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2018 Vol. 24, No. 2
Published: 2018-02-25
 
97 Blood Loss In Pedicle Subtraction Osteotomy Surgery for Rigid Scoliosis
Zhao Fujiang，Chen Zhiming，Ma Huasong，et al
Objective  To identify the predictors of intraoperative blood loss in pedicle subtraction osteotomy(PSO) surgery for rigid scoliosis.Methods  Data of 103 patients treated with PSO surgery for rigid scoliois by a single surgeon from January 2010 to September 2016 were retrospectively  analyzed.Sex，age，preoperative height，preoperative weight，BMI，scoliosis type，preoperative Cobb angle，correction rate on Cobb angle，rib resection，intraspinal anomalies，fused levels，surgical procedures，the number of pedicle screws，preoperative laboratory examination(hemoglobin，platelet count，PT，APTT，and INR) were recorded and analyzed with a multivariable linear stepwise regression to develop a predictive model of blood loss.Pearson's correlation was also calculated between operation time and blood loss.Results  Intraoperative blood loss was (2 311.1±1 123.1)mL(range，700 to 6 500 mL)，operation time was positively correlated to blood loss(Pearson's correlation 0.463，P＜0.000 1).Multivariate linear regression identified age，scoliosis type，the number of pedicle screws，preoperative Cobb angle as predictors of increased blood loss.The following formula was developed to predict blood loss during PSO surgery for rigid scoliosis：t＝－1 562.8＋42.6A＋629.0B＋78.8C＋9.9D.T was Blood loss(mL)，A wasage(year)，B was scoliosis type(AIS＝0，congenital scoliosi＝1)，C was number of pedicle screws，D waspreoperative Cobb angle of main coronal curve(degree).Conclusion  Age，scoliosis type，the number of pedicle screws，preoperative Cobb angle of main coronal curve are the predictors of blood loss，and a formula has been developed to predict the blood loss.Surgeons can use this model to predict blood loss while making small adjustments.Operation time is positively correlated with blood loss，measures should be taken to reduce the operation time，then avoid massive blood loss in PSO surgery for rigid scoliosis.
2018 Vol. 24 (2): 97-100 [Abstract] ( 334 ) HTML (1 KB)  PDF (605 KB)  ( 330 )
101 Influencing Factors of Subacromial Impingement Syndrom after Acromioclavicular Dislocation Treated by Clavicular Hook Plate
Zhou Yu 1，Bian Hengjie 1，Sun Yuming 2
Objective  To investigate the influencing factors and causes of subacromial impingement syndrome after acromioclavicular dislocation treated by clavicular hook plate.Methods  We conducteda retrospective study of 36 patients with Rockwood type Ⅲ acromioclavicular dislocationtreated by hook plate from June 2014 to October 2016 in Jiangsu province hospital of TCM.This study included two groups.There were 18 patients with subacromial impingement syndrome after clavicular hook plate treatment as experimental group，and 18 patient without syndrome as control group.Joint range of motion，acromion index and acromion were assessed by Constant score measured and by Grasheyview image of shoulder.Results  The Constant score of shoulder joint in the control group (90.17±1.73) was much better than that in the experimental group (57.02±1.49) 6 months after operation，with statistical difference.The acromion index of the experimental group was (0.79±0.07)，while that of the control group was (0.56±0.09)(P＜ 0.05)，which suggested there was a positive correlation between the incidence of acromion impingement and the acromion index.The acromion type showed no statistical significance between the two groups(P＞0.05)，but the type Ⅲ accounted for a larger proportion in the experimental group(66.7％).Conclusion  The acromion index and the acromion morphology influence the occurrence of subacromial impingement syndrome after acromioclavicular dislocation treatment with hook plate.
2018 Vol. 24 (2): 101-116 [Abstract] ( 276 ) HTML (1 KB)  PDF (662 KB)  ( 229 )
104 Analysis of the Correlation between the Bone Cement Diffusion and the Clinical Effect after PVP Base on the Digtal Quantification
Wang Shuanchi，Wang Fangfang，Tao Xiaobing
Objective  To explore the possibility of using digital orthopedic techniques to evaluate the dispersion of bone cement，and to evaluate the correlation between the diffusion volume and the diffusion coefficient of bone cement and clinical effect.Methods  Fifty-five patients with osteoporotic vertebral compression fractures who underwent percutaneous vertebroplasty from August 2015 to March，2006 were retrospectively studied.The injection volume of bone cement，the leakage of bone cement and complications were recorded.ODI score and VAS score were used to assess the postoperative spinal function and pain recovery at the timebeforeoperation，3 days，3 months and 6 months after the operation.CT scan was performed before and 3 days after operation.CT data were modeled in digital orthopedic software.The volume of bone cement，the volume of vertebral body and the diffusion ratio of bone cement were calculated.The difference between bone cement injection and bone cement diffusion ratio were compared.The relationship between the bone cement injection volume，dispersion volume，bone cement diffusion ratio and postoperative ODI，VAS score improvement were evaluated.Results  All the operations were successfully completed.(4.26±0.86) mlbone cement were injected(range 2.5 to 6.1 mL).No nerve injury，cerebrospinal fluid leakage and infection and other serious complicationshappened. Buttherewere 5 cases of small amountbone cement leakage.The mean volume of bone cement was (5.36±0.92)mL.There was significant difference between the injection volume of cement and the volume of diffusion (P＜0.05).There was a correlation between the volume of bone cement，the volume of diffusion of cementandthe VAS and ODI score at 3 days and 3 months after operation，and the correlation between bone cement injection volume and VAS and ODI were weaker.Conclusion  The application of digital orthopedic technique in the calculation of the volume of bone cement and the dispersion of bone cement has a high accuracy and reproducibility.The volume of bone cement，bone cement diffusion ratio and postoperative pain and functionimprovementare closely related. Compared to the amount of bone cement injection，this method is more objective and accurate.
2018 Vol. 24 (2): 104-107 [Abstract] ( 344 ) HTML (1 KB)  PDF (557 KB)  ( 279 )
108 Posterior Radical Debridement Intervertebral Fusion and Internal Fixation for the Treatment of Lumbar Brucella Spondylitis
He Xin，Zhang Jianan，Liu Jijun，et al
Objective  To evaluate the safety and efficacy of posterior radical debridement，intervertebral fusion and internal fixation for the treatment of lumbar brucella spondylitis.Methods  There were 16 cases(10 males，6 females) underwent posterior approach radical debridement，intervertebral fusion and internal fixation for the treatment of lumbar brucella spondylitis from January 2010 to January 2014.The average age was (40.6±15)years (19 to 66 years).All patients had single segment infection and had lower back pain.13 of them had persistent fever.Visual analogue scale (VAS) and Oswestry Disability Index questionnaire (ODI) were evaluated before operation andin the final follow-up.At the final follow-up，all patients underwent standard Brucella agglutination test，X-ray and computed tomography(CT) to evaluate clinical outcomes.Results  16 patients were followed up for 12 to 47 months(18.6±5.7) months.The operation time was 100 to 140 minutes (122±15)mins；blood loss was 300 to 650 mL (482±118)mL.There was nointraoperative and perioperative death，and nerve compression symptoms.13 cases with preoperative feverdid not have a fever at 10 days after operation.Compared with pre-operation，VAS and ODI were significant improved.At the final follow-up，All the patients were cured and got intervertebral fusion.Conclusion  Posterior radical debridement，intervertebral fusion and internal fixation for the treatment of lumbar Brucella spondylitis is a safe and effective treatment.
2018 Vol. 24 (2): 108-111 [Abstract] ( 316 ) HTML (1 KB)  PDF (1824 KB)  ( 322 )
112 Effect of Wrist Arthroscopy in the Treatment of Triangular Fibrocartilage Complex Injury
Zhang Hao，Fu Qingsong，Zhou Lingli，et al
Objective  To evaluate the effect of wrist arthroscopy in the treatment of triangular fibrocartilage complex injury.Methods  Twenty-two patients with triangular fibrocartilage complex injury were enrolled in our hospital from January 2013 to June 2016.Among them，there were 16 males(73％) and 6 female (27％) patients with a mean age of (31.5±8.27) (range，22 to 5) years.According to Palmer classification，16 patients had type Ⅰ injury (10 cases of ⅠA type，4 cases of ⅠB type，1 case of ⅠC type，1 case of ⅠD type)，and 6 cases had type Ⅱ injury (2 cases of type ⅡA，1 case of type Ⅱb，Ⅱc type 3 cases).The ⅠA，ⅠD type TFCC injury patients underwent simple debridement surgery；ⅠB，ⅠC type injury patient underwent the suture repair；type Ⅱ TFCC injury patients underwent debridement surgery with cartilage surgery.Wrist activity，wrist pain，grip strength，wrist function score (improved Mayo score) were evaluated.Results  All patients were followed up 9～24 months (mean，17.60±5.10 months).The results showed that the wrist pain was improved in 22 patients with postoperative follow-up.The grip strength was improved with the degree of rotational activity (157.05±3.26)°，the radius of the ulcer (39.45±1.60)°，the wrist Joint flexion and extension (126.95±1.65)°.According to improved Mayo score：excellent in 14 cases，good in 6 cases，fair in 2 cases；excellent rate of 90.9％.Conclusion  Wrist arthroscopy is a minimally invasive，effective and safe method for diagnosis and treatment of patients with TFCC injury.The followup effect is satisfactory and should be used as a routine diagnosis and treatment of ulcer joint pain.
2018 Vol. 24 (2): 112-116 [Abstract] ( 406 ) HTML (1 KB)  PDF (949 KB)  ( 886 )
117 Treatment of Failed Internal Fixation of Hip Fracture with Total Hip Arthroplasty
Qin Yongzhi，Ran Xuejun，Pu Chuancheng，et al

Objective  To evaluate the clinic effects of THA in failed internal fixation of hip fracture.Methods  30 patients treated from June 2012 to June 2016 were retrospectively analyzed to evaluate the curative effects of total hip arthroplasty.There were 21 patients with failed internal fixation of femoral neck fracture，6 with failed fixation of intertrochanteric fracture，3 with failed fixation of acetabular fracture.Results  All of the 30 patients underwent a successful operation and no complication occurred.The mean operation time was (85±22)mins.The patientswere followed up for 15.7 months (10～24 months).The average Harris Hip Score was improved from 68.5(range：52～78) preoperative to 92.6(range：85～96) postoperative.The good and excellent rate was 86.7％.There were no prosthesis loosening，sinking and dislocation at final follow-up.Conclusion  Total hip arthroplasty is a effective，safetreatment option for failed internal fixation of hip fracture.It can recover the hip joint function and alleviate the hip pain.At the same time，it can lessen those complications resulted from the joint dysfunction and improvethe lifequalitiesof patients.
2018 Vol. 24 (2): 117-120 [Abstract] ( 323 ) HTML (1 KB)  PDF (1292 KB)  ( 323 )
121 Influence of Limited Tourniquet Use Combined with Intravenous Tranexamic acid on Blood Loss in Total Knee Arthroplasty
Chen Boliang，Li Jun，Tian Weihua，et al
Objective  To investigate influence of limited tourniquet use combined with intravenous tranexamic acid on blood loss perioperative total knee arthroplasty (TKA). Methods  The clinical data of 122 patients with knee osteoarthritis undergoing total knee arthroplasty were analyzed retrospectively from March 2013 to August 2016 in our department.The 43 cases were treated with tourniquet without using tranexamic acid (Group A)，41 patients were treated with tourniquet and intravenous infusion of tranexamic acid (group B)，38 cases were treated with limited tourniquet use and intravenous infusion of tranexamic acid (group C).The sex，age，body mass index (BMI)，hemoglobin (Hb) and hematocrit (Hct) of the patient were collected and compared between the three groups.The length of operation，intraoperative blood loss，postoperative drainage，the number of blood transfusion and HSS score were recorded.The Gross formula was used to calculate the total blood loss and the hidden blood loss perioperative total knee arthroplasty.Results  The total blood loss in group A and group B and group C was significantly different (P＜0.001).There was no significant difference in total blood loss between group B and group C (P＝0.731).The hidden blood loss in group A and group B and group C was significantly different (P＜0.001).The hidden blood loss in group B and group C，the difference was statistically significant (P＝0.001).There were 13 cases (30.23％) in group A，3 cases (7.31％) in group B，2 cases (5.12％) in group C transfusing，and the rate of transfusion in group A，group B and group C were statistically significant (P＜0.05).There was no significant difference in HSS score between the three groups (F＝0.384，P＝0.681).Conclusion  The use of tranexamic acid in TKA can significantly reduce the total blood loss during the operation and reduce the transfusion rate.Limited tourniquet use in total knee arthroplasty can shorten the time of tourniquet，but it will not increase the operation time and perioperative blood loss.It is recommended for patients with high risk of thromboembolism to reduce the use of tourniquets.
2018 Vol. 24 (2): 121-129 [Abstract] ( 334 ) HTML (1 KB)  PDF (453 KB)  ( 262 )
125 A Comparative Study on the Clinical Outcomes between Total Hip Arthroplasty by Anterior Approach and Posterior Approach
Fu Weide，Mi Dong，Zhang Xu，et al
Objective  To further compare the clinical outcomes of total hip arthroplasty(THA)through direct anterior approach (DAA) and posterior approach (PA).Methods  We selected the consecutive cases of THA of our hospital from December 2013 to June 2016 according to the inclusion and exclusion criteria.All the 128 cases was divided into DAA group (57 cases) and PA group (71 cases).And the mean follow-up was 19.6 months.The operative time，blood loss，the leaving bed time，hospital stay，visual analog scale (VAS) and Harris score before operationwere recorded and analyzed.Meanwhile the acetabular anteversion angle and acetabular abduction angle were measured and analyzed.The postoperative complications were recorded.Results  The blood loss of the DAA group (232.4±28.6)mL was shorter than the PA group(382.3±37.5)mL (P＜0.05)；the leaving bed time of the DAA group (1.8±0.7)d was shorter than the PA group (4.3±2.1)d (P＜0.05)；the hospital stay of the DAA group was(7.4±1.9)d was shorter than the PA group(9.2±2.3)d (P＜0.05).However，the operative time of the DAA group(112.2±12.6)min was longer than the PA group(98.4±10.3)min (P＜0.05).The VAS score of the DAA group (2.3±0.9)w as lower than the PA group (2.9±1.3) at one month (P＜0.05)，the Harris score of the DAA group (84.3±4.2) was higher than the PA group (80.6±6.5) at one month (P＜0.05).The VAS score was (1.5±0.8) in DAA group and (1.3±1.1) in the PA group.The Harris score was (92.2±5.3) in DAA group and (90.5±6.8) in the PA group，which showed no significant difference between the two groups(P＞0.05).The acetabular anteversion angle was (21.3±3.3)° in DAA group and (20.6±4.3)° in the PA group.The acetabular abduction angle was (39.8±5.4)° in DAA group and (41.3±5.0)° in the PA group，which showed no significant difference between the two groups(P＞0.05).Conclusion  Direct anterior approach of THA has less blood loss，earlier get out of the bed，shorter hospital stays less pain and good position of acetabular prosthesis while comparing with PA group.The clinical outcomes are satisfactoryat about 20 months，however，the longer results needed longer follow up studies.
2018 Vol. 24 (2): 125-129 [Abstract] ( 327 ) HTML (1 KB)  PDF (1040 KB)  ( 435 )
130 Epidemiological Features Analysis of Uighur，Han and Kazak Patients with Osteosarcoma in Xinjiang Area
Yang Yong 1，Chen Jiangtao 1，Chu Huihui 2，et al
Objective  To investigate the epidemiological characteristics of osteosarcoma in Xinjiang area and provide reference for clinical work.Methods  The clinical data of 290 patients with osteosarcoma from January 2002 to June 2016 were reviewed，and related epidemiological information was collected and analyzed.Results  The annual number of osteosarcoma in Xinjiang was rising.There were 290 cases of osteosarcoma patients.Uighur was 56.6％ of the total.Male to female ratio was 1.2︰1.0.The age of them were (24.95±16.59)years.11～20 years old was the peak of mobility.The most common sites was around the knee joint (69.7％)，pathological type of conventional osteosarcoma was the majority，accounting for 87.2％ of the total.The first found symptoms were pain and swelling，accounted for 69.3％.41.7％ of the patients were admitted with immobility.Pathological fractures occurred in 7.9％.Ethnic grouping analysis showed that gender，age distribution between different ethnic groups，tumor location and pathological type showed no significant difference (P＞0.05)，there was significant difference of the positive rate of serum alkaline phosphatase (P＜0.05).Conclusion  The clinical value of serum alkaline phosphatase in osteosarcoma is higher than that in Han and other nationalities.
2018 Vol. 24 (2): 130-133 [Abstract] ( 363 ) HTML (1 KB)  PDF (568 KB)  ( 293 )
134 A Comparative Serological Study of Direct Anterior Approach and Posterolateral Approach in Total Tip Arthroplasty
Zhou Jiabin 1，Han Guiquan 2，Cui Guanxing 2，et al
Objective  To investigate the changes and clinical significance of serum levels in patients between direct anterior approach (DAA) and posterolateral (PLA) in total tip arthroplasty(THA).Methods  60 cases of total hip arthroplasty were collected from October 2015 to March 2017 inWeifang medical university affiliated hospital，26 cases underwent THA throughdirect anteroposterior approach，34 cases underwentTHA through posterior lateral approach.All patients were primary unilateral total hip arthroplasty.The general clinical data and incision length，operation time and intraoperative blood loss were collected from the two groups and fasting venous blood was collected in the morning.The contents of CRP，IL-1，TNF-α，CK in blood serum were detected on the day before operation and 1，3，5 days on the first day and the first day after operation.Results  The operative time，intraoperative blood loss，incision length，and acetabular prosthesis aberrations were significantly different between the DAA group and the PLA group (P＜0.05)，the rest of the general data showed no significant difference (P＞0.05).The levels of CRP，IL-1 and TNF-α in the serum of the two groups were higher than those before the first day，and reached the peak at 3 days after operation.The difference was statistically significant (P＜0.05).The changes of serum levels of CPR，IL-1，TNF-α，CK in the group DAA and group PLA were similar over time，but the levels of IL-1，TNF-α and CK in the DAA group were significantly lower than those in the group PLA.Conclusion  The levels of CRP，IL-1，TNF-α and CK in the serum of patientsachieved the highest on the third day after operation，which suggests that 3daysafter operation is the critical period for anti-inflammatory treatment after total hip replacement.The levels of IL-1，TNF- and CK in DAA group were lower，suggesting that DAA has less soft tissue injury than PLA，and the rate of acute aseptic inflammation is lower.Moreover，DAA incisionhas shorter length，shorter operation time and less bleeding during operation.DAA treatment is superior to PLA.
2018 Vol. 24 (2): 134-138 [Abstract] ( 332 ) HTML (1 KB)  PDF (553 KB)  ( 244 )
139 Relationship of Gonadal Hormone Levels with Age and Lesion Severity in Postmenopausal Women with Knee Osteoarthritis
Liu Yaping 1，Du Kaiyue 1，2，Guo Hongmin 3，et al
Objective  To explore the relationship of serum gonadal hormone levels with age and lesion severity in postmenopausal women with knee osteoarthritis.Methods  215 cases of postmenopausal female patients above 50 years old with knee joint replacement surgery or conservative treatment diagnosed as knee osteoarthritis in Shandong Jining the 1st People's Hospital bone and joint surgery from January 2016 to December 2016 were enrolled.According to age，every 10 years as a group，the patients weredivided into three groups.We measured height，weight，calculate body mass index，WOMAC scale score，X-ray and magnetic resonance imaging of the knee T2-mapping.Fasting blood samples were used to detect FSH，LH，estradiol，fasting blood glucose，triglyceride，and total cholesterol.In accordance with the level of FSH was divided into two groups，high FSH group (＞40 mIU／mL) and low FSH group (＜40 mIU／mL).High FSH group had42 cases at the age of 50～60，45 cases at the age of 61～70，26 cases more than 70 years old.Low FSH group had37 cases of 50～60 years old and 40 casesof 61～70 years oldand 25 cases more than 70 years old.WOMAC score and T-2 valueof thetwo groups wereobserved.Results  The height，weight，body mass index，blood triglyceride，cholesterol and blood sugar of the postmenopausal women with KOA did not change significantly with the increase of age，and the WOMAC score and the average T-2 value increased significantly.Serum FSH levels were the highest in the 50～60 year old group，and then decreased significantly with age，and serum LH and E2 gradually decreased.The decrease of LH was significant，and E2 was not significant.Compared with the high FSH group，there was no significant difference in age between the two groups，but the WOMAC score and T-2 value increased significantly.Conclusion  Knee osteoarthritis is age-related disease.With the decrease of follicle stimulating hormoneandestrogen，osteoarthritis syptomswillincreases.
2018 Vol. 24 (2): 139-152 [Abstract] ( 310 ) HTML (1 KB)  PDF (1204 KB)  ( 235 )
143 Fucosylation of CD44 on the Homing Ability of Rabbit Bone Marrow Mesenchymal Stem Cells
Xiao Fei，Jiao Jing，Huang Yucheng，et al
Objective  To investigate the effects of extracorporeal fucosylation of CD44 on the homing ability of rabbit bone marrow mesenchymal stem cells.Methods  First，BMSCs were constructed to stably express enhanced green fluorescent protein (EGFP).Then，BMSCs were subjected to fucosylation treatment in vitro.Finally，BMSCs were injected intravenously into the model rabbits with tibial fractures.After 6 weeks of injection，the levels of stromal cell-derived factor (SDF-1) and monocyte chemoattractant protein-1 (MCP-1) in rabbit serum were detected by ELISA.The expression levels of SDF-1 and MCP-1 protein in damaged bone tissue were detected by Western Blot.The positive rate of EGFP expression was detected by staining.Results  The results of fluorescence microscopy showed that BMSCs with stable expression of EGFP were successfully constructed.The results of ELISA and Western Blot showed that the secretion of SDF-1 and MCP-1 and the expression of SDF-1 and MCP-1 protein in BMSCs treatment group processed by fucosylated were significantly higher than those in BMSCs treatment group processed byno fucosylated (P＜0.01).The results of immunohistochemical staining showed that the positive rate of EGFP expression was also significantly increased (P＜0.05)，which indicated that the BMSCs at the injured bone tissue were significantly increased and helpful in the repair of bone injury.Conclusion  Extracorporeal fucosylationof CD44 molecules can significantly enhance the homing ability of rabbit BMSCs，which may be achieved by SDF-1 and MCP-1 regulation.
2018 Vol. 24 (2): 143-147 [Abstract] ( 358 ) HTML (1 KB)  PDF (1868 KB)  ( 247 )
156 Posterior Cervical Open-door Laminoplasty Combined with Pedicle Screw Fixation for Cervical Spinal Stenosis with Instability
Zhou Hongyu 1，Xu Shuang 2，Wang Gaoju 2，et al
Objective  To investigate the the necessity and curative effect of posterior cervical open-door laminoplasty combined with pedicle screw fixation for cervical spinal stenosis with instability.Methods  31 cases of cervical stenosis with unstable patients were selected to record the operation time，intraoperative bleeding and complications.Using JOA score of Japanese Orthopaedic Association (JOA) to assess neurological function；The physiological curvature of cervical vertebra was observed by X-ray.The position of vertebral pedicle screw was assessed by CT 3 d reconstruction.Results  All the patients completed the operation successfully，with an average operation time of 132min (110～180 min) and 320 mL(250～450 mL) of average blood loss.All patients were followed up for 12 months to 28 months with an average of 15 months.At the end of the follow-up，the JOA score was improved to (15.19±0.75) from (11.16±2.07) points before surgery，and the difference was statistically significant (t＝－15.03，P＜0.01).The curvature of the cervical vertebra was increased from the preoperative (6.52±7.34) degree to the last follow-up (9.00±11.01) degree，and the difference was statistically significant (t＝2.79，P＜0.01).In this group，the total number of screws was 136，of which the screw perforation rate was 10.3％，all of which perforated the outer wall.There were 3 cases of cerebrospinal fluid leakage and 1 patient with C5 nerve root paralysis.None of the patients underwent incision infection，nerve injury or the rupture of the portal axis.Conclusion  One-stage posterior cervical open-door combined with pedicle screw fixation is a safe and effective method for patients with cervical spinal stenosis and instability.
2018 Vol. 24 (2): 156-159 [Abstract] ( 404 ) HTML (1 KB)  PDF (2206 KB)  ( 311 )
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