ObjectiveTo investigate the effectiveness of internal and external lysis combined with Ilizarov external fixation technology for severe knee pathological flexion contracture deformity in children.MethodsA retrospective analysis was made on 12 children (12 knees) with severe knee pathological flexion contracture deformity who were treated with internal and external lysis and Ilizarov external fixation between August 2012 and January 2017. There were 9 boys and 3 girls with an age of 3-12 years (mean, 8.4 years). There were 8 cases of tuberculosis, 3 cases of haemophilia A, and 1 case of residual deformity after extensive hemangioma drug injection. The disease duration ranged from 5 months to 4 years, with an average of 20.3 months. The degree of knee contracture was (67.42±23.30)°, and the range of motion of knee was (38.33±14.98)°. The preoperative Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score was 78.42±15.57. The complication was observed after operation, and the degree of knee contracture, range of motion, and WOMAC score at 3 months and 1 year after operation were recorded and compared with those before operation.ResultsThe operations completed successfully in all children. All the 12 cases were followed up 9-24 months (mean, 14.5 months). All incisions healed by first intention after operation. The knee function of all children improved significantly and the weight-bearing walking function of the lower limbs restored. The degree of knee contracture, range of motion, and WOMAC score were significantly improved at 3 months and 1 year after operation (P<0.05), but there was no significant difference between 3 months and 1 year after operation (P>0.05).ConclusionFor severe knee pathological flexion contracture deformity in children, application of internal and external lysis combined with Ilizarov external fixation has advantages, such as small trauma, rapid recovery, and early postoperative knee function training, and good effectiveness.
Objective To investigate the effectiveness of absorbable pins for reconstructing pelvic stability in Salter innominate osteotomy for treating development dysplasia of the hip (DDH). Methods Between January 2003 and December 2008, 392 patients (440 hips) with DDH underwent a Salter procedure. There were 68 boys (82 hips) and 324 girls (358 hips) with a mean age of 3 years and 3 months (range, 1 year and 6 months-5 years). According to Tonnis classification criteria, 13 hips were rated as grade I, 304 hips as grade II, 82 hips as grade III, and 41 hips as grade IV. Based on the degree of displacement of the femoral head and acetabular index on the anteroposterior pelvic X-ray film, operation method was selected before operation. A total of 341 hips were managed with open reduction and Salter innominate osteotomy, and 99 hips with Salter innominate osteotomy and femoral shortening rotating osteotomy. All cases underwent autologous iliac crest grafting and fixation between osteotomy sites and bone graft with 2 absorbable pins. Results At 1 day after operation, anteroposterior pelvic X-ray examination showed concentric reduction in all hips, having no instability of the joint of the osteotomy sites or bone graft shifting. A total of 368 patients (413 hips) were followed up 1 to 7 years (mean, 3 years and 10 months). At 3 months after operation, no bone graft in stability or shift, and sliding or loosening of pins occurred. At last follow-up, concentric reduction rate was 100%; after hip loading, 358 patients had no claudication and limited hip activities, who had the stability of hips and negative Allis and Ortalani signs. No abnormal height growth was observed in all patients. According to Mckay’s hip function evaluation criteria, the results were excellent in 390 hips, good in 16 hips, and fair in 7 hips, with an excellent and good rate of 98.3%; according to Severin X-ray criteria, the results were excellent in 386 hips, good in 17 hips, and fair in 10 hips, with an excellent and good rate of 97.6%. Conclusion Absorbable pins can replace steel pins for fixation of the osteotomy sites and bone graft in Salter innoninate because of flexible and convenient operation without a need for reoperation of steel pins extraction.
Objective To investigate the effectiveness of lateral closing wedge osteotomy for treatment of traumatic cubitus varus deformity in children. Methods Between July 1996 and June 2010, 20 cases of traumatic cubitus varus deformity after humeral supracondylar fracture were treated by lateral closing wedge osteotomy. There were 13 boys and 7 girls, aged from 7 to 14 years (mean, 10.6 years). The left elbow was involved in 12 cases and right elbow in 8 cases. Thirteencases had received closed reduction, percutaneous Kirschner wire fixation, and external fixation in other hospital, and 7 cases misdiagnosed as elbow luxation and soft tissue injury had given external fixation. Cubitus varus deformity occurred at 2-12 years after injury. Preoperatively, the elbow range of motion (ROM) in flexion and extension was 100-150° (mean, 133.0°) and 0-24° (mean, 11.7°), respectively. The angle of cubitus varus deformity was 20-50° (mean, 32.1°). Results All incisions healed by first intention, and no related complication occurred. A total of 17 patients were followed up 1-14 years (mean, 5 years). X-ray films revealed that bone union was achieved in all cases within 5-8 weeks after operation (mean, 6 weeks). The deformity of cubitus varus was corrected in all cases. At last follow-up, the elbow ROM in flexion and extension was 110-150° (mean, 135.9°) and 0-27° (mean, 12.9°), respectively. According to Jupiter et al. elbow score system, the results were excellent in 14 cases, good in 2 cases, and fair in 1 case; the excellent and good rate was 94.1%. One patient underwent recurrence at 1 month after removal of the Kirschner wire, and lateral closing wedge osteotomy was performed again after 1 year. Conclusion Lateral closing wedge osteotomy is a safe and effective surgical procedure in correcting traumatic cubitus varus deformity in children, which is easy to operate and can be effective in reducing the complications.
Objective? To investigate the pathogenesis, diagnosis, and treatment of unilateral gluteal muscle contracture. Methods Between January 1990 and September 2009, 41 patients with unilateral gluteal muscle contracture were treated and the cl inical data were retrospectively analysed. Among them, 24 were male and 17 were female with an age range from 6 to 29 years (mean, 12 years). Thirty-nine patients had a definite history of repeat intragluteal injection. The locations were the left side in 9 cases and the right side in 32 cases. The main cl inical manifestations included lameness and abnormal gait. The medical examination showed pelvic obl ique and relative inequal ity of lower l imbs with a mean difference of 2.1 cm (range, 1.2-3.8 cm) in the distance form navel to malleolus medials. The X-ray films of pelvis showed outpouching trochanter of femur and pelvic obl ique. The CT scans showed no abnormal finding except pelvic obl ique and gluteal muscle contracture. The arc longitudinal incision was made into the posterolateral area nearby the greater trochanter and then lysis of the gluteal muscles was performed, followed by the skin traction of both legs and rehabil itation exercise. Results All incisions healed by first intention. Forty-one patients were followed up 1-20 years (mean, 5 years), and the signs of gluteal muscle contracture disappeared. After 1 year of operation, 34 patients had equal leg length, 5 patients had mild pelvic obl ique, and 2 patients had obvious pelvic obl ique. According to LIU Guohui et al. evaluation standard, the results were excellent in 33 cases, good in 6 cases, and poor in 2 cases with an excellent and good rate of 95.12% at 1 year after operation. Conclusion Unilateral gluteal muscle contracture leads to pelvic obl ique and inequal ity of lower l imbs, and it can be cured with the surgical release of the gluteal muscle contracture by the arc longitudinal incision into the posterolateral area nearby the greater trochanter, combined with postoperative skin traction and rehabil itation exercises.
Objective To investigate the operative procedure and the therapeutic effects of minimally invasive incision and percutaneous pinning in operative treatment of Gartland type III humeral supracondylar fracture in children. Methods From September 2002 to July 2009, 189 patients with Gartland type III humeral supracondylar fracture were treated with minimally invasive incision and percutaneous pinning. There were 137 males and 52 females, aged from 1 to 13 years (6.2 years on average). Injury was caused by sports in 173 cases, by traffic accident in 9 cases, by fall ing from height in 5 cases, and by earthquake in 2 cases. All fractures were closed fractures, compl icating others fracture in 11 cases, radial nerve injury in 36 cases, median nerve injury in 5 cases, ulnar nerve injury in 2 cases, and brachial artery injuryin 2 cases. The time from injury to hospital ization was 1 hour to 10 days. Neurovascular repair was performed at the same period. Results All incisions healed by first intention, no related compl ications occurred. A total of 143 patients were followed up 5 months to 5 years (12 months on average). X-ray films showed fracture healed within 2-4 months (2.5 months on average). Cubitus varus occurred in 6 cases, but the functions of elbow flexion and extension were good; 2 cases were given distal humeral wedge osteotomy and 4 cases continued keeping the functional training. According to the Flynn et al criteria, the results were excellent in 121 cases, good in 15 cases, and fair in 7 cases; the excellent and good rate was 95.1%. Only a small incision scar was found, the function returned to normal in the cases compl icated by nerve and blood vessel injury. Conclusion Minimally invasive incision and percutaneous pinning for operative treatment of Gartland type III humeral supracondylar fracture in children is a safe and effective surgical procedure, which has minimal trauma, short surgery time, quick recovery, simple operation, and can be effective in reducing the compl ications.