Objective To compare the effectiveness of arthroscopic and open ankle arthrodeses. Methods The clinical data were retrospectively analyzed from 30 patients undergoing unilateral ankle arthrodesis between January 2008 and January 2011. Of 30 patients, 14 underwent arthroscopic ankle arthrodesis (arthroscopic group), and 16 underwent open ankle arthrodesis (open group). There was no significant difference in gender, age, lesion type, disease duration, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score between 2 groups (P gt; 0.05). The operation time, intraoperative blood loss, postoperative hospitalization days, postoperative AOFAS score, and bony union rate were observed to evaluate the effectiveness. Results The operation time of arthroscopic group was significantly longer than that of open group (P lt; 0.05); the intraoperative blood loss and postoperative hospitalization days of arthroscopic group were significantly less than those of open group (P lt; 0.05). Superficial infection of incision occurred in 1 case of open group, and healing of incision by first intention was obtained in the other patients. All patients were followed up 12 months. No screw breakage was observed. The X-ray films showed bony fusion in 13 cases (92.86%) of arthroscopic group and in 10 cases (62.50%) of open group at 3 months after operation, showing significant difference (χ2=3.850, P=0.049); but no significant difference was found (χ2=0.910, P=0.341) in bony fusion rate between the arthroscopic group (14/14, 100%) and open group (15/16, 93.75%) at 12 months after operation. The AOFAS scores at 1, 3, 6, and 12 months after operation were significantly higher than preoperative score in 2 groups (P lt; 0.05). There was no significant difference in AOFAS score between 2 groups at 1 and 3 months (P gt; 0.05), but significant differences were found at 6 and 12 months (P lt; 0.05). Conclusion The overall effectiveness of arthroscopic ankle arthrodesis is better than that of open ankle arthrodesis, which can decrease intraoperative blood loss, shorten hospitalization days, get higher bony fusion rate, and obtain good ankle function recovery.
【Abstract】 Objective To review the basic and clinical research progress of lateral column lengthening (LCL).Methods The recent literature concerning LCL at home and abroad was extensively reviewed, and the research and development were summarized. Results LCL is one of the important surgical procedures for flatfoot deformity, and it has two procedures. There are some disputes in surgical selection of the Evans osteotomy and calcaneocuboid distraction arthrodesis for the treatment of flatfoot deformity. Conclusion Lateral column lengthening has been used more widely in clinical practice, but biomechanical and the long-term follow-up are needed.
Objective To review the latest research progress of fixation techniques of ankle arthrodesis.Methods The l iterature concerning the research of fixation techniques of ankle arthrodesis in recent years was reviewed. Then the characteristics and new research progress of different internal and external fixation techniques were analysed and compared. Results There are plenty of different types of internal and external fixation devices, each with distinct characteristics. Now it is widely considered that internal fixation is the first choice for end-stage ankle arthropathy. However, under the circumstances that patients with serious bone defect, chronic active infection, or extensive soft tissue damage are not suitable for internal fixation, ankle arthrodesis with external fixation is still a safe and effective method. Conclusion For severe or end-stage ankle arthropathy, ankle arthrodesis is a mature therapeutic way with exact effect. Researches on these two aspects, expansion of indications of internal fixation and comparison and combination of internal and external fixation techniques, need to be deepened, which is of great significance for choosing a better fixation method and acquiring a better therapeutic effect.
Objective To summarize the surgical technique of ankle arthrodesis using lateral malleolus osteotomy and locking proximal humeral plate internal fixation, and to evaluate the cl inical effectiveness. Methods Between March 2009 and June 2010, 18 patients with ankle joint disease were treated, including 8 cases of post-traumatic arthritis, 3 casesof rheumatoid arthritis, 5 cases of osteoarthritis, and 2 cases of post-traumatic necrosis of talus. There were 10 males and 8 females with an average age of 48 years (range, 36-67 years). The average disease duration was 3 years (range, 1-6 years). The main symptoms included swell ing, pain, and a l imited range of motion of the ankle. Four patients accompanied with ankle varus deformity and 2 patients with valgus deformity. According to American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system, the preoperative score was 43.5 ± 10.2. An ankle arthrodesis using lateral malleolus osteotomy and locking proximal humeral plate internal fixation was performed in all patients. Results Superficial wound infection and partial skin necrosis occurred in 1 case respectively, and were cured after symptomatic treatment; the other incisions healed by first intention without compl ications. Sixteen patients were followed up 16 months on average (range, 1-2 years). The X-ray films showed that bone fusion was obtained at 8-16 weeks (mean, 12 weeks) after operation. The symptom was rel ieved completely in all patients at last follow-up without compl ication of implant failure, nonunion, and malunion. The postoperative AOFAS ankle and hindfoot score was 83.0 ± 6.3, showing significant difference when compared with the preoperative score (t=26.20, P=0.00). Conclusion Ankle arthrodesis using lateral malleolus osteotomy and locking proximal humeral plate internal fixation has the advantages of feasible technique, the rigid fixation, and high fusion rate, soit may obtain a good cl inical effectiveness.
Objective To evaluate the cl inical results of arthroscopical subtalar arthrodesis for malunion of calcaneal fractures. Methods Between July 2006 and December 2008, 12 cases of malunion of calcaneal fractures were treated witharthroscopical subtalar arthrodesis, inculding 10 males and 2 females with an age range of 38-54 years (44.8 years on average). The location was left side in 5 cases and right side in 7 cases. The injury was caused by fall ing from height in 8 cases, by traffic accident in 3 cases, and other in 1 case. It was 3-7 months from injury to operation. All cases were classified as Stephens type II. The total score was 35.68 ± 10.35 and the pain score was 8.14 ± 1.83 before operation according to Hindfoot scores system of American Orthopaedic Foot amp; Ankle Society (AOFAS). Results All incisions achieved parimary heal ing and the patients were all followed up 14-32 months (18 months on average). The X-ray films showed bony fusion after 10-14 weeks (11.5 weeks on average). The total score was 76.45 ± 9.83 and the pain score was 1.52 ± 1.48 after operation according to Hindfoot scores system of AOFAS, showing significant difference when compared with those before operation (P lt; 0.01). Conclusion Arthroscopical subtalar arthrodesis can get satisfactory fusion rate with few compl ications for malunion of calcaneal fractures.
Objective To evaluate the clinical results of subtalar arthrodesis and calcaneal thalamus reconstruction for malunion of calcaneal fractures and to discuss the indications and its advantages of the management. Methods From December 1994 to January 2006, 84 cases(96 feet) of malunion of calcaneal fractures were treated with subtalar arthrodesis and calcaneal thalamus reconstruction. The L-shaped approach lateral to calcaneus was used. The bone autograft was harvested from iliac crest. Fiftyone cases were male and 33 cases were female, aging from 21 to 58 years (mean 385 years).One side was in volved in 72 cases and two sides in 12 cases. The injury was caused by falling from height in 57 cases, by traffic accident in 22 cases and other in 5 cases. It was 6-31 months from injury to operation (mean 9.5 months). Results Among the patients, all cases were followed up 1 to 132 months. The total excellent and good rate was 87.5%, including excellent in 31 feet, good in 53 feet and fair in 12 feet,according to Hindfoot scores system (American Orthopaedics Foot and Ankle Society). The B[AKo¨]hler’s and Gissane’s angles, the height of calcaneal thalamus and width of calcaneus were significant different from those of preoperation (Plt;0.01). Conclusion The treatment by bone autograft combined with subtalar arthrodesis and calcaneal thalamus reconstruction is an effective operation for malunion of calcaneal fractures, with advantages of correcting deformity, restoring the function of indfoot and relieving the pain of walking.
Objective To find out some parameters to judge the stability of the wrists after four-corner arthrodesis and to explore the strategyfor improving the range of motion (ROM) of the wrist after four-corner arthrodesis. Methods After the simulated four-corner arthrodesis was performed in both wrists of 8 men and 4 women cadaver, the wrists were fixed on the wrist motor simulator; and wrist movement including flexion, extension, radial deviation, ulnar deviation was simulated. The standard posteroanterior and lateral radiographs were taken for measuring the change of capitolunate angle（α）, radiolunate angle（β）, capitolunate posteroanterior angle（θ）, the height（H）and width（W）of the fused four carpal bone bloc. Results There were statistically significant differences in α,β,θ angles (P＜0.01) in the case of 50° flexion or 40° extension, and in H and W values (P＜0.05) in the case of 25° ulnar deviation or 15° radial deviation when compared with before movement. Conclusion Capitolunate angle, radiolunate angle, capitolunate posteroanterior angle, the height and the width of thefused four carpal bone bloc can be used to judge the stability of the wrists after four-corner arthrodesis.
Objective To investigate the efficacy of freeze-driedcancellous allograft in the treatment of spinal tuberculosis. Methods From January 1999 to August 2004, there were 31 cases of spinal tuberculosis who underwent surgery. The freeze-dried cancellous allograft was used as grafting material in all the cases.The cancellous allograft was packed in a titanium mesh cage or an artificial vertebrae, and then used as a strut graft anteriorly to implant into the bone defect after the redical debridement, and the instrumentation was done. Results Twenty-three cases were followed up 1.5 years to 5 years (3.7 years on average), and bonyfusion was achieved in 21 cases 6 months later. In 2 cases ceasing antituberculous therapy after 2 months of operation, the local recurrence was obvious. The loosened screw was noticed in one of these two cases, who had tuberculosis in lumbar spine. When antituberculous therapy continued, the bony fusion was observed in these two cases 12 months later. No further position change of the instrument wasnoticed in the patient carrying loosened screw, but the kyphosis of the thoracolumbar spine aggravated. Conclusion Freeze-dried cancellous allograft could be usedin the treatment of spinal tuberculosis. To achieve good results of allograft incorporation and remodeling, the rigid instrumentation should be performed, postoperative antituberculous therapy is also important.
OBJECTIVE: To review the recent progress in the treatment of wrist disorder by limited intercarpal arthrodesis and the related experimental study. METHODS: Recent original articles related to limited intercarpal arthrodesis, including clinical practice and experimental study, were extensively retrieved and carefully analyzed. RESULTS: Limited intercarpal arthrodesis could relieve pain and stabilize the wrist joint with partial motion. CONCLUSION: With suitable indication and well selected operation approach, the limited intercarpal arthrodesis should be the optimal surgical intervention than total carpal athrodesis in the treatment of wrist disorder.
Objective To evaluate the effectiveness, safety, cost and optimal dosing regimen of bone morphogenetic protein (BMP) used in the lumbar spine arthrodesis. Methods We formulated the clinical questions according to the PICO principle. We searched the ACP Journal Club (1991 to February 2008), The Cochrane Library (Issue 4, 2007) and PubMed (1990 to February 2008) as well as other relevant databases. The evidence retrieved was critically appraised. Results Current evidence showed that BMP was a satisfactory and safe behavior in lumbar arthrodesis. Its cost was equal to that of autogenous iliac bone graft. The types of BMP currently used in clinical practice are BMP-2 and BMP-7. Finished product of fixed composition ratio was recommended in anterior lumbar inter-body fusion, while in posterolateral fusion, 20mg of BMP-2 or 3.5mg of BMP-7 for each side was recommended, with proper carrier according to the place where it was used. Conclusion BMP may be introduced to China for lumbar spine arthrodesis. Before it is applied extensively, further large-scale, high-quality randomized controlled trials are needed. Meanwhile, more research is necessary to determine the proper dosage and preparation form for the dominant Chinese population.