大鼠盆神经节内投射至膀胱VIP、SP及NOS阳性神经元的研究

用辣根过氧化物酶(HRP)逆行追踪法与免疫组织化学、NADPH-d酶组织化学结合法,对大鼠盆神经节中支配膀胱的神经元进行了研究.结果显示在盆神经节中支配膀胱的神经细胞中存在HRP-VIP,HRP-SP及HRP-NOS双标细胞.提示膀胱功能的调节是多因素的,神经肽(VIP,SP)和NO在其中起重要作用.     

Leg Length Change After Curved Periacetabular Osteotomy and Its Impact on the Clinical Outcomes

BackgroundCurved periacetabular osteotomy (CPO) is one of the periacetabular osteotomies for the treatment of acetabular dysplasia. Several complications have been described after CPO, however, there have been no reports on the leg length change (LLC). This study aimed to investigate the LLC after CPO and its impact on the clinical outcomes.MethodsThis study was a retrospective review of 70 consecutive hips in 67 patients with symptomatic acetabular dysplasia who underwent CPO between March 2016 and April 2019. Preoperative and postoperative leg lengths were measured using anteroposterior radiographs, and the clinical outcomes were evaluated based on the Harris hip score (HHS) and Medical Outcomes Survey 36-item Short Form Health Survey (SF-36).ResultsThe mean LLC (and standard deviation) after CPO was −0.08 ± 3.10 mm. The mean HHS significantly improved from 73.5 points to 91.9 points (P < .001). The physical component and role component scores of SF-36 significantly improved from 35.1 to 46.1 (P < .001) and from 39.5 to 47.0 (P < .001), respectively. No significant differences were found between the preoperative and postoperative mental component scores of SF-36. In addition, among 70 hips, 35 hips exhibited leg length elongation (0 to plus 6.82 mm) after CPO, whereas 35 hips exhibited leg length shortening (0 to minus 6.23 mm). No significant differences were found in HHS and SF-36 between the leg elongation group and leg shortening group.ConclusionThe mean LLC after CPO was −0.08 ± 3.10 mm, and this change does not affect the postoperative clinical outcomes.     

Magnetic Resonance Imaging Assessment of Abductor Muscles Shortly After Curved Periacetabular Osteotomy

BackgroundCurved periacetabular osteotomy (CPO) is performed via an anterior approach without detachment of the hip abductor muscles. This study aimed to evaluate the abductor muscle status shortly after CPO on magnetic resonance imaging (MRI).MethodsWe prospectively evaluated 38 hips in 38 patients 1 week and 3 months after CPO between October 2017 and July 2019. The status of the abductor muscles was assessed on MRI using the following criteria: grade 0, normal; grade I, strain/edema; grade II, partial tear; and grade III, complete tear. We also evaluated associations between muscle status and patients’ characteristics.ResultsOne week after CPO, the gluteus maximus was classified as grade 0 in all patients. The gluteus medius was grade 0 in 84.2% of patients and grade I in 15.8%. The gluteus minimus was grade I in 55.3% of patients and grade II in 44.7%. Three months after CPO, both the gluteus maximus and gluteus medius were grade 0 in all patients, while the gluteus minimus was still grade I in 47.4%. There were no significant differences between patients with a grade 0 and grade I gluteus minimus at 3 months after CPO in patients’ characteristics (age and body mass index) or clinical scores (Harris Hip Score and Japanese Orthopedics Association score).ConclusionBoth the gluteus minimus and medius showed abnormal appearances on MRI 1 week after CPO, whereas only the gluteus minimus showed abnormalities 3 months after CPO. This abductor muscle status did not affect the postoperative Harris Hip Score or Japanese Orthopedics Association score.     

Prior Pelvic Osteotomy Affects the Outcome of Subsequent Total Hip Arthroplasty

BackgroundAlthough pelvic osteotomy (PO) is an important surgical procedure that can alleviate symptoms and potentially slow progression of osteoarthritis in patients with development dysplasia of the hip, some patients eventually require conversion to total hip arthroplasty (THA). This study aimed to determine the outcome of conversion THA in patients with prior PO.MethodsForty nine patients with a history of prior PO who underwent conversion THA at a single institution were matched at a 1:3 ratio based on the date of surgery, age, gender, and body mass index with 147 developmental dysplasia of the hip patients who underwent primary THA without prior PO. A retrospective chart review was performed to compare outcomes at a minimum follow-up of 2 years.ResultsPatients with prior PO required more supplemental screw fixation for the acetabular component (59.2% vs 38.1%, P = .016), more autologous bone grafting (24.5% vs 11.6%, P = .048), had a longer mean operative time (106.0 vs 79.8 minutes, P < .001), and greater estimated blood loss (350.0 vs 206.8 mL, P = .015). Patients with prior PO had smaller cup version angle (26.0° vs 29.0°, P = .012) and greater discrepancy in the limb length (10.3 vs 7.26 mm, P = .041). Eight hips (16.3%) with prior PO and 6 (4.1%) without osteotomy required reoperation (P = .008). There was no difference in outcome scores at the latest follow-up.Conclusion: THA after prior PO is technically demanding, leading to longer operative times, greater blood loss, and variation in implant placement. Although functional outcomes are similar, THA after a prior PO is more likely to require reoperation.ConclusionTHA after prior PO is technically demanding, leading to longer operative times, greater blood loss, and variation in implant placement. Although functional outcomes are similar, THA after a prior PO is more likely to require reoperation.     

High Rates of Spacer Fracture in the Setting of Extended Trochanteric Osteotomy With a Specific Thin-Core Articulating Antibiotic Hip Spacer

BackgroundTwo-stage revision remains the standard of care for prosthetic joint infection after total hip arthroplasty. However, there are substantial complications associated with articulating antibiotic hip spacers. Handmade and molded spacers have been shown to have higher rates of spacer fracture than antibiotic-coated prostheses (ACPs). The aim of this study is to review outcomes with an implant that is often categorized as an ACP spacer, the Zimmer-Biomet StageOne Select Femoral Spacer (ZBSO).MethodsA retrospective review was performed of 63 patients who underwent placement of a ZBSO. Patients were compared based on whether or not an extended trochanteric osteotomy (ETO) was performed using Fisher’s exact and t-tests.ResultsFive patients were excluded due to lack of follow-up or death shortly after stage 1 surgery, leaving 58 patients. Spacer fracture was noted in 5 of 58 patients (8.6%). Sixteen patients underwent ETO and 25.0% suffered a spacer fracture compared to 2.3% without ETO (odds ratio 13.7, P = .0248). There was no association between patient demographics or ETO length and spacer fracture. Two patients had periprosthetic fractures (3.4%) and 4 had dislocations (6.9%). Forty-nine patients (84.4%) went on to second-stage revision; of those 26.5% failed to clear the infection and required an average of 2.2 additional surgeries.ConclusionThe ZBSO spacer has overall complication rates similar to previously reported spacer series. Although the ZBSO looks like an ACP spacer, in the setting of ETO, it behaves like a molded or handmade spacer with a high rate of spacer fracture (25%) due to the small diameter of the core. This implant should be used with caution in combination with an ETO.     

The Effect of Functional Pelvic Tilt on the Three-Dimensional Acetabular Cup Orientation in Total Hip Arthroplasty Dislocations

BackgroundAnterior and posterior pelvic tilt appears to play a role in total hip arthroplasty (THA) stability. When changing from the standing to the sitting position, the pelvis typically rotates posteriorly while the hips flex and this affects the femoro-acetabular positions. This case-control study compares changes in 3-D acetabular cup orientation during functional pelvic tilt between posterior THA dislocations vs stable THAs.MethodsStanding and sitting 3-D cup orientation was compared between fifteen posterior dislocations vs 233 prospectively followed stable THAs. 3-D cup orientation was calculated using previously validated trigonometric algorithms on biplanar radiographs. Those algorithms combine the angles in the three anatomical planes (coronal inclination, transverse version, and sagittal ante-inclination) in the standing position with the change in sagittal pelvic tilt from standing to sitting to calculate the 3-D orientation in the sitting position.ResultsThe standing cup orientation of the dislocated THAs was only characterized by a lower coronal inclination (P = .039). Compared with the controls, from standing to sitting, they showed less posterior pelvic tilt (P < .001). This led to a significant lower coronal inclination (P < .001) and sagittal ante-inclination (P < .001) in the sitting position but similar transverse version (P = .366).ConclusionsComparing posterior THA dislocations to stable THAs, there is a lower increase of all three orientation angles from standing to sitting. This leads to a decreased sitting coronal inclination and sagittal ante-inclination which may lead to an increased risk of impingement ensued by THA instability. By contrast, the transverse version was not significantly different in both positions. This confirms the importance of biplanar data on functional cup orientation.Level of EvidenceDiagnostic, Level III.     

Role of high tibial osteotomy in medial compartment osteoarthritis of the knee: Indications,surgical technique and outcomes

Knee osteoarthritis (OA) is the most common joint disorder worldwide. In particular, primary knee OA often presents with a varus malalignment. This increases the loads going through the medial compartment resulting in cartilage degeneration and symptomatic arthritis. High tibial osteotomy (HTO) is the workhorse surgical procedure for treating medial knee OA. When performed precisely in the hands of an experienced surgeon, HTO can delay or avoid knee arthroplasty. Of note, outcomes of knee arthroplasty are at best unpredictable in patients of younger age. Hence, there is a growing need for joint preservation procedures for younger patients presenting with knee OA, of which HTO is one. Through this article, the authors of whom all are joint preservation surgeons with a special interest in osteotomy hope to share from their experience as well as the available literature on the indications, perioperative planning, surgical technique, outcomes as well as pearls and pitfalls of HTO.     

Comprehensive review of surgical approaches to the elbow

The choice of the most suitable surgical approach to the elbow forms the foundation of any successful elbow surgery. The surgical approach is based on the injury or pathology to be addressed and therefore specific anatomical details need to be considered. The surgeon must be comfortable with the bony, ligamentous and neurovascular anatomy of the elbow to consider and execute the best approach for each problem. This is an imperative to avoid iatrogenic injury.This article provides a detailed analysis, valuable technical tips, advantages and disadvantages of the most common approaches to the elbow. The lateral approaches include the Kocher, Kaplan and Extensor Digitorum Communis (EDC) Split approaches, the medial approaches include the Hotchkiss, Flexor carpi ulnaris (FCU) splitting approach, the Taylor and Scham approach. The anterior approach includes the anterior neurovascular interval approach and the posterior approaches include the Olecranon osteotomy, triceps sparing, triceps reflecting approach and finally the Boyd interval approach. The text and illustrations will provide a structured overview for the practicing surgeon.     

Longer Term Outcomes Following High Tibial Osteotomy for Osteoarthritis: A Prospective,Multi-Centre Observational Study Comparing Tomofix and OPTY-LINE Devices

PurposeAssessing surgical accuracy and patient-recorded outcome measures for patients fitted with either the OPTY-LINE intramedullary realignment system or the Tomofix plate for medial opening wedge high tibial osteotomy (HTO).Patients and methodsTwo matched case series of patients with symptomatic medial compartment osteoarthritis without other significant knee pathology. One group comprised of 19 patients receiving the Tomofix plate, whereas another comprised of 12 patients receiving the OPTY-LINE intramedullary nail. Patella-centred long leg alignment radiographs were assessed to calculate surgical accuracy in all cases. Patients completed knee injury osteoarthritis outcome scores (KOOS) and osteotomy surgery patient satisfaction questionnaires pre-operatively and at 24 months post-surgery.ResultsAbsolute surgical accuracy at 2 years post-surgery was a mean 4.2 [standard deviation 3.7] for OPTY-LINE versus 9.2 [SD 7.8] for Tomofix (p = 0.11, Mann–Whitney U test). On average, patients in either the OPTY-LINE or Tomofix cohort reported at least a minimal perceptible clinical improvement—minimum average improvement of 15—for all five KOOS themes. No significant difference in change of KOOS scores over time or patient satisfaction levels were observed between the two cohorts.ConclusionThe OPTY-LINE device for HTO performs to a similar level as the Tomofix device. Surgical accuracy data are promising for OPTY-LINE, but does not seem to readily translate into difference in patient-reported outcomes compared to Tomofix. Even longer follow-up periods, to measure survival rates, and true randomised trials on larger samples can elucidate if there is a benefit for using one device over the other.     

尺骨截骨位置不同对手术治疗儿童陈旧性孟氏骨折预后的影响

目的 探讨手术治疗儿童陈旧性孟氏骨折尺骨截骨点位置不同对疗效的影响。方法 回顾性队列研究。纳入2015年6月—2021年6月安徽省儿童医院骨科收治的68例儿童陈旧性孟氏骨折患者的临床资料,其中男42例、女26例,年龄3~12（6.6±2.4）岁。受伤至手术时间1~60个月,平均8.6个月。BadoⅠ型骨折60例,Ⅲ型8例。患儿均采用尺骨近端截骨矫形治疗,术中选择尺骨畸形最明显处截断尺骨,按照截骨点至尺骨近端间距占尺骨全长的比例不同分为3组,A组（占比≤25%）27例、B组（25%<占比<30%）20例、C组（占比≥30%）21例。观察指标：（1）对比3组患儿临床基线资料。（2）对比3组患儿手术时间,观察术后患肘肱桡关系恢复情况,尺骨截骨处愈合情况,以及并发症发生情况。（3）术后定期随访。取出内固定前,测量对比3组患儿肘关节旋前、旋后、伸肘、屈肘角度,采用Kim肘关节功能评分表评估并对比3组患儿肘关节功能;拆除内固定后,采用影像学Nakamura分级标准评估并对比3组患儿肘关节功能。结果 （1）3组患儿性别、年龄、患肢侧别、骨折分型、受伤至手术时间、术前患肢肘关节活动度等基线资料比较,差异均无统计学意义（P值均>0.05）。（2）3组患儿均顺利完成手术,A组手术时间为（100.6±31.7）min,B组为（133.0±24.2）min,C组为（94.9±28.6）min,差异无统计学意义（F=1.02,P=0.367）。术后第3天肘关节正侧位X线片示肱桡关系均恢复正常。A组有1例术后切口感染,予以抗感染治疗后愈合。68例患儿均获得随访,随访时间6~36个月,平均8.7个月。A组术后发生肱桡关节再脱位3例、半脱位3例,B组发生半脱位3例,C组发生半脱位2例、尺骨延迟愈合1例;3组间并发症发生情况比较,差异均无统计学意义（P值均>0.05）。3组患儿尺骨截骨处愈合时间比较,差异无统计学意义（F=0.01,P=0.989）。（3）3组患儿取出内固定前,肘关节旋前、旋后、伸肘、屈肘角度,以及Kim肘关节功能评定比较,差异均无统计学意义（P值均>0.05）。拆除内固定后,影像学Nakamura分级评定肘关节功能比较,3组间差异无统计学意义（Z=1.73,P=0.422）。结论 儿童陈旧性孟氏骨折采用尺骨近端截骨矫形治疗,术中选择尺骨畸形最明显处截断尺骨,尺骨截骨点位置的不同对患儿预后无明显影响。