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22 July 2016, Volume 20 Issue 31 Previous Issue    Next Issue

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Correlation between hidden blood loss and nutritional status in elderly patients after total hip replacement Zhu Dong-mei, Liu Guo-yin, Bao Lei, Wang Meng-ru, Ye Ming-zhu, Leng Nan-nan, Yang Zheng-qian, Xu Xiao-xiao, Chen Jian-min 2016, 20 (31):  4565-4574.  doi: 10.3969/j.issn.2095-4344.2016.31.001 Abstract ( 359 )   PDF (1326KB) ( 267 )   Save BACKGROUND: Perioperative high hidden blood loss affects the recovery of joint function after total hip replacement.  OBJECTIVE: To analyze the reliability of the Mini Nutritional Assessment on evaluating the nutritional status in elderly patients with femoral neck fracture on admission, and to investigate the effect of nutritional status variation on hidden blood loss after total hip replacement. METHODS: 234 elderly patients with femoral neck fracture underwent total hip replacement. By using Mini Nutritional Assessment, patients were randomly divided into three groups: well-nourishment group (n=52), malnourishment at risk group (n=92), and malnourishment group (n=90). The results were used to analyze the correlation of Mini Nutritional Assessment and serological nutrition indicators, and to hidden blood loss. RESULTS AND CONCLUSION: (1) Hidden blood loss: 101 patients suffered from high hidden blood loss. Hidden blood loss, its proportion to total blood loss and incidence of high hidden blood loss gradually increased with the deterioration of the nutritional status (P < 0.05). (2) Mini Nutritional Assessment: Pre-operative Mini Nutritional Assessment score, and the incidence of hidden blood loss evaluated by albumin, prealbumin, transferrin, lymphocyte count, the percentage of lymphocytes and hemoglobin was significantly higher in patients with high hidden blood loss than those with low hidden blood loss (P < 0.01). (3) Results of correlation analysis: High hidden blood loss was positively correlated with pre-operative Mini Nutritional Assessment, albumin, prealbumin, transferrin, the percentage of lymphocytes and hemoglobin (P < 0.05). (4) These findings confirm that risk evaluation with Mini Nutritional Assessment is a reliable method to assess the nutritional status in elderly patients undergoing total hip replacement. Its combination with various serum nutrition indicators can determine high hidden blood loss and the 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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Unicompartmental knee replacement for medial compartmental knee osteoarthritis: a four to six-year follow-up Lu Ning, Yang Yang 2016, 20 (31):  4575-4581.  doi: 10.3969/j.issn.2095-4344.2016.31.002 Abstract ( 532 )   PDF (1143KB) ( 185 )   Save BACKGROUND: Unicompartment knee replacement is more popular for small trauma, rapid recovery, low complication and almost normal knee mechanics, and has been more and more used in clinic to repair single compartment knee disease. At present, there is no report about the influence of the angle of the single condyle prosthesis on the survival rate. OBJECTIVE: To evaluate the effectiveness of unicompartmental knee replacement for medial compartmental osteoarthritis of the knee in 4-6 years of follow-up. METHODS: Thirty patients with medial compartmental osteoarthritis of the knee were treated by unicompartmental knee replacement with Oxford system. Complication occurrence was observed. Curative effects were evaluated with Hospital for Special Surgery score before and 3 months, 6 months and 1 year after surgery. On anteroposterior view, the varus/valgus alignments of the tibial components were measured relative to the long axis of the tibia. On lateral view, flexion/extension of the femoral component was measured relative to the posterior femoral cortex. RESULTS AND CONCLUSION: (1) Primary healing of incision was obtained in all patients, and no infection or lower limb deep venous thrombosis occurred. (2) All of the patients were followed up for 48-72 months. There was no prosthetic loosening, dislocation or revision for contralateral compartment and patellofemoral joint symptoms. (3) Hospital for Special Surgery score was significantly increased to (90.47±4.05) (P=0.00). (4) Tibial placement angle of single condyle prosthesis: The axis of the prosthesis was perpendicular to the axis of the tibia in 21 cases. Varus placement: 2° in 1 case, 4° in 3 cases, 5° in 2 cases, 6° in 2 cases, and 10° in 1 case. No valgus occurred in the tibial side. (5) Femoral prosthesis placement angle: The axis of the femoral prosthesis was parallel to the posterior edge of the femoral cortex in 22 cases, on the flexed position: 4° in 2 cases, 5° in 1 case, 6° in 1 case and 7° in 1 case; in the extension position: 3° in 1 case, 4° in 1 case and 5° in 1 case. (6) Results suggested that the unilateral condylar replacement for the repair of medial compartment osteoarthritis of the knee has a good initial effect. The middle-term and long-term efficacy needs longer follow-up 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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Influencing factors of knee function in osteoarthritis patients after total knee arthroplasty Gao Ji-hai, Wang Jiang-quan, Lv Dong-wei 2016, 20 (31):  4582-4588.  doi: 10.3969/j.issn.2095-4344.2016.31.003 Abstract ( 393 )   PDF (989KB) ( 224 )   Save BACKGROUND: Functional recovery after joint arthroplasty is an important indicator to evaluate the effect and prognosis of total knee arthroplasty, and is affected by patients and many kinds of outside factors. OBJECTIVE: To investigate the influencing factors of functional recovery of knee in patients with knee osteoarthritis after total knee arthroplasty. METHODS: Clinical data of 76 osteoarthritis patients undergoing total knee arthroplasty in the Dongying People’s Hospital from August 2007 to August 2013 were retrospectively analyzed. Hospital for Special Surgery knee score, knee pain Visual Analogue Score, range of motion and posterior slop angle of tibial plateau were compared before and 6 months after surgery. Changes in anterior condylar offset were recorded before and after femoral prosthesis arthroplasty. SPSS 21.0 software was used to analyze the influential factors for Hospital for Special Surgery knee scores after arthroplasty. RESULTS AND CONCLUSION: (1) Hospital for Special Surgery knee score, knee pain Visual Analogue Score, and range of motion were significantly higher 6 months after arthroplasty than that before arthroplasty (P < 0.05). (2) Pearson correlation analysis demonstrated that preoperative Hospital for Special Surgery knee score, preoperative knee pain Visual Analogue Score, preoperative range of motion, preoperative posterior slop angle of tibial plateau and preoperative and postoperative anterior condylar offset changes were positively correlated with postoperative Hospital for Special Surgery knee score (P < 0.05). Body mass index and inversion deformity angle were negatively correlated with postoperative Hospital for Special Surgery knee score (P < 0.05). (3) Multiple linear regression analysis showed body mass index was negatively correlated with postoperative Hospital for Special Surgery knee score (P < 0.05). Preoperative Hospital for Special Surgery knee score, preoperative knee pain Visual Analogue Score and preoperative posterior slop angle of tibial plateau were positively correlated with postoperative Hospital for Special Surgery knee score (P < 0.05). (4) These results indicated that total knee arthroplasty significantly improved knee joint function. Body mass index, preoperative Hospital for Special Surgery knee score, preoperative knee pain Visual Analogue Score, preoperative posterior slop angle of tibial plateau and preoperative and postoperative anterior condylar offset changes were correlated with the recovery of joint function after total knee arthroplasty.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Denervation therapy for intractable pain of knee joint after total knee arthroplasty Ma Song-he 2016, 20 (31):  4589-4595.  doi: 10.3969/j.issn.2095-4344.2016.31.004 Abstract ( 463 )   PDF (3660KB) ( 254 )   Save BACKGROUND: Anatomical studies on cutaneous nerve around the knee are less in China. Revision surgery or long-term use of medication is commonly used for intractable pain after knee replacement. However, these methods cannot effectively relieve postoperative pain.  OBJECTIVE: To explore the therapeutic effect of denervation scheme on intractable pain in patients with knee joint pain after knee replacement through identifying the distribution of the cutaneous skin around the knee joint in the study of anatomy of the knee joint. METHODS: Two adult cadavers and two fresh adult cadavers were dissected to observe the distribution of cutaneous nerves around the knee joint. 100 cases of knee joint of patients with intractable pain after total knee arthroplasty were randomly divided into two groups (n=50). Patients in the observation group underwent denervation scheme. Patients in the control group underwent drug treatment. Patients were followed up after surgery. Bone joint index score was used to evaluate the knee joint function. 36-Item Short-Form Health Survey (SF-36) was utilized to evaluate the quality of life. Visual analogue scale was employed to assess the patient’s pain. Adverse reactions were recorded.  RESULTS AND CONCLUSION: (1) Distribution of cutaneous nerves around the knee was fixed. Moreover, each cutaneous nerve had a more definite bony landmark, and could provide anatomic basis for related surgery. (2) Visual analogue scale scores were significantly lower in the observation group than in the control group (P < 0.05). (3) Bone joint index score was lower, but SF-36 scores were higher in the observation group than in the control group at 1, 3, 6 and 12 months after surgery (P < 0.05). (4) Three cases affected joint swelling in the observation group and two cases suffered from joint swelling in the control group. No significant difference in joint swelling was detected between the two groups (P > 0.05). (5) Necroscopy could identify anatomical distribution of cutaneous nerve around the knee. On this basis, denervation therapy can effectively improve symptoms and bone quality in patients with intractable pain, improve the quality of life of patients, and have better safety.  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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Humeral head replacement in a hemophilia B omarthritis patient Qi Wei-zhong, Lin Li-jun, Li Qi 2016, 20 (31):  4596-4602.  doi: 10.3969/j.issn.2095-4344.2016.31.005 Abstract ( 324 )   PDF (1218KB) ( 192 )   Save BACKGROUND: In the past, the surgical treatment of patients with hemophilia B was difficult, the bleeding was difficult to estimate, and the wound healing was difficult. In the perioperative period, the control of coagulation factor IX activity in a safe range can ensure the safety of the operation, resulting in well wound healing, good recovery, and no significant complications appeared in the long term. OBJECTIVE: To study essentials of perioperative diagnosis and treatment in omarthritis patients with hemophilia B undergoing humeral head replacement, and to analyze the importance on prognosis and rehabilitation. METHODS: The significance of surgical treatment for hemophilia B patients with arthritis, the prevention and treatment of perioperative complications were summarized through literature review. Humeral head replacement was conducted in a patient with hemophilia omarthritis by monitoring coagulation factor activity and infusing human prothrombin complex and frozen plasma.  RESULTS AND CONCLUSION: (1) According to the monitoring, patients, whose coagulation factor IX activity increased from 7% to 50%, underwent humeral head replacement. (2) Within three days after replacement, coagulation factor IX activity was controlled > 30%, 3 days-2 weeks > 20%. No obvious complication was found after surgery. (3) These results suggested that hemophilia B arthritis was commonly treated by surgical treatment, which plays an important role in assessing patient’s condition and treatment. During perioperative period, replacement therapy of human prothrombin complex and control of coagulation factor activity in a appropriate range can effectively prevent 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

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Biocompatibility of Sextant minimally invasive pedicle screw fixation for osteoporotic vertebral fractures in the elderly Wu Jian-jun 2016, 20 (31):  4603-1609.  doi: 10.3969/j.issn.2095-4344.2016.31.006 Abstract ( 435 )   PDF (1180KB) ( 219 )   Save BACKGROUND: Pedicle screw internal fixation is a commonly used method to treat osteoporotic fracture. Internal fixation can effectively reconstruct vertebral body height, restore physiological curvature, and maintain good spinal stability. OBJECTIVE: To investigate the biocompatibility of minimally invasive percutaneous pedicle screw (Sextant) fixation in the treatment of elderly patients with osteoporotic vertebral fractures. METHODS: A total of 71 cases of senile osteoporotic vertebral fractures were given minimally invasive percutaneous pedicle screw (Sextant) fixation for treatment. The C-arm X-ray machine was used to accurately locate the fracture vertebral body in different patients, and the corresponding surface was marked. In order to separate the subcutaneous tissue and fascia layer, the internal fixation with Sextant screw was used. 12 months after operation, the fixator was removed. The patients were followed up for 12 months, complications and tissues surrounding the fixator were observed. At 1, 3, 6, and 12 months after treatment, changes in Cobb angle, visual analogue scale score and Oswestry disability index were observed. RESULTS AND CONCLUSION: (1) The average operation time was 90.25 minutes; intraoperative blood loss was 85.15 mL. (2) At different time points after treatment, Cobb angle, visual analogue scale score and Oswestry disability index of the patients were significantly decreased at 1 month after treatment, and maintained stable from then on. Cobb angle, visual analogue scale score and Oswestry disability index were significantly less at 1, 3, 6 and 12 months after treatment compared with that before treatment (P < 0.05). There was no significant difference in each indicator at different time points after treatment (P > 0.05). (3) Two patients affected wound infection, and were cured after symptomatic treatment. No complications such as thrombosis appeared. During removal of the screw, surrounding tissues were observed. There was no inflammatory hyperplasia of soft tissue around the fixator. No fibrous tissue or black wall was found. (4) These results confirm that Sextant minimally invasive pedicle screw internal fixation in elderly patients with osteoporotic vertebral fractures can obtain satisfactory therapeutic effect, and has 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

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Transvertebral transposition of the spinal cord and posterior correction in patients suffering from neurologic deficit secondary to angular kyphoscoliosis: improvement of electrophysiology and function Li Ping, Sun Jian-min, Wang Tong 2016, 20 (31):  4610-4615.  doi: 10.3969/j.issn.2095-4344.2016.31.007 Abstract ( 315 )   PDF (1058KB) ( 279 )   Save BACKGROUND: Previous studies have shown that nerve function may achieve different degrees of recovery in most patients after transvertebral transposition of the spinal cord for repair of spinal cord nerve compression and kyphoscoliosis. However, the effective mechanism of the proposed method to improve postoperative nerve function is still not clear. OBJECTIVE: To investigate the improvement in neurological outcomes after transvertebral transposition of the spinal cord and posterior correction in patients suffering from neurologic deficit secondary to angular kyphoscoliosis. METHODS: Eighteen patients suffering from neurologic deficit secondary to angular kyphoscoliosis underwent transvertebral transposition of the spinal cord and posterior correction. Preoperatively and 1 week postoperatively, all patients were subjected to somatosensory evoked potential detection. During operation, motor evoked potentials and somatosensory evoked potentials were monitored. Using MRI, the distance from the inner edge of the spinal canal to the outer edge of the convex side of the spinal cord at apical region was measured, and the distance of spinal cord transposition was calculated.   RESULTS AND CONCLUSION: (1) There were no significant differences in terms of the latency and amplitude of posterior tibial nerve P40 (preoperatively versus intraoperatively: amplitude: (1.66±0.29) μV vs. (1.68±0.28) μV, P > 0.05; latency: (39.25±3.02) ms vs. (38.68±2.67) ms, P > 0.05). (2) After surgery, the major curve was improved with (51.1±21.2)% correction rate, and the mean kyphosis was improved with (38.9±18.1)%. The distance between spinal cord and canal on the convex side at the apex was decreased by (2.4±1.7) mm on average. (3) The amplitude and latency of posterior tibial nerve P40 at 1 week postoperatively were (2.21±0.40) μV and (34.98±2.83) ms, respectively (P < 0.05). (4) These results suggest that posterior correction and internal fixation can remarkably improve neurophysiological index and nerve function in patients with neurologic deficit secondary to angular kyphoscoliosis. 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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Intramedullary nail combined with blocking screws for treating distal tibial fractures Hou Jing-zhao, Zhang Qiu-lin, Bao Hong-wei, Wu Jin-chun, Tang Hao, Tang Xu-ri 2016, 20 (31):  4616-4622.  doi: 10.3969/j.issn.2095-4344.2016.31.008 Abstract ( 366 )   PDF (1909KB) ( 276 )   Save BACKGROUND: For the treatment of distal tibial fractures, open reduction and plate fixation, minimally invasive percutaneous plate fixation and intramedullary nail fixation are effective, but each has advantages and disadvantages. OBJECTIVE: To compare the effects of intramedullary nail combined with blocking screws versus minimally invasive percutaneous plate fixation in treating distal tibial fractures. METHODS: Fifty-one cases of distal tibial fractures were divided into two groups. The blocking screw group (23 cases) was treated with closed reduction and internal fixation with interlocking nail combined with blocking screws. The plate fixation group (28 cases) was treated with minimally invasive percutaneous plate fixation. Fracture healing time, recovery of tibial function and complication occurrence were observed during follow-up. RESULTS AND CONCLUSION: All patients were followed up for 8 to 32 months. (1) Except one patient in the plate fixation group, the other patients had bony union. The healing time was (4.6±1.7) months in the blocking screw group and (6.9±2.3) months in the plate fixation group. Significant differences in healing time were detected between the two groups (P < 0.05). (2) The excellent and good rate of tibial function recovery was significantly higher in the blocking screw group (100%) than in the plate fixation group (82%) (P < 0.05). (3) No significant difference in the incidence of adverse events was determined between the blocking screw group (13%) and plate fixation group (18%) (P > 0.05). (4) Results suggested that interlocking intramedullary nail combined with blocking screw fixation in the treatment of distal tibial fractures can promote fracture healing and joint function recovery.  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 headless compression screw and interlocking compression plate fixation in ankle fusion Gui Zhong-shan, Xu Xiao-feng, Li Huan-yi 2016, 20 (31):  4623-4629.  doi: 10.3969/j.issn.2095-4344.2016.31.009 Abstract ( 278 )   PDF (1225KB) ( 368 )   Save BACKGROUND: The ankle fusion is an important treating means of end-stage ankle joint disease. Internal fixation of implant has become the preferred way of fixation, but fixation of different implants has different effects. OBJECTIVE: To explore the value of different internal fixation methods in ankle fusion. METHODS: A retrospective analysis was performed in 64 cases of ankle fusion from September 2012 to March 2015. They were divided into the observation group (32 cases) and control group (32 cases) according to the way of internal fixation of implant. The observation group underwent headless compression screw fixation. The control group underwent interlocking compression plate fixation. Length of incision, operation time, postoperative drainage volume, postoperative complications, healing time of bone and functional recovery of ankle-hindfoot were observed and compared between the two groups. RESULTS AND CONCLUSION: (1) There was no statistical significance in operation time and healing time of bone between the two groups (P > 0.05). (2) Length of incision and postoperative drainage volume were significantly greater in the control group than in the observation group. The incidence of postoperative complications was significantly higher in the control group than in the observation group (P < 0.05). (3) No significant differences in preoperative American Orthopaedic Foot and Ankle Society ankle-hindfoot score were found between the two groups (P > 0.05), but the score was significantly higher in the observation group than in the control group in final follow-up (P < 0.05). (4) These findings suggest that compared with the interlocking compression plate, headless compression screw treatment for ankle fusion can obtain better effect, small trauma, less postoperative complications, fixed firmly, more in line with the physiological and biomechanical requirements. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of femoral neck fracture with different fixation ways Xia Zhi-feng, Liang Ming, Li Ya-feng, Zeng Guan-nan 2016, 20 (31):  4630-4636.  doi: 10.3969/j.issn.2095-4344.2016.31.010 Abstract ( 338 )   PDF (986KB) ( 232 )   Save BACKGROUND: Finite element method is widely used in the femoral neck fracture, but the study concerning different fixation methods of femoral neck fracture is not much. OBJECTIVE: To analyze biomechanical properties of different fixation methods for femoral neck fracture using finite element analysis.  METHODS: The femur of voluntters was scanned with CT, at thickness 0.6 mm, from the site above the greater trochanter of the femur. Scanning data were saved in .DICOM format. Data of right proximal femur were imported into Mimics software. Osteotomy was performed according to Pauwels I type fracture. Models of two tensile force screws, fully threaded hollow screw and proximal femoral locking plate were established. Three-dimensional finite element method was used to analyze stress distribution, stress concentration position, displacement distribution and maximum displacement in different models of femoral neck fracture with different internal fixation methods.  RESULTS AND CONCLUSION: (1) The maximum stress value of two lag screws model was biggest. The maximum stress value of fully threaded hollow screw model was minimized. The maximum stresses of two lag screws model, fully threaded hollow screw model and proximal femoral locking plate model all were concentrated in the fixed end of fractures. (2) The femoral maximum stress of two lag screws model was biggest. The femoral maximum stress value of proximal femoral locking plate model was minimized. The femoral maximum stresses of two lag screws model, fully threaded hollow screw model and proximal femoral locking plate model all were concentrated in the medial femoral small rotor near and medial femoral and fixation contact points. (3) The maximum displacement of two lag screws model was biggest. The maximum displacement of fully threaded hollow screw model was minimized. The maximum displacement of two lag screws model, fully threaded hollow screw model and proximal femoral locking plate model all was in the femoral head. (4) The maximum displacement value of two lag screws model fixed place was biggest. The maximum displacement value of fully threaded hollow screw model fixed place was minimized. The maximum displacement value of two lag screws model was biggest at femoral head. The maximum displacement value of fully threaded hollow screw model was minimized at femoral head. (5) Results showed that the treatment effect of fully threaded hollow screw on Pauwels I fractures was better than other two fixation methods. 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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Digital three-dimensional measurement and design of proximal femoral nail antirotation for intertrochanteric femoral fractures Chen Shao-ming, Lu Bin, Yang Zhi-qiang, Zhou Xue-li, Chen Xiao-hua 2016, 20 (31):  4637-4643.  doi: 10.3969/j.issn.2095-4344.2016.31.011 Abstract ( 364 )   PDF (1142KB) ( 215 )   Save BACKGROUND: For the department of orthopedics, digital technology can be used for a three-dimensional reconstruction of the fracture site, and visual virtual reset. This not only can preoperatively plan the operation path, make reasonable operation plan, but also can predict the prognosis after surgery. OBJECTIVE: To discuss the feasibility and clinical effect of digital technology for three-dimensional measurement and preoperative design in intertrochanteric fracture patients undergoing proximal femoral nail antirotation.  METHODS: Eighty patients of intertrochanteric fractures, who underwent proximal femoral nail antirotation in the Changyi People’s Hospital from January 2010 to January 2014, were selected in this study. According to the order of visiting, they were randomly divided into traditional treatment group and three-dimensional design group, with 40 cases in each group. Patients in the traditional treatment group received proximal femoral nail antirotation. Patients in the three-dimensional design group received preoperative CT scan to establish the digital three-dimensional model of intact femur. The analog was reset by technology. The length and diameter of medullary cavity were measured. The appropriate specifications of intramedullary nail were selected. On this basis, the plan of the operation and implementation of operation were made. Operation time, intraoperative bleeding volume and blood transfusion were recorded in the two groups. Hip function was evaluated by hip Harris score.  RESULTS AND CONCLUSION: (1) Operations in the two groups were successful. Significant differences in operation time, intraoperative bleeding volume and blood transfusion were determined between the two groups (P < 0.05). No significant difference in length of stay was detected between the two groups (P > 0.05). (2) All patients were followed up. Postoperative wound was healed. Broken nail or broken rod was not found at the end of the study. (3) At the end of the follow-up, the excellent and good rate of Harris hip score was 95% in the traditional treatment group and 93% in the three-dimensional design group; no significant difference was detected between the two groups. (4) Results suggested that the application of digital department of orthopedics technology for the treatment of intertrochanteric fracture of femur in patients with preoperative three-dimensional measurement and surgical design can significantly shorten the operation time and improve hip function. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Biomechanical analysis of proximal femoral nail antirotation-II and Asia 2 femur nail fixation for femoral subtrochanteric fractures in the elderly Wang Lian-jing, Zeng Xian-tie 2016, 20 (31):  4644-4650.  doi: 10.3969/j.issn.2095-4344.2016.31.012 Abstract ( 429 )   PDF (921KB) ( 386 )   Save BACKGROUND: Biomechanical studies on elderly subtrochanteric fracture by different fixation ways were more, but study on relatively proximal femoral nail antirotation-II (PFNA) and Asia 2 femur nail (A2FN) fixation for femoral subtrochanteric fractures in the elderly was less. OBJECTIVE: To study the biomechanical analysis of intramedullary nail PFNA-II and A2FN fixation for elderly femoral subtrochanteric fractures. METHODS: Three-dimensional finite element models of femoral subtrochanteric fractures fixed by PFNA-II and A2FN in the elderly were established. Three-dimensional finite element analysis was used to analyze stress distribution and displacement after femoral subtrochanteric fractures by PFNA-II and A2FN fixation. RESULTS AND CONCLUSION: (1) The overall maximum stress, nail maximum stress and hip screw or spiral blade maximum stress values of PFNA-II intramedullary fixation system were higher than that of A2FN intramedullary fixation system. The distal locking maximum stress value and femoral head surface maximum stress values of PFNA-II intramedullary fixation system were lower than that of A2FN intramedullary fixation system. (2) The maximum displacement of PFNA-II intramedullary fixation system was mainly concentrated in the large trochanter and femoral head pole. The maximum displacement of A2FN intramedullary fixation system was mainly concentrated in the large trochanter. The maximum displacement of PFNA-II intramedullary fixation system was higher than that of A2FN intramedullary fixation system. The maximum axial displacement of PFNA-II intramedullary fixation system was higher than that of A2FN intramedullary fixation system. The maximum sagittal displacement of PFNA-II intramedullary fixation system was higher than that of A2FN intramedullary fixation system. The maximum coronal displacement of PFNA-II intramedullary fixation system was higher than that of A2FN intramedullary fixation system. (3) The lateral fissure, front fissure and rear fissure of PFNA-II intramedullary fixation system were higher than that of A2FN intramedullary fracture fixation system, but the difference was less pronounced. (4) The maximum stress value on fracture section of PFNA-II intramedullary fracture fixation system was lower than that of A2FN intramedullary fixation system. (5) Results showed that A2FN intramedullary fixation system for intertrochanteric fractures has better biomechanical stability than PFNA-II intramedullary fixation system for intertrochanteric 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

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Biomechanical characteristics of external fixation for tibial plateau fractures Shang Hong-tao, Wang Quan, Liu Bin, Liu Wei 2016, 20 (31):  4651-4657.  doi: 10.3969/j.issn.2095-4344.2016.31.013 Abstract ( 371 )   PDF (923KB) ( 220 )   Save BACKGROUND: Scholars have studied the three-dimensional finite element models of tibial plateau fractures with different fixation methods, but the research on three-dimensional finite element model of tibial plateau fracture fixation was not much. OBJECTIVE: To analyze the biomechanical characteristics of external fixator for tibial plateau fracture by using the three-dimensional finite element method. METHODS: The tibial plateau fracture models treated with locking plate fixation and external fixator were established. Three-dimensional finite element analysis was used to analyze the stress distribution and displacement of two kinds of models. RESULTS AND CONCLUSION: (1) The average displacement value and the maximum displacement value of tibial plateau fracture external fixator model group were smaller than that of tibial plateau fracture locking plate fixation model group, but no significant difference was found (P > 0.05). (2) X axial displacement value and Y axial displacement value were smaller in the tibial plateau fracture external fixator model group than in the tibial plateau fracture locking plate fixation model group, but no significant difference was found (P > 0.05). (3) The stress of tibial plateau fracture locking plate fixation model focused on the junction of the screw and bone tissue as well as the junction of plates and screws. The maximum stress value of tibial plateau fracture locking plate fixation model (173 MPa) was greater than that of tibial plateau fracture external fixator model (86 MPa). The stress of tibial plateau fracture external fixator model was scattered. Obvious stress concentration did not occur. The stress at the junction of the clamp and the nail and the junction of the connecting rod and screw was higher than that at other regions, and was a weak link in the clinical mechanics. (4) Results showed that external fixation for tibial plateau fractures had better stability and fixing strength as compared with the internal fixation. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Biomechanical analysis of dynamic simulation of three dimensional finite element models of knee joint meniscus Chen Wen-dong, Yang Guang 2016, 20 (31):  4658-4664.  doi: 10.3969/j.issn.2095-4344.2016.31.014 Abstract ( 582 )   PDF (1596KB) ( 310 )   Save BACKGROUND: At present, although the study of three-dimensional finite element biomechanical analysis of knee joint meniscus has been reported and we have a certain understanding of the biomechanical changes of the meniscus, but the dynamic simulation of the knee meniscus in the same load conditions in the process of biomechanical analysis of the knee meniscus is less reported. OBJECTIVE: To analyze the biomechanical characteristics of the knee joint meniscus under different flexion angle by using analogue simulation of finite element method. METHODS: Based on knee MRI data of the normal adult volunteers, the medicine finite element simulation software Mimics10.01 and reverse engineering software Rapidform XOR3 were utilized to reconstruct three-dimensional finite element model of knee joint meniscus. The advanced finite element analysis software Abaqus6.10-1 was utilized for analogue simulation and for analyzing biomechanical changes during flexion under vertical load of 300 N.        RESULTS AND CONCLUSION: (1) While the knee joint flexed at 0°, 30°, 60° and 90°, with the increase of angle, maximum stress point moved from the anterior edge of tibia attachment surface of the medial meniscus posterior angle to the posterior edge of tibia attachment surface of the lateral meniscus anterior angle, and the stress range of lateral meniscus was greater than that of the medial meniscus. (2) The maximal displacement point moved from the midpoint of inner edge of the medial meniscus to the front outer-upper edge of the lateral meniscus at knee flexion of 0°, 30°, 60° and 90°. Moreover, the range of displacement of lateral meniscus was bigger than the medial meniscus. (3) These findings suggest that the meniscus is the major bearing structure in the process of knee flexion. The lateral meniscus injury rate is greater than the medial meniscus in process of exercise, which is associated with large stress and displacement. 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 lower anterior vertebral pedicle screw system and its effects on osteoporotic vertebral stability Ning Xu, Zhuang Yong, Liu Miao, Zhang Hao, Huang Ming-zhi 2016, 20 (31):  4665-4670.  doi: 10.3969/j.issn.2095-4344.2016.31.015 Abstract ( 214 )   PDF (1135KB) ( 277 )   Save BACKGROUND: Although the traditional surgical treatment can improve the symptoms of patients with senile osteoporotic vertebral fracture, the treatment easily produces bone graft fusion failure and pseudoarticulation formation and affects clinical effects.  OBJECTIVE: To investigate biomechanical properties of anterior cervical pedicle screw and the effects on osteoporotic vertebral stability. METHODS: A total of 16 fresh cadaver cervical specimens contained 64 motion segments (C3-4, C4-5, C5-6 and C6-7). The 64 segments by the way of implantation were randomly divided into ordinary anterior locking screw fixation group and lower anterior vertebral pedicle screw system group (32 segments per group). The mechanical properties were determined on the biomechanical testing machine for each group. RESULTS AND CONCLUSION: (1) Biomechanics: Compared with the ordinary anterior locking screw fixation group, the maximum pull-out strength, screw path length, postoperative vertebral column height, the maximum surface strain, strain maximum and the range of maximum values were increased in the lower anterior vertebral pedicle screw system group (P < 0.05). (2) Results suggest that compared with the ordinary anterior locking screw fixation group, lower cervical anterior pedicle screw required larger extraction force and was more stable for osteoporotic vertebrae. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Biomechanical properties of a novel pourable cement pedicle screw and its application to osteoporotic lumbar degeneration Liu Yang, Liu Dan, Xiao Yun-xiang, Chen Hai-dan, Zhao Hong-wei 2016, 20 (31):  4671-4676.  doi: 10.3969/j.issn.2095-4344.2016.31.016 Abstract ( 388 )   PDF (1094KB) ( 238 )   Save BACKGROUND: Fragile bone in senile osteoporosis patients easily weakened pedicle screw fixation capacity. Therefore, bone cement leakage and screw removal cannot be solved during pedicle screw repair in osteoporotic patients with degenerative lumbar spine. OBJECTIVE: To investigate the biomechanical properties of novel pourable pedicle screws and bone cement application effect in osteoporotic patients with degenerative lumbar spine. METHODS: Six lumbar specimens (T11-L5) at the mean age of (72.9±4.2) years were selected, totally 42 vertebrae. The average bone density was 0.696 g/cm2. Any side of all vertebrae was inserted with pourable pedicle screws. 2 mL of bone cement was perfused under the X-ray fluoroscopy with cement push rod and filling cylinder. The same number of conventional screws was inserted into the opposite side of the samples. Three-point bending test was performed in two kinds of screws. The maximum vertebral axial pullout force test and the maximum spin torque test were conducted in vertebra to observe the destruction of the vertebral body and implanted effect. RESULTS AND CONCLUSION: (1) The ultimate strength and yield load of novel pourable cement pedicle screws were significantly more than conventional screws (P < 0.05). Ultimate displacement and yield displacement were significantly less in novel pourable cement pedicle screws than in conventional screws (P < 0.05). (2) The maximum vertebral axial pullout force and the maximum spin torque were significantly higher in novel pourable pedicle screws than in conventional screws (P < 0.05). (3) In summary, novel pourable cement pedicle screw is simple to operate, can effectively control bone cement penetration, and improve screw stability in osteoporotic vertebrae. Moreover, after treatment, the removal of screws is convenient, cannot evidently destroy vertebral body or screw channel, and promote early recovery.    中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | Related Articles | Metrics

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Relationship of correction coefficient and measuring position in spectral CT imaging Gai Li-ping, Liu Ai-lian, Liu Yi-jun, Sun Mei-yu, Liu Jing-hong, Pu Ren-wang, Sun Min-qin,Ding Xiao-dong, Wang Li 2016, 20 (31):  4677-4686.  doi: 10.3969/j.issn.2095-4344.2016.31.017 Abstract ( 439 )   PDF (1544KB) ( 318 )   Save BACKGROUND: In spectral CT imaging study, the selection of scanning parameters is considered by most researchers, but the effects of measuring position are often overlooked. Actual measurement found that different measurement location had significant impact on the result of the measurement. Through measurement and mathematical model of a large amount of data, we can correct the measurement results of different location. The results with real data alignment are higher. OBJECTIVE: To explore effects of different measuring positions on results in spectral CT imaging, and to optimize correction coefficients. METHODS: GE standard water phantom was applied to orderly obtain 5 combined scanning parameters with 552 groups of data. Size measurement method was divided into two measuring range: ROI1 and ROI2. We selected 10 points to measure CT value, including Center, North, South, West and East. The measurement data of ROI1 and ROI2 were classified and screened based on the same sequence. Mathematical modeling and probability statistics analysis were used to optimize correction coefficient, get calibration function and draw experimental simulation curve. RESULTS AND CONCLUSION: (1) Measuring methods of ROI1 were superior to the ROI2’s on water phantom in spectrum CT. (2) To different scanning sequences, the measuring results were different. To the same scanning sequences, the measurements for different positions on water phantom in spectrum CT had remarkable influence on the measuring results, which varied from points to points. (3) Through setting up mathematical modeling, using method of statistical analysis, we could get the correction function on different measuring positions. (4) Above results confirmed that compared with the theoretical model and the experimental data of spectral CT scanning parameters, the coefficients of position can be adjusted, which can optimize the measuring results. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Absorbable screw and metal screw fixation for ankle fractures: comparison of biocompatibility and ankle function Zhao Xue-zhai, Li Hai-jun, Meng Cai-yun, Li Yan, Zhang Shi-feng, Liu Ming-hui 2016, 20 (31):  4687-4692.  doi: 10.3969/j.issn.2095-4344.2016.31.018 Abstract ( 527 )   PDF (1065KB) ( 231 )   Save BACKGROUND: Previous ankle fracture surgery mainly uses the internal fixation materials such as metal screws or Kirschner wire, which can achieve a strong internal fixation, but all need to be taken out in the secondary surgery. In recent years, elastic modulus of biodegradable absorbable screw is identical to that of cancellous bone, and has been widely used in clinic.  OBJECTIVE: To compare the biocompatibility and functional recovery of ankle joint in the repair of ankle fractures with absorbable screws and metal screws. METHODS: 100 patients with ankle fractures were selected, including 70 males and 30 females, at the age of 19 to 55 years old. Fifty patients were repaired with absorbable screws and fifty patients were repaired with metal screws. Clinical efficacy, Kofoed score, fracture healing time and adverse events were observed between the two groups after repair. RESULTS AND CONCLUSION: Patients were followed up for over 6 months in both groups, showing good bony callus, good contraposition and alignment at the fracture end. No delayed union or nonunion occurred. The excellent and good rate of clinical effect was 96% and 94% in the absorbable screw group and metal screw group, respectively, showing no significant difference. There was no significant difference in ankle Kofoed score, fracture healing time and incidence of adverse events between the two groups (P > 0.05). These results suggest that absorbable screw fixation for ankle fractures had good biocompatibility and could effectively restore ankle function; its effects are similar to that of traditional metal screws.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Application of finite element analysis in orthopedics: new theory and new progress Ni Peng-hui, Zhang Ying, Yang Jing, Xu Zi-ang, NuErBoLi, Cheng Kui, Liu Da-peng 2016, 20 (31):  4693-4699.  doi: 10.3969/j.issn.2095-4344.2016.31.019 Abstract ( 570 )   PDF (1164KB) ( 266 )   Save BACKGROUND: The limitations of computer technology in the study of bone biomechanics and the prediction of bone fixation strength, stability, fatigue damage and life expectancy are more difficult. OBJECTIVE: To investigate the new progress and application of finite element analysis in orthopedics. METHODS: The first author searched PubMed (http://www.ncbi.nlm.nih.gov/PubMed) and CNKI China journal full-text database (http://www.cnki.net/) published till November 2015. Key words were “finite element analysis, orthopedics, biomechanics”. There were 51 references in English and 320 Chinese literatures. According to the inclusion criteria, 40 literatures were selected.  RESULTS AND CONCLUSION: Biomechanics of human skeleton is very complex, and most of the mechanical state is a locomotive, non-static process, thus increasing the difficulty of orthopedic biomechanics research. The prediction concerning bone fixation strength, stability, fatigue damage and lifetime is more difficult. However, the finite element analysis technology, which has been widely applied and demonstrated its reliability actually in engineering fields, can solve these problems effectively. With the rapid development of computer technology, finite element analysis in the field of orthopedic applications has increasingly been used, which also promoted the development of orthopedic technology. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Internal and external fixation materials for the repair of pelvic fracture: reasonable choice and biocompatibility Lang Yi, Rong Kai, Chen Ping-bo 2016, 20 (31):  4700-4706.  doi: 10.3969/j.issn.2095-4344.2016.31.020 Abstract ( 355 )   PDF (991KB) ( 189 )   Save BACKGROUND: Pelvic fractures are mostly caused by high energy trauma. With the development of imaging techniques and in-depth study of the anatomical structure of the pelvis and biomechanics, internal fixation and external fixation materials are gradually being used in the repair of pelvic fracture. OBJECTIVE: To summarize features and applications of external fixation stent material, percutaneous screw fixation, percutaneous sacral iliac screw material for internal fixation and intramedullary tensile screw material for internal fixation after pelvic fracture. METHODS: We retrieved Wanfang Database and PubMed for studies on the application of internal fixation material and external fixation material in pelvic fracture from 1994 to 2015. All data were analyzed and summarized. RESULTS AND CONCLUSION: Application of pelvic external fixation materials contributed to the stability of early pelvic fractures, showed small injury, could increase the reliability of fixation. However, the biomechanical stability of external fixation materials was lower than other internal fixation, could only be used for the early temporary fixation of unstable pelvic fractures in particular cases. Internal fixation materials can achieve anatomical reduction, accorded with the requirements of the physical mechanics of the pelvis, improve the stability of the pelvis, and have become the first choice for repair of unstable pelvic fractures. Currently used methods are percutaneous hollow screw fixation, percutaneous fixation of the sacral iliac screw, and intramedullary lag screw fixation. The combination of external fixation and internal fixation can effectively restore the stability of the pelvic cavity. Therefore, we should consider the location, type and stability of the fracture to select the appropriate internal fixation and external fixation materials. 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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Vitamin E-stabilized ultrahigh molecular weight polyethylene in joint replacement Xian Jie, He Ben-xiang 2016, 20 (31):  4707-4712.  doi: 10.3969/j.issn.2095-4344.2016.31.021 Abstract ( 478 )   PDF (847KB) ( 302 )   Save BACKGROUND: As the latest generation of ultrahigh molecular weight polyethylene, vitamin E-stabilized ultrahigh molecular weight polyethylene has been widely put into use of various kinds of joint replacement. However, wear debris and osteolysis caused by that are still the vital factor influencing the clinical curative effect.  OBJECTIVE: To discuss and summarize the material characteristics and application progress of vitamin E-stabilized ultrahigh molecular weight polyethylene, and to seek the theoretical basis which can guide us to launch vitamin E-stabilized ultrahigh molecular weight polyethylene clinically.  METHODS: The first author retrieved the CNKI and Medline databases by computer. The keywords were “ultra-high molecular weight polyethylene, vitamin E-stabilized, joint replacement, application” in English. RESULTS AND CONCLUSION: Totally 92 articles were retrieved. According to the inclusion and exclusion criteria, 46 articles were included in result analysis. The results show that vitamin E-stabilized ultrahigh molecular weight polyethylene can not only enhance the physicochemical property of prosthesis, but also can integrate with free radicals to increase antioxidant rate of prothesis in order to prolong the long-term curative effect of prosthesis. However, it is still lack of vast of clinical cases and follow-up as evidence. In case of that, long-term clinical efficacy remains to be assessed.  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