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2017 Vol. 23, No. 5 Published: 2017-05-25

	385	MIS-TLIF with Unilateral Fixation versus TLIF with Bilateral Fixation for Lumbar Degenerative Disease：a Prospective Study
		Tang Xiangsheng，Tan Mingsheng，Yang Feng，et al
		Objective To compare the clinical outcomes of MIS-TLIF with unilateral fixation and TLIF with bilateral fixation for lumbar degenerative disease.Methods From June 2014 to December 2015，79 patients with lumbar degenerative disease were treated in our hospital.Patients were divided into two groups according to different surgery methods.36 patients underwent MIS-TLIF with unilateral pedicle screw fixation (unilateral group)，while 43 patients underwent conventional TLIF with bilateral pedicle screw fixation (bilateral group).Operation time，intraoperative blood loss，and postoperative hospital stay were recorded.Pre-and post-operative visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess the clinical outcomes.Results All patients underwent operation successfully.The unilateral group had significantly shorter operation time and less intraoperative blood loss than the bilateral group (P＜0.05).There was no significant difference in postoperative hospital stay between two groups (P＞0.05).Patients were followed up for 12～30 months.There were no significant differences in VAS and ODI scores between two groups before surgery (P＞0.05).After surgery，all the patients underwent significant differences with respect to the improvement of VAS and ODI scores (P＜0.05).At the last follow-up，there were no significant differences in VAS and ODI scores between two groups (P＞0.05). Conclusion Based on this study，MIS-TLIF with unilateral fixation could achievesimilar clinical outcomes to conventional TLIF with bilateral fixation，but resulted in shorter operation time and less intraoperative blood loss.
		2017 Vol. 23 (5): 385-389 [Abstract] ( 393 ) HTML (1 KB) PDF (3704 KB) ( 231 )

	390	Treatment of Primary Spondylodiscitisby One-stage Posterior Debridement，Bone Graft and Pedicle Screw Placement Fixation
		Liu Haiping，Hao Dingjun，Wang Xiaodong，et al
		Objective To evaluate the clinical effects of debridement，bone graft and internal fixation of pedicle screw placement in treating of primary spondylodiscitis through posterior approach.Methods Clinical data of 36 patients with primary spondylodiscitis treated in Honghui Hospital of Xi’an and from January 2013 to June 2015 were retrospectively analyzed.There were 15 males and 21 females with anaverage age of 61 years (range，43～68 years).All patients suffered from single level of spondylodiscitis，including 3 patients at L _2～3 ，11 at L _3～4 ，18 at L _4～5 and 4 at L ₅S₁.All 36 cases underwent one-stage posterior debridement，autogenousilliac bone grafting and internal fixation，tissue samples in focus were collected for bacterial culture and pathological examination during the operation，and then continuously closed irrigation wasapplied for 2～3 weeks postoperatively.Results All patients underwent the surgery successfully.The mean intraoperative estimate blood loss was (368±75) mL ( range，180～550 mL).Results of bacterial culture showed pseudomonas aeruginosa in 1 cases，staphylococcusaureus in 16 case and colibacillosisi in 1 case，with other 27 cases of negative culture results，Pathological results in dicated consistent with the menifestations of acute and chronic inflammation.At 3 weeks after the surgery，procalciton in became normal，an recover of routine bloodtest，erythrocyte sedimentation rate and C-reactive protein presented downtrend.Three months later，all the above lab data came back to norm alvalues.All incisions achieved primary healing.All patients were followed up 6 to 18 months (average，13 months)，and the symptom of pain relieved significantly.No recurrent infection hadhappened.A solid bony fusion was found in all patients after the surgery.Conclusion For patients with primary spondylodiscitis，one-stage posterior debridement，grafting，internal fixation and continuously closed irrigation has the advantages of complete focus clearance，simple and feasible procedures，as well as satisfactory clinical effects，which could avoid reoperationby posterior debridement via bone grafting，fixation and irrigation in one-stage.
		2017 Vol. 23 (5): 390-394 [Abstract] ( 414 ) HTML (1 KB) PDF (1685 KB) ( 418 )

	395	Treatment of Shoulder Dislocation Combined Greater Tuberosity Fractures of Proximal Humerus Under Arthroscopy
		Liu Haiping，Hao Dingjun，Wang Xiaodong，et al
		Objective To evaluate difference of the curative effect between arthroscopic mini-incision therapeutics Herbert nails and open reduction with internal fixation (ORIF) with plate for shoulder dislocation combined large tuberosity fracture of the proximal humerus，and to explore the potential mechanism，so as to provide reliable and effective evidence-based medicine for clinical research.Methods A total of 36 patients with shoulder dislocation combined large tuberosity fracture of the proximal humerus who were treated in our hospital from January 2014 to June 2015 were included in our study and were divided into two groups with arthroscopic mini-incision therapeutics Herbert nails and ORIF with plate.We compared the operation time，inoperative blood loss，hospitalization time and fracture healing time between the two groups，as well as the UCLA score and shoulder joint effect after treatment for 3 months.Results The average operation time，inoperative blood loss and hospitalization time of the Herbert nails under arthroscopy group was significantly better than those of the ORIF with plate group (P＜0.05).Fracture healing time of two groups：The facture healing time of the arthroscopic mini-incision therapeutics Herbert nails under arthroscopy group(9.36±0.64) weeks was shorter than the ORIF with plate group (9.36±0.64) weeks vs (10.22±0.96) weeks；t＝－4.481，P＜0.001).UCLA score after treatment for 3 months of the two groups：The UCLA score for pain and muscle strength of the arthroscopic mini-incision therapeutics Herbert nails group was higher than ORIF with plate group (P＜0.05).There was no significant difference of UCLA score for daily life and satisfaction between the two groups (P＞0.05).There was a significant difference of total UCLA score between the two groups (P＜0.05)；Curative effect of shoulder after treatment of the two groups：The excellent/good rate of the arthroscopic mini-incision therapeutics Herbert nails group was higher than the ORIF with plate group (77.78％ vs 66.11％；χ²=2.429，P＝0.048).Conclusion The arthroscopic mini-incision therapeutics Herbert nails operation is an ideal treatment method for shoulder dislocation combined large tuberosity fracture of the proximal humerus which has advantages of a clear diagnosis，safety-operation，good curative effect，and high dependability，and is worthy to promote in clinical.
		2017 Vol. 23 (5): 395-399 [Abstract] ( 428 ) HTML (1 KB) PDF (1223 KB) ( 419 )

	400	Sartorius Musculoskeletal Flap Transfer for Treating Old Femoral Neck Fracture Among Young Adults
		Wu Jian 1，2，Zhang Tuo 1，Qin Xingxing 1，et al
		Objective To explore the early and medium-term effect of sartorius musculoskeletal flap transfer for treating old femoral neck fracture among young adults.Methods 11 cases (7 males and 4 females) with old femoral neck fracture were admitted to our department from July 2009 to July 2016，with a mean age of 32.8 years old (18～46 years old) and a mean time of injury of 10.3 weeks(8～18 weeks).Injury causes included traffic accident (9 cases) and high falling accident (2 cases).Garden classification was as follows：I (0 case)，Ⅱ(1 case)，Ⅲ(1 case) and Ⅳ(3 cases).All patients underwent open reduction and internal fixation with 3 hollow lag screws through Smith-Petersen approach.A bone groove of 4.0 cm ×1.5 cm×1.0 cm was made with the anterior facture line of femoral neck as the center，then a sartorius muscle iliac flap was transplanted into the groove and fixed with full thread absorbable screws.Anteroposterior and lateral X-ray films of the hip joint were observed to evaluate facture healing and Harris hip score within 3 days，1 month，3 months，6 months，12 months and 24 months after operation，respectively.Results Among the 11 patients，1 patient died in an accident and lost to follow up，while 10 patients were followed up completely，with an average follow-up period of 38.3 months (13～83 months).Femoral neck fracture was healed in these 10 patients，with a mean healing time of 11.2 months (9～15 months).Lateral-superior femoral head collapse was found in 1 patient at 12 month follow-up，with no joint space narrowing.However，due to obvious hip joint pain，the patient underwent total hip replacement.The average Harris scores of the affected hip joint three days，1 month，3 months，6 months，12 months and 24 months after operation were 73.4，76.1，75.3，86.6，89.6 and 90.7，respectively.Conclusion Sartorius muscle blood supply appears to be segmental and vessels can be reserved.It is possible to perform sartorius musculoskeletal flap transfer in order to improve the blood supply of the fracture end and promote the healing of old femoral neck fracture among young adults.
		2017 Vol. 23 (5): 400-403 [Abstract] ( 530 ) HTML (1 KB) PDF (1466 KB) ( 350 )

	404	The Correlation Factor Analysis of Therapeutic Effect and Femoral Head Avasculer Necrosis for Pediatric Femoral Neck Fractures
		Chen Guanghui，Wang Hongwei，Wu qiong，et al
		Objective To evaluate the correlation factor between fracture reduction quality and femoral head avasculer necrosis and therapeutic effect and evaluate correlation factor of femoral head avasculer necrosis.Methods We retrospective analyzed the clinical record of 24 paediatric femoral neck fractures in our hospital from January 2004 to December 2015.All were closed fractures and performed operation.There were Delbet type Ⅰ in 0 case，type Ⅱ in 7 cases，type Ⅲ in 12 cases，Type Ⅳ in 5 cases.Early operation was involved in 11 cases，and delayed operation in 13 cases，respectively.Close reduction were involved in 16 cases，and open reduction in 8 cases，respectively.To evaluate postoperation function with Ratliff grade.Results No incision infection and nerve injury happened.There were femoral head avasculer necrosis in 4 cases，premature physeal closure in 4 cases，leg length discrepancy in 6 cases，cox vara in 4 cases，nonunion in 3 cases and implant failure in 1 case.According to Ratliff grade，there were excellent in 15 case，good in 6 cases，bad in 3 cases，with excellent and good rate of 87.5％.Conclusion Fracture anatomic reduction and firm fixation can improve the clinical effect of pediatric femoral neck fractures.Fracture reduction quality is relevant to femoral head avasculer necrosis，nounion and therapeutic effect.Femoral head avasculer necrosis is relevant to transepiphysis screws and fracture subtype，while independent to operation timing，joint decompression and reduction methods.
		2017 Vol. 23 (5): 404-408 [Abstract] ( 402 ) HTML (1 KB) PDF (2120 KB) ( 353 )

	409	Surgical Treatments of Proximal Femoral Lesions in 158 Cases
		Zhang Junliang 1，2，Zhou Guangxin 2，Fan Gentao 2，et al
		Objective To investigate the diagnosis，treatment and prognosis of lesions in proximal femoral.Methods 158 patients with proximal femoral lesions in our hospital fromJanuary 2001 to December 2014 were analyzed retrospectively.36 cases was diagnosed malignant tumors，and 122 cases was diagnosedbenign lesions.Malignant tumor mainly adopted the extended resection of tumor sections with hip arthroplasty.The surgical treatment of benign lesions mainly took the lesions scraping in addition to graft bone with internal fixation.Aggressive benign tumors received tumor segment resection and prosthetic replacement of hip joint.Results Followed up for 6 to 60 months，with an average of 29 months，19 cases were lost.6 cases of benign lesions developed postoperative recurrence.6 cases of malignant tumorsdied，8 cases appeared local recurrence，6 cases developed pulmonary metastasis.According to ISOLS score，the average score of benign lesion was 25.1，and malignant tumors was 19.7.Conclusion In order to reduce local disease recurrence and improve the patient's hip function and improve prognosis，the surgical treatments should be based on the pathological characteristics and the scope of proximal femoral lesions.Whether benign lesions and malignant tumors，patients could acquiregood hip joint function by surgery.
		2017 Vol. 23 (5): 409-412 [Abstract] ( 374 ) HTML (1 KB) PDF (1135 KB) ( 297 )

	413	Scarf Osteotomy Combined with Distal Soft Tissue Realignment for Moderate to Severe Hallux Valgus
		Jin Wenkuo，Sun Junsuo，Wang Tietao
		Objective To explore the efficacy and discuss the operative technique of Scarf osteotomy combined with distal soft tissue realignment for moderate to severe hallux valgus.Methods We evaluated 46 patients (49 feet) who underwent a Scarf osteotomy combined with distal soft tissue realignment.The mean duration of follow-up was 13 months in all the patients (range，10～17 months).The therapeutic effect was assessed with American Orthopaedic Foot and Ankle Society (AOFAS) before surgery and at the time of final follow-up.The hallux valgus angle(HVA) and intermetatarsal angle (IMA) were measured preoperatively，at six-week postoperative，and at the time of final follow-up.Sesamoid bone position were recorded preoperatively and at the time of final follow-up.All parameters were statistically analyzed with SPSS15.0.Results The AOFAS score improved from 50.03 points preoperatively to 87.18 points at the time of final follow-up.Mean preoperative HVA decreased from 29.43° degrees preoperatively to 12.79° degrees at the sixweek postoperative and was maintained at last follow-up at 13.51° degrees.The mean IMA decreased from 15.29° degrees preoperatively to 5.74° degrees at the six-week postoperative and regressed mildly at last follow-up to 7.81° degrees and sesamoid bone position) showed significant (P＜0.05) improvement at the time of final follow-up compared with preoperative.There was a mean loss of correction of the IMA of 2.07° degrees ，Although these regressions between the six-week postoperative and last follow-up radiographs were statistically significant，it did not result in functional impairment or consequences for quality of life.Conclusion Scarf osteotomy combined with distal soft tissue realignment is an ideal operative treatment for hallux valgus，can achieve a Satisfied short-term clinical outcomes.
		2017 Vol. 23 (5): 413-425 [Abstract] ( 423 ) HTML (1 KB) PDF (847 KB) ( 282 )

	416	Prevention and Treatment of Lower Extremity Deep Venous Thrombosis after Spinal Surgery in Adults
		Wang Donghai，Xin Wenhua，Zhu Yong，et al
		Objective To evaluate the safety and validity of layered measures in protecting spine surgery patients from deep venous thrombosis.Methods A total of 714 patients were recruited who had managed in the second affiliated hospital of Inner Mongolia medical university for spine surgery from 2015.03 to 2016.03.All cases were assessed the thrombosis risk factors according to Caprini criteria and guarded layered against thrombosis on the basis of VTE.Preventive measures comprised the physical prevention，including grading pressure stretch hose (thigh-length thromboembolic deterrent stockings，TEDS) and intermittent pneumatic compression devices (pneumatic sequential compression will device，PSCD)，and drug prevention with use of low molecular heparin intramuscular injection.Lower extremities vascular doppler ultrasound was performed prior to operation and on the day patients were enough to walk after surgery (people unable to walk was performed after 7～14 day of surgery) in order to evaluate for deep vein thrombosis.Postoperative flow and drainage of liquid color were monitored as well，whether having the incision hematoma，errhysis，whether epidural bleeding induced nerve injury symptoms and low molecular heparin induced thrombocytopenia occur were observed and recorded simultaneously.Results 714 cases of spinal surgery patients (8 cases of combined spinal cord or cauda equina nerve damage.) were inspected using the double lower extremities vascular doppler ultrasound and DVT occurred in 16 cases，incidence of DVT was 2.24％.According to the Caprini score，there was one case suffering from DVT in 119 patients of high-risk group (0.08％)，and 15 DVT cases in 594 patients of very high risk group (2.53％).No patients had pulmonary embolism (PE).The thrombus were all Peripheral ones，rather than hybrid and central thrombus，that included one popliteal venous thrombosis case(0.14％)，3 posterior tibial vein thrombosis case (0.42％)，and 2 venous thrombosis cases (0.28％)，10 muscular venous thrombosis cases (1.40％).DVT occurred on the left leg in 10 cases，right leg in 5 cases and double lower limbs in 1 case，in 9 cases of male and 7 cases of female by gender.12 cases had typical clinical symptoms and signs and 4 cases were symptomless.Results of postoperative 3 months doppler ultrasound showed the recanalization in all DVT cases.The incision errhysis occurred in 4 cases，incision hematoma in 1 case，epidural hematoma，low molecular heparin induced thrombocytopenia did not appear.Conclusion Caprini scale was taken to spinal postoperative VTE risk classification and individualized prevention according to the grading.All patients with spine surgery take physical prevention combined with anticoagulation drugs to guard against VTE.The results revealed that incidence of DVT was comparatively lower and main type was less dangerous plexus venosus leg muscle thrombosis.In the research，incision errhysis occurred in 4 cases，incision hematoma in 1 case.Besides，no epidural bleeding induced nerve injury symptoms and low molecular heparin induced thrombocytopenia happened.Therefore，we can preliminarily consider the preventive solution of this research to be a safe and effective therapy in postoperative thromboembolism prophylaxis for spinal surgery patients.
		2017 Vol. 23 (5): 416-421 [Abstract] ( 338 ) HTML (1 KB) PDF (472 KB) ( 420 )

	422	The Establishment and Clinical Significance of Prevention and Treatment Network for Adolescent Scoliosis in Zhongshan City
		Li Jia 1，Li Qing 1，Jin Dadi 2，et al
		Objective To explore the results and clinical significance of prevention and treatment network had exerted to integrated control for adolescent scoliosis.Methods From June 1997 to June 1998，18 329 students between 7 to 15 years old in 26 primary and junior middle schools were checked for scoliosis with three steps，and we established prevention and treatment network for adolescent scoliosis which consists of hospital，school and family.We establish archives for those with positive results，and then add them to adolescent scoliosis dynamic database.According to Cobb angle，underwent scoliosis knowledge learning，gymnastics，traction，braces，surgery and other treatment methods，and strictly followed-up.Results A total of 594 cases were investigated since 1997，and 533 cases were followed up，with 61 cases missed.The children whose Cobb’s angle ≥5° were separated into four groups：5°≤Cobb’s angle＜10°，10°≤Cobb’s angle＜20°，20°≤Cobb’s angle＜40°，Cobb’s angle≥40°，and then were treated with scoliosis knowledge learning，gymnastics，traction，braces or surgery respectively.This management strategy was named to step treatments.The rates of the worse of disease were 2.60％，6.55％ and 5.43％ in former three groups respectively.The last group underwent operations and achieved satisfactory results.Conclusion Prevention and treatment network for adolescent scoliosis can control the progression of scoliosis effectively.
		2017 Vol. 23 (5): 422-425 [Abstract] ( 282 ) HTML (1 KB) PDF (477 KB) ( 248 )

	426	Establishment of Novel Artificial Cervical Disc Goat Model and Related Study
		Lou Jigang1，Liu Hao1，Wu Wenjie2，et al
		Objective To observe the effect of novel domestic-made artificial cervical disc in vivo with goat model，in order to provide an experimental basis for further improvement and clinical application.Methods 12 male experimental goats underwent C_3～4 novel domestic-made artificial cervical disc replacement.All the goats were examined preoperatively and postoperatively on anteroposterior and lateral radiographs.The disc height (DH)，intervertebral angle (IVA) and functional spinal unit (FSU) lordosis angle were measured and analyzed statistically.Results All experimental goats survived after operation，without incision infection and paralysis.Hoarseness occurred in one goat the second day after operation，and disappeared one week later.Statistical comparison in DH，IVA and FSU lordosis angle at C_3～4 segment showed no significant difference among different time points.Conclusion Novel domestic-made artificial cervical disc system is easy to operate，has less complications，and can maintain the postoperative disc height and cervical spinal curvature well.
		2017 Vol. 23 (5): 426-429 [Abstract] ( 406 ) HTML (1 KB) PDF (1662 KB) ( 232 )

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