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2020 Vol. 26, No. 3
Published: 2020-03-25
 
200 Analysis of the Effect of Total Hip Arthroplasty after Failed Hip Preservation Surgery in Adult Patients with Developmental Dysplasia of the Hip
Maitikuerban·Maitusong 1，2，Li Guoqing 1，2，Wang Yang 1，2，et al
Objective  To retrospective analysis of the mid-term effect of total hip arthroplasty in adult DDH patients after failed hip preservation surgery.Methods  22 patients(30 hips) with developmental dysplasia of the hip who underwent total hip arthroplasty after failed hip preservation surgery from January 2014 to January 2019 were selected as the study subjects.Harris hip score system and visual analog score(VAS) were used to evaluate before and after surgery，and X-ray films were analyzed before and after surgery.Results  The average follow-up time for total hip arthroplasty in this study was (30.5±18.5) months.After total hip arthroplasty，the Harris overall score was improved from (38.7±10.6) preoperatively to (89.4±9.7) at the last follow-up and the difference was statistically significant (t＝19.67，P＜0.001).The postoperative scores of pain，walking，function，and activity were higher than those before surgery and the difference was statistically significant；The pain VAS score had decreased from the average (7.9±0.9) points before surgery to (1.4±1.0) at the last follow-up and the difference was statistically significant (t＝30.67，P＜0.01).The difference in the length of the lower limbs of the patients decreased from the average (3.32±0.51) cm before surgery to (0.71±0.33) cm after surgery，and the difference was statistically significant (t＝14.01，P＜0.001).All patients had no postoperative complications such as surgical incisions and periprosthetic infections，loosening of the prosthesis，hip dislocation，vascular and nerve damage，deep vein thrombosis and ectopic ossification；only 2 patients had longitudinal femoral proximal split line in surgery.Conclusion  Total hip arthroplasty in adult patients with developmental dysplasia of the hip after hip preservation surgey can achieve satisfactory mid-term results.
2020 Vol. 26 (3): 200-218 [Abstract] ( 411 ) HTML (1 KB)  PDF (1454 KB)  ( 51 )
206 3D Printing Assisted Ilioinguinal Approach for Surgical Treatment of Double Columns Acetabular Fractures
Objective  To analysis the clinical results and superiority of three-dimensional printing assisted ilioinguinal approach in the treatment of double columns acetabularfractures.Methods  A retrospective analysis was made on 12 patients with double columns acetabular fractures treated by 3D printing combined with single anterior approach from Jan，2016 to May，2019.There were 9 males and 3 females，with an average of(46.4±15.1)years (range：24 to 70 years).Preoperative3D printing of pelvic model and simulated surgery and pre-bending plates were applied.During the operation，the fractures were reduced and fixed with plates and screws via the ilioinguinal approach.The patients'operationtime，intraoperative blood loss and complications were recorded.The Matta evaluation criteria was used to assess fracture reduction and the modified Merle D’Aubigneand Postel scoring systemwas used for evaluating hip functionin patients.Results  All patients were completed the operationsuccessfully.The operationtime was 130~245 min，the amount of bleeding was 600~1 600 mL，the autotransfusion volume was 300~800 mL.Followed up ranged form 0.5 to 2.5 years，with an average of(1.5±0.7) years，all the fractures healed.Postoperative X-ray filmswere evaluated according to Matta imaging criteria：excellent in 6 cases，good in 4 cases，fair in 2 cases，and the excellent and good rate was 83.3%.Postoperative hip function was evaluated according to modified  Merle d'Aubigne and Postel criteria：excellentin 5 cases，good in 4 cases，fair in 3 cases，and the excellent and good rate was 75.0%.Conclusion  3D printing technique assisted ilioinguinal approach is feasible for double columns acetabular fracture.It can make accurate individualized reduction and fixation for fracture，has good efficacy.
2020 Vol. 26 (3): 206-209 [Abstract] ( 241 ) HTML (1 KB)  PDF (2204 KB)  ( 272 )
210 Navigation-Assisted Percutaneous Iliosacral Cannulate Screw in Treating Sacroiliac Complex Injury
Ye Jin 1，Tang Jin 1，Meng Chengfei 2，et al
Objective  To investigate the clinical effect，safety and technique notes for the navigation-assisted percutaneous cannulate screw fixation in treating patient with the sacroiliac complex injury.Methods  Thirty-five cases of patients with the sacroiliac complex injury who had been collected from January 2016 to December 2018 were treated using percutaneous cannulate screw fixation with three-dimensional navigation-assisted system in the central hospital of PLA.There were 24 males and 11 females，aged 19 to 67 years，with an average age of (35.2±3.5) years.Intraoperative indexes as duration，blooding volume，nerve or blood vessel lesion and postoperative complications were respectively documented.Condition was postoperatively evaluated by Matta radiological criteria.Pelvic function was assessed by Majeed scoring criteria at the last follow-up.Results  Thirty-five cases with 39 screws in all were placed without neurovascular complications.Each screw averagely took (41.5±4.3)mins with bleeding of(15.5±10.3)mL.Two patients with Morel-Lavallée injury underwent open debridement and VSD (vacuum sealing drainage).Intraoperatively，one patient broke through the cortical bone into the pelvic cavity，but no obvious neurovascular complications.One screw moved backward for 1 cm at the 1st month of follow-up，and this abnormal process was controlled by the reasonable intervention.Matta radiological evaluation presented the excellent rate with 88.57%.All patients were followed up from 9 to 18 moths，average (12.5±2.3)months.The Majeed standard of pelvic function evaluation in the last follow up showed the excellent rate with 91.43%.Conclusion  It can conclude that three-dimensional navigation-assisted percutaneous cannulate screw fixation in treating patient with the sacroiliac complex injury is an accurate，minimally invasive，safe and effective，which is worthy of clinical application.
2020 Vol. 26 (3): 210-213 [Abstract] ( 222 ) HTML (1 KB)  PDF (1217 KB)  ( 271 )
214 Reliability and Validity of IPAQ Long Forms in Patients with Activity After Total Knee Arthroplasty
Gao Dong，Zhang Xiaorui *，Pan Zhijun，et al
Objective  To investigate the reliability and validity of the International Physical Activity Questionnaire (IPAQ) long forms of patients after total knee arthroplasty. Methods  This study was carried out on 45 patients who had undergone total knee arthroplasty between January 2016 and June 2017.Among them were 20 males and 25 females with an average age of (60.22±5.42) years(range 55~69 years).We assessed test re-test reliability by repeating the questionnaire one week later (n=45).Discriminant and content validity was analyzed using physical activity (PA)，IPAQ long forms.Statistical analysis including the intraclass correlation coefficient (ICC) was carried out using the SPSS 24.0 software.Results  The reliability of IPAQ long forms one week later (ICC=0.814~0.979).IPAQ long forms were compared with the PA，and wefound that the physical activity energy expenditure of walking activities，moderate physical activity (MPA)，heavy physical activity，and total physical activity (TPA) for Intraclass correlation coefficient ranged from 0.70 to 0.87.Intraclass correlation coefficient values for walking activities were high (r=0.87).Conclusion  The IPAQ long forms measure the activity of patients after total knee arthroplasty and has demonstrated reliability and validity.
2020 Vol. 26 (3): 214-218 [Abstract] ( 271 ) HTML (1 KB)  PDF (774 KB)  ( 237 )
219 Analysis the Risk Factors for Increased Risk of Deep Venous Thrombosis Risk Increase in Traumatic Fracture Patients During Operation
Wang Yaxin 1，Xiao Yajuan 2，Li Xue 1，et al
Objective  To explore the risk factors for increased risk of deep venous thrombosis in patients with traumatic orthopedic fracture during operation.Methods  We observed and record the case data of sex，age，smoking history，chronic disease，fracture site，preoperative red blood cell count，preoperative platelet count，preoperative cholesterol，preoperative triglyceride，preoperative high density lipoprotein，preoperative low density lipoprotein，intraoperative anesthesia，operation time，input red blood cell volume，input plasma volume，blood recovery volume，tourniquet use time，tourniquet pressure，surgical posture，implantation type，bleeding volume，the quantity of rehydration，the use of antibiotics and the type of surgical incision in traumatic fractures who entered the anesthesia and operating room of 940th Hospital of PLA from April 2018 to May 2019.The data were analyzed by single factor analysis and those whose P＜0.05 in the single factor analysis would be evaluated by multivariate logistic regression analysis.Results  single factor analysis showed that preoperative red blood cell count，fracture site，intraoperative anesthesia，bleeding volume，the quantity of rehydration statistically significant (P＜0.05).Multivariate logistic regression analysis showed that fracture of lower limb (P＝0.044，OR=6.552，95% CI：1.051～40.857)，red blood cell count is on the high side (P＝0.006，OR=14.259，95% CI：2.118～96.018)，intravertebral anesthesia (P＝0.010，OR=7.292，95% CI：1.612～32.989)，general anesthesia (P＝0.006，OR=8.034，95% CI：1.799～35.875) were the main independent risk factor leading to increased risk of DVT.Conclusion  In patients with traumatic orthopedic fracture，the red blood cell count is on the high side before operation，intravertebral anesthesia or general anesthesia are the risk factor of increased risk of deep venous thrombosis.
2020 Vol. 26 (3): 219-222 [Abstract] ( 310 ) HTML (1 KB)  PDF (407 KB)  ( 306 )
223 Effect of Posterior Condylar Offset Ratio on the Recovery of Joint Function after Posterior-Stabilized Total Knee Arthroplasty
Li Chao，Wang Yehua *，LiYajun
Objective  To explorethe effect of the change of posterior femoral condylar offset ratio (PCOR) on the recovery of joint function after TKA.Methods  The clinical data of 53 female patients with osteoarthritis who hadundergone total knee arthroplasty at the Affiliated Hospital of Xuzhou Medical University from January 2016 to January 2018 were retrospectively analyzed.Based on the PCOR change，patients were divided into A (maintain or increased) group and B (decreased) group.The joint function was evaluated by theactive and passive flexion angle，the knee society score，and the WOMAC scoreat the last follow-up.The associations between the PCOR changes and the clinical variables in all patients were analyzed by Pearson linear correlation.Results  All patients were followed up for 12～15 months，withanaverage of 13 months.The PCOR change was 0.03±0.02 in the group A and －0.03±0.02 in the group B.In the last follow-up，active and passive range of knee flexion and their improvement had no statistical difference between the two groups.The Knee Society function scores and Western Ontario and McMaster Universities Osteoarthritis Index in group A were better thangroup B，the difference was statistically significant(P＜0.05).the PCOR change was not significantly correlated with theWOMAC score，active and passive range of flexion and their improvement.While the PCOR change was positively correlated with the KSS function score.Conclusion  The change of PCOR has no significant effect on the postoperative flexion angle after TKA，but restore or increasethe PCOR properly can obtain joint function.
2020 Vol. 26 (3): 223-231 [Abstract] ( 340 ) HTML (1 KB)  PDF (916 KB)  ( 261 )
228 Anatomy and Clinical Application of Distal Sural Neurovascular Flap
Xu Qiang，Zhang Xiping，Wang Biao，et al
Objective  To explore the anatomical basis and clinical application of distal sural neurovascular flap with downward shift of rotation point.Methods  Five cases of superior knee amputation were perfused with latex barium sulfate solution through the thigh artery.The origin，distribution，quantity and outer diameter of the perforating branch of the fascia near the posterolateral muscle septum of the leg were dissected and examined by X-ray.From January 2013 to September 2018，22 cases of distal sural neurovascular flap were used，they were 20 males and 2 females，and they aged 3 to 70 years with an average age of 43 years.The size of the flap was 6 cm×5 cm～14 cm×11 cm，the rotation point was 2~5 cm above the lateral malleolus，and the wound size in the recipient  area was 5 cm×4 cm~13 cm×10 cm.Results  The lateral calcaneal artery was 2.1 cm and 4.0 cm on the lateral malleolus，and 2 skin branches were sent out at，and the external diameter of the vessels penetrated into the deep fascia was 0.5~0.8 mm.In this group，14 cases were completely alive，8 cases were partial necrosis，and the necrotic area was about 1 cm×1 cm～1 cm×3 cm，which was cured after dressin.Conclusion  The flap blood supplyis reliable，flexible to design，safe in surgical heavest and suitable for repair leg and skin and soft tissue of the foot and ankle wounds.It is worthy of clinical promotion.
2020 Vol. 26 (3): 228-231 [Abstract] ( 365 ) HTML (1 KB)  PDF (2416 KB)  ( 286 )
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