[Application of high hip center technique in total hip arthroplasty in patients with Crowe typeâ ¡and â ¢ developmental dysplasia of hip and severe hip osteoarthritis].

OBJECTIVE: To explore the clinical efficacy of high hip center technique total hip arthroplasty （THA） for Crowe Ⅱand Ⅲ developmental dysplasia of hip （DDH） and severe hip osteoarthritis （HOA）. METHODS: From January 2018 to January 2020, 74 patients with Crowe typeⅡand Ⅲ DDH and severe HOA were admitted, and 37 cases of anatomical hip center reconstruction were taken as control group, including 7 males and 30 females, aged from 42 to 65 years old with an average of （58.40±4.98） years old, body mass index （BMI） ranged from 18 to 29 kg·m-2 with an average of （23.02±2.21） kg·m-2. Thirty-seven routine high hip center technical reconstruction were performed as study group, including 5 males and 32 females, aged from 41 to 65 years old with an average of （57.31±5.42） years old, BMI ranged from 18 to 29 kg·m-2 with an average of （23.14±2.07） kg·m-2. The patients presented with hip pain, limited function and range of motion, and gait instability before surgery. All patients underwent THA, the control group underwent intraoperative anatomical hip center reconstruction, and the study group underwent intraoperative high hip joint reconstruction. The perioperative indicators of the two groups were compared. The hip joint function, balance function and gait of the patients were evaluated before surgery, 3 months, 6 months, and 12 months after surgery. The length difference of both lower limbs, horizontal distance of rotation center, vertical distance of rotation center and femoral eccentricity were measured before operation and 1 year after operation. The incidence of complications in the two groups during the operation and postoperative follow-up was counted. RESULTS: The operation time of the study group was shorter than that of the control group, and the intraoperative blood loss was less than that of the control group （P<0.05）. After 12-months follow-up, 1 was lost to followvup in study group and 2 were lost to follow-up in control group. The Harris scores and Berg balance scale（BBS）, pace, stride frequency and single step length in the study group were higher than those in the control group at 3 months and 6 months after operation （P<0.05）；there was no statistically significant difference between the two groups in the indexes 12 months after operation （P>0.05）. The vertical distance of the center of rotation of the study group was greater than that of the control group 12 months after operation （P<0.05）, and there was no significant difference in the length difference of the lower limbs, the horizontal distance of the center of rotation, and the femoral eccentricity between two groups （P>0.05）. There were no complications in either group. CONCLUSION: The long-term effects of THA in patients with DDH and severe HOA were similar between the two central hip reconstruction methods, and the safety was good, and the high hip central reconstruction technique could shorten the operation time and reduce the amount of intraoperative blood loss.At the same time, it has certain advantages in early recovery of hip joint function, balance function and walking function of patients.

[Knot-free anchor repair of anterior talofibular ligament under total ankle arthroscopy].

OBJECTIVE: To explore clinical effect of repairing anterior talofibular ligament with knot-free anchors under total ankle arthroscopy in treating chronic lateral ankle instability. METHODS: From April 2018 to August 2021, 24 patients with chronic lateral ankle instability were treated with knot-free anchors under total ankle arthroscopy to repair anterior talofibular ligament, including 16 males and 8 females, aged from 22 to 42 years old with an average of(28.6±5.8) years old;the time from injury to opertaion ranged from 6 to 10 months with an average of(7.7±1.3) months. Preoperative and postoperative American Orhopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS), talar tilt, anterior talar translation(ATT) were recorded and compared. RESULTS: All patients were followed up from 10 to 12 months with an average of (10.2±1.14) months. Incision were healed at stageⅠ, and no infection, nerve injury and lateral ankle instability occurred. AOFAS score improved from(52.79±8.96) before opertaion to (93.00± 4.01) at 6 months after operation, 23 patients got excellent result and 1 good;VAS decreased from (5.50±0.98) before opertaion to (1.04±0.80) at 6 months after operation(P<0.05);talar tilt decreased from(9.16±2.09)° to (3.10±1.72)° at 3 months after operation(P<0.05);ATT decreased from(8.80±2.55) mm to (2.98±1.97) mm at 3 months after operation(P<0.05). Twenty-four patients drawer test and varus-valgus rotation wer negative. CONCLUSION: Repairing anterior talofibular ligament with knot-free anchors under total ankle arthroscopy for the treatment of chronic lateral ankle instability has advantages of less trauma, less complications safe and reliable, and good recovery of ankle joint function.

[Clinical therapeutic effect of a new bundle-to-bundle suturing method for acute Achilles tendon rupture].

OBJECTIVE: To investigate the clinical effect of a new bundle-to-bundle suturing method for acute Achilles tendon rupture. METHODS: From April 2013 to January 2015, 15 patients with acute Achilles tendon rupture were treated with a new bundle-to-bundle suturing method including 12 males and 3 females with an average age of 37.5 years old ranging from 27 to 56 years old. All of them were immobilized by cast for 6 weeks on the underlying limbs, and were educated for a rehabilitation training during the follow-up. RESULTS: All the patients were followed up for 9 to 17.5 months with an average of 13.5 months. According to the American Ankle Surgery Association (AOFAS), ankle and foot score was 93.3±3.5 at 6 months after operation. All patients got incomplete weight-bearing at 1.6 months on average after the operation, and back to primary work position 4.7 months later on average. All the wounds got primary healing. No incisional infection, necrosis of incisional marginal necrosis, rupture of the Achilles tendon, and gastrocnemius injury occurred. CONCLUSIONS: The surgical treatment of acute Achilles tendon rupture with bundle-to-bundle suturing method has advantages of mini-invasion, a low rate of incision problems and quick function recovery, and was valuable spread in clinic.

[Treatment of gouty arthritis of the first metatarsophalangeal joint by Masquelet technique].

OBJECTIVE: To study clinical curative effects of a Masquelet technology in the treatment of gouty arthritis in the first metatarsophalangeal joint. METHODS: From February 2012 to May 2016, 7 patients with the gouth arthritis of the first metatarsophalangeal joint were treated by the Masqueket technology. There were 5 males and 2 females, ranging in age from 42 to 58 years old, with an average age of 50 years old. During the regular follow up, the bone healing was assessed by the radiographic imaging, and the orthopaedic foot and ankle Association (AOFAS) ankle function scoring system was used for comprehensive evaluation. RESULTS: All the patients were followed up, and the duration ranged from 6 to 8 months, with a mean of 7 months. All the wounds obtained first intention healing, and there were no complications such as wound infection, flap necrosis and other soft tissue complications. The time to bone healing was 3 to 4 months, with an average of 3.6 months. The AOFAS score was increased from preoperative 42.5±4.6 to postoperative 85.0±10.5. CONCLUSIONS: The application of Masquelet technique in the treatment of first metatarsophalangeal joint gouty arthritis achieves obvious symptom relief, has less complications, and can effectively improve the quality of life of patients, which is a new and effective treatment.