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08 June 2019, Volume 23 Issue 16 Previous Issue    Next Issue

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Correlation of different treatment methods of synovial membrane in total knee arthroplasty with the joint function recovery   Zhou Hongxing, Yi Weiguo, Yuan Xiangsheng 2019, 23 (16):  2461-2466.  doi: 10.3969/j.issn.2095-4344.1168 Abstract ( 467 )   PDF (2831KB) ( 89 )   Save BACKGROUND: Total knee arthroplasty has been gradually applied in the treatment of knee joint diseases. However, there is still a controversy about whether synovectomy in surgery, even affecting joint function recovery. OBJECTIVE: To explore the effect of synovectomy in total knee arthroplasty on the functional recovery of knee joint, so as to provide reference for choosing appropriate surgical method in total knee arthroplasty. METHODS: One hundred and twenty patients with osteoarthritis undergoing unilateral total knee arthroplasty admitted at No.152 Hospital of Chinese PLA between September 2009 and September 2014 were included. The patients were randomized into two groups (n=60/group), undergoing retaining synovial membrane and synovectomy in total knee arthroplasty, respectively. Intraoperative tourniquet and postoperative drainage tube were used in all patients. Sex, age, body mass index, hemoglobin, preoperative Hospital Special Surgery knee score and Visual Analogue Scale score were compared between two groups. The operation time, drainage volume at postoperative 6, 24 and 48 hours and the hemoglobin level at postoperative 1 and 7 days, and 1 day before leaving hospital were recorded. Visual Analogue Scale score and Hospital Special Surgery knee score at postoperative 2 weeks, 3 months, 1, 2 and 4 years were detected. RESULTS AND CONCLUSION: (1) There was no significant difference in baseline data between two groups. (2) The operation time and drainage volume at postoperative 6 and 24 hours in the retaining synovial membrane group were significantly lower than those in the synovectomy group (P < 0.05). (3) The hemoglobin levels at postoperative 1 and 7 days, and 1 day before leaving hospital in the retaining synovial membrane group were significantly higher than those in the synovectomy group (P < 0.05). (4) The Visual Analogue Scale score and Hospital Special Surgery knee score at postoperative 2 weeks, 3 months and 1 year showed no significant differences between two groups. The scores at postoperative 2 and 4 years in the synovectomy group were superior to the retaining synovial membrane group (P < 0.05). (5) These findings imply that synovectomy in total knee arthroplasty for osteoarthritis increases postoperative blood loss, with risk for complications. Its short-term efficacy is similar with the retaining synovial membrane, but long-term efficacy is pertinent. Figures and Tables | References | Related Articles | Metrics

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Implementation of enhanced recovery after surgery in perioperative management of total knee arthroplasty Jin Jia, Xu Wei, Ai Hongzhen 2019, 23 (16):  2467-2472.  doi: 10.3969/j.issn.2095-4344.1201 Abstract ( 345 )   PDF (1302KB) ( 94 )   Save BACKGROUND: Enhanced recovery after surgery refers to the improvement, optimization and combination of perioperative management measures to alleviate surgical trauma stress response, reduce postoperative complications, shorten hospitalization time, and achieve the goal of rapid recovery. This concept has been widely used in gastrointestinal surgery and has been paid much attention by orthopedics in recent years. Therefore, the rapid rehabilitation management of knee arthroplasty has become an issue of concern. OBJECTIVE: To explore the effect of perioperative enhanced recovery after surgery on the rehabilitation in patients undergoing total knee arthroplasty. METHODS: Thirty patients undergoing total knee arthroplasty received perioperative enhanced recovery after surgery from January to June 2018 (trial group), and 30 patients undergoing total knee arthroplasty received traditional perioperative management from July to December 2017 (control group). All patients have provided the informed consents and the trial protocol has been approved by the ethics committee of the hospital. The postoperative early rehabilitation efficacy was compared, including active flexion angle, Hospital for Special Surgery score, and Visual Analog Scale scores at rest and in activity. The unscheduled readmission rate and satisfaction at postoperative 30 days were recorded. RESULTS AND CONCLUSION: (1) The active flexion angle at postoperative 3, 5 and 7 days and the Hospital for Special Surgery score at postoperative 1 and 3 months in the trial group were significantly higher than those in the control group (P < 0.05). (2) The Visual Analog Scale scores at rest and in activity at postoperative 6, 24 and 36 hours in the trial group were significantly lower than those in the control group (P < 0.05). (3) The unscheduled readmission rate in both two groups was zero. (4) Perioperative enhanced recovery after surgery could significantly improve the satisfaction (P < 0.01). (5) To conclude, perioperative enhanced recovery after surgery management can facilitate the early rehabilitation process in total knee arthroplasty, increase patients’ satisfaction and improve the medical service. Figures and Tables | References | Related Articles | Metrics

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Anterior cervical approach to expand longitudinal decompression range for treating cervical spondylotic myelopathy   Li Mi, Zhao Chengbin, Zhang Hanjun, Li Huazhe, Zhang Rui 2019, 23 (16):  2473-2478.  doi: 10.3969/j.issn.2095-4344.1202 Abstract ( 394 )   PDF (765KB) ( 126 )   Save BACKGROUND: Cervical anterior decompression and fusion for treating cervical spondylotic myelopathy is regarded as a classic surgical method because of its exact curative effect, small intraoperative trauma and the decompression. This study expands the longitudinal decompression range based on the original classical procedure and compares it with the clinical efficacy of the classic procedure. OBJECTIVE: To analyze the clinical efficacy of two different methods of anterior cervical decompression for treating cervical spondylotic myelopathy. METHODS: One hundred and twenty patients were randomly divided into two groups A (traditional anterior cervical decompression) and B (expansion of the longitudinal decompression range of the anterior cervical spine) (n=60/group). Informed consents were obtained from all patients, and the trial was approved by the Ethics Committee of the Fourth Affiliated Hospital of Harbin Medical University. All patients were followed up for 1 year. The intraoperative and postoperative blood loss, Japanese Orthopaedic Association score, cervical curvature index, cervical flexion and extension activity, intervertebral bone graft healing time and fusion rate were compared to assess the clinical efficacy. RESULTS AND CONCLUSION:(1) The intraoperative and postoperative blood loss in the group A was lower than that in group B (P < 0.05). (2) The recovery of neurological function (Japanese Orthopaedic Association score) in the group B was significantly better than that in the group A (P < 0.05). (3) There was no significant difference in the changes of cervical curvature index and range of motion between two groups (P > 0.05). (4) The postoperative healing time of intervertebral bone graft in the group B was significantly shorter than that in the group A (P < 0.05). There was no significant difference in the fusion rate between two groups (P > 0.05). (5) In summary, both surgical procedures can achieve good clinical results in the treatment of different degrees of cervical spine. The classic cervical anterior approach has little trauma during operation, and patients have certain advantages in postoperative bed-lifting activities. There is no significant difference in the recovery of cervical curvature and the rate of interbody fusion between two methods. The expansion of the longitudinal decompression range of the anterior cervical spine holds certain advantages in the neurological function of cervical spondylotic myelopathy and the healing time of intervertebral bone grafting. Figures and Tables | References | Related Articles | Metrics

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Efficacy of percutaneous kyphoplasty, zoledronic acid infusion versus their combinations for treating osteoporotic vertebral compression fractures in older adults    Zhang Mi, Liu Yang, Tan Junfeng, Li Minghui, Liu Libin 2019, 23 (16):  2479-2485.  doi: 10.3969/j.issn.2095-4344.1203 Abstract ( 311 )   PDF (1408KB) ( 139 )   Save BACKGROUND: Vertebroplasty is effective in relieving pain in elderly patients with osteoporotic thoracolumbar fractures, and zoledronic acid is an effective drug for treating osteoporosis. OBJECTIVE: To investigate the effect of zoledronic acid infusion on radiographic and clinical outcomes after percutaneous kyphoplasty for senile osteoporotic thoracolumbar fractures. METHODS: We retrospectively analyzed 89 elderly patients (aged > 65 years) with osteoporotic thoracolumbar fractures from August 2013 to June 2015 at Fifth Hospital in Wuhan. Thirty-two patients were treated with percutaneous kyphoplasty and 27 patients received zoledronic acid infusion at 3 days after percutaneous kyphoplasty, and 30 patients were treated with 5 mg zoledronic acid infusion, once yearly. The vertebral height, degree of kyphotic deformity, Visual Analog Scale, Oswestry Disability Index, bone mineral density T-value and complications were evaluated. RESULTS AND CONCLUSION: (1) The vertebral height, degree of kyphotic deformity, Visual Analog Scale, and Oswestry Disability Index in the percutaneous kyphoplasty and zoledronic acid plus percutaneous kyphoplasty groups were significantly superior to those in the baseline and zoledronic acid group (P < 0.05) at postoperative 1 week, 3, 6, 12 and 24 month. (2) The bone mineral density T-value of lumbar vertebrae at 12 and 24 months postoperatively in the percutaneous kyphoplasty and zoledronic acid plus percutaneous kyphoplasty groups was significantly higher than that at baseline (P < 0.05). (3) The vertebral height, degree of kyphotic deformity, and Oswestry Disability Index at postoperative 24 months in the zoledronic acid plus percutaneous kyphoplasty group were significantly superior to those in the percutaneous kyphoplasty group  (P < 0.05). (4) The incidence of vertebral re-fracture in the percutaneous kyphoplasty group was 16%, but no patient with vertebral re-fracture in the zoledronic acid plus percutaneous kyphoplasty group (P < 0.05). (5) In summary, 5 mg zoledronic acid infusion, once yearly combined with percutaneous kyphoplasty can restore vertebral height, reduce kyphotic deformity, alleviate pain, promote functional recovery of spinal cord and reduce vertebral re-fracture in the treatment of senile osteoporotic thoracolumbar fractures. Figures and Tables | References | Related Articles | Metrics

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Comparison of clinical efficacy of the double-incision locking plate combined with Osteobone implantation and autogenous iliac bone graft in the treatment of complex tibial plateau fractures   Yi Gang, Zhang Lei, Fu Shijie, Guo Xiaoguang, Liu Yang, Qin Bo, Luo Yuanfa, Wang Guoyou 2019, 23 (16):  2486-2492.  doi: 10.3969/j.issn.2095-4344.1204 Abstract ( 411 )   PDF (1616KB) ( 117 )   Save BACKGROUND: There are controversies about the treatment options for tibial plateau fractures. OBJECTIVE: To compare the clinical efficacy of double-incision locking plate combined with Osteobone implantation and autologous iliac bone graft in the treatment of complicated tibial plateau fractures. METHODS: Clinical data of 71 patients with complex tibial plateau fractures who underwent open reduction and internal fixation with double-incision locking plate and bone graft from January 2015 to January 2017 at the Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University were analyzed retrospectively. Among them, 35 cases (observation group) were treated with double-incision locking plate combined with Osteobone implantation bone graft, and 36 cases (control group) were treated with double-incision locking plate combined with autologous iliac bone graft. The informed consents were obtained from all patients and the trial was approved by the Ethics Committee of the hospital. The operation time, intraoperative blood loss, postoperative drainage volume and fracture healing time were compared between two groups. The Knee Injury and Osteoarthritis Outcome score, Hospital for Special Surgery score and Rasmussen imaging score were recorded in detail after operation. During the follow-up, the complications were statistically analyzed.   RESULTS AND CONCLUSION: (1) The two groups of patients healed after treatment. (2) Follow-up results showed that the operation time, intraoperative blood loss, postoperative drainage volume, fracture healing time, pain and symptom points in Knee Injury and Osteoarthritis Outcome score, collapse score and total score in Rasmussen imaging, and incidence of complications in the observation group were significantly better than those in the control group (P < 0.05). (3) The varus score and condylar widening score in Rasmussen imaging, and ability of daily living, sports and entertainment points in Knee Injury and Osteoarthritis Outcome score showed no significant differences between two groups (P > 0.05). (4) These results imply that compared with the autologous iliac bone graft, the treatment of complex tibial plateau fractures with the double-incision locking plate internal fixation combined with Osteobone implantation can shorten the operation time, reduce bleeding and complications, form a stronger support, and accelerate fracture healing. Figures and Tables | References | Related Articles | Metrics

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Efficacy and safety of proximal femoral anatomical locking compression plate and proximal femoral nail antirotation for long-segment comminuted subtrochanteric fractures of the femur: a non-randomized controlled trial   Zhang Jierong, Xiong Shixi, Tian Xiaolin, Gao Fangmao, Lin Chao, Yang Lixue 2019, 23 (16):  2493-2499.  doi: 10.3969/j.issn.2095-4344.1205 Abstract ( 372 )   PDF (5754KB) ( 93 )   Save BACKGROUND: The proximal femoral anatomical locking compression plate and proximal femoral nail antirotation device are commonly used in the treatment of long-segment comminuted subtrochanteric fractures of the femur. However, few studies have evaluated the difference in efficacy and safety between these two implants. OBJECTIVE: To compare the efficacy and safety of the proximal femoral anatomical locking compression plate versus proximal femoral nail antirotation in the treatment of long-segment comminuted subtrochanteric fractures of the femur, and to identify the optimal implant treatment plan. METHODS: This prospective, single-center, non-randomized controlled clinical trial will include 180 patients with long-segment comminuted subtrochanteric fractures of the femur from Sanya Traditional Chinese Medicine Hospital, China. The patients will be equally divided into a locking compression plate group and a proximal femoral nail antirotation group (n=90). All patients will be followed up at 2 and 10 months postoperatively. Patient recruitment and data collection will begin on 30 June 2019 and end on 30 June 2020. Analysis of the results will be performed from 1 to 30 July 2020. This study will be scheduled to end on 1 August 2022. This study was approved by the Medical Ethics Committee of Sanya Traditional Chinese Medicine Hospital in China on 15 March 2013 (approval No. (2013) (02)). This study will be performed in strict accordance with the Declaration of Helsinki formulated by the World Medical Association. Written informed consent regarding the study protocol and surgery procedure will be obtained from the participants’ family members or the participants themselves. This trial had been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1900021251) on 3 February 2019. Protocol version (1.0). RESULTS AND CONCLUSION: (1) The primary outcome measure is the rate of excellent and good Harris hip scores at 10 months postoperatively; this rate will be used to evaluate the recovery of hip function after repair. (2) The secondary outcome measures are the rate of excellent and good Harris hip scores preoperatively and 2 months postoperatively, intraoperative blood loss, operation time, incision length, hospital stay, fracture healing time, hip morphology on radiographs preoperatively and 2 months postoperatively, and incidence of adverse events 2 and 10 months postoperatively. (3) Our pilot study involved 80 patients with long-segment comminuted subtrochanteric fractures of the femur from February 2013 to February 2016 (locking compression plate group, n=40; proximal femoral nail antirotation group, n=40). The 10-month follow-up results showed that the intraoperative blood loss, operation time, incision length, hospital stay, and fracture healing time were lower in the proximal femoral nail antirotation group than in the locking compression plate group (P < 0.05). The rate of an excellent and good Harris hip score was higher in the proximal femoral nail antirotation group than in the locking compression plate group (P < 0.05). The complication rate was lower in the proximal femoral nail antirotation group (10.0%) than in the locking compression plate group (12.5%) (P > 0.05). These pilot study results in 80 patients verified higher efficacy and safety of proximal femoral nail antirotation than locking compression plate fixation in the treatment of long-segment comminuted subtrochanteric fractures of the femur. The results of the present study will provide evidence indicating whether proximal femoral nail antirotation in the treatment of long-segment comminuted subtrochanteric fractures of the femur can facilitate better recovery of hip function and higher safety than anatomical locking compression plate fixation. Figures and Tables | References | Related Articles | Metrics

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Internal fixation with locking plate and nail for treating Sanders III calcaneal fractures: one-year follow-up of modified “L-shape” incislon and bone graft versus “L-shape” incision without bone gratft   Kong Changgeng, Guo Xiang, Wu Duoqing 2019, 23 (16):  2500-2505.  doi: 10.3969/j.issn.2095-4344.1206 Abstract ( 288 )   PDF (6417KB) ( 109 )   Save BACKGROUND: Open reduction and internal fixation is the main treatment method for complex intra-articular fractures of the calcaneus, but the traditional “L” type incision related complications are still high, and there is still much controversy about intraoperative bone grafting. Therefore, choosing appropriate surgery is a hot topic for scholars at home and abroad to improve the clinical efficacy and reduce postoperative complications. OBJECTIVE: To investigate the clinical outcomes of modified “L-shape” incision and internal fixation with bone graft in the treatment of the Sanders III calcaneal fractures. METHODS: Data of 82 patients of fresh unilateral Sanders III type calcaneal fractures followed up for more than 1 year were retrospectively analyzed. The patients were divided into two groups: There were 42 cases in group of modified “L-shape” incision with bone graft (group A) and 40 cases in group of “L-shape” incision with non-bone graft (group B). The operation time, incision healing time, hospitalization time, weight-bearing time, foot function, complication rate and imaging parameters before and after operation were compared between two groups. RESULTS AND CONCLUSION: (1) Operation time, wound healing time, hospitalization time and weight bearing time were shorter in the group A than in the group B (P < 0.05). (2) There was no significant difference while comparing the two group’s Böhler’s angle, Gissane’s angle, calcaneal width and calcaneal height, on the first day after operation (P > 0.05). (3) At 1-year follow-up, there was no significant difference in the Gissane’s angle and calcaneal width between the two groups (P > 0.05), and there was a significant difference in Böhler’s angle and calcaneal height (P < 0.05), and the Böhler’s angle was lost in both groups (P < 0.05). (4) The Maryland Foot Score and excellent rate at the 1-year follow-up visit, with the differences being significant (P < 0.05). (5) The incidence of incision complications in group A was significantly lower than that in group B (12% vs. 30%), and this difference was significant (P < 0.05). (6) The modified “L-shape” incision with bone graft and internal fixation in treatment of the Sanders III type calcaneal fractures can obtain good reduction, lower postoperative incision complications. The bone grafting reduces Böhler’s angle loss and can obtain satisfactory clinical results. Figures and Tables | References | Related Articles | Metrics

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Relationship between bone mineral density of lumbar vertebrae and fat distribution in young adults assessed by quantitative CT Li Jialu, Cheng Xiaoguang, Jiang Tao, Zhao Hui, Zhang Jun 2019, 23 (16):  2506-2510.  doi: 10.3969/j.issn.2095-4344.1207 Abstract ( 416 )   PDF (1371KB) ( 87 )   Save BACKGROUND: Bone mineral density is used for the diagnosis of osteoporosis, and bone mineral density is related to genetic, environment and fat distribution factors. Dual energy X-ray absorptiometry and quantitative CT are main methods of measuring bone mineral density. OBJECTIVE: To investigate the relationship between lumbar spine bone mineral density and fat distribution in young adults by quantitative CT.   METHODS: Totally 262young adults aged 20-40 years in Beijing urban and suburb areas were screened based on inclusion and exclusion criteria, and all volunteers provided written informed consents. Quantitative CT was used to measure the intra-abdominal fat area, subcutaneous fat area and total abdominal fat area of L2-L4 bone mineral density and L4 vertebrae. The relationship between bone mineral density and fat distribution was analyzed by Pearson correlation analysis and multivariate linear regression. RESULTS AND CONCLUSION: (1) The area of intra-abdominal fat was negatively correlated with bone mineral density in young adults in Beijing (P < 0.05). (2) The area of subcutaneous fat and total abdominal fat were not correlated with bone mineral density. (3) Therefore, it is suggested to measure the bone mineral density of lumbar spondylous bone in young people and control obesity, so as to prevent osteoporosis and make early diagnosis. Figures and Tables | References | Related Articles | Metrics

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Imaging evaluation of Zero-P interbody fixation and fusion system versus titanium plate with cage interbody fixation and fusion system for treating cervical disc herniation    Wang Feng, Long Yaowu, Zhao Rui, Yuan Zhirui, Zhao Xiaodong 2019, 23 (16):  2511-2515.  doi: 10.3969/j.issn.2095-4344.1208 Abstract ( 569 )   PDF (1177KB) ( 98 )   Save BACKGROUND: Anterior cervical discectomy and decompression, and fusion for treating cervical disc herniation have significant effects, but there are shortcomings such as cervical instability and low fusion rate. Titanium plate with cage interbody fixation and fusion system can make up for these shortcomings, but there are still some common complications. A new Zero-P interbody fixation and fusion system with support and fixation function is widely used in clinical practice. OBJECTIVE: To compare the clinical effect of a new Zero-P interbody fixation and fusion system and titanium plate with cage interbody fixation and fusion system for treating cervical disc herniation. METHODS: Clinical data of 42 patients with single-segment cervical spondylosis admitted at Foshan Chancheng Central Hospital from January 2016 to June 2017 were analyzed retrospectively. According to the surgical method, 21 cases were treated with Zero-P interbody fixation and fusion system (Zero-P group) and 21 cases with titanium plate with cage interbody fixation and fusion system (titanium plate group). The operation time, intraoperative blood loss, Japanese Orthopaedic Association score and improvement rate, dysphagia, Cobb angle, and height and increase rate of the fused segment were compared between two groups. RESULTS AND CONCLUSION: (1) There was no significant difference in the intraoperative blood loss between two groups (P > 0.05), and the operation time in the Zero-P group was significantly shorter than that in the titanium plate group (P < 0.05). (2) The Japanese Orthopaedic Association scores in the two groups were significantly increased at 3, 6 and 18 months postoperatively (P < 0.05), and no significant difference was found in the scores and score improvement rate between two groups at the same follow-up time (P > 0.05). (3) Two patients (10%) in the titanium plate group developed mild dysphagia at 6 months after surgery, while the symptoms of dysphagia in the Zero-P group disappeared. There was still one case (5%) of mild dysphagia in the titanium plate group at postoperative 18 months. (4) The Cobb angle in the Zero-P group was significantly different from the titanium plate group at 3, 6 and 18 months postoperatively (P < 0.05). (5) There was no significant difference in the rate of height increase between two groups at 3 months postoperatively (P > 0.05). There was a significant difference in the rate of intervertebral height between two groups postoperative at postoperative 6 and 18 months (P < 0.05). (6) To conclude, Zero-P interbody fixation and fusion system and titanium plate with cage interbody fixation and fusion system for treating cervical disc herniation both can achieve good results. However, Zero-P interbody fixation and fusion system is more conducive to maintaining cervical curvature and intervertebral height, and reducing the incidence of postoperative dysphagia. Figures and Tables | References | Related Articles | Metrics

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Role of bone status in anterolateral portion of femoral head in the progression of osteonecrosis of the femoral head Wei Qiushi, Fang Bin, Chen Zhenqiu, He Mincong, Chen Xiaojun, Yang Fan, Zhang Qingwen, He Wei 2019, 23 (16):  2516-2522.  doi: 10.3969/j.issn.2095-4344.1148 Abstract ( 389 )   PDF (1256KB) ( 130 )   Save BACKGROUND: Mechanical stress plays an important role in the progressive collapse in osteonecrosis of the femoral head. Therefore, the bone structure of weight-bearing area may be the risk factor for collapse. OBJECTIVE: To investigate the relationship between the bone preservation of weight-bearing area and collapse progression in necrotic femoral head. METHODS: Eighty-seven patients (102 hips) with ARCO stage II osteonecrosis of the femoral head, diagnosed by MRI, were enrolled. All patients underwent a natural progression. Collapse and bone involvement of the weight-bearing area were viewed by anteroposterior and frog-leg lateral radiographs. According to the location of the necrotic lesion on the anterolateral portion of the femoral head, the necrosis was divided into three types: type 1, the posteromedial and central portions; type 2, part of the anterolateral portion; type 3, the entire anterolateral portion. The collapse rate and the time to collapse in different types were assessed. RESULTS AND CONCLUSION: (1) All patients were followed up for 3-58 months. (2) Of the 60 hips with collapse, 46 (76.7%) hip collapse was identified on anteroposterior radiograph. On frog-leg lateral radiograph showing collapsed femoral head could be identified in 57 (95.0%) hips, which was significantly different (P < 0.01). (3) In all 102 hips, the collapse rate in type 3 osteonecrosis of the femoral head was significantly higher than that of type 2 osteonecrosis of the femoral head (P < 0.001), and the time to collapse was markedly shortened. None collapse occurred in all six hips with type I osteonecrosis of the femoral head during follow-up. (4) In summary, preservation of anterolateral portion is associated with potential collapse progression in necrotic femoral head. Figures and Tables | References | Related Articles | Metrics

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Assessment of seven joint ultrasound score for early rheumatoid arthritis Hu Xiaoli, Gu Ying, Cai Yan, Xie Jin, Liu Chan 2019, 23 (16):  2523-2528.  doi: 10.3969/j.issn.2095-4344.1209 Abstract ( 446 )   PDF (1252KB) ( 120 )   Save BACKGROUND: Early discovery, diagnosis and treatment are critical for the prevention and treatment of early rheumatoid arthritis. Ultrasound scoring system can provide quantified data for the disease diagnosis and treatment. OBJECTIVE: To study the application value of seven joint ultrasound score in the diagnosis and treatment of early rheumatoid arthritis. METHODS: Fifty patients with early rheumatoid arthritis were as observation group, and 70 healthy subjects were as control group. All subjects were examined by high-frequency ultrasound. The joints included wrist joints, proximal interphalangeal joint of the second finger, proximal interphalangeal joint of the third finger, metacarpophalangeal joint of the second finger, metacarpophalangeal joint of the third finger, second metatarsophalangeal joint and fifth metatarsophalangeal joint. The seven joint ultrasound scores were compared between two groups. According to the clinical data, the seven joint ultrasound scores of patients with early rheumatoid arthritis at different stages of disease activity, function classification and grading signs were compared. The serum levels of high-sensitivity C-reactive protein and interleukin-6 were detected in the observation group. The seven joint ultrasound scores were compared between high-sensitivity C-reactive protein and interleukin-6 positive and negative groups.  RESULTS AND CONCLUSION: (1) The average score of seven joints in the observation group was higher than that in the control group (P < 0.05), and the average seven joint ultrasound score was higher than that in the control group (P < 0.05). (2) For the average seven joint ultrasound score, staging of disease activity in moderate severe group > stable and mild activity group (P < 0.05), grade III-IV group > grade I-II group (P < 0.05), sign grade II-III group > sign grade 0-I group (P < 0.05), and high-sensitivity C-reactive protein and interleukin-6 positive group > negative group (P < 0.05). (3) To conclude, the seven joint ultrasound score can fully describe the basic clinical characteristics of early rheumatoid arthritis, and can evaluate the disease activity, functional activity, the inflammatory degree and the degree of joint injury, so as to provide a reference for the diagnosis and treatment of early rheumatoid arthritis. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional models of Lenke3 type adult idiopathic scoliosis simulating orthopedic surgeries   Xin Daqi, Yang Xuejun, Wang Guoqiang, Xiao Yulong, Hu Zhenming, Xing Wenhua, Zhao Yan, Fu Yu, Zhu Yong, Bai Xianming 2019, 23 (16):  2529-2537.  doi: 10.3969/j.issn.2095-4344.1210 Abstract ( 398 )   PDF (3047KB) ( 80 )   Save BACKGROUND: Due to diversity and stiffness of adult idiopathic scoliosis, individualized patients need orthopedics and individualized design, which affect the surgical safety and prognosis. Making the surgical scheme should consider the factors affecting the orthopedics of thoracolumbar scoliosis. OBJECTIVE: To stimulate different surgical methods on the corrected model of Lenke3 type adult idiopathic scoliosis, and to understand the stress of pedicle screw and orthopedic efficacy.  METHODS: In optimized finite element model of Lenke3 type adult idiopathic scoliosis, finite element operations were simulated separately, including simulating different combinations: Case1:posterior vertebral key pedicle screw and posterior capsular release surgery; Case2: posterior vertebral key pedicle screw and posterior capsular release surgery as well as anterior release for thoracic scoliosis; Case3: posterior vertebral key pedicle screw and posterior capsular release surgery and anterior release for lumbar scoliosis; Case4: posterior vertebral key pedicle screw and posterior capsular release surgery and anterior release for thoracolumbar side convex; Case5: posterior vertebral key pedicle screwing and posterior capsular release surgery and anterior thoracolumbar scoliosis release surgery. The effectiveness and the biomechanical characteristics of three-dimensional orthopedics of different surgical programs in patients with Lenke3 type adult idiopathic scoliosis. RESULTS AND CONCLUSION: (1) Five surgical schemes were completed successfully on the optimized finite element model. (2) The maximum stress value in each pedicle screw was lower than the threshold of the screw itself, which concentrated on the L4 down side. (3) The orthopedic rates of thoracic spine scoliosis in Case1-5 were 63.9%, 59.9%, 67.6%, 61.5%, 66.4%, respectively, and orthopedic rates of lumbar scoliosis were 39.1%, 32.2%, 36.8%, 42.9%, 49.3%, respectively. (4) The experimental results of thoracic release surgery in Case3 and 5 showed the effectiveness of its orthopedics have no significant increase, but the stress of their respective pedicle screw structure would be significantly reduced. The results of Case4 and 5 showed its stresses in the vertebral body derotation and lumbar/thoracic screws are much better than other groups. (5) These experimental results provide quantitative indicators for finite element biomechanical study on adult idiopathic scoliosis, and subsequently provide some theoretical support to predict therapeutic effect of orthopedic surgery and formulate clinical programs for patient with Lenke3 type of adult idiopathic scoliosis. Figures and Tables | References | Related Articles | Metrics

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Etiology and diagnostic imaging of heterotopic ossification after total hip arthroplasty Mu Xinyan, Chang Xiaodan, Zhao Dewei 2019, 23 (16):  2538-2544.  doi: 10.3969/j.issn.2095-4344.1211 Abstract ( 515 )   PDF (1479KB) ( 76 )   Save BACKGROUND: Heterotopic ossification is a common complication after total hip arthroplasty, and there are no obvious clinical symptoms, but more severe heterotopic ossification can cause postoperative pain and joint mobility. The pathogenesis of heterotopic ossification is not fully understood, and there are many factors that can increase the incidence of heterotopic ossification. Because there is no effective non-surgical treatment of mature heterotopic ossification in clinical practice, it is especially important for the early diagnosis of heterotopic ossification. OBJECTIVE: To summarize the current research and progress of heterotopic ossification after total hip arthroplasty. METHODS: The first author searched PubMed, Springerlink and CNKI databases for the articles between 2008 and 2018. The keywords were “total hip arthroplasty, heterotopic ossification” in English and Chinese, respectively. Totally 278 English articles and 97 Chinese articles were retrieved, and 53 eligible articles were included for analysis and summary. RESULTS AND CONCLUSION:(1) At present, the pathogenesis of heterotopic ossification is not fully understood, and is related to systemic and local factors. (2) The risk factors for heterotopic ossification are divided into variable factors and invariable factors, and age, man, ankylosing spondylitis, history of hip surgery, hip ankylosis and other factors can increase the incidence of heterotopic ossification. (3) The diagnosis of heterotopic ossification mainly depends on imaging examination. The imaging findings of heterotopic ossification in different periods are different, and the sensitivity and specificity of different imaging examination methods for heterotopic ossification are also different. (4) There are various conclusions about the risk factors of heterotopic ossification, and there is no recognized best imaging examination method, but many research and analysis results can provide a basis for clinical prevention and diagnosis of heterotopic ossification after total hip arthroplasty. Figures and Tables | References | Related Articles | Metrics

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Development and prevention strategy of proximal junctional kyphosis after scoliosis surgery Dai Jianjun, Xing Wenhua 2019, 23 (16):  2545-2552.  doi: 10.3969/j.issn.2095-4344.1212 Abstract ( 294 )   PDF (1207KB) ( 90 )   Save BACKGROUND: With the rapid development of spinal orthopedic techniques, the posterior selective fusion of the spine can achieve good clinical results. However, proximal junctional kyphosis and proximal junctional failure are common complications after spinal deformity surgery. OBJECTIVE: To elaborate the progress factors of proximal junctional kyphosis, and summarize the prevention strategies to reduce the incidence of proximal junctional kyphosis and proximal junctional failure. METHODS: Relevant articles published from January 1994 to October 2018 were retrieved from PubMed databases. The keywords were “proximal junctional kyphosis, PJK”. The old and repeated articles were excluded, and 59 eligible articles were included for review. RESULTS AND CONCLUSION: (1) The incidence of proximal junctional kyphosis tends to be 20%-40%. (2) Risk factors for proximal junctional kyphosis include age, body mass index, low bone mineral density, preoperative sagittal imbalance, multiple diseases, combined anterior and posterior surgery, posterior ligament complex injury, and overcorrection. (3) Vertebroplasty, transverse hook, and ligament enhancement can reduce the incidence of proximal junctional kyphosis. Figures and Tables | References | Related Articles | Metrics

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Application of finite element technology in lumbar degenerative diseases Sun Ke, Yang Xuejun 2019, 23 (16):  2553-2559.  doi: 10.3969/j.issn.2095-4344.1213 Abstract ( 375 )   PDF (2731KB) ( 81 )   Save BACKGROUND: Because conservative treatment of lumbar degenerative diseases cannot fundamentally solve the causes of compression or deformity, many patients choose surgical treatment when conservative treatment is ineffective or combined with nerve root lesions. The biomechanical characteristics of lumbar degenerative diseases and their diagnosis and treatment are of particular concerns to clinicians. Compared with the traditional biomechanical experimental methods, the finite element method has the advantages of high reliability, low cost and good repeatability. OBJECTIVE: To study the stress and stability of lumbar degenerative diseases and lumbar spine after fusion by finite element method, and to analyze the application of finite element method in lumbar degenerative diseases. METHODS: PubMed data (http://www.ncbi.nlm.nih.gov/PubMed) and CNKI (http://www.cnki.net/) were retrieved by the first author until October 2018. The keywords were “lumbar vertebra, finite element method, biomechanics” in English and Chinese, respectively. Repetitive studies were excluded, and 43 articles eligible for inclusion criteria were included, including 18 Chinese and 25 English articles. RESULTS AND CONCLUSION: (1) It is of great significance to study the diagnosis and treatment process of lumbar degenerative diseases using finite element method, and it provides biomechanical basis for clinicians. (2) With the rapid development of science and technology and the gradual improvement of finite element model, it is possible to use finite element technology to develop personalized treatment for patients. (3) It is believed that with the development of computer technology, the finite element technology will be more perfect and provide more help for clinicians. Figures and Tables | References | Related Articles | Metrics

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Effects and influencing factors of neurophysiological monitoring on reducing the risk of nerve injury in spine surgery   Li Manglai, Yang Xuejun 2019, 23 (16):  2560-2565.  doi: 10.3969/j.issn.2095-4344.1169 Abstract ( 368 )   PDF (1045KB) ( 64 )   Save BACKGROUND: In recent decades, intraoperative neurophysiological monitoring technology has become an indispensable part in neurosurgery surgery, spine surgery and hand and foot surgery with rapid development. Proper use of intraoperative neurophysiological monitoring can reduce or avoid nerve injury intraoperatively. But there are many influencing factors of intraoperative neurophysiological monitoring technique, which will affect the accuracy of monitoring and lead to abnormal monitoring results. OBJECTIVE: To summarize the research status of mechanism and influencing factors of neurophysiological monitoring in spinal surgery. METHODS: The articles addressing the mechanism and influencing factors in intraoperative neurophysiological monitoring during spine surgery were retrieved in PubMed and CNKI databases. The keywords were “neurophysiologic monitoring, somatosensory evoked potential, motor evoked potential, electromyogram, propofol, muscle relaxants” in English and Chinese, respectively. A total of 52 eligible articles were included. RESULTS AND CONCLUSION: (1) The research progress of neurophysiological monitoring during spinal surgery and the influencing factors of neurophysiologic monitoring have been investigated in recent years. It is found that there are few studies on the mechanism and the influencing factors of neurophysiological monitoring during spinal surgery, but the literature concerning single factor is few, but the direct correlation of each study is closed. (2) Neurophysiological monitoring in spinal surgery is mature and widely used in clinical practice, which can significantly reduce the risk of intraoperative nerve injury. However, there are many influencing factors, which may have adverse effects on the monitoring results and affecting the surgical process and results. (3) Understanding the related factors and taking measures can improve the accuracy of intraoperative neurophysiological monitoring and reduce the risk of nerve injury. Figures and Tables | References | Related Articles | Metrics

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High intensity laser therapy for common sports injuries and orthopedic diseases Lü Ting, Ding Jie, Qian Yi, He Chen, Gao Feng, Xi Rui, Zhou Jingbin, Kong Xiliang 2019, 23 (16):  2566-2572.  doi: 10.3969/j.issn.2095-4344.1214 Abstract ( 817 )   PDF (1072KB) ( 139 )   Save BACKGROUND: High energy laser therapy has good penetration and high output power, and has broad prospects in the treatment of common orthopedic diseases and common sports injuries, such as degenerative diseases of bone and joints, chronic muscle and soft tissue injuries, and spinal diseases. At present, the clinical application of this therapy lacks a unified standard, and there is a lack of evidence-based medical support in terms of indications, parameters and courses of treatment. Therefore, more randomized controlled studies are needed. OBJECTIVE: To provide theoretical and methodological basis for high-energy laser therapy in the treatment of common sports injuries and orthopedic diseases. METHODS: Databases of PubMed, CNKI, and WanFang were searched from May-July, 2018. The keywords were “high intensity laser therapy, sports injuries, physical therapy, osteoarthritis degenerative disease, chronic muscle soft tissue injury, spinal disease” in English and Chinese, respectively for the articles published from 2010 to 2018. RESULTS AND CONCLUSION: (1) Twenty-one eligible articles were included in the study, including diseases such as osteoarticular degenerative diseases, chronic muscle soft tissue injuries, spinal diseases, metabolic diseases, and acute muscle and soft tissue injuries. (2) When dealing with the same disease, the parameters of high energy laser therapy have different choices. The course of the disease, the severity of the condition, and the thickness of the body’s blocking tissue may affect the adjustment of the treatment. (3) High energy laser therapy can reduce inflammation, production of painful substances, promote blood circulation and lymph circulation, and repair damaged tendons. High energy laser therapy can cure local bone loss and stimulate new bone formation. The treatment effect on common sports injuries and orthopedic diseases is expected. Figures and Tables | References | Related Articles | Metrics

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Application status and mechanism of musculoskeletal ultrasound in orthopedic diagnosis   Zhou Xuetian, Ma Yong, Guo Yang, Si Yuhao, Zong Yonggang, Zhong Chao 2019, 23 (16):  2573-2578.  doi: 10.3969/j.issn.2095-4344.1167 Abstract ( 456 )   PDF (2185KB) ( 119 )   Save BACKGROUND: With the maturation of musculoskeletal ultrasound, it is widely used in orthopedic diagnosis. OBJECTIVE: To review the application status of musculoskeletal ultrasound in the diagnosis of muscle and tendon, bone and cartilage, joint and nerve in recent years, and to explain its principle, advantages and disadvantages. METHODS: “Musculoskeletal ultrasound, orthopedics” in Chinese and English, respectively were as keywords to retrieve in CNKI, PubMed databases, and Elsevier databases for the articles published from 2013 to 2018. Forty-four articles about the application of musculoskeletal ultrasound in orthopedic diagnosis were reviewed. RESULTS AND CONCLUSION: (1) In the diagnosis of soft tissue diseases such as muscle, tendon, fascia and other soft tissue diseases, as well as in the examination of occult fractures, early arthritis and other diseases of bone and joint, musculoskeletal ultrasound is superior to MRI and CT, because it is simple, cheap, has high sensitivity and no radiation. (2) It can be used as the first choice to judge the recovery of function and the injury of peripheral nerve after operation because it can dynamically analyze the movement of muscles and bones and observe the changes of peripheral nerve. (3) In the future, the application of musculoskeletal ultrasound in the diagnosis of delayed muscle soreness and quantification of tendon abnormalities will be a new research direction. Figures and Tables | References | Related Articles | Metrics

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Proximal femoral nail antirotation versus hemiarthroplasty in treatment of unstable intertrochanteric fracture in older adults: a meta-analysis   Ouyang Jianfeng, Li Bingquan, Xuan Wenhu, Wang Suwei 2019, 23 (16):  2579-2584.  doi: 10.3969/j.issn.2095-4344.1185 Abstract ( 335 )   PDF (1235KB) ( 110 )   Save BACKGROUND: Surgical treatment is an accepted method for intertrochanteric fractures. For the older adults accompanied by severe osteoporosis and other diseases, how to treat intertrochanteric fractures still remains controversial. OBJECTIVE: To evaluate the effectiveness and safety of proximal femoral nail antirotation versus hemiarthroplasty in the treatment of unstable intertrochanteric fractures in older adults through meta-analysis. METHODS: According to the Cochrane system evaluation, a computer-based retrieval of Medline, PubMed, SPINGER, John Wiley, Science Direct, EBSCO, CNKI, WanFang, and VIP databases between 2008 and 2018 was performed. The keywords were “proximal femoral nail antirotation or PFNA, hemiarthroplasty, unstable intertrochanteric fractures” in English and Chinese, respectively. The literate was screened based on inclusion and exclusion criteria, and then quality evaluation was conducted. Meta-analysis was undergone on the Rev-Man 5.1 software. RUSULTS AND CONCLUSION: (1) Thirteen clinical trials were included, involving 1 223 patients, and including 6 randomized controlled trials. (2) Meta-analysis results showed that the operation time in the proximal femoral nail antirotation group was shorter [MD=-6.54, 95%Cl (-12.81, -0.21), P < 0.01], intraoperative blood loss was lower [MD=-130.83, 95%CI (-190.99, -70.68), P < 0.01], and the incidence of implant complications was higher [RR=2.32, 95%Cl (1.12, 4.84), P < 0.01] compared with the hemiarthroplasty group. (3) In the hemiarthroplasty group, the ambulation time was earlier [MD=18.06, 95%CI (10.3, 25.79), P < 0.000 1], and the Harris scores were increased [MD=-8.19, 95%Cl (-9.45, -6.93), P < 0.01] compared with the proximal femoral nail antirotation group. (4) There was no significant difference in the postoperative complications, hospitalization time or excellent and good rate in Harris scores between two groups (P > 0.05). (5) In summary, the operation time in the proximal femoral nail antirotation group is shorter and the amount of bleeding was less than those in the hemiarthroplasty group, but the incidence of implant complications is higher than that in the hemiarthroplasty group. The hemiarthroplasty group has an advantage in postoperative Harris score and postoperative loading time. Figures and Tables | References | Related Articles | Metrics

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Postoperative hip function of different hip joint preserving surgeries for osteonecrosis of femoral head: a network meta-analysis   Zhang Chi, Lü Haoyuan, Zhang Xiaoyun, Lin Zonghan, Chen Yueping, Zhu Jianglong, Long Feipan, Huang Junli, Mei Pengfei 2019, 23 (16):  2585-2593.  doi: 10.3969/j.issn.2095-4344.1215 Abstract ( 327 )   PDF (2383KB) ( 87 )   Save BACKGROUND: Hip joint preserving surgeries for osteonecrosis of femoral head has been a hotspot in recent years. At present, researchers have developed a variety of hip joint preserving surgical treatment programs, and the optimal treatment plan is still controversial. OBJECTIVE: To compare the postoperative hip function of different hip joint preserving surgeries for osteonecrosis of femoral head. METHODS: PubMed, Embase, The Cochrane Library, CBM, CNKI, WanFang and VIP databases were searched. According to the inclusion and exclusion criteria, literature screening, quality evaluation and data extraction were performed, and the network meta-analysis was conducted. RESULTS AND CONCLUSIONS: (1) A total of 23 randomized controlled trials were included, involving a total of 1 248 hips and 12 surgical treatment options. (2) Meta-analysis results showed that the Harris hip score at postoperative last follow-up of the core decompression combined with bone grafting and free vascularized fibular grafting was the highest. (3) Core decompression combined with bone marrow mesenchymal stem cells and tantalum rod was the second. (4) The above conclusions need to be further confirmed by high-quality randomized controlled trials. Figures and Tables | References | Related Articles | Metrics

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Preoperative skin traction for hip fractures: a systematic review   Wei Zhihui, Zhang Minghua, Zhang Zhongzu, Jiang Lian 2019, 23 (16):  2594-2600.  doi: 10.3969/j.issn.2095-4344.1216 Abstract ( 512 )   PDF (1424KB) ( 99 )   Save BACKGROUND: It is still controversial whether skin traction is suitable for hip fracture preoperatively. High-quality evidence-based medical evidence is needed to evaluate the advantages and disadvantages of the two methods. OBJECTIVE: To systematically review the efficacy and safety of preoperative skin traction versus non-traction in the treatment of hip fractures. METHODS: Databases of The Cochrane Library, Medline, EMbase, PubMed, VIP, WanFang and CNKI before August, 2018 were searched. The randomized controlled trials of skin traction and non-traction were retrieved. The Visual Analog Scale, administration of analgesic drugs, pressure sore, other complications, failure rate of fracture reduction, operation time and pain relief scores were conducted for meta-analysis using RevMan 5.3 software. RESULTS AND CONCLUSION: (1) Thirteen randomized controlled trials, including 1 658 patients, were included. (2) Meta-analysis results showed that there was no significant difference in the Visual Analog Scale,administration of analgesic drugs, incidence of other complications, failure rate of fracture reduction, fracture reduction difficulty, operation time and pain relief cores between two groups (P > 0.05). (3) The incidence of pressure sore in the non-traction group was significantly superior to the traction group (P < 0.05). (4) These results indicate that preoperative skin traction in hip fracture cannot relieve pain, or reduce the difficulty of reduction. On the contrary, it increases the incidence of pressure sores. However, the available evidence is insufficient to exclude the potential advantages of traction, especially in alleviating psychological stress in patients, so skin traction can be used according to practical experience. Figures and Tables | References | Related Articles | Metrics

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Effect of proprioceptive and balance training on rehabilitation of knee joint after total knee arthroplasty: a meta-analysis   Lu Yanyan, Xu Xuemeng, Liu Wengang, Du Jianping, Chen Guocai, Chen Guoqian, Qiu Bofan, Zheng Yi, Wu Zugui 2019, 23 (16):  2601-2607.  doi: 10.3969/j.issn.2095-4344.1217 Abstract ( 466 )   PDF (1468KB) ( 103 )   Save BACKGROUND: The effects of proprioceptive and balance training in the rehabilitation of patients after total knee arthroplasty have been studied much, which have been shown to improve the postoperative balance and posture controlling abilities and reduce risk for falls. However, there is a lack of evidence-based medicine due to differences in research level and quality. OBJECTIVE: To systematically evaluate the effects of proprioceptive and balance training on early rehabilitation after total knee arthroplasty. METHODS: Databases of CNKI, CBM, VIP, WanFang, PubMed, web of science, Cochrane Library and Embase were searched for randomized controlled trials concerning the effects of proprioceptive and balance training on knee joint after arthroplasty. Meta-analysis was completed with Review Manager 5.3 software. RESULTS AND CONCLUSION: (1) Twelve articles involving 688 patients were included. (2) The results of meta-analysis showed that the proprioceptive and balance training group had a significant improvement in timed up and go (WMD=-1.94, 95%CI: -3.47 to -0.41, P=0.01), Berg balance scale (WMD=6.48, 95%CI: 4.49-8.48, P < 0.000 01), single-leg stand balance (WMD=2.47, 95%CI: 2.07-2.87, P < 0.000 01), Biodex stability system (WMD=-0.42, 95%CI: -0.68 to -0.15, P=0.002), Hospital for Special Surgery function score (WMD=3.65, 95%CI: 1.72-5.58, P=0.000 2), Hospital for Special Surgery stability score (WMD=1.35, 95%CI: 0.71-2.00, P < 0.000 1), and EQ-5D-VAS (WMD=7.83, 95%CI: 1.11-14.54, P=0.02), compared with the conventional control group. (3) There was no significant difference between two groups in the angel reduction error (WMD=-3.23, 95%CI: -7.55-1.10, P=0.14), Hospital for Special Surgery pain score (WMD=2.22, 95%CI: -0.43-4.86, P=0.10), flexion deformity score (WMD=0.40, 95%CI: -0.69-1.49, P=0.47), range of motion (WMD=1.06, 95%CI: -0.86-2.98, P=0.28), or muscle strength (WMD=1.27, 95%CI: -0.03-2.57, P=0.05). (4) According to the results of this analysis, proprioceptive and balance training can effectively improve balance capacity, knee joint function and the quality of life for patients after total knee arthroplasty. While the results of pain, flexion deformity, range of motion of joint and muscle strength need to be interpreted carefully, which need to be confirmed through large sample size and high quality long-term follow-up studies. Figures and Tables | References | Related Articles | Metrics

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C3 laminectomy versus C3 laminoplasty for treating multi-segment cervical spondylotic myelopathy: a meta-analysis   Chang Jianzhong, Xiao Wei, Jin Qi, Sun Chengjun, Zhou Yichi, Zhao Zufa, Mao Xiaobing 2019, 23 (16):  2608-2613.  doi: 10.3969/j.issn.2095-4344.1218 Abstract ( 337 )   PDF (1352KB) ( 85 )   Save BACKGROUND: There are few objective evaluations concerning efficacy of C3 laminectomy versus C3 laminoplasty in posterior cervical expansive open-door laminoplasty and their effects on cervical function. OBJECTIVE: To systematically evaluate the efficacy of C3 laminectomy versus C3 laminoplasty in posterior cervical expansive open-door laminoplasty for treating multi-segment cervical spondylotic myelopathy. METHODS: Databases of Cochrane Central, PubMed, EMbase, the ISI Web of Knowledge Database, CNKI, CBM, VIP and WanFang were searched for the articles published before July 1, 2018. Randomized or non-randomized controlled trails that compared the efficacy of C3 laminectomy and C3 laminoplasty for treating multi-segment cervical spondylotic myelopathy were included. Meta-analyses were performed on RevMan 5.2 software provided by Cochrane Collaboration. RESULTS AND CONCLUSION: (1) Five studies involving 316 patients were included. Among the patients, 146 underwent C3 laminectomy and 170 underwent C3 laminoplasty. (2) The results of meta-analysis showed that: compared with C3 laminoplasty, C3 laminectomy had higher cervical range of motion [SMD=-5.89, 95%CI (-7.25, -4.70), P < 0.05], and lower incidence of axial symptoms [SMD=-0.23, 95%CI (0.12, 0.46), P < 0.05]. (3) There was no significant difference between two groups in the postoperative Japanese Orthopeadic Association score [SMD=-0.02, 95%CI (-0.55, 0.51), P=0.95 > 0.05]. (4) These results imply that posterior cervical laminoplasty for treating cervical spondylotic using C3 laminectomy and laminoplasty can obtain good clinical outcomes. However, laminectomy can prevent loss of cervical range of motion and reduce the incidence of axial symptoms. Figures and Tables | References | Related Articles | Metrics

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Meta-analysis of posterior cervical laminectomy titanium mini-plate versus lateral mass screw fixation for treating multilevel cervical spondylotic myelopathy   Wang Wei, Ma Junfeng, Cui Zijian, Zhang Lilong, Jiang Zehua, Lu Yun 2019, 23 (16):  2614-2624.  doi: 10.3969/j.issn.2095-4344.1219 Abstract ( 404 )   PDF (1959KB) ( 75 )   Save BACKGROUND: The main surgical procedures for treating multilevel cervical compressive myelopathy are posterior expansive unilateral open-door laminoplasty with titanium mini-plate and posterior cervical laminectomy with lateral mass screw fixation. However, the superiority of these two methods in clinical practice is still controversial. Relative comparative studies are various, but there is a lack of objective evaluation due to sample size. OBJECTIVE: To compare the efficacy, safety and postoperative complications of patients with multilevel cervical compressive myelopathy treated by these two procedures, and to further analyze their advantages and disadvantages. METHODS: CNKI, WanFang, VIP, PubMed, Embase, Cochrane Library and Science Direct databases were searched for the randomized controlled trials or nonrandomized controlled trials concerning posterior expansive unilateral open-door laminoplasty with titanium mini-plate versus posterior cervical laminectomy with lateral mass screw fixation. The following outcome measures were extracted: operation time, intraoperative blood loss, Japanese Orthopaedic Association scores, Visual Analog Scale, cervical curvature index, cervical dysfunction index, C5 nerve root paralysis, axial symptoms and other complications. Data analysis was conducted on STATA 15.1 software. RESULTS AND CONCLUSION: (1) A total of 16 studies, involving 1 666 patients. (2) Meta-analysis results showed that in the titanium mini-plate group, the operation time [WMD=-20.090, 95%CI (-27.759, -12.421), P < 0.000 01] and intraoperative blood loss [WMD=-42.519, 95%CI (-66.368, -18.670), P < 0.000 01] were superior to the lateral mass screw group. (3) There were no significant differences in the postoperative Japanese Orthopaedic Association score [WMD=-0.092, 95%CI (-0.177, -0.361), P=0.502 > 0.05], postoperative Visual Analog Scale score [WMD=-0.247, 95%CI (-0.667, 0.172), P=0.248 > 0.05], postoperative cervical curvature index [WMD=-0.314, 95%CI (-1.070, 0.441), P=0.415 > 0.05], and postoperative Cobb angle [WMD=0.193, 95%CI (-0.116, 0.502), P=0.220 > 0.05] between two groups. (4) The postoperative cervical dysfunction index [WMD=-1.361, 95%CI (-2.219, -0.503), P=0.002 < 0.05], axial symptoms [RR=0.572, 95%CI (0.43, 0.759), P < 0.000 01], C5 palsy [RR=0.313, 95%CI (0.211, 0.465), P < 0.000 01] and incidence of total complications [RR=0.521, 95%CI (0.426，0.637), P < 0.000 01] in the titanium mini-plate group were lower than those in the lateral mass screw group. (5) These results suggest that both titanium mini-plate and lateral mass screw obtain good short-term clinical efficacy in the treatment of multilevel cervical compressive myelopathy, and the long-term efficacy remains to be studied further. Compared with lateral mass screw group, the lateral mass screw group has lower incidence of C5 palsy, axial symptom and total complications, shorter operation time and less blood loss. Figures and Tables | References | Related Articles | Metrics