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    26 March 2015, Volume 19 Issue 13 Previous Issue    Next Issue
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    Four risk factors of deep venous thrombosis in lower limbs after total hip arthroplasty
    Zhang Sheng, Xie Xiao-chen, Yao Yue-feng, Wei Liang-chen
    2015, 19 (13):  1969-1973.  doi: 10.3969/j.issn.2095-4344.2015.13.001
    Abstract ( 328 )   PDF (689KB) ( 557 )   Save

    BACKGROUND: Deep venous thrombosis is one of the most common and dangerous complication. There will be serious consequences for failing to prevent deep venous thrombosis in advance, so we need to evaluate the risk factors of deep venous thrombosis.
    OBJECTIVE: To evaluate the clinical risk factors for lower limb deep vein thrombosis after total hip arthroplasty.
    METHODS: Data of 162 patients who were treated from January 2010 to February 2013 in Department of Bone and Joint Surgery, Shenzhen Hospital of Peking University for total hip arthroplasty were analyzed retrospectively. All patients received ultrasonography on deep veins of lower limb preoperatively and postoperatively 3 and 7 days. Risk factors of deep venous thrombosis were analyzed using Logistic regression analysis in patients undergoing total hip arthroplasty.
    RESULTS AND CONCLUSION: The selected factors for Logistic regression model contained bone cement prosthesis, age distribution, body mass index, and general anesthesia. Their OR values were 9.215, 11.247, 3.842, 4.825, respectively. They were risk factors for the occurrence of deep venous thrombosis. Above results indicated that use of bone cement prosthesis, age, body mass index > 25 kg/m2 and general anesthesia are risk factors for deep venous thrombosis after total hip replacement, so they should cause clinical attention and we should take active measures to prevent them.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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    Hidden blood loss after primary total hip arthroplasty: analysis of influential factors
    Xu Hai-yong, Zhang Ming, Fang Huai-xi, Le Guo-ping
    2015, 19 (13):  1974-1978.  doi: 10.3969/j.issn.2095-4344.2015.13.002
    Abstract ( 198 )   PDF (589KB) ( 409 )   Save

    BACKGROUND: The hidden blood loss, accounted for a fairly large proportion of perioperative blood loss in total hip replacement, can seriously affect the recovery of postoperative joint function, but the specific influential factors and mechanisms remain unknown at present.
    OBJECTIVE: To evaluate the relative influential factors for hidden blood loss after primary total hip arthroplasty by the blood loss condition, and to analyze the association between hidden blood loss and prognosis.
    METHODS: Clinical data of 110 patients who underwent primary total hip arthroplasty in the Liuzhou Worker’s Hospital between April 2011 and April 2013 were retrospectively analyzed. The hidden blood loss was calculated according to Ward and Gross formula. The effects of patient’s gender, age, body mass index, type of prosthesis, presence of internal diseases, and different causes of a disease on hidden blood loss after arthroplasty were analyzed. The patients were divided into the high blood loss group (≥ 480 mL) and the low blood loss group (< 480 mL) according to the hidden blood loss. All the patients were followed up for 1 year. The Harris hip score system was used to assess the recovery of hip joint function between the two groups. The correlation between hidden blood loss and the recovery of joint function was analyzed using Pearson’s correlation analysis
    RESULTS AND CONCLUSION: The total blood loss of primary total hip arthroplasty was (1 340±367) mL, and the hidden blood loss was (748±324) mL, and the percentage of hidden blood loss was 53.7%. The type of prosthesis, presence of internal diseases, and different causes of a disease were significantly associated with 
    hidden blood loss after total hip arthroplasty (P < 0.05). Gender, age, body mass index, and operation time were not significantly associated with hidden blood loss after total hip arthroplasty (P > 0.05). The hidden blood loss was correlated with postoperative functional recovery (P=0.046). Results indicated that type of prosthesis, presence of internal diseases, and different causes of a disease are main influential factors for hidden blood loss after total hip arthroplasty. The hidden blood loss has some influence on the recovery of postoperative joint function.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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    Comparison of proximal femoral intramedullary nail and hip arthroplasty in the treatment of intertrochanteric fracture
    Li Xian-jun
    2015, 19 (13):  1979-1983.  doi: 10.3969/j.issn.2095-4344.2015.13.003
    Abstract ( 399 )   PDF (672KB) ( 449 )   Save

    BACKGROUND: Intertrochanteric fracture is often found in osteoporotic elderly patients, the commonly used treatment includes intramedullary and extramedullary fixations, and joint replacement.
    OBJECTIVE: To compare the clinical effect of proximal femoral intramedullary nail and hip arthroplasty in the treatment of intertrochanteric fracture.
    METHODS: 198 patients of intertrochanteric fracture recruited from Heze Municipal Hospital from August 2009 to August 2013, were divided into two groups. Each group had 99 patients, receiving proximal femoral intramedullary nail and hip arthroplasty, respectively.
    RESULTS AND CONCLUSION: The average operation time, intraoperative blood loss and hospital stays in the proximal femoral intramedullary nail group were significantly shorter, while the healing time of fracture was significantly longer than that in the hip arthroplasty group. At postoperative 1 year, there was no statistical difference in the Harris score, the excellent and good rate of hip function, and the overall incidence of complications between the two groups. Experimental findings indicate that, both proximal femoral intramedullary nail and hip arthroplasty are biocompatible and effective in the treatment of intertrochanteric fracture, and each technique has their advantages and disadvantages, we should choose the proper technique according to the patient’s condition.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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    Comparison of epidural anesthesia and combined spinal-epidural anesthesia in elderly patients with hip arthroplasty: hemodynamic difference
    Deng Lve-chu, Luo Shao-jin, Zhu Huai-jun
    2015, 19 (13):  1984-1989.  doi: 10.3969/j.issn.2095-4344.2015.13.004
    Abstract ( 339 )   PDF (806KB) ( 422 )   Save

    BACKGROUND: Epidural anesthesia and combined spinal-epidural anesthesia are commonly used approaches for surgical anesthesia in elderly patients, and each has their advantages and disadvantages. Suitable anesthesia approach can stabilize the cycle, reduce the surgical risk and complications, and improve the success rate of treatment.
    OBJECTIVE: To analyze and compare the anesthesia effect of epidural anesthesia and combined spinal-epidural anesthesia in the elderly patients during hip arthroplasty, and explore the effect of different approaches on the on hemodynamics.
    METHODS: 80 elderly patients undergoing hip arthroplasty were randomly divided into experimental group and control group, with 40 cases in each group. The experimental group received combined spinal-epidural anesthesia. The control group received epidural anesthesia. The mean arterial pressure, central venous pressure, and heart rate variability at each time point, sensory and motor block onset and recovery times, each block plane after 30 minutes of anesthesia, Bromage score of motor block, and anesthetic effects in both groups of patients were compared.
    RESULTS AND CONCLUSION: The mean arterial pressure at 5 minutes, 30 minutes of anesthesia and after surgery in the control group was significantly lower than the experimental group at the same time point and before 
    anesthesia (P < 0.05). The heart rate at 5 minutes, 30 minutes of anesthesia and after surgery in the control group was significantly higher than that before anesthesia and the experimental group at the same time point (P < 0.05). The central venous pressure at 5 minutes, 30 minutes of anesthesia and after surgery in the control group was significantly higher than that before anesthesia and the experimental group at the same time point (P < 0.05). Sensory and motor block onset time in the experimental group was significantly shorter, while the sensory and motor block recovery time was significantly higher than the control group (P < 0.01). After patients in the two groups were anesthetized for 30 minutes, each block plane and Bromage score of motor block showed no significant difference (P > 0.05). Anesthetic effect in the experimental group was significantly better than the control group(χ2=5.691 7, P=0.017 0 < 0.05). Compared with epidural anesthesia, the combined spinal-epidural anesthesia can reduce hemodynamic changes in patients with hip replacement surgery, and has better anesthesia effect.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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    Analgesic effect of ropivacaine of lumbar epidural anesthesia in elderly patients for hip and knee arthroplasty
    Wang Yu, Zhu Yun-zhang, Liu Gang
    2015, 19 (13):  1990-1994.  doi: 10.3969/j.issn.2095-4344.2015.13.005
    Abstract ( 262 )   PDF (694KB) ( 596 )   Save

    BACKGROUND: Analgesia in different ways can be selected for the elderly in hip and knee arthroplasty. Considering the actual situation of the elderly patients, choice of anesthesia should be reasonable in order to achieve fast acting, long lasting time and good analgesic effect.
    OBJECTIVE: To explore the analgesic effect of ropivacaine of lumbar epidural anesthesia on elderly knee arthroplasty.
    METHODS: A total of 78 elderly patients aged 80-96 years, who were treated with hip and knee arthroplasty in the Shenyang Orthopaedic Hospital from September 2011 to September 2014, were enrolled in this study. They were equally and randomly assigned to control group and observation group, and separately administered continuous epidural anesthesia and lumbar epidural anesthesia with ropivacaine. The excellent and good rate, onset time, anesthetic induction, frequency of use of Duffing mixture, and adverse reactions were compared between the two groups.
    RESULTS AND CONCLUSION: The excellent and good rate of analgesic effect was higher in the observation group (97%) than in the control group (87%) (P < 0.05). Onset time was significantly shorter, the dose of anesthetic was significantly less, frequency of use of Duffing mixture was significantly less in the observation group than in the control group (P < 0.05). The difference was not significant in adverse reactions between the two groups (P > 0.05). Above results indicated that lumbar epidural anesthesia of ropivacaine obtained good 
    analgesic effects during elderly knee arthroplasty.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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    Concentrations of ropivacaine for analgesia after total hip arthroplasty
    Hu Bei, Chen Bin, Chen Wei, Ji Wei-wei
    2015, 19 (13):  1995-1999.  doi: 10.3969/j.issn.2095-4344.2015.13.006
    Abstract ( 279 )   PDF (658KB) ( 382 )   Save

    BACKGROUND: Severe pain after total hip arthroplasty is an important factor for successful rehabilitation of postoperative joint function. Analgesic method after total hip arthroplasty is a hot issue.
    OBJECTIVE: To investigate the analgesic effect of different concentrations of ropivacaine after total hip arthroplasty.
    METHODS: 69 patients undergoing total hip arthroplasty were recruited from Department of Anesthesiology, Suqian People’s Hospital, from January 2012 to June 2014. According to the ASA classification, their physical status was graded I to III. The involved patients were randomly divided into three groups: 0.25% ropivacaine group, 0.3% ropivacaine group, 0.35% ropivacaine group. Each group had 23 cases. At 30 minutes after the surgery, different concentrations of ropivacaine, 20 mL, were injected to patients due to continuous fascia iliaca compartment block. The catheter was then connected to a patient-controlled analgesia pump programmed to deliver 10 mL with a lockout interval of 60 minutes, for postoperative analgesia (72 hours). At 12, 24, 48 and 72 
    hours of blockade, the visual analogous scale (VAS) scores at rest, passive and active activity were recorded. When VAS score at rest ≥ 4 points, parecoxib sodium 40 mg was injected intravenously. The consumption of ropivacaine within 72 hours after the blockade, application of parecoxib sodium, time of ambulation, and adverse reactions during blockade were recorded. The analgesic effect in the three groups was also observed.
    RESULTS AND CONCLUSION: Compared with 0.25% ropivacaine group, static VAS scores of 0.3% ropivacaine group and 0.35% ropivacaine group showed no significant difference (P > 0.05), passive and active VAS scores were significantly decreased (P < 0.05), and the consumption of ropivacaine within 72 hours after the blockade was significantly decreased. There was no significant difference in the rest, passive and active VAS scores between 0.3% ropivacaine group and 0.35% ropivacaine group (P > 0.05). The ropivacaine consumption of 0.3% ropivacaine group and 0.35% ropivacaine group was not statistically significant (P > 0.05). The usage of parecoxib sodium in 0.3% ropivacaine group and 0.35% ropivacaine group was significantly lower than that in 0.25% ropivacaine group (P < 0.05). Day of first walk was earlier in the 0.3% ropivacaine group and 0.35% ropivacaine group. The incidence of complications among the three groups showed no significant difference (P > 0.05). Experimental findings indicate that, three different concentrations of ropivacaine has certain analgesic effects after total hip arthroplasty with fewer adverse reactions, and the concentration of 0.3% ropivacaine is the suitable concentration for postoperative analgesia of total hip arthroplasty, it can reduce the amount of parecoxib sodium and shorten the day of first walk.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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    Total knee arthroplasty without the patellar replacement: knee function and incidence of anterior knee pain
    Zhu Fei, Chen Yan-xi, Ouyang Gui-lin, Xia Qing
    2015, 19 (13):  2000-2004.  doi: 10.3969/j.issn.2095-4344.2015.13.007
    Abstract ( 257 )   PDF (744KB) ( 691 )   Save

    BACKGROUND: The incidence of patellar complications is decreasing, however, the necessity of patellar replacement remains unclear.
    OBJECTIVE: To investigate the incidence rate of anterior knee pain and postoperative pain score in total knee arthroplasty without the patellar replacement and to provide a reference for the formulation of clinical operation scheme.
    METHODS: 151 patients with 193 knees receiving total knee arthroplasty were involved in this study. All the patients were treated with patellar forming but not resurfacing of the patella. The Western Ontario and McMaster University (WOMAC) Osteoarthritis Index and America Hospital for Special Surgery (HSS) score were used to evaluate patients before surgery and at 6 and 12 months after surgery. The function of knee joint, the incidence rate of anterior knee pain and visual analogous scale score before and after operation were compared.
    RESULTS AND CONCLUSION: After 6 and 12 months of total knee arthroplasty, WOMAC osteoarthritis index was significantly lower and HSS score was significantly higher than those before surgery (P < 0.05). At 12 months 
    post-operation, the incidence rate of anterior knee pain was 11.3%, which was significantly lower than the preoperative rate (94.5%) (P < 0.05). At 12 months post-surgery, visual analogous scale scores were also significantly lower than the preoperative score (P < 0.05). Total knee replacement without resurfacing of the patella can effectively improve knee joint function in knee osteoarthritis or rheumatoid arthritis patients, ameliorate the symptoms of anterior knee pain, has a good clinical effect within short term post-operation. The middle- and long-term effects need further exploration.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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    Continuous femoral nerve block after total knee arthroplasty: ultrasound-guided puncture techniques and needle choice
    Wang Tao, He Kai-hua
    2015, 19 (13):  2005-2010.  doi: 10.3969/j.issn.2095-4344.2015.13.008
    Abstract ( 466 )   PDF (713KB) ( 402 )   Save

    BACKGROUND: Currently the ultrasound-guided continuous femoral nerve block has been widely used as a postoperative analgesia method after knee replacement surgery, but there are still some technical and practical details issues to be studied.
    OBJECTIVE: To evaluate the effect of ultrasound-guided imaging and safety evaluation of different puncture techniques and needle choice in the ultrasound-guided continuous femoral nerve block after total knee arthroplasty.
    METHODS: One hundred and sixty patients undergoing total knee arthroplasty were randomly divided into four groups, with 40 cases in each group. Continuous femoral nerve block was done after general anesthesia induction. Patients in each group were respectively punctured using 20 G needle (diameter 1.1 mm) out-of-plane approach, 20 G needle (diameter 1.1 mm) in-plane approach, 18 G needle (diameter 1.3 mm) out-of-plane approach, and 18 G needle (diameter   1.3 mm) in-plane approach. Patient-controlled analgesia pump was used 30 minutes before the end of surgery. The operating time of continuous femoral nerve block was recorded. The visual analogue scale scores at rest, active functional exercise and continuous passive movement state on 6, 24, 48, 72 hours after total knee arthroplasty were estimated. The presses of the pump, time of first walk, daily walk times and complication of continuous femoral nerve block were observed.
    RESULTS AND CONCLUSION: The operating time of continuous femoral nerve block in group D was shorter than that in other groups (P < 0.05). There was no difference of visual analogue scale scores, the presses of the pump, time of first walk, and daily walk times among each group. The incidence of puncture site pain in group C was higher than that in other groups (P < 0.05). The best ultrasound imaging was obtained by using 18 G needle in-plane approach for ultrasound-guided continuous femoral nerve block after total knee arthroplasty, and the complication incidence was not increased.


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    Short-term follow-up of total knee arthroplasty with LPS-Flex Mobile Bearing System knee prosthesis: range of motion of knee joint and function evaluation
    Wu Guang-peng, Xu Yao-zeng, Zhu Yong-sheng, Zhu Feng, Shao Hong-guo, Li Rong-qun, Zhou Jun
    2015, 19 (13):  2011-2016.  doi: 10.3969/j.issn.2095-4344.2015.13.009
    Abstract ( 407 )   PDF (818KB) ( 579 )   Save

    BACKGROUND: Total knee arthroplasty has matured in clinical treatment. LPS-Flex Mobile Bearing System (Zimmer, USA) artificial knee prosthesis is the high-flexion rotating platform type knee prosthesis. The time of its clinical application in China is short, so its advantages have not been reported.
    OBJECTIVE: To investigate the preliminary clinical outcome of the total knee arthroplasty with LPS-Flex Mobile Bearing system artificial knee prosthesis (Zimmer, USA), and to assess the biocompatibility of artificial prosthesis and host using range of motion of knee and function after replacement.
    METHODS: We retrospectively analyzed 37 patients (42 knees) undergoing total knee arthroplasty using Zimmer LPS-Flex Mobile Bearing prostheses (high-flexion rotating platform type knee prosthesis) in The First Hospital Affiliated to Soochow University from February 2012 to March 2014, including 9 males (10 knees) and 28 females 
    (32 knees), aged 47-78 years, averagely 63.7 years. Bone cement fixation was used, and the patella was not treated with replacement. Postoperative complications were observed. Ranges of motion of knee joint preoperatively and postoperatively were compared. The recovery of knee joint function was evaluated using Hospital for Special Surgery Knee Score.
    RESULTS AND CONCLUSION: A total of 34 cases (38 knees) were followed up for 6-28 months. Range of motion of knee joint improved from 88.5° before operation to 124.2° after operation on average. Hospital for Special Surgery Knee Score improved from 52.5 before replacement to 91.1 after replacement, showing significant differences (P < 0.01). Therapeutic effects were assessed according to Hospital for Special Surgery Knee Score: excellent in 20 cases, good in 16 cases, average in 2 cases, with an excellent and good rate of 95%. The incidence of various complications was low. These data suggested that short-period clinical outcomes of high-flexion rotating platform type knee prosthesis replacement are satisfactory. This prosthesis has advantages in its design, which is more close to the physical structure of knee joint, but its long-period outcomes deserve further investigations.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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    Self-made active antibiotic bone cement spacer: revision for infection after total knee arthroplasty
    Wang Li, Ha Baxi•kaken, Yin Jian, Yuan Hong
    2015, 19 (13):  2017-2022.  doi: 10.3969/j.issn.2095-4344.2015.13.010
    Abstract ( 289 )   PDF (761KB) ( 471 )   Save

    BACKGROUND: The purpose of total knee arthroplasty is to relieve the pain of joint, to restore the function of joint, and to elevate the quality of life of patients. If infection happened, for the patient it is disaster and for surgeon it is failure. As the development of technique, infection rate surrounding the prosthesis has lowered apparently after replacement.
    OBJECTIVE: To observe application effect of self-made active antibiotic bone cement spacer in the revision of total knee arthroplasty infection.
    METHODS: A total of 22 patients who had infection after total knee arthroplasty were treated in the Xinjiang Uygur Autonomous Region People’s Hospital from January 2006 to December 2012, including 14 females and 8 males, at the age of 66-81 years old, averagely 69.5 years. After definitive diagnosis, revision was performed. If one-stage revision should be conducted, original prosthesis should be removed, and antibiotic bone cement was used for second fixation. If two-stage revision should be conducted, self-made active antibiotic bone cement 
    spacer should be placed in femur and tibia during debridement. When infection was controlled after 6 months to 1 year, the prosthesis was considered to be placed. Follow-up was conducted after revision. New York Hospital for Special Surgery knee score was used.
    RESULTS AND CONCLUSION: All patients were followed up for 1 to 60 months. After treatment, two cases of debridement alone and one case of one-stage revision affected infection recurrence, and underwent two-stage revision. They did not suffer from neurovascular injury, prosthesis dislocation, loosening or deep vein thrombosis, and reached the standard of infection cure. At final follow-up, Hospital for Special Surgery score was 58-86, averagely (70.2±0.4). These results indicated that after total knee arthroplasty, correct therapeutic method should be selected to treat infection according to corresponding patient’s condition and different stages of infection. Joint function should be retained as much as possible so as to improve quality of life of patients.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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    Different anticoagulant drugs during knee joint replacement: changes of hemorheology
    Hu Yong, Peng Dan, Shen Yi, Chen Xia
    2015, 19 (13):  2023-2027.  doi: 10.3969/j.issn.2095-4344.2015.13.011
    Abstract ( 297 )   PDF (604KB) ( 602 )   Save

    BACKGROUND: After knee joint replacement, patients are often treated with Rivaroxaban and Enoxaparin Sodium for postoperative anticoagulation, avoiding the formation of deep vein thrombosis in lower limbs.
    OBJECTIVE: To explore the application effects of different anticoagulant drugs in patients with knee joint replacement.
    METHODS: Ninety patients underwent knee joint replacement in Xiangya Second Hospital of Central South University from July 2011 to July 2014, were randomly divided into two groups, with 45 patients in each group. The experimental group was treated with Rivaroxaban, while the control group was treated with Enoxaparin.
    RESULTS AND CONCLUSION: Postoperative drainage volume, total blood transfusion, bleeding index, quantity of blood platelet, activated partial thromboplastin time, thrombin reduction time, whole blood viscosity, plasma viscosity, D-dimer coagulation index, HSS score at postoperative 2 weeks, average ecchymosis area, average thigh circumference, and average leg circumference were significantly better in the experimental group, than in the control group (P < 0.05). The incidence of deep vein thrombosis of lower limbs in the experimental group was lower than that in the control group (P < 0.05). Experimental findings indicate that, both Rivaroxaban and Enoxaparin can exert anticoagulation effect during the knee joint replacement, and Rivaroxaban is better.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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    Risk factors for dysphagia after single-level anterior cervical fusion
    Chen Bo, Qu Xia, Yang Yi, Wang Kun, Xie Chong, Jin Ge-le
    2015, 19 (13):  2028-2033.  doi: 10.3969/j.issn.2095-4344. 2015.13.012
    Abstract ( 358 )   PDF (741KB) ( 493 )   Save

    BACKGROUND: Dysphagia is one of common early complications after anterior cervical fusion. Medium and severe dysphagia often causes serious influence on the patients. A variety of factors have been shown to have a correlation with the postoperative dysphagia, but specific mechanism is still unclear.
    OBJECTIVE: To explore the risk factors for dysphagia after single-level anterior cervical fusion.
    METHODS: From January 2011 to June 2013, data of 44 patients with dysphagia and 213 patients without dysphagia after single-level anterior cervical fusion were compared. The baseline data (age, gender, ethnicity, body mass index, smoking history, drinking history, hypertension, diabetes, course length, and type of cervical spondylosis) and perioperative data (intraoperative blood loss, internal fixation, the location of the operated level, operation time, and the side of operation approach) between two groups were compared by Logistic regression analysis to determine risk factors for postoperative dysphagia.
    RESULTS AND CONCLUSION: A total of 257 patients were included with a follow-up for 6 to 24 months postoperatively and 44 of them suffered from dysphagia after single-level anterior cervical fusion. The overall  prevalence for postoperative dysphagia was 17.1%. Univariate analysis indicated that age, gender, the location of the operated level, and course length were associated with postoperative dysphagia. Logistic regression analysis of multivariate analysis demonstrated that independent predictors for postoperative dysphagia included gender (female), age (> 60 years), the location of the operated level (C4-5, C5-6), and course length (> 12 months). Clinicians should give appropriate recognition and take corresponding measures to avoid it.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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    Different internal fixation treatment of thoracolumbar spinal tuberculosis: comparision of kyphosis Cobb angle and spinal stability
    Xing Wen-hua, Huo Hong-jun, Xiao Yu-long, Yang Xue-jun, Zhao Yan, Fu Yu, Zhu Yong, Li Feng, Xin Da-qi
    2015, 19 (13):  2034-2039.  doi: 10.3969/j.issn.2095-4344.2015.13.013
    Abstract ( 297 )   PDF (765KB) ( 515 )   Save

    BACKGROUND: Thoracic lumbar segment is prone to spinal tuberculosis, caseous necrosis tissue, dead bone compression of spinal cord and nerve root may cause neurological symptoms, and the majority of them is accompanied with mild and moderate spinal kyphosis deformity. Surgical treatment of spinal tuberculosis has been frequently reported in recent years, the commonly used treatment includes lesion clearance, bone graft fusion and internal fixation.
    OBJECTIVE: To investigate the principle of choosing different internal fixation treatment for thoracolumbar spinal tuberculosis.
    METHODS: 42 patients with thoracolumbar spinal tuberculosis were involved in this study from January 2001 to December 2011. All patients suffered from waist and back pains, with the disease course range of 1 month to 7 
    years. Four cases showed neurological deficit before surgery. According to the Frankel classification, 1 case was graded as Frankel C and 3 cases as Frankel D. The preoperative average Cobb angle of kyphosis was 27° (range 12°-45°). The internal fixation approaches were chosen according to the tuberculose focus and vertebral fracture extent. Thoraco-abdominal approach for thoracolumbar spine via diaphragm with the removal of 11 rib and(or) 12 rib was performed for all patients. Among these protocols, 25 cases underwent anterior focal debridement and bone grafting.  17 cases had anterior focal debridement and posterior pedicle screw internal fixation (one-stage surgery in 7 cases and second-stage surgery in 10 cases). All patients received anti-tuberculosis chemotherapy before and after operation.   36 cases used rib and 6 cases used iliac bone as bone graft. All patients were followed up from 17 months to 9 years. The correction of spinal deformity, spinal stability and spinal functional recovery were observed.
    RESULTS AND CONCLUSION: 30 patients were followed up after operations and the back pains disappeared. X-ray examination showed that, all patients were fixed well without no loosening and rupture, and achieved bony fusion (the mean time were 5.4 months). No tuberculosis recurred. Four cases complicated with spinal cord injury were E grade according to the Frankel classification. The Cobb angle was 0-26° (mean 14°) at 12 months after operation. On the premise of standard anti-tuberculosis chemotherapy, various internal fixation methods can be determined according to general conditions of patients and tuberculose focus site.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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    Short-segment versus long-segment pedicle screw fixation for repair of thoracolumbar fracture: one-year follow-up of vertebral compression rate
    Su Wei-kun, Ye Shao-teng
    2015, 19 (13):  2040-2044.  doi: 10.3969/j.issn.2095-4344.2015.13.014
    Abstract ( 305 )   PDF (721KB) ( 421 )   Save

    BACKGROUND: The effects of posterior decompression fixation in the repair of thoracolumbar fracture are affirmative. The fixation was divided into short-segment and long-segment pedicle screw fixation according to different treatment methods. The therapeutic effects of above two methods are controversial in the clinic at present.
    OBJECTIVE: To compare and observe the anterior vertebral compression ratio and the changes in Cobb angle after posterior short-segment and long-segment pedicle screw placement fixation in the repair of thoracolumbar fracture.
    METHODS: 120 patients with thoracolumbar fracture were enrolled in this study, and assigned to two groups according to fixation methods. Study group received posterior short-segment pedicle screw fixation. Control group received posterior long-segment pedicle screw fixation. Anterior vertebral compression rate and Cobb angle were observed before fixation, immediately and 12 months after fixation in both groups.
    RESULTS AND CONCLUSION: There was no significant difference in anterior vertebral compression rate and 
    Cobb angle between the two groups before fixation (P > 0.05). Anterior vertebral compression rate and Cobb angle were significantly smaller in the study group than in the control group immediately and 12 months after fixation (P < 0.05). Besides, surgical time and blood loss volume were less in the study group than in the control group (P < 0.05). These results indicated that posterior short-segment pedicle screw fixation for treatment of thoracolumbar fracture can effectively improve kyphosis, recover vertebral compression degree, and its surgical time is short and blood loss volume during surgery is little, so it is better than posterior long-segment pedicle screw fixation.


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    Paraspinal muscle approach of short-segment pedicle screw fixation for thoracolumbar fracture: change of Cobb’s angle at the injured segment
    Wang Shi-cheng, Huang Bi-liu, Pan Lei, Xue Hou-jun, Liu Qing-hua
    2015, 19 (13):  2045-2050.  doi: 10.3969/j.issn.2095-4344.2015.13.015
    Abstract ( 265 )   PDF (818KB) ( 453 )   Save

    BACKGROUND: Short-segment pedicle screw technology has been extensively used in the treatment and repair of thoracolumbar burst fractures. The technique of operative treatment through the paraspinal muscle approach has advantages such as less trauma and bleeding, and rapid recovery. However, it requires further investigations to verify the superiority of the paraspinal muscle approach of two lateral incisions near the posterior median line.
    OBJECTIVE: To evaluate the clinical efficacy and Cobb’s angle of short-segment pedicle screw fixation through paraspinal muscle approach of two lateral incisions near the posterior median line in the treatment of thoracic and lumbar fractures.  
    METHODS: From September 2010 to June 2012, 56 patients with thoracic and lumbar fractures were included in the retrospective study, including 42 males and14 females, with an average of 45 years (range 18-59 years). According to the surgical approach, patients were divided into two groups, traditional approach (n=25) and paraspinal muscle approach (n=31). The operative time, intraoperative blood loss, postoperative drainage and postoperative ambulant time in the two groups were observed and compared. The visual analog scale scores at 7 days, 1 month and 6 months postoperatively were recorded. The Cobb’s angles of suffered vertebra were measured preoperatively and at 7 days and 6 months postoperatively.
    RESULTS AND CONCLUSION: All patients were followed up after internal fixation. The paraspinal muscle approach was superior to traditional approach in the operation time, intraoperative blood loss, postoperative drainage and postoperative ambulant time, and visual analog scale scores at 7 days and 1 month postoperatively (P < 0.05). There was no significant difference between the preoperative and postoperative Cobb’s angle in the two groups (P > 0.05). The short-segment pedicle screw fixation through paraspinal muscle approach of two lateral incisions near the posterior median line in the treatment of thoracic and lumbar fractures, is an effective and minimally invasive treatment, with less trauma, less bleeding, rapid recovery, and simple operations. Similar to open surgery, this treatment can recover the anatomical morphology and reconstruct spinal stability, and had good biocompatibility to the host.


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    Posterior Isobar non-fusion internal fixation system in repair of lumbar disc herniation: more advantages in restoring range of motion of lumbar spine
    Liu Yan-bin, Fu Qiang
    2015, 19 (13):  2051-2056.  doi: 10.3969/j.issn.2095-4344.2015.13.016
    Abstract ( 393 )   PDF (860KB) ( 633 )   Save

    BACKGROUND: The patients with lumbar intervertebral disc protrusion can be treated with internal fixation of posterior surgery way. We can choose the conventional posterior intervertebral fusion nail stick system internal fixation. Isobar non-fusion internal fixation system was used in recent years. As a kind of a strong internal fixation of lumbar posterior dynamic screw rod fixation system, it has been gradually applied in clinic, and has been one of patient’s treatment options.
    OBJECTIVE: To compare and analyze the clinical efficacy of Isobar non-fusion internal fixation system and traditional intervertebral fusion nail rod system internal fixation operation method in treatment of lumbar disc herniation.
    METHODS: From September 2011 to September 2012, 40 patients with lumbar disc herniation who were treated in the Department of Orthopedic, Changhai Hospital, the Second Military Medial University of Chinese PLA were enrolled in this study. They were equally assigned to the Isobar non-fusion internal fixation system group (Isobar group) and the traditional intervertebral fusion nail rod system internal fixation group (rigid internal fixation group) and subjected to corresponding treatments.
    RESULTS AND CONCLUSION: Surgery was successfully completed in patients of the two groups. These patients received at least 2 years of follow-up, no drop out. Compared with pre-fixation, low back pain Visual Analog Scale and Oswestry Disability Index were improved significantly after fixation in both groups. Compared with the rigid internal fixation group, range of motion of lumbar spine was larger in the Isobar group. Low back 
    pain Visual Analog Scale and Oswestry Disability Index were similar between the two groups. These results indicated that posterior Isolbar non-fusion internal fixation obtained identical outcomes as traditional treatment, and showed more advantages in range of motion of lumbar spine.


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    Minimally invasive transforaminal lumbar interbody fusion: characteristics of screw malposition and cage displacement 
    Chen Xiao-tao, Xie Shou-ning, Wang Kai
    2015, 19 (13):  2057-2062.  doi: 10.3969/j.issn.2095-4344.2015.13.017
    Abstract ( 295 )   PDF (770KB) ( 534 )   Save

    BACKGROUND: Traditional open surgical transforaminal lumbar interbody fusion often needs a broader dissection of the paraspinal soft tissue and longer stretch time of soft tissue, induces greater surgical trauma and more blood loss. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) may reduce or avoid these shortcomings. However, MIS-TLIF technique needs a process of learning curve. Correctly understanding the MIS-TLIF technique and dealing with their associated complications, have an important clinical significance.
    OBJECTIVE: To summarize the MIS-TLIF complications for treatment of lumbar disease, and explore the prevention and treatment strategies.
    METHODS: Between May 2008 and May 2012, 100 patients with lumbar disease were treated using MIS-TLIF. All of patients had typical low back pain combined with leg pain, and were ineffective by conservative treatment for 6 months. There were lumbar spinal stenosis syndrome in 42 cases, lumbar spondylolisthesis in 31 cases, and lumbar disc herniation with lateral recess stenosis in 27 cases. The operative levels included L3/4 in         
    2 patients, L4/5 in 28 patients, L5/S1 in 50 patients, L3-L5 in 2 patients, and L4-S1 in 18 patients. The intraoperative and postoperative complications were recorded.
    RESULTS AND CONCLUSION: One patient appeared extradural hemorrhage 1 000 mL and was given blood transfusion, no complications were found. Pedicle screw malposition was found in 11 pedicle screws (11/435, 2.5%). Only one patient had new L5 radicular pain due to impingement by the tip of a bicortical S1 screw upon the lumbosacral trunk anterior to the sacrum. This screw was re-positioned at a subsequent procedure, with resolution of the radicular pain. Interbody cage malposition was found in 2 patients with 2 cages (2/120, 1.7%) after operations, they showed no clinical symptoms and were not treated. One patient with one cage (1/120, 0.8%) appeared cage displacement during follow-up, which required twice revision surgeries, one is cage re-position and the other is posterior interbody fusion. Within one month after operations, two patients had poor visualization in the right pulmonary arteriography, which was diagnosed as pulmonary embolism and was treated with thrombectomy and thrombolysis. No death and other consequence were found. Experimental findings indicate hat, MIS-TLIF is a safe, reliable and effective surgery for treating lumbar diseases, with few complications.


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    Primary lumbar intervertebral infection: debridement, bone graft and pedicle screw placement fixation 
    Li Long, Sheng Wei-bin, Yang Sen, Guo Hai-long
    2015, 19 (13):  2063-2068.  doi: 10.3969/j.issn.2095-4344.2015.13.018
    Abstract ( 329 )   PDF (846KB) ( 478 )   Save

    BACKGROUND: The method in repair of primary lumbar intervertebral infection is different in different positions, mainly containing anterior, posterior and anteroposterior pathways. In posterior pathway, muscle gap approach is recognized by many fellows. This program has its special advantage compared with conventional posteromedial approach. 
    OBJECTIVE: To evaluate the clinical effects of debridement, bone graft and internal fixation of pedicle screw placement in repair of primary lumbar intervertebral infection through posterior paraspinal muscle approach.
    METHODS: Clinical data of 13 patients with primary lumbar intervertebral infection were analyzed retrospectively. There were one case of L2-L3, two cases of L3-L4, four cases of L4-L5 and six cases of L5-S1. Lumbar pain was 
    obvious in all patients. Nine cases suffered from radioactive lower limb pain. All patients received debridement, bone graft and internal fixation of pedicle screw placement through paraspinal muscle approach via posteromedial incision. After treatment, clinical effects were evaluated using Visual Analog Scale and lumbar Japanese Orthopaedic Association scores.
    RESULTS AND CONCLUSION: All patients were followed up for 12-18 months, no recurrence. X-ray review demonstrated bony fusion, so loosening and breakage were not found in all patients. Visual Analog Scale scores revealed that Visual Analog Scale score was 8.15 preoperatively, 2.15 at 1 week postoperatively, 1 at final follow-up, showing significant difference (P < 0.05). There was significant difference in pain between pre-treatment and post-treatment, and pain apparently relieved after treatment. Lumbar Japanese Orthopaedic Association score showed that effective outcomes were found in all patients after treatment, including nine cases of excellent effects, three cases of good effects, one case of average effects, with the excellent and good rate of 92%. Above findings confirmed that one-stage debridement, bone graft and internal fixation of pedicle screw placement through posterior muscle gap approach provides a good repair method for patients with primary lumbar intervertebral infection. It can achieve intervertebral space directly through intervertebral foramen, retain the central spinous process and lamina, reduce the injury to paraspinal muscle, and keep spinal ligament complex. However, strong spine fixation contributes to bone fusion, and keeps the stability of the spine after repair.


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    Screw placement in repair of ankylosing spondylitis complicated by severe wheel-like kyphosis: stress distribution in multiple segments
    Ma Jun-yi, Yang Jing, Ma Yuan, Tian Hui-zhong
    2015, 19 (13):  2069-2074.  doi: 10.3969/j.issn.2095-4344.2015.13.019
    Abstract ( 196 )   PDF (827KB) ( 460 )   Save

    BACKGROUND: Kyphotic deformity in ankylosing spondylitis is the flexion deformity of spine sagittal plane in the late lesion. Spinal osteotomy is the only treatment method in patients with severe wheel-like kyphosis. For thoracic and thoracolumbar ankylosing spondylitis patients with lumbar severe wheel-like kyphosis, osteotomy at a single site cannot obtain safe and effective orthopedic effect.
    OBJECTIVE: To observe the orthopedic effect of total spine osteotomy combined with V-shaped osteotomy for correction of severe wheel-like kyphosis deformity due to ankylosing spondylitis, and to analyze stress  distribution.
    METHODS: From May 2003 to October 2012, total spine osteotomy combined with V-shaped osteotomy and pedicle screw fixation were adopted for repair of concurrent thoracic, thoracolumbar and lumbar severe wheel-like kyphosis deformity due to ankylosing spondylitis in 36 male cases in the Sixth Affiliated Hospital of Xinjiang Medical University. Spinal convex angle, chin-brow vertical angle and C7 plumb line were measured to evaluate orthopedic effect.
    RESULTS AND CONCLUSION: The whole spine convex Cobb angle was corrected from preoperatively (89.6±9.8)° to (32.2±6.7)° at 1 week after treatment, showing significant difference (P < 0.05), with an average correction rate of 64%. The chin-brow vertical angle was 9.6° averagely after correction (P < 0.05), with an average correction rate of 76%. The C7 plumb line was 4.4 cm averagely after correction (P < 0.05), with an average correction rate of 81%. After follow-up of 24-48 months, no significant difference in above indexes was detected during final follow-up and 1 week postoperatively (P > 0.05). Radiographs demonstrated that fixation position was good in all patients. These results confirmed that in patient with severe wheel-like kyphosis deformity due to ankylosing spondylitis, the application of total spine osteotomy combined with V-shaped osteotomy is a safe and effective method, can better correct the spinal sagittal curvature and reduce the risk of sagittal angle, result in the stress distribution in many segments and the shortening of the spine and epidural buckling in relatively long segment, can avoid nerve damage induced by spinal cord shortening and epidural excessive buckling within short segment.


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    AO/ASIF clavicular hook plate versus Kirschner wire for repair of distal clavicle fractures and acromioclavicular joint dislocation
    Wu Zhong-he, Pi Zhi-bing
    2015, 19 (13):  2075-2080.  doi: 10.3969/j.issn.2095-4344.2015.13.020
    Abstract ( 316 )   PDF (833KB) ( 493 )   Save

    BACKGROUND: According to worldwide statistics, internal fixation was commonly selected to treat patients with distal femoral fractures and acromioclavicular joint dislocation. The firmness of Kirschner wire is poor during fixation, so needle withdrawal easily appears, and the fixation would be failure. To reduce complications after fixation, AO/ASIF clavicular hook plate as a novel fixator has been used in treatment of distal clavicle fractures and acromioclavicular joint dislocation.
    OBJECTIVE: To explore the safety and effectiveness of AO/ASIF clavicular hook plate in the treatment of distal clavicle fractures and acromioclavicular dislocation, and to compare with Kirschner wire tension band.  
    METHODS: 100 patients with distal clavicle fractures and acromioclavicular joint dislocation, who were treated in the Department of Orthopedics of Tongcheng People’s Hospital from June 2010 to December 2013, were enrolled in this study. They were equally assigned into Kirschner wire tension band group and AO/ASIF clavicular hook plate group according to different fixation methods. The excellent and good rate of shoulder function recovery, shoulder function score and upper limb functional recovery were observed and compared between the two groups after fixation.
    RESULTS AND CONCLUSION: The excellent and good rate of shoulder function recovery was 98% in the AO/ASIF clavicular hook plate group after fixation, which was significantly higher than Kirschner wire tension band group (64%). The incidence of acromioclavicular re-dislocation was 0 after removal of fixator in the AO/ASIF clavicular hook plate group, which was lower than Kirschner wire tension band group (12%), showing significant differences between groups (P < 0.05). Japanese Orthopaedic Association score was significantly higher at 5 and 10 weeks after fixation in both groups compared with pre-fixation. Japanese Orthopaedic Association score was significantly higher in the AO/ASIF clavicular hook plate group than in the Kirschner wire tension band group (P < 0.05). The ranges of motion of adduction, abduction, flexion and extension were significantly higher in the AO/ASIF clavicular hook plate group than in the Kirschner wire tension band group at 10 weeks after fixation (P < 0.05). Above results suggested that AO/ASIF clavicular hook plate is a safe effective fixator for repair of distal clavicle fractures and acromioclavicular joint dislocation, and characterized by small incision, reliable fixation, and early shoulder activities.


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    New-type proximal humeral wing-shape anatomical plate for repairing proximal humerus fractures: effectively reduce the incidence of subacromial impingement
    Lu Ya-jun
    2015, 19 (13):  2081-2085.  doi: 10.3969/j.issn.2095-4344.2015.13.021
    Abstract ( 388 )   PDF (634KB) ( 373 )   Save

    BACKGROUND: The best repair method for proximal humeral fractures remains controversial at present. Although different techniques have been described for proximal humerus fractures, all these techniques have high postoperative complications, such as cut-out or back-out of the screws, nonunion, and subacromial impingement. Given the shortcomings of conventional plate fixation system, we had designed a new type of proximal humeral wing-shape anatomical plate for the repair of proximal humeral fractures.
    OBJECTIVE: To evaluate clinical outcomes and complications of proximal humeral wing-shape anatomical plate fixation for proximal humerus fractures.
    METHODS: A total of 60 patients with proximal humerus fractures who underwent proximal humeral wing-shape anatomical plate fixation from September 2012 to September 2013 were retrospectively analyzed. According to 
    Neer classification system, 24, 31 and 5 patients had 2-part, 3-part, and 4-part fractures, respectively. Functional evaluation of the shoulder was done using Constant-Murley score and Visual Analogue Scale was utilized for assessing the degree of shoulder pain.
    RESULTS AND CONCLUSION: All 60 patients were followed up for 12-24 months after fixation, and obtained bone healing. The healing time was 15.3±2.7 weeks (range 12-20 weeks). At the final follow-up, the Constant-Murley score was 81.5±14.6 (range 45-98). The mean Visual Analogue Scale score was 0.9 ± 0.9 points (range 0-7 points). During the follow-up, the overall rate of complications was 18% in 11 cases of 60 cases, including intraarticular screw penetration in 3 patients (5%), back-out of the screws in 1 patient (2%), varus malunion in 5 (8%) patients (containing 2 cases combined with screw penetration), humeral head necrosis in 2 patients (3%), subacromial impingement in 1 patient (2%) and superficial infection of incision in 1 patient (2%). No cases of avascular necrosis or hardware failure were noted. Above data suggested that self-made new-type proximal humeral wing-shape anatomical plate fixation for repairing proximal humerus fractures can obtain satisfactory outcomes, effectively reduce the incidence of postoperative subacromial impingement, is helpful to the recovery of shoulder function, and deserves to be further used.


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    Fixation with intramedullary nail and plate in the treatment of adult humeral shaft fracture: comparison of radial nerve injury and non-union rate
    Feng Tao
    2015, 19 (13):  2086-2090.  doi: 10.3969/j.issn.2095-4344.2015.13.022
    Abstract ( 276 )   PDF (677KB) ( 564 )   Save

    BACKGROUND: Internal fixation is the main treatment of humeral shaft fractures, especially for cases accompanied several injuries. According to the fracture reduction method and fixation methods, the commonly used repair methods include intramedullary nail and minimally invasive plate. How to choose a safe and effective method of internal fixation is a hot issue in the repair of humeral shaft fractures.
    OBJECTIVE: To explore the clinical effect of different fixations of intramedullary nail and plate in the treatment of adult humeral shaft fracture.
    METHODS: A total of 252 patients with humeral shaft fracture recruited from Heze Municipal Hospital from May 
    2010 to May 2013 were randomly divided into two groups, with 126 cases in each group. Patients in the two groups were treated with intramedullary nail fixation and plate fixation, respectively. The average operation time, intraoperative blood loss, hospital stays, and healing time of fracture in the two groups were recorded. All patients were followed up for 1 year postoperatively, the incidence of radial nerve injury, infection and non-union was compared. The recovery of shoulder joint and elbow joint of patients was assessed with Neer method and Mayo method, respectively.
    RESULTS AND CONCLUSION: After treatment, the rate of primary success of internal fixation showed no significant differences between the two groups (χ2=0.399 7, P > 0.05). The average operation time, intraoperative blood loss, the healing time of fracture and hospital stays in the intramedullary nail group were significantly shorter than that in the plate group B, the difference of the results were extremely significant in two groups (t=15.442 5, 21.713 4, 8.217 6, 1.214 8,  P < 0.01). After 1-year follow-up, the incidence of radial nerve injury showed extremely significant differences between the two groups (χ2=8.262 3, P < 0.01); the incidence of nonunion in the intramedullary nail group was significantly lower than that in the plate group, with extremely significant differences (χ2=3.947 2, P < 0.05). The overall incidence of complications in intramedullary nail group was significantly lower than that in the plate group, with extremely significant difference (χ2=11.977 9, P < 0.01). Besides, the Neer scores of shoulder joint and the Mayo scores of elbow joint between the two groups had no statistically significant difference (χ2=0.235 4, 0.273 0, P > 0.05). Both intramedullary nail and plate fixations show good clinical effect in treatment of adult humeral shaft fracture, and each technique has their advantages and disadvantages, we should choose the proper technique according to the patient’s condition.


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    Comparison of locking compression plate and anatomic plate internal fixation for Pilon fracture
    Wang Bin, Wang Zhi-zhong, Zhang Fan
    2015, 19 (13):  2091-2095.  doi: 10.3969/j.issn.2095-4344.2015.13.023
    Abstract ( 251 )   PDF (642KB) ( 423 )   Save

    BACKGROUND: As a conventional internal fixation method, anatomic plate has some shortcomings. Recently locking plate has been widely used in treatment of Pilon fracture. How to effective reconstruct articular facet at the distal tibia and to reduce soft tissue damage have attracted increasing attentions.
    OBJECTIVE: To compare the curative effect of locking compression plate versus anatomic plate internal fixation in treatment of Pilon fracture.
    METHODS: A retrospective analysis was performed among 72 patients of Ruedi-Allgower II and III Pilon fracture, who were selected from Sanshui People’s Hospital of Foshan between January 2010 and August 2014. The involved patients were randomly divided into two groups: 36 patients of observation group were treated with locking compression plate internal fixation, and 36 patients of control group were given anatomic plate internal 
    fixation. The average operation time, postoperative recovery time, postoperative complications, curative effect and postoperative fracture situation were compared between the two groups.
    RESULTS AND CONCLUSION: The average operation time and the average postoperative recovery time of observation group were significantly better than that of control group (P < 0.05). In terms of postoperative complications, there were less cases of delayed healing and non-union in the observation group than in the control group. 26 cases of observation group and 22 cases of control group recovered well after internal fixation, observation group was better than control group. There was no significant difference in the radiological evaluation results of postoperative recovery between the two groups (P > 0.05). Compared with the anatomic plate internal fixation, locking compression plate internal fixation can shorten the operation time and postoperative recovery time, reduce the incidence of delayed healing and nonunion after internal fixation, and improve clinical curative effect in treatment of Pilon fracture.


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    Dynamic hip screw fixation for femoral intertrochanteric fracture: failure reason
    Wei Jiu-ding, Fu Ting-jun, Cheng Zhong-yang, Jin Wen-xue, Da Zhao-ming, Xia Ya-yi
    2015, 19 (13):  2096-2012.  doi: 10.3969/j.issn.2095-4344.2015.13.024
    Abstract ( 349 )   PDF (869KB) ( 487 )   Save

    BACKGROUND: Intertrochanteric fracture showed shattered state of different degrees in the clinic. The medial cortex is often a lack of continuity. Indentation and lesser trochanter displacement often cause destruction of biomechanics of femoral calcar to different degrees. Under this condition, it is very important to perform detailed classification of fractures and to strictly master indication of dynamic hip screw.
    OBJECTIVE: To further analyze the reasons for failure of internal fixation with dynamic hip screw for intertrochanteric fracture.
    METHODS: Data of 82 patients with intertrochanteric fracture repaired by internal fixation with dynamic hip screw, who were treated at the Department of Orthopedics, Kangtai Branch of the Second Hospital of Lanzhou University from March 2004 to December 2013, were retrospectively analyzed. The reason for failure of internal fixation and prevention method were explored.
    RESULTS AND CONCLUSION: All patients were followed up for 4-48 months. Time of fracture healing was 12-38 weeks. Fixation failure was found in 12 cases, with an incidence of 15%. Of 12 failure cases, 7 cases 
    affected hip screw cutting out femoral head neck (including 1 case combined with avascular necrosis of the femoral head), 1 case suffered from compression screw slipping out of the tube, 3 cases experienced screw pulling out and breaking, plate loosening, and 1 case affected steel plate breakage. There were 1 case of Evans II type (8%), 3 cases of type III (25%), 5 cases of type IV (42%), and 3 cases of type V (25%). Lesser trochanter was not completely reset in 5 cases (42%). There were tip-apex distance > 25 mm in 7 cases (58%) and early weight loading (3 weeks after fixation) in 1 case (8%). These data confirmed that the selection of indications, the degree of stability after reduction, accuracy of implant position and postoperative unreasonable exercise will cause fixation failure of dynamic hip screw. Preoperative careful and comprehensive analysis, intraoperative precise operation and postoperative reasonable functional exercise are the keys to ensure success of fixation.


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    Complication of two intramedullary nail treatments of osteoporotic intertrochanteric fractures
    Yu Yan-yong
    2015, 19 (13):  2103-2107.  doi: 10.3969/j.issn.2095-4344.2015.13.025
    Abstract ( 250 )   PDF (701KB) ( 447 )   Save

    BACKGROUND: Dynamic hip screws have developed in recent years, and proximal femoral nail anti-rotation modified by the Association for the Study of Internal Fixation has been widely applied in clinics. Their efficacy has been well recognized.
    OBJECTIVE: To analyze and compare the complications of proximal femur intramedullary nail and proximal femoral nail anti-rotation treatments in elderly patients with osteoporotic intertrochanteric fracture.
    METHODS: Seventy elderly patients with osteoporotic intertrochanteric fracture were selected from the People’s Hospital of Yucheng City between June 2012 and June 2014. Patients were randomly divided into two groups: control group and experimental group, with 35 cases in each group. Control group was given proximal femur intramedullary nail treatment, while experimental group was given the proximal femoral nail anti-rotation treatment. The operation time, intraoperative blood loss, fracture healing time, postoperative complications and 
    hip Harris score were compared in two groups.
    RESULTS AND CONCLUSION: The operation time in the experimental group was significantly shorter than that in the control group (t=2.88, P < 0.05). The postoperative complication rate was 26% in control group and 9% in experimental group, with significant differences in the two groups (χ2 = 4.77, P < 0.05). Both proximal femur intramedullary nail and proximal femoral nail anti-rotation have few trauma and strong fixation for the treatment of osteoporotic intertrochanteric fractures, and proximal femoral nail anti-rotation has a shorter operation time and reduces postoperative complications.


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    Reverse less invasive stabilization system and proximal femoral nail anti-rotation in the treatment of senile intertrochanteric fractures
    Feng Xu-hui, Miao Hai-xiong
    2015, 19 (13):  2108-2113.  doi: 10.3969/j.issn.2095-4344.2015.13.026
    Abstract ( 307 )   PDF (826KB) ( 447 )   Save

    BACKGROUND: Unstable intertrochanteric fracture is often treated with proximal femoral nail anti-rotation (PFNA), which has good repair effect, but there is the risk of varus deformity. Reverse less invasive stabilization system (LISS) is a new treatment, which can avoid varus deformity. However, little evidence has focused on the comparison of PFNA and LISS.
    OBJECTIVE: To compare the clinical efficacy, complications and joint function of reverse LISS and PFNA in treatment of unstable intertrochanteric fractures in the elderly patients.
    METHODS: A retrospective analysis was performed among 64 elderly patients with unstable intertrochanteric fractures. Among them, 28 cases were treated with reverse LISS and 36 cases were treated with PFNA. The healing time, loading time, complications and Harris score of hip joint function after internal fixation were compared in the two groups. 
    RESULTS AND CONCLUSION: The loading time in the LISS group was earlier than the PFNA group. The healing time, incidence of complications and Harris score of hip joint function showed no significant differences between the two groups (P > 0.05). Reverse LISS internal fixation has similar efficacy and complication with PFNA for the treatment of senile unstable intertrochanteric fractures, and it is a reliable method for internal fixation with few complications.


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    Comparison of hollow compression screws and absorbable screws for the treatment of the fifth metatarsal fracture: ankle function and fracture displacement
    Wang Xi, Deng Yu, Yu Li, Su Ri-han, Zhao Xing, Zhu Shao-bo
    2015, 19 (13):  2114-2118.  doi: 10.3969/j.issn.2095-4344.2015.13.027
    Abstract ( 397 )   PDF (687KB) ( 1088 )   Save

    BACKGROUND: The hollow compression screws and absorbable screws can be applied for the treatment of the fifth metatarsal fracture. However, little evidence is obtained in China.
    OBJECTIVE: To compare ankle function and fracture displacement in patients with the fifth metatarsal fracture after interventions of hollow compression screws and absorbable screws.
    METHODS: 32 patients with the fifth metatarsal fracture were recruited from Zhongnan Hospital of Wuhan University between June 2012 and June 2014. According to the internal fixation method, the involved patients were divided into hollow compression screws group (n=18) and absorbable screws group (n=14). Clinical outcomes of patients in the two groups were evaluated through observations of the mean healing time, postoperative infection, ankle activity and fracture displacement.
    RESULTS AND CONCLUSION: All the 32 patients were followed up for 6-18 months and were all healed. Compared with the absorbable screws group, the healing time was shorter (P < 0.05), incidence of postoperative screw rupture and fracture displacement was lower (P < 0.05), and ankle activity was better in the hollow compression screws group (P < 0.05). It is necessary to enhance the strength, improve screw thread, increase  
    anti-pulling property, and allow early ankle activity, thus reducing the risk of clinical application of the absorbable screws.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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    Computer navigation technique-assisted posterior spinal pedicle screw placement fixation: accuracy and safety
    Chen Xiao-ming, Xiao Zeng-ming, Zong Shao-hui, Chen Qian-fen
    2015, 19 (13):  2119-2124.  doi: 10.3969/j.issn.2095-4344.2015.13.028
    Abstract ( 385 )   PDF (806KB) ( 435 )   Save

    BACKGROUND: Posterior pedicle screw fixation is an important method to treat various diseases of the spine and to stabilize the spine. Computer navigation system can completely, intuitively and truly reveal the morphology of various tissues and their positions so that the performer can obtain three-dimensional images in time and avoid the risk area of the operation to the utmost, and can directly introduce accurate placement of the screw in the vertebral body.
    OBJECTIVE: To evaluate the accuracy and safety of computer navigation technique-assisted posterior spinal pedicle screw placement.
    METHODS: 307 patients with spine diseases, who were treated in the First Affiliated Hospital of Guangxi Medical 
    University from July 2008 to January 2014, were enrolled in this study. They received computer navigation technique-assisted posterior spinal pedicle screw placement and laminectomy for decompression. C-arm fluoroscopy was applied to assess the precision of pedicle screw position during the operation. The mean implantation time per screw and the exposure time to radiation were recorded. 3-day postoperative radiographs and CT examination, which allowed measurements of screw position relative to pedicle position according to Andrew classification, were performed routinely.
    RESULTS AND CONCLUSION: Of the 1 820 screws inserted by computer-assisted navigation, 1 778 were grade I (accuracy 97.69 %). A total of 92 screws were implanted in the cervical vertebrae, including 90 grade-I screws (accuracy 97.82%). 502 screws were implanted in the thoracic vertebrae, including 492 grade-I screws (accuracy 98%). 1 226 screws were implanted in the lumbar vertebrae, including 1 196 grade-I screws (accuracy 97.2%). The mean implantation time per screw was (7.0±1.5) minutes. 215 patients were followed up for (12±6) months. No complications such as fixator displacement or breakage or neurovascular injury occurred. Above findings suggested that computer navigation system-assisted spinal pedicle screw implantation provides real-time, multi-perspective, three-dimensional visualization of spinal anatomy, ensures the accuracy and safety of spinal pedicle screw implantation, and apparently reduces exposure time to radiation.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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    Model of reduced pediatric supracondylar humeral fracture with residual displacements: a finite element analysis of mechanical responses
    Chen Lin-wei, Zhao Jing-tao, Zheng Ting-qu, He Chang-qiang, Sun Han-qiao, Huang Feng, Zheng Xiao-hui, Gan Yan-qun
    2015, 19 (13):  2125-2132.  doi: 10.3969/j.issn.2095-4344.2015.13.029
    Abstract ( 242 )   PDF (932KB) ( 423 )   Save

    BACKGROUND: Displacement of the distal fracture fragment is one of the most important facts that lead to cubitus varus following pediatric supracondylar humeral fracture. Mainstream technique emphasized the restoration of posterior-ulnar deviation of the distal fragment. However, there is an absence of supportive evidences from biomechanical studies.
    OBJECTIVE: To establish models of extension-ulnar type of supracondylar humeral fracture and investigate the mechanical stability of reduced fracture with residual displacements within functional restoration standard, so as to provide mechanic evidences supporting the empirical rule of manipulative reduction-“better anterior than posterior, better radial than ulnar”.
    METHODS: The fresh cadaveric bone of right upper extremity from a 7-year-old child was scanned using CT. Models of supracondylar humeral fracture differing in contact area of the fracture site and displacement direction of the distal fragment were established and underwent loading tests. Stress in both anterior and posterior margin of the fracture site and Baumann angle were recorded, and data were analyzed and compared.
    RESULTS AND CONCLUSION: In comparison of stress in the posterior margin, the value was significantly greater in the posteromedial-displacement group than the others. Stress value in fracture with 75% contact area was significantly greater than the other three groups. In comparison of stress in the anterior margin, a significantly greater value was obtained in the posteromedial-displaced group. Stress value in fracture with 85% contact area was significantly greater. When comparing stress in posterior margin and anterior margin, the absolute increment of stress value was greater in posterior displacement group than in anterior displacement group. Baumann angle increased significantly when fragment displaced medially. Above findings indicated that displacement direction altered the location of stress concentration. Stress augmentation was greater in posterior displacement group. Stress in related area significantly increased constantly when contact area of the fracture site reduced. Baumann changed obviously when fragment displaced medially. The results preliminarily verify the hypothesis that displacement of the distal fragment was the main contributor to cubitus varus following supracondylar humeral fracture. These findings provided certain evidences supporting the empirical rule “better anterior than posterior, better radial and ulnar”.


    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程


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