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2019 Vol. 25, No. 8 Published: 2019-08-25

	673	Value of Four Physical Examinations in Diagnosis of Supraspinatus Tendon Tear
		Mu Pan 1，Huang Suizhu 2，Zhang Chunqi 2
		Objective To investigate the diagnostic value of four different physical examinations for supraspinatus tendon tear.Methods The data of 80 patients who underwent arthroscopic shoulder surgery from October 2017 to October 2018 were retrospectively analyzed.The patients included 33 males and 47 females，aged 32-76 years，with an average age of 52.5 years.There were 49 right shoulders and 31 left shoulders，The patients had course of 3 months to 2 years，with an average of 1.2 years.All patients underwent the following physical examinations before operation：0 degree abduction resistance test，Jobe test，arm drop test and “hold-up resistance” test.The sensitivity，specificity，positive predictive value，negative predictive value，positive likelihood ratio，negative likelihood ratio and accuracy of four kinds of tests for the diagnosis of supraspinatus tendon tear were comprehensively analyzed.Results Arthroscopy confirmed that 36 of 80 patients were diagnosed as supraspinatus tendon tear.For supraspinatus tendon tear，the sensitivity of 0 degree abduction resistance test，Jobe test，arm falling test and "holding resistance" test were 58.3%，72.2%，41.7%，86.1%，specificity were 72.7%，63.6%，88.6%，70.5%，positive predictive values were 63.3%，61.9%，75.0%，70.5%，respectively.The positive likelihood ratios were 2.14，1.98，3.66 and 2.92，and the negative likelihood ratios were 0.57，0.44，0.66 and 0.20，respectively.Conclusion Arm drop test is the most effective method to determine the tear of supraspinatus tendon，and“hold-up resistance” test is the most effective method to detect and eliminate the tear of supraspinatus tendon.It has fixed position，easy operation and high diagnostic value.
		2019 Vol. 25 (8): 673-680 [Abstract] ( 340 ) HTML (1 KB) PDF (460 KB) ( 515 )

	676	Comparison of Clinical Effects of Double Pulley Combined with Suture Bridge Technique and Double Row Fixation in the Treatment of Full Thickness Rotator Cuff Tears
		Guo Weikang，Lai Bing，Huang Jian，et al
		Objective To compare of clinical effects of double pulley combined with suture bridge technique and double row fixation in the treatment of full thickness rotator cuff tears.Methods From March 2017 to December 2018，40 cases of patients with full thickness rotator cuff tears were selected.15 cases of patients were treated by double pulley combined with stitch bridge technology，while 25cases of patients were treated by double row fixing technique.The preoperative general data，the VAS score before operation and 3，6 and 9 months after operation，Constant-Murley score，UCLA shoulder joint score，and ASES score of two groups were compared.Results There were no significant differences in gender，age，tear side and tear causes between the two groups(P＞0.05).The difference of VAS scores of the two groups at 3 months after surgery were statistically significant(P＜0.05).There were no significant differences among VAS scores before sugery，6 months and 9 months after surgery(P＞0.05).There were no significant differences in the Constant-Murley score，UCLA shoulder score，and ASES score between the two groups before surgery and 3，6，and 9 months after surgery(P＞0.05).There were no significant differences in postoperative complication rate and satisfaction between the two groups(P＞0.05).Conclusion Arthroscopic double pulley combined with suture bridge technique and double row fixation for the treatment of rotator cuff tears can obtain better shoulder joint score.Compared with double-row fixation，the doublepulley combined suture bridge technique is more effective in the early postoperative pain relief of rotator cuff tear.
		2019 Vol. 25 (8): 676-680 [Abstract] ( 367 ) HTML (1 KB) PDF (2042 KB) ( 504 )

	681	Causes，Risk Factors and Preventive Analysis of Unplanned Readmission After Total Joint Arthroplasty
		Du Kunlun，Bai Xizhuang *
		Objective To analyze the causes，risk factors and prophylaxis of unplanned readmission in patients with total joint arthroplasty within 90 days of discharge.Methods A retrospective analysis of 348 patients with ostarthritis undergoing TJA were performed in June 2016 to June 2018 in our hospital.These patients were assigned into readmission group and non-readmission group according to whether or not they had been readmitted within 90 days after discharge.By comparing the clinical data of two groups，related risk factors of readmission group were analyzed by multivariate logistic regression models and student's test.Finally，the panel assessed whether patients in the unplanned readmission group could be prevented.Results The unplanned readmission rate of TJA within 90 days after discharge was 5.7 percent.The main reasons were stiffness，dislocation，wound infection，etc.There were 8 preventable cases.The differences of BMI，CCI，pattern of payment and education levels between the two groups were statistically significant.The results of multivariate Logistic regression analysis indicated that BMI，CCI were risk factors for unplanned readmission within 90 days after discharge.Conclusion The patients should be screened and evaluated strictly before surgery，the treatment measures during and after surgery should be optimized，and the postoperative rehabilitation training should be guided correctly to better identify risk factors，reduce complications，and further reduce the rate of unplanned readmission.
		2019 Vol. 25 (8): 681-685 [Abstract] ( 283 ) HTML (1 KB) PDF (458 KB) ( 348 )

	686	The Predictive Value of High Prognostic Nutritional Index in Elderly with Hip Fracture
		Hu Tianye，Ren Shaojun *，Lin Daochao
		Objective Tinvestigate the predictive value of prognostic nutritional index(PNI) for postoperative hip fracture in the elderly.Methods A retrospective analysis of 156 patients with hip fractures who underwent surgery in Shulan Hangzhou Hospital from January 2016 to January 2019 was conducted.The clinical data of patients' age，gender，surgical methods，serum albumin level，peripheral blood lymphocyte count were collected，as well as postoperative complications，postoperative hospital stay，and postoperative mortality.The patients were divided into two groups，PNI high(PNI≥40 n＝116) and PNI low group(PNI ＜40 n＝40)，using the receiver operating characteristic curve(ROC curve).Cox regression and log-rank tests were used to evaluate the correlation of PNI with one-year mortality.Results Patients with higher PNI had a better prognosis and higher one-year survival rate(P＜0.05).Multivariate analysis showed that age and PNI were the independent prognostic factors for hip fracture in the elderly.Conclusion PNI can be used as a prognostic indicator for clinical prediction of hip fracture in the elderly.
		2019 Vol. 25 (8): 686-689 [Abstract] ( 280 ) HTML (1 KB) PDF (609 KB) ( 358 )

	690	Effect of Different Total Hip Arthroplasty Surgical Approaches on Acetabular Prothesis Position and Reason Analysis
		Xin Wei，Wang Bo *，Chen Yi，et al
		Objective To study and analyze the difference about acetabular prosthesis positional accuracy between direct anterior approach(DAA) and conventional posterior lateral approach(PLA) in the total hip arthroplasty.Methods This is a retrospective study about 118 patients with total hip arthroplasty from January 1，2017 to December 31，2017.The DAA group had 56 patients，including 18 male and 38 female with an average age of (59.4±12.8)(range 46~85).The PLA group had 62 patients，including 35 male and 27 female with an average age of (63.2±10.6)(range：52~86).All patients were not obvious preoperative hip deformity.The acetabular component was a cementless prosthesis(pinnacle，R3，LCU link).The acetabular abduction angle and acetabular anteversion angle was measured by a hip X-ray.Results All patients had no serious complications such as dislocation and infection.The average operation time was (80.5±21.1)minutes in the DAA group and (61.2±11.2)minutes in the PLA group.In the DAA group，the acetabular abduction was (38.2±7.6)°，the acetabular anteversion angle was (14.9±4.5)°.In the PLA group，the acetabular abduction angle was (36.7±11.9)°，and the acetabular anteversion angle was (18.7±7.3)°.There was no significant statistic difference in abduction angle between the two groups(P＝0.57)，but the acetabular anteversion angle was higher in the PLA group than in the DAA group.There was a statistically significant difference between the two groups in the acetabular anteversion angle(P＝0.019).The anteversion angle of the DAA group was 82%(46/56) in the“Safe Zone” and 62.9%(39/62) in the PLA group.The abduction angle of the DAA group was 91%(51/56) in the“Safe Zone”and 72.5%(45/62) in the PLA group.Conclusion The accuracy of the acetabular anteversion angle in the DAA group is more stable than the PLA group.The DAA group's proportion in the “Safe Zone” is higher than the PLA group，but there is no statisical difference in the acetabular abduction angle between the two groups.
		2019 Vol. 25 (8): 690-694 [Abstract] ( 354 ) HTML (1 KB) PDF (1792 KB) ( 389 )

	695	Therapeutic Effect of Anti-rotation Proximal Femoral Intramedullary Nail and Anatomic Locking Compression Plate in Comminuted Fracture of Long Segment of Femur
		Wu Jingwei，Liu Limin，Gao Zhihua，et al
		Objective To investigate the efficacy and safety of anti-rotation proximal femoral nail(InterTAN) and anatomic locking compression plate(LCP) in the treatment of comminuted fractures in the long segment of the femur.Methods We selected and retrospectively analysed of clinical data of 59 patients with comminuted femoral fractures in our department from March 2016 to February 2017 in our hospital，according to different methods of internal fixation，patients were divided into group I(InterTAN internal fixation，27 cases) and group L(LCP internal fixation，32 cases).Peroperative indications，postoperative recovery，hip and knee joints functional recovery and complications were compared between the two groups.Results The operation time，intraoperative blood loss，incision length，and drainage volume in group I were all lower than those in group L.Times of intraoperative fluoroscopy was more than that in group L(P＜0.05).There was no statistically significant difference in the time of getting out of bed between the two groups(P＞0.05).The fracture healing time in group I was shorter than that in group L(P＜0.05).The hips in the I group had a better rate than the L group ［96.00% vs.68.97%，P＜0.05］.There was no statistically significant difference in the rate of excellent knee function in the I and L groups ［96.00% vs.89.66%，P＞0.05］.There was no statistically significant difference in the rates of loose fixation，deep venous thrombosis，stiffness of the knee joint，delayed fracture healing，malunion，femoral head necrosis，and incision infection in the I and L groups(P＞0.05).Conclusion In the long segment fracture of the lower femur，InterTAN can reduce surgical trauma，promote postoperative recovery and healing，and improve hip function compared with LCP.
		2019 Vol. 25 (8): 695-699 [Abstract] ( 290 ) HTML (1 KB) PDF (1233 KB) ( 372 )

	700	The Effect of Anterior Cruciate Ligament Reconstruction Under Arthroscopy with Three Approaches on Bone Canal Length and Graft Angle
		Li Ming，Liu Ning *
		Objective To explore the influence of arthroscopic anterior cruciate ligament reconstruction double-approach(anterior internal and external approaches of knee joint) and three-approach(anterior superior，anterior inferior and anterior external approaches of knee joint) on bone canal length and graft Angleandguide clinical practice.Methods Patients who underwent arthroscopic anterior cruciate ligament reconstruction in the Department of Sports Medicine of Zhengzhou Orthopaedics Hospital from October 2017 to July 2018 were followed up.There were 9 patients in the conventional double-access group，including 6 males and 3 females.The patientswere(31.33±7.47) years old(range：21~47 years old).There were 5 cases of left knee and 4 cases of right knee.There were 9 patients in the three access group，including 6 males and 3 females.The patients were(24.78±6.61) years old(range：19~37 years old).There were 4 cases of left knee and 5 cases of right knee.The length of femoral bone canal，the length of the tibia bone canal and the angle of the graft were measured after anterior cruciate ligament reconstruction and statistical analysis was performed.Results There was no statistically significant difference in age，left and right side between the three-way group and the two-way group.The operation time of the three-way group was(88.33±22.22)min，and the operation time of the double-entry group was(77.22±34.92)min.There was no significant difference between the two groups(P＞0.05).The length of the femoral bone canal in the three-way group was(35.56±5.24) mm，and the length of the femoral bone canal in the double-entry group was(35.87±6.59) mm.There was no significant difference between the two groups(P＞0.05).The length of the tibia bone canal in the three-way group was(39.25±2.63)mm，and the length of the tibia canal in the double-entry group was(33.36±3.50)mm.The length of the tibia canal in the three-way group was significantly longer than that in the double-entry group(P＜0.05).The graft angle of the three-way group was(150.57±8.16)°，and the graft angle of the two-way group was(153.10±6.49)°.There was no significant difference between the two groups(P＞0.05).Conclusion There are no significant difference in the operation time，the length of the femoral bone canal，and the graft angle between the three-way approach group and the conventional two-way approach group.However，the length of the tibia bone canal in the three-way group is significantly longer than the length of the tibia bone canal in the two-way group.The operation is more convenient，the field of view is clearer，and the residual debris in the joint cavity is less.At the same time，it can be clearly seen under the microscope to reduce the risk of graft fixation failure.Therefore，it is recommended to use a three-way approach in anterior cruciate ligament reconstruction.
		2019 Vol. 25 (8): 700-708 [Abstract] ( 333 ) HTML (1 KB) PDF (1385 KB) ( 492 )

	704	Classification and Management of Severe Arthrosis and Ipsilateral Tibia Stress Fracture
		Zhang yuan 1，Li Hui 2，Ma Jianbing 2*，et al
		Objective Management options of gonarthrosis with proximal tibia stress fracture are ill-defined.In this study，a new classification was proposed based on characteristics of 18 cases of gonarthrosis complicated by proximal tibia stress fracture.Methods From Aug 2011 to Jan 2015，a total of 18 cases of knee arthritis combined with ipsilateral tibia stress fracture were included，including 7 male and 11famale，with an average age of 66 years old(ranging from 62~71 years).In the 18 patients，8 patients underwentexcision of fracture fragment followed by rugular TKA.1 patients were treated by modulated TKA with a long stem and metal augments.TKA with a long stem were applied to 6 patients with extraarticular fracture and another 3 patients were added plate and screws.Results The patients were followed up for 12.3 months (from 3 to 21 months).Gonoarthrosis with proximal tibia stress fracture can be classified as intra-and extra-articular fracture.The former was then classified into segemental and marginal type.The later were then subdivided into stable and unstable type.After treatment according to the classification，average Knee Society Score improved from 23.62 to 80.87；and average functional score improved from 18.75 to 81.75.Conclusion Under the instruction of this simple classification，modulated TKA with or without internal fixtion can be used successfully to treat severe gonoarthrosis with proximal tibia stress fracture.
		2019 Vol. 25 (8): 704-708 [Abstract] ( 290 ) HTML (1 KB) PDF (3214 KB) ( 331 )

	709	Radiographic and Clinical Study of the Alignment in Knee with Osteoarthritis
		Gan Haoran 1，Cheng Kai 2，Zhao Wensheng 2，et al
		Objective To compare and analyse the alignment changes in knee with osteoarthritis and its correlation with imaging and clinical Clinical manifestations. Methods The data of imaging and clinical manifestations of patients who underwent Total Knee Arthroplasty(TKA) were obtained with the help of Picture Archiving and Communication Systems(PACS).The joint space width and angles were measured using goniometers provided by PACS system with the help of a real protractor.Using the mathematical model to calculate the low limb's bone hip-knee-ankle angle(HKA angle) which exclueded the cartilage factors.Patients were divided into two groups according to the bone-HKA angle.The age，Kellgren-Lawrence(KL) grade，course of disease，hip and knee ankle angle and BMI were retrospectively analyzed.Results A total of 30 patients(36 knee) were finally enrolled in the study.The mean age was 64.33，history of osteoarthritis was 11.83 years，BMI was 27.22 kg／m²，and VAS score was 81.67 in patients with bone-HKA angle ≤174.4 degrees.The mean age was 59.33，history of osteoarthritis was 5.67 years，BMI was 27.84 kg／m²，and VAS score was 70.83 in patients with bone-HKA angle >174.4 degrees.The of age，course of knee osteoarthritis and medial/lateral joint space width between two groups were statistically different，while there is no significance of the rest analytic items between the two groups.Bone-HKA angle was significantly correlated with age，the time of OA，and the medial and lateral joint space wide(P＜0.05).The correlation of joint space wide difference，transverse diameter of tibial plateau with Bone-HKA was not obvious(P＞0.05).Conclusion Biomechanical changes and non-uniform settlement existed as independent factors in the development and progression of knee osteoarthritis.The reduction of Bone-HKA angle caused by non-uniform settlement is a primary factor in OA.Articular cartilage degeneration and reduction of Bone-HKA aggravate the clinical symptoms of osteoarthritis patients.
		2019 Vol. 25 (8): 709-723 [Abstract] ( 304 ) HTML (1 KB) PDF (1038 KB) ( 342 )

	713	Effect of Parathyroid Hormone in an Asymmetric Force Bipedal Rat Scoliosis Model
		Lu Lingyun 1，Dai Zhehao 2*，Lv Guohua 2，et al
		Objective To evaluate the effect of parathyroid hormone in an asymmetric force bipedal rat scoliosis model.Methods 60 SD rats were divided into 3 groups：bipedal rat group，tether-bipedal rat group and parathyroid hormone(PTH) group.Bipedal rat model was made by amputation of the forelimbs and tail.The left inferior angle of scapula to the ipslateral bony pelvis was sutured in tether-bipedal rat group after amputation of the forelimbs and tail.Subcutaneous injection of PTH(20 μg/kg·d) was performed in PTH group.After 8 weeks，the tethering suture was released.Spinal deformity was documented with serial X-ray examinations，and the spinal Bone Mineral Density(BMD) in vivo were measured by serial dual X-ray absorptiometry(DXA) scan at an interval of 4 weeks.After sacrifice，the rotation angle of apical vertebrae was measured and Micro CT was used to analyze the bone micro-architecture.Results All rats in tether-bipedal rat group and PTH group developed scoliosis，and no scoliosis was detected in bipedal rat group.In tether-bipedal rat group and PTH group，the average Cobb angle progressed gradually after the operation and the Cobb angle in PTH group was significantly smaller than the same period tether-bipedal rat.The rotation angle of apical vertebral in PTH group was significantly reduced too.The spinal BMD in vivo increased with age in all groups(P＜0.05).Compared to that in bipedal rat group and tether-bipedal rat group，the spinal BMD increased significantly(P＜0.05).There was no difference in vBMD，BV/TV、Tb.Th，Tb.N，Tb.Sp between both side of vertebrae in bipedal rat group.The vBMD，BV/TV and Tb.Th on the concave side significantly increased，and Tb.Sp significantly decreased compared with that on the convex side in tether-bipedal rat group.The vBMD，BV/TV and Tb.Th on the concave side and vBMD on the convex side in tether-bipedal rat group significantly increased compared with the bipedal rat group.After the injection of PTH，the vBMD，BV/TV，Tb.Th and Tb.Sp on both sides were significantly improved，and the discrepancy between two sides were significantly reduced，compared to that in tether-bipedal rat group.Conclusion The application of PTH improved the bone remodeling level，BMD and bone microstructures，which can help to prevent the progress of scoliosis.That provided a new sight for the treatment of scoliosis.
		2019 Vol. 25 (8): 713-718 [Abstract] ( 186 ) HTML (1 KB) PDF (2625 KB) ( 269 )

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