Objective To compare the difference of anterior knee pain between mobile-bearing prosthesis and fixedbearing prosthesis after total knee arthroplasty (TKA). Methods Between January 2008 and October 2008, 72 patients withosteoarthritis were treated with primary TKA. All patients were randomly divided into fixed-bearing prosthesis group (n=37)and mobile-bearing prosthesis group (n=35). In fixed-bearing prosthesis group, there were 8 males and 29 females with an average age of 69.6 years (range, 57-76 years), weighing from 55 to 92 kg (mean, 66.7 kg); the locations were the left knee in 20 cases and the right knee in 17 cases; the body mass index (BMI) ranged from 17.6 to 37.3 (mean, 26.2); the disease duration was 3-22 years; the Knee Society Score (KSS) knee score, function score, patellar score, and pain score were 29.4 ± 15.3, 33.4 ± 16.8, 7.2 ± 2.5, and 2.5 ± 2.2, respectively; and the Insall-Salvati (I-S) index was 1.6 ± 0.3. In mobile-bearing prosthesis group, there were 9 males and 26 females with an average age of 68.2 years (range, 58-73 years), weighing from 50 to 86 kg (mean, 67.9 kg); the locations were the left knee in 30 cases and the right knee in 5 cases; the BMI ranged from 18.4 to 34.4 (mean, 25.6); the disease duration was 6-18 years; the KSS knee score, function score, patellar score, and pain score were 30.9 ± 14.7, 31.4 ± 14.4, 6.8 ± 3.1, and 2.0 ± 2.3, respectively; and the I-S index was 1.6 ± 0.2. There was no significant difference in general data between 2 groups (P gt; 0.05). Results All incisions healed by first intention; no deep vein thrombosis of lower l imbs or pulmonary embol ism occurred. All patients were followed up 12-16 months. In mobile-bearing prosthesis group, knee infection occurred in 1 case, dislocation of the knee in 1 case, and cl icking of the knee in 3 cases; in fixed-bearing prosthesis group, cl icking of the knee occurred in 1 case. There was no significant difference in KSS knee score, function score, patellar score, or pain score between 2 groups (P lt; 0.05) at last follow-up; and there was no significant difference in congruence angle, lateral patellofemoralangle, patellar tilt angle, lateral patellar displacement, patellar displacement, or I-S index between 2 groups at last follow-up (P gt; 0.05). Anterior knee pain occurred in 7 cases (18.9%) of the fixed-bearing prosthesis group and in 5 cases (14.3%) of the mobilebearing prosthesis group, showing no significant difference (χ2=0.227, P =0.634). There were significant differences in KSS knee score, function score, patellar score, and I-S index between patients with anterior knee pain and patients without anterior knee pain (P lt; 0.05). Conclusion Fixed-bearing prosthesis and mobile-bearing prosthesis have the same short-term effectiveness and the incidence of anterior knee pain.
Objective To evaluate the effectiveness of microplate fixation in open-door cervical expansive laminoplasty (ELP) by comparing with anchor fixation. Methods Between January 2005 and October 2008, 35 patients with multi-segment cervical spondylotic myelopathy were treated. Of them, 15 patients underwent ELP by microplate fixation (microplate group) and 20 patients underwent ELP by anchor fixation (anchor group). In microplate group, there were 10 malesand 5 females with the age of (51.2 ± 11.5) years; the disease duration ranged from 6 to 60 months (mean, 14 months); and the preoperative Japanese Orthopoaedic Association (JOA) score was 7.7 ± 2.5. In anchor group, there were 13 males and 7 females with the age of (50.7 ± 10.8) years; the disease duration ranged from 3 to 58 months (mean, 17 months); and the preoperative JOA score was 7.8 ± 2.9. There was no significant difference in the general data, such as gender, age, and JOA score between 2 groups (P gt; 0.05). Results All incisions healed by first intention. Thirty-five cases were followed up 24-68 months (mean, 32 months). The operation time was (113 ± 24) minutes in anchor group and (111 ± 27) minutes in microplate group, showing no significant difference (t=0.231 3, P=0.818 5). The rate of spinal canal expansion in microplate group (60% ± 24%) was significantly higher than that in anchor group (40% ± 18%) (t=2.820, P=0.008). The JOA scores of 2 groups at 3 months and 24 months after operation were significantly higher than the preoperative scores (P lt; 0.01). There was no significant difference in JOA score between 2 groups at 3 months after operation (t=1.620 5, P=0.114 6), but the JOA score of microplate group was significantly higher than that of anchor group at 24 months after operation (t=3.454 3, P=0.001 5). X-ray film, MRI, and CT scan at 3-6 months after operation displayed that door spindle reached bony fusion. There was no occurrence of ‘‘re-close of door’’ in 2 groups. The rate of compl ication in microplate group (13.3%, 2/15) was significantly lower than that in anchor group (25.0%, 5/20) (χ2=7.160 0, P=0.008 6). Conclusion ELP by microplate fixation can achieve the stabil ity quickly after operation, which can help patients to do functional exercises early, and has satisfactory effectiveness and less complications.
Objective To investigate the effect of methylprednisolone sodium succinate (MP) and mouse nerve growth factor (mNGF) for injection in treating acute spinal cord injury (ASCI) and cauda equina injury. Methods Between December 2004 and December 2007, 43 patients with ASCI and cauda equina injury were treated, including 33 males and 10 females with an average age of 43 years (range, 32-66 years). Injured vertebral columns were C2 in 1 case, C4 in 5 cases, C5 in 7cases, C6 in 3 cases, T8 in 1 case, T10 in 1 case, T11 in 2 cases, T12 in 3 cases, L1 in 9 cases, L2 in 5 cases, L3 in 3 cases, L4 in 1 case, and L5 in 2 cases. All the patients had sensory disturbance and motor dysfunction at admission. The Frankel scale was used for assessment of nerve function, 5 cases were rated as Grade A, 12 as Grade B, 22 as Grade C, and 4 as Grade D before operation. In 43 patients, 23 cases were treated with MP and mNGF (group A), 20 cases with MP only (group B). There was no significant difference in general data between 2 groups (P gt; 0.05). All the patients were admitted, received drug treatment within 8 hours of injury, and were given spinal canal decompression, bone transplantation, and internal fixation within 48 hours. The neurological function score systems of American Spinal Injury Association (ASIA) were used for neurological scores before treament, at 1 week and 2 years after treatment. The scores of the activity of daily l iving (ADL) were evaluated and compared. Results All the patients achieved heal ing of incision by first intention. Forty-three cases were followed up 24-61 months with an average of 30 months. Bone graft fusion was achieved after 6-17 months, 11 months on average with stable fixation. No death and compl ications of osteonecrosis and central obesity occurred. There was no significant difference in neurological function scores and ADL scores between 2 groups before treatment (P gt; 0.05); however, the neurological function scores and ADL scores at 1 week and 2 years after treatment were higher than those before treatment (P lt; 0.01) in 2 groups. Group A had higher neurological function scores and ADL scores than group B (P lt; 0.01). At 1 week and 2 years after treatment, the improvement rates of neurological function of group A (47.8%, 11/23 and 91.3%, 21/23) were significantly higher (P lt; 0.01) than those of group B (30.0%, 6/20 and 70.0%, 14/20). Conclusion MP and mNGF play an important role in improving the neurological function in patients with ASCI and cauda equina injury.