ObjectiveTo investigate the effectiveness of soft tissue balance technique by flexor pollicis longus (FPL) tendon transfer for Wassel Ⅳ-D thumb duplication in children. Methods A clinical data of 14 children with Wassel Ⅳ-D thumb duplication met the selection criteria between January 2017 and January 2021 was retrospectively analyzed. There were 5 boys and 9 girls with an average age of 21.6 months (range, 18-35 months). Ten cases were left hand deformity and 4 cases were right hand deformity. During operation, the radial thumb was excised, and the FPL tendon of the radial thumb was used to reconstruct the soft tissue balance of the ulnar thumb. Postoperative evaluation included the range of motion (ROM) of passive flexion and extension of the interphalangeal joint (IP) and metacarpophalangeal joint (MCP), the alignments of the IP and MCP, the percentage of the width of the nail plate and the circumference of the thumb at the level of the IP to contralateral thumb. Results All operations were completed successfully, and all incisions healed by first intention. The children were followed up 12-36 months (mean, 21.7 months). At last follow-up, the ROM of passive flexion and the deviation of the IP, and the deviation of the MCP significantly improved when compared with those before operation (P<0.05); the ROM of passive extension of the IP and the ROM of passive flexion of the MCP did not significantly improve when compared with those before operation (P>0.05). The ROMs of passive extension of the MCP were 0° before and after operation. The width of the nail plate was 76.6%±4.1% of the unaffected side, and the circumference of the thumb at the level of the IP was 92.0%±9.1% of the unaffected side. ConclusionThe soft tissue balance technique by FPL tendon trasfer can effectively correct the alignment of the Wassel Ⅳ-D thumb duplication in children, and maintain the correction effect effectively, but further follow-up and comprehensive evaluation are needed to investigate the long-term effectiveness.
Objective To analyze formation of the varus angle of the knee dueto osteoarthritis and to explore techniques of the soft tissue balance in the total knee arthroplasty(TKA). Methods One hundred patients with145 varus knees (18 males, 25 varus knees; 82 females, 120 varus knees) underwent TKA from January 1999 to December 2003. Their ages averaged 62.4 years (range, 45.80 years), and their HSS（hospital of special surgery）scores were 38.0±3.2 points. Before operation，all the patients were measured in the alignment of the lower extremity, accurate bonecutting was performed, and their static alignment was achieved. Then, the soft tissue release was made. The release performance consisted of 3 steps: release before the bone-cutting, release during the bone-cutting, and release after the bonecutting. Release of themedial ligament and capsule, elimination of the osteophytes, and release of thelateral patellar retinaculum were more important. Results The varus angles in these patients were 9.2±3.1° before operation. Among them,the varus angles caused by the soft tissue imbalance accounted for 53.2%，and caused by the bone structure accounted for 46.8%； and the latter caused by thetibia varus, 22.8%, and by the tibia plateau destruction, 24.0%. There was nosignificant difference between the varus angles caused by the soft tissue imbalance and the varus angles caused by the bone structure deformity (P＞0.05). According to the postoperative imaging studies, the correction degree for the varus angles by the bone-cutting was 4.3°, which represented 27.9% of the total corrected angles, and the correction degree for the varus angles corrected by the soft tissue balance was 10.7°, which represented 72.1% of the total corrected angles. The HSS scores were 87.0±4.5 points after operation, and the difference between preoperation and postoperation was significant. Conclusion The varus knee due to osteoarthritis results from the varus angle in the bone structure and the angles caused by the imbalance of the collateral ligaments and the soft tissues around the knee. The latter causative factor is more important in the formation of the varus knee and should only be corrected through the soft tissue release. The more important part to be released isthe attachments of the medial ligament and the posterior capsule. The release performance should be followed by the principles, i.e., step by step, tests at all the time, and avoidance of the excessive release.
Abstract: Objective To investigate the clinical effect of using zerobalanced ultrafiltration on postoperative lung function of coronary artery bypass grafting (CABG) patients under cardiopulmonary bypass (CPB). Methods Forty coronary artery bypass grafting patients in the First Affiliated Hospital of China Medical University from June 2006 to December 2008 were enrolled in this study, and were divided into two groups based on different ultrafiltration procedures. Patients in the experimental group (n=20), 14 males and 6 females, with an age of 65.43±8.31 years, underwent zerobalanced ultrafiltration and conventional ultrafiltration after CPB was carried out. Patients in the control group (n=20), 15 males and 5 females, with an age of 66.51±7.62 years, only underwent conventional ultrafiltration after temperature restoration. Preoperative pulmonary function and arterial blood gas were tested routinely. Airway resistance (Raw), oxygenation index (OI) and alveolar arterial oxygen difference ［P(Aa)O2］ were measured at the following points: before CPB, at the end of CPB, 6 hours, and 12 hours after operation. Postoperative mechanical ventilation time was also recorded. Results There was no significantly statistical difference between the two groups of patients in pulmonary function and arterial blood gas indexes before operation, and Raw, OI and P(Aa)O2 before CPB (Pgt;0.05). Nevertheless, at the points of 6 hours and 12 hours after operation, Raw ［2.22±0.31 cm H2O/(L·s) vs. 2.94±0.42 cm H2O/(L·s), F=0.061, Plt;0.05; 1.89±0.51 cm H2O/(L·s) vs. 2.52±0.29 cm H2O/(L·s), F=0.096, Plt;0.05］ and P(Aa)O2 (86.74±7.63 mm Hg vs. 111.66±7.49 mm Hg, F=0.036, Plt;0.05; 74.82±5.67 mm Hg vs. 95.23±6.78 mm Hg, F=0.059, Plt;0.05) of patients in the experimental group were significantly lower than those of patients in the control group. At the same points, OI of patients in the experimental group was significantly higher than that of patients in the control group (384.33±30.67 vs. 324.63±31.22, F=0.033, Plt;0.05; 342.24±23.43 vs. 293.67±25.44, F=0.047, Plt;005). Ventilator support time of the experimental group was shorter than the control group (15.44±3.93 h vs. 20.68±5.77 h,Plt;0.05). Conclusion Zerobalanced ultrafiltration can improve pulmonary function after coronary artery bypass grafting and shorten postoperative mechanical ventilation time.
ObjectiveTo explore the risk factors of coronal imbalance after posterior long-level fixation and fusion for degenerative lumbar scoliosis.MethodsRetrospectivly analyzed the clinical records of 41 patients with degenerative lumbar scoliosis who had received posterior long-level fixation and fusion with selective transforaminal lumbar interbody fusion (TLIF) accompanied by Ponte osteotomy between August 2011 and July 2016. Patients were divided into imbalance group (group A, 11 cases) and balance group (group B, 30 cases) according to state of coronal imbalance measured at last follow-up. The radiographic parameters at preoperation and last follow-up were measured, and the variance of preoperative and last follow-up parameters were calculated. The radiographic parameters included coronal Cobb angle, coronal balance distance (CBD), apical vertebral translation (AVT), apical vertebral rotation (AVR), Cobb angle of lumbar sacral curve (LSC), and L5 tilt angle (L5TA). Univariate analysis was performed for the factors including gender, age, preoperative T value of bone mineral density, number of instrumented vertebra, upper and lower instrumented vertebra, segments of TLIF, decompression, and Ponte osteotomy, as well as the continuous variables of preoperative imaging parameters with significant difference were converted into two-category variables, obtained the influence factors of postoperative coronal imbalance. Multivariate logistic regression analysis was performed to verify the risk factors from the preliminary screened influence factors and the variance of imaging parameters with significant difference between the two groups.ResultsThe follow-up time of groups A and B was (3.76±1.02) years and (3.56±1.03) years respectively, there was no significant difference between the two groups (t=0.547, P=0.587). The coronal Cobb angle, AVT, LSC Cobb angle, and L5TA in group A were significantly higher than those in group B before operation (P<0.05), and all the imaging parameters in group A were significantly higher than those in group B at last follow-up (P<0.05). There was no significant difference between the two groups in parameters including the variance of coronal Cobb angle, AVT, and LSC Cobb angle before and after operation (P>0.05), and there were significant differences between the two groups in parameters including the variance of CBD, L5TA, and AVR (P<0.05). Univariate analysis showed that preoperative L5TA was the influencing factor of postoperative coronal imbalance (P<0.05). Multivariate logistic regression analysis showed that preoperative L5TA≥15° was an independent risk factor of postoperative coronal imbalance, and variance of pre- and post-operative AVR was a protective factor.ConclusionPreoperative L5TA≥15° is an independent risk factor for coronal imbalance in patients with degenerative lumbar scoliosis after posterior long-level fixation and fusion.
In order to develop safe training intensity and training methods for the passive balance rehabilitation training system, we propose in this paper a mathematical model for human standing balance adjustment based on T-S fuzzy identification method. This model takes the acceleration of a multidimensional motion platform as its inputs, and human joint angles as its outputs. We used the artificial bee colony optimization algorithm to improve fuzzy C-means clustering algorithm, which enhanced the efficiency of the identification for antecedent parameters. Through some experiments, the data of 9 testees were collected, which were used for model training and model results validation. With the mean square error and cross-correlation between the simulation data and measured data, we concluded that the model was accurate and reasonable.
The judgment of the type of arrhythmia is the key to the prevention and diagnosis of early cardiovascular disease. Therefore, electrocardiogram (ECG) analysis has been widely used as an important basis for doctors to diagnose. However, due to the large differences in ECG signal morphology among different patients and the unbalanced distribution of categories, the existing automatic detection algorithms for arrhythmias have certain difficulties in the identification process. This paper designs a variable scale fusion network model for automatic recognition of heart rhythm types. In this study, a variable-scale fusion network model was proposed for automatic identification of heart rhythm types. The improved ECG generation network (EGAN) module was used to solve the imbalance of ECG data, and the ECG signal was reproduced in two dimensions in the form of gray recurrence plot (GRP) and spectrogram. Combined with the branching structure of the model, the automatic classification of variable-length heart beats was realized. The results of the study were verified by the Massachusetts institute of technology and Beth Israel hospital (MIT-BIH) arrhythmia database, which distinguished eight heart rhythm types. The average accuracy rate reached 99.36%, and the sensitivity and specificity were 96.11% and 99.84%, respectively. In conclusion, it is expected that this method can be used for clinical auxiliary diagnosis and smart wearable devices in the future.
ObjectiveTo explore the effect on sagittal spine-pelvis balance of different fusion segments in anterior cervical discectomy and fusion (ACDF).MethodsThe clinical data of 326 patients with cervical spondylotic myelopathy, treated by ACDF between January 2010 and December 2016, was retrospectively analysed. There were 175 males and 151 females with an average age of 56 years (range, 34-81 years). Fusion segments included single segment in 69 cases, double segments in 85 cases, three segments in 90 cases, and four segments in 82 cases. Full spine anterolateral X-ray films were performed before operationand at 12 months after operation. The spine-pelvis parameters of fusion segments were measured and compared. The parameters included C0-2 Cobb angle, C2-7 Cobb angle, C2-7 sagittal vertical axis (C2-7 SVA), T1 slope (T1S), thoracic inlet angle (TIA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), C7 sagittal vertical axis (C7 SVA), T1 pelvic angle (TPA). The Japanese Orthopaedic Association (JOA) score of cervical spine and visual analogue scale (VAS) scores of pain of cervical spine and upper extremity were compared before operation and at 12 months after operation. Pearson correlation analysis was performed on LL, PI, SS, C7 SVA, and TPA before and after operation to evaluate the changes of spine-pelvis fitting relationship after ACDF.ResultsAll 326 patients were followed up 12-32 months (mean, 18.5 months). During the follow-up period, internal fixator was in place, and no spinal cord nerve or peripheral soft tissue injury was found. JOA scores and cervical VAS scores improved significantly at 12 months after operation (P<0.05), no significant difference was found in VAS scores of upper extremity when compared with preoperative scores (P>0.05). The preoperative cervical VAS scores and the postoperative JOA scores at 12 months had significant differences between groups (P<0.05). At 12 months after operation, there was no significant difference in sagittal spine-pelvis parameters in the single segment group compared with preoperative ones (P>0.05); but the C0-2 Cobb angle, C2-7 Cobb angle, C2-7 SVA, T1S, TIA, C7 SVA, and TPA in the double segments, three segments, and four segments groups were significant larger than preoperative ones (P<0.05). The C0-2 Cobb angle, C2-7 Cobb angle, T1S, C7 SVA, and TPA among 4 groups had significant differences before operation and at 12 months after operation (P<0.05). At 12 months after operation, the changes of C7 SVA and TPA in the double segments, three segments, and four segments groups were significantly larger than those in the single segment group (P<0.05). PI had positive correlations with LL and SS before and after operation in 4 groups (P<0.05).ConclusionNormal fitting relationship between lumbar spine and pelvis in physiological state also exists in patients with cervical spondylotic myelopathy, and ACDF can not change this specific relationship. In patients with cervical spondylotic myelopathy, the sagittal spine-pelvis sequence do not change after ACDF single-level fusion, while the sagittal spine-pelvis balance change after double-level and multi-level fusion.
This study systematically explores the assessment tools for balance function in elderly patients after total hip arthroplasty and their clinical applications, while also envisioning future trends toward multidimensional integration and intelligent development. By summarizing the commonly used subjective and objective assessment in clinical practice and analyzing the application of these methods in preoperative prehabilitation and postoperative rehabilitation monitoring for elderly total hip arthroplasty patients, this article proposes that future efforts should focus on promoting the integration of subjective and objective assessment, developing intelligent predictive models, and establishing closed-loop rehabilitation systems to enhance the precision and effectiveness of assessment and rehabilitation.
Aiming at the gait instability phenomenon under disturbed conditions, domestic and foreign scholars have done some research works, but the relationship between the independent balancing act with the surface electromyographic and gait parameters in the process of instability has yet rarely been involved. In this study, using the gait analysis combined with electromyographic signal analysis, we investigated balance adjustment mechanism of joints and muscles of the human lower limb under the condition of walking on the level trail and after foot heel touching the ground and unexpected sliding. Studying 10 healthy subjects with the unified shoes, we acquired and analyzed the changing rule of the lower limb joint torque, joint angle, and the surface electromyographic of the main muscle groups involved in situations of dry or oid trails. Studies showed that when accident sliding happened, the body would increase ankle dorsiflexion torque moment, knee unbend torque and straight angle, and meanwhile increase the torque of hip extension, and timely adjust muscle activation time (Followed by activation of Tibialis anterior muscle→Rectus femoris→Gastrocnemius→Femoral biceps) to adjust the center of gravity, to maintain balance of the body, and to avoid falling down. The results of the research could be used to explore new ideas and to provide a certain reference value for preventing slip damage, rehabilitation training and development of lower limb walker.
Nowadays, for gait instability phenomenon, many researches have been carried out at home and abroad. However, the relationship between plantar pressure and gait parameters in the process of balance adjustment is still unclear. This study describes the human body adaptive balance reaction during slip events on slippery level walk by plantar pressure and gait analysis. Ten healthy male subjects walked on a level path wearing shoes with two contrastive contaminants (dry, oil). The study collected and analyzed the change rule of spatiotemporal parameters, plantar pressure parameters, vertical ground reaction force (VGRF), etc. The results showed that the human body adaptive balance reaction during slip events on slippery level walk mainly included lighter touch at the heel strikes, tighter grip at the toe offs, a lower velocity, a shorter stride length and longer support time. These changes are used to maintain or recover body balance. These results would be able to explore new ideas and provide reference value for slip injury prevention, walking rehabilitation training design, research and development of walking assistive equipments, etc.