OBJECTIVE: To determine the long-term results and possible complications of the posterior tibialis transfer in correction of the foot-drop in leprosy patients, and to compare the results by the circum-tibial and interosseous routes. METHODS: From January to October 2001, 37 cases (treated from October 1989 to October 1999) were followed up. Walking gait, active dorsiflexion and plantar flexion of the ankle joint, deformities of the feet, and patients’ satisfaction were recorded. RESULTS: Of 37 patients, 22 were treated by circum-tibial transfer, 15 by interosseous transfer. All patients’ Achilles tendons were lengthened. Excellent and good results were obtained in 30 cases (86%). The active dorsiflexion was better by interosseous route than by circum-tibial route. Out of 35 patients followed up for 2-11 years (4 years on average), 14 had talipes varus in 22 by circum-tibial transfer, 2 had talipes varus in 13 by interosseous transfer; there was significant difference between two routes (P lt; 0.05). The complications included drop-toe(5 cases), muscle atrophy (4 cases), tendon rupture (1 case) and tendon adhesion (1 case). CONCLUSION: Tibialis posterior transfer with elongation of tendo Achilles can obtain excellent results in treating foot-drop due to leprosy. Interosseous route is preferred and physiotherapy is emphasized pre- and postoperatively.
Objective To compare the short-term result between the high-flex (HF) and conventional posteriorstabil ized (PS) prosthesis in total knee arthroplasty (TKA). Methods From April 2005 to October 2007, 23 cases (27 knees) underwent TKA by HF prosthesis (HF group), and 35 cases (41 knees) underwent TKA by PS prosthesis (PS group).In HF group, there were 2 males (3 knees) and 21 females (24 knees) aged (64.3 ± 5.6) years, including 20 cases (23 knees) of osteoarthritis and 3 cases (4 knees) of rheumatoid arthritis; body mass index (BMI) was 27.3 ± 3.9; the course of disease was (5.3 ± 5.6) years; the Hospital for Special Surgery Scoring System (HSS) score was 58.4 ± 7.9; the Western Ontario and McMaster universities osteoarthritis index (WOMAC) score was 49.4 ± 6.9; the maximum knee flex degree was (107.6 ± 8.3)°; and the range of knee motion was (103.5 ± 7.7)°. In PS group, there were 3 males (3 knees) and 32 females (38 knees) aged (65.1 ± 5.9) years, including 33 cases (39 knees) of osteoarthritis and 2 cases (2 knees) of rheumatoid arthritis; BMI was 27.1 ± 4.1; the course of disease was (5.1 ± 4.9) years; HSS score was 60.1 ± 10.4; WOMAC score was 47.9 ± 7.2; the maximum knee flex degree was (108.4 ± 9.7)°; and the range of knee motion was (105.9 ± 11.4)°. There were no significant differences in general data between two groups (P gt; 0.05). Results All incisions achieved heal ing by first intention. No compl ication of ankylosis, blood vessel and nerve injuries, and prosthesis loosening occurred. All patients were followed up for 24-54 months (average 32.8 months). There were no significant differences in the HSS score, WOMAC score, the maximum knee flex degrees, and the range of knee motion at 3, 12, and 24 months after operation between two groups (P gt; 0.05), but there were significant differencesbetween pre- and post-operation (P lt; 0.05). Anterior knee pain occurred in 1 case of HF group and 4 cases of PS group after 24 months, the incidence rates were 3.70% in HF group and 9.76% in PS group, showing significant difference (P lt; 0.05). The X-ray films showed that no lucent zone around prosthesis and no patella baja were observed, and the force l ine was excellent. Conclusion There is no significant difference in the range of knee motion and cl inical scores between the HF prosthesis and the PS prosthesis, but the former’s incidence rate of anterior knee pain is lower.
ObjectiveTo investigate the optimal surgical opportunity timing of posterior hemivertebra resection by comparing the outcomes of surgical treatment for congenital spinal deformity in patients at different ages. MethodsBetween January 2007 and Februay 2013, 36 cases of congenital hemivertebra scoliosis underwent one-stage posterior hemivertebra resection and segmental instrumentation fixation and fusion. There were 22 males and 14 females, with an average age of 16.8 years (range, 5-48 years). The patients were divided into 3 groups:group A (≤10 years, n=7), group B (10-20 years, n=22), and group C (>20 years, n=7). There was no significant difference in gender, segment, type, and complication among 3 groups (P>0.05). Anteroposterior and lateral X-ray films were taken before and after operation to measure the scoliosis Cobb angle, kyphosis Cobb angle, and C7 plumb line-center sacral vertical line (C7PL-CSVL). The improvement rate was calculated. And the perioperative and long-term complications were recorded. ResultsThe operation time of group A was significantly less than that of group C (P<0.05); the intraoperative blood loss of group B and group C were significantly more than that of group A (P<0.05); and the fixed segments of group B and group C were significantly more than those of group A (P<0.05). Thirty-six cases were followed up 7-62 months (mean, 31.3 months). No poor wound healing, pedicle cutting, pseudoarticulation formation, and other complications occurred during the follow-up. At last follow-up, 31 patients obtained a balance of double shoulders and double hips. The scoliosis Cobb angle, kyphosis Cobb angle, and C7PL-CSVL at immediate after operation and last follow-up were significantly improved when compared with preoperative ones in 3 groups (P<0.05). The scoliosis Cobb angle at last follow-up of group B was significantly larger than that of group C, the kyphotic correction rate at immediate after operation was significantly larger in groups A and C than in group B, the kyphotic correction rate of group B at last follow-up was significantly less than that of group C, and C7PL-CSVL correction rate of group A at immediate after operation was significantly larger than that of group B, all showing significant differences (P<0.05). ConclusionEarly one stage posterior hemivertebra resection is safe and effective, especially in patients who had no formation of structural compensatory bending and spinal stiffness, which can shorten the operation time and reduce the fixed segments and intraoperative hemorrhage. Influence on the growth and activity of the spine is relatively small.
ObjectiveTo explore the clinical outcomes of open reduction and internal fixation by posterolateral and posteromedial approaches for treating posterior Pilon fractures in elderly patients. MethodsBetween August 2009 and August 2014, 20 elderly patients with posterior Pilon fractures were treated with open reduction and internal fixation by posterolateral and posteromedial approaches. There were 14 males and 6 females, aged from 66 to 83 years (mean, 72.7 years). The causes were falling injury in 11 cases and traffic accident injury in 9 cases. All the patients had lateral malleolus and medial malleolus fractures. The time from injury to operation was 7-14 days (mean, 8.6 days). The posterolateral incision was made to expose the posterolateral bone fragments of posterior malleolus and lateral malleolus fracture, and the posteromedial incision was made to expose the posteromedial fracture fragments of posterior malleolus and medial malleolus fracture. After reduction, fracture was fixed with locking plate or cannulated screw. All the patients began to functional exercise at 1 day after operation. ResultsThe operation time was 60-110 minutes (mean, 92 minutes). The incisions healed primarily in all patients. There were no complications of incision dehiscence, infection, implant exposure, and nerve damage. No irritation sign of tendon was observed. All 20 cases were followed up for 12-18 months (mean, 13 months). The X-ray films showed that fracture healed at 3-9 months, with an average of 5.2 months. During follow-up period, no loosening or breakage of the implant was observed. The other patients could walk normally except 2 patients (over 80 years old) who could walk with crutch. According to American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the results were excellent in 12 cases, good in 4 cases, and fair in 4 cases; the excellent and good rate was 80%. ConclusionA combination of posterolateral approach and posteromedial approach for open reduction and fixation of posterior Pilon fractures can achieve satisfactory effect in elderly patients. It has the advantages of protecting ankle blood supply and avoiding the soft tissue necrosis and implants exposure.
ObjectiveTo compare the complications and clinical scores of posterior lumbar intervertebral fusion (PLIF) in middle-aged and older patients of different ages, and to assess the risk of complications of PLIF in different ages, providing a reference for clinical treatment.MethodsThe clinical data of 1 136 patients, who were more than 55 years old and underwent PLIF between June 2013 and June 2016, were retrospectively analyzed. According to the age of patients undergoing surgery, they were divided into 3 groups as 55-64 years old, 65-74 years old, and ≥75 years old. The general characteristics, comorbidities, and surgical data of the three groups were compared, with comparison the morbidity of complications. According to the minimal clinical important difference (MCID), the improvement of patient’s pain visual analogue scale (VAS) score and the Oswestry disability index (ODI) score were compared. Univariate logistic regression analysis was used to analyze the difference of complications and the improvement of VAS and ODI scores. Multivariate logistic regression analysis was performed for the risk factors of complications.ResultsThere were significant differences in the number of surgical fusion segments and osteoporosis between groups (P<0.05); there was no significant difference in gender, body mass index, operation time, preoperative American Society of Anesthesiologists (ASA) classification, and comorbidities between groups (P>0.05). All patients were followed up 6-62 months with an average of 27.4 months. Among the results of postoperative complications, there were significant differences in the total incidence of intraoperative complications, systemic complications, minor complications, and the percentage of improvement of ODI score to MCID between groups (P<0.05); but there was no significant difference in the total incidence of complications at the end of long-term follow-up and the percentage of improvement of VAS score to MCID between groups (P>0.05). Univariate logistic regression analysis showed that after adjusting the confounding factors, there were significant differences in intraoperative complications and the percentage of improvement of ODI score to MCID between 55-64 and 65-74 years old groups (P<0.05); systemic complications, minor complications, complications at the end of long-term follow-up, and the percentage of improvement of ODI score to MCID in ≥75 years old group were significantly different from those in the other two groups (P<0.05). Multivariate logistic regression analysis showed that age was a risk factor for systemic complications, minor complications, and complications at the end of long-term follow-up. Except for age, long operation time was a risk factor for intraoperative complications, increased number of fusion segments was a risk factor for systemic complications, the number of comorbidities was a risk factor for minor complications, and osteoporosis was a risk factor for complications at the end of long-term follow-up.ConclusionThe risk of surgical complications is higher in the elderly patients (≥75 years) with lumbar degenerative diseases than in the middle-aged and older patients (<75 years), while the improvements of postoperative VAS and ODI scores were similar. Under the premise of fully assessing surgical indications, PLIF has a positive effect on improving the elderly patients’ quality of life.
Objective To compare the effectiveness and radiological changes of posterior decompression combined with Coflex interspinous dynamic reconstruction or lumbar 360° fusion for degenerative lumbar spinal disorders at L4, 5. MethodsBetween October 2008 and November 2010, a comparative study was carried out on patients with degenerative lumbar spinal disorders at L4, 5. In group A, 29 patients underwent posterior decompression combined with Coflex interspinous dynamic reconstruction; there were 20 males and 9 females with an average age of 45.1 years (range, 21-67 years); and the disease duration was 2 months to 4 years. In group B, 31 patients underwent posterior decompression combined with lumbar 360° fusion treatment; there were 16 males and 15 females with an average age of 56.2 years (range, 32-86 years); and the disease duration was 3 months to 6 years. Except the age, there was no significant difference in gender, disease duration, and etiology etc. between 2 groups (P gt; 0.05). The results were assessed by Japanese Orthopaedic Association (JOA), visual analogue scale (VAS) scores, and Oswestry disabil ity index (ODI). The range of motion (ROM) and intervertebral height of affected and adjacent segments, and the ROM of lumbar were measured before operation and last follow-up. Results Significant differences were found in the operative time and blood loss between 2 groups (P lt; 0.05). Intraoperative dural tear occurred in 1 case of group B, spinal canal venous plexus hemorrhage in 1 case of group B, and postoperative cerebrospinal fluid leakage in 2 cases of group A and B respectively, showing no significant difference (χ2=0.119, P =0.731). The follow-up was 12-21 months in group A and was 12-23 months in group B. At the last follow-up, the JOA, VAS scores, and ODI of groups A and B were significantly improvedwhen compared with the preoperative values (P lt; 0.05). The VAS score of group A was significantly higher than that of group B (P lt; 0.05). There was no significant difference in the intervertebral height of L4, 5 and L5, S1 of groups A and B between pre- and post-operation (P gt; 0.05). In group B, the intervertebral height of L3, 4 was significantly reduced (P lt; 0.05) compared with the preoperative one. There was no significant difference in the ROM of L5, S1 and ROM of lumbar in groups A and B between preand post-operation (P gt; 0.05). At last follow-up, the ROM of L4, 5 was significantly reduced in group A (P lt; 0.05), and the ROM of L3, 4 was significantly increased in group B (P lt; 0.05). Except significant differences in the intervertebral height and ROM of L3, 4 between 2 groups (P lt; 0.05), no significant difference was found in other parameters (P gt; 0.05). Conclusion Posterior decompression combined with Coflex interspinous dynamic reconstruction has the same effectiveness as lumbar 360° fusion in treating degenerative lumbar spinal disorders at L4, 5, but the former has a protective effect on the adjacent segments of fusion and is recommended for initial treatment of young adults and the elderly and frail patients with recurrent.
ObjectiveTo investigate the effectiveness of spring hook plate for posterior malleolus fracture by comparing with cannulated screw. MethodsBetween March 2012 and September 2013, 100 cases of posterior malleolus fracture were treated. Fracture was fixed with spring hook plate in 50 cases (research group) or with cannulated screw in 50 cases (control group). There was no significant difference in gender, age, cause of injury, associated injury, and injury to operation time between 2 groups P>0.05). The operation time, intraoperative blood loss, union time of fracture, ankle range of motion (ROM), and complications were recorded and compared. The ankle joint function was evaluated by the ankle hindfoot scale of American Orthopedic Foot and Ankle Society (AOFAS). ResultsThere was no significant difference in operation time and intraoperative blood loss between 2 groups P>0.05). The patients were followed up 6-12 months (mean, 9.8 months) in the control group and 6-12 months (mean, 9.2 months) in the research group. The X-ray films showed that fracture union was achieved in 2 groups; the union time of the research group[(9.5±1.4) weeks] was significantly shorter than that of the control group[(10.5±1.3) weeks] (t=2.029, P=0.017). The ROM was (25.1±3.2)° for dorsal extension and was (45.3±2.3)° for plantar flexion in the research group at 6 months after operation, which were significantly better than those of the control group[(22.2±2.3)° and (41.2±2.5)°] (t=-3.950, P=0.001; t=-5.212, P=0.000). The ankle hindfoot scale of AOFAS was 85.1±8.6 in the control group at 6 months; the results were excellent in 15 cases, good in 20 cases, and moderate in 15 cases with an excellent and good rate of 70%. The ankle hindfoot scale of AOFAS was 89.4±7.9 in the research group; the results were excellent in 20 cases, good in 22 cases, and moderate in 8 cases with an excellent and good rate of 84%; there was significant difference between 2 groups (t=-2.191, P=0.042; χ2=0.413, P=0.018). Incision infection occurred in 3 cases of the control group and in 2 cases of the research group, which was cured after dressing change; screw loosening and fracture displacement occurred in 3 and 4 cases of the control group, but did not in the research group. The complication rate of the control group and the research group was 20% and 4% respectively, showing significant difference between 2 groups (χ2=6.061, P=0.028). ConclusionSpring hook plate can shorten the time of union, increase the ROM of the ankle after operation, get good functional restoration, and decrease the rate of complication compared with cannulated screw fixation.
Objective To evaluate the clinical effects of surgical treatment for 30 patients with discogenic low back pain. Methods A total of 30 patients with 36 intervertebral discs were treated with posterior approach lumbar discectomy and interbody fusion with internal fixation by strict criteria. All patients were followed up for one year. The low back pain before and one year after surgery was evaluated by Japanese Orthopaedic Association (JOA) score and Visual Analogue Scale (VAS) score. Results The patients’ JOA score increased from 14.6±2.3 (before operation) to 27.1±0.9 (one year after operation) (t=–26.936, P<0.001), while the patients’ VAS score decreased from 6.2±1.6 (before operation) to 1.4±0.9 (one year after operation) (t=16.335, P<0.001), and the differences were significant. Conclusion When the conservative treatment is invalid, the operation of posterior lumbar intervertebral fusion is an effective method for the patinets with discogenic low back pain.
Objective To summarize the application of different types of perineal and vaginal reconstruction after posterior exenteration with resection of distal vagina and perineal body for patients with primary or recurrent advanced rectal cancer with distal vagina or perineal body invasion， and to review the advantages and shortages and the application range of common reconstructive surgical procedures. Method The clinical data of 10 rectal cancer patients underwent extended surgery with distal vagina and perineal body resection accompanied with or without hysterectomy from October 2009 to September 2013 were summarized. Results There was no perioperative mortality. Omental flaps were used for obliteration of pelvic defect in 4 patients. The uterus was pushed backward to fill the pelvic defect after severing the round ligament in 2 patients. A reversed pedicled sigmoid flap was employed for reconstruction of the vagina in 2 patients. The reversed flap of anterior vaginal wall was used for vaginal and perineal reconstruction in 3 patients. Three cases had postoperative complications， in which included 1 patient with pelvic sepsis who underwent reoperation for drainage， 2 patients with perineal wound infection. All other patients had an uneventful healing postoperatively. Conclusions Some types of one-stage pelvic and perineal-vaginal reconstruction after posterior exenteration with resection of distal vagina and perineal body could produce an expedited wound healing with acceptable morbidity. Despite the well documented pedicled musculocutaneous flap for reconstruction， omental flap， pedicled sigmoid flap， overturn of anterior vaginal wall for reconstruction and pushing-back of the uterus for filling pelvic cavity might also result in reduced pelvic and perineal associated complications. Pedicled musculocutaneous flap is better reserved for huge pelvic and perineal defect and should be recommended among Chinese surgeons.
Objective To evaluate the effectiveness of posterior malleolus fixation on the function of ankle in patients with ankle fracture. Methods Between June 2007 and June 2009, 110 patients with ankle fracture were treated with posteriormalleolus fixation in 59 patients (fixation group) or without fixation in 51 patients (non-fixation group). In fixation group, there were 31 males and 28 females with an average age of 62.6 years (range, 19-75 years); the causes of injury included traffic accident (20 cases), falling (18 cases), and sprain (21 cases) with a disease duration of 1-3 days (2.2 days on average); and the locations were left ankle in 32 cases and right ankle in 27 cases, including 6 cases of type I, 23 of type II, 19 of type III, and 11 of type IV according to the ankle fracture clssification. In non-fixation group, there were 38 males and 13 females with an average age of 64.5 years (range, 16-70 years); the causes of injury included traffic accident (15 cases), falling (12 cases), and sprain (24 cases) with a disease duration of 1-3 days (2.5 days on average); and the locations were left ankle in 22 cases and right ankle in 29 cases, including 8 cases of type I, 16 of type II, 19 of type III, and 8 of type IV according to the ankle fracture clssification. There was no significant difference in general data between 2 groups (P gt; 0.05). Results All patients of 2 groups achieved wound heal ing by first intention. The patients were followed up 12-18 months (16 months on average). X-ray films showed that fractures healed at 8-12 weeks (10 weeks on average) in fixation group and at 10-14 weeks (12 weeks on average) in non-fixation group. There were significant differences in the cl inical score (89.28 ± 8.62 vs. 86.88 ± 9.47, P lt; 0.05), postoperative reposition score (33.34 ± 2.15 vs. 31.24 ± 2.89, P lt; 0.05), and osteoarthritis score (13.22 ± 1.66 vs. 12.46 ± 2.03, P lt; 0.05) according to Phill i ps ankle scoring system between 2 groups at last follow-up. There was no significant difference in cl inical score of type I and II patients between 2 groups (P gt; 0.05), but significant differences were found in cl inical score and osteoarthritis score of type III and IV patients between 2 groups (P lt; 0.05). There were significant differences in the postoperative reposition score between 2 groups in all types of fractures (P lt; 0.05). Conclusion The posterior malleolus fixation may provide satisfactory cl inical functional outcomes for ankle fracture. Proper fracture classification and correct method of internal fixation are important for achieving good reduction and improving the long-term results.