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2018 Vol. 24, No. 8
Published: 2018-08-25
 
673 Perioperative Factors Associated with Hidden Blood Loss in Patients Received PLIF
Zhang Shengfei，Zhang Liang，Zhang Zhiqiang，et al
Objective  To analyze the correlation between the hidden blood loss and perioperative factors in patients received PLIF.Methods  We retrospectively analyzed 94 patients underwent PLIF surgery.There were 49 males and 45 females，aged 40~80 years，with an average of 60.8 years old.There were 36 cases of lumbar disc herniation，46 cases of lumbar spinal stenosis，12 cases of lumbar spondylolisthesis，including 61 cases of single-segment surgery and 33 cases of double-segment surgery.And there were 54 elderly patients and 42 overweighted patients.The date were grouped according to perioperative factors such as gender，age，BMI，surgery level and operation time.And we evaluated the influence of perioperative factors on hidden blood loss.Results  The operation time was(137.92±43.85)min，and the operation time of 59 cases was more than 120 min.The average perioperative total blood loss was(1 274.65±318.43)mL，with dominant blood loss of(746.44±118.62)mL，recessive blood loss of(529.47±189.53)mL.The recessive blood loss accounted for 41.38% of total blood loss.The single factor analysis showed the differences of hidden blood loss were statistically significant between different surgery level groups and different surgery time groups(P＜0.01).Multivariate linear regression model showed surgery level was an independent risk factor influencing the hidden blood loss.The hidden blood loss in single level surgery group was significantly less than double levels surgery group(P＜0.01).However，no obvious difference in ratio of hidden blood loss to total blood loss was observed(P＞0.05).Conclusion  Surgery levels is one of the independent factors affected hidden blood loss in patients received PLIF.More surgery time may associate with more hidden blood loss.
2018 Vol. 24 (8): 673-676 [Abstract] ( 357 ) HTML (1 KB)  PDF (453 KB)  ( 254 )
677 Comparison of Spinal Endoscopic Surgery and Lumbar Interbody Fusion in Treatment of Lumbar Intervertebral Disc Herniation Associated with End-plate Osteochondritis
Deng Yiqi，Sun Fujie，Wang Mingxing，et al
Objective  To compare the effects of spinal endoscopy and lumbar interbody fusion in treatment of lumbar intervertebral disc herniation associated with endplate osteochondritis.Methods  A retrospective analysis was performed on 116 cases of patients with lumbar intervertebral disc herniation associated with endplate osteochondritis.They underwent surgery in our department from March 2015 to February 2017 and were followed up for more than 1 year.The patients had an average age of 42.7 years old(range from 33 to 69 years old).According to the treatment，they were divided into two groups.27 cases were treated with percutaneous intervertebral endoscopic surgery(35 males and 20 females).There were 3 cases of L3～4，27 cases of L4～5 and 25 cases of L5S1.Removal of herniated nucleus pulposus and nerve root decompression and release were performed on the side with severe clinical symptoms.Another 61 cases(31 cases were males and 30 were females) were treated with interbody fusion surgery，including L3～4 in 5 cases，L4～5 in 29 cases and L5S1 in 27 cases.Laminar decompression was performed on the responsible intervertebral segment to remove the intervertebral disc tissue，and interbody fusion with bone graft to provide a firm pedicle screw fixation.The operation time，length of surgical incision，volume of blood loss，length of stay were compared between two groups.During the follow-up，the Visual analogue scale(VAS) and Oswestry disability index(ODI) were observed.Excellent rate was evaluated according to the MacNab criteria.Results  All patients were received successful treatment and followed up with a mean follow-up of 17.8 months(range 12 to 24 months).The operation time，length of surgical incision，volume of blood loss，length of stay in spinal endoscopy group were better than those in lumbar interbody fusion group(P＜0.05).Compared with pre-operation，the VAS and ODI scores were decreased in the first，6th month，and final follow-up after operation in two groups(P＜0.05).However，no significant difference was observed between spinal endoscopy group and lumbar interbody fusion group(P＞0.05).There was no statistical difference in the effective rates between spinal endoscopy group(92.7%) and lumbar interbody fusion group(88.5%)(P＞0.05).Conclusion  Spinal endoscopy and interbody fusion repair can achieve good effect in the treatment of lumbar intervertebral disc herniation associated with end-plate osteochondritis，and there is no statistical difference in effect between these two groups.However，spinal endoscopic surgery has advantages of minimal trauma，short hospitalization time and quick recovery.
2018 Vol. 24 (8): 677-681 [Abstract] ( 322 ) HTML (1 KB)  PDF (1550 KB)  ( 204 )
682 Pathogens and Antimicrobial Resistance of Postoperative Wound Infection in Open Fracture Patients
Xie Chengcheng，Chen Nan，Wu Di
Objective  To investigate the distribution and antimicrobial susceptibility of pathogens causing postoperative wound infection in open fracture patients，and provide evidence for rational use of antimicrobial agents in clinical practice.Methods  Specimens of patients with postoperative wound infection in the first affiliated hospital of Kunming medical university between June 2012 and June 2016 were collected and underwent microbial culture.Pathogens were identified.Antimicrobial susceptibility tests were performed.Distribution of pathogens and antimicrobial resistance were analyzed.Results  Among the 295 patients with postoperative wound infection，male and female accounted for 63.39% and 36.61% respectively.37.97% aged 20～40 years and 35.25% of patients aged 40～60 years.A total of 345 strains were isolated.218(63.19%) of the strains were gram-negative bacteria，mainly Escherichia coli，Pseudomonas aeruginosa and Klebsiella pneumonia.112(32.46%) of them were gram-positive bacteria，mainly Staphylococcus auerus and Staphylococcus epiderrmidis.And 15(4.35%)of them were fungi.The result of antimicrobial susceptibility testing for the major gramnegative pathogens showed that the drug resistance rate to penicillin was the highest(＞96%) and the drug resistance rate to vancomycin was the lowest(0%).The result of antimicrobial susceptibility testing for the major gram-positive pathogens showed that the drug resistance rate to imipenem was the lowest，the drug resistance rate to ampicillin was the lowest.Conclusion  The main pathogens causing postoperative wound infection are gram-negative bacteria，different pathogens have different drug resistance.It is necessary for clinicians to use the antimicrobial agents rationally during clinical treatment according to antimicrobial susceptibility testing results and effective measures should also be taken to prevent and control infection.
2018 Vol. 24 (8): 682-686 [Abstract] ( 273 ) HTML (1 KB)  PDF (519 KB)  ( 283 )
687 The Short-term Efficacy of Total Hip Arthroplasty for Adult Bilateral Dysplasia of the Hip
Sun Xiangyi，Zhang Lei *，Zhou Liwu，et al
Objective  To investigate the short-term clinical efficacy of total hip arthroplasty in the treatment of developmental dysplasia of bilateral hip.Methods  A retrospective analysis of 36 patients with bilateral DDH was performed.The patients were admitted to the Nanjing General Hospital from August 2012 to August 2016.There were 4 males and 32 females，with an average age of 52.1 years ranging from 29 to 67 years old.One-stage bilateral THA was performed in 16 patients and secondary THA was performed in the other 20 patients.The operative time，length of hospital stay，difference in length of bilateral lower limbs，and Harris hip scores were assessed by medical record retrieval and postoperative follow-up.Results  All patients were followed up for 18 to 54 months.The duration of hospitalization for one-stage operation was(11.0±3.3) days，which was significantly shorter than(19.8±5.4) days for staged surgery(t＝－0.4，P＜0.05).There were no significant differences between the two surgical procedures in terms of operative time，postoperative length of the lower extremities，and Harris scor.All patients had significantly lower bilateral length differences compared with preoperative(F＝8.87，P＝0.009)，Harris score improved significantly(F＝0.02，P＝0.006).Conclusion  Total hip arthroplasty is satisfactory in the treatment of bilateral DDH patients，one-stage or second-stage surgery can be selected according to the patient's condition.There is no significant difference between the two surgical procedures for postoperative hip function recovery.
2018 Vol. 24 (8): 687-691 [Abstract] ( 355 ) HTML (1 KB)  PDF (1370 KB)  ( 281 )
692 Comparison of Efficay of Direct Anterior Approach Versus Posterolateral Approach for Total Hip Arthroplasty in the Lateral Decubitus Position
Deng Xiangtian，Liu Juncai，Li Zhong，et al

Objective  To compare the clinical efficacy of the direct anterior approach(DAA) and the posterolateral approach(PLA)for total hip arthroplasty(THA) in the lateral decubitus position.Methods  A retrospective study was performed on 102 patients who underwent primary unilateral THA that accepted in the Affiliated Hospital of Southwest Medical University from January 2016 to December 2017.There were 51 cases underwent DAA and 51 cases underwent posterolateral approach.There was no significant difference in gender，age etc.(P＞0.05).The operation time，incision length，intraoperative blood loss，postoperative drainage，acetabulumposition，hospitalization time，postoperative complications and the Harris scores were recorded and compared.Results  The patients had an average follow-up of 9.6(range，7~16)months.The operationtime in DAA and PLA was(66.8±11.3) minutes and(62.9±9.2)minutes，respectively.There was no significant difference in operation time between 2 groups(P＜0.05).The incision length in DAA and PLA was(7.2±1.6) cm and(9.8±3.1) cm，respectively.The intraoperative blood loss was(58.3±11.2) mL and(86.8±12.3) mL，respectively.The postoperative drainage was(64.8±12.6) mL and(125.1±11.2)mL，respectively.The hospitalization time was(5.4±1.1) days and(7.8±1.8)days，respectively.There were statistically significant differences between the two groups in incision length，intraoperative blood loss，postoperative drainage and hospitalization time(P＜0.05).The acetabular abduction angle was (38.4±6.2)° in the anterior group and was(37.9±5.7)° in the posterolateralgroup，showing no significant difference(P＞0.05).The acetabularanteversion angle was (17.3±5.3)° in the anterior group and was (18.6±5.1)° in the posterolateral group，showing no significant difference(P＞0.05).Harris scores of DAA was higher than that of PLA group after 1 month and 3 months of operation，the difference was statistically significant(P＜0.05).Harris scores betweenthe two groups had no statistical significance in postoperative 6 months and latest follow-up(P＞0.05).Further analysis，at 3 months after operation，the joint function score in DAA group was significantly higher than that in PLA group(P＜0.05)，while there was no significant difference in the pain score and range of motion score between 2 groups(P＞0.05).VAS of DAA was less than that of PLA after 1 day，3 days，5 days and 7 days of operation，the difference between the two groups was statistically significant(P＜0.05).There were 3 cases(5.8% ) of postoperative dislocation in PLA and no dislocation in DAA.There was 1 case(3.2% ) of lateral femoral cutaneous nerve injury in DAA.Conclusion  Compared with the posterolateral approach，the direct anterior approach in the lateral decubitus position in total hip arthroplasty had the advantages of less bleeding，lesspain，faster postoperative recovery at early follow-up.
2018 Vol. 24 (8): 692-700 [Abstract] ( 296 ) HTML (1 KB)  PDF (899 KB)  ( 244 )
696 Incidence of Venous Thrombo Embolism(VTE) in Elective Knee Arthroscopy and an Analysis about Its Prophylaxis
Ji Zhenwei，Xu Kui，Wu Peng，et al
Objective  The incidence of symptomatic venous thrombo embolism(VTE) after knee arthroscopy is uncertain.To determine the incidence，anatomical distribution of venous thrombo embolism(VTE) in limbs undergoing elective unilateral knee arthroscopy without active pharmacologic prophylaxis，to quantify the impact of risk factors on its incidence，and to evaluate the necessity of active pharmacologic prophylaxis in patients undergoing arthroscopic surgery. Methods  A retrospective cohort study of elective arthroscopic knee procedures during a twelve-month period(January 1，2015 to December 31，2015) was performed in our department of orthopedics.There were 400 patients who had elective arthroscopic knee procedures.270 were male，and 130 were female，with a mean age of(38 ± 15.2) years.The mean duration of the operation was(55 ± 21) minutes.The patients undergoing elective knee arthroscopy received general physical prophylaxis，but did not receive any kind of chemoprophylaxis.During 6 weeks post surgery，all patients having arthroscopy in our institution were routinely examined.Clinical signs of VTE were checked and recorded，and the occurrence of symptomatic deep venous thrombosis(DVT) or pulmonary embolism(PE) within 6 weeks after surgery was identified by duplex ultrasonography or pulmonary arteriography.The general risk factors of VTE were also analyzed.Results  During 6 weeks post surgery，symptomatic DVT was detected in 4(1%) patients.Of these，1 was proximal，and 3 were distal.No patient died and no patient presented with clinically suspected PE.The risk of VTE was significantly higher among patients who had a tourniquet applied for more than 60 minutes or older than 60 years.Conclusion  The incidence of symptomatic VTE after arthroscopic knee surgery is very low.Routine pharmacological prophylaxis to prevent symptomatic venous thromboembolism is likely not needed in this patient population.Older age and operation time are associated with increased risk.A specific highrisk group for the development of VTE should be identified and received effective prophylaxis.
2018 Vol. 24 (8): 696-700 [Abstract] ( 330 ) HTML (1 KB)  PDF (438 KB)  ( 247 )
701 Application of Hinged Knee Prosthesis in Total Knee Arthroplasty for Patients with Severe Valgus Knee
Wang Yakang，Guo Jianbin，Wang Tao，et al
Objective  To investigate the feasibility，safety and efficacy of Endo-model hinged knee prosthesis in total knee arthroplasty for patients with severe valgus knee.Methods  The study included 10 cases aged 29~72 years，with anaverage of 45 years old.There were 7 females and 3 males.8 cases were unilateral and 2 patients with rheumatoid arthritis were bilateral.All the patients underwent total knee arthroplasty with hinge knee joint prosthesis.Femur-tibia angle(FTA)，knee society score(KSS)，range of motion was applied to evaluate the situation of functional recovery.Results  The patients were followedup at 1，3，6，12，24，36 month after surgery.The postoperative pain was significantly decreased.The knee deformity，stability and function all was good.Extension angle all reached 180°.Angle of greatest flexion can reach 95°~125°，with anaver age of 110°.KSS was improved from 34.25 before operation to 86.73 points after operation.Lower limb deformity and joint function improved.Postoperative X-ray shows good alignment and an average FTA of 6.62°.The prosthesis was on the good place.Conclusion  The therapeutic effect of Endo-model rotational hinge knee prosthesis used to severe valgus knee is satisfactory.The function of knee joint was significantly improved after operation.However，the indications need to be strictly confined and long-term follow-up is still required.
2018 Vol. 24 (8): 701-705 [Abstract] ( 364 ) HTML (1 KB)  PDF (1841 KB)  ( 266 )
706 The Biomechanical Changes of Humeroradial Joint after Reconstructed Anterior Bundle of Elbow Medlal Collateral Ligament
Jia Yongli 1，Zuo Xianhong 2，Zhang Peinan 1，et al
Objective  To compare the biomechanical data of the complete group and reconstruction group in the anterior medial collateral ligaments of the brachial joint and the effect of reconstruct MCL with artificial tendon fixed by interfacial screw.Methods  We used the human elbow joint specimen and put the pressure sensitive film into the space of humeroradial joint，then measured the valgus laxity of elbow，the pressure and the contact area of humeroradial joint in the different state and the anterior funicle of MCL and in the different flex angle.According to the different state of the anterior funicle of MCL the specimens were divided into 2 groups：the anterior funicle complete group and the anterior funicle reconstruction group ).There were 20 cases in every group.Results  There was no significant difference in the valgus laxity within group and between groups in different flexion degrees(P＞0.05).No significant difference was found in the intraarticular pressure in elbow flexion of 30，60，and 90° within group and between groups(P＞0.05) except in elbow flexion of 0°(P＜0.05).The stress area of the humeroulnar joint in 0° flexion was significantly larger than that in 30，60，and 90° flexion in the control group(P＜0.05)，but no significant difference was found within group and between groups in the other flexion degrees(P＞0.05).Conclusion  The anterior bundle of MCL has important significance for maintaining the valgus stability of the elbow.Reconstructing the anterior bundle by using artificial tendon and interference screw can instantly restore elbow inside of the structure stability，reduce the pressure in the humeroradial joint，increase the humeroradial joint contact area，reducing the incidence of humeroradial joint chronic injury.
2018 Vol. 24 (8): 706-709 [Abstract] ( 314 ) HTML (1 KB)  PDF (489 KB)  ( 218 )
710 Application of 3D Printing Technology in Degenerative Scoliosis Orthopedics
Huang Feiqiang 1，Feng Hualong 1，He Shenghua 2
Objective  To investigate the feasibility of preoperative 3D printing in correction of degenerative scoliosis deformity.Methods  From October 2014 to November 2015，30 patients were admitted to our hospital and were diagnosed as degenerative scoliosis deformity.These were 10 males and 20 females.The mean age was(55.2±6.8)(range 45~65).They were treated by 3D printing technology combined with selective pedicle screw fixation.All patients were followed up for 12 months.The VAS score，JOA score，ODI(functional index)，SF-36 health questionnaire score were used to evaluate the clinical efficacy.Imaging Cobb angle and apical vertebral offset imaging were evaluated.And we recorded and calculated the nail-setting time.CT was used for assessment of nail placement accuracy and record the relevant complications.Results  VAS score，JOA score，ODI index and SF-36 health questionnaire score were significantly different between those before operation and after operation(P＜0.05).There were significant differences in Cobb angle and apical vertebral offset distance between those before operation and 1，6 and 12 months after operation(P＜0.05).Comparation between VAS score，JOA score，ODI index，SF-36，Cobb angle and apical vertebra offset distance at 1，6 and 12 months after operation showed no significant difference(P＞0.05).The time of nail-setting was(2.0±0.2) min and the accuracy was 95.2%(339/356).Conclusion  3D printing technology combined with selective pedicle screw technique in the treatment of degenerative scoliosis deformity is safe，efficient and accurate.
2018 Vol. 24 (8): 710-714 [Abstract] ( 329 ) HTML (1 KB)  PDF (2382 KB)  ( 469 )
715 The Effects of Remote Ischemic Post-conditioning on Fracture Healing in Aged Rats
Zhou Meng 1，Huang Jiang 2，An Shuai 2，et al
Objective  To clarify whether remote ischemic post-conditioning can promote the expression of various factors in the process of fracture healing，and thus promote fracture healing.Methods  64 aged rats(18~20 months old)were randomly divided into two groups.The ischemic postconditioning group was treated with limb remote ischemic post-conditioning and the control group was blank.At 7，14，28，42 days after fracture，rats were sacrificed subsequent.Micro-computed tomography was performed to measure healing of the bone tissue and biomechanical testing was used to test mechanical strength.In addition，the two primary angiogenic mediators，HIF-1α and vascular endothelial growth factor，as well as the osteoblast markers runt-related transcription factor 2，alkaline phosphatase and osteocalcin，were determined at the mRNA and protein levels by reverse transcription-quantitative polymerase chain reaction and western blot analysis.Results  The callus volume and gray value of the hypoxia treatment group were significantly higher than those in the control group at 14，28 days and 42 days after operation(P＜0.01).The maximal force，stiffness and work to fracture of the tibial specimens in the hypoxic treatment group were significantly higher than those in the control group(P＜0.05).The expression of HIF-1α protein was significantly higher than that of the control group(P＜0.01).The protein expression levels of ALP，OCN and Runx2 in the remote ischemic post-conditioning group were significantly higher than those in the control group at three time points.Conclusion  Fracture after short-term appropriate frequency of ischemic post-ischemic adaptation can promote aged rat tibial fracture healing，its role is to promote osteogenesis and promote angiogenesis in two ways to achieve.
2018 Vol. 24 (8): 715-720 [Abstract] ( 220 ) HTML (1 KB)  PDF (1733 KB)  ( 229 )
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