目的 探讨前路小切口顶椎切除联合后路矫形手术治疗重度僵硬性脊柱侧凸的可行性及疗效。 方法 2009 年7月－2010年9月，采用前路小切口顶椎切除联合后路矫形手术治疗重度僵硬性脊柱侧凸18例。其中男9例，女9例，年龄10～24岁，平均14.5岁。其中15 例特发性脊柱侧凸（Lenke 2型6例，Lenke 3型1例，Lenke 4型8例），2 例脊髓空洞合并脊柱侧凸，1 例Chiari畸形合并脊柱侧凸。术前剃刀背高度（6.8 ± 2.3）cm，主胸弯Cobb角（99.6 ±10.0）°，主胸弯顶椎偏距（7.3 ± 1.3）cm。 结果 前路手术切口10～13 cm，平均（11.4 ± 1.0）cm；前路手术时间170～300 min，平均（215.3 ± 36.8）min；失血量300～1 300 mL，平均（662.5 ± 274.8） mL。所有患者随访25～39个月，平均30.7个月。末次随访时，剃刀背高度（1.0 ± 0.6）cm，矫正率86.7%；主胸弯Cobb角（31.4 ± 11.4）°，矫正率68.7%；主胸弯顶椎偏距（2.2 ± 0.9） cm，矫正率69.6%。上胸弯、胸腰弯/腰弯的Cobb 角及顶椎偏距亦明显矫正，冠状面及矢状面平衡与术前相比，差异无统计学意义（P＞0.05）。未发生神经系统并发症，1例患者在前路手术后入ICU行呼吸支持治疗12 h，1例患者出现椎弓根螺钉穿透椎弓根上壁，2例患者出现钛网位置不佳，随访未见钛网位置改变。 结论 采用前路小切口顶椎切除联合后路矫形治疗重度僵硬性脊柱侧凸安全可行，矫形效果满意。
Objective To investigate the safety, efficacy and morbidity of onestage urethroplasty by using bladder mucosa for treatment of hypospadias. Methods From August 1991 to August 2003, 38 cases of congenital hypospadias were given bladder mucosa flap procedure and one stage urethroplasty. Results Thirty-eight cases of hypospadias treated with one stageurethroplasty by using bladder mucosa were followed up 6 months-9 years afterthe procedure. The success rate of the operation was 95%. Three cases of urethral fistula after the procedure were surgically repaired again, 2 cases of urethral stricture recovered after distension. The complication markedly lessened, micturation became normal with the reconstructed meatussituated at the proper site on the glands. Conclusion one stage urethroplastyby using bladder mucosa for treatment of hypospadias is a simple, effective andsafe surgery.
【Abstract】 Objective To observe the effectiveness of limited operations and Ilizarov techniques for correction of congenital clubfoot (CCF) in adolescents, and to explore the new methods and new ideas for functional reconstruction of CCF. Methods Between September 2003 and July 2010, 25 adolescent patients (40 feet) with CCF were treated. Of the 25 patients, 14 were male (20 feet) and 11 were female (20 feet) with an age range from 12 to 25 years (mean, 15.7 years). The left feet were involved in 4 cases, the right feet in 6 cases, and both feet in 15 cases. According to Qin’s clubfoot deformity scale, 9 feet were rated as degree I, 17 feet as degree II, and 14 feet as degree III. In these cases, 9 feet were accompanied by internal rotation deformities of crus and 1 case by subluxation of right hip joint. After soft tissue release and osteotomy, 9 feet (degree I) were fixed by composite external fixation instruments, 31 feet by Ilizarov external fixation instruments. The deformity was corrected from 5 to 7 days after operation with distraction of 0.5-1.0 mm/d, then distraction stopped when the ankle was corrected at a hyperextension of 5 to 10° and light valgus. The affected limb might undergo weight bearing walking with external fixation at corrected position for 4 to 6 weeks. If one had both feet deformity, staged operation should be performed with a surgery interval of 3 to 6 months (mean, 4 months). Results The fixation time was 6-12 weeks (mean, 8 weeks) in 9 feet fixed by composite external fixation instruments, and it was 6-17 weeks (mean, 13 weeks) in 31 feet fixed by Ilizarov external fixation. All 25 patients were followed up 8 months to 6 years with an average of 37 months. During distraction process, slight pin track infection occurred in 6 cases (6 feet), which were cured after expectant management. One patient had recurrence of the deformity at 2 years postoperatively, who obtained satisfactory correction after Ilizarov external fixation for 4 weeks. The satisfactory correction and foot function were achieved in the other feet with walking on full weight-bearing. According to International Clubfoot Study Group (ICFSG) score, the results were excellent in 28 feet, good in 10 feet, and fair in 2 feet, with an excellent and good rate of 95% at last follow-up. Conclusion Combined limited operation with Ilizarov technique for correcting adolescent CCF is accord with biology principle and minimally invasive surgical principle, so it is a safe，minimally invasive, and effective method. It also can broaden the operative indications and correct degree III talipes equinovarus which is unattainable by traditional orthopedic surgery.
ObjectiveTo summarize the effectiveness of limited orthopedic surgery combined with external fixation for the treatment of lower extremity sequelae of middle and old aged post-poliomyelitis, and then to explore the strategy of surgical correction and functional reconstruction method.MethodsFrom the database of 23 310 cases of poliomyelitis sequelae treated by QIN Sihe Orthopaedic Surgical team between September 1982 and December 2017, 629 patients over 41 years old were retrieved and the epidemiological characteristics of the patients were analyzed. Between March 2011 and June 2015, 57 patients with poliomyelitis sequelae treated with limited operation and external fixation were followed up 2-6 years, and the history of poliomyelitis sequelae was 41-67 years (mean, 47.1 years). Preoperative histopathological gait included 29 cases of quadriceps gait, 17 cases of walking with crutch, and 11 cases of claudication only. The operative methods included Achilles tendon lengthening in 52 cases, supracondylar osteotomy in 39 cases, knee flexion release in 36 cases, calcaneal arthrodesis in 27 cases, flexion and hip arthrodesis in 21 cases, tibia and fibula osteotomy in 19 cases, triple arthrodesis in 11 cases, and tendon transposition in 1 case. After operation, 18 cases were treated with combined external fixator and 39 cases with Ilizarov ring external fixator.ResultsOf the 629 cases, 481 cases were less than 50 years old (76.47%), accounting for 144 cases between 51 and 65 years old (22.89%). Among them, 495 cases (78.70%) were diagnosed after 2003. Of the 57 patients obtained complete follow-up information, 7 had slight infection of needle path during traction orthopaedics, 2 had early postoperative venous thrombosis of lower extremities, and 2 had incomplete paralysis of the common peroneal nerve. There was no complications such as skin incision infection, vascular injury, and bone nonunion. According to the evaluation standard of postoperative efficacy standard in correction of lower extremity deformities, the results were excellent in 23 cases, good in 20 cases, fair in 12 cases, and poor in 2 cases, with an excellent and good rate of 75.44%. The 2 patients with poor effectiveness were reoperated to improve their function.ConclusionLimited orthopedic surgery combined with external fixation for the treatment of lower extremity sequelae of middle and old aged post-poliomyelitis can effectively correct deformities of lower limbs, improve function, delay the disability aggravated by decay, and avoid serious complications.
Objective Currently, there are few researches on lordosis associated with scol iosis. To explore the effects of nickel-titanium memory alloy staple (Staple) on the growth of thoracic lordosis by observing the histological changes of cartilage cells in the osteoepiphysis of the thoracic vertebrates in goats. Methods Eighteen 2-3 months old female goats, weighing 8-12 kg, were randomly divided into long staple group (n=6), short staple group (n=6), and blank control group (n=6). Long staple (7 mm) and short staple (4 mm) were implanted into T6-11 segments of goats in long and short staplegroups by anterior approach, respectively. The blank control group was not treated. The X-ray examination was performedpre-operatively and at 3 months post-operatively to observe the changes of Cobb angle. Then the growth plates and inferior facet processes of the apex vertebral body were harvested to observe the histological grades of cartilage by HE staining, and to observe prol iferation and apoptosis of chondrocytes through immunohistochemistry double label ing staining with poly-ADPribose- polymerase-p85 and prol iferating cell nuclear antigen. Results At 3 months after operation, the T6-11 Cobb angles were significantly higher than those of pre-operation in short staple group and long staple group, which were significantly higher than those in blank control group (P lt; 0.05), but there was no significant difference between short staple group and long staple group (P gt; 0.05). The results of HE staining and immunohistochemistry double staining showed that the number of chondrocytes were reduced obviously with irregular columnar arrangement and increased volume ratio of surrounding extracellular matrix in prol iferative zone and hypertrophic zone of growth plate and inferior articular process in both long and short staple groups, and this tendency was more noticeable in long staple group. There were significant differences in the grades of prol iferation viabil ity of chondrocytes between 2 staple groups and blank control group (P lt; 0.05), but there was no significant difference tewteen long staple group and short staple group (P gt; 0.05). The prol iferation viabil ities of chondrocytes in growth plate and inferior articular process were significantly higher in blank control group than in 2 staple groups (P lt; 0.01), but there was no significant difference between long staple group and short staple group (P gt; 0.05). Conclusion The histological evidences prove that the Staple implantation by anterior approach can reduce prol iferation viabil ity of chondrocytes in growth plate and inferior articular process of the thoracic vertebrates in goats, which conduces the growth direction of thoracic vertebrates to kyphosis.
Objective To assess the outcomes of pedicle subtration osteotomy and short-segment pedicle screw internal fixation in kyphosisdeformity. Methods From June 2001 to November 2003, 16 cases of kyphosis deformity were treated with pedicle subtration osteotomy and short-segment pedicle screw internal fixation, including 11 males and 5 females and aging 24-51 years. The kyphosis deformity was caused by ankylosing spondylitis in 12 cases, old lumbothoracic fracturedislocation in 2 cases, and vertebral dysplasia in 2 cases. The disease course was 7-25 years with an average of 12.8years. The whole spine radiographs were taken pre-and postoperatively. The sagittal balance was assessed by measuring thoracic kyphosis angle, lumbar lordosis angle, acrohorizontal angle and distance between posterosuperior point of S1and the vertical line. The clinical outcomes were assessed by Bridwell-Dewald scale for spinal disorders. Results The mean follow-up period was25.6 months. The mean bleeding was 1 100 ml. Satisfactory bone graft healing was achieved at final follow-up. Complications were paralytic intestinal obstruction in 1 case, dura laceration in 1 case, and temporary lower limb paralysis in 2 cases. Final follow-up radiograph showed an increase in lumbar lordosis angle from 9.6±16.4° to 42.6±14.3°(P＜0.05), whereas thoracic kyphosis angle remained relative stable. The distance between posterosuperior point of S1 and the vertical line was decreased from 97.5±45.6 mm to 10.7±9.6 mm(P＜0.05). Satisfactory clinical outcome was achieved by evaluating the changes of pain, social and working status. Conclusion Pedicle subtraction osteotomy and short-segment pedicle screw internal fixation is effective for correction of kyphosis deformity.
Objective To discuss the mechanisms and clinical effect of musculus extensor hallucis longus shifting in correcting hallux valgus (HV) deformity. Methods From April 2004 to December 2006,25 cases of HV (38 feet) were treated by musculus extensor hallucis longus shifing. There were 2 men and 23 women, aging from 22-60 years (mean 46.3 years).HV angle was 21.45° (mean 31.30°), intermetatarsal(IM) angle was 7-21° (mean 12.52°). The HV were corrected by cutting osteophyma of the first metatarsal bone, cutting transverse head of adductor pollicis, transferring musculus extensor hallucis longus and reconstructing its insertion. Results The patients were followed up 6-14 months after operation. HV angle and IM angle were 7.30°±2.62° and 6.50°±2.46° respectively, showing significantdifferences when compared with before operation (Plt;0.05). According to the American Orthopaedic Foot amp; Ankle Society (AOFAS) score system, the foot function was excellent in 25 feet, good in 7 feet and poor in 6 feet,and the excellent and good rate was 84.2%. Hallux varus occurred in 2 feet after 2 months of operation, metatarsophalangeal joint limitation of motion in 2feet after 3 months of operation, no HV recurred. ConclusionThe HV deforemity can be corrected by shifting the musculus extensor hallucis longus and reconstructing its insertion. It makes stress of metatarsophalangeal joint balance and prevent recurrance of HV deformity.
Objective To review the King-types Ⅲ and Ⅳ patients treated by the CD hybrid technique and evaluate clinical results on the shorter fusion levels. Methods Fifty-eight patients with idiopathic scoliosis were treated by the CD hybrid method from March 2000 to January 2003, among whom 40 were grouped as Kingtype Ⅲ and 18 as Kingtype Ⅳ; 41 were female and 17 were male. The Cobb angle of the thoracic curve was averaged 64°(range 50-83°), and the curve flexibility was 62%. The compensative lumbarcurve was averaged 37°（range 16-48°）, and the curve flexibility was 105%. With the neutral rotational vertebrae as a basis to select the low instrumentation vertebrae, the neutral rotational vertebrae or the vertebrae at 1 or 2 levelsproximal to the neutral rotational vertebrae were selected as the low instrumentation vertebrae in all the patients. Standing AP and lateral radiographs were taken respectively at the discharge, during the follow-up after discharge, and at the final follow-up. Results The patients were followed up for an average of 2.4 years (range 1.8-3.2). The corrected curves lost an average of 3.1°（range -1-5°）and the correction rate of the thoracic curve was 68% at the final follow-up.The plumbline from C7 was parallel to the sacral midline in 56 patients. The lumbar curves were corrected to an average of 8°（2-13°）automatically. The lumbosacral angle was corrected automatically by 53% and the low instrumentation vertebrae in 48 patients turned into stable vertebrae. The low instrumentation vertebrae lost 1.4 segments on average compared with the Harrington principle. No spinal imbalance was clinically observed in all the patients. Conclusion The choice of the low instrumentation vertebrae as the neutral rotational vertebrae can have a good result in the clinical practice. It can be applied in the CD hybrid technique in treatment of idiopathicthoracic curves.
A micro silicone oil liquid spring was designed and manufactured in this article. The performance of the liquid spring was studied by simulation analysis and mechanical test. A self-force source power-assisted knee orthosis was designed based on the liquid spring. This power-assisted knee orthosis can convert the kinetic energy of knee flexion into the elastic potential energy of liquid spring for storage, and release elastic potential energy to generate assisted torque which drives the knee joint for extension. The results showed that the average maximum reset force of the liquid spring was 1 240 N, and the average maximum assisted torque for the knee joint was 29.8 N·m. A musculoskeletal multibody dynamic model was used to analyze the biomechanical effect of the knee orthosis on the joint during knee bending (90°knee flexion). The results showed that the power-assisted knee orthosis could effectively reduce the biomechanical load of the knee joint for the user with a body weight of 80 kg. The maximum forces of the femoral-tibial joint force, patellar-femoral joint force, and quadriceps-ligament force were reduced by 24.5%, 23.8%, and 21.2%, respectively. The power-assisted knee orthosis designed in this article provides sufficient assisted torque for the knee joint. It lays a foundation for the subsequent commercial application due to its small size and lightweight.