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2019 Vol. 25, No. 1
Published: 2019-01-25
 
1 Correlation Analysis of Body Mass Index，Lumbar Facet Joint Angle and Degenerative Lumbar Spondylolisthesis
Gao Zhixiang，Yang Hongtao，Li Lei，et al
Objective  To explore the correlation between the body mass index，lumbar facet joint angle and degenerative lumbar spondylolisthesis.Methods  A total of 45 cases diagnosed as degenerative lumbar spondylolisthesis in our hospital from January 2016 to November 2017 were enrolled.And 90 cases of healthy controls who had health checkup during the same time were included in normal group.The body mass index was recorded，the lumbar facet joint angle of L4～5 at the cranial side and the caudal side as well as the facet-pedicle angle were measured，and the left and right lumbar facet joint angle were inspected for symmetry. Results  Compared with the normal group，the body mass index，the lumbar facet joint angle at the cranial side and the caudal side as well as the facet-pedicle angle were significantly different in the degenerative lumbar spondylolisthesis group (P＜0.05).There were possible correlations between the body mass index，the lumbar facet joint angle at the cranial side as，the facet-pedicle angle and degenerative lumbar spondylolisthesis (P＜0.05).Also，there was statistical difference between the symmetry of the left and right lumbar facet joint angle and the spondylolisthesis degree in the degenerative lumbar spondylolisthesis group (P＝0.04).Conclusion  Compared with normal people，the lumbar facet joint angle is more sagittal and the facet-pedicle angle was more horizontal in the patients with degenerative lumbar spondylolisthesis.
2019 Vol. 25 (1): 1-4 [Abstract] ( 259 ) HTML (1 KB)  PDF (1358 KB)  ( 315 )
5 Treatment of Unstable Thoracolumbar Vertebral Fractures with Posterior Short Segmental Pedicle Screw Fixation and Transpedical Bone Grafting
Zhao Chengyi，Li Qing，Liang Daochen，et al
Objective  To investigate the clinical effect of posterior short segmental pedicle screw fixation combined with transpedical bone grafting in the treatment of unstable thoracolumbar vertebral fracture.Methods  From January 2013 to January 2016，25 cases of unstable thoracolumbarvertebral fractures were treated with posterior short segmental pedicle screw fixation combined with transpedical bone grafting.This group was set up for the observation group.Another 25 unstable thoracolumbarvertebral fractures cases were retrospectively analyzed prior to December 2012.In those cases，which was set up for control group，the operation method was posterior long segmental (8 transpedical screw) fixation crossing the injured vertebrae.Both groups of patients were type A3 in AO classification and single vertebral body fracture.The VAS score of lumbar back pain，the ratio of the anterior edge height of the injured vertebra，the sagittal Cobb Angle，the nerve function before and after the operation and the incidence rate of empty shell in the injured vertebra were compared statistically between the two groups.Results  The two groups were followed up for 12~16 (14.5±2.9) month.There were significant improvements in the anterior edge height of the injured vertebra，the sagittal Cobb Angle and the nerve function in both groups after surgery，and the difference was statistically significant (P＜0.05). However，there was no statistically significant difference between the two groups (P＞0.05).The incidence rate of hollow shell in the injured vertebral body in the experimental group was smaller than that in the control group，and the difference was statistically significant (P＜0.05).There was no pedicle screw or rod breaking in the experimental group，but one case suffered rod breakage in the control group one year after surgery.Conclusion  It is safe and effective to treat unstable thoracolumbar vertebral fractures with posterior short segmental pedicle screw fixation combined with transpedical bone grafting.Meanwhile，it can effectively restore the height of injured vertebral column，promote the primary healing of injured vertebral body，reduce the occurrence of empty shell in injured vertebral body and rebuild the mechanical stability of spine.
2019 Vol. 25 (1): 5-8 [Abstract] ( 276 ) HTML (1 KB)  PDF (2227 KB)  ( 381 )
9 Comparative Research of the Clinic Efficacy of Reverse Shoulder Arthroplasty and Hemi-shoulder Arthroplasty for Shoulder Disease
Wang Lin 1，2，Tan Jie 2，Wang Hao 1，2，et al
Objective  To compare the curative effects of 2 operation methods of reverse shoulder arthroplasty and hemi-shoulder arthroplasty for shoulder joint dysfunction.Methods  Data of patients who underwent reverse shoulder arthroplasty and hemi-shoulder arthroplasty from January 2014 to June 2018 in our hospital were collected and followed up respectively.Range of motion(ROM)，Visual Analogue score(VAS)，University of California at LosAngeles score(UCLA)，Adjusted Constant-Murley score(CMS) and American Shoulder and Elbow Surgeons (ASES) of the last follow-up were statistically analyzed.Results  In this study，we found ROM of anteflexion，extorsion and abduction in reverse shoulder arthroplasty group were(130.56±3.09)degree，(38.44±2.70)degree and(131.78±2.54)degree respectively at last follow-up，results in hemi-shoulder arthroplasty group were anteflexion (104.12±7.66) degree，extorsion (27.06±3.93)degree and abduction (123.88±4.88)degree，anteflexion，extorsion and abduction were better in reverse shoulder arthroplasty group with P＜0.05.But intorsion degree was(41.67±3.39)degree in reverse shoulder arthroplasty group，with the degree of intorsion (48.76±3.29)degree in hemi-shoulder arthroplasty group，intorsion degree was relatively better in hemi-shoulder arthroplasty group with a significant P value below 0.05.The last follow-ups of UCLA，CMS and ASES in reverse shoulder arthroplasty group were (28.78±2.05)，(58.89±2.80) and (74.33±2.18) correspondingly，and UCLA (26.24±2.14)，CMS(56.12±2.47) and ASES (71.53±2.53) were detected in hemi-shoulder arthroplasty group，UCLA，CMSA and ASES were higher in reverse shoulder arthroplasty group through statistical analyses(P＜0.05).But VAS scores in reverse shoulder arthroplasty group and in hemi-shoulder arthroplasty group were (1.22±0.44) and (1.41±0.51)，which made VAS scores had no difference in comparison，with a pvalue above 0.05.Conclusion  Reverse shoulder arthroplasty had relatively better postoperative shoulder function than hemi-shoulder arthroplasty method，it could enhance and improve the quality of patients` life，but this method should hold strict indications and treat it seriously.
2019 Vol. 25 (1): 9-13 [Abstract] ( 363 ) HTML (1 KB)  PDF (1748 KB)  ( 378 )
14 Factors Affecting Length of Hospital Stay of Patients with Intertrochanteric Fracture
Ju Jiabao，Zhang Peixun *
Objective  To evaluate the factors associated with length of hospital stay of patients with intertrochanteric fracture.Methods  We retrospectively retrieved data of 153 patients with intertrochanteric fracture between January 2016 and December 2017.The data included age，gender，body mass index，fracture type，interval between fracture and admission，interval between admission and surgery，interval between fracture and surgery，surgery type，ASA grade，Charlson comorbidity index，hemoglobin level and serum albumin.Results  In univariable analyses，we found interval between admission and surgery，interval between fracture and surgery，hemoglobin level，serum albumin，gender，ASA grade and Charlson comorbidity index were significantly associated with length of hospital stay.Multivariable linear regression analysis suggested interval between admission and surgery(P＜0.001)and Charlson comorbidity index≥1(P＝0.029)were related to increased length of hospital stay.Conclusion  Delayed surgery and higher Charlson comorbidity index would extent the length of hospital stay of patients with intertrochanteric fracture.
2019 Vol. 25 (1): 14-33 [Abstract] ( 284 ) HTML (1 KB)  PDF (560 KB)  ( 197 )
17 The Influence of Obesity on Pain and Function Following Primary Total Knee Arthroplasty：a Retrospective Study
Wang Chao，Wei Rong，Wu Junlong，et al
Objective  To evaluate the influence of obesity on early pain and function following primary total knee arthroplasty (TKA) through comparing VAS score，the range of motion and complications among normal weight patients，overweight patients and obese patients.Methods  A total of 156 patients who underwent primary TKA were divided into normal group (18.0~23.9 kg／m2，overweight group (24.0~27.9 kg／m2) and obese group (BMI≥28.0 kg／m2) according to body mass index (BMI) from January 2017 to July 2018.We evaluated the baseline indicators，VAS score on the first，third，fifth and fifteenth days after operation. The range of motion and complications were evaluated on fifth and fifteenth days after operation.Results  There was no difference in the VAS score of the resting and active state on the first，third，fifth and fifteenth postoperative days.In addition，range of motion and complications on fifth and fifteenth postoperative days were not significantly among the three groups (P＞0.05).The length of stay in obese group was the longest (P＝0.031).Conclusion  Obesity does not affect patient’s early pain and functional rehabilitation，does not increase complications following primary TKA.Obese patients can gain satisfactory functional rehabilitation outcomes while the rehabilitation duration is longer.
2019 Vol. 25 (1): 17-20 [Abstract] ( 273 ) HTML (1 KB)  PDF (1238 KB)  ( 258 )
21 Treatment of Peri-knee Malignant Bone Destruction Tumor with Newly Designed Customized Pivoted Knee Prosthesis
Rao Yong，Tan Jie，Zhang Yue，et al

Objective  To evaluate the effectiveness of newly designed pivoted knee prosthesis for peri-knee bone destruction by malignant tumor.Methods  Clinic materials of patients admitted to our department between January 2012 and July 2018 and underwent customized newly designed pivoted knee prosthesis arthroplasty were collected.10 cases of patients were included in this research，including 4 male and 6 female，with an average age of (45.6±18.1)years old (Range 17 to 69 y).Duration of the disease was (3.7±1.6)months (Range 1 to 6 months).There were 2 osteosarcoma，1 chondrosarcoma，3 giant cell tumor，2 leiomyosarcoma and 2 other cases.The suffering sites were femur in 3 cases，tibia in 6 cases and both sites in 1 case.Based on the Enneking staging system，there were 1 case in stage ⅠA，3 in stage ⅠB，2 in stage ⅡA and 4 in stage ⅡB.Visual Analogue Scale (VAS)，Hospital for special surgery knee score (HSS) and American knee society knee score (KSS) before operation，discharging and last follow-up were collected and analyzed statistically.Meanwhile，the results of musculoskeletal tumor society system (MTSS) and radiographs were observed and analysed at last follow-up.Results  All surgeries were successfully completed.No surgery plan change happened.the average surgery time was 181.0±36.3 min with bleeding volume of (227.5±59.0)mL in operation.The patients were followed up for (25.3±19.9)months (range：3 to 68 months).The scores of VAS at preoperation，discharging and last follow-up periods were (6.30±1.16)，(2.40±0.84) and (1.90±0.74)(F＝66.962，P＜0.05)；HSS were (42.50±4.04)，(62.40±4.45)and (73.6±3.78)(F＝147.782，P＜0.05)；KSS were (37.30±3.83)，(68.60±2.32) and (76.10±4.56)(F＝311.274，P＜0.05)，respectively.The last follow-up scores of MTSS were (23.10±2.33).All cases were alive with prostheses in good condition，excluding 1 patient received revision for disalignment of prosthesis，1 patient underwent amputation for local tumor relapse and 2 patients died for systemic metastasis.Conclusion  The customized newly designed pivoted knee prosthesis is a good limb-sparing strategy for malignant bone tumors around knees.But，the indications for operation should be restricted for proper candidates，operation principles be seriously followed and also chemotherapy after operation be timely added to avoid recurrence of tumor.
2019 Vol. 25 (1): 21-47 [Abstract] ( 265 ) HTML (1 KB)  PDF (1535 KB)  ( 288 )
25 The Application of Llizarov Fixator Combined with Antibioticladen Bone Cement in Treatment of Infectious Bone Defect of Long Bone
Deng Xiangtian，Liu Juncai，Li Zhong，et al
Objective  To discuss the individual-based treatment technique and clinical effects of long bone with infectious bone defects using Ilizarov fixator combined with antibiotic-laden bone cement.Methods  From June 2011 to January 2017，21 patients suffered femoral，tibial and humeral infected nonunion with bone defects underwent operation in our hospital.The cases included 14 males and 7 females aged 37(18～65 years).The site of infected nonunion involved 12 tibias，7 femurs and 2 humerus.After debridement，the mean bone defect length of tibia was 7.2cm，the mean bone defect length of femur was 8.5 cm，the mean bone defect length of humerus was 6.0cm.Surgery was performed in two stage.The antibiotic-laden bone cement was implanted to control infection and form a bone-induced membrane after the infected scarred soft tissue and necrotic bone were debrided radically in the primary stage，the affected limb was fixed for bone transport by monolateral external fixator or fixed for bone transport by Ilizarov external fixator.After infection controlled，the bone transport was performed by Ilizarov technology in second stage.Results  All the patients were followed up for 12 to 24 months with an average of 18.5 months，the average fixation time was 17.2 months( range from 9 to 21 months)，the mean external fixation index was 2.38 months/cm.Bone results and functional results were evaluated by ASAMI classification.The bone results were excellent in 13 patients，good in 6 patients and fair in 2 patients.Good and excellent rate in bone results was 90.5%.The functional results were excellent in 11 patients，good in 7 patients and fair in 3 patients，good and excellent rate in functional results was 85.7% in our study.Conclusion  Our study suggested that Ilizarov fixator combined with antibiotic-laden bone cement can control infection effectively，correct deformity and rebuild limb function，was an effective method of treating long bone with infectious bone defects.
2019 Vol. 25 (1): 25-54 [Abstract] ( 365 ) HTML (1 KB)  PDF (2052 KB)  ( 414 )
29 Analysis of the Influence Factors in Venous Thromboembolism of Orthopaedic Trauma Patients
Yu Hongbo，Chu Renzhu，Yu Dawei，et al
Objective  To investigate the influencing factors of venous thromboembolism in patients with bone trauma.Methods  A total of 31 652 patients with bone trauma admitted to the Department of Orthopaedics of Wendeng Osteopathic Hospital from January 2012 to December 2016 were enrolled in the study (Smoky area).Color Doppler ultrasound or venography was used to examine 1 424 cases with venous thromboembolism.Retrospective analysis of the basic data of the patients included gender，age，past medical history，smoking history，bone trauma site，DVT predilection sites and associated diseases were performed with univariate and multivariate logistic regression analysis to analyze the influencing factors.Results  Of the 31 652 hospitalized patients with bone trauma，1 424 were diagnosed with complicated venous thromboembolis with an incidence of 4.50%.Among them，there were 1304 cases of DVT，and the incidence rate was 4.12%.There were 237 cases of PE，and the incidence rate was 0.74%.Univariate and multivariate logistic analysis showed that the incidence of venous thromboembolism in patients with bone trauma was asociate with age，long-term immobilization，bone trauma sites，diabetes，D-dimer levels，AIS，and ISS (P＜0.05).Conclusion  The incidence of venous thromboembolism in patients with bone trauma is closely related to age，need for long-term immobilization，bone trauma，diabetes and D-dimer levels.
2019 Vol. 25 (1): 29-33 [Abstract] ( 244 ) HTML (1 KB)  PDF (653 KB)  ( 357 )
34 Biomechanical Study of Bone Cement of Polymethyl Methacrylate with Calcium Phosphate and Gentamicin
Xiang Mingyuan，Li Chao，Wang Xuehui，et al
Objective  To study the biomechanical properties of bone cement which composed of different proportions of polymethyl methacrylate (PMMA)，β-Tricalcium phosphate (β-TCP)  and gentamicin Gentamicin(GM) and to screen out the proportion of ideal composite bone cement.Methods  The β-TCP powder was mixed with the corresponding PMMA powder at a total mass ratio of 15%，25%，and 35%，and then the GM powder was separately added to the above three groups at a total mass ratio of 4% to prepare a composite bone cement powder and the bone cement was prepared  with 2︰1 solid-liquid ratio as suggested by the manufacture.The injection time of each group of composite bone cement and the strength of the bone cement sample after drying were measured.The samples of each group were immersed in phosphate buffered saline at a ratio of 1︰5，and the corresponding numbered samples were taken at 1 day，3 days，5 days，1 week，2 weeks，3 weeks，and 4 weeks.The Ph value of the soaking solution，the amount of GM released，and the degradation rate and strength of the sample after drying were measured.Results  The strength of the composite bone cement slowly decreases after soaking.The in vitro degradation rate and GM release of composite bone cement increased with the increase of soaking time and increased with the increase of β-TCP content.The pH value of the composite bone cement soaking solution decreased with the increase of the soaking time and decreased with the increase of the β-TCP content.Conclusion  The β-TCP content of the composite bone cement has an ideal mixing ratio of 35%.The performance of the two groups of bone cement can be combined to the maximum extent，and the desired strength，degradation rate，and GM release amount can be obtained.
2019 Vol. 25 (1): 34-38 [Abstract] ( 224 ) HTML (1 KB)  PDF (820 KB)  ( 331 )
39 A CT Study of Acetabular Component Anteversion Positioning with Transverse Acetabular Ligament Orientation
Zhao Bingcheng，Wei Gehan，Qin Wenbao，et al
Objective  To measure native acetabular anteversion before total hip arthoplasty(THA) and acetabular component anteversion after THA using computed tomography(CT) method，and to evaluate the accuracy of acetabular component anteversion positioning with transverse acetabular ligament (TAL) orientation.Methods  Totally 40 patients (44 hips) undergoing primary THA in our hospital from January 2015 to January 2016 were enrolled in this study.All the arthroplasty were performed by one surgeon.we used posterior approach and positioned the acetabular component anteversion with TAL orientation，in which the inferomedial rim of the cup had been positioned parallel to the transverse acetabular ligament intraoperatively.Preoperatively and postoperatively，all the patients were examined by CT scan.We measured radiographic cup anteversion angle and native acetabular anteversion using a CT scan method.Acetabular component anteversion and native acetabular anteversion were statistically analyzed.Results  In all the 44 hips，TAL were identified.The mean acetabular component anteversion was (21.37±9.69)°，which was no significantly different from preoperatively native acetabular anteversion (P＞0 05).Among them，acetabular component anteversion of women and men were (24.59±11.57)°，(20.28±8.76)° respectivly，which was no significantly different from those preoperatively native acetabular anteversion (P＞0.05).The preoperatively native acetabular anteversion was significantly higher in females than in males(P＜0.05).Conclusion  We suggest that the transverse acetabular ligament is a practical anatomical landmark for precise determining cup anteversion in primary THA.
2019 Vol. 25 (1): 39-43 [Abstract] ( 338 ) HTML (1 KB)  PDF (1698 KB)  ( 336 )
44 Comparative Study on Morphology of Two Animal Models of Wear Particle Induced Osteolysis
Zhao Jiangbo 1，Li Yan 2，Tian Jianing 1，et al
Objective  To establish two models of osteolysis induced by wear particles，and to compare the indexes of inflammation，osteolysis and osteoclast count and provide a basis for the selection of animal models of osteolysis.Methods  The air pouch mouse model and murine calvarial osteolysis model were established. The morphology was observed by HE staining，the osteolysis was observed by scanning electron microscope，and the osteoclast count was performed by TRAP staining.Results  The bone resorption area (385.30±5.11) nm2 of the air pouch mouse model was significantly higher than that of the murine calvarial osteolysis model (288.60±4.89) nm2 (P＜0.05)，and the number of osteoclast cells (16.75±0.53) in the air pouch mouse model was significantly higher than that of the murine calvarial osteolysis model (9.55±0.48) (P＜0.05).Conclusion  All of the two animal models were successfully constructed，and the air pouch mouse model is better than that of the murine calvarial osteolysis model in the level of inflammation，osteolysis and osteoclast count，so the air pouch mouse model is better in the simulation of osteolysis induced by wear particles.
2019 Vol. 25 (1): 44-47 [Abstract] ( 342 ) HTML (1 KB)  PDF (1960 KB)  ( 225 )
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