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23 July 2015, Volume 19 Issue 31 Previous Issue    Next Issue

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Total hip replacement for Crowel III and IV hip dislocation: prosthesis position and stability  Ding Liang-jia, Liu Xiao-min, Liu Ying-li 2015, 19 (31):  4921-4926.  doi: 10.3969/j.issn.2095-4344.2015.31.001 Abstract ( 299 )   PDF (931KB) ( 869 )   Save BACKGROUND: Developmental dislocation of the hip is a type of adult hip dysplasia, including Crowe III and IV type; the type of dislocation of the hip is a severe prognosis. Total hip replacement is clinically used for the complex reconstruction of acetabulum. For injured acetabulum, autologous bone graft is effective to reconstruct acetabulum structure, provides good coverage and stability for the acetabulum. Postoperative combination with effective exercise can ensure the recovery of acetabulum function. OBJECTIVE: To analyze the correlation of prosthesis position selection during total hip replacement with clinical  short- and middle-term effects of Crowel III and Crowel IV hip dislocation. METHODS: Clinical data of 28 cases of dysplasia and dislocation of the hip joint combined with severe osteoarthritis, who were treated in the Department of Joint Surgery, the Second Affiliated Hospital, Inner Mongolia Medical University from December 2011 to December 2012, were retrospectively analyzed. All patients received total hip replacement. Implant was biological artificial total hip joint prosthesis. During 2-year follow-up, patients were rechecked by imaging regularly to analyze the imaging changes of acetabulum prosthesis position and bone graft fusion. Harris hip score was used to assess the recovery of hip function. The correlation of prosthesis position and short- and middle-term effects was analyzed. RESULTS AND CONCLUSION: The filling rate of medullary cavity of prosthesis was above 75%. The initial position was fixed and stable. The stability rate of femur-prosthesis interface reached 100%. Compared with pre-replacement, hip function was significantly improved at 6 months post surgery (t=25.55, 9.07; P < 0.05). These results indicate that total hip replacement for Crowel III and Crowel IV hip dislocation can effectively reconstruct the acetabulum, recover hip function, and stabilize prosthesis. Total hip replacement is characterized by good filling rate, high stability of femoral prosthesis interface, and stable initial fixation. The clinical repair effect is strongly associated with the position of the 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 Figures and Tables | References | Related Articles | Metrics

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Legacy posterior stabilized prosthesis for valgus knee deformity: midterm follow up  Guo Jiang, Zhang Zhong-jie, Xia Bo, Zhang Cai-dong, Fan Zhong-wei, Wu Tian-hao, Yang Hong-bin, Tan mei-yun 2015, 19 (31):  4927-4932.  doi: 10.3969/j.issn.2095-4344.2015.31.002 Abstract ( 288 )   PDF (1086KB) ( 376 )   Save BACKGROUND: Legacy posterior stabilized prosthesis has advantages in theoretic design, in vitro kinematics and abrasion, but it remains unclear whether its clinical outcomes for vaglus knee deformity are better than Legacy constrained condylar knee prosthesis. OBJECTIVE: To explore the midterm follow-up effect of Legacy posterior stabilized prosthesis in total knee arthroplasty in patients with valgus knee deformity. METHODS: From February 2006 to November 2013 in Department of Bone and Joint Surgery, Affiliated Hospital of Luzhou Medical College, total knee arthroplasty was used to treat valgus knee deformity in 33 cases (35  knees). Parapatellar medial approach was used. Precise osteotomy was utilized to correct limb alignment. Lateral soft tissue received selective release. Finally, an equal type of Legacy posterior stabilized prosthesis (Zimmer, USA) was implanted and fixed with antibiotic bone cement. The differences in hospital for special surgery knee score, range of motion of knee, femoral tibial angle, and maximum flexion and extension angle, as well as X-ray film results were compared and analyzed before and after replacement. The complications including deep vein thrombosis, peri-prosthetic infection, patellar clicking, unstable knee, and common peroneal nerve injury were recorded after surgery. RESULTS AND CONCLUSION: All patients were followed up for 24-50 months. The incision was healed in one-stage. No complications such as peri-prosthetic infection appeared. Three patients suffered from common peroneal nerve palsy, which was cured at half a year after surgery by expectant treatment such as trophic nerve. Two cases suffered from knee instability after replacement, which was improved at 1 month after external fixation with a brace. One case experienced deep vein thrombosis in the lower extremity, which was improved after treatment with low molecular weight heparin anticoagulation. During final follow-up, hospital for special surgery knee score increased from (51.85±4.15) preoperatively to (85.77±2.50) postoperatively (P < 0.01). There were excellent in 20 knees, good in 11 knees, with an excellent and good rate of 89%. X-ray films showed that hindlimb alignment was apparently corrected, prosthetic position was good, no loosening occurred. These data indicate that total knee arthroplasty, using parapatellar medial approach, obtained good correction outcomes through the accurate amputation to correct hindlimb alignment and selective release of the soft tissue with Legacy posterior stabilized prosthesis in the treatment of valgus knee deformity. 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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Effect of intravenous tranexamic acid on hidden blood loss in total knee arthroplasty  Zhao Min-wei, Li Zi-jian, Zhang Ke, Zeng Lin, Fang Tuo 2015, 19 (31):  4938-4943.  doi: 10.3969/j.issn.2095-4344.2015.31.004 Abstract ( 476 )   PDF (1022KB) ( 425 )   Save BACKGROUND: Massive blood loss was caused by an over-reactive fibrinolytic system, as a sequence of tourniquet usage and surgery trauma in total knee arthroplasty. As an antifibrinolytic drug, tranexamic acid has been proven to decrease not only the obvious and total blood loss, but also the ratio of allograft blood transfusion in total knee arthroplasty. Nevertheless, the effect of tranexamic acid on hidden blood loss in total knee arthroplasty had not been clarified yet. OBJECTIVE: To observe the effect of intravenous infusion of tranexamic acid on hidden blood loss in primary total knee arthroplasty. METHODS: Clinical data of 54 patients who received primary unilateral total knee arthroplasty in the Third Hospital, Peking University from June to December 2013 were retrospectively analyzed. They were divided into two groups according to the use of tranexamic acid. 22 patients in the tranexamic acid group were given 2 g  tranexamic acid by intravenous infusion during surgery. 32 patients in the control group were given an equal volume of physiological saline. Patients in both groups were orally given anticoagulant rivaroxaban after replacement. Hemoglobin level and blood hematocrit were recorded before and after surgery for 5 consecutive days. The total amount of blood loss and hidden blood loss were calculated by using Cross equation. The difference in the amount of blood loss was compared between the two groups. Lower extremity venous ultrasound examination was conducted at 1 week after replacement to determine deep venous thrombosis in the lower limb. RESULTS AND CONCLUSION: No significant difference in general data and perioperative conditions was detected between the two groups (P > 0.05). Postoperative drainage, dominant blood loss, total blood volume, the amount of autologous blood transfusion and the amount of allogeneic blood transfusion were significantly less in the tranexamic acid group than in the control group (P < 0.05). According to Gross formula, the difference of hidden blood loss was statistically significant between the tranexamic acid group (302.9±189.9) mL and the control group (596.8±271.4) mL  (P < 0.05). Deep vein thrombosis appeared in one case between the two groups after replacement. Results indicate that intravenous infusion of tranexamic acid dramatically decreased the hidden blood loss in unilateral total knee arthroplasty, reduced allogeneic blood transfusion, and simultaneously did not increase the incidence of deep vein thrombosis in the lower limb. 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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Tranexamic acid reduces blood loss in total knee arthroplasty: effectiveness and safety Cao Wan-jun, Zhu Shao-ling, Liu Xian-dong, Tang Cheng-jie, Zheng Jin-wen, Chen Xing-yu, Liu Ying, Xiao Peng 2015, 19 (31):  4944-4948.  doi: 10.3969/j.issn.2095-4344.2015.31.005 Abstract ( 405 )   PDF (846KB) ( 379 )   Save BACKGROUND: Tranexamic acid is a synthetic anti-fibrinolytic drug, and can effectively control blood loss after total knee arthroplasty through vein.  OBJECTIVE: To evaluate the effectiveness and safety of tranexamic acid in reducing blood loss after primary unilateral total knee arthroplasty. METHODS: From 2014 to 2015, 100 patients from the Department of Lower Limb, Sichuan Orthopaedic Hospital underwent primary unilateral total knee arthroplasty, and randomly divided into test group which used tranexamic acid and control group which used tranexamic acid, with 50 cases in each group. 1 g tranexamic acid was infused into the vein at 10 minutes before total knee arthroplasty in the test group, but tranexamic acid was not given in the control group. RESULTS AND CONCLUSION: The amount of total blood loss, postoperative wound drainage in 24 hours, and the amount of blood transfusion were significantly less in the test group than in the control group (P < 0.05). No significant differences in intraoperative blood loss and the number of patients receiving blood transfusion were found between the test and control groups. No significant difference in preoperative hemoglobin levels was detected before surgery, but hemoglobin levels were decreased after surgery between the two groups. Postoperative hemoglobin levels were apparently higher in the test group than in the control group after surgery. At 24 hours after surgery, no significant difference in coagulation was detectable between the two groups. At 6 days, double lower limb vein color Doppler ultrasound examination did not reveal deep vein thrombosis in both groups. These findings verify that treatment with tranexamic acid in the vein before primary unilateral total knee arthroplasty can evidently diminish the amount of perioperative blood loss and blood transfusion, reduce the risk  and cost of blood transfusion, which is good for rehabilitation and does 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 Figures and Tables | References | Related Articles | Metrics

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Different implants in the repair of Denis B thoracolumbar burst fracture: Cobb’s angle and height of anterior border of injured vertebral body  Xie Ping, Zhao Jian-guo, San You-li, Xiao Yu-chun, Lu Yang 2015, 19 (31):  4949-4954.  doi: 10.3969/j.issn.2095-4344.2015.31.006 Abstract ( 316 )   PDF (1065KB) ( 480 )   Save BACKGROUND: Denis B thoracolumbar burst fractures are common spinal injury and may be involved in the upper end plate injury. Fracture reduction and pedicle screw fixation are used to repair above injury. This scheme can effectively achieve the aim of correcting deformity, but the trabecular bone after crushing cannot be fully recovered. OBJECTIVE: To observe the repair effect of fracture reduction and pedicle screw fixation + artificial bone graft in vertebral body on Denis B thoracolumbar burst fracture, and compare with fracture reduction and pedicle screw fixation alone.  METHODS: Clinical data of 70 cases of Denis B thoracolumbar burst fractures, who were treated in the Department of Orthopedics, Zhangjiagang Aoyang Hospital from January 2012 to December 2014, were retrospectively analyzed. According to repair scheme, they were equally divided into two groups. Patients in the control group received fracture reduction and pedicle screw fixation. Patients in the observation group received fracture reduction and pedicle screw fixation + artificial bone graft in vertebral body. Oswsetry Disability Index, height of anterior border of injured vertebral body, lower back pain visual analogue scale and vertebral kyphosis Cobb’s angle were compared and observed between the two groups before repair, 1 week, 3 and 6 months after repair. RESULTS AND CONCLUSION: No significant difference in Visual Analogue Scale was detected at 1 week, 3 and 6 months after repair between the observation and control groups (P > 0.05). Oswsetry Disability Index was significantly lower in the observation group than in the control group (P < 0.05). No significant difference in the height of anterior border of injured vertebral body was detected between the observation and control groups (P > 0.05). Cobb’s angle was significantly lower in the observation group than in the control group (P < 0.05). These findings suggest that fracture reduction and pedicle screw fixation + artificial bone graft in vertebral body obtained good repair effects on Denis B thoracolumbar burst fracture, not only effectively corrected Cobb’s angle and the height of anterior border of injured vertebral body, but also helped to restore normal spinal loads by filling bone in the injured vertebral body.   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 imaging guided vertebral pedicle screw placement: accuracy analysis  Shao He-yang, Meng Li-juan 2015, 19 (31):  4955-4959.  doi: 10.3969/j.issn.2095-4344.2015.31.007 Abstract ( 405 )   PDF (901KB) ( 303 )   Save BACKGROUND: Pedicle screw implantation is a common method to repair various spinal diseases, but there is a big difficulty in the safety and accuracy of screw placement. OBJECTIVE: To explore the effects of spinal pedicle screw implantation in the implementation of image guidance. METHODS: A retrospective analysis was performed on clinical data of 118 cases of pedicle screw implantation in the Luohe Hospital of Traditional Chinese Medicine from December 2010 to December 2013. They received internal fixation with pedicle screws. They were equally divided into two groups according to guidance method. Observation group underwent three-dimensional imaging of spinal navigation. Control group received conventional X-ray fluoroscopy. Screw placement and repair-related indexes were observed in the two groups. After implantation, they were followed up for 1-12 months. Postoperative complications were compared in both groups.  RESULTS AND CONCLUSION: 59 patients in the observation group were implanted with 325 screws, and 59 patients in the control group were implanted with 319 screws. In the observation group, the excellent and good rate was 95% (319 screws). In the control group, the excellent and good rate was 78% (250 screws). There were significant differences in the excellent and good rate between the two groups (P < 0.05). The time required in screw placement was significantly shorter in the observation group than that in the control group (P < 0.05). Operation time and the intraoperative bleeding were significantly better in the observation group than in the control group (P < 0.05). The incidence rate of postoperative complications was lower in the observation group than in the control group (P < 0.05). These data suggest that under the guidance of three-dimensional imaging of spinal navigation, spine pedicle screw fixation can effectively shorten the time required for screw placement, improve the accuracy of implantation, and reduce the occurrence of postoperative 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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Unilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures: less bone cement leakage and ideal recovery  Wu Hong, Yuan Yuan, Liu Li-jin, Yan Liang, Xiong Li-wei, Zou Zhi-yuan, Min Zhi-hai 2015, 19 (31):  4960-4966.  doi: 10.3969/j.issn.2095-4344.2015.31.008 Abstract ( 304 )   PDF (1362KB) ( 382 )   Save BACKGROUND: Percutaneous vertebroplasty and percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture have obtained good outcomes, because the traditional method is invalid, but there are a variety of choices in operation time, anesthesia, surgical approach and method, and each method has its advantages and disadvantages. OBJECTIVE: To investigate the effect and preponderance of the manual reduction combined with unilateral percutaneous vertebroplasty under general anesthesia in the treatment of osteoporotic vertebral compression fractures.  METHODS: A total of 53 patients with single vertebral osteoporotic vertebral compression fractures, who were treated with percutaneous vertebroplasty, were retrospectively analyzed from July 2012 to December 2014. The new method group (32 cases) received manual reduction, underwent unilateral pedicle puncture and bone  cement injection during unilateral percutaneous vertebroplasty under general anesthesia. The conventional method group (21 cases) received conventional percutaneous vertebroplasty. RESULTS AND CONCLUSION: There was an average of 6-month follow-up (3-14 months). Significant differences in visual analogue scale scores, vertebral compression ratio and kyphosis Cobb’s angle were detected in the new method and the conventional method groups at 3 days post surgery and during final follow-up compared with before surgery (P < 0.01). No significant difference in visual analogue scale scores was found between the two groups (P > 0.05). Compared with the conventional method group, postoperative vertebral compression ratio, kyphosis Cobb’s angle and bone cement leakage rate were significantly lower in the new method group (P < 0.01). Results verified that the new method combined with the advantages of percutaneous vertebroplasty and percutaneous kyphoplasty, the advantages of unilateral and bilateral puncture approach. The new method can correct kyphosis deformity, effectively recover the vertebral height and physiological curvature and the puncture is safe. Simultaneously, the leakage rate of bone cement is reduced, and the distribution of bone cement is ideal. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Effect of paraplegia walking orthosis on rehabilitation of the lower extremity in patients with thoracic spinal cord injury Yang Qin, Tang Dan, Zhao Yan-ling, Zhu Zheng-kun, Yan Xiu-sheng, Hu Fo-sheng, Xu Hong-hui 2015, 19 (31):  4967-4972.  doi: 10.3969/j.issn.2095-4344.2015.31.009 Abstract ( 442 )   PDF (1099KB) ( 457 )   Save BACKGROUND: Thoracic spinal cord injury often leads to double lower limb paralysis. Paraplegia walking orthosis can improve lower limb dysfunction, improve the daily living activity, and regain the ability to stand and walk in patients with paraplegia. OBJECTIVE: To discuss the effects of paraplegia walking orthosis on muscle spasticity and recovery of function of the affected lower extremity in patients with thoracic spinal cord injury.  METHODS: The 20 patients with thoracic spinal cord injury (T5-12), according to the damage plane by American  Spinal Injury Association standard, were divided into complete damage group and incomplete damage group (n=10). All patients were fitted out paraplegia walking orthosis. They received residual muscle strength training, sitting balance training, and transfer training prior to assembly, and then subjected to standing exercise within parallel bar, balance and transfer training, and walking aid devices training indoor and outdoor, and elbow crutch training on foot after the assembly. RESULTS AND CONCLUSION: Compared with pre-treatment, American Spinal Injury Association score increased at 12 weeks after treatment with paraplegia walking orthosis, and sensation did not obviously alter. Spasm worsened with prolonged course of disease in the complete damage group. At 12 weeks after treatment, American Spinal Injury Association score increased, sensation apparently improved, and the spasm did not change with time in the incomplete damage group. Activities of daily living (modified Barthel index, and functional independence evaluation) evidently improved in both groups. Compared with 2 weeks, the 10-m walking time was noticeably reduced and the 6-minute walking distance was prolonged at 12 weeks in both groups. These results confirm that paraplegia walking orthosis fitted out in patients with thoracic spinal cord injury significantly improves the patient’s motor function, activities of daily living and walking ability, and also has certain influence on muscle spasm 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 Figures and Tables | References | Related Articles | Metrics

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Bilateral and unilateral pedicle screw assisted interbody fusion for degenerative lumbar spondylolisthesis in the elderly  Zhou Gang, Yang Xiao-hui, Huang Wei-min, Wang Cheng-wei, Zhang Yu-kun 2015, 19 (31):  4973-4977.  doi: 10.3969/j.issn.2095-4344.2015.31.010 Abstract ( 277 )   PDF (875KB) ( 430 )   Save BACKGROUND: Spinal canal decompression reduction fixation combined with bone graft fusion has been extensively applied in the clinic. Bilateral pedicle screw assisted interbody fusion and unilateral pedicle screw assisted interbody fusion are main methods to treat degenerative lumbar spinal stenosis and lumbar spondylolisthesis. OBJECTIVE: To compare early clinical therapeutic effects of bilateral and unilateral pedicle screw assisted interbody fusion in elderly patients with spinal stenosis and degenerative spondylolisthesis. METHODS: A total of 60 elderly patients with spinal stenosis with degenerative lumbar spondylolisthesis were selected, including 37 males and 23 females, at the age of 60 to 78 years old. They were divided into two groups, and subjected to decompression of spinal canal. In the treatment group (n=30), patients received unilateral pedicle screw assisted interbody fusion. In the control group (n=30), patients received bilateral pedicle screw assisted interbody fusion. After treatment, they were followed up for 1 year. The recovery of joint function was assessed using Japanese Orthopaedic Association scores in both groups. Simultaneously, complications were recorded. RESULTS AND CONCLUSION: Japanese Orthopaedic Association scores were 25.7±1.9 and 25.8±1.8 in the treatment and control groups, respectively, and no significant difference was found between groups. In the treatment group, three cases affected lower limb numbness and two cases suffered from dural tear, with the incidence of complication of 17%. In the control group, three cases affected lower limb numbness and three cases suffered from dural tear, with the incidence of complication of 20%; no significant difference was detected between the two groups. No adverse reaction related to bone graft was found in the two groups. These results confirm that bilateral or unilateral pedicle screw assisted interbody fusion in treatment of degenerative lumbar spondylolisthesis with spinal stenosis obtained good therapeutic effects. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Vertebroplasty for severe vertebral compression fractures: imaging evaluation  Shi Xin-le, Chen Yu-xiang, Liu Fei, Zhao Xiao-long 2015, 19 (31):  4978-4982.  doi: 10.3969/j.issn.2095-4344.2015.31.011 Abstract ( 348 )   PDF (916KB) ( 355 )   Save BACKGROUND: Recent reports only concern vertebroplasty for mild to moderate vertebral compression fractures, but seldom address vertebroplasty for severe vertebral compression fractures such as vertebral collapse. OBJECTIVE: To evaluate the efficacy and imaging features of percutaneous vertebroplasty for severe vertebral compression fractures.  METHODS: A total of 25 patients underwent single-level vertebroplasty for vertebral compression fractures. Imaging features were then analyzed including location, pattern of compression, extent of collapse, pre- and post kyphotic angle and adjacent disc height before and after vertebroplasty.  RESULTS AND CONCLUSION: 60% (16/25) patients involved the thoracolumbar junction. The height of collapsed vertebral body was 14%-30% of original vertebral body. The average height of collapse was 5.17 mm or 22% of original vertebral body. Kyphotic angle before vertebroplasty ranged from 0-33° (averagely 16°) with an average correction of 12° after vertebroplasty. Average disc height before vertebroplasty was 7.3 mm above and 7.7 mm below. Visual analogue scale score was significantly higher preoperatively than that postoperatively, showing significant difference in pain improvement (P < 0.015). These data suggest that percutaneous vertebroplasty is safe and effective in the treatment of single level severe vertebral compression 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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Different screw placement schemes in the treatment of middle-aged and young patients with displaced femoral neck fracture: reduction quality and femoral head necrosis rate Liu Fu-yao, Liu Cheng-wei, Wu Sheng-zhong 2015, 19 (31):  4983-4988.  doi: 10.3969/j.issn.2095-4344.2015.31.012 Abstract ( 374 )   PDF (1080KB) ( 396 )   Save BACKGROUND: The key difference between closed reduction and open reduction for femoral neck fracture is the incision of joint capsule or not. As for this problem, scholars have different opinions, but there is no unified conclusion. OBJECTIVE: To compare reduction quality and the rate of femoral head necrosis of open reduction and closed reduction in the treatment of femoral neck fracture in middle-aged and young patients with displaced femoral neck fracture. METHODS: Clinical data of 102 middle-aged and young patients with femoral neck fracture, who were treated in the Department of Traumatic Orthopedics, Guizhou Orthopedic Hospital from June 2008 to June 2014, were analyzed. They were followed up. According to the manner of reduction, they were divided into open reduction group (n=39) and closed reduction group (n=63). General data, postoperative fracture healing, the rate of femoral head necrosis and reduction quality were compared between the two groups. RESULTS AND CONCLUSION: No significant difference in general information, preoperative and postoperative hemoglobin difference, fracture healing time and fracture nonunion rate was detected between the two groups (P > 0.05). The rate of femoral head necrosis was lower in the open reduction group than in the closed reduction group, but reduction quality was higher in the open reduction group than in the closed reduction group (P < 0.05).  These results indicate that in the treatment of displaced femoral neck fractures in middle-aged and young patients, postoperative femoral head necrosis rate of open reduction and fixation is low, and the quality of reduction is better. Open reduction has a certain advantage, but the case number and case study have a certain limitation. We should choose the appropriate way of operation treatment according to the patient’s condition. 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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Modified proximal femoral nail anti-rotation II for repair of intertrochanteric fractures in the elderly: 6-month follow-up Liao Zhen-chen, Su Wei-song 2015, 19 (31):  4989-4993.  doi: 10.3969/j.issn.2095-4344.2015.31.013 Abstract ( 309 )   PDF (828KB) ( 538 )   Save BACKGROUND: Osteoporosis-induced unstable intertrochanteric fracture has a high failure rate and incidence of complications, and treatment is still controversial. OBJECTIVE: To compare the clinical effects of proximal femoral nail anti-rotation and modified proximal femoral nail anti-rotation II for treating intertrochanteric fractures in the elderly. METHODS: Data of 26 patients with intertrochanteric fracture who were treated with surgery in the Department of Orthopedic Surgery, Pingguo County People’s Hospital were retrospectively analyzed. Of them, 13 cases received proximal femoral nail anti-rotation, and 13 cases received modified proximal femoral nail anti-rotation II. RESULTS AND CONCLUSION: The patients in both groups were followed-up for 12 months, no drop out. Hip function restored perfectly after implantation in both groups. No significant difference in Harris score and fracture healing time was detected between the two groups. The incidence of pain in the lower limbs was lower in the proximal femoral nail anti-rotation II group than in the proximal femoral nail anti-rotation group (P < 0.05). Results verified that the therapeutic effect of modified proximal femoral nail anti-rotation II was better than proximal femoral nail anti-rotation, and it is safe 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 Figures and Tables | References | Related Articles | Metrics

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Gamma nail versus locking titanium plate fixation for unstable intertrochanteric fracture in the elderly: hip function  Gao Jin-wei, Chang Jia-nan, Liang Wei-zhi 2015, 19 (31):  4994-4999.  doi: 10.3969/j.issn.2095-4344.2015.31.014 Abstract ( 333 )   PDF (848KB) ( 549 )   Save BACKGROUND: With the diversification of the choice of internal fixation for femoral intertrochanteric fracture, the fixation method for the same kind of fracture can be selected according to surgeon’s habit, and there is no unified standard. OBJECTIVE: To compare Gamma nail and proximal femoral locking plate fixation for repair of femoral intertrochanteric fractures. METHODS: A total of 94 elderly patients with unstable intertrochanteric fractures were treated in the Shanxi Armed Police Corps Hospital from April 2009 to September 2012. They were divided into two groups according to fixation methods. Gamma nail group contained 46 cases. Proximal femoral locking plate group contained 48 cases. The two fixation methods were compared and analyzed from the following aspects: incision length, intraoperative bleeding volume, operation time, postoperative hip function recovery, loading time and complications. RESULTS AND CONCLUSION: Incision length, intraoperative bleeding volume, loading time and complications were better in the Gamma nail group than in the proximal femoral locking plate group (P < 0.05). No significant difference in operation time was detected between the two groups (P > 0.05). The excellent and good rate of hip  function was 96% (44/46) in the Gamma nail group and 92% (44/48) in the proximal femoral locking plate group at 1 year after treatment, and no significant difference was detectable between the two groups (P > 0.05). These findings suggest that Gamma nail and proximal femoral anatomic locking plate for the treatment of unstable intertrochanteric fractures can reach good recovery of hip function, but Gamma nail showed obvious advantages in incision length, intraoperative bleeding volume, loading time and 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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Proximal femoral nail anti-rotation for intertrochanteric fracture in aged patients Kang Ning, Yang Zi-quan, Zhang Chen, Feng Jun-yu 2015, 19 (31):  5000-5003.  doi: 10.3969/j.issn.2095-4344.2015.31.015 Abstract ( 396 )   PDF (709KB) ( 348 )   Save BACKGROUND: Proximal femoral nail anti-rotation has good biomechanical basis, and has obvious advantages for intertrochanteric fracture in aged patients, but there are some problems in the clinic, because of improper handling of material matching and operation details, which can impact therapeutic effects and functional recovery. OBJECTIVE: To analyze the efficacy and issues of proximal femoral nail anti-rotation in the treatment of intertrochanteric fracture in patients at more than 60 years old.  METHODS: From July 2011 to July 2012, proximal femoral nail anti-rotation was used to treat 56 cases of intertrochanteric fractures. Clinical data bank was established to analyze intraopeative problems and postoperative complications. At 1, 3, 6, 9 and 12 months postoperatively, outpatient and telephone follow-up were carried out to evaluate therapeutic effects and functional recovery of hip joint. RESULTS AND CONCLUSION: Four patients died within 1 year. Seven patients lost within a year for other reasons. The remaining 45 patients were followed with the time from 12 to 24 months, with an average time of 18.2 months. Harris score was (85.00±6.75) points. There were excellent in 26 cases, good in 15 cases, average in 3 cases and poor in 1 case, with an excellent and good rate of 91%. 18 cases were not satisfied with the position of fracture fragments. In 9 cases, proximal femur was not match with the proximal femoral nail anti-rotation. Seven cases were not satisfied because of the location and length of the spiral blade. Seven cases affected lateral cortex fracture. One case experienced postoperative pulmonary embolism. One case suffered from cardiovascular and cerebrovascular diseases. Nine cases suffered from local swelling. 13 cases  experienced hip pain. Five cases affected the healing of fracture extended. Results showed that proximal femoral nail anti-rotation for intertrochanteric fracture in aged patients obtained good outcomes, but we should improve the separation of fracture fragments and reduce intraoperative and postoperative 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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Fibular fixation for distal third tibia shaft fractures evidently improves tibial valgus and ankle function Shi Rui-ming, Feng Shi-qing 2015, 19 (31):  5004-5010.  doi: 10.3969/j.issn.2095-4344.2015.31.016 Abstract ( 438 )   PDF (1923KB) ( 484 )   Save BACKGROUND: Fractures of shafts of the tibia and fibula are the most common diaphyseal fractures among all long bones. The clinical significance of fibula fixation in treatment of distal third shaft fractures is controversial, and the studies are also different. OBJECTIVE: To explore the clinical significance of fibular fixation in treatment of distal third tibia shaft fractures. METHODS: A retrospective review has been performed on the clinical data of sixty-four cases with distal third tibia shaft fracture in Department of Orthopedics, China National Offshore Oil Corporation General Hospital from January 2006 to March 2010. All cases were divided into two groups based on whether the fibula was fixed or not: fibula fixation group (n=36) and fibula non-fixation group (n=28). Union rate of fracture, bone union time and tibial valgus angle were compared between the two groups. According to Merchant-Dietz criteria, the ankle range of motion and ankle evaluation score were evaluated and compared between the two groups. RESULTS AND CONCLUSION: No significant difference in union rate of fracture, bone union time and ankle range of motion was detected between two groups. Tibial valgus angle was smaller in the fibula fixation group (5.42±1.16)° than in the fibula non-fixation group (7.54±1.90)°(P=0.006). Ankle function score was higher in the fibula fixation group (93.58±0.97) than in the fibula non-fixation group (90.57±3.92) (P=0.000). Three cases in the fibula fixation group suffered from superficial wound infection, and achieved good healing after treatment of  anti-infection and changing dresses. Above results verify that fibular fixation can reduce tibial valgus angle and improve ankle joint function in treatment of distal third tibia 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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Anterolateral and medial approach fixation with compression plate and screw for middle and inferior humeral fractures: efficacy and safety  Wu Wei, Wang Hai-bo 2015, 19 (31):  5011-5015.  doi: 10.3969/j.issn.2095-4344.2015.31.017 Abstract ( 419 )   PDF (883KB) ( 378 )   Save BACKGROUND: Reduction and fixation are presently used for middle and inferior humeral fractures. The methods of fixation approach include anterolateral (including modified upper arm anterolateral), posterior and medial approaches. The repair approach of middle and inferior humeral fractures remains controversial. OBJECTIVE: To compare efficiency and safety of anterolateral and medial approach fixation with compression plate and screw for middle and inferior humeral fractures. METHODS: A total of 90 cases of middle and inferior humeral fractures treated in Chongqing Red Cross Hospital were equally and randomly divided into experimental group and control group. In the control group, patients were subjected to compression plate and screw through anterolateral approach. In the experimental group, patients were subjected to compression plate and screw through medial approach. Operation time, intraoperative blood loss, complications and the recovery of shoulder joint and elbow joint function were compared in patients of both groups. RESULTS AND CONCLUSION: Intraoperative blood loss was significantly lower in the experimental group than in the control group (P < 0.05). No significant difference in operation time and fracture healing time was found between the two groups (P > 0.05). During 6 months of follow-up, no significant difference in shoulder joint  function Neer score and elbow joint function Mayo score was detected between the two groups (P > 0.05). During the follow-up period, no wound infection, bone nonunion or chronic osteomyelitis appeared in both groups. These data confirm that the effects of medial approach and anterolateral approach for middle and inferior humeral fractures are similar. Medial approach leads to less blood loss, can effectively make up for the defects of the traditional repair scheme, and can be considered as one of fixation approach for middle and inferior humeral 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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Influential factors for AO plastic double plate fixation in repair of senile distal humeral fractures  Chen Ming-guang 2015, 19 (31):  5016-5020.  doi: 10.3969/j.issn.2095-4344.2015.31.018 Abstract ( 302 )   PDF (890KB) ( 354 )   Save BACKGROUND: Clinical treatment for elderly patients with distal humeral fractures includes conservative treatment, abduction, and open reduction and internal fixation. The methods for open reduction and internal fixation are various, and the effects are not unified, which brings great difficulties for clinical treatment. OBJECTIVE: To explore therapeutic effects and influential factors for open reduction and AO plastic double plate fixation for treating senile distal humeral fracture so as to provide the best treatment mode. METHODS: 114 patients with senile distal humeral fracture, who received open reduction and internal fixation in the Affiliated Hospital of Shaanxi University of Chinese Medicine from June 2009 to June 2013, were enrolled in this study. AO plastic double plate fixation was used. Self-designed questionnaire was utilized to investigate elbow recovery effect and influential factors. The possible influential factors were analyzed by chi square test and multiple Logistic regression analysis. RESULTS AND CONCLUSION: Among 114 patients, elbow joint function recovery was excellent in 85 cases and the excellent and good rate was 75%. Single factor analysis showed that significant differences were detected in different fracture types, AO type, with or without nerve injury, vascular injury and complications (P < 0.05). Multivariate Logistic regression analysis showed that fracture type, AO type and nerve injury were the main  factors that influence the treatment effect (P < 0.05). That was, elbow joint function recovery was worse because of open type fracture, C type fracture, fracture combined with nerve injury. Above results confirmed that fracture type, AO type and nerve injury are the main factors influencing the effect of open reduction and internal fixation with AO plastic double plate for treating elderly patients with distal humeral fracture, and intervention should be done according to its influential factors. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Locking compression plate for Pilon fracture: fracture healing and ankle function during 6-month follow-up Li Hai, Zheng Ding-long, Hu Guo-quan, Li Shi-xiang, Pan Zu-de 2015, 19 (31):  5021-5025.  doi: 10.3969/j.issn.2095-4344.2015.31.019 Abstract ( 339 )   PDF (793KB) ( 403 )   Save BACKGROUND: There are many methods that can repair Pilon fracture, but the effects are not ideal. With the development of science and technology, fundamental change of fracture fixation principle and innovation of technology and idea has brought new opportunities for Pilon fracture repair. Biological immobilization technology can further reduce the further damage to blood supply of bone outer membrane on the fracture end, do not disturb biomechanical environment of fracture healing, and is the new trend of present research and development. OBJECTIVE: To investigate the effect of locking compression plate fixation for repair of Pilon fracture using biological fixation technique. METHODS: Clinical data of 76 patients with Pilon fracture treated using locking compression plate fixation in the Nanhai District Economic Development Zone Guanyao Branch of the People’s Hospital from June 2008 to December 2013 were retrospectively analyzed. There were 49 males and 27 females, at the age of 39.5 years on average (range from 19 to 60 years). According to Ruedi-Allgower classification, there were 54 cases of type II and 22 cases of type III. In accordance with biological fixation technique, locking compression plate fixation was  applied to treat Pilon fracture. Following treatment, they were regularly followed up. Reduction quality was assessed by Burwell-Charnley radiological criteria. X-ray films were reviewed to observe fracture healing. During final follow-up, ankle function was evaluated according to Baird-Jackson score. RESULTS AND CONCLUSION: A total of 76 patients were followed up for 6 to 24 months. Reduction quality assessed by Burwell-Charnley radiological criteria was as follows: anatomic reduction of 68 cases, reduction of 8 cases, 71 cases of one-stage wound healing, and 5 cases of wound healing after dressing change, with the rate of one-stage healing of 93%. Fractures of all patients were healed. The healing time was 4 to 8.5 months, averagely 6.25 months. During final follow-up, ankle function assessed by Baird-Jackson score was as follows: there were 69 excellent cases, 5 good cases and 2 average cases. These results indicate that locking compression plate fixation for Pilon fracture obtained good stability, could effectively avoid the damage of fracture end blood supply, shorten the healing time; it was simple to operate, had small injury to soft tissue, and was an effective fixation method to repair Pilon 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 Figures and Tables | References | Related Articles | Metrics

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Cannulated screw and Kirschner wire fixation for fracture dislocation of tarsometatarsal joint: anatomic reduction and ankle functional assessment  Yang Zhao-xian, Zhao Han-ping 2015, 19 (31):  5026-5030.  doi: 10.3969/j.issn.2095-4344.2015.31.020 Abstract ( 407 )   PDF (807KB) ( 336 )   Save BACKGROUND: Closed reduction and internal fixation are mostly used to treat fracture dislocation of tarsometatarsal joint, but cannot obtain satisfactory repair effect. Redisplacement easily appeared after local swelling subsidence. Therefore, open reduction and internal fixation are actively used in the clinic to treat fracture dislocation of tarsometatarsal joint so as to restore foot function and to elevate quality of life. OBJECTIVE: To explore the clinical effect of open reduction and cannulated screw and Kirschner wire fixation for fracture dislocation of tarsometatarsal joint. METHODS: A total of 42 patients with fracture dislocation of tarsometatarsal joint in the 88 Hospital of Chinese PLA from September 2012 to September 2013 were selected and were given open reduction and cannulated screw and Kirschner wire fixation. After treatment, the recovery of patients was observed, and ankle hindfoot function was assessed with American Orthopaedic Foot and Ankle Society ankle hindfoot score.  RESULTS AND CONCLUSION: A total of 42 patients were followed up for 1-12 months. American Orthopaedic Foot and Ankle Society ankle hindfoot score results showed that there were excellent in 30 cases, good in 10 cases, and poor in 2 cases, and the 2 patients were subjected to high energy soft tissue injury. 37 patients in 4-6 months after operation started weight-bearing walking. Three patients had mild pain, a certain functional limitation, but could maintain normal walking gait. The remaining two patients complicated with traumatic arthritis, and were unable to do normal weight-bearing walking. These results show that open reduction and cannulated screw and Kirschner wire fixation can achieve good effect of anatomical reduction of fracture dislocation of tarsometatarsal joint, and improve patient’s ankle 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 Figures and Tables | References | Related Articles | Metrics

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Percutaneous cannulated screw fixation versus open reduction and internal fixation for medial malleolus fracture: recovery of joint function  Wang Rong-sheng, Xu Yu-dong, Luo Ben-huan, Wang Wei-chang, Wang Wei-xiong, He Li-wen, Liu Xiong-ye, Yang Qing 2015, 19 (31):  5031-5035.  doi: 10.3969/j.issn.2095-4344.2015.31.021 Abstract ( 351 )   PDF (853KB) ( 699 )   Save BACKGROUND: The ankle is one of the most important joints of human body. Medial malleolar fractures are very common, and there are lots of surgical methods to treat it. A traditional approach is open reduction and internal fixation. As views changed, percutaneous cannulated screw internal fixation become increasingly popular, but various clinical studies are still needed to analyze the efficacy of these two methods. OBJECTIVE: To compare the recovery of joint function after medial malleolus fracture repaired by open reduction and internal fixation and percutaneous cannulated screw fixation.  METHODS: A total of 63 cases of medial malleolus fracture, who were treated in the Department of Orthopedics, People’s Hospital of Xinyi City from March 2009 to March 2013, were enrolled. According to repair plan, they were divided into two groups: open reduction and internal fixation group (n=29) and percutaneous cannulated screw fixation group (n=34). Ankle function was assessed in accordance with Kofoed ankle score standard on admission and at 3 months after repair. RESULTS AND CONCLUSION: The patients were followed up for 3 to 12 months. Among 29 cases in the open reduction and internal fixation group, the wound was healed at grade A in 27 cases and at grade B in 2 cases; 29 cases were reset, and no poor reduction was found. In the percutaneous cannulated screw fixation group, 34 cases had healing at grade A, with the presence of good reduction. All patients experienced bone union, and no  infection appeared. In accordance with Kofoed score, at 3 months of follow-up, the satisfaction rate was 97% in the open reduction and internal fixation group, and 100% in the percutaneous cannulated screw fixation group. These data suggest that both open reduction and internal fixation and percutaneous cannulated screw fixation for medial malleolus fracture obtained positive effects, but percutaneous cannulated screw fixation showed small surgical trauma, which could reduce the rate of infection and contributed to early functional recovery of ankle joint. Figures and Tables | References | Related Articles | Metrics

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Core stabilization exercises, implant fixation and lumbar fusion for degenerative lumbar spondylolisthesis: lumbar function evaluation   Luo Sheng-fei, Zhang De-jian 2015, 19 (31):  5036-5040.  doi: 10.3969/j.issn.2095-4344.2015.31.022 Abstract ( 417 )   PDF (813KB) ( 1049 )   Save BACKGROUND: Lumbar degenerative disease is a common and frequently occurring disease in spinal surgery. With increasing age, the incidence rate is increased. OBJECTIVE: To elevate clinical outcomes and improve the quality of life of patients by analyzing spinal stability after lumbar implant fixation fusion and functional training in treatment of lumbar degenerative disease.  METHODS: (1) We used a prospective randomized controlled design. The 52 patients with I° or II° degenerative lumbar spondylolisthesis were randomly divided into two groups, with 26 cases in each group. Conventional exercises were carried out in the control group and core stabilization exercises for the treatment group, with course of treatment for 24 weeks. Curative effects of numerical rating scale and the Oswestry Disability Index were compared at 6, 12 and 24 weeks after treatment respectively. (2) Spinal stability after lumbar fusion and fixation of the implant for degenerative lumbar spondylolisthesis was evaluated by database document retrieval. RESULTS AND CONCLUSION: (1) After 24 weeks, numerical rating scale score and the Oswestry Disability Index were significantly lower in the treatment group than in the control group (P < 0.05 or P < 0.01). Core stabilization exercises apparently relieve lumbar pain and improve the ability of activities. Core stabilization exercises are better than conventional training. (2) Pedicle instrument fixation combined with interbody fusion is effective for lumbar spondylolisthesis within the second degree. Posterior interbody fusion has predominant mechanical property in maintaining spondylolisthesis orthopedic and stabilizing the structure. Correction loss and  fixation failure easily occur after posterolateral fusion, but clinical effects are not affected. 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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Digital design and clinical application of intramedullary nailing fixation for femoral shaft fracture based on accurate three-dimensional measurement  Chen Xuan-huang, Lin Hai-bin, Yu Zheng-xi, Chen Xu, Zheng Feng, Zhang Guo-dong 2015, 19 (31):  5041-5045.  doi: 10.3969/j.issn.2095-4344.2015.31.023 Abstract ( 421 )   PDF (1584KB) ( 702 )   Save BACKGROUND: The limitation of the traditional intramedullary nailing relies on the personal experience of the doctor. Moreover, the enlargement of the bone marrow causes the destruction of the biological environment of the marrow cavity and affects the healing of bone. OBJECTIVE: To observe therapeutic effect of digital technology assisted intramedullary nail fixation for femoral shaft fracture. METHODS: A total of 80 patients with femoral shaft fracture, who were treated in the Department of Orthopedics, Affiliated Hospital of Putian University from January 2010 to January 2014, were enrolled. Digital technology was used to assist treatment. Three-dimensional digital model of femoral shaft fracture was established before treatment. Virtual reduction was conducted in the three-dimensional digital fractures. The diameter of medullary cavity was measured. Appropriate specification of intramedullary nailing was selected according to the measurement data. Closed reduction and intramedullary nailing were performed according to operation scheme  of digital technology. RESULTS AND CONCLUSION: The 80 patients were followed up for 12 to 24 months. Fractures were completely healed. At 12 months after treatment, they were evaluated by clinical curative effect standard in department of orthopedics. There were excellent in 62 cases, good in 15 cases, and good in 3 cases, with the excellent and good rate of 96%. No complications occurred such as infection, fixator breakage or loosening. These results verify that digital technology assisted intramedullary nail fixation for femoral shaft fracture obtained positive therapeutic effects, could obviously shorten operation time, reduce surgical trauma, and diminish intraoperative X-ray emission to patients and health care workers. 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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Application of reverse engineering techniques to measure the distance and volume of medial and lateral compartments of human knee joint   Zhong Jin-ran, He Jian, Chen Jian, Chen Jing-hua, Lin Ying, Wang Xiang-bin 2015, 19 (31):  5046-5050.  doi: 10.3969/j.issn.2095-4344.2015.31.024 Abstract ( 374 )   PDF (898KB) ( 277 )   Save BACKGROUND: Knee joint is the most complicated structure of human body, and X-ray is often used to reflect the stenosis of knee compartment. However, radiographs are two-dimensional projection of three-dimensional joint structure. Thus, different joint shooting locations can impact the outcomes of measurement, and it is difficult to ensure the accuracy of repeated measurements. OBJECTIVE: To build three-dimensional model of knee compartment, measure the distance and volume, and provide the basis for subsequent models, biomechanics and relevant clinical studies. METHODS: Based on the principle of reverse engineering, using CT images of the knee joint and the software of Mimics, three-dimensional model of medial compartment knee structure was reconstructed. After the model was imported and smoothed, the medial and lateral compartment volumes were finally calculated by the software of Geomagic Studio. RESULTS AND CONCLUSION: Three-dimensional model of the knee compartment, including femur, tibia and fibula, was successfully structured by CT images. The models of knee and knee compartment could be observed at any angle or observed individually, and could be measured. It was discovered that the volume of medial and  lateral compartments of knee is close, although the joint space width of them is different, which illustrates that the procedure can accurately reflect the degree of knee joint space width in the round by calculating the volume of medial and lateral compartments of knee joint through computer. 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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Changes in apparent diffusion coefficient and T2 values in the lumbar intervertebral disc under short-time axial load  Cai Zhao-xi, Yang Ze-hong, Li Yong, Chen Jian-yu, Lai Bing-jia 2015, 19 (31):  5051-5056.  doi: 10.3969/j.issn.2095-4344.2015.31.025 Abstract ( 347 )   PDF (1224KB) ( 391 )   Save BACKGROUND: Disc functional magnetic resonance imaging studies are mostly carried out under lying and a non-load state, and do not reflect the changes in morphology and function of the upright human body under disc load conditions. Therefore, we need to study characteristics of disc functional magnetic resonance imaging in the upright state. OBJECTIVE: To analyze the effect of axial load on apparent diffusion coefficient and T2 of intervertebral discs. METHODS: The study consisted of 17 patients with low back pain aged 34-65 years. Before and after axial load, T2 weighted MR imaging, T1 weighted MR imaging, diffusion tensor imaging, and T2-mapping imaging of the lumbar spine were performed. Load quality was 40%-50% body weight. At 10 minutes after axial load, another diffusion tensor imaging was performed. After 15-minute load, another T2-mapping sequence was scanned.  Diffusion tensor imaging scan parameters: single echo-planar imaging, repetition time 2 500 ms, echo time 89 ms, six diffusion directions, b value of 400 s/mm2, sweep time 4:10 minutes. Raw data of diffusion tensor imaging were used to construct apparent diffusion coefficient map and b0 map. Apparent diffusion coefficient value of intervertebral discs was calculated before and after loading. T2 map was automatically constructed using T2-mapping sequence to measure apparent diffusion coefficient and T2 values in the whole intervertebral disc of nucleus pulposus, and the changes of them were analyzed under short-time axial load. RESULTS AND CONCLUSION: Pfirrmann grading results in 17 patients with 85 discs were obtained as follows: 0 in Grade I, 26 in Grade II, 19 in Grade III, 30 in Grade IV, and 10 in Grade V. All 85 disc T2 relaxation time mapping and 84 disc apparent diffusion coefficient mapping were accepted. Under short-time axial load in 84 discs, apparent diffusion coefficient reduced in the whole disc (reduced 38×10-3 mm2/s, Z=2.567, P < 0.05) and nucleus pulposus (reduced 62×10-3 mm2/s, Z=3.461, P < 0.05). Apparent diffusion coefficient changes mainly affected Grade Pfirrmann III discs (reduced 55×10-3mm2/s, Z=2.556, P < 0.05). T2 changes mainly affected normal intervertebral discs (Pfirrmann grade II). Under the load, T2 value of intervertebral discs diminished (reduced 3.17 ms, Z=2.967, P < 0.05). No significant difference in apparent diffusion coefficient and T2 value was detected under the load in other grades of the intervertebral discs (P > 0.05). These results suggest that changes in apparent diffusion coefficient and T2 values were different due to different Pfirrmann grades under short-time axial load. To evaluate magnetic resonance imaging function of intervertebral discs, we should choose different evaluation method according to different degeneration 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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A meta-analysis of proximal femoral nail anti-rotation, dynamic hip screw and total hip arthroplasty for intertrochanteric fractures in the elderly   Qiao Yong-jie, Cao Xue-fei, Zhang Lv-dan, Wang Qin-peng, Zhen Ping 2015, 19 (31):  5057-5064.  doi: 10.3969/j.issn.2095-4344.2015.31.026 Abstract ( 414 )   PDF (1310KB) ( 381 )   Save BACKGROUND: The methods to treat intertrochanteric fracture are controversial. A large number of clinical  studies concern the therapeutic effects of several popular methods to repair intertrochanteric fracture, but these results lack of independence, and may have bias that cannot be measured in the variable and observational studies. Thus, relevant studies have been limited. OBJECTIVE: To compare the repair effects of proximal femoral nail anti-rotation, dynamic hip screw and total hip arthroplasty on intertrochanteric fracture in aged patients by meta-analysis. METHODS: Four electronic databases were searched, including Cochrane library, PubMed, Web of Science and Chinese BioMedical Literature Database, to collect all randomized controlled trials concerning the treatment of intertrochanteric fractures in the elderly with proximal femoral nail anti-rotation, dynamic hip screw and total hip arthroplasty. Using meta-analysis of evidence-based medicine, X-ray exposure time, postoperative complication rate, postoperative bed time, postoperative wound infection rate, Harris hip scores, mean operation time, intraoperative blood loss, length of hospital stays and length of the incision were compared and evaluated. Standard and methodology quality of the trials were critically assessed and relative data were extracted. This study used the Review Manager 5.0 software provided by Cochrane collaboration network. RESULTS AND CONCLUSION: Twelve randomized controlled trials with 1 454 patients were included. Significant differences in mean operation time, intraoperative blood loss, X-ray exposure time, postoperative complication rate, and postoperative bed time were detected between the proximal femoral nail anti-rotation and dynamic hip screw groups (P < 0.05). Significant differences in length of hospital stays, postoperative complication rate, and postoperative bed time were observed between the proximal femoral nail anti-rotation and total hip arthroplasty groups (P < 0.05). Significant differences in postoperative complication rate, postoperative bed time, and Harris hip scores were detectable between the dynamic hip screw and total hip arthroplasty groups (P < 0.05). These data confirm that proximal femoral nail anti-rotation was apparently better than dynamic hip screw and total hip arthroplasty in operation time, intraoperative blood loss, length of hospital stays, postoperative complication rate, and postoperative bed time. Dynamic hip screw was better than proximal femoral nail anti-rotation in X-ray exposure time. Total hip arthroplasty was better than dynamic hip screw and proximal femoral nail anti-rotation in length of hospital stays, postoperative complication rate and postoperative bed 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 Figures and Tables | References | Related Articles | Metrics

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Dynamic hip screw combined with reduction fixation of lesser trochanter prevents hip coxa vara after intertrochanteric fractures: a meta-analysis Lin Zhen-hua, He Jia-nan, Liu Xing-mo 2015, 19 (31):  5065-5071.  doi: 10.3969/j.issn.2095-4344.2015.31.027 Abstract ( 285 )   PDF (1103KB) ( 477 )   Save BACKGROUND: More and more elderly patients have hip fractures because of diverse reasons, and most of the fractures are unstable fractures combined with the displacement of the lesser trochanter. At present, there are still many reports about using dynamic hip screw to repair unstable intertrochanteric fractures, and the effect is obvious. However, there are still great controversies regarding whether lesser trochanter fixation is performed during the repair process. OBJECTIVE: To evaluate the effect of using dynamic hip screw combined with the lesser trochanter fixation to repair intertrochanteric fractures and the occurrence of hip coxa vara after repair through a meta-analysis.  METHODS: The PubMed, EMCC, CBM, CNKI, VIP and Wanfang databases were retrieved by computer for randomized controlled trials on whether lesser trochanter reduction fixation was performed during the process of dynamic hip screw internal fixation for repair of intertrochanteric fractures. The quality of the included studies was evaluated according to the pre-designated inclusion and exclusion criteria. The available data were extracted and  analyzed using the RevMan5.2 software. RESULTS AND CONCLUSION: A total of 10 randomized controlled trials involving 604 patients were included. Among them, 298 cases were assigned to the dynamic hip screw combined with lesser trochanter fixation group, and 306 cases to the lesser trochanter unfixed group. The meta-analysis results indicated that hip coxa vara, other postoperative complications, the excellent and good rate of efficacy in the dynamic hip screw combined with lesser trochanter fixation group were all superior to those in the lesser trochanter unfixed group (all P < 0.000 1), and for hip coxa vara, the parameters were odds ratio=0.17, 95% confidence interval (0.07, 0.41), Z=3.99, P < 0.000 1. The operation time and the amount of blood loss in the lesser trochanter unfixed group were superior to those in the dynamic hip screw combined with lesser trochanter fixation group (all P < 0.000 1). These results suggest that the lesser trochanter unfixed therapy has the advantages of relatively simple operation, shorter operative time and less blood loss during the process of dynamic hip screw internal fixation for repair of unstable intertrochanteric fractures. However, the excellent and good rates of efficacy, hip coxa vara and other postoperative complications were superior in patients with intertrochanteric fracture above the Tronzo-Evans III type who received dynamic hip screw combined with lesser trochanter fixation to those who received lesser trochanter unfixed therapy. The results indicate that dynamic hip screw combined with lesser trochanter fixation for repair of intertrochanteric fracture is beneficial to prevent hip coxa vara and other 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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Meta-analysis of flexible intramedullary nailing and external fixation for pediatric femoral shaft fractures Guo Yong-cheng, Xing Guang-wei, Xia Bing, Feng Guo-ming, Dong Yan-zhao, Niu Xue-qiang, He Qian-yi 2015, 19 (31):  5072-5078.  doi: 10.3969/j.issn.2095-4344.2015.31.028 Abstract ( 405 )   PDF (1197KB) ( 691 )   Save BACKGROUND: Flexible intramedullary nailing and external fixation for pediatric femoral shaft fractures are two common methods in the clinic. It remains controversial which fixation methods are better. OBJECTIVE: To systematically evaluate the therapeutic effects of flexible intramedullary nailing and external fixation for pediatric femoral shaft fractures. METHODS: A computer-based search was performed on PubMed, Embase, Medline, and Cochrane library for literatures on clinical controlled trials of flexible intramedullary nailing and external fixation for pediatric femoral shaft fractures published before November 25, 2014. Literature language was not limited. The age of subjects was from 3 to 15 years. Modified Jadad was utilized to assess methodological quality of the included studies.   Meta-analysis was carried out using Stata 12.0 software. RESULTS AND CONCLUSION: Six papers involving 237 patients were included. Meta-analysis results showed that compared with external fixation, a low incidence of overall complications [relative risk (RR)=0.30, 95% confidence interval (CI): 0.19-0.46; P < 0.001] and pin-hole infection (RR=0.286, 95%CI: 0.13-0.61; P= 0.001), but a high risk of needle tail irritation (RR=1.86, 95%CI: 1.35-2.56; P < 0.001) were found following flexible intramedullary nailing. No significant differences in other complications were found between the two groups. These results confirm that compared with external fixation, elastic intramedullary nail has fewer complications and faster fracture healing. Elastic intramedullary nail is recommended for single pediatric femoral shaft fractures. However, external fixation is a better option for high energy injury of lower limbs, multiple trauma or severely soft tissue injury. 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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Osteoperiosteal decortications combined with other fixation methods for nonunion: bone graft and implant management  Tao Da-wei, Wang Zhi-gang, Zhang Kai 2015, 19 (31):  5079-5084.  doi: 10.3969/j.issn.2095-4344.2015.31.029 Abstract ( 333 )   PDF (638KB) ( 558 )   Save BACKGROUND: Osteoperiosteal decortication can treat the bone nonunion effectively, promote healing of fracture, but its action principle and key operation are not very clear, and there is less research addressing the postoperative treatment. OBJECTIVE: To review research progress of osteoperiosteal decortication for treating nonunion. METHODS: China National Knowledge Infrastructure, Wanfang database and PubMed database were used to search the related articles. The retrieval key words were “osteoperiosteal decortication, stripping, bone nonunion, bone disunion, bone delayed union”. Osteoperiosteal decortications combined with other fixation methods to repair the healing of bone nonunion were compared and analyzed. Bone implantation and implant management were summarized during repair. RESULTS AND CONCLUTION: 105 literatures were retrieved by computer. After primarily screening by reading titles and abstract, irrelevant and repeated literatures were excluded. Finally, 45 articles were summarized. Action principle, indications and operating points of osteoperiosteal decortications for bone nonunion were summarized. Osteoperiosteal decortications combined with other different fixation methods for the healing of bone nonunion were compared so as to better serve the clinic. Simultaneously, the paper also explores the combination with bone implant and management of implant during repair. Osteoperiosteal decortication with its simplicity and effectiveness has been respected in the field of orthopedics. However, for special patients, such as patients combined with destructive bone disease, osteoporosis, nonunion of hand and foot short bones, the treatment with osteoperiosteal decortications needs further researches. 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