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24 December 2015, Volume 19 Issue 53 Previous Issue    Next Issue

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Artificial cervical disc replacement and anterior cervical decompression and fusion for the treatment of single segmental cervical disc herniation: a 3-year follow-up Cheng Jun-jie, Sui Jiang-tao, Ma Yuan, Tian Hui-zhong 2015, 19 (53):  8529-8536.  doi: 10.3969/j.issn.2095-4344.2015.53.001 Abstract ( 456 )   PDF (739KB) ( 336 )   Save BACKGROUND: Anterior cervical discectomy and fusion surgery is a good choice for repair of degenerative cervical disc herniation, but it is reported that fusion can affect the exercise of cervical neighboring stages. Artificial disc replacement can not only play a role in mitigation of cervical disease neurological symptoms and signs, but also maintain stability and semental activity of cervical spine, and reduce secondary adjacent segmental degeneration. These two methods which applied in cervical degenerative intervertebral disc herniation still remain controversial. OBJECTIVE: To investigate the short-term effect of artificial cervical disc replacement and anterior cervical decompression and fusion for the treatment of single segmental cervical disc herniation. METHODS: Totally 48 patients with single segment radiculopathy or myelopathy cervical diseases induced by cervical disc herniation that required surgery and received a three-month follow-up were included and retrospectively analyzed. These patients were divided into replacement group (n=21) and fusion group (n=27) according to the different repair programs. Patients in the replacement group were subjected to Prestige LP cervical artificial disc replacement, and patients in the fusion group were subjected to disc fusion using interbody fusion cage of Johnson or allogeneic fibularing. They were followed up at 1 week, 3, 6, 12, 24, 36 months after treatment. Complications were recorded during the follow-up. The pain of patients was evaluated using neck and upper limb pain visual analogue scale scores. The therapeutic effect was evaluated using Japanese Orthopaedic Association (JOA) score. The clinical symptoms improvement and daily functional status of patients after treatment were evaluated using cervical disability index. RESULTS AND CONCLUSION: During the final follow-up, the fusion rate in fusion group was 93% (25/27). Comparisons between groups: at the 1 week and final follow-up after treatment, the visual analog scale scores of neck and upper limbs and cervical dysfunction indexes were all lower than those before treatment; the Japanese Orthopaedic Association scores were higher than those before treatment (P < 0.05). In the final follow-up, the visual analog scale scores of neck and upper limbs and cervical dysfunction index were all lower than those after one week of treatment, and the Japanese Orthopaedic Association scores were higher than those after one week of treatment (P < 0.05). There were no significant differences in the above indicators at each time point between these two groups (P > 0.05). The cervical activity and surgical segmental motion after cervical disc replacement were significantly higher than those in the fusion group; the difference was statistically significant (P < 0.05). There were no serious complications in these two groups. There was no significant difference in the incidence of complications between these two groups (P > 0.05). These results suggest that the artificial cervical disc replacement and anterior cervical decompression and fusion for the treatment of single cervical disc herniation have the same effect in terms of patients’ symptoms mitigation. With respect to fusion technique, artificial disc replacement surgery has the advantage of maintaining cervical stability and activities of replacement segments.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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The establishment of allogeneic blood transfusion prediction model and precise detection after total knee arthroplasty Zhou Zhi-guo, Fang Guang-wen, Zhang Ying-jian, Lv Ting-zhuo, Shang Fu-qing, Wang Shu-ping 2015, 19 (53):  8537-8542.  doi: 10.3969/j.issn.2095-4344.2015.53.002 Abstract ( 289 )   PDF (496KB) ( 416 )   Save BACKGROUND: How to effectively reduce allogeneic blood transfusion volume after knee arthroplasty has become a new clinical problem, but predictors of perioperative blood loss and allogenic blood transfusion after replacement have not been well defined. OBJECTIVE: To establish the prediction model of allogeneic transfusion volume after total knee arthroplasty by analyzing the preoperative and intraoperative related factors that influence the postoperative allogeneic transfusion volume, so as to provide a theoretical basis for the clinical selective application of the autologous blood retransfusion device.   METHODS: The materials of 120 postoperative allogenic transfusion patients who treated with unilateral total knee arthroplasty at Baodi Clinical College of Tianjin Medical University from January 2012 to December 2013 were retrospectively analyzed. Each patient’s gender, age, height, body weight, preoperative hemoglobin value, operation time, intraoperative blood loss volume and postoperative allogeneic transfusion volume were recorded in detail, and accordingly a prediction model of allogeneic transfusion volume was established after total knee arthroplasty. From January 2014 to December 2014, we applied this model in clinic. A total of 90 patients who predicted need for allogeneic transfusion after unilateral total knee arthroplasty were randomly divided into two groups. Autologous blood retransfusion device was used in the observation group. Conventional drainage was used in the control group. The blood transfusion volume of patients in these two groups was analyzed, and the prediction accuracy of the prediction model in these two groups was detected. RESULTS AND CONCLUSION:All patients completed the experimental observation. Pearson analysis showed that the patient’s age, height, body weight, preoperative hemoglobin values, operation time and intraoperative blood loss volume associated with postoperative allogeneic transfusion volume (P < 0.01). Multivariate regression analysis showed that the patient’s preoperative hemoglobin values, operation time and intraoperative blood loss volume associated with postoperative allogeneic transfusion volume (P < 0.01). Clinical application test results showed that the postoperative allogeneic transfusion volume in observation and control groups was respectively (611.30±191.14) mL and (571.55±200.53) mL, prediction accuracy was respectively (71.50±22.20)% and (70.94±19.23)%, the difference was not significant (P > 0.05). There were significant differences in allogeneic transfusion volume and total blood transfusion volume (including autologous and allogeneic blood transfusion volume) of patients in these two group (P < 0.01). The allogeneic transfusion volume in the observation group was significantly lower than that in the control group. These results suggest that the prediction model can successfully predict the allogeneic transfusion volume after total knee arthroplasty. The application of autologous blood retransfusion device in those patients who predicted need for postoperative allogenic transfusion after the replacement can effectively reduce the allogenic transfusion volume.   中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Unicompartmental and total knee arthroplasty for medial compartment osteoarthritis of the knee: comparison of five years of prosthesis survival rate Liang Ning, Samuel Yih Shyan Wong, Nick Clement, Deborah MacDonald, Daniel E Porter 2015, 19 (53):  8543-8548.  doi: 10.3969/j.issn.2095-4344.2015.53.003 Abstract ( 515 )   PDF (504KB) ( 396 )   Save BACKGROUND: Unicompartmental arthroplasty are more and more applied in the treatment of isolated medial compartment of knee joint osteoarthritis. OBJECTIVE: To compare the repair efficacy of unicompartmental knee arthroplasty and total knee arthroplasty in the treatment of knee medial compartment osteoarthritis. METHODS: Totally 109 patients with isolated medial compartment of knee joint osteoarthritis were enrolled, and then divided into unicompartmental arthroplasty group (n=41) and total knee arthroplasty group (n=68) according to the different repair methods. The average hospital stay, the incidence of complications after replacement, total scores of physical health and mental health, the Oxford knee joint scores and prosthesis survival rate after 5 years of replacement were compared. RESULTS AND CONCLUSION: The average hospital stay of patients in the unicompartmental arthroplasty group ((4.21±2.44) days) was shorter than that in the total knee arthroplasty group ((6.11±2.23) days) (P=0.001). There were no significant differences in the incidence of complications, total scores of physical health and mental health, the Oxford knee joint scores and other aspects between these two groups (P > 0.05). After 5 years of replacement, the prosthesis survival rate of unicompartmental arthroplasty group (90%) was lower than that in the total knee arthroplasty group (100%) (P < 0.05). These results suggest that as for patients with isolated medial compartment of knee joint osteoarthritis, unicompartmental arthroplasty and total knee arthroplasty have similar repair effect; however, the prosthesis survival rate is a little lower after 5 years of unicompartmental 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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Total hip arthroplasty repairs ankylosing spondylitis-associated hip joint lesion based on the biological level: 2-year follow-up Ding Liang-jia, Liu Ying-li, Liu Xiao-min, Ma Gang, Liu Chang-lu 2015, 19 (53):  8549-8553.  doi: 10.3969/j.issn.2095-4344.2015.53.004 Abstract ( 350 )   PDF (547KB) ( 252 )   Save BACKGROUND: Due to the continuous development of medical technology and prosthetic material study, patients with ankylosing spondylitis-associated hip joint lesion are often treated with artificial total hip arthroplasty. Because the majority patients of this kind of disease are young patients, it is of great importance for the patients’ life quality through maximizing the recovery of hip function, restoring the biomechanical balance of spine, pelvis and hip joint and prolonging the life of hip joint. OBJECTIVE: To observe the repair effect of total hip arthroplasty in treatment of ankylosing spondylitis-associated hip joint lesion based on the biological level. METHODS: Totally 60 patients with ankylosing spondylitis-associated hip joint lesion who received the treatment   at Department of Joint Surgery, the Second Affiliated Hospital of Inner Mongolia Medical University from December 2010 to December 2014 (including 2 years of follow-up) were selected and conducted total hip arthroplasty using biological type total hip prosthesis. During 2 years of follow-up, hip activity (total activity, flexion and extension, adduction, abduction, internal rotation, external rotation), hip Harris score, pain visual analog scale score, quality of life of patients were observed, counted and comparatively analyzed before replacement and in the final follow-up.  RESULTS AND CONCLUSION: The hip joint activity and other various indexes of patients in the final follow-up significantly recovered compared with before treatment (P < 0.05). Before treatment, the hip joint pain of patients was severe, the function and the quality of life were poor, however, in the final follow-up, the pain of patients was obviously relieved, hip function effectively recovered and quality of life improved significantly, the differences were statistically significant (P < 0.05). These results suggest that the application of total hip arthroplasty by using biological type total hip prosthesis on patients with ankytosing spondylitis-associated hip joint lesion can effectively restore physiological and anatomical structure of the hip joint, restore the function and activity of hip joint, relieve pain, and improve the quality of life.   中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Comparison of C5 nerve root palsy after laminoplasty with mini-titanium plate fixation and laminectomy with internal fixation Feng Da-peng, Xu Wei-bing,Zhao Zhi, Yuan Liang, Li Guang-can, Nan Feng, Li Zheng-wei 2015, 19 (53):  8554-8553.  doi: 10.3969/j.issn.2095-4344.2015.53.005 Abstract ( 404 )   PDF (580KB) ( 407 )   Save BACKGROUND: Laminoplasty and laminectomy are the most commonly used treatment methods for multilevel cervical spondylotic myelopathy, which is more common in elderly patients. C5 nerve root palsy is the common postoprative complication after posterior cervical repair. OBJECTIVE: To compare the incidence of C5 nerve root palsy after laminoplasty with mini-titanium plate fixation and laminectomy with internal fixation in repair of multilevel cervical spondylotic myelopathy. METHODS: Totally 134 patients with multilevel cervical spondylotic myelopathy from August 2010 to December 2014 were enrolled, and then divided into laminoplasty group (n=45) and laminectomy group (n=89) owing to different ways of repair. Patients in the laminoplasty group were treated with laminoplasty with mini-titanium plate fixation, and patients in the laminectomy group were treated with laminectomy with internal fixation. C5 nerve root palsy condition after repair was recorded and evaluated. The cervical lordosis angle (Cobb angle) and cervical curvature index were compared. The Japanese Orthopaedic Association score was used for neurological assessment. RESULTS AND CONCLUSION: All patients in both groups were followed up for more than 6 months. There were no significant differences in cervical lordotic angle and cervical curvature index at the first week before and after  the treatment between these two groups (P > 0.05). The Japanese Orthopaedic Association scores of patients after 6 months of treatment were significantly improved compared with that before treatment in these two groups (P < 0.05). There were 2 cases of C5 nerve root palsy after the treatment of laminoplasty, the occurrence rate was 4% (2/45); there were 10 cases of C5 nerve root palsy after the treatment of laminectomy, the occurrence rate was 11% (10/89); there was significant difference between these two groups (P < 0.05). These results suggest that compared with laminectomy fixation, the incidence of C5 nerve root palsy was lower after the laminoplasty with mini-trianium plate fixation, which can be widely used in decompression repair treatment of multilevel cervical spondylotic myelopathy.  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 trend of change and clinical significance of early-phase inflammatory indices after cervical fixation  Liang Chen, Sun Jian-min, Cui Xin-gang, Jiang Zhen-song, Li Tao 2015, 19 (53):  8560-8566.  doi: 10.3969/j.issn.2095-4344.2015.53.006 Abstract ( 346 )   PDF (491KB) ( 284 )   Save BACKGROUND: The infection after spinal internal fixation was its serious complications. A number of studies have shown that erythrocyte sedimentation rate and C-reactive protein are of great importance in judging infections. OBJECTIVE: To analyze the trend of change of erythrocyte sedimentation rate and C-reactive protein for patients without infection after the cervical fixation. METHODS: Totally 56 patients, who underwent cervical fixation from October 2013 to July 2014, were retrospectively analyzed, and then divided into anterior cervical group (n=29) and posterior cervical group (n=27). Patients in the anterior cervical group underwent anterior cervical decompression bone graft internal fixation. Patients in the posterior cervical group underwent posterior cervical unilateral open door decompression internal fixation. The peripheral blood was collected before fixation and at the early morning of the 1, 3, 6, 9 days after fixation. Erythrocyte sedimentation rate and C-reactive protein values were determined. The follow-up of patients was more than one year. Signs of infection did not appear. RESULTS AND CONCLUSION: (1) General rule: After the cervical fixation, the erythrocyte sedimentation rate was increased significantly and reached a peak on postoperative day 6. The peak level gradually decreased but has not returned to normal at the 9 postoperative days. The C-reactive protein increased significantly on the first postoperative day and reached a peak on postoperative day 3. The peak level rapidly decreased but has not returned to normal at the 9 postoperative days. The level of erythrocyte sedimentation rate of patients in the posterior cervical group was significantly higher than that in the anterior cervical group at 3, 6 and 9 days after internal fixation (P < 0.05). There was no significant difference in the C-reactive protein between these two groups (P > 0.05). (2) These results demonstrate that C-reactive protein is an important indicator of monitoring the inflammatory response of patients after cervical internal fixation, which was conductive to the judgment of early infection after internal fixation. The abnormal inflammatory indices of erythrocyte sedimentation rate and C-reactive protein do not suggest a presence of blade infection after internal fixation. C-reactive protein can reach the peak at 3 days after fixation. It is recommended to check blood at 2 and 3 days. If there is no apparent rebound, then the possibility of infection is small. It may indicate the presence of infection if the inflammatory indices increased again or decreased slowly after the decrease.   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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Thoracolumbar tuberculosis complicated with severe kyphosis: spinal stability after orthopedic fixation and bone grafting fusion Deng Qiang, Paerhati•Rexiti, Zhang Ya-lou, Sheng Wei-bin 2015, 19 (53):  8567-8572.  doi: 10.3969/j.issn.2095-4344.2015.53.007 Abstract ( 323 )   PDF (535KB) ( 304 )   Save BACKGROUND: At present, there was lack of reports on the efficacy of thoracolumbar tuberculosis complicated with severe kyphosis (> 90°). Choice of surgical treatment is necessary for patients with severe spinal tuberculosis kyphosis, affected heart and lung function and neurological disorders. OBJECTIVE: To retrospectively analyze the repair effect of I-stage posterior osteotomy orthopedic fixation and II-stage anterior debridement interbody bone grafting fusion in repair of patients with thoracolumbar tuberculosis complicated with severe kyphosis. METHODS: Totally 53 patients with spinal tuberculosis complicated with severe kyphosis were enrolled. Patients underwent posterior osteotomy orthopedic fixation in the first stage, and underwent anterior debridement interbody bone grafting fusion in the second stage. X-ray, CT, MRI and other imaging examinations were conducted before and after the treatment. Erythrocyte sedimentation rate, C-reactive protein, pain visual analog scale scores, kyphosis and ASIA spinal cord injury classification before and after the treatment were compared and analyzed for clinical evaluation of efficacy. RESULTS AND CONCLUSION: All patients had a successful surgery. The operative time was 290 (195-420) minutes, and the intra-operative amount of blood loss was 1800 (1 100-3 300) mL, the average number of fixed segments were 11.8 (9-16). All these 53 patients were followed up for 26-28 months. The erythrocyte sedimentation rate and C-reactive protein of patients after treatment gradually recovered to normal, and recovered to normal levels at the final follow-up. The mean correction of sagittal Cobb angle was 77.92°, the correction rate reached to 74.6% at the final follow-up. Till the final follow-up, the average loss of corrective angle was 1.35°. The lower back pain and limitation of function obtained varying degrees of alleviating after treatment. The visual analog scale scores in the final follow-up were significantly lower than those before treatment (t=19.219, P < 0.001). ASIA spinal cord injury scores gradually increased. Patients recovered the ability to live and work in varying degrees. These results suggest that I-stage posterior osteotomy orthopedic fixation combined with II-stage anterior debridement interbody bone graft fusion is an effective methods for repair of thoracolumbar tuberculosis complicated with severe kyphosis. The lesions of patients with thoracolumbar tuberculosis complicated with severe kyphosis who were enrolled in this study involve multiple vertebral body, long bone defect, and often need long segmental allograft bone grafting, with long-time of bone grafting fusion, therefore, zygapophyseal bone grafting fusion should be conducted to increase the stability of posterior bone grafting.  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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Supraclavicular nerve dissection and protection in plate internal fixation of clavicle fracture Xu Rui-da, Li Xiao-miao, Cheng Guang-qi, Han Xiao-feng 2015, 19 (53):  8573-8578.  doi: 10.3969/j.issn.2095-4344.2015.53.008 Abstract ( 397 )   PDF (652KB) ( 437 )   Save BACKGROUND: Open reduction and plate internal fixation has become a major repair and treatment method for clavicle fracture, however, this method often causes postoperative local skin numbness and hypoesthesia. Currently, there was still controversial about the effect of internal fixation on the free protection of supraclavicular nerve. OBJECTIVE: To investigate the clinical significance of supraclavicular nerve dissection and protection on open reduction and plate internal fixation of clavicle fracture. METHODS: Totally 57 patients with the middle third of the clavicle fracture were randomly divided into control group (n=34) and nerve protection group (n=23). Patients in these two groups all underwent plate internal fixation treatment. Patients in the nerve protection group underwent precious identifications and dissections of supraclavicular nerve when approaches were being done, carefully protections in the process of internal fixation. The incidence of local numbness, numbness severity, size, degree of influence on life, the improvement of the degree of numbness and pain were compared during the telephone follow-up after 1 year of surgery. RESULTS AND CONCLUSION: Totally 17 patients were followed up in each group. At the time of most serious symptom, 100% of all patients appeared local numbness in the control group, while 16 (94%) patients affected numbness in the nerve protection group. Until the latest follow-up, the number of patients with mild numbness symptoms decreased to 7 (41%) in control group and 3 (18%) in the nerve protection group, but there was no significant difference between the two groups (P > 0.05). The severity of numbness and the degree of influence on daily life all improved over time. These results suggest that local skin numbness is a higher incidence of complications after the internal fixation for clavicle fracture. The protection of the supraclavicular nerve may help the improvement of the long-term numbness symptoms, but not as good as expected.  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 locking plate and anti-rotation intramedullary nail in repair of intertrochanteric fracture in the elderly: 1-year follow-up Tian Geng, Yang Li-li, Wu Yong 2015, 19 (53):  8579-8584.  doi: 10.3969/j.issn.2095-4344.2015.53.009 Abstract ( 458 )   PDF (551KB) ( 445 )   Save BACKGROUND: There are more ways of internal fixation in treatment of elderly intertrochanteric fracture; however, how to choose a fixed way is the key issue of ensuring the efficacy. OBJECTIVE: To compare the therapeutic effect of proximal femoral anti-rotation intramedullary nail and proximal femoral locking plate in the treatment of elderly femoral intertrochanteric fractures. METHODS: Totally 100 patients with femoral intertrochanteric fractures who received the treatment at Qionghai City People’s Hospital from December 2009 to December 2013 were randomly divided into locking plate and anti-rotation intramedullary nail groups. Patients in the anti-rotation intramedullary nail group underwent internal fixation using proximal femoral anti-rotation intramedullary nail. Patients in the locking plate group underwent internal fixation using proximal femoral locking plate. RESULTS AND CONCLUSION: Compared with the locking plate group, the amount of bleeding, operation time, postoperative bed activity time and hospital stay in the anti-rotation intramedullary nail group significantly reduced, the excellent rate of Harris scores was significantly increased after 1 year of internal fixation and the incidence of complications and adverse reactions was significantly decreased. There was no host response to the material in these two groups.  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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Efficacy and safety of posterolateral knee inverted “L” shaped pathway when placing the supporting plate Song Chun-jian, Sun Hui, Yang Guang, Shi Hui-peng 2015, 19 (53):  8585-8590.  doi: 10.3969/j.issn.2095-4344.2015.53.010 Abstract ( 222 )   PDF (575KB) ( 402 )   Save BACKGROUND: Studies have shown that tibial plateau posterolateral fractures can be treated by posterolateral knee approach, however, there is no clear anatomical research to deeply evaluate and analyze this approach. OBJECTIVE: To evaluate the efficacy and safety of posterolateral knee inverted “L” shaped pathway in invloving tibial plateau posterolateral fractures. METHODS: Eight fresh frozen adult corpses, 16 knees side, were all dissected using posterolateral inverted “L” shaped pathway. During the dissection, the exposure range was observed and important parameters of anatomical structure were measured. RESULTS AND CONCLUSION: The pathway may be fully exposed to the posterolateral aspect of tibial plateau and posterior cruciate ligament tibial insertions. The operations completed by out team did not create any obvious interference to superior tibiofibular joint, fibular head and posterolateral corner structure. The exposed mean length of common peroneal nerve in incision was 56.48 mm, with a mean angle of 14.7° tilt towards the axis of the fibula. The mean distance between the neck of the fibular and fibular head tip was 31.26 mm, an average of 42.18 mm to the joint line. The mean distance between the opening of the interosseous membrane and the   articular surface was 48.78 mm. The divergence of the fibular artery from the posterior tibial artery was an average of 76.46 mm from articular surface. These results confirm that posterolateral inverted “L” shaped pathway met the requirements of anatomical reduction and buttress fixation for posterolateral tibial plateau fracture. Exposure of the common peroneal nerve can be minimized or even avoided by modifying the skin incision. Because the popliteal artery branches anterior tibial artery passed through interosseous membrane hole and peroneal artery and then separated from the posterior tibial artery, pathways dissection to distal deep area should be carried out carefully. Placement of a posterior buttressing plate carries a high vascular risk if the plate is implanted beneath these vessels.   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 References | Related Articles | Metrics

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Steinmann pin poking closed reduction axial combined with lateral multiple hollow screws internal fixation in repair of calcaneal fractures Lin Wen-chen, Lin Wei-dong, Wang Yu-xin 2015, 19 (53):  8591-8596.  doi: 10.3969/j.issn.2095-4344.2015.53.011 Abstract ( 311 )   PDF (594KB) ( 388 )   Save BACKGROUND: The treatment of calcaneal fractures using open surgery is likely to cause greater trauma. OBJECTIVE: To explore the clinical effect of steinmann pin poking closed reduction axial combined with lateral multiple hollow screws internal fixation in repair of Sanders II, III type calcaneal fractures. METHODS: The clinical data of 73 patients with Sanders II, III type calcaneal fractures were retrospectively analyzed and divided into conventional group (n=36) and experimental group (n=37) according to the treatment method. Patients in these two groups were respectively treated with conventional open reduction internal fixation and steinmann pin poking closed reduction axial combined with lateral multiple hollow screws internal fixation. RESULTS AND CONCLUSION: Compared with the conventional group, the hospital stays of patients in experimental group were shorter, hospital costs reduced. There were no obvious changes in the foot rating from the American Association of Ankle Injuries, Böhler angle and Gissane angle. The incidence of complications was significantly decreased. These results demonstrate that the treatment of Sanders II, III type calcaneal fractures with conventional open reduction and bone plate internal fixation and steinmann pin poking closed reduction axial combined with lateral multiple hollow screws internal fixation can obtain the basic equivalent clinical effect, however, the treatment of steinmann pin poking closed reduction axial combined with lateral multiple hollow screws internal fixation have more obvious advantages, such as a shorter hospital stays, less hospital costs, and also can effectively control the complications.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Construction of Lenke3 type adult idiopathic scoliosis finite element model and thoracic screw guide target 3D model Xin Da-qi, Huo Hong-jun, Hu Zhen-ming, Yang Xue-jun, Xing Wen-hua, Zhao Yan, Han Di 2015, 19 (53):  8597-8602.  doi: 10.3969/j.issn.2095-4344.2015.53.012 Abstract ( 310 )   PDF (559KB) ( 415 )   Save BACKGROUND: Studies have shown that posterior orthopedic internal fixation and anterior orthopedic internal fixation all can get good clinical outcomes for treatment of adult idiopathic scoliosis, however, it has not been reported on what kind of methods could achieve a better clinical outcome for treatment of Lenke3 type adult idiopathic scoliosis, have less risk of pedicle screws breakage and more reliable long-term efficacy.   OBJECTIVE: To establish the Lenke 3 type adult idiopathic scoliosis finite element model and thoracic screw guide target 3D model using finite element analysis software, so as to provide scientific basis for biomechanical analysis and scientific pedicle screw implantation. METHODS:The CT scan image from T1 to sacrum of one 28 years old volunteer with Lenke 3 type adult idiopathic scoliosis was imported into Mimics 16.0 software by Dicom form. Integral idiopathic scoliosis three dimensional model was established by geometry clear technology. Nail guide target of thoracic vertebra was established on vertebral model by design module in Mimics 16.0 software. The point cloud form of three dimensional model was imported into Geomagic Studio 11.0 software. Series of image processing of model were conducted. At last, three dimensional model was imported into ANSYS 14.0 finite element analysis software in order to build finite element model with biological properties. RESULTS AND CONCLUSION: Complete Lenke 3 type adult idiopathic scoliosis three dimensional finite element model was established successfully. It concluded 440 975 tetrahedron units and 580 bar units, totally 441 555 units and 1 077 318 nodes. Totally 12 nail guide target models of thoracic vertebra were established, including 4 682 tetrahedron units and  7 390 nodes. Lenke 3 type adult idiopathic scoliosis three dimensional finite element model and nail guide target of thoracic vertebral model with a realistic appearance were established successfully in this experiment. These results confirm that Lenke 3 type adult idiopathic scoliosis three dimensional finite element model provides scientific basis for further biomechanical experiments. Meanwhile, the construction of nail guide target model of thoracic vertebra provide a new scientific method for thoracic pedicle screw placement.   中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Dynamic hip screw and Gamma nail fixation repair unstable intertrochanteric fracture: a three-dimensional finite element analysis Huang Xiao-wei, Yu Bao-qing, Li Ze-xiang, Ao Rong-guang 2015, 19 (53):  8603-8608.  doi: 10.3969/j.issn.2095-4344.2015.53.013 Abstract ( 307 )   PDF (566KB) ( 318 )   Save BACKGROUND: For unstable intertrochanteric fracture repair, there are two views: extramedullary fixation or intramedullary fixation. Theoretically, intramedullary fixation is in line with the principles of minimally invasive, more mechanical and biological advantages. However, evidence-based medicine and related studies have shown that compared with the extramedullary fixation, intramedullary fixation did not reflect the proper theoretical advantage. OBJECTIVE: To compare the biomechanical performance of two kinds of internal fixation systems: dynamic hip screw and Gamma nail which commonly used in repair of intertrochanteric fractures by finite element method, and to evaluate the advantages and disadvantages of dynamic hip screw and Gamma nail in treatment of unstable intertrochanteric fracture.    METHODS: Three-dimensional finite element model of human femur unstable intertrochanteric fractures (31-A2; AO fracture classification), and the three-dimensional finite element models of dynamic hip screw and Gamma nail were established respectively, and were fixed according to the requirement of orthopedic surgery. The reference load which the joint bearing was at the peak time in adult step state period with the body mass of 700 N was stimulated. The stress distribution of bone, bone-internal fixation model, nail or screw, the strain and deformation of fracture location on the surface of the bone and bone-internal fixation model, the stress distribution along the femur and the loading transfer condition along the internal fixator and the like were analyzed. RESULTS AND CONCLUSION: Dynamic hip screw and Gamma nail have good sliding compression features which could make the continuous and dynamically axial compression of the fractured section. Under the load conditions, the displacement value of dynamic hip screw was larger. In the treatment of unstable intertrochanteric fracture, Gamma nail was stronger than dynamic hip screw. Two kinds of internal fixations all make the bearing load of the proximal femur reduce. In the treatment of 31-A2 type unstable intertrochanteric fractures, we should choose dynamic hip screw for fixation if the femoral calcar was not seriously crushed, little defect or no defects and can immediately rebuild the stability of femoral calcar during operation, otherwise, stronger internal fixation, namely Gamma nail fixation should be chosen.   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 random forest algorithm in terrain recognition to control active above-knee prosthesis Zhang Yan, Gao Xin, Chen Ling-ling, Zhang Hao-miao 2015, 19 (53):  8609-8614.  doi: 10.3969/j.issn.2095-4344.2015.53.014 Abstract ( 303 )   PDF (640KB) ( 1199 )   Save BACKGROUND: In the research of the active above-knee prosthesis, the existing motion pattern recognition methods have shown promising results, but the further improvement of the recognition accuracy and the reduction of the response time are still necessary. OBJECTIVE: To establish a terrain recognition system based on the random forest algorithm, achieve the identification of the front terrain, and obtain the motion mode of the subject on the terrain for the control of artificial limb. METHODS: A laser distance sensor and an inertial measurement unit sensor were fixed on the waist to collect the terrain information and human motion signals. The collected data were filtered and the characteristic values were extracted from the data. The random forest algorithm was applied in the establishment of the classifier, which was used to recognize the terrain. RESULTS AND CONCLUSION: The results showed that the terrain recognition system could recognize level ground, stair ascent/descent and ramp ascent/descent at a high accuracy, which could contribute to the control of the active above-knee prosthesis.   中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Stress analysis between “X”-shaped spine dynamic fixation and traditional pedicle screw fixation  Wang Yu, Mei Ji-wen, Mu Shang-qiang, Gao Feng, Huang Rui 2015, 19 (53):  8615-8620.  doi: 10.3969/j.issn.2095-4344.2015.53.015 Abstract ( 300 )   PDF (595KB) ( 270 )   Save BACKGROUND: Many scholars have developed a variety of dynamic elastic spine fixator. After biomechanical research, animal experiments and clinical application found that no one elastic spine fixator was generally recognized clinically. OBJECTIVE: To compare the stress difference between “X”-shaped spine dynamic fixation and traditional pedicle screw fixation. METHODS: Three-dimensional finite element models of “X”-shaped spine dynamic fixation and traditional pedicle screw fixation were established according to adult spine imaging data. Mechanical differences in vertical compression, flexion, extension, lateral bending and rotation were compared between the two groups.  RESULTS AND CONCLUSION: The stress at vertical compression was lower than that at flexion, extension, lateral bending and rotation in both groups. The stress at “X”-shaped spine dynamic fixation mainly focused on “X”-shaped connecting rod, but the stress of traditional pedicle screw fixation mainly focused on conjunction of screw-rod. Moreover, the stress of the screw of “X”-shaped spine dynamic fixation was significantly less than that of traditional pedicle screw fixation (P < 0.001). These results suggest that “X”-shaped spine dynamic fixation system can share stress of screws and reduce the postoperative stress concentration compared with traditional pedicle screw 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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Balloon vertebroplasty repairs vertebral compression fractures: biomechanical analysis Li Song-bai, Zhang Yuan-jin, Sun Fa-rui 2015, 19 (53):  8621-8626.  doi: 10.3969/j.issn.2095-4344.2015.53.016 Abstract ( 301 )   PDF (517KB) ( 425 )   Save BACKGROUND: For vertebral compression fractures treated by balloon vertebroplasty, there were still controversies in biomechanical and clinical studies about adjacent vertebral fractures is the result of osteoporosis progress, or the result of vertebral intervention and strengthening by injecting bone cement. More accurate conclusions can be obtained through more in-depth research and long-term follow-up. OBJECTIVE: To evaluate the effect of balloon vertebroplasty on biomechanical properties of vertebral body with compression fractures and unstrengthened adjacent vertebral body. METHODS: Totally 40 pig specimens with vertebral compression fractures were prepared and randomly divided into study and control groups. Specimens in the study group were subjected to balloon vertebroplasty. Specimens in the control group only wrapped with normal saline gauze. The biomechanical properties (vertebral height, maximum load), stress, strain and displacement values of specimens under 500 N loading in these two groups were compared. The stress and strain values of unstrengthened adjacent vertebral body before and after the balloon vertebroplasty in the study group were measured, and compared with the control group. RESULTS AND CONCLUSION: Compared with the original height, specimens in the study group can restore to its original height after balloon vertebroplasty, the differences were not significant (P > 0.05). The former, back, left and right vertebral height in the study group were significantly higher than those in the control group (P < 0.01). After the bone cement augmentation, the stiffness of vertebral body in the study group was significantly lower than that in the control group, the maximum loading was significantly increased compared with that in the control group (P < 0.05). Under a fixed loading of 500N, compared with the control group, the disc displacement value after the balloon vertebroplasty was significantly reduced and the disc strain and stress values were significantly increased in the study group (P < 0.05). There were no significant differences in the strain and stress values of the unstrengthened adjacent vertebral body before and after the balloon vertebroplasty in the study group (P > 0.05). There were no significant differences in the strain and stress values of the unstrengthened adjacent vertebral body after the balloon vertebroplasty between study group and control group (P > 0.05). These results suggest that vertebral maximum loading and stiffness recover well after the treatment of balloon vertebroplasty for vertebral compression fractures, which can achieve the effect of preventing vertebral fractures again. Meanwhile, balloon vertebroplasty treatment can not alter the biomechanical properties of adjacent vertebrae, and it is difficult to influence and lead vertebral fractures again, with a better security.  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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Measurement and comparison of the digital anatomy of the tibia proximal part for the Han and Mongolian nationality Zhang Zhi-feng, Zhao Zhen-qun, Huang Jian, Hou Bo, Wei Jing, Wang Xing, Zheng Lei-gang 2015, 19 (53):  8627-8632.  doi: 10.3969/j.issn.2095-4344.2015.53.017 Abstract ( 331 )   PDF (566KB) ( 355 )   Save BACKGROUND: In the process of designing knee joint prosthesis and operating total knee arthroplasty for the Chinese people, we should not only take into account the proximal tibial anatomical characteristics and the difference of geometry, but also should pay attention to the differences between different races. OBJECTIVE: To compare the anatomical morphological differences between Mongolian and Han nationality through measuring the CT tomography scanning and three-dimensional reconstruction measurement of tibia proximal part of Han and Mongolian nationality, so as to provide the data references for prosthesis selection used for total knee arthroplasty. METHODS: Totally 60 patients who received the treatment at the Department of Joint Surgery were collected, and divided into Han nationality and Mongolian nationality groups (n=30/group, 15 males and 15 females in each group). The age was (36.00+7.22) years old. 16-row helical CT scan (American GE Lightspeed 16) was used for spiral scanning, slice thickness 0.625 mm. Scanning images were exported in DICOM format and saved. Digital three-dimensional reconstruction measurement was conducted using Mimics 15.0 three-dimensional reconstruction software. The tibial plateau width, anteroposterior diameter of the medial tibial plateau and lateral anteroposterior diameter were measured respectively to observe whether there were any differences among sex, sides and nationality. RESULTS AND CONCLUSION: There were no significant differences in the above indicators between left and right sides (P > 0.05). There were significant differences in tibial plateau width, anteroposterior diameter of the medial tibial plateau and lateral anteroposterior diameter between males and females, and Han and Mongolian nationality groups (P < 0.05). Specific performed in: (1) There was significant difference in the morphological measurement parameters of proximal tibia between sex for Han and Mongolian nationality, and the mean value of male was larger compared with that of female. (2) There was certain significant difference in the part of the parameter indicators between Han and Mongolian nationality groups. These results suggest that the prosthesis should be chose and placed correctly according to the differences of morphological characteristics, gender, nationality, region of the Chinese people. (3) Digital three-dimensional reconstruction technology and individualized design can choose suitable prosthesis for different people, so as to ensure a good repair effect in patients after total knee 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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Management of perioperative main risks for total joint arthroplasty in patients with rheumatoid arthritis Gao Zhan-wang, Zhen Ping 2015, 19 (53):  8664-8669.  doi: 10.3969/j.issn.2095-4344.2015.53.019 Abstract ( 381 )   PDF (579KB) ( 638 )   Save BACKGROUND: Patients with rheumatoid arthritis have high cardiovascular disease risks and postsurgical complications such as postoperative infection and wound healing problems in the process of total joint arthroplasty. OBJECTIVE: To retrospectively review the peri-operative risks when undergoing total joint replacement in patients with rheumatoid arthritis, and assess these risks, propose solutions to guide clinical practice for better peri-operative management. METHODS: The studies related with perioperative cardiovascular risk, the risk of infection of total joint replacement were retrieved by the first author from PubMed database, GOOGLE academic database, CNKI database, Wanfang database, VIP database from 2000 to 2015 through computer. The key words in English and Chinese were respectively “Rheumatoid arthritis, Total joint arthroplast, Perioperative management, Infection, Postsurgical complications, Corticosteroid, Disease modifying antirheumatic drugs, Biologics”. Old and repetitive studies were excluded.   RESULTS AND CONCLUSION: A total of 97 articles were retrieved. Totally 53 articles which content was inconsistent with the research themes were excluded, and 44 papers were included in the analysis. We should make a comprehensive cardiovascular examination for the patients with rheumatoid arthritis before operation. If the cardiovascular disease of the patient is unstable, this condition should be clarified and treated appropriately before surgery, otherwise, patients need to check heart function, and predict the operation risk; We should reasonably arrange the anti-rheumatism medicines and corticosteroid during perioperative, so as to make a balance between reducing postoperative infection and preventing the condition relapse; Because rheumatoid arthritis often easy to erode the cervical spine, we should conduct routine imaging examination for the patients before total joint replacement. Movement should be gentle when general anesthesia was needed.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程   References | Related Articles | Metrics

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A meta-analysis of expandable intramedullary nail versus interlocking intramedullary nail for treatment of tibia fracture Wang Wen-da, Jin Qi, Ruan Wen-feng, Ping An-song 2015, 19 (53):  8670-8676.  doi: 10.3969/j.issn.2095-4344.2015.53.020 Abstract ( 215 )   PDF (488KB) ( 405 )   Save BACKGROUND: At present, a large number of studies have proved that the expandable intramedullary nail and interlocking intramedullary nail are effective in treatment of limb fractures. However, for the treatment of tibial fractures, the advantages and disadvantages of the two kinds of fixation methods are still inconclusive. OBJECTIVE: To systematically review the effectiveness and safety of expandable intramedullary nail and interlocking intramedullary nail for treatment of tibia fracture. METHODS: We searched PubMed, Embase, The Cochrane Library (Issue 1, 2015), CBM, CNKI, VIP and WanFang Data for articles concerning randomized controlled trials on expandable intramedullary nail versus interlocking intramedullary nail published from inception to January 1, 2015. The key words were “tibia, fracture, tibia fracture, tibia fractures, expandable intramedullary nail, expandable nail, intramedullary nail, interlocking intramedullary nail”. Meta-analysis was performed using RevMan 5.2 software. RESULTS AND CONCLUSION: Ten randomized controlled trials involving 574 patients were included. The results of meta-analysis showed that, compared with interlocking intramedullary nail, expandable intramedullary nail was shorter in operation time [MD=-23.42, 95%CI (-26.94, -19.90), P < 0.000 01], less in intraoperative hemorrhage [MD=-47.64, 95%CI (-52.21, -43.09), P < 0.000 01], less in fluoroscopy times [MD=-1.40, 95%CI (-1.49, -1.30), P < 0.000 01], shorter in union time [MD=-30.84, 95%CI (-35.27, -26.41), P < 0.000 01], and less in incidence of complications [OR=0.20, 95%CI (0.10, 0.40), P < 0.000 01]. The Johner-Wruh scores showed on significant difference. These findings suggest that expandable intramedullary nail for tibia fracture has more advantages than interlocking intramedullary nail. That is to say, the expandable intramedullary nail is an improved nail of interlocking intramedullary nail, but a large sample of high quality randomized controlled trials are still needed to confirm the conclusion.   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 locking plate for treating femoral intertrochanteric fractures: a systematic review Wang Feng, Li Zhen-wu, Yin Rui-feng, Li Zhi-an 2015, 19 (53):  8677-8684.  doi: 10.3969/j.issn.2095-4344.2015.53.021 Abstract ( 260 )   PDF (591KB) ( 303 )   Save BACKGROUND: Proximal femoral locking plate and proximal femoral nail anti-rotation are the two common methods for the treatment of femoral intertrochanteric fractures in clinic. However, there were few randomized controlled trials on the comparison of both methods. Most of them are retrospective case analysis, and short of systematic evaluation. OBJECTIVE: To systematically evaluate the clinical outcomes and safety between locking compression plate and proximal femoral nail anti-rotation for the treatment of the femoral intertrochanteric fractures. METHODS: The Cochrane Library (No.2 in 2015), PubMed(1966-01/2015-06), MEDLINE (1966-01/2015-06), EMbase (1984-01/2015-06), CNKI (1979-01/2015-06), VIP(1989-01/2015-06)and WanFang Data(1990-2015)were searched by computer. Meanwhile, relevant literature from the relevant journals and references were searched by hand. All the randomized controlled trials concerning locking compression plate   and proximal femoral nail anti-rotation for the treatment of the femoral intertrochanteric fractures were collected. The literature was strictly filtered out according to the inclusion criteria, and was strictly evaluated for the quality. Meta-analysis on the included results was performed with RevMan5.2 software from the Cochrane collaboration. RESULTS AND CONCLUSION: There were 54 potentially relevant papers, and finally, 11 randomized controlled trials were eligible for this investigation. A total of 917 patients were included containing locking compression plate group (464 cases), proximal femoral nail anti-rotation group (453 cases). The Meta-analysis results showed that there were no significant differences in Harris scores, excellent rate, complications, fracture healing time and hospital stays after treatment between the locking compression plate and proximal femoral nail anti-rotation groups. However, there were significant differences in the time of operation [MD=15.80，95% CI(7.57-24.04), P =0.000 2], peri-operative blood loss [MD=98.01, 95% CI(58.57-137.44)，P < 0.01], ambulation loading time [MD=8.07，95% CI(3.02-13.12)，P=0.002], the length of incision [MD=6.90，95% CI(1.07-12.73), P=0.02] and postoperative drainage volume [MD=41.85，95% CI(23.77-59.93)，P < 0.01]. These results suggest that the treatment of proximal femoral nail anti-rotation had shortened the length of incision and the time of operation. The treatment of locking compression plate took more time of ambulation loading time, more peri-operative blood loss and postoperative drainage volume. Because the number of cases which this study included are few, and the follow-up time was shorter, we should design stricter large sample randomized controlled studies in future increase the strength of the evidence by conducting medium and long-term follow-up.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Diabetes and complications of spinal surgery: a meta-analysis of comparative or controlled studies Lin Qiao, Li Zhao-wei, Qian Xuan-kun, Jiang Jin, Wang Jian-min 2015, 19 (53):  8685-8692.  doi: 10.3969/j.issn.2095-4344.2015.53.022 Abstract ( 330 )   PDF (537KB) ( 395 )   Save BACKGROUND: Currently, discectomy, fusion or decompression is considered an effective and conventional method for the treatment of spinal disease. Although there have been many reports on the adverse effects of diabetes on spinal surgery, but there are still some differences. OBJECTIVE: To systematically evaluate the observational studies and case-control studies about the effect of diabetes on the complications of spinal surgery. METHODS: The controlled and comparative studies regarding the effect of diabetes on the results and complications of spinal surgery were searched from the database according to the inclusion criteria. The observed indicators including mortality, revision rate, surgical site infection, the incidence of venous thrombosis, blood loss, operative time and hospitalization time. Two authors participated in extracting the data and evaluating the methodology and quality of the included studies. Meta-analysis was conducted according to the guidelines of epidemiological observational studies (MOOSE). The risk assessment of the extracted data was conducted using RevMan 5.2 software. RESULTS AND CONCLUSION: Eighteen literatures, involving 2 824 063 patients, were eventually enrolled. The  experimental result showed that the mortality, surgical site infection, incidence of venous thrombosis of diabetic patients after the spinal surgery were significantly higher than those of non-diabetic patients; the hospital stay was significantly longer than that of non-diabetic patients (P < 0.05). There were no significant differences in the risk of revision, intraoperative blood loss and operation time between diabetic patients and non-diabetic patients (P > 0.05). These results suggest that diabetic patients take a higher risk once accepting the spinal surgery than the non-diabetic patients. Diabetes increases the risks of postoperative mortality, surgical site infection, venous thrombosis and hospitalization time after spinal surgery.   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