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2018 Vol. 24, No. 1
Published: 2018-01-25
 
1 Clinical Observation on the Treatment of Upper Thoracic Metastatic Tumors by One stage Posterior Approach Total Vertebral Resection Combined with Bone Cement Infuse and Screw Fixation
Xue Wen，Guan Xiaoli，Liu Lin
Objective  To investigate the clinical effects of one-stage posterior approach total vertebral resection combined with bone cement infuse and screw fixation for upper thoracic metastatic tumors.Methods  A retrospective review was conducted on 11 consecutive patients (from March 2014 to June 2016)，with an average age of (61.6±18.3) years old.A total of 251 vertebrae were involved.All of them were metastatic tumors，including breast cancer (4 cases)，lung cancer (3 cases)，rectal cancer (1 case)，thyroid carcinoma (1 case)，esophageal cancer (1 case)，and prostate cancer (1 case).VAS scores from 3 to 5 points (good)，covering 2 of 11 cases；6 to 8 points (general) in 3 cases；8 to 10 points (poor) in 6 cases，with an average of 7.7 points.All the patients were treated with one-stage posterior total vertebral resection and pedicle screw fixation combined with bone cement perfusion.Results  The average surgery time was (155±37.2)min (120～210 min)；the intraoperative blood loss was (1 100±324)mL (800～2000 mL).There were no pneumothorax，epidural damage，nervous symptoms or other operation-related complications，nor any internal fixation and bone cement perfusion associated with blood vessels or nervous injury perioperative.The average follow-up time of patients was (16.3±13.7)months (6～33 months).The mean preoperative VAS score was 7.7 points，which decreased to 4.3 points postoperative.3 patients died of original cancer，while the other 8 patients remained alive.Conclusion  The operation method of one-stage posterior approach total vertebral resection combined with bone cement infuse and screw fixation for upper thoracic metastatic tumors is safe，minimal invasive and reliable，which can obviate anterior surgery injury.
2018 Vol. 24 (1): 1-4 [Abstract] ( 310 ) HTML (1 KB)  PDF (1733 KB)  ( 302 )
5 Comparison of MISPLIF and Traditional PLIF for Lumbar Degenerative Diseases by Computer Navigation
Shi Teng，Li Guangrun，Liu Xiaoyang，et al
Objective  To compare the clinical effect on MIS-PLIF by navigation with traditional PLIF by navigation for single segmental lumbar degenerative diseases.Methods  Clinical data about 106 patients with single-level lumbar degenerative diseases were retrospectively analyzed in our department from June 2014 to May 2017.42 cases (group A) underwent MIS decompression，posterior lumbar interbody fusion，percutaneous pedicle screw fixation assisted by navigation with average age of 54.3 years old (21～72).There were 24 males and 18 females，and 20 cases of lesions located in L4～5 segments，22 cases of L5 S1 segments.The other 64 cases (group B) underwent traditional open decompression，posterior lumbar interbody fusion assisted by navigation with average age of 56.7 years old (23～74).There were 33 males and 31 females，and 30 cases of lesions located in L4～5 segments，34 cases of L5 S1 segments.The operative time，X-ray exposure times，blood loss，postoperative ambulation and complications were compared between two groups.Furthermore，visual analogue scores (VAS) and X-ray examination were used to assess the clinical outcomes.Results  All the patients were followed up，and no complications such as infection，cerebrospinal fluid leakage (CSF leak) and nerve injury happened in both groups.Group A had longer operative time and X-ray exposure times than group B (P＜0.05)，but less blood loss during operation and after operation than group B (P＜0.05).There was no significant difference between the two preoperative VAS scores (P＜0.05).The VAS scores for low backache at 5th day and two weeks postoperative in group A was better than group B (P＜0.05)，but the scores was no statistical difference between two groups at 12 months postoperative.No difference for the VAS scores of leg pain was noted between two groups.Additional，there were significant differences (P＜0.01) for the VAS scores of low backache and leg pain between two groups at 5th day and two weeks and 12 months postoperative compared with preoperative. Conclusion  Treatment of single segmental lumbar degenerative disease，navigation assisted MIS-PLIF can alleviate the symptoms of patients with low backache and leg pain as well as open PLIF by navigation.Similarly，both types of surgery can be safely and effectively.In addition，as for the low backache，intraoperative blood loss，postoperative bed time，MIS group is superior than open group.
2018 Vol. 24 (1): 5-9 [Abstract] ( 325 ) HTML (1 KB)  PDF (1414 KB)  ( 266 )
10 Analysis of Risk Factors and Treatment of Surgical Site Infection after Spinal Instrumentation Surgery
Wu Xin，Shang Xian wen，Zhang Hao，et al
Objective  The clinical data of postoperative infection of spinal internal fixation was analyzed by logistic regression analysis to determine the independent risk factors and to explore the prevention and treatment measures based on independent factors.Methods  The cases of postoperative infection after spinal internal fixation operation from June 2006 to June 2015 at orthodontics of Affiliated Hospital of Guizhou Medical University were analyzed.There were 23 patients diagnosed as postoperative infection.The reasons of postoperative infection in each case were discussed.According to the domestic and foreign literatures，infection related risk factors were selected as observation index and cases were divided into infection group and non-infection group according to observation index.The number of cases for each group was counted.Logistic regression was used to analyze the correlation among selecting risk factors for infection after spine internal fixation.Statistical methods were used for Chi-square test，single factor analysis of Logistic regression and multivariate Logistic regression analysis.To find out the high risk factors and independent risk factors and summarize the prevention and treatment measures of infection after spinal internal fixation.Results  According to the statistical analysis，1 042 cases of spinal internal fixation surgery in our department in the past nine years，the postoperative infection rate was 2.20％ (23/1 042).We used for the chi-square test and single factor analysis of Logistic regression to analyze the risk factors.Age，obesity，malnutrition，American society of anesthesiologists score (ASA score)，surgical region，surgical approach，the application of steroids，the amount of blood loss and blood transfusion，postoperative cerebrospinal fluid leakage，the drainage tube placement time were inculded.The analysis showed that these factors were not correlated with spinal internal fixation infection.The independent risk factors of postoperative infection of spinal internal fixation analysed by multivariate logistic regression were diabetes，long-term smoking，prophylactic antibiotics without standardized using，incontinence，operation segment of spine，operation time，spinal surgery trauma index.We analyzed the effect of infection factors and statistical independent risk factors for patients.The corresponding preventive measures were summarized for independent risk factors.The treatment of infected patients were divided into two categories：conservative treatment and surgical treatment. Conclusion  Patients with those seven independent risk  factors of infection following spinal instrumentation surgery should be taken preventive measures.Patients with postoperative infection should be immediately treated with corresponding measures.Patients who have been diagnosed postoperative infection should be treated with comprehensive treatment by highly sensitive antibiotics，thorough debridement and drainage.
2018 Vol. 24 (1): 10-14 [Abstract] ( 326 ) HTML (1 KB)  PDF (453 KB)  ( 400 )
15 Survival Analysis of Patients with Osteosarcoma around the Knee Treated by Limb-salvage Surgery
Tan Pingxian 1，Shen Jingnan 2，Wang Jin 2，et al
Objective  To investigate the clinical efficacy，limb function，survival and complication of patients treated limb-salvage surgery for osteosarcoma around the knee. Methods  We retrospectively reviewed the clinical data for 120 patients with osteosarcoma around the knee who treated with limb-salvage surgery between1998 to 2008.The sample included 75 males and 45 females.The mean age of the patients was 18.9 years，ranged from 5 to 48 years.Osteosarcoma was diagnosed in the distal femur in 78 patients and in the proximal tibia in 42 patients.85 patients received standard chemotherapy，while 35 patients received non-standard chemotherapy.Statistical analyses were conducted to process and record patient data and analyze the surgery's efficacy，prognosis and survival rates.Results  All patients were followed for 6 to 144 months，with a mean length of 56.8 months.Twelve of the 120 patients (10％) required secondary amputation.The 5-year overall survival rate for the 120 patients was 61.8％.The 5-years overall survival rates were 71.6％ for patients treated with standard chemotherapy and 40％ for those treated with non-standard chemotherapy.There was a significant difference in survival rates between the treatments (P＜0.01).The average MSTS score was 25.47 points.There was no significant difference in postoperative knee flexion between patients with tumor in the distal femur and tumor in the proximal tibia.However，there was a higher incidence of extensor lag in patients with tumor in the proximal tibia than those with tumor in the distal femur，and the difference was significant (P＝0.03).Conclusion  Currently，limb-salvage surgery combined with neoadjuvant chemotherapy is the option for treating osteosarcoma around the knee.It can preserve knee function and appearance well，but has a relatively high incidence of complications.
2018 Vol. 24 (1): 15-30 [Abstract] ( 324 ) HTML (1 KB)  PDF (442 KB)  ( 241 )
19 Comparison of Arthroscopic Treatment through Ultrahigh Posteromedial Portal Versus Mini-open Reduction and Internal Fixation for Avulsion Fracture of the Tibial Attachment of the Posterior Cruciate Ligament
Wang Xinmin，Liu Fei，Zhao Haixia，et al
Objective  To compare the clinical outcome of arthroscopic reduction and internal fixation(ARIF) through ultrahigh posteromedial portal and mini-open reduction and internal fixation(ORIF) for avulsion fracture of the tibial attachment of the posterior cruciate ligament(PCL).Methods  From March 2011 to March 2017，68 cases of the avulsion fracture of Posterior Cruciate Ligament were treated operatively in our hospital.Thirty-three patients were treated with ARIF through ultrahigh posteromedial portal (Group A).Thirty-five patients were treated with ORIF with cannulated screws (Group B).There were 20 males and 13 females in group A，with a mean age of (30.2±2.1)years old，and 25 males and 10 females in group B，with a mean age of (28.3±3.6)years old.The PCL and avulsion bony fragment were fixed with 4.0 mm canulated screw (Synthes).The outcome were measured by X-ray，CT or MRI testing.Patients were available for clinical evaluation with KT-2000 arthrometer measurements and PDT tests，and knee function with the Intemational Knee Documentation Committee(IKDC)，Lysholm scores.Results  All the patients were followed up at an averge of 12～18 months.Primary union were achieved in all the fractures 3 months postoperatively.The average time of operations were (65.51±4.83)min in Group A and (45.36±3.29)min in Group B.There were no significant differences between group A and group B regarding the PDT negative rate (87.9％ versus 91.4％)，the Lysholm score (95.51±4.83 versus 96.40±3.78)，the IKDC score (93.34±3.61 versus 95.67±5.44).There were no significant differences between the surgical knee and the normal knee regarding the the results of KT-2000 at the tensile fore of 134 N，Group A：(2.47±1.02)mm vs (2.05±0.92)mm，Group B：(2.53±0.82)mm vs (2.24±0.73)mm at 90° of flexion.There were no significant differences between Group A and Group B of the surgical knee regarding the the results of KT-2000 (2.47±1.02)mm vs (2.53±0.82)mm at 90°of flexion.Conclusion  The treatment of the avulsion fracture of PCL with ultrahigh posteromedial portal under arthroscopy is a reliable technique，both arthroscopy and mini-incision surgery can achieve satisfactory clinical outcomes，but mini-open reduction and internal fixation(ORIF) can result in much shorter operative time and thus permit an early postoperative rehabilitation.
2018 Vol. 24 (1): 19-24 [Abstract] ( 313 ) HTML (1 KB)  PDF (1174 KB)  ( 303 )
25 Open Reduction and Internal Fixation Via Sinus Tarsi Approach Combined with Small Lateral Incision for the Treatment of Sanders Type Ⅲ Calcaneal Fractures
Hou Zhengxuan，Li Jianbo，Liu Ningbo，et al

Objective  To investigate open reduction and internal fixation via sinus tarsi approach with anatomical locking plate in the treatment of sanders type Ⅲ calcaneal fractures.Methods  Thirty-eight patients with unilateral Sanders type Ⅲ calcaneal fracture were recruited from February 2013 to February 2015.Patients were randomly divided into minimally invasive group and control group by random table method，with 19 cases in each group.The baseline information including age，sex，fracture cause，interval time from injury to operation，B-hler angle and Gissane angle before operation was analysed.All patients in the minimal invasive group underwent open reduction and internal fixation (ORIF) using sinus tarsi approach，and lateral L-type incision in the control group.B-hler angle and Gissane angle were measured before and after operation and the final follow-up inboth the two groups.American Orthopaedic Foot and Ankle Society(AOFAS) score were approved to evaluate the therapeutic effect after operation.Results  There was no significant difference in age，sex，fracture cause，interval time from injury to operation，B-hler angle and Gissane angle before operation between the two groups.The average follow-up time was 14.1 months in minimal invasive group，and 14.8 months in control group.All patients in the two groups had bone union in final follow-up.B-hler angle was (12.9±5.4)° and (11.7±5.1)° in minimal invasive andcontrol group before operation.After operation，B-hler angle were (27.2±5.3)°in minimal invasive group and (28.1±6.3)° in the control group.Gissane angle was (108.5±8.6)° and (109.9±8.2)° beforeoperation in minimal invasive and control group.Gissane angle of observation group was (123.3±5.0)° and the control group was (124.7±5.4)° after operation.There was significant difference in B-hler angle and Gissane angle before andafteroperation in both minimal invasive group and control group (P＜0.05).No significant difference was found in the median AOFAS score between the two groups (P＞0.05).Three of skin necrosis and 1 of superficial infection were found in the control group，and no wound complications in the minimal invasive group.Three patients suffered from varying degrees of subtalar joint stiffness and 1 patients suffered from traumatic arthritis in the minimal invasive group，and there were9patients ofsubtalar joint stiffness and 3 patientsof traumatic arthritis in the control group.Conclusion  ORIF via sinus tarsi approach and ORIF via a lateral L-type incisionhave similar therapeutic effect in the management of sanders type Ⅲ calcaneal fractures.And there are less incision complication and lower stiffness subtalar joint rate inORIF via sinus tarsi approach Patients.
2018 Vol. 24 (1): 25-30 [Abstract] ( 386 ) HTML (1 KB)  PDF (1882 KB)  ( 339 )
31 Two-stage Total Hip Arthroplasty after One-stage Debridement for Patients with Advance Active Tuberculosis of the Hip
Peng Weiqiu，Zhang Xianghong，Li Fuming，et al
Objective  To investigate the feasibility and effectiveness of two-stage total hip arthroplsty (THA) after one-stage debridement for patients with advance active tuberculosis (TB) of the hip.Methods  Fifteen consecutive patients (15 hips) with advanced active TB arthritis of the hip were retrospectively reviewed in our hospital.Out of these 15 cases，the hip of 13 were destroyed extensively with difficulties of thorough debridement at one operation，and the hips of the other 2 patients were detected of sinus tracts.All cases received the two-stage THA protocol and the perioperative antituberculous medication.During the first stage，a debridement was carried out after at least 2 weeks of antituberculous chemotherapy to remove abscesses and infect and necrotic tissues as thoroughly as possible.Then a minimum of 3 months (average 4.4 months) antituberculous chemotherapy was followed.And when the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were normal and the wound was well healed，hip prosthesis was implanted during the second stage.All cases were taken antituberculous chemotherapy to constitute a total duration of a minimum of 12 months after the first operation.Results  All 15 patients were followed up for 23 to 62 months (average 39 months).No reactivation of tuberculosis，loosing of prothesis，periprothesis fracture，dislocation was observed in our 15 patients except 1 patient received the second debridement because of failed to debridement thorough in first operation.The average Harris hip score was increased from preoperative 36 to 89 at the final follow-up.Conclusion  Two-stage THA after one-stage debridement following by the completed course of antituberculous medication is a alternative treatment option for patients with advanced active tuberculous of the hip under some difficult condition，such as patients with sinus tract or destroyed extensively with obstacles of thorough debridement at one operation.
2018 Vol. 24 (1): 31-38 [Abstract] ( 355 ) HTML (1 KB)  PDF (1874 KB)  ( 265 )
35 Analysis of Position Sense in THA Patient of Different Surgical Approaches
Zhang Jingyu
Objective  Joint instability can be roughly divided into mechanical instability and functional instability.It is reported that postoperative dislocation often occurs in the posterior approach，may be due to injury of soft tissue around the joints，that caused functional instability.We analyzed the location sense of hip joints with different approaches for total hip arthroplasty and analyzed their effects on postoperative dislocation.Methods  Fifty-eighty patients (116 hips)，who received THA in our hospital were admitted to our study.Patients with inadequate sensory measurements were excluded.The posterior approach involved 39 hip.There were 30 hip underwent anterolateral approach procedure，and 37 hip in the control group.Results  The absolute reduction angle error of the active external rotation in the Al group is significantly lower than that in the PL group.In the AL group and the control group，the relative reduction angle of the passive internal rotation，external rotation and active internal rotation was significantly lower than that of the PL group.Conclusion  This study shows that the patient has a better hip position sense in the anterolateral approach group due to the retention of soft tissue around the joint.
2018 Vol. 24 (1): 35-38 [Abstract] ( 308 ) HTML (1 KB)  PDF (396 KB)  ( 190 )
39 The Diagnostic Value of PAF Content and Changes of Platelet Parameters in Osteoarthritis of the Knee
Suo Cangping，Ye Yongjie
Objective  To observe the changes of PAF content and platelet parameters of patients with knee osteoarthritis.To investigate theireffects in the treatment of knee osteoarthritis and theirusages as  diagnostic and prognostic indicators in clinical application.Methods  20 cases of healthy people and 96 cases of patients with knee replacement surgery patients were included in this study.The platelet parameters was tested by five classifications of blood cells，the PAF content in serum and articular fluid was tested by enzyme-linked immunosorbent assay.And statistical analysis was performed in all results.Results  Compared with the normal group，the MPV，PCT and PDW of knee arthritis group increased slightly.The deference was statistically significant between the two groups(P＜0.05).The MPV，PCT and PDW of knee arthritis group decreasedto normal levels after treatment，The deference was not statistically significant between normal group and posttreatment group (P＞0.05)，The deference was statistically significant between normal group and knee arthritis group(P＜0.05).The deference of PLT as not statistically significant in all groups.The r value of each group was calculate by platelet parameters related analysis.The r value of MPV in each group was 0.001、0.64、0.001，respectively(P＝0.00);the r value of PLT in each group was 0.001，0.52，0.001，respectively (P＝0.00);the r value of PDW in each group was 0.001，0.58，0.001，respectively (P＝0.00).The above parameters were statistically significant between knee arthritis group and post-treatment group (P＜0.05). The r value of PLT was 0.001，0.001，0.001，respectively (P＝0.00)，The difference of it was not statistically significant in all groups.The PAF content inserum of knee arthritis group was 6.7 times as normal group's and the platelet parameters in articular fluid of knee arthritis groupand7 times as the normal group's.The deference was statistically significant between the two groups(P＜0.05).The PAF content inserum of post-treatment group was 5.6 times as normal group's and the platelet parameters in articular fluid of post-treatment group was 6.1 times as the normal group's.The deference was not statistically significant between the two groups(P＞0.05).The r value of PAF in serum and articular fluid was calculate by analysis in all groups.Only the knee arthritis group' result was relatedto PAF.The r value was rserum 0.78，rarticulart-fluid 0.82(P＝0.00)，respectively.The differnecewas statistically significant (P＞0.05).Conclusion  PAF，MPV，PCT and PDW are related to the knee osteoarthritis and can be used as one of the laboratory diagnostic indicators in clinical diagnosis and prognosis.
2018 Vol. 24 (1): 39-43 [Abstract] ( 327 ) HTML (1 KB)  PDF (1413 KB)  ( 209 )
44 Experimental Study of Rat Limb Preservation Method and Change of Muscle Biological Characteristics
Yan Xiaoli，Zhang Wei，Liu Linlin，et al
Objective  To observe the relationship of biologicalcharacteristics of amputated limb muscle between with different preservation methods.Methods  Quadriceps femoris muscles from Wistar rats werepreserved for 24 hours at 4℃ in extracellular-type trehalose containingKyoto (ETK)，University of Wisconsin (UW)，or lactated Ringer's (LR) solution (control).Amputated limbs of rats preserved with ETK，UW，or LR for6 or 24 hours at 4℃ were transplanted orthotopically.Blood samples from the external jugular vein were obtained 60 minutes after surgery for analysis of serumlevels of creatine phosphokinase (CPK)，aspartate aminotransferase (AST)，alanine aminotransferase(ALT)，lactate dehydrogenase (LDH)，creatinine (Cr)，bloodurea nitrogen (BUN)，and potassium (K).At week 8，terminallatency and amplitude were measured in the tibialis anterior muscle.Themuscles were also analyzed histologically by hematoxylin and eosin staining (HE) and Masson's trichrome staining.Results  In the 6-hour-preserved limb transplantation model，electrical amplitude was significantly lower inthe LR group.Histologically，muscles preserved with LR showed the mostatrophic changes.In the 24-hour-preserved model，the survival rate of the LR group was 37.5％ in contrast to 80％ in the ETK and UW groups.Electrical signals were not detected in the LR group owing to severe muscle atrophy and fibrosis.The ETK and UW groups showed good muscle functionelectrophysiologically.Conclusion  ETK solutions can protect muscle function and morphology in ischemia-reperfusion limbs and improve recipient survivalrates after transplantation of long-term-preserved limbs.
2018 Vol. 24 (1): 44-48 [Abstract] ( 278 ) HTML (1 KB)  PDF (2138 KB)  ( 213 )
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