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22 January 2015, Volume 19 Issue 4 Previous Issue    Next Issue

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Total knee arthroplasty for the treatment of bilateral knee rheumatoid arthritis in the same period Chen Rong-bo, Hou Na, Wang Ren, He Ming, Wang Er-feng, Zhang Wei-tao, Li Xiao-jian, Li Xian-zhi 2015, 19 (4):  493-498.  doi: 10.3969/j.issn.2095-4344.2015.04.001 Abstract ( 529 )   PDF (715KB) ( 519 )   Save BACKGROUND: Total knee arthroplasty is the major treatment of rheumatoid arthritis at advanced stage. Most of scholars prefer the staging replacement and adopt semi-restricting prosthesis to increase the stability of prosthesis. OBJECTIVE: To investigate the clinical effect of synchronous total knee arthroplasty for treatment of bilateral knee rheumatoid arthritis. METHODS: From June 2011 to December 2013, 27 patients of knee rheumatoid arthritis were recruited from the First Department of Orthopedics at the Third Hospital of Chinese PLA, and were treated with total knee arthroplasty at the bilateral sides over the same period. According to the symptoms, functional recovery and imaging evaluation, postoperative effect was assessed. The involved patients were followed up at 2 weeks,     1 month, 3 months, 6 months after surgery and afterwards once per year. The relief of pain symptoms, recovery of joint function, X-ray examination, loosening and sink of the prosthesis were observed during follow-ups. RESULTS AND CONCLUSION: All the patients were followed up over a period of 9-26 months. After operation the pain disappeared, preoperative flexion and varus valgus deformity were corrected, limb walking function recovered well. The Hospital for Special Surgery scores was average 31.8 points before operation and increased to average 82.7 points after operation. There was no infection, lower limb deep vein thrombosis, loosening and sink of the prosthesis. Simultaneous total knee arthroplasty at the bilateral sides is a safe, effective operation method in the treatment of bilateral knee rheumatoid arthritis, with short recovery time and hospitalization period, it can avoid psychological and economic impact of the two single knee replacement operations to the 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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Evaluation and influencing factors of knee function in aged patients with osteoarthritis before and after total knee arthroplasty Zhang Sheng-hai, Fu Li-ming, Ma Zhao-ji, Jiang Guo-wang 2015, 19 (4):  499-503.  doi: 10.3969/j.issn.2095-4344.2015.04.002 Abstract ( 403 )   PDF (578KB) ( 775 )   Save BACKGROUND: The number of total knee arthroplasty has exceeded that of total hip arthroplasty, however, there are fewer cases receiving total knee arthroplasty in China. This discrepancy can be explained by the uncertain attitude of patients towards the efficacy of total knee arthroplasty. More studies are needed to explore the clinical efficacy and related influencing factors. OBJECTIVE: To investigate the changes of knee function and its influencing factors after total knee arthroplasty in aged patients with osteoarthritis. METHODS: 60 patients with osteoarthritis were treated with total knee arthroplasty surgery and rehabilitation training in Anshan Central Hospital from August 2012 to May 2014. The patient’s age, weight, height, body mass index, muscle strength, VAS score, HSS score, ROM before and after total knee arthroplasty surgery, as well as early postoperative application of CPM were recorded. The correlation between postoperative HSS score and other factors was analyzed with Pearson correlation method. RESULTS AND CONCLUSION: The postoperative HSS score and ROM [87.3±5.5, (98.4±7.9)°] were significantly higher than those before surgery [45.8±5.7, (66.5±4.3)°, P < 0.05]. The postoperative HSS score was negatively correlated with preoperative VAS scores, preoperative HSS scores, preoperative ROM, and early postoperative application of CPM (P < 0.05). Total knee arthroplasty has an important treatment value of aged patients with osteoarthritis and can significantly improve joint function of patients. At the same time preoperative knee pain score, preoperative HSS score, preoperative ROM and early postoperative CPM application will influence the treatment effect. 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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Epidemiology of total knee arthroplasty: a retrospective analysis among 1 146 cases in Hefei City from 2008 to 2013   Xu Peng-fei, Yin Zong-sheng, Gao Wei-lu, Ma Zhi-xiang 2015, 19 (4):  504-509.  doi: 10.3969/j.issn.2095-4344.2015.04.003 Abstract ( 363 )   PDF (757KB) ( 796 )   Save BACKGROUND: Knee osteoarthritis is prevalent among the middle-aged and senior people in Asian countries, however, the epidemiology survey of total knee arthroplasty is rarely reported in China. OBJECTIVE: To retrospectively analyze the data of patients undergoing total knee arthroplasty from 2008 to 2013 in Hefei City, and explore the distribution of age and gender of these patients. METHODS: A retrospective analysis among patients undergoing total knee arthroplasty from January 1st 2008 to December 31st 2013 in Hefei City was performed. Data were extracted from the database of Medical Records Room of Relevant Hospitals in Hefei City, including the patient’s gender, age, disease duration, education level, body mass index and surgical site. In addition, more clinical information in one hospital were selected and analyzed, to compare the difference of clinical features between men and women. RESULTS AND CONCLUSION: From 2008 to 2013, totally 1 146 patients underwent total knee arthroplasty due to knee osteoarthritis. The rate of total knee arthroplasty increased over the 6 years and was much higher in women than in men. The single-centre registry data revealed that there was no difference in age, disease duration, education level, and body mass index and surgical site between men and women. Our findings indicate  that, the rate of total knee arthroplasty is increasing steadily from 2008 to 2013 in Hefei City and is higher in women than in men. Risk factors that account for such disparity in total knee arthroplasty utilization need to 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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Uncemented prosthesis revision of failed cemented hip arthroplasty: mid-term results  Li Peng, Zhu Zhi-qi, Hou Ming, Shi Zhan-jun 2015, 19 (4):  510-515.  doi: 10.3969/j.issn.2095-4344.2015.04.004 Abstract ( 614 )   PDF (990KB) ( 489 )   Save BACKGROUND: The uncemented prosthesis in primary total hip arthroplasty has obtained good outcomes, but its application in revision especially in failed cemented hip arthroplasty deserves further investigations. OBJECTIVE: To observe the mid-term results of uncemented revision of failed cemented hip arthroplasty. METHODS: 41 patients (47 hips) with uncemented revision of failed cemented hip arthroplasty were followed up from November 1997 to February 2013. In the 47 hips, 24 hips replaced the cemented stem component while 23 hips underwent the cemented acetabular revision. Prosthesis change was observed in radiographs. Harris functions were evaluated and prosthesis survival rate was analyzed. RESULTS AND CONCLUSION: A total of 33 patients (38 hips) were followed up for 1.3-14.8 years. The mean preoperative Harris hip score increased from 34 (range, 11-66) points to 85 (range, 55-94) points at the time of final follow-up (P < 0.01). 36 hips (95%) had an excellent stability. Osteolysis and migration of the prosthesis were seen in 2 hips (1 in acetabulum and 1 in femur), which needed re-revision. Heterotopic ossification developed in 9 hips (24%). The mean polyethylene liner wear was 0.08 mm (range, 0-0.25 mm) per year. The wear rate only correlated with changes of abduction angle of the acetabulum (P < 0.01). Imaging verified that loosening served as a failure criterion. Kaplan-Meier survival analysis was used to calculate uncemented prosthesis for 7 years and  showed that total survival rate was 89%. The survival rates of acetabular prosthesis and femoral prosthesis were respectively 93% and 92%. Results indicated that uncemented prosthesis could deal with the problem of bone deficiency and obtain satisfactory mid-term clinical results in revision of failed cemented 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 hip arthroplasty for ankylosing spondylitis: the spine-pelvis sagittal balance and quality of life   Gao Yi, Wang Bin, Xie Zi-kang, Shen Peng-fei, Xu Jian-da, Zheng Chong, Qu Yu-xing 2015, 19 (4):  516-521.  doi: 10.3969/j.issn.2095-4344.2015.04.005 Abstract ( 639 )   PDF (764KB) ( 1028 )   Save BACKGROUND: Total hip arthroplasty is usually taken to cure patients with ankylosing spondylitis combined with affected hip, to increase their life quality. But, its effects on sagittal balance of the spine-pelvis are not well known. OBJECTIVE: To analyze the effects of total hip arthroplasty on sagittal balance of the spine-pelvis and life quality in patients with ankylosing spondylitis combined with affected hip. METHODS: Clinic data of 47 consecutive patients with ankylosing spondylitis combined with affected hip who had total hip arthroplasty and were followed up for more than one year after operation from December 2008 to December 2013 were retrospectively analyzed. The spine-pelvis sagittal balancing parameters were measured. According to the SF-36 questionnaire, the dimensional scores were calculated to assess the life quality. Pearson correlation analysis was performed to analyze the correlation between the balancing parameters and SF-36 scores pre-operation, and the change of the balancing parameters and SF-36 scores pre- and post-operation were analyzed. RESULTS AND CONCLUSION: According to the data before total hip arthroplasty, sagittal vertical axis was negatively correlated with physiological function, body pain and vitality. Total kyphosis was negatively correlated with physiological function and general health. Lumbar lordosis was positively correlated with physiological function. Pelvic tilt angle was negatively correlated with the vitality and social function. Pelvic incident angle was negatively correlated with body pain, vitality and emotional role. No significant correlation was shown between sacral inclination angle and SF-36 items. After total hip arthroplasty, lumbar lordosis and sacral inclination angles were significantly increased, while sagittal vertical axis and pelvic tilt angle were significantly decreased compared with those before surgery. Total kyphosis and pelvic incident angle showed no significant differences before and after surgery. The SF-36 scores all got a statistically significant increase. Results showed that, sagittal vertical axis, total kyphosis, lumbar lordosis, pelvic incident angle and pelvic tilt angle are the potential factors influencing the life quality in patients with ankylosing spondylitis combined with affected hip. The total hip arthroplasty, which induces a better sagittal balance with an increased lumbar lordosis and sacral inclination angle, and a decreased sagittal vertical axis and pelvic tilt angle, can result in better life quality. 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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Restoration of fracture and dislocation of lower cervical spine: bone graft fusion and cervical stability Wang Jian-yuan, Deng Qiang, Sheng Wei-bin, Lu Yong-jiang 2015, 19 (4):  522-530.  doi: 10.3969/j.issn.2095-4344.2015.04.006 Abstract ( 386 )   PDF (1102KB) ( 609 )   Save BACKGROUND: The treatment of lower cervical spine fracture and dislocation is aimed to improve neurological functions of patients, the selection of surgical approach is conductive to the reduction and spinal decompression, also maintain strong fixation and bone graft fusion. OBJECTIVE: To explore the restoration approach of lower cervical spine fracture and dislocation, and investigate the effect on bone graft fusion and cervical stability. METHODS: A total of 126 patients with lower cervical spine fracture and dislocation were treated surgically from January 2009 to September 2013 in the First Affiliated Hospital of Xinjiang Medical University. Based on Frankel system, 7 cases were grade A, 48 were grade B, 54 were grade C, and 17 were grade D before surgery. Based on SLIC system, 15 cases were 4 points, 23 were 5 points, 25 were 6 points, 22 were 7 points, 18 were 8 points, 16 were 9 points, and 6 were    10 points. Surgical approaches were determined based on the SLIC system, with a combination of sub-axial injury classification system, the type of fracture, spinal cord compression, and cervical spine injury degree. Anterior surgery (single gap or cervical corpectomy and fusion, bone graft internal fixation) was performed on 91 cases; Posterior treatment (posterior decompression, reduction and internal fixation) was performed on 6 cases; Combined posterior and anterior approach was performed in 29 cases. The neurological function improvement was evaluated at follow-ups; fracture healing, bone graft fusion and cervical stability were determined with imaging findings. RESULTS AND CONCLUSION: All the 126 patients underwent surgery safely without severe complications such as tracheal or esophageal injury. Four patients appeared spinal cord injury and cerebrospinal fluid leakage, which were healed after corresponsive intervention. All patients were immobilized in a hard collar for 3 months postoperatively and were followed up for 6-18 moths. At postoperative 6 months, 5 cases of grade A were not recovered, one case of grade  B was not recovered, 1-2 degree of neurological function recovery was achieved in the remaining cases by Frankel system. X-ray finding showed the good recovery of cervical vertebrae sequence after operation. Fusion was achieved in all cases within 12 months (mean 8.5 months) except non-fusion in one case and delayed fusion in two cases. There was no pseudarthrosis or nonunion occurred. The interbody height, physiological curvature and cervical stability maintained well. The SLIC system, with a combination of sub-axial injury classification system, the type of fracture, spinal cord compression, and cervical spine injury degree should be considered before surgery. Reasonable selection of surgical approach can reconstruct spinal stability and achieve anatomical reduction and complete decompression, which is conducive to the recovery of neurological 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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Conservative treatment of mild ossification of cervical posterior longitudinal ligament: prognostic factors and timing of surgical repair Shen Cang-hai, Feng Yong-jian, Wang Li-guo, Yang Cheng, Peng Ning-ning, Wang Gui-jiang, Guo Xu 2015, 19 (4):  531-536.  doi: 10.3969/j.issn.2095-4344.2015.04.007 Abstract ( 346 )   PDF (729KB) ( 486 )   Save BACKGROUND: The therapeutic effect of surgery is apparently better than conservative treatment for ossification of the posterior longitudinal ligament of moderate to severe spinal cord compression. However, patients with mild and slow developed ossification of the posterior longitudinal ligament do not have severe signs and symptoms of spinal cord compression in a long period. The superiority of surgery treatment has not been confirmed compared with the conservative treatment. OBJECTIVE: To analyze the prognostic factors for patients with mild ossification of cervical posterior longitudinal ligament and to provide evidence for selecting timing of surgery patients with unfavourable prognosis after conservative treatment.  METHODS: Clinical information of 71 patients with mild ossification of cervical posterior longitudinal ligament, who were treated from January 2007 to January 2011, was prospectively analyzed. The Japanese Orthopedic Association score was at least 13 points. All patients received conservative management on admission. Prognostic factors that possibly affected conservative treatment were recorded. Follow-up was regularly conducted every 3 months after discharge. Neurological function of spinal cord was evaluated using Japanese Orthopedic Association score during follow-up of admission and discharge. Patients with increased symptom of spinal compression (Japanese Orthopedic Association score < 13 points; Japanese Orthopedic Association score decreased at least 2 points compared with initial hospitalization) underwent surgery treatment. RESULTS AND CONCLUSION: At the end of February 2014, 67 patients completed more than 3-year follow-up. Only 19 patients with increased symptom of spinal compression received surgery treatment (surgery group). The remaining  48 patients received conservative treatment during follow up (conservative group). Statistical analysis indicated that patients with stenosis of cervical spinal canal and segmental instability have a poor prognosis of conservative treatment. There was no significant difference in Japanese Orthopedic Association score between surgery group and conservative group at first follow-up (P > 0.05). Japanese Orthopedic Association score was lower before surgery as compared with at the beginning of follow-up in the surgery group, showing significant differences (P < 0.05). Nevertheless, after surgery treatment, no significant difference in Japanese Orthopedic Association score was detected during final follow-up between the surgery and conservative groups (P > 0.05). These results confirmed that conservative treatment is still the first choice for mild ossification of cervical posterior longitudinal ligament. Stenosis of cervical spinal canal and segmental instability are the influencing factor for poor prognosis of conservative treatment. Once the spinal compression is worse during conservative treatment, timely surgical treatment is effective for patients with poor prognostic factors. 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 for thoracolumbar spine infection without removing internal fixation   Lin Xu, Tan Lun, Zeng Jun, Wu Chao, Ding Yong, Guo Yong 2015, 19 (4):  537-542.  doi: 10.3969/j.issn.2095-4344.2015.04.008 Abstract ( 655 )   PDF (821KB) ( 546 )   Save BACKGROUND: Surgical site infection of instrumented thoracolumbar spine is not rare and may induce serious consequences. There’s controversy about whether to remove the internal fixation in the treatment of infection. OBJECTIVE: To evaluate the safety of the treatment for surgical site infection of thoracolumbar spine without removing internal fixation. METHODS: A total of 358 patients underwent thoracolumbar internal fixation in Department of Orthopedics, the Fourth People’s Hospital of Zigong City, between March 2008 and December 2012. Among them, 13 cases appeared surgical site infection of instrumented thoracolumbar spine, including 5 males and 8 females. The average age of the 13 cases was 54.5 years (31-65 years). After patients were treated with aggressive debridement, irrigation and anti-infective therapy, the wound healings were evaluated. The hemanalysis, erythrocyte sedimentation rate, C-reactive protein and visual analogous scale score were analyzed and compared before debridement and 6 months after debridement. RESULTS AND CONCLUSION: The 13 patients had surgical site infection of instrumented thoracolumbar spine during 1 to 13 months post-operation. After timely diagnosis, aggressive debridement and irrigation, as well as sensitive antibiotic therapy, 12 patients succeeded in curing infection and retaining implants. 1 patient with T12 fracture removed the fixation and cured infection. The follow-up time was 8-40 months, no case recurred. The hemanalysis, erythrocyte sedimentation rate, C-reactive protein and visual analogous scale score showed significant difference before debridement and 6 months after debridement (P < 0.05). Postoperative infection after thoracolumbar internal fixation should be timely diagnosis and receive surgical treatment. Through aggressive debridement, irrigation and sensitive antibiotic therapy, most patients can be cured without removing internal 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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Modified transmultifidus approach and posterior central approach of vertebrae pedicle screws in the treatment of thoracolumbar vertebral fractures: vertebral stability and related indexes Hu Zheng-xia, Li Kai-nan, He Zhi-yong 2015, 19 (4):  543-547.  doi: 10.3969/j.issn.2095-4344.2015.04.009 Abstract ( 422 )   PDF (707KB) ( 503 )   Save BACKGROUND: Traditional treatment of thoracolumbar fractures through posterior central approach may induce trauma. Wiltse et al have proposed the paraspinal approach of vertebrae pedicle screw in the treatment of thoracolumbar fractures. However, this treatment is restricted due to deficient exposure and high surgical technique. It’s widely concerned to reduce surgical trauma and achieve better restoration effect. OBJECTIVE: To analyze the surgical indications and advantages of vertebrae pedicle screws in the treatment of thoracolumbar fractures through the modified transmultifidus approach. METHODS: From September 2011 to September 2013, 30 patients with thoracolumbar fractures were treated with vertebrae pedicle screw in Chengdu University Affiliated Hospital. The involved patients were divided into two groups, receiving pedicle screw fixation through the normal approach and the improved paraspinal approach, respectively. RESULTS AND CONCLUSION: The improved paraspinal approach obviously shortened the screw placement time and the surgical time, reduced blood loss, and improved visual analogue scale scores, compared with traditional posterior central approach of vertebrae pedicle screws in the treatment of thoracolumbar fractures. There was no significant difference in the postoperative improvement of vertebral height and Cobb angles. The modified transmultifidus approach is better than posterior central approach in the improvement of postoperative pain, but shows no difference in the screw placement time, surgical time and blood loss, in treatment of thoracolumbar 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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Sextant system fixation for the repair of lumbar fracture: ratio of anterior to posterior border height of the injured vertebra and kyphosis Cobb angle  Liu Cheng-jun, Gu Zu-chao, Zhang Yu 2015, 19 (4):  548-553.  doi: 10.3969/j.issn.2095-4344.2015.04.010 Abstract ( 514 )   PDF (757KB) ( 578 )   Save BACKGROUND: Posterior lumbar pedicle screw fixation has been a common method to treat vertebral compression fractures. Traditional surgical incision of pedicle screw fixation commonly produces many local muscle tissue damages. Lumbar fixation by minimally invasive method is a big progress in minimally invasive spine surgery. OBJECTIVE: To investigate the therapeutic results of Sextant system with percutaneous pedicle screw fixation for the treatment of lumbar fracture, and to compare the changes in visual analog scale, the ratio of anterior to posterior border height of the injured vertebra, and kyphosis Cobb angle before and after fixation. METHODS: Data of 58 cases of vertebral compression fractures were retrospectively analyzed. All cases were treated by the senior associate chief physician (second author) at the Department of Orthopedics, the First People’s Hospital of Chengdu from January 2008 to December 2013. They received Sextant system with percutaneous pedicle screw fixation. Intraoperative blood loss, the changes in visual analog scale, the ratio of anterior to posterior border height of the injured vertebra, and kyphosis Cobb angle before and after fixation were observed. RESULTS AND CONCLUSION: The average blood loss during the surgery was 40 mL, with an average post-surgery drainage of 80 mL. Postoperative lumbar back pain was significantly reduced (P < 0.01). After 2 weeks of lying in bed, they could do early functional rehabilitation exercises. The ratio of anterior to posterior border height of the injured vertebra, and kyphosis Cobb angle were significantly improved after fixation (P < 0.05). There was no screw loosening or breakage. These data suggested that the Sextant system with percutaneous pedicle screw fixation for vertebral compression fractures can better restore the anterior border height and correct kyphosis. Moreover, blood loss is less. Pain became mild after fixation, which is convenient to early functional exercises after the 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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External fixation associated with limited internal fixation and vacuum sealing drainage repair Gustilo II and III fracture: time effectiveness and staging Cheng Yong-tao, Wang Wei, Zhao Yan, Zhang Hai-yang, Zhang Shu-cai 2015, 19 (4):  554-561.  doi: 10.3969/j.issn.2095-4344.2015.04.011 Abstract ( 388 )   PDF (893KB) ( 1041 )   Save BACKGROUND: Due to specificity of injury and site, surgical treatment for open fractures is complex and difficult, especially for those patients with high Gustilo grading and severe damage. At the same time, joint fracture requires high reduction technique and may induce high infection rate or complications, even high amputation rate. The fracture and surrounding tissue cannot be restored through one surgery. OBJECTIVE: To explore the clinical effects of external fixation associated with limited internal fixation and vacuum-sealing drainage on Gustilo II and III open fractures. METHODS: From January 2012 to December 2013, 13 cases of Gustilo II and III fractures were treated by external fixation combined with limited internal fixation and vacuum-sealing drainage. There were 11 male and   2 female. Three cases were Gustilo II fracture and 10 cases were Gustilo III fractures. According to the principle of timeliness, patients received the first or effective emergency debridement. All the fractures were fixed by external fixator combined with limited internal fixation. The wounds were sealed with vacuum-sealing drainage. Phased restoration of soft tissue injury and fracture treatment were performed. RESULTS AND CONCLUSION: The involved 13 patients were followed up for 6-18 months, and 12 cases were healed by split-thickness skin graft or flap transposition at the second phase. The wound healing time was 12-18 days, with an average of 14 days. Wound infection occurred in 1 case and was finally repaired by split-thickness skin graft following debridement and vacuum-sealing drainage. Pin tract infection occurred in 4 cases and was controlled by dressing. Schanz screw loose occurred in 5 cases at 4 months postoperatively. All the 13 cases had obtained bone union and the healing time was 4-12 months. Gustilo II and III open fractures can be treated by timeliness and staging method, which is conductive to properly assess articular fractures and soft tissue injury. External fixator combined with limited internal fixation and vacuum-sealing drainage by phased application can not only protect soft tissue and accelerate tissue repair, but also reduce infection and complications, lower the amputation rate, and shorten treatment time. So it is an effective treatment for Gustilo II and III 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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LISS plate versus condylar plate internal fixation for the treatment of distal femoral fractures: difference in bone healing and knee joint functional prognosis Xu Li 2015, 19 (4):  562-567.  doi: 10.3969/j.issn.2095-4344.2015.04.012 Abstract ( 471 )   PDF (812KB) ( 496 )   Save BACKGROUND: As more and more studies focus on the distal femoral fractures, the treatment has transformed from conventional conservative treatment to positive surgical treatment. At present, there are a variety of internal fixation methods in treatment of distal femoral fractures, but the prognosis is rarely reported. OBJECTIVE: To explore and compare the effect of LISS plate and condylar plate fixation on the prognosis and rehabilitation of patients with distal femoral fractures, and provide evidence for the choice of internal fixation. METHODS: Seventy-eight patients with distal femoral fractures were recruited from March 2009 to January 2013 and were randomly divided into two groups, with 39 cases in each group. The two groups were treated with internal fixation using LISS plate and condylar plate, respectively. The intraoperative and postoperative indicators of patients in the two groups were recorded. Evanich score at 12 months after discharge and adverse events during the follow-up were also observed. RESULTS AND CONCLUSION: The incision length and fracture healing time in the LISS plate group were shorter than the condylar plate group (P < 0.05). At 12 months after discharge, there was no statistically significant difference in pain scores and stability between the two groups (P > 0.05); while the range of motion, scores of quadriceps femoris strength and Evanich total scores in the LISS plate group were higher than the condylar plate group (P < 0.05), the subtraction project was less than the condylar plate group (P < 0.05). The incidence of adverse events during the follow-up period was 5% (2/39) in the LISS plate group and 20.5% (8/39) in the condylar plate group, the difference was statistically significant between the two groups (P < 0.05). LISS plate internal fixation is better than condylar plate fixation for treatment of distal femoral fractures, it can effectively promote fracture healing and functional recovery of knee joint, induce fewer complications, and is an ideal method of internal fixation in field of orthopedics. 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 of Tossy III acromioclavicular joint dislocation: biomechanical change of anchor-reconstructed coracoclavicular ligament Han Bing, Feng Hui, Chen Shuo, Wang De-guang, Zhang Chuan-kai 2015, 19 (4):  568-572.  doi: 10.3969/j.issn.2095-4344.2015.04.013 Abstract ( 432 )   PDF (645KB) ( 429 )   Save BACKGROUND: The commonly used methods of repairing the acromioclavicular joint dislocation are Kirschner wire tension band internal fixation, clavicular hook internal fixation and suture anchor internal fixation. Each method has their advantages and disadvantages. Both Kirschner wire and clavicular hook require secondary surgery to remove the internal fixators, and their design is not based on the biomechanical principle. OBJECTIVE: To reconstruct coracoclavicular ligament using anchor and perform biomechanical tests. METHODS: Ten shoulder antisepsis specimens were numbered and each specimen was tested by three trials. (1) Stretching coracoclavicular ligament: Specimens were fixed on the biomechanical machine and were tensile until the ligament was ruptured, the maximum failure load was recorded. (2) Reconstruction of coracoclavicular ligament using an anchor: Coracoclavicular ligment was reconstructed using an anchor, then specimens were fixed on the biomechanical machine and were tensile until the ligament was ruptured, the maximum failure load was recorded. (3) Reconstruction of coracoclavicular ligament using two anchors: Coracoclavicular ligment was reconstructed using two anchors, then specimens were fixed on the biomechanical machine and were tensile until the ligament was ruptured, the maximum failure load was recorded. RESULTS AND CONCLUSION: Coracoclavicular ligament fracture load was (413.0±123.48) N; the failure load was (345.1±111.23) N in an anchor group and 465.3±100.64 N in two anchors group. When coracoclavicular ligament is reconstructed using an anchor, the stress is concentrated under external forces, which is prone to the extraction of anchor and the failure of surgery, biomechanical data showed that the fracture load is lower than the coracoclavicular ligament, so the reconstruction is not reliable; when coracoclavicular ligament is reconstructed using two anchors, the stress is dispersed, which meet the biological features and the biomechanical data are ideal. 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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Anatomical locking compression plate in the repair of olecranon fracture: 6-month follow-up evaluation of elbow function Qi Yan, Tian Jun, Yao Yu, Liu Hao, Sun Lei 2015, 19 (4):  573-577.  doi: 10.3969/j.issn.2095-4344.2015.04.014 Abstract ( 464 )   PDF (610KB) ( 539 )   Save BACKGROUND: Improper treatment of olecranon fractures will affect elbow function. To reduce the incidence of complications and good recovery of elbow function, it is important to give accurate reduction and rigid internal fixation of olecranon fracture. OBJECTIVE: To investigate the anatomic locking compression plate in the repair of olecranon fracture. METHODS: Anatomical locking compression plate was used for open reduction and fixation in 36 cases of olecranon fracture. The recovery of elbow joint function of patients after operation was evaluated. RESULTS AND CONCLUSION: 36 cases of olecranon fracture received anatomical locking compression plate for open reduction and fixation, and were followed up for more than 6 months. No early complications were found in the incision such as infection or hematoma. They were primarily healed. Broberg and Morrey evaluation showed that the excellent and good rate was 94% (34/36). It is concluded that anatomical locking compression plate for olecranon fracture is simple to be operated. The fixation is firm. The patients can do early exercise postoperatively, less complications and good recovery of elbow joint 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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Open release combined with hinged external fixator repairs extremely severe elbow stiffness Liu Sheng-ping, Liu Guo-qiang 2015, 19 (4):  578-583.  doi: 10.3969/j.issn.2095-4344.2015.04.015 Abstract ( 438 )   PDF (796KB) ( 694 )   Save BACKGROUND: Once traumatic arthritis appears, degeneration of the joints will be inevitable. In the clinical treatment of moderate or less stiff elbow, traditional elbow stiffness release is the preferred repair method. However, its therapeutic effect is controversial in the clinical treatment of very severe elbow stiffness. The focus on conflict is articular surface damage after the implementation of the traditional release of elbow stiffness. OBJECTIVE: To observe the repair effect of open release combined with hinged external fixator on extremely severe elbow stiffness. METHODS: A total of 52 patients with extremely severe elbow joint stiffness were selected from the Third Department of Orthopedics, Yuebei People’s Hospital from May 2012 to July 2014. All patients signed the informed consent. In accordance with the approval of Hospital Ethics Committee, they were divided into control and study groups (n=26). Control group received the traditional elbow stiffness release. Study group received open release combined with hinged external fixator. The changes in flexion-extension range-of-motion and Mayo elbow joint function score were compared between the two groups. RESULTS AND CONCLUSION: After treatment with open release combined with hinged external fixator, significant differences in excellent and good rate, range-of-motion of flexion-extension and Mayo elbow joint function score were detected between the study group [96%, (117.5±20.5)°, (88.5±11.5) points] and the control group [77%, (93.5±18.5)°, (76.5±9.5) points] (P < 0.05). These results indicated that open release combined with hinged external fixator significantly improved elbow joint function in patients with extremely severe elbow stiffness, facilitated postoperative rehabilitation exercise activities, and had high value of clinical application. 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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Adjustable and ordinary locking compression plates for the repair of osteoporotic distal radius fractures: comparison of radial length and wrist function recovery Wang Bin, Gao Yi, Xu Jian-da, Xie Zi-kang, Shen Peng-fei, Zheng Chong, Qu Yu-xing 2015, 19 (4):  584-589.  doi: 10.3969/j.issn.2095-4344.2015.04.016 Abstract ( 441 )   PDF (829KB) ( 517 )   Save BACKGROUND: Locking compression plate in the treatment of osteoporotic distal radius fractures has achieved good results, but the changes in anatomic parameters of the distal radius after fixation with different kinds of plates remain unclear.  OBJECTIVE: To investigate the clinical outcomes of the adjustable locking compression plate for treatment of osteoporotic distal radius fractures by comparing with the ordinary locking compression plate.    METHODS: A total of 38 patients with osteoporotic distal radius fractures, who were treated in the Department of Orthopedics, Changzhou TCM Hospital Affiliated to Nanjing University of Traditional Chinese Medicine from January 2012 to January 2014, were retrospectively analyzed. According to the fixation schemes, the patients were divided into adjustable locking compression plate group (n=22) and ordinary locking compression plate group (n=16). Fractures were assessed by the AO type, and all incisions were from palm side. The volar tilt, radial inclination, and radial length were recorded and compared between the two groups after surgery and during final follow-up. Wrist function was assessed according to Denis Standard. RESULTS AND CONCLUSION: All patients were followed up from 5-26 months. All the patients got bone union at an average of 12.3 weeks (range from 9-16 weeks). The volar tilt was 10.6° and 11.3°, and the radial inclination was 21.1° and 19.2° in average instantly after operation, respectively in two groups. At the latest follow up, the volar tilt was 8.5° and 8.5°, and the radial inclination was 17.9° and 15.8° in average, respectively, which did not show significant differences (P > 0.05). The radial shortening values were 0.5 mm and 1.1 mm instantly after operation in two groups. At the latest follow up, the radial shortening values were 0.9 mm and 1.4 mm during final follow-up in the two groups, which exhibited significant differences (P < 0.05). According to Dienst assessment, in adjustable locking compression plate group, 16 cases were excellent, and 6 were good. In ordinary locking compression plate group, 11 cases were excellent, and 5 were good. There was no statistical difference between the two groups (P > 0.05). These results confirmed that the adjustable locking compression plate can obtain good volar tilt, radial inclination and wrist function in treating the osteoporotic distal radius fractures. Compared to the ordinary locking compression plate, it has better restoration of the radial length, which can be maintained during the 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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Plaster fixation versus cannulated screw internal fixation for the wrist scaphoid bone fresh fracture: comparison of functional recovery   Kayishaer • Maimaitiming, Zhao Yan 2015, 19 (4):  590-595.  doi: 10.3969/j.issn.2095-4344.2015.04.017 Abstract ( 752 )   PDF (873KB) ( 575 )   Save BACKGROUND: The stable fixation is not available due to specific position of wrist scaphoid fracture, the fracture is prone to non-union and ischemic necrosis of bone due to specific anatomy and blood supply. The choice between plaster fixation and internal fixation in treatment of wrist scaphoid bone fresh fracture remains controversial. OBJECTIVE: To compare and analyze functional recovery of the wrist scaphoid bone fresh fracture after plaster fixation and internal fixation. METHODS: Twenty-two patients with wrist scaphoid bone fresh fracture were recruited from the First Affiliated Hospital of Xinjiang Medical University from March 2012 to March 2014, and the injury time was 2 hours to 12 days. Preoperative X-ray films revealed that, the involved patients had no wrist scaphoid bone collapses, lunate bone dislocation, ischemic necrosis of bone and osseous changes. All the cases showed shift, unstable fractures. According to the patient’s willing and the surgical method, the involved patients were divided into two groups, receiving plaster fixation and cannulated screw internal fixation respectively. Each group contained 11 cases. Wrist joint function was evaluated using Cooney score system. There was no significant difference in the age distribution and gender between the two groups (P > 0.05). RESULTS AND CONCLUSION: At 3-6 months of follow-up, wrist joint function of patients in the two groups was compared and analyzed with Cooney scores. According to the Cooney scores, nine cases in internal fixation group were excellent,     1 good, 1 fair and none poor; one case in plaster fixation group was excellent, 5 good, 3 fair, and 2 poor. The excellent and good rate in the internal fixation group was significantly higher than that in the plaster fixation group (91%, 55%, t=4.817, P < 0.05). Although plaster fixation has certain effects on wrist scaphoid bone fresh fracture, open reduction and canulated screw fixation has obvious effect and promotes the functional recovery of wrist joint. Compared with plaster fixation, open reduction and cannulated screw fixation has a superiority for treating wrist scaphoid bone fresh 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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Implant fixation repairs lower extremity fractures in the elderly: effects of different anesthesia methods on hemodynamics and analgesia    Zhu Zi-fu 2015, 19 (4):  596-600.  doi: 10.3969/j.issn.2095-4344.2015.04.018 Abstract ( 328 )   PDF (767KB) ( 495 )   Save BACKGROUND: The medication of spinal-epidural anesthesia does not have great differences as compared with spinal anesthesia and epidural anesthesia alone. That is, a large-dose spinal anesthesia is first used. Epidural anesthesia is utilized to ensure effects and postoperative analgesia. Recent scholars proposed some new ideas: small-dose and low-concentration local spinal anesthetics are first used, and small-dose and low-concentration local epidural anesthetics are then utilized, which really plays a joint role in spinal and epidural anesthesia, and achieves perfect anesthesia outcomes, and reduces adverse reactions and complications. OBJECTIVE: To analyze application outcomes of small-dose and low-density local spinal-epidural anesthesia to repair surgery of elderly lower limb fractures. METHODS: A total of 68 cases, who would receive the surgery of unilateral lower limb in the Huizhou Central People’s Hospital, were selected in this study. They were equally assigned to control group and observation group according to the anesthesia manner. Each group contained 34 cases. Control group received continuous epidural anesthesia. Observation group received small-dose and low-density local spinal-epidural anesthesia. Onset time of anesthesia, blocking perfect time, the amount of narcotic drugs, lower limbs modified Bromage score and hemodynamic alterations were compared and analyzed between two groups.  RESULTS AND CONCLUSION: Onset time of anesthesia, blocking perfect time, the amount of narcotic drugs, and lower limbs modified Bromage score were better in the observation group than in the control group (P < 0.05). Mean arterial pressure was significantly lower at 5 and 10 minutes after anesthesia than that before anesthesia in both groups (P < 0.05). No significant difference was detected in other indexes. Patients from the two groups had stable vital signs. No postoperative cognitive dysfunction occurred. These data indicated that small-dose and low-density local spinal-epidural anesthesia was characterized by rapid onset, less dose, complete block and good analgesia. It is used in the repair surgery of lower extremity fractures in elderly, and has little effect on hemodynamics in patients, and can achieve a more perfect analgesia. 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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Memory alloy osteosynthesis plate fixation for flail chest injuries: 1-year follow-up Li Tie-bin, Zhang Hai-qing 2015, 19 (4):  601-605.  doi: 10.3969/j.issn.2095-4344.2015.04.019 Abstract ( 433 )   PDF (780KB) ( 474 )   Save BACKGROUND: Previously, many authors advocated that the rib fractures can be treated by conservative method. However, with the progress of internal fixation materials science and in-depth study of the rib injury, many authors have begun to recommend that rib fractures should be treated by internal fixation surgery, which may shorten the treatment period and improve patient’s quality of life. But which is the optimal fixation methods, is still controversial. OBJECTIVE: To summarize the clinical outcomes of the memory alloy osteosynthesis plate fixation for flail chest injuries. METHODS: From May 2008 to May 2011, 50 patients with flail chest were treated with memory alloy osteosynthesis plate fixation in Department of Thoracic Surgery, Qianjiang Central Hospital. There are 39 males and 11 females, the mean age was 42.6 years (range 22-67 years). The flail chest injuries were caused by traffic accidents in 38 cases, by falling from height in 11 cases, and by tire blast injury in 1 case. The mean number of rib fractures was 6.4±4.3 (range 3-11); the mean fracture sites were 11.2±5.6 (range 7-23). There were 25 patients with flail chest at left side, 17 cases at right side, and 8 cases at bilateral sides. The mean time from injury to the surgical time was 3.7±2.2 days (range 2-7 days). The length of postoperative ventilator use, postoperative ICU days, length of hospital stay, peripheral complications, fracture reduction and fracture healing time were observed. The chest wall pains before and after surgery were evaluated with the visual analog scale. RESULTS AND CONCLUSION: All incisions obtained healing by first intention and all patients were followed up for 13-22 months. There were no intraoperative complications. Mean postoperative ventilator days were 1.8±0.7 days (range 1-3 days); mean post-operative ICU days were 2.6±1.1 days (range 2-5 days); mean lengths of hospital stay were 14.9±3.1 days (range 12-17 days); the visual analog scale scores was reduced from preoperative 8.1±1.2 points to 4.9±0.9 points at 1 day post-surgery and 3.2±1.1 points at 1 week post-surgery. No cases of hardware failure, hardware prominence, wound infection, or nonunion were observed. All fractures reached clinical healing, and mean healing time was 3.1±1.2 months (range 2-4 months). The memory alloy osteosynthesis plate fixation is an effective technique for the treatment of flail chest, can provide stability for the injured segments of the chest wall, reduce ventilator time, decrease ventilator-associated complications, reduce deformity, and decrease chronic pain. 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 significance of CT image digital screw channel analog measurement of C4-C6 anterior fixed parameters    Fu Yu, Lin Bing, Li Xiao-he 2015, 19 (4):  606-611.  doi: 10.3969/j.issn.2095-4344.2015.04.020 Abstract ( 298 )   PDF (803KB) ( 675 )   Save BACKGROUND: Although anterior cervical surgery approach and anatomical structure were relatively complex, with big risk, it can stably fix cervical anterior column of the main load-bearing, and its relapse rate is relatively low. Because this technique is relatively new, there is lack of related fixation parameters in the clinic. OBJECTIVE: To measure fixed parameters of C4-C6 anterior approach and to provide references for extensive treatment of segmental anterior fixation. METHODS: CT imaging data of 35 patients without C4-C6 cervical lesions, who were examined from January 2009 to December 2012, were selected in this study. There were 20 males and 15 females at the age of 25-50 years old, averagely 41.2 years. The image data were rebuilt by Mimics16.01 software. Moreover, we measured vertebral anteroposterior and transverse diameters, vertebral height, anteroposterior and transverse diameters of vertebrae transverse foramen, the distance of medial borders of left and right transverse foramen, the angle and length of the left and right pedicle axis and sagittal and horizontal axes. RESULTS AND CONCLUSION: The vertebral transverse diameter of C4-C6 gradually increased from (26.67±0.25) mm to (32.89±0.12) mm; anterior and posterior diameter of C4-C6 gradually increased from (6.89±0.12) mm to (8.85±0.44) mm, showing significant differences between different segments (P < 0.05). In vertebral median sagittal plane, anterior, middle and posterior height from C4 [anterior (7.99±0.51) mm, middle (7.09±0.42) mm, posterior (7.76±0.49) mm], to C6 [anterior (9.89±0.45) mm, middle (8.42±0.75) mm, posterior (8.84±0.26) mm], showing significant difference among vertebral bodies (P < 0.05). Anteroposterior and transverse diameters of vertebrae transverse foramen gradually increased with increased vertebral order (P < 0.05). The distance of medial borders of C4-C6 left and right transverse foramen gradually increased from (25.10±0.45) mm to (28.89±0.56) mm, showing significant differences among different segments (P < 0.05). The angle and length of the left and right pedicle axis and sagittal and horizontal axes gradually increased with increased vertebral order (P < 0.05). 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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Value of 64-row spiral CT three-dimensional reconstruction in the repair of tibial plateau fractures   Ding Yan-ping, Yang Ying 2015, 19 (4):  612-617.  doi: 10.3969/j.issn.2095-4344.2015.04.021 Abstract ( 316 )   PDF (638KB) ( 443 )   Save BACKGROUND: Tibial plateau fracture will inhibit the normal function of the knee joint, and severely damage lower extremity function. Early diagnostic measures play a key role in prognosis. Previous studies mainly focused on multislice spiral CT three-dimensional reconstruction for diagnosis of tibial plateau fractures, but it is rare to compare diagnostic results and X-ray inspection methods. OBJECTIVE: To analyze the application effect of 64-row spiral CT three-dimensional reconstruction in the repair, diagnosis and treatment of tibial plateau fractures, and compare with diagnostic outcomes of traditional X-ray. METHODS: A total of 30 patients with tibial plateau fractures were selected from Ninth People’s Hospital of Wuxi City from October 2012 to October 2013. Patients were subjected to 64-row spiral CT scanning, three-dimensional reconstruction and X-ray plain film inspection. The inspection results were analyzed and compared. CT scanning used GE64 row spiral CT. Scanning range was the proximal tibia. Spacing of reconstruction was 1 mm. After completing the scan, data were uploaded to a working platform, and image reconstruction was completed. RESULTS AND CONCLUSION: Through 64-row spiral CT three-dimensional reconstruction, the degree of tibial plateau fractures, collapse, broken bones and displacement were clearly shown. According to the HOHI classification method: eight cases were type I, seven cases were type II, four cases were type III, five cases were type IV, three cases were type V, and three cases were type VI. The diagnosis rate was 100%. X-ray results showed that 25 cases were diagnosed, 3 cases were suspected diagnosis, 2 cases could not be confirmed. The diagnosis rate was 83%. Significant differences in the diagnosis rate were detectable between the two methods (P < 0.05). After surgical treatment, good clinical effects were found in patients. The excellent and good rate was 93%. These data suggested that 64-row spiral CT three- dimensional reconstruction has important application value in the diagnosis and treatment of tibial plateau fractures, can clearly show the characteristics of the anatomical morphology of fracture of tibial plateau, and provide important evidence for elevating repair effect. 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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Radiographic alterations before and after adult scoliosis surgery: correlation between spinal balance and healthy living status   Zou Hai-bo, Wu Chun-hui, Amir A. Mehbod, Corky Lick, Ensor E. Transfeldt 2015, 19 (4):  618-622.  doi: 10.3969/j.issn.2095-4344.2015.04.022 Abstract ( 361 )   PDF (684KB) ( 533 )   Save BACKGROUND: Radiographic parameters have been incorporated with healthy living status in adult scoliosis patients to guide surgery and predict treatment outcome. However, few studies presented how these radiographic parameters influence treatment outcome in adult scoliosis. OBJECTIVE: To evaluate the correlation between changes in radiographic parameters and healthy living status in adult scoliosis patients before and after surgery. METHODS: A total of 68 patients with adult scoliosis, who were treated between July 2008 and July 2010, were retrospectively analyzed. There were 18 males and 50 females, at the age of 20 to 88 years old, averagely 58.5 years. Before surgery and during final follow-up, all patients were photographed at posteroanterior and lateral positions using X-ray. Complete Oswestry Disability Index data were collected. Measurements included gravity line, C7 plumb line, Cobb angle, lumbar lordosis, slippage distance on coronal side, pelvic angle of incidence, sacral inclination angle and pelvic tilt angle. Correlation of radiological parameters and Oswestry Disability Index values was analyzed using Pearson’s correlation analysis. RESULTS AND CONCLUSION: Follow-up lasted 6 to 14 months. Significant differences in Oswestry Disability Index score were visible between preoperation (50.6±16.8) and postoperation (41.1±19.6) (P ≤ 0.001). Mean Cobb angle was reduced from 26° preoperatively to 10.7° postoperatively. Lateral olisthesis was reduced from 4.9 mm to almost zero in most patients. On the sagittal plane, C7 plumb line was significantly correlated to Oswestry Disability Index score both preoperatively and postoperatively. On the coronal plane, preoperative Cobb angle and postoperative lumbar lordosis were correlated to Oswestry Disability Index. Pelvic tilt angle change was equal to sacral inclination angle. No changes in pelvic incidence angle were found after the surgery. These data indicated spinal balance was correlated with healthy living status. Gravity line was not better than C7 plumb line. The improvement of the radiographic parameters did not predict the relief of symptoms. Lost sacral slope and retroverted pelvis were commonly seen in adult scoliosis. Surgical treatment could not significantly change sacral slope, retroverted pelvis, lumbar lordosis and sagittal balance. 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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Developmental dislocation of the hip in children: enhanced MRI in the observation of femoral blood supply Ge Wei, Li Qi, Li Lian-yong, Pan Shi-nong 2015, 19 (4):  623-628.  doi: 10.3969/j.issn.2095-4344.2015.04.023 Abstract ( 294 )   PDF (623KB) ( 499 )   Save BACKGROUND: The early diagnosis and treatment of the hip developmental dislocation in children have a great influence on the prognosis of the disease. Once the diagnosis is delayed, the difficulty of treatment and surgery failure rate will be increased. The imaging diagnosis is not only the indispensable accessory examination in the early diagnosis and treatment of the hip developmental dislocation, but also the research focus on this field. OBJECTIVE: To introduce the etiology and pathogenesis of the hip developmental dislocation in children, and summarize the new research progress from the aspects of the imaging diagnosis. METHODS: A computer-based retrieval was performed by the first author in the CNKI database and PubMed database to search papers on the hip developmental dislocation in children published between January 2004 and December 2014, using the key words of “developmental dysplasia of the hip, X-Ray, computed tomography, magnetic resonance, and ultrasound” in Chinese and English. According to inclusion and exclusion criteria, 51 papers were included in the final analysis. RESULTS AND CONCLUSION: The etiology of the hip developmental dislocation includes genetic factor, endocrine factors, intrauterine factors, mechanical factors and so on. The common accessory examinations include ultrasound, X-Ray, computed tomography and magnetic resonance imaging. Because of easy operation and low costs, X-Ray becomes the common examination to screen the hip developmental dislocation. Computed tomography can observe the shape and the positional relationship between the femoral head and the acetabulum in three-dimension, but for infants and young children, the radiation is large and the operation is difficult. Because of the early detection of pathological changes in cartilage during hip dislocation, magnetic resonance imaging becomes an indispensable examination for the early diagnosis of developmental dysplasia of the hip. Especially the enhanced magnetic resonance imaging has significant contribution to observe the blood supply, and is regarded as the focus to evaluate the postoperative treatment effect of developmental dysplasia of 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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Anatomical dynamic hip lock plate and proximal femoral nail antirotation repair intertrochanteric fracture of femur in the elderly: 16-month follow-up Shao Yun-feng, Zhang Xiang-sheng 2015, 19 (4):  629-633.  doi: 10.3969/j.issn.2095-4344.2015.04.024 Abstract ( 527 )   PDF (799KB) ( 507 )   Save BACKGROUND: Active fixation for intertrochanteric fracture of femur in the elderly has been recognized by us, but which fixation mode can be selected remains unclear. OBJECTIVE: To compare the therapeutic effects of anatomical dynamic hip lock plate and proximal femoral nail antirotation on repair of intertrochanteric fracture, and to explore the significance of fixation choice. METHODS: A total of 87 patients with elderly osteoporotic intertrochanteric fractures, who were treated in the Department of Orthopedics, Shekou People’s Hospital of Nanshan District of Shenzhen City from August 2009 to April 2014, were enrolled in this study. They received anatomical dynamic hip lock plate (lock plate group) and proximal femoral nail antirotation (nail antirotation group) separately. Ambulation time, load time, healing time, the degree of functional recovery and complications were compared between the two groups. RESULTS AND CONCLUSION: All patients were followed up for 16 to 24 months, averagely 19 months. The healing time was about 11 weeks in the lock plate and nail antirotation groups. At 2 weeks after repair, no significant difference was detected in Harris hip score (P > 0.05). The ambulation time and load time were shorter in nail antirotation group than in the lock plate group (P < 0.01). Four patients meant to receive proximal femoral nail antirotation, but finally received anatomical dynamic hip lock plate due to intertrochanteric diastema, narrow femoral canal and great curvature of the femur. During follow-up, coxa vara was found in one patient from the lock plate group. Fractures occurred again due to impact injury in one patient of the nail antirotation group. Results indicated that the two fixation methods for treating intertrochanteric fracture obtained good therapeutic effects. Suitable repair mode and implant can be selected according to patient’s conditions. 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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Comparison of anterior and posterior approaches for thoracolumbar burst fracture: a meta-analysis on Cobb angle loss, Frankel grading improvement and vertebral height loss Aikeremujiang•Muheremu, Sun Yu-qing, Wu Zhong-yan, Tian Wei 2015, 19 (4):  634-641.  doi: 10.3969/j.issn.2095-4344.2015.04.025 Abstract ( 545 )   PDF (447KB) ( 522 )   Save BACKGROUND: Although there are many studies comparing different surgical approaches for the patients with thoracolumbar burst fracture who need a surgical treatment, there are no multi-center large-scale randomized controlled studies to reach a conclusion with high evidence level. This makes it necessary to do a meta-analysis with the existing studies to compare anterior and posterior approaches in treatment of thoracolumbar burst fracture.  OBJECTIVE: To analyze the differences of anterior and posterior approaches for thoracolumbar burst fracture and provide guidance for the further operative treatments through a literature retrieval. METHODS: An online retrieval of PubMed, Medline, Elsevier, Wanfang and CNKI databases was performed for articles about the anterior and posterior approaches for thoracolumbar burst fracture, with the key words of “thoracolumbar fracture, randomized controlled trial, spinal fracture, RCT, anterior and posterior” in English, and “thoracolumbar fracture, anterior, posterior, spine” in Chinese. We compared the operative time, total blood loss, loss of Cobb angle, improvement in Frankel grading, and loss of the vertebral height between the anterior and posterior surgical approaches. RESULTS AND CONCLUSION: Finally 18 randomized controlled trials with a total of 925 patients were included. There were 459 cases in anterior approach group and 466 cases in posterior approach group. The anterior approach cost 36.47 minutes longer than posterior approach and the blood loss in the anterior approach group was 432.58 mL more than the posterior approach group. Compared with the posterior approach group, the loss of Cobb angle was 3.41° lower, the improvement of Frankel grading was 0.33° higher, and the loss of vertebral height was 1.76 mm lower in the anterior approach group. There were significant differences in the operative time, total blood loss, loss of Cobb angle, improvement in Frankel grading and loss of vertebral height between the anterior and posterior surgical approaches (P < 0.01). Although the anterior approach has disadvantages such as long operative time, more intraoperative blood loss, and high technical requirement, the good short-term and long-term results make it worthwhile to apply for the treatment of thoracolumbar burst 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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Biomechanical change in adjacent segments after cervical fusion and non-fusion: a meta-analysis of second surgery rate    Li Zhong-hai, Hou Shu-xun, Li Li, Tang Jia-guang, Ren Dong-feng, Zhao Yan-tao 2015, 19 (4):  642-647.  doi: 10.3969/j.issn.2095-4344.2015.04.026 Abstract ( 325 )   PDF (745KB) ( 527 )   Save BACKGROUND: Adjacent segment disease is a long-term complication of anterior cervical decompression and fusion, and has been paid great attention recently. Cause of disease contains increased range of motion in surgery adjacent segment, intervertebral height loss and high intradiscal pressure. In the clinic, compared with fusion surgery, whether cervical non-fusion can effectively decrease the incidence of adjacent segment disease remains poorly understood. OBJECTIVE: To systematically assess the effects of cervical fusion and cervical non-fusion on adjacent segment degeneration. METHODS: We retrieved the randomized controlled trial concerning cervical fusion versus cervical non-fusion to repair cervical syndrome in the Medline, PubMed, Embase and Cochrane databases from January 2000 to December 2013. This study compared the effects of two repair methods on adjacent segment disease and evaluated methodological quality of the included studies. A meta-analysis was performed using RevMan 5.2 software. Outcome indicators: second surgery was undergone due to postoperative adjacent segment disease. RESULTS AND CONCLUSION: After screening, five randomized controlled trials met the inclusion criteria. There were 1 602 patients. All patients received surgery due to cervical syndrome. 785 cases underwent anterior decompression and fusion, and 817 cases underwent intervertebral disc replacement. 1 066 patients completed all follow-up, with a total follow-up rate of 66.54%. There were 494 patients treated with anterior decompression and fusion and 572 patients with intervertebral disc replacement. A total of 68 patients underwent second surgery due to adjacent segment disease. Total second surgery rate was 6.38% (68/1 066), including 28 cases after intervertebral disc replacement and 40 cases after anterior decompression and fusion. The grade of quality evaluation of the included studies was high, including five studies with grade A. Moreover, heterogeneity was small (I2 = 14%). Meta-analysis results revealed that the second surgery rate of adjacent segment disease was lower after cervical non-fusion than after cervical fusion, which showed significant differences (odd ratio = 0.58, 95% confidence interval: 0.35, 0.96). These results suggested that the second surgery rate of adjacent segment disease was higher after cervical fusion than after cervical non-fusion. The alterations in cervical biomechanics caused by fusion greatly affected the occurrence of adjacent segment disease. 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 vertebral and non-vertebral fractures in postmenopausal women with anti-osteoporosis drugs: a network meta-analysis   Wang Jun, Ma Ting-ting, Zhang Yi-na, Zhang Jin-ping, Guo Jing-xue 2015, 19 (4):  648-656.  doi: 10.3969/j.issn.2095-4344.2015.04.027 Abstract ( 437 )   PDF (952KB) ( 603 )   Save BACKGROUND: Comparison of the incidence of fracture can be used as a manner to evaluate the therapeutic effects of anti-osteoporosis drugs. At present, there are a few network meta-analysis on different kinds of anti-osteoporosis drugs. OBJECTIVE: To comprehensively evaluate the risks of different anti-osteoporosis drugs in reducing the vertebral and non-vertebral fractures in postmenopausal women by applying Network Meta-analysis. METHODS: We retrieved The Cochrane Library, PubMed, EMbase, Wanfang, China Biology Medicine, VIP and China National Knowledge Infrastructure for randomized controlled trials about vertebral and non-vertebral fractures in postmenopausal women taking anti-osteoporosis drugs. Retrieval time was from building a database to July 2014. Two reviewers extracted and assessed independently the outcomes and quality of included trials according to inclusion and exclusion criteria. We used random effects Bayesian models and fixed effects Bayesian model in WinBUGS 1.4.3 combined R 3.03 software in the network meta-analysis. RESULTS AND CONCLUSION: Forty-six randomized controlled trials on vertebral fracture and forty-two randomized controlled trials on non-vertebral risk reduction with bisphosphonates (alendronate, risedronate, ibandronate, etidronate, and zoledronic acid), parathyroid hormone (teriparatide), biologics (denosumab), or selective estrogen receptor modulators (raloxifene, bazedoxifene) were identified by a systematic review. Individual study results were pooled in a network meta-analysis to indirectly compare treatment effects in postmenopausal women. The odd ratio and 95% confidence interval of drugs were estimated using random effects Bayesian models in WinBUGS 1.4.3. Zoledronic acid was best in the prevention of vertebral fractures. Risedronate reduced the risk of non-vertebral fracture in postmenopausal women better than other drugs. However, current network meta-analysis cannot give a certain conclusion. A large perspective study designed specially for confirmation is needed to confirm the results of our 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： Figures and Tables | References | Related Articles | Metrics