【Abstract】 Objective To investigate the method to avoid lengthening lower limbs after total hip arthroplasty in patients with congenital short femoral neck. Methods The clinical data were analyzed retrospectively from 38 patients undergoing unilateral total hip arthroplasty between April 2005 and December 2010. There were 26 males and 12 females, aged 45-78 years (mean, 62.3 years). Among these cases, there were 11 cases of avascular necrosis of the femoral head, 17 cases of hip osteoarthritis, and 10 cases of femoral neck fracture. Before operation, 29 cases had leg length discrepancy; and the shortened length of the legs was 10-24 mm with an average of 14.5 mm by clinical measurement, and was 11-25 mm with an average of 14.7 mm by X-ray film measurement. The Harris score before operation was 44.0 ± 3.6. Results At 1 day after operation, 3 cases had legs lengthening by clinical and X-ray film measurement; limb length difference less than 10 mm was regarded as equal limb length in the other 35 patients (92.1%). All incisions healed by first intention, and no complication of infection or lower limb deep venous thrombosis occurred. In 3 patients who had legs lengthening, 1 patient had abnormal gait and slight limping after increasing heel pad because the lower limb was lengthened by 16 mm, and 2 patients had slight limping. The other patients could walk normally and achieved pain relief of hip. Thirty-six patients were followed up 12-68 months (mean, 43.8 months). The Harris score was 86.7 ± 2.3 after 6 months, showing significant difference (t=3.260, P=0.031) when compared with that before operation. The X-ray films showed no prosthetic loosening or subsidence. Conclusion For patients with congenital short femoral neck during total hip arthroplasty, the surgeons should pay attention to osteotomy plane determination, limb length measurement, and use of the prosthesis with collar to avoid the lengthening lower limbs
Objective To investigate the effectiveness of minimally invasive transforaminal lumbar interbody fusion (TLIF) assisted with microscope for lumbar degenerative disease. Methods Retrospective analysis was made on the clinical data of 82 patients with lumbar degenerative disease (minimally invasive group) undergoing minimally invasive TLIF assisted with microscope between January 2010 and June 2011, which was compared with those of 76 patients (traditional group) undergoing traditional open TLIF. There was no significant difference in age, gender, disease duration, disease type, lesion level, preoperative visual analogue scale (VAS), and preoperative Oswestry disability index (ODI) between 2 groups (P gt; 0.05). The perioperative related parameters, radiography index, and effectiveness were documented and compared. Results There was no significant difference in operation time and intraoperative radiological exposure time between 2 groups (P gt; 0.05), but intraoperative blood loss and postoperative drainage volume in the minimally invasive group were significantly less than those in the traditional group (P lt; 0.05). Dural tear occurred in 2 patients of the traditional group. Superficial infection of incision occurred in 1 case in each group, respectively; and primary healing of incision was obtained in the other patients. All patients were followed up 12-28 months (mean, 18 months). No failure of internal fixation occurred. Radiological analysis showed that the bone graft fusion rate was 96.1% (73/76) in the traditional group and 95.1% (78/82) in the minimally invasive group at last follow-up, showing no significant difference (χ2= 0.012 2, P= 0.912 0). The postoperative ODI and VAS score were significantly improved when compared with preoperative ones in 2 groups (P lt; 0.05); the ODI of the minimally invasive group were significantly better than those of the traditional group at 3 months (t= — 11.941 1, P=0.000 0), and the VAS score of the minimally invasive group was significantly lower than that of the traditional group at 1 day and 3 months (P lt; 0.05); but no significant difference was found in ODI and VAS score between 2 groups at 1 year and last follow-up (P gt; 0.05). Conclusion Minimally invasive TLIF is an effective method to treat lumbar degenerative disease. This procedure is safe and reliable because it has less injury, less blood loss, and milder pain than the traditional open TLIF, and the short-term effectiveness is comparable in 2 procedures.
Objective To evaluate the mid-term cl inical outcome of instrumented sl ip reduction combined with 360° circumferencial fusion and restoration laminae for symptomatic adult isthmic spondylol isthesis. Methods Between October 2004 and March 2008, 44 patients with symptomatic isthmic spondylol isthesis underwent instrumented sl ip reduction combined with 360° circumferencial fusion and restoration laminae. There were 15 males and 29 females with an average age of38.4 years (range, 28-45 years). The disease duration was 14 months to 7 years (38 months on average). The affected vertebrae was L4-5 in 18 patients and L5, S1 in 26 patients. According to Meyerding’s grade for spondylol isthesis, 28 cases were rated as grade II and 16 as grade III. The visual analogae scale (VAS), Oswestry disabil ity index (ODI), and the short form 36 health survey (SF-36) scores were evaluated before operation and at last follow-up; the radiographical outcome was evaluated by measuring sl i pping percentage, heights of intervertebral space and foramen, and fusion rate. Results All patients were followed up 20-60 months (42 months on average). The VAS, ODI, and SF-36 scores were all significantly improved at last follow-up when compared with those before operation (P lt; 0.05). According to Morelos criteria, the cl inical results were excellent in 32 patients, good in 9, and fair in 3; the excellent and good rate was 93.2%. The preoperative average percentage of sl ip was 47.5%, which was improved to 2.6% 3 days after operation; the total average reduction rate was 97.4%, and it was maintained at last followup. The heights of intervertebral space and foramen were all improved significantly after operation (P lt; 0.05), and there was no significant difference between at 3 days after operation and at last follow-up (P gt; 0.05). X-ray and CT showed bony fusion 1 year after operation in all patients with a fusion rate of 100%. Compl ications included pain at donor site of il iac bone in 4 cases, superficial infection in 2 cases, dural tear in 1 case, and degeneration of adjacent vertebrae in 2 cases; no nerve root injury, pseudoarthrosis, failure of internal fixation, and acquired spinal canal stenosis occurred. Conclusion Instrumented sl ip reduction combined with 360° circumferencial fusion and restoration laminae is a rel iable procedure for adult isthmic spondylol isthesis with satisfactory mid-term results, a high fusion rate and low compl ication rate. The long-term outcomesshould be verified by follow-up in the future.
ObjectiveTo observe the feasibility of acellular cartilage extracellular matrix (ACECM) oriented scaffold combined with chondrocytes to construct tissue engineered cartilage.MethodsChondrocytes from the healthy articular cartilage tissue of pig were isolated, cultured, and passaged. The 3rd passage chondrocytes were labeled by PKH26. After MTT demonstrated that PKH26 had no influence on the biological activity of chondrocytes, labeled and unlabeled chondrocytes were seeded on ACECM oriented scaffold and cultivated. The adhesion, growth, and distribution were evaluated by gross observation, inverted microscope, and fluorescence microscope. Scanning electron microscope was used to observe the cellular morphology after cultivation for 3 days. Type Ⅱ collagen immunofluorescent staining was used to check the secretion of extracellular matrix. In addition, the complex of labeled chondrocytes and ACECM oriented scaffold (cell-scaffold complex) was transplanted into the subcutaneous tissue of nude mouse. After transplantation, general physical conditions of nude mouse were observed, and the growth of cell-scaffold complex was observed by molecular fluorescent living imaging system. After 4 weeks, the neotissue was harvested to analyze the properties of articular cartilage tissue by gross morphology and histological staining (Safranin O staining, toluidine blue staining, and typeⅡcollagen immunohistochemical staining).ResultsAfter chondrocytes that were mainly polygon and cobblestone like shape were seeded and cultured on ACECM oriented scaffold for 7 days, the neotissue was translucency and tenacious and cells grew along the oriented scaffold well by inverted microscope and fluorescence microscope. In the subcutaneous microenvironment, the cell-scaffold complex was cartilage-like tissue and abundant cartilage extracellular matrix (typeⅡcollagen) was observed by histological staining and typeⅡcollagen immunohistochemical staining.ConclusionACECM oriented scaffold is benefit to the cell adhesion, proliferation, and oriented growth and successfully constructes the tissue engineered cartilage in nude mouse model, which demonstrates that the ACECM oriented scaffold is promise to be applied in cartilage tissue engineering.
ObjectiveTo investigate the early effectiveness of proximal femur reconstruction combined with total hip arthroplasty (THA) in the treatment of adult Crowe type Ⅳ developmental dysplasia of the hip (DDH).MethodsBetween May 2015 and March 2018, 29 cases (33 hips) suffering from Crowe type Ⅳ DDH were treated with proximal femur reconstruction combined with THA. Of the 29 cases, there were 6 males (7 hips) and 23 females (26 hips), aged from 24 to 74 years with an average age of 44.9 years. The preoperative Harris hip score was 44.0±12.0. Gait abnormalities were found in all of the 33 hips with positive Trendelenburg sign, and the lower limb discrepancy was (3.8±1.6) cm. Preoperative X-ray films and CT both indicated serious anatomical abnormalities, including complete dislocation of the affected hip with significant move-up of the greater trochanter, abnormal development of the femoral neck, abnormal anterversion angle and neck-shaft angle, dysplasia of proximal femur and dysplasia of medullary cavity. The operation time, intraoperative blood loss, transfusion rate, and complications were recorded. The Gruen and DeLee-Charnley zoning methods were used to evaluate the aseptic loosening of the prosthesis on X-ray films. The Harris score was used to evaluate hip function. The lower limb discrepancy was calculated and compared with the preoperative value.ResultsThe operation time ranged from 80 to 240 minutes, with an average of 124.8 minutes. The intraoperative blood loss ranged from 165 to 1 300 mL, with an average of 568.4 mL. Seventeen patients (51.5%) received blood transfusion treatment. All the incisions healed by first intention without infection or deep vein thrombosis. All patients were followed up 19-53 months, with an average of 33 months. One patient had posterior hip dislocation because of falling from the bed at 4 weeks after operation, and was treated with manual reduction and fixation with abduction brace for 4 weeks, and no dislocation occurred during next 12-month follow-up. Two patients developed sciatic nerve palsy of the affected limbs after operation and were treated with mecobalamin, and recovered completely at 12 weeks later. Trendelenburg sign was positive in 3 patients and mild claudication occurred in 4 patients after operation. X-ray films showed that all the osteotomy sites healed at 3-6 months after operation, and no wire fracture was observed during the follow-up. The Harris score was 89.8±2.8 and lower limb discrepancy was (0.6±0.4) cm at last follow-up, both improved significantly (t=–22.917, P=0.000; t=11.958, P=0.000). The prosthesis of femur and acetabulum showed no obvious loosening and displacement, and achieved good bone ingrowth except 2 patients who had local osteolysis in the area of Gruen 1 and 7 around the femoral prosthesis, but no sign of loosening and sinking was observed.ConclusionThe treatment of Crowe Ⅳ DDH with proximal femur reconstruction and THA was satisfactory in the early postoperative period. The reconstruction technique of proximal femur can effectively restore the anatomical structure of proximal femur, which is one of the effective methods to deal with the deformity of proximal femur.