Guidelines for management of pediatric acute hyperextension spinal cord injury / 中华创伤杂志(英文版)

Pediatric acute hyperextension spinal cord injury (SCI) named as PAHSCI by us, is a special type of thoracolumbar SCI without radiographic abnormality and highly related to back-bend in dance training, which has been increasingly reported. At present, it has become the leading cause of SCI in children, and brings a heavy social and economic burden. Both domestic and foreign academic institutions and dance education organizations lack a correct understanding of PAHSCI and relevant standards, specifications or guidelines. In order to provide standardized guidance, the expert team formulated this guideline based on the principles of science and practicability, starting from the diagnosis, differential diagnosis, etiology, admission evaluation, treatment, complications and prevention. This guideline puts forward 23 recommendations for 14 related issues.

Guideline for diagnosis and treatment of spine trauma in the epidemic of COVID-19 / 中华创伤杂志(英文版)

Outbreak of COVID-19 is ongoing all over the world. Spine trauma is one of the most common types of trauma and will probably be encountered during the fight against COVID-19 and resumption of work and production. Patients with unstable spine fractures or continuous deterioration of neurological function require emergency surgery. The COVID-19 epidemic has brought tremendous challenges to the diagnosis and treatment of such patients. To coordinate the diagnosis and treatment of infectious disease prevention and spine trauma so as to formulate a rigorous diagnosis and treatment plan and to reduce the disability and mortality of the disease, multidisciplinary collaboration is needed. This expert consensus is formulated in order to (1) prevent and control the epidemic, (2) diagnose and treat patients with spine trauma reasonably, and (3) reduce the risk of cross-infection between patients and medical personnel during the treatment.

Curative effect of anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach for severe thoracolumbar burst fractures with spinal cord injury / 中国骨伤

OBJECTIVE@#To explore the effect of anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach for severe thoracolumbar burst fractures with spinal cord injury.@*METHODS@#From January 2016 to June 2018, 16 patients with severe thoracolumbar burst fractures (more than 50% of ratio of spinal canal encroachment, reverse fragment at the posterior edge of the vertebral body) with spinal cord injury were retrospectively analyzed, including 10 males and 6 females, ranging in age from 19 to 57 years old. Causes of injury:8 cases of fall injury, 6 cases of traffic accident injury and 2 cases of other injuries. Fracture site:T@*RESULTS@#All 16 patients were followed up, and the average follow up time was (15.9±5.4) months. The average operation time was (234±41) minutes and the average amount of bleeding was (431±93) ml. The loss of anterior height of injured vertebrae was (52.25±10.10)% before operation, (8.93± 3.61)% at 3 days after operation, and (9.25±2.88)% at the latest follow up. The results of 3 days after operation and the latest follow up were better than that before operation, and there was no significant differencesbetween results at the latest follow up and 3 days after operation (@*CONCLUSION@#For severe thoracolumbar burst fracture and spinal cord injury, with more than 50% of ratio of spinal canal encroachment and reverse fragment at the posterior edge of the vertebral body, the anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach has the characteristics of accurate reduction, complete decompression and firm fixation, and the clinical effect is satisfactory.

Efficacy of elastic intramedullary nail versus locking plate fixation in the treatment of middle clavicle fracture / 中国组织工程研究

BACKGROUND: For the treatment of middle clavicle fractures, elastic intramedullary nailing has gradually gained everyone's approval because of its small incision and short operation time. Locking plate fixation is currently the main surgical treatment. At present, there are a few comparative studies on the results of the two surgical treatments, but the results are still controversial. In particular, there is a lack of comparative studies on long-term efficacy and complications. OBJECTIVE: To compare clinical results and complications of locking plate and elastic intramedullary nailing for middle clavicular fracture. METHODS: A retrospective analysis of 85 patients with middle clavicular fractures who were hospitalized at the Army General Hospital of Second Medical College of Southern Medical University from June 2014 to June 2015 undergoing surgeries was performed. They were divided into two groups randomly: locking plate group (n=62) and elastic intramedullary nailing group (n=23). The incision length, operation time, blood loss and time of hospital staying were compared between the two groups. Regular follow-up, radiography assessment and postoperative complications and shoulder function score were measured. RESULTS AND CONCLUSION: (1) Incision length, operation time, blood loss and time of hospital staying were significantly better in the elastic intramedullary nailing group than in the locking plate group (P < 0.05). (2) The complications of the elastic intramedullary nailing group were significantly lower than that of the locking plate group (P < 0.05). The main complications of locking plate group were superficial wound infection, hypesthesia in the local incision and implant protuberance. Only two patients in the intramedullary nailing group experienced complications. (3) The healing rate of elastic intramedullary nailing group was higher than that of the locking plate group, which was not statistically significant (P > 0.05). (4) The DASH scores and the Constant-Murley scores of the two groups after operation were not statistically significant (P > 0.05). (5) The elastic intramedullary nailing and locking plate are both effective methods for the treatment of middle clavicular fracture. Incision length, operation time, blood loss and average length of hospital stay have obvious advantages; the incidence of complications is low; and recovery is fast in the elastic intramedullary nailing group. However, elastic nail may stimulate the local skin, causing some impact for the patients' daily life.

Comparison of clinical effects of total artificial hip replacement and cannulated screw fixation for the treatment of displaced femoral neck fractures in elderly patients / 中国骨伤

<p><b>OBJECTIVE</b>To compare of clinical effects of different surgical methods in the treatment of elderly femoral neck fractures.</p><p><b>METHODS</b>From January 2013 to June 2016, 144 elderly patients with femoral neck were treated and divided into artificial hip replacement group and cannulated screw fixation group according to the surgical methods. In the total hip arthroplasty group, there were 89 cases, 28 males and 61 females, with an average age of(84.10±3.10) years old;Hollow nail fixation group 55 cases, 20 males and 35 females, with an average age of (86.80±2.88) years. Preoperative patients data, postoperative complications, mortality and postoperative Harris hip score were compared between the two groups.</p><p><b>RESULTS</b>A total of 144 cases were followed up for 12 to 36 months with an average of 18 months. There was no significant difference between two groups in gender, fracture side, preoperative complications, osteoporosis, ASA score, injury to surgery interval, the number of patients admitted to ICU and perioperative death. However, the patients in hollow screw fixation group was older than the joint replacement group(=5.311,<0.05);The degree of preoperative fracture displacement in the joint replacement group was higher than that in the hollow nail fixation group(χ²=6.894,=0.009<0.05);Hollow nail fixation group in operation time, hospital stay, intraoperative blood loss, perioperative blood transfusion was significantly better than the number of joint replacement group(<0.05);The Harris score of the joint replacement group was higher than that of the hollow screw fixation group(<0.05).</p><p><b>CONCLUSIONS</b>For elderly femoral neck patients, if there is a significant shift in the fracture (Garden III, IV), the preferred treatment is hip replacement. Postoperative complications are relatively small, satisfactory joint function recovery. If the fracture displacement is not obvious (Garden type I, II) or patients with more medical diseases, poor physical condition, poor surgical tolerance, postoperative life expectancy is not high, the first choice is closed reduction and cannulated screw fixation.</p>

Dynesys and posterior decompression and fusion internal fixation for the treatment of lumbar degenerative diseases: a systematic review / 中国骨伤

<p><b>OBJECTIVE</b>Meta analysis was used to evaluate the efficacy and safety of Dynesys and posterior decompression and fusion internal fixation for lumbar degenerative diseases.</p><p><b>METHODS</b>The computer was used to retrieve the Cochrane library, Medline, Embase, CNKI, Wanfang database and Chinese biomedical literature database; and the references and main Chinese and English Department of orthopedics journals were manually searched. All the prospective or retrospective comparative studies on the clinical efficacy and safety of Dynesys and posterior decompression and fusion internal fixation were collected, so as to evaluate the methodological quality of the study and to extract the data. The RevMan 5.2 software provided by Cochrane collaboration was used for systematic evaluation.</p><p><b>RESULTS</b>A total of 9 clinical studies were included, including 3 prospective randomized controlled trials(RCT) and 6 retrospective controlled observational studies, which included 692 patients, with 336 cases in Dynesys group, and 356 cases in posterior decompression and fusion internal fixation (PLIF) group. The results showed that compared with PLIF, Dynesys system significantly decreased operation time(<0.01), intraoperative blood loss (<0.01). Both Dynesys and PLIF groups experienced improved ODI and back/leg pain VAS scores at final follow-up, and no statistically significant difference was noted according to the two surgical procedures(>0.05). Dynesys could remain the range of motion (ROM) of surgical segments with less increased ROM of adjacent segments compared with that of PLIF group(<0.01). Regarding the disc height of surgical segments, no statistically significant difference was noted according to the two groups(>0.05), but postoperative complications incidence rate in PLIF group was higher than that in Dynesys group (<0.05).</p><p><b>CONCLUSIONS</b>Both Dynesys system and PLIF can improve clinical outcomes of lumbar degenerative diseases effectively. Compared with PLIF, Dynesys could remain the range of motion(ROM) of surgical segments with less increased ROM of adjacent segments and lower complication incidence rate. But the ability to prevent adjacent segments degeneration needs more RCTs with long-term follow-up to confirm.</p>

Long-Term Outcome of Dynesys Dynamic Stabilization for Lumbar Spinal Stenosis / 中华医学杂志(英文版)

<p><b>Background</b>Many clinical studies over the past decade have indicated positive outcomes for patients treated with Dynesys dynamic stabilization for lumbar degenerative disease. However, long-term outcomes of Dynesys for lumbar spinal stenosis are rarely reported. The aim of this study was to analyze the long-term clinical and radiologic outcomes for patients with lumbar spinal stenosis treated with Dynesys stabilization.</p><p><b>Methods</b>Thirty-eight patients with lumbar spinal stenosis were treated with Dynesys stabilization from July 2008 to March 2010. The minimal duration of follow-up was 72 months. The patients were divided into stenosis and spondylolisthesis groups according to degenerative spondylolisthesis. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS). Radiographic evaluations included range of motion (ROM) and the disc heights of stabilized segments and the upper adjacent segments. We also evaluated the occurrence of radiographic and symptomatic adjacent segment degeneration (ASD).</p><p><b>Results</b>There were 23 patients in stenosis group and 15 patients in spondylolisthesis group. The ODI scores were significantly improved at the final follow-up evaluation, as compared to the baseline values (16.1 ± 5.7 vs. 57. 2 ± 14.2, t = 61.41, P < 0.01). The VAS scores for back and leg pain were significantly improved from 4.82 ± 0.89 and 4.04 ± 0.82 preoperatively to 0.93 ± 0.61 and 0.54 ± 0.51 postoperatively (t = 6.59, P < 0.01, and t = 5.91, P < 0.01, respectively). There were no differences between the two groups with respect to VAS and ODI scores. The ROM of stabilized segments decreased significantly from 7.8° ± 2.4° to 4.5° ± 1.5° (t = 7.18, P < 0.05), while the upper adjacent segments increased significantly from 8.3° ± 2.4° to 10.4° ± 2.4° (t = 2.87, P = 0.01). The change in disc height of stabilized segments was not significant (11.9 ± 2.1 preoperatively vs. 12.5 ± 1.5 postoperatively, t = 1.43, P = 0.15), whereas the decrease in disc height of the upper adjacent segments was significant (12.5 ± 2.0 preoperatively vs. 11.0 ± 1.7 postoperatively, t = 2.94, P = 0.01). The occurrence of radiographic and symptomatic ASD was 16% (6/38) and 3% (1/38), respectively.</p><p><b>Conclusions</b>Decompression and Dynesys stabilization for lumbar stenosis with or without spondylolisthesis showed good long-term clinical and radiographic results. Lumbar stenosis with or without Grade I spondylolisthesis, particularly in patients <60 years of age with mild-to-moderate lumbar disc degeneration, would be one of the main indications for the Dynesys system.</p>

Effect of hip fracture at different sites in elderly patients on prognosis / 中国骨伤

<p><b>OBJECTIVE</b>To determine the effect of site of fracture on the prognosis for patients of elderly hip fracture.</p><p><b>METHODS</b>From January 2012 to December 2014, 667 patients with hip fractures were divided into femoral neck fracture group and intertrochanteric fracture group according to the site of fracture. There were 304 cases of intertrochanteric fracture, including 96 males and 208 females, with an average age of (80.33±7.94) years old. There were 217 cases of femoral neck fracture, including 74 males and 143 females, with an average age of (79.82±9.33) years old. Patients' data, mortality and activities of daily living were compared between two groups.</p><p><b>RESULTS</b>There were no significant differences in age, gender, comorbidity, ASA classification, and anesthesia between two groups, but the time of admission to surgery, duration of operation, blood loss of intra-operative, volume of drainage, and the average of transfusion were shown to have significant differences. The levels of White blood cell count (WBC) for intertrochanteric fracture group were shown to be higher than that of femoral neck fracture patients at admission, 1, 3 and 5 days after operation. The levels of hemoglobin, and albumin for intertrochanteric fracture were lower than that of femoral neck fracture patients at all period of time. The mortality of intertrochanteric fracture group during hospitalization, 1, 3, 6, and 12 months were higher than that of femoral neck fracture, but did not reach significant difference. In patients who survived, the scores of ADL for femoral neck fracture were higher than that of intertrochanteric fracture at discharge, 1, 3 months after operation, but there was no significant difference for ADL at 6 and 12 months between two groups.</p><p><b>CONCLUSIONS</b>The response of stress for intertrochanteric fracture were more than femoral neck fracture, but the mortality was similar than that of femoral neck fracture after excluding the influence of age, sex, comorbidity, and other factors. Compared to intertrochanteric fracture, the femoral neck fracture patients had a better functional recovery during early stage, and the two groups reached a similar functional recovery at 1 year after operation.</p>

Extracellular splitting pattern of mitochondria and the depressant effects of CsA on the process / 中国骨伤

<p><b>OBJECTIVE</b>To investigate extracellular splitting pattern of mitochondria and the depressant effects of CsA on the process and explore the mechanism of post-traumatic SIRS and its therapeutic strategy.</p><p><b>METHODS</b>Ten male SD rats with 60 to 70 days age and 240 to 280 g weight were used for mitochondrial isolation. Freshly isolated mitochondria were randomly divided into two groups, which were cultured in blood plasma with or without CsA respectively for 8 h. COX and MDH were assayed by ELISA every 30 min. Meanwhile, Rat macrophage cell line NR8383 were treated as follows, control (group A): cultivation with normal medium; NR8383+CsA co-culture group (group B): culture medium was supplemented with CsA of 10 mmol/L; NR8383+intact mitochondria co-culture group (group C): culture medium was supplemented with intact mitochondria (mtDNA=5 g/ml); NR8383+intact mitochondria+CsA co-culture group (group D): culture medium was supplemented with intact mitochondria (mtDNA=5 μg/ml)and CsA of 10 mmol/L; NR8383+disrupted mitochondria co-culture group (group E): culture medium was supplemented with disrupted mitochondria (mtDNA=5 μg/ml); NR8383+disrupted mitochondria+CsA co-culture group (group F): culture medium was supplemented with disrupted mitochondria (mtDNA=5 μg/ml)and CsA of 10 mmol/L. TNF-α and IL-6 concentrations in supernatant were assessed at 1, 3, 5 h after culture.</p><p><b>RESULTS</b>In the mitochondria plasma cultures, MDH and COX levels were increased with the time and peaked at about 3 h and 3.5 h; CsA can delay the appearance of peak to 4.5 h. Among different treated groups,there was no significant difference in TNF-α and IL-6 between group A and group B; there was significant difference in TNF-α and IL-6 other groups. After 1 h culture, compared with group C, no significant difference of TNF-α and IL-6 was observed in group D, while TNF-α and IL-6 were significant higher in group E; after 3 h culture, compared with group C, TNF-α and IL-6 were significantly lower in group D, while TNF-α and IL-6 were significantly higher in group E; after 5 h culture, compared with group C, TNF-α and IL-6 were significantly lower in group D, while no significant difference of TNF-α and IL-6 were observed in group E. At each time point, there was no significant difference in TNF-α and IL-6 between group F and group E.</p><p><b>CONCLUSION</b>Mitochondria can split in serum with time, which will further activate macrophages. CsA has depressant effect to mitochondrial splitting on the process and will therefore inhibit the activation of macrophages.</p>

Protective effects of 3-methyladenine on acute lung injury caused by multiple trauma in rats / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the role of autophagy in acute lung injury (ALI) caused by multiple trauma in rats via pretreat with 3-methyladenine (3-MA).</p><p><b>METHODS</b>Forty-five Sprague-Dawley male rats, with age of 4 months and body weight of 250-300 g,were randomly divided into three groups. In the sham group, the rats received sphenotresia only;in the control group, the rats were made model of femur shaft fracture combined with brain injury, and treated with physiological saline by abdominal cavity at 1 hour before making model; in the 3-MA group, the rats were made model of femur shaft fracture combined with brain injury,and treated with 3-MA of 10 mg/kg by abdominal cavity at 1 hour before making model. Histologic changes and the concentration of related inflammatory factors in the damaged lung tissue were examined at 48 h after opteration, at the same time, the effect of 3-MA on the expression of LC-3 II and Beclin-1 was examined through reverse transcriptase polymerase chain reaction technique (RT-PCR).</p><p><b>RESULTS</b>Compared with sham group, LC-3 II and Beclin-1 level in control group at 48 h after operation were obviously increased (P < 0.01). Compared with control group, LC-3 II and Beclin-1 level in 3-MA group at 48 h after operation were obviously decreased (P < 0.01). Compared with sham group, the level of proinflammatory cytokines (TNF-α and IL-6) in control group obviously enhanced (P < 0.01). Compared with control group, above items in 3-MA group was obviously lower (P < 0.01). Compared with control group,the histopathological damage of lung in 3-MA group obviously reduced (P < 0.01).</p><p><b>CONCLUSION</b>Autophagy can aggravate the acute lung injury caused by fracture of shaft of femur combined with brain injuries,but 3-MA can reduce tissue damage by inhibiting the autophagy and inflammatory response.</p>

Percutaneous Nucleoplasty Using Coblation Technique for the Treatment of Chronic Nonspecific Low Back Pain: 5-year Follow-up Results / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>This study evaluated the efficacy of percutaneous nucleoplasty using coblation technique for the treatment of chronic nonspecific low back pain (LBP), after 5 years of follow-up.</p><p><b>METHODS</b>From September 2004 to November 2006, 172 patients underwent percutaneous nucleoplasty for chronic LBP in our department. Forty-one of these patients were followed up for a mean period of 67 months. Nucleoplasty was performed at L3/4 in 1 patient; L4/5 in 25 patients; L5/S1 in 2 patients; L3/4 and L4/5 in 2 patients; L4/5 and L5/S1 in 7 patients; and L3/4, L4/5, and L5/S1 in 4 patients. Patients were assessed preoperatively and at 1 week, 1 year, 3 years, and 5 years postoperatively. Pain was graded using a 10-cm Visual Analogue Scale (VAS) and the percentage reduction in pain score was calculated at each postoperative time point. The Oswestry Disability Index (ODI) was used to assess disability-related to lumbar spine degeneration, and patient satisfaction was assessed using the modified MacNab criteria.</p><p><b>RESULTS</b>There were significant differences among the preoperative, 1-week postoperative, and 3-year postoperative VAS and ODI scores, but not between the 3- and 5-year postoperative scores. There were no significant differences in age, sex, or preoperative symptoms between patients with effective and ineffective treatment, but there were significant differences in the number of levels treated, Pfirrmann grade of intervertebral disc degeneration, and provocative discography findings between these two groups. Excellent or good patient satisfaction was achieved in 87.9% of patients after 1 week, 72.4% after 1 year, 67.7% after 3 years, and 63.4% at the last follow-up.</p><p><b>CONCLUSIONS</b>Although previously published short- and medium-term outcomes after percutaneous nucleoplasty appeared to be satisfactory, our long-term follow-up results show a significant decline in patient satisfaction over time. Percutaneous nucleoplasty is a safe and simple technique, with therapeutic effectiveness for the treatment of chronic LBP in selected patients. The technique is minimally invasive and can be used as part of a stepwise treatment plan for chronic LBP.</p>

Comparison of Functional and Radiological Outcomes Between Two Posterior Approaches in the Treatment of Multilevel Cervical Spondylotic Myelopathy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Posterior cervical decompression is an accepted treatment for multilevel cervical spondylotic myelopathy (CSM). Each posterior technique has its own advantages and disadvantages. In the present study, we compared the functional and radiological outcomes of expansive hemilaminectomy and laminoplasty with mini titanium plate in the treatment of multilevel CSM.</p><p><b>METHODS</b>Forty-four patients with multilevel CSM treated with posterior cervical surgery in Department of Orthopedic Surgery, Beijing Army General Hospital from March 2011 to June 2012 were enrolled in this retrospective study. Patients were divided into two groups by surgical procedure: Laminoplasty (Group L) and hemilaminectomy (Group H). Perioperative parameters including age, sex, duration of symptoms, operative duration, and intraoperative blood loss were recorded and compared. Spinal canal area, calculated using AutoCAD ® software(Autodesk Inc., San Rafael, CA, USA), and neurological improvement, evaluated with Japanese Orthopedic Association score, were also compared.</p><p><b>RESULTS</b>Neurological improvement did not differ significantly between groups. Group H had a significantly shorter operative duration and significantly less blood loss. Mean expansion ratio was significantly greater in Group L (77.83 ± 6.41%) than in Group H (62.72 ± 3.86%) (P < 0.01).</p><p><b>CONCLUSIONS</b>Both surgical approaches are safe and effective in treating multilevel CSM. Laminoplasty provides a greater degree of enlargement of the spinal canal, whereas expansive hemilaminectomy has the advantages of shorter operative duration and less intraoperative blood loss.</p>

Comparison of unipedicular and bipedicular percutaneous kyphoplasty for treating osteoporotic vertebral compression fractures: a meta-analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Percutaneous vertebroplasty (PKP) has proved its effectiveness regarding minimal invasion, rapid pain reduction, safe cement augmentation, restoring vertebral height, and accelerating complete recovery of osteoporotic vertebral compression fractures (OVCFs). Whether unipedicular or bipedicular PKP provides a better outcome is controversial.</p><p><b>METHODS</b>We searched PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Knowledge, Chinese Biomedical Literature Database, and Wanfang Data from January 1980 to March 2013 with "kyphoplasty", "unipedicular", "bipedicular", "compression fracture", and "randomized controlled trial". Risk of bias in the included studies was assessed according to a 12-item scale. Meta-analysis was performed. Dichotomous and continuous variables were calculated using the odds ratio (OR) and standardized mean difference (SMD), respectively.</p><p><b>RESULTS</b>Seven studies involving 440 patients and 559 vertebral bodies met the criteria for inclusion. Among them, one randomized controlled trial had a high risk of bias and six a low risk. The pain visual analogue scale (VAS) SMDs were -0.02 (P = 0.88) for short-term follow-up (≤3 months) and 0.03 (P = 0.82) for long-term follow-up (≥ 1 year). Oswestry Disability Index (ODI) SMDs at short- and long-term follow-up were not statistically significant (-0.04, P = 0.77 and -0.07, P = 0.74, respectively). This meta-analysis showed greater polymethylmethacrylate volume (SMD -1.08, P = 0.00) and operation time (SMD -2.40, P = 0.00), favoring unipedicular PKP. Radiographic outcomes-preoperative kyphosis angle, restoration rate, reduction angle, loss of reduction angle-were not statistically different between the groups. Pooled analyses of cement leakage and subsequent adjacent OVCFs showed no significant differences between the groups, with OR = 0.82 (P = 0.79) and OR = 1.41 (P = 0.70), respectively.</p><p><b>CONCLUSIONS</b>This meta-analysis comparing unipedicular and bipedicular PKP demonstrated no significant differences regarding VAS, ODI, radiographic outcomes, or complications. Considering the longer operation time and radiation exposure with bipedicular PKP, we recommend unipedicular PKP over bipedicular PKP for treating OVCFs.</p>

Factors influencing postoperative mortality one year after surgery for hip fracture in Chinese elderly population / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Disability and death following hip fracture is becoming more common as the population ages. Previous reports have focused on the selection of internal fixation methods and the analysis of the perioperative therapeutic results in the Chinese population. Few studies have focused on factors influencing medium and long term survival after surgery for hip fracture. We conducted a retrospective study on the factors influencing survival one year after hip fracture surgery in our elderly Chinese population to provide a reference for improved treatment and to enhance efficacy.</p><p><b>METHODS</b>Records from patients undergoing treatment for hip fracture at our hospital from October 2009 through June 2011 were retrospectively reviewed. Through telephone follow-up, the health condition of each patient was surveyed, and the 1-year postoperative mortality was analyzed. The patients' age, gender, fracture type, pre-injury health condition, mobility, complications, surgical timing, surgical types, methods of anesthesia, and postoperative complications were analyzed. Univariate and multivariate regression analysis was performed on relevant influencing factors.</p><p><b>RESULTS</b>A total of 184 patients had complete data and were followed-up for 12-23 months (average, 16.5 months). There were 30 deaths (16.3%) at one-year. Univariate analysis revealed that factors such as age, gender, fracture-type, number of co-existing diseases, complications such as chronic obstructive pulmonary disease or sequelae of stroke, American society of Anesthesiology (ASA) scores, anesthesia methods, pre-injury activity, and post-operative complications were significantly different between survival versus mortality groups (P < 0.05). Multivariate regression analysis revealed that age, ASA score, pre-injury mobility and combined chronic obstructive pulmonary disease were independent risk factors for death.</p><p><b>CONCLUSION</b>Full consideration of medium-/long-term risk factors in the treatment of hip fracture in the elderly, selection of appropriate anesthesia and treatment methods, and improved pre-surgical health conditions would reduce postoperative mortality and enhance surgical efficacy.</p>

Dynesys dynamic stabilization system for the lumbar degenerative disease: a preliminary report from China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Dynesys dynamic stabilization system was first implanted in patients in 1994, and introduced to China in 2007. Therefore, it was a new technique for Chinese orthopedics and hence necessary to collect clinical data about Dynesys in China. The objective of this study was to report the preliminary results of Dynesys for the lumbar degenerative disease in China.</p><p><b>METHODS</b>Twenty-seven patients were treated with the Dynesys between July 2007 and January 2009. The diagnosis included degenerative spondylolisthesis (12 cases), degenerative spinal stenosis (nine cases), and lumbar intervertebral disc herniation (six cases). Back pain and leg pain were evaluated using 100-mm visual analog scales (VAS). The Oswestry Disability Index (ODI) was used to evaluate the patients' function. The intervertebral disc height and range of motion at the operative level were taken on radiographs.</p><p><b>RESULTS</b>All the patients were followed-up, with an average of (22.40 ± 4.23) months (range 15-32 months). VAS of back pain and leg pain were improved significantly (P < 0.05) at follow-up. The ODI scores were reduced from (62.58 ± 12.01)% preoperatively to (15.01 ± 5.71)% at follow-up (P < 0.05). The preoperative mean height of the intervertebral disc was (11.21 ± 1.58) mm (range 8.5-13.8 mm) and mean was (10.10 ± 1.78) mm (range 7.0-13.4 mm) at follow-up (P < 0.05). The mean range of motion of the implanted segment was (6.00 ± 1.79)° (range 2.5-9.3°) preoperatively and (5.47 ± 1.27)° (range 2.9-7.8°) at follow-up (P = 0.11).</p><p><b>CONCLUSIONS</b>The preliminary results of Dynesys for the lumbar degenerative disease in China are similar to the published results of other countries. It can significantly improve the clinic symptoms and preserved motion at the level of implantation. However, the long-term follow-up data need to be collected.</p>

Metallic modular radial head prostheses for Mason III and IV unreconstructable radial head fractures / 中国骨伤

<p><b>OBJECTIVE</b>To assess the early efficacy of metallic modular radial head prostheses in patients with Mason III and IV unreconstructable radial head fractures.</p><p><b>METHODS</b>The medical records of 16 patients (9 males, 7 females) with a mean age of 43 years old (31 to 57) with Mason III/IV unreconstructable radial head fractures requiring metallic modular radial head replacement between January 2009 and March 2012, were reviewed retrospectively. The functional results were assessed by range-of-movement, Mayo elbow performance score (MEPS). All patients underwent radiographic evaluation for radial head height and radiolucent lines.</p><p><b>RESULTS</b>Fourteen patients were evaluated with follow-up for 12 to 33 months with an average of 23 months. Range of movement parameters was significantly lower in the affected elbow than in the unaffected side (P < 0.01). MEPS results were excellent in 9 cases, good in 2 cases, fair in 2 cases, and poor in 1 case. According to Grewal grading, there were 4 cases of periprosthetic lucencies of the radius and 1 case had significant clinical signs of loosening.</p><p><b>CONCLUSION</b>Radial head replacement with the metallic modular prostheses yields satisfactory results regarding range of motion and function of the elbow joint in short term. The evolution of this prostheses needs to be evaluated with further studies to assess mid-term and long-term follow-up results.</p>

Psychological trauma of funnel chest in adolescents and the appropriate age for minimally invasive surgery repair / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Funnel chest has a negative effect on adolescents and it has a strong effect on adolescents' psychological and behavior. This study aimed to investigate the psychological characteristics and factors that affect adolescents with funnel chest and to evaluate the relationship between the patients' age and their physiological and psychological health. We aimed to establish an age model for maximum surgery benefits for funnel chest patients to provide an objective basis for choosing surgery.</p><p><b>METHODS</b>The study adopted a general evaluation approach to assess the risk and benefits of minimally invasive surgery for funnel chest. The funnel chest index, the Symptom Checklist-90, and the Eysenck Personality Questionnaire were used as assessment tools to observe physiological and psychological features in funnel chest patients. A sample of 234 adolescents with funnel chest was selected from a third-grade class-A hospital in Beijing. Age groups were adopted as an independent variable, and other factors in funnel chest patients were dependent variables.</p><p><b>RESULTS</b>There was a significant difference in the relapse rate for funnel chest in the different age groups (χ(2) = 11.883, P = 0.008). There was a higher relapse rate in patients of ≤10 or ≥19 years old than in patients of 11-18 years old. There was a significant difference in the SCL-90 total score in the different age groups (F = 12.538, P = 0.0001), the patients older than 13 years had a higher score than those younger than 13 years in the SCL-90. There was a significant difference in the standard score of E (introversion/ extraversion) in the different age groups (F = 10.06, P = 0.0001). There was also a significance in the funnel chest index before surgery in the different psychological scales (P < 0.01), with a higher funnel chest index score associated with more obvious psychological trauma. Age and the number of variables, including the relapse rate, SCL-90 score, standard score of E, and standard score of N in the EPQ were significantly correlated (correlation indices were 0.402, 0.623, -0.505, and 0.473, respectively, P < 0.01).</p><p><b>CONCLUSIONS</b>There are higher complication rates after surgery and relapse rates when funnel chest patients are too young or too old. There is more obvious psychological trauma in patients with a high funnel chest index. Our results indicate that the best age for surgery for funnel chest is 14-16 years.</p>

Analysis of the characteristics of articular cartilage lesions under knee arthroscopy in different age groups / 中国骨伤

<p><b>OBJECTIVE</b>To provide reliable data on articular cartilage lesions in different age group of patients with symptomatic knees requiring arthroscopy, and to analyze the characteristics of articular cartilage lesions.</p><p><b>METHODS</b>From November 2004 to September 2005, 568 patients were under arthroscopy in orthopaedics of Chinese PLA General Hospital. There were 242 males and 326 females, with a mean age of (43.0 +/- 11.2) years (ranged, 12 to 80 years). Surgery information including causes of injury, onset of symptoms, meniscus lesions, cruciate ligament pathology, articular cartilage lesions were collected by a special Data Management software. All the patients were divided into two groups : youth group and middle-aged group. The data of articular cartilage lesions of patients in the two groups were collected.</p><p><b>RESULTS</b>There were 923 articular cartilage lesions in 389 patients, and 13 lesions were iatrogenic. In youth group, 212 lesions were found in 121 patients, and the main cause of lesions was menisci menisci injury (57/121 cases). In middle-aged group, 711 lesions were found in 268 patients,and the main cause of lesions was osteoarthritis (218/268 cases). The articular cartilage lesions located majorly in the lateral femoral condyle, medial femoral condyle and patellae in patients of the two groups. The major depth of the lesion was grade IV (330 lesions) in middle-aged group and grade III (71 lesions) in youth group,respectively.</p><p><b>CONCLUSION</b>Articular cartilage lesions are common in patients under arthroscopy, and articular cartilage lesions of different age group of patients are different, so the best treatment method should be chosen regarding to age factors of patients.</p>

Effects of vertebral height restoration of vertebroplasty for osteoporotic vertebra compression fractures / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the effect of vertebral height restoration of vertebroplasty for osteoporotic vertebra compression fractures (VCFs).</p><p><b>METHODS</b>From October 2004 to June 2007, a total of 37 patients with 40 VCFs were treated by vertebroplasty. There were 12 males and 25 females with a mean age of (72.4 +/- 12.7) years (ranged, 48 to 87). Pain easement state was evaluated by visual analog scale (VAS) before and after operation, as well as in followed-up. Preoperative and postoperative vertebral height, kyphosis angle at fractured levels were measured on X-rays.</p><p><b>RESULTS</b>All of patients were followed-up for 12 to 47 months (averaged, 35.8 +/- 9.6). The VAS score was 8.4 +/- 1.6 before operative, 2.1 +/- 1.2 at the 2nd day after operative, there were significant difference between pre-and postoperative (P < 0.05); the average follow-up VAS was 1.6 +/- 0.9, there were significant difference as compared with the preoperative (P < 0.05). Lateral X-ray showed that the preoperative degree of vertebral height in the of anterior and middle vertebral were (72.0 +/- 10.6)% and (68.0 +/- 15.6)%, and postoperative were (76.0 +/- 8.6)% and (73.0 +/-6.1)%, respectively. There were no significant difference in vertebral height between preoperative and postoperative. The vertebral kyphosis angle was corrected from preoperative (7.8 +/- 2.7) degree to postoperative (8.1 +/- 2.3) degree.</p><p><b>CONCLUSION</b>Vertebroplasty is a safe and effective method for treatment of osteoporotic VCFs, it can relieve the pain effectively. Failure to restore vertebaral height does not seem to interfere with the excellent pain management.</p>

VSD combined with fascio-cutaneous flap transferation staging operation to treat post-traumatic osteomyelitis / 中国骨伤

<p><b>OBJECTIVE</b>To explore the therapeutic effects of VSD combined with fascio-cutaneous flap transferation staging operation for the treatment of post-traumatic osteomyelitis.</p><p><b>METHODS</b>From December 2007 to December 2009, 14 patients were treated with the technology of VSD combined with fascio-cutaneous flap transferation staging operatinon. Nine patients were males and 5 patients were females, and mean age was 36 years. All the patients were postoperative wound infection. Osteomyelitis of the tibia was in 9 cases, calcaneus in 3 cases, femur in 1 case, radius and ulna in 1 case; infection of time were from 2 to 96 weeks, an average time of 32 weeks.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 12 to 36 months, with an average of 19.2 months. All the patients were treated with debridement and VSD for 1 to 3 times, with an average of 1.57 times. The wounds of 13 cases healed well after flaps transferation, but of 1 case leakaged and healed after 3 weeks with the therapy of drainaging and changing dressings. Due to delayed healing or defects of bone, 8 patients had autologous bone grafted on the second stage. All wounds and fractures healed without recurrence of postoperative infection.</p><p><b>CONCLUSION</b>VSD combined with flap transferation is an effective treatment of post-traumatic osteomyelitis, which can shorten the treatment time and have better security and reliability than traditional methods.</p>