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25 November 2016, Volume 20 Issue 48 Previous Issue    Next Issue

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Combined use of intraarticular and intravenous tranexamic acid in total hip arthroplasty Sun Shi-wei, Yang Long, Xie Shui-an, Wang Jian, Xu Ru-bin 2016, 20 (48):  7149-7155.  doi: 10.3969/j.issn.2095-4344.2016.48.001 Abstract ( 538 )   PDF (1034KB) ( 316 )   Save BACKGROUND: Tranexamic acid has been shown to block the binding between fibrin containing lysine residues and fibrinolytic enzyme, to impede the decomposition of fibrin and to achieve the effect of hemostasis. OBJECTIVE: To assess the efficacy and safety of tranexamic acid in reducing the perioperative blood loss during the primary total hip arthroplasty by intravenous and intraarticular injection. METHODS: Sixty-five patients undergoing total hip arthroplasty were randomly assigned to two groups: intravenous and intraarticular injection group (combination group; n=31) and intravenous injection group (n=34). In the combination group, 15 mgkg tranexamic acid was intravenously injected at 30 minutes before replacement. 50 mL of tranexamic acid 1 g was intraarticularly given in the articular capsule after suturing the articular capsule during replacement. In the intravenous injection group, 1 g tranexamic acid was intravenously injected before replacement. 50 mL of physiological saline was intraarticularly given in the articular capsule after suturing the articular capsule during replacement. On day 2 after replacement, drainage tube was pulled out and recorded. On days 1 and 3 after replacement, coagulation, hematocrit and hemoglobin were reviewed. At 1 week after replacement, venous ultrasound examination of the lower extremities was conducted. The perioperative amount of blood transfusion was recorded in both groups. The total amount of perioperative blood loss was calculated by the Gross equation. RESULTS AND CONCLUSION: (1) The postoperative drainage, the cases of blood transfusion and the theoretical blood loss of the combination group were significantly less than in the intravenous injection group (P < 0.05). (2) Hemoglobin and hematocrit were significantly higher in the combination group than in the intravenous injection group on days 1 and 3 (P < 0.05). (3) There were no significant differences between the two groups in postoperative coagulation function, thromboembolic events, septum thrombosis or deep thromboembolic events (P > 0.05). (4) These findings suggested that combined use of intraarticular 15 mg/kg and intravenous tranexamic acid 1 g is an effective method to reduce the postoperative blood loss in total hip 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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Cocktail therapy reduces hidden blood loss after total hip arthroplasty Shi Li-jun, Bai Yu, Gao Fu-qiang, Sun Wei, Wang Wei-guo, Cheng Li-ming, Guo Wan-shou 2016, 20 (48):  7156-7162.  doi: 10.3969/j.issn.2095-4344.2016.48.002 Abstract ( 329 )   PDF (1035KB) ( 581 )   Save BACKGROUND: Epinephrine solution, tranexamic acid, hemostatic gels and powders have been used to reduce topical blood loss after total hip arthroplasty; however, none of these methods alone is sufficient. OBJECTIVE: To evaluate the efficacy of cocktail therapy on blood loss and transfusion rate after unilateral total hip arthroplasty.  METHODS: 125 patients with avascular necrosis of the femoral head were randomly divided into two groups. All patients received primary unilateral total hip arthroplasty. In the cocktail therapy group (n=64), cocktail (3 g of tranexamic acid and 0.25 mg diluted epinephrine solution) was intraarticlarly injected after musculoaponeurotic surgical closure. In the tranexamic acid group (n=61), physiological saline containing 3 g tranexamic acid was intraarticlarly injected after musculoaponeurotic surgical closure. Blood loss and transfusion rate were analyzed on postoperative days 1, 3, 5, and deep venous thrombosis and pulmonary embolism were followed up.  RESULTS AND CONCLUSION: Total blood loss, hidden blood loss and hemoglobin loss were lower in the cocktail therapy group than in the tranexamic acid group (P < 0.05). There was no significant difference in intraoperative blood loss and transfusion rate between the two groups. No incision infection, sudden excessive increases in blood pressure, symptomatic deep venous thrombosis, pulmonary embolism, or tranexamic acid-related complications was detected in either group. These results suggested that topical application of cocktail wine in total hip arthroplasty can effectively decrease postoperative hidden blood loss without serious adverse reaction or substantial 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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Protection of quadratus femoris and posterior soft tissue repair for the prevention of early dislocation in total hip arthroplasty through posterolateral approach Shi Si-feng, Lu Wen-hai, Zhou Bing, Chen Xiang-yang, Zhao Feng-chao, Guo Kai-jin 2016, 20 (48):  7163-7168.  doi: 10.3969/j.issn.2095-4344.2016.48.003 Abstract ( 292 )   PDF (931KB) ( 315 )   Save BACKGROUND: Dislocation after total hip arthroplasty is one of major complications. It is controversial whether posterior soft tissue repair should be carried out during total hip arthroplasty through posterolateral approach and few literatures focus on the protection of quadratus femoris. OBJECTIVE: To explore the effects of quadratus femoris protection and posterior soft tissue repair for the prevention of early dislocation in total hip arthroplasty through posterolateral approach. METHODS: Clinical data of 326 patients from Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University with primary total hip arthroplasty through posterolateral approach from January 2013 to August 2015 were retrospectively analyzed. According to different strategies of soft tissue management, they were assigned to two groups: observation group (187 patients) and control group (139 patients). Protection of quadratus femoris and posterior soft tissue repair was carried up in observation group. Control group did not receive posterior soft tissue repair and quadratus femoris was partially damaged. Early dislocation was defined as the dislocation occurred within 3 months after operation. Effects of the two methods on early dislocation were compared after arthroplasty. RESULTS AND CONCLUSION: There was one patient with dislocation in observation group (1/187, 0.5%) in the observation group and five patients with dislocation (5/139, 3.6%) in the control group. Dislocation rate was significantly higher in the control group than in the observation group (P < 0.05). Results suggested that in primary total hip arthroplasty through posterolateral approach, protection of quadratus femoris and posterior soft tissue repair will reduce early dislocation rate. Protection of quadratus femoris may play a role in keeping the balance of the soft tissue around the hip joint.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Optimization design and simulation analysis of artificial atlanto-odontoid joint structure Xiong Sheng, Chen Xi-liang, Wang Yun-feng, Hu Yong 2016, 20 (48):  7169-7174.  doi: 10.3969/j.issn.2095-4344.2016.48.004 Abstract ( 361 )   PDF (1021KB) ( 329 )   Save BACKGROUND: Studies have shown that traditional models of atlanto-axial joints have good biomechanical properties, but they cannot completely meet the requirements of the human body. Based on the basis of predecessors’ research, this article will explore a kind of atlanto-axial joint which can not only prevent its instability but also make the structure of axis parts a certain flexibility to make it meet the needs of the human body through the analysis of the requirement of atlanto-axial vertebral joints. OBJECTIVE: To analyze the torque change at the junction of cranial cervical vertebra lateral atlanto-axial joint by using finite element analysis, and discuss three-dimensional motion mechanical properties and fatigue life and safety factor of the atlanto-axial vertebral models using statics analysis. METHODS: Fatigue analysis was conducted in the static analysis for the optimized structure in the three-dimensional atlanto-axial vertebral models using finite element analysis. Torque of 0.5 N•m was put on the fixed plate. The performance and life span of the optimized model were evaluated by analyzing the results of simulation analysis. RESULTS AND CONCLUSION: The traditional model of the atlanto-odontoid joint is fixed by a pin in the body. The axis cannot rotate and the appearance is defective. The optimized artificial atlanto-odontoid joint can rebuild the good stability of atlanto-axial joints and can retain its movement function. The improved structure not only has a certain rotating angle, but also can limit the rotating angle of the model in a certain torque by the limit block. Because of the actual requirements, in order to lay solid, easy to operate, keep the motor functioning and avoid injury, atlanto-odontoid joint should use titanium alloy material. The selection of parameters has certain requirements. These results suggested that the optimized artificial atlanto-odontoid joint has met the commands of creativity and utility, which has feasibility in mechanics. All the parameters meet the requirements in the optimized structure. 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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Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion for treating two-level contiguous cervical spondylotic myelopathy Shen Qiang, Ding Hao, Zhu Zong-hao, Zhu Liang, Wei Xiao-kang, He Xu-feng 2016, 20 (48):  7175-7184.  doi: 10.3969/j.issn.2095-4344.2016.48.005 Abstract ( 393 )   PDF (939KB) ( 405 )   Save BACKGROUND: Anterior cervical discectomy and fusion with stand-alone cages and anterior cervical corpectomy and fusion with plate-mesh are widely used techniques in the treatment of cervical spondylotic myelopathy. There were less comparative studies about these two techniques in surgical treatment of two-level contiguous cervical spondylotic myelopathy patients based long-term follow-up. OBJECTIVE: To compare the efficacy between the anterior cervical discectomy and fusion and anterior cervical corpectomy and fusion procedures in patients with two-level contiguous cervical spondylotic myelopathy in clinical and radiological findings. METHODS: Between December 2006 and December 2009, 80 consecutive patients with two-level contiguous cervical spondylotic myelopathy were randomized into anterior cervical discectomy and fusion group and anterior cervical corpectomy and fusion group. The clinical and radiographic results were compared between the two groups. RESULTS AND CONCLUSION: The overall follow-up period of the patients ranged from 62 to 98 months (average 83.6 months). There were no significant differences between the two groups in Japanese Orthopedic Association score, Visual Analog Scale score, Odom’s criteria, fusion rates and complications. There were no significant differences between the two groups in the segmental and C2-7 Cobb angles at post-operation and 5-year follow-up. In anterior cervical discectomy and fusion group, both post-operative and 5-year follow-up segmental height was significantly larger than pre-operative segment height; in anterior cervical corpectomy and fusion group, only post-operative segmental height was significantly larger than pre-operative segmental height, not 5-year follow-up segmental height. More significant incensement of the segmental height was observed in anterior cervical discectomy and fusion cage group than that in anterior cervical corpectomy and fusion group at post-operative and 5-year follow-up. The instrument subsidence rates were similar between the two groups. In surgical treatment of two-level cervical spondylotic myelopathy, anterior cervical discectomy and fusion with stand-alone cage technique resulted in the same excellent clinical outcome as anterior cervical corpectomy and fusion with plate-mesh. However, anterior cervical discectomy and fusion with stand-alone cage technique exhibited better restoration of intervertebral height than that of anterior cervical corpectomy and fusion with plate-mesh technique. 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 anatomic porous titanium fusion cage A Jian-cuo, Wang Xi-min, Li Zhan-yin, Xu Zhi-hua 2016, 20 (48):  7185-7191.  doi: 10.3969/j.issn.2095-4344.2016.48.006 Abstract ( 413 )   PDF (1189KB) ( 286 )   Save BACKGROUND: Traditional horizontal cylindrical titanium alloy interbody fusion cage with screw thread can improve the symptoms of patients with degenerative lumbar disease, but the prognosis is poor and fusion rate is low.  OBJECTIVE: To study the biocompatibility of anatomic porous titanium fusion cage and application effect of degenerative lumbar disease. METHODS: Fifty patients with degenerative lumbar diseases were randomly divided into two groups. Patients in the experimental group (n=25) were treated with anatomic porous titanium fusion cage. Patients in the control group (n=25) were treated with traditional titanium fusion cage. After treatment, fusion rate, intervertebral space height ratio, intervertebral foramen height ratio, inter-vertebral angle activity domain, fusion segment lordosis angle, lumbar lordosis angle, lumbar horizontal angle and sacrohorizontal angle were observed. RESULTS AND CONCLUSION: Patients were followed up for 6 to 29 months. Fusion rate was significantly higher in the experimental group than in the control group (92%, 68%; P < 0.05). No adverse reactions were seen in the experimental group. Infection and chronic cerebrospinal fluid leakage were found in three cases of the control group. At 3 and 6 months after treatment, intervertebral space height ratio, intervertebral foramen height ratio, inter-vertebral angle activity domain (L3/4, L5/5 and L5/S1), fusion segment lordosis angle, lumbar lordosis angle, lumbar horizontal angle and sacrohorizontal angle were significantly larger in the experimental group than in the control group (all P < 0.05). These results suggest that anatomic porous titanium fusion cage for treating degenerative lumbar disease has good biocompatibility, and the fusion rate is high.  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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Special formed titanium mesh cages for treating spinal tuberculosis via one-stage posterior approach Abudunaibi•Aili, Zhang Hong-qi, Huang Wei-min, Li Lei, Tian Hui-zhong 2016, 20 (48):  7192-7199.  doi: 10.3969/j.issn.2095-4344.2016.48.007 Abstract ( 421 )   PDF (1306KB) ( 253 )   Save BACKGROUND: How to reconstruct the anterior defect after decomperation for posterior approach is the key of operation. We designed special formed titanium mesh cages matched with one-stage posterior approach surgery.  OBJECTIVE: To evaluate and observe the clinical feasibility and safety of one-stage posterior internal fixation and interbody fusion with special formed titanium mesh cages in the treatment of spinal tuberculosis. METHODS: Thirty-two patients with thoracic, lumbar and sacral tuberculosis undergoing special formed titanium mesh cages from July 2009 to June 2011 were enrolled in this study, including 10 cases of thoracic segments, 8 cases of thoracic waist segments (T11-L2), 10 cases of lumbar segments, and 4 cases of lumbar and sacral segments. Changes in neurological function, thoracic and lumbar spinal tuberculosis kyphosis, visual analogue scale score, intervertebral height, lumbosacral angle and erythrocyte sedimentation rate were compared before and after surgery. Operation time, intraoperative blood loss and graft fusion were observed. RESULTS AND CONCLUSION: (1) Average operation time was 199 minutes; intraoperative blood loss was 520 mL. (2) Postoperative follow-up was 48-72 months. Postoperative neurological function was improved to different degrees. Erythrocyte sedimentation rate recovered to normal 3 months after surgery in 32 patients. During final follow-up, kyphosis angle, lumbosacral angle and the height of intervertebral space were significantly improved (P < 0.001). Visual analogue scale scores decreased 2 weeks after surgery (P=0.001). All patients achieved bone fusion at 7 months averagely after surgery. Superficial wound infection occurred in two cases, and lately healed. No complications, such as tuberculosis, infectious meningitis or titanium mesh subsidence, occurred. (3) These findings confirmed that one-stage posterior internal fixation, debridement and interbody fusion with special formed titanium mesh cages can be a safe effective treatment method with minimal invasion for monosegmental spinal tuberculosis. Moreover, it can improve the stability of the anterior column of the spine.  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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Feasibility of acetabular posterior column lag screw guide based on digital model design Hu Shou-li, Mei Ji-wen, Mu Shang-qiang, Li Kun, Sun Hai-guang 2016, 20 (48):  7200-7205.  doi: 10.3969/j.issn.2095-4344.2016.48.008 Abstract ( 382 )   PDF (1169KB) ( 299 )   Save BACKGROUND: Acetabular posterior column fracture is usually treated by open reduction and internal fixation, but this type of operation has a long incision, big trauma, bleeding, and long operation time. The application of cancellous bone screw fixation in the anterior and posterior column fractures of acetabulum has been put forward in 1988, and it has the advantages of less surgical trauma, and fast healing of fracture. OBJECTIVE: To establish acetabular fracture lag screw fixed digital model through the technology of digital computer, and then design an acetabular posterior column lag screw into the needle guide for clinical application. METHODS: Data of 82 cases receiving pelvic CT scanning in Affiliated Hospital of Jilin Medical College from June 2012 to June 2015 were selected. Pelvic and acetabular three-dimensional models were reconstructed. According to the data, acetabular posterior column simulation lag screw placement method was set. Simulation was operated by digital technology. Acetabular posterior column lag screw guide device was designed and tested in vitro bone specimens. The experience of device applications was summarized, and could be used in clinic. RESULTS AND CONCLUSION: (1) 82 cases of virtual lag screw implantation succeeded. The distance between anterior superior iliac spine and iliac bone spinous was (158.13±6.94) mm in males, (152.45±7.41) mm in females. Virtual lag screw length was (12.21±1.86) mm in males and (10.38±2.01) mm in females. (2) Guiding device in vitro tests was successful, including the accurate positioning in 8 cases, good positioning in 2 cases, with the excellent and good rate of 100%. (3) A guide device was successfully used in clinical application. Patients did not have special discomfort and postoperative CT showed satisfactory results. (4) These findings demonstrated that screw fixation through anterior superior iliac spine, posterior superior iliac spine bony prominent line midpoint and ischial tuberosity connection for acetabular column fractures is feasible, and thus the design of the navigation device for implant shows high success rate. The navigation device in the posterior column of the acetabulum fracture can obtain strong stability for fixation, and the clinical effect is reliable.  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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Creep characteristics of tibial fractures with three internal and external fixation devices Wang Gang, Li Xin-ying, Zhang Shu-quan, Li Ya-jun 2016, 20 (48):  7206-7211.  doi: 10.3969/j.issn.2095-4344.2016.48.009 Abstract ( 434 )   PDF (956KB) ( 263 )   Save BACKGROUND: The creep mechanical properties of tibial fractures after fixation with intramedullary nails, steel plates and external fixation support are rarely reported. OBJECTIVE: To analyze the creep characteristics of tibial fractures with three internal and external fixation devices to provide biomechanical parameters for the clinic. METHODS: We simulated tibial fractures with intramedullary nails, steel plates, and external fixator. We performed axial compression creep tests on three sets of specimens on the electronic universal testing machine. RESULTS AND CONCLUSION: The creep variables of intramedullary nail fixation group were 0.22%, and the creep variables of steel plate fixation group were 0.34% in 7 200 s. In the external fixation group, creep variables were 0.42% in 7 200 s. The creep variables were larger in the external fixation group than in the plate fixation and intramedullary nail fixation groups at 7 200 s (P < 0.05). The creep deformation was greater in the plate fixation group than that of intramedullary nail fixation group in 7 200 s (P < 0.05). The results suggested that creep characteristics of the external fixation, plate fixation and intramedullary nail fixation were all changed, but the changes were different.  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 distal tibial articular surface defect of the ankle joint: three-dimensional finite element analysis Song Zuo-cheng, Yan Xiao-long 2016, 20 (48):  7212-7218.  doi: 10.3969/j.issn.2095-4344.2016.48.010 Abstract ( 593 )   PDF (788KB) ( 468 )   Save BACKGROUND: Studies found that three-dimensional finite element analysis can be used in the study of ankle biomechanics, but research on distal tibial articular surface defect was few. OBJECTIVE: To analyze the biomechanics of distal tibial articular surface defect with three-dimensional finite element, and provide the basis for mechanism of ankle injury related diseases. METHODS: We established ankle three-dimensional finite element model, and set different diameters of distal tibial articular surface defect, observed the peak stress of distal tibial articular surface at load of 1 400 N and the flexor of 14°, at load of 700 N and neutral position, at load 2 100 N and dorsiflexion of 10°, and contact area of tibial astragaloid joint surface at different postures and different defect diameters.  RESULTS AND CONCLUSION: (1) At load of 1 400 N and plantar flexion of 14°, the distal tibial articular surface front quadrant stress peak was smallest when the distal tibial articular surface defect diameter was 8 mm, and was maximum when defect diameter was 16 mm; the distal tibial articular surface front inner quadrant stress peak was smallest when the distal tibial articular surface defect diameter was 12 mm, and maximum when defect diameter was 16 mm; the distal tibial articular surface posterior quadrant stress peak was smallest when defect diameter was 12 mm, distal tibial articular surface posterior inner quadrant stress peak was smallest when defect diameter was 0 mm; the distal tibial exterior stress peak was maximum when defect diameter was 16 mm. (2) At load of 700 N and neutral position, exterior front quadrant, front inner quadrant, posterior quadrant and posterior inner quadrant stress peaks increased with the distal tibial articular surface defect increases; the distal tibial articular surface defect stress peak was maximum when defect diameter was 16 mm. (3) At load of 2 100 N and dorsiflexion of 10°, the distal tibial articular surface stress peak was maximum when defect diameter was 16 mm. (4) Results showed that distal tibial articular surface defect diameter was not exceeding 12 mm, and has little effect on the function of the ankle joint; defect diameter exceeding 12 mm has great effect on the ankle 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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Finite element analysis of unstable intertrochanteric fracture fixed with triangle proximal femoral nail Hu Qun-sheng, Jiang Zi-wei, Huang Feng 2016, 20 (48):  7219-7224.  doi: 10.3969/j.issn.2095-4344.2016.48.011 Abstract ( 367 )   PDF (1082KB) ( 374 )   Save BACKGROUND: Proximal femoral nail antirotation (PFNA) and Asian PFNA (PFNA-II) are the most common internal fixation methods in the treatment of intertrochanteric fractures. But stress concentration and failure of internal fixation are still inevitable. OBJECTIVE: To analyze the biomechanical behaviors of the unstable intertrochanteric fracture fixed with the new designed triangle proximal femoral nail and to testify its feasibility by compared with PFNA-II. METHODS: Three-dimensional finite element model of proximal femur was established by using CT data of femur. Then the Evans IV femoral intertrochanteric fracture was established, followed by fixed with triangle proximal femoral nail and PFNA-II, respectively. The stress distribution and biomechanical stability under the same load were compared between two nails.  RESULTS AND CONCLUSION: (1) The stress concentration of the two nails was both located at the junction of the screw blade and the main nail. (2) The maximum stress of PFNA-II and proximal femoral nail was 214 and 196.2 MPa, respectively. The displacement of PFNA-II model was significantly larger than that of the triangular proximal femoral nail (5.37 mm versus 5.18 mm). (3) To conclude, for Evans IV intertrochanteric fracture, the triangle proximal femoral nail is superiority to PFNA-II, showing the good fixation stability and low incidence of internal fixation failure, which all meet the treatment standards. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Three-dimensional printing-assisted selective segmental pedjcle screws for adolescent idiopathic scoliosis Zhang Shu-fang, Chen Rong-chun, Guo Chao-yang, Ye Shu-xi, Zhong Hong-fa, You Hui 2016, 20 (48):  7225-7231.  doi: 10.3969/j.issn.2095-4344.2016.48.012 Abstract ( 437 )   PDF (1388KB) ( 372 )   Save BACKGROUND: Three-dimensional (3D) printing has been popular for preoperative planning, and has been extensively used in bone tumor resection and pelvic fractures achieving satisfactory treatment outcomes. However, seldom used in adolescent idiopathic scoliosis. OBJECTIVE: To evaluate the clinical effect of 3D printing-assisted selective segmental pedicle screws for adolescent idiopathic scoliosis. METHODS: Seventy adolescent patients with idiopathic scoliosis from June 2014 to June 2015 were enrolled for retrospective analysis. Thin-layer computed tomography scan data of the patients were input into Mimics software in DICOM format for 3D editing and virtual surgery before surgery. The scoliosis model was created by 3D printing. Simulated operation was performed to design the optimum location of the plate screw, screw length measurement and screwing approach, and then real selective segmental pedicle screws were conducted. RESULTS AND CONCLUSION: Cobb angle of major thoracic curve in standing comnal plane and the distance of apical vertebra shift after operation were significantly improved compared with pre-operation (P < 0.05), without nerve, blood vessel or visceral injuries. The placement site, direction and length of pedicle screws were consistent with those in 3D printing model. These results suggest that 3D printing-assisted selective segmental pedicle screws can obtain accurate, safe and perfect outcomes in the treatment of adolescent idiopathic scoliosis through improving the correction rate and shortening the 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 Figures and Tables | References | Related Articles | Metrics

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Feasibility of three-dimensional printing composite template for lumbar posterior cortical bone screw Li Zhi-duo, Yuan Feng, Sheng Xiao-lei, Lu Hai-tao, Jiang Wei, Li Wei 2016, 20 (48):  7232-7338.  doi: 10.3969/j.issn.2095-4344.2016.48.013 Abstract ( 467 )   PDF (1134KB) ( 376 )   Save BACKGROUND: Cortical bone trajectory is a new lumbar posterior internal fixation technology, whose trajectory is different from traditional internal fixation technology. Cortical bone trajectory led to high failure rate lacking of experience for insertion. However, the three-dimensional template improves its safety and accuracy. OBJECTIVE: To validate the security and accuracy of lumbar vertebral cortical bone screw placement under the assistance of three-dimensional printing oriented template, and compare to the group with free hand insertion. METHODS: Six normal lumbar spine specimens were selected and randomly divided into groups A, B and C (n=2). Specimens in group A underwent free hand screw placement; group B underwent screw placement by the crista lambdoidalis composite guide; while group C underwent screw placement by the spinous process composite guide. All patients received CT scan. After data were processed using Mimics software for three-dimensional model reconstruction, computer-assisted design of optimum trajactory for lumbar vertebral cortical bone screw placement was worked out and made into a drill and screw template, where the surface was created as the inverse of lumbar posterior surface respectively. The drill template and lumbar model were materialized in a rapid prototyping machine. X-ray and CT scan were conducted to identify the screw position and direction, as well as pedicle cortical rupture. According to Grade grading, success rates and acceptable rates in groups A, B and C were evaluated and compared.  RESULTS AND CONCLUSION: (1) Among the three groups (2 specimens), 20 posterior cortical bone screws were implanted, showing a success rate of 70% (14/20) and acceptable rate of 80% (16/20) in the group A; a success rate of 70% (14/20) and acceptable rate of 95% (19/20) in the group B; a success rate of 95% (19/20) and acceptable rate of 100% (20/20) in the group C. (2) The success rate was significantly higher in the group C than in the groups A and B (P < 0.05). The acceptable rate was significantly higher in the group C than in the group A (P < 0.05). (3) These results verified that the group of vertebral lamina and spinous process composite template has a high matching relation which improves the safety and accuracy. It can theoretically reduce the risk of nerve and blood vessel injury. Simultaneously, the construction of crista lambdoidalis is not fit for the surface of template, which cannot completely match with the specimen.  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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Multislice spiral CT navigation of screw placement after complex tibial plateau fracture Xu Hong-wei, Wu Wei-guo 2016, 20 (48):  7239-7244.  doi: 10.3969/j.issn.2095-4344.2016.48.014 Abstract ( 348 )   PDF (4435KB) ( 554 )   Save BACKGROUND: At present, it lacks the ideal pedicle screws navigation method during screw placement for tibial plateau fractures. Related research showed that: multislice spiral CT reconstruction image has desired effect in navigation and positioning of pedicle screws after complex tibial plateau fractures, but has not yet been confirmed. OBJECTIVE: To study the application effects of multislice spiral CT imaging in navigation and positioning of pedicle screws after complex tibial plateau fractures.  METHODS: Eighty cases of complex tibial plateau fractures were selected from the Fifth Affiliated Hospital of Zhengzhou University from November 2014 to December 2015. All patients were treated with internal fixation with hollow nail and intramedullary nail. All patients were randomly divided into two groups, with 40 in each group. In the X-ray group, X-ray was used for screw navigation. In the spiral CT group, multislice spiral CT was used for screw navigation. The navigation effect of multislice spiral CT was assessed by comparing the repair effects between the two groups.  RESULTS AND CONCLUSION: (1) In the spiral CT group, fracture site, the degree of comminution, bone fracture displacement, and impairment score were significantly higher than in the X-ray group (P < 0.05). (2) Surgery time, blood loss, and postoperative drainage were significantly less in the spiral CT group than in the X-ray group (P < 0.05). (3) Success rate of pedicle screws at the first time was significantly higher in the spiral CT group than in the X-ray group (P < 0.05). The success rate of pedicle screws at least twice was significantly less in the spiral CT group than in the X-ray group (P < 0.05). (4) Complication rate was significantly lower in the spiral CT group (8%) than in the control group (18%) (P < 0.05). (5) These findings suggested that spiral CT image reconstruction of complex tibial plateau fractures pedicle screw showed the desired effect, could determine the exact location and navigation of pedicle screws. The screws can be placed accurately, improve the cure rate, and promote early recovery of complex tibial plateau fracture. 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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Lumbosacral sagittal parameters measured by magnetic resonance in association to L5/S1 intervertebral disc degeneration Ding Mu-chen, Shi Zhi-cai, Lu Chun-wen, Wu Jin-hui, Wang Chao, Yuan Jia-bin, Zhou Zhen 2016, 20 (48):  7245-7250.  doi: 10.3969/j.issn.2095-4344.2016.48.015 Abstract ( 348 )   PDF (3833KB) ( 531 )   Save BACKGROUND: Many studies have investigated the relationship between lumbosacral sagittal parameters and the disc degeneration diseases. However, the objects of these studies were mainly the patients with disc herniation, and parameters were measured on CT or X-ray. There are few publications reporting the relationship between lumbosacral sagittal parameters, which were measured on MRI, and patients who underwent surgery with disc extrusion. OBJECTIVE: To measure and compare the lumbosacral sagittal parameters in L5/S1 disc extrusion patients, and to investigate the relationship between the lumbosacral sagittal parameters and L5/S1 disc degeneration diseases. METHODS: A total of 90 lumbago patients aged 18 to 35 years old were included from the Department of Orthopedics, Changhai Hospital Affiliated to The Second Military Medical University from September 2014 to April 2016 for retrospective analysis. According to with or without L5/S1 intervertebral disc protrusion, they were divided into intervertebral disc herniation group (69 cases) and disc extrusion group (21 cases received surgery). The intervertebral disc herniation group was subdivided into degeneration group (35 cases) and control group (34 cases) according to with or without L5/S1 degeneration. Angles of lumbar lordosis (LL), sacral table angle (STA) and lumbosacral angle (LSA) were measured.  RESULTS AND CONCLUSION: Compared to the control group, the difference of LL was not significant in the degeneration group (P > 0.05), but STA and LSA were significantly reduced (P < 0.05). Compared with the no-disc herniation group, LL, STA and LSA were all decreased significantly in the disc extrusion group (P < 0.05). These results confirmed that LL in young adults with disc extrusion decreased significantly, however, in patients with disc degeneration, the decrease was not significant. The decrease in STA and LSA was strongly associated with disc degeneration diseases. STA and LSA are important parameters in the clinical evaluation of lumbosacral sagittal balance.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Correlation of nicotine dose and lumbar posterolateral fusion rate: imaging and biomechanical testing Yang Bao-jia, Yang Kai-shun, Yao Ru-bin 2016, 20 (48):  7251-7260.  doi: 10.3969/j.issn.2095-4344.2016.48.016 Abstract ( 442 )   PDF (6575KB) ( 338 )   Save BACKGROUND: Smoking affects blood supply around the graft area, ultimately affecting spinal fusion. Few studies reported the effects of different doses of nicotine on spinal fusion. OBJECTIVE: To evaluate nicotine effects on rabbit model of spinal fusion, and to clarify the correlation between the dose of nicotine and spinal fusion rate. METHODS: Sixty healthy adult white rabbits aged 6-8 months were selected and randomly divided into four groups, with 15 rabbits in each group. Rabbits in the four groups received L5/6 posterior lumbar intertransverse fusion under intramuscular anesthesia. On day 1 after surgery, rabbits in the control group were subcutaneously injected with physiological saline 1 mL/kg, three times a day. Rabbits in other groups received different doses of nicotine solution: 2, 4, 8 mg/kg through subcutaneous injection, three times a day. 12 weeks after surgery, effects of nicotine on the fusion rate of posterolateral lumbar interbody fusion surgery were determined by biomechanical testing, hand touch detection and imaging. RESULTS AND CONCLUSION: (1) Hand touch detection and imaging: 2 mg/kg nicotine did not have significant effect on spinal fusion. 4 and 8 mg/kg nicotine blocked spinal fusion and decreased fusion rate. (2) Biomechanical testing: Significant differences were detected between nicotine groups and control group (P < 0.01). Significant differences were detectable among the three nicotine groups (P < 0.01). No significant difference was determined between 4 mg/kg nicotine and 8 mg/kg nicotine groups (P > 0.05). All doses of nicotine affected callus formation, reduced fusion rate; moreover, with the increased dose, the fusion rate obviously diminished. (3) These findings concluded that all doses of nicotine could decrease spinal fusion. Moreover, the effect of nicotine on spinal fusion was dose-dependent.  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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Feasibility of implantation of a cemented femoral stem in the treatment of osteoporotic femoral neck fracture in elderly patients: study protocol of a randomized controlled trial Ren Rong, Li Ling-wei, Guo Qi-fa 2016, 20 (48):  7261-7266.  doi: 10.3969/j.issn.2095-4344.2016.48.017 Abstract ( 358 )   PDF (922KB) ( 300 )   Save BACKGROUND: Osteogenesis is a common problem after surgery for femoral neck fracture in elderly patients. Internal fixation for the treatment of femoral neck fracture should be performed to optimize bone remodeling and strengthen fractured bone trabeculae, with the aim of achieving strong fixation from the perspective of biomechanics. Percutaneous internal fixation with cannulated compression screws has become a preferred treatment method of osteoporotic femoral neck fracture in elderly patients, but the insufficient holding power of the screws used in the femoral neck does not lead to strong fixation. An alternative, joint prosthesis, is recommended for the repair of femoral neck fracture in elderly patients. However, its long-term therapeutic effects in the treatment of osteoporotic fracture of proximal femoral neck remain poorly understood in patients with avascular necrosis of the femoral head. OBJECTIVE: To investigate the the safety and effectiveness of implantation of cemented femoral stem versus percutaneous internal fixation with cannulated compression screws in the treatment of osteoporotic femoral neck fracture in elderly patients. METHODS: A single-center, prospective, randomized controlled, open-label trial will be performed in Qinghai University Affiliated Hospital, Qinghai, China. One hundred patients with avascular necrosis of the femoral head complicated by osteoporotic femoral neck fracture will be randomly assigned to two groups. Group 1 will undergo percutaneous internal fixation with cannulated compression screws (n=50) and group 2 will be implanted with cemented femoral stem (n=50). This study protocol has been approved by the Medical Ethics Committee of Qinghai University Affiliated Hospital in China and will be performed in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association. Signed informed consent regarding trial procedure and treatment will be obtained from each patient or their guardians. This trial was registered at ClinicalTrials.gov (NCT02901938). RESULTS AND CONCLUSION: The primary outcome measure of this study is hip joint function as assessed by Harris hip scores taken at baseline (prior to surgery), 1, 6 and 12 months after surgery. The secondary outcome measure is hip joint pain score on a Visual Analogue Scale at baseline (prior to surgery), 1, 6 and 12 months after surgery. Other outcome measures include the percentage of patients presenting with femoral head collapse, bone non-union, sterile prosthesis loosening or peri-prosthesis infection 6 and 12 months after surgery. These will be used to evaluate the histocompatibility of biomaterial with the host tissue. Randomized controlled studies are scarce on the long-term therapeutic effects of surgery in the treatment of osteoporotic femoral neck fracture in elderly patients presenting with avascular necrosis of the femoral head. This will be the first study to investigate the feasibility of implantation of cemented femoral stem versus percutaneous internal fixation with cannulated compression screws in the treatment of osteoporotic femoral neck fracture complicated by avascular necrosis of the femoral head. It will test from the perspectives of safety and efficacy through a stringent randomized controlled trial based on a 12-month follow-up evaluation.  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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Posterior percutaneous pedicle screw fixation for acute thoracolumbar vertebral fractures with simple anterior spinal column injury: study protocol for a retrospective, self-controlled trial Liang Lei, Liu Wen-de, Wu Yi-fan, Sun Xiao-hang, Ding Jun-jie 2016, 20 (48):  7267-7272.  doi: 10.3969/j.issn.2095-4344.2016.48.018 Abstract ( 365 )   PDF (941KB) ( 273 )   Save BACKGROUND: Posterior pedicle screw fixation is commonly used for thoracolumbar fracture. However, associated disadvantages include severe trauma, extensive bleeding, long rehabilitation time, and long postoperative duration of intractable lumbar stiffness and low back pain. Percutaneous pedicle screw external fixation can reduce injury caused by screw insertion into the paraspinal muscles; particularly in acute thoracolumbar vertebral compression fracture with simple anterior spinal column injury. We hypothesized that minimally invasive posterior percutaneous pedicle screw fixation for acute thoracolumbar vertebral fractures with simple anterior spinal column injury would exhibit good curative effects. OBJECTIVE: To retrospectively analyze the curative effects of minimally invasive posterior percutaneous pedicle screw fixation on acute thoracolumbar vertebral fractures with simple anterior spinal column injury. METHODS: This retrospective, single-center, self-controlled trial was performed in PLA 153 Central Hospital, Zhengzhou, Henan Province, China. Thirty-two patients with acute thoracolumbar vertebral fracture with simple anterior spinal column injury (22 males and 10 females, average age 34.7 years, range 25-47 years) were included. All patients underwent minimally invasive posterior percutaneous pedicle screw internal fixation and were followed up for 3 months. The primary outcome measure was the Cobb angle of the injured vertebral body before, immediately after, and 3 months after internal fixation, which was used to investigate the change in the thoracolumbar spine curvature. The secondary outcome measures included: the anterior height of the injured vertebral body and radiographic findings before and immediately after internal fixation and at the last follow-up (to evaluate the recovery of thoracolumbar vertebral fracture), operation time, intraoperative blood loss, duration of hospitalization, and incidence of adverse events 3 months after internal fixation. The study protocol had been approved by the Ethics Committee of PLA 153 Central Hospital, China and was performed in strict accordance with the Declaration of Helsinki developed by the World Medical Association. Signed informed consent regarding study protocol and treatments had been obtained from each patient. Trial registration: ClinicalTrial.gov identifier: NCT02963571; registered on November 10, 2016. DISCUSSION: This study aims to validate the curative effects of minimally invasive posterior percutaneous pedicle screw fixation in acute thoracolumbar vertebral fractures with simple anterior spinal column injury, and provide objective long-term follow-up data for future studies. 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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Research method and progresses of biomechanical properties of human spine Zhang En-ze, Liao Zhen-hua, Liu Wei-qiang 2016, 20 (48):  7273-7279.  doi: 10.3969/j.issn.2095-4344.2016.48.019 Abstract ( 612 )   PDF (1322KB) ( 322 )   Save BACKGROUND: With the gradual development of spine fusion surgery and artificial disc implant surgery, researchers have studied the characteristics of spine in various ways using many kinds of medical equipment in recent years. Biomechanical studies of more realistic simulation of human physiological environment and human movement are needed. OBJECTIVE: To review domestic and foreign documents and sum up the advantage and disadvantage of spinal biomechanics research methods from the aspects of measurement subjects and measurement methods. METHODS: The PubMed database, Web of Science database, Springer database and CNKI database were searched with key words of “biomechanical and (properties or study or evaluation), spinal biomechanics, spine mechanical test, spine and (kinematics or motion)” in English and Chinese respectively. Articles related to mechanics kinematics and dynamics of spine were included. Researches in recent five years and classic literature in this field were collected, and the repetitive studies were excluded. A total of 38 articles were discussed. RESULTS AND CONCLUSION: Researchers have studied the spinal mechanical properties of a plurality of structural details and the movement form in basic conditions simulating human motion in recent 30 years. Many spinal properties about mechanics and dynamics were mastered. There is need for more in-depth understanding of spinal properties in future, such as the damping characteristics of disc mechanics and coupling movement of spinal kinematics, which would be helpful in designing treatment products and curing spinal disease. 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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Molecular mechanism of magnesium ions in bone metabolism: research and progress Shang Xiao-pan, Li Tao, Lu Yu-tong, Deng Wei, Wang Wen-ju, Yang Yong-jin 2016, 20 (48):  7280-7287.  doi: 10.3969/j.issn.2095-4344.2016.48.020 Abstract ( 453 )   PDF (860KB) ( 582 )   Save BACKGROUND: The magnesium ions released from the degradation of magnesium alloy are an important cation in human body, which not only participate in various metabolic activities, but also regulate bone metabolism and involved in the reconstruction and stability of bone. Therefore, the abnormal concentration of magnesium ions can lead to bone metabolism related diseases. OBJECTIVE: To review the function and mechanisms of magnesium ions in bone metabolism and overview the related cytokines and signaling pathways. METHODS: A computer-based research of CJFD, PubMed and WanFang databases was performed for pertinent articls published from January 2000 to February 2016 using the keywords of “magnesium, bone metabolism, PI3K/Akt signal pathway, OPG/RANKL signal pathway, TRPM, and Wnt signal pathway” in Chinese and English, respectively. RESULTS AND CONCLUSION: The magnesium ions released from the degradation of magnesium alloy expose influence on the bone metabolism by regulating the related signaling pathways. The concentration changes of magnesium ions can induce the changes in cytokines in the signaling pathways related to bone metabolism, and further act on the bone remodeling. Whether the magnesium ions participate in bone metabolism through other pathways will be a hot spot.   中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Meta-analysis of anterior screw fixation versus posterior cervical fusion in treatment of odontoid fractures Zha Yuan-yu, Yang Yang, Zhou Yi-chi, Wei Ren-xiong, Zhang Shu-wei, Jin Wei 2016, 20 (48):  7288-7296.  doi: 10.3969/j.issn.2095-4344.2016.48.021 Abstract ( 491 )   PDF (1521KB) ( 341 )   Save BACKGROUND: Many studies concern the comparison of anterior screw fixation and posterior cervical fusion for odontoid fractures, but the sample size of many studies has limitations. There is lack of objective evaluation on advantages and disadvantages of two surgical methods. OBJECTIVE: This is a meta-analysis to compare the clinical results between anterior screw fixation versus posterior cervical fusion for odontoid fractures. METHODS: A systematic search of all the studies published was conducted on the PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), EMbase, the ISI Web of Knowledge Database, CNKI, VIP, CMB and Wanfang databases. Randomized and non-randomized controlled trials that compared between anterior and posterior approaches for odontoid fracture were identified from database foundation to March 1, 2016. The references were also searched by hand. Meta-analyses were performed by using the Rev-Man 5.3 software, provided by the Cochrane Collaboration. RESULTS AND CONCLUSION: (1) Twelve studies involving 514 patients were included. Among the patients, 287 underwent anterior approach and 227 underwent posterior approach. (2) The results of the meta-analysis indicated that, compared with posterior approach, anterior approach has advantages of less blood loss, shorter operative time, and a small degree of cervical rotation injury (P < 0.05). No statistical difference was determined in bone union and complication rate (P > 0.05). (3) These results suggested that both anterior and posterior approaches were demonstrated to be effective for odontoid fractures. Anterior screw fixation had obvious advantages: less bleeding, short operating time, small trauma and less spine injury. Thus, it is an ideal procedure to treat odontoid fractures. However, the operative approach should be chosen individually in clinical work.    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