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2024 Vol. 30, No. 5
Published: 2024-05-28
 
395 The Effect of Preoperative Paravertebral Muscle Degeneration on the Early Outcome of Single-Level PE-PLIF Surgery
Zhang Zhengyu，Wang Guotai，Feng Haoyu，Wu Hua
Objective To investigate the correlation between the reduction in cross sectional area (CSA) and fatty infiltration (FI) of anterior paraspinal muscles and psoas major muscles，and the degree of pain and functional status prior to surgery.Furthermore，we aim to determine whether these factors influence the surgical outcomes of percutaneous endoscopic posterior lumbar interbody fusion (PE-PLIF).Methods A total of 110 patients with lumbar degenerative diseases who met the criteria and underwent single-level PE-PLIF surgery for the first time in the Orthopaedics Department of Shanxi Bethune Hospital from September 2021 to September 2022 were selected.The cohort consisted of 61 males and 49 females，ranging in age from 35 to 70 years，with an average age of (51.98±13.49)years.Prior to surgery，the relative cross sectional area (rCSA) of the paraspinal muscles and psoas major muscles，as well as the fatty infiltration of the paraspinal muscles，were measured.The Oswestry disability index (ODI) and visual analogue scale (VAS) were used to evaluate the patients’ condition before surgery and at 1，6，and 12 months post-surgery.The correlations between variables were calculated using Pearson’s and Spearman’s correlation coefficients.The Kruskal-Wallis test was employed to compare the outcomes between subgroups with different rCSA values of the paraspinal and psoas major muscles and varying degrees of paraspinal muscle fatty infiltration.Results Paraspinal muscle fat infiltration was significantly correlated with ODI and VAS scores before operation (r＝0.420，P＜0.001 and r＝0.215，P＝0.024).ODI scores at 1 month and 6 months after surgery showed that paraspinal muscle fat infiltration was associated with good prognosis (r＝0.208，P＝0.030 and r＝0.192，P＝0.044).Conclusion Paraspinal muscle fat infiltration is closely related to pain and dysfunction before operation，and is associated with good prognosis at 1 month and 6 months after operation.
2024 Vol. 30 (5): 395- [Abstract] ( 121 ) HTML (1 KB)  PDF (1554 KB)  ( 64 )
400 Construction of a Column Chart Prediction Model for the Recovery Effect of Finger Replantation Function
Li Jianqiang，Jin Yu，Zhao Wenxian，Sun Hongfei
Objective To explore the risk factors for poor functional recovery of replanted fingers，and establish a predictive model for poor functional recovery of severed fingers.Methods A retrospective analysis was performed on the data of 309 patients (376 severed fingers) who underwent finger replantation surgery at Tangshan People’s Hospital between May 2017 and May 2022.Among them，231 males accounted for 274 severed fingers，while 78 females accounted for 102 severed fingers，with ages ranging from 19 to 67 years，and an average age of (41.57±8.59)years.One year post-surgery，the recovery of severed finger function was assessed，and patients were categorized into a poor recovery group and a control group.Univariate screening was conducted to collect data on patients’ general demographic characteristics，disease information，surgical details，and preoperative blood routine indicators.Multivariate analysis was then utilized to identify risk factors for poor finger function recovery，and the effect size of each indicator was visualized in a forest plot.Subsequently，a predictive model using column charts was constructed，and its efficacy was evaluated through the receiver operating characteristic (ROC) curve area under the curve (AUC)，calibration curve，and decision curve analysis (DCA).Results Among the 309 patients (376 severed fingers)，68 patients (81 severed fingers) exhibited poor postoperative functional recovery，representing 21.54% of the total.Statistically significant differences were observed between the two groups in smoking history，nature of injury，degree of amputation，amputation plane，exposure time of severed fingers，preservation method of severed fingers，and compliance with medical advice on rehabilitation exercise (P＜0.05).Logistic regression analysis revealed that the primary risk factors for poor functional recovery of severed fingers after surgery were smoking history，avulsion injury，amputation plane non-distal to the phalanx，exposure time of severed fingers ≥8 hours，and failure to adhere to medical advice on rehabilitation exercise.Internal validation indicated an AUC of 0.819 (95% CI：0.762~0.875)，suggesting a high consistency between the model’s predicted probability of poor functional recovery and the actual probability.The goodness-of-fit HL test yielded χ2=7.389 and P＝0.286，further supporting the model’s fit.DCA analysis demonstrated that the model exhibited good practicality within a risk threshold ranging from 12% to 75%.Conclusion The column chart model，constructed using variables such as smoking history，nature of injury，level of amputation，exposure time of severed finger，and compliance with medical advice on rehabilitation exercise，demonstrates a robust predictive effect for identifying poor functional recovery of severed fingers following replantation surgery.
2024 Vol. 30 (5): 400- [Abstract] ( 100 ) HTML (1 KB)  PDF (924 KB)  ( 64 )
404 “Double Cup” Technique：A Reliable Solution for the Treatment of Paprosky Type Ⅲ Acetabular Defects
Liu Quan，Zhang Rongwei，Mei Jiawei，Zhu Wanbo，Ma Ruixiang，Zhang Xianzuo，Zhu Chen
Objective To evaluate the early clinical outcomes of the “Double Cup” technique (titanium ring-free tantalum metal revision cup as an augmentation block) for the treatment of Paprosky Type Ⅲ acetabular defects.Methods A retrospective analysis was conducted to evaluate the early clinical outcomes of 54 revision cases treated with the “Double Cup” technique for Paprosky Type Ⅲ acetabular defects at the First Affiliated Hospital of University of Science and Technology of China.from 2017 to 2023.The cohort consisted of 27 male and 27 female patients，with ages ranging from 30 to 92 years [mean age (65.8±12.3)years].Clinical functional outcomes were assessed by recording preoperative and final follow-up Harris hip scores (HHS)，Oxford hip scores (OHS)，and 36-item short form survey (SF-36) functional scores.Preoperative and postoperative position of the center of rotation (COR) of the hip joint and leg length discrepancy (LLD) were evaluated radiographically.The occurrence of postoperative complications such as prosthesis loosening was also assessed during follow-up.Results All 54 patients were followed up for an average duration of (35.3±20.9)months，ranging from 8 to 80 months.Preoperatively，their HHS，OHS，and SF-36 functional scores were (35.6±10.5)，(24.4±7.1)，and (805.7±47.5) points，respectively.At the final follow-up，these scores improved significantly to (90.6±11.5)，(44.0±4.2)，and (859.4±47.4) points，respectively (P＜0.001)，indicating a marked improvement in hip function and overall health status.Radiographic examinations during the final follow-up revealed substantial improvements in acetabular COR and LLD compared to preoperative values (P＜0.001)，suggesting successful biomechanical reconstruction.No cases of periprosthetic infection were observed postoperatively.However，6 patients experienced prosthesis dislocation，of which only 1 patient required re-revision surgery due to recurrent dislocation during the follow-up period.Conclusion The “Double Cup” technique indeed represents a viable and reliable surgical option for the reconstruction of severe acetabular defects classified as Paprosky Type Ⅲ A and Ⅲ B.This technique has demonstrated low complication rates，high safety standards，and promising functional outcomes for patients.Therefore，it is indeed worthy of being actively promoted and considered in clinical practice for patients with these complex acetabular defects.The technique’s ability to effectively restore acetabular anatomy and biomechanics contributes significantly to its success and patient satisfaction.
2024 Vol. 30 (5): 404- [Abstract] ( 110 ) HTML (1 KB)  PDF (2359 KB)  ( 78 )
409 The Development and Preliminary Application of a Modular Osteotomy and Angle Measurement Device for Rotational Osteotomy on the Base of Femoral Neck
Hong Zexin，Chen Liang，Chen Jingyang，Chen Chenglin，Liu Zhuohua，Ma Chenhao，Yang Shaoxu，Wu Yufeng
Objective To investigate the clinical effect of rotatory osteotomy at the base of femoral neck assisted by 3D printing osteotomy guide and femoral head rotation angle measuring device.Methods From June 2019 to June 2022，a total of 3 male patients were included in the study.One patient had a right-sided lesion，while two had left-sided lesions.Their ages were 48，31，and 41 years，respectively.Prior to surgery，the rotation axis of the femoral neck and the rotation angle of the necrotic area of the femoral head were precisely calculated.Based on the principles of reverse engineering，a customized surgical dislocation guide and basal femoral neck osteotomy template were designed.Intraoperatively，the necrotic area of the femoral head was rotated precisely using a self-developed femoral head rotation angle measuring device.The intraoperative blood loss，operation time，and any postoperative complications were carefully recorded.The hip function of each patient was evaluated using the Harris hip score both before surgery and at the final follow-up after surgery.Results The application of the 3D printing-guided osteotomy template and femoral head rotation angle measuring device resulted in successful rotatory osteotomy in all three patients.The follow-up durations were 24 months，20 months，and 35 months，respectively.Intraoperatively，the blood loss was 300 mL，and the operation times were 130 minutes，180 minutes，and 205 minutes.Preoperatively，the Harris hip scores were 83，74，and 78 points，respectively.At the final follow-up，the Harris hip scores had improved to 94 points，86 points，and 83 points.Postoperative X-ray images revealed excellent rotation and fixation positions，and no complications were observed.Conclusion The combined use of a 3D printed guide and a femoral head rotation angle measuring device has the potential to transform traditional orthopedic surgery into a more quantifiable and standardized precision operation.This approach offers surgeons an effective new method for rapid positioning and precise osteotomy，promising to enhance the overall clinical outcomes of orthopedic procedures.
2024 Vol. 30 (5): 409- [Abstract] ( 122 ) HTML (1 KB)  PDF (3684 KB)  ( 123 )
414 Quadruple Surgical Approach for Treating Lateral Habitual Patellar Dislocations in Children and Adolescents
Huang Lin，Feng Chao，Lv Xuemin，Yang Zheng
Objective To explore the clinic effect of combined method of extensive lateral release，Z lengthening plasty of the lateral portion of quadricipital tendon，Roux-Goldthwait procedure(medial transplant of lateral half of the patella tendon )and single boundle reconstruction of medial patellofemoral ligament(MPFL) with adductor magnus tendon autograft for the treatment of habitual dislocation of patella (HDP) in children and adolescent.Methods From August 2016 to August 2019，a total of 13 skeletally immature patients (15 knees) with severe quadriceps contracture underwent the comprehensive surgical procedure.These included 3 male patients (3 knees) and 10 female patients (12 knees).The patients’ ages ranged from 9 to 14 years old，with an average age of (11.6±1.8)years.Preoperatively，risk factors for dislocation such as patellofemoral joint development，tibial tubercle deviation，lower limb malalignment，degree of torsion deformity，and patellar height were evaluated and analyzed through knee X-rays，MRI，hip-knee-ankle CT scans，and full-length X-rays of both lower limbs.Clinical examinations and knee joint X-rays were conducted during the final follow-up visit.Changes in Lysholm scores，patellofemoral joint congruency angles，and lateral patellofemoral angles were evaluated and compared between pre-surgery and the final follow-up.Results No infection，graft rejection，or rupture was observed in any of the cases.The patients were followed up for 24~58 months (average：36.9±12.5 months).Lysholm scores significantly improved from (75.7±8.7) preoperatively to (94.6±5.7) (P＜0.05) at the final follow-up.X-ray measurements indicated excellent patella reduction，with no recurrence of dislocation or subluxation.There was a statistically significant improvement in the congruency angle，from (73.4±17.2)° preoperatively to (－7.4±4.6)° (P＜0.01)，and in the lateral patellofemoral angle，from (－65.6±8.4)° preoperatively to (6.7±3.5)° (P＜0.01)，at the final follow-up.Two patients experienced poor wound healing but healed well after regular dressing changes.Conclusion In this mid-term study，the novel quadruple procedure，comprising extensive lateral release，Z-lengthening plasty of the lateral portion of the quadriceps tendon，the Roux-〖JP2〗Goldthwait procedure (medial transplantationof the lateral half of the patella tendon)，and single-bundle reconstruction of the MPFL using autograft from the adductor magnus tendon，was found to be effective in treating lateral HDP in skeletally immature patients with severe quadriceps contracture.
2024 Vol. 30 (5): 414- [Abstract] ( 119 ) HTML (1 KB)  PDF (3415 KB)  ( 161 )
419 Application of 3D Femoral Mechanical Axis Measurement in Total Knee Arthroplasty
Huang Qirimailatu，Xu Yongsheng，Bao Huricha，Qi Yansong，Wu Haihe
Objective To investigate the application of measuring the femoral valgus angle and intramedullary rod entry point on 3D models and 2D images in total knee arthroplasty(TKA).Methods Imaging data from 105 patients who underwent lower limb computed tomography angiography(CTA) were gathered.This cohort comprised 65 males and 40 females，with ages ranging from 26 to 69 years，averaging(52.40±3.22)years.Among these patients，49 underwent procedures on their left knee，while 56 underwent procedures on their right knee.The CT scans of these 105 patients were then imported into Mimics software (version 19.0) for the purpose of creating 3D reconstructions of the femur.Utilizing the Fluoroscopy Simulation tool，2D femoral images were derived from the 3D models.Subsequently，the femoral valgus angle and intramedullary rod entry point were measured on both the 3D models and the 2D images.The collected data were then analyzed using the Shapiro-Wilk test for statistical significance.Results (1)There was no statistically significant difference observed in the femoral valgus angle measurements between 3D models and 2D images (P＞0.05).However，notable statistical differences were found in the measurements of the intramedullary rod entry point，Whiteside’s line，and the distance to the highest point of the intercondylar notch between 3D models and 2D images (P＜0.05).(2)Among the parameters measured on 3D models，significant statistical differences were evident in the femoral valgus angle，the position of the intramedullary rod entry point，and the distance to the highest point of the intercondylar notch between different genders (P＜0.05).Conversely，the distance between the intramedullary rod entry point and Whiteside’s line did not demonstrate any statistically significant difference (P＞0.05).(3)The correlation analysis between age and the femoral valgus angle revealed a 〖JP2〗positive correlation with a correlation coefficient of r＝0.54(P＜0.001).Conclusion The intramedullary rod entry point determined using Whiteside’s line and the highest point of the intercondylar notch on 2D images is not a dependable reference for TKA.Consequently，data pertaining to the intramedullary rod entry point obtained from X-rays cannot provide precise parameters for TKA.However，the outcomes of measuring the femoral valgus angle on 2D images possess significant reference value and demonstrate variations in accordance with age and gender.
2024 Vol. 30 (5): 419- [Abstract] ( 120 ) HTML (1 KB)  PDF (1912 KB)  ( 92 )
424 The Significance of Changes in Notch Pathway Related Proteins in Synovium and Synovial Fluid of Patients with Knee Osteoarthritis
Li Wei，Huang Yaokai，Wang Honglin，Wang Lijun，Huang Zhengu，Chen Xinghua，Liu Jian
Objective To investigate the changes and significance of Notch pathway related proteins (Notch1，Notch3，Jagged1，Jagged2，Hes5) in synovium and synovial fluid of patients with knee osteoarthritis (KOA).Methods 80 patients with KOA admitted to Dazu Hospital Affiliated To Chongqing Medical University from January 2021 to December 2022 were selected as the study object (KOA group)，and 30 patients with meniscus injury admitted to our hospital in the same period were selected as the control group (control group).The severity of KOA was evaluated with Kelgren-Laurence (K-L) grading and Lequesne MG scale score.The expression levels of Notch1，Notch3，Jagged1，Jagged2，Hes5 in joint fluid and synovial tissue were detected by enzyme-linked immunosorbent assay and immunohistochemical staining respectively.The value of Notch1，Notch3，Jagged1，Jagged2，Hes5 in the diagnosis of KOA was analyzed with the subject’s working characteristic curve (ROC).Results The expression levels of Notch1，Notch3，Jagged1，Jagged2，and Hes5 in the joint fluid and synovial tissue of the KOA group were significantly higher than those in the control group (P＜0.05).The higher the K-L grade，the greater the expression levels of Notch1，Notch3，Jagged1，Jagged2，and Hes5 in the synovial fluid and synovial tissue (P＜0.05).Additionally，the expression levels of Notch1，Notch3，Jagged1，Jagged2，and Hes5 in the synovial fluid and synovial tissue of KOA patients positively correlated with the Lequesne MG scale scores (P＜0.05).The AUC values for the diagnosis of KOA using Notch1，Notch3，Jagged1，Jagged2，and Hes5 in the joint fluid were 0.563，0.786，0.600，0.453，and 0.543，respectively，while the AUC for the combination of all five markers was 0.710.In synovial tissue，the AUC values for the same markers were 0.467，0.671，0.572，0.551，and 0.456，respectively，with a combined AUC of 0.787.When combining the markers in both joint fluid and synovial tissue，the AUC reached 0.845.Conclusion The Notch pathway in the synovium and synovial fluid of KOA patients exhibits abnormal changes.The detection of Notch pathway-related proteins，including Notch1，Notch3，Jagged1，Jagged2，and Hes5，is beneficial for diagnosing KOA and assessing the severity of the disease.
2024 Vol. 30 (5): 424- [Abstract] ( 104 ) HTML (1 KB)  PDF (3568 KB)  ( 87 )
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