Abstract The fracture of the prosthetic stem after prosthetic replacement of femoral head is not rare. In this study, the photoeastic instrument was used to study the stress distribution on the prosthetic stem following its insertion and to analyse the factors influencing the fracture of the stem. Through the examination of 9 places in 8 cases, it was found that:(1) The removal of femoral calcar and the inframedullary filling of the bone cement directly influenced the stress distribution. (2) The valgus or varus condition of the prosthesis would lead to stress concentration on the stem. (3) Once lossening of the prosthesis occured it would change the preliminary installingstress distribution in the upper femur which would lead to fatigue fracture. Ths experimental data and clinical observation would provide scientific basis forthe prevention of fracture of prosthetic stem following prosthetic replacement of femoral head.
BJECTIVE: To study the effect of transposition of great adductor muscular tendon pedicled vessels in repairing the medial collateral ligament defect of knee joint. METHODS: From September 1991 to September 1999, on the basis study of applied anatomy, 30 patients with the medial collateral ligament defect were repaired with great adductor muscular tendon transposition pedicled vessels. Among them, there were 28 males and 2 females, aged 26 years in average. RESULTS: Followed up for 17 to 60 months, 93.3% patients reached excellent or good grades. No case fell into the poor grade. CONCLUSION: Because the great adductor muscular tendon is adjacent to the knee joint and similar to the knee ligament, it is appropriate to repair knee ligament. Transposition of the great adductor muscular tendon pedicled vessels is effective in the reconstruction of the medial collateral ligament defect of knee joint.
Objective To review progress of clinical application ofmorselized bone and to investigate relative exploration on it.Methods The recent articles on morselized bone in the field of clinicand experimental research were extensively reviewed, and relative examination of morselized bone referring to method and mechanism were investigated carefully.Results Morselized bone worked well clinically, especially inrevision ofartificial total hip joint, and it was proved effective with lots of advantages.Conclusion Morselized bone functions well clinically. Although its mechanism requires a further research, it still has a promising value in clinical application.
ObjectiveTo investigate the feasibility and effectiveness of proximal tibial hemiprosthesis replacement in the first stage and prosthesis revision in the second stage in reducing the risk of length discrepancy of limbs in children with proximal tibial osteosarcoma.MethodsBetween 2009 and 2013, 3 children with conventional osteosarcoma at the proximal tibia (stage ⅡB) were treated. There were 2 boys and 1 girl. They were 12, 13, and 13 years old, respectively. After 4 courses of preoperative chemotherapy, the proximal tumor segmental resection and proximal tibial hemiprosthesis replacement were performed. Then the patients underwent prosthetic revision in the second stage when they were 20, 17, and 17 years old, respectively.ResultsAll patients successfully completed two stages of operations. The length discrepancy of lower limb after the second stage operation were 19, 7, and 21 mm, respectively. Three patients were followed up 13, 3, and 27 months after the second stage operation, and the lower extremities functions were satisfactory. The Musculoskeletal Tumor Society (MSTS) score was 26, 27, and 25, respectively.ConclusionThe proximal tibial hemiprosthesis replacement in the first stage combined with prosthesis revision in the second stage for treating the proximal tibia osteosarcoma in children can keep the distal femur growth ability, reduce the length discreapancy of lower limb, and obtain satisfactory stability and good function.
Objective To estimate the clinical curative effect of replacement of inverttype artificial total scapula and shoulder joint prosthesis and reserving arm with rehabilitation of function in the treatment of malignant tumor in shoulder. Methods From February 2001 and November 2004, five youth patients with primary malignant shoulder tumors were treated operatively by resection of neoplasmsthoroughly, replacement of inverttype artificial total shoulder blade and joint prosthesis, the functional reconstruction. Of them, there were 4 males and 1 female, aging from 19 to 26 years with an average of 23.6 years. Two cases were diagnosed as having osteosarcoma, one as having chondrosarcoma, and 2 as having Ewing sarcoma. After operation, the upper limbs was immobilized for 3 weeks. The rehabilitation training including passive exercise and initiative exercise. Results The average operative time was 425 min (380 to 530 min), and the blood loss ranged from 1 250 ml to1 900 ml(1 540 ml on average). The follow-up ranged from 7 to52 onths,with an average of 24.6 months. Postoperative complication included 1 case of pneumothorax, one case of shoulder incision skin part necrosis and 1 case of clavicle stump raising and pierce skin with shallow infection. No complication of postoperative incision deeply infection, nerve damage and prosthesis exposure or dislocation occurred. According to the scoring system of JOA(Japan orthopaedics association), the average score was 65 (60 to 72). The flexion and extension function of elbow joint recovered to normal. Conclusion The replacement of inverttype artificial total scapula and shoulder joint prosthesis is an efficacious method for the treatment of malignant tumor in shoulder. There are advantages of numerous adaption, wide range of motion and goodstability. It can not only reserve arm but also rehabilitate function.
Objective To explore an improved method of surgical operation for reposition of the articular surface with Type Ⅲ Pilon fractures. Methods From January 1999 to December 2005, 20 patients (22 sides) with Type Ⅲ Pilon fractures were treated with the delayed open reduction and the internal fixation, which took the superior articular surface of the talus as a templet so as to reposition the lower articular surface of the tibia, strengthen the bone transplantation, fasten the internal fixation, and make an early functional exercise possible. Complete data were obtained from 16 of the patients with 18 sides (13 males,15 sides; 3 females, 3 sides; age, 14-48 years). The injury due to a fallingaccident was found in 12 patients (14 sides), and due to a traffic accident in 4patients (4 sides). Results The healing of the first intention was achieved in 14 sides, the delayed healing in 3 sides, and the infection in 1 side. The follow-up of all the 16 patients for 971 months (average, 22 months) including the X-ray examinations revealed that no screw for the internal fixation entering the articular cavity. According to the Teeny’s judging standards of radiology evaluating the result of the surgery for Pilon fractures, the anatomical reduction of the related articular surface was found in 77.8% of the sides (14/18) and thehealing of the first intention (stage Ⅰ) in 94.4% (17/18). According to the Mazur’s criteria, an excellent result was obtained in 5 sides, good in 7, fair in 5, and poor in 1. The excellent and good result was 66.7%. Conclusion Propermanagement of the injured soft tissues, prompt recovery of the tibial distant plateau height, and accurate reposition of the articular surface, enough transplant bone for the solid support, b internal fixation for the distant tibial anatomical structure, and early functional exercise are the key points to the successful operation.
The "bayonet" deformity from poliomyelitis is a peculiar type of deformity of knee. From January 1986 through December 1994, 23 cases of this type of knee deformity were corrected by surgery. The operative procedures performed were suprachondylar osteotomy of femur or subplateau osteotomy of tibia. The patients were followed up from 1 to 5 years, with an average of 3 years. The result rated excellent to good was 95.6%. The features of this disorder and the main points in the surgical procedure were discussed.
Objective To investigate the relationship between the initial stabil ity and infected loosening of the total hip arthroplasty (THA) prosthesis. Methods From January 2000 to December 2008, 110 cases (110 hips) were treated with THA revision. Among them, 15 cases (15 hips) were confirmed infected loosening. There were 8 males and 7 females with anaverage age of 62 years (range 42-75 years). The infected signs were found from 6 months to 2 years after initial THA. All of them had Tsukayama type IV and late infection, including 6 cases of acetabular infected loosening (5 cases of one-stage and 1 case of two-stage acetabular revision), 7 cases of simple infected loosening of femoral prosthesis (4 cases of one-stage and 3 cases of twostage femoral prosthesis revision), and 2 cases of joint capsule infection and sinus without prosthesis loosening (debridement and continuous irrigation). Results All incisions healed by first intention. Fifteen patients were followed up for 12 to 36 months (average 24 months). In 13 cases of revision, postoperative X-ray films showed that femoral acetabular prostheses were in good position, and had no cl inical and imaging infective signs of loosening. In 2 cases of joint capsule infection, sinus recurred 6 months postoperation without hip joint pain, the function of weight-bearing and walking of hip joint was normal. Harris score increased from preoperative average of 42 to postoperative average of 85; the results were excellent in 4 cases, good in 7 cases, and fair in 4 cases. Conclusion The infection of THA may occur in the whole joint, half-joint or just in joint capsule. The initial stabil ity of the prosthesis would affect the long-term survival of the prothesis. If the prosthesis initial stabil ity is obtained, even if there are infective factors, infections would also be l imited.