Effect of morphological changes in the sagittal plane of vertebrae and discs on degenerative kyphodeformity / 中国骨伤

OBJECTIVE@#To explore the effects of morphological changes such as vertebral wedge deformation and disc degeneration (collapse) on adult thoracolumbar/lumbar degenerative kyphosis(TL/LDK) deformity.@*METHODS@#A retrospective analysis of 32 patients with spinal TL/LDK deformity admitted from August 2015 to December 2020, including 8 males and 24 females, aged 48 to 75(60.3±12.4) years old. On the long-cassette standing upright lateral radiographs, the coronal Cobb angle, sagittal thoracic lumbar/lumbar kyphosis angle(KA) of spine were measured, and the height and wedge parameters of apex vertebral(AV) and two vertebrae(AV-1, AV-2, AV+1, AV+2) above and below AV and the intervertebrae and the intervertebral disc(AV-1D, AV-2D, AV+1D, AV+2D) were evaluated, involving anterior vertebral body height(AVH), posterior vertebral body height(PVH), vertebral wedge angle(VWA), ratio of vertebral wedging(RVW), anterior disc height(ADH), posterior disc height(PDH), disc wedge angle(DWA), ratio of disc wedging(RDW), and DWA/KA.@*RESULTS@#The average angle of kyphosis was (44.2±19.1)°. A significant decrease in anterior height of vertebral was observed compared to the posterior height of vertebral(P<0.005). There was no significant difference in anterior and posterior height of discs. The vertebral wedging ratio/contribution ratio:AV-2(14.98±10.95)%/(14.21±8.08)%, AV-1(21.08±12.39)%/(18.09±7.38)%, AV(26.94±11.94)%/(25.52±8.64)%, AV+1(24.19±8.42)%/(20.82±8.69)%, AV+2(20.56±7.80)%/(15.60±9.71)%, total contribution(94.23±22.25)%, the disc wedging ratio/contribution ratio:AV-2D(2.88±2.57)%/(5.27±4.11)%, AV-1D(1.98±1.41)%/(2.29±2.16)%, AV+1D(-5.54±3.75)%/(-0.57±0.46)%, AV+2D(-8.27±4.62)%/(-1.22±1.11)%, total contribution (5.77±4.79)%. And the contribution rate of AV was significantly higher than that of adjacent vertebral(P<0.05).@*CONCLUSION@#The vertebral body and intervertebral disc shape both have influence on thoracolumbar kyphosis. However, the contribution of vertebral morphometry to the angle of TL/LDK deformity is relatively more important than the disc. The contribution of the wedge change of the AV to the TL/LDK deformity is particularly significant.

A follow up study on the treatment of tibial fractures with intramedullary interlocking nail through the suprapatellar approach / 中国骨伤

OBJECTIVE@#To investigate the short-term effect of suprapatellar interlocking intramedullary nail in the treatment of tibial fractures.@*METHODS@#Eighty patients with tibial fractures treated from January 2016 to June 2018 were treated with interlocking intramedullary nail, who were divided into observation group (suprapatellar approach) and control group (patellar ligament approach) according to different surgical approaches. There were 40 cases in the observation group, including 28 males and 12 females, aged 28 to 67 years with a mean of (46.70±10.34) years. There were 40 cases in the control group, including 30 males and 10 females, aged 31 to 69 years with a mean of(49.38±10.74) years. The operation time, incision length, intraoperative C-arm X-ray fluoroscopy times, intraoperative blood loss, fracture healing time, postoperative active straight leg raise (SLR) time, hospital stay, visual analogue scale (VAS), knee pain rate and postoperative Hospital for Special Surgery (HSS) score were recorded and compared between two groups.@*RESULTS@#All the patients were followed up, and the duration ranged from 19 to 38 months, with an average of(24.60±4.52) months. In the observation group, the operation time was(53.83± 7.01) min;the incision length was (3.98±0.83) cm;the number of intraoperative C-arm X-ray fluoroscopy was (18.90±1.75) times;the fracture healing time was (10.03±0.89) weeks;the postoperative active SLR time was (1.19±0.25) days;and the hospital stay was(6.73±1.06) days. The above indexes were better than those in the control group (@*CONCLUSION@#The treatment of tibial fractures with suprapatellar interlocking intramedullary nail has the advantages of less trauma and better recovery of knee function. It can obtain more satisfactory clinical results and can be further widely used.

Effect of double plate technique combined with autogenous iliac bone graft in the treatment of femoral nonunion after intramedullary nailing / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of double plate combined with iliac bone graft in the treatment of femoral nonunion after intramedullary nailing.@*METHODS@#From December 2008 to December 2017, double plate combined with autogenous iliac bone graft was used to treat femoral nonunion after intramedullary nailing. There were 11 cases, including 10 males and 1 female, aged 35 to 62 years, and the time from fracture to nonunion was 12 to 20 months. According to Judet classification, there were 8 cases of atrophic nonunion and 3 cases of proliferative nonunion. Regular follow-up was conducted after operation to record the fracture healing time, load-bearing activity time and complications, and to observe the repair effect of double plate fixation combined with iliac bone graft on nonunion after femoral shaft fracture operation.@*RESULTS@#All patients were followed up for 12 to 22 months. The operation time was 70 to 130 min and the blood loss was 180 to 350 ml. After operation, 2 cases had knee stiffness, which recovered after passive exercise with CPM machine for 2 weeks;1 case had pain in iliac bone donor area, which was relieved after 3 months. The time of fracture healing was 24 to 40 weeks, and the time of complete weight-bearing activity was 14 to 32 weeks. SF-36 quality of life score at the final follow-up:body pain 70 to 82, activty 70 to 82, social function 72 to 83, the overall health 72 to 82. At the end of the follow-up, there were no complications such as limb shortening, infection, poor wound healing, internal fixation failure (fracture, loosening).@*CONCLUSION@#It is an effective method to treat nonunion of femur after intramedullary nailing by using double plate combined with autogenous iliac bone graft.

Analysis of related risk factors for the refracture of adjacent vertebral body after percutaneous kyphoplasty / 中国骨伤

OBJECTIVE@#To investigate the risk factors of vertebral refracture after percutaneous kyphoplasty (PKP) for osteoprotic vertebral compression fractures (OVCFs), and to provide reference for clinical prevention.@*METHODS@#A retrospective analysis of 228 OVCFs patients who met the inclusion criteria admitted from November 6, 2013 to December 14, 2018. There were 35 males and 193 females, with a male-to-female ratio of 3∶20, and aged 58 to 91 years with an average of (69.70±7.03) years. All patients were treated with PKP and had complete clinical data. According to whether refracture occurred after operation, they were divided into refracture group (24 cases) and non refracture group (204 cases). Factors that may be related to refracture (including gender, age, surgical segment, number of vertebral bodies in the surgical segment, whether combined with degenerative scoliosis, whether anti-osteoporosis treatment) were included in the univariate analyses, and the single factor analysis of statistically significant risk factors was carried out with multiple Logistic regression analysis to further clarify the independent risk factors for vertebral body refracture after PKP. Survival analysis was performed using the time of vertebral refracture after PKP as the end time of follow up, the occurrence of refracture after PKP as the endpoint event, and the presence or absence of degenerative lateral curvature as a variable factor.@*RESULTS@#All 228 patients were followed up for 1.8 to 63.6 months with an average of (28.8±15.6) months, and the refracture rate was 10.5%(24/228). There were statistically significant differences between two groups in age, number of operative vertebral bodies, whether combinedwith degenerative scoliosis and whether anti osteoporosis treatment (@*CONCLUSION@#Combined scoliosis is an independent risk factor for refracture after OVCFs vertebroplasty, and it is also a possible high-risk factor for refracture after surgery.

Medium-term efficacy of bio-lengthened stem arthroplasty in the treatment of unstable intertrochanteric femoral fractures in elderly patients / 中国骨伤

OBJECTIVE@#To explore the clinical effect of bio lengthened stem arthroplasty replacement in the treatment of unstable intertrochanteric fractures in the elderly.@*METHODS@#From January 2015 to January 2018, 64 elderly patients with unstable intertrochanteric fractures were analyzed retrospectively. According to the surgical treatment, patients were divided into arthroplasty replacement group (bio-lengthened stem arthroplasty replacement) and internal fixation group (PFNA). In the arthroplasty group, there were 34 cases, including 19 males and 15 females, with an average age of (81.32±3.81) years old. The Evans classification of fracture was type Ⅲ in 15 cases, type Ⅳ in 16 cases and type Ⅴ in 3 cases. In the internal fixation group, there were 30 cases, including 14 males and 16 females, with an average age of (79.90±3.61) years old. The Evans classification of fracture was type Ⅲ in 10 cases, type Ⅳ in 15 cases and type V in 5 cases. X ray and CT showed unstable intertrochanteric fracture of femur. The operation time, intraoperative blood loss and complications were observed. Harris hip function score and SF-36 life quality score were used to evaluate the clinical effect.@*RESULTS@#All the incisions healed in stage Ⅰ. All patients were followed up for 13 to 39 months with an average of 23.4 months. The operation time and bleeding volume of the patients in the arthroplasty replacement group were more than those in the internal fixation group (<0.05). At the final follow-up, Harris function score of hip joint in the arthroplasty group was better than that in the internal fixation group (< 0.05);SF-36 life quality score in the arthroplasty group was better than that in the internal fixation group (<0.05).@*CONCLUSION@#The treatmentof unstable intertrochanteric fractures with bio-lengthened stem arthroplasty replacement and internal fixation can achieve good clinical results, but with bio-lengthened stem arthroplasty replacement, the postoperative complications are less, the function of hip joint is better, and the life quality and satisfaction of patients are higher.

Guiding significance of lumbar quantitative computed tomography in percutaneous vertebroplasty for osteoporotic vertebral compression fractures / 中国骨伤

OBJECTIVE@#To investigate the guiding significance of lumbar quantitative computed tomography (QCT) in percutaneous vertebroplasty (PKP) for osteoporotic vertebral compression fractures (OVCF).@*METHODS@#The clinical data of 90 patients with OVCF underwent PKP from December 2017 to December 2018 were retrospectively analyzed. There were 24 femalesand66males, withanaverage agedof (74.47±6.60) yearsold. Allpatientswere received QCT examination before surgery, andaccording to the QCT value oflumbarspine, the patientswere dividedinto osteopenia decrease group (80 to 120 g/L, 17 cases, 30 vertebrae), osteoporosis group (40 to 80 g/L, 44 cases, 66 vertebrae) and severe osteoporosis group (<40 g/L, 29 cases, 39 vertebrae). Bone cement was injected into vertebral body, AP and lateral X-rays were done during operation. The diffusion and leakage of bone cement in injured vertebrae of patients with different QCT values were observed. Unilateral approach was used for patients whose bone cement diffused beyond the midline of the vertebral body, otherwise, and bilateral approach was adopted, and guiding significance of QCT in PKP for OVCF was analyzed.@*RESULTS@#In 90 cases of 135 vertebrae, 72 cases of 98 vertebral bone cement diffused beyond the midline, accounting for 72.59%. Unilateral approach was used for the 72 patients whose bone cement diffused beyond the midline of the vertebral body, among them, there were 5 cases with 8 vertebrae in osteopenia group, 40 cases with 55 vertebrae in osteoporosis group and 27 cases with 35 vertebrae in severe osteoporosis group. There was significant difference in the bone cement dispersion between three groups (=41.397, =0.000). Moreover, no bone cement leakage occurred in osteopenia group, 3 cases of 4 vertebrae occurred in osteoporosis group and 2 cases of 3 vertebrae in severe osteoporosis group. However, none of the patients with bone cement leakage caused nerve injury and other symptoms, and there was no significant difference in bone cement leakage between the three groups (=2.242, =0.326).@*CONCLUSION@#According to the QCT examination of lumbar spine, defining the degree of osteoporosis and guiding the puncture method can shorten the operation time, reduce the number of fluoroscopy, and effectively improve the safety of vertebroplasty.

Modified Mclaughlin procedure combined with locking plate for posterior shoulder dislocation with fracture / 中国骨伤

OBJECTIVE@#To study clinical effects of modified Mclaughlin procedure combined with locking plate for posterior shoulder dislocation with proximal humeral fracture which area of femoral head injury less than 40%.@*METHODS@#From July 2012 to June 2017, 7 patients with posterior shoulder dislocation were treated, including 5 males and 2 females; aged from 37 to 53 years old. Three patients combined with split of humerus head and 4 patients combined with humerus surgical neck fracture. All patients treated with modified Mclaughlin procedure combined with locking plate. Motion of shoulder joint after operation was observed, postoperative UCLA score was used to evaluate clinical effects.@*RESULTS@#Seven patients were followed up from 10 to 33 months. The motion of anteflexion and up-lift ranged from 130° to 170°, the motion of extorsion ranged from 45° to 75°, the motion of abduction ranged fron 105° to 150°, and the internal rotation was between L₃ to buttock. UCLA score ranged from 29 to 34; and 1 patient reached excellent, and 6 patients good.@*CONCLUSIONS@#The modified Mclaughlin procedure combined with locking plate showed satisfying result for posterior shoulder dislocation combined with fractures. However, the internal rotation of shoulder could be compromised.

Correlation of medial compartmental joint line elevation with femorotibial angle correction and clinical function after unicompartmental arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To study the correlation of postoperative femorotibial angle with medial compartmental joint line elevation after unicompartmental arthroplasty(UKA), as well as the correlation of joint line elevation with the clinical function by measuring radiological joint line.</p><p><b>METHODS</b>A retrospective study of 56 patients from July 2012 to August 2015 was performed. The mean body mass index (BMI) was 23.5 (ranged, 18.3 to 30.1). The standing anteroposterior radiographs of these patients were assessed both pre-and post-operatively, and the knee function was evaluated according to HSS grading. The correlation between postoperative femorotibial angle(FTA) and joint line elevation was analyzed as well as the correlation between joint line elevation and the clinical function.</p><p><b>RESULTS</b>The mean medial joint line elevation was (2.2±2.0) mm(ranged, -3.3 to 7.0 mm), and the mean FTA correction was (2.3±3.0)°(ranged, -4.5° to 9.6°). The mean follow-up period was 12.2 months. There was a significant correlation between in joint line elevation and FTA correction(<0.05), while there was no significant correlation between joint line elevation and the clinical function(>0.05).</p><p><b>CONCLUSIONS</b>There was a significant correlation between medial compartmental joint line elevation and FTA correction after UKA, and the proximal tibial osteotomy was critical during the procedure. There was no significant correlation between joint line elevation and the clinical function, which may be related to the design of UKA prosthesis.</p>

The effects of cervical spinous process fracture with posterior ligamentous complex injury on stability of the goat cervical spine / 医用生物力学

Objective To investigate the effect of cervical spinous process fracture with posterior ligamentous complex (PLC) injury on biomechanical stability of the goat cervical spine specimen in vitro, and evaluate the role of posterior structure in maintaining the stability of cervical spine. Methods Twenty-four fresh goat cervical spine C3-6 specimens were randomly and evenly divided into 3 groups: control group (group A), simple cervical spinous process fracture group (group B) and cervical spinous process fracture with PLC injury group (group C). Under loading of 1.5 N·m torque, the range of motion (ROM) in each group was respectively measured under 6 working conditions: flexion, extension, lateral bending and axial rotation, and the ROM differences among 3 groups were compared by using one-way ANOVA analysis. Results Simple cervical spinous process fracture had little effect on the stability of cervical spine and there was no significant difference in ROM between group B and control group (P>0.05) under all working conditions. Compared with control group, the ROM in flexion, extension and axial rotation significantly increased in group C (P0.05). Conclusions Simple cervical spinous process fracture does not affect the overall stability of cervical spine. Cervical spinous process fracture with PLC injury is more likely to cause cervical instability than simple cervical spinous process fracture, and surgical intervention is required in cervical spinous process fracture with PLC injury.

The effects of cervical spinous process fracture with posterior ligamentous complex injury on stability of the goat cervical spine / 医用生物力学

Objective To investigate the effect of cervical spinous process fracture with posterior ligamentous complex (PLC) injury on biomechanical stability of the goat cervical spine specimen in vitro,and evaluate the role of posterior structure in maintaining the stability of cervical spine.Methods Twenty-four fresh goat cervical spine C3-6 specimens were randomly and evenly divided into 3 groups:control group (group A),simple cervical spinous process fracture group (group B) and cervical spinous process fracture with PLC injury group (group C).Under loading of 1.5 N · m torque,the range of motion (ROM) in each group was respectively measured under 6 working conditions:flexion,extension,lateral bending and axial rotation,and the ROM differences among 3 groups were compared by using one-way ANOVA analysis.Results Simple cervical spinous process fracture had little effect on the stability of cervical spine and there was no significant difference in ROM between group B and control group (P ＞ 0.05) under all working conditions.Compared with control group,the ROM in flexion,extension and axial rotation significantly increased in group C (P ＜ 0.05),and no significant ROM difference was found in lateral bending between control group and group C (P ＞ 0.05).Conclusions Simple cervical spinous process fracture does not affect the overall stability of cervical spine.Cervical spinous process fracture with PLC injury is more likely to cause cervical instability than simple cervical spinous process fracture,and surgical intervention is required in cervical spinous process fracture with PLC injury.

Analysis on the occult blood loss after unicompartment knee arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To calculate the volume of occult blood loss after unicompartment knee arthroplasty(UKA), and analyze its influential factors by comparing with total knee arthroplasty.</p><p><b>METHODS</b>A retrospective study of 130 cases from July 2012 to July 2015 were enrolled, of which and 65 cases were UKA, and 65 cases were TKA. In UKA group there were 27 males and 38 females, and the mean age was (62.3±4.3) years old (ranged, 50 to 82 years old). There were 14 cases older than 70 years old, while 51 cases among 50 to 70 years old. The mean Body mass index (BMI) was (23.9±2.6) kg/m²(ranged, 18.3 to 30.1 kg/m²). In TKA group there were 23 males and 42 females, and the mean age was (67.4±4.9) years old (ranged, 57 to 81 years old). There were 34 cases older than 70 years old, while 31 cases among 50 to 70 years old. The mean BMI was (25.6±2.3) kg/m²(ranged, 20.6 to 33.1 kg/m²). Hidden blood loss was calculated according to Gross equation, and the differences between the two groups including different ages and genders were observed subsequently. The differences of red blood cell change between two groups were observed dynamically postoperatively.</p><p><b>RESULTS</b>Postoperative hidden blood loss was (375.25±168.09) ml, HSS score was 87.11±5.39 in UKA group. Hidden blood loss was (898.81±221.47) ml, HSS score was 82.23±3.08 in TKA group. The differences between the two groups were significant. There were no significant differences in ages and genders. There were no significant relationship between hidden blood loss and HSS score or BMI, while the differences of red blood cell change were significant on the second day, the 4th day and the 5th day. There was no allogenic blood transfusion in UKA group, while 3 patients with transfusion in TKA group.</p><p><b>CONCLUSIONS</b>Hidden blood loss is part of total blood loss after UKA, and the volume in UKA is less than that in TKA. It could be compensated by the body and rarely affect the knee function. The hidden blood is not a risk factor of transfusion.</p>

Distal fixation prosthesis for unstable intertrochanteric fractures in elderly patients: a mid-term follow-up study / 中国骨伤

<p><b>OBJECTIVE</b>To explore mid-term follow up results of distal fixation prosthesis in treating unstable intertrochanteric fractures in elderly patients.</p><p><b>METHODS</b>From May 2008 to March 2014,58 elderly patients with unstable intertrochanteric were treated with distal fixation prosthesis, among them, there were 15 males and 43 females aged from 75 to 87 years old with an average of 83.2 years old. Fracture were classified according to Evans classification, 39 cases were type I c and 19 cases were type I d. Surgical risk was evaluated before operation, 9 patients were performed total hip arthroplasty and 49 patients were performed prosthetic replacement hip joint function of patients with different age period, Evans classificaton, prothesis type, fixation method were evaluated respectively by using Harris score.</p><p><b>RESULTS</b>Fifty-six patients were followed up from 13 to 36 months with an average of 21.6 months. Harris score was 83.51 ± 6.40, 5 cases got excellent results, 38 cases good and 13 cases moderate. Harris score of patients aged from 75 to 80 years old was 88.64 ± 2.35, 81.64 ± 6.40 in patients aged more than 80 years old, and had significant differences between two groups; Harris score in patients with type Evans I c was 83.64 ± 6.53, and 83.11 ± 6.08 in type Evans I d, while there was no significant differences between two groups. There was no obvious meaning in Harris score between patients with tension band (83.63 ± 6.15) and without tension band (82.41 ± 6.57). There was no significant meaning in Harris score between patients with normal distal fixation prosthesis (83.34 ± 6.43) and femoral moment reconstruction distal fixation prosthesis (83.92 ± 6.51). There was 1 patient occurred hip joint dislocation on the operative side and re-dislocation after manual reduction, then received open reduction. Two patients occurred femoral osteolysis without clinical symptoms, and treated conservative treatment.</p><p><b>CONCLUSION</b>Artificial joint replacement for unstable intertrochanteric fractures in elderly patients, hip joint function in patients aged more than 80 years old is worse, while there was no obvious market effect in fracture classification, whether to use tension band and type of distal fixation prosthesis, moreover, proximal femoral osteolysis should be focused on.</p>

Anterior cervical intervertebral space decompression under microscope for cervical spondylotic myelopathy in elderly patients / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effects of anterior cervical intervertebral space decompression under microscope in treating cervical spondylotic myelopathy in elderly patients.</p><p><b>METHODS</b>From June 2009 to March 2012, 43 patients with cervical spondylotic myelopathy were treated with anterior cervical intervertebral space decompression and intervertebral fusion under microscope. There were 26 males and 17 females, aged from 60 to 72 years old with an average of (64.9±3.7) years. Japanese Orthopaedic Association System (JOA) score was from 7 to 12 points with an average of (9.5±1.8) points before operation. The function of nerves was assessed before and after operation according to JOA.</p><p><b>RESULTS</b>All patients were followed up from 10 to 18 months with an average of (14.7±1.6) months. Postoperative JOA score was (13.81±1.44) points (ranged, 10 to 16), had significantly higher than preoperative (P<0.01). According to the rate of the improved JOA score, 9 cases got excellent results, 26 good, 7 fair, 1 poor.</p><p><b>CONCLUSION</b>Anterior cervical intervertebral space decompression under microscope for cervical spondylotic myelopathy in elderly patients is safe and effective.</p>

Repair of soft tissue defects on the lower limbs with the facial pedicled flap with vascular perforating branch of leg / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the operative techniques and clinical results of the facial pedicled flap with vascular perforating branch of leg.</p><p><b>METHODS</b>From May 1998 to January 2009,62 patients with soft tissue defects on the lower limbs were treated by four kinds of flap pedicled with the medial, posterior,anterolateral and posterolateral vascular perforating branches in the leg, included 50 males and 12 females, aged from 7 to 78 years old. There were 23 cases of the facial pedicled flap based on the perforating branch of the tibialis posterior artery, 9 cases of the facial pedicled flap based on the distal perforating branch of peroneal artery, 22 cases of the facial pedicled flap based on the peroneal artery perforator, 8 cases of the facial pedicled flap based on the lateral popliteal cutaneous artery.</p><p><b>RESULTS</b>The remaining flaps were completely survived except for 2 cases with epidermal necrosis and scab of distal flap, and 1 case with skin necrosis and skingrafting later. The patients were followed-up for from 1 month to 3 years, the appearance of the flaps were satisfied and the function were good.</p><p><b>CONCLUSION</b>The blood supply area of single perforator vascular of the leg is insufficient, so the presence facial pedicled flap of arterial chains will expend obviously the area of perforator flap that be good to blood supply and venous return.</p>

Repair of wound defect with exposed tibia with facial flap pedicled with vascular perforating branch of leg / 中华创伤杂志

Objective To explore the method of repairing wound defects with exposed tibia. Methods 32 patients with soft tissue defects with exposed tibia were treated with three kinds of flaps pedicled with interior,lateral and posterior vascular perforating branches in the leg,respectively.Re- suits One flap with distal part necrotic was treated with change of dressings and got one-stage healing. One case had delayed union for muscular infection under the flap.Other flaps all were successful and sur- vived.No ostemyelitis was found.Conclusion The flap pedicled with vascular perforating branches of leg has abundant blood supply and is a good method for repairing small or middle wound defect with ex- posed tibia.