Pub Date : 2020-02-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.04.005
Muyi Wang, Bin Wang, Y. Qiu, Ze-zhang Zhu, C. Du, Liang Xu, Qinshuang Zhou, Bo Yang
Objective To investigate the incidence and management of deep surgical site infection(SSI) after the spinal deformity surgery. Methods This study retrospectively reviewed a consecutive cohort of 8818 patients with spinal deformity who received spinal deformity surgery between January1998 and December 2017 at our center. The diagnosis of deep SSI was based on the clinical symptoms, imaging data and laboratory findings. Early infection and late infection were defined as deep infections occurring 3 months after the initial procedure, respectively. All deep SSIs were first treated with irrigation and debridement, closed suction irrigation system and antibiotics. If the infection cannot be eradicated, dressing change is recommended within 2 years after the initial surgery. The instrumentation can be removed 2 years after the initial surgery with careful evaluation of the fusion mass. The posterior-anterior and lateral radiographs were used to measure the coronal parameters and sagittal alignment. Results Sixty patients were diagnosed as deep SSI after spinal deformity surgery, including 11 patients with early infection and 49 patients with late infection. No significant difference was observed in terms of age, gender ratio, surgical approach and fusion levels between the two groups. Deep SSI seemed to be more likely to occur between 2 and 5 years after surgery. Incidence of SSI was lowest in the patients with idiopathic scoliosis and ankylosing spondylitis, and highest in the patients with neuromuscular and syndromic scoliosis. There was a high rate of negative culture in the primary culture. Staphylococcus aureus and Escherichia coli were the most common organisms in the early infection, while patients with late infection had a high rate of low-virulent skin flora. In the early infection group, nine patients retained instrumentation while the implants were removed 2 years after the primary surgery in 2 patients. In patients with late infection, instrumentation was retained in 5 cases and removed in 10 cases until 2 years after the primary surgery. 34 cases were infected 2 years after the primary surgery and the implants were removed directly. One patient underwent reoperation with instrumentation 1 month after implant removal, another patient underwent reoperation 3 years after implant removal due to progression of deformity. Significant loss of coronal correction was noted at the latest follow-up. Conclusion The rate of deep SSI after spinal deformity surgery was 0.68%, of which the incidence of early infection and delayed infection was 0.12% and 0.56%, respectively. An increased risk of SSI in patients with neuromuscular and syndromic scoliosis was noted. If the infection cannot be eradicated after repeated debridement, we recommend instrumentation removal 2 years after the initial surgery, but there is still a high risk of loss of correction in these patients. Key words: Scoliosis; Kyphosis; Spinal fusion; Infection; Treat
{"title":"Incidence and management of deep surgical site infection following spinal deformity surgery: 8 818 cases at a single institution","authors":"Muyi Wang, Bin Wang, Y. Qiu, Ze-zhang Zhu, C. Du, Liang Xu, Qinshuang Zhou, Bo Yang","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.04.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.04.005","url":null,"abstract":"Objective \u0000To investigate the incidence and management of deep surgical site infection(SSI) after the spinal deformity surgery. \u0000 \u0000 \u0000Methods \u0000This study retrospectively reviewed a consecutive cohort of 8818 patients with spinal deformity who received spinal deformity surgery between January1998 and December 2017 at our center. The diagnosis of deep SSI was based on the clinical symptoms, imaging data and laboratory findings. Early infection and late infection were defined as deep infections occurring 3 months after the initial procedure, respectively. All deep SSIs were first treated with irrigation and debridement, closed suction irrigation system and antibiotics. If the infection cannot be eradicated, dressing change is recommended within 2 years after the initial surgery. The instrumentation can be removed 2 years after the initial surgery with careful evaluation of the fusion mass. The posterior-anterior and lateral radiographs were used to measure the coronal parameters and sagittal alignment. \u0000 \u0000 \u0000Results \u0000Sixty patients were diagnosed as deep SSI after spinal deformity surgery, including 11 patients with early infection and 49 patients with late infection. No significant difference was observed in terms of age, gender ratio, surgical approach and fusion levels between the two groups. Deep SSI seemed to be more likely to occur between 2 and 5 years after surgery. Incidence of SSI was lowest in the patients with idiopathic scoliosis and ankylosing spondylitis, and highest in the patients with neuromuscular and syndromic scoliosis. There was a high rate of negative culture in the primary culture. Staphylococcus aureus and Escherichia coli were the most common organisms in the early infection, while patients with late infection had a high rate of low-virulent skin flora. In the early infection group, nine patients retained instrumentation while the implants were removed 2 years after the primary surgery in 2 patients. In patients with late infection, instrumentation was retained in 5 cases and removed in 10 cases until 2 years after the primary surgery. 34 cases were infected 2 years after the primary surgery and the implants were removed directly. One patient underwent reoperation with instrumentation 1 month after implant removal, another patient underwent reoperation 3 years after implant removal due to progression of deformity. Significant loss of coronal correction was noted at the latest follow-up. \u0000 \u0000 \u0000Conclusion \u0000The rate of deep SSI after spinal deformity surgery was 0.68%, of which the incidence of early infection and delayed infection was 0.12% and 0.56%, respectively. An increased risk of SSI in patients with neuromuscular and syndromic scoliosis was noted. If the infection cannot be eradicated after repeated debridement, we recommend instrumentation removal 2 years after the initial surgery, but there is still a high risk of loss of correction in these patients. \u0000 \u0000 \u0000Key words: \u0000Scoliosis; Kyphosis; Spinal fusion; Infection; Treat","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"226-235"},"PeriodicalIF":0.0,"publicationDate":"2020-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49355009","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 : 2020-02-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.04.001
H. Ma, B. Shi, Zhen Liu, Ze-zhang Zhu
Objective To modify the global alignment and proportion (GAP) score according to the spinopelvic alignment of healthy volunteers and to validate the reliability of the GAP score and the modified GAP (M-GAP) score in the prediction of mechanical failure after corrective surgeries in adult degenerative scoliosis (ADS). Methods Clinical and radiographical data of 66 ADS patients undergoing correction surgeries in our center between January 2014 and January 2017 were retrospectively reviewed. The average age of the cohort was 60.2±7.1 years, including 13 male patients and 53 female patients. The predictive ability of GAP score to the mechanical failure was validated with Fisher's exact test and Linear-by-linear association test. Sagittal spinopelvic parameters were measured on lateral full-spine X-rays of 67 healthy volunteers aged between 50 and 70. The average age of these subjects was 58.2±5.4 years. Values of spinal and pelvic parameters including pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), global tilt (GT) and sagittal vertical axis (SVA) were measured. Simple linear regression analysis was conducted between PI and SS, LL and GT, respectively. The equations of regression analysis were used to calculate patients' ideal SS, LL and GT, and to establish the modified GAP (M-GAP) score. The predictive ability of M-GAP score to the mechanical failure was also validated. Results Sagittal spinal and pelvic parameters of healthy subjects were measured and illustrated. The correlations between SS, LL and PI were SS=0.40×PI+12, LL=0.46×PI+22 and GT=0.46×PI-5. According to the GAP score, the postoperative sagittal spinopelvic alignment was proportioned in 16 (24.2%) cases, moderately disproportioned in 32 (48.5%) cases and severely disproportioned in 18 (27.3%) cases according to the original GAP score, and the occurrence of mechanical complication was 18.8% (3/16), 12.5% (4/32) and 22.2%(4/18) respectively. The GAP categories were not significantly correlated with the prevalence of mechanical failure (P=0.633), and no significant linear correlation was found (χ2=5.022, P=0.822). After re-evaluation of M-GAP score, the postoperative sagittal spinopelvic alignment was proportioned in 32 (48.5%) cases, moderately disproportioned in 25 (37.9%) cases and severely disproportioned in 9 (13.6%) cases, and the occurrence of mechanical failure was 6.3% (2/32), 24.0% (6/25) and 30%(3/9), respectively. The prevalence of mechanical failure was statistically different between proportioned, moderately disproportioned and severely disproportioned spinopelvic alignment patients classified by M-GAP score (P=0.048), and there was a statistically significant linear association between the M-GAP categories and the occurrence of mechanical complications (χ2=0.093, P=0.034). Conclusion Poor predictive ability of the original GAP score to the mechanical failure was detected in ADS patients. However, the modified GAP score seemed to be a relia
{"title":"Prediction of mechanical complications after corrective surgeries in adult degenerative scoliosis: modification and validation of the global alignment and proportion (GAP) score","authors":"H. Ma, B. Shi, Zhen Liu, Ze-zhang Zhu","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.04.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.04.001","url":null,"abstract":"Objective \u0000To modify the global alignment and proportion (GAP) score according to the spinopelvic alignment of healthy volunteers and to validate the reliability of the GAP score and the modified GAP (M-GAP) score in the prediction of mechanical failure after corrective surgeries in adult degenerative scoliosis (ADS). \u0000 \u0000 \u0000Methods \u0000Clinical and radiographical data of 66 ADS patients undergoing correction surgeries in our center between January 2014 and January 2017 were retrospectively reviewed. The average age of the cohort was 60.2±7.1 years, including 13 male patients and 53 female patients. The predictive ability of GAP score to the mechanical failure was validated with Fisher's exact test and Linear-by-linear association test. Sagittal spinopelvic parameters were measured on lateral full-spine X-rays of 67 healthy volunteers aged between 50 and 70. The average age of these subjects was 58.2±5.4 years. Values of spinal and pelvic parameters including pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), global tilt (GT) and sagittal vertical axis (SVA) were measured. Simple linear regression analysis was conducted between PI and SS, LL and GT, respectively. The equations of regression analysis were used to calculate patients' ideal SS, LL and GT, and to establish the modified GAP (M-GAP) score. The predictive ability of M-GAP score to the mechanical failure was also validated. \u0000 \u0000 \u0000Results \u0000Sagittal spinal and pelvic parameters of healthy subjects were measured and illustrated. The correlations between SS, LL and PI were SS=0.40×PI+12, LL=0.46×PI+22 and GT=0.46×PI-5. According to the GAP score, the postoperative sagittal spinopelvic alignment was proportioned in 16 (24.2%) cases, moderately disproportioned in 32 (48.5%) cases and severely disproportioned in 18 (27.3%) cases according to the original GAP score, and the occurrence of mechanical complication was 18.8% (3/16), 12.5% (4/32) and 22.2%(4/18) respectively. The GAP categories were not significantly correlated with the prevalence of mechanical failure (P=0.633), and no significant linear correlation was found (χ2=5.022, P=0.822). After re-evaluation of M-GAP score, the postoperative sagittal spinopelvic alignment was proportioned in 32 (48.5%) cases, moderately disproportioned in 25 (37.9%) cases and severely disproportioned in 9 (13.6%) cases, and the occurrence of mechanical failure was 6.3% (2/32), 24.0% (6/25) and 30%(3/9), respectively. The prevalence of mechanical failure was statistically different between proportioned, moderately disproportioned and severely disproportioned spinopelvic alignment patients classified by M-GAP score (P=0.048), and there was a statistically significant linear association between the M-GAP categories and the occurrence of mechanical complications (χ2=0.093, P=0.034). \u0000 \u0000 \u0000Conclusion \u0000Poor predictive ability of the original GAP score to the mechanical failure was detected in ADS patients. However, the modified GAP score seemed to be a relia","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"193-198"},"PeriodicalIF":0.0,"publicationDate":"2020-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44686357","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 : 2020-02-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.04.002
Zhong He, X. Qin, Rui Yin, Y. Qiu
Objective To investigate the radiological presentations in relation to different ages in scoliosis associated with Chiari malformation typeⅠ(CMI). Methods A retrospective analysis was performed on 80 patients diagnosed with scoliosis associated with CMI from June 2010 to June 2018, who were classified into three groups according to their age: Children(age≤10 years), Adolescents (age 11-18 years) and Adults (age≥19 years). Curves were classified into typical and atypical patterns in the coronal plane. The coronal and sagittal radiographical parameters were measured in the three groups. Moreover, cerebellar tonsillar descent and syringomyelia patterns were measured on MRI, and the parameters among the three groups were compared statistically. Results The incidence of atypical curve patterns in Children (10 patients), Adolescents (44 patients) and Adults (26 patients) was 30.0%, 15.9%, and 50.0%, respectively (χ2=2.654, P=0.265). There was no statistical difference in the distribution of curve patterns among CMI patients with different age. In the coronal profile, Cobb angle (F=16.751, P<0.001) and flexibility (F=3.285, P=0.044) of main curve, Cobb angle of secondary curve (F=9.805, P<0.001) and coronal balance(CB) (F=5.249, P=0.007) showed statistical difference. The elderly patients tended to have larger Cobb angle of main and secondary curve with worse flexibility of main curve, and CB in Adolescents was better than the other two groups. In the sagittal profile, TK (F=4.324, P=0.017), LL (F=4.590, P=0.013), PI (F=5.501, P=0.006), and PT (F=3.220, P=0.045) showed statistical difference in the three groups, which were increasing significantly with aging. MRI parameters showed that younger patients were more likely to have a higher degree of cerebellar tonsillar descent (χ2=18.479, P<0.001) and distended syringomyelia (χ2=23.074, P=0.003). Conclusion With aging, Cobb angle of main curve is progressive, and the flexibility is worse, suggesting that early surgical intervention should be performed to reduce the risk of surgery. In addition, cerebellar tonsillar descent and syringomyelia in elderly patients are milder than young patients, indicating that there might be spontaneous remission. Key words: Arnold-Chiari malformation; Scoliosis; Syringomyelia; Age factors; Cross-sectional studies
{"title":"The natural history of radiological presentations in Chiari malformation type I with scoliosis: a cross-sectional study","authors":"Zhong He, X. Qin, Rui Yin, Y. Qiu","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.04.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.04.002","url":null,"abstract":"Objective \u0000To investigate the radiological presentations in relation to different ages in scoliosis associated with Chiari malformation typeⅠ(CMI). \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was performed on 80 patients diagnosed with scoliosis associated with CMI from June 2010 to June 2018, who were classified into three groups according to their age: Children(age≤10 years), Adolescents (age 11-18 years) and Adults (age≥19 years). Curves were classified into typical and atypical patterns in the coronal plane. The coronal and sagittal radiographical parameters were measured in the three groups. Moreover, cerebellar tonsillar descent and syringomyelia patterns were measured on MRI, and the parameters among the three groups were compared statistically. \u0000 \u0000 \u0000Results \u0000The incidence of atypical curve patterns in Children (10 patients), Adolescents (44 patients) and Adults (26 patients) was 30.0%, 15.9%, and 50.0%, respectively (χ2=2.654, P=0.265). There was no statistical difference in the distribution of curve patterns among CMI patients with different age. In the coronal profile, Cobb angle (F=16.751, P<0.001) and flexibility (F=3.285, P=0.044) of main curve, Cobb angle of secondary curve (F=9.805, P<0.001) and coronal balance(CB) (F=5.249, P=0.007) showed statistical difference. The elderly patients tended to have larger Cobb angle of main and secondary curve with worse flexibility of main curve, and CB in Adolescents was better than the other two groups. In the sagittal profile, TK (F=4.324, P=0.017), LL (F=4.590, P=0.013), PI (F=5.501, P=0.006), and PT (F=3.220, P=0.045) showed statistical difference in the three groups, which were increasing significantly with aging. MRI parameters showed that younger patients were more likely to have a higher degree of cerebellar tonsillar descent (χ2=18.479, P<0.001) and distended syringomyelia (χ2=23.074, P=0.003). \u0000 \u0000 \u0000Conclusion \u0000With aging, Cobb angle of main curve is progressive, and the flexibility is worse, suggesting that early surgical intervention should be performed to reduce the risk of surgery. In addition, cerebellar tonsillar descent and syringomyelia in elderly patients are milder than young patients, indicating that there might be spontaneous remission. \u0000 \u0000 \u0000Key words: \u0000Arnold-Chiari malformation; Scoliosis; Syringomyelia; Age factors; Cross-sectional studies","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"199-207"},"PeriodicalIF":0.0,"publicationDate":"2020-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48600901","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 : 2020-02-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.04.004
Liang Xu, Xu Sun, Bo Yang, C. Du, Qingshuang Zhou, Muyi Wang, Bin Wang, Yang Yu, B. Qian, Ze-zhang Zhu
Objective To evaluate long-term results of growth friendly non-fusion technique (GF) in the treatment of early-onset scoliosis (EOS). Methods From August 2008 to October 2019, a total of 26 EOS patients (mean age 7.2±2.4 years old) who had completed surgery with GF treatment, including 12 males and 14 females, were reviewed retrospectively. Among them, 16 patients underwent growing rod treatment while 10 patients underwent vertical expandable prosthetic titanium rib (VEPTR) treatment. All patients had minimum 2 lengthening procedure during distraction period and over 2-year follow-up after graduation. Radiographic data were collected before and after index surgery as well as at graduation and the latest follow-up. Complications were also recorded during distraction period and after graduation. Results A total of 145 lengthening procedures were performed in 26 patients, averagely 5.6 procedures per patient. The mean age at graduation was 12.6±1.6 years old. The average follow-up was 4.7±1.4 years duringdistraction period, and 2.9±0.9 years after graduation.The main Cobb angle was significantly decreased from 81.2°±17.3° to 41.1°±13.1°(t=8.124, P<0.001)after the index surgery, but slightly increased to 48.8°±15.4° at the end of distraction. After definitive spinal fusion, the main Cobb angle was notably decreased from 52.8°±16.1° to 45.4°±14.8° in 16 patients(t=2.415, P=0.035), with an average correction rate of 14.1%±9.4%. At the latest follow-up, the main Cobb angle was 45.2°±15.6° and the average correction rate was 44.3%±15.5% when comparing with the value before the index surgery. The thoracic and spinal height were significantly increased after initial surgery. During distraction period, the average gain of thoracic and spinal height was 3.3±0.9 cm and 5.6±1.9 cm, with the growth rate of 0.6±0.3 cm and 1.0±0.4 cm per distraction, respectively. A total of 36complications were recorded in 14 patients. There were 27 complications occurred during distraction period and 9 after graduation. Conclusion Surgical management of EOS with growing rod and VEPTR could effectively correct the spinal deformity and maintain spinal growth. The complication rate after graduation was relative lower than distraction period. However, the correction of definitive spinal fusion during graduation was relative lower. Key words: Child; Scoliosis; Orthopedic fixation devices; Follow-up studies; Spinal fusion
{"title":"The long-term results of growth friendly non-fusion technique in the treatment of early-onset scoliosis","authors":"Liang Xu, Xu Sun, Bo Yang, C. Du, Qingshuang Zhou, Muyi Wang, Bin Wang, Yang Yu, B. Qian, Ze-zhang Zhu","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.04.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.04.004","url":null,"abstract":"Objective \u0000To evaluate long-term results of growth friendly non-fusion technique (GF) in the treatment of early-onset scoliosis (EOS). \u0000 \u0000 \u0000Methods \u0000From August 2008 to October 2019, a total of 26 EOS patients (mean age 7.2±2.4 years old) who had completed surgery with GF treatment, including 12 males and 14 females, were reviewed retrospectively. Among them, 16 patients underwent growing rod treatment while 10 patients underwent vertical expandable prosthetic titanium rib (VEPTR) treatment. All patients had minimum 2 lengthening procedure during distraction period and over 2-year follow-up after graduation. Radiographic data were collected before and after index surgery as well as at graduation and the latest follow-up. Complications were also recorded during distraction period and after graduation. \u0000 \u0000 \u0000Results \u0000A total of 145 lengthening procedures were performed in 26 patients, averagely 5.6 procedures per patient. The mean age at graduation was 12.6±1.6 years old. The average follow-up was 4.7±1.4 years duringdistraction period, and 2.9±0.9 years after graduation.The main Cobb angle was significantly decreased from 81.2°±17.3° to 41.1°±13.1°(t=8.124, P<0.001)after the index surgery, but slightly increased to 48.8°±15.4° at the end of distraction. After definitive spinal fusion, the main Cobb angle was notably decreased from 52.8°±16.1° to 45.4°±14.8° in 16 patients(t=2.415, P=0.035), with an average correction rate of 14.1%±9.4%. At the latest follow-up, the main Cobb angle was 45.2°±15.6° and the average correction rate was 44.3%±15.5% when comparing with the value before the index surgery. The thoracic and spinal height were significantly increased after initial surgery. During distraction period, the average gain of thoracic and spinal height was 3.3±0.9 cm and 5.6±1.9 cm, with the growth rate of 0.6±0.3 cm and 1.0±0.4 cm per distraction, respectively. A total of 36complications were recorded in 14 patients. There were 27 complications occurred during distraction period and 9 after graduation. \u0000 \u0000 \u0000Conclusion \u0000Surgical management of EOS with growing rod and VEPTR could effectively correct the spinal deformity and maintain spinal growth. The complication rate after graduation was relative lower than distraction period. However, the correction of definitive spinal fusion during graduation was relative lower. \u0000 \u0000 \u0000Key words: \u0000Child; Scoliosis; Orthopedic fixation devices; Follow-up studies; Spinal fusion","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"217-225"},"PeriodicalIF":0.0,"publicationDate":"2020-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46528504","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 : 2020-02-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.04.006
Xi Chen, Xinyu Liu, Qing Yang, Yifan Liu, Suomao Yuan
Objective To investigate and compare the biomechanical strength of paravertebral foramen screws (PVFS), lateral mass screws (LMS) and pedicle screws (PS). Methods A total of 30 human cervical spine vertebrae (C3-C6) were harvested from 8 fresh-frozen cadaver specimens whose mean age was 45.3±11.2 years at death. The vertebrae were randomly divided into three groups for specific screws. For each vertebra, one side was randomly chosen for direct pullout strength test (speed 5 mm/s), and the other side for fatigue test (displacement ±1.0 mm, frequency 1 Hz, 500 cycles) and residual pullout strength test. 4.5 mm × 12 mm screws were used for PVFS, 3.5 mm × 14 mm screws for LMS, and 3.5 mm × 24 mm screws for PS. Results The direct pullout strength was 327.10±17.07 N for PVFS, 305.71 ± 11.63 N for LMS, and 635.67 ± 22.82 N for PS. The residual pullout strength was 265.62 ±18.19 N for PVFS, 192.80 ±17.10 N for LMS, and 494.89 ±41.79 N for PS. The residual pullout strength of PVFS, LMS and PS respectively, compared with the direct pullout strength, decreased by 18.8%, 36.93% and 22.15% (tPVFS=7.795, tLMS=17.267, tPS=9.349, P<0.001). The direct pullout strength of PS was higher than that of PVFS and LMS(t=34.245, t=40.741, P< 0.001), as well as PVFS was slightly higher than LMS (t=3.275, P=0.004). The residual pullout strength of PS was the highest, PVFS was the second, and LMS was the smallest (F=314.619, P<0.001). For the fatigue test, the load at the first cycle and the first time when the set position was reached of PVFS were higher than those of LMS (t=3.625, P=0.002; t=5.388, P<0.001) and PS (t=2.575, P=0.019; t=2.680, P=0.015), but there was no difference between those of LMS and PS (t=0.609, P=0.550; t=1.953, P=0.067). The load at the last cycle of PVFS and PS was higher than that of LMS (t=5.341, P<0.001; t=3.439, P=0.003), while there was no difference between PVFS and PS (t=1.606, P=0.126). Conclusion The direct pullout strength of PVFS was slightly higher than that of LMS, and the residual pullout strength was significantly higher than LMS. The property of fatigue resistance of PVFS was similar to PS and obviously better than LMS. In summary, PVFS can be used as an effective substitute for LMS and PS. Key words: Cervical vertebrae; Spinal fusion; Bone screws; Biomechanics
{"title":"Comparison of biomechanical properties of cervical paravertebral foramen screws, lateral mass screws and pedicle screws","authors":"Xi Chen, Xinyu Liu, Qing Yang, Yifan Liu, Suomao Yuan","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.04.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.04.006","url":null,"abstract":"Objective \u0000To investigate and compare the biomechanical strength of paravertebral foramen screws (PVFS), lateral mass screws (LMS) and pedicle screws (PS). \u0000 \u0000 \u0000Methods \u0000A total of 30 human cervical spine vertebrae (C3-C6) were harvested from 8 fresh-frozen cadaver specimens whose mean age was 45.3±11.2 years at death. The vertebrae were randomly divided into three groups for specific screws. For each vertebra, one side was randomly chosen for direct pullout strength test (speed 5 mm/s), and the other side for fatigue test (displacement ±1.0 mm, frequency 1 Hz, 500 cycles) and residual pullout strength test. 4.5 mm × 12 mm screws were used for PVFS, 3.5 mm × 14 mm screws for LMS, and 3.5 mm × 24 mm screws for PS. \u0000 \u0000 \u0000Results \u0000The direct pullout strength was 327.10±17.07 N for PVFS, 305.71 ± 11.63 N for LMS, and 635.67 ± 22.82 N for PS. The residual pullout strength was 265.62 ±18.19 N for PVFS, 192.80 ±17.10 N for LMS, and 494.89 ±41.79 N for PS. The residual pullout strength of PVFS, LMS and PS respectively, compared with the direct pullout strength, decreased by 18.8%, 36.93% and 22.15% (tPVFS=7.795, tLMS=17.267, tPS=9.349, P<0.001). The direct pullout strength of PS was higher than that of PVFS and LMS(t=34.245, t=40.741, P< 0.001), as well as PVFS was slightly higher than LMS (t=3.275, P=0.004). The residual pullout strength of PS was the highest, PVFS was the second, and LMS was the smallest (F=314.619, P<0.001). For the fatigue test, the load at the first cycle and the first time when the set position was reached of PVFS were higher than those of LMS (t=3.625, P=0.002; t=5.388, P<0.001) and PS (t=2.575, P=0.019; t=2.680, P=0.015), but there was no difference between those of LMS and PS (t=0.609, P=0.550; t=1.953, P=0.067). The load at the last cycle of PVFS and PS was higher than that of LMS (t=5.341, P<0.001; t=3.439, P=0.003), while there was no difference between PVFS and PS (t=1.606, P=0.126). \u0000 \u0000 \u0000Conclusion \u0000The direct pullout strength of PVFS was slightly higher than that of LMS, and the residual pullout strength was significantly higher than LMS. The property of fatigue resistance of PVFS was similar to PS and obviously better than LMS. In summary, PVFS can be used as an effective substitute for LMS and PS. \u0000 \u0000 \u0000Key words: \u0000Cervical vertebrae; Spinal fusion; Bone screws; Biomechanics","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"236-243"},"PeriodicalIF":0.0,"publicationDate":"2020-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47971155","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 : 2020-02-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.04.007
Pan Wu, Zhuo Pei, W. Zeng
Articular cartilage defect is a common joint damage, however, due to the particularity of cartilage tissue, its repair ability is limited. Thus, articular cartilage damage often changes to more severe osteoarthritis which brings huge pain and economic burden to patients. The development of cartilage tissue engineering brings good news to these patients, but also faces great challenges. Because of the characteristics of mesenchymal stem cells(MSCs) including autologous source, amplification and cartilage differentiation potential, MSCs are often used as the seed cells of cartilage tissue engineering and got widely attention. In the commonly used treatment strategy of articular cartilage differentiated from mesenchymal cells, in vitro pre culture and differentiation showed good therapeutic effects.The mesenchymal stem cells collected from the patient were concentrated, cultured and induced differentiation in vitro, a certain number of differentiated chondrocytes were obtained, and then the cells and culture matrix were transplanted to the patient together. However, the tissue engineering cartilage obtained from mesenchymal stem cells cannot fully meet the requirements of clinical treatment. Moreover, due to the differences of disease type, degree and individuality, there are various optimized factors for the treatment of MSCs derived tissue-engineered cartilage transplantation. For the same type of disease treatment, the optimization system still has no unified recognized standard. In order to obtain better adapt to the human body and meet the clinical requirements of articular cartilage, this review focus onoptimized factors of MSCs in the treatment of orthopedic diseases, summarize and analysis the research status, and discuss the induced factorsfrom three aspects: environmental factors, scaffold selection and seed cells.It provides an idea for using mesenchymal stem cells to obtain better tissue-engineered cartilage and to establish a better optimization system.
{"title":"Optimization system of mesenchymal stem cells for tissue engineering chondrogenic differentiation","authors":"Pan Wu, Zhuo Pei, W. Zeng","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.04.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.04.007","url":null,"abstract":"Articular cartilage defect is a common joint damage, however, due to the particularity of cartilage tissue, its repair ability is limited. Thus, articular cartilage damage often changes to more severe osteoarthritis which brings huge pain and economic burden to patients. The development of cartilage tissue engineering brings good news to these patients, but also faces great challenges. Because of the characteristics of mesenchymal stem cells(MSCs) including autologous source, amplification and cartilage differentiation potential, MSCs are often used as the seed cells of cartilage tissue engineering and got widely attention. In the commonly used treatment strategy of articular cartilage differentiated from mesenchymal cells, in vitro pre culture and differentiation showed good therapeutic effects.The mesenchymal stem cells collected from the patient were concentrated, cultured and induced differentiation in vitro, a certain number of differentiated chondrocytes were obtained, and then the cells and culture matrix were transplanted to the patient together. However, the tissue engineering cartilage obtained from mesenchymal stem cells cannot fully meet the requirements of clinical treatment. Moreover, due to the differences of disease type, degree and individuality, there are various optimized factors for the treatment of MSCs derived tissue-engineered cartilage transplantation. For the same type of disease treatment, the optimization system still has no unified recognized standard. In order to obtain better adapt to the human body and meet the clinical requirements of articular cartilage, this review focus onoptimized factors of MSCs in the treatment of orthopedic diseases, summarize and analysis the research status, and discuss the induced factorsfrom three aspects: environmental factors, scaffold selection and seed cells.It provides an idea for using mesenchymal stem cells to obtain better tissue-engineered cartilage and to establish a better optimization system.","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"244-256"},"PeriodicalIF":0.0,"publicationDate":"2020-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46195042","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 : 2020-02-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.04.003
J. Ji, Yong‐cheng Hu
Objective To evaluate the clinical effectiveness of the reconstruction of the thoracic and lumbar spine using the 3D-printed vertebral body after total en bloc spondylectomy. Methods From December 2016 to September 2019, 33 patients with spinal tumors were treated with total en bloc spondylectomy, including 25 males and 8 females with an average age of 58.0 years(range, 15 to 76). The locations of the lesions contained: 29 in the thoracic and 4 in the lumbar. The surgical segments includeda single vertebra in 30 cases, 2 vertebrae in 2 cases, and 3 vertebrae in 1 case. The tumor type: the primary malignant tumor in 6 cases, the metastatic tumor in 27 cases. The preoperative Tomita score was 2-5 points (mean 3.9 points), while Tokuhashi score was 9-15 points (average 11.1 points). Divided into two groups according to different reconstruction methods during total spinal resection, 33 patients with thoracolumbar vertebral body malignant tumors were divided into 3D printed artificial vertebral body reconstruction group (21 patients, 3D printed artificial vertebral body was used for anterior column reconstruction) and titanium Mesh reconstruction group (12 cases, titanium mesh implanted with allograft bone was used for reconstruction). The main observation indicators included the degree of spinal nerve damage and pain recovery, the local tumor control rate, and the incidence of prosthesis sinking. The visual analogue scale (VAS) at 24 hours and 3 months after operation was compared with that before operation using paired design t test. Results All cases were followed up for 3 to 31 months. There was no statistically significant difference in intraoperative blood loss (t=2.042, P>0.05), surgical time (t=0.591, P>0.05), and postoperative drainage (t=0.118, P>0.05) between the two groups. The visual analogue scale (VAS) between the two groups at preoperative, 24 hours and 3 months after operation was not statistically different (P<0.05). The Frankel grading of 31 patients (97.0%) had at least one grade improvement 3 months after operation. During the follow-up period, 12 patients (41.7%) who underwent reconstruction with titanium mesh showed different degrees of subsidence in imaging, and 21 patients who used 3D printed artificial vertebral reconstruction did not exhibit prosthetic deposition. Chi-square test results of postoperative sink rate of the two methods was statistically different (χ2=10.313, P=0.013). Conclusion This preliminary report suggests the 3D-printed vertebral body has good biocompatibility and mechanical stability, which can be used for reconstruction after total en bloc spondylectomy. Key words: Spinal neoplasms; Spinal fusion; Prostheses and implants
{"title":"Application of 3D printed porous artificial vertebra in reconstruction of thoracolumbar tumor","authors":"J. Ji, Yong‐cheng Hu","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.04.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.04.003","url":null,"abstract":"Objective \u0000To evaluate the clinical effectiveness of the reconstruction of the thoracic and lumbar spine using the 3D-printed vertebral body after total en bloc spondylectomy. \u0000 \u0000 \u0000Methods \u0000From December 2016 to September 2019, 33 patients with spinal tumors were treated with total en bloc spondylectomy, including 25 males and 8 females with an average age of 58.0 years(range, 15 to 76). The locations of the lesions contained: 29 in the thoracic and 4 in the lumbar. The surgical segments includeda single vertebra in 30 cases, 2 vertebrae in 2 cases, and 3 vertebrae in 1 case. The tumor type: the primary malignant tumor in 6 cases, the metastatic tumor in 27 cases. The preoperative Tomita score was 2-5 points (mean 3.9 points), while Tokuhashi score was 9-15 points (average 11.1 points). Divided into two groups according to different reconstruction methods during total spinal resection, 33 patients with thoracolumbar vertebral body malignant tumors were divided into 3D printed artificial vertebral body reconstruction group (21 patients, 3D printed artificial vertebral body was used for anterior column reconstruction) and titanium Mesh reconstruction group (12 cases, titanium mesh implanted with allograft bone was used for reconstruction). The main observation indicators included the degree of spinal nerve damage and pain recovery, the local tumor control rate, and the incidence of prosthesis sinking. The visual analogue scale (VAS) at 24 hours and 3 months after operation was compared with that before operation using paired design t test. \u0000 \u0000 \u0000Results \u0000All cases were followed up for 3 to 31 months. There was no statistically significant difference in intraoperative blood loss (t=2.042, P>0.05), surgical time (t=0.591, P>0.05), and postoperative drainage (t=0.118, P>0.05) between the two groups. The visual analogue scale (VAS) between the two groups at preoperative, 24 hours and 3 months after operation was not statistically different (P<0.05). The Frankel grading of 31 patients (97.0%) had at least one grade improvement 3 months after operation. During the follow-up period, 12 patients (41.7%) who underwent reconstruction with titanium mesh showed different degrees of subsidence in imaging, and 21 patients who used 3D printed artificial vertebral reconstruction did not exhibit prosthetic deposition. Chi-square test results of postoperative sink rate of the two methods was statistically different (χ2=10.313, P=0.013). \u0000 \u0000 \u0000Conclusion \u0000This preliminary report suggests the 3D-printed vertebral body has good biocompatibility and mechanical stability, which can be used for reconstruction after total en bloc spondylectomy. \u0000 \u0000 \u0000Key words: \u0000Spinal neoplasms; Spinal fusion; Prostheses and implants","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"208-216"},"PeriodicalIF":0.0,"publicationDate":"2020-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48872376","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 study the anatomical features of the distal humerus in Chinese healthy adults. Methods A total of 121 cases of normal elbow joint CT images were selected from the picture archiving and communication system (PACS), and reconstructed and measured on the AW4.5 workstation. Coronal plane and horizontal plane were determined by flexion-extension (FE) axis and humeral shaft, while the sagittal plane was perpendicular to the FE axis. The angle between the axis of humerus medullary cavity and the FE axis of elbow (H-FE angle) was measured on the coronal plane. The capitellar height (CH), lateral trochlear height (LTH), trochlear height (TH) and medial trochlear height (MTH) were measured on four different sagittal planes. The capitellar width (CW), capitellar depth (CD), anterior lateral trochlear width (ALTW), posterior lateral trochlear width (PLTW), trochlear width (TW), anterior medial trochlear width (AMTW), posterior medial trochlear width (PMTW), trochlear depth (TD), anterior lateral trochlear depth (ALTD), posterior lateral trochlear depth (PLTD), anterior medial trochlear depth (AMTD), posterior medial trochlear depth (PMTD), and distal humeral width (W) were measured on the horizontal plane. The gender differences in measured parameters, correlations between data, and differences in H-FE angle from 90° were analyzed. Results In male, CH was 21.5± 1.3 mm, CW 17.5±1.1 mm, CD 10.8±0.9 mm, TW 25.1±2.2 mm, TH 17.3±1.5 mm, TD 17.5±1.4 mm, ALTW 7.7±1.2 mm, PLTW 12.5±1.6 mm, AMTW 12.4±1.6 mm, PMTW 9.8±2.0 mm, ALTD 10.0±0.8 mm, PLTD 16.3±1.4 mm, AMTD 12.9±1.4 mm, PMTD 13.2±1.4 mm, LTH 20.6±1.3 mm, MTH 25.0±2.4 mm, W 42.6±2.5 mm. The above parameters in female was 18.7±1.1 mm, 15.3±1.1 mm, 9.5±0.6 mm, 21.7±1.5 mm, 15.4±1.7 mm, 15.6±1.5 mm, 6.8±1.3 mm, 10.7±1.4 mm, 10.6±1.4 mm, 8.5±1.4 mm, 8.9±0.8 mm, 14.5±1.1 mm, 11.4±1.1 mm, 11.5±1.0 mm, 18.1±1.4 mm, 21.6±1.4 mm and 37.0±1.8 mm, respectively. All the above anatomical parameters in men were larger than those in women with statistically significant difference (P 0.05). All measurements except for the H-FE angle had a positive correlation with the articular width (0.335≤r≤0.928, P<0.05). The difference between the angle of the H-FE axis (87.6°±3.4°) and 90° was statistically significant (t=-7.287, P<0.05). Conclusion The size of the distal humerus in male is larger than that in female without difference in shape. Distal humerus width can be used as an indicator to measure the size of the distal humerus. The humeral shaft is more biased toward the radial side. Key words: Humerus; Arthroplasty, replacement, elbow; Prosthesis design; Morphology; Tomography, X-ray computed
目的探讨我国健康成人肱骨远端解剖特征。方法从图像存档与通信系统(PACS)中选取121例正常肘关节CT图像，在AW4.5工作站重建测量。冠状面和水平面由屈伸(FE)轴和肱骨轴确定，矢状面垂直于FE轴。在冠状面上测量肱骨髓腔轴线与肘关节FE轴夹角(H-FE角)。在4个不同矢状面上测量小头高度(CH)、外侧滑车高度(LTH)、滑车高度(TH)和内侧滑车高度(MTH)。在水平面上测量小头宽度(CW)、小头深度(CD)、前外侧滑车宽度(ALTW)、后外侧滑车宽度(PLTW)、滑车宽度(TW)、前内侧滑车宽度(AMTW)、后内侧滑车宽度(PMTW)、滑车深度(TD)、前外侧滑车深度(ALTD)、后外侧滑车深度(PLTD)、前内侧滑车深度(AMTD)、后内侧滑车深度(PMTD)、肱骨远端宽度(W)。分析了测量参数的性别差异、数据之间的相关性以及90°H-FE角度的差异。结果男性CH为21.5±1.3 mm, CW为17.5±1.1 mm, CD为10.8±0.9 mm, TW为25.1±2.2 mm, TH为17.3±1.5 mm, TD为17.5±1.4 mm, ALTW为7.7±1.2 mm, PLTW为12.5±1.6 mm, AMTW为12.4±1.6 mm, PMTW为9.8±2.0 mm, ALTD为10.0±0.8 mm, PLTD为16.3±1.4 mm, AMTD为12.9±1.4 mm, PMTD为13.2±1.4 mm, LTH为20.6±1.3 mm, MTH为25.0±2.4 mm, w42.6±2.5 mm。女性分别为18.7±1.1 mm、15.3±1.1 mm、9.5±0.6 mm、21.7±1.5 mm、15.4±1.7 mm、15.6±1.5 mm、6.8±1.3 mm、10.7±1.4 mm、10.6±1.4 mm、8.5±1.4 mm、8.9±0.8 mm、14.5±1.1 mm、11.4±1.1 mm、11.5±1.0 mm、18.1±1.4 mm、21.6±1.4 mm和37.0±1.8 mm。以上解剖参数男性均大于女性，差异有统计学意义(P < 0.05)。除H-FE角外，其余指标均与关节宽度呈正相关(0.335≤r≤0.928,P<0.05)。H-FE轴角度(87.6°±3.4°)与90°的差异有统计学意义(t=-7.287, P<0.05)。结论男性肱骨远端大小大于女性，但形态上无差异。肱骨远端宽度可作为衡量肱骨远端大小的指标。肱骨轴更偏向桡骨侧。关键词:肱骨;关节置换术、置换、肘关节;假体设计;形态;x线计算机断层扫描
{"title":"CT anatomical features of the distal humerus in healthy adults","authors":"Wenbo Yang, Zhe Wang, Qing Han, Zedi Yang, Youqiong Li, Qingsan Zhu, K. Cheng","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.03.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.03.005","url":null,"abstract":"Objective \u0000To study the anatomical features of the distal humerus in Chinese healthy adults. \u0000 \u0000 \u0000Methods \u0000A total of 121 cases of normal elbow joint CT images were selected from the picture archiving and communication system (PACS), and reconstructed and measured on the AW4.5 workstation. Coronal plane and horizontal plane were determined by flexion-extension (FE) axis and humeral shaft, while the sagittal plane was perpendicular to the FE axis. The angle between the axis of humerus medullary cavity and the FE axis of elbow (H-FE angle) was measured on the coronal plane. The capitellar height (CH), lateral trochlear height (LTH), trochlear height (TH) and medial trochlear height (MTH) were measured on four different sagittal planes. The capitellar width (CW), capitellar depth (CD), anterior lateral trochlear width (ALTW), posterior lateral trochlear width (PLTW), trochlear width (TW), anterior medial trochlear width (AMTW), posterior medial trochlear width (PMTW), trochlear depth (TD), anterior lateral trochlear depth (ALTD), posterior lateral trochlear depth (PLTD), anterior medial trochlear depth (AMTD), posterior medial trochlear depth (PMTD), and distal humeral width (W) were measured on the horizontal plane. The gender differences in measured parameters, correlations between data, and differences in H-FE angle from 90° were analyzed. \u0000 \u0000 \u0000Results \u0000In male, CH was 21.5± 1.3 mm, CW 17.5±1.1 mm, CD 10.8±0.9 mm, TW 25.1±2.2 mm, TH 17.3±1.5 mm, TD 17.5±1.4 mm, ALTW 7.7±1.2 mm, PLTW 12.5±1.6 mm, AMTW 12.4±1.6 mm, PMTW 9.8±2.0 mm, ALTD 10.0±0.8 mm, PLTD 16.3±1.4 mm, AMTD 12.9±1.4 mm, PMTD 13.2±1.4 mm, LTH 20.6±1.3 mm, MTH 25.0±2.4 mm, W 42.6±2.5 mm. The above parameters in female was 18.7±1.1 mm, 15.3±1.1 mm, 9.5±0.6 mm, 21.7±1.5 mm, 15.4±1.7 mm, 15.6±1.5 mm, 6.8±1.3 mm, 10.7±1.4 mm, 10.6±1.4 mm, 8.5±1.4 mm, 8.9±0.8 mm, 14.5±1.1 mm, 11.4±1.1 mm, 11.5±1.0 mm, 18.1±1.4 mm, 21.6±1.4 mm and 37.0±1.8 mm, respectively. All the above anatomical parameters in men were larger than those in women with statistically significant difference (P 0.05). All measurements except for the H-FE angle had a positive correlation with the articular width (0.335≤r≤0.928, P<0.05). The difference between the angle of the H-FE axis (87.6°±3.4°) and 90° was statistically significant (t=-7.287, P<0.05). \u0000 \u0000 \u0000Conclusion \u0000The size of the distal humerus in male is larger than that in female without difference in shape. Distal humerus width can be used as an indicator to measure the size of the distal humerus. The humeral shaft is more biased toward the radial side. \u0000 \u0000 \u0000Key words: \u0000Humerus; Arthroplasty, replacement, elbow; Prosthesis design; Morphology; Tomography, X-ray computed","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"160-168"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47851683","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 : 2020-02-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.03.003
Shi-jun Gao
Objective To compare the primary clinical results of arthroscopic figure of 8 suture and ladder mesh suture fixations in treating anterior cruciate ligament (ACL) tibial avulsion fractures. Methods From August 2013 to November 2016, a total of 37 patients with ACL tibial avulsion fracture who had closed epiphyses underwent arthroscopy. By the Meyers-McKeever-Zaricznyj classification, 10 cases were type II, 22 type III and 5 type IV. There were 25 cases in the figure of 8 suture fixation group with two No.2 high-strength sutures crossed to form a 8 figure to pull out and fix the fracture through the tibial tunnels, including 17 males and 8 females with an average age of 18.91±9.34 years (range 14-36 years). The ladder mesh suture fixation group with three No.2 high-strength sutures woven into a mesh to pull out and fix the fracture through the tibial tunnels had 12 cases, including 8 males and 4 females with an average age of 19.63±7.85 years (range 15-33 years). At the latest follow-up, the Lysholm and International Knee Documentation Committee (IKDC) scores were used to estimate knee joint function, while the Lachman test and Pivot-shift test were used to estimate knee joint instability. The operation duration, knee range of motion (ROM) and the number of case with flexion contracture were evaluated. Results All 37 cases were followed up. The average follow-up duration was 16.35±5.27 months (range 10-22 months) in figure of 8 suture fixation group and 14.06±7.18 months (range 10-21 months) in ladder mesh suture fixation group. In figure of 8 suture fixation group, the Lysholm and IKDC average scores were 95.86±5.74 and 90.53±4.61, respectively. However, they were 96.53±3.17 and 92.15±5.54 in ladder mesh suture fixation group with no significant difference between the two groups after operation (t=0.723, P=0.462; t=1.018, P=0.279). The percentage of negative Lachman test and Pivot-shift test in the figure of 8 suture group was 92% (23/25) . There was no significant difference in the negative rate in the ladder mesh suture fixation group 100% (12/12, χ2=0.904, P=0.265). The average operation duration of ladder mesh suture fixation group was 61.8±6.3 minutes, which was longer than that of figure of 8 suture fixation group 43.5±5.9 minutes (t=2.714, P=0.025). Flexion contracture of ≥5° occurred in 4 cases in the figure of 8 suture group and 0 case in the ladder mesh suture fixation group with significant difference between the two groups (χ2=0.450, P=0.032). Conclusion In treating ACL tibial avulsion fractures, arthroscopic figure of 8 suture fixation and ladder mesh suture fixation can achieve satisfied functional recovery and stability. The ladder mesh suture fixation can effectively achieve reduction of fracture fragments and knee flexion contracture. It may have more advantages in treating rotational type III and type IV comminuted fractures. However, some disadvantages in this technique, such as high technical requirements an
{"title":"Arthroscopic fixation with figure of 8 suture versus ladder mesh suture for anterior cruciate ligament tibial avulsion fracture","authors":"Shi-jun Gao","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.03.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.03.003","url":null,"abstract":"Objective \u0000To compare the primary clinical results of arthroscopic figure of 8 suture and ladder mesh suture fixations in treating anterior cruciate ligament (ACL) tibial avulsion fractures. \u0000 \u0000 \u0000Methods \u0000From August 2013 to November 2016, a total of 37 patients with ACL tibial avulsion fracture who had closed epiphyses underwent arthroscopy. By the Meyers-McKeever-Zaricznyj classification, 10 cases were type II, 22 type III and 5 type IV. There were 25 cases in the figure of 8 suture fixation group with two No.2 high-strength sutures crossed to form a 8 figure to pull out and fix the fracture through the tibial tunnels, including 17 males and 8 females with an average age of 18.91±9.34 years (range 14-36 years). The ladder mesh suture fixation group with three No.2 high-strength sutures woven into a mesh to pull out and fix the fracture through the tibial tunnels had 12 cases, including 8 males and 4 females with an average age of 19.63±7.85 years (range 15-33 years). At the latest follow-up, the Lysholm and International Knee Documentation Committee (IKDC) scores were used to estimate knee joint function, while the Lachman test and Pivot-shift test were used to estimate knee joint instability. The operation duration, knee range of motion (ROM) and the number of case with flexion contracture were evaluated. \u0000 \u0000 \u0000Results \u0000All 37 cases were followed up. The average follow-up duration was 16.35±5.27 months (range 10-22 months) in figure of 8 suture fixation group and 14.06±7.18 months (range 10-21 months) in ladder mesh suture fixation group. In figure of 8 suture fixation group, the Lysholm and IKDC average scores were 95.86±5.74 and 90.53±4.61, respectively. However, they were 96.53±3.17 and 92.15±5.54 in ladder mesh suture fixation group with no significant difference between the two groups after operation (t=0.723, P=0.462; t=1.018, P=0.279). The percentage of negative Lachman test and Pivot-shift test in the figure of 8 suture group was 92% (23/25) . There was no significant difference in the negative rate in the ladder mesh suture fixation group 100% (12/12, χ2=0.904, P=0.265). The average operation duration of ladder mesh suture fixation group was 61.8±6.3 minutes, which was longer than that of figure of 8 suture fixation group 43.5±5.9 minutes (t=2.714, P=0.025). Flexion contracture of ≥5° occurred in 4 cases in the figure of 8 suture group and 0 case in the ladder mesh suture fixation group with significant difference between the two groups (χ2=0.450, P=0.032). \u0000 \u0000 \u0000Conclusion \u0000In treating ACL tibial avulsion fractures, arthroscopic figure of 8 suture fixation and ladder mesh suture fixation can achieve satisfied functional recovery and stability. The ladder mesh suture fixation can effectively achieve reduction of fracture fragments and knee flexion contracture. It may have more advantages in treating rotational type III and type IV comminuted fractures. However, some disadvantages in this technique, such as high technical requirements an","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"146-153"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42683049","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 : 2020-02-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.03.007
Bo Li, Xing-yu Zhao, Yuan-Xin Cheng, Yu Han, W. Feng, Dongsong Li
At present, total hip arthroplasty (THA) is the primary treatment for hip diseases such as femoral head necrosis and developmental dysplasia of the hip. It has good effects in reducing pain and improving joint function. The appearance of modular hip prosthesis facilitates adjustment of limb length and femoral offset. However, the wear between the interface of hip prosthesis can lead to inflammatory pseudotumor, osteolysis and other adverse reactions. To explore the risk factors of wear between hip prosthesis interface is helpful to improve the design and manufacturing concept of the product, improve the product performance, help surgeons optimize the operation technology and reduce the impact of human factors on the wear of the prosthesis. Many literatures have reported the mechanism of wear between the head-acetabula interface of prosthesis. The mechanism of wear between the interfaces has been described relatively clearly. In addition to the head-acetabula interface, the wear between the head-neck interface is another major cause of unexplained pain around the joint and prosthesis loosening after hip replacement. Many factors affect head-neck wear. The design of prosthesis (such as prosthesis material and prosthesis taper), surgical technology (such as impact strength and prosthesis mismatch) and patient factors (such as age, gender and activity) have important impact on head-neck wear. Adverse reactions caused by head-neck wear have also been widely concerned. However, there is no considerable solution for wear prevention. Thus, we should optimize the design of prosthesis, improve the surgical technology, and guide the rehabilitation of patients to prevent wear. In order to improve the attention of joint surgeons, the present paper reviews the literatures and analyzes the risk factors of head-neck interface wear and the clinical manifestations caused by head-neck wear.
{"title":"Risk factors and clinical manifestations of head-neck wear in artificial hip joints","authors":"Bo Li, Xing-yu Zhao, Yuan-Xin Cheng, Yu Han, W. Feng, Dongsong Li","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.03.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.03.007","url":null,"abstract":"At present, total hip arthroplasty (THA) is the primary treatment for hip diseases such as femoral head necrosis and developmental dysplasia of the hip. It has good effects in reducing pain and improving joint function. The appearance of modular hip prosthesis facilitates adjustment of limb length and femoral offset. However, the wear between the interface of hip prosthesis can lead to inflammatory pseudotumor, osteolysis and other adverse reactions. To explore the risk factors of wear between hip prosthesis interface is helpful to improve the design and manufacturing concept of the product, improve the product performance, help surgeons optimize the operation technology and reduce the impact of human factors on the wear of the prosthesis. Many literatures have reported the mechanism of wear between the head-acetabula interface of prosthesis. The mechanism of wear between the interfaces has been described relatively clearly. In addition to the head-acetabula interface, the wear between the head-neck interface is another major cause of unexplained pain around the joint and prosthesis loosening after hip replacement. Many factors affect head-neck wear. The design of prosthesis (such as prosthesis material and prosthesis taper), surgical technology (such as impact strength and prosthesis mismatch) and patient factors (such as age, gender and activity) have important impact on head-neck wear. Adverse reactions caused by head-neck wear have also been widely concerned. However, there is no considerable solution for wear prevention. Thus, we should optimize the design of prosthesis, improve the surgical technology, and guide the rehabilitation of patients to prevent wear. In order to improve the attention of joint surgeons, the present paper reviews the literatures and analyzes the risk factors of head-neck interface wear and the clinical manifestations caused by head-neck wear.","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"178-185"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46103308","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：