The surgical installation accuracy of the components in unicompartmental knee arthroplasty (UKA) is an important factor affecting the joint function and the implant life. Taking the ratio of the medial-lateral position of the femoral component relative to the tibial insert (a/A) as a parameter, and considering nine installation conditions of the femoral component, this study established the musculoskeletal multibody dynamics models of UKA to simulate the patients’ walking gait, and investigated the influences of the medial-lateral installation positions of the femoral component in UKA on the contact force, joint motion and ligament force of the knee joint. The results showed that, with the increase of a/A ratio, the medial contact force of the UKA implant was decreased and the lateral contact force of the cartilage was increased; the varus rotation, external rotation and posterior translation of the knee joint were increased; and the anterior cruciate ligament force, posterior cruciate ligament force and medial collateral ligament force were decreased. The medial-lateral installation positions of the femoral component in UKA had little effect on knee flexion-extension movement and lateral collateral ligament force. When the a/A ratio was less than or equalled to 0.375, the femoral component collided with the tibia. In order to prevent the overload on the medial implant and lateral cartilage, the excessive ligament force, and the collision between the femoral component and the tibia, it is suggested that the a/A ratio should be controlled within the range of 0.427?0.688 when the femoral component is installed in UKA. This study provides a reference for the accurate installation of the femoral component in UKA.
OBJECTIVE To review the physiological function of sodium hyaluronate in joints and its clinical applications. METHODS Many literatures were reviewed and analysed on therapeutic mechanism and the application foreground of sodium hyaluronate. RESULTS Extrinsic sodium hyaluronate plays an important role in improving synovial fluid and protecting cartilages as well as suppressing inflammation, so it is used in the treatment of joint diseases such as knee osteoarthritis, rheumatoid arthritis or temporomandibular osteoarthritis. CONCLUSION Sodium hyaluronate possesses a good applied prospect in joint diseases.
ObjectiveTo establish a sound management system for day surgery under the Joint Commission International (JCI) standard.MethodsFrom 2013, according to the provisions of JCI standard, a sound management system was established in the Second Affiliated Hospital of Zhejiang University School of Medicine by establishing the organizational structure of day surgery management, standardizing the operation process of day surgery, formulating standard operating rules and regulations, clarifying work responsibilities, strengthening the supervision of medical quality indicators at both hospital and department levels, and providing guidance for continuous performance.ResultsThe number of day operations in the hospital increased gradually, accounting for 25% of elective operations. During this period, there was no death of the patient, and these indexes remained low: the reservation cancellation rate of the patient was 0.9%, the transfer hospitalization rate was 0.23%, the unplanned reoperation rate was 0.012%, and the postoperative serious complications (bleeding, wound opening, etc.) was 0.03%.ConclusionThe establishment of day surgery management system under the JCI standard can standardize the development of day surgery and ensure the safety of patients.
ObjectiveTo introduce the surgery method to reset and fix tibial plateau fracture without opening joint capsule, and evaluate the safety and effectiveness of this method.
MethodsBetween July 2011 and July 2013, 51 patients with tibial plateau fracture accorded with the inclusion criteria were included. All of 51 patients, 17 cases underwent open reduction and internal fixation without opening joint capsule in trial group, and 34 cases underwent traditional surgery method in control group. There was no significant difference in gender, age, cause of injury, time from injury to admission, side of injury, and types of fracture between 2 groups (P>0.05). The operation time, intraoperative blood loss, incision length, incision heal ing, and fracture healing were compared between 2 groups. The tibial-femoral angle and collapse of joint surface were measured on X-ray film. At last follow-up, joint function was evaluated with Hospital for Special Surgery (HSS) knee function scale.
ResultsThe intraoperative blood loss in trial group was significantly less than that in control group (P<0.05). The incision length in trial group was significantly shorter than that in control group (P<0.05). Difference was not significant in operation time and the rate of incision heal ing between 2 groups (P>0.05). The patients were followed up 12-30 months (mean, 20.4 months) in trial group and 12-31 months (mean, 18.2 months) in control group. X-ray films indicated that all cases in 2 groups obtained fracture heal ing; there was no significant difference in the fracture healing time between 2 groups (t=1.382, P=0.173). On X-ray films, difference was not significant in tibial-femoral angle and collapse of joint surface between 2 groups (P>0.05). HSS score of the knee in trial group was significantly higher than that of control group (t=3.161, P=0.003).
ConclusionIt can reduce the intraoperative blood loss and shorten the incision length to use open reduction and internal fixation without opening joint capsule for tibial plateau fracture. Traction of joint capsule is helpful in the reduction and good recovery of joint surface collapse. In addition, the surgery without opening joint capsule can avoid joint stiffness and obtain better joint function.
Objective To explore the nursing quality standards of joint surgery based on “structure-process-outcome” three-dimensional quality evaluation model, and provide a reference for improving the quality of joint surgery nursing. Methods From March to July 2023, based on the “structure-process-outcome” three-dimensional quality structure model as the theoretical framework, combined with systematic literature review and semi-structured interviews, the quality standards of joint surgery specialist nursing were preliminarily formulated. The Delphi method was used for screening, demonstration, and correction, then the analytic hierarchy process was used to determine the weights. Results The recovery rates of the two rounds of expert letter consultation were 93.75% and 100.00%, respectively. The expert authority coefficients of both rounds were 0.95. The positive coefficients of experts in the two rounds were 0.93 and 1.00, respectively. The coefficients of variation after the second round of correspondence were 0-0.20. In the second round of correspondence inquiry, the Kendall harmony coefficients of primary standards, secondary standards and tertiary standards were 0.156, 0.115 and 0.285, respectively, with statistical significance (P<0.05). Finally, the quality standards of joint specialty nursing included 3 primary standards, 23 secondary standards and 99 tertiary standards. Conclusion The construction process of nursing quality standards of joint surgery specialty based on “structure-process-outcome” three-dimensional quality structure model is scientific and reliable, the index evaluation results are less volatile, and the opinions are concentrated, which can provide a basis for comprehensively, accurately and pertinently improving the quality of joint surgery specialty nursing.
【Abstract】 Objective To evaluate the early result of tri ple Endobutton technique for reconstructing coracoclavicularligament of chronic complete acromioclavicular joint dislocations. Methods Between January 2009 and June 2010, 14 patients with chronic complete acromioclavicular joint dislocations were treated with tri ple Endobutton technique for reconstructing coracoclavicular ligament. There were 10 males and 4 females with a mean age of 38.5 years (range,26-52 years). Injury was caused by traffic accident in 7 cases,by falling in 5 cases，and by bruise in 2 cases. The average time was 47 days from injury to the operation (range,29-75 days). All patients had pain and activity restriction. The X-ray films showed complete dislocation of acromioclavicular joint. According to Allman’s type, all cases were classified as III degree complete dislocations. Results At postoperation, wound healed by first intention with no early complication of infection or neurovascular injury. All patients were followed up 18.3 months on average (range,13-30 months). Acromioclavicular joint subluxation occurred in 1 patient at 1 week after operation, and no redislocation or other complication occurred in the other patients. American Shoulder and Elbow Surgeons (ASES) score was 90.8 ± 4.1 at last follow-up, showing significant difference when compared with the preoperative score (65.3 ± 4.4) (t= —17.57，P=0.00); Constant-Murley score was 91.7 ± 3.9, showing significant difference when compared with preoperative one (71.5 ± 4.6) (t=—75.02，P=0.00). The definite answer in Simple Shoulder Test (SST) averaged 9.7 (range,7-12). Conclusion The tri ple Endobutton technique for reconstructing coracoclavicular ligament is an effective method in treatment of chronic complete acromioclavicular joint dislocations. The short-term results are satisfactory.
ObjectiveTo investigate the cl inical characteristics, diagnosis, and treatment of metacarpophalangeal (MCP) joint locking with extension lag.
MethodsBetween February 2009 and April 2014, 17 patients (17 fingers) with MCP joint locking with extension lag were treated. The patients included 4 males and 13 females, and the average age was 40.7 years (range, 20-72 years). The index finger was locked in 12 cases and the middle finger in 5 cases. All patients could not fully extend the MCP joint at about 30° flexion without flexion limitation of the interphalangeal joint. The range of motion (ROM) of the MCP joint was (41.2±5.1)°. The visual analogue scale (VAS) score was 2.7±0.5. X-ray and CT scanning showed that there was a bony prominence on radial condyle of the metacarpal head in 15 primary patients, and a hook like osteophyte on ulnar condyle in 2 degenerative patients. All patients were treated with close reduction first, and open reduction was conducted when the manipulation failed.
ResultsSuccessful close reduction was achieved in 5 cases, and successful open reduction in 8 cases; 4 cases gave up treatment after failure for close reduction. All patients who achieved successful reduction were followed up 2.3 years on average (range, 6 months to 5 years and 2 months). The ROM of the MCP joint was increased to (80.4±6.6)° at last follow-up, showing significant difference when compared with ROM before reduction (t=-19.46, P=0.00). The VAS score decreased to 0.2±0.4 at last follow-up, also showing significant difference when compared with score before reduction (t=13.44, P=0.00).
ConclusionAccessory collateral ligament caught at the bony prominence on the radial condyle of the metacarpal head is the most common cause of the MCP joint locking with extension lag. Close reduction is feasible, but recurrence of locking is possible. Surgical treatment is advised in the event of manipulation failure or recurrent locking.
Objective To discuss the clinical application of preserving femoral neck in total hip arthroplasty and to analyze the early stage results.Methods From January 1999 to June 2001, 12 patients underwent total hip arthroplasty with preservation of femoral neck. We cut off the femoral head in infra-head position with improved Moore micro-incisions to reserve intact neck of femur. Thensuitable size of extra cup was selected and placed at 55° eversion angle. The internal cup, made from ultra high polymer poly thene and with ultra radius design, was placed at 45°eversion angle. Harris scores were recorded before operation, after operation and during the follow-up. During the follow-up, the X-rayfilms were taken to assess position, loosening of the prosthesis and ectopic ossification.Results All 12 patients were followed up 2-4.5years with an average of 3.1 years. The mean Harris score of hip elevated from 54 scores before operation to 92 scores of the last follow-up. Mild ectopic ossification occurred in 3 cases. There was no prosthesis loosening and femoral prosthesis setting, and only onepatient had mild bone absorption around femoral prosthesis.Conclusion Total hip arthroplasty with femoral neck preservation is a good option for the patients who need total hip arthroplasty for variable reasons, which is indicated for the patients whose femoral neck is intact with no osteoporosis.
【Abstract】 Objective To investigate the protective effect of early motion on articular cartilage after joint allograft by performing a controlled trial between different post-operation strategies after joint allograft in an animal model. Methods Twenty hemi-knee joints were harvested from 10 6-month-old New Zealand white rabbits (male or female, weighing 2.5-3.0 kg); 10 hemi-knee joints by deep frozen treatment (donors) were transplanted to unilateral knee joints (recipients) of 10 6-month-old Chinchilla rabbits (male or female, weighing 2.5-3.0 kg), which were divided into early motion group (n=5) and sustained fixation group (n=5); and 10 hemi-knee joints were used as blank control (n=5) and frozen control (n=5). The articular cartilage of allogenic joints was detected by X-ray film, gross, and histology at 6 weeks after operation. Results Gross observation: no obvious limitation of joint movements was observed in early motion group, but obvious limitation in sustained fixation group. X-ray films: the bone ends between donor and recipient healed well with good paraposition and alignment on the operation day and 2 weeks after operation; at 6 weeks, angulation deformity was observed in early motion group of 3 rabbits, and paraposition and alignment were satisfactory in sustained fixation group. Histological observation: HE staining showed that the chondrocytes had normal quantity and morphology with few nuclear fragmentation and karyolysis in early motion group, but the quantity of chondrocytes sharply decreased with dissolved nuclei and numerous fibrous tissues in the cartilage matrix in sustained fixation group. The cell survival rate of the early motion group (49.66% ± 2.15%) was significantly higher than that of the sustained fixation group (20.68% ± 1.24%) (P lt; 0.05). Scanning electron microscopy observation: nuclear membrane was intact with chromatin condensation and edema of mitochondria and rough surfaced endoplasmic reticulum in early motion group, and that the membrane of chondrocyte vanished with blurring border between chondrocyte and matrix, rupture of nuclear membrane and the disappearance of chromatin and organelles could be found in sustained fixation group. Conclusion Early motion has protective effect on articular cartilage after joint allograft, but cannot completely prevent degeneration of the allogenic articular cartilage.
OBJECTIVE To study the clinical effect of chitosan on prevention of elbow adhesion after elbow arthrolysis. METHODS Twenty six patients with elbow ankylosis were performed elbow arthrolysis, which divided into two groups, in chitosan group, 12 patients were injected 2% chitosan into the elbow joint cavity, and no chitosan used in the other 14 patients as control group. The average range of extension and flexion of elbow joint was detected to evaluate the clinical results. RESULTS All patients were followed up 8 to 51 months, averaged 24 months. In the chitosan group, the average range of extension and flexion of elbow joint was restored to 92.9 degrees +/- 20.9 degrees, with an average increase of 55.0 degrees +/- 15.9 degrees compared with preoperation. In the control group, the average range of extension and flexion of elbow joint was restored to 75.4 degrees +/- 17.5 degrees, with an average increase of 38.2 degrees +/- 11.9 degrees. The outcome showed significant difference between the chitosan group and the control group (P lt; 0.01). CONCLUSION Chitosan can prevent or reduce elbow adhesion after elbow arthrolysis.
