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2020 Vol. 26, No. 8
Published: 2020-08-25
 
673 Clinical Efficacy of Endoscopic-unilateral Laminectomy for Bbilateral Decompression for Lumbar Spinal Stenosis
Zhang Zhiqiang， Zhang Shengfei，Fan Xinyu，et al
Objective  To investigate the feasibility and efficacy of endoscopic-unilateral laminectomy for bilateral decompression (Endo-ULBD) for the treatment of lumbar spinal stenosis.Methods  From Jun 2018 to Jun 2019，24 patients(male 14，female 10)underwent Endo-ULBD were retrospectively analyzed.The age ranges from 42 to 78，with an average age of (58.5±10.8).Visual analogue scale and Oswestry disability index before operation were compared with those 1 day，1 month，6 month after operation.Modified MacNab criterion evaluated at the last follow-up postoperatively was used to identify the clinical efficacy.Results  All the 24 patients were followed up.The operation time ranged from 75 to 155 min，with an average of (58±23) min.VAS score and ODI score postoperatively were significantly improved compared with preoperative ones (P＜0.05).Modified MacNab criterion evaluated postoperatively indicated an efficacy of 13 excellent cases，8 good，2 fair and 1 poor.Conclusion  Endo-ULBD is a safe and efficient technique for the treatment of lumbar spinal stenosis.
2020 Vol. 26 (8): 673-675 [Abstract] ( 360 ) HTML (1 KB)  PDF (1608 KB)  ( 263 )
676 Effect of the Fused Level on Adjacent Disc Prosthesis in Hybridsurgery
Hu Lingyun 1，2，Wu Tingkui 1，Liu Hao 1，et al
Objective  To study the effect of the fused level on the prosthetic dynamics and complications in hybrid surgery compared with single-levelcervical disc replacement (CDR).Methods  Between March 2012 and September 2015，patients undergoing either a 1-level CDR or hybrid surgery(1-level CDR+fusion) wereretrospectively reviewed.All patients were followed up clinically and radiographically for a minimum of 4 years.The patients in the 1-level CDR group included 16 men and 26 women，with a mean age of (43.69±7.27)years (27~63).The patients in the hybrid group included 11 men and 15 women，with a mean age of (47.04±6.26)years (35~57).Radiologicalparameters and clinical outcome scores were evaluated at preoperative and postoperative follow-up points，includingsegmental alignmentand its changes，range of motion (ROM) of the disc replacement and its adjacent segments，migration and subsidence of the prosthesis，heterotopic ossification (HO)，adjacent segment degeneration (ASD) adjacent to the arthroplasty level，andclinical outcome scores.Results  Compared to the 1-level CDR group，the increased segmental lordosis immediately after surgery in the hybridgroup was more likely to be lost throughout the follow-up period(P＜0.05)，although both groups generally maintainedthe preoperative segmental alignment of the arthroplasty segment postoperatively(P＞0.05)；thehybridgroup did not exhibithypermobility of the disc prosthesis and preserved the preoperative ROM of theadjacent segment of the device(P＞0.05)；The mean amount of subsidence and migrationof the prosthesis in the hybridgroup was relatively larger，especially the difference in prosthesis migration was significant(P＜0.05)，but there was no significant difference in the number of cases of obvious migration or subsidence between the groups(P＞0.05)；the incidence rates of HO and ASD in the hybridgroup were higher，but there were no significant differences(P＞0.05).The clinical outcome scores of the two groups at the final follow-up were significantly improved compared with that of preoperative(P＜0.05)，and there were no significant differences between two groups(P＞0.05).Conclusion the fused level in the hybridgroup partially affected the dynamicperformance compared to single-level CDR，it did not increase prosthesis-related complications and causeadverse clinical outcomes.
2020 Vol. 26 (8): 676-687 [Abstract] ( 246 ) HTML (1 KB)  PDF (2511 KB)  ( 268 )
682 A Comparative Study on the Efficacy of Double-row Suture Anchor Bridge and Hollow Lag Screw in the Treatment of Elderly Patients with Greater Tuberosity Fracture
Bai Yunpeng，Qiu Yongmin，Ding Juhong，et al
Objective  To compare the efficacy of double-row suture anchor bridge and hollow lag screw fixation in the treatment of elderly patients with isolatedgreater tuberosity fracture.Methods  From June 2017 to June 2019，40 cases of isolatedgreater tuberosity fracture aged 60 years and over were treated in our hospital.They were divided into trial group (20 cases) and control group (20 cases) according to different fixation methods.The trial group was fixed with double-row suture anchor bridge，while the control group was fixed with multiple hollow lag screws.The time of fracture union，Constant-Murley score and visual analog scale (VAS) at the last follow-up，postoperative complications and secondary surgery rate were recorded and compared between the two groups. Results  40 patients were followed up for 12~24 months，with an average of (14.9±1.5) months.All patientshad fracture union.The union time was (7.9±2.3) weeks in the trial group and (8.5±3.1) weeks in the control group.There was no significant difference between the two groups (P＞0.05).At the last follow-up，ConstantMurley score was (89.4±11.2) in the trial group and (80.3±8.9) points in the control group.There was a significant difference between the two groups (P＜0.05).At the last follow-up，the VAS score of the trial group was (0.6±0.4)and the control group was (1.4±1.2) (P＜0.05).Postoperative infection was observed in 1 case in the trial group and 2 cases in the control group (P＞0.05).Re-displacement was observed in 0 cases in the trial group and 6 cases in the control group (P＜0.05)；impingement syndrome was observed in 0 cases in the trial group and 4 cases in the control group (P＜0.05)；secondary surgery was performed in 0 cases in the trial group and 10 cases in the control group (P＜0.05).Conclusion  The double-row suture anchor bridge is an effective and reliable method in the treatment of elderly patients with greater tuberostiy fracture.Compared with hollow lag screw fixation，this method can effectively improve the shoulderfunction，and reduce the incidence of complications and rate of reoperation.
2020 Vol. 26 (8): 682-687 [Abstract] ( 251 ) HTML (1 KB)  PDF (2058 KB)  ( 272 )
688 Study on the Efficacy of Erythropoietin in the Treatment of Perioperative Anemia in Patients with Joint Replacement of Different Ages
An Shuai，Li Jiayi，Li Zheng，et al
Objective  To investigate the effect of erythropoietin (EPO) combined with iron on anemia after hip and knee arthroplasty in different ages.Methods  149 patients with total hip arthroplasty (THA) and total knee arthroplasty (TKA) treated in XuanwuHospital of Capital Medical University were analyzed from May 2013 to December 2014，retrospectively.There were 42 males and 107 females，aged from 51 to 92 years old，with an average of (72.8±8.52) years old.Hip arthroplasty was performed in 74 cases and knee arthroplasty in 75 cases.According to the age of the patients，the patients were divided into two groups: the elderly group (≥65 years old，n＝121) and the non-elderly group (＜65 years old，n＝28).The patients in both groups were treated with EPO combined with iron during the perioperative period.The baseline information of patients，perioperative laboratory indexes，anemia rate before and after operation，allogeneic blood transfusion rate and blood loss volume were recorded.The blood volume of patients was calculated by Nadler equation and the hidden blood loss volume was calculated by Gross equation for statistical analysis.Results  The preoperative anemia rate in the elderly group was 24.0%，which was significantly higher than 7.1% in the non-elderly group(P＜0.05).The decrease level of hemoglobin (Hb) on the 1st，3rd and 5th day before and after operation in the elderly group was 23(12，30)g/L、29(18，38)g/L、26(15，37)g/L，respectively，which was significantly lower than that in the non-elderly group 30(22，36)g/L、38(29，49)g/L、32(23，45)g/L (P＜0.05).The rate of allogeneic blood transfusion：43.8%，in the elderly group were significantly higher than those in the non-elderly group 21.4%(P＜0.05).Blood loss：the total blood loss in the elderly group was 1 120(831，1 483)vs 1 087(821，1 480)mL，hidden blood loss 686(430，1 066)vs 505(414，1 116)mL，hidden blood loss ratio 61(51，75)vs 61(45，74)%，dominant blood loss 400(300，500) vs 440(205，558)mL，the difference was not statistically significant(P＞0.05).Conclusion  The preoperative anemia rate，allogeneic blood transfusion rate and blood transfusion volume in elderly patients with joint replacement are higher than those in non-elderly patients，and the blood management effect of EPO combined with iron is not good for the elderly.
2020 Vol. 26 (8): 688-692 [Abstract] ( 229 ) HTML (1 KB)  PDF (515 KB)  ( 249 )
693 Anterior Cruciate Ligament Reconstruction Using Single hamstring tendonAutograft with Remnant Preservation：Comparison of Outcomes According to the Lengthof Remnant Tissue
Chen Min，Lin Jia Jun，Liu Wenge
Objective  To compare clinical outcomes between groups of patients who underwent ACL reconstruction with single hamstring tendonautograft divided according to lengthof ACL remnant and investigate effect of remnant preservation on outcomes of ACL reconstruction.Methods  A total of 100 patients who underwent ACL reconstruction with single hamstring tendonautograft were retrospectively reviewedin the department of orthopedics of our hospital from January 2016 to February 2018.Patients were divided into three groups according to proportion of length of remnant tissue of injured ACL covering part of reconstructed ACL to total length of reconstructed ACL.Group A included 40 patients with no remnant，group B consisted of 35 patients with remnant of <50%，group C consisted of 25 patients with remnant of >50%.The results of knee function score，stability test and joint movement ability test (including return to activity and near-return to activity)were investigated and compared among the three groups at the last follow-up.Results Patients in the three groups follow-up duration were 25~47 months，with an average duration of (34.50±10.42) months.There was no statistically significant difference between three groups regarding preoperative IKDC subjective score，Lysholm score and Tegner score.At the last follow-up，the above scores in the three groups were all higher than that before surgery，and there was no statistical difference between the three groups in Lysholm knee score，while the subjective IKDC score (including physical activity and function) and Tegner score in group C were significantly better than those in group A and B.At the last follow-up，the results of Lachman，ADT and Pivot shift test in the three groups were all higher than those before the operation，and the paired comparison of results of Lachman，ADT and axial shift test among the three groups showed no statistical significance.At the last follow-up，there were no statistically significant differences in knee range of motion，hop test and near-return to activity among the three groups.However，patients of group C had significantly better outcomes inreturn to activity than those ingroup A and B.There was no significant difference in postoperativecomplications between the three groups.Results  ACL reconstructionusing single hamstring tendonautograftwith remnant preservation did not provide better anterior stability compared with conventional ACL reconstruction.However，preservation of remnant of >50% led to more improved activity-related clinical outcomes than no remnant preservation.In cases with substantial remnant tissue of injured ACL remaining，reconstruction of ACL while preserving as much remnant tissue as possible is recommended.
2020 Vol. 26 (8): 693-699 [Abstract] ( 232 ) HTML (1 KB)  PDF (1390 KB)  ( 443 )
700 Application of Ankle Pump Exercise Training Instrument in Prevention of Thrombus in Patients with Hip Fracture
Chen Yan，Jiang Wei，Wang Zhichong，et al
Objective  To explore the prevention effect of “ankle pump exercise training instrument” designed by our hospital on the prevention of thrombosis in patients with hip fracture.Methods  79 cases of hip fracture patients who were first hospitalized in our department from January 2018 to October 2019 were selected and randomly divided into a control group (41 cases) and a test group (38 cases) according to the random number table method.The control group was given traditional oral education to guide ankle pump exercise to prevent thrombus，and the test group was given ankle pump exercise to prevent thrombus by the ankle pump exercise training instrument designed by our hospital.The duration and angle of ankle pump exercise were compared between the two groups.Color ultrasound was used to examine the incidence of venous thrombosis in the lower extremity of the patients，and the incidence of thrombosis was compared between the two groups.Results  12 cases in the control group and 36 cases in the test group had the time of ankle pump exercise ≥5 min.18 cases with maximum angle of ankle pump exercise and 31 cases in the test group.The test group was better than the control group (P＜0.05) in duration and ankle flexion and extension Angle.The incidence of thrombosis was 9.8% in the control group and 2.6% in the test group.There was no significant difference in the incidence of thrombosis between the two groups (P＞0.05)，but the absolute incidence of thrombosis in the test group was significantly lower than that in the control group.Conclusion  Ankle pump exercise training instrument in hip fracture thrombosis prevention，with simple operation，traceable patient exercise data，reducing nurse workload，increasing patient compliance and so on，could play the role of quantifying the exercise time of ankle pump exercise and standardizing the exercise action，to achieve better prevention of deep vein thrombosis.It was worth popularizing in clinical practice.
2020 Vol. 26 (8): 700-706 [Abstract] ( 224 ) HTML (1 KB)  PDF (951 KB)  ( 238 )
703 Evaluation of the Effect of Electromagnetic Navigation System assisted Posterior Cruciate Ligament Reconstruction on Tibial Tunnel Positioning
Hu Pengyu，Yu Zhiping，Liu Duanzheng，et al
Objective  To evaluate the effect of the electromagnetic navigation system in assisting the posterior cruciate ligament reconstruction of the tibial tunnel positioning，and to provide a better surgical method for the clinic.Methods  30 fresh frozen adult knee joint specimens of the lower limbs were selected，regardless of gender，age，and left and right sides.The CT data of the specimens were imported into the electromagnetic navigation system for three-dimensional modeling.The optimal surgical path planning was completed before the operation，and the electromagnetic navigation system was real-time during the operation.The reconstruction of the tibial tunnel was completed under monitoring，and the sagittal angle，tunnel length and exit position of the tibial tunnel were measured.Results  Among 30 cases of knee joints，28 cases of steel needle exit point were located in the preoperatively planned footprint area，which was an effective tibial tunnel.The effective rate of electromagnetic navigation assisted tibial tunnel positioning was 93.33%.The excellent and good rate was 85.71% (24/28).The preoperative planning sagittal angle is (59.72±2.32)°，the postoperative measurement is (59.55±2.35)°，the error is (0.16±1.9)°；the preoperative planning tibial tunnel length is (69.56±2.79)mm，and the postoperative The actual measurement is (70.34±2.38)mm，and the error is (－0.78±2.27)mm.There was no significant difference in the sagittal angle and length of the tibial virtual tunnel planned before operation and the actual measurement after operation (P＞0.05).Conclusion  The electromagnetic navigation system assists in the positioning of the tibial tunnel in the downward reconstruction of the posterior cruciate ligament，with high accuracy and convenient operation，which can be used as a good auxiliary positioning method.
2020 Vol. 26 (8): 703-706 [Abstract] ( 216 ) HTML (1 KB)  PDF (1335 KB)  ( 353 )
707 Transplantation of BMSCs Modified with NGF Overexpression Plasmid Promotes Repair of Acute Spinal Cord Injury in Rats
Shi Yong，Xia Xiaoyan
Objective  To investigate the effect of bone marrow mesenchymal stem cell transplantation transfected with nerve growth factor (NGF) gene overexpression vector on the repair of acute spinal cord injury in rats.Methods  Human bone marrow mesenchymal stem cells (BMSCs) were extracted and the surface proteins of BMSCs were detected by flow cytometry.NGF overexpression vector plasmid was constructed by Cas-9 technology.BMSCs were transfected by lentivirus technology.The animal models of acute spinal cord injury in SD rats wereestablished by clamp method.SCI was constructed according to different treatment schemes.The models were divided into three groups: model group，BMSCs group and overexpression plasmid group.There were5models in each group.The NGF expression and nerve repair were detected by RT-PCR，Western blot and the immunofluorescence.Results  The expression of CD44 and CD29 was 60.2% and 58.3% in the second generation BMSCs，while the expression of CD34 and CD45 was 3.4% and 2.6% in the second generation BMSCs by flow cytometry.The transfection efficiency of lentivirus was over 90%.The BBB score of the model group was the lowest one day after operation，and that of the overexpression plasmid group was higher than that of the model group and BMSCs group (P＜0.05).Compared with model group and BMSCs group，the vacancy rate of hind limbs in overexpression plasmid group was significantly higher (P＜0.05).RTPCR results showed that the relative expression level of NGF in overexpression plasmid group was significantly higher than that in model group and BMSCs group (P＜0.05).The result of Western blot was the same as that of RT-PCR.Immunofluorescence results showed that NGF could co-stain with NeuN in the overexpressed plasmid group，and the number of neurons increased.The degree of spinal cord repair in overexpression plasmid group was better than that in BMSCs group and model group.It was found that the fracture spacing was obviously reduced and the repair of the broken end was better.Conclusion  NGF overexpression plasmid can promote BMSCs to differentiate into neurons and promote the functional recovery of SCI animal model.
2020 Vol. 26 (8): 707-715 [Abstract] ( 247 ) HTML (1 KB)  PDF (2890 KB)  ( 226 )
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