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2021 Vol. 27, No. 9
Published: 2021-09-25
 
769 The Application of Enhanced Recovery After Surgery Gastrointestinal Management Scheme in Patients with Posterior Lumbar Interbody Fusion Surgery
Qi Qiong 1，2，Zeng Liyun 3*，Pan Yingyan 1
Objective  To compare the different effects of the enhanced recovery after surgery(ERAS) preoperative gastrointestinal preparation measures and traditional gastrointestinal preparation measures in posterior lumbar interbody fusion(PLIF) surgery for lumbar disc herniation(LDH) patients.Methods  To tally 80 LDH patients before PLIF surgery were randomized into a control group and an intervention group，with 40 patients in each group，among them.There were 21 males and 19 females in the control group.The average age of patients was(53.73±14.07)years old.There were 23 males and 17 females in the control group，and the average age of patients was(57.98±11.61)years old.Control group received traditional gastrointestinal management measures，while the intervention group received ERAS gastrointestinal management measures.The incidence of aspiration and defecation during the surgery，postoperative hunger and thirsty，postoperative gastrointestinal recovery and length of stay between the two groups were compared.Results  No aspiration or defecation occurred in the two groups.The hunger，thirsty，gastrointestinal symptom score of the intervention group were lower than those of the control group(P＜0.05)，and The first time of exhaust after operation was earlier than that of the control group(P＜0.05).There was no statistically significant difference between the two groups in the time of first postoperative defecation，abdominal distention，constipation，time of defecation reconstruction，patient assessment of constipation symptom，postoperative length of hospital stay(P＞0.05).Conclusion  The application of ERAS gastrointestinal management plan to patients undergoing PLIF surgery can improve the perioperative subjective experience of patients，promote the recovery of early postoperative intestinal peristalsis，and do not increase the risk of abdominal distention，constipation，and prolonged postoperative hospital stay.It can be applied gradually.
2021 Vol. 27 (9): 769-773 [Abstract] ( 178 ) HTML (1 KB)  PDF (532 KB)  ( 289 )
774 Predictive Value of D-Dimer Combined with Other Indicators in Lower Extremity Deep Venous Thrombosis After Spinal Degenerative Surgery
Aoran·Maheshati，Hali·Habulihan，Yang Yi，et al
Objective  To explore the predictive value of D-dimer(D-D) combined with other blood indicators in the formation of deep venous thrombosis(DVT) after spinal degenerative surgery.Methods  The clinical data of 583 patients with spinal degenerative surgery received from October 2017 to December 2020 were collected continuously.The patients were divided into two groups according to whether DVT occurred after surgery.There were 60 cases in DVT group，including 28 males and 32 females，with an average age of(65±10)years.There were 523 cases in non-DVT group，including 269 males and 254 females，with an average of(63±12)years.The general clinical data of the two groups were recorded.The levels of five items of coagulation，D-D，fibrin/fibrinogen degradation products(FDP)，C-reactive protein(CRP)，procalcitonin(PCT) and interleukin-6(IL-6) were detected 3 days after surgery.The indicators with statistical differences between the two groups were fitted by logistic regression.The diagnostic efficacy was analyzed by receiver operating characteristic(ROC) curve，and area under curve(AUC) was calculated to estimate the predictive diagnostic value of DVT after spinal degenerative surgery.Results  (1)The levels of D-D，FDP and CRP in DVT group were significantly higher than those in non DVT group 3 days after operation(P＜0.05).(2)ROC curve analysis showed that the AUC of D-D，FDP and CRP in predicting the diagnosis of DVT were 0.881(95%CI：0.829~0.933)，0.864(95%CI：0.809~0.919) and 0.815(95%CI：0.759~0.870)，respectively.The AUC of D-D，FDP and CRP in predicting the diagnosis of DVT was 0.912(95%CI：0.861~0.963)，the sensitivity was 76.67%，and the specificity was 90.00%，which were higher than that of the three alone.Conclusion  The combined detection of D-D，FDP and CRP can improve the early diagnosis efficiency of the three independent detection for DVT，and has certain judgment value for the prediction diagnosis of DVT formation after spinal degeneration surgery.
2021 Vol. 27 (9): 774-778 [Abstract] ( 174 ) HTML (1 KB)  PDF (581 KB)  ( 198 )
779 Study on the Efficacy of 3D Printing Assisted Acetabular Rotation Center Reconstruction in Revision Patients with Severe Bone Defects
Xu Kangyong，Tong Ye，Tang Ruixin，et al
Objective  To study the early clinical outcomes of individualized 3D-printed titanium alloy socket cups in reconstruction of acetabular rotation center in patients with severe bone defects.Methods  Ten patients admitted to our hospital from January 2017 to December 2018 accepted individualized 3D-printed titanium alloy cups to reconstruct the acetabular rotation centre of severe bone defects.4 males and 6 females were included.The patients aged 36 to 67 years，with an average of(54.71±10.23).According to Paprosky acetabular defects classification，there were 3 cases of ⅡB，7 cases of ⅢA.The intraoperative bleeding and operating time，the position of the hip joint center(HJC) on pelvic radiographs before and after surgery and the Harris functional score of the hip joint and postoperative complications were collected to evaluate the early clinical results of this technique.Results  The operative time of the 10 patients ranged from 1.51 to 3.12 h，with a mean of (1.81±0.82)h.The intraoperative bleeding volume ranged from 650 to 1750 mL，with a mean of (983.43±459.22)mL.The follow-up period ranged from 13 to 26 months，with a mean of(18.35±4.51)months.The patient's postoperative acetabular centre of rotation improved significantly.Hip Harris function scores were 26 to 45 points before surgery，with an average of (34.02±14.91)points.And hip Harris function scores were 78 to 97 points at the last follow-up，with an average of (84.31±9.71)points.The difference was statistically significant (P＜0.01).10 patients had no complications such as prosthetic joint dislocation，prosthetic joint infection or periprosthetic fracture during the follow-up period.No radiolucent lines between the individual 3D printed socket cup and its host bone and no loosening of the prosthesis were observed on any of the pelvic radiographs during the postoperative follow-up period.At the 6-month postoperative follow-up，radiographs showed that the bone tissue around the 3D-printed cup was tightly integrated and reliably fixed，with good bone ingrowth.Conclusion  The use of individualized 3D-printed titanium cups was able to reconstruct the centre of rotation of the acetabulum with severe bone defects，and there was significant improvement in limb length and hip function after surgery.
2021 Vol. 27 (9): 779-789 [Abstract] ( 178 ) HTML (1 KB)  PDF (3120 KB)  ( 204 )
784 Efficacy of Arthroscopic Treatment of Knee Disease and the Risk Factors of Postoperative Acute Pain
Feng Chongyang，Ji Zhenwei，Wu Peng，et al
Objective  To investigate the clinical efficacy of arthroscopy in treating knee diseases and the risk factors leading to moderate and severe postoperative pain. Methods  A total of 224 patients who underwent elective knee arthroscopic surgery in our department from September 2019 to January 2021，were selected to participate in the study.There were 119 males and 105 females，with an age distribution between 16 and 77 years，with a mean age (43.24±14.01)years.In this study，the numerical rating scale(NRS) of the above patients at 72h postoperatively were evaluated，and the patients with NRS≥4 were included in the postoperative pain group，and patients with NRS<4 were in the postoperative painless group.Factors that might influence postoperative pain were compared between the two groups.The data were then screened by multivariate Logistic regression analysis to effectively analyze the independent risk factors for postoperative pain.The Lysholm knee function score was used to determine the postoperative efficacy at three months after the operation，the occurrence of postoperative complications was recorded，and the differences in Lysholm score between the pain group and the painless group were analyzed.Results  All 224 patients were followed up for 3 months postoperatively.88 patients(39.28%) were in the pain group in the acute postoperative phase(72 h postoperative time point) and 136 patients were in the pain free group after surgery.Overall，the Lysholm scale (82.84±5.72) scores of the patients at the 3 month postoperative point were significantly improved from the preoperative (43.82±11.24)scores(P＜0.05).The Lysholm scale (84.58±5.44)score at 3 months was higher in the no pain group than in the pain group (80.16±5.10) at the acute postoperative stage，and the difference was statistically significant(P＜0.05).For the results of univariate analysis of the risk factors associated with pain in the acute postoperative period，age，body mass index(BMI)，anxiety status，depression status，sleep quality，surgical procedures，and articular cartilage damage grade showed statistically significant differences(P＜0.05).Multivariate results analysis showed that advanced age，anxiety score≥9，depression score≥9，sleep quality score≥5，cruciate ligament reconstruction or intercondylar spine avulsion fracture reduction surgical approach，Outerbridge grade Ⅲ~Ⅳ，were independent risk factors for pain during the acute phase after knee arthroscopy.Conclusion  Arthroscopic treatment of knee diseases is clinically effective，whereas pain in the acute postoperative period compromises early recovery of knee function.Advanced age，BMI≥24 kg/m2，comorbid anxiety，depression，sleep disturbance，severe articular cartilage damage，cruciate ligament reconstruction or reduction of an avulsed intercondylar spine fracture are risk factors for pain in the acute phase after knee arthroscopy.
2021 Vol. 27 (9): 784-789 [Abstract] ( 190 ) HTML (1 KB)  PDF (503 KB)  ( 235 )
790 Clinical Study on the Treatment of the Tibial Posterior Cruciate Ligament Avulsion Fracture Under Arthroscopic Through Three Posterior Medial Approaches
Zhou Huaqiao，Ren Xiang，Xu Jun，et al
Objective  To investigate the effect of arthroscopic tibial posterior cruciate ligament avulsion fracture fixation with loop plate through three posterior medial approaches.Methods  From January 2018 to January 2020，23 patients with PCL tibial avulsion fracture were selected，including 16 males and 7 females.The age ranged from 16 to 46 years，with an average of(32.0±0.2)years.The posterior stinum was opened through the posterior internal three approaches under arthroscopy.The fracture block was exposed，cleaned and reduced.The fracture block was fixed by loop plate through Kirschner pinhole.The subjective knee joint function was evaluated by the international knee documentation committee(IKDC) and Lysholm score，and the knee joint stability was objectively evaluated by posterior drawer test(PDT) and KT-2000.Results  18 cases were followed up at the first，third，sixth，and 12th months after surgeries.All patients were able to freely flex up to more than 120° in the 3 months after the operation，and the fractures healed within 3 months.According to the IKDC functional scoring standard，14 cases were excellent，4 cases were good，and the excellent and good rate was 100%.Lysholm scores were 85 to 100 points，with an average of(95.2±0.56)points.14 cases were negative in PDT test，and 4 cases were grade 1.12 months after operation，the affected knee was(3.43±0.91)mm，and the healthy knee was(2.58±0.72)mm in KT-2000.There was no significant difference in the posterior tibia laxity between the affected knee and the healthy knee(P＞0.05).Conclusion  Arthroscopic treatment of PCL tibial anchor avulsion fractures with loop plate single tunnel fixation through the posterior internal three-way approach is a reliable operation method of less trauma，convenient operationand low risk.
2021 Vol. 27 (9): 790-793 [Abstract] ( 199 ) HTML (1 KB)  PDF (1706 KB)  ( 226 )
794 Efficacy Evaluation of Different Perioperative Tranexamic Acid Regimens in High Tibial Osteotomy
Zhou Dawei，Wang Zhimeng，Lu Yao，et al
Objective  To investigate the efficacy of different perioperative tranexamic acid regimens in high tibial osteotomy.Methods  54 patients with knee osteoarthritis who were admitted to honghui hospital affiliated to Xi'an jiaotong university from February 2016 to April 2020 were prospective analyzed，including 13 males and 41 females cases.The patients aged 44 to 65 years，with an average of (56.9±4.4).According to the random number table method，they were divided into three groups，with 18 cases in each group.Group A had intravenous infusion of 1 g TXA 30 min before operation，and deep immersion of 1g TXA for 5 minutes before closing the incision.Group B had intravenous infusion of 1g TXA 30 min before operation and before closing the incision.Group C had intravenous infusion of 1 g TXA before closing the incision，3 hours and 6 hours after operation.1 g TXA was added intravenously again.The total blood loss，hidden blood loss，48-hour drainage，blood transfusion rate，fibrinolysis level，thromboembolic events，incision complications，adverse reactions，VAS score，knee HSS score and quality of life SF-12 score.Results  The total blood loss was(493.56±74.27)mL in group A，(447.44±60.64)mL in group B and(411.36±73.14)mL in group C.The hidden blood loss of group A was(277.35±47.31)mL，(236.19±35.57)mL in group B and(197.47±50.17)mL in group C.The drainage volume was(146.35±37.66)mL in group A after 48 hours，(121.57±35.28)mL in group B and(84.12±26.93)mL in group C.The mean hemoglobin value on the first day after surgery was(112.65±12.23)g/L in group A，(117.51±11.12)g/L in group B，and(123.46±10.84)g/L in group C.The average value of hemoglobin at 3 days was(113.17±10.14)g/L in group A，(117.89±9.34)g/L in group B，and(124.45±10.42)g/L in group C.VAS pain score on the 1st and 3rd day after operation of group B and group C were both lower than group A；the SF-12 quality of life survey at 6 and 12 weeks after surgery showed that the body health score(PCS) of group C was significantly different from that of group A.Comparison of the above index groups，the differences were statistically significant(P＞0.05).There was no significant difference in the incidence of postoperative thromboembolic events，TXA adverse events，wound complications and knee HSS scores among the three groups (P＞0.05).Conclusion  The three tranexamic acid administration regimens in this study are safe and reliable.Among them，plan C can further reduce perioperative blood loss compared with plan A and plan B，and has the advantages of reducing pain and improving the patient's quality of life and knee joint function.
2021 Vol. 27 (9): 794-800 [Abstract] ( 183 ) HTML (1 KB)  PDF (1151 KB)  ( 206 )
801 The Anatomical Parameters Measurements and Clinical Significance of the Ulna Olecranon
Xiong xu，Zhao lan，Xu min，et al
Objective  To provide a theoretical reference for tension band fixation of olecranon fractures by measuring the anatomical parameters of the ulna olecranon. Methods  From September 2020 to December 2020，anteroposterior and lateral radiographs of the elbow were obtained for anatomic measurement in the retrospective study，including 30 males and 30 females.The mean age of males was (37.63±13.75)years，and that of females was (39.70±14.60)years.The following parameters were measured：the proximal ulna varus angle，the ulna olecranon width，and the angle between the tangent line of the olecranon fossa and ulna axis.Results  The mean value for the proximal ulna varus angle was (10.71±2.77)°in males and (9.97±2.89)°in females，and no significant difference was observed between the two groups (P＝0.70).The widths of the ulna olecranon in men(1.90±0.96)mm were significantly larger than those of females (1.61±0.12)mm (P＝0.00).The angle between the tangent line of the olecranon fossa and the ulna axis was (25.42±2.31)° in males and (23.12±2.64)° in females，and no significant difference was seen between the two genders (P＝0.10).Conclusion  Anatomical parameters of the olecranon were measured to provide a reference for the direction，angle and width of the K-wire during tension band operations for olecranon fractures，which will improve the accuracy of such procedures.
2021 Vol. 27 (9): 801-810 [Abstract] ( 403 ) HTML (1 KB)  PDF (896 KB)  ( 181 )
804 LINC00052 Plays a Protective Role Against the Injury of TNF-α Induced Human Articular Chondrocytes by Targeting miR-145
Abuduaini·Rewuti，Zhou Wenzheng，Che Lixin，et al

Objective  To identify the role of long non-coding RNA LINC00052 in the injury of tumor necrosis factor alpha(TNF-α)-induced human articular chondrocyte，and to elucidate its regulatory mechanism on miR-145.Methods  The injury model of human C-20/A4 articular chondrocyte was induced and constructed by using 0，10 and 30 ng/mL of TNF-α.Real-time quantitative polymerase chain reaction(RT-qPCR) was used to detect the expression levels of LINC00052 and miR-145 and their expression correlation.The specific short hairpin RNA was used to interfere with the expression of LINC00052 in C-20/A4 cells，and cell proliferation ability was detected by 3-(4，5-Dimethylthiazol-2-yl)-2，5-diphenyltetrazolium bromide(MTT).The protein expression levels of caspase-3(CASP3)，cleaved CASP3，and Bcl-2 related X(BAX) were detected by Western blotting.The concentrations of inflammatory factors including interleukin(IL)-1β，-6 and13 were detected by enzyme linked immunosorbent assay(ELISA).The direct regulation effect of LINC00052 on miR-145 was analyzed by dual luciferase reporter gene experiment.Rescue experiment was used to verify the role of LINC00052 by targeting miR-145 in the injury of TNF-α-induced C-20/A4 cells.Statistical analysis was compared by the  t and analysis of variance.Results  The expression level of LINC00052 in 0，10 and 30 ng/ mL of TNF-α-induced C-20/A4 cells showed an upward trend，while miR-145 showed a downward trend，and their expression was negatively correlated(P＜0.05).Interfering with LINC00052 reduced the proliferation of TNF-α-induced C-20/A4 cells，increased the protein expression levels of CASP3，cleared CASP3 and BAX，and elevated the concentrations of IL-1β，IL-6 and IL-13(P＜0.05).miR-145 is a direct target gene of LINC00052，and interfering with LINC00052 upregulated the expression level of miR-145 in C-20/A4 cells(P＜0.05).Interfering with miR-145 partially reversed the effect of LINC00052 suppression on the proliferation，apoptosis and inflammation in TNF-α-induced C-20/A4 cells(P＜0.05).Conclusion  LINC00052 plays a protective role against the injury ofTNF-α-induced human articular chondrocytes by targeting miR-145，and its mechanism may be related to the promotion of proliferation and the inhibition of apoptosis and inflammation.
2021 Vol. 27 (9): 804-810 [Abstract] ( 178 ) HTML (1 KB)  PDF (1078 KB)  ( 165 )
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