Feasibility of anterior pedicle screw fixation in lumbosacral spine: a radiographic and cadaveric study.

BACKGROUND: The anterior pedicle screw (APS) technique for L5 and S1 is crucial for proper anterior lumbar interbody fusion (ALIF). This study aimed to determine the projection, screw trajectory angle, and bone screw passageway length (BSPL), as well as the screw insertion regularity and the operating area within which it is safe to perform insertion. METHODS: Forty patients with low back pain, all of whom had lumbar computed tomography scans available, was included in this retrospective analysis. Radiographic parameters were measured, including: the distances from the projection to the upper endplate, lower endplate, and midline; the transverse and sagittal screw angles; and the BSPL. In addition, 10 fresh adult cadaveric lumbosacral spine segments were selected to determine the safe anatomic area in which to operate. Finally, APSs were inserted in L5 and S1 to determine the regularity of APS insertion. RESULTS: We measured the anterior projection parameters, including: the distances to the upper endplate (L5: 12.5±1.3 mm; S1: 4.54±0.87 mm), lower endplate (L5: 17.3±1.6 mm), and midline (L5: 6.6±0.7 mm; S1: 6.6±0.6 mm); the screw trajectory angle, including the transverse screw angle (L5: 25.3±2.8°; S1: 25.7±2.6°), sagittal screw angle (L5: 17.1±1.7°; S1: 22.4±1.1°); and the BSPL (L5: 48.6±3.5 mm; S1: 48.0±3.5 mm). The regularity of APS insertion in L5 and S1 was determined. Upon the needle reaching a point in the lateral view, it reached the corresponding point in the anteroposterior (AP) view. The anatomic parameters of the safe operating area were as follows: the distance from the abdominal aortic bifurcation to the L5 lower edge (40.50±9.40 mm); the distance from the common iliac vein confluence to the L5 lower edge (27.80±8.60 mm); and the horizontal distance from the inner edge of the common iliac vein to the L5 lower edge (37.50±1.30 mm). We also determined the distance between S1 holes (29.30±1.30 mm), the L5/S1 intervertebral height (17.20±1.50 mm), and the safe operating area (2,058.20±84.30 mm2). CONCLUSIONS: This study has determined the projection, screw trajectory angle, and BSPL of APSs in L5 and S1, their insertion regularity, and the area in which the operation can be safely performed.

[Current advances in research of semaphorin 3A:a potential target for the treatment of nospecific low back pain].

Nonspecific low back pain is closely associated with afferent nerve ingrowth into degenerated IVDs and increasing the inflammatory response. Members of the class 3 semaphorins signal their response through two prominent receptors; the NRP (Neuropilin-1) and the Plexin A. Sema3A (Semaphorin3A) is primarily known for their role in modulating neuronal survival as well as neurite outgrowth and guidance via regulation of Sema3A-NRP-1-plexinA signal pathway. Also, sema3A is shown to be conductive to innervate the inner painful degenerated IVDs (Intervertebral discs). Furthermore, sema3A is thought to act as a barrier to endothelial cells survival and migration on vascular endothelial growth factor (VEGF) and inhibition of KLF5-induced (Krüppel-like factor 5) inflammatory mediators within degenerated IVDs. Therefore, Sema3A produce a new perspective of dual-action therapeutic agent for attenuating the regulator of innervation and angiogenesis into degenerated IVDs and inhibition of KLF5-induced inflammation.

Appropriate insertion point for percutaneous pedicle screw placement in the lumbar spine using c-arm fluoroscopy: a cadaveric study.

BACKGROUND: We studied the characteristics and regularity of appropriate insertion points for percutaneous pedicle screw placement in the lumbar spine using C-arm X-ray fluoroscopy. The purpose of this study was to improve the accuracy of percutaneous pedicle screw placement and reduce the incidence of superior-level facet joint violation. METHODS: Six normal spinal specimens were included. Three different methods for placing percutaneous pedicle screws in the lumbar spine were applied, including the Roy-Camille method, Magerl method and Weinstein method. The relationships among the insertion point, pedicle projection and proximal facet joint on C-arm X-ray films were studied. The projection morphology of the vertebral pedicle in different segments of the lumbar spine was observed. The relationship between the outer edge of the pedicle projection and the outer edge of the cranial articular process was also studied. The distance between the insertion point and the facet joint (M1), the distance between the insertion point and outer edge of the cranial articular process (M2), and the distance between the insertion point and the projection center of the pedicle (M) were measured. RESULTS: In this study, we found that the projection shape of the vertebral pedicle differed across segments of the lumbar spine: the shape for L1-L3 was oval, and that for L4-L5 was round. The radiographic study showed that the outer edge of the cranial articular process was located on the lateral side of the outer edge of the pedicle projection and did not overlap with the pedicle projection. M for the Weinstein group was larger than that for the Roy-Camille group (P <  0.05). M1 for the Weinstein group was larger than that for the Roy-Camille and Magerl groups (P <  0.05). M2 for the Roy-Camille group was negative, M2 for the Magerl group was 0, and M2 for the Weinstein group was positive. CONCLUSION: Under C-arm X-ray fluoroscopy, we were able to accurately identify the characteristics and regularity of the appropriate insertion point for percutaneous pedicle screw placement in the lumbar spine, which was important for improving the accuracy of percutaneous pedicle screw placement and reducing the incidence of superior-level facet joint violation.

Iliac Bone Harvesting Techniques for Bone Reconstruction. Comparative Study Between Tricortical Bone Harvesting vs Trapdoor Technique.

OBJECTIVE: To investigate the effects of trapdoor-procedure-based bone harvesting and tricortical iliac bone harvesting on the iliac bone-graft donor site pain experienced by patients and their clinical effects. METHODS: A retrospective analysis was performed using the clinical data of 65 patients with tibial plateau fractures who received autologous iliac bone-supporting grafts in two hospitals between January 2014 and January 2019. The patients who received trapdoor-procedure-based bone harvesting (34 cases) were in the experimental group, and those who received tricortical iliac bone harvesting (31 cases) were in the control group. This study compared differences in iliac bone-graft donor site incision length, intraoperative blood loss, amount of bones harvested, operation time, and postoperative complications between the two bone-harvesting methods. Subsequently, it evaluated the pain experienced by the two patient groups in their iliac bone-graft donor sites and their clinical effects. RESULTS: One week after surgery, the differences between the iliac bone-graft donor site pain score (measured using SF-MPQ-2) of the experimental group and the control group were not statistically different. However, 3 weeks, 5 weeks, and 3 months after surgery, the iliac bone-graft donor site pain scores of the experimental group were significantly lower than those of the control group. The iliac bone-graft donor site incision length and operation time of the experimental group were not significantly different from those of the control group. However, the iliac bone-graft donor site intraoperative blood loss, amount of bones harvested and the incidence of complications of the experimental group were significantly lower than those of the control group. CONCLUSION: Trapdoor-procedure-based bone harvesting has lower donor site pain, intraoperative blood loss, and postoperative complications. However, for bone grafting in regions with significant bone loss, tricortical iliac bone harvesting remains the optimal option.

Multimodal Nutritional Management in Primary Lumbar Spine Surgery: A Randomized Controlled Trial.

STUDY DESIGN: A prospective randomized controlled trial. OBJECTIVE: The purpose of this study was to evaluate the clinical effect and safety of a new multimodal nutritional management (MNM) protocol for patients receiving primary lumbar spine surgery. SUMMARY OF BACKGROUND DATA: Poor nutritional status is common in the perioperative period in primary lumbar spine surgery, and may impede recovery after surgery. METHODS: A total of 187 patients were included in this prospective randomized controlled trial. They were randomly assigned to the MNM group or the control group. Albumin (ALB) infusion, postoperative ALB level, electrolyte disorders, postoperative electrolyte levels, transfusion rate, postoperative hemoglobin level, length of stay (LOS), and complications were compared between the groups. RESULTS: Compared with the control group, the rate and the total amount of ALB infusion were lower in the MNM group, and the postoperative level of ALB in the MNM group was higher on the first postoperative day, and the third postoperative day. The incidence of hypokalemia, hyponatremia, and hypocalcemia were lower in the MNM group. In the MNM group, the postoperative levels of sodium, potassium, and calcium were higher than the control group. The transfusion rate was similar between the two groups. The hemoglobin level was similar between the two groups on first postoperative day, but was higher in the MNM group on third postoperative day. LOS in the MNM group was shorter than in the control group. The incidence of wound drainage was lower in the MNM group. No statistical differences were observed regarding surgical complications between the two groups. CONCLUSION: The MNM protocol effectively reduced ALB infusion, the incidence of electrolyte disorders, and wound drainage, increased the postoperative levels of ALB, sodium, potassium, and calcium, and reduced the LOS without increasing the rate of postoperative complications. LEVEL OF EVIDENCE: 2.

[Analysis of correlative factors of spinal cord posterior displacement after single door laminoplasty].

OBJECTIVE: To observe the open angle (OA), cervical curvature angle (CA), preoperative spinal cord compression rate(PSCR), postoperative spinal cord shift (PSCS) in patients with chronic compressive cervical myelopathy undergoing C3-7 single open laminoplasty, and to explore the possible mechanism and influencing factors of postoperative average spinal cord drift, so as to provide objective basis for predicting PSCS. METHODS: From May 2012 to July 2016, 32 patients with multi-segmental chronic compressive cervical myelopathy who underwent single-door laminoplasty in our department were analyzed retrospectively, including 14 cases of cervical spondylotic myelopathy, 8 cases of developmental cervical spinal stenosis with cervical myelopathy, and 10 cases of ossification of posterior longitudinal ligament. The OA of cervical spine was measured on CT, the CA was measured on X-ray, the PSCR and PSCS were measured on MRI. The patients were divided into two groups according to PSCS(group A>=2.5 mm, group B<2.5 mm). In the group A, there were 11 males and 6 females, with an average age of (56.58±9.80) years old, a mean course of the disease of (23.52±7.86) months; while in group B, there were 6 males and 9 females, with an average age of (58.46±12.53) years old, a mean course of disease of (21.13±7.75) months. The correlation analysis between PSCS and OA, CA and PSCR was performed, and multiple linear analysis of correlated parameters was carried out. RESULTS: The OA in group A was (40.47±9.45) °, in group B was (27.84±5.67) °. The OA in group A was higher than that in group B (P<0.01), and OA was moderately correlated with PSCS (r=0.794, P=0.000). The CA was(11.56± 4.99) ° in group A and(6.64±3.28) ° in group B . The CA in group A was higher than that in group B (P<0.01), and CA was moderately correlated with PSCS (r=0.632, P=0.000). The PSCR was (27.70±2.92) % in group A , was (24.59±2.80) % in group B . The PSCR in group A was higher than that in group B(P<0.01), PSCR was moderately correlated with PSCS(r=0.667, P=0.000). The CA dependent variable was kicked out(P>0.1), and the partial regression coefficients of OA and PSCR were 0.113 and 0.059 respectively. CONCLUSIONS: PSCS is the result of OA, CA and PSCR, among which PSCR has the most important influence, OA is the second, CA is the least. PSCS can be predicted by 0.059×OA+0.113×PSCR-2.266 equation, which provides a theoretical basis for preoperative evaluation of spinal cord decompression after surgery.

[Analysis of influencing factors the postoperative axial symptoms of cervical single open-door laminoplasty].

OBJECTIVE: To explore the influencing factors and possible mechanism of axial symptoms(AS) after C3-C7 single open-door laminoplasty in patients with chronic compression cervical myelopathy. METHODS: The clinical data of 32 patients with multi-segment chronic compression cervical cord disease treated by C3-C7 single open-door laminectomy from May 2012 to July 2016 were retrospectively analyzed. Including cervical spondylotic myelopathy of 14 cases, developmental cervical stenosis complicated with cervical myelopathy of 8 cases, ossification of posterior longitudinal ligament(OPLL) of 10 cases. There were 17 males and 15 females, aged from 47 to 82 years old with an average of 57.46 year, the course of disease was 5 to 35 months with an average of 22.4 months. The opening angle(OA), cervical curvature angle(CA), preoperative spinal cord compression rate(PSCR) and postoperative spinal cord shift (PSCS) were recorded. After 2 weeks of surgery, determining whether occurred an AS condition according to the AS assessment criteria, the patients were divided into a axial symptom group and a non-axial symptom group, the general data and imaging parameters of the two groups were compared and the factors that may be postoperative AS were analyzed by binary Logistic regression analysis. RESULTS: At 2 weeks after operation, 13 patients occurred AS. There was no significant difference in gender, age and course of disease between axial symptom group and a non-axial symptom group (P>0.05). In axial symptom group, OA was(36.76±9.35)°, CA was(11.53±4.36)°, PSCR was(27.83±1.72)%, PSCS was (3.17±0.81) mm, while in non-axial symptom group, above items were (33.03±10.52)°, (7.71±4.73)°, (25.16±3.59)%, (2.43±0.95) mm, respectively, there was significant difference in CA, PSCR, PSCS between two groups(P<0.05), and there was no significant difference in OA between two groups(P>0.05). The results of the binary Logistic regression analysis of 3 parameters(OA, PSCR, PSCS) and AS showed OA and PSCR were eliminated in dependent variables, and the partial regression coefficient of PSCR was 0.311, and P=0.031. CONCLUSIONS: CA, PSCR, and PSCS are related influencing factors of AS, and PSCS is a high risk factor for AS. C4,5 nerve traction caused by posterior spinal movement, postoperative dural self-expansion causes greater traction of the spinal cord, excessive deformation of the cervical spinal cord causes autonomic nerve damage or necrosis that dominates blood vessels may be the pathogenesis of AS, but this is only a theoretical inference, and further improved experiment is necessary to verify it in the future.

[Comparison of clinical effects between anterior cervical discectomy combined with corpectomy and cervical posterior single open-door laminoplasty in treating three-segment cervical spondylotic myelopathy].

OBJECTIVE: To compare the clinical effects between anterior cervical discectomy and fusion(ACDF) combined with anterior cervical corpectomy and fusion(ACCF) and cervical posterior single open-door laminoplasty with mini-titanium plate fixation in treating three-segment cervical spondylotic myelopathy. METHODS: The clinical data of 63 patients (39 males and 24 females) with three-segment cervical spondylotic myelopathy underwent surgical treatment from March 2014 to March 2016 were retrospectively analyzed. Among them, 43 cases were treated by ACDF combined with ACCF(anterior group), and 20 cases were treated by cervical posterior single open-door laminoplasty with mini-titanium plate fixation(posterior group). Operative time, intraoperative blood loss, postoperative complications were compared between two groups. And according to JOA score to evaluate the clinical effect. RESULTS: All the patients were follow-up from 16 to 40 months with an average of 25.8 months. Operative time of anterior group and posterior group were (123.70±6.21) min and(118.70±5.41) min, respectively, there was no significant difference between two groups(P>0.05). Intraoperative blood loss of anterior group and posterior group were (85.23±7.51) ml and (107.18±9.41) ml, respectively, there was significant difference between two groups(P<0.05). In anterior group, axial symptoms occurred in 6 cases, dysphagia in 1 case, and no C5 nerve root palsy, hoarseness and choking cough were found, the incidence rate of complication was 16.3%(7/43); and in posterior group, axial symptoms occurred in 5 cases, C5 nerve root palsy in 1 case, and no dysphagia, hoarseness and choking cough were found, the incidence rate of complication was 30.0%(6/20); there was significant defference in incidence rate of complication between two group(P<0.05). At 1 week after operation and final follow-up, the JOA scores of anterior group were obviously better than that of posterior group(P<0.05). CONCLUSIONS: Above-mintioned two surgical treatment for cervical spondylotic myelopathy can provide instantly stability, the method of ACDF combined with ACCF was obviously better that of the method of cervical posterior single open-door laminoplasty in intraoperative blood loss, the incidence rate of complications, clinical effect.Thus, for the treatment of three-segment cervical spondylotic myelopathy, the method of ACDF combined with ACCF would be firstly chosen.

[Current advances on surgical treatment for knee articular cartilage injuries].

Chondral injuries are short of self-healing ability and need to surgical repair after articular cartilage injury. Conventional treatment includes debridement and drainage under arthroscope, micro-fracture, osteochondral autograft transplantation (OATS), mosaiplasty and osteochondral allografts (OCA), autologous chondrocyte implantation (ACI). Debridement and drainage could remove pain factor, and has advantages of simple operation, wide clinical application and early clinical effect. Micro-fracture and osteochondral autograft transplantation is suitable for small area of cartilage repair, while the further effect showed that fibrous cartilage permeated by drill could decrease postoperative clinical effect. Osteochondral autograft transplantation has better advantages for reconstruction complete of wear-bearing joint. Autologous chondrocyte implantation and allogeneic cartilage transplantation are suitable for large area of cartilage defect, postoperative survival of allogeneic cartilage transplantation is effected by local rejection reaction and decrease further clinical effect. Cartilage tissue engineering technology could improve repair quality of autologous chondrocyte implantation, and make repair tissue close to transparent cartilage, but has limit to combined subchondral bone plate, reactive bone edema, bone loss and bad axis of lower limb. New technology is applied to cartilage injury, and has advantages of less trauma, simple operation, rapid recover, good clinical effect and less cost;and could be main method for treat cartilage injury with surgical repair technology. How to improve repair quality with compression resistance and abrasive resistance are expected to be solved.

Application of different patella height indices in patients undergoing total knee arthroplasty.

BACKGROUND: One complication of total knee arthroplasty (TKA) is patella baja (PB). Patellar tendon shortening and joint line elevation are two main causes of PB. The purpose of this study was to determine the incidence of PB before and after TKA by measuring the patellar height and provide evidence for choosing a suitable index. METHODS: In total, 256 consecutive patients who underwent primary TKA were included in this study. Radiographic measurements were performed; the Insall-Salvati (IS) index, modified IS (MIS) index, Blackburne-Peel (BP) index, and Caton-Deschamps (CD) index were computed; and the incidence of PB was calculated before and after the operation. The consistency between the IS and MIS indices and between the BP and CD indices was analyzed. RESULTS: The preoperative incidence of true PB (TPB) and pseudo-PB (PPB) was 9.4 and 0.8%, respectively. The postoperative incidence of TPB and PPB was 10.2 and 9.0%, respectively. The consistency between the IS and MIS indices was moderate preoperatively (pre-kappa = 0.602) and postoperatively (post-kappa = 0.742). The consistency between the BP and CD indices was moderate preoperatively (pre-kappa = 0.742) and good postoperatively (post-kappa = 0.797). CONCLUSION: The incidence of PB, especially PPB, increased after TKA. The CD and BP indices are of greater importance for the diagnosis of PB after TKA. The MIS index is a better choice than the IS index to measure the length of the patellar tendon. To measure the height of the joint line, the BP index is better postoperatively and the CD index is better preoperatively.

A case-control study on the treatment of protrusion of lumbar intervertebral disc through PELD and MED.

We compared the clinical effects between the percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED) treatments for protrusion of lumbar intervertebral disc. We conducted a retrospective analysis on 60 patients who were diagnosed with single-segment protrusion of lumbar intervertebral disc during the period from January 2009 to June 2016. Patients were divided into two groups, the PELD and MED groups, which contained 30 cases each. We evaluated the operation results according to oswestry dysfunction index (ODI), visual analogue scale (VAS) and the improved MacNab standard. The average follow-up visit period after the operation was 18 months and the operation time of the two groups was not statistically different. The cadaverine quantity of bleeding in the PELD group is less than that in the MED group. Moreover, the average length of incision and the length of stay were shortened for the PELD group compared to the MED group. The ODI and VAS after operation for the two groups improved significantly compared to that before operation (P<0.05). The qualified rates of the PELD and MED groups were 93.0 and 90.0%, respectively, as of the improved MacNab method. The complication occurrence rates for the two groups during perioperative period were not different. Therefore, the short-term efficacy of the two minimally invasive operation methods (PELD and MED) on the treatment of protrusion of lumbar intervertebral disc is satisfactory. In cases where operation indications are chosen strictly, PELD can be regarded as a method of safety and efficiency due to the advantages of minimal incision, less bleeding, minimal trauma and faster postoperative recovery.

The efficacy and safety of using a bipolar sealer to prevent blood loss in spine surgery: A meta-analysis.

OBJECTIVE: The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) and non-RCTs was to evaluate the effect of using a bipolar sealer to prevent surgical bleeding in spine surgery. METHODS: In June 2017, the PubMed, Embase, Cochrane controlled trials register, Web of Science, Google, and Chinese Wanfang databases were used to identify RCTs and non-RCTs comparing the effects of intraoperative placement of a bipolar sealer versus standard electrocautery with regard to blood loss and blood transfusion. Stata 12.0 software was used to perform the meta-analysis. Weighted mean differences with 95% confidential intervals (CIs) were used for continuous outcomes, and relative risks with 95% CIs were used for discontinuous outcomes. After testing for publication bias and heterogeneity across studies, the data were aggregated and assessed with a random effects model when necessary. RESULTS: In total, 6 clinical trials with 560 patients were included in this meta-analysis. The pooled results indicated that the use of a bipolar sealer decreased the estimated blood loss (MD = -165.06, 95% CI -236.73 to -93.40, P < 0.001), the need for a blood transfusion (RR = 0.46, 95% CI 0.31 to 0.68, P < 0.001), the transfusion units used (MD = -0.41, 95% CI -0.60 to -0.21, P < 0.001), the operative time (MD = -12.98, 95% CI -21.82 to -4.15, P = 0.004) and the length of hospital stay (MD = -2.77, 95% CI -5.45 to -0.10, P = 0.042). No significant difference was observed for the occurrence of infection (RR = 0.52, 95% CI 0.19 to 1.39, P = 0.192). CONCLUSION: Based on the current meta-analysis, the use of a bipolar sealer is superior to standard electrocautery for reducing intraoperative blood loss and is therefore recommend for use during spine surgery.

Differentiating Primary Central Nervous System Lymphomas From Glioblastomas and Inflammatory Demyelinating Pseudotumor Using Relative Minimum Apparent Diffusion Coefficients.

OBJECTIVE: Our purpose was to evaluate the diagnostic performance of diffusion-weighted imaging, the relative minimum apparent diffusion coefficient (rADCmin) in differentiating primary central nervous system lymphomas (PCNSLs) from glioblastomas (GBMs) and inflammatory demyelinating pseudotumors (IDPs). MATERIALS AND METHODS: Magnetic resonance images were reviewed retrospectively in 82 patients including 39 PCNSLs, 35 GBMs, and 8 IDPs. Regions of interest were drawn around the tumor on contrast-enhanced axial images; these images were transferred onto coregistered ADC maps to obtain the ADCmin, and the normalized ADCmin ratios (rADCmin) were calculated using the formula rADCmin = ADCmin of the lesion / ADCmin of the normal white matter. The rADCmin values were compared between PCNSLs, GBMs, and IDPs using the analysis of variance test. Receiver operating characteristic curves were constructed to evaluate the diagnostic performance of rADCmin values and to determine the optimum thresholds. Simple logistic regression was analyzed to evaluate the relationship between ADCs and tumor cellularity. RESULTS: The rADCmin value was significantly lower in PCNSLs (0.675 ± 0.113) than GBMs (0.765 ± 0.059) and IDPs (0.834 ± 0.067) (PCNSL vs GBM, P < 0.001; PCNSL vs IDP, P < 0.001). Relative ADCmin was a significant assessor for differentiating PCNSLs from non-PCNCLs (P < 0.001). The optimal cutoff value was 0.722 (sensitivity, 74.5%; specificity, 74.1%; area under the curve, 0.803) on receiver operating characteristic analysis. A stronger negative correlation (r = -0.755, P = 0.000) was obtained between the cytoplasm and rADCmin. CONCLUSIONS: Relative ADCmin value is helpful in differentiating PCNSL from GBM and IDP. Thus, ADC values may provide a useful supplement to the information obtained from conventional contrast-enhanced magnetic resonance imaging and assist in future treatment planning.

Liposomal bupivacaine versus traditional bupivacaine for pain control after total hip arthroplasty: A meta-analysis.

BACKGROUND: In the past, the efficacy of local infiltration of liposomal bupivacaine for total hip arthroplasty (THA) patients was in debate. Therefore, this meta-analysis was conducted to determine whether local infiltration of liposomal bupivacaine provides better pain relief after THA. METHODS: We searched Web of Science, PubMed, Embase, and the Cochrane Library databases to the April 2017. Any studies comparing liposomal bupivacaine and traditional bupivacaine were included in our meta-analysis. The outcomes included visual analog scale (VAS) at 24, 48, and 72 hours, total morphine consumption at 24 hours, and the length of hospital stay. We assessed the pooled data using a random-effect model. RESULTS: Six studies were finally included in this meta-analysis. Our pooled data analysis demonstrated that liposomal bupivacaine was more effective than the traditional bupivacaine in terms of VAS at 24 hours (P  =  .018) and the length of hospital stay (P  =  .000). There was no significant difference in terms of the VAS at 48 and 72 hours and total morphine consumption at 24 hours (P >.05). CONCLUSION: Compared with the traditional bupivacaine, liposomal bupivacaine shows better pain control at 24 hours and reduces the length of hospital stay after THA. Its economic costs must be assessed in multimodal center randomized controlled trials when being recommended as a long-acting alternative analgesic agent for a THA patient.

[Treatment of posterior cruciate ligament avulsion fracture with rivet-assisted hollow nail:a case-control study].

OBJECTIVE: To retrospectively investigate the clinical effect of the rivet-assisted hollow screw in the treatment of posterior cruciate ligament avulsion fracture. METHODS: Total 49 patients with knee cruciate ligament avulsion fracture in the ending point of the ligament from January 2010 to December 2014 were divided into the treatment group and the control group. Thirty-one patients in treatment group were treated with rivet-assisted double cannulate nail, including 13 males and 18 females, ranging in age from 38 to 51 years old, with a mean of (40.6±5.1) years old; according to Meyers classification, 23 cases of type 2, 8 cases of type 3; 5 patients were caused by the low energy injury and 26 patients were caused by the high energy injury. Eighteen patients in control group were treated with double gold hollow screw fixation, including 5 males and 13 females, ranging in age from 36 to 52 years old, with an average age of (4.16±4.7) years old; according to Meyers classification, 14 cases of type 2 and 4 cases of type 3;2 patients were caused by the low energy injury and 16 patients were caused by the high energy injury. The operation time, postoperative complications, fracture healing time and the last AKS scoring system were compared between the two groups. RESULTS: All the patients were followed up, and the duration ranged from 12 to 24 months, with an average of 14.2 months. The patients in treatment group had no displacement of fracture fragments and internal fixation failure. The results of AKS score:pain was 48.1±1.5, activity was 21.3±2.7, stability was 20.9±2.5, walking ability was 47.3±1.9, under the stairs ability was 43.4±2.1, the total score was 190.7±2.9. There were 2 cases in control group had fracture fragment displacement and 1 patient had nail withdraw. The results of AKS score:pain was 40.1±2.2, activity was 20.1±0.2, stability was 18.1±3.2, walking ability was 46.3±1.7, under the stairs ability was 40.2 ±1.3, the total score was 180.2±1.4. Therefore, the comparison of the above indicators, the results of the treatment group were better than those of the control group. CONCLUSIONS: Rivet-assisted hollow screw fixation in the treatment of cruciate ligament avulsion fracture in the ending, has some advantages such as follows:accurate reduction, less postoperative complications and better postoperative knee function recovery, therefore it is an effective way to treat posterior cruciate ligament avulsion fracture.

[Case-control study on InterTan intramedullary nail in treating coronal femoral intertrochanteric fracture in elderly].

OBJECTIVE: To compare clinical effect of closed reduction and limited open reduction and internal fixation with InterTan intramedullary nail in treating elderly patients with coronal femoral intertrochanteric fracture. METHODS: From January 2013 to December 2015, 23 elderly patients with coronal femoral intertrochanteric fracture were divided into two groups according to different ways of reduction to be retrospectively analyzed. There were 12 cases with closed reduction and internal fixation with InterTan intramedullary nail group (closed reduction group), including 7 males and 5 females with an average age of(63.6±12.1) years old; while 11 cases with limited open reduction and internal fixation with InterTan intramedullary nail group(limited reduction group), including 6 males and 5 females with an average of (60.8±12.5) years old. Intraoperative blood loss, fluoroscopy, operative time, postoperative complications, hospital stays and bone healing time were observed and compared. Harris score of hip joint at 1 year after operation was compared between two groups. RESULTS: The incisions between two groups were healed well at stage I, and no complications occurred. One case was died during following-up, and 22 cases were obtained following-up from 12 to 23 months with an average of 13.6 months. There were significant difference in operative time, intraoperative blood loss and fluoroscopy(P<0.05); while no difference in hospital stays, postoperative complications(P>0.05). Harris score at 1 year after operation in open reduction group was(83.9±8.9), and(83.4±9.1) in closed reduction group without significant difference between two groups(P>0.05). CONCLUSIONS: Closed reduction and limited open reduction with InterTan intramedullary nail internal fixation for the treatment of intertrochanteric femoral coronal fractures could achieve good clinical effects, the former to receive more radiation dose, with less trauma;while the latter has disadvantages of long blood bleeding and operative time, but could obtain high quality of reduction.

[Delayed lower extremity deep venous thrombosis after operation for osteofibrous dysplasia of the left femur: report of one case].

Lower extremity deep venous thrombosis (LDVT) is one of the most common complications in orthopedic surgery, and it often occurs in the first 24 h after operation. We report a case of delayed LDVT, which occurred on d 16 after operation for osteofibrous dysplasia on the left femur. Upon the diagnosis confirmed, thrombolysis and anticoagulation therapy was conducted. The symptoms disappeared 3 weeks later and lower limb vascular ultrasound examination showed no remnant thrombosis.

[Case-control study on needle-knife to cut off the medial branch of the lumbar posterior ramus under C-arm guiding for the treatment of low back pain caused by lumbar facet osteoarthritis].

OBJECTIVE: To study the clinical efficacy of needle-knife to cut off the medial branch of the lumbar posterior ramus under C-arm guiding to treat low back pain caused by lumbar facet osteoarthritis. METHODS: From July 2009 to June 2011, 60 patients with low back pain caused by lumbar facet osteoarthritis were reviewed,including 34 males and 26 females, ranging in age from 39 to 73 years old,averaged 61.9 years old; the duration of the disease ranged from 6 to 120 months, with a mean of 18.9 months. All the patients were divided into two groups, 30 patients (18 males and 12 females, ranging in age from 39 to 71 years old, needle-knife group) were treated with needle-knife to cut off medial branch of the lumbar posterior ramus under C -arm guiding and the other 30 patients(16 males and 14 females, ranging in age from 41 to 73 years old, hormone injection group) were treated with hormone injection in lumbar facet joint under C-arm guiding. The preoperative JOA scores and the scores at the 1st, 12th and 26th weeks after treatment were analyzed. RESULTS: Before treatment,the JOA scores between the two groups had no significant difference (P= 0.479); after 1 week of treatment, the JOA scores between the two groups had significant difference (P= 0.040), the improvement rate of hormone injection group was superior than that of the needle-knife group,which were (58.73+/-18.20)% in needle-knife group and (71.10+/-22.19)% in hormone injection group; after 12 weeks of treatment, the JOA scores between the two groups had no significant difference(P=0.569), and the improvement rate between the two groups had no significant difference,which were (50.09+/-19.33)% in the needle-knife group and (48.70+/-18.36)%) in the hormone injection group; after 26 weeks of treatment,the JOA scores between the two groups had significant difference (P=0.000), the improvement rate of hormone injection group was superior than that of the needle-knife group,which were (48.56+/-28.24)% in needle-knife group and (15.62+/-11.23 )% in hormone injection group. CONCLUSION: Using needle-knife to cut off the medial branch of the lumbar posterior ramus could get longer efficacy than hormone injection in the treatment of lumbar facet osteoarthritis.