【Abstract】 Objective To evaluate the method and the early effectiveness of total hip arthroplasty in the treatment of protrusio acetabuli. Methods Between January 2006 and February 2010, 16 cases (16 hips) of protrusio acetabuli were treated, including 6 males and 10 females with an average age of 56.5 years (range, 39-72 years). The median disease duration was 6.4 years (range, 1 year and 6 months to 35 years). Involved hips included 7 left hips and 9 right hips; 3 patients had primary protrusio acetabuli and 13 patients had secondary protrusio acetabuli. The preoperative Harris score was 49.5 ± 5.5. According to Dunlop et al. classification criterion, there were 3 cases of mild, 9 cases of moderate, and 4 cases of severe. All patients received total hip arthroplasty with bone graft and cementless prosthesis for recovery of femoral offset and acetabular center of rotation. Results All incisions healed by first intention without complication of infection, deep venous thrombosis, or nerve injury. All patients were followed up 12-62 months with an average of 37 months. The Harris score at last follow-up was 90.5 ± 4.5, showing significant difference (t=49.578, P=0.000) when compared with preoperative score. The X-ray films showed that no prosthesis loosening or subsidence was observed, and bone graft healed with no sign of re-protrusion. Conclusion In treatment of protrusio acetabuli, total hip arthroplasty with bone graft and cementless prosthesis can recover the femoral offset and acetabular center of rotation and provide satisfactory early effectiveness.
【摘要】 目的 探讨负压封闭吸引（vacuum sealing drainage，VSD）敷料在创伤性慢性骨髓炎治疗中的作用。 方法 2006年6月-2009年8月收治13例创伤后慢性骨髓炎有较多脓性渗出物患者，其中男9例，女4例；年龄8~56岁，平均34岁。车祸致胫骨开放性骨折9例；腓骨骨折1例；高处坠落致跟骨开放性骨折2例；股骨骨折1例，术后均合并慢性骨髓炎，病程11~35个月。于病灶清除后，先采用VSD治疗，待创面清洁、骨面有肉芽组织形成后，8例直接二期缝合伤口，4例通过带蒂肌皮瓣或皮瓣修复创面，1例采用背阔肌皮瓣游离移植修复创面。 结果 使用VSD平均吸引18 d，更换VSD平均2.1次。创面渗出物逐渐减少，创面面积减小，经二期缝合、皮瓣移植等方法封闭创面。13例患者经6~31个月随访，慢性创伤后骨髓炎均治愈，无复发。 结论 采用VSD治疗创伤性慢性骨髓炎具有引流充分、炎症控制快、创面肉芽组织生长快、骨髓炎复发率低的优点。【Abstract】 Objective To evaluate the clinical efficacy of vacuum sealing drainage (VSD) in managing traumatic chronic osteomyelitis. Methods Between June 2006 and August 2009, 13 patients with a lot of purulent exudates after traumatic chronic osteomyelitis were treated in our hospital. There were nine males and four females with their ages ranged from 8 to 56 years old, averaging at 34. Among these cases of traumatic chronic osteomyelitis, nine occurred after operation for open tibial fractures and one occurred after operation for open fibula fracture caused by traffic accident; two occurred after operation for open calcaneal fracture and one occurred after operation for femur fracture caused by falling. The course of the disease ranged from 11 to 35 months. After the focus of infection was debrided completely, they were treated with VSD. As soon as the wound surface was clear and the bone surface was covered with granulation tissue, eight patients were treated with secondary suture, four were treated with local skin flap transplantation or musculocutaneous flap transplantation, and one was treated with free latissimus dorsi musculo-cutaneous flap. Results The exudates in and the area of the wound were both decreased after VSD procedure on the wound for an average of 18 days and replacing the VSD for an average of 2.1 times. The wound was covered by second suture or flap transplantation. After a follow-up of 6-31 months, all 13 cases of traumatic chronic osteomyelitis were healed with no recurrence. Conclusion Application of VSD in treating traumatic chronic osteomyelitis can drain thoroughly, control inflammation faster, promote granulation tissue, and decrease the rate of recurrence.
ObjectiveTo explore the technique of arthroscopic resection of benign tumor in the knee posterior septum and to evaluate its clinical results. MethodsBetween June 2008 and June 2012, 12 cases of benign tumor in the knee posterior septum were treated by arthroscopic surgery. There were 8 males and 4 females with an average age of 36.5 years (range, 22-50 years). The average disease duration was 8.4 months (range, 3 months to 2 years). Of 12 cases, there were 2 cases of chronic synovitis, 5 cases of ganglion, 4 cases of tenosynovial giant cell tumor, and 1 case of synovial hemangioma; solitary tumor involved in the knee posterior septum in 10 cases, and in the posterior septum and other part of the knee in 2 cases. All the patients underwent tumor removal under arthroscope with routine anterolateral and anteromedial portal, additional posteromedial portal and/or posterolateral portal. Trans-septal approach was used in 6 cases because the tumors located in the middle of the posterior septum. ResultsAll wounds healed by first intention with no complications such as infection, haematoma in the knee, injury of vessels and nerves, deep vein thrombosis, osteofascial compartment syndrome, or cutaneous necrosis. All patients were followed up 12-46 months with an average of 18.5 months. All patients achieved relief of knee pain and improvement of knee movement. The range of motion of the knee was significantly improved from (57.08±12.52)° at pre-operation to (120.83±13.95)° at last follow-up (t=-12.84, P=0.00). The visual analogue scale (VAS) score was significantly reduced from 5.00±1.04 at pre-operation to 1.50±0.91 at last follow-up (t=-18.00, P=0.00). The Lysholm score was significantly improved from 49.50±9.07 at pre-operation to 84.58±6.82 at last follow-up (t=-8.04, P=0.00). ConclusionThe benign tumor in the knee posterior septum can be completely resected under arthroscope, and the procedure is minimally invasive and useful to the restore knee function.
ObjectiveTo investigate the effectiveness and indications of deferred dynamization for nonunion of femoral shaft fractures after static interlocking nail. MethodsBetween March 2006 and June 2012, 26 patients with nonunion of femoral shaft fractures after static interlocking nail were treated with deferred dynamization, and their data were analyzed retrospectively. There were 19 males and 7 females with a mean age of 38 years (range, 22-46 years). Nonunion was found at 10-29 months (mean, 16 months) after open reduction and static interlocking nail for fracture fixation. Referring to Papakostidis criteria for nonunion, there were 7 cases of stable/hyperplastic type, 3 cases of stable/atrophic type, 12 cases of unstable/hyperplastic type, and 4 cases of unstable/atrophic type. ResultsAll incision healed at first stage. Twenty-six patients were followed up 10-28 months (mean, 14 months). A total of 16 (61.5%) fractures healed at 4-11 months after deferred dynamization (7 cases of stable/hyperplastic type and 9 cases of unstable/hyperplastic type); the other 10 fractures failed to heal. The healing rate was 100% (7/7) in patients with stable/hyperplastic type nonunion, 75% (9/12) in patients with unstable/hyperplastic type nonunion, and 0 in patients with stable/atrophic type and unstable/atrophic type nonunion. ConclusionDeferred dynamization is an effective method for hyperplastic nonunion of femoral shaft fractures after static interlocking nail, but it is not suitable for atrophic nonunion of femoral shaft fractures.
ObjectiveTo explore the treatment methed of recurrent patellar dislocation associated with old osteochondral fracture and to evaluate its effectiveness. MethodsBetween August 2010 and August 2014, 12 cases of recurrent patellar dislocation with old osteochondral fracture were treated. There were 4 males and 8 females with an average age of 18.3 years (range, 15-24 years). The left knee was involved in 7 cases and the right knee in 5 cases. All the patients had a history of patellar dislocation, the average interval from injury to first hospitalization was 7.6 months (range, 6-13 months). At preoperation, the range of motion (ROM) of the injured knee was (89.17±13.11)°; the Lysholm score was 56.67±18.91; the Q-angle was (17.50±5.28)°; and tibial tuberosity-trochlear groove (TT-TG) distance was (18.33±4.03) mm. The Q-angle was more than 20° and TT-TG distance was more than 20 mm in 6 of 12 cases. There were 6 cases of patellar osteochondral fracture, 5 cases of lateral femoral condylar osteochondral fracture, and 1 case of patellar osteochondral fracture combined with lateral femoral condylar osteochondral fracture. After osteochondral fracture fragments were removed under arthroscope, lateral patellar retinaculum releasing and medial patellar retinaculum reefing was performed in 2 cases, medial patellofemoral ligament (MPFL) reconstruction combined with both lateral patellar retinaculum releasing and medial patellar retinaculum reefing in 4 cases, and MPFL reconstruction, lateral patellar retinaculum releasing, medial patellar retinaculum reefing, and tibial tubercle transfer in 6 cases. ResultsAll wounds healed by first intention with no complication of infection, haematoma, skin necrosis, or bone nonunion. All patients were followed up 12-60 months with an average of 24.2 months. At 3 months after operation, all patellar dislocations were corrected; the Q-angle was (13.33±1.37)° and the TT-TG distance was (12.17±1.17) mm in 6 patients undergoing tibial tubercle transfer, showing significant differences when compared with preoperative values[(22.50±2.17)° and (21.33±2.34) mm] (t=15.25, P=0.00; t=8.27, P=0.00). All patients achieved relief of knee pain and knee locking; the knee ROM and the Lysholm score at last follow-up were (120.42±11.57)° and 89.25±9.71, showing significant differences when compared with preoperative ones (t=-11.61, P=0.00; t=-8.66, P=0.00). ConclusionIt has satisfactory short-term effectiveness to remove old osteochondral fragments that can not be reset and to correct patellar dislocation for recurrent patellar dislocation with old osteochondral fracture.
Objective To summarize the short-term effectivness of type IV Pipkin fracture through transtrochanteric approach with trochanteric osteotomy. Methods Between January 2007 and January 2010, 15 cases of type IV Pi pkin fracture were treated through transtrochanteric approach with trochanteric osteotomy. There were 9 males and 6 females with an average age of 42.5 years (range, 27-55 years). The causes of fractures included traffic accident (12 cases), fall ing from height (2 cases), and heavy pound injury (1 case). The time from injury to hospital ization was 4 hours to 7 days (mean, 2.3 days). All patients had l imitation of activity in the injured hips. The X-ray films and CT three-dimensional reconstruction indicated posterior dislocation of the hip joints and fractures of the femoral head and acetabulum, with no fracture of femoral neck. The locations of the femoral head fractures were under the round l igament in 9 cases and above the round l igament in 6 cases. Compl ications were treated firstly in all patients. The time from hospital ization to operation ranged from 2 to 10 days (mean, 4.5 days). Results All patients got primary wound heal ing with no early compl ication. All the patients were followed up 12-48 months with an average of 26 months. All osteotomies and acetabular fractures healed within 6 to 8 weeks. All patients achieved heal ing of femoral head fracture after 6-10 months. Mild heterotopic ossification occurred in 2 cases at 3 months after operation which were left untreated; and necrosis of the femoral head occurred in 1 case at 8 months after operation, was treated by total hip arthroplasty. At last follow-up, the flexion of the injuried hips ranged from 60 to 120° (mean, 92.5°). Based on Thompson et al. scoring scales, the results were excellent in 5 cases, good in 7 cases, fair in 2 cases, and poor in 1 case; the excellent and good rate was 80%. Conclusion Treatment of type IV Pipkin fracture through transtrochanteric approach with trochanteric osteotomy can provide good visual ization and protection of the blood supply of the femoral head.
ObjectiveTo explore the clinical effects of combined operation involving tibial tubercle distalization for the recurrent patellar dislocation with patella alta.MethodsBetween April 2010 and May 2016, 14 cases of recurrent patellar dislocation with patella alta were treated with combined operation involving tibial tubercle distalization. There were 5 males and 9 females with an average age of 18.5 years (range, 13-26 years). The left knee was involved in 9 cases and the right knee in 5 cases. The patella had dislocated 3.3 times on average (range, 2-5 times). The interval between the first dislocation and admission was 19.7 months on average (range, 4-60 months), and the main symptoms were knee pain and limited knee movement. Preoperative X-ray films, CT, and MRI examinations of knee joint showed that the epiphyseal plate closed in all patients. Of all patients, 3 patients had avulsion fracture of the inner edge of patella, and 2 patients had free body in articular cavity. The tibial tuberosity-trochlear groove (TT-TG) distance, patellar-trochlear-groove distance, Caton-Deschamps index, knee range of motion (ROM), Lysholm score, International Knee Documentation Committee (IKDC) score, Kujala score, and Tegner score were compared pre- and post-operation.ResultsAll patients had primary wound healing. All patients were followed up 24-72 months with an average of 34.6 months. X-ray film and CT examination showed that the patellar dislocation was corrected and the osteotomy of the tibial tubercle healed with an average healing time of 3.8 months (range, 3-5 month). At 1 day and 1 year after operation, the TT-TG distance, patellar-trochlear-groove distance, and Caton-Deschamps index showed significant differences when compared with preoperative values (P<0.05), but there was no significant difference between 1 day and 1 year after operation (P>0.05). At the 1 year and 2 years after operation, the knee ROM, Lysholm score, IKDC score, Kujala score, and Tegner score showed significant differences when compared with preoperative values (P<0.05), and there was no significant difference between the 1 year and 2 years after operation (P>0.05).Conclusion Combined operation involving tibial tubercle distalization is a safe and reliable method, which has satisfactory short-term effectiveness for the recurrent patellar dislocation with patella alta.