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Orthopedic robots, as intelligent medical devices, have achieved good outcomes in clinical application in some orthopedic surgeries. Artificial intelligence (AI) has played an important role in the development of orthopedic robots due to its powerful capabilities of information processing and decision-making. The developing trends of orthopedic robotics are automation and intelligentization. Since AI has demonstrated great advantages in preoperative planning, an increasing number of researchers have been devoted to AI application in intraoperative navigation by an orthopedic robot. This paper outlines the exploratory efforts in applying AI technology to the intraoperative navigation assisted by an orthopedic robot, describes the advantages of AI in improving accuracy and reducing radiation, and forecasts research prospects in application of AI technology to orthopedic robots based on the current situation.
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As the National Health Commission changes the management of novel corona virus infection, the situation and preventive policies for controlling the epidemic have also entered a new stage in China. Perioperative care strategies for orthopedic trauma such as designated isolation and nucleic acid test screening have also been adjusted in the new stage. Based on the perioperative work experiences in the new stage of epidemic from the frontline anti-epidemic staff of orthopedics in domestic hospitals and combined with the literature and relevant evidence-based medical data in perioperative care of orthopedic trauma patients under the current anti-epidemic policies at home and abroad, Chinese Orthopedic Association and Chinese Society of Traumatology organized relevant experts to formulate the Guideline for clinical perioperative care of orthopedic trauma patients in the new stage of novel corona virus infection ( version 2023). The guideline summarized 16 recommendations from the aspects of preoperative diagnosis and treatment, infection prevention, emergency operation and postoperative management to systematically standardize the perioperative clinical pathways, diagnosis and treatment processes of orthopedic trauma in the new stage of novel corona virus infection, so as to provide a guidance and reference for hospitals at all levels to carry out relevant work in current epidemic control policies.
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【Objective】 To evaluate the efficacy and safety of different doses and frequencies of oral Sildenafil in the treatment of erectile dysfunction (ED). 【Methods】 The randomized,open clinical trial included 120 ED patients who met the inclusion and exclusion criteria. The patients were randomly divided into the following groups:on-schedule (25 mg/day),on-demand (50 mg,taken irregularly half an hour before each sexual life),new regular group (25 mg/day,50 mg more before each sexual life),regular group (100 mg/time,twice/week). All treatments lasted for 8 weeks. The follow-up indexes included the five-item International Index of Erectile Function (IIEF-5),Erection Hardness Scale (EHS) and Sexual Encounter Profile (SEP2/3). The adverse reactions were recorded. 【Results】 The IIEF-5 scores of the four groups were significantly higher than those after baseline treatment (P0.05). In terms of effective rate,at the 16th week,there were significant differences between the on-demand group (10.7%) and new regular group (62.1%),and between the on-demand group (10.7%) and regular group (50.0%) (P<0.001). In terms of EHS, the percentage of grade 4 patients in regular group was significant higher than that in the on-demand group at the 8th week and 16th week (all P<0.05). In terms of positive rate of SEP-3,there was a significant difference between the on-demand group and regular group (P=0.042) at the 16th week. In the course of treatment,there were transient adverse reactions such as headache,blurred vision,stuffy nose and back pain,which did not affect the treatment. 【Conclusion】 All of the four treatment methods of oral sildenafil showed good efficacy. Both regular group and new regular group maintained good clinical efficacy during the follow-up,which is better than that of the on-demand group. The new regular scheme can be used as a new,safe and effective treatment option.
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The sources of common knee valgus deformities were classified in order to better plan the orthopedic methods, matching prostheses and soft tissue repair of knee valgus deformities.Based on the analysis of typical clinical cases and the operability of classification standards in practical clinical practice, it is of great significance to establish a reasonable morphological classification of knee valgus deformity, in order to grasp the characteristics and patterns of the onset of valgus deformity. According to the origin of the deformity and the tension of the medial and lateral collateral ligaments, the classification of the genu valgus deformity can be divided into the classification of the traditional Genu valgum deformity origin and the classification of the new Genu valgum deformity origin. Although both of them highlight the skeletal characteristics and soft tissue conditions of the valgus deformity, they are quite different. Traditional classification is based on femoral tibial angle, valgus angle, etc; The new classification is divided into mechanical angle, anatomical angle, distal condylar angle, etc. The origin of Genu valgum deformity is generally complex. The traditional classification cannot fully reflect the origin of valgus deformity and the tension state of soft tissue. The new classification, especially based on the classification of anatomical angle valgus deformity, can not only reflect the morphological and anatomical details of knee valgus deformity, but also reflect the tension state of the medial and lateral collateral ligaments and local soft tissue stress state that determine the stability of the knee joint. At present, the commonly used surgical methods for valgus deformity of the knee include periarticular osteotomy of the knee and total knee Joint replacement. The former focuses on correcting extraarticular deformity without over repairing ligaments, and the latter focuses on force line correction, which is the final treatment for terminal valgus deformity. The application of digital technology in clinical orthopedics can improve the accuracy of implant placement. Implant placement needs to be based on the patient's bone characteristics and degree of deformity. For patients with severe deformity, the application of digital technology can improve the accuracy of implant placement and assist in the treatment of knee valgus deformity.
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Objective:To explore the effectiveness and safety of robot-aided percutaneous anterior column screw combined with posterior plate fixtation treatment for transverse acetabular fractures with posterior wall.Methods:A retrospective analysis was conducted on the data of 13 patients with transverse acetabular fractures and posterior wall fractures treated by robot-aided percutaneous anterior column screws combined with posterior plate in Tianjin Hospital from May 2016 to May 2021. There were 9 males and 4 females, aged 49.1±8.5 years (range, 25-65 years), 9 cases of vehicle accidents, 2 cases of falling injuries, 2 cases of impact injuries, 7 cases of combined posterior hip dislocations, and 1 case of sciatic nerve injury. Apply Kocher-Langenbeck approach for reduction and fixation of the posterior wall and the posterior column and indirect reduction of the anterior column. Use robot navigation for percutaneous anterior column screw fixation, and record the time of inserting anterior column screws, incision length, and complications. The quality of fracture reduction was evaluated using Matta imaging, and the degree of ectopic ossification was evaluated using Brooker classification. The Matta modified Postel Merle D'Aobigne score was used to evaluate the function at 3, 6 months after surgery and at the last follow-up.Results:All 13 patients successfully completed the surgery. The insertion time of the anterior column screw was 19.4±4.0 min (range, 17-23 min), and the incision length was 8.0±1.4 mm (range, 6-10 mm). Postoperative imaging examination showed that all anterior column screws were located within the bone canal, with a screw length of 108.3±11.2 mm (range, 90-130 mm), and no complications such as nerve or vascular injury or incision infection occurred. All 13 patients were followed up for a period of 12-36 months, with an average of 18.6 months; All fractures healed, with a healing time of 2-6 months, average 3.4 months. According to the Matta imaging evaluation method, 11 of 13 patients had anatomical reduction of fractures, and 2 were evaluated as incomplete reduction due to a 1-2 mm gap in the anterior column. The anatomical reduction rate was 84%. At postoperative 3, 6 months and the last follow-up, the modified Postel Merle D'Aobigne scores were 13.4±1.1, 15.8±1.5, and 17.0±1.7, respectively, with statistically significant differences ( F=7.78, P=0.007). The difference between the last follow-up and postoperative 3 months was statistically significant ( P=0.002), and there was no statistically significant difference compared to postoperative 6 months ( P=0.222). At the last follow-up, 8 cases were excellent, 4 cases were good, and 1 case was fair, with an excellent and good rate of 92%. There was no occurrence of ectopic ossification, traumatic arthritis, or necrosis of the femoral head. Conclusion:Robot-aided percutaneous anterior column screw combined with posterior plate treatment for transverse acetabular fractures with posterior wall is safe and effective, and is worthy of clinical promotion.
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Objective:To explore the application value of graded surgical strategy and balanced load concept for thoracolumbar osteoporotic compression fractures (OVCFs) with kyphosis.Methods:All of 56 patients of thoracolumbar OVCFs with kyphosis were studied, including 11 males and 45 females, with an average of 75.6±9.3 years old. All patients had back pain, and 32 patients had nerve compression, including 5 patients with aggravation of vertebral collapse after conservative treatment, and 1 patient with cement loosening after percutaneous kyphoplasty (PKP) in another hospital. A graded surgical strategy was developed according to the concept of balanced load, including whether there existed nerve compression, kyphosis, sagittal index (SI), vertebral collapse, load capacity of anterior and middle columns, and fracture reducibility. All patients were treated with anti osteoporosis therapy. 24 patients without nerve compression underwent posture reduction and PKP; 32 patients with nerve compression underwent open surgery: 5 patients with arcuate ky-phosis and SI≤15° underwent Ponte osteotomy; 15 patients with angular kyphosis or SI>15° underwent posterior pedicle subtraction osteotomy (PSO) or/and modified PSO including intervertebral space; 11 patients with SI>15° and severe vertebral collapse (the height of anterior and middle vertebral bodies <1/3 of the average height of adjacent vertebral bodies) or cement loosen after PKP underwent vertebrectomy and reconstruction, of which 4 patients underwent posterior vertebral column resection (PVCR), and 8 patients underwent combined surgery including anterior subtotal vertebrectomy with support and posterior pedicle fixation. The clinical efficacy was evaluated by pain visual analog score (VAS) and Oswestry dysfunction index (ODI).Results:All patients were followed up for 12-60 months, with an average of 24.2 months. For the 24 patients with PKP, the symptoms improved significantly, and 1 case had adjacent vertebral fracture that was improved after PKP again. For the 32 patients with open surgery, the intraoperative blood loss was 400-1 800 ml, with an average of 960 ml (PVCR > PSO and combined surgery > Ponte); the operation time was 2-7 h, with an average of 4.3±1.9 h. The neurological symptoms improved after the operation. During follow-up, the artificial vertebral body and titanium mesh collapsed in 3 cases, but did not continue to deteriorate, no vertebral fracture, internal fixation displacement or loosening failure occurred on X-ray films. At the last follow-up, the VAS score and ODI score of 56 patients decreased from 7.0±2.6 and 60.4±16.2 pre-operation to 1.4±1.1 and 9.5+5.8 respectively, and local kyphosis angle improved from 18.1±4.3 pre-operation to 5.6±4.3. According to the overall satisfaction of patients, the effect was fair in 12 cases, good in 30 cases, excellent in 14 cases, and the excellent and good rate was 78.6%.Conclusion:The graded surgical strategy for thoracolumbar OVCFs with kyphosis based on the concept of balanced load can restore the balanced load of the anterior and middle columns of the spine, reduce the fixation and fusion segments, and reduce the risk of internal fixation displacement and loosening failure.
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Objective:To investigate the effect of Ponte osteotomy combined with bony bridge dissection and intervertebral bone grafting in the treatment of rigid degenerative scoliosis.Methods:From March 2017 to October 2021, this method was used to treat 21 cases of rigid degenerative scoliosis, including 7 males and 14 females, aged 59-76 years, with an average age of 67.6 years. All patients had intractable low back pain and limited standing and walking, while 15 patients had radiation pain in lower limbs. The preoperative standing X-ray film showed that the average Cobb angle of lumbar scoliosis was 51.3°±24.1°, the average lumbar lordosis was 5.4°±13.6°. The coronal balance distance (CBD) was 4.3±2.0 cm (range, 0.5-6.2 cm), and the sagittal vertical axis (SVA) was 5.9±3.1 cm (range, 1.5-6.8 cm). The bending images showed huge osteophyte with bone bridge formation in the vertebral body of the apex region, with poor mobility. Ponte osteotomy was performed according to the degeneration of the deformity. The bone bridge at apex area was cut off, and the intervertebral spaces at apex area and slipped or subluxated levels were release and grafted with granular autogenous decompression bone. During follow-up, the efficacy and deformity improvement were evaluated with visual analogue scale (VAS), Oswestry disability index (ODI) and standing X-ray films.Results:All patients successfully completed the operation. The operation time was 190-330 min, with an average of 250±68 min. The intraoperative bleeding was 700-1600 ml, with an average of 970±260ml. The patients were followed up for 12-36 months, with an average of 20.6±7.2 months. No internal fixation failure, fracture or revision occurred. At the last follow-up, the VAS of low back pain decreased from preoperative 6.1±2.2 to 2.1±1.8 ( t=6.45, P<0.001), and the leg pain decreased from 5.5±3.4 to 1.2±1.0 ( t=5.56, P<0.001).ODI decreased from 52.2%±22.2% to 16.4%±10.6% ( t=6.67, P<0.001). The Cobb angle of lumbar scoliosis was 19.3°±10.5°, with an average correction rate of 62.4%; lumbar lordosis was 34.4°±15.6 °, with average correction of 30°. CBD was 1.9±1.1 cm, with an average correction of 2.4 cm ( t=4.42, P<0.001); and SVA was 1.6±2.1 cm, with an average correction of 4.3 cm ( t=4.90, P<0.001). Conclusion:Ponte osteotomy combined with bone bridge dissection and intervertebral bone grafting is an effective method to treat rigid degenerative scoliosis, which can improve spinal sequence, CBD and SVA, avoid vertebral osteotomy and reduce fusion segments.
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Objective:To establish a risk assessment system focusing on surgical and anesthesian-related indicators for the incidence of complications and mortality of hip fracture surgery in senile patients, and to evaluate its prediction accuracy, sensitivity and specificity.Methods:From January 2020 to February 2021, a total of 1 086 elderly patients (493 males and 593 females) aged 76±5 years (ranging from 60 to 94 years) underwent hip fracture surgery in Tianjin Hospital were collected. A total of 543 patients were randomly selected for the establishment of the hip fracture scoring system in senile patients, including 253 males and 290 females, aged 75±6 years (ranging from 60 to 92 years). With the preoperative physiological factor score and surgical risk factor score as independent variables and the occurrence of complications and death as dependent variables, binary logistic regression analysis was performed to establish a surgical risk scoring system for hip fracture in senile patients. The remaining 543 patients, including 240 males and 303 females, aged 74±7 years (range 60-94 years), their data were used to compare AUC, sensitivity, specificity, and compliance of the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), Daping orthopedics operative risk scoring system for senile patient (DORSSSP), and our surgical risk scoring system for hip fracture in senile patients through receiver operating characteristic (ROC) curves, and to compare the predictive value of these systems for complication incidence and mortality.Results:The predictive model equation of the elderly hip fracture scoring system is: ln R1/ (1- R1) =-7.13+0.112× PS+0.148× OS; ln R2/ (1- R2) =-6.14+0.124× PS+0.136× OS; [ R1 is the incidence of complications, R2 is the mortality, PS (physiology score) is the score of preoperative physiological factors, and OS (operation score) is the score of surgical risk factors]. Among the 543 patients whose data were used to compared with the hip fracture scoring system, POSSUM and DORSSSP, 72 actually developed complications and 36 died. The complication rate predicted by surgical risk scoring system for hip fracture in senile patients was 12.05%±6.34% (range 6.18%-61.29%), and 64 cases were predicted to have complications. The predicted mortality was 6.05%±3.26% (range 2.45%-58.36%), and 29 cases were predicted to die. The complication rate predicted by POSSUM was 25.36%±13.95% (range 9.16%-76.34%), and 126 cases were predicted to have complications. The predicted mortality rate was 10.46%±5.31% (range 6.23%-59.34%), and 54 deaths were predicted. The predicted complication rate of DORSSSP was 19.34%±9.67% (range 8.36%-70.85%), and 99 cases were predicted to have complications. The predicted mortality was 10.12%±5.16% (range 7.35%-57.54%), and 52 deaths were predicted. In predicting the incidence of complications, the AUC of surgical risk scoring system for hip fracture in senile patients, POSSUM and DORSSSP were 0.95, 0.82 and 0.75, the sensitivity was 0.89, 0.83 and 0.85, the specificity was 0.80, 0.86 and 0.92, and the compliance rate was 0.94, 0.93 and 0.94, respectively. In the prediction of mortality, the AUC of surgical risk scoring system for hip fracture in senile patients, POSSUM and DORSSSP were 0.87, 0.67 and 0.71, the sensitivity was 0.85, 0.69 and 0.75, the specificity was 0.73, 0.94, 0.95, and the compliance rate was 0.94, 0.93 and 0.94, respectively. Conclusion:Compared with POSSUM and DORSSSP, hip fracture scoring system in elderly patients has improved its ability to predict surgical risk, and can accurately predict the incidence of complications and mortality in elderly patients undergoing hip surgery.
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Objective To compare the differences in kinematic parameters and plantar pressures for two types of knee varus with tibial and femoral origins in gait analysis, so as to provide biomechanical theoretical basis for different types of genu varus. Methods Twenty-six patients with unilateral knee osteoarthritis (KOA) varus genu were enrolled, with 13 from femoral and 13 from tibial sources. Using Noraxon MyoMotion three-dimensional (3D) motion capture system and Footscan plantar pressure test system, the gait of the subjects during natural walking was measured, the temporal and spatial parameters of the gait, the kinematics parameters of lower limb joints and plantar pressures were collected, to make comparative analysis between the two groups. Results The range of knee flexion and extension of tibial varus, the peak of hip abduction, the range of motion (ROM) of hip adduction and abduction and the peak of ankle pronation were larger than those of femoral lateral genu varus. The peak of knee flexion and hip adduction was smaller than that of femoral lateral genu varus. Compared with femoral varus, subjects with tibial varus had increased stress time and peak pressure on the plantar of the 4th and 5th metatarsals (P<0.05). In the 3rd metatarsal region, the impulse of healthy femoral limb was greater than that of healthy limb with tibial deformity. While in the medial calcaneal region, the impulse of healthy femoral limb was smaller (P<0.05). Conclusions There are some differences in kinematic parameters and plantar pressures between two different types of unilateral genu varus patients. The results of this study are helpful to understand the abnormal gait caused by genu varus, and provide reliable reference for postoperative rehabilitation and limb exercise for different types of genu varus.
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Objective To analyze the influence from material and size of the filling block on stress distributions of the tibial osteotomy model. Methods The filling blocks with three different materials (iliac bone, cancellous bone and polyetheretherketone (PEEK)) and five different sizes were established and implanted to the tibial osteotomy models, respectively. The mechanical loads were applied on the model, the stress distribution and edge displacement of the model were analyzed. Results For three kinds of materials, the stress at proximal end of the tibia and the plate, as well as edge displacement in the model implanted with filling block by iliac bone material were lower than those of the cancellous bone and PEEK, but the filling block by iliac bone material had the highest stress. When the filling blocks with different sizes were implanted in osteotomy space, the stress distribution on each part of the tibial osteotomy and edge displacement were different. Especially when the width of the filling block was reduced from 30 mm to 10 mm, the peak stress of the proximal tibia, steel plate and filling block was increased by 49. 3% , 92. 7% and 54. 4% on average. Conclusions Different filling block parameters will affect the stress distribution in different parts of the tibial osteotomy. The research results provide the theoretical basis for parameter selection of the tibial osteotomy filling block in clinic.
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Osteoclast is a type of multinuclear giant cell, which plays a role in bone resorption in the homeostasis of bone mass. Excessive bone resorption leads to osteoporosis and other diseases characterized by decreased bone mass. Ca 2+ metabolism plays an important role as a second messenger in the differentiation, migration, fusion and bone resorption of osteoclast. The transient receptor potential vanilloid (TRPV) ion channel is expressed in a variety of cells, including osteoclast. Current studies have found that the TRPV ion channel can participate in the production and bone resorption function of osteoclast by increasing intracellular Ca 2+ concentration and calcium oscillations. This article reviews the relationship between the TRPV ion channel and the changes of Ca 2+ concentration and the potential mechanisms involved in osteoclast activity, so as to provide a reference for further research on diseases characterized by abnormally increased activation of osteoclast in the future.
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Objective:To investigate the early effects of cup in cup technique in reconstructing paprosky III acetabular bone defect in revision hip arthroplasty.Methods:From January 2017 to December 2019, a total of 20 cases (20 hips) with paprosky III acetabular bone defect were reconstructed by Cup-in-Cup technique, including 9 males and 11 females. The age ranged from 45 to 76 years, with an average of 64.6 years. The causes of revision were aseptic loosening of prosthesis in 17 cases and loosening of prosthesis caused by periprosthetic infection in 3 cases. There were 13 hips with acetabular bone defect of paprosky IIIA and 7 hips with paprosky IIIB. The acetabular side was repaired in 13 cases, and the acetabulum and femoral side were repaired in 7 cases at the same time. Harris hip score was used to evaluate hip function during postoperative follow-up. The occurrence of serious complications such as intraoperative vascular and nerve injury, postoperative prosthesis dislocation, periprosthetic infection and fracture were counted. The height and horizontal position of hip rotation center were measured by X-ray film.Results:The operation duration was 110±25 min (range 80-180 min) and intraoperative bleeding was 700±180 ml. All cases were followed up for 12-36 months, with an average of 18 months. At the last follow-up, the Harris hip score of 16 cases was more than 80, with excellen in 2 cases, good in 14 cases and fair in 4 cases. The Harris score was 84.3±7.5, which was significantly higher than that before operation 40.1±16.6 ( t=15.34, P<0.001). The height of hip joint rotation center on the affected side decreased from 34.2± 3.3 mm before operation to 18.6±2.8 mm after operation with significant difference ( t=15.11, P<0.001). The horizontal distance increased from 18.1±5.5 mm before operation to 26.2±7.3 mm after operation with significant difference ( t=-5.95, P<0.001). After operation, the height of hip joint rotation center on the affected side was slightly higher than that on the opposite side, with a significant difference between the affected side 18.6±2.8 mm and the opposite side 12.2±3.3 mm ( t=6.73, P=0.018). The horizontal position was 26.2±7.3 mm, which had no significant difference compared with the contralateral 30.1±5.5 mm ( t=-3.29, P=0.381). There was no vascular and nerve injury, periprosthetic infection or incision related complications. During the following-up, the prosthesis was in satisfied position without prosthesis or screw loosening and fracture. Conclusion:The reconstruction of paprosky III acetabular bone defect with Cup-in-Cup technique in revision hip arthroplasty can obtain satisfied early effects, with achieving relatively normal hip rotation center and initial stability.
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Objective:To evaluate the value and efficacy of microscope-assisted minimally invasive anterior lumbar discectomy and zero-profile fusion (ALDF) for lumbar degenerative diseases.Methods:Anterior lumbar distractors were designed to maintain the distraction of intervertebral space and expose the posterior edge of the intervertebral space. From June 2018 to December 2020, 41 cases of lumbar degenerative diseases were treated with this operation, including 19 men and 22 women, aged 29-71 years old (average 42.1 years old). All patients had intractable low back pain. Imaging examination showed lumbar disc degeneration with narrow intervertebral space, including disc herniation with Modic changes in 7 cases, spinal stenosis with instability in 16 cases and spondylolisthesis in 18 cases. The involved levels included L 2,3 in 1 case, L 3,4 in 3 cases, L 2-L 4 in 1 case, L 4,5 in 17 cases and L 5S 1 in 19 cases. An incision was taken that was pararectus for L 2-L 4 and transverse for L 4-S 1, with the intervertebral disc exposed via extraperitoneal approach. The intervertebral space was released and distracted after discectomy in intervertebral space, and self-made distractors were used to maintain the space. Under microscope, the herniation, posterior annulus and osteophyte were removed for sufficient decompression, with a suitable self-anchoring cage implanted into the intervertebral space. The visual analogue score (VAS), Oswestry dysfunction index (ODI), intervertebral space height, lordosis angle and spondylolisthesis rate were evaluated. Results:Operations were performed successfully in all the patients. The operation time was 70-120 min with an average of 90 min, and the intraoperative blood loss was 15-70 ml with an average of 30 ml. No severe complication such as nerve or blood vessel injury occurred. The patients were followed up for 12 to 36 months, with an average of 18 months. At the last follow-up, VAS decreased from 6.4±2.3 to 1.1±0.9, and ODI decreased from 44.9%±16.9% to 5.8%±4.7%. Intervertebral space height recovered from 7.2±2.8 mm to 12.1±2.1 mm and lordosis angle recovered from 6.9°±4.8° to 10.1°±4.6°. X-ray showed significant recovery of intervertebral space height, lordosis angle and spondylolisthesis rate, with obvious interbody fusion and no displacement of cage. For 18 patients of spondylolisthesis, the slippage recovered from 16.6%±9.3% to 7.6%±5.3%, with an average improvement of 54.2%.Conclusion:Microscope-assisted minimally invasive ALDF can provide sufficient decompression and zero-profile fusion for lumbar degenerative diseases with satisfactory results during short-term follow-up.
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Objective:To compare the clinical effects of percutaneous curved vertebroplasty (PCVP) and unilateral percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fracture (OVCF).Methods:A retrospective cohort study was used to analyze the clinical data of 104 patients with single vertebral OVCF treated in Tianjin Hospital from September 2019 to September 2020, including 21 males and 83 females; aged 50-91 years [(70.3±7.7)years]. AO classification of the fracture was type A1 in 65 patients and type A2 in 39. The patients received PCVP (PCVP group, n=51) or unilateral PKP surgery (unilateral PKP group, n=53). The operation time, bone cement injection volume, intraoperative fluoroscopy frequency, effective dispersion times of bone cement and excellent rate of bone cement distribution were compared between the two groups. In evaluation of the therapeutic effects of the two groups, visual analogue scale (VAS) and Oswestry dysfunction index (ODI) were measured preoperatively and at postoperative 24 hours, 3 months and 6 months; Beck index was measured preoperatively and at postoperative 24 hours and 3 months. The rate of bone cement leakage and rate of refracture of adjacent vertebral bodies were compared between the two groups. Results:All patients were followed up for 6-8 months [(6.4±0.7)months]. The operation time, bone cement injection volume and intraoperative fluoroscopy frequency in PCVP group was (12.15±1.63)minutes, (2.13±0.28)ml and (24.74±1.71)times, shorter or less than (22.09±1.62)minutes, (5.30±0.52)ml and (30.09±1.86)times in unilateral PKP group (all P<0.01). The effective dispersion times of bone cement in PCVP group was (1.42±0.04)times, higher than (1.18±0.02)times in unilateral PKP group ( P<0.01). The excellent rate of bone cement distribution in PCVP group was 94%, higher than 70% in unilateral PKP group ( P<0.01). There were no significant differences in VAS, ODI and Beck index between the two groups before operation and at 24 hours and 3 months after operation (all P>0.05). VAS and ODI in PCVP group were (1.20±0.49)points and 16.52±5.22 at 6 months after operation, lower than (1.49±0.58)points and 20.16±5.16 in unilateral PKP group (all P<0.01). VAS and ODI in the two groups were significantly improved at 24 hours, 3 months and 6 months after operation when compared with those before operation (all P<0.05). Beck index in the two groups detected at 24 hours and 3 months after operation was improved from that before operation (all P<0.05). Unilateral PKP group showed Beck index was 0.75±0.07 at 3 months after operation, significantly lower than 0.79±0.07 at 24 hours after operation ( P<0.05), but there was no significant change in PCVP group ( P>0.05). The leakage rate of bone cement in PCVP group was 16% (8/51), lower than 47% (25/53) in unilateral PKP group ( P<0.01). There was no significant difference in the incidence of refracture of adjacent vertebral bodies between the two groups during follow-up ( P>0.05). Conclusion:For OVCF, PCVP is superior to unilateral PKP in terms of operation time, amount of bone cement injection, intraoperative fluoroscopy frequency, dispersion effect of bone cement in vertebral body, pain, function improvement, maintenance of injured vertebral height and incidence of bone cement leakage.
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Objective:To analyze the morphology and distribution characteristics of subchondral bone cysts of the talus by CT three-dimensional reconstruction.Methods:A total of 176 patients diagnosed with subchondral bone cyst of the talus after CT scan of the ankle or foot from 2015 to 2020 were retrieved from the imaging report database of Tianjin Hospital, including 77 males and 99 females, aged 14-84 years［(56.1±14.0)years］. After three-dimensional reconstruction of the talus and cyst area by Mimics 20.0 software, an equal 2×2 grid configuration was constructed to divide the domed articular surface into four regions: anteromedial, anterolateral, posteromedial and posterolateral. For subchondral cyst of the talus, area involved under grid localization, gender, age and side of the onset were recorded. The anteroposterior diameter, transverse diameter, depth, surface area and volume of the subchondral bone cyst of the talus were measured.Results:Subchondral cyst of the talus was anteromedial in 131 patients (74.4%), anterolateral in 5(2.8%), posteromedial in 34(19.3%), and posterolateral in 6(3.4%). Subchondral cyst of the talus occurred in the older aged (≥60 years) for 78 patients (44.3%), in the middle aged (45-59 years) for 62(35.2%), in young adults for 32(18.2%), and in preadolescents for 4(2.3%). The age composition of the subchondral cyst of the talus involving the anteromedial, anterolateral, posteromedial and posterolateral regions was 59(49, 64)years, 44(39, 45)years, 61(54, 68)years and 40(22, 58) years, respectively (all P<0.01). There were no statistically significant differences in gender and side of the onset (all P>0.05). The anteroposterior diameter of the subchondral bone cysts located anteromedially, anterolaterally, posteromedially and posterolaterally was (9.7±4.4)mm, (3.5±1.1)mm, (10.3±4.4)mm and (2.1±0.8)mm, respectively; the transverse diameter was (5.4±1.7)mm, (3.9±1.8)mm, (5.9±2.2)mm and (3.4±1.1)mm, respectively; the depth was (7.1±2.4)mm, (3.2±2.2)mm, (8.2±3.0)mm and (3.9±1.9)mm, respectively; the surface area was 156.1(82.6, 198.2)mm 2, 23.0(21.4, 28.9)mm 2, 180.0(75.1, 230.4)mm 2 and 28.0(20.3, 36.7)mm 2, respectively; the volume was 77.1(37.1, 129.1)mm 3, 23.9(14.2, 37.8)mm 3, 104.6(37.7, 157.4)mm 3 and 13.0(10.4, 16.0)mm 3, respectively. When comparing the anteroposterior diameter, transverse diameter, depth, surface area and volume of the subchondral bone cysts in the anteromedial and posteromedial regions with the anterolateral and posterolateral regions, the differences were statistically significant (all P<0.01) except for the transverse diameter of the subchondral bone cysts in the anteromedial region and the anterolateral region ( P>0.05). In addition, the depth of subchondral bone cysts in the anteromedial region was significantly greater than that in the posteromedial region ( P<0.05). Conclusions:Subchondral bone cysts of the talar are commonly found in the middle- and old-aged population. Anteromedial lesions of the talar dome are the most commonly seen, with large and deeply involved cysts, followed by posteromedial lesions of the dome, while anterolateral and posterolateral lesions of the dome are less common and have smaller cyst sizes. An equal 2×2 grid configuration for talar cysts is useful in positioning and characterizing bone cysts, and can assist clinicians in accurately diagnosing and treating bone cysts.
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Objective:To analyze the change trend of survival rate after hip fragility fracture in Tianjin Hospital from 2015 to 2021, and the influence of gender, marital status, age and number of complications on survival rate.Methods:From January 1, 2015 to December 31, 2021, a total of 12,570 patients with fragility fracture of hip were retrieved, including 3,934 males and 8,636 females. The age at admission was 74.11±9.50 years and 74.62±8.99 years respectively. By comparing the ID number with the Tianjin population information database, 2,054 cases died, including 804 males and 1,250 females, aged 81.34±7.88 years and 81.92±7.42 years respectively at the time of death. Acquire the patient's survival status, calculate the cumulative survival rate at 3 month intervals, study the change rule of the cumulative survival rate over time, and use Kaplan-Meier method to calculate the cumulative survival rate of the whole population and the impact of gender, marital status, age, and number of complications on the survival rate.Results:The median survival time of all the dead people after fracture was 13(3, 31) months, including 11(2, 27) months for males and 15(4, 32) months for females. Joinpoint regression showed that 9 months after the hip fragility fracture was the break point of the survival rate. The mortality rate changed significantly within 9 months after fracture (the annual change rate was 47%), and slowed down 9 months later (the annual change rate was 1%). There was a statistically significant difference in trend detection before and after the break point ( P<0.05). The age at admission was 80.11±7.71 years for the dead and 73.36±9.01 years for the non dead, with a statistically significant difference ( t=31.80, P<0.001). After normalization, the number of complications was 0.20±0.93 among the dead and 0.00±0.87 among the non dead, with a statistically significant difference ( t=88.81, P<0.001). The survival rate of men after hip fracture is lower than that of women, the number of people without spouse is lower than that of people with spouse, the number of people with more than 70 years old is lower than that of people with less than 70 years old, and the number of complications ≥2 people is lower than that of people with less than 1 complication, all of which are statistically significant ( P<0.05). Conclusion:The survival rate within 9 months after the occurrence of hip fragility fracture decreased significantly, and it needs to be tracked and managed for at least 9 months to effectively reduce the risk of death; Male, no spouse, age>70 years old, number of complications ≥2 will increase the risk of death after hip fragility fracture, leading to reduced survival rate of patients.
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Objective:To observe the effects of alendronate (ALN) on the expression of autophagy signaling pathway related proteins LC3, Beclin-1 and P62 in the muscle tissue of mice with denervated skeletal muscle atrophy, and to explore the potential molecular biological mechanism of ALN in the treatment of skeletal muscle atrophy.Methods:Thirty males C57BL/6 mice were divided into three groups with 10 mices in each group by random number method, including blank control group: sciatic nerve exposed without resection, model group: sciatic nerve exposed and resection, ALN group: sciatic nerve resection +ALN intervention. At the intervention stage, mices were given 1 mg/kg ALN by intragastric administration. The weight of gastrocnemius muscle was weighed by wet weight method. Atpase staining was used to distinguish muscle fiber types. HE staining was used to observe the arrangement and cross-sectional area of gastrocnemius muscle fibers in each group, and further quantitative analysis was performed by Image J 1.48 software. Western blotting and immunohistochemical staining were performed to detect the expressions of MHC and MuRF1 as well as LC3, Beclin-1 and P62 in gastrocnemius tissues of each group.Results:The weight of gastrocnemius muscle in the model group 137±7.80 mg was significantly lower than that in the blank control group 203±10.34 mg, which proved that the denervation muscle atrophy mouse model was successfully established. After intervention, the gastrocnemius muscle weight of ALN group 177±11.65 mg was significantly higher than that of model group, and the muscle mass was significantly improved. HE staining showed that muscle fibers in the model group were loosely arranged and the cross-sectional area was significantly smaller than that in the blank control group, and there were more blue stains among muscle fibers. Atpase staining showed that the distribution of type II muscle fibers in the model group was increased compared with that in the blank control group, and the distribution of type II muscle fibers in the ALN group was decreased compared with that in the model group, but higher than that in the blank control group. The results showed that the most widely distributed muscle fiber cross-sectional area was 600-800μm 2 in the blank control group, 200-400 μm 2 in the model group, and 400-600 μm 2 in the ALN group. The results of quantitative calculation of muscle fiber cross-sectional area by Image J 1.48 showed that the mean value of muscle fiber cross-sectional area in the model group was (352±18) μm 2, which was significantly reduced compared with the blank control group 794±20 μm 2. After ALN treatment, muscle fiber cross-sectional area recovered somewhat. The mean muscle fiber cross-sectional area of ALN group was 578±23 μm 2, which increased muscle fiber cross-sectional area by 29%. Western blotting results showed that the expressions of MHC, LC3 and Beclin-1 in model group were significantly lower than those in blank control group ( P<0.05), while MuRF1 and P62 proteins were significantly higher than those in blank control group ( P<0.05). The MHC, LC3 and Beclin-1 proteins in ALN group were significantly higher than those in model group (0.12±0.01 vs. 0.10±0.003, 0.15±0.02 vs. 0.10±0.02, 0.13±0.03 vs. 0.09±0.04). MuRF1 and P62 proteins in ALN group were significantly lower than those in model group (0.10±0.004 vs. 0.15±0.01, 0.16±0.03 vs. 0.20±0.03). MHC immunohistochemical staining showed that the expression of MHC in gastrocnemius of mice in model group was significantly lower than that in blank control group, and the expression of MHC in gastrocnemius of mice in ALN group was higher than that in model group ( P<0.05). Conclusion:ALN has a therapeutic effect on skeletal muscle atrophy, and its mechanism may be realized by moderately activating the LC3/Beclin-1 autophagy signaling pathway.
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Objective:To investigate the clinical effects of anterior cage inserting for old thoracolumbar fractures with kyphosis through facet joint approach.Methods:A retrospective analysis was conducted on 32 patients with old thoracolumbar fractures complicated with kyphosis admitted from January 2018 to December 2019, including 14 males and 18 females. The average age was 47.3±13.1 years (range, 26-70 years). Thoracolumbar injury classification (TLICS) scores of patients with initial injury were 3-5 points, with an average of 4.0 points. After 6.3±2.9 months (range, 3-16 months) conservative treatment, intractable thorax and lumbar or back pain still existed. Anterior cage inserting via articular protrusion was performed in 15 cases and posterior screw placement and bone grafting fusion of injured vertebrae was performed in 17 cases. Preoperative sagittal Cobb angle was 27.0°±3.9° and 26.8°±4.6° in the anterior cage inserting group and fixation on fractured vertebrae group ( t=0.07, P=0.946), respectively. Sagittal vertical axis (SVA) was 4.2±1.8 cm and 4.1±2.1 cm ( t=0.14, P=0.887), respectively. The number of patients with ASIA impairment scale (AIS) of the anterior cage inserting group before surgery was 1 in grade C, 4 in grade D and 10 in grade E. However, the number of that in fixation on fractured vertebrae group was 2 in grade C, 2 in grade D and 13 in grade E. There was no significant difference between the two groups (χ 2=1.34, P=0.520). Results:All 32 patients were followed up for 12.2±3.1 months in the anterior cage inserting group and 12.0±3.3 months in fixation on fractured vertebrae group. The operative duration of the anterior cage inserting group and fixation on fractured vertebrae was 128±24.5 min and 123±40.6 min ( t=0.42, P=0.681). The intraoperative blood loss was 485±12.6 ml and 478±16.3 ml ( t=0.13, P=0.894), respectively. At the last follow-up, the improvement rate of VAS score of the anterior cage inserting group was higher than that of fixation on fractured vertebrae group (90%±10% vs. 75%±20%, t=3.17, P=0.004). The height of anterior margin of injured vertebra in the two groups was increased by 1.02±0.10 cm and 0.29±0.14 cm, the change rate of anterior cage inserting group was higher than that of fixation on fractured vertebrae group (67.1%±31.5% vs. 19.0%±14.9%, t=16.29, P<0.001). The sagittal Cobb angle of the anterior cage inserting group was significantly lower than that of fixation on fractured vertebrae group (7.4°±1.5° vs. 11.6°±2.5°, t=-5.85, P<0.001). The SVA of anterior cage inserting group was lower than that of fixation on fractured vertebrae group (1.1±0.6 cm vs. 1.6±0.6 cm, t=2.35, P=0.025). There were 15 patients in AIS grade E in the anterior cage inserting group, while 1 patient in grade D and 16 patients in grade E in fixation on fractured vertebrae group without significant difference between the two groups (χ 2=0.83, P=0.706). Conclusion:The treatment of old thoracolumbar fractures with kyphosis through facet joint approach and anterior fixation could achieve satisfied effects and could relieve pain symptoms of thoracolumbar and back, compared with posterior fusion for injured vertebra with nail and bone grafting.
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Objective To investigate biomechanical characteristics of femoral neck fracture with different reduction qualities. Methods Three cases of Sawbones artificial femoral models were selected, and two cases of Pauwel III femoral neck fracture were modeled. Three cannulated screws were inserted into the models in the form of inverted triangle to fix the fracture. Two cases maintained different reduction qualities (defined as Model 1 and Model 2). In the 3 third case, no modeling operation was performed (defined as intact model). Then the strain gauges were respectively pasted on regions of interest of the 3 femoral models. Finally, the femur model was applied with the vertical load on mechanical testing machine. Results When the displacement of femoral head reached 4 mm, the average load of intact model, Model 1 and Model 2 was (236.30±5.35), (196.57±3.56), (69.50±2.95) N, showing significant differences. When the displacement of femoral head reached 5 mm, the average load of intact model, Model 1 and Model 2 was (276.7±3.40)，(232.93±2.64)，(80.83±4.54) N, showing significant differences. Conclusions The lower the reduction quality of the femoral neck fracture, the weaker the ability of the femur to bear stress, the higher the probability of nonunion, re-fracture and femoral head necrosis in the process of postoperative rehabilitation.
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Sarcopenia, referred to as myopenia, is a systemic syndrome characterized by decreased muscle mass and muscle strength, and decline of motor function.The elderly are a high incidence group of myopenia.With the aging of the world's population becoming increasingly severe, the incidence rate of sarcopenia has also increased, which has brought a heavy burden to the elderly family and society, and has become an important social health problem for the elderly.At present, there are more and more researches on sarcopenia, but the pathogenic factors of sarcopenia are complex and diverse.The prevention and treatment of sarcopenia still need to be further explored and studied.The establishment of an ideal animal model is the key premise and basis for the related research of sarcopenia.In this paper, the different modeling methods, advantages and disadvantages as well as the scope of application of sarcopenia animal models are described, which can provide reference and help for the subsequent animal experimental research of sarcopenia.