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2018 Vol. 24, No. 3
Published: 2018-03-25
 
195 Multiplefactor Analysis of Length of Stay Following Lumbar Spine Surgery
Guo Weijun 1，2，Cai Dongling 2，Chen Xiaofeng 2，et al
Objective  To identify predictors of length of stay(LOS) after lumbar spine surgery.Methods  Retrospective analysis was made on the clinical data of patients who were underwent open，posterior lumbar instrumented fusion with decompression by the orthopedic spine service at one institution between May 2016 and May 2017.LOS was determined from the date of surgery to the date of discharge.Predictors of LOS were investigated with a multivariate stepwise regression model，including pre-surgery factors(patient demographics，American Society of Anesthesiologists score and major medical comorbidities including diabetes，hypertension，pulmonary disease，heart disease or renal insufficiency) and perioperative factors(estimated blood loss，blood transfusion，fluids administered，surgery time，the methods of decompression，number of levels fused，drainage duration，blood transfusion after surgery，postoperative drainage volume and complications).Results  A total of 226 patients were identified.LOS ranged from 6 days to 34 days，with a median of 15 days.60(26.5％) patients were defined as the extended LOS group.Multivariate stepwise regression identified age(P＝0.010)，estimated blood loss(EBL)(P＜0.001)，and the methods of decompression(P＜0.001) as significant predictors of extended LOS.Conclusion  Age，estimated blood loss and the way of decompression in the surgery are the identified variables associating with LOS.Therefore，controlling blood loss during surgery and electing appropriate techniques of posterior decompression may be beneficial to shorten the length of hospital stay after surgery.
2018 Vol. 24 (3): 195-288 [Abstract] ( 347 ) HTML (1 KB)  PDF (670 KB)  ( 304 )
197 Early Clinical Effect and Safety of Minimally Invasive Surgery Transforaminal Lumbar Interbody Fusion in the Treatment of Lumbar Spondylolisthesis
Bai Liang，Zhuang Quankui
Objective  To analyze the early curative effect and safety of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar spondylolisthesis.Methods  60cases of lumbar spondylolisthesis patients treated in our hospital during January 2015 to June 2017 were recruited in this study and randomly divided into observation group and control group.30 patients in observation group wase given MIS-TLIF surgical intervention，while another 30 patients in control group was given conventional posterior lumbar intervertebral fusion (PLIF).All the patients were followed up for least 3 months after operation.The difference of operation time，intraoperative blood transfusion and postoperative suction drainage between two groups were compared.Plain lumbar spine X-ray or CT examination was conducted preoperative and 3 months after operation to observe the change of spondylolisthesis in two groups.VAS and ODI scoring system were used to assess patients postoperative pain and lumbar function recovery before and 3 days，1month and 3 months after operation.The overall prognosis and fine rate were caculated according to the MacNab standard.Results  The operating time in observation group was longer than control group，while the bed time，hospitalization time，intraoperative blood transfusion and postoperative suction drainage were lower than the control group (P＜0.05).The spondylolisthesis were 5.53° and 5.42° in two groups，while they were descended to 1.31°and 1.35°respectively.In two groups，there was statistical difference before and after operation(P＜0.05)，while with no statistical difference between two groups(P＞0.05).The VAS and ODI scores in observation group 3 days，1 month and 3month after operation were lower than that of control group (P＜0.05).The fine rate in observation group was 86.67％ and higher than 63.33％ in control group (P＜0.05).The incidence of complications，observation group was 6.67％，while the control group was 10.00％.There was no statistically significant difference between the two groups (P＞0.05).Conclusion  The therapeutic effect of MIS-TLIF in the treatment of lumbar spondylolisthesis was good and helpful to lumbar functional recovery.It has the advantages of small trauma，rapid recovery，thus was worthy of clinical promotion.
2018 Vol. 24 (3): 197-200 [Abstract] ( 365 ) HTML (1 KB)  PDF (1057 KB)  ( 329 )
201 Comparison of Percutaneous and Open Pedicle Screw Fixation Across Injured Veatebrae in the Treatment of Thoracolumbar Fracture
Chen Lei，Jing Juehua，Qian Jun，et al
Objective  To compare outcomes between percutaneous and open pedicle screw fixation across injured veatebrae in the treatment of thoracolumbar fracture. Methods  36 patients with thoracolumbar fracture who were treated with pedicle screw fixation across injured veatebrae were retrospectively reviewed.There were 26 males and 10 females，at the age of 19～63 years old，averagely (43.1±10.4) years old.16 patients underwent percutaneous pedicle screw fixation, and 20 patients underwent open pedicle screw fixation.Intraoperative blood loss，operation time，visual analogue scale(VAS)，Oswestry disability index(ODI) scores，Cobb angel，anterior height of fractured vertebrae were measured.Results  Blood loss in the percutaneous group was significantly less than in the open group(P＜0.05).VAS，ODI scores in the percutaneous group were significantly lower than in the open group in every follow-up time after surgery(P＜0.05).There was no significant difference in Cobb angel，anterior height of fractured vertebrae during follow-up between two groups(P＞0.05).Conclusion  Compared with open surgery，percutaneous pedicle screw fixation across injured veatebrae in the treatment of thoracolumbar fracture resulted in reduced injury，provided earlier recovery and better outcomes.
2018 Vol. 24 (3): 201-247 [Abstract] ( 343 ) HTML (1 KB)  PDF (1928 KB)  ( 296 )
205 Effect of Wiltse Approach for Pedicle Screw Fixation on the Function of Spinal Structure and Electrophysiological Condition of Multifidus in Patients with Lumbar Disc Herniation
Hou Zhengxuan，Liu Ningbo，Yuan Wenjie，et al
Objective  To investigate the effect of wiltse approach for pedicle screw fixation on the spinal structure and multifidus in patients with lumbar disc herniation.  Methods We retrospectively researched 74 cases of patients who were diagnosed with single segmental lumbar disc herniation and underwent surgical treatments in our hospital from October 2014 to August 2015.The patients were randomly divided into the observation group(37 cases) and control group (37 cases).They received non fusion internal fixation through Wiltse approach and posterior midline approach respectively.The surgical treatment，the recovery of spinal structure and function，the morphology and electrophysiological condition of the multiple muscles，the incidence of adverse reactions were compared between the two groups.Results  Both of the two groups had 2 cases of patients lost in the follow-up.The operation time of the two groups had no significant difference(P＞0.05)，the intraoperative blood loss and postoperative drainage of the observation group was less than the control group，and its length of stay was shorter.The differences were statistically significant (P＜0.05).12 and 24 months after the surgery，lumbar VAS score in the observation group was lower than the control group，and the ROM in the observation group was smaller than the control group，and the difference was statistically significant (P＜0.05)，while there was no statistical difference on JOA score，ODI score，PDH and FH between the two groups(P＞0.05).After the treatment，compared with the control group，the observation group had larger multifidus cross-sectional area，lower fatty infiltration classification，higher median frequency and mean amplitude of multifidus，and the difference were statistically significant (P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups (P＞0.05).Conclusion  Compared with the posterior midline approach，patients with Wiltse approach for pedicle screw fixation's operation have better condition，the structure and function of the spinal column are restored quickly，and the effect on the multifidus is smaller.It is safe method and worthy of popularization and application.
2018 Vol. 24 (3): 205-210 [Abstract] ( 411 ) HTML (1 KB)  PDF (1238 KB)  ( 332 )
211 Study on the Relationship between Cement Injection Rate and Post Operative Vertebral Fracture in PVP
Hu Le，Wang Jingcheng，Wang Yongxiang，et al
Objective  Percutaneous vertebroplasty is the most widely used method for the treatment of osteoporotic vertebral compression fractures (OVCF) by injecting bone cement into the fractured vertebral body.The purpose of our study was to identify the possible factors causing adjacent vertebral fractures after vertebroplasty and the appropriate amount of bone cement injection.Methods  From September 2012 to March 2016，98 patients with OVCF undergoing vertebroplasty were selected and 75 patients with complete follow-up information were included.22 had adjacent vertebral fracture (refracture group) during the follow-up period，and 53 patients had no adjacent vertebral fracture (control group).Gender，age，body weight，bone mineral density (BMD) and bone cement injection rate (injection volume of bone cement and bone fracture vertebral volume percentage) of the two groups were compared.The correlation between the above factors and adjacent vertebral fracture was analyzed.Results  Both groups of patients got effectively relief of back pain.In fracture group，there were 2 male cases and 20 female cases.The mean age was 75.77 years old.The mean weight was 51.24 kilogram.The mean BMD was －2.78 g/m2.In control group，there were 17 male cases and 36 female cases.The mean age was 73.19 years old.The mean weight was 53.08 kilogram.The mean BMD was －2.62 g/m2.Bone cement injection rate were analyzed by ROC curve.The AUC was 0.846(P＜0.001)，and the cutoff value was 0.405.It was found that the difference of sex，BMD and bone cement injection rate between the two groups were statistically significant(P＜0.05)，while it has no significant differences in the age and weight between two groups(P＞0.05).Conclusion  The bone cement injection rate，BMD value and gender are statistically significantly related to the occurrence of adjacent vertebral fractures after vertebroplasty，and the cement injection rate is more than 40.5％，which is easy to cause the adjacent vertebral fracture of the vertebral body.
2018 Vol. 24 (3): 211-222 [Abstract] ( 434 ) HTML (1 KB)  PDF (1644 KB)  ( 258 )
215 Efficacy of Three Dimensional Memory Fixator in Repair of Posterior Wall Acetabular Fractures with Posterior Dislocation
Lei Yukai 1，Qu Zhijun 2，Xu Shuogui 3
Objective  To observe the influence of three dimensional memory fixator in repair of posterior wall fracture complicated with posterior dislocation of joint on curative effect and hip joint function recovery.Methods  91 cases of patients with posterior wall fracture complicated with posterior dislocation of joint treated in our hospital were selected as the study objects.According to different internal fixations，the patients were divided into three-dimensional memory group (45 cases) and reconstructive plate group (46 cases).The three-dimensional memory group underwent three dimensional memory internal fixators repair，and the reconstructive plate group underwent reconstruction plate internal fixation.Clinical indicators，hip function，clinical efficacy were observed in the two groups，and the incidence of complications was calculated.Results  Operation time，intraoperative blood loss in three-dimensional memory group were significantly lower than those in the reconstructive plate group (P＜0.05).After 1 year treatment，joint deformity，mobility，pain degree and limb function score were significantly higher than those before treatment in the two groups (P＜0.05).Those in the three-dimensional memory group were significantly higher than those in the reconstructive plate group (P＜0.05).The excellent and good rate of the three-dimensional memory group was 91.30％，slightly higher than that of 82.22％ of the reconstructive plate group (P＞0.05).Complication rate of 3D memory group was 4.35％，slightly lower than that of 13.33％ in the reconstructive plate group (P＞0.05).Conclusion  Three dimensional memory fixator in Repair of posterior wall fracture complicated with posterior dislocation of joint，it can effectively promote the recovery of hip joint function，with less complications and definite clinical effect.
2018 Vol. 24 (3): 215-218 [Abstract] ( 287 ) HTML (1 KB)  PDF (1418 KB)  ( 269 )
219 Treatment of Inferior Tibiofibular Instability with Anterior Inferior Tibiofibular Ligament Augmentation Repair
Zhou Jinhua 1，Yan Xiaoyu 2，Xia Rongang 2，et al
Objective  To explore the clinical effect of the anterior inferior tibiofibular ligament (AITFL) repair technique with augmentation in the treatment of inferior tibiofibular joint instability.Methods  From March 2012 to December 2015，a total of 155 patients with ankle fractures with inferior tibiofibular instability treated in our hospital were randomly divided into two groups.There were 77 cases in AITFL repair with augmentation group treated with anatomical repair of AITFL and augmentation with an anchor.There were 78 patients in screws treatment group underwent standard screw fixation.The fraction defective of inferior tibiofibular joint reduction，inferior tibiofibular re-diastasis，ankle pain，Olerud-Molander ankle function score，and visible medical costs were observed.Results  Fractrues in both groups successfully healed.CT scan showed fraction defective of inferior tibiofibular joint reduction were 2.6％ (2/77) and 23.1％ (18/78) in the AITFL group and screw group，respectively.In the later follow-up，no patients had significant re-diastasis of inferior tibiofibular joint in AITFL group，while re-diastasis happened in 8.9％ (7/78) patients in screw group.At 3 months，6 months and 12 months after operation，the results of OMAS in AITFL group were higher than that in screw group，and the difference was statistically significant.No patients needed secondary surgery in AITFL group.But all patients underwent screw removal in screw group.The average visible medical expense of AITFL group was lower than that of the screw group.There was no serious complication in both groups.Conclusion  To treat inferior tibiofibular joint instability in cases of posterior malleolus fracture fixation and incomplete rupture of the posterior tibiofibular ligament without posterior malleolus fracture，the technique of AITFL repair with augmentation could be used as a alternative to the inferior tibiofibular screws fixation，and it could be obtained a reliable stability and satisfactory clinical results.In addition，other advantages of the technique included the good tibiofibular joint reduction，simplicity of operation，less damage，quick function recovery and no need for secondary surgery.
2018 Vol. 24 (3): 219-222 [Abstract] ( 351 ) HTML (1 KB)  PDF (1185 KB)  ( 229 )
223 Effect of Dexmedetomidine on Monitoring of Motor Evoked Potential in Anterior Cervical Surgery
Yan Bin，Huang Xiaohong，Wu Yuanjue，et al
Objective  To evaluate effect of dexmedetomidine for motor evoked potential monitoring during cervical spine surgery.Methods  90 patients undergoing single segment anterior cervical decompression were randomly assigned to a high-dose group，a low-dose group and a control group.The high-dose group was given a dosage of 1 μg /kg dexmede to midineat 10 minutes before the induction，while the low-dose group was given 0.5μg/kg dexmedetomidine and the control group received only the same dosage of saline injection.The amplitude and latency of motor evoked potential(MEP) was measured in three groups after drug administration，and the difference in amplitude and latency between the three groups was compared.At the same time，the effective extraction rate of MEP after cervical decompression was recorded and compared between the three group.Results  The high dosage of dexmedetomidine significantly decreased the amplitude of MEP and prolonged the latency，with statistically significance when compared with the control group.By contrast，the low dosage of dexmedetomidine had little influence on the amplitude and latency of MEP when compared with the control group.After the decompression of the cervical spine，the high dosage of dexmedetomidine resulted in the decrease of the effective extraction rate of ME while the low dose had little effect on the effective extraction rate of MEP.Conclusion  Different dosage of dexmedetomidine will affect the MEP monitoring during spinal surgery.The high dosage causes the decreased of amplitude，the prolonged of latency and the decreased of effective extraction rate.Therefore，the dosage of dexmedetomidine should be maintained at 0.5～1.0 g/kg during anesthesia induction，which will avoid the falsenegative result of MEP and improve the accuracy of monitoring during surgery.
2018 Vol. 24 (3): 223-225 [Abstract] ( 345 ) HTML (1 KB)  PDF (361 KB)  ( 315 )
226 Epidemiological Investigation for Knee Osteoarthritis of Kirgiz in Akqi County
Yu Yinghao 1，Zhao Jijun 1*，Ai-shan Er-tu 2，et al
Objective  To investigate the incidence and risk factors of knee osteoarthritis in Kirgiz population in Akqi.Methods  Samples were selected randomly from Kirgiz residents in Akqi.All of them fulfilled questionnaires at home，and those who had pain at knee within one month were examined with X-ray.SPSS 18.0 was used to analyze the data.Results  1 498 Kirgizes were included in the study，and the incidence of KOA in Akqi is 37.18％.The incidence in pastoral areas was higher than that in city，while the incidence in female was higher than that in male.These differences were statisticly significant (P＜0.05).Cold weather，climbing hills，working in squat position and kneeling may be risk factors of KOA.Conclusion  The incidence of KOA of those Kirgizes who were above 40 years old in Akqi is 37.18％.Cold weather，climbing hills，working in squat position and kneeling may be risk factors of KOA.
2018 Vol. 24 (3): 226-229 [Abstract] ( 365 ) HTML (1 KB)  PDF (511 KB)  ( 280 )
230 The Epidemiological Analysis of 1 080 Patients with Ankle Fractures
Zhu Wei，Qiu Xusheng，Shi Hongfei，et al
Objective  To analyze the sex and age，characteristic of patients suffering ankle fracture as well as its lateral and seasonal distribution.Methods  According to the database of Nanjing Drum Tower Hospital，the clinical data of 1080 ankle fracture cases from January 2005 to December 2016 were collected and analyzed.The sex and age characteristic，as well as lateral and seasonal distribution were analyzed statistically.Results  There were 598 male patients (55.4％，598/1 080) and 482 female patients (44.6％，482/1 080) in 1080 patients suffering ankle fracture totally.The incidence of ankle fracture in men under the age of 60 (62.2％，460/740) was more than that in women (37.8％，280/740).Besides，women over 60 years old (59.4％，200/340) was more likely suffering from ankle fracture than men of the same age (40.6％，138/340).The incidence rate of left ankle fractures (45.4％，496/1 080) is lower than that of right ones (51.0％，551/1 080).When comparing with other age groups，men from 30 to 59 years old and women from 60 to 69 years old have a higher risk of ankle fracture.The incidences in 14～19 years old and over 70 years old groups in winter were relatively high，while 20～29，30～39，40～49，50～59 year-old groups were relatively uniform distribution in all seasons.Conclusion  Ankle fractures，which is prone to be the right side，are more commom in men under 60 years old and women over 60 years old. Adolescents and the elderly are relatively easy to suffer，the remaining present a uniform distribution in all seasons.
2018 Vol. 24 (3): 230-233 [Abstract] ( 386 ) HTML (1 KB)  PDF (592 KB)  ( 285 )
234 Biomechanical Study of New Internal Fixation Device for the Greater Tuberosity Fracture of Humerus
Xue Zhaolong，Meng Yanli，Wang Qinye，et al
Objective  Biomechanical tests were performed on a new type of internal fixator for great tuberosity fractures of the humerus to test the mechanical stability of the internal fixation and the feasibility of the clinical trial and compare the biomechanical stability of cannulated screws，tension band and new type of internal fixation for the treatment of large tuberosity fractures of the humerus.Methods  18 fresh frozen adult cadaveric humeral specimens with rotator cuff muscle and a greater tuberosity fracture model were established.The samples were randomly divided into 3 groups.Hollow screws，tension band and new type of internal fixator were used to fix the great tubercle fracture.Before the test，each model were given 3 times of loading and unloading pretreatment.The loading rate was 10mm/min，and the pressure was between 0 and 80 N.There were 30 seconds between loads to eliminate the muscle relaxation effect and viscoelastic specimen model.The load value was set to zero in the end.Under protective load (900N)，each specimen was subjected to constant loading (10 mm/min).The displacement size and the corresponding load condition of the specimen were recorded automatically by computer software of the experimental machine.The greater tuberosity load when fracture had displacement of 2mm and 5mm was chosen to compare.Results  The loading of the three groups of specimens (cannulated screws，tension band and new type of internal fixator group) were ［(201.18±7.14)N，(238.83±31.04)N and (240.74±5.19)N］respectively，when the greater tuberosity had displacement of 2mm.Compared with the cannulated screw group，the tension band group was statistically significant (P＜0.01).Compared with the cannulated screw group，the new internal fixator group had statistical difference (P＜0.01)，and there was no significant difference between the new internal fixator group and the tension band group (P＞0.05).The compressive stress of three groups of specimens (cannulated screw tension band group，model group，new internal fixation group) were ［(410.48±32.79)N，(530.48±31.04)N，(728.36±10.43)N］respectively，when the greater tuberosity displacement was 5mm.Between the three groups，the tension band group was statistically significant difference compared with cannulated screws group (P＜0.01).Compared with cannulated screws group，the new type of internal fixator group was significantly better(P＜0.01) And there was statistical significance of the new internal fixator group compared with tension band group (P＜0.01).Conclusion  Compared with cannulated screws or tension bands，the new internal fixation device for the greater tuberosity of humerus shows obvious biomechanical advantages.The new type of internal fixator is theoretically stable for the fracture of large tuberosity of humerus and provides the basis for further clinical trials.
2018 Vol. 24 (3): 234-238 [Abstract] ( 345 ) HTML (1 KB)  PDF (1334 KB)  ( 377 )
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