in clinic. From June, 1985 to June, 1996, 18 cases with this kind of injury were treated by one stage repair of the tendon and skin defect. In this series, there were 15 males and 3 females, the length of tendon defects were ranged from 4 cm-6.1 cm, and the area of skin defect were ranged from 5.9 cm x 3 cm to 8.2 cm x 6 cm. The procedures were: (1) to debridement of the wound thoroughly; (2) to repair the achilles tendon; (3) to repair the skin defect with kinds of pedicle flap; (4) immobilization of ankle and knee for 6 weeks. No infection was occured after the operation. The flaps survived in all cases. After follow-up for one year in 15 cases, 12 patients went back to their work. It was concluded that (1) achilles tendon rupture should be treated carefully and properly during the emergency operation; (2) different methods should be selected according to the length of tendon defect; (3) because of its high survival and retained sensation after operation, the flap pedicled with posterior lateral malleolar artery is the best choice for repairing the skin defect.
Objective To introduce an effective method of treating old scaphoid fracture. Methods From April 1995 to April2002,11 patients with old scaphoid fracture were treated with transposition of vascularized periosteal flap and internal fixation; if necessary, the radial styloid was removed. Out of 11 patients( 8 males and 3 females, aged from 17 to 46 years), the fracture siteswere medialscaphoid in 7, the proximal one in 2 and the distal one in 2. The X-ray filmsshowed separated fracture lines. The fracture lines were less than 1 mm in 4patients and more than 1 mm in 3 patients. Sclerosis of skeleton ends and cystoid degeneration occurred in 2 patients, respectively. Results After a follow-up of 3 to 24 months, the fracture healing was obtained within 4 months in 9 casesand within 6 to 7 months in 2 cases. Internal fixation was taken out 3 months after bone healing. The carpal joint pain and weakness vanished in all cases.Conclusion Transposition of vascularized periosteal flap and internal fixation have many advantages, such as easy dissection, rich blood supply, quick new bone formation, short time of fracture healing and satisfactory function recovery of carpal joint.
ObjectiveTo investigate the effectiveness of autogenous tendon reconstruction under total arthroscopy in the treatment of chronic Achilles tendon rupture.MethodsBetween June 2015 and June 2018, 16 patients with chronic Achilles tendon ruptures were treated by autogenous tendon reconstruction under total arthroscopy. Of the 16 patients, 11 were males and 5 were females. Their mean age was 40.7 years (range, 21-55 years). The disease duration was 14-20 months (mean, 16.4 months). Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 41.2±2.2 and the pain visual analogue scale (VAS) score was 7.9±1.2. MRI and B-ultrasonography examinations showed that the Achilles tendon was not continuous. The length of Achilles tendon defect was 5.0-10.3 cm, with an average of 5.8 cm. The rupture of the Achilles tendon happened on top of the insertion of the tendon in 4 cases and at the tendon-muscle belly connection in 12 cases. The operation time, intraoperative blood loss, hospital stay, and related complications were recorded. The AOFAS score and VAS score were used to evaluate the improvement of ankle joint function and pain.ResultsThe average operation time was 77.2 minutes (range, 60-90 minutes). The average intraoperative blood loss was 20.5 mL (range, 15-30 mL). The average hospital stay was 7.2 days (range, 5-10 days). All incisions healed by first intention. There was no skin necrosis, infection, or deep vein thrombosis. All the patients were followed up 8-18 months, with an average of 12 months; and 10 cases were followed up more than 12 months. During the follow-up, there was no Achilles tendon re-rupture, and the symptoms of pain and heel lifting failure significantly improved. MRI reexamination showed that the continuity of Achilles tendon recovered. At 1, 3, 6, and 12 months postoperatively, AOFAS scores significantly improved and VAS scores significantly reduced, except for 1 month postoperatively, the scores at other time points were superior to that before operation, the differences were significant (P<0.05).ConclusionAutogenous tendon reconstruction under total arthroscopy in the treatment of chronic Achilles tendon rupture has the advantages of small trauma, rapid functional recovery, and satisfactory surgical efficacy.
Abstract To understand the femoral head activity in old fracture of femoral neck, 159 cases from 1982 to 1994 were observed through X-ray film, pathological sections, transparent electronic microscope, tetracycline label technique and ECT examination. The results showed that under a status without stress, the avascular femoral head tended to be repaired in its natural way. The collapse of femoral head was caused by stress to some extent duringthe active repair process. Great attention should be paid in treating fracture of femoral neck that load should never be put on the femoral head during the process of fracture healing.
ObjectiveTo explore the clinical effect of total hip arthroplasty (THA) in the treatment of old central dislocation of the hip joint. MethodsBetween January 2010 and June 2014, 21 patients (21 hips) with old central dislocation of the hip joint underwent THA and autologous bone graft for acetabulum reconstruction. There were 13 males and 8 females, aged 60-75 years (mean, 67.4 years). The left hip was involved in 12 cases and the right hip in 9 cases, with a disease course of 1-20 years (mean, 9.6 years). The causes were falling from height in 6 cases, traffic accident in 9 cases, crushing in 4 cases, and others in 2 cases. Hip pain, limited activity, and lameness were the main clinical symptoms. Preoperative Harris score was 32.95±2.06 and visual analogue scale (VAS) was 8.14±0.73. ResultsPrimary healing of incision was obtained in all patients. The patients were followed up 1.9-6.4 years (mean, 4.6 years). The X-ray films showed bone graft fusion at 4-24 months (mean, 12.5 months); there were no complications of grafted bone absorption, osteolysis, and infection. During follow-up, no prosthetic loosening or sinking, and no translucent zones around the prosthesis were observed. Harris score was significantly improved to 87.67±2.01 at 1 week and 92.10±1.95 at 1 year; and VAS score was significantly decreased to 2.57±0.81 at 1 week and 0.19 ±0.51 at 1 year (P < 0.05). ConclusionTHA is an effective surgical treatment for old central dislocation of the hip joint, because it can restore normal hip rotation center and reconstruct the hip joint function.