Objective To find out some parameters to judge the stability of the wrists after four-corner arthrodesis and to explore the strategyfor improving the range of motion (ROM) of the wrist after four-corner arthrodesis. Methods After the simulated four-corner arthrodesis was performed in both wrists of 8 men and 4 women cadaver, the wrists were fixed on the wrist motor simulator; and wrist movement including flexion, extension, radial deviation, ulnar deviation was simulated. The standard posteroanterior and lateral radiographs were taken for measuring the change of capitolunate angle（α）, radiolunate angle（β）, capitolunate posteroanterior angle（θ）, the height（H）and width（W）of the fused four carpal bone bloc. Results There were statistically significant differences in α,β,θ angles (P＜0.01) in the case of 50° flexion or 40° extension, and in H and W values (P＜0.05) in the case of 25° ulnar deviation or 15° radial deviation when compared with before movement. Conclusion Capitolunate angle, radiolunate angle, capitolunate posteroanterior angle, the height and the width of thefused four carpal bone bloc can be used to judge the stability of the wrists after four-corner arthrodesis.
A total of 12 cases of old facet dislocations of cervical spine treated between december 1988 and 1993 were analyzed in order to evaluate the efficacy of various surgical modalities. In this series, there were 8 males and 4 females, with ages ranged from 16 to 50 years old (averaged 37.8 years old). The duration from injury to admission to our hospital was ranged from 1 to 8 months (averaged 3.7 months). Dislocation levels were as follows: C3,4 in 1 case, C4,5 in 4 cases, C5,6 in 4 cases and C6,7 in 3 cases. Unilateral facet dislocation was in 7 cases and bilateral facet dislocation in 5 cases. Neurological status on admission was as follows: spinal cord and nerve root lesion in 5 cases, nerve root lesion alone in 5 cases and neurologically intact in 2 cases. Besides all facets receiving facetectomy and iliac bone graft, other four kinds of adjuvant treatments were used, including internal fixation by stainless wires laminae or spinous processes in 4 cases, Luque rod in 1 cases, anterior fibrolysis combined with posterior laminoplasty in 1 cases and sustained skull traction without internal fixation in 6 cases. The reduction efficacy from postoperative stustained skull traction was better and the stainless wires fixation ranked the next. The patients only suffering from the nerve root lesion recovered better, but those who had spinal cord combined with nerve root lesion recovered badly. In conclusion, for the treatment of old facet dislocation, it is necessary to resect the facet and graft with iliac bone.
Objective To evaluate the role of glenoid osseous structure on anterior stabil ity of shoulder so as to provide the biomechanical basis for cl inical treatment. Methods Ten fresh shoulder joint-bone specimens were collected from10 adult males cadavers donated voluntarily, including 4 left sides and 6 right sides. The displacements of the specimens were measured at 0° and 90° abduction of shoulder joint by giving 50 N posterior-anterior load under the conditions as follows: intact shoulder joint, glenoid l ip defect, 10% of osseous defect, 20% of osseous defect, and repairing osseous defect. Results For intact shoulder joint, glenoid l i p defect, 10% of osseous defect, 20% of osseous defect, and repairing osseous defect, the displacements were (10.73 ± 2.93), (11.43 ± 3.98), (13.58 ± 4.86), (18.53 ± 3.07), and (12.77 ± 3.13) mm, respectively at 0° abduction of shoulder joint; the displacements were (8.41 ± 2.10), (8.55 ± 2.28), (9.06 ± 2.67), (12.49 ± 2.32), and (8.55 ± 2.15) mm, respectively at 90° abduction of shoulder joint. There was no significant difference between intact shoulder joint and others (P gt; 0.05) except between intact shoulder joint and 20% of osseous defect (P lt; 0.05). Conclusion When shoulder glenoid l ip defects or the glenoid osseous defect is less than 20%, the shoulder stabil ity does not decrease obviously, indicating articular l igament complex is not damaged or is repaired. When glenoid osseous defect is more than 20% , the shoulder stabil ity decreases obviously even if articular l igament complex is not damaged or is repaired. Simultaneous repair of glenoid osseous defect andarticular l igament complex can recover the anterior stabil ity of the shoulder.
OBJECTIVE: To investigate the reparative and reconstructive method of post-traumatic lateral instability of the ankle. METHODS: From January 1992 to June 2000, 7 cases of male patients with ankle injury (aged 25-43 years) underwent Wetson-Jones modification. A bone tunnel was drilled through 2.5 cm upside the lateral malleolus tip and talus, and short peroneal tendon was cut to pass the tunnel to fix twining. RESULTS: All patients were followed up 2-10 years, 5 cases mineworkers changed to work on the ground, 2 patients returned to the original work, no traumatic arthritis occurred. According to Baird ankle joint scoring standard, the ankle function was excellent in all cases. CONCLUSION: Reformed Wetson-Jones modification can repair and reconstruct perfectly the traumatic instability of the ankle.
ObjectiveTo investigate the correlation between glenohumeral joint congruence and stability in recurrent shoulder dislocations. Methods Eighty-nine patients (89 sides) with recurrent shoulder dislocation admitted between June 2022 and June 2023 and met the selection criteria were included as study subjects. There were 36 males and 53 females with an average age of 44 years (range, 20-79 years). There were 40 cases of left shoulder and 49 cases of right shoulder. The shoulder joints dislocated 2-6 times, with an average of 3 times. The three-dimensional models of the humeral head and scapular glenoid were reconstructed using Mimics 20.0 software based on CT scanning images. The glenoid track (GT), inclusion index, chimerism index, fit index, and Hill-Sachs interval (HSI) were measured, and the degree of on/off track was judged (K value, the difference between HSI and GT). Multiple linear regression was used to analyze the correlation between the degree of on/off track (K value) and inclusion index, chimerism index, and fit index. ResultsMultiple linear regression analysis showed that the K value had no correlation with the inclusion index (P>0.05), and was positively correlated with the chimerism index and the fit index (P<0.05). Regression equation was K=–24.898+35.982×inclusion index+8.280×fit index, R2=0.084. ConclusionHumeral head and scapular glenoid bony area and curvature are associated with shoulder joint stability in recurrent shoulder dislocations. Increased humeral head bony area, decreased scapular glenoid bony area, increased humeral head curvature, and decreased scapular glenoid curvature are risk factors for glenohumeral joint stability.
Objective To investigate the effect of complete anterior bundle of medial collateral ligament (MCL) on the valgus stability of the elbow after reconstruction and to assess the efficacy of artificial tendon and interference screw in reconstruction the anterior bundle of MCL. Methods The bone-tendon of the elbow were made in 12 adult upper limb specimens. There were 8 males and 4 females, left side and right side in half. Using biomechanic ways and pressure sensitive film, the valgus laxity, the stress area of the humeroulnar joint, and the intra-articular pressure were measured in integrated anterior bundle of MCL (control group, n=12) and reconstructed anterior bundle of MCL with artificial tendon and interference screw (experimental group, n=12) in elbow flexion of 0, 30, 60, and 90°. Results There was no significant difference in the valgus laxity within group and between groups in different flexion degrees (P gt; 0.05). No significant difference was found in the intra-articular pressure in elbow flexion of 30, 60, and 90° within group and between groups (P gt; 0.05) except in elbow flexion of 0° (P lt; 0.05). The stress area of the humeroulnar joint in 0° flexion was significantly larger than that in 30, 60, and 90° flexion in the control group (P lt; 0.05), but no significant difference was found within group and between groups in the other flexion degrees (P gt; 0.05). Conclusion The anterior bundle of MCL has important significance for maintaining the valgus stability of the elbow, after reconstructing the anterior bundle by using artificial tendon and interference screw, the medial stability of elbow can be recovered immediately.
目的 通过对保留不同平面骶骨的新鲜人骨盆模型进行生物力学测试，分析骶骨切除平面与骨盆稳定性的关系，明确骶骨切除保留至何种程度时需行腰骶髂稳定性重建。 方法 选用6具正常成年男性新鲜尸体腰5-骨盆标本，采用200 N增量分级加载，以1.4 mm/min速率平稳加载直至1 000 N，依次测试保留完整骶骨及不同平面骶骨切除骨盆模型的最大主应力、剪切应力、位移及刚度变化，比较各组间的差异。最后测量1/2S1组骨盆环的极限载荷，记录骨折发生部位和骨折类型。 结果 随骶骨切除平面增高，最大主应力、剪切力及骶骨下沉位移在各测试点均有不同程度增大，骨盆的轴向刚度不断减小。当切除平面达骶1时，变化明显，尤其以经过骶1下1/4～下1/2时变化显著，与完整骶骨组比较，差异有统计学意义（P＜0.05）。骶1椎体下1/2平面切除后，骨盆的极限载荷是（2 375.97 ± 162.41）N，骨盆的破坏形态为经骶髂关节或骶椎的骨折。 结论 骶骨切除范围与骨盆环的稳定性密切相关，随着骶骨切除平面升高，残留骶髂关节各种应力急剧增高，骨盆的稳定性明显下降。当骶骨切除涉及骶1椎体时，极易发生骨折，需要进行腰骶髂局部重建以增强骶髂关节的稳定性。
Objective To evaluate of the valgus stability of the elbow after excision of the radial head, release of the medial collateral ligament (MCL), radial head replacement, and medial collateral ligament reconstruction.Methods Twelve fresh human cadaveric elbows were dissected to establish 7 kinds of specimens with elbow joint and ligaments as follow:①intact(n=12)； ②release of the medial collateral ligament(n=6)；③ excision of the radial head(n=6)；④excision of the radial head together with release of the medial collateral ligament(n=12)；⑤radial head replacement(n=6)；⑥medial collateral ligament reconstruction(n=6)；⑦radial head replacement together with medial collateral ligament reconstruction(n=12). Under two-newton-meter valgus torque, and at 0, 30, 60, 90 and 120 degrees of flexion with the forearm in supination, the valgus elbow laxity was quantified: All analysis was performed with SPSS 10.0 software.Results The least valgus laxity was seen in the intact state and its stability was the best. The laxity increased after resection of the radial head. The laxity was more after release of the medial collateral ligament than after resection of the radial head (Plt;0.01). The greatest laxity was observed after release of the medial collateral ligament together with resection of the radial head, so its stability was the worst. The laxity of the following implant of the radial head decreased. The laxity of the medial collateral ligament reconstruction was as much as that of the intact ligament (Pgt;0.05). The laxity of the radial head replacement together with medial collateral ligament reconstruction became less.Conclusion The results of this studyshow that the medial collateral ligament is the primary valgus stabilizer of the elbow and the radial head was a secondary constraint to resist valgus laxity.Both the medial collateral ligament reconstruction and the radial head replacement can restore the stability of elbow. If the radial head replacement can notbe carried out, the reconstruction of the medial collateral ligament is acceptable.
Objective To investigate the method and the cl inical outcomes of reconstruction of the knee stability after resection of tumors of the proximal fibula. Methods The cl inical data were retrospectively analyzed, from 16 patients with tumors of the proximal fibula undergoing proximal fibular resections and reconstructions of the lateral collateral ligament and the tendon of the biceps femoris with anchors between January 2008 and December 2009 (test group). Five patients underwent proximal fibular resection but were not given reconstruction surgery at the same period as the control group. There was no significant difference in gender, ages, disease duration, and tumor site between 2 groups (P gt; 0.05). Lateral stress test was performed after operation; X-ray films were taken to measure the joint space. Musculoskeletal Tumor Society (MSTS) functional score system was used to evaluate the joint function. Results All incisions healed by first intention in 2 groups. Iatrogenic complete peroneal nerve function loss occurred in patients undergoing Malawer type II surgical resection. The patients in both groups were followed up 12 to 36 months, with an average of 30 months. One patient with osteosarcoma of the test group developed local recurrence, and died of lung and systemic metastases after 12 months; the other patients had no recurrence. At last follow-up, the results of knee lateral stress test were negative in the test group, and the joint space increased and was classified as grade A; the results of knee lateral stress test were positive in the control group, and the joint space was classified as grade D. The MSTS score was 97.5 ± 3.5 in the test group and 87.5 ± 3.5 in the control group, showing significant difference (t=2.85, P=0.01). Conclusion The reconstruction of the bony attachment of the lateral collateral ligament and the tendon of the biceps femoris with anchors after resection of the proximal fibula is a safe, rel iable, and simple technique to reconstruct knee stabil ity after resection of tumors of the proximal fibula.
ObjectiveTo explore the application of enhanced funnel plots (EFP) and trial sequential analysis (TSA) in robustness assessment of meta-analysis results.MethodsData were extracted from published meta-analysis. The EFP was used to evaluate the robustness of the significance and heterogeneity of the current meta-analysis. The TSA was used to judge the sufficiency of the cumulative sample size of the current meta-analysis and to assess the robustness of conclusions based on current evidence.ResultsThe EFP showed that the meta-analysis results of low-density lipoprotein (LDL) was robust, and the meta-analysis results of triglyceride (TG), total cholesterol (TC) and high-density lipoprotein (HDL) were not stable. The TSA showed that the cumulative sample size of LDL had reached the required information size (RIS), and the current conclusion was stable. The cumulative Z value of TG, TC and HDL neither reached the RIS nor passed through the TSA monitoring boundary or futility boundary, indicating that current conclusions were not robust.ConclusionsThe combination of EFP and TSA can make a comprehensive judgment on the robustness of current meta-analysis results, and provide methodological support in the robustness assessment of results for future systematic reviews and meta-analyses.