The impact of post-traumatic stress on the clinical outcome in a cohort of patients with knee osteoarthritis and knee arthroplasty: A prospective study.

BACKGROUND: Knee osteoarthritis (KOA) is one of the most common musculoskeletal disorders and commonly occurs in older adults, predominantly female populations. Both populations have intimate links with trauma-related stress. Therefore, we intended to evaluate the prevalence of post-traumatic stress disorder (PTSD), which arises from KOA and determine its effects on the postoperative results in patients undergoing total knee arthroplasty (TKA). METHODS: The patients who fulfilled the diagnosis of KOA from February 2018 to October 2020 were interviewed. Patients were interviewed by a senior psychiatrist about evaluating their overall experience during their most difficult or stressful situations. KOA patients who underwent TKA were further analyzed to investigate whether PTSD influences the postoperative results. The PTSD Checklist-Civilian Version (PCL-C) and Western Ontario McMaster Universities (WOMAC) Osteoarthritis Index were used to assess PTS symptoms and clinical outcomes after TKA, respectively. RESULTS: 212 KOA patients completed this study with a mean follow-up of 16.7 months (7-36 months). The mean age was 62.5 ± 12.3 years, and 53.3% (113/212) were women. 64.6% of the sample (137/212) underwent TKA to relieve the symptoms of KOA. Patients with either PTS or PTSD tended to be younger (P < 0.05), female (P < 0.05) and undergo TKA (P < 0.05) than their counterparts. WOMAC-pain (P < 0.05), WOMAC-stiffness (P < 0.05), and WOMAC-physical function (P < 0.05) both before TKA and 6 months after TKA in the PTSD group is significantly higher compared to their counterparts. Logistic regression analysis showed that a history of OA-inducing trauma (adjusted OR = 2.0, 95% CI = 1.7-2.3, P = 0.003), posttraumatic KOA (adjusted OR = 1.7, 95% CI = 1.4-2.0, P < 0.001), and invasive treatment (adjusted OR = 2.0, 95% CI = 1.7-2.3, P = 0.032), were significantly associated with PTSD in KOA patients. CONCLUSIONS: Patients with KOA, especially those undergoing TKA, are associated with PTS symptoms and PTSD, indicating the need to evaluate it and offer care for them.

Self efficacy associated with regression from pregnancy-related pelvic girdle pain and low back pain following pregnancy.

BACKGROUND: Self-efficacy, one's ability to deal with pain, disability, and other symptoms through self-management techniques, positively affect the quality of life in patients with chronic diseases. Pregnancy-related back pain is a common musculoskeletal disorder pre- and postnatally. Hence, the study aimed to determine whether self-efficacy is associated with the development of back pain during pregnancy. METHODS: Between February 2020 and February 2021, a prospective case-control study was performed. Women with back pain were included. The self efficacy was assessed by the Chinese version of the General Self-efficacy Scale (GSES). Pregnancy-related back pain was measured using a self-reported scale. No regression from pregnancy-related back pain is defined as a recurrent or persistent pain score ≥ 3 over a week around 6 months postpartum. Women experiencing back pain during pregnancy are classified according to whether having a regression. This problem can be divided into pregnancy-related low back pain (LBP) and posterior girdle pain (PGP). The differences in variables were compared between groups. RESULTS: A total of 112 subjects have completed the study finally. These patients were followed up with an average of 7.2 months after childbirth ranging from six to 8 months. 31 subjects (27.7%) of the included women did not report regression 6 months postpartum. The mean self efficacy was 25.2 (SD:10.6). Patients with no regression tended to be older (LBP:25.9 ± 7.2 vs.31.8 ± 7.9, P = 0.023; PGP: 27.2 ± 7.9 vs. 35.9 ± 11.6, P < 0.001*), have a lower self efficacy (LBP:24.2 ± 6.6 vs.17.7 ± 7.1, P = 0.007; PGP: 27.6 ± 6.8 vs. 22.5 ± 7.0, P = 0.010), and need high daily physical demand in their vocations (LBP:17.4% vs. 60.0%, P = 0.019; PGP: 10.3% vs. 43.8%, P = 0.006) when compared to those with regression. Multivariate logistic analysis shows that risk factors for no regression from pregnancy-related back pain included LBP (OR = 2.36, 95%CI = 1.67-5.52, P < 0.001), pain ratings of the onset of back pain during pregnancy≥3(OR = 2.23, 95%CI = 1.56-6.24, P = 0.004), low self efficacy (OR = 2.19, 95%CI = 1.47-6.01, P < 0.001), and high daily physical demand in their vocations (OR = 2.01, 95%CI = 1.25-6.87, P = 0.001). CONCLUSIONS: Low self efficacy makes the women experience about two-fold risk to experience no regression from pregnancy-related back pain. Evaluation for self efficacy is simple enough to be used to improve perinatal health.

A new radiological parameter as a predictor of dysphagia based on oro-pharyngeal stenosis in a cohort of pediatric patients undergoing mal-reduced C1-2 pedicle screw fixation.

PURPOSE: C1 pedicle screw technique showed further advantages since it avoids the negative results from the sacrificed range of motion of the atlantooccipital joint compared to the occipitocervical fusion. However, some intractable complications are unavoidable. In the pediatric population, dysphagia after the atlantoaxial fixation can be accidentally serious. We aimed to determine the incidence of dysphagia in the pediatric population's cohort and its radiological predictor. METHODS: Between January 2010 and August 2018, this retrospective study included 42 pediatric patients with atlantoaxial dislocation due to trauma. They were followed up with an average duration of 8 years (range 5-18 years). Twenty-seven were males and 15 females with a mean age of 8.2 years (range 5-15 years) when undergoing operations. Patients were classified according to the presence of postoperative dysphagia according to the Bazaz dysphagia grading scale. The measurements, including pre- and postoperative CVT/NSL, O-C2, and C2-C7 sagittal angles, were performed. RESULTS: 26.2% of the patients (11/42) experienced postoperative dysphagia. A significant difference in the postoperative CVT/NSL (115.2 ± 13.2 vs.134.8 ± 17.3, P = 0.002), ΔCVT/NSL (7.0 ± 11.2 vs. 20.3 ± 10.5, P = 0.001), ΔO-C2 (- 3.2 ± 5.8 vs. 2.1 ± 5.1, P = 0.026), postoperative nPAS (9.4 ± 3.7 vs. 12.6 ± 4.2, P = 0.031) and ΔPAS (- 1.5 ± 4.1 vs. 2.0 ± 3.5, P = 0.010) between dysphagia group and non-dysphagia group were found. Adjustment for age, gender, and BMI, the multivariate logistic analysis showed that ΔCVT/NSL < 8.35° (OR = 5.23; 95% CI 4.97-5.50; P = 0.001) and ΔO-C2 (OR = 3.34; 95% CI 3.17-3.51; P = 0.001) remained associated with the occurrence of the swallowing problems. CONCLUSION: In comparison with ΔO-C2, ΔCVT/NSL might better predict postoperative dysphagia in children. LEVEL OF EVIDENCE I: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

Generalized joint laxity as a predictor of recovering from low back pain during pregnancy - A prospective study.

BACKGROUND: Low back pain (LBP) is a common musculoskeletal problem during pregnancy. The symptoms usually disappear gradually after delivery, but some women may have persistent problems even later in their lives. Individuals with generalized joint laxity (GJL) were expected to have more injuries on lumbar discs and require prolonged healing time. Therefore, this study aims to investigate whether the test of GJL before the pregnancy could predict the prognosis of pregnancy-related LBP. METHODS: 375 women were recruited from January 2017 to October 2017 in antenatal clinics. Those who suffered the LBP during pregnancy were analyzed and further grouped based on whether they recovered from LBP after deliver. The variables such as age, GJL level using Beighton score, and parity were recorded and examined for the risk analysis of unrecovered LBP. Also, the cut-off point for the Beighton score was determined by the receiver operating characteristic (ROC) curve, and the Pearson correlation between GJL levels and pain intensities was investigated. RESULTS: 324 pregnant women completed this study. The mean age of included participants was 29.4 ± 4.6 years. Thereinto, 210 women (64.8%) had LBP during their pregnancy. Of these, 51 women (24.3%) failed to recovery from LBP 2 years after delivery. Beighton score (≥6), LBP in a previous pregnancy, back pain, and high physical demand were risk factors for LBP without recovery (all P < 0.001). Besides, there was a significant correlation between HGS values and the intensities of LBP (r = -0.564, P = 0.002). CONCLUSIONS: Beighton score is a straightforward and reliable indicator of GJL, and the evaluation before pregnancy using it could help screen high risks for pregnancy-related LBP. The present findings may help encourage pregestational exercise targeted at trunk extensors to help alleviate and even avoid the intensities of LBP during pregnancy.

Personality traits predict regression of pelvic girdle pain after pregnancy: a longitudinal follow-up study.

BACKGROUND: Pelvic girdle pain (PGP) is a multifactorial condition with a partly unknown etiology. This condition can be mentally and physically compromising both during and after pregnancy. To provide all-around preventive measures to improve the recovery from PGP, it is a necessity for obstetricians and orthopaedists to develop predictive studies about the worse prognosis for this condition. Therefore, this study aims to determine whether personality traits can predict the consequences of long-term pregnancy-related PGP. METHODS: This was a prospective study conducted from January 2015 to August 2018. A total of 387 pregnant women were enrolled in this study. According to whether they had experienced PGP during the past 4 weeks, the subjects were classified into no PGP and PGP groups. Persistent PGP after the pregnancy was defined as a recurrent or continuous visual analog score (VAS) pain rating of ≥3 for more than 1 week. The Quick Big Five Personality Test (QBFPT) was used to assess personality traits. Data were obtained by mail or in the clinic. The authors collected data including age, BMI, educational level, annual household income, cesarean delivery, breastfeeding, unexpected sex of the baby, parity, sick leave, no or rare ability to take rest breaks at work, and PGP in the previous pregnancy. RESULTS: Of 387 included women, 264 subjects experienced PGP during the pregnancy with a mean age of 26.3 ± 4.5 years. A total of 80 of 264 (30.3%) women experienced persistent PGP after the pregnancy. Persistent PGP after the pregnancy was associated with higher levels of neuroticism (OR = 2.12, P = 0.001). Comparing women with persistent PGP, those who reported higher levels of extraversion and conscientiousness were more likely to recover from this condition (OR = 0.65, P = 0.001; OR = 0.78, P = 0.010, respectively). Besides, neuroticism was positively associated with higher pain scores (r = 0.52, P = 0.005). However, extraversion and conscientiousness domains showed negative correlations with pain score (r = - 0.48, P = 0.003; r = - 0.36, P = 0.001). CONCLUSIONS: Personality traits were significantly associated with the outcomes of PGP.

Subclinical Hypothyroidism Affects Postoperative Outcome of Patients Undergoing Total Knee Arthroplasty.

OBJECTIVE: The aim of this study was to investigate whether subclinical hypothyroidism could increase the risk of postoperative complications in patients undergoing primary total knee arthroplasty (TKA). METHODS: A prospective case-control study of 796 patients undergoing primary TKA between January 2015 and January 2020 was performed. A total of 700 patients (87.9%) were female and the average age of included patients was 65.0 years, with a standard deviation of 5.6. The participants who had subclinical hypothyroidism were referred to as the case group, while those without abnormal thyrotropin (TSH) were included in the control group (matched for age and gender). The fasting plasma levels of TSH were tested in the morning in all patients. The diagnosis of subclinical hypothyroidism was completed by a senior endocrinologist based on laboratory tests; namely, a serum TSH ≥ 5 mu/L and normal free thyroxine (FT4). Subclinical hypothyroidism was further described as mild (TSH < 10 mu/L) or severe (TSH ≥ 10 mu/L). The incidence of 90-day postoperative complications was compared between two cohorts. Logistic regression analysis was used for the risk factors of 90-day postoperative complications following TKA. RESULTS: A total of 398 patients had a diagnosis of subclinical hypothyroidism. Among them, 275 cases (69.1%) were described as mild (79 patients [19.8%] with low FT4 and 196 patients [49.2%] with normal FT4 in the repeated test) and 123 cases (30.9%) as severe subclinical hypothyroidism. Of the 196 patients (49.2%) with mild subclinical hypothyroidism and normal FT4, 63 patients (15.8%) had symptoms before surgery. Patients were followed up for an average duration of 25.4 months (6 to 43 months). A total of 265 patients (66.6%) received preoperative treatment for subclinical hypothyroidism, with an average therapy time of 9.2 months. There were 162 patients (40.7%) with positive autoantibodies to thyroid peroxidase (anti-TPO). There were no statistically significant differences in baseline data between cohorts (all P > 0.05). As for the cumulative 90-day outcomes, subclinical hypothyroidism increased the incidences of both medical and surgical complications following primary TKA compared to those without this condition (11.6% vs 7.2%, OR = 1.55, 95% confidence interval [CI] = 1.47-1.62, P < 0.05). Subclinical hypothyroidism caused patients to suffer increased total incidence of readmission within the first 90 days after discharge when compared to those without this condition (20.61% vs 14.15%, OR = 1.45, 95% CI = 1.41-1.49, P < 0.001). Controlling for preoperative and intraoperative variables, the patients with TSH ≥ 10 mu/L and positive anti-TPO and those without corrected subclinical hypothyroid and thyroid hormone supplementation were more likely to experience postoperative complications within 90 days of TKA. CONCLUSION: Subclinical hypothyroidism might increase the risk of postoperative complications within 90 days of TKA, especially for the patients with TSH ≥ 10 mu/L and positive anti-TPO and those without corrected subclinical hypothyroid and thyroid hormone supplementation.

Hand grip strength as a predictor of recovery from low back pain in the pregnant women-a prospective study.

BACKGROUND: Low back pain (LBP) is a common musculoskeletal problem during pregnancy with an estimated prevalence ranging from 30% to 78%. The symptoms usually disappear gradually after delivery, but some women may have persistent problems even later in their lives. The definite mechanism behind LBP during pregnancy remains unknown. Therefore, the purpose of this study was to investigate whether hand grip strength (HGS), which is a straightforward and reliable indicator of overall muscle strength, is associated with unrecovered LBP after delivery. METHODS: 257 pregnant women who registered at obstetrics units in two tertiary hospitals from January 2016 to June 2017 and meanwhile suffered the LBP during pregnancy were included. They were grouped based on whether they recovered from LBP after delivery (recovery was defined as a pain rating of ≤3). The variables such as age, HGS, and education level were recorded and examined for the risk analysis of unrecovered LBP. Also, the Pearson correlation between HGS levels and pain intensities was investigated. RESULTS: LBP without recovery at two years after delivery was reported among 22.7% of the subjects. Women with increasing age, low HGS (<25 kg), LBP in a previous pregnancy, back pain, sick leave, and a large amount of physical demand (all p < 0.05), were more likely to report LBP without recovery. Besides, there was a significant correlation between HGS values and the intensities of LBP (r = -0.525; p = 0.003). CONCLUSIONS: Low HGS has the highest OR value (adjusted OR = 9.12, P < 0.001) among these factors. The present findings may be used to design and encourage a specific stabilization exercise regime to build well stability of the lumbar spinal column and thus alleviating the LBP.

A radiologic parameter that could be applied in the development of sleep apnea in rheumatoid arthritis patients undergoing occipitocervical fusion.

BACKGROUND: The prevalence of sleep apnea in rheumatoid arthritis (RA) patients with occipitocervical lesions was 79%. Occipitocervical fusion (OCF) could incur sleep apnea or worsen this condition. Recent studies reported that this complication is caused by stenosis of the oropharyngeal airway accompanying a decrease in the occipitoaxial angle (O-C2a). However, there are several limitations to the application of the O-C2a, which decreases its effectiveness. Therefore, we aimed to evaluate the association between a new radiologic parameter, the CVT/NSL angle (CVT: craniocervical inclination in the second and fourth vertebrae; NSL: Nasion-Sella line), and sleep apnea in RA patients accepting OCF. METHODS: A total of 35 patients who underwent OCF due to upper cervical lesions secondary to RA and had sleep apnea before surgery were analyzed. Those who have a postoperative apnea-hypopnea index (AHI) < 15 and a ΔAHI ≥50% were considered "responders"; patients were otherwise considered "non-responders." They were analyzed whether pre- and postoperative radiologic parameters and their differences in plain lateral radiographs were correlated to the parameter related to sleep apnea. RESULTS: The included patients have a mean AHI of 21.9 (range, 10 to 52) before surgery. The mean postoperative CVT/NSLa, ΔCVT/NSLa, andΔO-C2a in complete responders were significantly greater compared with non-responders (p < 0.05). Both the changes in the CVT/NSLa and O-C2a were linearly correlated within patients. However, the R2 value for the CVT/NSLa was greater compared with the O-C2a (0.403 vs. 0.203). CONCLUSIONS: The usefulness of the new craniovertebral angle, CVT/NSLa, as an intraoperative indicator during OCF, is more valuable in comparison with the conventional method of measuring the O-C2a. Measuring the craniovertebral angle is extremely important in the planning of surgical treatment for the development of sleep apnea in rheumatoid arthritis patients undergoing occipitocervical fusion.

Different types of low back pain in relation to pre- and post-natal maternal depressive symptoms.

BACKGROUND: Low back pain (LBP) is a common musculoskeletal problem during pregnancy, with an estimated prevalence ranging from 30-78% (Mota MJ et al. J Back Musculoskelet Rehabil 28(2):351-7,2015 and Abebe E et al. J Med Sc Tech 3(3). 37-44,2014). Women reporting LBP are at increased risk of developing perinatal depression. Pregnancy-related LBP is highly heterogeneous and can be divided into lumbar pain (LP), posterior pelvic pain (PPP), and combined pain (CP). Therefore, the purpose of this study was to investigate the associations between LBP and perinatal depressive symptoms. METHODS: This was a retrospective case-control study conducted from January 2016 to April 2019. A total of 484 pregnant women were enrolled in this study: a case group of 242 pregnant women who were diagnosed with LBP and an age-matched control group of 242 pregnant women without LBP. The Edinburgh Postnatal Depression Scale (EPDS), LBP characteristics, and questionnaires about pregnancy that included demographic, parity, work, comorbidity, and previous pregnancy data were completed and compared between the case group and the control group. RESULTS: A total of 68 of 242 (28.1%) women experienced PPP, 142 (58.7%) had lumbar pain(LP), and 32 (13.2%) had combined pain. Furthermore, 26.5% of women with prenatal depression in the LP subgroup remained depressed 6 months postnatally, while the percentages for women in the PPP subgroup and CP subgroup were just 10.6% and 15.6%, respectively. The percentage of women who recovered anytime between delivery and six months postnatally in the PPP subgroup was significantly higher than that in the LP subgroup (31.7% vs. 14.7%, P < 0.001). CONCLUSIONS: There is a difference in the prevalence of prenatal, postnatal, and perinatal depressive symptoms among pregnant women with different types of LBP. It is necessary to screen prenatal and postnatal depression separately and differentiate the types of LBP during pregnancy. Attention to these factors may help to outline better management strategies to improve maternal health.

New Classification and Its Value Evaluation for Atlantoaxial Dislocation.

OBJECTIVE: To introduce the TOI classification system (the Traction reduction type [T type], Operation reduction type [O type], and Irreducible type [I type] classification system) and to determine the interobserver and intraobserver reliability of the TOI classification system. METHODS: Based on the characteristics of atlantoaxial dislocation (AAD), AAD was divided into Traction reduction type (T type), Operation reduction type (O type), and Irreducible type (I type). The analysis of interobserver and intraobserver agreements was done using kappa statistics. From July 2016 to January 2019, 213 AAD patients were retrospectively studied at four hospitals. Plain radiographs including extension and flexion views and three-dimensional CT images were obtained. Twenty independent observers, including eight experienced spine specialists and 12 orthopaedic fellows from four different residency training hospitals, completed the survey. RESULTS: The classification of the TOI system was based on etiology, the course of the disease, flexion-extension X-rays, three-dimensional CT reconstruction, and curative effects of skull traction. Flexion-extension X-rays demonstrating a successful reduction of the dislocated atlantoaxial joint and three-dimensional CT images showing osseous fusion of atlantoaxial facet joints and cervical traction reveal characteristics of T-type. Furthermore, this type can be divided into two subtypes, T1 and T2, according to the etiology and course of the disease. Unsatisfactorily reduction after 1-2 weeks of strict cervical traction, no reduction shown on flexion-extension X-rays, and no destruction or boneless fusion of atlantoaxial facet joints demonstrated in three-dimensional CT images are characteristics of type O. Atlantoaxial facet joint showing bone fusion or failure of reduction after cervical traction or three-dimensional CT images showing failure of surgical release are characteristics of type I. Interobserver and intraobserver reliability of the TOI classification system were moderate (κ = 0.543) and substantial (κ = 0.658), respectively. Interobserver and intraobserver reliability of the treatment choice were moderate (κ = 0.568) and substantial (κ = 0.675), respectively. There were no significant differences in the interobserver and intraobserver reliability between experienced spine specialists and fellows for all κ-values (P > 0.05). CONCLUSIONS: The TOI classification system had satisfactory reliability and, therefore, can be applied clinically and used by less experienced surgeons. We believe TOI can help surgeons choose appropriate treatment strategies.

Three-dimensional CT classification of fracture site and injury mechanism of axis ring / 中华骨科杂志

Objectives:To observe the anatomical location and mechanism of axis ring fractures (ARF) using 3-D CT scans, and propose a new classification for such fractures.Methods:By reviewing prospectively maintained database collecting ARF from 7 medical centers in China, 202 patients were included in this study. According to anatomical location, ARFs were classified into axis arthrosis fracture (AAF) and axis bony damage (ABD). The axis ring was divided into anterior, middle, and posterior rings, based on the border of the pars interarticularis (or pedicle) of axis. According to the features of ARF and previous study, a new classification was proposed based on the anatomical features of different fracture patterns, which was divided into three types and six subtypes (A1, A2, B1, B2, C1 and C2). The incidence of AAF and ABD and their distribution in different location of axis ring and the new classification, were observed.Results:In 202 patients with ARF, 501 anatomical structures were involved. 288 AAFs were found in 178 patients (288/501, 57%), while 213 ABDs were found in 149 patients (213/501, 43%). In anterior ring, 304 structures (304/501, 61%) were involved in injury, with 225 AAF and 79 ABD. In middle ring, 99 structures (99/501, 20%) were involved in injury, and all of them were ABD. In posterior ring, 98 structures (98/501, 19%) were involved in injury, with 63 AAF and 35 ABD. The anterior ring injuries (61%) were more common than middle (20%) or posterior ring (19%). In anterior ring, AAF (84%) were morecommon than ABD (16%); In middle ring, all the injuries were ABD; In posterior ring, AAFs (64%) were more common than ABD (36%). Type A fractures were featured with pedicle fractures and were identified in 30 patients (30/202, 15%). Type A1 fractures were bilateral pedicle fracture lines symmetrically or asymmetrically and identified in 12 (6%) patients; Type A2 fractures were pedicle fracture lineson one side and inferior articular facet injuries or lamina fractures on the otherside and identified in 18 (9%) patients. Type B fractures were featured with superior articular facet injuries or posterior wall of C2 body fractures on one side and identified in 136 patients (67%). Type B1 fractures were superior articular facet injuries or posterior wall of C2 body fractures on one side and pedicle fracture on the other side and identified in 57 (28%) patients; Type B2 fractures were superior articular facet injuries or posterior wall of C2 body fractures on one side and inferior articular facet injuries or lamina fractures on the otherside and identified in 79 (39%) patients. Type C fractures were featured with bilateral superior articular facet injuries or posterior wall of C2 body fractures and identified in 36 patients (18%). Type C1 fractures were bilateral superior articular facet injuries or posterior wall of C2 body fractures symmetrically and identified in 22 (11%) patients; Type C2 fractures were bilateral superior articular facet injuries or posterior wall of C2 body fractures asymmetrically and identified in 14 (7%) patients.Conclusion:ARF could occur in different anatomical locations, and most of these fractures were caused by hyperextension and axial load on superior articular facet on one or two sides. The new CT classification of ARF with three types and six subtypes might provide all fracture patterns, which could be useful for the choice of proper diagnosis and treatment for such fractures.

Guidance value of TOI classification for treatment of traumatic T-type atlantoaxial dislocation / 中华创伤杂志

Objective To investigate the guidance value of TOI classification in treating traumatic T-type atlantoaxial dislocation (ADD).Methods A retrospective case series study was made on 32 cases of traumatic TOI T-type ADD treated between January 2012 and December 2015.There were 19 males and 13 females,aged (38.4 ± 14.7) years.Fifteen cases of T1-type underwent external fixation or internal fixation without fusion,while 17 cases of T2-type underwent internal fixation with fusion.Symon-Lavender clinical standard,Japanese orthopedic association score (JOA),visual analogue scale (VAS),atlas-dens interval (ADI) and space available for the cord (SAC) were used to evaluate the therapeutic effect.Results Patients were followed up for 6-54 months (mean,32.4 months).At final follow-up,ADI was decreased to (2.3 ± 1.4) mm from preoperative (5.6 ± 1.6) mm,but SAC was increased to (15.4 ± 1.9) mm from preoperative (12.0 ± 2.9) mm(P ＜ 0.01).At final follow-up,cervical axial rotation range of motion was 102°-154° in T1-type cases and 57°-93° in T2-type cases.Range of motion for atlantoaxial joint was preserved in T1-type cases,but lost in T2-type cases.According to the Symon-Lavender clinical standard,there were 14 cases of mild disability,nine moderate disability,eight severe disability and one extremely severe disability before operation;there were 21 cases of mild disability,nine moderate disability and two severe disability at last follow-up.Significant difference was observed in the grades according to the Symon-Lavender clinical standard before operation and at last follow-up (P ＜0.05).At last follow-up,JOA score was increased to (14.6 ± 2.9) points from preoperative (9.9± 3.2) points,and VAS was decreased to (2.7 ± 1.3)points from preoperative (6.0 ± 1.6)points (P ＜ 0.01).Conclusions By using TOI classification,reconstruction of stability and improved neurological function can be achieved in treatment of traumatic T-type atlantoaxial dislocation.Non-fusion treatment of T1-type atlantoaxial dislocation can preserve range of motion for atlantoaxial joint.

Screw fixation via diploic bone paralleling to occiput table: anatomical analysis of a new technique and report of 11 cases.

Several types of posterior approaches have been adopted for occipitocervical fusion. Prior to this study, Foerater et al. in 1927 used a fibular strut graft in the site between the occiput and the lower cervical spine to achieve fusion. Since then, various techniques including wrings, Hartshill loop, AO reconstructive plate, and AXIS occipital plate were described and used widely. As far as we know, all these techniques involve the screw placement vertical to the diploic bone; however none has ever addressed the feasibility of screw placement in occiput parallelling to the diploic bone. In our study, 30 dry specimens of human occiputs were measured manually using vernier calipers and protractors. The intradiploic screw was first supposed to be inserted inferiorly to the superior nuchal line (SNL) prominence. The entry point located at the superior edge of the SNL prominence. Afterward, the measurements of extracranial occiput in SNL area on midline and bilateral 15 mm to the midline saggital-cutting planes of the occiput were conducted. The thickness of the occipital bone at the location of SNL prominence, the entry point, the exit point and the screw orientation were measured, respectively. Afterward, 11 patients with craniocervical malformation were treated surgically using this alternative and their X-ray radiographs and CT scans were evaluated postoperatively. The data showed that the occipital at the site of SNL prominence was the thickest. The thickest point was external occipital protuberance (EOP), which was up to 14 mm. The thickness decreased gradually from the site of SNL to the superior border of surgical decompressed area. The actual length of screw channel was about 26 mm. The mean thickness for safe screw insertion ranged from 5.73 to 14.14 mm. A total of 22 intraocciput screws parallel to diploic bone were placed precisely, without injury to the cerebral and inner occipital venous sinus. The results confirm that occiput is available for holding intraocciput screw paralleling to diploic bone.

Medial wedged proximal tibial osteotomy for treating genu varus deformity / 中国矫形外科杂志

[Objective]To discuss the efficacy of medial wedged proximal tibial osteotomy for treating genu varus deformity.[Methods]From July 1998 to October 2007,49 patients with genu varus deformity were treated by medial wedged proximal tibial osteotomy combined with internal fixation.Full-length anterior-posterior radiographs were taken preoperatively at 8 weeks and 1.5 years postoperatively.The parameters including the femorotibial angle and the medial joint space were measured on the radiographs.The pre-and postoperative function of knee were evaluated according to the HSS score system of the knee.[Results]All the 49 patients were followed up from 18 to 128 months.The mean postoperative femorotibial angle decreaced from 187.5??5.3? to 172.6??3.6?.The mean postoperative HSS score significantly improved from 83.2?15.3 to 47.2?17.6 points after 1.5 years of operation.The medial joint space increased from(2.4?1.2) mm to(4.3?1.2) mm.There were complications in 5 cases: 3 cases of intra-articular fracture during operation and 2 of postoperative superficial wound infections.There were no delayed union,no recurrence of varus deformity,and no blood vessels or nerves injury in all cases.The pain relieved and walking function improved significantly postoperativly.[Conclusion]Medial wedged proximal tibial osteotomy combined with internal fixation is an effect approach to treat genu varus deformity.

Use of first metatarsal neck osteotomy and inverted impaction fixation to correct symptomatic hallux valgus / 中国矫形外科杂志

[Objective]To assess the success of hallux valgus surgery of oblique and impaction osteotomy of first metatarsal neck.[Method]The outcome of 36 patients(45 feet)treated by this technique for symptomatic hallux valgus deformity was reviewed.The follow-up was two years.Lateral and AP radiographs were taken in a standing position pre-and postoperativly and hallux valgus angle(HV angle)and intermetatarsal angle(IM 1~2 angle)were measured accordingly.The efficacy of the surgery was evaluated by JOA scoring for foot disorders.[Result]The fracture healing was excellent.There was no case of delay union and nonunion.Two cases(three feet)were found to have superficial infection.The mean HV angle and IM 1~2 angle was revised by 15.6? and 4.2? respectively.JOA score was elevated for 29.6 points.[Conclusion]Hallux valgus can be corrected in three-dimension by the technique of first metatarsal neck osteotomy and inverted impaction fixation.