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2017 Vol. 23, No. 3
Published: 2017-03-25
 
193 Clinical Results of Hybrid Surgery of Cervical Disc Replacement Combined with Fusion in Treating Three-level Cervical Spondylosis
Yang Yi，Zeng Junfeng，Liu Hao，et al
Objective  To evaluate the effectiveness and safety of Prestige LP cervical disc replacement combined with Zero-Profile implant system interbody fusion intreating three-level cervical spondylosis.Methods  Patients who underwent three-level hybrid surgery using Prestige LP and Zero-P between September 2012 and April 2015 were retrospectively analyzed，clinical and radiologic data were collected.The visual analogue score (VAS)，Japan Orthopedic Association (JOA) score and neck disability index (NDI) were used to evaluate the clinical effect after surgery；cervical X-Rays and three-dimensional reconstruction CT scan were used to assess the postoperative prosthesis position and stability，the replacement segment activity and heterotopic ossification，and fusion rate in fusion segments.Results  24 cases were included in this study，9 patients underwent single level disc replacement+two-level interbody fusion，15 patietns underwent double-level disc replacement+single level interbodyfusion.39 Prestige LP artificial disc prosthesis and 33 Zero-P zero profile impalnts were impalnted at last.The VAS score，JOA score and NDI index at the final follow-up were significantly improved compared with that pre operation (P＜0.05)，no significant difference was found concerning the replacement segment range of motion between the final follow-up and preoperative (P＞0.05)，the overall cervical range of motion decreased significantlycompared with preoperative (P＜0.05).Conclusion  Hybrid surgery of Prestige LP cervical disc replacement combined with Zero-Profile interbody fusion may be a safe and effective option for the treatment of three-level cervical spondylosis.It can effectively relief the clinical symptoms，maintain cervical segmental range of motion，reduce therisk of nonfusionand decrease the adjacent segmental intervertebral disc stress.
2017 Vol. 23 (3): 193-197 [Abstract] ( 405 ) HTML (1 KB)  PDF (2909 KB)  ( 424 )
198 Risk Factors for Adjacent-level Ossification after Aterior Cervical Decompression and Fusion
Chen Kun，Liu Aigang，Cai Huimin
Objective  To analyze the risk factors for adjacent-level ossificationskin after anterior cervical decompression and fusion.Methods  The clinical data of 105 patients with cervical intervertebral disc herniation who underwent anterior cervical discectomy and fusion(ACDF) by Zero-P implant(n=51) or traditional titanium plate with cage(n=54) between June 2009 and August 2013 were retrospectively analyzed.The Bazaz dysphagia grading、the Neck Disability Index(NDI) 、Japanese Orthopaedic Association (JOA) scoring、ameliorative rate of symptom in both groups were measured and compared.The radiographs of the cervical spine were made to assess plate-to-dis distance and adjacent-level ossification development.Results  Surgical method，age，gender，blood loss，ameliorative rate of symptom，plate-to-dis distance and Osteoporosis were risk factors of calcaneal incision complications.Conclusion  It is helpful for avoiding adjacent-level ossification after nterior cervical decompression and fusion by using Zero-P，anti-osteoporosis treatment before operation，reducing blood loss，suitable plate and find-out the suitable position for the plate.
2017 Vol. 23 (3): 198-216 [Abstract] ( 310 ) HTML (1 KB)  PDF (880 KB)  ( 311 )
203 Factors Affecting Vertebrae Delayed Union after Percutaneous Kyphoplasty
He Xin，Hao Dingjun，Wu Qining
Objective  To investigate the factors involved in delayed vertebral union after PKP in patients with OVCF.Methods  This retrospective case-control study enrolled patients who had been treated using single-segment PKP from January 2011 to January 2012.Demographic and surgical data were collected to analyze the risk factors associated with delayed vertebral union after PKP.Results  A total of 580 patients with OVCF treated with PKP were enrolled in the study.Of these，29 (5.0%) had experienced delayed vertebral union and they were paired with age-and sex-matched patients who experienced vertebral union.Multivariate analyses revealed that a low preoperative bone mineral density (OR 0.114，95% CI 0.014～0.900)， the presence of an intravertebral cleft (OR 35.88，95% CI 1.690～762.034)，and a higher restoration rate of vertebral height (OR 4.053，95% CI 1.217～13.496) were independently associated with delayed vertebral union.Conclusion  Preoperative BMD，intravertebral cleft，and restoration rate of vertebral height appear to be risk factors for delayed vertebral union after PKP in patients with OVCF.
2017 Vol. 23 (3): 203-243 [Abstract] ( 287 ) HTML (1 KB)  PDF (2523 KB)  ( 301 )
208 The Application Research of New Fulrum Bending X-ray Films in Scoliosis
Yang Yilin，Wang Fei，Li Jingfeng，et al
Objective  to explore the effectof new fulcrum bending film technique on fusion strategy of adolescent idiopathic scoliosis.Methods  Based on new-designed fulcrum bending film technique，the fusion level of 23 AIS patients，which enrolled from June 2013 to April 2014，was identified before scoliosis operation.The study cohort had a mean age of 14.8 years(10～19 years) of which 18 were female and 5 male.AS regarded to Lenke classification，there 13 type 1AN，4 type 1BN，1 type 1A－ and 5 type 1CN.Besides radiological measurements were taken from Long-cassette standing anteroposterior film preoperative，immediate postoperative(1 week)and latest follow-up，fulcrum bending film was measured preoperatively.According to magnitude of Cobb angle，reservation of fusion segments could be calculated.Results  there was no statistically different between average Cobb angle of new fulcrum bending film preoperatively and that of anteroposterior standing film immediate postoperative(t＝0.7，P＝0.483)；and no significant changes appeared in the period from immediate postoperative to latest visit (t＝5.5，P＝0.001).17 of 23 population reserved one more motion segments compared with traditional Harrington technique.Conclusion  New fulcrum bending film technique could safely evaluated the selection of fusion level in AIS patients.In contrast with traditional method，it could reserve more fusion vertebrae，saving more motion segments of spine.
2017 Vol. 23 (3): 208-211 [Abstract] ( 290 ) HTML (1 KB)  PDF (2451 KB)  ( 216 )
212 An Analysis of Clinical Outcomes of Percutaneous Endoscopic Interlaminar Discectomy for Lumbar Disc Herniation
Tong Zhihui，Fei Zhongcheng，Ge Maosuo，et al
Objective  To investigate the surgical techniques and clinical effects of percutaneous endoscopic interlaminar discectomy in the treatment of lumbar disc herniation.Methods  A total of 29 patients with lumbar disc herniation were treated by percutaneous endoscopic interlaminar discectomy from November 2014 to February 2016.There were 19 males and 10 females，whose average age was 55 years old.All cases had intracanalicular lumbar disc herniation，L4～5in 11cases，L5S1 in 18.The Visual Analogue Scale(VAS)，Oswestry Disability Index(ODI) and modified MacNab criteria were used for the evaluation of clinical effects.Results  The operation was completed successfully in 28 patients，1 patient was transfere to open operation.The mean operation time was 96 min.The 28 patients were followed up for 6～9 months(average 8.3 months)，low back and leg pain，sensory disturbance and muscle weakness were alleviated in different degrees after the operation.The VAS scores of low back pain and leg pain were (4.50±1.95) and (8.07±1.18) point preoperatively，(0.79±0.69) and (0.93±0.72) point at 6～9 months after the operation.The ODI scores were (65.43±15.15)% preoperatively and (9.64±6.09)% at 6～9 months after the operation.Statistically significant differences existed in the VAS scores of low back and leg pain and ODI scores preoperatively and at 6～9 months after the operation(P＝0.000).The excellent and good rate was 94.6% in the latest follow up according to the modified MacNab criteria.Conclusion  Percutaneous endoscopic interlaminar discectomy for lumbar disc herniation presents satisfactory short-term clinical outcomes due to reliable surgical technique and appropriate patients.The complications should be avoided during operation.
2017 Vol. 23 (3): 212-216 [Abstract] ( 390 ) HTML (1 KB)  PDF (1327 KB)  ( 378 )
217 Failure Cause Analysis of Percutaneous Endoscopic Lumbar Discectomy
Wang Yongfu，He Youzhi，Wang Shangyuan，et al
Objective  To analyze the failure cause analysis of percutaneous endoscopic lumbar discectomy (PELD).Methods  From February 2010 to February 2014，421 patients had undergone PELD.The operation time，length of stay，postoperative complications，clinical outcomes (using modified Macnab criteria)，failure rate of PELD and rate of recurrence were collected.Results  The follow-up time was 12～56 months with a mean of 31.6 months.Operative time was 30～100 mins a mean of 58.4 mins；hospitalization time was 2～5 days a mean of 3.4 days；the rate of good-to-excellent was 90.3%；the failure rate of PELD was 4.3% (18/421)；the rate of recurrence was 0.7% (3/421).The reasons of failure showed as following：incomplete removal of herniated disc material in 12 patients (66.7%)，recurrence in 3 (16.7%) patients，postoperative persistent pain in 2 patients (11.1%)，nerve root injury in 1 patient (5.6%).The reasons of incomplete removal of herniated disc material as following：technically inappropriate positioning of the working channel in 4 patients (33.3%)，migrated discs herniation in 3 patients (25.0%)，central disc in 3 patients (25.0%)，axillary type in 3 patients (25.0%)，and shoulder type in 1 patient (8.3%).Two patients with persistent pain，the MRI and CT examination showeds that they were associated with lateral recess stenosis.Conclusion  PELD can achieve a satisfactory clinical outcomes，however，successful PELD requires techniques to remove the herniated disc fragments in various types of disc herniations，the accumulation of surgical experience and precise placement of the working channel.
2017 Vol. 23 (3): 217-220 [Abstract] ( 325 ) HTML (1 KB)  PDF (1994 KB)  ( 286 )
221 Internal Fixation in the Treatment of Proximal Femoral Tumor with Reversed Non-contact Bridging Plates
Liu Chang 1，2，Qiao Suchi 1，Li Cheng 1，et al
Objective  To evaluate the treatment efficacy of proximal femoral benign tumor with reversed non-contact bridging plates.Methods  We retrospectively analyzed the 44 patients who suffered benign tumor in proximal femur and received treatment in the department of orthopaedics of Changhai hospital.After the curettage of tumor lesion and bone grafting，26 patients in Group A received the internal fixation with reversed non-contact bridging plates，while 18 patients in Group B received the external fixation with braces.The adverse events rate，the time of weight loading after operation，and Harris hip scores (one month，three months and half a year after operation respectively) between the two groups were compared.Results  There was no loosening or breakage of internal fixation in Group A during the follow-up，while one patient in Group B suffered fracture in the bone grafting location.The time of weight loading after operation in Group A was shorter than that in Group B，P＜0.001.The Harris hip scores of one month and three months after operation in Group A were higher than those in Group B.Differences were statistically significant as the P values were 0.009 and 0.007，respectively.Conclusion  Reversed non-contact bridging plates have a good result in the treatment of the proximal femoral benign tumor.The plate helps to shorten the time before weight loading after operation and promote the functional recovery of hip.
2017 Vol. 23 (3): 221-225 [Abstract] ( 325 ) HTML (1 KB)  PDF (2192 KB)  ( 281 )
226 Clinical Results and Risk Factors for Poor Outcome of Intramedullary Nailing in the Treatment of Proximal Humeral Fractures
Xiong Fujun 1，2，He Xijing 1，Feng Hongwei 2，et al
Objective  To assess the clinical and radiological results of fractures of the proximal humerus treated with intramedullary nail fixation and analyze the risk factors associated with a poor outcome.Methods  45 cases of patients with proximal humeral fractures in our hospital from June 2012 to April 2015 were selected as study objects.Patients were analyzed retrospectively with a minimum follow-up of 12～14 months (average 13.1 months).Of all the patients，18 were male and 27 were female.Their age were between 56～74 years old (average 63.8 years).Parameters including operative time and blood loss were recorded.At 1，3，6，12 months after operation，the radiological assessment included AP and axial X-rays in the scapular plane were recorded.Functional outcome of different Neer type fracture were evaluated using the rating scale of the American Shoulder and Elbow Surgeons (ASES)，Constant Score，Visual Analogue Scale (VAS) scores and DASH scores.Logistic regression analysis was used to analyze the association between poor outcomes and age，gender，hypertension and other factors.Results  All patients completed the follow-up，mean operation time was (126.8±17.2) min and mean blood loss was (173.9±22.1) mL.91.1% of patients were satisfied with treatment.X-rays showed a healing rate of 95.6%，with two cases of pseudarthrosis.At last follow up，the VAS score was (1.6±0.3)，ASES score was (85.7±6.0) and Constant Score was (70.8±4.6)，DASH score was (15.0±0.9).Mean mobility was (147.6±11.3) ° of fiexion，(33.0±3.2) ° of lateral and (28.4±1.8) ° of medial rotation.Significant differences were found in the Constant score in individuals under 60 years of age (P＜0.05).Varus healing was observed in 16 patients (35.6%).Functional differences were found when patients with varus healing were compared with those who had anatomical healing.Age，hypertension and osteoporosis were independent risk factors for adverse outcomes.Conclusion  The intramedullary nail fixation is an effective implant for stabilization of displaced proximal humeral fracture with a good functional outcome.Its advantages are short operation time，small incision，less trauma，less blood supply and less complications.Age，hypertension and osteoporosis and other factors may lead to adverse outcomes.
2017 Vol. 23 (3): 226-230 [Abstract] ( 373 ) HTML (1 KB)  PDF (1069 KB)  ( 261 )
231 TT-TG Parameters Values of Adolescents with Epiphyseal Non-closure
Yan Bin，Hou Yanjie，Xu Chao
Objective  To measure a tibial tuberosity-trochlear groove (TT-TG) distance of adolescents with epiphyseal non-closure by computed tomography (CT)，for the establishment of TT-TG parameters values and providing reference for diagnosing and treating patellar instability patients.Methods  50 healthy adolescent volunteers (12 to 16 years old) in Xinjiang were recruited for the CT measuring on knee joints for，and the general information，physical examination and CT data were analyzed.We compared the TT-TG among adolescents with epiphyseal closure and non-closure and the patients with patellar instability.Results  It was found that 32 healthy adolescents with epiphyseal non-closure and 16 adolescents with epiphyseal closure were included the 50 volunteers after screening，but 2 volunteers were ruled out.Each of them was scanned both knee joints.The TT-TG of healthy adolescents with epiphyseal non-closure were higher than that with the epiphyseal closure group，but with no significantly difference (P＞0.05).There are no significant difference between the two measurers for the TT-TG measuring of the same people (P＞0.05).There are no significant difference between males and females in the adolescents with epiphyseal non-closure group (P＞0.05).Compared with the healthy adolescents with epiphyseal non-closure，TT-TG of patellar instability patients with both epiphyseal non-closure and epiphyseal closure were higher (P＜0.05).Among the patellar instability patients，TT-TG in the epiphyseal non-closure group were significantly higher than that in the epiphyseal closure group (P＜0.05).The probability of patellar instability in healthy adolescents with epiphyseal non-closure was higher than that in healthy adolescents with epiphyseal closure (P＜0.05).The probability of undergoing surgery for patellar instability patients with epiphyseal non-closure was higher than that with epiphyseal closure (P＜0.05).Conclusion  Epiphyseal non-closure can enhance the prevalence of patellar instability.Our study preliminary showed the TT-TG parameters values of adolescents with epiphyseal non-closure，and it has a crucial clinical reference for diagnosing and treating patellar instability patients.
2017 Vol. 23 (3): 231-234 [Abstract] ( 452 ) HTML (1 KB)  PDF (863 KB)  ( 346 )
235 Clinical Study of Autologous Adipose Derived Mesenchymal Stem Cells in the Treatment of Osteoarthritis
Han jian 1，2，Yin Zhenhua 2，Li Fuhang 2，et al
Objective  To discusses the safety and effectiveness of the treatment injection for knee osteoarthritis by using a utologous ADSCS composite sodium hyaluronate，platelet rich plasma (PRP).Methods  Take the abdominal adipose tissue，get hADSCs separation，plenty of ADSCS obtained with in vitro culture，and by flow cytometry instrument to detect the surface markers and analysis into cartilage cells differentiation ability.30 patients with mild-to-moderate of knee joint osteoarthritis were selected from the orthopedic outpatient service center in the first people’s hospital of Xianyang city.ADSCs composite sodium hyaluronate，platelet rich plasma were injected into patient’s articular cavity.The indicators such as patients with adverse reactions，knee activity score，pain visual analogue scale (VAS) score as well as the surface of knee join under MRI were evaluated before and after the intervention.Results  Abdominal adipose tissue separated hADSCs were positive expression of CD105 and CD29，CD45，CD34 negative expression，in vitro with good osteogenesis，into fat，cartilage capacity；There was no adverse reaction in the patients who suffered clinical intervention.And patient’s knee pain relief，activity range was improved compared with before treatment.MRI imaging showed that the patchy shadow in the area of the joint surface and low signal area were significantly reduced.There was no obvious joint effusion，and the thickness of articular surface was increased.Conclusion  The articular cavity injection therapy with ADSCs compound sodium hyaluronate，platelet rich plasma (PRP) for patients who suffered with osteoarthritis can effectively improved the knee joint motion，to reduce pain and improve the quality of life.The thickness of the joint surface was increased and the joint degeneration was delayed by MRI imaging.
2017 Vol. 23 (3): 235-239 [Abstract] ( 369 ) HTML (1 KB)  PDF (2326 KB)  ( 731 )
240 Association between PTH Gene Polymorphism and Osteoporotic Fracture
Wang Qifei，Xue Tao，Zhang Qinghua，et al
Objective  To explore the relationship between the polymorphism of PTH gene rs1459015 and bone mineral density(BMD) of osteoporotic fracture in Han nationality in Beijing.Methods  The subjects included 127 osteoporotic fracture(fracture group) and 145 non-osteoporotic fracture(control group).All subjects living in Beijing are Han Chinese without relationship.PTH gene polymorphisms were identified by SNaPshot.BMDs of the lumbar spine (L2～4) and proximal femur including neck，Ward’s，triangle troch and total hip were measured by dual energy X-ray absorptiometry.Allele frequency and genotype frequency were calculated.The BMD difference of two groups and the relationship of the PTH gene polymorphism with BMD of each location in fracture group were analyzed.Results  The A and G allele frequency in two groups were 19.7%，80.3% and 18.6%，81.4%，without statistical significance(P＞0.05).AA、AG、GG genotype frequencies of two populations were 3.9%，31.5%，64.6% and 3.4%，30.3%，66.2%，and this difference was not statistically significant(P＞0.05).The BMDs of each location in fracture group were lower than those in control group，and the differences were statistically significant(P＜0.05)，not including the difference of BMD of neck.The BMDs of GG genotype were higher than those of AA and AG genotype in fracture group (P＞0.05).Compared with AA and GG genotypes in fracture group，AG genotype had higher BMD of hip.Conclusion  The PTH gene polymorphism is not associated with BMD of osteoporotic fracture.
2017 Vol. 23 (3): 240-243 [Abstract] ( 379 ) HTML (1 KB)  PDF (428 KB)  ( 274 )
252 Clinical Effect of Total Hip Arthroplasty for Adult Crowe Type Ⅳ Developmental Dysplasia of the Hip
Zhang Xiaozhao，Lu Dengpeng，Liu Xi，et al
Objective  This study was designed to evluate the clinical efficacy of total hip arthroplasty(THA) with acetabular reconstruction and transverse subtrochanteric shortening osteotomy in adult Crowe Ⅳ DDH in plateau.Methods  Crowe Ⅳ type DDH adult patients 15 hips including 4 male patients (4 hips) and 10 females (11 hips)，with average age at (36±8) years old (range from 23 to 56 years)，underwent acetabular reconstruction and transverse subtrochanteric shortening osteotomy during THA from May 2009 to May 2013.Biological acetabular cup and S-ROM femoral prosthesis with ceramic-ceramic interface was used and preoperative and postoperative Harris score were assessed for evaluating the efficacy and analyzed statistically.Results  13 cases (14 hips) were followed up (except one case was lost) for 23 months averagely (range 18～36 months).Preoperative and postoperative Harris score was (38.56±3.67) and (85.43±2.89) points respectively.Postoperative hip joint function was significantly improved and pain reduced.Conclusion  It is safe and effective to perform THA with acetabular reconstruction and transverse subtrochanteric shortening osteotomy in Crowe type Ⅳ adult DDH patients.
2017 Vol. 23 (3): 252-256 [Abstract] ( 293 ) HTML (1 KB)  PDF (990 KB)  ( 311 )
230 Arthroscopic Arthrodesis for Ankle Arthritis without Bone Graft
Xiaojun Duan，Liu Yang，Li Yin
2017 Vol. 23 (3): 230-230 [Abstract] ( 310 ) HTML (1 KB)  PDF (301 KB)  ( 229 )
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