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2020 Vol. 26, No. 6
Published: 2020-06-25
 
481 Correlation Analysis of Spine-pelvic Parameters and Quality of Life After Long Segmental Fixation of Degenerative Scoliosis
Hu Weiran，Shi Xinge，Wang Hongqiang，et al
Objective  To retrospectively study the spinal-pelvic parameters after long segment fixation in patients with degenerative scoliosis，including sagital vertical axis(SVA)，thoracic kyphosis(TK)，sacral slope(SS)，pelvic tilt(PT)，pelvic incidence(PI)，T1 pelvic angle(TPA)，analyze the difference between the parametersand(PI-LL) and study the correlation between the parameters and the score of quality of life.Methods  32 patients with degenerative scoliosis treated in our hospital from March 2013 to May 2018 were analyzed retrospectively，including 10 males and 22 females.The patients aged from 60.0 to 73.0 years with an average age of (64.0±3.5) years.All patients were treated with posterior long segmental fixation.The spine-pelvic parameters were measured after operation，and the correlation was statistically analyzed by filling in the International Scoliosis Research Society scale(scoliosis research society，SRS-22)，Oswestry disability index(ODI) and visual analogue scale(VAS).Results  The postoperativeparameters SVA，LL，PT and PI-LL were closely correlated with SRS-22 score，ODI score，back pain VAS score.SVA was significantly correlated with all sub-items of SRS-22 score and VAS score(P＜0.05).TK was significantly correlated with self-image，psychological status and treatment satisfaction in SRS-22 score(P＜0.05).LL was significantly correlated with all subitems of SRS-22 score，ODI score and back painVAS score (P＜0.05).PT was significantly correlated with ODI score and back pain VAS score (P＜0.05).TPA was significantly correlated with pain，self-image of SRS-22 score，ODI score and back pain VAS score SRS-22 score (P＜0.05).PI-LL was significantly correlated with pain of SRS-22 score，ODI and back pain VAS score(P＜0.05).PI and SS had no significant correlation with all scores，and all spine-pelvic parameters had no significant correlation with lower limb pain VAS score(P＞0.05).Conclusion  Postoperative spine-pelvic parameters such as SVA，LL，PT and PI-LL in patients with degenerative scoliosis are closely related to postoperative quality of life score SRS-22，ODI and back pain VAS score，while PI and SS are not significantly correlated with all scores.Appropriate preoperative design for spine-pelvic parameters SVA，LL，PT and PI-LL is helpful to achieve the best postoperative efficacy.
2020 Vol. 26 (6): 481-486 [Abstract] ( 319 ) HTML (1 KB)  PDF (1204 KB)  ( 368 )
487 Relationships between Acromion Index，Glenoid Inclination and Functional Recovery After Arthroscopic Surgery
Zhang Haiying 1，Zheng Chenying 2
Objective  To explore the relationships between acromion index，glenoid inclination and functional recovery after arthroscopic surgery.Methods  From September 2016 to September 2018，50 patients who underwent shoulder arthroscopic surgery in Orthopaedic Department of Oriental Hospital of Beijing University of traditional Chinese medicine and Dongzhimen Hospital of Beijing University of traditional Chinese Medicine were selected as the study objects.There were 27 males and 23 females，with an average age of (55.70±13.04)years (range 30~75 years)，including left shoulder 21 cases，right shoulder 29 cases.X-ray，magnetic resonance imaging (MRI) and electronic computed tomography (CT) were performed before and 12 months after operation；Constant-Murley score and University of California，Los Angeles (UCLA) score were used to evaluate the function of shoulder joint.And Pearson’s test was used to analyze the correlations between the imaging indexes，morphological parameters of glenoid and Constant-Murley，UCLA scores.Results  At 12 months after operation，the acromion index，acromial angle，coracoacromial ligament thickness，acromioclavicular osteophyte height，glenoid height，width and inclination angle were significantly lower than those before operation (P＜0.05)，and the scapulohumeral space and glenoid rotation angle of shoulder joint were significantly greater than those before operation (P＜0.05).The scores of Constant-Murley and UCLA at 12 months after operation were significantly higher than those before operation (P＜0.05).The acromion index，acromial angle，coracoacromial ligament thickness，acromioclavicular osteophyte height，glenoid height，width and inclination angle were negatively correlated with the Constant-Murley and UCLA scores (P＜0.05)，and the scapulohumeral space and glenoid rotation angle of shoulder joint were positively correlated with the Constant-Murley and UCLA scores (P＜0.05).Conclusion  Acromion index and glenoid inclination are closely related to Constant-Murley and UCLA scores，which may be an effective index to reflect the functional recovery after arthroscopy.
2020 Vol. 26 (6): 487-503 [Abstract] ( 242 ) HTML (1 KB)  PDF (794 KB)  ( 252 )
491 Short-term Outcomes of 3D Printed Titanium Trabecular Metal Acetabular Cups and Bone Allograft for Revision Hip Arthroplasty with Acetabular Bone Deficiency
Guo Yu，Wang Ling，Ding Yujian，et al

Objective  To investigate the short-term outcomes of 3D printed titanium trabecular metal (TTM) acetabular cups in treatment of revision hip arthroplasty with acetabular bone deficiency.Methods  The clinical data of 8 patients with acetabular bone deficiency using 3D printed TTM acetabular cups and bone allograft at Wuxi People’s Hospital from February 2017 to August 2018 were retrospectively analyzed.There were 3 males and 5 females，with an average age of (78.1±7.0)years (64~87 years).According to Paprosky acetabular defect classification，2 had ⅡB defects，1 had ⅡC defects，3 had ⅢA defects and 2 had ⅢB defects.The acetabular defect was reconstructed by TTM acetabular cups and bone grafting technique.The TTM acetabular cups were designed and fabricated according to each patient’s bone defects using 3D printing technology.During the follow-up，Harris hip score was recorded to assessed the efficacy，and X-rays were performed to evaluate the acetabular prosthesis position，migration，and graft incorporation.Results  The mean follow-up was (25.0±6.1)months (18~36 months).The Harris hip score improved from (36.3±8.5)preoperatively to (82.8±6.3)postoperatively.TTM cups resulted in generally reliable restoration of the hip center.The difference of vertical distance and horizontal distance between bilateral sides was (0.5±2.7)mm and (－2.0±6.1)mm，respectively.Acetabular component loosening was not found，effective bone incorporation was achieved in all cases，and no re-revisions had been conducted at last follow-up.Conclusion  3D printed titanium trabecular metal acetabular cups combined with bone allograft for revision hip arthroplasty with acetabular bone deficiency canprovide early stability，improve hip scores and reconstruct the rotation center in short-term follow-up.
2020 Vol. 26 (6): 491-494 [Abstract] ( 273 ) HTML (1 KB)  PDF (1697 KB)  ( 416 )
495 Green Channel Multidisciplinary Diagnosis and Treatment Improvethe Clinical Efficacy of Elderly Intertrochanteric Fracture Patients
Zhao Liping，Wu Yaogang，Sha Weiping，et al
Objective  To study the clinical effect of green channel and multi-disciplinary diagnosis and treatment modeon the elderly patients with intertrochanteric fracture of femur.Methods  The clinical data of 322 elderly patients (≥70 years old) with intertrochanteric fracture of femur treated by two kinds of operation modes were statistically analyzed.According to the diagnosis and treatment modes，they were divided into two groups：the priority group (green channel multidisciplinary diagnosis and treatment mode，160 cases) and the routine group (routine diagnosis and treatment mode，162 cases).The waiting time for operation，operation time，bleeding volume，length of stay and postoperative complications were compared between the two groups.Results  The waiting time for operation of patients was significantly different between priority group(38.8 h) and routine group(132.4 h，P＜0.01)，and the hospital stay of patients was significantly different between priority group(6.4±2.1)d and routine group(12.3±6.2)d，P＜0.01).There was no significant difference in the operation time and bleeding volume between the two groups(P＞0.05).The complications of patients in the priority group(30/160，18.8%) was significantly lower than that in the routine group(91/162，56.1%；P＜0.01).The incidences of pulmonary infection，deep vein thrombosis(DVT)，delirium and pressure sore of patients in the priority group was significantly lower than that in the routine group 5.6%(9/160) VS 20.4%(33/162)，4.4%(7/160) VS 12.3%(20/162)，3.7%(6/160) VS 8.6%(14/162)，1.3%(2/160) VS 6.8%(11/162)，P＜0.05.There was no significant difference in the incidences of respiratory failure，sudden death，heart failure，pulmonary embolism and cerebral infarctionbetween the two groups(P＞0.05).Conclusion  Through the establishment of green channel and multi-disciplinary diagnosis and treatment mode，early operation，if possible，can significantly reduce the hospitalization time and postoperative complications of the elderly patients with intertrochanteric fracture of femur，which is of great clinical significance for the standardized treatment of hip fracture in the elderly.
2020 Vol. 26 (6): 495-498 [Abstract] ( 301 ) HTML (1 KB)  PDF (445 KB)  ( 284 )
499 Safety and Effectiveness of Enhanced Recovery after Surgery (ERAS) in Total Knee Arthroplasty：a Meta-Analysis
Jia Junxiu，Tang Chong，Zhang Qinghua，et al
Objective  To systematically evaluate the safety and effectiveness of accelerated rehabilitation surgery (enhanced recovery after surgery，ERAS) in total knee arthroplasty.Methods  A randomized controlled trial (Randomized controlled trial，RCT) of ERAS in total knee arthroplasty was searched in Embase，Pubmed，Science Direct，Medline，Cochrane Library，CNKI，Wanfang，Vipp and other databases.Cochrane tool was used to evaluate the literature risk.RevMan 5.3 and R3.6.2 software were used for data analysis.Results  A total of 1673 patients with 6 articles of RCT，were included，including 565 patients in ERAS group and 1108 patients in control group.Meta-analysis showed that compared with the control group.the hospitalization time of ERAS group was significantly shortened by 2.17 days (MD=－2.17，95%CI －3.36~0.99，P＜0.01).ERAS group was 9.1%，which was significantly lower than that of control group (r＝0.30，95%CI 0.10~0.94，P＝0.02).Conclusion  The application of ERAS in total knee arthroplasty is safe and effective，which can significantly shorten the hospitalization time and reduce postoperative complications，which is worthy of extensive clinical promotion.
2020 Vol. 26 (6): 499-503 [Abstract] ( 261 ) HTML (1 KB)  PDF (1288 KB)  ( 401 )
504 Application of Self-made Anatomic Plate for Posterolateral Tibial Plateau Fracture with the Supra-fibular-head Approach
Chu Xudong 1，Xu ruisheng 2，Zhan Deping 1，et al
Objective  To evaluate the clinical effect and identify the advantages for the treatment of posterolateral tibial plateau fracture by using self-made anatomic plate for posterolateral condyle of tibial plateau with the supra-fibular-head approach.Methods  12 patients with posterolateral tibial plateau fracture were selected and treated from March 2016 to August 2018.They aged from 23 to 66 years with an average of (48.5±11.7)years.According to the 3D CT segmentation for lateral tibial plateau：12 cases had fracturein Ⅰ area；11 cases in both Ⅰ+Ⅱ areas；5 cases in Ⅰ+Ⅱ+Ⅲ areas.Self-made anatomic plate for posterolateral tibial plateau with the supra-fibular-head approach was applied to all these patients.After the operation，these patients hadperiodically follow-up，guidance for knee joint functional exercise and observation for postoperative complications.The fracture reduction was evaluated according to the Rasmussen score of the knee joint.The knee joint function was evaluated by thescore of the hospital for special surgery(HSS).Results  The operation took 46~65 mins，average(51.5±5.9)mins.All of wounds healed by first intention without complications like infection，skin necrosis，osteomyelitis or nerves injuries etc.Follow-up period was 10~31 months，average(13.5±6.2)months.During this time period，there was no internal fixation failure，fracture or displacement.No knee joint instability or articular step-off，no malformation of knock knee or bow leg etcwere founded.Accordingto Rasmussen radiographic evaluation，clinical outcomes were excellentin 9 cases，goodin 2 cases，fairin 1 cases.It took 9~12 weeks for clinical fracture healing after the operation，with an average (10.8±1.2)weeks.Internal fixation was successfully taken out for 8 studies in 11~18 months after the operation，with an average (13.5±2.2)months.The mean HSS(the Hospital for Special Surgery)score of all patients were excellent in 10 cases，good in 1 case and fair in 1 case with the excellent and good rate was 91.7％.Conclusion  These results reveal that the suprafibular-head approach is simple and safe，with minimal trauma and without the risk of blood vessels or nerves injuries.The anatomic plate for posterolateral tibial plateau can have a direct and efficient support to the fracture fragments.The combination use of both has an obvious advantage to treat posterolateral tibial plateau fractures，which is worth learning and promoting.
2020 Vol. 26 (6): 504-538 [Abstract] ( 294 ) HTML (1 KB)  PDF (1496 KB)  ( 286 )
508 Study of Tranexamic Acid in Reducing Recessive Blood Loss in Eelderly Patients with Intertrochanteric Fracture after APFNA Operation：A Randomized Controlled Study
Zhang Hui 1，Huang Yanan 1，Tu Dianqi 2，et al
Objective  To assess the impact of tranexamine acid on the hidden blood loss in intertrochanteric fractures treated with Asia proximal femoral nail anti-rotation(APFNA)and related complications.Methods  A randomized controlled study was used.A total of 80 elderly patients with APFNA internal fixation for intertrochan teric fractures in the Department of Orthopedics of Tongzhou District Hospitalin Beijing from April 2017 to August 2018 were included and randomly divided into two groups by random number table method.The observation group was treated with tranexamic acid and the control group with or without tranexamic acid.In the observation group，there were a total of 40 patients，including 11 males and 29 females，the average age was (76.15±7.55)years (65~91 years).Patients in the observation group were treated with 1g tranexamic acid added to 250 mL 0.9% sodium chloride injection while undergoing intraoperative dermectomy.A total of 40 patients were included in the control group，including 13 males and 27 females，the average age was (76.28±7.57)years (65~91 years).Patients in the control group were treated with 250 mL 0.9% sodium chloride injection by slow intravenous drip.Gender，height，weight，operation time，RBC hematocrit before and after operation，intraoperative and postoperative blood loss were observed in the 2 groups.Color ultrasound examination of lower limb veins was performed 10 days after operation to determine whether there was thrombosis.Results  The total blood loss was (681.29±148.04)mL in the observation group and (973.85±186.50)mL in the control group.There was statistically significant difference (P＜0.05).The average invisible blood losswas (529.79±56.10)mL in the observation group and (817.35±92.89)mL in the control group，and the difference was statistically significant (P＜0.05).The average dominant blood losswas (151.50±93.80)mL in the observation group and (156.50±95.15)mL in the control group，and the difference was not statistically significant (P＞0.05).There were no cases of thrombosis in either group.5 patients (12.50%) in the observation group received blood transfusion，with an average transfusion volume of 1.40 U.In the control group，13 patients (32.50%，13/40) received blood transfusion，with an average of 2.55 U.The difference in blood transfusion rate between groups was statistically significant (P＝0.033)，while the difference in average blood transfusion volume between groups was not statistically significant (P＞0.05).Conclusion  After the treatment of intertrochanteric fractures with APFNA，hidden blood lossis a large proportion of total blood loss，close to 85%，the application of tranexamic acid can effectively reduce the elderly intertrochanteric fracture with APFNA both total blood loss and hidden blood loss，postoperative of hidden blood loss can reduce about 35%，and did not significantly increase the incidence of DVT.The treatment has high security and good operability.
2020 Vol. 26 (6): 508-512 [Abstract] ( 414 ) HTML (1 KB)  PDF (1244 KB)  ( 400 )
513 The Preparation of Medical Titanium Plate Surfacial Coating 2-MPC and Its Effect on the Formation of Bacterial Biofilm
Objective  To explore the effect of medical titanium plate surfacial coating 2-MPC on the formation of bacterial biofilm.Methods  The surface of titanium plates were coated with 2-MPC using chemical grafting method and its morphology was observed by scanning electron microscopy.With standard strains of Staphylococcus aureus (ATCC25923) as an experimental bacteria，the titanium plates surfacial coating 2-MPC(experimental group) and normal plates(control group) were co-cultured into 5mL bacterial liquid with 1.5×106cfu/mL bacteria concentration.When cultured for 24h and 48h，the viable bacteria adhered on the surface experimental group and control group were counted and scanned by electron microscopy.Results  Scanning electron microscopy results showed that titanium plate surface coated by 2-MPC which prepared by chemical grafting method was smooth，with its original texture disappear.In vitro when cultured for 24h and 48h，the quantity of viable bacteria in the experimental group was significantly less than that in the control group(P＜0.05).Scanning electron microscopy observations showed that at 24h and 48h，the amounts of adhesional bacterial and formatted biofilm in experimental group were significantly less than that in the control group.(P＜0.05).And the numbers of formatted bacterial biofilm in the experimental group were significantly less than that in the control group at 48h.Conclusion  The chemical grafting method can make 2-MPC coated on titanium plate surface effectively，and 2-MPC coating can effectively inhibit bacterial adhesion to titanium plate surface，and prevent the bacterial biofilm’s formation on the titanium plate surface.
2020 Vol. 26 (6): 513-516 [Abstract] ( 226 ) HTML (1 KB)  PDF (1517 KB)  ( 204 )
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