Objective To investigate the short-term effectiveness of reconstructive locked plate for treating sternoclavicular joint dislocation. Methods Between February 2008 and February 2012, 11 patients with sternoclavicular joint dislocation were treated with reconstructive locked plate, and the clinical data were retrospectively analyzed. There were 7 males and 4 females, aged 30-55 years (mean, 44 years). The causes of injury included traffic accident in 8 cases and crashing in 3 cases. The disease duration ranged from 2 hours to 11 days (median, 6 days). All patients had anterior dislocation of sternoclavicular joint. According to the Grade system, there were 2 cases of type II and 9 cases of type III. Results All patients obtained healing of incisions by first intention after operation. There was no neurovascular injury. The X-ray films showed that satisfactory reduction of joint dislocation and stable internal fixation were obtained at 2 days after operation. All patients were followed up 9-24 months (mean, 16 months). According to the Rockwood criteria, the score was 10-15 (mean, 13.2); the results were excellent in 9 cases and good in 2 cases, with an excellent and good rate of 100% at 9 months after operation. No internal fixation failure or re-dislocation occurred. All internal fixators were removed at 9-15 months after operation. Both the stability and the functions of the shoulder joint were good. Conclusion The reconstructive locked plate in treating sternoclavicular joint dislocation has the advantages of good stability and satisfactory reduction, and the patients can do functional exercises early and obtain good recovery of the shoulder joint function. The short-term effectiveness is satisfactory.
Objective To explore the effectivness of arthroscopic synovectomy in the treatment of pigmented villonodular synovitis (PVNS) of the knee. Methods A retrospective analysis was conducted on 13 patients with PVNS of the knee treated with arthroscopic synovectomy between June 2008 and December 2011, including 8 left knees and 5 right knees. There were 9 males and 4 females, aged 25-45 years (mean, 33 years). Of 13 patients, 5 had a history of trauma, and 8 had no history of trauma. The disease duration ranged from 4 months to 80 months (mean, 44 months). The preoperative Lysholm score was 45.3 ± 4.2, and International Knee Documentation Committee (IKDC) 2000 score was 46.8 ± 4.9. All patients underwent arthroscopic synovectomy and postoperative radiotherapy. Results The pathological examination proved PVNS in all cases. All incisions obtained healing by first intention after operation. There was no neurovascular injury or knee infection. The average follow-up period was 21.8 months (range, 12-30 months). The Lysholm score was 90.2 ± 7.4, and IKDC2000 score was 87.8 ± 3.8 at last follow-up, showing significant differences when compared with preoperative scores (t=22.64, P=0.00; t=24.32, P=0.00). No recurrence was observed during follow-up. Conclusion Arthroscopic synovectomy can be effective in the treatment of PVNS of the knee, and it has the merits of minimal invasion, rapid function recovery of the knee joint, and satisfactory results. So it is a safe, promising, and minimal invasive procedure in treatment of PVNS.
ObjectiveTo explore the effectiveness of high strength suture fixation in treatment of patellar transverse fracture.MethodsBetween June 2014 and June 2016, 38 patients with the patellar transverse fracture were treated with high strength suture internal fixation. There were 24 males and 14 females with the age of 26 to 64 years (mean, 45 years). There were 6 cases of accident injury and 32 cases of crashing injury. The time interval between injury and surgery was 2-8 days (mean, 5 days). The preoperative visual analogue scale (VAS) score, Lysholm score, and range of motion (ROM) of patients were 84.3±8.4, 44.5±7.2, and (62±12)°, respectively.ResultsAll patients’ incisions healed by first intention after operation. There was no neurovascular injury, deep venous thrombosis of lower limbs, or local foreign matter irritation reaction. The X-ray films showed that the reduction of patella and the location of internal fixator were good at 2 days after operation. All the 38 patients were followed up 12-18 months (mean, 16 months). All fractures healed and the healing time was 2-4 months (mean, 3 months). At last follow-up, according to the Böstman criteria, 36 patients were rated as excellent and 2 as good, with an excellent and good rate of 100%. The VAS score, Lysholm score, and ROM of patients were 10.2±6.6, 93.1±6.4, and (124±14)°, respectively, showing significant differences when compared with preoperative ones (t=42.759, P=0.000; t=31.099, P=0.000; t=20.727, P=0.000).ConclusionApplication of high strength suture fixation in the treatment of patellar transverse fracture has advantages of simple to operate, effective fixation, and less complication. It can avoid reoperation of removing the internal fixators. The satisfied ROM and function of the knee joint can be obtained after operation.
ObjectiveTo investigate the differential expression of transient receptor potential vanilloid receptor 4 (TRPV4) protein in the osteoarthritis (OA) and normal cartilages, and explore the role of TRPV4 in the prevention and treatment of OA.MethodsThe cartilage tissues from the patients of knee OA (OA group) and femoral neck fracture (control group) were taken. In OA group, there were 6 males and 9 females; the age ranged from 55 to 78 years (mean, 69 years); the Kellgren-Lawrence (K-L) score was 3.0±0.8. In control group, there were 5 males and 10 females; the age ranged from 57 to 91 years (mean, 71 years). There was no significant difference in gender and age between the two groups (P>0.05). Western blot, real-time fluorescence quantitative PCR, Masson staining, and immunohistochemical staining were used to detect the difference in protein and mRNA expressions of TRPV4 between the OA and normal cartilages. Then the relationship between the K-L score of OA and the rate of TRPV4-positive cells was analyzed.ResultsThe relative expression of TRPV4 protein and mRNA in OA group were 0.454±0.199 and 2.951±1.200, which were higher than those in control group (0.165±0.074, 1.437±0.682). The difference in relative expression of TRPV4 protein was significant (t=2.718, P=0.026). Histology observation showed that the chondrocytes arranged disorderly in OA group, the structure of extracellular matrix was abnormal, and the cartilage defect reached the deep layer. There were more TRPV4-positive cells in the degenerated tissue, and the rate of TRPV4-positive cells was 37.353%±13.496%. The chondrocytes were arranged well in control group, and the rate of TRPV4-positive cells was only 9.642%±3.284%. There was a significant difference between the two groups (t=7.491, P=0.000). The rate of TRPV4-positive cells in OA group was positively correlated with the OA K-L score (r=0.775, P=0.001).ConclusionThe TRPV4 expression increased in OA cartilages that may contribute to the development of OA.
Objective To explore the effectiveness of arthroscopic binding fixation using suture through single bone tunnel for posterior cruciate ligament (PCL) tibial insertion fractures in adults. Methods Between October 2019 and October 2021, 16 patients with PCL tibial insertion fractures were treated with arthroscopic binding fixation using suture through single bone tunnel. There were 11 males and 5 females with an average age of 41.1 years (range, 26-58 years). The fractures were caused by traffic accident in 12 cases and sports in 4 cases. The time from injury to operation ranged from 2 to 10 days with an average of 6.0 days. The fractures were classified as Meyers-McKeever type Ⅱ in 4 cases and type Ⅲ in 9 cases, and Zaricznyi type Ⅳ in 3 cases. There were 2 cases of grade Ⅰ, 7 cases of grade Ⅱ, and 7 cases of grade Ⅲ in the posterior drawer test. There were 3 cases combined with lateral collateral ligament injury and 2 cases with meniscus injury. The visual analogue scale (VAS) score, Lysholm score, International Knee Documentation Committee (IKDC) score, and knee range of motion were used to evaluate knee joint function. The posterior drawer test and knee stability tester (Kneelax 3) were used to evaluate knee joint stability. The X-ray films were used to evaluate fracture reduction and healing. Results All incisions healed by first intention after operation. There was no incision infection, popliteal neurovascular injury, or deep venous thrombosis of lower limbs. All patients were followed up 6-12 months, with an average of 10 months. X-ray films at 6 months after operation showed the fractures obtained bone union. There were 11 cases of grade 0, 4 cases of gradeⅠ, and 1 case of grade Ⅱin posterior drawer test, showing significant difference when compared with preoperative results (Z=23.167, P<0.001). The VAS score, Lysholm score, IKDC score, knee range of motion, and the results of Kneelax3 examination all significantly improved when compared with preoperative results (P<0.05). Conclusion For adult patients with PCL tibial insertion fractures, the arthroscopic binding fixation using suture through single bone tunnel has the advantages of minimal trauma, good fracture reduction, reliable fixation, and fewer complications. The patient’s knee joint function recovers well.
Objective To investigate the short-term effectiveness of joint distraction by Ilizarov combined with arthroscopic debridement in the treatment of knee osteoarthritis (KOA). Methods Between January 2014 and January 2015, 15 patients (15 knees) with KOA were treated using arthroscopic debridement assisting with the Ilizarov distraction technology. There were 7 males and 8 females, aged from 45 to 64 years (mean, 55 years). The left knee and the right knee were involved in 6 and 9 cases respectively. The disease duration was 2.0-9.5 years (median, 6 years). They all had received conservative treatment for 6 months and got poor clinical improvement. The preoperative visual analogue scale (VAS) score, the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, the knee injury and osteoarthritis outcome score (KOOS), the range of motion (ROM) for knee, and the radiographic joint space width were 76.2±8.8, 59.3±5.7, 44.3±7.2, (75±21)°, and (2.5±0.4) mm respectively. According to Kellgren-Lawrence grade system, 11 cases were rated as grade III and 4 cases as grade IV. Results There was no poor incision healing, infection, and deep vein thrombosis. All the 15 patients were followed up 12-18 months (mean, 15.5 months). Patients achieved pain relief. The knee activity was obviously improved. The postoperative VAS score, WOMAC score, KOOS score, and ROM at 12 months were 20.9±7.8, 38.2±5.5, 92.1±6.9, and (118±14)° respectively, showing significant difference when compared with preoperative ones (t=18.213, P=0.000; t=10.317, P=0.000; t=18.564, P=0.000; t=6.599, P=0.000). Postoperative X-ray film showed that joint space width at 12 months was (3.8±0.3) mm, showing significant difference when compared with preoperative one (t=10.070, P=0.000). Conclusion Joint distraction by Ilizarov combined with arthroscopic debridement can effectively relieve pain, improve the function and quality of life. It was beneficial to cartilaginous tissue repair and delaying the degenerative process of KOA. The short-term effectiveness is satisfactory.