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2021 Vol. 27, No. 2
Published: 2021-02-25
 
97 The Influence of Posterolateral Approach and Direct Anterior Approach on the Position of Anatomic Stems During Primary Total Hip Replacement
Tang Yu，Liu Juncai，Chen Jian，et al
Objective  To explore the influence of the posterolateral approach and the direct anterior approach on the position of the prosthesis stem and the analysis of the factors affecting the anteversion angle of the femur in the initial total hip arthroplasty.Methods  A total of 108 cases of 114 hip joints were included in our hospital from June 2015 to June 2020 in which the same doctor used an anatomical stem for the first total hip replacement.The flexion range of the affected hip was less than 60°，the lower extremity needs to be extended more than 2 cm，the BMI was more than 30 kg／m2 and the patient requires the posterolateral approach to use the posterolateral approach approach，the rest of the patients use the posterolateral approach approach，posterolateral approach group has 44 cases of hips，male There were 24 hips and 20 female hips，with an average age of (60.1±12.1)years.There were 70 hips in the posterolateral approach group，of which 38 were male hips and 32 were female hips，with an average age of (59.8±11.4)years.The patient lies in the supine position，CT scans the affected side (anterior superior iliac spine to tibial tubercle)，reconstructs the three-dimensional figure of the femur，and measures the position of the femoral prosthetic stem in the sagittal，coronal and horizontal planes，anteversion angle，and osteotomy from the lesser tuberosity Distance and the anteroposterior distance of the femoral head.Results  Before the operation，the anteversion angle of the femur was (23.2±10.4)° in the posterolateral approach group and (27.7±10.9)° in the posterolateral approach group.The difference between the two groups was statistically significant (P＝0.003).The postoperative femoral anteversion angles of the two groups were (28.5±11.5)° and (30.7±9.2)°，respectively，and the difference was not statistically significant (P＝0.141).After the comparison of the changes in the anteversion angle between the two groups，the difference was statistically significant (P＝0.043)；the difference between the sagittal and sagittal angles of the prosthesis was statistically significant (P＝0.008，P＝0.003).The preoperative anteversion angle was related to the postoperative anteversion angle，and the difference was statistically significant (P＝0.001)；the difference between posterolateral approach approach flexion implantation and posterolateral approach approach implantation was statistically significant (P＝0.043)；femoral head There was no statistically significant difference in the changes of the front-to-back distance between the two approaches (P＝0.882).Conclusion  The preoperative femoral anteversion angle is a factor that affects the postoperative anteversion angle.The surgical approach does not affect the postoperative anteversion angle and the change of the femoral head's anteroposterior distance.The surgical approach affects the position of the prosthesis stem in the sagittal plane.
2021 Vol. 27 (2): 97-102 [Abstract] ( 254 ) HTML (1 KB)  PDF (1221 KB)  ( 234 )
103 The Effect of Expandable Intramedullary Nail in the Treatment of Intertrochanteric Fractures in Elderly Patients
Objective  To explore the clinical efficacy of expandable proximal femoral nail (EPFN) in the treatment of osteoporotic intertrochanteric fractures in elderly patients.Methods  49 elderly patients with osteoporotic intertrochanteric fractures admitted to our department from January 2015 to December 2016 were selected and randomly fixed with EPFN and InterTAN respectively.There were 23 patients in the EPFN treatment group，including 7 males and 16 females with an average age of (75.2±6.1) years (range：68~89).There were 16 cases of AO/OTA 31-A2 type and 7 cases of 31-A3 type.The InterTAN treatment group had 26 patients，including 10 males and 16 females with an average (73.2±2.6)years old(range：70~87).The operation time，intraoperative fluoroscopy time，intraoperative blood loss，surgical incision length，postoperative weight bearing time，fracture healing time，postoperative complication rate and Harris hip function score were evaluated and compared.Results  Patients in both groups were followed up for 24 to 48 weeks，with an average of (36.0±6.7)weeks.There was 1 case of bedsores in the EPFN group，1 case of pulmonary infection，1 case of urinary tract infection after operation in the InterTAN group，1 case of contralateral femoral neck fracture.There was no significant difference in the postoperative complications between the two groups (P＞0.05).The operation time，intraoperative fluoroscopy time，intraoperative blood loss，and surgical incision length in the EPFN group were significantly shorter or less than those in the InterTAN group (P＜0.05).There was no significant differences of postoperative weight bearing time，fracture healing time and Harris hip function scores between the two groups (P＞0.05).Conclusion  EPFN and InterTAN for the treatment of elderly osteoporotic intertrochanteric fractures have the advantages of less trauma，firm fixation，early mobility，and fewer complications.However，EPFN is simple to operate and is superior in terms of shortening operation time and reducing intraoperative blood loss.InterTAN is more suitable for elderly patients with poor physical tolerance
2021 Vol. 27 (2): 103-107 [Abstract] ( 292 ) HTML (1 KB)  PDF (2956 KB)  ( 246 )
108 Early Clinical Study of Domestic “Skywalker” Surgical Robot for Knee Arthroplasty
Xia Runzhi，Tong Zhicheng，Zhang Jingwei，et al
Objective  To evaluate the surgical accuracy of the robot assisted orthopedic surgery system，“Skywalker” system，and verify the early clinical osteotomy effect，so as to provide experimental basis for system improvement and clinical use.Methods  The clinical data of 5 patients who received total knee arthroplasty assisted by “Skywalker” arthroplasty robot in the joint surgery department of the ninth people's hospital affiliated to medical college of Shanghai Jiaotong university from June to September 2020 were retrospectively analyzed.There were 2 males and 3 females with the age of(68.4±4.7)years (range：64~76 years) with a BMI of (27.1±3.3)kg/m2.The “Skywalker” surgical robot system was used for preoperative planning of knee arthroplasty.During the surgery，the robot arm reached the designated position，and the osteotomy was performed by the surgeon.The difference between the preoperative planned osteotomy and the actual osteotomy was evaluated，and the lower limb alignment angle before and after the surgery was measured.Results  The actual error is the difference between the actual osteotomy amount and the expected osteotomy amount，and the absolute value of the actual error can be taken as the judgment standard of the error.There were 6 absolute errors in 6 sites including the medial and lateral condyles of the distal femur，the medial and lateral posterior condyles of the femur and the medial and lateral sides of the tibial plateau.73.3% of the absolute errors were between 0~1 mm(22/30)，16.7% were between 1~2 mm(5/30)，and 6.7% were between 2~3 mm(2/30).The absolute error of the lateral tibial plateau in one patient was 3.1mm.The lower limb alignment angle in 5 patients tended to 180°more than before，and the mean angle errors between preoperative planned angles and postoperative angles of lower limb alignment angle，coronal femoral component angle，and coronal tibial component angle were less than 1°.The operation process of 5 patients was smooth，and no postoperative complications such as surgical site infection，deep vein thrombosis and vascular nerve injury were observed.Conclusion  “Skywalker” system has good osteotomy accuracy and stability and is expected to assist joint surgeons to achieve better results of intraoperative osteotomy and postoperative reconstruction of lower limb alignment in clinical use in the future.
2021 Vol. 27 (2): 108-117 [Abstract] ( 305 ) HTML (1 KB)  PDF (1625 KB)  ( 457 )
114 Application of Erythrocytapheresis in Patients with High Altitude Polycythemia Underwent Arthroplasty
Deng Liqing，Li Jia，Gan Yanfeng，et al

Objective  To investigate the safety of erythrocytapheresis in patients with high altitude polycythemia undergoing arthroplasty and the effectiveness of reducing the incidence of lower extremity deep vein thrombosis(DVT).Methods  A retrospective analysis was carried out focusing on the clinical data of 45 Tibetan male patients who underwent total hip arthroplasty(THA) and total knee arthroplasty (TKA) in the Department of Orthopaedics of our hospital from October 2018 to August 2020.Of the enrolled 45 patients，34 cases underwent THA and the other 11 cases were provided with TKA.The average age was (51.40±13.29) years old (ranging：31 to 73).The body mass index(BMI) was 21.79~33.79 kg／m2，with a mean BMI of (28.69±3.05) kg／m2；and the mean preoperative hemoglobin was (215.10±17.92)g/L，with a mean value of 191.00~249.00 g/L.In addition，the indication of preoperative therapeutic erythrocytapheresis was Hb>190g/L.Blood samples were taken for routine blood test prior to and on the second day of erythrocytapheresis，the first day and the third day after the operation to observe the changes of red blood cell count(RBC)，hemoglobin(Hb) and hematocrit(Hct).Meanwhile，D-Dimer was detected by blood sampling before erythrocytapheresis and the first day after operation to observe the change of D-Dimer.All patients were examined by color Doppler ultrasound of of veins of both lower extremities routinely for DVT screening before and 1，3，7，14，35 days after operation.Results  Routine blood test：RBC was tested to be(5.89~8.70)×1012/L and(3.84~6.63)×1012/L before and after erythrocytapheresis，with a mean value of (6.85±0.95)×1012/L and (5.30±0.75)×1012/L，respectively；besides，it was (3.21~6.18)×1012/L and (3.25~6.10)×1012/L one day and three day after operation，with the mean value of (4.76±0.89)×1012/L and (4.28±0.98)×1012/L，respectively.There was statistical difference between the values after single-harvest，postoperative day 1，postoperative day 3 and before single-harvest (P＜0.05).Hb was 191.00~249.00 g/L and 133.00~191.00 g/L before erythrocytapheresis and after erythrocytapheresis，with the mean Hb of(215.10±17.92)g/L and (167.60±16.26)g/L，respectively；in addition，it was 109.00~180.00 g/L and 108.00~175.00 g/L 1 day and 3 day after operation，with the mean Hb of(150.67±21.95)g/L and(133.00±24.15)g/L，respectively；and the difference was statistically significant between the values after single-harvest，postoperative day 1，postoperative day 3 and before single-harvest(P＜0.05).Hct was detected to be 57.70%~72.80% and 38.90%~57.30% before erythrocytapheresis and after erythrocytapheresis，with a mean value of (62.73±5.24)% and (49.45±4.93)%，respectively；and it was 32.10%~52.70% and 32.30%~50.20% one day and three day after operation，with the mean value of (44.11±5.94)% and (38.70±6.52)%，respectively，with statistically significant difference between the values after single-harvest，postoperative day 1，postoperative day 3 and before single-harvest (P＜0.05).2.D-Dimer was detected to be 0.01~1.20 mg/L and 2.37~6.07 mg/L before erythrocytapheresis and one day after operation，with the mean value of (0.28±0.45)mg/L and (4.04±1.54)mg/L，respectively；and the difference was statistically significant (P＜0.05).3.In terms of DVT，one patient was found to have thrombosis of bilateral posterior tibial vein，left fibular vein and calf intermuscular vein on the first day after THA.In addition，there was no cases of pulmonary embolism and blood transfusion. Conclusion  Erythrocytapheresis can be effective to reduce the incidence of DVT for the population with high altitude polycythemia in the perioperative period of arthroplasty.Besides，it is safe and reliable，exhibiting good clinical application value.
2021 Vol. 27 (2): 114-117 [Abstract] ( 279 ) HTML (1 KB)  PDF (437 KB)  ( 162 )
118 Clinical Study of Spinal Cord Injury on Male Sexual Function
Li Guangwei 1，WangShaobo 2，Zhao Wenkui 3，et al
Objective  To investigate the impact of male sexual function by the injury of spinal cord.Methods  39 cases of traumatic spinal cord injury patients in 2nd People's Hospital of Zhengzhou from December 2017 to May 2019 were included in this retrospective research.All patients were male，aged from 28 to 46 years，with an average age of (37.5±5.5) years.All patients underwent surgery after injury.International index of ecrectile function(IIEF) was used to evaluate patients' erection function.The neurological classification of spinal cord injury developed by American Spinal Injury Association (ASIA ) and ASIA motor and sensory scores were used to evaluate the neurological function of spinal cord injury.We evaluated the impacts of neurological and sexual function before and after injury of spinal cord，compare neurological and sexual function recovery after surgery.For the patients with sexual dysfunction were examine for felex erection and psychogenic erection function.Results  All patients received follow-up in a period of 14 to 31 months (mean 21.9±5.2).ASIA sensory score was (116.9±50.0)，ASIA motor score was (60.5±14.3).IIEF-5 decreased from (22.9±1.4) pre-injuryly to (11.3±2.7) post-injuryly.Aside from the Sensorimotor dysfunction，sexual function was also affected significantly after injury (P＜0.05).After surgery，IIEF-5 was (17.9±5.2)，ASIA sensory score was (174.6±36.0)，ASIA motor score was (83.0±13.8)，with significantly improved compared with which before surgery(P＜0.05).Conclusion  Traumatic injury of spinal cord can make obvious impact on male sexual function，aside from sensorimotor dysfunction.Time of treatment，injury segment，damage level and time to recover affect the extent of the damage of sexual function and recovery.
2021 Vol. 27 (2): 118-126 [Abstract] ( 192 ) HTML (1 KB)  PDF (528 KB)  ( 259 )
122 Clinical Characteristics and Pathogenic Bacteria Analysis of 333 Patients with Osteomyelitis
Feng Qiangsheng，Song Yuejuan *，Ha Xiaoqin，et al
Objective  To analyze the etiology distribution and clinical characteristics of osteomyelitis patients，and to provide theoretical basis for etiology diagnosis and treatment of osteomyelitis patients.Methods  We analyzed the clinical characteristics，pathogen distribution and drug resistance of 333 patients with osteomyelitis in our hospital from January 2018 to March 2020.300 cases of non bacterial infection were taken as negative control group.There were 333 cases in infection group，including 255 males and 78 females，with an average age of (40.19±17.91)years (range，2~98 years).There were 300 cases in the control group，189 males and 111 females，aged from 5 to 90 years，with an average of (34.80±23.67)years.The infection biomarkers of the two groups：procalcitonin (PCT)，C-reactive protein(CRP)，interleukin-6(IL-6) and neutrophil(neu) were compared by area under curve(AUC) of receiver operating characteristic curve(ROC).Results  The main age distribution of infection group：244 Cases(73.27%) were 20~59 years old；48 cases (14.41%) were younger than 20 years old.The average number of hospitalizations was (2.22±1.80)times/person，and the average length of stay was (17.03±12.30)days.The first infection site was tibia(105 cases，31.5%)，followed by fumur(76 cases，22.8%)，jawbone (26 cases，7.8%) and calcaneus (25 cases，7.5%).The main sources of pathogenic bacteria were secretion，tissue fluid and blood culture，which were 42.51%(88/207)，15.46%(32/207) and 14.98%(31/207)，respectively.The operation rate of osteomyelitis patients was 71.17%(237/333)，including debridement and drainage in 126 cases(37.84%)，and fixed removal in 73 cases(21.93%)，etc.The positive rate of pathogenic bacteria was 62.16%(207/333)，Staphylococcus aureus was 64.25%(133/207).34 cases were mixed infection.The drug resistance rate of Staphylococcus aureus was 45.1% for oxacillin，91.0% for penicillin，and 0 for tegacyclin，vancomycin and linezolid.The area under ROC curve (AUC) of neu%，CRP，IL-6 and PCT were 0.534，0.670，0.356 and 0.257，respectively，which showed that only CRP had diagnostic value for osteomyelitis.When CRP≥0.937 mg/mL，the sensitivity was 0.639 and the specificity was 0.663.Conclusion  The patients with osteomyelitis are characterized long treatment period，low detection rate of pathogenic bacteria and complicated，but Staphylococcus aureus is the most common pathogen.It is necessary to send the microbiological samples for identification，clinical antimicrobial susceptibility test and combined detection with CRP，so as to provide accurate diagnosis and guidance for clinical medication.
2021 Vol. 27 (2): 122-126 [Abstract] ( 232 ) HTML (1 KB)  PDF (1094 KB)  ( 265 )
127 The Relationship Between Blood Lipid and Osteoporotic Fracture in Elderly Women
Wu Jian，Zhou Tao *，Yu Bing，et al
Objective  To investigate the relationship between triglyceride (TG)，total cholesterol (TC)，low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) with bone density (BMD) and osteoporotic fractures in elderly women.Methods  Retrospective analysis was performed on 110 female osteoporotic patients who underwent outpatient physical examination or were hospitalized from September 2018 to March 2020.The age range ranged from 55~83 years，with an average age of (68.26±6.28)years.According to whether or not osteoporotic fracture occurred，52 cases with an average age of(69.04±6.30)years old(range：56~83 year)were included in fracture group and 58 caseswith an average ago of (67.57±6.24)years old(range：55~80 year) were includedin non-fracture group.Bone mineral density (BMD) and fasting lipid profile were measured in all patients，and general information such as age and body mass index (BMI) were recorded.The relationship between BMD and age，BMI，TG，TC，LDL-C and HDL-C in fracture group was analyzed by Pearson correlation analysis.Correlation coefficient r greater than zero indicated positive correlation，and r less than zero indicated negative correlation.With TC，TG，LDL-C and HDL-C as independent variables，Logistic regression analysis was used to explore the risk factors of osteoporotic fractures in elderly women，P＜0.05 was considered statistically significant.Results  In elderly women with osteoporotic fractures，age was negatively correlated with BMD of L1~4，femoral neck，Ward triangle，greater trochanter，intertrochanteric，and total hip (r<0，P＜0.05)，BMI was positively correlated with BMD in L1~4 and hip regions(r>0，P＜0.05)，TC and TG were negatively correlated with BMD in L1~4 and hip regions (r<0，P＜0.05)，HDLC had no correlation with BMD in L1~4 and hip regions (r<0，P＞0.05)，LDL-C was negatively correlated with BMD of Ward triangle，greater trochanter，intertrochanteric and total hip (r<0，P＜0.05).In elderly women，TC was an independent risk factor for osteoporotic fracture，and HDL-C was a protective factor for osteoporotic fracture (P＜0.05).Conclusion  In elderly women with osteoporotic fractures，the correlation of TC，TG and LDL-C in blood lipids with BMD at different sites was different，while HDL-C had no correlation with BMD at different sites.In elderly women，TC is a risk factor for osteoporotic fracture，and HDL-C may be a protective factor for osteoporotic fracture.
2021 Vol. 27 (2): 127-136 [Abstract] ( 199 ) HTML (1 KB)  PDF (518 KB)  ( 175 )
131 Research on the Correlation between Serum VEGF and VCAM-1 levels and Delayed Healing after Femoral Neck Fracture Surgery
Ju Xiaochen，Shu Li，Zhou Ling，et al
Objective  To analyze the effect of serum vascular endothelial growth factor(VEGF) and vascular cell adhesion molecule-1(VCAM-1) levels on delayed healing of patients with femoral neck fracture，and to evaluate the predictive value of each index in delayed healing.Methods  The clinical data of 189 patients with femoral neck fracture who completed treatment and postoperative follow-up in the Sixth Affiliated Hospital of Xinjiang Medical University from March 2017 to May 2019 were retrospectively analyzed.40 patients with delayed healing after femoral neck fracture surgery were included in delayed healing group，40 patients with good healing were included in the non-delayed healing group.the data of 40 healthy people who received routine physical examination and were confirmed as healthy people in the same period were retrospectively selected as the healthy control group.All the patients received routine examination and laboratory related index examination at admission，and the examination results were complete，the detection results of levels of serum VEGF and VCAM-1 in three groups were mainly recorded at admission.After 4，8 and 12 weeks of surgery，the levels of serum VEGF and VCAM-1 of femoral neck fracture patients were detected and compared.The correlation between serum indexes after at different time after surgery was analyzed.The effect of changes of serum levels in perioperative period on delayed healing after femoral neck fracture surgery was analyzed.The Receiver Operating Characteristic (ROC) curve was used to test the predictive value of serum indexes at different time for delayed healing.Results  On admission，the level of serum VEGF in 80 patients with femoral neck fracture was lower than that in control group，and the level of VCAM-1 was higher than that in control group (P＜0.05).The level of VEGF in delayed healing group at different time after surgery was lower than that in non-delayed healing group，and the level of VCAM-1 was higher than that in non-delayed healing group (P＜0.05).The levels of serum VEGF had negative correlation with VCAM-1 in patients with femoral neck fracture 4，8 weeks after surgery (r=0.513，P＜0.05)，and the correlation was the strongest at 4 weeks of surgery.There was no correlation between VEGF and VCAM-1 after 12 weeks of surgery.The results of linear regression analysis showed that the changes of serum VEGF and VCAM-1 levels in perioperative period may be the influencing factors of postoperative delayed healing in patients with femoral neck fracture (P＜0.05).At different time after surgery，the serum VEGF and VCAM-1 levels had certain predictive value for delayed healing after femoral neck fracture surgery (all AUC>0.7，P＜0.05)，and the predictive value was the highest 8 weeks after surgery，and the corresponding areas under the curve were：0.766，0.781.Conclusion  The postoperative serum VEGF and VCAM-1 interactions in patients with femoral neck fracture are closely related to postoperative delayed healing，which may be the influencing factor of postoperative delayed healing.The dynamic monitoring of serum VEGF and VCAM-1 levels at different time after surgery can well predict the risk of delayed healing of fracture，guide clinical rational prevention and treatment，and reduce the occurrence of delayed healing.
2021 Vol. 27 (2): 131-136 [Abstract] ( 184 ) HTML (1 KB)  PDF (919 KB)  ( 191 )
137 Effect of N-acetylcysteine on Chondrocyte Matrix Degradation and its Effect on Osteoarthritis
Zhang Weihua，Zhang Jianye，Ye Heng，et al
Objective  To investigate the effect of N-acetylcysteine(NAC) on chondrocyte matrix degradation and osteoarthritis.Methods  The model of chondrocytes induced by interleukin(IL)-1β was established in vitro，and the cell viability was measured by tetramethylazozolium salt(methyl thiazolyl tetrazolium，MTT) method and stained with pyridine iodide.Superoxide detection(SOD) kit，total glutathione peroxidase(GPX) detection kit wereused to detect intracellular ROS，SOD and GPX content.The expression of matrix metalloproteinase(MMP)-3，-9，-13 and ADAMTS 4 were detected by Western blot.Chondrocyte matrix was detected by Alcin blue staining.A rat model of osteoarthritis was established by right knee anterior cruciate ligament resection in vivo，and the mechanical pain threshold and knee joint swelling diameter of rats were detected.RT-PCR was used to detect the expression levels of MMP-4，MMP-9 and MMP-13 in rat synovial tissues.Safranin O staining was used to detect the pathological changes in rat synovial tissues.Results  NAC can significantly inhibit the production of ROS，SOD and GPX induced by IL-1β in chondrocytes，as well as down-regulating the expression of MMP-4，MMP-9，MMP-13 and ADAMTS 4.In addition，NACcouldalso inhibit chondrocyte matrix degradation in vitro.NAC significantly increased the threshold of mechanical pain and reduced joint swelling in OA rats.RT-PCR results showed that NAC significantly down-regulated the espression of MMP-4，MMP-9，and MMP-13 in synovial tissue of OA rats.Safranin O staining showed that NAC significantly relieved the destruction and degradation of joint matrix in OA rats.Conclusion  N-acetylcysteine can inhibit IL-1βinduced oxidative stress-mediated chondrocyte matrix degradation，and it has potential therapeutic value for osteoarthritis.
2021 Vol. 27 (2): 137-142 [Abstract] ( 270 ) HTML (1 KB)  PDF (2700 KB)  ( 197 )
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