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2019 Vol. 25, No. 2
Published: 2019-02-25
 
97 Influence of Different Bone Cement Injection on Patients with Single Segment Thoracolumbar OVCF
Wang Fushun，Zhang Lin，Wang Zhiqi，et al
Objective  To investigate the influence of bone cement injection schemes by unilateral，near middle-line and bilateral on postoperative pain degree and perioperative complications of patients with single segment thoracolumbar OVCF.Methods  165 patients with single segment thoracolumbar OVCF were chosen from July 2015 to March 2017 and randomly divided into three group including A group (55 patients) with bone cement injection schemes by unilateral，B group (55 patients) with bone cement injection schemes by near middle-line and C group (55 patients) with bone cement injection schemes by bilateral；and the pain VAS score before and after operation，intraoperative and postoperative complication incidence of both groups were compared.Results  The pain VAS score in 1d after operation of B group and C group were significantly lower than A group(P＜0.05).There was no significant difference in the pain VAS score in 12 weeks，24 weeks and 48 weeks after operation between 2 groups(P＞0.05).The bone cement leakage incidence of C group were significantly lower than A group and B group(P＜0.05).The re-cement injection rate of A group were significantly higher than B group and C group(P＜0.05).Conclusion  Compared with bone cement injection schemes by unilateral，bone cement injection schemes by near middle-line and bilateral in the treatment of patients with single segment thoracolumbar OVCF can efficiently relieve early postoperative pain and reduce perioperative risk of complications.
2019 Vol. 25 (2): 97-100 [Abstract] ( 341 ) HTML (1 KB)  PDF (735 KB)  ( 280 )
101 Analysis on the Risk Factors of Recurrence of Lumbar Disc Herniation in Patients after Intervertebral Foramen Surgery
Wei Bing
Objective  To investigate the risk factors for recurrence after intervertebral foramen surgery in patients with lumbar disc herniation (LDH).Methods  The clinical data of 130 patients with LDH who underwent transforaminal surgery received from hospital from January 2016 to February 2017 were retrospectively analyzed.According to whether there was recurrence within 1 year after surgery，they were divided into recurrent group (13 cases) and non-recurred group (117 cases).The identify factors associated with recurrence after intervertebral foramen surgery in patients with LDHwere determined by single factor and multivariate logistic linear regression analysis.Results  There were no differences in the rates of gender，body mass index (BMI)，hypertension，diabetes，hyperlipidemia，LDH type，prominent position，surgical procedure，operation time between the recurrent group and the non-recurred group (P＞0.05)，while the rates of age ≥60 years，duration ≥4 years，mild or moderate degeneration of lumbar disc，L4～5 of surgical segment，postoperative intervertebral activity ≥10°，intraoperative annulus fibrosus damage，incompletednucleus pulposus removalof the recurrent group were significantly higher than those of onrecurred group (P＜0.05)，which were the independent risk factors for recurrence after vertebral perforating surgery in patients with LDH (OR=6.352，5.201，3.317，7.894，3.006，1.389，2.476，P＝0.000，0.000，0.001，0.000，0.005，0.036，0.000).Conclusion  There are many risk factors for recurrence after intervertebral foramen surgery in patients with LDH，suggesting that patients with high risk factors should be highly regarded in clinical practice，and targeted preventive measures should be given to reduce the recurrence rate.
2019 Vol. 25 (2): 101-116 [Abstract] ( 348 ) HTML (1 KB)  PDF (521 KB)  ( 480 )
105 Analysis of Influencing Factors of Femoral Head Necrosis after Closed Reduction and Internal Fixationwith Cannulated Compression Screws
Wang Tianxing 1，2，Li Guoqing 1，2，Wang Yang 1，2，et al
Objective  To analyze the influencing factors of femoral head necrosis after closed reduction and internal with cannulated compression screws of femoral neck fracture.Methods  A total of 118 patients with femoral neck fractures underwent closed reduction and cannulated compression screws were selected according to the inclusion criteria.Statistical analysis was performed on 9 factors including age，gender，ethnicity，fracture Garden classification，timing of surgery，Garden's alignment index，triglyceride，total cholesterol and low density lipoprotein，and analyzed the relationship between femoral head necrosis and closed reduction and internal withcannulatedcompression screws of femoral neck fracture.Results  According to the t-test or chi-square test of 9 factors，there was no statistical significance of femoral head necrosis after femoral neck fracture internal fixation with ethnicity and total cholesterol.Age，gender，fracture Garden classification，timing of surgery，Garden's alignment index，triglyceride，lowdensity lipoprotein were statistically significant.According to binary logisticanalysis，gender，triglyceride was not statistically significant，but age，Garden classification，timing of surgery，Garden's alignment index，low density lipoprotein has statistical significance.Conclusion  For femoral neck fractures，age，fracture Garden classification，timing of surgery，Garden'salignment index，and lowdensity lipoprotein are risk factors for femoral head necrosis after closed reduction and internal withcannulatedcompression screws of femoral neck fracture.
2019 Vol. 25 (2): 105-112 [Abstract] ( 298 ) HTML (1 KB)  PDF (489 KB)  ( 452 )
109 Clinical Observation of Arthroscopic Assisted Treatment of Acute Posterior Medial angle Injury
Qian Chunsheng，Liu Jianeng，Fu Changma
Objective  To observe the clinical effect of arthroscopic assisted treatment of acute posterior medial angle injury.Methods  From April 2017 to March 2018，12 patients with acute posterior medial corner injury of knee joint were treated with knee arthroscopy due to trauma，among which 7 were males and 5 were females，aged 22~71 years old，with an average of 46.8 years old.Preoperative MRI showed the injury of medial collateral ligament.Physical examination knee flexion during and 30°﹑0° valgus stress test were all positive.Intraoperative arthroscopic exploration was performed to identify the posterior medial corner of the knee.All 12 cases were treated by medial meniscus posterior keratoplasty or suture，medial collateral ligament and posterior medial Angle anchoring.The knee function score (Lysholm and WOMAC) and VAS pain score were used to measure the knee flexion angle and evaluate the knee function at the 6th month after surgery.Results  Knee flexion and extension activities were good，and there were no symptoms of periarticular redness and instability.Preoperative WOMAC score (22.52±19.99) and postoperative score (8.13±7.22) showed statistically significant differences between the two groups (P＜0.05).Preoperative Lysholm score (33.81±5.45) and postoperative score (81.83±4.08) were significantly different between the two groups (P＜0.05)，VAS pain score (4.1±0.5) and postoperative score (2.3±0.2).Preoperative flexion angle (85.95±8.80)°，and postoperative flexion angle (115.73±6.71)° were statistically difference (P＜0.05).Conclusion  The injury of medial meniscus can be treated under arthroscopy，and assisted incision and repair of the posterior medial angle.which has the advantages of safety，stability and stability，and the well restored function of the knee joint.
2019 Vol. 25 (2): 109-112 [Abstract] ( 273 ) HTML (1 KB)  PDF (1488 KB)  ( 390 )
113 Effect of Intra-articular Tranexamic Acid and Epinephrine on Blood Loss after Total Knee Arthroplasty
Qi Fan，Xu Pei，Yang Jin，et al
Objective  To explore the effect and safety of intra-articular tranexamic acid(TXA) and epinephrine on blood loss after primary unilateral total knee arthroplasty(TKA).Methods  136 cases of severe knee arthritis patients scheduled to undergo TKA were divided randomly into group A (n＝68)and group B(n＝68) according to the number list method.Before the release of the tourniquet，TXA 3g was injected into the articular cavity in group A，and TXA 3g and epinephrine 0.25mg were injected in group B.Operation time，tourniquet application time，hospital stay time，straight leg lifting time，change rate of longitude of large (small) leg postoperative 3 d，postoperative knee joint activity (1 week，1 month，3 months after surgery)，hospital for special surgery(HSS)knee score at 3 months after surgery，total blood loss，intraoperative blood loss，hidden blood loss，hemoglobin decline value postoperative 3 d，hematokrit decline value postoperative 3 d，allogeneic blood transfusion rate，incidence of subcutaneous ecchymosis area > 1% were compared between the two groups.The adverse reactions in the two groups were recorded.Results  Operation time，tourniquet application time，length of hospital stay，straight leg lifting time，change rate of longitude of thign and lower 3d after surgery，postoperative knee joint activity (1 week，1 month，3 months after surgery)，HSS knee score at 3 months after surgery were statistically different between the two groups(P＜0.05).Total blood loss，hidden blood loss，hemoglobin decline value 3 d after surgery，hematokrit decline value 3 d after surgery，incidence of subcutaneous ecchymosis area > 1% in group B were lower than those in group A(P＜0.05).Serious adverse reactions including incision infection and necrosis，deep vein thrombosis and symptomatic pulmonary embolism，rise of blood pressure and arrhythmia did not happen in the two groups.Conclusion  The effect of intra-articular TXA and epinephrine to reduce blood loss after TKA operation is significantly better than that of TXA alone and has certain safety.
2019 Vol. 25 (2): 113-116 [Abstract] ( 281 ) HTML (1 KB)  PDF (464 KB)  ( 355 )
117 Radiographic Changes of Knee Alignment in Contralateral Knee After Unilateral Total Knee Arthroplastyin Knee Osteoarthritis Patients
Wu Zongfang，Qin Jianghui，Jiang Qing，et al
Objective  To study the radiographic changes of knee alignment in nonoperative contralateral knee after unilateral knee arthroplasty due to knee osteoarthritis and analyze the effect of K-L grade (Kellgren-Lawrence grade) on the radiographic changes of knee alignment in nonoperative contralateral knee after unilateral knee arthroplasty.Methods  A total of 157 patients undergoing primary unilateral knee arthroplasty between January 2017 and April 2018 in the Department of Sports Medicine and Adult Reconstructive Surgery of Drum Tower Hospital were retrospectively analyzed，including 62 patients with K-L grade 1 to 2 (group A) and 95 patients with K-L grade 3 to 4 (group B).Postoperative change of hip-knee-angle (HKA)，mechanical axis deviation (MAD)，joint space width (JSW)，lateral distal femur angle (LDFA)，medial proximal tibial angle (MPTA)，joint line convergence angle (JLCA) in contralateral knee and postoperative change of leg-length discrepancy (LLD) were compared between the two groups and analyze the relation between postoperative change of knee alignment in operative knee and contralateral knee.Postoperative changes of knee alignment in contralateral knee was compared between patients under total knee arthroplasty (TKA) and patients under unicompartmental knee arthroplasty(UKA).Results  There was no statistically difference between the two groups regarding gender，age，body mass index (BMI)，surgical methods and surgeon.Postoperative change of contralateral knee MAD，HKA in group A was (－2.3±7.6)mm，(－0.6±1.0)°，compared to that of group B (－8.0±14.3)mm，(－1.0±1.3)°，showing statistical significance (P＜0.05).Postoperative change of contralateral knee JSW，LDFA，MPTA，JLCA in group A was (0.6±1.2)mm，(0.4±1.6)°，(0.2±2.1)°，(－0.2±2.0)°，compared to that of group B (0.6±1.4)mm，(0.4±1.7)°，(－0.1±2.2)°，(－0.4±2.3)°，showing no statistical significance (P＞0.05).Postoperative change of LLD in group A was (－3.5±6.5)mm，compared to that of group B(－5.6±12.2)mm，showing no statistical significance (P＞0.05).The relation between postoperative change of MAD in operative knee and postoperative change of HKA in contralateral knee were in positive correlation(P＜0.05)，and postoperative change of MAD in operative knee and postoperative change of MAD in contralateral knee were in positive correlation(P＜0.05).Postoperative changes of knee alignment between patients under total knee arthroplasty(TKA) and patients under unicompartmental knee arthroplasty(UKA) showed no statistical significance (P＞0.05).Conclusion  patients with knee osteoarthritis who undergo unilateral knee arthroplasty，improvement of contralateral mechanical axis can be measured radiographically，with more change in K-L grade 3 to 4 than K-L grade 1 to 2，which will not be influenced by surgical methods.Postoperative change of HKA，MAD in operative knee and postoperative change of MAD in contralateral knee are in positive correlation respectively.Further research is necessary to determine whether this improvement may delay the progression of contralateral knee osteoarthritis.
2019 Vol. 25 (2): 117-122 [Abstract] ( 270 ) HTML (1 KB)  PDF (1806 KB)  ( 305 )
123 Diagnosis and Treatment of Giant Cell Tumor of Bone Treated by Expanded Curettage and Bone Cement Filling
Tong Xiaopeng，He Hongbo，Liu Qing，et al
Objective  To explore the clinical effect of expand curettage and bone cement filling in (giant cell tumor of bone，GCT)treatment，in order to further guide clinical diagnosis and treatment.Methods  We retrospective analyzed 64 cases of GCT patients treated by expanded curettage and bone cement filling in our hospital，including 28 males and 36 females with a mean age of 31.6 years (range，16~59 y).Tumors were located in distal femur in 26 cases，proximal tibia in 17 cases，proximal femur in 8 cases，proximal humerus in 10 cases，talus in 2 cases and calcaneus in 1 case.Tumor image was graded according to the Campanacci classification criteria.There were 20 patients with grade I，29 patients with grade Ⅱ，and 15 patients with grade Ⅲ.Eight clinical factors were analyzed by single factor analysis，such as gender，age，location of tumor，Campanacci classification，MSTS score，whether having a pathological fracture，Whether having a soft tissue mass，tumor size and tumor recurrence.Logistic regression analysis was used in multi-factor analysis，and the correlation between Campanacci grades and tumor recurrence was analyzed by χ2 analysis.Results   All 64 patients were followed up for 12 to 74 months，with an average of 42.8 months.Eight of 64 cases recurred with recurrence rate was12.5%.There was no distant metastasis and malignant transformation after operation.The postoperative evaluation of limb function was (27.06±1.45).The results of multivariate logistic regression model indicated that Campanacci grades was a key factor affecting tumor recurrence (regression coefficien t=2.368，P=0.04).The P values of recurrence rates were 0.007 and 0.002 for Campanacci grade I and grade Ⅱ，as well as grade I and grade Ⅲ，respectively after the analysis of χ2 test，suggesting a statistical significance in their difference (P＜0.05).The P value of Campanacci Ⅱ and Ⅲ was 0.23，which did not show any statistical significance (P＞0.05).There were no complications such as articular surface collapse and fracture in the long-term follow-up group after operation.Instead，the joint mobility was good and walking function was satisfactory.Conclusion  Expanded curettage and bone cement filling treatment is a reliable treatment for GCT，The overall recurrence rate is relatively low and the recovery of limb function is satisfactory.The Campanacci grades is the key factor that affects the recurrence.
2019 Vol. 25 (2): 123-130 [Abstract] ( 271 ) HTML (1 KB)  PDF (984 KB)  ( 348 )
127 Biomechanic Evaluation of a New Cervical Anterior Mesh
Li Chao，Ge Feng，Xu Cheng
Objective  To evaluate the three-dimensional biomechanic stability of a new fixable anterior cervical mesh in a corpectomy model.Methods  We designed and produced the novel mesh.And Six fresh male cadaver cervical specimens were used.The intact，C5 corpectomy fixed with mesh and plate，C5 corpectomy fixed with fixable mesh were tested.range of motion of the fixed segments were measured under non-contact photographic recording system.Results  The fixable mesh can provide enough stability，but not as stable as mesh-plate mode，especially in flexion movement.Conclusion  The fixable mesh can provide enough stability after anterior cervical corpecomy.Although not as stable as mesh-plate，the new mode may be favor to fusion.
2019 Vol. 25 (2): 127-130 [Abstract] ( 345 ) HTML (1 KB)  PDF (1330 KB)  ( 393 )
131 The Biomechanical Study of Plate Fixationin the Treatment of Distal Radius Fracture through the Volar or Dorsal Approach
Zhang Liang 1，Zou Ning 1，Zhou Jianwei 2，et al

Objective  To compare the biomechanical properties of distal radius fracture by volar or dorsal plate fixation.And provide theoretical basis for the strategy of treatment for the distal radius fracture.Methods  The unstable type of fracture were established in 10 distal radius specimens.The specimens were randomly assigned to volar or dorsal plate fixation groups (n＝5 in each group).Biomechanical testings were conducted in these specimens after plate fixation.Results  a) In the dorsal displacement type of distal radius fracture，there was no significant difference between volar and dorsal plate fixation groups in stress intensity，axial rigidity or shearing rigidity (P＞0.05).b) No significant difference was found in the torque or torsional rigidity between the volar and dorsal plate fixation groups (P＞0.05).c) In the axial stress testings，no significant difference was found in the ultimate strength of absorbed energy by bone between the two groups (P＞0.05).d) The present results were only 6% different from the theoretical analysis of combined rod stress，which proved the validity of the present experimental stress results.Conclusion  In the dorsal displacement type of distal radius fracture，the biomechanical properties were similar between the volar and dorsal plate fixation groups.Although dorsal plate fixation resulted in better outcomes，there were no significant differences between the two groups.In clinical practice，however，it is easier，more convenient，more practical and more effective to use the volar plate fixation.
2019 Vol. 25 (2): 131-134 [Abstract] ( 296 ) HTML (1 KB)  PDF (1102 KB)  ( 365 )
135 The Regulation of Adiponectin on Human Nucleus Pulposus Cells Proliferation and Apoptosis
Li Yumin，Lei Aifeng，Wang Chunmei，et al
Objective  To investigate the role of adiponectin on human nucleus pulposus cells proliferation and apoptosis.Methods  TNF-α was used to induce apoptosis in human nucleus pulposus cells.CCK8 test，TUNEL and flow cytometry were used to detect the proliferation and apoptosis of human nucleus pulposus cells.Gain and loss of function was used to investigate the role and mechanism of adiponectin on the proliferation and apoptosis of human nucleus pulposus cells.Results  TNF-α inhibited proliferation and induced apoptosis of human nucleus pulposus cells，adiponectin could antagonize the proliferation and apoptosis induction in human nucleus pulposus cells by TNF-α.Silence of Adipo R1/R2 can enhance human nucleus pulposus cells proliferation and apoptosis induced by TNF-α.Conclusion  Adiponectin can regulate the proliferation and apoptosis of human nucleus pulposus cells through Adipo R1 and Adipo R2.
2019 Vol. 25 (2): 135-139 [Abstract] ( 285 ) HTML (1 KB)  PDF (2532 KB)  ( 209 )
140 Experimental Study of Wound Healing Process of Diabetic Rats under Different Blood Glucose Concentration
Zeng Wenchao，Gong Ru，Guo Hongmin，et al
Objective   To study the effect of blood glucose level on the wound healing of diabetic rats.Methods  Diabetes mellitus model was built by streptozotocin injection in male rats aged 3~4 months.The diabetes mellitus rats were divided into four groups according to the level of blood gulcose regulated by insulin.The wound model was formed by operation.Afterwards，rats were killed at 0 (the same day of injury)，3，7 and 14 days after injury.The wound healing area was measured，in combination with the observation of the pathological changes of wound tissues.Results  When the blood sugar concentration was controlled at 160~190 mg/dL，the wound healing rate was the fastest，followed by at the level lower than 160 mg/dL with no significant difference in macrophages.At higher blood sugar levels，the healing rate of wounds was delayed obviously，and macrophages in surrounding tissues exhibited remarkable decrease.Conclusion  It is beneficial to wound healing at low levels of high blood sugar concentration in diabetic rats.
2019 Vol. 25 (2): 140-142 [Abstract] ( 244 ) HTML (1 KB)  PDF (1613 KB)  ( 331 )
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