Clinical outcomes of hip arthroscopic treatment for femoroacetabular impingement:a comparative study between Inside-out and Outside-in approach / 中国骨伤

OBJECTIVE@#To compare the clinical outcomes and complications of hip arthroscopic treatment for femoroacetabular impingement (FAI) performed with either Inside-out or Outside-in approach.@*METHODS@#The clinical date of 48 patients with FAI treated by hip arthroscopy surgery and follow-up from June 2016 to June 2019 were retrospectively analyzed. According to the different operative methods, the patients were divided into two groups. Inside-out group, from central compartment to peripheral compartment;Outside-in group, from peripheral compartment to central compartment. There were 14 males and 10 females in Inside-out group with an averageage of (39.8±7.6)years old, 13 males and 11 females in Inside-out group with an average age of (39.5±9.1)years old in Outside-in group. There was no significant difference in age, gender, body mass index, side, impingement type, medical history and follow-up time between the two groups. The complication occurrence rate, modified Harris hip score (mHHS)and nonarthritic hip score (NAHS) were compared between these two groups.@*RESULTS@#The mHHs and NAHS scores of the two groups were significantly higher than those before operation, but there was no significant difference between the two groups (@*CONCLUSION@#Both hip arthroscopic surgery methods can obtain satisfactory clinical efficacy in the treatment of FAI, but the incidence of postoperative complications of Outside-in surgical method is lower. The out-side in method can be preferentially selected for the patients with the indications of operation.

Tissue-engineered cartilage implantation for the treatment of full-thickness knee cartilage defects / 中国组织工程研究

BACKGROUND:The use of normal hyaline cartilage to repair large areas of full-thickness knee cartilage defect has been a hot topic recently; however, a follow-up study with a relative large number of patients is required. OBJECTIVE:To make a preliminary study concerning the methods and therapeutic effects of tissue-engineered cartilage (TEC) implantation for treating large-area full-thickness knee cartilage defects. METHODS:Twenty-one patients (23 knees) diagnosed with cartilage defect of the knee joint (Outbridge III-IV) were enrolled. The area of the cartilage defect was 3.5-11.2 cm2. All of the patients were given TEC treatment. Postoperative functional exercise of the knee joint was carried out in these patients as planned. We regularly reviewed the knee MRI and calculated visual analog scale score, International Knee Documentation Committee (IKDC) score, and Lysholm score. RESULTS AND CONCLUSION:All the patients were followed up for 3 to 12 months. Postoperatively knee pain relieved obviously, and the visual analog scale score was significantly declined compared with the preoperation (P<0.05). All the patients manifested painless 1 year after surgery. The 1-year postoperative MRI showed that the injured cartilage grew well. The thickness and MRI signal of the graft was the same as the normal cartilage, and the bone healed completely. The IKDC and Lysholm scores were significantly improved at 3, 6, 12 months after the surgery, and the difference was statistically significant before and after the surgery (P<0.05). Overall, TEC is an improved technique of chondrocyte implantation, which is an effective and safe method for cartilage defect repair.

Case-control study on needle-knife to cut off the medial branch of the lumbar posterior ramus under C-arm guiding for the treatment of low back pain caused by lumbar facet osteoarthritis / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical efficacy of needle-knife to cut off the medial branch of the lumbar posterior ramus under C-arm guiding to treat low back pain caused by lumbar facet osteoarthritis.</p><p><b>METHODS</b>From July 2009 to June 2011, 60 patients with low back pain caused by lumbar facet osteoarthritis were reviewed,including 34 males and 26 females, ranging in age from 39 to 73 years old,averaged 61.9 years old; the duration of the disease ranged from 6 to 120 months, with a mean of 18.9 months. All the patients were divided into two groups, 30 patients (18 males and 12 females, ranging in age from 39 to 71 years old, needle-knife group) were treated with needle-knife to cut off medial branch of the lumbar posterior ramus under C -arm guiding and the other 30 patients(16 males and 14 females, ranging in age from 41 to 73 years old, hormone injection group) were treated with hormone injection in lumbar facet joint under C-arm guiding. The preoperative JOA scores and the scores at the 1st, 12th and 26th weeks after treatment were analyzed.</p><p><b>RESULTS</b>Before treatment,the JOA scores between the two groups had no significant difference (P= 0.479); after 1 week of treatment, the JOA scores between the two groups had significant difference (P= 0.040), the improvement rate of hormone injection group was superior than that of the needle-knife group,which were (58.73+/-18.20)% in needle-knife group and (71.10+/-22.19)% in hormone injection group; after 12 weeks of treatment, the JOA scores between the two groups had no significant difference(P=0.569), and the improvement rate between the two groups had no significant difference,which were (50.09+/-19.33)% in the needle-knife group and (48.70+/-18.36)%) in the hormone injection group; after 26 weeks of treatment,the JOA scores between the two groups had significant difference (P=0.000), the improvement rate of hormone injection group was superior than that of the needle-knife group,which were (48.56+/-28.24)% in needle-knife group and (15.62+/-11.23 )% in hormone injection group.</p><p><b>CONCLUSION</b>Using needle-knife to cut off the medial branch of the lumbar posterior ramus could get longer efficacy than hormone injection in the treatment of lumbar facet osteoarthritis.</p>

Efficacy and safety of using denervation to treat the low back pain due to lumbar joint origin / 中国骨伤

<p><b>OBJECTIVE</b>To explore efficacy and safety of using denervation of dorsal medial branch to treat the low back pain due to lumbar joint origin.</p><p><b>METHODS</b>From March 2009 to October 2010,10 patients with the low back pain due to lumbar joint origin were enrolled in this study including 6 males and 4 females with an average age of 56.4 years old (41 to 68). The average disease duration was 1.2 years (0.5 to 3). All patients were operated by blocking the dorsal medial branch. Single branch (dorsal medial branch of the involved level), dual branches (dorsal medial branches of the involved and the upper or lower level, 5 with the upper level, 5 with the lower level), three branches (dorsal medial branches of the involved and the upper and lower levels), four branches (dorsal medial branches of the involved and the upper two and lower levels) were blocked by 0.5% lidocaine 15 ml compounded with betamethasone injection 1 ml (10 mg/ml) and a cobalt ammonium injection 500 microg at the junction of the superior articular process and the transverse process. Low back pain VAS, average EMG of multifidus of the involved level and low back muscle strength were assessed and statistically compared. Low back muscle strength was measured by the back power meter.</p><p><b>RESULTS</b>The mean low back pain VAS of the 10 patients in the preoperation was 6.85 +/- 1.55, in single branch blocked group was 5.80 +/- 1.05, in dual branches blocked group was 3.65 +/- 1.20, in three branches blocked group was 2.80 +/- 1.10 and in four branches blocked group was 2.75 +/- 1.15. Average EMG of multifidus was 69.25 +/- 2.13 in the preoperation,in single branch blocked group was 62.15 +/- 1.85, in dual branches blocked group was 51.25 +/- 1.28, in three branches blocked group was 47.30 +/- 1.85 and in four branches blocked group was 45.96 +/- 1.98. The mean low back muscle strength was 60 kg in the preoperation, in single branch blocked group was 55 kg,in dual branches blocked group was 48 kg, in three branches blocked group was 44 kg and in four branches blocked group was 43 kg. Among the dual branches blocked group,low back pain VAS and low back muscle strength in the dorsal medial branches of the involved and the upper level blocked showed great decline compared with those in the dorsal medial branches of the involved and the lower level blocked.</p><p><b>CONCLUSION</b>It is effective by denervation of dorsal medial branch to treat the low back pain due to lumbar joint origin. There are significant difference in low back pain VAS between every two among the preoperation,single branch blocked group,dual branches blocked group and three branches blocked group. There is no significant difference between four branches blocked group and three branches blocked group. In low back muscle strength and average EMG of multifidus, compared with the preoperation group,there is no significant decline in single branch blocked and dual branches blocked group,and there is significant decline in three branches blocked and four branches blocked group. Therefore, single or dual dorsal medial branch blocked is safety. Among the dual branches blocked group, dorsal medial branches of the involved and the upper level blocked should be given priority to. There is a certain risk in three or four dorsal medial branches blocked which should be used with caution.</p>

Clinical study on surgical treatment for thoracolumbar burst fractures / 中国骨伤

<p><b>OBJECTIVE</b>To explore the choice of operative approach for thoracolumbar burst fractures and evaluate its clinical effects.</p><p><b>METHODS</b>From September 2005 to March 2009, the clinical data of 94 patients with thoracolumbar burst fractures were analyzed retrospectively. Including 59 males and 35 femals with an average age of 36.8 years (ranged from 20 to 63). The fractures were classified according to Denis classification: 17 cases of type A, 32 cases of type B, 6 cases of type C, 24 cases of type D, 15 cases of type E. Neurological injuries were classified according to ASIA classification: 3 cases of grade A, 4 cases of type B, 23 cases of grade C, 38 cases of grade D, 26 cases of grade E. Among the patients, 42 cases were treated with reduction, decompression, internal fixation with pedicle-screw through posterior approach, meanwhile, of them, 18 cases with posterior-lateral bone graft fusion; 36 cases were treated with decompression, bone graft, through anterior approach, of them, 16 cases with TSRH system fixation and 20 cases with Zeplate system fixation; 16 cases (because of bone block intruded into vertebral canal leading to spinal cord compression ) were treated with anterior and posterior approach, internal fixation with pedicle-screw through posterior approach and subtotal vertebrectomy, decompression, titanium mesh cages bone graft fusion through anterior approach, meanwhile, of them, 8 cases with screw-rod and titanium steel plate system fixation.</p><p><b>RESULTS</b>All patients obtained good results and were followed up from 9 to 52 months with an average of 22.8 months. Cobb angle were corrected from preoperatively (25.00 +/- 5.50) degrees to postoperatively (4.20 +/- 1.80) degrees. Height of anterior and posterior border of vertebral body improved from preoperatively (50.80 +/- 2.82)%, (79.30 +/- 3.08)% to postoperatively (94.85 +/- 1.80)%, (98.20 +/- 1.40)%, respectively. The ratio of protruded bones to the spinal canal anteroposterior diameter decreased from preoperatively (33.10 +/- 1.40)% to postoperatively (6.70 +/- 1.50)%. Sagittal abnormity were corrected; posterior convex angle and height were no markedly lost during follow-up; no internal fixation loosening and titanium mesh displacement were found. In the aspect of never function, except for 1 case of grade A there is no recovered others obtained different improvement, among them, from grade A to B was in 2 cases; B to C, D was in 2,2, respectively; C to D, E was 16,7, respectively; D to E was in 38 cases.</p><p><b>CONCLUSION</b>The two factors decide surgical methods:the integrity of posterior ligamentous complex and nervous system function. Anterior approach refers to patients with incomplete spinal cord injury and anterior vertebral canal compression; posterior approach refers to patients with injury of posterior ligamentous complex; combination with anterior and posterior approach refers to patients with two injury factors.</p>

Enhanced diagnostic value of 99Tcm-MDP SPECT/CT in patients with spinal bone malignancy / 中华核医学杂志

Objective To investigate the additional diagnostic value of 99Tcm-MDP SPECT/CT over conventional SPECT scan in patients with spinal bone malignancy. Methods Fifty-two patients (mean age (56±14) years) with suspicious spinal bone diseases underwent both bone SPECT and SPECT/CT imaging right after 99Tcm-MDP whole-body planar bone scintigraphy. All patients were pathologically diagnosed by either spine operation or trans-spinal biopsy. The images were evaluated by two independent reviewers; inter-reviewer agreement was evaluated using a weighted Kappa score. Each focus of abnormality was recorded using a 4-point diagnostic confidence scale: benign (B), possibly benign (PB), possibly malignant (PM) or malignant (M). Results Accord to the pathological results, 36 patients had bone malignancy (19 with metastatic tumors and 17 with non-metastatic tumors) and 16 had benign lesions. Over SPECT images, two reviewers rated 73.1% (38/52) and 67.3% (35/52) the lesions as the equivocal (PB or PM) respectively. Over SPECT/CT images, they rated only 25.0% (13/52) and 13.5% (7/52) lesions as the equivocal. Inter-reviewer agreement was 63.5% (weighted Kappa score=0.62) for SPECT and 78.9% (weighted Kappa score=0.81) for SPECT/CT. Conclusions Compared with99Tcm-MDP SPECT, 99Tcm-MDP SPECT/CT results in a significant reduction of equivocal diagnoses for the spinal bone malignancy.

The precision of glomerular filtration rate determined by Gates method and compared with the results from renal pathological changes / 中华核医学杂志

Objective To evaluate the precision of GFR using Gates method and compared with the results from renal pathological changes. Methods Twenty-seven patients whose 99Tcm-DTPA renograms had no obvious uptake phase were enrolled in Group A, and 27 patients whose 99Tcm-DTPA renograms had obvious uptake phase were enrolled in Group B. The measurement of GFR by Gates method was compared to the creatinine clearance measured and predicted by Cockroft-Gault (C-G), modification of diet in renal disease (MDRD) and SCr level. Renal pathological changes in two groups were compared using Pearson correlation and t test analysis. Results In Group A, GFR determined by Gates method did not show correlation with that estimated by C-G or 1/SCr (r = 0. 357,0. 376, both P ＞0.05), but was significantly correlated with GFR estimated by MDRD(r = 0. 440, P ＜ 0.05). In Group B, GFR determined by Gates method showed significantly correlation among GFR estimated by MDRD, C-G, and 1/SCr (r =0. 471, 0. 527,0. 452, all P ＜ 0.05). Renal tubulointerstitial damage score in Group A was higher than that in Group B (7.15±2.32, 3.70±3.06, t=4.66, P ＜0.001). Conclusions GFR determined by Gates method is less precise when 99Tcm-DTPA renogram has no obvious uptake phase than that when 99Tcm-DTPA renogram has obvious uptake phase. Renal tubulointerstitial damage is a strong indicator of no obvious uptake phase in 99Tcm-DTPA renogram.

The added diagnostic value of SPECT/CT imaging for bone metastases from lung cancer / 中华核医学杂志

Objective To investigate the added diagnostic value of SPECT/CT imaging over routine planar whole-body bone scintigraphy (WBBS) for bone metastases from lung cancer. Methods One hundred and forty-six patients with lung cancer, confirmed by pathological examination, underwent routine 99Tcm-MDP (1110 MBq) WBBS, followed by SPECT/CT over the regions with indeterminate findings on WBBS. Both WBBS and bone SPECT/CT images were interpreted by two experienced nuclear medicine physicians in consensus as the positive, negative or uncertain bone metastases. The final diagnosis was comfirmed by pathology or clinical follow-up. x2 test was used to compare the differences between the two imaging methods. Results Finally, 45 patients were diagnosed as positive bone metastases and the other 101 as negative. The diagnostic sensitivity of bone SPECT/CT for bone metastases from lung cancer was 93.3%(42/45), singnificantly higher than that of WBBS (64.4%, 29/45) (x2 = 19.944, P＜0.05). The diagnostic accuracy of bone SPECT/CT was 89.7% ( 131/146), much higher than that of WBBS (44.5%,65/146) ( x2 = 69. 598,P ＜ 0.05). The uncertain and incorrect diagnostic rates of bone SPECT/CT and WBBS were 10.3% ( 15/146, raging from 5.3% to 15.2% with 95% confidence interval (CI) ) and 55.5% (81/146, raging from 47. 4% to 63.5% with95% CI), respectively. Conclusion BoneSPECT/CT provides incremental diagnostic value over routine WBBS for bone metastases from lung cancer.

Surgical treatment of the old with degenerative lumbar spinal stenosis / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the perioperative characteristics and surgical methods in treating the old with degenerative lumbar spinal stenosis.</p><p><b>METHODS</b>From January 2000 to October 2007, 36 patients with degenerative lumbar spinal stenosis with the age more than 60 years,including 16 males and 20 females, the age from 60 to 81 years with an average of 67.5 years. Of all patients, 6 cases were treated by simple surgical decompression, 16 cases by decompressive laminectomy, 20 cases by decompressive laminectomy combined with internal fixation and fusion.</p><p><b>RESULTS</b>No death cases occurred during perioperation and complication occurred in 14 cases, including cerebrospinal fluid leakage in 3 cases, incision late healed in 1 case, heart abnormal symptom in 1 case, respiratory infection in 1 case, gastrointestinal symptom in 4 cases, urinary system infection in 1 case, spirital symptom in 1 case. After symptomatic treatment, all complications improved. All the cases were followed up from 6 months to 5 years with an average of 2.5 years. Oswestry scoring improved from preoperative 45.66 +/- 7.12 to postoperative 16.80 +/- 5.75, there was significant difference between before and after operation (P < 0.05).</p><p><b>CONCLUSION</b>The age and heath condition are not operative absolute contraindication in treating old with degenerative lumbar spinal stenosis,with the proper operation modus after controlling concomitant diseases, the surgical treatment could guarantee the satisfactory therapeutic effect.</p>

Surgical treatment for lumbar spinal stenosis by different methods / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the relationship between decompression methods of lumbar spinal stenosis and outcomes.</p><p><b>METHODS</b>From September 1996 to March 2007, 68 patients with degenerative lumbar spinal stenosis were investigated retrospectively. There were 40 males and 28 females with the mean age of 52.8 years (ranging from 32 to 78 years old). And the average history was 51 months. According to Hansraj classification of lumbar spinal stenosis and levels response to symptom,the classic lumbar spinal stenosis were treated with complete laminectomy and foramintomy (18 cases in group A), hemilaminectomy and foreminotomy (11 cases in group B), complete fenestration and foraminotomy (17 cases in group C); and other patients with complicated lumbar spinal stenosis (22 cases in group D) were treated with decompression and intervertebral fusion and internal fixation. The clinical results of all patients were analyzed according to JOA score (15 scoring method).</p><p><b>RESULTS</b>All patients were followed up with an average of 64 months (ranging from 8 months to 11 years). At final follow-up,the improvement rate of JOA score in the group A,B,C,D was respectively (51.2 +/- 26.6)%, (60.7 +/- 21.1)%, (59.3 +/- 23.1)% and (59.1 +/- 22.7)%. These data were significantly difference than that of preoperative (P < 0.001).</p><p><b>CONCLUSION</b>CT and MRI results combining with clinical symptom and sign is the key to determine decompressive extent; lumbar stability is the key to determine fixation and intervertebral fusion in treating lumbar spinal stenosis.</p>