Pub Date : 2020-01-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.02.002
Cailong Liu, Lichuang Wu, Yi-lin Ye
Objective To explore the feasibility and clinical effect of single bundle anatomic intrathecal reconstruction of proximal injury of anterior cruciate ligament (ACL) using dissociate peroneus longus tendon combined with semitendinosus tendon. Methods From January 2015 to September 2016, a total of 24 patients with proximal injury of ACL, confirmed by arthroscopy, were admitted to the sports medicine department of our hospital. The ACL was completely ruptured from the proximal footprint and the tibial side residual remained intact. There were 19 males and 5 females; 16 cases on the right side and 8 cases on the left side. The mean age was 27.88±7.13 years old; The interval between injury and surgery was 14.83±9.09 d; The dissociate peroneus longus tendon and semitendinosus tendonfrom the injured extremity were folded in half, then braided and trimmed into ACL graft for use. The ACL remnant was preserved and the graft was pulled through the stump for single bundle anatomic intrathecal reconstruction. The ACL graft was fixed with Endobutton on the femoral side and interference screw on the tibial side. The results of Lachman test, Lysholm scores, Tegner scores and International Knee Documentation Committee (IKDC) subjective scores of knee before operation and at final visit were recorded to evaluate the stability and function of the knee. Visual analogue score (VAS) was used to record the changes of pain at the site where the peroneal longus tendon was harvested. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scores were recorded before injury and at the final visit to assess the effect of ankle function after peroneal longus tendon resection. Results The diameter of the ACL graft made of dissociate peroneus longus tendon and semitendinosus tendon is 8.88±0.30 mm. All patients were followed up at the outpatient clinic, with an average of 34.38±5.40 months, and no serious complications such as rerupture and joint infection were found. There were 16 grade B, 6 grade C and 2 grade D for preoperative Lachman test, none with hard end point. At last vist, there were 23 cases of grade A and 1 grade B, all with hard end points for Lachman test. At the preoperative and final visit, the Lysholm scores of the knee joint were 35.20±11.92 and 94.29±2.92 (t=23.850, P=0.000). Tegner scores were 3.46±0.93 and 8.04±1.00 (t=16.653, P=0.000). The subjective IKDC scores of knee joint were 47.63±13.06 and 91.71±3.75 (t=15.972, P=0.000). At the final visit, all the indicators of the knee were improved compared with those before surgery, and the difference was statistically significant.The AOFAS scores before injury and at the final visit were 98.83 (2.78) and 98.17 (4.01), respectively, with no statistically significant difference (t=1.850, P=0.076) . The VAS scores for the harvest of theperoneus longus tendon were 4.50±1.41, 0.54±0.65 and 0.29±0.55 immediately and 6 months after the operation and at the last visit.There was statistica
{"title":"Single bundle anatomic intrathecal reconstruction of proximal injury of anterior cruciate ligament with dissociate peroneus longus tendon and semitendinosus tendon","authors":"Cailong Liu, Lichuang Wu, Yi-lin Ye","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.02.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.02.002","url":null,"abstract":"Objective \u0000To explore the feasibility and clinical effect of single bundle anatomic intrathecal reconstruction of proximal injury of anterior cruciate ligament (ACL) using dissociate peroneus longus tendon combined with semitendinosus tendon. \u0000 \u0000 \u0000Methods \u0000From January 2015 to September 2016, a total of 24 patients with proximal injury of ACL, confirmed by arthroscopy, were admitted to the sports medicine department of our hospital. The ACL was completely ruptured from the proximal footprint and the tibial side residual remained intact. There were 19 males and 5 females; 16 cases on the right side and 8 cases on the left side. The mean age was 27.88±7.13 years old; The interval between injury and surgery was 14.83±9.09 d; The dissociate peroneus longus tendon and semitendinosus tendonfrom the injured extremity were folded in half, then braided and trimmed into ACL graft for use. The ACL remnant was preserved and the graft was pulled through the stump for single bundle anatomic intrathecal reconstruction. The ACL graft was fixed with Endobutton on the femoral side and interference screw on the tibial side. The results of Lachman test, Lysholm scores, Tegner scores and International Knee Documentation Committee (IKDC) subjective scores of knee before operation and at final visit were recorded to evaluate the stability and function of the knee. Visual analogue score (VAS) was used to record the changes of pain at the site where the peroneal longus tendon was harvested. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scores were recorded before injury and at the final visit to assess the effect of ankle function after peroneal longus tendon resection. \u0000 \u0000 \u0000Results \u0000The diameter of the ACL graft made of dissociate peroneus longus tendon and semitendinosus tendon is 8.88±0.30 mm. All patients were followed up at the outpatient clinic, with an average of 34.38±5.40 months, and no serious complications such as rerupture and joint infection were found. There were 16 grade B, 6 grade C and 2 grade D for preoperative Lachman test, none with hard end point. At last vist, there were 23 cases of grade A and 1 grade B, all with hard end points for Lachman test. At the preoperative and final visit, the Lysholm scores of the knee joint were 35.20±11.92 and 94.29±2.92 (t=23.850, P=0.000). Tegner scores were 3.46±0.93 and 8.04±1.00 (t=16.653, P=0.000). The subjective IKDC scores of knee joint were 47.63±13.06 and 91.71±3.75 (t=15.972, P=0.000). At the final visit, all the indicators of the knee were improved compared with those before surgery, and the difference was statistically significant.The AOFAS scores before injury and at the final visit were 98.83 (2.78) and 98.17 (4.01), respectively, with no statistically significant difference (t=1.850, P=0.076) . The VAS scores for the harvest of theperoneus longus tendon were 4.50±1.41, 0.54±0.65 and 0.29±0.55 immediately and 6 months after the operation and at the last visit.There was statistica","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"73-81"},"PeriodicalIF":0.0,"publicationDate":"2020-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41364390","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 : 2020-01-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.02.006
Kangming Chen, Gang-yong Huang, Guang-lei Zhao, Changquan Liu
Total hip arthroplasty (THA) is a well developed technique to which the spatial orientation of acetabular component is crucial. Since the idea of "safe zone" being proposed, such idea has long been obeyed by hip surgeons but has also been challenged in recent years. This is because post-operative instability could happen even if acetabular components are placed within "safe zone" . The latest researches have demonstrated that sagittal spinal balance and spino-pelvic mobility can affect the spatial orientation of acetabular components. Factors including spinal degenerative changes, long lumbosacral changes and spinal ankyloses can lead to sagittal spinal imbalance and/or influence spino-pelvic mobility, which subsequently affect pelvic retroversion. Proper pelvic retroversion is a way to compensate for sagittal spinal imbalance and is beneficial to post-operative stability. It is necessary for hip surgeons to rethink "safe zone" before performing THA and understand spinal balance as well as spinopelvic mobility. The goal is to reduce the rate of dislocation. This review started by introducing the related spinopelvic parameters frequently seen in papers published recently and the definitions of acetabular cup orientations. After the spinal sagittal balance and its compensatory mechanisms session, discussed its clinical relevance, as well as the significance of spinal mobility, in spinopelvic motion under three different postures.
{"title":"The influence of spinal sagittal balance on acetabular component orientation and its clinical relevance","authors":"Kangming Chen, Gang-yong Huang, Guang-lei Zhao, Changquan Liu","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.02.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.02.006","url":null,"abstract":"Total hip arthroplasty (THA) is a well developed technique to which the spatial orientation of acetabular component is crucial. Since the idea of \"safe zone\" being proposed, such idea has long been obeyed by hip surgeons but has also been challenged in recent years. This is because post-operative instability could happen even if acetabular components are placed within \"safe zone\" . The latest researches have demonstrated that sagittal spinal balance and spino-pelvic mobility can affect the spatial orientation of acetabular components. Factors including spinal degenerative changes, long lumbosacral changes and spinal ankyloses can lead to sagittal spinal imbalance and/or influence spino-pelvic mobility, which subsequently affect pelvic retroversion. Proper pelvic retroversion is a way to compensate for sagittal spinal imbalance and is beneficial to post-operative stability. It is necessary for hip surgeons to rethink \"safe zone\" before performing THA and understand spinal balance as well as spinopelvic mobility. The goal is to reduce the rate of dislocation. This review started by introducing the related spinopelvic parameters frequently seen in papers published recently and the definitions of acetabular cup orientations. After the spinal sagittal balance and its compensatory mechanisms session, discussed its clinical relevance, as well as the significance of spinal mobility, in spinopelvic motion under three different postures.","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"103-109"},"PeriodicalIF":0.0,"publicationDate":"2020-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48606434","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 : 2020-01-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.02.005
Guiyu Lou, Na Qi, Ke Yang, Litao Qin, Yuwei Zhang
Objective To provide experimental evidence for genetic counseling and prenatal molecular diagnosis by analyzing the clinical characteristics and screening for pathogenic genes of a five-generation suspected multiple epiphyseal dysplasia (MED) family (17 patients). Methods The family members' medical history, general physical examination and hip joint X-ray examination were collected. Peripheral blood samples of the family members were collected and DNA were extracted from these samples. The exons of clinical genes from probands' DNA were sequenced by High throughput sequencing method. Next Gene software was used to compare and analyze the sequence and INGENUITY software was further used to annotate the mutations in order to find the pathogenic mutations in probands. The suspicious mutations were confirmed in pedigree members by PCR and Sanger sequencing. Results The family consisted of 5 generations and 38 members. Pedigree analysis was consistent with autosomal dominant inheritance. There were 17 patients in the family, and their clinical manifestations showed abnormal walking posture in childhood, pain in hip and knee joints, and typical pathological changes of epiphyseal dysplasia on X-ray. Cartilage oligomeric matrix protein (COMP) gene c.1153G>A (p.Asp385Asn) missense heterozygous mutation was screened in proband, which was genotypically and phenotypically segregated in the pedigree. Conclusion A missense mutation of the comp gene has been identified in a pedigree affected with MED which was the first reported in a big family. Our result is conducive to the further diagnosis and treatment and also provides a molecular basisfor the future prenatal diagnosis. Key words: Osteochondrodysplasias; Pedigree; DNA, intergenic; DNA mutational analysis
{"title":"Clinical characteristics and pathogenic gene analysis in a large pedigree with multiple epiphyseal dysplasia","authors":"Guiyu Lou, Na Qi, Ke Yang, Litao Qin, Yuwei Zhang","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.02.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.02.005","url":null,"abstract":"Objective \u0000To provide experimental evidence for genetic counseling and prenatal molecular diagnosis by analyzing the clinical characteristics and screening for pathogenic genes of a five-generation suspected multiple epiphyseal dysplasia (MED) family (17 patients). \u0000 \u0000 \u0000Methods \u0000The family members' medical history, general physical examination and hip joint X-ray examination were collected. Peripheral blood samples of the family members were collected and DNA were extracted from these samples. The exons of clinical genes from probands' DNA were sequenced by High throughput sequencing method. Next Gene software was used to compare and analyze the sequence and INGENUITY software was further used to annotate the mutations in order to find the pathogenic mutations in probands. The suspicious mutations were confirmed in pedigree members by PCR and Sanger sequencing. \u0000 \u0000 \u0000Results \u0000The family consisted of 5 generations and 38 members. Pedigree analysis was consistent with autosomal dominant inheritance. There were 17 patients in the family, and their clinical manifestations showed abnormal walking posture in childhood, pain in hip and knee joints, and typical pathological changes of epiphyseal dysplasia on X-ray. Cartilage oligomeric matrix protein (COMP) gene c.1153G>A (p.Asp385Asn) missense heterozygous mutation was screened in proband, which was genotypically and phenotypically segregated in the pedigree. \u0000 \u0000 \u0000Conclusion \u0000A missense mutation of the comp gene has been identified in a pedigree affected with MED which was the first reported in a big family. Our result is conducive to the further diagnosis and treatment and also provides a molecular basisfor the future prenatal diagnosis. \u0000 \u0000 \u0000Key words: \u0000Osteochondrodysplasias; Pedigree; DNA, intergenic; DNA mutational analysis","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"97-102"},"PeriodicalIF":0.0,"publicationDate":"2020-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44520130","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 : 2019-12-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.24.004
Biao Wang, Jian Chen, Haiping Zhang, Simin He, Qinpeng Zhao, Lingbo Kong, Yuhang Wang, H. Meng, D. Hao
Objective To explore the safety and effectiveness of a novel percutaneous self-expanding forceful reduction screw system in the treatment of thoracolumbar fracture with severe vertebral height loss. Methods Thirty-eight patients of thoracolumbar fracture with more than 50%vertebral height loss were treated with the novel percutaneous self-expanding forceful reduction screw between March 2014 and June 2015. The screw system is a single plane screw with a reduction angle of 0,3,6,9 degrees. During the operation, the fracture vertebral body was automatically restored during the locking process of the top cap. All the patients were single vertebral fractures. Percutaneous screw fixation and reduction was used in the operation. Two groups of screws were used to fix the two adjacent vertebrae of the injured vertebra and to restore the injured vertebral body, without fusion treatment. The vertebral body index (VBI), height of the anterior margin of fractured vertebra (HAMFV), vertebral body angle (VBA), bisegmental Cobb angle (BCA), visual analog scale (VAS) and Oswestry disability index (ODI) of the patients before and after operation, 6 months after operation, and at the end of the follow-up were compared. The scoring results were compared using a t test. Results The operation was completed successfully in 38 cases. A total of 152 screws were placed. The accuracy rate of CT evaluation was 98.7%. The average operation time was 90.7±21.9 min, and the average intraoperative bleeding amount was 89.2±31.9 ml. The patients' preoperative VBI, HAMFV, VBA, BCA, VAS and ODI scores were 0.38±0.07, 0.38±0.06, 25.45°±4.54°, 18.66°±8.57°, 7.76±1.02, and 44.58%±2.33%, respectively. The postoperative measurements were 0.93±0.03, 0.95±0.02, 3.71°± 1.35°, 5.84°±6.80 °, 4.29±1.16 and 24.37%±1.88%. At the last follow-up, the measurements were 0.92±0.03, 0.94±0.02, 3.89° ±1.31°,6.05°±7.00°, 1.71±0.65 and 5.95%±2.67%. There was significant difference between the preoperative and postoperative data, as well as the preoperative and the last follow-up data (P<0.05). Conclusion In the treatment of thoracolumbar fractures with severe loss of vertebral height, the novel percutaneous self-expanding forceful reduction screw system has achieved satisfactory vertebral height restoration and kyphosis correction. Key words: Thoracic vertebrae; Lumbar vertebrae; Spinal fractures; Surgical procedures, minimally invasive; Internal fixators
{"title":"The clinical outcomes of percutaneous self-expanding forceful reduction screw system for the treatment of thoracolumbar fracture with severe loss of vertebral height","authors":"Biao Wang, Jian Chen, Haiping Zhang, Simin He, Qinpeng Zhao, Lingbo Kong, Yuhang Wang, H. Meng, D. Hao","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.24.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.24.004","url":null,"abstract":"Objective \u0000To explore the safety and effectiveness of a novel percutaneous self-expanding forceful reduction screw system in the treatment of thoracolumbar fracture with severe vertebral height loss. \u0000 \u0000 \u0000Methods \u0000Thirty-eight patients of thoracolumbar fracture with more than 50%vertebral height loss were treated with the novel percutaneous self-expanding forceful reduction screw between March 2014 and June 2015. The screw system is a single plane screw with a reduction angle of 0,3,6,9 degrees. During the operation, the fracture vertebral body was automatically restored during the locking process of the top cap. All the patients were single vertebral fractures. Percutaneous screw fixation and reduction was used in the operation. Two groups of screws were used to fix the two adjacent vertebrae of the injured vertebra and to restore the injured vertebral body, without fusion treatment. The vertebral body index (VBI), height of the anterior margin of fractured vertebra (HAMFV), vertebral body angle (VBA), bisegmental Cobb angle (BCA), visual analog scale (VAS) and Oswestry disability index (ODI) of the patients before and after operation, 6 months after operation, and at the end of the follow-up were compared. The scoring results were compared using a t test. \u0000 \u0000 \u0000Results \u0000The operation was completed successfully in 38 cases. A total of 152 screws were placed. The accuracy rate of CT evaluation was 98.7%. The average operation time was 90.7±21.9 min, and the average intraoperative bleeding amount was 89.2±31.9 ml. The patients' preoperative VBI, HAMFV, VBA, BCA, VAS and ODI scores were 0.38±0.07, 0.38±0.06, 25.45°±4.54°, 18.66°±8.57°, 7.76±1.02, and 44.58%±2.33%, respectively. The postoperative measurements were 0.93±0.03, 0.95±0.02, 3.71°± 1.35°, 5.84°±6.80 °, 4.29±1.16 and 24.37%±1.88%. At the last follow-up, the measurements were 0.92±0.03, 0.94±0.02, 3.89° ±1.31°,6.05°±7.00°, 1.71±0.65 and 5.95%±2.67%. There was significant difference between the preoperative and postoperative data, as well as the preoperative and the last follow-up data (P<0.05). \u0000 \u0000 \u0000Conclusion \u0000In the treatment of thoracolumbar fractures with severe loss of vertebral height, the novel percutaneous self-expanding forceful reduction screw system has achieved satisfactory vertebral height restoration and kyphosis correction. \u0000 \u0000 \u0000Key words: \u0000Thoracic vertebrae; Lumbar vertebrae; Spinal fractures; Surgical procedures, minimally invasive; Internal fixators","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1514-1522"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46251784","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 : 2019-12-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.24.006
Shuang Yang
Cervical muscle group has complex anatomical and physiological characteristics, which plays an important role in maintaining cervical stability and participating in cervical activity. Long-term bow of the head will cause irreversible injury to the neck muscle. The clinical manifestations are stiffness of the neck, and increased muscle tension. In severe cases, muscle spasms are like stripes. The pain caused by it for more than 3 months is called chronic neck pain(CNP). With the increasing incidence of chronic neck pain in the population, the related case reports and clinical studies are also increasing. At present, it is generally believed that persistent non-autonomous hypertension of neck muscle is the primary pathological mechanism of chronic neck pain. For the objective, quantitative analysis and evaluation of neck muscle tension is helpful to predict the occurrence of chronic neck pain, explain its pathogenesis and formulate treatment measures, which has gradually become the main development trend in this field. In recent years, with the development of auxiliary medicine, evaluation methods have changed with each passing day, which provides a variety of options for clinical research. In this paper, several mainstream detection methods of cervical muscle tension are summarized, and the shear wave elastography technology, surface electromyography, magnetic resonance imaging and diffusion tensor imaging are introduced respectively. Their development history, and the working principle of each technology aredescribed in detail. By reviewing the classical clinical research cases at domestic and abroad, the research status of each technology in the field of cervical muscle detection is deeply analyzed. The development trend, potential advantages and limitations of Yang's modulus, integrated electromyography, root mean square value, mean power frequency, median frequency, cross sectional area and apparent diffusion coefficient were evaluated. The purpose of this paper is to summarize experience, guide clinic, deepen the understanding of microcosmic pathogenesis of chronic neck pain, provide theoretical basis for exploring new detection methods, provide omni-directional, multi-level and three-dimensional new clinical diagnosis and treatment strategies for related fields, and provide new methods and ideas for the follow-up study of chronic neck pain.
{"title":"The clinical research progress of neck muscle tensity detection methods and evaluation index","authors":"Shuang Yang","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.24.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.24.006","url":null,"abstract":"Cervical muscle group has complex anatomical and physiological characteristics, which plays an important role in maintaining cervical stability and participating in cervical activity. Long-term bow of the head will cause irreversible injury to the neck muscle. The clinical manifestations are stiffness of the neck, and increased muscle tension. In severe cases, muscle spasms are like stripes. The pain caused by it for more than 3 months is called chronic neck pain(CNP). With the increasing incidence of chronic neck pain in the population, the related case reports and clinical studies are also increasing. At present, it is generally believed that persistent non-autonomous hypertension of neck muscle is the primary pathological mechanism of chronic neck pain. For the objective, quantitative analysis and evaluation of neck muscle tension is helpful to predict the occurrence of chronic neck pain, explain its pathogenesis and formulate treatment measures, which has gradually become the main development trend in this field. In recent years, with the development of auxiliary medicine, evaluation methods have changed with each passing day, which provides a variety of options for clinical research. In this paper, several mainstream detection methods of cervical muscle tension are summarized, and the shear wave elastography technology, surface electromyography, magnetic resonance imaging and diffusion tensor imaging are introduced respectively. Their development history, and the working principle of each technology aredescribed in detail. By reviewing the classical clinical research cases at domestic and abroad, the research status of each technology in the field of cervical muscle detection is deeply analyzed. The development trend, potential advantages and limitations of Yang's modulus, integrated electromyography, root mean square value, mean power frequency, median frequency, cross sectional area and apparent diffusion coefficient were evaluated. The purpose of this paper is to summarize experience, guide clinic, deepen the understanding of microcosmic pathogenesis of chronic neck pain, provide theoretical basis for exploring new detection methods, provide omni-directional, multi-level and three-dimensional new clinical diagnosis and treatment strategies for related fields, and provide new methods and ideas for the follow-up study of chronic neck pain.","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1536-1542"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48769713","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 : 2019-12-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.24.005
Bao-ting Zhang, Yunzhen Chen
Objective To analyzed demographic and clinical characteristics in hospitalized patients with osteoporotic vertebral compression fractures(OVCFs)and to provide certain evidence for prevention and treatment of the disease. Methods Retrospectively analyzedthe clinical data of 2 028 patients with OVCF from January 2009 to December 2018 in the Spine Department of Qilu Hospital of Shandong University. The trend of composition ratio and average age of OVCF patients in the past ten years were observed, the differences of the demographic characteristics and clinical characteristics between different genders as well as the correlation between the number of fractured vertebral bodies of OVCF and various influencing factors were analyzed, and the characteristics of OVCF inpatients were summarized. Results Of 2 028 patients, 374 were males and 1654 were females.The average age was 70.50±9.73 years old, and the male is 73.29±10.23 and the female is 69.87±9.46. A significant increase in the constituent ratio of OVCF between 2009 and 2018 (6.85% in 2009 vs. 13.24% in 2013) and the mean age of OVCF patients increased from 67.54±9.92 years in 2009 to 70.96±9.63 years in 2018were identified.There were significant differences in age distribution of OVCFs in different gender. When the age was less than 70 years old,the fracture ratio of female was higher than that of males, especially between 60 and 70 years old (38.63%∶17.91%); However, when the age was more than 70 years, the fracture ratio of male was higher than that of female especially after 80 years old(29.15%:12.70%). There were significant differences in occupation distribution of OVCFs indifferent gender. Peasants (47.94%), professionals (18.32%) and workers (14.63%) were the top three in female while peasants (35.56%), workers (26.47%) and professionals(20.05%) in male. Falling was the main injury cause of OVCF and there were significant differences in the distribution of causes of OVCF injuries between different genders. The proportion of traffic accident injuries infemaleswas higher than that in maleswhile the proportion of sprains inmaleswas higher than that in females.Moreover,there was a statistically significant difference in the distribution of fracture vertebral bodies between patients of different ages, with or without fracture history and smoking history and different ages of menopause.Among them, the number of fractured vertebral bodies was positively correlated with age(r=0.79, P<0.05).The composition ratio of single vertebral fracture of patients without fracture history, menopausal ageunder 50 and withoutsmoking history was higher than that with fracture history, menopausal age over 50 and with smoking history. On the contrary,the composition ratio of two or more vertebral fractures in patients without fracture history and menopausal agebelow 50 was lower than thatwith fracture history and menopausal ageover 50. Particularly, the ratio of three or more vertebral fractures with sm
{"title":"Analysis of the demographic and clinical characteristics of hospitalized patients with osteoporotic vertebral compression fractures","authors":"Bao-ting Zhang, Yunzhen Chen","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.24.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.24.005","url":null,"abstract":"Objective \u0000To analyzed demographic and clinical characteristics in hospitalized patients with osteoporotic vertebral compression fractures(OVCFs)and to provide certain evidence for prevention and treatment of the disease. \u0000 \u0000 \u0000Methods \u0000Retrospectively analyzedthe clinical data of 2 028 patients with OVCF from January 2009 to December 2018 in the Spine Department of Qilu Hospital of Shandong University. The trend of composition ratio and average age of OVCF patients in the past ten years were observed, the differences of the demographic characteristics and clinical characteristics between different genders as well as the correlation between the number of fractured vertebral bodies of OVCF and various influencing factors were analyzed, and the characteristics of OVCF inpatients were summarized. \u0000 \u0000 \u0000Results \u0000Of 2 028 patients, 374 were males and 1654 were females.The average age was 70.50±9.73 years old, and the male is 73.29±10.23 and the female is 69.87±9.46. A significant increase in the constituent ratio of OVCF between 2009 and 2018 (6.85% in 2009 vs. 13.24% in 2013) and the mean age of OVCF patients increased from 67.54±9.92 years in 2009 to 70.96±9.63 years in 2018were identified.There were significant differences in age distribution of OVCFs in different gender. When the age was less than 70 years old,the fracture ratio of female was higher than that of males, especially between 60 and 70 years old (38.63%∶17.91%); However, when the age was more than 70 years, the fracture ratio of male was higher than that of female especially after 80 years old(29.15%:12.70%). There were significant differences in occupation distribution of OVCFs indifferent gender. Peasants (47.94%), professionals (18.32%) and workers (14.63%) were the top three in female while peasants (35.56%), workers (26.47%) and professionals(20.05%) in male. Falling was the main injury cause of OVCF and there were significant differences in the distribution of causes of OVCF injuries between different genders. The proportion of traffic accident injuries infemaleswas higher than that in maleswhile the proportion of sprains inmaleswas higher than that in females.Moreover,there was a statistically significant difference in the distribution of fracture vertebral bodies between patients of different ages, with or without fracture history and smoking history and different ages of menopause.Among them, the number of fractured vertebral bodies was positively correlated with age(r=0.79, P<0.05).The composition ratio of single vertebral fracture of patients without fracture history, menopausal ageunder 50 and withoutsmoking history was higher than that with fracture history, menopausal age over 50 and with smoking history. On the contrary,the composition ratio of two or more vertebral fractures in patients without fracture history and menopausal agebelow 50 was lower than thatwith fracture history and menopausal ageover 50. Particularly, the ratio of three or more vertebral fractures with sm","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1523-1535"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46656844","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 : 2019-12-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.24.007
Hanqiang Ouyang, Liang Jiang, Xiaoguang Liu, Huishu Yuan, Zhongjun Liu
The cross-fusion research of artificial intelligence technology and spinal surgery represented by machine learning and neural network model is a new research direction and hot issue in the field of artificial intelligence in recent years. The anatomy and disease symptoms of the spine are complex, and the diagnosis and treatment of spinal surgery require rich clinical experience. However, the distribution of medical resources in China is seriously uneven. How to improve the ability of primary medical services so that the most extensive patient groups can benefitis still an urgent problem to be solved. Artificial intelligence is a technical science that researches and develops theories, methods, technologies, and application systems for simulating, extending and expanding human intelligence. With the advent of the era of big data medical technology, artificial intelligence technology may solve this problem by transforming "experts sinking" into "tech sinking" . At present, technologies such as confrontation learning, weakly supervised learning, intensive learning and graph neural networks have become research hotspots in the field of artificial intelligence, and have also played an important role in many fields of clinical medicine. Based on the advantages of deep learning and neural network in disease learning, many spine surgeons combine it with the diagnosis and treatment of cervical spondylosis, low back pain, lumbar degenerative diseases, spinal deformity, spinal tumors, and other spine-related diseases. The rapid location and accurate diagnosis of the disease not only makes it an effective tool for the comprehensive diagnosis of spinal diseases but also provides the basis for the most reasonable treatment options for spinal diseases. In the domestic application of artificial intelligence in the diagnosis and treatment of spinal surgery, it can also solve the problems of difficult diagnosis and complicated treatment of spinal diseases faced by primary doctors, reduce the rate of misdiagnosis and missed diagnosis, and effectively reduce the economic and social burden of spinal diseases. This paper reviews the research progress of artificial intelligence represented by deep learning in the field of diagnosis and treatment of spinal surgery at home and abroad, and the advantages and application prospects of artificial intelligence in the diagnosis and treatment of spinal surgery.
{"title":"Research progress in the application status and development trend of artificial intelligence in the diagnosis and treatment of spinal disease","authors":"Hanqiang Ouyang, Liang Jiang, Xiaoguang Liu, Huishu Yuan, Zhongjun Liu","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.24.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.24.007","url":null,"abstract":"The cross-fusion research of artificial intelligence technology and spinal surgery represented by machine learning and neural network model is a new research direction and hot issue in the field of artificial intelligence in recent years. The anatomy and disease symptoms of the spine are complex, and the diagnosis and treatment of spinal surgery require rich clinical experience. However, the distribution of medical resources in China is seriously uneven. How to improve the ability of primary medical services so that the most extensive patient groups can benefitis still an urgent problem to be solved. Artificial intelligence is a technical science that researches and develops theories, methods, technologies, and application systems for simulating, extending and expanding human intelligence. With the advent of the era of big data medical technology, artificial intelligence technology may solve this problem by transforming \"experts sinking\" into \"tech sinking\" . At present, technologies such as confrontation learning, weakly supervised learning, intensive learning and graph neural networks have become research hotspots in the field of artificial intelligence, and have also played an important role in many fields of clinical medicine. Based on the advantages of deep learning and neural network in disease learning, many spine surgeons combine it with the diagnosis and treatment of cervical spondylosis, low back pain, lumbar degenerative diseases, spinal deformity, spinal tumors, and other spine-related diseases. The rapid location and accurate diagnosis of the disease not only makes it an effective tool for the comprehensive diagnosis of spinal diseases but also provides the basis for the most reasonable treatment options for spinal diseases. In the domestic application of artificial intelligence in the diagnosis and treatment of spinal surgery, it can also solve the problems of difficult diagnosis and complicated treatment of spinal diseases faced by primary doctors, reduce the rate of misdiagnosis and missed diagnosis, and effectively reduce the economic and social burden of spinal diseases. This paper reviews the research progress of artificial intelligence represented by deep learning in the field of diagnosis and treatment of spinal surgery at home and abroad, and the advantages and application prospects of artificial intelligence in the diagnosis and treatment of spinal surgery.","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1543-1548"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43236305","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 : 2019-12-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.24.003
Hongli Wang, Feizhou Lyu, Xiaosheng Ma, X. Xia
Objective To summarize the clinical features of cervical spondylosis with distal upper extremity amyotrophy; and further analyze the clinical efficacy of cervical anterior decompression and fusion on cervical spondylosis with distal upper extremity amyotrophy. Methods Thirty cases of cervical spondylosis with distal upper extremity amyotrophy were analyzed retrospectively from June 2006 to June 2015. nineteen males and eleven females with an average age of 55.20±9.08 years (41 to 72 years) were included. The preoperative course was 1 to 108 months with a median of 6 months. The muscle extent of the affected group, the segmentation and location of spinal canal stenosis, and the results of neurophysiological examination were analyzed. The muscular strength recovery of atrophic muscles was evaluated by Manual Muscle Testing (MMT), and the clinical satisfaction was assessed at the last followed up. Results The muscles involved in patients of cervical spondylosis with distal upper extremity amyotrophy are mainly the thenar muscle (17 cases, 56.7%), interosseous muscle (15 cases, 50.0%), and shypothenar muscles (13 cases, 43.3%). Most cases of imaging findings showed multi-segmental degeneration, of which C5, 6 (24 cases, 80.0%), C6,7 (21 cases, 70.0%) segments were most common, and the types of anterior compression: 23 segments (33.5%) of the central type, 37 segments (54.4%) of the lateral-central type, and 8 segments (11.8%) of the foramen type. Neuroelectrophysiological examination showed that cervical spinal cord anterior horn cells or nerve root damage, the most commonly involved segments of C7, C8, T1(18 cases, 60.0%). The average follow-up time was 36.8 months. At the last follow-up, MMT assessment showed that thirteen patients (43.3%) in this group had muscle strength recovery for more than one grade at the last follow-up. The average clinical satisfaction was 73.4%. Conclusion The clinical diagnosis of cervical spondylosis with distal upper extremity amyotrophy requires a combination of clinical symptoms, imaging findings and neurophysiological examination results for comprehensive judgment. Cervical anterior decompression and fusion can effectively prevent the progression of cervical spondylosis in distal upper extremity amyotrophy patients, and some patients can get a good muscle recovery. Key words: Cervical vertebrae; Spinal cord compression; Muscular atrophy; Spinal fusion
{"title":"Clinical diagnosis and surgical treatment of cervical spondylosis with distal upper extremity amyotrophy","authors":"Hongli Wang, Feizhou Lyu, Xiaosheng Ma, X. Xia","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.24.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.24.003","url":null,"abstract":"Objective \u0000To summarize the clinical features of cervical spondylosis with distal upper extremity amyotrophy; and further analyze the clinical efficacy of cervical anterior decompression and fusion on cervical spondylosis with distal upper extremity amyotrophy. \u0000 \u0000 \u0000Methods \u0000Thirty cases of cervical spondylosis with distal upper extremity amyotrophy were analyzed retrospectively from June 2006 to June 2015. nineteen males and eleven females with an average age of 55.20±9.08 years (41 to 72 years) were included. The preoperative course was 1 to 108 months with a median of 6 months. The muscle extent of the affected group, the segmentation and location of spinal canal stenosis, and the results of neurophysiological examination were analyzed. The muscular strength recovery of atrophic muscles was evaluated by Manual Muscle Testing (MMT), and the clinical satisfaction was assessed at the last followed up. \u0000 \u0000 \u0000Results \u0000The muscles involved in patients of cervical spondylosis with distal upper extremity amyotrophy are mainly the thenar muscle (17 cases, 56.7%), interosseous muscle (15 cases, 50.0%), and shypothenar muscles (13 cases, 43.3%). Most cases of imaging findings showed multi-segmental degeneration, of which C5, 6 (24 cases, 80.0%), C6,7 (21 cases, 70.0%) segments were most common, and the types of anterior compression: 23 segments (33.5%) of the central type, 37 segments (54.4%) of the lateral-central type, and 8 segments (11.8%) of the foramen type. Neuroelectrophysiological examination showed that cervical spinal cord anterior horn cells or nerve root damage, the most commonly involved segments of C7, C8, T1(18 cases, 60.0%). The average follow-up time was 36.8 months. At the last follow-up, MMT assessment showed that thirteen patients (43.3%) in this group had muscle strength recovery for more than one grade at the last follow-up. The average clinical satisfaction was 73.4%. \u0000 \u0000 \u0000Conclusion \u0000The clinical diagnosis of cervical spondylosis with distal upper extremity amyotrophy requires a combination of clinical symptoms, imaging findings and neurophysiological examination results for comprehensive judgment. Cervical anterior decompression and fusion can effectively prevent the progression of cervical spondylosis in distal upper extremity amyotrophy patients, and some patients can get a good muscle recovery. \u0000 \u0000 \u0000Key words: \u0000Cervical vertebrae; Spinal cord compression; Muscular atrophy; Spinal fusion","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1507-1513"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46362989","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 develop a new type of triple-leaf-enhanced cervical spine plate system, to study its biomechanical properties, perform clinical preliminary applications, and observe clinical effects. Methods Twelve fresh goat specimens were used, and the high-precision digital display grating displacement sensor system was used to compare the stability, fatigue strength and tensile strength of the fixation of the anterior nailing of the new type of triple-leaf-enhanced cervical spine plate system. All of 92 patients with cervical spondylosis who underwent cervical anterior decompression, cage or titanium mesh fusion, with new PRUNUS spine plate system or Atlantis spine plate system internal fixation were selected from January 2015 to January 2018. Comparative study recorded intraoperative blood loss, operative time, preoperative cervical Cobb angle, pain visual analogue scale (VAS), and Japanese Orthopaedic Association (JOA) spinal function score, and neurological improvement ratewas calculated. Frankel grading was used to evaluate pre and postoperative functional status of the anterior and posterior nerves, so as to comprehensively evaluate the initial clinical efficacy of the new PRUNUS spine plate system. Results The biomechanical tests showed that: 1) The flexion, extension, left bending, right bending, left rotation and right rotation ROM after fixing with the new PRUNUS spine plate system were 1.02°±0.13°, 1.32°±0.11°, 0.96°±0.23°, 1.03°±0.19°, 1.37°±0.17° and 1.05°±0.08°. ROM after fixation of Atlantis spine plate system were 0.99°±0.11°, 1.08°±0.23°, 0.83°±0.21°, 0.82°±0.13°, 1.18°±0.43°, 1.17°±0.17°, respectively. There was no significant statistical difference between the two groups; 2) The fatigue life of the new PRUNUS spine plate system and Atlantis spine plate system were 6.3×105 and 6.1×105, and the fatigue strengths were 512.12 Mpa and 502.85 Mpa respectively. There was no statistical difference between the two groups. 3) The maximum pull-out force of the new PRUNUS spine plate system was 483.62±39.14 N, and the maximum pull-out force of the Atlantis spine plate system was 396.55±22.79 N. The difference between the two groups was statistically significant. In the clinical application, the new PRUNUS spine plate system was used, the average operation time was 102.8±13.6 min, and the average blood loss was 56.8±14.1 ml. Using the Atlantis spine plate system, the average operation time was 132.8±15.7 min, and the average blood loss was 76.8±19.1 ml. The difference between the two groups was statistically significant; Using the new PRUNUS spine plate system, the VAS score was reduced from 5.42±1.17 before surgery to 1.58±0.44, the preoperative JOA score was 8.13±1.26, and the JOA score was 14.71±1.16 at the last follow-up. Using the Atlantis spine plate system, the VAS score was 6.94±1.06 before surgery. dropped to 1.75±0.35, the preoperative JOA score was 9.26±1.32, and the JOA score was 14.96±1.56 at the last follow-up. Th
目的研制一种新型三叶增强颈椎钢板系统，研究其生物力学性能，进行临床初步应用，观察临床效果。方法采用12只新鲜山羊标本，采用高精度数显光栅位移传感器系统，比较新型三叶增强颈椎钢板系统前钉固定的稳定性、疲劳强度和抗拉强度。选取2015年1月至2018年1月间行颈椎前路减压、cage或钛网融合、新型PRUNUS脊柱钢板系统或Atlantis脊柱钢板系统内固定的92例颈椎病患者。对比研究记录术中出血量、手术时间、术前颈椎Cobb角、疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)脊柱功能评分，并计算神经系统改好率。采用Frankel分级法评价前后神经的术前和术后功能状态，综合评价新型PRUNUS脊柱钢板系统的初步临床疗效。结果生物力学试验表明:1)新型PRUNUS脊柱钢板系统固定后屈伸、左屈、右屈、左旋、右旋ROM分别为1.02°±0.13°、1.32°±0.11°、0.96°±0.23°、1.03°±0.19°、1.37°±0.17°和1.05°±0.08°。Atlantis脊柱钢板系统固定后ROM分别为0.99°±0.11°、1.08°±0.23°、0.83°±0.21°、0.82°±0.13°、1.18°±0.43°、1.17°±0.17°。两组间差异无统计学意义;2)新型PRUNUS脊柱板系统和Atlantis脊柱板系统的疲劳寿命分别为6.3×105和6.1×105，疲劳强度分别为512.12 Mpa和502.85 Mpa。两组间无统计学差异。3)新型PRUNUS脊柱钢板系统的最大拔出力为483.62±39.14 N, Atlantis脊柱钢板系统的最大拔出力为396.55±22.79 N，两组差异有统计学意义。在临床应用中，采用新型PRUNUS脊柱钢板系统，平均手术时间为102.8±13.6 min，平均出血量为56.8±14.1 ml。采用Atlantis脊柱钢板系统，平均手术时间为132.8±15.7 min，平均出血量为76.8±19.1 ml，两组差异有统计学意义;使用新型PRUNUS脊柱钢板系统，VAS评分由术前的5.42±1.17降至1.58±0.44，术前JOA评分为8.13±1.26，末次随访时JOA评分为14.71±1.16。采用Atlantis脊柱钢板系统，术前VAS评分为6.94±1.06。术前JOA评分为9.26±1.32，末次随访时JOA评分为14.96±1.56。两组间无显著差异。结论新型PRUNUS脊柱钢板系统具有良好的生物力学性能，对颈椎的稳定性有良好的效果，尤其适用于术后修复和骨质疏松患者。操作简单方便，安全有效，值得临床推广。关键词:颈椎;内部固定器;生物力学;治疗结果
{"title":"New PRUNUS spine plate system and its biomechanical research and preliminary clinical application","authors":"Detai Qi, Xiaofeng Zhao, Yi-Bo Zhao, Xiang-dong Lu, Xu Yang, Xiao-nan Wang, Run-tian Zhou, Yuan-zhang Jin","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.24.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.24.002","url":null,"abstract":"Objective \u0000To develop a new type of triple-leaf-enhanced cervical spine plate system, to study its biomechanical properties, perform clinical preliminary applications, and observe clinical effects. \u0000 \u0000 \u0000Methods \u0000Twelve fresh goat specimens were used, and the high-precision digital display grating displacement sensor system was used to compare the stability, fatigue strength and tensile strength of the fixation of the anterior nailing of the new type of triple-leaf-enhanced cervical spine plate system. All of 92 patients with cervical spondylosis who underwent cervical anterior decompression, cage or titanium mesh fusion, with new PRUNUS spine plate system or Atlantis spine plate system internal fixation were selected from January 2015 to January 2018. Comparative study recorded intraoperative blood loss, operative time, preoperative cervical Cobb angle, pain visual analogue scale (VAS), and Japanese Orthopaedic Association (JOA) spinal function score, and neurological improvement ratewas calculated. Frankel grading was used to evaluate pre and postoperative functional status of the anterior and posterior nerves, so as to comprehensively evaluate the initial clinical efficacy of the new PRUNUS spine plate system. \u0000 \u0000 \u0000Results \u0000The biomechanical tests showed that: 1) The flexion, extension, left bending, right bending, left rotation and right rotation ROM after fixing with the new PRUNUS spine plate system were 1.02°±0.13°, 1.32°±0.11°, 0.96°±0.23°, 1.03°±0.19°, 1.37°±0.17° and 1.05°±0.08°. ROM after fixation of Atlantis spine plate system were 0.99°±0.11°, 1.08°±0.23°, 0.83°±0.21°, 0.82°±0.13°, 1.18°±0.43°, 1.17°±0.17°, respectively. There was no significant statistical difference between the two groups; 2) The fatigue life of the new PRUNUS spine plate system and Atlantis spine plate system were 6.3×105 and 6.1×105, and the fatigue strengths were 512.12 Mpa and 502.85 Mpa respectively. There was no statistical difference between the two groups. 3) The maximum pull-out force of the new PRUNUS spine plate system was 483.62±39.14 N, and the maximum pull-out force of the Atlantis spine plate system was 396.55±22.79 N. The difference between the two groups was statistically significant. In the clinical application, the new PRUNUS spine plate system was used, the average operation time was 102.8±13.6 min, and the average blood loss was 56.8±14.1 ml. Using the Atlantis spine plate system, the average operation time was 132.8±15.7 min, and the average blood loss was 76.8±19.1 ml. The difference between the two groups was statistically significant; Using the new PRUNUS spine plate system, the VAS score was reduced from 5.42±1.17 before surgery to 1.58±0.44, the preoperative JOA score was 8.13±1.26, and the JOA score was 14.71±1.16 at the last follow-up. Using the Atlantis spine plate system, the VAS score was 6.94±1.06 before surgery. dropped to 1.75±0.35, the preoperative JOA score was 9.26±1.32, and the JOA score was 14.96±1.56 at the last follow-up. Th","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1496-1506"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43420331","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 : 2019-12-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.23.004
Rui Luo, Guomin Li, B. Liu, Bo Li, X. Tian, Hu Ruyin
Objective To evaluate the clinical effects of the implantation of porous tantalum rod under three-dimensional (3D) C-arm positioning in the treatment of ARCO I and II non-traumatic femoral head necrosis. Methods Fifty patients (58 hips, 39 males and 11 females, mean age 33.52 years) with non-traumatic femoral head in ARCO I-II were included from January 2009 to December 2011. All patients received implantation of porous tantalum rod. The 3D C-arm X-ray positioning was used in 24 patients (29 hips), while traditional C-arm X-ray positioning was performed in the other patients. The visual analogue scale (VAS), Harris score and superior rate were evaluated at 0.5, 1, 2, and 4 years after the surgery. Total hip arthroplasty was regarded as the end event for survival rate. Results In the 3D C-arm X-ray positioning group, the VAS score decreased from 7.17±1.00 points preoperatively to 2.38±0.86 points at half year, to 2.10±1.40 points at 1 year, to 2.38±1.66 points at 2 years, and to 2.21±1.47 points at 4 years postoperatively (F=98.78, P=0.00). Meanwhile, the Harris score increased significantly from 73.97±3.49 points preoperatively to 89.90±1.93, 89.93±3.26, 89.21±5.83, 88.57±5.70 points at the follow up, respectively (F=84.35, P=0.00). According to the analysis of the pre-operative and post-operative image data, there was no significant difference in progress in the ARCO staging at 23 hips duration the follow-up. Four hips were developed to ARCO III and two hips to ARCO II. Thus, the success rate of operation was 79% (23/29). There were two hips underwent total hip arthroplasty, so the survival rate of femoral head was 93% (27/29). The trend of VAS score and Harris score in the C-arm X-ray positioning group was in accordance with the 3D C-arm X-ray positioning group but without statistically significant difference (P>0.05). The operation duration 31.38±3.96 min, blood loss 36.72±5.59 ml, the ratio of distance of metal rod to bone cortex in femoral neck 0.48±0.10, and the distance of mental rod to center of necrosis 0.18±0.07 cm in 3D C-arm X-ray positioning group was superior to C-arm X-ray positioning group (respectively 41.97±4.64 min, 41.49±4.46 ml, 0.46±0.06, 0.23±0.10 cm, P<0.05). Conclusion The implantation of tantalum rod in treating ARCO I-II non-traumatic femoral head necrosis can increase the function of hip joint, relieve the symptoms of necrosis of femoral head, alleviate the progress of femoral head necrosis in X-ray, and obtain a higher survival rate. The 3D C-arm positioning in surgical operation could improve the accuracy and safety of surgery. Key words: Femur head necrosis; Tantalum; Imaging, three-dimensional; X-rays; Radiography
{"title":"Clinical effects of the implantation of porous tantalum rod under three-dimensional C-arm positioning in treating ARCO I-II non-traumatic necrosis of the femoral head","authors":"Rui Luo, Guomin Li, B. Liu, Bo Li, X. Tian, Hu Ruyin","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.23.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.23.004","url":null,"abstract":"Objective \u0000To evaluate the clinical effects of the implantation of porous tantalum rod under three-dimensional (3D) C-arm positioning in the treatment of ARCO I and II non-traumatic femoral head necrosis. \u0000 \u0000 \u0000Methods \u0000Fifty patients (58 hips, 39 males and 11 females, mean age 33.52 years) with non-traumatic femoral head in ARCO I-II were included from January 2009 to December 2011. All patients received implantation of porous tantalum rod. The 3D C-arm X-ray positioning was used in 24 patients (29 hips), while traditional C-arm X-ray positioning was performed in the other patients. The visual analogue scale (VAS), Harris score and superior rate were evaluated at 0.5, 1, 2, and 4 years after the surgery. Total hip arthroplasty was regarded as the end event for survival rate. \u0000 \u0000 \u0000Results \u0000In the 3D C-arm X-ray positioning group, the VAS score decreased from 7.17±1.00 points preoperatively to 2.38±0.86 points at half year, to 2.10±1.40 points at 1 year, to 2.38±1.66 points at 2 years, and to 2.21±1.47 points at 4 years postoperatively (F=98.78, P=0.00). Meanwhile, the Harris score increased significantly from 73.97±3.49 points preoperatively to 89.90±1.93, 89.93±3.26, 89.21±5.83, 88.57±5.70 points at the follow up, respectively (F=84.35, P=0.00). According to the analysis of the pre-operative and post-operative image data, there was no significant difference in progress in the ARCO staging at 23 hips duration the follow-up. Four hips were developed to ARCO III and two hips to ARCO II. Thus, the success rate of operation was 79% (23/29). There were two hips underwent total hip arthroplasty, so the survival rate of femoral head was 93% (27/29). The trend of VAS score and Harris score in the C-arm X-ray positioning group was in accordance with the 3D C-arm X-ray positioning group but without statistically significant difference (P>0.05). The operation duration 31.38±3.96 min, blood loss 36.72±5.59 ml, the ratio of distance of metal rod to bone cortex in femoral neck 0.48±0.10, and the distance of mental rod to center of necrosis 0.18±0.07 cm in 3D C-arm X-ray positioning group was superior to C-arm X-ray positioning group (respectively 41.97±4.64 min, 41.49±4.46 ml, 0.46±0.06, 0.23±0.10 cm, P<0.05). \u0000 \u0000 \u0000Conclusion \u0000The implantation of tantalum rod in treating ARCO I-II non-traumatic femoral head necrosis can increase the function of hip joint, relieve the symptoms of necrosis of femoral head, alleviate the progress of femoral head necrosis in X-ray, and obtain a higher survival rate. The 3D C-arm positioning in surgical operation could improve the accuracy and safety of surgery. \u0000 \u0000 \u0000Key words: \u0000Femur head necrosis; Tantalum; Imaging, three-dimensional; X-rays; Radiography","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1440-1446"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42757632","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}
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