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2023 Vol. 29, No. 6
Published: 2023-06-25
 
481 Clinical Study of Early Epidural Hematoma After Anterior Cervical Canal Decompression
Qi Hao，Gu Yuntao，Xu Chunzhao，Ren Shanwu，Zhao Hai，Fu Kun
Objective To investigate the causes，clinical treatment and preventive measures of early epidural hematoma after anterior cervical canal decompression.
Methods We retrospectively analyzed the clinical data of 1 685 patients admitted to the Second Affiliated Hospital of Hainan Medical College from January 2010 to December 2021 who underwent concurrent anterior cervical decompression surgery.All patients were treated with anterior cervical subtotal corpectomy and decompression and fusion or anterior cervical discectomy and decompression and fusion，among which 5 cases were complicated with early epidural hematoma.2 cases were male and 3 cases were female.The patients aged 55~69 years，with an average age of (62.40±5.27) years.Two cases were diagnosed with ossification of posterior longitudinal ligament of cervical vertebra and spinal cord before operation.The causes，appearance time，main clinical manifestations and reoperation time of early epidural hematoma in 5 patients were analyzed.Results All 5 patients were followed up for an average of (17.20±4.32) months.All 5 patients with early epidural hematoma occurred within 6 hours after surgery and underwent emergency surgical treatment.Cervical magnetic resonance examination before surgery showed that the hematoma compressed the spinal cord，and the operation proved to be the formation of epidural hematoma.All 5 patients recovered to the preoperative level or better than the preoperative level.Conclusion The peak period of early epidural hematoma occurrence after anterior cervical decompression surgery is within 6 hours after surgery.The main clinical manifestation of early epidural hematoma is progressive neurological impairment，and the diagnosis is mainly based on clinical manifestations and cervical magnetic resonance examination.Emergency operation to remove hematoma after diagnosis is the main measure to avoid permanent damage to neurological function.
2023 Vol. 29 (6): 481- [Abstract] ( 170 ) HTML (1 KB)  PDF (2493 KB)  ( 305 )
487 Fracture Reduction with Different Medial Cortical Support in Pertrochanteric Fractures Treated with Intertan Fixation
Zhang Xingsheng，Sang Qinghua，Zhang Xiaoguang，Yang Fei，Hu Liting，Li Dongliang
Objective To analyze the effects of different medial cortical support reduction on the results of radiological and clinical function in pertrochanteric fractures treated with InterTan fixation.Methods A total of 133 cases，including 61 men and 72 women，with average age (77.2±6.4)years of pertrochanteric fractures at Yanqing Hospital of Peking University Third Hospital were treated with InterTan from January 2017 to December 2020.They were divided into three groups according to the relationship of the medial cortex between the femoral shaft and the medial femoral neck after operation，positive support (group A，30 cases)，neutral support (group B，77 cases) and negative support (group C，26 cases).The patient demographic of the three groups were compared.The variations of neck-shaft angle and femoral neck length and functional scores after operation were also compared statistically.Results 133 patients were followed up for 3 to 24 months，with a mean follow-up of (12.1±8.9) months.In group C，two patients occurred cut-out，and underwent total hip arthroplasty revision.The rest of the patients had bony healing of the intertrochanteric fracture.At the final follow-up，the loss of neck stem angle was (2.10±1.61) °，(1.73±2.02) °，(5.60±5.61) ° in groups A、B  and C，respectively.And the loss of femoral neck length was (2.16±1.30) mm，(1.92±1.16) mm，(5.62±4.22) mm respectively.Group C showed the greatest loss of cervical stem angle and femoral neck length，with statistically significant differences compared with groups A and B (P＜0.05).After 1 months of follow-up，the functional recovery scores in group A and group B showed good functional outcomes than group C(P＜0.05)，while the basic activities of daily living were all recovered after at the final follow-up.There was no statistical difference among the three groups (P＞0.05).Conclusion Positive and neutral support reduction of medial cortex combined with InterTan fixation resulted in the least loss of neck stem angle and femoral neck length in patients and can achieve better clinical results early in the postoperative period.In our clinical practice，we should avoid negative medial cortical support reduction to reduce the incidence of complications such as screw cut-out.
2023 Vol. 29 (6): 487- [Abstract] ( 202 ) HTML (1 KB)  PDF (2103 KB)  ( 389 )
491 A Clinical Study of Patellofemoral Joint Replacement in the Treatment of Patellofemoral Joint Osteoarthritis
Liu Siye，Jing Lin，Zhang Hongmei，Yan Qi，Tang Jixiang，Li Yan，Ai Qi
Objective To investigate the clinical efficacy，surgical techniques and intraoperative precautions of patellofemoral arthroplasty(PFA) for patellofemoral osteoarthritis(PFOA).Methods A retrospective analysis of 146 knees in 134 patients with PFOA treated by PFA surgery in our department from August 2013 to December 2019，including 46 males and 88 females，aged 48~73 (52.4±7.6) years old.86 cases of left knee and 60 cases of right knee were included.According to Dejour classification，there were 23 knees of Type A，49 knees of Type B，54 knees of Type C，20 knees of Type D.The course of disease was 8 to 53 (17.1±3.2) months，and the patients were evaluated by preoperative VAS score and Lysholm knee joint score.Complications such as joint infections and hematomas after the operation were followed up at 1 month，3 months，2 years，and 4 years after the operation.The front and side Xrays of the knee joint and the patella axial film were taken and recorded VAS，Lysholm scores，efficacy evaluation，and patient satisfaction were statistically analyzed.Results The average follow-up time was 17 to 53 (32.1±6.8) months.The postoperative wounds of 134 patients of 146 knees healed at grade I，with a high degree of satisfaction.The effective rate of treatment was 97.95%.The VAS score was based on the preoperative score of (8.43±1.31).It descends to (1.43±0.19) points three months after surgery，and the VAS score reached (0.13±0.02) points at the last followup.The difference was statistically significant (P＜0.05).The Lysholm knee score increased from (46.08±2.08) points before surgery to (88.65±0.61) points three months after surgery，and reached (97.92±0.49) points at the last followup.The difference was statistically significant (P＜0.05).During the follow-up，1 case of knee pain with tilted patella，2 cases of patellofemoral joint snapping and patellar subluxation，all the above 3 patients underwent revision surgery，1 case had lower patella after revision，and no revision was performed again.The remaining patients did not Complications such as dislocation of the patella and loosening of the prosthesis occurred.Conclusion The second-generation prosthetic PFA surgery can solve the problem of patellofemoral joint osteoarthritis.It is an effective treatment for PFOA after failure of non-surgical treatment.In clinical practice，the indications and contraindications of PFA should be strictly grasped.Grasp the correct operation points during the operation，and take active rehabilitation exercise guidance after the operation.The effect is good.The treatment method is worthy of clinical promotion.
2023 Vol. 29 (6): 491- [Abstract] ( 167 ) HTML (1 KB)  PDF (3070 KB)  ( 259 )
497 Study on the Medium Term Efficacy of the Tantalum Monoblock Tibial Component in Primary Total Knee Arthroplasty
Wu Qi，Guo Haitao，Zhang Jingyi，Yan Ming，Diwu Weilong
Objective To compare the postoperative outcomes of the cementless tantalum monoblock tibial component (TMT) with cemented fixation of the tibial component in the primary total knee arthroplasty.Methods A retrospective analysis was performed on 54 patients (65 knees) who were treated with TMT and 43 patients (52 knees) with cemented fixation of the tibial component in primary TKA in Xijing Hospital from 2012 to 2015.There were 54 patients (65 knees) in TMT group，including 10 males and 44 females，with an average age of (62.8±5.6) years.There were 43 patients (52 knees) in cemented fixation of the tibial component group，including 8 males and 35 females，with an average age of (64.4±4.8) years.Knee society score(KSS)，range of motion (ROM)，visual analogue scale(VAS)and femorotibial angle(FTA)，radiographic evaluation，postoperative complications and the midterm survivor rate of prosthesis were compared between the two groups before and after operation.KSS，ROM，VAS and FTA were compared TMT group before and after operation.Results All patients had been followed up for 4~7 years，with an average of (5±1.8) years.There was no significant differences in KSS，ROM，VAS and FTA between two groups after operation.There was significant differences in KSS，ROM，VAS and FTA of TMT group before and after operation.1 case underwent revision due to knee instability in TMT group.2 cases underwent partial revision due to periprosthic joint infection (PJI) in cemented fixation of the tibial component group.Early radiolucent line in TMT group gradually disappeared showing good bone ingrowth.Incidence of PJI was lower in TMT group than in cemented fixation of the tibial component group.There was no significant difference in other complications and implant suevivorship between the two groups.Conclusion The application of TMT in the primary TKA has the advantage of better bone ingrowth and bacteriostasis，with good clinical results and better theoretical prosthesis survival rate.However，the long-term effect still needs to be observed and evaluated.
2023 Vol. 29 (6): 497- [Abstract] ( 146 ) HTML (1 KB)  PDF (1907 KB)  ( 168 )
502 Early Clinical and Radiographic Outcomes of Domestic Robot assisted Total Knee Arthroplasty
Du Mincong，Li Zheng，Jiang Yunfei，Xie Tianlang，Sun Wenxuan，li Qianli，Yang Shikang，Wu Jiangpeng，Cao Guanglei
Objective To explore the short-term clinical and radiographic outcomes of domestic robot assisted total knee arthroplasty(RATKA).Methods A prospective randomized controlled study was conducted.The patients who met the inclusion and exclusion criteria for TKA surgery during the period from October 2021 to March 2022 were selected and divided into RATKA group and conventional group randomly.A total of 23 patients were finally included and divided into RATKA group and conventional TKA group by random envelope method.There were 11 patients in the RATKA group，among them 3 males and 8 females.Their mean age is (68.7±7.8) years old.There were 12 patients in the traditional TKA group，which had 1 male and 11 females.Their mean age was (70.8±5.0) years old.The radiographical accuracy indicators of the two groups of patients were recorded and analyzed as well as clinical efficacy indicators，including the lower limb alignment and prosthesis position，operation time，blood loss，functional score，perioperative complications，etc.Results For radiographical indicators，the deviation value of HKA in RATKA group was lower than that in conventional TKA group，which were(1.16±1.14) °and (2.56±1.90) °，P＝0.047，respectively.The deviation value of LTC was also lower than that in traditional TKA group，which were (0.95±0.71) ° and (1.75±0.98) °，P＝0.039.The operation time in RATKA group was (125.0 ± 8.4) min，which was significantly longer than that in traditional TKA group (101.0±28.5) min，P＝0.027.As for the osteotomy time，perioperative blood loss，range of motion (ROM)，clinical scores，there was no statistically significant difference (P＞0.05).There was no significant difference in the incidence of perioperative complications between the two groups (P＞0.05).Conclusion With the help of domestic RATKA system，the initial total knee replacement is more accurate in lower limb alignment and lateral tibial prosthesis installation.It’s safe，reliable and worth promotion in clinic.
2023 Vol. 29 (6): 502- [Abstract] ( 173 ) HTML (1 KB)  PDF (5328 KB)  ( 297 )
509 Preliminary Effect of Percutaneous Large Channel Spinal Endoscopy in the Treatment of Elderly Lumbar Spinal Stenosis
Sun Zhiguo，Sha Xika，Xu Kuo，Zhang Shuwen，Wang Hao
Objective To explore the recent efficacy of percutaneous large channel spinal endoscopy in the treatment of single segment lumbar spinal stenosis in the elderly.Methods From January 2020 to January 2021，24 elderly patients with single level degenerative lumbar spinal stenosis were treated by percutaneous large channel spinal endoscopy in our department，including 13 males and 11 females.The average age was 60~84 years (72.6±4.3).The section of responsible included 4 cases at L3～4 segment，12 cases at L4～5 segment，and 8 cases at L5S1 segment.Lumbar spinal stenosis patients included 6 cases of central type，12 cases of lateral recess type，6 cases of central type combined with lateral recess type.Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the patients before and after surgery，and MacNab was improved to evaluate the clinical efficacy of patients.Results The 24 patients in this group successfully completed the operation.The operation time was 55~86 min (65.3±10.4) min.Tthe intraoperative fluoroscopy was 3~5 times (3.2±0.2) times.The length of the surgical incision was about 10 mm，and the hospital stay was 3~7 days (4.1±0.3) days.Dural sac tear occurred in 1 patient during operation.One patient had pain and allergy in the affected limb.There were no obvious sequelae after symptomatic treatment.The patients were followed up for 12 to 24 months (16.3±2.1) months.The VAS score and ODI score of lumbar and leg pain after surgery were statistically different from those before surgery (P＜0.05).There was significant difference between each time point after operation (P＜0.05).At 12 months after operation，the modified MacNab evaluation showed that the curative effect was excellent in 18 cases，good in 3 cases，and fair in 3 cases，with an excellent and good rate of 87.5%.Conclusion Percutaneous large channel spinal endoscopy for the treatment of elderly single segment lumbar spinal stenosis has the advantages of less trauma，less bleeding，short hospital stay，quick postoperative recovery，and good short-term effect.
2023 Vol. 29 (6): 509- [Abstract] ( 146 ) HTML (1 KB)  PDF (3286 KB)  ( 286 )
515 Application of a New Positioning and Puncture Device for Percutaneous Endoscopic Lumbar Discectomy
Li Guodong，Zhuo Simin，Pan Shixin，Pan Jingwei，Li Quan，He Enmou，Yang Long，Gan Xiutian
Objective To develop a novel puncture localization device and evaluate its application value in assisting puncture localization in lumbar intervertebral foramen surgery.Methods A right triangle can be constructed in the three-dimensional space of the lumbar spine，and the hypotenuse was that the ideal puncture path for the posterolateral approach.According to this principle，a puncture positioning device was developed to assist surgery.From June 2020 to April 2021，there were 64 patients diagnosed with single segment lumbar disc herniation and underwent percutaneous transforaminal surgery in the orthopedic department of Wuzhou Red Cross Hospital，including 34 males and 30 females.The age range was 22~79 years，with an average of (55.15±16.42) years old.Patients were randomly divided into a puncture positioning device group and a traditional group that completed puncture positioning with freehand technqiue under C-arm fluoroscopy.Among them，the device group had 34 cases and the traditional group had 30 cases.We compare the puncture frequency，puncture time，fluoroscopy frequency，visual analogue scale(VAS) pain score，Japanese Orthopaedic Association (JOA) score，and Oswestry Disability Index (ODI) of two groups of patients at specific times before and after surgery.Results The puncture frequency，puncture time，and fluoroscopy frequency of the positioning device group were all lower than those of the traditional group，with a statistically significant difference (P＜0.05).The JOA score and ODI index of the two groups of patients improved significantly at 1 day and 6 months after surgery compared to before surgery (P＜0.05)；There was no statistically significant difference in VAS score，JOA score，and ODI index between the two groups (P＞0.05).Conclusion Right triangle measurement can be used as a new preoperative design method.The application of this new puncture positioning device in lumbar intervertebral foramen endoscopic surgery can reduce the number and time of punctures，improve accuracy，and is particularly suitable for beginners.
2023 Vol. 29 (6): 515- [Abstract] ( 139 ) HTML (1 KB)  PDF (8655 KB)  ( 37 )
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