Background: Sagittal plane placement of the tibial component in total knee replacement (TKR) has important implications for maximizing the range of flexion motion, allowing collateral ligaments to function more normal...Background: Sagittal plane placement of the tibial component in total knee replacement (TKR) has important implications for maximizing the range of flexion motion, allowing collateral ligaments to function more normally, as well as providing ideal compressive loading on the tibial bone-prosthesis interface. This study attempts to quantify the normal posterior tibial slope (PTS) angle pre-operatively and post-operatively in osteoarthritic patients after using a conventional extramedullary tibial resection guide to assess its effectiveness. Methods: Forty-nine primary cementless total knee replacements in 34 osteoarthritic patients were measured radiographically pre-operatively and one year post-operatively to determine the PTS and its effect on range of motion. Lateral X-rays, using the anterior cortical line of the tibia, were employed for all measurements. Results: Pre-operative PTS measured 11.83˚ (range 5˚ - 18˚), while post-operative PTS of implanted tibial components measured 11.30o (range 4˚ - 18˚). The pre-operative range of motion of 112˚ (range 30˚ to 135˚) was improved to 119˚ (range 90˚ to 135˚) post-operatively after 1 year. Conclusions: Anterior tibial shaft referencing using a conventional extramedullary tibial resection guide provides an easy and convenient method for reproducing the anatomical PTS during TKR. This methodology provided improvement in average range of motion from 112˚ pre-operatively to 119˚ post-operatively at one year.展开更多
Tumor resection causes damage in the head and neck which creates problems in swallowing, chewing, articulation, and vision, all of which seriously affect patients' quality of life. In this work, we evaluated the a...Tumor resection causes damage in the head and neck which creates problems in swallowing, chewing, articulation, and vision, all of which seriously affect patients' quality of life. In this work, we evaluated the application of a free medial tibial flap in reconstruction of head and neck defects after tumor resection. We discussed the anatomy, surgical technique, and the advantages and disadvantages of the flap. We found several benefits for the flap, such as, it is especially effective for the defects that require thin-layer epithelium to cover or the separated soft tissue defect; a two-team approach can be used because the donor site is far away from the head and neck; and the flap is easy to integrate because of the subcutaneous fat layer of the free medial tibial flap is thin and the flap is soft. Thus, the medial tibial flap could replace the forearm flap for certain applications.展开更多
AIM To measure single baseline deep posterior compartment pressure in tibial fracture complicated by acute compartment syndrome(ACS) and to correlate it with functional outcome.METHODS Thirty-two tibial fractures with...AIM To measure single baseline deep posterior compartment pressure in tibial fracture complicated by acute compartment syndrome(ACS) and to correlate it with functional outcome.METHODS Thirty-two tibial fractures with ACS were evaluated clinically and the deep posterior compartment pressure was measured. Urgent fasciotomy was needed in 30 patients. Definite surgical fixation was performed either primarily or once fasciotomy wound was healthy. The patients were followed up at 3 mo, 6 mo and one year. At one year, the functional outcome [lower extremity functional scale(LEFS)] and complications were assessed.RESULTS Three limbs were amputated. In remaining 29 patients, the average times for clinical and radiological union were 25.2 ± 10.9 wk(10 to 54 wk) and 23.8 ± 9.2 wk(12 to 52 wk) respectively. Nine patients had delayed union and 2 had nonunion who needed bone grafting to augment healing. Most common complaint at follow up was ankle stiffness(76%) that caused difficulty in walking,running and squatting. Of 21 patients who had paralysis at diagnosis, 13(62%) did not recover and additional five patients developed paralysis at follow-up. On LEFS evaluation, there were 14 patients(48.3%) with severe disability, 10 patients(34.5%) with moderate disability and 5 patients(17.2%) with minimal disability. The mean pressures in patients with minimal disability, moderate disability and severe disability were 37.8, 48.4 and 58.79 mmH g respectively(P < 0.001).CONCLUSION ACS in tibial fractures causes severe functional disability in majority of patients. These patients are prone for delayed union and nonunion; however, long term disability is mainly because of severe soft tissue contracture. Intracompartmental pressure(ICP) correlates with functional disability; patients with relatively high ICP are prone for poor functional outcome.展开更多
Neurostimulation remains the mainstay of treatment for patients with faecal incontinence who fails to respond to available conservative measures.Sacral nerve stimulation(SNS)is the main form of neurostimulation that i...Neurostimulation remains the mainstay of treatment for patients with faecal incontinence who fails to respond to available conservative measures.Sacral nerve stimulation(SNS)is the main form of neurostimulation that is in use today.Posterior tibial nerve stimulation(PTNS)-both the percutaneous and the transcutaneous routes-remains a relatively new entry in neurostimulation.Though in its infancy,PTNS holds promise to be an effective,patient friendly,safe and cheap treatment.However,presently PTNS only appears to have a minor role with SNS having the limelight in treating patients with faecal incontinence.This seems to have arisen as the strong,uniform and evidence based data on SNS remains to have been unchallenged yet by the weak,disjointed and unsupported evidence for both percutaneous and transcutaneous PTNS.The use of PTNS is slowly gaining acceptance.However,several questions remain unanswered in the delivery of PTNS.These have raised dilemmas which as long as they remain unsolved can considerably weaken the argument that PTNS could offer a viable alternative to SNS.This paper reviews available information on PTNS and focuses on these dilemmas in the light of existing evidence.展开更多
Introduction: Varus equine foot deformity is common in developing countries. The management of these deformities is surgical in adults. Several surgical techniques have been described with more or less satisfactory re...Introduction: Varus equine foot deformity is common in developing countries. The management of these deformities is surgical in adults. Several surgical techniques have been described with more or less satisfactory results. To our knowledge, no study has been performed on the simultaneous association of double arthrodesis, posteromedial release, and posterior tibial transfer in a single operation in inveterate paralytic varus equines feet. The purpose of this work was to evaluate the results obtained. Patients and Method: This was a retrospective descriptive study from January 01, 2018 to December 31, 2021. It concerned inveterate paralytic varus equines feet operated on by the simultaneous association in a single operative time of double arthrodesis of the foot, posteromedial release of the back foot and transfer of the posterior tibial muscle to the lateral cuneiform. We identified seven patients with a mean age of 22.1 years with extremes of 11 years and 36 years. There were three males and four females. The cause of the deformity was neurological in all cases. All patients had painful walking discomfort and shoeing difficulties. The average time to management was 13.3 years with extremes of 4 and 25 years. The chronology of the interventional steps was posteromedial release, arthrodesis, and transfer of the posterior tibial muscle to the lateral cuneiform. The average postoperative follow-up was 21.7 months with extremes of 6 and 48 months. The parameters studied were the duration of the procedure, complications related to the procedure, muscle strength at the last recoil, consolidation of the arthrodesis, residual pain, patient activity, gait perimeter, stepping, ankle mobility, residual deformity, footwear, protrusion of the transferred tendon, and the possibility of walking on the heel. Final results were graded according to the Angus and Cowell criteria. Results: No intraoperative complications were noted. An early superficial infection of the surgical site was noted. It was treated with local care and healed without sequel. Residual pain was present in one case. Tibiotalar osteoarthritis was observed in one case, which required a tibiotalar arthrodesis. At the last follow-up, consolidation of the arthrodesis was effective in all patients. The posterior tibial muscle was side 5 (n = 4) and 4 (n = 3). The patients’ activity was normal without assistance in all cases. The walking perimeter was greater than 1 km in six patients. Patient activity was normal without assistance in all cases. Stepping was absent in all patients. No difficulty with footwear was noted. According to the Angus and Cowell criteria, the result was good (n = 6), i.e. 85.7% and bad (n = 1), i.e. 14.3% of cases. Conclusion: This study suggests that double arthrodesis associated with posteromedial release and transfer of the posterior tibial in one step in inveterate paralytic varus equines feet, gives satisfactory results. It allows for easy shoeing and plantigrade walking without stepping. Complications are essentially represented by the absence of fusion of the arthrodesis and tibiotalar arthrosis.展开更多
Purpose: To restore the normal axial alignment of the lower extremity is important in reconstructive knee surgery. The aim of this study was to evaluate lower-limb alignment and posterior tibial slope. Methods: Thirty...Purpose: To restore the normal axial alignment of the lower extremity is important in reconstructive knee surgery. The aim of this study was to evaluate lower-limb alignment and posterior tibial slope. Methods: Thirty-two male and 32 female outpatients aged 22 to 46 were recruited. A full weight-bearing anteroposterior radiograph of the entire lower limb was obtained for each subject. The axial alignment was measured based on the centers of the femoral head, knee, and ankle. The tibiofemoral (TF), tibial joint (TJ), and posterior tibial slope (TS) angles were determined. Results: The mean TF angle was more varus in women (177.8°) than men (179.2°), and the mean TJ angle was more medially inclined in women than men. Women had a greater TJ angle than men (93.3° vs. 91.6°). The mean posterior TS was greater in men than women (16.0° vs. 12.5°, p < 0.05), while the mean TS angle was greater in women (14.8°) than men (12.3°). Conclusion: Knee alignment and geometry vary among populations. In our study, the TF angle was varus among all participants. The knee joint was more medially inclined in women than men. And also the posterior TS was greater in women than men.展开更多
Background: Tibial polyethylene wear is related late failure in total knee arthroplasty. The cruciate substitute design depending on the campost mechanism to secure the knee cinematics after a posterior stabilized tot...Background: Tibial polyethylene wear is related late failure in total knee arthroplasty. The cruciate substitute design depending on the campost mechanism to secure the knee cinematics after a posterior stabilized total knee arthroplasty (PS-TKA). A post fracture can occur after damage failure of the post. Aim: Report a case of post refracture after a PS-TKA and review the lecture about post wear in PS-TKA. Case presentation: A 63 woman with a primary TKA had a diagnosis of polyethylene post fracture. The polyethylene exchange wasn’t enough and revisions of all components were necessary. Conclusion: In patient with previous well function, subtle swelling and giving away sings after PS-TKA, a post fracture must be excluded.展开更多
背景:治疗后交叉韧带胫骨附着点撕脱骨折的最佳手术技术仍值得商榷。随着关节镜手术的应用与成熟,它在后交叉韧带胫骨附着点撕脱骨折的诊疗中有很大前景。目的:综述关节镜技术在后交叉韧带胫骨附着点撕脱骨折治疗中的应用与进展,包括不...背景:治疗后交叉韧带胫骨附着点撕脱骨折的最佳手术技术仍值得商榷。随着关节镜手术的应用与成熟,它在后交叉韧带胫骨附着点撕脱骨折的诊疗中有很大前景。目的:综述关节镜技术在后交叉韧带胫骨附着点撕脱骨折治疗中的应用与进展,包括不同关节镜治疗方法、手术入路、胫骨隧道设计、缝合材料选择以及内固定植入物选择等。方法:通过计算机对中国知网、PubMed、Web of Science及ScienceDirect等数据库中的相关文献进行检索,检索时间为2003年1月至2023年11月,中文检索词为“后交叉韧带,后十字韧带,撕脱骨折,关节镜”;英文检索词为“posterior cruciate ligament,avulsion,fracture,tibia,arthroscopic,operation,fixation,treatment”。共纳入97篇文献进行综述。结果与结论:关节镜技术提供了一种可靠的治疗方式来治疗后交叉韧带胫骨附着点撕脱骨折。根据入路、缝合材料类型以及用于缝合的入路和胫骨隧道数量等不同,关节镜技术可以分为关节镜下缝线固定结合自体移植物增强重建、关节镜下多交叉带缝合桥固定、关节镜下高强度缝线固定以及关节镜下直接前后缝合悬吊固定等几类。在各种研究中,常用的临床结果评估指标包括关节活动度、Lysholm评分、国际膝关节文献委员会评分及KT-2000关节测量仪差等,研究显示关节镜手术后末次随访时上述指标检测结果较术前显著改善,影像学随访结果显示关节镜手术都取得了令人满意的结果。在随访过程中,接受关节镜技术治疗后的各类交叉韧带胫骨附着点撕脱骨折患者都未出现严重并发症,例如创伤性关节炎、神经血管损伤、围手术期伤口感染、血栓形成以及骨折不愈合等。展开更多
AIM To determine the location of medial tibial plateau stress fractures and its relationship with tibial plateau morphology using magnetic resonance imaging(MRI).METHODS A retrospective review of patients with a diagn...AIM To determine the location of medial tibial plateau stress fractures and its relationship with tibial plateau morphology using magnetic resonance imaging(MRI).METHODS A retrospective review of patients with a diagnosis of stress fracture of the medial tibial plateau was performed for a 5-year period. Fourteen patients [three female and 11 male, with an average age of 36.4 years(range, 15-50 years)], who underwent knee MRI, were included. The appearance of the tibial plateau stress fracture and the geometry of the tibial plateau were reviewed and measured on MRI.RESULTS Thirteen of 14 stress fractures were linear, and one of them stellated on MRI images. The location of fractures was classified into three types. Three fractures were located anteromedially(AM type), six posteromedially(PM type), and five posteriorly(P type) at the medial tibial plateau. In addition, tibial posterior slope at the medial tibial plateau tended to be larger when the fracture was located more posteriorly on MRI.CONCLUSION We found that MRI showed three different localizations of medial tibial plateau stress fractures, which were associated with tibial posterior slope at the medial tibial plateau.展开更多
文摘Background: Sagittal plane placement of the tibial component in total knee replacement (TKR) has important implications for maximizing the range of flexion motion, allowing collateral ligaments to function more normally, as well as providing ideal compressive loading on the tibial bone-prosthesis interface. This study attempts to quantify the normal posterior tibial slope (PTS) angle pre-operatively and post-operatively in osteoarthritic patients after using a conventional extramedullary tibial resection guide to assess its effectiveness. Methods: Forty-nine primary cementless total knee replacements in 34 osteoarthritic patients were measured radiographically pre-operatively and one year post-operatively to determine the PTS and its effect on range of motion. Lateral X-rays, using the anterior cortical line of the tibia, were employed for all measurements. Results: Pre-operative PTS measured 11.83˚ (range 5˚ - 18˚), while post-operative PTS of implanted tibial components measured 11.30o (range 4˚ - 18˚). The pre-operative range of motion of 112˚ (range 30˚ to 135˚) was improved to 119˚ (range 90˚ to 135˚) post-operatively after 1 year. Conclusions: Anterior tibial shaft referencing using a conventional extramedullary tibial resection guide provides an easy and convenient method for reproducing the anatomical PTS during TKR. This methodology provided improvement in average range of motion from 112˚ pre-operatively to 119˚ post-operatively at one year.
文摘Tumor resection causes damage in the head and neck which creates problems in swallowing, chewing, articulation, and vision, all of which seriously affect patients' quality of life. In this work, we evaluated the application of a free medial tibial flap in reconstruction of head and neck defects after tumor resection. We discussed the anatomy, surgical technique, and the advantages and disadvantages of the flap. We found several benefits for the flap, such as, it is especially effective for the defects that require thin-layer epithelium to cover or the separated soft tissue defect; a two-team approach can be used because the donor site is far away from the head and neck; and the flap is easy to integrate because of the subcutaneous fat layer of the free medial tibial flap is thin and the flap is soft. Thus, the medial tibial flap could replace the forearm flap for certain applications.
文摘AIM To measure single baseline deep posterior compartment pressure in tibial fracture complicated by acute compartment syndrome(ACS) and to correlate it with functional outcome.METHODS Thirty-two tibial fractures with ACS were evaluated clinically and the deep posterior compartment pressure was measured. Urgent fasciotomy was needed in 30 patients. Definite surgical fixation was performed either primarily or once fasciotomy wound was healthy. The patients were followed up at 3 mo, 6 mo and one year. At one year, the functional outcome [lower extremity functional scale(LEFS)] and complications were assessed.RESULTS Three limbs were amputated. In remaining 29 patients, the average times for clinical and radiological union were 25.2 ± 10.9 wk(10 to 54 wk) and 23.8 ± 9.2 wk(12 to 52 wk) respectively. Nine patients had delayed union and 2 had nonunion who needed bone grafting to augment healing. Most common complaint at follow up was ankle stiffness(76%) that caused difficulty in walking,running and squatting. Of 21 patients who had paralysis at diagnosis, 13(62%) did not recover and additional five patients developed paralysis at follow-up. On LEFS evaluation, there were 14 patients(48.3%) with severe disability, 10 patients(34.5%) with moderate disability and 5 patients(17.2%) with minimal disability. The mean pressures in patients with minimal disability, moderate disability and severe disability were 37.8, 48.4 and 58.79 mmH g respectively(P < 0.001).CONCLUSION ACS in tibial fractures causes severe functional disability in majority of patients. These patients are prone for delayed union and nonunion; however, long term disability is mainly because of severe soft tissue contracture. Intracompartmental pressure(ICP) correlates with functional disability; patients with relatively high ICP are prone for poor functional outcome.
文摘Neurostimulation remains the mainstay of treatment for patients with faecal incontinence who fails to respond to available conservative measures.Sacral nerve stimulation(SNS)is the main form of neurostimulation that is in use today.Posterior tibial nerve stimulation(PTNS)-both the percutaneous and the transcutaneous routes-remains a relatively new entry in neurostimulation.Though in its infancy,PTNS holds promise to be an effective,patient friendly,safe and cheap treatment.However,presently PTNS only appears to have a minor role with SNS having the limelight in treating patients with faecal incontinence.This seems to have arisen as the strong,uniform and evidence based data on SNS remains to have been unchallenged yet by the weak,disjointed and unsupported evidence for both percutaneous and transcutaneous PTNS.The use of PTNS is slowly gaining acceptance.However,several questions remain unanswered in the delivery of PTNS.These have raised dilemmas which as long as they remain unsolved can considerably weaken the argument that PTNS could offer a viable alternative to SNS.This paper reviews available information on PTNS and focuses on these dilemmas in the light of existing evidence.
文摘Introduction: Varus equine foot deformity is common in developing countries. The management of these deformities is surgical in adults. Several surgical techniques have been described with more or less satisfactory results. To our knowledge, no study has been performed on the simultaneous association of double arthrodesis, posteromedial release, and posterior tibial transfer in a single operation in inveterate paralytic varus equines feet. The purpose of this work was to evaluate the results obtained. Patients and Method: This was a retrospective descriptive study from January 01, 2018 to December 31, 2021. It concerned inveterate paralytic varus equines feet operated on by the simultaneous association in a single operative time of double arthrodesis of the foot, posteromedial release of the back foot and transfer of the posterior tibial muscle to the lateral cuneiform. We identified seven patients with a mean age of 22.1 years with extremes of 11 years and 36 years. There were three males and four females. The cause of the deformity was neurological in all cases. All patients had painful walking discomfort and shoeing difficulties. The average time to management was 13.3 years with extremes of 4 and 25 years. The chronology of the interventional steps was posteromedial release, arthrodesis, and transfer of the posterior tibial muscle to the lateral cuneiform. The average postoperative follow-up was 21.7 months with extremes of 6 and 48 months. The parameters studied were the duration of the procedure, complications related to the procedure, muscle strength at the last recoil, consolidation of the arthrodesis, residual pain, patient activity, gait perimeter, stepping, ankle mobility, residual deformity, footwear, protrusion of the transferred tendon, and the possibility of walking on the heel. Final results were graded according to the Angus and Cowell criteria. Results: No intraoperative complications were noted. An early superficial infection of the surgical site was noted. It was treated with local care and healed without sequel. Residual pain was present in one case. Tibiotalar osteoarthritis was observed in one case, which required a tibiotalar arthrodesis. At the last follow-up, consolidation of the arthrodesis was effective in all patients. The posterior tibial muscle was side 5 (n = 4) and 4 (n = 3). The patients’ activity was normal without assistance in all cases. The walking perimeter was greater than 1 km in six patients. Patient activity was normal without assistance in all cases. Stepping was absent in all patients. No difficulty with footwear was noted. According to the Angus and Cowell criteria, the result was good (n = 6), i.e. 85.7% and bad (n = 1), i.e. 14.3% of cases. Conclusion: This study suggests that double arthrodesis associated with posteromedial release and transfer of the posterior tibial in one step in inveterate paralytic varus equines feet, gives satisfactory results. It allows for easy shoeing and plantigrade walking without stepping. Complications are essentially represented by the absence of fusion of the arthrodesis and tibiotalar arthrosis.
文摘Purpose: To restore the normal axial alignment of the lower extremity is important in reconstructive knee surgery. The aim of this study was to evaluate lower-limb alignment and posterior tibial slope. Methods: Thirty-two male and 32 female outpatients aged 22 to 46 were recruited. A full weight-bearing anteroposterior radiograph of the entire lower limb was obtained for each subject. The axial alignment was measured based on the centers of the femoral head, knee, and ankle. The tibiofemoral (TF), tibial joint (TJ), and posterior tibial slope (TS) angles were determined. Results: The mean TF angle was more varus in women (177.8°) than men (179.2°), and the mean TJ angle was more medially inclined in women than men. Women had a greater TJ angle than men (93.3° vs. 91.6°). The mean posterior TS was greater in men than women (16.0° vs. 12.5°, p < 0.05), while the mean TS angle was greater in women (14.8°) than men (12.3°). Conclusion: Knee alignment and geometry vary among populations. In our study, the TF angle was varus among all participants. The knee joint was more medially inclined in women than men. And also the posterior TS was greater in women than men.
文摘Background: Tibial polyethylene wear is related late failure in total knee arthroplasty. The cruciate substitute design depending on the campost mechanism to secure the knee cinematics after a posterior stabilized total knee arthroplasty (PS-TKA). A post fracture can occur after damage failure of the post. Aim: Report a case of post refracture after a PS-TKA and review the lecture about post wear in PS-TKA. Case presentation: A 63 woman with a primary TKA had a diagnosis of polyethylene post fracture. The polyethylene exchange wasn’t enough and revisions of all components were necessary. Conclusion: In patient with previous well function, subtle swelling and giving away sings after PS-TKA, a post fracture must be excluded.
文摘背景:治疗后交叉韧带胫骨附着点撕脱骨折的最佳手术技术仍值得商榷。随着关节镜手术的应用与成熟,它在后交叉韧带胫骨附着点撕脱骨折的诊疗中有很大前景。目的:综述关节镜技术在后交叉韧带胫骨附着点撕脱骨折治疗中的应用与进展,包括不同关节镜治疗方法、手术入路、胫骨隧道设计、缝合材料选择以及内固定植入物选择等。方法:通过计算机对中国知网、PubMed、Web of Science及ScienceDirect等数据库中的相关文献进行检索,检索时间为2003年1月至2023年11月,中文检索词为“后交叉韧带,后十字韧带,撕脱骨折,关节镜”;英文检索词为“posterior cruciate ligament,avulsion,fracture,tibia,arthroscopic,operation,fixation,treatment”。共纳入97篇文献进行综述。结果与结论:关节镜技术提供了一种可靠的治疗方式来治疗后交叉韧带胫骨附着点撕脱骨折。根据入路、缝合材料类型以及用于缝合的入路和胫骨隧道数量等不同,关节镜技术可以分为关节镜下缝线固定结合自体移植物增强重建、关节镜下多交叉带缝合桥固定、关节镜下高强度缝线固定以及关节镜下直接前后缝合悬吊固定等几类。在各种研究中,常用的临床结果评估指标包括关节活动度、Lysholm评分、国际膝关节文献委员会评分及KT-2000关节测量仪差等,研究显示关节镜手术后末次随访时上述指标检测结果较术前显著改善,影像学随访结果显示关节镜手术都取得了令人满意的结果。在随访过程中,接受关节镜技术治疗后的各类交叉韧带胫骨附着点撕脱骨折患者都未出现严重并发症,例如创伤性关节炎、神经血管损伤、围手术期伤口感染、血栓形成以及骨折不愈合等。
文摘AIM To determine the location of medial tibial plateau stress fractures and its relationship with tibial plateau morphology using magnetic resonance imaging(MRI).METHODS A retrospective review of patients with a diagnosis of stress fracture of the medial tibial plateau was performed for a 5-year period. Fourteen patients [three female and 11 male, with an average age of 36.4 years(range, 15-50 years)], who underwent knee MRI, were included. The appearance of the tibial plateau stress fracture and the geometry of the tibial plateau were reviewed and measured on MRI.RESULTS Thirteen of 14 stress fractures were linear, and one of them stellated on MRI images. The location of fractures was classified into three types. Three fractures were located anteromedially(AM type), six posteromedially(PM type), and five posteriorly(P type) at the medial tibial plateau. In addition, tibial posterior slope at the medial tibial plateau tended to be larger when the fracture was located more posteriorly on MRI.CONCLUSION We found that MRI showed three different localizations of medial tibial plateau stress fractures, which were associated with tibial posterior slope at the medial tibial plateau.
