Quick Search
  Office Online
  Journal Online
Current Issue
Archive
Advanced Search
Read Articles
Download Articles
2024 Vol. 30, No. 6
Published: 2024-06-28
 
481 Anterior Debridement，Bone Graft Fusion，and Internal Fixation Combined with Anti Osteoporosis Treatment in Elderly Patients with Spinal Tuberculosis
Li Jikai，Wang Huiwang，Li Tongxian，Wu Huarong
Objective〓To evaluate the clinical efficacy of anterior debridement，bone graft fusion，and internal fixation combined with antiosteoporosis treatment in elderly patients with spinal tuberculosis and osteoporosis.Methods〓This study encompassed 98 elderly patients with spinal tuberculosis and osteoporosis who were treated from March 2021 to June 2022.Utilizing a random number table method，the patients were divided into two groups：The observation group，consisting of 48 patients (28 males and 20 females)，with an average age of (65.35±8.20)years，ranging from 60 to 73 years old，and the control group，comprising 50 patients (28 males and 22 females)，aged between 62 and 75 years，with a mean age of (67.20±7.60)years.Both groups underwent anterior debridement，bone graft fusion，and internal fixation，accompanied by antituberculosis treatment administered preand postoperatively for 12~18 months.The observation group additionally received antiosteoporosis treatment，encompassing calcium carbonate D3，alfacalcidol，and zoledronic acid injection，whereas the control group did not receive formal antiosteoporosis medication.Parameters such as surgical time，intraoperative blood loss，postoperative bed rest duration，erythrocyte sedimentation rate(ESR)，visual analogue scale(VAS) for pain assessment，kyphotic Cobb angle，bone graft fusion time，postoperative complications，and bone mineral density (BMD) at the final followup were recorded and statistically analyzed.Results〓 All patients were followed up for a duration ranging from 13 to 17 months，with an average followup period of (14.00±2.30)months.The observation group demonstrated notable benefits from the antiosteoporosis treatment.Specifically，the postoperative bed rest time in the observation group was (3.95±0.76) weeks，which was considerably shorter than the (4.58±1.01) weeks required by the control group (P＝0.027).At the sixmonth postsurgery mark，the ESR in the observation group measured at (27.60±3.40)mm/h，whereas the control group recorded an ESR of (30.20±2.97)mm/h (P＝0.008).Additionally，the VAS in the observation group stood at (2.20±0.83)，notably lower than the (3.40±0.77) score observed in the control group (P＝0.001).Furthermore，the bone graft fusion time in the observation group was (3.95±0.43)months，significantly shorter compared to the (4.57±0.79)months in the control group (P＝0.003).Regarding the correction degree of kyphotic Cobb angle，the observation group achieved (5.93±0.94)°，while the control group reached (6.73±1.80)°，although this difference was not statistically significant (P＝0.081).Upon the final followup，the Tscore for osteoporosis in the observation group was (－2.40±0.39)，which was significantly higher than the (－3.20±0.40) recorded in the control group (P＜0.001).Lastly，the incidence of postoperative complications in the observation group was 5.00%，which was lower than the 9.10% seen in the control group，albeit this difference was not statistically significant (P＝0.662).Conclusion〓Anterior debridement，bone graft fusion，and internal fixation combined with formal antiosteoporosis treatment show significant advantages in postoperative recovery，inflammatory markers，osteoporosis，pain relief，and bone graft fusion in elderly patients with spinal tuberculosis and osteoporosis.This approach provides valuable insights for related clinical practices.
2024 Vol. 30 (6): 481- [Abstract] ( 118 ) HTML (1 KB)  PDF (1279 KB)  ( 94 )
486 Clinical Treatment of Epiphyseal Fracture of Coronoid Process of Ulna in Children
Sun Qiang，Ye Jiajun，Zhou Ying
Objective〓To explore the characteristics and clinical treatment of ulnar coronal process epiphyseal fractures in children.Methods〓A retrospective analysis was performed on 102 children with ulnar coronal process epiphyseal fractures admitted to the Children's Orthopaedics Department of Sichuan Orthopaedics Hospital from January 2014 to January 2023.The cohort comprised 82 males and 20 females，with 54 fractures on the left side and 48 on the right.The age range was from 1 year，11 months to 14 years，6 months，with an average age of (9.53±3.27) years.Based on the Regan Morrey classification，there were 49 cases of type Ⅰ，27 cases of type Ⅱ，and 26 cases of type Ⅲ fractures.Among these cases，39 were accompanied by elbow joint dislocation，and 75 were accompanied by fractures in other body parts.Fifty-nine cases underwent conservative treatment，while 43 cases underwent surgical intervention.Surgical fixation materials included a combination of hollow nails and Kirschner wires in 10 cases，Kirschner wires alone in 9 cases，and steel plates in 24 cases.Results〓All patients were followed up for a duration ranging from 10 months to 4 years and 9 months，with an average follow-up period of (30.02±8.77)months.Based on the Mayo elbow joint function evaluation criteria，the outcomes were classified as 81 excellent cases，17 good cases，and 4 fair cases，resulting in an excellent and good rate of 96.08%.Conclusion〓Coronary process epiphyseal fractures of the ulna in children are frequently accompanied by additional fractures and elbow joint dislocations.To avoid misdiagnosis，it is crucial to thoroughly investigate the patient's medical history and injury mechanisms，conduct a detailed physical examination，capture lateral images of the injured limb，and perform a CT plain scan or MRI.For Regan-Morrey type I fractures and those with small fragments，minimal displacement，and a stable elbow joint，conservative treatment is often adopted.However，for comminuted fractures such as Regan-Morrey type Ⅱ and Ⅲ fractures，accompanied by elbow instability，fixation with micro T-shaped locking plates，hollow screws，or Kirschner wires through an anterior approach is more recommended，often resulting in a better prognosis in the later stages.
2024 Vol. 30 (6): 486- [Abstract] ( 142 ) HTML (1 KB)  PDF (2361 KB)  ( 148 )
490 Clinical Effect Analysis of Anterior Debridement and Bone Grafting Combined With Plate Internal Fixation in the Treatment of Sacroiliac Joint Tuberculosis
Yiliyaer Batuer，Gu Fuding，Tang Wei，Ma Liang，Mierzhati Aisha，Dilixiati Abulizi
Objective〓 To investigate the value of primary anterior defoliation and bone grafting combined with internal fixation of sacroiliac joint plate in the treatment of sacroiliac joint tuberculosis.Methods〓A retrospective analysis was performed on 30 patients with sacroiliac joint tuberculosis treated at the Eighth Affiliated Hospital of Xinjiang Medical University from January 2013 to June 2022.According to Kim's classification，there were 9 cases of type Ⅲ and 21 cases of type Ⅳ.The patients were divided into a control group and a study group based on the surgical approach.The control group comprised 14 patients，including 6 males and 8 females，with an age range of 18 to 73 years and a mean age of (54.57±16.93 )years.They underwent anterior lesion clearance and bone fusion.The study group consisted of 16 patients，with 5 males and 11 females，ranging in age from 25 to 72 years，with a mean age of (48.38±14.59)years.All patients underwent anterior debridement，bone grafting，and plate internal fixation，followed by anti-tuberculosis treatment for 12 to 18 months after surgery.The operation time，intraoperative blood loss，bone graft fusion time，erythrocyte sedimentation rate(ESR)，and C-reactive protein(CRP) levels before and 3 months after surgery were compared between the two groups.The visual analog scale(VAS) and Majeed score were used to evaluate the preoperative and postoperative effectiveness.Results〓All patients were followed up for a duration ranging from 12 to 18 months，with a mean follow-up of (14.24±1.72)months.All 30 cases of sacroiliac joint tuberculosis patients achieved cure.When comparing the two groups in terms of operation time，partial weight-bearing bone graft fusion time，and post-operative downtime，statistically significant differences were observed (P＜0.05).The VAS and Majeed grading index improved significantly from pre-operation to post-operation in both groups (P＜0.05).At 1 week post-operation，there was a significant difference in the VAS between the two groups (P＜0.05)，but no significant difference was found at 3 months and 6 months post-operation (P＞0.05).However，there were significant differences in Majeed scores between the two groups at 3 months and 6 months post-operation (P＜0.05).Conclusion〓 The use of anterior debridement and bone graft fusion combined with sacroiliac plate fixation is an efficacious approach for treating sacroiliac joint tuberculosis.This method boasts the advantages of a simplified surgical procedure，early stabilization of the pelvis，a shorter bone graft fusion time，and a significant improvement in pelvic function.
2024 Vol. 30 (6): 490- [Abstract] ( 107 ) HTML (1 KB)  PDF (1069 KB)  ( 91 )
496 Analysis of Therapeutic Efficacy of Arthroscopic Minimally Invasive Treatment for Deep Gluteal Syndrome
Li Qingshan，Sun Guanjun，Yin Yi
Objective〓To investigate the effectiveness and safety of arthroscopic minimally invasive treatment for deep gluteal syndrome(DGS) and establish the classification of DGS under arthroscopy.Methods〓A retrospective analysis was performed on 32 patients with DGS treated in the Joint Surgery Department of Suining Central Hospital from June 2021 to June 2022.The cohort comprised 15 males and 17 females，ranging in age from 24 to 70 years，with a mean age of (51.62±5.33)years.The number of incisions，surgical duration，and intraoperative blood loss were documented.Pain assessment was conducted using the visual analogue scale(VAS)，while hip joint function and patient satisfaction were evaluated using the modified Harris hip score(HHS)，modified Benson surgical outcome scores，and DGS scores.These evaluations were performed before surgery，on postoperative day 1，at 2 weeks，3 months，6 months，and 1 year after surgery.Results〓All patients successfully underwent arthroscopic minimally invasive treatment，with an average surgical duration of (42.36±13.27)minutes and intraoperative blood loss ranging from 5 to 40 mL，averaging (8.16±17.34)mL.No significant neurovascular complications were encountered during or after surgery.Intraoperatively，DGS was primarily classified into four types.Preoperatively，the VAS was (7.52±0.64)，and the modified HHS was (56.82±3.23).On the first postoperative day，the VAS decreased to (2.27±0.56)，and the modified HHS increased to (84.19±5.76)，both showing statistically significant differences compared to preoperative scores (P＜0.05).At 6 months postoperatively，the VAS further decreased to (0.45±0.51)，and the modified HHS improved to (95.34±2.73)，also demonstrating statistically significant differences from preoperative scores (P＜0.05).During the 1-year follow-up，the DGS quantitative scores gradually declined，and at 1 year postoperatively，all cases had a score of 6 or less.Comparisons between preoperative and postoperative scores revealed statistically significant differences (P＜0.05).The 1-year follow-up revealed excellent patient satisfaction in 27 cases，good in 2 cases，and fair in 3 cases，resulting in an excellent and good satisfaction rate of 90.63%.Conclusion〓Arthroscopic minimally invasive treatment for DGS，particularly the sciatic nerve deep gluteal space release technique，is proven to be safe with minimal trauma.It effectively and rapidly alleviates pain，resulting in high patient satisfaction rates.
2024 Vol. 30 (6): 496- [Abstract] ( 108 ) HTML (1 KB)  PDF (5656 KB)  ( 115 )
502 Short-Term Outcomes of Inactivated Reimplantation Versus Prosthetic Replacement of Periarticular Osteosarcoma of the Knee in Children
Song Ning，Zhang Qiang，Du Junwei，Wu Junshen，Dai Zhibing，Jiang Renbing
Objective〓To investigate the difference in short-term clinical efficacy between inactivation and replantation of tumor segments of periarticular osteosarcoma of the knee joint and total knee tumor prosthesis replacement in children.Methods〓 A retrospective analysis was conducted on clinical data from 26 patients with knee joint osteosarcoma treated in the Bone and Soft Tissue Tumors and Melanoma Department of Xinjiang Medical University Affiliated Tumor Hospital from January 2019 to January 2022.The cohort comprised 13 males and 13 females，ranging in age from 8 to 16 years，with a mean age of (11.88±2.42)years.Eight patients underwent tumor segment inactivation and replantation (5 femur，3 tibia)，forming the inactivation-replantation group，while 18 patients underwent total knee tumor prosthesis replacement surgery (9 femur，9 tibia)，constituting the prosthesis replacement group.Comparisons were made between the two groups in terms of general clinical data，functional assessment using the musculoskeletal tumor society(MSTS) score，knee joint range of motion(ROM) evaluation，regular postoperative X-ray examination，limb length discrepancy evaluation，oncologic assessment，and complication analysis.Results〓The follow-up period for the 26 patients with osteosarcoma around the knee joint ranged from 20 to 56 months，averaging (29.50±6.46)months.In the inactivation and replantation group，the limb length discrepancy ranged from 0.63 to 1.75 cm，averaging (1.03±0.37)cm，while in the prosthesis replacement group，the discrepancy ranged from 0.73 to 4.00 cm，averaging (1.96±0.88)cm.The comparison between the two groups revealed a statistically significant difference in limb length discrepancy (t＝2.86，P＝0.009).The average MSTS score for the inactivation and replantation group was (26.63±1.51)，whereas the prosthesis replacement group scored (24.50±1.89) points on average.This comparison also showed a statistically significant difference in MSTS scores (t＝2.81，P＝0.01).At the final follow-up，the average knee flexion angle in the inactivation and replantation group was (62.13±13.78)% of the healthy side，while the total knee tumor prosthesis replacement group exhibited an average knee flexion angle of (65.68±10.40)% of the healthy side.However，the comparison of knee flexion angles between the two groups did not reveal a statistically significant difference (χ2=1.25，P＝0.26).Conclusion〓In children，the inactivation and reimplantation of periarticular osteosarcoma tumor segments，aimed at preserving the epiphysis，can effectively maintain the growth and development potential of the affected limb.This approach also significantly enhances the joint function of the patient，demonstrating superior implant fusion，fewer complications，and overall，a better clinical outcome during short-term follow-up.
2024 Vol. 30 (6): 502- [Abstract] ( 102 ) HTML (1 KB)  PDF (3642 KB)  ( 110 )
508 Efficacy of Umbilical Cord Mesenchymal Stem Cells and Stromal Vascular Fraction in Treatment of Knee Osteoarthritis
Li Bao，Cui Xianghong，Li Han，Liu Ming，Li Haokun，Liu Xinwei，Li Sitong
Objective〓To evaluate the clinical efficacy of human allogenic umbilical cord mesenchymal stem cells(UC-MSCs) and autologous fat-derived stromal vascular fraction(SVF) in the treatment of knee osteoarthritis.Methods〓Between January 2020 and June 2021，44 patients with osteoarthritis treated at the General Hospital of Northern Theater Command were randomly assigned to two groups：The UC-MSCs group (where UC-MSCs were injected into the articular cavity) and the SVF group (where SVF was injected into the joint cavity).The UC-MSCs group comprised 22 patients，including 8 males and 14 females，with an age range from 46 to 63 years and an average age of (55.6±5.8) years.Of these，13 cases involved the left knee and 9 cases the right knee.The SVF group also had 22 patients，including 10 males and 12 females，with an age range from 48 to 65 years and an average age of (55.2±7.3) years.Within this group，14 cases involved the left knee and 8 cases the right knee.Before injection and at 6 and 12 months post-injection，the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)，Lysholm score，visual analogue scale (VAS)，and imaging findings of the affected knee joint were used to comprehensively evaluate the efficacy of both treatment methods in managing knee osteoarthritis.Results〓 A total of 40 patients were followed up for a duration ranging from 12 to 21 months，averaging (14.9±5.2) months.However，four cases were lost to follow-up，with one from the UC-MSCs group and three from the SVF group.Preoperatively，there was no statistically significant difference in general information between the two groups (P＞0.05).Post-injection，the WOMAC score，Lysholm score，and VAS of patients in the UC-MSCs group were all superior to those in the SVF group (P＜0.05).During the follow-up period，no serious adverse reactions were observed in either group，but the incidence of adverse reactions in the UC-MSCs group was higher than that in the SVF group (P＜0.05).Conclusion〓Both formulations are effective in treating knee osteoarthritis.The efficacy of UC-MSCs is superior to SVF，but the incidence of adverse reactions (fever，swelling) after injection is higher than that of SVF.
2024 Vol. 30 (6): 508- [Abstract] ( 120 ) HTML (1 KB)  PDF (1357 KB)  ( 107 )
514 The Effect and Mechanism of Collagen Membranes Loaded With Fibrinogen on the Healing of Femur Fractures in Rats
Yang Ping，Lei Zhijie，Yu Jianglin，Qiu Xusheng，Chen Yixin，Qi Xiaoyang
Objective〓 To investigate the effect and mechanism of the collagen membrane loaded with fibrinogen on healing of femoral fractures in rats.Methods〓The rat femur fracture models were randomly divided into three groups：control group，collagen membrane group，and fibrinogen-loaded collagen membrane group.At 8 weeks post-surgery，the affected femurs of the rats were analyzed using Micro-CT scanning to assess callus formation.Primary bone marrow mesenchymal stem cells (BMSC) were divided into osteogenic control group，fibrinogen+osteogenic induction group，fibrinogen + PNU-74654 + osteogenic induction group.BCIP/NBT staining was used to detect the level of alkaline phosphatases(ALP) in BMSC.Wsetern blot was used to detect the protein expression of osteogenic markers，collagen Ⅰ(COL-1)，ALP，Runt-related transcription factor 2(RUNX2)，and β-Catenin.Results〓 The Micro-CT analysis revealed that at 2 months post-surgery，the fibrinogen-loaded collagen membrane group exhibited significantly higher levels of callus formation compared to the control group.ALP staining and Western blot results further indicated that fibrinogen promotes osteogenesis by upregulating the expression of osteogenic markers through the activation of the Wnt/β-Catenin signaling pathway.However，when PNU-74654 (a Wnt/β-Catenin inhibitor) was utilized，the expression of osteogenic markers was significantly reduced (P＜0.05).Conclusion〓 The fibrinogen-loaded collagen membrane can accelerate femur fracture healing in rats，and fibrinogen accomplishes this by promoting osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) via the activation of the Wnt/β-Catenin signaling pathway.
2024 Vol. 30 (6): 514- [Abstract] ( 103 ) HTML (1 KB)  PDF (5133 KB)  ( 76 )
Copyright © Editorial Board of sygkzz
     ���������� 14010702070875��
Supported by:Beijing Magtech