Loading...

Table of Content

    27 May 2016, Volume 20 Issue 22 Previous Issue    Next Issue
    For Selected: Toggle Thumbnails
    Effects of intraarticular tranexamic acid injection combined with 3-hour drainage tube occlusion postoperatively on blood loss in unicompartmental knee arthroplasty
    Zeng Bing, Liu Gang, He Zhi-sheng, Zheng Lian-jie, Jing Feng-bo, Lv Hao
    2016, 20 (22):  3197-3204.  doi: 10.3969/j.issn.2095-4344.2016.22.001
    Abstract ( 403 )   PDF (1164KB) ( 309 )   Save

    BACKGROUND: Unicompartmental knee arthroplasty has become mainstream operation for treatment of unicompartmental osteoarthritis of the knee, but unicompartmental knee arthroplasty still has some problems, such as excessive bleeding-induced postoperative blood transfusion, increased blood transfusion rate, hospitalization expense and complication of blood transfusion. As tranexamic acid for total knee arthroplasty has achieved good effects. It is significant to investigate whether local application of tranexamic acid can effectively reduce blood loss in unicompartmental arthroplasty.

    OBJECTIVE: To investigate the efficacy and safety of the intra-articular tranexamic acid injection in treating perioperative blood loss in patients undergoing unicompartmental knee arthroplasty. 
    METHODS: 122 patients with knee osteoarthritis undergoing unicompartmental knee arthroplasty in the Department of Orthopedics, the Second Affiliated Hospital of Dalian Medical University from January 2014 to August 2015 were enrolled in this study. All patients were randomly divided into two groups. Patients in the tranexamic acid group were injected with 10 mL of tranexamic acid (containing 1 000 mg) + 10 mL of sodium chloride injection in the articular cavity before loosening the tourniquet. Patients in the control group received 20 mL of sodium chloride injection in the articular cavity. In both groups, the drainage tube was clipped for 3 hours after injection. At 48 hours after replacement, the drainage tube was pulled out. We compared and analyzed hemoglobin levels and hematocrit at 2 days and 1 month postoperatively, total blood loss and drainage volume at 2 days postoperatively, the number of patients receiving blood transfusion, Hospital for Special Surgery scores of knee function at 1 week and 1 month postoperatively, and thrombosis at 1 week postoperatively, and evaluated effects of tranexamic acid on blood loss after unicompartmental knee arthroplasty.

    RESULTS AND CONCLUSION: (1) Hemoglobin levels and hematocrit were significantly higher in the tranexamic acid group than in the control group at 2 days postoperatively (P < 0.05). No significant difference in hemoglobin levels and hematocrit was detected at 1 month postoperatively in both groups (P > 0.05). (2) Drainage volume and total blood loss were significantly less in the tranexamic acid group than in the control group at 2 days postoperatively (P < 0.05). (3) The number of patients receiving blood transfusion was significantly less in the tranexamic acid group (0 case) than in the control group (6 cases) (P < 0.05). (4) Scores of Hospital for Special Surgery were significantly higher in the tranexamic acid group than in the control group at 1 week postoperatively (P < 0.05). No significant difference in above socres was identified between the two groups at 1 month postoperatively. (5) No venous thrombosis was found at 1 week postoperatively in both groups. (6) These results confirm that during knee medial unicompartmental arthroplasty, intra-articular injection of tranexamic acid combined with 3 hours of blood occlusion can effectively reduce drainage volume, perioperative blood loss, blood transfusion, is beneficial to the early recovery of knee joint function after replacement, and does not increase the risk of lower extremity deep venous thrombosis.

    中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
    Figures and Tables | References | Related Articles | Metrics
    A comparison of computer-assisted total knee arthroplasty through vastus medialis approach and conventional arthroplasty
    Liu Peng, Liu Ping-ping
    2016, 20 (22):  3205-3211.  doi: 10.3969/j.issn.2095-4344.2016.22.002
    Abstract ( 410 )   PDF (1123KB) ( 259 )   Save

    BACKGROUND: In the treatment of primary knee osteoarthritis, total knee arthroplasty is a common treatment, but there are some shortcomings in the traditional operation, which may lead to early failure of the prosthesis.

    OBJECTIVE: To explore the difference of computer-assisted total knee arthroplasty by vastus medialis approach from the traditional total knee arthroplasty.
    METHODS: A total of 79 patients with primary knee osteoarthritis were randomly divided into control group (41 cases) and observation group (38 cases), which underwent conventional total knee arthroplasty and computer-assisted total knee arthroplasty by vastus medialis approach. Surgical incision, operation time, total blood loss and drainage volume were recorded and compared in both groups. In 12 months of follow-up, Hospital for Special Surgery knee score was evaluated, and the complications were recorded and compared between the two groups.

    RESULTS AND CONCLUSION: (1) Operative incision was significantly less in the observation group than in the control group. Operation time was significantly shorter in the observation group than in the control group. Total blood loss and drainage volume were significantly less in the observation group than in the control group (all P < 0.05). (2) Patients in both groups were followed up for 12 months. Index score and total score of knee function were significantly higher in the observation group than in the control group (all P < 0.05). (3) No adverse events such as infection, prosthesis loosening or fracture appeared in the observation group. In the control group, four cases affected prosthesis loosening. One case suffered from wound infection. Above events were improved obviously after active treatment. No serious complications occurred. The incidence of complications was significantly lower in the observation group than in the control group (P < 0.05). (4) The results show that, compared with the traditional operation, the choice of the femoral medial approach and the use of computer aided design technology can simulate the knee replacement process, set the cutting position, improve the accuracy and success rate of surgery, have less trauma, and effectively improve knee function, and reduce the incidence of postoperative complications.

    中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

    Figures and Tables | References | Related Articles | Metrics
    Osteoporosis-related factors in patients with knee osteoarthritis before total knee arthroplasty
    Ren Zhi-shuai, Cheng Zhao-jun, Sun He-jun, Sun Zhen-hui, Cui Zi-jian, Zhang Li-long, Lin Yong-zhi, Zhang Ren-zan, Peng Bing, Zhang Xue-li
    2016, 20 (22):  3212-3218.  doi: 10.3969/j.issn.2095-4344.2016.22.003
    Abstract ( 469 )   PDF (1240KB) ( 251 )   Save

    BACKGROUND: The greatest risk of osteoporosis in total knee arthroplasty is perioperative and long-term periprosthetic fractures. However, limited by the traditional concept of osteoarthritis patients who usually not associated with osteoporosis, domestic clinical trials have not given enough attention to the osteoporosis before total knee arthroplasty. 

    OBJECTIVE: To analyze the osteoporosis and its relative factors in osteoarthritis patients before total knee arthroplasty.
    METHODS: Data of 81 cases (81 knees) of knee osteoarthritis who underwent total knee arthroplasty in the Department of Joint Surgery of Tianjin People’s Hospital from January 2012 to November 2014 were retrospectively analyzed. They received lumbar spine and hip bone mineral density examination before surgery. The correlation of bone mineral density with age, body mass index, knee motion range, and knee deformity was analyzed before surgery. The independent risk factors for osteoporosis before replacement were analyzed. 

    RESULTS AND CONCLUSION: (1) Of 81 patients, there were normal bone mineral density in 25 cases (31%), osteopenia in 35 cases (43%), and osteoporosis in 21 cases (26%). All 10 males had no osteoporosis and 21 in 71 female cases suffered osteoporosis (30%). The incidence of osteoporosis in females was significantly higher than in male patients (P=0.046). (2) There was a linear correlation of bone mineral density with age and body mass index (correlation coefficient r=-0.230, 0.225). (3) The age of ≥ 65 years and body mass index ≥ 25 kg/m2 were independent risk factors of osteoporosis before replacement (P < 0.05). (4) Patients with knee osteoarthritis had higher incidence of osteopenia and osteoporosis before total knee arthroplasty. The degree of osteoporosis was negatively correlated with age, but positively correlated with body mass index. The age of ≥ 65 years and body mass index < 25 kg/m2 were independent risk factors for preoperative osteoporosis. Thus, bone mineral density examination is essential for those patients before total knee arthroplasty.

    中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

    Figures and Tables | References | Related Articles | Metrics
    Effects of drainage versus nondrainage after total knee arthroplasty: a randomized controlled trial
    Ren Guo-qing, Liu Hong-yun, Teng Xue-ren, Zhang Hai-ning, Lu Jing
    2016, 20 (22):  3219-3226.  doi: 10.3969/j.issn.2095-4344.2016.22.004
    Abstract ( 346 )   PDF (1237KB) ( 237 )   Save

    BACKGROUND: Total knee arthroplasty had been generally accepted as the final treatment plan, relieving pain and reconstructing function of knee joint. However, whether drainage tube can be used after replacement is still controversial.

    OBJECTIVE: To compare the clinical effects of drainage versus nondrainage after primary unilateral total knee arthroplasty.
    METHODS: Total 102 patients undergoing primary unilateral total knee arthroplasty were randomly divided into 2 groups. In the drainage groiup, a drainage tube was used. In the nondrainage group, drainage tube was not used. Total blood loss was calculated by recording the hemoglobin and hematocrit before operation and that after 1, 3, 7 days of operation. The pain visual analogue scale scores, arthrocele, ecchymosis, infection rate, and deep venous thrombosis of lower extremity were examined and analyzed postoperatively. Knee Society Scores were recorded at 1 year postoperatively. Above indexes were compared between the two groups. 

    RESULTS AND CONCLUSION: (1) Total blood loss and blood transfusion rate were significantly higher in the drainage group than in the nondrainage group (P < 0.05). (2) There was no statistically significant difference in the pain visual analogue scale scores, arthrocele, ecchymosis, infection rate, and deep venous thrombosis of lower extremity between the two groups after replacement (P > 0.05). (3) No significant difference in Knee Society Scores was detected between the two groups (P > 0.05). (4) Results indicated that the total blood loss and blood transfusion rate may decrease significantly in patients without wound drainage after total knee arthroplasty. Limb swelling and ecchymosis area were not increased. No significant difference in infection, deep venous thrombosis of lower extremity and knee function was detectable between the two groups. Thus, total knee arthroplasty without wound drainage is safe and does not have obvious adverse consequences.


    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
    Novel Zero-P versus titanium plate with cage interbody fixation and fusion system in repairing cervical spondylosis: early stability
    Xu Yi-qi, Zhang Xue-song, Sun Tai-cun, Jing Dan-feng, Chen Hai-ning, Cui Xue-wen
    2016, 20 (22):  3227-3234.  doi: 10.3969/j.issn.2095-4344.2016.22.005
    Abstract ( 858 )   PDF (1331KB) ( 334 )   Save

    BACKGROUND: It is notable to treat cervical spondylosis using the anterior cervical discectomy and fusion, but there are such complications as cervical instability and low fusion rate. Titanium plate with cage can solve those defects, while anterior unfamiliar matter and dysphagia appear. A new anterior cervical interbody fusion Zero-P with support and fixation function has been widely used in clinic.

    OBJECTIVE: To analyze early stability in repairing cervical spondylosis using a new Zero-P interbody fixation and fusion system, and compare with a titanium plate with cage interbody fixation and fusion system.
    METHODS: We retrospectively analyzed the clinical date of 31 patients with cervical spondylosis who underwent the anterior cervical discectomy and fusion in the Department of Orthopedics, Affiliated Hospital of Jiangsu University between August 2010 and August 2014. Fifteen patients were treated with a Zero-P implant (Zero-P group) and sixteen patients with a titanium plate with cage (cage group). We recorded operation time, intraoperative blood loss, preoperative and postoperative Visual Analogue Scale scores and Japanese Orthopedic Association scores, postoperative incidence of dysphagia and degeneration rate of adjacent joint. 

    RESULTS AND CONCLUSION: (1) Postoperative symptoms were apparently improved, without severe complications in both groups. (2) Operation time and intraoperative blood loss were better in the Zero-P group than in the cage group (P < 0.05). (3) Postoperative Visual Analogue Scale scores and Japanese Orthopedic Association scores were significantly improved in both groups (P < 0.05). The recovery rate of Japanese Orthopedic Association scores was similar between the two groups (81%, 81%; P > 0.05). (4) Mild dysphagia was experienced by one case (7%) in the Zero-P group, but nine cases (44%) in the cage group. Significant difference in the incidence of dysphagia was detected between the two groups after treatment (P=0.037). However, no significant difference in degeneration rate was detectable between the two groups (P=0.48). (5) These findings verify that in the anterior cervical discectomy and fusion, the new Zero-P and titanium plate with cage interbody fixation and fusion system are effective choices for cervical spondylosis. However, the Zero-P interbody fixation and fusion system showed a low incidence of postoperative dysphagia and better stability.


    中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

    Figures and Tables | References | Related Articles | Metrics
    Posterior cervical single door and double door laminoplasty for repair of multilevel cervical myelopathy: motion range of cervical vertebrae
    Liang He-sheng, Xiao Li-jun, Deng De-li
    2016, 20 (22):  3235-3241.  doi: 10.3969/j.issn.2095-4344.2016.22.006
    Abstract ( 695 )   PDF (1326KB) ( 270 )   Save

    BACKGROUND: Previous studies on posterior cervical single door and double door laminoplasty for repair of multilevel cervical myelopathy mainly focus on neurological function and clinical parameters and lack of certain comprehensiveness.

    OBJECTIVE: To explore the effects of posterior cervical single door and double door laminoplasty for repair of multilevel cervical myelopathy.
    METHODS: We selected 120 patients with multilevel cervical myelopathy and randomly divided into single door group (n=60) and double door group (n=60). The single door group underwent single door laminoplasty. The double door group underwent double door laminoplasty. The blood loss, length of stay, complication rate, neurological function improvement, motion range of cervical vertebrae and imaging changes were compared between the two groups. 

    RESULTS AND CONCLUSION: (1) Blood loss was significantly less, length of stay was significantly shorter, and the incidence of axial symptom was significantly reduced in the double door group than in the single door group (all P < 0.05). (2) No significant difference in complication rate such as side leakage of cerebrospinal fluid, hematoma, infection and paralysis was detected between the two groups (P > 0.05). The incidence of axial symptoms was significantly less in the double door group than in the single door group (P < 0.05). (3) There were no significant differences in preoperative Japanese Orthopaedic Association scores, postoperative Japanese Orthopaedic Association scores, and improvement in neurological function between the two groups (P > 0.05). Postoperative Japanese Orthopaedic Association scores were significantly increased as compared with that preoperatively in both groups (P < 0.05). (4) No significant difference in motion range of cervical vertebrae, inflexion, extension angle and sagittal diameter of spinal canal was detectable between the two groups (P > 0.05). Motion range of cervical vertebrae, extension angle, and inflexion angle were smaller after treatment compared with that preoperatively in both groups (P < 0.05). The increased degree of sagittal diameter of spinal canal was smaller, and the motion range of cervical vertebrae kept better in the double door group than in the single door group. (5) These results indicate that the effect of double door laminoplasty for repair of multilevel cervical myelopathy was significant. The double door laminoplasty can shorten the length of stay, reduce blood loss, axial symptoms, and loss rate of motion range of the cervical vertebrae. In the clinic, treatment can be carried out according to different indications.


    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
    Extended posterior screw rod fixation for youth thoracolumbar simple flexion compression fracture: improvement in orthopedic reduction efficiency
    Zou Shou-ping, Tan Xiao-yun, Huang Qiang, Lu Dao-yun
    2016, 20 (22):  3242-3248.  doi: 10.3969/j.issn.2095-4344.2016.22.007
    Abstract ( 417 )   PDF (4408KB) ( 209 )   Save

    BACKGROUND: The type of simply youth compressibility fracture of thoracic and lumbar spine with posterior vertebral injury nailing reset scheme can effectively reset with mechanics from the rear, but due to bone characteristics of the youth, the rear force cannot effectively open anterior and middle columns. To improve the effect of rear reset during the operation becomes the focus of clinical attention and difficult issues.

    OBJECTIVE: To retrospectively analyze reset reconstruction effects of posterior screw rod fixation for youth thoracolumbar simple flexion compression fracture. 
    METHODS: Patients with youth thoracolumbar simple flexion compression fracture were treated with posterior screw rod fixation from June 2014 to June 2015. Perioperative indicators (operation time, blood loss, average length of stay and complication rate) were recorded. Patients were followed up. Imaging indexes (anterior height of vertebral compression, Cobb angle of the injured vertebra) and subjective effect index (low back pain visual analog scale and the Oswestry Disability Index) were observed.

    RESULTS AND CONCLUSION: (1) Imaging index: Anterior height of vertebral compression and Cobb angle of the injured vertebra were significantly improved after treatment (P < 0.05). No significant difference was detected at different time points after treatment (P > 0.05). (2) Subjective effect index: low back pain visual analog scale and the Oswestry Disability Index were significantly improved after treatment (P < 0.05). No significant difference was found at different time points after treatment (P > 0.05). (3) No nerve injury complications appeared in all patients, without leakage of cerebrospinal fluid. (4) Results indicated that extended posterior screw rod fixation for youth thoracolumbar simple flexion compression fracture can obtain effective reduction due to special bone characteristics of the youth, improve reduction efficiency, do not increase patient’s trauma and the effects are affirmative. 
    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
    Posterior laminectomy for thoracolumbar fracture and spinal cord compression: a follow-up on Cobb’s angle and vertebral height
    Li Jun, Wang Yong-sheng, Feng Ting, Wang Bo, Qiu Jian-zhao
    2016, 20 (22):  3249-3254.  doi: 10.3969/j.issn.2095-4344.2016.22.008
    Abstract ( 398 )   PDF (970KB) ( 224 )   Save

    BACKGROUND: Due to special physiological and anatomical location, stability of the spine is very complicated during thoracolumbar fractures. It is difficult to identify the stability of the spine. It should be based on their individual circumstances, to explore more effective internal fixation repair method.

    OBJECTIVE: To explore the Cobb’s angle and vertebral height of patients with thoracolumbar fracture and spinal cord compression treated with posterior laminectomy and screw fixation, and compared with anterior laminectomy. 
    METHODS: One hundred patients with thoracolumbar fracture and spinal cord compression, who were treated in the Panyu District Central Hospital from January 2013 to November 2014, were enrolled in this study. The patients were equally and randomly divided into posterior laminectomy fixation group and anterior laminectomy fixation group. Tactile and sports of American Spinal Injury Association scores, Cobb’s angle and vertebral height were assessed before treatment and 1 month after treatment, and fixation effects were compared between the two groups.

    RESULTS AND CONCLUSION: (1) No significant difference in each index was detected between the two groups preoperatively (P > 0.05). (2) Tactile and sports of American Spinal Injury Association scores, Cobb’s angle and vertebral height were better in the posterior laminectomy fixation group than in the anterior laminectomy fixation group at 1 month postoperatively (P < 0.05). (3) These findings indicated that compared with the anterior laminectomy fixation, posterior laminectomy fixation for thoracolumbar fracture combined with spinal cord compression obtained better outcomes, and could obviously relieve spinal cord compression. Posterior laminectomy fixation is a safe and effective treatment method for thoracolumbar fracture and spinal cord compression. 
    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
    RTS versus SEXTANT percutaneous pedicle screw fixation for unstable thoracolumbar fractures under minimally invasive technology: recovery of the height of the vertebral body
    Zhao Gang, Zhou Ying-jie, Wang Xu-ke
    2016, 20 (22):  3255-3262.  doi: 10.3969/j.issn.2095-4344.2016.22.009
    Abstract ( 546 )   PDF (5291KB) ( 228 )   Save

    BACKGROUND: In recent years, with the development of minimally invasive techniques, the application of percutaneous pedicle screw fixation techniques gradually become widespread, but in the percutaneous pedicle screw fixation for thoracolumbar fractures, due to lack of reduction apparatus or power defect, the reduction of the injured vertebra is poor. In order to improve this deficiency, we design a percutaneous pedicle screw system in order to achieve the desired effect of reduction.

    OBJECTIVE: To investigate the two different effects for treating unstable thoracolumbar fractures by fixing RTS (rotation softened trauma fixation system) or SEXTANT screws under minimally invasive technology. 
    METHODS: From October 2011 to June 2013, 50 patients who suffered from single-segment thoracolumbar fractures without any nerve-injured symptoms were treated by using percutaneous pedicle screws. Among them, 25 cases used Sextant screws; the others used RTS screws. Data were compared between the two groups, including the height of injured vertebrae, Cobb’s angle, visual analogue scale scores and Oswestry disability index 1 week, 3 and 6 months postoperatively, and during final follow-up.

    RESULTS AND CONCLUSION: (1) All patients were followed up for 8-18 months. (2) The height of injured vertebrae and Cobb’s angle were restored in both groups, showing significant differences (P < 0.01). The restoration of the height of injured vertebrae and Cobb’s angle was better in the RTS group than in the SEXTANT group after treatment (P < 0.05-0.01). (3) The visual analogue scale scores and Oswestry disability index were significantly better in the RTS group than in the SEXTANT group 6 months postoperatively and during final follow-up (P < 0.05). (4) These results suggest that both RTS and SEXTANT systems can effectively repair single-segment thoracolumbar fractures without any nerve-injured symptoms. However, it is clear that the recovery of the height of the vertebral body is more satisfied and the postoperative pain and dysfunction were more minor in the RTS group. 
    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
    Finite element analysis of stress of the adjacent vertebral end plate of T12 vertebral body in different compression states
    Feng Jie-rong, Yin Hai-dong, Chen Wei, Huang Ming-guang
    2016, 20 (22):  3263-3271.  doi: 10.3969/j.issn.2095-4344.2016.22.010
    Abstract ( 343 )   PDF (7101KB) ( 199 )   Save

    BACKGROUND: Vertebral compression fractures are the most common vertebral fractures in the elderly patients with osteoporosis, and the correlation between the compression of anterior border of vertebral body and adjacent vertebral refractures is not clear.

    OBJECTIVE: To establish a model of different compression of T12 vertebral body with finite element method, and analyze the relationship between the compression of T12 vertebral body and the stress of adjacent vertebral plate.
    METHODS: Based on thoracolumbar CT data of normal adult volunteers, MIMICS/3-matic was imported. Through image segmentation, repair and three-dimensional mesh of access to thoracic and lumbar T11-L1 data, grid assigned material properties was imported to ABAQUS so as to establish ligament, joint and other small features and obtain realistic three-dimensional finite element model. The six degrees of freedom, including anteflexion, posterior extension, left and right flexion, left and right rotation, were loaded, to verify the validity of the normal model. With the frontier of vertebral body compression to 90%, 80%, 70%…10% of the nine states, MISES stresses of the T11 and L1 segment intervertebral disc endplate were extracted; the relationship curve of compression state and endplate stress was obtained.

    RESULTS AND CONCLUSION: (1) The model was highly realistic and could reflect the actual stress state. (2) The stress value of T11 vertebral body and L1 vertebral body was positively correlated with the compression of T12 vertebral body. Increased stress may lead to an increased likelihood of end plate fractures, which increases the risk of fractures in the adjacent vertebral bodies.
    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
    Unstable pelvic fractures treated with cancellous bone screw fixation: inflammatory factor levels
    Xu Meng-fan, Zhuang Huan-xiong, Mai Hu-qiang, Chen Shi-xiong
    2016, 20 (22):  3272-3278.  doi: 10.3969/j.issn.2095-4344.2016.22.011
    Abstract ( 372 )   PDF (1133KB) ( 230 )   Save

    BACKGROUND: After different metal fixation materials are implanted into the human body, peripheral tissue inflammatory response to varying degrees will appear in the early stage. Poor biocompatibility of the corresponding materials will lead to prolonged duration of inflammatory reaction. 

    OBJECTIVE: To investigate the inflammatory factor level changes and biocompatibility of cancellous bone screw fixation in treatment of unstable pelvic fractures.
    METHODS: A total of 61 patients with unstable pelvic fractures were randomly divided into the observation group (29 cases) and the control group (32 cases). The 29 patients in the observation group underwent cancellous bone screw fixation. The 32 patients in the control group underwent conventional therapy. During 12 months of follow-up, Majeed function score and inflammatory factor level changes and adverse events were observed and compared between the two groups. 

    RESULTS AND CONCLUSION: (1) Majeed function scores were significantly higher in both groups after treatment as compared with that preoperatively (all P < 0.05). The Majeed function scores were significantly higher in the observation group than in the control group 12 months after treatment (P < 0.05). (2) Inflammatory factor levels: Interleukin 6, C- reactive protein, and tumor necrosis factor alpha levels were significantly lower in both groups after treatment as compared with that preoperatively (all P < 0.05). No significant difference in above indexes was found between the two groups before and after treatment (P > 0.05). (3) Adverse events: one case affected incision infection after operation in the observation group. In the control group, four patients experienced incision infection. One suffered from nonunion, and one had bone necrosis. Above patients were treated in time, and were cured, so there were no deaths. There were significant differences in the incidence of adverse events between the 2 groups (P < 0.05). (4) The research results show that cancellous bone screw fixation for unstable pelvic fractures can obtain satisfactory clinical results, and have good 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
    Foot drop after tibial lengthening osteotomy using Ilizarov and Orthofix external fixators
    Yilihamujiang•Wusiman, Maimaitiming•Saiyiti, Abuduhaibier•Abula, Aihemaitijiang•Yusufu
    2016, 20 (22):  3279-3286.  doi: 10.3969/j.issn.2095-4344.2016.22.012
    Abstract ( 581 )   PDF (1333KB) ( 238 )   Save

    BACKGROUND: Tibial lengthening osteotomy has the advantages of light trauma, less pain, fast healing of bone that extended, and large amplitude of extension. However, it is often accompanied by a number of postoperative complications, among which postoperative foot drop is more common. It is one of the complications that is more difficult to deal with clinically.

    OBJECTIVE: To compare the incidence of foot drop after tibial lengthening osteotomy using Ilizarov external fixator and Orthofix external fixator.
    METHODS: Clinical data of 148 patients with tibial defects treated by tibial lengthening osteotomy in the Department of Micro-Reconstructive Surgery, First Affiliated Hospital of Xinjiang Medical University from July 2012 to May 2014 were retrospectively analyzed. All patients were divided into two groups according to the type of fixators: Ilizarov external fixator group (n=72) and Orthofix external fixator group (n=76). The incidence of foot drop after tibial lengthening osteotomy was compared between the two groups.
    RESULTS AND CONCLUSION: (1) Follow-up time was 1-1.3 years. Tibial defects of all patients were repaired. (2) There were 37 patients with foot drop, including 26 cases in the Ilizarov external fixation group and 11 cases in the Orthofix external fixation group. The incidence of foot drop was significantly higher in the Ilizarov external fixator group than in the Orthofix external fixator group (36%, 15%; P < 0.05). (3) The foot drop was improved in 28 cases among the 37 patients. The remaining nine patients were lost to follow-up, so they affected severe foot drop. Self functional exercise and ankle joint mobilization could not correct the foot drop. Achilles tendon lengthening improved the foot drop. (4) These findings verify that the incidence of Ilizarov external fixator on tibial proximal osteotomy in patients with foot drop was significantly higher than that of the Orthofix External fixator. The authors believe that the occurrence of foot drop after tibial osteotomy is associated with the patient’s own and external fixation. Therefore, strictly surgical skills, preoperative careful design, intraoperative fine operation, postoperative follow-up and timely treatment are the keys to reduce foot drop after tibial lengthening osteotomy. 
    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
    Correlation between reduction quality of femoral neck fracture and femoral head necrosis evaluated by three-dimensional measurement method
    Zhang Li-peng, Zhang Guo-ling, Xu Wei, Wang Dan, Wang Wen-liang
    2016, 20 (22):  3287-3293.  doi: 10.3969/j.issn.2095-4344.2016.22.013
    Abstract ( 350 )   PDF (1475KB) ( 226 )   Save

    BACKGROUND: Reduction quality is essential for the healing and function of limb. Traditional X-ray and CT scans have some limitations in quantitatively and visually observing the reduction quality of the remnant fracture in three-dimensional displacements. Mimics have advantages in bone rapid modeling and three-dimensional measurement, which offers the chance in quantifying the reduction quality of the displacement in three-dimensional methods.

    OBJECTIVE: To measure residual displacement in femoral neck fracture patients with satisfactory reduction by using three-dimensional measurement method, and to evaluate the association between residual displacement and femoral head necrosis. 
    METHODS: We enrolled 141 patients with femoral neck fracture, who were treated in the Third Department of Joint, Affiliated Hospital of Logistics University of People’s Armed Police Force from January 2012 to December 2013. All patients were divided into undisplaced fracture group (n=44; Garden1&2) and displaced fracture group (n=97; Garden3&4). Based on DICOM data of CT files, three-dimensional models were constructed in each patient. Three parameters were measured: displacement of femoral head’s center, fossa capitis femoris and rotational displacement. Femoral head necrosis was followed up. The correlation between residual displacement and femoral head necrosis was explored.
    RESULTS AND CONCLUSION: (1) The duration of follow-up in those patients ranged from 25 to 43 months. Femoral head necrosis occurred in 7 cases from the undisplaced fracture group and 21 cases from the displaced fracture group. (2) The three parameters (displacement of femoral head’s center, fossa capitis femoris and rotational displacement) were respectively (7.44±2.84) mm, (11.75±4.12) mm and (17.68±8.99)° in the undisplaced group, and (6.51±3.75) mm, (9.34±5.27) mm and (14.67±7.43)° in the displaced group. Except displacement of femoral head’s center, significant differences in the other two parameters were detected between the two groups (P < 0.05). (3) These findings suggest that poor reduction quality is the main factor causing femoral head necrosis. X ray is insufficient to describe the spatial shift and the angle, and has limitations in assessing the reduction quality of femoral neck fracture. Three-dimensional measurement has certain advantages to assess quality of fracture reduction. 
     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
    Static finite element analysis of the stability of osteotomy after hallux valgus surgery based on wrapped curtain method with external fixation
    Bi Chun-qiang, Wen Jian-min, Sun Wei-dong, Wang Li-zhen, Mao Rui, Bian Qiang, Wen Guan-nan, Chang Cheng, Zhang Yu-liang, Fan Yu-bo
    2016, 20 (22):  3294-3300.  doi: 10.3969/j.issn.2095-4344.2016.22.014
    Abstract ( 429 )   PDF (1314KB) ( 194 )   Save

    BACKGROUND: Integrated Traditional Chinese and Western Medicine minimally invasive treatment for hallux valgus based on wrapped curtain method with “8”-shaped bandage and sub toe pad external fixation has been used for a long time in the clinic. This method abandons the internal implant fixation and external plaster fixation. After surgery, patients could take care of themselves. However, the activity of the broken end may cause fracture nonunion, which once aroused scholars’ question. Recently, with the continuous improvement of foot biomechanics research, foot finite element model and applications become a reality.

    OBJECTIVE: To evaluate the stability of osteotomy after the operation of wrapped curtain method with “8”-shaped bandage and sub toe pad external fixation on the basis of static finite element method.
    METHODS: A young female volunteer with hallux valgus was selected, whose body weight was 58 kg, and right foot hallux abductor valgus angle was 24°; intermetatarsal angle was 13°; proximal articulator set angle was 7°; distal articulator set angle was 7°. CT was used to scan the right foot. ABAQUS software was applied to establish a finite element model of right foot hallux valgus bone, and model of the first metatarsal neck minimally invasive osteotomy was simulated based on wrapped curtain method with external fixation. Von Mises stress and displacement at the osteotomy end were calculated.

    RESULTS AND CONCLUSION: (1) The maximum stress was 0.067 MPa without external fixation, and the maximum stress was 1.258 MPa with the external fixation. Stress was mainly distributed in the outer edge of the osteotomy. (2) The maximum absolute displacement was 0.363 mm without external fixation, and the maximum absolute displacement was 0.716 mm with external fixation. The two largest displacements were both in the Z-axis direction. Statistical analysis confirmed that the four nodes absolute displacement and stress were significantly different (P < 0.01). (3) The maximum relative displacement was 0.101 mm. The maximum relative displacement was 0.046 mm with external fixation. The maximum relative displacement without external fixation was -0.102 mm and occurred in the Z-axis. The maximum relative displacement with external fixation was 0.110 mm and occurred in the Y-axis. (4) One-way analysis of variance confirmed that the four nodes relative displacements were not statistically significant in X-axis and Y-axis (P > 0.05). The four nodes relative displacements were statistically significant in Z-axis (P < 0.05). (5) These findings suggest that the external fixation based on wrapped curtain method after hallux valgus surgery could effectively reduce osteotomy displacement. The moderate stress and elastic fixation are conducive to fracture healing. 

    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
    Action mechanism for effects of tibial rotational alignment technique on patellofemoral joint biomechanics
    Liu Kai
    2016, 20 (22):  3301-3307.  doi: 10.3969/j.issn.2095-4344.2016.22.015
    Abstract ( 361 )   PDF (1072KB) ( 181 )   Save

    BACKGROUND: At present, the placement of tibial anatomic landmarks has no gold standard during total knee arthroplasty. In order to achieve the most ideal rotation function of the tibial prosthesis, we should do the preparation before surgery, understand tibial rotational alignment to rationally select and apply the prosthesis.

    OBJECTIVE: To investigate the effect of tibial rotational alignment technique on patellofemoral joint biomechanics and related mechanisms.
    METHODS: Ten pairs of human knee joint specimens were collected to prepare experimental platform. Specimens were fixed on the experiment frame, which was fixed on the material testing instrument for mechanics experiment. We set different knee flexion angles, including 30°, 60°, 90° and 120°. Joint replacement was performed with the knee prosthesis. Samples were randomly assigned to two groups (n=5). Tibial nodule technology and ROM technology were used to identify rotational alignment of the tibial prosthesis. The medial and lateral patellofemoral joint contact pressure peak and patellofemoral contact area at different knee angles, and the medial and lateral parts of patellofemoral contact area at deep knee angles were observed in both groups.
    RESULTS AND CONCLUSION: (1) During flexion angle from 30° to 60°, the peak contact pressure of medial patellofemoral joint increased, and decreased gradually in both groups. At flexion angle of 90°, contact pressure reached the minimum value, then increased gradually, and reached the maximum value at 120°. No significant difference in peak contact pressure of medial patellofemoral joint at different knee angles was detected between the two groups (all P > 0.05). (2) During flexion angle from 30° to 60°, peak contact pressure of lateral patellofemoral joint decreased constantly, and then gradually increased. No significant difference in peak contact pressure of lateral patellofemoral joint at different knee angles was detectable between the two groups (all P > 0.05). (3) During flexion angle from 30° to 60°, patellofemoral contact area decreased, and then increased gradually in both groups. No significant difference in patellofemoral contact area at different knee angles was identified between the two groups (all P > 0.05). (4) At 90° and 120°, no significant difference in the area of medial and lateral contact parts was determined between the two groups (all P > 0.05). (5) Experimental results showed that tibial nodule technology and ROM technology for identifying tibial rotational alignment during total knee arthroplasty can obtain considerable biomechanical effects of patellofemoral joint. 

    中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
    Figures and Tables | References | Related Articles | Metrics
    One-way versus universal pedicle screw fixation for lumbar fractures: biomechanics
    Lv Sheng-jiang, Fu Li-juan, Li Hong-mei
    2016, 20 (22):  3308-3314.  doi: 10.3969/j.issn.2095-4344.2016.22.016
    Abstract ( 339 )   PDF (955KB) ( 256 )   Save

    BACKGROUND: Previous studies have performed three-dimensional finite element analysis on lumbar fracture fixation. However, a few studies concerned three-dimensional finite element analysis of lumbar spinal pedicle screw fixation.

    OBJECTIVE: To analyze the biomechanical characteristics of one-way screw and universal screw fixation for lumbar fractures using finite element method. 
    METHODS: Models of lumbar fractures treated with one-way screw and universal screw fixation were established. Three-dimensional finite element method was used to analyze and compare the maximum axial displacement, maximum bending degree, maximum stress on the pedicle screw fixation system and maximum stress of intervertebral disc in normal vertebral fracture model, one-way and universal pedicle screw fixation models.
    RESULTS AND CONCLUSION: (1) The maximum axial displacement at anteflexion, posterior extension, left lateral curvature and right lateral curvature was significantly lower in the one-way fixation group and universal fixation group than in the normal group (P < 0.05-0.01). The maximum axial displacement at above directions was lower in the universal fixation group than in the one-way fixation group. (2) The maximum bending degree was significantly lower in the one-way and universal fixation groups than in the normal group (P < 0.05-0.01). The maximum bending degree at various directions was lower in the universal fixation group than in the one-way fixation group. (3) The maximum stress on the pedicle screw fixation system at various directions was lower in the universal fixation group than in the one-way fixation group (P < 0.05-0.01). (4) The maximum stress of intervertebral disc was significantly lower in the one-way and universal fixation groups than in the normal group (P < 0.05-0.01). The maximum stress of intervertebral disc at various directions was lower in the universal fixation group than in the one-way fixation group. (5) Results suggested that one-way and universal screw fixation for lumbar fracture can bear most of the stress, obviously decrease the maximum axial displacement, maximum bending degree, maximum stress on the pedicle screw fixation system and maximum stress of intervertebral disc. The stability of universal screw fixation was better than that of one-way 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
    Osteoporotic vertebral compression fractures: correlation between number of fractured vertebrae and C7 plumb line/sacro-femoral distance ratio
    Zhang Yi-long, Sun Zhi-jie, Wang Ya-hui, Ren Lei, Sun He
    2016, 20 (22):  3315-3321.  doi: 10.3969/j.issn.2095-4344.2016.22.017
    Abstract ( 393 )   PDF (1070KB) ( 266 )   Save

    BACKGROUND: Sagittal imbalance induced by vertebral osteoporotic fractures has not been paid enough attention in previous studies. 

    OBJECTIVE: To assess the correlation of osteoporotic vertebral compression fracture and spinal sagittal imbalance.
    METHODS: Sixty patients with old osteoporotic vertebral compression fracture, who were treated in the Department of Spine Surgery, the Affiliated Hospital of Chengde Medical College from February 2013 to August 2015, were enrolled in this study as the observation group. Sixty healthy old people from physical examination center were enrolled as the control group. The whole-spine anteroposterior and lateral X-ray films were taken in both groups. The number and the location of fractured vertebrae were recorded. Sagittal parameters of both groups including thoracic kyphotic angle, lumbar lordotic angle, T1-spinopelvic inclination angle and the C7 plumb line/sacro-femoral distance (PL/SFD) ratio were measured and compared among groups. The observation group was divided into three subgroups according to the number of fractured vertebrae, i.e., single-vertebrae fracture subgroup, double-vertebrae fracture subgroup and above triple-vertebrae fracture subgroup. The C7 PL/SFD ratio of the three subgroups was compared. The correlation between the number of fractured vertebrae and the C7 PL/SFD ratio was analyzed.
    RESULTS AND CONCLUSION: (1) The thoracic kyphotic angle of the observation group was bigger than that of the control group (P < 0.05). The lumbar lordotic angle of the observation group was smaller than that of the control group (P < 0.05). The absolute value of the T1-spinopelvic inclination angle of the observation group (-1.81±1.48)° was smaller than that of the control group (-3.35±1.22)° (P < 0.05). The C7 PL/SFD ratio of the observation group was significantly bigger than that of the control group (P < 0.05). (2) In the observation group, there were 4 cases of single-vertebrae fracture, 25 cases of double-vertebrae fracture and 31 cases of above triple-vertebrae fracture. Significant differences in the C7 PL/SFD ratio were determined among subgroups (P < 0.05). The number of fractured vertebrae was positively correlated with the C7 PL/SFD ratio; the correlation coefficient was 0.747. (3) Results indicated that osteoporotic vertebral compression fracture can change spinal local sagittal alignment. Multiple compression fractures of vertebrae can cause spinal sagittal imbalance. The gravity center of human body shifts forward. The number of fractured vertebrae was positively correlated with the range of shift forward.

    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
    Comparison of sagittal spino-pelvic morphology and life quality between degenerative and isthmic lumbar spondylolisthesis patients
    Wang Pu, Meng Xiang-lu, Wang Jian-dong, Ma Hai-chao
    2016, 20 (22):  3322-3327.  doi: 10.3969/j.issn.2095-4344.2016.22.018
    Abstract ( 424 )   PDF (1036KB) ( 258 )   Save

    BACKGROUND: Due to different pathogenesis of degenerative and isthmic lumbar spondylolisthesis, the differences in sagittal spino-pelvic morphology and life quality between them are still unclear.

    OBJECTIVE: To investigate the differences in sagittal spino-pelvic morphology and life quality between degenerative and adult isthmic lumbar spondylolisis patients.
    METHODS: From May 2012 to February 2015, 169 lumbar spondylolisthesis patients with complete imaging data were included in the study. Degenerative group contained 83 patients, and isthmic group contained 86 patients. The following radiographical parameters were measured on standard standing lateral radiographs of the entire spine, including thoracic kyphosis, lumbar lordosis, sagittal vertical axis, pelvic incidence, pelvic tilt and sacral slope. Meanwhile, slippage angle, slippage percentage and slippage distance of all patients were also measured. SF-36 scale was employed to evaluate life quality, which was compared between groups.
    RESULTS AND CONCLUSION: (1) Lumbar lordosis, thoracic kyphosis and slippage angle were significantly lower in the degenerative group than those in the isthmic group (P < 0.05-0.01). The sagittal vertical axis in degenerative group was higher than that in isthmic group (P < 0.01). (2) With respect to the domains of SF-36 scale, degenerative group had lower physical functioning score and social functioning score compared with the isthmic group (P < 0.01). (3) Pelvic incidence, pelvic tilt, sacral slope, slippage percentage and slippage distance showed no significant difference between two groups (P > 0.05). (4) Results suggested that pelvic morphology between the degenerative and isthmic lumbar spondylolisthesis was similar. Compared with degenerative lumbar spondylolisthesis, isthmic spondylolisthesis patients have higher thoracic kyphosis, lumbar lordosis and slippage angle. In addition, notable limitations of physical functioning and social functioning were found in degenerative lumbar spondylolisthesis patients. 

    中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
    Figures and Tables | References | Related Articles | Metrics
    One-stage total hip arthroplasty versus femoral head arthroplasty for elderly femoral neck fractures: a meta-analysis of hip function and complications
    Ye Xiang-yang, Wang Hua-lei, Zhao Yu-guo, Wang Hai-yu, Cheng Sheng
    2016, 20 (22):  3328-3336.  doi: 10.3969/j.issn.2095-4344.2016.22.019
    Abstract ( 540 )   PDF (1404KB) ( 287 )   Save

    BACKGROUND: There are objections to the efficacy and safety of total hip arthroplasty and artificial femoral head arthroplasty in the treatment of femoral neck fracture.

    OBJECTIVE: To assess the efficacy and safety of one-stage total hip arthroplasty and femoral head arthroplasty for > 60-year-old patients with femoral neck fractures.
    METHODS: According to the search strategy of Cochrane collaboration network, we searched PubMed (1966 to December 2014), EMbase (1974 to December 2014), Cochrane Library (Issue 3, 2011), China Biology Medicine database (1978 to December 2014), China National Knowledge Infrastructure (1994 to December 2014), VIP database (1989 to December 2014), and Wanfang Database (1979 to December 2014). Twenty-one articles on total hip arthroplasty and hemiarthroplasty for elderly femoral neck fractures were included. Two reviewers independently evaluated the quality of the included studies and extracted the data. In case of disagreement, settlement was made by negotiation. Meta-analysis was performed by RevMan 5.0 software in the included studies.
    RESULTS AND CONCLUSION: (1) Literature analysis: five randomized controlled studies, three quasi-randomized controlled studies, and thirteen retrospective cohort studies were included, containing 2 250 patients. (2) Meta-analysis: No significant difference in rate of dislocation, deep infection rate and mortality rate in 1 year after replacement was detected between total hip arthroplasty and hemiarthroplasty for elderly femoral neck fractures (dislocation rate: RR=1.38, 95%CI: 0.81-2.34; deep infection rate RR=1.12, 95%CI: 0.60-2.11; mortality rate RR=0.90, 95%CI: 0.69-1.18). Reoperation rate was higher in the hemiarthroplasty group than in the total hip arthroplasty group (RR=0.46, 95%CI: 0.32-0.66). Harris score on the affected side between 1 and 4 years was significantly higher in the total hip arthroplasty group than in the hemiarthroplasty group (MD=5.64, 95%CI: 2.82-8.46). (3) Results suggested that if physical conditions permit, compared with hemiarthroplasty group, femoral neck fractures patients aged > 60 years old in the total hip arthroplasty group had better hip function, but no significant difference was found in dislocation, deep infection and mortality between both 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
    Plate fixation versus intramedullary fixation for clavicle fractures: a meta-analysis
    Qiu Hao, Lu Min-peng, Luan Fu-jun, Wei Zhi-hui, Ma Ji-kun, Zhang Ming-hua
    2016, 20 (22):  3337-3344.  doi: 10.3969/j.issn.2095-4344.2016.22.020
    Abstract ( 485 )   PDF (1440KB) ( 254 )   Save

    BACKGROUND: Plate fixation or intramedullary fixation for clavicle fractures has remained a matter of debate. At present, there is a need for a higher level of evidence to evaluate the advantages and disadvantages of two different surgical methods. 

    OBJECTIVE: To assess the clinical efficacy of intramedullary fixation versus plate fixation in the treatment of clavicle fractures.
    METHODS: We conducted a computerized search of the electronic databases like Cochrane Library, PubMed, Embase, OVID, CBM, CNKI, Wanfang and VIP for relevant randomized controlled trials on plate fixation or intramedullary fixation for clavicle fractures. The quality of the included studies was independently assessed with RevMan 5.3 software. The meta-analysis was performed in Stata 13.0.
    RESULTS AND CONCLUSION: Eight randomized controlled trials with 527 patients were included in this meta-analysis. The meta-analysis results showed union time, surgery time, incision length, hospital stay and infection rate were less in the intramedullary fixation group than in the plate fixation group (P < 0.05). No significant difference in shoulder function score, upper limb function score, fracture nonunion and refracture was determined between the two groups (P < 0.05). The current evidences suggested that intramedullary fixation is the optimum choice in the treatment of clavicle fractures.

    中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
    Figures and Tables | References | Related Articles | Metrics