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2019 Vol. 25, No. 11
Published: 2019-11-25
 
961 Clinical Comparison of Elastic Intramedullary Nail and Kirschner Wire Fixation for Treatment of Radius Neck Fracture in Children
Yang Daxing，Shan Yanju，Zhang Yan，et al
Objective  To study the clinic effect of elastic intramedullary nail and kirschner wire fixation for treatment ofradiusneck fracture in children with O’Brien Ⅱ and Ⅲ.Methods  Thedata of 122 children data with O’Brien Ⅱ and Ⅲ radius neck fractures from June 2014 to May 2017 were retrospectively analyzed.According to the fixation method，60 children with elastic intramedullary nailing were set as the control group，including 34 males and 26 females；aged 5~13 years，mean (7.8 ± 1.4) years；41 cases O’Brien Ⅱ tibia neck fractures and 19 cases type Ⅲ of radial neck fracture.62 children with Kirschner wire fixation were set as the study group，including 35 males and 27 females；aged 6~12 years，mean (8.2±1.5) years old；39 cases of O’Brien Ⅱ radial neck fracture and 23 cases type Ⅲ tibia of neck fracture.The surgery situation，reduction situation，and Mayo elbow function scores between the two groups were compared.Results  The operation time and hospitalization time of the control group were significantly higher than that of the study group，and the differences were statistically significant (P＜0.05).There was no significant difference in intraoperative blood loss and fracture healing time between the two groups (P＞0.05).In the control group，there were46 patients with excellentreduction，10 good，4 mean，and nopoor reduction.The study group had 50 patients with excellent reduction，9 good，3 middle，and 0 poor results.There was no statistical significance (P＞0.05).There were no significant differences in pain，motor function，stability，daily activity scores，and Mayo elbow joint function total scores between the two groups (P＞0.05).Conclusion  Elastic intramedullary nail and Kirschner wire fixation for O’Brien type Ⅱ and Ⅲ children with radius neck fractures can achieve good clinical results and restore the elbow joint function of children.However，the operation time and hospitalization time of Kirschner wire fixation treatment are shorter.
2019 Vol. 25 (11): 961-964 [Abstract] ( 314 ) HTML (1 KB)  PDF (1732 KB)  ( 338 )
965 Clinical Analysis of Elbow Arthroplasty in The Treatment of Advanced Elbow Toint Rheumatoid Arthritis
Zhang Chunsheng 1，2，Du Bin 2*，Sun Guangquan 2，et al
Objective  To analyze the clinical efficacy of total elbow arthroplasty in the treatment of advanced elbow joint rheumatoid arthritis.Methods  Eleven patients with elbow joint rheumatoid arthritis treated in the Department of Orthopedics in Jiangsu Provincial Hospital of TCM from January 2012 to June 2018 were selected.All 11 patients were unilateral and all patients underwent total elbow arthroplasty.There were 3 males and 8 females；the age ranged from 46 to 91 years，with an average age of (59.55±12.28) years.The Mayo score，C-reactive protein，rheumatoid factor，erythrocyte sedimentation rate and complications of the elbow joint were compared before surgery，10 days after surgery，3 months after surgery and last follow-up.Results  All patients were followed up for 12~66 months with an average of (26.6±15.1) months.The Mayo scores of patients before surgery，10 days after surgery，3 months after surgery and last follow-up were (30.91±9.86)，(62.00±5.22)，(85.55±6.93)，and (91.93±4.01)，respectively.The pain scores were (16.00±7.68)，(25.27±3.29)，(38.18±4.05)，and (41.83±2.31)，respectively.The motor function scores were (3.27±1.85)，(14.00±2.14)，(17.54±2.16)，and (18.11±1.61)，respectively，the postoperative period was significantly improved compared with preoperative and preoperative.The postoperative rheumatoid factor and erythrocyte sedimentation rate showed a downward trend，and C-reactive protein increased slightly on the 10th postoperative day.The postoperative 3 months after surgery and last follow-up decreased compared with the preoperative period.X-ray films showed no prosthesis wear，loosening and rupture during the follow-up period，abnormal position of the prosthesis，periprosthetic fracture，heterotopic ossification，etc.Survival rate was 100%.There was no infection after operation，no nerve injury，and the incision was difficult to heal in 1 case (9.11%).The incision healed after dressing for 3 weeks.Pain around the elbow occurred during follow-up was found in 1 case (9.11%) and relieved by administration of analgesic drugs and functional training.All patients were discharged from hospital，and no other complications occurred at the last follow-up.Conclusion  Artificial total elbow arthroplasty is effective in the treatment of advanced elbow joint rheumatoid arthritis，which is beneficial to improve the elbow joint function and reduce inflammation in patients，and it is safe and worth promotion.
2019 Vol. 25 (11): 965-985 [Abstract] ( 322 ) HTML (1 KB)  PDF (1014 KB)  ( 333 )
969 Effect of ERAS Pathway on the Postoperative Outcomes of Unicompartmental Knee Arthroplasty
Chen Chang，Chen Ge，Liu Juncai，et al
Objective  To investigate the effect of enhanced recovery after surgery (ERAS) pathway on the early outcomes，satisfaction and complications of unicompartmental knee arthroplasty (UKA).Methods   A randomized controlled trial was conducted on 50 cases of unicompartmental knee arthroplasty (UKA) in our department from January 2016 to January 2018.50 patients were randomly dividedinto ERAS group (n＝25) or non-ERAS group (n＝25).There were 25 cases in ERAS group，including 11 males and 14 females，with an average age of (60.2±4.9) years (49~69 years)； There were 25 cases in non-ERAS group，including 10 males and 15 females，with an average age of (59.8±5.1) years (47~69 years).The blood loss，length of stay(LOS)，mean decrease of hemoglobin 3 days after operation and total hospitalization expenses were compared.The effectiveness was evaluated by HSS score，VAS score，range of motion(ROM) and subjective satisfaction score at 1，3 and 12 months after operation.At the lastest follow-up，postoperative complications such as periprosthetic joint infection(PJI)，prosthetic loosening and deep venous thrombosis(DVT) were recorded.Results  The blood loss during operation，mean decrease of hemoglobin 3 days after operation，the length of stay and total hospitalization expenses in ERAS group were lower than those in non-ERAS group (P＜0.05).Both groups were followed up 12~22 months(mean，16.9 months).HSS score in ERAS group was higher than that in non-ERAS group at 1 month and 3 months after operation (P＜0.05)，and there was no significant difference in HSS score between two groups at 12 months after operation (P＞0.05).The ROM of ERAS group was higher than that of non-ERAS group at 1 month，3 months and 12 months after operation (P＜0.05).The VAS score of ERAS group was lower than that of non-ERAS group before operation and at POD 1~4 (P＜0.05).At the last follow-up，no complication such as periprosthetic joint infection，prosthetic loosening，deep venous thrombosis(DVT) occurred in all cases.Conclusion  Enhanced recovery after surgery(ERAS) can reduce early postoperative pain，promote early recovery，improve the early effect of unicompartmental knee arthroplasty(UKA) and gain a better postoperative satisfaction.
2019 Vol. 25 (11): 969-990 [Abstract] ( 270 ) HTML (1 KB)  PDF (505 KB)  ( 393 )
974 Comparative Analysis of Clinical Efficacy of Deltoid Approach and Deltopectoral Approach for the Treatment of Elderly Proximal Humeral Fractures
Li Sibo，Chen Xiaochun，Jiang Haitao，et al
Objective  To comapre the clinical outcomes of Neer Ⅱ and Ⅲ elderly osteoporotic proximal humerus fractures by deltoid approach and deltopectoral approach.Methods  From January 2013 to January 2017，81 patients with Neer Ⅱ and Ⅲ elderly osteoporotic proximal humeral fractures were treated with proximal humerus locking plate.Among them，42 cases were treated with minimally invasive approach through deltoid under anterolateral acromion，including 12 males and 30 females with an average of (69.8±10.4)years old (61~81 y).39 cases were treated with traditional deltopectoral approach，17 males and 22 females with an average age of (68.7±12.6)years old (59~82 y).The clinical efficacy of two surgical approaches were evaluated by observing pre-and post-operative creatine kinase，fracture reduction quality，fracture healing time，shoulder muscle strength and function.Results  Of the 81 patients，72 follow-up，including 38 minimal approach and 34 traditional approach The follow-up period was 12 to 58 months with an average of 35 months.There was no significant difference in the quality of the reduction and healing time between the two groups(P＞0.05)，In the muscle injury (creatine kinase)，shoulder muscle strength and shoulder function，the deltoid group was significantly better than the traditional deltopectoral group (P＜0.05).Conclusion  Compared with the traditional deltopectoral approach，the treatment of Neer Ⅱ and Ⅲ elderly osteoporotic proximal humeral fractures through the deltoid approach has the advantages of less surgical trauma and quick postoperative recovery.The clinical effect is satisfactory and can be used as preferred treatment for Neer Ⅱ and Ⅲ elderly osteoporotic proximal humerus fractures.
2019 Vol. 25 (11): 974-977 [Abstract] ( 278 ) HTML (1 KB)  PDF (1554 KB)  ( 303 )
978 A Comparative Study on the Therapeutic Effect of Tumor Knee Prosthesis and Large Segment Allogeneic Bone Reconstruction in the Treatment of Tumor Around Knee Joint
Wang Zhen，Liu Jijun
Objective  To explore the surgical indications，clinical effects and complications of tumor type knee joint prosthesis combined with large segment allograft and vascularized fibula reconstruction in the treatment of periarticular tumors of the knee joint.Methods  From June 2010 to June 2015，51 cases of periarticular tumor in our center were analyzed retrospectively，including 28 males and 23 females，aged 7~61 years with an average of (17.8±1.2) years.There were 37 cases of osteosarcoma，12 Ewing’s sarcoma，1 case of recurrence of giant cell of bone，1 case of chondrosarcoma grade Ⅱ.31 cases involved the distal femur and 20 cases involved the proximal tibia.There were 33 cases of tumor type knee arthroplasty，20 of which were located in the femur，13 in the tibia，18 in the femur，11 in the femur and 7 in the tibia.Results  all 51 patients were followed up for 47~71 months，with an average of (58.0±3.0) months.14 patients (27.5%) died，23 patients (45.1%) had pulmonary metastasis，3 patients (5.9%) had local recurrence，6 patients(11.8%) had postoperative infection，and 5 patients (9.8%) survived without tumor.The mean score of the patients with tumor type knee prosthesis replacement was (24.5±2.1)，and the mean score of the patients with vascularized fibula reconstruction was (26.1±1.7).Conclusion  Limb salvage surgery has become the main treatment of malignant tumors around the knee joint.Tumor type knee prosthesis is the main reconstruction method，with the advantages of early weight-bearing，good stability，early complications and so on.The reconstruction of fibula with vascularization combined with massive allograft has certain advantages for the patients whose epiphysis is not obviously involved and whose expected survival time is longer，but there are many postoperative complications，so the indications must be strictly controled.
2019 Vol. 25 (11): 978-981 [Abstract] ( 214 ) HTML (1 KB)  PDF (1757 KB)  ( 304 )
982 An Arthroscopic Technique of Suture Anchor Fixation Through Double Bone Tunnels for Tibial Eminence Avulsion Fracture
Zhang Po，Wang Xiaomin，Shi Changhan，et al

Objective  To investigate the clinical effect of arthroscopic fixation with TwinFix anchors and double Ethibond sutures on tibial eminence avulsion fracture.Methods  Data of 14 patients who have tibial eminence avulsion fracture of Meyer-Mckeever Ⅲ type from January 2016 to December 2017 in our department were analyzed，including 8 cases of maleand 6 cases of female.They were 18~54 years old (mean 37.4±9.12).There were 9 cases of left knee and 5 cases of right knee.There were 11 cases of type ⅢA and 3 cases of type ⅢB.And there were fresh fracture in 12 cases，dated fracture in 2 cases.All patients accepted arthroscopic reduction and suture anchor fixation through double bone tunnels，and had evaluated by lysholm knee score after operation.Results  The mean operation time was (48.0±   5.52)mins (range，40~60mins).All the patients were followed up.The mean follow-up period was (14.8±4.31)months(range，6~24 months).All the fractures healed after 3 months of follow-up.The patients were followed up to 6 months，the Lysholm score was (94.8±3.4)(range，70～98).The 5 patients were followed up to 24 months，and the Lysholm score was (95.6±2.9).All 14 patients were negative for Lanchman test.In 13 patients，the range of motion of knee joint was normal，and only 1 patient (repaired medial collateral ligament at the same time) extended and returned to normal，with a flexion of 90°~100°.Conclusion  The method of treatment of tibial eminence avulsion fracture with TwinFix suture anchors has following advantages：small in wounding，simple in operation，reliable in fixation，good in knee stability，few in complication，and has excellent clinical effect which is worthy of promotion.
2019 Vol. 25 (11): 982-985 [Abstract] ( 304 ) HTML (1 KB)  PDF (1547 KB)  ( 306 )
986 Biomechanicalinitial Stabilitytest of the Uncovertebral Joint Fusion Cage
Yang Yi 1，Luo Shuai 2*，Liu Hao 1*，et al
Objective  To test the biomechanicalinitial stability of the uncovertebral joint fusion cage.Methods  20 goat cervical specimens were randomly assigned to 4 groups：Group A，the intact cervical spine group；Group B，the iliac bone group；Group C，the uncovertebral joint fusion cage group；Group D，the non-profile cage control group.The specimens were exposed to nondestructive testing in all 3 planes of spinal motion：extension/flexion，lateral bending and axial rotation，using the moment of force 1 N·m，2 N·m，3 N·m，and 4 N·m.The flexibility method was used for evaluation of stability，and nonconstrained pure moment bending load was applied for three loading and unloading cycles in each plane，while the data of the final cycle was recorded for analysis of range of motion (ROM).Results  The ROM of extension/flexion，lateral bending and axial rotation in the uncovertebral joint fusion cage group and the non-profile cage control group were both smaller than the iliac bone group(P＜0.05).There was no significant difference concerning ROM of extension/flexion between the uncovertebral joint fusion cage group and the non-profile cage control group.The ROM of lateral bending and axial rotation in the uncovertebral joint fusion cage group was smaller than the non-profile cage control group(P＜0.05).Conclusion  The uncovertebral joint fusion cage and the non-profile cage can both provide better initial stability compared the iliac bone.The uncovertebral joint fusion cage can provide similar initial extension/flexion stability but a little better lateral bending and axial rotation stability compared with the non-profile cage.
2019 Vol. 25 (11): 986-990 [Abstract] ( 266 ) HTML (1 KB)  PDF (2115 KB)  ( 195 )
991 Role of RANKL/RANK/OPG Signaling Pathway in Periprosthetic Osteolysis Induced by Tricalcium Phosphate Wear Particles
He Zhiqiang，Yang Yafan，Chen Xianzhou，et al
Objective  To investigate the role of RANKL/RANK/OPG signaling pathway in periprosthetic osteolysis induced by tricalcium phosphate wear particles.Methods  30 mice were randomly divided into sham operation group，model group and OPG group.The murine calvarial model of osteolysis mice were induced by tricalcium phosphate wear particles.OPG (3mg/kg) was locally injected to the calvarium under the periosteum every two weeks，while the sham operation group and the model group were given the same amount of saline.2 weeks later，the number of osteoclasts and osteolysis area，the levels of IL-1β，IL-6 and TNF-α in the periosteum of the skull and the mRNA expression levels of RANKL，RANK and OPG in the skull were measured.Results  Compared with the sham-operated group，the number of osteoclasts and osteolysis area in the model group and OPG group increased，the levels of IL-1β，IL-6 and TNF-α in the periosteum increased，the relative expression of RANKL mRNA and RANK mRNA in the skull increased，and the relative expression of OPG mRNA decreased (P<0.05).Compared with the model group，the number of osteoclasts and osteolysis area in the skull of OPG group decreased.The levels of IL-1β，IL-6 and TNF-α in periosteum decreased，the relative expression of RANKL mRNA and RANK mRNA in skull decreased，and the relative expression of OPG mRNA increased (P<0.05).Conclusion  RANKL/RANK/OPG signaling pathway is involved in the regulation of tricalcium phosphate wear particles induced periprosthetic osteolysis，while the OPG intervention can significantly inhibit osteolysis，which can be used as a therapeutic target for periprosthetic osteolysis.
2019 Vol. 25 (11): 991-995 [Abstract] ( 245 ) HTML (1 KB)  PDF (1482 KB)  ( 201 )
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