Repair effect of neurotrophic factor III (NT-3) on rats with spinal injury model and its mechanism.

The present study aimed to study the repair effect of neurotrophic factor III (NT-3) on spinal injury model rats and its mechanism. Wistar rats with spinal injury were established by accelerated compression stroke after the operation and divided into control group, model group, and NT-3 intervention group. The motor function of rats in each group was evaluated at different postoperative time points (3, 7, 14 d). HE staining was used to detect the changes in tissue structure and morphology of the injured spinal column in each group. The changes of SOD, MDA and GSH in serum of rats were detected. The concentrations of inflammatory cytokines IL-1ß, IL-6, IL-17 and TNF-α in serum were detected by enzyme-linked immunosorbent assay (ELISA). Western blot was used to detect the expression changes of anti-apoptotic protein (Bcl-2) and pro-apoptotic protein (Bax) in injured spinal tissue of rats in each group. Compared with model group, motor function score of NT-3 intervention group increased gradually, and had statistical significance at 7 and 14 days (5.29±1.62 vs 9.33±2.16, 5.92±1.44 vs 14.56±2.45, T =7.386, 9.294, P =0.004, 0.000). The levels of SOD and GSH in serum of NT-3 intervention group were significantly increased (t=9.117, 12.207, P=0.000, 0.000), while the level of MDA was significantly decreased (t=5.089, P=0.011). Serum levels of inflammatory cytokines IL-1ß, IL-6, IL-17 and TNF-α in NT-3 intervention group were significantly decreased (T =6.157, 7.958, 6.339, 6.288, P=0.008, 0.005, 0.005, 0.007). In the NT-3 treatment group, Bax protein was significantly decreased (0.24±0.05 vs 0.89±0.12, T =8.579, P=0.001), and the relative expression of Bcl-2 protein was significantly increased (0.75±0.06 vs 0.13±0.05, T =9.367, P=0.001). Neurotrophic factor III can promote spinal injury repair in spinal injury model rats, and play a role by enhancing antioxidant stress ability, inhibiting inflammatory factors, promoting Bcl-2 and decreasing Bax expression.

Evaluation of the clinical efficacy of the bilateral pedicle cement anchoring technique in percutaneous vertebroplasty for Kümmell disease.

The present study aimed to evaluate the clinical efficacy of the bilateral pedicle cement anchoring technique combined with the postural reduction in percutaneous vertebroplasty (PVP) for Kümmell disease. For this purpose, a retrospective study was performed on 18 patients with Kümmell disease who between January 2018 and June 2021 underwent bilateral pedicle cement anchoring combined with postural reduction in PVP. Pre- and post-operative bone mineral density, injected cement volume, visual analogue scale (VAS) values, Oswestry disability index (ODI) scores, Cobb angle measurements and anterior vertebral height (AVH) were recorded and assessed. The mean follow-up duration was 8.4±1.2 months. The average VAS score decreased from 8.17±0.71 pre-operatively to 1.56±0.62 post-operatively and remained at 2.00±0.91 at the final follow-up visit (P<0.05). The average ODI improved from 86.44±5.5 pre-operatively to 24.33±7.82 post-operatively. Until the last follow-up, the ODI remained at 27.11±8.76 (P<0.05). Similarly, the changes in the Cobb angle and AVH before and after surgery were also statistically significant in the radiological evaluation (P<0.05). During the follow-up, two patients experienced adjacent vertebral fractures. The loosening of cement was not found. Overall, the present study demonstrated that during the treatment of Kümmell disease with PVP, the bilateral pedicle cement anchoring technique combined with postural reduction can achieve good clinical outcomes.

Breakage risk of different sacroiliac screws in unilateral sacral fractures a finite element analysis.

OBJECTIVE: To compare the breakage risk of lengthened sacroiliac screws and ordinary sacroiliac screws to treat unilateral vertical sacral fractures and provide a reference for clinical application. METHODS: A finite element model of Tile C pelvic ring injury (unilateral type Denis II fracture of the sacrum) was produced. The sacral fractures were fixed with a lengthened sacroiliac screw and ordinary sacroiliac screw in 6 types of models. The maximal von Mises stresses and stress distributions of the two kinds of screws when standing on both feet were measured and compared. RESULTS: The maximal von Mises stress of the lengthened screw was less than that of the ordinary screw. Compared with ordinary screw, the stress distribution in the lengthened screw was more homogeneous. CONCLUSIONS: The breakage risk of screws fixed in double segments is lower than that of screws fixed in single segments, the breakage risk of lengthened screws is lower than that of ordinary screws, and the breakage risk of screws fixed in S2 segments is lower than that of screws fixed in S1 segments.

Efficacy Evaluation of Zoledronic Acid Combined with Chemotherapy in the Treatment of Lung Cancer Spinal Metastases on Computed Tomography Images on Intelligent Algorithms.

To analyze the effectiveness and safety of zoledronic acid combined with chemotherapy for lung cancer spinal metastases, 96 patients with lung cancer spinal metastases were averagely classified into the experimental group (gemcitabine, cisplatin, and zoledronic acid) and the control group (gemcitabine and cisplatin). An optimized noise variance estimation algorithm (OMAPB) was proposed based on the maximum a posteriori Bayesian method (MAPB), and the algorithm was applied to the patient's computed tomography (CT) scan. The results indicated that in terms of curative effect, the number of complete remission (CR), partial remission (PR) cases, effective rate, and clinical benefit rate of the test group was significantly higher than those of the control group. The number of progress disease (PD) cases was significantly lower than that of the control group (P < 0.05). The disease progression time of the test group patients was 6.2 months, and the disease progression time of the control group patients was 3.7 months (P < 0.05). The test group patients had 8 cases of bone marrow suppression and gastrointestinal reactions after treatment. In the test group, there were 8 cases of bone marrow suppression, 9 cases of gastrointestinal reaction, 3 cases of fever, 4 cases of pain, and 2 cases of hair loss. The patients in the control group were complicated with bone marrow suppression in 14 cases, gastrointestinal reaction in 17 cases, fever in 5 cases, pain in 4 cases, and hair loss in 6 cases. The difference was statistically significant (P < 0.05). It showed that zoledronic acid combined with chemotherapy could effectively improve the treatment efficiency and clinical benefit rate of patients with lung cancer spinal metastases, prolong the progression of the disease, reduce the degree of bone tissue damage, and would not increase chemotherapy adverse events.

Anatomic relationship between S2 sacroiliac screws' entry points and pelvic external branches of superior gluteal artery.

OBJECTIVE: To study the relationship between the pelvic external branches of the superior gluteal artery and the entry area of the S2 sacroiliac screw to provide the anatomical basis and technical reference for avoiding the superior gluteal artery injury during the clinical screw placement. METHODS: CTA imaging of superior gluteal artery of 74 healthy adults (37 males and 37 females) was randomly selected. The safe bony entry area ('safe area' for abbreviation) of S2 sacroiliac screw in the standard lateral view of the pelvis three-dimensional reconstruction CT image was determined by the CT auxiliary measurement software. The relationship between the pelvic external branches of the superior gluteal artery and the safe area of S2 sacroiliac screw was observed, and the cases in which the artery intersected the safe area were counted. The distance between the safe area and the superior gluteal artery branches closest to it was measured for the cases in which the artery and the safe area did not intersect. RESULTS: 21 of the 74 cases did not have a bone channel of horizontal S2 sacroiliac screw, so they were excluded from this study. In the remaining 53 cases, 12 cases had the deep superior branch of the superior gluteal artery through the safe area of S2 screw (22.6%), and 16 cases had the superficial branch of the superior gluteal artery through the safe area of S2 screw (30.2%). There was no obvious overlap feature and law between the safe area and the superficial and deep superior branches. In 20 cases of the 53 cases, the safe area of S2 screw was located between the deep superior branch and the superficial branch of superior gluteal artery (37.7%), and in 5 cases, the safe area of S2 screw was located behind the superficial branch of superior gluteal artery (9.4%). In the cases where the superior gluteal artery did not intersect the screw entry bony safe area, the part of superior gluteal artery closest to the safe area was located in front or back of the widest part of the safe area. CONCLUSION: The risk of accidental injury of the deep superior branch and superficial branch of the superior gluteal artery is high during the process of S2 sacroiliac screw placement. Even if the screw entry point is located in the bony safe area, the absolute safety of screw placement cannot be guaranteed. We strongly suggest that a careful and thorough plan is needed before surgery.

Guide wire displacement in robot-assisted spinal pedicle screw implantation.

AIM: Guide wire displacement in spinal pedicle screw implantation was analyzed in order to reduce or avoid the occurrence of this phenomenon and to reduce the complications associated with robot-assisted pedicle screw implantation surgery. MATERIAL AND METHODS: From April 2017 to December 2019, a retrospective study was conducted with 398 patients who underwent robot-assisted spinal pedicle screw implantation. The causes of guide wire displacement in 60 punctures were analyzed. RESULTS: There were 2,408 robot-assisted wire punctures of the pedicle, of which 2,348 wire punctures were located well within the pedicle, and 60 wire displacements occurred during robot-assisted wire puncture, with a displacement rate of 2.49%. There was 1 case of thoracic segmental artery injury and 1 case of spinal cord incomplete injury. CONCLUSIONS: As it is a rare phenomenon in robot-assisted spinal pedicle screw implantation, guide wire displacement should be avoided as much as possible to improve the accuracy of screw placement and reduce surgical complications during the operation.

Risk factor analysis of pulmonary cement embolism during percutaneous vertebroplasty or kyphoplasty for osteoporotic vertebral compression fractures.

OBJECTIVE: The purpose of this research is to evaluate the risk factors and incidence of pulmonary cement embolism (PCE) during percutaneous vertebroplasty (PVP) or kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs) based on postoperative computed tomography (CT). METHODS: A total of 2344 patients who underwent PVP or PKP due to OVCFs in our spine center were analyzed retrospectively. According to the detection of postoperative pulmonary CT, the patients were divided into two groups: pulmonary cement embolism group (PCE group) and non-pulmonary cement embolism group (NPCE group). Demographic data in both groups were compared using the χ2 test for qualitative data and the unpaired t test for quantitative data. Multiple logistic regression analysis was carried out to identify risk factors that were significantly related to the PCE resulting from cement leakage. RESULTS: PCE was found in 34 patients (1.9% 34/1782) with pulmonary CT examination after operation. There was no statistically significant difference in the parameters such as age, gender, body mass index (BMI), and cement volume in the two groups. Patients with three or more involved vertebrae had a significantly increased risk to suffer from PCE than those with one involved vertebra (p=0.046 OR 2.412 [95% CI 1.017-5.722]). Patients who suffered thoracic fracture had a significantly increased risk to suffer from PCE than those who suffered thoracolumbar fracture (p=0.001 OR 0.241 [95% CI 0.105-0.550]). And significantly increased PCE risk also was observed in thoracic fracture compared with lumbar fracture patients (p=0.028 OR 0.094 [95% CI 0.114-0.779]). The risk of PCE within 2 weeks after fracture was significantly higher than that after 2 weeks of fracture (p=0.000 OR 0.178 [95% CI 0.074-0.429]). Patients who underwent PVP surgery had a significantly increased PCE risk than those who underwent PKP surgery (p=0.001 OR 0.187 [95% CI 0.069-0.509]). CONCLUSION: The real incidence of PCE is underestimated due to the lack of routine postoperative pulmonary imaging examination. The number of involved vertebrae, fracture location, operation timing, and operation methods are independent risk factors for PCE.

MiR-34a regulates Schwann cell proliferation and migration by targeting CNTN2.

The proliferation and migration of Schwann cells contribute to axonal outgrowth and functional recovery after peripheral nerve injury. Previously, several microRNAs were abnormally expressed after peripheral nerve injury and they played important roles in peripheral nerve regeneration. However, the role and underlying mechanism of miR-34a in peripheral nerve injury remain largely unknown. The levels of miR-34a and contactin-2 (CNTN2) were detected by quantitative real-time PCR. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide and transwell assays were used to examine cell proliferation and migration, respectively. The protein level of CNTN2 was measured by western blot. The binding sites of miR-34a and CNTN2 were predicted by the online software and confirmed by dual-luciferase reporter assay and RNA immunoprecipitation (RIP) assay. Following sciatic nerve injury, the expression of miR-34a was downregulated in the crushed nerve segment, reaching a minimum at the seventh day. Knockdown of miR-34a enhanced the axon outgrowth of dorsal root ganglion neurons. Moreover, miR-34a overexpression evidently inhibited the proliferation of Schwann cells, whereas its knockdown showed the opposite effects. In addition, CNTN2 was a direct target of miR-34a and its expression was negatively regulated by miR-34a in the crushed nerve segment. Besides, CNTN2 overexpression or knockdown could reverse the effects of miR-34a upregulation or downregulation on proliferation and migration of Schwann cells, respectively. Collectively, miR-34a inhibited the proliferation and migration of Schwann cells via targeting CNTN2, which might provide a new approach to peripheral nerve regeneration.

Biomechanical comparison of three minimally invasive fixations for unilateral pubic rami fractures.

BACKGROUND: To compare the mechanical characteristics of a percutaneous superior pubic intramedullary screw, percutaneous bridging plate and percutaneous screw-rod system of the anterior ring for the treatment of unilateral vertical pubic fractures to provide a reference for clinical application. METHODS: A finite element model of pelvic anterior ring injury (unilateral vertical pubic fracture) was produced. The fractures were fixed with a percutaneous superior pubic intramedullary screw, percutaneous bridging plate and percutaneous screw-rod system of the anterior ring and their combinations in 5 types of models. The fracture stabilities under vertical, bilateral and anterior-posterior load were quantified and compared based on the displacement of the hip joints' midpoint as quantificational index of fracture stability. RESULTS: In the condition of bilateral and anterior-posterior load, the vertical, bilateral and anterior-posterior displacements of the hip joints' midpoint of different models were significantly different respectively. In general, the displacements of the 5 pelvic anterior ring fixations were ranked from maximum to minimum as follows: bridging plate, pelvic anterior screw-rod system, combination of bridging plate and pelvic anterior screw-rod system, superior pubic intramedullary screw and combination of superior pubic intramedullary screw and pelvic anterior screw-rod system. CONCLUSION: For the fixation in unilateral pubic fractures of pelvic ring injury, the percutaneous superior pubic intramedullary screw is optimal, the percutaneous pelvic anterior screw-rod system is the second choice, and percutaneous bridging plate ranks the third. The percutaneous pelvic anterior screw-rod system can significantly increase fixation stability of the percutaneous superior pubic intramedullary screw and the percutaneous bridging plate.

Neuroprotective effect of ischemic postconditioning on sciatic nerve transection.

Ischemic preconditioning or postconditioning has been shown to have neuroprotective effect on cerebral ischemia, but it has not been studied in peripheral nerve injury. In this study, a rat model of sciatic nerve transection was established, and subjected to three cycles of ischemia for 10 minutes + reperfusion for 10 minutes, once a day. After ischemic postconditioning, serum insulin-like growth factor 1 expression increased; sciatic nerve Schwann cell myelination increased; sensory function and motor function were restored. These findings indicate that ischemic postconditioning can effectively protect injured sciatic nerve. The protective effect is possibly associated with upregulation of insulin-like growth factor 1.

Diagnosis and management of spinal tuberculosis combined with brucellosis: A case report and literature review.

Tuberculosis combined with brucellosis is a very rare condition. Overlapping clinical presentation and laboratory parameters of tuberculosis and brucellosis may lead to misdiagnosis or delayed diagnosis of the condition. The current study presents the case of a 45-year-old male with symptoms of lower back pain, non-tender swelling in the right flank, intermittent hyperpyrexia, sweating, body aches and numbness and weakness of right lower limb. A lumbar computed tomograph (CT) scan and magnetic resonance imaging indicated vertebral destruction and the formation of sequestra and thecal sac compression. Tuberculosis was suspected, but subsequent culture of blood and pus revealed the co-infection of Mycobacterium tuberculosis and Brucella melitensis. The patient was treated with antibiotics, CT-guided percutaneous drainage of the abscess and posterior approach decompression, debridement, instrumentation and fusion. Co-existence of spinal tuberculosis and brucellosis is rare and clinicians should strengthen the awareness of such conditions in similar patients. CT-guided percutaneous drainage is effective in the diagnosis and management of spinal tuberculosis with abscess.

Anatomical relation between S1 sacroiliac screws' entrance points and superior gluteal artery.

BACKGROUND: To conduct radiologic anatomical study on the relation between S1 sacroiliac screws' entry points and the route of the pelvic outer superior gluteal artery branches with the aim to provide the anatomical basis and technical reference for the avoidance of damage to the superior gluteal artery during the horizontal sacroiliac screw placement. METHODS: Superior gluteal artery CTA (CT angiography) vascular imaging of 74 healthy adults (37 women and 37 men) was done with 128-slice spiral CT (computed tomography). The CT attendant-measuring software was used to portray the "safe bony entrance area" (hereinafter referred to as "Safe Area") of the S1 segment in the standard lateral pelvic view of three-dimensional reconstruction. The anatomical relation between S1 sacroiliac screws' Safe Area and the pelvic outer superior gluteal artery branches was observed and recorded. The number of cases in which artery branches intersected the Safe Area was counted. The cases in which superior gluteal artery branches disjointed from the Safe Area were identified, and the shortest distance between the Safe Area and the superior gluteal artery branch closest to the Safe Area was measured. RESULTS: Three cases out of the 74 sample cases were excluded from this study as they were found to have no bony space for horizontal screw placement in S1 segment. Among the remaining 71 sample cases, there are 32 cases (45.1%) where the deep superior branch of superior gluteal artery passes through the Safe Area of S1 entrance point. There was no distinguishing feature and rule on how the deep superior branches and the Safe Area overlapped. In the 39 cases in which superior gluteal artery branches disjointed from the Safe Area, the deep superior branches of superior gluteal artery were the branches closest to the Safe Area and the part of the branch closest to the Safe Area was located in front of the widest part of the Safe Area. The shortest distance between the deep superior branch and the Safe Area is 0.86 ± 0.84 cm. CONCLUSION: There is a high risk of accidental injury of the deep superior branches of superior gluteal artery in the process of S1 sacroiliac screw placement. Even if the entry points are located in the safe bony entrance area, the absolute secure placement cannot be assured. We suggest that great attention should be paid to make thorough preoperative plans.

An Experimental Study on Repeated Brief Ischemia in Promoting Sciatic Nerve Repair and Regeneration in Rats.

BACKGROUND: Research has shown that ischemic preconditioning reduced the severity of ischemia-reperfusion injury in brain in rats, we have a hypothesis that repeated brief ischemia has positive effects on peripheral nerve damage. This study was conducted to investigate the potential protective effects of repeated brief ischemia on peripheral nerve regeneration using a rat model of experimental sciatic nerve transection injury. METHODS: Treatment groups (groups A-D) received repeated, brief ischemia every 1 day/2 days/3 days/7 days. After surgery for 4, 8, 12 weeks, we evaluated sciatic functional index test, gastrocnemius muscle wet mass, axon and nerve fiber diameter, density, G-ratio, immunohistochemistry of S-100, vascular endothelial growth factor (VEGF), and the ultrastructure of the nerves. RESULTS: Sciatic functional index test and muscle wet mass were improved on the repeated brief ischemia groups. Ischemia treatment resulted in a significant increase in axon and nerve fiber density as well as S-100 and VEGF-positive cell, which indicated that repeated brief ischemia promotes Schwann cell proliferation and reconstruction. CONCLUSIONS: This study exhibits the positive effects of repeated brief ischemia in sciatic nerve transection injury, possibly in part because it can improve VEGF and the physiologic state of Schwann cells in the ischemic environment and then accelerate the ability of neurite outgrow.

Comparison of the risk of breakage of two kinds of sacroiliac screws in the treatment of bilateral sacral fractures.

PURPOSE: This study aimed at comparing the risk of breakage of lengthened sacroiliac screw and ordinary sacroiliac screw for the treatment of bilateral vertical sacral fractures to provide reference for clinical application. METHODS: A finite element model of type C pelvic ring injury (bilateral type Denis II fracture of sacrum) was produced. The bilateral sacral fractures were fixed with lengthened sacroiliac screw and ordinary sacroiliac screw in seven types of models, respectively. The maximal Von Mises stresses and stress distribution of the two kinds of screws in the case of standing on both feet were measured and compared. RESULTS: (1) Whether in lengthened sacroiliac screw or ordinary sacroiliac screw, the maximal Von Mises stress of screw fixation only in S1 segment is the largest, and the maximal Von Mises stress of screw fixation only in S2 segment is minor, and the maximal Von Mises stress of screw fixation in S1 and S2 segments, respectively, is the least. (2) When S1 and S2 were both fixed with ordinary screws, the maximal Von Mises stress of screw in S1 segment is larger than that of S2. When S1 and S2 were both fixed with lengthened screws, the maximal Von Mises stress of screw in S1 segment is similar to that of S2. (3) The maximal Von Mises stresses of bilateral symmetrical screws are similar. (4) When only S1 was fixed, the maximal Von Mises stress of lengthened screw is less than that of ordinary screw. When only S2 was fixed, the maximal Von Mises stress of lengthened screw is larger than that of ordinary screw. When S1 and S2 were both fixed, the maximal Von Mises stress of lengthened screw is slightly less than that of ordinary screw. (5) Whether in lengthened screw or ordinary screw, the stress concentrations all exhibited at the regions of screws corresponding to the sacral fracture regions and the part between sacral bilateral fracture lines. Compared with ordinary screw, the stress distribution in lengthened screw is more homogeneous. Whether in lengthened screw or ordinary screw, the stress distribution of only one sacral segment fixation is more concentrated than that of two sacral segments' fixation. When S1 and S2 were both fixed, the stress distribution of upper screw is more concentrated and that of lower screw is more homogeneous. CONCLUSION: In a finite elements simulated type C pelvic ring disruption (bilateral type Denis II sacral fracture), the breakage risk of screws fixed in double-segment bilaterally symmetrically is low, and the breakage risk of screws fixed in S2 segment is lower than that of S1 segment. The bilaterally symmetrical screw fixation in double-segment is strongly recommended to reduce the breakage risk of screws. In addition, the breakage risk of lengthened screws is lower than that of ordinary screws except when screws are fixed in only S2 segment, which merits attention.

[Efficacies of percutaneous multiple needle puncturing for releasing hip adductor muscle during total hip arthroplasty].

OBJECTIVE: To summarize our experiences of applying percutaneous multiple needle puncturing technique for releasing adductor muscle during total hip arthroplasty (THA) for ischemic necrosis of femoral head and provide rationales for clinical practice. METHODS: From January 2008 to December 2012, 36 adult patients with ischemic necrosis of femoral head (36 hips) and 36 adult patients with femoral neck fracture (36 hips) were recruited. The group of ischemic necrosis of femoral head was designated as experiment group in which there were 29 males and 7 females with an average age of 67.9 (60-78) years. According to the Ficat system, there were type III (n = 24) and type IV (n = 12) . The affected leg shortening of this group prior to surgery was over 2 cm. The group of femoral neck fracture was selected as control group in which there were 16 males and 20 females with an average age of 70.1 (60-82) years. According to the Garden system, there were type III (n = 16) and type IV (n = 20). All cases underwent THA with Press-fit prosthesis. After fixing prosthetic components, leg length discrepancy was corrected. And percutaneous multiple needle puncturing was applied for releasing adductor muscle in experiment group. The follow-up period was 2 years. The safety and efficiency were evaluated by HHS (Harris Hip Score) and the range of motion (ROM) of hip extorsion and abduction. RESULTS: There was no occurrence of such early complications as palsy of obturator nerve, hematoma in adductor muscle area or serious deep vein embolism.No serious complications of deep infection, femoral head dislocation, recurrent adductor muscle contracture, prosthesis loosening, subsidence, excursion or penetration occurred up until the final follow-up. The range of hip motion of extorsion and abduction: (1) in experimental group, the postoperative ROM (abduction:44.9 ± 0.8, extorsion:45.1 ± 0.9) was significantly larger than that of preoperative (abduction: 30.0 ± 4.6, extorsion:31.5 ± 4.6) ; (2) the postoperative ROM of experimental group had no significant changes until the final follow-up (abduction: 44.7 ± 0.9, extorsion:45.25 ± 0.81); (3) at the last time of follow-up, no significant inter-group difference existed in ROM (abduction:44.86 ± 0.68, extorsion:45.6 ± 0.8). HHS: (1) in experimental group, HHS increased significantly from 39.64 ± 3.93 preoperatively to 82.8 ± 3.6 at 3 months postoperatively; (2) in two groups, HHS of 2 years postoperation (experimental group: 88.6 ± 4.1, control group: 89.1 ± 4.0) was significantly larger than that of 3 months postoperation (experimental group: 82.8 ± 3.6, control group:83.1 ± 3.1); (3) at the time of 3 months and 2 years postoperation, no significant inter-group difference existed in HHS. CONCLUSION: The technique percutaneous multiple needle puncturing for releasing adductor muscle during THA for ischemic necrosis of femoral head is both safe and efficacious. And it solves the problems of soft tissue balancing mini-invasiveness.