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2022 Vol. 28, No. 8
Published: 2022-08-25
 
673 Effect of Kashin-Beck Disease on the Height and Morphology of Lower Cervical Intervertebral Space
Wu Xueyuan，Yi Zhi，Ma Hongwei，Ling Ming，Jin Zhankui，Sun Zhengming
Objective To measure the height of cervical intervertebral space and observe the imaging morphology in elderly patients with Kashin-Beck disease(KBD)to clarify the influence of KBD on the lower cervical vertebrae.Methods From Aug 2019 to Dec 2019，a total of 92 patients with KBD (38 men and 54 women)with an average age of (58.89±7.67)years (range：47~70 years)and 98 healthy subjects (42 men and 56 women)with an average age of (58.35±7.38)years (range：49~69 years)were enrolled and examed at the Second People's Hospital of Ning Xian.The KBD patients (KBD group)and the healthy subjects (control group)were taken with lateral cervical radiographs to observe the imaging manifestations of the lower cervical intervertebral space.The anterior，middle and posterior heights of the intervertebral space from C2～7in neutral position were measured and statistical analysis was performed.Results The results of this study showed that the middle heights of C4～7 in male and female in KBD group were lower than that of C2～4，with significant statistical difference (P＜0.05).The middle heights of C2～4 in both male and female in KBD group were lower than those in the control group，but with no statistical significance (P＞0.05).The middle heights of C4～7 in both male and female in KBD group were lower than those of control group (P＜0.05).There were statistically significant differences in the middle height of C2～4 between male and female patients in KBD group (P＜0.05)，and there was no significant difference in the middle heights of C4～7 between the two genders (P＞0.05).The X-ray examination showed that imaging morphologies of lower cervical intervertebral space were divided into normal intervertebral height in 27 cases (29.35%)，widened height in 11 cases (11.96%)，narrow height in 42 cases (45.65%) and elliptical space in 12 cases (13.04%) based on the height and shape of the intervertebral space.The characteristic changes of endplate were depression，uneven or sclerosis.Conclusion  The KBD does not affect the development of cervical intervertebral disc，while，the patients with KBD are prone to the occurrence of cervical disc degeneration and height loss.This study primarily confirmed that KBD and cervical disc degeneration may have a certain correlation.
2022 Vol. 28 (8): 673-678 [Abstract] ( 211 ) HTML (1 KB)  PDF (3624 KB)  ( 232 )
679 Comparison of Transpositive Tenodesis and Tenontotomy of  Biceps Tendon in Treating Massive Rotator Cuff Tears
Ma Dong，Yuan Bo，Li Yumin
Objective To compare the clinical outcomes of arthroscopic transpositive tenodesis and tenontotomy of biceps tendon in treating massive rotator cuff tears.Methods From March 2018 to August 2020，a total of 44 patients with massive rotator cuff tear received arthroscopic rotator cuff repair surgery in Civil Aviation General Hospital，and the data were retrospectively analyzed.The patients included 15 males and 29 females and aged 40~80 years，with an average age of (63.1±8.4)years.There were 21 patients in transpositive tenodesis group，and 23 patients in tenontotomy group.All the patients were diagnosed as anterior-superior or posterior-superior massive rotator cuff tears based on MRI and arthroscopy images.The postoperative follow ups were conducted in the 1st，3rd and 12th months.Both groups were evaluated according to the range of motion(ROM)，visual analogue scale(VAS)，University of California Los Angeles(UCLA) scores and Constant-Murley scores before and after the surgery.The conditions of rotator cuff healing and acromio-humeral interval (AHI)were assessed using magnetic resonance imaging(MRI).Results 44 cases were followed up for 11 to 13 months，with an average of (12.1±0.4)months.In the transpositive tenodesis group 12 months after operation，the VAS score decreased from (7.6±1.4)points before surgery to (1.1±1.8)points afer surgery，the UCLA score increased from (14.8±6.7)points before surgery to (32.1±4.9)points，after surgery，the Constant-Murley score increased from (52.4±21.4)points before surgery to (92.8±13.0)points afer surgery，the AHI increased from (6.0±1.6)mm before surgery to (8.5±1.1)mm after surgery.All the difference were statistically significant (P＜0.05).In the tenontotomy group 12 months after operation，the VAS score decreased from (7.7±1.4)points to (1.0±1.3)points，the UCLA score increased from (13.6±5.2)points to (32.9±2.7)points，the ConstantMurley score increased from (51.2±23.0)points to (95.2±6.4)points after surgery.All the difference were statistically significant (P＜0.05).Although the AHI increased from preoperative (5.8±1.6)mm to postoperative (6.3±1.3)mm in the tenontotomy group，there was no significant difference(P＞0.05).There were no significant differences in range of motion，the VAS score，the UCLA score and the ConstantMurley score between 2 groups 12 months after operation (P＞0.05)，while the AHI of tenontotomy group was much less than that of transpositive tenodesis group (P＜0.001).Although there were 2 cases of rotator cuff retear in tenontotomy group and no case of rotator cuff retear in transpositive tenodesis group，no statistical difference was observed(P＞0.05).Conclusion Both arthroscopic transpositive tenodesis and tenontotomy of biceps tendon can achieve satisfactory clinical outcomes in treating massive rotator cuff tears.Without increasing surgical difficulty obviously，arthroscopic transpositive tenodesis of biceps tendon can improve mechanical strength of rotator cuff and get better subacromial space.
2022 Vol. 28 (8): 679-685 [Abstract] ( 247 ) HTML (1 KB)  PDF (6074 KB)  ( 284 )
686 Clinical Efficacy of Joint Capsule Suture in Arthroscopic Surgery of Femomacetabular Impingement
Yang Weiming，Cao Xuewei，Tian Tieqiao，Zhao Caiqiong，Lin Dingkun
Objective To assess the effect of suturing the joint capsule in arthroscopic surgery for femoralacetabular impingement(FAI).Methods  A total of 62 patients diagnosed with FAI and treated with hip arthroscopy in Guangdong Provincial Hospital of Chinese Medicine from June 2019 to December 2020 were retrospectively analyzed.All patients underwent hip arthroscopy，labrum repair and femur plasty.According to whether the joint capsule was sutured in the operation or not，patients were divided into sutured group (n＝32) and unsutured group (n＝30).There were 15 males and 17 females，with an average age of (36.3±8.9) in sutured group.There were 14 males and 16 females，with an average age of (37.8±6.2) in unsutured group.Shoelace method was applied to suture joint capsule in the sutured group，while the joint capsule was left unsutured in the other group.All patients were assessed by the modified Harris hip score (mHHS)，hip outcome score sports specific subscale (HOS-SSS)，hip outcome score-activities of daily living (HOS-ADL).MRI was performed six months after the operation to evaluate the capsular condition.Results The operations in both groups were successfully completed.The operation time of sutured group was significantly longer than that of unsutured group (P＜0.05)，but there was no significant difference in day of hospitalization between the two groups (P＞0.05).No serious complications occurred.All patients were followed up for 9~12 months，with a mean follow-up of (10.2±5.3)months.Preoperative HOS-ADL score，HOS-SSS score，mHHS score had no significant difference between the two groups (P＞0.05).HOS-ADL score，HOS-SSS score，mHHS score were significantly increased in both groups at 6 months (P＜0.001).HOS-ADL score，HOS-SSS score，mHHS score of the sutured group were higher than those of the unsutured group at the 6-month follow-up (P＜0.05).Conclusion Suturing the joint capsule with shoelace method in arthroscopic hip surgery can improve the clinical outcome of FAI arthroscopic hip surgery，without increasing risk of complications.
2022 Vol. 28 (8): 686-690 [Abstract] ( 201 ) HTML (1 KB)  PDF (4830 KB)  ( 235 )
691 Clinical Effect of Anterior Cruciate Ligament Reconstruction Combined with High Tibial Osteotomy in the Treatment of Anterior Cruciate Ligament Injury Combined with Osteoarthritis
Liu Guoli，Li Liang，Yi Fan，Xie Kunnan，Yin Xianghui，Zhang Yanrui，Dai Shifeng
Objective To investigate the clinical effect of anterior cruciate ligament reconstruction combined with high tibial osteotomy in the treatment of anterior cruciate ligament injury combined with medial compartment osteoarthritis.Methods A retrospective analysis was performed on 18 patients with anterior cruciate ligament injury complicated by medial single-compartment osteoarthritis at the Second Hospital of Tangshan from June 2015 to February 2018.There were 10 males and 8 females with an average age of (51.20±4.80)years (range，42~57 years).Cruciate ligament reconstruction and tibial high osteotomy were performed simultaneously.Follow-up visits were made at 1，6，12 and 24 months after operation.Full-length radiographs of lower limbs and anteroposterial-lateral radiographs of affected knee were reviewed，the union of osteotomy line was investigated，and the passing point of mechanical axis of lower limb and posterior tibial angle were measured.At the last follow-up，Lachman test and KT-1000 test were performed to objectively evaluate the stability of the knee joint.Lysholm score，Tegner knee motion score and international knee documentation committee (IKDC) score were used to evaluate knee function.Results All patients were followed up for 24~36 months，with an average of (28.30±5.70)months.There was no joint stiffness，infection，bone nonunion or delayed union during the follow-up period.2 patients developed postoperative tibial vein thrombosis and received active antithrombotic therapy.At the last follow-up，Lysholm score，Tegner knee motion score and IKDC score were significantly improved compared with those before surgery(P<0.05).At last follow-up，the mechanical axis of lower extremity was adjusted from preoperative varus (7.05±2.34)° to postoperative valgus (1.22±0.43)°，and the difference was statistically significant (P<0.05).The posterior angle of tibial plateau was (9.16±1.41)° before operation and (10.24±2.37)° after operation，and the difference was not statistically significant (P>0.05).Continuous radiographs in 4 patients showed progressive medial compartment osteoarthritis exacerbation，Lachman test was positive in 3 cases.Conclusion Anterior cruciate ligament reconstruction combined with high tibial osteotomy can effectively improve joint stability and osteoarthritis symptoms，and the clinical effect is satisfactory，but the high rate of arthritis progression and ligament relaxation should not be ignored.
2022 Vol. 28 (8): 691-695 [Abstract] ( 276 ) HTML (1 KB)  PDF (3842 KB)  ( 278 )
696 Clinical Epidemiological Analysis of Anterior Talofibular Ligament Injuries
Zheng Guo，Yang Qiandong，Wang Zhenyu，Wang Yunjiao，Tang Kanglai，Tao Xu
Objective To study the clinical characteristics and epidemiology of anterior talofibular ligament(ATFL)injuries.Methods The 360 inpatients with ATFL injury from July 2007 to December 2020 in Sports Medicine Center of the First Affiliated Hospital of Army Medical University were retrospectively analyzed.Among them，there were 231 males and 129 females.149 left ankles and 211 right ankles were included.The ages ranged from 8 to 86 years，with a mean of (30.6±13.3)years.There were 177 avulsion fractures of the ATFL insertion (including 168 cases on the fibular side and 9 cases on the talar side)，and there were 183 midsubstance injuries.The time from the injury to treatment ranged from 0 to 365 months，with an average of (20.7±44.5)months.The patients were divided into groups according to the injuries types，and the factors such as injuries cause，time from injuries to treatment，gender，side，age and combined injuries were analyzed.At the same time，the individual factors and combined injuries of different types of ATFL injuries were compared.Results Male patients (231 cases)with ATFL injuries accounted for 64.2%.The peak of incidence was from 18 to 40 years old (66.4%).The number of patients who visited the hospital within one month after injuries was more than 32.8%.The main cause of injuries was sprain (51.1%)，followed by sports injuries (32.8%).The combined and concurrent injuries included talar cartilage and bone injuries (23.1%)，chronic ankle instability (20.3%)，ankle impingement syndrome(16.4%)，followed by calcaneofibular ligament injuries(11.4%) and traumatic arthritis (9.2%).The incidence of ATFL insubstance injuries (50.8%) and insertion avulsion fracture (49.2%)were similar，but the probability of combined and concurrent injuries were higher than that of the latter (P＜0.05)，and the difference of age structure had statistical significance (P＜0.05).Conclusion The incidence rate of avulsion fracture and in-substance injuries are not significantly different.The rate of injuries of the insubstance Complications injuries is higher(58.6%).The talus cartilage and bone injuries (23.1%) and chronic ankle instability (20.3%) are most common.The avulsion fracture is mainly fibula side (94.9%)，and the combined and concurrent injuries were less (41.4%).
2022 Vol. 28 (8): 696-701 [Abstract] ( 245 ) HTML (1 KB)  PDF (2231 KB)  ( 481 )
702 pplication of Multidisciplinary Teamwork Combined with Enhanced Recovery after Surgery in the Treatment of Hip Fractures in Elderly Patients
Yu Hongwei，Zhang Jinhua，Lin Tao，Pang Zhe
Objective To explore the clinical effect of multidisciplinary teamwork in the application of enhanced recevery after surgery in the treatment of hip fractures in elderly patients.Methods 100 patients with femoral intertrochanteric fracture treated in Datong Fifth People's Hospital from August 2019 to December 2020 were randomly divided into control group (50 cases)and study group (50 cases).There were 21 males and 29 females in the control group.The average age was (73.0±10.7)years (range，70~87 years).27 left fracture and 23 right fracture were included.There were 30 cases of stable type EvansⅠ，15 cases of unstable type EvansⅠand 5 cases of type EvansⅡ.There were 19 males and 31 females in ERAS group.The average age was (75.0±11.2)years (range，70~89 years).There were 21 cases on the left and 29 cases on the right.There were 33 cases of stable type EvansⅠ，13 cases of unstable type EvansⅠ，and 4 cases of type EvansⅡ.Multidisciplinary teamwork ERAS treatment process and traditional conventional treatment process were used respectively.The preoperative waiting time，average hospital stay，hospitalization cost and visual analogue scale(VAS)，inpatient satisfaction score，incidence of complications and the hip Harris scores.Results The preoperative hospital stay，average hospital stay，hospitalization expenses and the incidence of postoperative complications in ERAS group were lower than those in the control group.The satisfaction score and the hip Harris scores of postoperative in ERAS group were higher than those in the control group (P＜0.001).The VAS score of pain in ERAS group was significantly lower than that in control group on the first day after operation (P＜0.05)，but there was no significant difference between the two groups before operation and on the fifth day(P＞0.05).Conclusion The application of multi-disciplinary teamwork assisted enhanced recovery after surgery in the treatment of hip fractures in elderly patients can significantly improve the medical quality and satisfaction of patients，reduce the occurrence of complications and reduce the treatment cost.
2022 Vol. 28 (8): 702-705 [Abstract] ( 194 ) HTML (1 KB)  PDF (914 KB)  ( 265 )
706 Characteristics of Gait Parameters Evaluated with Three Dimensional Gait Analysis Technique in Children with Intoeing Gait
Zhang Yaru，Li Yang，Li Yiying，Yu Yan，Lu Xiaoying，Jiang Shuyun
Objective To study the gait characteristics of the intoeing children and the influencing factors of intoeing children and provide a scientific basis for early assessment and intervention of intoeing children.Methods From January 2019 to September 2021，48 children with intoeing were selected from the outpatient department of Gait and Motion Analysis Center of Yueyang Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine.23 males and 25 females were included.The age ranged from 5 to 10 years，with an average of (7.75±1.55)years.At the same time，the 3D gait data of 48 healthy children were collected from the database of normal children，including 29 males and 19 females.The age ranged from 5 to 10 years，with an average of (7.81±2.13)years.To analyze and summarize the characteristics and influencing factors of gait parameters in children with intoeing.Results (1)The spatial and temporal parameters of children with intoeing were increased by step width (P＜0.01).(2)The kinematic parameters of children with intoeing group showed that the maximum internal rotation angle of hip joint increased (P＜0.05)，the maximum flexion angle of hip joint，the maximum internal rotation angle of knee joint and the maximum internal rotation angle of ankle joint increased significantly (P＜0.01)，and the maximum dorsiflexion angle of ankle joint decreased (P＜0.05).(3)The kinetic parameters of children with intoeing showed that the maximum flexion moment of the hip joint increased (P＜0.05)，the maximum abductor moment and the maximum power decreased (P＜0.05)，the peak adduction moment and maximum power of knee joint support phase increased significantly (P＜0.01)and the maximum plantar-flexion moment of the ankle joint decreased significantly (P＜0.01).(4)There was a significant linear relationship between the maximum internal rotation angle of hip，knee and ankle，the maximum dorsiflexion angle of ankle and the maximum abduction moment of hip joint and intoeing (P＜0.05).Conclusion The spatiotemporal，kinematic and kinetic parameters of the children with intoeing are significantly different from those of the healthy children.The influencing factors of intoeing are the maximum internal rotation angle of the hip，knee and ankle，the maximum dorsiflexion angle of the ankle and the maximum abduction moment of the hip joint.
2022 Vol. 28 (8): 706-711 [Abstract] ( 199 ) HTML (1 KB)  PDF (2117 KB)  ( 302 )
712 Effect of miR-429 on Osteogenic Differentiation of MC3T3-E1 Cells in a Hypoxic Environment
Huang Jiang，Jiao Xufeng，An Shuai，Wang Juyong，Cao Guanglei，Shen Huiliang
Objective To investigate the effect of miR-429 on the osteogenic differentiation of MC3T3-E1 cells in a hypoxic environment.Methods The hypoxia environment was simulated by Cobalt chloride (CoCl-2)in vitro and in vivo，the expression of hypoxia-inducible factor-1α (HIF-1α)was detected by Western blotting to verify the hypoxia condition.The expression of miR-429 in cell tissues and the fracture site was observed by real time-quantitative polymerase chain reaction，(RT-qPCR).The proliferation and apoptosis of MC3T3-E1 cells under hypoxia were detected.miR-429 was overexpressed in MC3T3-E1 cells by lentiviral transfection technology as the experimental group and the control group was transfected with empty plasmid cells，and alkaline phosphatase (ALP)activity detection，alizarin red staining，western blotting and other methods were used to observe the ALP activity，mineral content and protein expression of various osteogenic markers in cells to verify the osteogenic differentiation of MC3T3-E1 cells.The fracture model was injected locally with a lentiviral vector overexpressing miR-429，and the fracture healing was observed by Micro-CT and qRT-PCR.Results The high expression of HIF-1α in MC3T3-E1 cells in a hypoxic environment up-regulated the expression of miR-429.After MC3T3-E1 cells were transfected with miR-429 overexpressing virus，the activity of ALP in the cells，the mineralization of cell matrix and the levels of osteogenic markers (RUNX2 and OC)were higher than those in the control group.After injection of lentiviral reagents overexpressing miR-429 in vivo，the Micro-CT of fracture healing were better and the expression of miR-429 in bone tissue were higher than those in the control group.Conclusion MiR-429 is highly expressed in hypoxic environment and plays a role in inducing osteogenic differentiation of MC3T3-E1 cells.
2022 Vol. 28 (8): 712-716 [Abstract] ( 186 ) HTML (1 KB)  PDF (2449 KB)  ( 226 )
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