Study on the application of a new type of vertebral plate nail guide / 中国骨伤

OBJECTIVE@#To explore safety and accuracy of novel C@*METHODS@#From January 2018 to June 2018, 40 patients who underwent three-dimensional CT of cervical spine were selected, including 21 males and 19 females, heighted from 165 to 180 cm with an average of (172.9±9.5) cm, aged from 38 to 55 years old (51.1±12.8) years old, excluding patients with axis lamina defect and hypoplasia. Two sets of 3D printed specimens were made from the three-dimensional CT data of cervical spine of each patient, and both of than were used for the in vitro nailing experiment. According to different nail placement methods, in vitro experimental part of this experiment was divided into guide nail placement group and hand nail placement group, 40 pieces in each group. At the same time, the three-dimensionalmodel of cervical spine of 40 patients was reconstructed on computer, and the ideal needle point data and inclination angle were obtained by computer simulation of the nail placement. This is 3D simulation nail placement group, 40 pieces. With vitro experiment, the risk level of screw placement, the position of needle exit point and inclination angle were measured in guide nail group and hand nail group. Based on the accuracy of needle point and inclination angle of nail path, the data of guide nail group, the hand nail group and 3D simulation nail group were compared, and the data of each group were statistically analyzed to determine the accuracy.@*RESULTS@#In guide nail group, 75 screws were acceptable and 5 were dangerous. The acceptable rate was 94%, and the double cortical rate was 93%. There were 62 position-acceptable screws in hand nail group, and 18 positions were dangerous, with an acceptable rate of 78% and a double cortical rate of 33%. The difference between two groups was statistically significant (@*CONCLUSION@#The guide is universal, with stable structure, accurate guidance, and easy operation. It could be placed with bilateral lamina screws at the same time, shortening the time of nail placement, avoiding collision of two way cross screws, increase the rate of double cortex. Ultimately, efficiency and security can be improved.

Relationship between lower limb alignment distribution and short-term clinical results after primary total knee arthroplasty in patients with varying degrees of knee varus / 中国骨伤

OBJECTIVE@#To analyze the relationship between the distribution of lower limb alignment and short term clinical efficacy in patients with varus-type osteoarthritis after primary total knee arthroplasty (TKA).@*METHODS@#From December 2016 to March 2018, 87 patients (101 knees) with knee osteoarthritis were treated with the first total knee arthroplasty by the same medical group, including 21 males(25 knees) and 66 females(76 knees), ranging in age from 51 to 85 years old, with a mean of (67.6±7.0) years old. According to the difference of hip knee ankle angle (HKA) after total knee arthroplasty, the patients were divided into 4 groups:neutral position group (group A), -3°≤HKA≤3°, 50 knees;slight varus group (group B), 3°0.05). There was no significant difference in knee joint activity among the 4 groups. The score of femoral prosthesis force line within ±3°was better than that of the other group (0.05).@*CONCLUSION@#The short term clinical efficacy of patients with knee varus osteoarthritis after primary total knee arthroplasty is related to the distribution of lower limbs alignment. The short-term clinical efficacy of slight inversion position can be similar to that of neutral position. The force line distribution of femoral prosthesis is related to the short term clinical efficacy after primary knee arthroplasty.

Relationship between low basal metabolic rate and mortality in older adults with hip fractures / 中国组织工程研究

BACKGROUND: Basal metabolic rate (BMR) is an important indicator of human energy metabolism, and low BMR leads to the dysfunction of liver and kidney. Low BMR is usually found in patients with hip fractures, but there is a lack of study on the relationship between mortality of hip fracture and low BMR. OBJECTIVE: To investigate the effect of low BMR on the 1-year mortality in older adults with hip fractures. METHODS: Totally 507 patients with hip fractures aged more than 60 years from January 2014 to March 2016 were included in this retrospective study. Age, sex, surgery or not, surgical pathway, duration from injury to surgery, hospitalized pulmonary infection, number and kind of comorbidities, and 1-year mortality were recorded. BMR on admission was recorded, and multiple Logistic regression analysis was applied. RESULTS AND CONCLUSION: All patients were followed up for 13-15 months, and the 1-year mortality was 13.41% (68/507). The mortality in the low BMR group was significantly higher than that in the non-low BMR group (P ＜ 0.05). Logistic regression analysis showed that older age, conventional treatment, number of combined medical diseases, hospitalized pulmonary infection, and low BMR are risk factors for 1-year mortality in older adults with hip fracture. These results imply that low BMR is strongly associated with 1-year mortality in older adults with hip fracture. BMR can reflect the nutritional status, neuroendocrine, cellular and energy metabolism. Thereafter, for older adults with hip fractures and low BMI, nutrition therapy, re-warming, and endocrine therapy may help reduce the trauma-induced mortality.

Femoral revision of the hip: reason, type and different techniques / 中国组织工程研究

BACKGROUND: Total hip arthroplasty has been widely used in clinical practice, and achieved good clinical efficacy. However, with the yearly increased number of patients receiving primary arthroplasty, the number of revision hip arthroplasty patients has increased. However, hip arthroplasty is one of the most difficult hip surgery, and it is challenging. OBJECTIVE: To review the causes of femoral revision of the hip arthroplasty, the classification of the femoral bone defect, and the type of prosthesis available in the clinical revision, and the clinical effect of the different prosthesis, so as to provide reference for femoral revision. METHODS: CNKI, Web of Science, and PubMed were searched for the literatures published between January 1975 and August 2017 with the key words of "Revision total hip arthroplasty, Femur revision, Cemented femoral revision, Cemenless femoral revision Reoperation, Porous-coated stems, Modular, tapered stem, Wagner SL revision Stem". RESULTS AND CONCLUSION: (1) A total of 1 041 articles were retrieved. After reading the abstract, unrelated and repeated studies were excluded. Finally, 109 studies were included. Of them, there were 106 English studies and 3 Chinese studies. Femoral revision was analyzed and summarized. (2) Femoral revision of the hip is still the future challenges facing the joint surgeon. We continue to strive to overcome the direction. Although the current material science and surgical technology are now rapidly developed, only the analysis of the reasons for the revision of the femoral side, identifying the femoral side bone defect classification, mastering the treatment of different defects and the application of the principle of prosthesis type, making reasonable femoral revision program is the key to success according to the patient's age and activity.

Expression of NOD2 and NLRP3 in the articular cartilage of a rabbit model of osteoarthritis established by arthrorisis using plaster cast / 中国组织工程研究

BACKGROUND: Nucleotide-binding oligomerization domain (NOD)-like receptor plays an important role against inflammatory responses caused by pathogens and non-pathogens, as well as in the initial stage of autoimmune response. Meanwhile, NOD2 and NOD-like receptor protein 3 (NLRP3) are the representative proteins of NOD-like receptor family. OBJECTIVE: To detect the expression of NOD2 and NLRP3 in a rabbit model of osteoarthritis. METHODS: Thirty New Zealand rabbits were randomly divided into six groups (n=5 per group), including five experimental groups (2, 4, 6, 8 and 10 weeks) and one control group. The model of osteoarthritis was established by fixing the left knee joints using plaster cast, and were sacrificed at postoperative 2, 4, 6, 8 and 10 weeks. The controls received no intervention, and were killed at 10 weeks postoperatively. The left distal femur articular cartilage was taken for safranin-fast green staining. The pathological changes were evaluated by Mankin's scores, and the expression levels of NOD2 and NLRP3 were detected by immunohistochemistry. RESULTS AND CONCLUSION: The Mankin's scores in the experimental groups were significantly higher than those in the control group (P <0.01). Moreover, the scores in the experimental groups were significantly increased with time (P < 0.01). The expression levels of NOD2 and NLRP3 in the chondrocytes were also increased with time (P < 0.01). These results indicate that the expresison of NOD2 and NLRP3 in the cartilage cells is positively correlated with the pathological changes of osteoarthritis, which may be through promoting apoptosis in cartilage cells, thus accelerating the development of osteoarthritis.

Effect of admission blood urea and creatinine levels on mortality in elderly patients with hip fracture / 中国骨伤

<p><b>OBJECTIVE</b>To observe the effect of admission blood urea and creatinine levels on mortality in elderly patients with hip fracture.</p><p><b>METHODS</b>Form January 2013 to December 2014, 767 elder patients with hip fracture were treated in our hospital including 253 males and 514 females, aged from 65 to 96 years old with an average of(75.67±6.81) years old. According blood urea and creatinine levels, the 767 hip fracture patients were divided into four groups as follow: group A(blood urea>=5 mmol/L, creatinine>=70 μmol/L); group B (blood urea>=5 mmol/L, creatinine<70 μmol/L); group C (blood urea<5 mmol/L, creatinine>=70 μmol/L); group D(blood urea<5 mmol/L, creatinine<70 μmol/L). In group A, there were 211 patients including 70 males and 141 females, aged from 65 to 95 years old with an average of(80.24±6.51) years old; in group B, there were 355 patients including 125 males and 230 females, aged from 65 to 93 years old with an average of(78.46±7.09) years old; in group C, there were 36 patients including 11 males and 25 females, aged from 65 to 95 years old with an average of (77.83±6.78) years old; in group D, there were 165 patients including 47 males and 118 females, aged from 65 to 96 years old with an average of (76.71±8.35) years old. The survivals and dead patients in four groups were collected and in-hospital mortality rate, 3-month, 12-month and 18-month mortality rate of patients were calculated. COX regression analysis was performed on these data, and clinical significance of serum urea and creatinine at admission in the elderly patients was researched.</p><p><b>RESULTS</b>All 767 hip fracture patients were followed up from 18 to 24 months with an average of (21.33±1.25) months, 159 patients were died in follow up period. The in-hospital mortality rate in 3-month, 12-month and 18-month mortality rate of the patients with high blood urea and high blood creatinine (urea>=5 mmol/L, creatinine>=70 μmol/L) were 2.37%, 9.95%, 16.11% and 26.07%, and were higher than other three groups respectively. COX regression analysis revealed that the independent predictors effecting the mortality rate included age [=0.000, OR=1.375, 95%CI(1.155, 1.637)], blood urea at admission [=0.000, OR=1.375, 95%CI(1.155, 1.637)], and blood creatinine at admission[=0.037, OR=1.213, 95%CI(1.121, 1.484)].</p><p><b>CONCLUSIONS</b>Elderly hip fracture patients with high serum urea and high serum creatinine at admission indicate higher fatality rate. Age, serum urea and serum creatinine at admission were independent predictors of fatality rate of elderly hip fracture patients.</p>

Bond strength analysis of the bone cement- stem interface of hip arthroplasties

OBJECTIVE@#To study and establish the preliminary linear and modified models for the interface shear mechanics performance between implant and bone cement and to explore its damage significance.@*METHOD@#The loosening research between artificial hip joint prosthesis stem and bone cement interface performance can be evaluated by the push-in test. Based on the debonding performance test, the analytical expressions of the average load and displacement from the debonding failure and splitting failure process were deduced and determined. The correlations of the expressions of the average load-displacement and statistical experimental data were analyzed.@*RESULTS@#It demonstrated that the interface debonding failure mechanical model could be characterized as interface bond strength mechanical performance. Based on analysis of models and experimental data by the three statistical analysis methods, the results indicated the modified model could be better represented by the interfacial debonding strength properties. The bond stress τ and relative sliding s distribution along the embedment regional were coupling affected by both pressure arch effect and shear lag effect in bone cement. Two stress peaks of implant have been found at the distance from 0.175La loading tip to 0.325La free tip, which also verified the early loosening clinical reports for the proximal and latter region. As the bone cement arch effect, the bond stress peak tend to move to the free tip when the debonding failure would be changed into the splitting failure, which presents a preliminary study on the mechanism of early debonding failure for the stem-cement interface.@*CONCLUSIONS@#Functional models of the stem-bone cement interfacial debonding failure are developed to analyze the relevant mechanism. The different locational titanium alloy stress, and the interfacial bond stress and the relative slides are evaluated to acquire a guide of the different positions of interfacial damage. The coupling effect which is original from the pressure arch and the interfacial shear hysteresis cumulative effect has influence on the interfacial debonding and damage process.

Preoperative reformatting for C_2 pedicle screw track using three-dimensional computed tomography technique / 中华创伤杂志

Objective To discuss the technique and value of preoperative reformatting with three-dimensional computed tomography technique for C_2 pedicle screw track.Methods GE Light Speed 16 Pro spinal CT scans of 15 adult dry vertebrae were loaded into an imaging station (software ADW4.2).Two methods of C_2 pedicle screw techniques were analyzed through virtual screw trajectory by VR (volume rendering) and MPR (multiple planar reformatting) techniques,in method A,screw entry point was the intersection between the media-vertical and the cranial line of C_2 inferior facet joint,in method B,the screw track was from the cranial and medial quadrant of the dorsal part of C_2 inferior facet joint.Results The screw track could be observed dynamically from any plane.Two vertebrae were ob- served with smaller height in isthmus and the medial edge of the transverse foramen since no space was a- vailable for the screw.The screw trajectories data were compared between method A and method B,which showed that the angles towards the cephalad (in sagittal plane) and midline (in transverse plane) were bigger in method A than in method B (P＜0.05,0.01),but the safe screw diameter was smaller in method A than in method B (P＜0.05),and there was no difference of the screw length between the two methods(P＜0.05 ).Conclusion In this research,the individual C_2 pedicle screw entry points, screw diameter and security screw angle can be simulated,and the screw track can be observed dynami- cally to make sure if it transits the bone structure completely.Preoperative three-dimensional computed tomography reformatting for pedicle screw track is of great value in clinical and basic researches.