Objective To summarize the surgical technique and the effectiveness of Becker V-shaped lateral rotation osteotomy in total hip arthroplasty (THA) for Crowe type IV development dislocation of the hip (DDH). Methods Between January 2000 and December 2009, 18 patients (22 hips) with Crowe type IV DDH underwent THA. There were 3 males and 15 females with an average age of 54 years (range, 41-75 years). The unilateral hip was involved in 14 cases and bilateral hips in 4 cases. All patients had over anteversion of the femoral neck, with the acetabular anteversion angle of (21.28 ± 4.87)°, the femoral neck anteversion angle of (59.06 ± 1.44)°, and combined anteversion angle of (80.33 ± 1.55)°. All the patients had limb-length discrepancy, ranged from 1.0 to 3.5 cm (mean, 2.5 cm). Before operation, gluteus medius muscle strength was grade 2 in 17 hips and grade 3 in 5 hips; severe or moderate claudication was observed in 13 and 5 patients, respectively. Trendelenburg sign was positive in all patients. Preoperative Harris score was 30.00 ± 6.32. Cementless prosthesis was used. Becker V-shaped lateral rotation osteotomy and subtrochanteric shortening with overlapping femoral resection were performed, and proximal femoral shaft splitting was performed on 21 hips having narrow bone marrow cavity. Results All the cases achieved primary healing of incision. No complication of anterior dislocation, deep infection, nerve traction injury, or femoral uncontrolled fracture occurred. All the cases were followed up 3-12 years (mean, 8 years). Postoperative X-ray films showed that the initial fixation result of femoral prosthesis was excellent in 18 hips and good in 4 hips. Bone healing of osteotomy stump was obtained at 3-6 months (mean, 5 months) after operation. Affected limb prolonged for 2.5-3.5 cm (mean, 3.0 cm ) at 1 year after operation; limb-length discrepancy was 0.5-1.5 cm (mean, 1.0 cm). The gluteus medius muscle strength was restored to grade 4 in 5 hips and grade 5 in 17 hips. At last follow-up, 13 patients had no claudication, and 5 patients had mild claudication; Trendelenburg sign was negative in 15 cases and was positive in 3 cases; the Harris score was significantly improved to 91.89 ± 3.22; all showing significant difference when compared with preoperative ones (P lt; 0.05). At last follow-up, the acetabular anteversion angle, the femoral neck anteversion angle, and combined anteversion angle were (19.33 ± 4.49), (13.33 ± 5.70), and (32.67 ± 5.35)°, respectively, all showing significant differences when compared with preoperative ones (P lt; 0.05). No aseptic loosening, osteolysis, or rediolucent line was found around the femoral component. No implant subsidence, stem varus, or revision occurred. Conclusion Becker V-shaped lateral rotation osteotomy is a safe and predictable method to treat type Crowe type IV DDH.
ObjectiveTo compare the effectiveness of sequestrum clearance and impacting bone graft via surgical hip dislocation approach and core decompression and bone graft for avascular necrosis of the femoral head (ANFH) at Association Research Circulation Osseous (ARCO) stage Ⅲ.MethodsA clinical data of 60 patients (69 hips) of non-traumatic ANFH at ARCO stage Ⅲ, which met the inclusion criteria between October 2013 and April 2016, was retrospectively analyzed. Among them, 24 patients (28 hips) were treated with sequestrum clearance and impacting bone graft via surgical hip dislocation approach (group A); and 36 patients (41 hips) were treated with core decompression, sequestrum clearance, impacting bone graft, and nonvascular fibular allograft supporting (group B). There was no significant difference in gender, age, disease duration, affected side, type and stage of the ANFH, and preoperative Harris hip score and visual analogue scale (VAS) score between the two groups (P>0.05). After operation, the function of the hip was evaluated by Harris hip score, imaging examination was performed to observe the femoral head shape and evaluate whether the hip preserving success.ResultsThe incisions of two groups healed by first intention. All patients were followed up. The follow-up time was 12-48 month (mean, 25.8 months) in group A and 12-54 months (mean, 26.4 months) in group B. At last follow-up, 5 hips in group A were classified as clinical failure, femoral head survival rate was 82.1%, the median survival time was 43 months. While 19 hips in group B were classified as clinical failure, femoral head survival rate was 53.7%, the median survival time was 42 months. There was significant difference in survival curve distribution between the two groups (χ2= 4.123, P=0.042), and the surgical procedures of group A was superior to group B. In the two groups, the Harris hip scores at last follow-up were significantly higher than preoperative ones (P<0.05), and VAS scores were significantly lower than preoperative ones (P<0.05). There was no significant difference in Harris hip score and VAS score at last follow-up between the two groups (P>0.05). All grafted bones got fusion according to the X-ray films, and there was no significant difference in the fusion time between the two groups (t=0.752, P=0.456). In group A, greater trochanter bone cutting were healed well; and the heterotopic ossification around the hip joint occurred in 1 case.ConclusionThe surgery of impacting bone graft via surgical hip dislocation approach and core decompression and bone graft can be applied to treat ANFH at ARCO stage ⅢA which was mild collapse and satisfactory effectiveness can be obtained. While for the patients of ANFH at ARCO stage Ⅲ B with severe collapse, the hip survival rate of the former is better than that of the latter.
OBJECTIVE: To investigate the etiology, pathological mechanism and treatment of cervical fracture-dislocation without spinal cord injury. METHODS: Nine patients with cervical fracture-dislocation without spinal cord injury were male and aged 22 to 63 years. Based on the clinical symptoms and roentgenographic changes, the injury mechanism was analyzed; and the pathological characteristics and treatment principle were put forward. RESULTS: Anterior reduction was employed in all 9 cases. Eight cases were reduced completely while 1 case was reduced partially. After following up 1 to 3 years, 7 cases recovered completely and the other 2 cases relieved their symptoms obviously. No nervous symptoms aggravated during the following-up period. CONCLUSION: Fracture-dislocation of the cervical spine without spinal cord injury has special pathological mechanism. The surgical intervention is needed for solid fixation and complete decompression without any delayed neurosymptoms.
Objective To investigate the effectiveness of reconstructing medial patellofemoral l igament with hamstring tendon autografts for the treatment of recurrent patellar dislocation under arthroscopy. Methods Between January 2005 and January 2010, 22 cases of recurrent patellar dislocation were treated by lateral retinacular release and reconstructionof the medial patellofemoral ligament with hamstring tendon autografts under arthroscopy. There were 5 males and 17 females, aged 15-19 years (mean, 17.3 years). The average number of dislocation was 4 (range, 3-8). The main cl inical symptoms were pain and swell ing of knee joint, weakness in the leg, and limited range of motion (ROM). The patellar tilt test, pressing pain of patellofemoral ligament insertion, and apprehension sign showed positive results. According to International Knee Documentation Committee (IKDC) scoring criteria, the subjective IKDC score was 36.7 ± 4.7, and the Lysholm score was 69.3 ± 3.8. X-ray films showed that the patella inclined outwards. Results All incisions healed by first intention. Twenty-two cases were followed up 18-49 months (mean, 34 months). Pain and swelling of knee joint and weakness were improved obviously. No recurrence was found during follow-up. The ROM of knee in flexion and extension was improved when compared with preoperative ROM. The subjective IKDC score was 92.4 ± 5.3 and the Lysholm knee score was 91.7 ± 5.2, showing significant differences when compared with preoperative scores (P lt; 0.05). Conclusion Reconstruction of the medial patellofemoral ligament with hamstring tendon autografts under arthroscopy is an effective method to treat recurrent patellar dislocation.
A total of 12 cases of old facet dislocations of cervical spine treated between december 1988 and 1993 were analyzed in order to evaluate the efficacy of various surgical modalities. In this series, there were 8 males and 4 females, with ages ranged from 16 to 50 years old (averaged 37.8 years old). The duration from injury to admission to our hospital was ranged from 1 to 8 months (averaged 3.7 months). Dislocation levels were as follows: C3,4 in 1 case, C4,5 in 4 cases, C5,6 in 4 cases and C6,7 in 3 cases. Unilateral facet dislocation was in 7 cases and bilateral facet dislocation in 5 cases. Neurological status on admission was as follows: spinal cord and nerve root lesion in 5 cases, nerve root lesion alone in 5 cases and neurologically intact in 2 cases. Besides all facets receiving facetectomy and iliac bone graft, other four kinds of adjuvant treatments were used, including internal fixation by stainless wires laminae or spinous processes in 4 cases, Luque rod in 1 cases, anterior fibrolysis combined with posterior laminoplasty in 1 cases and sustained skull traction without internal fixation in 6 cases. The reduction efficacy from postoperative stustained skull traction was better and the stainless wires fixation ranked the next. The patients only suffering from the nerve root lesion recovered better, but those who had spinal cord combined with nerve root lesion recovered badly. In conclusion, for the treatment of old facet dislocation, it is necessary to resect the facet and graft with iliac bone.
ObjectiveTo observe the effectiveness of arthroscopic reconstruction of medial patellofemoral ligament (MPFL) with a single bundle of autogenous half peroneal longus tendon, and medial displacement of lateral hemitibial tuberosity for the treatment of recurrent dislocation of patella.Methods Retrospectively analyse the clinical data of 24 patients (24 knees) with recurrent patellar dislocation with tibial tuberosity-trochlear groove distance (TT-TG) values more than 15 mm who were admitted between September 2014 and September 2018. Of which 7 were male and 17 were female; aged 16-35 years old with an average of 25.8 years. The disease duration ranged from 15 to 46 months, with an average of 26.7 months. All patients had a history of knee trauma, and a positive result of apprehension test on the affected knee. All patients underwent the surgery of arthroscopic reconstruction of MPFL with a single bundle of autogenous half peroneal longus tendon, and medial displacement of lateral hemitibial tuberosity. Before and after operation, Kujala score was used to evaluate patellofemoral joint function, Lysholm score was used to evaluate knee joint function; CT and MRI were used to measure and compare the changes of congruence angle (CA), patellar tilt angle (PTA), and lateral patella displacement (LPD) in order to evaluate patella stability.ResultsAll incisions healed by first intention, and no infection or neurovascular injury occurred. Deep vein thrombosis of the lower extremities occurred in 2 cases at 4 and 7 days after operation respectively, and the thrombosis disappeared after symptomatic treatment. All the 24 patients were followed up 12-14 months (mean, 12.9 months). During follow-up, no patellar dislocation reoccurred in the affected knee. At last follow-up, the apprehension test was negative in every patients. The TT-TG, CA, PTA, and LPD were significantly improved when compared with those before operation (P<0.05). The Kujala score and Lysholm score at 1 month and last follow-up were significantly better than those before operation, and the above scores at last follow-up were significantly better than those at 1 month after operation (P<0.05). According to Lysholm score, the patients’ knee joint functions were excellent in 13 cases, good in 10 cases, and fair in 1 case, and the excellent and good rate was 95.8%.ConclusionArthroscopic reconstruction of MPFL with a single bundle of autogenous half peroneal longus tendon combined with medial displacement of lateral hemitibial tuberosity has the advantages of minimal invision and reliable effectiveness. It can be used as one of the effective surgical methods for the treatment of recurrent dislocation of patella.
Redislocation of the femoral head may be occured after its operative reduction in the congenital dislocation of the hip, therefore, it is greatly important to disclose the causes of the redislocation in order to avoid this every complication and improve the curative effect of this operation. Seven cases of redislocation from 106 cases (128 sides) of the congenital dislocation of the hip which had been reduced operatively were studied with relative measurements of the hip joints on roentgenogram, associated their pathologic conditions described in operation. The results showed that, in these cases, there were (0.843 +/- 0.692) cm upward displacement of the femoral head beyond the horizontal Y line, (68.86 +/- 0.692) degree of the femoral anteversion, the more lateral displacement of the femoral head compared to the opposite side and the acetabular index increasing up to (33.86 +/- 3.72) degree from (26.14 +/- 2.73) degree of the operative correction. These phenomena indicate that the redislocation after operative reduction of the femoral head in congenital dislocation of the hip is mainly related to four causes which include the existence of large pressure between acetabulum and femoral head, the uncorrected abnormal femoral anteversion, the residue of the pathologic tissues in the acetabulum and the reascending of the acetabular index having been corrected in operation.
Objective To summarize the research progress of surgical treatment for anterior shoulder dislocation and combined injuries. Methods The related literature was reviewed, and the surgical treatment options for the anterior shoulder dislocation and its combined injuries were summarized. Results Anterior shoulder dislocation can combine with anteroinferior capsular ligament complex injury (Bankart injury), bony Bankart defect, and Hill-Sachs lesion. For Bankart and bony Bankart injuries, arthroscopic repair or coracoid osteotomy combined with bony graft reconstruction can be performed. For Hill-Sachs lesion, conservative treatment, soft tissue repair, or bony reconstruction should be selected based on the extent of the bone defect. For bipolar injury, the Bankart repair, Remplissage, or arthroplasty should be selected based on the extent of the glenoid defect. Conclusion With the development of arthroscopy and the improvement of the surgical concept, there is a complete set of surgical options for various injuries of the anterior shoulder dislocation. When choosing a surgical procedure, the patient’s specific injury and age, exercise level, and other relating factors should be comprehensively assessed in order to achieve the best results.
Objective To investigate the morphological anatomical abnormal ities of high congenital dislocation of hip in adults and provide anatomical basis for the total hip arthroplasty (THA). Methods From May 1997 to July 2008, 49 patients (57 hi ps) with high congenital dislocation of hip (Hartofilakidis type III) were treated. There were 6 males and 43 females with an average age of 29.4 years old (18-56 years old). The locations were left in 24 hi ps and right in 33 hi ps. The morphological parameters (including femoral length, isthmus, height of femoral head center, neck-shaft angle, medialhead offset, anteversion angle, canal flare index, anteroposterior diameter of the true acetabulum, posterior thickness of the true acetabulum, depth of the true acetabulum) of suffering hips (dislocation group, n=57) were measured by preoperative X-ray, CT and intraoperative cl inical observation and were compared with those of contralateral hips (control group, n=41). The intraoperative situations of hip were observed. Results The height of dislocation was (45.41 ± 2.15) mm. The length difference of both lower extremities was (40.41 ± 2.02) mm. In dislocation group, isthmus was shortened; height of femoral head center, neck-shaft angle and medial head offset were decreased; and anteversion angle was increased. CT showed that the canal flare index was larger than 4.7, femoral shape was funnel-shaped according to Noble classification. Anteroposterior diameter of the true acetabulum became smaller, posterior thickness of the true acetabulum became thicker, and depth of the true acetabulum was shallower. There were statistically significant differences in the morphological parameters of femur and acetabulum between two groups (P lt; 0.05). The intraoperative measurements showed that the anteroposterior diameter of acetabulum was (32.98 ± 1.02) mm and the depth of acetabulum was (14.21 ± 0.56) mm. There was no statistically significant difference between intraoperative measurements and preoperative measurements (P gt; 0.05). The acetabulum was full of fat and fibrous tissues. Running of the sciatic nerve in 40 cases were changed and it ran upward and laterally. Conclusion When high congenital dislocation of the hip in adults is treated with THA, anatomical variation must be fully taken into account. The acetabulum is expanded toward posterosuperior, excessive reamed should be avoided to prevent femoral fractures, and appropriate or tailor-made prosthesis was selected.
Twelve cases (13 hips) of congenital dislocation of hip (CDH)in a group above the age of six were treated by Chiari pelvic osteotomy from Jan. 1991 to Dec. 1992. The results following operative treatment rated as good in 85 percents according to the clinical and radiologic examinations. The indications, and the results with the operation as the functional reconstuction of the hip concerned were discussed.