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2021 Vol. 27, No. 3
Published: 2021-03-25
 
193 Short-termchanges and Significance of Cervical Sagittal Parameters After ACDF of Cervical Spondylotic Myelopathy
Zeng Xianghong 1，Liang Bowei 2*，Xie Kegong 1，et al
Objective  To compare the difference of cervical sagittal parameters between normal subjects and patients with cervical spondylotic myelopathy (CSM)，and to explore the influence of the changes of cervical sagittal parameters before and after anterior discectomy and interbody fusion (ACDF) on the surgical efficacy. Methods  The cervical spine DR examination results of 96 normal physical examinees from June 2019 to June 2020 in the physical examination center of the Affiliated Hospital of Youjiang Medical College for Nationalities were collected，and the medical records and follow-up results of 76 patients with CSM in the department of spine and bone diseases of the Affiliated Hospital of Youjiang Medical College for Nationalities from January 2016 to October 2019 were collected.The C2～7 Cobb angle，C2～7 sagittal vertical axis (C2～7 SVA)，T1 slope (T1S) and thoracic inlet angle (TIA) were measured in normal subjects and CSM patients before and after operation，The Japanese Orthopaedic Association scores (JOA)，neck disability index (NDI) and visual analogue score (VAS) were collected before and 12 months after surgery.Results  The difference of C2～7 Cobb angle，C2～7 SVA，T1S and TIA between healthy group and CSM group hasstatistically significant (P＜0.05)；the comparison of the four parameters were (18.86±7.22)°、 (12.09±3.51)°，(14.00±6.00)mm、 (19.38±4.65)mm，(25.99±4.27)°、(23.41±5.63)°，(82.40±7.03)°、 (77.64±7.27)°.The difference of JOA score，NDI index and VAS score of CSM patients before and after ACDF had statistically significant.C2～7 Cobb angle，C2～7 SVA，T1S and TIA changed from (12.09±3.51) °，(19.38±4.65)mm，(23.41±5.63)°，(77.64±7.27)°preoperatively to (17.19±5.06) °，(15.24±4.24)mm，(24.67±3.39)°，(79.46±5.39)°postoperatively，respectively.The difference of C2～7 Cobb angle before and after CSM was correlated with the difference of evaluation index (P＜0.05)，but the difference of C2～7 SVA，T1S and TIA was not correlated with the difference of evaluation index (P＞0.05).The preoperative JOA score，NDI index and VAS score of high and low Cobb angle group，C2～7 SVA Group，T1S group and TIA group were not statistically significant；the postoperative JOA score，NDI index and VAS score of high and low C2～7 Cobb angle group were statistically significant (P＜0.05)；while the postoperative JOA score，NDI index and VAS score of high and low C2～7 SVA Group，T1S group and TIA group were not statistically significant (P＞0.05).Conclusion  Normal subjects have larger C2～7 Cobb angle and smaller C2～7 SVA，T1S and TIA than CSM patients；the imbalance of cervical sagittal position may increase the risk of neck pain and CSM.The C2～7 Cobb angle will increased，C2～7 SVA will decreased，and T1S and TIA will be close to those before operation.The C2～7 Cobb angle is related to the improvement of clinical symptoms，but the other three parameters are not.
2021 Vol. 27 (3): 193-198 [Abstract] ( 275 ) HTML (1 KB)  PDF (1367 KB)  ( 242 )
199 Clinical Efficacy of Sterile Exsanguination Silicone Tourniquets on Primary Total Knee Arthroplasty
Sun Yongqiang，Liu Guojie，Li Shuailei，et al
Objective  To compare the clinical efficacy on the accelerated recovery of postoperative patients in Primary TKA with pneumatic tourniquet and a sterile exsanguination silicone tourniquet.Methods  In total 50 patients undergoing primary total knee arthroplasty were retrospectively studied from April to October in 2020.With the design of sequential trial，in total 25 patients (20 cases of single knee，5 cases of double knee，a total of 30 knees) qualified were assigned to group sterile exsanguination silicone tourniquet from April to July；total 27 patients (24 cases of single knee，3 cases of double knees，a total of 30 knees) were included into the group of pneumatic tourniquets.Intraoperative blood loss before releasing tourniquet，total blood loss，surgical time，tourniquet use time，allogeneic blood transfusion rates，incidence of deep venous thrombosis and knee active range of motion (ROM) were summarized.Visual clarity of surgical field，thigh pain and knee pain were measured by the Visual Analog Scale.Lovett muscle strength classification standard was adopted to evaluate quadriceps strength.Results  Compared to pneumatic tourniquet，the sterile exsanguination silicone tourniquet group could obviously decrease the blood loss before releasing tourniquet (P＜0.01).Meanwhile，the excellent visual clarity of surgery field could be acquired in sterile exsanguination silicone tourniquet group with Score (P＜0.01).However，there is no significant difference in total blood loss between the two groups (P＝0.67).In sterile exsanguination silicone tourniquet group，tourniquet use time (64.10±4.98) min，operation time (73.03±6.11) min，the incidence of deep vein thrombosis was 13.33%.In pneumatic tourniquet group，tourniquet use time (70.73±13.13) min，operation time (79.33±14.57) min，the incidence of deep vein thrombosis was 36.67%.The difference between the two groups was statistically significant (P＝0.01，P＝0.04，P＝0.04).In the postoperative early stage，the thigh VAS score，knee VAS score，quadriceps strength and knee active range of motion in sterile exsanguination silicone tourniquet group were much better than those in pneumatic tourniquet group.There was no significant difference for allogeneic blood transfusion rates and tramadol demand rate between groups.Conclusion  A sterile exsanguination silicone tourniquet is an effective method to reduce intraoperative blood loss and provide much visual clarity of surgery field，which is beneficial to improve surgical efficiency and decrease tourniquet use time and and surgical time.In the postoperative early stage，compared to pneumatic tourniquet，sterile exsanguination silicone tourniquet could reduce the crush injury and thigh pain of tourniquet，improve quadriceps strength and knee active range of motion，which is beneficial to faster recovery for patient as well as increasing patient satisfactions.
2021 Vol. 27 (3): 199-204 [Abstract] ( 482 ) HTML (1 KB)  PDF (1589 KB)  ( 218 )
205 Cannulated Screws Combined with Medial Buttress Plate in the Treatment of Pauwels Type Ⅲ Femoral Neck Fracture
Objective  To study the application of cannulated screw combined with medial buttress plate in the treatment of Pauwels typeⅢ femoral neck fracture.Methods  From November 2015 to October 2018，58 patients with Pauwels type Ⅲ femoral neck fractures who met the inclusion criteria wereenrolled and randomly divided into two groups：cannulated screw，cannulated screwscombined with medial buttress plate，with 29 cases in each group.The average operation time，intraoperative blood loss，intraoperative fluoroscopy，postoperative complications (such as nail removal，nonunion，femoral head necrosis rate，hip varus，femoral neck shortening，etc.) were observed and compared between the two groups.Harris Hip Score at 6，12and 24 months after operation were used to assess hip joint function.Results  All patients were followed up 24~56 months，with an average of (30.6±6.1)months.(1)Compared with the cannulated screw group，the average operation time and intraoperative blood loss of the cannulated screwcombined with medial buttress plate group were longer and more，but the time of intraoperative fluoroscopy was less，and the difference was statistically significant (P＜0.05).(2) The excellent and good rate of fracture reduction in cannulated screwcombined with medial buttress plate group is high，and the difference is statistically significant.(3) The incidence of postoperative complications such as screw withdrawal，femoral head necrosis，hip varus，and femoral neck shortening in cannulated screw combined withmedial buttress plate group was lower than that of the cannulated screw group，and the difference was statistically significant (P＜0.05).The incidence of nonunion was similar between the two groups，and the difference was not statistically significant (P＞0.05).(4)Compared with the cannulated screw group，the Harris Hip Score of the cannulated screw combined with medial buttress plate group was significantly higher at 6，12，and 24 months after surgery，and the difference was statistically significant.(P＜0.05).Conclusion  Cannulated screw combined with medial buttress plate is more effective in the treatment of Pauwels tape Ⅲ femoral neck fracture.and the postoperative complication rate is low，which can provide a reference for clinical treatment of this type of fracture.
2021 Vol. 27 (3): 205-209 [Abstract] ( 357 ) HTML (1 KB)  PDF (1786 KB)  ( 227 )
210 Feasibility Analysis of Nutritional Metabolites and Vitamin D in Predicting Hhip Fracture in Elderly Women with Osteoporosis
Xie Junjie 1，Zhang Can 1，Liu Xiaying 2，et al
Objective  To study the correlation between hip osteoporosis fractures in elderly women and lipid and other nutrient metabolites，and to explore the feasibility of vitamin D，blood lipid，uric acid and other nutrient metabolites in predicting hip osteoporosis fractures in elderly women.Methods  A retrospective study was conducted to collect 194 elderly women with osteoporosis and elderly women with osteoporosis fractures of the hip who visited the hospital between 2014 and 2015，which were divided into simple osteoporosis group (108 cases) and osteoporosis fractures of the hip group (86 cases).We compared two groups of patients in general，each part of the hip bone mineral density，blood total cholesterol(TC)，serum triglyceride(TG)，serum high density lipoprotein cholesterol(HDL-C)，serum low density lipoprotein cholesterol(LDL-C)，serum uric acid(UA)，25-OH-VitD(25OH-VD) and diabetes prevalence data.Univariate analysis and screening were conducted on the related factors of hip fracture in patients with osteoporosis，and Logistic multivariate regression analysis was performed to screen out the independent risk factors.Independent and joint prediction probability analysis was carried out for the screened risks，and ROC curves of independent and joint prediction were drawn.The area under the curve and pairwise area comparison were calculated using MedCalc 18.5 software.Results  There were statistically significant differences in femoral neck BMD，intertrochanteric BMD，greater trochanter BMD，Vit D，TC，TG，LDL-C and UA (P＜0.05).The results of Logistics regression analysis showed that the decrease of Vit D was an independent risk factor for fracture，while the increase of TC was a protective factor for fracture，and the P values were <0.001 and 0.003，respectively.The ROC curve was plotted and the area under the curve was calculated.The AUC of Vit D，TG and joint prediction was 0.804，0.734 and 0.849.The cutoff point of Vit D was 23.955 ng/mL and the cutoff point of TG was 4.950 mmol/L.Comparison between groups showed that the AUC area of the combined prediction was greater than that of the single strand prediction of Vit D and TG (P＜0.05)，while there was no statistical difference between the single strand prediction of Vit D and TG (P＞0.05).Conclusion  The feasibility of vitamin D and serum total cholesterol in the prediction of hip fracture in elderly women with osteoporosis is proved，but more prospective study is still needed.
2021 Vol. 27 (3): 210-257 [Abstract] ( 312 ) HTML (1 KB)  PDF (639 KB)  ( 230 )
215 3D Printing Technology and Computer-assisted Taylor Space External Fixation Technology in Treatment of Complex Deformities of the Lower Limbs
Objective  To study the clinical effect of 3D printing technology combined with computer-assisted Taylor space external fixator in the treatment of complex deformities of lower limbs.Methods  A retrospective analysis was conducted on 13 patients with lower extremity deformities treated in the Affiliated Hospital of Qinghai University from January 2016 to January 2020，including 5 males and 8 females，with an average age of (31.62±8.99)years.And 12 patients with foot deformities (15 feet) and 1 patient with tibial deformity.The patients were received orthopedic surgeries of 3D printing technology and Taylor space external fixator.Postoperative evaluation according to the standards of Paley.Patients with foot deformities before and after surgery were evaluated using the American Society of Foot and Ankle Surgery (AOFAS) Ankle-Hindfoot Score System and Manchester-Oxford Foot Questionnaire (MOXFQ) score scale.Results  The postoperative follow-up time was (79.76±32.68)weeks.After the external frame removed，Paley evaluation of the limb showed that 6 cases were excellent，7 cases were good and 3 cases were general.AOFAS and MOXFQ scores showed significant differences in preoperative and postoperative patient scores (P＜0.05).Conclusion  The combination of 3D printing technology and computer-assisted Taylor space external fixation has the characteristics of accurate data and strong controllability and it has good clinical effects in the treatment of complex deformities of the lower limbs.
2021 Vol. 27 (3): 215-219 [Abstract] ( 243 ) HTML (1 KB)  PDF (2863 KB)  ( 253 )
220 Application of Lateral Edge of Extensor Longus Tendon in Total Knee Arthroplasty in Patients with RA
Zhang Congming，Lu Yao，Duan Ning，et al

Objective  In patients with rheumatoid arthritis undergoing total knee replacement，the accuracy of tibia platform osteotomy was estimated by the comparison of the outer edge of the extensor hallucis longus (EHL)tendon before ankle joint with the traditional method as a body surface marker in the center of the talus. Methods  Objective To evaluate the preoperative and postoperative X-ray films of 76 primary total knee arthroplasty patients with rheumatoid arthritis in our hospital from 2008 to 2014.Before August 2012，the patients with traditional method were group A.Group A had 30 cases(37 knees)，including 7 males and 23 females with an average age of (63.15±12.15)(range：48~81 y).After August 2012，35 cases(39 knee) with EHL tendon before ankle joint as a reference were group B.Group B had 11 male and 24 female with anaverage age of (68.27±9.46)(range：47~85 y).All the 76 knees were operated using patellar medial incision.The angle (alpha angle) between the coronal line and the mechanical line of the tibia was measured beforeorafter surgery.Angles of (90±2)° were accepted as the normal boundaries while more than 92 degrees are considered as valgus，and below 88 as varus.T-test was used for general data and chi-square test was used for enumeration data.Results  There was no significant difference between group A (79.92±6.54)° and group B (80.62±6.36)°before operation.The average post-operative alpha angle of Group A was (88.46±3.88)°and (89.59±2.21)°in the group B.The number of prosthesis alpha angle in normal range in group A was lower than that in group B.The difference was significant (P＝0.026).Conclusion  The use of the EHL tendon before ankle joint as a reference improves coronal tibial alignment accuracy of TKA in RA patients.
2021 Vol. 27 (3): 220-223 [Abstract] ( 223 ) HTML (1 KB)  PDF (959 KB)  ( 208 )
224 Expression of Serum miR-34a in Patients with Osteoscarma and Its Value in Diagnosis and Prognosis
Luo Lang，He Wei，Zhang Lei *
Objective  To investigate the expression and clinical significance of circulation miR-34a in patients with osteoscarma(OS).Methods  54 patients with OS and 54 healthy peoples from Hanchuan City People’ Hospital were prospectively analysed.There were 23 males and 31 females with an average age of (15.6±2.3) years (10~30 years).There were 25 males and 29 females with an average age of (16.3±2.1) years (range：10~30 years).The expression of miR-34a in serum of all the people was detected by reverse transcription-quantitative polymerase chain reaction (RT-qPCR)，receiver operating characteristic curves (ROC) was used to determine the diagnostic value of OS.The relationship between the miRNA-34a and clinicopathological parameters of OS was single factor and multiple factor analyzed.The relationship between the expression of miR-34a and the survival rate of patients with OS was analysed by Kaplan Meier and log rank test. Results  The level of miR-34a in serum of patients with OS was significantly lower than the healthy control (P＜0.01).ROC showed that the AUC was 0.830，the sensitivity and specificity were 79.6% and 75.9% respectively.The expression of miR-34a was related to tumor size，TNM stage and metastasis (P＜0.05)，but not to gender，age and tumor location (P＞0.05).The TNM stage and metastasis were the independent factor influencing the expression of miR-34a.The overall survival rate of patients with the low expression of miR-34a was significantly lower than that with high expression (P＝0.003).Conclusion  miR-34a with the tumor suppressor gene may be involved in the genesis，development and prognosis of OS，and may be a potential serum molecular marker for early diagnosis of OS.
2021 Vol. 27 (3): 224-234 [Abstract] ( 225 ) HTML (1 KB)  PDF (699 KB)  ( 207 )
228 FGD5-AS1 Regulating miR-761 Affecting the Proliferation，Migration and Apoptosis of Osteosarcoma Cells
Li Feng，Gong Jicheng，Du Jingzhu，et al
Objective  To investigate the effect of long-chain non-coding RNA(lncRNA) PH domain containing 5 antisense RNA 1(FGD5-AS1) on the proliferation，migration and apoptosis of osteosarcoma cells by targeting miR-761.Methods  Osteosarcoma tissue and paratumoral tissue samples were collected from 30 patients with osteosarcoma，who underwent surgery in our hospital from 2016 to 2018.There were male 18 and female 12，age 7~69 years old，mean age (20.2±1.29) years old.The expression level of FGD5-AS1 was detected by real-time fluorescent quantitative PCR (RT-qPCR).Osteosarcoma cells U2OS were divided into transfection small interfering RNA negative control (si-NC) group，transfection of si-FGD5-AS1 (si-FGD5-AS1) group，transfection of si-FGD5-AS1 and miRNA mimics negative control (si-FGD5-AS1+miR-NC) group，transfection of si-FGD5-AS1 plus miR-761 mimics (si-FGD5-AS1+miR-761) group，transfection of si-FGD5-AS1 plusmiRNA inhibitor negative control (si-FGD5-AS1+anti-miR-NC) group and transfection of si-FGD5-AS1 plus miR-761 inhibitors (si-FGD5-AS1+anti-miR-761) group.The methyl thiazolyl tetrazolium (MTT) method，colony formation experiment，and flow cytometry were used to detect cell viability，colony forming ability，and apoptosis，respectively.Double luciferase reporting experiments and RT-qPCR confirmed the targeted regulation of FGD5-AS1 on miR-761.Results  Compared with adjacent tumor tissues，the expression level of FGD5-AS1 in osteosarcoma tissues was significantly increased (P＜0.05).Compared with the si-NC group，the survival rate，clone formation numbers，migrating cell numbers of U2OS cells in the si-FGD5-AS1 group was significantly reduced，while cell apoptosis rate was significantly increased (P＜0.05).Compared with the si-FGD5-AS1+miR-NC group，the survival rate，clone formation numbers，migrating cell numbers of U2OS cells in the si-FGD5-AS1+miR-761 group was significantly reduced，while cell apoptosis rate was significantly increased (P＜0.05).Compared with the si-FGD5-AS1+anti-miR-NC group，the survival rate，clone formation numbers，migrating cell numbers of U2OS cells in the si-FGD5-AS1+anti-miR-761 group was significantly increased，while cell apoptosis rate was significantly reduced (P＜0.05).FGD5-AS1 has a targeted negative regulatory effect on miR-761.Conclusion  FGD5-AS1 is highly expressed in osteosarcoma.Inhibiting FGD5-AS1 inhibits the proliferation and migration，and induce apoptosis of osteosarcoma cells by up-regulating miR-761.
2021 Vol. 27 (3): 228-234 [Abstract] ( 232 ) HTML (1 KB)  PDF (2244 KB)  ( 185 )
235 Finite Element Analysis of the Treatment of Femoral Neck Fracture in Young Adults with Quadratus Femoris Bone Flap Transplantation and Internal Fixation
Objective  To study the biomechanical characteristics of quadratus femoris bone flap transplantation combined with internal fixation in the treatment of femoral neck fracture in young adults.Methods  A three-dimensional finite element model of proximal femur was reconstructed by importing the original CT data of a healthy young volunteer into Mimics software to simulate the femoral neck fracture，quadratus bone flap implantation and cannulated screw placement.The stress of 1000 N was loaded axially on the top of femoral head to study the different distribution (positive triangle，inverted triangle)，fracture position (inferior head type，transcervical type，basal type)，anteversion angle (+5°，+10°，0°，－5°，－10°) and neck stem angle (+5°，+10°，0°，－5°，－10°) of hollow nails，and to compare the stress peak value and stress concentration point of internal fixation and femoral model.Results  The stress concentration areas of femur and cannulated nail were distributed in the lateral cortex at the junction of femoral neck and femoral shaft.The stress of inverted triangle hollow nail is the lowest，the peak value was (32.2±0.93)MPa；the stress of fracture is the lowest，the peak value is (34.56±0.82)MPa；the stress of normal anatomic angle of anteversion and neck stem angle (corresponding to 0° position in the model) was the lowest，the peak value was (34.56±0.82)MPa.Conclusion  The quadratus muscle bone flap has little effect on the mechanical changes of the proximal femur.The number of three hollow nails is just right and the inverted triangle distribution is better than other forms in the mechanical characteristics and reducing the collapse of the femoral head.The stress of normal anteversion and the neck shaft angle are the least.
2021 Vol. 27 (3): 235-238 [Abstract] ( 311 ) HTML (1 KB)  PDF (1769 KB)  ( 191 )
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