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2017 Vol. 23, No. 12
Published: 2017-12-25
 
1057 Surgical Treatment of Rheumatoid Arthritis in Cervical Spine
Yang Ruifeng 1，2，Tan Junming 2
Objective  To summarize the clinical experience of the surgical treatment for rheumatoid arthritis (RA) of cervical spine.Methods  Sixteen patients who underwent surgical treatment for cervical spine of rheumatoid arthritis between June 2012 and June 2015 were enrolled in this retrospective study.All patients were cervical vertebral instability by imaging findings into AAS，VS，SAS.Including 9 cases of reducible atlantoaxial subluxation patients were treated with posterior approach fusion with graft and intenal fixation，2 patients with irriducible atlantoaxial dislocation were treated with occipitocervical fusion.Occipitocervical fusion was performed in 1 patient，posterior atlantal arch excision was performed in 1 patient.One irriducible atlantoaxial dislocation were treated with microscopic transoral approach C1～2 screw fixation，1 irriducible atlantoaxial dislocation(IAAD) were treated with navigation aided microscopic transoral approach combine with ventral decompression onestage C1～2 posterior approach fusion with graft and intemal fixation，1 case of SAS secondary to AAS underwent multiple segment fusion and internal fixation.2 patients with VS were treated with occipitocervical fixation，1 routine foramen magnum decompression and internal fixation.2 subaxial subluxations (SAS) patients underent multiple segmental fixation fusion.There were 2 men and 14 women with an average age of (55.8±4.3) years (range，41～65 years).The average course of disease was (15.7±2.8) years (range，11～20 years).Pain was evaluated by Visual Analogue Scale (VAS) scores before and after surgery.Ranawat grading scale，Japanese Orthopaedic Association (JOA) scores，posterior atlantoodontoid interval(PADI)，cervicomedullary angle(CMA)were used to determine myelopathy.Clinical and radiological data were collected before surgery，at 3 and (or) 6 months after surgery，and at final follow-up.Results  Patients were followed up for 3～36 months (23.2±3.6 months)，15 cases of had a significant neurological improvement，1 cases have no improvement but also no nerve damage aggravated，16 cases of postoperative patients with odontoid pannus around a preoperative decrease.Solid fusion was confirmed by CT in all cases.No internal fixation loosening and fracture，spinal cord and nerve root and vertebral artery injury，adrenocortical crisis happened.Conclusion  Individualized surgical planning should be adopted in patients with RA in upper cervical spine，which can effectively slow down the damage process cervical inflammation of rheumatoid arthritis，improve clinical outcomes，improve the quality of life.
2017 Vol. 23 (12): 1057-1061 [Abstract] ( 342 ) HTML (1 KB)  PDF (1270 KB)  ( 293 )
1062 3D Printing of Individual Navigation Templates Assisted Lumbar Pedicle Screw in the Treatment of Spondylolis Thesis Effect
Chen Jiahua，Deng Ye，Cai Zhi，et al
Objective  To explore the effect of 3D printing individualized navigation template in the treatment of lumbar spondylolisthesis with lumbar vertebral pedicle screw placement.Methods  60 cases of lumbar spondylolisthesis admitted to our hospital from March 2013 to March 2015 were randomly divided into the observation group (30 cases) and the control group (30 cases).The control group used the traditional three-dimensional CT reconstruction image before operation to make the operation plan，and the observation group used the 3D printing technique to make the operation plan before operation.Comparison of two groups of patients with operation time and blood loss，preoperative and postoperative 3 months，6 months after surgery，postoperative spinal cord function 12 months Japan Association (Japanese Orthopaedic Association，Department of orthopedics，JOA) score，visual analogue scale (visual analogue scale，VAS) of complications and postoperative changes.Results  The operation time of the observation group was shorter than the control group，and the bleeding was less than the control group (P＜0.05)；add 12 months JOA score of two groups after 3 months and 6 months after surgery，postoperative (P＜0.05)；the JOA score of the observation group after 3 months and 6 months after surgery，surgery after 12 months was higher than the control group (P＜0.05)；reduced 12 months VAS score of two groups after 3 months and 6 months after surgery，postoperative (P＜0.05)；the VAS score of the observation group after 3 months and 6 months after surgery，12 months after the operation was lower than that of control group (P＜0.05)；the incidence of complications was lower than control group patients in the observation group，but the difference was not statistically significant (P＞0.05).Conclusion  3D printing individualized navigation template assisted lumbar pedicle screw placement in the treatment of lumbar spondylolisthesis is significant and worthy of study.
2017 Vol. 23 (12): 1062-1065 [Abstract] ( 273 ) HTML (1 KB)  PDF (2734 KB)  ( 310 )
1066 Modified Mini-open Latarjet Procedure for Recurrent Anterior Shoulder Instability
Lai Junhui 1，Jiang Tao 2，Huang Yongquan 2，et al
Objective  To evaluate the results of modified mini-open Latarjet procedure for recurrent anterior shoulder dislocation.Methods  From January 2012 to December 2014 there are 14 patients，including 11 males and 3 females(4 left and 10 right)ranged from 19 to 43 years old with an average of 25.1 years old.The modified mini-open Latarjet procedure were performed for patients with anterior shoulder instability.The X-ray film and CT scan were repeated at the end of the final follow-up to find out if there was any progression of the degenerative change of the glenohumeral joint and if the transferred coracoid process united.The clinical effects were evaluated according to Constant-Murley scores and VAS scores.Results  The average duration of the follow-up ranged from 12 to 36 months with an average of 22.8 months.The skin scare ranged from 4.5 to 6.5 cm with an average of 4.9 cm.According to the CT scanning at the final follow up，the graft was as at the same level of the glenoid in 92.86％ of the patients.Vertical positioning was perfect in 100.0％.The Constant-Murley scores were from 87 to 100 with an average of 94.7.The VAS score was from 0.5 to 2.0.There were no cases of recurrent dislocation or subluxation，graft fractures and the screw loosened.Conclusion  The modified mini-open latarjet procedure has shown satisfactory results with good graft positioning and minimal complications.
2017 Vol. 23 (12): 1066-1077 [Abstract] ( 391 ) HTML (1 KB)  PDF (1453 KB)  ( 291 )
1069 Comparison of Early Effect between Primary Total Hip Arthroplasty through Two Approaches
Hu Lianying，Jia Qiyu，Cao Yi，et al
Objective  To compare the early clinical effects of anterolateral and posterolateral surgical approaches in primary total hip arthroplasty(THA).Methods  Between February 2012 and February 2015，76 cases of primary THA were treated by posterolateral surgical approache (PSA).Among them，there were 34 males and 42 females，aged 62 to 78 years with an average of 68.5 years.Another 64 cases of primary THA were treated by anterolateral surgical approache(ASA) at the same period.Among them，there were 33 males and 31 females，aged 50 to 79 years with a mean of 70.5 years.Incision length，operation time，blood loss，postoperative lead flow，time to exercise and postoperative hospitalization time were analysed and compared between two groups.The Harris hip score was used to evaluate and compare hip functions and complications before operation，6 months after operation and the latest follow up between two groups.Results  All the patients were followed up and the duration ranged from 10 to 48 months (averaged 25.5 months).1 case in PSA group had delayed infection and received revision 18 months after primary THA.2 cases dislocation were observed in PSA group and underwent manipulative reduction.There was no infection and dislocation case in ASA group.There were no significant differences of the blood loss volume and the postoperative drainage between the two groups(P＞0.05).But the operation time 、 the incision length 、the time to exercise and the postoperative hospitalization time of the PSA group were longer than the ASA group (P＜0.05).No significant difference was found in the Harris score between the two groups before operaiton ［PSA group(42.43±7.25)，ASA group (41.72±6.98)，P＞0.05］、6 months after operation ［PSA group(87.90±7.36)，ASA group (90.20±8.05)，P＞0.05］and the last follow up ［PSA group(90.30±8.24)，ASA group (92.50±9.20)，P＞0.05］.Conclusion  Primary THA through the two approaches(PSA and ASA) can achieve favorable short-term effectiveness.Compared with THA through PSA，THA through ASA need a relatively short operation time and with a relatively small incision.The patients can get out of bed earlier，thus reduce the complications and shorten the hospitalization time.It has advantage about prevention of postoperative dislocation.
2017 Vol. 23 (12): 1069-1081 [Abstract] ( 313 ) HTML (1 KB)  PDF (1299 KB)  ( 296 )
1073 Case Control Study on Proximal Femoral Cannulated Screw Locking Plate Compressed by Cannulated Compression Screw and Cannulated Screws in Treating Young Adults with Femoral Neck Fractures
Wang Guihua，Feng Yuxu，Tan Li，et al
Objective  To compare the short-term clinical effects of proximal femoral cannulated screw locking plate compressed by cannulated compression screw and cannulated screws in treating young adults with femoral neck fractures.Methods  The clinical data of 56 cases with femoral neck fracture treated in our hospital from January 2013 to January 2015 were analyzed retrospectively.The patients were divided into two groups(group A and B)based on the different fixation method.Of them，30 cases(group A，18 males and 12 females)were treated with proximal femoral cannulated screw locking plate compressed by cannulated compression screw and 26 cases(group B，15 males and 11 females)with three compressed canulated screws.Operative time，intraoperative blood loss，healing time of fracture，incidence of non union and femoral head necrosis，incidence of failure fixation，joint function (Harris score)were compared between two groups，and statistical analysis was performed.Results  All 56 patients were followed up from 18 to 30 months with an average of 24 months.There was no significant differences in incidence of non union and femoral head necrosis between two groups(P＞0.05).Operative time of group A (94.70±4.96)min was more than that of group B (67.30±5.65)min (P＜0.05).Intraoperative blood loss of group A (144.27±26.42)mL was more than that of group B (77.73±7.86)mL (P＜0.05).Healing time of fracture of group A (11.33±1.09)months was less than that of group B(13.19±1.27)months (P＜0.05).In group A，there were no internal fixation failure cases；and in group B，screw retreating occurred in 3 cases，screw cutout from the femoral head occurred in 2 cases；there was significant differences between the two groups(P＜0.05).Joint function (Harris score) of group A (80.87±2.55) was higher than that of group B(79.30±2.96) (P＜0.05).Conclusion  Proximal femoral cannulated screw locking plate compressed by cannulated compression screw has advantages of reliable fixation in treatment of femoral neck fractures.Compared with the traditional three compressed canulated screws，proximal femoral cannulated screw locking plate compressed by cannulated compression screw has less healing time and fixation failure rate and higher hip function scoring.But this operation mode is more complicated，the operation time is prolonged and the amount of Intraoperative blood loss is increased.
2017 Vol. 23 (12): 1073-1077 [Abstract] ( 327 ) HTML (1 KB)  PDF (1682 KB)  ( 339 )
1078 Clinical Effect of Total Knee Arthroplasty on Patients with Late Knee Osteoarthritis Combined with Valgus Knee Deformity
Wu Yanjie，Zhang Yumin，Wang Yakang，et al
Objective  To investigate the surgical technique and clinical effect oftotal knee arthroplasty in treatment oflateknee osteoarthritis combined with valgus knee deformity.Methods  A total of 53 patients(26 males，27 females) received total knee arthroplasty for late knees osteoarthritis complicated with valgus deformitybetween February 2012 andFebruary 2014 in xi'an Honghui hospital.We adopted a stable prosthesissurgery through the knee midline incision，lateral patellar approach，a lateral soft tissue releasecorrecting of knee valgus deformity.Then conventional anticoagulation and early functional exercise such as flexion and extensionwere utilized.Preoperative and postoperative X-ray was conducted in patients with measuring femor-tibial angle (FTA) andparallel knee scoring system (KSS) and knee functional score were used to evaluate the clinical effect.Results  53 patients were followed up for 13 to 24 months withthetypeIwoundhealing，no infection and dehiscence.Preoperative FTA was15.3°(10.1°～19.3°) and postoperative FTA was 5.2° (4.3°～8.4°)，knee joint's range of motion increasedfrom 72°(61 °～85°) to 98°(89°～110°).The KSS score increased from an average of 25.3points (13～39 points) preoperatively to 89.1 points (85～97 points).The knee function score increase froman average of 23.0 points (2～38 points) beforeoperation to 89.3 points (84～97 points) after operation.These improvement are all statistically significent.Conclusion  Total knee arthroplastyusing the lateral patellar approach，a selective osteotomy and soft tissue release and balance technicis an effective way in treatment oflateknee osteoarthritis combined with valgus knee deformity.
2017 Vol. 23 (12): 1078-1081 [Abstract] ( 257 ) HTML (1 KB)  PDF (1255 KB)  ( 305 )
1082 Treatment of Gustilo Type Ⅲ Tibiofibular Fractures with Zipper Negative Pressure Close Drainage Combined with Externalfixator
Cheng Qiuxin|Yu Zhuanyi|Zhou Jiangjun|et al
Objective  To investigate the efficacy of zipper negative pressure close drainage combined with external fixator in the treatment of Gustilo type Ⅲ tibiofibular fractures.Methods  From April 2014 to May 2017，20 cases of Gustilo type Ⅲopen fracture of tibia and fibula were treated with zipper type open door negative pressure drainage combined with external fixation.There were 15 males and 5 feimales，aged 17～58 years with an average of 35.6 years old.According to Gustilo typing，there were 5 cases of type Ⅲ A，10 cases of type Ⅲ B，5 cases of type Ⅲ C.All patients underwent emergency debriderment.Close drainage with zipper was used to protect the wound surface，.The wound was cosed by direct suture、 free skin graft or skin flap.Results  20 patients were followed up for 12 to 30 months(20.95±1.16)months.All the patients were treated with zipper open door negative pressure drainage and the wound was closed after 4～30 days late.2 patients suffered from wound infection and tissue necrosis.After debridement and zipper open door negative pressure drainage，the wound was repaired by free skin grafting and transfer flap.1 cases of nail infection were cured by dressing and antibiotic therapy.20 cases of fracture were healed and the healing time was 6～16 months (12.60±0.65)months，2 cases had delayed union of bone，2cases had nonunion，removal of the external fixator and bone dreat plate screw fixation，and finally healed.At the last follow-up，the function of knee and ankle was evaluated according to the Johner-Wruhs score standard.Excellent in 12 cases，good in 7 cases and poor in 1 cases，excellent rate 95 percent.Conclusion  Open the zipper type vacunm sealing drainage combined with external fixation in the treatment of Gustilo type Ⅲ tibiofibular fractures can effectively prevent wound infection.It，is a safe and effective method of treatment.
2017 Vol. 23 (12): 1082-1085 [Abstract] ( 295 ) HTML (1 KB)  PDF (1578 KB)  ( 306 )
1086 Clinical Application of Tranexamic Acid in Total Hip Arthroplasty
Liu Feng 1，2 Liu Baoyi 2，Zhao Dewei 2
Objective  To compare different application methods of the tranexamic acid (TXA) in the treatment of primary total hip arthroplasty (THA) and evaluate the efficacy and safety of patients with blood loss (both dominant blood loss and hidden blood loss).Methods  From November 2015 to November 2016，75 cases of patients in the Zhongshan hospital of Dalian university in the treatment of total hip replacement，including 31 cases of male，44 cases of female，average age 61.0±5.5(50～71 years old)，all patients who meet the inclusion criteria，and sign preoperative informed consent and cooperate with clinical research.75 patients were randomly divided into A，B，C，group of four patients in each group (n＝25).Group A：1g tranexamic acid was given intravenously 30 minutes before surgery intravenous.Group B：30 minutes before surgery 1g tranexamic acid was given intravenously and 1 g tranexamic acid was given during operation.Group C：30 minutes before surgery 1 g tranexamic acid was given intravenously ＋1 g tranexamic acid was given during operation＋1 g tranexamic acid was given intravenously 3 hours after surgery.We recorded the amount of hemoglobin，postoperative drainage and preoperative and postoperative bleeding (Hgb) and hematocrit (Hct)，meanwhile examined lower extremity deep venous color Doppler ultrasound both preoperatively and postoperatively，observing whether the deep venous thrombosis of lower extremity (DVT) were formed.SPSS17.0 software were used for statistical analysis of the results.Results  Group A：Dominant blood loss was (748.3±80.2)mL，hidden blood loss was (273.7±85.0)mL；group B：Dominant blood loss was (514.4±67.6)mL，hidden blood loss was (193.1±71.0)mL；group C：Dominant blood loss was (463.3±67.6)mL，hidden blood loss (168.2±75.0)mL.Three different method way of ammonia tranexamic acid group applied in B，C gruop were sharply decreased compare with group A，indicating dominant blood loss and hidden blood loss was both dropped in the treatment of primary total hip arthroplasty (P＜0.05)，the difference was statistically significant；but between group B and C，the dominant blood loss and hidden blood loss had no significant difference (P＞0.05).And according to the application of ammonia method in all three groups，tranexamic acid，lower extremity deep venous thrombosis and pulmonary embolism was not seen in all patients，indicating this drug is safe and effective.Conclusion  Compare with group A，both group B and Ccan significantly reduce perioperative blood loss in the primary total hip arthroplasty，and does not cause deep venous thrombosis and pulmonary embolism，these treatments are safe and effective role；but B and C comparison has no statistically significant，so 1 g tranexamic acid given intravenously 30 minutes before surgery plus 1 g tranexamic acid given during operation is recommended in the application of ammonia tranexamic acid for total hip replacement.
2017 Vol. 23 (12): 1086-1094 [Abstract] ( 311 ) HTML (1 KB)  PDF (524 KB)  ( 355 )
1091 Osteogenic Differentiation Capacity of Mixed Cultured Bone Marrow Mesenchymal Stem Cells and Adipose-derived Mesenchymal Stem Cells
Wang Xiaowei，Gao Chunsheng，Yan Huichao，et al
Objective  To assess the osteogenic differentiation in the condition of co-culture of BMSC and ADSC.Methods  ADSC and BMSC obtained under sterile conditions.Oil red O was used to identify two cells after being induced into fat.Toluidine blue staining was used to identify two cells after being induced into Chondrocytes.Alizarin red staining were used in osteogenic induction group.Osteogenic induction group was divided into four sub-groups，group A：BMSC＋ADSC uninduced group(BMSC：ADSC＝1︰1)；group B：BMSC induced group；group C：ADSC induced group；group D：BMSC＋ADSC induced group(BMSC：ADSC＝1︰1).OCN and RUNX2 mRNA expression were detected by qPCR after osteogenic induction for 14 days，while the protein expression of OCN and RUNX2 were tested by Western blot at the same time.Results  Oil red O staining，Toluidine blue staining and Alizarin red staining showed positive results.The mRNA expression and protein expression of OCN and RUNX2 were significiantly higher than the other three groups after osteogenic induction for 14 days in vitro.Conclusion  The ability of osteogenic potential strengthened to some extent under the condition of co-culturing.
2017 Vol. 23 (12): 1091-1094 [Abstract] ( 233 ) HTML (1 KB)  PDF (1335 KB)  ( 203 )
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