Objective To investigate the causes and managements of acetabular fracture during primary total hip arthroplasty (THA). Methods Between May 2005 and July 2008, 9 patients (9 hi ps) suffered from acetabular fractures during primary THA. There were 1 male and 8 females with an average age of 63.3 years (range, 41-73 years), including 4 cases of developmental dysplasia of the hip, 2 cases of rheumatoid arthritis, 1 case of old femoral neck fracture, 1 case of avascular necrosis of femoral head, and 1 case of ankylosing spondyl itis. Three left hips and 6 right hips were involved. The preoperative Harris score was 40.4 ± 2.9. All the patients underwent cementless THA. Among nine acetabular fractures, 8 fractures were stable (2 anterior wall fractures and 6 posterior wall fractures), which were fixed by additional augmentation screws in 7 cases and accepted no special treatment in 1 case; 1 fracture was unstable (posterior wall fracture with posterior column incomplete fracture), which was treated by bone grafting and additional screws. Results The postoperative X-ray films showed that the position of the prosthesis were favorable. All incisions healed by first intention without early compl ication. Nine patients were followed up 1-4 years (mean, 2 years and 7 months). The Harris score was 87.8 ± 3.9 at last follow-up, showing significant difference when compared with the preoperative score (t=44.904, P=0.000). The X-ray films showed fracture heal ing at 8 weeks. No loosening occurred. Conclusion When primary THA is performed, the preoperative X-ray film should be studied and measured carefully, operation should be accurate and violence should be avoided. The diameter of the acetabular component should be equal to the diameter of a drill or not larger than 2 mm. In patients with severe osteoporosis, the diameter of the acetabular components should be the same diameter as a drill and additional screws are used to fix, or cemented cup is used. Once an acetabular fracture occurs during the primary THA, additional screw or bone grafting with additional screws should be chosen according to the fracture type and stabil ity, and good cl inical results can be expected.
Objective To evaluate the usefulness of minimal incision technique in total knee arthroplasty (TKA) by comparing the early compl ications after minimal incision TKA and those after traditional incision. Methods From May 2004 to July 2005, 38 patients (46 knees) underwent TKA using the minimal incision technique (minimal incision group), and 43 patients (54 knees) underwent TKA using the traditional incision technique at the same period (traditional incision group). The inimal incision group included 12 male patients (12 knees) and 26 female patients (34 knees), and their ages ranged from 52 to 76 years. Twenty-four patients (28 knees) had osteoarthritis and 14 patients (18 knees) had rheumatic arthritis. The varus deformity of the knee was found in 30 patients (34 knees) and valgus deformity was found in 8 patients (12 knees). TheAmerican Knee Society Score (AKSS) score was 37.5 ± 12.6, and the disease course was (7.5 ± 2.3) years. The raditional incision group included 15 male patients (19 knees) and 28 female patients (35 knees), and their ages ranged from 55 to 82 years. Thirtytwo patients (37 knees) had osteoarthritis and 11 patients (17 knees) had rheumatic arthritis. Varus deformity of the knee was found in 34 patients (41 knees) and valgus deformity was found in 9 patients (13 knees). The AKSS score was 31.1 ± 10.2, and the disease course was (10.1 ± 4.2) years. There were no statistically significant differences in the general data between two groups (P gt; 0.05). Results The incision length, the operation time and the drainage flow were (12.6 ± 1.2) cm, (95 ± 15) minutes and (650.1 ± 10.0) mL in the minimal incision group and (18.7 ± 2.3) cm, (63 ± 11) minutes and (300.0 ± 20.0) mL in the traditional incision group; showing statistically significant differences between two groups (P lt; 0.05). In the minimal incision group, 4 patients (4 knees) developed infections at the operated knees, including 2 early infection and 2 late infection, which were all cured by corresponding treatment. Deep vein thrombosis occurred in 1 patient on the third day after operation and was managed successfully by thrombolytic therapy. Cutaneous necrosis was found in 2 patients on the seventh and ninth postoperative day separately, which healed uneventfully after intensive local treatment. On the twelfth postoperative month, 1 patient had femoral fractured at the site of supracondylar region after a careless fall, but the prosthesis was stable. The fracture was fixed by a plate and healed uneventfully. In the traditional incision group, only 1 patient (1 knee) developed early infection at the operated knee on the tenth postoperative day, which was managed by corresponding treatment. And there were no periprosthetic fracture, cutaneous necrosis or deep vein thrombosis. The patients were followed up for (3.7 ± 0.4) years in the minimalincision group and (3.9 ± 0.6) years in the traditional incision group. At the latest follow-up, the AKSS scores were 78.2 ± 6.7 in the minimal incision group and 81.2 ± 7.3 in the traditional incision group, showing statistically significant ifferences (P lt; 0.05) when compared with those before operation and no statistically significant difference between two groups (P gt; 0.05). Conclusion Minimally invasive TKA has relatively higher compl ication rate than traditional incision. Strict patient inclusion criteria, competent surgery skill, proper instrument and intensive perioperative management are essential to success.
Objective To investigate the operative methods, cl inical outcomes and compl ications of total hi p arthroplasty (THA) in the treatment of patient with hi p joint flexion rigidity due to ankylosing spondyl itis (AS). Methods From May 1992 to July 2004, 56 patients (32 left hips and 39 right hips) with AS received THA through a modified anterolateral approach, including 52 males (67 hips) and 4 females (4 hips) aged 17-48 years with an average of 35.5 years. All the hips were ankylosed in (43.1 ± 7.2)° of flexion and 15 patients had bilaterally ankylosed hips. Preoperatively, Harris hip score was (42.6 ± 5.3) points and all the hips were classified as stage IV according to the standard of American College of Rheumatology (ACR). And the course of disease was 3-11 years. Results Intraoperatively, 1 patient suffering from proximal femur fracture due to severe osteoporosis was treated with titanium wire fixation, and the fracture was healed 6 weeks later. All the patients were followed up for 3-15 years (average 5.3 years). Postoperatively, 1 patient (1 hip) got subcutaneous soft tissue infection at 8 days, 1 patient (1 hip) got wound disunion at 11 days, 2 patients (2 hips) got infection at 11 months and 3 years, respectively. All the infections were healed after symptomatic treatment. The wounds of the rest 52 patients were healed by first intention without joint infections. The postoperative X-rays demonstrated that 4 hips (5.6%) had loose acetabulum prosthesis, 3 hips (4.2%) had loose femoral prosthesis and 5 hips had loose acetabulum and femoral prosthesis (7.0%), and the total loosening rate was 16.8%. Among which, 8 hips received revision resulting in satisfactory therapeutic effects, and the rest 4 hips had no further treatment. Fifteen hips (21.1%) had heterotopic ossification, which was rel ieved after taking nonsteroidal anti-inflamatory drugs. Harris hip score at final follow-up was (82.7 ± 4.1) points, indicating there was a significant difference between before and after operation (P lt; 0.05). Ten hips were evaluated as excellent, 43 hips good, 14 hips fare, and 4 hips bad, and the excellent and good rate was 74.7%. Conclusion THA through the anterolateral approach is effective for the treatment of patient with hip joint flexion rigidity caused by AS.
Objective To study the effect of all-coated long stem prosthesis associated with allograft in revision total hip replacement (THR). Methods From January 1997 to January 2004, 20 patients with non-infectious loosened implant after primary THR were treated. There were 12 males and 8 females with a mean age of 65 years (58-77 years). The average period between primary THR and revision THR was 12 years (3-18 years). According to classification of Paprosky, there were10 cases of type II, 6 cases of type IIIA, 3 cases of type IIIB and 1 case of type IV. All-coated long stem prosthesis was used in all cases. Impacting bone grafting was done in 12 cases and impacting bone grafting associated with cortical strut grafting in 8 cases. The mean amount of morsel ized bone was 20 g (5-35 g), the length of cortical bone was 10-22 cm. Results All the incisions got heal ing by first intension. All patients were followed up for an average period of 36 months (16-48 months). Dislocation occurred at 5 days after operation and was cured with closed reduction and traction in 1 case. There was significant difference (P lt; 0.05) in the mean Harris score between preoperation (50.0 ± 2.3) and postoperation (90.0 ± 2.5). The X-ray checking showed that continuous radiolucent l ine of 3 mm occurred in 1 case, prosthesis subsidence of 5 mm and 7 mm in 2 cases and that no bone absorption was observed. Seven cases of cortical bone grafting union was achieved within 3 years except 1 case of cortical bone un-union. Conclusion It can obtained the initial stabil ization of prosthesis to use all-coated long stem prosthesis associated with allograft in revision THR to treat femur bone defect after THR. The short-term effects of the cl inical and X-ray checking are satisfactory, but future effect is to be observed.
【Abstract】 Objective To compare the two different techniques determining tibial rotational al ignment in total kneearthroplasty(TKA) to enhance postoperative effect and reduce compl ications. Methods From May 2006 to April 2007, 60 patients(27 males, 33 females, aged 55-78 years ) received TKA and randomly divided into 2 groups(n =30): tibial rotational al ignmentin TKA was determined by medical 1/3 of tibial tubercle in Group A, by medial border of tibial tubercle at 0-9°varus inGroup B, by medical 1/3 of tibial tubercle at 20°or greater varus or by the mean l ine between medial border of tibial tubercle andmedical 1/3 of tibial tubercle at 10-19°varus. The angle of rotation of polyethylene cushion was calculated. Results The angleof rotation of polyethylene cushion in Group A was (8.4±3.8)° at 0-9°varus, (3.5±2.7)° at 10-19°varus and (0 ±2.4)° at 20°varusor over, respectively, and there was significant difference (P lt; 0.05). The angle of rotation of polyethylene cushion in Group Bwas (0 ±2.1)° at 0-9° varus, (0 ±2.0)° at 10-19°varus and (0 ±1.7)° at 20°varus or over, respectively, and there was no significantdifference (P gt; 0.05). The angle of rotation of polyethylene cushion averaged (5.6±2.8)°in Group A and (0±1.9)° in Group B,showing significant difference (P lt; 0.05). Conclusion The range of ideal tibial rotational al ignment in TKA was from medialborder of the tibial tubercle to medical 1/3 of the tibial tubercle, and is decided by the degree of varus deformities and valgus deformities.
Objective To review the advance in the researchand clinical application of the tibial rotational alignment technique in the total knee arthroplasty in China and abroad. Methods The recent literature concerned with the tibial rotational alignment technique in the totalknee arthroplasty was extensively reviewed and briefly summarized. Results According to the literature reviewed, the traditional tibial rotational references for the total knee arthroplasty were affected by many factors, so that the references were not accurate enough. There have been no unified references.ConclusionChoosing the range from the medial border of the tibial tubercle to the medial 1/3 of the tibial tubercle, decided by the degrees of the varus deformities and the valgus deformities, to determine the rotaional alignment of the tibial component will create an optimal tibiofemoral rotational alignment.
Objective To analyse the results of posterior cruciate l igament-retained mobile-bearing total knee arthroplasty (TKA) in treatment of rheumatoid arthritis (RA) and to solve the problems often encountered during surgery. Methods From February 1999 to August 2005, the cl inical data from 73 patients with RA undergoing TKA were analysed retrospectively. In 73 patients, 38 patients were treated with posterior cruciate l igament-retained mobile-bearing prosthesis (group A), while 35 patients were treated with posterior stabil ized fixed-bearing prosthesis (group B). Another 70 patients with osteoarthritis (OA) treated with an posterior cruciate l igament-retained mobile-bearing prosthesis served as controls (group C). In group A, there were 8 males and 30 females with an average age of 56.5 years and an average diseasecourse of 16.8 years. In group B, there were 6 males and 29 females with an average age of 57.3 years and an average disease course of 17.1 years. In group C, there were 37 males and 33 females with an average age of 65.4 years and an average disease course of 10.8 years. There was no significant difference (P gt; 0.05) in general data between groups A and B, but there were significant differences (P lt; 0.05) when compared with group C. Results In groups A and B, 2 cases (5.3%) and 1 case (2.9%) had poor heal ing of incision, respectively; in group C, all cases had good heal ing of incision. There were significant differences in heal ing rate of incision between groups A, B and group C (P lt; 0.05). All patients were followed up 7.6 years on average (range, 3.5-10.5 years). Deep infection occurred in 1 case respectively in 3 groups, showing no significant difference (P gt; 0.05). Posterior instabil ity occurred in 1 case (2.6%) 5 years after operation in group A and 2 cases (2.9%) 9 years after operation in group C, and no posterior instabil ity occurred in group B; showing significant differences between groups A, C and group B (P lt; 0.05). There were significant differences (P lt; 0.05) in knee score, Feller patellar score, and anterior knee pain score between pre- and postoperative values among groups A, B, and C. There were significant differences (P lt; 0.05) in the function scores between pre- and post-operative values in 3 groups, between groups A, B and group C pre- and post-operatively. Conclusion Posterior cruciate l igament-retained mobile-bearing TKA can yield satisfactory cl inical results in treatment of RA at intermediate-term followup. This mobile-bearing prosthesis has a low prevalence of posterior instabil ity and a good outcome for anterior knee function without patellar resurfacing.
目的 建立急性白血病（AL）患者八色流式免疫表型分析起始管方案。 方法 用胞膜CD3（CD3）、CD19、CD10、CD34、CD45、胞浆CD79a（cCD79a）、髓过氧化物酶（MPO)和胞浆CD3（cCD3）等8种抗体建立八色流式染色方案。膜表面抗体直接染色；膜内抗体经固定破膜，再染色后上机检测。将3个血小板减少患者骨髓标本分别进行抗体的单色染色和缺一色染色；最后对17例确诊的AL初发患者标本进行检测。 结果 用单色染色来确定染色方案中各抗体的检测电压及荧光补偿；缺一色染色中，阳性细胞群较单色染色变化均＜10%，表明方案中的各抗体相互作用小。17例AL初发患者中，6例急性B淋巴细胞白血病原始细胞均为CD34和CD19阳性，5例cCD79a阳性和4例CD10阳性；4例急性T淋巴细胞白血病患者均为cCD3阳性；6例急性髓细胞白血病均为CD34和MPO阳性；1例B+T混合表型AL患者CD34、cCD3、CD19、cCD79a及CD10均为阳性，MPO和CD3为阴性，此检测方案能够确定各类AL的细胞类型。 结论 建立了AL患者八色流式免疫表型分析起始管方案，操作简便快速，适用于临床检测。