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27 August 2015, Volume 19 Issue 35 Previous Issue    Next Issue

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Carbon-coated artificial femoral head replacement for unstable and osteoporotic femoral fractures in the elderly Zhang Zheng-ping, Chang Zhen, Zhao Qin-peng 2015, 19 (35):  5577-5582.  doi: 10.3969/j.issn.2095-4344.2015.35.001 Abstract ( 274 )   PDF (1092KB) ( 300 )   Save BACKGROUND: Elderly patients are more prone to unstable and osteoporotic fractures. In the clinical surgical treatment, different programs can be taken. Internal fixation was done previously. However, the precise choice of the methods of unstable and osteoporotic femoral fractures in the elderly was still controversial. OBJECTIVE: To investigate the clinical effect of carbon-coated artificial femoral head replacement in the treatment of elderly patients with unstable and osteoporotic femoral fractures. METHODS: A retrospective analysis was performed in the Honghui Hospital Affiliated to Health Science Center, Xi’an Jiaotong University from February 2013 to February 2014 in 83 cases of unstable and osteoporotic femoral fractures. These patients were divided into control group (42 cases) and observation group (41 cases) according to treatment methods. Conventional internal fixation and artificial femoral head replacement were conducted. Operation time, intraoperative blood loss, postoperative bed time and hospital stay were observed in the two  groups. Patients were followed up for 12 months. Recovery of hip function and complications were observed and compared between the two groups. RESULTS AND CONCLUSION: No significant difference in operation time and intraoperative blood loss was detected between the observation group and the control group (P > 0.05). Postoperative bed time and hospital stay were significantly shorter in the observation group than in the control group (P < 0.05). The excellent and good rate of hip joint function was significantly higher in the observation group than in the control group, but the complication rate was significantly lower in the observation group than in the control group (P < 0.05). These findings suggest that carbon-coated artificial femoral head replacement for unstable and osteoporotic femoral fractures in the elderly obtained good repair effects, had small injury to the patient and less complications. Moreover, it can better improve hip 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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Total hip arthroplasty versus hollow screw fixation for the repair of femoral neck fractures in the middle-aged and elder patients: hip function Lin Qing-bo 2015, 19 (35):  5583-5587.  doi: 10.3969/j.issn.2095-4344.2015.35.002 Abstract ( 492 )   PDF (878KB) ( 346 )   Save BACKGROUND: The repair method of femoral neck fractures included internal fixation and hip arthroplasty. The selection of repair methods is affected by many factors, such as age, condition of patients, and own physical condition. The selection of repair methods for femoral neck fractures is always controversial.  OBJECTIVE: To compare the hip function and prognosis of elderly patients with femoral neck fractures after total hip arthroplasty and hollow screw fixation. METHODS: 140 patients aged less than 60 years, who accepted treatment in Rizhao Hospital of Traditional Chinese Medicine from April 2012 to February 2014, were selected. They were randomly divided into replacement group and fixation group (n=70). Patients in the replacement group received total hip arthroplasty, and patients in the fixation group received hollow compression screw fixation. Harris score of the hip, complications and satisfactions of the hip were observed, compared and analyzed between the two groups at 1 month post surgery. RESULTS AND CONCLUSION: The excellent and good rate of Harris score at 1 month post surgery was significantly higher in the replacement group (90%) than in the fixation group (63%) (P < 0.05). The incidence of complications was significantly lower in the replacement group (6%) than in the fixation group (29%) (P < 0.05). The satisfaction was significantly higher in the replacement group (93%) than in the fixation group (79%) (P < 0.05). These results verify that the application of total hip arthroplasty for middle-aged and elder patients with femoral neck fracture has a rapid recovery on joint function, has fewer complications, and is suitable for patients who pursue high-quality survival activities. Cannulated compression screw fixation is suitable for middle-aged and elder patients with good quality of preoperative bone. 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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Effects of different ventilation modes on stress reaction of hypertensive patients treated with hip arthroplasty She Shu-song, Zhou Bo, Xu Shun-cai 2015, 19 (35):  5588-5592.  doi: 10.3969/j.issn.2095-4344.2015.35.003 Abstract ( 305 )   PDF (925KB) ( 342 )   Save BACKGROUND: When hip replacement patients treated with general anesthesia, intubation can cause physical stimulus of receptors of throat and trachea, which can increase stress response of patients, especially in patients with hypertension. LMA Supreme laryngeal mask can lessen cardiovascular stress response of perioperative patients and reduce airway complications. OBJECTIVE: To investigate the effects of Supreme laryngeal mask and endotracheal intubation on stress response of hypertensive patients with hip arthroplasty.  METHODS: A total of 45 patients treated with hip arthroplasty in the Shuyang Renci Hospital from January 2010  to September 2014 were enrolled in this study. They were divided into laryngeal mask group (23 cases) and endotracheal intubation group (22 cases). The same protocol for induction and maintenance of general anesthesia was used in the two groups. During arthroplasty, systolic blood pressure, diastolic blood pressure, heart rate and blood oxygen saturation were monitored in patients. Systolic blood pressure, diastolic blood pressure, blood oxygen saturation, heart rate, blood glucose, plasma epinephrine, norepinephrine, serum cortisol, angiotensin II and atrial natriuretic factor levels were recorded before induction (T0), immediately (T1), 5 minutes (T2) and 15 minutes (T3) after intubation in the two groups. RESULTS AND CONCLUSION: Systolic blood pressure and diastolic blood pressure were significantly reduced in the T1-T3 compared with T0 in the laryngeal mask group (P < 0.05); blood oxygen saturation and heart rate were stable in T0-T3 (P > 0.05). Systolic blood pressure and diastolic blood pressure were significantly increased at T1 compared with T0, systolic blood pressure was significantly reduced at T2 and T3 compared with T0, and diastolic blood pressure was significantly diminished at T3 compared with T0 in the endotracheal intubation group (P < 0.05). Blood oxygen saturation and heart rate were significantly higher at T1 (P < 0.05). Compared with endotracheal intubation group, systolic blood pressure and diastolic blood pressure were significantly lower at T1-T3 (P < 0.05), and heart rate was significantly slower at T1 and T2 (P < 0.05) in the laryngeal mask group. Blood oxygen saturation was significantly higher at T1 in the laryngeal mask group than in the endotracheal intubation group (P < 0.05). Compared with T0, blood glucose, plasma epinephrine, norepinephrine and cortisol contents were significantly higher at T1-T3 in the endotracheal intubation group, and above indexes were higher in the endotracheal intubation group than in the laryngeal mask group (P < 0.05). Angiotensin II levels were significantly higher at T1-T3 compared with T0 in the endotracheal intubation group, and it was significantly higher in the endotracheal intubation group than in the laryngeal mask group (P < 0.05). Atrial natriuretic factor levels were increased at T1-T3 in the two groups, and it was significantly higher in the endotracheal intubation group than in the laryngeal mask group (P < 0.05). These results confirm that laryngeal mask slightly impacted stress-related biochemical indicators, which is a physiological basis for slight effect of laryngeal mask on hemodynamics. Compared with endotracheal intubation, laryngeal mask obviously lessened stress reaction of hypertensive patients under general anesthesia treated with hip arthroplasty. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Preventive effect of zoledronic acid on bone loss around the prosthesis stem after hip replacement  Liu Guo-qing, Yuan Zhen-feng, Liu Peng, Pang Tong-tao, Zhang Xian-wei 2015, 19 (35):  5593-5597.  doi: 10.3969/j.issn.2095-4344.2015.35.004 Abstract ( 423 )   PDF (942KB) ( 336 )   Save BACKGROUND: Bone loss to different degrees may appear within 1 year after hip replacement in the femoral or acetabular sides, and severely affect long-term stability of the prosthesis and bone strength. Thus, to reduce bone loss around the prosthesis stem after total hip replacement is significant to prolong the use time of the prosthesis and to prevent fractures surrounding the prosthesis. OBJECTIVE: To observe the preventive effect of zoledronic acid on bone loss surrounding the prosthesis stem after hip replacement.   METHODS: A total of 80 patients after total hip replacement in the People’s Hospital of Shenxian from February 2011 to September 2014 were enrolled in this study. They were divided into two groups (n=40). At 4 days after replacement, patients in the observation group received treatment with zoledronic acid, but those in the control  group did not give zoledronic acid. The rest medication was identical between the two groups. Bone mineral density in the hip was measured before replacement and at 1 year after replacement in both groups. Serum calcium and phosphorus levels and alkaline phosphatase activities were observed before replacement, 3 days and 1 year after medication in the two groups. Adverse reaction during medication was recorded in the observation group. RESULTS AND CONCLUSION: The average bone mineral density was significantly decreased in both groups at 1 year after replacement, and significant differences were found as compared with before replacement (P < 0.05). The average bone mineral density was significantly higher in the observation group than in the control group at 1 year after replacement (P < 0.05). Calcium and phosphorus levels were significantly diminished at 3 days after medication as compared with that before replacement (P < 0.05). Calcium and phosphorus levels maintained at the level before replacement at 1 year after medication. Alkaline phosphatase activities were slightly reduced within a short time after replacement in both groups, but no significant difference was found as compared with before replacement (P > 0.05). Alkaline phosphatase activities were low in the observation group at 1 year after medication, and significant difference was detected as compared with the control group and that before replacement (P < 0.05). No significant difference in alkaline phosphatase activities was detectable in the control group between 1-year post medication and pre-replacement (P > 0.05). Within two or three days after medication, nine patients suffered from varying degrees of muscle aches and fever in the observation group, and above symptoms were lessened after taking acetaminophen. These results verify that after total hip replacement, zoledronic acid injection can effectively prevent bone loss around the prosthesis in early stage after replacement, but fever symptoms may occur within a week after replacement. Thus, it is recommended that zoledronic acid injection can be given at 1 week after replacement. If fever and other symptoms appear, acetaminophen can be given. 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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Feasibility of posterior composite release of the knee joint after total knee arthroplasty  Zhang Feng, Li Zhan-qi, He Xi-jing 2015, 19 (35):  5598-5603.  doi: 10.3969/j.issn.2095-4344.2015.35.005 Abstract ( 333 )   PDF (1078KB) ( 347 )   Save BACKGROUND: Knee osteoarthritis can be treated by total knee arthroplasty. To improve therapeutic effect and promote postoperative recovery, we should take effective measures to improve the joint space and postoperative range of motion. OBJECTIVE: To explore the effectiveness and feasibility of posterior composite release of the knee joint after total knee arthroplasty. METHODS: 118 knee osteoarthritis patients undergoing unilateral total knee arthroplasty in two hospitals from December 2009 to December 2013 were selected, and were randomly divided into control group (59 cases) and observation group (59 cases). After osteotomy during operation, the control group underwent bone removal of conventional condylar hyperplasia. Observation group underwent posterior composite release of the knee joint. Postoperative extension, flexion gap and the time required for postoperative active flexion 90° and 120° were  observed in the two groups. Hospital for Special Surgery Knee Score and maximum flexion angle were recorded in 3 months of follow up, and compared between the two groups.  RESULTS AND CONCLUSION: Through the statistics and comparison, no significant difference in flexion gap was found between the two groups (P > 0.05). However, significant differences in extension gap, the time for active flexion 90° and 120°and the maximum flexion angle were detectable between the two groups, and above indexes were better in the observation group than in the control group (P < 0.05). Hospital for Special Surgery Knee Score of each index and total score were significantly higher in the observation group than in the control group (P < 0.05). These results suggest that rear joint composite release after total knee arthroplasty has certain validity and feasibility, can effectively improve knee extensor gap and the postoperative range of motion during replacement, but does not impact flexion gap during replacement. 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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Effects of intravenous versus topical application of tranexamic acid on blood loss following total knee arthroplasty Chai Xing-yu, Su Chang-zheng, Pang Tao, Lv Dong, Zhu Biao, Hou Zhen-yang, Li Zhen, Xu Zheng-wen, Zhao Ting-bao 2015, 19 (35):  5604-5609.  doi: 10.3969/j.issn.2095-4344.2015.35.006 Abstract ( 257 )   PDF (1112KB) ( 584 )   Save BACKGROUND: Increasing reports have focused on the application of tranexamic acid to reduce bleeding during total knee arthroplasty, but its usage method remains controversial. OBJECTIVE: To explore the impact of topical articular application of tranexamic acid and intravenous application of tranexamic acid on blood loss during primary unilateral total knee arthroplasty. METHODS: According to randomized controlled principle, 90 patients who received unilateral total knee arthroplasty in the Tengzhou Central People’s Hospital from October 2013 to December 2014 were enrolled in this study, and randomly assigned to intravenous injection group and topical injection group (n=45). Patients in the intravenous injection group were given tranexamic acid by intravenous injection (10 mg/kg, maximum 1.2 g) during the induction of anaesthesia. Patients in the topical injection group were given intraarticularly tranexamic acid (2 g dissolved in 50 mL physiological saline) before articular capsule suture and after prosthesis fixation. Drainage amount after replacement, hemoglobin and hematocrit on the next day after replacement, and the number of blood transfusion population were compared between the two groups. Simultaneously, clinical symptoms of pulmonary embolism and deep vein thrombosis in the lower limb were observed. If necessary, lower  extremity vascular Doppler ultrasound was conducted. RESULTS AND CONCLUSION: No significant differences in drainage amount after replacement, hemoglobin and hematocrit on the next day after replacement, the number of blood transfusion population, and the proportion of blood transfusion were detected between the two groups (P > 0.05). No deep vein thrombosis was found in the lower limbs at 14 days after replacement in both groups. These findings confirm that compared with intravenous systemic application, periarticular topical application of tranexamic acid during total knee replacement could obtain identical effects on reducing blood loss and blood transfusion after surgery, and could avoid relevant complications of intravenous application of tranexamic acid. 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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Effects of general anesthesia and epidural anesthesia on coagulation function during total knee replacement in the elderly  Ma Hua-shan, Liu Jin-shan, Tian Ling, Dong Chuan-zhen, Chen Li-yong 2015, 19 (35):  5610-5614.  doi: 10.3969/j.issn.2095-4344.2015.35.007 Abstract ( 318 )   PDF (935KB) ( 251 )   Save BACKGROUND: In perioperative period of total knee replacement in elderly patients, it is crucial to maintain the normal function of blood coagulation. However, many factors may influence coagulation function of patients in perioperative period. Of them, anesthesia is an important factor. Different anesthesia methods will produce different effects on blood coagulation. Appropriate anesthesia methods should be selected in the clinic to maintain the stability of coagulation function. OBJECTIVE: To explore the effect of application of general anesthesia and epidural anesthesia in elderly knee replacement and the effects on the function of blood coagulation. METHODS: A retrospective analysis was performed on clinical data of 135 elderly patients after total knee replacement in Dongying Hospital of Shandong Provincial Hospital Group from September 2012 to September 2013. All patients were divided into control group (67 cases; general anesthesia) and observation group (68 cases; epidural anesthesia) according to the mode of anesthesia. Coagulation indexes and D-dimer levels were  observed before anesthesia, 6 hours after anesthesia, and 1 day after replacement in both groups. The incidence of deep venous thrombosis was measured and compared between the two groups in 12-month follow-up.  RESULTS AND CONCLUSION: Through the statistics and comparison, no significant difference was detected in blood coagulation indexes at different time points in the two groups (all P > 0.05). However, significant differences in D-dimer levels were detectable between the two groups at 6 hours after anesthesia and in the morning at 1 day after replacement. D-dimer levels were significantly lower in the observation group than in the control group (all P < 0.05). The incidences of deep venous thrombosis were 3% and 21% in the observation and control groups, respectively, showing significant differences (P < 0.05). These results suggest that epidural anesthesia during elderly totak knee replacement obtained good effects, and could maintain stable coagulation 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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Safety of epidural combined with small-dose intravenous anesthesia during total knee arthroplasty in elderly patients with hypertension   Zhang Wei-qiang, Xu Guan-jie, Yang Li-xin, Li Tong-hua, Zhang Xiao-lin, Zhang Wen-jing 2015, 19 (35):  5615-5619.  doi: 10.3969/j.issn.2095-4344.2015.35.008 Abstract ( 286 )   PDF (925KB) ( 273 )   Save BACKGROUND: Elderly hypertensive patients often associated with organ and tissue ischemia. All kinds of risks are easy to appear in the process of undergoing arthroplasty. To ensure the smooth operation and to improve the safety of the surgery treatment, it is needed to choose an appropriate mode of anesthesia. OBJECTIVE: To explore the application security of epidural combined with small dose of intravenous anesthesia in total knee arthroplasty in elderly hypertensive patients. METHODS: A total of 64 elderly hypertensive patients with arthroplasty in the Third Hospital of Hebei Medical University from December 2013 to December 2014 were selected and were divided into control group (32 cases) and observation group (32 cases). They were given total intravenous anesthesia and epidural block combined with small dose of intravenous anesthesia. Systolic blood pressure, diastolic blood pressure, heart rate, blood oxygen saturation and changes in respiratory rate were detected before anesthesia, after anesthesia induction, 10 minutes after anesthesia,  10 minutes after use of bone cement, and at the end of arthroplasty in both groups. The usage of vasoactive drugs (including ephedrine and dopamine) during arthroplasty and adverse events after arthroplasty were recorded. RESULTS AND CONCLUSION: Compared with pre-anesthesia, systolic blood pressure and diastolic blood pressure were significantly reduced and blood oxygen saturation was increased at 10 minutes after anesthesia and 10 minutes after the application of bone cement in both groups (P < 0.05). In the end of arthroplasty, systolic blood pressure, diastolic blood pressure and respiratory rate were significantly higher in the control group than in the observation group (P < 0.05). A total of 3 cases in the observation group and 15 cases in the control group used vasoactive drugs (including ephedrine and dopamine), and there was a significant difference in its usage (P < 0.05). Moreover, five patients in the control group experienced respiratory insufficiency, which was apparently improved after given the short-term ventilator support. These results confirm that compared with the total intravenous anesthesia, epidural block combined with small dose of intravenous anesthesia showed a high safety during total knee arthroplasty in elderly hypertensive 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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Effects of different analgesia schemes on joint function and adverse reactions following total knee arthroplasty Zhang Dang-sheng, Zhou Hai 2015, 19 (35):  5620-5624.  doi: 10.3969/j.issn.2095-4344.2015.35.009 Abstract ( 306 )   PDF (955KB) ( 314 )   Save BACKGROUND: Severe knee pain after total knee arthroplasty is an important factor for the poor recovery of knee function after replacement. How to give a satisfactory postoperative analgesia scheme is currently a hot research. OBJECTIVE: To explore the clinical effects of different analgesic program methods on postoperative pain and functional recovery in patients undergoing total knee arthroplasty. METHODS: From March 2010 to February 2014, 60 patients with unilateral knee arthroplasty were randomly divided into three groups: epidural analgesia group, intravenous analgesia group, and continuous femoral nerve block analgesia group. 20 patients in each group received corresponding postoperative analgesia. Visual Analogue Scale score before replacement, 1, 6, 24, 48 and 96 hours after replacement, the recovery of range of motion at 24, 48 and 72 hours after replacement, KSS score of the knee and adverse reactions after replacement were recorded and compared in each group.  RESULTS AND CONCLUSION: Compared with the preoperative data, Visual Analogue Scale score was reduced in continuous femoral nerve block analgesia group at 1, 24, 48 and 96 hours after replacement (P < 0.05). The recovery of range of motion was best in the continuous femoral nerve block analgesia group, followed by epidural analgesia group, and it was poorest in the intravenous analgesia group (P < 0.05). Compared with the preoperative data, postoperative KSS scores increased at 1 and 3 months after replacement in the three groups (P < 0.05). Compared with the continuous femoral nerve block analgesia group, knee joint function score was  decreased in the intravenous analgesia group (P < 0.05). Results verified that continuous femoral nerve block analgesia had good overall effects, helped the recovery of postoperative joint function, and was 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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Arthroplasty versus arthroscopy for recurrent anterior dislocation of the shoulder joint with severe bone defects: 3-year follow-up  Chen Hui, Wang Qun, Yan Shuang-xi, Dong Tian-yun, Zou Hai-bing 2015, 19 (35):  5625-5629.  doi: 10.3969/j.issn.2095-4344.2015.35.010 Abstract ( 362 )   PDF (927KB) ( 302 )   Save BACKGROUND: With the development of surgical techniques and reconstruction material technology, joint replacement has also been widely used in the dislocation of the shoulder; especially all kinds of custom-made or assembled prosthesis make replacement indications improved evidently. OBJECTIVE: To investigate the long-term effects of arthroscopy or arthroplasty for treating recurrent anterior dislocation of the shoulder joint with severe bone defects. METHODS: 144 patients with recurrent anterior dislocation of the shoulder joint with severe bone defects were enrolled in this study. They were divided into treatment group and control group based on a random drawing (n=72). The control group was given arthroscopic surgery, and the treatment group was subjected to arthroplasty. The 3 years of followed-up were done by telephone investigation and further consultation. Neer shoulder score, shoulder activity and complications were recorded.  RESULTS AND CONCLUSION: After 3-year followed-up, the excellent and good rate of shoulder function was significantly higher in the treatment group (90%) than in the control group (81%) (P < 0.05). The magnitude of the flexion in the 3-year followed-up was apparently increased, while the lateral margin external rotation was decreased, which showed significant differences after intragroup comparison (P < 0.05). Simultaneously, the magnitude of the flexion and the lateral margin external rotation in the treatment group had statistically significant differences compared to the control group in the 3-year followed-up (P < 0.05). The complications of wound infection, shoulder dislocation, and implant loosening in the treatment group during follow-up were significantly lower than in the control group (P < 0.05). These findings verified that compared with arthroscopic surgery, arthroplasty for treating recurrent anterior dislocation of the shoulder joint with severe bone defects in long-term follow-up can effectively restore shoulder function and range of motion, and it has few complications, thereby effectively rebuilds shoulder 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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Two kinds of posterior intervertebral fusion for lumbar spondylolisthesis: fusion rate and height of intervertebral loss  He Cheng-wen, Bai Rui-jun 2015, 19 (35):  5630-5635.  doi: 10.3969/j.issn.2095-4344.2015.35.011 Abstract ( 258 )   PDF (1134KB) ( 333 )   Save BACKGROUND: The major aim of repair of lumbar spondylolisthesis is to restore and reconstruct the stability of spine sequence, and to relieve compression of herniated disc on nerve root. Pedicle screw system and bone graft fusion become the preferred way to treat spondylolisthesis of most scholars. Most scholars are prone to posterior interbody fusion or posterolateral interbody fusion. OBJECTIVE: To compare the clinical curative effects of posterior autologous iliac bone graft fusion and posterior Cage intervertebral bone graft fusion in patients with degenerative lumbar spondylolisthesis by observing fusion rate and height of intervertebral loss. METHODS: A total of 61 patients with degenerative lumbar spondylolisthesis in Xuancheng Central Hospital from July 2008 to December 2013 were enrolled in this study. According to the different types of interbody fusion, 37 cases in autologous ilium group received posterior autologous iliac bone graft fusion. 24 cases in the Cage interbody fusion cage group underwent posterior Cage interbody fusion cage fusion. Operation time, blood loss, spondylolisthesis reduction, graft fusion and Japanese Orthopaedic Association score were compared between  the two groups. The significance of different fusion manners on prognosis was explored in patients with degenerative lumbar spondylolisthesis. RESULTS AND CONCLUSION: No significant difference in blood loss was detected between the two groups (P > 0.05). However, the operation time was significantly longer in the autologous ilium group than in the Cage interbody fusion cage group (P < 0.05). The reduction rate, bone graft fusion rate and improvement rate of clinical curative effects were good in both groups, and no significant difference was detectable in above indexes between the two groups (P > 0.05). Significant difference in the height of intervertebral loss was detectable between the two groups in final follow-up (P < 0.05). The height of intervertebral loss was better in the Cage interbody fusion cage group than in the autologous ilium group. These findings indicate that two kinds of bone graft fusion manners for lumbar spondylolisthesis obtained good reduction and clinical curative effects, but the height of intervertebral loss was small in the Cage interbody fusion cage fusion during long-period follow-up, and the clinical 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

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Design and application of screw-assisted reduction of fractured vertebrae  Li Guo-hua, Wu Wei-ping, He Shi-sheng, Li Shan-zhu, Zeng Zhi-li, Yu Yan, Cai Xiao-bing, Yilihamu•Tuoheti 2015, 19 (35):  5636-5640.  doi: 10.3969/j.issn.2095-4344.2015.35.012 Abstract ( 252 )   PDF (1811KB) ( 361 )   Save BACKGROUND: Screw fixation of the fractured vertebral body can share the stress of implant, increase fixing strength, and help to maintain the stability of late fracture. However, whether it can assist reduction using fracture vertebral screw, but no relevant clinical reports were found at present. OBJECTIVE: To explore the effectiveness of self-designed screw-assisted reduction of fractured vertebrae.  METHODS: 161 cases of thoracolumbar fracture who had been hospitalized between June 2001 and June 2009 were enrolled in this study, including 101 males and 60 females, at the age of 22-67 years, averagely 36 years. By Denis classification, 64 cases affected burst fractures and 97 flexion-compression fractures. Fracture levels involved T11 (9 cases), T12 (63 cases), L1 (74 cases) and L2 (15 cases). The self-designed method of reduction assisted with screw insertion was used. The efficacy of this reduction method was evaluated by operation time, intraoperative bleeding, fracture union time, height ratio of anterior borders of injured and normal vertebrae,  sagittal Cobb’s angle, and reduction of fragments.  RESULTS AND CONCLUSION: The operation time ranged from 60 to 150 minutes, averaging 80 minutes. The intraoperative bleeding ranged from 67 to 750 mL, averaging 98 mL. The follow-up time ranged from 16 to 42 months in 161 patients. Fracture union time ranged from 10 to 18 weeks, averaging 12.6 weeks. The ratio of anterior heights and sagittal Cobb’s angle of fractured vertebrae were significantly improved from (54.39±9.60)% and (22.55±7.90)° respectively preoperatiion to (82.80±6.63)% and (8.91°±5.85)° 12 months postoperation (P < 0.05). The size of spinal canal was increased by (46.5±2.6)% postoperatively. CT scan revealed satisfactory fragment reduction and no deep infection appeared. These findings suggest that our self-designed screw-assisted reduction of the fractured vertebrae can improve the reduction quality in the treatment of thoracolumbar fractures.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Pedicle screw for lumbar disc herniation under transforaminal endoscopy   Chen Guang-ru, Wei Jian-min 2015, 19 (35):  5641-5645.  doi: 10.3969/j.issn.2095-4344.2015.35.013 Abstract ( 305 )   PDF (980KB) ( 486 )   Save BACKGROUND: Lumbar disc herniation is a clinical syndrome of lumbar pain and radiated pain of the lower limb induced by biochemical changes after intervertebral disc degeneration. Transforaminal endoscopic spine system (TESSYS) and Yeung endoscopic spine system (YESS) are commonly used in the clinic, but their effects are different. OBJECTIVE: To compare the curative effect of TESSYS and YESS in treatment of lumbar disc herniation. METHODS: Follow-up data of 134 cases of lumbar disc herniation were retrospectively analyzed. They were assigned to TESSYS group (n=76) and YESS group (n=58). Intraoperative condition, pain at various time points after repair, and lumbar function changes were compared between the two groups. RESULTS AND CONCLUSION: (1) No significant difference in Visual Analogue Scale and Oswestry Disability Index scores was detected between the two groups before repair (P > 0.05). At 1, 3, and 6 months after repair and during final follow-up, above scores were significantly decreased in both groups (P < 0.05). Above scores were significantly lower in the TESSYS group than in the YESS group at various time points after repair (P < 0.05).  (2) No significant difference in Japanese Orthopedic Association score was found between the two groups before repair (P > 0.05). Japanese Orthopedic Association score was greater in the TESSYS group than in the YESS group at 1, 3 and 6 months following repair and during final follow-up (P < 0.05). (3) The excellent and good rate was significantly greater in the TESSYS group than in the YESS group during final follow-up (P < 0.05). (4) Operation time and incision length were significantly shorter in the TESSYS group than in the YESS group. No significant difference in the amount of bleeding was detectable between the two groups (P > 0.05). Results suggest that TESSYS for lumbar disc herniation was characterized by small trauma, mild pain and good recovery of 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 | Related Articles | Metrics

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Internal fixation, external fixation and conservative treatment for unstable pelvic fractures: callus growth and fracture healing rate   Liu Guo-xiong, Xiao Liu-bin, Li Peng-fei, Ma Han-fei, Lian Yin-chuan, Wang Qing-hua, Wu Yuan-cheng 2015, 19 (35):  5646-5651.  doi: 10.3969/j.issn.2095-4344.2015.35.014 Abstract ( 509 )   PDF (954KB) ( 353 )   Save BACKGROUND: There are many methods in the clinic to treat pelvic fractures, mainly conservative treatment, internal fixation and external fixation. Conservative treatment often causes complications due to poor reduction after fractures. Fixation has good effects on repair of unstable fractures, but fixation is seldom used for pelvic fractures.  OBJECTIVE: To observe the effects of internal fixation on unstable pelvic fractures, and compare with conservative treatment and external fixation. METHODS: 126 cases of unstable pelvic fractures from Longhua District People’s Hospital of Shenzhen City from January 2008 to June 2014 were divided into three groups: conservative treatment group, external fixation group and internal fixation group (n=42). After treatment, patients received X-ray examination. Lindahl imaging criteria were used as evidence. The quality of fracture reduction was evaluated. Patients were regularly followed up after treatment. The recovery of limb function was evaluated according to Majeed standard. Repair effects, the excellent and good rates of fracture healing and callus growth were evaluated in the last follow-up. RESULTS AND CONCLUSION: During the last follow-up, the total efficiency was 81% in the internal fixation group, 69% in the conservative treatment group, and 71% in the external fixation group, and results were  significantly better in the internal fixation group than in the other two groups (P < 0.05). The Lindahl and Majeed scores were significantly higher in the internal fixation group than in the other two groups (P < 0.05). These results suggest that internal fixation for unstable pelvic fracture obtained better recovery effects and efficiency than conservative treatment and external fixation. Thus, the internal fixation is more suitable for patients with unstable pelvic 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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Intramedullary nail versus dynamic hip screw for intertrochanteric fracture in the elderly: circulatory blood volume Miao Shi-chang, Zhou Rong-kui, Niu Xiao-juan 2015, 19 (35):  5652-5657.  doi: 10.3969/j.issn.2095-4344.2015.35.015 Abstract ( 280 )   PDF (1000KB) ( 274 )   Save BACKGROUND: The key of intertrochanteric fractures in elderly patients is to select the appropriate fixation, but few clinical studies concerned different fixation methods for blood volume of blood circulation system in elderly patients with intertrochanteric fractures. OBJECTIVE: To compare the effects of proximal femoral intramedullary nail and dynamic hip screw on blood  volume of blood circulation system in elderly patients with intertrochanteric fractures.   METHODS: A total of 48 elderly patients with intertrochanteric fractures, who were treated in the Jiangyin Hospital Affiliated to Nanjing University of Traditional Chinese Medicine from January 2012 to September 2014, were enrolled in this study. These patients were assigned to two groups (n=24). Patients in the observation group received treatment with proximal femoral intramedullary nail, and patients in the control group received treatment with dynamic hip screw. Postoperative blood loss, perioperative blood transfusion, preoperative and 3-day postoperative hemoglobin difference, incidence of postoperative complications, dominant blood loss, and hidden blood loss were compared between the two groups. Range of motion of the hip and Harris score of the hip were compared between the two groups at 4 and 12 months post surgery. RESULTS AND CONCLUSION: Intraoperative blood loss was less in the observation group than in the control group  (P < 0.05). No significant differences in perioperative blood transfusion and preoperative and 3-day postoperative hemoglobin were detected between the two groups (P > 0.05). The operation time was significantly longer in the observation group than in the control group (P < 0.05). The incidence of postoperative complications was significantly lower in the observation group than in the control group (P < 0.05). No significant difference in length of hospital stay was detected between the two groups (P > 0.05). Within the same time period, the range of motion of the hip and Harris score of the hip were better in the observation group than in the control group (P < 0.05). The total amount of blood loss and dominant blood loss were less in the observation group than in the control group (P < 0.05). These findings indicate that compared with the dynamic hip screw, proximal femoral nail fixation for intertrochanteric fracture has less intraoperative blood loss, lower incidence of postoperative complications, postoperative range of motion of the hip and better hip score. However, operation time of proximal femoral nail was long. There were no significant differences in hemoglobin difference and perioperative blood transfusion between the two fixation methods. 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 hip varus after internal fixation of intertrochanteric fracture Gou Cheng-guo 2015, 19 (35):  5658-5662.  doi: 10.3969/j.issn.2095-4344.2015.35.016 Abstract ( 242 )   PDF (831KB) ( 289 )   Save BACKGROUND: Hip varus is likely to occur after internal fixation of intertrochanteric fracture. There are less studies on influential factors of hip varus after internal fixation. OBJECTIVE: To explore the influential factors of hip varus after internal fixation of intertrochanteric fracture. METHODS: Eighty patients with femoral fracture undergoing internal fixation treatment were selected. Single factor analysis and Logistic regression analysis were performed. Whether hip varus occurred or not served as dependent variable, and independent variables included age, sex, body mass index, fracture classification, bone mineral density, time from injury to internal fixation, internal fixation method, lesser trochanter restoration, postoperative weight-bearing time. RESULTS AND CONCLUSION: All the patients were followed up for over 6 months postoperatively. Twelve patients had postoperative hip varus with an incidence rate of 15%. Hip varus occurred within 1-4 months after operation, with a mean coxa vara angle of 99.1° (94°-107°). Fracture classification, bone mineral density, postoperative weight-bearing time were influential factors for hip varus in patients with femoral fracture undergoing internal fixation (P < 0.05). But age, sex, body mass index, time from injury to surgery, internal fixation method and lesser trochanter restoration were not influential factors (P > 0.05). Logistic regression analysis showed that fracture classification, bone mineral density, postoperative weight-bearing time were independent risk factors for the occurrence of hip varus after internal fixation of intertrochanteric 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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Interlocking intramedullary nail versus dynamic compression plate fixation for nonunion after femoral shaft fracture  Song Cai, Liang Xi-jun, Liu Xiang-yang, Guo Xue-de 2015, 19 (35):  5663-5668.  doi: 10.3969/j.issn.2095-4344.2015.35.017 Abstract ( 226 )   PDF (979KB) ( 297 )   Save BACKGROUND: Bone nonunion may occur after limb trauma fracture. Internal fixation of implant is a common mode of repair, but fixation of different implants has different effects. OBJECTIVE: To explore the application value of different implant fixation in limb trauma of nonunion after femoral shaft fracture. METHODS: A retrospective analysis was performed on 72 cases of nonunion after femoral shaft fractures in Bozhou People’s Hospital from November 2012 to November 2013. They were divided into the observation group (36 cases) and control group (36 cases) according to the way of treatment, which were given interlocking intramedullary nail and dynamic compression plate fixation. Length of incision, intraoperative blood transfusion volume, postoperative drainage volume, operation time, fracture healing time and functional recovery of knee joint were observed and compared between the two groups. RESULTS AND CONCLUSION: There was no statistical significance in operation time and length of the incision between the two groups (both P > 0.05). Intraoperative amount of blood transfusion and postoperative drainage were significantly higher in the control group than in the observation group; the fracture healing time was significantly longer in the control group than in the observation group; infection rate in final follow-up was  significantly higher in the control group than in the observation group (all P < 0.05). No significant differences in preoperative knee joint International Knee Documentation Committee knee evaluation form and Lysholm score were found between the two groups (all P > 0.05), but above two scores were significantly higher in the observation group than in the control group in final follow-up (all P < 0.05). These findings suggest that compared with the dynamic compression plate, interlocking intramedullary nail in treatment of bone nonunion after femoral shaft fracture can obtain good effect, firm fixation, low infection rate, and is more in line with the physiological and biomechanical requirements. 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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LISS locking plate and common plate in the repair of intra-articular proximal tibial fractures: choice of optimal implant  Du Yu-xi, Liu Nian-xi, Niu Zhi-hui, Liu Zhuo 2015, 19 (35):  5669-5673.  doi: 10.3969/j.issn.2095-4344.2015.35.018 Abstract ( 462 )   PDF (920KB) ( 311 )   Save BACKGROUND: The proximal tibial fractures within joint are a common type of fracture, and clinical treatment is difficult. The implant internal fixation is a commonly used method of treatment. However, the choice of the optimal implant internal fixation is always the key problem in clinical research. OBJECTIVE: To explore the curative effect of different implant internal fixation for the treatment of intra-articular proximal tibial fractures and to obtain the better treatment through the comparative analysis. METHODS: A total of 32 patients of intra-articular proximal tibial fracture, who were treated with different implant internal fixation for the treatment of proximal tibia, were selected from the Department of Orthopedics, People’s Hospital of Zezhou County of Jincheng City and Second Affiliated Hospital of Shanxi Medical University from September 2010 to September 2013. These patients were divided into two groups according to fixation methods (n=16). Observation and control groups received LISS locking plate and common plate, respectively. The amount  of bleeding, operation time and incision length were observed in both groups. Patients were followed up for 1 to 12 months after treatment so as to record fracture healing time, full weight bearing time and excellent and good rate and to observe the incidence of complications, including joint stiffness, loosening, nonunion and infection. RESULTS AND CONCLUSION: Incision length and operation time in the observation group were significantly shorter than that in the control group, and the amount of bleeding was significantly lower in the observation group than that of control group (all P < 0.05). The healing of fracture and the full weight bearing time were significantly shorter in the observation group than that in the control group (both P < 0.05). The incidence of complications was significantly lower in the observation group (13%) than in the control group (46%; P < 0.05). The total excellent and good rate of repair was significantly higher in the observation group than in the control group (94%, 69%, P < 0.05). These results confirm that compared with the traditional plate fixation, internal fixation with LISS locking plate for treating intra-articular proximal tibial fractures can get better therapeutic effects, greatly reduces the injuries to soft tissue and fracture blood supply, promotes fracture healing and restores joint 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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The distal fibula anatomic plate combined with hollow screw fixation for Danis-Weber B double ankle fractures Ma Yun-hong 2015, 19 (35):  5674-5678.  doi: 10.3969/j.issn.2095-4344.2015.35.019 Abstract ( 336 )   PDF (2706KB) ( 397 )   Save BACKGROUND: Ankle joint fracture is a common fracture in the clinic. Proportion of Danis-Weber B fracture was large. Anatomic reduction and suitable internal fixator of lateral malleolus are the key for successful repair.  OBJECTIVE: To analyze the anatomic reduction effect of anatomic plate combined with hollow screw fixation for inner and outer side fracture of the ankle joint.  METHODS: A total of 32 patients with Danis-Weber B ankle fracture, who were treated from March 2010 to October 2013, were retrospectively analyzed. Plate and screw were used for internal fixation of lateral malleolus. Double thread compression screw was used for fixation of medial malleolus. American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale and Kofoed Ankle Rating scale were utilized to assess ankle function. Visual Analogue Scale was applied to evaluate the improvement in the degree of pain after repair. Radiographic analysis was conducted within a fixed position on the line for biomechanical level after internal fixation. RESULTS AND CONCLUSION: All patients were followed up for 6-24 months. All cases had bony union.  AOFAS score, Kofoed score and visual analogue scale were significantly better at 6 months post-treatment than pre-treatment (P < 0.05). Radiographic results revealed good alignment and contraposition following internal fixation. Only one patient suffered from infection, and others did not have any adverse reactions. These results indicate that anatomic plate and hollow screw fixation for the treatment of the medial malleolus and lateral malleolus fractures of ankle joint can exert their characteristics and biomechanical advantage, so fracture reached anatomical reduction of the ankle.  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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Titanium alloy implant fixation for senile distal humeral fractures: feasibility and effectiveness  Li Xu-hui 2015, 19 (35):  5679-5683.  doi: 10.3969/j.issn.2095-4344.2015.35.020 Abstract ( 408 )   PDF (855KB) ( 386 )   Save BACKGROUND: It has a certain difficulty in the clinical treatment of distal humeral fractures in elderly people. According to the particularity of elderly patients, during clinical treatment of senile distal humeral fracture, conservative treatment or the metal implant internal fixation remains controversial. OBJECTIVE: To explore the feasibility and effectiveness of metal implants for the repair of senile distal humeral fractures. METHODS: A total of 35 hospitalized elderly patients with distal humeral fracture in Beijing Renhe Hospital from September 2008 to September 2013 were studied. 19 cases were given titanium implant fixation (experimental group), 16 cases were given conventional conservative treatment (control group). RESULTS AND CONCLUSION: Totally 35 patients were followed up. In the experimental group, elbow joint function was excellent in eight cases and good in four cases, with total excellent and good rate of 63%. The excellent and good rate was significantly higher in the experimental group than in the control group (31%; P < 0.05). In the experimental group, three patients suffered from infection of incisional wound, and two patients experienced sensory anesthesia of ulnar nerve innervation area. They had recovered after symptomatic treatment. No nonunion of fracture or loosening of fixator appeared. These suggest that metal implant for senile distal humeral fracture obtained good outcomes, and showed feasibility and effectiveness.    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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Closed reduction and external fixation for treatment of AO type C distal radius fractures in the elderly: biological advantage   Huang Xiao-nan 2015, 19 (35):  5684-5690.  doi: 10.3969/j.issn.2095-4344.2015.35.021 Abstract ( 347 )   PDF (966KB) ( 414 )   Save BACKGROUND: Unstable distal radius fracture is the most common fracture in the elderly patients, how to treat this kind of intra-articular distal radius fracture remains controversial. OBJECTIVE: To summarize the clinical, radiographic outcomes and complications of closed reduction and external fixation of the AO type C distal radial fracture. METHODS: From May 2009 to May 2012, we performed closed reduction and external fixation in 122 patients (122 wrists) with the AO type C distal radial fractures. According to AO fracture classification: C1 in 16 patients, C2 in 63 patients, and C3 in 43 patients. The study participants underwent clinical and radiographical evaluation at 3, 6, 12 weeks, and 1 year postoperatively and annually thereafter. Wrist joint function of patients was  anteroposterior and lateral X-ray films by palmar angulation, ulnar variance, radial height, and quality of articular reduction according to Knirck’s classification. RESULTS AND CONCLUSION: All 122 patients were followed up for 13 to 28 months. The mean operative time was 19.1±11.2 minutes; the mean fluoroscopy time was 7.8±2.6 seconds; the mean bleeding loss was 45.7±14.8 mL; the mean length of hospital stay was 2.7±1.9 days; the mean union time was 3.1±0.7 months. At the final follow-up, the average modified McBride score was 6.7 points (range, 1 to 23 points), the rate of good to excellent was 62%. The average palmar angulation was 11.7±2.6° (range, 10° to 15°). The average ulnar variance was 21.3±5.7° (range, 18° to 26°). The mean radial height was 12.9±2.8 mm (range, 10 to 16 mm). Quality of articular reduction based on Knirck and Jupiter’s classification shows Stage 1 in 108 patients and Stage 2 in 14 patients. Eight patients (6.6%) suffered from postoperative complications, including pin tract infection in six patients, sensory branch of the radial nerve neuritis in two patients. Results verified that closed reduction and external fixation of the AO type C distal radial fractures can achieve a satisfactory clinical function, has a less trauma, shorter hospital stay, lower rate of complications, faster fracture union, especially is suitable for treatment of the AO type C distal radial fractures in the elderly. Figures and Tables | References | Related Articles | Metrics

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Mini-plate fixation for complicated metacarpal fractures: better than Kirschner wire fixation  Luo Hong-bin 2015, 19 (35):  5691-5696.  doi: 10.3969/j.issn.2095-4344.2015.35.022 Abstract ( 330 )   PDF (1178KB) ( 336 )   Save BACKGROUND: Fracture must be properly reset, cannot present angle, rotation and overlapping shift. Kirschner wire fixation is fit for transverse fracture of first metacarpal bone of proximal phalanx and middle phalanx. Mini-plate fixation is fit for disfigurement or short bevel fracture of metacarpal bone and proximal finger backbone. Which is fit for cmplicated fracture of metacarpal bone? OBJECTIVE: To analyze the clinical effective and safety of complicated metacarpal fractures after fixed with mini-plates and Kirschner wires. METHODS: A total of 68 cases of complicated metacarpal fractures (72 sites) were chosen from Sanshui Hospital of Foshan Municipal Hospital of Traditional Chinese Medicine as the research subjects. They received  open reduction and internal fixation, and were divided into two groups. Mini-plate group contained 36 cases (39 sites). Kirschner wire group contained 32 cases (33 sites). Healing time of metacarpal and phalangeal fractures, functional recovery and wound infection were observed. Clinical effects and complications were compared between the two groups. Bone healing was observed using X-ray. The recovery of hand function was evaluated using total action flexion score of American Society for Surgery of the Hand. RESULTS AND CONCLUSION: Patients in the mini-plate group were followed up for 3-12 months, and patients in the Kirschner wire group were followed up for 3-10 months. In the mini-plate group, the excellent and good rate of total action flexion score was 92%. X-ray films revealed that healing time was 4-6 weeks, averagely 4.7 weeks. Complications: no bone nonunion occurred. Moreover, patients with closed fracture did not suffer from postoperative infection. Patients with open fracture suffered from infection to different degrees at three fracture sites. In the Kirschner wire group, the excellent and good rate of total action flexion score was 76%. X-ray films demonstrated that healing time was 6-9 weeks, averagely 7.7 weeks. Complications: bone nonunion was observed at three fracture sites. After bone grafting, postoperative infection was found in 4 sites of 28 sites of open fracture. Statistical analysis showed that significant differences in total action flexion score were detectable between the two groups at 3 months of follow-up (P < 0.05). These results suggest that the clinical effect of mini-plate fixation for complicated metacarpal fracture was apparently better than that of Kirschner wire, so mini-plate fixation can be used as an effective repair method for complicated metacarpal 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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Odontoid cannulated screw fixation using digital navigation based on three-dimensional printing technique Chen Xuan-huang, Zhang Guo-dong, Wu Chang-fu, Lin Hai-bin, Chen Xu, Yu Zheng-xi, Sun Yu-qing 2015, 19 (35):  5697-5704.  doi: 10.3969/j.issn.2095-4344.2015.35.023 Abstract ( 405 )   PDF (3817KB) ( 572 )   Save BACKGROUND: Odontoid fracture is very common in cervical spine injuries, the special position of odontoid process, which is adjacent to important anatomic structure, makes screw placement difficult, and a slight discrepancy in position and orientation of the inserted screw leads to a decrease in intensity of internal fixation, even invalid internal fixation. Therefore, it is very necessary to develop an individualized treatment protocol by which screws can be precisely and safely placed and which is worthy of clinical popularization. OBJECTIVE: To study the navigation of Mimics software and three dimensional (3D)-printed module in anterior odontoid cannulated screw fixation and to investigate its feasibility and accuracy. METHODS: Sixteen human cadaveric cervical spines were scanned by a continuous thin-slice CT scanner. Original DICOM CT images were three-dimensionally reconstructed using Mimics software. The screw channel and support column were designed for C2 vertebra odontoid cannulated screw fixation for odontoid fracture. Segmentation of bone surface was performed. Navigation modules with screw channel were built using 3D printing technique. Navigation modules were used to aid screw placement. Screw fitting and placement were evaluated using X-ray and CT scan. RESULTS AND CONCLUSION: Totally 16 navigation modules were built and 22 screws were implanted. During and after screw placement, the cortical bone along screw channel and surrounding the vertebral body was not cracked. Postoperative X-ray and CT scans showed that some factors regarding screw placement such as entry point, orientation and depth of placement were consistent with those ideal factors simulated by Mimics software. The navigation modules were closely attached to the corresponding bony structure in front of the vertebral body, with a satisfactory gomphosis. Screw fitting and stability were good during application. These results verify that with the aid of navigation module, anterior odontoid cannulated screw fixation is reliable for treatment of odontoid fracture, which provides insights into the popularization of 3D printing-based digital navigation technique in orthopedic implantation. 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 biomechanical properties of femoral core decompression materials Biao Wu 2015, 19 (35):  5705-5711.  doi: 10.3969/j.issn.2095-4344.2015.35.024 Abstract ( 323 )   PDF (851KB) ( 333 )   Save BACKGROUND: With the help of computer aided analysis technique, the prediction and analysis of the surgical treatment and rehabilitation of patients with femoral necrosis, which can realize the scientific operation and recovery of the patients after surgery, is a hot research topic in the field of international related research. OBJECTIVE: By studying the force deformation and stress distribution, fracture risk, and Interface’s biomechanical properties of the femoral head in different core decompression materials, we can provide the basis for choosing the appropriate core decompression material. METHODS: Based on nuclear magnetic resonance imaging images of six patients with different ages, the three-dimensional model and finite element analysis model were established, and the physiological load and four different types of materials (Actifuse, BioOss, Osteoset, Prodense) were set up. Finite element analysis software AnsysWorkbench was used to analyze the performance of the femur. RESULTS AND CONCLUSION: The maximum stress distribution law of the femur in the work process was obtained. With the increase of the Young’s modulus of the material, the maximum normal stress of the femoral necrosis region was decreased, but the biomechanical properties of the joint surface, such as sliding distance, friction stress and pressure, are increased. On the basis of comprehensive consideration of the biomechanical properties of the fracture risk and the junction, a suitable core decompression material (Osteoset) is recommended. 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 test of improved retrograde screwed nail  Zhao Qin-peng, Zhang Zheng-ping, Hao Ding-jun 2015, 19 (35):  5712-5717.  doi: 10.3969/j.issn.2095-4344.2015.35.025 Abstract ( 271 )   PDF (1001KB) ( 304 )   Save BACKGROUND: At present, humeral fractures can be mainly treated by antegrade screwed intramedullary nail and traditional interlocking intramedullary nail, but above methods easily induce rotator cuff injury. Results of relevant study revealed that retrograde intramedullary nailing can solve the above problems. OBJECTIVE: To analyze biomechanical test results of retrograde improved screwed nail and to provide a basis for the further clinical use. METHODS: (1) According to the anatomical characteristics of the human humerus, specimens of humerus were subjected to biomechanical test. (2) A total of 80 cases of humeral fractures were selected from the Orthopeadic Surgery of Xi’an Red Cross Hospital Affiliated to Xi’an Jiaotong University School of Medicine from December 2013 to January 2015. Patients were randomly divided into improved nail group and prototype nail group (n=40), which were given improved nail and prototype nail, respectively.  RESULTS AND CONCLUSION: (1) Anti-axial compression, anti-tension, anti-torsion, and anti-bending functions were significantly better in the improved screwed nail than in the prototype nail (P < 0.05). (2) The excellent and good rate of clinical curative effects was significantly higher in the improved nail group than in the prototype nail group. No infection, metal fracture or internal fixation loosening occurred in all patients of the two groups. These findings suggest that compared with traditional screwed nail, retrograde improved screwed nail had more advantages, more reasonable biomechanical design, more simple operation, and lower incidence of complications, so it is fit for clinical application. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Biomechanical evaluation on the stability of anterior cervical pedicle screw fixation for osteoporosis Li Zhen-wei, Xiang Yang-ming 2015, 19 (35):  5718-5722.  doi: 10.3969/j.issn.2095-4344.2015.35.026 Abstract ( 334 )   PDF (901KB) ( 302 )   Save BACKGROUND: Anterior cervical discectomy and bone graft fusion are effective method to treat cervical spondylosis. This method can provide firm fixation and the fusion rate is high. However, for cervical vertebra involved in more than two segments, the stability of fixator and bone graft is poor due to big bone graft span, which may easily cause fusion failure and pseudarthrosis, and impact curative effects. OBJECTIVE: To investigate biomechanical stability of anterior cervical pedicle screw implantation for osteoporosis in the vertebra. METHODS: A total of 12 human cervical vertebrae were collected, including 6 vertebrae with normal bone density and 6 vertebrae with osteoporosis. Data of 60 vertebra specimens were analyzed. 30 osteoporotic specimens  implanted in anterior cervical pedicle screw were set as anterior cervical pedicle screw group. 30 normal specimens implanted in anterior cervical pedicle screw were set as anterior vertebral screw group. According to bone density, 40 vertebrae were collected in above two groups, and were considered as normal bone mineral density group, instant osteoporosis group, fatigue normal bone mineral density group, and fatigue osteoporosis group (n=10). Bone mineral density of each vertebra was detected using dual-energy X-ray absorptiometry. Biomechanical index of two kinds of screws was detected using ElectroForce 3510 material testing machine. RESULTS AND CONCLUSION: Bone mineral content, vertebral screw pull-out strength, vertebral screw pull-out stiffness, pedicle screw pull-out strength, and pedicle screw pull-out stiffness were significantly higher in the anterior cervical pedicle screw group than in the anterior vertebral screw group (P < 0.05). The maximum axial pull-out strength of normal bone mineral density group, instant osteoporosis group, fatigue normal bone mineral density group, and fatigue osteoporosis group was significantly higher than in the anterior vertebral screw group (P < 0.05). The results confirmed that osteoporotic vertebral biomechanical performance is more stable in anterior pedicle screws compared with the anterior vertebral screw. 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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Characteristics of lower lumbar pedicle screw angle in Chinese population using digital technology Wang Hai-zhou, Li Hong-wei, Wang Shuang, Ji Nan, Wang Shuai 2015, 19 (35):  5723-5727.  doi: 10.3969/j.issn.2095-4344.2015.35.027 Abstract ( 337 )   PDF (790KB) ( 282 )   Save BACKGROUND: Pedicle screw fixation is the mainstream type of spine operation currently. The key point of the fixation is to make the screw pass through the center of pedicle. The angle of pedicle screw implantation is a key factor for repair quality. In previous literatures, angle of pedicle screw is determined according to the patient body, and is easily disturbed by factors such as position of the body.  OBJECTIVE: To determine the inserting angle of pedicle screw of lower lumbar spine taking local anatomic landmark as a reference using digital technology. METHODS: 3D-CT data of 100 patients were selected. The fourth and fifth lumbar vertebrae received three-dimensional reconstruction, and the operation was simulated using digital technology to achieve optimal placement. After simulation, the angle of pedicle screw was measured. The angle of the planes of the midline of the screw and the midline of the spine served as coronal angle. The angle of the planes of the midline of the screw and the upper surface of the vertebral body served as sagittal angle.  RESULTS AND CONCLUSION: Measure results suggest that each angle was bigger than the angle in previous studies, which might be induced by different reference markers. Standard deviation of each angle was also big. These findings verify that the anatomical differences of pedicles were apparent. Thus, we should insert the  pedicle screws individually. Method of locating reference using anatomic landmarks of a single vertebral body can maximize to avoid interference posture. The combination with preoperative three-dimensional reconstruction is more in line with the requirements of pedicle screw, and can effectively improve the accuracy of pedicle screws. 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 countious femoral nerve block versus continuous epidural analgesia after total knee arthroplasty Yuan Zhi-min, Wei Jian-tong, Wen Jing-rong, Yang Sen, Quan Dong-he 2015, 19 (35):  5728-5734.  doi: 10.3969/j.issn.2095-4344.2015.35.028 Abstract ( 403 )   PDF (1136KB) ( 336 )   Save BACKGROUND: Pain is the significant cause for patients with early rehabilitation after total knee arthroplasty. Continuous epidural analgesia and continuous femoral nerve block are effective analgesic methods after total knee arthroplasty, however, which method has better effects and less complications remains controversial. OBJECTIVE: To compare the efficacy and safety of countious femoral nerve block and continuous epidural analgesia after total knee arthroplasty. METHODS: We searched Cochrane Library, PubMed, EMBASE, Web of Science, CBM, CNKI, VIP, and WangFang. Meanwhile, we also searched conference papers and academic dissertation. The retrieval time was from database establishment to October 1, 2014. Studies of randomized controlled trials on countious femoral nerve block and continuous epidural analgesia after total knee arthroplasty were included. We evaluated the quality of these included studies and analyzed data by Cochrane Collaboration’s RevMan 5.0 software. RESULTS AND CONCLUSION: A total of 12 randomized controlled trials (4 English articles and 8 Chinese articles) involving 680 patients were included. There were 343 patients with countious femoral nerve block and 337 patients with continuous epidural analgesia. Meta-analysis results revealed that no significant differences in visual analog scale scores were detected between the countious femoral nerve block and continuous epidural analgesia groups at 6, 12, 24 and 48 hours after total knee arthroplasty. However, compared with the continuous epidural analgesia group, countious femoral nerve block could decrease the incidences of nausea/vomiting (RR=0.36, 95% CI: 0.21-0.63, P=0.003), urine retention (RR=0.08, 95% CI: 0.04-0.16, P < 0.001) and dizziness (RR=0.24, 95% CI: 0.06-0.99, P=0.05). These results indicate that compared with epidural analgesia, countious femoral nerve block after total knee arthroplasty provided a strong analgesia effect, contributed to early functional training, had less adverse reactions, and was a safe and effective analgesic method. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Effects of general and epidural anesthesia on the formation of deep vein thrombosis after total knee arthroplasty: a meta-analysis Aikeremujiang•Muheremu, Huang Zhu-yi, Feng Lei, Ma Xian-zhi, Liu Qing 2015, 19 (35):  5735-5740.  doi: 10.3969/j.issn.2095-4344.2015.35.029 Abstract ( 478 )   PDF (774KB) ( 597 )   Save BACKGROUND: Although the therapeutic effect of total knee arthroplasty for severe gonarthritis is reliable, deep vein thrombosis also occurred in many patients. Therefore, deep vein thrombosis has been a major reason for unexpected death after total knee arthroplasty. OBJECTIVE: To study the incidence of deep vein thrombosis after total knee arthroplasty with general and epidural anesthesia. METHODS: We searched “PubMed”, “Medline”, “Elsevier”, “Embase”, Cochrane library, “Wanfang”, “China National Knowledge Infrastructure” for papers published from January 2000 to March 2015. The mesh words were “total knee arthroplasty”, “TKA”, “thrombosis”, “DVT”, “randomized controlled trial”, “RCT” for studies concerning deep vein thrombosis after total knee arthroplasty with different anesthetic methods. The double blind method was used for data extraction and assessment of literature quality. Revman5.3 software was utilized to analyze the extracted data using meta-analysis. RESULTS AND CONCLUSION: There were 8 studies including 885 patients. The heterogeneity of the included studies was very low (I2=0, P=0.72). The combined OR was 0.25 (95% confidence interval: 0.18, 1.35), indicating that continuous epidural anesthesia in total knee arthroplasty could apparently reduce the possible formation of postoperative deep vein thrombosis. Because of lack of the changes in coagulation factors under general anesthesia and epidural anesthesia, the mechanism underlying epidural anesthesia to reduce the incidence of deep vein thrombosis deserves further investigations. Among patients with deep vein thrombosis, continuous epidural anesthesia could diminish the possible formation of deep vein thrombosis. Thus, epidural anesthesia should be used firstly for knee replacement in patients with high 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