Quick Search
  Office Online
  Journal Online
Current Issue
Archive
Advanced Search
Read Articles
Download Articles
2019 Vol. 25, No. 12
Published: 2019-12-25
 
1057 Surgical Treatment and Prognosis of Posterior Monteggia Fracture dislocations in Adults with Radial Head Fracture
You Yanliang 1，Ren Yuqi 2*，Huang Jiale 2，et al
Objective  To explore the surgical methods and clinical prognosis of posterior Monteggia fracture-dislocations in adults with radial head fracture.Methods  A retrospective study was made on the postoperative functional recovery of 18 adult patients with posterior Monteggia fracture-dislocations with radial head fracture in our hospital.There were 14 males and 4 females，11 left elbows and 7 right elbows，with an average age of (37.6±10.6) years.According to Jupiter’s classification，there were 12 cases of type ⅡA，4 cases of type ⅡC and 2 cases of type ⅡD.Radial head fractures were classified according to Mason’s classification，including 11 cases of type Ⅲ，5 cases of type Ⅱ and 2 cases of type Ⅰ.Ulnas were fixed with olecranon anatomical locking plate in 15 cases(6 cases were combined with Kirschner wire and 8-shaped tension band) and straight locking plate in 3 cases.There were 3 cases of radius head replacement，13 cases of plate screw or hollow screw internal fixation and 2 cases without internal fixation.Results  16 cases were followed up for an average of (15.3±5.9)months.Elbow flexion and extension averaged (103.8±23.1)° and rotation averaged (99.1±23.3)°.The average score of MEPS was (83.4±13.5)，and the excellent and good rate was 81.3% according to the MEPS.Two of the 16 patients had bone nonunion after operation.Conclusion  The principle of surgical treatment of posterior Monteggia fracture-dislocations in adults with radial head fracture is to restore the length of ulna and the geometric shape of radial head and ensure the anatomical reduction of joint.The key is to deal with all coronal process-related injuries.Radial head replacement can prevent the fusion of radius and ulna after operation，and intraoperative rigid and sufficient internal fixation can reduce the incidence of nonunion.
2019 Vol. 25 (12): 1057-1061 [Abstract] ( 339 ) HTML (1 KB)  PDF (1718 KB)  ( 367 )
1062 Comparison of Clinical Outcomes after Total Knee Arthroplasty for Kashin-Beck Disease and Osteoarthritis
Bai Lulu 1，2，Li Hui 2，Ma Jianbing 2*，et al
Objective  Kaschin-beck disease (KBD) is a common musculoskeletal endemic disease in China，in which the knee is the most commonly involved.Total knee arthroplasty (TKA) is often indicated for late stage KBD patients.The purpose of this study was to investigate the satisfaction and clinical results after TKA in patients with KBD.Methods  From January 2015 to December 2015，21 patients (28 knees) with KBD who underwent TKA were analyzed retrospectively，with an average age of (60.5±6.00) years old(rang：50~72 years).47 patients (52 knees) with osteoarthritis(OA) who underwent TKA in the same period were selected as the control group，with an average age of (66.3±8.04) years old(rang：52~81 years).The satisfaction of the two groups was compared with the satisfaction scale of the 2011 Knee Society Scoring System.EQ-5D-5L was used to evaluate the health-related quality of life，KSS and WOMAC scores were used to compare the preoperative and postoperative symptoms and activity ability of patients in the two groups.Results  The patients in KBD group were followed up for (41.6±3.53)months(from 36 to 48 months)，and patients in OA group were followed up for (40.7±3.40)months(from 36 to 48 months).Except for the age of the patients KBD(60.54±6.0)，OA(66.33±8.04)，(P＜0.05)，there was no significant difference in the baseline data between the two groups.The KSS and WOMAC scores of all patients were significantly improved after operation.The satisfaction score of patients in KBD group was significantly higher than that in OA group (P＜0 05).Further analysis showed that the postoperative walking ability of patients with KBD was inferior to the OA group，and the total score of WOMAC，the score of stiffness and difficulty of daily life of WOMAC in the group of KBD were significant higher than those in the group of OA(P＜0.05).The EQ-5D-5L(P＝0.056)and the total knee score(P＝0.75) were not statistically different between the two groups.Conclusion  Although patients with KBD after TKA had inferior clinical outcome than patients with OA，they did have higher satisfaction.This study demonstrates that TKA can significantly improve the symptoms and function of patients with KBD，but how to improve postoperative mobility and stiffness need to be further studied.
2019 Vol. 25 (12): 1062-1072 [Abstract] ( 341 ) HTML (1 KB)  PDF (2084 KB)  ( 341 )
1067 Anterior Cruciate Cruciate Ligament Retention and Stump Reconstruction Surgery for Anterior Cruciate Ligament Injury
Li Lei，Wu Hao *
Objective  To analyze the short-term follow-up of patients with anterior cruciate ligament injury under arthroscopic anterior cruciate ligament stump preservation reconstruction.Methods  Eighty patients with anterior cruciate ligament injury treated in our hospital from March 2015 to January 2017 were selected.A simple randomized grouping method was used to assign eligible patients according to the ratio of 1︰1.Those with random numbers ranging from 1 to 40 were the observation group，and those with 41 to 80 were the control group.The control group (40 cases)underwent traditional standard anterior cruciate ligament reconstruction，including 27 males and 13 females；aged 20 to 56 years，with an average(37.73±8.79)years of age.The observation group(40 cases)underwent arthroscopic anterior cruciate ligament retention stump reconstruction，including 24 males and 16 females；aged 21 to 55 years，with an average(38.11±8.46)years of age.The Lysholm knee joint score，the international knee documentation committee (IKDC)score，the passive knee regeneration test results of the affected side，the passive activity detection threshold，The rate of secondary arthroscopy and the synovial coverage of the patients examined.Results  The Lysholm score and IKDC score of the observation group at 3 months and 6 months after operation were higher than those of the control group (P＜0.05).The passive angle regeneration test of the affected knee joint at 3 months and 6 months after the observation group was performed.The results were lower than the control group (P＜0.05)；The observation threshold of passive motion of the affected knee joint in the observation group at 3 months and 6 months after operation was lower than that in the control group (P＜0.05)；There was no significant difference in the rate of secondary arthroscopy in the observation group at 20.00% compared with 25.00% in the control group (P＞0.05)；There was no significant difference in the distribution of synovial coverage between the two groups of patients (P＞0.05).Conclusion  Arthroscopic anterior cruciate ligament retention and stump reconstruction can treat tendon bone healing，In addition，the residual tendon cuff-like wrap wrapped tendon can increase the stability of the knee joint and improve the knee function and proprioception of patients in the early postoperative period，which has certain application value.
2019 Vol. 25 (12): 1067-1072 [Abstract] ( 261 ) HTML (1 KB)  PDF (1398 KB)  ( 458 )
1073 Analysis of the Clinical Effect of Total Knee Arthroplastyin Stiff Knees
Xiao Shizhuo，Zhen Qiu，Li Yu，et al
Objective  To analyze and compare the clinical effect of total knee arthroplasty(TKA) for patients with knee stiffness.Methods  Nineteen patients (23 knees) were retrospectively analyzed after total knee arthroplasty from May 2012 to April 2017，including 7 males and 12 females.The age ranges from 48 to 79，with an average age of (63.63±7.75).The follow-up results were divided into three groups before operation，six months after operation and two years after operation and compared with each other.Clinical evaluation was performed using American Knee Society Knee(AKS) Score and range of motion(ROM).Results  All 19 patients were followed up，and AKS and ROM were followed up for 6 months and 2 years after TKA.The range of motion increased from (31.17±9.63)°(range：10°to 47°)before surgery to (93.04±14.83)°(range：55° to 115°) six months after surgery，and (85.00±19.83)°(range：35° to 110°) two years after surgery.The difference between preoperative and postoperative activities was significant(P＜0.05).The range of joint motion decreased from six months to two years after surgery (P＜0.05).AKS scores were (33.17±12.32)(range：12 to 69)before surgery，(74.44±12.72)(range：53 to 99)six months after surgery，and (70.57±13.24)(range：52 to 96) two years after surgery.There were significant differences between preoperative and postoperative scores (P＜0.05)，and the AKS scores were significantly improved after the operation compared with that before the operation，but there was no significant difference between six months after the operation and two years after the operation (P＞0.05).Conclusion  Total knee replacement can significantly improve the motor function and quality of life of patients with knee stiffness.
2019 Vol. 25 (12): 1073-1084 [Abstract] ( 287 ) HTML (1 KB)  PDF (1424 KB)  ( 452 )
1077 Risk Factor Assessment and Clinical Analysis of Delirium after Artificial Joint Replacement
Zhao Liben，Yang Guojing *，Zhang Lei
Objective  To evaluate the incidence and risk factors for postoperative delirium in artificial joint arthroplasty.Methods  212 patients who met the criteria for artificial joint replacement from August 2014 to May 2015 were selected.There were 157 females and 55 males，with a mean age of (73.9±5.2)years (range 60~91 years).Delirium was assessed by the delirium scale，the evaluating method of disturbance of consciousness.The patients were divided into delirium group and non-delirium group.General conditions，medical history，surgically related indicators，1~3 d postoperative laboratory examination and other indicators were recorded.Statistical analysis of the differences in clinical indicators between the two groups，multivariate Logistic regression analysis of postoperative delirium independent risk factors.Results  A total of 35 cases (16.5%)were found to have delirium.There were 25 females and 10 males，with a mean age of (81.8±4.9)years (range 68~91 years).The majority of postoperative delirium (85.7%)occurred at 72hafter operation.The incidence of delirium after hip replacement (82.9%)was higher than that of knee replacement (17.1%).The age (P＝0.005)，the proportion of patients with dementia (P＝0.043)，stroke (P＝0.002)，history of alcohol abuse (P＝0.022)，and fentanyl dosage (P＝0.037)in the delirium group were significantly higher than those in the non-delirium group.In the delirium group，the preoperative total protein level (P＝0.035)and preoperative PaO2 (P＝0.002)were significantly lower than those in the non-delirium group，while the preoperative indicators and the clinical indicators 1~3 days after surgery showed no statistically significant difference (P＞0.05).Multiple regression analysis revealed that advanced age，history of dementia，alcohol abuse and stroke，preoperative low arterial oxygen partial pressure，postoperative use of opioids and femoral neck fractures were all independent risk factors for delirium after artificial joint replacement.Conclusion  femoral neck patients with advanced age，prior history of dementia，alcohol abuse or stroke，and preoperative hypoxemia are of greater risk of postoperative delirium.The surgeon should be alert to the occurrence of this complication early in the operation and communicate well.Optimization of postoperative analgesia project，such as reduction of opioid use，will help reduce delirium.
2019 Vol. 25 (12): 1077-1088 [Abstract] ( 291 ) HTML (1 KB)  PDF (477 KB)  ( 311 )
1081 Clinical Comparative Study of two Methods in the Treatment of Peroneal Tendon Dislocation
Xu Zhi，Feng Guocheng，Zhu Ming *
Objective  To compare the surgical effect of fibula drilling suture fixation and suture fixation with suture anchor in the treatment of peroneal tendon dislocation. Methods  26 patients with peroneal tendon dislocation were treated with surgery from October 2016 to August 2018，and these patients were divided into two groups according to different fixation and repair ways.Fibula drilling suture fixationon the superior peroneal retinaculum(SPR) was uesed in 12 patients and suture fixationon with suture anchor wasused in another 14 patients.There was no significant difference in gender，age，injury side and injury cause between the two groups (P＞0.05).The AOFAS (American orthopaedic foot and ankle society) score and VAS(visual analogue scale) score were recorded at preoperative and minimal 9-month of follow-up.In addition，the operative time，intraoperative bleeding and surgical costs were compared.SPSS18.0 soft ware was used for statistical processing，and the statistical data were analyzed by t-test，with P＜0.05 indicating that the difference was statistically significant.Results  All patients were followed up for 9 to 12 months，with an average of (10.23±1.18) months.There were no significant differences in the compare of VAS score and AOFAS score postoperative between the two groups(P＞0.05).There were significant differences in operative time，bleeding，and cost between the two groups (P＜0.05).Conclusion  Both fibula drilling suture fixation and suture fixation with suture anchorto repairthe superior peroneal retinaculum(SPR) have excellent effect in surgical treatment of peroneal tendon dislocation.There are no difference in the two treatment，but the fibula drilling suture fixationhas obviously advantage in terms of the operative time and intraoperative bleeding.And in terms of operation cost，the method of suture fixation with suture anchor has certain advantages.
2019 Vol. 25 (12): 1081-1084 [Abstract] ( 380 ) HTML (1 KB)  PDF (1136 KB)  ( 347 )
1085 Individual Treatment and Curative Effect Analysis of Complex Talus Body Fracture
Lei Jinlai，Zhuang Yan，Cong Yuxuan，et al
Objective  To investigate individual treatmentand curative effectof complex talus body fracture.Methods  From January 2014 to December 2017，11 patients with talar body fractures underwentthe operation.There were 2 females and 9 males.The mean age of the patients was (29.6±5.9) years.According to Sneppenclassification，all of them were type Ⅴ.The mechanism ofinjury was a fall from the heightin 7 patients，a traffic accident in 3 patients，a crush injury in 1 patients.The mean intervalbetween injuryand surgical treatment for fractures was (6.9±1.7) days.There were 5 cases of anteriormedial incision，4 cases of anteriorlateral incision and 2 cases of combined approach.All patients were fixed with canulated screws.Results  All patients were followed up for (32.4±8.1) months.Nonecrosis ofincision and wound infection were found.A11 fractures had achieved bone union；the average healing time was (18.0±3.5) weeks.Functional results were assessed according to A0FAS score.There were 5 patients withexcellent results，3with good result，2 with fair resultand 1with poorresult.Theoverall excellent and good rate was 72.7％.Avascular necrosis occured in 2 cases.Arthrodesis was needed in 2 cases.Conclusion  Complex talus body fracture should be treated individually according to the fracture shape，carefully operated to reduce soft tissue dissection，protect the remaining blood supply，late loading，and maximize the preservation of ankle function.
2019 Vol. 25 (12): 1085-1088 [Abstract] ( 289 ) HTML (1 KB)  PDF (2236 KB)  ( 315 )
1089 Clinical Study of Minimally Invasive Bone Harvest From Fixed Site of Posterior Iliac Crest
Tu Yonggang，Ren Shaodong *，Ma Bangxing，et al
Objective  To explore the feasibility and clinical effect of minimally invasive bone harvest from fixed site of posterior iliac crest.Methods  From June 2012 to May 2018，40 patients with delayed union and nonunion required bone graft were randomly divided into experimental group and control group.There were 20 cases in each group.The experimental group was treated with minimally invasive posterior iliac crest bone harvest，while the control group was treated with traditional open bone harvest.The operation time，incision length，blood loss during operation and postoperative complications were analyzed，and the bone healing of delayed union and nonunion were followed up.Results  In experimental group，the operation time was (15.70±3.61)min，the incision length was(1.42±0.28)cm，the operative bleeding was (16.05±4.72)mL，the wound healed as expected.Local Hematoma was the only complication.In 3 cases，local hematoma appeared and could subside without serious complication.Incontrol Group，theoperation time was(37.90±4.99)min，incision length was (5.02±0.50)cm，operative bleeding was (49.50±8.72)mL，wound infection and poor healing in 2 cases，injury of lateral femoral cutaneous nerve in 2 cases，bone pain in 3 cases and iliac bone depression in 2 cases.The operation time，incision length and bleeding of the two groups were significantly lower than that of the control group (P＜0.01).There were significant differences in the incidence of postoperative complications (P＜0.05).There was no significant difference in the bone healing rate of delayed union and nonunion between the two groups (P＞0.05).Conclusion  Both minimally invasive posterior iliac crest osteotomy and traditional open bone harvest can achieve the goal of autologous iliac bone grafting，but minimally invasive posterior iliac crest bone harvest has the advantages of less surgical injury，less bleeding，simple operation and fewer complications.
2019 Vol. 25 (12): 1089-1091 [Abstract] ( 222 ) HTML (1 KB)  PDF (1067 KB)  ( 325 )
1092 Orai2 Plays an Essential Role in Proliferation，Apoptosis and Differentiation of Osteoblast
Objective  To determine the role of Orai2 in regulating osteoblast proliferation，apoptosis and differentiation in osteoblasts.Methods  Western blot and real-time PCR were used to detect the protein expression and mRNA transcription levels of Orai2 after osteoblastic induction.The expression of Orai2 was silenced in MC3T3-E1 osteoblasts by transfecting Orai2 shRNA，and unrelated interference shRNA was transfected as negative control.MC3T3-E1 osteoblasts were divided into control group and Orai2 shRNA group.In the control group and Orai2 shRNA group，cell proliferation and apoptosis，the transcription of Runx2，Osterix and ALP，and Ras-ERK1/2 signaling pathway activity were tested to dentify whether Orai2 is involved in the regulation of osteogenesis.Results  After osteogenic induction，Orai2 protein expression level and mRNA transcription level were gradually increased (P＜0.05).Compared with the control group，Orai2 was knockdown successfully after Orai2 shRNA transfected in MC3T3-E1 cells.Furthermore，compared with the control group，the proliferation were decreased and apoptosis were increased after Orai2 knockdown.Moreover，compared with the control group，the transcription of Runx2，Osterix and ALP，were decreased after Orai2 knockdown.We also found that Ras-ERK1/2 signaling pathway activity were inhibited compared with the control group.Conclusion  The inhibition of Orai2 expression can significantly reduce the activity of Ras-Erk1/2 signaling pathway，reduce the proliferation of osteoblasts，increase the apoptosis of osteoblasts，and inhibit the differentiation of osteoblasts，resulting in the decrease in the number of osteoblasts and the involvement in the occurrence and development of osteoporosis.
2019 Vol. 25 (12): 1092-1109 [Abstract] ( 230 ) HTML (1 KB)  PDF (1558 KB)  ( 217 )
Copyright © Editorial Board of sygkzz
     ���������� 14010702070875��
Supported by:Beijing Magtech