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2021 Vol. 27, No. 4
Published: 2021-04-25
 
289 Clinical Effect of Modified Percutaneous Vertebroplasty in the Treatment of Thoracic Vertebral Fracture with Pedicle Dysplasia
Zhang Jianan，Liu Tuanjiang，Tian Ye，et al
Objective  To investigate the safety and efficacy of extrapedicular approach percutaneous vertebroplasty(PVP) in the treatment of osteoporotic thoracic fractures with pedicle dysplasia.Methods  We retrospectively analyzed 43 cases had osteoporotic thoracic fractures with pedicle dysplasia from January 2016 to January 2020.There were 16 males and 27 females with an average age of (72.40±5.02)years (range，60~82 years).Pedicle dysplasia was defined as undeveloped cancellous bone marrow cavity，and only cortical bone was connected.Preoperative X-ray and CT examination showed that the pedicle was abnormal.The study included 18 cases of T5，16 cases of T6 and 9 cases of T7.Extrapedicular approach PVP was performed for every patients.Gender，age，bone mineral density，fractured vertebral body，operation time，bone cement injection volume and follow-up time were recorded.Visual analogue scale(VAS) and vertebral height ratio at preoperation，1 day after operation，3 months after operation and the last follow-up were recorded and compared.Oswestry disability index(ODI) at preoperation，3 months after operation and the last follow-up were recorded and compared.Results  All 43 patients were followed up for 12~24 months，with an average of (17.16±3.79)months.The operation time was (27.65±4.52)min，and the injection volume of bone cement was (2.19±0.54)mL.The VAS of all patients were (6.56±0.54) before surgery，(2.14±0.35) 1 day after surgery，(1.74±0.49) 3 months after surgery，and (1.09±0.29) at the last follow-up (all P＜0.05).The ODI of all patients were (74.07±4.32)% before surgery，(22.95±2.73)% 3 months after surgery，and (18.19±2.37)% at the last follow-up (all P＜0.05).The vertebral height ratio of all patients were (88.56±5.48)% before surgery，(88.44±5.50)% 1 day after surgery，(86.91±5.36)% 3 months after surgery，and (86.21±5.00)% at the last follow-up.At the last follow-up，the loss of vertebral height ratio was statistically significant lower than preoperation(P＜0.05).Paravertebral bone cement leakage was found in 4 cases，and bone cement leakage in intervertebral disc was found in 1 case.No bone cement leakage in spinal canal and pulmonary embolism.were found.Conclusion  Extrapedicular approach PVP is safe and effective in the treatment of osteoporotic thoracic fractures with pedicle dysplasia.
2021 Vol. 27 (4): 289-293 [Abstract] ( 295 ) HTML (1 KB)  PDF (2789 KB)  ( 199 )
294 Surgery Plan and Curative Effect of Type Ⅱ Multilevel Cervical Spondylotic Myelopathy According to Spinal Cord Line
Liang Dongmu，Han Laichun，Hao Chen，et al
Objective  To compare the clinical efficacy and imaging results of anterior decompression with fusion (ADF) and of posterior open-door laminoplasty (LAMP) in the treatment of type Ⅱ multilevel cervical spondylotic myelopathy (MCSM)according to spinal cord line (SC line)and to provide a reference for the selection of surgical procedures.Methods  65 patients with type Ⅱ MCSM who underwent surgical treatment in our hospital from January 2014 to June 2018wereretrospectively analyzed.The research objects were divided into ADF group and LAMP group.There were 30 cases in the ADF group，including 21 males and 9 femaleswith an average of (62.5±10.7) (range：37~79 year).The LAMP group involves 35 cases，including 22 males and 13 femaleswith an average of (61.1±10.7)(range：34~81 year).According to whether there was residual compression of the anterior spinal cord during the follow-up after LAMP operation，the patients were divided into the subgroup LAMP(+) andLAMP(－) subgroup.There were12 cases of residual anterior compressionin LAMP(+)groupand 23 cases of  without residual anterior compressionin LAMP(－) group.The the Japanese Orthopaedic Association Scores(JOA)，improvement rate and pain visual analogue scale(VAS)，cervical curvature and range of motion before and after operation were studied.Results  The JOA improvement rate at the last follow-up in the ADF group and the LAMP group were (64.0±8.1)% and (48.7±14.7)% respectively.The VAS score was (1.1±0.4) and (1.4±0.6)points respectively.There were statistically significant differences in the VAS scores and the JOA of the two groups (P＜0.05).At the last followup，the average cervical curvature in the ADF group increased from (12.9±7.7)° to (15.7±6.8)°，and the LAMP group decreased from (17.1±6.1)° to (14.1±5.4).There were statistical differences (P＜0.05).The range of motion (ROM) of the cervical spine before operation in the ADF group was (24.5±6.3)°，and the last follow-up was (19.2±5.5)°.The preoperative cervical ROM of the LAMP group was (23.9±6.6)°，and the last follow-up was (18.9±5.4)°，and the ROM of the cervical spine in both groups was significantly lower than that before operation (P＜0.05).The improvement rates of JOA at the last follow-up of LAMP(+) and LAMP(－) subgroups were (32.7±9.2)% and (57.0±9.4)%  respectively.The VAS scores were (1.8±0.5) points and (1.3±0.5) points，respectively.The changes in the angle of curvature were (4.0±1.0)° and (2.3±1.5)°，respectively.There were statistically significant differences in the JOA improvement rate，VAS score and changes in the angle of curvature between the two subgroups (P＜0.05).The postoperative complication rate was 16.7% in the ADF group and 25.7% in the LAMP group，and the difference was not statistically significant (χ2=0.782，P=0.376).Conclusion  The recoveryis better for patients with type Ⅱ MCSMunderwentanterior surgery. The contact with or exceed the SC line in the front of the spinal cord before surgery，and loss of postoperative cervical spine curvature are risk factors for residual compression of the anterior spinal cord after LAMP surgery.Residual compression in front of the spinal cord after LAMP surgery impedes recovery of neurological function.
2021 Vol. 27 (4): 294-305 [Abstract] ( 211 ) HTML (1 KB)  PDF (3013 KB)  ( 255 )
300 Clinical Effect of Posterior Decompression and Fixation Combined with Vertebroplasty in Treatment of Thoracolumbar Spinal Metastases
Wu Xueyuan，Hao Cuipei，Jin Zhankui，et al
Objective  To explore the clinical effect of posterior palliative decompression and pedicular screws fixation combined with vertebroplasty in treatment of thoracolumbar spinal metastases.Methods  From Aug.2017 to Dec.2019，a total of 21 patients (9 men and 12 women) with thoracolumbar spinal metastases were treated in our department，with an average age of(58.8±7.84)years(range：45~76 years).All patients had nervous system damage and severe thoracolumbar back pain.They were treated with the surger of palliative resection of the debulk tumor，decompression of the spinal cord，insertion of the pedicle screws system to restore the stability and injection of bone cement in the vertebra of tumor.Visual analogue scale(VAS) and Oswestry dysfunction index(ODI) were applied to analyze the improvement of the back pain and life quality 1 day before surgery，1 week postoperatively and at the last follow-up.Results  All the operations were successfully completed.7 patients had bone cement leakage in the procedure of vertebroplasty，and complications due to heat-induced effects and toxicity did not occur.All the 21 patients were followed up and the average follow-up time was (9.0±1.5)months (range：6~12 months).The symptoms of thoracolumbar back pain were instantly relieved after operation.The scores of VAS decreased significantly from (8.40±1.28)points preoperatively to (2.52±0.60 )1 week postoperatively，and (2.86±1.04)points at the last follow-up.There were significant decrease in ODI scores from (69.43±7.45)points preoperatively to (24.16±4.41)points 1 week postoperatively and (26.48±5.22)points at the last follow-up.The difference of the VAS scores and ODI scores in 1 week postoperatively and at the last follow-up were statistically significant comparing with that preoperatively (P＜0.05).There was no loosening，fracture or pull-out of the screw，and no migration of the bone cement.All patients had neurofunction improved at least one Frankel grade after surgery.Four patients had local recurrence，of which 1 patient had a Frankel grade B at the 8 months follow-up after surgery and was not reoperated.The other three patients，who had symptoms of nerve root compression，continued to receive local radiotherapy or chemotherapy.Conclusion  The methods of posterior palliative decompression and pedicular screws fixation combined with vertebroplasty in treatment of thoracolumbar spinal metastases can efficiently reduce the thoracolumbar back pain and improve patients’ life quality with advanced cancer.This method gains satisfactory short-term clinical outcomes.
2021 Vol. 27 (4): 300-305 [Abstract] ( 257 ) HTML (1 KB)  PDF (2949 KB)  ( 254 )
306 Evaluating the Effectiveness of Intermittent Pneumatic Compression in the Prevention of Deep Vein Thrombosis After Hip Arthroplasty
Li Ke，Li Jing，Sun Hong，et al
Objective  To evaluate the effectiveness of intermittent pneumatic compression (IPC) in the prevention of DVT after hip arthroplasty.Methods  From Jan.2013 to Dec.2014，consecutive patients treated with low dose Aspirin after hip arthroplasty were collected as thecontrol group.From Jan.2015 to Dec.2016，patients received both IPC and low dose Aspirin were included in the IPC group.We retrospectively collected and analyzed the demographic data such as age，gender，body mass index(BMI)，time of operation，hospitalization period，and underlying disease for hip arthroplasty.A total of 778 patients were collected in this retrospective study.Among them，thecontrol group had 286 patients(157 males，129 females).The average age was(61.21±7.92).The IPC group had 492 patients(268 males，224 females).The average age was(60.48±8.04).The effectiveness of IPC in the prevention of DVT was evaluated through the comparison of DVT incidences between the two groups.Risk factors affecting the development of DVT were determined from age，gender，BMI，time of operation，and hospitalization period.Any complications related to the application of IPC would be collected as well.Results  The mean follow-up time were(11.75±6.44)months and(11.02±6.69)months of the control group and the IPC group，respectively(P＝0.134).There were no significant differences in most demographic data between the two groups.However，hospitalization period of the control group was significantly longer than that of the IPC group (P＜0.001).There were 12 patients and 7 patients developing DVT in thecontrol group and the IPC group，respectively.The IPC group (1.4%) had a remarkably lower incidence of DVT than the control group did(4.2%)，P＜0.05.There was no IPC relating complication observed in the IPC group.The patients having DVT were older and stayed longer inthehospital than those not affected by DVT(P＜0.05).Conclusion  The results of the current study suggest that IPC might be an effective and safe option for the prevention of DVT after hip arthroplasty.
2021 Vol. 27 (4): 306-309 [Abstract] ( 220 ) HTML (1 KB)  PDF (446 KB)  ( 224 )
310 The Medial Meniscus Posterior Root Tears is an Independent Risk Factor of Cartilage Damagein Varus Knee Osteoarthritis
Yi Hong 1，2，Zhu Xinhui 1，Fan Jianbo 1，et al
Objective  To determine whether MMPRT is an independent factor for the cartilage damage in varus KOAby studyingthe influences of both the knee varus and medial meniscus posterior root tears(MMPRT) on the cartilage damage in knee osteoarthritis (KOA) patients.Methods  From February 2018 to August 2020，a total of 92 subjects were enrolled.The KOA patients with knee varus were divided into the moderate and severe group according to the Outerbridge/ICRS classification.The moderate group contained 45 cases (12 males，33 females)，with an average age of (60.62±6.18)years old，and the sever group contained 47 cases (11 males，36 females)，with an average age of (61.51±5.09)years old.The varus angle was measured and Knee Injury and Osteoarthritis Outcome Score (KOOS) were performed respectively.MMPRT was confirmed under the arthroscopy.Multivariate linear regression was performedfor the cartilage damage. Results  In the severe group，the ICRS score，the knee varus angle，the MMPRT incidence，and the KOOS items except for the KOOS-symptomwere significantly higher than those of the moderate group，but there was no difference in the MMPRT grade between the two groups.Multiple linear regression analysis found that the varus angle and the MMPRT incidence were independent factors of ICRS score.Conclusion  In KOA patients with knee varus more than 5°，MMPRT is an independent risk factor that promotes the cartilage damage.
2021 Vol. 27 (4): 310-319 [Abstract] ( 239 ) HTML (1 KB)  PDF (816 KB)  ( 266 )
314 Platelet Rich Plasma in Treatment of Acute Trans Scaphoid Perilunate Dislocation
Ding Junjie，Bai Shunning *
Objective  To investigate the clinical effect of intra-articular injection of intra-articular Platelet-Rich Plasma (PRP) combined with open reduction and internal fixation in the treatment of acute trans-scaphoid perilunate dislocation (TSPD).Methods  Between July 2016 and July 2018，18 TSPD patients treated with PRP injection after open reduction and internal fixation were selected as the PRP group.There were 12 males and 6 females，with an average age of (34.8±11.3)years(range，25~53 years).The causes of injury inclued as follows：8 cases of falling，6 cases of machine impact，4 cases of violent injury in traffic accidents.Between June 2014 and June 2016，18 patients with TSPD who underwent open reduction and internal fixation in our department were selected as the control group，including 10 males and 8 females，with an average age of (32.5±9.2)years(range，23~51 years).The causes of injury inclued as follows：7 cases of falling，6 cases of machine impact，5 cases of violent injury in traffic accidents.According to Herbert’s classification，all fractures in injury were type B4.Before operation and at last follow-up，Krimmer wrist score，imaging results，complications，disability of arm shoulder and hand (DASH) and Mayo function score were compared between the two groups.Results  All patients were followed up with an average of (32.5±7.8)months (range，24~48 months).In the PRP group，the Krimmer score was significantly higher than that in the control group (P＜0.01).In the PRP group，the Krimmer wrist function was excellent in 16 cases，good in 1 case，fair in 1 case，and poor in 0 case，and the excellent and good rate of 94.44%.In the control group，10 cases were excellent，3 cases were good，3 cases were fair，and 2 cases were poor，and the excellent and good rate was 72.22%；All patients in the PRP group had no necrosis of the scaphoid and lunate at last follow-up，and there was no infection and traumatic arthritis during the follow-up.In the control group，4 cases result in avascular necrosis of scaphoid，3 patients had traumatic arthritis，and 1 patient had postoperative wound infection.There was significant difference in the incidence of complications between the two groups (P＜0.01).At last follow-up，the average DASH score was (12.83±2.27) in PRP group and (49.20±5.41) in control group.The difference was statistically significant (P＜0.05).The Mayo wrist score of the two groups was improved after operation，and the Mayo wrist score of PRP group was higher than that of the control group at the last follow-up，the difference was statistically significant (P＜0.05).Conclusion  PRP in the treatment of TSPD can promote fracture healing，repair articular cartilage damage and reduce the incidence of post-operative complications，so as to improve the quality of life，which may have better application values.
2021 Vol. 27 (4): 314-319 [Abstract] ( 225 ) HTML (1 KB)  PDF (3005 KB)  ( 807 )
320 Effect of Femoral Offset Change on the Postoperative Function of Intertrochanteric Fracture in Elderly People
Chen Xinxing，Zhang Yinchang，Ma Jimin，et al
Objective  To investigate the effects of altering the femoral offset on the postoperative function of femoral trochanteric fracture in elderly people.Methods  A total of 96 patients undergoing single femoral trochanteric fracture closed and internal fixation between September 2017 and June 2019 met the inclusion criteria.According to difference of femoral offset between operative side and contralateral side，the patients were divided into 3 groups：decreased offset group (<－5 mm，34 cases)，normal offset group(－5~5 mm，32 cases)，and increased offset group (>5 mm，30 cases).The reduction group had 34 patients inincluding 14 males and 20 females.The average age was (77.47±8.12)years old.There were 19 stable fractures and 15 unstable fractures.Among them，there were 9 ASA Ⅱ level and 25 ASA Ⅲ level.T the normal group had 32 patients，including 13 males and 19 females.The average age was (80.09±7.17)years old.There were 20 stable fractures and 12 unstable fractures.Among them，there were 8 ASA level Ⅱ，24 ASA level Ⅲ.The enlarged group had 30 patients，including 9 males and 21 females.The average age was (81.00±7.63)years old.There were 20 stable fractures and 10 unstable fractures.Among them，there were 6 ASA level Ⅱ，24 ASA level Ⅲ.Clinical efficacy was evaluated by Harris score 3 months，6 months and 1 year after surgery.Results  There were no statistically significant differences in age，gender，fracture type，ASA grading and postoperative hemoglobin among the three groups (P＞0.05).3 months and 6 months after surgery Harris score in the decrease group was higher than that in the normal group and the increase group，and the difference was statistically significant (P＜0.05).Harris score 1 year after surgery showed no statistically significant difference between the normal group and the decrease group (P＞0.05)，The scores of the increased group at 3 months，6 months and 1 year after surgery were lower than those of the normal group and the decreased group，with statistically significant differences (P＜0.05).Conclusion  Femoral offset affects postoperative function of patients with intertrochanteric fracture.Postoperative offset decrease can promote early recovery of femoral trochanteric fracture，reduce pain，and improve the quality of life.Postoperative offset increase will delay the recovery of patients，postoperative joint function score is lower.
2021 Vol. 27 (4): 320-323 [Abstract] ( 294 ) HTML (1 KB)  PDF (1165 KB)  ( 149 )
324 Reconstruction of the Tendon-bone and Tendon-prosthesis Attachment with Vascularized Periosteum
Ru Neng，Liang Jie
Objective  To investigate the feasibilityof reconstructing the tendon-bone attachment of the bone defect around the joint and tendon-bone anchor point on metal implant surface by using vascularized periosteum.Methods  We established the rabbit model of bilateral radial humeral biceps tendon-bone insertion defect and repaired this model by the following 4 methods.Method A：The broken end of the tendon was placed in the center of the defect.Then the defect and broken end of the tendon were wrapped by the posterolateral periosteum flap with ulnar artery.And they were sutured and fixed.A1：The broken end of the tendon insertion point was not covered with free periosteum but sutured to the broken end of the bone tissue at the bone defect.B：The tendon insertion was sutured on the titanium plate.Then the bone defect and the titanium plate-tendon insertion suture were wrapped by periosteum flap.B1：The broken end of the tendon insertion point was sutured on the internal fixation titanium plate without free periosteum covering.The bone defect repair and tendon-bone healing were evaluated by gross observation，X-ray，histological morphology，immunohistochemistry and biomechanical measurement at the 6th and 12th week after surgery.Results  After 12 weeks，bone defects recovery occurred in all the case of group A and group B.Only 1 case in group A1 and none in group B1 recovered.The tendonbone union forming could be observed in group A，group A1 and group B after 12 weeks，while group B1 failed.At the 6th and 12th week，the number of mature osteoblasts in group A was significantly higher than that in the other groups (P<0.01)，while the number of osteoblasts in group B was significantly higher than that in the other groups at the 12th week (P<0.01).The number of capillaries，thickness of tendon-bone ingrowth，BMP，IOD of bFGF immunohistochemical staining in group A and group B were significantly higher than those in group A1 without free periosteal repair(P<0.01).After 6 weeks，the tensile strength of the samples in normal control group were stronger than that in group A and group A1，but there was no difference between group A and group B.After 12 weeks，the tensile strength was shown as normal control group >group A >group B >group A1.Conclusion  The method of wrapping tendon and bone defect with vascularized periosteum graft can not only effectively repair bone defect but also reconstruct tendon-bone healing point at the same time.Although the vascularized periosteum can not form a mature bone tissue interface on the surface of the titanium implant，it could form a tendon-bone fibrous connection，which could promote indirect healing.Meantime our result also indicate that tendons cannot"self-heal"at the plant interface in titanium.
2021 Vol. 27 (4): 324-384 [Abstract] ( 197 ) HTML (1 KB)  PDF (2331 KB)  ( 307 )
330 Effect of miRNA-27α regulating PPARγ/ApoA5 pathway on hormonal femoral necrosis in rats
Huang Tao，Cui Yong *
Objective  To investigate the effect of miRNA-27α regulating peroxisome proliferator-activated receptor (PPARγ)/apolipoprotein A5(ApoA5) pathway on steroid-induced femoral head necrosis in rats induced by methylprednisolone.Methods  Thirty female SPF-grade SD rats were divided into 5 groups according to the random number method，with 6 in each group.1 group was a blank control group；4 groups were model groups.An in vitro model of femoral head necrosis was induced by methylprednisolone.Immunohistochemical analysis of bone morphology，qRT-PCR analysis of gene expression changes，and MTT method were used to detect cell proliferation and viability.Results  Hormone-induced rat femoral head sections showed sparse，broken，and disordered bone trabeculae，significantly reduced the area of bone trabeculae，and significantly reduced the content of miRNA-27α (P＜0.05).The levels of PPARγ and ApoA5 mRNA expression were significant increased (P＜0.05).PPARγ and ApoA5 showed a negative correlation with miRNA-27α，with correlation coefficients of 0.725 and 0.683，respectively.In the injection group of methylprednisolone and miRNA-27α mimics，the levels of PPARγ and ApoA5 mRNA significantly decreased (P＜0.05)；the proliferation of miRNA-27α mimics group was significantly higher than that of miRNA-27α inhibitor group.The chondrocyte survival rate in the model group was significantly reduced，but the miRNA-27α inhibitor group also produced a greater inhibitory effect.Conclusion  miRNA-27α can delay the progress of hormonal femoral head necrosis by inhibiting the expression of PPARγ / ApoA5.
2021 Vol. 27 (4): 330-334 [Abstract] ( 184 ) HTML (1 KB)  PDF (2119 KB)  ( 204 )
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