Objective To discuss the effectiveness of antibiotic-impregnated cement temporary spacer for osteomyel itis and nonunion of bone caused by intramedullary fixation. Methods Between June 2002 and May 2006, 12 patients with chronic osteomyel itis and nonunion of bone caused by intramedullary nail ing were treated, including 8 males and 4 females with an average age of 40.2 years (range, 26-53 years). The fracture locations included tibia in 7 cases and femur in 5cases. Infection occurred within 2 weeks after intramedullary fixation in 7 cases and within 3 months in 5 cases. The mean time from infection to admission was 5 months (range, 1-24 months). The results of bacteria culture were positive in 10 cases and negative in 2 cases. White blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were higher than normal values. An antibiotic-impregnated cement temporary spacer was inserted after removal of biomembrane and internal fixator, thorough debridement and irrigation. After osteomyel itis was controlled by antibiotic therapy postoperatively, two-stage bone transplantation and internal fixation were performed after 3 to 6 months. Results All wounds healed by first intention without early compl ication. All cases were followed up 24 to 48 months (mean, 34 months). WBC count, ESR, and CRP were normal at 3 months postoperatively. The X-ray films showed the fracture heal ing at 10-14 weeks after operation (mean, 12 weeks). Expect one patient had knee range of motion of 90°, the lower l imb function of the others returned to normal. No infection recurred during follow-up. Conclusion Antibiotic-impregnated cement temporary spacer could control osteomyelitis and nonunion of bone caused by intramedullary nail ing, and two-stage bone transplantation and internal fixation after osteomyelitis is an effictive and ideal way to treat osteomyelitis and nonunion of bone caused by intramedullary nail ing.
Objective To explore the way and therapeutic effect of one stage total hi p replacement (THR) intreating ischemic necrosis of femoral head combined with intertrochanteric fracture. Methods From July 1997 to September 2005, one stage THR was performed in 18 cases (11 left and 7 right) of ischemic necrosis of femoral head combined with fresh intertrochanteric fracture, including 13 males and 5 females, with an age range of 32-60 years. There were 11 primary cases, 2 cases of ankylosing spondyl itis, 2 cases of rheumatic arthritis, 2 cases of congenital acetabular dysplasia and 1 case of femoral neck fracture fixed using cannulated cancellous screws postoperatively in all cases of ischemic necrosis of femoral head. They suffered from ischemic necrosis of femoral head for 8 years (4-23 years). According to Evan’s intertrochanteric fracture classification, there were 4 cases of type II, 6 cases of type III, 5 cases of type IV and 3 cases of type V. According to the Ficat ischemic necrosis of femoral head classification, there were 5 cases of type III, and 13 cases of type IV. The disease course was 2-12 hours. The average value of Harris evaluation was 35.2 preoperatively. The prosthesis of biology was used. Results All wounds healed by first intention. One case suffered deep venous thrombosis 3 days postoperatively and recovered completely after treatment. No infection of urinary system and lung as well as no bedsore occurred postoperatively. The X-ray films showed that the fracture ends healed and that prosthesis had good form attitude and position after 4 months of operation. All cases were followed up for 2 years. They could walk and take care of themselves after 6 months. The average value of Harris evaluation was 94.7 points postoperatively (P lt; 0.05). The results were excellent in 15 cases, good in 2 cases, fair in 1 case according to Harris evaluation standard of THR; the excellent and good rate was 94.4%. Conclusion One stage THR for treating ischemic necrosis of femoral head combined with intertrochanteric fracture can avoid secondary operation. It could resume the ideal function of the hip joint.
【Abstract】 Objective To investigate the effectiveness of the vacuum sealing drainage (VSD) technique with split middle thickness skin replantation for the treatment of severe skin closed internal degloving injury (CIDI). Methods Between July 2008 and April 2011, 16 patients with severe skin CIDI were treated. There were 11 males and 5 females, aged 17-56 years (mean, 28 years). Injury was caused by traffic accident in all cases. The time between injury and operation was 2-8 hours (mean, 5 hours). Peeling skin parts included the upper limb in 3 cases and the lower limb in 13 cases. The range of skin exfoliation was 5%-12% (mean, 7%) of the body surface area with different degree of skin contamination. After thorough debridement, exfoliative skin was made split middle thickness skin graft for in situ replantation, and then VSD was performed. Results After 7 days of VSD therapy, graft skin survived successfully in 14 cases; partial necrosis of graft skin occurred in 2 cases, and was cured after thorough debridement combined with antibiotics for 7 days. All patients were followed up 6-18 months (mean, 12 months). The appearance of the limb was satisfactory without obvious scar formation, and the blood supply and sensation were normal.The joint function was normal. Conclusion For patients with severe skin CIDI, VSD treatment combined with split middle thickness skin replantation can improve the local blood circulation of the limb, promote replantation skin survival, and shorten healing time of wound. The clinical effectiveness is satisfactory.
Objective To investigate the operative method of trabecular metal rod implant for the treatment of the early adult avascular necrosis of the femoral head (ANFH) and its cl inical efficacy. Methods From March 2005 to January 2007, 28 patients of ANFH were treated by trabecular metal rod implant, including 18 males and 10 females aged 18-56 years old (average 30.6 years old). The ANFH was induced by trauma in 7 cases, steroid in 10 cases, alcohol in 5 cases and unknownreason in 6 cases. There were 22 cases of unilateral ANFH and 6 of bilateral ANFH, involving 18 left hips and 16 right hips. According to Association Research Circulation Osseous (ARCO) international classification of osteonecrosis launched in 1997, 16 cases (16 hips) were classified as stage I, 12 cases (15 hips) as stage I, 1 case (1 hip) as stage III and 2 cases (2 hips) as stage IV. Harris score was 50.3 ± 2.2 preoperatively. The course of disease was 12-24 months (average 16 months). Results All wounds healed by first intention, and no postoperative compl ication occurred. All the cases were followed up for 18-36 months (average 26 months). The pain and functional l imitation of patients were improved significantly. The Harris score was 85.7 ± 2.4 18 months after operation, showing a significant difference when compared with preoperative score (P lt; 0.05). Twenty-three cases were graded as excellent, 3 as good and 2 as fair, with the excellent and good rate of 92.86%. Conclusion Trabecular metal rod implant is an effective method for the treatment of early ANFH and can minimize the occurrence of compl ications, but the follow-up observation of its long-term herapeutic effect is still needed.
ObjectiveTo evaluate the effectiveness of Oxford mobile-bearing bipolar prosthesis unicompartmental knee arthroplasty (UKA) in the treatment of single compartmental knee osteoarthritis. MethodsBetween June 2011 and July 2013, 22 cases of single compartmental knee osteoarthritis were treated by Oxford mobile-bearing bipolar prosthesis UKA. Of 22 cases, 8 were male and 14 were female with an average age of 65 years (range, 45-80 years); the left knee was involved in 12 cases, and the right knee in 10 cases, with a mean disease duration of 32.5 months (range, 8-90 months). The mean weight was 55.2 kg (range, 50-65 kg), and the mean body mass index was 20.8 kg/m2(range, 17-25 kg/m2). Osteoarthritis involved in the single knee medial compartment in all patients. Knee society score (KSS) and range of motion (ROM) were measured to evaluate the knee joint function. ResultsPrimary healing of incision was obtained in all patients, and there was no complication of infection, bedsore, or deep venous thrombosis. Postoperative follow-up was 2-4 years (mean, 3.2 years). The X-ray films showed good position of prosthesis, no prosthesis dislocation, or periprosthetic infection during follow-up. Knee ROM, KSS function score, and KSS clinical score were significantly improved at 1 week after operation and at last follow-up when compared with preoperative ones (P＜0.05), but no significant difference was shown between at 1 week and at last follow-up (P>0.05). ConclusionOxford mobile-bearing bipolar prosthesis UKA is an effective method to treat single compartmental knee osteoarthritis, with the advantages of less trauma, earlier rehabilitation exercise, near physiological state in joint function, and less risk of complications.
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.
ObjectiveTo explore whether unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) or bilateral TKAs should be performed in patients with bilateral knee osteoarthritis.MethodsBetween April 2015 and February 2017, 24 patients with bilateral knee osteoarthritis who met the selection criteria were included in the study and randomly divided into 2 groups (n=12). The patients in observation group were treated with TKA of the multicompartmental osteoarthritis knee in the first-stage operation and UKA of the unicompartmental osteoarthritis knee in the second-stage operation; and the patients in control group were treated with bilateral TKAs in staging operation. The operation time, the amount of postoperative drainage, and the time of active flexion of the knee joint at 90° were recorded. The difference of hemoglobin (Hb) before and after the second-stage operation was recorded, and the decrease of Hb was observed. The hospital stay after the second-stage operation was observed. The Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, and range of motion (ROM) were recorded at 7 days after the first-stage operation, and at 15 days, 45 days, and 6 months after the second-stage operation. At 1 year after the second-stage operation, the mean values of the above indexes of both knees were taken as the individual comprehensive evaluation. The X-ray films were taken regularly to examine the prosthesis and lower extremity force line. ResultsThe incisions in both groups were healed by first intention after two stage operations. The differences in the operation time, the amount of postoperative drainage, and the time of active flexion of the knee joint at 90° between the two groups were not significant in the first-stage operation (P>0.05) and were significant in the second-stage operation (P<0.05). The decrease of Hb and hospital stay after the second-stage operation were significantly lower in observation group than in control group (P<0.05). Both groups were followed up, the follow-up time was 12-18 months (mean, 14 months) in observation group and 12-21 months (mean, 16 months) in control group. During the follow-up period, X-ray films showed that the prosthesis positions of both sides were normal as well as the alignment line, and no infection, loosening or dislocation of prosthesis occurred. There was no significant difference in HSS score, VAS score, and ROM of multicompartmental osteoarthritis knee at 7 days after the first-stage operation between the two groups (P>0.05), indicating that the two groups were still comparable. The HSS score, VAS score, and ROM of unicompartmental osteoarthritis knee in observation group were superior to control group (P<0.05) after the second-stage operation. At 1 year, the HSS score, VAS score, and ROM in observation group were also superior to control group (P<0.05).ConclusionOn the premise of strict indications, the patients with bilateral knee osteoarthritis should be treated according to their own pathological changes in order to obtain better short-term effectiveness.
Objective To evaluate the effectiveness of one-stage total knee arthroplasty (TKA) for femoral supracondylar fracture combined with knee osteoarthritis. Methods Between January 2012 and March 2015, a total of 19 patients (19 knees) with femoral supracondylar fracture and knee osteoarthritis were treated with one-stage TKA. Of 19 cases, 8 were male and 11 were female with an average age of 69.6 years (range, 60-85 years). The mean body mass index was 22.6 kg/m2 (range, 22.0-27.5 kg/m2). The left knee was involved in 13 cases, and the right knee in 6 cases. The causes of femoral supracondylar fracture were falls in 10 cases, traffic accidents in 8 cases, and other injury in 1 case. All fractures were classified as type A according to AO/Association for the Study of Internal Fixation (AO/ASIF) classification. The interval of injury and operation was 4-13 days (mean, 8.6 days). The disease duration of osteoarthritis ranged from 30 to 90 months (mean, 52.6 months). During follow-up, the knee society score (KSS) and the range of motion (ROM) were used to evaluate the knee function; anteroposterior and lateral X-ray films of the knee were used to observe the position of the prosthesis. Results All the incisions healed at the first stage, and there was no early complication such as pulmonary infection, pressure ulcer, and urinary tract infection. All patients were followed up 2-4 years with an average of 2.6 years. The ROM and KSS functional scores and clinical scores were significantly improved at 15 days and 2 years after operation, showing significant differences when compared with those before operation (P<0.05). There were significant differences in the ROM and KSS functional scores and clinical scores between two time points after operation (P<0.05). X-ray films showed the fracture bone healing, good alignment, no loosening of prosthesis at 2 years after operarion. Conclusion One-stage TKA for femoral supracondylar fracture combined with knee osteoarthritis can achieve good effectiveness. It can not only reconstruct joint function, but also cure osteoarthritis and fracture at the same time, shorten the healing time, reduce the incidence of related complications.
Objective To investigate the relationship between the initial stabil ity and infected loosening of the total hip arthroplasty (THA) prosthesis. Methods From January 2000 to December 2008, 110 cases (110 hips) were treated with THA revision. Among them, 15 cases (15 hips) were confirmed infected loosening. There were 8 males and 7 females with anaverage age of 62 years (range 42-75 years). The infected signs were found from 6 months to 2 years after initial THA. All of them had Tsukayama type IV and late infection, including 6 cases of acetabular infected loosening (5 cases of one-stage and 1 case of two-stage acetabular revision), 7 cases of simple infected loosening of femoral prosthesis (4 cases of one-stage and 3 cases of twostage femoral prosthesis revision), and 2 cases of joint capsule infection and sinus without prosthesis loosening (debridement and continuous irrigation). Results All incisions healed by first intention. Fifteen patients were followed up for 12 to 36 months (average 24 months). In 13 cases of revision, postoperative X-ray films showed that femoral acetabular prostheses were in good position, and had no cl inical and imaging infective signs of loosening. In 2 cases of joint capsule infection, sinus recurred 6 months postoperation without hip joint pain, the function of weight-bearing and walking of hip joint was normal. Harris score increased from preoperative average of 42 to postoperative average of 85; the results were excellent in 4 cases, good in 7 cases, and fair in 4 cases. Conclusion The infection of THA may occur in the whole joint, half-joint or just in joint capsule. The initial stabil ity of the prosthesis would affect the long-term survival of the prothesis. If the prosthesis initial stabil ity is obtained, even if there are infective factors, infections would also be l imited.