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2020 Vol. 26, No. 2
Published: 2020-02-25
 
97 Efficacy of Manipulation Reduction and Splint External Fixation in the Treatment of Forearm Fractures in Children
Ke Huarong 1，2,Guo Yueming 1，Lu Fengshan 1，et al
Objective  To study the clinical efficacy of forearm fractures in children with the treatment of manual reduction and splint external fixation.Methods  68 patients who met the standard forearm fracture criteria were randomly divided into observation group(36 cases)and control group(32 cases).The observation group was treated with manual reduction splint external fixation.There was a total of 36 cases，including 25 males and 11 females，ranging from 6 to 14 in age，with an average of(10.63±3.72)years old.There were 13 cases on the left side and 23 cases on the right side.The time from injury to consultation ranged from 2.5 to 19.0 hours，with an average of(9.60±2.53)hours.The control group was treated with the elastic intramedullary nail fixation.There was a total of 32 cases，including 23 males and 9 females，ranging from 7 to 14 in age，with an average(10.68±3.82)years old；including 11 cases on the left side and 21 cases on the right side.The time from injury to consultation ranged from 2.0 to 19.0 hours，with an average of(9.86±2.38)hours.Then the two groups of patients were compared to estimate the curative effect on fracture healing time，treatment cost and the days of hospitalization and complications，which are based on Anderson score. Results  All fractures healed within 9 to 14 weeks，with an average of 12.15 weeks.The difference in healing time between the two groups was not statistically significant(P＞0.05).The treatment cost(2 232.61±81.75)yuan in the observation group was lower than that in the control group(15 730.25±835.52)yuan，the difference was statistically significant(P＜0.05)，the length of stay(6.39±2.43)d was shorter than that in the control group(13.16±2.78)d，and the incidence of complications(16.67%)was lower than that in the control group(53.13%)，the difference was statistically significant(P＜0.05).In comparison of Anderson scores between the two groups，the excellent and good rate was 88.89% in the observation group and 90.63% in the control group.There was no statistically significant difference between the two groups(P＞0.05).Conclusion  Manual reduction splint external fixation and elastic intramedullary nail internal fixation can both achieve satisfactory results for forearm fracture.However，manual reduction splint external fixation has the advantages of less trauma，simpler technique，lower cost，shorter hospital stay and fewer complications，which are worthy of recommendation.
2020 Vol. 26 (2): 97-102 [Abstract] ( 344 ) HTML (1 KB)  PDF (1813 KB)  ( 416 )
103 Treatment of the Denis Ⅱ and Ⅲ Sacral Fracture with Nerve Injury
Liu Wei 1，Yang Zhaohui 2
Objective  To compare the effect of nerve exploration and decompression with fixation withsimple fracturefixation in Denis Ⅱ and Ⅲ sacral fractures with nerve injury patients.Methods  Thirty-two patients (20 males and 12 females)，aged 18~60 years，with an average age of 41.7 years，who were hospitalized in our hospital from August 2016 to August 2018，were randomly divided into fixed group (n＝16 cases) and decompression group (n＝16 cases).They were treated with internal fixation and internal fixation plus nerve decompression respectively.Lindahl imaging score，ASIA disability grade and ISNCSCI score were compared between the two groups at 1，3 and 6 months after operation.Results  The amount of bleeding in decompression group was more than that in fixed group (P＜0.05)，but there was no significant difference in the number of days in hospital between the two groups (P＞0.05).After 6 months of follow-up，there was no significant difference in Lindahl imaging score between the two groups (P＞0.05).Bone fusion and good healing were achieved in all cases.Compared with the recovery of nerve injury，there were differences between the two groups.Although the nerve injuries recovered to some extent after the two treatments，ASIA disability grade and ISNCSCI score both showed that the effect of decompression group was better than that of fixed group (P＜0.05).Conclusion  For the patients with Denis Ⅱ and Ⅲ sacral fractures and nerve injury，strong fixation is the basis of fracture healing.On this basis，timely treatment of nerve exploration and decompression is more beneficial to the recovery of nerve injury.
2020 Vol. 26 (2): 103-107 [Abstract] ( 212 ) HTML (1 KB)  PDF (1574 KB)  ( 314 )
108 Early Curative Effect and Clinical Application Value of Minimally Invasive Total Hip Arthroplasty by SuperPATH
Wu Ke，Li Baojun *，Chai Zhiyong，et al
Objective  To investigate the early effect and clinical application value of minimally invasive total hip arthroplasty by SuperPATH.Methods  We collected information of 60 patients that underwent total hip arthroplasty from May 2016 to June 2017 in our department.There were 35 cases of femoral head necrosis and 25 cases of femoral neck fracture.30 cases of patients that accepted the surgery of minimally invasive total hip arthroplasty by SuperPATH were included in experimental group.20 cases of the patients were male，and 10 cases of patients were famale.16 cases of patients were diagonosed as femoral head necrosis，and 14 cases of patients were diagonosed as femoral neck fracture.The average ages were(71.2±3.1)years old.30 cases of patients that accepted the surgery of traditional total hip replacement were included in control group.Among them，15 cases of patients were male，15 cases of patients were famale，19 cases of patients were diagonosed as femoral head necrosis，and 11 cases of patients were diagonosed as femoral neck fracture，the average ages were(71.2±3.2)years old.We recoreded the length of incision，the operation time，operative bleeding，postoperative drainage，hemoglobin reduction，and the VAS grade and Harris grade at a week after operation，1 month，3 months and 6 months after operation.Results  The length of incision，operative bleeding，postoperative drainage，hemoglobin reduction in experimental group were less than these of control group(P＜0.05).The operation time in experimental group were longer than in control group，(P＜0.05).There were significant differenced in VAS grade and Harris grade at a week after operation and a month after operation in experimental group and in control group(P＜0.05).There were no significant differenced in VAS grade(P＞0.05)，but the Harris grade had a signifcant difference(P＜0.05))at 3 months after operation.No significant difference was found in VAS grade and Harris grade at 6 months after operation(P＞0.05).Conclusion  Compared with the surgery of minimally invasive total hip arthroplasty by SuperPATH and the surgery of traditional total hip replacement in the treatment of femoral head necrosis and femoral neck fracture，the former had more advantages，such as less soft tissue injury，less bleeding，faster postoperative recovery，better short-term efficacy.Patients are satisfied with the surgery of minimally invasive total hip arthroplasty by SuperPATH，and this kind of surgery can achieve rapid postoperative rehabilitation.
2020 Vol. 26 (2): 108-147 [Abstract] ( 230 ) HTML (1 KB)  PDF (1273 KB)  ( 301 )
113 Therapeutic Effect Study of Patellofemoral Articular Cartilage Injury on Oxford Unicondylar Knee Arthroplasty
Chen Kaipeng 1，Zhang Yuming 2*,Zhang Dengjun 2，et al
Objective  To investigate the effect of single iliac replacement on the postoperative outcome of patients with anterior medial osteoarthritis complicated with patellofemoral articular cartilage injury.Methods  From March 2016 to August 2018，67 cases of single sacral replacement were performed in our department.All cases were treated with unilateral knee osteoarthritis.All cases were unilateral knee replacement，including 19 males and 48 females；aged 51~84 years with an average of (64.67±8.37)years，including 41 cases of left knee，26 cases of right knee；BMI range from 19.56 to 30.47 (mean：25.27±2.56).Duration of disease was 0.5~20.0 years (mean：5.08±4.83)years.Intraoperative patellofemoral articular cartilage injury was recorded by Outerbridge grading and grouped.The postoperative follow-up was evaluated by Oxford knee joint score (OKS score) and Lonner patellofemoral joint score to evaluate postoperative outcome and patellofemoral joint pain and functional improvement.The scores of preoperative and postoperative follow-up were statistically analyzed，and the difference was statistically significant，P＜0.05.Results  All patients were followed up for 12~25 months with an average of(18.12±3.68)months.The OKS score was reduced from the preoperative average (44.42±4.86) to the postoperative average (21.46±4.64)，P＜0.01；Lonner pain The score increased from the preoperative average (29.91±2.48) points to the postoperative average (49.54±2.42) points，P＜0.01；the Lonner functional score increased from the preoperative average (23.17±1.40) points to the postoperative average (38.89±1.41 points)，P＜0.01；intraoperative observation revealed that 35 knees (52%) with medial patellofemoral articular cartilage injury，compared with no patellofemoral joint cartilage injury (32 knees)，postoperative patellofemoral joint pain and function were obtained Improvement，comparison of OKS score，Lonner pain and functional scores at 1，3，6 and 12 months after surgery had no significant difference.Conclusion  The intraoperative medial patellofemoral articular cartilage injury does not affect the shortterm efficacy of Oxford monoterpene replacement.UKA can be used as a treatment for patients with anterior knee osteoarthritis with medial patellofemoral articular cartilage injury.
2020 Vol. 26 (2): 113-117 [Abstract] ( 193 ) HTML (1 KB)  PDF (1251 KB)  ( 293 )
118 Clinical Observation of Multiple Ligament Injuries of Medial Rotatory Ddislocation with Autogenous Tendon Reconstruction Assisted by Arthroscopy in The First Stage
Li Shuai 1，li Yuji 2*,Chang Xudong 2，et al
Objective  To evaluate the clinic outcome of KD-Ⅲ-MC multiple ligament injuries by using arthroscope assisting the with first period reconstruction of ligament and provide data aid for the treatment of multiple ligament of knee-joint.Methods  According to the standard of Hua Xi Knee Dislocation and Multiple Ligament，32 KD-Ⅲ-MC examples were selected from in the Second Joint Department of 1st hospital of Gansu TCM Univ.from July 2015 to July 2018，which included 24 males and 8 females，with an average age of (35.42±7.86)years.The causes of injury were 14 cases of traffic accidents，8 cases of sprains，6 cases of smashing injuries，and 4 cases of fall injuries.The time from injury to operation was 14~21 days，with an average of (16.25±2.87) days.All patients had an international knee documentation committee (IKDC) score of grade D.The pre and post-drawer tests were ≥Ⅱ degrees，the Lachman test was Ⅲ degrees，the end point disappeared，and the medial collateral Ligament (MCL) injuries were classified as Grade Ⅱ or higher using the American Medical Association’s three-degree classification.X-ray examination of the Tilos stress site showed：forward stress tibial advance (8.15±3.46) mm，backward stress tibial advance (12.51±3.98) mm，and medial valgus stress medial gap (8.46±3.91) mm.Unilateral autologous tendons were taken under arthroscopy for single-beam reconstruction of the anterior and posterior cruciate ligaments during the same period of surgery.The medial structures were fixed with suture anchors and the capsular contraction was repaired if necessary.Results  The incisions of all patients healed in one stage without infection；one case had deep vein thrombosis.All patients were followed up for 12 to 18 months，with an average of (14.18±2.45) months.At the last follow-up，all patients turned negative before and after the drawer test and Lachman test.Two patients had grade Ⅱ MCL injury and one had stiff knee.According to IKDC comprehensive score，there were 10 cases of grade A，16 cases of grade B，6 cases of grade C.Compared with preoperative，the difference was statistically significant (P＜0.05).At the same time，patients with different injury types in the KD-Ⅲ-MC type were statistically grouped，and the Lysholm function score of the corresponding period was observed.As a result，the last knee Lysholm score was significantly different from that before surgery (P＜0.05).There was no significant difference between the various types of injury before surgery (P＞0.05).The Lysholm function score of the knee joint in the cartilage injury group was lower than that in the other groups after the last follow-up，indicating that poor recovery in the ligament injury group was related to articular cartilage injury.The Lysholm scores of the knees in all groups increased significantly at 3 months after surgery，and the differences were relatively large.The differences at 6 and 12 months after surgery were smaller than the 3 months after surgery.Conclusion  In KD-Ⅲ-MC multiple ligament injury，a single bundle of autologous tendon which was used to reconstruct anterior cruciate ligament (ACL)，posterior cruciate ligament (PCL) under arthroscope，with line anchor Nail fixation and enhanced sutures，joint capsule tightening and medial anatomical autogenous tendon reconstruction can achieve good short-term results.
2020 Vol. 26 (2): 118-123 [Abstract] ( 273 ) HTML (1 KB)  PDF (2101 KB)  ( 390 )
124 The Outcomes of Modified Anteromedial Approach in the Treatment of Ruedi-Allgower Ⅲ Pilon Fracture
Hu Yuanjun，Cheng Ruiping *，Shi Huiming，et al
Objective  To explore the clinical outcomes of modified anteromedial approach in the treatment of Ruedi-Allgower Ⅲ Pilon fractures.Methods  38 patients with closed Ruedi-Allgower Ⅲ Pilon fracture were treated with open reduction and internal fixation through ankle modified anteromedial approach in our department retrospectively from January 2015 to January 2018.There were 30 males and 8 females with an average age of(48.0±11.7 )(range：23 to 76 )，including 19 left and 19 right sides.The blood loss，operation time，American 0rthopedic Foot and Ankle Society(AOFAS)and the complications were analyzed.Results  The average follow-up of 38 patients was(17.58±6.82)months(range：12 to 36 months).The incisions displayed grade A healing in 37 patients.One patient(2.6%)suffered from skin necrosis of superficial incision.There was no case of infection，delayed union or nonunion.The average bleeding were(99.87±53.28)mL and the average operation time were(134.39±26.11)min.According to evaluation criteria of Burwell-Charnley，there were 32 excellent cases，5 good and 1 poor and the excellent-good rate was 97.4%.At the last follow-up，the average AOFAS score of ankle were(93.66±3.76)points.30 cases were excellent，7 cases were good，and 97.4% of patients showed excellent good results.Conclusion  The Modified anteromedial approach of ankle is an effective method for the treatment of Ruedi-Allgower Ⅲ Pilon fractures.It has little interference to the soft tissue and satisfactory effect.It is worthy of further clinical study.
2020 Vol. 26 (2): 124-127 [Abstract] ( 277 ) HTML (1 KB)  PDF (1155 KB)  ( 254 )
128 Expression and Significance of SP and S100A12 in Serum and Synovial Tissue of DDH Patients with OA
Chen Feng，Yin Dong，Wei Jianxun，et al
Objective  To investigate the expression and significance of substance P(SP)and calcium binding protein(S100A12)in serum and synovial tissue of patients with hip dysplasia(DDH).Methods  This study takes a retrospective approach.Weselected 182 DDH patients，including 114 DDH patients(DDH group)，68 DDH patients with osteoarthritis(OA group)，and 40 patients with hip traumatic fracture who underwent surgery as control group.The expression of SP and S100A12 in serum and synovial tissue of the three groups were detected by ELISA and immunohistochemistry and compared.Results  The expression levels of SP and S100A12 in serum of OA group were significantly higher than those of DDH group and control group(P＜0.05)，and the expression levels of SP and S100A12 in serum of DDH group were significantly higher than those of control group(P＜0.05).The expression levels of SP and S100A12 in hip synovial tissue of OA group were significantly higher than those of DDH group and control group(P＜0.05)，and the expression levels of SP and S100A12 in hip synovial tissue of DDH group were significantly higher than those of DDH group(P＜0.05).The expression level of S100A12 was significantly higher in OA group than in DDH group and control group(P＜0.05).The expression of SP and S100A12 in hip synovium was significantly higher in OA group than in DDH group and control group(P＜0.05)，and the expression of SP and S100A12 in hip synovium in DDH group was significantly higher than that in control group(P＜0.05).Conclusion  The expression of SP and S100A12 in serum and hip synovial tissue of DDH patients is significantly higher than that in normal hip synovial tissue.The increase of SP and S100A12 expression in DDH patients with OA is more significant，which may be related to joint degeneration and joints.It is related to inflammatory changes.
2020 Vol. 26 (2): 128-131 [Abstract] ( 182 ) HTML (1 KB)  PDF (1173 KB)  ( 193 )
132 Experimental Study on Repairing Huge Rotator Cuff Defect of Rabbits with Autologous Hamstring Tendon
Zhang Lei 1，Gao Qingfeng 2*，Cheng Xue 1，et al
Objective  To investigate the early healing outcomes of tendons and bones in huge rotator cuff defect of rabbits treated with autologous hamstring tendon. Methods  Forty male New Zealand white rabbits were randomly divided into three groups：normal group(n＝8)，model group(n＝8)and experimental group(n＝24).The normal group was rfed in the same manner but was not treated.In the model group，a 1.5 cm×1.0 cm rotator cuff defect was made by cutting from the greater tuberosity of humeral head of both forelegs of the rabbits and the skin was directly closed without suture repair.In the experimental group，the huge rotator cuff defect was further repaired by suturing with autologous hamstring tendon on the basis of the model group.8 white rabbits were sacrificed at 8，16，and 24 weeks after surgery in the experimental group and specimens of rotator cuff in both forelegs were collected，which were processed for histomorphological analysis and biomechanical research tests.Results  Histomorphological analysis showed that collagen fibers increased significantly at the tendon-bone interface at 24 weeks after the operation in the experimental group.Healing components like Sharpey fibers，fibrochondrocytes，and fibrocartilage were found at the tendon-bone junction of the cut.Biomechanical analysis showed that the maximum load of tendons in the experimental group continued to increase with time(comparison between time points，P＜0.05)，and strong mechanical strength could be obtained after 24 weeks.Conclusion  The application of autologous hamstring tendon to repair huge rotator cuff defects can lead to satisfactory tendon bone healing outcomes in rabbits.
2020 Vol. 26 (2): 132-135 [Abstract] ( 213 ) HTML (1 KB)  PDF (1958 KB)  ( 303 )
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