[Mid-term follow-up and clinical efficacy of total knee arthroplasty for osteoarthritis patients with Parkinson's disease].

OBJECTIVE: To investigate clinical efficacy and experience of total knee arthroplasty in treating knee osteoarthritis patients with Parkinson's disease. METHODS: From January 2011 to January 2014, 19 knee osteoarthritis patients with Parkinson's disease treated with total knee arthroplasty were collected. Among them, including 9 males and 10 females aged from 61 to 83 years old with an average of 71.3 years old. Radiology results were checked before and after operation. VAS score and KSS score were applied to evaluate clinical effects. Patients were classified according to HoehnYahr grade, 3 cases in grade 1, 4 cases in grade 1.5, 2 cases in grade 2, 4 cases in grade 2.5, 2 cases in grade 3 and 1 case in grade 4. RESULTS: Nineteen patients were followed up from 3 to 7 years with an average of 4.3 years. The pain of patients was significantly reduced or disappeared. All incisions were healed at stage I. At the latest follow-up, 3 patients had knee pain, and mild pain in 1 patient, moderate in 1 patient without severe pain. VAS score was reduced from preoperative 8.4±1.3 to the latest follow-up 3.1±1.2, the difference was statistically significant (P<0.05). KSS score improved from 43.6±7.3 before operation to 91.8±10.6 after operation. The condition of Parkinson's were controlled by medicine. No loosening and subsidence of prosthesis by X-ray examination. CONCLUSIONS: Total knee arthroplasty is a safe and effective method for the treatment of Parkinson's disease and has satisfactory mid-term clinical effect.

[Mid-term follow-up and coping strategies of bone cement leakage after percutaneous kyphoplasty].

OBJECTIVE: To retrospectively analyze the clinical data of 17 patients with bone cement leakage after percutaneous kyphoplasty and explore the leakage type and mid-term clinical effects. METHODS: The clinical data of 17 patients with osteoporotic vertebral compression fractures occurred bone cement leakage after percutaneous kyphoplasty from October 2011 to October 2016 were collected. There were 7 males and 10 females, aged from 68 to 87 years old with an average of 78 years. All the patients had the history of low emergy trauma who had normal activity and full self-care for living before trauma, and complained with the lower back pain without signs and symptoms of nerve root injury after trauma. According to the anatomical location by images, the bone cement leakage pathways was confirmed, the preoperative and postoperative vertebral body height and Cobb angle were measured, the improvement of spinal stenosis were recorded. Preoperative and postoperative visual analogue scale (VAS) and Oswestry Disability Index(ODI) were used to evaluate pain and daily activities. RESULTS: All the patients were followed up for 4 to 7 years with an average of 5.1 years. According to anatomical location by images, we found the bone cement leakage pathways of vertebral side type in 6 cases, intervertebral disc type in 3 cases, spinal canal type in 2 cases, vertebral pedicle type in 5 cases and mixed type in 1 case. Vertebral body height from preoperative(27.7±3.5)% restored to (56.4±2.5)% at final follow-up, and the kyphosis was corrected with Cobb angle from preoperative(45.3±4.2)° corrected to(18.3±3.1)° at final follow-up. VAS score decreased from preoperative 7.9±1.5 to 2.1±0.5 at final follow-up. ODI obviously restored from preoperative(49.1±7.5)% to (23.5±3.7)% at final follow-up. The nerve symptoms in lower limbs occurred in 2 cases, and the neurological symptom was disappeared after urgent symptomatic treatment and anaphase trophic nerve treating. Lower back pain occurred in 3 cases, including one case of unbearable pain, and the pain disappeared after symptomatic treatment. CONCLUSIONS: Although the rate of bone cement leakage during percutaneous vertebral kyphoplasty is not low, the bone cement leakage has little influence on PKP surgery. Even if a little leakage occurred within the spinal canal during the surgery, spinal canal decompression will not be needed urgently. The significant clinical symptoms caused by leakage can basically disappear after treatment in mid-term follow-up.

[Case-control study on effect of anterolateral and posterolateral approaches on early postoperative hip abductor strength in total hip arthroplasty].

OBJECTIVE: To compare the difference of early postoperative hip abductor strength and function between improved Gibson anterolateral approach (group A) and conventional Gibson posterolateral approach (group B) in patients who had underwent total hip arthroplasty (THA). METHODS: Among 149 patients performing total hip arthroplasty,130 patients were followed up and were randomly divided into two groups (19 unqualified cases were excluded). Group A included 65 cases who underwent anterolateral approach, and the other group included 65 cases who underwent posterolateral approach. In the group A, male:female = 26:39,with an average age of (72.5 ± 8.3) years old, BMI of (24.7 ± 3.7) kg/m², and hip abductor strength of (1.08 ± 0.49) N · m/kg. In the group B, male:female = 30:35, with an average age of (71.6 ± 7.1) years old, BMI of (25.5 ± 3.9) kg/m², and hip abductor strength of (1.05 ± 0.51) N · m/kg. In the age-related control group, male:female = 33:32, with an average age of (73.1 ± 7.5) years old, BMI of (24.2 ± 3.8) kg/m², and hip abductor strength of (1.17 ± 0.53) N · m/kg. The age, BMI, hip abductor strength, anatomy of surgical approach, hip abduction angles and Harris score in all patients were evaluated at the day before surgery and at 1, 2, 3, 6, and 12 months after surgery. All preoperative clinical data (age, BMI and abductor strength of the uninjured side limb ) of these cases had no significant differences. RESULTS: At 1, 2, 3, 6, and 12 months after surgery, the hip abductor strength in group A were (0.53 ± 0.13), (0.66 ± 0.21), (0.85 ± 0.15), (0.95 ± 0.19), (1.03 ± 0.13) N · m/kg respectively, while in group B were (0.46 ± 0.14), (0.57 ± 0.18), (0.78 ± 0.12), (0.85 ± 0.18), (0.98 ± 0.14) N · m/ kg respectively.The differences between the two groups at the 6th months after operation were significant; the hip abduction angles in group A were (25.35 ± 4.31)°, (36.53 ± 5.13)°, (48.07 ± 1.62)°, (61.53 ± 1.77)°, (68.62 ± 3.16)°,while in group B were (23.47 ± 2.41)°, (33.42 ± 4.23)°, (46.64 ± 2.51)°, (60.96 ± 1.75)°, (67.47 ± 4.36)°. The differences between the two groups at the 3rd month after operation were significant. Harris score in the group A were 72.23 ± 2.57, 79.36 ± 3.91, 84.75 ± 3.17, 88.63 ± 2.16, 95.21 ± 1.37 repectively ; while in the group B were 71.58 ± 3.62, 78.96 ± 2.21, 83.97 ± 3.57, 87.92 ± 2.94, 94.83 ± 1.62 respectively. There were no significant differences between them. CONCLUSION: Owing to less muscles interrupted, the THA with improved Gibson anterolateral approach offers a better improvement in earlier hip abductor strength and abduction angle compared with the conventional surgery.

[Reversed sural neurovascular fasciocutaneous flap for reconstruction of soft tissue defects of lower limbs].

OBJECTIVE: To investigate the clinical application of the reversed sural neurovascular fasciocutaneous flap. METHODS: From January 2007 to May 2009,10 patients (6 males and 4 females) with soft tissue defects on lower limbs were treated by reversed sural neurovascular fasciocutaneous flap. The end-to-side neuroanastomosis were used to reinnervate the flap and microsurgery was used for anastomosing small saphenous vein. The age ranged from 16 to 55 years (mean, 32 years). There were 6 patient with soft tissue defects on foot, 2 patients with exposed bone after operation, 2 patients with chronic ulcer on limb. The patients were evaluated with appearance, blood supply, texture and 2-PD of the flaps. RESULTS: All the patients were followed for 6 to 24 months (mean, 15 months). The flaps in all 10 patients survived completely. The appearance, blood supply and texture of the flaps were excellent and 2-PD was 9 to 12 mm. CONCLUSION: This flap has sufficient blood supply and high survival rate. It also effectively retains the feeling of dorsolateral heeland improved quality of life.

[Influence of pedicle screws with different insertion depth on neighboring uninfused segments in a goat lumbar spinal fusion model].

OBJECTIVE: To observe the influences of pedicle screws in various insertion depth on the adjacent segment disc degeneration following lumbar spinal fusion. To explore the relationship between the internal fixation rigidity and incidence of adjacent segment disease. METHODS: Sixteen hybrid male Bohr goats of 10 months old, weighting between 25 and 30 kg, were randomly devided into a control group (N group), and 3 experimental groups, each group had 4 goats. The L4 vertebra of each goat in the experimental groups was fractured, L3-L5 segments were internal fixed with pedicle screws followed by intervertebral joint fusion by a posterior approach. Three experimental groups were devided according to the length of pedicle screws applied, vertebras of goats in L group were internal fixed by the screws at the length of 25 mm, for M group and S group, 20 mm and 15 mm, accordingly. The goats in the control group were treated without any operation. Biomechanical changes and MRI index of upper unfused segment (L2) were measured 24 weeks after operation, and histological changes were observed as well. RESULTS: The pressure and straining of L2 vertebral body and intervertebral disc of L group increased more than N group (P < 0.05), and degenerated cell counting in nucleus pulposus increased as well (P < 0.05). However, MRI index remain unchanged (P > 0.05). CONCLUSIONS: Rigid internal fixation increases the pressure and straining of vertebral body and intervertebral disc of upper adjacent segment, accelerating the degeneration process following lumbar spinal fusion in goats.

[Surgical treatment of tibia plateau fractures with external fixator and the locking plate].

OBJECTIVE: To observe the clinical effect of the treatment for complex fractures of the tibial plateau through the application of the external fixator and the locking plate. METHODS: From Feb. 2006 to Oct. 2008,12 patients with tibial plateau fractures were treated with external fixator and locking plate included 8 males and 4 females with an average age of 38 years ranging from 23 to 59. According to Schatzker type, 7 cases were type V and 5 cases were type VI. Using an anteromedial incision and an anterolateral approach, the locking plate were fixed in the tibia lateral. The collapse and height lossing of tibial plateau was observed through X-ray film before and after operation. The function of knee joint was evaluated according to HSS scoring. RESULTS: These patients were followed up for 4 to 18 months (means 9.79 months). Eleven cases had bone primary union,and 1 delayed union. No deep phlebothrombosis and osteofascial compartment syndrome occurened. The average healing time was 3.1 months. Between the preoperative and postoperative X-ray film there were no second stage depression fracture of the tibial plateau,postoperative reduction loss and bad alignment. The range of knee flexion was 90 degrees to 110 degrees. The HSS knee functional scoring was(75.50 +/- 10.01)scores after operation and (21.50 +/- 11.68) scores before operation. CONCLUSION: The treatment with the external fixator and the locking plate for complex fractures of the tibial plateau could provid continuous stability of fixation,prevent the fracture from second stage displacement and the knee force line change, protect the soft-tissue around the knee, reduce the postoperative complications. The knee joint function is satisfied.