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1.
Zhonghua Yi Xue Za Zhi ; 93(9): 690-2, 2013 Mar 05.
Artigo em Chinês | MEDLINE | ID: mdl-23751749

RESUMO

OBJECTIVE: To explore the imaging reasons for periprosthetic femoral fractures during the operation of total hip arthroplasty with anatomic prosthesis. METHODS: The fracture group consisted of 7 cases with periprosthetic femoral fracture (PPFF) and the non-fracture group 21 cases without PPFF during the operation of total hip arthroplasty (THA) among the 144 cases of primary THA with anatomic prosthesis. The preoperative plain films of hip joint were taken to calibrate the Sharp's angle, centre edge (CE) angle, femoral neck shaft angle, femoral anteversion angle of neck, bowing angle of proximal femoral shaft part, width of narrowest part in proximal femoral shaft. For each case, surgical details, age, height and weight were recorded. The results were analyzed with independent sample t test by software SPSS 17.0. RESULTS: No significant difference existed in general situation, Sharp's angle and CE's angle between two groups. And there were significant differences in femoral neck shaft angle (P = 0.040), femoral anteversion angle of neck (P = 0.026), bowing angle of proximal femoral shaft part (P = 0.024), width of narrowest part in proximal femoral shaft (P = 0.021). CONCLUSION: Dysplasia of proximal femur is a major cause of periprosthetic femoral fracture during the operation of total hip arthroplasty with anatomic prosthesis.


Assuntos
Artroplastia de Quadril , Fraturas do Fêmur/diagnóstico por imagem , Fraturas Periprotéticas , Adulto , Idoso , Artroplastia de Quadril/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos
2.
Chin Med J (Engl) ; 126(9): 1732-7, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23652059

RESUMO

BACKGROUND: Adjacent segment degeneration could seriously affect the long-term prognosis of lumbar fusion. Dynamic fixation such as the interspinous fixation, which is characterized by retaining the motion function of the spinal segment, has obtained satisfactory short-term effects in the clinical setting. But there are few reports about the biomechanical experiments on whether dynamic fixation could prevent adjacent segment degeneration. METHODS: The surgical segments of all 23 patients were L4/5. Thirteen patients with disc herniation of L4/5 underwent Wallis implantation surgery, and 10 patients with spinal stenosis of L4/5 underwent posterior lumbar interbody fusion (PLIF). L3-S1 segmental stiffness and displacement were measured by a spine stiffness gauge (SSG) device during surgery when the vertebral plate was exposed or during spinal decompression or internal fixation. Five fresh, frozen cadavers were used in the self control experiment, which was carried out in four steps: exposure of the vertebral plate, decompression of the spinal canal, implantation of a Wallis fixing device, and PLIF of L4/5 after removing the Wallis fixing device. Then, L3-S1 segment stiffness was measured by an SSG device. RESULTS: The experiments showed that the average stiffness of the L4/5 segment was (37.1 ± 8.9) N/mm after exposure of the vertebral plate, while after spinal decompression, the average stiffness fell to (26.2 ± 7.1) N/mm, decreasing by 25.8% (P < 0.05). For the adjacent segments L3/4 and L5/S1, their stiffness showed no significant difference between the L4/5 segment decompression and the exposure of the vertebral plate (P > 0.05). After Wallis implantation of L4/5, the stiffness of the cephalic adjacent segment L3/4 was (45.8 ± 10.7) N/mm, which was 20.5% more than that after the exposure of the vertebral plate (P < 0.05); after L4/5 PLIF surgery, the stiffness of L3/4 was (35.3 ± 10.7) N/mm and was decreased by 12.4% more than that after the exposure of the vertebral plate (P < 0.05). The stiffness of the cephalic adjacent segment L3/4 after fixation in the Wallis group was significantly higher than that of the PLIF group (P < 0.05). Cadaver experiments showed that the stiffness of the cephalic adjacent segment in the Wallis group was significantly higher than that of the PLIF group after L4/5 segment fixation (P < 0.05); the stiffness of the L5/S1 segment showed no significant difference between PLIF surgery and Wallis implantation (P > 0.05). CONCLUSIONS: After interspinous (Wallis) fixation, the stiffness of the cephalic adjacent segment increased. After PLIF with pedicle screw fixation, the stiffness of the cephalic adjacent segment decreased. An interspinous fixation system (Wallis) has a protective effect for cephalic adjacent segments for the immediate post-operative state.


Assuntos
Parafusos Ósseos , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fusão Vertebral/instrumentação
3.
Zhonghua Yi Xue Za Zhi ; 92(7): 472-5, 2012 Feb 21.
Artigo em Chinês | MEDLINE | ID: mdl-22490969

RESUMO

OBJECTIVE: Untreated ruptures of anterior cruciate ligament (ACL) lead to progressive meniscus tear and development of knee osteoarthritis over decades. The present study was designed to explore the early results of ACL reconstruction for the patients with unstable ACL-deficient knee with osteoarthritis. METHODS: Twelve patients with a mean age of 46 years (range: 35 - 54) underwent ACL reconstruction for ACL-deficient knee with osteoarthritis. All had chronic anterior instability and one or more episodes of knee instability. There was no previous diagnosis of ACL ruptures and no prior ligament surgery on involved knee. The preoperative duration of symptoms was 1 to 5 years. ACL reconstruction with arthroscopic single-bundle four-strand hamstring tendon autograft was performed for all patients. The laxity of knee was determined with Lachman and pivot tests. The patient subjective evaluation of function was examined with the modified Lysholm scoring scale pre- and post-operatively. RESULTS: Obvious articular cartilage degeneration and cartilage space stenosis in medial compartment were found in 9 patients and complex medial meniscus tear in 10. During the follow-up period of 9 - 36 months, there was no graft failure or loss of ROM (range of motion) for any of these knees. The symptoms of instability were relieved in all patients. The post-operative knee stability improved markedly. The modified Lysholm scores improved from a median pre-operative score of 62.0 points to an average of 89.5 at the last follow-up. CONCLUSION: ACL reconstruction with hamstring tendon may significantly relieve symptoms and improve knee functions in the patients of chronic anterior cruciate ligament-deficient knee with osteoarthritis, especially in those with primary symptoms of instability.


Assuntos
Ligamento Cruzado Anterior/cirurgia , Instabilidade Articular/cirurgia , Osteoartrite do Joelho/cirurgia , Adulto , Lesões do Ligamento Cruzado Anterior , Doença Crônica , Feminino , Humanos , Instabilidade Articular/complicações , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Resultado do Tratamento
4.
Zhonghua Wai Ke Za Zhi ; 48(8): 601-5, 2010 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-20646478

RESUMO

OBJECTIVE: To evaluate the effects of cementless revising cup or acetabular reinforcement cages for reconstructing the massive acetabular deficiency. METHODS: From September 2001 to September 2008, 22 loosening acetabular cases (24 hips) were revised using cementless revising cup or acetabular reinforcement cases for reconstructing massive bone defect after particulate bone grafting. There were 2 cases (2 hips) using Lima cementless revising cup, 2 cases (2 hips) using Kerboull ring, and 18 cases (20 hips) using restoration GAP cages. Six cases (6 hips) were male, and 16 cases (18 hips) were female. The mean age was 62 years old (34 - 79 years old). Septic loosening was in 2 cases (2 hips), and aseptic loosening in 20 cases (22 hips). The mean follow-up was 48 months (18 - 84 months). RESULTS: There was no clinical or radiological evidence of loosening for the revising acetabular components at the last follow-up point. The mean Harris hip score was improved significantly from 56 points (44 - 75) before revision to 89 points (78 - 94) at the last follow-up after revision. Excellent and good rate was 95.5% (21/22 cases). The average abduction angle of the three types of acetabular reconstructive cages were 50.1 degrees (39.0 degrees - 66.0 degrees), and almost all cases of the hip rotation center were restored after revision surgery. At the last follow-up, the reinforcement cages were no immigration and breakup, and there was no radiolucent line around the acetabular components. The bone graft integrated well into surrounding acetabular bone. CONCLUSION: The method of revising the massive acetabular bone defect by cementless revising cup and acetabular reinforcement cages restores the normal hip rotation center, supplies the primary stability of the revising component, and protects the bone graft from mechanical overload during its revascularization phase, which is a reliable method for revising the massive acetabular deficiency after total hip arthroplasty.


Assuntos
Acetábulo/cirurgia , Prótese de Quadril , Adulto , Idoso , Artroplastia de Quadril , Transplante Ósseo , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Reoperação/métodos , Stents
5.
Zhonghua Wai Ke Za Zhi ; 46(13): 966-9, 2008 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-19035193

RESUMO

OBJECTIVE: To investigate the etiologies and prevention of patellar instability after total knee arthroplasty (TKA). METHODS: From September 1997 to April 2005, 94 patients (105 knees) underwent TKA without patellar resurfacing. All of them were osteoarthritis. Ten patients (14 knees) were performed with Rotation Knee (RK) prostheses. Forty patients were performed with mobile bearing TACK prostheses, and 44 patients with GEMINI prostheses. Subluxation and tilt of patella were evaluated by X-rays before or after operation. RESULTS: The incidence of patellar instability after operation was 28.6% in patients who had genu valgus deformity, and was 29.5% in whom had patellar instability preoperative. The incidence of patellar instability in RK, TACK, and GEMINI group was 28.6%, 20.9%, and 16.7% respectively after operations. Four patients had obvious femoral or tibial components malrotation. CONCLUSIONS: The etiologies of patellofemoral instability include pre-operative conditions, prosthetic design, and improper positioning of the prosthetic component. So the suitable component design and skillful operative technique will help the surgeon to avoid this complication.


Assuntos
Artroplastia do Joelho , Instabilidade Articular/etiologia , Patela , Idoso , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Feminino , Seguimentos , Humanos , Instabilidade Articular/prevenção & controle , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle
6.
Zhonghua Wai Ke Za Zhi ; 44(20): 1411-3, 2006 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-17217836

RESUMO

OBJECTIVE: To investigate the change in joint line after knee arthroplasty. METHODS: A total of 43 patients had 25 primary cruciate-retaining total knee replacements (Link Gemini MKII) and 25 rotational knee replacements (Link Endo-Model Rotational Knee System) sacrificing collateral ligaments and cruciate ligaments. Lateral radiographs were made both preoperatively and postoperatively. The change in the relative position of the joint line preoperatively and postoperatively was defined as the difference between the perpendicular distance from the weight-bearing surface of the tibial plateau to the tibial tubercle of the natural tibia (JL) and perpendicular distance from the weight-bearing surface of the prosthetic tibial component to the tibial tubercle (JL'). This distance was JL'-JL. The statistical differences between 2 groups were analyzed. RESULTS: The distance of JL'-JL was 2.0 mm (-1.3 - 7.2 mm) in 22 patients with Gemini replacement, whereas the distance was 3.1 mm (-1.5 - 12.3 mm) in the other patients with rotational knee system. The difference was significant. CONCLUSIONS: If the collateral ligaments and cruciate ligaments are removed during the knee replacement operations, the prosthetic joint line is likely to be malpositioned proximally. The fibular styloid and medial or lateral epicondylar reference points can be used to determine proper position of the joint line during operation.


Assuntos
Artroplastia do Joelho/métodos , Articulação do Joelho/patologia , Complicações Pós-Operatórias , Idoso , Artroplastia do Joelho/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Resultado do Tratamento
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