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2018 Vol. 24, No. 6
Published: 2018-06-25
 
481 Clinical Efficacy of Anterior Cervical Bridge Locking Fusion Cage in the Treatment of Degenerative Cervical Spondylosis with ACDF
Zhao Liping，Sha Weiping，Wang Liming，et al
Objective  To evaluate the clinical efficacy of ROI-C in the treatment of degenerative cervical spondylosis with anterior cervical discectomy and fusion.Methods  A retrospective analysis from October 2013 to September 2016，104 patients underwent degenerative cervical spondylosis anterior intervertebral decompression and ROI-C interbody fusion，with 108 ROI-C implanted.There were 40 cases of nerve root type cervical spondylosis and 64 cases of cervical spondylotic myelopathy.X-rays or CT were perfomed 3 days，3 months，6 months and 12 months after operation.Neural function and pain were evaluated at the end of the follow-up with the JOA and VAS score to observe the operation time，intraoperative blood loss and complications.Intervertebral height changes and intervertebral fusion were evaluated according to the final follow-up cervical X or CT.Results  104 cases were followed up for (18.41±7.39)months (ranging from 8 to 30 months).The operation time was (51.30±2.17)min in single segment procedures and (105.53±7.14)min two segment procedures；the average operative bleeding was (43.72±2.63)mL in single segment procedures and (71.57±4.20)mL in two segment procedures.In nerve root type cervical spondylosis patients，JOA and VAS score，vertebral height improved significantly from preoperative (14.53±1.02)，(7.70±1.60) and (3.94±0.78)mm to postoperative (16.79±0.95)，(2.36±0.90) and (6.76±1.11)mm (P＝0.001) at the end of follow-up.In cervical spondylotic myelopathy patients，JOA and VAS score，vertebral height improved significantly from preoperative (10.18±1.62)，(3.53±1.46) and (3.71±0.80)mm to postoperative (14.21±1.82)，(1.44±0.79) and (6.50±1.13)mm (P＝0.001)：at the end of follow-up.The average time of fusison in single segment group was (4.20±1.53)months，(5.41±6.15)months in two segment group，and 7 months in 3 segment group.No complications were observed in all the cases such as spinal cord injury，dysphagia，hoarseness and ROI-C shifting or sinking.Conclusion  In the treatment of degenerative cervical spondylosis，ACDF with ROI-C can effectively reconstruct the intervertebral height，obtaining reliable cervical intervertebral stability and fusion rate，as for shorter operative time，less bleeding，less postoperative complications and improving the neurological function and postoperative pain significantly，so ACDF using ROI-C alone in treatment of cervical spondylosis is safe，effective，and clinical effect satisfactory.
2018 Vol. 24 (6): 481-486 [Abstract] ( 371 ) HTML (1 KB)  PDF (1357 KB)  ( 308 )
487 Surgery Strategies for Lower Cervical Spine Fracture Complicated with Zygapophyseal Joints Dislocation
Objective  To explore the surgical strategies for patients of lower cervical spinefracture complicated with zygapophyseal joints dislocation.Methods  We retrospectively analyzed 47 cases of lower cervical spine fracture complicated with zygapophyseal joints dislocation，including 35 cases of males and 12 cases of females，from January，2008 to August，2016.Mean ageof the patientswas (42.2±10.8)years (range，22～65 years).Among them，19 cases underwent simple anterior decompression and internal fixation and bone graft fusion after closed reduction，and the remaining 28 cases were treated with single posterior open reduction decompression internal fixation and bone graft fusion second to the failure of closed reduction.American Spinal Injury Association (ASIA) Grade of neurologic function was used for evaluation of therapeutic effect.Results  Mean of follow-up was (21.6±8.6)months (range，12～47 months).The operation time and amount of bleeding were (97.8±7.1)min and (127.5±15.8)mL，respectively，in the group of simple anterior decompression and internalfixation and bone graft fusion.And the operation time and amount of blood loss were (127.2±8.6)min and (412.5±19.5)mL，separately，in the group ofsingle posterior open reduction decompression internal fixation and bone graft fusion.All facet dislocations achieved satisfactoryreduction after surgery.And ASIA grade in both of the two groups were significantly improved aftersurgery (P＜0.05).Mean of bone grafting fusion time (5.8±1.6)months (range，4～9 months).There was no instrumentation looseness，fracture and displacement during the follow-up.Conclusion  For the patients of lower cervical spine fracture complicated with zygapophyseal joints dislocation，once obtained closed reduction，simple anterior decompression and internal fixation and bone graft fusion is enough for decompression and stability reconstruction；once failed for closed reduction，single posterior open reduction decompression fixation and fusion is more suitable to achieve zygapophyseal joints dislocation reduction，and the recovery of neurological deficit is very satisfying due to effective spinal canal decompression.
2018 Vol. 24 (6): 487-490 [Abstract] ( 435 ) HTML (1 KB)  PDF (1721 KB)  ( 359 )
491 Tranexamic Acid Combined with Iron in Total Knee Arthroplasty：A Prospective Randomized Controlled Study
Yang Qing，Yang Yi，Yang Liu，et al
Objective  To investigate the clinical efficacy and safety of tranexamic acid combined with sucrose iron in total knee arthroplasty (TKA).Methods  From January 2016 to June 2017，180 patients were enrolled in this study and randomly assigned to tranexamic acid combined iron group (combined group)，tranexamic acid group and iron group.Record replacement at admission，the day before surgery，after surgery，three，five days of hemoglobin concentration，hematocrit.The number of blood loss，postoperative drainage and postoperative blood transfusion were recorded.Besides，the amount of preoperative blood volume，total blood loss were recorded.Results  The average age of the patients was 65 years.All preoperative data were not statistically significant (P＞0.05).The levels of preoperative hemoglobin in combination group and iron group were significantly higher than those in group tranexamicacid group (P＜0.05).At the same time，the blood loss and total blood loss were significantly lower in the combined group than in the group (P＜0.05).There were no complications such as infection，deep vein thrombosis，pulmonary embolism during follow-up.Conclusion  Tranexamic acid and iron can effectively improve the perioperative hemoglobin concentration，reduce the total blood loss，reduce postoperative blood transfusion.
2018 Vol. 24 (6): 491-509 [Abstract] ( 375 ) HTML (1 KB)  PDF (444 KB)  ( 258 )
495 Clinical Efficacy of Unicompartmental Knee Arthroplasty for Anteromedial Osteoarthritis
Yue Yongchuan 1，Liu Juncai 1，Zhang Xiaoxia 2，et al
Objective  To evaluate the clinical efficacy of UKA in the treatment of anteromedial osteoarthritis(AMAO).Methods  Clinical data of 45 patients (47 knees) who underwent OxfordⅢunicompartmental knee arthroplasty from June 2014 to June 2017 in our dept were retrospectively analyzed.The intraoperative blood loss，operation time，postoperative drainage volume and complications were recorded.The knee joint range of motion(ROM)，Oxford knee score(OKS)，hospital for special surgery score (HSS) and Western Ontario and MacMaster score(WOMAC) were recorded before operation and after operation to analysis the clinical efficacy of Oxford Ⅲ UKA.Results  Patients with good recovery after surgery and no complications such as infection and deep venous thrombosis happened. The average intraoperative blood loss was (95.8±17.5)mL，the average operation time was (83.8±12.1)min，the average postoperative drainage volume was (154.3±32.5)mL.The average follow-up time were 25.6 months(6～58 months)，and there were no sign of prosthesis loosening，polyethylene liner dislocation and progressing the lateral compartment osteoarthritis，only one case with unexplained pain happened during follow-up.Compared with preoperative ones，the last follow-up ROM，OKS，HSS，WOMAC scores were obviously improved (P＜ 0.05).Conclusion  UKA is an effective procedure for AMAO with less trauma，rapid recovery and proprioception exist.The short-term clinical efficacy is satisfied，but long-term efficacy remains to be seen.
2018 Vol. 24 (6): 495-499 [Abstract] ( 319 ) HTML (1 KB)  PDF (1146 KB)  ( 322 )
500 Sit-to-stand Biomechanics after Tumor-type Knee Arthroplasty
Zhu Zhengfei 1，Song Yixin 2，Kang Jianfeng 1，et al

Objective  To study the biomechanical characteristics of sit-to-stand after tumor-type knee arthroplasty and explore the strategies of personalized/individual rehabilitation and the pre-protection method for the healthy limbs.Methods  The gaits were collected on the sit-to-stand movement in 3 stand-up way and 5 seat height，the completion time of STS，knee flexion angle，symmetry of the ground reaction force and the force situation of the replacement side and contralateral side were respectively evaluated.Results  With hand on armrest，hands akimbo，hand on 720 mm desktop，patients after tumor-type knee arthroplasty (the experimental group) spend 5.6 seconds，2.5 seconds and 4.6 seconds，while patients spend 2.2 seconds，3.0 seconds and 3.6 seconds in control group.The difference was statistically significant in hand on armrest (P＜0.05).The symmetry of ground reaction force in the sit-to-stand movement was between 0.5 to 1.0.Conclusion  Six months after tumor-type knee arthroplasty，the healthy side was still the mainstay on the sit-to-stand movement.The STS showed asymmetry.After operation，the early use of double lower extremity personalized orthosis，brace or personalized orthopedic insoles may promote effective rehabilitation of knee function and pre-protective effects of healthy side.In the process of rehabilitation，sympathetic rehabilitation strategies should be strictly implemented after surgery.
2018 Vol. 24 (6): 500-522 [Abstract] ( 278 ) HTML (1 KB)  PDF (1355 KB)  ( 257 )
505 The Clinical Effect of Modified Kinder Surgery with HyProCure in Treatment of Flatfoot with Accessory Navicular
Zhang Dexiang，Li Yuehui，Zhong Xiao，et al
Objective  To evaluate the short-term effectiveness of modified Kinder surgical with HyProCure subtalar stabilization in treatment of flatfoot with accessory navicular.Methods  Between December 2014 and Octobetr 2016，17 patients (24 feet) with flatfoot related with accessory navicular were treated，which received conservative treatment for more than half a year，but the pain symptoms were not relieved.There were 6 males (8 feet) and 11 females (16 feet) with the average age of 13.5 years (range，11～17 years).The American Orthopaedic Foot and Ankle Society (AOFAS) ankle and foot function score was (71.7±4.3)，the preoperative pain visual analogue scale (VAS) was (5.54±0.93).The preoperative examination showed type Ⅱ accessory navicular，with posterior foot mild valgus deformity.The height of the arch was reduced in varying degrees.All of them received excision of accessory navicular，placement of HyProCure subtalar stabilization and reconstruction of posterior tibial tendon insertion on navicular with anchor.There were percutaneous Achilles tendon lengthening in 8 feet and gastrocnemius lysis in 7 feet and spring ligament tightening surgery in 5 feet.The talar-first metatarsal angle (Meary 's angle) and calcaneus inclination angle (Pitch angle) were measured on the lateral X-ray，and the talonavicular coverage angle (TCA) and talocalcaneal angle(Kite angle) were measured on the frontal，the AOFAS ankle and foot function score and VAS score were used to evaluate the effectiveness.Results  Seventeen patients (24 feet) were followed up for 7 to 23 months with an average of 13.6 months.The talar first metatarsal angle and calcaneus inclination angle on the lateral X ray and the talonavicular coverage angle and talocalcaneal angle on the frontal were improved (P＜0.05).Compared with preoperation，AOFAS ankle and foot function score and VAS score were significantly improved at last follow-up，the difference were statistically significant(P＜0.05).Conclusion  The modified Kinder surgical with HyProCure subtalar stabilization is a good choice for the treatment of flatfoot related with accessory navicular，which can effectively correct the flatfoot deformity，recover foot function and induce less complications，but the long-term effectiveness needs further follow-up.
2018 Vol. 24 (6): 505-509 [Abstract] ( 335 ) HTML (1 KB)  PDF (930 KB)  ( 332 )
510 Direct Anterior Approach Versus Posterior Approach for Total Hip Arthroplasty Meta-analysis
Peng Yonggang，Ren Jiangdong，Zhang Kun，et al
Objective  To performed a systematic review and meta-analysis to assess the outcome of direct anterior approach (DAA) and posterior approach (PA) for total hip arthroplasty.Methods  Published studies comparing DAA and PA for THA were searched in major databases from the inception of each database until October 2017 without language restriction.Eligible studies were selected according to inclusion and exclution criteria.The data were extracted and the quality of included studies was evaluated by two reviewers.Meta analysis was performed using RevMan 5.3 software.Results  A total of 10 prospective comparative studies (7 randomized) with patients treated with DAA (n＝407) or PA (n＝405) were included.The result of Meta-analysis showed that DAA was superior to PA in early postoperative function rehabilitation and acticities and the patients in DAA group had less pain than these in PA after operation.The incidence of lateral femoral cutaneous nerve injury and the percentage of acetabular cups placed within the Lewinnek safe zone were higher in DAA group than PA group.There was no significant difference in the incidence of intraoperative fractures，postoperative dislocation，incision complications，heterotopic ossification and groin pain between the two groups.Neither were the operation time，length of hospital stay，intraoperative blood less or angle of acetabular cup anteversion angle of cup inclination. Conclusion  The early recovery of DAA for THA is better than that of PA after operation.Postoperative pain in DAA group is less，but the incidence of lateral femoral cutaneous nerve injury is high.
2018 Vol. 24 (6): 510-515 [Abstract] ( 321 ) HTML (1 KB)  PDF (2701 KB)  ( 250 )
516 Finite Element Analysis of “F” Fixation Technique for the Femoral Neck Fractures
Xu Jinghong，Tang Zhihui，Mao Chengpeng，et al
Objective  Through the three-dimensional finite element method，the advantages and disadvantages of the “F” fixation method and the traditional fixation method were compared in the treatment of femoral neck fracture，in order to provide the most optimal one for clinical application.Methods  Using the reverse modeling technology，the bone of normal adult volunteers proximal femur was scanned by CT.Mimics10.0 and Geomagic 2012 software were used to reconstruct the 3D structure of the femur，the femoral neck fracture model (Pauwels angle=70 degrees) was simulated in the Cero3.0，And then the nails were implanted according to the traditional fixation method (the control group) and the “F” fixation method (the experimental group).In Abaqus 6.14，two working conditions，single foot standing and double foot standing，were calculated.Results  a) In the control group，the stress was concentrated on the upper end of bolt，the bottom of the two lower screws，and the calcar femorale.In the experimental group，the stress mainly concentrated in the screw，and distributed evenly along the screw to the nail tail and surrounding bone.The stress distribution at the fracture end of the fracture，especially at the calcar femorale.b)Compared with the control group，the experimental group had significantly reduced stress distance (P＜0.01) at the fracture distance of the calcar femorale，reduced total displacement of the femoral head (P＜0.05) and the relative displacement of the fracture end (P＜0.05).Conclusion  The shape of “F” technology can not only eliminate the torsional stress and shear stress at the fracture end while maintaining axial compressive stress.The strong oblique nail implantation can form new core pillar in the cantilever structure，thereby effectively reduce the shear stress of fracture that provides good mechanical environment for fracture healing.
2018 Vol. 24 (6): 516-518 [Abstract] ( 375 ) HTML (1 KB)  PDF (581 KB)  ( 334 )
519 Effect of Partialthickness Tear of Supraspinatus on the Distribution of Tendon Stress：Finite Element Analysis
Xing Qiujuan 1，Zhao Dongfeng 2，Dai Weiwei 3，et al
Objective  To study the effect of partial-thickness tear of the supraspinatus tendon by finite element analysis.Methods  The shoulder of volunteer was scanned by CT.The CT images were imported into Mimics 16.0，and segmented scapula，proximal humerus，supraspinatus muscle，and thenthe models were imported into Geomagic studio 2012 to fit the NURBS surface of the models.The supraspinatus tendon was divided into 3 regions.According to the damage depth，3 model were build (A group 20%，B group 40%，C group 60%).All models were meshed in Hypermesh 13.0，and normal supraspinatus muscle injury model was uesed as control.Through changing the relative position of glenoid humeral joint，the above models were fixed at different abduction degree (0°、30°、60°、90°).Then all models were exported to Abaqus 6.14.Results  a)During the abduction of the shoulder，the middle region of the supraspinatus was the most stressed，followed by the anterior and posterior regions.b)With the increase of shoulder abduction angle，the stress produced by supraspinatus muscle was maximal at abduction of 30°，which was significantly different from other abduction angles (P＜0.05).The stress of tendon in 90 °abduction angles was still significantly greater than that of 0°angles，and there was a significant difference (P＜0.05).c) In the three groups of anterior and posterior region injury，the tendon stress in group C was significantly greater than that in group A and group B (P＜0.01)，and there was no significant difference between group A and B group (P＞0.05).d) In the three groups of middle area injuries，the tendon stress in group B and group C was significantly greater than that in group A (P＜0.01)，and there was no significant difference between group B and group C (P＞0.05).Conclusion  The stress in the middle supraspinatus is significantly higher than that in the anterior and posterior regions.The depth of injury is 40% at the middle part of supraspinatus，and 60% at the anterior and posterior parts，that can cause the stress concentration around the injured tendons and extend to full thickness injury，that should be actively reconstructed.
2018 Vol. 24 (6): 519-522 [Abstract] ( 345 ) HTML (1 KB)  PDF (550 KB)  ( 332 )
523 Study on the Mechanism of SIRT1 Toregulates Osteoblast Differentiation Through the PI3K/AKT Pathway
Zhi Liqiang 1，Yang Yixin 2，Xu Mao 3，et al
Objective  To studying the interaction between the SIRT1 gene and the PI3K-AKT pathway and investigate the effect of SIRT1 on osteoblast differentiation. Methods  Osteoblasts were extracted from the skull of Sprague Dawley rats and cultured for 3～4 passages.Then Cells were randomized into control group，resveratrol group and resveratrol + EX-527 group.Cell Counting Kit-8 (CCK-8) was used to determine the cytotoxicity of resveratrol and EX-527.Alkaline phosphatase (ALP) and alizarin red S staining were used to detect ALP levels and calcium nodules，respectively.Immunohistochemistry was used to observe the production of type I collagen to determine the differentiation of cells.The expression of SIRT1，Runt-related transcription factor 2 (RUNX2)，Osteopontin (OPN) and the phosphorylation levels of phosphatidylinositol 3 kinase(PI3K)andprotein kinaseB(AKT).Results  Resveratrol and EX-527 had no effect on cell proliferation (P＞0.05).ALP level and calcium nodules increased significantly after addition of resveratrol，but decreased significantly after addition of EX-527.The amont of Type I collagen were up-regulated because of the resveratrol.The expression of RUNX2 and OPN in osteoblast increased with the increase of SIRT1 expression (P＜0.01 or P＜0.001).When SIRT1 was inhibited，the protein expression of related factors also decreased (P＜0.001).Concurrently，the phosphorylated levels of PI3K and AKT also showed SIRT1-dependent up-regulation and down-regulation (P＜0.05 or P＜0.001).Conclusion  The effect of SIRT1 on rat osteoblast differentiation may be mediated through the PI3K-AKT pathway.
2018 Vol. 24 (6): 523-534 [Abstract] ( 443 ) HTML (1 KB)  PDF (1850 KB)  ( 269 )
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