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2022 Vol. 28, No. 5
Published: 2022-05-25
 
385 The Clinical Observation of U-shaped Rod Combined with Isthmus Bone Graft and Single segment Fixation in the Treatment of Simple Lumbar Spondylolysis
Cheng Gang 1，Yang Xiaoling 2，TangYongtao 1，Wu Changjun 1，Wei Siqi 1*
Objective  To study the clinical efficacy of a U-shaped rod combined with isthmus bone graftting and single-segment fixation in the treatment of simple lumbar spondylolysis.To analyze the postoperative isthmus fusion and long-term effect.Methods  Thirty-seven simple lumbar spondylolysis patients treated with a U-shaped rod combined with isthmic bone grafting and single-segment fixation in University of Chinese Academy of Sciences-Shenzhen Hospital from January 2017 to December 2019 were analyzed retrospectively，including 26 males and 11 females.The age ranged from 17 to 42 years with an average of (26.54±6.32)years.The duration of surgery，intraoperative blood loss and postoperative drainage volume were recorded.The preoperative visual analogue scale(VAS) and Oswestry disability index(ODI) were compared to postoperatively.The fusion of isthmus was observed.Results  The patients were followed for 24~60 months postoperatively，with an average of (37.46±9.71)years.The VAS of patients with postoperative low back pain was lower than preoperatively，and the difference was statistically significant (P＜0.05).The ODI after operation was significantly improved compared with that before operation，and the difference was statistically significant (P＜0.05).The bony fusion rate was 82.43%，and the duration of fusion was (8.82±3.63)months.At the final follow-up，none of the patients had secondary lumbar spondylolisthesis or adjacent segmental disc degeneration，there were no complications such as rupture or loosening of internal fixation.Conclusion  In the treatment of simple lumbar spondylolysis，a U-shaped rod combined with isthmic bone grafting and single-segment fixation is characterized by a short and simple operation with a small incision，safety，little bleeding and few complications. The surgery relieves lumbago，lumbar function is recovered，the isthmic bony fusion rate is high，and the internal fixation is firm.Therefore，the surgery has definite therapeutic effect.
2022 Vol. 28 (5): 385-389 [Abstract] ( 243 ) HTML (1 KB)  PDF (2040 KB)  ( 323 )
390 Correlation Analysis Of Skeletal Muscle Mass And Spinal Stenosis-Degree In Elderly Patients With Degenerative Lumbar Spinal Stenosis
You Lipan，Wei Bo *
Objective  To investigate the correlation between skeletal muscle mass and spinal stenosis degree in elderly patients with degenerative lumbar spinal stenosis(DLSS).Methods  From June 2019 to October 2021，80 elderly patients with degenerative lumbar spinal stenosis(DLSS group) and 45 physical examination volunteers(control group)were selected.Absolute claudication distance(ACD) was measured to evaluate the degree of DLSS spinal stenosis. According to the degree of DLSS spinal stenosis，DLSS patients were divided into mild group(grade 5~6，22 cases)，moderate group(grade 3~4，41 cases)and severe group(grade 1~2，17 cases)，and were divided into sarcopenia group(23 cases)and no sarcopenia group(57 cases) according to whether or not combined with sarcopenia.Skeletal muscle mass of the whole body and limbs were measured by dual-energy X-ray absorptiometry，and the relative skeletal muscle index(RSMI) was calculated.The total cross-sectional area(TCSA) and total fatless cross-sectional area(TFCSA) of multifidus were measured by MRI，and the TCSA/TFCSA ratio was calculated.The relation between all skeletal muscle mass，limb skeletal muscle mass，RSMI and TCSA，TFCSA，TFCSA/ TCSA ratio and DLSS spinal stenosis were analyzed.Results  The skeletal muscle mass of upper limb，lower limb，whole body，RSMI，TFCSA and TFCSA/TCSA ratio in DLSS group were lower than those in control group(P＜0.05).The skeletal muscle mass of upper limb，lower limb，whole body，RSMI，TFCSA and TFCSA/TCSA ratios in sarcopenia group were lower than those in no sarcopenia group(P＜0.05).The skeletal muscle mass of upper limb，lower limb，whole body，RSMI，TFCSA and TFCSA/TCSA ratios in severe group were lower than those in moderate group and mild group(P＜0.05)，and those in moderate group were lower than those in mild group(P＜0.05).In DLSS group，skeletal muscle mass of upper limb，lower limb，whole body and RSMI were positively correlated with TFCSA and TFCSA/TCSA ratio(P＜0.05)，but negatively correlated with spinal stenosis grade(P＜0.05).Conclusion  Skeletal muscle mass in extremities and whole body is correlated with lumbar multifidus atrophy and spinal stenosis in elderly DLSS patients.
2022 Vol. 28 (5): 390-411 [Abstract] ( 201 ) HTML (1 KB)  PDF (806 KB)  ( 245 )
394 Factors associated with surgical effect and complications in PKP
Zhou Tiancheng 1，Ren Yanjun 2，Xiao Xing 2，Li Jingkun 2，Zhang Kaining 2，Wang Zhijin 3，Zou Debo 2
Objective  To explore the efficacy of percutaneous kyphoplasty(PKP) for the treatment of osteoporotic vertebral compression fractures(OVCF) and the related factors of bone cement leakage situation，and to optimize the surgical protocol.Methods  We retrospectively reviewed 56 patients treated with PKP due to spinal fracture from 2019 to 2020，and the patients included 10 males and 46 females.The age ranged from 51 to 87 years，with an average of (69.60±8.85)years.The distribution of fractured vertebrae was as follows：4 cases of 3 vertebrae，4 cases of 2 vertebrae，and 48 cases of single vertebra.2 T8，2 T9，4 T10，14 T11，5 T12，14 L1，6 L2，9 L3，8 L4，and 4 L5 vertebrae.X-ray，CT，MRI，and BMD were performed on all patients before the operation. Postoperative review of imaging data，assessment of treatment effect，statistics on bone cement leakage cases.The effect of the surgery was analyzed by paired t-test，logistic regression analysis，and linear regression analysis to explore the cause and optimize the surgical protocol.Results  All the operations were performed successfully.The compressed vertebral height and Cobb angle of the injured vertebrae were recovered in patients after surgery compared with those before surgery.There were 36 vertebrae with cement leakage.We found that the surgical effect of PKP was related to the amount of cement injected，the degree of disc degeneration，age，the degree of vertebral compression，and the volume of the balloon(D-W≈2，VIF＜5，P＜0.05).Risk factors for cement disc leakage included more cement injection，superior endplate fracture，and cement in the vertebral close to the Superior endplate(Hosmer Lemeshow test=0.780，P＜0.05).Conclusion  PKP needs to refine preoperative imaging studies to develop a surgical protocol based on the degree of disc degeneration，age，and degree of vertebral compression.The amount of cement injection，the volume of the balloon，and the distribution pattern of cement can be controlled intraoperatively to obtain a better surgical result and to reduce surgical complications.
2022 Vol. 28 (5): 394-400 [Abstract] ( 274 ) HTML (1 KB)  PDF (4797 KB)  ( 301 )
401 Effectiveness of Sliding Osteotomy of Lateral Femur Condyle for Correcting Fixed Valgus Deformity in Total Knee Arthroplasty
Objective  To observe the clinical effect of sliding osteotomy of lateral femur condyle for correcting fixed valgus deformity in primary total knee arthroplasty (TKA).Methods  From May 2017 to June 2020，15 patients (17 knees)with Fixed valgus knees deformity including 5 men(5 knees)and 10 women(12 knees)underwent primary total knee arthmplasty.Average age was 69.5 years(range 59~76 years).The average weight was 73.6 kg(range 64.5~89.0 kg)and average body height was 170.5 cm(range 156~178 cm).The diagnoses of the patients were osteoarthritis in 13 cases(15 knees)and rheumatoid arthritis in 2 cases(2 knees).All patients were rated as type Ⅱ according to Krackow classification of valgus knee.During primary TKA，sliding osteotomy lateral femoral condyle for restoring soft tissue balance and correcting valgus deformity were performed via a medial parapatellar approach.Posterior stabilized prosthesis was employed in all cases.Properative and postoperative imaging parameters and clinical outcomes were evaluated.Results  Average followup was 30.5 months(range 3~50 months).The tibiofemoral angle was corrected from preoperative (199.5±3.3)° to postoperative (172.4±1.5)°(P＜0.05).The femoral transepicondylar angle (FTEA) was significant improved from preoperative (80.3±1.7)°to postoperative (89.5±1.5)° (P＜0.05).According to knee society score(KSS) criterion.The clinical score improved from preoperative (33.2±6.5) to postoperative (89.1±1.2) and the functional score improved from (41.9±7.5) to (82.3±5.1)，the range of movement increased from preoperative (62.0±10.1)° before surgery to postoperative (115.0±10.7)°.There was significant statistic difference(P＜0.05).At the last follow-up，the X-ray showed that the position of the prosthesis was good，patella dislocation was not detected and complete union was found at the osteotomy site.The clinical mediolateral instability was not detected.Conclusion  Sliding osteotomy of lateral femur condyle is safe and effective for correcting fixed valgus deformity in primary TKA.Restoration of lower limb alignment and balance soft tissue may be achieved with satisfactory clinical outcomes.
2022 Vol. 28 (5): 401-405 [Abstract] ( 233 ) HTML (1 KB)  PDF (2534 KB)  ( 270 )
406 Effect of Different Tranexamic Acid Administration Methods on Lowering Blood Loss During Unicompartmental Knee Arthroplasty
Huang Jingxing 1，2，Zhang Min 2*，Pang Junyao 1，2，Yan Yubing 1，2
Objective  To compare the effect of different Tranexamic acid(TXA)administration methods，namely，articular injection(AI)，intravenous injection(II) combined with AI(AI+II)，and no application of tranexamic acid on blood loss(BL)，blood transfusion(BT)，and related complications in patients undergoing unicompartmental knee arthroplasty(UKA).Methods  A analysis was conducted on 120 patients，who suffered from unilateral medial compartment knee osteoarthritis and were treated with UKA from September 2018 to March 2020.There were 35 males and 85 females，aged from 51 to 88 years，with an average age of 69 years.They were divided into three groups according to the random number table method：single AI(n＝40)，AI+II(n＝40)，and control group(n＝40).The preoperative and postoperative hemoglobin(Hb) concentrations，Hb decline degree，hematocrit(Hct)test，activated partial thromboplastin time(APTT)，prothrombin time(PT)，and D-dimer were compared among the three groups.Results  The postoperative Hb concentration，decrease degree of Hb and postoperative HCT in AI group were (124.8±4.1)g/L，(11.2±3.6)g/L and(39.1±2.4)% respectively，those in AI+II group were (126.0±3.8)g/L，(9.3±4.4)g/L and (39.1±2.2)% respectively，and those in control group were (120.7±4.4)g/L，(15.5±6.1)g/L and (37.8±14.2)% respectively. There was no significant difference between AI group and AI+II Group(P＞0.05).The postoperative Hb concentration and HCT of Ai Group and AI+II group were higher than those of the control group，and the decrease degree of Hb was lower than that of the control group.The difference was statistically significant (P＜0.05).APTT，PT and D-dimer in AI group were (29.7±1.2)s，(12.7±0.8)s and(473.2±74.9)ng/ml respectively，those in AI+II group were(28.6±1.5)s，(12.2±0.5)s and (603.0±148.7)ng/mL respectively，and those in control group were (29.8±1.4)s，(12.9±0.8)s and (486.0±80.0)ng/mL respectively.There was no significant difference between AI group and control group (P＞0.05)；The postoperative APTT and PT in AI group and control group were higher than those in AI+II group，and the postoperative D-dimer was lower than that in AI+II group.The difference was statistically significant (P＜0.05). Conclusion  In UKA，compared with AI+II，AI can reduce the risk of lower extremity deep venous thrombosis under the condition of reducing the same blood loss，which is similar to the control group.Therefore，we believe that the application of TXA only through AI in UKA can make the patients have less blood loss and safer in the perioperative period.
2022 Vol. 28 (5): 406-411 [Abstract] ( 227 ) HTML (1 KB)  PDF (931 KB)  ( 236 )
412 Comparison of Efficacy for Open and Percutaneous Pedicle Screw Fixation in the Treatment of Simple Thoracolumbar Vertebral Body Fractures
Hu Ming，Bi Dapeng，Yu Shengbao *
Objective  To compare the clinical efficacy of posterior open and percutaneous pedicle screw fixation in the treatment of single segment asymptomatic thoracolumbar vertebral body fractures.Methods  From August 2018 to November 2020，32 patients with thoracolumbar vertebral body fractures including 18 males and 14 females with an average age of (53.56±9.48)were randomly divided into open group(n＝16)and percutaneous group(n＝16).The percutaneous group was treated with minimally invasive percutaneous pedicle screw fixation，and the open group was treated with open pedicle screw fixation.The operation time，intraoperative blood loss，postoperative hospital stay，incision length，visual analogue score(VAS) before and after surgery，the ratio of anterior and posterior vertebral height(%) and kyphosis Cobb angle at the last follow-up were compared between the two groups.Results  All patients were followed up for 6 ~ 12 months，with an average follow-up of (9.20±2.14)months.There were no significant differences in baseline data，ratio of anterior and posterior vertebral height(%) and kyphosis Cobb angle between the two groups(P＞0.05).The VAS score of the percutaneous group was slightly higher than that of the open group on the first day after operation，but the difference was not statistically significant(P＞0.05).The ratio of anterior and posterior vertebral height(%)and kyphosis Cobb angle in two groups were significantly improved postoperation(P＜0.05).The minimally invasive group had less intraoperative blood loss，shorter operation time，shorter postoperative hospital stay，shorter incision length，lower VAS score on the third day after operation and the differences were statistically significant compared with the open group(P＜0.05).Conclusion  Minimally invasive percutaneous pedicle screw fixation and open pedicle screw fixation in the treatment of thoracolumbar vertebral body fractures have the same curative effect，but the percutaneous group has the advantages of less blood loss，shorter operation time and postoperative hospital stay，less trauma and lower VAS.
2022 Vol. 28 (5): 412-435 [Abstract] ( 245 ) HTML (1 KB)  PDF (3854 KB)  ( 261 )
416 Preliminary Study on the Mechanism of Taraxasterol in the Treatment of Knee Osteoarthritis in Rats
Xie Zikang，Shi Mingyu *，Jiang Yang，Wang Bin，Shen Pengfei，Zheng Chong，Yang Xiaofeng
Objective  To study the mechanism of taraxasterol in the treatment of knee osteoarthritis(KOA)in rats.Methods  KOA rats model was prepared by injecting 0.2 mL of 4% papain solution +0.03 mmol/L cysteine into the joint cavity.The taraxasterol 2.5 mg/kg(low-dose group)，5 mg/kg(medium-dose group)，10mg/kg(high-dose group)and saline(model group)were administered by gavage，respectively.The sham operation group was prepared by injecting 0.2 mL of normal saline into the joint cavity and gavage with normal saline.4 weeks after administration，the serum levels of tumor necrosis factor-α(TNF-α)，interleukin-1 β(IL-1β)，IL-6，matrix metalloproteinase-1(MMP-1)，MMP-3 and cysteine aspartic acid protease-1(Capase-1)in were determined by enzymelinked immunosorption.The expression levels of microRNA(miRNA)-140 and miRNA-146a in articular cartilage tissue were determined by -time PCR(RT-qPCR).The protein expression levels of inhibitor of NF-κB(IκB)，inhibitor κB kinase β(IKKβ)，nuclear factor-κB(NF-κB)，transforming growth factor-βactivated kinase 1(TAK1)，NOD-like receptors 3(NLRP3)，apoptosis-associated speck-like protein containing CARD(ASC)in articular cartilage tissue were determined by Western blot.The pathological observation of articular cartilage was conducted.Results  Compared with the sham operation group，the serum levels of TNF-α，IL-1β，IL-6，MMP-1，MMP-3，Capase-1 and the protein expression levels of IκB，IKKβ，NFκB，TAK1，NLRP3，ASC and Mankin score in articular cartilage tissue in high-dose，medium-dose，low-dose group and model group was significantly increased(P＜0.05)，the expression levels of miRNA-140 and miRNA-146a in articular cartilage were significantly decreased(P＜0.05).Compared with the model group，the serum levels of TNF-α，IL-1β，IL-6，MMP-1，MMP-3，Capase-1 and the protein expression levels of IκB，IKKβ，NF-κB，TAK1，NLRP3，ASC and Mankin score in articular cartilage tissue in high-dose，medium-dose and low-dose group was significantly decreased(P＜0.05)，it decreased significantly with the increase of dose(P＜0.05)，the expression levels of miRNA-140 and miRNA146a in articular cartilage were significantly increasedd(P＜0.05)，it increased significantly with the increase of dose(P＜0.05).Conclusion  Taraxasterol has a protective effect on KOA rats，alleviate the pathological changes of articular cartilage tissue，and it was dose-dependent.The mechanism might be related to inflammation inhibition，up-regulation of miRNA expression and activation blocked of TAK1/NF-κB，NLRP3 signaling pathway.
2022 Vol. 28 (5): 416-421 [Abstract] ( 227 ) HTML (1 KB)  PDF (2683 KB)  ( 237 )
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