ObjectiveTo evaluate the short-term effectiveness of the short incision and non-end-to-end suturing system in the treatment of acute closed Achilles tendon rupture. MethodsBetween September 2011 and September 2013, 22 patients with acute Achilles tendon rupture were treated with self-designed minimally invasive non-end-to-end suturing system. There were 16 males and 6 females, aged from 22 to 55 years (mean, 32.6 years). The left side was involved in 12 cases and the right side in 10 cases. The causes included sports injury in 16 patients, violent injury in 4 patients, and falling injury in 2 patients. MRI revealed that the distance from the ruptured site to the calcaneal tuberosity ranged from 40 to 70 mm (mean, 35 mm). The duration from injury to surgery ranged from 0.5 to 7 days (mean, 4.2 days). The incision of 4 cm in length was made at the initial point of Achilles tendon, and minimally invasive non-end-to-end suturing system was used to hold the Achilles. The ruptured tendon was sutured with two non-absorbed thread. The limb was fixed with plaster for 6 weeks. ResultsThe incision all healed by first intention without complications of sural nerve damage and infection. All patients were followed up 8-14 months (mean, 11 months). According to the Arner-Lindholm functional score criteria, the results were excellent in 19 cases and good in 3 cases. No Achilles tendon rupture happened again during follow-up. ConclusionThe small incision with non-end-to-end suturing system is an effective operation strategy for treatment of acute Achilles rupture. The patients can do function exercise at early-stage with satisfatory short-term effectiveness.
Objective To compare the clinical results of mobile-bearing and fixed-bearing prostheses in total knee arthroplasty (TKA) during 10 years follow-up so as to provide a reference for clinical selection of TKA prosthesis. Methods Between January 2002 and December 2005, 113 patients with osteoarthritis of the knee joint underwent primary TKA, and the clinical data were retrospectively analyzed. Mobile-bearing prosthesis was used in 47 cases (group A) and fixed-bearing prosthesis in 66 cases (group B). There was no significant difference in age, gender, body mass index, varus and flexion deformity of the knee, range of motion (ROM) of the knee, knee society score (KSS), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) between 2 groups before operation (P>0.05), so the data were comparable. Results The operation time of groups A and B was (88.1±6.5) and (90.3±7.2) minutes respectively, showing no significant difference (t=1.666,P=0.099). The wounds healed by first intention in all patients of both groups, and no postoperative early complications of incision infection and deep venous thrombosis occurred. The follow-up time was 10.2-12.3 years (mean, 10.8 years) in group A, and was 10.2-12.6 years (mean, 11.3 years) in group B. Revision was performed in 3 cases of group A and 4 cases of group B; the survival rates of prosthesis were 93.6% and 93.9% in groups A and B respectively, showing no significant difference (χ2=0.005,P=0.944). The postoperative knee ROM, KSS score, and WOMAC score were significantly improved when compared with preoperative ones (P<0.05). The knee ROM and KSS score of group B were significantly better than those of group A at 6 weeks after operation (P<0.05), but no significant difference was found between 2 groups at 1, 3, and 10 years after operation (P>0.05). The WOMAC score of group A was significantly better than that of group B at 10 years after operation (t=2.086,P=0.037), but no significant difference was shown at 6 weeks, 1 year, and 3 years after operation (P>0.05). At 10 years after operation, the excellent and good rate of KSS score was 87.2% in group A and was 84.8% in group B, showing no significant difference (χ2=0.018,P=0.893). Conclusion Good medium- and long-term clinical results can be achieved in TKA with both mobile-bearing and fixed-bearing prostheses. The TKA with fixed-bearing prosthesis is relatively simple with better early effectiveness of rehabilitation; and the TKA with mobile-bearing prosthesis could provide better long-term degree of satisfaction in WOMAC score, but a higher surgical skill and soft tissue balance techniques are needed.
ObjectiveTo explore the effectiveness of the clavicular hook plate combined with trapezius muscle fascia for reconstruction of acromioclavicular and coracoclavicular ligaments to treat acute complete acromioclavicular dislocations. MethodsBetween January 2008 and April 2012, 66 patients with acromioclavicular dislocation were treated with the clavicular hook plate combined with trapezius muscle fascia for reconstruction of acromioclavicular and coracoclavicular ligaments in 32 cases (experimental group) and with the clavicular hook plate in 34 cases (control group). There was no significant difference in gender, age, injured side, the cause of injury, and the time from injury to operation between 2 groups (P>0.05). Visual analogue scale (VAS), Constant shoulder scores, and coracoid clavi-cledistance (CC.Dist) were measured at preoperation and at 2 years after operation. Signal/noise quotiem (SNQ) was measured by MRI at 2 years after operation. The operation complications were observed. ResultsThe patients of 2 groups obtained primary healing of incision. The morbidity of complication in experimental group (12.5%, 4/32) was significantly lower than that in control group (91.2%, 31/34) (χ2=40.96, P=0.00). All the cases were followed up 2.8 years on average (range, 2 to 4 years). VAS scores and CC.Dist significantly decreased at 2 years after operation when compared with preoperative values in the 2 groups (P<0.05). VAS scores and CC.Dist of the experimental group were significantly lower than those in the control group (P<0.05). According to Constant shoulder scores at 2 years after operation, the results were excellent in 19 cases, good in 11 cases, and general in 2 cases with an excellent and good rate of 93.75% in the experimental group; the results were excellent in 7 cases, good in 8 cases, general in 16 cases, and poor in 3 cases with an excellent and good rate of 44.11% in the control group; and significant difference was shown between 2 groups (t=2.30, P=0.03). SNQ was significantly lower in experimental group than in control group at 2 years after operation (t=55.03, P=0.00), indicating that ligament healing was better in experimental group than control group. ConclusionCompared with simple clavicular hook plate fixation, the clavicular hook plate combined with trapezius muscle fascia for reconstruction of acromioclavicular and coracoclavicular ligaments is successful in treating acute complete acromioclavicular dislocations, with the advantages of higher ligament healing, less complication, and early improvement of shoulder functions.