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2019 Vol. 25, No. 4
Published: 2019-04-25
 
289 Analysis of Characteristics and Prognosis of Postoperative Pyrexia in Lumbar Fusion
Xu Weiliang 1，2，Cai Dongling 2*，Guo Weijun 2
Objective  To observe and analyze the characteristics of postoperative pyrexia and the correlation with prognosis after lumbar fusion.Methods  A retrospective study was conducted in the 126 patients who underwent lumbar fusion from September 2017 to September 2018 in the Department of Orthopaedics，Panyu Hospital of Chinese Medicine，including 38 males and 88 females，aged (57.64±11.16)years old.The daily highest temperature (from pre-operation day 1 to postoperation day 7)，infections during the hospitalization，the type of infections，and the length of stay were collected.The postoperative pyrexia was defined as over 37.8 ℃.The changes of postoperative temperature，and characteristics of postoperative pyrexia were observed.The correlation between continuous fever (over 2 days) and infection events was analyzed，as well as the effect on the length of stay.Results  A total of 35 patients (27.78%) experienced postoperative fever.The first pyrexia commonly occured on day 1 postoperatively (62.86%).The average highest temperature was found on day 1 postoperatively (37.30±0.50)℃.Among all patients，the highest fever rate occured on day 1 postoperatively (17.46%).Noninfectious factors caused pyrexia in 28 cases (80%).Continuous fever was significantly associated with postoperative infection (χ2=7.359，P＜0.01)，and significantly prolonged the length of stay (t＝3.300，P＜0.01).Conclusion  Non-infectious factor is the most common reason for postoperative pyrexia after lumbar fusion.Consecutive pyrexia for at least 2 days may increase the incidence of infection，and prolong the length of stay.
2019 Vol. 25 (4): 289-292 [Abstract] ( 377 ) HTML (1 KB)  PDF (469 KB)  ( 327 )
293 Analysis of Risk Factors of Vertebral Re-fracture after OVCF Cement Augmentation
Zhang Shengfei，Zhang Liang，Tao Yuping，et al
Objective  To analyze the influencing factors of vertebral body re-fracture after OVCF cement treatment.Methods  The data of 100 patients with vertebral body re-fracture treated with bone cement augmentation surgery in spinal surgery in our hospital from August 2009 to December 2017 were retrospectively reviewed.Randomly selected 100 patients with no re-fracture after operation in the same period were used for comparison.We compared the gender，age，BMI，BMD，number of vertebral enhancements，bone cement usage，bone cement leakage，AVH recovery rate，bone cement distribution，surgical methods，whether the patients had anti-osteoporosis treatment，other fractures and long-term use of glucocorticoids.Results  Univariate analysis showed that there was no significant difference in gender，age，BMI，bone cement usage，surgical methods，and number of vertebral enhancement between the study group and the control group (P＞0.05).However，the study group was more severe than the control group in osteoporosis，with more cases of bone cement intervertebral disc leakage，unequal distribution of long-term glucocorticoid and bone cement，greater AVH recovery rate，and a higher proportion of other fractures.The proportion of regular anti-osteoporosis treatment was even lower (P＜0.05).Logistic regression analysis showed that the study group had a higher proportion of long-term glucocorticoid treatment，and a lower proportion of regular anti-osteoporosis treatment (P＜0.05).Conclusion  Severe osteoporosis，bone cement intervertebral disc leakage，uneven distribution of bone cement，excessive AVH recovery rate，irregular treatment of osteoporosis，other combined fractures，long-term use of glucocorticoids，are all causes of postoperative vertebral fractures after OVCF bone cement augmentation.
2019 Vol. 25 (4): 293-296 [Abstract] ( 400 ) HTML (1 KB)  PDF (1672 KB)  ( 287 )
297 Clinical Research of Multiloc Intramedullary Nail and Locking Plate in the Treatment of Elderly Humeral Surgical Neck Fracture
Chen Ruihong 1，Ge Hongqing 2，Cuan Hua 2
Objective  To explore the clinic effect of Multiloc PHN and PHILOS for the Neer Ⅱ humerus surgical neck fracture in the elderly retrospectively.Methods  Thirty patients with NeerⅡhumerus surgical neck in the elderly from June 2016 to June 2018 were reviewed.There were 5 males and 25 females，aged 54~88 years，with an average age of (72.3±12.7) years.Ten patients were treated with Multiloc PHN，Twenty patients were treated with PHILOS.The operation time，incision length，intraoperative bleeding volume，visual analogue scale (VAS) and Constant-Murley shoulder function score were compared between the two groups.Results  There was no significant ifference in the operation time，The follow-up time of Multiloc PHN was 0.9~1.8 years，with an average of 1.3 years，while that of PHILOS group was 1.1~2.1 years，with an average of 1.5 years.the length of the incision，perioperative blood loss，the VAS，the Constant score in the two groups (P＞0.05).Compared with PHILOS，The neck stem angle on the first day after operation of the Multiloc PHN was larger，and the difference was statistically significant (P＜0.05).Conclusion  Multiloc PHN and PHILOS can get the same clinic outcomes for treatment of the NeerⅡ humerus surgical neck，Multiloc PHN can stabilize the proximal end of the humerus with multiple screws in multiple dimensions and directions，and control the rotation of fracture ends more effectively.Patients can make the function exercise early after operation，and the joint function can recover well.
2019 Vol. 25 (4): 297-300 [Abstract] ( 254 ) HTML (1 KB)  PDF (1530 KB)  ( 295 )
301 Clinical Application of 3D Print Fracture Model in Complex Acetabular Fracture
Huang Jiajun，Huang Zhiyong，Guo Qiang，et al
Objective  To analyze the clinical efficacy of 3D print fracture model and bridgelink internal fixation system for complex acetabular fracture.Methods  92 patients with complex acetabular fracturewere enrolled in the study in People's Hospital of Chengyang District from February 2015 to February 2017.The patients were treated with routine surgical approach.46 patients were randomly selectedwith 3D print fracture model before operation and bridge-link internal fixation system(3D group) andthe other 46 patients (Traditional group) were treated with traditional treatment.The operation related indexes，fracture reduction，hip joint function and complications of two groups werecompared.Results  Compared with the traditional group，the time of operation was shorter，less bleeding in the operation，less flow rate after operation and short hospitalization time in group 3D(P＜0.05).Immediately after surgery，the fracture reduction was evaluated.The total resetting satisfaction of the two groups was high，the 3D group was slightly higher than the traditional group，but there was no significant difference(P＞0.05).6 months after surgery，in the three aspects of pain，movement amplitude and walking ability，3D group were slightly higher than the traditional group，but the difference was not statistically significant(P＞0.05)，but the difference was statistically significant on the total score(P＜0.05).6 months after surgery，the total incidence of group 3D was 4.35%，which was slightly lower than that of the traditional group 13.04%(P＞0.05).Conclusion  The 3D printing techniquewith bridgelink internal fixation system oncomplex acetabular fracture before operation can shorten the time of operation，reduce the amount of blood loss and help the patient to recover quickly.
2019 Vol. 25 (4): 301-304 [Abstract] ( 286 ) HTML (1 KB)  PDF (1252 KB)  ( 299 )
305 Effect of Methylprednisolone on the Early Clinical Effect of Knee Arthroplasty
Zhang Quan 1，Ren Guangzong 1，Ren Weiping 2，et al
Objective  To investigation the effect of methyl prednisolone on the early clinical effect after knee arthroplasty with multimode cocktail periarticular injection (MCPI).Methods  A prospective randomized controlled trial was conducted in 60 patients from January 2018 to June 2018 with 30 patients in each group.The patients received a combination of methylprednisolone and no methylprednisolone to control postoperative pain.Visual analogue score (VAS) was used to evaluate the pain at rest and activity after operation.The swelling degree of knee joint was observed and the active range of knee motion was measured at different time intervals.Results  The results showed that adding methylprednisolone to MCPI could reduce the degree of joint pain and swelling in the early stage (within 24 hours) after operation，and increase the time of active straight leg elevation in advance (P＜0.05)，there was a significant difference between the two groups (P＜0.05).There was no significant difference between the other data (P＞0.05).Steroid hormones also did not increase the risk of postoperative wound infection or tendon rupture.Conclusion  Adding methylprednisolone to MCPI can improve the pain relief effect in the early stage (within 24 hours) after total knee replacement，advance the time of raising straight leg，reduce the degree of joint swelling，and have no obvious complications.However，there is no significant effect on the motion of knee joint in the early stage after operation.
2019 Vol. 25 (4): 305-309 [Abstract] ( 372 ) HTML (1 KB)  PDF (532 KB)  ( 256 )
310 Musculoskeletal Ultrasound in The Diagnosis of Senile Degenerative Knee Joint Lesions
Liu Jie，Liu An，Chen Shiqiang
Objective  To investigate the clinical diagnostic value of musculoskeletal ultrasound in the diagnosis of senile degenerative knee joint lesions.Methods  Sixty patients (87 knees) with degenerative knee arthropathy were selected.All knees were examined by musculoskeletal ultrasound，MRI and arthroscopic surgery.The clinical value of musculoskeletal ultrasound in the diagnosis of degenerative knee joint disease was analyzed by comparing the results of ultrasound and MRI examination of knee joint with the diagnosis after arthroscopic surgery.Results  Musculoskeletal ultrasound could clearly show articular cartilage lesions，synovial thickening and joint effusion，and the abundance of blood flow signals in proliferative synovium.There was no significant difference between ultrasound and MRI in diagnostic coincidence rate (P＞0.05).However，for the diagnosis of tendon，meniscus and ligament injuries，MRI was significantly better than musculoskeletal ultrasound，the difference was statistically significant (P＜0.05).Conclusion  The diagnostic value of musculoskeletal ultrasound for early degenerative knee joint lesions is the same as that of MRI.It canbe used as a routine examination of knee joint diseases in middleaged and elderly people，and is worthy of clinical application.
2019 Vol. 25 (4): 310-312 [Abstract] ( 277 ) HTML (1 KB)  PDF (1261 KB)  ( 313 )
313 Analyses of Microbiology and Outcome in Early，Delayed and Late Prosthetic Joint Infection
Chen Zhi 1，Zhou Zongke 2*，Shen Bin 2，et al
Objective  To analyze the microbiology and antibiotic susceptibility of bacteria isolated from infected hip and knee joint，compareorganism profile and antibiotic susceptibilitybetween the acute，delayed and late infection patientsand to assess the antibiotic and surgery treatment outcome of prosthetic joint infection. Methods  The microbiology and antimicrobial susceptibility data of prosthetic hip and knee infection patients between January 1，2010 and December 31，2015 were retrospective reviewed and analyzed.A total of 146 patients were identified.111 cases were prosthetic hip infection and 35 cases were prosthetic knee infection，with a mean age of (57.37±14.74)(range，29~89 ).The patients were divided into the acute，delayed and late infection groups.There were 19 cases in the acute group，20 cases in the delayed group and 107 in the lateinfection group.The organism profile，antibiotic susceptibility and treatment outcome were compared.Results  Gram-positive bacteria wasthe main pathogen，whichwas found in 57.89% cases of the acute group，60.00% of the delayed group and 54.21%of thelate infection group.The most common organisms were Staphylococcus Epidermidis and Staphylococcus Aureus.The infections caused by Gram-negative bacteria were mainly enterobacter cloacae，pseudomonas aereginasa and escherichia coli.The results of antibiotic susceptibility showed bacteria were sensitive to antibiotic such as rifampin，linezolid，furantoin，quinupristin and vancomycin，but Gentamicin，tobramycin and cephalosporins had high resistance rate.And，with the increase of the infection time，the resistance of pathogen increased gradually.Two-stage revision was the most common surgical approach，encountered 89.72%，followed by irrigation and debridement (5.48%) and one-stage revision (4.79%).Conclusion  The pathogen spectrum of prosthetic joint infectionis wide and complex，the dominate pathogen is Gram-positive bacteria，and the most common organisms is Staphylococcus.The antibiotic resistance rate is high，and with the increase of the infection time，the resistance rate increased gradually.So the antibiotic treatment and surgical approach should be individually and fully evaluated.
2019 Vol. 25 (4): 313-316 [Abstract] ( 467 ) HTML (1 KB)  PDF (444 KB)  ( 301 )
317 Short-term Outcomes of Two Surgical Method in the Treatment of End-stage Hallux Rigidus
Qu Fufeng 1，Ji Weina 2，Zeng Qiu 2，et al
Objective  To evaluate the short-term outcomes of the first metatarsophalangeal joint replacement and the first metatarsophalangeal joint fusion in the treatment of end-stage hallux rigidus.Methods  From February 2015 to August 2016，27 patients (27 feet) were diagnosed with end-stage hallux rigidus and eligible to research standard.They were treated by the first metatarsophalangeal joint replacement or fusion，and their age ranged from 28 to 52 years old with an average age of (39.0±3.6)years old.Among them，the joint fusion group had 2 males and 10 females，and their age ranged from 30 to 52 years old，with an average age of (40.0±2.5)years old.Joint replacement group were consisted of 5 males and 10 females，and their age ranged from 28 to 52 years old with an average age of (39.0±3.4)years old.The outcomes were analyzed by the range of motion (ROM)of first metatarsophalangeal joint，Maryland score，and Visual Analogue Score(VAS) of the last follow-up and preoperation.Results  All the patients were effectively followed up，and their follow-up times were 11 to 17 months with the average follow-up time of (14.0±2.7)months.There were no significant differences in follow-up time between the two groups (P＜0.05).In joint fusion group，the average Maryland scores were increased by 15.3 points and the average VAS scores were decreased by 4.4 points in the final follow-up，and the differences were statistically significant (P＜0.05).The joint range of motion were lost in the fusion group after the operation.All the patients in the fusion group obtained the fusion at the end of follow-up，and 4 patients had metatarsalgia and the pain was nearly disappeared after treatment by orthopaedic insoles.In joint replacement group，the average Maryland scores were increased by 20.2 points，the average VAS scores were decreased by 4.6 points，and the average ROM was increased by 40.1°in the last follow-up，and the difference were statistically significant (P＜0.05).All patients in the joint replacement group，there were no prosthesis adverse events in the last follow-up，and 1 patient suffered incision necrosis after surgery，and the wound healed after dressing.There were no significant difference between the two groups in preoperative average ROM，average VAS score and Maryland score (P＞0.05).The average Maryland score of the joint replacement group were higher than that of the joint fusion group at the last follow-up，and the difference were statistically significant between two groups (P＜0.05).There were no significant difference in VAS scores between the two groups at the last follow-up (P＞0.05).At the end of the follow-up，the joint fusion group lost the ROM，which could not be compared between groups.Conclusion  The short-term outcomes of first metatarsophalangeal joint replacement and fusion were satisfied in the treatment of hallux rigidus，and the outcomes of first metatarsophalangeal joint replacement were better，but the long-term outcomes need to be further follow-up.
2019 Vol. 25 (4): 317-325 [Abstract] ( 234 ) HTML (1 KB)  PDF (1012 KB)  ( 224 )
321 Comparison between CT and X-ray in the Diagnosis and Treatment of Intertrochanteric Fractures
Shi Lei 1，Lv Yang 2，Zhou Fang 2*
Objective  To explore the value of CT and X-ray in the classification and surgical methods of intertrochanteric fractures.Methods  We retrospectively analysed the patients with intertrochanteric fracture who was treated at 3rd Hospital of Peking University and Yanqing Hospital before September 2016.Therewas a total of 261 cases with X-ray and CT examination retained.Six orthopaedic surgeons determined the AO classification and surgical methods according to X-ray and CT，respectively.Results  CT examination did not show clear value of classification.For senior surgeons，they tended to change part of A2.1 to other subtypes after reading CT，with statistical differences (P＜0.05).In terms of treatment methods，32 patients were changed to use extra-medullary plates due to the judgment of fracture of lateral trochanteric wallshown in CT.The differencewas statisticalsignificant (P＜0.05).Meanwhile，CT reduced the differences in treatment methods among different surgeons.Conclusion  Compared with X-ray，CT of great value in the diagnosis and treatment of intertrochanteric fractures，which is mainly reflected in the fact that senior surgeons are more accurate in the judgment of lateral wall fractures which requiring reconstruction，and select extra-medullary locking plate，which is more appropriate.
2019 Vol. 25 (4): 321-325 [Abstract] ( 224 ) HTML (1 KB)  PDF (845 KB)  ( 283 )
326 The Characterization and Histocompatibility of 3D Printed PLLA/β-TCP Composite Artificial Bone
Cen Chaode 1，Zhang Yong 2，Luo Cong 3*，et al
Objective  To prepare the Poly(L-lactic acid)/β- tricalcium phosphate(PLLA/β-TCP)composite artificial boneutilizing 3D printing technologyand investigate its physical properties and histocompatibility in vivo to verify its feasibility as tissue engineered bone materials.Methods  The PLLA/β-TCP composite artificial bones were fabricated by 3D printing technology，their microstructure was observed by Scanning electron microscopy (SEM)，their physical strength was detected by dynamic and static fatigue testing machine.Their porosity was measured by Mercury porosimeter and densimetry.The state of crawling C3H10 cells in composite artificial bones were observed by SEM to evaluate the cytocompatibility of artificial bones.The leaching solution of composite artificial bones was used to culture the C3H10 cells and observing the effect of it on cell differentiation.The histocompatibility of PLLA/ β-TCP composite artificial bones implanted in the gluteus muscle mass of New Zealand rabbits were observed after one month，two months and three months.Results  SEM showed that PLLA/β-TCP had a porous structure.The C3H10 cells cultured in PLLA/ β-TCP composite artificial bone were fully extended and energetic，which indicating PLLA/β- TCP composited artificial bones had good cellular compatibility.The maximum elasticity modulus of PLLA/ β-TCP composite artificial bones was (21.1±3.4)MPa and the maximum bending strength was (9.5±2.3)MPa，the porosity of PLLA/β-TCP composited artificial bone we needed was (51±3)%.The alkaline phosphatase staining and alizarin red staining were performed after C3H10 cells cultured at the seventh day and twenty-first day，the positive results indicated that there was osteoinductive composition in the artificial bone.The tissue sections showed that the artificial bones were surrounded by a layer of loose and dropsical fibrous tissue when PLLA/β-TCP composited artificial bone were implanted in muscle bags at early stage，in which we could find a small amount of neutrophils and lymphocytes.The artificial bone was closely associated with the surrounding tissues and the boundary was blurred，we just observed a little amount of lymphocytes in fiber bundles in the late stage.The experimental results were in accordance with the standard of local reaction after implantation of national medical device.Conclusion  3D printed PLLA/β-TCP composite and porous artificial bone has excellent mechanical strength，good cell compatibility，osteoinduction and histocompatibility，which is an ideal tissue engineered bone material.
2019 Vol. 25 (4): 326-365 [Abstract] ( 320 ) HTML (1 KB)  PDF (4239 KB)  ( 285 )
333 Biomechanical Study of Cortical Bone Trajectory Screw Fixation in the Osteoportic Type-A3 Thoracolumbar Fractures
Cao Shifeng，Song Xin，Ni Ming，et al
Objective  To analyze biomechanical stability of cortical bone trajectory system inthe osteoporotic type-A3 thoracolumbar fractures.Methods  Six fresh thoracolumbar spinal function units (L1~3) were harvested from old cadaver spines.Bone mineral density (BMD) was measured for all the vertebral bodies.The ranges of motion of all specimens were detected on the MTS-858 spinal biomechanics testing instrument under different states respectively，normal state，classic pedicle screw fixation，cortical bone trajectoryscrew fixation，type A3 L2 vertebral body fracture classicpedicle screw fixation，and type A3 L2 vertebral body fracture cortical bone trajectory screw fixation.Results  Ranges of motion at flexion，extension，left bending，right bending，left axial rotation and right axial rotation were significantly lower in the cortical bone trajectory screw group and classic pedicle screw group than in the normal state group (P＜0.01).There were no significant differences between the rages of motion of the cortical bone trajectory screw fixation group and classic pedicle screw fixation group.The ranges of threedimensional motion were significantly lower in the type A3 L2 vertebral body fracture classic pedicle screw fixation group and type A3 L2 vertebral body fracture cortical bone trajectory screw fixation group than in the normal state group (P＜0.05).Likewise，there were no significant differences between the range of motion of the type A3 L2 vertebral body fracture classic pedicle screw fixation group and type A3 L2 vertebral body fracture cortical bone trajectory screw fixation group (P＞0.05).The range of motion between the classic pedicle screw fixation group and the type A3 L2 vertebral body fracture classic pedicle screw fixation group was insignificant (P＞0.05).Conclusion  These results confirmed that cortical bone trajectory technology can obtain similarimmediatestability as the traditional pedicle screw fixationinthe osteoporotic type-A3 thoracolumbar fractures.Simultaneously，it is a good choice for the osteoporotic type-A3 thoracolumbar fractures.
2019 Vol. 25 (4): 333-337 [Abstract] ( 321 ) HTML (1 KB)  PDF (1675 KB)  ( 181 )
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