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Objective:To investigate the effect of periacetabular osteotomy (PAO) assisted by preoperative 3D printing planning on the treatment of early developmental dislocation of the hip (DDH).Methods:A retrospective study was conducted of the 39 patients (44 hips) with CROWE type Ⅰ DDH who had been treated at Department of Orthopaedics, Guizhou Provincial People＇s Hospital from May 2015 to April 2019. In the observation group of 19 patients (22 hips) who were treated by PAO assisted by preoperative 3D printing planning, there were 4 males (4 hips) and 15 females (18 hips) with a mean age of 23(19, 39) years; in the control group of 20 patients (22 hips) who were treated by mere PAO, there were 2 males (2 hips) and 18 females (20 hips) with a mean age of 23(20, 29) years. The 2 groups were compared in terms of operation time, intraoperative bleeding, hospital stay, fluoroscopic frequency, Wiberg lateral center-edge angle (LCE), acetabular index (AC), acetabulum coverage rate, Harris hip scores (HHS) and complications at the final follow-up.Results:There were no significant differences between the 2 groups in their preoperative general data, showing compatibility of the 2 groups ( P>0.05). Both groups were successfully followed up for 6 to 12 months (mean, 9.6 months). The operation time [100 (90, 120) min], intraoperative bleeding [160 (150, 180) mL], hospital stay [6 (5, 7) d], and fluoroscopic frequency [24 (22, 25) times] in the observation group were all significantly better than those in the control group [140 (100, 157) min, 200 (180, 250) mL,9(7, 11) d and 28 (24, 32) times] in the control group ( P<0.05). However, there were no significant differences between the 2 groups in LCE, AC or acetabulum coverage rate immediately after operation, or in HHS or complications at the final follow-up( P>0.05). Conclusions:Although PAO has a definite therapeutic effect on early DDH, PAO assisted by preoperative 3D printing planning can effectively reduce operation time, intraoperative bleeding, hospital stay and intraoperative fluoroscopy. Thus, combination of the two can result in a better therapeutic effect than PAO alone.
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JS001 (toripalimab) is a humanized IgG monoclonal antibody which strongly inhibits programmed cell death protein 1 (PD1). In this study, we used a different iodine isotype (I) to label JS001 probes to target the human PD1 (hPD1) antigen. , the half maximal effective concentration (EC) value of I-JS001 did not significantly differ from that of JS001. The uptake of I-JS001 by activated T cells was 5.63 times higher than that by nonactivated T cells after 2 h of incubation. The binding affinity of I-JS001 to T cells of different lineages after phytohemagglutinin (PHA) stimulation reached 4.26 nmol/L. Humanized C57BL/6 mice bearing mouse sarcoma S180 cell tumors were validated for immuno-positron emission tomography (immuno-PET) imaging. Pathological staining was used to assess the expression of PD1 in tumor tissues. The homologous Ihuman IgG (IhIgG) group or blocking group was used as a control group. Immuno-PET imaging showed that the uptake in the tumor area of the I-JS001 group at different time points was significantly higher than that of the blocking group or the I-hIgG group in the humanized mouse model. Taken together, these results suggest that this radiotracer has potential for noninvasive monitoring and directing tumor-specific personalized immunotherapy in PD1-positive tumors.
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Programmed death receptor 1 (PD-1) and its ligand PD-L1 have been shown to play an important role in evading the immune system. In recent years, PD-1/PD-L1 blockade has shown significant clinical effects in many malignancies, including malignant melanoma, renal cell carcinoma, classic Hodgkin lymphoma, non-small cell lung cancer and so on. PD-1/PD-L1 signaling pathway has become a new target of immunotherapy in patients with malignant tumors. However, there are few researches on immunotherapy in malignant bone tumors, and the progress of clinical research on PD-1/PD-L1 remains to be elucidated. This review started from the mechanism of PD-1/PD-L1 signaling in tumor immunity, and analyzed the application prospect of PD-1/PD-L1 antibodies in malignant bone tumors. We hope to provide a theoretical basis for the treatment of malignant bone tumors based on PD-1/PD-L1 signaling pathway in China.
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Objective@#To evaluate the clinical effects of the implantation of porous tantalum rod under three-dimensional (3D) C-arm positioning in the treatment of ARCO I and II non-traumatic femoral head necrosis.@*Methods@#Fifty patients (58 hips, 39 males and 11 females, mean age 33.52 years) with non-traumatic femoral head in ARCO I-II were included from January 2009 to December 2011. All patients received implantation of porous tantalum rod. The 3D C-arm X-ray positioning was used in 24 patients (29 hips), while traditional C-arm X-ray positioning was performed in the other patients. The visual analogue scale (VAS), Harris score and superior rate were evaluated at 0.5, 1, 2, and 4 years after the surgery. Total hip arthroplasty was regarded as the end event for survival rate.@*Results@#In the 3D C-arm X-ray positioning group, the VAS score decreased from 7.17±1.00 points preoperatively to 2.38±0.86 points at half year, to 2.10±1.40 points at 1 year, to 2.38±1.66 points at 2 years, and to 2.21±1.47 points at 4 years postoperatively (F=98.78, P=0.00). Meanwhile, the Harris score increased significantly from 73.97±3.49 points preoperatively to 89.90±1.93, 89.93±3.26, 89.21±5.83, 88.57±5.70 points at the follow up, respectively (F=84.35, P=0.00). According to the analysis of the pre-operative and post-operative image data, there was no significant difference in progress in the ARCO staging at 23 hips duration the follow-up. Four hips were developed to ARCO III and two hips to ARCO II. Thus, the success rate of operation was 79% (23/29). There were two hips underwent total hip arthroplasty, so the survival rate of femoral head was 93% (27/29). The trend of VAS score and Harris score in the C-arm X-ray positioning group was in accordance with the 3D C-arm X-ray positioning group but without statistically significant difference (P>0.05). The operation duration 31.38±3.96 min, blood loss 36.72±5.59 ml, the ratio of distance of metal rod to bone cortex in femoral neck 0.48±0.10, and the distance of mental rod to center of necrosis 0.18±0.07 cm in 3D C-arm X-ray positioning group was superior to C-arm X-ray positioning group (respectively 41.97±4.64 min, 41.49±4.46 ml, 0.46±0.06, 0.23±0.10 cm, P<0.05).@*Conclusion@#The implantation of tantalum rod in treating ARCO I-II non-traumatic femoral head necrosis can increase the function of hip joint, relieve the symptoms of necrosis of femoral head, alleviate the progress of femoral head necrosis in X-ray, and obtain a higher survival rate. The 3D C-arm positioning in surgical operation could improve the accuracy and safety of surgery.
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To investigate the differentiation of bone mesenchymal stem cells(BMSCs) into chon-drocytes by miRNA-206 and its mechanism in osteoarthritis(OA). Methods From January, 2017 to July, 2018, rat BMSCs were isolated, and their CD90 and CD45 were detected by flow cytometry. Transfection of miRNA-206 or miRNA-206 inhibitors into BMSCs using lentiviral vectors, dexamethasone induction for 14 d, then use alician blue staining and type II collagen immunostaining to detect chondrogenic differentiation. MTT assay was used to detect the proliferation of mesenchymal stem cells. Western blot analysis was used to detect the Aggrecan, Col II, Sox9 and Runx2 markers in chondroblast cells. The expression level of the marker gene of Sox9 mRNA in chondroblasts were detected by RT-PCR.OA rat models were treated with lentiviral vectors transfected with miRNA-206 or miRNA-206 inhibitors, and Aggrecan, Col II, Sox9, Runx2 which were the markers of chondrogenesis were detected by Western blot. Results The purity of isolated BMSCs was (80.7±3.9)%. BMSCs transfected with miRNA-206 could promote cell proliferation and increase chondrogenic differentiation. Western blot results showed that the expression of Aggre-can, Col II and Sox9 was increased in the miRNA-206 transfection group, and the expression of Runx2 was down-regulate. Meanwhile, RT-PCR results showed that miRNA-206 can up-regulate the expression of the chondroblast marker gene Sox9 mRNA in BMSCs.Compared with the OA group, miRNA-206 could increase the expression of Aggre-can, Col II and Sox9 signaling proteins in cartilage tissue (P＜0.05), and down-regulate the expression level of Runx2 (P＜0.05). Conclusion The miRNA-206 can positively regulate the differentiation of BMSCs into chondrocytes, increase the ability of cell proliferation, up-regulate the expression of Aggrecan, Col II and Sox9, and down-regulate Runx2.The miRNA-206 increase chondrogenic capacity in rat models of osteoarthritis.
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Objective To explore a practical and feasible method for isolation,culture and identification of mouse bone marrow endothelial progenitor cells(EPCs).Methods Bone marrow-derived mononuclear cells isolated by density gradient centrifugation were cultured in endothelial cell growth medium-2 MV medium.Growth and morphological changes of the cells were observed under inverted microscopy.Cell proliferation was observed by cell counting kit-8 assay.Surface markers of the EPCs were detected by flow cytometry.Angiogenic tube formation was determined by Matrigel tube formation assay.Fluores cein isothiocyanat e-ulex europaeus agglutinin-1 (FITC-UEA-1) binding and Dil-Ac-LDL uptake capabilities were observed by fluorescent microscopy.Results In the early stage,the cells were round and spindle-shaped after induced culture for 4 days.After 7 days,the cells grew in colony arrangement and gradually increased in number.After 14 days,the cells were differently shaped,such as short shuttle and triangle.After 21 days,the typical "paving stone" appearance of the cells was observed.The cells were positive for endothelial markers in flow cytometry:CD34 + (84.3％),vascular endothelial growth factor receptor 2 + (74.1％),but CD45 + (4.04％).The cells were capable of forming capillary-like tubes,up-taking Dil-Ac-LDL and binding FITC-UEA-1 in Matrigels.Conclusions A reliable method for isolation,culture and identification of mouse bone marrow EPCs may be improved on the basis of previous experiences.Since the EPCs obtained by this method may be capable of good proliferation,large in number,and stable in biological characteristics,they can serve as ideal seed cells for related subsequent studies.
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Objective To evaluate the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) in preventing heterotopic ossification after hip arthroscopy.Methods Literature search was conducted in PubMed,Embase,Cochrane Library,CNKI and Wanfang data with time range from January 1973 to November 2017.Clinical case control articles on NSAIDs in preventing heterotopic ossification after hip arthroscopy were screened based on the inclusion and exclusion criteria.Meta analysis was done using RevMan 5.3 software to investigate the incidence of complications such as heterotopic ossification and gastrointestinal bleeding after hip arthroscopy in patients taking NSAIDs orally.Results Six articles were included in the study,with a total of 754 cases and 536 controls.NSAIDs reduced the incidence of heterotopic ossification after hip arthroscopy (RR =0.09,95％ CI 0.03-0.27,P ＜ 0.05).Selective COX-2 inhibitor celecoxib (RR =0.17,95％ CI 0.03-0.91,P ＜ 0.05) and PG synthase inhibitor of naproxen (RR =0.17,95％ CI 0.09-0.32,P ＜ 0.05) were also effective in preventing heterotopic ossification.There was no significant difference in the incidence of gastrointestinal complications between the cases and controls after NSAIDs prophylaxis (RR =2.17,95％ CI 0.92-5.12,P ＞ 0.05).Conclusion NSAIDs can effectively reduce the incidence of heterotopic ossification after hip arthroscopy and does not increase the incidence of postoperative gastrointestinal complications.Therefore,it is effective and safe to use NSAIDs to prevent the occurrence of heterotopic ossification after hip arthroscopy.
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Hip arthroscopy has become a routine treatment for the localized hip lesions.With the rapid development of arthroscopy,the number of surgeries has increased greatly.Though hip arthroscopy is considered as low risk operation,its complications have been constantly reported and noted.There are two major types in hip arthroscopy surgeries:conventional operative complications and special complications.Conventional operative complications include venous thromboembolism,hemorrhage,and pain.Special complications are associated with arthroscopic techniques and local anatomical structures of the hip,such as the perineal nerve,the lateral femoral cutaneous nerve,the acetabular labium or the iatrogenic injury of the cartilage surface of the femoral head.Hip arthroscopy has obvious advantages such as small surgical wound and rapid recovery,but its complications can not be ignored.Joint surgeons must fully recognize it and keep vigilant so as to avoid complications as much as possible.This review will systematically elaborate the complications of hip arthroscopic surgery from general and special aspects so as to provide ideas for reducing the occurrence of complications in hip arthroscopic surgery.
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Venous thromboembolism (VTE) is a common complication of hip and knee arthroplasty and of many major orthopedic surgeries.VTE mainly includes two aspects,ie,deep vein thrombosis (DVT) and pulmonary embolism (PE).Symptomatic PE is likely to endanger patients' life,resulting in irreversible severe consequences.With the return of venous blood,DVT may also fall off at any time,forming a new PE.Therefore,the prevention of VTE in large orthopedic surgeries has been highly valued by scholars worldwide.However,the problem of VTE after arthroscopic surgery has not drawn much attention from clinicians.Researchers have not reached a consensus on whether routine anticoagulation therapy is required after surgery because of VTE's low incidence and discrepancy among various studies (0.42％-17.9％).With a large number of knee arthroscopy being performed per year,the postoperative VTE incidence can not be ignored.For these reasons,some scholars have suggested that patients after knee arthroscopy should be stratified and that patients with a higher risk of postoperative VTE need to be given anticoagulant therapy.Risk factors for VTE after knee arthroscopy may have effects on the clinical treatment of patients.Therefore,a review of the literature to explore the possible risk factors for postoperative VTE was conducted.
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Objective To investigate the effects of xenogenic bone with chitosan/norvancomycin sustained-release biomaterials in treating infectious bone defects in rabbits.Methods Xenogenic bone with chitosan/norvancomycin sustained-release biomaterials was made by electrospinning technique.Rabbit infectious bone defect models were made by Methicillin-resistant Staphylococcus aureus.A successful model was evaluated with the standard of more than three points in Norden score assessment.All models were divided into two groups by random number table method,with eight models in each.The control group was treated with surgical debridement,and the experimental group was implanted with bone particles of xenogenic bone with chitosan/norvancomycin sustained-release system after debridement.Postoperatively,general conditions,X-ray,histological results of HE staining,and bacteriological examination results of the rabbits were observed.Results X-ray showed significant bone defects,sequestration,periosteal reaction,and soft tissue swelling after one month of modeling,with Norden score of (3.84 ± 0.52) points.The general conditions were good and the sinus tracts were healed in experimental group after two months of treatment.The control group demonstrated generally poor conditions with swollen sinus and purulent discharge.Two rabbits were died of sepsis.The pathological scores of tibial were (0.41 ± 0.08) points in experimental group,and (3.27 ± 0.26) points in control group by gross observation.The pathological score of experimental group was significantly lower than control group(P ＜ 0.05).The bone defects were basically repaired in experimental group.The longest diameter of bone defect in experimental group was (0.11 ± 0.02)cm,significantly smaller than (0.48 ± 0.06) cm in control group (P ＜ 0.05).There were no obvious signs of osteomyelitis and the bone defects were well repaired in experimental group.Periosteal reaction,soft tissue swelling,a substantial number of bone destruction,and sequestration were observed in control group.The Norden score was (1.32 ± 0.23) points in experimental group,lower than (5.21 ± 0.48) points in control group(P ＜ 0.05).HE staining showed a large amount of trabecular bone formation,bone cell formation,and fibrous hyperplasia in experimental group,with no obvious signs of infection.On the other hand,infiltration of inflammatory cells,necrotic tissue,and sequestration were observed in control group.The histological score was(0.61 ± 0.10) points in experimental group,lower than (4.21 ± 0.41) points in control group (P ＜0.05).The negative rate of bacterial culture in experimental group was 33％,lower than 100％ in control group (P ＜ 0.05).Conclusion Xenogenic bone with ehitosan/norvancomycin sustained-release biomaterials has excellent effect in infection clearance and bone defect reparation in treatment of infectious bone defects in rabbits.
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Objective To discuss the application of mobile C-arm CT scan in the operations for thoracolumbar burst fractures of type A3.Methods From January 2012 to December 2014,21 patients with single-segment thoracolumbar burst fracture (AO type A3) were treated.They were 15 males and 6 females,aged from 17 to 68 years (average,43.6 years).By the American Spinal Injury Association (ASIA) grading,one was grade A,2 were grade B,12 grade C,4 grade D and 2 grade E.Preoperative CT examination was conducted.Mobile C-arm CT scan was performed to evaluate reduction of the fragments after the fracture was reset by posterior pedicle screwing.Laminotomy for canal decompression or reduction of the fragments would be performed if it was indicated by the results of mobile C-arm CT scan.CT examination was conducted postoperatively to assess the fracture reduction and recovery of the canal calibre.Results All the patients were followed up for an average of 15.5 months (from 10 to 18 months).Their cobb angle,vertebral anterior margin compression rate,spinal occupancy rate,vertebral translocation rate and visual analogue score at postoperation and final follow-up were significantly improved compared with their preoperative values (P ＜ 0.05),but there were no significant differences between postoperation and final follow-up in all the above indexes (P ＞ 0.05).Postoperative ASIA grading showed that the spinal function was improved from grade B to grade C in one,from grade C to grade D in 4 cases,from grade C to grade E in 5 cases,and from grade D to grade E in 3 cases.Conclusion Since intraoperative C-arm CT scan can help decide whether laminectomy for canal decompression is conducted or not in the surgery of thoracolumbar burst fractures,it enhances the surgical safety and reliability.
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Objective To evaluate the clinical effects of the Masquelet technique combined with antibiotic calcium sulfate pellets in treating infected bone defects.Methods From February 2014 to February 2016,9 patients with infected bone defects were treated in our department,including 7 males and 2 females,with an average age of 37.0 years (range,24-56 years).6 cases were infected because of open fractures,3 infected after internal fixation operation.All defects were located in the lower limb diaphysis and metaphysis (3 cases in femur,6 cases in tibia).The length of the bone defects were 4-12 cm after debridement,all defects filled with PMMA loaded with Vancomycin,and fixed with exterual fixators.After 6-10 weeks,the bone cement spacers were taken out and the antibiotic calcium sulfate pellets were implanted into the membrane.A certain amount of autogenous cancellous bone granules would be mixed into the calcium sulfate pellets if the defect was larger than 6-8 cm.5 cases remained fixed with external fixators,3 cases replaced for plates,1 case replaced for plaster external fixator.Regular X-ray follow-ups were taken and complications recorded as well.Evaluate the healing of bone defect and functional recovery of adjacent joints by Samantha X score system,visual analogue scale (VAS) and Paley method,respectively.Results The 9 cases were followed up for a mean duration of 9.3 months (range,6-15 months).All bone defects healed after a mean time of 14 weeks (range,10-24 weeks).The wound poor healing occurred in only 1 case in the first stage of surgery,and cured by dressing changes.No complications of the recurrence of infection and implant failure.At the last follow-up,the average Samantha X score was 4.9,the VAS score was 0 to 3 (average 1.5) for patients standing on crutches and all the bone defect healing graded excellent evaluated by Paley method,the functional recovery of the adjacent joints graded:excellent in 6 cases,good in 2 cases,and fair in 1 case (the excellent and good rate was 89％).Conclusion Masquelet technique combined with antibiotic calcium sulfate particles is effective in the treatment of infected bone defects.
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The clinical application of arthroscopic minimally invasive treatment of shoulder joint disease technology has become a routine,and it has been widely carried out around the world.Compared with the traditional open surgery,it only needs to establish a few channels in the shoulder and then the diagnosis and treatment of the structure under the acromion and glenoid joint internal lesions can be completed through the arthroscopic technique under direct vision,of course,including local collection of pathological specimens.Shoulder arthroscopic surgery has the advantages of simple operation technique,small economic burden of patients,small tissue trauma,quick recovery and high accuracy of disease diagnosis.At present,there are two main options for shoulder arthroscopy:the beach chair position (BCP) and the lateral decubitus position (LDP).The choice of surgical position for surgeons is closely related to the intraoperative operation,the risk of complications,the efficacy of surgery,and the cost of setting the posture.Shoulder arthroscopy of these two positions have their own advantages and disadvantages:in the BCP,the surgeon gets a better anatomical operation experience,if necessary,can be converted into open surgery at any time.Without continuous traction,upper limb nerve and vascular damage caused by traction can be avoid.But the incidence of cerebral ischemic events in patients may increase in the BCP.There is also possibility of the nerve damage of the pillow small nerve,great auricular nerve,lateral femoral cutaneous nerve and other nerves.In theory the risk of air embolism in the patients will increase in the BCP,and the cost of setting the position is also higher than the LDP.While in the LDP due to the patient's forearm continuous traction,the surgeon can get a more extensive operating space,and the occurrence of cerebral ischemic events is very rare.In the treatment of anterior shoulder instability after shoulder arthroscopic surgery,there is a lower recurrence rate in the LDP.The cost of setting the position is also significantly lower than the BCP.Of course,the disadvantages of the LDP is also obvious.In the LDP,the brachial plexus and other nerves or vascular injury may increase due to the continuous traction of the forearm.Meanwhile sustained traction in the LDP is also a risk factor for thrombosis,and so on.Therefore,there is still a debate about the optimal location of the shoulder arthroscopy.Many clinicians choose shoulder arthroscopic position based on their own experience and habits.
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Objective To observe the effect of vancomycin-loaded calcium sulfate for one-stage treatment of chronic osteomyelitis.Methods A retrospective case series study was made on 26 patients with chronic osteomyelitis treated from January 2014 to April 2016.There were 23 males and 3 females,with a mean age of 35.8 years (range,16-90 years).After focus debridement of osteomyelitis,the cavities were filled with vancomycin-loaded calcium sulfate and systemic antibiotics were used.Meanwhile,gentamicin was added to patients showing unclear pathogens.Three patients underwent flap transfer surgery simultaneously due to the inadequate soft tissue coverage.Wound healing,local redness and swelling,sinus recurrence,recovery of osteomyelitis and repair of bone defect were detected after operation.Results All patients were followed up for 6-30 months (mean,19.5 months).Primary healing was achieved in all patients.One patient experienced wound exudate and was effectively managed by dressing change,one patient experienced inadequate local soft tissue coverage and was effectively managed by a second flap transfer surgery,and one patient remained wound unhealing after two surgeries and was cured by infected bone resection using the Masquelet induced membrane technique.Follow-up showed local bone defect was repaired in all patients without bone infection recurrence.Conclusions For patients with chronic osteomyelitis,one-stage surgery with vancomycin-loaded calcium sulfate can control infection with simultaneous repair of bone defect.Therefore,the procedure is a simple and effective method and worthy of clinical practice.
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Objective To prospectively compare the clinical efficacy between high versus low viscosity bone cement in percutaneous vertebroplasty (PVP) for severe osteoporotic vertebral compression fractures (OVCF).Methods A prospective study was conducted in 61 old patients with single severe OVCF who had sought medical attention in our hospital from August 2014 to October 2015.They were randomly assigned to group H (n =30) to receive PVP using high viscosity bone cement and group L (n =31) to receive PVP using low viscosity bone cement.The 2 groups were compared preoperatively and postoperatively in terms of visual analogue scale (VAS),Oswestry disability index(ODI),short Form-36 General Health Survey(SF-36),Kyphosis cobb's angle,height of the injured vertebra,and volume and leakage of bone cement.Results Significant improvements in VAS,ODI and SF-36 score were noted after operation in both groups,but there were no significant differences between the 2 groups (P ＞ 0.05).The 2 groups made significant improvements after operation in cobb's angle and height recovery rate of the injured vertebra;improvements in group H (14.7° ± 3.4° and 28％ ± 8％) were significantly greater than in group L (16.5° ± 2.5° and 22％ ± 7％) (P ＜ 0.05).The bone cement volumes in groups H and L were 4.94 ± 0.72 mL and 4.89 ±0.75 mL respectively,showing no statistically significant difference between the 2 groups (P ＞ 0.05).The leakage rate in group H was significantly lower than that in group L (13.33％ versus 35.48％) (P ＜ 0.05).All the patients were followed up for a mean time of 12 months (range,from 3 to 17 months).Cauda equina symptoms were observed in one patient and compression fracture of the adjacent vertebra happened in 2 patients,but no infection or pulmonary embolism occurred in any patient.Conclusions Both high viscosity cement PVP and low viscosity cement PVP can relieve back pain and improve quality of life in patients with severe OVCF,but the former may increase the efficacy and safety of PVP obviously in correction of cobb's angle,height restoration of the injured vertebra and reduction of cement leakage.
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Objective To discuss the application of mobile C-arm CT scan in the operations for thoracolumbar burst fractures of type A3.Methods From January 2012 to December 2014,21 patients with single-segment thoracolumbar burst fracture (AO type A3) were treated.They were 15 males and 6 females,aged from 17 to 68 years (average,43.6 years).By the American Spinal Injury Association (ASIA) grading,one was grade A,2 were grade B,12 grade C,4 grade D and 2 grade E.Preoperative CT examination was conducted.Mobile C-arm CT scan was performed to evaluate reduction of the fragments after the fracture was reset by posterior pedicle screwing.Laminotomy for canal decompression or reduction of the fragments would be performed if it was indicated by the results of mobile C-arm CT scan.CT examination was conducted postoperatively to assess the fracture reduction and recovery of the canal calibre.Results All the patients were followed up for an average of 15.5 months (from 10 to 18 months).Their cobb angle,vertebral anterior margin compression rate,spinal occupancy rate,vertebral translocation rate and visual analogue score at postoperation and final follow-up were significantly improved compared with their preoperative values (P ＜ 0.05),but there were no significant differences between postoperation and final follow-up in all the above indexes (P ＞ 0.05).Postoperative ASIA grading showed that the spinal function was improved from grade B to grade C in one,from grade C to grade D in 4 cases,from grade C to grade E in 5 cases,and from grade D to grade E in 3 cases.Conclusion Since intraoperative C-arm CT scan can help decide whether laminectomy for canal decompression is conducted or not in the surgery of thoracolumbar burst fractures,it enhances the surgical safety and reliability.
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Objective To compare open reduction and internal fixation (ORIF) and minimally invasive percutaneous plate osteosynthesis (MIPPO) in the operative treatment of complicated proximal humeral fractures.Methods From January 2014 to October 2015,55 complicated proximal humeral fractures were treated at our department.They were 32 men and 23 women,from 21 to 81 years of age (average,51 years).According to Neer classification,34 cases belonged to three-part fractures and 21 ones to four-part fractures,14 of which were complicated with dislocation.Of them,35 received ORIF and 20 underwent MIPPO.The 2 groups were compared in terms of operation time,intraoperative blood loss,incision length and Neer scoring of the shoulder function at the final follow-ups.The 2 groups were compatible without significant differences in preoperative demographic data (P ＞ 0.05).Results The 55 patients were followed up for 6 to 12 months(mean,9 months).The operation time (100.5 ± 10.2 min),intraoperative blood loss (80.0 ± 10.5 mL),and incision length (7.5 ± 3.2 cm) in the MIPPO group were significantly better than those in the ORIF group (120.0±10.1 min,200.5±10.2mL,and10.5±5.3cm,respectively) (P ＜0.05).According to the Neer scoring of the shoulder function at the final follow-ups,the good to excellent rate was 71.4％ (25/35) in the ORIF group and 85.0％ (17/20) in the MIPPO group,showing a significant difference (P ＜ O.05).The incidence of humeral head necrosis was 15 in the ORIF group,significantly higher than that (3) in the MIPPO group (P ＜ 0.05).Conclusion In treatment of complex proximal humeral fractures,compared with ORIF,MIPPO may lead to less damage to local blood supply,less trauma,and quicker functional recovery due to early functional exercise.
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Objective To investigate the safety and efficacy of a customized guide plate which is designed by digital medical technology and manufactured by 3D printing in clinical percutaneous needling at the hip joint.Methods Enrolled in this study were 9 patients with hip disorder who required hip joint needling during the period from April 2015 to August 2015.They were 7 males and 2 females,21 to 53 years of age (average,42 years).Laterality:5 left sides and 4 right sides.Conditions:4 cases of traumatic arthritis and 5 cases of osteoarthritis.All of them underwent lamellar CT scans whose data were imported into the software of Mimics 10.01 for 3D reconstruction.Then the software of 3-matic was used to design a customized guide plate on the reconstructed models.Finally,3D printing was used to manufacture the guide plate.The needle angle,direction and depth were adjusted in vitro and the operation was simulated before actual needling in clinic.After percutaneous hip joint needling was performed in the 9 patients separately,the accuracy of needling was checked using C-arm fluoroscopy.Results The percutaneous hip joint needling was performed successfully in the 9 patients in whom the customized guide plate was used.The results were consistent with what had been designed on the reconstructed models.The operation time in the 9 patients averaged 417.7 s (range,from 387 s to 590 s).Little intraoperative bleeding was observed at the site of needling,fluoroscopy was applied only once for check.No neurovascular injury or other operation-related complications occurred.Conclusion For patients who need repeated percutaneous needling at the hip joint,the customized guide plate designed by us can improve accuracy and ensure safety and efficacy of needling.
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Objective To compare the effect and safety between cemented and uncemented long-stem hip arthroplasty for treatment of unstable intertrochanteric fracture in the elderly.Methods A retrospective review was made on 70 cases (70-87 years old) undergone artificial long-stem hip arthroplasty of unstable intertrochanteric fracture between June 2012 and June 2014.According to the material of prostheses,the cases were assigned to cemented group (n =36) and uncemented group (n =34).Operation-related index,postoperative complications,ambulation time,Harris hip score and prosthesis stability and excellent results were compared between the two groups.Results There were no significant differences in operation time,bleeding volume and ambulation time between the two groups (P ＞ 0.05).Postoperative drainage volume and blood transfusion volume in cemented group [(277.4 ± 22.0) ml and (245.1 ± 17.8) ml] were lower than these in uncemented group[(294.2 ± 33.7) ml and (262.8 ± 30.9)ml] (P ＜0.05).Harris scores in cemented group were higher than these in uncemented group 1 and 3 months after operation(P ＜0.05),and there were no significant differences 6 and 12 months after operation(P ＞ 0.05).Complication rate had no significant difference between the two groups (P ＞ 0.05).Two cases were died of cement poisoning,one case of subsequent acute myocardial infarction,and two cases of subsequent acute cerebral infarction.Sixty-five cases were followed up for 12-36 months,which showed no complications such as prosthesis loosening,displacement or infection.Prosthesis stability and treatment excellent rate between the two groups were not significantly different (P ＞ 0.05).Conclusions Clinical efficacy of the two treatments is comparable,including good function recovery and early off-bed activity.Cemented long-stem hip arthroplasty reduces blood requirements,but the risk of cement poisoning exists.
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Objective To observe the outcome of uncemented hip arthroplasty for failed internal fixation of intertrochanteric fracture.Methods Seventeen patients admitted from Februaty 2010 to January 2014 were reviewed retrospectively in this study.The patients aged 67.2 years (range, 41-80 years) composed 6 males and 11 females.There were 15 patients with intertrochanteric fracture and 2 intertrochanteric and subtrochanteric fracture.The primary internal fixation method was dynamic hip screw (DHS) fixation in 2 patients, proximal femoral nail anti-rotation(PFNA) fixation in 12 patients and intramedullary nailing in 3 patients.Arthroplasty with a prosthetic hip was performed for 15 patients and with a prosthetic femoral head was done for 2 patients 3-48 months after the internal fixation.Harris score was used for evaluation of the results of hip arthroplasty.Preoperative Harris score was (32.6 ± 6.8)points.Results All the patients were followed up for 6 to 48 months.One patient with intraoperative femoral fracture experienced early subsidence and dislocation of femoral stem following allogeneic bone plate and titanium cable fixation and had further revision surgery.One patient had secondary subsidence of the femoral stem without pain and limitation of motion.One patient had primary infection recurrence after arthroplasty, but the infection remained uncured even after a series of treatments like repeated debridements, sustained vacuum drainage, prosthesis removal, debridement and temporary spacer implantation.Sixteen patients showed postoperative pain relief and good hip function recovery characterized by the ability to care for themselves and no prosthetic loosening.Harris hip score signficantly improved to (79.2 ± 15.9) points at the final follow-up (P ＜ 0.01).Conclusions Uncemented hip arthroplasty is an effective method for the failed internal fixation of peritrochanteric fracture.The procedure achieves satisfactory function recovery, early weight-bearing exercise and early recovery of self-care ability,and avoids the complications of bone cement use.