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22 October 2015, Volume 19 Issue 44 Previous Issue    Next Issue

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Angle of acetabular cup in total hip replacement affects the safety of joint flexion and extension Shao Jian-shu, Li Xiao-long, Liu Wei-feng, Zhu Zhou, Jiang Xiao-jun, Ji Xu-biao 2015, 19 (44):  7053-7058.  doi: 10.3969/j.issn.2095-4344.2015.44.001 Abstract ( 624 )   PDF (1342KB) ( 356 )   Save BACKGROUND: Major complication after total hip replacement was instability in the form of dislocation. The probability of above complications has a great relationship with the mistakes of the angle of acetabular cup prosthesis. OBJECTIVE: To explore the influence of angle of acetabular cup in total hip replacement on the safety of joint flexion and extension. METHODS: A total of 60 patients, who underwent total hip replacement in the Wujin Hospital Affiliated to Jiangsu University from January 2012 to December 2014, were enrolled in this study. Three dimensional directional monitoring device, CT scanning and image processing tools were used to preset the angle of the acetabular cup and to set abduction angle and anteversion angle. Test data were recorded and subjected to statistical analysis. RESULTS AND CONCLUSION: Acetabular cup was implanted under five different conditions: abduction angle 45°, anteversion angle 15°; abduction angle 60°, anteversion angle 15°; abduction angle 30°, anteversion angle 15°; abduction angle 45°, anteversion angle 5°; abduction angle 45°, anteversion angle 25°. According to statistics, in the patients with anteversion angle of 15°, when the acetabular cup was placed, the bigger the abduction angle, the bigger the range of abduction angle of the acetabular cup induced by pelvic tilt was. If the anteversion angle increased, the anteversion angle of the acetabular cup was reduced. With the increased pelvic tilt angle, the anteversion angle of the acetabular cup was big. Moreover, in patients with anteversion angle of 15°, the anteversion angle of the acetabular cup should keep consistent. When the abduction angle of the acetabular cup increased, the range of anteversion angle of the acetabular cup induced by pelvic tilt was diminished. These data showed that the abduction angle and anteversion angle of the acetabular cup have mutual restriction. When the acetabular cup was placed, big anteversion angle (15±10)° can wrap the femoral head, reduce the incidence of dislocation, and make flexion and extension safe.  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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Eccentricity changes affect joint pain and function after total hip arthroplasty Guo Peng-fei, Zhou Jing-jie, Fan Jing, Li Shu-gang 2015, 19 (44):  7059-7064.  doi: 10.3969/j.issn.2095-4344.2015.44.002 Abstract ( 444 )   PDF (927KB) ( 334 )   Save BACKGROUND: Recovery and reconstruction of femoral eccentricity and hip rotation center after total hip arthroplasty directly affect joint function. However, there is lack of studies on the effects of femoral eccentricity on pain and joint function in patients undergoing total hip arthroplasty. OBJECTIVE: To explore the effects of femoral eccentricity changes on joint pain and functional recovery after total hip arthroplasty.  METHODS: Data of 162 cases after total hip arthroplasty were analyzed. Patients were divided into three groups according to the difference of femoral eccentricity on the affected and healthy sides. In the reduction group (30 cases), the difference value was < -5 mm. In the normal group (87 cases), the difference value was -5-5 mm. In the increased group (45 cases), the difference value was > 5 mm. Femoral stem and femoral prosthesis type were compared among different groups. SF-12 scale score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Harris score were evaluated and compared before and after replacement.  RESULTS AND CONCLUSION: Standard eccentricity of femoral prosthesis mainly accounted for 77%, 63% and 73% in the reduction group, normal group and increased group, respectively (P > 0.05). No significant difference in average eccentricity was detected in each group between the affected and healthy sides (P > 0.05). WOMAC score was significantly higher after replacement than that before replacement in three groups (P < 0.05). No significant difference in WOMAC score was found among three groups before replacement (P > 0.05). No significant differences in pain and stiffness were detected among three groups after replacement (P > 0.05), and significant differences in physical function were found (P < 0.05). The physical function was highest in the normal group. No significant difference in SF-12 scale score was seen in the three groups before and after replacement (P > 0.05). The physical ability score was elevated after replacement in the three groups (P < 0.05). Mental scores were significantly elevated in reduction and normal groups (P < 0.05). The excellent and good rate of Harris score was significantly higher in the increased group (96%) than in the reduction group (70%) and normal group (87%) (P < 0.05). These findings indicate that the increased eccentricity contributed to the pain easement after total hip arthroplasty and promoted functional recovery. The decreased eccentricity could worsen patient’s pain, and was not conducive to the restoration of joint function after 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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Multi-mode analgesia of celecoxib after hip and knee replacement Xu Feng, Yang Yu-zhen, Hao Jie 2015, 19 (44):  7065-7070.  doi: 10.3969/j.issn.2095-4344.2015.44.003 Abstract ( 421 )   PDF (950KB) ( 259 )   Save   BACKGROUND: Hip and knee replacement is a common surgery in the clinic; the procedure is relatively complex; and the risk of surgery is relatively high, so that postoperative analgesia is not satisfactory. Perioperative pain management has been a clinical concern. To find safe and effective analgesia has become one of the important tasks of joint surgeons. OBJECTIVE: To investigate the effect of celecoxib on multi-mode analgesia after hip and knee replacement. METHODS: A total of 80 cases undergoing hip and knee replacement in the Chongqing Dongnan Hospital from September 2012 to September 2013 were enrolled in this study. These patients were randomly divided into two groups. In the control group, celecoxib was not used for analgesia after replacement. In the experimental group, celecoxib was used after replacement. The pain was observed at 1-5 days after surgery in the two groups. When the analgesic pump was removed, the drug dosage and opioid analgesics use were recorded. Side effects of drug use were also recorded.  RESULTS AND CONCLUSION: In terms of analgesic efficacy, the analgesic effect was better in the experimental group than in the control group (95%, 85%, P < 0.05). 95% patients in the experimental group were satisfied with the analgesia, which was significantly higher than in the control group (65%; P < 0.05). No significant difference in pain visual analogue scale score was detected between the two groups immediately, 4 and 5 days after surgery (P > 0.05). Pain visual analogue scale score was significantly lower in the experimental group than in the control group at 1, 2 and 3 days post surgery (P < 0.05). The drug dosage was significantly more in the experimental group than in the control group after surgery (P < 0.05). The frequency of opioid use in the experimental group was significantly lower than in the control group (P < 0.05). The complication rate was significantly lower in the experimental group (8%) than in the control group (18%) (P < 0.05). These findings demonstrate that the analgesic effect of celecoxib was ideal after hip and knee replacement using multi-mode analgesia, which can reduce the dose of analgesic drugs and have small adverse reaction. 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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Intravenous drip and topical application using tranexamic acid decrease hidden blood loss after total hip arthroplasty Zhang Cheng-huan, Liu Yun, Zhao Jian-ning, Meng Jia, Yuan Tao, Bao Ni-rong 2015, 19 (44):  7071-7076.  doi: 10.3969/j.issn.2095-4344.2015.44.004 Abstract ( 432 )   PDF (1081KB) ( 307 )   Save BACKGROUND: Tranexamic acid has been more and more used in reducing bleeding after joint replacement, but its usage method and dosage remain controversial, and become a hot focus in recent years.  OBJECTIVE: To investigate the efficacy and safety of intravenous drip combined with intra-articular injection of tranexamic acid on postoperative hidden blood loss in patients who received primary total hip arthroplasty.  METHODS: Clinical data of 65 patients undergoing primary total hip arthroplasty were randomized to the test group and the control group. The patients in the test group received 0.5 g tranexamic acid through intravenous drip when the surgery starts and 0.5 g tranexamic acid inside hip joint through a drainage tube after capsule closure, and retaining for 6 hours. The patients in the control group intravenously received the same volume of physiological saline, and 50 mL physiological saline through a drainage tube after suture, and retaining for 6 hours. We compared with intraoperative blood loss, postoperative dominant blood loss and hidden blood loss,  pain score, blood transfusion rate, deep vein thrombosis and day of hospitalization in both groups. RESULTS AND CONCLUSION: Hemoglobin and hematocrit were higher in the test group than in the control group after replacement (P < 0.05). The volumes of dominant blood loss and hidden blood loss were lower in the test group than in the control group after replacement (P < 0.05). Blood transfusion rate and day of hospitalization were less in the test group than in the control group (P < 0.05). No significant difference in intraoperative blood loss, pain score and incidence of deep vein thrombosis was detectable between the two groups (P > 0.05). These results indicate that the intravenous drip combined intra-articular injection of tranexamic acid in patients receiving total hip arthroplasty could reduce the amounts of postoperative dominant and hidden blood loss and blood transfusion rate, and did not increase the incidence 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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Dexmedetomidin relieves inflammatory response in the aged patients after hip replacement Song Hai-ming, Ma Jing-hua, Chen Hui 2015, 19 (44):  7077-7081.  doi: 10.3969/j.issn.2095-4344.2015.44.005 Abstract ( 448 )   PDF (854KB) ( 261 )   Save BACKGROUND: Hip replacement surgery is a common surgery in elderly patients. Regulatory effect of dexmedetomidin on inflammatory response in the aged patients after hip replacement attracted more and more attention. OBJECTIVE: To observe the effects of dexmedetomidin on inflammatory response in aged patients undergoing hip replacement, and to provide theoretical reference for inflammatory sedation. METHODS: 100 elderly patients aged from 60 to 75 years with hip replacement surgery were randomly divided into control group and observation group (n=50). The control group intravenously received midazolam injection. The observation group received dexmedetomidin injection. Changes in inflammatory markers, such as C-reactive protein, tumor necrosis factor-α and leukocyte count and Ramsay sedation score changes were compared and observed between the two groups before replacement (T0), 24 hours (T1) and 48 hours (T2) after replacement.  RESULTS AND CONCLUSION: Leukocyte level presented an increased trend in both groups at T1. C-reactive protein and tumor necrosis factor-α levels decreased, and no significant difference was detected between the two groups (P > 0.05). At T2, leukocyte levels were significantly increased in the observation group (P < 0.05), and leukocyte levels were gradually returned to T0 level in the control group. C-reactive protein and tumor necrosis factor-α levels were lower at T2 than at T1 in both groups (P < 0.05). However, the decreased degree was bigger in the observation group than in the control group. Ramsay sedation score was significantly higher in the observation group than in the control group at T1 and T2 (P < 0.01). These findings indicate that dexmedetomidine for sedation after hip replacement can lessen inflammatory response and contribute to the recovery of 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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Hemodynamic changes in lower extremity deep vein thrombosis after total hip replacement Li Lei 2015, 19 (44):  7082-7086.  doi: 10.3969/j.issn.2095-4344.2015.44.006 Abstract ( 416 )   PDF (876KB) ( 325 )   Save BACKGROUND: It is very important to early diagnosis of lower extremity deep vein thrombosis after total hip replacement, which also has very important meaning for the timely treatment and judging the curative effect. OBJECTIVE: To study the blood changes of the patients complicated with lower extremity deep vein thrombosis after hip joint replacement, so as to provide the reference for the early prediction and intervention. METHODS: Among 60 cases of hip joint replacement patients who received the treatment from January 2009 to  September 2014, there were 32 cases of postoperative patients complicated with lower extremity deep vein thrombosis (lower extremity deep vein thrombosis group), 28 cases without concurrent lower extremity deep vein thrombosis (non-lower extremity deep vein thrombosis group). The change of the blood rheology index of patients was detected at the 1st, 3rd, 5th days after hip joint replacement. RESULTS AND CONCLUSION: The detection results showed that the various coagulation markers in the lower extremity deep vein thrombosis group after the replacement were abnormally higher than those in the non-lower extremity deep vein thrombosis group, which showed that the hypercoagulability attitudes of patients after hip joint replacement closely related to the occurrence of lower extremity deep vein thrombosis, however, the D- dimer and fibrinogen levels of patients at the 3rd and 5th days after hip joint replacement in lower extremity deep vein thrombosis group were significantly higher than non-lower extremity deep vein thrombosis group, which showed that the increase of D- dimer and fibrinogen levels was positively correlated with the occurrence of lower extremity deep vein thrombosis after hip joint replacement. These results suggest that patients should undergo dynamic blood monitoring after hip joint replacement. If the test results were continuously increased, we should doubt whether the occurrence of thrombosis, and then take preventive measures as early as possible. 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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Relationship between artificial hip replacement dislocation and anterolateral approach in repairing hip joint capsule Lao Shi-gao, Luo Ren, Meng Zhi-jian, Li Xu, Qiu Hong-sheng, Wei Zhen-fei 2015, 19 (44):  7087-7091.  doi: 10.3969/j.issn.2095-4344.2015.44.007 Abstract ( 298 )   PDF (929KB) ( 216 )   Save BACKGROUND: Studies have shown that anterolateral approach for repairing the hip joint capsule has great effects on dislocation after hip replacement, but it remains unclear at present. OBJECTIVE: To study the impact of anterolateral approach for repairing the hip joint capsule on dislocation after artificial hip joint replacement. METHODS: 480 patients, who received artificial hip joint replacement in the First People’s Hospital of Qinzhou from January 2010 to January 2014, were enrolled in this study. They were divided into the control group (January 2010 to January 2012) and the observation group (February 2012 to January 2014) according to the order of their admission, each of 240 cases. The control group was subdivided into the total hip replacement group (A1 group) and the femoral head replacement group (A2 group), each of 120 cases; and the observation group was also subdivided into the total hip replacement group (B1 group) and the femoral head replacement group (B2 group), each of 120 cases. A1 group and A2 group were subjected to artificial hip joint replacement via anterolateral approach. B1 group and B2 group were subjected to artificial hip joint replacement via anterolateral approach and the repair of the joint capsule. The postoperative early dislocation rate was analyzed in patients of A1 group and B1 group. Postoperative early dislocation rate was analyzed in patients of A2 group and B2 group. RESULTS AND CONCLUSION: The rate of early postoperative dislocation was 6.7% in A1 group, and 0.8% in the B1 group. The rate of early postoperative dislocation was significantly higher in the A1 group than in the B1 group (P < 0.05). The rate of early postoperative dislocation was 3.3% in the A2 group and 0.8% in the B2 group. No significant difference was found between the A2 and B2 groups (P > 0.05). Results showed that anterolateral approach in repairing the hip joint capsule can effectively reduce the incidence of postoperative dislocation after the total hip replacement, but does not obviously impact postoperative dislocation. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Total hip arthroplasty for hip osteoarthritis and femoral neck fracture: comparison of hidden blood loss 2015, 19 (44):  7092-7096.  doi: 10.3969/j.issn.2095-4344.2015.44.008 Abstract ( 257 )   PDF (825KB) ( 296 )   Save BACKGROUND: There were still lacking related clinical researches in the aspects of whether the total blood loss and hidden blood loss were connected with pathogenesis, whether the total blood loss and hidden blood loss were different among the patients who conducted total hip arthroplasty under different pathogenesis, and whether the preoperative intervention should be conducted for a particular cause? OBJECTIVE: To compare and analyze the hidden blood loss of patients with hip osteoarthritis and femoral neck fracture after total hip replacement. METHODS: The clinical data of 150 patients who received the unilateral total hip arthroplasty treatment from June 2013 to January 2015 were collected and analyzed, including 54 patients with hip osteoarthritis (30 male cases and 24 female cases ), 96 patients with femoral neck fracture (41 male cases and 55 female cases). The pre-and post-operative blood routine and intro-and post-operative blood loss and transfusion were recorded, and hidden blood loss during pen-operation period was evaluated. RESULTS AND CONCLUSION: Total blood loss was (1 616±216) mL, hidden blood loss was (699±102) mL, and hidden blood loss accounted for 43.3% of the total blood loss. The total blood loss was (1 742±254) mL in the hip osteoarthritis group, hidden blood loss was (758±127) mL, hidden blood loss accounted for 44.6% of the total blood loss; The average total blood loss was (1 470±189) mL in the femoral neck fracture group, hidden blood loss was (625±98) mL, hidden blood loss accounts for 42.1% of the total blood loss. The total blood loss and hidden blood loss in hip osteoarthritis group were significantly higher than those in the femoral neck fracture group (P < 0.05). However, there was no significant difference on the hidden blood loss accounts for the proportion of the total blood loss between two groups (P=0.419 3). These results suggest that the total blood loss and hidden blood loss are different for the patients who underwent total hip arthroplasty in the premise of both pathogenesis. Therefore, before the total hip arthroplasty, we should fully take into account the primary cause of patients and estimate the total blood loss and hidden blood loss, so as to take appropriate preventive measures in time to ensure the safety of the replacement process. 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 biomarkers predict periprosthetic joint infection and aseptic loosening after joint arthroplasty Zhang Yu-ge, Wang Guo-dong, Zhang Yuan-min, Zhao Xiao-wei, Niu Shuai-shuai 2015, 19 (44):  7097-7102.  doi: 10.3969/j.issn.2095-4344.2015.44.009 Abstract ( 477 )   PDF (991KB) ( 222 )   Save BACKGROUND: Periprosthetic joint infection is a complication that is difficult to deal with after joint arthroplasty. Early diagnosis is the key to treatment. To find a fast response, high-sensitivity and high-specificity molecular biomarker can significantly optimize the diagnosis process of periprosthetic joint infection.  OBJECTIVE: To monitor blood procalcitonin, interleukin-6 and lipopolysaccharide binding protein levels, to compare with blood leukocyte count and C-reactive protein levels, to identify above indexes, and to distinguish sensitivity and specificity of periprosthetic joint infection. METHODS: A total of 81 patients with pain after arthroplasty who were treated in Affiliated Hospital of Jining Medical College from January 2008 to December 2013 were enrolled in this study. The repair surgery of all patients was divided into two stages. In the first stage, complete debridement and the installation of temporary occupancy device were conducted. After 3 months averagely, two-phase reconstruction was performed. At 1 day before surgery, venous blood was collected. Calcitonin, interleukin 6, lipopolysaccharide binding protein, leukocyte count and C- reactive protein levels were detected. During the operation, synovial membrane and sample of false envelope around the prosthesis were collected. Bacterial and histological examinations were performed. The sensitivity and specificity were calculated using receiver operating characteristic curve. RESULTS AND CONCLUSION: One-way analysis of variance results showed that the receiver operating characteristic curve of lipopolysaccharide binding protein was bigger, 0.962; 95 confidence interval 0.924-1.000. Diagnostic value was optimal, and the critical value was 23.5 μg/L. These data suggested that when lipopolysaccharide binding protein exceeded 23.5 μg/L before surgery, periprosthetic joint infection would be identified. The receiver operating characteristic curve of C-reactive protein was 0.871. The receiver operating characteristic curve of leukocytes was close to 0.5. The diagnostic value of leukocyte count on periprosthetic joint infection was not great. These findings indicate that lipopolysaccharide binding protein has good application prospect in the diagnosis of periprosthetic joint infection after joint replacement, and shows high positive predictive rate and negative predictive rate of periprosthetic joint infection.   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 paracetamol and tramadol for perioperative analgesia of total knee arthroplasty Liu Yan 2015, 19 (44):  7103-7107.  doi: 10.3969/j.issn.2095-4344.2015.44.010 Abstract ( 286 )   PDF (839KB) ( 245 )   Save BACKGROUND: The function was poor in middle aged and elderly patients with total knee replacement. If there was no ideal anesthesia during the operation, the prognosis of patients would be poor. Therefore, it is necessary to explore the analgesic drugs for artificial knee joint arthroplasty. OBJECTIVE: To investigate clinical analgesic efficacy of tramadol and paracetamol in total knee arthroplasty and the drug safety. METHODS: 200 cases undergoing unilateral total knee arthroplasty in the Department of Orthopedics of Huaian First Hospital Affiliated to Nanjing Medical University from December 2013 to January 2015 were enrolled in this study. According to the different methods of analgesia, patients were divided into control and experimental groups, with 100 cases in each group. Control group received intravenous patient controlled analgesia. Experimental group received paracetamol and tramadol orally. Clinical analgesic efficacy and safety of tramadol paracetamol in total knee arthroplasty were analyzed.  RESULTS AND CONCLUSION: No significant difference in visual analogue scale score was detected immediately, 4 and 5 days after replacement in both groups. Visual analogue scale score was significantly lower in the experimental group than in the control group at 1-3 days after replacement. Hospital for Special Surgery scores at 7 and 12 months after replacement and Special Surgery scores at 24 and 72 hours after replacement were significantly higher in the experimental group than in the control group. The twice doses of tramadol and paracetamol were significantly lower at 24 and 48 hours after replacement in the experimental group than in the control group. The incidence of complications was significantly lower in the experimental group than in the control group. These data verify that during perioperative analgesia, the effects of tramadol and paracetamol were ideal, could lessen patient’s pain, contribute to the recovery of knee function, have less adverse reactions, and have a certain clinical application value.  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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Analgesia after total knee arthroplasty: comparison of preemptive analgesia and multimodal combined analgesia Tian Yuan, Wang Zhi-yong, Zhang Zhi-qiang 2015, 19 (44):  7108-7113.  doi: 10.3969/j.issn.2095-4344.2015.44.011 Abstract ( 455 )   PDF (820KB) ( 262 )   Save BACKGROUND: There are many multimodal analgesia schemes in perioperative period of total knee arthroplasty, but there is no ideal scheme. OBJECTIVE: To explore the effects of multi-mode and preemptive analgesia on analgesic effect after total knee arthroplasty. METHODS: 120 patients with severe osteoarthritis who underwent unilateral knee arthroplasty were enrolled in this study. According to different analgesic effects, the patients could be divided into four groups (n=30). In the control group, no corresponding analgesic measures were found before and during replacement. In the preemptive analgesia group, celecoxib was orally taken before replacement. In the cocktail analgesia group, cocktail was periarticularly injected during replacement. In the multimodal combined analgesia group, celecoxib was orally taken before replacement + cocktail was periarticularly injected during replacement. After replacement, intravenous patient-controlled analgesia pump was applied in each group. Active flexion range-of-motion, visual analogue scale score in the resting and active states and knee Keen Society Score were measured at various time points after total knee arthroplasty in four groups. Adverse reactions were recorded after replacement. RESULTS AND CONCLUSION: Active flexion range-of-motion, visual analogue scale score in the resting and active states and knee Keen Society Score were better in the preemptive analgesia, cocktail analgesia and   multimodal combined analgesia groups than in the control group at various time points after replacement (all P < 0.05). Above indexes were better in the multimodal combined analgesia group than in the preemptive analgesia and cocktail analgesia groups (all P < 0.05). No significant difference in above indexes was detected between the preemptive analgesia and cocktail analgesia groups (all P > 0.05). No significant difference in the number of cases affecting nausea and vomiting was detected at 2 weeks after replacement in the four groups (P > 0.05). There was no deep venous thrombosis of double lower limbs or necrosis and infection of incision. These findings suggest that the effects of preemptive analgesia before total knee arthroplasty, local injection analgesia during replacement, and the combined analgesia of intravenous patient-controlled analgesia pump after replacement were ideal. Adverse reactions did not increase, and the operation was safe. At present, multimodal combined analgesia has been accepted by us, but to achieve truly painless results after total knee arthroplasty still needs more efforts. 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 knee arthroplasty analgesia: gabapentin combined with continuous femoral nerve block Guo Xiu-zhen, Gao Bin-li 2015, 19 (44):  7114-7119.  doi: 10.3969/j.issn.2095-4344.2015.44.012 Abstract ( 320 )   PDF (922KB) ( 303 )   Save BACKGROUND: Traditional analgesia method can relieve the pain after total knee arthroplasty, but the prognosis is poor and drug dependence is strong. Therefore, it is of great significance to study the analgesic drugs in perioperative period of total knee arthroplasty. OBJECTIVE: To explore the analgesic effect of gabapentin combined with continuous femoral nerve block on total knee arthroplasty.  METHODS: A total of 48 patients with knee osteoarthritis receiving total knee arthroplasty in the Department of Orthopedics, Affiliated Hospital of Inner Mongolia Medical University from October 2013 to October 2014 were   enrolled in this study. Using general anesthesia, femoral nerve block was conducted before anesthesia. Analgesia pump was connected after arthroplasty. Patients were randomized to two groups. The control group received multimodal analgesia, and the experimental group received gabapentin combined with continuous femoral nerve block analgesia. Patient’s pain was scored by using resting, activity visual analog scale. Postoperative quality of life, range of motion of knee joint and complications were observed. RESULTS AND CONCLUSION: No significant difference in preoperative resting pain and activity pain was detected between the two groups (P > 0.05). Visual analog scale scores were decreased with time prolonged after arthroplasty in both groups. Visual analog scale scores of resting pain and activity pain were significantly lower in the experimental group than in the control group at 1, 3 and 7 days and 1 month (P < 0.05). Range of motion was significantly larger in the experimental group than in the control group at 3-7 days after arthroplasty (P < 0.05). Activity of daily living score, physical function score, mental function score and social function score were significantly higher in the experimental group than in the control group (P < 0.05). The complication rate was significantly lower in the experimental group than in the control group (17%, 46%, P < 0.05). These data indicate that during perioperative period of total knee arthroplasty, analgesic effect of gabapentin combined with continuous femoral nerve block is ideal. In particular, in patients with acute pain within 48 hours, their combination can promote early rehabilitation of the patient’s knee, and few side effects are found. 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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Bone graft fusion fixation for single-segment thoracic/lumbar spinal tuberculosis: effective reconstruction of spinal stabilization and deformity correction Chen Tao, Jia Shi-qing, Liu Chang-sheng, Lai Ying-jing, Zhang Xiang 2015, 19 (44):  7120-7124.  doi: 10.3969/j.issn.2095-4344.2015.44.013 Abstract ( 262 )   PDF (1026KB) ( 195 )   Save BACKGROUND: On the basis of thorough debridement, homochronous anterior or staging posterior fixation has been a standard scheme for spinal tuberculosis. Numerous studies confirmed that above approach has obtained good effects, but the anterior approach has some disadvantages, such as complex anatomic structure, great trauma, relatively more complications, and difficult operation and fixator implantation. OBJECTIVE: To observe spinal stabilization and deformity correction in patients with single-segment thoracic/lumbar spinal tuberculosis after posterior debridement and interbody fusion. METHODS: Clinical data of 36 patients with single-segment thoracic/lumbar spinal tuberculosis undergoing one-stage posterior debridement and interbody fusion in the Guangxi Yulin Orthopedics Hospital of Integrated Traditional Chinese and Western Medicine from January 2008 to January 2012 were retrospectively analyzed. There were 2 cases in single T11/12 segment, 4 in T12/L1 segments, 6 in L3/4 segments, 22 in L4/5 segments  and 2 in L5/S1 segments. Of them, 24 patients suffered from different degrees of spinal nerve injury. At 6, 12 and 24 months after surgery, all patients were followed up. Bone graft fusion, kyphosis correction, functional recovery of the spinal cord and complications were observed. RESULTS AND CONCLUSION: All patients were followed up for 24-38 months. Cobb angle of kyphosis and spinal stenosis rate were significantly improved at 2 years after treatment (P < 0.05). The lumbar back pain symptoms were significantly improved in final follow-up (P < 0.05), with an intervertebral fusion rate of 100%. No lesion residue and recurrence, correction loss, fixation loosening or displacement was found. These results demonstrated that in patients with single-segment thoracic/lumbar spinal tuberculosis, posterior debridement and interbody fusion can effectively reconstruct spinal stabilization, correct deformity, and promote the functional recovery of spinal nerves. 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 evaluation of pedicle screw fixation for repairing thoracolumbar fracture via fractured vertebrae Qu Peng, Wang Wen-ji 2015, 19 (44):  7125-7130.  doi: 10.3969/j.issn.2095-4344.2015.44.014 Abstract ( 330 )   PDF (1054KB) ( 311 )   Save BACKGROUND: Traditionally repairing single vertebral thoracolumbar fracture often uses of cross-vertebral 4 screw fixation. Because of “parallelogram effect” and the “suspension effect”, it is prone to have internal fixation failure, reset height and correction angle loss, and other complications. However, these complications can be avoided or reduced by fractured vertebra pedicle screw fixation. OBJECTIVE: To investigate the feasibility evaluation of pedicle screw fixation for repairing thoracolumbar fracture via fractured vertebrae. METHODS: A total of 23 patients with single segment thoracolumbar fractures treated at the First Hospital of Lanzhou University between January 2013 and June 2014 were retrospectively analyzed. The fractured segments were between T11 to L2, the patient’s average age was 47.8 years old. All the patients received the posterior pedicle screws and adjacent and up and down six pedicle screw internal fixation within 10 days after injury. The repair effect was observed, including short-term postoperative complications, vertebral height ratio, Cobb angle and the recovery of spinal neurological function. RESULTS AND CONCLUSION: Twenty-three cases were followed up for 4 to 15 months. All patients had no   severe complications in the short term (4 to 15 months) after treatment. There was no screw rod breakage or internal fixation loosening at the last follow-up. The vertebral height ratios and Cobb angle which were measured in postoperative and final follow-up were significantly improved compared with the preoperative data (P < 0.05). The two indicators had a slight rebound in the last follow-up compared with that after treatment, but the difference was not significant (P > 0.05). The spinal neurological functions of most patients were partially recovered at the last follow-up. These results suggest that pedicle screw embedding fixation repairing thoracolumbar fracture via fractured vertebrae can effectively restore vertebral height and correct kyphosis, and maintain correction effect. The advantages are obvious with a low occurrence rate of pedicle screw 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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Waveflex elastic fixation and discectomy annulus in repair and reconstruction of spinal stability in patients with lumbar disc herniation Zhang Zhao-chuan, Jiang Xiao-wei, Dai Wei-xiang, Wu De-hui, Ma Chao, Wang Zhao-hong, Han Meng, Feng Jie, Liu Guang-pu 2015, 19 (44):  7131-7136.  doi: 10.3969/j.issn.2095-4344.2015.44.015 Abstract ( 400 )   PDF (1174KB) ( 577 )   Save BACKGROUND: For reason of pathological particularity, treatments for young adult patients with lumbar disc herniation require more demanding procedures. Traditional discectomy and rigid fixation and fusion receive a lower clinical satisfaction rate because of their concomitant complications. Waveflex is a semi-rigid fixation system with non-fusion pedicle screws. Once combined with the technology of annulus repair, it can maintain the normal movement of the segments, and can thus raise clinical satisfaction rate. OBJECTIVE: To evaluate the short-term efficacy of the treatment of young adult lumbar disc herniation through the technology of the posterior Waveflex non-fusion pedicle screw elastic fixed small window nucleus pulposus extirpation associated with annulus repair. METHODS: Thirty-eight patients with lumbar disc herniation were involved in this study, among which, 18 cases in the elastic fixation group were subjected to a posterior lumbar small window nucleuspulposus extraction along with annulus repair together bound with Waveflex elastic fixation; the rest 20 cases in the nucleus pulposus removal group underwent simple nucleus pulposus extirpation. After these operations, a series of follow-up study was conducted, including: follow-up analysis of clinical efficacy and complications, collection of low-back pain visual analogue scores, collection of Japanese Orthopaedic Association scores (JOA), regular assessment of Oswestry dysfunction index, and reevaluation of the lumbar lateral radiographs related indicators. RESULTS AND CONCLUSION: Follow-up visits to the patients were conducted 12-20 months later since the operations. Both groups showed a better performance than before treatment in the pain visual analogue scale, low back pain JOA score, and Oswestry dysfunction index of low-back pain (P < 0.05) during the last visit. The pain visual analogue scale, low back pain JOA score, and Oswestry dysfunction index of low-back pain in the dynamic fixation group were superior to those in the nucleus pulposus removal group (P <0.05). Still in the last follow-up, operative segment disc height in the dynamic fixation group was greater than that before treatment, and the operative segment range of motion was smaller than that before treatment (P <0.05). These results suggest that compared to nucleus pulposus removal, Waveflex system associated with nucleus pulposus excision annulus repair has a more satisfactory effect in the early recovery of lumbar spine function and exerts a positive effect on the stability of the operated segments in the treatment of lumbar protrusion of the intervertebral disc in young adults. 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 intramedullary nail fixation for treating intertrochanteric fractures in young patients: joint function and complications in 3-month follow-up Yang Li-ming, Xie Zhi-yue, Xiong Min 2015, 19 (44):  7137-7141.  doi: 10.3969/j.issn.2095-4344.2015.44.016 Abstract ( 340 )   PDF (899KB) ( 309 )   Save BACKGROUND: Intramedullary nail with rigid biomechanics was firstly selected for proximal femoral fracture. Proximal femoral intramedullary nail can effectively control the shortening and rotation of the fracture, allow patients to do early exercise and weight bearing, and promote the improvement of joint function. OBJECTIVE: To investigate the effects of proximal femoral intramedullary nail for treating intertrochanteric fractures on the recovery of joint function in young patients. METHODS: 80 young patients with intertrochanteric fractures were randomly divided into the treatment group and the control group, with 40 cases in each group. The control group received dynamic hip screw fixation, and the treatment group received proximal femoral nail fixation. Perioperative index, complications and functional recovery of knee joint after 3 months of treatment were compared between the two groups. RESULTS AND CONCLUSION: Compared with the control group, length of incision, intraoperative blood loss, operative time, fracture healing time and postoperative ambulation time were significantly reduced in the treatment group (P < 0.05). Complications such as postoperative nonunion, hip varus, limb shortening and deep vein thrombosis were significantly less in the treatment group than in the control group (P < 0.05). After follow-up  at 3 months post treatment, the excellent and good rate of hip function was significantly higher in the treatment group than in the control group (93%, 80%; P < 0.05). These results suggest that proximal femoral nail for treating intertrochanteric fractures in young patients follows the principle of biomechanics, reflects the characteristics of minimal invasion, and has few complications, and promotes the recovery of 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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Bone graft fusion and Kirschner wire fixation for calcaneal fractures with subtalar arthritis: modified small “L” approach Li Gong 2015, 19 (44):  7142-7147.  doi: 10.3969/j.issn.2095-4344.2015.44.017 Abstract ( 356 )   PDF (974KB) ( 246 )   Save BACKGROUND: Calcaneal fractures with subtalar arthritis were treated with bone graft fusion in the clinic, but previous big “L” approach could cause great trauma to patients, and was not conducive to the patient’s recovery. OBJECTIVE: To explore the repair effect of modified small “L” approach in bone fusion Kirschner wire on calcaneal fractures with subtalar arthritis. METHODS: Clinical data of 23 patients with calcaneal fracture with subtalar arthritis in the First Hospital-Fengtai Hospital, Peking University from November 2012 to November 2013 were retrospectively analyzed. All patients received modified bone graft fusion via small “L” approach. Repair effect was observed. American Orthopaedic Foot and Ankle Society scores and hind foot scores were evaluated before and after treatment. RESULTS AND CONCLUSION: Bone graft fusion was successfully conducted in 23 patients. The operation time was 55-90 minutes, averagely (70±2.5) minutes. All incision was healed well after operation. Wound infection or flap necrosis did not occur. During follow-up, patients reached bone healing, and no talus osteonecrosis or bone absorption appeared. By the time of the last follow-up, AOFAS score of 23 patients was (85.6±3.7), which was  significantly higher than (50.3±6.2) points before treatment (P < 0.05). These results suggest that modified bone graft fusion with small “L” approach for calcaneal fracture with subtalar arthritis obtained good clinical effects.Moreover, the operation was simple and the complications were less. This method can effectively solve the insufficient exposure of inside of the subtalar joint via previous approaches and big processing difficulty.  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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Preparation of peri-epiphyseal fracture models in young rabbits: cross-epiphyseal plate internal fixation affects epiphyseal growth?  Cui Qing-da1, Liu Wei2, Wang Xin3, Ma Long4, Zhang Shi-qian2, Pan Qi2, Bi Zheng-gang2, Geng Shuo2 2015, 19 (44):  7148-7155.  doi: 10.3969/j.issn.2095-4344.2015.44.018 Abstract ( 230 )   PDF (2959KB) ( 340 )   Save BACKGROUND: There are various therapies for children limb fractures involving the epiphysis or the metaphysis. According to the different methods, studies on the growth of the epiphyseal plate are a lot, most of which focus on  the effects of Kirschner wires with different diameters or hollow screw internal fixation on the development of epiphyseal plate. However, there are rare studies on the influence of cross-epiphyseal plate internal fixation on the growth of epiphyseal plate as well as the influence level. OBJECTIVE: To prepare a peri-epiphyseal fracture model in young rabbits and to observe the effects of cross-epiphyseal plate implantation and removal on the growth of epiphyseal plate. METHODS: Traverse fracture models were made 5 mm above the right femoral distal epiphyseal plate of 60 young rabbits, and then fixed with suitable “L” steel plate and four screws across the epiphyseal plate and peri-epiphyseal fracture line. The left side served as control. Eight rabbits were killed and observed at 2, 4, 8, 12 weeks after modeling, respectively, to take out the femoral specimens for measurement of femoral length, thickness of the epiphyseal plate, and number of mastocytes per unit column. Histopathology observation was done and changes in mastocytes and thickness of the epiphyseal plate were detected. Another seven rabbits were selected to remove the metal plate, continued to feed for 2 weeks and finally executed to observe the above-mentioned indexes. RESULTS AND CONCLUSION: (1) There were significant differences in the above indexes between the plate and control groups at 4, 8, 12 weeks after modeling (P < 0.05 or P < 0.001) but not at 2 weeks after modeling (P > 0.05). These findings indicate that within 2 weeks after cross-epiphyseal plate internal fixation, proper pressue has no remarkable influence on the growth of epiphyseal plate; but after persistent internal fixation (> 4 weeks), the growth of epiphyseal plate can be partially or completed retarded. (2) At 2 and 4 weeks after modeling, the plate was removed, and 2 weeks later, the femoral length, thickness of the epiphyseal plate and mastocyte counting per unit column were improved to different extents, and there were no differences between the plate and control group (P > 0.05). At 8 and 12 weeks after modeling, the plate was removed, and 2 weeks later, the femoral length and thickness of the epiphyseal plate were shortened, and the number of mastocytes per unit column was decreased obviously, which significantly differed from the control group (P < 0.001). These findings indicate that the chondrocytes in the proliferative and hypertrophy layers lose the differentiation and proliferation abilities, and the femoral length and epiphyseal plate thickness are difficult to recover.  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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Finite element analysis of tibial slope in mobile-bearing unicompartmental knee arthroplasty Zhu Guang-duo, Guo Wan-shou, Cheng Li-ming, Liu Zhao-hui, Zhang Qi-dong 2015, 19 (44):  7156-7162.  doi: 10.3969/j.issn.2095-4344.2015.44.019 Abstract ( 378 )   PDF (5476KB) ( 242 )   Save BACKGROUND: At present, there still remain controversies concerning the choice of tibial slope in unicompartmental knee arthroplasty, and the related biomechanical studies are rare. OBJECTIVE: To find the rational tibial slope in mobile-bearing unicompartmental knee arthroplasty through the results of finite element analysis. METHODS: A finite element model of normal knee was established and validated using the techniques of three-dimensional reconstruction and finite element pre-processing. Then the finite element models of unicompartmental knee arthroplasty with different tibial slopes were established based on the normal knee model. The finite element analyses were conducted after the boundary conditions and loads were unified. RESULTS AND CONCLUSION: The finite element models of unicompartmental knee arthroplasty with different tibial slopes were established successfully. The results of the finite element analyses indicated that the posteromedial tibial cortical and cancellous bone stress increased gradually as the posterior slope increasing, as well as the load distribution and the cartilage contact pressures of lateral compartment. The anteromedial tibial cortical stress increased significantly with the anterior slope. A posterior tibial slope of 0°-7° can be recommended when implanting a mobile-bearing unicompartmental knee arthroplasty. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Application of 3D printing technology in the repair of pelvic fracture Wei Xin-wang, Yang Zhi, Yao Jun, Li Yi-long, Zhao Jin-min 2015, 19 (44):  7163-7166.  doi: 10.3969/j.issn.2095-4344.2015.44.020 Abstract ( 247 )   PDF (4451KB) ( 591 )   Save BACKGROUND: 3D printing technology for preoperative planning has been a trend at present. Moreover, this technology has been extensively used in bone tumor resection and maxillofacial surgery, but seldom used in fracture repair. OBJECTIVE: To explore the value of 3D printing technology application in preoperative evaluation of pelvic fracture, planning and during surgery. METHODS: Pelvic fracture patients underwent preoperative CT scan. Pelvic models of the patients were printed using 3D printing technology at 1:1. Preoperative processing was conducted, including choice of approach, design of incision exposure range, design of fracture reduction, pre-implantation position of the steel plate, optimal plastic design of steel plate, measurement of screw length and design of screw direction. Matta score of pelvic fracture reduction and Majeed score of pelvic function after repair were measured during follow-up. RESULTS AND CONCLUSION: The operation time was 55-130 minutes, averagely (84.75±20.15) minutes. Intraoperative blood loss was 200-800 mL, averagely (417.00±173.58) mL. After operation, no incision infection, fracture nonunion, fixator loosening or breakage appeared. All patients were followed up for 8-24 months. The fracture healing time was 10-16 weeks, averagely 12.5 weeks. Fracture reduction was assessed according to  Matta scoring: excellent in 15 cases, good in 3 cases, average in 2 cases, and poor in 0 case, with an excellent and good rate of 90%. Postoperative function was assessed according to Majeed scoring: excellent in 13 cases, good in 5 cases, average in 2 cases, and poor in 0 case, with an excellent and good rate of 90%. These findings showed that the application of 3D printing technology in pelvic fracture can determine the fracture’s displacement, is helpful for accurate reduction and plate modeling, reduces surgery duration and intraoperative blood loss and complication, finally achieves better surgical result. 3D printing technology can better evaluate and plan the pelvic fracture before repair, and can be used as a routine project preparation of pelvic fracture repair.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Application of three-dimensional reconstruction using Mimics software to repair of Pilon fracture Huang Jian, Wang Xiao-ping, Deng Zhi-cheng, Wu Wei-wei, Chen Lu-yao, Hu Shi-qiang, Wei Zhan-tu, Guo Sheng 2015, 19 (44):  7167-7171.  doi: 10.3969/j.issn.2095-4344.2015.44.021 Abstract ( 426 )   PDF (949KB) ( 359 )   Save BACKGROUND: Mimics software is a three-dimensional (3D) image processing and editing tool based on CT scan data. Mimics software can rebuild the data and images gotten in CT, MRI and ultrasound scans into 3D images and display on the computer screen so as to help clinicians understand the type of fracture and the relationship of the 3D structure of the surrounding tissue and to provide a great help in the development of orthopedics operation. OBJECTIVE: To explore the application effect of Mimics software 3D reconstruction on perioperative period of Pilon fracture. METHODS: This study selected 61 cases of Pilon fracture, who received the surgery in the Zhongshan City Xiaolan People’s Hospital from September 2008 to September 2013, as research objects. They were randomly divided into 3D group and control group in accordance with the time of admission. All patients underwent  anterioposterior and lateral X-ray film examination and multi-slice spiral CT scan. Patients in the control group received internal fixation according to above examination results. Patients of the 3D group, on the base of those of the control group, were subjected to internal fixation after three-dimensional entity reconstruction by using Mimics V 10.0 software. Operation time and functional curative effect in the postoperative follow-up were compared between the two groups. RESULTS AND CONCLUSION: The operation time was significantly less in the 3D group than in the control group (P < 0.05). The number of patients with excellent 6-month functional curative effect was more, and the number of patients with poor effect was less in the 3D group than in the control group. The 6-month functional curative effect was better in the 3D group than in the control group (P < 0.05). These results showed that the application of Mimics software 3D reconstruction to the perioperative period of Pilon fractures can give comprehensive assessment of the situation of fracture, optimize and improve the preoperative plan and reduce the risk of surgery, and promote the successful completion of internal fixation.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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CT three-dimensional reconstruction evaluates pedicle screw position classification: reliability analysis Yan Bing-shan, Yin Wang-ping, Ni Miao-zhong, Chen Yan-chao, Dong Jia-chun 2015, 19 (44):  7172-7176.  doi: 10.3969/j.issn.2095-4344.2015.44.022 Abstract ( 503 )   PDF (743KB) ( 428 )   Save BACKGROUND: In recent years, CT has been gradually adopted to evaluate the pedicle screw position, but there are less reports about the reliability of the application of CT three-dimensional reconstruction evaluating pedicle screw position. OBJECTIVE: To investigate the reliability of the application of CT three-dimensional reconstruction evaluating pedicle screw position classification. METHODS: Twenty-seven patients with pedicle screw placement were included. CT scan was conducted within one week after embedding. Two-dimensional and three-dimensional CT image data were randomly observed by two professional orthopedists. Screw position was performed classification according to Rao Grading method. Interobserver reliability and intraobserver reliability were evaluated using consistency test. RESULTS AND CONCLUSION: One hundred and sixteen pedicle screws were inserted in 27 patients. The grading determination of the screw position using two-dimensional CT images showed that the interobserver reliability and intraobserver reliability were highly consistent. Kappa coefficients were respectively 0.656 and 0.631. The grading determination of the screw position using three-dimensional reconstruction CT images showed that the interobserver reliability and intraobserver reliability were both strongest. Kappa coefficients were respectively 0.833 and 0.863. These results show that the reliability of applying CT three-dimensional reconstruction on evaluating pedicle screw position is high, which proves a certain clinical application value. 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 percutaneous kyphoplasty bone cement injection on biomechanics of adjacent lumbar spine in animal models with osteoporosis Aimaijiang Kuerban, Fan Shun-wu, Liu Chao, Wang Yin-kui, Shen Hong-da 2015, 19 (44):  7177-7181.  doi: 10.3969/j.issn.2095-4344.2015.44.023 Abstract ( 270 )   PDF (873KB) ( 279 )   Save BACKGROUND: Adjacent vertebral secondary fracture after operation is the most common complication of percutaneous kyphoplasty bone cement injection. Studying the effects of percutaneous kyphoplasty bone cement injection on biomechanical function of adjacent lumbar spine in animal model with osteoporosis will have some guiding significance for clinical practice. OBJECTIVE: To investigate the effects of percutaneous kyphoplasty bone cement injection on biomechanical function of adjacent lumbar spine in rabbit models with osteoporosis. METHODS: Thirty-six New Zealand female white rabbits were ovariectomized to establish L3 vertebral osteoporotic fracture model, and then randomly and evenly divided into control group (treated with open reduction and internal fixation operation) and experimental group (treated with percutaneous kyphoplasty bone cement  injection). At the 5th, 10th and 15th months after operation, L2, L4 bone mineral density, L2, L4 maximum bending and compressive load, the ratio of anterior and posterior heights of L3 vertebrae to average height of L2 and L4 vertebrae, and the sagittal Cobb angle of L2 and L4 vertebrae were detected. RESULTS AND CONCLUSION: The bone mineral density, maximum bending and compressive load, vertebral height ratio at different time points after operation in experimental group were higher compared with the preoperative level (P <  0.05). The sagittal Cobb angle in experimental group was smaller compared with the preoperative level (P < 0.05). In the control group, the bone mineral density, maximum bending and compressive load at different time points after operation were all higher compared with preoperative level (P < 0.05). There were no significant difference of the vertebral height ratio and sagittal Cobb angle compared with the preoperative level. The bone mineral density, maximum bending and compressive load, vertebral height ratio at different time points after operation in experimental group were higher compared with the control group (P < 0.05). The sagittal Cobb angle was smaller compared with the control group (P < 0.05). These results demonstrate that percutaneous kyphoplasty bone cement injection can better improve the bone density, carrying capacity and kyphosis of osteoporosis fractures adjacent vertebrae. 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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Internal fixation materials for posterior ankle fracture and its biomechanical properties 2015, 19 (44):  7182-7187.  doi: 10.3969/j.issn.2095-4344.2015.44.024 Abstract ( 311 )   PDF (868KB) ( 246 )   Save BACKGROUND: Posterior malleolar fracture is an important factor affecting the prognosis of ankle fractures. Posterior malleolar fracture often caused by high energy trauma. Using what kind of fixation and fixation materials biomechanics, and how to embed has become a current research hotspot. OBJECTIVE: To compare the clinical outcomes of different fixation materials on posterior malleolar fracture, and analyze the effect of different fixation methods on biomechanical outcome of posterior malleolar fracture fixation, so as to provide a basis and reference of selecting the best fixation for the clinical treatment of ankle fracture. METHODS: The relevant literature included by PubMed database and the China National Knowledge database from the year of 1976 to 2015 were retrieved by the first author through computer. English key words are “Ankle fracture; internal fixation; biomechanics; biocompatibility”, Chinese language search terms are “posterior malleolar fracture; internal fixation; biomechanics; biocompatibility”. Summarize the most commonly used metal fixation materials and absorbable content materials. The clinical commonly used metal fixation materials including bone plate and screws, absorbable fixation materials such as biodegradable material polylactic acid, polyethylene plastic ester, polylactide gum ester, etc. The biomechanical properties were analyzed. RESULTS AND CONCLUSION: The new locking screw can withstand more buckling and shear force. Lag screw has a tapping action, and the pulling was stronger after tapping, but for patients with osteoporosis, the pressure effect of screw on fracture fragments was limited, the strength was not enough, at this time, locking plate should be used. Locking plate has a greater stability and higher confrontational feature to bending stress, less likely to pull out. Steel coupling screw provides better stability. To avoid secondary removing of the fixation, stress protection after fixation and other shortcomings after the metal material fixation fracture healing, the strength of the absorbable fixation material made by biodegradable material polylactic acid, polyvinyl acetate glue and polypropylene plastic ester after high temperature and pressure processing was increased. Absorbable fixation material may overcome the adverse effects associated with metal fixation, such as imageological examination, secondary implant removal. These results show that the mechanical properties of the absorbable screws are more closer to human bone, no surrounding bone vulnerability due to stress shields, no osteoporosis occurs, and can degrade in the body, but its fixation strength is still less than the traditional fixed screw and bone plate. We should choose a suitable fixation material according to the forces of fracture site and the size of the fracture fragments. 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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Clinical application of tranexamic acid in perioperative period of total knee arthroplasty Wang Xin-rui, Wang Tao, Zhang Zhi-qiang 2015, 19 (44):  7188-7192.  doi: 10.3969/j.issn.2095-4344.2015.44.025 Abstract ( 273 )   PDF (678KB) ( 340 )   Save BACKGROUND: We have not found an effective and safe way to reduce postoperative bleeding after total knee arthroplasty. Tranexamic acid is a synthetic lysine antifibrinolytic drug, can reversibly block the plasminogen binding to fibrin, which prevent degradation of fibrin clots, effectively reduce postoperative bleeding, but this process to reduce bleeding may increase the risk of postoperative venous thrombosis and pulmonary embolism. The present study showed that the optimal use manner of tranexamic acid in the clinic was not clear. There are still a lot of doubts on the risk of postoperative thromboembolic events. OBJECTIVE: To summarize the effectiveness and safety of three different ways (intravenous, topical and oral) of taking tranexamic acid in total knee arthroplasty.  METHODS: We searched PubMed and Chinese Journal Full-text Database from January 1970 to January 2015 in the title and abstract. The key words were “tranexamic acid; oral; topical; intravenous infusion; blood loss; safety; total knee arthroplasty”. Meta-analysis, review and repeated articles were excluded. RESULTS AND CONCLUSION: The application of tranexamic acid in the clinic mainly contained intravenous, topical, oral modes. Under the premise of the safe use of tranexamic acid, different modes could control the amount of bleeding to different degrees. It is believed that with the wide use of tranexamic acid during and after total knee arthroplasty, there will be more optimal mode that can better control blood loss after total knee arthroplasty.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Proximal femoral nail antirotation versus artificial femoral head replacement for intertrochanteric fracture in the elderly: a meta-analysis Pei Jun-peng, Yang Wen-long, Lan Xi, Huang Sheng-li 2015, 19 (44):  7193-7201.  doi: 10.3969/j.issn.2095-4344.2015.44.026 Abstract ( 309 )   PDF (1560KB) ( 305 )   Save BACKGROUND: Proximal femoral nail antirotation and femoral head replacement could quickly recover hip function in intertrochanteric fractures in the elderly, but whose efficacy is better remains controversial. OBJECTIVE: To compare the differences in the effects of proximal femoral nail antirotation and femoral head replacement on intertrochanteric fractures in the elderly by using a meta-analysis. METHODS: The relevant literatures were searched in PubMed, Cochrane, CNKI, Wanfang database and VIP, and other relevant journal such as Chinese Journal of Orthopaedics and Orthopedic Journal of China for articles published in recent five years. Randomized controlled trials concerning proximal femoral nail antirotation and femoral head replacement for the treatment of intertrochanteric fractures in the Chinese elderly were collected. Baseline data, operation time, intraoperative blood loss, postoperative out-of-bed time, length of stay, Harris score, complication rate and number of death were collected and processed using RevMan 5.30 software for meta analysis. RESULTS AND CONCLUSION: Totally 37 clinical controlled trials with 3 216 patients were recruited. Meta-analysis results showed that compared with femoral head replacement, proximal femoral nail antirotation was at a disadvantage in postoperative out-of-bed time, length of stay and joint function in the early stage. No significant difference in complication and mortality was detected between proximal femoral nail antirotation and femoral head replacement. However, proximal femoral nail antirotation had some advantages such as short operation time, small trauma, and less intraoperative blood loss, and showed good midterm and long-term outcomes of joint function.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Proximal femoral nail anti-rotation and dynamic hip screw in repair of intertrochanteric fracture in the elderly: a meta-analysis Liu Li-guo, Ha Si-lu, Zhang Xie-zhuo, Xu Chao, Yilihamu•Tuoheti 2015, 19 (44):  7202-7208.  doi: 10.3969/j.issn.2095-4344.2015.44.027 Abstract ( 270 )   PDF (1122KB) ( 202 )   Save BACKGROUND: Now a lot of studies have confirmed that in contrast with the dynamic hip screw, the proximal femoral nail anti-rotation has a better therapeutic effect on the treatment of intertrochanteric fractures in the elderly, but there is no definite conclusion on the specific superiority at present. OBJECTIVE: To compare the curative effects of proximal femoral nail anti-rotation and dynamic hip screw in repair of intertrochanteric fracture using a meta-analysis. METHODS: We searched VIP database, Wanfang database, PubMed database and Embase database from 2011 to 2015, and collected randomized controlled trials on proximal femoral nail anti-rotation and dynamic hip screw in repair of intertrochanteric fracture. Operation time, intraoperative blood loss, hospital stays, fracture healing time, Harris score, length of incision, bed time walking after the operation were used as evaluation indexes of meta analysis. Data were analyzed using RevMan 5.3 software. RESULTS AND CONCLUSION: In the end, we used 9 literatures, which contained 858 patients of intertrochanteric fractures in the elderly. The time of publication was from 2011 to 2015, and all of them were published in Chinese. The results of Meta-analysis showed that, compared with dynamic hip screw, proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in the elderly could effectively reduce operation time, blood loss, hospital stays, fracture healing time, length of incision and the time of walking after the operation was earlier, and it could obtain better recovery of hip function. We can point out that compared with dynamic hip screw, proximal femoral nail anti-rotation has certain advantages in the treatment of intertrochanteric fractures in the elderly. In some conditions, the patients and the hospitals can give priority to choose the proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in the elderly.  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 reconstruction plate and Kirschner wire fixation for the treatment of clavicle fractures    Zhang Xie-zhuo, Liu Li-guo, Ha Si-lu, Xu Chao, Yilihamu•Tuoheti 2015, 19 (44):  7209-7216.  doi: 10.3969/j.issn.2095-4344.2015.44.028 Abstract ( 324 )   PDF (1309KB) ( 276 )   Save BACKGROUND: At present, a large number of studies have confirmed that reconstruction plate compared to Kirschner wire in the treatment of clavicular fracture showed good effects, but there is no precise report on the specific advantages at present. Clinical randomized controlled study is less, and lacks of systematic evaluation. OBJECTIVE: To systematically evaluate the efficacy and safety of the treatment of the clavicle fractures with the reconstruction plate and the Kirschner wire by using a meta-analysis. METHODS: We retrieved the MEDLINE, Embase, PubMed, Cochrane library, CNKI, Wanfang database and VIP database from 2008 to 2015 by computer to collect all controlled study relevant to reconstruction plate and Kirschner wire in the treatment of clavicle fracture, and screened the literatures that met the inclusion criteria. All literatures were analyzed in strict quality evaluation. Excellent rate, delayed healing of incision, malunion, postoperative infection, loosening of internal fixation, postoperative fracture displacement, operation time, intraoperative bleeding volume and fracture healing time were selected as the evaluation indexes of a meta-analysis. Meta-analysis was performed with RevMan 5.2 software from the Cochrane Collaboration. RESULTS AND CONCLUSION: Finally 12 Chinese articles published from 2008 to 2014 were included, with 911 patients. Meta-analysis results showed that compared with Kirschner wire, the reconstruction plate has a certain advantage in improving the excellent and good rate, shortening the delayed wound healing and reducing deformity healing, reducing postoperative infection, preventing the loosening of internal fixation and avoiding postoperative fracture displacement. However, the two surgical methods in the treatment of clavicular fracture were not significant in operation time, intraoperative blood loss and fracture healing time. These results suggest that compared with the Kirschner wire, reconstruction plate fixation for treatment of clavicular fracture had better curative effect. The reconstruction plate can be firstly selected in the permit of patient economic conditions and hospital conditions. Due to the limited sample size in this study, the multicenter, large-sample and long-term clinical randomized controlled studies with more strict design are needed to increase the reliability of the evidence.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics