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2018 Vol. 24, No. 11
Published: 2018-11-25
 
961 Clinical Application of Percutaneous Endoscopic Posterior Cervical Discectomy in Patients with Adjacent Segment Disease after Cervical Fusion
Yang Lijin 1，Chen Bolai 2，Lin Yongpeng 2，et al
Objective  To investigate the clinical value of percutaneous endoscopic posterior cervical discectomy in patients with adjacent segment disease after cervical fusion.Methods  From April 2015 to June 2017，8 cases of adjacent segment disease after anterior cervical fusion were treated in our department，including 6 males and 2 females，aged 49~77 years (average 60.9 years).The adjacent segment disease occurred in 48~162 months after fusion (average 94.3 months)，there were 4 cases of cervical spondylotic radiculopathy，3 cases of cervical spondylotic myelopathy and 1 case of mixed cervical spondylosis.PPECD therapy was used and record the operation time，the days of hospitalization and the complications.The Japanese Orthopedic Association (JOA) score and cervical disability function index (Neck Disability Index，NDI) were used to evaluate neurological function，visual analogue scale(VAS) was used to evaluate neck and upper limb pain，in the last follow-up，the clinical efficacy was evaluated according to the Odom standard and the JOA improvement rate.The lateral X-ray of the cervical spine was used to measure the intervertebral height of the surgical segment.The ROM of the surgical segment was measured by the dynamic X-ray and the data were compared before and after the follow-up.Results  All cases were successfully performed under the complete percutaneous endoscopy，no cases needed to be changed.There were 9 sections of the operative segment，7 cases of single segment，1 cases of double segment，1 cases of C3～4 segment，4 cases of C4～5 segment，1 cases of C5～6，C6～7 double segment and 2 cases of C6～7 segment，the operation time was 62~140 min (average 94.8 min)，and the average number of hospitalization days was 4.8 days.8 cases were followed up，the follow-up of 8~33 months (average  15.9±6.7 months)，VAS，NDI and JOA were significantly improved at 1 weeks after operation (P＜0.05)，and VAS，NDI and JOA at the last time were further improved than those at 1 weeks after operation.The difference was statistically significant (P＜0.05).The preoperative surgical segment ROM was (5.27±1.26)°，(5.63±1.48)° at 1 week，and (5.44±1.56)° at the last follow-up.There was no statistical difference before and after surgery (P＞0.05).There was no significant difference in the height of intervertebral space between preoperative and final follow-up (P＞0.05).There were no injuries of the spinal nerve and important vessels during the operation，and no complications such as wound infection and hematoma were found after operation.According to the Odom standard，the excellent rate at the last follow-up was 87.5% (excellent 5 cases，good 2 cases，middle 1 cases，0 poor cases)，and the improvement rate of JOA score was 78.14%.Conclusion  As a newly minimally invasive technique，PPECD technology provides a safe and effective way in the treatment of adjacent segment disease after cervical fusion and achieves good recent clinical results.
2018 Vol. 24 (11): 961-966 [Abstract] ( 361 ) HTML (1 KB)  PDF (2172 KB)  ( 344 )
967 Family Doctor Service Mode for Patients with Lumbar Disc Disease
Zeng Wuxiong，Huang Binggang，Liu Shutian，et al
Objective  To explore the effects of the family doctor service mode on the self-perception burden and negative emotion in patients with lumbar disc disease.Methods  From January 2017 to June 2017 98 cases of lumbar intervertebral disc herniation in our community hospital were selected as the research objects by the convenient sampling，and divided into the routine group and the family doctor group，with 49 cases in each group.The routine group received the intervention measures under the guidance of the conventional management mode，and the family doctor group received the guidance of the family doctor service model.The self perceived burden and negative emotion were compared between the normal group and the family doctor group.Results  Before intervention，there were no statistically significant difference between the family doctor group and the normall group patients in the economic burden，emotional burden，physical burden，Self rating Anxiety Scale score(SAS)，Self rating Depression Scale score(SDS)(P＞0.05).After three months of intervention，the scores of economic burden，emotional burden，physical burden，Self rating Anxiety Scale score，Self rating Depression Scale score between the family doctor group and the concentional group were better tan those of the control group，and the decrease of the family doctor group was more significantly (P＜0.05).Conclusion  Individualized health management can significantly reduce the self-perception burden of patients with lumbar disc diseases，which can significantly improve the negative emotions of patients，and it is worthy of clinical application and promotion.
2018 Vol. 24 (11): 967-974 [Abstract] ( 276 ) HTML (1 KB)  PDF (456 KB)  ( 384 )
970 Clinical Analysis of 3D Printing Technique Assisted Pedicle Screw Placement in the Treatment of Thoracolumbar Fractures
Liu Zhengpeng 1，Wang Yahui 1，Chu Li 2，et al
Objective  To compare the effect of 3D printing technique，CT and X-ray assisting pedicle screw placement in the treatment of thoracolumbar fractures. Methods  Sixty-six patients with thoracolumbar fractures treated in our hospital were retrospectively analyzed and divided into two groups according to the treatment method.33 patients in the control group were treated with conventional CT and X-ray assisting pedicle screw operation and 33 patients in the observation group were treated with pedicle screw operation assisted with 3D printing.The indicators including operation time，intraoperative X-ray exposure，intraoperative blood loss，intraoperative blood transfusion，nail placement related information including number of staples，accurate nail placement，accuracy of nail placement.consistent screws including sagittal screw implantation angle，difference in screw internal inclination angle，difference in horizontal position of screw insertion point，reduction index of injured vertebrae including front and rear height ratio of injured vertebrae，sagittal kyphosis Cobb angle and complications were compared between the two groups during perioperative period.Results  The operation time，intraoperative blood loss，intraoperative X-ray exposure and intraoperative blood transfusion in the observation group were significantly lower than those in control group (P＜0.05).The nail placement accuracy of the observation group was 94.4%，which was significantly higher than that of control group (74.5%) (P＜0.05).Sagittal screw implantation angle，difference in screw internal inclination angle，difference in horizontal position of screw insertion point in the observation group were significantly lower than those in control group (P＜0.05).After treatment，front and back height ratio of injured spine of two groups significantly increased(P＜0.05)，and the sagittal kyphosis Cobb angle of two groups significantly decreased(P＜0.05)；the front and back height ratio of injured spine of the observation groupwas significantly higher than that of the control group at 0.5 and 1 year after treatment (P＜0.05)，and the sagittal kyphosis Cobb angle of injured spine of the observation groupwas significantly lower than thatof the control group (P＜0.05).The complication rate of the observation group was 6.1%，which was lower than that of the control group (12.2%) (P＞0.05).Conclusion  Compared with conventional CT and X-ray，3D-print assisted pedicle screw therapy in treatment of thoracolumbar fractures has the advantages of short operative time，less intraoperative blood loss and transfusion，low radiation damage，high accuracy of setting screws，correcting the spine deformity significantly and low complication.
2018 Vol. 24 (11): 970-974 [Abstract] ( 292 ) HTML (1 KB)  PDF (1736 KB)  ( 296 )
975 Comparison of Two Surgical Approaches in the Treatment of Thoracolumbar Fractures with Spinal Cord Injury
Jie Junjie，Li Ruofei，Liang Huiping
Objective  To compare the clinical effects of two operative approaches in the treatment of thoracolumbar fractures with spinal cord injury.Methods  We included 78 patients with thoracolumbar fractures and spinal cord injuries treated in our hospital (2016.1~2017.1).According to the surgical approach，there were 40 patients in the anterior group and 38 in the posterior approach group.The operative time，blood loss，blood transfusion，bone graft fusion time，Cobb angle，spinal canal stenosis rate and spinal neurological function were compared between the two groups.Results  The operation time，blood loss，and blood transfusion volume in the anterior group were significantly higher than those in the posterior group (P＜0.05).There was no significant difference in the fusion time between the anterior group and the posterior group (P＞0.05).There was no significant difference in Cobb angle and spinal stenosis rate between the two groups before surgery and 1 week after surgery (P＞0.05).At 6 months after operation，the Cobb angle of the anterior group was lower than that of the posterior group (P＜0.05).There was no significant difference in the rate of spinal stenosis between the two groups (P＞0.05).At 1 week and 6 months after operation，Cobb in both groups was significantly lower than that before surgery (P＜0.05)，and the rate of spinal stenosis was significantly higher than before surgery (P＜0.05).At 6 months after operation，there was no significant difference in the ASIA spinal neurological function between the two groups (P＞0.05).Conclusion  Anterior surgery has the disadvantage of greater surgical trauma in patients with thoracolumbar fractures and spinal cord injuries compared with posterior surgery，but Cobb angle maintenance after surgery is better，and there is no significant difference in spinal cord functional recovery between the two treatment.
2018 Vol. 24 (11): 975-978 [Abstract] ( 281 ) HTML (1 KB)  PDF (1553 KB)  ( 237 )
979 Correlated Risk Factors Analysis of the Mortality of Pelvic Fracture Patients
Fu Weide，Mi Dong，Zhang Xu，et al
Objective  To explore the correlated risk factors of the mortality of pelvic fracture patients.Methods  We retrospectively analyzed the clinical data of the pelvic fracture patients from January 2013 to January 2018，including age，sex，hospital stays，vital signs，injury severity scale (ISS)，Glasgow coma scale (GCS)，visiting time after injury，type of pelvic fracture，associated injuries，the intravascular embolotherapy and the pelvic fracture fixation.Then we used the logistic regression method to analyze the risk factors of the mortality of pelvic fracture patients.Results  This study included 356 pelvic fracture patients totally，47 of them died，the mortality rate was 13.2%.The result of logistic regression showed that shock index (OR＝23.246，CI：11.732~76.758)，lowest PaO2/FiO2 (OR＝37.926，CI：18.347~87.237)，blood transfusion in 24 hours (OR＝3.236，CI：1.232~10.356)，ISS (OR＝85.116，CI：35.011~115.326)，GCS(OR＝15.231，CI：5.785~26.234)，associated head injury(OR＝12.322，CI：6.14329.579)，associated abdomen injury(OR＝6.213，CI：2.260~15.237)，associated perineum injury(OR＝1.314，CI：1.072~4.213)，associated spine injury(OR＝4.526，CI：1.127~16.349)，associated limbs injury(OR＝8.012，CI：2.104~32.768)，open fracture pelvis (OR＝12.359，CI：3.273~41.786)，Tile A type (OR＝2.783，CI：1.126~5.382) and Tile C type (OR＝6.917，CI：1.245~13.627) were the risk factors of the mortality of pelvis fracture.Conclusion  serious trauma，blood transfusion in 24 hours，shock，coma and associated head，abdomen，perineum，spine as well as limbs injuries are the risk factors of the mortality of pelvis fracture.
2018 Vol. 24 (11): 979-990 [Abstract] ( 330 ) HTML (1 KB)  PDF (406 KB)  ( 255 )
982 Related Factors Analysis of Femoral Head Osteonecrosis after Cannulated Screw Fixation in Femoral Neck Fracture
Wang Rui，Xue Dong，Gan HongQuan，et al
ObjectiveTo investigate the related factors of avascular necrosis of femoral head after cannulated screw fixation in patients with femoral neck fracture.Methods A retrospective study of 108 patients diagnosed with femoral neck fracture by closed reduction and percutaneous cannulated screw fixation between April 2014and February 2016，23 patients had femoral head necrosis (positive group) and 85 had no femoral head necrosis (negative group) in postoperative follow-up，and analyzed the possible related factors of the two groups.Results  21.30% of patients suffered femoral head osteonecrosis during the follow-up.Farden type of fractype (P＝0.01)，Body mass Index (P＝0.02) and three-dimensional reconstruction of femoral neck fracture in different directions were the risk factors of osteonecrosis of femoral head，but age，sex，whether preoperative traction，time to wait for surgery，full weight-bearing time，whether the impants removed，there was no significant difference between two groups(P＞0.05).Conclusion  For the patients with femoral neck fracture，we should strictly grasp the indications before the operation of cannulated screw fixation，and adopt hip replacement in time for the patients with high osteonecrosis risk such as sensible fracture displacement and obese，appropriate weight loss after surgery was necessary.
2018 Vol. 24 (11): 982-986 [Abstract] ( 325 ) HTML (1 KB)  PDF (1873 KB)  ( 213 )
987 Treatment of AORI Ⅱa type tibial defects of osteoarthritis with varus knee in primary TKA
Yang Shuncheng，Li Zhong，Chen Ge，et al
Objective  To explore the surgical technique and short-term effect of AORI Ⅱa type tibial defects of osteoarthritis with varus knee in primary total knee arthroplasty.Methods  Eight patients (10 knees) suffered from severe genu varum and osteoarthritis and AORI Ⅱa type tibial defects.There were 3 knees of male patients and 7 knees of female patients.The average age was(68.8±6.7) years (from 61 to 79 years).Posterior CruciateStabilizing Total Knee Prostheses were used for all patients.Varus deformity were corrected by removal of the osteophytes，outward shift of osteotomy，selected soft tissue release.Met al block and stem extension were used for all patients，autologous bone graft for 2 knees.The range of motion and X-ray were observed regularly and the results were evaluated according to Lysholmscores.Results  Intraoperative soft tissue balance was good，and restricted met al block was not used.The patients were followed up for 14~50 months (average 26 months) after operation.The Lysholm score was (25.16±5.04) before operation，(85.4±10.3) at last follow-up.The ROM was (61.37±10.24) ° before operation，(86.1±11.4)° at last follow-up.At the last follow-up，there was no complication of tibial plateau collapse and prosthesis loosening.ROM and Lysholm scores were significantly better than those before surgery(P＜0.05).Conclusion  The short-term effectiveness of total knee arthroplasty using removal of the osteophytes，outward shift of osteotomy，selected soft tissue release，met al block augmentation and stem extension for AORI Ⅱa type tibial defects and varus knee deformity is satisfactory.Satisfactory alignment，stability of the tibia prosthesis and function of knee can be achieved.
2018 Vol. 24 (11): 987-990 [Abstract] ( 249 ) HTML (1 KB)  PDF (997 KB)  ( 416 )
991 Calcaneal Osteotomy Combined with Modified Kidner Surgery In Treatment of Flat foot with Accessory Navicular
CaiJie 1，Qu Fufeng 1，Xu Junkui 2，et al
Objective  To evaluate the clinical effect of calcaneal displacement osteotomy combined with modified Kidner operation for treatment of flatfoot related with accessory navicular by clinical and imaging findings.Methods  From January 2014 to December 2015，our department treated 19 cases (25 feet)flatfoot related with accessory navicular.There were 7 males (9 feet)，12 females (16 feet)；aged 18 to 52 years with an average age of (33.2±9.8) years.All patients underwent conservative treatment more than 6 months，All the patients were flexible flat foot，with varying degrees of flat feet and calcaneal valgus.The posterior tibial tendon was preformed and reconstructed with a wire anchor.The preoperative and final follow-up were evaluated by the Maryland function score and the VAS pain score.Before and after the operation，the patients underwent weight-bearing anteroposterior and lateral X-ray of foot and recorded the change of calcaneus inclination angle (Pitch)，talocalcaneal angle (Kite) and talar first metatarsal (Meary ' s) angle in lateral X-ray offoot，the Talonavicular coverage angle (TCA) and the talar first metatarsal angle (T1M1) of the weight-bearing anteroposterior x-ray.Results  All the patients were followed up.The follow-up time of 14~36 months，the average follow-up time was (23.6±7.1) months.At the final follow-up patients Maryland score was (92.1±2.1) points，VAS pain score was (0.7±0.9)，compared with preoperative were statistically significant (P＜0.01).Postoperative weightbearing lateral radiographs of calcaneus inclination angle，talocalcaneal angle and talar first metatarsal angle，weight-bearing anteroposterior radiograph of the talonavicular coverage angle，talus first metatarsal angle werecompared with those preoperative.The differences were statistically significant (P＜0.01).All incisions were healed without internal fixation related complications.At the final follow-up，the pain of the foot disappeared，and the deformity was significantly improved.Conclusion  The medial displacement calcaneal osteotomy combined with modified Kidner surgical for treatment of flatfoot related with accessory navicular can effectively correct the flatfoot deformity，postoperative foot function recovery，with less complications.
2018 Vol. 24 (11): 991-994 [Abstract] ( 458 ) HTML (1 KB)  PDF (1133 KB)  ( 206 )
995 Analysis of Coracoid Process Morphological Changes on Subscapular Tendon Lesion
Ling Yiming 1，Zhang Kaiwei 2，Shen Fengjun 2
Objective  To explore the numerical changes of five methods of measuring coracoid process morphology and to determine which indexes are the most significant in judging the subscapular tendon injury caused by coracoid impingement and provide reference for clinical diagnosis.Methods  The clinical data of 100 patients with subscapular tendon injury were collected and examined by MRI.There were 42 male and 58 female patients.The injury were found in 52 left shoulder and 48 right shoulder，with the injury grade 0 in 22 cases，grade 1 in 36 cases，grade 2 in 23 cases，grade 3 in 19 cases).The coracoid-humeral distanc(CH)，the coracoid index(CI)，the angle between coracoid body and joint pelvis(A1)，the angle between coracoid neck and articular pelvis(A2)，and the angle between coracoid neck and coracoid were measured(A3).Results  The P values of each group were calculated respectively(α＝0.05)，CH：P＝0.000，with statistical significance；CI：P＝0.259，no statistical significance；A1：P＝0.018，no statistical significance；A2：P＝0.007，with statistical signi-ficance；A3：P＝0.000，with statistical significance.Conclusion  The morphological changes of coracoid process can lead to coracoid process impingement to some extent，and eventually lead to subscapular tendon injury.
2018 Vol. 24 (11): 995-1001 [Abstract] ( 288 ) HTML (1 KB)  PDF (889 KB)  ( 284 )
998 Relationship of the Femoral Intercondylar Angle with Anterior Cruciate Ligament Injury
Huang Mengquan，Guo Naiming，Peng Jun，et al
Objective  To determine relationships of the femoral intercondylar angle and tibial plateau slope with anterior cruciate ligament injury.Methods  From January 2014 to June 2015，thirty-four patients with ACL-injured (case group) and ACL-intact (control group) in each group were researched retrospectively.The medial tibial plateau slope (MTPS)，lateral tibial plateau slope (LTPS)，and femoral intercondylar angle (FIA) was measured on MR images.The data were compared between different genders and groups.Logistic regression analysis was performed to determine the influence of the anatomic factors on ACL status (injured or intact).Results  No significant differences in the mean values of FIA，MTPS and LTPS were found between male and female patients.The FIA in the case group was significantly smaller than that in control group (P＝0.021).LTPS in the case group was significantly higher than the control (P＝0.004).There were significant different in FIA，LTPS and ACL (P＝0.025，P＝0.002).Logist regression model of merging probability showed that AUC＝0.764.Conclusion  The femoral intercondylar angle and the lateral tibial plateau slope are risk factors of ACL injury.It can be more accurate to predict the ACL injury by united FIA and LTPS.
2018 Vol. 24 (11): 998-1001 [Abstract] ( 302 ) HTML (1 KB)  PDF (1032 KB)  ( 217 )
1002 Study on Expression and Biological Function of Matrix Met alloproteinases 11 in Osteosarcoma
Miu Xiaogang，Abuduaini Rewuti，Wang Li，et al
Objective  To detect the expression of matrix met alloproteinases 11 (MMP-11) in osteosarcoma tissues and adjacent matched normal osteosarcoma tissues，and explore the effect of silencing MMP-11 expression on the biological behaviors of osteosarcoma cells.Methods  MMP-11 expression was detected in 40 paired osteosarcoma tissues and adjacent matched normal osteosarcoma tissues using Quantitative RT-PCR analysis and immunohistochemistry technology.MMP-11 siRNA and siRNA control were transfected into osteosarcoma cells (HOS and Saos-2).RNA and protein were collected after 48 h，and Quantitative RT-PCR analysis and Western blots were applied to detected the expression of MMP-11 in osteosarcoma cells.3-(4，5-dimethyl-2-thiazolyl)-2，5-diphenyl-2-H-tetrazolium bromide (MTT)，wound-healing assay and flow cytometry were applied to detected the growth，migration and apoptosis of osteosarcoma cells after RNAi-mediated silencing of MMP-11，respectively.Results  The MMP-11 mRNA expression in osteosarcoma tissues was significantly up regulated than adjacent matched normal osteosarcoma tissues (P＜0.05).The mRNA expression levels of MMP-11 in the adjacent matched normal osteosarcoma tissues was (1.0±0.22)，while its relative expression in osteosarcoma tissues was (3.94±0.79)(P＜0.05).Immunohistochemical technique also showed that the positive rate of MMP-11 protein in osteosarcoma was significantly higher than that of in the adjacent matched normal osteosarcoma tissues (P＜0.05).Transfection of MMP-11 siRNA in osteosarcoma cells significantly reduced the expression levels of MMP-11 (P＜0.05).Knockdown of MMP-11 markedly inhibited cell growth and migration，and promoted cell apoptosis (P＜0.05).Conclusion  MMP-11 is high expression in osteosarcoma.Knockdown of MMP-11 inhibits cell proliferation and migration，and induces cell apoptosis in osteosarcoma cells，suggesting MMP-11 acts as an oncogene involved in the development of osteosarcoma.
2018 Vol. 24 (11): 1002-1005 [Abstract] ( 249 ) HTML (1 KB)  PDF (1521 KB)  ( 178 )
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