Objective To review the research progress of the risk factors for slip progression and the pathogenesis of lumbosacral spondylolisthesis, and to discuss the value of Spinal Deformity Study Group (SDSG) classification system for lumbosacral spondylolisthesis. Methods Recent articles about the risk factors for slip progression and the pathogenesis of lumbosacral spondylolisthesis were reviewed and comprehensively analyzed with SDSG classification system of lumbosacral spondylolisthesis. Results Pelvic incidence (PI) is the key pathogenic factor of lumbosacral spondylolisthesis. The Meyerding grade of slip, PI, sacro-pelvic balance, and spino-pelvic balance not only are the fundamental risk factors of slip progression, but also are the key factors to determine how to treat and influence the prognosis. Therefore, compared with Wiltse, Marchetti-Bartolozzi, and Mac-Thiong-Labelle classification systems of lumbosacral spondylolisthesis, SDSG classification based on these factors mentioned above, has better homogeneity between the subjects of subgroup, and better reliability, moreover, could better guide operative plan and judge the prognosis. Conclusion It is suggested that the SDSG classification system should be the standard classification for lumbosacral spondylolisthesis for the clinical and research work.
Objective To investigate the difference in acetabular tilt angle (ATA) between adults with deve-lopmental dysplasia of the hip (DDH) and normal adults and the effect of ATA on acetabular version. Methods Between February 2009 and October 2015, 31 adult female patients with DDH (39 hips) (DDH group) and 31 female patients with osteoarthritis of the knee (31 hips) who had no history of hip disease (control group) were included in this study. The average age was 39 years (range, 18-59 years) in the DDH group, and was 69 years (range, 52-79 years) in control group. The morphometric parameters of the acetabulum including ATA, acetabular anteversion angle (AAA), acetabular inclination angle (AIA), acetabular cranial anteversion angle (ACAA), and acetabular sector angle (ASA) were mea- sured by CT reconstruction; The ASA was used as an index for acetabular coverage of the femoral head. The correlation between ATA and other parameters was analyzed using Pearson correlation analysis. Results The values of ATA, AAA, and AIA of the DDH group were significantly larger than those of the control group (P<0.05). The ASA in all directions was significantly decreased in the DDH group when compared with the values in the control group (P<0.05). There was no significant difference in ACAA between two groups (t=1.918, P=0.523). The ATA was positively correlated with AAA and ACAA in the DDH group (r=0.439, P=0.001; r=0.436, P=0.002), but there was no correlation between ATA and AIA (r=0.123, P=0.308). In the control group, the ATA was not correlated with AAA, ACAA, and AIA (r=–0.004, P=0.724; r=–0.079, P=0.626; r=–0.058, P=0.724). Regarding acetabular coverage of the femoral head, the ATA and AAA were correlated negatively with anterior ASA (P<0.05) and positively with posterior ASA (P<0.05), but had no correlation with superior ASA (P>0.05) in the DDH group; AIA was correlated negatively with anterior ASA and superior ASA (P<0.05) and had no correlation with posterior ASA (r=–0.092, P=0.440). In the control group, there was no correlation between ATA and ASA in any direction (P>0.05). In the DDH group, defects of the acetabular anterior wall, lateral wall, and posterior wall were observed in 18 hips (46.2%), 15 hips (38.5%), and 6 hips (15.3%), respectively. ATA value of the posterior wall defect [(15.70±10.00)°] was significantly smaller than those of the acetabular anterior wall and lateral wall defects [(22.91±5.06)° and (21.59±3.81) °] (P<0.05), but no signficant difference was found between anterior wall and lateral wall defects (P>0.05). Conclusion ATA will influence acetabular version in DDH. The anterior rotation of the acetabular fragment during periacetabular osteotomies is an anatomically reasonable maneuver for hips with anterolateral acetabular defect, while the maneuver should be avoided in hips with posterior acetabular defect.
The tilted supine position has been evaluated to be one of the significantly effective approaches to prevent bedsore of the patients in the bedridden state. Thus, it has deeply positive influences that in view of dynamics this study explores how the position works. Based on the anatomical theories, this study formulates the human dynamic model. Furthermore, the dynamic simulation of three usual postures in tilted supine position including lying on back, lying with one knee bent and lying with the upper and lower limb on one side lifted is carried out. Therefore, the changes of the three driving forces named as chest force, waist force and thigh force in the tilted supine position can be observed. In order to verify the validity of this simulation, this study obtains the electromyogram measurements of ectopectoralis, external obliques and thigh muscles which are respectively close to the chest, waist and thigh by conducting the human force measurements experiment. The result revealed that in terms of range and trend, the experimental data and simulation’s data were consistent. In conclusion, the changes of these muscles in the supine position movements are researched efficiently by both this experiment and the dynamic simulation. Besides, the result is crucially key to find the mechanism of human’s tilted supine position movements.
Objective To compare the effectiveness of supramalleolar osteotomy (SMOT) and ankle arthrodesis (AA) in the treatment of inverted ankle osteoarthritis (OA) in Takakura 3A stage with talus tilt. Methods The clinical data of 41 patients with inverted ankle OA in Takakura 3A stage with talus tilt admitted between January 2016 to January 2020 and met the selection criteria were retrospectively analyzed, and they were divided into SMOT group (21 cases) and AA group (20 cases) according to the surgical method. There was no significant difference in baseline data such as gender, age, affected side, cause of injury, and preoperative talar tilt angle (TT), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS) score, short-form 36 health survey scale (SF-36) score, and sagittal range of motion (ROM) between the two groups (P>0.05). The operation time, intraoperative blood loss, partial weight-bearing time, and complications were recorded in the two groups. AOFAS ankle-hindfoot score, VAS score, SF-36 score, and sagittal ROM were used to evaluate the effectiveness. Bone healing was observed and the time of bony healing was recorded. In the SMOT group, the tibial lateral surface angle (TLS), TT, and the tibial articular surface angle (TAS) were measured on ankle joint weight-bearing anteroposterior and lateral X-ray films and compared with those before operation. And Takakura staging assessment was also performed. ResultsThe operation time and intraoperative blood loss in AA group were significantly less than those in SMOT group (P<0.05). Patients in both groups were followed up 24-36 months, with an average of 28.9 months. Incision infection occurred in 2 patients in SMOT group and 1 patient in AA group, respectively, and no vascular or nerve injury occurred in both groups. The partial weight-bearing time of SMOT group was significantly less than that of AA group (P<0.05), but there was no significant difference in bony healing time between the two groups (P>0.05). At last follow-up, the difference of VAS score and SF-36 score before and after operation of AA group were less than those of SMOT group, and the difference of sagittal ROM before and after operation in SMOT group was less than that of AA group, with significant differences (P<0.05). The difference of AOFAS ankle-hindfoot score before and after operation in AA group was slightly greater than that in SMOT group, but the difference was not significant (P>0.05). The above scores in both groups significantly improved when compared with those before operation (P<0.05). Sagittal ROM in AA group was significantly less than that before operation (P<0.05), while there was no significant difference in SMOT group (P>0.05). In the SMOT group, 17 patients (81.0%) showed improvement in imaging staging, 2 patients (9.5%) showed no improvement in staging, and 2 patients (9.5%) showed stage aggravation. TLS, TAS, and TT significantly improved when compared with those before operation (P<0.05). At last follow-up, 2 patients in SMOT group received AA due to pain and stage aggravation, and 1 patient with bone nonunion underwent bone graft. Subtalar joint fusion was performed in 1 case of subtalar arthritis in AA group.Conclusion For inverted ankle OA in Takakura 3A stage with talus tilt, both SMOT and AA can significantly releave pain, improve foot function and quality of life, but AA has more definite effectiveness and better patient satisfaction.
Objective To explore the influencing factors of intraocular lens (IOL) position after cataract surgery and analyze the effect of ocular biological parameters on IOL centering under different axial length (AL). Methods Patients who underwent cataract phacoemulsification and IOL implantation at West China Hospital of Sichuan University between February and July 2024 were prospectively selected. According to the different AL values, the patients were divided into non-high myopia group (22.0 mm≤AL＜26.0 mm) and high myopia group (AL≥26.0 mm) to explore the influencing factors of IOL position after cataract surgery. Results This study included a total of 240 patients (240 eyes), with 120 cases (120 eyes) in both the non-high myopia group and the high myopia group. The preoperative lens tilt and decentration of the non-high myopia group and high myopia group were (4.41±1.07)°, (0.13±0.09) mm and (3.57±1.81)°, (0.20±0.10) mm, respectively. The results of multiple linear regression analysis showed that in the non-high myopia group, preoperative lens tilt (P<0.001) was the influencing factor of postoperative IOL tilt, while lens thickness (P=0.027) and preoperative lens decentration (P<0.001) were the influencing factors of postoperative IOL decentration. In the high myopia group, lens thickness (P=0.023) and preoperative lens tilt (P<0.001) were the influencing factors of postoperative IOL tilt, while anterior chamber depth (P=0.030), lens thickness (P=0.013), and preoperative lens decentration (P<0.001) were the influencing factors of postoperative IOL decentration. Conclusion Ophthalmologists can accurately predict the postoperative IOL position based on the patient’s degree of myopia (with a focus on identifying high myopia) and specific ocular biological parameters before surgery, thereby optimizing surgical plans and improving postoperative outcomes.