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Objective:To compare the outcomes between hook thin plate compression technique and conventional screw-plate fixation in the treatment of adolescent tibial tubercle avulsion fractures.Methods:A retrospective analysis was performed of the 43 adolescent patients with tibial tubercle avulsion fracture who had been treated at Department of Orthopedics and Traumatology, Beijing Jishuitan Hospital from January 2018 to October 2020. There were 42 males and one female, aged from 13 to 17 years. According to their treatment methods, they were divided into an observation group (9 cases) treated with hook thin plate compression technique and a control group (34 cases) treated with fixation with cannulated screws alone or in addition with a 1/3 tube plate. The maximum range of knee flexion, B?stman score, and cases returning to school at one month after operation, as well as fracture union time, B?stman score and cases with complications at the last follow-up were compared between the 2 groups.Results:There were no significant differences in the preoperative general data between the 2 groups, showing comparability ( P>0.05). By the postoperative one month, the maximum range of knee flexion [90.0° (85.0°, 102.5°)], B?stman score [21.0 (18.5, 21.0)] and cases returning to school (7) in the observation group were significantly better than those in the control group [22.5° (15.0°, 30.0°), 11.0 (10.0, 13.0), and 0] ( P<0.001). The last follow-up revealed no significant differences between the 2 groups in frature union time [(2.7±0.5) months versus (2.8±0.5) months], B?stman score [30.0 (30.0, 30.0) versus 30.0 (30.0, 30.0), 30.0)] or cases with complications (1 versus 2) ( P>0.05). Conclusion:In the treatment of adolescent tibial tubercle avulsion fractures, compared with conventional fixation with cannulated screws alone or in addition with a 1/3 tube plate, hook thin plate compression technique may lead to better outcomes, because it allows early rehabilitation to shorten the postoperative immobilization time and promote early functional recovery.
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Objective:To investigate the current situation of perioperative fasting management in patients with orthopaedic trauma waiting for elective surgery (those combined with diabetes mellitus included) and the surgeons' awareness in China.Methods:From November 1st to December 31st, 2021, the questionnaire forms were distributed through WeChat in the exchange group of National Enhanced Recovery Surgery (ERAS) and the exchange group of national training orthopaedists in Beijing Jishuitan Hospital. The survey contents included: time for preoperative water deprivation and for postoperative recovery of drinking in patients without diabetes mellitus, the rationales for orthopaedists to choose perioperative dietary management, the orthopaedists＇understanding of the existing guidelines, time for preoperative water deprivation and postoperative recovery of drinking and diabetes-related issues in patients with diabetes mellitus, and the time for postoperative recovery in all the patients (For the postoperative recovery of eating, there is no difference between patients with and without diabetes mellitus). The relationships were analyzed between some professional data of the orthopaedists and their rationales for choice of management strategies and their understanding of the guidelines.Results:A total of 565 valid questionnaires were collected. 12.92% (73/565) of orthopaedists required their patients without diabetes mellitus not to drink for at least 2 hours. In fact, the proportion of water prohibition from 0 o'clock on the day of operation was still the highest [24.07% (136/565)]. Respectively, 22.83% (129/565) and 42.12% (238/565) of the orthopaedists chose "water intake is allowed once awakened" and "water intake after at least 6 hours after operation" for their patients without diabetes mellitus. 33.98% (192/565) of the orthopaedists required all the patients fasted for at least 6 hours before surgery, and 44.25% (250/565) of the orthopaedists chose "eating can be resumed if there is no discomfort for 2 hours after water intake" .21.06% (119/565) of the orthopaedists demonstrated that they were quite familiar with the guidelines and carried out perioperative dietary management according to the guidelines. The management of water deprivation was more inconsistent for patients with diabetes mellitus, and more hospitals followed the traditional principles for water deprivation. The proportions of water deprivation starting at 0 o'clock on the day of operation, 8 hours before operation, 6 hours before operation and 4 hours before operation accounted respectively for 22.83% (129/565), 19.12% (108/565), 21.95% (124/565), and 18.94%% (107/565). The level of an orthopaedist's hospital and the professional rank of an orthopaedist were the factors related to the orthopaedist's understanding of the guidelines ( P<0.05). Conclusions:The current perioperative dietary management guidelines are not widely implemented or well known in Chinese faculties of orthopaedic trauma. The process of perioperative dietary management needs to be optimized for the patients combined with diabetes mellitus.
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Objective:To evaluate the effectiveness of perioperative fasting abbreviation in traumatic patients with orthopaedic trauma and diabetes mellitus undergoing selective surgery.Methods:The patients were selected for this prospective nonrandomized controlled study who had undergone selective surgery from June 2019 to June 2021 at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. They were divided into an intervention group and a control group according to the wards where they stayed. The intervention group was fasted for solids from 0 o'clock on the surgery day and received oral solution with 6.25% maltodextrin which had been prepared by the nutritional department 3 hours prior to surgery. The control group was fasted for either liquids or solids from the midnight before surgery. All patients were evaluated according to the wake-up score and defensive reflex score after surgery. Once they were awakened, they were allowed slag-free drinks. Normal food was allowed if there was no discomfort after 2 hours. The 2 groups were compared in terms of basic information, actual preoperative fasting time, total amount of preoperative drinking, and postoperative time for initial drinking and eating. The perioperative subjective feelings (anxiety, thirst, hunger, nausea, fatigue, dizziness, sweating, stomach discomfort, etc.), grip strength and blood glucose were observed and compared between the 2 groups. Adverse reactions in the 2 groups were also observed.Results:A total of 135 patients were included, including 52 in the intervention group and 83 in the control group. The intervention group consisted of 22 males and 30 females aged from 30 to 84 years; the control group consisted of 39 males and 44 females aged from 29 to 81 years. There was no significant difference in the basic information between the 2 groups, showing comparability ( P>0.05). The intervention group had significantly shorter preoperative fasting time [3.5 (2.5, 6.3) h versus 12.0 (9.0, 16.0) h], significantly higher water intake before surgery [300 (200, 300) mL versus 100 (100, 200) mL], significantly shorter postoperative fasting time [0.08 (0, 1.25) h versus 2.00(0, 6.00) h], and significantly reduced time to return to normal diet [2.0 (2.0, 2.3) h versus 3.0(2.0, 6.0) h] than the control group (all P<0.05). The symptoms of anxiety, fatigue, sweating, and stomach discomfort in the intervention group were significantly fewer than those in the control group throughout the evaluation period. The thirst in the intervention group was significantly alleviated than that in the control group immediately after returning to the ward after surgery, and the dizziness and hunger were significantly alleviated than those in the control group when the patients left the ward to the operation room before surgery and immediately after returning to the ward. The symptom of nausea after returning to normal diet in the intervention group was significantly relieved compared with the control group. All the comparisons above showed statistically significant differences ( P<0.05). The blood glucose in the intervention group 2 hours after taking slag-free drinks was significantly higher than that in the control group ( Z=-2.108, P=0.035). There was no significant difference in the blood glucose between the 2 groups during other measurement periods ( P>0.05). There were no serious adverse reactions in either of the 2 groups. Conclusion:The protocol of perioperative fasting abbreviation may be safe and feasible for the patients with orthopaedic trauma and diabetes mellitus undergoing selective surgery, because it shows benefits of improving the patients' subjective feelings and stabilizing the blood glucose perioperatively.
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Objective:To investigate the factors associated with delay in anticoagulant therapy in patients with cerebral venous sinus thrombosis (CVST) and its effect on outcome.Methods:Patients with CVST admitted to Changhai Hospital, Naval Medical University from January 2010 to August 2021 were retrospectively enrolled. Patients were divided into early anticoagulation group and late anticoagulation group by the median time interval from first symptom to initiation of anticoagulation. The modified Rankin Scale was used for outcome assessment at 90 d after onset. 0-2 scores were defined as good outcome and 3-6 were defined as poor outcome. Demographic and clinical data were compared for the early versus late anticoagulation group and for the good versus poor outcome groups. Multivariable logistic regression was used to identify independent influencing factors of delay in anticoagulation and the correlation of delay in anticoagulation with poor outcome. Results:A total of 131 patients were included, their age was 40.07±15.11 years old, and 68 (51.91%) were male. Of these, 65 patients (49.62%) were in the early anticoagulation group and 14 (10.69%) were in the poor outcome group. Compared with the late anticoagulation group, the early anticoagulation group had a significantly higher proportion of patients with seizures and brain parenchymal damage as well as higher D-dimer levels on admission, while the proportion of patients with visual impairment/papilloedema was significantly lower (all P<0.05). Compared with the good outcome group, the poor outcome group had significantly higher proportions of patients with seizures, dyskinesia, impaired consciousness, low Glasgow Coma Scale score, and brain parenchymal damage as well as higher D-dimer, total cholesterol and low density lipoprotein cholesterol levels, sites of thrombus involvement were more common in the superior sagittal and straight sinuses, and significantly lower proportions of patients with headache and lower albumin levels on admission (all P<0.05). Multivariate logistic regression analysis showed that visual impairment/papilloedema (odds ratio [ OR] 0.119, 95% confidence interval [ CI] 0.030-0.473; P=0.002) and brain parenchymal damage ( OR 1.341, 95% CI 1.042-1.727; P=0.023) were independently associated with a delay in anticoagulation treatment, and a delay in anticoagulation treatment ( OR 6.102, 95% CI 1.185-30.504; P=0.030) and D-dimer level on admission ( OR 1.299, 95% CI 1.141-1.480; P<0.001) were the independent predictors of poor outcome in patients with CVST. Conclusions:Visual impairment/papilloedema and absence of brain parenchymal damage on cranial imaging are the independent risk factors for delay in anticoagulation in patients with CVST. The delay in anticoagulation is strongly associated with the poor outcome in patients with CVST.
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Objective:To investigate the clinical efficacy and safety of Xiaoaiping injection combined with chemotherapy in treatment of non-small cell lung cancer (NSCLC) patients.Methods:Based on LinkDoc database, a total of 1 144 patients first diagnosed as stage Ⅲ B-Ⅳ NSCLC in 4 medical centers including Henan Cancer Hospital from 2014 to 2018 were enrolled. The baseline data of included patients was used to make propensity score matching. The patients were divided into the experimental group (Xiaoaiping injection combined with chemotherapy) and the control group (chemotherapy alone), 572 cases in each group. The objective response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free survival (PFS), time to progression (TTP) and adverse reactions of the two groups were observed and compared. Results:Based on the statistical results of patients with records of efficacy evaluation, the ORR of the experimental group and the control group was 26.54% (86/324) and 26.07% (79/303), respectively, and there was no statistically significant difference ( χ2 = 0.02, P = 0.894); the DCR of both groups was 61.42% (199/324) and 62.38% (189/303), respectively, and there was no statistically significant difference ( χ2 = 0.06, P = 0.805). The median OS time of the experimental group and the control group was 21.2 months and 16.5 months, respectively, and there was a statistically significant difference ( χ2 = 7.53, P = 0.006). The median PFS time was 9.3 months and 8.9 months, respectively, and there was no statistically significant difference ( χ2 = 2.25, P = 0.134). The median TTP was 1.8 months (1.2 months, 5.1 months) and 1.7 months (1.2 months, 5.8 months), respectively, and there was a statistically significant difference ( Z = 3.89, P = 0.049). The incidence of bone marrow suppression was 75.52% (432/572) and 64.51% (369/572),respectively in the experimental group and the control group, and there was a statistically significant difference ( χ2 = 16.53, P <0.001); the incidence of liver dysfunction was 39.86% (228/572) and 29.55% (169/572), respectively, and there was a statistically significant difference ( χ2 = 13.43, P < 0.001); the incidence of abnormal kidney function was 2.45% (14/572) and 3.15% (18/572), respectively, and there was no statistically significant difference ( χ2 = 0.51, P = 0.473). Conclusions:Xiaoaiping injection combined with chemotherapy can prolong the survival time of patients with advanced NSCLC. It is necessary to pay attention to the potential risks of bone marrow suppression and liver damage.
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Objective:To investigate the techniques used in blood flow control of Kimura laparoscopic spleen-preserving pancreatectomy (LSPDP).Methods:Forty·five patients with benign or low-grade malignant pancreatic diseases undergoing LSPDP at Huzhou Central Hospital from May 2014 to Oct 2021 were analyzed retrospectively. Patients were divided into splenic vascular flow control group ( n=22) and routine management group ( n=23). Results:There was no significant difference in gender, age, BMI, accompanying symptoms, hypertension, diabetes, lesion size and pathological diagnosis between the two groups (all P>0.05). A higher overall spleen preservation rate (90.9% vs. 52.2%, χ2=8.213, P=0.004), lower incidence of morbidity with Clavien grade ≥ Ⅱ (22.7% vs. 73.9%, χ2=9.911, P=0.002) and shorter postoperative hospital stay [(9.6±4.5) d vs. (14.3±6.6) d, t=2.447, P=0.008] were achieved in the vascular flow control group compared with those in the routine group. Conclusion:Splenic vascular flow control techniques improve the success rate of spleen preservation in laparoscopic distal pancreatectomy, reduce the postoperative complications and shorten the postoperative hospital stay.
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Objective:To investigate the value of relative lumbar lordosis (RLL) and lumbar distribution index (LDI) in predicting the occurrence of adjacent segment disease (ASDis) after lumbar fusion surgery.Methods:This study retrospectively reviewed 163 consecutive patients (58 males and 105 females) who had undergone lumbar fusion and had been followed over 2 years,with an average age of 58.7 years; among them, 74, 71, and 18 patients had undergone fusion of one-level, two-level, and three-level, respectively. They were divided into the non-ASDis group and ASDis group based on the presence of ASDis or not. Pre- and post-operative spinopelvic parameters were measured on the upright lateral radiographs. RLL was calculated as measured lumbar lordosis (LL) minus ideal LL, and LDI was calculated as the ratio of postoperative low lumbar lordosis (LLL) to LL. Each parameter was stratified into 1 "aligned" subgroup and 3 "disproportioned" subgroups in accordance with values. Cochran-Armitage test of trend andlogistic analysis were performed to investigate the association between these two parameters and the occurrence of ASDis.Results:The average follow-up duration after initial surgery was 46±14 months (range, 25 to 134 months). Twenty-four (14.7%) patients were diagnosed as ASDis. The age ( t=3.13, P=0.002) and the proportion of 2-level and 3-level fusion (χ 2=10.27, P=0.006) in the ASDis group were significantly higher than those in the non-ASDis group ( P<0.05). There were no statistically significant differences between groups with respect to other general data. The ratios of moderate and severe hypolordosis of RLL were significantly higher in the ASDis group than that in the non-ASDis group (χ 2=16.92, P<0.001). There was also a significant linear trend with higher degree of hypolordosis being associated with higher rates of ASDis. However, distribution of four statuses of LDI did not differ statistically between groups. After controlling the confounders, the logistic regression analysis revealed that age, odd ratio ( OR)=1.07, 95% CI: (1.01, 1.13), P=0.018), moderate[ OR=4.34, 95% CI: (1.03, 18.41), P=0.046] and severe hypolordosis [ OR=11.64, 95% CI: (1.30, 104.49), P=0.028] were significantly associated with the occurrence of ASDis. Conclusion:A significant association between postoperative RLL and occurrence of ASDis after lumbar fusion surgery were detected. Setting surgical goals according to RLL may help reduce the ASDis rate. However, LDI is not identified to be predictive factors of the occurrence of ASDis.
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Objective:To investigate reversal of vertebral wedging and to evaluate the contribution of adding satellite rods to correction maintenance in patients with adolescent Scheuermann kyphosis (SK) after posterior-only instrumented correction.Methods:A retrospective cohort study with SK was performed. From January 2009 to December 2018, a total of 26 SK patients (21 males and 5 females) who received posterior instrumented correction surgery at the age of 13–16 years were included. The mean age was 14.5±0.9 years. Risser sign was level 1 in 5 patients, level 2 in 10 patients and level 3 in 11 patients. Patients receiving placement with a standard 2-RC construct were composed in the 2-RC group, and those with enhanced instrumentation with satellite rods adding to 2-RC via duet screws were assigned to the S-RC group. The anterior vertebral body height (AVBH), posterior vertebral body height (PVBH), global kyphosis (GK), disc wedging angle (DWA), vertebral wedging angle (VWA) and Scoliosis Research Society questionnaires-22 (SRS-22) were collected preoperatively, immediately postoperatively, and at the latest follow-up. Further, these outcomes were compared between the two groups.Results:The average follow-up durations for the S-RC and 2-RC groups were 3.1±1.0 and 2.9±1.1 years ( t=0.04, P=0.837), respectively. Remarkable postoperative correction of GK was observed in S-RC group and 2-RC group without significant difference (51.1%±5.1% vs. 46.7%±5.8%, t=1.74, P=0.099). The correction loss of S-RC group was significantly less than that at 2-RC group during follow-up (0.6°±0.3° vs. 1.8°±0.8°, t=-6.52, P<0.001). The ratio between AVBH and PVBH of deformed vertebrae notably increased in S-RC group and 2-RC group from post-operation to the latest follow-up ( P<0.05). Compared with the 2-RC group, the S-RC group had significantly greater increase in AVBH/PVBH ratio during follow-up (32.6%±8.5% vs. 22.5%±13.4%, t=2.31, P=0.030). The two groups had similar preoperative and postoperative SRS-22 questionnaire scores for all domains ( P>0.05). Conclusion:The AVBH of deformed vertebrae could be increased after posterior correction in SK patients. Compared with the traditional two-rod construct, satellite rods construction could be more effective which could achieve greater vertebral remodeling and less correction loss.
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Objective:To investigate the risk factors of long-term shoulder imbalance in patients presented postoperative shoulder imbalance who underwent single segment hemivertebra resection, and the role of postoperative trunk shift in shoulder imbalance.Methods:All of 30 patients who presented shoulder imbalance after hemivertebrae resection and short fusion from July 2006 to December 2018 were reviewed in this study, including 16 males and 14 females, aged 4.53±2.05 years (range, 2-8 years). Among them, 10 cases were thoracic hemivertebra, 12 thoracolumbar hemivertebra and 8 lumbar hemivertebra. According to the vertical height difference at the highest point of soft tissue shadows on both shoulders in the final follow-up upright posteroanterior radiograph, which was shoulder imbalance (SI), they were divided into two groups: Group B (balance, shoulder imbalance less than 10 mm) and Group IB (imbalance, shoulder imbalance more than 10 mm). Several radiographic parameters were measured preoperatively, 3 months after surgery and at the final follow-up, such as SI, distance between C 7 plumbline and center sacral vertical line (C 7PL-CSVL), Cobb angle of main curve, cobb angle of proximal curve (CAPC), Cobb angle of distal curve (CADC), upper instrumented vertebra offset (UO), lower instrumented vertebra offset (LO), upper instrumented vertebra slope (US), lower instrumented vertebra slope (LS), T1 tilt and sagittal vertical axis (SVA). Results:The mean follow-up period was 54.3±33.7 months (range, 24-132 months). A mean of 3.1 segments were fused. 7 cases (70%) of thoracic, 6 cases (50%) of thoracolumbar and 3 cases of lumbar hemivertebrae (37.5%) with shoulder imbalance at 3 months after surgery remained imbalanced at the last follow-up. Thirteen cases presented coronal imbalance postoperative (C 7PL-CSVL>2 cm), among 6 cases whose trunk shafted to the side of the higher shoulder postoperatively, 5 cases presented aggravated SI at final follow-up, and among 7 cases whose trunk shafted to the side of the lower shoulder postoperatively, 6 cases presented aggravated SI at final follow-up, while the difference had statistical significance ( P=0.029). The static analysis indicated that postoperative and long-term C 7PL-CSVL, long-term lowest instrumented vertebra and long-term T 1 tilt were risk factors of shoulder imbalance at final follow-up. Conclusion:A proportion of congenital scoliosis patients who presented shoulder imbalance after hemivertebra resection plus short fusion are less likely to achieve shoulder balance at the final follow-up. Long-term shoulder imbalance is often presented in the patients whose trunk shafted to the side of the higher shoulder postoperatively.
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Objective:To evaluate whether pelvic fixation is needed in patients undergoing posterior lumbosacral hemivertebra (LSHV) resection and long fusion.Methods:All 32 adult spinal deformity patients with posterior hemivertebra (HV) resection and long segment fixation treated from April 2005 to August 2019 were analyzed retrospectively, including 12 males and 20 females with a mean age of 32.9±8.8 years. According to the state of coronal balance distance (CBD), there were 15 cases of type A (preoperative CBD≤ 30 mm), 1 case of type B (preoperative CBD>30 mm and C 7 plumb line offset to the concave side), and 16 cases of type C (preoperative CBD>30 mm and C 7 plumb line offset to the convex side). The clinical and imaging data before operation, immediately after operation and at the last follow-up were collected, and the short-term and long-term complications related to operation were recorded. The improvement of Cobb angle and coronal balance of primary curve and compensatory curve were evaluated on the whole spine frontal and lateral X-ray films, and the change of coronal balance type after operation was evaluated. According to the mode of distal internal fixation, the patients were divided into two groups: PF group (pelvic fixation): distal fixation to iliac or sacroiliac; NPF group (non-pelvic fixation): distal fixation to L 5 or S 1. Results:All 32 patients were followed up with an average time of 3.9±2.6 years (range 2-11 years). The Cobb angle of primary curve in PF and NPF groups were 42.6°±13.5° and 41.3°±10.9° respectively before operation, and corrected to 13.1°±5.4° and 17.7°±5.8° respectively after operation. It maintained at 13.4°±5.1°and 18.5°±6.7° in the two groups at the last follow-up, respectively ( FPF=32.58, FNPF=28.64, P<0.001). The correction rates were 69.3%±11.8% and 57.6%±10.3%, respectively ( t=2.14, P=0.012). The compensatory curves of in the two groups were corrected from 54.9°±14.8° and 46.8°±13.6° before operation to 17.3°±9.6° and 15.4°±8.4° after operation. It also maintained at 18.5°±8.8°and 17.6°±9.5° in the two groups at the last follow-up, respectively ( FPF=42.97, FNPF=38.56, P<0.001). The correction rates were 68.4%±16.7% and 67.2%±14.9%, respectively ( t=0.17, P=0.849) in the two groups. In PF group, the primary and compensatory curve were similar (69.3%±11.8% vs. 68.4%±16.7%, t=0.15, P=0.837), while the correction rate of compensatory curve in NPF group was significantly higher than that of the primary curve (67.2%±14.9% vs. 57.6%±10.3%, t=2.13, P=0.013). Coronal decompensation occurred in 12 patients (12/32, 37.5%). The CBD in PF and NPF groups was corrected from 33.3±11.2 mm and 28.8±8.1 mm preoperatively to 18.5±3.5 mm and 27.1±6.8 mm postoperatively, respectively, and it showed no significant change at the last follow-up ( FPF=41.61, P<0.001; FNPF=0.38, P=0.896). While the CBD in PF group was significantly better than that in NPF group ( t=3.23, P=0.002; t=2.94, P=0.008). The incidence of coronal decompensation in PF group was 0%, which was significantly lower than 50% (12/24) in NPF group (χ 2=6.40, P=0.014). In addition, 6 cases in PF group were type C coronal decompensation before operation, and the coronal balance was corrected to type A after surgery (100%). Among 10 patients with type C coronal decompensation in NFP, 4 (40%) patients returned to type A after operation, and the difference was statistically significant (6/6 vs. 4/10, χ 2=5.76, P=0.034). Conclusion:Coronal decompensation (12/32, 37.5%) is not rare in patients after posterior LSHV resection and long fusion. Attention should be paid to the match of the corrections between lumbosacral deformity and compensatory curve, which is of great significance in coronal balance reconstruction. Pelvic fixation is helpful to reduce the incidence of postoperative coronal decompensation, especially for the type C patients.
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Objective:To evaluate a self-designed intelligent robot-assisted minimally invasive reduction system in the reduction of unstable pelvic fractures by a cadaveric anatomic study.Methods:Ten unembalmed cadavers (7 male and 3 female ones) were used in this study. In each cadaveric specimen an unstable pelvic fracture was created in accordance with clinical case models (3 cases of type B1, 4 cases of type B2 and 3 cases of type C1 by the Tile classification). A self-designed intelligent robot-assisted minimally invasive reduction system was used to assist the reduction in the cadaveric models. Intraoperative registration and navigation time, autonomous reduction time, total operation time and reduction error were measured.Results:Effective reduction was completed in 10 bone models with the assistance of our self-designed intelligent robot-assisted minimally invasive reduction system. The time for intraoperative registration and navigation averaged 47.4 min (from 32 to 74 min), the autonomous reduction time 73.9 min (from 48 to 96 min), and the total operation time 121.3 min (from 83 to 170 min). The reduction error averaged 2.02 mm (from 1.67 to 2.62 mm), and the reduction results met the clinical requirements.Conclusion:Our self-designed intelligent robot-assisted minimally invasive reduction system is a new clinical solution for unstable pelvic fractures, showing advantages of agreement with clinical operative procedures, high reduction accuracy and operational feasibility, and reduced radiation exposure compared to a conventional operation.
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Objective:To evaluate the emergency iliosacral screw fixation assisted by TiRobot for unstable posterior pelvic ring fracture.Methods:The 26 patients with unstable pelvic fracture were analyzed retrospectively who had undergone emergency iliosacral screw fixation at Department of Orthopedics & Traumatology, Beijing Jishuitan Hospital from June 2018 to December 2020. They were divided into 2 groups depending on whether orthopaedic TiRobot was used to assist screw insertion. In the observation group of 14 cases subjected to TiRobot-assisted insertion of iliosacral screws, there were 10 males and 4 females with an age of (45.9 ± 10.1) years; in the control group of 12 cases subjected to conventional manual insertion of iliosacral screws, there were 9 males and 3 females with an age of (49.2 ± 11.3) years. All the surgeries were conducted within 24 hours after injury. The 2 groups were compared in terms of screw insertion time, pin insertion, intraoperative blood loss, fluoroscopy time, postoperative screw position, fracture reduction and Harris hip score at the final follow-up.Results:The 2 groups were comparable because there was no significant difference between them in their preoperative general clinical data or follow-up time ( P>0.05). The screw insertion time [(16.1 ± 3.4) min] and fluoroscopy time [(8.1 ± 3.3) s] in the observation group were significantly shorter than those in the control group [(26.4 ± 5.4) min and (25.2 ± 7.4) s], and the pin insertions [1 (1, 2) times] and intraoperative blood loss [(10.5 ± 6.4) mL] in the former were significantly less than those in the latter [6 (3, 8) times and (24.8 ± 6.7) mL] (all P<0.05). Postoperatively, the sacroiliac screw position was excellent in 18 cases and good in 2 in the observation group while excellent in 14 cases, good in 2 and poor in 2 in the control group; the fracture reduction was excellent in 12 cases, good in one and fair in one in the observation group while excellent in 10 cases, good in one and fair in one in the control group, showing insignificant differences in the above comparisons ( P>0.05). There was no significant difference either in the Harris hip score at the final follow-up between the 2 groups ( P>0.05). Conclusion:Compared with conventional manual insertion of iliosacral screws, emergency iliosacral screw fixation assisted by TiRobot can effectively decrease surgical time and reduce operative invasion due to a higher accuracy rate of screw insertion.
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Objective:To evaluate the radiographic and clinical outcomes of pre-operative Halo-gravity traction (HGT) and posterior correction surgery in treating patients with neurological deficits secondary to severe focal angular kyphosis of the upper thoracic spine.Methods:A total of 16 patients (11 males, 5 females) with neurologic deficits secondary to severe focal angular kyphosis of the upper thoracic spine undergoing preoperative HGT and posterior correction operation from January 2010 to December 2019 were retrospectively analyzed. The average age was 12.9±5.6 years (range 6-27 years). The standing X-ray of whole spine was taken at pre-, post-traction and post-operation. The Cobb angles of main curve at both sagittal and coronal planes were measured accordingly. The neurologic function at pre-traction, post-traction and post-operation was assessed according to the American Spinal Injury Association (ASIA) grading. The complications during HGT, operation and post-operative follow-up were recorded for each patient.Results:The average values of focal kyphosis and scoliosis were 96.1°±16.0° (71°-128°) and 75.5°±20.5° (40°-107°) at pre-traction respectively. The spinal cord function graded by ASIA criteria at pre-traction was B in 1 patient, C in 6 and D in 9, respectively. The correction rates of focal kyphosis and scoliosis were 32.8%±15.0% (18.0%-65.9%) and 22.9%±8.0% (14.1%-38.6%) after traction, which were further improved to 45.4%±14.9% (29.0%-69.0%) and 33.6%±8.6% (23.3%-49.3%) at post-operation without significant correction loss during 35.6±14.2 (24-72) months follow-up. After traction, the spinal cord function improved to grade D in 4 patients and grade E in 12 patients. At the last follow-up, the spinal cord functions were grade E in 15 patients and grade C in 1 patient. No neurologic monitor events occurred during operation. One patient suffered from transient left brachial plexus after operation. Further, proximal hook loosening was observed in 2 patients during follow-up. The spinal cord function was ASIA grade C pre-operatively in one patient, who recovered to ASIA grade E after operation and significantly deteriorated to ASIA C at 4 years follow-up.Conclusion:The correction of spinal kyphoscoliosis was satisfactory in this cohort. Preoperative HGT followed by posterior spinal correction surgery is an effective and safe procedure in treating neurological deficits secondary to focal angular kyphosis in the upper thoracic spine.
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Objective:To analyze the factors which may influence postoperative early ambulation in patients with fresh fracture so as to further optimize the perioperative protocol based on the concept of enhanced recovery after surgery (ERAS).Methods:A retrospective analysis was conducted of the patients who had been treated for a single fresh fracture at the extremity, pelvis or acetabulum from May 2019 to July 2019. Collected were the data concerning basic features of patients, perioperative ERAS management and surgery, as well as early ambulation on the day of surgery or the first day after surgery. The patients were divided into an early ambulation group and a non-early ambulation group according to the time of ambulation. Statistical analyses were performed of the relationships between early ambulation and 20 potential factors concerning basic features of patients, perioperative ERAS management and surgery. Logistic correlation analysis was performed to identify risk factors for postoperative early ambulation.Results:A total of 306 patients were included, including 96 upper limb, 203 lower limb, 5 acetabular and 2 pelvic fractures. Of them, 150 ambulaed from bed on the day of surgery or the first day after surgery while 156 did not. Significant differences were observed between the 2 groups in fracture site, intake of carbohydrate liquids the night before surgery and the day of surgery, catheter indwelling, intraoperative liquid transfusion volume and postoperative complications ( P < 0.05). Logistic correlation analysis of the relationship between the above factors and postoperative early ambulation found that fracture site and intraoperative liquid transfusion volume were significantly correlated with postoperative early ambulation ( P < 0.05). Conclusions:About half of the patients with a single fresh fracture may ambulate early after surgery. Fracture site and intraoperative liquid transfusion volume may be significantly correlated with postoperative early ambulation.
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Objective:To compare the perioperative data between the pararectus and ilioinguinal approaches in the internal fixation of acetabular fractures.Methods:A randomized controlled trial was conducted to enroll 74 patients with acetabular fracture who were admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from June 2018 to January 2021. They were randomly divided into 2 groups. In group A of 37 cases, there were 28 males and 9 females with an age of (55.8±15.2) years, and 10 anterior column fractures, 7 anterior+posterior hemi-transverse fractures, one transverse fracture, 3 T-shaped fractures and 16 both column fractures according to Letournel-Judet classification. In group B of 37 cases, there were 28 males and 9 females with an age of (49.4±14.6) years, and 8 anterior column fractures, 6 anterior+ posterior hemi-transverse fractures, 2 transverse fractures, 2 T-shaped fractures and 19 both column fractures according to Letournel-Judet classification. Group A was subjected to open reduction and plate fixation via the pararectus approach while group B to open reduction and plate fixation via the ilioinguinal approach. The 2 groups were compared in terms of operation time, intraoperative blood loss, postoperative reduction and perioperative complications.Results:There were no significant differences in baseline data between the 2 groups, showing comparability between them ( P>0.05). The operation time in group A [150 (120, 180) min] was significantly shorter than that in group B [180 (150, 225) min] ( P<0.05). There were no significance differences between the 2 groups in intraoperative blood loss [800 (600, 1, 000) mL versus 1, 000(600, 1, 300) mL], rate of good to excellent reduction [91.9%(34/37) versus 78.4%(29/37)], or incidence of complications [24.3%(9/37) versus 45.9%(17/37)] ( P>0.05). Conclusion:Compared with the ilioinguinal approach, the pararectus approach can reduce operation time significantly in the internal fixation of acetabular fractures.
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Objective:To evaluate the safety and efficacy of one-stage posterior-only jumping hemivertebra (HV) resection combined with respective short fusions in the treatment of congenital scoliosis (CS) caused by multiple HVs.Methods:All of 13 consecutive patients with multiple HVs treated surgically from January 2010 to December 2017 were retrospectively reviewed, including 4 males and 9 females with a mean age of 3.7±1.2 years. One child had 4 HVs, and the rest had 2 HVs. The responsible HVs causing local scoliosis/kyphosis deformity or coronal plane deviation were selected as the target of resection. The distal HV was removed firstly and then the proximal one was resected; both of the fixation vertebraes were horizontalized during surgery. The clinical and imaging data of the children before the initial operation, immediately after the operation and at the latest follow-up were collected, and the short-term and long-term complications related to surgery were recorded. The data were evaluated on the whole-standing spine anteroposterior and lateral films, including the corrections of proximal and distal main curves, coronal balance, local kyphosis, and the improvement of spinal growth height (upper and lower internal fixation length, T 1-S 1 length). At the same time, the re-progression of coronal and sagittal deformities of the spine during growth was recorded (coronal decompensation: emerging postoperative curve progression more than 20°; kyphosis progression: kyphosis aggravation between upper and lower internal fixation more than 40°) and internal-fixation-related complications (screw cutting, screw malposition) were recorded. Results:Dual HVs were resected in each child, of which 8 (61.5%) were located on contralateral side of the spine, and 5 (38.5%) were located on ipsilateral side of the spine. The follow-up time was 6.2±3.3 years (range 2.0-10.5 years) after surgery. The Cobb angles of proximal and distal main curves were 36.7°±11.8° and 35.2°±7.8° respectively before surgery and were corrected to 9.7°±6.6° and 6.1°±4.1° respectively after surgery ( F=31.249, F=93.83, P< 0.001) ( t=6.888, t=10.954, P<0.001), and the correction rates was 73.6%±19.6% and 82.7%±11.7%, respectively. They were maintained at 14.3°±5.4° and 8.0°±4.6° at the latest follow-up, showing the correction rates loss of 15.8%±26.9% and 6.9%±7%, respectively. The coronal balance improved from 17.2±14.8 mm pre-operatively to -0.2±15.7 mm postoperatively ( t=2.703, P=0.008), and it remained at 0±18.4 mm at the final follow-up ( F=4.137, P=0.024). The T 1-S 1 length was corrected to 273.8±27.3 mm postoperatively, slightly increased compared with pre-operation 256.3±24.0 mm, ( t=0.680, P=0.527), and significantly increased to 333.2±33.4 mm at the latest follow-up ( t=2.986, P<0.001; F=6.704, P=0.003). Seven patients had local kyphosis before operation, which was significantly improved from 32.2°±13.6° to 6.1°±9.8° with a correction rate of 93.4%±27.0% after surgery ( t=3.355, P=0.004), which showed no significant loss of correction at the latest follow-up (5.4°±10.4°) ( F=11.187, P=0.002). Six patients (46.2%) developed coronal decompensation (Curve magnitude >20 °), with an average of 21.7°±1.9°. Two cases (15.4%) had progressive kyphosis between the thoracic regional internal fixations at 3 months after surgery, which were 68° and 58° respectively. After bracing, both coronal decompensation and sagittal kyphosis were improved. At the last follow-up, the coronal decompensation was improved to 14.7±8.9° and the kyphosis was alleviated to 55° and 46°, respectively. Conclusion:Posterior-only skipping hemivertebra resection and short fusion is a safe, effective procedure yielding significantly improvement of the growth imbalance and reginal spinal deformities of CS with multiple HVs. The mid-term follow-up results showed that the progress of the scoliosis was common during the growth period, which could be further controlled by supplementary brace treatment.
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Objective:To investigate the association of the cross-sectional area of lumbar paraspinal muscle with the spino-pelvic profile based on Roussouly classification.Methods:From January 2019 to December 2019, 102 patients with lumbar disc herniation were collected, the index level included L 2, 3 in 3 cases(2.9%), L 3, 4 in 14 cases(13.7%), L 4,5 in 58 cases (56.9%), and L 5S 1 in 27 cases (23.5%). According to Roussouly classification, there were 29 cases of type I (28.4%), aged 57.0±11.7 years old (range 43 to 72 years old), 31 of type II (30.4%), aged 56.9±10.3 years old (range 40 to 70 years old), 28 of type III (27.5%), aged 53.5±12.9 years old (range 42 to 70 years old), and 14 of type IV (13.7%), aged 59.7±9.5 years old (range 51 to 70 years old). The clinical status of the patients were evaluated with the MOS 36-item short-form health survey (SF-36), Oswestry disability index (ODI) and visual analog scale (VAS). Select all patients with L 1, 2, L 2, 3, L 3, 4, L 4, 5 and L 5S 1 disc level axial MRI images, to measure the cross-sectional area (CSA) of paraspinal muscles (back extensor muscle and psoas muscle) and the CSA of intervertebral disc at each disc level, and calculate the relative cross-sectional area (RCSA: the ratio of the CSA of muscles to that of the disc at the same level). One-way ANOVA was used to test the RCSA of the paraspinal muscles of the four groups, and then LSD- t test was used for pair wise comparisons to compare the RCSA of the paraspinal muscles in each group. Results:There was no significant difference in age ( F=1.067, P=0.367), female/male sex ratio ( χ2=2.412, P=0.491) and body mass index ( F=0.326, P=0.481). Roussouly type I group showed lower SF-36 score in both SF-36 PCS (31.5±6.5, F=3.207, P=0.047) and SF-36 MCS (33.9±5.7, F=3.409, P=0.031) compared with the other three types. In contrast, there were no significant differences in VAS Back Pain ( F=0.140, P>0.05), VAS leg pain ( F=0.622, P>0.05). and ODI scores ( F=1.075, P>0.05) among the types. At each level from L 1, 2 to L 5S 1, the RCSA of psoas muscle in Roussouly type IV (19.18±6.98, 35.36±10.37, 41.25±14.35, 61.58±12.03, 59.29±11.73) was significantly lower than that in patients with any other Roussouly type ( P<0.05), while no significant difference in the psoas RCSA among type I, type II and type III curves ( P>0.05). With regards to back extensor muscle, the RCSAs of back extensor muscle in Roussouly types I (135.32±19.86, 138.53±22.92, 125.06±21.44, 122.40±19.69, 110.87±18.08) and II (131.30±18.68, 136.39±24.87, 122.61±22.52, 121.10±20.47, 107.46±18.29) were significantly lower than those in Roussouly type III and IV at each level ( P<0.05), yet no significant difference between type I and II or between type III and IV. The ratio between the RCSA of back extensor muscle and psoas muscle in four types increased gradually from L 1, 2 to L 5S 1, with that being higher in type II (0.20±0.07, 0.33±0.09, 0.40±0.13, 0.58±0.11, 0.65±0.08) and lower in type IV (0.13±0.05, 0.24±0.07, 0.31±0.10, 0.47±0.10, 0.52±0.11). Conclusion:RCSA of paraspinal muscles varied among Roussouly types, suggesting a significant association between paraspinal muscles and the sagittal spino-pelvic alignment. Sagittal spino-pelvic alignment may be involved in the degeneration of paraspinal muscles.
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Objective:To explore the efficacy and correction mechanism of posterior column osteotomy for treatment of "Lenke 5-like" lumbar congenital scoliosis.Methods:From April 2008 to September 2019, 16 patients with lumbar congenital scoliosis underwent posterior column osteotomy were retrospectively reviewed including 6 males and 10 females, aged 23.9±11.7 years (range, 14-48 years). Among them, 8 cases were unsegmentation, 5 malformation and 3 mixed type. The average segments of PCO were 5.3. Posterior column osteotomy was adapted after the insertion of pedicle screws, then removed spinous process, ligaments, superior and inferior facet and corrected the deformity with the rods. The pre- and post-operative and last follow-up radiographic parameters were measured: Cobb angle of lumbar curve, distance between C 7 plumbline and center sacral vertical line (C7PL-CSVL), deformity angle (DA), disc correction angle (DCA) of instrumented segments, disc angle above upper instrumented vertebra (DAAU), lower instrumented vertebra disc angle (LDA), upper instrumented vertebra slope (US), lower instrumented vertebra slope (LS), lower instrumented vertebra offset (LO) and sagittal parameters such as thoracic kyphosis (TK), lumbar lordosis(LL) and thoracic junctional kyphosis (TJK). The Scoliosis Research Society-22 questionnaire (SRS-22) were conducted at preoperation and the final follow up to evaluate the clinical outcomes. Results:The mean follow-up period was 16.69±7.65 months (range, 12-36 months). The coronal DA was 26.74°±10.59° while the sagittal DA was 14.70°±11.63°. The pre- and post-operative Cobb angle were 51.19°±12.91° and 23.25°±12.86° while the correction rate was 57.17%±16.31% and reached 24.26°±13.19° in the last follow-up. The improvement of DAAU, LDA, US, LS, and LO pre- and post-operative had statistical significance ( P<0.001). The pre- and post-operative and the last follow-up C 7PL-CSVL were 27.13±17.08 mm, 21.81±12.80 mm and 20.24±15.02 mm. The pre-operative, postoperative and last follow-up DAAU were -4.35°±2.12°, 1.36°±2.34° and 1.60°±2.45°. The pre- and post-operative LDA were -7.03°±4.40° and 2.42°±3.39°, and the last follow-up LDA was 2.81°±2.98°. US and LS decreased from pre-operative 12.01°±8.33° and 21.46°±5.79° to 2.84°±7.52° and 11.64°±6.06°. The mean US and LS were 4.22°±6.56° and 11.56°±6.02° in the last follow-up. LO decreased after surgery and keep unchanged in the last follow-up, which were 12.71°±6.43°, 6.31°±5.17° and 7.01°±4.73°, respectively. For the sagittal plane parameters, the changes of TK, LL, and TJK reached statistical significance through the surgery. LL increased from 33.69°±14.01° to 44.28°±10.07° through the surgery and reached 41.97°±6.69° at the last follow-up while TK increased from 13.41°±12.37° to 23.52°±8.10°, TJK decreased from 29.02°±20.74° to 16.20°±12.62° after the surgery and reached 16.07°±13.33° at the last follow-up. The pre-operative, post-operative and last follow-up thoracic kyphosis were 13.41°±12.37°, 23.52°± 8.10°, and 24.21°±7.39°. There was no statistical significance of the change of C 7PL-CSVL, SVA, SSA and PI-LL through the surgery ( P>0.05). At the final follow-up, the self-image and psychologic status scores of SRS-22 were significantly higher than that before surgery ( t=15.457, P<0.001; t=14.726, P<0.001), and there was no significant difference in the rest of the domain ( P>0.05). Conclusion:"Lenke5-like" lumbar congenital scoliosis could obtain satisfactory correction of coronal and sagittal deformities with the treatment of posterior column osteotomy, while there was no significant loss of correction during follow-up. The incidence of surgical complications is low.
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Objective:To evaluate the outcomes of transforaminal lumbar interbody fusion (TLIF) for patients with lumbar spinal stenosis (LSS) and diffuse idiopathic skeletal hyperostosis (DISH).Methods:This study recruited 33 patients (15 male and 18 female) with LSS and DISH who underwent TLIF surgery from January 2010 to July 2018. The mean age was 65.1±11.2 years old and the instrumented segments averaged 1.45±0.42 levels. Another group of LSS patients without DISH were well matched to the DISH group at a 1∶1 ratio in terms of age, sex, and instrumented levels. Lumbar lordosis, local lordosis as well as lowerlumbarlordosis were measured on X-ray taken before and after surgery. According to Pfirrmann's classification, the degree of preoperative disc degeneration was evaluated on preoperative MRI, and the incidence of postoperative fusion cage subsidence was recorded during follow-up. Oswestry disability index (ODI) was used to evaluate the lumbar function and visual analogue scale(VAS) scores for low back pain and leg pain were used to evaluate the quality of life.Results:There were no significant difference between two groups in terms of age, bone mineral density, operative time, postoperative bleeding volume, fusion levels and postoperative follow-up time. Compared with the non-DISH group (3.20±0.95), the DISH group had higher degeneration disc according to Pfirrmann's classification (3.82±0.64) ( t=3.109, P=0.002), lower lumbar lordosis(37.4°±8.5° vs. 45.2°±12.2°, t=3.013, P=0.003), and lower lower lumbar lordosis (18.3°±3.9° vs. 21.9°±5.4°, t=3.104, P=0.002). After TLIF surgery, lumbar lordosis was significantly improved in both groups. During follow-up, notable correction loss was noted in DISH group in terms of lumbar lordosis (43.6°±9.7° vs. 50.1°±10.2°, t=2.652, P=0.010), lower lumbar lordosis (19.1°±4.7° vs. 22.9°±5.2°, t=2.540, P=0.013) as well as local lumbar lordosis (17.4°±6.5° vs. 22.7°±7.2°, t=3.138, P=0.002). Moreover, these above value in the DISH group were significantly lower than those in the non-DISH group. At the latest follow-up, 12 patients in the DISH group were identified with cage subsidence, which were significantly higher than in the non-DISH group (36.3% vs. 12.1%, χ2=5.280, P=0.022). Till the latest follow-up, both groups had considerable improvement of the ODI score, back pain and leg pain VAS score. However, the back pain VAS scores in the DISH group were significantly higher than that in the non-DISH group ( t=2.862, P=0.005). Conclusion:Compared with LSS patients without DISH, LSS patients with DISH are more likely to have cage subsidence and loss of correction of lumbar lordosis angle after TLIF surgery. Moreover, the VAS score of low back pain in LSS patients with DISH was lower than those without DISH.
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BACKGROUND@#Scoliosis secondary to neurofibromatosis type 1 (NF1) in children aged 10°/year) were identified. The age at modulation and the AV before and after modulation were obtained. Patients with (n = 18) and without rapid curve progression (n = 10) were statistically compared.@*RESULTS@#Twenty-eight patients with a mean age of 6.5 ± 1.9 years at the initial visit were reviewed. The mean Cobb angle of the main curve was 41.7° ± 2.4° at the initial visit and increased to 67.1° ± 8.6° during a mean follow-up of 44.1 ± 8.5 months. The overall AV was 6.6° ± 2.4°/year for all patients. At the last follow-up, all patients presented curve progression of >5°, and 20 (71%) patients had progressed by >20°. Rapid curve progression was observed in 18 (64%) patients and was associated with younger age at the initial visit and a higher incidence of modulation change during follow-up (t = 2.868, P = 0.008 and 10°/year is associated with younger age at the initial visit, and modulation change indicated the occurrence of the rapid curve progression phase.