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2021 Vol. 27, No. 7
Published: 2021-07-25
 
577 Comparison of Two Different Surgical Techniques in Treatment of Rotator Cuff Injury Combined with Long Head of the Biceps Tendon Lesions in Elderly Patients
Ren Ye，Qi Jun，You Hongbo，et al
Objective  To systematically evaluate the early effect of rotator cuff repair combined with tenotomy or tenodesis of long head of the biceps tendon in elderly patients.Methods  The clinical data of 82 patients over 70 years old who underwent shoulder cuff repair combined with biceps longhead tendon surgery under arthroscopy were analyzed retrospectively from June 2015 to December 2019.37 cases (37 shoulders) were included in the fixation group，including 15 males and 22 females.The patients were 71~87 years old，with an average age of (74.3±4.4)years；45 cases (45 shoulders) who underwent long head tendon resection were included in the amputation group，including18 males and 27 females.The patientswere 70~88 yearsold，with an average age of (76.1±5.2)years.The operation time，biceps related complications (popeye deformity，biceps spasm，upper arm pain，etc.)，recent complications of operation (infection，wound problems，fracture，neurovascular injury，death，etc.)，the American shoulder and elbow surgeons(ASES) score 12 months after operation，Disability of arm，shoulder and hand(DASH) and the MOS 36-item short-form health survey(SF-36) were compared.Results  All patients were followed up for 13~18 months.The operation time of the fixation group was (73.76±32.37) min，which was significantly longer than that of the amputation group (57.67±21.83) min (P＝0.021).The incidence of biceps related complications was 5.4% (2/37) and the recent complications of operation was 13.4%(5/37) in fixation group；the incidence of biceps related complications was 17.8%(8/45) and the recent complications of operation was 6.7%(3/45) in amputation group.Twelvemonths after operation，the ASES score and DASH score of fixation group and amputation group were (86.7±4.4)，(83.9±11.1) and (8.5±4.2)，(9.7±1.9) respectively，and there was no significant difference between the two groups (P＞0.05).The scores of physical function，physical function，physical pain and general health status in the fixed group were significantly higher than those in the amputated group (P＜0.05).There was no significant difference in vitality，social function，emotional function and mental health between the two groups.Conclusion  Elderly patients with rotator cuff suture fixation and direct cut off the long head of biceps brachii tendon can achieve excellent clinical efficacy after one year；compared with the cut-off operation，the probability of biceps related complications after fixation operation is lower，but the probability of early surgical complications is higher，the quality of life is higher，and the selfcare ability is stronger.
2021 Vol. 27 (7): 577-582 [Abstract] ( 270 ) HTML (1 KB)  PDF (1851 KB)  ( 383 )
583 Comparison of Clinical Outcomes of Double-row and Single-row Fixations in Arthroscopic Rotator Cuff Repair
Lin Yongsheng，Chen Hong，Li Yang，et al
Objective  To compare the clinical effects of double-row fixation and single-row fixation in the treatment of rotator cuff tears.Methods  From October 2016 to December 2018，76 patients diagnosed with rotator cuff tear were enrolled.36 patients were treated with double row fixation，while 40 patients were treated with single row fixation.There were 12 males and 24 females in the double row group.The mean age was (58.75±7.32)years.There were 23 males and 17 females in the SR group.The mean age was (57.57±7.29)years.The VAS (visual analogue scale)，the UCLA (University of California at Los Angeles) shoulder score，the rating scale of ASES (American shoulder and elbow surgeons) were compared between the two groups.Results  All the patients were followed up for 12 to 23 months(18±3).There were no significant differences in gender，age，tear type and time between the two groups(P＞0.05).The VAS scores of the double row groupwas significantly lowerthan the single row group at 3 months after surgery(P＜0.05).There were no significant differences among VAS scores before surgery，6 months and 12 months after surgery(P＞0.05).There were no significant differences in the UCLA shoulder score，and ASES score between the two groups before surgery and 3，6，and 12 months after surgery(P＞0.05).There were no significant differences in postoperative complication rate and satisfaction between the two groups(P＞0.05).Conclusion  Arthroscopic double row and single row fixation both can obtain good shoulder function.Compared with single row fixation，the double row fixation is more effective in the early period of postoperational pain relief of rotator cuff tear.
2021 Vol. 27 (7): 583-586 [Abstract] ( 266 ) HTML (1 KB)  PDF (728 KB)  ( 222 )
587 The Mid-term Effect of Multi-channel Arthroscopy in the Treatment of Diffusepigmented Villonodular Synovitis of the Knee
Chen Jian，Chen Ge，Li Zhong，et al
Objective  To evaluate and analyze the mid-term efficacy of multi-channel arthroscopic clearance in the treatment of diffuse pigmented villonodular synovitis of knee joint.Methods  From July 2013 to December 2015，31 patients with diffuse pigmentation villonodular synovitis of knee joint were treated，including 12 males and 19 females.The average age was (49.4±15.4) years old.There were17 case of the right knee and 14 case ofthe left knee.All patients had varying degrees of knee swelling，pain and limitation of movement before surgery，and all patients received multi-channel arthroscopic lesion clearance and histopathological examination for diagnosis.The assessment was conducted by comparing the visual analogue score of pain，Lysholm knee score，international knee documentation committee (IKDC) score，and knee range of motion (ROM)before surgery and at the last follow-up.Results  All the patients had stage I wound healing，the mean operation time was (79.0±26.1) min，the mean postoperative hospital stay was (5.5±2.3) days，no postoperative infection and complications.All the 31 patients were followed up for 61 to 90 months，the mean follow-up time was (74.0±8.9) months.All patients had no significant Knee swelling and pain at the last follow-up，and the range of motion of the Knee was significantly improved.The visual analogue scale (VAS) of pain decreased from (6.5±0.8) to (1.3±0.9) at the last follow-up，and the Lysholm knee score increased from (47.9±6.4) to (88.5±3.0).The IKDCscore was increased from (51.7±4.6) to (89.4±4.5)，and the ROMof knee joint was improved from (88.9±9.7) ° to (126.1±7.9) °，the differenceswere statistically significant (P＜0.001).In the last follow-up，4 of the 31 patients had postoperative recurrence，with a recurrence rate of 12.9%.Conclusion  Multi-channel arthroscopic clearance is a minimally invasive，safe and effective treatment for pigmented villonodular synovitis of the knee joint，which has the advantages of less trauma，quick postoperative recovery，fewer complications and low recurrence rate.
2021 Vol. 27 (7): 587-592 [Abstract] ( 177 ) HTML (1 KB)  PDF (1912 KB)  ( 244 )
593 The Effect of Suspension of Reflexed Semitendinosus Combined with Anterior Cruciate Ligament Reconstruction in Treatment of Medial Collateral Ligament and Anterior Cruciate Ligament Rupture
Wu Penghuan 1，Yuan Aidong 1，Hu Zhengbo 2，et al
Objective  To explore the early optimal surgical procedure for injuries of anterior cruciate ligament (ACL) and medial collateral ligament (MCL).Methods  In this perspective study，45 patients with ACL and MCL rupture admitted to our hospital from Janurary 2013 to Janurary 2018 were divided into two groups according to the order of admission.21 patients underwent ACL construction combined with suspension of transposable semitendinosus surgery in group A.24 patients underwent ACL reconstruction combined with suture anchor surgery in group B.In group A，there were 17 males and 4 females.The average age was (32.4±15.6)years，ranging from 20 to 55 years.In the B group，there were 18 males and 6 females.The average age was (31.6±16.3)years，ranging from 18 to 52 years.Patients were assessed in 3 months，6 months，12 months and 24months after surgery，and the knee medial joint space width，the Lysholm knee function score and the international knee documentation committee knee evaluation form (IKDC) score were recorded.Results  40 patients were analyzed at last，including 18 patients in group A，22 patients in group B.All the patients were followed up for 24 to 32 months，with an average of (27.6±4.3) months. Before operation，the knee medial joint space width，the Lysholm score and the IKDC score were (10.3±2.2) mm，(35.5±3.7)，(35.8±4.3) in group A and (10.8±1.4) mm，(34.4±2.7)，(39.5±6.4) in group B.After 24 months，the knee medial joint space width，the Lysholm score and the IKDC score of the group A were，(3.5±0.2) mm，(91.6±2.1)，(83.0±3.4)，and were (1.9±0.1) mm，(93.9±1.3)，(85.0±3.6) in group B.The levels of the medial joint space width，Lysholm scores，and IKDC scores were significantly improved compared with those before operation (P＜0.05)，however，and the width of postoperative medial space in group A was significantly greater than that in group B (P＜0.05)，however there was no statistically significant difference between the two groups in the remaining indicators of the same period.Conclusion  For patients with ACL and MCL rupture，the ACL reconstruction combined with suspension of transposable semitendinosus operation has less trauma，simple operation，good knee stability and functiong scroes.
2021 Vol. 27 (7): 593-597 [Abstract] ( 176 ) HTML (1 KB)  PDF (1907 KB)  ( 212 )
598 Risk Factors of SurgicalSite Infection in Pilon Fracture
Li Qinghu，Fu Baisheng，Zhao Chuang，et al
Objective  To analyze the risk factors of surgical site infection in Pilon fracture.Methods  From January 2005 to December 2019，621 patients with Pilon fracture were treated with open reduction and internal fixation.According to the surgical site infection，the patients were divided into two groups：infection group (n＝39)，including male (n＝26) and female (n＝13)，with an average age of (43.4±13.5)years(range from 20 to 72 years)，and non-infection group (n＝582)，including 303 males and 279 females，with an average age of (42.1±12.0)years(range from 19 to 71 years).Age，sex，smoking，BMI，diabetes，alcohol consumption，hypertension，soft tissue injury，operation time，blood transfusion，and drainage time were included in the possible risk factors.The statistical method was univariate analysis first，and then multivariate Logistic regression analysis was used to analyze the significant risk factors.Results  The rate of surgical site infection of Pilon fracture was 6.28%.Univariate analysis showed that there were significant differences in diabetes，operation time and soft tissue injury between infection group and non-infection group，while multivariate Logistic regression analysis found that only operation time was significantly correlated with operation site infection (P＜0.01).Conclusion  Operation time is an independent predictor of surgical site infection after open reduction and internal fixation of Pilon fracture.Although severe soft tissue injury can increase the infection rate of surgical site，it is not an independent predictor of surgical site infection after open reduction and plate internal fixation of Pilon fracture.
2021 Vol. 27 (7): 598-606 [Abstract] ( 128 ) HTML (1 KB)  PDF (456 KB)  ( 207 )
601 The Epidemiology of Hip Fractures of the Elderly in China
Li Xingguo 1，Deng Yelong 2，Liu Zhaohui 1，et al

Objective  To explore the epidemiological characteristics and research status of elderly hip fractures in Chinaand provide some basis for the prevention and treatment of elderly hip fracturebyliterature analysis.Methods  The literaturerelated to epidemiologyof elderly hip fractures published in PubMed，Web of Science，Cochrane，Chinese Biomedical Literature(CBM)，Embase，CNKI，VIP，and Wanfang Database weresearched.The literaturewere searched and screened by two researchers independently.Quality assessment of caseseries studieswereusedto assess the risk of bias for the selected literature.And data was extracted using GraphPad Prism 8 software and analyzed using SPSS 21.0 statistical software.Results   A total of 245 literature were searched，17 of which met the inclusion criteria.A total of 75 407 patients were included.There were 24 552 males(32.6%) and 50 855 females(67.4%).10 014 patients were divided into 4 groups by ages in 7 studies.There were a total of 2 296 cases (22.9%) in the group aged 60 to 69，including 925 males and 1 371 females.There were 3 855 cases(38.5%) in the group aged 70 to 79，including 1 367 males and 2 488 females.There were 3 187 cases (31.8%) in the group aged 80 to 89，including 1 098 males and 2 089 females.There were 676 cases (6.8%) in the group aged 90 and older，including 209 males and 467 females.There were more female patients than male patients in all age groups，and the differencewere statistically significant (χ2=29.70，P<0.001).Fracture types were mentioned in 11 studies，including 13 791 patients，6 941 cases(49.7%) of intertrochanteric fractures and 6 850 cases(50.3%) of femoral neck fractures，of which 6 studies divide 8 172 patients into 4 groups by ages: There were 2 048 cases in the group aged 60 to 69，including 1 286 cases of femoral neck fracture and 762 cases of intertrochanteric fracture.There were 2 787 cases in the group aged 70 to 79，including 1 367 cases of femoral neck fracture and 1 306 cases of intertrochanteric fracture.There were 2 779 cases in the group aged 80 to 89，including 1 255 cases of femoral neck fracture and 1 524 cases of intertrochanteric fracture.There were 588 cases in the group aged 90 and older，there were 210 cases of femoral neck fracture and 348 cases of intertrochanteric fracture.There wa no significant difference in terms of fracture type constituent ratio among different age groups (χ2=195.0，P＞0.05).A total of 5 657 patients were included，of which there were 5 047 cases (89.2%) caused by falls.The relationship between the incidence and season is mentioned in 3 studies，reaching 3 422 cases，845 cases (24.7%) in spring，784 cases(22.9%) in summer，795 cases(23.2%) in autumn，and 998 cases(29.2%) in winter.Compared with other seasons，there were more cases in winter，and the difference was statistically significant (χ2 =17.35，P<0.001).Conclusion  The comprehensive analysis of the literature shows that the number of elderly hip fracture patients in China is more than that of men in the past ten years，and the male to female ratio is about 1:2.The proportion of patients aged 70 to 79 is higher than that of other groups，and the proportion of patients aged 90 and above is lower than that of other groups.The ration of patients with intertrochanteric fracture and femoral neck fracture is about 1︰1.Among epidemic factors，falls account for 89.2%；The number of patients in winter is higher than that in other seasons.There is long hospital stay and high hospitalization costs.
2021 Vol. 27 (7): 601-606 [Abstract] ( 264 ) HTML (1 KB)  PDF (1029 KB)  ( 389 )
607 Changes of Plasma IGF-1，NPY and BAP in Diabetic Patients with Fracture During Perioperative Period
Li Qi，Li Lin，Meng Shanshan，et al
Objective  To study the changes of perioperative plasma levels of insulin-like growth factor-1 (IGF-1)，neuropeptide Y (NPY) and bone alkaline phosphatase (BAP) in diabetic patients with fracture，and to explore their effects on fracture healing in diabetic patients.Methods  Seventy patients with lower limb fracture surgery under selective subarachnoid anesthesia from September 2018 to March 2019 were selected.According to whether there was type 2 diabetes，they were divided into the diabetes group and the control group，with thirty-five patients in each group.Diabetes mellitus group included 16 males and 19 females. The mean age was (59.80±8.33) years old.The control group had 18 males and 17 females.The mean age was (54.37±13.07) years old.Two milliliter of elbow-vein blood was extracted pre-operation and 24 hours after surgery，respectively.Plasma was separated and the contents of IGF-1，NPY and BAP in plasma were determined by enzyme linked immunosorbent assay (ELISA).Results  The plasma levels of IGF-1，NPY and BAP were significantly higher at 24 hours after surgery than before surgery in the diabetic group and the control group (P＜0.05).The plasma level of IGF-1 in diabetic group was lower than that in control group before and after surgery (P＜0.05).Before surgery，the plasma NPY and BAP levels were significantly higher than that of control group (P＜0.05).After surgery，the increase of NPY in plasma was significantly lower in the diabetic group than that in the control group (P＜0.05).Conclusion  IGF-1，NPY and BAP are all involved in the regulation of bone healing repair process.The decrease of IGF-1，the smaller degree of NPY increase and the continuous increase of BAP may be related to delayed bone healing during early stage after fracture surgery in diabetic patients.
2021 Vol. 27 (7): 607-637 [Abstract] ( 182 ) HTML (1 KB)  PDF (498 KB)  ( 155 )
610 Application Value of Anti-Xa Factor Activity Monitoring and ATⅢActivity Detection in Prevention of Thrombosis and Hemorrhage after TKA
Abuduhelili Aini，Ju Xiaochen，Sun Rongxin *
Objective  To study the value of anti-Xa factor activity monitoring combined with ATⅢ activity detection in preventing bleeding and venous thrombosis after total knee arthroplasty(TKA) by aprospective study.Methods  74 patients with osteoarthritis who underwent unilateral TKA surgery in our hospitalwere selected and randomly divided into the experimental group and the control group.The experimental group was given subcutaneous injection of low molecular weight heparin (LMWH) 4 250 IU 12 hours after operation.The coagulation index and the activity of anti-Xa factor were detected 4 hours later，and the dose of LMWH was adapted according to the activity of anti-Xa factor.The activity of anti-Xa factor was maintained between 0.3~0.7 IU/mL.The control group was given subcutaneous injection of LMWH 4 250 IU 12 hours after operation.The coagulation index was detected 4 hours later，and the routine subcutaneous injection of LMWH 4 250 IU once/day anticoagulation therapy was given on the second day after operation.In the two groups，APTT，D-two dimers (D-Di)，Hb，lower limb color Doppler ultrasound the subcutaneous hemorrhagewere routinely recorded and analyzed in 1 d，6 d and 11 d after operation.Results  On the 1st day after operation，there was no statistically difference in APTT，D-Di，Hb，thrombus incidence and subcutaneous hemorrhage area (percentage of body surface area) between the two groups (P＞0.05).On the 6th day after operation，there was no statistically difference in APTT between the two groups (P＞0.05).But，D-Di，Hb change afteroperation，thrombosis incidence，and the area of subcutaneous hemorrhage of the experimental group was lower then control group (P＜0.05).On the 11th day after operation，there was no statistically difference in APTT between the groups (P＞0.05).D-Di，Hb and preoperative difference，thrombosis incidence，and the area of subcutaneoushemorrhage of the experimental group was lower then control group(P＜0.05).Conclusion  Using LMWH anticoagulant therapy after TKA，detecting the activity of AT Ⅲ before operationand adjusting the dosage of LMWH according to the activity of anti-Xa factorduring the anticoagulation can effectively reduce the incidence of postoperative lower extremity venous thrombosis and the risk of bleeding.Thistreatment should be promoted in clinical practice.
2021 Vol. 27 (7): 610-614 [Abstract] ( 196 ) HTML (1 KB)  PDF (472 KB)  ( 183 )
615 Effect of miR-96 on Proliferation and Invasion of Osteosarcoma MG63 Cell Line by Interfering with NKD2 Expression
Zhang Jianye，Zhang Weihua
Objective  To investigate the effect of miR-96 on proliferation and invasion of osteosarcoma MG63 cell line by interfering with naked cuticle homolog 2 (NKD2) expression.Methods  The clinical data of 57 osteosarcoma specimens collected in our hospital from September 2013 to February 2018 were retrospectively analyzed as the study group，and the adjacent tissues 5cm away from the tumor boundary were collected as the control group，including 39 males and 18 females.The age ranged from 21 to 49，with an average age of (28.16±6.73).Osteosarcoma MG63 cells were divided into miR-96 inhibition group and blank control group.After 48 hours of culture，the expression levels of miR-96 and nkd2 in MG63 cells were detected by RT-qPCR and Western blot.MTT method was used to detect the cell proliferation.Cell apoptosis and cell cycle distribution were detected by flow cytometry.Results  The expression level of miR-96 in osteos arcoma tissue was significantly higher than that in normal bone tissue (P＜0.05).The expression level of NKD2 protein in osteosarcoma tissue was significantly lower than that in normal bone tissue (P＜0.05).The expression level of miR-96 in osteosarcoma cells in the miR-96 inhibition group was significantly lower than that in the blank control group (P＜0.05).The expression level of NKD2 in osteosarcoma cells in miR-96 inhibition group was significantly higher than that in the blank control group (P＜0.05).The relative absorbance of osteosarcoma MG63 cell lines in the miR-96 inhibition group was significantly lower than that in the blank control group (P＜0.05).The apoptosis rate of osteosarcoma MG63 cell line inmiR-96 inhibition group was significantly higher than that in the blank control group (P＜0.05).The cell cycle of osteosarcoma MG63 cell line was significantly different between the miR-96 inhibition group and the blank control group (P＜0.05).Conclusion  miR-96 is highly expressed in osteosarcoma，and NKD2 is down-regulated in osteosarcoma.miR-96 promotes the growth and invasion of osteosarcoma MG63 cell line by inhibiting NKD2 expression，thus inhibits early apoptosis of osteosarcoma MG63 cell line.
2021 Vol. 27 (7): 615-631 [Abstract] ( 176 ) HTML (1 KB)  PDF (610 KB)  ( 166 )
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