ObjectiveTo summarize the research progress of two-stage revision for periprosthetic joint infection (PJI) after hip and knee arthroplasties.MethodsThe related literature on two-stage revision for PJI was summarized, and the new progress in the choice of spacers, systemic antibiotic therapy, and risk factors were analyzed.ResultsTwo-stage revision is a common way to treat infection after hip and knee arthroplasties. The types of spacers used in the one-stage operation are diverse and each has its own advantages and disadvantages. Non-articular spacers are mainly used for the patients with poor soft tissue conditions around the joints and severe bone defects. But the joint mobility is not good after the placement of the spacer. Articular spacers can restore the affected joint movement after operation, which is beneficial to the joint mobility after two-stage operation. The use of antibiotics is an indispensable part of the treatment process, and the effectiveness of short-term antibiotic treatment is similar to long-term treatment. Identifying the relevant risk factors that influence the prognosis of the two-stage revision can help preoperative management and reduce the recurrence rate of infection.ConclusionThere are still controversies about the choice of spacers and systemic antibiotic therapy during the two-stage revision and treatment of PJI. The factors affecting the prognosis of the two-stage revision need to be explored and the further high-quality research is needed.
Objective To observe whether the motor nerve babysitter could improve the delayed nerve anastomosisand promote the functional recovery. Methods Sixteen SD rats weighing 200-250 g were randomly divided into 2 groups.In group A, the left musculocutaneous nerve was transected to make the model of biceps brachii denervation and anastomosed to its proximal end 6 weeks later; In group B, the musculocutaneous nerve was transected and the distal end was coapted to the purely motor medial pectoral nerve immediately (nerve babysitter) and the musculocutaneous nerve was separated from the medial pectoral nerve, and reanastomosed to its proximal end 6 weeks later. In the animal model, the left l imbs served as experimental sides, the right l imbs as control sides. After 6 and 12 weeks of the second surgery, behavioral test (grooming test) was performed and the degree of the biceps brachii atrophy was observed, the latent period and the ampl itude of the maximun action potentials of the biceps brachii were detected, the wet muscle weight, muscle fiber cross-section area and the activity of Na+-K+-ATPase of the biceps brachii were measured. Results After 4 weeks of the second surgery, grooming behavior was found in group B, while few grooming behavior was seen in group A till 6 weeks after the secondary surgery. After 6 weeks of the second surgery, the recovery rate of the latent period and the ampl itude, the wet muscle weight, muscle fiber cross-section area and the enzymatic activity of Na+-K+-ATPase of the biceps brachii in group A was 187.25% ± 1.97%, 46.25% ± 4.63%, 55.14% ± 1.99%, 49.97% ± 1.71%, and 65.81% ± 2.24%, respectively, which was significantly different from that in group B (155.96% ± 3.02%, 51.21% ± 2.13%, 74.18% ± 1.82%, 55.05% ± 1.64% and 71.08% ± 1.53%, respectively, P lt; 0.05). After 12 weeks of the second surgery, the recovery rate of the latent period and ampl itude, the wet muscle weight, muscle fiber cross-section area andthe enzymatic activity of Na+-K+- ATPase of the biceps brachii in group A was 145.36% ± 3.27%, 51.84% ± 5.02%, 77.92% ± 1.73%, 61.04% ± 2.68% and 71.94% ± 1.65%, respectively, which was significantly different from that in group B (129.83% ± 8.36%, 75.22% ± 2.78%, 84.51% ± 1.34%, 78.75% ± 3.69% and 84.86% ± 1.81%, respectively, P lt; 0.05). Conclusion Motor nerve babysitting could reduce muscular damage after denervation, improve the effect of delayed nerve repair and promote the functional recovery of musculocutaneous nerve.
ObjectiveTo observe the difference between crenel lateral interbody fusion (CLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar spondylolisthesis (DLS) combined with lumbar spinal stenosis (LSS).MethodsThe clinical data of DLS combined with LSS patients meeting the selection criteria admitted between May 2018 and May 2019 were retrospectively analyzed. According to different surgical methods, the patients were divided into CLIF group (33 cases) and TLIF group (32 cases). There were no significant differences (P>0.05) between the two groups in gender, age, disease duration, lesion segments, lumbar bone mineral density, degree of lumbar spondylolisthesis, and preoperative visual analogue scale (VAS) score, Oswestry disability index (ODI), intervertebral space height, intervertebral foramen height, lumbar lordosis (LL), and segmental lordosis (SL). The operation time, intraoperative blood loss, and perioperative complications were recorded and compared between the two groups. Lumbar CT scan was performed at last follow-up to compare the intervertebral fusion rate between the two groups. Intervertebral space height, intervertebral foramen height, LL, and SL were measured before operation, at 2 weeks, 3 months after operation, and at last follow-up. VAS score and ODI were used to evaluate the pain and improvement of the quality of life of the patients.ResultsThere were no neurological and vascular complications in the two groups. The operation time and intraoperative blood loss in CLIF group were significantly less than those in TLIF group (P<0.05). Patients in both groups were followed up for a median time of 18 months. All the incisions healed by first intention except 1 incision in TLIF group because of poor blood glucose control. No complications such as bedsore, falling pneumonia, and deep venous thrombosis were found in both groups. At last follow-up, the intervertebral fusion rates in CLIF and TLIF group were 90.91% (30/33) and 93.75% (30/32), respectively, showing no significant difference (χ2=0.185, P=0.667). The VAS score, ODI, intervertebral space height, intervertebral foramen height, LL, and SL were significantly improved in both groups at each time point after operation (P<0.05). Except that VAS score in CLIF group was significantly lower than that in TLIF group at 2 weeks after operation (Z=−4.303, P=0.000), there were no significant differences in VAS score and ODI between the two groups at other time points (P>0.05). The intervertebral space height, intervertebral foramen height, LL, and SL in CLIF group were significantly higher than those in TLIF group at each time point after operation, and the differences were significant (P<0.05).ConclusionCLIF in the treatment of DLS combined with LSS can achieve the similar effectiveness with traditional TLIF, and has such advantages as minimal invasion and faster recovery.
Objective To study the effectiveness and acetabular prosthesis selection of the total hip arthroplasty (THA) for Crowe type IV congenital dysplasia of the hip with dislocation in adults. Methods Between June 2008 and May 2012, 8 adult patients (8 hips) with Crowe type IV congenital dysplasia of the hip with dislocation underwent THA. They were all female, aged 20-35 years with a mean age of 25 years. The left hip was involved in 5 cases and the right hip in 3 cases. The Harris score of involved hip was 53.9 ± 6.6. The shortened length of involved extremity was 4-6 cm (mean, 4.8 cm). The X-ray films showed complete dislocation in all cases. The acetabular prosthesis with diameter of 42-44 mm and S-ROM femoral prosthesis were used in THA. Results The incisions healed by first intention. There was no hip dislocation events and sciatic nerve injury during the follow-up. Femoral nerve injury occurred in 1 case and asymptomatic venous thrombosis of the leg muscle occurred in 2 cases. All the patients were followed up 1-5 years (mean, 3 years). All cases showed obvious improvement of claudication and could restore to work. At 6 months after operation, the mean length difference between affected and contralateral extremities was 0.4 cm (range, — 1.0-0.6 cm); the Harris score was significantly increased to 87.6 ± 0.3 (t=1.77, P=0.00). The X-ray films showed that all cases got bony union at 3-6 months after operation and stable interface between acetabular prosthesis and bone. No revision was involved during the follow-up. Conclusion THA with small acetabular cup and subtrochanteric osteotomy is an effective method in the treatment of Crowe type IV congenital dysplasia of the hip with dislocation in adults. The early effectiveness is satisfactory. The long-term survival rate of prosthesis needs to be followed up.
ObjectiveTo analyse the effectiveness of unicompartmental knee arthroplasty (UKA) for the patients with spontaneous osteonecrosis of the knee (SONK). MethodsBetween January 2012 and December 2016, 31 patients with SONK was admitted and treated with medial UKA. All patients were examined by both plain radiography and magnetic resonance images. The patients were composed of 5 men and 26 women with an average age of 64.3 years (range, 48-79 years), and with 16 left joints and 15 right joints. The average disease duration was 14.7 months (range, 6-26 months). Preoperative visual analogue scale (VAS) was 6.00±1.15, Hospital for Special Surgery (HSS) score was 55.77±11.03, and knee range of motion (ROM) was (114.68±10.40)°. The imaging examinations showed that all the lesions were located in the medial compartment of the knee joint and there were 19 patients with Aglietti stage Ⅳ and 12 patients with Aglietti stage Ⅴ. Preoperative femorotibial angle (FTA) was (177.39±1.63)° and posterior tibial slope (PTS) was (84.05±1.39)°. ResultsAll the incisions healed by first intention. All patients were followed up 14-46 months (mean, 25 months). At last follow-up, VAS score was 2.06±0.72 and HSS score was 86.45±3.67, which both improved significantly when compared with preoperative scores (t=22.73, P=0.00; t=–14.72, P=0.00). ROM was (118.06±3.80)° with no significant difference when compared with preoperative ROM (t=–1.78, P=0.08). The X-ray films showed there was no severe adverse events, such as periprosthetic infection, aseptic loosening, bearing dislocation, and so on. At last follow- up, PTS was (85.30±1.19)° with significant difference compared with preoperative one (t=–4.07, P=0.00); while FTA was (177.51±1.98)° with no significant difference when compared with preoperative FTA (t=–0.38, P=0.71). ConclusionUKA may be an optional management for SONK with minimally invasive, bone-preserving, and rapid recovery.
ObjectiveTo evaluate the effectiveness of cement-injectable cannulated pedicle screw combined with multiple level Schwab grade Ⅰ osteotomy for chronic thoracolumbar osteoporotic fractures with kyphosis.MethodsThe clinical data of 27 patients with symptomatic chronic thoracolumbar osteoporotic fractures combined with kyphosis treated between June 2015 and June 2017 were retrospectively analysed. Among them, there were 8 males and 19 females, with an average age of 69.5 years (range, 56-81 years). The damage segment (kyphosis vertex) included T11 in 4 cases, T12 in 12 cases, L1 in 10 cases, and L2 in 1 case. The disease duration ranged from 3 to 21 months, with an average of 12.5 months. The T value of lumbar vertebral bone mineral density ranged from −4.9 to −2.5, with an average value of −3.61. The American Spinal Injury Association (ASIA) classification was used to evaluate spinal cord injury, there were 1 case of grade D and 26 cases of grade E. The visual analogue scale (VAS) score, Oswestry disability index (ODI), kyphosis Cobb angle of fracture site, and sagittal vertical axis (SVA) data were obtained before operation, at 2 weeks after operation, 3 months after operation, and last follow-up, to evaluate the quality of life and improvement of sagittal spine parameters.ResultsNo complications related to pedicle screw and bone cement occurred. The incisions healed by first intention in 26 cases, and 1 incision healed after dressing change due to poor blood glucose control. There were no complications such as bedsore, hypostatic pneumonia, or deep venous thrombosis. All patients were followed up 8-24 months, with an average of 16.6 months. The VAS score, ODI score, Cobb angle, and SVA were significantly improved when compared with those before operation (P<0.05). There was no significant difference in Cobb angle between each time point after operation (P>0.05); the VAS score and ODI score at 3 months after operation and last follow-up were significantly better than those at 2 weeks after operation (P<0.05), and the ODI score at last follow-up was further improved when compared with the score at 3 months (P<0.05), but there was no significant difference in VAS score (P>0.05); SVA at last follow-up was significantly worse than that at 2 weeks and 3 months after operation (P<0.05), but there was no significant difference between at 2 weeks and 3 months after operation (P>0.05). During the follow-up period, there was no complication such as pedicle screw loosening, breakage or cutting, adjacent vertebral fracture, proximal junctional kyphosis, and so on.ConclusionFor the chronic thoracolumbar osteoporotic fractures combined with kyphosis, the cement-injectable cannulated pedicle screw and multiple level Schwab grade Ⅰ osteotomy has the advantages of less operation trauma, quick recovery, and remarkable effectiveness.
Objective To investigate the early-term effectiveness of extra-large uncemented acetabular components for hip revision in the treatment of extensive acetabular bone defect. Methods Between September 2008 and May 2012, 13 patients (13 hips) with extensive acetabular bone defect underwent first hip revision using extra-large uncemented acetabular components (Jumbo cup). The diameter of Jumbo cup was larger than or equal to 64 mm for male and 60 mm for female. There were 4 males and 9 females with an average age of 64.7 years (range, 58-84 years). The period from primary arthroplasty to revision was 3-16 years (mean, 9.6 years). According to Paprosky classification, acetabular bone defect was rated as stage IIA in 2 cases, as stage IIB in 5 cases, as stage IIC in 4 cases, and as stage IIIA in 2 cases. The preoperative vertical distance from the center of involved femoral head to interteardrop line was (21.2 ± 6.1) mm longer than that of normal side. The Harris score and the rotation center of hip were evaluated preoperatively and postoperatively. Results Healing of incision by first intention was obtained in all patients, and no complication of dislocation, infection, and injury of sciatic nerve or femoral nerve occurred. The duration of follow-up ranged from 13 to 40 months (mean, 23.5 months). Partial or complete pain relief was achieved in all patients. The other patients could walk independently and restored to their routine jobs except for 1 case of hemiplegia caused by acute cerebral infarction at 3 months after surgery. In 5 patients with bone implantation, with the prolonging follow-up, the allograft could integrate with the host bone without absorption, and the bone fusion time was 9-35 months (mean, 14.5 months). At last follow-up, the X-ray films revealed that the vertical distance from the center of involved femoral head to interteardrop line was (6.0 ± 3.1) mm longer than that of normal side, which was significantly reduced when compared with preoperative value (t=11.13, P=0.00). No periprosthetic transparent region, prosthesis displacement, or screw breakage occurred. The Harris score was significantly increased from 30.4 ± 8.8 preoperatively to 85.1 ± 3.2 at last follow-up (t=22.11, P=0.00). Conclusion The application of extra-large uncemented acetabular components could be an effective technique for the reconstruction of extensive acetabular bone defect, and gain a good early-term effectiveness. The long-term survival rate of prostheses needs to be followed up.