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23 July 2014, Volume 18 Issue 31 Previous Issue    Next Issue

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Intraoperative frozen section analysis and 99Tcm triplephase bone scanning for diagnosing periprosthetic infection in hip Zhang Jiong, Wang Yi, Feng Jian-min, Song Yan-yan, Liu Zhi-hong, He Chuan 2014, 18 (31):  4921-4928.  doi: 10.3969/j.issn.2095-4344.2014.31.001 Abstract ( 534 )   PDF (922KB) ( 520 )   Save BACKGROUND: Conventional serological, imaging and laboratory diagnosis methods for diagnosing periprosthetic infection are difficult to achieve ideal sensitivity, specificity and accuracy. In particular, the differential diagnosis of septic loosening and aseptic loosening in late stage after prosthetic replacement lacks of commonly accepted diagnostic criteria. The combination of preoperative, intraoperative and postoperative diagnostic methods is of great significance in the identifying infection diagnosis and formulating renovation strategy. OBJECTIVE: To diagnose periprosthetic hip joint infection by combined use of preoperative 99Tcm triplephase bone scanning and intraoperative neutrophil count in frozen section analysis, and to compare with conventional diagnostic tools. METHODS: Between April 2008 and May 2013, 44 hip revision cases were enrolled. Combined with clinical symptoms and serological examination, 18 cases whose erythrocyte sedimentation rate and C-reactive protein increased were considered as clinically suspected infection group; 26 cases with normal serological examination were considered as clinically suspected aseptic loosening group. 99Tcm triplephase bone scanning was performed in all patients, and combined with intraoperative frozen section analysis. If both results were negative, the diagnosis was aseptic loosening and did one-stage revision surgery; otherwise, periprosthetic infection was detected and two-stage revision surgery was conducted. By postoperative follow-up serological indexes and surgery outcomes, statistics of work curve of subjects was used to evaluate the diagnostic values of 99Tcm triplephase bone scanning and frozen section analysis. RESULTS AND CONCLUSION: In 18 cases of clinically suspected infection group, 16 cases of preoperative 99Tcm triplephase bone scanning and intraoperative frozen section results were positive, so two-stage revision surgeries were performed; 2 cases with negative results received one-stage revision surgery after excluding infection. In 26 cases of clinically suspected aseptic loosening group, 25 cases of preoperative 99Tcm three-phase bone scanning and intraoperative frozen section results were negative, and diagnosed as aseptic loosening, so one-stage revision surgery was performed. One patient affected infection of staphylococcus aureus in one-sample of the three samples in postoperative microbiological pathogen detection, and diagnosed as periprosthetic infection, so one-stage revision surgery was carried out. After combined use of 99Tcm triplephase bone scanning and intraoperative frozen section analysis, performance curve area increased from 0.906 to 0.972, sensitivity of diagnosis of infection increased from 89% to 94%, specificity of diagnosis of infection increased from 92% to 100%. However, no significant difference was detected in diagnostic methods. These data indicated that adding the method of 99Tcm triplephase bone scanning and intraoperative frozen section analysis technique, on the basis of serological and other conventional diagnostic tools, can differentiate infections from aseptic loosening of hip prosthesis. Negative results of 99Tcm triplephase bone scan showed high correlation between the diagnosis of aseptic loosening of the prosthesis and good diagnostic value to exclude infection. Combining with intraoperative frozen section method has a very good clinical value for the revision surgery. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Lateral versus posterolateral approach in total hip arthroplasty: restoration of joint function in 2-year follow-up Zheng Kai-da, He Peng, Rong Xi-cang, Huang Wen-han, Yao Zi-long 2014, 18 (31):  4929-4933.  doi: 10.3969/j.issn.2095-4344.2014.31.002 Abstract ( 523 )   PDF (625KB) ( 538 )   Save BACKGROUND: Clinical effects and the recovery of hip function after total hip arthroplasty via different approaches are quite different. OBJECTIVE: To observe total hip arthroplasty through lateral approach and posterolateral approach, and to evaluate the difference in hip function during 2-year follow-up.  METHODS: Totally 93 patients who treated with total hip arthroplasty from March 2009 to March 2012 in the Department of Orthopedics, Yangjiang Municipal Traditional Chinese Medicine Hospital were enrolled in this study. They were randomly divided into lateral approach group (45 cases, 60 hips) and posterolateral approach group (48 cases, 60 hips).  RESULTS AND CONCLUSION: All patients were followed up for averagely 2 years. No significant difference in operation time, postoperative complications, and the recovery of hip function in the middle and late phases of replacement was visible (P > 0.05). However, perioperative blood loss, operative length, blood transfusion rate, postoperative hemoglobin levels, and early postoperative hip joint functional recovery were better in the posterolateral approach group than in the lateral approach group (P < 0.05). In the 2 years after replacement, no significant difference in therapeutic effects was detectable between the two groups (P > 0.05). Moreover, no significant difference in the incidence of adverse reactions was visible such as postoperative infection, dislocation, loosening, bone cement reaction, intraoperative fractures of proximal end of the femur and venous thromboembolism between lateral approach and posterolateral approach groups (P > 0.05). Results indicated that posterolateral approach in total hip arthroplasty is helpful to early recovery, but long-term effects are similar to lateral approach. Figures and Tables | References | Related Articles | Metrics

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Analgesic effects of continuous fascia iliaca compartment block versus continuous epidural analgesia after total hip arthroplasty Sun Xiao-juan, Zhang Hong-xing, Dong Bu-huai, Li Jing, Wu Xu-cai, Xiao Li, Zhang Han, Cai Liang, 2014, 18 (31):  4934-4938.  doi: 10.3969/j.issn.2095-4344.2014.31.003 Abstract ( 422 )   PDF (644KB) ( 563 )   Save BACKGROUND: Epidural analgesia has been considered a gold standard for postoperative analgesia in the lower limbs. Its outcomes are accurate and adverse reactions are few, so it can be used in the clinic. However, this method has adverse reactions such as hypotension and urine retention. Low molecular weight heparin should be used after operation, which can increase the possibility of epidural hematoma, and limits its application to epidural analgesia in the clinic. At present, few studies concerned ultrasound guided continuous fascia iliaca compartment block technology. OBJECTIVE: To evaluate the efficacy of postoperative pain relief and the joint rehabilitation between a continuous fascia iliaca compartment block and a continuous epidural analgesia for patients undergoing total hip arthroplasty.  METHODS: A total of 60 patients undergoing a selective total hip arthroplasty were assigned to continuous fascia iliaca compartment block group and continuous epidural analgesia group (n=30). All patients in both groups received a pre-fluence before general anesthesia. Continuous fascia iliaca compartment block group were injected with 0.25% ropivacaine 30 mL via iliac fascia gap. Continuous epidural analgesia group received 0.20% ropivacaine 10 mL via epidural catheter, indwelling catheter. When the analgesic effect was identified, anesthesia intubation was carried out. After operation, medicine was given via iliac fascia and epidural analgesia pump in both groups respectively. Postoperative analgesia in single dose was not given. If pain could not be endured, analgesia would be rescued (parecoxib 20-40 mg/time) according to pain degree. Visual analogue scale scores, supplemental analgesia of parecoxib, complication of anesthesia, Harris hip joint scores, day of first walk, and duration of hospital stay were recorded. RESULTS AND CONCLUSION: No significant difference in visual analogue scale scores, supplemental analgesia, Harris hip joint scores and duration of hospital stay was detected. Day of first walk was earlier in the continuous fascia iliaca compartment block group than in the continuous epidural analgesia group. The complications were apparently lower in the continuous fascia iliaca compartment block group than in the continuous epidural analgesia group. These data indicated that after total hip arthroplasty, two kinds of analgesia methods could provide satisfactory postoperative outcomes. Hip joint was perfectly recovered. However, the complications of continuous fascia iliaca compartment block were less, and helpful to patients’ early off-bed activities, and could be considered as a good choice for analgesia after total hip arthroplasty. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Total knee arthroplasty without patellar resurfacing for degenerative osteoarthritis: effects of patellar chondromalacia on clinical outcomes Xu Chao, Hou Yan-jie, Yilihamu•Tuoheti, Guan Zhen-peng, Li Shan-zhu1, Wang Xin 2014, 18 (31):  4939-4943.  doi: 10.3969/j.issn.2095-4344.2014.31.004 Abstract ( 403 )   PDF (688KB) ( 790 )   Save BACKGROUND: There remains controversy that whether patellar resurfacing in total knee arthroplasty and whether patellar chondromalacia has influence on clinical outcomes. OBJECTIVE: To evaluate anterior knee pain, clinical function and effects of patellar chondromalacia on clinical outcomes after total knee arthroplasty without patellar resurfacing for degenerative osteoarthritis. METHODS: Clinical data of 162 patients (162 knees) with degenerative osteoarthritis undergoing total knee arthroplasty without patellar resurfacing from June 2008 to February 2010 were retrospectively analyzed. Outerbridge classification was used for patellar chondromalacia, Visual Analogue Scale for anterior knee pain, and the Knee Society clinical scoring system for clinical function. RESULTS AND CONCLUSION: The incision of all patients reached stage-I healing. The patellar chondromalacia: grade I in 18 patients, grade II in 36 patients, grade III in 62 patients, and grade IV in 35 patients. At the final follow-up, there were six (4.0%) patients with anterior knee pain, including four cases of mild pain and two cases of moderate pain, no severe pain. The mean Knee Society clinical scoring system scores and patellar score were obviously elevated. Outerbridge classification did not affect the incidence of anterior knee pain after replacement (χ2=0.42, P=0.94), the Knee Society clinical scoring system score (knee score: F=1.83, P=0.14; functional score: F=0.56, P=0.64) and partellar score (F=0.78, P=0.51). These data suggested that total knee arthroplasty without patellar resurfacing for degenerative osteoarthritis can obtain satisfactory clinical outcomes, and the patellar chondromalacia may not affect the clinical outcomes. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Early postoperative pain between the first and second staged bilateral total knee arthroplasty: a retrospective comparative analysis Sun Jiu-yi, Zhou Yi-qin 2014, 18 (31):  4944-4949.  doi: 10.3969/j.issn.2095-4344.2014.31.005 Abstract ( 440 )   PDF (686KB) ( 453 )   Save BACKGROUND: Total knee arthroplasty solves a great pain for patients with severe knee joint disease, and its clinical curative effects have been generally accepted. In the clinic, the formulation of clinical analgesic program of the two surgeries in patients undergoing double knee prosthesis lacks of the support of evidence-based medicine. OBJECTIVE: To compare the differences in pain during early stage of primary and secondary surgeries in bilateral total knee arthroplasty, and to provide evidence for clinical analgesic programs. METHODS: A total of 87 patients receiving staged bilateral total knee arthroplasty from January 2009 to January 2013 were retrospectively analyzed. Visual analogue scale was compared at 24, 48 and 72 hours after first and second staged total knee arthroplasty, including seating and maximum flexion position. In addition, the difference in early pain score was compared between second and first total knee arthroplasty in different intervals (less than 6 months, 6-12 months, more than 12 months). RESULTS AND CONCLUSION: The visual analogue scale scores at seating and maximum flexion position at 24 and 48 hours after second total knee arthroplasty were significantly higher than the first surgery. No significant  difference in visual analogue scale scores was detected between 72-hour seating and maximum flexion position. Visual analogue scale scores were significantly higher in the interval of less than 6 months than in the 6-12 month group and more than 12 month group in the 24-hour seating and maximum flexion position after second total knee arthroplasty. No significant difference in visual analogue scale scores was detected between the 6-12 month group and more than 12 month group at seating and maximum flexion position. Results suggested that the pain of second surgery was obviously higher than the first surgery within 48 hours after staged bilateral total knee arthroplasty, and this can provide a clinical evidence to enhance the analgesic strategy in the second staged bilateral total knee arthroplasty. The interval between two surgeries also affected the early pain after second surgery. Considered the aspect of postoperative pain, it is better to suggest the interval between first and second surgeries in staged total knee arthroplasty should be more than 6 months. This can reduce pain after second surgery, elevate patient’s satisfaction and accelerate the speed of recovery. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Short- and medium-term efficacy of artificial cervical disc replacement versus fusion for cervical spondylosis Gao Ming-yong, Tao Hai-ying, Wei Ai-lin, He Bin 2014, 18 (31):  4950-4956.  doi: 10.3969/j.issn.2095-4344.2014.31.006 Abstract ( 605 )   PDF (899KB) ( 349 )   Save BACKGROUND: Recently, non-fusion technology representing as artificial cervical disc replacement continues to improve. On the basis of reconstruction of disc structure and function of involved segments, cervical spine structure of surgery area segment is significantly close to dynamic and static load stress distribution required by natural physiological systems. It effects are apparent in protecting intervertebral facet joints of degenerated segment and structure and function of the cervical spine of adjacent segments and in maintaining cervical dynamic stability, which presented obvious methodological strengths compared with segmental fusion technology. OBJECTIVE: To evaluate the clinical outcomes of anterior cervical discectomy and fusion and Bryan artificial cervical disc replacement in the treatment of single-level cervical spondylotic myelopathy or radiculopathy.  METHODS: A total of 43 middle and old age patients with single-level cervical spondylotic myelopathy or radiculopathy, who were treated from March 2010 to March 2012, were enrolled in this study. They were randomly assigned to anterior cervical discectomy and fusion group (fusion group) and Bryan artificial cervical disc replacement group. Range-of-motion of cervical overall and adjacent intervertebral area near the intervertebral space was observed with radiography. During follow-up, postoperative recovery of neurological function was evaluated using Japanese Orthopaedic Association scale, visual analog scale and neck disability index. RESULTS AND CONCLUSION: None patients experienced complications of neurovascular injury during and after the surgery. Range-of-motion of postoperative overall cervical vertebra and adjacent joint was improved in the Bryan artificial cervical disc replacement group compared with the fusion group. Neurological function was apparently improved after surgery in each group. At 3 months after surgery, scores of Japanese Orthopaedic Association, visual analog scale and neck disability index were significantly improved in the Bryan artificial cervical disc replacement group compared with the fusion group (P < 0.05). During final follow-up, there were significant differences in visual analog scale scores between the two groups. Japanese Orthopaedic Association scale score and neck disability index score were similar between the two groups. During follow-up, no prosthesis sinking, displacement or heterotopic ossification were detected. These data indicated that artificial cervical disc replacement could effectively keep the range of motion of cervical segments and protect disc degeneration of adjacent segment. Mid-term follow up obtained similar improvement of neurological function of fusion surgery. The moderate-term and short-term efficacies of non-fusion technology were better than fusion technology in the treatment of single-level cervical spondylopathy 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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interTan compression interlocking intramedullary nail for femoral intertrochanteric fractures: clinical application and design advantages Lu Da-lu, Lv Xian-jun, Li Bin, Yang Da-xing 2014, 18 (31):  4957-4961.  doi: 10.3969/j.issn.2095-4344.2014.31.007 Abstract ( 575 )   PDF (719KB) ( 487 )   Save BACKGROUND: There is no unified method for treatment of intertrochanteric fracture. Previous dynamic hip screw fixation has some shortcomings, and is gradually replaced by intramedullary nail fixation. interTan is a compression interlocking intramedullary nail designed by Smith Nephew in USA according the characteristics of intertrochanteric fracture. Unique design of pressurized screw thread has controllable linear pressure. Moreover, it has the stability of Z-effect anti-rotation. OBJECTIVE: To analyze the clinical therapeutic effects and superiority of interTan compression interlocking intramedullary nail for intertrochanteric fracture.  METHODS: A total of 60 patients with intertrochanteric fracture undergoing interTan compression interlocking intramedullary nail in the Department of Orthopedics, Beijing Chaoyang Emergency Rescue Center from January 2011 to December 2012 were enrolled in the experimental group. A total of 60 patients with intertrochanteric fractures receiving dynamic hip screw fixation in the Department of Orthopedics, Beijing Chaoyang Emergency Rescue Center from January 2009 to December 2010 were enrolled in the control group. RESULTS AND CONCLUSION: Peri-operative bleeding volume, postoperative ambulation time, numerical rating scale score, radiographic healing time and weight-bearing time in the experimental group were lower than those of control group. At 3, 6 months and 1 year after fixation, Harris score and hospital for special surgery knee score were higher in the experimental group than in the control group. These data indicated that compared with dynamic hip screw, interTan compression interlocking intramedullary nail has unique stability due to its design. Internal fixation can reduce operation trauma, promote fracture healing and improve joint function, and exhibit  good clinical therapeutic effects for intertrochanteric fractures. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Characteristics of locking reconstruction titanium plate in the treatment of acetabular fracture for aged patients Wang Hai-bin, Meng Chun-yang, Wu Bin, Han Liang, Gao Ming, Jia Cun-ling, Jia Dai-liang 2014, 18 (31):  4962-4967.  doi: 10.3969/j.issn.2095-4344.2014.31.008 Abstract ( 273 )   PDF (633KB) ( 470 )   Save BACKGROUND: Pelvic and acetabular fractures in elderly are frequently observed in the clinic, and the incidence gradually increased. Moreover, it is difficult to conduct reduction and fixation due to their physical status and osteoporosis to different degrees. Locking plate is ideal fixation material in surgical treatment of acetabular fractures in elderly due to the special functions and good molding of screw and locking plate. OBJECTIVE: To analyze the advantages and disadvantages of locking reconstruction plate used in the acetabular fracture for the aged patients and to improve the clinical effect of acetabular fractures in elderly. METHODS: From January 2010 to February 2013, 21 aged patients with acetabular fracture were treated by open reduction and internal fixation with locking reconstruction plates made of titanium and 00Cr18Ni14Mo3 stainless steel in the Department of Orthopedics Affiliated Hospital of Jining Medical University. RESULTS AND CONCLUSION: Of 21 patients, 20 cases were followed up for 12-18 months (mean 14 months), but one dropped out. All the fractures were healed within 4-6 months and no failure cases. According to Matta evaluation criteria, the satisfactory rate was 90%. According to the D’Aubigne scoring system, the excellent and good rate was 95%. These data indicated that locking reconstruction titanium plate is reliable, has low failure rate and satisfactory clinical effects for acetabular fracture in aged patients, and is ideal fixation material in treatment of acetabular fractures in elderly. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Feasibility of two kinds of atlantal lateral mass screw fixation Gong Min, Jiang Jun-wei, Liu Hao, Zhou Yun 2014, 18 (31):  4968-4972.  doi: 10.3969/j.issn.2095-4344.2014.31.009 Abstract ( 567 )   PDF (597KB) ( 342 )   Save BACKGROUND: Atlantal lateral mass screw fixation contains lateral mass screw fixation under the posterior arch of the atlas and lateral mass screw fixation via the posterior arch of atlas (also called atlas pedicle screw fixation) according to different insertion points. The two methods have their advantages and disadvantages. There are lacks of the comparative studies on bony anatomy feasibility by two kinds of atlantal lateral mass screw fixation. OBJECTIVE: To compare the feasibility associated with two kinds of atlantal lateral mass screw fixations taking Chinese data of atlantal bony anatomy as evidence. METHODS: Data of CT scans in 30 adults with cervical spondylosis (60 sides) were collected, and data were reconstructed using CT workstation. We measured key bone anatomy structure after atlantal lateral mass screw fixation. The atlantal lateral mass was suitable for lateral mass screw fixation via the posterior arch of atlas if its height and width of vertebral artery groove at the posterior arch ≥ 4 mm. It was suitable for lateral mass screw fixation under the posterior arch of the atlas if the height of posterior arch of atlas lateral mass ≥ 4 mm. RESULTS AND CONCLUSION: The height of vertebral artery groove at the posterior arch was (4.54±1.17) mm. The width of vertebral artery groove at the posterior arch was (8.69±1.12) mm. The height of posterior arch of atlas lateral mass was (4.98±1.07) mm. There were 41 cases with the height of vertebral artery groove at the posterior arch > 4 mm (suitable for lateral mass screw fixation via the posterior arch of atlas, occupying 68%. There were 52 cases with the height of posterior arch of atlas lateral mass > 4 mm (suitable for lateral mass screw  fixation under the posterior arch of the atlas), occupying 87%. There were significant differences in the differences between the two groups (P < 0.05). These results indicated that lateral mass screw fixation under the posterior arch of the atlas was more feasible compared with lateral mass screw fixation via the posterior arch of atlas. Preoperative CT measure for key anatomic structure was significant for making personalized surgical plan. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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MC+® and ROI-CTM cervical fusion cage for cervical spondylosis: comparison of early postoperative cervical stability and fusion rate  Zhang Wei-hong, Yuan Shuo, Meng Chun-yang, Gao Feng, Yuan Wen 2014, 18 (31):  4973-4979.  doi: 10.3969/j.issn.2095-4344.2014.31.010 Abstract ( 526 )   PDF (908KB) ( 593 )   Save BACKGROUND: Anterior cervical decompression and internal fixation is the most common treatment for cervical spondylosis at present. Low profile or zero notch internal fixation materials are constantly emerging in order to reduce the effect of titanium plate thickness on the esophagus and pharynx, and to simplify the operation procedure. The self-locking interbody fusion MC+® and ROI-CTM provides a solution of titanium plate notch effect and more simple operation methods for anterior cervical operation. OBJECTIVE: To compare the effect on cervical stability, fusion rate and clinical efficacy by anterior cervical decompression and internal fixation using various self-locking interbody fusion MC+® or ROI-CTM to treat cervical spondylosis. METHODS: From June to September 2013, we treated 36 cervical spondylosis patients by anterior cervical  decompression and internal fixation. According to different types of intervertebral fusion device, the patients were divided into two groups: MC+® group and ROI-CTM group. Each patient underwent cervical anteroposterior and lateral radiographs, lateral flexion extension radiographs, CT scanning before operation, at 3 days, and 3 months after operation. Cervical curvature, intervertebral height, vertebral angle displacement and horizontal displacement were measured. Cervical pain visual analog scale score and Bazaz dysphagia score were evaluated. RESULTS AND CONCLUSION: In both groups, cervical curvature and intervertebral space height showed significantly increases after operation (P < 0.05), but no significant difference in cervical curvature and intervertebral space height was detected between two groups at 3 days or 3 months after operation (P > 0.05). In MC+® group, angle displacement and horizontal displacement showed significant increases in 3 days after operation (P < 0.05), but angle displacement and horizontal displacement at 3 months after operation showed significantly decrease compared with those of before operation and 3 months after operation (P < 0.05). In ROI-CTM group, angle displacement and horizontal displacement showed a marked decline at 3 days and 3 months after operation. Angle displacement and horizontal displacement were significantly higher in MC+® group than in the ROI-CTM group at 3 days or 3 months. No significant differences in fusion rate were detected between both groups at 3 months (P > 0.05). No significant differences in cervical pain visual analog scale score and Bazaz dysphagia score were detectable between both groups (P > 0.05). These data indicated that anterior cervical decompression and internal fixation combined with MC+® or ROI-CTM cervical fusion cage for single-segment cervical spondylosis has reliable clinical therapeutic effects, and the operation is simple; uncomfortable throat pain is less. MC+® cage was relatively cheap. The combination with cervical external fixation can achieve the requirement of vertebral stability. ROI-CTM cage can achieve satisfactory postoperative immediate stability, and is a satisfactory choice for treating cervical spondylosis. In conclusion, the two kinds of locking fusion cage have their advantages and disadvantages. A suitable fusion cage should be selected according to patients’ economic situation and vertebral stability requirements. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Advantages of an anterior cervical Zero-P implant for cervical spondylosis Wang Gang1, Wu Tao1, Huang Xin-peng, Li Wei-lin, Xie Ning, Chen Hua-jiang, Liu Jun, Wang Yun-hua, Huang Ye, Ni Bin 2014, 18 (31):  4980-4985.  doi: 10.3969/j.issn.2095-4344.2014.31.011 Abstract ( 846 )   PDF (808KB) ( 807 )   Save BACKGROUND: The application of anterior cervical plate for anterior cervical discectomy and fusion will induce some complications such as dysphagia after treatment. OBJECTIVE: To observe the clinical efficacy of the new implant Zero-P system for cervical spondylosis patients and its effect on reducing complications after treatment. METHODS: A total of 51 cervical spondylosis cases underwent anterior cervical discectomy and fusion using Zero-P system. Neurological function was evaluated by neck/arm visual analogue scale, neck disability index and Japanese Orthopaedic Association scores pretreatment, at 3 days, 3, 6 months, 1, 2 years post-treatment. The incidence of postoperative dysphagia was evaluated using dysphagia score. Anteroposterior & lateral and dynamics X-ray films were used to evaluate the efficacy of graft fusion and internal fixation-related complications. RESULTS AND CONCLUSION: The patients were followed up for 6-30 months, averagely 15.4 months. After treatment, their incision achieved stage I healing. Pain was relieved and muscle force was restored in all patients after treatment. Visual analogue scale and neck disability index scores were apparently improved. Improvement rate of Japanese Orthopaedic Association score was 85.7%. At 2 days after treatment, seven patients experienced mild and moderate dysphagia. During follow up, implant subsidence was not observed. No complications, such as screw loose, breakage or fixator displacement, were found. Results suggested that the new cervical stand-alone anterior fusion device in anterior cervical discectomy and fusion procedure for the treatment of cervical spondylosis has offered an excellent clinical outcome. Its design has the advantages of cervical interbody fusion and anterior cervical plate. There were less relevant complications. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Spinal external fixator distraction reduction combined with vertebroplasty in the repair of osteoporotic vertebral fractures Li Zhu, Wang Wen-jun, Yao Nv-zhao, Song Xi-zheng 2014, 18 (31):  4986-4991.  doi: 10.3969/j.issn.2095-4344.2014.31.012 Abstract ( 343 )   PDF (752KB) ( 510 )   Save BACKGROUND: Percutaneous vertebroplasty is an effective minimally invasive method in the treatment of osteoporotic vertebral compression fractures. However, there are some shortcomings during clinical application, such as cannot recover vertebral height or correct local kyphosis, as well as the incidence of cement leakage is very high. OBJECTIVE: To evaluate the latest clinical effect of spinal external fixator distraction reduction combined with vertebroplasty for osteoporotic vertebral fractures.  METHODS: From January 2012 to June 2013, 55 sever osteoporotic fracture patients accepted the treatment of spinal external fixator distraction reduction combined with vertebroplasty. During the operation, we firstly used percutaneous pedicle screw fixator to open the closed reduction and to correct the kyphosis, followed by vertebroplasty via percutaneous puncture. Then we measured the compression rate of vertebral body of compression fracture, the kyphosis angle and the rate of intraspinal occupancy before and after operation. Meanwhile, we evaluated the clinical effect with Visual Analogue Scale and Oswestry disability index. RESULTS AND CONCLUSION: Visual Analogue Scale scores and Oswestry disability index were significantly improved after treatment and during final follow-up (P < 0.05). Low back pain was basically relieved. The patients  could do out-of-bed activity at 1-3 days after treatment. Among the 57 vertebral bodies of 55 cases, 4 suffered from the cement leakage without obvious clinical symptoms. The height of vertebral compression fracture, the kyphosis angle, and the rate of intraspinal occupancy were significantly improved after the spinal external fixator combined with vertebroplasty and during the last follow-up (P < 0.05), and no significant difference was detected between postoperation and final follow-up. These data indicated that spinal external fixator distraction reduction combined with percutaneous vertebroplasty for severe osteoporotic vertebral compression fractures is a safe effective minimally invasive method with stable therapeutic effects. Cement leakage rate was low, and spinal stability was satisfactory. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Bilateral pedicle screw and echelon tight closure spinal cord technique combined with implant fixations for correcting stiff spinal angular kyphosis  Ma Hua-song, Wang Xiao-ping, Tan Rong, Chen Zhi-ming, Lu Ming, Yuan Wei, Xu Qi-ming, Ren Dong-yun, Ma Wei, Li Long, Wu Jia-jian, Zhang Jing, Zheng Rui, Xin Shen 2014, 18 (31):  4992-4997.  doi: 10.3969/j.issn.2095-4344.2014.31.013 Abstract ( 314 )   PDF (859KB) ( 433 )   Save BACKGROUND: The treatment difficulties of thoracolumbar angular kyphosis surgery are: low correction rate, hard to rebuild sagittal plane, easily induce neurological complications, postoperative loss of balance, high incidence of pseudarthrosis and postoperative loss of correction degree. OBJECTIVE: To explore the safety and efficacy of modified posterior vertebral column resection osteotomy and bilateral pedicle screw combined with echelon tight closure spinal cord technique and implant fixation for severe spinal angular kyphosis.  METHODS: A total of 87 severe spinal angular kyphosis patients, 36 males and 51 females, who were treated in the Department of Orthopedics, the 306 Hospital of Chinese PLA from January 2006 to December 2013, were enrolled in this study. They underwent posterior vertebral column resection, bilateral pedicle screw combined with echelon tight closure spinal cord, and implant fixation. Kyphosis, spinal sagittal imbalance, offset rate towards trunk side, operation time and intraoperative blood loss were observed before and after treatment. RESULTS AND CONCLUSION: The preoperative average kyphosis was 90.1° (31°-138°). The postoperative average kyphosis was 27.9° (15°-57°). The improvement rate was 76%. The improvement rate of trunk sagittal offset was 76%. Intraoperative blood loss was 800-3 000 mL, and average blood loss was 2 300 mL. The operation time was 5-7 hours, averagely 5.9 hours. Before treatment, two patients affected neurologic symptoms in double lower extremity, and their Frankel classification was grade C and became grade E after treatment. All patients were followed up for 9-57 months. Bony fusion was achieved in all patients. No complications of spinal cord injury appeared, and no orthopedic angle missing occurred. These results indicate that during posterior vertebral column resection for treating severe angular stiffness of the thoracic kyphosis, blood vessels could be maintained greatly. Blood vessel injury-induced ischemic changes in spinal cord and ischemic reperfusion injury could be avoided. To reduce hemorrhage and to keep effective blood volume in patients with low body mass are effective for early recovery after treatment. Bilateral pedicle screw combined with echelon tight closure spinal cord technique greatly protected spinal cord cells against injury. We should pay attention to the protection and loose of nerve root to avoid postoperative nerve root irritation. Sufficient bone fusion ensures kyphosis correction, avoids spine lateral offset, and plays a key role in spinal function and postoperative orthopedic effect.  Subject headings: kyphosis; internal fixators; osteotomy; orthopedic fixation devices 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Percutaneous iliosacral screw versus percutaneous reconstruction plate fixation for Tile C sacral fractures Yin Shi-yuan, Luo Xue-feng, Shen Ming-quan, Xie Zeng-ru 2014, 18 (31):  4998-5003.  doi: 10.3969/j.issn.2095-4344.2014.31.014 Abstract ( 311 )   PDF (802KB) ( 378 )   Save BACKGROUND: Percutaneous iliosacral screw internal fixation and percutaneous reconstruction plate internal fixation are two kinds of popular minimally invasive surgical methods in recent years. However, due to lack of the support of related evidence-based medicine, it is controversial to choose which kind of surgical methods in the clinic. OBJECTIVE: To compare the difference for treating Tile C sacral fractures between percutaneous iliosacral screw and percutaneous reconstruction plate.   METHODS: Clinical data of 63 cases of unilateral Tile C sacral fractures were retrospectively analyzed, including 26 cases of percutaneous iliosacral screw internal fixation and 37 cases of percutaneous reconstruction plate internal fixation. The data of operation time, intraoperative bleeding loss, length of incision, X-ray exposure frequency and fracture healing time were compared between both groups. The clinical efficacy was evaluated based on Matta standards and Majeed standards. RESULTS AND CONCLUSION: All 63 patients were followed up for 12-36 months. No significant difference in union of fracture was detected between both groups. Intraoperative bleeding loss, length of incision, and clinical therapeutic outcomes were better in the percutaneous iliosacral screw internal fixation group than in the percutaneous reconstruction plate internal fixation group. However, percutaneous iliosacral screw internal fixation has greater surgical risk, asks for higher technology compared with percutaneous reconstruction plate internal fixation, and percutaneous iliosacral screw internal fixation suits experienced treatment team. The clinical   therapeutic effects were poorer in percutaneous reconstruction plate internal fixation group than in percutaneous iliosacral screw internal fixation group, but percutaneous reconstruction plate internal fixation has shorter operative time, less X-ray exposure frequency, easier operation, and more convenient to be spread in primary hospitals. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Patellar fracture fixation: biomechanical characteristics of static and dynamic compression Xu Feng, Wang An-qing, Min Hong-wei, Yin Xiao-feng, Liu Ke-min 2014, 18 (31):  5004-5010.  doi: 10.3969/j.issn.2095-4344.2014.31.015 Abstract ( 459 )   PDF (431KB) ( 586 )   Save BACKGROUND: Static compressure effect between the fracture fragments was generated by fixation itself (tension band wire and screw), but dynamic compression effects were generated during flexion. Mechanical strength and stability of patellar fracture fixation have obvious advantages. However, there are lacks of quantitative comparative studies on static and dynamic compression effects of these fixation methods. OBJECTIVE: To observe strength changes and clinical significance of static and dynamic compression using four fixation techniques. METHODS: Standardized transverse patellar fracture models were created with fresh cow patellas. The patellas were randomly divided into four groups: fixation was accomplished with modified tension band wiring (wire group); modified tension band with braided cable (cable group); interfragmentary screws (screw group); cannulated screw tension band with wire (cannulated screw group). Before fracture fixation, Fuji pressure-sensitive film was laid among fracture fragments to measure the pressure among fracture fragments after fixation, i.e., static and dynamic compression. Model of each group was measured as follows: (1) after fixation, the fixation was removed, and the Fuji pressure-sensitive film was taken out; (2) after fixation, material testing machine was used. Samples underwent a three-point bending test with a 5 000 N load, simulating dynamic compression during knee flexion. Subsequently, Fuji pressure-sensitive film was taken out. Each Fuji pressure-sensitive film was tested using prescale FPD-8010E software. Thus, average pressure among broken bone ends was obtained, and statistical analysis was performed. Static and dynamic compression among broken bone ends was compared in each group. RESULTS AND CONCLUSION: Average static compression was significantly lower in the wire group than in the cable group, screw group and cannulated screw group (P < 0.05). Under 5 000 N load of dynamic compression, similar compression among broken bone ends was visible among wire group and cable group, screw group and cannulated screw group (P > 0.05). Dynamic compression was higher than static compression in the wire group (P < 0.05). Results verified that compared with modified tension band wire fixation technique, cable or screw could evidently increase static compression among broken bone ends, but simultaneously weaken dynamic compression among broken bone ends. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | Related Articles | Metrics

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Biomechanical comparison of three fixation methods in the repair of posterolateral tibial plateau fracture Zhang Yan, Liang Xu, Fan Xin-bin, Shao Jin, Liu Yue, Ye Wei-guang, Wu Liang, Yang Tie-yi, 2014, 18 (31):  5011-5016.  doi: 10.3969/j.issn.2095-4344.2014.31.016 Abstract ( 320 )   PDF (719KB) ( 402 )   Save BACKGROUND: Repair programs of posterolateral tibial plateau fracture included posterior plate screws, lateral plate screw and anterior and posterior lag screw fixation. To choose which fixation methods depends on clinical experiences of physicians. Study results are mainly clinical reports, and lack of mechanical evidence. OBJECTIVE: To compare biomechanical changes in three fixed manners (lateral plate screw group, posterior plate screw group and anterior and posterior lag screw group) in the repair of posterolateral fracture of tibial plateau from the angle of biomechanics. METHODS: A total of tibial specimens of six adult male antisepsis corpses (12 samples) were used for measuring bone mineral density of metaphysis. 1/2 posterolateral tibial plateau fracture model was established by electric pendulum saw. The model was randomly divided into three groups: lateral plate screw group, posterior plate screw group and anterior and posterior lag screw group. Finite element method and biomechanics were used to test axial displacement value and the maximal displacement distribution area under the axial loads of 250, 500, and 1 000 N. RESULTS AND CONCLUSION: There was no significant difference in average bone density in three groups of metaphysis (P > 0.05). The minimum axial displacement of the fracture fragments was in the anterior and posterior lag screw group (0.013 521 mm), followed by posterior plate screw group (0.016 991 mm), and the maximum was visible in the lateral plate screw group (0.138 200 mm) under 250 N load. Displacement value was similar to the 250 N under 500 and 1 000 N. According to the results of biomechanics, displacement values of anterior and posterior lag screw was obviously less than the lateral plate screw group and posterior plate screw group (P < 0.05). There was no significant difference between the lateral plate screw group and posterior plate screw group (P > 0.05). The maximal displacement distribution area was proximal tibiofibular joint border zone in two methods. These data indicated that the biomechanical stability was most advantageous in the anterior and posterior lag screw group, and poorest in the lateral plate screw group. In the clinic, anterior and posterior lag screw fixation can be used as a first choice for repair of posterolateral tibial plateau fracture. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Establishment of digital template of cannulated screw fixation for femoral neck fractures Cao Zhen-hua, Yin He-ping, Li Shu-wen 2014, 18 (31):  5017-5023.  doi: 10.3969/j.issn.2095-4344.2014.31.017 Abstract ( 480 )   PDF (922KB) ( 488 )   Save BACKGROUND: In accordance with AO principles of fracture treatment, the tendency of femoral neck fracture is to cut open articular capsule, clean hematoma, carry out dissection and reduction, strengthen internal fixation, not necessary to suture articular capsule, resulting in decreasing the incidence of avascular necrosis. Cannulated screw placement for femoral neck fracture is a key to stabilize the structure. However, accuracy of nail placement is greatly affected by individual difference, two-dimensional imaging equipment for pedicle screw positioning and physician’s experiences. An assisted pedicle screw method that has strong practicability, low cost, and is easily spread to be used is urgently needed. OBJECTIVE: To construct three-dimensional models of femoral neck fractures with cannulated compression screw, to precisely establish navigation template using three-dimensional bio-printing technology and to verify. METHODS: After 18 volunteers signed informed consent. Continuous spiral CT was used to scan bilateral upper end of the femur via encryption. Dicom data were loaded into Amira 3.1 software for reconstructing three-dimensional fracture models, and then these data were loaded into Image-ware12.1 software. The best puncture channel was designed digitally. Three-dimensional models of femoral neck fractures with screw were reconstructed. Anatomic morphology was extracted, and reverse template was established. Physical template was printed with three-dimensional bio-printing technology, and verified by surgical simulation.  RESULTS AND CONCLUSION: Three-dimensional models of femoral neck fractures and models of cannulated screw were successfully established. Digital channel and optimal puncture pathway were designed, and navigation template was made. Screw placement during surgical simulation was in the optimal position. Produced three-dimensional model well adhered to navigation template in vitro. After successful puncture, fault verified that the position of puncture channel was exact. These findings indicated that three-dimensional models of digital simulated femoral neck fracture fixation were successfully established. Reverse engineering and three-dimensional bio-printing technology improve the accuracy of surgical procedures, and provide theoretical basis and technical support for the clinic. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Computer simulation of three-dimensional modeling for the best screw direction in atlas pedicle Qin Tao1, Du Yuan-li1, Zheng Dong2, Zhu Wen-tao2 2014, 18 (31):  5024-5029.  doi: 10.3969/j.issn.2095-4344.2014.31.018 Abstract ( 248 )   PDF (768KB) ( 487 )   Save BACKGROUND: Atlantoaxial anatomical structures were special. Compared with thoracolumbar vertebrae, there is no fixed anatomical marker for screw implantation. Moreover, pedicle structural variation is great. The current consensus view is to suggest an individualized program of pedicle screws. The development of orthopedic digital software technology provides a novel manner for preoperative design. OBJECTIVE: To originally design 3D matrix model, to observe atlas pedicle channel, pedicle screw safety zone, to measure optimal program for screw fixation, and to simplify preoperative design of entering pedicle screw. METHODS: Continuous atlas CT data of 12 healthy adults in picture archiving and communication system of People’s Hospital, Three Gorges University were imported into Mimics 10.01 software. There were seven males and five females, at the age of 30-65 years old, averagely 45 years. After three-dimensional reconstruction, the three-dimensional reconstruction models were imported into 3Dmax 2009 as .dwg format. The reference three-dimensional planes and the sites of nail insertion were determined by the atlas modeling. The modeling consisted of 17×17×2 elements and the transverse section angles ranged from 0° to 40° and the sagittal section  angles ranged from 0° to 40° with a space of 2.5°. 578 elements were used to simulate pedicle screw array model. Perspective observation showed that the diameter was 3.5 mm, and length was 22 mm in pedicle channel. Thus, safety area, best screw channel and screw angle were analyzed.  RESULTS AND CONCLUSION: The total number of elements in the matrix study was 17×17×2×12 in 12 subjects. 175 screws in total of 6 936 units could safely meet the operative standard. No significant difference in the number of pedicle screw between left and right sides (P > 0.05). Results indicated that the digital three-dimensional modeling technology is an effective, simple, accurate way in the preoperative design and measurement for atlas pedicle surgery. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Unipedicular versus bipedicular percutaneous kyphoplasty for treating osteoporotic vertebral compression fractures: a meta-analysis Yin Le-le, Xu Xiao-xiong, Pan Qi-lin, Zuo Kang-kang 2014, 18 (31):  5030-5035.  doi: 10.3969/j.issn.2095-4344.2014.31.019 Abstract ( 267 )   PDF (788KB) ( 437 )   Save BACKGROUND: Percutaneous kyphoplasty, as a kind of minimally invasive surgery, has been proved to be effective in the treatment of osteoporotic vertebral compression fractures. Percutaneous kyphoplasty has simple operation and safe mode, can relieve pain quickly, and obviously restore vertebral body height. However, the therapeutic effects of unipedicular and bipedicular percutaneous kyphoplasty for osteoporotic vertebral compression fractures are controversial. OBJECTIVE: To analyze controlled trials on the therapy with unipedicular and bipedicular percutaneous kyphoplasty using meta-analysis, and to compare the effectiveness and superiority of the two methods with a large sample size. METHODS: We retrieved PubMed, Web of Knowledge, China Journal Full-text database, Wanfang database, and Super Star database for articles on meta-analysis of unipedicular versus bipedicular percutaneous kyphoplasty published from 2000 to 2014 in Chinese and English. Unipedicular percutaneous kyphoplasty served as experimental group and bipedicular percutaneous kyphoplasty as control group. Curative effect and the difference between evaluation indexes were expressed as the weighted mean difference and 95% confidence interval and the RR value. Statistical analysis was carried out using Review Manager 5.2 software. RESULTS AND CONCLUSION: A total of seven randomized controlled trials were collected. Results of statistical analysis showed that visual analogus scale scores were decreased in both groups, but no significant difference was detected [RR= -0.08, 95%CI(-0.05, -0.21), P=0.21]. There was no significant difference in Cobb angle change [RR= -0.07, 95%CI(-0.16, -1.47), P=0.93]. No significant difference in the average recovered height of vertebral bodies was detected [RR=-1.76, 95%CI(-4.21, -0.69), P=0.16]. Operation time was shorter in unipedicular percutaneous kyphoplasty than in bipedicular percutaneous kyphoplasty [RR= -23.99, 95%CI(-26.01, -21.97), P < 0.000 01]. These data indicated that compared with bipedicular percutaneous kyphoplasty, unipedicular percutaneous kyphoplasty could effectively reduce the operation time. However, no significant difference in visual analogus scale scores, Cobb angle change and the average recovered height of vertebral bodies was visible in statistical analysis in both groups. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Microsurgical discectomy versus microendoscopic discectomy for treatment of lumbar disc herniations: a meta-analysis Liu Meng-jun, Du Bin, Wei Xin-wei, Wang Shi-hai, Lin Qing, Wang Song, Chen Zhi-xin 2014, 18 (31):  5036-5043.  doi: 10.3969/j.issn.2095-4344.2014.31.020 Abstract ( 547 )   PDF (797KB) ( 426 )   Save BACKGROUND: Microsurgical discectomy and microendoscopic discectomy are effective safe methods for treatment of lumbar disc herniations. Currently, the comparative study on two kinds of microtechnology was less, and the conclusion of each study is different. OBJECTIVE: To compare the safety and effectiveness between microsurgical discectomy and microendoscopic discectomy for treatment of lumbar disc herniations using meta-analysis. METHODS: Cochrane Library, PubMed, CNKI, VIP, Web of Science and Wanfang were searched for articles published from building to November 2013. Related journals were retrieved by hand. Randomized controlled trials of microsurgical discectomy and microendoscopic discectomy for treatment of lumbar disc herniations were collected. Qualities of included studies were evaluated using RevMan 5.2 software, and then analyzed by meta-analysis. RESULTS AND CONCLUSION: A total of 5 randomized controlled trials involving 1 430 cases were included. The results of meta-analysis indicated that no significant difference between microsurgical discectomy and microendoscopic discectomy groups was detected in the length of hospital stay [MD=-0.19 (-0.43, 0.05), P=0.13], the improvement rate of Oswestry disability index [MD=2.78 (-0.15, 5.72), P=0.06], the improvement rate of  visual analogue scale [MD=1.96 (-0.29, 4.21), P=0.09] and the root injure [RR= 0.20 (0.03, 1.12), P=0.07]. Compared with microendoscopic discectomy, microsurgical discectomy showed less surgical time [MD=-10.13 (-14.06, -6.21), P < 0.000 01], less blood loss [MD=-24.27 (-39.45, -9.08), P=0.002], lower incidence of dural tear [RR=0.28(0.11, 0.68), P=0.005], lower risk of recurrent herniation [RR=0.34 (0.14, 0.83), P=0.02]. Above data showed that microsurgical discectomy for lumbar disc herniations was safe and effective under the same condition, but with updated technology and equipment, above conclusion is not necessarily always the same. We suggested that clinical physicians should choose a manner based on practical condition. This topic still requires the verification of more high-quality randomized controlled trials, and the conclusion should be updated promptly. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Hip arthroplasty and internal fixation for the repair of femoral neck fracture in the elderly patients: a meta-analysis of reoperation and complications Ji Ning, Sun Zhen-hui, Jiang Ze-hua, Zhang Yu, Wang Lei, Zhang Xue-li 2014, 18 (31):  5044-5049.  doi: 10.3969/j.issn.2095-4344.2014.31.021 Abstract ( 381 )   PDF (622KB) ( 385 )   Save BACKGROUND: Hip arthroplasty and internal fixation are presently effective therapeutic methods in treatment of femoral neck fracture in the elderly. However, which method can reduce the incidence of postoperative complications remains controversial. OBJECTIVE: To systematically review the reoperation, postoperative complications and 1-year and 2-year mortality after hip arthroplasty and internal fixation in the elderly with femoral neck fracture. METHODS: Pubmed/Medline, EMBASE, and Cochrane CENTRAL databases were retrieved by computer for articles published before May 2013. Systematic review on randomized controlled trials of hip arthroplasty versus internal fixation for femoral neck fractures in the elderly was conducted using the Cochrane Collaboration’s RevMan 5.2 software. Outcome measures included reoperation, main complications related to the surgery and mortality. RESULTS AND CONCLUSION: Six published randomized controlled trials of nine literatures containing 1 496 cases were involved in this review. Meta-analysis results indicated that reoperation rate was greater in the internal fixation group within and more than 2 years after the surgery compared with the hip arthroplasty group (P < 0.000 01). Compared with hip arthroplasty group, internal fixation significantly increased the main complications related to the surgery [OR=8.79, 95%CI(6.50-11.88), P < 0.000 01]. No significant difference in 1-year and 2-year mortality after surgery was detected between the internal fixation and hip arthroplasty groups [OR=0.85, 95%CI(0.66-1.11), P=0.23; OR=0.88, 95%CI(0.70-1.10), P=0.27]. These data suggested that the  long-term reoperation rate and incidence of main complications were obviously higher in internal fixation compared with hip arthroplasty for femoral neck fracture in the elderly, and no significant difference in 1-year and 2-year mortality after the surgery was detectable between the two methods. Clinical recommended hip arthroplasty in the repair of femoral neck fracture in the elderly. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Biomechanical changes after implant fixation for femoral condyle fracture Tan Lin-qiang, Cui Yong, Zhang Hua 2014, 18 (31):  5050-5055.  doi: 10.3969/j.issn.2095-4344.2014.31.022 Abstract ( 429 )   PDF (675KB) ( 354 )   Save BACKGROUND: Clinical treatment of epicondyle fractures and intercondylar comminuted fractures is quite tricky due to instability and spread to the articular surface. Common complications contained bone delayed union, nonunion, broken nails and broken boards. Internal fixation for fractures is various, but reasonable choice for clinical fixation plays a decisive role for repair of fractures.  OBJECTIVE: To explore the repair effects of various fixation methods on femoral condyle fracture from different aspects such as fracture type, bone healing, functional recovery and biomechanics. METHODS: First author searched PubMed database and China National Knowledge Infrastructure for articles about various fixation methods in repair of femoral condyle fracture published from January 2000 to April 2014. Key words were “femoral condyle fracture, internal fixation, biomechanics, load-displacement, axial stiffness, horizontal shear stiffness”. Totally 142 articles were retrieved, but 39 articles met the inclusion criteria. RESULTS AND CONCLUSION: Femoral condyle fracture caused the damage to normal anatomic structure of knee join, changed normal anatomical axis and the mechanical axis of knee joint. Therefore, anatomic reduction and rigid internal fixation are necessary. During treatment, the advantages and disadvantages of various fixation methods should be known. It is necessary to fully evaluate the type of intercondylar fractures of the femoral condyle and soft tissue injury. According to biological characteristics of the human body and mechanical property, internal fixation device should be reasonably used. Individual treatment programs should be provided. Thus, the occurrence of postoperative complications should be reduced utmostly, resulting in a satisfactory repair outcome. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | Related Articles | Metrics

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Clinical transformation of ankle joint biomechanics analyzed by three-dimensional finite element Guo Peng-chao, Wang Cheng-wei 2014, 18 (31):  5056-5061.  doi: 10.3969/j.issn.2095-4344.2014.31.023 Abstract ( 367 )   PDF (722KB) ( 555 )   Save BACKGROUND: Ankle joint is a center of body weight, foot pressure buffering and human contact with the ground and easily gets injury. The study of orthopedic biomechanics continues to mature and develop. Models were established with three-dimensional finite element software to analyze ankle biomechanics and to study clinical diseases, which gradually become a hot research topic. OBJECTIVE: To investigate the current status of three-dimensional finite element analysis of biomechanics in the ankle and to review the clinical research progress. METHODS: China National Knowledge Infrastructure and PubMed (from January 1986 to March 2014) were used to search the related finite element articles about ankle. The retrieval words included ankle, finite element, biomechanics and mechanics research. After excluding objective-independent papers or repeated articles, 47 papers were included for further analysis. RESULTS AND CONCLUSION: Ankle joint complex biomechanics mechanism and variety of injury could break mechanics balance of its surrounding structure and lead to instability and traumatic arthritis. Ankle’s three-dimensional finite element model can accurately reflect anatomical structure and virtual simulation can reappear the operation method in the simulation biomechanics experiment, such as compression, tension, bending, torsion and anti-fatigue mechanics. It makes the direction of the research from biomechanics of static to dynamic, which finds a more suitable solution to diagnose and treat clinical diseases. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Evaluation for fracture risk in elderly patients after hemiarthroplasty Hua Han-bing, Bi Zheng-gang 2014, 18 (31):  5062-5067.  doi: 10.3969/j.issn.2095-4344.2014.31.024 Abstract ( 522 )   PDF (769KB) ( 425 )   Save BACKGROUND: For evaluation of risks of periprosthetic fractures in elderly patients aged > 75 years old after hemiarthroplasty, we should perform dynamic observation of postoperative physical health status, quality of life, hip function and bone mineral density. Presently, there is lack of general investigation. OBJECTIVE: To provide references for clinical diagnosis and prediction of periprosthetic fractures after hemiarthroplasty in elderly patients. METHODS: On the basis of arranging the exploration results of recent studies on risk factors for periprosthetic fractures of hip joint, we analyzed the monitoring method of scholars concerning fracture-associated risk factors. Simultaneously, in combination of the development of modern inspection sciences, the method was applied in the clinic. Thus, we summarized general evaluation methods with clinical significance for risk factors of prosthesis fracture in elderly patients after hemiarthroplasty. RESULTS AND CONCLUSION: For elderly patients with femoral neck or intertrochanteric fracture combined with various medical illness, hemiarthroplasty is an effective manner presently. Fractures surrounding the prosthesis in elderly patients postoperatively gradually increased. Once fracture appeared, it would bring a great attack on patients’ spirit, economy and even life. Therefore, early evaluation on the risk factors for fractures surrounding the prosthesis is a necessary measure for preventing and saving this disastrous consequence by selecting general correct prevention and treatment strategies. This will greatly improve patients’ prognosis and elevated patient’s quality of life and survival rate. Present short-term small-sample prospective follow-up studies suggested that comprehensive dynamic evaluation possibly has a certain clinical significance for the evaluation of risks of fractures after hemiarthroplasty in elderly patients, and deserves further investigations. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Clinical application of intra-articular injection drugs in orthopedics: features and value Ma Jin-hui, Sun Wei, Gao Fu-qiang, Wang Yun-ting, Li Zi-rong 2014, 18 (31):  5068-5074.  doi: 10.3969/j.issn.2095-4344.2014.31.025 Abstract ( 695 )   PDF (687KB) ( 1015 )   Save BACKGROUND: As a more common method in the orthopedic field, the method of intra-articular injection drugs has distinct curative effects, but there are some complications. In a certain extent, this method caters to the psychological fear of surgery, and can serve as a kind of conservative treatment. But some experts believed that because of the limit of sterile conditions, intra-articular injection of drugs will increase the risk of intra-articular infection and they opposed this method.  OBJECTIVE: To review the efficacy and adverse reactions of intra-articular injection drugs in recent years, and explain clinical applications of intra-articular injection drugs in orthopedics. METHODS: A computer-based search was conducted in PubMed and Wanfang database for articles related to the application of intra-articular injection drugs in orthopedics published between January 2007 and December 2013. The English and Chinese key words were “intra-articular, injection, orthopaedics, tranexamic acid, hyaluronic acid, corticosteroid, drugs”. Data were checked in the first trial, old articles and repetitive studies were excluded. The relevant 43 articles accorded with inclusion criteria were reviewed. RESULTS AND CONCLUSION: In orthopedics, the method of intra-articular injection drugs is simple, economic and effective, but at the same time, there are some side effects. Tranexamic acid by intra-articular injection can significantly reduce blood loss after total joint replacement, is safety and economic. Intra-articular injection joint lubricant can reduce internal friction of joints and improve the adhesion of joint cavity, can be used as a good conservative treatment for osteoarthritis. Intra-articular injection hormone drugs can treat inflammatory arthritis, and short-term curative effect is obvious, but due to large long-term side effects, the method is not recommended now. Intra-articular injection of analgesic drugs and other drugs have both advantages complications. The efficacy of intra-articular injection drugs in orthopedics is obvious; meanwhile, this method has some complications. Orthopedic surgeons should select related drugs by indications. We still need to further make reasonable regimen with intra-articular injection drugs in future large-scale study. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Arthroplasty, saddle prosthesis and allograft in the treatment of bone tumors around the hip Wan Chang-tao, Ming Jiang-hua, Peng Hao 2014, 18 (31):  5070-5079.  doi: 10.3969/j.issn.2095-4344.2014.31.026 Abstract ( 292 )   PDF (554KB) ( 415 )   Save BACKGROUND: The region around the hip is a bone tumor predilection site. It is difficult to conduct tumor resection due to the involvement of weight loading area. Tumor resection requires high surgical technique. The pelvis and hip are often needed to be rebuilt. OBJECTIVE: To compare the effects of three reconstruction methods after tumor resection around the hip. METHODS: From January 2007 to December 2012, 20 patients with bone tumors around the hip were treated by surgery in the Zhongshan Hospital, Wuhan University, including 7 benign tumors, 13 borderline and malignant tumors. Eight patients received allograft. Eight patients received arthroplasty. Four patients received saddle prosthesis. RESULTS AND CONCLUSION: A total of 20 patients were followed up for 5 to 60 months (averagely 40 months). According to Enneking evaluation criterion, the operative outcome was evaluated as excellent in 8 cases, good in 5 cases, average in 4 cases, and poor in 3 cases. Excellent and good rate was 65%. Results suggested that after excision of bone tumors, allograft, arthroplasty or saddle prosthesis can significantly elevate patient’s survival rate, improve patient’s living quality and is an effective therapy for treating tumors around the hip. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Low molecular weight heparins versus rivaroxaban for prevention of lower extremity deep venous thrombosis following surgery of bone metastases Qi Dian-wen, Zhang Guo-chuan, Hu Wen-hai, Hu Tong-yu, Guo Chang-zhi, Zhao Ming, 2014, 18 (31):  5080-5084.  doi: 10.3969/j.issn.2095-4344.2014.31.027 Abstract ( 413 )   PDF (664KB) ( 696 )   Save BACKGROUND: The risk of lower extremity deep venous thrombosis was high in patients with bone metastases. Major surgery is a major risk factor for thrombosis. There was no standard prophylactic regimen available. OBJECTIVE: To investigate the efficacy and safety of low molecular weight heparins versus rivaroxaban in the postoperative prevention of lower extremity deep venous thrombosis in patients with bone metastases. METHODS: From January 2010 to December 2013, a total of 73 patients with bone metastasis in spine, pelvis and lower extremities, who underwent open surgery in the Department of Musculoskeletal Tumor, Third Hospital, Hebei Medical University, China, were retrospectively analyzed. The patients were divided into low molecular weight heparins group (n=41) and rivaroxaban group (n=32) according to the prophylactic drugs after surgery. RESULTS AND CONCLUSION: Nine cases (22%) in the low molecular weight heparins group were found lower extremity deep venous thrombosis, and six cases (19%) in the rivaroxaban group suffered from lower extremity deep venous thrombosis, showing no significant differences (χ2=0.11, P=0.74). The incidences of bleeding events in both groups were respectively 7.32% and 6.25%, showing no significant differences (correctionχ2=0.083, P > 0.05). There were no significant differences regarding the levels of platelet, activated partial thromboplastin time and prothrombin time between both groups preoperatively or postoperatively (P > 0.05).   Therefore, the efficacy and safety of low molecular weight heparins and rivaroxaban in the postoperative prevention of lower extremity deep venous thrombosis were similar. Both could effectively reduce the incidence of deep venous thrombosis, with a relative low risk of bleeding. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics