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24 September 2014, Volume 18 Issue 40 Previous Issue    Next Issue

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Tranexamic acid injection through articular cavity and discontinuous clip pipe after total hip arthroplasty: changes in bleeding amount Fan Fu-cheng, Gui Bin-jie 2014, 18 (40):  6397-6402.  doi: 10.3969/j.issn.2095-4344.2014.40.001 Abstract ( 610 )   PDF (667KB) ( 1028 )   Save BACKGROUND: With the increased number of patients with total hip arthroplasty, blood source became less gradually. Simultaneously, the risk of a variety of serious diseases infected by blood transfusion troubled the patients. Thus, it is very important to find a method that can reduce blood transfusion and did not increase risk. There are reports addressing the application of tranexamic acid to reduce bleeding during total knee, total hip arthroplasty and spinal surgery.  OBJECTIVE: To explore the effects of injection with tranexamic acid through articular cavity and discontinuous clip pipe on blood loss, functional recovery and complication after total hip arthroplasty. METHODS: A total of 99 patients, who received total hip arthroplasty because of femoral fracture or coxarthropathy from January 2011 to February 2014, were selected in this study. They were divided into tranexamic acid group (n=55) and control group (n=44). After skin suture, patients in the tranexamic acid group were injected with 2.0 g tranexamic acid dissolved in 20 mL physiological saline through articular cavity. After replacement, the drainage was opened after 2 hours of interval. From then on, the drainage was opened for 10 minutes every 4 hours. Patients in the control group received discontinuous clip pipe. Negative pressure drainage tube was pulled out at 48 hours after replacement. Blood loss, the number of blood transfusion, blood transfusion volume, 24-hour postoperative hemoglobin and hematocrit, preoperative, 3-hour postoperative fibrinogen, prothrombin time and activated partial thromboplastin time, 6-month postoperative hip Harris score and lower extremity deep vein thrombosis or pulmonary embolism were compared between the two groups. RESULTS AND CONCLUSION: Significant differences in blood loss, the number of blood transfusion, blood transfusion volume, 24-hour postoperative hemoglobin and hematocrit were visible after replacement in patients of both groups (P < 0.05). Blood loss, the number of blood transfusion, blood transfusion volume, 24-hour postoperative hemoglobin and hematocrit were better in the tranexamic acid group than in the control group. No significant difference in preoperative, 3-hour postoperative fibrinogen, prothrombin time and activated partial thromboplastin time was detectable between the two groups (P > 0.05). No significant difference in 6-month postoperative hip Harris score was found between the two groups (P > 0.05). No lower extremity deep vein thrombosis was observed using Doppler ultrasonography at 3, 10 and 14 days after replacement in 99 patients. Lower extremity deep vein thrombosis or pulmonary embolism was not detected at 6 months after replacement. Above data indicated that injection with tranexamic acid through articular cavity and discontinuous clip pipe after total hip arthroplasty could obviously decrease postoperative blood loss and blood transfusion, and did not increase the risk of lower extremity deep vein thrombosis. 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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Prevention of early posterior dislocation after total hip arthroplasty: significance of repairing posterior joint capsule and external rotators Lin Qi-yi, Li Yu-mao, Xie Xiao-yong, Zhang Yu-jiu, Lin Zhi-jun 2014, 18 (40):  6403-6407.  doi: 10.3969/j.issn.2095-4344.2014.40.002 Abstract ( 594 )   PDF (801KB) ( 990 )   Save BACKGROUND: Primary dislocation after total hip arthroplasty is a major complication, besides prosthesis loosening. It is controversial whether joint capsule and external rotators should be repaired during total hip arthroplasty through posterolateral approach. OBJECTIVE: To explore the clinical significance of joint capsule and external rotator repair on preventing hip dislocation after primary total hip arthroplasty through posterolateral approach. METHODS: Clinical data of patients with primary or secondary hip osteoarthritis after primary total hip arthroplasty through posterolateral approach were retrospectively analyzed. They were assigned to two groups according to different strategies of soft tissue repair. Control group did not receive posterior soft tissue repair. Combined repair group received the repair of joint capsule and short external rotators. All patients were followed up for more than 1 year. Early dislocation was defined as the dislocation occurred within 1 year after operation. The effects of different repair methods on early dislocation rate were compared. RESULTS AND CONCLUSION: There were 362 patients. Totally 390 case-times of primary total hip arthroplasty were included. Early dislocation occurred in 7 cases, of which 6 case-times in the control group (2.2%, 6/268), and 1 case-time in the repair group (0.8%, 1/122). There were significant differences in the incidence rate of early dislocation between the repair group and control group (P=0.012). These findings confirmed that the combined repair of posterior joint capsule and short external rotators could decrease the rate of early dislocation after primary total hip arthroplasty through posterolateral approach. 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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Adult bilateral Crowe type-IV developmental dysplasia of the hip: is the prosthesis an optimal therapeutic strategy? Sun Xiao-liang, Wu Liang, Wu Guo-feng, Zhou Jian, Wang Kun, Zhang Jian-wei, Zhou Li-ping,Gong Zong-ming, Tang Zhen-yu 2014, 18 (40):  6408-6412.  doi: 10.3969/j.issn.2095-4344.2014.40.003 Abstract ( 598 )   PDF (679KB) ( 970 )   Save BACKGROUND: Crowe type-IV developmental dysplasia of the hip presented complete dislocation of the femoral head, significantly shortening lower limb, serious adverse development of upper segment of acetabulum and femur, and even deformity. At present, there are no reports concerning its therapeutic strategy. OBJECTIVE: To explore the therapeutic strategy of adult bilateral Crowe type-IV developmental dysplasia of the hip.  METHODS: A total of 12 cases of adult bilateral Crowe type-IV developmental dysplasia of the hip, who were treated in the Department of Orthopedics, The First People’s Hospital of Changzhou from January 2000 to January 2013, were collected. There were 5 males and 7 females, at the age of 19-47 years old, averagely 33.5 years old. After two or three weeks of skeletal traction, they received bilateral total hip arthroplasty. Hip rotation center was reconstituted at the level of the “true” acetabulum. The subtrochanteric osteotomy was performed for patients with reduction difficulty. For patients with femoral neck anteversion > 40°, subtrochanteric rotary osteotomy was performed.  RESULTS AND CONCLUSION: Disappearance of hip pain, satisfied move function and normal gait were gained after operation. Lower limbs recovered to be isometric. The average leg lengthening was 3.1 cm (range, 2.5 to 4.8 cm).One patient affected sciatic nerve irritation. The average followed-up time was 3.5 years. No fracture, dislocation or loosening of the prosthesis appeared. The post-operative Harris Hip Score averaged 86.3. By reconstruction of the hip rotation center in the “true” acetabular level, correction of femoral neck anteversion, reconstruction of function of the abduction muscle and proper selection of prosthesis, total hip arthroplasty for adult bilateral Crowe type-IV developmental dysplasia of the hip could obtain good curative effects. 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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Design and fabrication of uncemented femoral prosthesis using CAD/CAM/Robotic integration method Han Wen-long, Zhu Jian-fei, Wu Qi, Liu Chang-hua, Wang Ai-min, Xi Wen-ming 2014, 18 (40):  6413-6418.  doi: 10.3969/j.issn.2095-4344.2014.40.004 Abstract ( 450 )   PDF (689KB) ( 709 )   Save BACKGROUND: In total hip replacements, aseptic loosening of uncemented femoral hip prosthesis is the main reason for the failure of artificial hip replacement, the prerequisite of reducing aseptic loosening of prosthesis is to increase filling area of femoral prosthesis in femoral cavity. OBJECTIVE: To obtain the filling rate of customized femoral prosthesis in femoral cavity and verify the validity of the methods of CAD/CAM/Robotic integration and the robot grind. METHODS: In this paper, the CT data of femur were used to reconstruct three-dimensional model of femoral cavity. According to this model, a custom uncemented femoral hip prosthesis was designed, then the model of this custom prosthesis was imported into the CAD/CAM/Robotic software to generate cut path. After the cut path was imported into the robotic controller, the custom prosthesis can be fabricated, then this custom prosthesis was inserted into the femoral cavity, and the filling result of the custom prosthesis in femoral cavity was analyzed. RESULTS AND CONCLUSION: The experiment results showed that the customized prosthesis in femoral cavity achieved good filling result, the structure of femoral cavity resisted the rotation of the customized prosthesis in femoral cavity, and the customized prosthesis obtained stable fixation in the femoral cavity. 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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Extended trochanteric osteotomy combined with long-stem cementless prosthesis in hip revision Zhou Wei, Liu Dong-hai, Xu Zhen-wei, Wu Deng-ke, Zhao Shi-yang 2014, 18 (40):  6419-6424.  doi: 10.3969/j.issn.2095-4344.2014.40.005 Abstract ( 727 )   PDF (598KB) ( 879 )   Save BACKGROUND: Extraction of a well fixed cementless femoral stem or a cemented stem is difficult during revision of total hip arthroplasty. The extended trochanteric osteotomy provides excellent methods, and combining with long-stem cementless prosthesis can better reduce postoperative complications. OBJECTIVE: To retrospectively analyze the recent clinical curative effect after extended trochanteric osteotomy combined with long-stem cementless prosthesis in hip revision. METHODS: A total of 25 patients undergoing hip revision were selected from the Department of Osteoarthrosis, Pingdingshan First People’s Hospital, China from May 2008 to May 2013. Of them, 17 patients were subjected to the extended trochanteric osteotomy combined with single-incision and double-approaches. The femurs were reconstructed with long-stem cementless prosthesis. All patients were followed-up for 12 to 60 months. Pre-operative and post-operative Harris hip scores, the post-operative complications, the bone cutting length, the length of stem in contact with cortical bone, the length of the end of bone cutting to the end of the prosthesis were recorded. RESULTS AND CONCLUSION: 17 patients were followed-up. The mean length of bone was 17 cm (15-23 cm). The mean length of stem in contact with cortical bone was 6.4 cm (4-11 cm). The mean length of the end of bone to the end of the prosthesis was 11.5 cm (8-18.5 cm). After follow-up, the mean Harris hip scores were improved from (39.0 ± 13.6) scores preoperatively to (75.0 ± 14.9) scores postoperatively (P < 0.01). Subsidence occurred in two hips. The cutting sites of 17 cases of extended trochanteric osteotomy were fixed well. These data suggested that the operation through single-incision and double-approach to the hip, while preserving the attachment of the external rotators and posterior capsule, will strength rear hip stability and prevent postoperative dislocations. Recent effects were satisfactory, but the long-term outcomes should be further investigated. 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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Design features and clinical results of anatomic femoral stem in total hip arthroplasty Jiang Tao, Sun Jun-ying, Zha Guo-chun, You Zhen-jun, Wang Tao 2014, 18 (40):  6425-6431.  doi: 10.3969/j.issn.2095-4344.2014.40.006 Abstract ( 1115 )   PDF (808KB) ( 922 )   Save BACKGROUND: Ribbed anatomic femoral stem meets the biomechanical features of the femur, and has achieved satisfactory clinical efficacy with good initial stability, rapid bone growth and low stress shielding. OBJECTIVE: To evaluate the design features and clinical results of the cementless anatomic Ribbed femoral stem (Ribbed stem) in total hip arthroplasty. METHODS: We retrospectively analyzed 52 patients (52 hips) with hip joint disease who were treated with Ribbed stem in total hip arthroplasty between March 2010 and March 2012. There were 20 males and 32 females. The mean age was 59 years (range 22-78 years). The mean follow-up was 3.1 years (range 2-4 years). The preoperative and postoperative Harris hip scores, the rate of postoperative thigh pain, the incidence of intraoperative femoral fracture, wound healing, dislocation and revision were recorded. Radiographic evaluation was used to evaluate the rate of stem fill, subsidence of femoral stem, periprosthetic radiolucent line, bone ingrowth, stress shielding, and osteolysis. RESULTS AND CONCLUSION: The incidence of intraoperative femoral fracture was 6%. All incisions were healed. There were no cases of hip dislocation and revision; the rate of thigh pain was 6%, no patient had thigh pain after 1 year postoperatively. The mean preoperative Harris hip score was 48 points, which improved to a mean of 96 points at the final follow-up. Postoperative X-ray showed that all patients had a satisfactory femoral fill in both planes and all of the femoral stems were well-fixed at the final follow-up. The average filling rate was 91%, 88% and 86% by normotopia imaging, while 88%, 85% and 81% by lateral imaging, at the metaphysic, middle and distal ends respectively. At the final follow-up, 49 hips (92%) showed stable bone ingrowth, 3 hips showed stable fiber ingrowth. No osteolysis around the components at the femur or acetabulum was observed. 5 (10%) hips appeared the subsidence of femoral stems, which were < 2 mm. The stress shielding phenomenon occurred in all patients, including first-degree in 31 hips, second-degree in 19 hips, third-degree in 2 hips, and fourth-degree in no case. Experimental findings indicate that, Ribbed stem with a rational design can achieve satisfactory clinical outcomes with good initial stability, rapid bone growth and low stress shielding. 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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Prosthesis size in total knee arthroplasty predicted using digital pre-operative plan Hu Han-sheng, Wang Jing-cheng, Xiong Chuan-zhi, Yan Lian-qi, Wang Qiang, Chen Gang 2014, 18 (40):  6432-6437.  doi: 10.3969/j.issn.2095-4344.2014.40.007 Abstract ( 326 )   PDF (721KB) ( 717 )   Save BACKGROUND: Differences of knee anthropometry between individuals are significant, while preoperative templating is not accurate in predicting the prosthesis size. OBJECTIVE: To improve the accuracy of pre-operative plan in predicting the prosthesis size in total knee arthroplasty using digital technologies. METHODS: Between January 2013 and May 2004, 50 patients (20 men and 30 women; aged 54-82 years; mean age, 67.8 years) received primary total knee arthroplasty for osteoarthritis and were retrospectively analyzed. According to the treatment, the patients were divided into two groups. The digital group, a series of 21 patients, underwent 64-row MDCT before total knee replacement. CT images were imported into Mimics, and three-dimensional models of femur and tibia were reconstructed. Then, computer-aided design files of different sizes of prostheses provided by the manufacturers were imported into Mimics, too. Surgical simulation of osteotomy and prostheses implantation were performed in Mimics, component size was determined by the contour of distal femur and proximal tibia. The control group, a series of 29 patients, underwent primary total knee arthroplasty using conventional approaches. The agreement between preoperative plan and the actual prosthesis size was assessed during the surgery. Postoperative X-ray of low limb was taken to evaluate the accuracy of sizing and the efficacy of digital technologies was assessed. RESULTS AND CONCLUSION: The intraoperative and postoperative evaluation showed inaccurate sizing of  femoral and tibial components in 1 case in digital group and in 11 cases in conventional group. The accuracy of prediction was 95% in digital group and 62% in conventional group, with significant differences between the two groups (P < 0.05). Four overhanging and two notching cases were observed in conventional group, but none in digital group. The digital technologies provide an effective means for accurate prediction of prosthesis size and personalized surgical simulation. 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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The quality of life and curative effect among elder patients after total knee replacement surgery for severe knee osteoarthritis Xia Run-fu, Li Jian-feng, Yan Jin-yu, Zhang Shu-lian 2014, 18 (40):  6438-6443.  doi: 10.3969/j.issn.2095-4344.2014.40.008 Abstract ( 459 )   PDF (698KB) ( 824 )   Save BACKGROUND: Total knee replacement is regarded an effective treatment of knee osteoarthritis, based on the transformation of biology-psychology-social medicine pattern, the concept of “quality of life” has attracted increasing concerns. OBJECTIVE: To observe the effects of total knee replacement surgery on the pain, function and quality of life among elder patients with severe knee osteoarthritis. METHODS: A total of 102 elder patients with severe knee osteoarthritis were recruited from the Second Affiliated Hospital of Inner Mongolia Medical University between January 2010 and January 2013. The clinical manifestations and 12-month follow-up outcomes were observed and recorded. The involved patients were randomly divided into two groups: treatment group (59 cases, receiving total knee replacement) and control group (43 cases, receiving expectant treatment such as drugs, but no surgery). Patients were evaluated using HSS scale and WHOQOL-100 scale before surgery and 12 months after surgery. Furthermore, the correlation between influencing factors and HSS and WHOQOL-100 scores was analyzed. RESULTS AND CONCLUSION: At 12 months postoperatively, the HSS scores of patients in treatment group was (82.03±10.17) points, which was obviously higher than that in control group (P < 0.01). The WHOQOL-100 scores in treatment group were also significantly higher than that in control group (P < 0.01). The psychology sub-item scores of patients after total knee replacement were close to that of normal controls (P > 0.50). The regression analysis shows that marital status (β=1.988), complication (β=2.035) and HSS scores (β=2.108) are the main influencing factors for the quality of life among patients undergoing replacement. Experimental findings indicate that, HSS score is an effective indicator to assess the effect of total knee replacement on the pain and function of elder patients with severe knee osteoarthritis. WHOQOL-100 is introduced to further improve the assessment of quality of life after total knee replacement surgery in severe knee osteoarthritis. The marital status, complication and HSS scores are the key influencing factors for the quality of life among severe knee osteoarthritis patients. Deep vein thrombosis affects the out-of-bed time, and the mate-accompanying during the follow-ups plays a positive role on the quality of life and mental state of patients. 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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Treatment options and efficacy evaluation for multilevel cervical spondylotic myelopathy Hou Zeng-tao, Zhao Ai-lin, Guo Chuan-you, Chen Bo-hua 2014, 18 (40):  6444-6450.  doi: 10.3969/j.issn.2095-4344.2014.40.009 Abstract ( 420 )   PDF (688KB) ( 655 )   Save BACKGROUND: Operation is an important measure to improve the function of spinal cord and to stop the pathological progress of multilevel cervical spondylotic myelopathy. There are controversies how to select the optimum operation mode, to reduce postoperative complications and to elevate clinical curative effects. OBJECTIVE: To systematically review patients’ profiles of multilevel cervical spondylotic myelopathy, and to evaluate the effects of simple anterior approach, simple posterior approach and one stage posterior anterior combined approach on cervical spinal curvature index and functional recovery in patients. METHODS: 148 sample profiles of patients, who received multilevel cervical spondylotic myelopathy operation in The Affiliated Hospital of Qingdao University and Qingdao Municipal Hospital from February 2000 to February 2008, and met the inclusion and exclusion criteria, were selected. They were divided into simple anterior approach group, simple posterior approach group and one stage posterior anterior combined approach group. The differences in the functional recovery were assessed after treatment using different therapeutic methods. RESULTS AND CONCLUSION: Cervical spinal curvature index was highest in the simple posterior approach group before treatment (P < 0.01). Cervical spinal curvature index was highest in the one stage posterior anterior combined approach group after treatment (P < 0.01). Changes in cervical spinal curvature index were most obvious in the simple anterior approach group before and after treatment (P < 0.01). No significant difference in Japanese Orthopaedic Association Scores was detected among three groups after treatment (P > 0.05). Significant differences in improvement rate of Japanese Orthopaedic Association Scores were detectable after treatment between the one stage posterior anterior combined approach group and simple anterior approach and simple posterior approach groups (P < 0.001). Significant differences in cervical dysfunction index and SF-36 scores were detectable among the three groups before and after treatment (P < 0.05). Results indicated that compared with the simple anterior approach and simple posterior approach, decompression through one stage posterior anterior combined approach is a reliable and effective operative procedure for treatment of multilevel cervical spondylotic myelopathy. 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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Pedicle screw paraspinal muscle approach versus posterior median approach fixation for thoracolumbar fractures: comparison of the stability Zhang Zhao-chuan, Ma Chao, Wu De-hui, Wu Ji-bin, Dai Wei-xiang, Wang Zhao-hong, Han Meng,Feng Jie, Liu Guang-pu 2014, 18 (40):  6451-6458.  doi: 10.3969/j.issn.2095-4344.2014.40.010 Abstract ( 456 )   PDF (915KB) ( 643 )   Save BACKGROUND: Spinal posterior surgery is the most common treatment method for thoracolumbar fracture. During exposure of conventional posterior surgery, a wide-range stripping and pulling of paraspinal muscles easily induced failure syndrome of lumbar surgery. OBJECTIVE: To compare the reset conditions and stability of thoracolumbar fractures after treatment with pedicle screw paraspinal muscle approach and conventional posterior median approach fixation. METHODS: A total of 62 patients with thoracolumbar fractures without nerve injury were retrospectively analyzed. 22 patients were treated with paraspinal muscle approach and general spine system. 21 patients were treated with conventional median approach and general spine system. 19 patients were treated with conventional median approach and AF internal fixation system. The therapeutic effects of the three kinds of fixation methods were compared by comparing clinical indexes in patients of the three groups, including operation time, intraoperative blood loss, postoperative drainage, dead space volume, scores of the Visual Analogue Scale of back pain, wound complications, height of injured vertebrae and the Cobb angle. RESULTS AND CONCLUSION: Operation time, intraoperative blood loss, postoperative drainage and dead space volume were better in the paraspinal muscle approach and general spine system group than in the conventional median approach and general spine system group and conventional median approach and AF internal fixation system group (P < 0.05). No significant difference in height of injured vertebrae and the Cobb angle was detectable among the three groups at 3 days after fixation (P > 0.05). No significant difference in scores of the Visual Analogue Scale of back pain was visible among the three groups at 1 week after fixation (P > 0.05). The scores of the Visual Analogue Scale of back pain were apparently lower in the paraspinal muscle approach and general spine system group than in the conventional median approach and general spine system group and conventional median approach and AF internal fixation system group at 3 and 6 months after fixation. No incision infection was observed in patients of the three groups. These results suggested that compared with conventional posterior median approach, paraspinal muscle approach has some advantages, such as small trauma, less bleeding, postoperative rapid recovery, and high degree of satisfaction. The effects of general spine system and AF internal fixation system in the repair of thoracolumbar fractures on internal fixation are similar, but general spine system has some advantages such as simple to be operated, save time, less bleeding, stable fixation and good reduction. General spine system combined with paraspinal muscle approach is a good method to repair thoracolumbar spine 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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Anterior plate internal fixation and autologous iliac bone graft fusion in the repair of thoracic spinal tuberculosis: bone healing Huang Jiang, Li Xiao-feng, Yang Yuan 2014, 18 (40):  6459-6463.  doi: 10.3969/j.issn.2095-4344.2014.40.011 Abstract ( 456 )   PDF (758KB) ( 864 )   Save BACKGROUND: Thoracic vertebrae connected with the ribs of corresponding segments constitute the thorax. Because of thoracic vertebrae deeply and complicated structure, it is difficult to operate or to expose thoracic vertebrae completely. The traditional anterior ways can thoroughly remove the focus and achieve a good internal fixation, but this treatment needs to cut the rid. The surgeon discovered in years of clinical practice that distraction of intercostal space without cutting off the ribs could completely remove the focus and achieve fixation and fusion. OBJECTIVE: To explore the feasibility, advantages and disadvantages of anterior plate fixation and autologous bone graft fusion in the repair of thoracic spinal tuberculosis. METHODS: A total of 30 cases of thoracic spinal tuberculosis were enrolled. On the base of traditional thoracic spinal anterior surgical approach, the rib was reserved. Anterior distraction device was used to open the ribs for clearance and to move the focus of thoracic spinal tuberculosis. Autologous ilium was obtained and subjected to fusion and anterior plate fixation. Visual Analog Scale, Oswestry Disability Index, Frankel grade and Bridwell bone healing rating were used before and after treatment. RESULTS AND CONCLUSION: A total of 30 patients were followed up for 3-60 months. The bone healing (class A) was seen, but no fistula formation was visible. Nerve compression symptoms were improved, without aggravating cases. Postoperatively, the average Cobb angle correction was 10.32°. After 6 months, imaging revealed bone fusion of affected vertebral body. After 18 months, the vertebral height was not lost obviously, no recurrence of vertebral tuberculosis. These results indicated that anterior intercostal space without cutting ribs exposed clearly, showing a large space, where can meet the requirement of first-stage debridement fixation and fusion in the repair of thoracic tuberculosis. The pathological changes were visibly clear; the focus was thoroughly removed, and the ribs were reserved. The outcomes are identical to rib resection. Simultaneously, autogenous iliac trilateral cortex has good supporting effects. Loose cancellous bone mesh has good osteogenesis and is helpful to bone healing. 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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Extreme lateral lumbar disc herniation after pedicle screw fixation and interbody fusion cage: lumbar stability at long-tem follow-up   Shi Rui-ming, Li Guo-sheng, Zhang Yi-feng, Huang Zhen-yuan, Sun Li, Wang Cun 2014, 18 (40):  6464-6470.  doi: 10.3969/j.issn.2095-4344.2014.40.012 Abstract ( 499 )   PDF (1014KB) ( 618 )   Save BACKGROUND: Extreme lateral lumbar disc herniation is a rare type of lumbar disc herniation, there are a variety of treatment methods, but the therapeutic efficacy and recurrence rate are controversial. OBJECTIVE: To investigate the availability of lumbar pedicle screw fixation combined with interbody fusion cage for treating extreme lateral lumbar disc herniation. METHODS: We retrospectively analyzed 19 patients with extreme lateral lumbar disc herniation after treatment with lumbar pedicle screw fixation combining with interbody fusion cage from March 2006 to January 2009. The outcomes were evaluated depending on VAS scoring standard and Macnab scoring standard, lumbar stability were observed postoperatively. We analyzed the spinal stability in recurrent lumbar disc herniation patients after lumbar pedicle screw fixation combined with interbody fusion cage depending on literature search. RESULTS AND CONCLUSION: All the 19 patients were followed up for 13 months to 3 years, the leg and lumbar pain of all the patients were relieved to varying degrees. Preoperative VAS score was 7.3±1.28 points and postoperative VAS score was 2.1±0.8 points, showing significant difference between two groups (P < 0.05). The excellent and good rate was up to 95% with 15 excellent results, 3 good results and 1 acceptable result depending on Macnab evaluation standard. There was no pedicle screw loosening, broken, non-fusion phenomenon. All the lumbar interbody fusions were good. No one occurred secondary lumbar spinal stenosis. Experimental findings indicate that, lumbar pedicle screw fixation combined with interbody fusion cage for extremely lateral lumbar disc herniation, is characterized as fast symptom relief, strong fixation and good lumbar stability. 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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Posterior pedicle screw system in repair of degenerative lumbar scoliosis with stenosis: correction rate and Cobb angle recovery Wang Lei, Qi Rong, Kang Quan-ming, Liu Li-min, Chen Hua, Wang Kai 2014, 18 (40):  6471-6475.  doi: 10.3969/j.issn.2095-4344.2014.40.013 Abstract ( 427 )   PDF (812KB) ( 622 )   Save BACKGROUND: Simple spinal decompression for lumbar degeneration-induced lumbar scoliosis spinal stenosis is difficult to obtain long-term efficacy. Because simple decompression is considered an iatrogenic lumbar instability, and can aggravate lumbar deformity. Posterior lumbar pedicle screw fixation combined with decompression and fusion obtained good curative effects in patients. OBJECTIVE: To investigate the clinical efficacy of posterior decompression, internal fixation, and bone graft fusion with posterior pedicle screw system in the treatment of degenerative lumbar scoliosis with stenosis. METHODS: A retrospective analysis was performed in 18 patients with degenerative lumbar scoliosis with stenosis who received surgical treatment from February 2009 to November 2012. These patients consisted of 6 males and 12 females, with a mean age of 62.2 years (range, 48-80 years). They had lumbar scoliosis with a mean Cobb angle of 28.6° and underwent posterior decompression, internal fixation, and bone graft fusion.  RESULTS AND CONCLUSION: All the 18 patients achieved satisfactory follow-up. The mean follow-up was 22 months. All patients were satisfied with treatment outcomes and had improved quality of life. The mean correction angle was 13.7° (range, 6.0°-28.4°) after operation. There was no failure of internal fixation, and no infected cases were found. These data inducated that posterior decompression, internal fixation, and bone graft fusion is one of the effective methods for treating degenerative lumbar scoliosis with stenosis. 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 effect of lumbar dynamic fixation for treatment of lumbar disc herniation Ming Jiang-hua, Zhao Qi, Yang Bin, Zheng Hui-feng 2014, 18 (40):  6476-6481.  doi: 10.3969/j.issn.2095-4344.2014.40.014 Abstract ( 553 )   PDF (389KB) ( 753 )   Save BACKGROUND: Currently, one of common methods is discectomy, nerve root decompression and fusion rigid fixation from the midline approach for disc herniation which is inefficient by conservative treatments. Thus, it is causing degeneration and limiting lumbar physiological activity of adjacent segments. The treatment of non-fusion lumbar disc herniation with the traditional posterior midline incision approach has some disadvantages such as big incision, wide peeling, and back muscle denervation. OBJECTIVE: To observe therapeutic effects of dynamic stabilization system through Wiltse approach on lumbar disc herniation, and to compare the outcomes with traditional posterior approach. METHODS: A total of 46 patients, who had undergone discectomy and internal fixation using dynamic stabilization systems for lumbar disc herniation at the Renmin Hospital of Wuhan University from January 2011 to January 2013, were enrolled in this study. The operation was performed through the traditional posterior approach in 25 patients and Wiltse approach in 21 patients. RESULTS AND CONCLUSION: All 46 patients were followed up for 7 to 31 months (averagely, 13.8±2.4 months). The length of incision, intraoperative blood loss, and postoperative drainage amount were less in the Wiltse approach group than in the traditional posterior approach group (P < 0.05). No significant difference in visual analog scale scores and operative time was detected between the two groups at 1 week and 6 months after fixation (P > 0.05). Radiographs revealed that the position of implants was good in all patients, no loosing or breakage. These data verified that the early effect of dynamic stabilization system through Wiltse approach for lumbar disc herniation is similar to that of traditional posterior approach. 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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Implantation of plate and hollow screw for the repair of the split fracture of greater tuberosity of humerus: comparison of shoulder joint function    Wang Guang-yong, Du Jun-sheng, Zhong Bing 2014, 18 (40):  6482-6487.  doi: 10.3969/j.issn.2095-4344.2014.40.015 Abstract ( 540 )   PDF (722KB) ( 664 )   Save BACKGROUND: Canada Montreal Scholar Mutch et al have recently proposed a new morphologic classification of fracture of greater tuberosity of humerus. They divided these fractures into three types: avulsion, split and depression. OBJECTIVE: To compare the recovery of shoulder function after conventional plate-screw and hollow-screw fixation for the repair of the split fracture of greater tuberosity of humerus. METHODS: Patients with greater tuberosity of humerus, who were treated in the Department of Orthopedics of Yichang Yiling Hospital, China from January 2010 to January 2014, were classified according to Mutch’s classification. A total of 83 patients with split greater tuberosity of humerus after complete follow-up were retrospectively analyzed. Of them, 23 cases received plate-screw fixation as plate-screw group, and 60 cases received hollow-screw fixation as hollow-screw group. Visual Analog Scale, the United States Scores of Shoulder and Elbow Surgeons, and Constant and Murley Scoring Systems were utilized to assess the therapeutic outcomes. Patient’s pain and changes in shoulder function were analyzed before and after treatment. RESULTS AND CONCLUSION: A total of 83 patients were followed up. Fixator was obtained at 1 year after surgery in all patients. No significant difference in Visual Analog Scale, the United States Scores of Shoulder and Elbow Surgeons, and Constant and Murley Scoring Systems was detected in both groups before treatment (P > 0.05). Significant differences in Visual Analog Scale, the United States Scores of Shoulder and Elbow Surgeons, and Constant and Murley Scoring Systems were detectable in both groups at 16 months after removal of the fixator (P < 0.05). Data were better in the hollow-screw group than in the plate-screw group. Above results suggested that hollow-screw fixation in the repair of split fracture of greater tuberosite of humerus is simple to be operated, with small trauma, and is an ideal fixation method. Clinical repair effect is better than plate-screw fixation. 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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Double steel plate and Y-type steel plate for intercondylar humeral fractures: the selection of surgical approach Liu Xiu-xin, Wang Chong, Ren Zheng 2014, 18 (40):  6488-6494.  doi: 10.3969/j.issn.2095-4344.2014.40.016 Abstract ( 590 )   PDF (2018KB) ( 664 )   Save BACKGROUND: With the development of AO, the treatment of intercondylar humeral fractures with open reduction has been a trend. However, the methods of fixation become many. There is no conclusion of which method is optimal. OBJECTIVE: To investigate the clinical effect of two kinds of different fixation methods (Y-type steel plate and double steel plate) for intercondylar humeral fractures via different surgical approaches. METHODS: A retrospective analysis of clinical data of 86 cases of fresh intercondylar humeral fractures in the Department of Orthopedics, Sixth Affiliated Hospital, Xinjiang Medical University, between December 2003 and May 2014 were conducted in this study. According to the different fixation materials, patients were divided into two groups: double steel group (n= 44, including the surgical approach of ulna olecranon osteotomy which had 22 cases and the surgical approach of triceps V shaped severance which had 22 cases), Y-type steel group (n=42, including the surgical approach of ulna olecranon osteotomy which had 21 cases and the surgical approach of triceps V shaped severance which had 21 cases). The clinical curative effect and related complications of the two groups after operation were analyzed. During follow-up, modified Cassebaum elbow scoring system was used to evaluate the excellent and good rate of therapy. RESULTS AND CONCLUSION: After followed up for 12-36 months, the total excellent and good rate of Y-type steel plate was 76% and the total excellent and good rate of double steel plate was 77%. There were no significant differences between the two groups (P > 0.05). But interestingly, the surgical approach of ulna olecranon osteotomy was better than the surgical approach of triceps V shaped severance and the difference was statistically significant (P < 0.05). Above data suggested that Y-type steel plate and double steel plate were effective ways in the repair of intercondylar humeral fractures. However, for different surgical approaches, the surgical approach of ulna olecranon osteotomy was better than the surgical approach of triceps V shaped severance. 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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New-style bone holder versus reduction forceps in treatment of clavicular fracture Fu Zi-xin, Liu Kai-xiang 2014, 18 (40):  6495-6500.  doi: 10.3969/j.issn.2095-4344.2014.40.017 Abstract ( 458 )   PDF (830KB) ( 675 )   Save BACKGROUND: The current fixation methods for clavicle fracture are mainly anatomy plate or reconstruction plate. The specific devices for maintaining fracture alignment and fixation are rarely reported. The majority of physicians prefer reduction forceps to maintain fracture alignment and retain plate for internal fixation. However, reduction forceps have many disadvantages, such as large damage, instable fixation and difficult to bend or mould plates. OBJECTIVE: To compare the clinical effect of new-style bone holder and reduction forceps in treatment of clavicular fractures.  METHODS: A total of 75 patients with clavicular fractures were recruited from Department of Orthopedics, Huai’an First Hospital, Affiliated to Nanjing Medical University, between December 2011 and December 2013. The involved patients were randomly divided into two groups, new-style bone holder (39 cases) and reduction forceps (36 cases). In new-style bone holder group, the wounds were opened and reduced using reduction forceps, then new-style bone holder was applied to maintain fracture alignment and internal fixation; in reduction forceps group, the wounds were opened and reduced using reduction forceps, then reduction forceps was applied to maintain fracture alignment and internal fixation. The length of incision, the time of operation, intraoperative blood loss, fracture healing time and clinical efficacy in two groups were compared.  RESULTS AND CONCLUSION: All cases were followed up for over half a year. There was no significant difference between the two groups in the length of incision (P > 0.05). The new-style bone holder group was obviously better than reduction forceps group in the time of operation, intraoperative blood loss and fracture healing time, with significant difference (P < 0.01). The clinical efficacy was significantly higher than reduction forceps group. Experimental findings indicate that, new-style bone holder is characterized by simple operation, few trauma, stable fixation, short operation time, and rapid fracture healing. 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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Treatment on femoral shaft and distal femoral fractures with intramedullary nail and locking plate: reliable internal fixation Han Jun-zhu, Zhu Xun-bing, Zhang Tao, Chen Hui 2014, 18 (40):  6501-6506.  doi: 10.3969/j.issn.2095-4344.2014.40.018 Abstract ( 477 )   PDF (720KB) ( 638 )   Save BACKGROUND: There are many reports about clinical effect of femoral fractures with intramedullary nail and distal femoral fractures with locking plate. However, there is less report about clinical effect of femoral and distal femoral fractures. OBJECTIVE: To investigate the clinical effect of femoral and distal femoral fractures using intramedullary nail combined with locking plate. METHODS: Eighteen patients with femoral and distal femoral fractures were treated by internal fixation with intramedullary nail combined with locking plate. Among them, six cases had femoral and supracondylar fractures, seven cases had femoral and condylar fractures, and five cases had femoral and intercondylar fractures. According to the AO classification, three cases were type 33A2, three cases were type 33A3, two cases were type 33B1, five cases were type 33B2, one case was type 33C1, three cases were type 33C2, and one case was type 33C3. The fractures union and complications were followed up and observed, and knee joint function was judged by HSS score. RESULTS AND CONCLUSION: All the 18 patients were followed up for 12-24 months. The time for fracture union ranged from 3 to 5 months, average 3.4 months. No infection and disunion, no fracture malunion, no internal fixation loosening and breaking, no refracture happened. The HSS score ranged from 68 to 96 points, average 86.8 points. There were 12 excellent cases, 5 good cases, and 1 common case. The excellent and good rate was 94.4%. The internal fixation using intramedullary nail combined with locking plate is a good method for treatment of femoral and distal femoral fractures, due to less surgical trauma, simple and reliable fixation, high rate of fracture healing, low rate of complications, and excellent function. 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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Compression interlocking intramedullary nail system versus dynamic hip screw extramedullary fixation in the repair of Evans V intertrochanteric fractures in the elderly Zhu Yong-chao 2014, 18 (40):  6507-6512.  doi: 10.3969/j.issn.2095-4344.2014.40.019 Abstract ( 448 )   PDF (817KB) ( 509 )   Save BACKGROUND: There are many methods of internal fixation to treat intertrochanteric fractures. Intramedullary or extramedullary fixation remains controversial. As for biomechanics, intramedullary fixation has more advantages compared with extramedullary fixation. Whether intramedullary fixation is better for treatment of Evans V type intertrochanteric fracture in the elderly? OBJECTIVE: To compare the clinical effects of intramedullary or extramedullary fixation for the treatment of Evans V type intertrochanteric fracture in the elderly. METHODS: A total of 47 patients with Evans V type intertrochanteric fracture in the elderly from Department of Orthopedics, Shenyang People’s Armed Police Corps Hospital from December 2010 to December 2013 were selected. They were separately subjected to compression interlocking intramedullary nail system and dynamic hip screw system extramedullary fixation. RESULTS AND CONCLUSION: Patients in the dynamic hip screw group were averagely followed up for 12 months, and those in the compression interlocking intramedullary nail group were averagely followed up for 10 months. Both groups reached bone healing during follow-up. After fixation, average operation time and intraoperative blood loss were less in the dynamic hip screw group than in the interlocking intramedullary nail group (P < 0.05). However, fracture healing time was significantly shorter in the anti-spin intramedullary nail group than in the dynamic hip screw group. Moreover, Harris scores revealed that hip joint function was better in the interlocking intramedullary nail group than in the dynamic hip screw group (P < 0.05). In the extramedullary group, nail loose exit was detected in one case, plate breakage in one case. In the intramedullary group, screw loose was detected in one case. Results suggested that two kinds of fixation for treating intertrochanteric fracture achieved good therapeutic effects. However, for Evans V intertrochanteric fractures in a short period, compression interlocking intramedullary nail fixation can make patients do weight-loading activities earlier before joint replacement, and hip joint function effects are better. 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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Finite element modeling and mechanical analysis for Cam-type femoroacetabular impingement Liu Qian, Wang Wan-chun, Yao Chang-hai 2014, 18 (40):  6513-6518.  doi: 10.3969/j.issn.2095-4344.2014.40.020 Abstract ( 597 )   PDF (698KB) ( 1001 )   Save BACKGROUND: Cam-type femoroacetabular impingement can impose elevated mechanical loading in the hip, and may eventually result in hip osteoarthritis, while mechanical mechanism on how this deformity leads to osteoarthritis is still unclear. OBJECTIVE: To analyze intra-articular mechanical environment of Cam-type femoroacetabular impingement in hip joint using three-dimensional finite element method, and to further understand the features of pathological mechanics.  METHODS: Three-dimensional geometry models of normal and Cam-type femoroacetabular impingement joints were constructed using Mimics and Hypermesh software with the CT data of normal hip joint. These hip models were imported into LS-DYNA analysis system, then dynamic loads and motions for standing up and sitting down were applied to all joint models. Intra-articular cartilage contact pressures and stresses were analyzed in normal hip joint and hip joint with Cam-type femoroacetabular impingement. RESULTS AND CONCLUSION: Based on CT data, models of normal hip joint and hip joint with Cam-type femoroacetabular impingement including articular cartilage for three-dimensional finite element analysis were accurately constructed. Peak contact pressures were 4.43 and 4.59 MPa at the anterosuperior region of the acetabular rim during sitting down and standing up. The peaks of Cam-type femoroacetabular impingement hip joint were 14.96 and 14.86 MPa. Peak pressures and stress concentration were found at the anterosuperior area of acetabular rim. High contact pressure at the acetabular cartilage may be the mechanical mechanism of osteoarthritis induced by Cam-type femoroacetabular impingement. 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 a normal adult’s pelvis three-dimensional finite element model based on CT image and reverse engineering method Liu Xiao-long, Wang Zhao-hui, Xiong Bo, Zeng Min-chuan 2014, 18 (40):  6519-6523.  doi: 10.3969/j.issn.2095-4344.2014.40.021 Abstract ( 710 )   PDF (685KB) ( 1068 )   Save BACKGROUND: Pelvis is the most complicated structure of human body, and many scholars have devoted themselves to its biomechanical study. However, it is difficult to construct the pelvic finite element model containing main muscles and ligaments, as a result of its irregular shape and complicated structure.  OBJECTIVE: To establish a normal human pelvis three-dimensional finite element model and provide digital model for the subsequent biomechanics analysis of pelvis. METHODS: Pelvic CT images of healthy male volunteers were stored in DICOM format and then put into Mimics 10.01 software for three-dimensional medical image reconstruction. The files were imported into reverse engineering software Geomagic studio 11 for surface processing and establishing surface model; then the surface model was introduced into finite element analysis software Ansys 14.0 for finite element meshing. RESULTS AND CONCLUSION: A normal adult pelvis three-dimensional finite element model was developed, including 818 294 units and 149 290 nodes. Based on the CT images, we established pelvic finite element model, which have good accuracy, anatomical and geometric similarity, and could provide the basis for subsequent biomechanics analysis of pelvis. 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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Three-dimensional finite element analysis on intramedullary controlled dynamic nailing for femoral shaft fracture Wang Guo-dong, Jiang Hai-bo, Zhang Yuan-min, Zhao Xiao-wei, Pan Tao 2014, 18 (40):  6524-6530.  doi: 10.3969/j.issn.2095-4344.2014.40.022 Abstract ( 628 )   PDF (765KB) ( 672 )   Save BACKGROUND: Interlocking intramedullary nail complications contain nail bent or broken, exit, re-fracture at spiketail or nail hole. Thus, our team designs a novel intramedullary controlled dynamic nail. OBJECTIVE: To evaluate the rationality and safety of intramedullary controlled dynamic nail design and strength, and to give rational proposal for its clinical application. METHODS: The three-dimensional finite element models of composite femur, transverse fractures of the femoral shaft were constructed with intramedullary controlled dynamic nailing. The stress and strain were detected under vertical loads and gait cycle. RESULTS AND CONCLUSION: The maximum stress of the intact femur under the compression load was at femoral neck and the medial and lateral aspects of the femoral shaft; while the stresses of fractured femur were at the interface between screw and screw hole. In gait cycle, in case of intact bone, large stresses were found in the distal 1/2 of anteriomedialis of femoral shaft; while the stress distribution in fractured femur was similar with the former. Intramedullary controlled dynamic nailing has the ability of generating compression between fragments. These suggest that intramedullary controlled dynamic nailing is rational and good at design and biomechanical properties. 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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Finite element analysis of anteroposterior integration fixation by posterolateral nail-stick system for thoracolumbar disorders   Wang Jian-liang, Xu Ke-feng 2014, 18 (40):  6531-6535.  doi: 10.3969/j.issn.2095-4344.2014.40.023 Abstract ( 453 )   PDF (738KB) ( 724 )   Save BACKGROUND: Currently thoracolumbar fixation techniques have its advantages and disadvantages, it is necessary to explore a new internal fixation to fix the spine effectively and conveniently. OBJECTIVE: To establish thoracolumbar (T12-L2) three-dimensional finite element model and observe the effect of anteroposterior integration fixation by posterolateral nail-stick system on thoracolumbar stability. METHODS: Based on the CT scan data of normal human T12-L2 segments, we used Geomagic 11.0, Ug 7.0, Hypermesh 10.0, Abaqus 6.9.1 software to establish a three-dimensional finite element model of T12-L2 segments. Subsequently we established nail-stick system posterior fixation, anterior fixation, posterolateral anteroposterior integration fixation model. T12 segment was given 500 N preload and 7.5 N·m torque, to simulate thoracolumbar flexion, extension, lateral bending and rotation. The average rigidity of fixed segments under different conditions were observed. RESULTS AND CONCLUSION: Three fixation models showed a higher average rigidity than normal model under different conditions. The average rigidity in anteroposterior integration fixation by posterolateral nail-stick system was increased by 13%, 28%, 11%, 17% and 9%, compared with simple posterior fixation under the conditions such as anterior flexion, lateral bending and lateral rotation, respectively. Under the posterior extension, the average rigidity was reduced by 6% than the posterior fixation. Compared with the anterior fixation, the average rigidity in anteroposterior integration fixation by posterolateral nail-stick system was reduced by 15%, 10%, and 14% under the conditions of anterior flexion and lateral bending. While the average rigidity was higher than anterior flexion under the posterior extension and lateral rotation, increasing 5%, 12% and 2%. The anteroposterior integration fixation by posterolateral nail-stick system can improve the stability of fixed segments, and the stability is higher than anterior fixation at posterior extension and lateral rotation, while higher than posterior fixation in anterior flexion, lateral bending and lateral rotation. So it is a potential fixation method. 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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Three-dimensional finite element analysis on the support and protection of spine protector for thoracic-lumbar vertebra He Jian-ying, Deng Liang, Li Chen, Wu Xiao-hui, Shu Yong, Dong Xie-ping 2014, 18 (40):  6536-6541.  doi: 10.3969/j.issn.2095-4344.2014.40.024 Abstract ( 350 )   PDF (905KB) ( 886 )   Save  BACKGROUND: Human spine protector can protect human thoracic-lumbar vertebra segments against injury, and the design and development of a novel dynamic protector needs the verification of various experimental means. OBJECTIVE: Using the three-dimensional finite element method, we evaluate the effect of spine protector and the biomechanical reaction of thoracic-lumbar vertebra under the axial loading. METHODS: The thoracic-lumbar vertebra were cut from the whole spine three-dimensional finite element model. Then the thoracic-lumbar vertebra models carrying spine protector were taken as experimental group, while the models without the protector served as control group. All the specimens were evaluated, constrained, loaded and figured out by its properties. The results of equivalent stress and strain distribution were obtained from the data. RESULTS AND CONCLUSION: In both groups, the stress was distributed at axial and posterior column of L2 when the load was applied in axial direction. According to the data obtained from the experiment, both the experimental group and the control group had achieved the maximum stress at 16 ms, 3.919 Mpa and 5.727 MPa, respectively. The statistical analysis result showed that the stress varied significantly at T12 and L2 in two groups (both P < 0.05). However, the stress distribution at T11 and L1 showed no significant difference between the two groups (both P > 0.05). Experimental findings indicate that, spine protector can significantly reduce the vertical stress of the thoracic-lumbar vertebra when falling on the ground, and share the vertical load, which is protective to thoracic-lumbar vertebra. 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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Meta-analysis of therapeutic effects of computer-assisted navigation versus conventional total knee arthroplasty    Liu Bing-gen, Pang Qing-jiang 2014, 18 (40):  6542-6547.  doi: 10.3969/j.issn.2095-4344.2014.40.025 Abstract ( 441 )   PDF (687KB) ( 618 )   Save BACKGROUND: It is still controversial whether computer-assisted navigation elevated the accuracy and clinical outcomes of total knee arthroplasty. OBJECTIVE: To analyze the literatures in English and Chinese on computer-assisted navigation total knee arthroplasty, and to evaluate the clinical outcomes between computer-assisted navigation and conventional total knee arthroplasty. METHODS: We retrieved PubMed, Ovid, Elsevier, China National Knowledge Infrastructure and Digital Library for literatures concerning randomized controlled trial of clinical outcomes of computer-assisted navigation and total knee arthroplasty published from January 1st 2005 to December 31st 2013. Meta analysis was performed with RevMan 5.0 software from the Cochrane collaboration. Clinical outcomes of computer-assisted navigation total knee arthroplasty and conventional technique were compared. The heterogeneity of data was checked. RESULTS AND CONCLUSION: A total of 16 randomized controlled papers were included in this analysis. Computer-assisted navigation group consisted of 1 322 knees, and the conventional group consisted of 1 299 knees. Compared with the conventional group, patients in the computer-assisted navigation group had a significantly lower risk of implant malalignment at more than 3° as well as more than 2°, malalignment for both coronal femoral component and coronal tibial component of > 3°, and both sagittal femoral component alignment and tibial slope at > 3° malalignment. The meta-analysis did not find a significant difference in the sagittal tibial component alignment, the rates of complications, axial (rotational) alignment of the femoral component and the tibial component between both groups. These data indicated that computer-assisted navigation group had significant improvement in alignment of the limb and the component position, but long-term clinical outcomes using computer-assisted surgery in total knee arthroplasty require further investigation. 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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Meta-analysis of plating versus intramedullary nailing for forearm shaft fractures in adults Li Lian-hua, Wang Hao, Wu Da-long, Zhang Yan, Cai Yan-hong, Liu Zhi, Sun Tian-sheng 2014, 18 (40):  6548-6552.  doi: 10.3969/j.issn.2095-4344.2014.40.026 Abstract ( 486 )   PDF (614KB) ( 728 )   Save BACKGROUND: The ways of surgical fixation of forearm shaft fractures contained plate fixation and intramedullary nail fixation. The advantage of plate fixation is anatomical reduction. The disadvantage is more peeled tissues, which greatly destroys blood supply and many surgical complications. Moreover, refracture easily appeared. The advantage of intramedullary nailing is minimal invasion, but disadvantage is poor ability to control the rotation. It remains controversial that plate fixation and intramedullary nail fixation for forearm shaft fractures which can obtain better repair effects.  OBJECTIVE: To systematically evaluate the efficacy of plate fixation and intramedullary nail fixation in the repair of forearm shaft fractures in adults. METHODS: We retrieved PubMed, MEDLINE, CINAHL, EBM, Chinese BioMedical Literature Database, Wanfang Database and Chinese Academic Journal Network, and retrieved Chinese Journal of Surgery by hand. Prospective or retrospective comparative studies concerning plate fixation versus intramedullary nailing for forearm shaft fractures were collected. Jadad was utilized to assess methodological quality of the included studies. Effective data were extracted using Stata 12.0 software for meta-analysis. RESULTS AND CONCLUSION: Totally four clinical trials were included, including one prospective clinical trial and three retrospective observational studies. No significant differences were found in functional outcomes, complications, bone union time, operative time, forearm rotation arc, refracture and nonunion between plate fixation and intramedullary nail fixation groups. Results indicated that plate fixation and intramedullary nail fixation in the repair of forearm shaft fractures in adults obtained identical effects. However, the reliability of study results should be verified by randomized controlled trial of multi-center, large-sample and long-period follow-up. 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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Meta-analysis on endobutton plate versus the other fixation methods for acromioclavicular joint dislocation Wang Zhi-zhou, Qu Guang-hua, Han Ya-jun, Xu Chao, Yilihamu•Tuoheti 2014, 18 (40):  6553-6561.  doi: 10.3969/j.issn.2095-4344.2014.40.027 Abstract ( 759 )   PDF (932KB) ( 764 )   Save BACKGROUND: At present, the anatomic reconstruction of coracoclavicular ligament is a trend for the treatment of acromioclavicular joint dislocation. Endobutton plate is a new and effective surgical method found in recent years. Although the recent curative effect is satisfactory, as a method of internal fixation, its rigid fixation does not conform to the requirements of the biomechanics. Furthermore, a randomized controlled clinical study and systematic evaluation are absent. OBJECTIVE: To systematically evaluate clinical outcomes and safety between endobutton plate and the other surgical methods for treatment of acromioclavicular joint dislocation. METHODS: Cochrane (2014-01), PubMed (1966-01/2014-03), Medline (1966-01/2014-03), EMbase (1984-01/2014-03), CNKI (1979-01/2014-03), VIP (1989-01/2014-03) and Wanfang (1989-01/2014-03) databases were searched by computer. Six Chinese journals about orthopedics were searched by hand. References of relevant literatures were searched. Randomized controlled trials that were related to different surgical methods for the treatment of acromioclavicular joint dislocation were collected. In accordance with inclusion criteria, some literatures were included and their qualities were assessed strictly. Meta-analysis was performed with RevMan 5.2 software from the Cochrane Collaboration. RESULTS AND CONCLUSION: Finally 7 published studies with randomized controlled trials met all the inclusion criteria. A total of 359 patients were included, containing 152 cases of endobutton plates fixation, 149 cases of clavicle hook plate fixation, and 58 cases of screw fixation. Except two researches addressed the comparison among three surgical ways, the remaining were about two ways. Meta-analysis showed that the excellent rate was better in endobutton plates fixation than in clavicle hook plate fixation (P=0.0002) and in screw fixation (P=0.009). Compared with other fixation methods, there were significant differences in shoulder joint pain (P=0.01), but no significant difference was detected in operation time, upper limb muscle strength, bleeding amount, redislocation and surgical wound infection (P=0.44, P=0.10, P=0.37, P=0.21, P=0.96). Results indicated that, the efficiency of endobutton plates fixation for acromioclavicular joint dislocation was better than clavicle hook plate fixation and screw fixation, and caused less shoulder pain than clavicle hook plate fixation. There was no significant difference in operation time, upper limb muscle strength, bleeding amount, redislocation and surgical wound infection among the three methods. Due to the limited number of cases in this study, the multicenter, large-sample and long-term clinical randomized controlled studies are needed to increase the strength of the evidence. 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