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2022 Vol. 28, No. 12
Published: 2022-12-25
 
1057 Comparison of Two Surgical Approaches in the Treatment of  Prolapsed Lumbar Disc Herniation with Lumbar Instability
Ma Zijian，Ma Mingling，Wang Yongxiang，Feng Xinmin，Dong Hui，Cai Jun
Objective To compare the shortterm efficacy of unilateral biportal endoscopy(UBE)and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of prolapsed lumbar disc herniation with lumbar instability.Methods A study of 46 patients with prolapsed lumbar intervertebral disc herniation and lumbar instability who were admitted to the department of orthopedics spine of Northern Jiangsu People's Hospital from July 2019 to September 2021 was retrospectively analyzed.According to the surgical methods，they were divided into UBE group and MIS-TLIF group.There were 22 patients in UBE group，including 10 males and 12 females.The patients aged 37~71 years，with an average age of (67.6±9.2)years.There were 24 patients in MISTLIF group，including 11 males and 13 females.The patients aged 52 to 75 years，with an average age of (66.7±8.6)years.The operation time，incision length，postoperative drainage volume，length of hospital stay，visual analogue scale(VAS)，oswestry disability index(ODI)，modified MacNab criteria，fusion rate and complications were compared between the two groups.Results Compared to the MIS-TLIF group，the operation time of the UBE group was longer，but the postoperative drainage volume was less than that of the MISTLIF group，the hospital stay was shorter，and the surgical incision was smaller.The difference was statistically significant.In terms of surgical efficacy，the VAS scores of UBE patients at the 2 week，1 month，and 3 month follow-up were lower than those of the MIS-TLIF group，and the differences between the two groups were statistically significant，especially at 3 months after surgery.Also，there were no statistically significant differences between the two groups at the 6 month and 12 month follow-up.There were statistically significant differences between the two groups in ODI score at the 2 week and 1 month follow-up and patients in the UBE group presented with lower scores.There were no statistically significant differences between the two groups at the 3 month，6 month and 12 month follow-up.At the 6 month follow up after surgery，there were no statistically significant differences between the two groups in terms of the excellent and good rate and the fusion rate.Conclusion Unilateral biportal endoscopy for the treatment of prolapsed lumbar disc herniation with lumbar instability allows for smaller surgical incisions，relief of patient pain in the early postoperative period，and its operational flexibility and open field of view are worth promoting clinically.
2022 Vol. 28 (12): 1057- [Abstract] ( 226 ) HTML (1 KB)  PDF (1862 KB)  ( 256 )
1062 Effects of Osteoporosis on the Sagittal Spine-pelvic Parameters in Elderly Patients
Objective To investigate the effects of osteoporosis on the sagittal spinepelvic parameters in elderly patients.Methods 115 patients with osteoporosis received from the osteoporosis specialist outpatient clinic of Department of Orthopedics in Union Hospital of Tongji Medical College from June 2020 to June 2021 were selected as the observation group.21 males and 94 females were included.The age ranged form 58 to 79，with an average age of (67.76±9.17)years.60 patients without osteoporosis who came to our hospital for health examination during the same period were selected as the control group including 18 males and 42 females.The age ranged form 54 to 76，with an average age of (65.25±10.38)years.Low-radiation X-ray machine was used to take lateral X-rays of the spine including the hip joint in the standing position to assess the spine-pelvic sagittal morphology.Thoracic kyphosis(TK)，lumbar lordosis(LL)，pelvic incidence(PI)，pelvic tilt(PT)，sacral slope(SS)and the sagittal vertical axis(SVA)were measured.The intraclass correlation coefficient(ICC)was used to evaluate the reliability of the intraobserver and interobserver.The spinepelvic sagittal parameters of the two groups were compared to analyze the effects of osteoporosis on the sagittal spine-pelvis parameters in elderly patients.Results The intra-observer and inter-observer ICC were 0.90～0.95.There were significant differences between the observation group and the control group in SVA，SS，PT，LL and TK (P＜0.05).PI of the observation group was not statistically different from that of the control group(P＞0.05).Conclusion The sagittal spinopelvic parameters in elderly patients change mainly in SVA，SS，PT，LL and TK after osteoporosis，while the PI is relatively constant.
2022 Vol. 28 (12): 1062- [Abstract] ( 176 ) HTML (1 KB)  PDF (1112 KB)  ( 206 )
1066 Arthroscopic Releasing Combined with Upper Limb Rehabilitation Training Robot in the Treatment of Elbow Stiffness
Objective To explore the clinical efficacy of arthroscopic releaseing combined with active upper limb rehabilitation training robot for elbow stiffness.Methods 31 patients with elbow stiffness treated in Hongdu hospital of TCM from January 2018 to June 2021 were collected.After the study was approved by the hospital ethics committee and obtained the informed consent of the patients，they were randomly divided into two group.There were 15 cases in the control group and 16 cases in the observation group.The patients in the control group were treated with simple arthroscopic elbow releasing surgery.In the control group，there were 8 males and 7 females with an average age of (33.5±6.2)years.The observation group were treated with arthroscopic release surgery combined with adaptive tracking active upper limb rehabilitation training robot training.In the observation group，there were 10 males and 6 females with an average age of (37.2±5.2)years.The changes of range of motion(ROM)before and after operation were compared between the two groups，and the rehabilitation of elbow function was evaluated by Mayo score standard.Results The patients in both groups were followed up for 10 to15 months，with an average of (11.5±3.3)months.According to the Mayo score，excellent rate and joint range of motion of the two groups after operation were higher than those before operation，and the increase in the observation group was more obvious than that in the control group(P＜0.05).Conclusion Arthroscopic releasing combined with adaptive tracking active upper limb rehabilitation training robot in the treatment of elbow stiffness is better than simple arthroscopic release in the improvement of elbow range of motion and function，and has a good clinical effect.
2022 Vol. 28 (12): 1066- [Abstract] ( 134 ) HTML (1 KB)  PDF (3865 KB)  ( 269 )
1070 Comparative Study of Biological Short Stem and Standard Stem in Total Hip Replacement through Direct Anterior Approach in Lateral Decubitus Position for Osteonecrosis of the Femoral Head
Objective To compare the clinical efficacy of biological short stem and standard stem in total hip arthroplasty(THA)through direct anterior approach(DAA)in lateral decubitus position in the treatment of osteonecrosis of the femoral head(ONFH).Methods A total of 145 hips were enrolled in a retrospective analysis of patients with ONFH admitted to Ward of Osteonecrosis and Joint Reconstruction of Honghui Hospital from January 2019 to March 2021.There were 69 hips(34 males and 35 females，aged 59.16±8.86 years) in the short stem group and 76 hips(35 males and 41 females，aged 58.28±8.59 years) in the standard stem group according to the type of femoral stem prosthesis.Perioperative indexes，including operative time，incision length and intraoperative blood loss were compared between the two groups.Visual analogue score(VAS) of pain before surgery and 1，3，7 days after surgery，Harris score of hip joint before surgery and 1，3，6 months after surgery and the last followup were recorded.Preoperative and postoperative Xray films were used to measure hip eccentricity，implant subsidence and varus migration.Results There were no significant differences in operative time and incision length between the two groups(P＞0.05).The amount of intraoperative blood loss in the short stalk group was less than that in the standard stalk group(P＜0.05).There was no significant difference in preoperative and postoperative VAS between two groups(P＞0.05).Preoperative Harris hip score was not significantly different between the two groups(P＞0.05)，there was significant difference between 1 and 3 months after operation(P＜0.05)，and there was no significant difference in the scores at 6 months after operation and at the last follow-up(P＞0.05).Follow-up imaging measurements 12 months after surgery showed that 2 patients in the short stem group had prosthesis migration >3 °.The deviation angle of the standard stem group was less than 3°.There were 3 cases of prosthesis sinking more than 3 mm in short stem group.Standard stem group prosthesis sinking was less than 3 mm.The difference of bilateral eccentricity was less than 4 mm between the two groups.Conclusion Compared with the standard handle，the short stem hip prosthesis has more advantages in THA treatment of ONFH with DDA approach，which can reduce the difficulty of intraoperative treatment of femoral side，shorten the operation time，reduce intraoperative bleeding，and achieve higher postoperative satisfaction.
2022 Vol. 28 (12): 1070- [Abstract] ( 175 ) HTML (1 KB)  PDF (2956 KB)  ( 249 )
1074 Study on the Relation between Metabolic Syndrome and Deep Vein Thrombosis after Total Knee Arthroplasty
Objective To study the correlation between the incidence of total deep vein thrombosis(DVT)and symptomatic DVT after total knee arthroplasty(TKA)and each component and quantity of the metabolic syndrome(MS).Methods 618 patients who underwent initial TKA in our department from January 2020 to December 2021 were retrospectively analyzed.MS was diagnosed according to the criteria of the Diabetes Branch of Chinese Medical Association.There were 166 male patients aged 50～81 years，with an average age of (66.94±6.90)years and 452 female patients aged 52～81 years，with an average age of (65.90±7.57)years.All patients were also divided into five groups(0MS factor group，1MS factor group，2MS factor group，3MS factor group，and 4MS factor group)based on the number of MS components achieved.All subjects underwent preoperative bilateral lower extremity vascular ultrasound to rule out preoperative lower extremity DVT，and postoperative bilateral lower extremity vascular ultrasound to screen for DVT.Clinical signs were also examined and symptomatic DVT events after TKA were recorded.Univariate and multifactorial logistic regression analyses were used to clarify the correlation between MS and its components and quantities with the incidence of total and symptomatic postoperative DVT.Results 618 patients undergoing TKA were included in this study.260 patients(42.10%)had DVT after surgeries and 49 patients(7.93%) had symptomatic DVT.In total knee arthroplasty，dyslipidemia was related with both the incidence rate of total DVT ［95% CI(1.492~3.310)，P＜0.001］ and symptomatic DVT ［95% CI(2.192~15.232)，P＜0.001］.Body mass index(BMI) ≥25 kg／m2 was related with total DVT ［95% CI(0.371~0.801)，P＝ 0.027］ was related with the incidence rate of total DVT ［95%CI(0.623~4.777)，P＝0.074］and metabolic syndrome was related with the incidence rate of total DVT ［95%CI(2.221~7.384)，P＝0.042］ and not related with symptomatic DVT ［95%CI(1.036~12.575)，P＝0.077］.Conclusion Patients with MS have increased risk of the incidence rate of total DVT after total knee arthroplasty.Dyslipidemia in the MS component is an independent risk factor for the incidence rate of total DVT and symptomatic DVT after total knee arthroplasty，and overweight(BMI≥25 kg／m2) is an independent risk factor for the incidence rate of total DVT after total knee arthroplasty.The incidence rate of total DVT and symptomatic DVT after total knee arthroplasty is related to the number of MS components；the higher the number of MS components，the higher the incidence rate of total DVT and symptomatic DVT after surgery.
2022 Vol. 28 (12): 1074- [Abstract] ( 177 ) HTML (1 KB)  PDF (514 KB)  ( 157 )
1079 Analysis of the Oxidative Stress State and the Expression of Beclin1 and Mtor in the Tendons and Bone Tissues of Patients With Rotator Cuff Injury
Objective Tobserve the oxidative stress response and the differential expression of Beclin1 and mTOR in the bone tissues of the tendon and the footprint area of the rotator cuff when the rotator cuff injury occurs.Methods Twenty patients with rotator cuff injury were selected，including 10 males and 10 females.The average age was(61.52±7.32).All patients underwent shoulder arthroscopic rotator cuff anchor repair.The injured tendon tissue and bone tissue samples at rotator cuff insertion were taken as the injured group，and the normal tendon tissue and bone tissue samples beside the footmark were taken as the control group.The DCFHDA method was used to detect the total reactive oxygen species(ROS) level in the tendon and bone tissue samples，the DHE method was used to detect the superoxide dismutase(SOD) content；the RTPCR technique was used to detect the expression of Beclin1 and mTOR mRNA in the tendon and bone tissue.Western blot(WB) detects Beclin1，p-mTOR/mTOR protein expression.Results Compared with the control group，in the injured group，total reactive oxygen species(ROS)，Beclin1 gene and protein were up-regulated(P＜0.05)，mTOR gene and p-mTOR protein were down-regulated(P＜0.05)，and superoxide dismutase(SOD)was down-regulated in the tendon and up-regulated in the bone tissue(P＜0.05).mTOR protein in the injury group was not significantly up-regulated(P＞0.05).Conclusion Rotator cuff injury stimulates the oxidative stress response in the tendon and in the bone tissue of rotator cuff stop point and foot print area，and can also regulate the expression of autophagy factors Beclin1 and mTOR.It affects the healing of the rotator cuff，indicating oxidative stress and autophagy，and has an important regulatory effect on tendonbone healing.
2022 Vol. 28 (12): 1079- [Abstract] ( 151 ) HTML (1 KB)  PDF (1370 KB)  ( 247 )
1084 Effect and Mechanism of Adiponectin on Bone Quality and Biomechanics of Vertebral Body Strengthened with Calcium Phosphate Cement in Osteoporosis Rats
Objective To study the effect and mechanism of adiponectin(APN)on bone quality and biomechanics of vertebral body strengthened with calcium phosphate cement(CPC) in osteoporosis rats.Methods Thirty osteoporosis model rats were prepared by bilateral oophorectomy.They were randomly divided into control group，1 mg/kg APN group and 2 mg/kg APN group.All rats were strengthened with CPC of the fourth lumbar vertebra.7 days later，they were given local injection of normal saline，1 mg/kg APN and 2mg/kg APN respectively for 4 weeks.Bone mineral density，trabecular volume fraction(BV/TV)，average trabecular thickness(Tb.Th)，average trabecular number(Tb.N)，maximum coincidence，stiffness and relative expression levels of alkaline phosphatase(ALP)，osteocalcin(OCN)，osteopontin(OPN)，phosphorylated p38MAPK(pp38 MAPK)，phosphorylated JNK(pJNK)，phosphorylated ERK1/2(pERK1/2)were measured.Results Bone mineral density，BV/TB，Tb.Th，Tb.N，maximum coincidence，stiffness and mRNA relative expression levels of ALP，OCN，OPN and protein relative expression levels of ALP，OCN，OPN，p-p38mpak，p-JNK and p-ERK1/2 were higher than those of the control group.Conclusion APN enhances the bone mass and biomechanical strength of vertebral body strengthened with calcium phosphate cement in osteoporosis rats，and the activation of p38MAPK，JNK，ERK1/2 pathways are related molecular mechanisms.
2022 Vol. 28 (12): 1084- [Abstract] ( 153 ) HTML (1 KB)  PDF (1180 KB)  ( 157 )
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