Objective To compare the effectiveness of one-stage bilateral total hip arthroplasty by direct anterior approach (DAA) and by posterolateral approach, and to investigate the application value of DAA in one-stage bilateral total hip arthroplasty. Methods The clinical data of 65 patients who underwent one-stage bilateral total hip arthroplasty by DAA or posterolateral approach between June 2010 and November 2015 were analyzed retrospectively. DAA was used in 34 cases (group A) and posterolateral approach was used in 31 cases (group B). There was no significant difference in the gender, age, body mass index, preoperative hemoglobin level, etiology, disease duration, preoperative Harris score, and preoperative visual analogue scale (VAS) score between 2 groups (P>0.05) with comparability. The incision length, operation time, intraoperative blood loss, total blood transfusion volume, hospitalization time, early postoperative complications, Harris score, and VAS score were recorded and compared between 2 groups. The simple Likert scale method was applied to evaluate the patient satisfaction, and the imaging evaluation was used. Results The incision length, operation time, intraoperative blood loss, total blood transfusion volume, and hospitalization time of group A were significantly less than those of group B (P<0.05). The patients were followed up 15-48 months (mean, 25.3 months) in group A and 12-51 months (mean, 27.6 months) in group B. The overall incidence of complications related to surgery in group A (10.29%) was significantly lower than that of group B (19.35%) (χ2=8.769, P=0.023). The acetabular anteversion and abduction angle were in the normal range of 2 groups except 1 hip (1.47%) of group A had a higher acetabular anteversion than normal value. Unstable fixed prosthesis happened in 1 hip of groups A and B respectively, and the remaining femoral calcar had no obvious bone resorption and fixed stably. The Harris score and VAS score at each time point after operation of 2 groups were significantly improved when compared with preoperative scores (P<0.05), and the differences between the time points after operation were also significant (P<0.05). The Harris score at 1 and 3 months after operation and the VAS score at 3 days after operation of group A were significantly better than those of group B (P<0.05), but no significant difference was found at last follow-up between 2 groups (P>0.05). According to the simple Likert scale method to analyze patient satisfaction, comprehensive satisfaction of group A (97.1%, 33/34) was significantly higher than that of group B (67.7%, 21/31) (χ2=10.343, P=0.001). Conclusion The application of DAA in one-stage bilateral total hip arthroplasty can significantly relieve the pain, accelerate the recovery of hip joint function, and improve the patient satisfaction. But in clinical application, more attentions should be paid to strictly grasp the indications and prevent the early complications. The long-term effectiveness needs to be further observed.
ObjectiveTo explore the effectiveness of posteromedial and anterolateral approaches in the treatment of posterolateral tibial plateau collapsed and splited fractures. MethodsNineteen consecutive patients with posterolateral tibial plateau collapsed and splited fractures were treated between August 2010 and August 2013, and the clinical data were retrospectively analyzed. There were 13 males and 6 females, with an average age of 36.9 years (range, 25-75 years). All cases had closed fractures, involving 8 left sides and 11 right sides. Fractures involved posterior column according to the threecolumn classification based on CT scans; according to the Schatzker classification, all fractures were type Ⅱ; according to the AO/Association for the Study of Internal Fixation classification (AO/OTA), all fractures were type 41-B3.1.2. The interval between injury and operation was 7-14 days (mean, 9 days). The reduction of collapsed fractures and implantation of artificial bone allograft were supported by T-shaped distal radius plate via the posteromedial approach. The splited fractures was fixed by less invasive stabilization system (LISS) plate via the anterolateral approach. ResultsThe mean operation time was 69.0 minutes (range, 50-105 minutes). All incisions healed by first intention without neurovascular complications or wound infection. All patients were followed up 14-20 months (mean, 18.2 months). X-ray and CT examinations showed that collapsed tibial plateau and joint surface were completely corrected; bony union was obtained at 12 weeks on average (range, 10-16 weeks). No secondary collapsed fracture and knee varus or valgus occurred. The results were excellent in 12 cases, good in 5 cases, and fair in 2 cases with an excellent and good rate of 89.5% according to the Rasmussen's scoring system for knee function. ConclusionThe posteromedial approach combined with anterolateral approach for posterolateral tibial plateau fractures can fully expose the posterolateral aspects of the tibial plateau, and thus collapsed and splited fractures can be treated at the same time, which will lead to less operative time and good outcomes in the treatment of posterolateral tibial plateau collapsed and splited fractures.
Objective To investigate the feasibility of anterolateral approach for L5 vertebral resection, bone grafting, and screw rod fixation by imaging and biomechanics researches. Methods Twenty formalized adult cadavers (12 males and 8 females) were randomly divided into 2 groups; L5 vertebral resection, bone graft, and screw rod fixation was performed on 10 specimens by using anterolateral approach (experimental group), and on the other 10 specimens by combined anterior and posterior approach. CT scanning and three-dimensional reconstruction were performed in the experimental group; preoperative maximal safe entry angle and depth of screws and intraoperative actual entry angle and depth of screws were measured; the sacral screw position was observed after operation. The biomechanical test was done in 2 groups. Results Twenty specimens smoothly underwent L5 excision and reconstruction. CT scan showed that there was no significant difference in maximal safe entry angle and depth of screws between males and females in experimental group before operation (P>0.05); the maximal safe entry angle and depth were 51.93° and 47.88 mm for anterior screw, and were 37.04° and 46.28 mm for posterior screw. After operation, depth of the sacral anterior and posterior screws were appropriate, which did not pierce into the spinal canal. The biomechanical test results indicated that the flexion, extension, and lateral flexion displacements, and vertical compression stiffness showed no significant difference between 2 groups (P>0.05). Conclusion For L5 lesions not invading posterior column, to use L5 vertebral resection, bone graft, and screw rod fixation by anterolateral approach is a safe and feasible method to reconstruct lumbosacral stability, with the advantages of no changing posture, less operation time and incision, and prevention of bone graft shift, but effectiveness need further be identified.
ObjectiveTo study the effectiveness of a new anterolateral approach of distal femur in the treatment of type C distal femoral fractures by comparing with traditional lateral and anterolateral approaches. MethodsThe clinical data of 51 patients with type C distal femoral fractures treated between January 2008 and August 2011 were retrospectively analyzed. Of 51 patients, 24 patients received the new anterolateral approach of distal femur combined with fixation of condylar buttress plate (modified group), and 27 patients underwent traditional lateral or anterolateral approach combined with fixation of condylar buttress plate (traditional group). There was no significant difference in gender, age, injury cause, American Society of Anesthesiologist (ASA) classification, side, fracture type, complication, and the time from injury to operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, frequency of intraoperative fluoroscopy, hospitalization time, fracture healing time, and Hospital for Special Surgery (HSS) scores of the knee at 3, 6, and 12 months were recorded. ResultsThe operation was successfully completed and the incision healed by first intention in all patients. The operation time and frequency of intraoperative fluoroscopy of modified group were significantly less than those of traditional group (P<0.05). But the intraoperative blood loss and the hospitalization time showed no significant difference between 2 groups (P>0.05). All patients were followed up 12-37 months (mean, 21.3 months). X-ray films showed all fractures were union. The fracture healing time was (12.92±2.24) weeks in the modified group and (13.24±2.52) weeks in the traditional group, showing no significant difference (t=0.476, P=0.637). The knee HSS scores of modified group were significantly higher than those of traditional group at 3, 6, and 12 months after operation (P<0.05). There was no significant difference in the incidence of knee varus or valgus, leg length discrepancy, internal fixator loosening, flexing dysfunction of knee, traumatic arthritis of knee, and total complications between 2 groups (P>0.05). ConclusionComparing with traditional lateral and anterolateral approaches, using the new anterolateral approach to treat type C distal femoral fractures has the advantages of less damage to soft tissue, excellent exposure, less operation time, and frequency of intraoperative fluoroscopy, and better postoperative rehabilitation of knee joint.
ObjectiveTo compare the effectiveness of posterior malleolus fractures treated by plate and screw internal fixation through posterolateral approach.MethodsThe clinical data of 95 patients with posterior malleolus fractures who were admitted between January 2016 and December 2019 and met the selection criteria were retrospectively analysed. They were divided into plate group (44 cases, treated with posterolateral plate internal fixation) and screw group (51 cases, treated with posterolateral screw internal fixation) according to different treatment methods. There was no significant difference in general data between the two groups of patients such as age, gender, cause of injury, side of injury, ankle fracture or injury classification, time from injury to operation, and percentage of posterior ankle fracture area to the distal tibia articular surface (P>0.05). The operation time, hospital stay, fracture healing time, and surgical complications were compared between the two groups. Imaging examinations (X-ray film, CT scan and reconstruction) were used to assess the reduction quality of ankle fracture, articular congruity, and re-displacement in ankle fracture. At last follow-up, the pain visual analogue scale (VAS) score was used to evaluate the patients’ pain, and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used to evaluate ankle joint function.ResultsPatients in both groups were followed up 6-30 months, with an average of 18.2 months. The operation time of the plate group was significantly longer than that of the screw group (U=−2.040, P=0.041); there was no significant difference in hospital stay between the two groups (U=−1.068, P=0.285). Incision swelling occurred in 2 cases in the plate group, sural nerve injury in 3 cases, and traumatic arthritis in 2 cases during follow-up. In the screw group, there were 1, 2, and 2 cases, respectively. The incidence of complications in the two groups (15.9% vs. 9.8%) was not significantly different (P=0.372). All patients who underwent tibiofibular screw fixation underwent the removal of the tibiofibular screw before taking full weight bearing at 12 weeks after operation, and there was no screw fracture and retention. During the follow-up, there was no infection, re-displacement of fracture, delayed bone union or nonunion, and there was no significant difference in fracture healing time between the two groups (t=0.345, P=0.731). There was no significant difference between the two groups of reduction quality of ankle fracture and articular congruity evaluation results (P>0.05). At last follow-up, there was no significant difference in VAS score, AOFAS ankle-hindfoot score and evaluation grade between the two groups (P>0.05).ConclusionBoth the plate and screw internal fixation through posterolateral approach can achieve satisfied effectiveness in the treatment of posterior ankle fractures with maintenance of fracture reduction, and recovery of ankle joint function. The screw internal fixation has the advantages of minimal invasion and shorter operation time.
Objective To summarize the effectiveness of 3.5 mm T support plate fixation for simple postero-lateral tibial plateau fractures by posterolateral inverted L-shaped approach. Methods Between March 2011 and January 2016, 13 patients with simple posterolateral tibial plateau fracture were treated with 3.5 mm T support plate fixation by posterolateral inverted L-shaped approach. Of 13 cases, 6 were male and 7 were female, aged 28 to 52 years (mean, 43 years). The left side was involved in 5 cases and the right side in 8 cases. The causes of injury were traffic accidents in 6 cases, falls in 3 cases, and falling from height in 4 cases. All of patients had fresh closed fracture by X-ray, CT three dimensional reconstruction, and MRI. According to Schatzker classification, 4 cases were rated as type II and 9 cases as type III. The time between injury and operation was 5-9 days (mean, 7 days). Results One case had incision skin necrosis, which was cured after debridement and skin grafting; and primary healing was obtained in the other cases. The patients were followed up 10-16 months (mean, 13 months). The X-ray film showed that the fracture line was blurred at 3 months after operation, and disappeared at 12 months after operation. There was no complications of wound infection, major neurovascular injury, loosening or breakage of internal fixation, and dislocation of joint surface. The Hospital for Special Surgery (HSS) knee function score was 94 (range, 89-97) at last follow-up; all were excellent. Conclusion The 3.5 mm T support plate fixation by posterolateral inverted L-shaped approach is one of preferred surgical method for the treatment of simple posterolateral tibial plateau fractures.
Objective To compare the short-term effectiveness of staged bilateral total hip arthroplasty via different approaches. Methods Thirty-two patients (64 hips) with bilateral hip disease were treated with total hip arthroplasty between January 2012 and December 2014. There were 20 males and 12 females with the mean age of 45.3 years (range, 30-67 years). There were avascular necrosis of femoral head in 14 cases, developmental dislocation of the hip in 12 cases, ankylosing spondylitis in 4 cases, osteoarthritis in 2 cases. All patients were treated with total hip arthroplasty; and the direct anterior approach (DAA) or direct lateral approach (DLA) was chosen for the unilateral hip randomly. The length of incision, operation time, total blood loss volume, the time of first postoperative activity, and the acetabular anteversion angle were compared. The Harris score, visual analogue scale (VAS) score, and incidence of complication were compared between 2 groups. Results All incisions healed at stage Ⅰ. All patients were followed up 20-53 months (mean, 39.6 months). The length of incision, total blood loss volume, the time of first postoperative activity were significantly shorter in DAA group than in DLA group (P<0.05). The operation time was significantly longer in DAA group than in DLA group (P<0.05). There was no significant difference in acetabular anteversion angle between 2 groups (t=1.122, P=0.266). The incidence of complication were 25.00% and 15.63% in DAA group and DLA group, respectively, showing no significant difference (χ2=0.869, P=0.536). The Harris score in DAA group significantly increased at 3 and 9 months after operation than in DLA group (P<0.05); there was no significant difference at 18 months after operation between 2 groups (P>0.05). The VAS score was significantly lower in DAA group than in DLA group at 1 day, 3 days, and 1 week after operation (P<0.05); there was no significant difference at 4 and 8 weeks between 2 groups (P>0.05). The prosthesis did not loosen and sink during the follow-up. Conclusion Total hip arthroplasty via DAA can reduce operation related complication and speed up the recovery of hip function at the early stage after operation. However, the lateral cutaneous nerve injury is the most common complication.
Objective To compare the effectiveness between the posterolateral approach and the posterolateral combined posteromedial approaches in the treatment of Mason type 2B posterior malleolar fracture. Methods A retrospective analysis was performed on the clinical data of 79 patients with posterior ankle fracture who met the selection criteria between January 2015 and January 2022. There were 62 cases of Mason 2B Pilon subtype and 17 cases of avulsion subtype. Among Mason 2B Pilon subtype patients, 35 were treated with posterolateral approach (group A), 27 patients were treated with combined approach (group B). There was no significant difference in gender, age, injured side, cause of injury, time from injury to operation, preoperative hospital stay, preoperative visualanalogue scale (VAS) score, and intraoperative internal fixation between the two groups (P>0.05). All patients with Mason 2B avulsion subtype were treated by posterolateral approach, including 7 males and 10 females, aged from 25 to 68 years, with an average of 46.1 years. The operation time, intraoperative blood loss, postoperative hospital stay, and complications were recorded. The reduction quality was evaluated by Ovadia deals radiographic score, and the ankle function and pain were evaluated by VAS score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and ankle range of motion. Results Mason 2B Pilon subtype: There was no significant difference in operation time, intraoperative blood loss, postoperative hospital stay, and follow-up time between the two groups (P>0.05). The radiological evaluation of Ovadia deals in group A was significantly worse than that in group B (P<0.05). The VAS score in the two groups significantly improved at each time point after operation, and the VAS score and AOFAS score further improved with the extension of time after operation, and the differences were significant (P<0.05). Except that the AOFAS score of group A was significantly lower than that of group B at last follow-up (P<0.05), there was no significant difference in VAS score and AOFAS score between the two groups at other time points (P>0.05). At last follow-up, the ankle range of motion in group A was significantly less than that in group B (P<0.05). There was no significant difference in the incidence of sural nerve injury, deep tissue infection, limitation of toe movement, and traumatic ankle arthritis between the two groups (P>0.05). Mason 2B avulsion subtype: The operation time was (119.47±20.61) minutes and the intraoperative blood loss was 50 (35, 55) mL. Seventeen patients were followed up 13-25 months, with an average of 18 months. The Ovadia deals score was excellent in 10 cases, good in 6 cases, and poor in 1 case at 1 week after operation, and the excellent and good rate was 94.1%. All fractures healed in 8-18 weeks with an average of 12.35 weeks. There were 1 case of sural nerve injury and 3 cases of traumatic ankle arthritis after operation. No deep tissue infection or limitation of toe movement occurred. The VAS score decreased significantly and AOFAS score increased significantly with time, and the differences were significant between different time points before and after operation (P<0.05). The ankle range of motion at last follow-up was (56.71±2.47)°. ConclusionCompared with the posterolateral approach, the combined approach is a better choice for the treatment of Mason 2B Pilon subtype. If the posteromedial bone block does not affect the reduction of the medial malleolus, the posterolateral approach can achieve good effectiveness for Mason 2B avulsion subtype.
Objective To compare the effectiveness between improved anterolateral approach and lateral approach in the treatment of senile intertrochanteric fracture. Methods The clinical data were retrospectively analyzed, from 61 patients with senile intertrochanteric fracture treated between February 2008 and February 2010. Of 61 patients, 34 patients underwent improved anterolateral approach combined with fixation of dynamic hip screw (improved group), and 27 patients underwent conventional lateral approach combined with fixation of dynamic hip screw (conventional group). There was no significant difference in gender, age, injury cause, Evans classification, comorbidities, disease duration, or Harris hip scores between 2 groups (P gt; 0.05). Results The operation was successfully completed in all patients. The operation time, blood loss, perspective frequency during operation, drainage volume, hospitalization days, and out-of-bed time in the improved group were significantly less than those in the conventional group (P lt; 0.05). All patients were followed up 12-24 months (mean, 18.7 months). Bone union was achieved in both groups; the fracture healing time was (11.64 ± 1.28) weeks in the improved group and was (12.29 ± 1.12) weeks in the conventional group, showing no significant difference (t=2.15, P=0.15). Harris hip scores at 3, 6, and 12 months were significantly better than preoperative scores in 2 groups (P lt; 0.05), and significant differences were found among different time points after operation in 2 groups (P lt; 0.05), between 2 groups after operation (P lt; 0.05). There was no significant difference in the incidence of incision infection, limb shortening, coax vara, internal fixation loosening, main screw cutting-out from femoral head between 2 groups (P gt; 0.05), but the incidence of total complications in the improved group was significantly lower than that in the conventional group (P lt; 0.05). Conclusion Compared with conventional lateral approach, improved anterolateral approach has the advantages of sufficient exposure, reducing muscle damage and surgical risk in treating intertrochanteric fracture. Operating treatment of improved anterolateral approach combined with early rehabilitation after surgery can recover hip joint function as quickly as possible.
Objective To explore the feasibility and effectiveness of vertebroplasty with reverse designed unilateral targeted puncture in treatment of osteoporotic vertebral compression fracture (OVCF) by comparing with curved unilateral puncture. Methods A total of 52 patients with OVCF met selection criteria and were admitted between January 2019 and June 2021 were selected as the research objects. According to the random number table method, they were divided into two groups (n=26). In trial group, the reverse designed unilateral targeted puncture was used in the percutaneous vertebroplasty (PVP); while the control group used the curved unilateral puncture. There was no significant difference in gender, age, bone mineral density (T value), cause of injury, time from injury to operation, the level of responsible vertebral body, pedicle diameter of the planned puncture vertebral body, and preoperative visual analogue scale (VAS) score, anterior vertebral height, and Cobb angle between the two groups (P>0.05). The operation time, bone cement injection volume and leakage, intraoperative radiation exposure times, and hospitalization costs in the two groups were recorded. VAS score was used to evaluate the relief degree of low back pain after operation. X-ray film was used to review the diffusion degree of bone cement in the responsible vertebral body, and Cobb angle and anterior vertebral height were measured. Results The operation was successfully completed in the two groups. Patients in the two groups were followed up 12-18 months, with an average of 13.6 months. The operation time, volume of injected bone cement, intraoperative radiation exposure times, and hospitalization costs in the trial group were significantly lower than those in the control group (P<0.05). With the prolongation of time, the low back pain of the two groups gradually relieved, and the VAS score significantly decreased (P<0.05). And there was no significant difference in VAS score between the two groups at each time point (P>0.05). There were 2 cases (7.6%) of bone cement leakage in the trial group and 3 cases (11.5%) in the control group, and no significant difference was found in the incidence of bone cement leakage and the diffusion degree of bone cement between the two groups (P>0.05). Imaging examination showed that compared with pre-operation, the anterior vertebral height of the two groups significantly increased and Cobb angle significantly decreased at 2 days and 1 year after operation (P<0.05); while compared with 2 days before operation, the anterior vertebral height of the two groups significantly decreased and Cobb angle significantly increased at 1 year after operation (P<0.05). There was no significant difference in the above indexes between the two groups at different time points after operation (P>0.05). Conclusion Compared with curved unilateral puncture, the use of reverse designed unilateral targeted puncture during PVP in the treatment of OVCF can not only achieve similar effectiveness, but also has the advantages of less radiation exposure, shorter operation time, and less hospitalization costs.