Objective:To summarize the research progress of anterior cutaneous nerve injury and repair in knee arthroplasty. Methods:The relevant literature at home and abroad in recent years was reviewed and summarized from the anatomy of anterior cutaneous nerve, nerve injury grade, clinical manifestations, prevention and treatment of anterior cutaneous nerve. Results:The anterior cutaneous nerve injury is a common complication of knee arthroplasty. Because the anterior cutaneous nerve branches are many and thin, and mainly run between the first and second layers of fascia, this level is often ignored during surgical exposure. In addition, the knee arthroplasty does not routinely perform the exploration and repair of the cutaneous nerve. So the anterior cutaneous nerve injury is difficult to avoid, and can lead to postoperative skin numbness and knee pain. At present, studies have explored the feasibility of preventing its occurrence from the aspects of improved incision and intraoperative separation of protective nerve. There is no effective prevention and treatment measures for this complication. For patients with skin numbness after knee arthroplasty, the effectiveness of drug treatment is not clear. Local nerve block or nerve excision can be used to treat patients with painful symptoms after knee arthroplasty considering cutaneous pseudoneuroma. Conclusion:Knee arthroplasty is widely used and anterior cutaneous nerve injury is common in clinic. In the future, more high-quality clinical studies are needed to further explore the prevention and treatment measures of this complication and evaluate the clinical benefits obtained.

Developmental dysplasia of hip (DDH) usually associates with acetabular dysplasia and femoral head deformity. It causes a poor match between the acetabulum and the femoral head, which in turn leads to abnormal mechanotransduction in the lower limbs, eventually causing hip pain and developing hip osteoarthritis (HOA). (HOA). Total hip arthroplasty (THA) is currently the preferred method for advanced and severe adult DDH. However, because of the developmental abnormalities of the acetabular structure, including the anterolateral bony deficiency and the increased anteversion of the acetabulum, the optimal position of the acetabular cup and the methods of intraoperative stabilization remain controversial. This article reviewed the progress of the effect of installing acetabular cup between anatomical and lifted positions in THA, and provided references for installation and handling of acetabulum in the treatment of DDH with THA according to image classification, different types of prosthesis, biomechanics, bone mass and hip function.

Objective:To investigate the incluence of abnormal anterior cruciate ligament (ACL) MRI on the efficacy of unicompartmental knee arthroplasty (UKA).Methods:This study used statistical methods such as t test, rank sum test, and analysis of variance to retrospectively analyse the patients with anterior medial knee osteoarthritis treated by UKA admitted from May 2014 to May 2019 in the department of joint surgery of The First Affiliated Hospital of Guangzhou Medical University.Inclusion criteria: diagnosed anteromedial knee osteoarthritis, knee MRI showed only medial compartment cartilage wear and ACL abnormality, intra-operative findings showed only anterior medial cartilage wear while ACL function was normal. Exclusion criteria: multi-compartment osteoarthritis, rheumatoid arthritis, infectious arthritis. The MRI results showed ACL conditions, which were divided into ACL-MRI normal group and ACL-MRI abnormal group. A total of 55 patients (61 knees), of which 26 cases (30 knees) had complete ACLs, and 29 cases (31 knees) had abnormal ACLs. For the two groups, the Hospital for Special Surgery knee score (HSS), visual analogue scale (VAS) and range of motion (ROM) were used to evaluate the knee joint functions before operation and the last follow-up situation after operation respectively.Whether the prosthesis was loosening or infected after the operation, and whether the gasket had abrasion, dislocation or other complications, were also observed.Results:All the patients were followed up for the longest time of five years, with an average follow-up time of (21±17) months. At the last follow-up of normal ACL-MRI group after surgery, the average HSS score was(75.9 ± 7.6). The average VAS score was 1.0(0.7, 1.3), and the average ROM was (109.9±9.9)°. Postoperative ACL-MRI was abnormal at the last follow-up of the group. The average HSS score was(77.7 ± 6.6). The average VAS score was 0.8(0.6, 1.1), and the average ROM was(108.0±10.6)°. All the data were significantly improved compared with the preoperative scores. There was no statistically significant difference between the two groups in knee range of motion, knee HSS score and pain score (P>0.05). No complication such as prosthesis infection, loosening, fat embolism, gasket wear, or dislocation occurred in the two groups.Conclusion:The patients with preoperative abnormal ACL MRI but the ACL is confirmed unbroken and good function during operation may have good short-term and mid-term effects after UKA, which still needs follow-up for the long-term results.

寰枢椎不稳和脱位在临床上比较多见,造成寰枢椎不稳的原因很多,包括有外伤(骨折或脱位)、发育畸形、肿瘤、炎症及退变等,易导致上颈髓受压,危及患者生命,也可以渐进性发展形成慢性高位颈脊髓病.寰枢椎不稳通常需做寰枢椎融合术.可采用前路、侧路或后路.前路经口入路的技术要求比较高且感染的概率较大,侧路的方法使用较少,后路显露容易,且便于安置内固定,在临床上的实际应用远多于前入路.近年来,随着对寰枢椎后路融合内固定方法及生物力学的深入研究,使手术方法的选择更具有了科学性,其疗效得到逐步提高.本文着重对寰枢椎后路融合内固定技术及其生物力学作一综述.

Objective:In order to provide the mechanical evident of atlantoaxial pedical screw and crosslink compression for instable Jefferson fracture,we evaluated the stability of atlantoaxial junction fixation by it.Methods:six of the adult cervical spinal specimens which were entirewet-cadavers(from occipitale to C4) were made to simulate the unstable Jefferson fracture.These of specimens dislocated were fixed by atlantoaxial pedical screw and atlantoaxial pedical screw and crosslink system.The three dimensional movements of C1-C2 were recorded though photogrametry with a pure moment of 1.53 Nm.The range of motion(ROM) of each specimens in two fixations was caculated.Results:The ROM for the atlantoaxial pedical screw and crosslink lower than atlantoaxial pedical screw in flecion-extension and lateral bending(P>0.05).In axial torsion,the atlantoaxial pedical screw and crosslink significantly lower than atlantoaxial pedical screw(P<0.05).Conclusions:According to the biomechanical testing,atlantoaxial pedical screw and atlantoaxial pedical screw and crosslink system fixation on atlantoaxial instability provide excellent postoperative stability.However,atlantoaxial pedical screw and crosslink system fixation has better stability than atlantoaxial pedical screw in axial torsion.