Zhongguo gu shang = China journal of orthopaedics and traumatology最新文献

Total shoulder arthroplasty(TSA) is primarily used for treating severe shoulder injuries or diseases and has been shown to effectively improve shoulder function. With the expansion of TSA indications and an aging population, the demand for TSA continues to grow. To address this demand and alleviate the economic burden on patients, many countries have adopted the day surgery model for TSA, accompanied by extensive research and discussions on its safety and feasibility. This paper systematically reviews the safety, patient inclusion and exclusion criteria, implementation processes, and perioperative management strategies for TSA day surgery. Based on an analysis of relevant literature from domestic and international sources, the findings indicate that TSA day surgery, when preceded by appropriate patient screening, can safely replace traditional inpatient care. Furthermore, it could significantly reduce hospitalization durations, lower treatment costs, and optimize the utilization of medical resources. However, in clinical practice, there is still a lack of standardized protocols for patient selection criteria and perioperative management strategies. As China's aging population intensifies, TSA day surgery presents promising application prospects. Nevertheless, the development of day surgery in China lags behind that of other countries, and research on TSA day surgery remains in its early stages. Moving forward, research and clinical practices tailored to China's specific needs should be prioritized. Practical clinical operation guidelines must be established to facilitate the widespread adoption and standardized implementation of TSA day surgery, ultimately providing patients with higher-quality and safer medical care.

Objective: To explore clinical efficacy of ultrasound-guided manual reduction combined with external fixation with small splints of fir bark in treating O'Brien typeⅡand Ⅲ radial neck fractures in children.

Methods: A retrospective analysis was conducted on clinical data of 21 children with type O'BrienⅡand Ⅲ radial neck fractures admitted from June 2023 to December 2024, including 11 boys and 10 girls; aged from 4 to 12 years old with an average of (8.43±1.60) years old;12 patients with O'Brien typeⅡand 9 patients with type Ⅲ. All treatments were carried out using ultrasound-guided manual reduction. Ultrasound examination was conducted again to check the quality of fracture reduction after reduction was completed. After the treatment, external fixation with small splints of fir bark was performed. The success rate of manual reduction and the incidence of complications during the process of manual reduction were observed. Postoperative images and post-operative functions were evaluated using Metaizeau standard.

Results: All the children were followed up, and the duration ranged from 3 to 12 months. Closed reduction was successful in 19 children, while 2 children had difficulty in reduction and were transferred to surgical treatment. No related complications such as neurovascular injury occurred. Closed reduction was successful in 19 patients. Postoperative X-ray films showed good alignment and alignment of fractures, and the fracture healing time ranged from 4 to 7 weeks. Metaizeau criteria at 3 months after treatment, 17 patients were excellent and 2 good. In the later functional evaluation, all 19 patients were rated as excellent, and no obvious elbow joint dysfunction or residual pain occurred.

Conclusion: Ultrasound-guided manual reduction could effectively increase success rate of manual reduction for O'Brien typeⅡand Ⅲ radial neck fractures in children, and reduce radiation and adverse outcomes.

Objective: To explore effect and mechanism of formononetin on recovery of neurological function after chronic spinal cord injury (SCI) in rats.

Methods: Twenty-four SPF male SD rats, aged from 8 to 9 weeks old, weighted (327.29±15.19) g, were selected and randomly divided into sham operation group(Sham group), model group (Vehicle group), and formononetin group, with 8 rats in each group. Vehicle group and formononetin group were established chronic SCI models in rats by hydrogel compression. On the first day after modeling in formononetin group, formononetin officinalis solution was continuous administered orally (with a standard of 30 mg·kg^-1) for 28 days, once a day. Basso-Beattie-Bresnahan (BBB) score, forelimb grip strength and rotating bar test of rats were performed in each group at 1, 7, 14, 21 and 28 days after modeling respectively to evaluate the limb motor function. Twenty-eight days after modeling, cardiac perfusion samples were collected to detect endoplasmic reticulum stress and neuronal apoptosis in spinal cord tissue. Hematoxylin-eosin staining was used to observe SCI, Nissl staining was used to observe number of surviving neurons, and Western blot (WB) was used to detect Bcl-2-associated X protein(Bax), B-cell lymphoma-2(Bcl-2) proteins and apoptosis-related proteins. The expression of endoplasmic reticulum stress pathway-related proteins was observed by immunofluorescence staining.

Results: Formononetin group were better than Vehicle group in BBB score on the 21st day after operation and grip test on the 3rd, 7th and 21st days, there were statistically differences(P<0.05). The results of HE and Nissl staining showed the number of surviving nerve cells in formononetin group were better than those in Vehicle group, and the difference were statistically significant(P<0.05). WB results showed the expression of Bcl-2 was upregulated, and protein expressions of Bax, C/EBP homologous protein(CHOP), phosphorylated protein kinase R-like endoplasmic reticulum kinase(p-PERK), and phosphorylated eukaryotic initiation factor 2α(p-eIF2α) in formononetin group were down regulated compared with Vehicle group, the differences were statistically significant(P<0.05). Immunofluorescence showed the protein expressions of p-PERK and activating transcription factor 6(ATF6) in neurons in formononetin group decreased compared with Vehicle group, and the differences were statistically significant (P<0.05).

Conclusion: Formononetin could alleviate pathological changes after chronic SCI in rats, improve behavioral scores, and promote the recovery of spinal cord nerve function. The specific mechanism may be related to the inhibition of necrotic apoptosis mediated by endoplasmic reticulum stress signaling pathway.

Objective: To explore clinical efficacy of Ilizarov technique combined with the segmented removal of bone cement in treating tibial and skin-soft tissue composite defects.

Methods: From July 2018 to December 2021, 9 patients with composite defects of tibia and skin and soft tissue of the lower leg were treated by Ilizarov technique combined with segmented removal of bone cement, including 7 males and 2 females, aged from 38 to 52 years old, 4 patients on the left side and 5 patients on the right side;the length of bone defect ranged from 8.0 to 12.0 cm;the wound area ranged from 4.0 cm×5.0 cm to 6.0 cm×10.0 cm. After the infection lesion in the lower leg has been cleared and the infection has been controlled by bone cement filling for 6 to 8 weeks, the bone cement was removed after tibial osteotomy. Then, new bone cement was made and divided into several small sections to fill the bone defect area, leaving a sliding gap. Bone slippage began at 10 days after operation (1 mm/d, performed in 6 sessions). As the slippage progressed, the bone cement segments were removed successively until the connection points were successfully connected and the wound healed. The locking was completed, the mineralization of the sliding gap and bone healing at the docking point were evaluated based on X-ray films from 3 to 6(monthly), 9 and 12 months. The clinical efficacy was evaluated by Paley criteria at 2 years after operation.

Results: All 9 patients were followed up for 17 to 30 months. There were no soft tissue collapse or entrapment, and no complications such as infection recurrence occurred on the wound surface during bone segment sliding process. Eight patients achieved successful bony union at the junction, 1 patient achieved bony union after bone grafting at the junction, 6 patients had successful wound healing, and 3 patients underwent surgical adjustment due to indentations of skin margin at the junction, which affected the appearance. All the wounds achieved primary healing after operation. Two years after operation, the therapeutic effect was evaluated according to Paley standard, 7 patients got excellent results and 2 good.

Conclusion: Ilizarov technique combined with segmented removal of bone cement could simultaneously address composite defects of tibia and skin soft tissue of the lower leg, reducing flap surgery and avoiding complications such as soft tissue collapse and entrapation during bone segment sliding.

Objective: To compare efficacy of high-frequency ultrasound(US) and MRI in detecting rotator cuff tears.

Methods: From June 2023 to January 2024, 104 patients with unilateral shoulder pain or dysfunction were selected, including 40 males and 64 females, aged from 29 to 87 years old with an average of (59.8±11.9) years old. Methods 7 patients caused by trauma and 97 patients caused by non-trauma. All patients were underwent US and MRI examinations, and taking results of arthroscopic surgery as gold standard; the accuracy rate, positive coincidence rate, negative coincidence rate and total coincidence rate of US and MRI in diagnosis of rotator cuff tears were compared, and the diagnostic efficacy between two methods were analyzed.

Results: Eighty-two patients was diagnosed as rotator cuff tears by arthroscopy(67 patients with partial tears and 15 patients with full-thickness tears), positive rate was 78.8%, accuracy rate of US in diagnosing rotator cuff tear was 29.3% (24/82), and that of MRI was 47.6%(39/82). Moreover, the diagnostic efficacy of MRI was significantly higher than that of US(χ²=5.799, P=0.061). According to analysis of tear depth, the accuracy rate of US in diagnosing full-thickness tears was 46.7% (7/15), and that of MRI was 53.3%(8/15), with no statistically significant difference (P=0.715). The accuracy rate of US in diagnosing partial tear was 25.3% (17/67), significantly lower than 46.2% (31/67) of MRI, and the difference was statistically significant (χ²=6.362, P=0.012). The total coincidence rates of US, MRI and the combined diagnosis of US+MRI for rotator cuff tear were 51.0%, 62.5% and 66.3% respectively.

Conclusion: MRI is superior to US in diagnosing rotator cuff tears, especially partial tears, and comparable in diagnosing full-thickness tears. When combined diagnosis of US and MRI could further improve diagnostic efficiency, it is recommended to apply it in combination in clinical practice.

Objective: To explore safe zones for acetabular prosthesis implantation in patients with ankylosing spondylitis (AS) at different anterior pelvic plane tilts (APPt), and to determine the optimal implantation angle of the prosthesis through the safe zones with different ranges of motion. To explore the influencing factors of size and scope of the safe zone.

Methods: CT data of pelvis before total hip arthroplasty (THA) in a 54-year-old male patient with Tonnis stage Ⅳ left hip arthritis, and virtual THA simulated by computer prosthesis with a femoral head diameter of 32 mm, a head-to-neck ratio of 2.67, and a cervical-shaft angle of 132° was selected and assembled by tilting forward by 15°. After defining the target range of motion of hip joint that could meet functions such as standing, sitting, and squatting, acetabular prosthesis implantation safety zones corresponding to bony impact and prosthesis impact when the anterior pelvic plane inclination angles are -10°, -5°, 0°, 5°, 10°, 15°, 20° and 25° respectively were calculated. A model to change the parameters of the femoral prosthesis was select and calculated the safety zone when different prostheses were implanted.

Results: When the range of motion of spine and pelvis disappeared, the safe zone for implant placement could meet the requirements of standing, sitting and squatting was extremely small. When the pelvis was tilted forward by 10° to backward by 25°, the abduction angle of acetabular implant could meet the daily range of motion decreased from 55.7° to 45.8°, and the forward inclination angle decreased from 29.9° to 7.4°. The diameter of femoral head was positively correlated with the size of safe zone. Within the range of 24 to 32 mm, for every 0.17 mm increased in the diameter of femoral head, the safe range of acetabular anterior inclination angle and abduction angle increased for 4° to 6°. For the ball head of the same diameter, the safety zone showed a trend of first increasing and then decreased with the increase of cervical shaft angle or anterior inclination angle of femur.

Conclusion: When AS patients undergo THA, precise implantation techniques are required to obtain a safe range of motion that could meet the requirements of standing, sitting and squatting. For patients with obvious anterior or posterior pelvic tilt, personalized prosthesis implantation should be carried out to reduce prosthesis suspension and impact on the iliopsoas muscle. Large-diameter femoral head prostheses are more sensitive to changes in the cervical shaft angle and anterior inclination angle, and the area of the implanted combined safety zone is larger.