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2022 Vol. 28, No. 1
Published: 2022-01-25
 
1 Data Analysis of 2 574 Cases with Lower Extremity Short Deformity Treated with Limb Lengthening Technique
Pan Qi 1，Zhang Yonghong 2*，Qin Sihe 3*，Guo Baofeng 4，Zheng Xuejian 3，Zang Jiancheng 3，Wang Yilan 3，Li Shuliang 1
Objective  To summarize the data of the patients accepted limb lengthening surgeries in past 35 years and to discuss the distribution and changes of the patients accepted limb lengthening treatment.Methods  We retrospectively reviewed 2 574 patients who accepted limb lengthening surgeries in Qin Sihe's orthopedic team between January 1983 and December 2017 The data of gender，age，gait，surgical area and pathogenesis were analyzed.Results  2 574 patients were included in this group.Gender distribution was 1 556 males(60.45%) and 1 018 females(39.55%).The age ranged from 3 years to 58 years with an average of (21.91±10.18) years.9 walking situations were recorded pre-operation，including mild claudication 1 402 cases(54.47%)and severe claudication 528 cases(20.51%).The lengthening sites including ilium，femur，tibia and fibula，calcaneum，metatarsus and tarsus.Over 54 etiologies including sequalae of poliomyelitis，trauma and et al.Conclusion  Distribution of the patients revealed that，more male patients accepte limb lengthening compared with females.Patients in different life phase have different demands of treatment，more patients wish to improve their limb function compared with change the appearance and the surgical area varies over time.The data of the patients provide precious experiences for understanding the situation of the patients with limb discrepancy and the development of limb lengthening technique.
2022 Vol. 28 (1): 1-7 [Abstract] ( 239 ) HTML (1 KB)  PDF (4145 KB)  ( 268 )
8 Comparison of the Curative Effect of Different Conservative Treatment Methods on Adolescent Idiopathic Scoliosis
Zhang Yajie 1，Wang Liancheng 2*，Dong Jiaxing 1，Wang Shuai 1
Objective  To study the effects of brace therapy，specific exercise therapy，and a combination of the two on the curve，quality of life and trunk muscle strength of adolescent patients with idiopathic scoliosis.Methods  60 adolescent idiopathic scoliosis patients underwent bracing，exercise and combined treatment of the bracing and exercise in Tianjin Hospital from September 2018 to February 2021 with 20 patients in each group.Among them，there were 4 males and 16 females in the brace group，and the ages ranged from 10 to 15 years with an average age of (13.46±1.46)years.There were 7 males and 13 females in the exercise group，and the ages ranged from 10.00 to 14.50 years with an average age of (12.83±1.77)years.In the combined group，there were 6 males and 14 females，and the age ranged from 10 to 15 years with an average age of (13.02±1.56)years.The three groups were treated in accordance with the established individualized plan.The general data and imaging data before treatment and at the last follow-up were recorded，as well as the SRS-22 questionnaire (scoliosis research society-22) and the surface electromyography(EMG) signals on both sides of the paraspinal muscles.Results  Compared with before treatment，the three groups of treatments can prevent the progression of scoliosis Cobb angle and ATR (angle of trunk rotation，ATR).The Cobb angle，ATR in the combined group and ATR of the exercise group had statistically significant differences compared those before treatment (P＜0.05).In terms of quality of life，the improvement of pain，mental health and treatment satisfaction in the exercise group and the combined group was better than that of the brace group (P＜0.05).The surface EMG results showed the convex side was higher than the concave side near the apical vertebra in the brace group and exercise group，(P＜0.05).The root mean square(RMS) between the brace group and the combination group was statistically different (P＜0.05).Conclusion  The combination of brace and specific exercise therapy can more effectively improve the Cobb angle and ATR of patients，and improve the quality of life and paraspinal muscle strength.
2022 Vol. 28 (1): 8-19 [Abstract] ( 234 ) HTML (1 KB)  PDF (933 KB)  ( 292 )
12 Treatment of Thoracolumbar Vertebral Compression Fracture with Modified Paripedicular Unilateral Percutaneous Vertebroplasty
Zhang Tao，Yuan Zhongshan，Xia Liangzheng，Deng Yinghu *，Yu Tao，Zhou Minghao
Objective  To prospectively analyze the efficacy and safety of lateral bone cement cannulation combined with modified parapedicular unilateral percutaneous vertebroplasty for thoracolumbar vertebral compression fractures.Methods  Data of 40 cases of osteoporotic vertebral compression fracture (OVCF) in thoracic and lumbar segment (T10~L2) meeting the inclusion criteria of this study were collected from January 2019 to December 2020，and the patients including 3 males and 37 females.The age ranged from 61 to 86 years，with an average of (71.1±7.06) years.The distribution of fractured vertebrae was as follows：1 trivertebrae，3 bivertebrae，and 36 single vertebrae，including 4 T10 vertebrae，4 T11 vertebrae，19 T12 vertebrae，15 L1 vertebrae，and 3 L2 vertebrae.The visual analogue scale (VAS) of pain at each time point was recorded before surgery，1d after surgery and at the last postoperative followup，and statistical analysis was performed to compare the differences between the preoperative and postoperative time points.Results  All the operations were performed successfully，and the operation time was 20~65 min，with an average of (31.25±9.31) min.All patients were followed up for 10~24 months，with an average of (17.70±4.10) months.No surgical complications occurred in any of the patients.Low back pain VAS score was (6.42±0.58) points before surgery，(2.40±0.49) points 1 d after surgery，and (1.62±0.48) points at the last follow-up.VAS scores at all postoperative time points were significantly improved compared with those before surgery，and the difference was statistically significant (P＜0.05).Conclusion  The treatment of thoracolumbar vertebral compression fracture with lateral bone cement cannulation combined with modified parapedicular unilateral percutaneous vertebroplasty is a safe，effective and minimally invasive surgical method for thoracolumbar vertebral compression fracture in the elderly.
2022 Vol. 28 (1): 12-40 [Abstract] ( 199 ) HTML (1 KB)  PDF (2265 KB)  ( 277 )
16 The Mid term Effect of Autogenous Femoral Head Transplantation and Reconstruction of Acetabulum in the Treatment of Hip Dysplasia
Luy Xin 1，Su Rina 2，Zhang Zhifeng 3，Sun Zhiwen 1*
Objective  To summarize the mid-term efficacy of autogenous femoral head transplantation to reconstruct the acetabulum in the treatment of hip dysplasia. Methods  Data of 21 patients with hip dysplasia treated with autogenous femoral head transplantation to reconstruct the acetabulum and total hip arthroplasty in the Department of Joint Surgery of Chifeng Hospital from July 2012 to July 2016 was retrospectively analyzed.Among them，there were 6 males and 15 females，aged from 32 to 66 years old，with an average age of (50.67±8.62)years.The Harris scores were collected before surgery and at the last follow-up.The imaging evaluation included preoperative Xrays of the hip joints and X-rays of the hips at the last follow-up to assess the position of the artificial joint and the healing of the femoral head bone graft.Results  All 21 patients in this group were followed up.The follow-up time ranged from 52 to 96 months，with an average of (75.05±12.14)months.The preoperative Harris score was 21~42 points，with an average of (31.33±5.77)points，and at the last follow-up，it was 83~94 points with an average of (88.81±2.98)points.Two of the patients showed bone resorption at the femoral head bone graft on hip X-rays at 6 months and 8 months after surgery，but the position of the acetabular prosthesis and bone ingrowth were good.Conclusion  The use of autogenous femoral head transplantation to reconstruct the acetabulum and total hip replacement in the treatment of hip dysplasia has a satisfactory midterm effect，and there are no related complications such as prosthesis loosening.
2022 Vol. 28 (1): 16-19 [Abstract] ( 189 ) HTML (1 KB)  PDF (1687 KB)  ( 234 )
20 Risk Factors and Prognosis of Postoperative Delirium in Patients Over 90 with Hip Fracture
Zhao Shengjie 1，Zheng Huayong 2，Wang Xiaowei 2*，Sun Tiansheng 2，Zhang Jianzheng 2，Liu zhi 2
Objective  To investigate the incidence of postoperative delirium in hip fracture patients over 90，the risk factors of delirium，and study the influence of delirium on perioperative complications，mortality and walking ability.Methods  A retrospective observation study was conducted to analyze the data of hip fracture patients over 90 in the seventh medical center of the General Hospital of the Chinese people's Liberation Army from January 2012 to December 2018.157 patients were divided into delirium group and non delirium group according to whether delirium occurred after operation.There were41 patients in delirium group，including 15 males，26 females，aged 90~104 years old，with an average of (93.17±3.15)years.And there were 116 patients in non delirium group，including 43 males and 73 females，aged 90~102 years old，with an average age of (92.07±2.44)years.The general data，perioperative complications，postoperative mortality and walking ability of the two groups were compared.Results  Delirium occurred in 41 patients(26.1%) after operation in over 90 yearship fracture.Delirium mainly occurred within 1-3d after operation，and the duration was mostly within 1 week.The 4or morecomobidities (OR=5.205，95%CI：1.649~16.431；P＝0.005)，time of operation (OR=1.540，95%CI：1.204~1.969；P＝0.001)，general anesthesia (OR=2.463，95%CI：1.852~7.117；P＝0.036) were independent risk factors for delirium after operation.The incidence of cerebrovascular events 3 cases (7.3%)，cardiac adverse events 9 cases(22.0%)，pulmonary infection 13 cases(31.7%) in delirium group were higher than those in non-delirium group (cerebrovascular events，0 cases；10 cases(8.6%)；pulmonary infection，18 cases (15.5%).There werestatistical difference (P＜0.05).The mean lengths of stay in delirium group were (19.19±15.14)days，and those of non-delirium group were (14.77±10.53)d.The difference were statistically significant (t＝2.049，P＝0.042).The mortality of 30 days，1 year and overall mortality in delirium group were 17.1% (7 cases)，43.9%(18 cases) and 56.1%(23 cases)，respectively，which were higher than those of non-delirium group (30 days，4.3%，5 cases；1 year，18.1%，21 cases；overall，34.5%，40 cases)，respectively，which hadstatistical differences (P＜0.05).After adjusting the related confounding factors，delirium was an independent risk factor for 30 days mortality after operation (OR=7.825，95%CI：1.327~46.154；P＝0.023) and 1 year (OR=2.991，95%CI：1.162~1.696；P＝0.023).In the delirium group，23 patients survived at 1 year after operation，only 6(26.1%) could walk independently，14(60.9%) needed auxiliary device，3(13.0%) were in bed；95 patients survived at 1 year after operation，34(35.8%) could walk independently，52(54.7%) needed auxiliary device，9(9.5%) needed to stay in bed.There was no significant difference between the two groups (χ2=0.888，P＝0.641).Conclusion  The incidence of postoperative delirium in very elderly patients with hip fracture is high，and the peak was 1-3 days after operation.The 4 or more comorbidities，timeof surgery and general anesthesia are independent risk factors for postoperative delirium.The incidence of perioperative complications (cerebrovascular time，adverse cardiac events and pulmonary infection) and postoperative mortality in delirium patients are high，which are independent risk factors for 30 days and 1 year after operation.
2022 Vol. 28 (1): 20-24 [Abstract] ( 194 ) HTML (1 KB)  PDF (471 KB)  ( 193 )
25 Investigation and Analysis on Clinical Characteristics of 362 Inpatients with Diabetic Foot Infection
Wen Fengping，Liu Xing，Tian Shikun
Objectie  To investigate and analyze the clinical characteristics of inpatients with diabetic foot infection (DFI) and provide reference for effective clinical prevention and treatment of DFI.Methods  The medical records of patients with diabetic foot infection who were admitted to the central hospital of enshi prefecture from January 2018 to December 2020，were retrospectively analyzed.According to Wagner classification，the DFI patients were divided into mild DFI group(41.44%) and severe DFI group(58.56%).Among the patients there were 245 males(67.68％) and 117 females(32.32％).Primary school and junior high school accounted for the highest proportion of education level (79.01%).Characteristics including patients basic data，wound microbiology information，therapies，outcomes，and health economics information were analyzed and compared between the two groups.Results  There were statistically significant difference in gender distribution、BMI and peripheral vascular disease of patients of different groups(P＜0.05).Diabetic foot infections were more common in the toes.There were 524 strains of microorganisms isolated from the 345 patients (95.31%)，including Staphylococcus aureus (23.28%)，Pseudomonas aeruginosa (15.65%)，and Klebsiella pneumoniae (11.45%).The severe DFI group had significantly higher ratios of polymicrobial bacteria and Gram-negative bacteria infections(P＝0.032，P＝0.015)，and increased levels of white blood cell counts(WBC)，neutrophils percentage (NEUT)，procalcitonin (PCT)，and C-reactive protein (CRP)(all P＜0.05) when compared with the mild DFI group.248(68.51%)patients were treated by surgery.There were significant differences in ratios of recovery and amputation between severe DFI group and mild DFI group(P＜0.05).The average hospitalization time of patients with DFI was 24 days with the average hospitalization cost of 34 250 yuan.There were statistically significant differences in the hospitalization time and hospitalization cost between severe DFI group and mild DFI group(P＜0.05).Conclusion  There are more male patients with DFI in the author’s unit.The high rate of complications，infection and amputation bring serious economic burden to the patients and the society.It is necessary to strengthen the prevention and health education of DFI.
2022 Vol. 28 (1): 25-29 [Abstract] ( 182 ) HTML (1 KB)  PDF (514 KB)  ( 228 )
30 Application and Value of Metagenomic Sequencing Technology in Searching Pathogenic Bacteria in Periprosthetic Infection
Dong Wenchao 1，Zan Qiang 2，Ma Jianbing 3，Qing Zhong 3，Zhi Liqiang 3*
Objective  To investigate the role and value of metagenomic sequencing technology in detection of pathogenic bacteria around prosthesis.Methods  60 patients，including 38 knee patients and 22 hip patients with prosthetic joint infection (PJI) or aseptic loosening were enrolled in the Department of Joint Surgery，Xi’an Honghui Hospital from January 2019 to January 2021.All patients were older than 18 years old.There were 42 cases in PJI group，including 16 males and 26 females with an average age of (64.33±13.03).There were 18 cases in AL group，including 6 males and 12 females with an average age of (62.50±9.78).Conventional bacterial culture and mNGS were used to detect pathogenic bacteria in joint fluid or synovial tissue samples from patients.The sensitivity，specificity，positive predictive value，negative predictive value，consistency rate，and detection time of PJI in articular fluid or synovial tissue specimens were compared between mNGS and conventional bacterial culture.Twenty PJI patients who received only negative conventional culture from January 2017 to December 2018 were further selected as the empirical antibiotic group.Twenty PJI patients who underwent mNGS testing from January 2019 to January 2021 were included in the targeted antibiotic group.The two groups were followed up for at least 6 months，and the differences between the two groups in the time of antibiotic use，the cost of antibiotics in hospital，the number of adverse reactions and recurrence cases were counted.Results  Among 42 PJI patients，30 were positive in bacterial culture and 40 were positive in mNGS.Among the 18 AL patients，2 were positive for bacterial culture and 7 were positive for mNGS.A total of 12 kinds of pathogenic bacteria were detected in bacterial culture and 31 kinds of pathogenic bacteria were detected in mNGS.The sensitivity，specificity，positive predictive value，negative predictive value and consistency rate of bacterial culture group and mNGS group were 71.4%，94.4%，93.8%，33.3%，60.0% and 95.2%，61.1%，85.1%，84.6%，85.0%，respectively.The detection time of mNGS group was significantly shorter (1.87±0.39)d In culture group (5.55±0.65)d.There were statistically significant differences in sensitivity，specificity，coincidence rate and detection time between the two groups (P＜0.05).The duration of intravenous antibiotics in TA group was (10.15±1.50)d，and the antibiotic cost was (6 149.15±763.06)yuan.The duration of intravenous antibiotics in control group EA was (14.52±2.00)d，and the antibiotic treatment cost was (10 874.70±1 353.63)yuan.There were statistically significant differences in the time of intravenous antibiotic use and treatment cost between the two groups (P＜0.05). Conclusion  mNGS can effectively identify the pathogenic bacteria of PJI patients.Compared with traditional culture，mNGS has higher sensitivity and consistency rate，more advantages in detection time and antibiotic cost，higher diagnostic efficiency in the diagnosis of PJI，and can provide powerful clinical guidance in the diagnosis and treatment of PJI.
2022 Vol. 28 (1): 30-35 [Abstract] ( 185 ) HTML (1 KB)  PDF (1168 KB)  ( 233 )
36 Effect and Mechanism of miR-133a Inhibiting Osteosarcoma Cell Invasion By Targeting MMP-14
Huang Shengxiang，Mei Haibo*，Liu Kun，Tang Jin，Wu Jiangyan
Objective  To study the effect and mechanism of miR-133a on inhibiting osteosarcoma cell invasion via targeting matrix metalloproteinase-14 (MMP-14). Methods  Normal osteoblasts hFOB1.19 and osteosarcoma cells MG63，U2OS and SAOS2 were cultured and the expression of miR-133a was detected by fluorescence quantitative PCR.MG63 cells were divided into miR-negative control (NC) group，miR-133a group，pcDNA3.1+miR-NC group，pcDNA3.1+miR-133a group，pcDNA3.1-MMP-14+miR-133a group and transfected with NC mimic，miR-133a mimic，pcDNA3.1 plasmid and MMP-14 overexpressed pcDNA3.1 plasmid.Thenthe number of cell invasion was detected by Transwell，the expression level of MMP-14 was detected by Western blot and the targeted binding of miR-133a to 3'UTR of MMP-14 gene mRNA was verified by double luciferase reporter gene assay.Results  The expression level of miR133a in MG63，U2OS and SAOS2 cells were lower than that in hFOB1.19 cell，and the expression level of miR-133a in MG63 cells decreased most significantly.The invasion number of MG63 cells in miR-133a group was less than that in miR-NC group.The expression level of MMP-14 and the fluorescence activity of double luciferase reporter gene containing wild type 3'UTR of MMP-14 were lower than those in miR-NC group.The invasion number of MG63 cells in pcDNA3.1-MMP-14+miR-133a group was more than that in pcDNA3.1+miR-133a group.Conclusion  miR-133a can inhibit the invasion of osteosarcoma MG63 cells，and the targeted inhibition of MMP-14 geneis one of the possible molecular mechanism.
2022 Vol. 28 (1): 36-40 [Abstract] ( 183 ) HTML (1 KB)  PDF (1500 KB)  ( 197 )
41 Experimental Study on MMP-2 Promoting Osteogenic Differentiation of Myogenic Mesenchymal Stem Cells
Zhu Zhongsheng，Yin Nuo，Zhang Dong，Xiao Haijun，Xue Feng *
Objective  To observe the effect of MMP-2 on the osteogenic differentiation of muscle-derived mesenchymal stem cells.Methods  The rat thigh muscle tissue was taken for primary culture，and mesenchymal stem cells were isolated and identified by flow cytometry.The Plvx-IRES-ZsGreen1-MMP-2 overexpression vector and Plvx-shRNA2-sh-MMP-2 interference vector were constructed，and the mesenchymal stem cells were treated with MMP-2 overexpression and suppression.Western blotting was used to detect the expression of osteogenic related genes RUNX2，OCN and ALP in the muscle-derived mesenchymal stem cells on the first，7th，and 14th days after plasmid transfection.Alizarin red staining was further performed to detect the osteogenic differentiation of mesenchymal stem cells on the 7th and 14th days.Results  The primary cultured muscle-derived mesenchymal stem cells were identified as rat muscle stem cells by flow cytometry；the construction of Plvx-IRES-ZsGreen1-MMP-2 overexpression vector and Plvx-shRNA2-sh-MMP-2 interference vector could effectively interfere the expression of MMP-2 in mesenchymal stem cells.Western blot detection results showed that the expression of osteogenic genes RUNX2，OCN and ALP in the MMP-2-upregulating group were significantly increased on the 7th and 14th days，and were significantly decreased on the 7th and 14th days in the MMP-2-downregulating group.However，on the 7th day of culture，there was little difference in Alizarin Red staining both in the MMP-2-upregulating group and MMP-2-downregulating group.On the 14th day of culture，the Alizarin Red staining of the MMP-2 overexpression group had the most calcium nodules.Conclusion  MMP-2 can promote the osteogenic differentiation of myogenic mesenchymal stem cells and the formation of calcium nodules.
2022 Vol. 28 (1): 41-46 [Abstract] ( 275 ) HTML (1 KB)  PDF (3153 KB)  ( 232 )
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