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23 April 2015, Volume 19 Issue 17 Previous Issue    Next Issue

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Significance of Ranawat’s triangle method in determining the rotation center of normal hip joint Liu Ya-bin, Ma Xin-long 2015, 19 (17):  2625-2630.  doi: 10.3969/j.issn.2095-4344.2015.17.001 Abstract ( 1916 )   PDF (461KB) ( 722 )   Save BACKGROUND: It is crucial to determine the location of the rotation center of the hip joint using X-ray. Ranawat’s triangle is commonly used to define the hip rotational center in bilateral developmental dysplasia of the hip and revision hip surgery especially in cases with bone stock deficiency, but there are rare articles about its value in normal hip. OBJECTIVE: To compare the difference between Ranawat’s triangle method and Mose circle method in determining the healthy hip joint rotational center. METHODS: We selected 30 patients with normal traumatic femoral neck fracture, who underwent unilateral total hip arthroplasty. Ranawat’s triangle method and Mose circle method were applied to measure the anteroposterior radiographs of the pelvis after arthroplasty and to compare the distance between the hip rotational center and the reference lines (X-axis: teardrop line; Y-axis: a line perpendicular to the X-axis, drawn from the intersection of the Kohler line and the teardrop line. The distance from the hip joint rotational center to X-axis is dx1, dx2 and the distance to Y-axis is dy1, dy2 in Ranawat’s triangle and Mose circle respectively.). We also compared the ratios (dx1/H, dy1/W; dx2/H, dy2/W) in the pelvic height (H: the distance between the highest point on the iliac wing and the lowest point on the ischial tuberosity) and width (W: the distance between the most lateral points on the iliac crests). RESULTS AND CONCLUSION: When the values were compared with both methods, highly significant differences were observed for both X and Y, Ranawat’s triangle method dx1=(19.52±3.03) mm, dy1=(24.43±2.26) mm; and Mose circle method dx2=(11.90±3.55) mm, dy2=(34.29±3.79) mm (P < 0.001) and these ratios (dx1/H=0.099 2±0.013 3, dy1/W=0.085 5±0.006 9; dx2/H=0.061 1±0.019 4, dy2/W=0.120 1±0.017 8) in pelvic height and width (P < 0.001). Scatterplot results demonstrated that the hip rotational center identified by Ranawat’s triangle method is near to the proximal end and medial end, which may affect mechanical environment surrounding the joint. For cases of bilateral hip dysplasia and joint revision, because of the changes in structure surrounding the acetabulum, Ranawat’s triangle method can be a feasible method to identify the hip rotational center. For cases of unilateral lesion, Mose circle method can exactly identify the hip rotational center taking healthy side as a control. 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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Old femoral neck fractures with senile osteoporosis: choice of femoral prosthesis according to femoral calcar-medullary cavity ratio Zhu Xu-ri, Sun Guang-quan, Liu Xin, Chen Guo-qing, Du Bin 2015, 19 (17):  2631-2636.  doi: 10.3969/j.issn.2095-4344.2015.17.002 Abstract ( 336 )   PDF (326KB) ( 486 )   Save BACKGROUND: Old femoral neck fractures with senile osteoporosis have more surgical difficulties. There are a lot of intraoperative and postoperative complications and long-term effects are poor.   OBJECTIVE: To explore the clinical outcomes of hip arthroplasty in patients with old femoral neck fractures with senile osteoporosis. METHODS: From October 2012 to July 2014, 20 patients with old femoral neck fractures and senile osteoporosis were enrolled in this study. Posterolateral approach was used to perform hip arthroplasty. Of them, 14 patients received primary total hip arthroplasty with biological prosthesis, and 6 patients were subjected to semi-hip arthroplasty with straight shank cylindrical renovated biological prosthesis. RESULTS AND CONCLUSION: The patients were followed up for 3 to 24 months. Harris score was apparently increased after arthroplasty in patients with old femoral neck fractures and senile osteoporosis compared with pre-arthroplasty. Postoperative radiographs revealed that femoral stem biological fixation was good. Bone fixation was visible in radiographs at 3 months after arthroplasty. These findings suggested that old femoral neck fractures and senile osteoporosis could be treated with hip arthroplasty. To select the type of prosthesis and surgical methods according to the femoral calcar-medullary cavity ratio in patients with old femoral neck fractures and senile osteoporosis can effectively restore the function of hip joint. 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 follow-up of total hip arthroplasty with Accolade TMZF cementless femoral prosthesis Zhu Yong-sheng, Xu Yao-zeng, Zhu Feng, Wu Guang-peng, Shao Hong-guo 2015, 19 (17):  2637-2641.  doi: 10.3969/j.issn.2095-4344.2015.17.003 Abstract ( 292 )   PDF (572KB) ( 589 )   Save BACKGROUND: Compared with the fixation of bone cement prosthesis, the fixation of cementless femoral prosthesis does not have the following worries, including cement-prosthesis separation, cement sheath rupture, and cement debris-induced osteolysis. Long-term outcomes are good, and the survival rate is high.  OBJECTIVE: To observe the preliminary clinical results and complications of total hip arthroplasty with Accolade TMZF cementless femoral stem. METHODS: From February 2010 to July 2012, 67 patients (70 hips) underwent primary total hip arthroplasty with cementless femoral stem. All patients were treated with Accolade TMZF Biological hip prosthesis system. Femoral component was treated with the same Accolade TMZF cementless femoral stem. Acetabular component was treated with Secure-fit HA and Trident PSL HA. The first mortar joint friction surface was treated with ceramic-ceramic composite in 49 hips, ceramic-polyethylene composite in 19 hips and metal-polyethylene composite in 2 hips. After replacement, hip imaging data were utilized to assess biological fixation of femoral stem prosthesis, osteolysis surrounding the prosthesis, and prosthesis subsidence, and to observe hip function, thigh pain and complications. RESULTS AND CONCLUSION: All cases were followed up for more than 2 years. The mean Harris hip score was (32.7±6.2) preoperatively, and improved to (89.2±5.1) during final follow-up. During final follow-up, four patients (6%) suffered from slight pain. No moderate and severe pain or extremely severe pain occurred. None of the patients needed second operation due to failure for various reasons. X-ray films showed that no prosthesis displacement or loosening. Bone fixation surrounding the prosthesis was visible at the femoral side. Only one hip had subsidence of less than 2 mm, and the remaining did not experience subsidence. No blood vessels or nerve injury appeared during the surgery. During prosthesis placement, femoral calcar cleavage fracture occurred in 4 hips, so wire cerclage was used. Deep vein thrombosis in the lower limb or fractures surrounding the prosthesis was not found after placement. These results indicated that the preliminary clinical results of primary total hip arthroplasty with Accolade TMZF cementless femoral stem are encouraging, can effectively improve the function of hip joint. But the follow-up time is shorter, mid-term long-term curative effect should be further observed. 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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Comprehensive prevention of deep vein thrombosis after total hip replacement Chen Jian-hong, Xi Zi-long, Yuan Zhu 2015, 19 (17):  2642-2647.  doi: 10.3969/j.issn.2095-4344.2015.17.004 Abstract ( 336 )   PDF (360KB) ( 539 )   Save BACKGROUND: A high incidence of deep vein thrombosis after total hip replacement does great harm to patients, so it is necessary to look for a safe and effective prevention program after total hip replacement to reduce the harm of deep vein thrombosis. OBJECTIVE: To observe the influence of comprehensive prevention scheme on deep vein thrombosis after total hip replacement. METHODS: 102 cases undergoing total hip replacement were randomly divided into observation group and control group with 51 cases in each group. Patients in the observation group received the comprehensive prevention program, which is composed of three interventions: sequential cross combined with low molecular heparin, intermittent pneumatic pressure therapy and continuous femoral nerve block analgesia. In the control group, patients received low-molecular-weight heparin for anticoagulation therapy by the doctor according to his clinical experience, or intermittent pneumatic pressure therapy. The occurrence and distribution of deep vein thrombosis were compared in patients of both groups. At the same time, platelet and hemoglobin were recorded. RESULTS AND CONCLUSION: In the observation group, three patients suffered from deep vein thrombosis with an incidence of 6%. In the control group, 11 patients affected deep vein thrombosis, with an incidence of 22%. There were significant differences between the two groups (P < 0.05). No significant difference in constituent ratio of the distribution of deep vein thrombosis was detected in the distal vein and proximal vein in patients of both groups (P > 0.05). Hemoglobin value was lower at 1 day after surgery compared with that pre-operation in the two groups (P < 0.05). Platelet value was lower at 1 day after surgery compared with that pre-operation in the two groups (P > 0.05). No significant difference in hemoglobin and platelet values was detected between two groups at 1 and 6 days after surgery (P > 0.05). Results indicated that the comprehensive prevention program containing the sequential and cross combined with low molecular heparin, intermittent pneumatic pressure therapy and continuous femoral nerve block analgesia can significantly reduce the incidence of deep vein thrombosis, and no serious complications occurred, and the effects are affirmative and reliable. 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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Effects of tranexamic acid on hidden blood loss after total knee arthroplasty in animal models Yuan Lei, Bao Ni-rong, Zhao Jian-ning 2015, 19 (17):  2648-2654.  doi: 10.3969/j.issn.2095-4344.2015.17.005 Abstract ( 381 )   PDF (405KB) ( 444 )   Save  BACKGROUND: Hidden blood loss leads to severe anemia after orthopedic joint arthroplasty. Blood transfusion is needed. Use of tranexamic acid can significantly decrease perioperative blood loss, reduce blood transfusion rate, however, mechanism of action of tranexamic acid on hidden blood loss and its relevance are not clear. OBJECTIVE: By establishing the rabbit models of total knee prosthesis, this study was designed to observe the variation of early preoperative blood loss with tranexamic acid, and to study the effects of tranexamic acid on hidden blood loss and its influence on deep venous thrombosis of lower limb.   METHODS: We designed the rabbit knee prosthesis ourselves. A total of 20 adult New Zealand rabbits were randomly divided into two groups, each group with 10 rabbits. Knee arthroplasty on the same side was performed. Experimental group received intravenous injection of 0.5 g 100 mL tranexamic acid at 15 minutes before replacement. Control group was given 100 mL sodium chloride at the same time. Blood was collected from all animals through ear vein at 1 day before replacement, 3, 6, 24, 48, 72 hours and 7 days after replacement. Blood routine examination and blood coagulation function test were conducted. The content of plasma D-Dimer was determined. Simultaneously, the operation time and intraoperative bleeding amount were recorded. After replacement, lower limb venous ultrasonography was performed. RESULTS AND CONCLUSION: No significant difference in body weight, hemoglobin, hematocrit, and D-Dimer levels was detected between the two groups before replacement (P > 0.05). Significant differences in operation time and intraoperative dominant blood loss were detectable between the two groups (P < 0.05). Significant differences in hemoglobin and hematocrit were detected at 24 hours after replacement (P < 0.05), and these were better in the experimental group than in the control group. No significant difference in D-Dimer was observed between the two groups after replacement (P > 0.05). Operation time and intraoperative dominant blood loss were significantly associated with hemoglobin and hematocrit at 24 hours after replacement (P < 0.05). The changes in hemoglobin and hematocrit at 72 hours and 7 days after replacement were not apparently correlated with intraoperative D-Dimer changes. Obvious thrombus was not seen by lower limb venous ultrasonography after replacement. These results indicated that the use of tranexamic acid before total knee arthroplasty apparently reduced the intraoperative dominant blood loss, shortened operation time, and noticeably decreased hidden blood loss at 1 day after replacement, which was caused by the increased fibrinolysis with surgical stress, and did not apparently impact other hidden blood loss induced by other mechanism. Simultaneously, tranexamic acid is safe and reliable, and does not increase the risk of perioperative thrombus.  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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Efficacy and safety of tranexamic acid on blood loss after unilateral total knee arthroplasty Min Peng, Peng Yin-xiao, Hu Jiang-hai, Gu Zu-chao 2015, 19 (17):  2655-2660.  doi: 10.3969/j.issn.2095-4344.2015.17.006 Abstract ( 386 )   PDF (331KB) ( 508 )   Save BACKGROUND: Total knee arthroplasty is always associated with peripheral blood loss. Blood transfusion not only involves additional cost and prolongs rehabilitation time, but also carries substantial risk of immunologic reaction and disease transmission. Therefore it is very important to reduce blood loss of total knee arthroplasty. OBJECTIVE: To investigate the efficacy and safety of tranexamic acid on reducing blood loss after total knee arthroplasty. METHODS: We enrolled 64 patients with primary osteoarthritis undergoing a unilateral total knee arthroplasty and randomized them into two groups, with 32 patients in each group. Tranexamic acid group: patients received intravenous drop infusion of tranexamic acid dissolved in 250 mL normal saline (10 mg/kg) at 15 minutes before operation; control group: patients just received 250 mL normal saline. Intraoperative blood loss, postoperative blood loss, postoperative hemoglobin levels, amount of blood transfusion, and number of patients requiring blood transfusion were compared. Fibrinogen, prothrombin time and other coagulation indicators were also examined before operation and 3 hours after operation. Deep vein thrombosis in both limbs of all patients was examined by the color Doppler ultrasonography 30 days after operation. RESULTS AND CONCLUSION: There was no significant difference in intraoperative blood loss between the two groups (P > 0.05). Postoperative volume of blood loss was lower in the tranexamic acid group than in the control group (P < 0.001). The amount of blood transfusion and number of patients requiring blood transfusion were lower in the tranexamic acid group than in the control group (P < 0.001). The postoperative hemoglobin levels were obviously higher in the tranexamic acid group than in the control group (P < 0.001). There was no significant difference in coagulation indicators between two groups at postoperative 3 hours, but D-dimer value in the two groups was significantly higher than that before surgery, and the tranexamic acid group was lower than the control group (P < 0.001). No cases appeared deep vein thrombosis after operation. Experimental findings indicate that, tranexamic acid can effectively reduce postoperative blood loss and blood transfusion, as well as number of blood transfusions after total knee arthroplasty. And it did not increase the risk of 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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Thrombosis prediction within short time after total knee arthroplasty: dynamic monitoring of D-Dimer and fibrin degradation products Yuan Wei, Ma Hua-song, Wang Xiao-ping, Chen Zhi-ming, Lu Ming, Xu Qi-ming, Ren Dong-yun 2015, 19 (17):  2661-2666.  doi: 10.3969/j.issn.2095-4344.2015.17.007 Abstract ( 371 )   PDF (631KB) ( 451 )   Save BACKGROUND: Deep vein thrombosis after total knee arthroplasty has attracted increasing attention in recent years, but how to detect deep vein thrombosis in the early time in clinical practice remains unclear. Whether it is necessary to perform type-B ultrasonic or other invasive examination in lower limbs has become a hot issue. OBJECTIVE: To explore the significance of D-Dimer and fibrin degradation products in the prediction of deep vein thrombosis after total knee arthroplasty. METHODS: 56 patients received total knee arthroplasty were collected from Department of Orthopedics, The 306th Hospital of Chinese PLA, between December 2012 and February 2014. The D-Dimer and fibrin degradation products were dynamically monitored before operation and at 1, 3, 5, 7, 10 days post-operation. All the patients received type-B ultrasonic examination in double lower limbs at 10 days post-operation, and divided into thrombus group and non-thrombus group. The D-Dimer and fibrin degradation products in the two groups were compared. RESULTS AND CONCLUSION: Deep vein thrombosis was found in 13 cases by ultrasonic-B postoperation, D-Dimer and fibrin degradation products showed no significant difference between the two groups at 1 week after operation (P > 0.05), but the difference was significant at 10 days (P < 0.01). D-Dimer and fibrin degradation products index should be monitored dynamically for at least 10 days after operation, which is helpful for the early diagnosis of 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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Patellar arthroplasty in one-stage bilateral total knee arthroplasty for knee osteoarthritis Gao Zi-li, Sun Kang, Tian Shao-qi 2015, 19 (17):  2667-2671.  doi: 10.3969/j.issn.2095-4344.2015.17.008 Abstract ( 412 )   PDF (177KB) ( 505 )   Save BACKGROUND: Total knee arthroplasty is one of the most effective and successful operations for the treatment of various end-stage or severe knee diseases. However, there is no consensus about routine patella resurfacing in total knee arthroplasty.   OBJECTIVE: To investigate the efficacy of patellar arthroplasty in one-stage bilateral total knee arthroplasty for the treatment of knee osteoarthritis. METHODS: Patients undergoing bilateral total knee arthroplasty were selected from the Department of Orthopedic Surgery, Affiliated Hospital of Qingdao University in China between February 2013 and February 2014. They were randomly assigned to two groups. Patellar resurfacing group received patellar arthroplasty. Non-patellar resurfacing group did not receive patellar arthroplasty. RESULTS AND CONCLUSION: At 3, 6 and 12 months following the surgery, no significant difference in Knee Society Score and range of motion of knee joint was detected between the two groups (P > 0.05). 12 cases experienced anterior knee pain, including 4(13%) of the patellar resurfacing group and 8(27%) of the non-patellar resurfacing group. There were no complications such as prosthesis fracture, loosening, displacement, patellar fracture or patellar necrosis, and patellar prosthesis revision. Results verified that patellar arthroplasty and non-patellar arthroplasty have the same short-term effectiveness in one-stage bilateral total knee arthroplasty for osteoarthritis. 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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Artificial cervical disc replacement: range of motion of replacement segment and degeneration of adjacent segments Chen Xuan-yu, Wu Ji, Zheng Chao, Huang Rong-rong, Cui Yu-ming, Shang Yong, Fan Heng-hua, Yu Pan-feng, Zhao Xu-hong, Chu Dong 2015, 19 (17):  2672-2676.  doi: 10.3969/j.issn.2095-4344.2015.17.009 Abstract ( 273 )   PDF (460KB) ( 442 )   Save BACKGROUND: In recent years, artificial cervical disc replacement surgery as a new method for the treatment of cervical disease has gradually been accepted and understood, but relevant complications have gradually attracted attention. OBJECTIVE: To investigate the clinical outcomes of artificial cervical disc replacement in the treatment of cervical disease and the range of motion of the replacement segment. METHODS: A total of 25 patients with artificial cervical disc replacement in the treatment of cervical spondylosis, who were treated in the Department of Orthopedics, Air Force General Hospital of Chinese PLA from August 2006 to April 2012, were enrolled in this study, including 15 males and 10 females, aged 31-76 years, averagely 51.04 years. There were 6 cases of double segments and 19 cases of single segment. They were followed up for 24 to 93 months. Clinical results were assessed using the Japanese Orthopaedic Association score, cervical dysfunction index and pain visual analog scale scores. Imaging was used to observe range of motion, cervical curvature, heterotopic ossification, and degeneration of adjacent segments. RESULTS AND CONCLUSION: Neurological function in all patients was improved to different degrees. One case suffered from mild heterotopic ossification, but no clinical symptoms were found. No significant difference in range of motion of surgical segment, and range of motion of upper and lower adjacent segments was detected between pre-replacement and final follow-up results (P > 0.05). No significant difference in range of motion of C2-C7 was found between pre-replacement and final follow-up results (P > 0.05). Japanese Orthopaedic Association score, cervical dysfunction index and pain visual analog scale scores were significantly improved during final follow-up compared with pre-replacement (P < 0.05). These results indicated that artificial cervical disc replacement in the treatment of cervical disease can achieve better clinical efficacy, can keep the range of motion of replacement segment and avoid the accelerated degeneration of adjacent segments. 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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Correlation of trace elements and bone fusion surrounding hip prosthesis Fu Xiao-dong, Wang Wei-li, Shen Yi, Li Xiao-miao 2015, 19 (17):  2677-2682.  doi: 10.3969/j.issn.2095-4344.2015.17.010 Abstract ( 388 )   PDF (367KB) ( 419 )   Save  BACKGROUND: The prosthesis fusion rate after total hip replacement is closely related to the reconstruction process of bone, which is affected by the factors around the implant of patient. Trace elements are strongly associated with the ossification. Thus, the content of trace elements in proximal femur may affect the bone fusion and survival rate of the prosthesis.   OBJECTIVE: To analyze the correlation of trace elements and bone fusion surrounding the prosthesis in proximal femur. METHODS: Bone samples were obtained from the discarded metaphysis region of the proximal femur in 24 patients with primary total hip replacement. Trace element (calcium, magnesium, zinc, parathyroid hormone, activated vitamin D3) contents were detected after vitro cell culture. Bone mineral density was tested surrounding the prosthesis at 1 week, 3 and 6 months after replacement by dual energy X-ray absorption method with a bone density meter. The difference in trace elements was compared in patients at different ages and different genders. The correlation between above five kinds of trace elements and bone mineral density was analyzed. RESULTS AND CONCLUSION: No significant difference in trace element contents was detected in different age groups and different gender groups (P > 0.05). Zinc content was positively correlated with parathyroid hormone and magnesium contents (P < 0.05). Zinc was positively associated with bone mineral density in the region 7 (P < 0.05). The further studies concerning the trace elements in proximal femur can be used to predict and intervene in the longevity of hip prosthesis. 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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Anatomic measurements of internal fixation-related implantation points of inferior thoracic spinal latero-anterior vertebral screws Sun Xiang-xin, Wang Zhi-jie 2015, 19 (17):  2683-2687.  doi: 10.3969/j.issn.2095-4344.2015.17.011 Abstract ( 355 )   PDF (238KB) ( 429 )   Save BACKGROUND: There are many reports on the entrance point of adult inferior thoracic spinal latero-anterior screw. Because of the differences in race, districts and the shape of vertebral body are various, and the choice of screw placement position is also varied.   OBJECTIVE: To provide an anatomical reference for the implantation of clinical screws for inferior thoracic spinal latero-anterior fixation with the concave rib set as a reference. METHODS: Spinal specimens from 20 adult cadavers were observed, and anatomical data were collected from the concave ribs. One vernier caliper was used for the measurements. RESULTS AND CONCLUSION: The thoracic transverse diameters and the distance between the upper and the inferior edge of the concave rib and upper endplate increased gradually as the vertebral number increased, whereas the distances between the upper and the inferior edge of the concave rib and inferior endplate and between the anterior edge of the concave rib and anterior edge of the vertebral canal decreased gradually. Above findings suggested that the anatomical positions of the inferior thoracic concave ribs followed a set of rules. The concave rib could be used as a simple, constant, and reliable reference point for inferior thoracic spinal latero-anterior fixation screw placement. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 全文链接： Figures and Tables | References | Related Articles | Metrics

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Percutaneous screw fixation combined with articular process bone grafting for the treatment of thoracolumbar fractures: constructing long-term stability Gao Hao-ran, Zhao Hai-en, Qian Shu, Guo Shi-kong, Li Hong, Qian Ji-xian 2015, 19 (17):  2688-2693.  doi: 10.3969/j.issn.2095-4344.2015.17.012 Abstract ( 428 )   PDF (1251KB) ( 869 )   Save  BACKGROUND: It has been a hotspot in the treatment of spinal fracture by minimally invasive approach. Compare with open operation, minimally invasive surgery has less trauma, less bleeding, less tissue damage and shorter hospital stay. But no clinical study focuses on the reduction effect of minimally invasive percutaneous screw fixation and maintenance of vertebral height. OBJECTIVE: To compare the difference of minimally invasive percutaneous screw combined with articular process bone grafting and simple screw fixation in the treatment of thoracolumbar fracture on maintaining vertebral height. METHODS: Clinical data of 79 patients with T11-L2 thoracolumbar fractures (AO type: A1, A2, A3, B1) were retrospectively analyzed. Among them, 41 cases were treated by percutaneous pedicle screw fixation combined with articular process bone grafting, while 38 cases were treated by percutaneous pedicle screw fixation, from January 2010 to September 2013. Perioperative indicators in the two groups, visual analogue scale scores, and Oswestry Disability Index before and after surgery, as well as at final follow-up were compared between the two groups. The anterior and posterior of vertebral height, the recovery of Cobb’s angle were evaluated. RESULTS AND CONCLUSION: The patients in the grafting group were followed up for 4-36 months and those in the non-grafting group were followed up for 5-30 months, there was no significant difference in the follow-up time between the two groups (P=0.25). The operation time, intraoperative blood loss, postoperative ambulation time and hospital stay showed no significant difference between the two groups (P > 0.05). The follow-up results showed that, no significant difference was found in visual analogue scale scores and Oswestry Disability Index between the two groups (P > 0.05). However, the anterior and posterior of vertebral height, the recovery of Cobb's angle in the grafting group were significantly better than that in the non-grafting group (P < 0.05). The short-term efficacy and security are similar between the two surgery methods in the treatment of thoracolumbar fracture. However, minimally invasive percutaneous screw combined with articular process bone grafting shows great advantages in recovering and maintaining the long-term 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 decompression screw fixation for treatment of thoracolumbar burst fracture combined with spinal cord injury: evaluation of neurological function Li Fei, Jiang Yu-wen, Huang Ming-guang, Zeng Qiu-tao 2015, 19 (17):  2694-2698.  doi: 10.3969/j.issn.2095-4344.2015.17.013 Abstract ( 408 )   PDF (276KB) ( 396 )   Save BACKGROUND: The surgical treatment of thoracolumbar burst fracture combined with spinal cord injury is to relieve mechanical compression on the spinal cord and reconstruct spinal stability through internal fixation. This theory is derived from a lot of animal experiments and important biomechanical principles, but the available clinical data are still scarce. OBJECTIVE: To investigate the efficacy of posterior decompression and screw internal fixation for the treatment of thoracolumbar fractures combined spinal cord compression, and to evaluate vertebral body height, kyphosis angle and neurological function. METHODS: A retrospective study was performed among 75 patients with thoracolumbar fractures combined spinal cord compression, who were recruited from Department of Orthopedics, the First People’s Hospital of Shunde District of Foshan City, from January 2010 to February 2013. They underwent posterior decompression and internal fixation. The preoperative and postoperative kyphosis angle, vertebral height and neurological function were compared. RESULTS AND CONCLUSION: The preoperative kyphotic angle was (25.2±2.1)° and postoperative kyphotic angle was (8.8±2.3)°, with significant differences (P < 0.05). Preoperative vertebral body height was (58.4±14.2)% and postoperative vertebral body height was (92.3±6.8)%. According to ASIA score, 48 cases had slight impairment of neurological function, scores more than 40 points, and 45 of them had completely recovered walking ability, the recovery rate was 94%; the remaining 27 cases had moderate or severe neurological function impairment, scoring less than 40 points, and 15 of them appeared obvious recovery of neurological function, the recovery rate was 56%. Posterior decompression and internal fixation for treatment of thoracolumbar burst fracture combined with spinal cord injury can effectively restore the vertebral height and kyphosis, and improve significantly 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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Transforaminal lumbar interbody fusion via Quadrant system: early correction of lumbar spondylolisthesis Hao Ying-jie, Li Zhi-lei, Yu Lei, Zhang Di, Liu Tao 2015, 19 (17):  2699-2703.  doi: 10.3969/j.issn.2095-4344.2015.17.014 Abstract ( 418 )   PDF (451KB) ( 506 )   Save BACKGROUND: Conventional therapies for lumbar spondylolisthesis can result in trauma, bleeding and low back pain. With the vigorous development of spinal biomechanics and novel spinal fixation systems, we have more understanding on the reduction and fusion after spondylolisthesis. OBJECTIVE: To observe the clinical effects of transforaminal lumbar interbody fusion via the quadrant system on lumbar spondylolisthesis and related biomechanical changes. METHODS: A retrospective analysis was done in 23 patients with lumbar spondylolisthesis undergoing transforaminal lumbar interbody fusion via the quadrant system admitted from June 2012 to September 2013. Oswestry disability index and visual analog scale score were detected at 3 months and 1 year after treatment, as well as fusion conditions and internal fixation with or without loosening or breakage. RESULTS AND CONCLUSION: All patients were successfully treated, with no cerebrospinal fluid leakage and nerve injury. Incisions were healed well in all cases except one case suffered from incision infection that was controlled after 10 days of antibiotic treatment. All the patients were followed up. The Oswestry disability indexes and visual analog scale scores were significantly improved at 3 months and 1 year after treatment (P < 0.05), but there was no difference in these two scores at 3 months and 1 year after treatment (P > 0.05). The improvement rates of Oswestry disability index and visual analog scale score were (65.3±14.8)% and (58.2±12.0)%, respectively. These findings indicate that the transforaminal lumbar interbody fusion via the quadrant system is safe and effective to correct lumbar spondylolisthesis, maintains the biomechanical stability, improves patient’s symptoms, reduces the incidence of low back pain and improves the quality of life. 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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Delayed healing or post-operative recurrence in pediatric spinal tuberculosis: efficacy of individualized re-operation Zhang Xiao-dong, Mardan•Mamat, Yakup•Abulizi, Ailixier, Sheng Wei-bin, Deng Qiang 2015, 19 (17):  2704-2710.  doi: 10.3969/j.issn.2095-4344.2015.17.015 Abstract ( 341 )   PDF (514KB) ( 438 )   Save BACKGROUND: Due to the emergence of drug-resistant tuberculosis and mismanagement in tuberculosis patients, the incidence of delayed healing or recurrent after spinal tuberculosis surgery is gradually increasing, especially in strongly predisposal children. Therefore, exploring the risk factors of delayed healing or post-operative recurrence in pediatric patients after spinal tuberculosis surgery, will have significance in the prevention and treatment of tuberculosis.   OBJECTIVE: To analyze the risk factors of delayed healing or post-operative recurrence in pediatric spinal tuberculosis, and evaluate the efficacy of individualized re-operation. METHODS: From June 1998 to June 2013, clinical data of 145 pediatric patients with spinal tuberculosis were reviewed retrospectively, and some cases of delayed healing or post-operative recurrence in spinal tuberculosis were compared with other without delayed healing or post-operative recurrence. The patient’s age, gender, nutritional condition, lesion debridement, history of chemotherapy and internal fixation, complicated spinal lesion, scope of lesions, preoperative erythrocyte sedimentation rate > 60 mm/h, and postoperative complications were analyzed by Logistic regression analysis. The risk factors of delayed healing or post-operative recurrence were analyzed. After re-operation, erythrocyte sedimentation rate, C-reactive protein and imaging studies were detected. RESULTS AND CONCLUSION: After surgery, 29 cases appeared delayed healing or post-operative recurrence and 12 of them received re-operation. The incidence of delayed healing or post-operative recurrence in pediatric spinal tuberculosis was 20% and the re-operation rate was 8.3%. Logistic regression analysis showed that, nutritional condition, history of chemotherapy, lesion debridement, and scope of lesions were significantly correlated with delayed healing or post-operative recurrence (P < 0.05). While patient’s age, gender, history of internal fixation, complicated spinal lesion, preoperative erythrocyte sedimentation rate > 60 mm/h, and postoperative complications had no correlation with the delayed healing or post-operative recurrence (P > 0.05). Individualized re-operation can achieve good outcomes. Experimental findings indicate that, the risk factors of delayed healing or post-operative recurrence in pediatric spinal tuberculosis are very complex, enhancing the nutrition, complete debridement of lesions, and receiving chemotherapy can effectively decrease the incidence. According to the initial surgery and patient’s conditions, individualized re-operation is the key to the success. 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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Screw plate fixation, intramedullary fixation and artificial femoral head replacement in the repair of femoral intertrochanteric fractures in the elderly: choice and comparison Zuo Jin-bu, Yu Lei, Liang Hong-wei, Wang Wei, Zhao Bin 2015, 19 (17):  2711-2718.  doi: 10.3969/j.issn.2095-4344.2015.17.016 Abstract ( 537 )   PDF (787KB) ( 1238 )   Save BACKGROUND: Nowadays, the internal fixation materials for the clinical treatment of femoral intertrochanteric fractures are broadly divided into two categories: intramedullary fixation system and extramedullary fixation system. Artificial femoral head replacement can be selected for unstable intertrochanteric fractures. However, the effects of diverse treatments usually lack of macroscopical evaluation.　 OBJECTIVE: To investigate and compare the clinical effects of different surgical treatments for femoral intertrochanteric fractures in the elderly. METHODS: 168 elderly patients with intertrochanteric fractures, who were treated in the Department of Orthopedics, Beijing Municipal Corps Hospital of Chinese People’s Armed Police Forces from June 2005 to June 2010, were enrolled in this study. They were treated by screw plate fixation system (dynamic hip screw, dynamic condylar screw), intramedullary fixation system (Gamma 3 nail, expandable intramedullary nail) and artificial femoral head replacement, including 69 males and 99 females, at the age of 75-94 years, averagely 81.4 years. According to Evans type, there were 20 cases of type I, 43 cases of type II, 57 cases of type III, 33 cases of type IV and 15 cases of type V. Operative time, blood loss, weight-bearing ambulation time, and hip function were compared and evaluated in patients of each group. RESULTS AND CONCLUSION: After treatment, patients were followed up for 14-39 months. At 12 months after treatment, Harris score was used to assess hip function in the affected side. Fracture was healed within 12 months. There was no significant difference in excellent and good rate among four groups (P > 0.05). Operative time and blood loss were significantly better in the expandable intramedullary nail group than in the other groups (P < 0.05). Weight-bearing ambulation time was significantly better in the artificial femoral head group than in the other groups    (P < 0.01). Results suggest that according to fracture typing, in combination with osteoporosis in elderly patients, suitable repair method could improve therapeutic effects for femoral intertrochanteric fractures, and reduce postoperative complications. Dynamic hip screw is firstly selected for Evens types I and II stable intertrochanteric fractures. The intramedullary fixation system can be selected for unstable intertrochanteric fractures as Evans types III-V. Artificial hip arthroplasty is good for elderly patients with unstable intertrochanteric fractures as well as severe osteoporosis. 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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Fixation with three kinds of implants to repair osteoporotic intertrochanteric fractures: univariate and multivariate analysis of failure Zhou Bo, Zhu Qi, Zhong Shu-taoZhou Bo, Zhu Qi, Zhong Shu-tao 2015, 19 (17):  2719-2723.  doi: 10.3969/j.issn.2095-4344.2015.17.017 Abstract ( 360 )   PDF (266KB) ( 489 )   Save BACKGROUND: Intertrochanteric fracture is one of the common complications in patients with senile osteoporosis. Internal fixation is a common method in clinical therapy. Different internal fixators are selected in different studies. However, there are few studies on influential factors for outcomes of internal fixation at present. OBJECTIVE: To investigate related influential factors for outcomes of internal fixation in elderly patients with osteoporotic intertrochanteric fracture.  METHODS: A total of 86 elderly patients with osteoporotic intertrochanteric fracture, who were treated in the Guanghua Hospital from May 2011 to May 2014, were enrolled in this study. They were divided into three groups according to different manners of fixation. There were dynamic hip screw group (n=34), proximal intramedullary nail group (n=41) and proximal femoral compression plate group (n=11). Rate of fixation failure was compared among the three groups. The relevant factors affecting fixation effects were analyzed using univariate and multivariate analysis. RESULTS AND CONCLUSION: Internal fixation failure was detected in 5 patients (15%) in the dynamic hip screw group, 11 patients (26%) in the proximal intramedullary nail group, and 4 patients (36%) in the proximal femoral compression plate group. Results of univariate analysis revealed that Evanse genotyping of patients，whether fractures were found on outer arm side, degree of osteoporosis, quality of reduction, steeple distance, whether combined with internal medicine diseases and selection of fixator were associated with internal fixation effects (P < 0.05). However, the internal fixation effects were not correlated with gender, age, hospital stay and ambulation time (P > 0.05). Multivariate analysis results demonstrated that unstable fractures, severe osteoporosis, fractures of the lateral arm, medical illness, steeple distance > 25 mm, and different internal fixators are independent factors affecting internal fixation effects in 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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Intramedullary nail or anatomical plate internal fixation for closed reduction of femoral shaft fracture: comparison of fracture stability Shi Hai-shan 2015, 19 (17):  2724-2729.  doi: 10.3969/j.issn.2095-4344.2015.17.018 Abstract ( 346 )   PDF (403KB) ( 462 )   Save BACKGROUND: Closed reduction of femoral shaft fracture is a common orthopedic fracture type, and can be treated conservatively, but comminuted fracture and serious conditions should be treated by surgery. Intramedullary nail and anatomical plate are commonly used for internal fixation, the choice of the two materials for the femoral fixation remains controversial. OBJECTIVE: To compare and analyze the clinical prognosis and fracture stability in closed reduction of femoral shaft fractures with intramedullary nail or anatomical bone plates. METHODS: From January 2011 to December 2013, 86 patients with femoral shaft fracture recruited from Jiangdu People’s Hospital of Yangzhou were involved in the retrospective study. All patients were divided into two groups, receiving intramedullary nail and anatomical bone plates, respectively. Clinical prognosis, fracture stability and adverse events in the two groups were compared. RESULTS AND CONCLUSION: The intraoperative blood loss and postoperation drainage volume in the intramedullary nail group were significantly lower, while the operation time and fracture healing time were significantly shorter than the anatomical bone plates group (P < 0.05). The excellent and good rate was higher in the two groups, and there was no significant difference between the two groups, although the rate in intramedullary nail group was higher than anatomical bone plates group (P > 0.05). The adverse reactions in intramedullary nail group were significantly less than anatomical bone plates group (9%, 35%, P < 0.05). Compared with the intramedullary nail group, more cases in anatomical bone plates group appeared poor fixation and fixator rupture, the incidence of complications was higher, and postoperative stability was poorer. Experimental findings indicate that, both intramedullary nail and anatomical bone plates can achieve good outcomes in the treatment of closed reduction of femoral shaft fractures, but the intramedullary nailing causes fewer trauma, lower incidence of adverse events, and better compatibility and stable, it is worthy 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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Fresh and old tibial intercondylar eminence fracture by arthroscopic wire fixation Xie Hu, Zhang Ji-ping, Li Yong-zhong, Min Hua, Lin Hua 2015, 19 (17):  2730-2734.  doi: 10.3969/j.issn.2095-4344.2015.17.019 Abstract ( 370 )   PDF (328KB) ( 465 )   Save  BACKGROUND: Arthroscopic treatment of tibial eminence fracture requires tiny wire, induces less epiphyseal plate damage during operations, obtains strong fixations, allows early movement postoperatively, obviously attenuate the injuries, facilitate wound healing, and reduce complications.   OBJECTIVE: To investigate the biocompatibility of arthroscopic reduction and wire fixation in treatment of fresh and old tibial eminence fractures. METHODS: Twenty-five patients with fresh and old tibial eminence fractures were treated with arthroscopic reduction and wire fixation from January 2010 to April 2012 in the Second People’s Hospital of Yichang City. The postoperative fracture healing time and knee function improvement in the two groups were observed. RESULTS AND CONCLUSION: Compared with the fresh fracture patients, the fracture healing time was longer, Lachman test positive rate was higher in the old fracture patients than (P < 0.05), knee flexion and extension activity and Lysholm score were lower (P < 0.05). Experimental findings indicate that, arthroscopic reduction and wire fixation is a feasible clinical treatment of fresh and old tibial intercondylar eminence 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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Indications for screw fixation of posterior malleolas fractures   Cheng Yuan, Gao Shi-chang, Ni Wei-dong, Liang An-lin 2015, 19 (17):  2735-2740.  doi: 10.3969/j.issn.2095-4344.2015.17.020 Abstract ( 417 )   PDF (669KB) ( 455 )   Save BACKGROUND: Posterior malleolar fractures are often accompanied by ankle joint instability, if the stability of ankle joint is not recovered, it is prone to traumatic arthritis of the ankle. However, the indications of internal fixation of posterior malleolar fractures remain controversial.< OBJECTIVE: To explore the indications for internal fixation of posterior malleolar fractures by comparing the clinical effects of posterior malleolar fractures treated with internal fixation or not. METHODS: 42 patients with malleolar fractures involving posterior ankle were recruited from the First Affiliated Hospital of Chongqing Medical University from January 2007 to January 2012. According to preoperative CT scans of ankle joint, 42 cases were divided into the internal fixation group and the non-fixation group. 27 cases in the fixation group had posterior malleolar fractures in more than 10% of the distal tibial articular surface and/or dislocation of the posterior malleolar fractures greater than 2 mm, and were treated with screws. 15 cases in the non-fixation group had posterior malleolar fractures in less than 10% of the distal tibial articular surface and dislocation of the posterior malleolar fractures less than 2 mm, and were treated with non-operation. The average healing time of posterior malleolar fractures, postoperative complications, ankle-hindfoot scores of American Orthopedic Foot and Ankle Society were compared during the follow-up postoperatively. RESULTS AND CONCLUSION: All of 42 patients with ankle fractures achieved bony union within 6 months. In the fixation group, 1 case had postoperative superficial infection of the wounds in the medial ankle and lateral ankle, and the wound got healed completely with anti-infection therapy. One case in each group had postoperative superficial necrosis in the incisional edges, and got healed by dress changing. For the other cases, there was no wound infection, internal fixation loosening, breakage or failure and other adverse events during the follow-ups. Ankle functions were evaluated one year after operations according to the ankle-hindfoot score standard of American Orthopedic Foot and Ankle Society. The score of the fixation group was (83.74±10.35) points, with excellent ankle functions in 10 cases, good in 12 cases, fair in 5 cases, and no poor case, and the rate of patients achieving excellent and good ankle functions reached 82%; the score of non-fixation group was (85.60±10.40) points, with excellent ankle functions in 7 cases, good in 5 cases, fair in 3 cases and no poor case. The rate of patients achieving excellent and good ankle functions reached 80%. The ankle function evaluation results of both groups showed no statistical difference (P > 0.05). It is reasonable to consider “posterior malleolar fractures is higher than 10% of the distal tibial articular surface and/or dislocation of the posterior malleolar fractures greater than 2 mm” as the indications for internal fixation of posterior malleolar 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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Kirschner wire and mini-plate fixation in repair of metacarpal and phalangeal fractures: hand function and adverse reactions Xia Xiao-ming 2015, 19 (17):  2741-2744.  doi: 10.3969/j.issn.2095-4344.2015.17.021 Abstract ( 314 )   PDF (214KB) ( 503 )   Save BACKGROUND: Kirschner wire fixation is the most extensive method to repair metacarpal and phalangeal fractures, but it has some disadvantages such as poor stability and many complications. Present studies suggest that surface rigidity, stability of fracture fragments and fracture healing of mini-plate were better than other fixation methods. Based on anatomical reduction, mini-plate fixation can firmly fix the bone, does not destroy articular surface, so it can restore hand function to the maximum extent. OBJECTIVE: To compare and analyze the therapeutic effects and adverse reactions of Kirschner wire and mini-plate fixation for repair of metacarpal and phalangeal fractures. METHODS: A total of 76 patients with metacarpal and phalangeal fractures, who accepted surgical treatment in Department of Orthopedics, Yixing No. 2 People’s Hospital from January 2011 to January 2014, were selected. Patients were randomly divided into observation group and control group, with 38 cases in each group. The patients in the observation group (46 places) were treated by mini-plate fixation, while those in the control group (50 places) were fixed with Kirschner wire. Hand function was evaluated after treatment. Healing and complications were compared in both groups. RESULTS AND CONCLUSION: The excellent and good rate in the observation group was 91% (42/46), and 68% (34/50) in the control group, and the significant differences between the two groups were detected (P < 0.05). Total active flexion degree, length of hospital stay and healing time were respectively (147.2±89.6)°, (5.1±2.1) days and (51.4±18.3) days in the observation group, and (132.4±35.3)°, (6.9±2.4) days and (65.5±23.8) days in the control group. Length of hospital stay and healing time were shorter, but total active flexion was greater in the observation group than in the control group (P < 0.05). Incidence of infection and delayed healing of bone were significantly lower in the observation group than in the control group (P < 0.05). Results suggest that compared with the Kirschner wire, mini-plate fixation for metacarpal and phalangeal fractures can obviously improve hand function, shorten length of hospital stay and healing time. It is safe and reliable, and is one of good clinical treatment options. 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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Mimics simulation software for screw placement in pedicle screw fixation for treating severe lumbar facet joint degeneration Bu Guo-qiang, Mao Zhong-xuan 2015, 19 (17):  2745-2751.  doi: 10.3969/j.issn.2095-4344.2015.17.022 Abstract ( 575 )   PDF (617KB) ( 479 )   Save BACKGROUND: Lumbar pedicle screw placement technique is a very mature technology in spinal surgery. There are many methods for determining the screw entry points and direction in the clinic. However, for patients with severe lumbar facet degeneration, severe osteophytosis can be found in the surgical area. Smooth and accurate screw placement has some difficulties. OBJECTIVE: To observe the effects of screw placement simulation using Mimics software on pedicle screw fixation before repair of severe lumbar facet joint degeneration. METHODS: A total of 78 cases of severe lumbar zygapophysial degeneration evaluated by CT and MR, who received single-segment lumbar pedicle screw fixation, were enrolled in this study. They were randomly divided into two groups, including simulation screw group (n=39) and control group (n=39). Totally 312 pedicle screws were implanted in the two groups. In the simulation screw group, Mimics software was used to perform 3D reconstruction before surgery and to simulate vertebral pedicle screw operation. In the 3D images, screw entry points and surrounding bony landmarks of pedicle screw were observed. The angle and depth of screw placement were measured. During the operation, pedicle screw placement was conducted in accordance with above results of observation and measurement. In the control group, pedicle screw was implanted according to the conventional method. After treatment, an X-ray CT examination was performed in the evaluation of the accuracy of pedicle screw placement. RESULTS AND CONCLUSION: No postoperative complication occurred in the simulation screw group. 153 of 156 screws were located in vertebral pedicle in the postoperative examination. The correct rate of screw placement was significantly higher in the simulation screw group than in the control group (98.1%, 88.5%, χ2=11.49, P < 0.05). The operation time, amount of bleeding and radiation exposure time were significantly shorter in the simulation screw group than in the control group (P < 0.05). These findings indicate that the lumbar facet joint degeneration accounted for a large proportion in patients with lumbar pedicle screw fixation. Facet joint degeneration increases the difficulties on distinguishing anatomical landmarks of insertion point, which brings a great difficulty for screw placement. The simulation of Mimics software in screw placement can improve accuracy in pedicle screw fixation in patients with severe lumbar facet joint degeneration, reduce complications, operation time, amount of bleeding, and radiation exposure time. 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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Digital placement and clinical application of lumbar pedicle screws based on 3D printing Chen Xuan-huang, Xu Wei-hong, Huang Wen-hua, Lin Hai-bin, Zhang Guo-dong, Wu Chang-fu, Chen Xu, Yu Zheng-xi 2015, 19 (17):  2752-2757.  doi: 10.3969/j.issn.2095-4344.2015.17.023 Abstract ( 686 )   PDF (890KB) ( 1075 )   Save BACKGROUND: 3D printing to prepare individualized navigation template-assisted screw placement can elevate screw placement accuracy of spinal pedicle screw, and have good prospects for clinical application. OBJECTIVE: To investigate the method of lumbar pedicle screw navigation placement using digital design of Mimics software combined with 3D printing module, and to explore its feasibility and accuracy. METHODS: From February 2012 to August 2013, a total of 60 patients with lumbar diseases underwent 3D printing module-assisted lumbar pedicle screw navigation placement. All patients received continuous thin slice CT scan. We collected Dicom format images. Mimics software was used for 3D reconstruction to design screw channel and the supporting column of lumbar pedicle screw placement and to divide strippable bone surface, to design navigation module with screw channel, and then to carry out 3D printing. Navigation module was utilized for navigation screw placement during the surgery. The position and replacement of screw were observed. X-ray and CT scan were applied to assess the outcomes of screw placement. The patients were followed up for (12.17±3.21) months. Oswestry Disability Index was employed to evaluate the improvement of lumbar function. Japanese Orthopaedic Association (low back pain) scoring system was used to assess the therapeutic effects. RESULTS AND CONCLUSION: 253 navigation modules were made and 253 screws were implanted. Screw channel and postoperative bone surrounding the vertebral body were observed, and no breakage was found. Postoperative X-ray and CT scan revealed that the direction of eight pedicle screws was migrated compared with preoperative design, but their positions were still satisfactory. The placement site, direction and length of 245 pedicle screws were consistent with the desired site, direction and length in Mimics software, with an accuracy of 96.84%. The navigation module was tightly connected to bone structure in front of the corresponding vertebral body, with good chimeric degree. During application, the position and stability were good. During final follow-up, Japanese Orthopaedic Association score increased, and Oswestry Disability Index was lower compared with pre-operation (P < 0.01), with an excellent and good rate of 95%. Above results confirmed that with the aid of navigation module, the digital placement of lumbar pedicle screws was precise, characterized by less complications and good therapeutic effects, and contributed to the recovery of lumbar function in 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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Design and development of a new thoracolumbar distraction reduction device in vitro Feng Qi-jin，Gu Fu-shun,Xia Qun 2015, 19 (17):  2758-2761.  doi: 10.3969/j.issn.2095-4344.2015.17.024 Abstract ( 412 )   PDF (335KB) ( 451 )   Save BACKGROUND: For the elderly osteoporotic thoracolumbar burst fractures without nerve root symptoms, it is difficult to choose between traditional surgical and conservative treatment, because they have their advantages and disadvantages. How to select their advantages and to discard their disadvantages? Concept of minimal invasion builds a new platform and provides a new way of thinking and therapeutic tool. OBJECTIVE: To design and develop a new thoracolumbar distraction reduction device in vitro in the repair of elderly osteoporotic burst fractures. METHODS: We designed and developed a new type of thoracic and lumbar spine in vitro distraction reduction device, including bracket, guide pin and two hollow screws. Its characteristic is that it also contained distractor, pressurizer and wrench. In accordance with the theory of “muscles as important as bones” and actual anatomical condition, bone fragment in the spine canal was restored using percutaneous ligament reconstructive technique. RESULTS AND CONCLUSION: This thoracic and lumbar spine in vitro distraction reduction device combined with ligament reconstructive technique can be used in elderly osteoporotic burst fractures and elderly osteoporotic compression fractures. It is percutaneous minimally invasive operation, can restore the height of anterior and central cylinders and correct Cobb’s angle through multi angle distraction. Simultaneously, percutaneous vertebroplasty can be utilized. Bone cement was infused in the injured vertebra. According to patients’ economic situation, percutaneous balloon kyphoplasty can be employed. These can provide an inexpensive, less-pain, less-invasive way to repair. 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： References | Related Articles | Metrics

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Three-dimensional finite element analysis on stress changes after rib-vertebral unit fixation for tuberculosis of thoracic spine (T6-8) Zhao Yan, Jiang Jian-ming, Li Xiao-he, Huo Hong-jun, Zuo Yuan, Xiao Yu-long, Yang Xue-jun 2015, 19 (17):  2762-2767.  doi: 10.3969/j.issn.2095-4344.2015.17.025 Abstract ( 430 )   PDF (425KB) ( 483 )   Save BACKGROUND: At present, there is lack of relevant biomechanical model for the T6-T7-T8 rib-vertebral fix unit. In addition, there is no support of parameters of basic studies on reasons and reasonable explanation of screw breakage, poor quality of bone fusion and adjacent segment degeneration. OBJECTIVE: To develop a three-dimensional finite element model of bone graft with vertebral tuberculosis debridement and posterior rib-vertebral unit fixed system through tuberculosis of thoracic spine (T6-8), and to analyze the stress so as to improve it. METHODS: Spiral CT data of one male patient (172 cm, 71 kg, 39-year-old) with T7 vertebral tuberculosis were imported into computer to develop a three-dimensional finite element model of bone graft with vertebral debridement and posterior vertebral unit fixed system through tuberculosis of T6-8 by Mimics 13.0 and Ansys 11.0 finite element software. 500 N pressure and 10 N•m torque were loaded to the vertebral body by 3 kinds of physiological loads which simulated flexion, extension and lateral bending. The stress distribution of fixation devices under different loads was compared. RESULTS AND CONCLUSION: At the positions of anteflexion and extension, the stress mainly concentrated to screw tail, and the stress of upper screw was greater than the middle and lower screws. For connecting rods, the stress of the middle was always less than the lower middle and the middle stress was zero. At lateral bending position, the stresses of upper and middle screw tail were quite, and the unilateral stress of connecting rod was also equivalent. For three different dynamics at the same point, the stress of middle connecting rod increased in the lateral bending motion, and the stress of lower screw tail was equivalent. These data suggested that it is prone to fatigue fracture at upper screw tail by bone graft with vertebral tuberculosis debridement and posterior rib-vertebral unit fixed system through tuberculosis of thoracic spine (T6-8) at the three positions of anteflexion, extension and lateral bending. The lower connecting rod at the positions of anteflexion and extension and the middle connecting rod at the position of lateral bending easily cause fatigue 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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Prosthetic matching of knee valgus for total knee arthroplasty: three-dimensional digital measurement and analysis Yuan Jing, Zhen Ping, Song Yan-feng, Wang De-gui, Gao Ming-xuan, Li Sheng-gui 2015, 19 (17):  2768-2774.  doi: 10.3969/j.issn.2095-4344.2015.17.026 Abstract ( 779 )   PDF (414KB) ( 525 )   Save BACKGROUND: Knee valgus deformity often needs total knee arthroplasty. The choice of prosthesis in total knee arthroplasty significantly affects the long-term effects. The currently used prosthesis is designed based on the data of western countries, which cannot well match with Chinese data. OBJECTIVE: To observe the abnormality of anatomical morphology of the femoral condyle and tibial plateau, and provide anatomical data for total knee arthroplasty in treatment of knee valgus deformity. METHODS: 41 adult patients (53 knees) with knee valgus deformity were detected with CT scan, the obtained images were imported into Mimics 10.01 software, and digital three-dimensional model was established. The anatomical parameters were measured, and the distribution and correlation were analyzed. The knee joint parameters between knee valgus deformity patients and healthy normal knee in single deformity patients (control group, n=29) were compared RESULTS AND CONCLUSION: X-ray findings showed that, tibiofemoral angle of knee valgus was (15.4±5.1)°, anatomical lateral distal femoral angle at coronal plane (76.6±1.2)° was decreased, and anatomical medial posterior tibia angle (95.8±0.5)° was increased. CT findings showed that, the distal condylar angle (6.5±1.3)° was increased, the poster condylar angle (5.2±1.2)° was also increased. There were significant differences compared with the control group (P < 0.05). In the total knee arthroplasty of knee valgus deformity, anatomical abnormality of femoral condyle and tibial plateau should be noted. 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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Biomarkers of deep venous thrombosis after total joint arthroplasty Chen Hui, Wang Yan 2015, 19 (17):  2775-2781.  doi: 10.3969/j.issn.2095-4344.2015.17.027 Abstract ( 491 )   PDF (466KB) ( 473 )   Save BACKGROUND: Deep venous thrombosis is one of the common and fatal complications of total joint arthroplasty. For our clinical practice, we require duplex ultrasound and venography to evaluate the presence of deep venous thrombosis, but the diagnostic tools have several disadvantages.   OBJECTIVE: To explore the appropriate and non-invasive biomarkers in the early diagnosis of deep venous thrombosis. METHODS: With the key words of “Thrombosis, DVT, Biomarker, Total Joint Arthroplasty, D-dimer, Factor VIII, Thrombin Generation, Fibrin Monomer, P-selectin, Inflammatory Cytokines, Microparticles, Leukocyte Count, Genetic factors, MicroRNAs”, a computer-based search was performed for articles published in PubMed database from January 1995 to March 2015. After the initial screening, the reserved articles were further detailed, summarized and concluded. RESULTS AND CONCLUSION: Totally 66 articles were collected. This brief review is used to analyze the mechanism of the biomarkers which are classified into three levels as follow: detection of blood coagulation, inflammation markers and molecular biology and genetics-based biomarkers. The review also showed a great need of economic and safer biomarkers for the clinic and provided the theoretical basis to diagnose and predict deep venous thrombosis in an early stage. 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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Elastic stable intramedullary nailing versus plate fixation for the repair of humeral fractures in children: a meta-analysis Lv Gang, Meng Qing-cai, Miao De-sheng, Ma Lei 2015, 19 (17):  2782-2788.  doi: 10.3969/j.issn.2095-4344.2015.17.028 Abstract ( 289 )   PDF (261KB) ( 400 )   Save BACKGROUND: There is no consensus on the choice of elastic stable intramedullary nailing or plate fixation for the treatment of humeral fractures in children. Current research is limited to small-sample studies, and it is difficult to carry out a large-sample multicenter analysis. OBJECTIVE: To evaluate the efficacy and safety of elastic stable intramedullary nailing and plate fixation for the treatment of humeral fractures in children with meta-analysis. METHODS: The PubMed database, EMbase database, CBM database, CNKI database, VIP database and Wangfang database were searched with computer to collect the controlled trials of elastic stable intramedullary nailing versus plate fixation for humerus fractures in children, and related journals were manually searched. The searching time ranged from the date of database establishment to August 2014. The trails were selected, the data were extracted and the quality was evaluated by two investigators independently. RESULTS AND CONCLUSION: Two randomized controlled trials and three retrospective controlled trials were included in the meta-analysis. The Meta-analysis results showed that the postoperative functional recovery Constant score of the elastic stable intramedullary nailing group was higher than that of the plate fixation group (P < 0.01). The bone union time, operation time, incision length, intraoperative blood loss and the hospital stay of the   elastic stable intramedullary nailing group were less than those of the plate fixation group (P < 0.01). There were no significant differences in incidence rate of complications, nonunion, wound infection and malunion between two groups (P > 0.05). Based on the current evidence, elastic stable intramedullary nailing for the treatment of humeral fractures in children is superior to the plate fixation in the efficacy. There is no significant difference in incidence rate of complications between elastic stable intramedullary nailing and plate fixation. But all the studies were small-sample, and high-risk original study. Clinical trials with adequate samples, rational design and strict execution shall be carried out to provide more reliable 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