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2017 Vol. 23, No. 4
Published: 2017-04-25
 
289 A Comparative Study about the Treatment of Unilateral or Bilateral Injured Vertebra Fixation for Thoracolumbar Burst Fractures
Zhang Guichun 1，Zhang Ke 2，Chen Chen 1，et al
Objective  To explore the clinical value of unilateral injured vertebra fixation combined with short-segment fixation in the treatment of thoracolumbar burst fractures.Methods  We compared blood loss，operative time，kyphosis angle and vertebral height ratio of the unilateral injured vertebra fixation group Ⅰ(41 cases) with bilateral injured vertebra fixation group Ⅱ(34 cases). All these cases were admitted in our hospital from September 2011 to July 2015.Results  All of the operations were successfully completed，409 screws were inserted.The average healing time of the fracture was 15.6 months(from 12 to 24 months).There were no cases whose neurological impairment got worse.The 11 cases preoperative with incomplete neurological impairment got full recovery after operation.No breakage、loosening and exit of internal fixation occurred during the follow-up.There were no cases whose kyphosis lost more than 10 degrees.The operative time，blood loss of the two groups had no statistically difference(P＞0.05).Their postoperative vertebral height ratio and kyphosis angle of the two groups compared with preoperative were statistically significant(P＜0.05).1 year follow-up had no statistically difference compared with 1 week follow-up(P＞0.05).1 week follow-up of their vertebral height ratio and kyphosis angle had no statistically difference compared with each other (P＞0.05). Conclusion  Injured vertebra fixation combined with short-segment fixation for thoracolumbar burst fractures can improve the kyphosis，rectify with vertebral compression，avoid the lost of reduction and reduce the complication of implant.Unilateral or bilateral injured vertebra fixation can achieve the same effects.
2017 Vol. 23 (4): 289-292 [Abstract] ( 447 ) HTML (1 KB)  PDF (2079 KB)  ( 289 )
293 A Clinical Report of Total Resection and Double Titanium Cage Reconstruction for Lumbar Spinal Metastases Via a Single Posterior Approach
Liu Shuai，Li Zhengwei，Feng Dapeng
Objective  To evaluate the clinical effects of total resection and double titanium cage reconstruction on patients with lumbar spinal metastases.Methods  According to the inclusion criteria，we prospectively selected 11 patients with lumbar spinal metastases of our hospital from January 2014 to January 2016.All patients underwent a total recection via a single posterior approach and double titanium cage reconstruction meanwhile adjuvant chemoradiotherapy was performed to prevent systemic and local tumors after surgery.VAS score，ASIA impairment scale，status of tumor relapse and the success of internal fixation were analyzed to assess the clinical effects and security of our surgical method.Results  Local pain or radicular leg pain was relieved for all patients postoperatively.Significant improvements in neurological function were achieved in 9 patients (81.8％)，while 2 patients received a preoperative ASIA impairment scale.The mean operation time was 5.7 h，with an average blood loss of 2 100 mL.Follow-up time lasted 5 to 16 months (Mean＝10 months) during which three patients died of the disease and one patient suffered local recurrence.None of the 11 patients suffered major postoperative complications such as dural injury，cerebrospinal fluid leakage，vascular injury，wound infection and other complications.And no instrumentation failure，titanium cage prolapse and loss of intervertebral height during the follow-up period.Conclusion  The total resection and double titanium cage reconstruction via a single posterior approach is feasible，safe and effective for special selected cases with poor-prognosis lumbar spinal metastases and less than 1 year of survival.
2017 Vol. 23 (4): 293-300 [Abstract] ( 418 ) HTML (1 KB)  PDF (2559 KB)  ( 210 )
297 Clinical and Radiological Outcome of Transforaminal Thoracic Interbody Fusion for Thoracolumbar Fracture-dislocations
Wang Wentao1，Duan Kun2，Wang Xinwen1，et al
Objective  To explore the clinical effect of transforaminal thoracic interbody fusion (TTIF) for the treatment of thoracolumbar fracture-dislocations.Methods  42 consecutive patients with thoracolumbar fracture-dislocations underwent TTIF in our institution but four patients could not be followed up.Radiographs and computed tomography (CT) data was prospective examined and compared.The clinical outcome was measured in terms of the American Spinal Injury Association (ASIA) score，perioperative complications related to operation.Results  These 38 patients include 24males and 14 females，with an average age of (39.4±9.7) years.The mean duration between injury and surgery was 17.6 (11～23) hours of the 38 patients，all operative procedure was successfully.There were 5 cerebral spinal fluid leakages.The mean operative time was (170±30)min.The blood loss was (820±110)mL，the mean ASIA sensory score was (77.9±12.2) and (90.5±11.8).The average ASIA motor score was (70.5±7.2) and (83.5±9.1) before surgery and at the final follow-up，respectively.The spinal canal narrowing decreased from (72.8±4.5)％ before surgery to 4.0±2.1)％ at the final follow-up，the solid fusion rate was 100％.There was radiological sign of instrumentation failure at the final follow-up.Conclusion  Our findings suggest that TTIF allows for safe interbody fusion and circumferential decompression，requires only a posterior approach，and is associated with a lower incidence of surgery-related complications.
2017 Vol. 23 (4): 297-300 [Abstract] ( 468 ) HTML (1 KB)  PDF (2198 KB)  ( 230 )
301 Correlation Analysis of Osteoporosis and Adjacent-level Ossification after Nterior Cervical Decompression and Fusion
Huang Donghai，You Ruijin，Xiao Yizeng，et al
Objective  To Investigate the relationship between osteoporosis and adjacentlevel ossification after nterior cervical decompression and fusion.Methods  The clinical data of 105 patients with cervical intervertebral disc herniation who underwent anterior cervical discectomy and fusion(ACDF) between June 2009 and August 2013 were retrospectively analyzed .Bone mineral density (BMD)before and after ACDFs 、the incidence of adjacent-level ossification after ACDFs and the degree of adjacent-level ossification after ACDFs were analysed.Results  Adjacent-level ossification after ACDFs related to Low BMD and osteoporosis.Osteoporosis and the severity of adjacent-level ossification after ACDF were positively correlated.The change of Osteoporosis and the severity of adjacent-level ossification after ACDF were negatively correlated.Conclusion  It may be helpful to reduce the incidence and the severity of adjacent-level ossification after ACDF by using anti-osteoporosis drug.
2017 Vol. 23 (4): 301-305 [Abstract] ( 386 ) HTML (1 KB)  PDF (1032 KB)  ( 245 )
306 Correlation of Perioperative Levels of Inflammatory Factors with Postoperative Delirium in Elderly Total Hip Arthroplasty
Wang Guifang，Shang Pingfu，WangTao

Objective  To investigate the correlation between the occurrence of postoperative delirium and the level of inflammatory factors in the elderly patients after total hip arthroplasty.Methods  182 patients aged more than years with total hip arthroplasty were enrolled in this study and divided into delirium group (58 cases) and control group (124 cases) by reference to disturbance of consciousness.The levels of serum C-reactive protein (CRP)，interleukin (IL)-1β，IL-6 and tumor necrosis factor (TNF)-α were measured before operation and 1h and 6h after operation.The correlation between the above indexes and the postoperative delirium was analyzed.Results  Compared with before operation，the levels of IL-1β and IL-6 at 1h and 6h after operation and CRP at 6h after operation in the delirium group，and the levels of IL-6 at 1h and 6h after operation and CRP at 6h after operation in the control group were significantly increased(P＜0.05).Compared with the control group，the level of IL-1β at 1h after operation and IL-6 at 6h after operation in the delirium group was significantly higher(P＜0.05).Regression analysis showed that the level of IL-1β at 1 hour after operation and IL-6 at 6h after operation was an independent risk factor of postoperative delirium(P＜0.05).Conclusion  The incidence of delirium in elderly patients with total hip arthroplasty is high，and early detection of IL-1β and IL-6 levels can help to predict the risk of postoperative delirium.
2017 Vol. 23 (4): 306-308 [Abstract] ( 409 ) HTML (1 KB)  PDF (392 KB)  ( 244 )
309 Analysis of the Risk Factors of Slow Incision Healing and Flap Necrosis after the Operation of Closed Calcaneal Fracture
Ji Ke，Wang Suchun，Li Danyong，et al
Objective  To analyze the risk factors of slow incision healing and flap necrosis after the operation of closed calcaneal fracture，and to provide some references for the prevention and treatment of soft tissue complications after the operation of closed calcaneal fracture.Methods  402 patients with closed calcaneal fracture from March 2011 to March 2016 in the Traditional Chinese Medicine Hospital of Zhangjiagang and First Hospital Affiliated to Soochow University were selected and divided into two groups according to the occurrence of the soft tissue complications，including the patients with slow incision healing and flap necrosis as the occurrence group，and the patients without slow incision healing and flap necrosis as the nonoccurrence group. The incidence of soft tissue complications and clinical data between the two groups were compared，the factors with statistical difference were involved in the Logistic regression analysis，and the risk factors of slow incision healing and flap necrosis after the operation of closed calcaneal fracture were summarized. Results  50 of 402 patients were observed the soft tissue complications，the incidence rate was 12.44％，29 cases (58.00％) with slow incision healing，and 21 patients (42.00％) with flap necrosis. Multivariate analysis showed that diabetes and steel plate internal fixation were risk factors for slow incision healing and flap necrosis，and dynamic traction and autogenous iliac bone graft were protective factors (P＜0.05).Conclusion  The incidence of soft tissue complications after the operation of closed calcaneal fracture is closely related to the physical status and the operation scheme. The adjustment of blood glucose level and the scientific operation should be paid more attention.
2017 Vol. 23 (4): 309-311 [Abstract] ( 421 ) HTML (1 KB)  PDF (366 KB)  ( 219 )
312 Diagnosis and Threapy of Tumor Induced Osteomalacia (TIO)
Duan Liang，Gong Liqun，Liu Jun，et al
Objective  To analyzethe clinical characteristics of tumor induced osteomalacia (TIO).Methods  To analyze the clinical data of 8 patients with TIO in laboratory and imaging examination.Results  8 cases of patients were in line with the clinical diagnosis of low phosphorusosteomalacia.All patients were adults adults.They had low blood phosphorus，highurinary phosphorus level，the normal low blood calcium level，elevated alkaline phosphatase，basic normal parathyroid hormone.Octreotide imaging revealed 1 negative case，7 cases with prompt high expression of somatostatin receptor.2 routine CT，6 MRI，2 regular color Doppler ultrasound，2 whole body bone scan，4 PET-CT examinationwere performed.After a clear positioning，surgical treatment were adopted.Postoperative pathological diagnosis were confirmed.Conclusion  TIO shows typical clinical characteristics.Clear TIO tumor site is the premise and key of surgical resection，osteomalacia imaging，ultrasound，CT and MRI are valuable for the discovery of the disease and positioning.
2017 Vol. 23 (4): 312-332 [Abstract] ( 448 ) HTML (1 KB)  PDF (1118 KB)  ( 652 )
315 The Efficacy of Anatomic Locking Plate and Hook Plate in the Treatment of Unstable Distal Clavicle Fractures
Wang Zhiqiang，Li Shuwei，Liu liang，et al
Objective  To evaluate the clinical and radiologic outcomes of unstable distal clavicle fractures treated with anatomic plate and hook plate.Methods  Between 2013.5 and 2016.1，40 patients with unstable distal clavicle fractures underwent open reduction and internal fixation at our institution with either a clavicular hook plate (27 patients) or a distal clavicular locking plate (13 patients) or a clavicular hook plate (27 patients) were evaluated.The main outcome comparisons included rate of union，rate of complication and the shoulder joint functional which evaluated using Constant and California-Los Angeles (UCLA) scores.Results  Bone union was achieved in all patients.Satisfactory clinical and radiologic outcomes were obtained.Between the patients who used hook plate ［Constant score (87.8±4.9)；UCLA score (30.7±2.8)］and the patients who used locking plate［Constant score (90.2±2.7)；UCLA score (31.8±2.2)］and the patients who used hook plate［Constant score (87.8±4.9)；UCLA score (30.7±2.8)］，there was no statistically significant difference in clinical outcomes of Constant score and UCLA score.However，the results indicated that the locking plate group had a lower rate of complications.Conclusion  Both distal clavicular locking plate and clavicular hook plate achieved good results in the treatment of unstable distal clavicle fractures；however，internal fixation with a distal clavicular locking plate had a lower rate of complications，patients without additional coraclavicular ligament augmentation also achieved satisfactory shoulder functional outcomes.Therefore，anatomic locking plate can be considered the first of the treatment options for unstable distal clavicle fracture.
2017 Vol. 23 (4): 315-318 [Abstract] ( 478 ) HTML (1 KB)  PDF (1229 KB)  ( 387 )
319 Relationship between Hypertension and Osteoarthritis of Knee
Huang Zhi 1，2，Liu Hanlin 2，Wei Lei 1，et al
Objective  To explore relationship between hypertension and joint function of OA.Methods  Clinical data of 104 OA patients with or without hypertension were analyzed retrospectively.Results  the HSS score was significantly lower in OA with hypertension than in simple OA and especially the female cases.Hypertension in OA was significantly positively related to obesity.Conclusion  Hypertension may significantly relate to both occurrence and progression of OA，especially to female’s OA.Hypertension prevention may be useful in reducing future OA risk.
2017 Vol. 23 (4): 319-322 [Abstract] ( 494 ) HTML (1 KB)  PDF (474 KB)  ( 203 )
323 Measurement and Clinical Value of the Knee Joint in Normal People in Beijing
HaoYan，Zhang Shuming，Zhou Mi，et al
Objective  To find the relationship among femoral condyle sagittal transverse diameter ratio，height of patella and posterior tibial slope angle and provide guidance for the selection in size of the femoral prosthesis and posterior condylar osteotomy line arrangements in Total knee arthroplasty.Methods  CT images were scanned，three-dimensional reconstruction was rebuilt and measuredusing HiNet PACS 5 software.According to the different gender and side group，received the measurement data using linear regression，t test and other statistical methods.P value less than 0.05 was defined as statistically significant.Results  The ratio of femoral condyle and sagittal transverse diameter was in the range of 0.80～0.97 obtained from 160 normal knees；The heightof patellarand posterior tibial slope angle：Female group was significantly greater than the male group (P＜0.001 and P＜0.001，respectively)and no significant difference between left and right side (P＞0.05 and P＞0.05，respectively).To obtain the normal linear parameters，the ratio of femoral condyle and sagittal transverse diameter was positively correlated with the height of patella(male，r2＝0.358；female，r2＝0.689，respectively)，while the ratio of femoral condyle and sagittal transverse diameter was not positively correlated to patellar height orposterior tibial slope angle.Conclusion  Chinese knee joint femoral condyle sagittal transverse diameter ratio is relatively larger than the current mainstream foreign femoral condyle prosthesis，and it is positively correlated with the height of patella.However，in TKA increase or decrease the posterior tibial osteotomy angle，cannot change the posterior condylar osteotomy line position and the relative height of patella.
2017 Vol. 23 (4): 323-327 [Abstract] ( 454 ) HTML (1 KB)  PDF (1755 KB)  ( 257 )
328 The Comparative Research of Knees’ Articular Surface Cartilage and Loose Body’s Surface Cartilage Using Fourier Transform Infrared Spectroscopic Imaging
Fan Jiaqiang 1，Yuan Juhui 2，Hao yunjia 1，et al
Objective  To study the difference between articular surface cartilage and loose body’s surface cartilage.Methods  The knees’ articular surface cartilage and loose body’s surface cartilage were collected research objects，using Fourier Transform Infrared Spectroscopic Imaging and Principle Component Analysis to explore the different of the two samples.Results  There was no different in the total PGs content of the two samples calculated by an indirection method.N-H bending vibration wavenumber of collagen in the second derivative peaks (in articular surface cartilage is 1 514 cm－1，in the loose body is 1 516 cm－1) and N-H bending vibration and C-N stretching vibration wavenumber of Amide Ⅱ in the second derivative peaks (in articular cartilage is 1 573 cm－1，in the loose body is 1 575 cm－1) showing up an obvious blue shift.PCA shows that the articular surface cartilage was mainly distributed in the first quadrant，and the loose body was mainly distributed in the three or four quadrant.Conclusion  The component of loose body surface cartilage，especially collagen has some deficient compared with articular surface cartilage.
2017 Vol. 23 (4): 328-332 [Abstract] ( 258 ) HTML (1 KB)  PDF (1168 KB)  ( 295 )
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