Objective To assess the curative effect of the subtalararthrodesis on the serious subtalar joint with the posterior tibial tendon dysfunction.Methods From October 2000 to February 2006, 31 patients (18 males, 13 females; age 23-62 years, averaged 36.4years) with serious subtalar joint osteoarthrisis and stage Ⅱ posterior tibial tendon dysfunction were treated by the subtalar arthrodesis. The tibial tendon dysfunction involved 15 right and 16 left lower extremities, which were caused by retrograde osteoarthritis in 14 patients,sequel of an injury in 8 patients, infection in 7 patients, and anatomic structural abnormity in 2 patients. The treatment course averaged 9.5 months (range, 6-30 months). Before the subtalar arthrodesis, the injured tendons were repaired, and then the bone grafting was performed in the tarsus sinus. All of the patients were assessed before and after operation according to the Hindfoot scores system (American Orthopedics Foot and Ankle Society, AOFAS). Results Among the patients, 28 were followed up on an average of 23.6 months (range, 8-61 months). The AOFAS scores ranged from 45.30±1.08 before operation to 79.60±2.14 afteroperation. The pain indexes ranged from 15.40±2.23 before operation to 38.50±2.61 after operation. The functional indexes of the foot and ankle joint ranged from averaged 21.60±3.01 before operation to averaged 37.40±2.83 after operation. The statistical analysis of the t-test on all the above data showed that there was a significant difference between beforeoperation and after operation (P＜0.01). The angles between the longitudinal line of the talar and the calcaneal bone were 43.70±1.06° before operation and 29.40±0.98° after operation, and the deviation angles between the calcanealline and the talus were 48.20±0.85° before operation and 39.40±1.02° after operation. There was a significant difference between before operation and after operation (P＜0.01). Conclusion The subtalar arthrodesis combined with the bone grafting in the tarsus sinus and the repair of the injured tendons can effectivelycorrect the deformity of the deformity of the metapodium, relieve the pain, retin the adjacent joint motion ability, and this method can be recommended for the adult patient who suffers from serious subtalar osteoarthritis and stage Ⅱ osterior tibial tendon dysfunction.
Objective To review the research progress of C terminal propeptide of collagen type II (CTX-II), a osteoarthritis (OA) biomarker. Methods Domestic and international l iterature about CTX-II was reviewed extensively and summarized. Results CTX-II is investigated broadly and has the best performance of all currently available biomarkers. CTX-II is a truly useful biomarker for early diagnosis, prognosis, and measurement of treatment response in OA. Conclusion Single CTX-II may be not sufficient for early diagnosis and prognosis of OA, so a combination of CTX-II and other biomarkers or diagnosis methods is needed.
OBJECTIVE To present a simple and reliable method for the reconstruction of metacarpophalangeal joint by the cartilage transplantation of metatarsophalangeal joint. METHODS From 1990, nine cases (11 sides) with traumatic metacarpophalangeal joint defect were treated by the autogenous cartilage transplantation of metatarsophalangeal joint followed by modified treatment. Appropriate biological mechanics was provided by internal fixation and collateral ligament repair. RESULTS Followed up 6 months to 7 years, the range of joint motion was increased 35.1 degrees. The fusion of donor phalanges was fine, and the range of joint motion was decreased, even ankylosis after plastic operation, but no pain and no effect on walk. CONCLUSION The key to successful operation is better matching of cartilage, reliable internal fixation, ligament reconstruction, thin cartilage and little bone of the donor, appropriate biological mechanical surroundings.
Objective To assess the effect of medial distal femoral osteotomy combined with interlocking nailing on the treatment of knee osteoarthritis with valgus deformity. Methods From May 1996 toAugust 2000, 16 patients with knee osteoarthritis accompanied by valgus deformity were treated by medial wedged distal femoral osteotomy combined with interlocking nailing. Full-length radiographs were taken before operation and 8 weeks and 2 years after operation. The parameters, including the femorotibial angle, the tibial angle, the femoral angle, the femoral condyletibial plateau angle, and the lateral joint space, were measured by these radiographs. The function of knee was evaluated by the 100 point rating scale standard of knee. Results The mean postoperative score was significantly improved from 50.4±15.9 points to 78.5±12.9 points 2 years after the surgery. The lateraljoint space was increased from 2.1±1.8 mm to 4.7±1.7 mm and the femoral condyletibial angle decreased from 5.6±2.9° to 1.6±3.4°. There were complications in 2 cases: 1 case of delayed union and 1 case of superficial wound infection. Conclusion Medial distal femoral osteotomy combined with interlocking nailing proves to be an effective approach to treat knee osteoarthritis with valgus deformity.
ObjectiveTo summarize the research progress of pathological manifestations and mechanism of endochondral ossification in osteoarthritis (OA). MethodsThe literature about endochondral ossification, bone-cartilage remodeling in OA, and joints development was reviewed, analyzed, and summarized. ResultsChondrocyte hypertrophy and apoptosis, vascular invasion, replication of the tidemark, thickening calcified cartilage, and thinning superficial cartilage are the characteristics of cartilage degeneration in OA. Articular cartilage and growth plate are similar in structure, and cartilage degeneration in OA is similar to a process of endochondral ossification of the growth plate. ConclusionLoss of stability characterization from resting metabolic balance to a high conversion state of temporary cartilage in stimulation of abnormal mechanical stresses and cytokines would subsequently contributed to continual calcification and remodeling of articular cartilage, which may be the key link of the initiation and development of OA.
Objective To evaluate the clinical results of cementless total hip replacement (THR) in treating osteoarthritis and identifying the factors affecting the results. Methods From January 1995 to December 1999, 76 patients(85 hips) with osteoarthritis of hip joint were treated. These patients were assessed according to Harris hip score and X-ray film. The average follow-up time was 49.3 months. Results The average Harris score in the patients was 90.9 points. The excellent or good rate was 91.9%(75/85). Pain in the thigh existed in 23 hips (27.5%). The femoral osteolysis occurred in 14 hips(16.5%). The radiographical result demonstrated femoral loosening in 2 hips. harris score became lower when the femoral component of osteoarthritis of hip jointl. Pain in the thigh may be related to the varus placement of femoral component and femoral osteolysis. Femorla osteolysis is one of important factors affectin the long-term outcomes.
【Abstract】 Objective To evaluate the flexibil ity of the treatment of osteoarthritis secondary to acetabular dysplasiaby total hip arthroplasty (THA) , in which the acetabular component is placed in the true acetabulum and femoral osteotomy is not performed. Methods From January 1999 to December 2005, 35 THA procedures were performed in 32 patients with 35 hips, including 6 males with 7 hips and 26 females with 28 hips, with the average age of 53 years (ranging from 28 years to 72 years). On the basis of Crowe classification, type I included 10 patients with 11 hips, type II included 14 patients with 15 hips, type III included 5 patients with 6 hips, and type IV included 3 patients with 3 hips. All patients experienced severe pain and dysfunction. In 19 cases, the leg length discrepancy was from 3 cm to 6 cm. The Harris score was 41.49 ± 10.13 before the operation. In all procedures, the soft tissue was released entirely and the acetabular component was placed in the true acetabulum, but femoral osteotomy was not performed. Results The average operation time of unilateral THA was 50 minutes. All patients were given transfusion from 2 U to 4 U. All incisions healed at the first stage. After the operation, the leg was lengthened 2-6 cm, and the two legs were equally long. The follow-up lasted for 12 to 60 months. The Harris score was 84.71 ± 9.34 after the operation, showing statistically significant differece (P lt; 0.05). According to cl inical outcomes and X-ray films, no dislocation, femoral fracture, femoral or sciatic nerve palsy was detected. Conclusion It is effective to use THA procedures for osteoarthritis secondary to acetabular dysplasia. If the soft tissue is released entirely, the leg will be lengthened 4-6 cm without nerve palsy.
Objective To evaluate the results of rotational acetabular osteotomy (RAO) combined with debridement under arthroscope in the treatment of adult developmental dysplasia of the hip (DDH). Methods Between April 2002 and August 2007, 24 cases (29 hips) of DDH were treated with RAO combined with debridement under arthroscope. There were 2 males (2 hips) and 22 females (27 hips) with an average age of 37.7 years (range, 21-50 years). The locations were the left hip in 7 cases, the right hip in 12 cases, and both hips in 5 cases. The course of hip pain was 8-216 months (median, 30.5 months). According to Crowe DDH classification, there were 24 hips of type I and 5 hips of type II. According to Touml;nnis hip osteoarthritis classification, there were 20 hips of stage I and 9 hips of stage II. Results The mean operation time was 150 minutes (range, 120-180 minutes); the mean intraoperative blood loss was 600 mL (range, 500-700 mL); and the mean postoperative drainage volume was 200 mL(range, 50-400 mL). All incisions healed by first intention. Twenty-four cases were followed up 4.5 years on average (range, 3-8 years). At last follow-up, claudication disappeared in 16 hips and was improved in 8 hips. The Harris hip score was improved from 79.4 ± 9.8 preoperatively to 95.1 ± 8.6 postoperatively, showing significant difference (t=2.467, P=0.010). The visual analogue scale (VAS) score was improved from 5.1 ± 0.8 preoperatively to 1.1 ± 0.6 postoperatively, showing significant difference (t=2.118, P=0.011). The X-rayfilms showed union was achieved at 12-16 weeks (mean, 13.5 weeks). There were significant differences in the centre edge angle, Sharp angle, acetabular coverage rate, and acetabulum-head index between preoperation and postoperation (P lt; 0.05). Twenty hips at Touml;nnis stage I maintained after operation, among 9 hips at Touml;nnis stage II, 5 hips was improved to stage I and 4 hips maintained. Conclusion It has a satisfactory result to treat adult DDH by RAO combined with debridement under arthroscope, which may increase the congruency of hip joint, delay or prevent the progression of hip osteoarthritis.
Objective To investigate the rotational mismatch of total kneereplacement with medial 1/3 of tibial tuberosity as bony landmark in osteoarthritic patients with varus or valgus deformity. Methods Axial images on computed tomography of 62 knees (including 55 varus deformities and 7 valgus deformities) in 32 Chinese osteoarthritic patients who had total knee arthroplasty were analyzed, compared with that of 10 healthy knees. On images of the distal femur, the angle between the lines of surgical epicondylar axis(SEA) and posterior condylar axis was measured as posterior condylar angle (PCA), and on images of the proximal tibia, a baseline for the anteriorposterior axis of each component was drawn based on the SEA for the femur and the medial 1/3 of the tibial tuberosity for the tibia. The angle between these lines (Angle α) was defined as therotational mismatch between the components when they were aligned to the anatomic landmarks of each bone. Results The sulcus of medial epicondyle of femur could be identified on CT images of over 80% osteoarthritic knees; the median value of PCA was +2.36°, with an individual variation of 0° to +7.5°. Angle α was +6.45±3.68°(range, 0° to +11.8°) in 10 healthy knees, which increased significantly to +10.85±10.47°(range, 0° to +28.1°)in 55 varus knees (P＜0.05), which also increased significantly to +11.6±7.3°(range, -6.5° to +26.8°) in 7 valgus knees (P＜ 0.05). Conclusion With the medial 1/3 of the tibial tuberosity as the rotational landmark for the tibial component, there was a tendency to align the tibial component in external rotational position relative to the femoral component in knees with normal alignment, the rotational mismatch increased in Chinese osteoarthritic knees with varus and valgus deformity.
Objective To review the effect of calcitonin on cartilage and subchondral bone of osteoarthritis. Methods Recent l iteratures about the effect of calcitonin on osteoarthritis was reviewed. Results Calcitonin could promotethe synthesis of important cartilage matrix such as proteoglycans and collagen II, propell ing the regeneration of cartilage and subchondral bone. Conclusion Calcitonin can protect articular cartilage through promoting the synthesis of cartilage and inhibiting its degradation.