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2019 Vol. 25, No. 6
Published: 2019-06-25
 
481 Mobi-C ArtificialDisc Replacementand Anterior Cervical Discectomy and Fusion with ROI-C in Treatment of Single-level Cervical Spondylosis
Zhang Ge，Zhang Yazhong，Zheng Peiyan，et al
Objective  To compare the clinical efficacy of Mobi-C artificial disc replacementand anterior cervical discectomyand fusion with ROI-C in treatingsingle-level cervical spondylosis.Methods  From March 2016 to September 2017，a total of 35 patients with the cervical spondylosis was treated with Mobi-C artificial disc replacementand anterior cervical discectomyand fusion with ROI-C in our department.they were divided into Mobi-C artificial disc replacement (groupA，15 cases)and anterior cervical discectomyand fusion with ROI-C (groupB，20 cases).The patients were followed up for more than 12 months after operation.Recording operation time，intraoperative blood loss and surgical-related complications.The Japanese Orthopedic Association (JOA)score、cervical disability function index (Neck Disability Index，NDI)and visual analogue scale(VAS)were used to evaluate the clinical efficacy.The lateral X-ray of the cervical spine was used to measure the Cobb angle of the local lordosis and the overall lordosis(C2～7)of the cervical intervertebral disc.The ROM(range of motion)of the cervical spinewas measured by the dynamic X-ray and the data were compared before and after the follow-up.Results  All 35 patients were followed up.JOA、NDI and VAS at the last time were further improved than those at preoperative.There was no significant difference in the preoperative between the two groups in the JOA、NDI and VAS(P＞0.05).There was no significant difference in the final follow-up between the two groups in the JOA、NDI and VAS(P＞0.05).There was no significant difference between preoperative and final follow-up in the Cobb angle of the local lordosis，the overall lordosis(C2～7)of the cervical intervertebral disc and the range of motion of cervical spine of the Mobi-C artificial disc replacement(P＞0.05)；there was no significant difference between preoperative and final follow-up in the Cobb angle of the local lordosis and the overall lordosis(C2～7)of the cervical intervertebral disc of anterior cervical discectomyand fusion with ROI-C(P＞0.05).The difference was statistically significant of the range of motion of cervical spine in final follow-up(P＜0.05).There was no significant difference in thepreoperative between the two groups in the Cobb angle of the local lordosis，the overall lordosis(C2～7)of the cervical intervertebral disc and the range of motion of the cervical spine(P＞0.05).There was significant difference in the final follow-up between the two groups in the Cobb angle of the local lordosis，the overall lordosis(C2～7)of the cervical intervertebral disc and the range of motion of the cervical spine(P＜0.05).Conclusion  Compared with the anterior cervical discectomyand fusion with ROI-C，Mobi-C artificial disc replacement has similar effective treatments in treatingsingle-level cervical spondylosis，and better maintain cervical mobility，which can be used as an effective treatment for cervical spondylosis.
2019 Vol. 25 (6): 481-504 [Abstract] ( 351 ) HTML (1 KB)  PDF (2954 KB)  ( 529 )
488 Clinical Application of Transpedicular External Reduction Device in Percutaneous Kyphoplasty
Zhao Lei，Zeng Yiwen，Wang Gangrui *，et al
Objective  To study the clinical application of transpedicular external reduction device in percutaneous kyphoplasty(PKP)for osteoporotic vertebral body compression fractures(OVCFs) from October 2010 to June 2017.Methods  Forty patients with thoracolumbar vertebral osteoporotic compression fractures were divided into observation group and control group.The patients aged 58 to 75 years，with 12 male and 28 female.There were 20 cases in each group，and the patients underwent two different treatment：observation group had Percutaneous kyphoplasty and the control group had kyphoplasty combined with transpedicular external reduction device.Postoperative morphological changes of the injured vertebral body，sagittal Cobb angle，visual analog scale of pain level (visual analogue scale，VAS)，bone cement injection volume，bone cement leakage rate，and postoperative complications were studied.Results  We successfully injected bone cement into 40 vertebral bodies.No bone cement toxicity reaction，no symptoms of spinal nerve injury，no cardiovascular and cerebral vascular complications and pulmonary embolism，no death during surgery were found.The postoperative vertebral volume change was significantly increased compared with that before operation (P＜0.05)，and the increase in the observation group was less than control group，the postoperative Cobb angle was significantly decreased (P＜0.05)，and the reduction of observation group was less than that of control group.The VAS scores of the two groups were significantly lower than those before surgery (P＜0.05).The improvement of postoperative and preoperative VAS scores were less in the observation group compared with control group.The amount of bone cement injected into each vertebral body in the control group was more than that of observation group.The cement leakage rate of the control group was lower than that of the observation group(P＜0.05).Conclusion  For patients with osteoporotic vertebral compression fractures，percutaneous kyphoplasty combined with transpedicular external reduction has superior biomechanical reduction performance，which can effectively restore and maintain the biomechanical stability of the spine，which can be overcome the defect of PKP in the recovery of vertebral height and improves the curative effect.
2019 Vol. 25 (6): 488-492 [Abstract] ( 410 ) HTML (1 KB)  PDF (1958 KB)  ( 328 )
493 Clinical Effect of Extreme Lateral Interbody Fusion (XLIF) Combined with Posterior Percutaneous Pedicle Screw Fixation in the Treatment of Lumbar Intervertebral Infection
Yang Zhengwei，Lu Hongwei，Hu Junxian，et al
Objective  To evaluate effect of minimally invasive extreme lateral interbody fusion (XLIF) combined with posterior percutaneous pedicle screw fixation in the treatment of pyogenic lumbar intervertebral infection.Methods  20 cases with pyogenic lumbar intervertebral space infection who underwent surgery with XLIFtechnique and posterior percutaneous pedicle screw fixation were included in the study from January 2012 to December 2018 in our hospital.Their data about operative time，estimate blood loss，length of stay，bone fusion state，kyphosis and sagittal balance correction，clinical and radiographic characteristics were retrospectively collected and analyzed.Results  Twenty consecutive cases (were reviewed，with mean age of 54.9 years old (18~67)and 18.9 months (11~56)follow-up duration.There were 23 operative levels analyzed in this study.The mean operative time was (279.6±73.9)minutes per segment，and estimate blood loss (241.3±70.1)mL，with mean postoperative length of stay (4.4±2.8)days.At the final follow-up，11 to 56 months postoperatively，back pain visual analogue scores (VAS) and Oswestry disability index (ODI) were significantly reduced (9.30±1.63% vs 0.65±0.49 and 77.65±9.41% vs 6.60±1.05 respectively) compared to preoperative values(P＜0.05).Lumbar lordosis increased 6.12° (14.7%) (P＜0.05)and segmental kyphosis reduced 1.99° (－21.6%) (P＜0.05) postoperatively which demonstrated sagittal balance maintained and kyphotic deformity corrected effectively.Moreover，indirect decompression indexes including intervertebral space height，foraminal height，foraminal area，spinal canal cross sectional area (CSA) and central sagittal diameter were significantly improved postoperatively(P＜0.05).Bone fusions were verified radiographically in all cases at the final follow-up.All the patients showed neurological recovery and no reoperation was needed and no recurrence of infection.Conclusion  Minimally invasive XLIF technique combined with posterior percutaneous pedicle screw fixation showed merits of debridement completely，keeping spine stability effectively and improved clinical and radiographic parameters in proper selected pyogenic lumbar intervertebral infection cases.
2019 Vol. 25 (6): 493-499 [Abstract] ( 345 ) HTML (1 KB)  PDF (1941 KB)  ( 350 )
500 Mid-term Follow-up of Total Hip Arthroplasty for the Treatment of Osteoarthritis Secondary to Pyogenic Hip Arthritis
Tao Qifeng，Chen Chunyu，Wu Feipeng，et al
Objective  To investigate the mid-term effect of total hip replacement in patients with osteoarthritis secondary to pyogenic hip arthritis.Methods  From January 2007 to November 2012，7 adolescent patients with hip osteoarthritis caused by hip infection were treated，including 4 males and 3 females，aged 34~54 years，with an average age of 42.57 years.Hip joint infection occurred in childhood or adolescence.The age of infection ranged from 4 to 12 years，with an average age of 6.86 years.The average infection time was 35.71 years (28~42 years).Results  All patients were followed up for 41 to 80 months，with an average of 52 months.The lower limbs of 7 patients were shortened 3~11 cm before operation，with an average of 5.9 cm.The unequal length of lower limbs improved 1~3 cm after operation，with an average of 1.5 cm.Harris score increased from 49.85 points (27~70 points) before operation to 90.29 points (77~95 points) after operation.During the follow-up period，no prosthesis loosening or osteolysis occurred in all patients.Conclusion  Total hip arthroplasty is safe and satisfactory for patients with osteoarthritis sequelae of pyogenic hip arthritis，and can effectively relieve joint pain.
2019 Vol. 25 (6): 500-504 [Abstract] ( 272 ) HTML (1 KB)  PDF (1156 KB)  ( 379 )
505 Finite Element Analysis of Patellar C1 Fracture Treated by Tension Band with Different Needle Insertion Angles
Wang Mingbo，Lv Huicheng，Zhang Pei，et al
Objective  To establish a three-dimensional finite element model for internal fixation of patellar C1 fracture with titanium cable tension band，and to analyze the finite element mechanics of the model.Methods  One adult male volunteer was scanned by thin slice CT of lower extremity.The patella geometric model was established by image data through software.The patella C1 fracture was simulated by the segmentation function of software.Two tension band pins and “8” shaped titanium cable were generated by the scanning function of software.A three-dimensional tension band fixation model of C1 fracture was established to simulate the 90 degree patellofemoral joint of flexion knee.Finite element analysis was carried out to analyze the displacement and deformation characteristics of the force 600N.Results  a)Displacement of fracture patella：Parallel insertion of tension band pin was smaller than that of angular insertion of tension band pin；b)Pressure of fracture surface：When tension band was parallel，the peak pressure of fracture surface was larger than that of angular insertion；c)Relative sliding distance of fracture surface：When tension band pin was parallel，it is smaller than that of angular insertion.Conclusion  Parallel tension band pin placement is better than angular pin placement.The results are consistent with biomechanical results.Finite element analysis is helpful to understand the advantages and disadvantages of different angle tension band internal fixation for patellar fracture，and to provide a theoretical basis for further understanding the therapeutic effect of patellar fracture.
2019 Vol. 25 (6): 505-513 [Abstract] ( 237 ) HTML (1 KB)  PDF (1328 KB)  ( 287 )
509 Medium-term Outcomes of Anterior Cruciate Ligament Reconstruction with LARS Artificial Ligament Versus Hamstring Tendon Autograft
Li Yu 1，Zhang Hao 2，Wang Lizhi 1，et al
Objective  To assess the clinical outcome of anterior cruciate ligament reconstruction with LARS artificial ligament versus hamstring tendon autografts.Methods  We designed retrospective study patients that anterior cruciate ligament reconstruction with LARS artificial ligament or hamstring tendon autografts to compare with the clinical outcome in the department between January 2014 and January 2017.Two groups of patients underwent surgeries with LARS artificial ligament (25 cases，Artificial ligament group) or hamstring tendon autograft (35 cases，Tendon autograft group).The Lysholm，Tegner score and International Knee Documentation Committee (IKDC) score of patients before and last follow-up after operation were assessed.The objective knee stability was assessed by side to side difference of anterior drawer test and Lachman test.Results  All the patients were followed up 24 to 54 months，with a mean of 36 months.The Lysholm，Tegner，IKDC score are improved in the two groups before surgery and in last follow-up.There were statistically significant difference(P＜0.05).Before surgery there was no significant difference in the Lysholm，Tegner，IKDC score (P＞0.05).Compared the Artificial ligament group with the Tendon autograft group at the latest follow up，the Lysholm score，Tegner sore，IKDC score，anterior drawer test and Lachman test were no statistical differences between the two groups (P＞0.05).The time to return sport was (19.52±2.33) weeks in the Artificial ligament group，whereas (29.54±2.33) weeks in the Tendon autograft group，where existed a statistical difference between them (P＜0.05).Conclusion  Both the LARS artificial ligament and the hamstring tendon autograft are effective for ACL reconstruction to regain knee function and stability with similar mediumterm clinical consequences.However，the LARS artificial ligament takes an advantage of earlier return to sport over the hamstring tendon autograft.
2019 Vol. 25 (6): 509-513 [Abstract] ( 374 ) HTML (1 KB)  PDF (1082 KB)  ( 564 )
514 Comparative Study of Suture Anchor and Herbert Screw in the Treatment of Zone I Fracture of the Fifth Metatarsal Base
Zhang Lei，Xiao Jilong，Kong Deming，et al
Objective  To compare the suture anchor and Herbert screw in the treatment of zone I fracture of the fifth metatarsal base.Methods  We studied 46 cases of zone I fracture of the fifth metatarsal base treated surgically in our hospital from January 2013 to December 2017，including 21 males and 25 females.The patients aged 17 to 58 years，with an average age of (37.9±5.1).They were divided into two groups according to different internal fixation methods：24 cases in the suture anchor group and 22 cases in the Herbert screw group.The operative time，intraoperative blood loss，intraoperative fluoroscopy frequency，weight bearing time，fracture healing time，fracture displacement cases and functional recovery of the affected foot were compared between the two groups.Results  The follow-up period ranged from 12 to 18 months，with an average of (14.5±1.6)months.The incision healed normally in all 46 cases，and no incision infection or osteomyelitis occurred.In the suture anchor group，the operation time was (13.0±1.5)minutes，the amount of bleeding was (8.5±3.4)mL，the number of fluoroscopy was (2.1±1.5)times，the time of beginning weightbearing was (6.1±0.4)weeks，the time of fracture healing was (8.2±0.5)weeks.Thre was 1 case of fracture displacement and the Maryland foot function score was (93.2±4.2)points in 6 months after operation.In Herbert screw group，the operation time was (22.0±3.8)minutes，the amount of bleeding was (15.6±5.7)mL，the number of fluoroscopes was (5.0±2.7)times，the time of starting weight-bearing was (8.1±0.5)weeks，the time of fracture healing was (9.2±0.5)weeks.There was 1 case of displaced fracture，and the Maryland foot function score was (85.2±5.5)points in 6 months after operation.Conclusion  Compared with Herbert screw，suture anchor has obvious advantages in operation time，bleeding volume，fluoroscopy frequency，weightbearing time，fracture healing time and ankle joint function in the treatment of zone I fracture of the fifth metatarsal base，but there is no difference in fixation firmness.
2019 Vol. 25 (6): 514-527 [Abstract] ( 300 ) HTML (1 KB)  PDF (1591 KB)  ( 592 )
518 Comparison of Main Treatment Methods in Infectious Nonunion
Guo Jiaqi 1，Yang Zhaohui 2*
Objective  To explore the efficacy of Masquelet technology and Ilizarov technology in the treatment of infectious nonunion.Methods  In this study 30 cases of infective nonunion treated by Ilizarov technique and Masquelet technique in the Department of Traumatic Orthopaedics of the 2nd Hospital of Shanxi Medical University were collected.They were 20~65 years old with an mean age of (32.6±11.2)years old.12 cases were treated with Masquelet technique and 18 cases were treated with Ilizarov technique.The treatment time，cost，number of operations，complications and efficacy evaluation were studied.By analyzing the results，the advantages and disadvantages of the two technologies were compared.Results  All patients in Ilizarov technique group were followed up for an average of (18.04 ±3.67)months.The average healing time was (19.22±3.52)months.The mean follow-up time of Masquelet technique group was (17.07±2.69)months，and the mean healing time was (6.00±2.17)months.There was significant difference in operation cost between the two groups (P＜0.05)；there was no significant difference in the total number of operations (P＞0.05).There was significant difference in the number of infection control operations and the number of bone reconstruction operations (P＜0.05).Conclusion  With current medical level and technical conditions，the implementation of two kinds of surgical treatment of infectious nonunion can basically achieve the goal.Both methods have obvious advantages and disadvantages.Ilizarov technique can completely control infection without worrying about the number of bone defects and it has low or unnecessary requirement for bone grafting and low requirement for the surrounding soft tissue environment.Masquelet technique is limited by bone defect，which not only requires lots of bone grafts，but also can not be completely debrided.Skin grafting is often a necessary step.However，it has low cost and fewer operations，which is beneficial to patients in the course of treatment.
2019 Vol. 25 (6): 518-522 [Abstract] ( 295 ) HTML (1 KB)  PDF (1668 KB)  ( 267 )
523 A Preliminary Study of DFSAA in the Knee Osteoarthritis Patients Based on CT-three Dimensional Reconstruction-measurement
Ke Song，Wang Min *，Xu Yuan，et al
Objective  To analyze the laws of distal femoral sagittal anterior angle (DFSAA) in the patients with knee osteoarthritis preliminary and to discuss the influence that DFSAA will have on the location of the femoral component installation after total knee arthroplasty.Methods  The data of 131 patients who took knee arthroplasty between January 2017 and January 2018 were collected.The 3D images of bilateral femurs were acquired by CT full-length scan of bilateral lower limbs，then the DFSAA of 262 femurs were measured separately with Mimics 17.0 software and also analyzed statistically，and finally the measurement results were compared between males and females and between the left side and the right side.Results  The DFSAA was (2.51±1.50)° (0.05°~5.74°) on average；it was (2.58±1.59)° in males and (2.50±1.49)° in females，and the difference between males and females was not significant (t-test，P>0.05).For individual patients，the difference of DFSAA between the left side and the right side was 1.039 7° on average (0.01°~3.08°)；and it was less than 2° in 90% patients.When the value of DFSAA was 3° or less，the incidence of the notch was 4.48%.When the value of DFSAA was greater than 3°，the incidence of the notch was 18.37%；there were differences between the two groups to compare (chi-square test，P＝0.028).Conclusion  The value of DFSAA varies among the patient with knee osteoarthritis，which should be considered before total knee arthroplasty.For patient with DFSAA value more than 3°，anatomic-axis osteotomy is recommended；for patient with DFSAA value less than 3°，mechanical-axis osteotomy is recommended.
2019 Vol. 25 (6): 523-527 [Abstract] ( 304 ) HTML (1 KB)  PDF (1031 KB)  ( 306 )
528 Effect of Risedronate Sodium on Healing of Osteoporotic Fracture Rats and Its Biomechanical Evaluation
Ke Chenghui，He Lijiang *，Huang Junjie，et al
Objective  To evaluate the effect of risedronate on the healing of osteoporotic fracture in rats by relevant biomechanics.Methods  Ninety healthy female SD rats aged 6 months were randomly divided into A，B，and C3 groups：normal control group (group A)，ovariectomized model + femoral shaft fracture model + risedronate sodium.Treatment group (group B) and ovariectomized model + femoral shaft fracture model + saline gavage group (group C).Before the fracture modeling of each group，10 paw withdrawals were randomly selected，and the BMD value of the right femur fracture healing was detected.After the sacrificed rats，the right femoral stem was taken to detect the maximum load at the new epiphysis，the maximum load recovery rate.At the 3rd and 6th week after fracture modeling，rats in each group were tested again.Results  In the modeling of fractures of rats in each group，the BMD value group and the intra-group comparison，before the modeling group，the P>0.05，the results were not statistically significant.In the comparison of mean values between groups and groups，the results were statistically significant(P＜0.05).In the comparison between the biomechanical properties of the groups before and after the modeling of osteoporotic fractures in each group，the results were statistically significant(P＜0.05)，except in the maximum load recovery rate.In the comparison between groups B and C，the results were not statistically significant.In the maximum load，the results were not statistically significantin Group C.Conclusion  The short-term application of risedronate sodium can promote the healing of osteoporotic fractures.
2019 Vol. 25 (6): 528-532 [Abstract] ( 249 ) HTML (1 KB)  PDF (491 KB)  ( 313 )
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