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28 May 2015, Volume 19 Issue 22 Previous Issue    Next Issue

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Application of ulinastatin to total knee arthroplasty Feng Ji-ze 2015, 19 (22):  3445-3450.  doi: 10.3969/j.issn.2095-4344.2015.22.001 Abstract ( 336 )   PDF (837KB) ( 303 )   Save BACKGROUND: Ulinastatin is a broad spectrum of trypsin inhibitor purified and extracted from human urine. Its main pharmacological mechanism is to inhibit the excessive release of lysosomal enzymes and to improve tissue perfusion and microcirculation. Studies addressing ulinastatin effects on acute and chronic pain after total knee arthroplasty and the incidence of postoperative deep vein thrombosis are rare. OBJECTIVE: To observe the effects of ulinastatin on inflammatory mediators, postoperative pain, postoperative coagulation, incidence of deep vein and superficial vein thrombosis and the recovery of postoperative limb function in patients undergoing bilateral total knee arthroplasty using inflatable tourniquet.   METHODS: A total of 72 patients receiving bilateral total knee arthroplasty were equally and randomly divided into control group and experimental group. Experimental group received intravenous infusion of ulinastatin and control group received an equal volume of normal saline. All patients received the same general and postoperative analgesia and rehabilitation protocols. The inflammation and coagulation indicators were recorded at different time points. The pain score at rest and activity and postoperative quality of recovery score were observed. According to the results of lower extremity vascular ultrasound, we analyzed the incidence of thrombosis. RESULTS AND CONCLUSION: Levels of inflammatory cytokines of the experimental group were lower than that in the control group at partial time points (P < 0.05). Visual Analogue Scale score at rest and activity in the experimental group at 4 hours after the surgery was significantly lower than that in the control group (P < 0.05). No significant difference in coagulation parameters at each time point was found between the two groups (P > 0.05). Compared with the time of entering the operation room, fibrinogen levels were significantly lower at 4 and 24 hours after surgery in both groups, but significantly higher at 48 hours (P < 0.05). Activated partial thromboplastin time was significantly longer in both groups at 24 and 48 hours after surgery (P < 0.05). At 4-48 hours after surgery, D-Dimer expression was significantly increased in the two groups (P < 0.05). Compared with the control group, the number of thrombosis was reduced and total length of the thrombosis was significantly shorter in the experimental group (P < 0.05). Postoperative quality of recovery score was higher in the experimental group at 4 hours, 1, 3, 5, and 7 days after surgery than in the control group (P < 0.05). These data indicate that ulinastatin can alleviate inflammatory response and early postoperative pain scores at rest and activity, reduce quantity of inter-vein thrombosis of lower extremity muscle, slow the speed of thrombosis and improve the quality of postoperative recovery in patients undergoing total knee 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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Efficacy and safety of tranexamic acid on reducing blood loss in bilateral total knee arthroplasty Wang Rong, Tian Shao-qi, Ha Cheng-zhi, Song Rui-xue, Sun Kang 2015, 19 (22):  3451-3456.  doi: 10.3969/j.issn.2095-4344.2015.22.002 Abstract ( 484 )   PDF (747KB) ( 567 )   Save BACKGROUND: The blood loss and the need of blood transfusion after bilateral total knee arthroplasty are very high. Therefore, the use of medicine such as tranexamic acid in total knee arthroplasty is overheated in recent years. Tranexamic acid has been proved to be able to decrease the blood loss after total knee arthroplasty, while the study of its use in bilateral total knee arthroplasty is seldom. OBJECTIVE: To observe the effect and safety of tranexamic acid on perioperative blood loss and the change of hemoglobin in patients undergoing bilateral total knee arthroplasty. METHODS: We selected 69 patients who received bilateral total knee arthroplasty and divided them into two different groups randomly. The patients in the experimental group were given 1 g of tranexamie acid dissolved in 100 mL of 5% glucose solution through intravenous infusion. Those in control group were only given 5%  glucose solution 100 mL. Total blood loss, intraoperative blood loss, the hidden blood loss, amount of  postoperative drainage, the ratio of blood transfusion, hemoglobin, D-dimer, prothrombin time and activated partial thromboplastin time were studied and compared between the two groups. We also observed the incidence of thrombotic events between the two groups. RESULTS AND CONCLUSION: The blood loss of the experimental group was significantly lower compared to the control group (t=2.194-2.908, P < 0.05). The blood transfusion rate of experimental group was significantly lower compared to the control group (χ2=5.219, P=0.022). The hemoglobin of the experimental group was significantly higher than that of the control group at 3 and 5 days after replacement (t=-3.481, 2.319, P < 0.05). No significant difference in prothrombin time and activated partial thromboplastin time was detectable between the two groups before and after replacement (P > 0.05). Thrombotic events were not visible in both groups. Venous ultrasonography in the lower extremity did not reveal deep venous thrombosis. Above results suggest that tranexamic acid can significantly reduce intraoperative blood loss in patients undergoing bilateral total knee arthroplasty, decreases the requirement of blood transfusion and the dynamic change of hemoglobin, and does not increase the risk of thrombosis.   Figures and Tables | References | Related Articles | Metrics

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Ice intervention inhibits hemoglobin decrease and pain after total knee replacement Xu Fei, Lv Yong-ming, Song Ying-chun, Li Xia, Xing En-hong, Yang Yang, Du Yuan-liang, Zhang Li-chao, Dai Hai-feng, Dong Xiao-qiang, He Wen-jing, Zhang Yan-bo 2015, 19 (22):  3457-3461.  doi: 10.3969/j.issn.2095-4344.2015.22.003 Abstract ( 458 )   PDF (685KB) ( 549 )   Save BACKGROUND: To reduce the amount of bleeding and the amount of hemoglobin after total knee replacement has been a key project in the clinical research in the division of bone and joint. Currently, ice therapy has been widely used in the clinic for tissue swelling and pain due to various physical and chemical factors. OBJECTIVE: To investigate the risk factors of postoperative hemoglobin after total knee replacement and discuss the effects of ice intervention. METHODS: 240 patients with osteoarthritis based on the random draw principles were equally divided into the treatment group and the control group. The general information, disease status, diagnosis and treatment and prognosis of the two groups were investigated. All patients were actively subjected to artificial total knee replacement. On the basis of the treatment in the control group, the treatment group received ice intervention at 2  hours after replacement for 7 consecutive days. RESULTS AND CONCLUSION: The postoperative hemoglobin decrease occurred in 34 patients, with the incidence of 14.2% among 240 patients at 7 days after replacement. Multivariate logistic regression analysis results showed that age, no ice treatment, body mass index were the main risk factors for hemoglobin decrease after total knee replacement (P < 0.05). Compared with the control group, the postoperative hemoglobin values of the treatment group were significantly higher (P < 0.05). Hemoglobin decrease values, total blood loss, blood transfusion rate, blood transfusion amount, and pain score at 3 and 7 days after replacement were significantly lower in the treatment group than in the control group (P < 0.05). The knee function excellent and good rate was 96.7% in the treatment group, and 95.8% in the control group, which showed no significant difference (P > 0.05). Results verify that clinical application of total knee replacement facilitated the knee recovery in patients with osteoarthritis, but hemoglobin decrease and bleeding existed. Active ice intervention can reduce the risk and relieve postoperative 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   Figures and Tables | References | Related Articles | Metrics

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Xu Hereti•Wutikuer, Physician, Department of Joint Surgery, Xinjiang Uygur Autonomous Region People’s Hospital, Urumqi 830001, Xinjiang Uygur Autonomous Region, China Xu Hereti•Wutikuer, Habaxi•Kaken, Wang Li, Zhao Xi-bin, Yuan Hong 2015, 19 (22):  3462-3466.  doi: 10.3969/j.issn.2095-4344.2015.22.004 Abstract ( 284 )   PDF (1966KB) ( 276 )   Save BACKGROUND: As the number of elder patients become more and more, the number of arthroplasty operations becomes more, but periprosthetic fractures appear nearly 0.1%-5% as the report. The incidence of fractures grows up year by year. According to the part of fracture happened, it may have high incidence of complications and revision operation, and its treatment is also a big problem in orthopedics. OBJECTIVE: To explore the repair method and effect of periprosthetic fractures after total knee arthroplasty. METHODS: Nine patients had periprosthetic fractures around the knee joint and visited the Xinjiang Uygur Autonomous Region People’s Hospital from January 2007 to December 2012. There were six cases with femur fractures and three with tibia fractures. All the patients had consultations before operation to make sure the type of the prosthesis we used: PFC Sigma Depuy in three cases, and BIOMET Company’s Vanguard in six cases. From the X-ray, we used Kim Classify for femur fracture and used Felix Classify for tibia fracture. Three cases used locking compression plate. Three cases used intramedullary nail. Three cases used LISS system for internal  fixation. Follow-up was conducted after treatment. New York Hospital for Special Surgery knee score was used to assess knee function. The occurrence of complications was recorded. RESULTS AND CONCLUSION: All nine patients had osteoporosis, and their wound was healed in one stage. Patients were followed up for 9-34 months. Fractures were healed in all patients in averagely 9.4 weeks. There was no deep vein thrombosis in limbs. No infection or loosening appeared. After repair, New York Hospital for Special Surgery knee score was utilized to assess knee function: excellent in five cases, good in three cases, and average in one case. After repair, early exercise was done in patients, and complications were less. These results indicate that periprosthetic fractures can be healed in one stage, and painless knee joint can be obtained. Suitable fixation manner can be obtained in the clinic according to the type of prosthesis and type of 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   Figures and Tables | References | Related Articles | Metrics

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Unicompartmental arthroplasty versus total knee arthroplasty: stress analysis of prosthetic contact surface  Zhou Bing-zheng, Bai Lun-hao, Li Bin, Wang Guang-bin 2015, 19 (22):  3467-3471.  doi: 10.3969/j.issn.2095-4344.2015.22.005 Abstract ( 343 )   PDF (895KB) ( 315 )   Save BACKGROUND: Compared with total knee arthroplasty, unicompartmental arthroplasty has the advantage of minimal invasion. Regarding the gold standard of total knee arthroplasty, the survival rate of unicompartmental arthroplasty remains controversial. OBJECTIVE: To establish three-dimensional finite element model of unicompartmental arthroplasty and total knee arthroplasty, and comparatively analyze the changes in stress on the prosthetic contact surface. METHODS: One case underwent unicompartmental arthroplasty on one side, and received total knee arthroplasty on the opposite side. Knees were scanned by 3D CT before operation. Knee models were established by three-dimensional software. The matched prosthesis was designed by parameterization software. Three-dimensional models for unicompartmental arthroplasty and total knee arthroplasty were established. By finite element analysis software, maximal equivalent stress was simulated when knee flexion was 0°, 10°, 30° and 60° in standing and walking cases, and results were compared and analyzed. RESULTS AND CONCLUSION: No significant difference in maximal equivalent stress was detected when knee  flexion was 0° and 10° in unicompartmental arthroplasty prosthesis and total knee arthroplasty prosthesis in standing case (P > 0.05). At knee flexion of 30° and 60° in standing case, the maximal equivalent stress was significantly greater in unicompartmental arthroplasty prosthesis than in the total knee arthroplasty prosthesis (15.01%, 6.08%; P < 0.05). When knee flexion was 0°, 10° 30° and 60° in standing case, the maximal equivalent stress was higher in unicompartmental arthroplasty prosthesis than in the total knee arthroplasty prosthesis (5.45%, 6.65%, 6.67%, 9.01%;  P < 0.05). These findings verified that in the case of standing, there was no practical significance in wearing of polyethylene insert between unicompartmental arthroplasty prosthesis and total knee arthroplasty prosthesis. In the case of walking, the wearing of unicompartmental arthroplasty may be higher than that of total knee arthroplasty prosthesis, which provides guidance for the clinical practice. 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   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   Figures and Tables | References | Related Articles | Metrics

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Dexmedetomidine dose for epidural anesthesia in the elderly knee arthroplasty Shi Hong-yi 2015, 19 (22):  3472-3476.  doi: 10.3969/j.issn.2095-4344.2015.22.006 Abstract ( 248 )   PDF (939KB) ( 312 )   Save BACKGROUND: Dural elderly knee arthroplasty anesthesia is a common mode of anesthesia. Dexmedetomidine, because of good analgesic effects, is widely applied to epidural anesthesia in elderly knee replacement, but different applied dose of dexmedetomidine may lead to different results. OBJECTIVE: To explore the effects of different doses of dexmedetomidine for epidural anesthesia in elderly knee arthroplasty. METHODS: A total of 75 cases of older patients undergoing knee replacement surgery were selected and randomly divided into dexmedetomidine loading and maintenance group (25 cases), dexmedetomidine group  (25 cases), and the normal saline group (25 cases), and then they were given small doses of dexmedetomidine loading and maintenance, dexmedetomidine maintenance, intravenous infusion of normal saline. Blood pressure, heart rate, Calm/Alert Standard Score and the operation degree of forgetting were observed and compared in the three groups. The time points included T0 (after epidural anesthesia), T1 (3 minutes after medication), T2 (5 minutes after medication), T3 (10 minutes after medication), T4 (15 minutes after medication), and T5        (30 minutes after medication). RESULTS AND CONCLUSION: After the use of drugs, blood pressure and heart rate were decreased in the dexmedetomidine loading and maintenance group and dexmedetomidine group. Blood pressure and heart rate were significantly lower in the dexmedetomidine loading and maintenance group than that of dexmedetomidine maintenance group (P < 0.05). Moreover, it was slowest in T3 phase and in T4 phase in the dexmedetomidine group (P < 0.05). After 5 minutes of medication, Calm/Alert Standard Score was decreased in the dexmedetomidine loading and maintenance group and dexmedetomidine group. In T3 phase, deep sedation and heart rate decreased significantly in the dexmedetomidine loading and maintenance group; above symptoms could be improved by giving atropine. In T4 phase, score was lowest in the dexmedetomidine group (P < 0.05), but deep sedation was not found; the decreased degree of blood pressure and heart rate was lighter in the dexmedetomidine group than in the dexmedetomidine loading and maintenance group. The complete oblivion extents of the operation-related procedures were respectively 72%, 68% and 0% in the dexmedetomidine loading and maintenance group, dexmedetomidine group and normal saline group. Above extent was significantly greater in the dexmedetomidine loading and maintenance group and dexmedetomidine group than in the normal saline group (P < 0.05). No significant difference was detected between groups (P > 0.05). These findings suggest that in elderly patients undergoing knee replacement, small dose of dexmedetomidine continuous infusion for epidural anesthesia can achieve good effects on analgesia and sedation, can eliminate the bad memories for patients with operation, and is a scientific mode of anesthesia. 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   Figures and Tables | References | Related Articles | Metrics

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Combined spinal-epidural anesthesia with ropicavaine in elderly patients undergoing knee or hip arthroplasty: low incidence of postoperative side effects 2015, 19 (22):  3477-3481.  doi: 10.3969/j.issn.2095-4344.2015.22.007 Abstract ( 389 )   PDF (858KB) ( 311 )   Save BACKGROUND: General anesthesia or continuous epidural anesthesia can be commonly selected for lower limb joint surgery in the elderly. The effect of epidural anesthesia is precise, and can be easily controlled. The effect of muscle relaxation is good. However, the time of anesthesia induction is relatively long, and it is not ideal in the control of pain in the visceral peritoneum reflection region. Moreover, circulatory system interference can be greatly affected by lumbar anesthesia. OBJECTIVE: To evaluate the effects of combined spinal-epidural anesthesia with ropicavaine in elderly patients undergoing lower limb arthroplasty. METHODS: Ninety patients undergoing lower limb arthroplasty admitted to Heze Municipal Hospital from September 2013 to November 2014 were chosen and were equally and randomly assigned to two groups, including 52 cases of knee replacement and 38 cases of hip replacement. Patients in the control group received  continuous epidural anesthesia. Patients in the observation group received combined spinal-epidural anesthesia with ropicavaine. Vital signs, onset time of anesthesia, drug consumption, analgesic effect and postoperative side effects were observed and compared in both groups. RESULTS AND CONCLUSION: Heart rate, pulse, and arterial oxygen saturation were significantly lower in the control group than in the observation group. Vital signs in the observation group were more stable, and the significant difference was detected between the two groups (P < 0.05). Onset time of anesthesia and drug consumption were significantly better in the observation group than in the control group, showing very significant differences between the two groups  (P < 0.01). The excellent and good rate of analgesic effects was lower in the control group (67%) than in the observation group (89%), which showed significant differences between the two groups (P < 0.05). In the control group, vomiting appeared in 10 cases and dyspnea appeared in 4 cases, with an incidence of side effect of 31%. In the observation group, vomiting appeared in 3 cases and dyspnea in 2 cases, with the incidence of side effects of 11%. The incidence of side effect was significantly higher in the control group than in the observation group (P < 0.05). These data indicate that combined spinal-epidural anesthesia with ropicavaine showed good analgesic effect in elderly patients receiving lower limb arthroplasty. The onset time of anesthesia was short. Drug consumption was low. The incidence of side effects was low. 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   Figures and Tables | References | Related Articles | Metrics

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Double-action hemiarthroplasty versus total hip arthroplasty for intertrochanteric fracture in the elderly  Niu Cun-liang 2015, 19 (22):  3482-3486.  doi: 10.3969/j.issn.2095-4344.2015.22.008 Abstract ( 491 )   PDF (997KB) ( 423 )   Save BACKGROUND: Doubld-action hemiarthroplasty and total hip arthroplasty are reliable methods to treat intertrochanteric fracture of femur in the elderly, but which is better remains controversial in the clinic. OBJECTIVE: To observe the practical effect of prosthetic replacement with different methods in treatment of intertrochanteric fracture of femur in the elderly, and to assess the clinical value. METHODS: A total of 54 elderly patients with intertrochanteric fracture of femur at the age of over 65 years old were randomly assigned to two groups. In the observation group (n=27), patients underwent graded cement double-action arthroplasty. In the control group (n=27), patients received cementless total hip arthroplasty. They were followed up for 2 years. Harris scores were recorded in the two groups so as to assess the therapeutic effects. Follow-up recurrence rate, adverse events and host response to materials were analyzed. RESULTS AND CONCLUSION: The therapeutic effects were similar between the observation and control groups (89%, 81%; P > 0.05), but recurrence rate of 2-year follow-up was significantly lower in the observation group than in the control group (4%, 30%; P < 0.05). Moreover, dislocation, acetabular wear and loosening were not found. Results indicate that the midterm effects were similar between graded cement double-action arthroplasty and total hip arthroplasty in treatment of intertrochanteric fracture in the elderly, but graded cement double-action arthroplasty significantly decreases the recurrence rate. 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   Figures and Tables | References | Related Articles | Metrics

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Comparison of the range of motion of the femoral head at two different diameters during primary total hip arthroplasty  Fan Yu-ping 2015, 19 (22):  3487-3490.  doi: 10.3969/j.issn.2095-4344.2015.22.009 Abstract ( 339 )   PDF (678KB) ( 246 )   Save BACKGROUND: Dislocation is a common short-term complication after total hip arthroplasty. Many factors can induce dislocation. Among controllable factors, the diameter of the femoral head may be one of factors affecting the incidence of dislocation. Generally, large prosthesis meets the biomechanical feature of hip joint, and can increase the joint stability. OBJECTIVE: To observe the effects of different diameters of the femoral head on range of motion of the hip joint during primary total hip arthroplasty so as to provide evidence for selecting the prosthesis with an ideal diameter. METHODS: We collected data of 77 cases (87 hips), who underwent primary total hip arthroplasty with the femora head of 28 mm and 32 mm diameter in the Department of Orthopedics, Inner Mongolia Autonomous Region Wulanchabu Central Hospital from August 2009 to August 2012. Hip prosthesis was provided by ZIMMER Company. The hip motion interface was made from polyethylene on metal. The femoral head prosthesis was used as follows: 28 mm diameter in 51 hips, and 32 mm diameter in 36 hips. Posterior approach was utilized. Range of motion of hip internal rotation and external rotation to dislocation was measured at hip flexion 90° during the operation, and compared between different diameter groups. RESULTS AND CONCLUSION: The method of surgery was not changed during operation in all patients. No  significant difference in the sum of degree at dislocation was detected between two different diameter groups (P > 0.05). No significant difference in the intraoperative range of motion during total hip arthroplasty was visible in patients with femoral neck fracture between the two different diameter groups (P > 0.05). No significant difference in the intraoperative range of motion during total hip arthroplasty was visible in patients with avascular necrosis of the femoral head between the two different diameter groups (P > 0.05). These data suggested that compared with the femoral head of 28 mm diameter, the femoral head of 32 mm diameter did not increase the range of motion during total hip arthroplasty. After operation, two kinds of femoral head did not affect the dislocation after total hip arthroplasty in 2-year 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   Figures and Tables | References | Related Articles | Metrics

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Femoral head replacement and clover titanium plate fixation in the repair of unstable intertrochanteric fractures in elderly patients  Wu Kai 2015, 19 (22):  3491-3495.  doi: 10.3969/j.issn.2095-4344.2015.22.010 Abstract ( 286 )   PDF (890KB) ( 302 )   Save BACKGROUND: The unstable intertrochanteric fractures are common in the elderly patients. Artificial femoral head replacement is a common treatment method, and different ways can be selected for reconstruction. OBJECTIVE: To explore the clinical effect of femoral head replacement combined with clover titanium plate fixation for unstable intertrochanteric fractures of the elderly. METHODS: A retrospective analysis was performed in 64 elderly patients with unstable intertrochanteric bone in the Jiangyou 903 Hospital from December 2011 to December 2012. They were given femoral head replacement treatment, and were divided into control group (32 cases) and experimental group (32 cases) according to reconstruction method. They received steel wire tension band and reconstruction and clover titanium plate fixation. RESULTS AND CONCLUSION: There were no significant differences in operation time and bleeding volume in operation process, postoperative recovery time of joint activities, time of out-of-bed activity, and bone callus formation time between the two groups (P > 0.05). However, compared with the control group, therapeutic effect was better and the incidence of complications was low in the experimental group (P < 0.05). These data suggest that femoral head replacement combined with the implementation of clover titanium plate fixation treatment can obtain good results for treatment of unstable intertrochanteric fracture in elderly 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   Figures and Tables | References | Related Articles | Metrics

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Cervical posterior implant fixation for multi-segment cervical spondylotic myelopathy: improves symptoms but diminishes cervical range of motion Zhao Yong, Chu Yan-chen, Li Xue-sen, Ma Jin-long, Zou Yun-wen 2015, 19 (22):  3496-3502.  doi: 10.3969/j.issn.2095-4344.2015.22.011 Abstract ( 470 )   PDF (740KB) ( 377 )   Save BACKGROUND: Cervical Open-door laminoplasty with unilateral mass screw fixation and laminectomy with bilateral mass screw fixation are both procedures that treat cervical spondylotic myelopathy by expanding the space available for the spinal cord. Effectiveness and safety of two operative methods remain unclear. OBJECTIVE: To investigate the biocompatibility of implant and host between open-door laminoplasty with unilateral mass screw fixation and laminectomy with bilateral mass screw fixation to treat multi-segment cervical spondylotic myelopathy. METHODS: Data of 117 patients with multi-segment cervical spondylotic myelopathy (≥ 3 segments) were retrospectively analyzed. Sixty-five cases underwent open-door laminoplasty with unilateral mass screw fixation (laminoplasty group). Fifty-two cases underwent laminectomy with bilateral mass screw fixation (laminectomy group). Clinical outcomes were evaluated by the Japanese Orthopaedic Association scoring system and by recovery rate. Cervical curvature index and cervical range of motion were assessed by X-ray films in both groups. RESULTS AND CONCLUSION: The average follow-up time was 28 months (range 12-59 months) in both groups. No C5 nerve root palsy occurred in the two groups. Japanese Orthopaedic Association scores were greater during final follow-up than pre-fixation in both groups (P < 0.01). No significant difference in Japanese Orthopaedic Association score, recovery rate, and final follow-up cervical curvature index was detected in both groups (P > 0.05). Cervical range of motion was lower during final follow-up than pre-fixation in both groups (P < 0.01). Results confirmed that open-door laminoplasty with unilateral mass screw fixation and laminectomy with bilateral mass screw fixation have similar effectiveness in the improvement of neurological function, relieving pain and reducing complications, but will greatly reduce the cervical range of motion.  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   Figures and Tables | References | Related Articles | Metrics

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Artificial cervical disc prosthesis and zero-profile interbody fixation and fusion system for cervical disease: 2-year follow-up  Dong Zhen-yu, Chu Ge, Huang Yi-fei, Yuan Feng-yun 2015, 19 (22):  3503-3507.  doi: 10.3969/j.issn.2095-4344.2015.22.012 Abstract ( 417 )   PDF (1173KB) ( 246 )   Save BACKGROUND: Artificial cervical disc prosthesis simulates range of motion and buffer shock function of normal intervertebral discs. Clinical experiments verify that artificial cervical disc prosthesis material has good biocompatibility and mechanical characteristics. OBJECTIVE: To evaluate artificial cervical disc replacement and zero-profile interbody fixation and fusion system for multilevel cervical disease in 2-year follow-up. METHODS: Artificial cervical disc replacement and zero-profile interbody fixation and fusion system were used to  treat 42 patients with multilevel cervical disease. The patient presented typical symptoms and signs of spinal cord or nerve root compression. There were 18 cases of cervical myelopathy, 15 cases of nerve root cervical spondylosis and 10 cases of mixed type of cervical spondylosis. After treatment, mean operation time, blood loss and reoperation rate were measured. Postoperative complications, disability index of neck function, visual analog scale, function unit range of corresponding surgery segments of the cervical spine, Cobb angle of C2-C7 vertebral body, range of motion of adjacent segment of proximal and distal vertebral bodies were observed and clinical outcomes were evaluated. RESULTS AND CONCLUSION: All cases finished the operation and were scored at various time points. After treatment, radiating pain of shoulder and neck and upper extremity were remarkably lessened. Numbness and sensory loss symptoms disappeared obviously. Quality of life elevated noticeably. Visual analog scale and the disability index of neck function score were decreased in final follow-up compared with pre-treatment (P < 0.001). C2-C7 vertebrae Cobb angle, FSU angle, range of motion of proximal surgery adjacent segment and range of motion of the distal surgery adjacent segment were elevated compared with pre-treatment (P < 0.001). These data indicate that cervical spondylosis was improved after treatment. Each index of cervical spondylosis after artificial cervical disc replacement and zero-profile interbody fixation and fusion system was reconstructed to different degrees. 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   Figures and Tables | References | Related Articles | Metrics

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Anterior cervical plate fixation and graft fusion in the repair of adult cervical tuberculosis: good biocompatibility   Liang Liang, Fulati•maimaiti, Zhu Song-qing, Xu Tao, Sheng Wei-bin 2015, 19 (22):  3508-3512.  doi: 10.3969/j.issn.2095-4344.2015.22.013 Abstract ( 317 )   PDF (1560KB) ( 282 )   Save BACKGROUND: Spinal tuberculosis seldom involves cervical vertebra. The application of anti-tuberculosis drug has slight effects on patients combined with nerve dysfunction and severe vertebral destruction, which results in unstable cervical vertebra. OBJECTIVE: To evaluate biocompatibility of graft and host after one-stage anterior debridement graft fusion and internal fixation in the repair of adult cervical tuberculosis. METHODS: A total of 14 patients who suffered from cervical tuberculosis were admitted into Department of Spinal Surgery, First Affiliated Hospital, Xinjiang Medical University between May 2010 and June 2012. They underwent Zephir anterior cervical plate for one-stage anterior debridement graft fusion and internal fixation. RESULTS AND CONCLUSION: Compared with pre-fixation, erythrocyte sedimentation rate, C-reactive protein and visual analog scale score were lower in final follow-up (P < 0.05), and Japanese Orthopaedic Association score increased (P < 0.05). Except that Frankel grade recovered to grade D from grade C in one case, Frankel grade did not alter in the remaining patients. Compared with pre-fixation, Cobb angle was apparently shortened in seven patients with kyphosis. Following internal fixation, bone trabecula was visible between the vertebral body and graft region after fixation. No displacement, bone resorption, nonunion or pseudoarthrosis occurred. Neck pain and limited function relieved or disappeared to different degrees after fixation. These findings suggest this method can effectively treat cervical tuberculosis. Moreover, the biocompatibility of the plate and host is good. Figures and Tables | References | Related Articles | Metrics

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Pedicle screw fixation through paraspinal approach for thoracolumbar fractures: a follow-up of correction effect and biocompatibility Cui Wei, Zhang Yong-peng, Zhang Bin 2015, 19 (22):  3513-3518.  doi: 10.3969/j.issn.2095-4344.2015.22.014 Abstract ( 260 )   PDF (1131KB) ( 284 )   Save BACKGROUND: Different operation approaches can be selected during the repair of thoracolumbar fractures. Traditional posterior median approach will cause great wound on patients, and easily induces some adverse consequences. OBJECTIVE: To compare the effects and biocompatibility of conventional posterior median approach and paraspinal approach fixation for treatment of thoracolumbar fractures.  METHODS: A retrospective analysis was performed on clinical data of 53 cases of thoracolumbar fracture in the Shaanxi Province Nuclear Industry 215 Hospital from December 2012 to December 2013. They were divided into two groups according to approach method. The control group (n=27) received pedicle screw placement fixation through conventional posterior median approach. The observation group (n=26) underwent pedicle screw placement fixation through paraspinal muscle approach. After repair, they were followed up for 12 months. Imaging results, pain score and perioperative relevant indexes were observed and compared in both groups. RESULTS AND CONCLUSION: Imaging examination was conducted before repair, immediately after repair and during final follow-up in both groups. The height of vertebral anterior border and kyphosis correction effect were good after different therapies in both group, but no significant difference was detectable between the two groups  (all P > 0.05). These findings suggest that height of vertebral anterior border and kyphosis correction effect were identical between the two groups. Pain visual analog scale score was significantly lower in the observation group than in the control group at 24 hours and 3 days after repair and during final follow-up (all P < 0.05). Perioperative relevant indexes were analyzed in both groups. Intraoperative bleeding amount, drainage and bed time after repair were observed in the observation group, which showed significant advantages as compared with the control group (all P < 0.05). These results confirmed that compared with the traditional posterior median approach surgery, minimally invasive pedicle screw placement through paraspinal muscle approach for thoracolumbar fractures can obtain better repair effects and biocompatibility. 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   Figures and Tables | References | Related Articles | Metrics

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Pedicle screw placement fixation through the injured vertebra in the repair of thoracolumbar fracture: 3-year follow-up  Zhou Zhuo-peng, Fan Jian-wen, Zhi Wei-hong 2015, 19 (22):  3519-3524.  doi: 10.3969/j.issn.2095-4344.2015.22.015 Abstract ( 271 )   PDF (1027KB) ( 310 )   Save BACKGROUND: Many previous retrospective small-sample studies analyzed the short-term effects using pedicle screw placement to repair thoracolumbar fracture. Conclusions are relatively thin. Simultaneously, screw placement in the injured vertebra can further stabilize the vertebral body, and reduce screw and rod breakage and loss of correction. OBJECTIVE: To evaluate the long-term effects of pedicle screw placement fixation through the injured vertebra in the repair of thoracolumbar fracture. METHODS: From February 2010 to February 2012, 36 patients with thoracolumbar fracture, who were treated in the Department of Orthopedics, Guangzhou Panyu District Second People’s Hospital, were selected. They were  treated by vertebral pedicle screw placement fixation. Height ratio of preoperative injured vertebral leading edge was averagely 36%. Kyphosis angle (Cobb angle) was 25°. Sagittal diameter of the center of the vertebral canal was 60%. Nerve function was classified according to Frankel classification: grade A, 2 cases; grade B, 6 cases; grade C, 10 cases; grade D, 9 cases; grade E, 9 cases. The height ratio of injured vertebra, kyphosis angle (Cobb angle), sagittal diameter of the center of the vertebral canal and Frankel classification of nerve function were compared before and after treatment. RESULTS AND CONCLUSION: The postoperative follow-up was 3-3.5 years. Pain was obviously alleviated postoperatively in 36 patients. Average height ratio of injured vertebra was 95%. Kyphosis angle (Cobb angle) was 3.5°. Sagittal diameter of the center of the vertebral canal was 96%. Significant difference was found in the above indexes before and after treatment (P < 0.05). Postoperative neurologic recovery: grade A in 1 case, grade B in 2 cases, grade C in 3 cases, grade D in 4 cases, and grade E in 26 cases. Postoperative fractures were reset. Complications such as breakage, loosing or correction loss were not found. These findings suggest that pedicle screw placement fixation through the injured vertebra in the repair of thoracolumbar fracture can make a satisfactory reduction, enhance the pressure stability of the spine, reduce the internal fixation of fracture and vertebral height loss, and have good long-term effects, indicating that the implant and host have good biocompatibility. 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   Figures and Tables | References | Related Articles | Metrics

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Type AO-C1 thoracolumbar vertebral fracture-dislocations: four-screw two-rod single-segment reduction fixation  Tang Huan-zhang, Xu Hao, Dong Liang, Zhao Xiao-ming 2015, 19 (22):  3525-3530.  doi: 10.3969/j.issn.2095-4344.2015.22.016 Abstract ( 317 )   PDF (1353KB) ( 324 )   Save BACKGROUND: The type AO-C1 thoracolumbar acute spine injury is a kind of high-energy instable injury, can cause thoracolumbar fracture-dislocation, and mainly associated with spinal nerve injury. Generally, all needs to posterior open reduction, decompression, bone graft fusion and multiple-segmental internal fixation of pedicle screw rod system, which causes excessive loss of spinal movement segment and a large number of application of internal fixators. OBJECTIVE: To evaluate the treatment effect of posterior pedicle screw mono-segmental internal fixation for treatment of the type AO-C1 thoracolumbar vertebrae fracture-dislocations. METHODS: From January 2008 to December 2013, 17 cases of type AO-C1 thoracolumbar fracture-dislocation were followed up. All patients were treated with one-stage posterior open reduction and pedicle screw-rod fixation.  Of them, eight cases received four screws and two rods for single-segment fixation in upper and lower vertebrae adjacent to intervertebral space after dislocation (4-screw 2-rod group). Nine cases received eight screws and two rods for multiple-segment fixation in the upper and lower vertebrae adjacent to intervertebral space after dislocation (8-screw 2-rod group). Operative time and intraoperative blood loss were compared between the two groups. The Cobb’s angle was measured on lateral X-ray film of two groups preoperatively and 1 week postoperatively and during the final follow-up. The neurological function was evaluated by Frankel classification. The visual analogue scale was adopted to assess the degree of low back pain. RESULTS AND CONCLUSION: Patients were followed up for 1 to 5 years. Significant differences were detected in the operative time between the two groups, and operative time was better in the 4-screw 2-rod group than in the 8-screw 2-rod group (P < 0.05). No significant difference was found in intraoperative blood loss between the two groups. The deformity of fracture-dislocation had been corrected, and the pain of low back had significantly relieved in all patients after fixation. According to Frankel classification, two cases at Grade A were improved to Grade E, but eight cases at Grade A got no improvement after treatment. Two cases at Grade B were also improved to Grade E at the final follow-up. Significant differences in Cobb’s angle and visual analogue scale were detectable at 1 week postoperatively and during final follow-up as compared with preoperatively (P < 0.05), but no significant difference was visible between final follow-up and 1 week postoperatively. No significant difference in Cobb’s angle and visual analogue scale was observed between the 4-screw 2-rod group and 8-screw 2-rod group. Results indicate that there was no significant difference in the clinical efficacy between 4-screw 2-rod single-segment and 8-screw 2-rod multiple-segment fixation for treating type C1 thoracolumbar vertebrae fracture-dislocation. Therefore, AO-C1 thoracolumbar vertebrae fracture-dislocation could be treated with 4-screw 2-rod single-segment reduction 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   Figures and Tables | References | Related Articles | Metrics

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Vertebral decompression and implant fixation for thoracolumbar burst fractures: posterior approach is safer in follow-up   Jia Jin-long, Yang Qing-guo, Zhang Yin-shun, Li Wei, Liu Guang-yi 2015, 19 (22):  3531-3537.  doi: 10.3969/j.issn.2095-4344.2015.22.017 Abstract ( 309 )   PDF (5867KB) ( 316 )   Save BACKGROUND: Previously, serious thoracolumbar burst fractures with spinal cord injury were mainly treated by anterior surgery. The superiority of conventional posterior repair lies in strong reduction and fixation effects. However, it is difficult to fully decompression. The anterior and central cylinders of the injured vertebra cannot receive good reconstruction. Loss of correction and internal fixation failure always appear. It remains controversial which repair method is more ideal. OBJECTIVE: To comparatively analyze the effect of posterior and anterior approaches with subtotal vertebrectomy, decompression, reconstruction of spine, and internal fixation for patients with thoracolumbar burst fractures. METHODS: The data of 42 patients with thoracolumbar burst fracture treated by anterior and posterior approaches with subtotal vertebrectomy, decompression, and reconstruction of spine from May 2006 to December 2012 was retrospectively analyzed. They were divided into two groups according to the surgical procedures: anterior approach group (n=23) and posterior approach group (n=19). They were followed up for at least 24 months. Repair results and imaging results were compared in patients of both groups. RESULTS AND CONCLUSION: None patients in the two groups affected fixator loosing or breakage, and  obtained good bone fusion. The intraoperative blood loss was more and operative time was longer in the anterior approach group than in the posterior approach group, showing significant difference (P < 0.05). The pulmonary function was significantly better in the posterior approach group than in the anterior approach group (P < 0.05). Visual Analog Scale score, Japanese Orthopaedic Association score for back pain and Frankel classification were significantly improved during final follow-up compared with pre-treatment in both groups, but no significant difference was found between groups (P > 0.05). No significant difference in the anterior vertebral height and kyphosis Cobb angle was detected before treatment, at 1 week after treatment and during final follow-up (P > 0.05). The incidence of postoperative complications was significantly higher in the anterior approach group than in the posterior approach group (P < 0.05). These findings confirm that subtotal vertebrectomy through anterior approach and posterior approach can effectively repair thoracolumbar burst fractures. However, the complications of posterior approach are less, and posterior approach has few impacts on the pulmonary function, is safe, and has good biocompatibility with the host. 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   Figures and Tables | References | Related Articles | Metrics

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Three-dimensional memory fixation versus reconstruction titanium plate to repair posterior wall acetabular fracture with posterior dislocation  Liang Yun-yang 2015, 19 (22):  3538-3542.  doi: 10.3969/j.issn.2095-4344.2015.22.018 Abstract ( 269 )   PDF (951KB) ( 310 )   Save BACKGROUND: Posterior wall fractures of the acetabulum with posterior dislocation of the acetabular joint mostly require the operation of open reduction and internal fixation. Different materials can be chosen for internal fixation operation. OBJECTIVE: To explore the effect of acetabular three-dimensional memory fixation system on acetabular posterior wall fractures accompanying the acetabulum joint dislocation. METHODS: A retrospective analysis was performed on clinical data of 92 cases of acetabular posterior wall fracture and dislocation at the Heze Municipal Hospital of Shandong Province from February 2010 to February 2014. All patients received the operation of open reduction and internal fixation. They were divided into three-dimensional memory fixation group (45 cases) and reconstruction titanium plate group (47 cases) according to different fixators. All patients were followed up for 12 months after fixation. RESULTS AND CONCLUSION: The operation time and intraoperative blood loss were significantly longer or higher in the reconstruction titanium plate group than in the three-dimensional memory fixation group (P < 0.05). Harris score was significantly greater in the three-dimensional memory fixation group than in the reconstruction titanium plate group during final follow-up (P < 0.05). Thromboembolic complications or deep infection were not detected after fixation in both groups. These findings confirm that three-dimensional memory fixation system obtained good effects in the treatment of the posterior wall fractures of the acetabulum with posterior dislocation. 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   Figures and Tables | References | Related Articles | Metrics

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Dynamic hip screw, proximal femoral nail antirotation and InterTan nail for intertrochanteric fractures Shao Jin, Yang Tie-yi, Wang Zhi, Zhang Yan, Liu Shu-yi 2015, 19 (22):  3543-3549.  doi: 10.3969/j.issn.2095-4344.2015.22.019 Abstract ( 307 )   PDF (1283KB) ( 484 )   Save BACKGROUND: The extramedullary fixation system including dynamic hip screw (DHS) is commonly used in treatment of Intertrochanteric fracture. However, in patients with unstable intertrochanteric fracture, extramedullary fixation system often leads to the failure of fracture fixation. Intramedullary fixation system including both proximal femoral nail antirotation (PFNA) and InterTan nail has been widely used in the treatment of unstable intertrochanteric fractures. OBJECTIVE: To compare the therapeutic effects of extramedullary fixation system containing DHS, PFNA and InterTan nail in the treatment of intertrochanteric fracture. METHODS: Literatures were searched in Wanfang, PubMed, Embase, Medline, the Cochrane library to screen literatures published from January 1990 to November 2014. Relevant studies addressing extramedullary fixation system containing DHS, PFNA and InterTan nail were screened. RESULTS AND CONCLUSION: 346 articles were screened, and 13 of them were in accordance with the inclusion criteria. 1 271 patients with different types of intertrochanteric fracture were assessed in this study. Compared to DHS group, patients treated with PFNA and InterTan nail had shorter operation time and less blood loss. No significant difference in rehabilitation time and Harris score was detected among three kinds of fixation methods. Additionally, PFNA and InterTan nail had a similar effect. These findings verify that compared with DHS, PFNA and InterTan nail can optimize the surgery, but cannot elevate postoperative outcomes. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程   Figures and Tables | References | Related Articles | Metrics

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Nail anti-rotation blade versus locking plate for the repair of elderly unstable intertrochanteric fractures: hip function   Wu Han, Zhang Jian, Li Qiang, Yuan Qi 2015, 19 (22):  3550-3554.  doi: 10.3969/j.issn.2095-4344.2015.22.020 Abstract ( 272 )   PDF (911KB) ( 482 )   Save BACKGROUND: Elderly patients have more loose bone. After fractures, bones are mostly crushed. Simultaneously, many elderly patients experience many internal diseases. Various organs have dysfunction. Surgery tolerance is poor, which also brings difficulty in treatment with internal fixator, and increases the risk of therapy. Thus, the choice of internal fixation method is not uniform. OBJECTIVE: To compare and analyze the repair effects of proximal femoral nail anti-rotation blade and anatomic proximal femoral locking plate in treatment of unstable intertrochanteric fractures in the elderly. METHODS: A total of 100 elderly patients with unstable intertrochanteric fractures were selected from the Youyi Branch, Kunshan First People’s Hospital from April 2011 to June 2013. They were randomly assigned to two groups. Patients in the experimental group received internal fixation with proximal femoral nail anti-rotation blade. Patients in the control group received anatomic proximal femoral locking plate. After treatment, follow-up was conducted. Operative indexes, postoperative Harris score for hip function and incidence of complications were compared and analyzed in both groups. RESULTS AND CONCLUSION: No significant difference in various indexes was detected in both groups (P > 0.05). Harris scores were significantly better in the experimental group than in the control group (P < 0.05). Postoperative complications were significantly less in the experimental group than in the control group (P < 0.05). These results indicated that internal fixation of proximal femoral nail anti-rotation blade for unstable intertrochanteric fractures in the elderly achieved satisfactory results in the recovery of joint function and had the advantage of few complications. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程   Figures and Tables | References | Related Articles | Metrics

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Adjustable patella claws and absorbable suture versus Kirschner wire tension band in the repair of comminuted patellar fractures Cui Hai-feng 2015, 19 (22):  3555-3559.  doi: 10.3969/j.issn.2095-4344.2015.22.021 Abstract ( 562 )   PDF (1019KB) ( 360 )   Save BACKGROUND: High-energy patellar comminuted fracture significantly increased. Single fixation cannot meet the requirement of anatomical repositioning of the patella, multiple-point strong fixation, and early functional exercise. OBJECTIVE: To compare the clinical effect of adjustable patella claws + absorbable suture and Kirschner wire tension band in the repair of comminuted patellar fractures. METHODS: A total of 57 patients with comminuted patella fracture were randomly selected and randomly assigned to two groups. 29 cases received open reduction and adjustable patella claws + absorbable suture fixation. 28 cases received open reduction and Kirschner wire tension band fixation. Operative time, incision length, fracture healing time, postoperative complications and Hospital for Special Surgery knee function scores were compared between the two groups, and then statistical analysis was conducted. RESULTS AND CONCLUSION: No significant difference in incision length and operative time was detected between the adjustable patella claws + absorbable suture group and Kirschner wire tension band group.  Significant differences in healing time, incidence of complications and knee function after treatment were observed between the two groups, and above indications were better in the adjustable patella claws + absorbable suture group than in the Kirschner wire tension band group (P < 0.05). These results confirm that compared with the Kirschner wire tension band, adjustable patella claws + absorbable suture in repair of patellar comminuted fracture has some advantages such as short healing time, less postoperative complications, as well as good functional recovery of knee joint. The fixation is accorded with biomechanical principle of internal fixation, simple to operate, firmly fixed, and has good prospects. 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   Figures and Tables | References | Related Articles | Metrics

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Anterior and posterior approaches of plate fixation for repair of Schatzker V and VI tibial plateau fractures  Li Jiang-ping 2015, 19 (22):  3560-3564.  doi: 10.3969/j.issn.2095-4344.2015.22.022 Abstract ( 361 )   PDF (847KB) ( 274 )   Save BACKGROUND: Schatzker V and VI tibial plateau fractures are often accompanied by severe articular facet collapse, separation of tibial condyles, damage of soft tissue and peripheral blood vessels. To reduce soft tissue damage, clinical treatments include limited open and reduction, Kirschner wire internal fixation and external fixation, however, these treatments are ineffective for the reduction of articular facet. OBJECTIVE: To evaluate the biocompatibility of titanium alloy locking compression plate fixation through the medial or posteromedial combined anterolateral approaches for treatment of Schatzker V and VI tibial plateau fractures. METHODS: Fifty patients of Schatzker V and VI tibial plateau fractures recruited from our hospital were analyzed retrospectively, and were treated with locking plate fixation through the combined approaches. The repair effect in patients was observed. RESULTS AND CONCLUSION: After plate fixation, the fractures in 50 patients were clinically healed, no cases appeared nonunion, loosening or breakage. According to the Rasmussen Rating, anatomical location average score was (14.3±1.9) points, with the good rate of 90%; average score of knee function was (24.3±2.5) points, with the good rate of 84%. At 1 year post-surgery, knee flexion range was 100°-130°, average 115°. Experimental findings indicate that, the plate fixation through the combined approaches can achieve good stability, good fracture reduction, and good functional recovery in treatment of Schatzker V and VI tibial plateau 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   Figures and Tables | References | Related Articles | Metrics

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Suture anchors for the repair of deltoid ligament injury: restore the stability of ankle joint   Tian Yong, Ma Xiao 2015, 19 (22):  3565-3570.  doi: 10.3969/j.issn.2095-4344.2015.22.023 Abstract ( 445 )   PDF (942KB) ( 798 )   Save BACKGROUND: Ankle fractures combined with deltoid ligament injury are not uncommon in clinical practice, prone to misdiagnosis and missed diagnosis, resulting in ankle instability, chronic pain and traumatic arthritis. In recent years, because of the research and development of anatomy and biomechanical characteristics of deltoid ligament, the treatment and surgical methods of ankle fracture combined with deltoid ligament injury have progress and development, but it remains controversial. OBJECTIVE: To evaluate the clinical effect of suture anchor repair in the treatment of ankle fracture combined with deltoid ligament injury. METHODS: Twenty-seven patients with ankle fracture combined with deltoid ligament injury were selected between January 2010 and January 2013. The lateral malleolus and posterior malleolus fracture patients were treated with open reduction and internal fixation, and all the deltoid ligament injury patients were treated with anchor repair. The tibiofibular syndesmosis isolated patients received internal fixation with a cancellous bone screw. RESULTS AND CONCLUSION: All 27 patients were followed-up for 11-35 months, averagely 23 months. The evaluation according to the American Orthopaedic Foot and Ankle Society score system showed that the excellent and good rate was 74.1%. The results indicate that anchor could perfectly restore the stability of ankle 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   Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of the refined interspinous dynamic system based on Coflex Qu Shao-dong, Hai Yong, Su Qing-jun, Qu Shao-peng 2015, 19 (22):  3571-3578.  doi: 10.3969/j.issn.2095-4344.2015.22.024 Abstract ( 254 )   PDF (1175KB) ( 676 )   Save BACKGROUND: The Coflex is widely used in China, but it has a high complication rate of spinous process fracture. OBJECTIVE: With the help of finite element analysis, to verify if rigid restriction of spinous process contacts in modified Coflex design is semi-rigid restriction so as to reduce the stress of spinous process in spine flexion and extension, lateral bending and rotation and to decrease the risk of spinous process fracture. METHODS: The images were extracted from patients who had undergone abdomen CT scans in the Beijing Chaoyang Hospital affiliated to Capital Medical University. Three-dimensional finite element model of lumbar spine was established. The Coflex model and the corresponding modified Coflex model were established and then simplified in the SolidWorks software of CAD. Tensile force, shearing force and axial rotating force in resting state were analyzed in ANSYS software. RESULTS AND CONCLUSION: Under tensile force, transversal shearing force and axial rotating force, compared with Coflex system, the stress of spinous process model was reduced in the modified system (P < 0.01). These findings indicate that the forces of the modified model are superior to the force of Coflex. It can reduce stress in the spinous process under stresses and diminish the occurrence of spinous process 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   Figures and Tables | References | Related Articles | Metrics

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Biomechanical characteristics of placement methods of the thoracic pedicle screw system  Yu De-jun, Liu Li-jing, Jin Song, Tian Shao-hua 2015, 19 (22):  3579-3583.  doi: 10.3969/j.issn.2095-4344.2015.22.025 Abstract ( 322 )   PDF (856KB) ( 338 )   Save BACKGROUND: Studies have shown that placement, needling point, angle and length of pedicle screws for thoracic vertebral fractures have been unified. Many studies concerned axial pull-out force and biomechanical behavior of a single screw, but few reports addressed the biomechanical behavior after the replacement with three kinds of screw connecting to rods.  OBJECTIVE: To further observe and compare biomechanical behavior after three kinds of thoracic screw placement connecting rod using biomechanical testing, to understand the strength of thoracic pedicle screw replacement connecting rods, and the effects of its pulling out on the stress of the bone surrounding the placement site. METHODS: The fresh frozen specimens of thoracic vertebra were divided into three groups at random: the pedicle fixation group, the transverse process-vertebral body fixation group, and modified rib transverse process fixation group. Thoracic pedicle screw system was inserted by the standard placement method in each group. The experiment was measured on the mechanical equipment. During pulling out, the strength that bone bore was described with dynamic curve, followed by statistical analysis. The difference in the gripping force on the thoracic vertebra among three kinds of screw placement method was compared. RESULTS AND CONCLUSION: Among three kinds of screw placement methods and among three kinds of  screw placement methods on the injured vertebral body, the gripping force was significantly bigger in the pedicle fixation group than in the transverse process-vertebral body fixation group and modified rib transverse process fixation group (P < 0.01). No significant difference in the gripping force was detected between the transverse process-vertebral body fixation group and modified rib transverse process fixation group. Results verified that the stability of loading ability was apparently better in the pedicle fixation group compared with the transverse process-vertebral body fixation group and modified rib transverse process fixation group.   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   Figures and Tables | References | Related Articles | Metrics

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Locking plate fixation versus the third generation of the gamma nail fixation for intertrochanteric fractures: biomechanical stability  Gui Shu-guang, Li De-bin, Liu An-ping, Hu Xiao-dong 2015, 19 (22):  3584-3589.  doi: 10.3969/j.issn.2095-4344.2015.22.026 Abstract ( 411 )   PDF (950KB) ( 357 )   Save BACKGROUND: Being used in senile intertrochanteric fracture, the third generation of Gamma nail may isolate fracture fragments and it is difficult to be secured in the rotor, so the stability is poor. Varus deformity easily appears, which is difficult to support or satisfactorily reset. OBJECTIVE: To compare the effects and stability of the proximal femoral locking plate and the third generation of the gamma nail in the treatment of stable intertrochanteric fracture. METHODS: (1) A total of 64 patients with intertrochanteric fractures were respectively treated with the third generation of the gamma nail fixation (n=32) and proximal femoral locking plate fixation (n=32). Fracture reduction and healing were assessed using anteroposterior and lateral radiographs. Femoral rotor varus angle and intertrochanteric medial inclination received biomechanical measurement. (2) Eight femoral specimens whose shape and size were approximated were selected to be randomly assigned to Gamma 3 group and proximal femoral locking plate group (n=4), which respectively received Gamma 3 fixation and proximal femoral locking plate fixation. After axial compression test and destruction test, load-displacement curve was drawn. The maximum yield load value was calculated by torsion test. RESULTS AND CONCLUSION: Operative time and intraoperative blood loss were significantly more in the proximal femoral locking plate group than in the Gamma 3 group (P < 0.05). The fracture quality assessment results were better in the proximal femoral locking plate group than in the Gamma 3 group (P < 0.05). The axial stiffness and corresponding torque of various torsion angles were smaller in the proximal femoral locking plate group than in the Gamma 3 group (P < 0.05). Experimental results indicated that in the course of fixating intertrochanteric fracture merged with greater trochanter fracture, the proximal femur locking plate has obtained more biomechanical 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   Figures and Tables | References | Related Articles | Metrics

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Pedicle screw placement combined with filler for lumbar vertebra fractures  Zhou Gang, Gan Zi-ming, Huang Wei-min, Wang Cheng-wei 2015, 19 (22):  3590-3594.  doi: 10.3969/j.issn.2095-4344.2015.22.027 Abstract ( 257 )   PDF (1008KB) ( 261 )   Save BACKGROUND: Conventional cross-segment pedicle screw fixation will cause some complications such as kyphosis and loss of corrective angle. Fixation of pedicle screw placement of the injured vertebral body improves the disadvantages of conventional posterior screw placement, and obtains ideal outcomes. OBJECTIVE: To investigate the clinical application value of pedicle screw placement combined with filler for lumbar vertebra fracture. METHODS: Clinical data of patients with pedicle screw placement combined with filler for lumbar vertebra fracture were retrospectively analyzed. They were repaired with pedicle screw placement combined with bone graft as well as pedicle screw placement combined with bone cement. The ratio of anterior border to posterior border of the injured vertebral body after surgery and changes in Cobb angle were observed. Patients were followed up and results were compared. RESULTS AND CONCLUSION: Pedicle screw placement combined with filler has many advantages, and obtained good outcomes in the treatment of lumbar vertebral fracture. However, the extensive application has some problems and disputes. Clinical physicians should pay more attention on choice of surgical indications, prevention and treatment of perioperative and long-term complications and postoperative treatment of osteoporosis. The pedicle screw fixation combined with calcium phosphate bone cement has a broad prospect, can maintain the effect of spine reduction, and is worth to spread in the clinical treatment of lumbar 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   Figures and Tables | References | Related Articles | Metrics

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Systematic review of dynamic hip plate and proximal femoral intramedullary nail fixation for intertrochanteric fracture in adults    Zhai Sheng, Lv Qing 2015, 19 (22):  3595-3603.  doi: 10.3969/j.issn.2095-4344.2015.22.028 Abstract ( 336 )   PDF (1936KB) ( 626 )   Save BACKGROUND: Intertrochanteric fractures are often treated with extramedullary fixation and intramedullary fixation. Which internal fixation can better repair intertrochanteric fractures remains controversial. OBJECTIVE: To compare the efficacy and safety of dynamic hip plate and proximal femoral intramedullary nail fixation in treatment of intertrochanteric fracture in adults. METHODS: All randomized clinical trials relevant to comparing proximal femoral intramedullary nail fixation with dynamic hip plate for intertrochanteric fracture in adults from 1966 to 2013 were identified. The quality of the trials was assessed. The outcomes included length of surgery, operative blood loss, postoperative femoral shaft fracture, cut-out of the implant from the femoral head, non-union of the fracture, reoperation rate, wound infection, postoperative hip pain (hip joint pain and thigh pain), which were extracted and reviewed systematically. RESULTS AND CONCLUSION: 4 757 trial participants with 4 748 fractures were included in the 31 published trials. There was no significant difference in the length of surgery, reoperation rate, cut-out of the implant from the femoral head, non-union of the fracture, wound infection and postoperative hip pain between the two groups  (P > 0.05) between dynamic hip plate and proximal femoral intramedullary nail fixation. Compared with dynamic hip plate fixation, proximal femoral intramedullary nail fixation had less blood loss and significantly higher rate of femoral shaft fractures (P=0.003). Experimental findings show that, in treatment of intertrochanteric fracture, intramedullary nail fixation is associated with significantly lower blood loss. However, the risk of femoral shaft fracture is increased compared with dynamic plate fixation. There were no differences in length of surgery, cut-out of the implant from the femoral head, non-union of the fracture, reoperation rate, wound infection and postoperative hip pain. The results of this systematic review should be explained prudently because of some limitations of included trials. To obtain more reliable conclusions, large-scale randomized controlled trials of strict design, uniform index and long-term follow-up are needed. 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   Figures and Tables | References | Related Articles | Metrics

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Injured vertebra pedicle screw fixation and cross-segment pedicle screw fixation for thoracolumbar fracture: a meta-analysis   Wu Yi, He He-bei, Sun Yong-jian, Li Wei-cheng, Ding Chao 2015, 19 (22):  3604-3608.  doi: 10.3969/j.issn.2095-4344.2015.22.029 Abstract ( 250 )   PDF (892KB) ( 307 )   Save BACKGROUND: Thoracolumbar fracture becomes more in the clinic. The fixation manner of thoracolumbar fracture is controversial. Injured vertebra pedicle screw fixation or traditional cross-segment pedicle screw fixation are controversial and lack the support of evidence-based medicine. OBJECTIVE: To evaluate the outcomes of injured vertebra pedicle screw and cross-segment pedicle screw fixation for thoracolumbar fractures. METHODS: According to Cochrane system evaluation, the following databases were retrieved: National Library of Medicine database, China National Knowledge Infrastructure, Wanfang database and VIP database. Conference proceedings were searched by hand. The retrieval time ranged from 2005 to March 2015. Randomized controlled trials were collected. Meta-analysis was performed by using Cochrane Collaboration Revman 4.2. RESULTS AND CONCLUSION: By screening, a total of 14 clinical controlled trials were selected, including 956 patients. Meta-analysis results showed that postoperative Cobb angle was improved significantly in the vertebral pedicle screw group than in the cross-segment pedicle screw fixation group (OR=-2.72, 95%CI: -3.08--2.35, P < 0.01). Correction rate of the vertebral height was higher in the vertebral pedicle screw group than in the cross-segment pedicle screw fixation group (OR=7.45, 95%CI:6.94-7.97, P < 0.01). The failure rate was lower in the vertebral pedicle screw group than in the cross-segment pedicle screw fixation group (OR=0.12, 95%CI: 0.05- 0.27, P < 0.01). Results verify that postoperative Cobb angle improved significantly after the injured vertebrae pedicle screw and cross-segment pedicle screw fixation for thoracolumbar fractures. The height was obviously corrected and fewer complications were caused such as implant failure. The fixation effect was good.  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   Figures and Tables | References | Related Articles | Metrics