The Polished MS-30 Stem With a Solid Centralizer: A Minimum 10-year Review of Radiological and Clinical Outcomes 拋光 MS-30 假體固體與實心置中器的結合:最少術後十年的造影和臨床結果

AbstractBackground/PurposeMS-30 is a triple tapered cemented femoral stem. Before 2005, it was used together with a solid centralizer. We wanted to investigate its effect on the migration behaviour and survivorship of polished stem with a minimum of 10 years.MethodsTwenty-seven hips in 26 patients were available for follow-up. The mean length of follow-up was 12.1 years. Clinical outcomes were documented with the Harris Hip Score. Radiographs were examined for evidence of aseptic loosening.ResultsThe average Harris Hip Score was 74.8. No stem was revised for aseptic loosening. Two stems (7.4%) developed radiolucent lines of more than 2 mm width with osteolysis. The mean subsidence was 0.77 mm. The survival rate at the 10th postoperative year, with aseptic loosening as the end point, was 100%.ConclusionThe polished MS-30 stem with a solid centralizer has a satisfactory long-term outcome. Its mean subsidence was less than that of other polished tapered stems reported in the literature

Global sagittal alignment after surgery of right thoracic idiopathic scoliosis in adolescents and adults with and without thoracic hypokyphosis

The study procedure was conducted in accordance to guidelines approved by the institutional clinical research ethics committee (CREC No. 2016.722) and the Declaration of Helsinki. Written informed consent was obtained from all subjects and their parents before participating in this study.AbstractThis study aimed to characterize global sagittal alignment in adolescent idiopathic scoliosis (AIS) with normal kyphosis (NTK, kyphosis > 10°) and with thoracic hypokyphosis (THK, kyphosis < 10°), before and after posterior spinal fusion, and compare them with asymptomatic controls. 27 AIS girls and young adults with right thoracic curves were included (seventeen with age ≤ 18 years, then age > 21). Biplanar radiographies were acquired at baseline, immediate post-operatively, 1-year and 2-year follow-up, and 3D reconstruction of the spine and pelvis was performed. NTK and THK showed different global sagittal alignment, as well as differences compared to controls. AIS with THK at baseline had higher SVA/SFD (2.0 ± 2.9 vs − 0.4 ± 1.9; P < 0.05) and OD-HA (0.2 ± 1.4° vs − 1.3 ± 1.6°; P < 0.05) than controls, indicating that THK had compensated balance with unusual forward leaning posture. Immediately post-operation, SVA/SFD remained high (1.3 ± 3.0) while OD-HA reversed (− 1.2 ± 1.7°), indicating that THK patients had found partially compensated balance. After 2-yeas, both SVA/SFD (− 1.3 ± 2.1) and OD-HA (− 1.4 ± 0.9°) were normalized. The changes in global sagittal alignment and mechanism of balance are different in AIS with or without THK. As the head plays a critical role on balance during immediate and delayed post-operation, OD-HA can be complementary parameter for assessing global balance during post-operative follow-up of AIS patients with THK.The investigation was fully supported by a grant from the General Research Funding of Hong Kong (Project no. 14206716) (W.C.W.C.), and a funding from the BiomecAM Chair Program on Musculoskeletal Modeling (with the support of Société Générale, Covea, Yves Cotrel Foundation, ParisTech Foundation and Proteor) (C.V.)

Soft tissue release and osteotomies in the treatment of patients with spastic diplegic cerebral palsy

We aim to study the outcome of soft tissue releases by tendon elongations and osteotomies in fixed joint contractures by clinical examination and patient self-reported assessment on 20 patients (14 males and 6 females) with spastic diplegic cerebral palsy treated with single-event multilevel surgery (SEMLS) between 2000 and 2012. A questionnaire was used to collect information on problems encountered before and after surgery and decision on surgery. Comparing patients with Gross Motor Function Classification System class I/II, (N = 8), III (N = 8) and IV/V , patients of classes IV/V showed much slower mean recovery time than I/II group (14.00 vs. 4.38 months, p < 0.01). SEMLS in the treatment of patients with spastic diplegia had good mid-term results in most patients. The patients who had unfavourable outcomes are associated with mental retardation, general or local complications and previous selective dorsal rhizotomy surgery. Patient selection and good rehabilitations preoperation and postoperation provided the most favourable outcomes of SEMLS. 中 文 摘 要: 我們的目的是通過臨床檢查和患者自我報告，評估20例（男14例，女6例）痙攣型雙癱性腦癱患者在2000年至2012年之間進行單次多層手術治療（SEMLS），研究以肌腱延長和截骨術等軟組織鬆解治療固定關節攣縮弛的結果。使用問卷收集手術前後遇到的問題以及手術決定的信息。比較粗大運動功能分類系統運GMFCS I / II級（N = 8）、III（N = 8）和IV / V組患者的平均恢復時間比I / II組慢（14.00比4.38個月，p <0.01）。 SEMLS治療痙攣型雙癱性腦癱在大多數患者中有良好的中期療效。不良後果的患者與弱智、全身或局部並發症以及先前選擇性背側神經根切斷術相關。患者選擇、手術前後的良好康復提供了SEMLS最有利的結果。 Keywords: osteotomy, cerebral palsy, single-event multi-level surger

Twelve-year follow-up of a case of proximal femoral Unicameral Bone Cyst (UBC) treated by steroid injection using radiological and DXA scan data

This report is of a proximal femoral unicameral bone cyst in a patient presented at 3 years. Intra-lesional steroid injection was used to treat this large active lesion. The response to treatment was monitored with the use of dual-energy X-ray absorptiometry (DXA) scan as an indirect method of monitoring the activity of the bone cyst. The patient had developed stress fracture during the course of treatment which had remodelled fully after successful treatment with multiple injections; at 12-year follow-up, the patient reached skeletal maturity. The affected femur had remodelled back to normal radiological appearance without avascular necrosis. This has demonstrated that steroid injection is a safe and effective procedure to achieve regression of a large active bone cyst in the proximal femur. It is a minimal invasive procedure resulting in no scar. DXA scan is a useful method combining clinical assessment to monitor status of the bone cyst to allow timing of injection. 中文摘要: 本報告為3歲患者的股骨近端骨囊腫，以用病灶內類固醇注射來治療這個巨大的活性病灶。 使用雙能X射線吸收測定法 (DXA) 掃描作為間接方法監測骨囊腫活性對治療的反應。 患者在治療過程中出現了應力性骨折，經多次注射成功治療後已完全改型，隨訪12年，患者達到骨骼成熟。 受影響的股骨已經重新恢復正常的放射學外觀及沒有缺血性壞死。 這證明了類固醇注射是一種安全有效的方法，以實現股骨近端巨大活躍骨囊腫的消退。 這是微創手術，沒有疤痕。 DXA掃描結合臨床評估以監測骨囊腫狀態是有效的方法以允許注射時機。 Keywords: DXA, steroid injection, Unicameral Bone Cys

Abnormal Skeletal Growth in Adolescent Idiopathic Scoliosis Is Associated with Abnormal Quantitative Expression of Melatonin Receptor, MT2

The defect of the melatonin signaling pathway has been proposed to be one of the key etiopathogenic factors in adolescent idiopathic scoliosis (AIS). A previous report showed that melatonin receptor, MT2, was undetectable in some AIS girls. The present study aimed to investigate whether the abnormal MT2 expression in AIS is quantitative or qualitative. Cultured osteoblasts were obtained from 41 AIS girls and nine normal controls. Semi-quantification of protein expression by Western blot and mRNA expression by TaqMan real-time PCR for both MT1 and MT2 were performed. Anthropometric parameters were also compared and correlated with the protein expression and mRNA expression of the receptors. The results showed significantly lower protein and mRNA expression of MT2 in AIS girls compared with that in normal controls (p = 0.02 and p = 0.019, respectively). No differences were found in the expression of MT1. When dichotomizing the AIS girls according to their MT2 expression, the group with low expression was found to have a significantly longer arm span (p = 0.036). The results of this study showed for the first time a quantitative change of MT2 in AIS that was also correlated with abnormal arm span as part of abnormal systemic skeletal growth