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2018 Vol. 24, No. 12
Published: 2018-12-25
 
1057 Retrospective Study of the Clinical Effect of Quadrant Channels through Wiltse Approach in Treatment of Single-level Thoracolumbar Bursting Fractures
Li Sibo，Chen Xiaochun，Jiang Haitao，et al
Objective  To retrospectively analyze clinical effect of pedicle screw internal fixation through the injured vertebra for treating single-level thoracolumbar bursting fracture in the quadrant expansive channel combined with the muscular gap (wiltse) approach.Methods  From January 2014 to January 2017，48 cases of single-level thoracolumbar bursting fracture were treated with 2 rods and 6 screws in 6 vetebra including the injured vetebra through the quadrant expansive channel with Wiltse approach.According to AO classification，there were 29 cases of type A 3.1 and 19 cases of type A 3.2.Spinal nerve function were all Frankel E.10 months after operation，the internal fixation were explanted.Clinical effect was evaluated by observing the vertebral anterior height，kyphosis，VAS and JOA score changes before and after operation.Results  All cases were followed up for 12 to 42 months with an average of 25.5 months.The anterior height of vertebral body recovered well(P＜0.05)immediately after operation.And kyphosis was improved significantly(P＜0.05).The VAS score was improved from 6.5 points to 2.3 points，and the JOA score increased from 13.38 points to 16.85 points.Screw position and stability was good.No injury of spinal cord function was found.Conclusion  The quadrant expansive channel combined with Wiltse approach by the injured vertebral set screw in the treatment of single thoracolumbar bursting fracture has the advantages of simple operation，less trauma，accurate screw entrance point，fast recovery after operation，and has satifying effect.
2018 Vol. 24 (12): 1057-1060 [Abstract] ( 327 ) HTML (1 KB)  PDF (1106 KB)  ( 243 )
1061 Cause Analysis of Nucleus Pulposus Residue after Percutaneous Endoscopic Lumbar Discectomy
Li Dagang，Chen Shizhong，Zhou Qizhang
Objective  To analyze the cause of nucleus pulposus residue after percutaneous endoscopic lumbar discectomy(PELD).Methods  From August 2012 to July 2017，315 patients with primary lumbar disc herniation(LDH) were treated with PELD.There were 193 males and 122 females.The patients aged from 16 to 81 years，with an average age of 43.5 years.307 patients had single level procedure，7 patients had double level procedure，and 1 patients had three level procedure.102 patients were treated by intralaminar approach，and 213 patients were treated by transforaminal approach.Lumbar MRI or CT was checked after the operation.According to the result of MRI or CT，The patients were divided into residue group or non-residue group.All patients were followed up for 4 months to 5 years.The gender，age，operation approach，0swestry disability index(ODI)，and visual analogue scale(VAS) were analyzed between the two groups.Results  Nucleus pulposus residue happened in 26 patients and the incidence rate was 8.25%.There were 9 females and 17 males.All the patients had single level LDH，including 10 discs of L5S1 and 16 discs of L4～5.7 patients were treated by intralaminar approach，and 19 patients were treated by transforaminal approach.Only 2 patients needed second procedure.There was no significant difference between the two groups in the gender，age，operation approach，ODI before operation，and VAS before operation.There was significant difference between the two groups in the ODI after operation，and VAS after operation.Conclusion  Nucleus pulposus residue is a common complication after PELD.Insufficent surgical experience is the primary cause.Part of the patients are unsatisfied with the result，but few of the patients need second operation.
2018 Vol. 24 (12): 1061-1064 [Abstract] ( 291 ) HTML (1 KB)  PDF (1420 KB)  ( 254 )
1065 Clinical Study on Arthroscopic Treatment of Elbow Stiffness
Wang lizhi，Li yu，Yang hongbin
Objective  To investigate the clinical results of arthroscopic surgery on the stiffness of the elbow joint caused by intrinsic factors.Methods  From May 2013 to May 2016，21 cases of elbow stiffness caused by intrinsic factors were treated by arthroscopic surgery in the Affiliated Hospital of Southwest Medical University，including 13 male and 8 femal.The patients were 17 to 64 years old，with an average age of (41.8±7.1) years，and a retrospective analysis was carried out.Articular capsule contracture was released under arthroscopy，synovium hyperplasia was cleared，free body was removed，and osteophytes hyperplasia was cleaned by grinding.Patients with ulnar nerve compression syndrome were pretreated with ulnar nerve release.The range of motion (ROM) before and after surgery was observed and compared，and the rehabilitation of elbow function was evaluated by Mayo scoring system.Results  All surgeries were successful and followed up for 9 to 26 months，with an average of (15.4±10.7) months.The average maximum flexion and extension range of elbow joint was (63.7±22.3) degree before operation and (106.5±32.8)degree after operation.After the operation，the score of Mayo elbow joint functional system was improved (28.5±6.2)，eight patients got an excellent result，10 good and 3 fair.There were no nerve or vascular injury，no infection，ectopic ossification，thrombosis and other complications，and the postoperative pain and joint activity were significantly improved.Conclusion  Arthroscopic surgery of the elbow joint caused by intrinsic factors can effectively improve the elbow joint activity and the function of the elbow joint.It is a safe and effective treatment，and the curative effect is satisfactory.
2018 Vol. 24 (12): 1065-1068 [Abstract] ( 205 ) HTML (1 KB)  PDF (1411 KB)  ( 423 )
1069 Treatment of Terrible Triad of the Elbow with External Fixator and Suture Anchors
Chen Yuanrong 1，Jiang Yong 2*，Hong Shi 1，et al
Objective  To investigate the clinical efficacy of hinged external fixator combined with suture anchor in the treatment of terrible triad of the elbow.Methods  A retrospective analysis of 27 patients(sex：16 males and 11 females；aged 23 to 59 years，mean 37.8 ) with “terrible triad of the elbow” from March 2013 to June 2017 was performed.All patients underwent hinged external fixation combined with suture anchor.At the last follow-up，the elbow function were assessed according to Mayo elbow function evaluation standard.Results  All patients were followed up for 12 to 33 months with a mean of 18.4 months.According to Mayo elbow function evaluation standard，the results were excellent in 18 cases，good in 5 cases，fair in 3 cases，and poor in 1 cases，with an excellent and good rate of 85.2%.During the follow-up 3 case had heterotopic ossification of the elbow and 2 cases had elbow traumatic arthritis.Radiology showed that all fractures healed，no complications such as vascular nerve，infection，internal fixation loosening and so on.Conclusion  Hinged external fixator with suture anchors can achieve good reduction and fixation，restore the stability of the elbow joint，less complications in the treatment of terrible triad of the elbow，and the clinical effect is reliable.
2018 Vol. 24 (12): 1069-1072 [Abstract] ( 257 ) HTML (1 KB)  PDF (1201 KB)  ( 331 )
1073 Clinical Outcome of Hip Hemiarthroplasty on Intertrochanteric Fracture in Elderly Patients
Wu Bin，Lin Mingxia *，Shen Ningjiang，et al
Objective  To evaluate functional recovery and mortality through one year follow-up after surgery of intertrochanteric fracture by PFNA osteosynthesis and hip hemiarthroplasty.Methods  A total of 163 consecutive patients(74 males and 89 females，average age 78.20±10.71 years) with intertrochanteric fractures were divided into osteosynthesis group and arthroplasty groups according to treatment techniques.We evaluated patient mortality and functional status according to Functional Independence Measure(FIM) scores.FIM were assessed atdischarge from the hospitaland one year after surgeries.Results  Inthe follow-up1 year after surgery，50 patients had died (30.67%).22 patientswere from the arthroplasty group and 28 from osteosynthesis group (P＞0.05).The arthroplasty group had significantly higher FIM when they discharged from the hospital (80.07±11.34) and one year after surgery (97.34±9.78，P＜0.05).Patient age，time to surgery，and transfusion volumewere detected as significant related factors of FIM.Conclusion  Functional loss resulted from intertrochanteric fractures can be reduced by arthroplasty instead of osteosynthesis.No significant differencein mortality through one year of follow-up was observed between arthroplasty and osteosynthesis surgeries.
2018 Vol. 24 (12): 1073-1092 [Abstract] ( 266 ) HTML (1 KB)  PDF (455 KB)  ( 236 )
1077 Total Hip Arthroplasty With Wagner Cone Stem and Transverse Subtrochanteric Osteotomy in Treatment of Crowe type Ⅳ Developmental Dysplasia of the Hip
Peng Yonggang，Zhang Kun，Miao Runqing，et al
Objective  To analyze the clinical outcome and complications of total hip arthroplasty(THA) with Wagner Cone stem and transverse subtrochanteric osteotomy in treatment of Crowe type iv Developmental Dysplasia of the Hip(DDH).Methods  51 patients(67 hips) underwent THA with Wagner Cone stem and transverse subtrochanteric osteotomy from January，2009 to December，2015 were included in our study.There were 44 women and 7 men.The age was 16 to 65，with an average age of 40 years.All the patients were diagnosed as Crowe type Ⅳ DDH.The clinical function of the patients was evaluated by Harris Hip joint score and AP pelvic view and fulllength view of the lower extremities were used to evaluate the position of prosthesis，the healing of osteotomy，the osteolysis and the sinking of prosthesis.Results  The average duration of follow-up was 54 months(Range 24~108 months).The mean Harris hip score was improved from 37.5(range：30~55) preoperatively to 85.8 postoperatively(range：78~96)，and there were statistically significant differences in Harris hip score(P＜0.05).Mean leg-length discrepancy had decreased from 3.8 cm(range，0~8 cm) preoperatively to 0.8 cm(range，0~1.5 cm) by the latest follow-up evaluation.Femoral shortening subtrochanteric osteotomy was performed with an average femoral resection of 3.1 cm(range：1.5~6.5 cm).There were 3 cases of intraoperative fracture，5 cases of postoperative dislocation，1 case of nonunion(2 hips)，without infection，nerve palsy，prosthesis loosening and sinking.Conclusion  Total hip arthroplasty with Wagner Cone stem and transverse subtrochanteric osteotomy for Crowe Ⅳ developmental dysplasia of the hip can obtain satisfactory clinical outcomes with less complications and effectively balance the length of two lower limbs and simplify the complexity of the operation.
2018 Vol. 24 (12): 1077-1081 [Abstract] ( 379 ) HTML (1 KB)  PDF (1792 KB)  ( 295 )
1082 Treatment of Avascular Talar Necrosis by Transposition of Vascularized Anterior Tibial Periosteal Flap Plus Autogenous Bone Graft
Yan Zuofa 1，2，Su Yun 1*，Ma Yanming 3，et al
Objective  To evaluate the outcome of transposition of vascularized anterior tibial periosteal flap plus autogenous bone graft in the treatment of avascular talar necrosis.Methods  From April 2012 to June 2016，24 patients，including 14 males and 10 females with an average age of 57.2 years old underwent surgery of transposition of vascularized anterior tibial periosteal flap plus autogenous bone graft.According to modified Ficat&Arlet classification system，10 cases were in stage Ⅱ，12 cases were in stage Ⅲ，and 2 cases were in stage Ⅳ.The patient was followed up by Kenwright's criteria.Results  The follow-up period was 24 to 96 months，with an average of 36.2 months.According to Kenwright criteria，9 cases were excellent，13 cases were good，1 case was fair，and 1 case was poor.The clinical symptoms were completely or partially relieved.The excellent and good rate was 91.67%.Conclusion  Vascularized anterior tibial periosteal flap plus autogenous bone graft for the treatment of talar avascular necrosis has achieved satisfactory clinical results and is worthy of clinical application.
2018 Vol. 24 (12): 1082-1084 [Abstract] ( 338 ) HTML (1 KB)  PDF (1159 KB)  ( 368 )
1085 Effection of Bacteria-culture Sample Number on the Confirmation of the Pathogens of Chronic Osteomyelitis
Ma Xianzhi 1，Wang Zhendong 2，Wang Manyi 3，et al
Objective  To examine the correlations between the bacteria-culture sample during the debridement in the operation and its ability to confirm the causative pathogens of chronic osteomyelitis.Methods  255 patients with chronic osteomyelitis in our hospital from January 2007 to January 2014，were selected in the current study.There were 202 male and 53 female，with the average age of (45.2±16.5)years(15~84 years).Bacteria were sent to culture for 295 times in total，in which there were one sample for 63 times，two samples for 76 times，three samples for 51 times，four samples for 41 times，and five samples for 64 times.After finishing the bacterium culture，bacterial spectrum，population and its ability to confirm the pathogens were calculated and different samples were compared.Results  42 kinds of bacteria were examined in the bacteria culture，the top five bacteria were Staphylococcus Aureus(35.51%)，the Staphylococcus Epidermidis(14.29%)，Pseudomonas Aeruginosa(9.80%)，Enterobacter Cloacae(5.31%)，and Escherichia Coli(4.49%).Detection rate among different samples were：66.7%(one sample)，69.7%(Two samples)，74.5%(Three samples)，78.0%(Four samples)，and 90.6%(Five samples or above).Percentage of pathogens detected in different samples were 42.1%(Two samples)，51.9%(Three samples)，68.3%(Four samples)，and 82.8%(Five samples or above).The result of the comparison between two samples and four samples，two samples and five samples，three samples and five samples，were statistically significant(P＜0.05).Conclusion  Five samples sent to bacteria culture have the strongest detection ability of the causative pathogens，while one sample has the poorest detection ability.Therefore，at least five samples sent to bacteria culture to confirm the causative pathogen is recommended during the operation.
2018 Vol. 24 (12): 1085-1088 [Abstract] ( 161 ) HTML (1 KB)  PDF (532 KB)  ( 191 )
1089 Biomechanics of Lower Limb Joints of the Elderly and the Young
Wang Hanghui 1，2，Song Yixin 1，2*，Han Weihua 1，et al
Objective  To evaluate the differences between the elderly and young people in daily activities with a three-dimensional gait analysis system and provide them subject-specific guidance.Methods  The elderly group consisted of ten healthy elderly people.The young group consisted of ten young healthy people.The kinematics and kinetic parameters were compared using the Vicon 3-dimensional motion analysis system and the skeletal muscle multi-body dynamics software.Results  The walking cycle of the elderly group was higher than that of the young group when walking horizontally，and the span decreased(P＜0.01).Individual differnce for kinematic/kinetic parameters occurred among elderly people.The maximal ankle contact forces were higher than the young group(P＜0.05).Conclusion  The three-dimensional gait analysis has a better predictive value for the risk of osteoarthritis in the middle-aged and the elderly.Older people should increase physical exercise，feasible early gait modification training program and orthopedic insoles.
2018 Vol. 24 (12): 1089-1092 [Abstract] ( 302 ) HTML (1 KB)  PDF (1784 KB)  ( 231 )
1093 Study on the Effect of NGF on Nerve Injury in Rabbits with Osteofascial Compartment Syndrome
Liu Yi，Zhang Jinlong，Sun Yuyu，et al
Objective  To establish an animal model of rabbit basilar compartment syndrome and to use nerve growth factor (NGF) for neuroprotection and repair early to achieve early treatment of nerve injury in compartment syndrome.Methods  Experiments were performed at the Animal Laboratory of Nantong University from September 2016 to December 2017.Twenty-four rabbits were divided into three groups：control group (8)，injury non-injection NGF group (8)，and injury-injected NGF group (8).The animal model of fascia compartment syndrome was made by using the tourniquet method and was loosened by tightly dressing the calf of one side of the rabbit after tourniquet for 8 hours.Measurements were made at 4 hours，8 hours，1 day，3 days，5 days，7 days，2 weeks，and 4 weeks after release of the tourniquet.Western blotting was used to investigate the changes of nerve cell proliferation after nerve injury in rabbits with compartment syndrome.In the injury injection group，the nerve growth factor (PEPRO TECH.INC) was injected locally immediately after the model was successfully prepared.The solution was injected intramuscularly with 2 ml of saline solution，30 μg each time，once a day for 4 weeks.The experimental rabbits (control group)，5 days after injury (injured noninjection group)，and 5 days after injury (injury injection group) rabbit hind leg nerve samples were collected for immunofluorescence experiments and HE staining analysis.Results  After loosening the tourniquet，the injured calf rapidly swelled.After 4 hours，the pressure in the fascia reached (2.0±0.2)kPa.It peaked after 1 day，and then gradually decreased.Western blot showed that PCNA showed low expression in the control group and began to upregulate after 4 hours in rabbit compartment syndrome.The expression peaked at 5 days (P＜0.05).Then，PCNA gradually decreased.The results of HE staining showed that nerve fiber breakage，edema，vacuoles，and irregular shape of tissue morphology were observed in the non-injected NGF group 5 days after injury，while the experimental group given NGF injection had significantly better tissue morphology at the same time point.Double-labeled fluorescence results showed that NGF injection after rabbit osteofascial compartment syndrome promoted nerve recovery by increasing early Schwann cell proliferation.Conclusion  This model can simulate clinical practice better.The change of pathological index can objectively reflect the severity of the disease，and it can prove that nerve injury can occur early in the compartment syndrome.Early application of NGF has a significant effect on the treatment of nerve injury in compartment syndrome.
2018 Vol. 24 (12): 1093-1105 [Abstract] ( 282 ) HTML (1 KB)  PDF (1827 KB)  ( 289 )
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