Objective To simulate anterosuperior instabil ity of the shoulder by a combination of massive irreparable rotator cuff tears and coracoacromial arch disruption in cadaveric specimens, use proximally based conjoined tendon transfer forcoracoacromial l igament (CAL) reconstruction to restrain against superior humeral subluxation, and investigate its feasibility and biomechanics property. Methods Nine donated male-adult and fresh-frozen cadaveric glenohumeral joints were applied to mimic a massive irreparable rotator cuff tear in each shoulder. The integrity of the rotator cuff tendons and morphology of the CAL were visually inspected in the course of specimen preparation. Cal ipers were used to measure the length of the CAL’s length of the medial and the lateral bands, the width of coracoid process and the acromion attachment, and the thickness in the middle, as well as the length, width and thickness of the conjoined tendon and the lateral half of the removed conjoined tendon. The glenohumeral joints were positioned in a combination of 30° extension, 0° abduction and 30° external rotation. The value of anterosuperior humeral head translation was measured after the appl ication of a 50 N axial compressive load to the humeral shaft under 4 sequential scenarios: intact CAL, subperiosteal CAL release, CAL anatomic reattachment, entire CAL excision after lateral half of the proximally based conjoined tendon transfer for CAL reconstruction. Results All specimens had an intact rotator cuff on gross inspection. CAL morphology revealed 1 Y-shaped, 4 quadrangular, and 4 broad l igaments. The length of the medial and lateral bands of the CAL was (28.91 ± 5.56) mm and (31.90 ± 4.21) mm, respectively; the width of coracoid process and acromion attachment of the CAL was (26.80 ± 10.24) mm and (15.86 ± 2.28) mm, respectively; and the thickness of middle part of the CAL was (1.61 ± 0.36) mm. The length, width, and thickness of the proximal part of the proximally based conjoined tendon was (84.91 ± 9.42), (19.74 ± 1.77), and (2.09 ± 0.45) mm, respectively. The length and width of the removed lateral half of the proximally conjoined tendon was (42.67 ± 3.10) mm and (9.89 ± 0.93) mm, respectively. The anterosuperior humeral head translation was intact CAL (8.13 ± 1.99) mm, subperiosteal CAL release (9.68 ± 1.97) mm, CAL anatomic reattachment (8.57 ± 1.97) mm, and the lateral half of the proximally conjoined tendon transfer for CAL reconstruction (8.59 ± 2.06) mm. A significant increase in anterosuperior migration was found after subperiosteal CAL release was compared with intact CAL (P lt; 0.05). The translation after CAL anatomic reattachment and lateral half of the proximally conjoined tendon transfer for CAL reconstruction increased over intact CAL, though no significance was found (P gt; 0.05); when they were compared with subperiosteal CAL release, the migration decreased significantly (P lt; 0.05). The translation of lateral half of the proximally conjoined tendon transfer for CAL reconstruction increased over CAL anatomic reattachment, but no significance was evident (P gt; 0.05). Conclusion The CAL should be preserved or reconstructed as far as possible during subacromial decompression, rotator cuff tears repair, and hemiarthroplasty for patients with massive rotator cuff deficiency. If preservation or the insertion reattachment after subperiosteal release from acromion of the CAL of the CAL is impossible, or CAL is entirely resected becauseof previous operation, the use of the lateral half of the proximally based conjoined tendon transfer for CAL reconstruction isfeasible.
Objective To investigate the relationship between the initial stabil ity and infected loosening of the total hip arthroplasty (THA) prosthesis. Methods From January 2000 to December 2008, 110 cases (110 hips) were treated with THA revision. Among them, 15 cases (15 hips) were confirmed infected loosening. There were 8 males and 7 females with anaverage age of 62 years (range 42-75 years). The infected signs were found from 6 months to 2 years after initial THA. All of them had Tsukayama type IV and late infection, including 6 cases of acetabular infected loosening (5 cases of one-stage and 1 case of two-stage acetabular revision), 7 cases of simple infected loosening of femoral prosthesis (4 cases of one-stage and 3 cases of twostage femoral prosthesis revision), and 2 cases of joint capsule infection and sinus without prosthesis loosening (debridement and continuous irrigation). Results All incisions healed by first intention. Fifteen patients were followed up for 12 to 36 months (average 24 months). In 13 cases of revision, postoperative X-ray films showed that femoral acetabular prostheses were in good position, and had no cl inical and imaging infective signs of loosening. In 2 cases of joint capsule infection, sinus recurred 6 months postoperation without hip joint pain, the function of weight-bearing and walking of hip joint was normal. Harris score increased from preoperative average of 42 to postoperative average of 85; the results were excellent in 4 cases, good in 7 cases, and fair in 4 cases. Conclusion The infection of THA may occur in the whole joint, half-joint or just in joint capsule. The initial stabil ity of the prosthesis would affect the long-term survival of the prothesis. If the prosthesis initial stabil ity is obtained, even if there are infective factors, infections would also be l imited.
Objective To analyze the main reasons of acetabular component initial instabil ity after primary total hip arthroplasty (THA) and to disscuss the prevention and management. Methods The cl inical data were retrospectively analyzed from 19 patients undergoing revision for acetabular component initial instabil ity after primary THA between January 2003 and June 2010. There were 11 males and 8 females, aged from 55 to 79 years (mean, 67.2 years). The locations were lefthip in 9 cases and right hip in 10 cases. The cementless hip prosthesis was used in 12 cases and cement hip rosthesis in 7 cases. The revisions were performed at 3 weeks to 6 months after primary THA. The reasons of early failure were analyzed. Both the coverage rate of acetabulum-bone and the Harris hip score were compared between pre- and post-revision. Results The main reason of acetabular component initial instabil ity after primary THA may be unsuitable treatment of acetabulum, improper selection of acetabular component, and incorrect place angle of acetabular component. Sciatic nerve palsy occurred in 1 case and recovered at 7 weeks after revision. Sl ight fracture of the acetabulum in 1 case and healed at 3 months after revision. All incisions healed by first intention. No infection, vessel injury, displacement of acetabular component, or deep vein thrombosis occurred. The patients were followed up 11-73 months (mean, 28 months). At last follow-up, no acetabular component instabil ity was observed. The coverage rate of acetabulum-bone was increased from 67.9% ± 5.5% before revision to 87.7% ± 5.2% after revision, showing significant difference (t=11.592，P=0.003). The Harris hip score at last follow-up (84.4 ± 4.6) was significantly higher than that at pre-revision (56.5 ± 9.3) (t=11.380，P=0.005). Conclusion Detailed surgical plan, proper choice of component, correct place angle and elaborative planning, and proficient surgical skill are necessary to achieve the initial stability of acetabular component in THA．
Objective To explore the techenique of fusing the reconstructed titanic plate, the C2 pedical screws, and the autogenous granulated cancellous bone graft in the occipitocervical region. Methods From April 2002 to January 2005, 19 patients aged 31-67 years with occipitocervical instability underwent the occipitocervical fusion using the reconstructed plate, C2 pedical screws, and autogenous granulated cancellous bone graft. Of the patients, 8 had complex occipitocervical deformity，8 had old atlantoaxial fracture and dislocation，2 had rheumatoid arthritis and anterior dislocation of the atlantoaxial joint, and 1 had cancer of the dentoid process of the axis． Results No complication occurred during and after operation．The follow-up for an average of 16 months in 19 patients showed that all the patients achieved solid bony fusion in the occipitocervical region．There was no broken plate, broken screw, looseness of the internal fixation or neurovascular injury. Conclusion The fixation of the C2 pedical screws with the reconstructed titanic plate is reliable, the insertion is easy, and the autogenous granulated cancellous bone graft has a high fusion rate, thus resulting in a satisfactory effect in the occipitocervical fusion.
It will cause hidden trouble on clinical application if the uroflowmeter is out of control. This paper introduces a scheme of uroflowmeter calibration device based on digital signal processor (DSP) and gear pump and shows studies of its feasibility. According to the research plan, we analyzed its stability, repeatability and linearity by building a testing system and carried out experiments on it. The flow test system is composed of DSP, gear pump and other components. The test results showed that the system could produce a stable water flow with high precision of repeated measurement and different flow rate. The test system can calibrate the urine flow rate well within the range of 9~50 mL/s which has clinical significance, and the flow error is less than 1%, which meets the technical requirements of the calibration apparatus. The research scheme of uroflowmeter calibration device on DSP and gear pump is feasible.
The shoulder joint is the most prone to dislocation in the whole body, and more than 95% of them are anterior dislocation. Improper treatment after the initial dislocation is easy to lead to recurrent anterior dislocation or anterior shoulder instability, and the outcomes following conservative treatment is poor. Anterior shoulder instability can damage the soft tissue structure and bone structure that maintain the stability of shoulder joint, among which bone structure is the most important factor affecting the stability of shoulder joint. Diagnosis should be combined with medical history, physical examination, and auxiliary examination. Currently, three-dimensional CT is the most commonly used auxiliary examination means. However, various bone defect measurement and preoperative evaluation methods based on three-dimensional CT and the glenoid track theory have their own advantages and disadvantages, and there is still a lack of gold standard. Currently, the mainstream treatment methods mainly include Bankart procedure, coracoid process transposition, glenoid reconstruction with free bone graft, Bankart combined with Remplissage procedure, and subscapular tendon binding tamponade, etc. Each of these procedures has its own advantages and disadvantages. For the diagnosis and treatment of anterior shoulder instability, there are still too many unknown, further research and exploration need to be studied.
OBJECTIVE: To observe the early clinical results with degenerative lumbar instability treated with transpedical screw fixation and intertransverse process autogenous bone grafting. METHODS: From September 2000 to February 2002, 19 patients (5 males and 14 females) of degenerative lumbar spine instability were treated with decompression for spinal canal stenosis, transpedical screw fixation and intertransverse process autogenous bone grafting. The locations of degenerative lumbar spine instability were between L4 and L5 in 10 patients, between L3, L4 and L5 in 4 cases, between L3 and L4 in 3 cases, between L5 and S1 in 2 cases. The results were evaluated after operation. The preoperative clinical symptoms disappeared completely as excellent results, relieved obviously as good results, improved as fair results and unrelieved or worsened as poor results. RESULTS: Seventeen patients were followed up for 4-18 months with an average of 8.1 months. The results of the treatment were excellent in 12 patients, good in 4 patients and fair in 1 patient. The excellent and good rate was 94.1%. Intertransverse process arthrodesis was obtained after 6 months of operation in all cases. No loosened and broken instruments occurred. CONCLUSION: The advantages of degenerative lumbar spine instability treated with transpedical screw fixation and intertransverse are reliable fixation, high successful rate of fusion and less influence on spinal canal. The above results show satisfactory clinical outcome.
ObjectiveTo explore the effects of core stable training on cervical vertebrae pain, cervical function and balance ability in patients with neck type cervical spondylopathy (NTCS).MethodsFrom January to August 2018, 98 patients with NTCS were treated. According to the odd and even bed numbers, 49 patients were enrolled in the observation group and 49 were in the control group. The patients in the control group was given Kinesio tape treatment, and the observation group was given core stability training based on the treatment of the control group. Cervical vertebrae pain was assessed by Visual Analogue Scale (VAS), Clinical Assessment Scale for Cervical Spondylosis (CASCS) and Neck Disability Index (NDI); cervical vertebra activity were used to assess the cervical; the Berg Balance Scale (BBS) was used to assess patients’ balance before intervention and at the 4th week of intervention. The incidence of complications during the intervention and the effective of treatment 4 weeks after intervention were recorded. The recurrence rate 6 months after the intervention was recorded.ResultsThere were no significant difference in CASCS, NDI, VAS, and BBS scores between the two groups before intervention (P>0.05). At the 4th week of the intervention, the CASCS and BBS scores of the two groups were higher than those before the intervention, and the VAS and NDI scores were lower than those before the intervention (P<0.05); and the CASCS and BBS scores in observation group at the 4th week of the intervention were higher than that of control group, and VAS and NDI scores were lower than those of the control group (P<0.05). There was no significant difference in the activity of the cervical vertebrae before intervention in both of the two groups (P>0.05). At the 4th week of the intervention, the activity of the cervical vertebrae in all directions was bigger than that of before the intervention in both of the two groups (P<0.05), and that in observation group were bigger than that of the control group (P<0.05). The effective rate at the 4th week in the observation group (95.92%) was higher than that in the control group (81.83%)(P<0.05). The recurrence rate 6 months after intervention in the observation group (6.38%) was lower than that in the control group (22.50%) (P<0.05).ConclusionCore stability training can relieve cervical spondylosis in NTCS patients, and improve the cervical function and patients’ balance; it has high safety and stable efficacy.
Objective
To evaluate the effectiveness of posterior unilateral pedicle screw fixation plus lumbar interbody fusion in treatment of degenerative lumbar instability.
Methods
Between February 2008 and December 2011, 33 patients with degenerative lumbar instability were treated with posterior unilateral pedicle screw fixation plus lumbar interbody fusion, including 14 cases of lumbar disc protrusion with instability, 15 cases of lumbar spinal stenosis with instability, 3 recurrent cases of lumbar disc protrusion at 1 year after discectomy, and 1 case of extreme lateral lumbar disc protrusion. There were 20 males and 13 females with an average age of 47.2 years (range, 39-75 years). The average disease duration was 12.8 months (range, 6-25 months). Single-segment-fixation was performed in 28 cases (L4, 5 in 21 cases, L5, S1 in 6 cases, and L5, 6 in 1 case), and double-segment-fixation was performed in 5 cases (L3, 4 and L4, 5). The clinical results were evaluated by using Oswestry disability index (ODI) and modified Japanese Orthopaedic Association (JOA) score for low back pain.
Results
Infection occurred in 1 case, and was cured after dressing change; primary healing was obtained in the other patients. Thirty-one patients were followed up 32.3 months on average (range, 15-53 months). Cage displacement occurred in 1 case who received bilateral pedicle screw fixation plus lumbar interbody fusion; no screw breaking, Cage displacement, or pseudoarthrosis was observed in the others. X-ray films showed bone fusion in the other patients except 1 case of bone fusion failure. ODI and JOA score at last follow-up were significantly improved when compared with the ones before operation and at 2 weeks after operation (P lt; 0.05); the improvement rates were 74.0% ± 10.1% and 83.6% ± 9.4%, respectively.
Conclusion
Posterior unilateral pedicle screw fixation plus lumbar interbody fusion is an effective and reliable method for patients with degenerative lumbar instability because it has the advantages of simple operation and less trauma.
ObjectiveTo review the research progress of cementless intercalary prosthesis stem. MethodsThe literature about the cementless intercalary prosthesis in treatment of bone defects of extremities was reviewed, and the designing and application of prosthesis stem were analyzed. ResultsCementless intercalary prosthesis has the advantages of good biocompatibility. However, there are also some disadvantages, including the multiple factors affecting the fixation of the prosthesis stem and individual differences in the stability of the prosthesis. The methods to improve the fixation stability of prosthesis stem mainly include the optimization of prosthesis stem shape, addition of auxiliary fixation, and improvement of coating materials on the stem surface as well as porous structure of the stem surface. Among these methods, augment with auxiliary fixation has the most satisfactory effect on improving the stability of prosthesis. However, the deficiency of the method is the increasing risk of the larger incision exposure and surgical trauma. ConclusionImproving the design and fixation method of the cementless intercalary prosthesis stem can further improve the stability of the prosthesis. Under the premise of avoiding increasing surgical trauma as much as possible, addition of the auxiliary fixation can be a feasible choice to improve the fixation stability of prosthesis.
