Effect of a double-buffered diagnosis and treatment model for emergency orthopedic trauma patients during pandemic of corona virus disease 2019 / 中华创伤杂志

During pandemic of corona virus disease 2019 (COVID-19), emergency orthopedic trauma is commonly seen. It is particularly important to ensure the emergency treatment quality of orthopedic trauma but avoid cross-infection between doctors and patients. The double-buffered diagnosis and treatment mode refers to the model of patients first undergoing medical observation in the comprehensive buffer ward and the inpatient buffer rooms of various disciplines after admission to confirm the exclusion of COVID-19 and then receiving specialist diagnosis and treatment. The authors summarize the experiences of using the double-buffered diagnosis and treatment model in the Department of Orthopedics, Renmin Hospital of Wuhan University during the prevention and control of COVID-19 pandemic so as to provide a reference for treatment of orthopedic patients.

Comparison of hybrid and traditional growing rod techniques in the treatment of early-onset congenital scoliosis / 中华外科杂志

Objective@#To compare the surgical outcomes between hybrid and traditional growing rod (GR) techniques in the treatment of early-onset congenital scoliosis (C-EOS).@*Methods@#A review was conducted of C-EOS patients who had undergone hybrid GR treatment at Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School. Another group of patients who had undergone traditional GR were well matched to the hybrid GR group at a 1∶1 ratio in terms of main Cobb angle, age at initial surgery, and lengthening numbers. There were 5 boys and 8 girls with an age of (5.6±2.8) years in the hybrid GR group, and 6 boys and 8 girls with an age of (6.1±3.0) years in the traditional GR group, respectively. All patients had minimum 2-year follow-up and over 2 lengthening procedures. Radiographic data were compared with paired t tests in either group between each visit, and with independent t tests between the two groups.@*Results@#On average, the hybrid group had a follow-up of (42.2±13.4) months (range:27-81 months), and had (4.0±1.8) lengthening procedures with a lengthening interval of (10.5±1.0) months; and the traditional GR group had a follow-up of (45.4±15.2) months (range: 24-76 months), and experienced (4.2±1.9) lengthenings with an interval of (10.8±1.1) months. After the index surgery, the major Cobb angle, C7 translation, apical vertebral translation, and thoracic kyphosis (TK) had remarkable improvement in both groups. Notably, the hybrid GR group had significantly higher correction rates of major Cobb angle (t=2.348, P=0.027) and TK (t=3.768, P<0.001) than the traditional GR group. At the latest follow-up, the hybrid GR group had remarkably smaller Cobb angle of the major curve than the traditional GR group (t=2.790, P=0.010). At the same time, the hybrid GR group had higher T1-S1 height gain than the traditional GR group (t=2.846, P=0.008) after the index surgery. Whereas, non-significant difference was noted between two groups with regards to the T1-S1 growth rate during follow-up (t=0.516, P=0.610). Ten complications occurred during the follow-up period, including 2 in the hybrid GR group and 8 in the traditional GR group. The incidence of rod breakage and PJK in the traditional group was 3 and 4 times as high as that of the hybrid GR group, respectively.@*Conclusions@#The hybrid growing rod can not only help to improve the correction of spinal deformity but also decrease postoperative complications during follow-up. Moreover, apical short fusion shows no significant influence on spinal growth.

Outcome of traditional growing rods for correction of apical vertebra rotation in early-onset scoliosis / 中华外科杂志

Objective@#To evaluate the correction result of traditional dual growing rods on apical vertebral rotation.@*Methods@#This study recruited 19 early-onset scoliosis patients (6 boys and 13 girls) who had received traditional dual growing rods treatment at Department of Spine Surgery, Nanjing Drum Tower Hospital from January 2009 to July 2015. The age at initial surgery was (5.7±1.7)years(range, 3 to 9 years). Measurements of primary curve magnitude, height of T1-S1, apical vertebral translation(AVR), apical vertebral body-rib ratio, apical vertebral rotation, thoracic rotation and rib hump were compared between pre-operatively, post-operatively, and at latest follow-up, through a paired-t test. Pearson correlation test was used for correlation analysis between parameters.@*Results@#All patients had a follow-up of (49.5±12.8)months(range, 24 to 71 months). A total of 111 operative procedures were performed, among which there were 92 lengthening procedures, averagely 4.8 lengthening procedures per patient. The average interval for each lengthening procedure was 10 months. The Cobb angle of primary curve was notably decreased from (66.5±13.2)° to (35.2±10.9)°(t=24.013, P<0.01), and no significant correction loss was found at the latest follow-up ((36.7±10.7)°)(t=-1.324, P=0.202). In addition, significant correction of AVR, thoracic rotation, apical vertebral translation, apical vertebra body-rib ratio, and rib hump were noted after initial surgery. Whereas, these parameters significant increased during follow-up(all P <0.05) except for thoracic rotation. Pearson correlation analysis showed that the increase of AVR during follow-up significantly correlated with change of apical vertebra translation, apical vertebral body-rib ratio, and rib hump(r=0.652, 0.814, 0.695; all P<0.05).@*Conclusions@#Significant correction of AVR can be achieved after initial surgery in early-onset scoliosis patients treated with traditional dual growing rods. However, such a technique can hardly prevent the deterioration of AVR during follow-up.

Anatomical study of a new iliosacral screw placement in adult via CT reconstruction / 中华骨科杂志

Objective To investigate the feasibility and safety of a novel iliosacral screw placement in adult pelvis by computed tomography(CT).Methods All of 50 adults with normal pelvis,including 25 males and 25 females with the age rang-ing from 28 to 81,were included in this study.The mean age was(51.9±11.7)years.Based on three-dimensional(3D)CT recon-structions of these specimens,virtual iliosacral screw channel was identified and measured.The virtual iliosacral screw channel holding the greatest width and length of osseous channel was measured by rotating the 3D pelvis.Measurements of the determined channels including connector-related parameters(divergent angle,cephalad angle,S1 pedicle width,embedding depth and skin distance)and iliosacral-screw related parameters(convergent angle,caudal angle,iliac length,sacral length,max-length and skin distance).Results There was a virtual channel going through the ilium as well as iliosacral joint and into the sacral in either side of each specimen. The connector-related parameters in males included divergent angle, cephalad angle, S1 pedicle width, embedding depth and skin distance,and they were 28.5°±6.3°,27.9°±5.6°,(22.5±2.4)mm,(18.8±3.1)mm and(52.8±8.4)mm, respectively. In females, they were 26.9°±5.7°, 25.8°±7.2°, (20.4±2.2) mm, (16.9±2.5) mm and (56.3±7.4) mm, respectively. The S1 pedicle width and embedding depth in males were higher than that of females, while the skin distance in females was higher than that of males. The iliosacral-screw related parameters in males included convergent angle, caudal angle, iliac length, sacral length, max-length and skin distance, and they were 61.5°±6.6°, 16.4°±3.2°, (16.6±2.8) mm, (73.0±5.7) mm, (96.8±5.5)mm and(65.0±11.9)mm,respectively.In females,they were 63.1°±5.7°,16.1°±4.8°,(15.1±2.4)mm,(74.0±6.4)mm, (96.8±5.4)mm and(68.0±11.4)mm.The iliac length in males was higher than that of females.Conclusion It is safe and feasi-ble to place iliosacral screw when performing spino-pelvic fixation.Preoperative CT imaging and 3D reconstructions may help to determine correct anchoring point and screw channel individually.

Proximal junctional kyphosis after posterior hemivertebra resection and instrumented fusion in young children with congenital scoliosis / 中华外科杂志

Objective@#To investigate the risk factors of proximal junctional kyphosis(PJK) in young children who underwent posterior hemivertebra resection and instrumented fusion.@*Methods@#This study reviewed the charts and radiographs of 136 consecutive young children with congenital scoliosis who underwent posterior hemivertebra resection and instrumented fusion in Department of Orthopaedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2009 to June 2014, including 75 males and 61 females, with an average age of (5.0±1.7)years(3-10 years). Proximal junctional angle(PJA), spino-pelvic parameters and segmental kyphosis (SK) were recorded pre- and post-operation and at last follow-up.The changes of PJA and radiographic features of proximal junction were also observed.χ2 test and t-test were used to analyzed enumeration data and measurement data, respectively.@*Results@#The average follow-up period was (32.8±10.3)months (ranging from 24 to 73 months) by June 2016. Among these patients, PJK occurred in 19 cases. Fifteen patients developed PJK during the first 3 months after surgery.The most common type of PJK was ligamentous failure.Compared with the non-PJK group (22.2%, 37.6%, 13.7%), the PJK group showed higher rate of preoperative TK>40°(9/19), fusion levels >4 (13/19) and greater SK change > 30°(9/19)(χ2=7.259, 6.375, 12.368; all P<0.05), while there were no difference between the two groups in terms of preoperative PJA, lumbar lordosis, SVA and upper instrument vertebra location(all P>0.05). The average PJA increased from 7.5°±2.9° to 21.3°±4.3° at 3 months after surgery to 20.6°±3.7° at the final follow-up visit in the PJK group.At the time of the final follow-up visit, ten patients received brace treatment, with no significant progression of PJA.@*Conclusions@#PJK might mainly occurs within 3 months postoperatively.Its prognostic factors include preoperative hyperkyphosis, over correction of kyphosis and ligamentous failure.

Outcome and complications of growing rods for correction of hyperkyphotic early-onset scoliosis / 中华骨科杂志

Objective To evaluate the changes in sagittal profiles and complications during treatment with growing rods (GRs) in hyperkyphotic early-onset scoliosis (EOS).Methods From December 2009 to December 2016,a total of 32 EOS patients who received growing rods treatment in our center,including 8 males and 24 females,were reviewed retrospectively.All the patients had minimum 2-year follow-up and over 2 lengthenings.Based on the reference value of thoracic kyphosis (TK) in T2-12 of normal children,the patients were categorized into an N group (20°≤TK≤50°,15 cases,4 males and 11 females) or K group (TK≥50°,17 cases,4 males and 13 females).The distribution of etiology was similar between the two groups.The average age was (6.2±2.0) years and (6.3±2.3) years respectively,curve flexibility was 34.6％± 10.4％ and 35.8％± 11.2％ before surgery.The precontoured rods were tunneled submuscularly,connecting proximal and distal anchors,and tandem or domino connectors.The rods were then locked after applying direct distraction that allowed appropriate elongation.The connectors were all placed under the deep fascia.Results The mean follow-up in the N and K groups was (5.5±1.9) years and (5.5±2.1) years,respectively.The distribution of proximal and distal anchors was similar between the two groups.The N and K groups,respectively,had an average number of lengthenings of 5.1±2.0 and 5.3±2.3,with mean lengthening intervals of (11.3±2.3) months and (10.9±1.9) months,respectively.In the N group,TK was decreased from 36.0°±9.4° to 30.6°±.8.3° after surgery,and to 32.2°±7.8° at the last follow-up,demonstrating it was maintained within the normal range.In the K group,TK was markedly reduced from 67.6°±11.6° to 41.7°±8.7° after the index surgery,with a correction rate of 38.3％± 14.6％,and the difference was statistically significant.And then it slightly increased to 46.5°±8.4° at the last follow-up,with correction loss of 7.1％±4.2％,and the difference was not statistically significant compared with the postoperatiom.The complication rate in the K group was significantly higher than in the N group (76.5％ vs.33.3％,P=0.031).The most common implant-and alignment-related complication in both groups was rod fracture (15.6％) and proximal junctional kyphosis (21.9％),respectively.The incidence of rod fracture in the N group and K group was 6.7％ and 23.5％,respectively.And the incidence of proximal junctional kyphosis was noted as 13.3％ and 29.4％ in the N group and K group,respectively.Proximal junctional angle (PJA) in the K group was greater than that in the N group preoperatively,postoperatively and at the last follow-up.Moreover,the increasing amount of PJA was significantly greater in the K group compared to the N group (1.6°± 1.0° vs.0.7°±0.8°).Four and seven complication events in the N and K groups,respectively,were evaluated with Grade Ⅰ.Four and seven complication events in the N and K groups,respectively,were classified as Grade Ⅱ A.Conclusion GRs can effectively restore the sagittal profile in hyperkyphotie EOS patients,but with a higher complication rate compared to the patients with normal kyphosis.

Transforaminal lumbar interbody fusion in treating degenerative spondylolisthesis at L 4 with kyphotic versus non-kyphotic angulation / 中华骨科杂志

Objective To compare the radiographic and clinical results of transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative spondylolisthesis (DS) with or without kyphotic angulation.Methods This study retrospectively reviewed a consecutive cohort of 137 patients with L4 DS (Meyerding grade Ⅰ or Ⅱ) who received TLIF between January 2009 and December 2012 and had a minimum follow-up of 2 years,including 24 males and 113 females,with the average age of 59.1±11.6 years(45-72 years).The enrolled patients were divided into two groups based on the angulation of intervertebral space:the kyphotic group and the non-kyphotic group.Slip angle (SA),anterior disc height (ADH),posterior disc height (PDH),slip percentage (SP) and segmental kyphosis (SK) was measured to evaluate the radiographic outcomes.Oswestry disability index (ODI) and visual analogue scale (VAS) was collected to evaluate the clinical results.The radiographic measurements and clinical indexes were recorded before and after surgery and at latest follow-up.The independent samples t test was performed to analyze the differences between the two groups in terms of radiographic and clinical outcomes.Results Kyphotic slip was observed in 21 (15.3％) patients,while non-kyphotic slip in 116 (84.7％) patients.No significant difference was observed in terms of age,gender,operation time and blood loss between the two groups.The preoperative SA in kyphotic and non-kyphotic group was 3.1°±2.3° and-8.2°±4.7°,respectively.The kyphotic group had significantly lower ADH and higher PDH than the non-kyphotic group,while there was no significant difference in SP between the two groups.After surgery,the postoperative and latest follow up radiographic results showed that patients of both groups had significant improvement,without significant differences between groups in terms of ADH,PDH,SA and SK,but the reduction of slip was significantly higher in the kyphotic group.Postoperative and follow-up ODI and VAS scores demonstrated remarkable improvement after surgery,without difference between groups,despite being higher in the kyphotic group than the non-kyphotic group preoperatively.Conclusion The kyphotic angulation of intervertebral space benefits to and facilitates slip reduction for L4 DS via TLIF procedure,and achieves improvements in life quality which is similar to the nonkyphotic group.