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2016 Vol. 22, No. 12
Published: 2016-12-25
 
1057 Early and Mid-term Outcomes of Zero-Profile Implant in Treatment of Cervical Spondylosis with Osteoporosis
Zhang Liang 1，2，Liu Zhongjun 2，Wang Jingcheng 1， et al
Objective  To analyze the early and mid-term efficacy and safety of Zero-Profile implant in treatment of cervical spondylosis with osteoporosis.Methods  From December 2010 to May 2013，18 patients underwent anterior cervical operation with Zero-P in treating cervical spondylosis with osteoporosis.There were 10 cases of cervical spondylotic radiculopathy，6 of myelopathy and 2 of mixed Type.The NDI score、JOA score、cervical Cobb angle，height of intervertebral space of the fusion segment and dysphagia-related symptoms were reviewed respectively at preoperative and 3 months，12 months and 36 months postoperative.Results  All 18 cases were followed-up from 36 to 50 months.The surgery lasted an average of 62 min (range，45 to 100 min)，mean blood loss was 50.5mL (range，from 30 to 145 mL).The sign，neurologic symptom，cervical Cobb angle and height of intervertebral space in all cases had significant improvement.There were 2 of 18 patients complained minor dysphagia at 3 month follow-up，but none at 12 month.Conclusion  The early and mid-term clinical and radiographic efficacy of Zero-P used in treating cervical spondylosis with osteoporosis was satisfactory.The device can improve and maintain the cervical lordosis and height of intervertebral space.The incidence of postoperative dysphagia was low.
2016 Vol. 22 (12): 1057-1061 [Abstract] ( 435 ) HTML (1 KB)  PDF (2476 KB)  ( 404 )
1062 Early Clinical Effect of Direct Anterior Approach and Posterolateral Approach in total Hip Arthroplasty
Wu Guofeng，Sun Xiaoliang，Zhou Jian， et al
Objective  To compare the early clinical effect of direct anterior approach and post lateral approach in total hip arthroplasty.Methods  From November 2015 to January 2016，there were 32 patients (40 hips) late osteonecrosis of femoral head and osteoarthritis patients.Those patients were assigned to DAA and PLA group.We compared the BMI in preoperation、intraoperatve blood soss、operation time、postoperation first walk time and postoperation first month、second month、third month Harris hip score.Results  The BMI：group DAA is (23.34±5.63)，group PLA is (27.34±5.30)，group DAA were lower than group PLA，The difference was significant(t＝－4.81，P＜0.05).Group DAA were all higher than that in group PLA in intraoperatve blood soss、postoperation first walk time and postoperation first month、second month、third month Harris hip score，but in the operation time group DAA is(124±29.21)min，group PLA is(53±10.56)min(t＝ 26.82，P＜0.05).Conclusion  The direct anterior approach is better than posterolateral approach for faster postoperative recovery in total hip arthroplasty and better early clinical curative effect.
2016 Vol. 22 (12): 1062-1068 [Abstract] ( 466 ) HTML (1 KB)  PDF (1650 KB)  ( 455 )
1065 Clinical Features and Treatment Analysis of Distal Femur Fractures in Elderly Osteoporosis Patients
Yang Kai，Qu Xianfang
Objective  To investigate the clinical features and treatment of distal femur fractures in elderly osteoporosis patients.Methods  A retrospective analysis was made for 15 cases of distal femur fractures in elderly osteoporosis from March 2010 to February 2014，comprising of 6 male and 9 female with an average age of 69.6 years (ranged 65 to 77 years).According to AO classification，10 cases were of type C2 and 5 of type C3.All patients were treated by stageⅠof bone graft procedures combined double-lock plating fixation via anteriormiddle approach.After operation，they were intervened by anti-osteoporosis treatment and functional exercise and guidance.All cases were followed up regularly and performed X-rays.The function of affected knee was evaluated at the end of the follow-up.Results  The distal femur fractures in elderly osteoporosis patients was displacement and comminuted.The bone cortex of distal femur was visible thin while the cancellous bone was sparse.And there was serious bone defect which was more severe than that of preoperative imaging evaluation.With follow-up time of 12～18 months (average 13.7 months )，all patients got bone-healing during 12 weeks to 28 weeks (average 18.3 weeks ).According to knee functional evaluation，6 cases were excellent，8 good and 1 fair.The total excellent and good rate was 93.3％.Conclusion  The distal femur fractures in elderly osteoporosis patients were much more complex.The surgery of stageⅠof bone graft procedures combined double-lock plating fixation via anteriormiddle approach is an effective way for them，which has advantages of obvious exposure，early stable fixation and support and less complication.
2016 Vol. 22 (12): 1065-1068 [Abstract] ( 389 ) HTML (1 KB)  PDF (925 KB)  ( 333 )
1069 Simultaneous Bilateral and Staged Bilateral Total Knee Arthroplasty in Treatment of Knee Osteoarthritis
Shi Chao，Li Zhaoding，Luo Zhongwei， et al
Objective  To investigate the clinical effect of simultaneous bilateral total knee arthroplasty and staged bilateral total knee arthroplasty in the treatment of patients with osteoarthritis of the knee.Methods  From June 2013 to January 2015，66 cases of patients with bilateral knee replacement surgery in our department were selected.This study included 36 cases of simultaneous bilateral total knee arthroplasty and 30 cases of staged bilateral total knee arthroplasty.The treatment and clinical effect of two groups were retrospectively analyzed.Results  There were advantages in operation time and hospital stays in the the group of simultaneous bilateral total knee arthroplasty (both P＜0.01)，and there were advantages in the staged replacement group in the postoperative blood volume，postoperative hemoglobin and blood transfusion (both P＜0.01).The simultaneous group had higher leukocyte，C-reactive protein(CRP) and erythrocyte sedimentation rate (ESR) than replacement group，the difference has statistical significance (P＜ 0.05 or P＜0.01).In knee function (HSS score)，there was no significant difference between the two groups (P＞0.05).In terms of complications，fever and the number of complications after simultaneous group was significantly more than staged group，and the difference was statistically significant (P＜ 0.05).Conclusion  The two groups in the treatment effect have different advantages in the short term follow-up，but in the long term follow-up of knee joint function，there were not significantly different.The use of the same simultaneous and staged replacement surgery，postoperative recovery are more satisfied with the results.
2016 Vol. 22 (12): 1069-1076 [Abstract] ( 401 ) HTML (1 KB)  PDF (1142 KB)  ( 271 )
1073 The Efficacy Studies of Different Timing Applications Tranexamic Acid in Total Knee Arthroplasty
Yang Ziquan，Ji Jianjun
Objective  To research and discuss on the application tranexamic acid the hemostatic effect of total knee arthroplasty in patients with perioperative blood loss of efficacy .Methods  Were retrospectively analyzed between December 2013 and June 2015，90 cases in our hospital of patients with unilateral total knee replacement for the first time，according to the use of different timing can be divided into three groups：0.5 h preoperative intravenous application of 33 cases of tranexamic acid in group A，intraoperative suture incision vein tranexamic acid application before the 27 cases of group B，no application of tranexamic acid 30 patients in group C.Comparison of three groups of patients with postoperative flow and hidden blood loss，total blood loss and blood transfusion rate，postoperative day 3 hemoglobin values and the incidence of postoperative lower limb deep vein thrombosis and pulmonary embolism.Results  Group A and group B patients postoperative blood loss，blood transfusion rate was lower than that in group C，and compared with group B，the effect of group A is more significant，the difference was statistically significant (P＜ 0.05).Group A and group B patients postoperative day 3 the amount of hemoglobin was significantly higher in group C，and in group A than group B，the difference was statistically significant (P＜ 0.05)，no postoperative 3 group were lower extremity deep vein thrombosis and pulmonary embolism.Conclusion  Tranexamic acid can effectively reduce blood loss in patients with total knee arthroplasty，reduce the blood transfusion requirements，and preoperative 0.5 h dosing intraoperative drug effect is more significant.
2016 Vol. 22 (12): 1073-1076 [Abstract] ( 314 ) HTML (1 KB)  PDF (403 KB)  ( 394 )
1077 Evaluation of Tibial Tubercle Wedge Osteotomy in Treatment of Severe Stiff Knee with Total Knee Arthroplasty
Wang Lei，Shen Weizhong，Jiang Zhong
Objective  To investigate the application of tibial tubercle wedge osteotomy in treatment of severe stiff knee with total knee arthroplasty，analyze the clinical result and surgical technique，and provide reference for the selection of clinical operation.Methods  23 cases diagnosed as stiff knee since May 2005 to October 2014 underwent total knee arthroplasty.All patients were followed up，mainly evaluated from the visual analog scale (VAS)，the function of the knee score (KSS) and range of motion (ROM).Results  All the patients were successfully performed without any severe complications.All patients with osteotomy healed within 5 months，VAS score reduced by preoperative (5.25±  1.56) points (range 4～8 points) to postoperative (1.26±0.64) points (range 0～4 points)，KSS score improved from preoperative (42.76±7.80) points (range 35～56 points) to postoperative (90.05±17.24) points (range 67～92 points).Knee range of move improved from preoperative (52.36±24.45)° (range 15°～80°) to (90.15±17.56)°(range 60°～ 110°) at the time of last follow-up.Conclusion  Tibial tubercle wedge osteotomy technique is an effective and safe approach to increase the exposure of the knee joint，wedge osteotomy can disperse the stress loaded on screws，and give continuous dynamic compression between fractures to increase the healing rate.Wedge osteotomy also can correct alignment of the lower limbs to obtain good clinical results.
2016 Vol. 22 (12): 1077-1090 [Abstract] ( 353 ) HTML (1 KB)  PDF (1279 KB)  ( 307 )
1080 Study of Rehabnitation Program on the Isokinetic Muscle Power of Athletes after Anterior Cruciate Ligament Reconstruction
Zhang Mingyu，Zhang Liang，Zheng Jiang， et al
Objective  To evaluate the influence of rehabilitation program on the muscle power of athletes with anterior cruciate ligament rupture after the reconstruction，and measure the muscle strength after training by isokinetic muscle strength system.Methods  Subjects were assigned randomly to either exercise group(n＝15，isokinetic exercises) or control group(n＝15，commonly exercises).Both groups received rehabilitation training after ACL reconstruction.Subjects were assessed with isokinetic measurement after 12 and 24 weeks postoperation.Results  After operation 12 and 24 weeks of constant speed strength training，the exercise group in 60°/s，120°/s test flex and extent peak torque has a different degree of growth，were significantly higher than that in control group (P＜0.05).Conclusion  Isokinetic strength training of rehabilitation for recovery of muscle function after ACL reconstruction has good promoting effect，worthy of further promotion.
2016 Vol. 22 (12): 1080-1082 [Abstract] ( 426 ) HTML (1 KB)  PDF (383 KB)  ( 403 )
1083 Vacuum Assisted Closure Combined with Irrigation of Oxygen on Treatment of Chronic Wound in Orthopedics
Xu Juan，Huan Xuelai，Zang Dehua， et al
Objective  To evaluate the feasibility to treat chronic wound in orthopedics with method of vacuum assisted closure (VAC) combined with irrigation of oxygen.Methods  60 patients with traumatic chronic wound in orthopedics were divided into 2 groups (30 cases in each groups).VAC was performed in control group for 10 days，while VAC combined with irrigation of oxygen (2 liters/min)was performed in observation group for 10 days as well.pH value of wound exucation，temperature of wound，PUSH (pressure ulcer scale for healing) scores，granulation tissue coverage rate，skin graft survival，the time to reach the required skin grafting conditions and healing time and cure rate of each group were recorded at 0 d and 10 d.Results  After ten days of treatment，in the observation group，pH value of wound bed exudate(7.50±0.26) was lower than that of the control group，(7.22±0.16)(P＜0.01)，The time to reach the required skin grafting conditions(12.65±7.16)was lower than that of the control group(18.28±8.85)(P＜0.01).The temperature of wound bed(34.02±0.41)was higher than that of the control group (33.25 ±0.35)(P＜0.01).The granulation tissue coverage rate (34.30±2.83)% was higher than that of the control group(27.27 ±3.54)%(P＝0.00).The Skin graft survival (93.22±1.91)% was higher than that of the control group (83.21±1.86)%(P＝0.00).There was no statistically significant difference between the PUSH score results of the two groups(P＞0.05).All patients were followed up for 3 months.The cure rate was 86.67%(26/30) in observation group and 53.33%(16/30) in control group.The healing time was (35±15.5)day in observation group and(49±23.4) d in controlling group.There were statistically significant difference between the two groups (P＜0.05 respectively).Conclusion  VAC combined with irrigation of oxygen can promote granulation tissue growth and wound healing.The method is feasible and is better than VAC therapy.
2016 Vol. 22 (12): 1083-1086 [Abstract] ( 336 ) HTML (1 KB)  PDF (441 KB)  ( 301 )
1087 Fate of Osteophytes and Sclerosis in Fusied Segments after Lumbar Fusion
Li Chuanling，Zhao Feng，Lyu Huizhao，et al
Objective  To investigate the fate of sclerosis and anterior osteophytes in the fused segments after instrumented lumbar fusion for degenerative lumbar disorders.Methods  Thirty patients (9 males，21 females；60 vertebra；mean age of 66.8 years(45～86 years) were divided into a posterolateral fusion group (n＝14，28vertebrae) and a posterior lumbar interbody fusion group(n＝ 16，32 vertebrae).Serial radiographs obtained preoperatively；postoperatively at 3，6，12 and 24 months；and last follow-up，sclerotic areas of each involved vertebra were mapped and osteophyte lengths were measured.Results  Sclerosis and osteophytes decreased with time for the instrumented fusion.The decrease in sclerotic areas and osteophytes length was observed as early as 3 months postoperatively；and the significant change between each time point were noted in initial 3-and 6-month intervals.In terms of the type of surgery，similar changes were noted in the posterolateral fusion and posterior lumbar interbody fusion groups.Conclusion  Resorption of osteophytes and sclerosis after instrumented spine fusion were observed.Significant resorption was noted at 3 and 6 months postoperatively.Resorption of osteophytes and sclerosis after instrumented spine fusion could be helpful to confirm the successful union.
2016 Vol. 22 (12): 1087-1090 [Abstract] ( 379 ) HTML (1 KB)  PDF (2102 KB)  ( 282 )
1091 Finite Element Analysis of Different Screw Path after Femoral Neck Fracture Healing
Hu Qunsheng 1，Jiang Ziwei 2，Huang Feng 2
Objective  To investigate the stress distribution of different screw path of proximal femur after femoral neck fracture healing with removal of cannulated screws so as to provide theoretical reference for rehabilitation and prevention of complications after surgery.Methods  Dimensional finite element model of the human proximal femur was reconstructed by 64-slice spiral CT scan.Finite element model of equilateral triangle and inverted triangle screw path were established respectively.Under the same load and constraint，the von stresses of the femural in different models were compared by the finite element analysis.Results  The maximum von stress were concentrated in the region of calcar under the femoral neck.The maximum von stress of equilateral triangle model (11.02 MPa) was much larger than inverted triangle model(10.82 MPa) and normal proximal femur model (10.58 MPa).Conclusion  The stress of femur neck would increase significantly after equilateral triangle screws were removed.It was needed to pay close attention to risk of femoral neck fracture when did rehabilitation and functional exercises after surgery.
2016 Vol. 22 (12): 1091-1093 [Abstract] ( 367 ) HTML (1 KB)  PDF (867 KB)  ( 277 )
1094 A Preliminary Study on the Effect of Lidocaine on Anabolism of Collagen Ⅱand Aggrecan in Cultured Chondrocytes
Yang Zhaohui
Objective  To investigate the effect of lidocaine on anabolism of cultured rabbit knee articular chondrocytes.Methods  Six anesthetized New Zealand big white rabbits were killed.We collected knee cartilage and separated articular chondrocytes，which were exposed to 2 mmoL//L lidocaine or saline for 3﹑6 or 9 days.The relative expression of Collagen Ⅱ and aggrecan of articular chondrocytes were assessed with RT-RNA.SPSS 13.0 software was used to analyze the data.Results  RT-PCR assay showed the relative expression of Collagen Ⅱ mRNA exposed to 2 mmoL/L lidocaine for 3﹑6 or 9 days was (18.51±2.34)﹑(16.95±3.10)﹑(15.79±3.57)，the ones exposed to saline for 3﹑6 or 9 days was (19.48±4.01)(18.76±1.96)(17.81±3.05)respevtively，there wasn’t statistically significant difference between lidocaine groups and saline groups (t＝－0.32﹑－0.45﹑－0.72)(All -P＞0.05).The relative expression of aggrecan mRNA exposed to 2mmoL/L lidocaine for 3﹑6 or 9 days was(9.72±0.32)﹑(9.59±0.78)﹑(12.54±1.06)，the ones exposed to saline for 3﹑6 or 9 days was (10.68±1.07)﹑(10.06±0.93)﹑(9.87±1.12)respevtively，there was statistically significant difference between lidocaine and saline groups at the ninth day (t＝2.59，P＜0.05).Conclusion  The effect was limited on anabolism of cultured rabbit knee articular chondrocytes exposed to lidocaine at finite time and concentration.
2016 Vol. 22 (12): 1094-1096 [Abstract] ( 303 ) HTML (1 KB)  PDF (414 KB)  ( 190 )
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