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2017 Vol. 23, No. 7
Published: 2017-07-25
 
577 Locking Plate Internal Fixation for Adult NeerⅣ Proximal Humerus Fracture and Clinical Effect
Wu Jinhua，Duan Xiaoliang，Wang Haiyun，et al
Objective  To discuss the methods of reduction，fixation，and postoperative recovery in the treatment for adult Neer Ⅳ proximal humerus fracture using the locking plate internal fixation，and to observe the treatment effect.Methods  The open reduction and locking plate internal fixation were used to treat adult Neer Ⅳ proximal humerus fractures.This treatment had been used in 26 cases，in which 18 cases were associated with humeral head dislocation.In the operation，the junction between the deltoid and the pectoralis major was exposed.Then based on the integrity of soft tissues like the shoulder articular capsule，the extracapsular reduction method or intracapsular reduction method was adopted.We restored the dislocated humeral head to its normal position.Then fractures were reducted based on circumstances such as bone displacement.K-wires were usedfor temporary fixation.We placed the anatomical lock plate at the lateral sideof proximal humerus to fix the fracture.After operation，patients underwent strict rehabilitation training under the therapist's guidance.Results  Follow-up of patients ranges from 12 months to 5 years with anaverage of 38 months.Among them，three patients hadmuscular atrophy in the shoulder.And the shoulder was not of good shape.Allshoulder joints have recovered in 12 weeks after operation excepttwo.No patients suffered from shoulder joint re-dislocation or nonunion.Humerus height loss occurred in four cases.In one case，the humeral head screw protruded from the articular surface.In two cases，patients developed humeral head ischemic necrosis respectively after six months and 15 months.The necrosis rate was 7.69％.In the last follow-up，ASES rates of the 26 patients ranged from 62 to 100 with an average of 92.8；and their Constant-Murley rates range from 68 to 100 with an average of 91.9.According to the Neer results，18 cases were rated excellent，6 good，1 ordinary，and 1 poor.The rate ofexcellent and good were 92.3％.Conclusion  Adult Neer Ⅳ proximal humerus fractures are mostly caused by high energy injuries，and usually with high rate of associated humeral head dislocation.The treatment of open reduction and locking plate internal fixation ensure favorable prognosis.Treatment effect is affected by several factors，such as the fracture degree，operation process，and rehabilitation training.A relatively higher location of the major tubercle of humerus causes the shoulder collision injury，which will has long-term impact on extension and upward movement of the shoulder joint.Underestimation of reconstruction of the proximal humerus medial pillar may cause humeral head varus and sink after operation.The arthralgia of the humeral head ischemic necrosis is less severe comparing to that of the femur head of lower limbs.And the humeral head ischemic necrosis is not necessarily the cause of shoulder joint malfunction.
2017 Vol. 23 (7): 577-582 [Abstract] ( 482 ) HTML (1 KB)  PDF (1990 KB)  ( 384 )
583 Extra-Articular Tibia Vara Affects Radiological Outcome of Total Knee Arthroplasty
He Qiang，Ma Jianbing，Sun Xiangxiang
Objective  Tibia Vara is an extra-articular deformity，in which the development of medial proximal tibial growth is retarded because of dysplasia.Our objective is to measure tibial varus angle in patients with knee osteoarthritis，to analyze the proportion of patients with tibial varus deformity in patients with knee osteoarthritisand to investigate the effect of tibial varus deformity on the component alignment and clinical outcomes after total knee arthroplasty.Methods  We retrospectively reviewed and selected sixty adult patients with varus knee osteoarthritis underwent TKA between from August 2015 to December 2015.The patients were divided into two groups as the tibia vara group and the non-tibia vara group.Two surgeons measured the tibia vara angle (TVA) and Hip knee ankle angle (HKA) in preoperative radiography.All patients were also recorded with the American Knee Society score and WOMAC score preoperatively.After surgery，the HKA and medial proximal tibia angle (MPTA) were measured in long-standing radiography.Patients' KSS score and WOMAC score were also recorded.Results  The mean TVA was (0.69±0.44)° in non-tibia vara group，while the mean TVA was (2.53±0.56)° in tibia vara group.The mean TVA in all patients was (1.12±0.52)°.Nine patients (20％) had TVAs of 0° in in non-tibia vara group.Fourteen patients (100％) had TVAs of more than 2° in tibia vara group.All patients in tibia vara group had TVAs of more than 2 degree.14 out of 60 patients (23.3％) had of more than 2 degree.The mean HKA was (178.8±1.5)° in non-tibia vara group，while the mean HKA was(177±2.0)°in tibia vara group.After TKA，two patients (4.3％) had HKA Outlier in non-tibia vara group，but three ones(21.4％) had HKA Outlier in tibia vara group.The mean range of motion (ROM) was (112.0±11.5)° in non-tibia vara group，while the mean ROM was (105±8.0)° in tibia vara group.The mean WOMAC score was (15.6±3.2) in normal group，while the mean WOMAC score was (16.8±4.0) in tibia vara group.The mean KSS function score was (92.5±3.5) in normal group，while the mean KSS function score was (94.0±2.4) in tibia vara group.Conclusion  23.3％ patients of Chinese female people scheduled for TKA had tibia vara (TVA≥2°).The mean TVA in female patients with knee arthritis was (1.12±0.52)°.An TVA greater than 2 degree was found to have a statistically significant influence on postoperative MPTA.Accurate proximal tibial cutting and tibial component lateralized is suggested，if the degree of tibia vara is considable significant.
2017 Vol. 23 (7): 583-588 [Abstract] ( 434 ) HTML (1 KB)  PDF (1966 KB)  ( 266 )
589 Clinical Observation of External Fixation in the Treatment of Tibia and Fibula Gustilo Ⅲ Fractures
Zhang Futian，Zhao jie，Zhang Rongfeng，et al
Objective  To observe the clinical effect of different types of external fixation in the treatment of tibia and fibula with Gustilo Ⅲ fracture.Methods  From January 2012 to 2015 January，22 cases of Gustilo-type Ⅲ fractures with bone defects were treated in our hospital.All patients wounds were thoroughly debrided and fractures were given a semi-circular external fixation.Residual woundsweretreated with skin flap，skin grafting，local soft tissue.Ilizarov circular external fixators were used to fix fracture.Osteotomy and bone lengthening wereused to treat bone defect.Results  All of the 22 patients were followed up.The follow-up time was 16 to 36 months (average 20 months).17 patients withbone lengtheninggot boneunionwithoutoperation.In 5 cases of patients with malalignment，external fixationwas removed andpatients underwent bone grafting and plate fixation.All the patients gotbone union.According to the Johner-Wruhs score，there were 18 cases of excellent，3 cases of goodand poor in 1 cases，the excellent and good rate was 95.5％.Conclusion  External fixationcan effectively protect the soft tissue blood supply and reduce the secondary injury，which isconsistent with trauma control theory.It can alsopromote the recovery of limbs and functional reconstructioninbone defect of tibia and fibula of Gustilo Ⅲ.It is an ideal fixation method for the treatment of Gustilo Ⅲ fractures.
2017 Vol. 23 (7): 589-592 [Abstract] ( 393 ) HTML (1 KB)  PDF (2114 KB)  ( 223 )
593 Clinical Experience of Prothesis Retention Debridement and Rifampicin in Early Low Toxicity Infection after Arthroplasty
Tang Miao，Tang Ruixin，Zhou Ye，et al
Objective  To explore the effectiveness and safety of prothesis retention debridement and rifampicin in early low toxicity infection after arthroplasty.Methods  We made a retrospective analysis on 12 patients with an initial low toxicity infection after arthroplasty in our hospital from February 2010 to February 2016.Among them，there were 4 male patients and 8 female patients.They aged from 65 to 75 with an average of 70.There were four patients with an infection after a total hip replacement and eight patients with an infection after a total knee replacement.The infection appears from the seventh day to one month after the replacement.Three patients with fistula and three patients with an acute infection underwent prothesis retention debridement，and they were treated with antibiotics for a week according to the results of drug sensitivity results.Then they took 300 mg of rifampicin and 500 mg of ciprofloxacin twice a day for six months.The other six patients were treated with rifampicin andotherantibioticsaccording to the results of drug sensitivity results.If the results were not good，they would have a prothesis retention debridement again and then have a rifampicin combination therapy.All patients were followedup，and follow-up visit period ranged from 6 to 27 months with an average of 24 months.Follow-up observation included：blood cell counts，blood sedimentation，C-reactive protein，liver function and imaging data，joint motion degree and joint function.The cure standard included the foll：There was no clinical infection；blood sedimentation was less than 20 mm/h，C-reactive protein was less than 5 mg/L or it significantly reduced and returned to normal；joint pain decreased or disappeared；range of joint motion was good.Results  One patient had prosthesis failure in the therapeutic process.After accepting the joint revision，the patient was cured.The other 11 patients finished 6 months treatment.9 of them were cured successfully，but 2 of them failed.The overall cure rate was 81.8%.The infection was controlled.Conclusion  Prothesis retention debridement and rifampicin in the treatment of early low toxicity infection after arthroplasty have a certain clinical efficacy and safety，which provides a certain reference value for the treatment of early low toxicity infection after arthroplasty.
2017 Vol. 23 (7): 593-596 [Abstract] ( 368 ) HTML (1 KB)  PDF (1059 KB)  ( 311 )
597 Artificial Mesh in Malignant Bone Tumor Resection and Prosthesis Replacement
Li Lizhi，Lü Zhi
Objective  To explore the application of the artificial mesh in reconstruction of the joint capsuleand soft tissue in the case of malignant bone tumor treated with wide resection and prosthesis replacement.Methods  From Jun 2012 to Apr 2017，21 cases of malignant tumor near shoulder，hip and knee joint were treated by reconstruction surgery with prosthesis replacement.The surgical procedure was regional wide resection and prosthesis replacement with joint capsule reconstructed by artificial mesh.All cases were followed up after operation.The clinical results were evaluated post-operatively.Results  There were 12 males and 9 females，age from 14 to 78 years.There were 3 tumorsin acetabulum，4 in proximal humerus，11 in proximal femur and 3 in proximal tibia.5 of themwere secondary lesions and 16 were primary malignant bone tumors.All patients were followed up for 32 months，ranging from 9 to 54 months with well-healed incisions.The drainage of less than 50ml-24h was the indication to pull out the drainage tube.No infection or dislocation occurred.At the last follow up，all patients were satisfied with the results of surgery.Conclusion  The artificial mesh plays an important role in increasing the stability of joints after prosthesis replacementand improving the function of reconstructed soft tissues after wide resection.Satisfactory results has been obtained.
2017 Vol. 23 (7): 597-599 [Abstract] ( 316 ) HTML (1 KB)  PDF (1377 KB)  ( 325 )
600 Comparison of ACDF with Zero-P and Cages with Plate in Treatment of Multiple-level Cervical Spondylosis with Cervical Kyphosis
Zhang Zaiheng 1，Li Yujie 1，Wang Yongfeng 2，et al
Objective  To evaluate the clinical outcomes and complications of ACDF with Zero-P and cages with plate in treating multiple-level cervical spondylosis (MCS) with cervical kyphosis.Methods  Clinical data of patients with MCS caused by degenerative disc herniation were retrospectively analyzedfrom August 2012 to March 2016.Clinical parameters including Japanese orthopedic association (JOA)score，neck disabled index(NDI) and visual analogue scale(VAS) were evaluated.The orthopaedic effect of Zero-P and cages with plate were investigated according to changes of the cervical Cobb angle and intervertebral space height.Results  All patients were followed up for an average of 24.7 months in Group A and 25.2 months in Group B.45 cases of patients’ main symptoms were significantly reduced.There was no serious complications.Postoperative symptoms improved with time.The JOA score，the VAS score，the NDI index，the cervical intervertebral height and the Cobb angle one month after operation and during last follow-up were improved significantly compared with the preoperative data.The differences were statistically significant(P＜0.05) in Group A and Group B.But the differences between Group A and Group B were not statistically significant(P＞0.05).Conclusion  Based on the follow-up，Anterior cervical decompression and fusion with Zero-P and cages with plate could achieve good effect in treating multilevel cervical spondylotic myelopathy with kyphosis.
2017 Vol. 23 (7): 600-608 [Abstract] ( 429 ) HTML (1 KB)  PDF (1535 KB)  ( 275 )
604 Osteonecrosis of Femur Head after Femur Neck Fracture with the Treatment of Internal Fixation and Sartorius Iliac Flap Transplant
Cheng Genxi
Objective  To explore factors related to occurrence of osteonecrosis of femur head after femur neck fracture with the treatment of hollow screws and sartorius iliac flap transplant.Methods  A total of 113 patients of femur neck fractures treated by hollow screws and sartorius iliac flap transplant between February 2005 and January 2015 were analyzed in our hospital.Patients were divided into non-osteonecrosis of femur head group and osteonecrosis of femur head group according to the occurrence of osteonecrosis of femur head at last follow-up.According to clinical information and imaging data，we selected some factors such as gender，age，time from injury to operation，Garden type of fracture，operation time，quality of reduction，weight bearing time and removal of screws，which may affect the occurrence of osteonecrosis of femur head after operation.The selected factors were grouped and assigned.After excluding unrelated factorsby one-way chi-square test analysis，multivariable Logistic regression ereused to analyze the data.Results  113 patients were followed up for 23～105 months.A total of 23 patients had osteonecrosis of femur head occurred at last follow-up.After one-way chi-square test analysis to the above 8 factors，there was statistic significance between groups about Garden type of fracture，operation time and quality of reduction(P＜0.05)，and there was no statistic significance about other factors(P＞0.05).Multiariable Logistic regression analysis showed，Garden type of fracture was the independent influencing factor for occurrence of osteonecrosis of femur head after femur neck fracture with the treatment of hollow screws and sartorius iliac flap transplant.Conclusion  Type of fracture after injury initially affectsoccurrence of osteonecrosis of femur head after femur neck fracture with the treatment of hollow screws and sartorius iliac flap transplant.Reduction at the first time and reduced operation timecanimproving quality of reduction and reduce the rate of occurrence of osteonecrosis of femur head.
2017 Vol. 23 (7): 604-608 [Abstract] ( 307 ) HTML (1 KB)  PDF (1675 KB)  ( 233 )
609 Repair of Pathological Bone Defect with Autogenous Fibula Graft
Pang Jiasheng，Xie Weining，Lihua
Objective  To observe the application and long-term efficacy of autologous fibula graft in the treatment of pathological bone defect.Methods  From May 2008 to July 2015，23 patients with pathological bone defect were treated.There were 14 males and 9 females，aged 0.5～72 years old，with an average of 22 years old.7 patients were treated with vascularized fibula graft and 16 patiemts without vascular graft.5 patients with iliac bone graft；2 patients with allograft bone transplantation；1 patients with iliac bone and artificial bone graft.Results  20 patients were followed up for 5～84 months (mean 24.7 months).X-ray examination showed that 17 graft survived and restored limb function.Bone healing time was 3～39 months.There were 3 patients with bone graft not survived.Conclusion  Autologous fibular grafting is an ideal treatment for repairing pathological bone defects.
2017 Vol. 23 (7): 609-611 [Abstract] ( 390 ) HTML (1 KB)  PDF (1089 KB)  ( 288 )
612 Finite Element Analysis of Intraoperative Cervical Sustained Traction
Lin Lei，Wu Wei，Li Banruo，et al
Objective  To investigate the safety of using cervical sustained traction during cervical operation.Methods  High resolution CT(SOMATOM Definition，Munich，Germany) scan was performed with a healthy adult female volunteer，and data was preserved with DICOM format.The 3D CT model of cervical spine was built with commercially 3D reconstruction software(Mimics17.0 Materialise，Leuven，Belgium).We used the model optimizing software(Catia V5R20，Paris，French) to optimize the mesh and preserved with STL format and the finite element analysis software (Abaqus6.13，Rhode Island，America) to preform finite element analysis.A 10 Nm pure motion was applied to the intact and reconstruction model with neutral，flexation and extension position.Cervical sustained traction (from 50N to 300N) was applied to the model with different position，and the length of cervical canal，transverse diameter and sagittal diameter of each cervical vertebra levels were measured.Results  With the increasing of the cervical sustained traction，the biggest increment of length of cervical canal was in extension，and the smallest was in neutral position；the transverse diameter and sagittal diameter of each cervical vertebra levels were both decreased.The mostly decrease of transverse and sagittal diameter was in extension position and least was in neutral position.With 50N sustained traction in neutral position，the length of cervical canal was increased to 1.76％，compared with the flexation and extension position without any traction.The transverse diameter of each cervical vertebra levels were smaller than it in flexation condition，and bigger than it in extension condition except C6 plane，the sagittal diameter every cervical vertebra plane was the smallest compared with others among these three curvatures，but its increase/reduce value was all less than 1mm.Conclusion  With small cervical sustained traction，there is no dangerous of spinal cord injury due to cervical cord stretching or spinal canal stenosis aggravating during the cervical surgery.The traction is a safe and practical method.
2017 Vol. 23 (7): 612-617 [Abstract] ( 348 ) HTML (1 KB)  PDF (3121 KB)  ( 260 )
618 Anti-inflammatory and Analgesic Mechanism of Extracorporeal Shock Wave on Musculoskeletal Pain
Zhou Diyuan 1，Tao Huihong 2，Yang Yaoqing 2，et al
Objective  In recent years，attention to non-invasive shock wave therapy which characteristic of fewer side effects and its application in the treatment has increased，this paper intends to explores the mechanisms of extracorporeal shock wave therapy for bone and joint and muscle pain；the function and transformation of Inflammatory during treatment.Methods  Forty male Sprague-Dawley rats were randomly divided into normal control group，model control group，experimental group 1 and experimental group 2，10 rats in each group.By comparing the time of inflammation resolution and swelling extent，serum levels of inflammatory factors，inflammatory cells in tissue sections to study the mechanism of shock wave in anti-inflammatory and analgesia.Results  The shock wave therapy could alleviate local inflammation，alleviate inflammatory exudation and infiltration of inflammatory cells，improve symptoms，relieve pain，and do no obvious damage to local tissue.It may be related to the increase of anti-inflammatory analgesic factor and the decrease of Inflammatory factor.Conclusion  Extracorporeal shock wave therapy alleviate local inflammation and accelerate the dissipation of inflammation which improve symptoms，reduce pain.The mechanism may be related to promote β-endorphin production，inhibition of PGE2，5-HT and other pain factor release and Nitric oxide is also play an important regulatory role in therapy，but it’s mode of action is not clear.
2017 Vol. 23 (7): 618-625 [Abstract] ( 452 ) HTML (1 KB)  PDF (1080 KB)  ( 398 )
640 Analysis of Risk Factors for Chronic Infection after Total Hip Arthroplasty
Pu Chuancheng，Ran Xuejun，Qin Zhiyong
Objective  To analyze the risk factors of chronic infection after total hip replacement，and to provide more reference for reducing postoperative infection rate.Methods  A retrospective analysis was made in 1021 patients of joint hip arthroplasty from January 2012 to June 2016 in our hospital.The patients of postoperative chronic infection was the observation group，and the patients with no postoperative chronic infection was the control group.Gender，age，operation time，blood glucose，surgery the content of hemoglobin，preoperative serum albumin and other factors of the patients were compared and statistical analyzed.Results  13 cases of chronic infection in 1021 patients after total hip arthroplasty.The postoperative infection rate was 1.27％.13 strains of bacteria were detected as follows: Staphylococcus aureus (38.46％)，Escherichia coli (23.07％)，Pseudomonas aeruginosa (15.38％)，Staphylococcus epidermidis ( 7.69％)，Klebsiella pneumoniae (7.69％)，Candida albicans (7.69％).The risk factors of chronic infection after total hip replacement were mainly operative time，blood glucose，hemoglobin content，preoperative preoperative serum albumin (P＜0.05).After multivariate Logistic regression analysis，the patient's operation time，blood glucose，preoperative hemoglobin and preoperative serum albumin were the risk factors of infection after artificial hip replacement.Conclusion  There are many risk factors for hip arthroplasty after a chronic infection，including patients age，operation time，preoperative serum albumin.Effective preventive measures should beusedaccording to the risk factors in order to reduce the incidence of chronic infection.
2017 Vol. 23 (7): 640-642 [Abstract] ( 422 ) HTML (1 KB)  PDF (376 KB)  ( 237 )
665 Risk Factors Research for Hidden Blood Loss after Percutaneous Kyphoplasty
Lu Haibo，Liu Liqun，Wu Changming
Objective  To examine the amount of hidden blood loss and determine its relative influential factors after percutaneous kyphoplasty.Methods  We retrospectively analyzed 124patients of thoracolumbar vertebral compression fracturetreated withPKP from June 2012 to June2016 inLiaoyang CentralHospital.The amount of hidden blood loss was Calculated.The influential factors on hidden blood loss analyzed included gender，age，body mass index，the degree of vertebral compression，the degree of vertebral body restoration，number of treated fracture levels，bone mineral density，bone cement leakage and internal diseases (diabetes，hypertension).Results  The mean amount of hidden blood loss was (304±171)mL.The degree of vertebral compression，the degree of vertebral body restoration，number of treated fracture levels，bone mineral density，bone cement leakage were significantly associated with the amount of hidden blood loss (P＜0.05).Gender，age，body mass index，diabetes，hypertension were not significantly associated with the amount of hidden blood loss(P＞0.05).Conclusion  Hidden blood loss cannot be ignored，especially for multiple injuries patients and the elderly with poor physical condition.Having a correct understanding of hidden blood loss can help ensure patients’ safety in perioperative period.
2017 Vol. 23 (7): 665-667 [Abstract] ( 288 ) HTML (1 KB)  PDF (383 KB)  ( 213 )
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