Objective To discuss the clinical application of preserving femoral neck in total hip arthroplasty and to analyze the early stage results.Methods From January 1999 to June 2001, 12 patients underwent total hip arthroplasty with preservation of femoral neck. We cut off the femoral head in infra-head position with improved Moore micro-incisions to reserve intact neck of femur. Thensuitable size of extra cup was selected and placed at 55° eversion angle. The internal cup, made from ultra high polymer poly thene and with ultra radius design, was placed at 45°eversion angle. Harris scores were recorded before operation, after operation and during the follow-up. During the follow-up, the X-rayfilms were taken to assess position, loosening of the prosthesis and ectopic ossification.Results All 12 patients were followed up 2-4.5years with an average of 3.1 years. The mean Harris score of hip elevated from 54 scores before operation to 92 scores of the last follow-up. Mild ectopic ossification occurred in 3 cases. There was no prosthesis loosening and femoral prosthesis setting, and only onepatient had mild bone absorption around femoral prosthesis.Conclusion Total hip arthroplasty with femoral neck preservation is a good option for the patients who need total hip arthroplasty for variable reasons, which is indicated for the patients whose femoral neck is intact with no osteoporosis.
Objective To investigate the clinicalvalue of modified Weaver-Dunn technique in repair of acute acromioclavicular dislocation. Methods From January 1993 to December 1998, 18 cases of acromioclavicular dislocation were treated bymodified Weaver-Dunn technique, and other 17 cases of the same suffering were treated by tension band fixation of the acromioclavicular joints. All of the patients were followed up for 12-36 months before clinical evaluation of the functionof shoulder joints, according to University of Pennsylvanian Shoulder Score System. Results In short term, the shoulder joints recovered much more rapidly in the cases repaired by modified Weaver-Dunn technique; 12, 24 and 36 months after operation, the scores of the cases repaired by modified Weaver-Dunn technique were (1897±67), (193.7±3.6) and (194.7±3.4) respectively according to the Shoulder Score System, while those of the cases treated by tension band fixation were (167.3±7.8), (170.2±6.3) and (165.6±5.9) respectively. The above data indicated that there was significant difference between two groups (P＜0.05). Conclusion The modified Weaver-Dunn technique was a better surgical approach than tension band fixation for repair of acute acromioclavicular dislocation.
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.
It is very difficult to repair large articular cartilage defect of the hip. From May 1990 to April 1994, 47 hips in 42 patients of large articuler cartilage defects were repaired by allograft of skull periosteum. Among them, 14 cases, whose femoral heads were grade. IV necrosis, were given deep iliac circumflex artery pedicled iliac bone graft simultaneously. The skull periosteum had been treated by low tempreturel (-40 degrees C) before and kept in Nitrogen (-196 degrees C) till use. During the operation, the skull periosteum was sutured tightly to the femoral head and sticked to the accetabulum by medical ZT glue. Thirty eight hips in 34 patients were followed up for 2-6 years with an average of 3.4 years. According to the hip postoperative criteria of Wu Zhi-kang, 25 cases were excellent, 5 cases very good, 3 cases good and 1 case fair. The mean score increased from 6.4 before operation to 15.8 after operation. The results showed, in compare with autograft of periosteum for biological resurface of large articular defect, this method is free of donor-site morbidity. Skull periosteum allograft was effective for the treatment of large articular cartilage defects in hip.
Objective To compare the bone resorption between the proximal fixation of the anatomique benoist giraud（ABG） hip and the distal fixation of the anatomic medullary locking（AML） hip by the medium-term X-ray films, and to evaluate the clinical results of the two prostheses. Methods From January 1992 to December 1996, 298 patients (396 hips) underwent the total hip arthroplasty at Wilson Hospital in Korea. In 125 patients, 176 hips were ABG hips, including 103 avascularnecrosis hips, 57 dysplasia hips, and 16 other diseased hips; In the other 173 patient the remaining 220 hips were AML hips, including 147 avascular necrosis hips, 65 dysplasia hips, and 8 other diseased hips. The A-P X-ray imagings were followed up for 5-12 years averaged 8 years, and were compared with the immediate postoperative X-ray imagings. The bone resorption area was measured and the bone resorption cases were recorded according to the Gruen zone obsesvation. Results During operation, 2 ABG hips and 5 AML hips were cracked at the femoral diaphysis; 3 ABG hips and 1 AML hip were cracked at the metaphysis; 6 ABGhips and 3 AML hips were fractured because of trauma after operation; among them, 2 ABG hips needed the stem revision and the remaining hips underwent the openreduction and the internal fixation. During the follow-up, 9 ABG hips were revised, 7 hips of which developed the aseptic loosening. No AML hip was revised, but 3 AML hips developed the aseptic loosening. The bone resorption pattern in theABG and AML hips was similar. The bone resorption occurred most commonly in theGruen zones 1 and 7, and it extended from the metaphysis to the diaphysis. In the Guren zones 2, 5, 6 and 7, there were more AML hips than ABG hips that developed the bone resorption. The bone resorption area around the AML hip was larger than that around the ABG hip. Conclusion The stress shielding bone resorption usually occurs proximally to the union area of the bone and the prosthesis. The ABG prosthesis is a proximal fixation prosthesis, therefore, the stress shielding bone resorption can be reduced. The bone resorption around the AML prosthesis develops slowly within 10 years after operation. The stress shielding bone resoption may reach the summit within 10 years and it will not develop endlessly, so the prosthesis will be stable for a long time. The probabilityof the bone resorption in the ABG prosthesis is smaller than that in the AMLprosthesis. The bone resorption around the AML prosthesis may develop slowly after 10 years and will not affect the stability of the prosthesis for a long time.
In order to restore the function of shoulder joint in patient with tumor of upper end of humerus, artificial humeral head replacement was performed. The materials included resinene, nylon-6 and large molecular polyethylene from 1978 to 1993, 14 patients were treated. The tumors involved in this group were giant cell tumor, synviosarcoma, bone cyst, osteochondroma, osteoblastoma, osteofibrosarcoma, osteosarcoma, chondrosarcoma, parosteosarcoma and malignant giant cell tumor. After resection of the tumor, the artificial prosthesis was implanted with bone cement. After 1 to 16 years follow-up, functions of the shoulder joint were reserved in 86% of the patients.
Objective To establish the three-dimensional (3D) finite element model of the knee joint including posterolateral complex (PLC), and to simulate the reconstruction biomechanical analysis in this model. Methods The knee of a 26-year-old healthy man was scanned by MRI to obtain the image data of the knee in the coronal, sagittal, and axial position. First, Mimics10.01 and Hyperworks 8.0 softwares were used to extract each slice profile data of the knee joint in a two-dimensional image data respectively and to establish 3D geometric model of bone, meniscus, articular cartilage, and ligament. Second, Unigraphics software NX 4.0 was used to establish a 3D finite element model of knee joint, which had the functions of Mesh, material properties, component connection, and contact definition. Third, displacement measurement on the model and reconstructing biomechanical analysis for PLC simulation were performed. Results The 3D finite element model of the knee joint including PLC was established successfully. Under 134 N forward force, the tibia forward displacement was 4.83 mm. PLC simulation reconstruction biomechanical analysis of the 3D finite element model of the knee joint showed that under 10 N·m varus and external rotation torque conditions, the knee varus and external rotation angles of simulation reconstruction were greater than those of the intact knee, and less than those of PLC missing. Conclusion The 3D finite element model of the knee joint including PLC can be established by the reverse engineering, and it is valid and can be used as the basis for the biomechanical properties to analog reconstruction of PLC.
Objective To explore the anatomic basis for theanterior approach screw fixation through the C2 vertebral body into the C1 lateral mass and toinvestigate its primary clinical application. Methods Twenty-one adult corpse specimens were anatomically measured. The minimum lateral angle α, the maximum lateral angle β, and the maximum posterior angle γ were calculated based on the data from the anatomic measurement. All the specimens were given an X-ray examination, the minimum lateral angle α, the maximum lateral angle β, and the maximum posterior angle γ were measured. The statistical analysis was made on the data obtained from the calculation in the specimens and the measurement in the X-ray films. The simulation of the approach was made onthe specimen. From October 2004 to July 2006, the simulated approach was used in 5 patients (3 males, 2 females; age, 30-55 years; illness course, 3 months-2 years) with the old atlanto-axial joint dislocation . The Frankel grading system revealed the spinal cord injury degree as follows: 1 patientwas in Grade B, 2 in Grade C, and 2 in Grade D. All the patients were treated with this surgical approach. The postoperative X-ray and CT examinations were performed. Results Angle α was 14.0±1.6°, β was 30.0±2.3°, γ was 29.0±2.9°. No significant difference existed between the angles calculated in the specimens and measured in the X-ray films (Pgt;0.05). The angles for the practical application during operation were as follows: α was 11.2±1.6°, β was 28.8±2.3°, and γ was 29.3±2.9°. The follow-up for an average of 14 months revealed that 1 patient recovered to Grade C, 1 to Grade D2, and 3 to Grade D3 in the spinal cord function according the modified Frankel grading system.Conclusion The anterior approach screw fixation through the C2 vertebral body into the C1 lateral massis feasible and safe in treatment of the old atlantoaxial joint dislocation ifthe screw insertion is exact in direction. This technique only makes the atlas temporarily stable, and so the posterior bone graft should be added into the atlantoaxial joint immediately in the one- or two-stage operation so as to achieve a long-lasting stability.
Fourteen patients with anterior cruciate ligament (ACL) injuries were treated with carbon fiber—superficial fascia complex and were followed up with an average of 25 months. The overall results in our series were excellent or good. The patients had stable knees and few had some subjective complaints. The influence on the knee function after injury of ACL was discussed.
Objective To evaluate the effectiveness of the shared decision-making scheme in postoperative out-of-hospital extended care for patients with total hip/knee arthroplasty (THA/TKA). Methods Patients who underwent THA/TKA in the Department of Orthopedic Surgery at West China Hospital of Sichuan University between October 2023 and April 2024 were included using convenience sampling. Patients were divided into the control group (odd-numbered dates) and the intervention group (even-numbered dates) based on the surgical dates. The intervention group was received care guided by a shared decision-making protocol, whereas the control group was followed the standard post-arthroplasty follow-up procedures. Differences between the two groups were compared in terms of decision-making capacity, decision satisfaction, and hip/knee function at the following time points: on the day of discharge, 3 weeks after discharge, 2 months after discharge, and 3 months after discharge. Results A total of 118 patients were included, with 59 cases in each group. There were no significant differences in demographic and clinical characteristics between the two groups (P>0.05). In terms of decision-making, compared with the control group, the experimental group had stronger decision-making ability, lower decision-making conflict, and more satisfaction with the decision-making process (P<0.05). In terms of joint function, the experimental group showed better joint function than the control group at 3 weeks, 2 months, and 3 months after surgery (P<0.05). There was no significant difference in the pain dimension of the Western Ontario and McMaster Universities Osteoarthritis index between the two groups (P=0.199). Conclusions Compared with the traditional follow-up protocol, the shared decision-making protocol can enhance patient engagement in medical decision-making, reduce decisional conflict, improve satisfaction with the decision-making process, and simultaneously promote joint functional recovery and expedite the rehabilitation process.