Les reprises d'ostéotomies après deux ans

Summary Fifty–one of 168 arthritic hips treated by non prosthetic procedures needed reoperation with insertion of a total hip prosthesis. The failure of the primary treatment was obvious in nine hips which were reoperated on during the two following years. Twenty-five hips were not significantly improved by the primary operation and needed total hip replacement between the second and the seventh postoperative years. An effective benefit of the primary treatment was observed in seventeen hips, but its duration did not last ten years in five of these cases. These data suggest that there is at least a 20% risk of unsatisfactory results with the procedures described in this study. However, procedures aimed at the treatment of architectural defects of the hip show a lower rate of reoperation than procedures intending basically to cure the arthritic process. Technical difficulties which may be met in inserting the femoral component are mainly due to the deformity of the upper part of the femur. Soft tissues scar fibrosis and muscle imbalance due to the former operation may compromise the usual good functional results observed with primary total hip arthroplasty.

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Les reprises d'ostéotomies après deux ans

Résumé Les reprises d'ostéotomies par prothèse totale réalisées après la deuxième année post-opératoire n'ont pas le caractère d'échec formel des réinterventions plus précoces. Néanmoins, nous estimons que seules les réinterventions effectuées après un délai de sept ans laissent à l'intervention initiale une efficacité significative. Les reprises réalisées entre deux et sept ans n'ont en effet été précédées ni d'une amélioration durable de la cotation clinique, ni d'une amélioration de l'aspect radiologique de la hanche. L'indication opératoire et sa réalisation technique n'étant pas en cause, notre étude fait apparaître qu'une ostéotomie présente un risque incontournable de 20 % de reprise par prothèse totale. Sur le plan technique, les difficultés rencontrées lors de la réintervention diminuent lorque le délai augmente. Les résultats sont plus tardifs et moins satisfaisants que ceux des arthroplasties sur hanche vierge. Les reprises sont moins fréquentes et globalement plus tardives dans les interventions destinées à corriger un vice architectural.

     

Bilateral and concomitant pathology’ surgeries do not affect the outcomes of mini-open distal linear metatarsal osteotomy (Bosch osteotomy) with manipulation for hallux valgus deformity

BackgroundBosch osteotomy for hallux valgus (HV) deformity has advantages of reduction both the operating time and surgical dissection, and may be performed bilaterally and with fewer complications than other surgical procedures as well as early weight-bearing. However, there are few reports on the effects of bilateral simultaneous surgery, simultaneous surgery on concomitant pathologies, and the preoperative HV angle on the postoperative results. The present assessed the factors that might affect the improvement in clinical outcomes following mini-open Bosch osteotomy with manipulation to treat HV deformity.MethodsSeventy patients with 110 feet were included. They were divided into groups as follows: unilateral and bilateral simultaneous surgery groups, Bosch osteotomy alone and simultaneous surgeries for concomitant pathologies groups, and preoperative HV angle< 40° and ≥ 40° groups. Subjective clinical outcome scores using the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and the HV and intermetatarsal first and second metatarsal (M1M2) angles according to the anteroposterior (A-P) view of the weighted foot X-ray were assessed preoperatively and at 12 months after surgery.ResultsThe mean HV angle, M1M2 angle and all subscales of the SAFE-Q score showed significant improvement at 12 months after surgery, regardless of simultaneous bilateral surgery, simultaneous surgery for concomitant pathologies, or the preoperative HV angle. On comparing the groups, there were no significant differences in the HV angle at 12 months after surgery. Significant inferiority at 12 months after surgery was found in the intermetatarsal angle in the simultaneous surgery for concomitant pathologies group and in all subscales of the SAFE-Q score in the HV angle ≥ 40° group.ConclusionMini-open Bosch osteotomy with manipulation for HV deformity demonstrated good results in both radiological assessments and subjective clinical scores at 12 months after surgery, even for simultaneous bilateral surgery, simultaneous concomitant pathologies’ surgery, and severe HV deformity.Level of EvidencePrognostic Level III, retrospective cohort study.     

Computer-Assisted Rotational Acetabular Osteotomy for Patients with Acetabular Dysplasia

Rotational acetabular osteotomy (RAO) is a well-established surgical procedure for patients with acetabular dysplasia, and excellent long-term results have been reported. However, RAO is technically demanding and precise execution of this procedure requires experience with this surgery. The usefulness of computer navigation in RAO includes its ability to perform three-dimensional (3D) preoperative planning, enable safe osteotomy even with a poor visual field, reduce exposure to radiation from intraoperative fluoroscopy, and display the tip position of the chisel in real time, which is educationally useful as it allows staff other than the operator to follow the progress of the surgery. In our results comparing 23 hips that underwent RAO with navigation and 23 hips operated on without navigation, no significant difference in radiological assessment was observed. However, no perioperative complications were observed in the navigation group whereas one case of transient femoral nerve palsy was observed in non-navigation group. A more accurate and safer RAO can be performed using 3D preoperative planning and intraoperative assistance with a computed tomography-based navigation system.     

胫骨下段巨大骨软骨瘤的治疗

目的介绍胫骨下段巨大骨软骨瘤的手术方法,评价其临床疗效。方法应用经胫骨楔形截骨、腓骨双截骨保留外侧骨膜、重建腓骨时将其内外侧旋转180°的方法切除胫骨下段巨大骨软骨瘤12例。结果12例随访6～35个月,未见复发,肢体生长发育不受影响,功能正常;临床疗效：治愈11例,好转1例。结论该术式治疗胫骨下段巨大骨软骨瘤,可保证暴露充分,切除彻底,疗效满意。     

全脊柱截骨矫正严重后凸畸形

[目的]探讨全脊柱截骨矫正脊柱后凸的治疗经验。[方法]全脊柱截骨加椎弓根钉内固定系统闭合及植骨矫正脊柱后凸。[结果]于1984～2005年采用上述方法治疗50例病人。术后全组病例均未发生脊髓损伤，术后临床症状得到不同程度的改善。经历2～15a平均2．4a随访，X线CT复查示螺钉位置良好，无松动断钉。植骨3个月后均达到满意融合。[结论]经全脊柱截骨加有效的内固定手术不仅手术视野开阔操作安全方便；而且截骨和内固定相结合同时完成，是治疗脊柱后凸目前更完善并不断改进一种好方法。     

Is bilateral hallux valgus chevron osteotomy a safe procedure for ambulatory surgery?

IntroductionSeveral osteotomies of the first metatarsal have been described for treatment of hallux valgus but chevron osteotomy is one of the most common and well-established procedure for treating this deformity. Although there is a trend towards considering bilateral surgery there is lack of publications addressing bilateral treatment in ambulatory units. The aim of this study is to analyze results of bilateral and unilateral distal chevron osteotomies associated with lateral soft tissue release as ambulatory procedures.Materials and MethodsA retrospective review was made about the patients treated at our ambulatory unit over a period of five years. Initially, general information as patient’s satisfaction’s rate and return to normal activity’s time and evaluation of standardized follow-up charts and records made by the surgeon were recorded. Secondly, the hallux metatarsophalangeal interphalangeal scale developed by the American Orthopedic Foot & Ankle Society was used.ResultsA total of 194 patients with 230 feet operated were included in this study. We found 29 patients that didn’t meet the inclusion criteria and were excluded. The unilateral group was composed by 139 feet and the bilateral group by 52 feet. The improvement between preoperative and discharge clinical and radiographic results was significant independently in both groups. A total of 14% of complications were found in our study, 19% in the unilateral group and 12% at the bilateral group. None of them required revision surgery.ConclusionBilateral distal chevron osteotomies, associated with lateral soft tissue release, are safe and effective ambulatory procedures. It was found a satisfactory deformity correction in moderate HV. Both patients that underwent unilateral and bilateral procedures had similar clinical and radiological outcomes with no increase in complications or return to normal activity time. With this study it was demonstrated that bilateral chevron osteotomies can be performed as ambulatory procedures.     

Increased rates of delayed union after percutaneous Akin osteotomy

Background

Akin osteotomy is a well-known surgical procedure in forefoot surgery. When performing percutaneously, we have found a lot of delayed unions on follow up X-rays. The objective of this study was to assess the incidence of delayed union when performing a percutaneous Akin osteotomy.

双侧下颌升支矢状劈开截骨术后稳定性的研究

目的:主要探讨BSSRO后退下颌骨术后骨的稳定性,了解导致复发的有关因素。方法:46例单纯下颌前突患者,不包括存在偏颌畸形的病例。所有患者于手术前一周(T1)、术后一周(T2)、术后6个月或6个月以上(T3)分别拍摄头颅定位侧位片,测量硬组织的相对位移。结果:BSSRO后退下颌骨后,使得硬组织Li点平均后退了6.5mm,B点平均后退了7.3mm,Pg点是8.5mm,Me点为9.1mm。各标志点的平均复发率为:Li点复发率为23.1%、B点复发率为24.7%、Pg点复发率为25.9%、Me点复发率为26.4%。结论:影响下颌升支矢状劈开截骨后退术后复发的因素很多,其中受髁状突的影响使得下颌骨在向前复发的过程中并不是完全的水平复发,而是水平逆时针旋转复发。复发可能与后退量存在相关关系,但需要超过一定的后退量。     

Computer-assisted distal radius osteotomy

PURPOSE: To establish the accuracy, precision, and clinical feasibility of a novel technique of computer-assisted distal radius osteotomy for the correction of symptomatic distal radius malunion. METHODS: Six patients underwent a computer-assisted distal radius osteotomy and were followed-up for an average of 25 months. Objective radiographic measurements and functional outcomes, as measured by clinical examination including grip strength and range of motion, and Disability of the Arm, Shoulder and Hand (DASH) questionnaires, were used. RESULTS: The mean radiographic parameters included an increase of radial inclination to 21 degrees from 12 degrees (normal, 23 degrees ). Dorsal and volar tilt (malunion) were corrected to 9 degrees from -30 degrees and 21 degrees, respectively (normal, 10 degrees ). Ulnar variance was corrected to 1.9 mm from 7.5 mm (normal, +1.5 mm). Normal is defined as the average of the contralateral limb radiographs. The mean clinical outcome measures at an average of 25 months included a DASH global score of 14, a DASH individual item average score of 1.6, and an average affected side grip strength of 79% when compared with the unaffected side. CONCLUSIONS: The results of the computer-assisted technique were comparable with published results of traditional non-computer-assisted opening wedge osteotomy techniques. This technique allows a surgeon to accurately and precisely recognize and correct 3-dimensional deformities of the distal radius including axial malalignment (supination). The technique has the added benefit of reducing radiation exposure to the patient and surgical team because fluoroscopy is not used during the procedure. Additional benefits of the computer-assisted technique include the ability to perform multiple surgical simulations to optimize the alignment plan, and it serves as an excellent teaching tool for less-experienced surgeons.     

成人脊柱后凸畸形后路全脊椎截骨矫形手术1200例报告

[目的]总结成人脊柱后凸畸形后路全脊椎截骨矫形手术方式。[方法]通过后方入路经双侧椎弓根、椎体行楔形截骨,直到椎体前缘皮质下,并行椎弓根钉棒系统内固定。[结果]共手术矫正后凸及侧后凸畸形1 200例,其中男938例,女262例;发病时间5.6～28年,平均11.6年;年龄15～52岁,后凸畸形时间2.5～26年,平均7.3年。后凸病因:强直性脊柱炎后凸畸形720例;脊柱压缩性骨折246例;脊柱结核132例;先天性脊柱后凸畸形59例;休门氏病后凸43例。最高截骨平面T9水平,单病例最多截骨达4处,平均截骨2处,一处椎体截骨时间平均30 min,出血约100 ml,术中脊髓和神经根保护安全。[结论]成人脊柱后凸畸形后路全脊椎截骨矫形手术截骨规范充分、手术时间短、术中出血少、脊髓和神经根保护安全、截骨创面对合紧密、利于截骨创面愈合。适用于各种原因导致的脊柱后凸畸形截骨矫正手术,显著降低术中和术后并发症。     

Minimally invasive distal first metatarsal osteotomy can be an option for recurrent hallux valgus

BackgroundRecurrence rate of surgical treatment of hallux valgus ranges in the literature from 2.7% to 16%, regardless of used procedure. In this study, long-term results of a minimally invasive distal osteotomy of the first metatarsal bone for treatment of recurrent hallux valgus are described.Methods32 consecutive percutaneous distal osteotomies of the first metatarsal were performed in 26 patients for treatment of recurrent hallux valgus. Primary surgery had been soft tissue procedures in 8 cases (25%), first metatarsal or phalangeal osteotomies in 19 cases (59.4%) and Keller procedures in 5 cases (15.6%).ResultsPatients were assessed with a mean follow-up of 9.8 ± 4.3 years. All patients reported the disappearance or reduction of the pain. The mean overall AOFAS score improved from 46.9 ± 17.8 points to 85.2 ± 14.9 at final follow-up. The mean hallux valgus angle decreased from 26.1 ± 9.1 to 9.7 ± 5.4°, the intermetatarsal angle decreased from 11.5 ± 4.5 to 6.7 ± 4.0°. No major complications were recorded with a re-recurrence rate of 3.1% (1 case).ConclusionsPercutaneous distal osteotomy of the first metatarsal can be a reliable and safe surgical option in the recurrent hallux valgus with low complication rate and the advantages of a minimally invasive surgery.Levels of evidence: IV, Retrospective Case Series.     

多片段LeFortI型截骨矫治严重牙颌面畸形

目的：采用多片段Le Fort I型截骨术矫治严重牙颌面畸形，并为克服术后骨段固位不良之缺点自制一种腭侧固定夹板。方法；以该手术方法联合双侧下颌升支矢状劈开术（BSSRO）矫治上颌宽度不足伴上下颌其它严重畸形的患者19例。采用单纯多片段Le Fort I型截骨6例，联合BSSRO13例。19例中上颌两片段Le Fort I型截骨12例，3片段7例。结果：术后随访6例，平均22.6m,6/6间距离平均扩宽7.3mm,3/3间平均扩宽3.9mm。无严重并发症及明显复发，咬合关系满意。结论：应用良好的腭侧固定夹板，采用多片段Le Fort I截骨联合BSSRO可一次满意矫治严重双颌畸形。     

可吸收棒在拇外翻第1跖骨基底截骨治疗的应用

目的探讨可吸收棒在拇外翻第1跖骨基底楔形截骨术中的应用疗效。方法对青中年中至重度拇外翻患者采用第1跖骨基底截骨结合拇趾骨赘切除、关节囊紧缩缝合 拇内收肌松解术,截骨端以可吸收棒交叉固定。结果53例(81足),随访3~16个月。采用美国足踝矫形学会拇外翻评分标准,平均HVA矫正17°,平均IMA矫正6°,优63足,良14足,差4足,优良率95%。结论截骨端采用可吸收棒交叉固定同金属螺钉相比能避免对软组织的刺激,安全有效,不需再次手术取出内固定。     

脊柱侧凸矫形术后严重冠状面失衡再次手术翻修的疗效及并发症

目的 ：观察脊柱侧凸矫形术后发生严重冠状面失衡进行再次手术翻修的效果及并发症。方法 ：回顾性分析我院2013年1月～2021年8月手术治疗的7例脊柱侧凸矫形术后严重冠状面失衡患者的临床资料,其中男性3例,女性4例;本次手术年龄21.3±7.5岁（14～32岁）。随访16.3±4.2个月（12～25个月）。统计初次手术年龄、既往手术次数、本次手术时间、出血量和固定节段。在本次手术前、术后即刻及末次随访时在全脊柱正侧位X线片上测量主胸弯及腰弯Cobb角、最下固定椎倾斜角、冠状面平衡距离（coronal balance distance,CBD）、冠状面骨盆倾斜角等,计算CBD的矫正率。术前、术后即刻及末次随访时使用SF-36量表评估患者生活质量。记录本次手术后各类并发症发生及转归情况。结果：初次手术年龄8.86±4.14岁（3～15岁）;手术次数5.29±3.55次（2～13次）;本次手术时间为346.14±64.65min,术中出血量1342.86±687.65ml;6例患者行不对称性PSO截骨,1例患者行多节段Ponte截骨、延长内固定融合节段。术前CBD为77.23±33.28mm,...     

拇外翻截骨矫形绷带外固定的疗效

目的分析微创截骨矫形后绷带外固定拇外翻治疗的效果。方法对519例(961足)拇外翻患者微创截骨矫形术后采用"8"字绷带缠绕外固定。结果患者均获得随访,时间3~36个月。截骨均愈合,时间为12~20周。无骨折不愈合或假关节形成者。结论绷带外固定可以达到维持复位后的固定要求,使骨折愈合;与传统固定方法比较该方法具有方便、灵活、痛苦小且可早期功能锻炼等优点,值得在一些特殊部位骨折固定中应用。