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BackgroundAnterior cervical discectomy and fusion is the golden standard for anterior surgery treating elderly cervical degenerative disease, but the previous implant has some problems such as looseness, translocation, sinking and dysphagia, So Zero-p implant and PCB implant have been developed to decrease the complications.MethodsThe clinical data of 57 patients with single level cervical spondylotic myelopathy were retrospectively analyzed. 27 patients adopting Zero-p interbody fusion cage as implant (Zero-p group) and 30 patients adopting integrated plate cage benezech (PCB) as implant (PCB group) from January 2010 to October 2012. Observe whether are differences between the two groups of patients on operation time, intraoperatve blood loss,Japanese Orthopaedic Association (JOA) scores before and after operation, intervertebral height, cervical physiological curvature, fusion rate, Postoperative dysphagia rate and complications.ResultsZero-p group’s operation time is 98.2 + 15.2 min and its intraoperatve blood loss is 88.2 + 12.9 ml, both of which are lower than those of PCB group (109.8 + 16.9 min,95.2 + 11.6 ml ), so their differences are statistically significant (P < 0.05). The two groups’ JOA scores 3 months after operation and in the last follow-up are significantly higher than those before operation, so the differences are statistically significant (P < 0.05). Coob angle 3 months after operation and in the last follow-up improves obviously compared with before operation, so the difference is statistically significant (P < 0.05). The two groups’ operation segments intervertebral height 3 months after operation and in the last follow-up improves obviously compared with before operation, so the difference is statistically significant (P < 0.05) Zero-p group has one patient with dysphagia after operation and PCB group has four patients with dysphagia after operation, so there is no statistical differences between the two groups on dysphagia rate (P > 0.05, P = 0.415). PCB group has two patients with screws backing out and two patients with hoarseness after operation, the two groups’ operation segments all saw bony union in the last follow-up. Zero-p group postoperative complications are lower than PCB group (P < 0.05, P = 0.044).ConclusionsZero-profile implant and PCB implant both achieved good clinical effects on the treatment of cervical spondylotic myelopathy, the two groups both saw bony union in operation segments, but Zero-profile implant has the advantages of easy operation, short operation time, less intraoperatve blood loss and less complications.

Background. Diabetes mellitus (DM) is a common disease that has an adverse impact on most orthopedic surgeries, and its prevalence has gradually increased in recent years. We aim to investigate the influence of DM on comorbidities and complications of patients undergoing primary total lower extremity arthroplasty. Methods. PubMed, Embase, Cochrane Library, Medline, and Web of Science were systematically searched for relevant studies published before December 2019. Demographic data, comorbidities, and postoperative complications after primary total hip arthroplasties (THA) or primary total knee arthroplasties (TKA) were assessed between DM and non-DM patients. Meta-analysis was conducted using Review Manager 5.3, and forest plots were drawn for each variable. Results. A total of 1,560,461 patients (215,916 patients with DM and 1,344,545 patients without DM) from 23 studies were included in this meta-analysis. The incidences of several preoperative comorbidities (hypertension (HTN), kidney disease, cardiac and cerebrovascular disease) were generally higher in patients with DM. Moreover, DM patients had a higher rate of postoperative complications (superficial and deep infection, deep vein thrombosis (DVT), and in-hospital mortality) compared to non-DM patients. Conclusions. DM patients were more likely to suffer from comorbidities and had a higher risk of complications in total lower extremity arthroplasty compared to non-DM patients. It is necessary to identify DM and control hyperglycemia in the perioperative period to prevent postoperative complications in patients with DM.

This article describes the independent factors that affect kyphotic angle reduction in the treatment of osteoporotic vertebral compression fractures with kyphoplasty. Between January 2008 and September 2011, one hundred twenty-six patients with a single-level osteoporotic compression fracture who underwent kyphoplasty were evaluated for a minimum of 1 year postoperatively. Nine independent variables related to patient characteristics (age, sex, bone mineral density [BMD], and body mass index), fracture characteristics (fracture level, fracture age, and preoperative kyphotic angle), and surgical variables (total injected cement volume and cement leakage) were assessed. Kyphotic angle reduction was the dependent variable. Univariate and multivariate linear regression analyses were used to determine the factors associated with kyphotic angle reduction.Significant improvements occurred in mean anterior vertebral height variation, middle vertebral height variation, kyphotic angle, and visual analog scale and Oswestry Disability Index scores immediate postoperatively and at final follow-up compared with the preoperative values. Univariate analyses indicated correlations between kyphotic angle reduction with BMD, fracture age, preoperative kyphotic angle, and cement volume. The final multiple linear regression model resulted in a formula that accounted for 23.3% of the variability in kyphotic angle reduction: preoperative kyphotic angle (b=0.260; P=.002), BMD (b=-0.249; P=.004), and fracture age (b=-0.226; P=.009). Kyphoplasty is a safe and effective treatment for osteoporotic compression fractures.

Cells encapsulation by biomaterials has been widely studied as a strategy of building tissue construct in tissue engineering. Conventional encapsulation of cells using hydrogels often needs the polymerization process or relatively complex molding process. In this study, we developed a facile strategy for the in situ fabrication of biodegradable cell‐laden starch foams. By utilizing the unique gelatinization property of starch, cell‐laden starch foams with tunable architecture were rapidly prepared in a green and biological‐friendly process. The bubble size and stiffness of starch foams could be tuned by controlling the content of premixed starch in the cell culture medium. Cells were encapsulated in situ during the foaming process, and the resultant starch foams could be used as building blocks to fabricate three‐dimensional tissue construct. The potential application of the cell‐laden starch foams in neural tissue engineering was also validated. RSC96 Schwann cells were encapsulated in the starch foams and revealed good viability. Due to the serum‐induced degradation of the starch, RSC96 Schwann cells could be released from the starch foams in a controlled manner while remaining high viability. Dorsal root ganglion (DRG) neurons co‐cultured with the cell‐laden starch foams extended significantly longer neurites compared with neurons cultured in minimum Eagle's medium (664.88 ± 190.39 μm vs. 311.19 ± 105.25 μm). DRG neurons retained high viability even after encapsulation in the starch foams for 3 days. This facile strategy of rapidly fabricating cell‐laden starch foams can be further extended to construct centimeter‐scale micro‐tissue for tissue engineering applications. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 108B:104–116, 2020.

BackgroundAnterior cervical discectomy and fusion (ACDF) was one of the preferred treatments for degenerative cervical spondylosis. However, the motion of adjacent segment was significantly increased after operation. So cervical disc arthroplasty have been suggested to keep the motion of adjacent segment. A new implant named dynamic cervical implant (DCI) has been developed to keep the motion of adjacent segment.MethodsWe retrospectively reviewed 91 patients treated for single level cervical spondylotic myelopathy with anterior cervical discectomy and fusion (ACDF), dynamic cervical implant (DCI) and cervical total disc replacement (CTDR) between sep 2009 and Mar 2011 in our hospital. They were divided into three groups by surgical methods: ACDF group (group A, 34 cases), DCI group (group B, 25 cases), CTDR group (group C, 32 cases). Operation time, intraoperative blood loss, preoperative and postoperative JOA score and JOA recovery rate were compared among the three groups. Pre-and postoperative hyperextension and hyperflexion radiograms were observed to measure range of motion (ROM) of C2–7, operative and adjacent levels.ResultsThere was no statistical difference in operative time, intraoperative blood loss, and JOA recovery rate (P > 0.05) among three groups. But the differences of their postoperative JOA scores and preoperative JOA scores were of statistical significance (P < 0.05). Compared the pre-and postoperative ROM of C2–7, operative, upper and lower levels of each group respectively, the difference between preoperative ROM and postoperative ROM of group A were of statistically significant (P < 0.05), while was no statistically significant of group C (P > 0.05). There was no statistically significant difference between preoperative ROM and postoperative ROM of upper and lower levels in group B (P > 0.05), but had statistically significance of C2–7 and operative levels (P < 0.05).ConclusionsThree operations are effective therapies for single level cervical spondylotic myelopathy. But each group has respective advantages and disadvantages.

Intradiscal cement leakage was associated with the degeneration of cement-containing disc but did not reduce the clinical efficacy at early stages.

Study design: This is an observational retrospective cohort study.Objective: The purpose of this study is to investigate the incidence rate of depression and anxiety and the changes in patients treated with percutaneous kyphoplasty (PKP) following ERAS protocol.Summary of background data: The incidence of depression and anxiety is not uncommon in patients with osteoporotic vertebral compression fracture (OVCF), which affects the prognosis of surgery.Enhanced recovery after surgery (ERAS) protocols can improve the perioperative stress response of patients.Materials and Methods: Patients were treated conventionally in 2019 as the control group (CG) (n = 281), and patients were treated according to the ERAS protocol in 2020 as the intervention group (IG) (n = 251).All patients were evaluated for depression and anxiety using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) at admission, postoperative 1 week, 1 month and 3, 6, 12 months.Results: The degree of depression statistically decreased in the IG at follow-up periods (p < 0.001), and the degree of anxiety statistically decreased at 1 week (p < 0.001), 1 month (p < 0.001), 3 months (p = 0.017). Patients in the IG could soothe depression and anxiety disorders faster than patients in the CG and maintain psychological stability at the follow-up periods. The percentage of moderate or above depression in the IG was statistically fewer than in the CG at follow-up periods (p<0.01). The odds ratio (OR) was respectively 0.410, 0.357, 0.294, 0.333, 0.327 from 1 week to 12 months. While the percentage of patients with moderate or above anxiety signi cantly decreased in the IG at 1 week (p < 0.001), OR = 0.528, 1 month (p = 0.037), OR = 0.309 and 12 months (p = 0.040), OR = 0.554, no differences between 3 months (p = 0.187) and 6 months (p = 0.133).Conclusion: PKP following ERAS protocol to treat patients with OVCF had a better effect on relieving postoperative anxiety and depression than following conventional protocol.