Objective To evaluate the effect of weight-bearing time on micro-fracture therapy for small sized osteochondral lesion of the talus (OLT) by comparing early weight-bearing and postponed weight-bearing. Methods Between March 2010 and September 2011, 43 patients with small sized OLT (lt; 2 cm2) scheduled for arthroscopic micro-fracture therapy were randomly divided into early weight-bearing group (n=22) and postponed weight-bearing group (n=21). There was no significant difference in gender, age, body mass index, disease duration, disease cause, preoperative visual analogue scale (VAS) score, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score between 2 groups (P gt; 0.05). All patients of 2 groups received micro-fracture treatment under arthroscopy. Full weight bearing began under the protection of “8” figure shaped splint at immediately after operation in early weight-bearing group, and weight bearing began at 6 weeks after operation in postponed weight-bearing group. Results The size of cartilage injury was (1.24 ± 0.35) cm2 in early weight-bearing group and was (1.25 ± 0.42) cm2 in postponed weight-bearing group by arthroscopy measurement, showing no significant difference between 2 groups (t=0.09, P=0.93); and there was no significant difference in cartilage injury grading between 2 groups (Z= — 1.45, P=0.15). The follow-up time was 12-18 months (mean, 14.5 months) in 2 groups. VAS and AOFAS scores of each group at each time point after operation were all significantly improved when compared with preoperative scores (P lt; 0.05), but no significant difference was found between 2 groups at 3, 6, and 12 months after operation (P gt; 0.05). The time of returning to work in early weight-bearing group [(6.35 ± 1.93) months] was significantly shorter than that in postponed weight-bearing group [(8.75 ± 1.48) months] (t= — 4.10, P=0.00). Conclusion For patients with small sized OLT, early weight-bearing and postponed weight-bearing after micro-fracture therapy under arthroscopy have similar short-term results. But patients undergoing early weight-bearing can earlier return to work than patients undergoing postponed weight-bearing.
Objective To investigate the effect of preoperative rehabilitation on early function of joints after total hip arthroplasty by comparing with non-preoperative rehabilitation. Methods Between March 2010 and November 2011, 98 patients with hip disease were recruited in study. Of 98 patients, 49 received preoperative rehabilitation for 2 weeks in trial group, and 49 did not receive preoperative rehabilitation in control group. There was no significant difference in gender, age, disease duration, disease cause, preoperative visual analogue scale (VAS) score, and preoperative Harris score between 2 groups (P gt; 0.05). Results There was no significant difference in VAS score at each time point after operation between 2 groups (P gt; 0.05), but significant differences were found in Harris score (P lt; 0.05). At 3 days after operation, compliance evaluation results showed that 36 cases were of full compliance, and 13 cases were of partial compliance in trial group; 27 cases were of full compliance, 14 cases were of partial compliance, and 8 cases were of non-compliance in control group; there was significant difference between 2 groups (Z=2.286, P=0.002). The ambulation time was within 7 days in trial group, and was within 7 days in 47 cases and more than 7 days in 2 cases in control group; there was significant difference between 2 groups (Z=3.840, P=0.000). Conclusion Preoperative rehabilitation plays an important role in compliance, decreased bed rest time, and hip function improvement in patients after total hip arthroplasty.
Objective To investigate the effects of altering the femoral offset after total hip arthroplasty on postoperative pain and function. Methods A total of 162 patients undergoing single total hip arthroplasty between March 2009 and December 2011 met the inclusion criteria. According to difference of femoral offset between operative side and contralateral side, the patients were divided into 3 groups: decreased offset group (lt; — 5 mm, 30 cases), normal offset group ( — 5-5 mm, 87 cases), and increased offset group (gt; 5 mm, 45 cases). There was no significant difference in gender, age, and disease duration among 3 groups (P gt; 0.05). The types of femoral stem and head prosthesis were compared among 3 groups. Short Form 12 Health Survey (SF-12) score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, and Harris score were used to evaluate the clinical outcomes. Results Standard offset femoral prosthesis was most used, followed by increased offset femoral prosthesis, and decreased offset femoral prosthesis was least in 3 groups. The types of femoral stem and head prosthesis showed no significant difference among 3 groups (P gt; 0.05). The patients were followed up 12-33 months (mean, 25 months). There was no significant difference in SF-12 score among 3 groups at 1 year after operation (P gt; 0.05); there was no significant difference in WOMAC pain and stiffness scores among 3 groups (P gt; 0.05) except WOMAC body function score (P lt; 0.05). According to Harris scoring criteria, the results were excellent in 13 cases, good in 8 cases, fair in 7 cases, and poor in 2 cases in decreased offset group; the results were excellent in 42 cases, good in 34 cases, fair in 9 cases, and poor in 2 cases in normal offset group; the results were excellent in 31 cases, good in 12 cases, and fair in 2 cases in increased offset group; and significant difference was found among 3 groups (Z= — 3.152, P=0.008). Conclusion Increased offset is more conducive to joint functional recovery and pain relief; decreased offset may lead to joint function deterioration and pain aggravation.
Objective To investigate the method and effectiveness of coracoplasty with mini-incision for subcoracoid impingement syndrome. Methods Between May 2006 and September 2011, 4 patients with subcoracoid impingement syndrome were treated, including 3 cases of congenital dysplasia of the coracoid process and 1 case of anterior glenohumeral instability. There were 3 males and 1 female with an average age of 36 years (range, 20-56 years). The disease duration was 6-22 months (mean, 11.2 months). The patients had a history of chronic pain and click of the anterior should, which was aggravated in adduction, internal rotation, and flexion. The results of the coracoid impingement test were positive by Neer and Hawkins-Kennedy impingement sign. The axial CT in adduction position showed that the coracohumeral interval decreased and coracoid index increased. The 2 cm lateral coracoid incision was made and the 0.5-1.5 cm coracoid neck was revealed and cut by osteotomy. The coracoplasty was performed by amputating the conjoined tendon insertion of the short head of the biceps and the coracobrachialis muscle and suturing to proximal coracoid osteotomy surface. Shoulder was fixed with the external braces for 6 weeks. Results Healing of incision by first intention was observed in all cases without any complication. All the 4 patients were followed up from 8 months to 5 years. At last follow-up, pain and click disappeared. The mean visual analogue scale (VAS), University of California at Los Angeles (UCLA), Constant, and simple shoulder test (SST) scores were significantly improved from 7.75, 10.25, 65.50, and 9.75 at preoperation to 0.25, 34.25, 91.25, and 0.25 at last follow-up respectively. The axial CT in adduction position and MRI showed that long coracoid process was removed; the coracohumeral interval was increased to 13.38 mm from 4.16 mm at preoperation; and the coracoid index was decreased to 0.28 mm from 13.08 mm at preoperation. Conclusion Coracoplasty with mini-incision is an effective method to relieve clinical symptoms of subcoracoid impingement, which has less complications and faster recovery.
【Abstract】 Objective To investigate the relationships between residual displacement of weight-bearing and non weight-bearing zones (gap displacement and step displacement) and hip function by analyzing the CT images after reconstruction of acetabular fractures. Methods The CT measures and clinical outcome were retrospectively analyzed from 48 patients with displaced acetabular fracture between June 2004 and June 2009. All patients were treated by open reduction and internal fixation, and were followed up 24 to 72 months (mean, 36 months); all fractures healed after operation. The residual displacement involved the weight-bearing zone in 30 cases (weight-bearing group), and involved the non weight-bearing zone in 18 cases (non weight-bearing group). The clinical outcomes were evaluated by Merle d’Aubigné-Postel criteria, and the reduction of articular surface by CT images, including the maximums of two indexes (gap displacement and step displacement). All the data were analyzed in accordance with the Spearman rank correlation coefficient analysis. Results There was b negative correlation between the hip function and the residual displacement values in weight-bearing group (rs= — 0.722, P=0.001). But there was no correlation between the hip function and the residual displacement values in non weight-bearing group (rs=0.481, P=0.059). The results of clinical follow-up were similar to the correlation analysis results. In weight-bearing group, the hip function had b negative correlation with step displacement (rs= — 0.825, P=0.002), but it had no correlation with gap displacement (rs=0.577, P=0.134). Conclusion In patients with acetabular fracture, the hip function has correlation not only with the extent of the residual displacement but also with the location of the residual displacement, so the residual displacement of weight-bearing zone is a key factor to affect the hip function. In patients with residual displacement in weight-bearing zone, the bigger the step displacement is, the worse the hip function is.
【Abstract】 Objective To evaluate the early result of tri ple Endobutton technique for reconstructing coracoclavicularligament of chronic complete acromioclavicular joint dislocations. Methods Between January 2009 and June 2010, 14 patients with chronic complete acromioclavicular joint dislocations were treated with tri ple Endobutton technique for reconstructing coracoclavicular ligament. There were 10 males and 4 females with a mean age of 38.5 years (range,26-52 years). Injury was caused by traffic accident in 7 cases,by falling in 5 cases，and by bruise in 2 cases. The average time was 47 days from injury to the operation (range,29-75 days). All patients had pain and activity restriction. The X-ray films showed complete dislocation of acromioclavicular joint. According to Allman’s type, all cases were classified as III degree complete dislocations. Results At postoperation, wound healed by first intention with no early complication of infection or neurovascular injury. All patients were followed up 18.3 months on average (range,13-30 months). Acromioclavicular joint subluxation occurred in 1 patient at 1 week after operation, and no redislocation or other complication occurred in the other patients. American Shoulder and Elbow Surgeons (ASES) score was 90.8 ± 4.1 at last follow-up, showing significant difference when compared with the preoperative score (65.3 ± 4.4) (t= —17.57，P=0.00); Constant-Murley score was 91.7 ± 3.9, showing significant difference when compared with preoperative one (71.5 ± 4.6) (t=—75.02，P=0.00). The definite answer in Simple Shoulder Test (SST) averaged 9.7 (range,7-12). Conclusion The tri ple Endobutton technique for reconstructing coracoclavicular ligament is an effective method in treatment of chronic complete acromioclavicular joint dislocations. The short-term results are satisfactory.
Objective To evaluate the effect of associated ulnar styloid fracture on wrist function after distal radius fracture by comparing the cl inical data between the cases of distal radius fracture with or without ulnar styloid fractures. Methods The cl inical data of 182 patients with distal radius fracture between February 2005 and May 2010 were retrospectively analyzed, including 75 with ulnar styloid fracture (group A), and 107 without ulnar styloid fracture (group B). There was no significant difference in sex, age, disease duration, and fracture classification between 2 groups (P gt; 0.05). In groups A and B, closed reduction and spl intlet or cast fixation were performed in 42 and 63 cases respectively, and openreduction and internal fixation in 33 and 44 cases respectively. All ulnar styloid fractures were not treated. Results Thepatients were followed up 21 months on average in group A and 20 months on average in group B. All incisions healed by first intention after operation. Ulnar wrist pain occurred in 4 patients (5.3%) of group A and 6 patients (5.6%) of group B, showing no significant difference (χ2=0.063, P=0.802). The fracture heal ing time was (10.9 ± 2.7) weeks in group A and (11.6 ± 2.3) weeks in group B, showing no significant difference (t=1.880, P=0.062). There was no significant difference in the palmar tilt angle, the ulnar incl ination angle, and the radial length between groups A and B when fracture healing (P gt; 0.05). At last follow-up, there was no significant difference in wrist flexion-extension, radial-ulnar deviation, pronation-supination, and grip and pinch strength between 2 groups (P gt; 0.05). According to the Gartland-Werley score in groups A and B, the results were excellent in 24 and 35 cases, good in 43 and 57 cases, fair in 5 and 10 cases, and poor in 3 and 5 cases with execllent and good rate of 89.3% and 86.0%, respectively, showing no significant difference between 2 groups (Z= —0.203, P=0.839). There were significant differences in the above indexes between patients undergoing closed reduction and open reduction in group A (P lt; 0.05). Conclusion Associated ulnar styloid fracture has no obvious effect on the wrist function after distal radius fracture. The anatomical reduction of distal radial fracture is the crucial importance in the treatment of distal radial fracture accompanying ulnar styloid fracture.
Objective To investigate the influencing factors of the hi p functional recovery after Pi pkin fracture surgery. Methods The cl inical data were retrospectively analysed, from 37 patients with Pi pkin fracture between May 2002 and February 2009. There were 32 males and 5 females, aged 26 to 98 years (median, 43 years). The causes of injury were traffic accident in 31 cases, a fall ing in 4 cases, and fall ing from height in 2 cases. The time from injury to operation was 1-28 days (mean, 8.6 days). According to the Pi pkin classification criteria, there were 23 cases of type II, 8 cases of type III, and 6 cases of type IV. Open reduction and internal fixation (ORIF) were performed in 27 cases, total hip arthroplasty (THA) in 10 cases.The relationships between gender, age, time from injury to surgery, type of fracture, treatment way and the hip functionalrecovery were analysed statistically. Results All patients achieved heal ing of incision by first intention, no infection anddeep venous thrombosis occurred. All patients were followed up 10 to 94 months with an average of 40.5 months. Bonefusion was observed at 5-11 months (mean, 8.9 months) in patients undergoing ORIF by X-ray examination; no prostheticloosening or subsidence occurred in patients undergoing THA. At last follow-up, Oxford Hip Score (OHS) was 16-58 points(mean, 37.2 points); the results were excellent in 12 cases, good in 13 cases, fair in 2 cases, and poor in 10 cases. The univarible analysis showed that the type of fracture and treatment way significantly affected the hip functional recovery (P lt; 0.05). The multivarible analysis showed that the type of fracture and treatment way had no significant effect on the hip functional recovery (P gt; 0.05). Conclusion Type and treatment way of Pi pkin fracture may affect postoperative hi p function recovery, so appropriate treatment should be selected based on fracture type to ensure the restoration of joint function.
ObjectiveTo evaluate the middle- and long-term effectiveness of primary total hip arthroplasty (THA) in patients with chronic autoimmune inflammatory diseases. MethodsBetween January 1990 and June 2006, 42 patients (51 hips) with chronic autoimmune inflammatory diseases underwent THA. There were 15 males (18 hips) and 27 females (33 hips) with an average age of 36.9 years (range, 22-70 years). The locations were the left side in 29 hips and the right side in 22 hips. Of 42 cases, there were 11 cases of systemic lupus erythematosus (13 hips), 16 cases of rheumatoid arthritis (22 hips), and 15 cases of ankylosing spondylitis (16 hips). The causes of THA included avascular necrosis of the femoral head in 26 cases (34 hips), ankylosis of the hip in 15 cases (16 hips), and fracture of the femoral neck in 1 case (1 hip). The Harris score was 32.49 ± 9.50. The physical component summary (PCS) and mental component summary (MCS) of short form 36 health survey scale (SF-36) scores were 25.53 ± 4.46 and 42.28 ± 6.27, respectively. ResultsAll incisions healed primarily. All 42 patients were followed up 5-21 years (mean, 9.1 years). At last follow-up, the Harris score was 89.25 ± 8.47; PCS and MCS of the SF-36 were 51.35 ± 4.28 and 55.29 ± 8.31, respectively; and significant differences in the scores were found between pre- and post-operation (P lt; 0.05). Complications included limp (4 cases), prosthesis dislocation (2 cases, 2 hips), periprosthetic fracture (1 case, 1 hip), aseptic loosening (2 cases, 2 hips), and ectopic ossification (3 cases, 3 hips). ConclusionTHA seems to be a good choice for patients with chronic autoimmune inflammatory diseases.