Abstract Background and study aims Multiple surgical approaches have been studied and accepted for the removal of highly downward migrated lumbar disc herniation (LDH). Here, we investigated the efficacy and safety of full-endoscopic foraminoplasty for highly downward migrated LDH. Patients and methods Thirty-seven patients with highly down-migrated LDH treated by the full-endoscopic foraminoplasty between January 2018 and January 2020 were retrospectively investigated. Clinical parameters were evaluated preoperatively and 1, 6, and 12 months postoperatively, using pre- and post-operative Oswestry Disability Index (ODI) scores for functional improvement, visual analog scale (VAS) for leg and back pain, and modified MacNab criteria for patients satisfactory. Results Thirty-seven patients with highly downward migrated LDH were successfully removed via the transforaminal full-endoscopic discectomy. The average VAS back and leg pain scores were significantly reduced from 7.41 ± 1.17 and 8.68 ± 1.06 before operation to 3.14 ± 0.89 and 2.70 ± 0.46 at postoperative 1 month, and 1.76 ± 0.59 and 0.92 ± 0.28 at postoperative 12 months, respectively ( P < 0.05). The average ODI scores were reduced from 92.86 ± 6.41 to 15.30 ± 4.43 at postoperative 1 month, and 9.81 ± 3.24 at postoperative 12 months ( P < 0.05). Based on the modifed MacNab criteria, 36 out of 37 patients (97.30%) were rated as excellent or good outcomes. Conclusion The full-endoscopic foraminoplasty can be used successfully for surgical removal of high grade down-migrated LDH, and it could serve as an efficient alternative technique for patients with highly downward migrated LDH.
To investigate the correlation between the level of serum VEGF and bFGF with metastasis and re- currence of osteosarcoma.52 patients with osteosarcoma and 60 healthy people as control group were selected. The serum contents of VEGF and bFGF were determined with ELISA before and after operation.The serum contents of VEGF and bFGF before operation were significantly higher than that in control group ( P < 0.01). The serum contents of VEGF and bFGF after operation descreased significantly but were significantly higher than that in control group(P<0. 01). The serum contents of VEGF and bFGF before operation were positively related to the size of primarily tumor, Enneking type and tumor differentiation(P<0.05). The serum contents of VEGF and bFGF before and after operation were different significantly between recurrence and metastasis positive group with recurrence and metastasis negative group ( P < 0. 01). The Cox proportional hazards model showed that the serum contents of VEGF and bFGF before and after operation were an independent factor of the recurrence and metastasis for osteosar- coma patients after operative ( P <0. 01).The serum contents of VEGF and bFGF before and after operation can offer valuable assessments in evaluation of progression and metastasis prognosis.
To evaluate the effectiveness of high tibial osteotomy (HTO) assisted by three-dimensional (3-D) printing technology for correction of varus knee with osteoarthritis.Between January 2014 and June 2015, 16 patients (20 knees) with varus knee and osteoarthritis underwent HTO assisted by 3-D printing technology; a locking compression plate was used for internal fixation after HTO. There were 6 males and 10 females, aged 30-60 years (mean, 45.5 years). The disease duration was 1-10 years (mean, 6.2 years). The unilateral knee was involved in 12 cases and bilateral knees in 4 cases. According to Koshino's staging system, 3 knees were classified as stage I, 7 knees as stage II, 8 knees as stage III, and 2 knees as stage IV. Preoperative Hospital for Special Surgery (HSS) knee score was 63.8 ± 2.2; the femorotibial angle was (184.8 ± 2.9)°; and Insall-Salvati index was 1.03 ± 0.13.All the wounds healed primarily, and no complication of infection, osteofacial compartment syndrom, or deep vein thrombosis was observed. All patients were followed up 6-18 months (mean, 12.6 months). Personal paralysis was observed in 1 case (1 knee), and was cured after expectant treatment. Bone union time was 2.7-3.4 months (mean, 2.9 months). At 6 months after operation, the femorotibial angle was (173.8 ± 2.0)°, showing significant difference when compared with preoperative one (t = 11.70, P = 0.00); Insall-Salvati index was 1.04 ± 0.12, showing no significant difference when compared with preoperative one (t = -0.20, P = 0.85); and HSS knee score was significantly increased to 88.9 ± 3.1 (t = -25.44, P = 0.00). At last follow-up, the results were excellent in 13 knees, good in 6 knees, fair in 1 knee, and the excellent and good rate was 95%.3-D printing cutting block can greatly improve the accuracy of HTO, avoid repeated X-ray and multiple osteotomy, shorten the operation time, and ensure better effectiveness for correction of varus knee with osteoarthritis.
Objective To investigate the clinical curative effects on anterolateral distal tibial locking plate in patients with comminuted fracture of distal tibia.Methods Fifty-two patients with comminuted fracture of distal tibia admitted into our hospital from October 2008 to December 2009 underwent entocnemial open reduction,the fracture of distal tibia were fixed by anterolateral distal tibial locking plate.With the early stage functional training of ankle and knee joint,after operation and without external fixation.Results All patients were followed up for 8 to 18 months.All incisions were healed by first intention.According to the Tornetta score standard,38 patients were in excellent grade,12 patients were in good grade and 2 patients were in middle grade.The excellent and good rate was 96.15％.No complication happened.Conclusions Anterolateral distal tibial locking plate in the treatment of fracture of comminuted distal tibia has many merits,such as convenient operantion,reliable fixation and slight damage to skin,soft tissue and it is an ideal therapeutic method to treat fracture of distal tibia near joint,especially for comminuted fracture.
Key words:
Anterolateral distal tibial locking plate; Comminuted fracture of distal tibia; Fracture fixation; Internal fixation
Objective To investigate the operation on files under command stream of Ansys for fast establishment and analysis on three - dimensional finite element of femur.Methods One integrated and fresh femurs in adult corpses was selected,experimental procedure included pretreatment on femurs,high - speed thin layer CT scans with layer of 0.625 mm,compile on mask files,preliminary three - dimensional reconstruction,treatment for surface smoothness,exportation of 3 - D model to Mimics 10.01,partition of grid under command stream of Ansys,achievement of material attributes by empirical formula,further exportation of 3 - D model to Mimics 10.01,finite element was established and analysis on finite element was done. Results Fast establishment on three - dimensional finite element of femoral specimens carried out,simple analysis on finite element achieved.Conclusions Three -dimensional finite element can be established more effectively by applying files under command stream of Ansys.Therefore the number of bone - related medical analysis can be achieved.
Key words:
Three - dimensional reconstruction ; Finite element ; Modeling ; Digitization
Abstract Background: This study aimed to compare the efficacy and safety of oral tranexamic acid (TXA) with intravenous (IV) TXA in reducing perioperative blood loss in total-knee arthroplasty (TKA) and total-hip arthroplasty (THA). Methods: PubMed, Web of Science, Embase, and Cochrane Library were fully searched for relevant studies. Studies comparing the efficacy and safety of oral TXA with IV TXA in TKA and THA were included in this research. Odds ratio (OR) or risk difference (RD) was applied to compare dichotomous variables, while mean difference (MD) was used to compare continues variables. Results: A total of 7 studies (5 randomized controlled trials and 2 retrospective studies) were included into this study. As for patients undergoing TKA or THA, there were no obvious differences between oral TXA group and IV TXA group in hemoglobin (Hb) drop (MD = 0.06, 95% confidence interval [CI] = −0.01 to 0.13, P = .09), transfusion rate (OR = 0.78, 95% CI = 0.54–1.13, P = .19), total blood loss (MD = 16.31, 95% CI = −69.85 to 102.46, P = .71), total Hb loss (MD = 5.18, 95% CI = −12.65 to 23.02, P = .57), length of hospital stay (MD = -0.06, 95% CI = −0.30 to 0.18, P = .63), drain out (MD = 21.04, 95% CI = −15.81 to 57.88, P = .26), incidence of deep vein deep vein thrombosis (RD = 0.00, 95% CI = −0.01 to 0.01, P = .82) or pulmonary embolism (RD = 0.00, 95% CI = −0.01 to 0.01, P = .91). The sample size of this study was small and several included studies were with relatively low quality. Conclusion: Oral TXA is equivalent to IV TXA in reducing perioperative blood loss and should be recommended in TKA and THA. More high-quality studies are needed to elucidate this issue.
Objective. To explore the feasibility of 3D printing-assisted pedicle screw correction surgery for degenerative scoliosis. Methods. From January 1, 2015 to January 31, 2020, patients with degenerative scoliosis who received corrective surgery in our hospital were retrospectively analyzed. Patients were grouped based on the fixation methods. Patients in the control group received traditional pedicle screw internal fixation, while those in the study group received 3D printing-assisted pedicle screw fixation. The therapeutic effects were compared. Results. There were 78 cases in the control group and 82 cases in the study group. There were no significant differences in scoliotic Cobb’s angle, pelvic incidence-lumbar lordosis (PI-LL), VAS score, JOA score, social function, physical function, role function, or cognitive function between the study group and the control group before the surgery, but there were differences in the above parameters between the two groups after surgery. The incidence of postoperative complications in the study group was also significantly lower in the study group. Conclusion. 3D printing-assisted pedicle screw correction surgery provides a strong 3D correction force with reliable effect and fewer complications, and is a good treatment choice for degenerative scoliosis.
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