Objective To investigate the short-term effectiveness of Swanson artificial joint replacement in treating post-traumatic metacarpophalangeal joint stiffness. Methods Between August 2007 and May 2010, 11 cases (13 fingers) of metacarpophalangeal joint stiffness with soft tissue defects underwent Swanson artificial joint replacement. There were 7 males (9 fingers) and 4 females (4 fingers), aged 43 to 65 years with an average of 49 years. The involved fingers included 4 thumbs, 4 index fingers, 3 middle fingers, and 2 ring fingers. The types of injury included open and crush injury in 8 fingers, fracture of the metacarpophalangeal joint in 3 fingers, metacarpophalangeal joint severing in 2 fingers. The time from joint stiffness to hospitalization was 12 to 48 weeks (mean, 24 weeks). The joint activity was (136.82 ± 28.96)°. According to total active motion (TAM) assessment, included good in 1 finger, fair in 6 fingers, and poor in 6 fingers before operation. The activities of daily living were assessed by Sollerman score, which was 45.64 ± 11.04. The X-ray films and CT scan showed traumatic arthritis of the metacarpophalangeal joint. Results The incision healed by first intention. All patients were followed up 12 to 34 months (mean, 24.1 months). At last follow-up, the joint activity was (194.64 ± 28.86)°, showing significant difference when compared with preoperative value (t=25.214, P=0.000). According to TAM assessment, including excellent in 1 finger, good in 4 fingers, fair in 7 fingers, and poor in 1 finger. The Sollerman score was 67.45 ± 8.20 postoperatively, showing significant difference when compared with the preoperative score (t=10.470, P=0.000). X-ray examination showed no prosthesis fracture, periprosthetic fracture, or joint dislocation occurred at last follow-up. Conclusion Swanson artificial joint replacement can be appl ied to treat posttraumatic metacarpophalangeal joint stiffness, which can improve the joint activity and has satisfactory short-term effectiveness.
Objective To evaluate the results of open arthrolysis by elevated the lateral and medial collateral l igament-musculature complex from the supracondylar ridge of the humerus in treatment of post-traumatic elbow stiffness. Methods From March 2003 to December 2007, 33 patients with post-traumatic elbow stiffness were treated with open arthrolysis by elevated the lateral and medial collateral l igament-musculature complex from the supracondylar ridge of the humerus. There were 23 males and 10 females, aged 17-70 years old (mean 41.8 years old). According to Morrey, 15 caseswere extremely serious (less than 30° extension-flexion arc) and 18 cases were serious (30-60° extension-flexion arc). The range of motion of the elbow stiffness was (32.5 ± 28.9)° and the Mayo score was 51.9±13.1 before operation. All initial fractures were healed according to cl inical examination and X-rays films. All patients present with a post-traumatic elbow stiffness and the average period from initial trauma to elbow arthrolysis was 16.9 months (2-72 months). Results Wound infection occurred in 1 patient and cured after dressing change and anti-infectious treatment. The wounds healed by first intension in 32 cases. No patient showed sign of elbow instabil ity and debil itating pain. All patients were followed up 6 months to 5 years (mean 3.3 years). At last follow up, the Mayo score was 82.3 ± 14.4 and the range of motion of elbow stiffness was (108.8 ± 36.0)°; showing significant differences when compared with preoperation (P lt; 0.05). According to Mayo evaluation, the results were excellent in 11 cases, good in 18 cases, fair in 2 cases, and poor in 2 cases, the excellent and good rate was 87.88%. Thirty-one patients achieve satisfactory results. Two patients were not satisfied with the result, but the satisfactory results were achieved by a second arthrol ysis. Conclusion Open elbow arthrolysis and postoperative rehabil itation for patients with elbow stiffness can improve joint function and ensure the stabil ity of elbows.
OBJECTIVE: Extension stiffness of knee joint is always treated by the quadricepsplasty, but the main deficiency of this method is that patient feels weakness of lower limb and easily kneels down. The aim of this article is to explore the method to resolve the complications after quadricepsplasty. METHODS: Since 1978 to 1997, on the basis of traditional procedures of quadricepsplasty, sartorius muscle was used to reinforce the extension of knee joint. The lower 2/3 of sartorius muscle was fully dissociated only with its insertion intact. A tendon-periosteal-bone flap, about 2 cm in width, was managed on the anterior surface of patella, with its pedicle on the medial edge of patella. The tendon-periosteal-bone flap was used to fix the dissociated sartorious into patella to reinforce the extension of knee joint. The very lower part of sartorius was mainly aponeurosis, with the help of an aponeurosis bundle of iliotibial tract, it was fixed into the insertion of patellar ligament, through a bony tunnel chiseled adjacent to the insertion of patellar ligament. By now the movement of knee joint extension was strengthened by the transferred sartorius muscle. Postoperatively, every patient was required to extend and flex knee joint actively and/or passively. Altogether 12 patients were treated, 9 of them were followed up with an average of 14 months. RESULTS: The average movement was increased from 15 degrees to 102 degrees, and the average myodynamia was improved from grade II to grade IV. CONCLUSION: Traditional quadricepsplasty co-operated with transfer of sartorius muscle can strengthen the myodynamia of knee joint extension. It is simple method and can really achieve good function.
ObjectiveTo observe the changes of plasma homocysteine (Hcy) and brachial ankle pulse wave velocity (baPWV) in patients with subclinical hypothyroidism, and discuss the relationship between subclinical hypothyroidism and arterial stiffness. MethodSeventy-three patients with subclinical hypothyroidism who were not treated before were divided into two groups according to thyroid stimulating hormone (TSH) level between January 2013 and June 2014. There were 35 patients in group A (4 mU/L < TSH < 10 mU/L) and 38 in group B (TSH ≥ 10 mU/L). Another 30 healthy individuals were selected as controls. Hcy and baPWV were determined in all subjects. ResultsCompared with the controls, patients had significantly higher level of TSH, Hcy and baPWV in group A, and had significantly higher TSH, triacylglycerol (TG), low density lipoprotein cholesterol (LDL)-C, Hcy, and baPWV in group B (P<0.05). Compared with group A, TSH, TG, LDL-C, Hcy, and baPWV in group B patiens were significantly higher (P<0.05). Pearson correlation analysis showed that Hcy was positively correlated with TSH (r=0.353, P<0.01) and baPWV was positively correlated with TSH (r=0.416, P<0.01). ConclusionsHcy level and peripheric arterial stiffness increase in patients with subclinical hypothyroidism. Both of them are correlated positively with TSH.
ObjectiveTo summarize the progress of transient elastography in predicting the prognosis of hepatic surgery. MethodsThe related literatures were reviewed. ResultsLiver stiffness can be measured by using transient elastography.In patients with hepatocarcinoma, the liver stiffness measurements are higher, the more likely they are to have surgical complications and hepatocarcinoma recurrence.Liver transplant recipients with higher liver stiffness measurements tend to have higher acute rejection and hepatitis C recurrence rates. ConclusionTransient elastography can evaluate hepatic functional reserve to help improve the outcome of hepatic surgery.
ObjectiveTo review the research progress of complications associated with open elbow arthrolysis so as to provide clinical reference for complication prevention and treatment. MethodsThe recent publications on open elbow arthrolysis and complications associated with it were extensively reviewed and analyzed. ResultsComplications associated with open elbow arthrolysis include ulnar nerve symptom and neuropathy, elbow instability, heterotopic ossification, and hematoma. Although some progress has been made in the complication prevention and treatment recently, there are still some challenges in the control of surgical trauma, intervention of heterotopic ossification and elbow instability after surgery, as well as postoperative analgesia due to the limitation of surgical techniques and the uncertain mechanism of these complications. ConclusionOpen elbow arthrolysis is safe and effective for elbow stiffness. However, more research on the mechanism of complications should be carried out, to further improve the overall effect of the surgery.
ObjectiveTo explore the effectiveness and safety of open arthrolysis combined with internal fixator removal for post-traumatic elbow stiffness. MethodsA retrospective analysis was made on the data of 80 cases treated by open arthrolysis for elbow stiffness between January 2010 and December 2011. The patients were divided into 2 groups:no internal fixation group (group A, n=39) and internal fixation group (group B, n=41) according to whether they underwent internal fixator removal at the same time. No significant difference was found in age, gender, affected side, injury time, elbow rigidity grade, and severity of heterotopic ossification (HO) between 2 groups (P>0.05) except for original injury type (P<0.05). The effectiveness was evaluated by the occurrence of complications including ulnar nerve symptoms, HO recurrence and re-fracture, the elbow range of motion (ROM) and the Mayo elbow performance score (MEPS). ResultsThe mean follow-up duration was 15.7 months (range, 12-18 months) in group A and 16.1 months (range, 12-20 months) in group B. Ulnar nerve symptoms in 5 cases (12.8%) and HO reccurrence in 1 case (2.6%) occurred in group A, while ulnar nerve symptoms in 4 cases (9.8%), HO recurrence 1 case (2.4%), and refracture in 1 case (2.4%) occurred in group B. The incidence of each complication showed no significant difference between 2 groups (P>0.05). Both the ROM and the MEPS at last follow-up increased significantly when compared with preoperative ones in 2 groups (P<0.05). Besides, MEPS of group A was significantly higher than that of group B (t=2.36, P=0.02), but no significant difference was found in the ROM between 2 groups at last follow-up (t=0.40, P=0.69). Based on MEPS, the results were excellent in 16 cases, good in 16 cases, fair in 6 cases, and poor in 1 case in group A with an excellent and good rate of 82.1%;the results were excellent in 10 cases, good in 25 cases, fair in 4 cases, and poor in 2 cases in group B with an excellent and good rate of 85.4%. There was no significant difference in excellent and good rate between 2 groups (χ2=0.16, P=0.69). ConclusionOpen elbow arthrolysis combined with internal fixator removal for post-traumatic elbow stiffness is safe and effective. However, measures for prevention of re-fracture should always be taken into consideration.
ObjectiveTo investigate the effect of tissue interface stiffness change on the spreading, proliferation, and osteogenic differentiation of rat bone marrow mesenchymal stem cells (BMSCs), and to find the suitable stiffness range for stem cell differentiation. MethodsBone marrow of male Sprague Dawley rats (4 weeks old) were selected to isolate and culture BMSCs by whole bone marrow cell adherent method. The third generation BMSCs (1×105 cells/mL) were inoculated into the ordinary culture dishes covered with polyacrylamide hydrophilic gel (PA) which elastic modulus was 1, 4, 10, 40, and 80 kPa (cells seeded on PA), and ordinary culture dish (75 MPa extreme high elastic modulus) as control. Spreading of cells in different stiffness of PA was observed under light microscope. The elastic modulus values of 4, 10, and 40 kPa PA were selected as groups A, B, and C respectively; the ordinary culture dish (75 MPa extreme high elastic modulus) was used as control group (group D). Cell counts was used to detect the growth conditions of BMSCs, alkaline phosphatase (ALP) kit to detect the concentration of ALP, alizarin red staining technique to detect calcium deposition status, and real-time quatitative PCR technique to detect the expressions of bone gla protein (BGP), Runx2, and collagen type I mRNA. ResultsWith increased PA stiffness, BMSCs spreading area gradually increased, especially in 10 kPa and 40 kPa. At 1 and 2 days after culture, the growth rate showed no significant difference between groups (P > 0.05); at 3-5 days, the growth rate of groups B and C was significantly faster than that of groups A and D (P < 0.05), but difference was not statistically significant between groups A and D (P < 0.05); at 5 days, the proliferation of group C was significantly higher than that of group B (P < 0.05). ALP concentrations were (53.69±0.89), (97.30±1.57), (126.60±14.54), and (12.93±0.58) U/gprot in groups A, B, C, and D respectively; groups A, B, and C were significantly higher than group D, and group C was significantly higher than groups A and B (P < 0.05). Alizarin red staining showed that the percentages of calcium nodules was 20.07%±4.24% in group C; group C was significantly higher than groups A, B, and D (P < 0.05). The expression levels of BGP and collagen type I mRNA were significantly higher in groups A, B, and C than group D, and in group C than groups A and B (P < 0.05). The expression level of Runx2 mRNA was significantly higher in groups B and C than group D, and in group C than group B (P < 0.05), but no significant difference was found between groups A and D (P > 0.05). ConclusionPA elastic modulus of 10-40 kPa can promote the proliferation and osteogenic differentiation of BMSCs, and the higher the stiffness, the stronger the promoting effect.
Objective To investigate effectiveness of rotator cuff repair with manipulation release and arthroscopic debridement for rotator cuff tear with shoulder stiffness. Methods A retrospectively study was performed on the data of 15 patients with rotator cuff tear combined with shoulder stiffness (stiff group) and 24 patients without stiffness (non-stiff group) between January 2014 and December 2015. The patients in the stiff group underwent arthroscopic rotator cuff repair with manipulation release and arthroscopic debridement while the patients in the non-stiff group only received arthroscopic rotator cuff repair. The patients in the stiff group were older than the patients in the non-stiff group, showing significant difference (P<0.05). There was no significant difference in gender, type of rotator cuff tear, side of rotator cuff tear, and combined with diabetes between 2 groups (P>0.05). The visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM) were used to evaluate the effectiveness after operation. Results All incisions healed by first intention without any complication after operation. The patients were followed up 13-31 months in the stiff group (mean, 19.2 months) and 13-23 months in the non-stiff group (mean, 20.3 months). There was no significant difference in follow- up time between 2 groups (t=–0.573, P=0.570). The VAS score in the stiff group was higher than that in the non-stiff group before operation (t=–2.166, P=0.037); there was no significant difference between 2 groups at 3, 6, 12 months and last follow-up (P>0.05). The forward flexion and external rotation were significantly lower in the stiff group than those in the non-stiff group before operation and at 3 months after operation (P<0.05); there was no significant difference between 2 groups at 6, 12 months and last follow-up (P>0.05). At last follow-up, the internal rotation was beyond L3 level in 2 groups. The preoperative UCLA score was significant lower in the stiff group than that in the non-stiff group (P=0.037); but there was no significant difference in UCLA score at last follow-up between 2 groups (P=0.786). There was no significant difference in pre- and post-operative ASES scores between 2 groups (P>0.05). Conclusion Satisfactory effectiveness can be achieved in the patients with rotator cuff tear combined with shoulder stiffness after rotator cuff repair with manipulation release and arthroscopic debridement, although the patients with shoulder stiffness had slower postoperative recovery of ROM until 6 months after operation.
ObjectiveTo compare the biomechanical characteristics of self-made nickel-titanium shape memory alloy stepped plate with calcaneal plate and cannulated compression screws in fixing calcaneal osteotomy.MethodsCalcaneal osteotomy was operated on 6 fresh-frozen lower limbs collected from donors. Then three kinds of fixation materials were applied in random, including the self-made nickel-titanium shape memory alloy stepped plate (group A), calcaneal plate (group B), and cannulated compression screws (group C). Immediately after fixation, axial loading of 20-600 N and 20 N/s in speed was introduced to record the biomechanical data including maximum displacement, elastic displacement, and maximum load. Then fatigue test was performed (5 Hz in frequency and repeat 3 000 times) and the same axial loading was introduced to collect the biomechanical data. Finally, the axial compression stiffness before and after fatigue test were calculated.ResultsThere was no significant difference in the axial compression stiffness between pre- and post-fatigue test in each group (P>0.05). However, the axial compression stiffness was significant higher in group A than that in groups B and C both before and after fatigue test (P<0.05). No significant difference was found between group B and group C (P>0.05).ConclusionSelf-made nickel-titanium shape memory alloy stepped plate is better than calcaneal plate and cannulated compression screws in axial load stiffness after being used to fix calcaneal osteotomy.