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2020 Vol. 26, No. 7
Published: 2020-07-25
 
577 Effect of Posterior Cervical Expansive Open-door Laminoplasty on Cervical Sagittal Balance
Pan Yubo，Feng Haoyu，Chenchen，et al
Objective  To explore the changes of cervical sagittal balance after posterior cervical expansive open-door laminoplasty procedure.Methods  The radiological and clinical data were analyzed retrospectively for 108 patients undergoing posterior cervical expansive open-door laminoplasty (C3~C7) in Department of Orthopaedic Surgery，ShanXi Bethune Hospital，from January 2014 to December 2017.The C0～2 Cobb angle，C2～7 SVA，C2～7 Cobb angle，and T1-Slope were recorded before operation and at the 24thmonth follow-up.The preoperative and the 24thmonth follow-up Japanese Orthopaedic Association (JOA) score，neck disabilityindex (NDI)，the MOS item short from health survey(SF-36)，visual analog scale (VAS) were recorded respectively，the severity of axial symptoms was also recorded at the 24th month follow-up.Results  The JOA score and SF-36 score increased to (14.08±2.17)，(51.25±5.82) from pre-operative (11.16±2.28)，(42.76±5.63).The NDI score and VAS score decreased from pre-operative (15.61±5.43)，(4.64±1.87) to (11.36±7.93)，(3.31±1.62) at the 24th month follow-up，respectively，the value changes were all statistically significant (P＝0.001，P＝0.001，P＝0.001，P＝0.022).The C0～2 Cobb angle，C2～7 SVA increase to(15.36±4.51)°，(25.49±11.52)mm formpre-operative (11.37±5.54)°，(21.09±5.86)mm，C2～7 Cobb angle decrease to(10.65±8.72)°frompre-operative (13.93±8.68)°，the value changes were all respectively statisticallysignificant (P＝0.001，P＝0.001，P＝0.016).T1-slope changed from (26.84±5.10)° before operation to (26.31±4.8) °，the difference was not statistically significant (P＝0.186).The change in C0～2 Cobb angle was positively related to the change in C2～7 SVA(Pearson=0.420，P＝0.015).At the 24th month follow-up，the average VAS score of high T1 group was (3.13±1.60) and low T1 group was (2.45±1.31)，the differences were statisticallysignificant between the 2 groups (P=0.015).The incidence of severe axial symptoms was 64.8% in the high T1-Slope group and 33.3% in the low T1-Slope group.Conclusion  There was significant impact of posterior cervical expansive open-door laminoplasty procedure on cervical sagittal balance.The cervical vertebrae show a tendency of tilting forward，suggesting that overextension of the upper cervical vertebra might be used to maintain the center of gravity of the skull and horizontal vision.And more severe axial symptoms often occurs in patients with high T1-Slope.
2020 Vol. 26 (7): 577-582 [Abstract] ( 268 ) HTML (1 KB)  PDF (1623 KB)  ( 399 )
583 Treatment of Intertrochanteric Fracture with Lateral Wall Fracture Using Proximal Femoral Nail Antirotation and Cannulate Screw
Objective  To review the results of proximal femoral nail antirotation (PFNA) combined with cannulate screw for reconstruction of lateral femoral wall in the treatment of intertrochanteric fracture.Methods  The clinical data of 60 elderly patients with intertrochanteric fractures involved in lateral wall rupture from September 2017 to September 2019 were retrospectively analyzed.They were divided into group A (PFNA alone，30 cases) and group B (PFNA combined with cannulate screw reconstruction of lateral femoral wall，30 cases).There was no significant difference in general information such as gender，age，side，cause of injury，and time from injury to operation between the two groups (P＞0.05).The operation time，intraoperative blood loss，fracture healing time，postoperative complications，and tip apex distance (TAD) were compared between the two groups.The Harris hip score was used to evaluate the function 12 months after operation.Results  The two groups were followed up for 9 to 16 months，with an average of 12 months.There was no significant difference in intraoperative blood loss and TAD at 2 months after operation in the two groups (P＞0.05).The operation time in group B was significantly longer than that in group A (t＝1.48，P＝0.045)；there were 5 complications (16.6%) occurred in group A after operation，including 1 case of main nail fracture，2 cases of displacement and nonunion (reoperation was performed again by artificial hip replacement)；2 patients with screw pull-out.There were 3 complications (10%)occurred in group B，including one case with fracture again in the intramedullary nail distal (reoperation was performed again by the full-length intramedullary nail).1 case with screw pull-out，and 1 case with ischemic necrosis of the femoral head (reoperation was performed again by artificial hip replacement)；there was no significant difference in the incidence of complications between the two groups (P＞0.05) .But，the fracture healing time in group A was significantly longer than that group B，showing significant difference(t＝2.064，P＝0.023).According to the Harris hip score at 12 months after operation，group B was significantly better than group A (t＝2.98，P＝0.01).Conclusion  Compared with PFNA alone，the treatment of intertrochanteric fracture with PFNA combined with cannulate screw reconstruction of lateral femoral wall can significantly reduce postoperative complications，promote fracture healing，and quickly restore the daily life ability of patients.
2020 Vol. 26 (7): 583-586 [Abstract] ( 284 ) HTML (1 KB)  PDF (1382 KB)  ( 228 )
587 The Role of Ortho One PROMT Score in Predicting the Repairability of Meniscus Tear
Xiao Qiongrun，Yang Guofu *，Sun Haoyuan
Objective  At present，it is still difficult to accurately predict the surgical method of meniscus injury before surgery.The purpose of this study was to evaluate the accuracy of the Ortho One PROMT score in predicting the repairability of meniscus tears，and to test whether it has the solution to the difficulty of predicting meniscus surgery before surgery.Methods  58 meniscuin 55 kneesunderwent arthroscopic surgery for meniscus injury from March 2019 to December 2019 were included in our hospital.This study was divided into two parts.Inthe part I，scoring process was performed by two grading doctors，who scored the meniscus injury independently according to the Ortho One PROMT scoring rules，and predicted the operation of meniscus surgery based on the score.Inthe part II，we compared the meniscus surgical procedures predicted by the two scoring doctors with the actual surgical procedures of the surgeons，and finally evaluate the accuracy，sensitivity and specificity of the Ortho One PROMT score in predicting the repairability of meniscus tears.Results  The scoring doctor predicted that the average correct rate of meniscus repair was 86.9%，the average sensitivity was 86.9%，and the average specificity was 87.5%.The average correct rate of the predicted meniscectomy was 87.5%，the average sensitivity was 87.5%，and the average specificity was 86.9%.The prediction results of the two scoring doctors were highly consistent with the actual operation methods of the surgeon (k＝0.78，k＝0.67).Conclusion  The Ortho One PROMT score predicts meniscus tear repairability is not only simple and easy to operate，but also has good accuracy，sensitivity and specificity.It can effectively solve the problem of difficulty in predicting the meniscus surgery，and has the value of clinical application.
2020 Vol. 26 (7): 587-604 [Abstract] ( 256 ) HTML (1 KB)  PDF (715 KB)  ( 223 )
591 Postoperative Evaluation of Recurrent Bone Giant Cell Tumor in Knee Treated with Denosumab
Li Yong，Zhang Jianfeng，Yan Ming，et al
Objective  To explore the surgical methods after treatment of recurrent bone giant cell tumor with Denosumab.Methods  From February 2014 to December 2019，22 patients（9 males，13 females，11 distal femur，11 proximal tibia）with recurrent bone giant cell tumor of the knee were treated with Denosumab in our department.Theaverage age was (34.09±11.62)years (18~55 years).22 patients received 3 months of treatment with Denosumab(subcutaneous injection of 120 mg/times on 1，8，15，29 day and followed by 120 mg/month).22 patients were divided into 2 groups according to surgical methods.12 Patients underwent Intracapsular curettageandbone cement filling and internal fixation in group 1(7 cases of distal femur and 5 cases of proximal tibia).10 Patients underwent wide excision and prosthesis replacement in group 2(4 cases of distal femur and 6 cases of proximal tibia).Postoperative patients were followed up by DR，CT，MRI and local ultrasound.To observe the local recurrence of tumor，the function of the limb was evaluated using the MSTS score of the Musculoskeletal Tumor Society after operation and in three months after operation.Results  There was no significant difference in the basic data of 22 patients.22 patients were followed up from 12 months to 48 months with anaverage follow-up of (26.77±9.19)months.The total recurrence rate of the two groups was 13.64% (3/22).There were 3 recurrent cases in group 1(2 cases of distal femur and 1 case of proximal tibia).The recurrence rate in group 1 was 25.00% (3/12).All the postoperative wounds healed in stage I，and there were no surgical complications.There were no recurrent cases in group 2.The recurrence rate in group 2 was 0 (0/10).One patient had vein thrombosis in popliteal vein in one week after operation.But thrombus disappeared after 2 weeks of thrombolysis.1 patient's wound had fat liquefaction.The wound had healed with debridement and suture.There were no related complications such as loosening and dislocation of prosthesis.The MSTS in Group 1 score was (28.17±1.11)and that in Group 2 was (26.70±0.95).The MSTS score in group 1 was significantly higher than that in group 2(P＜0.05).Conclusion  Denosumab is an effective adjuvant therapy for recurrent bone giant cell tumor，and recurrence risk is higher after discontinuation of medication.Extensive excisionand prosthesis replacement are recommended to reduce the risk of local recurrence after treatment with Denosumab.
2020 Vol. 26 (7): 591-595 [Abstract] ( 148 ) HTML (1 KB)  PDF (2354 KB)  ( 237 )
596 The Effect of Hallux Valgus Deformity Correction with Tibial Sesamoid Reduction
Yang Jie，Liang Xiaojun，Wang Junhu，et al
Objective  To investigate the effect of hallux valgus deformity correction with tibial sesamoid suspension reduction on imaging and clinical outcome，and to evaluate its safety and complications.Methods  From January 2016 to December 2017，30 patients who underwent hallux valgus correction surgery with sesamoid dislocation in our hospital were included in group A.All of them accepted osteotomy，lateral soft tissue release and tibial sesamoid suspension reduction.Another 30 cases who underwent osteotomy and lateral soft tissue release in our department from January 2016 to December 2017 were included in B group.All cases were treated with Scarf osteotomy (combined with Akin osteotomy if necessary).After follow-up，HVA，1~2 IMA，DMAA and the tibial sesamoid position (TSP) were measured on imaging，and the clinical outcome was evaluated with the AOFAS.Results  Two groups of the patients were followed up for 6-26 months，the average follow-up time was (14.1±5.34)months.There was no significant difference in the correction effect of HVA，1~2 IMA and DMAA between the two groups preopertion and post-operation (P＞0.05).The correction degree of TSP and AOFAS score in the A group was significantly better than that in the control group (P＜0.05).Conclusion  In hallux valgus surgery，tibial sesamoid suspension reduction can obviously correct the position of sesamoid and improve the clinical outcome，but there is no effect on HVA，1~2 IMA and DMAA.
2020 Vol. 26 (7): 596-608 [Abstract] ( 258 ) HTML (1 KB)  PDF (1100 KB)  ( 310 )
600 Dysfunction Analysis of Masquelet Technique for the Treatment of Long Bone Segmental Defects of Lower Limb
Ji Zhengang，Zhou Dapeng *，Han Tianyu，et al
Objective  To evaluate dysfunction of induced membrane technique for restoration of long bone segmental defect for differentreasons.Methods  A retrospective case series analysis was made from January 2012 to March 2019.Fifty-two patients (43 males，9 females)met the inclusion criteriawith a mean age of (36.7±4.5)years (range，15~73 years) admitted in General Hospital of Northern Theater Command.According to intial injury，there were 28 cases of traffic accident，4 cases of bruise injury caused by heavy object，11 cases of fall，2 cases of falling accident from high place，3 cases of military training injury，3 cases of bone tumor，and 1 case of osteomyelitis.According to the lesion sites，there were 22 cases of femur，28 cases of tibia and 2 cases of fibula.Masquelet technique was performed including phase Ⅰsurgical debridement，microbiology cultures and antibiotics-loaded bone cement impregnation to induce a membrane.Bone defect reconstruction was done by intramembranous bone grafting At phase Ⅱ，6~ 8 weeks after phase Ⅰ.Paley bone union evaluation system andX-ray films were observed during follow-up periods.Results  All patients were followed up for (41.9±6.7) months (range，12~ 92 months).There were 47 cases obtained one-stage bone healing.31 cases were excellent，9 cases were good，7 cases were fair and 5 cases were poor according to Paley bone union evaluation system.The total effective rate was 76.9 percent.One case of osteomyelitis recurred after internal fixation removal，still under treatment.One case required debridement due to superficial infection.One case required to be treated by induced membrane technique again due to recurrence.Two cases poor existed as bone remodeling in bone graft area.Two cases underwent amputation because of recurrence.Two cases recurred because of deep infection，they could not return to normal activities and needed walking aids.The knee joint was slightly painful in three patients after exercise.One patient presented with mild squatting pain，seven patients presented with 0°~ 45° degree of motion of the knee joint，three patients presented with 0°~ 90° degree of motion of the knee joint.One underwent ankle fusion，and two patients presented with mild ankle flexion and extension limitation.Conclusion  Masquelet induced membrane technique could promote fracture healing，restore limb function and reduce complications.Delayed treatment of diaphyseal bone defect and long fixation time of epiphyseal bone defect are the main reasons for limited joint movement.
2020 Vol. 26 (7): 600-604 [Abstract] ( 250 ) HTML (1 KB)  PDF (1734 KB)  ( 344 )
605 Biomechanical Simulation Analysis of Femoral Stem with Trabecular Structure Based on 3D Printing Technology
Ge Zhiqiang 1，Ge Zhixia 1，Chen Jia 2，et al
Objective  To investigate the stress distribution of the femoral stem with 3D printing trabecular structure by establishing solid structure and trabecular structure femoral stem prosthesis and using finite element simulation.Methods  By comparing the three-dimensional models of solid structure prosthesis and 3D printing trabecular structure femoral stem prosthesis，a finite element model was established to simulate the standing state of prosthesis with different structural designs after implantation，and the biomechanical properties of the two designs were compared.Results  The results showed that the peak stress in the finite element model appeared in the area of 3D printing trabecular structure.When standing on one foot，the peak stress of femoral stem with 3D printing trabecular structure was 8.6 MPa.The peak stress of the femoral stem with 3D printing trabecular structure was 3.9 MPa when the feet were standing.Conclusion  Compared with the solid structure of femoral stem prosthesis，the stress distribution of 3D printing trabecular bone structure is significantly optimized，and the maximum stress value is significantly reduced；therefore，the superior mechanical bearing performance of 3D printing bone trabecular structure reduces the stress shielding effect of femoral stem，which is more conducive to bone growth around the prosthesis，thus avoiding prosthesis loosening and providing safety guarantee for patients' rehabilitation.
2020 Vol. 26 (7): 605-608 [Abstract] ( 182 ) HTML (1 KB)  PDF (953 KB)  ( 365 )
609 The Effect of Uniplanar Versus Biplanar Medial Open-wedge Proximal Tibial Osteotomy on Posterior Tibial Slope
Zeng Jianchun 1，Zeng Yirong 1*，Luo Wei 2，et al
Objective  To evaluate the effect of uniplanar versus biplanar medial open-wedge high tibialosteotomy（OWHTO） on posterior tibial slope (PTS) following treatment of varus gonarthrosis with medial opening-wedge high tibial osteotomy.Methods  This study included 23 cases (29 knees) with medial compartment knee osteoarthritis treated with OWHTO，of which 8 cases (10 knees) were treated with uniplanar HTO (uniplanar HTO group)，15 cases (19 knees) were treated with biplanar HTO (biplanar HTO group)，both group were fixed with Tomofix plate.The imaging evaluation included the preoperative mechanical medial proximal tibial angle (mMPTA)，mechanical lateral distal femoral angle，mLDFA (mLDFA)，PTS，and the anatomical femorotibial Angle (aFTA).Postoperative mMPTA，PTS and aFTA were also measured.The average follow-up was (1.30±0.54)years (0.6~2.0 years).Results  There were no significant difference between two groups about preoperative mMPTA，mLDFA，FTA.PTS of uniplanar HTO group was larger than biplanar HTO group，(14.56±4.55)° and (9.87±2.63)° respectively.MMPTA was significantly increased in both groups，whereas the aFTA decreased with significant difference.The postoperative PTS of uniplanar HTO group decreased compared with that of pre-operation with no significant difference.The PTS of biplanar HTO group increased compared with that of pre-operation with significant difference.Conclusion  Both uniplanar and biplanar HTO can correct varus gonarthrosis，but biplanar HTO may result in increasing of PTS more easily，the effect of uniplanar HTO on PTS is less than biplanar HTO.
2020 Vol. 26 (7): 609-613 [Abstract] ( 270 ) HTML (1 KB)  PDF (901 KB)  ( 260 )
614 Effect of lncRNA HOXA11-AS on the Inhibition of Chondrocyte Apoptosis and Matrix Degradation in Osteoarthritis Rats
Qian Liang，Li Hongjun，Shi Yuan，et al
Objective  To investigate the expression of long-nocoding RNA (lncRNA) HOXA11-AS in osteoarthritis (OA) rat chondrocytes and its effect on chondrocyte apoptosis，matrix degradation and nuclear factor κB (Nuclear factor kappa B，NF-κB) .Methods  Rats were injected with Freund's complete adjuvant to construct OA rat model，and chondrocytes were isolated and cultured after modeling.Small interfering RNA (Small interfering RNA，siRNA) technology was used to inhibit the expression of HOXA11-AS in chondrocytes；Cell Counting Kit-8 (CCK-8) was used to to detect the viability of chondrocytes after transfection of siRNA at different times.Quantitative Real-time PCR (qRT-PCR) detected the expression of HOXA11-AS and matrix metallo protein-13(MMP-13)a disintesrin and metalloprotease with thrombospondin type 5 motifs(ADAMTS-5)，CollagenⅡ，aggrecan in chondrocytes.Flow cytometry was used to detect chondrocyte apoptosis.Enzyme-linked immuno sorbent assay (ELISA)was used to detect the expression of BCL2-Associated X Protein（Bax）、B-cell lymphoma-2（Bcl-2）、Caspase-3 in chondrocyte supernatant.And Western blot was used to detect the expression of extracellular matrix related proteins MMP-13，ADAMTS-5，CollagenⅡ，aggrecan and anti-nuclear factor kappa B inhibitory protein（IκBα），anti-phosphorylated nuclear factor kappa B inhibitory protein （p-IκBα）、nuclear factor kappa B（NF-κB 65）.Immunofluorescence staining was used to detect the expression of NF-κB in chondrocyte nuclei.Results  Compared with the normal group of chondrocytes，HOXA11-AS was highly expressed in chondrocytes of OA rats.Compared with NC siRNA group，the cell viability of HOXA11-AS siRNA group was significantly decreased.Apoptosis rate，proapoptotic factor Baxandthe expression level of Caspase-3 significantly increased，while the expression level of anti-apoptotic factor Bcl-2 was significantly decreased.Meanwhile，compared with NC siRNA group，the protein and gene expression levels of collagen II and aggrecan in HOXA11-AS siRNA group were significantly higher.The expression levels of MMP-13 and ADAMTS-5 genes and proteins were significantly increased，the expression level of IκBα protein was significantly decreased，and the expression levels of p-IκBα and NF-κB p65 were significantly increased.In addition，NF-κB was significant expression in the nucleusin HOXA11-AS siRNA group.Conclusion  lncRNA HOXA11-AS can inhibit the apoptosis and matrix degradation of chondrocytes in rats with osteoarthritis and prevent the activation of NF-κB signaling pathway.
2020 Vol. 26 (7): 614-623 [Abstract] ( 182 ) HTML (1 KB)  PDF (1274 KB)  ( 290 )
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