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Bone defects caused by different causes such as trauma, severe bone infection and other factors are common in clinic and difficult to treat. Usually, bone substitutes are required for repair. Current bone grafting materials used clinically include autologous bones, allogeneic bones, xenografts, and synthetic materials, etc. Other than autologous bones, the major hurdles of rest bone grafts have various degrees of poor biological activity and lack of active ingredients to provide osteogenic impetus. Bone marrow contains various components such as stem cells and bioactive factors, which are contributive to osteogenesis. In response, the technique of bone marrow enrichment, based on the efficient utilization of components within bone marrow, has been risen, aiming to extract osteogenic cells and factors from bone marrow of patients and incorporate them into 3D scaffolds for fabricating bone grafts with high osteoinductivity. However, the scientific guidance and application specification are lacked with regard to the clinical scope, approach, safety and effectiveness. In this context, under the organization of Chinese Orthopedic Association, the Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair ( version 2023) is formulated based on the evidence-based medicine. The consensus covers the topics of the characteristics, range of application, safety and application notes of the technique of autologous bone marrow enrichment and proposes corresponding recommendations, hoping to provide better guidance for clinical practice of the technique.
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Background Furniture manufacturing is one of the typical labor-intensive industries, and workers in this industry face a high risk of work-related musculoskeletal disorders (WMSDs), which seriously affect the physical and mental health of workers. Objective To explore the prevalence and potential risk factors of WMSDs among workers in a large-scale furniture manufacturing factory. Methods A cross-sectional study of 3431 workers in a furniture factory in Guangdong Province was conducted from September to December 2019. Information including reported WMSDs in various body parts in the past year, demographic characteristics, work organization factors, job characteristics, and work postures was collected by an electronic version of Musculoskeletal Disorders Questionnaire. Pearson χ2 test and binary logistic regression were used to analyze the risk factors leading to WMSDs. Results The overall prevalence rate of WMSDs was 32.12% (1102/3431). The most common WMSDs symptoms occurred in the neck (16.85%), followed by the feet (15.27%), shoulders (14.81%), and hands (14.25%). The prevalence rates of WMSDs in the neck, shoulders, elbows, hands, legs, and feet were significantly different among different types of work (P<0.05). The results of multiple logistic regression analysis showed that individual factors, work organization factors, job characteristics, and awkward work postures were associated with the frequency of reporting WMSDs in specific parts of workers. Comparatively poor physical health (including moderate, poor, and very poor) was positively correlated with neck, shoulder, hand, and foot WMSDs (OR=1.479-4.077); working with an uncomfortable posture (OR=1.983) and doing the same task almost every day (OR=1.783) were positively correlated with neck pain; doing the same task almost every day (OR=2.408) and neck twisting for a long time (OR=1.830) were positively correlated with shoulder pain; bending wrists up and down frequently (OR=1.948) and bending wrists for a long time (OR=2.081) were positively correlated with hand pain; prolonged standing (OR=1.953) and often working overtime (OR=1.627) were positively correlated with feet pain; sufficient rest time was negatively correlated with WMSDs in the neck, shoulders, hands, and foot (OR=0.544-0.717). Conclusion The prevalence rate of WMSDs in furniture manufacturing workers is relatively high, and neck, feet, shoulders, and hands are the most involved body parts. The frequency of reporting WMSDs is related to individual factors, work organization factors, job characteristics, and awkward work postures.
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Objectives To assess the clinical outcomes,the technical characteristics of percutaneus endoscopic interlaminar decompression for lumbar lateral recess stenosis in elderly patients.Methods From May 2014 to June 2015,76 elderly patients with lumber lateral recess stenosis were accepted percutaneus endoscopic interlaminar decompression,including 48 males and 28 females aged from 60-91 years old (average,71.7:8.8 years).There were 40 patients with stenosis in L45,29 patients with stenosis in L5S1 and 7 patients with stenosis in L4.5 and L5S1.Back and leg pain were assessed by visual analogue scale (VAS).The influence of pain was evaluated by Oswestry disability index (ODI).The change of spinal canal was assessed by lateral recess angle.The MacNab criteria was evaluated at last follow-up.Results All of the 76 operations had been completed successfully with an average operation time of 64.3±23.9 min (range,56-98 min).An average follow-up time was 31.5 months (range,24-36months).There was no operative segment errors and nerve root tear during operation.Dural sac tear in 1 case,2 cases of nerve root injury and 1 case of postoperative kakesthesia,transient seizures after anesthesia occurred in 1 case and 1 case had postoperative delirium.There were significances in lumbocrural pain scores,leg pain scores and ODI scores between preoperation and postoperative 1,3,6,12 month and last follow-up (P＜0.05).In the MacNab last follow-up,the fineness rate was 92.1％,including 52 cases of excellence,18 cases of good,and 6 cases of fair.The latera recess angle between preoperation and postoperation was significantly different.During follow-up period,there were 3 cases developed into lumbar instability.No recurrence,discitis and leakage of cerebrospinal fluid were found,delayed incision healing was found in 1 case.Conclusions Percutaneus endoscopic interlaminar decompression for lumbar lateral recess stenosis in elderly patients is a safe,effective and minimally invasive method of operation with the characteristics of precise decompression of bone stenosis,sufficient resection of ligamentum flavum to decompress soft stenosis,small effect on spinal stability and low complications.
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Objective To evaluate the clinical efficacy of anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach in the treatment of Denis type B thoracolumbar burst fractures.Methods A retrospective case series study was made on 26 cases (14 males and 12 females,mean age of 48.5 years) of Denis type B thoracolumbar burst fractures treated by anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach from January 2007 to June 2009.Age was 18-68 years (mean,48.5 years).The fractured vertebrae included T1 in three cases,L1 in 18 and L2 in five.The neurological status was Grade C in eight cases,Grade D in 12 cases and Grade E in six cases according to American Spinal Injury Association (ASIA) classification.The operation duration,blood loss and incision length were recorded.The neurological function,lower back pain were evaluated by visual analogue score (VAS),correction of kyphosis and restoration of the fractured vertebral body height followed and documented at 3,6 and 9 months and annually after surgery.The healing of the graft was assessed using Brantigan method based on 3-dimensional computed tomography at final follow-up.Results All patients were successfully managed with this approach.The operation duration was (214.6 ± 30.5)min,and the intraoperative blood loss was (389.7 ± 57.1) ml.The length of incision was (8.5 ± 1.3) cm.All patients were followed up for (6.3 ± 0.4) years.At final follow-up,the neurological functions of all patients with incomplete neurological deficit were improved for at least one grade.The VAS of lower back pain was improved from preoperative (7.8-± 1.6) points to (2.1 ± 0.8) points at final follow-up (P ＜ 0.05).The height of the intervertebral body was restored from preoperative (29.8 ± 5.3) mm to (35.2 ± 2.4) mm at final follow-up (P ＜ 0.05).The kyphosis was corrected from preoperative (20.4 ± 11.7) ° to (11.3 ± 5.5) ° at final follow-up (P ＜ 0.05).Bone fusion was achieved in all patients,with no looseness,breakage or displacement of internal fixation at follow-up.Conclusions Anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach can reduce the surgical trauma,achieve complete spinal canal decompression,adjust kyphosis,fix segment,obtain high rate of bone graft fusion and hence is a safe and effective method with minimal invasion for Denis type B thoracolumbar burst fractures.
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A meta-analysis was performed to evaluate whether a beneficial clinical effect of the Total Disc Replacement [TDR] over lumbar fusion for the treatment of patients with Degenerative Disc Disease [DDD]. An electronic search of PubMed, Cochrane Central Register of Controlled Trials, and EMBASE from their inception to 2012 was completed, and we assessed risk bias and retrieved relevant data, and meta-analysis was performed, if appropriate. Oswestry Disability Index [ODI], Visual Analog Score [VAS], patient satisfaction or VAS patient satisfaction, narcotic use, overall success rate, reoperation rate, work status, "surgery again?", complications and radiographic outcomes were evaluated. Six RCTs were included in this meta-analysis. At 2 years, TDR was demonstrated to be more beneficial for patients compared to lumbar fusion in the following outcomes, including ODI scores [MD:-4.87, 95% CI: -7.77 to -1.97, p=0.001], patient satisfaction [OR:1.91, 95% CI: 1.27 to 2.86, p=0.002] and VAS patient satisfaction [MD:9.10, 95% CI: 3.20 to 14.99, p=0.002], the percentage of using narcotics [OR=0.54, 95%CI: 0.31 to 0.96, p=0.03], overall success rate [OR:1.68, 95% CI: 1.26 to 2.25, p=0.005], the rate of patients to chose the same surgical treatment again [OR:2.38, 95% CI: 1.72 to 3.28, p < 0.001], and complications [OR=0.50, 95%CI: 0.29 to 0.84, p=0.008]. Other outcomes, including re-operation rate [OR:0.62, 95% CI: 0.36 to 1.06, p=0.08] and work status [OR=1.05, 95% CI: 0.75 to 1.47, p=0.80], were demonstrated to be no differences between the two groups. In a long-term of follow-up [2 years], TDR shows a significant superiority for the treatment of lumbar DDD compared with fusion
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Humans , Spinal Fusion , Lumbar Vertebrae , Meta-Analysis as Topic , Randomized Controlled Trials as Topic , Intervertebral Disc DegenerationABSTRACT
<p><b>OBJECTIVE</b>To evaluate the mid-term effectiveness of nano-hydroxyapatite/polyamide66 (n-HA/PA66) cage in the anterior spinal reconstruction.</p><p><b>METHODS</b>There were 177 patients who undergone the anterior decompression and fusion with n-HA/PA66 cage and internal fixation between January 2008 and January 2010 included in this study. There were 117 male and 60 female patients aged from 18 to 74 years. The diagnoses included cervical fracture in 47 patients, thoracic or lumbar fracture in 50 patients, cervical spondylopathy in 58 patients, spinal tuberculosis in 17 patients and spinal tumor in 5 patients. The X-ray and three-dimensional CT were followed up in all these patients to observe the spinal alignment, the rate of fusion and the rate of n-HA/PA66 cage subsidence and translocation. The neurological functions of patients with spinal fracture were evaluated by Frankel grading; the improvement of the clinical symptoms of the other patients were assessed by visual analogue scale (VAS) scores and Japan Orthopaedic Association (JOA) scores or SF-36 scores.</p><p><b>RESULTS</b>All the 177 patients had been followed-up for 36 to 70 months after surgery (average 51 months). Except the slight cage translocation been found in the only one patient with cervical fracture, no cage prolapsed or breakage was exist in our patients up to the last follow-up. In the patients with spinal fracture, the mean time for fusion was 4.5 months, the rate of fusion was 95.9% and the rate of cage subsidence was 5.2%; while in the patients with cervical spondylopathy, the mean time for fusion was 4.4 months, the fusion rate was 96.5% and the subsidence rate was 5.2%; while in patients with spinal tuberculosis, the mean fusion time was 5.5 months, the rate of fusion was 94.0%, the rate of subsidence was 5.9%; and in the patients with tumor, the mean time for fusion was 6.0 months, the fusion rate was 100%, and the cage subsidence was found in only one patient. The preoperative symptoms of each patient were improved to varying degrees after surgery. At the last follow-up, the Frankel grading of patients of spinal fracture with incomplete paralysis improved 0 to 2 classes; the VAS, JOA or SF-36 scores of the other patients were improved significantly than their respective scores before surgery (t = 2.982, 4.126 and 3.980, P < 0.05).</p><p><b>CONCLUSIONS</b>The n-HA/PA66 cage has much higher rate of osseous fusion and lower cage subsidence, it is an ideal cage which can provide effective restoring and maintaining for the spinal alignment and intervertebral height. Moreover, the mid-term clinical results of anterior reconstruction with this cage in the patients with spinal trauma, degeneration, tuberculosis or tumor are well content.</p>
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Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Durapatite , Fracture Fixation, Internal , Nanostructures , Nylons , Spinal Diseases , General Surgery , Spinal Fusion , Methods , Treatment OutcomeABSTRACT
Objective To evaluate cause,treatment and prevention of esophageal fistula caused by anterior cervical spine surgery.Methods Between January 2004 and December 2011,2348 patients underwent anterior cervical spine surgery.Among them,5 patients suffered from esophageal fistula owing to operation,including 3 males and 2 females,with an average age of 34 years (range,14 to 48 years).The diagnosis of these patients included 3 cases of cervi(c)al injury,1 case of cervical spondylosis and 1 case of cervical tuberculosis.There was 1 patient whose esophageal injury was founded during the surgery,and that was directly repaired.For another 4 patients,esophageal fistulas were founded after operation; one case underwent debridement and orificium fistulae repair; one case only underwent debridement; one case underwent debridement and second-stage removal of hardware; and one case underwent debridement and second-stage removal of hardware and esophageal repair with sternocleidomastoid flap.Postoperative treatment included esophageal rest,enteral nutrition,wound drainage,and antibiotic administration.Methylene blue was used to evaluate status of orificium fistulae.Results All patients with esophageal fistula were cured 9 to 61 weeks after treatment,and oral intake was achieved.They were followed up for 6-48 months.There was no recurrence of esophageal fistula,cervical instability and infectious spondylitis in any ease.All patients were satisfied with swallowing function and outcome of cervical spine diseases.The Frankel grade was improved averagely one grade in patients with cervical injury,and the JOA score was improved from preoperative 9 points to postoperative 15 points in patients with cervical spondylosis.Conclusion Successful management of esophageal fistula caused by anterior cervical spinal surgery depends on primary closure of the perforation with or without muscle flaps,surgical drainage,esophageal rest and nutrition support,and removal of hardware if necessary.Prevention consists of the careful operation and gentle tissue handling.
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Objective To analyze the relationship of the lateral angulation with the incision level after anterior approach operation for thoracolumbar fractures by evaluating the Cobb' s angle at different approach levels.Methods A retrospective study was done on 154 patients with thoracolumbar fractures treated consecutively with anterior operation from May 2004 to January 2008.The preoperative,postoperative and follow-up angle of coronal Cobb and the postoperative angle between screws and endplates on the anteroposterior radiograph were measured.According to the relationship between the injury vertebrae and the incision level,the patients were divided into two groups,ie,incision level ≥2 vertebrae group and incision level ≤ 1 vertebra group.Results All patients were followed up for 6-47 months(mean 37 months),which showed significant postoperative lateral angulation(P ＜ 0.01)especially at follow-up (P ＞ 0.05).The coronal Cobb' s angle showed insignificant difference before operation between two groups but it was increased after operation and during the follow-up(P ＜0.01).The screws A or B were more parallel to the endplate in two groups(P ＜ 0.01),while the parallel of the screws C or D to the endplate showed no statistical difference(P ＞ 0.05).Conclusions Compared with the operation with incision level ≥2 vertebrae,the operation with incision level ≤ 1 vertebra can more easily induce postoperative lateral angulation and exert a significant impact on implantation orientation of the vertebral screws A and B,which may indirectly lead to postoperative lateral angulation.
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ObjectiveTo evaluate the mid-term clinical effect of nano-hydroxyapatite and polyamide 66 (n-HA/PA66) intervertebral fusion cage in treatment of thoracolumbar burst fractures.Methods A total of 87 patients with thoracolumbar burst fractures were managed by thoracolumbar body resection combined with n-HA/PA66 intervertebral fusion cage from December 2007 to September 2008.The clinical effect, safety and radiographic outcomes were evaluated.Results No nerve damage was deteriorated in all the patients.The neural function was improved for 1-2 grade except for four patients at Frankel grade A.The patients were followed up for mean 21.3 months (17-24 months).The kyphosis was (14.4 ± 12.6)° preoperatively, (3.7 ± 8.7) ° immediately after surgery and (4.0 ± 8.3)° at final follow-up.The distance between the upper and lower vertebral bodies was (96.9 ± 17.2) mm preoperatively, (109.5 ± 17.1) mm immediately after surgery and (108.3 ± 16.4) mm at final follow-up.No cage replacement, internal fixation breakage or neurologic impairment were observed during follow-up period.There were 58 patients with grade E fusion, 22 with grade D fusion and 7 with grade C fusion.ConclusionsAnterior decompression combined with n-HA/PA66 intervertebral fusion cage is an effective method for treatment of thoracolumbar burst fracture.The kyphosis is rectified and the intervertebral distance is corrected, with a high rate of fusion.
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@#ObjectiveTo explore the mechanism of estrogen inhibiting osteoblast apoptosis induced with serum hungry.MethodsOsteoblasts of the second or third generation from newly born SD rats calvaria were divided randomly into three groups: control group,serum hungry group,serum hungry with estrogen group.Cells of each group were incubated for 1,2,3,5,7 or 14 d,and then were stained immunohistochemically.The rates of positive cells of each group were analyzed.ResultsThere was a little positive expression of Bax,Bcl2 and Fas in control group.The expression of Bax and Fas were significantly increased(P<0.05)in serum hungry group,peak time was 14 d,but the expression of Bcl-2 were not affected.Compared with that of serum hungry group,the expression of Bax and Fas significantly decreased(P<0.05) in serum hungry and estrogen group,peak time was still 14 d,while that of Bcl-2 increased(P<0.05).ConclusionSerum hungry can increase the expression of Bax and Fas in osteoblast,that can be inhibited by estrogen.Estrogen can also increase the expression of Bcl-2 in osteoblast.All of these may play a role in inhibiting osteoblast apoptosis induced with serum hungry.
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BACKGROUND: Continuous passive motion assisted with diathermia will promote the restoration of joint movement of the extremities.OBJECTIVE: To improve joint movement with continuous motion assisted with diathermia after surgical treatment on simple fracture of upper or lower extremity.DESIGN: A randomized controlled trial.SETTING: Huaxi Hospital of Sichuan University.PARTICIPANTS: Eighty-four cases of simple extremity fracture treated in the Orthopedic Department of Huaxi Hospital of Sichuan University from October 2000 to July 2002 were included in this trial. Of them, 16 cases were elbow movement disorder and 68 were knee movement disorder. They were randomly assigned into two groups with 42 cases each.METHODS: The 42 cases in the treatment group were preheated before continuous passive motion while those in the control group just received continuous passive motion. The improvement of joint movement between thetwo groups were assessed and compared according to the joint movement scale.MAIN OUTCOME MEASURES: The joint movement before and after treatment and the indices of joint movement scale in the two groups.RESULTS: All of the eighty-four cases entered the analysis. The joint movement in the treatment group was better than that in the control group [ (101.40 ± 25.76)° vs (86.14 ± 27.66)°, t = 5.25, P ＜ 0.01 ]. The index of joint movement scale in the treatment group was also higher than that of the control group[ (84.32 ± 16.54) vs(64. 89 ± 13.76) ] ( t = 4.24, P ＜ 0.01 ) ].CONCLUSION: Continuous passive motion assisted with diathermia is better than simple continuous passive motion in improving the joint movement and function of elbow and knee.