Objective: To investigate the clinical efficacy of the cement-screw technique in repairing tibial plateau bone defects in total knee arthroplasty (TKA) recipients and summarize the preoperative prehabilitation strateg...Objective: To investigate the clinical efficacy of the cement-screw technique in repairing tibial plateau bone defects in total knee arthroplasty (TKA) recipients and summarize the preoperative prehabilitation strategies for such surgeries. Methods: A total of 33 TKA recipients (45 knees) in our department underwent repair of unilateral or bilateral tibial defects using the cement-screw technique. The subjects were divided into two groups based on the differences in preoperative interventions. The control group received routine preoperative health education according to the consensus, while the observation group received instructive and standardized prehabilitation exercises for four weeks in addition to the routine education. Scale scores, intraoperative parameters, and postoperative recovery indicators were recorded at different time pointsand subjected to statistical analysis for intra-group and inter-group differences. All subjects underwent long-term follow-up for at least 24 months. Results: Within each group at different time points, there were statistically significant differences in VAS, ROM, and HSS scores (p Conclusions: Cement-screw technique for repairing tibial plateau bone defects in TKA recipients can significantly relieve pain, and improve joint function. Prehabilitation can improve preoperative rehabilitation reserves in these patients, accelerate postoperative recovery, and contribute to better short-term clinical outcomes.展开更多
BACKGROUND Injuries to multiple fingertips pose a significant treatment dilemma.Numerous reconstructive options exist,all with the ultimate goal of restoring function and sensibility to the injured fingertips.CASE SUM...BACKGROUND Injuries to multiple fingertips pose a significant treatment dilemma.Numerous reconstructive options exist,all with the ultimate goal of restoring function and sensibility to the injured fingertips.CASE SUMMARY A 24-year-old male suffered injury to multiple fingertips of the right hand,resulting in exposed distal phalanges of the middle,ring,and small fingers.The amputated distal stumps were not possible for replantation.Free flap coverage was selected in order to achieve better functional outcome.The fingertip defects were covered by performing a right second toe split tibial flap using local anesthesia at the harvest site and brachial plexus nerve block for the right upper extremity.At 6-month follow-up,all three of the reconstructed fingertips had some preserved nail growth,Semmes-Weinstein Monofilaments testing was equal to the contralateral side and the Static Two-Point Discrimination were comparable to the contralateral side.CONCLUSION This report provides a novel reconstructive option for the management of multiple fingertip injuries and demonstrates the utility of supermicrosurgery in management of these injuries.展开更多
BACKGROUND The Ilizarov bone transport(IBT)and the Masquelet induced membrane technique(IMT)have specific merits and shortcomings,but numerous studies have shown their efficacy in the management of extensive long-bone...BACKGROUND The Ilizarov bone transport(IBT)and the Masquelet induced membrane technique(IMT)have specific merits and shortcomings,but numerous studies have shown their efficacy in the management of extensive long-bone defects of various etiologies,including congenital deficiencies.Combining their strong benefits seems a promising strategy to enhance bone regeneration and reduce the risk of refractures in the management of post-traumatic and congenital defects and nonunion that failed to respond to other treatments.AIM To combine IBT and IMT for the management of severe tibial defects and pseudarthrosis,and present preliminary results of this technological solution.METHODS Seven adults with post-traumatic tibial defects(subgroup A)and nine children(subgroup B)with congenital pseudarthrosis of the tibia(CPT)were treated with the combination of IMT and IBT after the failure of previous treatments.The mean number of previous surgeries was 2.0±0.2 in subgroup A and 3.3±0.7 in subgroup B.Step 1 included Ilizarov frame placement and spacer introduction into the defect to generate the induced membrane which remained in the interfragmental gap after spacer removal.Step 2 was an osteotomy and bone transport of the fragment through the tunnel in the induced membrane,its compression and docking for consolidation without grafting.The outcomes were retrospectively studied after a mean follow-up of 20.8±2.7 mo in subgroup A and 25.3±2.3 mo in subgroup B.RESULTS The“true defect”after resection was 13.3±1.7%in subgroup A and 31.0±3.0%in subgroup B relative to the contralateral limb.Upon completion of treatment,defects were filled by 75.4±10.6%and 34.6±4.2%,respectively.Total duration of external fixation was 397±9.2 and 270.1±16.3 d,including spacer retention time of 42.4±4.5 and 55.8±6.6 d,in subgroups A and B,respectively.Bone infection was not observed.Postoperative complications were several cases of pin-tract infection and regenerate deformity in both subgroups.Ischemic regeneration was observed in two cases of subgroup B.Complications were corrected during the course of treatment.Bone union was achieved in all patients of subgroup A and in seven patients of subgroup B.One non-united CPT case was further treated with the Ilizarov compression method only and achieved union.After a follow-up period of two to three years,refractures occurred in four cases of united CPT.CONCLUSION The combination of IMT and IBT provides good outcomes in post-traumatic tibial defects after previous treatment failure but external fixation is longer due to spacer retention.Refractures may occur in severe CPT.展开更多
BACKGROUND Bone transport and distraction osteogenesis has been widely used to treat bone defects after traumatic surgery,but,skin and soft tissue incarceration can be as high as 27.6%.AIM To investigate the efficacy ...BACKGROUND Bone transport and distraction osteogenesis has been widely used to treat bone defects after traumatic surgery,but,skin and soft tissue incarceration can be as high as 27.6%.AIM To investigate the efficacy of inserting a tissue expander to prevent soft tissue incarceration.METHODS Between January 2016 and December 2018,12 patients underwent implantation of a tissue expander in the subcutaneous layer in the vicinity of a tibial defect to maintain the soft tissue in position.A certain amount of normal saline was injected into the tissue expander during surgery and was then gradually extracted to shrink the expander during the course of transport distraction osteogenesis.The tissue expander was removed when the two ends of the tibial defect were close enough.RESULTS In all 12 patients,the expanders remained intact in the subcutaneous layer of the bone defect area during the course of transport distraction osteogenesis.When bone transport was adequate,the expander was removed and the bone transport process was completed.During the whole process,there was no incarceration of skin and soft tissue in the bone defect area.Complications occurred in one patient,who experienced poor wound healing.CONCLUSION The pre-filled expander technique can effectively avoid soft tissue incarceration.The authors’primary success with this method indicates that it may be a valuable tool in the management of incarcerated soft tissue.展开更多
文摘Objective: To investigate the clinical efficacy of the cement-screw technique in repairing tibial plateau bone defects in total knee arthroplasty (TKA) recipients and summarize the preoperative prehabilitation strategies for such surgeries. Methods: A total of 33 TKA recipients (45 knees) in our department underwent repair of unilateral or bilateral tibial defects using the cement-screw technique. The subjects were divided into two groups based on the differences in preoperative interventions. The control group received routine preoperative health education according to the consensus, while the observation group received instructive and standardized prehabilitation exercises for four weeks in addition to the routine education. Scale scores, intraoperative parameters, and postoperative recovery indicators were recorded at different time pointsand subjected to statistical analysis for intra-group and inter-group differences. All subjects underwent long-term follow-up for at least 24 months. Results: Within each group at different time points, there were statistically significant differences in VAS, ROM, and HSS scores (p Conclusions: Cement-screw technique for repairing tibial plateau bone defects in TKA recipients can significantly relieve pain, and improve joint function. Prehabilitation can improve preoperative rehabilitation reserves in these patients, accelerate postoperative recovery, and contribute to better short-term clinical outcomes.
文摘BACKGROUND Injuries to multiple fingertips pose a significant treatment dilemma.Numerous reconstructive options exist,all with the ultimate goal of restoring function and sensibility to the injured fingertips.CASE SUMMARY A 24-year-old male suffered injury to multiple fingertips of the right hand,resulting in exposed distal phalanges of the middle,ring,and small fingers.The amputated distal stumps were not possible for replantation.Free flap coverage was selected in order to achieve better functional outcome.The fingertip defects were covered by performing a right second toe split tibial flap using local anesthesia at the harvest site and brachial plexus nerve block for the right upper extremity.At 6-month follow-up,all three of the reconstructed fingertips had some preserved nail growth,Semmes-Weinstein Monofilaments testing was equal to the contralateral side and the Static Two-Point Discrimination were comparable to the contralateral side.CONCLUSION This report provides a novel reconstructive option for the management of multiple fingertip injuries and demonstrates the utility of supermicrosurgery in management of these injuries.
文摘BACKGROUND The Ilizarov bone transport(IBT)and the Masquelet induced membrane technique(IMT)have specific merits and shortcomings,but numerous studies have shown their efficacy in the management of extensive long-bone defects of various etiologies,including congenital deficiencies.Combining their strong benefits seems a promising strategy to enhance bone regeneration and reduce the risk of refractures in the management of post-traumatic and congenital defects and nonunion that failed to respond to other treatments.AIM To combine IBT and IMT for the management of severe tibial defects and pseudarthrosis,and present preliminary results of this technological solution.METHODS Seven adults with post-traumatic tibial defects(subgroup A)and nine children(subgroup B)with congenital pseudarthrosis of the tibia(CPT)were treated with the combination of IMT and IBT after the failure of previous treatments.The mean number of previous surgeries was 2.0±0.2 in subgroup A and 3.3±0.7 in subgroup B.Step 1 included Ilizarov frame placement and spacer introduction into the defect to generate the induced membrane which remained in the interfragmental gap after spacer removal.Step 2 was an osteotomy and bone transport of the fragment through the tunnel in the induced membrane,its compression and docking for consolidation without grafting.The outcomes were retrospectively studied after a mean follow-up of 20.8±2.7 mo in subgroup A and 25.3±2.3 mo in subgroup B.RESULTS The“true defect”after resection was 13.3±1.7%in subgroup A and 31.0±3.0%in subgroup B relative to the contralateral limb.Upon completion of treatment,defects were filled by 75.4±10.6%and 34.6±4.2%,respectively.Total duration of external fixation was 397±9.2 and 270.1±16.3 d,including spacer retention time of 42.4±4.5 and 55.8±6.6 d,in subgroups A and B,respectively.Bone infection was not observed.Postoperative complications were several cases of pin-tract infection and regenerate deformity in both subgroups.Ischemic regeneration was observed in two cases of subgroup B.Complications were corrected during the course of treatment.Bone union was achieved in all patients of subgroup A and in seven patients of subgroup B.One non-united CPT case was further treated with the Ilizarov compression method only and achieved union.After a follow-up period of two to three years,refractures occurred in four cases of united CPT.CONCLUSION The combination of IMT and IBT provides good outcomes in post-traumatic tibial defects after previous treatment failure but external fixation is longer due to spacer retention.Refractures may occur in severe CPT.
文摘BACKGROUND Bone transport and distraction osteogenesis has been widely used to treat bone defects after traumatic surgery,but,skin and soft tissue incarceration can be as high as 27.6%.AIM To investigate the efficacy of inserting a tissue expander to prevent soft tissue incarceration.METHODS Between January 2016 and December 2018,12 patients underwent implantation of a tissue expander in the subcutaneous layer in the vicinity of a tibial defect to maintain the soft tissue in position.A certain amount of normal saline was injected into the tissue expander during surgery and was then gradually extracted to shrink the expander during the course of transport distraction osteogenesis.The tissue expander was removed when the two ends of the tibial defect were close enough.RESULTS In all 12 patients,the expanders remained intact in the subcutaneous layer of the bone defect area during the course of transport distraction osteogenesis.When bone transport was adequate,the expander was removed and the bone transport process was completed.During the whole process,there was no incarceration of skin and soft tissue in the bone defect area.Complications occurred in one patient,who experienced poor wound healing.CONCLUSION The pre-filled expander technique can effectively avoid soft tissue incarceration.The authors’primary success with this method indicates that it may be a valuable tool in the management of incarcerated soft tissue.
