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22 April 2016, Volume 20 Issue 17 Previous Issue    Next Issue

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Intra-articular and intravenous injection of tranexamic acid effectively reduces blood loss after total knee arthroplasty Xu Jian, Ha Cheng-zhi, Tian Shao-qi, Wang Yuan-he, Liu Ning-ning, Sun Kang 2016, 20 (17):  2437-2442.  doi: 10.3969/j.issn.2095-4344.2016.17.001 Abstract ( 407 )   PDF (405KB) ( 407 )   Save BACKGROUND: Studies have shown that tranexamic acid can effectively reduce postoperative blood loss in patients with total knee arthroplasty. There are many means to inject tranexamic acid (intra-articular injection, intravenous injection and their combination). Which is the best way has no conclusion. OBJECTIVE: To explore whether all three ways (intra-articular injection, intravenous injection and their combination) to inject tranexamic acid can all effectively reduce the bleeding after total knee arthroplasty. METHODS: 103 patients undergoing unilateral total knee arthroplasty from December 2014 to December 2015 were enrolled in this study. The patients were allocated into four groups according to injection way. In the intra-articular injection group, 2 000 mg of tranexamic acid was given through the intra-articular injection after incision suture. In the intravenous injection group, 1 000 mg of tranexamic acid was given through the intravenous injection at 15 minutes before the use of tourniquet. In the combined modality therapy group, above methods were used. In the blank control group, tranexamic acid was not given. RESULTS AND CONCLUSION: (1) Total blood loss and blood transfusion rate were less in the intra-articular injection group and combined modality therapy group than in the intravenous injection group (P < 0.05). The total blood loss was more in the intra-articular injection group than in the combined modality therapy group (P > 0.05). The blood transfusion rate was 0% in the intra-articular injection group and combined modality therapy group. (2) Adverse reaction: deep vein thrombosis, pulmonary embolism, wound infection, hematoma or gangrene was not observed in all groups. (3) Results confirmed that intra-articular combined with intravenous injection can reduce effectively postoperative blood loss and the effect is better than separate administration.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Modified design of biotype self-locking hip joint prosthesis Huang Wei-tao, Li Cai-hua, Jiang Tuo, Yang Jun 2016, 20 (17):  2443-2450.  doi: 10.3969/j.issn.2095-4344.2016.17.002 Abstract ( 520 )   PDF (889KB) ( 478 )   Save BACKGROUND: Hip prosthesis needs to meet the good structural compatibility with femoral bone marrow cavity and the biomechanical properties of the original bone tissue. However, the difference of individual anatomical characteristics and the stress concentration in the local area after replacement directly affect postoperative combination of femoral prosthesis stem, force flow transfer and femoral reconstruction, and finally result in aseptic loosening of hip joint in some patients. OBJECTIVE: To analyze the biomechanical characteristics of modified biotype self-locking hip prosthesis by the method of finite element analysis, and to provide the reference for the application of self-locking hip prosthesis in hip replacement. METHODS: Experimental design contained traditional biotype hip joint prosthesis group and self-locking hip joint prosthesis group. In accordance with the finite element models of self-locking hip prosthesis, 28 kinds of screw fixation were established. Three-dimensional models were generated in the Minics system. After the optimization of prosthesis, prosthesis was designed. In the Solidworks software, the femur was re-positioned and set for contacting set in Ansys to analyze the stress distribution and displacement distribution of the femoral-prosthesis-screw by Ansys. We compared the peak of stress and displacement of the femur and prosthesis, and analyzed the biomechanical stability of prosthesis. Huang Wei-tao, Associate chief physician, Shunde Hospital of Traditional Chinese Medicine, Foshan 528333, Guangdong Province, China RESULTS AND CONCLUSION: (1) By using the Ansys finite element method, we analyzed the stress and displacement distribution of the femoral-prosthesis-screw. The minimum stress peak value of the femur was 15.698 MPa. The minimum stress peak value of prosthesis was 45.491 MPa. The minimum stress peak value of screw was 8.359 MPa. The minimum displacement peak value of femur was 1.125 3 mm. The minimum displacement peak value of prosthesis was 1.039 6 mm. The minimum displacement peak value of screw was 0.566 4 mm. (2) Compared with the traditional biotype hip joint prosthesis group, in 28 kinds of self-locking hip joint prostheses, the stress was minimum in the group E. The displacement was minimum in groups A-F. Regarding comprehensive stress and displacement, groups A-F were the best combination. The maximum stress of femoral-prosthesis-screw was 18.936, 59.494 and 12.382 MPa. The maximum displacement of femoral-prosthesis-screw was 1.125 3, 1.039 6 and 0.626 3 mm. (3) These findings indicated that the stress and displacement parameters of groups A-F was the best parameter combination in 28 kinds of self-locking hip joint prostheses, and it is the recommended index of researching and developing self-locking hip 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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Finite element analysis of femoral prosthesis implant in total knee arthroplasty: positioning parameters and clinical optimization Xu Gao-wei, Dong Bin, Cui Hai-yong, Ma Qiang 2016, 20 (17):  2451-2458.  doi: 10.3969/j.issn.2095-4344.2016.17.003 Abstract ( 492 )   PDF (445KB) ( 474 )   Save BACKGROUND: Three-dimensional finite element simulation has been widely used in biomechanics. However, there is little research in knee joint replacement. The study of femoral prosthesis is less.  OBJECTIVE: To analyze the optimal positioning parameters of knee replacement and femoral prosthesis implantation, and to verify the efficacy of Gemini-PS knee prosthesis in total knee arthroplasty.  METHODS: (1) Knee finite element model in total knee replacement was constructed. Orthogonal experiment was performed in femoral osteotomy positioning parameters. The shift amount A, external rotation degree B, and valgus degree C of femoral prosthesis were selected as the relevant factors for orthogonal experiment. Three values were taken for each parameter to establish orthogonal tables. Nine experimental combined knee replacement finite element models were created and analyzed with finite element. Analysis of variance and range analysis were used by optimization. (2) Totally 42 patients (47 knees) with knee osteoarthritis received total knee arthroplasty with Gemini-PS knee joint prosthesis. Knee joint function was evaluated after replacement with Hospital for Special Surgery knee score and American Knee Society knee score. Knee pain was assessed with Visual Analogue Scale score.  RESULTS AND CONCLUSION: (1) Minimal polyethylene substrate surface compressive stress peak was translation 0 mm, external rotation of 3°, valgus 6°; the peak stress was 15.9 MPa. Among the influential factors, the effects of internal and external translation were larger than that of external rotation angle, and greater than that of valgus angle. The optimal positioning parameter combination was pan 0 mm, external rotation 3°, valgus 6° by range analysis and variance analysis. Orthogonal experiment was valid by simulation. (2) 42 patients were followed up for 12-36 months. One patient affected subcutaneous fat liquefaction of the lower segment of the incision. Hospital for Special Surgery knee score and American Knee Society knee score were significantly higher after implantation (P < 0.05). Visual Analogue Scale score was significantly lower after replacement (P < 0.05). X-ray films showed that osteolysis, dislocation or loosening was not found. The recovery of knee joint was good after operation. (3) These findings suggest that small changes in the site of femoral prosthesis implantation can cause abnormal distribution of polyethylene liner surface stress peaks. Accurate positioning of femoral prosthesis in total knee arthroplasty can achieve better clinical results.  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 Deluxe-PS and PFC Sigma RP prostheses in knee joint replacement Sun Feng-long, Zhang Yao-hua, Li Qiang, Li Fu, Dong Ming 2016, 20 (17):  2459-2466.  doi: 10.3969/j.issn.2095-4344.2016.17.004 Abstract ( 742 )   PDF (1166KB) ( 744 )   Save BACKGROUND: During artificial knee replacement for all kinds of severe knee disease or conservative treatment for end-stage knee disease, Deluxe-PS knee prosthesis and PFC Sigma RP knee prosthesis have their advantages. OBJECTIVE: To compare and analyze the matching of the Deluxe-PS and PFC Sigma RP knee prostheses with bone cross section. METHODS: According to the use of the knee prosthesis, 87 gonarthritis patients undergoing bilateral knee replacement were divided into two groups. 46 cases in the test group received Deluxe-PS knee prosthesis replacement. 41 cases in the control group received PFC Sigma RP knee prosthesis replacement. Operation time and intraoperative blood loss were compared between the two groups. American Knee Society score, knee score of American Special Surgical Hospital and knee joint range of motion were used to evaluate knee joint function before replacement, 3 months after replacement and during final follow-up. Anteroposterior X-ray films were obtained after replacement to measure valgus angle and flexion angle of femoral prosthesis. RESULTS AND CONCLUSION: (1) Operation time and intraoperative blood loss were significantly better in the test group than in the control group (P < 0.05). (2) No significant difference in American Knee Society score, knee score of American Special Surgical Hospital and knee joint motion was detected between the two groups before replacement and 3 months after replacement (P > 0.05). Above indexes were significantly improved in both groups at 3 months after replacement and during final follow-up (P < 0.05). (3) No significant difference in valgus angle and flexion angle of femoral prosthesis was identified between test and control groups during final follow-up (P > 0.05). (4) These findings indicate that effect of Deluxe-PS type artificial knee prosthesis was identical to that of PFC Sigma RP knee prosthesis in knee osteoarthritis patients receiving bilateral knee joint replacement. Deluxe-PS type artificial knee prosthesis can perfectly realize high-accuracy combination of the prosthesis and the bone cross section, and enhance the fusion suitability of the prosthesis and the bone surface. Deluxe-PS type artificial knee prosthesis has the advantage of operation. This advantage is possibly because Deluxe-PS type artificial knee prosthesis is more in line with the anatomical structure of the knee joint of Chinese.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Characteristics of rotating high-flexion prosthesis for the middle-aged patients with knee osteoarthritis in total knee replacement Qiu Li-biao, Peng Wei-qiu, Li Fu-ming, Cheng Ke-lin, Wei Zhao-lan, Wei Zhao-xi 2016, 20 (17):  2467-2473.  doi: 10.3969/j.issn.2095-4344.2016.17.005 Abstract ( 468 )   PDF (1018KB) ( 522 )   Save BACKGROUND: Total knee replacement is the main treatment for the end of the knee joint disease. How to choose prosthesis replacement according to the different situations of the patient is one of the focuses in the field of joint surgery. OBJECTIVE: To evaluate middle or short term effects of rotating high-flexion prosthesis for the middle-aged patients with osteoarthritis of knee in total knee replacement. METHODS: We retrospectively analyzed 48 osteoarthritis patients (55 knees) undergoing total knee replacement with rotating high-flexion prosthesis in the Liuzhou People’s Hospital from January 2009 to January 2013. RESULTS AND CONCLUSION: (1) Forty-eight patients were followed up for 23-42 months, mean (24±2.7) months. (2) Knee range of motion and Hospital for Special Surgery knee score were significantly increased after implantation. The excellent and good rate of Hospital for Special Surgery knee score was 85.4%. (3) No infection, loosening or dislocation occurred in all patients. (4) These findings suggest that curative effect of rotating high-flexion prosthesis is definite. After implantation, the range of motion was high, which was accorded with movement pattern of the human body. Prosthesis has a long life, and its repair rate is low. It is an ideal method for the middle-aged patients who want to perform high-flexion activities.  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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Risk of deep venous thrombosis among patients undergoing knee arthroscopy based on Caprini risk assessment Xu Liu-hai, Zeng Yong, Huang Wei, Wang Mao-peng, Que Xiang-yong, Yi Chun-yan 2016, 20 (17):  2474-2480.  doi: 10.3969/j.issn.2095-4344.2016.17.006 Abstract ( 674 )   PDF (898KB) ( 620 )   Save BACKGROUND: After arthroscopic knee surgery, deep vein thrombosis easily occurs. Currently, there were no specific clinical manifestations in deep vein thrombosis, so a fast, convenient and reliable risk assessment tool was needed to evaluate the clinical high-risk groups for prevention and intervention. The effectiveness of Caprini Risk Assessment Scale used in thrombosis risk assessment has been confirmed by a large number of researches, but the current domestic research is less.  OBJECTIVE: To verify the validity of Caprini risk assessment scale in evaluations of high deep venous thrombosis risk patients among knee arthroscopy patients, and to explore effective strategies for prevention of deep vein thrombosis in patients undergoing knee arthroscopic surgery. METHODS: A case-control study design was used to collect 49 deep vein thrombosis patients admitted to the Department of Orthopedics, Renhe Hospital of Three Gorges University from January 2008 to June 2015 as case group, and randomly selected 98 patients admitted during the same period of non-deep vein thrombosis patients as control group. Caprini risk assessment scale was used to assess risk assessment and risk grading of deep venous thrombosis, and to explore the correlation between risk classification and risk of deep vein thrombosis. RESULTS AND CONCLUSION: (1) Basic conditions comparison: application time of tourniquet, the proportion of smoking patients, and proportion of deep venous thrombosis and (or) the history of pulmonary thromboembolism were higher in the case group than in the control group (P < 0.05). (2) Caprini score was significantly higher in the case group than in the control group (P < 0.001). In the case group, the proportion of very high risk patients (53%) was highest, followed by high risk (25%), totally 78%. In the control group, the proportion of high risk patients (32%) was highest, followed by low risk (29%). Significant differences in above risk degree analysis were identified between the two groups (P < 0.001). (3) Deep venous thrombosis and (or) the history of pulmonary thromboembolism was positively correlated with Caprini score in the case and control groups (P < 0.05). Caprini score was positively associated with application time of tourniquet in the case group (P < 0.05). (4) Logistic regression analysis of Caprini risk classification and the risk of deep vein thrombosis: with increased caprini risk classification, the risk of deep vein thrombosis increased significantly. The risk of deep venous thrombosis in patients with high risk and very high risk was 2.130 and 11.786 times of patients with low risk, respectively. (5) These results indicate that Caprini risk assessment model can effectively assess the risk of deep vein thrombosis among patients receiving knee arthroscopy. 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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Severe kyphosis in thoracolumbar fracture patients with injured intervertebral disc after posterior fixation Wei Xiao-dong, Song Hong-liang, Gong Wei-ming, Jia Tang-hong 2016, 20 (17):  2481-2487.  doi: 10.3969/j.issn.2095-4344.2016.17.007 Abstract ( 623 )   PDF (874KB) ( 468 )   Save BACKGROUND: Thoracolumbar fracture often accompanies with the injury of adjacent intervertebral disc. Traditional posterior short-segment fixation does not deal with the injured intervertebral disc, which may be the main reason for kyphosis in patients after surgery. OBJECTIVE: To investigate the effect of injured intervertebral disc on kyphosis angle in patients with single vertebral thoracolumbar fracture after treated with posterior short-segment fixation alone. METHODS: From January 2009 to June 2014, 40 cases of thoracolumbar fractures were treated in Jinan Central Hospital. They were followed-up at preoperation, 2 and 12 months after operation and 6 months after internal fixation removal. Data were obtained from X-ray and MRI scanning. According to the preoperative MRI images, cases were assigned to observation group (17 cases) and control group (23 cases) according to injury and non-injury intervertebral disc. Data of vertebral wedge angle, sagittal plane kyphosis, proximal intervertebral disc angle, sagittal index and degeneration classification of proximal intervertebral disc angle from two different groups were analyzed at each follow-up time point (18-30 months, averagely 23.6 months). RESULTS AND CONCLUSION: (1) Imaging parameters: sagittal plane kyphosis was significantly severer at 6 months than that at 2 months in both groups (P < 0.05). Sagittal plane kyphosis, proximal intervertebral disc angle and sagittal index were greater in the observation group than in the control group at 12 months after surgery and 6 months after fixator removal (P < 0.05). (2) Degeneration classification of proximal intervertebral disc angle: Pearce degeneration grade of proximal intervertebral disc was significantly higher in the observation group than in the control group at 2 months after surgery and 6 months after internal fixation removal (P < 0.05). (3) Results suggested that kyphosis may appear in the patients with thoracolumbar fracture after a posterior short-segment fixation alone, and the injured disc may lead to more severe kyphosis.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Pedicle screw fixation for thoracolumbar fracture with spinal cord injury: a comparison of the selective injury segment and the whole bone graft fusion Shi Xiao-lin, Zhang Hao, Liu Lei, Shi Xiao-dong, Jin Xiao-ning, Liu Qing-ge, Yuan Wei-dong 2016, 20 (17):  2488-2495.  doi: 10.3969/j.issn.2095-4344.2016.17.008 Abstract ( 311 )   PDF (1208KB) ( 418 )   Save BACKGROUND: Spinal canal decompression is needed in posterior pedicle screw fixation surgery for thoracolumbar burst fractures combine with spinal cord injury. The structure of posterior spine is often damaged. The posterolateral bone fusion in all fixed segment is still the main surgery. In order to further reduce fusion segment and maintain motor unit, it is necessary to perform selective segmental bone graft fusion during fixation and decompression.  OBJECTIVE: To discuss the advantages of selective posterolateral vertebral fusion for thoracolumbar fracture with spinal injury through comparing with posterolateral vertebral fusion. METHODS: Data of 83 thoracolumbar burst fracture cases, who received posterior lumbar decompression and short segment fixation with pedicle screws and bone graft through injured vertebra from January 2006 to July 2013, were analyzed retrospectively. According to fusion segments, above patients were divided into selective posterolateral vertebral fusion group (n=42) and the whole posterolateral vertebral fusion group (n=41). Perioperative index, internal fixation, vertebral height loss rate, Cobb angle, spinal nerve recovery and Oswestry Disability Index were compared between the two groups.  RESULTS AND CONCLUSION: (1) All cases were followed up for 25-32 months. (2) There was no statistical significance in operation time, intraoperative blood loss and ambulation time between the two groups (P > 0.05). Postoperative drainage volume was less in the selective posterolateral vertebral fusion group than in the whole posterolateral vertebral fusion group (P < 0.05). Before removal of fixator, there was no loosened fixator or breakage of screw or stick. (3) There were improvements in the rate of vertebral front height loss and Cobb angle in both groups at various time points after operation (P < 0.05). There was no statistical significance in the rate of vertebral front height loss and Cobb angle in both groups (P > 0.05). (4) There was no significant difference in fusion rate at 6 months after treatment between the two groups (P > 0.05). Fusion was achieved in both groups before removal of the fixator. (5) Spinal nerve recovery was found after treatment in both groups. No significant difference in Oswestry Disability Index was detected in final follow-up (P > 0.05). (6) Results verified that compared with the whole posterolateral vertebral fusion, selective posterolateral vertebral fusion can obtain a good vertebral height and prevent Cobb angle loss again, reduce the internal fixation loosening and breakage. After removal of the fixator, selective posterolateral vertebral fusion can reduce spinal motion unit lost, and decrease the adjacent vertebral degeneration. 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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Curved vertebroplasty device for thoracolumbar osteoporotic vertebral compression fractures Xiong Sen, Mao Ke-ya, Han Zhen-chuan, Zhang Ya-bin, Wang Xu-xuan, Li Xiu-can 2016, 20 (17):  2496-2502.  doi: 10.3969/j.issn.2095-4344.2016.17.009 Abstract ( 469 )   PDF (949KB) ( 876 )   Save BACKGROUND: Currently, the cement delivery device used in vertebral augmentation vertebral augmentation (vertebroplasty and kyphoplasty) has flat tips that cannot be bent. During surgery, we always choose injection cement by symmetric way to keep the balance of power on the biomechanics of the vertebral body, while the traditional cement delivery tube can only be used in ipsilateral vertebral body. OBJECTIVE: To evaluate the feasibility of curved vertebroplasty device for the treatment of thoracolumbar osteoporotic vertebral compression fractures. METHODS: Sixty patients (72 vertebral bodies) with osteoporotic vertebral compression fractures were enrolled, including 8 cases of double-level vertebral fractures and 2 cases of three-level vertebral fractures. All operations applied curved delivery device in percutaneous vertebroplasty. We recorded operation time, intraoperative blood loss, and X-ray imaging data through prospective self control study. Treatment effect was evaluated with modified Oswestry disability index, Visual Analogue Scale scores and the World Health Organization Quality of Life assessment. The patients were followed up for 6 months to 2 years.  RESULTS AND CONCLUSION: (1) Surgery was performed successfully on all 60 patients. The average operation time was 27 minutes (20-45 minutes) for 50 cases by unilateral transpedicular approach. (2) The mean amount of bone cement in every single vertebral of all 72 vertebrae was averagely 6.4 mL (4.2-9.5 mL). Bone cement distribution had not been found to be biased one-sided without severe leakage. (3) Visual Analogue Scale score and Oswestry disability index were significantly improved at 1 day after treatment (P < 0.05). During the final follow-up, no significant difference was detected as compared with 1 day postoperatively (P > 0.05). (4) The ratio of good quality of life in 1 month than postoperatively (87%) and in the last follow-up (92%) was significantly greater compared with the preoperative ratio (27%) (P < 0.05). (5) These findings confirmed that curved vertebroplasty device in unilateral pedicle puncture could ensure bilateral symmetric distribution of bone cement. All patients are satisfied with treatment. It is proved to be a feasible simple and safe method.    中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Different orthopedic implants for repairing elderly patients with hip diseases: complications and death factors Chen Xiang-xu, Wang Chen, Lin Yu-cheng, Wang Shan-zheng, Zhang Xue-jun 2016, 20 (17):  2503-2510.  doi: 10.3969/j.issn.2095-4344.2016.17.010 Abstract ( 660 )   PDF (905KB) ( 790 )   Save BACKGROUND: Elderly patients with hip surgery in the department of orthopedics are often associated with a variety of diseases, and easily suffer from complications after implantation.  OBJECTIVE: To analyze the characteristics and the factors of complications and mortality of the elderly patients with hip disease by different orthopedic implants. METHODS: 249 patients accepted total hip arthroplasty, femoral head replacement, proximal femoral nail, Gamma nail, and hollow screw fixation. We analyzed patients’ age, sex, hip disease type, anesthesia risk assessment, psychological and psychiatric factors, admission hemoglobin, preoperative albumin, Charlson comorbidity index, ways of anesthesia, orthopedic implants, operation time, intraoperative bleeding, length of stay, postoperative complications, mortality and survival. RESULTS AND CONCLUSION: Hip disease in the elderly was repaired with five kinds of implants. (1) There were significant differences in age, anesthesia risk assessment, hemoglobin on admission and preoperative albumin, length of stay, duration and intraoperative bleeding. No significant difference in complications and death was found. (2) The most significant indicators affecting complications were length of stay and albumin on admission and preoperative Charlson comorbidity index. The most significant indicators affecting death were age and hemoglobin on admission and preoperative Charlson comorbidity index. (3) Significance of comprehensive assessment of patients before placement: during hip operation, implants were not the factors that affected the complications and mortality after placement, patients with artificial joint replacement could get out of bed early, and complications and mortality could be reduced. Elderly patients with anemia, hypoalbuminemia and Charlson comorbidity index ≥3 should be given a high degree of attention. We should assess Charlson comorbidity index as early as possible, positively treat complications, correct anemia and hypoproteinemia, prevent the occurrence of complications, shorten the length of hospital stay, and reduce the mortality after 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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“T”-shaped locking plate for posterolateral tibial plateau fractures by Carlson posterolateral approach: 12-month follow-up Feng Chong, Jia Dai-liang, Lei Xue-feng, Zhang Gang, Xing Qi-ning 2016, 20 (17):  2511-2518.  doi: 10.3969/j.issn.2095-4344.2016.17.011 Abstract ( 420 )   PDF (1103KB) ( 740 )   Save BACKGROUND: Single fracture or collapse of the posterolateral tibial plateau fractures is relatively rare in the clinical work. Rational choice of surgical approach and internal fixation for posterolateral plateau fracture is significant to restore the lower limb force line, maintain the joint stability and obtain good biocompatibility. OBJECTIVE: To compare the stability and biocompatibility of Carlson posterolateral and posterior midline approaches for the treatment of posterolateral tibial plateau fractures with “T” shaped locking plate. METHODS: From July 2011 to July 2014, 43 patients with posterolateral tibial plateau fractures, who were treated in the Affiliated Hospital of Jining Medical University, were retrospectively analyzed. All patients were assigned to two groups according to approaches. In the Carlson posterolateral approach group, 22 cases received “T”-shaped plate insertion by Carlson posterolateral approach. In the posterior midline approach group, 21 cases received “T”-shaped plate insertion by posterior midline approach. After repair, perioperative data, fixation effects and knee function score were compared and analyzed between both groups. RESULTS AND CONCLUSION: (1) 43 cases (43 knees) of posterolateral tibial plateau fractures were followed up strictly. (2) No significant difference in operation time, fracture healing time, total load time, Hospital for Special Surgery score at 12 months postoperatively, tibial plateau angle and posterior slope angle immediately and 12 months postoperatively was detected between both groups (P > 0.05). (3) Significant differences in fracture exposure, blood loss, and excellent and good rate of Rasmussen at 12 months postoperatively were identified in both groups. Moreover, above indexes were better in the Carlson posterolateral approach group than in the posterior midline approach group (P < 0.05). (4) These findings confirmed that for a single fracture or collapse of the posterolateral tibial plateau fractures, two kinds of surgical approaches can achieve full and direct exposure. Carlson posterolateral approach has good repair effect, fixation effect and biocompatibility. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Three-dimensional reconstruction visualization system enhances the accuracy of lower cervical pedicle screw implantation Liu Bo, Sun Yong-qiang, Wang Tong-ming, Yang Zhong-jie, Shi Da-peng 2016, 20 (17):  2519-2525.  doi: 10.3969/j.issn.2095-4344.2016.17.012 Abstract ( 463 )   PDF (1018KB) ( 663 )   Save BACKGROUND: Pedicle screw implantation is a common method to repair many kinds of diseases of the lower cervical spine. Three-dimensional (3D) reconstruction visualization system can be used in order to improve the accuracy of the implant and improve the prognosis. OBJECTIVE: To investigate the effect of 3D reconstruction visualization system on the accuracy of cervical pedicle screw implantation. METHODS: The clinical data of 89 patients with cervical spine dislocation, who underwent cervical pedicle screw implantation, were analyzed retrospectively. Patients were divided into control group (46 cases) and observation group (43 cases) according to the navigation method. Patients in the control group underwent C arm X ray two dimensional navigation. Patients in the observation group underwent three-dimensional reconstruction visualization system navigation. Intraoperative placement time was observed, and the accuracy of screw placement was assessed in both groups. The cases were followed up for 12 months, and the adverse events were recorded and compared. RESULTS AND CONCLUSION: (1) Intraoperative implantation time was shorter in the observation group than in the control group, but no significant difference was found (P > 0.05). (2) Accuracy rate: There were no three types of nail cases in the observation group, and the accuracy rate was 93% (40/43). In the control group, two cases affected three types of nailing, and the accuracy rate was 81% (37/46). The accuracy rate was significantly higher in the observation group than in the control group (P < 0.05). (3) Postoperative follow-up: None suffered from nerve tissue injury to vertebral artery, blood vessel and spinal cord. The screws of the two groups were in stable condition, without screw breakage or loosening. (4) Results suggested that in lower cervical pedicle nail implantation, 3D reconstruction navigation system can effectively improve the accuracy of screw placement, and does not increase nailing time or lead to adverse events. It is a safe and effective navigation mode. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Three-dimensional transient motion characteristics of atlanto-axial joint in healthy adults under physiological load Wei Dong, Xia Qun, Miao Jun, Bai Jian-qiang, Liu Jia-nan, Li Hong-da 2016, 20 (17):  2526-2532.  doi: 10.3969/j.issn.2095-4344.2016.17.013 Abstract ( 383 )   PDF (1012KB) ( 884 )   Save BACKGROUND: The cervical spine of the human body is an important structure carrying the head and connecting the spine. Its volume is small, but its flexibility was great. Activity frequency was highest. Simultaneously, cervical spine is the most complicated bony structure of geometric and kinematic characteristics of human body, bears the physiological load of the head, has functions of flexion and extension, lateral bending and rotation. Therefore, the cervical spine has become one of the most vulnerable structures with degenerative diseases of the spine. Analysis of upper cervical spine biomechanics, recognition and understanding of its normal function and mechanical mechanism will provide a theoretical basis for better treatment of upper cervical spine disorders. OBJECTIVE: To observe the in vivo three-dimensional kinematics of the upper cervical spine in healthy human beings under physiological load with dual fluorescence X-ray imaging system and spiral CT. METHODS: Seventeen healthy volunteers were recruited for this study. The vertebral segment motion of each subject was reconstructed with three-dimensional computed tomography and solid modeling software. In vivo cervical vertebral motion during functional postures was observed with dual fluoroscopic imaging. Coordinate systems were established at the vertebral center to obtain the intervertebral range of motion.  RESULTS AND CONCLUSION: (1) During the flexion-extension motion, significant differences in the distance in coronal axis, sagittal axis and angle of rotation were detected in C1-2 and C2-3 segments. (2) During the left-right bending motion, the angle of rotation was obviously greater at C1-2 segment than that at C2-3 segment. During the left-right twisting motion, significant differences in distance of the vertical axis and the coronal axis, lateral flexion angle and rotation angle were detectable between C1-2 and C2-3 segments. (3) These findings confirmed that dual fluorescence X-ray imaging system combined with CT scan can obtain atlanto-axial three-dimensional instantaneous motion of six-DOF data of healthy adults, and found that the main motion of the C1-2 vertebrae is rotating. These data may provide us with some new information about the in vivo kinematics of the upper cervical spine and the non-fixed surgical operation. 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 distribution of pedicle screw fixation for thoracolumbar fractures with finite element analysis Deng Hai-tang 2016, 20 (17):  2533-2539.  doi: 10.3969/j.issn.2095-4344.2016.17.014 Abstract ( 382 )   PDF (914KB) ( 623 )   Save BACKGROUND: Spinal surgery requires a relatively high accuracy. At present, the study of pedicle screw fixation is more focused on the safety and stability, but the premise is the safe and effective screw placement. Selection of the insertion point is the key to success. OBJECTIVE: To analyze stress distribution of different pedicle screw implantation methods for thoracolumbar fractures by using finite element analysis. METHODS: T9-L3 segments of a thoracolumbar burst fractures patient were scanned in the Department of Orthopedics, Zhaoqing City First People’s Hospital in January 2015. 616 CT Dicom images were obtained and introduced into engineering software. Finite element geometric model was established. Posterior approach orthopedic surgery was simulated. Stress distribution after pedicle screw fixation for thoracolumbar fractures was analyzed. RESULTS AND CONCLUSION: (1) The three-dimensional motion range of the fixation with six screws and two rods was small in anteflexion, lateral bending, and axial rotation, followed by five screws and two rods by posterior approach (single right vertebral fixation). The motion range of the fixation with four screws and two rods was biggest, but biomechanical stability was poorest. (2) In different fixation models, upper screw stress was larger in anteflexion than other states in the fixation with four screws and two rods by posterior trans-traumatic-vertebra, four screws and two rods by posterior injured vertebra, six screws and two rods by posterior injured vertebra, five screws and two rods by posterior approach (single right injured vertebra) and six screws and two rods by posterior approach (upper injured vertebra), followed by left axial rotation and right axial rotation. Significant differences in screw stress were found in different motion states (P < 0.05). (3) In different fixation modes, the stress ratio of upper and lower screws was significantly larger in the fixation with four screws and two rods by posterior trans-traumatic-vertebra, four screws and two rods by posterior injured vertebra, six screws and two rods by posterior injured vertebra, five screws and two rods by posterior approach (single right injured vertebra) and six screws and two rods by posterior approach (upper injured vertebra) than other motion states (P < 0.05), followed by right axial rotation and right lateral bending. Significant differences in stress ratio of upper and lower screws were detectable in different motion states (P < 0.05). (4) Results suggested that finite element analysis could better simulate complex spine mechanical system, accurately reflect the stress distribution of spinal pedicle screw model, and provide the basis for making pedicle screw program.  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 and stability of finite element models of distal tibial fractures Yang Zhi-gang, Gan Lin, Ye Jun-xing 2016, 20 (17):  2540-2545.  doi: 10.3969/j.issn.2095-4344.2016.17.015 Abstract ( 513 )   PDF (840KB) ( 847 )   Save BACKGROUND: Traditional studies on foot and ankle biomechanics have limitation. Ankle joint was complicated and had big range of motion, so it is difficult to establish finite element models and to analyze the type of fracture. OBJECTIVE: To construct the finite element models of distal tibial fractures and analyze the stability. METHODS: CT data of ankle were collected from a normal male volunteer and the three-dimensional reconstruction of volunteer was made by Mimics software, and the effectiveness was verified. The ratio of different joint involvement and height of fracture block were assumed with Solidwork software, and finite element models of distal tibial fractures were established. Fracture stability was analyzed by ANSYS software using finite element method. RESULTS AND CONCLUSION: The distal tibia fracture model was consistent with the relevant literature data, and finite element analysis could be further conducted. The ratio of articular surface involved was positively associated with fragment height and fracture displacement, and negatively associated with fracture stability. These results indicate that the three-dimensional finite element models of distal tibial fractures were successfully established. Fracture stability was associated with the ratio of articular surface involved and fragment height.  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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Conduction characteristics of human lumbar facet joint pressures during simulated spinal manipulation versus spinal mobilization Zhang Jun, Wang Fei, Liu Qiang, Zhang Hui, Sun Pei-dong, Liang Dong-zhu, Zhao Ping 2016, 20 (17):  2546-2554.  doi: 10.3969/j.issn.2095-4344.2016.17.016 Abstract ( 454 )   PDF (1104KB) ( 1095 )   Save BACKGROUND: The aim of spinal mobilization and spinal manipulation is to correct vertebral subluxation. However, facet joint pressures are not clear during these two therapies.    OBJECTIVE: To compare human lumbar facet joint pressures during simulated high-velocity, low-amplitude spinal manipulation versus low-velocity, low-amplitude spinal mobilization. METHODS: Totally 12 adult fresh lumbar spinal specimens (T12-S2) were divided into two groups randomly. Parameters of simulated spinal mobilization (n=6): preload angle 15° (speed 3°/s), maximum angle 20° (speed 1°/s), with 9 N horizontal force to L5 spinous process. Parameters of simulated spinal manipulation (n=6): preload angle 15° (speed 3°/s), impulse angle 20° (impulse speed 33°/s), with 22 N horizontal force to L5 spinous process. Pressures of bilateral L4-5/L5-S1 facet joints were measured with Tekscan system.  RESULTS AND CONCLUSION: (1) During two spinal manipulative therapies (rotation to the right and then back to the neutral position), pressures of right facet joints decreased first and then increased gradually, while pressures of left facet joints changed oppositely. (2) Pressures of right facet joints were similar regardless of manipulation type (P > 0.05). The maximum pressure of left facet joints was larger during manipulation than that during mobilization (P < 0.05). (3) Descending speed of pressures of right joint was larger during manipulation than that during mobilization (P < 0.01), and no significant difference in ascending speed of pressure of right facet joints was detected (P > 0.05). Both ascending and descending speeds of the left facet joints were larger during manipulation than that during mobilization  (P < 0.01). (4) During two spinal manipulative therapies, pressures of ipsilateral facet joints decreased first and then increased, while pressures of contralateral facet joints increased first and then decreased. Joint pressure after treatment restored to that before treatment. (5) Impulse speed and magnitude of pressures of facet joints during manipulation were larger than that during mobilization. Facet joints are more possible to be injured during manipulation than that during mobilization. During manipulation, we should pay attention to the speed and intensity of the impact.  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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Repair of femoral shaft fracture with bridging combined internal fixation and locking plate screw system: a biomechanical comparison Lv Zhi-qiang, Li Xing-hua, Wang Ai-guo 2016, 20 (17):  2555-2561.  doi: 10.3969/j.issn.2095-4344.2016.17.017 Abstract ( 392 )   PDF (966KB) ( 972 )   Save BACKGROUND: Different methods of internal fixation can be selected during the repair of femoral shaft fractures in the clinic, including bridging combined internal fixation and metal locking plate screw fixation. OBJECTIVE: To compare the biomechanical properties of bridging combined internal fixation and metal locking plate screw fixation for femoral shaft fracture.  METHODS: Eighteen femoral samples were collected and randomly divided to three groups, with six in each group. In the normal control group, no treatment was given. In the other groups, models of femoral shaft fracture were established. In the bridging combination group, samples underwent bridging combined internal fixation. In the locking plate screw group, samples underwent metal locking plate screw fixation. Biomechanical test was conducted in samples of the three groups. In the femoral compression experiments, we recorded the maximum displacement under the maximal load 500 N. In the femoral flexion experiment, we recorded the maximum displacement under the maximal load of 100 N. In the femoral retroversion experiment, we recorded the maximum displacement under the maximal load of 100 N.  RESULTS AND CONCLUSION: (1) Compression experiment at different loads: the maximum displacement was larger in the bridging combination group and locking plate screw group than in the normal control group. Under the maximum load of 500 N, the maximum displacement was significantly larger in the bridging combination group and locking plate screw group than in the normal control group (P < 0.05). Moreover, the maximum displacement was significantly less in the bridging combination group than in the locking plate screw group (P < 0.05). (2) Flexion experiment under different loads: the maximum displacement was larger in the bridging combination group and locking plate screw group than in the normal control group. Under the maximal load of 100 N, the maximum displacement was significantly larger in the bridging combination group and locking plate screw group than in the normal control group (P < 0.05). Moreover, the maximum displacement was significantly smaller in the bridging combination group than in the locking plate screw group (P < 0.05). (3) Retroflexion experiment under different loads: the maximum displacement was larger in the bridging combination group and locking plate screw group than in the normal control group. Under the maximal load of 100 N, the maximum displacement was significantly larger in the bridging combination group and locking plate screw group than in the normal control group (P < 0.05). Moreover, the maximum displacement was significantly smaller in the bridging combination group than in the locking plate screw group (P < 0.05). (4) These results suggested that in vitro simulated femoral shaft fracture bridging combination fixation and metal locking plate screw system can obtain good fixation effect; the design meets the principle of biomechanics. Among them, bridging combined internal fixation can maintain a smaller displacement, suggesting good deformation resistance under compressive stress, anteflexion and retroflexion stress.  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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High viscosity bone cement for osteoporotic vertebral compression fractures: a protocol for prospective self-controlled open-label clinical trial Wu Yin-liang, Wang Qiang, Li Fa-nian, Peng Jun, Jiang Long, Chen Liang 2016, 20 (17):  2562-2568.  doi: 10.3969/j.issn.2095-4344.2016.17.018 Abstract ( 492 )   PDF (1001KB) ( 782 )   Save BACKGROUND: Traditional bone cement in the treatment of osteoporotic vertebral compression fracture easily induces heat dissipation effect, leakage, big difference in mechanical strength with the surrounding tissue, which greatly affects treatment effect of osteoporotic vertebral compression fracture. This prospective self-controlled open-label clinical trial is designed to analyze the effectiveness of a novel high viscosity bone cement for osteoporotic vertebral compression fractures. METHODS/DESIGN: This prospective self-controlled open-label clinical trial will be performed in the Yixing Hospital Affiliated to Jiangsu University of China. High viscosity bone cement will be implanted in patients with osteoporotic vertebral compression fractures by percutaneous vertebroplasty. Immediate outcomes: Pain symptom of patients before and after implantation of high viscosity bone cement, and Visual Analogue Scale score. Middle- and long-term outcomes: The recovery of spinal function, Oswestry dysfunction index questionnaire, vertebral body height, bone cement leakage rate, Barthel index and SF-36 quality of life scale score. DISCUSSION: This trial will provide a clinical basis for the treatment of osteoporotic vertebral compression fractures with high viscosity bone cement. ETHICS APPROVAL: This trial has been approved by the Medical Ethics Committee, Yixing Hospital Affiliated to Jiangsu University (Approval number 0136). Patients and their family members have signed the informed consent.  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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Osteogenesis-related factor Runx2 expression in necrotic femoral head tissue: study protocol for a non-randomized, parallel-controlled trial Yang Li-qing, Dong Cheng-jian, Zhu Shu 2016, 20 (17):  2569-2574.  doi: 10.3969/j.issn.2095-4344.2016.17.019 Abstract ( 357 )   PDF (775KB) ( 697 )   Save BACKGROUND: Osteonecrosis of the femoral head (ONFH) results from an interruption of the blood supply to the femoral head or injury-caused death of chondrocytes and bone marrow components. Many osteogenesis-related factors, such as Runt-related transcription factor 2 (Runx2), bone morphogenetic protein (BMP), osteoprotegerin and osteocalcin, are involved in the subsequent repair process. The Runx2 gene has been shown to control osteoblast differentiation and formation by upregulating the transcription of various mineralization-related protein genes, allowing osteoblast precursors differentiation into osteoblasts, and playing a key role in bone repair. METHODS/DESIGN: This retrospective, single-center, non-randomized, parallel-controlled trial was performed at Shengjing Hospital of China Medical University, China. Fifteen patients with ONFH and 15 patients with osteoarthritis undergoing total hip replacement were included. Primary measure was Runx2messenger RNA (mRNA) expression in femoral head and neck tissue, and secondary measures included BMP-2, BMP-7 and osteoprotegerin mRNA expression, as well as osteocalcin immunoreactivity. This trial was registered at ClinicalTrials.gov (identifier: NCT02735538) and acquired written approval from the Ethics Committee of Shengjing Hospital of China Medical University (approval No. 2016PS222K). Written informed consent was obtained from each included patient. DISCUSSION: This study involved in the detection of mRNA expression of several bone repair-related genes, including Runx2, in the femoral head and neck of patients with ONFH was performed between 2010 and 2011. This observational study will help clarify the role and possible clinical significance of Runx2 in femoral head necrosis, bone repair and reconstruction.  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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Meta-analysis of femoral shaft fractures treated with interlocking intramedullary nail and extramedullary plate Abulimiti•Amuti, Zhang Xie-zhuo, Xu Chao, Ding Hui-yong 2016, 20 (17):  2575-2584.  doi: 10.3969/j.issn.2095-4344.2016.17.020 Abstract ( 408 )   PDF (1330KB) ( 417 )   Save BACKGROUND: With deep understanding of the concept of biological fixation, more and more physicians choose interlocking intramedullary nail in the repair of femoral shaft fracture. Compared with traditional extramedullary plate, the superiority of the interlocking intramedullary nail has not been reported at present. Randomized controlled clinical study is less, and lacks of systematic evaluation.  OBJECTIVE: The results of meta-analysis were used to compare the therapeutic effects of interlocking intramedullary nail and steel plate for femoral shaft fractures. METHODS: We retrieved the MEDLINE, Embase, PubMed, Cochrane library, CNKI, Wanfang database, and Vip database from 2000 to 2015 by computer to collect randomized controlled study on interlocking intramedullary nail and extramedullary plate for treatment of femoral shaft fractures. We screened the literatures that met the inclusion criteria, were strict quality evaluation of the selection. Excellent and good rate, operation time, intraoperative blood loss, hospitalization time, recovery time of knee joint function reaching 135°, knee joint function recovery time of the second operation to remove the internal fixation for reaching 135°, postoperative drainage volume, fracture healing time, nonunion or delayed union, internal fixation loosening, postoperative infection, and osteomyelitis were considered as the evaluation index of meta-analysis. Meta-analysis was performed with RevMan 5.2 software from the Cochrane Collaboration. RESULTS AND CONCLUSION: Finally 10 Chinese articles were included, including 915 patients with femoral shaft fractures. The results of meta-analysis showed that compared with extramedullary plate, interlocking intramedullary nails for femoral shaft fractures could effectively reduce the amount of blood loss, postoperative drainage, shorten operation time, hospitalization time, fracture healing time, reduce the incidence of postoperative infection, and obtain recovery of knee joint function. These results suggest that interlocking intramedullary nail for treating femoral shaft fractures has certain advantages. The interlocking intramedullary nail can be firstly selected in the permit of patient’s economic conditions and hospital conditions.  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