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2019 Vol. 25, No. 10
Published: 2019-10-25
 
865 Efficacy and Safety of PVP and PKP in Freshosteoporotic Vertebral Compression Fracture
Ju Jiabao，Zhang Peixun *
Objective  Toevaluate the efficacy and safety of percutaneous vertebroplasty (PVP) and percutaneous balloon kyphoplasty (PKP) in fresh osteoporotic vertebral compression fractures.Methods  We retrospectively collected medical records and images of 129 patients with fresh fractures between 2017 and 2018.Preoperative and postoperative anterior vertebral body height，Cobb’s angle，activities of daily living (ADL)score，pain visual analogue score(VAS)，length of hospital stay，bone cement dosage，cement leakage and complications were included in the analysis.Results  There were significant differences in the height of the anterior vertebral body，Cobb's angle and VAS score between pre-operation and post-operationin the PVP and PKP group(P＜0.01)，while statistical difference in ADL scoreonly in PVP group(P＜0.01).There were no notable differences in length of hospital stays，volumeof bone cement，leakage events and perioperative complications between the two groups.With regard to the fresh fractures complicated withold compressions，there weresignificant differences in the height of the anterior body，Cobb’s angle and VAS between pre-operation and post-operation in both groups(P＜0.05).Conclusion  Both PVP and PKP can effectively restore the height loss of fresh compressions，improve kyphosis and relieve pain.In addition，PVP and PKP are equally safe and effective in fresh fractures complicated with old compressions，but both have poor performance in improving daily activities.
2019 Vol. 25 (10): 865-869 [Abstract] ( 297 ) HTML (1 KB)  PDF (1495 KB)  ( 283 )
870 Comparison of Percutaneous and Open Pedicle Screw Fixation for Treatment of Type A Thoracolumbar Fractures
Su Xueyuan 1，Song Wenhui 2，Liu Yiwei 1，et al
Objective  To compare the clinical efficacy of percutaneous pedicle screw fixation and traditional open surgury for thoracolumbar fracture without neurolodical deficit.Methods  A retrospective analysis was made with the dataof 49 thoracolumbar fractures patients in our hospital from September 2015 to September 2017.26 cases were treated with open pedicle screw fixation and 23 cases were treated with percutaneous pedicle screw fixation.Clinica and surgical evaluation including perioperative indicators，anterior height ratio of fracture vertebral，kyphosis angle of injured vertebra，visual Analogue Score (VAS score)，the Oswestry Disability Index(ODI score).Results  The intraoperative blood loss，length of hospital stay and VAS score 2 days after surgery of the percutaneous group were significantly lower than the open group (P＜0.05)，which suggest percutaneous group will suffer less trauma.There was no significant difference between the two groups in the anterior height ratio of fracture vertebral of postoperative and the kyphosis angle of injured vertebra (P＞0.05)，which suggest the two surgical can provide good correction and reduction for the fractured.There was no statistically significant difference between the two groups in VAS score at the last follow-up (P＞0.05)，and there was significant difference between the two groups in ODI score (P＜0.05)，which indicate that the percutaneous group had a higher quality of life.Conclusion  Percutaneous pedicle screw fixation has the advantages of smaller intraoperative blood loss，smaller incision，shorter hospitalization time，lower pain，better lumbar and dorsal muscle function.Patients are beneficial in the early postoperative period and have good clinical efficacy in the long term.It can be regarded as one of the excellent options for the treatment of thoracolumbar type A fracture.
2019 Vol. 25 (10): 870-874 [Abstract] ( 266 ) HTML (1 KB)  PDF (2640 KB)  ( 380 )
875 Effect Analysis of the Treatment on Comminuted Fracture of Proximal Humerus in Elderly Patients
Fei Kai，Han Weifeng，Wang Bing，et al
Objective  To investigate the clinical efficacy of surgical treatment of comminuted proximal humeral fractures.Methods  Retrospective analysis of 58 cases of proximal humerus comminuted fractures treated with anatomical locking plate internal fixation between March 2010 and March 2016 in our hospital and complete follow-up was obtained.This study included 26 cases of male and 32 cases of female.The patients aged 60 to 85 years，with an average age of (68.5±2.5)years.According to Neer classification，there were 48 cases of 3-part fracture，10 cases of 4-part fracture，8 cases of proximal humerus comminuted fracture with shoulder dislocation，and 15 cases of craniocerebral injury combined with proximal humerus comminuted fracture.All of them were treated with proximal humerus anatomical locking plate for open reduction and internal fixation，postoperative external fixation，and guided early passive functional exercise.Clinical efficacy was evaluated by Neer shoulder function score，pain visual simulation score and Constant shoulder score.Reexamination of fracture healing by X-ray plain film.Results  Follow-up time ranged from 24 to 60 months，with an average of (39±8.6)months.During the follow-up period，there were no case of humerus head necrosis.According to the Neer shoulder function score，there were excellent in 20 cases(34.5%)，good in 30 cases(51.7%)，medium in 6 cases(10.34%) and poor in 2 cases(3.45%).The 1 year follow-up after X-ray operation was up to the standard of clinical healing.Conclusion  Early internal fixation for comminuted fractures of the proximal humerus and early operative internal fixation for fractures may be performed in patients with shoulder dislocation.Early functional exercise of shoulder joint was performed under the protection of postoperative abduction stent.It can not only obtain better shoulder joint function，but also be beneficial to the good healing of fracture，which can obtain more satisfactory clinical curative effect.
2019 Vol. 25 (10): 875-878 [Abstract] ( 276 ) HTML (1 KB)  PDF (1462 KB)  ( 390 )
879 Comparative Study of the Treatment of Unstable Fractures of the Distal Radius with Locking Plate
Zheng Zepeng，Sun Yuming *
Objective  To analyze the clinical efficacy of universal double column locking plate and T-shapedlocking plate in the treatment of unstable distal radius fractures.Methods  From January 2016 to January 2018，68 patients with unstable distal radius fractures who underwent orthopedic surgery in our hospital were randomly divided into the experimental group and the control group.The experimental group was treated with the volar approach.T-shaped locking compression plate treatment，the control group was treated with universal double column locking plate.There were 34 patients in the experimental group，including 16 males and 18 females aged 46~75 years with an average of (54.16±12.54).There were 34 patients in the control group，including 18 males and 16 females aged 44~77 years with an average age of (53.27±13.74).The bone healing time，wrist joint mobility，imaging related indicators，wrist joint function scores and postoperative complications were compared before and after surgery.Results  The wrist joint activity of the control group was significantly better than that of the experimental group (P＜0.05).The palm tilt angle and ulnar deviation angle of the group were significantly better than those before operation (P＜0.05).The palm tilt angle and ulnar angle of the control group were significantly better than the experimental group (P＜0.05)；There was no significant difference in the time of bone healing between the control group and the bone healing time of the experimental group (P＞0.05).The wrist function activity score of control group was significantly better than the test group at 6 months after surgery (P＜0.05)，and thecomplication rateof control group was significantly less than the test group(P＜0.05).Conclusion  The universal double column locking plate is used to treat unstable fractures of the distal radius.The reduction effect is good.The wrist joints have good motion，the wrist joint function score is high，and the complications are few，which is obviously better than the T-shapedlocking plate.
2019 Vol. 25 (10): 879-882 [Abstract] ( 273 ) HTML (1 KB)  PDF (1789 KB)  ( 322 )
883 Effect of Wiberg Patella Classification on Patellar Tracjectory and Function after Total Knee Arthroplasty with Patella Preservation
Objective  To study the patellar morphology，postoperative trajectory and function of total knee arthroplasty (TKA).Methods  From January 2016 to January 2017，76 patients (81 knees) underwent total knee arthroplasty for osteoarthritis of the knee.The patients aged 53~77 years，with an average age of (66.19±6.83) years，including 21 males(22 knees) and 55 females(59 knees).Axial patellar films were taken on a digital X-ray imaging system with 45 degrees flexion and 30 degrees projection angle.Patellar classification was assessed by Wiberg criteria and patellofemoral inclination angle，patellofemoral index and patellofemoral fit angle were measured.During the operation，the patella was preserved，osteophytes around the patella were removed，and normal patellar anatomy was maintained.Preoperative Wiberg type Ⅰ patella was found in 18 case of knees，type Ⅱ in 49 case of knees and type Ⅲ in 14 case of knees.The imaging indexes and HSS functional score (HSS)，KSS functional score (KSS) and Fellar Patellar Score (Fellar Patellar Score)，upstairs and downstairs score and VAS score of anterior knee pain were compared before and after operation for different Wiberg patellar classification.Results  The follow-up time was more than two years，and the average follow-up time was (25.16±6.24) months.Patellofemoral index decreased from preoperative (－10.04±4.74)degrees to postoperative (－7.54±4.61)degrees.The difference was statistically significant (P＝0.000).Patellofemoral index decreased from preoperative (1.50±0.54) to postoperative (1.17±0.59).The difference was statistically significant (P＝0.047).Preoperative tilt angle of patella of Wiberg type Ⅰ(－11.05±5.6)degrees，typeⅡ (－8.74±5.6)degrees，type Ⅲ(－13.22±3.72)degrees had significant difference (P＝0.013) before operation.Patellofemoral index of Wiberg type Ⅰ(1.53 ±0.53)，type Ⅱ (1.35±0.47)，and type type Ⅲ(1.95±0.58) had significant difference(P＝0.004).The preoperative patellar tilt angle and patellofemoral index of Wiberg Ⅱ patients were smaller than those of the other two types.There were significant differences in patellofemoral fitness angles among different Wiberg patellar types before operation.(P＝0.006).There was no significant difference in patellar tilt (P＝0.117)，patellofemoral index (P＝0.058) and suitable angle (P＝0.572) among different Wiberg classification patients (P＞0.05).There were no significant differences in HSS score (P＝0.572)，KSS clinical score (P＝0.657)，KSS functional score (P＝0.066)，patella score (P＝0.102)，upstairs and downstairs score (P＝0.080)，VAS score (P=0.332) among the patients with different Wiberg classification.Conclusion  In total knee arthroplasty，good patellar trajectory and clinical effect can be achieved by patelloplasty and lateral retinaculum release.Wiberg's patellar morphology has no significant effect on the function after total knee arthroplasty with patellar preservation.
2019 Vol. 25 (10): 883-902 [Abstract] ( 316 ) HTML (1 KB)  PDF (1639 KB)  ( 288 )
888 Ilizarov Transverse Tibial Bone Transporting in the Treatment of Diabetic Foot with Wagner 3～4
Kong Zhen，Sun Yongjian *，Cheng Hongfen，et al
Objective  To discuss the effect of Ilizarov transverse tibial bone transporting in the treatment of diabetic foot with Wagner 3～4.Methods  24 patients with Wagner 3～4 diabetic foot were collected between June 2015 to February 2018.The patients were all treated with The Ilizarov transverse tibial bone transporting.They were 17 men and 7 women，aged from 41 to 76 years (average，58.4 years)，including 9 cases on the right and 15 cases on the left side.5 cases were Wagner 3～4.The wound healing was observed after operation.We measured skin temperature of affected limbs and the ankle-brachial index，got the visual analogue pain scores and examined the maximum systolic blood flow velocity of the posterior tibial artery with color Doppler ultrasound before and after operation.Results  The cases were followed up for 16.5months (range：9 to 32 months ).All the affected feet were salvaged and healed.The temperature of affected foot skin after operation was (34.21±1.32)℃，compared with preoperative (31.34±2.02)℃，the difference was statistically significant (P＜0.01).The postoperative VAS score (0.46±1.13) was compared with the preoperative (4.41±3.02)points，and the difference was statistically significant (P＜0.01).The postoperative ankle index was (0.91±0.18)，which was statistically significant compared with that preoperative (0.53±0.23) (P＜0.01).The maximum systolic blood flow velocity of posterior tibial artery examined by color Doppler ultrasonography after operation was (37.12±4.21)cm/s，which was statistically significant compared with preoperative (28.84±3.27)cm/s(P＜0.01).Conclusion  The Ilizarov transverse tibial bone transporting is a effective method to treat diabetic foot with Wagner 3~4.The operation is simple and the effect of improving circulation and limb salvage is good.
2019 Vol. 25 (10): 888-891 [Abstract] ( 300 ) HTML (1 KB)  PDF (1777 KB)  ( 368 )
892 Application and Experience of Pedicle Screw Insertion Assisted by Tianjiorthopaedic Robot
Yang Rui，Li Yongqi，Zhang Ke，et al
Objective  This research aimto observe the difference of clinical efficacy of robot-assisted versus conventional freehand pedicle screw insertion in thoracolumbar surgery，and toevaluate the accuracy，safety and radiation doseof the robot-assisted system.Methods  88 patientswere randomly assigned toreceive pedicle screw insertion by using random digits table from April 2017 to February 2018.45 patients were treated by robot-assisted spinal instrumentation and 43 patients were treated by freehand surgery.Then the operation time and blood loss of 2 groups were compared，and intraoperative X-ray exposure was also done.The computer tomographic scans were used to assess the accuracy and safety of the inserted pedicle screws between thetwo groups using the Gertzbein-Robbins grade scores.Results  There were no significant differences in terms of the baseline，such as gender，age and diseaseetc.between the two groups(P＞0.05).The average operation time was (48.87±8.82) min in therobotassisted group and(46.57±7.05) min in the freehand group(P＞0.05).The blood loss was (21.27±13.13)mL in robot-assisted group and(20.95 ±17.37)mL in the freehand group(P＞0.05).208 pedicle screws were inserted in the robot-assisted group，and the Gertzbein-Robbins scores was categorized as A of 203 screws and B in 5 screws；202 pedicle screws were placed in the freehand group.The Gertzbein-Robbins scores were A in 164，Bin 22，C in 15 and D in 1 screw，respectively；and the significant differences were shown in accuracy of pedicle screws placement (P＜0.05).Robot-assisted system also significantly decreases intraoperative radiation exposure(P＜0.05).Conclusion  The accuracy and safety of robot-assistedpedicle screw placement compared with the traditional freehandprocedurewere significantly improved without increasing the amount of bleeding，operation time，and also significantly reducing the radiation dose of intraoperative fluoroscopy.
2019 Vol. 25 (10): 892-897 [Abstract] ( 257 ) HTML (1 KB)  PDF (3531 KB)  ( 637 )
898 Ankle Arthrodesis Using Ilizarov Fixator for Patients with endstage Ankle Arthropathies
Wang Xingshan，Huang Ye *，Liu Jian，et al
Objective  To evaluate the outcome of ankle arthrodesis using Ilizarov fixator for patients with end-stage ankle arthropathies.Methods  We retrospectively studied 20 patients who underwent ankle arthrodesis with Ilizarov external fixator from May 2016 to December 2017.Twelve male patients and 8 female patients were included.The mean age was (59.05±7.83)years old(range 47~77 years).Outcomes were measured by The American orthopaedic foot and ankle society (AOFAS) hindfoot score，rate of union，rate of complications，and alignment of the ankle joint.Results  Ankle fusion was achieved in allpatients.The mean time to healing was (3.70±1.04)months (range 3~6 months).Delayed wound healing，stent-tract infection and severe swelling were presented in one patient separately.Medial tibial talar angle improved from (86.84±6.26)degrees pre-operatively to (89.90±1.37) degrees post-operatively (P＜0.05).Lateral talar station decreased from (5.50±3.97)mm to (2.85±2.72)mm(P＜0.05).AOFAS score improved significantly from (39.00±8.34) pre-operatively to (80.65±8.86) post-operatively(P＜0.001).Conclusion  Ankle arthrodesis using Ilizarov fixator can achieve good radiological and clinical outcomes for patients with end-stage ankle arthropathy，associated with low prevalence of ankle joint malalignment and high fusion rates.
2019 Vol. 25 (10): 898-902 [Abstract] ( 273 ) HTML (1 KB)  PDF (1522 KB)  ( 352 )
903 Value of CT Scanning in Degeneration of Patellar Femoral Joint of the Knee Joint at 30 Degrees Flexion
ZhangYunhai，LiuWei，Huang Donghui，et al
Objective  To study the value of CT scanning in 30°-flexed knee in diagnosis of patellar femoral joint degeneration.Methods  From January 2012 to June 2014，66 patients with patellar femoral joint degeneration was collected in clinic and whose knee was scanned with CT at 20° and 30° flexion alternatively.The patellar lateral tilt angle (PLTA)and congruence angle(CA) was measured and compared.Fifteen voluteers without patellar femoral joint degeneration were collected as the control group whose knee was scanned and measured in the same way.The extent of pain in patients with patellar femoral joint disease was messured with visual analogue scale and its corraltion to PLTA and CA were analyzed.Results  In control group，PLTA was (15.56±3.63)° in knee with 30 degree flexion and (17.34±4.33)° in knee with 20 degree flexion and there was no significant difference，CA of five persons was more than 0°with 20°flexation and none was more than 0°with 30°flexation.In patient group，PLTA was (11.84±5.82)° in 30°-flexed knee and (12.83±5.12)° in 20°-flexed knee and there was no significant difference between twogroup.CA of 51 persons was more than 0°in 20°-flexed knee and 35 was more than 0°in 30°-flexed knee，there was significant difference between two flexed angle for CA.There was significant difference in PLTA between two groups in 30°flexed knee and in 20°-flexedknee.In patients group，there are four types of patellar femoral joint alignment，there are 15patients in type I whose PLTA<12° and CA<0°，and whose PLTA was (9.47±3.61)°；there are 26 patients in type Ⅱ whose PLTA<12° and CA>0°，and whose PLTA was (6.78±4.93)°；there are 9 patients in type Ⅲ whose PLTA>12° and CA>0°，and whose PLTA was (15.89±4.26)°；there are 16 patients in type Ⅳ whose PLTA>12° and CA<0°，and whose PLTA was(17.87±2.73)°.Conclusion  For patients older than 40 years，PLTA<12° has great value in diagnosing the patients with patellar femoral joint disease when measured in 30°-flexed knee.
2019 Vol. 25 (10): 903-905 [Abstract] ( 279 ) HTML (1 KB)  PDF (673 KB)  ( 203 )
906 STIM1 Regulates Ras Signaling Pathways to Promote Osteoblasts Proliferation
Guo Yunshan，Hao Dingjun，Liu Haiping，et al
Objective  The abnormal proliferation of osteoblasts leads to decreased bone mass，which is an important reason for the occurrence and development of osteoporosis.A large number of studies have found that Orai1 plays a very important role in regulating osteoblast proliferation and apoptosis.STIM1 is an important protein that can activate Orai1.However，there is no relevant report on whether STIM1 is involved in the regulation of osteoblast proliferation The purpose of this study was to determine the role of STIM1 in regulating osteoblast proliferation in osteoblasts.Methods  After STIM1 knockdown，cell proliferation and cell cycle，the transcription of CyclinD1，CyclinE，CDK4 and CDK6，and Ras signaling pathway activity were tested to identify whether STIM1 is involved in the regulation of osteoblast proliferations.Results  STIM1 was knockdown successfully after STIM1 siRNA transfected in MC3T3-E1 cells(P＜0.05).We found that the proliferation were decreased and cell cycle were arrested after STIM1 knockdown(P＜0.05).Furthermore，we found that the transcription of CyclinD1 was decreased after STIM1 knockdown(P＜0.05).We also found that Ras signaling pathway activity were inhibited(P＜0.05).The inhibition of Ras signaling pathway activity by ars-853 significantly inhibited the role of STIM1 in promoting the proliferation of osteoblasts(P＜0.05).Conclusion  The results identified that STIM1 may activate Ras signaling pathway，thus regulating osteoblast proliferation.
2019 Vol. 25 (10): 906-911 [Abstract] ( 244 ) HTML (1 KB)  PDF (752 KB)  ( 235 )
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