Quick Search
  Office Online
  Journal Online
Current Issue
Archive
Advanced Search
Read Articles
Download Articles
2018 Vol. 24, No. 7
Published: 2018-07-25
 
577 Analysis of Hidden Blood Loss During Perioperative Period and the Influential Factors after Surgery of Thoracolumbar Burst Fracture
Chu Peilin，Shi Yuebin *，Hao peng，et al
Objective  To investigat the HBL and determine its influential factors after surgery.Methods  A total of 78 patients between January 2015 and January 2017 were available and included in the study.The demographic information of the patients was collected，include patients’age，gender，weight，height，fracture levels，surgery approach，coagulation，percentage of vertebral height loss and restoration.HBL was calculated according to Gross’s formula.Influential factors were further analyzed by multivariate linear regression analysis.Results  The mean HBL was(303.5±59.0)mL，account for mean(53.0±10.2)% for total blood loss.Multiple and stepwise regression analysis revealed that the preoperative APPT，percentage of anterior and medium vertebral height restoration，were positively correlated with HBL.The association between HBL and the influential factors can analysis based on the regression model equation as follows：HBL= ［1+e(10.81+10.11×APTT+189.52×anterior height restoration +22.01×medium height restoration)］－1.Conclusion  HBL during perioperative period is much larger than what we considered and account for a substantial portion of the total blood loss.The blood loss，preoperative APPT，percentage of anterior and medium vertebral height restoration are positively correlated with HBL.HBL needs to be paid more attention to ensure patients’ safety.
2018 Vol. 24 (7): 577-580 [Abstract] ( 325 ) HTML (1 KB)  PDF (493 KB)  ( 347 )
581 Characteristics and Clinical Significance of Recurrent Thoracolumbar Tuberculosis
Objective  To provide guidance for early clinical discovery，early treatment and improvement of the prognosis of patients with recurrent thoracolumbar tuberculosis.Methods  A retrospective analysis was made of 69 patients with recurrent thoracolumbar tuberculosis admitted to our hospital from January 2006 to 2015，including 40 males and 29 females aged(37.5±14.5)years，13 cases of thoracic tuberculosis，20 cases of thoracolumbar tuberculosis and 32 cases of lumbar tuberculosis.4 cases of lumbosacral tuberculosis，a statistical analysis of their clinical manifestations，imaging features and laboratory examinations.Results  Pain which is the major clinical manifestations was found in 55.1% of the recurrent patients.89.9% patients developed paravertebral abscess，which is the most common imaging manifestation.Tuberculosis bacteria culture and drug sensitivity test was performed in 53 patients.A total of 22 patients developed drug resistance.Drug resistant tuberculosis accounted for 41.5%.28 patients with pulmonary tuberculosis，2 patients with pulmonary tuberculosis associated with urinary system tuberculosis and 1 patient with tuberculous peritonitis.Before the recurrence，32 cases had 6 months，9 cases had 6 to 12 months，8 cases had 12 to 18 months，4 cases had 18 to 24 month，3 cases had 24 to 36 months，5 cases 36 to 48 months，3 cases had 48 to 60 months，5 cases had 60 months or more，the longest time was 84 months(7 years).43 patients had only one recurrence，and 26 patients recurred repeatedly.The recurrence rate was 37.7% in the recurrent patients.Conclusion  2 years after surgery is the most concentrated time for recurrence in Surgical treatment of thoracolumbar tuberculosis.If pain，sinus tract，local mass and nerve symptoms，ESR and C-reactive protein were higher than normal 3 month after operation，the possibility of recurrence after operation should be warned.If we find paravertebral abscess，internal fixation loosening，bone destruction and so on，it is very important to improve the prognosis of patients by taking treatment measures as early as possible.
2018 Vol. 24 (7): 581-588 [Abstract] ( 298 ) HTML (1 KB)  PDF (382 KB)  ( 206 )
584 Facet Joint Angle and Facet Tropism in L4~5 Degenerative Lumbar Spondylolisthesis
Guo Machao，Lu Shibao *，Kong Chao

Objective  To explore the role of facet joint angle(FJA)and facet tropism(FT)in degenerative lumbar spondylolisthesis(DLS).Methods In group DLS，50 patients were enrolled in our hospital from January 2016 to December 2017.There were18 male and 32 women，with an average age of(63.94±9.96)years.Control group had 50 patients from our inpatient ward or outpatient department.Lumbar CT showed no obvious abnormalities and only lumbar degenerative changes.There were a total of 50 patients，22 men and 28 women，with an average age of(62.05±11.42)years.In the DLS group，FJA of each patient at L3～4，L4～5and L5S1 was measured on CT.The independent sample t test was used to compare the difference of FJA between the DLS group and the normal group.Pfirrmann grading of intervertebral disc degeneration between the DLS and control groups were compared with the Mann-Whitney U test.Results  The results of the Mann-Whitney U test demonstrated no significant difference in Pfirrmann grading at the L3～4，L4～5，and L5S1 levels between the DLS and control groups(p = 0.641，0.953，and 0.795，respectively).The DLS group was compared with the normal group，and there was a statistical difference between the two groups in the L4～5(P＜0.001).There were statistical differences between the two groups in the L3～4(P＝0.002).There was no statistical difference between the two groups in the L5S1(P＝0.903).Conclusion  FT is a risk factor for the occurrence of DLS.DLS patients have more sagittal FJA than normal people.We tend to think that this is the result of the second reconstitution of FJ in the occurrence of DLS.
2018 Vol. 24 (7): 584-588 [Abstract] ( 280 ) HTML (1 KB)  PDF (880 KB)  ( 268 )
589 Effectiveness of Femoral Supracondylar Osteotomy For the Treatment of Valgus Knee with Osteoarthritis
Deng xiangtian 1，Wang xinyuan 2，Liu juncai 1，et al
Objective  To evaluate the clinical efficacy of medial close supracondylar osteotomy of the femoral condyle with Tomofix locking compression palte for the treatment of valgus knee osteoarthritis.Methods  A retrospective study was performed on 24 patients with valgus knee and osteoarthritis who underwent medial close supracondylar osteotomyof the femoral condyle combined with Tomofixlocking compression paltefixation in the Affiliated Hospital of Southwest Medical University from January 2016 to December 2017.There were 9 males(9 knees)and 15 females(15 knees)，aged 30~58 years(mean，43.6 years).The disease duration was 1 to 8 years(mean，5.6 years).According to Kellgren-Lawrenee grading standard，13 knees were classified as stage I，9 knees as stage Ⅱ，and 2 knees as stage Ⅲ.The full-length AP view of the lower extremity and the weight bearing AP and lateral view of the knee were obtained before and after operation，and the lateral distal femoral angle，femoral-tibial angle were evaluated.Clinical outcomes were comprehensively assessed according to the bone healing time，postoperative complications，progress of knee osteoarthritis after operation，theLysholm score，Hospital for Special Surgery(HSS)score，and International Knee Documentation Committee(IKDC)score before and after operation.Results  All the wounds healed primarily，and no complication of infection，deep vein thrombosis，nonunion or delayed union was observed.All patients were followed up 9~22 months(mean，14.8 months).At last follow-up，the valgus deformity of knee joint was corrected in all patients after operation.The lateral distal femoral angles was improved from the preoperative(78.36±2.78)° to the final follow up time(84.72±3.64)°(P＜0.05).Tibiofemoral angle was improved from the preoperative(170.41±3.86)° to the final follow up time(181.45±2.78)°(P＜0.05).Lysholmscore，Hospital of Special Surgery(HSS)score，and International Knee Documentation Committee(IKDC)score were significantly higher than preoperative ones(P＜0.05).Conclusion  The medial close supracondylar osteotomy combined with Tomofix locking compression palte fixation is a convient method for the treatment of valgus knee osteoarthritis and can effectively correct the valgus deformity.The short-term clinical efficacy is satisfactory，but long-term efficacy remains to be investigated.
2018 Vol. 24 (7): 589-592 [Abstract] ( 358 ) HTML (1 KB)  PDF (881 KB)  ( 301 )
593 Comparison of Clinical Efficacy of SuperPATH and Anterolateral Small Incision Approach in THA
Huang Wenwen，Yin Dong，Huang Yu，et al
Objective  To compare the short-term clinical efficacy between the SuperPATH minimally invasive approach and the anterior lateral small incision.approach in total hip arthroplasty.Methods  From Feb 2015 to Feb 2017，80 patients undrwent THA were involved.All cases were randomly divided into 2 groups.40 cases were treated by using SuperPATH approach as Super PATH group，while another 40 cases were treated by using anterolateral small incision approach as small incision group.The length of incision，operative time，intraoperative bleeding，postoperative drainage，hospitalization time，abduction angle and anteversion angle time were compared between the two groups.The visual pain analogue score(VAS)before operation and the VAS score of 1 day，days，1month and 3 months after operation and the Harris score of hip function before operation，and in 7 days，1 month and 6 months after operation were compared between the two groups.Results  In SuperPATH group，the incision length was smaller than that of the anterior lateral small incision group(P＜0.05)；The hemorrhage，postoperative drainage and hospitalization time in SuperPATH group were less than those in the anterior lateral small incision group，and the difference was statistically significant(P＜0.05)，but SuperPATH group had longer operation time than the small incision group(P＜0.05).Compared with the small incision group，the patient in the SuperPATH suffered less pain within 1day and 7days(P＜0.05)，similar pain in 1month and 3 months(P＞0.05).The SuperPATH group's Harris hip score was increased significantly than small incision group from 7days，1 month and 3months after surgery(P＜0.05)，However，there was no significant difference in hip function between the two groups from 6 months after surgery(P＞0.05).And there was no significant difference of abduction angle and angle of anteversion between 2 groups.Conclusion  Both SuperPATH approach and anterolateral small incision approach can obtain good hip function in THA，but Super PATH approach can obtain a good joint stability，less trauma，faster postoperative recovery，but which influence on long-term effect needs further follow-up.
2018 Vol. 24 (7): 593-604 [Abstract] ( 313 ) HTML (1 KB)  PDF (463 KB)  ( 277 )
597 Clinical Effect of A-C Tightrope Fixation with Assistance of Arthroscopy in Treatment of Acromioclavicular Joint Dislocation
Chen Luanping 1，Deng Jinjing 1，Sun Tianxiang 2，et al
Objective  To Analyse the clinical effect of A-C tightrope fixation with assistance of arthroscopy in treatment of acromioclavicular joint dislocation.Methods From May 2012 to Sept 2013，there were 25 patients of acromioclavicular joint dislocation(Rockwood Ⅲ Ⅳ)treated with double titianium plate A-C tightrope fixation under arthroscopic vision，there were 13 males and 12 females，with an average age of (30.5±6.2)years(25 to 56 years )，during the surgey we could apply indirect or direct acromioclavicular joint dislocation reduction with arthroscopic inspection，and fix coracoid and distance clavicle with A-C tightrope ropes，Karlsson scores were applied to evaluate clinic effect in last follow-up.Results  All the patient underwent the surgery successfully and there was no infection，no recurrent dislocation and inernal fixation loss.All the patients were followed up，the duration ranged from 12 to 18 months，with average of (15.3±3.8)months.The result of follow-up were excellent in 18 patients，good in 5 patients and poor in 2 patients with standard of Karlsson sores.The excellence and good rate was 92%.Conclusion  There is some advantages of A-C tightrope fixation with assistance of arthroscopy in treatment of acromioclavicular joint dislocation，including less trauma，accurate manipulatation，satisficatory shoulder fuction recovery.
2018 Vol. 24 (7): 597-599 [Abstract] ( 419 ) HTML (1 KB)  PDF (823 KB)  ( 343 )
600 Effect of Active Body Temperature Protection on Coagulation Function and Bleeding in Lower Limb Fracture Surgery
Jia Chuan 1，2，Qu Yuxing 2，Gao Yi
Objective To observe the effect of active temperature protection on the coagulation function and the change of blood volume in patients with lower limb fracture. Methods  80 cases of ASA Ⅰ~Ⅱ patients with lower limb fractures and open reduction were randomly divided into the active temperature protection group and the control group.The room temperature wass set to 26° when temperature protection groups entered into the operating room，and the temperature had been reset to 22°till surgery starts.3M inflatable thermal insulation blankets covered their chest and the target body temperature was set to 38℃.The blankets were separated from the skin of the patients.Intravenous fluids temperature was 37℃，and rinse fluid temperature was also 37℃.The control group patients were covered with the surgical towel sheet，with room temperature being set to 22℃；thermal blankets were not used，and room temperature liquid were used for infusion and rinse.Auricular temperature of two groups of patients were recorded in the operating room(T1)，tangent(T2)，1h(T3)after the surgery，1h(T4)after the operation.And venous thrombosis were respectively measured.Intraoperative blood loss and 36h drainage were recorded，and the amountr of blood transfusions was recorded.Results  a)Compared with the body temperature protection group，the ear temperature of the control group was significantly lower than the active body temperature protection group during operation T4，and the difference was statistically significant(P＜0.05)b)The blooding volume in the active body temperature protection group and drainage volume were lower than those in the control group(P＜0.05)；c)Compared with the body temperature protection group，T3 and T4 were significantly prolonged in the formation of fibroin protein and the time of the formation of blood clots.The maximum amplitude of the control group was significantly shortened in T4，which presents statistical significance.(P＜0.05).Conclusion  Low temperature can induce inhibition of blood coagulation factor activity and platelet function in the orthopaedic patients with fracture of lower limb during the intraoperative and postoperative process，which leads to increased blood loss and flow rate as well as an increase in the probability of blood transfusion.Active temperature protection can reduce the body heat loss，decrease fibrinolysis and reduce the blood loss in patients with lower extremity fracture.
2018 Vol. 24 (7): 600-604 [Abstract] ( 321 ) HTML (1 KB)  PDF (508 KB)  ( 261 )
605 The Effect of Patellofemoral Joint Pressure on Functional Recovery after Knee Arthroplasty
Liu Tao 1，Du Mengnan 2，Gao Shijun 1，et al
Objective  To investigate the effect of patellafemerol joint contact stress on the function of knee joint.Methods  A total of 24 patients who accepted unilateral total knee arthroplasty(male 8 cases，female 16 cases)from April 2016 to December 2016.To measure the PFJS in different angle of knee flexion(30°、60°、90°、120°)before and after the prothesis was replaced with pressure sensitive films.The patients were divide into two groups according to the indentation(the dumbbell-shaped and the comet-shaped).The knee joint flexion，kujala score，HSS knee joint score and knee anterior pain were followed up for 1~1.5 years at lest The results were statistically processed.Results  The general condition of the patient，preoperative HSS，ROM and the patellofemoral joint stress had no obvious statistical significance.According to indentation，14 patients were gouped into the dumbbell set.The patellofemoral joint pressure distribution was normal，and imaging showed no obvious tilt.10 patients grouped into the comet group，including 7 patients with patellofemoral pressure distribution too tends to the lateral contact surfaces，more than 3 main tending to the inside contact pressure distribution.Postoperative imaging showed all patients with patellar tilt to different exten.Follow-up results showed two groups of patients with postoperative HSS score，ROM and knee pain，were better than preoperative(P＜0.05).The dumbbell group’s kujala score and ROM were better than the comet group(P＜0.05).There was no significant difference between group HSS scores(P＜0.05).Conclusion  Patellofemoral joint pressure has a certain effect on the recovery of knee joint function after TKA and the adjustment of patellofemoral joint biomechanics should be paid attention to.
2018 Vol. 24 (7): 605-608 [Abstract] ( 295 ) HTML (1 KB)  PDF (793 KB)  ( 294 )
609 Establishment and Evaluation of Goat Chronic Cervical Spinal Cord Compression Model
Shen Baoliang，Li Yunfei，Han Qintian，et al
Objective  To develop a new animal model of chronic cervical compressive myelopathy and to assess its feasibility.Methods  Twelve Chong-ming goats were divided into two groups：control group(n＝3)and experimental group(n＝9).A new spinal cord compression device was placed into the C3 vertebral body by anterior approach operation，and the syringe valve was fixed subcutaneously.In the experimental group 0.1 ml of contrast agent were injected into the balloon every week after operation，which gradually expanded the balloon，resulting in the continuous compression to the experimental animal spinal cord.In the control group，after the implanation of compression device，we only punctured with the needle but did not inject the contrast agent each week.In the 4th week，8th week and 12th week，the Tarlov scoring method was used to grade the spinal motor function of the experimental animals，and the cervical vertebral X-ray and CT examination were performed，and 2 experimental animals were euthanized at different time points for pathological examination of the compression spinal section.Results  The Tarlov scores were 5(normal)at all time points in the control group.Tarlov scores were not changed in the experimental group in the 4th week(n＝9).In the 8th week(n＝7)the Tarlov score was 4 in 3 goats and 5 in 4 goats.In the 12th week(n＝5)，the Tarlov score was 3 in 3 goats，2 in 2 goats.Imaging showed no obvious abnormalities in the spinal cord.The balloon compression system of the experimental group was stable，and the spinal cord was gradually compressed with the enlargement of the balloon after the continuous injection of the contrast agent.There was no obvious abnormality in the pathological examination.No obvious abnormalities were observed in the experimental group at the 4th week.In the 8th week，we found the spinal cord ventral horn neurons degeneration，decreased cell body size，but not seen obvious decrease of neuron number.Some white matter appeared mild demyelination changes.Some axises showed cavitation degeneration.In the 12th week，the neuronal cell degeneration was obvious.Necrosis，degeneration of nucleus，the diffuse demyelination of white matter，and the obvious degeneration of axonal vacuolar were found.Conclusion  Modeling experimental animal postoperative spinal movement function，imaging and pathological examination results in chronic compression characteristic of cervical myelopathy show that the new type of spinal cord compression system can establish a stable and repeatable chronic animal model of spinal cord compression.
2018 Vol. 24 (7): 609-612 [Abstract] ( 257 ) HTML (1 KB)  PDF (1426 KB)  ( 268 )
613 Exploration of Reasonable Position of Screws using Intramedullary Fixation for Geratic Intertrochanteric Fracture with Quantitative CT
Han Dacheng，Wang Jialong，Long Anhua，et al
Objective  To discuss the reasonable position of screws in intramedullary fixation for intertrochanteric fractures.We used quantitative computed tomography(QCT)method to detect the bone mineral density(BMD)of the cadaveric femoral head and made the quantitative analysis.Methods  The 16 femoral heads of 12 corpses were minute dissected and dislocated from the hip joint.All the femoral heads accepted the QCT scan.The geometry center of the femoral head as the origin point.The X axis was defined as the long axis along the femoral neck and going through the origin point，and the Y axis was defined as perpendicular to the X axis and going through the origin point either in coronary plane，while the Z axis pass the same origin point of the femoral head and perpendicular to both the X axis and Y axis in oblique sagittal plane.These three axes perpendicular to each other through the origin point，constructed the three-dimensional structure in space.The scan thickness was 3mm along every axis，and the distribution curve of bone mineral density within the femoral bone was described after statistical analysis.Results  The BMD of these femoral heads in the X，Y，Z axis showed the unimodal curve of continuous change，the sample density distribution was consistent(P＞0.05).The relative peak value of BMD areas appeared in proximal of femoral head original point within about 0.9~1.5 cm along the X axis，bone mineral density peak area along the Y axis and Z axis of 0.9 cm and 0.6 cm on both sides of original point(P＜0.05).The high bone density area of the three axes forms a space structure indicating the optimal position area for the lag screws of the femoral head.Conclusion  According to the determination of quantitative CT，the BMD curve change of the femoral heads appears along the direction of the vector law，and high relative BMD value exist in this space area，indicated that we should put the lag screws in this space area with relative high BMD value using intramedullary fixation system in the treatment of senile intertrochanteric fractures，in order to obtain good clinical results.
2018 Vol. 24 (7): 613-624 [Abstract] ( 306 ) HTML (1 KB)  PDF (1758 KB)  ( 299 )
Copyright © Editorial Board of sygkzz
     ���������� 14010702070875��
Supported by:Beijing Magtech