Abstract The fracture of the prosthetic stem after prosthetic replacement of femoral head is not rare. In this study, the photoeastic instrument was used to study the stress distribution on the prosthetic stem following its insertion and to analyse the factors influencing the fracture of the stem. Through the examination of 9 places in 8 cases, it was found that:(1) The removal of femoral calcar and the inframedullary filling of the bone cement directly influenced the stress distribution. (2) The valgus or varus condition of the prosthesis would lead to stress concentration on the stem. (3) Once lossening of the prosthesis occured it would change the preliminary installingstress distribution in the upper femur which would lead to fatigue fracture. Ths experimental data and clinical observation would provide scientific basis forthe prevention of fracture of prosthetic stem following prosthetic replacement of femoral head.
ObjectiveTo evaluate the clinical value of multi-slice CT in the diagnosis of complications due to breast augmentation. MethodsWe collected the imaging data of 32 female patients who accepted multi-slice CT examination in the second People's Hospital of Chengdu after breast augmentation between February 2010 and February 2015. The position, shape, edge, internal density, leakage, rupture and hard nodules of the prosthesis were observed and analyzed carefully. ResultsIn the 32 patients with breast augmentation, 12 were normal with bilateral symmetry and without abnormal shape or density. Among the other 20 patients, 11 had capsular contracture, 5 had prosthesis leakage, rupture and hard nodules, 4 had breast infection, 1 had fibroadenoma, 1 had cystoma, and 5 had little calcified nodules in the breast tissue. ConclusionThe multi-slice CT scan can clearly and accurately show the position, shape and size of the breast prosthesis as well as the existence of leakage, rupture and hard nodules in the prosthesis. It plays a very important role in the diagnosis of the complications due to breast augmentation and can be effective guidance for clinical operation.
OBJECTIVE To review the history and current status of total wrist arthroplasty. METHODS The original articles about wrist arthroplasty in recent years were reviewed. RESULTS The properties of wrist prosthesis of different generations were reviewed, with the emphasis on the prosthesis design and biomechanical behaviours. The surgical techniques, complications and salvage procedures were also discussed. CONCLUSION Although wrist arthrodesis is highly successful in treating the end-stage wrist arthritis, total wrist arthroplasty using well-designed prosthesis remains an alternative for the patients with special demands of hand functions.
Objective To probe a satisfactory surgical management of the limbsalvage for osteogenic malignant tumors around the knees. Methods From January1989 to December 2001, 42 patients (19 males and 18 females, aged 12-46) with osteogenic malignant tumors around the knees underwent surgical management of the limb salvage, including prosthesis replacement, allogenous bone grafting, and bone cement with adriamycin filled. Based on the pathological examination, osteosarcoma was found in 11 patients, synoviosarcoma in 4 patients, malignant fibrous histiocytoma in 3 patients, and giant cell tumor of the bone in 19 patients. All the patients underwent neoadjuvant chemotherapy for 1-2 courses before operatioexcept the patients with giant cell tumor of the bone. The patients underwent prosthesis replacement, allogenous bone grafting, bone cement with adriamycin filled, and postoperative chemotherapy. By the Enneking evaluating system, the patients were assessed on their reconstructed limb functions after the reconstructive operation for the musculoskeleta malignant tumors. Of the patients, 37 were followed up after operation. Results According to the follow-up for 3-11 years (mean, 5.6 years) in the 37 patients, 2 patients had recurrence and metastasis of the tumor, and died 3 and 4 years after operation, respectively. One patient underwent amputation of the limb for local recurrence of the tumor. One patient had amputation of the limb for the preoperative radiotherapy and the infection and necrosis of the operative wound after the limb-salvage surgery. Two patients had amputation of the limb for the rejection of the allogenous bone graft and theformation of the fistula.Thirty-one patients had good wound healing andgood functions of the limb. The results were evaluated by the Enneking evaluating system as follows: excellent in 7 patients, good in 14, fair in 10, and poor in 6. Conclusion Making an early diagnosis, recognizing the operative indication, choosing the operative method, and performing the preoperative and postoperative chemotherapy and/or radiotherapy are the keys to achieving an ideal limb-salvage surgery for osteogenic malignant tumors around the knees.
After freatment of prosthesis replacement for 12 malignant tumer of the proximal humoral werereported. The operation were performed after the indications and methods of treatment had beendefined. All of the 12 cases were followed-up, in the average of 8 yeare. On functional evaluation , 8cases had satisfactory result , but per in 1 cases and 3 cases died from recurrence or metastasis withinfive years. The indieation of the procthetic replantation, the complications, and revision weredisecused.
ObjectiveTo investigate the effect of preoperative valgus or varus deformity on the prosthesis installation and alignment restoration in total knee arthroplasty (TKA). MethodsBetween January 2012 and December 2013, 198 patients (245 knees) with osteoarthritis underwent primary TKA, and the clinical data were retrospectively analyzed. There were 23 males and 175 females, with the average age of 67 years (range, 43-90 years). Single knee and double knees were involved in 151 and 47 cases respectively. The disease duration was from 1 month to 30 years (mean, 8.99 years). The anteroposterior X-ray films of whole lower limbs were taken, and the femorotibial angle (FT) was measured before operation and at 1 week after operation; the mechanical femoral angle (MF) and the anatomical tibial angle (AT) at 1 week after operation were measured. The correlation analysis was made for pre-and post-operative FT, MF, and AT. According to the valgus or varus deformity before operation, all patients were divided into 5 groups:≥20° varus (group A), 10-20° varus (group B), ≤10° varus (group C), < 10° valgus (group D), and≥10° valgus (group E), and the above indicators were compared between groups. And the rate of the good limb alignment was recorded after operation. ResultsThe pre-and post-operative FT were (171.53±9.12) and (177.38±3.57)° respectively, and postoperative MF and AT were (89.00±2.68) and (88.62±2.16)° respectively. Preoperative FT was associated with postoperative FT and MF (r=0.375, P=0.000; r=0.386, P=0.000), but it was not correlated with AT (r=0.024, P=0.710). Postoperative FT was associated with MF and AT (r=0.707, P=0.000; r=0.582, P=0.000). Postoperative FT was significantly increased when compared with preoperative FT in each group (P < 0.05). There were significant differences in preoperative FT between groups (P < 0.05). There were significant differences in postoperative FT when compared group A with groups B, C, D, and E (P < 0.05), and when compared groups B and C with groups D and E (P < 0.05), but there was no significant difference between groups B and C, and between groups D and E (P>0.05). The rate of good alignment was 70.2% (172/245); it was 27.8% (5/18), 66.0% (62/94), 74.4% (67/90), 88.9% (32/36), and 85.7% (6/7) in groups A, B, C, D, and E respectively, showing significant differences between groups (P < 0.05). There was no significant difference in postoperative AT between groups (P>0.05). Except for between group D and group E (P>0.05), significant difference in MF was shown between the other groups (P < 0.05). ConclusionThe more severe deformity of lower limb before TKA, the higher risk of deviation for prosthesis installation and poor alignment in TKA.
ObjectiveTo investigate the accuracy and value of digital planning with bone parameters in determining the appropriate prosthesis for total hip arthroplasty (THA). MethodsThe preoperative radiographs was taken in 13 cases scheduled for THA between September 2012 and June 2013; the bone parameters were measured by digital template, and the prosthesis was selected and preoperative plan was made. There were 4 males and 9 females with an average age of 54.08 years (range, 41-79 years), including 8 left hips and 5 right hips. The causes were osteonecrosis of the femoral head in 8 cases and femoral neck fracture in 5 cases (3 cases had osteonecrosis of the femoral head). ResultsThe operation time was 140-254 minutes (mean, 191.8 minutes). Two cases received blood transfusion, and 6 patients received plasma substitutes transfusion. There was no intraoperative fractures or postoperative thrombosis; atherosclerotic plaque occurred in 2 cases. Thirteen cases were followed up 12-24 months with an average of 17.3 months. The pain was relieved and limb function was improved in all patients. Harris score was significantly improved from preoperative 54.0±12.9 to 91.1±4.1 at 3 months after operation (t=7.259, P=0.000). Compared with the actual implants, the appropriate sizes of femoral stem was selected in 12 cases (92.31%) (excellent in 9 cases, good in 3 cases, and poor in 1 case), and the appropriate sizes of acetabular cup was selected in 11 cases (84.62%) (excellent in 7 cases, good in 4 cases, and poor in 2 cases). ConclusionDigital planning could increase the accuracy in choosing the size of prosthesis for THA.
ObjectiveTo discuss the influence of early postoperative hemodynamic, postoperative mortality and the incidence of adverse cardiovascular events with the phenomenon of prosthesis-patient mismatch. MethodsWe retrospectively analyzed the clinical data of 89 patients who had simple aortic valve replacement in our hospital bewteen January 2012 and January 2014. The 89 patients were divided into two groups including a match group (16 females and 48 males with average age of 58.1±10.4 years) and a mismatch group (15 females and 10 males with average age of 65.3±12.8 years). We compared early results between the two groups. ResultsThere is a statistic difference (P < 0.05) in aortic flow velocity, mean pressure gradient, and the maximum pressure gradient between the two groups. The survival rate of the match group is significantly lower than that of the mismatch group (P < 0.05). And there is a statistical difference in adverse cardiovascular event-free incidence between the two groups (P < 0.001). ConclusionThe phenomenon of prosthesis-patient mismatch can affect postoperative hemodynamic and lead to heart failure after surgery. And early mortality and the incidence of cardiovascular adverse events in patients are increased due to prosthesis-patient mismatch.
ObjectiveTo review the current development in therapy of congenital funnel chest. MethodsRecent literature concerning the development of the treatment method for congenital funnel chest was extensively reviewed and summarized. ResultsThe main therapies for congenital funnel chest are thoracoplasty (Ravitch sternum elevation procedure and minimal invasive Nuss procedure) and prosthesis implantation. The magnetic mini-mover procedure and the vacuum bell are still in the research phase. ConclusionBesides the improvement in function, the requirement in appearance after surgery is also improved in the treatment of congenital funnel chest. The minimally invasive surgery and non-invasive procedures could be expected in the future.
Heart valve replacement is the major surgical treatment of severe valvular diseases. Due to the durability and reoperation-free, mechanical valves are widely used. Bioprosthesis valves became popular recently because of long service life and no demand for lifelong anticoagulation. However, how to choose the appropriate prosthetic heart valves, especially the application of bioprosthesis valves for patients at 55 to 65 years is still a major problem. This review focuses on more effective and scientific basis for rational choice of mechanical and bioprosthesis valve.