BACKGROUND It has been confirmed that the increased posterior tibial slope over 12 degrees is a risk factor for anterior cruciate ligament injury,and varus deformity can aggravate the progression of medial osteoarthri...BACKGROUND It has been confirmed that the increased posterior tibial slope over 12 degrees is a risk factor for anterior cruciate ligament injury,and varus deformity can aggravate the progression of medial osteoarthritis.AIM To evaluate the efficacy of modified high tibial osteotomy(HTO)and anterior cruciate ligament reconstruction(ACLR)in the treatment of anterior cruciate ligament(ACL)injuries with varus deformities and increased posterior tibial slope(PTS)based on clinical and imaging data.METHODS The patient data in this retrospective study were collected from 2019 to 2021.A total of 6 patients were diagnosed with ACL injury combined with varus deformities and increased PTS.All patients underwent modified open wedge HTO and ACLR.The degree of correction of varus deformity and the PTS was evaluated by radiography and magnetic resonance imaging.RESULTS All 6 patients(6 knee joints)were followed up for an average of 20.8±3.7 months.The average age at surgery was 29.5±3.8 years.At the last follow-up,all patients resumed competitive sports.The International Knee Documentation Committee score increased from 50.3±3.1 to 87.0±2.8,the Lysholm score increased from 43.8±4.9 to 86±3.1,and the Tegner activity level increased from 2.2±0.7 to 7.0±0.6.The average movement distance of the tibia anterior translation was 4.8±1.1 mm,medial proximal tibial angle(MPTA)was 88.9±1.3°at the last follow-up,and the PTS was 8.4±1.4°,both of which were significantly higher than those before surgery(P<0.05).CONCLUSION Modified open wedge HTO combined with ACLR can effectively treat patients with ACL ruptures with an associated increased PTS and varus deformity.The short-term effect is significant,but the long-term effect requires further follow-up.展开更多
Hallux valgus is a relatively common and multifaceted complex deformity of the front part of the foot. It is the result of multiple effects of innate (endogenous) and exogenous etiological factors with different degre...Hallux valgus is a relatively common and multifaceted complex deformity of the front part of the foot. It is the result of multiple effects of innate (endogenous) and exogenous etiological factors with different degrees of influence. The degree of hallux valgus deformity is usually assessed by radiological values of hallux valgus (HV) and intermetatarsal (IM) angles. The aim of the paper is to justify the definition of hallux valgus deformity as a function of one angle, (HVA or IMA), and then to determine the functional connection and the most suitable function equalizing the values of the angles IMA and HVA. As hallux valgus is a double angulation deformity, the analytically determined connection between the HVA and IMA angles reduces the study of the deformity to the study of function with one argument, and makes the analysis of deformity changes before and after operative treatment simpler. For the determined connections between the angles, the values of linear proportionality coefficients and regression coefficients of corresponding linear functions of analytical equalization of the value of the IM angle and the degree of deformity for a given value of the HV angle were experimentally determined. The obtained results were checked on a sample of 396 operatively treated hallux valgus deformities. The presented analytical approach and the obtained functional links of IMA and HVA enable quantitative observation of the change in the degree of deformity based on the radiologically determined value of these angles, and the established nonlinear function will be useful for evaluating the expected value of the IM angle and the degree of deformity based only on the measured value of the HV angle. .展开更多
Objective: This study aims to evaluate the efficacy and safety of using a strip-shaped cymba conchae orthosis for the nonsurgical correction of complex auricular deformities. Methods: Clinical data were collected from...Objective: This study aims to evaluate the efficacy and safety of using a strip-shaped cymba conchae orthosis for the nonsurgical correction of complex auricular deformities. Methods: Clinical data were collected from 2020 to 2021 for 6 patients who underwent correction using a stripshaped cymba conchae orthosis. The indications, corrective effects, and complications associated with use of the orthosis were analyzed. Results: There were four indications for treatment: cryptotia with helix adhesion;cryptotia with grade I microtia;cryptotia with excessive helix thickness;and auricular deformity beyond the treatment time window(≥6 months). Excellent corrective effects were observed in all 6 patients. Complications occurred in one patient, who recovered after symptomatic treatment. Conclusion: The use of a strip-shaped cymba conchae orthosis alone or combined with a U-shaped helix orthosis presents a feasible approach for correcting complex auricular deformities or deformities beyond the treatment time window in pediatric patients.展开更多
Objective The Vickers ligament is thought to hinder the growth of palmar ulnar radius by tethering the lunate to the radius,leading to Madelung deformity.The purpose of this study was to clarify the nature of the Vick...Objective The Vickers ligament is thought to hinder the growth of palmar ulnar radius by tethering the lunate to the radius,leading to Madelung deformity.The purpose of this study was to clarify the nature of the Vickers ligament and investigate its pathogenesis in Madelung deformities based on our observation of the Vickers ligament.Methods All 22 patients(33 wrists)with Madelung deformities treated surgically between 2018 and 2022 were included.The diagnosis was confirmed radiographically in all patients.The three-dimensional computed tomography(3D-CT)data of 16 patients(19 wrists)were available.Magnetic resonance imaging(MRI)data were available for 9 patients(14 wrists).Wrist arthroscopy was used in 4 patients.The Vickers ligament was resected and submitted for histopathological examination in 8 patients.Radiographic outcomes,3D-CT,MRI,arthroscopy,surgical findings,and histopathology of the Vickers ligament were evaluated.Results The 3D-CT revealed that the Vickers ligament originated in the metaphysis and formed a metaphyseal defect at the palmar ulnar radius.In the sequential MR coronal images,the Vickers ligament could be divided into 3 branches,extending to the lunate,triquetrum and ulnar styloid.Arthroscopy and surgical findings revealed that the nature of the Vickers ligament was the stretched palmar ligament of the wrist.The histopathology results revealed ligamentous tissue and fibrocartilaginous metaplasia with a structure similar to that of the triangular fibrocartilage complex(TFCC).Conclusions The Vickers ligament is not a separate aberrant ligament.The nature of the Vickers ligament is a combination of the stretched TFCC ligament(palmar radioulnar ligament,ulnotriquetral ligament and ulnolunate ligament)and radiolunate ligament.The possible pathogenesis of Madelung deformity might be focal early epiphyseal closure at the middle part of the sigmoid notch,which leads to focal growth retardation of the radius and pulls palmar ligaments proximally to form the Vickers ligament.展开更多
Hallux valgus is a complex deformity of the forefoot. It is the result of multiple effects of endogenous and exogenous etiological factors with different degrees of influence. The degree of hallux valgus deformity was...Hallux valgus is a complex deformity of the forefoot. It is the result of multiple effects of endogenous and exogenous etiological factors with different degrees of influence. The degree of hallux valgus deformity was assessed by radiological values of hallux valgus (HVA) and intermetatarsal (IMA) angle. Thus, each hallux valgus deformity corresponds to a pair (HVA, IMA) of hallux valgus angle (HVA) and intermetatarsal angle (IMA) values in the plane of the deformity. The intensity of the point position vector S (HVA, IMA) in the deformation plane determined by the relation represents the absolute (conjugate) value of the power deformities. The goal of the article is to explain the advantage of the definition of the degree of hallux valgus deformity using its absolute (conjugate) value, and then to show that the degree of deformity defined in this way enables a better classification of deformities for all values of the HVA and IMA angles. Furthermore, in this article, applying the definition of conjugate deformity, analytical expressions were constructed for the assessment of the average value of deformity correction after operative treatment, as well as the error assessment of deformity correction after operative treatment. All obtained results were checked on a sample of 396 operatively treated feet.展开更多
Joint deformity and dysfunction are common and serious complications in the late stage of rheumatoid arthritis,which seriously affect the quality of life of patients.Traditional Chinese medicine(TCM)believes that join...Joint deformity and dysfunction are common and serious complications in the late stage of rheumatoid arthritis,which seriously affect the quality of life of patients.Traditional Chinese medicine(TCM)believes that joint deformity and dysfunction in some patients with rheumatoid arthritis are closely related to the apraxia of meridians and tendons due to enduring illness.Based on the theory of meridians and tendons circulation,using the local and nearby therapeutic effect of acupoints as the treatment method in clinical practice,we conducted penetration needling of Houxi,Baxie,Wailaogong as well as Ashi points of interphalangeal joints of both hands through bilateral Sanjian,and used the uniform reinforcing-reducing method to soothe tendons and meridians,thus effectively improving the dysfunction of deformed joints.展开更多
Coronal plane deformity around the knee,also known as genu varum or genu valgum,is a common finding in clinical practice for pediatricians and orthopedists.These deformities can be physiological or pathological.If unt...Coronal plane deformity around the knee,also known as genu varum or genu valgum,is a common finding in clinical practice for pediatricians and orthopedists.These deformities can be physiological or pathological.If untreated,pathological deformities can lead to abnormal joint loading and a consequent risk of premature osteoarthritis.The aim of this review is to provide a framework for the diagnosis and management of genu varum and genu valgum in skeletally immature patients.展开更多
The dynamic fracture behavior of the three-point bending beam with double deformity inclusions under impact loading is studied by using digital high-speed photography in combination with the transmission-type dynamic ...The dynamic fracture behavior of the three-point bending beam with double deformity inclusions under impact loading is studied by using digital high-speed photography in combination with the transmission-type dynamic caustic method. The experimental results indicate that the fluctuation of crack propagation velocity v first increases and then decreases in the crack propagation process. During the process of crack propagating into the inclusion area, the fracture resistance effect of the circular inclusion is the most significant and the effects of triangular and square inclusions are less obvious. The stress intensity factor near the crack tip increases during the propagation process and reaches its maximum value when the crack tip is close to the inclusions. The crack tip’s dynamic stress intensity factor （ DSIF） decreases when the crack exceeds the middle area of the double inclusions. These results provide an experimental basis and scientific foundation to strengthen the evaluation and fracture analysis of the structure containing deformity inclusions.展开更多
The approach combining the dynamic caustics method with high-speed photography technology is used to study the interaction between propagating cracks and three kinds of deformity inclusions（ cylinder inclusion, quadr...The approach combining the dynamic caustics method with high-speed photography technology is used to study the interaction between propagating cracks and three kinds of deformity inclusions（ cylinder inclusion, quadruple inclusion and triangular inclusion） under lowvelocity impact loading. By recording the caustic spots of crack tips at different moments during the crack propagation, the variation regulations of dynamic stress intensity factors（ DSIF） and crack growth velocity with respect to time are obtained. The experimental results showthat the resistance effects to crack growth are varied with different shapes of inclusions in specimens, and the quadruple inclusion＇s effect is more apparent. The distortion degree of caustic spots is affected by the shapes of inclusions as well, and the situation is more serious for cylinder and quadruple inclusions. The overall values of DSIFs of triangular inclusion specimen are greater than the others, and the crack growth velocities, characteristic sizes and DSIFs showprocesses of fluctuations because of the disturbance of reflection waves in specimens. The results provide an experimental basis for the analysis of strength and impact-resistance ability in structures with deformity inclusions.展开更多
AIM: To evaluate the effect of releasing the orbicularis retaining ligament(ORL) complex of the tear trough combined with the transconjunctival blepharoplasty in the surgical management of tear trough deformity compar...AIM: To evaluate the effect of releasing the orbicularis retaining ligament(ORL) complex of the tear trough combined with the transconjunctival blepharoplasty in the surgical management of tear trough deformity compared with the effect of blepharoplasty alone. METHODS: A prospective, randomized(by closed envelope technique), controlled surgical trial which included 50 patients(100 eyes) with bilateral visible tear trough deformity and lower eyelid fat bulging, was divided into two groups where 25 patients(50 eyes) had tear trough-ORL release with blepharoplasty and 25 patients(50 eyes) didn't. Qualitative and quantitative assessments of tear trough deformity were done at 6 mo postoperatively, achieving grade 0 or 1 of Barton's classification was considered a success. Standardized photographic documentation of each patient was done pre and postoperatively, also assessment of the patients' satisfaction postoperatively was done and ranked as excellent, very good, good or fair. RESULTS: There was statistically significant difference between the two groups in the overall aesthetic results postoperatively regarding the qualitative and quantitative analysis of the tear trough deformity, where patients who had tear trough-ORL complex release had more successful outcomes than those of the second group. CONCLUSION: ORL release should be done in patients with tear trough deformity in order to release the tethering effect of this ligament which causes the prominence of the naso jugal groove.展开更多
Aim:To investigate the impact of abnormal sperm morphology using the sperm deformity index (SDI) on reactive oxygen species (ROS) production and its correlation with sperm DNA damage.Methods:Semen samples were collect...Aim:To investigate the impact of abnormal sperm morphology using the sperm deformity index (SDI) on reactive oxygen species (ROS) production and its correlation with sperm DNA damage.Methods:Semen samples were collected from men undergoing infertility screening (n=7) and healthy donors (n=6).Mature spermatozoa were isolated and incubated with 5 mmol/L β-nicotinamide adenine dinucleotide phosphate (NADPH) for up to 24 h to induce ROS.Sperm morphology was evaluated using strict Tygerberg's criteria and the SDI.ROS levels and DNA damage were assessed using chemiluminescence and terminal deoxynucleotidyl transferase-mediated fluorescein- dUTP nick end labeling (TUNEL) assays,respectively.Results:SDI values (median [interquartiles]) were higher in patients than donors (2 [1.8,2.1] vs.1.53 [1.52,1.58],P=0.008).Aliquots treated with NADPH showed higher ROS levels (1.22 [0.30,1.87] vs.0.39 [0.10,0.57],P=0.03) and higher incidence of DNA damage than those not treated (10 [4.69,24.85] vs.3.85 [2.58,5.10],P=0.008).Higher DNA damage was also seen following 24 h of incubation in patients compared to donors.SDI correlated with the percentage increase in sperm DNA damage following incubation for 24 h in samples treated with NADPH (r=0.7,P=0.008) and controls (r=0.58,P=0.04). Conclusion:SDI may be a useful tool in identifying potential infertile males with abnormal prevalence of oxidative stress (OS)-induced DNA damage.NADPH plays a role in ROS-mediated sperm DNA damage,which appears to be more evident in infertile patients with semen samples containing a high incidence of morphologically abnormal spermatozoa.展开更多
Supernumerary marker chromosome 15 （sSMC[15]） is the most frequent marker chromosome, and it is generally regarded as unimportant if it does not contain the Prader-Willi/Angelman syndrome critical region （PWACR）. ...Supernumerary marker chromosome 15 （sSMC[15]） is the most frequent marker chromosome, and it is generally regarded as unimportant if it does not contain the Prader-Willi/Angelman syndrome critical region （PWACR）. The clinical importance of the larger markers in association with the critical region is mentioned in almost all reports related to marker chromosome 15, and smaller markers are solely associated with minor dysmorphic features, azoospermia and recurrent miscarriages. However, these small sSMC（15）s without the PWACR may also determine a specific phenotype. A dysmorphic examination of an azoospermic patient in a genetics clinic was performed and was followed by a peripheral blood lymphocyte chromosomal analysis according to standard cytogenetic methods. Nucleolar region （NOR） banding, C-banding, fluorescence in situ hybridization and a molecular investigation of Y-microdeletions were also performed. The clinical evaluation identified dysmorphic features accompanied with azoospermia and severe ‘Angle Class Ⅱ, Division 1 Open Bite Deformity＇. The molecular cytogenetic study revealed the small sSMC（15）. In addition, a Y-microdeletion analysis showed that the azoospermia was not the result of a deletion. Although the presented case might represent a coincidental example of supernumerary marker 15 and mandibular anomaly association, the condition may also define a specific phenotype that may be more than azoospermia. This condition may be characterized by infertility, malar hypoplasia, mandibular anomaly, keloid formation and minor dysmorphic features.展开更多
Objective: A common cavity deformity(CCD) is a deformed inner ear in which the cochlea and vestibule are confluent forming a common rudimentary cystic cavity that results in profound hearing loss. There are few studie...Objective: A common cavity deformity(CCD) is a deformed inner ear in which the cochlea and vestibule are confluent forming a common rudimentary cystic cavity that results in profound hearing loss. There are few studies paying attention to common cavity. Our group is engrossed in observing the improvement of auditory and verbal abilities in children who have received cochlear implantation(CI), and comparing these targets between children with common cavity and normal inner ear structure.Material and methods: A retrospective study was conducted in 12 patients with profound hearing loss that were divided into a common cavity group and a control group, six in each group matched in sex, age and time of implantation, based on inner ear structure. Categories of Auditory Performance(CAP) and speech intelligibility rating(SIR) scores and aided hearing thresholds were collected and compared between the two groups. All patients wore CI for more than 1 year at the Cochlear Center of Anhui Medical University from 2011 to 2015.Results: Postoperative CAP and SIR scores were higher than before operation in both groups(p < 0.05), although the scores were lower in the CCD group than in the control group(p < 0.05). The aided threshold was also lower in the control group than in the CCD group(p < 0.05).Conclusion: Even though audiological improvement in children with CCD was not as good as in those without CCD, CI provides benefits in auditory perception and communication skills in these children.展开更多
Summary： Preoperative planning of corrective osteotomy with traditional radiography has limitations in regards to determining the ideal osteotomy location and orientation in three-dimensional femoral de- formities. T...Summary： Preoperative planning of corrective osteotomy with traditional radiography has limitations in regards to determining the ideal osteotomy location and orientation in three-dimensional femoral de- formities. Though a successful operation can be planned preoperatively, intraoperative contingencies might adhere to the procedural plan in the performance of operation. To efficiently perform a planned procedure, proposed is a design to implement three-dimensional reconstruction photography, based on computer-tomography （CT） scan. A custom-made guide was designed to navigate the osteotomy as planned, and additionally, a personalized intramedullary nail was used for fixation after osteotomy. Three-dimensional （3D） photography of deformed femur was established based on the CT dataset and transferred into 3D photography processing software for further planning. Osteotomy planes were de- signed and adjusted at deformity sites to correct the 3D deformities. The methodology of a custom-made osteotomy guide was introduced in femoral corrective osteotomy, for the first time, to navigate the op- eration as planned. After the virtual osteotomy and reduction of bone segments, the parameters of a custom-made intramedullary nail were measured for manufacturing. Findings Virtual operation in computer shows complete correction of the 3D deformity. The osteotomy guide, obtained by rapid-prototyping techniques, navigates mimicking surgery on rapid-prototyping model of the involved femur as planned. Internal fixation was achieved using the custom-made intramedullary nail. Interpreta- tion three-dimensional visualization introduces an advantage in preoperative planning for corrective os- teotomy of 3D femoral deformity, and the custom-made osteotomy guide is crucial to realize such a de- liberate plan during the actual procedures. The internal fixator, such as an intramedullary nail, can be modified or personalized for fixation in unique cases.展开更多
AIM: To evaluate published data on the predictors of progressive adolescent idiopathic scoliosis(AIS) in order to evaluate their efficacy and level of evidence. METHODS: Selection criteria:(1) study design: randomized...AIM: To evaluate published data on the predictors of progressive adolescent idiopathic scoliosis(AIS) in order to evaluate their efficacy and level of evidence. METHODS: Selection criteria:(1) study design: randomized controlled clinical trials, prospective cohort studies and case series, retrospective comparative and none comparative studies;(2) participants: adolescents with AIS aged from 10 to 20 years; and(3) treatment: observation, bracing, and other. Search method: Ovid MEDLINE, Embase, the Cochrane Library, Pub Medand patent data bases. All years through August 2014 were included. Data were collected that showed an association between the studied characteristics and the progression of AIS or the severity of the spine deformity. Odds ratio(OR), sensitivity, specificity, positive and negative predictive values were also collected. A metaanalysis was performed to evaluate the pooled OR and predictive values, if more than 1 study presented a result. The GRADE approach was applied to evaluate the level of evidence.RESULTS: The review included 25 studies. All studies showed statistically significant or borderline association between severity or progression of AIS with the following characteristics:(1) An increase of the Cobb angle or axial rotation during brace treatment;(2) decrease of the rib-vertebral angle at the apical level of the convex side during brace treatment;(3) initial Cobb angle severity(> 25o);(4) osteopenia;(5) patient age < 13 years at diagnosis;(6) premenarche status;(7) skeletal immaturity;(8) thoracic deformity;(9) brain stem vestibular dysfunction; and(10) multiple indices combining radiographic, demographic, and physiologic characteristics. Single nucleotide polymorphisms of the following genes:(1) calmodulin 1;(2) estrogen receptor 1;(3) tryptophan hydroxylase 1;(3) insulin-like growth factor 1;(5) neurotrophin 3;(6) interleukin-17 receptor C;(7) melatonin receptor 1B, and(8) Scoli Score test. Other predictors included:(1) impairment of melatonin signaling in osteoblasts and peripheral blood mononuclear cells(PBMC);(2) G-protein signaling dysfunction in PBMC; and(3) the level of platelet calmodulin. However, predictive values of all these findings were limited, and the levels of evidence were low. The pooled result of brace treatment outcomes demonstrated that around 27% of patents with AIS experienced exacerbation of the spine deformity during or after brace treatment, and 15% required surgical correction. However, the level of evidence is also low due to the limitations of the included studies.CONCLUSION: This review did not reveal any methods for the prediction of progression in AIS that could be recommended for clinical use as diagnostic criteria.展开更多
This study aimed to examine the clinical and radiographic outcomes of primary total knee arthroplasy（TKA） with use of Nex Gen#174; Legacy#174; Constrained Condylar Knee（CCK） prosthesis for severe knee deformity. C...This study aimed to examine the clinical and radiographic outcomes of primary total knee arthroplasy（TKA） with use of Nex Gen#174; Legacy#174; Constrained Condylar Knee（CCK） prosthesis for severe knee deformity. Clinical data of 46 patients（48 knees in total, aged 61 years on average） with severe knee deformity who underwent TKA with Nex Gen#174; Legacy#174; CCK prosthesis between December 2007 and February 2012 were retrospectively analyzed. There were 34 knees with severe valgus with incompetent medial collateral ligament, 11 knees with severe flexion contracture with inability to achieve knee balancing in flexion and extension by posterior soft tissue release, 2 knees with Charcot arthritis with severe varus and bone loss, and 1 with traumatic osteoarthritis with severe varus and ligamentous instability. The mean duration of follow-up was 71 months（range 40–90 months）. The New Knee Society scoring（NKSS） system and the Hospital for Special Surgery（HSS） score were used to evaluate the functional and clinical outcomes. Visual Analogue Scale（VAS） was used for pain measurement and Knee Society criteria for evaluation of radiological images. The results showed that, in the total 48 knees, 1 case of loosening due to short-stem tibial component at 3 months post-operatively underwent revision. The 6-year prosthesis survival rate in this cohort was 97.9%. There was no component infection occurring within 6 years. Significant post-operative improvements were found in NKSS and HSS scores. Patient satisfaction was significantly increased. Pain score was decreased significantly. Total functional score was improved from 31.46±11.43 to 86.42±8.87, range of motion（ROM） from 42.42°±23.57° to 95.31°±23.45° and the flexion contracture from 5.31°±7.87° to 0.92°±1.80°. Preoperative radiographic study showed excessive valgus（≥7°） in 37 knees, and varus deformity in 3 knees. Post-operative femorotibial alignment was valgus 3.88°±1.76° in 48 knees. Antero/posterior（A/P） view of X-ray films showed 4 radiolucent lines（RLL） in 48 tibial components. It was concluded that TKA with CCK is effective for the treatment of the severe unstable knee that cannot be balanced by soft tissue.展开更多
Congenital absence of the splenic artery is a very rare condition.To the best of our knowledge, congenital absence of the splenic artery accompanied with absence of the splenic vein has not been reported.We report a c...Congenital absence of the splenic artery is a very rare condition.To the best of our knowledge, congenital absence of the splenic artery accompanied with absence of the splenic vein has not been reported.We report a case of the absence of the splenic artery and vein in a 61-year-old woman who presented with postprandial epigastric discomfort. Upper gastrointestinal endoscopy showed a dilated, pulsatile vessel in the fundus and duodenal stenosis. An abdominal computed tomography(CT)scan revealed absence of the splenic vein with a tortuously engorged gastroepiploic vein.Three-dimensional CT demonstrated the tortuously dilated left gastric artery and the left gastroepiploic artery with non-visualization of the splenic artery.After administration of a proton pump inhibitor,abdominal symptoms resolved without any recurrence of symptoms during 6 mo of follow-up.展开更多
BACKGROUND Surgical treatment of knee osteoarthritis(KOA)complicated by extra-articular deformity has always been controversial regardless of whether it is simultaneous or staged.Simultaneous total knee arthroplasty(T...BACKGROUND Surgical treatment of knee osteoarthritis(KOA)complicated by extra-articular deformity has always been controversial regardless of whether it is simultaneous or staged.Simultaneous total knee arthroplasty(TKA)combined with supracondylar osteotomy without plate for treatment of KOA complicated by femoral varus deformity has not been reported in the literature.CASE SUMMARY A 53-year-old Chinese woman complained of left knee pain for 6 years that worsened for 4 mo during her visit on April 3,2020,accompanied by instability in walking,which seriously affected quality of life.According to her medical history and preoperative imaging,the patient was diagnosed with left KOA with varus deformity.We used the angular center of rotation principle for osteotomy of the femur deformity and placed a poststabilized femur prosthesis into the knee joint.At the same time,a 13 mm×130 mm femur extension rod was used instead of a steel plate to fix the end of the femur osteotomy,reducing the possible complications caused by steel plate implantation and reducing the economic burden on patients.The operation successfully solved two major problems of KOA and varus deformity,and the clinical and imaging evaluation of postoperative followup were satisfactory.CONCLUSION TKA and supracondylar femoral osteotomy can be used for simultaneous KOA treatment and deformity correction.展开更多
BACKGROUND Recently,medical three-dimensional printing technology(3DPT)has demonstrated potential benefits for the treatment of cubitus varus deformity(CVD)by improving accuracy of the osteotomy through the use of an ...BACKGROUND Recently,medical three-dimensional printing technology(3DPT)has demonstrated potential benefits for the treatment of cubitus varus deformity(CVD)by improving accuracy of the osteotomy through the use of an osteotomy guide,with or without a patient-mated plate.Here,we present an interesting CVD case,involving a patient who was treated with corrective biplanar chevron osteotomy using an innovative customized osteotomy guide and a newly designed patient-matched monoblock crosslink plate created with 3DPT.CASE SUMMARY A 32-year-old female presented with a significant CVD from childhood injury.A computer simulation was processed using images from computerized tomography scans of both upper extremities.The biplanar chevron osteotomy was designed to create identical anatomy between the mirror image of the contralateral distal humerus and the osteotomized distal humerus.Next,the customized osteotomy guide and patient-matched monoblock crosslink plate were designed and printed.A simulation osteotomy was created for the real-sized bone model,and the operation was performed using the posterior paratricipital approach with k-wire positioning from the customized osteotomy guide as a predrilled hole for screw fixation to achieve immediate control of the reduction after osteotomy.Our method allowed for successful treatment of the CVD case,significantly improving the patient’s radiographic and clinical outcomes,with satisfactory result.CONCLUSION 3DPT-created patient-matched osteotomy guide and instrumentation provides accurate control during CVD correction.展开更多
AIM To determine the incidence and risk factors for mechanical complications （MC） after surgical correction of adult spinal deformity （ASD） with osteotomy.METHODSA retrospective study was performed. Inclusion crit...AIM To determine the incidence and risk factors for mechanical complications （MC） after surgical correction of adult spinal deformity （ASD） with osteotomy.METHODSA retrospective study was performed. Inclusion criteria： Surgical correction of ASD using osteotomy; male or female; 〉 20 years old; follow-up ≥ 24 mo or revision. The MC of spine and spinal instrumentation were studied separately. Risk analysis included assessment of the association between more than 50 different characteristics （demographic, clinical, radiographic, and instrumentation） with different types of MC.RESULTSThe medical records of 94 operations in 88 subjects were analyzed： Female （68%）, mean age 58.6 （SD, 12.7） years. Cumulative incidence of MC at 2 year follow-up was 43.6%. Of these, 78% required revision （ P 〈 0.001）. The following characteristics had significant （ P ≤ 0.05） association with MC： （1） Preoperative： osteoporosis, smoking, previous spinal operation, sagittal vertical axis （SVA） 〉 100 mm, lumbar lordosis （LL） 〈 34°; （2） postoperative： SVA 〉 75 mm; operative correction： SVA 〉 75 mm, LL 〉 30°, thoracic kyphosis 〉 25°, and pelvic tilt 〉 9°; a fall; pseudarthrosis; and （3） device and surgical technique： use of previously implanted instrumentation; use of domino and/or parallel connectors; type of osteotomy （PSO vs SPO） if preoperative SVA 〈 100 mm; lumbar osteotomy location; in-situ rod contouring 〉 60°; and fxation to sacrum/pelvis.CONCLUSIONRisk of MC after surgical correction of ASD is substantial. To decrease this risk over- and/or insuffcient correction of the sagittal imbalance should be avoided.展开更多
文摘BACKGROUND It has been confirmed that the increased posterior tibial slope over 12 degrees is a risk factor for anterior cruciate ligament injury,and varus deformity can aggravate the progression of medial osteoarthritis.AIM To evaluate the efficacy of modified high tibial osteotomy(HTO)and anterior cruciate ligament reconstruction(ACLR)in the treatment of anterior cruciate ligament(ACL)injuries with varus deformities and increased posterior tibial slope(PTS)based on clinical and imaging data.METHODS The patient data in this retrospective study were collected from 2019 to 2021.A total of 6 patients were diagnosed with ACL injury combined with varus deformities and increased PTS.All patients underwent modified open wedge HTO and ACLR.The degree of correction of varus deformity and the PTS was evaluated by radiography and magnetic resonance imaging.RESULTS All 6 patients(6 knee joints)were followed up for an average of 20.8±3.7 months.The average age at surgery was 29.5±3.8 years.At the last follow-up,all patients resumed competitive sports.The International Knee Documentation Committee score increased from 50.3±3.1 to 87.0±2.8,the Lysholm score increased from 43.8±4.9 to 86±3.1,and the Tegner activity level increased from 2.2±0.7 to 7.0±0.6.The average movement distance of the tibia anterior translation was 4.8±1.1 mm,medial proximal tibial angle(MPTA)was 88.9±1.3°at the last follow-up,and the PTS was 8.4±1.4°,both of which were significantly higher than those before surgery(P<0.05).CONCLUSION Modified open wedge HTO combined with ACLR can effectively treat patients with ACL ruptures with an associated increased PTS and varus deformity.The short-term effect is significant,but the long-term effect requires further follow-up.
文摘Hallux valgus is a relatively common and multifaceted complex deformity of the front part of the foot. It is the result of multiple effects of innate (endogenous) and exogenous etiological factors with different degrees of influence. The degree of hallux valgus deformity is usually assessed by radiological values of hallux valgus (HV) and intermetatarsal (IM) angles. The aim of the paper is to justify the definition of hallux valgus deformity as a function of one angle, (HVA or IMA), and then to determine the functional connection and the most suitable function equalizing the values of the angles IMA and HVA. As hallux valgus is a double angulation deformity, the analytically determined connection between the HVA and IMA angles reduces the study of the deformity to the study of function with one argument, and makes the analysis of deformity changes before and after operative treatment simpler. For the determined connections between the angles, the values of linear proportionality coefficients and regression coefficients of corresponding linear functions of analytical equalization of the value of the IM angle and the degree of deformity for a given value of the HV angle were experimentally determined. The obtained results were checked on a sample of 396 operatively treated hallux valgus deformities. The presented analytical approach and the obtained functional links of IMA and HVA enable quantitative observation of the change in the degree of deformity based on the radiologically determined value of these angles, and the established nonlinear function will be useful for evaluating the expected value of the IM angle and the degree of deformity based only on the measured value of the HV angle. .
文摘Objective: This study aims to evaluate the efficacy and safety of using a strip-shaped cymba conchae orthosis for the nonsurgical correction of complex auricular deformities. Methods: Clinical data were collected from 2020 to 2021 for 6 patients who underwent correction using a stripshaped cymba conchae orthosis. The indications, corrective effects, and complications associated with use of the orthosis were analyzed. Results: There were four indications for treatment: cryptotia with helix adhesion;cryptotia with grade I microtia;cryptotia with excessive helix thickness;and auricular deformity beyond the treatment time window(≥6 months). Excellent corrective effects were observed in all 6 patients. Complications occurred in one patient, who recovered after symptomatic treatment. Conclusion: The use of a strip-shaped cymba conchae orthosis alone or combined with a U-shaped helix orthosis presents a feasible approach for correcting complex auricular deformities or deformities beyond the treatment time window in pediatric patients.
基金supported by the Natural Science Foundation of Beijing Municipality(No.7222087)Beijing JST Research Funding(No.ZR-202217).
文摘Objective The Vickers ligament is thought to hinder the growth of palmar ulnar radius by tethering the lunate to the radius,leading to Madelung deformity.The purpose of this study was to clarify the nature of the Vickers ligament and investigate its pathogenesis in Madelung deformities based on our observation of the Vickers ligament.Methods All 22 patients(33 wrists)with Madelung deformities treated surgically between 2018 and 2022 were included.The diagnosis was confirmed radiographically in all patients.The three-dimensional computed tomography(3D-CT)data of 16 patients(19 wrists)were available.Magnetic resonance imaging(MRI)data were available for 9 patients(14 wrists).Wrist arthroscopy was used in 4 patients.The Vickers ligament was resected and submitted for histopathological examination in 8 patients.Radiographic outcomes,3D-CT,MRI,arthroscopy,surgical findings,and histopathology of the Vickers ligament were evaluated.Results The 3D-CT revealed that the Vickers ligament originated in the metaphysis and formed a metaphyseal defect at the palmar ulnar radius.In the sequential MR coronal images,the Vickers ligament could be divided into 3 branches,extending to the lunate,triquetrum and ulnar styloid.Arthroscopy and surgical findings revealed that the nature of the Vickers ligament was the stretched palmar ligament of the wrist.The histopathology results revealed ligamentous tissue and fibrocartilaginous metaplasia with a structure similar to that of the triangular fibrocartilage complex(TFCC).Conclusions The Vickers ligament is not a separate aberrant ligament.The nature of the Vickers ligament is a combination of the stretched TFCC ligament(palmar radioulnar ligament,ulnotriquetral ligament and ulnolunate ligament)and radiolunate ligament.The possible pathogenesis of Madelung deformity might be focal early epiphyseal closure at the middle part of the sigmoid notch,which leads to focal growth retardation of the radius and pulls palmar ligaments proximally to form the Vickers ligament.
文摘Hallux valgus is a complex deformity of the forefoot. It is the result of multiple effects of endogenous and exogenous etiological factors with different degrees of influence. The degree of hallux valgus deformity was assessed by radiological values of hallux valgus (HVA) and intermetatarsal (IMA) angle. Thus, each hallux valgus deformity corresponds to a pair (HVA, IMA) of hallux valgus angle (HVA) and intermetatarsal angle (IMA) values in the plane of the deformity. The intensity of the point position vector S (HVA, IMA) in the deformation plane determined by the relation represents the absolute (conjugate) value of the power deformities. The goal of the article is to explain the advantage of the definition of the degree of hallux valgus deformity using its absolute (conjugate) value, and then to show that the degree of deformity defined in this way enables a better classification of deformities for all values of the HVA and IMA angles. Furthermore, in this article, applying the definition of conjugate deformity, analytical expressions were constructed for the assessment of the average value of deformity correction after operative treatment, as well as the error assessment of deformity correction after operative treatment. All obtained results were checked on a sample of 396 operatively treated feet.
基金Supported by National Natural Science Foundation of China(82205105).
文摘Joint deformity and dysfunction are common and serious complications in the late stage of rheumatoid arthritis,which seriously affect the quality of life of patients.Traditional Chinese medicine(TCM)believes that joint deformity and dysfunction in some patients with rheumatoid arthritis are closely related to the apraxia of meridians and tendons due to enduring illness.Based on the theory of meridians and tendons circulation,using the local and nearby therapeutic effect of acupoints as the treatment method in clinical practice,we conducted penetration needling of Houxi,Baxie,Wailaogong as well as Ashi points of interphalangeal joints of both hands through bilateral Sanjian,and used the uniform reinforcing-reducing method to soothe tendons and meridians,thus effectively improving the dysfunction of deformed joints.
文摘Coronal plane deformity around the knee,also known as genu varum or genu valgum,is a common finding in clinical practice for pediatricians and orthopedists.These deformities can be physiological or pathological.If untreated,pathological deformities can lead to abnormal joint loading and a consequent risk of premature osteoarthritis.The aim of this review is to provide a framework for the diagnosis and management of genu varum and genu valgum in skeletally immature patients.
基金The National Basic Research Program of China(973 Program)(No.2011CB606105)the National Natural Science Foundation of China(No.51374210,51134025)
文摘The dynamic fracture behavior of the three-point bending beam with double deformity inclusions under impact loading is studied by using digital high-speed photography in combination with the transmission-type dynamic caustic method. The experimental results indicate that the fluctuation of crack propagation velocity v first increases and then decreases in the crack propagation process. During the process of crack propagating into the inclusion area, the fracture resistance effect of the circular inclusion is the most significant and the effects of triangular and square inclusions are less obvious. The stress intensity factor near the crack tip increases during the propagation process and reaches its maximum value when the crack tip is close to the inclusions. The crack tip’s dynamic stress intensity factor （ DSIF） decreases when the crack exceeds the middle area of the double inclusions. These results provide an experimental basis and scientific foundation to strengthen the evaluation and fracture analysis of the structure containing deformity inclusions.
基金The National Natural Science Foundation of China(No.51374210,51134025)the 111 Project(No.B14006)
文摘The approach combining the dynamic caustics method with high-speed photography technology is used to study the interaction between propagating cracks and three kinds of deformity inclusions（ cylinder inclusion, quadruple inclusion and triangular inclusion） under lowvelocity impact loading. By recording the caustic spots of crack tips at different moments during the crack propagation, the variation regulations of dynamic stress intensity factors（ DSIF） and crack growth velocity with respect to time are obtained. The experimental results showthat the resistance effects to crack growth are varied with different shapes of inclusions in specimens, and the quadruple inclusion＇s effect is more apparent. The distortion degree of caustic spots is affected by the shapes of inclusions as well, and the situation is more serious for cylinder and quadruple inclusions. The overall values of DSIFs of triangular inclusion specimen are greater than the others, and the crack growth velocities, characteristic sizes and DSIFs showprocesses of fluctuations because of the disturbance of reflection waves in specimens. The results provide an experimental basis for the analysis of strength and impact-resistance ability in structures with deformity inclusions.
文摘AIM: To evaluate the effect of releasing the orbicularis retaining ligament(ORL) complex of the tear trough combined with the transconjunctival blepharoplasty in the surgical management of tear trough deformity compared with the effect of blepharoplasty alone. METHODS: A prospective, randomized(by closed envelope technique), controlled surgical trial which included 50 patients(100 eyes) with bilateral visible tear trough deformity and lower eyelid fat bulging, was divided into two groups where 25 patients(50 eyes) had tear trough-ORL release with blepharoplasty and 25 patients(50 eyes) didn't. Qualitative and quantitative assessments of tear trough deformity were done at 6 mo postoperatively, achieving grade 0 or 1 of Barton's classification was considered a success. Standardized photographic documentation of each patient was done pre and postoperatively, also assessment of the patients' satisfaction postoperatively was done and ranked as excellent, very good, good or fair. RESULTS: There was statistically significant difference between the two groups in the overall aesthetic results postoperatively regarding the qualitative and quantitative analysis of the tear trough deformity, where patients who had tear trough-ORL complex release had more successful outcomes than those of the second group. CONCLUSION: ORL release should be done in patients with tear trough deformity in order to release the tethering effect of this ligament which causes the prominence of the naso jugal groove.
文摘Aim:To investigate the impact of abnormal sperm morphology using the sperm deformity index (SDI) on reactive oxygen species (ROS) production and its correlation with sperm DNA damage.Methods:Semen samples were collected from men undergoing infertility screening (n=7) and healthy donors (n=6).Mature spermatozoa were isolated and incubated with 5 mmol/L β-nicotinamide adenine dinucleotide phosphate (NADPH) for up to 24 h to induce ROS.Sperm morphology was evaluated using strict Tygerberg's criteria and the SDI.ROS levels and DNA damage were assessed using chemiluminescence and terminal deoxynucleotidyl transferase-mediated fluorescein- dUTP nick end labeling (TUNEL) assays,respectively.Results:SDI values (median [interquartiles]) were higher in patients than donors (2 [1.8,2.1] vs.1.53 [1.52,1.58],P=0.008).Aliquots treated with NADPH showed higher ROS levels (1.22 [0.30,1.87] vs.0.39 [0.10,0.57],P=0.03) and higher incidence of DNA damage than those not treated (10 [4.69,24.85] vs.3.85 [2.58,5.10],P=0.008).Higher DNA damage was also seen following 24 h of incubation in patients compared to donors.SDI correlated with the percentage increase in sperm DNA damage following incubation for 24 h in samples treated with NADPH (r=0.7,P=0.008) and controls (r=0.58,P=0.04). Conclusion:SDI may be a useful tool in identifying potential infertile males with abnormal prevalence of oxidative stress (OS)-induced DNA damage.NADPH plays a role in ROS-mediated sperm DNA damage,which appears to be more evident in infertile patients with semen samples containing a high incidence of morphologically abnormal spermatozoa.
文摘Supernumerary marker chromosome 15 （sSMC[15]） is the most frequent marker chromosome, and it is generally regarded as unimportant if it does not contain the Prader-Willi/Angelman syndrome critical region （PWACR）. The clinical importance of the larger markers in association with the critical region is mentioned in almost all reports related to marker chromosome 15, and smaller markers are solely associated with minor dysmorphic features, azoospermia and recurrent miscarriages. However, these small sSMC（15）s without the PWACR may also determine a specific phenotype. A dysmorphic examination of an azoospermic patient in a genetics clinic was performed and was followed by a peripheral blood lymphocyte chromosomal analysis according to standard cytogenetic methods. Nucleolar region （NOR） banding, C-banding, fluorescence in situ hybridization and a molecular investigation of Y-microdeletions were also performed. The clinical evaluation identified dysmorphic features accompanied with azoospermia and severe ‘Angle Class Ⅱ, Division 1 Open Bite Deformity＇. The molecular cytogenetic study revealed the small sSMC（15）. In addition, a Y-microdeletion analysis showed that the azoospermia was not the result of a deletion. Although the presented case might represent a coincidental example of supernumerary marker 15 and mandibular anomaly association, the condition may also define a specific phenotype that may be more than azoospermia. This condition may be characterized by infertility, malar hypoplasia, mandibular anomaly, keloid formation and minor dysmorphic features.
文摘Objective: A common cavity deformity(CCD) is a deformed inner ear in which the cochlea and vestibule are confluent forming a common rudimentary cystic cavity that results in profound hearing loss. There are few studies paying attention to common cavity. Our group is engrossed in observing the improvement of auditory and verbal abilities in children who have received cochlear implantation(CI), and comparing these targets between children with common cavity and normal inner ear structure.Material and methods: A retrospective study was conducted in 12 patients with profound hearing loss that were divided into a common cavity group and a control group, six in each group matched in sex, age and time of implantation, based on inner ear structure. Categories of Auditory Performance(CAP) and speech intelligibility rating(SIR) scores and aided hearing thresholds were collected and compared between the two groups. All patients wore CI for more than 1 year at the Cochlear Center of Anhui Medical University from 2011 to 2015.Results: Postoperative CAP and SIR scores were higher than before operation in both groups(p < 0.05), although the scores were lower in the CCD group than in the control group(p < 0.05). The aided threshold was also lower in the control group than in the CCD group(p < 0.05).Conclusion: Even though audiological improvement in children with CCD was not as good as in those without CCD, CI provides benefits in auditory perception and communication skills in these children.
基金supported by grants from the National Natural Science Foundation of China (No. 81141022)the General Hospital of Chinese Liberation Army (No. 10KMM09)
文摘Summary： Preoperative planning of corrective osteotomy with traditional radiography has limitations in regards to determining the ideal osteotomy location and orientation in three-dimensional femoral de- formities. Though a successful operation can be planned preoperatively, intraoperative contingencies might adhere to the procedural plan in the performance of operation. To efficiently perform a planned procedure, proposed is a design to implement three-dimensional reconstruction photography, based on computer-tomography （CT） scan. A custom-made guide was designed to navigate the osteotomy as planned, and additionally, a personalized intramedullary nail was used for fixation after osteotomy. Three-dimensional （3D） photography of deformed femur was established based on the CT dataset and transferred into 3D photography processing software for further planning. Osteotomy planes were de- signed and adjusted at deformity sites to correct the 3D deformities. The methodology of a custom-made osteotomy guide was introduced in femoral corrective osteotomy, for the first time, to navigate the op- eration as planned. After the virtual osteotomy and reduction of bone segments, the parameters of a custom-made intramedullary nail were measured for manufacturing. Findings Virtual operation in computer shows complete correction of the 3D deformity. The osteotomy guide, obtained by rapid-prototyping techniques, navigates mimicking surgery on rapid-prototyping model of the involved femur as planned. Internal fixation was achieved using the custom-made intramedullary nail. Interpreta- tion three-dimensional visualization introduces an advantage in preoperative planning for corrective os- teotomy of 3D femoral deformity, and the custom-made osteotomy guide is crucial to realize such a de- liberate plan during the actual procedures. The internal fixator, such as an intramedullary nail, can be modified or personalized for fixation in unique cases.
文摘AIM: To evaluate published data on the predictors of progressive adolescent idiopathic scoliosis(AIS) in order to evaluate their efficacy and level of evidence. METHODS: Selection criteria:(1) study design: randomized controlled clinical trials, prospective cohort studies and case series, retrospective comparative and none comparative studies;(2) participants: adolescents with AIS aged from 10 to 20 years; and(3) treatment: observation, bracing, and other. Search method: Ovid MEDLINE, Embase, the Cochrane Library, Pub Medand patent data bases. All years through August 2014 were included. Data were collected that showed an association between the studied characteristics and the progression of AIS or the severity of the spine deformity. Odds ratio(OR), sensitivity, specificity, positive and negative predictive values were also collected. A metaanalysis was performed to evaluate the pooled OR and predictive values, if more than 1 study presented a result. The GRADE approach was applied to evaluate the level of evidence.RESULTS: The review included 25 studies. All studies showed statistically significant or borderline association between severity or progression of AIS with the following characteristics:(1) An increase of the Cobb angle or axial rotation during brace treatment;(2) decrease of the rib-vertebral angle at the apical level of the convex side during brace treatment;(3) initial Cobb angle severity(> 25o);(4) osteopenia;(5) patient age < 13 years at diagnosis;(6) premenarche status;(7) skeletal immaturity;(8) thoracic deformity;(9) brain stem vestibular dysfunction; and(10) multiple indices combining radiographic, demographic, and physiologic characteristics. Single nucleotide polymorphisms of the following genes:(1) calmodulin 1;(2) estrogen receptor 1;(3) tryptophan hydroxylase 1;(3) insulin-like growth factor 1;(5) neurotrophin 3;(6) interleukin-17 receptor C;(7) melatonin receptor 1B, and(8) Scoli Score test. Other predictors included:(1) impairment of melatonin signaling in osteoblasts and peripheral blood mononuclear cells(PBMC);(2) G-protein signaling dysfunction in PBMC; and(3) the level of platelet calmodulin. However, predictive values of all these findings were limited, and the levels of evidence were low. The pooled result of brace treatment outcomes demonstrated that around 27% of patents with AIS experienced exacerbation of the spine deformity during or after brace treatment, and 15% required surgical correction. However, the level of evidence is also low due to the limitations of the included studies.CONCLUSION: This review did not reveal any methods for the prediction of progression in AIS that could be recommended for clinical use as diagnostic criteria.
基金supported by a grant from the National Nature Science Foundation of China(No.81371973)
文摘This study aimed to examine the clinical and radiographic outcomes of primary total knee arthroplasy（TKA） with use of Nex Gen#174; Legacy#174; Constrained Condylar Knee（CCK） prosthesis for severe knee deformity. Clinical data of 46 patients（48 knees in total, aged 61 years on average） with severe knee deformity who underwent TKA with Nex Gen#174; Legacy#174; CCK prosthesis between December 2007 and February 2012 were retrospectively analyzed. There were 34 knees with severe valgus with incompetent medial collateral ligament, 11 knees with severe flexion contracture with inability to achieve knee balancing in flexion and extension by posterior soft tissue release, 2 knees with Charcot arthritis with severe varus and bone loss, and 1 with traumatic osteoarthritis with severe varus and ligamentous instability. The mean duration of follow-up was 71 months（range 40–90 months）. The New Knee Society scoring（NKSS） system and the Hospital for Special Surgery（HSS） score were used to evaluate the functional and clinical outcomes. Visual Analogue Scale（VAS） was used for pain measurement and Knee Society criteria for evaluation of radiological images. The results showed that, in the total 48 knees, 1 case of loosening due to short-stem tibial component at 3 months post-operatively underwent revision. The 6-year prosthesis survival rate in this cohort was 97.9%. There was no component infection occurring within 6 years. Significant post-operative improvements were found in NKSS and HSS scores. Patient satisfaction was significantly increased. Pain score was decreased significantly. Total functional score was improved from 31.46±11.43 to 86.42±8.87, range of motion（ROM） from 42.42°±23.57° to 95.31°±23.45° and the flexion contracture from 5.31°±7.87° to 0.92°±1.80°. Preoperative radiographic study showed excessive valgus（≥7°） in 37 knees, and varus deformity in 3 knees. Post-operative femorotibial alignment was valgus 3.88°±1.76° in 48 knees. Antero/posterior（A/P） view of X-ray films showed 4 radiolucent lines（RLL） in 48 tibial components. It was concluded that TKA with CCK is effective for the treatment of the severe unstable knee that cannot be balanced by soft tissue.
文摘Congenital absence of the splenic artery is a very rare condition.To the best of our knowledge, congenital absence of the splenic artery accompanied with absence of the splenic vein has not been reported.We report a case of the absence of the splenic artery and vein in a 61-year-old woman who presented with postprandial epigastric discomfort. Upper gastrointestinal endoscopy showed a dilated, pulsatile vessel in the fundus and duodenal stenosis. An abdominal computed tomography(CT)scan revealed absence of the splenic vein with a tortuously engorged gastroepiploic vein.Three-dimensional CT demonstrated the tortuously dilated left gastric artery and the left gastroepiploic artery with non-visualization of the splenic artery.After administration of a proton pump inhibitor,abdominal symptoms resolved without any recurrence of symptoms during 6 mo of follow-up.
文摘BACKGROUND Surgical treatment of knee osteoarthritis(KOA)complicated by extra-articular deformity has always been controversial regardless of whether it is simultaneous or staged.Simultaneous total knee arthroplasty(TKA)combined with supracondylar osteotomy without plate for treatment of KOA complicated by femoral varus deformity has not been reported in the literature.CASE SUMMARY A 53-year-old Chinese woman complained of left knee pain for 6 years that worsened for 4 mo during her visit on April 3,2020,accompanied by instability in walking,which seriously affected quality of life.According to her medical history and preoperative imaging,the patient was diagnosed with left KOA with varus deformity.We used the angular center of rotation principle for osteotomy of the femur deformity and placed a poststabilized femur prosthesis into the knee joint.At the same time,a 13 mm×130 mm femur extension rod was used instead of a steel plate to fix the end of the femur osteotomy,reducing the possible complications caused by steel plate implantation and reducing the economic burden on patients.The operation successfully solved two major problems of KOA and varus deformity,and the clinical and imaging evaluation of postoperative followup were satisfactory.CONCLUSION TKA and supracondylar femoral osteotomy can be used for simultaneous KOA treatment and deformity correction.
文摘BACKGROUND Recently,medical three-dimensional printing technology(3DPT)has demonstrated potential benefits for the treatment of cubitus varus deformity(CVD)by improving accuracy of the osteotomy through the use of an osteotomy guide,with or without a patient-mated plate.Here,we present an interesting CVD case,involving a patient who was treated with corrective biplanar chevron osteotomy using an innovative customized osteotomy guide and a newly designed patient-matched monoblock crosslink plate created with 3DPT.CASE SUMMARY A 32-year-old female presented with a significant CVD from childhood injury.A computer simulation was processed using images from computerized tomography scans of both upper extremities.The biplanar chevron osteotomy was designed to create identical anatomy between the mirror image of the contralateral distal humerus and the osteotomized distal humerus.Next,the customized osteotomy guide and patient-matched monoblock crosslink plate were designed and printed.A simulation osteotomy was created for the real-sized bone model,and the operation was performed using the posterior paratricipital approach with k-wire positioning from the customized osteotomy guide as a predrilled hole for screw fixation to achieve immediate control of the reduction after osteotomy.Our method allowed for successful treatment of the CVD case,significantly improving the patient’s radiographic and clinical outcomes,with satisfactory result.CONCLUSION 3DPT-created patient-matched osteotomy guide and instrumentation provides accurate control during CVD correction.
基金Supported by Medicrea(New York,NY 10013,United States)
文摘AIM To determine the incidence and risk factors for mechanical complications （MC） after surgical correction of adult spinal deformity （ASD） with osteotomy.METHODSA retrospective study was performed. Inclusion criteria： Surgical correction of ASD using osteotomy; male or female; 〉 20 years old; follow-up ≥ 24 mo or revision. The MC of spine and spinal instrumentation were studied separately. Risk analysis included assessment of the association between more than 50 different characteristics （demographic, clinical, radiographic, and instrumentation） with different types of MC.RESULTSThe medical records of 94 operations in 88 subjects were analyzed： Female （68%）, mean age 58.6 （SD, 12.7） years. Cumulative incidence of MC at 2 year follow-up was 43.6%. Of these, 78% required revision （ P 〈 0.001）. The following characteristics had significant （ P ≤ 0.05） association with MC： （1） Preoperative： osteoporosis, smoking, previous spinal operation, sagittal vertical axis （SVA） 〉 100 mm, lumbar lordosis （LL） 〈 34°; （2） postoperative： SVA 〉 75 mm; operative correction： SVA 〉 75 mm, LL 〉 30°, thoracic kyphosis 〉 25°, and pelvic tilt 〉 9°; a fall; pseudarthrosis; and （3） device and surgical technique： use of previously implanted instrumentation; use of domino and/or parallel connectors; type of osteotomy （PSO vs SPO） if preoperative SVA 〈 100 mm; lumbar osteotomy location; in-situ rod contouring 〉 60°; and fxation to sacrum/pelvis.CONCLUSIONRisk of MC after surgical correction of ASD is substantial. To decrease this risk over- and/or insuffcient correction of the sagittal imbalance should be avoided.
