【Abstract】 Objective To investigate the appl ication and significance of computer assisted orthopedicsurgery(CAOS) in orthopedic trauma surgery. Methods In orthopedic trauma surgery, the appl ication status of CAOS was?analysed and the related problems were summarized. Results At present, CAOS is seldom used to reduce fractures but frequently used to insert internal fixation devices and reconstruct the cruciate l igament in orthopedic trauma surgery. And the studies have shown its superiority. During CAOS appl ication, surgeons should pay attention to some problems such as the disadvantages, cl inical evaluation, the roles of the surgeons and correct micro-traumatic concept. Conclusion CAOS is very important and cannot be replaced in orthopedic trauma minimal invasion surgery and surgeons should pay attention to some important related problems to make it develop successfully in the study of CAOS.
Ilizarov first reported the tibial transverse transport (TTT) for limb regeneration and functional reconstruction. The law of tension-stress could activate and enhance the regenerative potentials of living tissues, leading to growth or regeneration of muscles, fascia, blood vessels, and nerves simultaneously. Ilizarov discovered the phenomenon of rich vascular network formation during distraction osteogenesis process, but he did not apply this technique purposely to reconstruct microcirculation. Chinese orthopedic surgeons first used the TTT to treat lower extremity vascular lesions and diabetic foot ulcers. At present, some small sample clinical studies showed that the TTT could reconstruct microvascular network in the lower limbs of diabetic foot and promote the healing of foot ulcers. The use of TTT could significantly reduce the overall risk of diabetic foot complication especially the amputation risk. This expert consensus is initiated by the Chinese Association of Orthopaedic Surgeons (CAOS), Taskforce Group of Tibial Cortex Transverse Transport Technique for the Treatment of Diabetic Foot Ulcers. This expert consensus provides clear recommendations for indications, contraindications, principles for surgical procedures, preoperative and postoperative management, which maximize the success rate for TTT surgery in treatment of severe diabetic foot ulcers.
Objective To discuss the recent advancement of total knee arthroplasty (TKA) in the aspects of prosthesis selection, and compare the cl inical effect of every kind of knee prostheses so as to provide more information for cl inical appl ication. Methods The l iterature concerning prosthesis selection was extensively reviewed, and the methods and data were analyzed and summarized. Results The major disputes consisted of posterior cruciate retained versus excised,fixed-bearing versus mobile-bearing, high-flex versus standard implants and patella resurfacing versus nonresurfacing for TKA. Every kind of knee prostheses displayed safety and effectiveness in early and medium term follow-up, no significant differences were found in cl inical results. Conclusion Prosthesis selection in TKA should be overall considerated, and the merits of every kind of prostheses should be judged with long-term follow-up results.
Objective To evaluate and compare the efficacy of anterior subcutaneous and submuscular transposition of the ulnar nerve in treating cubital tunnel syndrome. Methods From August 2006 to August 2008, 66 patients with cubital tunnel syndrome were treated with anterior subcutaneous transposition (subcutaneous group, 24 cases) and with anterior submuscular transposition (submuscular group, 42 cases). According to McGowan stages, all patients were at Stage2 or 3 entrapment neuropathy with paresthesia in the ring and small fingers. Respectively, 3 cases and 8 cases compl icated by interosseous muscle atrophy in subcutaneous group and in submuscular group. No significant difference was found in gender, age, duration of the disease, and compl ication between two groups (P lt; 0.05). The surgical features, distribution of Bishop rates, two-point discrimination test, muscular strength, and compl ications were recorded. Results The operation time was (28.4 ± 5.2) minutes in subcutaneous group and (43.8 ± 5.6) minutes in submuscular group, showing significant difference (P lt; 0.01). The incision length was (12.2 ± 2.5) cm in subcutaneous group and (13.6 ± 2.8) cm in submuscular group, showing significant difference (P lt; 0.05). All patients were followed up 1-3 years. According to Bishop scoring system, the results were excellent in 18 cases, good in 4 cases, and poor in 2 cases in subcutaneous group; excellent in 36 cases, good in 3 cases, and poor in 3 cases in submuscular group; and showing no significant difference between two groups (P gt; 0.05). At 6 months postoperatively, twopoint discrimination and grip strength were improved when compared with that of preoperation (P lt; 0.05), but there was no significant difference between two groups (P gt; 0.05). Pain and dysesthesia of the scar were noted in 1 patient of the subcutaneous group and 3 patients of the submuscular group. No infection or hematoma was found and no patient needed reoperation. Conclusion Both operative methods are effective alternative for treating cubital tunnel syndrome. The anterior ubcutaneous anterior transposition of the ulnar nerve has fewer traumas, and it is a better choice for some old patients.
【Abstract】 Objective To investigate the effectiveness of surgical treatment for discogenic low back pain (DLBP) by minimally invasive transforaminal lumbar interbody fusion (TLIF) combined with unilateral pedicle screw fixation (UPSF). Methods Between March 2006 and July 2009, 57 patients with single-level DLBP were treated by minimally invasive TLIF combined with UPSF, including 27 males and 30 females with an average age of 45.6 years (range, 38-61 years) and a disease duration of 3.8 years (range, 9 months to 11 years). The involved segments included L2，3 in 2 cases, L3，4 in 5 cases, L4，5 in 29 cases, and L5, S1 in 21 cases. The operative time, incision length, intraoperative blood loss, postoperative drainage volume, hospitalization times, fusion rate, and complications were observed. The effectiveness were evaluated through Oswestry disability index (ODI) and visual analogue score (VAS), and the operative outcomes were compared in different groups classified according to various pressures of the contrast medium and sensitivities to discoblock after inducing consistent pain. Results The operation time, incision length, blood loss, postoperative drainage volume, and hospitalization times were (84.6 ± 37.4) minutes, (3.4 ± 0.6) cm, (132.5 ± 23.2) mL, (58.7 ± 21.4) mL, and (6.5 ± 0.8) days, respectively. All patients were followed up 2 years and 2 months to 5 years and 4 months (mean, 3.2 years). At last follow-up, ODI and VAS scores were significantly improved when compared with preoperative scores (P lt; 0.05). The effectiveness according to ODI were excellent in 27 cases, good in 22 cases, fair in 6 cases, and poor in 2 cases, with an excellent and good rate of 86.0%. All patients acquired b interbody fusion. At last follow-up according to ODI and VAS scores, better results were found in patients of low-pressure sensitive group and high-sensitive discoblock group (P lt; 0.05). Conclusion Minimally invasive TLIF combined with UPSF is reliable for DLBP with minimal surgical trauma, less paravertebral tissue injury, and fewer complications, but the indications for operation must be strictly followed. Patients being sensitive to low-pressure or high-sensitive to discoblock can achieve better surgical results.
Objective To investigate the effectiveness of surgical treatment for single-level degenerative lumbar instabil ity (DLI) by comparing traditional open transforaminal lumbar interbody fusion (TLIF) with minimally invasive TLIF. Methods Between March 2007 and May 2009，87 patients with single-level DLI were treated by traditional open TLIF (group A, n=45) and by minimally invasive TLIF (group B, n=42), respectively. There was no significant difference in gender, age, disease duration, segment level, combined diseases of lumbar spine, or the proportion of uni- and bilateral symptom between 2groups (P gt; 0.05). The indexes of surgical trauma，systemic inflammatory response, cl inical outcomes, and aravertebral muscle injury were compared between 2 groups. Results Operation was performed successfully in all patients. The patients were followed up 2.9 years on average in group A and 2.8 years on average in group B. The incision, blood loss, and postoperative drainage in group B were significantly less than those in group A (P lt; 0.05), but the operation time in group B was significantly longer than that in group A (P lt; 0.05). There were significant differences (P lt; 0.05) in C-reactive protein, leucocyte count, and creatine kinase MM between 2 groups at 24 hours postoperatively as well as in C-reactive protein at 6 days postoperatively; group B was superior to group A. At last follow-up, the Oswestry disabil ity index (ODI) and visual analogue score (VAS) were significantly improved when compared with the preoperative scores in 2 groups (P lt; 0.05). There were significant differences in ODI and back pain VAS score (P lt; 0.05), but no significant difference in leg pain VAS score (P gt; 0.05) between 2 groups. At last follow-up, no low back pain occurred in 8 and 18 cases, mild in 25 and 18 cases, moderate in 9 and 6 cases, and severe in 3 and 0 cases in groups A and B, respectively, showing that low back pain was significantly l ighter in group B than in group A (Z= —2.574, P=0.010). At last follow-up, the atrophy ratio of multifidus muscle was 37% ± 13% in group A and was 15% ± 7% in group B, showing significant difference (t=12.674, P=0.000). The multifidus muscle atrophy was rated as grade I in 18 and 44 sides, as grade II in 42 and 32 sides, and as grade III in 30 and 8 sides in groups A and B, respectively, showing significant difference (Z= — 4.947, P=0.000). Conclusion Both traditional open TLIF and minimally invasive TLIF are the effective treatments for single-level DLI. Minimally invasive TLIF has less surgical trauma, sl ighter postoperative systemic inflammatory response, less paravertebral muscle injury, and lower incidence of postoperative back pain, but it has longer operation time.
Objective To evaluate the cl inical outcomes and values of anterior segmental decompression and double-plate fixation (ASDDF) for treatment of ski p cervical spondylotic myelopathy (SCSM). Methods Between June 2005 and June 2008, 17 patients with SCSM were treated with ASDDF. There were 10 males and 7 females with an average age of 58.8 years (range, 41-74 years) and an average disease duration of 9.7 months (range, 6-39 months). According to JapaneseOrthopaedic Association (JOA) score system, 2 patients were rated as extreme severe condition, 7 as severe, 7 as moderate, and 1 as mild. MRI images showed 42 affected cervical disc levels, including 26 disc levels with high-intensity intramedullary lesions on T2, 4 with low-intensity intramedullary lesions on T1, and 12 with significant cord compression but no signal change; according to Nagata classification scale, there were 5 abnormal segments at class I, 21 at class II, and 16 at class III. The rate of fusion, the Cobb angle, and the range of motion (ROM) of the cervical spine were measured preoperatively and postoperatively by the X-ray examinations. The improvement of the neurological function was evaluated by the JOA score. Results The average time of follow-up was 28.6 months (range, 24-58 months). After operation, dysphagia occurred in 2 cases (symptom rel ief after 1 month), hoarseness in 1 case (symptom rel ief after 3 months of methylcobalamin treatment), and degeneration of adjacent segments without symptom in 3 cases. The X-ray films showed the fusion rate of 100% at 12 months after operation without displacement, resorption or collapse of bone graft, and without breakage or loosening of plate and screw. The Cobb angles were (13.3 ± 10.4)° preoperatively, (15.8 ± 10.8)° immediately postoperatively, and (15.4 ± 11.4)° at last follow-up; the ROM of the cervical spine were (41.3 ± 17.4)° preoperatively and (23.8 ± 18.8)° at last follow-up; and the JOA scores were 8.2 ± 2.9 preoperatively, 13.7 ± 3.0 at 12 months postoperatively, and 13.9 ± 2.8 at last follow-up. All indexes showed significant differences between before operation and after operation (P lt; 0.05). The results of JOA scores were excellent in 8 cases, good in 6, fair in 2, and poor in 1 with an average improvement rate of 66.8% (range, 14%-88%) for the neurological function. Conclusion Adequate decompression, high rate of fusion, sol id mechanical stabil ity, improvement of total cervical lordosis,and the neurological function can be achieved through ASDDF for treatment of SCSM.
ObjectiveTo summarize the management principle and clinical suggestions of the osteotomy gap of opening wedge high tibial osteotomy (OWHTO).MethodsThe related literature of the osteotomy gap of OWHTO in recent years was reviewed, summarized, and analyzed.ResultsDelayed union and non-union of the osteotomy gap are main complications of OWHTO. Tomofix plate, as locking steel plate, has the characteristics of angular stability and can better maintain the stability of the osteotomy gap, promote bone healing, and avoid loss of correction. There are some treatment options for the osteotomy gap site, such as, without bone, autologous bone graft, allogeneic bone graft, bone substitute materials graft, and augment factor graft to enhance bone healing. When the osteotomy gap is less than 10 mm, it achieves a good outcome without bone graft. For the obesity, lateral hinge fracture, large osteotomy gap, or correction angle more than 10°, the bone graft should be considered. In cases whose osteotomy gap is nonunion or delayed union, the autologous bone graft is still the gold standard. When the osteotomy gap repaired with the allogeneic bone graft, it is better to choose fragmented cancellous or wedge-shaped cancellous bone, combining with the locking plate technology, also can achieve better bone union. The bone substitute material of calcium-phosphorus is used in the osteotomy gap, which has the characteristics of excellent bone conduction, good biocompatibility, and resorption, combining with the locking plate technology, which can also achieve better bone union in the osteotomy gap. The augment factors enhance the bone healing of the osteotomy gap of OWHTO is still questionable. The bone union of the osteotomy gap is also related to the size of the osteotomy gap and whether the lateral hinge is broken or not.ConclusionNo matter what type of materials for the osteotomy gap, OWHTO can improve the function and relieve pain for knee osteoarthritis. More randomized controlled trials are needed to provide evidence for clinical decision to determine which treatment option is better for the osteotomy gap of OWHTO.
ObjectiveTo establish an efficient method of isolating and culturing high activity and high purity of Schwann cells, and to identify the cells at the levels of transcription and translation. MethodsThe sciatic nerves harvested from a 4-week-old Sprague Dawley rat were digested in the collagenase I for 15 minutes after dissecting, and then the explants were planted in culture flask directly. The cells were cultured and passaged in vitro, the growth state and morphological changes of the cells were observed under inverted phase contrast microscope. MTT assay was used to test the proliferation of cells and the cells growth curve was drawn. RT-PCR and immunohistochemistry staining were used to detect S100 and glial fibrillary acidic protein (GFAP) at the levels of transcription and translation, respectively. The purity of cells was caculated under microscope. ResultsAfter the digestion of collagenase I, fibroblast-like cells appeared around explants within 24 hours, with slender cell body and weak refraction. After tissues were transferred to another culture flask, a large number of dipolar or tripolar cells were seen after 48 hours, with slender ecphyma, plump cell body, and b refraction, and the cells formed colonies within 72 hours. The cells were covered with the bottom of culture flask within 48-72 hours after passaging at a ratio of 1∶2, and spiral colonies appeared. Cells showed vigorous growth and full cytoplasm after many passages. MTT assay results showed that the cells at passage 3 entered the logarithmic growth phase on the 3rd day, reached the plateau phase on the 7th day with cell proliferation, and the growth curve was “S” shape. RT-PCR results showed that the cells expressed S100 gene and GFAP gene, and immunohistochemistry staining showed that most of the cells were positively stained, indicating that the majority of cells expressing S100 protein and GFAP protein. The purity of Schwann cells was 98.37% ± 0.30%. ConclusionHigh activity and high purity of Schwann cells can be acquired rapidly by single-enzyme digestion and explant-culture method.
Objective To discuss the relationship between recovery of anatomical integrity and functional outcome in elderly patients with distal radius fractures by comparing the effects of open reduction and closed reduction. Methods The cl inical data were retrospectively analyzed from 78 elderly patients with distal radius fractures treating with nonoperation andoperation from February 2005 to March 2009. Thirty-seven patients underwent closed reduction and spl intlet fixation or cast appl ication (non-operation group), and forty-one patients underwent open reduction and internal fixation (operation group). In non-operation group, there were 15 males and 22 females with an average age of 73 years (60-83 years). According to the AO classification system for fracture, there were 8 cases of type A2, 7 cases of type A3, 7 cases of type B1, 4 cases of type B2, 2 cases of type B3, 4 cases of type C1, 2 cases of type C2, and 3 cases of type C3. The time from injury to admission was between 30 minutes and 3 days with a mean time of 1 day. In operation group, there were 18 males and 23 females with an average age of 71 years (62-80 years). According to the AO classification system for fracture, there were 5 cases of type A2, 7 cases of type A3, 7 cases of type B1, 6 cases of type B2, 3 cases of type B3, 4 cases of type C1, 5 cases of type C2, and 4 cases of type C3. The time from injury to admission was between 30 minutes and 7 days with a mean time of 1 day. There were no significant differences (P gt; 0.05) in sex, age, disease course and fracture classification between two groups. Results All incisions obtained heal ing by first intention after operation in operation group. All patients were followed up for 9-36 months (20 months on average). Fracture heal ing was achieved within 8 to 15 weeks, with an average of 11 weeks. There were no significant differences (P gt; 0.05) in fracture heal ing time between non-operation group [(10.8 ± 2.0) weeks] and operation group [(11.7 ± 2.5) weeks]. At last follow-up, thepalmar tilt angle was (5.6 ± 2.0)° and (8.6 ± 3.0)°, the radial incl ination angle was (19.1 ± 4.9)° and (21.8 ± 2.0)°, and the radial length was (8.3 ± 1.3) mm and (10.4 ± 1.4) mm in non-operation group and operation group, respectively; showing significant differences (P lt; 0.05) between two groups. According to the Gartland-Werley score, the results were excellent in 9 cases, good in 21 cases, fair in 5 cases, and poor in 2 cases in non-operation group, the excellent and good rate was 81.1%; in operation group, the results were excellent in 13 cases, good in 25 cases, fair in 2 cases, and poor in 1 case, the excellent and good rate was 92.7%, showing no significant difference (P gt; 0.05) between two groups. There were no significant differences (P gt; 0.05) in flexion and extension activity of wrist, radioulnar partial activity, pronation-supination activity, grip and pinch strength between two groups. Conclusion Open reduction and closed reduction can achieve satisfactory functional outcomes, but closed reduction was inferior to open reduction in anatomic reduction for treating distal radius fractures in elderly patients.