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2019 Vol. 25, No. 7
Published: 2019-07-25
 
577 Clinical Efficacy of C2 Laminar Screw in Children's Cranial-cervical Junction Surgery
Zhu Changrong，Wang Jianhua，Ma Xiangyang，et al

Objective  To investigate the clinical effects of using axial laminar screw in the operation of craniocervical junction in pediatric population.Methods  From September 2009 to August 2016，12 pediatric patients who underwent axial laminar screwwere retrospectively analyzed.There were 8males and 4 females with an average age of 8.2 years old(range 2～14).The main manifestations were neck pain，limb weakness and numbness.8 cases hadupper cervical myelopathy.Preoperative imaging examination was performed to clear the spinal cordinjury and vertebral artery variability.The spinal cord function was evaluated by JOA scoring system.The average of preoperative JOA score was 13.3.Results  All the 12 cases were followed up for 6 to 20 months (mean 10 months).Atlantoaxialfixation was performed in 7 cases and occipital cervical fixation in 5 cases.Among them，7 cases were treated with bilateral laminar screw and 5 cases with unilateral pedicle screw combined with pedicle screw fixation.No spinal nerve or vertebral artery injury was found.All cases had bony fusion.All 8 patients with preoperative neurological impairment had all the sensory abnormalities recovered，6 patients had normal muscle strength after operation，2 left hand grip strength decreased (grade 4)，and 1 left lower limb flexibility decreased.The JOA score at the last follow-up was 15.8.Conclusion  In pediatric patients who are not suitable for pedicle screw placement，the short-term curative effect of laminar screw fixation is reliable.
2019 Vol. 25 (7): 577-587 [Abstract] ( 246 ) HTML (1 KB)  PDF (1710 KB)  ( 378 )
581 A Comparative Study of 3D Printing Navigation Template and Computer Navigation-assisted C2 Pedicle and Pars Screws Placement
TianYe 1，2，Zhang Jianan 2，Fan Yong 2，et al
Objective  To compare the accuracy and safety of 3D printing navigation template and computer navigation-assisted C2 pedicle and pars screws placement and explore the advantages of the 3D printing template based C2 screws placement.Methods  64 patients who underwentthe C2 pedicle screws and C2 pars screws insertion in our hospital were included.According to the different methods of screw placement，they were divided into the 3D printing navigation template group (group A) and the computer navigation group (group B).Group A was divided into two subgroups：A1 (C2 pedicle screw) and A2 (C2 parsscrew)；Group B was divided into B1 (C2 pedicle screw) and B2 (C2 parsscrew).Group A consisted of 32 patients，including 21 males and 11 females with a mean age of 47.2±11.1 years(27~64 years).All patients were treated with 3D printing navigation template between June 2015 and September 2018.Group B consisted of 32 patients，including 19 males and 13 females with a mean age of 45.6±10.4 years(25~60 years).All patients were treated with the computer navigation between January 2014 and September 2018.All patients underwent cervical X-ray，CT，MRI and CTA before surgery.The disease types，nail placement time，intraoperative blood loss，intraoperative fluoroscopy frequency were compared between the two groups.Besides，the VAS score and JOA score were compared before operation，3 days after operation，and 6 months after operation.All patients undertook cervical CT scan after surgery，and the accuracy of screw placement and the incidence of related complications in the two groups were compared according to Hlubek's new C2 screw grading standard and CT results.Results  In the two groups，the time of screw placement and intraoperative fluoroscopy in group A were better than that in group B，and the difference was statistically significant (P＜0.05).The difference of intraoperative blood loss was not statistically significant (P＞0.05).There was no significant difference in preoperative VAS score and JOA score between the two groups (P＞0.05)，and VAS and JOA scores were significantly improved 3 days after surgery and 6 months after surgery，with statistically significant differences (P＜0.05).There was no significant difference between the two groups (P＞0.05).64 C2 screws were implanted in group A，and the accuracy rate of grade A was 95.31%，among which 52 screws were implanted in group A1，and the accuracy rate of grade A was 96.15%.12 screws were implanted in group A2，and the accuracy rate of grade A was 91.67%.64 C2 screws were implanted in group B，and the accuracy rate of grade A was 84.38%，among which 50 screws were implanted in group B1，and the accuracy rate of grade A was 84.00%.14 screws were implanted in group B2，and the accuracy rate of grade A was 85.71%.The accuracy of screw placement between group A and group B was statistically significant (P＝0.041)，and the accuracy of screw placement between group A1 and group B1 was statistically significant (P＝0.039).There was no significant difference between group A2 and group B2 (P＝0.636).There were no complications of blood vessel and nerve related to nail placement in both groups.Conclusion  Although the placement of C2 pedicle screws and C2 pars screws by 3D printing navigation template and computer navigation implantation can provide higher accuracy，safety and clinical efficacy.The guide template technology is better than the navigation technology in the accuracy of C2 pedicle screw implantation.
2019 Vol. 25 (7): 581-587 [Abstract] ( 294 ) HTML (1 KB)  PDF (1572 KB)  ( 378 )
588 Analysis of Correlation between Classification of High Signal Intensity Ratio of Intramedullary MRI T2WI and Prognosis in Multilevel Cervical Spondyloticmyelopathy
Liang Shuo，Guan Haishan *
Objective  To classify the quantitative signal change ratio(QSCR) ratio in cervical spinal cordof patients with multilevel cervical spondylotic myelopathy (MCSM) on magnetic resonance imaging (MRI T2WI) and to explore the correlation between the quantitative signal change ratio grading system in the spinal cord of cervical spine on MRI T2W1 and the clinical effect after decompression.Methods  The clinical data of 50 patients with multilevel cervical spondylotic myelopathy accompanied by intramedullary high signal intensity changes on MRI T2WI were collected from January 2014 to December 2017.They were divided into <50% group (group A) and ≥50% group (group B) according to whether the improvement rate of nerve function was more than 50%.The high signal area of 0.1 cm2 and the normal intramedullary signal area of C7~T1 0.1 cm2 on the same sagittal plane were measured on cervical MRI T2WI，and the quantitative change rate of signal intensity was calculated.According to JOA score，the quantitative change rate of intramedullary signal intensity before operation was graded 4.Results  All patients were followed up regularly for 6 to 24 months.There were no significant differences in sex ratio，age，course of disease，number of lesion segments，preoperative JOA score and follow-up time between the two groups (P＞0.05).There were 25 patients in group A，with preoperative QSCR of (1.61+0.25)；and 25 patients in group B，with preoperative QSCR of (1.30+0.18).Preoperative QSCR was negatively correlated with JOA score improvement rate (r=－0.876，P＜0.001).The improvement rate of JOA score better than 75% is excellent in 6 cases；the improvement rate of JOA score was 50% to 74%，which was good in 19 cases；the improvement rate of JOA score was 25% to 49%，which was fair in 16 cases；The improvement rate of JOA score below 25% is poor，in 9 cases.The results of variance analysis showed that there was a significant difference in the quantitative signal change ratio among the four groups (P＜0.01)，and There were significant differences between the excellent group and the good group，between the good group and the fair group，between the fair group and the poor group(P＜0.05).Conclusion  Preoperative grading of intramedullary high signal in MCSM is of guiding significance for evaluating prognosis.Surgery before the quantitative change rate of signal intensity reaches a higher level can improve the curative effect of surgery.
2019 Vol. 25 (7): 588-591 [Abstract] ( 352 ) HTML (1 KB)  PDF (514 KB)  ( 349 )
592 Epidemiological Characteristics of Hip Fracture：a Single Center Analysis of 1 397 Cases
Ju Jiabao，Zhang Peixun *
Objective  To investigate the epidemiological characteristics of hip fracture.Methods  We retrospectively retrieved data of patients with hip fracture in Peking University People's Hospital between January 2011 and December 2018，including age，gender，fracture type and admission date.We used SPSS 20.0 to analyze the epidemiology of hip fracture and various subtypes.Results  A total of 1 397 hip fractures were included into analysis，with 476(34.1%) males and 921(65.9%) females and 830(59.4%) femoral neck fractures and 567(40.6%) intertrochanteric fractures.The ratio of male to female was 1︰1.93.The average age of patients with hip fracture was (75.7±12.7) years old，with (72.6±15.6) years of age in male patients and (77.3±10.6) years of age in female.There were 218(12.8%) cases in the young and middle-aged group and 1 179(87.2%) cases in the elderly group.Conclusion  The number of cases of hip fracture is on the rise，and the proportion of women is higher than that of men.The proportion of males in the young and middle-aged group is higher than that of female，while quite the opposite in the elderly group.
2019 Vol. 25 (7): 592-595 [Abstract] ( 294 ) HTML (1 KB)  PDF (1348 KB)  ( 360 )
596 Significance of A New Method for the assessment in the Distal Tibiofibular Syndesmosis Injury
Wang Zhisheng 1，Yang Haitao 2，Wu Zhixin 1，et al
Objective  To investigate the value of the new method in the distal tibiofibular syndesmosis reduction of ankle fracture combined with distal tibiofibular syndesmosis injury during operations.Methods  A retrospective analysis of 24 operative cases of ankle fractures with distal tibiofibular syndesmosis injury from February 2014 to May 2017 was performed.There were18 males and 6 females，which aged 24~65 years old.The average age was(37.5±6.9).The reduction of the distal tibiofibular syndesmosis was determined by tibiofibular clear space，tibiofibular overlap，ankle medial space and “the front profile”.Distance from fibular anterior-posterior edge to syndesmosis (G value) were measured on the CT scans.Comparisons were conducted between the X-ray films to evaluate their diagnostic efficacy，with G value as a golden standard.American Orthopedic Foot and Ankle Society (AOFAS) scores were used to assess the clinical outcome.Results  Of the 24 cases，4(16.7%) were diagnosed with syndesmosis malreduction evaluated with G value.All the patients were followed up for 12 to 46 months (average，16.6 months).No non-union，screw breakage，or syndesmosis separation after screw removal occurred.The American Orthopaedic Foot and Ankle Society (AOFAS) scoring showed a good/excellent rate of 91.7%.Conclusion  The observation of tibiofibular clear space，tibiofibular overlap，ankle medial space combined with “the front profile” can improve the reduction of the distal tibiofibular syndesmosis and function of ankle.
2019 Vol. 25 (7): 596-598 [Abstract] ( 263 ) HTML (1 KB)  PDF (1240 KB)  ( 282 )
599 Arthroscopic Treatment of Avulsion Fracture of the Posterior Cruciate Ligament by Double Endobutton through Two Posterior Medial Approaches
Fu Yun，Bai Yinwei，Zhang Wenzhou，et al
Objective  To investigate the effect of arthroscopic posteromedial double approaches for tibial avulsion fracture of posterior cruciate ligament fixed with double Endobutton plate.Methods  From Feb.2016 to Aug.2017，14 cases of fresh tibial avulsion fracture of posterior cruciate ligament were treated by arthroscopic surgery through anterolateral，anterolateral and posteromedial high and low approaches.There were 10 males and 4 females，aged from 23 to 50 years，with an average age of 36.6 years.The clinical outcomes were evaluated by Lysholm score andthe IKDC subjective knee score before and after operation at 6 months.Knee stability was evaluated with KT-2000.Results  All 14 cases were followed up for 6 to 24 months，with an average of 12 months.At 3 months after operation，all the fractures met the clinical healing criteria，and no delayed union or nonunion occurred.The Lysholm scoreafter 6 months of follow-up increased from (36.5±4.9) preoperatively to (87.0±5.2)postoperatively(P＜0.05).And the IKDC score was improved from preoperative 53.2±6.4 to (82.5±5.8)(P＜0.05).The difference was statistically significant.KT-2000 measurementresults revealed that there were no significant differences between the surgical knee and the normal knee：(2.51±0.73)mm versus (2.82±0.68)mm(P＞0.05).Conclusion  The technique of arthroscopic posteromedial double approaches and fixationwith double Endobutton plateis satisfactoryin the treatment of avulsion of the posterior cruciate ligament of the knee，and has the advantages of less trauma，simple operation and less complications.
2019 Vol. 25 (7): 599-606 [Abstract] ( 351 ) HTML (1 KB)  PDF (809 KB)  ( 310 )
602 Prognosis Related Factors of Ewing's Sarcoma and Construction of Nomogram
Yu Haiquan 1，Tian Yuliang 1，Lu Ning 2
Objective  To analyze the related factors of Ewing's sarcoma prognosis，and to construct a nomogram to predict the long-term survival rate of patients.Methods  The clinical data of 1 110 patients with primary tumors with Ewing's sarcoma registered in the SEER database from 2004 to 2015 were collected to analyze the risk factors affecting the prognosis of patients.The nomogram map was constructed and verified internally，and the accuracy of the prediction model was evaluated using the consistency index (C-index).Results  The cumulative survival rates of 1 110 patients with ES in 3，5，and 10 years were 70.46% (70.43% to 70.49%)，61.70% (61.67% to 61.73%)，and 54.41% (54.37% to 54.45%)，respectively.Multivariate COX regression analysis showed that age，race，T stage，N stage，M stage，and whether surgery were independent risk factors for the prognosis of patients with Ewing sarcoma (P＜0.05).Then we construct a nomogram prediction model based on six independent risk factors.The calibration curves of 3，5，and 10 years survival rates showed a high consistency between the nomogram prediction model and the actual observed survival rate (C-index = 0.717，95% CI = 0.708 to 0.726).Conclusion  The predictive effect of the nomogram scoring system for ES patients with 3，5，and 10 years is better，which provides an alternative visual survival prediction chart for the clinic.
2019 Vol. 25 (7): 602-606 [Abstract] ( 308 ) HTML (1 KB)  PDF (1529 KB)  ( 276 )
607 Application of CT and Three-dimensional Reconstruction in the Measurement of Pedicle Width in Patients with Thoracolumbar Fractures
Liu Xu 1，Zhang Jin 2
Objective  To investigate the application of CT and three-dimensional reconstruction technology in the measurement of pedicle outer width (POW) of osteoporotic vertebral compression fractures in patients and middleaged and young people with thoracolumbar fractures(T11~L5).Methods  Data of all patients with thoracolumbar fracture treated in our hospital from October 2016 to June 2018 were collected for retrospective analysis.Among them，105 patients with OVCF were group A，with an average age of (73.26±6.28)years old.The 72 cases of traumatic thoracolumbar fracture treated at the same time were group B，with an average of (38.90±8.58)years old.The POW values of both sides of vertebral pedicle corresponding to T11~L5 and the differences between different gendersbetween the two groupswere compared.And we calculated the patientpercentages of POW less than 5mm and 7mm.Results  There was no statistical difference in POW of the left and right sides of the spine between the two groups (P＞0.01).The POW corresponding of T11~L3 in groups A was smaller than that in group B (P＜0.01)，and no difference in L4 and L5.There were 118 patients in group A withPOWless than 5 mm，accounting for 8.03% of the total number of the group，mainly distributed in the spine of T11~L3，and 15 patients in group B whose POW less than5mm，accounting for 1.49%.The proportion of patients with POW less than7mm in group A was 46.87%.distributedin T11~L4，and the proportion of patients with POW less than 7mm in group B was 13.10%，distributed in T11~L3.Conclusion  Three-dimensional CT reconstruction examination before surgery can effectively measure the width of pedicle，evaluate the feasibility of surgical treatment，and help reduce the incidence of surgical complications.
2019 Vol. 25 (7): 607-615 [Abstract] ( 305 ) HTML (1 KB)  PDF (715 KB)  ( 292 )
611 Effect of Alendronate Combined with Sodium Fluoride on Osteoblasts from Rats in Vitro
Wei Xincheng，Yang Lingyun，Xu Nuo，et al
Objective  To study the effect of alendronate combined with sodium fluoride on osteoblasts in vitro.Methods  To observe the proliferation and alkaline phosphatase(ALP) activity，the osteoblasts primarily cultured in vitro were isolated from the skull of rats by trypsin digestion method，andstimulated by alendronate and sodium fluoride at different concentrations.The expression of OPG/RANKL was examined by Western Blotting.Results  There was the most significant promotion in osteoblast differentiation and proliferation when the osteoblasts were cultured at the concentration of alendronate of 10－6mmol/L and sodium fluoride of 10－8mmol/L.Compared with the control group，the osteoblastsincombined therapy group had significantly promotion in proliferation and ALP activity.The expression of OPG was increased，and the expression of RANKL was decreased.There were statistically significantdifferences in proliferation，ALP activity and expression of OPG/RANKL.An inhibitory effect was observed at high concentrations of sodium fluoride (10－3mmol/L、10－4mmol/L ).Conclusion  Both alendronate and sodium fluoride can promote osteoblast proliferation and differentiation，and there is synergistic effect when they combined.Sodium fluoride at high concentrations had an inhibitory effect on osteoblasts.
2019 Vol. 25 (7): 611-615 [Abstract] ( 248 ) HTML (1 KB)  PDF (1177 KB)  ( 199 )
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