Comparison of the Clinical Efficacy of Two Reduction Methods for the Treatment of Irreducible Unilateral Subaxial Cervical Facet Joint Dislocation.

OBJECTIVE: To compare the clinical efficacy of the minimally invasive technique and the open method in the treatment of irreducible unilateral subaxial cervical facet joint dislocation (SCFD). METHODS: From March 2015 to September 2018, 62 patients with unilateral SCFD were studied. The cases were divided into 2 groups based on different surgery strategies. Thirty-one patients were enrolled in the minimally invasive surgery (MIS) group, and 31 patients were enrolled in the open surgery group. The duration of prone position operation, blood loss, and total hospitalization costs were recorded. The clinical effects were evaluated using visual analogue scale scores, the Oswestry Disability Index, and Japanese Orthopedic Association scores at each follow-up. In addition, the segmental Cobb angle and intervertebral height were recorded and compared. RESULTS: The amount of intraoperative blood loss, prone position operation duration, and total hospital costs in the MIS group were significantly lower than in the open surgery group. The visual analogue scale, Oswestry Disability Index, and Japanese Orthopedic Association scores of the 2 groups significantly improved after the operation. A satisfactory fusion rate was obtained in both groups, and the segmental Cobb angle and intervertebral height scores in both groups improved significantly. CONCLUSIONS: Minimally invasive reduction had equal clinical efficacy to posterior open surgery. However, MIS was less invasive and had lower costs. Therefore, it is a potential option in the treatment of SCFD.

Management for lumbar spinal stenosis: Protocol for a network meta-analysis and systematic review.

INTRODUCTION: Lumbar spinal stenosis (LSS) is caused by structural changes of the spine, which lead to several severe symptoms, including back pain, leg pain, numbness and tingling in the legs, as well as reduced physical function. However, there is little evidence suggesting whether a patient with LSS should be treated with surgery. If surgery is recommended, which type of surgery benefits the patient most? To answer these questions, we will conduct a network meta-analysis and a systematic review to compare surgical and nonsurgical interventions in terms of efficacy as well as safety in adult patients with LSS. METHODS AND ANALYSIS: We will search the PubMed, Cochrane library, and EMBASE databases for articles published prior to October 10, 2019. We will search for randomized controlled trials assessing surgical and nonsurgical interventions for adult patients with degenerative LSS without any language restrictions. The primary outcome measures will be pain and disability. The secondary outcomes will include adverse events (number of events or number of people with each type of adverse event), reoperations, complications, blood loss and operation time. We will obtain the full texts of the potentially relevant studies and independently assess them. The quality of evidence will be evaluated according to the Grading of Recommendations Assessment, Development and Evaluation framework. A random-effects network meta-analysis will be performed to analyze all the evidence under the frequentist framework, and the ranking results will be presented. We will generate plots depicting the network geometry using Stata. The network meta-analysis will be performed according to the Bayesian framework. Ethics and dissemination Ethics approval is not required. The research will be published in a peer-reviewed journal.

A new method of measurement of cerebral circulation time: contrast-enhanced ultrasonography in healthy adults and patients with intracranial shunts.

Alterations in the cerebral circulation time (CCT) are observed in several cerebrovascular diseases. We designed a new method of global CCT measurement using gray-scale contrast-enhanced ultrasound and studied healthy Chinese adults and patients with intracranial shunts. Eighty-one healthy volunteers and eight patients with intracranial shunt disease were enrolled. The contrast agent Sonovue was used. Perfusion in the carotid artery and internal jugular vein bilaterally was recorded. Start and peak filling CCTs were calculated and analyzed. Imaging of carotid vessels was uncomplicated in all patients. The bilateral start CCT was 6.23 ± 1.39 s in healthy patients. There were no significant differences within subgroups and contrast-dosage groups. In the patient group, the mean start CCT was 3.0 ± 0.56 s. There was a significant difference between the control and patient groups (p < 0.001). This new method using gray-scale contrast imaging can measure CCT and cerebral blood volume accurately. It can be used to visualize blood flow differences in real time and is less dependent on the training of the operator.

Treatment of complicated tibial plateau fractures with dual plating via a 2-incision technique.

The operative treatment of complicated bicondylar fractures of the tibial plateau remains a challenge to most surgeons. This retrospective study was designed to evaluate the clinical and radiological outcomes of dual plating via a 2-incision technique for the repair of complicated bicondylar tibial plateau fractures. A series of consecutive patients with bicondylar tibial plateau fractures treated by open reduction and internal fixation with a double buttress plate or a combination of locking plate and buttress plate via a 2-incision technique between March 2004 and March 2008 were retrospectively analyzed. Radiological and clinical results and complications of the 2 different fixation methods were compared. Seventy-nine patients matching the criteria of this study were followed up for at least 24 months. All of the fractures healed, with 3 cases of deep infection, 7 cases of secondary loss of reduction, 3 cases of secondary loss of alignment, and 10 cases of knee instability. At 24-month follow-up, mean Hospital for Special Surgery scores were 77.8±9.4 and 79.0±7.9 in the double buttress plate group and combination group, respectively. No significant differences in clinical or radiographic outcomes were found between the 2 groups, except that the combination group needed less bone graft. Dual plating with 2 incisions provided good exposition for the reduction and fixation of complicated bicondylar tibial plateau fractures. Using a combination of locking plate and buttress plate reduced the amount of bone graft compared with the double buttress plate technique.

Application of locking plate in long-bone atrophic nonunion following external fixation.

The treatment of atrophic fracture nonunion continues to represent a therapeutic challenge. Large segmental osteopenia is often seen in patients who received uniplanar or hybrid external fixators as the definitive method of fixation for high-energy fractures, and this adds more difficulties to the treatment of fracture nonunion. This retrospective study was designed to assess the outcome of locking compression plating with autologous bone grafting in patients with long-bone atrophic nonunion following external fixation.From January 2004 to December 2009, a series of consecutive patients with atrophic nonunion of the long bone following external fixation were treated with this method in our institution. The clinical outcomes and complications of these patients were retrospectively analyzed. Twenty-seven patients with 28 fracture nonunions were involved in this study. Mean follow-up was 14.2±3.4 months. Bony union was achieved in all 27 patients within a mean 18.6±4.8 weeks after revision surgery. Two patients developed superficial wound infections. No deep infections were found, and no implant failure was seen. Three patients reported minor pain in the donor site of the bone graft, and no other donor site complications were found.Revision osteosynthesis of long-bone atrophic nonunion following external fixation by locking compression plating with autologous iliac crest bone grafting represents a safe and efficacious modality for the treatment of these challenging conditions.

Silencing of calpain expression reduces the metastatic potential of human osteosarcoma cells.

Osteosarcoma, the most common primary bone tumor in young adults, is characterized by local invasion and distant metastasis. But detailed mechanisms of tumorigenicity and metastasis of osteosarcoma are not well known. We report the involvement of calpains, a family of calcium-activated, cysteine proteases, in the invasive and metastatic processes of human osteosarcoma cells. By using siRNA treatment, the expression of mu- and m-calpains were downregulated in human Saos-2 osteosarcoma cells. Both the adhesive and invasive potentials were significantly attenuated in calpain siRNA-transfected human Saos-2 osteosarcoma cells. MMPs are the main factors involved in malignant tumor invasion and metastasis. siRNA of calpains also significantly inhibited the secretion of MMP-2 in Saos-2 cells. These results suggest that mu- and m-calpains are important in the invasion and metastasis of human osteosarcoma cells, and calpains might be targeted to reduce tumor progression.

In vitro model test and preliminary clinical application of a new method of ultrasonographic imaging: Vascular enhancement technology.

Vascular enhancement technology (VET) is a new form of ultrasonographic technology that can optimize images by enhancing the B-mode display with information derived from power Doppler. We designed an in vitro model to evaluate the accuracy and application method of VET and to apply this technology preliminarily in vivo in the vascular periphery. An in vitro model was designed with a flow pump system to simulate blood flow in soft tissue and the intracranial vasculature. Modeling vessels were imaged by traditional B mode, color Doppler flow imaging and VET. The diameter of the various silicon tubes was measured to verify the accuracy of VET. For in vivo application, 15 normal subjects and 26 patients suspected of having carotid artery plaques and cerebrovascular disease were examined using these three image modes. The imaging effects were observed and compared. VET imaging could clarify the lumens of the modeling vessels and reduce artifacts. The caliber of three sizes of silicon tubing was also measured accurately by VET. Of 15 normal subjects, sound artifacts in large vessels were inhibited and the intermedia membrane was clearly displayed by VET. The boundaries of carotid plaques were manifested by VET with well-defined edges. Three cases of hypoechoic soft plaque on the anterior wall missed in B-mode imaging were detected by VET. Intracranial scanning with VET identified cerebral vascular disease, including cerebral stenosis, arteriovenous malformations and aneurysms. The size and shape of the focus displayed by VET coincided with that observed using digital subtraction arteriography. VET is helpful in improving detection of the boundary of vessels and visualization of the microvasculature.

Evaluation of transcranial color-coded duplex sonography for cerebral artery stenosis or occlusion.

BACKGROUND AND PURPOSE: Cerebral artery stenosis or occlusion is the most common etiological factor in patients with acute cerebral ischemia, but the rate of early diagnosis is low. The purpose of the study is to evaluate the diagnostic accuracy of transcranial color-coded sonography (TCCS) for cerebral artery stenosis with digital subtraction angiography used as the gold standard of reference. METHODS: Seventy-eight patients who were suspected of cerebrovascular disease were involved in the study. Major cerebral arteries were observed through the transcranial echo window by TCCS. The course, shape of the color blood beam and velocity were given special attention. The hemodynamic parameter was measured and analyzed. The findings of TCCS were compared with the results of digital subtraction angiography, according to a double-blind design. A 4-fold table was used as the statistical analysis method to evaluate TCCS. The indexes included sensitivity, specificity, accuracy and false-positive rate. RESULTS: Imaging of TCCS revealed that the blood flow beam narrowed where the artery had stenosis and looked like girdling. The velocity of the foci increased abnormally, while the velocity before and after the foci decreased. Severe stenosis and the long stenotic segment may show discontinuity of the blood flow beam. The velocity of the foci did not noticeably increase or decrease. The blood flow beam of the occlusive artery cannot be seen and the frequency spectrum cannot be obtained, but the other artery was well visualized at the same time. Analysis of the diagnostic value of TCCS according to the 4-fold table included the validity index, with a sensitivity, specificity, false-positive rate, false-negative rate, accuracy, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and Youden index of 72.9%, 82.9%, 17.1%, 27.0%, 78.2%, 79.4%, 77.3%, 4.3, 0.3 and 0.56, respectively. The reliability index included the agreement rate and kappa value, which were 78.2% and 0.56, respectively. CONCLUSIONS: TCCS could be considered a valuable method for the screening diagnosis of cerebral artery stenosis or occlusion.

Effects of bone cement particles on the function of pseudocapsule-derived fibroblasts.

BACKGROUND: Despite the wide clinical use of bone cement, little is known about cellular responses to the debris from this material. We thus investigated the effects of bone cement particles on the secretion of soluble osteotropic factors in prosthetic pseudomembrane-derived fibroblasts. METHODS: Bone cement particles were added to fibroblasts maintained in tissue culture. The secretions of soluble receptor activator for nuclear factor kappa B ligand and osteoprotegerin together with interleukin-6 and tumor necrosis factor-alpha were assessed by enzyme-linked immunosorbent assays. The fibroblasts were also co-cultured with osteoclast precursors in the presence and absence of particles, and we assessed osteoclast formation and bone resorption. RESULTS: The particles produced an increase in the secretion of soluble receptor activator for nuclear factor kappa B ligand, interleukin-6 and tumor necrosis factor-alpha, but not osteoprotegerin. At a concentration of 88 particles/cell, bone cement particles yielded a 2-fold increase (327 pg/mL) in soluble receptor activator for nuclear factor kappa B ligand secretion, a 5-fold (239 pg/mL) increase in interleukin-6 secretion and 4-fold (129 pg/mL) increase in tumor necrosis factor-alpha secretion. The particles also enhanced bone resorption in the co-culture group. Both the increase in soluble receptor activator for nuclear factor kappa B ligand secretion and the increase in bone resorption were inhibited by the addition of neutralizing antibodies to the proinflammatory cytokines. INTERPRETATION: Our findings show that bone cement particles are capable of stimulating the secretion of soluble receptor activator for nuclear factor kappa B ligand in pseudocapsule-derived fibroblasts by increasing the secretion of proinflammatory cytokines, and may also promote implant loosening.