BACKGROUND Although metaphyseal ulnar shortening osteotomy(MUSO)is safer for the treatment of ulnar impaction syndrome(UIS)than diaphyseal ulnar shortening osteotomy(DUSO),DUSO is widely used for UIS treatment.AIM To ...BACKGROUND Although metaphyseal ulnar shortening osteotomy(MUSO)is safer for the treatment of ulnar impaction syndrome(UIS)than diaphyseal ulnar shortening osteotomy(DUSO),DUSO is widely used for UIS treatment.AIM To evaluate the effectiveness of DUSO and MUSO for UIS treatment and determine the factors that should be considered when choosing surgical treatment for UIS.METHODS Articles comparing the effectiveness of DUSO and MUSO for UIS treatment were systematically retrieved from MEDLINE(Ovid),PubMed,EMBASE,and Cochrane Library.The demography,incidence of complications,secondary operation rate,postoperative DASH score,wrist pain on the visual analogue scale,and grip strength improvement were also evaluated.In addition,the correlation between the improvement of grip strength and the shortening of osteotomy length of ulna was analyzed.The outcome of the patient was discontinuous,and the odds ratio,risk ratio(RR),and 95%CI were calculated and analyzed via RevMan5.3 software.RESULTS Six studies,including 83 patients receiving MUSO(experimental group)and 112 patients receiving DUSO(control group),were included in the meta-analysis.The second operation rate was significantly higher after DUSO than after MUSO.The DASH scores were slightly lower in the MUSO group than in the DUSO group.The patients receiving MUSO had slightly better pain relief effect than patients receiving DUSO.However,the incidence of complications and improvement of grip strength were not significantly different between the two groups.CONCLUSION Although DUSO and MUSO provide similar effects for UIS,MUSO is associated with a lower secondary operation rate,slightly lower postoperative DASH scores and slightly better pain relief effect than DUSO,indicating that MUSO can effectively be used for UIS treatment.展开更多
We have reviewed 17 patients (18 hips) who required repeated open reduction for recurrent or persistent dislocation after a previous attempt at zigzag osteotomy combined with fibular allowgraft for developmental dyspl...We have reviewed 17 patients (18 hips) who required repeated open reduction for recurrent or persistent dislocation after a previous attempt at zigzag osteotomy combined with fibular allowgraft for developmental dysplasia of the hip (DDH). The purposes of this study were to examine predictors of redislocation and to evaluate the long-term outcomes after revision surgery. The mean age at primary open reduction was 24 months (13 to 36). The median time to the recognition of failure was 4.6 months. The second reduction was performed at a mean age of 26.3 months (17 to 42) and the mean age at final follow-up was 79.7 months (58 to 105) and the mean time follow-up was 42.4 months (37 to 76). We treated the hips with a new open reduction through an anteromedial approach. A constricted anteromedial capsule was always found as the main factor;all had an intact anteromedial capsule, and there was an inverted transverse ligament in five cases and a very tight psoas tendon in another four cases, eversion of the limbus in six cases, densing anterior capsule in five cases. We perform with the condition that all hips were cleared of scar tissue;five hips had adductor tenotomy;four hips required release of the psoas tendon, five eversion of the limbus. Release of the transverse ligament was required in five cases each. All hips with Kirschner wire through the femoral head into the acetabulum. Three hips required femoral shortening (average of 1.5 cm);a derotation varus osteotomy was performed in two hips from ten and twelve weeks after repeated open reduction. Postoperative results according to modified McKay criteria for clinical: excellent: 3 of 18 hips (16.7%);good: 8 of 18 hips (44.4%);fair: 6 of 18 hips (33.3%);and poor: 1 of 18 hips (5.6%). We suggest that technical failure is usually the cause for redislocation with all that has an intact anteromedial capsule. There was an inverted transverse ligament, tight psoas tendon, eversion of the limbus, and densing anterior capsule. We believe that abnormal femoral version and femoral head dysplasia are also important factors for redislocation too.展开更多
目的探讨应用肱骨髁上短缩旋转楔形截骨联合尺神经原位松解治疗创伤性肘外翻合并迟发性尺神经炎的手术技术和疗效。方法回顾性分析2015年1月-2019年12月收治的10例创伤性肘外翻畸形合并迟发性尺神经炎患者病例资料。依据顾玉东推荐的肘...目的探讨应用肱骨髁上短缩旋转楔形截骨联合尺神经原位松解治疗创伤性肘外翻合并迟发性尺神经炎的手术技术和疗效。方法回顾性分析2015年1月-2019年12月收治的10例创伤性肘外翻畸形合并迟发性尺神经炎患者病例资料。依据顾玉东推荐的肘管综合征分期标准:轻度3例,中度3例,重度4例。所有患者均行肱骨髁上短缩旋转楔形截骨联合尺神经原位松解术治疗。结果术后随访时间为12~36个月,平均24个月,10例均达到骨性愈合。术后末次随访小指两点辨别觉(4.1±1.4)mm;握力(23.6±8.9)kg;提携角11.7°±4.5°;肘关节屈曲活动度116.4°±11.6°,各项指标手术前后差异具有统计学意义(P<0.05)。术后按Yokohama City University尺神经炎评分标准,改善率85%,肘关节功能评定按HSS评分系统进行评定,优良率90%。结论采用肱骨髁上短缩旋转楔形截骨术治疗创伤性肘外翻畸形外观的同时,恢复了肘关节正常生物力学;联合尺神经原位松解术治疗创伤性肘外翻合并的迟发性尺神经炎是一种可同时矫正肘关节旋转畸形、符合解剖学特点、对患者创伤小且疗效满意的联合术式。展开更多
Orthopaedic surgeons specialising in adult hip reconstruction surgery often face the problem of osteoarthritis secondary to congenital hip disease(CHD). To achieve better communication among physicians,better treatmen...Orthopaedic surgeons specialising in adult hip reconstruction surgery often face the problem of osteoarthritis secondary to congenital hip disease(CHD). To achieve better communication among physicians,better treatment planning and evaluation of the results of various treatment options,an agreed terminology is needed to describe the entire pathology. Furthermore,a generally accepted classification of the deformities is necessary. Herein,the authors propose the use of the term "congenital hip disease" and its classification as dysplasia,low dislocation and high dislocation. Knowledge of the CHD natural history facilitates comprehension of the potential development and progression of the disease,which differs among the aforementioned types. This can lead to better understanding of the anatomical abnormalities found in the different CHD types and thus facilitate preoperative planning and choice of the most appropriate management for adult patients. The basic principles for improved results of total hip replacement in patients with CHD,especially those with low and high dislocation,are: Wide exposure,restoration of the normal centre of rotation and the use of special techniques and implants for the reconstruction of the acetabulum and femur. Application of these principles during total hip replacement in young female patients born with severe deformities of the hip joint has led to radical improvement of their quality of life.展开更多
文摘BACKGROUND Although metaphyseal ulnar shortening osteotomy(MUSO)is safer for the treatment of ulnar impaction syndrome(UIS)than diaphyseal ulnar shortening osteotomy(DUSO),DUSO is widely used for UIS treatment.AIM To evaluate the effectiveness of DUSO and MUSO for UIS treatment and determine the factors that should be considered when choosing surgical treatment for UIS.METHODS Articles comparing the effectiveness of DUSO and MUSO for UIS treatment were systematically retrieved from MEDLINE(Ovid),PubMed,EMBASE,and Cochrane Library.The demography,incidence of complications,secondary operation rate,postoperative DASH score,wrist pain on the visual analogue scale,and grip strength improvement were also evaluated.In addition,the correlation between the improvement of grip strength and the shortening of osteotomy length of ulna was analyzed.The outcome of the patient was discontinuous,and the odds ratio,risk ratio(RR),and 95%CI were calculated and analyzed via RevMan5.3 software.RESULTS Six studies,including 83 patients receiving MUSO(experimental group)and 112 patients receiving DUSO(control group),were included in the meta-analysis.The second operation rate was significantly higher after DUSO than after MUSO.The DASH scores were slightly lower in the MUSO group than in the DUSO group.The patients receiving MUSO had slightly better pain relief effect than patients receiving DUSO.However,the incidence of complications and improvement of grip strength were not significantly different between the two groups.CONCLUSION Although DUSO and MUSO provide similar effects for UIS,MUSO is associated with a lower secondary operation rate,slightly lower postoperative DASH scores and slightly better pain relief effect than DUSO,indicating that MUSO can effectively be used for UIS treatment.
文摘We have reviewed 17 patients (18 hips) who required repeated open reduction for recurrent or persistent dislocation after a previous attempt at zigzag osteotomy combined with fibular allowgraft for developmental dysplasia of the hip (DDH). The purposes of this study were to examine predictors of redislocation and to evaluate the long-term outcomes after revision surgery. The mean age at primary open reduction was 24 months (13 to 36). The median time to the recognition of failure was 4.6 months. The second reduction was performed at a mean age of 26.3 months (17 to 42) and the mean age at final follow-up was 79.7 months (58 to 105) and the mean time follow-up was 42.4 months (37 to 76). We treated the hips with a new open reduction through an anteromedial approach. A constricted anteromedial capsule was always found as the main factor;all had an intact anteromedial capsule, and there was an inverted transverse ligament in five cases and a very tight psoas tendon in another four cases, eversion of the limbus in six cases, densing anterior capsule in five cases. We perform with the condition that all hips were cleared of scar tissue;five hips had adductor tenotomy;four hips required release of the psoas tendon, five eversion of the limbus. Release of the transverse ligament was required in five cases each. All hips with Kirschner wire through the femoral head into the acetabulum. Three hips required femoral shortening (average of 1.5 cm);a derotation varus osteotomy was performed in two hips from ten and twelve weeks after repeated open reduction. Postoperative results according to modified McKay criteria for clinical: excellent: 3 of 18 hips (16.7%);good: 8 of 18 hips (44.4%);fair: 6 of 18 hips (33.3%);and poor: 1 of 18 hips (5.6%). We suggest that technical failure is usually the cause for redislocation with all that has an intact anteromedial capsule. There was an inverted transverse ligament, tight psoas tendon, eversion of the limbus, and densing anterior capsule. We believe that abnormal femoral version and femoral head dysplasia are also important factors for redislocation too.
文摘目的探讨应用肱骨髁上短缩旋转楔形截骨联合尺神经原位松解治疗创伤性肘外翻合并迟发性尺神经炎的手术技术和疗效。方法回顾性分析2015年1月-2019年12月收治的10例创伤性肘外翻畸形合并迟发性尺神经炎患者病例资料。依据顾玉东推荐的肘管综合征分期标准:轻度3例,中度3例,重度4例。所有患者均行肱骨髁上短缩旋转楔形截骨联合尺神经原位松解术治疗。结果术后随访时间为12~36个月,平均24个月,10例均达到骨性愈合。术后末次随访小指两点辨别觉(4.1±1.4)mm;握力(23.6±8.9)kg;提携角11.7°±4.5°;肘关节屈曲活动度116.4°±11.6°,各项指标手术前后差异具有统计学意义(P<0.05)。术后按Yokohama City University尺神经炎评分标准,改善率85%,肘关节功能评定按HSS评分系统进行评定,优良率90%。结论采用肱骨髁上短缩旋转楔形截骨术治疗创伤性肘外翻畸形外观的同时,恢复了肘关节正常生物力学;联合尺神经原位松解术治疗创伤性肘外翻合并的迟发性尺神经炎是一种可同时矫正肘关节旋转畸形、符合解剖学特点、对患者创伤小且疗效满意的联合术式。
文摘Orthopaedic surgeons specialising in adult hip reconstruction surgery often face the problem of osteoarthritis secondary to congenital hip disease(CHD). To achieve better communication among physicians,better treatment planning and evaluation of the results of various treatment options,an agreed terminology is needed to describe the entire pathology. Furthermore,a generally accepted classification of the deformities is necessary. Herein,the authors propose the use of the term "congenital hip disease" and its classification as dysplasia,low dislocation and high dislocation. Knowledge of the CHD natural history facilitates comprehension of the potential development and progression of the disease,which differs among the aforementioned types. This can lead to better understanding of the anatomical abnormalities found in the different CHD types and thus facilitate preoperative planning and choice of the most appropriate management for adult patients. The basic principles for improved results of total hip replacement in patients with CHD,especially those with low and high dislocation,are: Wide exposure,restoration of the normal centre of rotation and the use of special techniques and implants for the reconstruction of the acetabulum and femur. Application of these principles during total hip replacement in young female patients born with severe deformities of the hip joint has led to radical improvement of their quality of life.
