Objective To explore the effect of minimally invasive and mini-incision surgery (MIS) in total hip arthroplasty (THA) on late osteonecrosis of femoral head (ONFH). Methods From March 2003, Eighteen patients (22 hips) with ONFH underwent MIS in THA. Their ages ranged from 24to 57 years, including 13 males and 5 females. The mean body mass index ranged from 17.1 to 30.1(24.6 on average). The Harris hip score was 46 points before operation. Modified posterior-lateral approach was adopted, and the MIS THA was performed by cementless prosthesis. As a comparison, 18 patients (22 hips) were performed by conventional THA at the same period. The data, including bleeding volume during operation, incision length, operative time, and postoperative function recovery, were compared. Results Follow-ups were done for 6 to 20 months (11 months on average). Dislocation occurred in one patient that underwent conventional THA 2 days after operation. No complication occurred in MIS THA group. The incision lengths ranged from 8.7 to 10.5 cm (9.3 cm on average) in MIS THA group, being statistically different (Plt;0.01). There was no significant difference in Harris scoring of the function between the two groups both before the operation and after the operation (Pgt;0.05). The operative time was almost the same, but the bleeding volume in MIS THA group was less (Plt;0.05). The function recovery was faster in MIS THA group.Conclusion The MIS THA is an alternative to the treatment of late ONFH. The advantages of MIS THA are fewer trauma, less bleeding volume, and faster recovery. The MIS THA should be performed by surgeons with rich experiences in THA and hospitals with necessary instruments.
Objective To establish a new operative method to repair defects of palm and proximal fingers with double vascular pedicle flaps. Methods From August 1992 to June 2000, 20 cases of soft tissue defects of palm and fingers were repaired with double vascular pedicle flaps. Twenty patients included 9 males and 11 females, aged 17-35 years. The causes were crush,avulsion, and so on. The interval between injury and operation was 3-11 hours.The wound area ranged from 8 cm×12 cm to 10 cm×20 cm. We devised the two side flaps on pectoral-umbilical place with well-known blood vessel to cover flexion and extension regions of palm and the multi-lobes skin flap to cover defect of fingers simultaneously. Results Out of 20 patients, 19 were followed up 8-12 months with an average of 9.8 months. All the flaps survived completely. The skin colour and the contour of the palm and digits were good. Conclusion The double vascular pedicle flap is one of the best choices torepair soft tissue defect of the palm and proximal fingers; the procedure is simple and the operation is extended easily.
Objective To evaluate the effect of the treatment of necrosis of femoral head with the free vascularized fibula grafting. Methods From October 2000 to February 2002, 31 hips in 26 patients with ischemic necrosis of the femoral head were treated with free vascularized fibula graft. Among these patients, 21 patients (25 hips) were followed up for 6-18 months(12 months on average). According to Steinberg stage:Ⅱ period, 5 hips;Ⅲ period,8 hips; Ⅳ period, 12 hips.Results Among 25hips, their Harris Hip Score at all satges were improved during the follow-up. The symptom of pain diminished or disappeared after operation. The patient’s ability to work and live was notlimited or only slightly limited during the follow-up. Radiographic evaluation showed that most femoral heads improved (18 hips) or unchanged (6 hips) and only oneworsened.Conclusion The free vascularized fibular grafting is a valuable method for femoral head necrosis. With this method, we can prevent or delay the process of the disease.
Objective To introduce a method to repair soft tissue defect in different regions and different areas of hand in one procedure. Methods From May 2002 to May 2005, anterolateral femoral flap or lobulated anterolateral femoralflap(forming irregular anterolateral femoral flap) was designed into different shapes to repair multiple soft tissue defect in different regions in hand, whichwas used clinically in 27 cases. Among 27 cases, there were 16 males and 11 females; the locations were left hand in 9 , right hand in 16 and left foot in 2; including 5 penetrating injury, 9 hotpressing injury, 2 soft tissue defection of instep and planta by milled injury, 6 gearing injury and 5 carding machine injury. All the cases complicated by exposure of tendons, bones or joints. Defect was repaired with H-shape flaps in 5 cases of penetrating palm injuries; with Y-shape or K-shape flaps in 11 cases of dorsals or combined with fingers of hand with skin defect; with shape flaps in 3 cases of dorsals combined with sides of palms or the first web of hands with skin defect and in 2 cases of skin defects of dorsals combinedwith palms of feet;with h-shape flaps in 6 cases of skin defects of dorsal or palms combined with disconnected skin defect of fingers. The sizes of main flaps ranged from 6.5 cm×4.8 cm to 17.0 cm×12.0 cm, the sizes of lobulate flaps ranged from 3.5 cm×2.8 cm to 7.5 cm×4.5 cm. Results Allflaps survived without vascular crisis after operation. Except the fascia flapall recipient sites healed by first intention. The follow-up period ranged from 3 months to 1 year, all cases had satisfactory appearance, the texture of flaps was soft. Except 2 cases of penetrating injury, 3 cases of hotpressing injuryand1 case of carding machine injury whose function was not satisfactory, theremaining cases achieved the function of snap and pinch. More than 1 year after operation, the sense of pain and touch recovered. There was no functional impairment at the donor sites although scar hyperplasia was formed in some cases.Conclusion The application of irregular anterolateral femoralflap is an optimal choice for complex skin defect of hand.
ObjectiveTo investigate the clinical anatomy and application of free profunda femoral artery pedicled chimeric myocutaneous perforator flap in the defect reconstruction after radical resection of tongue carcinoma. MethodsBetween April 2011 and January 2016, 44 cases of tongue carcinoma underwent radical resection, and tongue defects were reconstructed by free profunda femoral artery pedicled chimeric myocutaneous perforator flaps at the same stage. There were 40 males and 4 females, with a mean age of 46.3 years (range, 32-71 years). The pathologic type was squamous cell carcinoma, which involved the lingual margin in 24 cases, the ventral tongue in 17 cases, and the mouth floor in 3 cases. According to Union for International Cancer Control (UICC) TNM staging, 16 cases were rated as T4N0M0, 11 cases as T4N1M0, 9 cases as T3N1M0, and 8 cases as T3N2M0. The course of disease ranged from 1 to 22 months (mean, 8.6 months). The size of perforator flap ranged from 8.5 cm×4.0 cm to 12.0 cm×6.5 cm, and the size of muscle flap ranged from 4.0 cm×3.0 cm to 7.5 cm×5.0 cm. The adductor magnus myocutaneous flap with a pedicle of (8.3±0.5) cm was used in 11 cases, and the gracilis muscle myocutaneous flap with a pedicle of (8.1±0.8) cm was used in 33 cases. The donor sites were sutured directly. ResultsAll 44 perforator flaps survived uneventfully, and the donor site healed well. The patients were followed up for 12 to 40 months (mean, 23.8 months). The reconstructed tongue had good appearance and function in swallowing and language. No local recurrence was found. Only linear scar was left at the donor sites. ConclusionThe free profunda femoral artery pedicled chimeric myocutaneous perforator flap can be harvested in various forms, and is an ideal choice to reconstruct defect after radical resection of tongue carcinoma.
Objective To evaluate the clinical effect of cannulatedscrew on treatment of femoral neck fracture(FNF). Methods Forty-two FNFpatients were treated by using cannulated screw from January 2001 to December 2005.There were 22males and 20 females with an average age of 41 years (19-59 years). Fracture was caused by traffic accident in 21 cases, by falling from height in 14 cases and by bruise in 7 cases. All cases were fresh fracture. According to Garden criterion for typing, 15 cases were classified as type Ⅱ, 16 cases as type Ⅲ and 11 cases as type Ⅳ . It was 7 hours to 15 days from injury to operation. Results Thepatients were followed up for 1-6 years with an average of 2.5 years. The average fracture union time was 6.5 months. Three patients had ischemic necrosis of femoral head, andloosening and breakage of screw and rob was observed in 1 case. According to Brumback criterion for hip joint function, the result was excellent in 18 cases, good in 20 cases and bad in 4 cases, and the excellent and good rate was 90.4%. Conclusion Cannulated screw fixation is a good method to treat FNF in young adults. It can improve the rate of fracture union and reduce the rate of avascular necrosis of femoral head.
The injuries of the femoral arteries were mistreated in 5 cases. The causes of the mistakes were resulted from: the initial cause of the injury was not carefully analyzed; the arterial injury was overlooked by the concomitant injuries, and the improper method of management was selected, as a result, 2 patients died from acute renal failure and the other 3 patients developed the complications of secondary thrombosis of the artery or rupture of the artery at the anastomotic site following repair. Of the 3 patients, 2 patients had recovered following reoperation and the other 1 patient had lost his limb from amputation. It should be emphasized that all of the following key points might avoid the mistakes occurred in the management of the injury of the femoral artery: (1) early diagnosis; (2) debredment of arteral end; (3) in infections wounds, insted of vein transplantation bypass technique should be done.
This paper reported the use of superficial temporal vessels pedicled postauricular island flap for the reconstruction of eye socket. Six cases were treated by this method since 1988 with universal satisfactory results. The disign of the flap was diseribed. The operative procedure was detailed, and the advantages of the flap were evaluated: 1. The donor defect was hidden behind the ear; 2. The flap has a relatively long pedicle, hence easy for distant transfer, and 3. the blood supply was highly reliable.
Objective To study the effect of core decompression combining with autologous cortical sustaining bone and cancellous bone graft in treating osteonecrosis of the femoral head (ONFH). Methods From February 2004 to May 2008, 64 patients (77 hi ps) with ONFH were treated with core decompression combining with autologous cortical sustaining bone and cancellous bone graft, including 45 males and 19 females and aging 23 to 60 years with an average age of 43 years. There were 51 cases of unilateral ONFH and 13 cases of bilateral ONFH. ONFH was caused by alcohol in 39 cases(47 hi ps), by steroid in 21 cases (26 hi ps), and by trauma in 4 cases (4 hi ps). The disease course was 1-12 years. The pain time was 2-14 months (average 7 months). All the cases underwent imageology and postoperation pathology examination to confirm the diagnosis of ONFH. According to Association Research Circulation Osseous (ARCO) international classification of osteonecrosis, 17 cases (23 hips) were classified as stage I A, 2 cases (3 hips) as stage I B, 21 cases (24 hips) as stage II A, 2 cases (2 hips) as stage II B, 4 cases (4 hips) as stage II C, and 18 cases (21 hips) as stage III A. The outcome was evaluated both cl inically by Harris score and radiologically by imageology. Results A total of 59 cases (69 hips) were followed up for 12-62 months with an average of 32.1 months. The Harris score was 87.12 ± 8.68 at 12 months after operation, showing significant difference (P lt; 0.05) when compared with the preoperative one (68.38 ± 14.49). The results were excellent in 39 hips, good in 18 hips, fair in 6 hips, and poor in 6 hip; and the excellent and good rate was 82.6%. Radiographic evaluation was 21 hips (30.4%) of grade I, 42 hips (60.9%) of grade II, and 6 hips (8.7%) of grade III. One case had the compl ication of il ium bone donor site, 21 cases had l ittle pain or numbness, and the other cases had no uncomfortable compl ication. Conclusion The method of core decompression combining with autologous cortical sustaining bone and cancellous bone graft can improve the means of bone grafts, prevent the collapse of the femoral head, and is less traumatic than common procedures. Cl inical effects are obvious and effective.
Objetive To investigate the effect of elastic pivot stable biteplate on treating irredueible temporal bone displacement of the temporomandibular joint. Methods Twenty-eight cases of irredueible temporal bone displacement of the temporomandibular joint treated with the elasticpivot stable biteplate from 2000 to 2004 were summarized. The ages of the patients ranged from 15 to 58 yeras includding 11 men and 17 women.Results All the patients were treated for 1 month and followed up for 3 to 6 months. The effective rate was 87.51%. The patients who had shorter course of diseases obtained better effect than the patients who had longer courses of diseases. Conclusion Elastic pivot stable biteplate is an effective alternative for treating irredueible temporal bone displacement of the temporomandibular joint and it exerts better effect on the patients that have short courses of diseases.