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2019 Vol. 25, No. 9
Published: 2019-09-25
 
769 Effect of Bone-cement Position Relative to Endplate after Vertebral Augmentationon Adjacent Vertebrae Fracture
Li Yajun 1，Wang Yehua 1*，Fang Yiling 2，et al
Objective  To explore the impact upon adjacent vertebrae fracture resulting from the position of bone-cement relative to surgical vertebrae and adjacent vertebrae endplates after percutaneous vertebroplasty(PVP) or percutaneous kyphoplasty (PKP).Methods  The clinical data of 191 patients aging from 56 to 83 who received PVP or PKP from July 2013 to March 2017 because of osteoporotic vertebral compression fractures were retrospectively analyzed.The follow-up period was 20 monthsandthe average age of the patients was 69.8 years old.There were 202 surgical vertebrae，including 37 vertebrae of male patients and 165 vertebrae from female patients.According to the occurrence of adjacent vertebral fracture(AVF)，the patients were divided into two groups.The first group was AVF Group(n＝22)and the second group was non-AVF Group(n＝180).The age，gender，body mass index (BMI)，bone mineral density (BMD)，the contact rate of bone-cement endplates，the leakage rate of cement intervertebral disc and the distance between bone-cement and adjacent vertebral endplate in the two groups were compared.Results  There was no significant difference in age，gender，BMI and BMD between the two groups (P＞0.05).The difference between the contact rate of bone-cement and surgical vertebra in the two groups was of no statistical significance(χ2=3.251，P＝0.071)，but the bone-cement intradiscal leak in the Group AVF was significantly higher than that in the group non-AVF and the difference was statistically significant(χ2=5.018，P＝0.025).The mean value of the distance between bone-cement and adjacent vertebral endplate in the Group AVF was (6.49±3.13)mm，while the distance in the Group non-AVF was(8.71±4.38)mm.The difference between the two groups was statistically significant(t＝2.307，P＝0.022).Conclusion  The bone-cement intradiscal leakageis risk factor for adjacent vertebral fracture.The smaller distance of bone-boundary between adjacent endplate，the chance of occurring homolateral AVF is larger.The operators can choose different methods to adequately strengthen the surgical vertebrae or to guarantee safe distance between bone-cement and adjacent vertebral endplate according to the height of vertebrae before surgery.
2019 Vol. 25 (9): 769-780 [Abstract] ( 376 ) HTML (1 KB)  PDF (1058 KB)  ( 276 )
773 Refinement of Clinical Features and Mechanism of Acute Abdominal Emergency after Spinal Cord Injury
Liu Shujia 1，2，Chen Zhenbo 1，3，Yu Weiyong 1，3，et al
Objective  To summarize the clinical manifestations and signs of acute abdominal emergency(AAE) in patients with spinal cord injury(SCI).Methods  The medical records of SCI patients over 14 years old admitted to China rehabilitation research center from January 2010 to February 2019 were retrospectively analyzed.Results  All the 〓4 396 patients with SCI were included，and a total of 38 patients were newly diagnosed with AAE.There were 16 cases of acute cholecystitis，15 cases of intestinal obstruction，3 cases of pancreatitis，2 cases of appendicitis and 2 cases of perforation and rupture of viscera.The AIS classification of SCI was grade A in 25 cases，grade B in 3 cases，grade C in 8 cases，and grade D in 2 cases.The first symptom was abdominal distension in 24 cases，abdominal pain in 17 cases，abdominal muscle tension in only 3 cases.The incidence of cholecystitis and ileus was 0.36％ and 0.34％ respectively.4 case of severe AAE：1 gastric perforation，1 intestinal rupture and 2 acute gangrene cholecystitis.None had typical signs of AAE.Conclusion  The diagnosis of AAE based on the classic manifestations and signs is not suitable for patients with high level SCI.Acute cholecystitis is the most common cause of AAE in patients with SCI.Abdominal distension is the most common complaint in patients in AAE with SCI.The possibility of abdominal organ damage should be considered when patients with SCI experience hypotension that cannot be corrected due to change of body position，abnormal increase of muscular tone and abnormal increase of urine leakage.Imaging examination and laboratory examination are effective means to improve the diagnosis rate of AAE in patients with SCI.
2019 Vol. 25 (9): 773-775 [Abstract] ( 301 ) HTML (1 KB)  PDF (900 KB)  ( 249 )
776 Clinical Observation of the Treatment of Proximal Humerus Fracture with the Integrated Model of Operation and Rehabilitation
Yü Xiang 1，Li Xu 1，Wang Yongjun 2
Objective  To compare the clinical efficacy of integrated surgical rehabilitation model and conventional rehabilitation model for postoperative treatment of proximal humerus fractures.Methods  A total of 100 patients with proximal humerus fractures who received PHILOS plate internal fixation in the department of orthopaedics of Shanghai Seventh People’s Hospital from January 2017 to December 2018 were collected.Patients were divided into two groups according to the random number table：traditional rehabilitation group and graded rehabilitation group，with 50 cases in each group.Patients in the traditional rehabilitation group received shoulder joint function rehabilitation according to the rehabilitation guidelines.In the graded rehabilitation group，the corresponding rehabilitation program was adopted according to Safety assessment of early rehabilitation.Patients were followed up at 4 time points：1 day after surgery，2 weeks after surgery，1 month after surgery and 3 months after surgery，and the Neer scores of shoulder joints in the two groups were compared.The incidence of adverse reactions was recorded and compared between the two groups throughout the follow-up period.Results  A total of 91 patients were followed up，including 45 patients in the traditional rehabilitation group and 46 patients in the graded rehabilitation group.Neer scores of shoulder joints in the two groups showed a gradually increasing trend at 4 time points of 1 day after surgery，2 weeks after surgery，1 month after surgery and 3 months after surgery (P＜0.05).Neer scores of the graded rehabilitation group were significantly better than those of the traditional rehabilitation group at 2 weeks and 1 month after surgery，but there was no significant difference in Neer scores between the two groups at 3 months after surgery(P＞0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion  Guiding postoperative rehabilitation of proximal humerus fractures with the mode of integrated surgery and rehabilitation can significantly improve the efficiency of rehabilitation，while not increasing the incidence of complications.
2019 Vol. 25 (9): 776-780 [Abstract] ( 289 ) HTML (1 KB)  PDF (591 KB)  ( 225 )
786 Singh Index in Hip re-fractures After Intertrochanteric Fractureoperation
Zhang Xingsheng，Zhou Fang *，Zhang Zhishan，et al
Objective  To compare the Singh index of patients with contra-lateral hip re-fractures and non-fractures after operation of intertrochanteric fractures and investigate the value of Singh index in patients with intertrochanteric fractures.Methods  Records from 218 cases undergoing surgery for intertrochanteric fracture at our hospital from January 2014 to December 2016 were retrospectively reviewed，the patients were divided into a re-fracture group and no-re-fracture group according to presence or absence of re-fracture on the contra-lateral hip after operation.Singh index grading were compared between the two groups.Results  a)All patients were followed up from 24 to 60 months with an average of 42.9 months，the incidence of contra-lateral hip re-fractures after intertrochanteric fractures was 5.2％，and the interval between the first fractures and the contralateral fractures was 11.5 months；b)The Singh index of the non-fracture group after intertrochanteric fracture was graded at an average of 4.0，whilein the re-fracture group itwas 3.5，P＝0.05.The difference between the two groups was statistically significant.The Singh index lower than grade 4 can be used as a threshold for predicting contra-lateral hip re-fractures after intertrochanteric fractures.c) The correlation index of Spearman about Singh index and BMD was 0.66，P＜0.001，which had a significant correlation.Conclusion  The lower the Singh index of patients with intertrochanteric fractures，the more severe of the reduction in bone loss，and the incidence of contralateral hip fractures is higher (P＜0.05).The Singh index is a simple and effective method for assessing contralateral hip fracture after operation of intertrochanteric fractures.
2019 Vol. 25 (9): 786-789 [Abstract] ( 361 ) HTML (1 KB)  PDF (1600 KB)  ( 257 )
790 The Mid-term Outcome of Total Knee Arthroplasty on Secondary Traumatic Arthritis After The Treatment of Tibia Plateau Fracture
Zhao Guanghui，He Qiang，Ma Jianbing，et al
Objective  To investigate the clinical outcome of total knee arthroplasty on secondary traumatic arthritis after tibia plateau fracture.Methods  From January 2007 to January 2017，13 consecutive patients underwent TKA after tibial plateau fracture，including 9 males and 4 females，with the average age of 57 years，ranging from 43 years to 75 years.The fracture was classified according to Schatzker.There were 1 case of type I，3 cases of type II，4 cases of type III，3 cases of type IV and 2 case of type V.The treatment method were conservative treatment in three cases，and open reduction and internal fixation in ten cases.The mean interval between fracture and knee arthroplasty was 7 years (range：1to 14 years).Patients were assessed pre-operatively and post-operatively using knee society score (KSS) and function score.The flexion and extension ROM of the knee joint was (78.5±32.5) ° pre-operatively.The KSS score was (63.8±12.1)，function score was(62.8±9.8) pre-operatively.Results  Implant selection varied according to the pathology found at surgery.Six cases used the posterior stabilized implants.Three cases with tibia bone defect used bone and screws.In three cases，metal wedges and stem were used.Only one case used the constrained implant because of injury of medial collateral ligament.Complications included wound complication in one case，deep venous thrombosis in three cases and stiff knee in one case.Patients were followed up for 68 months on average (range：12 to 113 months).At last follow-up，the KSS score was(81.7±11.1) and function score was (83.5±15.4)，the flexion and extension ROM of the knee joint was (105.4±18.2) °.No case showed significant differences when compared with preoperative values (P＜〓0.05).Conclusion  Patients treated with total knee arthroplasty after a previous fracture of the tibial plateau have substantial improvement in function and relief of pain，restoring the alignment of the limbs.However，these patients are at increased risk for peri-operative complications and good surgical skill is required.
2019 Vol. 25 (9): 790-798 [Abstract] ( 288 ) HTML (1 KB)  PDF (1434 KB)  ( 474 )
795 Study on Anterior Cruciate Ligament Rupture in Combination with Bucket-Handle Meniscus Tears in Different Position
Yi Hong，Gao Hong，Zhu Xinhui，et al
Objective  To explore clinical effects of simultaneous anterior cruciate ligament ( ACL ) reconstruction and Bucket-Handle meniscus repair and the relationship between the location of the BucketHandle meniscus tears and the length of the disease.Methods  There were 19 patients who underwent arthroscopic anterior cruciate ligament ( ACL )reconstruction and repair of a bucket-handle meniscus tearbetween January 2012 and December 2018 with minimum 6-month to 2 years follow-up were retrospectively identified.The patients，including 10 males and 8 females，aged 19 to 56 years，with an average of 31.2 years.All patients in this group underwent anterior cruciate ligament reconstruction combined with meniscus suture repair surgery，before and after surgery，IKDC score and Lysholm knee function score evaluation.We used Kneene’s time division criteria to divide patients into three groups：acute group (5 cases)，sub-chronic group (6 cases)chronic phase group(8 cases)，andanalyzed the relationship between the position of Bucket-Handle Meniscus Tears and the duration of injury.Results  All 19 patients were followed up for an average of 1.5 years(range 6 months to 2years).The incidence of the medial Bucket-Handle Meniscus Tears increased with the duration of injury，with the acute phase accounting for 60.0％，the subchronic phase accounting for 66.7％，and the chronic phase accounting for 75％.There was no significant correlation between the incidence of the lateral Bucket-Handle Meniscus Tears and the duration of injury.Preoperative and postoperative Lysholm score and IKDC are significant statistical significance.Conclusion  The incidence of menisus tears increases with the duration of injury，and the incidence ofthe lateral Bucket-Handle Meniscus Tears is not significantly different from the duration of injury while the incidence of the medial Bucket-Handle Meniscus Tears increases.Anterior cruciate ligament rupture combined with the Bucket-Handle Meniscus Tears should be repaired early.The use of suture repair technique has no significant difference in clinical outcome，postoperative benefit of knee joint function Recovery，higher meniscus healing rate，satisfactory clinical outcome.
2019 Vol. 25 (9): 795-798 [Abstract] ( 296 ) HTML (1 KB)  PDF (855 KB)  ( 409 )
799 Study on Thedynamic Process of the Ponseti Management for Clubfoot
Liu Yubin 1，2，3，Li Songjian 1，Zhao Li 2，3，et al
Objective  To analyze the dynamic process of Ponseti management for clubfoot deformity，and clarify the details of each cast for deformity component.Methods  The medical records were retrospectively reviewed from our database to identify patients with idiopathic clubfeet treated during the period between October 2007 and December 2012.78 cases (115 feet) managed using Ponseti method were included in the present study.We observed the changes of each component angle along with cast number increased and analyzed the dynamic process of Ponseti method.One-way ANOVA was applied for the statistical analysis for correction ability of each cast，and a p value below 0.05 was considered statistically significant.Results  The first cast was better than other casts and PAT procedure in the correction of cavus，adductus，and varus；and there was statistical difference in cavus(P<0.05).Equinus deformity was corrected mainly by PAT procedure (22.57±13.53) °，and also large correction ability for the first cast (about 14.37±15.92) °.The correction of each component was a simultaneous and gradual process.However，various casts or PAT procedure contributed differently to the deformity correction.The first cast was important in the correction of cavus，adductus，and varus；while，equinus was corrected mainly by PAT procedure and the first cast.Conclusion  The process of Ponseti management for clubfoot is corrected simultaneously and gradually，and the first cast has an important role in the process of deformity correction.It is suggested that the importance of the first cast should be fully considered in clinical practice.
2019 Vol. 25 (9): 799-803 [Abstract] ( 274 ) HTML (1 KB)  PDF (1252 KB)  ( 277 )
804 Study on Thromboelastography and Routine Coagulation Function and Severity of Trauma in Patients with Multiple Trauma
Huang Jing 1，Yan Xinming 2*
Objective  To explore the clinical relationship between thromboelastogram，routine coagulation function and severity of trauma in patients with multiple trauma. Methods  126 patients with multiple injuries were selected from the Emergency Department of the Affiliated Hospital of Shanxi Medical University from April to November，2018.126 patients were divided into light group，medium group and heavy group according to Kampala trauma score at admission.TEG and routine coagulation tests were performed within 12 hours after injury.Another 30 healthy people in the same period were selected as control group to observe the differences of the experimental parameters of the four groups.The correlation between the parameters of the two methods was also analyzed.Results  There were significant differences in fibrinogen，D-dimer and platelet counts between the four groups in routine coagulation tests.There was only significant difference in MA value between the four groups in TEG indexes.The correlation analysis between TEG parameters and routine coagulation indexes showed that R value was positively correlated with prothrombin time and activated partial thromboplastin time.K value was positively correlated with APTT and thrombin time，negatively correlated with Fib and PLT；alpha angle was positively correlated with Fib，D-dimer and PLT，negatively correlated with PT，APTT and TT；MA value was positively correlated with Fib and PLT，and negatively correlated with PT.Conclusion  Early coagulation dysfunction in patients with multiple trauma of different degrees is diverse.Combined application of TEG and routine coagulation examination can comprehensively evaluate early coagulation dysfunction in patients with multiple trauma.
2019 Vol. 25 (9): 804-829 [Abstract] ( 328 ) HTML (1 KB)  PDF  (0 KB)  ( 148 )
808 The Establishment of An Animal Model of Goat for Uncovertebral Joint Fusion Cage and Related Research
Liu Hao，Yang Yi，Chen Lin，et al
Objective  To explore the preliminary result of cervical uncovertebral joint fusion cage in an animal model of goat.Methods  Anterior cervical discectomy and fusion using the uncovertebral joint fusion cage at C3~4 level were performed in 12 goats.Postoperative X-rays，CT scan and Micro-CT scan were performed for evaluation.Results  No incision infection，nerve injury，vertebral artery injury，and implant failure were observed.The fusion rate is 75.0％ three months after operation and 83.3％ six months after operation demonstrated by CT scan.Micro-CT scan showed obvious trabecular bone in the lateral uncovertebral joint region and in part of goats obvious trabecular bone were observed around the cage.Conclusion  Goat can be a good animal model for uncovertebral joint fusion cage.The uncovertebral joint fusion cage is a safe and feasible cage but future studies are needed.
2019 Vol. 25 (9): 808-811 [Abstract] ( 311 ) HTML (1 KB)  PDF (2287 KB)  ( 368 )
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