【作者简介】〖KG2〗〖HTSS〗蒋青(1963-),女,四川遂宁人,主管护师,硕士,Email:jq0987@yahoo.cn
Objective To explore the related factors of femoral stem anteversion (FSA) after total hip arthroplasty (THA), so as to provide reference for clinical design of FSA before operation and reduce the risk of hip dislocation after arthroplasty. Methods Ninty-three patients (103 hips) who underwent THA between October 2021 and September 2022 and met the selection criteria were selected as the study subjects. Among them, there were 48 males and 45 females with an average age of 58.5 years (range, 25-88 years). Body mass index was 18.00-37.84 kg/m2, with an average of 24.92 kg/m2. There were 51 cases (57 hips) of osteonecrosis of femoral head, 35 cases (39 hips) of hip osteoarthritis, and 7 cases (7 hips) of congenital hip dysplasia. Based on CT images, the following indicators were measured: preoperative femoral neck anteversion (FNA), preoperative femoral rotation angle (FRA), preoperative acetabular anteversion (AA), and preoperative combined anteversion (CA; the sum of preoperative FNA and AA); postoperative FSA and the change in femoral anteversion angle (the difference between postoperative FSA and preoperative FNA). Based on preoperative X-ray films, the following indicators were measured: femoral cortical thickness index (CTI) and canal flare index (CFI), the proximal femoral medullary cavity was classified according to Noble classification (champagne cup type, normal type, chimney type), neck-shaft angle (NSA), and femoral offset (FO). Pearson correlation analysis, one-way ANOVA, and Point-biserial correlation analysis were used to investigate the correlation between postoperative FSA, postoperative change in femoral anteversion angle, and patient diagnosis, proximal femoral medullary cavity anatomy type, gender, age, as well as preoperative FNA, FRA, AA, CA, NSA, FO, CTI, and CFI. FSA was used as the dependent variable and the independent variables that may be related to it were included for multiple linear regression analysis. Results Based on CT image measurement, preoperative FNA was (15.96±10.01)°, FRA (3.36±10.87)°, AA (12.94±8.83)°, CA (28.9±12.6)°, postoperative FSA (16.18±11.01)°, and postoperative change in femoral anteversion angle was (0.22±9.98)°. Based on preoperative X-ray films measurements, the CTI was 0.586±0.081; the CFI was 4.135±1.125, with 23 hips classified as champagne cup type, 68 hips as normal type, and 12 hips as chimney type in the proximal femoral medullary cavity anatomy; NSA was (132.87±7.83)°; FO was (40.53±10.11) mm. There was no significant difference between preoperative FNA and postoperative FSA (t=−0.227, P=0.821). Pearson correlation analysis showed that postoperative FSA was positively correlated with preoperative FNA, preoperative CA, postoperative change in femoral anteversion angle, and age (P<0.05), while negatively correlated with preoperative FRA (P<0.05). The postoperative change in femoral anteversion angle were positively correlated with preoperative FRA and postoperative FSA (P<0.05), and negatively correlated with preoperative CA and FNA (P<0.05). One-way ANOVA analysis showed that the above two indicators were not correlated with diagnosis and the proximal femoral medullary cavity anatomy type (P>0.05). Multiple linear regression analysis showed a linear correlation between FSA and FNA, CA, age, and FRA (F=10.998, P<0.001), and the best fit model was FSA=0.48×FNA–2.551. Conclusion The factors related to FSA after THA include patient’s age, preoperative FNA, CA, FRA and postoperative femoral anteversion, of which preoperative FNA is the most closely related. When designing a surgical plan before surgery, attention should be paid to the patient’s preoperative FNA, and if necessary, CT around the hip joint should be scanned to gain a detailed understanding of the proximal femoral anatomical structure.
Objective To investigate the effectiveness of a single threaded anchor fixation under shoulder arthroscopy in the treatment of fresh bony Bankart injury. Methods Between January 2017 and May 2021, 12 patients with fresh bony Bankart injury caused by trauma were treated with a single threaded anchor fixation under shoulder arthroscopy. There were 10 males and 2 females with an average age of 38.8 years (range, 21-64 years). The time between injury and operation ranged from 7 to 30 days (mean, 15.8 days). Preoperative American Shoulder and Elbow Surgeons (ASES) score was 44.9±17.4, the University of California at Los Angeles (UCLA) score was 13.1±5.5; the forward supination, lateral external rotation, and lateral internal rotation of shoulder were (130.8±11.8)°, (25.0±7.9)°, and 9.2±1.6, respectively. CT scan and three-dimensional (3D) reconstruction showed that the fracture fragment area was less than 1/4 of the glenoid area in 10 cases, and 1/4-1/2 in 2 cases. The operation time was recorded. During follow-up, ASES score, UCLA score, Rowes score, and shoulder range of motion were used to evaluate the effectiveness, and shoulder CT scan and 3D reconstruction were used to evaluate the fracture position and healing. Results The operation time ranged from 50 to 150 minutes (mean, 85.5 minutes). All patients were followed up 3-18 months (mean, 9.1 months). There was no serious adverse effect such as infection, re-dislocation, or thrombosis. Three patients had shoulder adhesions after operation. At last follow-up, the forward supination of shoulder [(162.1±30.3)°], lateral external rotation [(37.5±11.2)°], and lateral internal rotation (9.2±1.6) significantly improved when compared with those before operation (t=3.331, P=0.003; t=3.153, P=0.005; t=2.716, P=0.013). The ASES score was 89.7±11.8 and the UCLA score was 32.8±2.4, which significantly increased when compared with those before operation (t=7.368, P<0.001; t=11.370, P<0.001). The Rowes score ranged from 75 to 100 (mean, 92.9). Among them, 9 cases were excellent and 3 cases were good, with an excellent and good rate of 100%. CT re-examination showed that the fracture line disappeared in 11 cases, and the fracture alignment was good; the alignment of the fracture fragment was poor in 1 case whose fracture fragment area was between 1/4 and 1/2 of the glenoid area. Conclusion For the fracture fragment area not exceeding 1/4 of the glenoid, the labrum-capsule complex at the lower end of the bone fragment intact, and the non-comminuted fresh bony Bankart injury, a single threaded anchor fixation under shoulder arthroscopy can achieve better effectiveness, has the advantages of less trauma and faster postoperative recovery.
Objective To investigate the relationship between the vertical distance from semitendinosus insertion to tibial plateau (S-T) and the physical characteristics of patients, in order to provide reference for incision design to expose the semitendinosus insertion. Methods The patients with ligament injury who underwent primary anterior cruciate ligament reconstruction between January 2022 and December 2022 were selected as the research subjects. The patients’ baseline data were collected, including age, gender, height, and body mass. During reconstruction operation, the S-T was measured. Considering the S-T as the dependent variable and baseline data as the independent variable, multiple linear regression analysis was used to establish a regression equation to determine the possible influencing factors of semitendinosus insertion location. Results According to the selection standard, a total of 214 patients were enrolled, including 156 males and 58 females, aged (27±9) years (14-49 years), with a height of (174.7±6.8) cm (range, 160-196 cm) and a body mass of (73.43±12.35) kg (range, 53-105 kg). The S-T was (56.36±3.61) mm (range, 47-67 mm). The multiple linear regression analysis results showed that the height was positively correlated with S-T (β=0.407, SE=0.055, t=7.543, P<0.001); the regression equation was S-T=−14.701+0.407×height, R2=0.690. ConclusionThere was a linear relationship between the height and semitendinosus insertion. The location of semitendinosus insertion estimated by the formula (S-T=−14.701+0.407×height) is reasonable, which provides a theoretical basis for rapid, accurate, and safe location of semitendinosus insertion and design of surgical incision in clinic.
Objective To investigate the effectiveness of MAKO robotic-arm assisted total hip arthroplasty (THA) via direct anterior approach (DAA) for bony fused hips in ankylosing spondylitis (AS). Methods Between June 2021 and January 2022, MAKO robotic-arm assisted THA via DAA was applied to treat 10 cases (12 hips) of AS with bony fused hips. There were 7 males and 3 females; the age ranged from 30 to 71 years, with an average age of 42.4 years. The duration of AS was 12-35 years, with an average of 21.4 years. The preoperative hip was ankylosed in flexion in 3 cases, with a flexion angle of 20°, 30°, 35°, respectively; 9 cases were ankylosed in extension. The operation time and complications were recorded; the visual analogue scale (VAS) score, Harris score, and Oxford hip scale (OHS) score before and after operation, and postoperative range of motion (flexion, extension, internal rotation, external rotation, adduction, and abduction) were used to evaluate the recovery of joint function; according to the postoperative anteroposterior X-ray film and CT scan of both hip joints, the abduction angle, anteversion angle, the difference between bilateral combined off-set and the lower limb length discrepancy were measured. Results The operation time ranged from 80 to 190 minutes (mean, 134.6 minutes). All 10 patients were followed up 5-11 months (mean, 7.4 months). There was no serious adverse events such as incision infection, deep vein thrombosis of lower extremities, hip redislocation, aseptic loosening of the prosthesis, or death. At 5 months after operation, the acetabular prosthesis angle of abduction was 37°-45° (mean, 40.3°), anteversion angle was 9°-20° (mean, 15.8°). The difference between bilateral combined off-set was 0-10 mm (mean, 4.3 mm); the lower limb length discrepancy was 0-12 mm (mean, 3.5 mm). At last follow-up, the average range of motion of the hip joint was 89.2° in flexion (range, 80°-100°), 1.7° in extension (range, –5°-10°), 7.1° in internal rotation (range, 0°-15°), 20.4° in external rotation (range, 10°-30°), 7.9° in adduction (range, 0°-20°), and 16.5° in abduction (range, 10°-25°). At last follow-up, the VAS score, Harris score, and OHS score significantly improved when compared with those before operation (P<0.05). ConclusionThe MAKO robotic-arm assisted THA via DAA can achieve satisfactory results in the treatment of AS with bony fused hip, which has the advantages of accurate prosthesis installation, soft tissue release, and less trauma during operation.
ObjectiveTo evaluate the value of total knee arthroplasty (TKA) with computer navigation by comparing with conventional TKA. MethodsBetween May 2010 and December 2011, 45 patients underwent primary unilateral TKA, and the clinical data were retrospectively analyzed. Of 45 patients, 22 cases were treated with TKA with computer navigation (group A), 23 cases with the conventional TKA (group B). There was no significant difference in gender, age, body mass index, side, cause of disease, disease duration, preoperative range of motion (ROM) of the knee, and preoperative Hospital for Special Surgery (HSS) score between 2 groups (P > 0.05). The operation time, intraoperative blood loss, incidence of patellar retinacular release, complication, and drainage volume were compared. The prosthesis loosening, postoperative HSS score, and ROM of the knee were also compared. ResultsNo difference was found in the incidence of patellar retinacular release during TKA, and it was 13.6% (3/22) in group A and was 4.3% (1/23) in group B, showing no significant difference (χ2=1.198, P=0.346). The operation time of group A was significantly longer than that of group B (t=7.557, P=0.000). There was no significant difference in intraoperative blood loss during TKA between 2 groups (t=-0.295, P=0.769), while the drainage volume of group A was significantly less than that of group B (t=-2.419, P=0.020). Incomplete fracture during TKA and acute infection occurred at 8 days after TKA in 1 case of group A respectively, while no fracture or infection was found in group B, showing significant difference (Z=-0.509, P=0.000). The patients of 2 groups were followed up 27-46 months. No significant difference in valgus and varus of knee, and malalignment of the femoral and tibial prosthesis was found (P > 0.05). There was no significant difference in HSS score and ROM of the knee at last follow-up between 2 groups (P > 0.05). No prosthesis loosening was found in 2 groups. ConclusionTKA with computer navigation has similar results to conventional TKA in the mechanical alignment, but it obviously prolongs operation time. It may also increase the incidence of infection and tractor pin related fracture.
Objective To explore the impact of anemia on the incidence of perioperative lower limb deep vein thrombosis (DVT) in patients undergoing total hip arthroplasty (THA). Methods A retrospective analysis was conducted on clinical data of 1 916 non-fracture patients who underwent THA between September 2015 and December 2021, meeting the selection criteria. Among them, there were 811 male and 1 105 female patients, aged between 18 and 94 years with an average of 59.2 years. Among the patients, 213 were diagnosed with anemia, while 1 703 were not. Preoperative DVT was observed in 55 patients, while 1 861 patients did not have DVT preoperatively (of which 75 patients developed new-onset DVT postoperatively). Univariate analysis was performed on variables including age, gender, body mass index (BMI), diabetes, hypertension, history of tumors, history of thrombosis, history of smoking, revision surgery, preoperative D-dimer positivity (≥0.5 mg/L), presence of anemia, operation time, intraoperative blood loss, transfusion requirement, and pre- and post-operative levels of red blood cells, hemoglobin, hematocrit, and platelets. Furthermore, logistic regression was utilized for multivariate analysis to identify risk factors associated with DVT formation. Results Univariate analysis showed that age, gender, hypertension, revision surgery, preoperative levels of red blood cells, preoperative hemoglobin, preoperative D-dimer positivity, and anemia were influencing factors for preoperative DVT (P<0.05). Further logistic regression analysis indicated that age (>60 years old), female, preoperative D-dimer positivity, and anemia were risk factors for preoperative DVT (P<0.05). Univariate analysis also revealed that age, female, revision surgery, preoperative D-dimer positivity, anemia, transfusion requirement, postoperative level of red blood cells, and postoperative hemoglobin level were influencing factors for postoperative new-onset DVT (P<0.05). Further logistic regression analysis indicated that age (>60 years old), female, and revision surgery were risk factors for postoperative new-onset DVT (P<0.05). Conclusion The incidence of anemia is higher among patients with preoperative DVT for THA, and anemia is an independent risk factor for preoperative DVT occurrence in THA. While anemia may not be an independent risk factor for THA postoperative new-onset DVT, the incidence of anemia is higher among patients with postoperative new-onset DVT.
ObjectiveTo explore the correlation between the Barthel index score and other factors with the preoperative occurrence of deep vein thrombosis (DVT) in patients undergoing total hip arthroplasty (THA) revision surgery. MethodsA retrospective analysis was conducted on clinical data from 122 patients who met the inclusion criteria and underwent THA revision surgery between April 2017 and November 2020. Among them, 61 were male and 61 were female, with an age range of 32-85 years (mean, 65.3 years). The reasons for revision included prosthetic joint infection in 7 cases, periprosthetic fracture in 4 cases, prosthetic dislocation in 6 cases, and aseptic loosening in 105 cases. The Barthel index score was 76.4±17.7, with 10 cases classified as level 1, 57 as level 2, 37 as level 3, and 18 as level 4. Univariate analysis was performed on variables such as age, gender, body mass index, Barthel index score, preoperative D-dimer positivity, history of diabetes, hypertension, cancer, cerebral infarction, smoking, and thrombosis in patients with and without preoperative DVT. Furthermore, logistic regression was used to identify risk factors for preoperative DVT in THA revision surgery. The incidence of preoperative DVT was compared among different Barthel index score groups. ResultsPreoperative DVT was detected in 11 patients (9.02%), all of whom had intermuscular venous thrombosis. Among them, 1 had prosthetic joint infection, 1 had periprosthetic fracture, 1 had prosthetic dislocation, and 8 had aseptic loosening. Univariate analysis showed significant differences between the two groups in terms of age, gender, and Barthel index score (P<0.05). logistic regression further revealed that female, age ≥70 years, and Barthel index score<60 were independent risk factors for preoperative DVT in patients undergoing THA revision surgery (P<0.05). The incidence of preoperative DVT in patients with Barthel index scores of levels 1, 2, 3, and 4 were 0 case (0%), 2 cases (3.5%), 3 cases (8.1%), and 6 cases (33.3%), respectively. A significant correlation was found between Barthel index score classification and the incidence of preoperative DVT in patients undergoing THA revision surgery (χ2=10.843, P=0.001). ConclusionIn patients undergoing THA revision surgery, older age, female, and lower Barthel index scores are associated with higher preoperative DVT incidence. For patients with low preoperative Barthel index scores, preoperative thrombosis screening should be emphasized.