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2021 Vol. 27, No. 6
Published: 2021-06-25
 
481 The Medium-Long-Term Effect of Microscope-Assisted Modified TLIF Unilateral Approach with Bilateral Decompression and Unilateral fixation for the Treatment of Lumbar Spinal Stenosis
Wang Huiwang，Wu Zhanyong*，Wu Huarong，et al
Objective  To investigate the medium-long-term clinical efficacy of modified transforaminal lumbar interbody fusion (TLIF) by unilateral approach with bilateral decompression and unilateral fixation assisted by microscope for the treatment of lumbar spinal stenosis.Methods  We retrospectively analyzed 26 cases (17 males and 9 females) with lumbar spinal stenosis treated underwent modified transforaminal lumbar interbody fusion(TLIF) by unilateral approach with bilateral decompression and unilateral fixation assisted by microscope from August 2010 to February 2018.Their ages ranged from 47 to 71 years old，with a mean age of (61.5±6.28)years old.The operation level was L3～4 in 4 cases，L4～5 in 11 cases，L5S1 in 9 cases and L4～5 and L5S1 in 2 cases.Clinical outcomes including operation duration，surgical blood loss，post-operative drainage volume and complications were recorded.Low back and lower limb pain were assessed using the visual analogue scale (VAS) and the Oswestry disability index(ODI) assessesed the functional condition of the lumbar spine.Average intervertebral height，lumbar Cobb angle were utilized to evaluate the reduction of intervertebral height and lumbar lordosis.At the last follow-up，Bridwell standard was used to evaluate the interbody fusion，and MacNab standard was used to evaluate the clinical efficacy of patients.Results  All patients were followed up for 25 to 98 months，with an average of (61.2±22.9)months.The average operation time was (89.2±19.9)min and the average intraoperative blood loss was (172.9±63.1)mL.The average postoperative drainage volume was (93.0±27.2)mL.VAS score of low back pain，VAS score of lower limb pain and ODI index were significantly decreased compared with those before surgery，with statistical significance (P<0.05).The height of the intervertebral space of the operative segment was significantly increased after operation compared with that before operation，and the difference was statistically significant (P<0.05).The lordosis of lumbar spine was increased after surgery，but the difference was not statistically significant (P＞0.05).In the last follow-up，there were 24 cases (92.3%) of interbody fusion in accordance with Bridwell standard Ⅰ and Ⅱ.According to MacNab standard，19 cases were excellent，5 cases were good，and 2 cases were fair.The excellent and good rate was 92.3%.One patient had cerebrospinal fluid leakage，and the incision healed in grade A after intensive dressing change without any complications such as loosening or fracture of internal fixator.Conclusion  The microscopeassisted modified TLIF unilateral approach with bilateral decompression and unilateral fixation can achieve satisfactory medium-long-term clinical effects in the treatment of lumbar spinal stenosis.
2021 Vol. 27 (6): 481-487 [Abstract] ( 268 ) HTML (1 KB)  PDF (5561 KB)  ( 325 )
488 Analysis of Risk Factors for Deep Vein Thrombosis After Spinal Surgery
Chai Weihao，Li Zhongwei，Hali Habulihan，et al
Objective  To explore the risk factors of deep venous thromhosis(DVT)after spinal surgery，analyze and find out related high-risk factors，and provide evidence for preventing and reducing the formation of deep venous thromhosis after spinal surgery.Methods  The postoperative clinical data of 480 patients with spinal diseases admitted to the Orthopedic Center of the First Affiliated Hospital of Xinjiang Medical University from June 2016 to June 2020 were retrospectively analyzed，According to the results of ultrasound diagnosis of lower extremity veins within 1 week after operation，patients were divided into DVT group(30 cases)and non-DVT group(450 cases).Wecompared the age，gender，body mass index(BMI)，history of smoking，drinking history，tumor，hypertension，hyperlipidemia，and diabetes，preoperative D-dimer，and spinal cord Injury，the use of anticoagulants，the presence or absence of intraoperative blood transfusion，vertebral body segments，whether intraoperative nerve root decompression，intraoperative blood loss，surgical duration and postoperative time to the ground and other related factors.AndLogistic regression model Multivariate analysis was used to analyze the risk factors of postoperative DVT.Results  Univariate analysis showed that there was difference between the two groups of patients in terms of age composition，BMI，smoking history，diabetes，preoperative D-dimer abnormalities，whether they were combined with spinal cord injury，whether they were taking anticoagulants，whether they received blood transfusions，vertebral body segments，and whether they received nerve root decompression.There were significant differences in factors such as root decompression，intraoperative blood loss ≥500 mL，operation time，and postoperative time to ground(P<0.05).Logistic regression model showed that age，preoperative D-dimer abnormality，intraoperative blood transfusion，multi-segment vertebral body，intraoperative nerve root decompression，postoperative time to ground ≥5 days were statistically associated with the formation of DVT after spinal surgery(P<0.05).Conclusion  Age ≥60 years old，preoperative D-dimer abnormality，intraoperative blood transfusion，multi-segment vertebral body，intraoperative nerve root decompression，and postoperative landing time ≥5 days are high risk factors for the formation of DVT after spinal disease.Patients with spinal diseases with this high-risk factor should closely prevent the occurrence of DVT after spinal surgery.
2021 Vol. 27 (6): 488-511 [Abstract] ( 226 ) HTML (1 KB)  PDF (478 KB)  ( 244 )
492 Observation on the Treatment of Acetabular Defect with Autologous Femoral Head Combined with Conventional Prosthesis After Excision of Acetabular Tumor
Zhou Nannan，Zheng Jiaqian *，Zeng Zhiming，et al
Objective  To explore the feasibility of the treatment of acetabular defect with autologous femoral head combined with conventional prosthesis after excision of acetabular tumor，and to study the oncologic and functional prognosis of this operation by follow-up(≥2 years).Methods  Five patients admitted to our hospital from April 2010 to October 2017 who underwent the treatment of acetabular defect with autologous femoral head combined with conventional prosthesis after excision of acetabular tumor.Inpreoperative preparation，all patients underwent radiographic and pathological examination to determine the nature，type，and extent of tumor involvement in the acetabulum.Then，the simulated resection of the tumor was carried out with the help of computer，and the personalized surgical scheme was designed.Postoperatively，all patients were restricted to weight-bearing.Walking was assisted by a walking aid 1 month after the operation，and walking independently 6 months after the operation.Postoperative follow-up was conducted to review the CT，MRI and X-ray of the pelvis，and the CT of the lungs，so as to evaluate the oncologic prognosis.Musculoskeletal oncology society score(MSTS)was used to evaluate functional prognosis. Results  All the 5 cases received the operation successfully，achieved R0 resection of the tumor during the operation，and reconstruction of acetabulum with autologous bone grafting combined with Porous tantalum cup and conventional hip prosthesis.All patients were followed up for more than 2 years(range，24~120 months).Functional score was evaluated by MSTS at the last follow-up，and the functional score of 5 patients at the last follow-up was 26~30 points，with an average of (28.2±1.6)points.The imaging data during the follow-up in all patients indicated that the prosthesis was fixed in all patients，no acetabular prosthesis was displaced or loosened，and no joint dislocation was observed.There were no complications such as nonunion of bone graft，deep infection and poor healing of operative mouth in all patients.Conclusion  This procedure maximizes the recovery of the normal rotation center of the acetabulum.Combined with the use of conventional porous tantalum metal cups andbconventional hip prosthesis，it achieves the early and long-term stability of the prosthesis from the perspective of anatomy and biology.The results of follow-up indicated that the operation is safe and effective，and achieved good recovery of hip joint function，realized long-term survival of artificial joint prosthesis after the operation of acetabular peripheral tumor，and improved the quality of life of patients.
2021 Vol. 27 (6): 492-505 [Abstract] ( 228 ) HTML (1 KB)  PDF (2579 KB)  ( 253 )
497 Characteristics of Femeral Head Necrosis in Human Immunodeficiency Virus(HIV)-Positive Patients
Li Shuguang，Zhao Rugang，Zhang Yao，et al
Objective  To investigate the clinical characteristics and risk factors of femur head necrosis in human immunodeficiency virus(HIV)positive patients.Methods  81 HIV-positive patients with femoral head necrosis admitted to our hospital from October 2015 to October 2019 were selected as the observation group，and 81 non-HIV-positive patients with femoral head necrosis corresponding to gender and age at the same period were selected as the control group.The clinical characteristics of the two groups were compared.Results  There was no statistical difference(P＞0.05)between observation group and control group in career，location，ARCO stage，hip pain visual analog scale(visual analogue scale，VAS)score，hip flexion and Harris hip joint function score，no differences were found between the two groups in hypertension，cardiovascular disease，diabetes，hyperlipidemia and other complications，serum albumin were found no statistical difference between the two groups(P＞0.05)，The ratio of alcohol-induced femoral head necrosis in the observation group(2.50%)was significantly lower than that in the control group(43.21%)，and the difference was statistically significant(P<0.05).The hemoglobin level and BMI of the observation group were significantly lower than that in the control group(P<0.05).The count of CD4+T cells in peripheral blood of patients in the observation group was generally low，among which 32 cases(39.51%)had CD4+T cells <200 / μL.Conclusion  There is no significant difference in the incidence and severity of non-traumatic femoral head necrosis in HIVpositive patients compared with the normal population.Among HIV-positive patients，the ratio of alcohol-induced non-traumatic femoral head necrosis is significantly lower than that of the control group.CD4+T cell count in peripheral blood of such patients is generally low，so certain attention should be paid during surgical treatment.
2021 Vol. 27 (6): 497-500 [Abstract] ( 185 ) HTML (1 KB)  PDF (413 KB)  ( 191 )
501 Clinical Use of FRAIL Scale in Older Patients of Primary Total Knee Arthroplasty
Wu Jingliang，Zhang Congxiao，Song Huawei，et al
Objective  To explore the clinical use of FRAIL scale mong older patients of primary total knee arthroplasty(total knee arthroplasty，TKA).Methods  Aretrospective analysis of clinical data of 518 older patients(311 males，207 females，age range 60~79 years，and mean age (69.4±6.1)years，who received treatment of primary TKA between Jan 2017 and November 2020 in orthopedics department of Beijing Haidian Hospital was performed.A 30 days follow-up work for complications(incisional infection，periprosthetic infection，myocardial infarction，malignant arrhythmias，pulmonary embolism，cerebral infarction，pneumonia，postoperative delirium，and urinary infection )after surgery was conducted for all included patients.FRAIL scale was used to assess the frail status of included patientson admission.Logistic regression analysis was performed to examine the association between components of FRAIL scale and frailty diagnosed by FRAIL scale with the risk of short-term complications.Results  93 patients(18.0%)were diagnosed with frailty，182 patients(35.1%)were pre-frail and 243 patients(46.9%)were robust.In total，16 patients(3.1%)experienced short-term complications.Among them，7 patients(7.5%)belonged to frail group，5 patients(2.7%)belonged to pre-frail group and 4 patients(1.6%)belonged to robust group.The multivariate logistic regression analyses showed that resistance(OR=1.52，95%CI：1.02~2.28)，illnesses(OR=1.75，95%CI：1.08~2.82)and loss of weight(OR=1.66，95%CI：1.00~2.76)were associated with higher risk of short-term complications after primary TKA.Frail patients(OR=4.86，95%CI：1.39~17.03)had significantly higher risk of short-term complications after primary TKA.Conclusion  Among older patients received primary TKA，those frail patients have higher risk of short-term complications.FRAIL scale can be used in clinical practice for older patients of primary TKA to identify those have higher risk of short-term complications.
2021 Vol. 27 (6): 501-505 [Abstract] ( 213 ) HTML (1 KB)  PDF (443 KB)  ( 260 )
506 The Influence of MIPPO and Super-Articular External Fixation on the Ankle Function of Patients with Gustilo Type Ⅱ Open Distal Tibial Fracture
Liu Yan，Xing Jianfei，Song Shaofeng，et al
Objective  To compare and analyze the clinical effects of minimally invasive percutaneous plate osteosynthesis (MIPPO) and over-articular external fixation in the treatment of Gustilo typeⅡopen distal tibial fractures，and to explore the effects of the two operations on the patient's ankle joint function.Methods  In this retrospective study，122 patients with Gustilo type Ⅱopen distal tibial fractures in our hospital from January 2018 to January 2017 were divided into two groups according to different surgical plans.There were 61 cases in each group.Group A was treated with MIPPO，and group B was treated with super-articular external fixation.The operation and postoperative recovery，excellent and good rate of recovery of ankle joint function，incidence of postoperative complications and dorsal artery of the affected limbs [systolic flow (SF)，diastolic flow (DF)，time average maximum (TAM)，resistance index (RI)，stress index [procalcitonin (PCT)，interleukin-6 (IL-6)，prostaglandin E-2 (PGE-2)，substance P (SP)]，hemodynamic parameters of the pain degree and Lowa ankle score were compared between the two groups.Results  The operation time，swelling subsided time，and average hospital stay in the A group were shorter than those in the B group (P<0.05).The excellent and good rate of recovery of ankle joint function in the A group (95.08%) was higher than that of the B group (81.97%)，P<0.05.Serum levels of PCT，IL-6，PGE-2，and SP in the A group were lower than those in the B group at 1，3，and 7 days after operation (P<0.05).The SF，DF and TAM of the dorsal foot arteries of the affected limbs in the A group were higher than those in the B group at 1，3，and 7 days after the operation，and the RI was lower than that in the B group (P<0.05).The total incidence of postoperative complications in the A group (11.48%) and the B group (9.84%) were not statistically different (P＞0.05).The exercise VAS score and resting VAS score of the A group were lower than those of the B group at 3 months，6 months，and 12 months after the operation，and the Lowa ankle score was higher than that of the B group (P<0.05).Conclusion  Compared with over-articular external fixation，the clinical effect of MIPPO in the treatment of Gustilo Ⅱ type open distal tibial fracture is better，and it can further improve the recovery of ankle joint function.
2021 Vol. 27 (6): 506-511 [Abstract] ( 185 ) HTML (1 KB)  PDF (1264 KB)  ( 260 )
512 Study on the Relationship Between the Sagittal Shape of the Spine and Pelvis and the Recurrence After Transforaminal Endoscopic Discectomy in Treatment of Lumbar Disc Herniation
Zhou Zhihua，Deng Zhe，Zhou Xiao，et al
Objective  To explore the key parameters of the sagittal plane of the spinal pelvis after transforaminal endoscopic discectomy in treatment of patients with lumbar disc herniation and clarify the relationship between different Roussouly classifications of the lumbar and recurrence of transforaminal endoscopic discectomy in treatment of patients with lumbar disc herniation.Methods  The data of patients with lumbar disc herniation treated by transforaminal endoscopic discectomy from January 2015 to December 2019 were retrospectively analyzed.The patients of recurrence were included in the experimental group(32 cases)，among them，there were 18 males and 14 females.The patients were 36~51 years old with an average age of(41.2±9.8).There were 21 cases of L4～5 and 11 cases of L5S1.Randomly selected patients without recurrence after operation were included in a control group(32 cases).Among them，there were 17 males and 15 females.The patients were 35~54 years old with an average age of(46.3±10.6).There were 21 cases of L4～5，11 cases of L5S1.In standing position on the whole spine before operation，divide the sagittal curve of the lumbar spine into four types according to the position of the apex of the lumbar spine(Roussouly classification).Type Ⅰ：the apex is in the L5 vertebral body or L4～5 intervertebral space.Type Ⅱ：the apex is at the bottom or middle of L4.Type Ⅲ：the apex is in the upper L4 or L3～4 intervertebral space.Type Ⅳ：the apex is located at and above the L3 vertebral body.The lumbar lordosis angle(LL)，pelvic incidence angle(PI)，pelvic tilt angle(PT)，and sacral tilt angle(SS) were measured，compare the imaging index and Roussouly classification between the two groups.Results  Experimental group PI was (31.5±3.3)°，PT was (11.7±2.7)°，SS was (25.1±4.2)° and LL was (31.6±2.5)°，all were significantly lower than the control group (44.0±5.6)°，(15.1±3.8)°，(28.2±3.2)° and (50.3±3.3)°(P<0.05).The proportions of type Ⅰ，type Ⅱ，type Ⅲ and type Ⅳ in the experimental group were 50%，40.6%，0 and 9.4%，in the control group，they were 12.5%，15.6%，40.6%，and31.3%，respectively.among them：the type Ⅰ and type Ⅱ in the experimental group was higher than that of the control group，(P<0.05)，the type Ⅲ and type Ⅳ in the experimental group was lower than that in the control group(P<0.05).Conclusion  Low PI is more likely to cause the recurrence of lumbar disc herniation after transforaminal endoscopic discectomy.Roussouly type Ⅰ and type Ⅱ lumbar disc herniation have a higher chance of recurrence after transforaminal endoscopic discectomy，should be chose carefully for transforaminal endoscopic discectomy and protection after surgery should be used.
2021 Vol. 27 (6): 512-527 [Abstract] ( 189 ) HTML (1 KB)  PDF (2478 KB)  ( 214 )
517 IL-15Rα and RUNX2 Polymorphisms Associated with OPLL in the Mongolian Population
Li Pengfei，Zhu Shufen *
Objective  To study polymorphic loci in RUNX2 and IL-15Rα and explore the relationtion betweenpolymorphic loci in RUNX2 and IL-15Rα and OPLL of Mongolian in Inner Mongolia.Methods  From January 2014 to December 2019，Mongolian OPLL patients and Mongolian people with physical examination in the same period were selected as the research objects.Gene polymorphism of two candidate genes RUNX2 and IL-15Rα were detected by sequencing in 110 OPLL Mongolian patients.There were 75 males and 35 females.The average age was(53.0±12.8)years old.Control group included 118 healthy Mongolian people，including 65 males and 53 females.The average age was(58.0±11.2)years old.The result of sequencing of patients were compared with control subjects to screen loci with significant difference.Results  The frequencies of rs1321075 genotype and allele were compared between 118 healthy Mongolian and 110 Mongolian OPLL patients by chi square test.The differences of AC and CC genotype were statistically significant(P< 0.05)，The OR value(95% CI)was 0.584(0.343，0.997)，1.978(1.166，3.353)，the OR value(95% CI)of allele C was 0.588(0.386，0.895)，the difference was statistically significant.Compared with the genotype and allele frequency of rs16873379，the differences of CT and TT were statistically significant(P<0.05)，the OR value(95% CI)was 2.756(1.595，4.760)，0.266(0.153，0.461)，respectively.The OR value of allele C(95% CI)was 2.514(1.678，3.768)；the difference of genotype and allele frequency of rs2296139 was statistically significant(P<0.05)，OR value(95% CI)was 0.416(0.218，0.797)，and the difference of genotype and allele frequency of other loci was not statistically significant(P＞0.05).Conclusion  Polymorphism of rs1321075 and rs2296139 in RUNX2 and IL-15Rα may be responsible for OPLL in Mongolian population patients in Inner Mongolia.
2021 Vol. 27 (6): 517-533 [Abstract] ( 202 ) HTML (1 KB)  PDF (494 KB)  ( 191 )
522 The Relationship Between Macrophage Polarization and Glial Scar Formation in Mice Model of Spinal Cord Injury
Yang Mingkun 1，Zhang Xu 1，Dang Xiaoqian 2，et al
Objective  To investigate the relationship between macrophage polarization and glial scar formation in mice model of spinal cord injury(SCI).Methods  A total of 40 specific pathogen-free male C57BL/6 mice were randomly divided into the model(n=20)and control(n=20)groups.The model group was divided into 1 d，7 d，14 d，and 28 d post-model groups，with 5 mice in each group.The control group underwent the same procedures without damaging the spinal cord.Spinal cord tissue samples were obtained at 1 d，7 d，14 d，and 28 d after SCI，HE and immunohistochemical staining were used to observe glial scar formation following SCI.RTqPCR and ELISA assay were used to detect the expression of M1 markers TNF-a，IL-1β，and M2 markers Arginase-1，IL-10.Results  The staining results showed that the glial scar of spinal cord was formed in the experimental group and no glial scar of spinal cord in the control group.The markers IL-1β and TNF-α of M1-type macrophages in the fluorescence quantitative PCR experimental group were higher than those in the control group at each time point after spinal cord injury，and the difference was statistically significant(P<0.01).The highest expression was observed on the 7th day after spinal cord injury，and then decreased gradually，and tended to be stable on the 28th day.There were no significant changes in the expression of IL-1β and TNF-a in the control group at each time point(P＞0.05).IL-10 and Arginase-1 markers of M2 macrophages in the experimental group were higher than those in the control group at each time point after spinal cord injury，and the difference was statistically significant(P<0.01).The highest expression was observed on the 14th day after spinal cord injury，and then decreased gradually，and tended to be stable on the 28th day.There were no significant changes in the expression of IL-10 and Arginase-1 in the control group at each time point(P＞0.05).The expression of the markers IL-1β and TNF-α of M1-type macrophages detected by ELISA were significantly higher in the experimental group than in the control group at each time point(P<0.01).The expression of IL-1β and TNF-α in the experimental group was the highest on the 7th day after spinal cord injury，and then decreased gradually，and tended to be stable on the 28th day.There were no significant differences in the expression of IL-1β and TNF-α in the control group at each time point(P＞0.05).The expression of markers IL-10 and Arginase-1 of M2-type macrophages in the experimental group was significantly higher than that in the control group，and the difference was statistically significant(P<0.01).The expression of IL-10 and Arginase-1 in the experimental group reached the highest level on the 14th day after spinal cord injury，and then decreased gradually and tended to be stable on the 28th day after spinal cord injury.There was no statistical significance in the expression of IL-10 and Arginase-1 in the control group at each time point(P＞0.05).Conclusion  Macrophages were are mainly polarized to M1 phenotype in the first 7 days during glia scar formation after SCI，which were then gradually polarized into M2 phenotype at 7 days，and tended to be stabilized at 28 days after SCI.
2021 Vol. 27 (6): 522-527 [Abstract] ( 203 ) HTML (1 KB)  PDF (1690 KB)  ( 213 )
528 Proliferation Regulation of MiR-27b-3p Targeting ID-3 on Osteosarcoma Cells
Li Zhiqiang，Liu Shujiang，Shen Chao，et al
Objective  To observe the targeting relationship between microRNA-27b-3p(miR-27b-3p)and DNA binding/differentiation inhibitory protein-3(ID-3)，and analyze its regulatory effect on proliferation on ostersarcoma cells.Methods  Prospective research methods was applicated.Osteosarcoma cell line U20S was selected.Targeting relationship between miR-27b-3p and ID-3 was verified by double luciferase reporter gene assay.The blank control group，empty vector transfection group，miR-27b-3p mimic group，miR-27b-3p mimic and siRNA ID-3 co-transfection group were established.Cell activity was detected by CCK-8 method.Clonal formation was detected by cells colony formation experiment.ID-3 and PCNA were detected by Western Blot method.40 cases of osteosarcoma were selected，including 22 males and 18 females.The average age was(16.3±4.3)years old.Expression of miR-27b-3p was detected by real-time fluorescence quantitative PCR.ID-3 and PCNA were detected by immunohistochemistry method.Results  MiR-27b-3p could reduce the luciferase activity in pGL-3-ID-3-WT cells.Compared with the blank control group and the empty vector transfection group，the activity of miR-27b-3p mimic group，the number of colonies and the expression of PCNA decreased.Andthey could be reversed in co transfection group.Negative correlation was found between miR-27b-3p and ID-3，miR-27b-3p and PCNA in osteosarcoma.Positive correlation was found between ID-3 and PCNA in osteosarcoma.The expression of miR-27b-3p was correlated with survival time.Conclusion  MiR-27b-3p targeting ID-3 negatively regulates the proliferation on osteosarcoma cells.Lower expression of miR-27b-3p may be related to poor prognosis.
2021 Vol. 27 (6): 528-533 [Abstract] ( 172 ) HTML (1 KB)  PDF (2235 KB)  ( 258 )
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