Abstract:Objective To compare the curative effect of high-viscosity and low-viscosity bone cement in percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fracture (OVCF). Methods Sixty OVCF patients treated by PKP from March 2013 to September 2014 in Gaoyao People's Hospital were randomly divided into low-viscosity group (treated by low-viscosity bone cement PKP) and high-viscosity group (treated by high-viscosity bone cement PKP), with 30 patients in each group. The height of involving vertebrae and kyphosis Cobb angle in two groups were compared before and after operation; Visual analogue scale (VAS), Oswestry disability index (ODI) and 36-item short form health survey questionnaires (SF-36) score were adopted to evaluate the pain degree, dysfunction, quality of life and other subjective sensations of the patients; Complications such as bone cement leakage and recent pulmonary embolism were also recorded. Results The injected bone cement volume in low-viscosity group and high-viscosity group were (3.1 ± 0.6) mL and (3.6 ± 0.8) mL respectively, the difference was statistically significant (P <0.05). The patients were followed up for 3-6 months (the average was 4 months). VAS score, ODI, SF-36 score, vertebral height and kyphosis Cobb angle in two groups at 1 d and 3 months after the surgery were better than preoperative ones (P<0.05). Among them, the above postoperative indicators in high-viscosity group at 1 day and 3 months after the operation were better than those in low-viscosity group (P <0.05). Bone cement leakage and recent pulmonary embolism occurred in 6, 2 cases in low-viscosity group and 1, 0 cases in high-viscosity one, showing statistical differences of complication incidences between two groups (P <0.05). Conclusion Compared with low-viscosity bone cement PKP, short-term efficacy of high-viscosity bone cement PKP in the treatment of OVCF is more ideal with lower complications of bone cement leakage and recent pulmonary embolism, which is worthy of clinical application and popularization.
Abstract:Objective To study application value of CT guided percutaneous vertebroplasty (PVP) combined with 3D reconstruction for treatment of thoracolumbar fractures. Methods Clinical data of 526 patients (868 vertebrae) with thoracolumbar fractures treated by CT imaging Pin-point laser navigation system guided PVP from August 2007 to November 2014 in Zhongshan Hospital Affiliated to Zhongshan University, were retrospectively analyzed. According to whether used 3D reconstruction during PVP, patients were divided into two groups, non 3D group (246 cases, 420 vertebrae) and 3D group (280 cases, 448 vertebrae). Visual analogue scale (VAS) scores, central vertebral body height at 1 day preoperatively and 3 days postoperatively were compared between two groups; Forty patients from each group were randomly selected to determine the single vertebral body operation time; Complications such as bone cement leakage, pulmonary embolism, spinal cord compression were observed. Results VAS scores at 3 days after surgery showed similar results in both groups, which were significantly lower than preoperative ones (P <0.05); There were no significant differences in central vertebral body height between preoperation and postoperation; Average single lumbar vertebrae operation time was (22.1 ± 1.1) min in 3D group and (41.1 ± 1.9) min in non 3D group (P <0.05). Four cases had positioning errors and needed to reoperation in non 3D group; Cement leakage had happened in 96 vertebrae in 3D group and 93 in non 3D group, no pulmonary embolism or spinal cord compression aggravation occurred. During 3-6 months (mean 4.5 months) follow-up period, no local pain reoccurred. Conclusion CT guided PVP combined with 3D reconstruction for thoracolumbar fractures could obtain good clinical effect with the advantages of high precision, time-saving and safety.
Abstract:Objective To design screw rod internal fixation instruments specially used for posterior atlantoaxial surgery, and to observe its preliminary clinical applications. Methods In view of the shortcomings of current posterior cervical screw rod fixation system for atlantoaxial dislocation during the clinical practice, a set of new specified posterior atlantoaxial screw rod fixation system was designed, including C1 reduction screw, C2 fulcrum screw, automatic anti-rotation fixation rod, transverse-link of screw tail as well as other matched installation instruments such as cone-shaped screw tap. Six patients performed posterior atlantoaxial screw rod fixation with this new-type system under intratracheal general anesthesia, and the applications were observed. Results All 6 patients underwent the operations successfully, including 3 cases of fixation without bone graft fusion and 3 of fixation with bone graft fusion. The average operative time was 95 min (60-150 min), and the average intraoperative estimate blood loss was 50 mL (30-80 mL). No spinal cord or vertebral artery injuries were found during the operation. Screw, fixation rod and transverse-link of this new fixation system were installed in place at one go, with no repeated adjustments or assistance by additional tools. Postoperative X-ray, CT and MRI results showed a satisfied reduction and decompression. Conclusion The specified posterior atlantoaxial screw rod fixation system is a novel and creative device, not only simplify the operation procedure, but also has a satisfactory preliminary clinical effects and excellent application prospect.
Abstract:Finite element (FE) analysis of femur biomechanics is a hotspot in the research field of digital orthopedics. In this paper, FE model establishment of femur and the following stress analysis based on the models were introduced, FE results for femoral injury systems were discussed, and finally the clinical application value of FE techniques for preoperative planning guidance, risk prediction and prognosis evaluation, as well as the design, optimization and modification of medical devices were reviewed.
Abstract:Objective To explore the curative effects of close reduction and tension-band fixation with percutaneous patellar pin for patellar fractures. Methods Clinical data of 42 patients with transverse patellar closed fractures (Rockwood Ⅱ type) treated by close reduction and tension-band fixation with percutaneous patellar pin from January 2010 to August 2014 in Qingyuan People's Hospital, were analyzed retrospectively. The operation time, incision length, intraoperative estimate blood loss, hospitalization stay were recorded, fracture healing and complications were observed, therapeutic effects were assessed according to Bostman's patella fractures functional criteria. Results The operation time ranged from 30 to 65 min (average 40.6 min), length of incision was 1.8 to 3.2 cm (average 2.4 cm), intraoperative estimate blood loss was 20 to 40 mL (average 26.4 mL), length of hospital stay was 5 to 9 days (average 6.5 days). All patients were followed up for 12 to 18 months (average 15.5 months). The healing duration was 2 to 5 months (average 3.8 months) with fracture healing rate of 100%. According to Bostman's criteria, there was excellent in 28 cases, good in 14, with the excellent and good rate of 100% (42/42). There were no complications such as knee joint pain, refracture, pin tract infection, or pin rotation, loosening or pull-out during the follow-up period. Conclusions Treatment of close reduction and tension-band fixation with percutaneous patellar pin for patellar fracture is characterized by minimal damage, reliable fixation, early rehabilitation and good functional recovery.
Abstract:Objective To explore the application value of simplified Chinese version of Roland-Morris disability questionnaire (SC-RMDQ) in functional evaluation for urban and rural patients with low back pain (LBP). Methods From April 2009 to April 2011, 187 LBP patients including 99 urban and 88 rural patients were evaluated by SC-RMDQ, simplified Chinese Oswestry disability index (SC-ODI) and visual analogue scale (VAS). Major causes of LBP were recorded. Reliability was tested by internal consistency (Cronbach's α) and reproducibility (intraclass coefficient of correlation, ICC) analysis; Validity was tested by Pearson correlation analysis. Results The leading causes for LBP were waist bending (49%) and spraining (25%) in rural patients, and sedentariness (39%) and vibration (18%) in urban patients. SC-RMDQ had high internal consistency (Cronbach's α value of 0.883 in rural patients and 0.874 in urban patients) and good reproducibility (ICC value of 0.952 in rural patients and 0.949 in urban patients). SC-RMDQ also showed significant correlation with SC-ODI and VAS in rural areas (SC-RMDQ/SC-ODI: r = 0.841; SC-RMDQ/VAS: r = 0.685, P <0.05) and in urban areas (SC-RMDQ/SC-ODI: r = 0.818, P <0.05; SC-RMDQ/VAS: r = 0.666, P <0.05). Conclusions Although the major causes of LBP are significantly different between rural and urban patients, SC-RMDQ has good reliability and validity, which is a suitable method to evaluate disability of rural and urban LBP patients.
Abstract:Objective To investigate the effects of serum albumin, hemoglobin levels and lymphocyte counts on the prognosis of elderly patients after hip fracture surgery. Methods Clinical data of 86 elderly patients with unilateral hip fracture treated surgically in Sanshui Hospital of Foshan Hospital of Chinese Traditional Medicine from April 2010 to April 2013 were analyzed retrospectively. Patients were divided into survival group (n = 79) and death group (n = 7) according to the prognosis condition after one year's follow-up. Serum albumin, hemoglobin levels and lymphocyte counts at admission date were compared between two groups, and the differences of mortality rates were analyzed between patients at normal levels and abnormal levels in serum. Results In survival group, levels of serum albumin and hemoglobin at admission date were higher than those in death group (P <0.05), while lymphocyte counts had no statistical differences between two groups (P >0.05). Mortality rates in patients with nomal serum albumin and hemoglobin levels were lower than those in patients with abnormal levels (P <0.05); while there were no statistical differences of mortality rates between patients with normal and abnormal lymphocyte counts (P >0.05). Multiple logistic regression analysis showed that low levels of serum albumin and hemoglobin were the major risks of mortality for elderly patients undergoing hip fracture surgery (P <0.05). Conclusions Serum albumin and hemoglobin levels have significant influences on the prognosis of elderly patients after hip fracture surgery, as a result, the parameters could be used as important indexes for prognosis evaluation.
Abstract:Objective To investigate the differences of internal fixation effects between proximal femoral nail anti-rotation (PFNA) and proximal femoral nail (PFN) for femoral intertrochanteric fractures in elderly. Methods A total of 120 elderly patients with femoral intertrochanteric fractures treated from January 2013 to June 2015 in Dapu County People's Hospital of Meizhou City, were selected and randomly divided into PFN group (n = 59, performing PFN internal fixation) and PFNA group (n = 61, performing PFNA internal fixation). Operation time, intraoperative estimate blood loss, fracture healing time and complications were recorded in two groups. At the latest follow-up, hip functional recovery as well as patient satisfaction were evaluated in two groups. Results Operation time in PFN and PFNA group was (95 ± 14) and (62 ± 12) min respectively, the difference between two groups had statistical significance (P <0.05). Intraoperative estimate blood loss in PFN and PFNA group was (140 ± 181) and (138 ± 20) mL respectively, there was no statistical difference between two groups (P >0.05). All patients were followed up for an average of 18.6 months (12-24 months). Fracture healing time, excellent and good rate of hip Harris scoring and patients satisfaction at the last follow-up showed similar results in two groups (P >0.05), while the difference of complication rate between two groups had statistical significance (P <0.05). Conclusion Both PFNA and PFN internal fixation could obtain satisfactory clinical effects for treatment of femoral intertrochanteric fractures in elderly, while compared with PFN internal fixation, operation time for PFNA internal fixation is shorter, postoperative complication rate is lower, which could be considered comprehensively when making surgery planning.
Abstract:Diseases of cervical facet joint is a common source of chronic neck pain.Clinically,the accuracy and stability of the diagnosis of cervical facet joint-induced pain is often been concerned,whereas the pathophysiology and pain mechanism,especially the related neurobiological information were still not recognized adequately.In this paper,researches in pain from cervical facet joint,which is a integrated reaction regulated and maintained by all kinds of inflammatory factors and neurotransmitters,were reviewed from the aspect of cytological level of pain induction: the innervation and the distribution of pain receptors of cervical facet joint were introduced,irreversible neuropathological changes of cervical facet joint after chronic injuries were discussed which involved neuron activation,inflammatory cytokines release and changes of neuronal phenotype,at the same time,neurotransmitters and peptides involved in starting and sustaining the facet joint pain were emphasized which including the following three categories: pain neurotransmitters,stress-related proteins and local inflammatory factors,as well as spinal glutamate.
Abstract:Objective To investigate the diagnostic value of T-cell spot of tuberculosis (T-SPOT.TB) assay for patients with spinal tuberculosis. Methods From January 2012 to October 2014, a total of 110 suspected patients with spinal tuberculosis accepted both tuberculin skin test (TST) and T-SPOT.TB assay in Zhengzhou Orthopedics Hospital, in which TST using two standards of TST 5 (induration size ≥5 mm) and TST 15 (induration size ≥15 mm). According to the results of clinical diagnosis, the sensitivity, specificity, positive predict value and negative predict value of the two tests were evaluated and compared with each other. Results There were 68 patients diagnosed as spinal tuberculosis finally. The sensitivity, specificity, positive predict value and negative predict value of TST 5, TST 15 and T-SPOT.TB assay was 93%, 33%, 69%, 74%, and 47%, 83%, 82%, 49%, and 91%, 90%, 94%, 86% respectively. The sensitivity of T-SPOT.TB was higher than TST 15, and the specificity was higher than TST 5; The positive predict value and the negative predict value were all higher than TST 5 and TST 15 (P <0.05). Conclusion Compared with TST, T-SPOT.TB assay possesses more satisfactory sensitivity and specificity in the diagnosis of spinal tuberculosis, which could be used to help the early diagnosis of spinal tuberculosis.