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2020 Vol. 26, No. 4
Published: 2020-04-25
289
Application of Low-temperature Intermittent Cement Injection Technique in the Treatment of Osteoporotic Vertebral Compression Fracture with Peripheral Wall Damage by Percutaneous Kyphoplasty
Yuan Quan，Jiang Jian，Li Hao，et al
Objective
To explore the clinical efficacy of Low-temperature intermittent cement injection technique in the treatment of osteoporotic vertebral compression fracture with peripheral wall damage by percutaneous kyphoplasty(PKP)by comparing with temperature gradient cement injection technique.
Methods
A total of 60 patients，all of which were single vertebral fractures with osteoporotic vertebral fracture and peripheral wall damage from Jan.2015 to Dec.2018 were reviewed.According to the different methods of cement injection technique，the patients were divided into temperature gradient cement injection technique group and Low-temperature intermittent cement injection technique group，both groups included 30 patients separately.Outcomes were evaluated pre-and postoperative by using visual analogue score(VAS)，Oswestry disability index(ODI)，the local kyphosis angle，the anterior relative vertebral height ratio.Surgical duration，cement volume，cement distribution and the occurrence of cement leakage were compared between the two groups.
Results
The average follow-up of the two groups was(15.3±8.4)months and(18.6±8.2)months，and there was no significant difference between the two groups(P＞0.05).The VAS score and ODI were significantly improved after operation in both groups(P＜0.05).There was no significant difference between the final follow-up and postoperation in both groups(P＞0.05).The VAS score and ODI at postoperation and the final follow-up were significantly different between the two groups(P＜0.05)，while no statistical significance at the rest of the time(P＞0.05).As for the anterior relative vertebral height ratio and the local kyphosis angle，there was no significant difference at preoperation，postoperation and final follow-up(P＞0.05).The cement injectable working time in low-temperature intermittent cement injection technique group was significantly longer than that in temperature gradient cement injection technique group(P＜0.05)，but there was no significant difference in surgical duration(P＞0.05).The cement volume and cement distribution in low-temperature intermittent cement injection technique group was superior to temperature gradient cement injection technique group.Cement leakage occurred in only 2 patients，with a leakage rate of 6.7%，in low-temperature intermittent cement injection technique group，which was significantly lower than that of 26.7% in temperature gradient cement injection technique group(P＜ 0.05).
Conclusion
The application of low-temperature intermittent cement injection technique in the treatment of osteoporotic vertebral compressionfracture with peripheral wall damage by PKP can effectively prolong cement injectable working time，which is beneficial to increase cement volume and distribution in the vertebral body，and obtain better clinical results.Also，it can reduce the incidence of cement leakage.
2020 Vol. 26 (4): 289-294 [
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291
A Study of Drainage After Total Hip Arthroplasty with Direct Anterior Approach：to Use or Not to Use?
Ji Xiaofeng，Shang Xifu，Li Guoyuan，et al
Objective
To compare the difference and clinical effect between drainage tube and non-drainage tube after total hip arthroplasty with direct anterior approach(DAA).Methods From January 2018 to December 2018，a total of 50 cases that had total hip arthroplasty were enrolled.There were 27 left and 23 right hip joints，including 28 males and 22 females.Among them，25 cases had drainage tube and 25 caseshad no drainage tube.Bioprosthesis was used in all cases.All patients accepted articular cavity injectionwith 20 mL saline plus 1.0 g tranexamic acid.The drainage tube group clamped the drainage tube and opened it in the next morning.The drainage tube was removed 24~48 hours later.We compared the levels of hemoglobin and hematocrit at 24 hours and 3 days after operation，pain degree，wound healing and Harris hip score at half a year after operation.
Results
There were no significant differences in hemoglobin and hematocrit at 24 hours and 3 days after operation，pain degree and Harris score at one year after operation between the two groups(P＜0.05).
Conclusion
For direct anteriorapproach total hip arthroplasty，no drainage tube will not affect the clinical effect，not increase the incidence of complications，reduce the nursing process.It is recommended that drainage tube should not to be placed routinely.
2020 Vol. 26 (4): 291-297 [
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298
Perioperative Hemodialysis Strategy for Total Hip Arthroplasty in Patients with Uremia
Ding Zheru，Wu Yuli，Qian Qirong，et al
Objective
To explore the perioperative hemodialysis strategy of uremia patients undergoing total hip arthroplasty.
Methods
This study was a retrospective analysis.74 patients with uremia who were admitted to the joint surgery department of Changzheng Hospital Affiliated to the Naval Military Medical University from June 2006 to June 2017 were selected as the study objects.Heparinfree hemodialysis was performed in the control group 1 day before surgery and on the first day after surgery.The study group was used low molecular weight heparin hemodialysis 1 day before surgery and on the first day after surgery.The renal function，hemoglobin reduction，blood coagulation index and joint function recovery of the two groups were observed and compared.
Results
All patients were followed up for 13~102 months，with an average of (34.5±6.8) months.The indexes of blood urea nitrogen，blood potassium and blood creatinine in the study group were better than those in the control group (P＜0.05).There were no significant differences in the Harris scores of coagulation function，bleeding volume and hip joint function after surgeries between the two groups (P＞0.05).
Conclusion
For uremic dialysis patients，there was no significant difference in postoperative bleeding，blood coagulation，and joint function recovery between heparin-free hemodialysis and low-molecular-weight heparin hemodialysis during total hip arthroplasty.However，the renal function of patients with low molecular weight heparin hemodialysis is significantly better than that of patients without heparin hemodialysis.This suggests that for patients with uremia who require total hip arthroplasty，low-molecular-weight heparin hemodialysis is recommended during the perioperative period，which helps to protect patients' renal function，improve the safety of surgery，and reduce the risks.This deserves to be widely used in clinical practice.
2020 Vol. 26 (4): 298-321 [
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301
Study on Analgesic Effect of Single-Shot Femoral Nerve Block Combined with Periarticular Injection After Total Knee Arthroplasty
Gong Jianbao，Ding Yuan，Gao Chaohua，et al
Objective
To evaluate the analgesic effect of single-shot femoral nerve block combined with periarticular injection after total knee arthroplasty.
Methods
50 patients with total knee arthroplasty were selected from January 2017 to May 2018 in our hospital.There were 22 males and 28 females.The patients were 60 to 80 years old and the average age was(69.90±9.46).All of them were divided into the experimental group of combined periarticular injection of analgesia and single-shot femoral nerve block，or the control group of single-shot femoral nerve block alone group randomly.There were 25 cases in each group.The VAS score at rest and in activity，ROM，the rate of adverse reactions after operation was compared between the two groups.
Results
The experimental group had significantly lower VAS score than the control group at 6，12，24，48h both at rest and in activity (P＜0.05).The ROM in the experimental group were also significantly better than the control group at 1 and 2 days after the operation，while there was on difference in the ROM at 3 and 7 days after the operation between the two groups (P＞0.05)，and there was no significant difference in postoperative complications between the two groups(P＞0.05).
Conclusion
Combination of periarticular injection of analgesia and single-shot femoral nerve block is more effective than femoral nerve block alone in relieving early postoperative pain，which indeed helpful to early functional exercise.And there was no increase in postoperative complications.However，no significant advantage for long-term functional recovery has been found.
2020 Vol. 26 (4): 301-326 [
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304
Effect of Remaining Mild Varus on Clinical Outcome after Total Knee Arthroplasty in Patients with Lateral Femoral Bowing
Zhang Long 1，2,Li Hui 2，Ma Jianbing 2，et al
Objective
To explore the effect of remaining mild varus on postoperative functional recovery after total knee arthroplasty (TKA) in patients with femoral bowing.
Methods
A retrospective review of aprospectively maintained data base were performed.We retrospectively analyzed 59 patients (71 knees) of undergoing TKA by the same surgeon，including 6 cases (8 knees) of males and 53 cases(63 knees) of females，from January of 2015 to December of 2015.Mean age of patients was (67.7±5.7)(range 58~82).Femoral bowing Angle and hip-knee-ankle Anglewere measured.FBA<177° was defined as the femoral bowing.Patients were divided into two groups according to the postoperative HKA angle from weight-bearing full-leg radiographs：varus malalignment group with 32 patients (37 knees)，HKA<177°；neutral alignment groupwith 27 patients (34 knees)，HKA was (180±3)°.The Knee Society Score (KSS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were compared between preoperative and postoperative.
Results
Mean of follow-up was (49.30±4.11)months (range，43~55 months).No revisions occurred in any of the groups at midtermfollow-up.There were no statistical difference in preoperative KSS and WOMAC scores.All patients improved between preoperative and post-operative timepoints(P＜0.05).The WOMAC total score of varus malalignment group(5.57±6.23) were significantly lower than that in the neutral alignment group (9.27±8.86)；the WOMACpart C score of varus malalignment group(4.95±5.87)were significantly lower than that in the neutral alignment group(8.24±7.68).There was no significant difference in the remaining scores (P＜0.05).
Conclusion
For patients with lateral femoral bowing，residual varus alignment leads to better clinical outcomes after TKA than neutral alignment at a mean follow-up of 49.3 months.However，The effect of residual varus alignment on the survivalship of the prosthesis and the long-term outcome needs to be further evaluated.
2020 Vol. 26 (4): 304-308 [
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309
Arthroscopic Double Endobutton Versus Open Reduction and Internal Fixation for Tibial Avulsion Fracture of Posterior Cruciate Ligament
Feng Yansong，Shi Zhanying，Hu Juzheng，et al
Objective
To compare the clinical efficacy between two Endobutton plates fixation under arthroscope and open reduction and cannulated screw fixation in tibial avulsion fracture of posterior cruciate ligament.
Methods
From March 2015 to June 2018，56 patients with acute tibial avulsion fracture of posterior cruciate ligament underwent surgery in our hospital who were randomly divided into two groups.26 patients underwent surgery with two Endobutton plates combined with high-strength line fixation under arthroscope (the arthroscope group).30 patients underwent surgery with modified posteromedial incision of knee by using two cannulated screws ( the open reduction group).The indicators such as operation time，hospitalization expenses，knee pain score before surgery and 3 days，1 month and 1 year after surgery，last follow-up in knee range of motion，Lysholm score，positive rate of posterior stress radiography and postoperative complications were recorded and analyzed for the comparison of two groups.
Results
All patients in both groups underwent successful operation without any incision-related complications.The operation time of the arthroscope group was longer than that of the open reduction group(P＜0.05).By comparing the hospitalization expenses，the cost of the arthroscope group was higher than that of the open reduction group(P＜0.05).In terms of the pain score in three days after surgery，the pain score of the arthroscope group was lower than that of the open reduction group (P＜0.05).There was no significant difference in knee pain scores between two groups based on the period of before operation，1 month and 1 year after operation (P＞0.05).There was no significant difference in knee range of motion in the last follow-up evaluation，Lysholm score，and the positive rate of posterior stress radiography (P＞0.05).
Conclusion
The usage of two Endobutton plates under arthroscope，and the usage of the modified posterior medial approach to the knee joint for the treatment of PCL abutment avulsion fracture with cannulated screws can both achieve good surgical results.The advantages such as minimally invasive and mild early pain are obvious in the arthroscope group，however，the operation time is longer and the cost is slightly higher of this group than that of the open reduction group.
2020 Vol. 26 (4): 309-312 [
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Therapeutic Effectiveness of Radial Extracorporeal Shockwave Therapy Combined with Plateletrich Plasma Injection on Chronic Plantar Fasciitis
Yang Yong，Xiong Xiaojiang，Chen Jian *
Objective
To investigate the clinical efficacy of radial extracorporeal shockwave therapy(ESWT)combined with platelet-rich plasma(PRP)injection in the treatment of chronic plantar fasciitis.
Methods
In this prospective，single-center，randomized control trial，60 patients with chronic plantar fasciitis treated in our hospital from January 2017 to Dec. 2018 were randomly divided into ESWT group，PRP group and ESWT-PRP combined group，with 20 cases in each group.The visual analogue scale (VAS) and revised foot function index (FFI-R) was compared before treatment，and 4，12 and 24 weeks after treatment.We calculated the thickness of the plantar fascia under the ultrasound localization before treatment and 24 weeks after treatment.
Results
There were no significant differences of the characteristics，VAS scores or FFI-R scores between 3 groups.After treatment，the VAS scores and FFI-R scores of 3 groups were significantly improved than before treatment (P＜0.05).The improvement of VAS and FFI-R scores in the ESWT group and ESWT-PRP combined group were superior to the PRP group in the 4th week (P＜0.05)，while the improvement of VAS and FFI-R scores in the PRP group and ESWT-PRP combined group were superior to the ESWT group in the 24th week (P＜0.05).There was significant improvement in the thickness of the plantar fascia before treatment and 24 weeks after treatment in all groups (P＜ 0.05).VAS score was positively correlated with the thickness of the plantar fascia.No serious adverse reactions occurred after the treatment.
Conclusion
Radial extracorporeal shockwave therapy combined with platelet-rich plasma injection is a safe and effective treatment for chronic plantar fasciitis，and it has rapid onset，lasting results and no adverse effect.It’sworthy further clinical research and promotion.
2020 Vol. 26 (4): 313-316 [
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317
Influence of Odontoid Descent on Postoperative Neurological Function in Basilar Invagination with Irreducible Atlantoaxial Dislocation
Li Yaobin，Bai Hao，Liu Chenxin，et al
Objective
To evaluate the relationship between odontoid descent and postoperative neurological function.
Methods
19 patients who underwent foramen magnum decompression for basilar invagination with irreducible atlantoaxial dislocation were included.Anterior atlantodental interval(AADI)，clivoaxial angle(CXA)and the distance of the tip of dens to McRae Line(McRL)were measured preoperatively and at the last follow-up.The Japanese Orthopaedic Association(JOA)scoring system were used to characterize neurological function.Pearson correlation analysis was applied to analyse the relationship between JOA improvement rate and odontoid descent rate(ODR)，change of AADI(△AADI)and CXA(△CXA).
Results
The average follow-up was (20.42±8.24)months.The preoperative JOA was (11.21±2.62)，and JOA at follow-up was (14.53±2.19).The improvement rate of JOA was (58.75±24.43)%.Significant relationship between JOA improvement rate and ODR was found(R＝0.88，P＜0.05).No significant relationship was found between JOA improvement rate and △AADI(R＝0.07，P＝0.77)and △CXA(R＝－0.04，P＝0.98).
Conclusion
The surgical efficacy of foramen magnum decompression in basilar invagination with irreducible atlantoaxial dislocationis mainly depended on odontoid descent rate.When odonotoid decended to some degree，the surgical efficacy of foramen magnum decompression is optimum.
2020 Vol. 26 (4): 317-321 [
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322
Relationship between Cam Deformity and Subchondral Sclerosis of Acetabulum in Cam-type Femoroacetabular Impingement Syndrome
Objective
To analyze the correlation between cam deformity and subchondral bone thickness of acetabulum and histological characteristics of hip osteoarthritis by measuring the thickness and αangle ofacetabulum in patients with cam-type femoroacetabular impingement syndrome.
Methods
109 patients with hip joint MRI in our hospital were retrospectively analyzed，including 65 male and 44 female，with an average age of (29.4±1.2).The thickness of the subchondral bone of the acetabulum was quantified，and the correlation between cam deformity and the degree of sclerosis of the subchondral acetabulum was analyzed.
Results
23 patients had camtype femoroacetabular impingement syndrome with angle of α≥50°and 86 patients had no cam deformity with angle of alpha ＜50°.The incidence was 21.1%.The thickness of subchondral bone in cam-shaped deformity was 0.71 mm thicker than that in non-cam-shaped deformity(P＜0.05).The subchondral bone thickening of the cam deformity of the acetabulum was different，mainly in the anterior and upper part of the acetabulum.There were 7 deformities in the cam deformity.They were circular darts，thin layers，lenses，hooks，arcs，clouds and droplets.
Conclusion
There is a correlation between cam deformity and subchondral bone thickness of acetabulum.The thickness of subchondral sclerosis of acetabulum with cam deformity is higher than that of normal acetabulum，which was consistent with the early histological characteristics of hip osteoarthritis.
2020 Vol. 26 (4): 322-326 [
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327
The Relationship between the Expression of RecQ5 and Malignant Degree of Osteosarcoma
Zhi Liqiang 1，Tong Zhichao 2，Yao Shuxin 1，et al
Objective
To analyze the different expression of RecQ5 in different tissues and cells，inferring the relationship between RecQ5 expression and the degree of malignancy in different tissues.
Methods
35 OS samples，20 tumor adjacent tissues samples and 20 normal bone samples were chosen for the research.We compared the expression of RecQ5 among OS tissues，tumor adjacenttissues and bone tissues by immunohistochemical method and analyzed the relationship between expression intensity of RecQ5 and malignant degree of tissues，including AJCC staging.Moreover，Real-time PCR and Western blot were used to detect the mRNA and protein level of RecQ5 in hFOB1.19，U2OS and MG-63 cell lines.
Results
RecQ5 expression decreased inhuman osteosarcoma tissue.According to immunohistochemical results，the positive rate of RecQ5 expression was 100%(20/20)in normal bone tissues and positive rate was 90%(18/20) in tumor adjacent tissues，while the positive rate was 68.5%(24/35)in osteosarcoma tissues，which had statistically significant difference between the former two(P＝0.004)，but no significant difference in the former two(P＞0.05).Further analysis of relationship between expression intensity and malignancy degree of tissues found that the expression intensity of RecQ5 decreased with increasing of malignant degree of tissues(P＜0.05)and OS staging(P＜0.005)，which showed the expression of RecQ5 was negatively correlated with malignancy degree of tissues.Both Real-time PCR and Western blot showed the mRNA and protein level of RecQ5 expression was reduced in MG-63 and U2OS cells，compared to hFOB 1.19 cells(P＜0.05).
Conclusion
The expression level of RecQ5is negatively correlated with the malignancy degree of tissues.Deletion of RecQ5 is associated with the occurrence of osteosarcoma.
2020 Vol. 26 (4): 327-347 [
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