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23 December 2016, Volume 20 Issue 53 Previous Issue    Next Issue

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Detection and analysis of serum metal ions concentration level after metal-to-metal hip arthroplasty Cui Peng, Jiang Wen-xue, Fan Meng, Wan Yan-lin 2016, 20 (53):  7909-7916.  doi: 10.3969/j.issn.2095-4344.2016.53.001 Abstract ( 605 )   PDF (1288KB) ( 571 )   Save BACKGROUND: Metal-metal hip prosthesis is suitable for young patients with a large amount of activity, but the friction between the interface will lead to metal debris, and release metal ions into blood. Accurate determination and analysis will help to direct clinical operation.  OBJECTIVE: To determine serum cobalt (Co), chromium (Cr), and molybdenum (Mo) ion levels at various time points in patients resurfacing arthroplasty of the hip (RSAH) and metal-metal total hip arthroplasty (M-M THR) by inductively coupled plasma mass spectrometry (ICP-MS), and analyze the influential factors. METHODS: We included 32 patients undergoing RSAH (40 hips) and 12 patients undergoing M-M THR (14 hips). Average metal ion value of six normal people was considered as normal reference value. Prosthesis position was measured by using X-ray and CT after replacement. ICP-MS could accurately determine serum metal ion levels in patients after hip arthroplasty.  RESULTS AND CONCLUSION: The concentrations of serum Co ion reached the peak at 1 year after operation, which was 7.7-fold relative to normal people. Cr ion reached its peak at 9 months after operation, which was 7.5-fold relative to normal people. Mo ion concentration kept the increased trend, reached 7.8-fold 5 years after replacement relative to normal people (P < 0.05). Five years after total hip arthroplasty, Co and Cr ions concentrations were 10.6-fold and 9.8-fold relative to normal people, respectively. ICP-MS could precisely measure serum metal ion levels after hip arthroplasty. Serum Co ions reached a peak at 1 year, and Cr ions reached a peak at 9 months, and stabilized after 5 years. Above ion levels were slightly higher than that of RSAH. These findings concluded that metal ion concentrations rose obviously compared to the normal level after metal-metal hip prosthesis, and had an obvious trend of increasing and stability. The concentrations had close relationship with the acetabulum prosthesis position, and affected by the joint function after surgery.   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 pre-administration of Shengmai injection on ischemia-reperfusion injury of skeletal muscle in lower limb after knee joint replacement Mei Gao-chang, Li Yuan-hai 2016, 20 (53):  7917-7924.  doi: 10.3969/j.issn.2095-4344.2016.53.002 Abstract ( 479 )   PDF (1247KB) ( 558 )   Save BACKGROUND: The use of tourniquets in limb surgery often leads to ischemia-reperfusion injury, and can cause important organ damage through inflammation. In recent years, Chinese herbal medicine prevention and treatment of skeletal muscle ischemia-reperfusion injury has made great progress, and its effective composition and mechanism of action can provide new treatment ideas for broadening the application areas. OBJECTIVE: To investigate the protective mechanism of Shengmai injection pretreatment on knee arthroplasty to lower limb skeletal muscle ischemia-reperfusion.  METHODS: Sixty cases undergoing elective knee replacement surgery were equally and randomly divided into Shengmai injection group and control group. In the Shengmai injection group, Shengmai injection 1 mL/kg (100 mL diluted with normal saline) was intravenously injected 10 minutes before induction of anesthesia. In the control group, an equal volume of physiological saline was injected. Blood pressure, heart rate, arterial blood gas pH, PaCO2, surgery time and tourniquet time were recorded before, during and after surgery. Serum tumor necrosis factor-α, interleukine-8, superoxide dismutase, and malondialdehyde levels were compared before tourniquet (T0), before tourniquet release (T1), and 1 hour of reperfusion (T2).  RESULTS AND CONCLUSION: (1) Preoperative, intraoperative and postoperative blood pressure, heart rate, pH and PaCO2 were not significantly different between the Shengmai injection and control groups. In the control group, intraoperative blood pressure decreased, heart rate became slow, and carbon dioxide partial pressure increased, which were significantly lower than that before and after surgery, but pH, standard bicarbonate, and alkali residual value were gradually reduced (P < 0.05). Intraoperative blood pressure and heart rate were higher, but PaCO2 were lower in the Shengmai injection group compared with the control group. Intraoperative and postoperative pH, standard bicarbonate, and alkali residual value were higher in the Shengmai injection group than in the control group (P < 0.05). (2) Operation time and tourniquet time were not significantly different between the two groups (P > 0.05). (3) At T0, T1 and T2, superoxide dismutase levels decreased, while malondialdehyde, tumor necrosis factor-α, and interleukine-8 levels gradually increased in the control group (P < 0.05). Each indicator was not significant in the Shengmai injection group. Compared with the control group, superoxide dismutase levels were significantly increased at T1 and T2, but malondialdehyde, tumor necrosis factor-α, and interleukine-8 levels significantly reduced in the Shengmai injection group (P < 0.05). (4) These results suggested that Shengmai injection with multi-target effects can improve microcirculation, the ability of hypoxia, and respiratory function, resist inflammation and stabilize blood pressure, by elevating levels of malondialdehyde, reducing tumor necrosis factor-α, interleukine-8, and malondialdehyde level to effectively prevent lower limb skeletal muscle ischemia-reperfusion injury on knee arthroplasty. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Perioperative blood management combined with Bazhen Tang improves hemoglobin and hypercoagulability in senile patients after joint replacement Song Yu-cheng, Deng Ying-jie, Liu Zhen-feng, Liang Zhi-quan, Liao Jun, Hong Han-gang, Fang Rui 2016, 20 (53):  7925-7931.  doi: 10.3969/j.issn.2095-4344.2016.53.003 Abstract ( 744 )   PDF (1228KB) ( 616 )   Save BACKGROUND: Perioperative blood management has been extensively used in orthopedic clinic. However, how the combination of traditional Chinese medicine and perioperative blood management influences the blood biochemical indexes and hypercoagulability after major operation is rarely reported. OBJECTIVE: To evaluate the effects of the perioperative blood management combined with Bazhen Tang on hemoglobin and hypercoagulability in senile patients after joint replacement. METHODS: 160 patients undergoing hip or knee artificial joint replacement were enrolled, including 59 cases of total hip replacement and 91 cases of total knee arthroplasty. All patients according to gender, age and disease were equivalently randomized into experimental group (56 cases of primary unilateral joint replacement and 24 cases of bilateral first stage replacement and hip-knee reversion) and control group (54 cases of primary unilateral joint replacement and 26 cases of bilateral first stage replacement and hip-knee reversion). The experimental group patients were given appropriate Bazhen Tang at preoperative 5 days, and those controls received no intervention. All cases were treated with rivaroxaban (anticoagulation) and tranexamic acid (hemostasis) after replacement. The contents of hemoglobin, D-dimer, platelet and fibrinogen in the peripheral blood were recorded at postoperative 3, 7 and 14 days; the amount of postoperative blood loss was recorded, and the incidence rates of deep venous thrombosis and pulmonary embolism after replacement were observed by color Doppler ultrasound. RESULTS AND CONCLUSION: (1) After unilateral replacement, one case in the control group underwent allogenetic blood transfusion. After bilateral reversion, both two groups underwent allogenetic blood transfusion, but the amount of transfused blood in the experimental group was less than that in the control group (P < 0.000). (2) Hemoglobin was significantly increased in the experimental group compared with the control groups at postoperative 7 and 14 days after bilateral reversion (P=0.012, 0.003). (3) At postoperative 3 and 7 days, the D-dimer content was obviously declined in the experimental group compared with the control group, and there were significant differences in platelet and fibrinogen contents between groups (P=0.010, 0.017, 0.014). After replacement, there were 9 cases of deep venous thrombosis and none of pulmonary embolism in the experimental group; 19 cases of deep venous thrombosis and 2 cases of pulmonary embolism (treated in respiratory ICU) in the control group, and the incidence of complication showed significant difference between groups (P < 0.001). (5) These results suggest that the combination of Bazhen Tang and perioperative blood management can decrease bleeding in senile patients after joint replacement, promote the hemoglobin rising after bilateral replacement or reversion, and improve the hypercoagulability by reduction in the D-dimer and fibrinogen contents, thus cutting down the incidence of deep venous thrombosis and pulmonary embolism. 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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Subtotal corpectomy and reconstruction with titanium mesh cage implantation and pedicle screw fixation through posterior approach in treatment of thoracolumbar burst fracture or thoracolumbar fracture dislocation Qiu Hao, Lu Min-peng, Dong Jing, Zhang Zhong-zu, Chu Tong-wei, Wang Qun-bo, Quan Zheng-xue, Jiang Dian-ming 2016, 20 (53):  7932-7938.  doi: 10.3969/j.issn.2095-4344.2016.53.004 Abstract ( 324 )   PDF (1373KB) ( 451 )   Save BACKGROUND: Thoracolumbar burst fracture or thoracolumbar fracture dislocation are the common types of fracture in spine surgery. Surgical treatment is often used for this kind of injury. Different surgical methods have their own advantages and disadvantages.  OBJECTIVE: To evaluate the clinical effects of subtotal corpectomy and reconstruction with titanium mesh cage implantation and pedicle screw fixation through posterior approach alone in treatment of thoracolumbar burst fracture or thoracolumbar fracture dislocation. METHODS: Data of 18 patients of thoracolumbar burst fracture or thoracolumbar fracture dislocation were retrospectively analyzed from October 2010 to October 2013. They were treated by subtotal corpectomy and reconstruction with titanium mesh cage implantation and pedicle screw fixation through posterior approach alone. The neurological status was compared by Frankel scoring system pre-operatively and post-operatively. The anterior height of the fractured vertebral, Cobb angle of the fractured vertebral by radiographs and the volume rate of spinal canal were calculated pre-operatively, post-operatively and final follow-up. Repair effects were evaluated. RESULTS AND CONCLUSION: (1) All patients were followed up for 24 to 38 months. All patients were cured and instrumentations were not loose and broken. Titanium mesh subsidence did not occur. (2) The anterior height of the fractured vertebral body, the volume rate of spinal canal and the average Cobb angle were significantly improved, and there was a significant difference of all indices between preoperatively and postoperatively (P < 0.05), but no significant difference between final follow-up and immediately after surgery (P > 0.05). (3) Results suggested that treatment of thoracolumbar burst fracture or thoracolumbar fracture dislocation by subtotal corpectomy and reconstruction with titanium mesh cage implantation and pedicle screw fixation through posterior approach alone are effective and safe in reconstructing intervertebral body height, Cobb angle and spinal canal volume. 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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Lumbar unilateral and bilateral interbody fusion with internal fixation versus non-internal fixation for treating lumbar disc herniation Wang Hua-jin, Zhang Jian, Sheng Wei-bin 2016, 20 (53):  7939-7945.  doi: 10.3969/j.issn.2095-4344.2016.53.005 Abstract ( 390 )   PDF (1457KB) ( 553 )   Save BACKGROUND: At present, there are many types of surgeries for lumbar disc herniation, mainly removal of intervertebral disc and nerve root compression to lessen patient’s symptoms, containing lumbar interbody fusion with internal fixation and non-internal fixation. OBJECTIVE: To compare the efficacy of lumbar interbody fusion with internal fixation and non-internal fixation for treating lumbar disc herniation. METHODS: Clinical data of 563 cases of lumbar disc herniation were retrospectively analyzed. According to repair methods, patients were assigned to internal fixation group (group A; n=348) and non-internal fixation group (group B; n=215). The group A was subdivided into unilateral fixation group (group A1; n=107) and bilateral fixation group (group A2; n=241). The group B was subdivided into microendoscopic discectomy group (group B1; n=125) and decompression group (group B2; n=90). Operative time, intraoperative blood loss, postoperative hospital stay, operation cost and related complications were recorded in each group. Visual Analogue Scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores and Oswestry Disability Index (ODI) were compared among the four groups at 1, 3, 6 and 12 months after surgery. Macnab clinical efficacy was evaluated after postoperative 12 months. RESULTS AND CONCLUSION: (1) Postoperative VAS scores, JOA scores and ODI scores were significantly improved in each group (P < 0.05) compared with preoperative scores. Following up 1 year postoperatively, postoperative VAS scores, JOA scores, and ODI scores were not significantly different among the four groups (P > 0.05). There was no significant difference in Macnab clinical efficacy postoperatively (P > 0.05). (2) Intraoperative nerve root injury, cerebrospinal fluid leakage and the incidence of postoperative infection were not significantly different (P > 0.05), but significant differences in postoperative recurrence rate were detected (P < 0.05). Postoperative recurrence of group B1 was obviously higher than that of other three groups. (3) Intraoperative blood loss, operative time, postoperative hospital stay and surgery cost were significantly different (P < 0.05). Intraoperative blood loss and postoperative hospitalization stay of group B1 were obviously lower than other three groups. Operation time and surgery cost of group B2 were obviously lower than the other three groups. (4) These results suggested that the treatment of lumbar disc herniation surgery was varied, including internal fixation and non-internal fixation. Satisfactory results can be obtained in a short period. Both can be used as an effective method for repairing lumbar disc herniation.  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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Applied anatomy and clinical significance of three-dimensional reconstruction of the lumbosacal plexus Zhu Ai-guo, Chen Yun, Zhang Feng, Zhu Jian-wei, Jin Guo-hua 2016, 20 (53):  7946-7951.  doi: 10.3969/j.issn.2095-4344.2016.53.006 Abstract ( 870 )   PDF (997KB) ( 544 )   Save BACKGROUND: Conception of three-dimensional reconstruction of the lumbosacal plexus is confused, and actual physical anatomy is needed to confirm its range and area thus providing guidence for clinical pratice. OBJECTIVE: To measu the range and area of three-dimensional reconstruction of the lumbosacal plexus using different definitions, thereby providing anatomical basis for minimally invasive technique of lumbar disc. METHODS: Posterior dissections of the lumbosacral plexus were performed bilaterally on 20 embalmed adult cadavers. Particular attention was paid to dissect anterior branches of lumbar nerve, upper articular process and lower vertebrae. Bilateral nerve roots at each spinal level were identified, and dissected distally to expose the plexus. The length of bottom and height of three-dimensional reconstruction locating on the lateral upper articular process between L3-S1 and the lateral of dural sac were measured to calculate the area. RESULTS AND CONCLUSION: (1) The area of three-dimensional reconstruction locating on the lateral upper articular process between L3-S1 ranged from 23.8 mm2 to 30.7 mm2 in males, and 18.7 mm2 to 27.3 mm2, respectively. The area of three-dimensional resconstruction locating on the lateral dural sac ranged from 92.4mm2 to 103.7 mm2, and 87.5 mm2 to 102.7mm2, respectively. (2) In conclusion, the area of three-dimensional reconstruction locating on the lateral upper articular process between L3-S1 and dural sac covers from 18.7 mm2 to 30.7 mm2, and from 87.5 to 103.7 mm2, respectively, so operating in this triangle is safe. 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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Design and analysis of hand rehabilitation training device based on three-dimensional modeling Luo Li, Chi Peng-fei, Ma Ming, Zhao Yong, Sun Wu-dong, Huang Hai-yang 2016, 20 (53):  7952-7958.  doi: 10.3969/j.issn.2095-4344.2016.53.007 Abstract ( 630 )   PDF (1266KB) ( 543 )   Save BACKGROUND: The existing artificial rehabilitation training method has low efficiency, and it would take a lot of time, so the therapist cannot focus on the improvement and optimization of treatment. OBJECTIVE: To design a hand rehabilitation training device for the patient who has hand movement disorder. METHODS: Based on the analysis of hand movement function, the range of motion of the metacarpophalangeal and interphalangeal joints was obtained, and the hand rehabilitation training device was designed. The device mainly included the exoskeleton executive system and control test system. Finally, the designed device was used for kinematics simulation. RESULTS AND CONCLUSION: (1) The simulation results showed that the hand rehabilitation training robot’s knuckle range and trajectory had a certain error to human, but the maximum difference was only 5.13 mm. Moreover, the designed adjustment allowance could effectively compensate for the difference. (2) Moreover, each component of the hand rehabilitation training device was controlled by cylinder, and could help patients to complete simple daily life activities. (3) The designed hand rehabilitation training device could help patients to complete simple grasping, holding and kneading. Compared with modern rehabilitation device, the hand rehabilitation training device was simple, lighter weight and wearable. It has good practicability and can be used for hand rehabilitation training.  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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Design and biomechanical properties of a novel low elastic modulus spine pedicle screw Ruan Zhi, A Lu-ti 2016, 20 (53):  7959-7965.  doi: 10.3969/j.issn.2095-4344.2016.53.008 Abstract ( 437 )   PDF (1168KB) ( 317 )   Save BACKGROUND: Bone cement is commonly used to strengthen pedicle screws that can improve the ability of screw fixation, but the bone cement leakage and difficulty of screw out remain to be resolved. OBJECTIVE: To investigate the development and biomechanical characteristics of a novel low elastic modulus pedicle screw. METHODS: The novel low elastic modulus pedicle screw was implanted into one side of vertebral pedicle removed from a human complete spine, followed by 2 mL bone cement perfusion using bone cement pusher and infusion tube under X-ray, while the conventional screw was implanted into the contralateral side as control. All vertebrae underwent the three-point bending test, maximum axial pullout force, maximum torque and cyclic bending resistance test. RESULTS AND CONCLUSION: (1) The novel low elastic modulus screw and conventional screw had no significant difference in the yield load (P > 0.05). The yield displacement, maximum pullout force, maximum torque and maximum loading of the novel low elastic modulus screw were all significantly higher than those of the conventional screw (P < 0.05), while it showed significant reduction in displacement (P < 0.05). (2) These results indicate that the novel low elastic modulus pedicle screw is easy to operate, avoids the bone cement leakage, and can improve the biomechanical properties and stability of osteoporotic vertebrae and keep the spine stiffness and stability, which is beneficial for spinal fusion. Figures and Tables | References | Related Articles | Metrics

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Best choice of three-dimensional printing-assisted pedicle subtraction osteotomy for the treatment of kyphosis deformity Zhang Shu-fang, Zhong Hong-fa, Chen Rong-chun, Guo Zhao-yang, Ye Shu-xi, You Hui 2016, 20 (53):  7966-7972.  doi: 10.3969/j.issn.2095-4344.2016.53.009 Abstract ( 443 )   PDF (3359KB) ( 589 )   Save BACKGROUND: Three-dimensional (3D) printing for preoperative planning has been gaining popularity at present. 3D printing has been frequently used in bone tumor resection and pelvic fracture surgery, but seldom used in kyphosis deformity. OBJECTIVE: To evaluate the clinical effect of 3D printing-assisted pedicle subtraction osteotomy for the treatment of kyphosis deformity. METHODS: Data of 40 patients with kyphosis deformity from June 2014 to June 2015 were retrospectively analyzed. All patients were randomly assigned to two groups. Patients in the 3D printing group underwent 3D printing-assisted pedicle subtraction osteotomy. Patients in the control group underwent pedicle vertebral osteotomy. RESULTS AND CONCLUSION: Operation time, blood loss and radiation exposure time were significantly lower in the 3D printing group than in the control group, but correction rate was obviously higher in the 3D printing group than in the control group. Visual analog scale scores and Oswestry disability index in both groups were lower after surgery compared with that before surgery. These findings suggested that 3D printing-assisted pedicle subtraction osteotomy is feasible for treatment of spinal kyphosis. The orthopedic effect is good. It can reduce the operation time and blood loss.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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3D-printed module-assisted minimally invasive lumbar pedicle screw placement: study protocol for a self-controlled, open-label clinical trial with 2-year follow-up Yu Zheng-xi, Chen Xuan-huang, Zhang Guo-dong, Chen Xu, Wu Chang-fu, Zheng Zu-gao, Gao Xiao-qiang, Lin Hai-bin 2016, 20 (53):  7973-7978.  doi: 10.3969/j.issn.2095-4344.2016.53.010 Abstract ( 341 )   PDF (4080KB) ( 364 )   Save BACKGROUND: Minimally invasive pedicle screw fixation is an effective treatment for thoracolumbar diseases, but skilled operations are required during the internal fixation. If inaccurate implantation occurs, adverse reactions will appear postoperatively; for example, the implanted screw will fall off. 3D printing can manufacture a suitable implant for a patient, accurately simulate the repair process, and reduce the difficulty and complexity of the operation, aiming to produce an implant that is most suitable for repair surgery. OBJECTIVE: To verify that precise localization during minimally invasive lumbar pedicle screw placement can be achieved with the assistance of a 3D-printed module. METHODS: A single-center, self-controlled, open-label clinical study with 2-year follow-up was carried out at the Affiliated Hospital of Putian University, Putian, Fujian Province, China. Preoperative thin-layer CT data from 36 cases of lumbar spine fixation were collected and digitally reconstructed using Mimics software. An ideal channel for screw insertion via the vertebral pedicle was preset, and a 3D-printed navigation module with a screw channel was designed and printed based on the anatomical structures of the bone surface that could be stripped around the screw channel. Minimally invasive pedicle screw fixation was then navigated by the 3D-printed module using the Quadrant system. A thin-layer CT scan was used for postoperative three-dimensional reconstruction. The primary outcome measure was accurate rate of screw placement, which was used to assess whether the screw placement under navigation by the 3D-printed module achieved the desired results. Secondary outcome measures included lumbar CT results preoperatively, 6 and 24 months postoperatively, operation time, intraoperative blood loss, duration of radiation exposure, and incidence of adverse events at 6 and 24 months postoperatively. Some results from the completed surgery are given below: the time of operation, amount of bleeding and duration of radiation exposure were (120.58 ± 56.46) minutes, (136.83±40.62) mL, and (50±11) seconds, respectively. A total of 186 screws were inserted in the patients, with a 98% accuracy rate. This trial was registered at ClinicalTrials.gov (NCT02970578) on 16 November 2016. Approved by the Ethics Committee of Putian University, Fujian Province, China, the study protocol was performed in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association.Written informed consent was obtained from all participants prior to the trial. Patient recruitment began at November 2012 and lasted until November 2015, and follow-up data collection will be accomplished until March 2017. DISCUSSION: The study aims to test our hypothesis that a 3D-printed module is a valuable aid for screw localization in minimally invasive lumbar pedicle screw placement, providing clinical data for 3D-printed module-assisted minimally invasive lumbar surgery using the Quadrant system.   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 digital navigation modules-assisted accurate placement of femoral neck hollow lag screws Chen Xu, Yu Zheng-xi, Chen Xuan-huang, Zhang Guo-dong, Wu Xian-wei, Cai Han-hua, Wu Chang-fu, Dai Yu-lin 2016, 20 (53):  7979-7984.  doi: 10.3969/j.issn.2095-4344.2016.53.011 Abstract ( 377 )   PDF (4268KB) ( 751 )   Save BACKGROUND: Computer-assisted orthopedic technique can help physicians develop more accurate preoperative planning and surgical simulation. 3D printing technology erects a bridge for the virtual design and implementation, and the design of the surgical program will be accurately put into practice. OBJECTIVE: To investigate Mimics software digital design combined with 3D printing navigation modules-assisted accurate placement of femoral neck hollow lag screw, verify on corpse specimen, and observe its effects. METHODS: Ten adult cadaveric pelvic specimens were used to make 20 models of femoral neck fracture. After continuous thin-slice CT scan, Dicom format images were collected for three-dimensional (3D) reconstruction by using Mimics software to identify the path of hollow lag screw and for 3D measurement. According to anatomic structure of bone surface, navigation modules with screw path were designed for 3D printing. The screw was implanted and the fixation was finished. The position and screw placement were observed. CT scanning was used to evaluate its effects. RESULTS AND CONCLUSION: Totally 20 navigation modules were designed and 60 screws were implanted to observe the bone around femoral head and femoral neck. No screw penetration occurred. After surgery, reconstruction with CT scanning found that compared with preoperatively, the site, direction and length of screw insertion were consistent with that established by Mimics software. The accuracy rate was 100%. The navigation modules were closely bonded to the corresponding bony structure of greater trochanter of femur. Chimerism was good. The position and stability were good in the application. These results suggested that with the help of digital design and 3D printing navigation module, femoral neck hollow lag screw can be accurately placed into the ideal position. 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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Effect of periprosthetic fracture on hip function after femoral neck-preserving total hip arthroplasty: study protocol for a prospective, single-center, self-controlled trial with 2-year follow-up Qin Di, Han Yong-tai, Li Hui-jie 2016, 20 (53):  7985-7991.  doi: 10.3969/j.issn.2095-4344.2016.53.012 Abstract ( 442 )   PDF (1057KB) ( 394 )   Save BACKGROUND: Total hip replacement with a collum femoris preserving (CFP) short stem prosthesis can reportedly reduce postoperative complications and preserve maximum bone tissue for long-term revision. However, CFP replacement has a relatively high risk of intraoperative periprosthetic fractures that can seriously harm hip function recovery. OBJECTIVE: To analyze risk factors for periprosthetic fractures and develop preventive measures to reduce postoperative complications. METHODS: A prospective, single-center, self-controlled, open-label clinical study with 2-year follow-up will be carried out at the Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China. We will analyze imaging data from 25 patients who undergo total hip replacement with the CFP prosthesis. Primary outcome measure is hip function recovery as assessed by Harris hip score preoperatively and 6, 12, and 24 months postoperatively. Secondary outcome measures include fracture severity as assessed by periprosthetic fracture classification according to the American Academy of Orthopaedic Surgeons guidelines, and bone healing as assessed by CT and radiographic findings preoperatively and 6, 12, and 24 months postoperatively, including parameters of the proximal and mesal medullary cavity of the fractured femur (width of the medullary cavity at the point 20 mm above the midpoint of the small trochanter, at the midpoint of the small trochanter, at the point 20 mm below the midpoint of the small trochanter, and at the fracture line; width of the corresponding prostheses), intertrochanteric width, femoral neck-stem angle, femoral neck anteversion, femoral neck length, ratio of the distal end of the prosthesis to the medullary space, and height of the femoral calcar. Other outcome measures are multiple logistic regression analysis results of risk factors for periprosthetic fracture during hip replacement, and the incidence of adverse events within 24 months postoperatively. This study was registered at ClinicalTrials.gov (NCT 02981823) on 24 November 2016. Approved by the Ethics Committee of the Third Hospital of Hebei Medical University, China (approval number: KE2016-011-1), the study protocol will be performed in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association. Written informed consent will be obtained from all participants prior to the trial. DISCUSSION: This study will be expected to provide references for reducing the incidence of periprosthetic fracture during hip replacement with the CFP prosthesis. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Digital three-dimensional imaging models for repair of complex long bone fractures: study protocol for a randomized controlled trial with 6-month follow-up Zhao Zi-chun, Li Zhao-wei, Tang Bao-ming, Guo Qi-fa 2016, 20 (53):  7992-7997.  doi: 10.3969/j.issn.2095-4344.2016.53.013 Abstract ( 291 )   PDF (997KB) ( 378 )   Save BACKGROUND: During internal fixation for complex long bone fractures, it is difficult to position the internal fixator completely to the contours of the bone surface, often resulting in unstable fixation and affecting the quality of the repair. Digital three-dimensional (3D) models were therefore established based on computed tomography (CT) scans that closely reflected the site and degree of fractures, thereby guiding precise positioning of the internal fixator. From a safety point of view, the digital 3D-derived model was created to ensure that the internal fixator could achieve better repairs of complex long bone fractures. OBJECTIVE: To investigate the application of digital 3D models for repairing complex long bone fractures. METHODS: We propose to conduct a prospective, single-center, randomized, controlled, open-label, clinical trial with 6-month follow-up at the Department of Orthopedics Trauma, Affiliated Hospital of Qinghai University, China. Sixty-three patients with complex long bone fractures will be randomized into two groups. In the observation group (n=32), digital 3D models based on CT images will be used to establish internal fixation. In the control group (n=31), patients will undergo conventional internal fixation. All patients will be followed up for 6 months. The primary outcome will be total efficacy at 6 months postoperatively in both groups. The secondary outcomes will be (1) hip function evaluated by Harris scores before and 6 months after surgery; (2) fracture healing observed by plain radiography before and 6 months after surgery; (3) pain relief evaluated by a visual analogue scale before and 6 months after surgery; (4) assessment during the hospital stay and 6 months after surgery to assess recovery of the patient’s condition; (5) operation time to evaluate the speed of operation. Other outcome will be the incidence of adverse reactions at 6 months postoperatively. The study protocol has been approved by the Ethics Committee of Affiliated Hospital of Qinghai University of China, approval number NQH14023. All protocols will be in accordance with Declaration of Helsinki, formulated by the World Medical Association. Written informed consent will be provided by participants. This trial has registered with ClinicalTrials.gov (identifier NCT02964754) on 12 November 2016. DISCUSSION: This trial will analyze the feasibility of digital 3D models for repairing complex long bone fractures with the aim to provide a new method for accurate, safe, reliable preoperative planning to achieve a better repair effect.    中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Classification of ankle injury on radiography and magnetic resonance imaging: study protocol for a self-controlled, clinical trial with 3-month follow-up Liu Guo-bin, Zhang Guo-ping, Ren Qing-yun, Lei Li-cun, Zhao Feng, Gao Hong-yang, Zhu Chao-hua, 2016, 20 (53):  7998-8003.  doi: 10.3969/j.issn.2095-4344.2016.53.014 Abstract ( 509 )   PDF (1030KB) ( 602 )   Save BACKGROUND: Radiography is commonly used for investigating ankle injury, but is inadequate for diagnosing some ankle fractures and ligamentous injuries. Thus, radiography cannot be used for accurate fracture classification or to formulate a treatment program. In contrast, magnetic resonance imaging can clearly show occult ankle fractures and ligamentous injuries, and can diagnose fracture combined with ligamentous injury. Therefore, radiography combined with magnetic resonance imaging may potentially be adequate for fracture classification and postoperative evaluation. OBJECTIVE: To observe the application of radiography plus magnetic resonance imaging for ankle joint classification and postoperative evaluation. METHODS: We conducted a retrospective, single-center, self-controlled, clinical trial at the First Hospital, Hebei Medical University, China. Sixty-eight patients with ankle injury received internal fixation for fracture and ligament repair. The site of fractures was determined using radiography plus magnetic resonance imaging. Ankle fractures were categorized preoperatively using the Lauge-Hansen classification. We then defined imaging evaluation criteria, which were used to assess ankle fractures postoperatively. The primary outcome was the percentage of patients with an excellent outcome according to the evaluation criteria at postoperative 3 months. The secondary outcomes were the preoperative Lauge-Hansen classification; fracture repair as evaluated by radiography plus magnetic resonance imaging preoperatively and 3 months postoperatively. Other outcome was incidence of adverse events at postoperative 3 months. Results demonstrated that 53% of patients had an excellent outcome according to the evaluation criteria at postoperative 3 months. The numbers of patients with excellent, good and poor outcomes were 36, 23 and 9, respectively. In accordance with the Lauge-Hansen classification, there were 7 cases of pronation-abduction, 14 cases of pronation-external rotation (pronation-eversion), 13 cases of supination-adduction, and 35 cases of supination-external rotation (supination-eversion). The incidence of adverse events at postoperative 3 months was 17%. This trial has registered with ClinicalTrials.gov (identifier: NCT02964754) on 16 November 2016. The study protocol has been conducted in accordance with the Declaration of Helsinki, formulated by the World Medical Association. Written informed consent was obtained from all participants. Subjects had been recruited in July 2015. This trial is expected to end in 2 years. DISCUSSION: This study will analyze the feasibility of radiography plus magnetic resonance imaging for ankle fracture classification and postoperative evaluation to provide an accurate clinical basis for repair of ankle injury.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Percutaneous pedicle screw internal fixation combined with pedicle screw implanting in injured vertebra body for treating single segment of thoracolumbar fracture Li Rui-long, Zhang Qiang, Yang Liu-zhu, Luo Jin, Huang Wen, Feng Liang-en, Su Mou, Liang Da-di 2016, 20 (53):  8004-8009.  doi: 10.3969/j.issn.2095-4344.2016.53.015 Abstract ( 364 )   PDF (2637KB) ( 397 )   Save BACKGROUND: Studies have shown that percutaneous pedicle screw internal fixation for treatment of thoracolumbar fracture has got good clinical results, but for the injured vertebra body, whether pedicle screw should be implanted in injured vertebra body and unilateral or bilateral implanting screw is still controversial. OBJECTIVE: To investigate the clinical efficacy of the percutaneous pedicle screw internal fixation combined with pedicle screw implanting in injured vertebra body for treatment of single segment of thoracolumbar fracture. METHODS: Totally 21 patients with single segment thoracolumbar fractures were treated by the percutaneous pedicle screw internal fixation combined with pedicle screw implanting in injured vertebra body, including 16 males and 5 females. There were T11 in 2 cases, T12 in 4 cases, L1 in 13 cases, and L2 in 2 cases. The Visual Analog Scale scores (VAS), the Japanese Orthopaedic Association (JOA) disability scores and Cobb’s angle were recorded preoperatively and postoperatively. In addition, complications were also recorded. RESULTS AND CONCLUSION: (1) The VAS scores at 1 week and 3, 6 and 12 months after treatment were significantly lower than those before surgery (P < 0.001). In addition, VAS scores were lower at 1 week than that at postoperative 3, 6, 12 months (P < 0.001). No significant difference in VAS scores was detected at postoperative 3, 6, 12 months. (2) Lumbar function: JOA scores were significantly higher at postoperative 1 week and 12 months than those before treatment (P < 0.001), and the postoperative JOA scores were significantly higher at 12 months than at postoperative 1 week (P < 0.001). (3) Cobb’s angle was significantly smaller at 1 week and 12 months after surgery than that before treatment (P < 0.001). No significant difference in Cobb’s angle was detectable at 1 week and 12 months after surgery. (4) No complications were found. (5) These results suggest that the percutaneous pedicle screw internal fixation combined with pedicle screw implanting in injured vertebra body for single segment of thoracolumbar fracture can correct kyphosis, improve the thoracolumbar motion, quickly relieve patient’s back pain, and is very safe.  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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InterTan nail versus proximal femoral nail antirotation for femoral intertrochanteric fractures: a systematic review and meta-analysis Hu Bing-yan, Ai Jin-wei, Chen Qiong, Yao Zhong-jun 2016, 20 (53):  8010-8021.  doi: 10.3969/j.issn.2095-4344.2016.53.016 Abstract ( 456 )   PDF (1990KB) ( 551 )   Save BACKGROUND: The conclusion of current studies about the difference of clinical efficacy between InterTan nail and proximal femoral nail antirotation (PFNA) for femoral intertrochanteric fractures is still controversial. OBJECTIVE: To compare the difference in therapeutic efficacy between InterTan nail and PFNA for femoral intertrochanteric fractures using systematical review and meta-analysis. METHODS: A computer-based online search was conducted in PubMed, The Cochrane Library (Issue 4, 2016), Embase, CNKI, VIP, CBM, and Wan-Fang databases up to May 8, 2016 to screen the relevant controlled trials of InterTan nail versus PFNA for the treatment of femoral intertrochanteric fractures. Two reviewers independently selected the studies, extracted information, and assessed the quality of included trials. Data extraction from eligible studies was pooled and meta-analyzed using Stata13.1 software. RESULTS AND CONCLUSION: A total of 8 randomized and 8 non-randomized trials involving 1 323 patients were included. There were 658 patients undergoing InterTan nail and 665 patients undergoing PFNA. The meta-analysis results showed that there were no significant differences in excellent rate, intraoperative blood loss, bedridden time, and fracture healing time (P > 0.05). The operative time in InterTan nail group was longer than PFNA group [MD=11.51 , 95%CI(6.41，11.62), P < 0.01]. However, the InterTan nail was superior to PFNA in increasing the Harris scores [MD=1.38, 95%CI(0.25, 2.51), P=0.02], and decreasing the complication rates [RR=0.54, 95%CI(0.44, 0.67), P < 0.01]. Due to the limitations of the included studies, more high-quality randomized controlled trials are needed to verify the above conclusion. In addition, future studies should focus on the difference in therapeutic efficacy of the two treatments in different fracture types and the osteoporosis patients.    中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Different doses of rivaroxaban versus enoxaparin for prevention of venous thromboembolism after total hip arthroplasty: a meta-analysis of safety and efficacy Wei Zhi-hui, Zhang Ming-hua, Zhao Bo, Min Jing, Qiu Hao, Lu Min-peng 2016, 20 (53):  8022-8031.  doi: 10.3969/j.issn.2095-4344.2016.53.017 Abstract ( 345 )   PDF (1431KB) ( 554 )   Save BACKGROUND: Rivaroxaban and enoxaparin are commonly used drugs to prevent venous thromboembolism after total hip arthroplasty. There is still some controversy on the safety and efficacy. At present, there is no research on the optimal dose of rivaroxaban in domestic and foreign countries. OBJECTIVE: To systematically review the protective effect and safety for prevention of venous thromboembolism after total hip arthroplasty between rivaroxaban and enoxaparin. METHODS: Databases were retrieved including The Cochrane Library (Issue 9, 2014), Medline, EMbase, PubMed, VIP, WanFang and CNKI (from database foundation to September 2015) for randomized controlled trials about rivaroxaban compared with enoxaparin to prevent venous thromboembolism after total hip arthroplasty. Meta-analysis was conducted in two kinds of treatment of deep vein thrombosis, major venous thromboembolism, major bleeding events, non-major bleeding and minor bleeding events. RESULTS AND CONCLUSION: (1) Overall results showed that: efficacy of rivaroxaban was better than enoxaparin in the prevention of venous thromboembolism after total hip arthroplasty, but rivaroxaban has greater risk for hemorrhage. (2) Subgroup analysis results demonstrated that the efficacy of rivaroxaban at 10 and 30 mg/d was better than that of enoxaparin in the prevention of venous thromboembolism (P < 0.05). The efficacy of rivaroxaban at 10 mg/d was better than that of enoxaparin in the prevention of venous thromboembolism (P < 0.05). The risk of hemorrhage when using rivaroxaban at 30, 40 and 60 mg/d was higher than that of enoxaparin (P < 0.05). (3) Comprehensive subgroup analysis results showed that the efficacy and safety of rivaroxaban at 10 mg/d were better than enoxaparin. (4) Due to the limited quantity and quality of included studies, these conclusions need more high-quality and large multicenter randomized controlled trials to verify.  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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Autologous blood transfusion drainage versus conventional suction drainage in total knee arthroplasty: a meta-analysis of randomized controlled trials Liu Jun, Pan Jian-ke, Hong Kun-hao, Xie Hui, Guo Da, Xu Shu-chai 2016, 20 (53):  8032-8042.  doi: 10.3969/j.issn.2095-4344.2016.53.018 Abstract ( 430 )   PDF (1002KB) ( 351 )   Save BACKGROUND: At present, when compared with the conventional suction drainage, the advantages of autologous blood transfusion drainage after total knee arthroplasty have not been clear yet and need evidence of evidence-based medicine to support. OBJECTIVE: Based on the existing evidence of evidence-based medicine, compared with the conventional suction drainage, we evaluated the efficiency, safety, and potential advantages of autologous blood transfusion drainage in total knee arthroplasty. METHODS: We performed a systematic literature search of PubMed, Embase, and the Cochrane Library; all randomized controlled trials that compared the effects of autologous blood transfusion drainage and conventional suction drainage in total knee arthroplasty were included for meta-analysis. RESULTS AND CONCLUSION: Twelve randomized controlled trials, including 1 119 cases (556 cases for autologous blood transfusion drainage and 563 cases for conventional suction drainage), were identified. Meta-analysis results demonstrated that patients in the autologous blood transfusion drainage group benefitted from a lower blood transfusion rate (OR=0.28, 95%CI: 0.14-0.55, Z=3.67, P=0.000 2) and a lower number of units transfused per patient (weighted mean difference=-0.56, 95%CI: -0.79- -0.33, Z=4.71, P < 0.000 01). Wound complications, deep vein thrombosis, febrile complications, post-operative hemoglobin on days 5–8, drainage volume, and hospital stay length did not significantly differ between autologous blood transfusion drainage and conventional suction drainage groups (P > 0.05). This meta-analysis suggests that autologous blood transfusion drainage offers a safe and efficient alternative to conventional suction drainage with a lower blood transfusion rate and a smaller number of units transfused per patient.  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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Common peroneal nerve injury after primary total knee arthroplasty: risk factors and strategies of prevention and treatment Chen You-rong, Wan Fu-yin, Guo Wan-shou, Wang Wei-guo, Cheng Li-ming, Zhang Qi-dong, Ding Ran 2016, 20 (53):  8043-8050.  doi: 10.3969/j.issn.2095-4344.2016.53.019 Abstract ( 489 )   PDF (2187KB) ( 548 )   Save BACKGROUND: Common peroneal nerve injury is one of the rare but serious complications after total knee arthroplasty. With the increased amount of operations, peroneal nerve injury would become more and more common, although the incidence rate is relatively low. OBJECTIVE: To review the literatures published in recent years and related to common peroneal nerve injury after primary total knee arthroplasty, to explore the research progress, risk factors, prophylactic measures and treatment strategies. METHODS: A computer-based online search was performed in the databases of Chinese National Knowledge Internet, CqVip and PubMed from January 1980 to August 2016 for the literatures related to peroneal nerve injury after primary total knee arthroplasty. The key words were “total knee arthroplasty, common peroneal nerve injury, common peroneal nerve paralysis, common peroneal nerve palsy” in Chinese and English. Repeated and old studies were excluded. Totally 52 literatures or professional books were in accordance with the inclusion criteria. There were 6 Chinese articles, 45 English articles and 1 professional book. RESULTS AND CONCLUSION: With the increased amount of total knee arthroplasty, peroneal nerve injury would become more and more common. The consequence would be very serious if this complication happened, so the effective prevention was most important. The accepted risk factors link to common peroneal nerve injury after total knee arthroplasty included: surgeons injured dangerous zone of peroneal nerve, severe flexion or valgus deformity of knee, rough operation, inappropriate use of pneumatic tourniquet, preoperative neuropathy, internal problems, obesity, methods of anesthesia and postoperative analgesia, hematoma formation, and local compression. Meanwhile, early recognition of peroneal nerve injury after total knee arthroplasty, and taking operative or non-operative therapies would promote the recovery of injured nerve and prevent further muscular atrophy. There were many risk factors about peroneal nerve injury after total knee arthroplasty. However, so far, the exact etiology and pathogenesis remain unclearly, and further studies are needed to solve the clinical problem. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Effects of different wear particles on multiple systems after artificial joint replacement Qiu Xiao-ming, Zhen Ping, Li Guang-yong 2016, 20 (53):  8051-8056.  doi: 10.3969/j.issn.2095-4344.2016.53.020 Abstract ( 432 )   PDF (1029KB) ( 306 )   Save BACKGROUND: Studies demonstrated that wear particles can lead to aseptic loosening of the prosthesis, and spread to the whole body, and have systemic effects on multiple systems. OBJECTIVE: To summarize research status and new progress of the generation, characteristics of wear particles, and pathways that are transferred to the body, as well as effects of different wear particles on systemic multi-system.  METHODS: We retrieved database of CNKI and PubMed for particles concerning wear particles after artificial joint replacement published from January 1999 to April 2016. The articles regarding effects of wear particles on prosthesis loosening were excluded. Key words were “wear particles”. RESULTS AND CONCLUSION: Regardless of the fixation or prosthesis material used for artificial joint replacement, friction between the prosthesis and fretting between the prosthesis and the bone interface can produce wear particles. At present, there are no clinical complications of short-term effects of bone cement, polyethylene, ceramic wear particles on human. In contrast, systemic reactions caused by metal wear particles are more common. The metal ions not only affect the whole body, but also can cause damage to the human body. Nowadays, the research on the mechanism of prosthesis replacement wear particles mainly concerns in vitro cells, but there are few complete animal models. Scholars generally agreed that particle-mediated disease has a long-term latency; the long-term effects of exposure to metal particles are still unclear, and need to be explored. 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