Objective To investigate the cl inical results and complications of minimally invasive anterior transarticular screw fixation and fusion for atlantoaxial instabil ity. Methods Between May 2007 and December 2010, 13 patients with atlantoaxial instabil ity were treated with minimally invasive anterior transarticular screw fixation and fusion under endoscope. There were 11 males and 2 females, aged 17-61 years (mean, 41.3 years). The time between injury and operation was 5-14 days (mean, 7.4 days). All cases included 6 patients with Jefferson fracture, 5 with odontoid fracture, and 2 with os odontoideum. According to Frankel classification of nerve functions, 2 cases were rated as grade D and 11 cases as graed E. The operation time, intra-operative blood loss, radiation exposure time, and complications were recorded and analyzed. The stabil ity was observed by X-ray films. The cl inical outcome was assessed using the Frankel scale, and the fusion rates were determined by CT scan threedimensional reconstruction at last follow-up. Results The mean operation time was 124 minutes (range, 95-156 minutes); the mean intra-operative blood loss was 65 mL (range, 30-105 mL); and the mean radiation exposure time was 41 seconds (range, 30-64 seconds). Thirteen patients were followed up 12-47 months (mean, 25.9 months). No blood vessel and nerve injuries or internal fixator failure occurred. The bone fusion time was 6 months, and the dynamic cervical radiography showed no instabil ity occured. At last follow-up, the neurological function was grade E in all patients. The fusion rate was 84.6% (11/13). No continuous bone bridge was seen in the joint space of 2 patients, but they achieved stabil ity. Conclusion Minimally invasive anterior transarticular screw fixation and fusion is a safe and effective procedure for treatment of atlantoaxial instabil ity.
ObjectiveTo evaluate the effectiveness of modified Ilizarov hip reconstruction in the treatment of hip instability.MethodsThe clinical data of 13 young patients with hip diseases treated with modified Ilizarov hip reconstruction between January 2010 and March 2018 were retrospectively analyzed. There were 2 males and 11 females, aged from 14 to 34 years, with an average age of 24.2 years. There were 1 case of hip dysplasia and dislocation due to spinal bifida, 3 cases of hip dysplasia after pyogenic arthritis of the hip, 2 cases of developmental dysplasiaof the hip (DDH) accompanying femoral head necrosis who rejected hip replacement, 6 cases of young DDH refused to undergo hip replacement, and 1 case of bilateral hip dysplasia with dislocation due to sputum cerebral palsy. The disease duration was 2-20 years, with an average of 8.5 years. Preoperative Trendelenburg sign was positive in 12 cases and negative in 1 case. The preoperative Harris score of hip joint was 53.5±8.9 and the unequal length of lower limbs was (46.08±15.73) mm. Postoperative Harris hip score and patients' satisfaction with effectiveness evaluated according to their self scoring were used to assess the effectiveness.ResultsAll 13 patients were followed up 1-5 years, with an average of 2.6 years. Five patients developed postoperative needle infection, which improved after dressing change; 7 patients had limited knee joint activity and improved after knee joint function training. The Trendelenburg sign was negative at 1 year after operation, and the patient’s hip pain symptoms were relieved or disappeared. The Harris hip score of patients at 1 year after operation was 84.5±6.1, which was significantly improved when compared with preoperative one (t=－10.538, P=0.000). According to Harris hip score, the effectiveness results were excellent in 4 cases, good in 5 cases, and fair in 4 cases, with an excellent and good rate of 69.2%. The unequal length of lower limbs was (15.38±7.27) mm, which was significantly better than that before operation (t=11.826, P=0.000). At last follow-up, the patients' satisfaction score was 80%-95%, with an average of 88%.ConclusionModified Ilizarov hip reconstruction can be used to treat young patients with hip disease who are unsuitable or refuse to undergo artificial hip replacement. Its effectiveness is reliable, and it has unique advantages in limb limp improvement and limb shortening correction.
ObjectiveTo compare the effectiveness between modified Brostrom method repair and anatomical reconstruction anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) with single fibular tunnel for chronic lateral ankle instability. MethodsTwenty ankle specimens of fresh cadaver were dissected to provide the anatomic data of ATFL and CFL and to observe the neurovascular distribution. Between January 2008 and December 2011, 48 patients (48 ankles) with chronic lateral ankle instability were randomly divided to groups A and B (n=24). The direct repair of ATFL and CFL by modified Brostrom method was performed in group A, and anatomic doublebundle reconstruction of ATFL and CFL with free semitendinosus tendon autograft in group B. There was no significant difference in sex, age, body mass index, injury side, the causes of injury, interval of injury and operation, talar tilt angle, talus forward shift, ankle plantar flexion, dorsiflexion, valgus, varus, American Orthopaedic Foot and Ankle Society (AOFAS) score, and visual analogue score (VAS) between 2 groups (P>0.05). The image parameters and range of motion were compared between 2 groups after operation; AOFAS and VAS scores were used to evaluate the effectiveness. ResultsAll the incisions healed by first intention in 2 groups; no complication of nerve injury, infection, or skin necrosis was observed. All the patients were followed up 2-5 years (mean, 3.4 years); no subtalar stiffness or recurrent instability occurred during follow-up. The talar tilt angle, talus forward shift, AOFAS score, and VAS score were significantly improved at 2 years after operation when compared with preoperative ones in 2 groups (P<0.05). There was no significant difference in range of motion of ankle plantar flexion, dorsiflexion, and ankle valgus, and VAS score between 2 groups (P>0.05), but group B was significantly better than group A in the range of motion of ankle varus, talar tilt angle, talus forward shift, and AOFAS score (P<0.05). In the each item of AOFAS score, there was no significant difference in pain, abnormal gait, support and autonomic function, ankle flexion and extension, hind foot motion, and alignment between 2 groups (P>0.05), but group B was significantly better than group A in walking, maximum walking distance, and ankle stability (P<0.05). ConclusionThe described technique, which involves anatomic double-bundle reconstruction of the ATFL and CFL with single fibular tunnel and modified incision, is a viable option for treating lateral ankle instability, especially for young patients who need high stability and revision.
Objective To simulate anterosuperior instabil ity of the shoulder by a combination of massive irreparable rotator cuff tears and coracoacromial arch disruption in cadaveric specimens, use proximally based conjoined tendon transfer forcoracoacromial l igament (CAL) reconstruction to restrain against superior humeral subluxation, and investigate its feasibility and biomechanics property. Methods Nine donated male-adult and fresh-frozen cadaveric glenohumeral joints were applied to mimic a massive irreparable rotator cuff tear in each shoulder. The integrity of the rotator cuff tendons and morphology of the CAL were visually inspected in the course of specimen preparation. Cal ipers were used to measure the length of the CAL’s length of the medial and the lateral bands, the width of coracoid process and the acromion attachment, and the thickness in the middle, as well as the length, width and thickness of the conjoined tendon and the lateral half of the removed conjoined tendon. The glenohumeral joints were positioned in a combination of 30° extension, 0° abduction and 30° external rotation. The value of anterosuperior humeral head translation was measured after the appl ication of a 50 N axial compressive load to the humeral shaft under 4 sequential scenarios: intact CAL, subperiosteal CAL release, CAL anatomic reattachment, entire CAL excision after lateral half of the proximally based conjoined tendon transfer for CAL reconstruction. Results All specimens had an intact rotator cuff on gross inspection. CAL morphology revealed 1 Y-shaped, 4 quadrangular, and 4 broad l igaments. The length of the medial and lateral bands of the CAL was (28.91 ± 5.56) mm and (31.90 ± 4.21) mm, respectively; the width of coracoid process and acromion attachment of the CAL was (26.80 ± 10.24) mm and (15.86 ± 2.28) mm, respectively; and the thickness of middle part of the CAL was (1.61 ± 0.36) mm. The length, width, and thickness of the proximal part of the proximally based conjoined tendon was (84.91 ± 9.42), (19.74 ± 1.77), and (2.09 ± 0.45) mm, respectively. The length and width of the removed lateral half of the proximally conjoined tendon was (42.67 ± 3.10) mm and (9.89 ± 0.93) mm, respectively. The anterosuperior humeral head translation was intact CAL (8.13 ± 1.99) mm, subperiosteal CAL release (9.68 ± 1.97) mm, CAL anatomic reattachment (8.57 ± 1.97) mm, and the lateral half of the proximally conjoined tendon transfer for CAL reconstruction (8.59 ± 2.06) mm. A significant increase in anterosuperior migration was found after subperiosteal CAL release was compared with intact CAL (P lt; 0.05). The translation after CAL anatomic reattachment and lateral half of the proximally conjoined tendon transfer for CAL reconstruction increased over intact CAL, though no significance was found (P gt; 0.05); when they were compared with subperiosteal CAL release, the migration decreased significantly (P lt; 0.05). The translation of lateral half of the proximally conjoined tendon transfer for CAL reconstruction increased over CAL anatomic reattachment, but no significance was evident (P gt; 0.05). Conclusion The CAL should be preserved or reconstructed as far as possible during subacromial decompression, rotator cuff tears repair, and hemiarthroplasty for patients with massive rotator cuff deficiency. If preservation or the insertion reattachment after subperiosteal release from acromion of the CAL of the CAL is impossible, or CAL is entirely resected becauseof previous operation, the use of the lateral half of the proximally based conjoined tendon transfer for CAL reconstruction isfeasible.
Objective To investigate the radiographic and clinical outcomes of dorsal intercarpal ligament capsulodesis (DILC) procedure for chronic static scapholunate dissociation. Methods Between January 2008 and January 2011, 12 patients with chronic static scapholunate dissociation were treated with DILC. Of 12 cases, 10 were male and 2 were female with an average age of 42 years (range, 20-66 years). All injuries were caused by falling. The interval from injury to surgery was 3-19 months (mean, 8 months). Physical examination at admission showed wrist tenderness and limited range of motion (ROM). Radiological examination showed that scapholunate gap was greater than 3 mm on posteroanterior view, and scapholunate angle more than 60° on the lateral view. Before operation, the grip strength was (25.4±8.2) kg; the wrist ROM was (56.7±11.5)° in flexion and (52.0±15.2)° in extension; visual analogue scale (VAS) score was 6.3±1.4; and disabilities of arm, shoulder & hand (DASH) score was 39.5±7.4. According to Garcia-Elias staging criteria, all cases were rated as stage 4, indicating that the scapholunate interosseous ligament was completely injured and reduction could easily be obtained. Eight patients had wrist instability. Results Primary healing of incision was achieved, no complication was found. All patients were followed up 13-34 months (mean, 15.9 months). During surgery, all deformities were corrected completely, but 7 patients (58%) recurred at 1 month after Kirschner wire removal. Compared with preoperative ones, the scapholunate gap, scapholunate angle, radiolunate angle, lunocapitate angle, and wrist height ratio at 1 month after Kirschner wire removal and last follow-up showed no significant difference (P > 0.05); the wrist flexion and extension ROM were significantly decreaed to (46.8±7.2)° and (42.0±9.0)° at last follow-up (P < 0.05); the grip strength was significantly increased to (32.7±9.6) kg at last follow-up (P < 0.05); VAS score and DASH score were improved to 1.7±1.0 and 8.1±8.7 (P < 0.05). Conclusion Carpal collapse will recur in short time after DILC. DILC is not the best way to treat chronic static scapholunate dissociation.
ObjectiveTo explore the effectiveness of one-stage posterior medial corner (PMC) repair or reconstruction combined with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction in treating KD-ⅢM dislocation. Methods The clinical data of 15 patients with knee KD-ⅢM dislocation who met the selection criteria between January 2016 and July 2019 were retrospectively analyzed. There were 9 males and 6 females, aged 22-61 years (mean, 40.3 years). Injuries were caused by violence of flexion, valgus, and external rotation, including 10 cases of traffic accident injuries, 3 cases of crush injuries, 1 case of winch injury, and 1 case of explosion injury. The time from injury to operation ranged from 3 days to 6 months, with an average of 18.5 days. PMC repair combined with PCL+ACL reconstruction was performed in 10 cases in acute stage (within 3 weeks after injury), including 3 cases of irreducible dislocation. PMC+PCL+ACL reconstruction was performed in 5 cases with chronic dislocation. Before operation and at last follow-up, the knee joint function was evaluated by Lysholm score and International Knee Documentation Committee (IKDC) 2000 score. KT-3000 was used to evaluate the forward stability of the knee (calculated the difference of tibial anterior displacement of both knees), the X-ray films of the stress position of the knee joint was used to evaluate the valgus of the knee (calculated the difference of medial joint space width of both knees) and the backward stability (calculated the difference of tibial posterior displacement of both knees), and the internal and external rotation stability was evaluated by knee flexion 30° tibial external rotation and knee flexion 90° tibial internal rotation tests (calculated the difference of tibial internal rotation and the difference of tibial external rotation of both knees). Results The operation time was 120-240 minutes, with an average of 186.5 minutes. Patients were followed up 24-48 months, with an average of 27.4 months. There was no complication such as infection, deep vein thrombosis, vascular injury, or heterotopic ossification. At last follow-up, the Lysholm score, IKDC2000 score, the difference of tibial anterior displacement of both knees, the difference of medial joint space width of both knees, the difference of tibial posterior displacement of both knees, the difference of tibial internal rotation and the difference of tibial external rotation of both knees significantly improved when compared with preoperative ones (P<0.05). According to the IKDC2000 valgus stability grading standard, there were 3 cases of grade C and 12 cases of grade D before operation, and 10 cases of grade A and 5 cases of grade B at last follow-up, which was significantly improved when compared with that before operation (Z=−4.930, P=0.000). At last follow-up, the pivot shift tests of 15 patients were negative. The anterior and posterior drawer tests of 10 patients were negative, 5 patients had mild instability, both the anterior and posterior drawer tests were positive. ConclusionKD-ⅢM dislocation of the knee joint can lead to the posterior medial and anterior instability. Acute dislocation combined with “dimple sign” requires surgical reduction as soon as possible to repair PMC and reconstruct PCL and ACL. In chronic patients, PMC is difficult to repair, it is recommended to reconstruct PMC, PCL, and ACL at one stage to improve knee joint stability. The early and middle effectiveness are satisfactory.
Objective To investigate the management of extention apparatus and cl inical results of total knee arthroplasty (TKA) of osteoarthritis. Methods Between June 2007 and June 2009, 386 patients (460 knees) with osteoarthritis received TKA, including 216 left knees and 244 right knees. There were 125 males (145 knees) and 261 females (315 knees) with an average age of 60.3 years (range, 58-85 years). The disease duration was 4-12 years (mean, 6.7 years). The X-ray films and CT scanning showed that all patients had femur-tibia joint degeneration and osteophyte formation at the edgeof joint. According to modified Burnett patellar resurfacing indication, whether or not to replace the patellar was determined, and the patellar track was determined by combining no thumb test and towel clamp traction test. Patella resurfacing was performed in 53 cases (56 knees, resurfacing group), no patella resurfacing in 333 cases (404 knees, non-resurfacing group), and lateral retinacular releasing 68 cases (72 knees). The postoperative imaging and knee society score (KSS), patellofemoral compl ications were analyzed. Results All wounds healed by first intention. All the patients were followed up 1-3 years (mean, 26 months). Deep infection occurred in 3 cases (1 case of resurfacing group and 2 cases of non-resurfacing group) at 3-7 months and they were cured after two-stage reversion. Patellofemoral compl ications occurred in 2 cases of resurfacing group (2/56, 3.57%) and in 9 cases of non-resurfacing group (9/404, 2.23%), showing no significant difference (χ2=0.38, P=0.54). There were significant differences in KSS and visual analogue scale (VAS) at 2 and 3 year after operation when compared with before operation (P lt; 0.05). No significant difference in KSS and VAS of resurfacing group and non-resurfacing group were observed at 3 years after operation (P gt; 0.05). Conclusion It is benefit for selective patellar resurfacing and the patellar tract improvement to select patellar resurfacing indication according to the multi-factor assessment and to determine the patellar tract by combining no thumb test and towel clamp traction test, which can reduce the patellofemoral compl ication rate after TKA.
Objective To explore the relationship between microsatellite instability （MSI） and gastric cancer. Methods The related literatures at home and abroad were consulted and reviewed. Results The MSI is the replication errors caused by mismatch repair system defects. Gastric cancer which exhibiting MSI has characteris clinicopathological feature and prognosis. Detection the MSI of precancerous lesions and gastric cancer tissues can evaluate the risk and prognosis of gastric cancer. MSI include nuclear microsatellite stability （nMSI） and mitochondrial microsatellite instability （mtMSI）. Conclusions MSI plays an important role in the occurrence and development of gastric cancer. MSI may become a important indicator to forecast precancerosis risks and clinical prognosis of gastric cancer.
Objective To improve the safety of the percutaneous anterior transarticular screw fixation (PATSF) by measuring the parameters related to PATSF. Methods Spiral CT scan and three-dimensional reconstructions of the atlantoaxis were performed in 50 adult volunteers. The section of inner margin of atlantal superior articular facet, the coronal plane ofvertebral artery cavity, and the sagittal plane of atlano-axis were obtained with multiplanar reconstruction on hel ical CT. The atlantoaxial vertebral structure and the direction of vertebral artery cavity were observed. The parameters related to PATSF were measured and analysed. Results The suitable position of screw insertion was 4.0 mm from the midpoint of the axoidean anteroinferior margin. The maximum external angle of PATSF was (29.89 ± 1.41)°; the minimum external angle was (4.37±0.87)°; the maximum backward angle was (32.41 ± 1.66)°; the optimal external angle was (17.13 ± 0.88)°; the optimal backward angle was (17.62 ± 1.03)°; and the optimal screw length was (41.57±0.79) mm. The atlantoaxial articular facial diameter was (16.71 ± 1.61) mm; the maximum distance of atlantal lateral displacement was (6.96 ± 1.09) mm; and the ratio of them was 41.80% ± 5.69%. Conclusion The optimal insertion of PATSF is safe and rel iable. The screw can be inserted when the displacement of the atlantal lateral mass is in a certain degree.
A microsatellite is a short, repetitive sequence of DNA (usually 2 to 4 nucleotides in length). Multiple primary lung cancers (MPLC) are more than one primary lung cancer lesions arising synchronously in different locations of the same or different side of the lung. These neoplasms may have same or different histological types, but one lesion is not a metastasis from another, as each neoplasm arises independently in the lung. Abnormal microsatellite changes are closely related to the pathogenesis and development of MPLC. In this review, several aspects are discussed:①definition and origin of microsatellite; ②abnormal changes of microsatellite; ③definition and categories of MPLC; ④the influence of microsatellite on early diagnosis, treatment and prognosis of MPLC.