Objective To investigate the advantages and the clinical outcomes of the treatment of comminuted inferior femoral fractures with combination of supracondylar locked intramedullary nail and shape memory block hoop internal fixator under arthroscopy. Methods From June 2002 to December 2004, 12 cases of comminuted inferior femoral fractures were treated(9 males, 3 females). Of them, 5 cases were classified as type B and 7 cases as type C according to AO classification . All cases were treated with combination of supracondylar locked intramedullary nail and shape memory block hoop internal fixator under arthroscopy. In 12 cases of one-stage bone grafting, there 5 of autologous cancellous bone grafting and 7 allo-freeze drying bone grafting.Results With a follow-up of 6 to 18 months, all fractures healed within 3 to 6 months. There were no infection and nonunion. The function of all the knees joint was excellent. According to Noye’s criterion for knee scoring, the results were excellent in 9 cases and good in 3 cases; the excellent and good rate was 100%. Conclusion It is a good method to treat comminuted inferior femoral fractures with combination of supracondylar locked intramedullary nail and shape memory block hoop internal fixator under arthroscopy. It has many advantages of less injury to knee joint, good anatomic reduction and reliable fixation.
Objective To compare the effectiveness of arthroscopy assisted percutaneous internal fixation and open reduction and internal fixation for Schatzker types II and III tibial plateau fractures. Methods Between August 2006 and April 2010, 58 patients with tibial plateau fractures of Schatzker types II and III were treated with arthroscopy assisted percutaneous internal fixation (arthroscopy group, n=38), and with open reduction and internal fixation (control group, n=20). There was no significant difference in gender, age, disease duration, fracture type, and compl ication between 2 groups (P gt; 0.05). The operation time, incision length, fracture heal ing time, and compl ications were compared between 2 groups. Knee function score and the range of motion were measured according to American Hospital for Special Surgery (HSS) scorestandard. Results All patients achieved primary incision heal ing. The arthroscopy group had smaller incision length andlonger operation time than the control group, showing significant differences (P lt; 0.05). The patients of 2 groups were followed up 12 to 14 months. At 6 months, the HSS score and the range of motion of the arthroscopy group were significantly greater than those of the control group (P lt; 0.05). The X-ray films showed bony union in 2 groups. The fracture heal ing time of the arthroscopy group was shorter than that of the control group, but no significant difference was found (t=2.14, P=0.41). Morning stiffness occurred in 2 cases (5.3%) of the arthroscopy group, joint pain in 6 cases (30.0%) of the control group (3 cases had joint stiffness) at 1 week, which were cured after symptomatic treatment. There was significant difference in the incidence of compl ications between 2 groups (χ2=6.743, P=0.016). Conclusion The arthroscopy assisted percutaneous internal fixation is better than open reduction and internal fixation in the treatment of tibial plateau fractures of Schatzker types II and III, because it has smaller incision length and shorter fracture heal ing time.
Objective To evaluate the results of rotational acetabular osteotomy (RAO) combined with debridement under arthroscope in the treatment of adult developmental dysplasia of the hip (DDH). Methods Between April 2002 and August 2007, 24 cases (29 hips) of DDH were treated with RAO combined with debridement under arthroscope. There were 2 males (2 hips) and 22 females (27 hips) with an average age of 37.7 years (range, 21-50 years). The locations were the left hip in 7 cases, the right hip in 12 cases, and both hips in 5 cases. The course of hip pain was 8-216 months (median, 30.5 months). According to Crowe DDH classification, there were 24 hips of type I and 5 hips of type II. According to Touml;nnis hip osteoarthritis classification, there were 20 hips of stage I and 9 hips of stage II. Results The mean operation time was 150 minutes (range, 120-180 minutes); the mean intraoperative blood loss was 600 mL (range, 500-700 mL); and the mean postoperative drainage volume was 200 mL(range, 50-400 mL). All incisions healed by first intention. Twenty-four cases were followed up 4.5 years on average (range, 3-8 years). At last follow-up, claudication disappeared in 16 hips and was improved in 8 hips. The Harris hip score was improved from 79.4 ± 9.8 preoperatively to 95.1 ± 8.6 postoperatively, showing significant difference (t=2.467, P=0.010). The visual analogue scale (VAS) score was improved from 5.1 ± 0.8 preoperatively to 1.1 ± 0.6 postoperatively, showing significant difference (t=2.118, P=0.011). The X-rayfilms showed union was achieved at 12-16 weeks (mean, 13.5 weeks). There were significant differences in the centre edge angle, Sharp angle, acetabular coverage rate, and acetabulum-head index between preoperation and postoperation (P lt; 0.05). Twenty hips at Touml;nnis stage I maintained after operation, among 9 hips at Touml;nnis stage II, 5 hips was improved to stage I and 4 hips maintained. Conclusion It has a satisfactory result to treat adult DDH by RAO combined with debridement under arthroscope, which may increase the congruency of hip joint, delay or prevent the progression of hip osteoarthritis.
Objective To explore the methods of repairing cartilagedefects and to introduce the clinical experience with the autologous osteochondral transplantation. Methods Twenty-five patients with chondral and osteochondral defects of the weight-bearing surfaces were treated by the autologous osteochondral transplantation for the repair of the chondral and osteochondral defects of the unweightbearing surfaces under arthroscope. According to the shape of the defects, the different dimensions of the osteochondral autograft were selected. All the patients began the training of the continuous passive motion after operation. Six weeks after operation, the patients began to walk in the weightbearing habitus. However, in the control group, another 25 patients were retrospectively analyzed, who had chondral and osteochondral defects of the weight-bearing surfaces but were treated only by the cleaning and drilling procedures. The scores evaluated bythe Brittberg-Peterson scoring scale of the 2 group were 98.65±9.87 and 96.98±8.94 respectively. Results The follow-upfor 3-24 months after operation revealed that the treated knee joint had a goodmotion extent. The pain was obviously alleviated. Based on the longitudinal study with the three-dimensional spoiled magnetic resonance imaging (MRI), the signal intensity of the repaired tissues approached to the normal condition. The scores evaluated by the Brittberg-Peterson scoring scale were almost zero 3 monthsafter operation in the experimental group, and the scores were 58.48±6.98 inthe control group. There were significant differences between the experimental group and the control group(P＜0.01). Conclusion Autologous osteochondral transplanation under arthroscope is a good curative method for the cartilage defects, with advantages of minimal invasiveness and avoidanceofrejections resulting from allografts. However, its long-term effect needs to befurther studied. The conventional therapies including cleaning and drilling are useful in alleviating the symptoms.
Objective To explore the diagnosis and treatment of anterior cruciate l igament (ACL) cysts of the knees. Methods The cl inical data were retrospectively analysed from 13 patients with ACL cysts between December 2000 and August 2007. The patients included 7 males and 6 females with an average age of 46.3 years (range, 32-55 years). The locationswere the left knee in 6 cases and the right knee in 7 cases. Seven cases had an obvious history of trauma, 4 cases had a history of chronic injury, and 2 cases had no obvious incentive factor. The disease duration was from 6 to 29 months (mean, 20 months). Anterior drawer test was positive in 1 case, pivot shift test was positive in 1 case, and McMurray test was positive in 3 cases. Six cases were preoperatively diagnosed by MRI. The cysts located near the tibial insertion in 6 cases, between the ACL and the posterior cruciate l igament in 3 cases, and near the femoral attachment in 4 cases. All cysts were arthroscopically resected and had the pathohistological examination. Results The pathohistological examination showed mucoid degeneration of collagen and connective tissues, and the diagnosis result was ACL cyst. All incisions healed by first intention, and no compl ication occurred. Thirteen patients were followed up 2 to 5 years (mean, 2 years and 6 months). The symptoms of arthralgia, swell ing, and interlocking of the affected knees disappeared. At 24 months postoperatively, the anterior drawer test was positive in 1 case, the pivot shift test was positive in 1 case, and McMurray test was positive in 4 cases. There was no recurrence during the follow-up. There were significant differences in the range of motion and Lysholm score between pre- and post-operation (P lt; 0.01). Conclusion ACL cysts may be indicated by simple knee pain, especially when accompanied by l imitation of joint motion without imaging evidence of osteoarthritis. The MRI finding is very important in the diagnosis of ACL cysts, and arthroscopic resection and debridement is the first choice in the treatment of ACL cysts.
ObjectiveTo evaluate the technique and the effectiveness of arthroscopic fixation with percutaneous cannulated screws for acute displaced isolated greater tuberosity fractures of the proximal humerus. MethodsA retrospective analysis was made on the clinical data of 15 patients with acute displaced isolated greater tuberosity fractures of the proximal humerus, who accepted arthroscopic percutaneous cannulated screw fixation treatment between January 2010 and February 2013. There were 8 males and 7 females with an average age of 44.9 years (range, 31-66 years). Eight left shoulders and 7 right shoulders were affected. The mean interval of injury and operation was 9.9 days (range, 4-19 days). Before operation, the average range of motion (ROM) values of the affected shoulder were (74.13±17.19)° in forward flexion, (121.67±17.50)° in abduction, (T11±2)° in internal rotation, and (39.27±8.08)° in external rotation; the visual analogue scale (VAS) score was 6.46±1.30; and Costant score was 62.27±11.90. ResultsOperations were all successfully completed and incision healed by first intention in all cases. All cases were followed up 12-27 months (mean, 15 months). Postoperative X-ray films showed good reduction, alignment, and union of fracture. The average fracture healing time was 8 weeks (range, 6-13 weeks). At last follow-up, the ROM of the affected shoulder were significantly improved to (169.33±7.99)° in forward flexion, (156.67±10.47)° in abduction, (T6±2)° in internal rotation, and (71.67±7.94)° in external rotation (P<0.05); the VAS score was significantly reduced to 1.73±1.02 (t=-8.51, P=0.00); and the Costant score was significantly increased to 96.20±2.34 (t=11.50, P=0.00). No complication was found, such as neural or vascular injury, infection, shoulder joint adhesion, fixation failure, or fracture displacement. ConclusionArthroscopic fixation with percutaneous cannulated screws is a safe method to treat acute displaced isolated greater tuberosity fractures of the proximal humerus, and it has good short-term effectiveness with the advantages of little trauma and satisfactory functional recovery.
OBJECTIVE To investigate the effects of intra-articular injection of sodium hyaluronate in post-operation treatment of the knee. METHODS From January 1998 to February 2001, 4 ml of sodium hyaluronate injection was injected into the knee joint of the 134 cases at the end of arthroscope operation, or the 91 cases undergoing open operation of the knee at the time when the drain tube was removed (treatment group). Five days after operation, the hydrarthrosis was removed and 2 ml of sodium hyaluronate was injected into the knee joint. According to the patient’s condition, injection of sodium hyaluronate was performed once a week for several weeks. Clinical evaluation was made by evaluating pain visual analog scale (VAS) and painless range of movement (ROM) of the joint at every definite point of time. The 85 patients in control group used nothing at the same time. RESULTS The VAS score of patients in the treatment group was significant lower than that of the control group. The period to the maximal painless ROM of the joint was 6 days in the treatment group after open operation, while 9 days in the control group. CONCLUSION Sodium hyaluronate appears effective in relieving post-operation pain of the knee joint.
Objective To investigate the clinical applicationand curative effect of isoionic microtrauma arthroscope on treatment of knee arthropathy. Methods From May 2003 to November 2004, 52 cases of knee joint injury were cured by using isoionic microtrauma arthroscope, including 30 cases ofknee osteoarthritis, 10 cases of meniscus injury, 5 cases of kneecap dislocation, 5 cases of laxity of anterior cruciate ligation and 2 cases of rheumatoid arthritis. In accordance with Lysholm criterion for knee joint function, the scores were 35.5±4.9 before operation. Results All of these patients were followed up for 2-17 months. The scores of knee joint function was 86.4±5.3 after operation, and there was significant difference (Plt;0.001). Conclusion Isoionic microtrauma arthroscope is characterized by low-temperature hemoagglutination, crimpling,boiling, cutting and hemostasia, which makes kneejoint arthroscope operation easier-to-do, miner histological scathe and lighter side effect; so it is favourable for functional recovery and its curative effect is satisfactory.
Objective To investigate the method and short-term effectiveness of arthroscopic reconstruction of anterior cruciate l igament (ACL) using RetroButton-allogeneic tendon-interference screw. Methods Between June 2009 and October 2009, 23 patients with ACL rupture were treated by arthroscopic reconstruction with RetroButton-allogeneic tendon-interference screw. There were 15 males and 8 females with an average age of 32.5 years (range, 19-46 years), including 17 left knees and 6 right knees. The injury causes were sport trauma (13 cases), traffic accident (8 cases), and fall ing injury(2 cases). There were 7 acute cases (lt; 6 weeks) and 16 chronic cases (gt; 6 weeks). Among the cases, 11 cases compl icated by medial meniscus injury, 6 by lateral meniscus injury, 3 by the both injuries, and 5 by articular cartilage injury. All cases had no injuries of posterior cruciate l igament, medial or lateral collateral l igament, or posterolateral structure. The time from injury to operation ranged from 3 weeks to 32 months. Lysholm and International Knee Documentation Committee (IKDC) scores were used for subjective evaluation, while Lachman test and KT-1000 measurement for objective evaluation. Results All wounds healed by first intention. The symptoms of unstable knee were improved obviously. No high fever, infection, or immunologic rejection were observed. Refractoriness synovitis and joint effusion occurred in 1 case after operation, and was improved after articular cavity flushing for 7 times within 3 weeks. All cases were followed up 10-17 months (mean, 14.7 months). There were significant differences in Lysholm score, IKDC score, Lachman test, and KT-1000 measurement between pre-operation and last follow-up (P lt; 0.05). Conclusion Arthroscopic reconstruction of ACL with RetroButton-allogeneic tendon-interferencescrew is simple and safe, and its short-term effectiveness is satisfactory.
Objective To explore the surgical method and cl inical short-term outcomes of internal fixation combined closed reduction with arthroscope aid in treating patellar fracture. Methods From June 2004 to July 2008, 42 patients with fresh simple patellar fracture underwent internal fixation combined closed reduction with arthroscope aid, included28 males and 14 females, aged 16-59 years (35 years on average). The locations were 19 left knees and 23 right knees. Injury was by traffic accident in 21 cases, by fall ing in 11 cases, by sports in 7 cases and by crush in 3 cases. All the patients had fresh closed fracture, including 38 cases of transverse fracture and 4 cases of stellate fracture. The Lysholm score was 68.60 ± 15.20; the proprioceptive function of the knee joints was (3.72 ± 0.12)°. The time from injury to operation was 3-42 hours (12 hours on average). After the treatment of affil iated injury under the arthroscope, patellar fracture was reduced with manipulation method, fracture was fixed with tensile force screw or modified tension band. Results All incisions obtained heal ing by first intention after operation, 42 patients were followed up for 12-39 months (16 months on average). The X-ray films showed callus at the fracture and the smooth cartilage surface 6-9 weeks (7 weeks on average) after operation. The flexed motion range of knee joint at last follow-up was at normal range in 38 cases, was l imited in 4 cases. Circumference of suffered l imbs 15 cm above the patella was the same as normal ones in 23 cases, atrophied 0.7 cm in 19 cases. There were no breakage of internal fixation and shift of fracture and patellofemoral arthritis at last follow-up. The proprioceptive function of the knee joints was (2.06 ± 0.11)° and the Lysholm score was 95.10 ± 3.92; all showing statistically significant differences when compared with preoperation (P lt; 0.05). Conclusion This treatment method has advantages as follows: mini-wound, early exercises and few compl ications, which can rinse articular cavity and repair the affil iated injury at the same time.