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2016 Vol. 22, No. 11
Published: 2016-11-25
 
961 Effect of Two Kinds of Anterior Cervical Decompression and Fusion Methods for Cervical Spondylosis
Shang Rongan，Wang Shaofei，Chao Jianhu，et al.
Objective  To compare the clinical effects between traditional titanium plate with cage (group A)and Zero-P (group B) in treating cervical spondylosis.Methods  The clinical data of 46 patients with cervical spondylotic myelopathy who underwent anterior cervical discectomy and fusion(ACDF) by traditional titanium plate with cage (group A， n ＝24) or Zero-P implant (group B， n ＝24) between July 2012 and June 2014 were retrospectively analyzed.The operation time，intraoperative blood loss，postoperative JOA scores，NDI score，Bazaz dysphagia score，cervical curvature，vertebral angle displacement and horizontal displacement were compared between groups.Results  There was no statistical significance in terms of operation time and blood loss between group A and B(P＞0.05).The JOA score，NDI score of the last follow-up was significant improved (P＜0.05)，but no statistical difference was found between both groups(P＞0.05).The cervical curvature showed significantly increases after operation (P＜0.05)，Bazaz dysphagia score between the two groups was statistically significant (P＜0.05).The cervical curvature，angle displacement and horizontal displacement were significantly higher in group A than in the group B at 6 months and final follow-up.Conclusion  Zero-P implant and traditional titanium plate with cage have similar effective treatments for cervical spondylosis，while Zero-P implant has lower incidence of dysphagia and adjacent segment degeneration.
2016 Vol. 22 (11): 961-964 [Abstract] ( 469 ) HTML (1 KB)  [RICH HTML] ( 0 ) PDF (1157 KB)  ( 319 )
965 Height Restoration of Compressed Vertebrae after Percutaneous Vertebroplasty with Medium-viscosity Cement and High-viscosity Cement in the Treatment of Osteoporotic Vertebral Compression Fractures
Wang Mingxing，Deng Yiqi，Zhao Feng，et al
Objective  To compare the clinical efficacy of medium-viscosity cement with high-viscosity cement percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures to restore compressed vertebrae height.Methods  Enrolled for this study were 158 vertebrae with osteoporotic vertebral compression fracture who had been treated by PVP in our department from Oct.2011 to Mar.2014 and followed up for at least two year.The cement volume injected were recorded.The anterior vertebral heights and the kyphosis angle were measured preoperative，post operative and at follow-up.They were randomly assigned into two groups according to the bone-cements they used.Postoperative vertebral height restoration，kyphosis correction were compared.Results  The average cement volume injected was (4.2±1.6)mL，the average anterior height was (17.8±5.7)mm，cobb angle was (20.3±6.7)° before operation，and the average anterior height was (22.2±4.2)mm，cobb angle was (13.8±4.8)°after operation.The average anterior height was (22.0±4.5)mm，cobb angle was (13.1±5.2)° at follow-up，and anterior compression improvement was (15.1±9.6)%，cobb angle correction degree was (6.7±5.5)° in the medium-viscosity cement group.The average cement volume injected was (4.8±1.5)mL，the average anterior height was (17.1±5.5)mm，cobb angle was (21.8±6.5)° before operation，and the average anterior height was (23.6±4.7)mm，cobb angle was (12.8±5.4)° after operation and the average anterior height was (23.3±4.8)mm，cobb angle was (12.8±5.4)° at follow-up，and anterior compression improvement was (20.7±12.1)%，cobb angle correction degree was (－9.4±7.5)° in the high-viscosity cement group.There were no significant differences between these 2 groups in bone cement volume injected(P＞0.05).The average anterior height，cobb angle at postoperation were significantly improved after operation in both groups (P＜0.05).The anterior compression improvement and cobb angle correction degree of high-viscosity cement group were significantly better than the medium-viscosity cement group (P＜0.05).Conclusion  Both medium-viscosity cement and high-viscosity cement PVP can restore vertebra height and improve kyphosis for the treatment of osteopo rotic vertebral compression fractures，whereas high-viscosity cement PVP is more effective in vertebral height restoration.
2016 Vol. 22 (11): 965-969 [Abstract] ( 442 ) HTML (1 KB)  [RICH HTML] ( 0 ) PDF (2301 KB)  ( 341 )
970 Hemiarthroplasty in Intertrochanteric Fractures in Elderly Patients：5 to 9 Years Follow-up Result
Fan Shaodi，Wu Guozhong，Tang Lihu，et al
Objective  To evaluate the clinical results of the Hemiarthroplasty in intertrochanteric fracture in elderly patients with mid-term and long-term follow-up.Methods  46 elderly cases with intertrochanteric fracture treated by the Hemiarthroplasty were followed up for 5～9 years.The function of hip，reason and the rate of death and changes of X-ray were observed.Results  70% patients had good hip function and 50% patients died after 7 years follow-up.52.2% patients had good hip function and 89.1% patients died after 9 years follow-up.The X-ray had more changes after longer follow-up.Conclusion  Hemiarthroplasty is a nice treating method in eld intertrochanteric fractures patients and has good hip function.
2016 Vol. 22 (11): 970-988 [Abstract] ( 375 ) HTML (1 KB)  [RICH HTML] ( 1 ) PDF (1349 KB)  ( 393 )
973 Efficacy and Safety of Systemic Administration of Tranexamic Acid for Blood Salvage in Patients Undergoing PFNA Operation for Intertrochanteric Fracture
Li Hui，Ma Jianbing，Chen Xinlin，et al
Objective  To evaluate the efficiency and safety of systemic application of tranexamic acid (TA) for blood salvage during operation of proximal femoral nail anti-rotation(PFNA) for patients sustained inter-trochancteric fracture.Methods  We retrospectively enrolled 108 patients operated from Janury 2013 to December 2014 and divided them in to two groups which were then named TA group (56 patients)and control group(52 patients)according to whether TA was administrated or not.We then compared change in hemoglobin，transfusion rates，hemoglobin at 4-5 days after operation and complications between the two groups.Results  The total blood loss was less for patients in the TA group than for the control group(541.05±162.18)mL versus (803.10±264.86)mL，respectively.The blood transfusion rate was also less for patients in the TA group than for the control group：12.5% (7/56) versus 30.7%(16/52)，respectively.The rate of deep venous thromembolism of two groups had no significant difference.Conclusion  Systemic tranexamic acid administration can efficiently reduce blood loss after PFNA without obvious adverse outcomes.
2016 Vol. 22 (11): 973-975 [Abstract] ( 482 ) HTML (1 KB)  [RICH HTML] ( 0 ) PDF (357 KB)  ( 353 )
976 The Clinical Efficacy and Prognostic Evaluation of Locking Compression Plate in the Treatment of Pilon Medial Column Fracture Based on Four-column Theory
Wang Zhe 1，Li Shenglong 2，Tang Xin
Objective  To discuss the clinical efficacy and prognostic evaluation of locking compression plate in the treatment of Pilon medial column fracture with the guidance from four-column theory.Methods  We retrospectively analyzed 27 cases of patients from April 2013 to April 2015 with the admittance to the department of Orthopedic Trauma in the first affiliated hospital of Dalian Medical University，diagnosed as Pilon medial column fracture and underwent surgical therapies by locking compression plate (LCP)，aging from 16 to 78，47.80 on average.There were 20 male cases and 7 female cases.12 sides were on the left side，17 sides were on the right side，2 cases were on both side.According to AO/OTA classification，there were 14 sides of type 43B2，7 sides of type 43C1，3 sides of type 43C2，5 sides of type 43C3.On the basis of Ruedi-Allgower classification，there were 7 sides of Type I，13 sides of Type Ⅱ，9 sides of Type Ⅲ.Medial columns of all cases were interfered based on four-column theory.24 sides were close fractures，while 5 sides were open injuries.4 sides were classified to Gustilo Ⅱ，1 side Gustilo Ⅲc.26 sides were treated by open reduction internal fixation through distal tibial medial approach and 3 sides by close reduction external fixation by LCP.Patients were required for knee joint functional practice with non-weight bearing in post-operative 3 days，ankle joint of extension and flexion practice in post-operative 2 weeks.Its clinical efficacy was respectively assessed on the basis of Burwell-Charnley radiograhic standard，Hind-foot and ankle scoring system by AOFAS and Tornetta clinical evaluation standard.Results  The operative time was (90.52±12.75)min，mean intra-operative blood loss was (77.25±3.27)mL and mean length of stay was (8.32±1.28)d.All cases had been followed up from 1 to 7 months.Incision infection occurred in 1 cases after operation，the wound healed 1 weeks after debridements and antibiotic therapies.There was no complications for therest cases shown as incision infection，suppuration，deep vein thrombosis，peripheral soft tissue necrosis，delayed union/union or osteomyelitis.The excellence rate of reduction was 89.60% (26/29).Post-operative follow-up indicated that ankle joint evaluated by AOFAS ankle-posterior foot scoring system scored from 68 to 92.The clinical excellence rate of Pilon fractures was 86.20%(25/29).Conclusion  As for Pilon fractures with medial column interfered， it can reduce soft tissue injuries and lower the incidence of postoperative complications to obtained an expected clinical curative effect and prognostic evaluation under the guidance from four-column theory to conceive a suitable surgical strategy.
2016 Vol. 22 (11): 976-979 [Abstract] ( 427 ) HTML (1 KB)  [RICH HTML] ( 0 ) PDF (970 KB)  ( 389 )
980 Elective Ilizarov Bone Transport Technique in the Treatment of Infected Tibial Bone Defect
Cao Jianming，Zhou Yajing，Zhu Qiaohui， et al
Objective  The present study was performed to explore the clinical outcome of bone transport with the llizarov technique using an external fixator for treating infected bone defects of the tibia.Methods  A total of 17 cases underwent elective llizarov surgery were enrolled in our hospital between Nov.2011 and Jan.2011.Bone transport was performed with llizarov circular external fixator.There were 13 males and 4 females，with average age of 36 years (range：20～59 years).The causes for bone defects included traffic accidents (9 cases)，falling from a height (5 cases)，bruise (3 cases).All patients were diagnosed with open fracture wounds：one with Gustilo Ⅱ open injury，five with Gustilo Ⅲ A open injury，seven with Gustilo Ⅲ A open injury and four with Gustilo Ⅲ C open injury.Five cases were found with bone defects on the left side，while twelve cases were found on the right sideBone defects in the upper segments of the tibia were observed in 7 patients，in the middle segments of the tibia were observed in 6 patients and in the lower segments of tibia were in 4 cases.The length of defect of the tibia was 6～10 cm before bone transport.The area of the defective soft tissue after wound debridement was 3 cm×4 cm～7 cm×9 cm.The firststage operation was conducted to clean the wound.First the infected bone segments were removedThen the bone cement beads were implanted or the wound was covered by VSD and flap to prevent wound infection.During elective llizarov surgery，bone transport technology using an external fixator was performed after transporting or forcing bone segments to make defective bone repair and reconstruction.Variable parameters including the length of bone detect and the duration of carrying the external fixator were recorded.Then function of injured limb was evaluated by scoring.Results  All the patients were followed up for 10～22 months with an average of 13.5 months.In 12 cases of patients with postoperative flaps survived more than 5 cases of free skin graft or wound.Tibial bone segment shifting or extension of the 6～10 cm，with an average of 7 cm；external fixator carry time 7～16 months，the defect of the tibia were obtained reconstruction，with an average of 11 months.According to Paley standard to evaluate bone lengthening bone removal and functional results，13 cases were excellent，good in 3 cases，1 cases，the excellent rate was 94.1%.Conclusion  Given the advantages of short treatment duration and less complication，bone transport with the llizarov method and assisted with an external fixator was recommended for treating patients with infected bone defects of the tibiaMeanwhile，this technique also had an excellent outcome for limb reconstruction and deformity correction.Our results provided a reference for the clinical application of this technique.
2016 Vol. 22 (11): 980-984 [Abstract] ( 384 ) HTML (1 KB)  [RICH HTML] ( 0 ) PDF (1572 KB)  ( 375 )
985 Posteromedial Approach Combined with Anterolateral Limited Incision for the Treatment of Pilon Fracture
Niu Xingang，Gong Feng，Yan Lisheng
Objective  To discuss operative technique and clinical result of posteromedial approach combined with Anterolateral limited incision for the treatment of Pilon fracture.Methods  10 cases tibial Pilon fractures were operated through posteromedial approach combined with anterolateral limited incision from March 2010 to January 2015，including 9 males and 1 female.Their ages were 24 to 56 years with an average of 36.5 years.The time until surgery was 5 hours to 14 days with an average of 9 days.All the cases were unilateral closed fractures with large posterior fracture fragments of diatal tibia，including 7 left and 3 right sides.The fractures were evaluated by AO/OTA classification，2 cases were type 43C1 and 8 cases were type 43C2.Soft tissue injury was evaluated by Tsherne classification.4 cases were grade 0，4 cases were grade 1 and 2 cases were grade 2.Fibular fracture and anterolateral distal tibia fracture fragments were reduced and fixed through Anterolateral limited incision.Posteromedial approach was used to expose posterior and medial fractures of distal tibia，and these fractures got good reduction and screw fixation.Through posteromedial approach a medial distal tibial locking plate was introduced to stabilize distial tibia by MIPPO technique.Results  All the incisions healed well.All patients were followed up for 12 to 24 months and mean follow-up time was 16.5 months.The time to fractures healing was 12 to 24 weeks with an average of 15.1weeks.According to Mazur criterion，ankle function was excellent in 6 cases，good in 2 cases，fair in 2 cases，and the excellent and good rate was 80%.Conclusion  The indication for posteromedial approach combined with anterolateral limited incision is closed Pilon fracture with large posterior fracture fragments of distal tibia.This technique can effectively expose，reduce and fix posterior and medial fracture fragments of distal tibia.It can decrease iatrogenic soft tissue injury，preserve the blood supply of fracture fragments，and has less complication rate and good treatment result.
2016 Vol. 22 (11): 985-988 [Abstract] ( 393 ) HTML (1 KB)  [RICH HTML] ( 0 ) PDF (3480 KB)  ( 316 )
989 Minimally Invasive Surgery in Treatment of Hammer Toe
Zhao Siqiao，Ma Shunqian，Gao Zhanao，et al
Objective  To evaluate the clinical results after minimally invasive surgery in treatment of hammer toe.Methods  The clinical data of 218 patients (344 toes) with hammer toe who received the minimally invasive surgery between January 2012 and January 2016 were reviewed.There were 8 males and 210 females with an average age of 59.80 years.215 patients (309 toes) suffered from hammer toe in second toe；29 patients (31 toes) in third toe；4 patients (4 toes) in fourth toe.215 patients (338 toes) suffered from hallux valgus at the same time.ACFAS Scoring Scale for forefoot was (41.3±10.71) before surgery.Results  All patients were followed for 6～30 months.ACFAS Scoring Scale for forefoot is 88.6±5.29 after surgery.The difference had statistical significance before and after surgery (P＝0.000).90.83% patients had excellent results，7.79% good，and 1.38% bad.Conclusion  Hammer toe can be corrected with less trauma，faster recovery，less complications，and more satisfaction by flexibly using a variety of minimally invasive surgery.
2016 Vol. 22 (11): 989-991 [Abstract] ( 470 ) HTML (1 KB)  [RICH HTML] ( 0 ) PDF (1413 KB)  ( 271 )
992 The Variation Analysis of Glu，GSP，EGF and TGF-β1 after Acute Traumatic Fractures
Guo Qi 1，Cai Xianhua 2
Objective  To investigate the variation and clinical significance of blood glucose (Glu)，glycosylated serum protein (GSP)，epidermal growth factor (EGF) and transforming growth factor beta 1 (TGF-β1) levels after acute traumatic fractures.Methods  150 cases of patients with acute traumatic fractures in our orthopaedic department were selected from 2010 to 2015，and were retrospectively analyzed.There were 32 cases with diagnosis of diabetes under hypoglycemic therapy (known group)，21 cases diagnosed diabetes after admission (unknown group)，and 97 cases fracture patients without diabetes (non-diabetes group).At the same time，40 healthy patients were selected as the healthy group.The serum Glu，GSP，EGF，TGF-β1 levels were detected and analyzed before admission and after fracture for 2 weeks.Results  The Glu levels of the known group，the unknown group’s and non-diabetes group were significantly higher than that of the healthy group (P＜0.05) during admission.The GSP levels of the unknown group was significantly higher than the known group，the non-diabetes group and the healthy group (P＜0.05); The Glu levels of the four groups had no statistical significance after operation for 2 weeks(P＞0.05)，while the GSP levels of the unknow group was significantly higher than the known group，the non-diabetes group and the healthy group (P＜0.05).The EGF，TGF-β1 levels in non-diabetes group were significantly higher than the known group，the unknown group and the healthy group with statistically difference (P＜0.05).Conclusion  The serum Glu level can be the observation index for traumatic stress of post fracture，and the GSP can identify the reason of high Glu levels in patients.The serum EGF，TGF-β1 levels variation may be associated with fracture healing ability of patients.
2016 Vol. 22 (11): 992-1001 [Abstract] ( 327 ) HTML (1 KB)  [RICH HTML] ( 0 ) PDF (472 KB)  ( 311 )
995 Effect of Compensation Eccentric Strength Trainingon of Lower Limbs on Patients with Patello-femoral Pain Syndrome
Bai Zhenmin，Lyu Qiannan，Zhao Shuang，et al
Objective  To use the Compensation Eccentric Strength Training System on patients with Patello-femoral pain syndrome，and assess the influence of rehabilitation on strength training.Methods  20 athletes who met the entry criteria PFPS from Beijing sport university were randomly divided into experimental and control groups.The experimental group underwent six weeks of lower limb centrifugal strength training，twice a week，using compensation eccentric strength training system(CC03).Load intensity of the subject were 120% 12RM maximum amount of centripetal force，15/group with 2 for each group.Use the BTE Primus (RS) maximum radial centrifugal peak torque and peak torque maximum system test subjects before and after training.Using the SPECTRON IR infrared thermal imaging for medical diagnostic test systems，affected part of the knee and surrounding normal skin temperature difference.PFPS subjects were evaluated using KOOS，VAS ratings.Results  The average centrifugal force and KOOS score after training from subjects in the experimental group were significantly improved compared with before training (P＜0.05).VAS score and suffering knees and surrounding normal skin temperature difference were significantly lower (P＜0.05).At the same time there was no clear data of the change in the control group subjects (P＞0.05).Comparing the experimental group and the control group after the experiment，we found VAS score and knee lesion compared with the surrounding normal skin temperature of the subjects in the experimental group difference with the control group decreased significantly，bilateral lower extremity average centrifugal force and KOOS score was significantly increased(P＜0.05).Conclusion  The improvement of the centrifugal force of the lower limbs has a therapeutic effect on PFPS.
2016 Vol. 22 (11): 995-1009 [Abstract] ( 365 ) HTML (1 KB)  [RICH HTML] ( 0 ) PDF (460 KB)  ( 370 )
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