Objective To analyze the necessity of routinely performing foraminoplasty during percutaneous transforaminal endoscopic discectomy (PETD). Methods A total of 412 patients including 231 males and 181 females with an average age of 39.1±13 (20-80) years were enrolled in the present study. All patients were preoperatively diagnosed with single-segment lumbar disc herniation and underwent PETD by the same surgical group. The affected segments were at L3-4 in 32 cases, L4-5 in 289 cases, and L5S1 in 91 cases. Among them, 306 cases had no prolapse, 89 had mild up/down prolapse, and 17 had severe prolapse. MRI sagittal imaging was used to measure the height and width of the intervertebral foramen of L3, 4, L4, 5 and L5S1 segments, the distance between the lower edge of vertebral pedicle and the upper edge of the lower vertebral pedicle and the distance between the point 3 mm to the ventral side of the intervertebral space to the superior articular process. The necessity of performing foraminoplasty was evaluated by measuring the change of intervertebral foramen width using dynamic X-ray and verified during operation. Results The height of the intervertebral foramen of L3,4, L4,5 and L5S1 segments were 1.99±0.25, 1.89±0.15 and 1.52±0.26 cm, respectively. The width of the intervertebral foramen was 0.78±0.14, 0.75±0.13 and 0.64±0.13 cm, respectively. The distance between the lower edge of vertebral pedicle and the upper edge of the lower vertebral pedicle were 1.14±0.17, 1.05±0.16, and 0.98±0.19 cm, respectively. The distance between the point 3 mm to the ventral side of the intervertebral space to the superior articular process were 1.11±0.31, 1.17±0.20, and 0.95±0.14 cm, respectively. The width of the intervertebral foramen of the L3, 4 and L4,5 segments was significantly greater at the over-flexion position than at the over-extension position (P<0.05). Intraoperative verification showed that 347 cases (group A) did not need foraminoplasty. However, the other 65 patients (group B) needed foraminoplasty, including 31 at L4, 5 segment and 34 at L5S1 segment. One patient in group A and one in group B underwent revision operation due to residual intervertebral disc. At 2 years of follow-up, recurrence occurred in 4 patients in group A and 2 patients in group B. The ODI score and JOA score in group A and B were 18%±9%, 24.2±1.3 and 16%±7%, 23.9±1.3, respectively. There were not significantly different between patients in group A and B (t=1.70, P=0.090; t=1.71, P=0.088). The VAS score of lumbar pain of patients in group A was better than that of patients in group B (P<0.05). Conclusion Most of PETD of L3-S1 segments can reach the therapeutic target without performing foraminoplasty with half-half technique combined with far lateral access technique. Due to the special anatomical position of L5-S1 segment, the probability of performing foraminoplasty during operation is much higher. Performing foraminoplasty or not depends on the preoperativ
{"title":"Necessity of routinely performing foraminoplasty during percutaneous endoscopic transforaminal discectomy in treating lumbar disc herniation","authors":"Xinyu Liu, Suomao Yuan, Yong‐hao Tian, Jun Yan, Wanlong Xu, Liangtai Gong, Yanping Zheng","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.19.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.19.001","url":null,"abstract":"Objective \u0000To analyze the necessity of routinely performing foraminoplasty during percutaneous transforaminal endoscopic discectomy (PETD). \u0000 \u0000 \u0000Methods \u0000A total of 412 patients including 231 males and 181 females with an average age of 39.1±13 (20-80) years were enrolled in the present study. All patients were preoperatively diagnosed with single-segment lumbar disc herniation and underwent PETD by the same surgical group. The affected segments were at L3-4 in 32 cases, L4-5 in 289 cases, and L5S1 in 91 cases. Among them, 306 cases had no prolapse, 89 had mild up/down prolapse, and 17 had severe prolapse. MRI sagittal imaging was used to measure the height and width of the intervertebral foramen of L3, 4, L4, 5 and L5S1 segments, the distance between the lower edge of vertebral pedicle and the upper edge of the lower vertebral pedicle and the distance between the point 3 mm to the ventral side of the intervertebral space to the superior articular process. The necessity of performing foraminoplasty was evaluated by measuring the change of intervertebral foramen width using dynamic X-ray and verified during operation. \u0000 \u0000 \u0000Results \u0000The height of the intervertebral foramen of L3,4, L4,5 and L5S1 segments were 1.99±0.25, 1.89±0.15 and 1.52±0.26 cm, respectively. The width of the intervertebral foramen was 0.78±0.14, 0.75±0.13 and 0.64±0.13 cm, respectively. The distance between the lower edge of vertebral pedicle and the upper edge of the lower vertebral pedicle were 1.14±0.17, 1.05±0.16, and 0.98±0.19 cm, respectively. The distance between the point 3 mm to the ventral side of the intervertebral space to the superior articular process were 1.11±0.31, 1.17±0.20, and 0.95±0.14 cm, respectively. The width of the intervertebral foramen of the L3, 4 and L4,5 segments was significantly greater at the over-flexion position than at the over-extension position (P<0.05). Intraoperative verification showed that 347 cases (group A) did not need foraminoplasty. However, the other 65 patients (group B) needed foraminoplasty, including 31 at L4, 5 segment and 34 at L5S1 segment. One patient in group A and one in group B underwent revision operation due to residual intervertebral disc. At 2 years of follow-up, recurrence occurred in 4 patients in group A and 2 patients in group B. The ODI score and JOA score in group A and B were 18%±9%, 24.2±1.3 and 16%±7%, 23.9±1.3, respectively. There were not significantly different between patients in group A and B (t=1.70, P=0.090; t=1.71, P=0.088). The VAS score of lumbar pain of patients in group A was better than that of patients in group B (P<0.05). \u0000 \u0000 \u0000Conclusion \u0000Most of PETD of L3-S1 segments can reach the therapeutic target without performing foraminoplasty with half-half technique combined with far lateral access technique. Due to the special anatomical position of L5-S1 segment, the probability of performing foraminoplasty during operation is much higher. Performing foraminoplasty or not depends on the preoperativ","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1165-1172"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47670685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To explore the relationship between the compression depth and compressive stress of the anterior and posterior cervical spinal cord in different sports positions. Methods Specimens of ten intact fresh cervical spine (C1-T1) from adult cadaver were collected. In order to simulate cervical disc degeneration and abnormal ligamentum flavum, we placed two hemispherical steel balls into the anterior and posterior side of the cervical spinal cord through the bone window of the C4, 5. The measurement was conducted in 10%, 20%, 30%, 40%, 50%, and 60% of the sagittal diameter for the compressive stress of the anterior and posterior cervical spinal cord under different compression depths of flexion, neutral, and posterior extension. Results The anterior depth of a certain pressure with the posterior pressure depth was increasing in neutral position, the stress on the anterior of the cervical cord-meningeal complex (CCMC) had no significant change, while the stress on the posterior of the CCMC increased greatly with the increasing of the degree of canal occlusion. The stress on the posterior of the CCMC varied insignificantly between 10% and 20% depth of canal occlusion (P>0.05). However, there was remarkable significance among 30% and 60% (P 0.05). However, there was remarkable significance among 20% and 60% (P 0.05). However, there was remarkable significance among 30% and 60% (P 0.05). However, there was remarkable significance among 20% and 60% (P<0.05). The stress on the posterior of the CCMC had no significant change. Compared with the neutral position, the anterior flexion position and the posterior extension position had different trends in the compressive stress in the anterior and posterior aspect of the cervical spinal cord. Conclusion The stress on the anterior and the posterior of the CCMC has a closely nonlinear relationship with the depth of canal occlusion. With the increase of the depth of canal occlusion, the stress is increasing, especially running over the 30% depress of canal occlusion under neutral position. However, the stress is increased, especially running over the 20% depress of canal occlusion under the flexion and extension position. Key words: Spinal cord; Stress, mechanical; Posture; Biomechanics
{"title":"Correlation between compression depth and compressive stress of the anteroposterior cervical spinal cord in different sports positions","authors":"Xiaofeng Zhao, Yi-Bo Zhao, Xiang-dong Lu, Xiao-nan Wang, Run-tian Zhou, Yuan-zhang Jin, Detai Qi, Xu Yang","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.19.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.19.006","url":null,"abstract":"Objective \u0000To explore the relationship between the compression depth and compressive stress of the anterior and posterior cervical spinal cord in different sports positions. \u0000 \u0000 \u0000Methods \u0000Specimens of ten intact fresh cervical spine (C1-T1) from adult cadaver were collected. In order to simulate cervical disc degeneration and abnormal ligamentum flavum, we placed two hemispherical steel balls into the anterior and posterior side of the cervical spinal cord through the bone window of the C4, 5. The measurement was conducted in 10%, 20%, 30%, 40%, 50%, and 60% of the sagittal diameter for the compressive stress of the anterior and posterior cervical spinal cord under different compression depths of flexion, neutral, and posterior extension. \u0000 \u0000 \u0000Results \u0000The anterior depth of a certain pressure with the posterior pressure depth was increasing in neutral position, the stress on the anterior of the cervical cord-meningeal complex (CCMC) had no significant change, while the stress on the posterior of the CCMC increased greatly with the increasing of the degree of canal occlusion. The stress on the posterior of the CCMC varied insignificantly between 10% and 20% depth of canal occlusion (P>0.05). However, there was remarkable significance among 30% and 60% (P 0.05). However, there was remarkable significance among 20% and 60% (P 0.05). However, there was remarkable significance among 30% and 60% (P 0.05). However, there was remarkable significance among 20% and 60% (P<0.05). The stress on the posterior of the CCMC had no significant change. Compared with the neutral position, the anterior flexion position and the posterior extension position had different trends in the compressive stress in the anterior and posterior aspect of the cervical spinal cord. \u0000 \u0000 \u0000Conclusion \u0000The stress on the anterior and the posterior of the CCMC has a closely nonlinear relationship with the depth of canal occlusion. With the increase of the depth of canal occlusion, the stress is increasing, especially running over the 30% depress of canal occlusion under neutral position. However, the stress is increased, especially running over the 20% depress of canal occlusion under the flexion and extension position. \u0000 \u0000 \u0000Key words: \u0000Spinal cord; Stress, mechanical; Posture; Biomechanics","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1199-1207"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49360181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To investigate the microhardness distribution of cancellous bone in the proximal tibia and its clinical significance. Methods Three fresh tibias were obtained and examined by X-ray and CT to exclude skeletal pathologies, such as osteoporosis, osteoarthritis. According to the Heim's square, the proximal tibias were cut off. Each of the proximal tibias was divided into three parts, the medial condyle, the intercondylar area and the lateral condyle. Each part was divided into three sections, proximal, middle and distal sections. Each of the proximal tibias was divided into 9 regions. Bone specimens with a thickness of 3 mm were taken from each region using a high precision low-speed saw and fixed on flat sheets. The microhardness of the bone tissue was measured using a Vickers microhardness tester after polish. Ten effective micro-indentation tests were conducted in each region. After measurement the diagonal length of the indentations, the microhardness values were calculated via software provided by the hardness tester. Analysis of variance and Tukey method were used to compare the microhardness values of different parts, sections and regions of cancellous bone. The microhardness distribution of the proximal tibia was analyzed. Results A total of 270 effective indentations were made in the specimens, and the microhardness values were obtained. The average microhardness of the three proximal tibias was 40.98±3.44, 34.92±4.64 and 39.49±3.86 HV, respectively. There was a significant difference among the groups (F=55.87, P=0.000). The microhardness distribution of bone tissue in the three proximal tibias was similar. In the comparison of different parts, the microhardness of medial condyle was greater than that of the lateral condyle, which was larger than that of the intercondylar area. The difference between the parts was statistically significant (F=18.42, 8.236, 10.877; P=0.000, 0.001, 0.000). In the comparison of different sections, the microhardness of the distal section was greater than that of the proximal section, which was larger than that of the middle section. The difference between the sections was statistically significant (F=8.720, 17.140, 6.142; P=0.000, 0.000, 0.003). The microhardness distribution was similar among different regions. The region with the highest microhardness is the medial condyle of the distal section with microhardness of 44.87±3.25 HV (range 39.2-49.7 HV). The lowest microhardness was in the intercondylar area of the middle section with hardness of 29.41±4.53 HV (range 24.8-36.2 HV). Conclusion The microhardness value of cancellous bone near the articular surface at the proximal tibia was smaller, which could disperse the load and protect the fragile of articular cartilage. Furthermore, the microhardness of the transition zone is larger. The microhardness value of the cancellous bone in medial tibia condyle is the greatest, which is related to load-bearing. Key words: Hardness tes
{"title":"Micro-hardness distribution of proximal tibia in human skeleton","authors":"Jianzhao Wang, B. Yin, Sheng Li, Guobin Liu, Xiaojuan Zhang, Zusheng Hu, WeiWei Wu","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.19.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.19.007","url":null,"abstract":"Objective \u0000To investigate the microhardness distribution of cancellous bone in the proximal tibia and its clinical significance. \u0000 \u0000 \u0000Methods \u0000Three fresh tibias were obtained and examined by X-ray and CT to exclude skeletal pathologies, such as osteoporosis, osteoarthritis. According to the Heim's square, the proximal tibias were cut off. Each of the proximal tibias was divided into three parts, the medial condyle, the intercondylar area and the lateral condyle. Each part was divided into three sections, proximal, middle and distal sections. Each of the proximal tibias was divided into 9 regions. Bone specimens with a thickness of 3 mm were taken from each region using a high precision low-speed saw and fixed on flat sheets. The microhardness of the bone tissue was measured using a Vickers microhardness tester after polish. Ten effective micro-indentation tests were conducted in each region. After measurement the diagonal length of the indentations, the microhardness values were calculated via software provided by the hardness tester. Analysis of variance and Tukey method were used to compare the microhardness values of different parts, sections and regions of cancellous bone. The microhardness distribution of the proximal tibia was analyzed. \u0000 \u0000 \u0000Results \u0000A total of 270 effective indentations were made in the specimens, and the microhardness values were obtained. The average microhardness of the three proximal tibias was 40.98±3.44, 34.92±4.64 and 39.49±3.86 HV, respectively. There was a significant difference among the groups (F=55.87, P=0.000). The microhardness distribution of bone tissue in the three proximal tibias was similar. In the comparison of different parts, the microhardness of medial condyle was greater than that of the lateral condyle, which was larger than that of the intercondylar area. The difference between the parts was statistically significant (F=18.42, 8.236, 10.877; P=0.000, 0.001, 0.000). In the comparison of different sections, the microhardness of the distal section was greater than that of the proximal section, which was larger than that of the middle section. The difference between the sections was statistically significant (F=8.720, 17.140, 6.142; P=0.000, 0.000, 0.003). The microhardness distribution was similar among different regions. The region with the highest microhardness is the medial condyle of the distal section with microhardness of 44.87±3.25 HV (range 39.2-49.7 HV). The lowest microhardness was in the intercondylar area of the middle section with hardness of 29.41±4.53 HV (range 24.8-36.2 HV). \u0000 \u0000 \u0000Conclusion \u0000The microhardness value of cancellous bone near the articular surface at the proximal tibia was smaller, which could disperse the load and protect the fragile of articular cartilage. Furthermore, the microhardness of the transition zone is larger. The microhardness value of the cancellous bone in medial tibia condyle is the greatest, which is related to load-bearing. \u0000 \u0000 \u0000Key words: \u0000Hardness tes","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1208-1214"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42308180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.19.005
Yi Ma, K. Fang, S. Gang, Jing Peng, Ling Jiang, Li Sun, Yan Zhu
Objective To investigate the incidence and risk factors of postoperative acute renal injury (AKI) in patients after primary unilateral hip and knee replacement. Methods Between January 2016 and July 2018, A total of 1 490 patients underwent hip and knee arthroplasty were enrolled. There were 507 male and 983 female with a median age of 66 years (range: 18 to 95 years). There were 201 patients underwent femoral head replacement, 897 total hip arthroplasty and 392 total knee arthroplasty, respectively. The creatinine value was 68.79 μmol/L preoperatively. Demographic, perioperative and postoperative data were recorded. The development of AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The demographic information, comorbidities, preoperative medication, type of surgery, type of anesthesia, intraoperative anesthetics, operation time, intravenous fluid type and dose, amount of bleeding and postoperative creatinine values were recorded. Predictors associated with AKI and postoperative creatinine was determined by multiple regressions. Results There were 80 cases developed AKI with the incidence of AKI 5.4%. Among the AKI patients, there were 69 cases (4.6%) in AKI stage 1, 7 cases (0.5%) in AKI stage 2, and 4 cases (0.3%) in AKI stage 3. The creatinine value was 72.03 μmol/L after surgery. The length of postoperative hospital stay was 9 days. There were 5 patients died in hospital. The independent risk factors of AKI after hip and knee arthroplasty included old age, a higher American Society of Anesthesiologists (ASA) grade and preoperative diabetes (P<0.05). The risk of postoperative AKI in patients aged 60-69 years, 70-79 years, and older than 80 years was 2.259, 2.798, and 6.049 times than that of patients under 60 years of age, respectively. The risk of postoperative AKI in patients with ASA grade II, III, and IV was 3.749, 9.023, and 21.595 times than that of ASA grade I patients, respectively. The risk of AKI in patients with diabetes before surgery was 2.377 times higher than that in non-diabetics. Age, diabetes, hypertension and preoperative serum creatinine were positively correlated with postoperative creatinine values (P<0.05). Intensive care unit admissions were greater in AKI patients than that in non-AKI patients (25.0%, 5.6%, χ2=-6.774, P<0.001). Compared with non-AKI patients, the postoperative length of hospital stay was longer in AKI patients (Z=-3.904, P<0.001). Conclusion The incidence of postoperative AKI after primary hip and knee replacement was 5.4%. The older age, ASA grade, and diabetes were independently associated with risk of AKI. Old age, male, preoperative diabetes, hypertension and a higher preoperative creatinine value can predict postoperative increased creatinine levels at postoperation. The risk factors for AKI included old age, a higher ASA grade and diabetes. The postoperative length of hospital stay was longer in AKI patients. Key words: Acute kidney
{"title":"Incidence and risk factors of postoperative acute renal injury in patients underwent hip and knee replacement","authors":"Yi Ma, K. Fang, S. Gang, Jing Peng, Ling Jiang, Li Sun, Yan Zhu","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.19.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.19.005","url":null,"abstract":"Objective \u0000To investigate the incidence and risk factors of postoperative acute renal injury (AKI) in patients after primary unilateral hip and knee replacement. \u0000 \u0000 \u0000Methods \u0000Between January 2016 and July 2018, A total of 1 490 patients underwent hip and knee arthroplasty were enrolled. There were 507 male and 983 female with a median age of 66 years (range: 18 to 95 years). There were 201 patients underwent femoral head replacement, 897 total hip arthroplasty and 392 total knee arthroplasty, respectively. The creatinine value was 68.79 μmol/L preoperatively. Demographic, perioperative and postoperative data were recorded. The development of AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The demographic information, comorbidities, preoperative medication, type of surgery, type of anesthesia, intraoperative anesthetics, operation time, intravenous fluid type and dose, amount of bleeding and postoperative creatinine values were recorded. Predictors associated with AKI and postoperative creatinine was determined by multiple regressions. \u0000 \u0000 \u0000Results \u0000There were 80 cases developed AKI with the incidence of AKI 5.4%. Among the AKI patients, there were 69 cases (4.6%) in AKI stage 1, 7 cases (0.5%) in AKI stage 2, and 4 cases (0.3%) in AKI stage 3. The creatinine value was 72.03 μmol/L after surgery. The length of postoperative hospital stay was 9 days. There were 5 patients died in hospital. The independent risk factors of AKI after hip and knee arthroplasty included old age, a higher American Society of Anesthesiologists (ASA) grade and preoperative diabetes (P<0.05). The risk of postoperative AKI in patients aged 60-69 years, 70-79 years, and older than 80 years was 2.259, 2.798, and 6.049 times than that of patients under 60 years of age, respectively. The risk of postoperative AKI in patients with ASA grade II, III, and IV was 3.749, 9.023, and 21.595 times than that of ASA grade I patients, respectively. The risk of AKI in patients with diabetes before surgery was 2.377 times higher than that in non-diabetics. Age, diabetes, hypertension and preoperative serum creatinine were positively correlated with postoperative creatinine values (P<0.05). Intensive care unit admissions were greater in AKI patients than that in non-AKI patients (25.0%, 5.6%, χ2=-6.774, P<0.001). Compared with non-AKI patients, the postoperative length of hospital stay was longer in AKI patients (Z=-3.904, P<0.001). \u0000 \u0000 \u0000Conclusion \u0000The incidence of postoperative AKI after primary hip and knee replacement was 5.4%. The older age, ASA grade, and diabetes were independently associated with risk of AKI. Old age, male, preoperative diabetes, hypertension and a higher preoperative creatinine value can predict postoperative increased creatinine levels at postoperation. The risk factors for AKI included old age, a higher ASA grade and diabetes. The postoperative length of hospital stay was longer in AKI patients. \u0000 \u0000 \u0000Key words: \u0000Acute kidney","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1192-1198"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43502838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.19.002
Lei He, Y. Qian, Zuo Lyu, Wei He
Objective To investigate the preventive effects of gelatin sponge debris pre-filling on bone cement leakage during percutaneous kyphoplasty (PKP) for vertebral osteoporotic fracture with cortical bone rupture. Methods The data of 256 cases (294 segments) of osteoporotic vertebral compression fracture (OVCF) treated with PKP from January 2014 to July 2016 were retrospectively analyzed. There were 106 segments in 92 males and 188 segments in 164 females. In 119 cases, a total of 132 segments were pre-filled with gelatin sponge debris before bone cement injection. The average age was 74.4±7.7 years. In 137 cases, 162 segments were not pre-filled with gelatin sponge debris, with average age of 73.3±6.4 years. The incidences of cement leakage, visual analogue scale (VAS), Oswestry disability index (ODI), the change of anterior vertebral height and kyphosis angle before and after operation were compared between the two groups. Results In gelatin sponge group, the incidence of cement leakage was 12.6% (15/119), including 3.4% (4/119), 0.8% (1/119), 1.7% (2/119), 5.0% (6/119) and 1.7% (2/119) of the endplate type, the lateral type, the anterior type, the posterior type and the mixed type. The incidence of cement leakage in non-gelatin sponge group was 23.4% (32/137), including 4.4% (6/137), 5.1% (7/137), 5.1% (7/137), 5.8% (8/137) and 2.9% (4/137) of the endplate type, the lateral type, the anterior type, the posterior type and the mixed type. The difference of total cement leakage rate between the two groups was significant (χ2=4.912, P=0.027). There was no significant difference in leakage rates among different types (P>0.05). Postoperative symptoms were improved in both groups. VAS score and ODI index were improved at 1, 3 and 6 months after operation (P<0.05). However, there was no significant difference in VAS score and ODI index at preoperative and post-operative follow-up between groups. There were no significant difference between the two groups in the height of the anterior edge of the injured vertebra before operation (17.3±3.2 mm, 17.5±5.4 mm), the kyphosis angle before operation (18.9°±2.0°, 18.7°±2.3°), the height of the anterior edge of the injured vertebra after operation (22.7±3.6 mm, 22.4±5.4 mm), and the kyphosis angle after operation (11.2°±1.4°, 11.9°±1.8°). Conclusion Gelatin sponge debris pre-filling can effectively reduce bone cement leakage after PKP in patients with vertebral cortical bone rupture. There was no significant effect on the improvement of symptoms after PKP. Key words: Spine; Kyphoplasty; Osteoporotic fractures; Gelatin sponge, absorbable
{"title":"Application of gelatin sponge debris pre-perfusion in percutaneous kyphoplasty for vertebral fracture with cortical rupture","authors":"Lei He, Y. Qian, Zuo Lyu, Wei He","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.19.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.19.002","url":null,"abstract":"Objective \u0000To investigate the preventive effects of gelatin sponge debris pre-filling on bone cement leakage during percutaneous kyphoplasty (PKP) for vertebral osteoporotic fracture with cortical bone rupture. \u0000 \u0000 \u0000Methods \u0000The data of 256 cases (294 segments) of osteoporotic vertebral compression fracture (OVCF) treated with PKP from January 2014 to July 2016 were retrospectively analyzed. There were 106 segments in 92 males and 188 segments in 164 females. In 119 cases, a total of 132 segments were pre-filled with gelatin sponge debris before bone cement injection. The average age was 74.4±7.7 years. In 137 cases, 162 segments were not pre-filled with gelatin sponge debris, with average age of 73.3±6.4 years. The incidences of cement leakage, visual analogue scale (VAS), Oswestry disability index (ODI), the change of anterior vertebral height and kyphosis angle before and after operation were compared between the two groups. \u0000 \u0000 \u0000Results \u0000In gelatin sponge group, the incidence of cement leakage was 12.6% (15/119), including 3.4% (4/119), 0.8% (1/119), 1.7% (2/119), 5.0% (6/119) and 1.7% (2/119) of the endplate type, the lateral type, the anterior type, the posterior type and the mixed type. The incidence of cement leakage in non-gelatin sponge group was 23.4% (32/137), including 4.4% (6/137), 5.1% (7/137), 5.1% (7/137), 5.8% (8/137) and 2.9% (4/137) of the endplate type, the lateral type, the anterior type, the posterior type and the mixed type. The difference of total cement leakage rate between the two groups was significant (χ2=4.912, P=0.027). There was no significant difference in leakage rates among different types (P>0.05). Postoperative symptoms were improved in both groups. VAS score and ODI index were improved at 1, 3 and 6 months after operation (P<0.05). However, there was no significant difference in VAS score and ODI index at preoperative and post-operative follow-up between groups. There were no significant difference between the two groups in the height of the anterior edge of the injured vertebra before operation (17.3±3.2 mm, 17.5±5.4 mm), the kyphosis angle before operation (18.9°±2.0°, 18.7°±2.3°), the height of the anterior edge of the injured vertebra after operation (22.7±3.6 mm, 22.4±5.4 mm), and the kyphosis angle after operation (11.2°±1.4°, 11.9°±1.8°). \u0000 \u0000 \u0000Conclusion \u0000Gelatin sponge debris pre-filling can effectively reduce bone cement leakage after PKP in patients with vertebral cortical bone rupture. There was no significant effect on the improvement of symptoms after PKP. \u0000 \u0000 \u0000Key words: \u0000Spine; Kyphoplasty; Osteoporotic fractures; Gelatin sponge, absorbable","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1173-1179"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42809936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.19.004
E. Deng, Wei-li Shi, X. Xie, D. Jiang, Lin-xin Chen, Yue-lin Hu
Objective To investigate clinical outcomes of modified reattachment of superior peroneal retinaculum (SPR) for patients with recurrent peroneal tendon dislocation. Methods A total of 24 cases with recurrent peroneal tendon dislocation from December 2012 to June 2017 were treated with modified reattachment of SPR. There were 20 males and 4 females. The average age was 24.9±9.3 years (14-48 years). The average BMI was 23.18±3.50 kg/m2 (15.8-32.2 kg/m2). A 4-5 cm incision was made along the lateral margin of the fibula and curved distally around the fibular tip in line with the peroneal excursion. The superior peroneal retinaculum, peroneus longus and peroneus brevis were exposed. The periosteum and SPR were stripped from the fibula. The false pouch was formed. Two suture anchors were inserted into the postero-lateral ridge of the lateral malleolus without damaging the cartilaginous ridge, after which the SPR was reattached to the lateral malleolus with the anchored suture. The inner layer of the false pouch was incised, while the outer layer (periosteum) was sutured with the SPR in a pants-over-vest style. The following items, including American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS), rate of return to previous sports level, time to return to sports activity, complication, and patients satisfaction were evaluated preoperatively and at the final follow-up. Results The average operation duration was 36.1±8.8 min (20-51 min). The blood loss was 1-10 ml, average 4.1±2.7 ml. The follow-up was carried out in 22 cases for mean 33.9±15.7 months (13-61 months). AOFAS score was improved from 77.8±7.8 points to 95.5±4.3 points significantly (t=-11.89, P<0.001). VAS score was reduced from 4.2±2.4 to 0.3±0.8 significantly (t=7.69, P<0.001). Mean duration return to sports activity was 5.0±1.9 months (3-10 months). A total of 20 patients (91%) returned to their previous sports level. Only one patient (5%) was found with limitation of range of motion, while two patients (9%) reported pain at the scar site without recurrence. The satisfaction rate was 91%. Conclusion Clinical outcomes of modified reattachment of SPR for patients with recurrent peroneal tendon dislocation was safe and effective. Key words: Tendinopathy; Dislocations; Wounds and injuries; Reconstructive surgical procedures
{"title":"Clinical outcomes of modified reattachment of superior peroneal retinaculum for recurrent peroneal tendon dislocation","authors":"E. Deng, Wei-li Shi, X. Xie, D. Jiang, Lin-xin Chen, Yue-lin Hu","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.19.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.19.004","url":null,"abstract":"Objective \u0000To investigate clinical outcomes of modified reattachment of superior peroneal retinaculum (SPR) for patients with recurrent peroneal tendon dislocation. \u0000 \u0000 \u0000Methods \u0000A total of 24 cases with recurrent peroneal tendon dislocation from December 2012 to June 2017 were treated with modified reattachment of SPR. There were 20 males and 4 females. The average age was 24.9±9.3 years (14-48 years). The average BMI was 23.18±3.50 kg/m2 (15.8-32.2 kg/m2). A 4-5 cm incision was made along the lateral margin of the fibula and curved distally around the fibular tip in line with the peroneal excursion. The superior peroneal retinaculum, peroneus longus and peroneus brevis were exposed. The periosteum and SPR were stripped from the fibula. The false pouch was formed. Two suture anchors were inserted into the postero-lateral ridge of the lateral malleolus without damaging the cartilaginous ridge, after which the SPR was reattached to the lateral malleolus with the anchored suture. The inner layer of the false pouch was incised, while the outer layer (periosteum) was sutured with the SPR in a pants-over-vest style. The following items, including American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS), rate of return to previous sports level, time to return to sports activity, complication, and patients satisfaction were evaluated preoperatively and at the final follow-up. \u0000 \u0000 \u0000Results \u0000The average operation duration was 36.1±8.8 min (20-51 min). The blood loss was 1-10 ml, average 4.1±2.7 ml. The follow-up was carried out in 22 cases for mean 33.9±15.7 months (13-61 months). AOFAS score was improved from 77.8±7.8 points to 95.5±4.3 points significantly (t=-11.89, P<0.001). VAS score was reduced from 4.2±2.4 to 0.3±0.8 significantly (t=7.69, P<0.001). Mean duration return to sports activity was 5.0±1.9 months (3-10 months). A total of 20 patients (91%) returned to their previous sports level. Only one patient (5%) was found with limitation of range of motion, while two patients (9%) reported pain at the scar site without recurrence. The satisfaction rate was 91%. \u0000 \u0000 \u0000Conclusion \u0000Clinical outcomes of modified reattachment of SPR for patients with recurrent peroneal tendon dislocation was safe and effective. \u0000 \u0000 \u0000Key words: \u0000Tendinopathy; Dislocations; Wounds and injuries; Reconstructive surgical procedures","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1186-1191"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48853330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.18.006
Li Zhuojie, Qiu Yong, Qian Bang-ping
Objective To investigate the differential expression of lncRNA in the serum of ankylosing spondylitis (AS) patients, with the goal of findingnew potential biomarkers for the diagnosis and targeted treatment of AS. Methods A total of 19 AS patients and 19 age-matched healthy controls treated at Nanjing Drum Tower Hospitalfrom January 2017 to September 2017 were recruited. Average age were 38.74±7.42 (range, 25-51) and 37.00±6.86 (range, 26-50). High-throughput lncRNA sequencing technology was used to detect differently expressed lncRNAs in the serum of 3 AS patients and 3 healthy controls. Target lncRNAs for further validation were selected according to the P values and fold-changes. In the rest of the serum samples (16 AS patients and 16 healthy controls), Trizol-based technique was used to extract total RNA, and after reverse transcription to obtain cDNA, RT-qPCR was preformed to confirm the sequencing results. Results Using high-throughput lncRNA sequencing, a total of 41 up-regulated and 2 down-regulated lncRNAs were detected in the serum of AS patients. After sorted by the P values, 4 lncRNAswith a fold-change larger than 2 were chosen as the target genes for RT-qPCR (ENST00000365494.1, P=2.6×10-277, fold-change: 2.05; ENST00000364938.1, P=2.49×10-77, fold-change: 2.19; ENST 00000363046.1, P=2.67×10-29, fold-change: 2.51; ENST00000384756.1, P=6.17×10-21, fold-change: 2.28). RT-qPCR results showed the relative expression of lncRNA ENST00000365494.1 was 1.80±0.22 (P=0.304), lncRNA ENST00000364938.1was 0.78±0.07 (P=0.417), lncRNA ENST00000363046.1was 1.28±0.24 (P=0.793), lncRNA ENST00000384756.1 was 1.52±0.25 (P=0.611)and tendency of up-regulation was found in 3 of them, which was consistent with the sequencing results. However, the difference did not achieve statistical significance. Conclusion Sequencing result could not be confirmed by RT-qPCR with a larger sample size, which implied the differential expression of lncRNA might not exist in the peripheral blood of AS patients, and further studies regarding lncRNA in AS could focus more on its differential expression and function in the focal tissue. Key words: Spondylitis, ankylosing; Regulatory sequences, ribonucleic acid; Gene expression
{"title":"Differential expression of lncRNA in the serum of ankylosing spondylitis patients","authors":"Li Zhuojie, Qiu Yong, Qian Bang-ping","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.18.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.18.006","url":null,"abstract":"Objective \u0000To investigate the differential expression of lncRNA in the serum of ankylosing spondylitis (AS) patients, with the goal of findingnew potential biomarkers for the diagnosis and targeted treatment of AS. \u0000 \u0000 \u0000Methods \u0000A total of 19 AS patients and 19 age-matched healthy controls treated at Nanjing Drum Tower Hospitalfrom January 2017 to September 2017 were recruited. Average age were 38.74±7.42 (range, 25-51) and 37.00±6.86 (range, 26-50). High-throughput lncRNA sequencing technology was used to detect differently expressed lncRNAs in the serum of 3 AS patients and 3 healthy controls. Target lncRNAs for further validation were selected according to the P values and fold-changes. In the rest of the serum samples (16 AS patients and 16 healthy controls), Trizol-based technique was used to extract total RNA, and after reverse transcription to obtain cDNA, RT-qPCR was preformed to confirm the sequencing results. \u0000 \u0000 \u0000Results \u0000Using high-throughput lncRNA sequencing, a total of 41 up-regulated and 2 down-regulated lncRNAs were detected in the serum of AS patients. After sorted by the P values, 4 lncRNAswith a fold-change larger than 2 were chosen as the target genes for RT-qPCR (ENST00000365494.1, P=2.6×10-277, fold-change: 2.05; ENST00000364938.1, P=2.49×10-77, fold-change: 2.19; ENST 00000363046.1, P=2.67×10-29, fold-change: 2.51; ENST00000384756.1, P=6.17×10-21, fold-change: 2.28). RT-qPCR results showed the relative expression of lncRNA ENST00000365494.1 was 1.80±0.22 (P=0.304), lncRNA ENST00000364938.1was 0.78±0.07 (P=0.417), lncRNA ENST00000363046.1was 1.28±0.24 (P=0.793), lncRNA ENST00000384756.1 was 1.52±0.25 (P=0.611)and tendency of up-regulation was found in 3 of them, which was consistent with the sequencing results. However, the difference did not achieve statistical significance. \u0000 \u0000 \u0000Conclusion \u0000Sequencing result could not be confirmed by RT-qPCR with a larger sample size, which implied the differential expression of lncRNA might not exist in the peripheral blood of AS patients, and further studies regarding lncRNA in AS could focus more on its differential expression and function in the focal tissue. \u0000 \u0000 \u0000Key words: \u0000Spondylitis, ankylosing; Regulatory sequences, ribonucleic acid; Gene expression","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1142-1148"},"PeriodicalIF":0.0,"publicationDate":"2019-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43802054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.18.001
Sen Chen, Zhigang Nie, S. Deng, Hong-song Fang, Zhi-hui Jin
Objective To evaluate the efficacy of green surgery pathway on senile hip fractures. Methods The green surgery pathway was implement in senile (≥75 years) hip fracture cases in our department since March 2016. A historically controlled trial study was designed: 97 senile hip fracture patients admitted between March 2016 and March 2017 were included in the intervention group and 78 senile hip fracture patients admitted between March 2015 and March 2016 were included in the control group. The patients’ general information were recorded, including gender, age, type of fracture, internal medical conditions, surgery method, the American Association of Anesthesiologists classification of physical status (ASA) classification, et al. The hip function was evaluated by the Harris score system at one week,6 months and one year after surgery. The waiting time for operation, operation time, length of hospital stay, complications during hospitalization and hip Harris score were compared between the two groups. Results For the baseline data between the two groups in terms of gender, age, fracture type, surgery method, ASA classification, and combined underlying disease, the differences were not statistically significant. The waiting time for operation of the green surgery pathway group (36.3±7.8 h) was significantly shorter than that in the control group (46.9±11.4 h, t=6.995, P=0.000). The operation time of the green surgery pathway group was 45.4±17.5 min, and that of the control group was 43.8±20.8 min, the differences were not statistically significant. The length of hospital stay in the green surgery pathway group (6.8±2.4 d) was significantly shorter than that in the control group (9.5±2.8 d), the difference was statistically significant (t=6.866, P=0.000). In the green surgery pathway group, one patient developed acute myocardial infarction at 15 h after surgery and died of invalid rescue. In the control group, one patient developed acute cerebral hemorrhage 3 d after surgery and died of invalid rescue. The incidence of pulmonary infection, urinary tract infection, and acne in the green surgery pathway group were lower than that in the control group, the differences were statistically significant (χ2PI=5.081, PPI=0.024; χ2UI=6.841, PUI=0.009; χ2acne=11.768, Pcne=0.001). For the incidence of acute myocardial infarction, acute cerebrovascular accident, pulmonary embolism and deep vein thrombosis between the two groups, the differences were not statistically significant. The Harris score of hip in the green surgery pathway was higher than that in the control group (72.6±13.1 points vs 62.2±15.4 points, t=4.826, P=0.000) one week after the surgery, the difference was statistically significant. While the score was slightly higher than that of the control group in the half year (93.8±16.8 vs 90.5±14.7) and one year (94.1±18.3 vs 92.4±15.9) after surgery, but the differences were not statistically significant. The mortality rate of the green surger
目的评价绿色手术路径治疗老年髋部骨折的疗效。方法自2016年3月起，对我科老年（≥75岁）髋部骨折患者实施绿色手术路径。设计了一项历史对照试验研究：干预组包括2016年3月至2017年3月期间入院的97名老年性髋部骨折患者，对照组包括2015年3月和2016年3月份期间入院的78名老年性髋关节骨折患者。记录患者的一般信息，包括性别、年龄、骨折类型、内部医疗状况、手术方法、美国麻醉师协会身体状况分类（ASA）分类等。在手术后一周、6个月和一年通过Harris评分系统评估髋关节功能。比较两组患者的手术等待时间、手术时间、住院时间、住院并发症及髋关节Harris评分。结果两组在性别、年龄、骨折类型、手术方法、ASA分类和合并基础疾病方面的基线数据差异无统计学意义。绿色手术路径组的等待手术时间（36.3±7.8小时）明显短于对照组（46.9±11.4小时，t=6.995，P=0.000）。绿色手术路径的手术时间为45.4±17.5分钟，对照组为43.8±20.8分钟，差异无统计学意义。绿色手术路径组的住院时间（6.8±2.4 d）明显短于对照组（9.5±2.8 d），差异有统计学意义（t=6.866，P=0.000）。对照组1例术后3d出现急性脑出血，抢救无效死亡。绿色手术路径组肺部感染、尿路感染和痤疮的发生率低于对照组，差异有统计学意义（χ2PI=5.081，PPI=0.024；χ2UI=6.841，PUI=0.009；χ2acne=11.768，Pcne=0.001），肺栓塞和深静脉血栓形成两组间差异无统计学意义。术后1周，绿色手术路径髋关节Harris评分高于对照组（72.6±13.1分vs 62.2±15.4分，t=4.826，P=0.000），差异有统计学意义。术后半年（93.8±16.8 vs 90.5±14.7）和一年（94.1±18.3 vs 92.4±15.9）评分略高于对照组，但差异无统计学意义。术后一年内，绿色手术路径的死亡率略低于对照组（6.19%vs 8.97%），但差异无统计学意义。结论实施绿色手术路径可以减少床上并发症的发生，促进髋关节早期康复，有效缩短住院时间。它具有社会效益和健康经济效益，值得进一步推广。关键词：髋部骨折；病例对照研究；治疗结果；术后并发症
{"title":"The efficacy of green surgery pathway on senile hip fractures","authors":"Sen Chen, Zhigang Nie, S. Deng, Hong-song Fang, Zhi-hui Jin","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.18.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.18.001","url":null,"abstract":"Objective \u0000To evaluate the efficacy of green surgery pathway on senile hip fractures. \u0000 \u0000 \u0000Methods \u0000The green surgery pathway was implement in senile (≥75 years) hip fracture cases in our department since March 2016. A historically controlled trial study was designed: 97 senile hip fracture patients admitted between March 2016 and March 2017 were included in the intervention group and 78 senile hip fracture patients admitted between March 2015 and March 2016 were included in the control group. The patients’ general information were recorded, including gender, age, type of fracture, internal medical conditions, surgery method, the American Association of Anesthesiologists classification of physical status (ASA) classification, et al. The hip function was evaluated by the Harris score system at one week,6 months and one year after surgery. The waiting time for operation, operation time, length of hospital stay, complications during hospitalization and hip Harris score were compared between the two groups. \u0000 \u0000 \u0000Results \u0000For the baseline data between the two groups in terms of gender, age, fracture type, surgery method, ASA classification, and combined underlying disease, the differences were not statistically significant. The waiting time for operation of the green surgery pathway group (36.3±7.8 h) was significantly shorter than that in the control group (46.9±11.4 h, t=6.995, P=0.000). The operation time of the green surgery pathway group was 45.4±17.5 min, and that of the control group was 43.8±20.8 min, the differences were not statistically significant. The length of hospital stay in the green surgery pathway group (6.8±2.4 d) was significantly shorter than that in the control group (9.5±2.8 d), the difference was statistically significant (t=6.866, P=0.000). In the green surgery pathway group, one patient developed acute myocardial infarction at 15 h after surgery and died of invalid rescue. In the control group, one patient developed acute cerebral hemorrhage 3 d after surgery and died of invalid rescue. The incidence of pulmonary infection, urinary tract infection, and acne in the green surgery pathway group were lower than that in the control group, the differences were statistically significant (χ2PI=5.081, PPI=0.024; χ2UI=6.841, PUI=0.009; χ2acne=11.768, Pcne=0.001). For the incidence of acute myocardial infarction, acute cerebrovascular accident, pulmonary embolism and deep vein thrombosis between the two groups, the differences were not statistically significant. The Harris score of hip in the green surgery pathway was higher than that in the control group (72.6±13.1 points vs 62.2±15.4 points, t=4.826, P=0.000) one week after the surgery, the difference was statistically significant. While the score was slightly higher than that of the control group in the half year (93.8±16.8 vs 90.5±14.7) and one year (94.1±18.3 vs 92.4±15.9) after surgery, but the differences were not statistically significant. The mortality rate of the green surger","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1101-1107"},"PeriodicalIF":0.0,"publicationDate":"2019-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45022558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.18.005
Junzhe Ding, Shibao Lu, C. Kong
Objective To measure the cross-sectional area (CSA) and fatty infiltration (FI) of lumbar paravertebral muscles in patients with degenerative lumbar scoliosis (DLS), and to analyze the mechanism and clinical significance of paravertebral muscles degeneration. Methods A retrospective study was performed on 118 patients with DLS who were enrolled in our hospital from September 2016 to September 2017. All patients had complete preoperative image data. Preoperative lumbar lordosis (LL), Cobb angle, and vertebral rotation were measured on spinal X-ray plain film. The CSA and FI of the paravertebral muscle on the upper and lower intervertebral level of the scoliosis apical vertebrae were measured by lumbar MRI, and the CSA, FI and their correlation with the Cobb angle were compared. Results This study enrolled 118 DLS patients, including 49 males and 69 females. The mean age of the patients was 65.4 ± 7.2 years, with an average BMI of 24.7 ± 3.4 and lumbar symptoms including LBP, sciatica, numbness and intermittent claudication, decreased myodynamia and other symptoms. The lasting time of symptoms were 21 months (3-60 months). The Cobb angle of the patients averaged 18.5°±6.7°. Of all patients, 60 patients had a scoliosis to the left, and 58 patients had a scoliosis to the right. The number of patients with lateral apical vertebrae located at L1-L4 were: 12 cases of L1, 41 cases of L2, 49 cases of L3, 16 cases of L4. The CSA of the concave side psoas muscle was significantly larger than that of the convex side(upper intervertebral level, concave side 3.74±2.17 cm2, convex side 3.56±1.91 cm2; lower intervertebral level, concave side 6.54±3.08 cm2, convex side 6.31±3.302 cm2. And the CSA of the concave side multifidus muscle and the extensor muscle group was significantly smaller than the convex side, multifidus muscle: upper intervertebral level, concave side 9.47±3.86 cm2, convex side 10.25±4.20 cm2; lower intervertebral level, concave side 9.30±3.61 cm2, convex side 10.21±3.81 cm2; extensor muscle group: upper intervertebral level, concave side 18.35±4.94 cm2, convex side 19.37±5.17 cm2; lower intervertebral level, concave side 18.98±4.73 cm2, convex side 19.81±5.16 cm2. The concave side FI of extensor muscle group is significantly larger than the convex side, upper intervertebral level, concave side 30.63±15.09, convex side 23.48±15.00; lower intervertebral level, concave side 37.87±19.38, convex side 30.43±16.89. There was a correlation between the degree of asymmetry of CSA and FI in the multifidus, dorsal extension muscles, paravertebral muscle and the scoliosis Cobb angle. Conclusion The paravertebral muscles of lumbar vertebrae are not a whole in the degenerative changes of DLS. There are different anatomical and physiological effects of lumbar flexion and extension muscle groups. The extensor muscles play an important role in antagonizing the progression of DLS. Improving paravertebral muscle function is an important element
{"title":"Asymmetric degeneration of paravertebral muscles in degenerative lumbar scoliosis and potential significance","authors":"Junzhe Ding, Shibao Lu, C. Kong","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.18.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.18.005","url":null,"abstract":"Objective \u0000To measure the cross-sectional area (CSA) and fatty infiltration (FI) of lumbar paravertebral muscles in patients with degenerative lumbar scoliosis (DLS), and to analyze the mechanism and clinical significance of paravertebral muscles degeneration. \u0000 \u0000 \u0000Methods \u0000A retrospective study was performed on 118 patients with DLS who were enrolled in our hospital from September 2016 to September 2017. All patients had complete preoperative image data. Preoperative lumbar lordosis (LL), Cobb angle, and vertebral rotation were measured on spinal X-ray plain film. The CSA and FI of the paravertebral muscle on the upper and lower intervertebral level of the scoliosis apical vertebrae were measured by lumbar MRI, and the CSA, FI and their correlation with the Cobb angle were compared. \u0000 \u0000 \u0000Results \u0000This study enrolled 118 DLS patients, including 49 males and 69 females. The mean age of the patients was 65.4 ± 7.2 years, with an average BMI of 24.7 ± 3.4 and lumbar symptoms including LBP, sciatica, numbness and intermittent claudication, decreased myodynamia and other symptoms. The lasting time of symptoms were 21 months (3-60 months). The Cobb angle of the patients averaged 18.5°±6.7°. Of all patients, 60 patients had a scoliosis to the left, and 58 patients had a scoliosis to the right. The number of patients with lateral apical vertebrae located at L1-L4 were: 12 cases of L1, 41 cases of L2, 49 cases of L3, 16 cases of L4. The CSA of the concave side psoas muscle was significantly larger than that of the convex side(upper intervertebral level, concave side 3.74±2.17 cm2, convex side 3.56±1.91 cm2; lower intervertebral level, concave side 6.54±3.08 cm2, convex side 6.31±3.302 cm2. And the CSA of the concave side multifidus muscle and the extensor muscle group was significantly smaller than the convex side, multifidus muscle: upper intervertebral level, concave side 9.47±3.86 cm2, convex side 10.25±4.20 cm2; lower intervertebral level, concave side 9.30±3.61 cm2, convex side 10.21±3.81 cm2; extensor muscle group: upper intervertebral level, concave side 18.35±4.94 cm2, convex side 19.37±5.17 cm2; lower intervertebral level, concave side 18.98±4.73 cm2, convex side 19.81±5.16 cm2. The concave side FI of extensor muscle group is significantly larger than the convex side, upper intervertebral level, concave side 30.63±15.09, convex side 23.48±15.00; lower intervertebral level, concave side 37.87±19.38, convex side 30.43±16.89. There was a correlation between the degree of asymmetry of CSA and FI in the multifidus, dorsal extension muscles, paravertebral muscle and the scoliosis Cobb angle. \u0000 \u0000 \u0000Conclusion \u0000The paravertebral muscles of lumbar vertebrae are not a whole in the degenerative changes of DLS. There are different anatomical and physiological effects of lumbar flexion and extension muscle groups. The extensor muscles play an important role in antagonizing the progression of DLS. Improving paravertebral muscle function is an important element ","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1133-1141"},"PeriodicalIF":0.0,"publicationDate":"2019-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42061207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.18.008
Jing Zhang, Zhenxian Chen, Yongchang Gao, Xuan Zhang, Zhongmin Jin
Osteoarthritis are usual disease in middle aged and elderly people. High tibial osteotomy is a common method which performed to treat medial compartment osteoarthritis in varus knees. Unicondylar knee arthroplasty is an established treatment option for symptomatic osteoarthritis isolated to one compartment, and received remarkably effect. Total knee arthroplasty is the standard treatment of serious knee disease. The knee kinematics have changed after the knee was diseased, and the kinematics after surgery are different from the natural joint. The flexion-extension rotation, anterior-posterior translation and interior-exterior rotation are most important kinematics of tibia-femur joint. The anterior-posterior translation and interior-exterior rotation, which as the secondary kinematics, even are paradoxical after total knee arthroplasty. Secondary kinematics studies played an important role in prosthesis design and postoperative functional assessment. Measurement and description methods of knee joint secondary kinematics were reviewed in this article. The factors influencing secondary kinematics were investigated for natural knee joint, osteoarthritis knee joint and knee joint after total knee replacement separately, and the influence of total knee replacement design was emphasized. At last, the impact of knee secondary kinematics to biomechanics, friction and wear were also introduced. After comparison of multi-research results, the measurement precision was found to need further improvement due to the restrict of measuring technology and description methods. Many factors influence knee secondary kinematics, including activities, measurement environment and individual difference. The anterior-posterior translation was found complex after total knee replacement, and the prosthesis design played an important role. Posterior cruciate ligament-retaining knee replacement lead forward slide of the femoral component during flexion, which paradoxical from natural knee. The anatomical design prosthesis were hopeful to realize more natural kinematics. The component malalignment and soft tissue balance during surgey also have significant role in knee secondary kinematics. The knee secondary kinematics study is of great significance to biomechanics and wear.
{"title":"Research status for knee joint secondary kinematics","authors":"Jing Zhang, Zhenxian Chen, Yongchang Gao, Xuan Zhang, Zhongmin Jin","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.18.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.18.008","url":null,"abstract":"Osteoarthritis are usual disease in middle aged and elderly people. High tibial osteotomy is a common method which performed to treat medial compartment osteoarthritis in varus knees. Unicondylar knee arthroplasty is an established treatment option for symptomatic osteoarthritis isolated to one compartment, and received remarkably effect. Total knee arthroplasty is the standard treatment of serious knee disease. The knee kinematics have changed after the knee was diseased, and the kinematics after surgery are different from the natural joint. The flexion-extension rotation, anterior-posterior translation and interior-exterior rotation are most important kinematics of tibia-femur joint. The anterior-posterior translation and interior-exterior rotation, which as the secondary kinematics, even are paradoxical after total knee arthroplasty. Secondary kinematics studies played an important role in prosthesis design and postoperative functional assessment. Measurement and description methods of knee joint secondary kinematics were reviewed in this article. The factors influencing secondary kinematics were investigated for natural knee joint, osteoarthritis knee joint and knee joint after total knee replacement separately, and the influence of total knee replacement design was emphasized. At last, the impact of knee secondary kinematics to biomechanics, friction and wear were also introduced. After comparison of multi-research results, the measurement precision was found to need further improvement due to the restrict of measuring technology and description methods. Many factors influence knee secondary kinematics, including activities, measurement environment and individual difference. The anterior-posterior translation was found complex after total knee replacement, and the prosthesis design played an important role. Posterior cruciate ligament-retaining knee replacement lead forward slide of the femoral component during flexion, which paradoxical from natural knee. The anatomical design prosthesis were hopeful to realize more natural kinematics. The component malalignment and soft tissue balance during surgey also have significant role in knee secondary kinematics. The knee secondary kinematics study is of great significance to biomechanics and wear.","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1157-1164"},"PeriodicalIF":0.0,"publicationDate":"2019-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49376271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：