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    26 August 2016, Volume 20 Issue 35 Previous Issue    Next Issue
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    Accuracy of analog two-dimensional and digital three-dimensional preoperative templating for predicting implant size in total knee arthroplasty
    Xu Jie, Li Deng, Zhang Ying-bin, Huang Yu-lin, Cai Zhi-qing, Ma Ruo-fan
    2016, 20 (35):  5173-5179.  doi: 10.3969/j.issn.2095-4344.2016.35.001
    Abstract ( 561 )   PDF (1854KB) ( 521 )   Save

    BACKGROUND: It is the key point to choose the right size of the prosthesis, and grasp the direction and thickness for osteotomy during total knee arthroplasty. In order to achieve the goal, accurate preoperative planning is very important.

    OBJECTIVE: To compare the accuracy of preoperative templating in total knee arthroplasty using conventional two-dimensional (2D) and computed tomography (CT)-based three-dimensional (3D) procedures (templating on 3D image & surgical rehearsing on rapid prototype technology-models), and to confirm the necessity of 3D evaluation for preoperative planning.
    METHODS: A total of 25 patients undergoing primary total knee arthroplasty were randomly selected, including 10 males and 15 females, at the age of 58 and 79 years old. 2D and 3D images were collected from all patients. Preoperative templating was performed for each total knee arthroplasty using both conventional 2D radiographs and a CT-based 3D image model. Accuracies with regard to the predicted and actual implant sizes were determined for each procedure. 
    RESULTS AND CONCLUSION：The 3D procedure was found to be more accurate in predicting implant size of 80% femoral and 72% tibial components than those of the 2D procedure (4% femoral and 12% tibial components). Significant differences in the consistent rate of femoral and tibial prosthesis models were detected significantly (P < 0.05). Kappa coefficient statistics demonstrated that goodness of fit of prosthesis model was good in 3D preoperative templating. Results confirmed that the superiority of 3D preoperative templating over 2D conventional evaluation is in predicting implant size, and provides more comprehensive information on skeletal anatomy.

     
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    Effects of total knee arthroplasty on proximal tibial reconstruction using finite element analysis
    Wang Hai-yu, Wang Ting
    2016, 20 (35):  5180-5186.  doi: 10.3969/j.issn.2095-4344.2016.35.002
    Abstract ( 337 )   PDF (1085KB) ( 306 )   Save

    BACKGROUND: The studies about biomechanics of total knee arthroplasty were more, but the research on finite element analysis of the effect of total knee arthroplasty on proximal tibial reconstruction was not much.

    OBJECTIVE: To study the effect of total knee arthroplasty on proximal tibial reconstruction using finite element analysis.
    METHODS: We designed knee models of two materials: one was functionally graded material models of collagen and titanium composite materials; another was titanium alloy material model. We created two prosthesis material tibia-knee prosthesis model, and analyzed bone density distribution of proximal tibia, the maximum stress value of the medial tibia and the lateral tibia, and the maximum stress value of medial tibia and prosthesis junction, as well as lateral tibia and prosthesis junction after knee arthroplasty.
    RESULTS AND CONCLUSION: (1) Bone density of proximal tibia after total knee arthroplasty: The bone density of the knee prosthesis handle with medial and lateral tibia at the junction of tibial plateau was decreased than that of the initial state. Stress shielding effect was lower in collagen and titanium composite materials of functionally graded material models than that of titanium alloy material model. The bone density of shank end of the tibial prosthesis was obviously increased compared with the medial and lateral tibia, showing stress concentration. (2) The maximum stress value of the medial and the lateral tibia: The maximum stress value of the medial and the lateral tibia in collagen and titanium composite models was lower than that of titanium alloy material model. The maximum stress values of the lateral tibia of collagen and titanium composite models and titanium alloy material model were lower than that of medial tibia. (3) The maximum stress of medial tibia, lateral tibia and prosthesis junction: The stress distribution of collagen and titanium composite models was relatively uniform. The stress distribution of titanium alloy material model showed fluctuation. Stress concentration appeared in pallets and prosthesis junction and the shank end of the prosthesis. The maximum stress values of lateral tibia and prosthesis junction of collagen and titanium composite models and titanium alloy material model were lower than that of medial tibia and prosthesis junction. (4) These findings showed that knee prosthesis has a certain stress shielding effect on tibia after total knee arthroplasty. The stress shielding effect of collagen and titanium composite material prosthesis was lower than titanium alloy material prosthesis, and could improve tibial incurred stress. 

    中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
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    Effects of compression and non-compression fusion cage on lumbar fusion
    Gu Yong, Wang Ling-jun, Chen Liang
    2016, 20 (35):  5187-5194.  doi: 10.3969/j.issn.2095-4344.2016.35.003
    Abstract ( 383 )   PDF (1332KB) ( 311 )   Save

    BACKGROUND: The posterior lumbar interbody fusion is one of the effective methods for the treatment of lumbar and sacral spine diseases. Most surgeons fix the cage by compressing the disc space in order to keep stability and prevent dislodgement. However, some surgeons think that the non-compression technique does favor for increasing of the disc and foraminal height and thus improving the clinical outcomes, and does not increase the risk of fusion shift.

    OBJECTIVE: To compare the effects in fixing the cage by the compression and non-compression techniques on posterior lumbar interbody fusion. 
    METHODS: Data of 64 patients with single-segment lumbar degeneration undergoing posterior lumbar interbody fusion between August 2009 and June 2014 were retrospectively analyzed. Fusion device was fixed according to compression of intervertebral space. These patients were divided into compression group (n=30) and non-compression group (n=34).
    RESULTS AND CONCLUSION: (1) Curative effects: Lumbar and leg pain visual analogue score, Oswestry disability index, SF-36 score and the height of intervertebral space, intervertebral foramen height and lumbar lordosis were significantly improved postoperatively in each group compared with preoperatively (P < 0.05). The intervertebral space, intervertebral foramen height and lumbar lordosis were significantly better in the non-compression group than in the compression group (P < 0.05). (2) Lumbar fusion rate: No significant difference in lumbar fusion rate was detected 6 and 12 months after surgery and during final follow-up (P > 0.05). (3) Correlation analysis: The increase of the intervertebral space and the height of the intervertebral foramen were not significantly correlated with the improvement of the clinical curative effect (P > 0.05). (4) Test results demonstrated that outcomes of the compression technique to fix the cage are equivalent to the non-compression in posterior lumbar interbody fusion. Non-compression is advantageous to increase the intervertebral space and the height of the intervertebral foramen. Both of them are conducive to the recovery of lumbar lordosis, but are not correlated with the increase in clinical curative effect. 

     
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    Selective decompression of lumbar root canal and pedicle screw fixation after laminectomy for the treatment of elderly lumbar spinal stenosis: indications and prognosis
    Zhou Li, Yang Hong-lin, Cao Xiao-jian
    2016, 20 (35):  5195-5202.  doi: 10.3969/j.issn.2095-4344.2016.35.004
    Abstract ( 396 )   PDF (1260KB) ( 330 )   Save

    BACKGROUND: Due to complicated and special lumbar spinal stenosis disease and different degrees of lumbar degeneration in the elderly, it requires very careful choice of repair methods and repair technology.

    OBJECTIVE: To investigate the indications and prognosis effect of the treatments of elderly lumbar spinal stenosis by selective decompression of lumbar root canal under direct vision and laminectomy.
    METHODS: Clinical data of 167 elderly patients with lumbar spinal stenosis were retrospectively analyzed. A total of 82 patients were treated with selective decompression of lumbar root canal as the selective decompression group, with a clear nerve root compression but without central canal stenosis. A total of 85 patients were treated with laminectom and treated with pedicle screw fixation as the whole lamina cut group, with distinct central canal stenosis. The indications were analyzed between the two groups. Clinical effects were assessed using Japanese Orthopaedic Association and Oswestry Disability Index before and after surgery. 
    RESULTS AND CONCLUSION: (1) All patients were operated successfully. There was no serious complication during treatment. (2) Japanese Orthopaedic Association and Oswestry Disability Index were significantly improved at last follow-up in two groups compared with preoperation (P < 0.05). No significant difference in Japanese Orthopaedic Association and Oswestry Disability Index was detected between the two groups at various time points (P > 0.05). Clinical symptoms disappeared or relieved at last follow-up in two groups. The prognosis in two groups had significantly improved. (3) Results indicated that laminectomy and pedicle screw fixation in elderly patients with lumbar spinal stenosis and central canal stenosis obtained significant effects. For elderly patients with lumbar spinal stenosis but without central canal stenosis, selective decompression of lumbar root canal under direct vision was given, and it is effective and reliable. The two methods are suitable for different patients, and are effective and reliable way to repair. 

    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
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    Influences of BioFlex dynamic stabilization system fixation on the stress of adjacent segments of intervertebral disc at different decompression ranges
    Wan Sheng-yu1, Yang Bo2, Lin Xu1
    2016, 20 (35):  5203-5209.  doi: 10.3969/j.issn.2095-4344.2016.35.005
    Abstract ( 234 )   PDF (1163KB) ( 328 )   Save

    BACKGROUND: BioFlex system as a new pedicle screw fixation of dynamic stabilization device has less been reported concerning its biomechanics. 

    OBJECTIVE: To study the effect of BioFlex system fixation at different decompression ranges on disc stress at adjacent segments. 
    METHODS: Eight samples of fresh calf spines were used. Under physiologic axial loads (500, 900, 2 300 N), electronic universal testing machine was used to simulate the lumbar spine at three physiological states (standing, sitting and bending, standing on a portable 20 kg weight and bending). Progressive decompression modeling for each specimen and dividing into five groups: (1) complete status group; (2) complete status + BioFlex group; (3) partial laminectomy + BioFlex group; (4) 1/2 medial facetectomy + BioFlex group; (5) total facetectomy + BioFlex group. Strain gauges were used to record the stress of disc annulus. Electronic universal testing machine was used to record load-displacement curve and calculate stiffness.
    RESULTS AND CONCLUSION: (1) The stress of the adjacent segment of the intervertebral disc increased with the expansion of the range of decompression. Compared with the complete status, stress obviously increased after BioFlex fixation, showing significant differences (P < 0.05). The stress was significantly increased in the 1/2 medial facetectomy + BioFlex group compared with the partial laminectomy + BioFlex group (P < 0.05). However, no significant difference was detected between the partial laminectomy + BioFlex group and complete status + BioFlex group, and between total facetectomy + BioFlex group and 1/2 medial facetectomy + BioFlex group (P > 0.05). (2) Axial stiffness reduced with the expansion of the range of decompression. Compared with the complete status, axial stiffness noticeably increased after BioFlex fixation. The difference was not significant among four kinds of reconstruction structures. (3) These findings confirmed that after BioFlex fixation, with the expansion of the range of decompression, the stress of adjacent segments of intervertebral disc gradually increased, but different ranges of decompression cannot affect the stiffness of reconstruction structure. 
     
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    Biomechanics and stability of the spine after implantation with pedicle screw and cervical vertebral screw fixation
    Liu Miao, Shang Xian-wen, Ning Xu, Zhuang Yong, Xu Shun-en
    2016, 20 (35):  5210-5215.  doi: 10.3969/j.issn.2095-4344.2016.35.006
    Abstract ( 314 )   PDF (996KB) ( 261 )   Save

    BACKGROUND: From the point of view of human anatomy, the load of the spine is more. When the body moves, the range of activities, and activity are relatively large. After screws were implanted in the spine, if biomechanical properties and stability are not up to the standard, it easily leads to lack of grip force of screw and screw loosening so as to increase the incidence of complications after treatment. 

    OBJECTIVE: To compare biomechanical properties and stability of the spine after insertion of pedicle screw and cervical vertebral screw into the spine.
    METHODS: 100 vertebrae under human cervical spine specimens were analyzed and randomly divided into cervical vertebral screw fixation group and pedicle screw fixation group. Cervical vertebral screws and pedicle screws were implanted in lower cervical spine specimens. Electro Force 3510 material testing machine was used to test axial pull-out force, axial pull-out strength after the fatigue loading, and fixed stability. The biomechanical properties and stability were compared after two kinds of screws were implanted in the spine. 
    RESULTS AND CONCLUSION: (1) Instantaneous pull out force and immediate pull out stiffness were significantly higher in the pedicle screw fixation group than in the cervical vertebral screw fixation group(P < 0.05). (2) Fatigue pull-out strength and fatigue pull-out stiffness did not have significant differences in both groups, but statistical analysis showed significant differences (P < 0.05). Fatigue pull-out strength and fatigue pull-out stiffness were significantly higher in the pedicle screw fixation group than in the cervical vertebral screw fixation group. (3) These results suggested that pedicle screw fixation after implantation in the spine provides sufficient fixation stability, has better fatigue resistance, elevates instantaneous pull-out force and fatigue pull-out strength, and presents strong stability. 

     
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    Adjacent segment degeneration after anterior cervical corpectomy and fusion
    Zhai Peng-fei, Liu Wei, Sun Zhi-ming, Zhang Xue-li
    2016, 20 (35):  5216-5223.  doi: 10.3969/j.issn.2095-4344.2016.35.007
    Abstract ( 286 )   PDF (1528KB) ( 333 )   Save

    BACKGROUND: In recent years, the researchers have studied the adjacent segment degeneration after cervical fusion. Several studies concerned the adjacent segment degeneration after anterior cervical corpectomy and fusion.

    OBJECTIVE: To evaluate the correlative factors of adjacent segment degeneration after anterior cervical corpectomy and fusion.
    METHODS: 122 patients were included in the study from 126 patients who underwent anterior cervical corpectomy and fusion that operated by the same treatment team and involved a single vertebral body and the two plates between February 2009 and February 2012. The final follow-up period was 3 years. According to the degeneration progress of adjacent segment degeneration, these patients were divided into non-progression group and progression group. The gender, age, preoperative adjacent segment degeneration, cervical range of motion, upper and lower vertebral range of motion, surgical segment, titanium mesh subsidence, plate-to-disc distance, and cervical curvature index were compared between two groups. Logistic regression analysis was applied to analyze the correlative factors of adjacent segment degeneration.
    RESULTS AND CONCLUSION: (1) There were significant differences in preoperative adjacent segment degeneration, postoperative cervical range of motion, postoperative upper and lower vertebral range of motion, and postoperative cervical curvature index (P < 0.05), which were included in logistic regression analysis. (2) Logistic regression analysis regression model: adjacent segment degeneration=0.317× postoperative cervical range of motion+3.374×preoperative adjacent segment degeneration+1.862 × postoperative lower vertebral range of motion-0.795×postoperative cervical curvature index-16.481. Logistic regression analysis demonstrated that preoperative range of motion, postoperative cervical range of motion, postoperative lower vertebral range of motion and postoperative cervical curvature index were correlative factors of range of motion after adjacent segment degeneration (P < 0.05). (3) These results indicated that preoperative adjacent segment degeneration, postoperative cervical range of motion, postoperative lower vertebral range of motion and postoperative cervical curvature index were correlative factors of adjacent segment degeneration. We should actively carry out effective measures to prevent the progress of the adjacent segment degeneration before, during and after anterior cervical corpectomy and fusion. 

    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
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    Proximal femoral nail antirotation fixation for osteoporotic intertrochanteric fracture in the elderly: characteristics of deep venous thrombosis of lower extremity
    Wei Jun-qiang, Liu Li-rui, Wang Xin-yu, Yan Shi, Jin Yu, Feng Zhen
    2016, 20 (35):  5224-5230.  doi: 10.3969/j.issn.2095-4344.2016.35.008
    Abstract ( 383 )   PDF (1247KB) ( 231 )   Save

    BACKGROUND: The risk of lower-extremity deep venous thrombosis was high in patients with the osteoporotic hip fracture. The aged age and hip fracture surgery are major risk factors for thrombosis. No study concerned the critical point in time course to the lower extremity deep venous thrombosis in the osteoporotic hip fracture patients.

    OBJECTIVE: To analyze the incidence of the perioperative deep venous thrombosis of lower extremity limb at different time slots in senile osteoporotic intertrochanteric fracture patients repaired by proximal femoral nail antirotation fixation.
    METHODS: From June 2012 to January 2016, 220 cases diagnosed as osteoporotic intertrochanteric fracture and performed closed reduction and proximal femoral nail antirotation fixation were selected from the Department of Orthopedics, the Affiliated Hospital of Chengde Medical College in China. Based on administered low-molecular-weight heparins (LMWH) or not after trauma, there were two groups: LMWH group and the non-LMWH group. Vascular Doppler ultrasound was conducted at 1, 3 and 5 days after trauma, more than 5 days after trauma, 2, 5, 7 and 14 days after surgery. The total number of cases and incidence of thrombosis were recorded and compared between the two groups. The number of cases and the incidence of new thrombosis were recorded at different time points in both groups. Frequency distribution table was used to analyze the time of suffering thrombosis after injury and surgery.
    RESULTS AND CONCLUSION: (1) Among 220 cases, 18 cases in the LMWH group (n=154) affected thrombosis, with an incidence of 12%, and 15 cases in the non-LMWH group (n=66) experienced deep vein thrombosis, with an incidence of 23%. Significant differences in the incidence of thrombosis were detected between the two groups (P=0.041). (2) Peak time of thrombus was 3 days before injury and 1 day after surgery in both groups. (3) Results suggested that the incidence of deep vein thrombosis was high in proximal femoral nail antirotation fixation for intertrochanteric fracture. The peak time of deep vein thrombosis was 3 days before injury and 1 day after surgery. The prevention of deep vein thrombosis should begin from injury. Prophylactic anticoagulation after injury can dramatically decrease the incidence 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
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    Dual fixed anchor biomechanics and application in front of recurrent shoulder dislocation with severe bone defects
    Wu Shu-hong
    2016, 20 (35):  5231-5236.  doi: 10.3969/j.issn.2095-4344.2016.35.009
    Abstract ( 347 )   PDF (1113KB) ( 288 )   Save

    BACKGROUND: Anterior dislocation of the shoulder joint is mainly due to trauma caused by anterior labral capsular ligaments complex functional deficiency. At present, the main clinical use is conservative treatment, but the long-term effect is poor, and cannot achieve the desired results. 

    OBJECTIVE: To study the biomechanical characteristics of dual fixed anchors and their effects in recurrent anterior dislocation of the shoulder with severe bone defect. 
    METHODS: According to the treatment, 88 patients with recurrent anterior dislocation of the shoulder with severe bone defect were divided into conservative treatment group (n=44) and dual fixed anchor group (n=44). Japan AG-ISOKN material tensile tester was used to measure biomechanical properties of dual fixed anchors. Conservative treatment group received closed manipulative reduction. Dual fixed anchor group received dual fixed anchor fixation. The repair effects were compared between the two groups.
    RESULTS AND CONCLUSION: (1) Biomechanical parameters: in dual fixed anchor bending test, limit strength was (3 534±321) N; limit displacement was (21.12±2.50) mm; the yield load was (2 342±154) N; yield shift was (13.10±53) mm. Maximum axial pullout force was (809±25.2) N. The maximum spin torque was (1.2±0.3) N•m. (2) Clinical test results: Total effective rate was 96% in the dual fixed anchor group and 86% in the conservative treatment group (P < 0.05). Ranges of motion of anteflexion and lift and shoulder joint stability score were significantly higher in the dual fixed anchor group than in the conservative treatment group during final follow-up (P < 0.05). Range of external rotation motion was significantly smaller in the dual fixed anchor group than in the conservative treatment group (P < 0.05). The complication rate was lower in the dual fixed anchor group (11%) than in the conservative treatment group (25%) (P < 0.05). (3) Results verified that dual fixed anchors have good biomechanical characteristics, may have ideal repair effect in the treatment of recurrent anterior dislocation of the shoulder with severe bone defect, and can improve functions and activities of the shoulder joint. The low complication rate is more conducive to shoulder reconstruction.

    中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
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    Finite element analysis of distal femoral locking plate and minimally invasive internal fixation system in different motion states
    Hao Ting, Wang Xing-guo, Li Xiao-he
    2016, 20 (35):  5237-5243.  doi: 10.3969/j.issn.2095-4344.2016.35.010
    Abstract ( 251 )   PDF (1238KB) ( 308 )   Save

    BACKGROUND: Traditional distal femoral fixation plate screw breakage is relatively common. Designing good anatomical and attached fixation system is the key for clinical application.

    OBJECTIVE: To perform finite element analysis in two states of motion of the minimally invasive distal femoral fixation system, compare stress distribution of different parts in the same fixed way, different fixed methods and the same fixed parts of different motion states.
    METHODS: Imaging data of a 34-year-old male patient weighing 68 kg with 33-C1 type fracture of distal femur were selected. CT data were input into Mimics 16.0 for reconstruction. PRO-E software was used to establish minimally invasive internal fixation system with distal femoral locking plate. Data were introduced into reconstructed models of distal femur fracture in Mimics for grid division. Data were introduced into Ansys products 11.0 to construct finite element model, fix the surface of distal femur, and loaded 340 N on greater trochanter of femur. Stress distribution of each plate, screw hole and screw tail was analyzed in each group. Stress at the same region was compared in flexion and extension movement states. 
    RESULTS AND CONCLUSION: (1) Finite element models of anatomic locking plate for distal femur fracture fixation were successfully established, totally 43 536 units, 41 256 nodes. (2) With the steel segment gradually down (S1-S5), the stress gradually increased. A1-A5 with the increase in the number of screws, the stress gradually increased, but A6 suddenly decreased. (3) According to the cloud atlas of stress, these were well distributed except A1. From distal end to extremity of screw, the stress of screws increased. Among corresponding segments, significant differences in stress around the nail holes and steel segment stress were detected. Moreover, the steel stress was greater than the stress of corresponding segment of screw hole. (4) Results suggest that using anatomical locking plate and minimally invasive internal fixation system for distal femur fracture in a variety of fixed modes and moving conditions, the stress of each part is less than the yield strength of the titanium alloy screw, so the fixed system will not produce instantaneous deformation or fracture. 

     
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    Establishment of personalized locking clavicle plate model and finite element analysis
    Yin Feng, Wang Xiao-dong, Liang Wei, Ren Long-tao
    2016, 20 (35):  5244-5249.  doi: 10.3969/j.issn.2095-4344.2016.35.011
    Abstract ( 568 )   PDF (1638KB) ( 256 )   Save

    BACKGROUND: The finite element analysis method is more accurate and fast to construct the three-dimensional model of the human skeleton and design the bone surgical medical instrument.

    OBJECTIVE: To establish locking plate model according to the clavicle model, analyze and evaluate stress distribution of locking plate of the finite element model under bending and torsion conditions.
    METHODS: Chest scan was carried out in a healthy young adult male by adopting 64-row spiral CT and his two-dimensional image data were gotten. The obtained data were analyzed with Mimics 10.0 software to establish the three-dimensional clavicle finite element model. The clavicle locking fixation plate model was established by applying the UG software. The locking fixation plate was evaluated by utilizing the abaqus software when the plate was bent while down to give force of 200 N, and twisted while 200 N•mm, to simulate the force and analyze the stress distribution of the locking plate.
    RESULTS AND CONCLUSION: Based on the original image parameters provided by CT, this experiment produced a three-dimensional model of the clavical titanium plate which fitted better to bones. This model can obtain a single individual, personalized plate by three-dimensional printing technology. The finite element analysis basically can simulate the actual stress of the plate. For straight plate and “S”-shape plate, in lateral bending and axial torsion loads, the maximum stress distribution of the seven-hole titanium plate is located in the center of the center hole. During actual surgical procedures, clavicle fracture fragments and middle locking hole had stress superposition. If the titanium plate can avoid the stress concentration, it can effectively avoid the occurrence of the broken plate after implantation, provide theoretical guidance for clinical practice, and provide reference and technical route for biomechanical analysis of other types of titanium plate. 

     
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    Three-dimensional digital measurement and clinical significance of geometric parameters on proximal tibial surface and cross-section of adult women in southeastern area of Fujian province of China
    Ding Xiao-ming, Liao Dan-qiong, Zhuang Yue-hong, Cai Yong-qiang, Li Xiao-he, Enhejirigala, Zhang Shao-jie, Wang Zhi-qiang, Wang Hai-yan
    2016, 20 (35):  5250-5255.  doi: 10.3969/j.issn.2095-4344.2016.35.012
    Abstract ( 285 )   PDF (1336KB) ( 317 )   Save

    BACKGROUND: Artificial knee joint replacement is the main surgical method for the treatment of severe knee joint deformation, but due to the limited existing knee prosthesis type. The stature of Fujian population in southeast China was shorter than that of the north. The size of artificial knee joint usually did not fit for patients in clinic. The substitution effect was poor.

    OBJECTIVE: To measure the geometric parameters of proximal surface and cross-section of adult female tibia in southeastern area of Fujian Province of China, and provide basic data for design and replacement of artificial knee joint in females. 
    METHODS: We chose 85 cases of dry female skeleton in southeastern area of Fujian Province of China, measured tibial plateau width, medial tibial plateau width and anteroposterior diameter, lateral tibial plateau width and anteroposterior diameter. We collected clinical normal proximal tibial CT data of 36 patients (38-65 years old), with scan range of 30 cm (intercondylar eminence 30 cm) and layer thickness of 0.625 mm. Mimics 16.0 three-dimensional reconstruction software was used to measure above indexes and cut the reconstructed models with thickness of 3 mm, totally 10 layers. We divided its widest distance into four equal parts, and measured tibial anteroposterior diameter on three points. Statistical software was used to analyze the linear relationship between the data. 
    RESULTS AND CONCLUSION: The experiment has successfully obtained geometric parameters of tibial specimens of adult females in southeastern area of Fujian province of China. Tibia platform inside and outside diameters were greater than the width inside and outside; inside and outside diameter and inside and outside width were similar. Ten segment planes of tibia, inside and outside diameters were always less than middle anteroposterior diameter. Three groups of data increased firstly, and then reduced. There were positive correlations between tibia length and width of the medial tibia platform, the lateral tibia platform width and anteroposterior diameter, the medial tibia platform width and anteroposterior diameter, and the lateral tibia platform width and anteroposterior diameter (P < 0.05). These results suggested that relevant parameters of tibial plateau adult women in southeastern area of Fujian province of China showed some regular changes. Our results may provide quantitative reference data for the design and operation of artificial tibial plateau. 

    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
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    Vertebroplasty for osteoporotic vertebral compression fractures: missed diagnosis, severe vertebral compression, bone cement leakage and recurrent fractures in 225 cases
    Zhang Hui, Gao Zhong-yu, Xu Cai-yuan, Zhang Tong-xing, Zhang Tao
    2016, 20 (35):  5256-5262.  doi: 10.3969/j.issn.2095-4344.2016.35.013
    Abstract ( 375 )   PDF (1342KB) ( 553 )   Save

    BACKGROUND: Percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures has achieved very good results.

    OBJECTIVE: To discuss and resolve some problems related to thoracic and lumbar vertebroplasty.
    METHODS: 225 patients (78 males and 147 females) aged 53 to 92 years old were included in this study. They all accepted percutaneous vertebrolplasty and we observed and made a record about some questions related this surgery during perioperative period.
    RESULTS AND CONCLUSION: Six cases (2.7%) missed diagnosis. More than two-third of the compression degree were found in sixteen cases (7.1%). Forty-five (12.8%) vertebrae suffered from bone cement leakage in twenty-nine cases (12.9%). Recurrent fractures appeared in ten cases (4.4%). Multiple vertebrae fractures appeared in seventy-nine cases (35.1%). (1) Strategies for missed diagnosis: conduct preoperative physical examination carefully; avoid missing the point of pain; increase MRI scanning when necessary. (2) Coping strategies for severe vertebral fractures: place the needle into the parallel endplates as far as possibly; puncture along the lumbar spine pedicle base and the lateral thoracic pedicle. (3) Coping strategies for cement leakage: when cement leakage over the lower edge of the end plate occurred in operation, we should immediately put the C-arm X-ray machine into anteroposterior position to determine the orientation of the leakage and stop injecting; we should continue to inject the bone cement into the no leak-side to ensure the filling amount of vertebral bone cement. (4) Coping strategies for recurrent fractures: reoperation. (5) Coping strategies for multiple fractures: patients with multiple fractures often have a feature of poor constitution and more complications. So, it is necessary to shorten the operation time, and determine unilateral or bilateral puncture ways depending on the degree of vertebral compression to save operation time.

    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
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    New vertebral compression fractures after vertebroplasty: association with osteoporosis and spinal sagittal imbalances
    Zhang Yi-long, Ren Lei, Sun Zhi-jie, Wang Ya-hui, Sun He
    2016, 20 (35):  5263-5269.  doi: 10.3969/j.issn.2095-4344.2016.35.014
    Abstract ( 436 )   PDF (1140KB) ( 321 )   Save

    BACKGROUND: Recent report addressing new vertebral fracture after vertebroplasty or balloon kyphoplasty has increased gradually. It remains controversial whether new vertebral fracture is induced by bone cement augmentation or osteoporosis. 

    OBJECTIVE: To observe new vertebral fracture after conservative treatment and bone cement augmentation for osteoporotic vertebral compression fractures, analyze the relationship between new vertebral fracture and spinal sagittal parameters, and explore the risk factors for new vertebral fracture. 
    METHODS: From June 2011 to December 2014, 160 patients with osteoporotic vertebral compression fractures in thoracic and lumbar vertebrae were selected from the Department of Spine Surgery, the Affiliated Hospital of Chengde Medical College. According to therapeutic regimen, the patients were divided into two groups. The observation group (n=80) received vertebroplasty or kyphoplasty. The control group (n=80) underwent conservative treatment. At 1 day after surgery in the observation group and after walking in the control group, patients were subjected to anteroposterior and lateral X-ray in the entire length of the spine. Bone mineral density, number and location of new vertebral fractures and sagittal parameters during follow-up were recorded and compared between groups. After final follow-up, according to the appearance of new vertebral fracture, patients in both groups were assigned to two subgroups. The difference in above indicators was compared between the two subgroups. The relationship between new vertebral fracture and spinal sagittal parameters was analyzed.
    RESULTS AND CONCLUSION: (1) There were no statistically significant differences in gender, age, body mass index, bone mineral density, pelvic index, sacral slope, pelvic tilt, thoracic kyphotic angle, lumbar lordotic angle, C7/sacro-femoral distance ratio and occurrence rate of new fractures between the two treated groups (P > 0.05). (2) There were no statistically significant differences in gender, age, body mass index, pelvic index, and lumbar lordotic angle between new vertebral fracture group and non-fracture group. There were statistically significant differences in bone mineral density, sacral slope, pelvic tilt, thoracic kyphotic angle and the C7/sacro-femoral distance between the new vertebral fracture group and the control group (P < 0.05). (3) Results confirmed that new vertebral compression fractures after vertebroplasty, Kyphoplasty or conservative treatment for osteoporotic vertebral compression fractures were definitely associated with osteoporosis and spinal sagittal imbalance.

     
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    Expression of interleukin-1 beta, interleukin-6 and cyclooxygenase 2 in cervical intervertebral disc of cervical spondylosis patients with different clinical symptoms
    Hu Wei, Ma Xin-long, Yuan Jian-jun, Zhang Ren-zan, Peng Bing, Zhang Xue-li
    2016, 20 (35):  5270-5276.  doi: 10.3969/j.issn.2095-4344.2016.35.015
    Abstract ( 344 )   PDF (1245KB) ( 233 )   Save

    BACKGROUND: During degeneration of cervical spine, biochemical changes appeared in intervertebral disc cells. During this process, a variety of inflammatory cytokines may lead to disc herniation, which stimulates the production of a variety of inflammatory factors from surrounding adjacent tissue.

    OBJECTIVE: To explore the expression and significance of interleukin-1β, interleukin-6 and cyclooxygenase 2 in patients with different clinical symptoms of cervical spinal cord oppression.
    METHODS: Protrusion of the intervertebral disc or disc of responsibility among patients with anterior disc resection and internal fixation were divided into three groups according to clinical symptoms: myelopathic symptom group, nerve root symptom group and cervical spine trauma group. Intervertebral disc received hematoxylin-eosin staining and immunohistochemical staining for morphological observation. Positive cells were counted according to the result of immunohistochemical staining. 
    RESULTS AND CONCLUSION: (1) Hematoxylin-eosin staining results showed visible inflammatory cell infiltration and new blood vessel formation in the myelopathic symptom group and nerve root symptom group. No remarkable inflammatory cell infiltration or new blood vessel formation was seen in cervical spine trauma group. (2) Immunohistochemical staining interleukin-1β-, interleukin-6-positive cells were seen in the myelopathic symptom group. Cytoplasm was stained tan. Cyclooxygenase 2-positive cells showed a low number. The numbers of interleukin-1β-, interleukin-6- and cyclooxygenase 2-positive cells were significantly more in the nerve root symptom group than in the myelopathic symptom group. The numbers of interleukin-1β-, interleukin-6- and cyclooxygenase 2-positive cells were small in the cervical spine trauma group. (3) Expression rate and IA value of interleukin-1β, expression rate and IA value of interleukin-6 were significantly higher in the myelopathic symptom group and nerve root symptom group than in the cervical spine trauma group (P < 0.05). Expression rate and IA value of cyclooxygenase 2 were significantly higher in the nerve root symptom group than in the cervical spine trauma group. (4) These results suggested that interleukin-1β, interleukin-6 and cyclooxygenase 2 expression could be found in the cervical intervertebral disc after protrusion, and played a role in early degeneration of cervical intervertebral disc. The expressions of these inflammatory factors were significantly different in patients with different clinical symptoms of cervical spinal cord compression. 

    中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
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    Expression of miR-140-3p in synovial fluid of knee osteoarthritis patients reflects the progression of osteoarthritis
    Yin Chun-ming, Pan Xiao-hua
    2016, 20 (35):  5277-5283.  doi: 10.3969/j.issn.2095-4344.2016.35.016
    Abstract ( 374 )   PDF (1117KB) ( 326 )   Save

    BACKGROUND: Osteoarthritis is an age-related joint disease characterized by articular cartilage degeneration.

    OBJECTIVE: To assess the expression of miR-140-3p in synovial fluid of knee osteoarthritis, and identify whether miR-140-3p levels in synovial fluid are correlated with disease severity.
    METHODS: We collected 10 healthy volunteers, 10 patients with gouty arthritis, 10 patients with rheumatoid arthritis, and 45 patients with knee osteoarthritis (15 cases in early stage, 15 cases in middle stage and 15 cases in the late stage). Real-time fluorescence quantitative PCR was used to detect miR-140-3p expression in synovial fluid in each group.
    RESULTS AND CONCLUSION: (1) Expression of miR-140-3p was significantly down-regulated in knee osteoarthritis group. Significant differences in miR-140-3p expression were detected between non-knee osteoarthritis group and knee osteoarthritis group (P < 0.05). No significant difference in miR-140-3p expression was determined among healthy control group, gouty arthritis group and rheumatoid arthritis group (P > 0.05). (2) The miR-140-3p expression in the healthy control group was 11.4 times that in the knee osteoarthritis group. The expression of miR-140-3p decreased with the increase of the severity of osteoarthritis. (3) Spearman rank correlation analysis suggested that the expression of miR-140-3p was negatively correlated with osteoarthritis severity. (4) Results suggest that the expression of miR-140-3p in synovial fluid can reflect the progression of knee osteoarthritis to a certain extent.

     
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    Short-term effects of anterior cruciate ligament reconsruction with femoral tunnel suspension fixation on bone tunnel and graft change
    Ma Wen-juan, Zhang Kai-wei
    2016, 20 (35):  5284-5289.  doi: 10.3969/j.issn.2095-4344.2016.35.017
    Abstract ( 395 )   PDF (1139KB) ( 268 )   Save

    BACKGROUND: Femoral tunnel suspensory fixation device for anterior cruciate ligament reconstruction has a certain clinical comparison. However, there are a few fixture researches on the expansion of bone tunnel and graft changes.

    OBJECTIVE: To observe the short-period effect of femoral tunnel side fixtures Endobutton and Tightrope used in autologous hamstring anterior cruciate ligament reconstruction on bone tunnel and implant change.
    METHODS: Twenty-three patients with anterior cruciate ligament injuries received one-stage hamstring reconstruction, including 13 cases of femoral tunnel fixation with Endobutton and 10 cases with Tightrope. Tibial tunnel used extrusion screws. We observed operation time, recent effects after operation (Lysholm knee score, IKDC score) and the postoperative change of femoral tunnel diameter and graft length.
    RESULTS AND CONCLUSION: (1) Twenty-three cases were followed up for 9-12 months, averagely 10 months. (2) Joint motion was not limited in both groups. No significant difference in IKDC and Lysholm scores was determined between the two groups (P > 0.05). (3) Graft length and femoral tunnel diameter were significantly higher in the Endobutton group during final follow-up compared with that at 1 week postoperatively (P < 0.05). (4) These results suggested that the recent effects were similar between Tightrope and Endobutton fixation, but Tightrope fixation device reduces the length of graft and the extent of bone tunnel enlargement. 

     
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    Measurement of bone metabolism markers and changes of bone mineral density in patients with bone and joint disease and fractures in perioperative period
    Li Shi-hong, Liu Yang
    2016, 20 (35):  5290-5295.  doi: 10.3969/j.issn.2095-4344.2016.35.018
    Abstract ( 453 )   PDF (1081KB) ( 205 )   Save

    BACKGROUND: The bone mineral density is a static parameter that reflects the bone mass in a relatively long time. If you want to know the dynamic changes of bone metabolism, bone metabolism markers should be evaluated.

    OBJECTIVE: To explore changes of bone metabolism markers and bone mineral density during perioperative period in patients with spine and joint degeneration and osteoporotic fractures.
    METHODS: We retrieved PubMed and Wanfang database for articles published from 2005 to 2016. The key words were “bone metabolic markers, bone mineral density, serum, urine”. Twenty-nine articles were analyzed according to inclusion and exclusion criteria.
    RESULTS AND CONCLUSION: At present, bone formation markers commonly used in clinic mainly included bone alkaline phosphatase, osteocalcin, procollagen type I N-terminal peptide, and procollagen type I C-terminal peptide. Bone resorption markers included tartrate resistant acid phosphatase, collagen type I N-terminal telopeptide, collagen type I C-terminal telopeptide, deoxidation pyridinoline, pyridinoline, and hydroxyproline. Bone mineral density had little change, and bone resorption markers were elevated in patients with spine and joint degeneration and osteoporotic fractures, indicating active resorption. Increased bone formation markers in patients with fracture during perioperative period suggested that new bone formed in perioperative period of fracture. In the perioperative period, bone formation markers reduced and bone formation was inhibited in patients with bone degeneration. Increased bone resorption is more obvious in perioperative period in patients with bone and joint disease and fractures, which probably further aggravated the degree of osteoporosis, and should be treated by regular anti-osteoporosis therapy.
     
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    Ratio of vertebral facet joint spacing and height in L5 spondylolytic vertebra
    Sun Yue-zhao, Qiang Xiao-jun
    2016, 20 (35):  5296-5303.  doi: 10.3969/j.issn.2095-4344.2016.35.019
    Abstract ( 466 )   PDF (2102KB) ( 442 )   Save

    BACKGROUND: It is difficult to expose bilateral facet joints in L5 spondylolysis patients compared with non-spondylolysis patients. Thus, vertebral facet joint spacing and height in L5 spondylolysis patients can be used as indirect diagnostic signs that play key roles in the diagnosis of spondylolysis.

    OBJECTIVE: To analyze the ratio of vertebral facet joint spacing and height in L5 spondylolytic vertebra and the relationship between the lumbar spondylolysis and the relative spacing of articular process.
    METHODS: (1) Analysis of anatomical structure characteristics and diagnostic methods of lumbar spondylolysis: The ratio of vertebral facet joint spacing and height in L5 spondylolytic vertebra in diagnosing feasibility of lumbar spondylolysis was analyzed. (2) A total of 23 patients with L5 spondylolysis from Department of Orthopedics, Puyang Oilfield General Hospital and 30 normal controls were collected from April 2013 to February 2015. The ratio of vertebral facet joint spacing and height in L5 spondylolytic vertebra was measured between the two groups. 

    RESULTS AND CONCLUSION: (1) The ratio of vertebral facet joint spacing and height in L5 spondylolytic vertebra reflected that the occurrence of L5 spondylolysis was probably associated with the width of L5 vertebral facet joint spacing. (2) Clinical trial results showed that the ratio of vertebral facet joint spacing and height in L5 spondylolytic vertebra in L5 spondylolysis patients was higher than normal controls. (3) Results indicate that the ratio of vertebral facet joint spacing and height in L5 spondylolytic vertebra reflects the occurrence of L5 spondylolysis.

    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

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    Mechanical device for prevention of deep vein thrombosis on patient compliance: a meta-analysis based on observational studies
    Xie Yu, Zhang Cheng-huan, Liu Yun
    2016, 20 (35):  5304-5312.  doi: 10.3969/j.issn.2095-4344.2016.35.020
    Abstract ( 525 )   PDF (1704KB) ( 243 )   Save

    BACKGROUND: Compliance of mechanical device reduced in the prevention of deep venous thrombosis.

    OBJECTIVE: To evaluate the compliance on mechanical prevention measures in the prevention of deep venous thrombosis, and to analyze the reason for compliance reduction. 
    METHODS: We searched Cochrane Library, PubMed, Embase, and Medline for articles on compliance of inpatients on mechanical device for prevention of deep vein thrombosis published from inception to December 2015. At the same time, the “snowball” method was used to screen the references. After the literatures were screened, using the Newcastle Ottawa Scale tools and Agency for Healthcare Research and Quality standard, two researchers evaluated the quality of the literatures independently and strictly. Data were extracted if meet the discharge standard. The software of Meta-analyst Beta3.13 was used for heterogeneity analysis and publication bias test in the extracted data. According to the heterogeneity analysis results and literature types, a reasonable statistical analysis method was selected to collate, summarize and discuss.
    RESULTS AND CONCLUSION: Finally, 12 papers were included, 9 of which were cross-sectional studies, 2 cohort studies, and 1 case-control study. The odds ratio about compliance rate of inpatients with mechanical devices was 53.2% (95%CI: 38.7-67.2). Subgroup analysis showed that the odds ratio about compliance rate of pneumatic compression devices was 54.9% (95%CI: 34.9-73.4). The odds ratio about compliance rate on elastic stockings was 47.9% (95%CI: 34.3-61.8). The detection of mechanical device of surgical patients showed that odds ratio about compliance rate was 66.8% (95%CI: 47.4-81.7). Our results confirm that the compliance rate of the use of mechanical devices for the prevention of deep venous thrombosis in clinical inpatients requests to be improved. The reason for reduced compliance rate should be further investigated to improve the compliance rate.

    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
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    Clinical outcomes of intra-articular route versus intravenous route of tranexamic acid during total knee arthroplasty: a meta-analysis
    Zhou Kai-di, Wang Hong-yi, Yan Yu-fei, Hong Wei-xiang, Feng Jian-min
    2016, 20 (35):  5313-5320.  doi: 10.3969/j.issn.2095-4344.2016.35.021
    Abstract ( 315 )   PDF (1416KB) ( 295 )   Save

    BACKGROUND: Tranexamic acid administered either in intra-articular route or in intravenous route can significantly reduce blood loss during total knee arthroplasty. Recent studies are still controversial in application mode of tranexamic acid in the clinic.

    OBJECTIVE: To compare the clinical outcomes of tranexamic acid in intra-articular route and intravenous route during total knee arthroplasty.
    METHODS: PubMed, OVID, Web of Science, and EMBASE were searched to identify randomized controlled trials concerning the comparison of tranexamic acid in intra-articular route and intravenous route during total knee arthroplasty published before 1 May 2015. Transfusion rate, hemoglobin decline, drainage volume and thromboembolic complication rate were considered as indexes to evaluate the clinical effect, for meta-analysis.
    RESULTS AND CONCLUSION: Six randomized controlled trials involving 847 patients were included. Meta-analysis results showed no significant difference between intra-articular and intravenous administration of tranexamic acid in terms of transfusion rate, hemoglobin decline, drainage volume, total blood loss, and thromboembolic complication rate. Subgroup analysis for dose regimen showed that when occlusion time of drainage tube was < 2 hours. Intra-articular route of tranexamic acid showed high drainage volume and hemoglobin decline compared with the intravenous route of tranexamic acid (P < 0.01). Results confirmed that during total knee arthroplasty, clinical effects of intra-articular and intravenous routes of tranexamic acid are similar during total knee arthroplasty. Moreover, it is recommended that occlusion of drainage tube can be conducted for 2 hours in intra-articular route of tranexamic acid. 

    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
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