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2024 Vol. 30, No. 3
Published: 2024-03-28
 
193 Expert Consensus on the Treatment of Lumbar Spinal Stenosis Using One-hole Split Endoscopy Technique
Minimally Invasive Spine Expert Committee of the Chinese Association of Traditional Chinese Medicine，Orthopaedic Rehabilitation Committee of Chinese Association of Rehabilitation Medicine，Spine Surger
The incidence of lumbar spinal stenosis (LSS) is increasing year by year，which has seriously affected the physical health and quality of life of middle-aged and elderly people.At present，the commonly used methods for spinal endoscopic treatment of LSS include unilateral biportal endoscopy (UBE)，One-hole Split Endoscopy(OSE)，and percutaneous transforaminal endoscopic discectomy(PTED).The trauma of OSE for LSS is smaller than that of UBE (one surgical pathway).OSE has more thorough decompression of the spinal canal and nerve root than PTED.OSE has the advantages of short surgical operation time，less intraoperative bleeding，less surgical trauma，and fast postoperative recovery.Although OSE technology has been successfully applied in clinical treatment for 4 years，its awareness and popularity are still insufficient.At present，there is a lack of expert consensus and guidelines for OSE treatment of LSS.To further improve the understanding and mastery level of OSE among spinal surgeons，Under the sponsorship of the Spinal Minimally Invasive Expert Committee of the Chinese Society of Traditional Chinese Medicine，the Orthopaedic Rehabilitation Professional Committee of the Chinese Rehabilitation Medicine Association，and the Spinal Surgery Expert Group of the Orthopaedic Physician Regular Assessment Professional Committee of the Chinese Medical Association，and with the cooperation of the Basic Medical Work Committee of the Shandong Geriatrics Association，OSE expert members refer to the guidelines recommended by the World Health Organization to develop methods，determine important clinical problems to be solved through investigation，and evaluate literatures published in the field of OSE，UBE，PTED.Based on current evidence-based medicine，recommendations were ultimately formed through Delphi voting and expert group discussions，covering the indications，contraindications，diagnosis，surgical methods，surgical procedures，postoperative rehabilitation considerations，and preoperative and postoperative evaluations of OSE.The aim was to provide clinical guidance and assistance for spinal surgeonswhen using OSE for LSSand to improve the diagnosis and treatment level of LSS spinal endoscopy in China.
2024 Vol. 30 (3): 193- [Abstract] ( 158 ) HTML (1 KB)  PDF (2401 KB)  ( 67 )
205 Establishing a Prediction Model for Post-Operative Refracture of Osteoporotic Vertebral Compression Fractures
Shi Zhan，Fan Mingxing，Wang Qilong，He Da
Objective〓To investigate the risk of refracture after osteoporotic vertebral compression fracture (OVCF) surgery，construct a risk prediction model，and identify effective prevention and treatment measures.Methods〓A total of 119 patients with OVCF admitted to Beijing Jishuitan Hospital from August 2021 to June 2022 were selected as the research subjects.According to the occurrence of postoperative refracture，they were divided into a recurrent group and a non-recurrent group.The recurrent group comprised 22 patients (11 males and 11 females) with a mean age of (72.02±5.58)years，while the non-recurrent group consisted of 97 patients (50 males and 47 females) with a mean age of (70.79±6.81)years.Statistical analysis was conducted on the general characteristics of both groups.The Lasso-Logistic regression model was used to screen the independent variables of recurrent fractures after OVCF surgery.The Akaike’s information criterion (AIC) and Bayesian information criterion (BIC) were used to compare the predictive performance of full variable logistic regression，stepwise logistic regression，and Lasso-Logistic regression.The nomogram model was constructed，and the receiver operating characteristic (ROC) and calibration curve were used to analyze the performance of the nomogram model for recurrent fractures after OVCF surgery.Results〓After a follow-up period ranging from 8 to 20 months，with a mean duration of (12.00±2.40)months.Univariate analysis revealed significant differences between the refracture and non-refracture groups in terms of body mass index (BMI)，bone mineral density T-score，tartrate-resistant acid phosphatase 5b(TPACP-5b)，receptor activator of nuclear factor kappa B ligand (RANKL)，osteoprotegerin (OPG)，postoperative anti-osteoporosis treatment，interleukin(IL)-17，history of long-term glucocorticoid use，spinal deformity index (SDI) value，surgical segment Cobb angle，kyphosis angle，and number of operated vertebral bodies (P＜0.05).The Lasso-Logistic regression model analysis identified an optimal lambda.lse value of 0.049，at which point the variables included in the model were bone density，SDI value，IL-17，and postoperative anti-osteoporosis treatment.Validation using BIC and AIC confirmed the good fitting and predictive capabilities of the constructed model.The nomogram model demonstrated an area under the receiver operating characteristic curve(AUC) of 0.865，with a sensitivity of 95.45% and a specificity of 68.04%.Additionally，the calibration curve indicated a close alignment between the model’s predictions and actual outcomes.Conclusion〓The occurrence of postoperative re-fracture after OVCF is affected by various aspects during the perioperative period，including BMD T-value，SDI value，Cobb angle of the operated segment，IL-17，posterior convexity angle，postoperative anti-osteoporosis treatment，and the number of operated vertebral bodies，based on which the risk of re-fracture of the patients can be predicted effectively，providing a reference basis for the prevention and treatment of re-fracture in the clinic.
2024 Vol. 30 (3): 205- [Abstract] ( 151 ) HTML (1 KB)  PDF (1621 KB)  ( 153 )
211 Effect of Intervertebral Differential Dynamic System Combined with Tergumed on Lumbar Disc Herniation
Fan Chen，Shi Xiuxiu，Fan Ru，Hou Shuxun，Li Xiao，Liu Kemin
Objective〓To observe and compare the efficacy of intervertebral differential dynamics (IDD) combined with proxomed tergumed (Tergumed) and IDD combined exercise therapy in the treatment of patients with lumbar disc herniation.Methods〓64 lumbar disc herniation (LDH) patients who met the inclusion and exclusion criteria at the Fourth Medical Center of the General Hospital of the Chinese People’s Liberation Army from March 2022 to March 2023 were randomly divided into a experiment group and a control group using a random number table method.There were 32 cases in the experimental group，including 18 males and 14 females，aged from 26 to 60 years old，with an average age of (50.21±5.53) years old.There were 32 cases in the control group，including 19 males and 13 females，aged from 29 to 59 years old，with an average age of (50.65±6.12) years old.Both groups were given health education，and the control group was treated with IDD combined with exercise therapy once a day，5 times a week for 4 weeks.The experimental group was treated with IDD combined with Tergumed，and the IDD treatment was the same as the control group.The patients had Tergumed training three times a week for a total of 12 units for 4 weeks.The visual analogue scale (VAS) was used to evaluate the degree of lumbar pain，and the Oswestry disability index (ODI) was used to evaluate the change in the degree of dysfunction.Tergumed was used to evaluate lumbar biomechanical data-changes in lumbar flexion，dorsiflexion range of motion，and maximum muscle strength-in both groups.They were evaluated before treatment，at 4 weeks，and at 16 weeks.Results〓Before treatment，there were no significant differences in VAS score，ODI score，lumbar anterior flexion，dorsiflexion motion and maximum muscle strength between two groups (P＞0.05).After 4 weeks and 16 weeks of treatment，VAS，ODI and biomechanical data of 2 groups were better than before treatment，the difference was statistically significant (P＜0.05).After 16 weeks of treatment，there was no statistically significant difference in pain VAS score between the two groups (P＞0.05)，and the lower limit of 95% confidence interval 0.19(－0.07~1.03) was greater than the preset－1，meeting the non-inferiority test standard.After 4 weeks of treatment，there was no significant difference in the changes of ODI and biomechanical data between the two groups (P＞0.05).At 16 weeks，the changes in the maximum muscular strength values of flexion and extension in the experimental group were better than those in the control group before treatment (P＜0.05).Conclusion〓The clinical efficacy of IDD combined with Tergumed in the treatment of LDH patients is not inferior to that of IDD combined with conventional exercise therapy，which can significantly relieve pain，increase lumbar muscle strength and improve lumbar function under the premise of labor saving，and is safe and reliable，worthy of clinical promotion.
2024 Vol. 30 (3): 211- [Abstract] ( 110 ) HTML (1 KB)  PDF (1574 KB)  ( 101 )
217 A Prognostic Nomogram Model to Predict Deep Vein Thrombosis in Preoperative Pelvic Fracture Patients
Li Yongxia，Jiang Jiamei，Shi Dongcheng，Wu Wei，Zhu Xiaoguang，Feng Qiming
Objective〓To investigate the risk and prognostic factors of deep vein thrombos(DVT) is in pelvic fracture patients before surgery and to develop a nomogram model to predict the risk of DVT.Methods〓A retrospective observational study was conducted，including 665 patients hospitalized in the emergency intensive care unit(EICU) with pelvic fractures from January 2017 to January 2022.The value of stress hyperglycemia ratio(SHR) was calculated based on the patient’s immediate blood glucose and hemoglobin A1c(HbA1c).According to the results of ultrasound examination，the subjects were divided into DVT group and non-DVT group.There were 236 patients in the DVT group，including 165 males and 71 females，aged from 18 to 89 years old，with an median age of 56 years old.There were 429 patients in the non-DVT group，including 312 males and 117 females，aged from 19 to 92 years old，with an median age of 49 years old.The differences of demographic characteristics，laboratory indicators，injury severity score(ISS) and other data were compared.Logistic regression analysis was used to screen for risk factors in the DVT group.Logistic regression analysis was applied to identify independent risk factors for DVT after pelvic fracture.Receiver operating characteristic(ROC) curve was used to analyze the predictive the clinical value of those parameters to predict preoperative DVT.Results〓Significant differences were observed between the DVT and non-DVT groups in age，ISS，hemoglobin，platelet，albumin，blood glucose，SHR，the 24-hour RBC transfusion volume and length of hospital stay(P＜0.05).Logistic regression analysis revealed that the following factors were independent risk factors for DVT：Age between 50 and 69 years (OR=2.02，95%CI：1.4~2.95，P＜0.001)，age over 70 years (OR=4.74，95%CI：2.57~8.97，P＜0.001)，ISS (OR=1.57，95% CI：1.11~2.23，P＝0.012)，hemoglobin levels of 100~124 g/L (OR=0.53，95% CI：0.36~0.80，P＝0.002)，hemoglobin levels over 124 g/L (OR=0.32，95% CI：0.21~0.50，P＜0.001)，and SHR (OR=1.64，95% CI：1.12~2.41，P＝0.011).ROC curve analysis demonstrated that the area under the ROC curve (AUC) for age，ISS，hemoglobin，and SHR in predicting DVT were 0.63，0.59，0.64，and 0.57，respectively，with an overall AUC of 0.72.A predictive nomogram model was constructed using these identified risk factors.The calibration chart of the model indicated a good agreement between the predicted probability and the actual occurrence probability，and decision curve analysis confirmed the nomogram’s ability to predict the risk of DVT.Conclusion〓 Age，ISS，hemoglobin levels，and SHR are independent risk factors for DVT in preoperative pelvic fracture patients.The nomogram prediction model，based on logistic regression，exhibits good predictive efficacy for DVT in this patient population.
2024 Vol. 30 (3): 217- [Abstract] ( 107 ) HTML (1 KB)  PDF (1659 KB)  ( 81 )
222 A Comparative Study of Sacroiliac Screw Placement Guided By 3D Printing Screw Guide and Navigation
Gao Bo，Wu Bi，Yan Min，Jiang Wei，Wang Hong，Chen Xi，Liu Yuehong
Objective〓This study aimed to compare the clinical effectiveness of 3D printing screw guides with navigation in assisting surgery for sacroiliac screw placement.Methods〓We retrospectively analyzed clinical data from 32 patients who underwent surgical treatment for sacroiliac joint injuries using sacroiliac screws between June 2018 and June 2021.Patients were divided into two groups：The 3D printing screw guide group (17 cases) and the navigation group (15 cases).In the 3D printing screw guide group，13 males and 4 females with a mean age of (37.81±9.73)years old (range：23~56 years old) were included，with 10 cases of Tile type B and 7 cases of type C.The navigation group comprised 12 males and 3 females with a mean age of (36.23±9.35)years old (range：23~58 years old)，including 9 cases of Tile type B and 6 cases of type C.We compared intraoperative fluoroscopy frequency，screw placement time，intraoperative blood loss，and postoperative complications between the two groups.Pelvic function was evaluated one year postoperatively using the Majeed score，and fracture reduction was assessed using Matta criteriaResults〓 There were no wound infection or nerve injury complications in either group.All patients were followed up for an average of (19.82±0.25)months (range：12~32 months).Comparisons between the two groups revealed no significant difference in intraoperative fluoroscopy frequency (P＞0.05).However，intraoperative blood loss was higher in the 3D printing screw guide group than in the navigation group (P＜0.05).Conversely，screw placement time was shorter in the 3D printing screw guide group compared to the navigation group (P＜0.05).According to Matta criteria，the 3D printing screw guide group had 12 excellent，4 good，and 1 fair cases，while the navigation group had 11 excellent，3 good，and 1 fair cases (P＞0.05).According to Majeed score at one year after operation，ranged from 67 to 93，mean (85.76±6.86) in 3D printing screw guide group，and ranged from 68 to 92，mean (86.47±7.37) in the navigation group(P＞0.05).Conclusion〓 The use of 3D printing screw guides in assisting sacroiliac screw placement surgery offers advantages such as reduced screw placement time，accurate nail placement，and does not require high-tech equipment.This approach could be promoted in clinical practice.
2024 Vol. 30 (3): 222- [Abstract] ( 113 ) HTML (1 KB)  PDF (3320 KB)  ( 95 )
226 Relationship Between Stem Length and Aseptic Loosening of Prosthesis After Operation of Distal Femoral Tumor
Xu Gang，Chen Yu
Objective〓To investigate the effect of stem length on aseptic loosening after knee prosthesis replacement for tumors of distal femur.Methods〓A total of 164 patients with tumors of distal femur who underwent knee prosthesis replacement in Sichuan friendship hospital from June 2015 to June 2021 were selected.According to the aseptic loosening of the prosthesis during the follow-up of 2 to 8 years，the patients were divided into two groups：non-loosening group and loosening group.There were 126 patients in the non-loosening group，71 males and 55 females，aged from 25 to 69 years old，with an average age of (47.69±5.48) years old.There were 38 patients in the loosening group，including 24 males and 14 females，aged from 27 to 70 years old，with an average age of (46.12±5.33) years old.The clinical data of the two groups were compared.Kaplan-Meier method was used to analyze the relationship between the length of the stem and the service life of the prosthesis.Random forest algorithm and multivariate Logistic regression were used to analyze the factors affecting postoperative aseptic loosening of the prosthesis.The sensitivity of the research results was analyzed by correlation E-value method.The dose-effect relationship between the length of prosthesis stalk and postoperative aseptic loosening was analyzed by restriction cubic spline.Establish a prediction model and evaluate its prediction efficiency.Results〓The results of Kaplan-Meier analysis showed that the length of prosthesis handle was related to the service life of prosthesis (P＜0.001).The increase of the distance between the lower limb force line and the center of the knee joint were the risk factors of postoperative aseptic loosening of the prosthesis (P＜0.05)，the length of the prosthesis，the ratio of the diameter of the medullary stalk to the femur，mechanical lateral distal femoral angle (mLDFA) and the increase of postoperative hip knee ankle angle (HKAA) were protective factors (P＜0.05).Sensitivity analysis showed that E=2.015.In both male and female patients，there was no non-linear relationship between stem length and postoperative aseptic loosening (P＞0.05).When the model predicted that the probability of aseptic loosening of the prosthesis was 0.80，the Jordan index was the highest (77.77)，the accuracy was 92.24%，the sensitivity was 85.63%，the specificity was 92.14%，and the area under the subject working characteristic (ROC) curve was 0.825 (95% CI：0.766~0.884，P＜0.001).Conclusion〓The distance of lower limb force line from the center of knee joint，the length of prosthetic stem and the ratio of medullary stalk to femoral diameter are the influencing factors of aseptic loosening after knee prosthesis replacement in patients with distal femoral tumor.It is suggested that surgeons should choose longer prosthetic handle and thicker medullary handle to increase the fit of prosthetic medullary handle to the diameter of femur and medullary cavity diameter.Regular postoperative monitoring of the deviation of the lower limb force line is recommended，with prompt reconstruction of the lower limb force line when necessary.
2024 Vol. 30 (3): 226- [Abstract] ( 113 ) HTML (1 KB)  PDF (1818 KB)  ( 76 )
232 The Effect of Cement Distribution on Adjacent Vertebral Body Re-Fracture After PKP and Analysis of Related Risk Factors
Liao Changhe，Zhu Guxin，Ma Hangzhan
Objective〓To assess the impact of cement distribution following percutaneous kyphoplasty (PKP) on the occurrence of adjacent vertebral body re-fracture and to identify associated risk factors.Methods〓A retrospective study was conducted on 112 patients with single-segment osteoporotic vertebral compression fractures (OVCF) treated with PKP between August 2021 and May 2023.The patients were categorized into two groups：Recurrent fracture group and non-fracture group，based on the occurrence of re-fracture.The recurrent fracture group comprised 20 patients (6 males and 14 females) with a mean age of (77.50±7.34)years.Of these，12 fractures occurred in the thoracic segment and 8 in the lumbar segment.The non-fracture group included 92 patients (24 males and 68 females) with a mean age of (72.59±8.29)years，with 43 fractures in the thoracic segment and 49 in the lumbar segment.Clinical data were collected and analyzed using t-test and χ2 test.Logistic regression analysis was employed to identify risk factors for recurrent fracture.The predictive capability of risk factors and cement distribution for postoperative recurrent fracture was evaluated using receiver operating characteristic (ROC) curves and the area under the curve (AUC).Results〓The patients in both groups were followed up for 12 to 17 months，with a mean follow-up of (13.05±0.89) months in the re-fractured group and (12.33±2.20) months in the unfractured group.The incidence of recurrent fracture of adjacent vertebrae after PKP was 17.86%.Recurrent fractures occurred at a mean of (27.00±12.33)weeks after the initial PKP procedure.Statistical analysis revealed significant differences between the recurrent fracture and non-fracture groups in terms of age，recovery rate of the anterior vertebral body height，postoperative anti-osteoporosis treatment，bone cement distribution patterns，cement leakage，and recovery rate of the anterior vertebral body height (P＜0.05).Logistic regression analysis identified bone cement distribution patterns，absence of postoperative anti-osteoporosis treatment，and cement leakage as independent predictors of recurrent fracture following PKP (P＜0.05).Among the cement distribution patterns，type I exhibited a higher risk of postoperative recurrent fracture compared to types Ⅱ to Ⅴ(OR=12.764，P＜0.05).The predictive value of cement distribution typing for recurrent fracture after PKP was evaluated，revealing an area under the curve (AUC) of 0.277，with a sensitivity of 5.00% and a specificity of 72.80%.Conclusion〓Bone cement distribution type I has a higher risk of recurrent fracture compared to other distribution patterns.Bone cement dispersion patterns，lack of postoperative osteoporosis treatment，and cement leakage are all risk factors for recurrent fractures after PKP.
2024 Vol. 30 (3): 232- [Abstract] ( 152 ) HTML (1 KB)  PDF (2319 KB)  ( 136 )
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