Risk predictors of perioperative complications for the palliative surgical treatment of spinal metastasis

BackgroundThe complication rate for palliative surgery in spinal metastasis is relatively high, and major complications can impair the patient's activities of daily living. However, surgical indications are determined based primarily on the prognosis of the cancer, with the risk of complications not truly considered. We aimed to identify the risk predictors for perioperative complications in palliative surgery for spinal metastasis.MethodsA multicentered, retrospective review of 195 consecutive patients with spinal metastasis who underwent palliative surgeries with posterior procedures from 2001 to 2016 was performed. We evaluated the type and incidence of perioperative complications within 14 days after surgery. Patients were categorized into either the complication group (C) or no-complication group (NC). Univariate and multivariate analyses were used to identify potential predictors for perioperative complications.ResultsThirty patients (15%) experienced one or more complications within 14 days of surgery. The most frequent complications were surgical site infection (4%) and motor weakness (3%). A history of diabetes mellitus (C; 37%, NC; 9%: p < 0.01) and surgical time over 300 min (C; 27%, NC; 12%: p < 0.05) were significantly associated with complications according to univariate analysis. Increased blood loss and non-ambulatory status were determined to be potential risk factors. Of these factors, multivariate logistic regression revealed that a history of diabetes mellitus (OR: 6.6, p < 0.001) and blood loss over 1 L (OR: 2.7, p < 0.05) were the independent risk factors for perioperative complications. There was no difference in glycated hemoglobin A1c between the diabetes patients with and without perioperative complications.ConclusionsDiabetes mellitus should be used for the risk stratification of surgical candidates regardless of the treatment status, and strict prevention of bleeding is needed in palliative surgeries with posterior procedures to mitigate the risk of perioperative complications.     

Early post-operative opioid consumption: A comparison between medial unicompartmental,patellofemoral, and total knee arthroplasty

BackgroundWhile there is emerging literature describing the use of narcotics for post-operative pain control following TKA, little data is available regarding narcotic use in partial knee replacements. The aim of this study is to compare the early post-operative narcotic requirements after medial compartmental arthroplasty (UKA) and patellofemoral arthroplasty (PFA) with that of TKA.MethodsIn this retrospective chart review, we identified 37 patients who underwent PFA and 71 patients who underwent UKA. We identified a cohort of TKA patients who were matched to the unicompartmental group based on sex and age (n = 108). The primary outcome measure was self-reported use of opioids for pain management at the first post-operative clinic visit. Opioid use between groups was compared using Chi-square analysis.ResultsThe PFA group was younger (p < 0.001) and consisted of more females (p < 0.001) than the UKA group. The UKA cohort had more non-smoking patients (p = 0.044) compared to the PFA cohort. Self-reported opioid use at the first post-operative visit differed between the three groups of patients (p < 0.001). A greater proportion of both PFA (38% vs. 11%; p < 0.001) and TKA (41% vs. 11%; p = 0.01) patients reported opioid use when compared to UKA patients. No differences in opioid use existed between TKA and PFA groups (p = 0.61).ConclusionThe prevalence of PFA patients who report opioid use at the first post-operative visit is similar to that for patients following TKA, suggesting that pain management protocols for this specific subset of partial knee arthroplasty patients should be structured similar to TKA patients and separate from UKA patients.     

个体化数字导板结合3D打印技术在旋转铰链型人工膝关节置换术中的应用

目的探讨个体化数字导板结合3D打印技术在旋转铰链型人工膝关节置换术中的应用。方法 2011年6月至2014年7月,采用旋转铰链型人工膝关节置换术治疗胫骨近端恶性骨肿瘤16例。术前行64排螺旋CT及3.0T MRI扫描,建立膝关节三维解剖模型并模拟手术及设计复位导板,应用熔融沉积成型技术制作实体导板,术中引导骨肿瘤截骨。结果所有患者均获随访,随访时间为5~44个月,平均31个月,总优良率为88.1%。膝关节活动度为伸膝0°、屈膝90°~125°(平均106°)。术后肿瘤局部复发4例,但无假体松动、感染等并发症发生。结论旋转铰链型人工膝关节可减少骨与假体之间的应力,降低假体松动及疲劳性骨折发生率,因此旋转铰链型膝关节置换术是膝部恶性骨肿瘤较理想的保肢方法。而应用个体化数字导板可减少手术操作时间,提高假体安装精度,从而达到更佳的手术效果。     

Biofabrication of a PLGA–TCP‐based porous bioactive bone substitute with sustained release of icaritin

A phytomolecule, icaritin, has been identified and shown to be osteopromotive for the prevention of osteoporosis and osteonecrosis. This study aimed to produce a bioactive poly (l ‐lactide‐co‐glycolide)–tricalcium phosphate (PLGA–TCP)‐based porous scaffold incorporating the osteopromotive phytomolecule icaritin, using a fine spinning technology. Both the structure and the composition of icaritin‐releasing PLGA–TCP‐based scaffolds were evaluated by scanning electron microscopy (SEM). The porosity was quantified by both water absorption and micro‐computed tomography (micro‐CT). The mechanical properties were evaluated using a compression test. In vitro release of icaritin from the PLGA–TCP scaffold was quantified by high‐performance liquid chromatography (HPLC). The attachment, proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) on the composite scaffold were evaluated. Both an in vitro cytotoxicity test and an in vivo test via muscular implantation were conducted to confirm the scaffold's biocompatibility. The results showed that the PLGA–TCP–icaritin composite scaffold was porous, with interconnected macro‐ (about 480 µm) and micropores (2–15 µm). The mechanical properties of the PLGA–TCP–icaritin scaffold were comparable with those of the pure PLGA–TCP scaffold, yet was spinning direction‐dependent. Icaritin content was detected in the medium and increased with time. The PLGA–TCP–icaritin scaffold facilitated the attachment, proliferation and osteogenic differentiation of BMSCs. In vitro cytotoxicity test and in vivo intramuscular implantation showed that the composite scaffold had no toxicity with good biocompatibility. In conclusion, an osteopromotive phytomolecule, icaritin, was successfully incorporated into PLGA–TCP to form an innovative porous composite scaffold with sustained release of osteopromotive icaritin, and this scaffold had good biocompatibility and osteopromotion, suggesting its potential for orthopaedic applications. Copyright © 2012 John Wiley & Sons, Ltd.     

骨质疏松症对松质骨骨小梁应力与微损伤关系的影响

目的应用显微CT和微有限元分析评估微损伤、微骨折骨小梁的应力、应变,探讨骨质疏松症对骨小梁应力和微损伤、微骨折之间关系的影响。方法通过显微CT扫描健康和骨质疏松人体髋臼松质骨,构建松质骨块三维微有限元模型,在无摩擦的位移边界条件下模拟松质骨块的单轴压缩实验,通过非线性微有限元分析得到在不同表观应变下骨小梁的应力、应变、微损伤和微骨折。结果 0.05%~0.50%表观应变下,健康和骨质疏松松质骨未损伤骨小梁的应力在50 MPa以下,微损伤骨小梁应力在110 MPa以上。健康松质骨骨小梁的平均应力相对较高,骨质疏松松质骨骨小梁最高应力值相对较高。健康和骨质疏松松质骨骨小梁均出现微损伤,健康松质骨骨小梁微损伤较多,骨质疏松骨骨小梁出现微骨折。结论在表观小应变范围内,健康松质骨骨小梁能承受更高的应力,出现较多的微损伤,而骨质疏松松质骨高应力骨小梁群内出现微骨折。