The "bayonet" deformity from poliomyelitis is a peculiar type of deformity of knee. From January 1986 through December 1994, 23 cases of this type of knee deformity were corrected by surgery. The operative procedures performed were suprachondylar osteotomy of femur or subplateau osteotomy of tibia. The patients were followed up from 1 to 5 years, with an average of 3 years. The result rated excellent to good was 95.6%. The features of this disorder and the main points in the surgical procedure were discussed.
Various tissue flaps were used in the repair of 255 cases of the wounds from severe deep burns and cicatricial deformities. The types of flaps used included: 6 kinds of myocutaneous flaps in 54 cases, 10 kinds of axial cutaneous flaps in 50cases, 7 kinds of fasciocutaneous flaps in 44 cases, pedicled subcutaneous tissues flaps in 12 cases, pedicled thin skin flaps in 54 cases, subdermal vascular networks cutaneous flaps in 38 cases, and free skin flaps with arter ialization of vein flap, retrograd island cutaneous flap with great or small saphaneous vein, in each. The survival rate from the transplantation was 99.2 per cent, and the rate of primary healing was 94.5 per cent. According to the time interval between the injury and operation and the conditions of the wounds, the patients were divided into acute, infected and selective cases, and the rate of primary healing was 93.0 per cent, 91.6 per cent and 97.9 per cent, respectively. The selection of the types of flap to be used and the attentions to be taken dueing operation were discussed.
Objective To discuss the operative method and therapeutic effect of correcting nasal deformity after prothesis of unilateral complete harel ip with design of nasal subunits. Methods From January 2006 to December 2008, 18 patients with nasal deformity after prothesis of unilateral complete harel ip were treated. There were 7 males and 11 femalesaged 6-26 years old. The deformity located on the left side in 11 cases and the right side in 7 cases with major manifestations of deviation and crispation towards normal side of nasal columella, applanation and collapse of nasal ala, lenity and dyssymmetry of nostrils, malposition of basement of nasal ala. Time between harel ip prothesis and secondary epithesis was 4-21 years (average 8 years). During epithesis, nasal columella were extended, collapse nasal alar cartilages were l iberated and fixed in symmetrical positions, injured upper l ip was extended with nasolabial flap or to “tongue-l ike” flap on nasal base. Eleven cases were implanted L-type sil icone prothesis to hump nose. Results For 1 case suffered postoperative rejection, the implant of L-type sil icone prothesis was taken out promptly, and reimplant of prothesis was performed 6 months later without postoperative rejection. The incision of the other patients all healed by first intention without any postoperative compl ications. The effect of epithesis was good with such manifestations as the eminence of injured nasal ala, normal radian, and symmetrical nostils. All patients werefollowed up for 3 months-2 years (average 8 months). The incision was hidden with well-maintained appearance and no obvious scar. Conclusion Based on feature of nasal subunits and formation causes of deformity, individual-orientated epithesis design of nasal ala margin, nasal columella basement incisions, reset and fix nasal alar cartilages and tissues values can provide the patients suffering the secondary nasal deformity with satisfied appearance.
Objective To evaluate the cl inical results of the femoral reconstruction technique in patients with proximal femoral deformity in total hip arthroplasty. Methods Between March 2004 and June 2009, total hip arthroplasty procedures were performed on 25 patients (26 hips) with hip joint disease and proximal femoral deformity, including primary osteoarthritis of the hip joint (2 hips), developmental dysplasia of the hip (8 hips), traumatic arthritis of the hip (14 hips), and tuberculosus arthritis of the hip (2 hips). There were 10 males (10 hips) and 15 females (16 hips), with an average age of 64 years (range, 42-82 years). The disease duration was 10 months to 25 years (mean, 10.6 years). The Harris score was 44.2 ± 5.1, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was 45.0 ± 2.7 before operation. According to Berry’s classification system of primary disease, 8 hips were classified as developmental dysplasia of hip, 7 hips as malunion of fracture, 2 hips as chronic tuberculosis, 2 hips as sl ipped femoral epiphysis, 1 hip as previous subtrochanteric osteotomy, 1 hip as previous shelf operation of the acetabulum, and 5 hips as previous internal fixation; according to the anatomic site of the deformity, there were 5 hips of greater trochanter, 10 hips of femoral neck level, 10 hips of metaphyseal level, and 1 hip of diaphysis. Results All wounds healed by first intention. Deep venous thrombosis occurred in 3 patients within 1 week, and were cured with braking and anticoagulant therapy. Bursal synovitis of great trochanter occurred in 1 patient after 6 weeks, and was eased after taking drugs for pain rel ief. All patients were followed up 1 year and 6 months to 6 years, with an average of 3 years and 3 months. The Harris score and WOMAC score at last follow-up were 88.4 ± 3.6 and 82.0 ± 5.2 respectively, showing significant differences when compared with preoperative scores (P lt; 0.05). The X-ray films at last follow-up showed good location of prosthesis and no loosening expect 1 patient who had aseptic loosening and was given revision at 8 months postopera tively. Conclusion Proximal femoral deformity classification will contribute to the choice of prosthesis and surgical strategy,thus the good results of femoral reconstruction and cl inical results would be obtained.
ObjectiveTo investigate the effectiveness of limited middle and posterior column osteotomy via transvertebral space approach in treatment of old thoracolumbar compression fracture.MethodsA clinical data of 47 patients with old thoracolumbar compression fractures, who met the selection criteria between January 2010 and March 2018, was retrospectively analyzed. Twenty-five patients (group A) underwent the limited middle and posterior column osteotomy via transvertebral space approach, and 22 patients (group B) underwent the pedicle subtraction osteotomy (PSO). There was no significant difference in gender, age, cause of injury, time from injury to operation, fracture segment, and preoperative Cobb angle, sagittal vertical axis (SVA), visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and Oswestry disability index (ODI) between the two groups (P>0.05). The operation time, intraoperative blood loss, and postoperative complications, as well as postoperative Cobb angle, SVA, VAS score, JOA score, ODI and the differences of all indexes between pre- and post-operation were recorded and compared between the two groups. The neurological function was evaluated by Frankel scale.ResultsThe operations of both groups were successfully completed. The operation time and intraoperative blood loss in group A were significant lower than those in group B (P<0.05). All incisions healed by first intetion. All patients were followed up 23-27 months (mean, 24.2 months) in group A and 24-28 months (mean, 24.8 months) in group B. At last follow-up, the VAS score, JOA score, ODI, Cobb angle, and SVA of the two groups were compared with those before operation, and the differences were significant (P<0.05). There was no significant difference between the two groups (P>0.05) in the indexes at last follow-up and the difference between pre- and post-operation. The lower extremity neurological symptoms (Frankel grade D) in 3 patients of group A before operation relieved (Frankel grade E) at last follow-up. The other patients were Frankel grade E. At last follow-up, CT showed bony fusion in the grafted area without any complications such as failure of internal fixation or pseudarthrosis.ConclusionFor patients with old thoracolumbar compression fractures, the limited middle and posterior column osteotomy via transvertebral space approach has a satisfactory effectiveness. Compared with PSO, it can reduce surgical trauma on the basis of achieving the same degree of deformity correction.
Objective To study the effectiveness of long segment fixation combined with vertebroplasty (LSF-VP) for severe osteoporotic thoracolumbar compressive fractures with kyphosis deformity. Methods Between March 2006 and May 2012, a retrospective analysis was made on the clinical data of 48 cases of severe osteoporotic thoracolumbar compressive fractures with more than 50% collapse of the anterior vertebral body or more than 40 ° of sagittal angulation, which were treated by LSF-VP in 27 cases (LSF-VP group) or percutaneous kyphoplasty (PKP) in 21 cases (PKP group). All patients suffered from single thoracolumbar vertebral compressive fracture at T11 to L2. There was no significant difference in gender, age, spinal segment, and T values of bone mineral density between 2 groups (P gt; 0.05). The effectiveness of the treatment was appraised by visual analogue scale (VAS), Cobb angle of thoracolumbar kyphosis, height of anterior/posterior vertebral body, and compressive ratio of vertebrae before and after operations. Results The LSF-VP group had longer operation time, hospitalization days, and more bone cement injection volume than the PKP group, showing significant differences (P lt; 0.05). Intraoperative blood loss in LSF-VP group ranged from 220 to 1 050 mL (mean, 517 mL). No pulmonaryor cerebral embolism or cerebrospinal fluid leakage was found in both groups. Asymptomatic bone cement leakage was found in 3 cases of LSF-VP group and 2 cases of PKP group. The patients were followed up for 16-78 months (mean, 41.1 months) in LSF-VP group, and 12-71 months (mean, 42.1 months) in PKP group. No fixation failure such as loosened or broken pedicle screw was found in LSF-VP group during the follow-up, and no re-fracture or adjacent vertebral body fracture was found. Two cases in PKP group at 39 and 56 months after operation respectively were found to have poor maintenance of vertebral height and loss of rectification (Cobb angle was more than 40o) with recurrence of pain, which were treated by second surgery of LSF-VP; another case had compressive fracture of the adjacent segment and thoracolumbar kyphosis at 16 months after operation, which was treated by second surgery of LSF-VP. There were significant differences in the other indexes between each pair of the three time points (P lt; 0.05), except the Cobb angle of thoracolumbar kyphosis, and the height of posterior vertebral body between discharge and last follow-up in LSF-VP group, and except the Cobb angle of thoracolumbar kyphosis and compressive ratio of bertebrae between discharge and last follow-up in PKP group (P gt; 0.05). After operation, the other indexes of LSF-VP group were significantly better than those of PKP group at each time point (P lt; 0.05), except the VAS score and the height of posterior vertebral body at discharge (P gt; 0.05). Conclusion The effectiveness of LSF-VP is satisfactory in treating severe osteoporotic thoracolumbar compressive fractures with kyphosis deformity. LSF-VP can acquire better rectification of kyphosis and recovery of vertebral body height than PKP.
In 1984, according to the criteria of the classifieation for congenital hand deformity which wasput out by the International Hand Surgery Committee, we had made an investigation for congenitalhand deformity among 318066 newborns in Shanghai. It was found that the inctdence of a congenitalhand malformation was 0. 0808 percent among the total newborns. The congenital malformation ofthe thumb was 37. 74 percent of all deformities of the hand. According to the statistical analysis, we ...
Objective To summarize the clinical characteristics of foot and ankle deformities combined with knee and lower limb deformities and evaluate the advantages, clinical outcomes, and considerations of QIN Sihe’s surgical strategy for treating such complex deformities. Methods Between January 2022 and December 2024, 32 patients with foot and ankle deformities combined with knee and lower limb deformities were enrolled. The cohort included 23 males and 9 females, aged 10-67 years (mean, 41.1 years). The main etiologies included post-polio sequelae (20 cases) and congenital limb deformities (3 cases). Deformities were categorized as follows: equinovarus foot (12 cases), equinus foot (2 cases), equinovalgus foot (3 cases), equinus foot with swan-neck deformity (2 cases), calcaneus foot (5 cases), foot valgus (2 cases), knee flexion deformity (14 cases), genu recurvatum (4 cases), genu varum (3 cases), genu valgum (3 cases), lower limb shortening (3 cases), and lower limb external rotation (6 cases). QIN Sihe’s surgical strategies included osteotomies, tendon releases, and tendon transfers for deformity correction, followed by external fixation for residual deformity adjustment and stabilization. Outcomes were assessed using QIN Sihe’s Postoperative Evaluation Criteria for Lower Limb (Foot and Ankle) Deformity Correction and Functional Reconstruction. Results All patients were followed up 8-32 months (mean, 16.5 months). Complications included pin tract infection (1 case, 1 site), ankle pain (2 cases), delayed healing at the proximal tibial osteotomy site (1 case), and anterior talar dislocation (1 case). At last follow-up, insufficient correction of foot deformity was observed in 1 case; both knee and lower limb deformities were corrected, with only mild recurrence of knee flexion deformity in 1 case. The foot/ankle and knee joint function improved. Based on QIN Sihe’s Postoperative Evaluation Criteria for Lower Limb (Foot and Ankle) Deformity Correction and Functional Reconstruction, outcomes were rated as excellent in 30 cases and good in 2 cases, with an excellent-good rate of 100%. Conclusion Foot and ankle deformities combined with knee and lower limb deformities are complex, QIN Sihe’s surgical strategy can achieve satisfactory clinical outcomes for simultaneous correction.
Abstract Postburn deformities, including hypertrophic scars, scar contracture and defect or deformity of tissue or organ, are the commonest disorders in plastic surgery. It is also difficult to deal with. If the diformity involved multiple organs, oftentimes the teatmentis very difficult because the material for repair is limited and the donorsite usually could not provide adequate amount of skin for repair. Since 1978,2496 cases of various postburn deformities were admitted. In this article, theoptimal time to operate was discussed. The use of flap transfer and soft tissueexpander was described. Prolonged traction in the treatment of severe contracture of large joint was also described.
Objective To introduce a method of the surgicalcorrectionof Poland’s syndrome in children. Methods From May 1990 to May 2002, 3 female children with Poland’s syndrome were treated. One child of 12 years old with defects of the right second and third costal cartilages, pectoralis major and pectoralis minor underwent repair of chest wall with graft of autologous costal cartilage from left sixth costal cartilage and transfer of the latissimus dorsi flap. The other 2 children, 3 and 16 years old, with defects of theleft second, third and fourth costal cartilages, pectoralis major and pectoralis minor underwent graft of autogenous costal cartilage from the right sixth costal cartilage and implant of Dexon mesh. Results Three patients were followed up 1, 7 and 10 years postoperatively, respectively.The contour of chest wall in 3 patients were improved. The functions of the chest, back and upper limbs in the deformitis side were good and the growth and development of thechildren were normal during follow-up postoperatively.Conclusion The congenital deformities of multiple systems and parts in the body are involved in Poland’s syndrome so that it is necessary to make a proper surgical plan according to the extent of lesions for a satisfactory result.