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Bai R.J.,Beijing Jishuitan Hospital
Zhonghua yi xue za zhi | Year: 2016

OBJECTIVE: To investigate the MR image characteristics and clinical significance of focal periphyseal edema (FOPE) zone of the adolescent knee which was with or without trauma history, and provide the basis for the correct diagnosis and treatment.METHOD: A total of 12 patients (9 boys, age range 12-16 years, average age 14 years old, 3 girls, age range 12-15 years, average age 13 years )who had pain of the knee without the traumatic history and 16 patients (12 boys, age range 10-15 years, average age 14 years; 4 girls, age range 11-13 years, average age 12 years) who were painful in the knee after trauma were included in this study. The knee MR examinations were performed in all the patients. The characteristics of MRI between painful knee without trauma and painful knee after trauma were compared and analyzed, and the average vertical distances from the farthest of the edema area to the epiphyseal plate were measured. The vertical distances were measured respectively in sagittal view and coronal view in PD-FS and in sagittal view in T1WI, and the average for the three were calculated. At last, the images with the results of operation or follow-up examinations were compared and confirmed by double blind method.RESULTS: The MRI characteristics of FOPE zone in the 12 adolescent who complained painful knee but had no trauma showed low signal intensity in T1WI and high signal intensity in PD-FS. The edema centered at the physis and extended into both the adjacent epiphysis and metaphysic.In addition, it shaped like patches and thread, and edema range(14.5±6.6)mm.The MRI findings of the 16 adolescent had pain of the knee after injury characterized by a wide range of low T1WI signal intensity and increased PD-FS signal intensity involving the articular surface of the epiphysis.The range of edema was (26.2±8.8)mm.There was statistically significant difference between non-traumatic edema and the edema caused by trauma (t=4.346, P<0.05).CONCLUSION: A FOPE zone of the adolescent knee is likely to be related to pain in the adolescent growth period and physiologic physeal fusion, and should not be mistaken for an abnormality, while the larger range of edema surrounding the epiphyseal plate may be associated with the trauma of the knee.

Li N.,Beijing Jishuitan Hospital
Zhonghua yi xue za zhi | Year: 2016

OBJECTIVE: To evaluate the clinical efficacy of intramedullary nail fixation in atypical femoral fractures and explore the management approach.METHOD: From January 2010 to December 2014, a total of 116 patients over 60 years old with femoral intertrochanteric fractures or femoral shaft fractures were treated in Department of Orthopaedics and Traumatology. Among the patients, 11 with atypical femoral fractures, aged from 62 to 82 ( 69.3±5.6) years old, received surgical treatments. There were 2 males (18.2%) and 9 females (81.8%). 5 patients (45.5%) had the prodromal symptom of thigh pain. 9 patients (81.8%) had the history of long-term use of bisphosphonates with the duration of 3 to 9 (5.3±2.1) years. All the fractures received close reduction and antegrade intramedullary nail fixation. The Thoresen score and EuroQol 5 dimensions scores (EQ-5D) were applied to evaluate the extremity function and life quality after surgery.RESULT: All the operations were performed successfully. At least 1 years follow-up was accomplished with the follow-up period of 1 to 4 (1.8±0.9) years. There were 8 (72.7%) excellent, 2 (18.2%) good, 1 (9.1%) fair according to the Thoresen score with total excellent to good rate up to 90.9% at the last follow-up. The EQ-5D scores showed the life quality was similar with that before injury (P>0.05). Fracture healing was achieved in all 11 cases with time from 3 to 8 (5.7±1.6) month. There was no case complicated with infection, nonunion or implant failure during the follow-up period. No contralateral atypical femoral fracture was observed.CONCLUSION: Atypical femoral fractures are uncommon in the clinical practice. Accurate diagnosis and appropriate management approach are the keys of satisfactory outcomes.

Zhang J.,Beijing Jishuitan Hospital | Jiang C.,Beijing Jishuitan Hospital
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2011

The double-row technique is a new concept for arthroscopic treatment of bony Bankart lesion in shoulder instability. It presents a new and reproducible technique for arthroscopic fixation of bony Bankart fragments with suture anchors. This technique creates double-mattress sutures which compress the fragment against its bone bed and restores better bony anatomy of the anterior glenoid rim with stable and non-tilting fixation that may improve healing. Level of evidence Therapeutic studies, Level IV. © 2011 Springer-Verlag.

Tian W.,Beijing Jishuitan Hospital
Journal of Spinal Disorders and Techniques | Year: 2014

STUDY DESIGN:: Retrospective cohort study.OBJECTIVE:: To identify the potential preoperative factors and surgical technique factors that are associated with long-term range of motion (ROM) after surgery. Further, this article aimed to guide selection of CADR patients and a fine surgical technique.SUMMARY OF BACKGROUND DATA:: Segmental ROM is the most important parameter concerning cervical kinematics after a CADR. There are few researches regarding the influencing factors on postoperative ROM, and consistent results have not yet been reported.METHODS:: The cohort comprised a total of 68 discs implanted into 57 patients who were retrospectively analyzed. The mean follow-up period was 84.1 months. Segmental ROM and other useful parameters were measured using lateral neutral, extension, and flexion radiographs which were obtained preoperatively, 3 months after surgery and at last follow-up. Preoperative CT and clinical assessment were also used. To find out associated factors, the patients were divided into two groups according to the segmental ROM at last follow-up.RESULTS:: After surgery, the clinical outcomes were satisfactory. The segmental ROM at last follow-up (7.8±4.3°) was preserved without significant change from preoperative ROM (8.8±3.8°). The patients who had a better segmental ROM after surgery were found to have a higher preoperative segmental ROM, a younger age, a better disc insertion angle and disc insertion depth. These four factors were identified as independent risk factors (P of 0.027, 0.017, 0.036, and 0.046, respectively) for long-term ROM.CONCLUSION:: The postoperative, long-term, segmental ROM was well preserved and found to be affected by the preoperative segmental ROM, patient’s age, disc insertion angle, and insertion depth. © 2014 by Lippincott Williams & Wilkins, Inc.

Xiong G.,Beijing Jishuitan Hospital
Journal of Huazhong University of Science and Technology. Medical sciences = Hua zhong ke ji da xue xue bao. Yi xue Ying De wen ban = Huazhong keji daxue xuebao. Yixue Yingdewen ban | Year: 2010

To explore the clinical classification of hamate hook fracture and the treatment strategy for different type of fractures, 12 patients who suffered from hamate hook fractures were followed up retrospectively. According to the fracture sites and the prognosis, we classified the hamate hook fractures into 3 types. Type I referred to an avulsion fracture at the tip of hamate hook, type II was a fracture in the middle part of hamate hook, and type III represented a fracture at the base of hamate hook. By the classification, in our series, only 1 fell into type I, 7 type II, and 4 type III. The results were evaluated with respect to the functional recovery, recovery time and the association among the clinical classification, pre-operative complications and treatment results. The average follow-up time of this group was 8.4±3.9 months. Two cases were found to have fracture non-union and both of them were type II fractures. Six patients had complications before operation. Five cases were type II fractures and 1 case type III fracture. All the patients were satisfied with the results at the time of the last follow-up. Their pain scale and grip strength improved significantly after treatment. All the pre-operative complications were relieved. The recovery time of hamate hook excision was significantly shorter than that of the other two treatments. The incidences of both pre-operative complications and non-union in type II fractures were higher than those in type I and type III fractures. It was concluded that, generally, the treatment effects with hamate hook fracture are quite good. The complication incidence and prognosis of the fracture are closely related to the clinical classification. Early intervention is critical for type II fractures.

Wen T.,Beijing Jishuitan Hospital | Lv Y.,Traumatology and Orthopaedics Research Institute of Beijing and Beijing Jishuitan Hospital
International Journal of Clinical and Experimental Medicine | Year: 2015

Objective: The objective of the paper is to find the association between inadequate gestational weight gain and pregnancy outcomes in normal weight women in China. Method: A retrospective study was conducted among 13,776 normal weight pregnant women who received antenatal care and delivered singleton infants at the participating hospital during August, 2009 to July, 2013. Adverse pregnancy outcomes like low birth weight (LBW), preterm birth, birth asphyxia, neonatal intensive care unit (NICU) admission and length of hospital stay were compared and analyzed between two groups with inadequate and adequate gestational weight gain. Results: According to the IOM recommendations, inadequate gestational weight gain was found to be 14.7% in this study. Women with inadequate gestational weight gain (GWG) were found to be at a higher risk for LBW (aOR = 2.13, 95% CI: 1.75, 2.86) and preterm birth (aOR = 1.44, 95% CI: 1.21, 1.67) than those in the adequate gestational weight gain group, after adjusting for monthly family income, maternal education, occupation, and whether they received any advice regarding benefits of gestational weight gain and residential area. However, inadequate GWG was not associated with longer hospital stay (aOR = 1.13, 95% CI: 0.91-1.43) in adjusted model. In addition, the rate of birth asphyxia and NICU admission were similar in both groups (P > 0.05). Conclusions: Normal weight pregnant women with GWG below the recommended AIOM 2009 guidelines were found to be at an increased risk of low birth weight and preterm birth. © 2015, E-Century Publishing Corporation. All rights reserved.

Song G.Y.,Beijing Jishuitan Hospital
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association | Year: 2013

The role of the anterior cruciate ligament remnant in anterior cruciate ligament reconstruction (ACLR) is debated. The purposes of this systematic review were (1) to summarize the clinical outcomes of patients undergoing remnant-preserving ACLR and (2) to investigate whether those outcomes were superior to standard ACLR. The PubMed database was searched using specific inclusion and exclusion criteria for clinical studies reporting both preoperative conditions and postoperative outcomes of remnant-preserving ACLR. All reported postoperative complications were analyzed. In addition, a modified Coleman Methodology Score (CMS) system was used to assess the methodologic quality of the included studies. Thirteen studies were included with a mean CMS value of 71.7 (range, 57 to 92). In total, 546 patients underwent remnant-preserving ACLR by 3 different procedures: standard ACLR plus tibial remnant tensioning (n = 166), selective-bundle augmentation (n = 337), and standard ACLR plus tibial remnant sparing (n = 43). All clinical outcomes improved significantly (P < .05) at the final follow-up (mean, 27.9 months). Seven studies directly compared postoperative clinical outcomes between remnant-preserving ACLR and standard ACLR. In 6 of the 7 studies, similar postoperative clinical outcomes were reported between groups. One study reported superior clinical outcomes after remnant-preserving ACLR. There was no significant difference between groups regarding the overall rate of postoperative complications. The mean CMS showed moderate methodologic quality for the included studies. This systematic review showed significant postoperative improvements in patients undergoing remnant-preserving ACLR in all of the studies. However, further comparisons between remnant-preserving ACLR and standard ACLR showed inconsistent results in the 7 comparative studies, with 6 reporting equivalent postoperative clinical outcomes between groups. There was no significant difference in the rate of total complications between groups. The currently available evidence is not sufficiently strong to support the superiority of remnant-preserving ACLR. Level IV, systematic review of Level I-IV studies. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Li F.L.,Beijing Jishuitan Hospital
Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences | Year: 2012

To evaluate the clinical results of primary shoulder arthroplasty for the treatment of complex proximal humeral fractures with the trabecular metal prosthesis. In the study, 57 consecutive patients with complex proximal humeral fractures underwent primary shoulder arthroplasty with the trabecular metal prosthesis, of whom 45 patients were available for the final follow-up (78.9%), and were retrospectively assessed. There were 15 men and 30 women with the average age of (64.9±10.6) years (range: 45 to 85 years), and 14 left shoulders and 31 right shoulders were involved. The mean time from injury to surgery was (10.2±4.8) days. According to Neer's classification, there were 3 patients with a three-part fracture, 4 with a three-part dislocation, 2 with a four-part fracture, 22 with a four-part dislocation, 4 with a four-part valgus-impaction, and 10 with a head splitting. Thirty-nine patients were treated with hemiarthroplasty, and the rest with total shoulder arthroplasty. After a mean follow-up time of (18.7±8.1) months (range: 12 to 41 months), the average range of motion of patients were 130.4°±36.5° for forward elevation, 37.6°±16.6° for external rotation and L3 level (±3 vertebrae) for internal rotation. The average VAS pain score, ASES score, Constant-Murley score and UCLA score were 0.5±1.2 (0-4), 81.4±13.9 (43-100), 81.6±13.6 (52-100) and 28.5±5.1 (16-35), respectively. The average patient satisfaction rate was 95.6%. The greater tuberosity healed anatomically in 42 patients, which was confirmed by the postoperative radiographs, while the greater tuberosity nonunion was found in the other three patients. Superior migration of humeral head was found in two patients. There were no complications, such as infection, prosthetic loosening or neurovascular injury, related to the surgery. Primary shoulder arthroplasty for complex proximal humeral fractures with the trabecular metal prosthesis could yield good clinical results. The healing rate of the greater tuberosity was 93.3%.

Tian W.,Beijing Jishuitan Hospital
Zhonghua wai ke za zhi [Chinese journal of surgery] | Year: 2012

Use sagittal reconstruction CT to verify the surgical strategy for cervical ossification of the posterior longitudinal ligament (OPLL). A retrospective study of 161 patients (106 males and 55 females) who had undergone surgery for OPLL from July 2007 to November 2010 was performed. The mean age at surgery was 54.5 years (range from 26 to 77 years). The mean follow-up period was 28 months (12 - 54 months). There were 40 patients accept anterior approach surgeries (anterior group) which include 14 cases of anterior cervical corpectomy and fusion and 26 cases of anterior cervical discectomy and fusion. There were 120 patients accept posterior approach surgeries (posterior group) which was spinous process-splitting laminoplasty for cervical myelopathy using coralline hydroxyapatite. One patient accepted combined anterior and posterior approach. According to the sagittal reconstruction CT, the main reason for spinal cord compression was cervical disc herniation in anterior group, and OPLL in posterior group. The level of spinal cord compression was 1 to 2 levels in anterior group, and 1 to 5 levels in posterior group with a major of 2 to 4 levels. As the classification of OPLL, segmental type and circumscribed type were major of segmental type in anterior group and all of the four types were in posterior group, the distribution of each type was average. The patients of posterior group were classified into two groups according to the modified K-line classification, and clinical results were compared between the two groups. The modified K-line was defined as a line that connects the midpoints of the spinal canal at C(2) and C(7) on sagittal CT myelography. Compression to the spinal cord did not exceed the K-line in the modified K-line(+) group and did exceed it in the modified K-line(-) group. Clinical data were compared using t-test or χ(2) test. Correlation analysis was used to determine the relationships of C(2)-C(7) angulation between sagittal reconstruction CT and neutral position X-ray. The patient of anterior group had better recovery rate of the JOA score (72% ± 27%) than the posterior group (59% ± 35%) at the latest follow-up (t = 2.238, P = 0.027). In posterior group, the patients of modified K-line(+) group had better recovery rate of the JOA score (63% ± 37%) than the K-line(-) group (49% ± 30%) at the latest follow up (t = 2.150, P = 0.034). The C(2)-C(7) angulation on sagittal reconstruction CT was 11° ± 9° which has significantly correlated with the C(2)-C(7) angulation on neutral position X-ray which was 10° ± 10° (r = 0.947, P < 0.01). Considering the selection of surgical approach, it should be combined with the main clinical diagnosis for spinal cord compression, the level of compression, the classification of OPLL and the kyphotic alignment of the cervical spine. The modified K-line is a simple and practical tool for making decisions regarding the surgical strategy for cervical OPLL patients.

STUDY DESIGN.: Case report. OBJECTIVES.: To assess the feasibility, safety and accuracy of a new robotic system for performing posterior C1–2 transarticular screw fixation for atlantoaxial instability. SUMMARY OF BACKGROUND DATA.: C1–2 transarticular fixation is a reliable procedure. However, the procedure is high-risk because of the important structures and frequent anatomical variation around the atlantoaxial region. Navigation improves the accuracy, but it might require repeated adjustments of the trajectories, which is inconvenient. Robot-assisted surgery can make this process easier and have the potential to improve the safety and accuracy. METHODS.: A 43-year-old man with atlantoaxial deformity and instability underwent posterior C1–2 transarticular screw fixation under the guidance of the new robotic system (TiRobot, co-designed by Beijing Jishuitan hospital and TINAVI Medical Technologies Co., Ltd.). We performed a surgery of posterior decompression and C0–2 fusion. Based on the intraoperative 3D images, we planned the trajectory on the robot system. Then, the robotic arm spontaneously moved to guide the screw insertion. RESULTS.: A unilateral C1–2 transarticular screw was safely placed with good accuracy. The calculated deviation of the planned position and actual position was 0.8798?mm. There were no intraoperative complications. Postoperative CT showed there were no perforations and loosening of the screw. CONCLUSION.: We report the first case of atlantoaxial transarticular screw fixation using the TiRobot system. The intraoperative 3-dimensional images based robotic guidance for complex upper cervical deformity could be feasible, safe and accurate, and has a significant clinical potential in spine surgery.Level of Evidence: 4 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

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