1.Clinical value of the prognostic nutritional index in predicting the prognosis of patients with advanced liver cancer treated with transarterial chemoembolization combined with ablation therapy
Wenjing YANG ; Lingyi ZHU ; Chaoming HUANG ; Qi HUANG ; Zijian ZHU ; Yeyu ZHANG ; Shiji FANG ; Liyun ZHENG ; Zhongwei ZHAO ; Jiansong JI
Journal of Interventional Radiology 2025;34(5):512-517
Objective To assess the clinical value of prognostic nutritional index(PNI)in predicting the prognosis of patients with advanced liver cancer treated with transarterial chemoembolization(TACE)combined with ablation therapy.Methods A total of 112 patients with advanced liver cancer,who received TACE combined with ablation at the Lishui Municipal Central Hospital of China from January 2020 to January 2024,were enrolled in this study.The general data,survival status,and survival time were collected.The Youden index of PNI was calculated using the receiver operating characteristic(ROC)curve model,and the optimal cutoff value was determined.Based on the optimal cutoff value,the patients were divided into low-PNI group and high-PNI group.The progression-free survival(PFS)and overall survival(OS)time were compared between the two groups,and the independent risk factors affecting PFS and OS were analyzed.Results The Youden index for PNI was 0.43,and the optimal cutoff value of PNI was 43.95.The low-PNI group included 65 patients,and the high-PNI group included 47 patients.There were no statistically significant differences in the baseline data between the two groups.The median PFS and the median OS in the high-PNI group were 13.21 months(95%CI=4.37-22.03)and 40.80 months(95%CI=31.55-50.05)respectively,which were longer than 9.20 months(95%CI=6.58-11.82)and 21.37 months(95%CI=16.56-26.17)respectively in the low-PNI group,the differences were statistically significant(both P<0.05).The 6-month,one-year and 2-year PFS in the high-PNI group was 56.95%,47.25%and 33.87%respectively,which were higher than 43.95%,32.56%and 16.31%respectively in the low-PNI group.The one-year,2-year and 3-year cumulative survival rates in the high-PNI group were 80.77%,66.66%and 39.40%respectively,which were higher than 63.79%,34.31%and 27.75%respectively in the low-PNI group.Multivariate regression analysis indicated that the number of nodules,metastasis and PNI significantly affected OS,and metastasis and PNI strikingly affected PFS.High PNI was a protective factor for both PFS and OS.Conclusion For patients with advanced liver cancer treated with TACE combined with ablation therapy,PNI is an effective indicator for predicting the prognosis.
2.Effect and prognosis of thoracolumbar fracture combined with incomplete spinal cord injury on male sexual function
Gao SI ; Yuexin WANG ; Daole HU ; Guojin HOU ; Zhongwei YANG ; Yan GUO ; Zhishan ZHANG ; Hongquan JI ; Fang ZHOU ; Yun TIAN ; Yang LYU
Chinese Journal of Orthopaedics 2025;45(9):552-560
Objective:To investigate the effects of thoracolumbar vertebral fracture with incomplete spinal cord injury on male sexual function and postoperative prognosis.Methods:A retrospective review was conducted on data from 144 male patients with thoracolumbar vertebral fractures and incomplete spinal cord injuries treated between May 2009 and May 2021 in the Department of Traumatology and Orthopedics at Peking University Third Hospital. Patients ranged in age from 19 to 55 years (mean: 38.6±10.6 years) and underwent posterior incision and reduction internal fixation. The International Index of Erectile Function-5 (IIEF-5), the Premature Ejaculation Diagnostic Tool (PEDT), and the International Spinal Cord Injury Male Sexual Function Basic Data Set were used for sexual function evaluation. Based on the American Spinal Injury Association (ASIA) Spinal Cord Injury classification, changes in neurological and sexual function were assessed at the pre-injury stage, 3 months post-injury, 2 years postoperatively, and at the final follow-up. Factors influencing sexual dysfunction and recovery were analyzed. Spearman correlation analysis was used to identify factors affecting sexual function injury and recovery.Results:A total of 117 patients were included in the final analysis. Follow-up duration ranged from 26.2 to 161.7 months (mean: 74.6±40.5 months). After injury, ASIA grades were distributed as follows: 43 patients with grade B, 41 with grade C, and 33 with grade D. At the 2-year follow-up, 30 patients were grade E, 63 grade D, 19 grade C, and 5 grade B. Improvement in ASIA classification was observed in 90.6% (106/117) of patients: 79 improved by one grade, 27 by two grades, 8 remained unchanged, 1 worsened by one grade, and 2 worsened by two grades. Mean IIEF-5 scores were 19.5±6.4 pre-injury, 8.7±8.0 at 3 months post-injury, and 17.5±7.1 at 2 years postoperatively, with statistically significant differences ( F=123.247, P<0.001). Differences between 3 months post-injury vs. pre-injury and 2 years postoperatively vs. 3 months post-injury were statistically significant ( P<0.05). Mean PEDT scores were 5.3±3.1 pre-injury, 6.9±5.2 at 3 months post-injury, and 6.4±5.1 at 2 years postoperatively, with statistically significant differences ( F=17.014, P<0.001). The difference between 3 months post-injury and pre-injury was statistically significant ( P<0.05), but not between 2 years postoperatively and 3 months post-injury ( P>0.05). At the 2-year follow-up, 96 patients had their IIEF-5 classification restored to pre-injury levels, 85 restored PEDT classifications, and 83 restored both. Post-injury ASIA classification was positively correlated with a decrease in IIEF-5 score and an increase in PEDT score at 3 months post-injury ( P<0.05). Injury segment was positively correlated with the decrease in IIEF-5 score ( P<0.05). Time from injury to surgery showed a positive correlation with increased PEDT score at 3 months ( P<0.05). Post-injury ASIA grade, injury segment, time to surgery, age, intraoperative decompression, and spinal cord function recovery all showed significant correlations with changes in IIEF-5 and (or) PEDT scores at 2 years postoperatively ( P<0.05). According to the International Spinal Cord Injury Male Sexual Function Basic Data Set, the proportion of patients willing to discuss sexual issues increased from 29.9% at 3 months post-injury to 47.9% at 2 years postoperatively ( P<0.05). The proportion of patients with absent or diminished psychogenic erections remained stable (48.7% vs. 48.9%, P>0.05), while those with normal reflexive erections increased from 34.2% to 65.0% ( P<0.05). Conclusion:Thoracolumbar fractures with incomplete spinal cord injury result in reduced erectile function and increased incidence of premature ejaculation. The degree of spinal cord injury and the level of the injured segment are strongly correlated with the extent of sexual dysfunction. At the 2-year postoperative follow-up, 70.9% of patients had recovered sexual function to pre-injury levels.
3.Correlation between neutrophil-lymphocyte ratio and diabetic kidney disease
Yufei YUAN ; Zhongwei FANG ; Yang WANG
Chinese Journal of Diabetes 2025;33(4):264-268
Objective To investigate the association between neutrophil-lymphocyte ratio(NLR)and diabetic kidney disease(DKD)in patients with type 2 diabetes mellitus(T2DM).Methods 548 T2DM patients hospitalized in The Second People's Hospital of Liaocheng from January 2022 to March 2023 were divided into control(Con,UACR≤30 mg/g,n=393)group,microalbuminuria(Mic,UACR 30~300 mg/g,n=103)group and macroalbuminuria(Mac,UACR>300 mg/g,n=52)group according to the levels of UACR.Results In the Con,Mic and Mac groups,blood urea nitrogen(BUN),serum creatinine(Scr),serum uric acid(SUA),cystatin C(CysC)and total cholesterol(TC)increased successively(P<0.05),and estimated glomerular filtration rate(eGFR)decreased successively(P<0.05).The systolic blood pressure(SBP),NLR,neutrophil count and lymphocyte count(Lym)in the Mic and Mac groups were higher than those in the Con group(P<0.05).The age,DM duration and hypertension duration in the Mic group were higher than those in the Con group(P<0.05),and the hemoglobin(Hb)in the Mac group was lower than that in the Con group(P<0.05).Logistic regression analysis showed that Hb,Lym,age,SBP,NLR,BUN,Scr,eGFR,SUA,CysC,DM duration,hypertension,hypertension duration,and the use of antihypertensive drugs were all influencing factors for the occurrence of DKD.After adjusting for multiple confounding factors,it was shown that NLR(OR 1.223,95%CI 1.082~1.382),SBP(OR 1.018,95%CI 1.005~1.031),and eGFR(OR 0.973,95%CI 0.954~0.991)remained the influencing factors of DKD.In male DKD patients across different age groups,with BMI<29.9 kg/m2,non-smoking,non-drinking and without comorbid diabetic retinopathy and hypertension,the NLR was significantly higher compared to the Con group(P<0.05).However,no interaction effects were observed between these variables and NLR in relation to DKD(P>0.05).Conclusions NLR is closely related to the occurrence and development of DKD.
4.Effect and prognosis of thoracolumbar fracture combined with incomplete spinal cord injury on male sexual function
Gao SI ; Yuexin WANG ; Daole HU ; Guojin HOU ; Zhongwei YANG ; Yan GUO ; Zhishan ZHANG ; Hongquan JI ; Fang ZHOU ; Yun TIAN ; Yang LYU
Chinese Journal of Orthopaedics 2025;45(9):552-560
Objective:To investigate the effects of thoracolumbar vertebral fracture with incomplete spinal cord injury on male sexual function and postoperative prognosis.Methods:A retrospective review was conducted on data from 144 male patients with thoracolumbar vertebral fractures and incomplete spinal cord injuries treated between May 2009 and May 2021 in the Department of Traumatology and Orthopedics at Peking University Third Hospital. Patients ranged in age from 19 to 55 years (mean: 38.6±10.6 years) and underwent posterior incision and reduction internal fixation. The International Index of Erectile Function-5 (IIEF-5), the Premature Ejaculation Diagnostic Tool (PEDT), and the International Spinal Cord Injury Male Sexual Function Basic Data Set were used for sexual function evaluation. Based on the American Spinal Injury Association (ASIA) Spinal Cord Injury classification, changes in neurological and sexual function were assessed at the pre-injury stage, 3 months post-injury, 2 years postoperatively, and at the final follow-up. Factors influencing sexual dysfunction and recovery were analyzed. Spearman correlation analysis was used to identify factors affecting sexual function injury and recovery.Results:A total of 117 patients were included in the final analysis. Follow-up duration ranged from 26.2 to 161.7 months (mean: 74.6±40.5 months). After injury, ASIA grades were distributed as follows: 43 patients with grade B, 41 with grade C, and 33 with grade D. At the 2-year follow-up, 30 patients were grade E, 63 grade D, 19 grade C, and 5 grade B. Improvement in ASIA classification was observed in 90.6% (106/117) of patients: 79 improved by one grade, 27 by two grades, 8 remained unchanged, 1 worsened by one grade, and 2 worsened by two grades. Mean IIEF-5 scores were 19.5±6.4 pre-injury, 8.7±8.0 at 3 months post-injury, and 17.5±7.1 at 2 years postoperatively, with statistically significant differences ( F=123.247, P<0.001). Differences between 3 months post-injury vs. pre-injury and 2 years postoperatively vs. 3 months post-injury were statistically significant ( P<0.05). Mean PEDT scores were 5.3±3.1 pre-injury, 6.9±5.2 at 3 months post-injury, and 6.4±5.1 at 2 years postoperatively, with statistically significant differences ( F=17.014, P<0.001). The difference between 3 months post-injury and pre-injury was statistically significant ( P<0.05), but not between 2 years postoperatively and 3 months post-injury ( P>0.05). At the 2-year follow-up, 96 patients had their IIEF-5 classification restored to pre-injury levels, 85 restored PEDT classifications, and 83 restored both. Post-injury ASIA classification was positively correlated with a decrease in IIEF-5 score and an increase in PEDT score at 3 months post-injury ( P<0.05). Injury segment was positively correlated with the decrease in IIEF-5 score ( P<0.05). Time from injury to surgery showed a positive correlation with increased PEDT score at 3 months ( P<0.05). Post-injury ASIA grade, injury segment, time to surgery, age, intraoperative decompression, and spinal cord function recovery all showed significant correlations with changes in IIEF-5 and (or) PEDT scores at 2 years postoperatively ( P<0.05). According to the International Spinal Cord Injury Male Sexual Function Basic Data Set, the proportion of patients willing to discuss sexual issues increased from 29.9% at 3 months post-injury to 47.9% at 2 years postoperatively ( P<0.05). The proportion of patients with absent or diminished psychogenic erections remained stable (48.7% vs. 48.9%, P>0.05), while those with normal reflexive erections increased from 34.2% to 65.0% ( P<0.05). Conclusion:Thoracolumbar fractures with incomplete spinal cord injury result in reduced erectile function and increased incidence of premature ejaculation. The degree of spinal cord injury and the level of the injured segment are strongly correlated with the extent of sexual dysfunction. At the 2-year postoperative follow-up, 70.9% of patients had recovered sexual function to pre-injury levels.
5.Efficacy of a New Intramedullary Fixation System Proximal Femoral Universal Nail in the Treatment of Intertrochanteric Femoral Fractures in Elderly Patients
Yuan CAO ; Jixing FAN ; Zengzhen CUI ; Zhongwei YANG ; Yang LV ; Yun TIAN ; Fang ZHOU
Chinese Journal of Minimally Invasive Surgery 2025;25(6):329-334
Objective To evaluate the efficacy of proximal femoral universal nail(PFUN),a new type of intramedullary fixation system,in the treatment of acute unilateral intertrochanteric femoral fracture in elderly patients.Methods From January 2022 to January 2024,200 patients with acute unilateral femoral intertrochanteric fracture were treated in our department.After closed traction reduction,PFUN was implanted with small incisions.Unified rehabilitation plan was adopted after surgery.The functional evaluation was performed by using the Harris hip score system at the last follow-up.Results The operation time was 25-182 min(median,63.0 min).The intraoperative blood loss was 10-750 ml(median,50.0 ml).Intraoperative blood transfusion(suspension of red blood cells)was required in 40 cases(20%).The postoperative hospital stay was 1-15 d(mean,4.0±1.9 d).The postoperative femoral neck-shaft angle was 116.7°-140.1°(mean,132.4°±5.5°).The quality of fracture reduction on the first day after surgery showed 140 cases as excellent,54 cases acceptable,and 6 cases poor.Complications occurred in 13 cases,including superficial wound infection in 2 cases,who were cured by regular wound dressing change and antibiotic treatment,lower extremity deep vein thrombosis in 8 cases,who were given low molecular weight heparin anticoagulation treatment until improvement,pneumonia in 2 cases and urinary tract infection in 1 case,who were cured or improved after specialist treatment.At one month after surgery,the hip joint X-ray showed blurred fracture lines,callus formation at the fracture site,and no internal fixation failure.There was no internal fixation failure within 3 months after surgery.At six months after surgery,all fractures achieved healing without any failure of internal fixation.All the 200 cases were followed up for 12-29 months(mean,16.1±2.7 months).One case experienced internal fixation failure,and underwent head and neck screw resection,internal fixation removal and hip replacement.At the last follow-up,the postoperative recovery was satisfactory.The Harris score of hip joint was 70-94 points(mean,88.8±2.8 points),including 103 cases as excellent,92 cases good,and 5 cases fair,with an excellent and good rate of 97.5%(195/200).Conclusion PFUN is effective in the treatment of intertrochanteric femoral fractures in elderly patients,with reliable fixation,rapid postoperative recovery,and low failure rate of internal fixation,especially suitable for unstable cases with internal or external wall fractures.
6.Efficacy of a New Intramedullary Fixation System Proximal Femoral Universal Nail in the Treatment of Intertrochanteric Femoral Fractures in Elderly Patients
Yuan CAO ; Jixing FAN ; Zengzhen CUI ; Zhongwei YANG ; Yang LV ; Yun TIAN ; Fang ZHOU
Chinese Journal of Minimally Invasive Surgery 2025;25(6):329-334
Objective To evaluate the efficacy of proximal femoral universal nail(PFUN),a new type of intramedullary fixation system,in the treatment of acute unilateral intertrochanteric femoral fracture in elderly patients.Methods From January 2022 to January 2024,200 patients with acute unilateral femoral intertrochanteric fracture were treated in our department.After closed traction reduction,PFUN was implanted with small incisions.Unified rehabilitation plan was adopted after surgery.The functional evaluation was performed by using the Harris hip score system at the last follow-up.Results The operation time was 25-182 min(median,63.0 min).The intraoperative blood loss was 10-750 ml(median,50.0 ml).Intraoperative blood transfusion(suspension of red blood cells)was required in 40 cases(20%).The postoperative hospital stay was 1-15 d(mean,4.0±1.9 d).The postoperative femoral neck-shaft angle was 116.7°-140.1°(mean,132.4°±5.5°).The quality of fracture reduction on the first day after surgery showed 140 cases as excellent,54 cases acceptable,and 6 cases poor.Complications occurred in 13 cases,including superficial wound infection in 2 cases,who were cured by regular wound dressing change and antibiotic treatment,lower extremity deep vein thrombosis in 8 cases,who were given low molecular weight heparin anticoagulation treatment until improvement,pneumonia in 2 cases and urinary tract infection in 1 case,who were cured or improved after specialist treatment.At one month after surgery,the hip joint X-ray showed blurred fracture lines,callus formation at the fracture site,and no internal fixation failure.There was no internal fixation failure within 3 months after surgery.At six months after surgery,all fractures achieved healing without any failure of internal fixation.All the 200 cases were followed up for 12-29 months(mean,16.1±2.7 months).One case experienced internal fixation failure,and underwent head and neck screw resection,internal fixation removal and hip replacement.At the last follow-up,the postoperative recovery was satisfactory.The Harris score of hip joint was 70-94 points(mean,88.8±2.8 points),including 103 cases as excellent,92 cases good,and 5 cases fair,with an excellent and good rate of 97.5%(195/200).Conclusion PFUN is effective in the treatment of intertrochanteric femoral fractures in elderly patients,with reliable fixation,rapid postoperative recovery,and low failure rate of internal fixation,especially suitable for unstable cases with internal or external wall fractures.
7.Correlation between neutrophil-lymphocyte ratio and diabetic kidney disease
Yufei YUAN ; Zhongwei FANG ; Yang WANG
Chinese Journal of Diabetes 2025;33(4):264-268
Objective To investigate the association between neutrophil-lymphocyte ratio(NLR)and diabetic kidney disease(DKD)in patients with type 2 diabetes mellitus(T2DM).Methods 548 T2DM patients hospitalized in The Second People's Hospital of Liaocheng from January 2022 to March 2023 were divided into control(Con,UACR≤30 mg/g,n=393)group,microalbuminuria(Mic,UACR 30~300 mg/g,n=103)group and macroalbuminuria(Mac,UACR>300 mg/g,n=52)group according to the levels of UACR.Results In the Con,Mic and Mac groups,blood urea nitrogen(BUN),serum creatinine(Scr),serum uric acid(SUA),cystatin C(CysC)and total cholesterol(TC)increased successively(P<0.05),and estimated glomerular filtration rate(eGFR)decreased successively(P<0.05).The systolic blood pressure(SBP),NLR,neutrophil count and lymphocyte count(Lym)in the Mic and Mac groups were higher than those in the Con group(P<0.05).The age,DM duration and hypertension duration in the Mic group were higher than those in the Con group(P<0.05),and the hemoglobin(Hb)in the Mac group was lower than that in the Con group(P<0.05).Logistic regression analysis showed that Hb,Lym,age,SBP,NLR,BUN,Scr,eGFR,SUA,CysC,DM duration,hypertension,hypertension duration,and the use of antihypertensive drugs were all influencing factors for the occurrence of DKD.After adjusting for multiple confounding factors,it was shown that NLR(OR 1.223,95%CI 1.082~1.382),SBP(OR 1.018,95%CI 1.005~1.031),and eGFR(OR 0.973,95%CI 0.954~0.991)remained the influencing factors of DKD.In male DKD patients across different age groups,with BMI<29.9 kg/m2,non-smoking,non-drinking and without comorbid diabetic retinopathy and hypertension,the NLR was significantly higher compared to the Con group(P<0.05).However,no interaction effects were observed between these variables and NLR in relation to DKD(P>0.05).Conclusions NLR is closely related to the occurrence and development of DKD.
8.Application of 3D printed model combined with visual surgical simulation in clinical teaching of extremity bone defects
Bingchuan LIU ; Xingcai LI ; Zhongwei YANG ; Guojin HOU ; Fang ZHOU ; Yun TIAN
Chinese Journal of Medical Education Research 2024;23(9):1286-1291
Objective:To investigate the application effect of the comprehensive innovative teaching model with "3D printed model combined with visual surgical simulation" as the core in the clinical teaching of extremity bone defects.Methods:The physicians who participated in the clinical management of patients with extremity bone defects in Department of Orthopedics, Peking University Third Hospital, from March 2019 to December 2021 were selected as subjects and were divided into standardized training group with 52 physicians and refresher physician group with 58 physicians. Teaching and training was performed for the special disease of extremity bone defects, including basic knowledge teaching, dressing change for infected wounds, multidisciplinary discussion, digital surgical simulation, and practical surgical operation. The assessment indices for teaching quality included the assessment of theoretical knowledge and clinical skills, the objective evaluation of the clinical ability of patient management, and an investigation of the degree of satisfaction. SPSS 22.0 was used for the t-test and the chi-square test. Results:After training, both groups had significant increases in the assessment scores of theoretical knowledge [(32.4±6.7)and (42.2±3.8)] and clinical practice skills [(19.6±2.0), (20.8±2.2), (20.5±2.5), (21.5±2.3)]( P<0.05). After training, the standardized training group had significant increases in the scores of six objective evaluation indicators [(8.3±0.8) vs. (6.9±1.1), (7.4±0.7) vs. (6.3±1.5), (7.2±1.3) vs. (5.0±1.4), (7.9±1.2) vs. (4.0±1.5), (8.4±0.8) vs. (6.4±1.6), (40.3±2.6) vs. (28.6±2.4)]( P<0.01), while the refresher physician group had significant improvements in four aspects, i.e., the understanding of extremity bone defects [(8.1±0.9) vs. (7.2±1.1)], the self-confidence in facing complex extremity bone defects [(8.1±1.2) vs. (6.6±0.9)], spatial thinking ability in repair surgery for bone defects [(8.6±0.8) vs. (7.3±0.9)], and overall clinical performance in actual management of patients with bone defects [(41.4±2.3) vs. (37.3±1.8)] ( P<0.01). The satisfaction score for this comprehensive innovative teaching model was (95.3±3.2) points in the standardized training group and (94.8±2.8) points in the refresher physician group. Conclusions:The comprehensive innovative teaching model with "3D printed model combined with visual surgical simulation" as the core can significantly improve the basic knowledge and clinical skills of physicians in a short period of time and meet the needs for learning surgical techniques and advanced diagnosis and treatment concepts among refresher physicians.
9.Characteristics and treatment of snow sports injuries in Zhangjiakou Zone of the Olympic Winter Games Beijing 2022
Zhongwei YANG ; Ao SUN ; Shan GAO ; Fang ZHOU
Chinese Journal of Orthopaedic Trauma 2023;25(12):1017-1024
Objective:To characterize the injuries suffered by athletes in snow events other than alpine skiing in the Zhangjiakou Zone of the Olympic Winter Games Beijing 2022, in order to provide insights for prevention of sports injuries and preparation of large-scale winter sports events.Methods:The medical records were retrospectively collected of all athletes who had been treated at Beijing University Third Hospital Chongli within the closed loop of the Zhangjiakou Zone during the Winter Olympics and Paralympics (from November 21, 2021 to April 5, 2022). The incidence, severity and part of the injuries were analyzed, as well as the medical treatment process.Results:In the Zhangjiakou Zone, a total of 1,188 athletes participated in the Winter Olympic Games, with an injury incidence of 2.9% (34/1,188), while 420 ones participated in the Winter Paralympic Games, with an injury incidence of 1.7% (7/420). The average daily medical visits were the highest during the Winter Olympics phase (1.16 visits per day), and their emergency severity index (ESI) ranged from level 3 to level 4. The department of orthopedics was visited the most (92.7%, 38/41). Lower limb injuries accounted for the highest proportion (53.7%, 22/41), with the knee ones accounting for 36.6% (15/41) of all injuries. Most of the athletes with ESI level 3 received splint fixation (62.5%, 5/8), while those with ESI level 4 mostly received observation and follow-up (57.6%, 19/33). A total of 57 radiological examinations were performed in the 41 athletes. X-ray was used the most frequently on a single day (5.00 times) while magnetic resonance imaging was per day on average (0.16 times). The transfer time for the athletes injured was (27.4±8.8) min which was not influenced by the 4 weather conditions (cloudy, sunny, light snow, and cloudy) ( P=0.374). Conclusions:The incidence of injuries during the Beijing Winter Olympics in the Zhangjiakou Zone was lower than that in other areas of the Beijing Winter Olympics and in previous Winter Olympics. There were no serious life-threatening cases. The imaging examination resources and transfer speed in the Zhangjiakou Zone were able to meet the medical needs of athletes at all stages of the Beijing Winter Olympics and Paralympics. Athletes should pay attention to protection of their lower limbs during skiing competitions.
10.Clinical effects of 3D printed porous titanium-alloy prosthesis in reconstruction of long bone defects of lower extremities
Bingchuan LIU ; Xingcai LI ; Weipeng QIU ; Yong XING ; Zhongwei YANG ; Guojin HOU ; Zhongjun LIU ; Fang ZHOU ; Yufeng ZHENG ; Peng WEN ; Yun TIAN
Chinese Journal of Orthopaedics 2022;42(10):626-634
Objective:To analyze and summarize the clinical effects of 3D printed porous titanium-alloy prosthesis implantation in the treatment of long bone defects of lower extremities.Methods:We retrospectively studied the clinical cases with lower extremity bone defect treated by 3D printed porous titanium prostheses from December 2017 to November 2021. 18 patients who were followed up for more than 12 months were included in this study. The enrolled patients included 12 males and 6 females, with an average of 48.9±22.5 years (range, 13-79 years), and an average body mass index of 23.1±4.3 kg/m 2 (range, 17.2-27.1 kg/m 2). There were 14 osteomyelitis-derived bone defects and 4 nonunion-derived bone defects. The bone defect locations included 10 cases of femur and 8 cases of tibia. The average bone defect distance was 13.9±9.7 cm (range, 5.8-31.2 cm), and the proportion of the defect length to the long bone (femur of tibia) was average 33.7%±16.8% (range, 15.0%-63.0%). The clinical efficacy was comprehensively evaluated through gross observation, imaging evaluation, changes in the total length of lower extremities and long bones, femorotibial angle (FTA) measurement, lower extremity functional scale (LEFS), satisfaction, complications and other indicators, focusing on the stabilization mechanism of the prosthesis and the regeneration of new bone. Results:All 18 patients were followed up for 12-35 months, with an average of 16.3 months. Postoperative X-rays at 1, 3, 12 and 24 months showed that new bone could gradually creep along the prosthesis surface. The preoperative bone defect length of long bone and total length of lower limb were respectively 39.4±4.0 cm and 80.5±5.7 cm, which were different from those of the healthy side by 1.6±1.0 cm and 1.5±1.1 cm. One week after implantation, the length of long bone and lower limb was 39.9±3.5 cm and 80.9±6.2 cm, respectively, and the average difference was 1.0±0.6 cm and 0.9±1.1 cm compared with the healthy side. At the last follow-up, the length of long bone and lower limb was 39.7±3.6 cm and 80.9±7.8 cm, with an average difference of 1.8±1.1 cm and 1.0±0.7 cm from the healthy side. There were no significant differences in the length of long bone and lower limbs at the three time points before surgery, one week after surgery and the last follow-up ( F=0.12, 0.04; P>0.05). The average FTA of the affected limb was 174.7° (173.9°, 175.5°), 175.2°(173.5°, 176.4°), and 175.0°(173.5°, 176.3°) at three time nodes, before surgery, one week after surgery and the last follow-up, respectively, and there was no significant statistical difference in pairwise comparison ( Z=0.01, P>0.05). Patients had a mean LEFS score of 50 (46, 51) at the last follow-up, significantly higher than the preoperative score of 20 (17, 21) ( Z=-5.56, P<0.001). The mean satisfaction score of the 18 patients at the last follow-up was 9.7. Two patients (11.1%) had screw fractures but all 3D printed porous titanium alloy prostheses remained stable without significant loosening or displacement. Two patients (11.1%) had nail channel infection of external fixator, all patients with channel infection were cured by intravenous antibiotics combined with local disinfection and dressing change. Conclusion:The implantation of 3D printed porous titanium-alloy prosthesis could efficiently and safely repair the long bone defects of the lower extremities. The prosthesis could maintain stable in the early and middle postoperative period. The length of the long bones and lower limbs did not change significantly with the weight-bearing and functional exercise of the limbs. The new bone could gradually crawl and grow from both ends of the defect, and the patient's limb function recovered significantly, and the patient's satisfaction was high.

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