To evaluate the results of the management of post-traumatic tibial infected nonunion using bone transport with external fixators. Materials and methods: We retrospectively reviewed a consecutive series of 35 patients from 2000 to 2008 in our hospital who were treated for the post-traumatic tibial nonunion by bone transport with an external fixator. Thirty-two limbs (80%) were in active infected state. The mean amount of bone defect was 3.5 cm (range 1.0 to 7.8 cm) as measured on plain radiographs. The mean leg-length discrepancy was 4.4 cm (range 0 to 8.7 cm). Results: The mean follow-up was 72.5 months (range 35-106 months). All the patients had bony union and the infection had been controlled. The mean external fixation index was 40.7 day/cm (range 34.2-46.9 day/cm). The mean length gained was 7.9 cm (range 4.0-10.5 cm). Based on the criteria recommended by Paley et al., 28 bone results were excellent, 5 good, 2 fair, and none poor; 30 functional results were excellent, 4 good, 1 fair, and none poor. Conclusion: Bone transport with an external fixator is a safe, effective, and minimally invasive technique to treat post-traumatic tibial infected nonunion.
Objective
To explore the feasibility and accuracy of the Individualized Custom Femoral Cutting Guides in unicompartmental knee arthroplasty(UKA) of femoral specimens, and provide an experimental basis for clinical application.
Methods
From January 2016 to February 2017, 40 adult femoral specimens were selected from the Department of anatomy, affiliated medical university of Fudan University. There were 22 males and 18 females. The age was 35-78 years and the height was 152-178 cm. The digital table method was randomly divided into the trial group(individualized custom femoral cutting guides group, 20 femurs)and the control group(20 femurs). The trial group used individualized custom femoral cutting guides assisted UKA surgery, CT was performed preoperatively for data collection, and then design a cutting guide with 3D reverse technology, then 3D printing technology was used to produce individualized custom femoral cutting guide. At last, the surgery navigation templates were applied in the personalized UKA. In the control group, conventional fixation osteotomy was used in UKA. The operation was performed in the same group of medical groups. The two groups were compared in terms of osteotomy time and alignment of the lower limb.
Results
In the trial group, the navigation templates all contacted closely the bony structures of femoral condyle with no displacement. The osteotomy time were (3.31±0.56) min the trial group and (4.45±0.74) min in the control group, respectively (t=-5.500, P<0.01). The postoperative femoral component valgus/varus angle (FCVA) were 1.31°±0.86° in the trial group and 2.84°±1.58° in the control group, respectively (t=-3.789, P<0.01) . Correspondingly, the femoral component posterior slope angle (FCPSA) were 8.84°±0.60° and 6.25°±1.96°, respectively (t=5.661, P<0.01) . There was significant difference between the two groups, the postoperative tibial component valgus/varus angle and tibial component posterior slope angle in the trial group were closer to 0° and 10° , respectively, which indicated the position of femoral prosthesis was more precise.
Conclusions
The individualized custom femoral cutting guides does improve the accuracy of femoral prosthesis position in UKA and saving time.
Key words:
Arthroplasty, replacement, knee; Unicompartmental knee arthroplasty; Single compartment osteoarthritis; Component alignment
Objective to evaluate the diagnostic value of dedicated extremity MR system for meniscal tears. Methods 78 knee joints of 56 patients confirmed by subsequent arthroscopy or surgery were examined with 0.2T dedicated extremity MR system. All MR images were retrospectively analyzed for meniscal lesions. Results 98 menisci out of 167 observed menisci (62.8%) revealed linear or irregular regions of intermediate signal intensity that extended to the articular surface (grade 3). 14 menisci (8 9%) with fragmentations. 15 menisci (9.6%) contained one or more circular foci or linear regions of intermediate signal intensity that did not extent to an articular surface (grade 1 or 2). If the results of arthroscopy or/and surgery were considered the golden rule, the diagnostic sensitivity, specificity, and accuracy of dedicated MR system for meniscal tears were 100%, 92%, and 97%, respectively. Conclusion dedicated extremity MR system has high diagnostic power for meniscal tears of knee joints.
Objective To investigate the first-aid methods for patients with gelsemism.Methods The application of preventive tracheal intubation were given in the emergency rescue in 20 cases patients with gelsemism.Then gived the mechanical ventilation with the SIMV mode.the breathing rate were 16-18 times/min,and the tidal volume was 6-8ml/kg.3 cases of pulmonary edema were added PEEP 5-10cm H20. On the basis of stable respiratory cycle, 14 cases were given gastric lavaged with water and catharsised by giving 20% mannitol,6 cases were catharsised by giving 20% mannitol only.Results 18 cases were cured (18/20) and 2 cases were dead(2/20) after the treatment for 1-3 weeks.The cured one were all smoothly off-line,and the mechanical ventilation time were for 1.5-8.3(4.6 ± 2.2)d.And the direct cause of death were respiratory failure. Conclusions Preventive tracheal intubation is the primary rescue measures for the gelsemism.
Key words:
Gelsemism; Tracheal intubation
We report our treatment for chronic radial head dislocation associated with segment bone defect and shortening in ulna after osteomyelitis, using bone transport with a unilateral external fixator.Between October 1994 and January 2009, 10 patients with chronic radial head dislocation associated with bone defect and shortening in ulna caused by osteomyelitis underwent bone transport using a unilateral external fixator in our unit. There were six males and four females, with a mean age of 14.2 years (range, 10-17 years). The mean ulna defect measured as the discrepancy between the length of the radius and the ulna was 5.4 cm (range, 3.5-7.8 cm).In a mean follow-up of 78 months (range, 27-132 months), all patients had achieved bony union and complete reduction of the radial head. All patients were satisfied with the cosmetic appearance of the elbow and the length of the upper extremity. The mean arc of flexion-extension was improved by 26.5 degrees (from preoperative 96.5 degrees to postoperative 123.0 degrees) and the mean arc of supination-pronation was improved by 48.5 degrees (from preoperative 86.5 degrees to postoperative 135.0 degrees). The mean bone healing index was 40.5 d/cm (range, 35-47 d/cm). The mean ulnar lengthening was 5.2 cm (range, 3.5-7.5 cm).Although it is time consuming, bone transport is a therapeutic alternative for chronic dislocation of the radial head associated with bone defect and shortening in ulna.Therapeutic study, level V.
Objective According to 8 cases of cerebella substantial Hemangioblastoma,the diagnose and treatment of substantial were discussed.Methods Retrospective analysis on the clinical manifestation and assisted examination and methods of operation of 8 cases of cerebella substantial Hemangibolastoma.Results All cases were diagnosed surely after operation,the resection of the whole substantial Hemangioblastoma is difficult.Conclusion It is important to consider the substantial focus of cerebellum as substantial Hemangioblastoma.It can be reduced the operative risk and recurrence rate that preoperative occlusion of the arteries of the substantial Hemangioblastoma and intraoperative block of arteries at first and then block of veins and then resection of substantial Hemangibolastoma.
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