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24 June 2016, Volume 20 Issue 26 Previous Issue    Next Issue

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Biomechanical characteristics of bipolar femoral head prosthesis replacement and internal fixation for femoral neck fractures in the elderly Jiang Yuan-tao, Jiao Jian-bao, Xue Jin-wei, Wang Yun-fei 2016, 20 (26):  3805-3810.  doi: 10.3969/j.issn.2095-4344.2016.26.001 Abstract ( 383 )   PDF (1116KB) ( 240 )   Save BACKGROUND: Bipolar femoral head prosthesis has achieved the desired repair effect in patients with femoral neck fracture, but there is still much controversy on the biomechanical properties of bipolar artificial femoral head prosthesis.  OBJECTIVE: To compare biomechanical properties of the bipolar femoral head prosthesis replacement and internal fixation in the repair of femoral neck fracture in the elderly. METHODS: Twenty-three (46 sides) senile femoral neck fracture specimens were analyzed and randomized into internal fixation group (n=23) and bipolar femoral head prosthesis replacement group (n=23). Specimens in the internal fixation group underwent conventional metal implant fixation. Specimens in the bipolar femoral head prosthesis replacement group underwent bipolar femoral head prosthesis replacement. Mechanical properties of femoral prosthesis stem were tested on universal testing machine. Biomechanical properties after bipolar femoral head prosthesis replacement and internal fixation were compared. RESULTS AND CONCLUSION: (1) The maximum load was significantly higher in the bipolar femoral head prosthesis replacement group than in the internal fixation group (P < 0.05). The maximum load trend images showed that the maximum load was significantly higher in the bipolar femoral head prosthesis replacement group than in the internal fixation group (P < 0.05). (2) The displacement in axial pull test was significantly shorter in the bipolar femoral head prosthesis replacement group than in the internal fixation group (P < 0.05). The displacement trend images exhibited that the displacement in axial pull test was significantly shorter in the bipolar femoral head prosthesis replacement group than in the internal fixation group (P < 0.05). (3) These findings suggest that compared with the implant, bipolar femoral head prosthesis replacement in the repair of femoral neck fracture in the elderly is more stable, has better repair effects, can elevate hip function and obtain good initial stability.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Total hip arthroplasty for determining the position of the prosthesis and the biomechanical properties Qi Da-chun, An Xin-rong 2016, 20 (26):  3811-3816.  doi: 10.3969/j.issn.2095-4344.2016.26.002 Abstract ( 361 )   PDF (974KB) ( 259 )   Save BACKGROUND: During total hip arthroplasty, it is difficult to accurately determine the exact orientation of the pelvis. Pelvic position is prone to change during treatment. After prosthesis implantation, angle deviation easily occurs. The surgeon is difficult to accurately determine the position and orientation of the prosthesis. OBJECTIVE: To investigate the effects of prosthesis position during total hip arthroplasty by using three-dimensional computer-aided technique, and to analyze the biomechanical properties of the prosthesis in total hip arthroplasty. METHODS: Data of ten patients undergoing total hip arthroplasty in the Affiliated Hospital of Binzhou Medical University from January to November 2015 were analyzed. SIEMENS/DEFINITION dual source CT was used to scan the skeleton of patients. CT data were collected as a basis for data in modeling. Slice thickness was 0.732 mm; resolution of the inner surface was 512 × 512. CT data were imported in three-dimensional reconstruction software of a computer. The models of femur and pelvis were established. According to the type of fracture, false models of total hip arthroplasty were established. Simultaneously, biomechanical prosthesis models were established. We determined research methods of prosthesis position by computer-aided techniques and analyzed biomechanical properties in total hip arthroplasty.  RESULTS AND CONCLUSION: (1) The use of computer-aided technology could clearly show the defect site. After determining the defect position using computer-aided techniques, prosthesis implantation and repair effect could be simulated in the software. (2) The computer-aided through technology could accurately determine the vertical weight of the human. The acetabular center of rotation was used as the origin. A vertical parallel line was generated. The sagittal and coronal planes of the prosthesis could be set in new coordinates. (3) With the aid of computer, total hip prosthesis models were constrained and loaded, which lay the foundation for the operation through the model development. (4) The 10 patients achieved successful surgery. The position of prosthesis was correct in nine patients, with a success rate of 90%. Patients were followed up for 3 months. The patients did not have other complications. (5) These results suggest that computer-aided technology can do three-dimensional construction and analysis of the prosthesis, and can construct the position of the prosthesis during total hip arthroplasty according to three-dimensional reconstruction of the digitized pelvis model so as to achieve precise positioning of surface hip prostheses, which can prevent excessive wear of the joint, make pelvis closer to the physiological state of the mechanical distribution, and achieve the desired effect. 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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Changes of acetabular angle at different positions after total hip arthroplasty Tang Zhi, Gui Bin-jie, Ding Nan, Rong Gen-xiang, Gao Jie, Wang Si-sheng 2016, 20 (26):  3817-3822.  doi: 10.3969/j.issn.2095-4344.2016.26.003 Abstract ( 521 )   PDF (999KB) ( 226 )   Save  BACKGROUND: During total hip arthroplasty, placement angle of acetabular prosthesis is significant for clinical curative effects. OBJECTIVE: To investigate the abduction angle and anteversion angle of acetabular prosthesis at different positions during total hip arthroplasty and related influential factors. METHODS: Thirty-five patients undergoing total hip arthroplasty were included in this study, containing 21 males and 14 females, at the age of 51-75 years old. The same patient at different positions underwent X-ray examination, including standing anteroposterior pelvis radiographic imaging, standing lateral radiographic imaging and supine anteroposterior pelvis radiographic imaging. Abduction angle and anteversion angle of acetabular prosthesis were measured. RESULTS AND CONCLUSION: (1) Abduction angle and anteversion angle at standing position were bigger than that at supine position (48.47°, 45.89°; 12.44°, 6.17°; P < 0.05). (2) The change in anteversion angle was associated with pelvic incidence angle and pelvic tilt angle. The change in abduction angle was associated with pelvic obliquity. (3) The range of abduction angle (40±10)° and anteversion angle (15±10)° of acetabular prosthesis was identified as security zone. (4) Results suggested that there were changes in acetabular abduction angle and anteversion angle between supine anteroposterior pelvis radiographic imaging and standing anteroposterior pelvis radiographic imaging after total hip arthroplasty. Acetabular angle was associated with pelvic obliquity, pelvic incidence and pelvic tilt.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Influential factors for hidden blood loss after primary unilateral total knee arthroplasty Huang Jia-gu, Zhang Ke, Tian Hua, Wang Xiao-yong, Cai Hong, Li Zi-jian, Li Feng 2016, 20 (26):  3823-3829.  doi: 10.3969/j.issn.2095-4344.2016.26.004 Abstract ( 350 )   PDF (955KB) ( 229 )   Save BACKGROUND: Hidden blood loss is one of most important complications after total knee arthroplasty, but the mechanism and influential factors are not yet clear. OBJECTIVE: To analyze the relative influential factors for hidden blood loss in primary unilateral total knee arthroplasty. METHODS: Data of 235 patients who had undergone primary unilateral total knee arthroplasty from April to September 2014 were retrospectively studied. There were 38 males and 197 females aged from 48 to 82 years old with a mean age of 66 years. The Gross formula was used to calculate the amount of hidden blood loss. The effects of gender, age, height, body weight, body mass index, anesthesia method, administration of tranexamic acid, postoperative anticoagulation method, type of prosthesis, tourniquet time and pre-operative coagulation function on the postoperative hidden blood loss and total blood loss after total knee arthroplasty were analyzed. RESULTS AND CONCLUSION: (1) Significant differences in hidden blood loss and total blood loss after total knee arthroplasty were detected between male and female patients (P < 0.01). Significant differences in hidden blood loss and total blood loss were found between tranexamic acid and non-tranexamic acid groups (P < 0.05, P < 0.01). (2) Multivariate linear regression analysis showed that preoperative hemoglobin level and height were important factors influencing the blood loss after arthroplasty. Hidden blood loss and total blood loss were not correlated with age, body mass index, anesthesia method, postoperative anticoagulation method, type of prosthesis, tourniquet time and preoperative coagulation function. (3) Results indicate that gender and administration of tranexamic acid affect hidden blood loss and total blood loss after total knee arthroplasty. However, age, body mass index, anesthesia method, postoperative anticoagulation method, type of prosthesis, tourniquet time and preoperative coagulation function do not greatly affect hidden blood loss.   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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Correlation of free fatty acids and hidden blood loss after total knee arthroplasty Wang Shao-gang, Tao Zhong-liang, Wang Sheng, Tang Ji-ying 2016, 20 (26):  3830-3836.  doi: 10.3969/j.issn.2095-4344.2016.26.005 Abstract ( 328 )   PDF (4448KB) ( 224 )   Save BACKGROUND: Hidden blood loss, after total knee arthroplasty, attracts surgeons’ attention. There are various hypotheses about etiopathogenisis of hidden blood loss, but no one can reasonably explain its mechanism. OBJECTIVE: To research the correlation of free fatty acids and hidden blood loss after total knee arthroplasty, and explore the etiology and mechanism of hidden blood loss after total knee arthroplasty.  METHODS: Clinical data of 42 osteoarthritis patients who underwent primary unilateral total knee arthroplasty were collected in this study. Intraoperative and postoperative dominant blood loss was recorded. Blood samples were collected preoperatively and 24, 48, 72, and 96 hours postoperatively. Changes in hemoglobin, erythrocyte count, hematocrit and free fatty acids were detected in blood. Hidden blood loss was obtained by Gross equation. Simultaneously, stains were added to the blood smear. Changes of cells morphology were observed under a microscope.  RESULTS AND CONCLUSION: (1) Hemoglobin and erythrocyte count decreased significantly at 24 and 48 hours postoperatively, and significant differences were determined as compared with that preoperatively (P < 0.01). (2) Free fatty acids levels increased significantly within 24 hours after surgery, and decreased to preoperative levels at 72 and 96 hours later. Hidden blood loss was also significant at 24 and 48 hours after surgery, which showed positive correlation with free fatty acids content. (3) A plenty of abnormal erythrocytes were observed under the microscope. At 24 and 48 hours postoperatively, erythrocyte shrinkage and damage were mainly presented. At 96 hours, no significant abnormality was found. (4) These results indicated that free fatty acids were strongly associated with postoperative hidden blood loss. Surgeon should pay attention to the fatty droplets which may enter into the circulation in the process of reaming the femoral canal so as to reduce intraoperative total blood loss. 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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Key techniques of internal fixation for proximal tibial fractures based on digital design and three-dimensional printing Zheng Feng, Yu Zheng-xi, Chen Xuan-huang, Zheng Zu-gao, Wu Chang-fu, Wu Xian-wei, Lin Hai-bin, Zhang Guo-dong, Chen Xu 2016, 20 (26):  3837-3842.  doi: 10.3969/j.issn.2095-4344.2016.26.006 Abstract ( 269 )   PDF (4318KB) ( 663 )   Save BACKGROUND: Preliminary experiments have performed three-dimensional (3D) reconstruction of proximal tibial fractures, digital steel plate design, the establishment of the proximal tibia plate standard parts library and the operation simulation of 3D printing. OBJECTIVE: To explore feasibility and accuracy of standard parts library plates and screws in the proximal tibial fracture internal fixation navigation in digital design combined with 3D printing model on the basis of preliminary studies. METHODS: Dicom format images of continuous thin layer CT scanning were collected in 20 cases of proximal tibial fractures, and uploaded in Mimics software for 3D reconstruction and fracture reduction. Plate and screw selected from standard part library were used for virtual fixation. Navigation module with screw channel was designed. 3D printing skeleton, bone plate, and navigation module were used for skeleton model and internal fixation. Screw and plate were placed by navigation. Navigation module card, nail and board position were observed. Postoperative appearance and CT scanning were utilized to assess outcomes. RESULTS AND CONCLUSION: After CT scanning and reconstruction in 20 skeleton models, in combination with appearance, the position of plate, screw insertion point, the direction, length and diameter of the screw were consistent with that in Mimics software. The navigation module and the corresponding proximal end of the tibia were closely bonded with good fitting degree. In the application, card slots and stability were good, and could perfectly guide plate and screw placement. These reuslts suggest that with the aid of navigation module, standard parts library plate internal fixation for proximal tibia fracture has high accuracy. On the basis of digital design and 3D printing, digital internal fixation technology of standard parts library plate is expected to achieve good implant navigation in the department of orthopedics.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Effects of simulated weightlessness on biomechanics of motion unit of rhesus monkey lumbar vertebra Wang Xiao-ping, Lu Ming, Ma Pei, Chen Zhi-ming, Yuan Wei, Zhao Fu-jiang, Zhao Hao,Ren Dong-yun, Ma Hua-song, Wu Zhi-hong 2016, 20 (26):  3843-3848.  doi: 10.3969/j.issn.2095-4344.2016.26.007 Abstract ( 278 )   PDF (3232KB) ( 214 )   Save BACKGROUND: It is generally believed that the spine will be extended, and vertebral muscle atrophy, bone loss of vertebral body, increased height and area of intervertebral disc, changes of composition of intervertebral disc will occur in the condition of weightlessness. These are likely to be the cause of high incidence of low back pain. OBJECTIVE: To observe changes in lumbar spine bone microstructure analysis of simulated weightlessness on rhesus lumbar spine biomechanics. METHODS: Fourteen young rhesus monkeys were randomly divided into two groups: control group (n=7; free activities in the cage during the experiment), and experimental group (n=7; the use of head-down-10° on a special bed by bundle lying to simulate weightlessness). RESULTS AND CONCLUSION: (1) The results of Micro-CT examination: in the experimental group, structure model index in trabecular bone of increased. Trabecular bone changed from plate-like to the rod-like change. The intersection number of bone tissue in unit length to non-bone tissue declined. The average width of the canal between the trabecular bone increased, suggesting that there have been signs of osteoporosis in the experimental group. (2) Under an optical microscope, in the experimental group, bone hyperplasia line was disordered and irregular. Thick endplate trabecular bone became small, shallow, and arranged substantially perpendicular to the direction of trabecular bone and cartilage endplate. The closer the endplate surface, the smaller trabecular bone was. Compared with the control group, these small trabecular bones were thin and curved. Bone marrow cavity was oval. The degree of the connection between the trabecular bones is poor, reflecting the structural characteristics of significant osteoporosis. (3) It is indicated that weightlessness affected the biomechanical properties of rhesus lumbar motion unit.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Safety of screw placement for severe spinal deformity with the use of O-arm three-dimensional computer-assisted navigation system Wang Tao, Wang Hui, Song Yan-li, Yang Da-long, Wei Hai-kun, Liu Feng-yu, Ding Wen-yuan 2016, 20 (26):  3849-3855.  doi: 10.3969/j.issn.2095-4344.2016.26.008 Abstract ( 638 )   PDF (1399KB) ( 251 )   Save BACKGROUND: O-arm navigation integrates CT image quality and the flexible mobility of the C-arm. Surgery for severe spinal deformity is very difficult, with high incidence of nerve injury, so it is a challenging surgery for spinal surgery. The role of O-arm in the correction of spinal deformity is particularly important. OBJECTIVE: To explore the effect and safety of pedicle screw placement in severe spinal deformity under the guidance of O-arm navigation system. METHODS: Clinical data of 25 patients with severe spinal deformity with the aid of O-arm navigation were retrospectively analyzed. We observed pedicle screw insertion, operation time, intraoperative blood loss, correction of scoliosis and correction of kyphosis, and assessed the safety of screw insertion. RESULTS AND CONCLUSION: (1) Totally 326 pedicle screws were implanted in 25 patients. According to NEO classification, 280 pedicle screws (92%) belonged to grade 0 (no perforation of pedicle cortex). Grade 1: perforation of pedicle cortex, < 2 mm, including 44 screws (8%); grade 2: perforation of pedicle cortex, > 2 mm, < 4 mm, including 0 screw (0%); grade 3: perforation of pedicle cortex, > 4 mm, including  0 screw (0%). (2) Operation time was (272.3±17.3) minutes. Intraoperative blood loss was (1 710.0±229.1) mL. (3) Cobb angle of scoliosis was changed from (70.5±6.0)° preoperatively to (22.8±4.8)° postoperatively. Cobb angle of kyphosis was changed from (72.0±5.2)° preoperatively to (28.1±5.7)° postoperatively. Significant differences were detected (P < 0.05). (4) These findings verify that with the guide of the O-arm navigation system, the accuracy of screw insertion is high. The risk of intraoperative nerve injury was reduced. The scoliosis and kyphosis deformity were improved effectively.  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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Percutaneous vertebroplasty or percutaneous kyphoplasty for Kummell’s disease with vertebral posterior wall collapse: how to treat individually? Yu Hai-ming, Li Yi-zhong, Yao Xue-dong, Lin Jin-kuang, Pan Yuan-cheng, Zhuang Hua-feng,Wang Pei-wen 2016, 20 (26):  3856-3862.  doi: 10.3969/j.issn.2095-4344.2016.26.009 Abstract ( 401 )   PDF (1833KB) ( 324 )   Save BACKGROUND: Stage I or II Kummell’s disease is usually suggested to be treated with percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). Stage III Kummell’s disease with neurologic deficit is treated with open decompression, cement-augmented combined with internal fixation. However, surgical options for stage III Kummell’s disease with dural sac compression but with no nervous symptoms are in dispute and rarely reported. OBJECTIVE: To investigate the surgical options of Kummell’s disease with vertebral posterior wall collapse. METHODS: Fourteen patients with Kummell’s disease with vertebral posterior wall collapse were enrolled as experimental group and treated with PVP or PKP based on the degree of postural reduction. Another 28 patients with osteoporotic vertebral fracture as control group were treated with PKP. Then all patients were followed up to observe vertebral height, Cobb angle, visual analog scale and the Oswestry disability index. RESULTS AND CONCLUSION: After followed up for 10 to 42 months, the restored vertebral height, Cobb angle, visual analog scale and Oswestry disability index were significantly improved in the two groups (P < 0.05). The postoperative vertebral height in the experimental group was significantly higher than that in the control group (P < 0.05). But no significant differences in Cobb angle, visual analog scale scores and Oswestry disability index were found between the two groups after operation (P > 0.05). These data suggest that based on the degree of postural reduction, individualized PVP or PKP for Kummell’s disease with vertebral posterior wall collapse can attain satisfactory outcomes. 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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Significance of dynamic monitoring of D-dimer levels in predicting deep vein thrombosis after spinal nerve repair Wu Hao, Wang Yong-xin, Li Quan-cai, Huang Bin, Guo Yun-fa, Liu Ya-jun, Wang Jin-long, Luo Kun 2016, 20 (26):  3863-3869.  doi: 10.3969/j.issn.2095-4344.2016.26.010 Abstract ( 522 )   PDF (1134KB) ( 235 )   Save BACKGROUND: Deep vein thrombosis is a common postoperative complication after spinal surgery in clinical department of neurosurgery and department of orthopedics. Deep vein thrombosis is mostly related to vein intima injury, stasis and activation of blood coagulation factor. Early effective prediction can effectively avoid the adverse effects on the prognosis of patients with deep vein thrombosis. D-dimer used in the prediction of deep venous thrombosis has high sensitivity and specificity, and can be used as a sensitive predictor for deep vein thrombosis. OBJECTIVE: To explore the relationship between plasma D-dimer mass concentration and deep vein thrombosis after spinal surgery. METHODS: A total of 83 patients treated with spinal surgery collected from Department of Neurosurgery, First Affiliated Hospital of Xinjiang Medical University from April 2014 to August 2015 were retrospectively analyzed. They were divided into two groups according to postoperative plasma D-dimer mass concentration: D-dimer positive group (n=48) and D-dimer negative group (n=35). We monitored D-dimer mass concentration in both groups preoperatively and postoperatively 1, 3, 5, 9 and 14 days, and analyzed the relationship between D-dimer mass concentration and deep vein thrombosis. RESULTS AND CONCLUSION: (1) No significant difference in D-dimer mass concentration was determined between the two groups (P > 0.05). D-dimer mass concentration was significantly higher in the D-dimer positive group than in the D-dimer negative group 1, 3, 5, 9, and 14 days postoperatively (P < 0.05). (2) After operation, plasma D-dimer of 28 cases was positive, with persistent increasing. Double lower limb deep vein color Doppler ultrasound demonstrated that seven patients experienced deep vein thrombosis and four patients suffered from pulmonary embolism in D-dimer positive group. There was no deep vein thrombosis and pulmonary embolism in the D-dimer negative group. (3) These results indicate that positive D-dimer concentration of patients after spinal surgery suggests the possibility of deep vein thrombosis. If the concentration of D-dimer is persistently high, we should highly alert to the occurrence of deep vein thrombosis.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Biomechanical properties of lateral plate combined with medial percutaneous lag screw and its application in the distal tibial fractures Wang Quan, Wang Dong-lai 2016, 20 (26):  3870-3875.  doi: 10.3969/j.issn.2095-4344.2016.26.011 Abstract ( 288 )   PDF (1063KB) ( 206 )   Save BACKGROUND: Current clinical studies seldom concern biomechanical properties of lateral plate combined with medial percutaneous lag screw. Moreover, effects of clinical application to distal tibial fractures are not investigated.  OBJECTIVE: To explore biomechanical properties of lateral plate combined with medial percutaneous lag screw, and to analyze the repair effect on distal tibial fractures. METHODS: Six adult antiseptic tibia specimens were studied. Bone saw was used to make a bone defect in 1 cm length, which was fixed with lateral plate and lateral plate combined with medial percutaneous lag screw. Three point bending test, axial compression test and rotation test were performed. Clinical data of twenty cases of distal tibial fracture patients from the Department of Orthopedics of Hebei Medical University were analyzed and randomly divided into lateral plate group and lateral plate combined with medial percutaneous lag screw group (n=10). Clinical repair effects were compared between the two groups.   RESULTS AND CONCLUSION: (1) Biomechanical indexes of cadaver specimens: no significant difference in torsional strength was determined between the two groups (P > 0.05). Bending stress and axial displacement were significantly lower in the lateral plate combined with medial percutaneous lag screw group than in the lateral plate group (P < 0.05). (2) Repair surgery related indicators: operation time, intraoperative blood loss, length of stay and fracture healing time were significantly less in the lateral plate combined with medial percutaneous lag screw group than in the lateral plate group (P < 0.05). (3) Repair effects: There were nine cases of fracture healing in the lateral plate combined with medial percutaneous lag screw group 3 months after treatment. The total effective rate was significantly higher in the lateral plate combined with medial percutaneous lag screw group (90%) than in the lateral plate group (70%) (P < 0.05). (4) These findings indicate that lateral plate combined with medial percutaneous lag screw has a unique advantage in resisting axial compression, torsion and bending. Its application to distal tibial fractures obtains ideal effects, can improve the clinical efficacy and stability.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Titanium plate combined with bone graft and internal fixation for calcaneal fractures: influencing factors for lateral L-shaped incision healing Zhang Bai, Qi Xiu, Han Zuo-feng, Zhang Ying 2016, 20 (26):  3876-3882.  doi: 10.3969/j.issn.2095-4344.2016.26.012 Abstract ( 344 )   PDF (1558KB) ( 247 )   Save BACKGROUND: Calcaneus has its special anatomy. Moreover, it is difficult to expose the inside to the posterior side of the joint surface. Lateral calcaneal soft tissue was less. The joint surface can be clearly exposed after incision, so lateral L-shaped incision is conventionally used in calcaneal surgery. OBJECTIVE: To analyze the suspicious factors influencing the open reduction titanium plate for calcaneal fracture and internal fixation of L-shaped wound healing during bone graft. METHODS: A total of 84 cases (94 sides) of calcaneal fractures, who were treated in the Disabled Rehabilitation Center in Liaoning Province from June 2011 to November 2014, were included in this study. They were grouped according to the source of bone graft. Allograft group contained 52 sides (44 cases). Autogenous iliac bone graft group contained 42 sides (40 cases). Operation time of calcaneus was 7-10 days after injury. L-shaped incision was made for open reduction and internal fixation with titanium plate and bone graft. The patient’s age, the type of bone graft, type of drainage and drainage time that may cause the incision complications were investigated and analyzed. RESULTS AND CONCLUSION: (1) Among 84 cases of 94 calcaneal fractures after operation, 16 sides affected complications. (2) Significant differences in the incidence of complications were detected between negative pressure drainage and skin flap drainage (P < 0.05). Negative pressure drainage had a significant effect on reducing the incidence of incision complications. (3) Significant differences in the incidence of incision complications were determined between the allograft group and autogenous iliac bone graft group (P < 0.05). Implantation of autogenous iliac bone could significantly reduce the incidence of incision complications. (4) No significant difference was detected between the complication group and non-complication group in age and drainage time (P > 0.05). (5) These findings indicate that 7-10 days after injury, operation after the swelling subsided completely, the negative pressure drainage, and planting autogenous iliac crest can reduce the incidence of complications related to lateral calcaneal L-shaped incision.  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 finite element analysis of stress distribution in necrotic femoral head before and after tantalum rod implantation Zhu Gang, Zhang Li-gui, Zheng Zhong, Xu Ming-jie, Yang Ming 2016, 20 (26):  3883-3889.  doi: 10.3969/j.issn.2095-4344.2016.26.013 Abstract ( 368 )   PDF (1282KB) ( 190 )   Save BACKGROUND: Tantalum rod implant technology is a new method of early osteonecrosis treatment. Current research on stress distribution before and after tantalum rod implant in different sizes of femoral head necrosis area is few. OBJECTIVE: To analyze the stress distribution before and after tantalum rod implantation in different sizes of necrotic femoral head area using three-dimensional finite element method. METHODS: Three-dimensional finite element models of normal femoral head and necrotic femoral head of 15, 20 and 30 mm diameter were constructed. Eight measuring points were chosen on two tiers of each necrotic model to detect the stress distribution and its alteration before and after tantalum rod implantation. RESULTS AND CONCLUSION: (1) Stress concentration were found on every necrotic femoral head, most pronounced on the one with 30 mm lesion. (2) Tantalum implant appeared to reduce the stress concentration generally. Comparison of the peak points of these models indicated most significant benefit in 15 mm lesion, next in 30 mm lesion, last in 20 mm lesion. (3) Results indicate that larger lesion entails more concentrated stress distribution and more likely to collapse. Tantalum rod implantation can delay the development of necrosis of the femoral head, and is most effective in small lesion. 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 finite element analysis of unstable intertrochanteric fracture in different fixation ways Chen Shao-ming, Qiu Yu-jin, Lu Bin, Yang Zhi-qiang, Wang Bao-jiu, Feng Zhen-dong 2016, 20 (26):  3890-3896.  doi: 10.3969/j.issn.2095-4344.2016.26.014 Abstract ( 332 )   PDF (994KB) ( 218 )   Save BACKGROUND: The morphological and mechanical transfers of unstable intertrochanteric fractures were complicated, so it is difficult to analyze the biomechanical characteristics of the common experimental methods in a comprehensive way. Moreover, the high cost, long cycle and poor repeatability of common tests limit its application in biomechanics.  OBJECTIVE: To analyze the biomechanical characteristics of unstable intertrochanteric fracture in different fixation ways by three-dimensional finite element analysis. METHODS: Intertrochanteric fracture locking dynamic hip fixation model (C1), Gamma nail fixation model (C2) and proximal femoral anatomical locking plate model (C3) were established. The distal end of the femur was fixed, and subjected to the hip reaction force of 2 800 N and abduction muscle strength of 1 200 N. Three-dimensional finite element analysis was used to analyze the stress distribution, stress concentration and maximum displacement of unstable intertrochanteric fracture in three different fixation ways. RESULTS AND CONCLUSION: (1) Stress: the anterolateral stress and anteromedial stress of C3 were the maximum. Posterolateral stress and posteromedial stress of C3 were the minimum. There were significant differences among the three groups (all P < 0.05). (2) Stress of fracture space: significant differences in anterolateral stress, anteromedial stress, posterolateral stress and posteromedial stress were determined in C1, C2 and C3 (P < 0.05). Anterolateral stress of C3 was significantly less than anterolateral stresses of C1 and C2 (P < 0.05). Anteromedial stress of C3 was significantly less than that of C1 and C2 (P < 0.05). Posterolateral stress of C1 was significantly larger than that of C2 and C3 (P < 0.05). Posteromedial stress of C1 was significantly larger than that of C2 (P < 0.05). Posteromedial stress of C3 was significantly less than that of C1 and C2 (P < 0.05). (3) Significant differences in bone stress around the screw top were detected among the three groups (P < 0.05). Bone stress around the screw top of C3 was significantly larger than that of C1 and C2 (P < 0.05). (4) Thus, locking dynamic hip screw, Gamma nail and proximal femoral anatomical locking plate have their advantages and disadvantages for treatment of unstable intertrochanteric fracture of the femur. The appropriate internal fixation device should be selected according to the need.  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 the three and four cannulated screws for Pauwels III femoral neck fractures Zhang Hao, Shi Xue-feng, Yang Chun-bao, Lv Ji-hong, Xiang Yi, Sun Zhen-jun, Guan Jing-tao, Tang Yong, Xu Li-min 2016, 20 (26):  3897-3902.  doi: 10.3969/j.issn.2095-4344.2016.26.015 Abstract ( 378 )   PDF (899KB) ( 284 )   Save BACKGROUND: Femoral neck fracture is mainly fixed by three inverted triangle cannulated screws. Scholars have proposed to add a cannulated screw to enhance the fixation strength of femoral neck fracture of Pauwels III type based on three cannulated screw fixation, but the stability is not verified. OBJECTIVE: To analyze the biomechanical stability and stress of the three and four cannulated screws for the treatment of the Pauwels III femoral neck fractures. METHODS: The CT imaging results of the fourth generation of artificial bone sawbones were imported into the Mimics software wherein a three-dimensional finite element model of the proximal femur was prepared and introduced in the 3-matic software. Models of middle segment of femoral neck with Pauwels III fractures were established. Cannulated screw models were established with UG 8.0 software and introduced in the fractures models. Finally, finite element models of Pauwels III femoral neck fractures fixed with three and four screws were established. In the same condition, an axial load of 411 N was applied on the femoral head with Abaqus software. The displacement of two markers of the broken ends and internal fixation system Von Mises stress distribution were compared between the two models. RESULTS AND CONCLUSION: (1) The displacement was 0.42 mm in three screws model, and 0.17 mm in the four screws model. (2) Von Mises stress peak was 547 MPa and 27.8 MPa in both models. The peak value was lower in models of four screws than that of three screws. Stress concentration position was at the fracture site in both models. The stress range of models of four screws was more extensive and scattered. (3) Finite element analysis results demonstrated that four-screw implantation for Pauwels III femoral neck fractures had strong anti-shearing force and biomechanical stability. Clinical advantages need further clinical comparative study.    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 clavicle fracture with superior and anterior plate fixation Liu Dong, Wang Jian-ming, Zhang De-gang, Zhang Kai, Du Gang-qiang 2016, 20 (26):  3903-3908.  doi: 10.3969/j.issn.2095-4344.2016.26.016 Abstract ( 333 )   PDF (981KB) ( 278 )   Save BACKGROUND: Many scholars researched the biomechanics of middle clavicle fracture plate fixation, but little researched the plate position. OBJECTIVE: To observe the biomechanical characteristics of anterior and superior plates for clavicle fracture with three-dimensional finite element models.  METHODS: Three-dimensional finite element models of clavicle fracture with anterior and superior plates were established. The stress after anterior and superior plate fixation was analyzed. The maximum stress and displacement of plate fixation for clavicular fracture were observed under compression, torsion and three-point bending.  RESULTS AND CONCLUSION: (1) In the compressed condition, the maximum stress and maximum fracture displacement were similar between the superior and anterior plate fixation (P > 0.05). (2) Under clockwise twist condition, the maximum stress and maximum fracture displacement were smaller in the superior plate fixation group than in the anterior plate fixation group (P < 0.05). (3) Under counterclockwise twist condition, the maximum stress and maximum fracture displacement were similar between the anterior and superior plate fixation groups (P > 0.05). (4) Under three-point bending condition, the maximum stress was similar between the superior and anterior plate fixation groups (P > 0.05). The maximum fracture displacement was bigger in the superior plate fixation group than in the anterior plate fixation group (P < 0.05). (5) These findings suggest that superior fixation of clavicle fracture reconstruction plate has more advantages than the anterior plate fixation. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Comparison of biomechanics of common compression plate and locking plate fixation for middle and lower complex humeral shaft fracture in the elderly Zhao Feng-feng 2016, 20 (26):  3909-3915.  doi: 10.3969/j.issn.2095-4344.2016.26.017 Abstract ( 360 )   PDF (1065KB) ( 213 )   Save BACKGROUND: The lower and middle humeral shaft fractures are common upper limb fractures. Incidence rate and recurrence rate were high in the elderly population. However, there is a lack of a method with ideal curative effect. OBJECTIVE: To compare and analyze the biomechanical differences between common compression plate and locking plate fixation in the repair of middle and lower complex humeral shaft fracture in the elderly. METHODS: 30 pairs of antiseptic elderly humerus specimens were selected to make models of middle and lower humeral shaft fracture. Two humeri from the same individual were randomly assigned to two groups, and subjected to locking plate and common compression plate fixation. Experimental mechanics models were used to determine displacement and torsion angle under compression, bending and torsion. Data were analyzed and compared between the two groups. RESULTS AND CONCLUSION: (1) After exclusion of relevant factors, specimens with high bone density and excellent quality were selected from all specimens. (2) Under axial load of 500 N, the bending load of 7.0 N•m and torsional load of 3 N•m or less, the strain was smaller in locking plate group than in common compression plate group under compression, bending and torsion (P < 0.05). Relative displacement under the above loading was smaller in locking plate group than in common compression plate group (P < 0.05). (3) Above data suggested that locking plate has good compressive, flexural and torsional rigidity, can ensure the stability and integrity of the fracture connection.  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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Distal femoral rotational axis reference method based on magnetic resonance technique Lv Guo-yi, Li Zhen-xu, Xiang Xu, Li Jian-ling, Yin Jie 2016, 20 (26):  3916-3922.  doi: 10.3969/j.issn.2095-4344.2016.26.018 Abstract ( 333 )   PDF (1155KB) ( 257 )   Save BACKGROUND: Problems regarding the prosthesis in the horizontal plane and the rotation of the femur and tibia prosthesis on line are relatively weak. The distal femoral rotation axis is mainly the transepicondylar axis. Due to patient differences as well as anatomy and intraoperative display, it is difficult to accurately locate the axis in the process of knee arthroplasty. OBJECTIVE: To investigate application of magnetic resonance technique in determining the axis of rotation of the distal femur, to provide reference and basis for femoral rotational alignment during total knee arthroplasty. METHODS: Data of 122 cases without knee joint disease, who were diagnosed and treated in the Department of Orthopedics of Nanyang City Center Hospital from September 2014 to October 2015, were analyzed. Magnetic resonance technique was used to measure femoral epicondyle axes (STEA), femoral epicondyle axes (CTEA), the anteroposterior axis (APL) and femoral shaft (PCL). Simultaneously, magnetic resonance technique was utilized to measure femoral ankle angle (PCA), ankle twist angle (CTA), axis vertical line and ankle axis angle (PAPA). Each data were tested three times, and the average value was calculatd. We analyzed the method of magnetic resonance technique to determine reference axis of distal femoral rotation.  RESULTS AND CONCLUSION: (1) Accuracy of the angle close to surgical transepicondylar axis: 3° PCL> CTEA > APL vertical line. (2) No significant difference in PCA was detected in two sets of measurements (P > 0.05). CTA and PAPA parameters in the first measurement by magnetic resonance imaging diagnosis were significantly lower than the second measurement (P < 0.05). (3) Results indicate that magnetic resonance technology provides ideal reference for distal femoral rotation, can accurately measure the CTA, PCA, PAPA and other indicators. It is a more reliable determination method and can be used in scientific determination of femoral rotational alignment reference axis in total knee arthroplasty. Except STEA, the accuracy of 3° PCL is highest.  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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Navigation method of 64-slice CT reconstruction in tibial plateau fractures Xu Hong-wei 2016, 20 (26):  3923-3928.  doi: 10.3969/j.issn.2095-4344.2016.26.019 Abstract ( 316 )   PDF (1028KB) ( 182 )   Save BACKGROUND: 64-slice CT reconstruction technique for tibial plateau fractures has obtained satisfactory results. This technology can reconstruct three-dimensional fracture relations, provide more scientific positioning and navigation standards for physicians, and improve the clinical cure rate. However, in the clinic, navigation method of 64-slice CT reconstruction techniques for tibial plateau fractures lacks a unified standard. OBJECTIVE: To study the navigation method and effect of 64-slice CT reconstruction in tibial plateau fractures. METHODS: A total of 44 patients with tibial plateau fractures were enrolled in this study, including 27 males and 17 females, at the age between 21 and 74 years old. These patients were randomly divided into two groups (n=22). The control group underwent navigation method according to physician’s experience. The test group underwent navigation method according to 64-slice spiral CT scan results. Healing time, full weight-bearing time, knee motion range at 1 year postoperatively, the recovery of knee function at 1 year postoperatively and adverse reaction were compared between the two groups.  RESULTS AND CONCLUSION: (1) No significant differences in full weight-bearing time and knee motion range at 1 year postoperatively were detected between the two groups (P > 0.05). Healing time was significantly shorter in the test group than in the control group (P < 0.05). (2) The excellent and good rate of knee joint was 100% at 1 year postoperatively in the test group, which was significantly higher than the control group (81%) (P < 0.05). (3) The complication rate was significantly lower in the test group (8%) than in the control group (18%) (P < 0.05). (4) These results indicate that the effect of 64-slice CT reconstruction for navigation in tibial plateau fractures was ideal, could clearly simulate the pedicle screw fixation channel, visibly display anatomic characteristics of tibial plateau fractures, improve internal fixation accuracy, and improve repair effect.   中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Meta-analysis of death risk factors for hip fracture in the elderly Wang Xin 2016, 20 (26):  3929-3937.  doi: 10.3969/j.issn.2095-4344.2016.26.020 Abstract ( 277 )   PDF (1798KB) ( 279 )   Save BACKGROUND: At present, with the aging trend of the world’s population and social development, the proportion of hip fracture is on the rise, and the morbidity and mortality rate are high. Therefore, it is necessary to analyze the risk factors for death in old patients with hip fractures.  OBJECTIVE: To review and systematically analyze the death risk factors for hip fracture all over the world. METHODS: The PubMed, Medline, EMBASE, the Cochrane library, China Knowledge Resource Integrated Database, VIP database resources were reviewed for mortality risk factors for hip fracture in the elderly. Meta analysis of mortality risk factors for hip fracture in the elderly was conducted by Stata11.0 software, and then the pooled odd ratio (ORs) and 95% confidence interval (95% CI) of each risk factor were calculated from the patient’s own factors and iatrogenic factors in order to analyze risk factors for hip fracture in the elderly. RESULTS AND CONCLUSION: (1) 47 literatures were searched and among them 27 literatures were included in our meta-analysis. (2) The results of meta-analysis showed that mortality risk factors for hip fracture in the elderly included male, older than 60 years of age, body mass index, high American Society of Anesthesiologists Score, delay time from fracture to surgery, poor daily living before fracture, type of fracture, pre-fracture lung disease, pre-fracture cardiovascular disease, and pre-fracture dementia. (3) Results indicated that high mortality of the elderly patients with hip fractures possibly resulted from combined actions of physiological condition, operative factors and postoperative rehabilitation. Before treatment, fully understanding the patient’s physical function and health status, fully assessing the risk of surgery, and selecting the appropriate type of surgery can reduce complication rate and mortality and improve patients’ prognosis.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Meta-analysis of titanium plate and elastic intramedullary nail in the treatment of midshaft clavicular fractures   Ye Yong, Li Jun, Jing Jue-hua 2016, 20 (26):  3938-3945.  doi: 10.3969/j.issn.2095-4344.2016.26.021 Abstract ( 284 )   PDF (1104KB) ( 223 )   Save BACKGROUND: Elastic stable intramedullary nailing and titanium plate fixation are two methods for the treatment of midshaft clavicular fractures. Current research about comparison of these two methods is not too much, and most of cases were retrospectively analyzed. OBJECTIVE: To compare the efficacy of elastic stable intramedullary nailing and titanium plate fixation for midshaft clavicular fractures. METHODS: The PubMed database, CBM, EMbase database, Cochrane Library database, CNKI database and Wangfang database were searched to collect the trials on midshaft clavicular fractures. The searching time ranged from the date of building to September 2015. The quality of trails was evaluated. RESULTS AND CONCLUSION: (1) Seven trials involving 512 patients were included. (2) Meta-analysis results showed the postoperative functional recovery was better in the elastic stable intramedullary nailing group than that of the plate fixation group (P < 0.01). (3) The average bone union time, operation time, incision length, intraoperative blood loss and the hospital stay of the elastic stable intramedullary nailing group were less than those of the plate fixation group (P < 0.01). (4) There were no significant differences in incidence rate of complications between two groups. (5) It is concluded that elastic stable intramedullary nailing for treating midshaft clavicular fractures is superior to the plate fixation in the efficacy. As the first choice for treatment of midshaft clavicular fractures, above conclusions are needed to be verified by large-scale multi-center randomized controlled trials.    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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Strategy and adjuvant therapy of internal fixation implant and external fixation stent for treating tibial fracture nonunion Hong Fan, Xie Jia-bing, Ding Guo-zheng 2016, 20 (26):  3946-3952.  doi: 10.3969/j.issn.2095-4344.2016.26.022 Abstract ( 426 )   PDF (1056KB) ( 188 )   Save BACKGROUND: Nonunion is a common clinical problem in the prognosis of tibial fracture. The treatment method of tibial fracture nonunion is extensive and develops rapidly. Different repair plans should be taken to the nonunion of tibial fractures caused by different factors. OBJECTIVE: To summarize the repair strategy and effect of adjuvant therapy of internal fixation implants and external fixation stent for treatment of tibial fracture nonunion. METHODS: The PubMed database and CNKI database were retrieved by the author of this article for the published articles related to reason and treatment method of nonunion. The key words were “tibial fracture nonunion, reason, treatment, implant, external fixation”. The repetitive and old articles were eliminated. RESULTS AND CONCLUSION: (1) Finally 35 articles were selected for further analysis. (2) Surgical method is the chief treatment for tibial fracture nonunion. We choose different surgical methods for the best curative effect according to the reasons of nonunion and whether it is infected or not. The biological and structural factors that cause bone delayed healing should be considered in the treatment. (3) The fixed treatment on the structure is divided into external fixation and internal fixation. Intramedullary nail and compression plate can give stability of nonunion without infected tibial fractures, and it is a good solution to the structural problems. External fixation can be used for nonunion of infected tibial fracture. (4) To solve the biological problems of nonunion of tibial fractures (bone defect), various bone grafting materials and bone grafting techniques can be used. It is generally required to fix the bone graft in the treatment of nonunion of the tibia fracture. In recent years, biological materials have been gradually applied to solve the problem of bone nonunion of tibial fractures. Although electrical stimulation and ultrasound have been shown to promote fracture healing, it has not been clinically proven to be used in the treatment of nonunion of tibial 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