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28 January 2017, Volume 21 Issue 3 Previous Issue    Next Issue

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Cocktail therapy reduces hidden blood loss after total knee arthroplasty Shi Li-jun, Gao Fu-qiang, Sun Wei, Wang Wei-guo, Cheng Li-ming, Guo Wan-shou 2017, 21 (3):  329-334.  doi: 10.3969/j.issn.2095-4344.2017.03.001 Abstract ( 468 )   PDF (1027KB) ( 281 )   Save BACKGROUND: Blood loss after total knee arthroplasty is a common problem that will affect the clinical effects. As a kind of hemostatic medicine, tranexamic acid has been more and more used in reducing bleeding after joint replacement. However, there are few studies concerning the combined use of tranexamic acid with other hemostatic drugs. OBJECTIVE: To evaluate the efficacy and safety of intra-articular administration of cocktail wine (tranexamic acid plus diluted-epinephrine) on perioperative blood loss and transfusion in primary unilateral total knee arthroplasty. METHODS: From July 2013 to October 2015, 113 patients scheduled to undergo total knee arthroplasty were randomized into two groups. Cocktail wine group (57 patients) received intra-articular cocktail wine (3 g tranexamic acid plus 0.25 mg diluted-epinephrine; 1:200 000). Tranexamic acid group (56 patients) received 3 g topical tranexamic acid alone. All patients were not drain inserted after the operation. During perioperative period, intraoperative blood loss, postoperative dominant blood loss, occult blood loss and allogeneic blood transfusion were observed. Within postoperative 90 days, the incidences of symptomatic deep venous thrombosis and pulmonary embolism were observed. RESULTS AND CONCLUSION: (1) The topical administration of cocktail wine significantly reduced total blood loss (P = 0.007), hidden blood loss (P=0.000) and transfusion rate (0% vs. 5.4%), without increasing the risk of thromboembolic and hemodynamic complications (P > 0.05). (2) Therefore, the hemostatic effect of topical tranexamic acid plus diluted-epinephrine was better than tranexamic acid alone. Their combination does not produce severe adverse reactions, and can be used as an important method to reduce blood loss after total knee arthroplasty.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Effects and safety assessment of methylprednisolone on postoperative nausea and vomiting and pain after total knee arthroplasty Tian Hai-tao, Wang Yuan-he, Tian Shao-qi, Zhang Xu-teng, Sun Kang 2017, 21 (3):  335-339.  doi: 10.3969/j.issn.2095-4344.2017.03.002 Abstract ( 465 )   PDF (958KB) ( 272 )   Save BACKGROUND: At present, dexamethasone has been widely used in the perioperative period of major surgery in the orthopedics for reducing postoperative pain and nausea and vomiting, but the study on the application of methylprednisolone to reducing postoperative nausea and vomiting and pain after unilateral total knee arthroplasty is rarely reported. OBJECTIVE: To evaluate the effects and safety assessment of the application of methylprednisolone on postoperative nausea and vomiting and pain after unilateral total knee arthroplasty. METHODS: A total of 86 patients undergoing unilateral total knee arthroplasty were randomly assigned to two groups. Patients in the methylprednisolone group were given methylprednisolone 40 mg in intravenous drip within 24 hours during and after replacement. Patients in the control group were given an equal volume of saline in intravenous drip at the same time. The incidence of postoperative nausea and vomiting was observed and recorded at 0-6 hours, 6-24 hours, 24-48 hours, and 48-72 hours after surgery, as well as the total incidence was recorded in both groups. Pain visual analogue scale (VAS) score at 6, 24, 48 and 72 hours after replacement, and knee joint scoring system (KSS) score at 3 days after replacement were recorded. C-reactive protein and fasting blood glucose were determined. The occurrence of adverse reactions postoperatively was recorded in 6-month follow-up in both groups. RESULTS AND CONCLUSION: (1) The total incidence rate of postoperative nausea and vomiting during 0-72 hours after surgery, and incidence rates of nausea and vomiting at 6 and 24 hours were significantly lower in the methylprednisolone group than in the control group (P < 0.05). (2) Pain VAS score was significantly lower in the methylprednisolone group than in the control group at 6 and 24 hours after surgery (P < 0.05). (3) KSS scores were significantly higher in the methylprednisolone group than in the control group after surgery (P < 0.05). (4) C-reactive protein and fasting blood glucose were not significantly different between two groups before and after surgery (P > 0.05). (5) The surgical incision was found to heal in 3-month follow-up and no postoperative infection occurred in both groups. (6) Results show that methylprednisolone can obviously reduce postoperative nausea and vomiting and pain in unilateral total knee arthroplasty, and did not increase the incidence of postoperative infection.  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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Pedicle subtraction osteotomy for repairing thoracolumbar degenerative kyphosis: correlation of spino-pelvic parameters Li Hao-ran, Cui Qing, Dong Zhan-yin, Zhang Jian-hua, Li Hai-qing, Zhao Ling 2017, 21 (3):  345-349.  doi: 10.3969/j.issn.2095-4344.2017.03.004 Abstract ( 399 )   PDF (1116KB) ( 247 )   Save BACKGROUND: Thoracolumbar degenerative kyphosis could experience severe lumbar back pain due to sagittal plane imbalance, thereby affecting quality of life. Thus, it is very important to reconstruct spino-pelvic profile in these patients. OBJECTIVE: To explore the relationships between life quality and spino-pelvic parameters following pedicle subtraction osteotomy for thoracolumbar degenerative kyphosis and the clinical significance. METHODS: Between May 2010 and October 2014, 59 patients with thoracolumbar degenerative kyphosis undergoing L2 pedicle subtraction osteotomy in Cangzhou Hospital of Integrated Traditional and Western Medicine were retrospectively reviewed. Anteroposterior and lateral X-ray films of all patients during standing were photographed before and after surgery. The pre-and post-operative thoracic kyphosis, lumbar lordosis, sagittal imbalance, T1 pelvic angle, pelvic incidence, sacral slope and pelvic tilt were measured in all patients. The patients’ quality of life was evaluated using SF-36 preoperatively and postoperatively. RESULTS AND CONCLUSION: (1) Significant differences were observed in the improvement of thoracic kyphosis, lumbar lordosis, pelvic tilt, sacral slope and sagittal imbalance (P < 0.01). With respect to SF-36, postoperative SF-36 score was higher than preoperative postoperative SF-36 score (P < 0.01). (2) The alteration of lumbar lordosis showed significant correlation with the change of pelvic tilt, sacral slope and sagittal imbalance. The change of pelvic tilt exhibited cardinal correlation with the change of sacral slope, body pain and general health. The improvement of sagittal imbalance significantly correlated with the improvement of lumbar lordosis, body pain and general health. The improvement of T1 pelvic angle significantly correlated with the improvement of lumbar lordosis, sagittal imbalance, body pain and general health. (3) Pedicle subtraction osteotomy can effectively restore spino-pelvic sagittal profile, improve the life quality and relieve pain for the patients with thoracolumbar degenerative kyphosis.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Percutaneous vertebroplasty, percutaneous kyphoplasty and expansive pedicle screw fixation for repairing primary osteoporotic thoracolumbar fractures   Wang Ling, Zhao Hong-xia, Hua Qiang 2017, 21 (3):  350-355.  doi: 10.3969/j.issn.2095-4344.2017.03.005 Abstract ( 310 )   PDF (1181KB) ( 273 )   Save BACKGROUND: Percutaneous vertebroplasty, percutaneous kyphoplasty and expandable pedicle screw fixation can treat primary osteoporotic thoracolumbar fractures. The three methods have their own advantages and disadvantages.  OBJECTIVE: To investigate the methods and clinical effects of primary osteoporotic thoracolumbar fractures.  METHODS: Clinical data of 61 patients with primary osteoporotic thoracolumbar fractures were collected and retrospectively analyzed. Perioperative preparation must be done. All patients were treated by percutaneous vertebroplasty, percutaneous kyphoplasty and expansive pedicle screw fixation. We recorded Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) before treatment, 3 months after treatment, as well as sagittal index (SI) and Cobb angle of vertebral fracture before treatment, 3 days and 3 months after treatment.  RESULTS AND CONCLUSION: (1) All cases were followed up for 12-18 months. (2) There was no significant difference in VAS scores, ODI, SI and Cobb angle of vertebral fracture among the three groups of patients preoperatively. (3) At 3 months after treatment, there were significant differences in VAS scores and ODI in the three groups as compared with that preoperation (P < 0.05). However, no significant difference in VAS and ODI was determined among intergroup comparison (P > 0.05). (4) SI and Cobb angle of vertebral fracture were significantly increased; the difference was statistically significant (P < 0.05). The efficacy was similar between the percutaneous kyphoplasty and expansive pedicle screw fixation groups (P > 0.05), and was better than the percutaneous vertebroplasty group (P < 0.05). (5) Three kinds of treatment can effectively restore the vertebral height and intensity, relieve pain and stabilize the spine, and no significant vertebral compression was found in the short term. However, restoration of postoperative vertebral height was better in percutaneous kyphoplasty and expansive pedicle screw fixation groups than in the percutaneous vertebroplasty group. In view of their respective indications, advantages and disadvantages, the key point of raising therapeutic effect was to choose appropriate surgical procedures.  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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Screw placement selection of minimally invasive percutaneous pedicle screw fixation for thoracolumbar fractures Zou Wei, Xiao Jie, Long Hao, Zhang Yang, Wu Chen, Du Yu-hui, Feng Ming-xing, Zhou Chang-jun 2017, 21 (3):  356-361.  doi: 10.3969/j.issn.2095-4344.2017.03.006 Abstract ( 342 )   PDF (1814KB) ( 270 )   Save BACKGROUND: Monoaxial pedicle screws are not conducive to the installation during percutaneous pedicle screw technique, but it has better mechanical conductivity and stability than polyaxial pedicle screws. How to select and use these two kinds of screws in the clinic to exert their advantages and to further elevate efficacy has become a subject worthy of reflection. OBJECTIVE: To compare the clinical efficacy of percutaneous pedicle screw placement for thoracolumbar fracture using monoaxial and polyaxial pedicle screws at different placement selections.  METHODS: A total of 46 cases of thoracolumbar fracture without neurological symptoms underwent minimally invasive percutaneous pedicle screw fixation. 25 patients (monoaxial screw group) were treated with monoaxial pedicle screws and the other 21 ones (polyaxial screw group) with polyaxial pedicle screws. Kyphotic angle, correction rate, correction loss rate and height of injury vertebrae were compared before and after fixation in both groups. The therapeutic effects of monoaxial and polyaxial percutaneous pedicle screw fixation in the treatment of thoracolumbar fractures were evaluated.  RESULTS AND CONCLUSION: (1) Fixation time, blood loss, complication and hospital stay were not significantly different in both groups (P > 0.05). (2) Kyphotic angle and height of the fractured vertebra body were significantly different between the two groups (P < 0.05). (3) The restoration of anterior height of injured vertebrae, kyphotic angle and correction rate were better in the monoaxial screw group than in the polyaxial screw group after treatment (P < 0.05). The correction loss rate was significantly better in the monoaxial screw group than in the polyaxial screw group during last follow-up (P < 0.05). However, there was no significant difference in the posterior height of injured vertebraeafter fixation (P > 0.05). (4) These findings indicate that compared with the polyaxial percutaneous pedicle screw fixation, the monoaxial pedicle screw may be preferable in percutaneous pedicle screw fixation for thoracolumbar fractures, has more satisfactory fracture distraction reduction, and has less postoperative correction loss rate.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Biomechanics of lumbar cortical bone trajectory screw fixation Yao Yu, Xue Hua-wei, Zhao Jian, Zhang Feng, Cao Yong, Chen Xiang-dong, Zhao Jin-long, Jiang Xing-jie 2017, 21 (3):  362-366.  doi: 10.3969/j.issn.2095-4344.2017.03.007 Abstract ( 330 )   PDF (3466KB) ( 243 )   Save BACKGROUND: Santoni put forward the cortical bone trajectory technology by changing the traditional pedicle screw placement for lumbar internal fixation in order to obtain better control of the screw and bone in 2009. OBJECTIVE: To analyze biomechanical stability of cortical bone trajectory system in the lumbar fusion.  METHODS: Twenty fresh newborn calf L3/4, L5/6 motion segment specimens were obtained, and their ranges of motion were detected under different states, as normal controls. Subsequently, twenty samples were divided into cortical bone trajectory screw group and traditional pedicle screw group, which underwent cortical bone trajectory screw fixation combined with posterior lumbar fusion and traditional pedicle screw fixation combined with posterior lumbar fusion, respectively. Without destruction, ranges of motion were detected under different states in both groups. In the revision group, after the test in the traditional pedicle screw group, screw was withdrawn, and cortical bone trajectory screw was used to detect its range of motion under different states. RESULTS AND CONCLUSION: Ranges of motion at bending to the left and right, anteflexion, posterior extension and axial rotation were significantly lower in the cortical bone trajectory screw group and traditional pedicle screw group than in the normal control group (P < 0.05). No significant difference in bending to the left and right, anteflexion, posterior extension and axial rotation was detected between the cortical bone trajectory screw and revision groups and traditional pedicle screw group (P > 0.05). These results confirmed that cortical bone trajectory technology combined with posterior lumbar fusion can obtain identical stability as the traditional pedicle screw fixation combined with posterior lumbar fusion. Simultaneously, it is a new choice for revision after traditional pedicle screw fixation.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Tibial avulsion fractures of anterior cruciate ligament repaired with Arthrex sutures passing through combining free knotting technique Jia Yan-bo, Liang Zi-hong, Ren Yi-zhong, Han Chang-xu, Kong Ling-yue, Eerduntu 2017, 21 (3):  367-372.  doi: 10.3969/j.issn.2095-4344.2017.03.008 Abstract ( 894 )   PDF (1288KB) ( 378 )   Save BACKGROUND: The treatment method of tibial avulsion fractures of anterior cruciate ligament is varied; each has its advantages. OBJECTIVE: To investigate the methods and clinical effects of the treatment of avulsion fractures of tibial insertion of anterior cruciate ligament by the means of making two decussate lines and four strands of non-absorbable Arthrex sutures passing through two bone tunnels combined with pushlock free knotting anchor under arthroscopy. METHODS: From December 2014 to November 2015, 23 cases of avulsion fractures of tibial insertion of anterior cruciate ligament were treated in the Second Hospital of Inner Mongolia Medical University. Under the arthroscopy, avulsed fracture was fixed in tibial intercondylar eminence by the means of making two decussate lines of Arthrex sutures passing through. At the same time, pushlock free knotting anchor beside tibial tubercle provided a tightening of tension for Arthrex sutures, which could strengthen the fixation of avulsion fracture blocks. Knee joint Lysholm and Tegner scores were followed up. Knee stability was evaluated by anterior drawer test and Lachman test. Postoperative reset and healing were evaluated with X-ray films.  RESULTS AND CONCLUSION: (1) All 23 patients were followed up for 6 months to 1 year. (2) Lysholm scale of the knee function was (47.31±6.16) preoperatively and (94.69±1.28) postoperatively (P < 0.05). Tegner score was (3.14±1.58) preoperatively and (7.74±1.69) postoperatively (P < 0.05). (3) Lachman test of all cases was negative. X-ray films demonstrated that fracture healing was good. There was no repeated swelling or cross locking of the joint. The knee was not limited by flexion or extension. No infection or deep venous thrombosis of lower extremity occurred. (4) The method of Arthrex sutures passing through two bone tunnels combined with pushlock free knotting anchor under arthroscopy has the advantages of minimally invasive, simple operation, reliable fixation, no metal implants and satisfactory result to treat the tibial intercondylar eminence fracture of anterior cruciate ligament.    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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Accuracy of digital orthopedic three-dimensional reconstruction for thoracolumbar pedicle screw placement   Chen Lu-yao, Hu Shi-qiang, Wang Xiao-ping, Wu Wei-wei, Wei Zhan-tu, Huang Jian 2017, 21 (3):  373-377.  doi: 10.3969/j.issn.2095-4344.2017.03.009 Abstract ( 493 )   PDF (948KB) ( 235 )   Save BACKGROUND: With the emergence of more sophisticated imaging instruments in recent years, orthopedic preoperative examination becomes more clear and accurate. With the help of three-dimensional reconstruction technology, it is bound to improve the accuracy of pedicle screw placement. OBJECTIVE: To investigate the accuracy and safety of digital three-dimensional reconstruction technique in the placement of thoracolumbar pedicle screw. METHODS: 200 cases of pedicle screw fixation were collected and randomly divided into two groups. One group was treated with traditional anatomical landmarks combined with intraoperative fluoroscopic fixation of pedicle screws. Assisted thoracic pedicle screws were implanted with digital three-dimensional reconstruction technique. Preparation time, the amount of bleeding, accuracy of pedicle screw placement, and neurovascular injury of pedicle were recorded by comparing the preoperative and postoperative spine digital models of the pre-and post-virtual spine. RESULTS AND CONCLUSION: (1) The accuracy rate of pedicle screw placement was 85% and 99% in the nail-hand nail group and the auxiliary nail group respectively, and the success rate of one-time placement was 80% and 95%; the excellent and good rates of placement were 86% and 96%, respectively (P > 0.05). (2) The preparation time of nail channel was (5.87±1.34) minutes and the volume of blood loss during nailing was (10.08±7.58) mL in the nail-hand nailing group. The preparation time of nail channel was (3.91±2.28) minutes and the volume of blood loss during nailing was (18.31±8.56) mL in the auxiliary nail group. There was significant difference between the two groups (P < 0.05). (3) Nerve injury occurred in six cases, and vascular injury in eight cases in the nail-hand nailing group. Nerve injury occurred in 0 case, and vascular injury in one case in the auxiliary nail group. There were significant differences in nerve and vascular injuries between the two groups (P < 0.05). (4) These results confirm that the accuracy and safety of digital three-dimensional reconstruction technique in the treatment of thoracolumbar pedicle screw placement are 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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Finite-element analysis of a novel posterior atlantoaxial restricted non-fusion fixation system Du Shi-yao, Zhou Feng-jin, Ni Bin, Chen Bo, Chen Jin-shui 2017, 21 (3):  383-389.  doi: 10.3969/j.issn.2095-4344.2017.03.011 Abstract ( 545 )   PDF (1822KB) ( 223 )   Save BACKGROUND: Atlantoaxial fusion is currently the main surgical treatment of atlantoaxial dislocation, but the premise is at the expense of atlantoaxial range of motion, especially the rotation motion. Restricted non-fusion fixation is a method that can maintain the atlantoaxial stability, while retain the atlantoaxial range of motion. Further research should be performed to compare the biomechanical characteristics between the two methods. OBJECTIVE: To develop a three-dimensional finite element model of atlantoaxial instability, compare and determine the biomechanical properties of posterior atlantoaxial restricted non-fusion fixation system and posterior atlantoaxial screw-rod fixation system.  METHODS: A verified intact finite element upper cervical (C0-C3) model was established and analyzed by Simpleware 3.0, Geomagic 8.0, Hypermesh 10.0, Abaqus 6.9, and Rhino 4.0 softwares based on the CT data collected from a 31-year-old healthy male volunteer. The moment couple of 1.5 N•m was loaded, which made the model movement in flexion-extension, lateral bending, and rotating direction, respectively. The range of motion was recorded and compared with the in vitro biomechanical experimental data to verify the effectiveness of the model. The ranges of motion of the posterior atlantoaxial restricted non-fusion fixation system model and the posterior atlantoaxial screw-rod fixation system model were analyzed using the finite element method under flexion, extension, lateral bending, and axial rotation; meanwhile, stress nephograms of the posterior atlantoaxial restricted non-fusion fixation system model were observed.  RESULTS AND CONCLUSION: (1) There were 206 747 elements and 72 500 nodes in the intact model of upper cervical spine (C0-C3) in this experiment, and the range of motion of intact model validated with the reported cadaveric experimental data. (2) The range of motion of the posterior atlantoaxial restricted non-fusion fixation system group was similar to which of the posterior atlantoaxial screw-rod fixation system group in flexion-extension direction. (3) In lateral bending direction, the range of motion of the posterior atlantoaxial restricted non-fusion fixation system model was obviously limited, respectively. The range of motion of the posterior atlantoaxial restricted non-fusion fixation system model was larger than that of the atlantoaxial dislocation model and basically same as that of the normal atlantoaxial model. (4) As to the rotating direction, the range of motion of the posterior atlantoaxial restricted non-fusion fixation system mainly disappeared at the atlantoaxial segment; by contrast, a majority of rotating motion was still retained in the posterior atlantoaxial restricted non-fusion fixation system group. (5) The stress concentration occurred in the contact part between the screw and the connecting rod in posterior atlantoaxial restricted non-fusion fixation system model. (6) Results suggest that posterior atlantoaxial restricted non-fusion fixation system is effective and useful for atlantoaxial fixation. It not only restricted atlantoaxial flexion-extension, but also preserved axial rotation and lateral bending at the atlantoaxial 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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Three-dimensional finite element analysis of Kirschner nails and external fixation for Bennett fracture Liu Jun, Liao Su-ping 2017, 21 (3):  390-395.  doi: 10.3969/j.issn.2095-4344.2017.03.012 Abstract ( 515 )   PDF (1174KB) ( 243 )   Save BACKGROUND: Klinefelter nails and external fixation were commonly used treatment methods for Bennett fracture, but study about biomechanics of two methods was little. OBJECTIVE: To establish three-dimensional finite element models of Bennett fracture by Klinefelter nails and external fixation, and analyze its biomechanics. METHODS: Three-dimensional models of Bennett fracture were established by small external fixation and Kirschner nail treatment. The Bennett fracture models established by small external fixation treatment were considered as model A. Bennett fracture models established by Kirschner nail treatment were considered as model B. 120 N load was applied to the first metacarpal X-axis direction. The X-direction displacement and total displacement of model A and model B, and the fracture fragments stress of model A and model B were observed. RESULTS AND CONCLUSION: (1) In the X direction, the absolute values of maximum displacement and minimum displacement of model A at proximal fragment and distal fragment were less than model B; the maximum relative displacement, minimum relative displacement and average relative displacement of model A were less than model B. The differences of the average displacement of the proximal fracture fragment and the distal fragment, and the relative mean displacement in two models were statistically significant (P < 0.05). (2) In total displacement, absolute values of the maximum displacement and minimum displacement of model A at proximal fragment were less than model B; absolute values of the maximum displacement and minimum displacement of model A at distal fragment were less than model B; the maximum relative displacement, minimum relative displacement and average relative displacement of model A were less than model B. The differences of the average displacement of the proximal fracture fragment and the distal fragment, and the relative mean displacement in two models were statistically significant (P < 0.05). (3) The maximum stress value, a minimum stress value and the average stress values of fracture fragments of model A were significantly smaller than model B. The difference of the mean stress value in two models was statistically significant (P < 0.05). (4) These findings showed that the X-direction displacement and the total displacement were smaller, and the fracture fragments stress was uniform in small external fixation and Kirschner nail treatment for Bennett fracture, indicating that small external fixation for Bennett fracture has more advantages compared with Klinefelter nail.  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 knee flexion and extension movement Zhang Li-chao, Zhang Li-min, Lv Yong-ming, Wang Zhi-hui, Yang Yang, Xu Fei, Dai Hai-feng, Li Jia, Cao Xiang-yu, Wu Li-zhu 2017, 21 (3):  396-400.  doi: 10.3969/j.issn.2095-4344.2017.03.013 Abstract ( 420 )   PDF (896KB) ( 256 )   Save BACKGROUND: Three dimensional finite element analysis is widely used in orthopedics, but research in the knee flexion movement is not much. OBJECTIVE: To analyze biomechanical properties of knee flexion using finite element analysis. METHODS: Three dimensional finite element models and models of knee flexion at 30 degrees, 60 degrees and 120 degrees were established. Femoral forward movement, femur inward movement, tibia internal rotation and tibia vara were analyzed at different flexion angles. RESULTS AND CONCLUSION: (1) When knee flexion was at 30 degrees, 60 degrees and 120 degrees, the femur had backward movement. The backward movement value was larger at 60 degrees than at 30 and 120 degrees (P < 0.05). The backward movement value was larger at 120 degrees than at 30 degrees (P > 0.05). (2) The femur had outward movement at 30 degrees, and inward movement at 120 degrees. The inward movement value was significantly larger at 120 degrees than at 30 and 60 degrees (P < 0.05). No significant difference in outward movement was determined between the 30 and 60 degrees (P > 0.05). (3) Tibia internal rotation was not significantly different at 30, 60 and 120 degrees of flexion (P > 0.05). (4) Tibia vara was found at 30, 60 and 120 degrees of flexion, but the tibia vara was not obvious at 120 degrees. The tibia vara was maximum at 60 degrees, and significantly higher than that at 120 degrees (P < 0.05). The tibia vara was larger at 30 degrees than at 120 degrees (P > 0.05). (5) These findings verify that backward movement was most obvious at 60 degrees. Femur inward movement was most large at 120 degrees. Tibia internal rotation was noticeable at 30 and 120 degrees. Tibia vara was remarkable at 60 degrees.  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 prosthesis position during hip arthroplasty Jia Jin-ling, Dong Yu-zhen 2017, 21 (3):  401-405.  doi: 10.3969/j.issn.2095-4344.2017.03.014 Abstract ( 377 )   PDF (832KB) ( 293 )   Save BACKGROUND: Three-dimensional finite element studies found that the installation location of the hip prosthesis is closely related to the effects of hip replacement, but studies on different anteversion and abduction angle of the hip prosthesis mounting position on the effects of hip biomechanics are not much. OBJECTIVE: To analyze the biomechanical characteristics of different prosthetic positions in hip arthroplasty using three-dimensional finite element analysis. METHODS: One healthy volunteer was selected and data of pelvis and femur were collected. Three-dimensional geometric model of this volunteer was established and received finite element network partitioning. CT scan was used to obtain prosthesis model data and accurate prosthesis model was established. 16 kinds of different prosthesis position model of hip replacement were established. Vertically downward force of 780 N was applied on the top of sacroiliac joint and pubic symphysis. The acetabular stress peak, femoral stress peaks, polyethylene liner peak stress and polyethylene liner damage zone volume of 16 kinds of model were observed. RESULTS AND CONCLUSION: (1) The acetabular stress peak, femoral stress peaks, polyethylene liner peak stress and polyethylene liner damage zone volume of 16 kinds of different prosthesis position model of hip replacement, anteversion angle 10° abduction angle 50° got the best results. The acetabular stress peak was 51.23 MPa; femoral stress peak was 26.34 MPa. Polyethylene liner peak stress was 5.288 MPa and polyethylene liner damage zone volume was 2.239×10-7 m3. (2) These results indicated that anteversion angle 10° abduction angle 50° is the ideal hip replacement degree. The peak stresses of acetabulum, femur, and polyethylene liner at this installation angle are minimum; polyethylene liner damage zone volume is also minimum. This can provide data for clinical reference.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Comparison of the accuracy of lower cervical anterior transpedicular screws between three-dimensional printing assembly navigation template and free hand placement Sheng Xiao-lei, Yuan Feng, Li Zhi-duo, Yang Yu-ming, Lu Hai-tao, Zhang Jun-wei 2017, 21 (3):  406-411.  doi: 10.3969/j.issn.2095-4344.2017.03.015 Abstract ( 304 )   PDF (1219KB) ( 235 )   Save BACKGROUND: Lower cervical anterior transpedicular screw technology combines the advantages of the anterior and posterior surgery; therefore, the pressure releasing and reconstruction problems can be solved via one time anterior surgery, whereas, the difficulty and risk of the operation are increased. However, the three-dimensional (3D) printing assembly navigation template improves the safety and accuracy of screw placement. OBJECTIVE: To explore the feasibility and accuracy of 3D printing assembly navigation template in lower cervical anterior transpedicular screws and compare it with free hand pedicle screw placement. METHODS: Lower cervical spine specimens of six adult (2 males, 4 females, average age 58.5 years old ranged from 53 to 64 years) corpses were equally and randomly divided into two groups. Group A underwent free hand pedicle screw placement. Groups B (lower cervical anterior transpedicular screws assisted by personalized 3D printing combined navigation template): Three cadaveric lower cervical spines were examined using CT and data in DICOM format were recorded. After data were processed using software Mimics for 3D model reconstruction, computer-assisted design of optimum trajactory for lower cervical (C3-C7) anterior transpedicular screws placement was worked out and made into a drill template, where the surface was created as the inverse of anterior surface of cervical vertebra. The drill template was materialized in a 3D printing and used to place the screws. Subsequently, CT scan was performed to evaluate the screw orientation and acceptability. RESULTS AND CONCLUSION: (1) Thirty screws were inserted in Group A. The pedicle perforation was classified by CT, Grade 1: 22 screws, Grade 2: 6 screws, Grade 3: 2 screws; insertion rate was acceptable (Grades 1-2): 28 (93%). Thirty screws were inserted in Group B. The pedicle perforation was classified by CT, Grade 1: 25 screws, Grade 2: 4 screws, Grade 3: 1 screw; insertion rate was acceptable (Grades 1-2): 29 (97%). There were no statistically significant differences in the rate of acceptable insertion and orientation between two groups (P > 0.05). (2) These results suggested that 3D printing combined navigation template consisted with drill hole cap and screw hole, with functions of double direction. Compared with the traditional method, personalized 3D printing combined navigation template can be used simply.    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 uncinate process and various vertebral body structures in adolescents: three-dimensional reconstruction based on CT images Wang Xing, Zhang Shao-jie, Shi Jun, Li Xiao-he, Liu Ying, Li Zhi-jun, Hou Er-fei, Chen Jie, Wang Wei 2017, 21 (3):  412-417.  doi: 10.3969/j.issn.2095-4344.2017.03.016 Abstract ( 283 )   PDF (1412KB) ( 243 )   Save BACKGROUND: With the change of modern living habits, the incidence of cervical disease and cervical related diseases is increasingly at younger age. Based on this feature, the discussion of the relationship between the cervical spine and vertebral body as well as regular feature can provide theoretical basis for early diagnosis, prevention and treatment of cervical spondylosis.  OBJECTIVE: To analyze the correlation structure of the cervical vertebra uncinate process with the vertebral body and intervertebral foramen among adolescents. METHODS: A total of 66 cases without injuries, neurological symptoms or signs of 6 to 20 years old were scanned with multi-row thin-slice spiral CT from C1-T1. The original data were loaded in DICOM format into three-dimensional reconstruction software for measurement and statistical analysis. RESULTS AND CONCLUSION: (1) In addition to uncinate process height and vertebral body height, the uncinate process spacing, uncinate base width and diameter between the vertebrae and a uncinate process base radius vector length and vertebral bodies were positively correlated (P < 0.05). (2) Uncinate high uncinate base long uncinate base width and height between the foramen in addition to the uncinate process had a positive correlation with the length of the substrate (P < 0.05). (3) In conclusion, there is a certain correlation in juvenile cervical uncovertebral joint between the uncinate process and vertebral body and intervertebral foramen. With the growth of age, cervical activity is increased and the uncinate hyperplasia, trauma, and fracture can oppress spinal nerve within the intervertebral foramen to cause corresponding nerve root type of cervical spondylosis. 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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Magnetic resonance T2 mapping and T1ρ imaging of adult rhesus monkeys with lumbar intervertebral disc degeneration in free-range population   Chen Jiang-bo, Pan Xi-min, Chen Ying-ming, Wu Zhi-qiang, Meng Zhong-meng, Chen Li-qiang, Zhuang Wen-quan 2017, 21 (3):  418-422.  doi: 10.3969/j.issn.2095-4344.2017.03.017 Abstract ( 351 )   PDF (1122KB) ( 275 )   Save BACKGROUND: Primates are considered to be the most appropriate animal model of lumbar intervertebraldisc degeneration, but the disc degenerated characteristics of monkeys were rarely reported. OBJECTIVE: To verify the degenerated regularity and characteristics of lumbar intervertebral disks in rhesus monkeys with magnetic resonance T2 mapping and T1ρ imaging technology. METHODS: The sagittal lumbar intervertebral disc magnetic resonance T2 weighted imaging,T2 weighted mapping imaging and T1ρ weighted imaging of 63 adult rhesus monkeys were acquired on 1.5T magnetic resonance equipment. The T2-map value and T1ρ value of lumbar intervertebral disc regions of interest were calculated on the post-processing workstation. RESULTS AND CONCLUSION: (1) This study obtained 425 better magnetic resonance images of lumbar intervertebral disks in adult rhesus monkeys. T2-map value and T1ρ value of nucleus pulposus were most consistent by different persons, and the Kappa coefficient was more than 0.93. (2) The T2-map value and T1ρ value of nucleus pulposus were both negatively correlated significantly with Pfirrmann grades (r=-0.842, P < 0.01; r=-0.896, P < 0.01). The T1ρ value and T2-map value of nucleus pulposus were significantly statistically different between Pfirrmann grades I-IV (P < 0.001, P < 0.001). The T1ρ value of nucleus pulposus was negatively correlated significantly with Pfirrmann grade II-III (r=-0.517, P < 0.01) and Pfirrmann grade IV-V (r=-0.499, P < 0.01). The T2-map value of nucleus pulposus was also negatively correlated significantly with Pfirrmann grade II-III (r=-0.617, P < 0.01) and Pfirrmann grade IV-V (r=-0.652, P < 0.01). (3) The T2-map value of L1-2 and L2-3 segments nucleus pulposus were significantly lower than that in L6-7 and L7-S1 segments (P < 0.05). (4) There were significant differences in age among the T1ρ value and T2-map value of nucleus pulposus (r=-0.702, P < 0.001, r=-0.730, P < 0.001). (5) It is concluded that magnetic resonance T2 mapping and T1ρimaging technology can objectively and sensitively assess the degenerated process of nucleus pulposus in rhesus monkeys. The degeneration in upper lumbar segments (L1-2 and L2-3) was earlier and more severe than that in lower lumbar segments (L6-7 and L7-S1) in rhesus monkeys. Age is one of the most important factors in lumbar intervertebral disc degeneration of adult rhesus monkeys. 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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Incidence and risk factors of deep vein thrombosis during waiting period before operation for calcaneal fractures by ultrasound elastography Lu Zhong-lin, Cao Zhi-qiang, Gao Guo-liang, Jing Qing-ling, Zhang Wei, Huang Yong 2017, 21 (3):  423-427.  doi: 10.3969/j.issn.2095-4344.2017.03.018 Abstract ( 371 )   PDF (959KB) ( 222 )   Save BACKGROUND: Deep vein thrombosis occurred during waiting period before operation affects the prognosis of calcaneal fractures. Therefore, it has important clinical significance for its accurate diagnosis. The staging of thrombosis during waiting period before operation for calcaneal fractures is rarely reported. OBJECTIVE: To detect the incidence and risk factors of deep vein thrombosis in patients with calcaneal fracture by ultrasound elastography imaging after staging diagnosis of thrombosis. METHODS: All objects were included in the study from patients with calcaneal fractures waiting for surgery in the Qinghai University Affiliated Hospital between 2008 and 2015. Patients received preoperative duplex ultrasonography. Those with thrombosis received ultrasound elastography. The incidence of thrombosis was calculated. According to medical records, age, sex, body mass index and history of smoking were collected. The correlation between thrombosis and above factors was analyzed by multiple Logistic regression analysis. RESULTS AND CONCLUSION: (1) One hundred and forty-nine patients were finally included. Of these, 22 (14.8%) were found to affect deep vein thrombosis in the lower limb. The incidence of acute thrombosis was 9.4%. (2) Multiple Logistic regression analysis suggested that age (P=0.009, OR=1.063, 95% confidence interval (CI) 1.010–1.117), body mass index (P=0.019, OR=1.302, 95% CI 1.124–1.430), history of smoking (P=0.017, OR=5.124, 95% CI 1.347-18.359), and operation waiting time (P=0.000, OR=5.190, 95% CI 1.396–19.266) were risk factors of acute lower extremity deep venous thrombosis. (3) These results suggest that the incidences of preoperative deep vein thrombosis and acute deep vein thrombosis are very high. The risk assessment of acute deep vein thrombosis should be taken according to the patient’s age, smoking history, body mass index, as well as the time waiting for surgery. The corresponding diagnosis and treatment program should be given to patients with thrombosis. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Application and research progress of three-dimensional printing in the field of orthopaedics    He Xue-feng, Xiong Ai-bing 2017, 21 (3):  428-432.  doi: 10.3969/j.issn.2095-4344.2017.03.019 Abstract ( 714 )   PDF (833KB) ( 387 )   Save BACKGROUND: Three-dimensional (3D) biological printing uses tissue engineering and stem cell research results, and takes living cells and other cell active ingredients as printing materials, finally realizing biological tissue printing and production.  OBJECTIVE: To review the application and research progress of 3D printing in the field of orthopaedics. METHODS: A computer-based search of PubMed, Ovid, and CNKI databases was performed for relevant literatures about application and research progress of 3D printing in the field of orthopaedics, all of which were published from 2007 to 2016. “three-dimensional printing, 3D printing, plastic and reconstructive surgery, orthopaedic, organ printing” were used as keywords during the searching process. According to inclusion and exclusion criteria, 44 articles were included for further analysis and summary. RESULTS AND CONCLUSION: 3D printing was mainly applied into craniomaxillofacial reconstruction, nose, ear and cartilage reconstruction, breast reconstruction, and skin printing. Its application in bone and prosthetic fabrication was quite mature. Based on the development of 3D printing from prosthetic fabrication to bioactive printing, organ printing will eventually become reality to completely solve the autologous or allograft transplantation limitations.  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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Treatment research and new progress of early-onset scoliosis Wu Min-hao, Sun Wen-chao, Yan Fei-fei, Xie Yuan-long, Hou Zhi-qiang, Feng Fan, Cai Lin 2017, 21 (3):  433-439.  doi: 10.3969/j.issn.2095-4344.2017.03.020 Abstract ( 413 )   PDF (1113KB) ( 342 )   Save BACKGROUND: Early-onset scoliosis is a kind of disease that seriously affects the growth of children’s spine and development of cardiorespiratory function. The treatment of the disease has always been the focus of many clinical researchers. OBJECTIVE: To analyze the therapy for early-onset scoliosis and explore the spinal fusion, spinal non-fusion, conventional growth rod technology and magnetic controlled growth rod technology of early-onset scoliosis. METHODS: We retrieved PubMed, CENTRAL, EMbase, the ISI Web of Knowledge Databases, VIP, CNKI, CBM and Wanfang Database for related studies published from inception of the database to March 2016. The key words were “scoliosis, growing rod, complications”. The included 54 studies were analyzed and discussed. RESULTS AND CONCLUSION: For these children of early-onset scoliosis, we should not only maintain the correction of spine deformities, but also protect the ability of spine growth, keeping the normal cardiopulmonary function. In addition to conventional (non-surgical) treatment, there are surgical treatment (such as spinal fusion and growing rod technique) and magnetically controlled growing rod, a new technology for the treatment of early-onset scoliosis. A comprehensive understanding of the effect of surgical treatment on the spine growth and cardiopulmonary function of children with early-onset scoliosis will help to prevent the occurrence of related complications, so as to obtain a better therapeutic 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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Application and thinking of nucleus replacement, total disc replacement and posterior lumbar dynamic stabilization device for lumbar degenerative diseases Liu Fu-qian, Liang Wei-guo, Ye Dong-ping 2017, 21 (3):  440-444.  doi: 10.3969/j.issn.2095-4344.2017.03.021 Abstract ( 343 )   PDF (1004KB) ( 270 )   Save BACKGROUND: Lumbar fusion surgery as an important and effective means of treating degenerative diseases is widely used in clinical application for almost a century. However, long-term clinical evidence showed that lumbar fusion also brought some problems, such as the loss of waist flexibility, complications of donor site, fusion segment motion loss and accelerating the adjacent segment degeneration. In recent years, the theory of spinal dynamic stabilization had spread widely, and a variety of non-fusion surgery is becoming more broadly used in treatment of lumbar degenerative disease. OBJECTIVE: To review the application of non-fusion surgery in the treatment of lumbar degenerative diseases and explain application perspectives and experiences. METHODS: Databases including PubMed and CNKI were retrieved to collect clinical application and views about non-fusion internal fixation in the treatment of lumbar degenerative diseases from 2007 to 2016. The key words were “lumbar, non-fusion, bone fusion, dynamic stabilization, adjacent segment degeneration”. RESULTS AND CONCLUSION: Thirty papers were included in the final analysis after screening by two independent researchers. We summarized the lumbar non-fusion technology, including artificial nucleus replacement, total disc replacement and posterior lumbar dynamic stabilization device. The philosophy of these new technologies is to provide stability and physiological activity, reducing the abnormal stress that leads to adjacent segment degeneration. These methods can be applied to the step of treatment of lumbar degenerative diseases and to reduce the fusion of diseased segments. Simultaneously, it is needed to strictly grasp the indications for surgery, to identify the cause of the pain caused by low back pain and lumbar spine instability, and to select the most suitable non-fusion device for individual treatment.  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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Treatment scheme selection strategy and progress of elderly femoral neck fracture of Garden type II Li Bai-tong1, Zhou Tian-yi2, Liu Zhen2, Shang Jian2 2017, 21 (3):  445-449.  doi: 10.3969/j.issn.2095-4344.2017.03.022 Abstract ( 360 )   PDF (821KB) ( 226 )   Save BACKGROUND: There are various treatment methods for femoral neck fracture in the elderly, and they have advantages and disadvantages, especially for the elderly type of stable femoral neck fractures Garden type II of treatment options. OBJECTIVE: To summarize the current main clinical methods of senile femoral neck fractures of Garden type II, compare the advantages and disadvantages of internal fixation and joint replacement, and provide the best treatment for orthopedic surgeons. METHODS: We retrieved PubMed database. Key words were elderly femoral neck fracture, Garden type II, selection strategy and progress. Combining with the clinical cases encountered in the comparative analysis, the relevant discussion was analyzed. RESULTS AND CONCLUSION: Although the risk of surgery and the pain of non-surgical patients in early stage, the effects are not ideal. Internal fixation of Garden type II femoral neck fracture and joint replacement in elderly patients is controversial. For the elderly and Garden type II femoral neck fractures, the rate of revision after cannulated screw fixation was significantly higher than that of hip replacement. Both cement-type and biological-type implant prosthesis can improve hip function largely, and reduce non-surgical complications, and finally get a satisfactory clinical effect. The clinician should make the best treatment plan according to the patient’s age, bone condition, fracture type and physical condition.  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 applied to the diagnosis andtreatment of osteonecrosis of femoral head: latest progress Hong Guo-ju, Han Xiao-rui, Fang Bin, Zhou Guang-quan, He Wei, Chen Lei-lei 2017, 21 (3):  450-455.  doi: 10.3969/j.issn.2095-4344.2017.03.023 Abstract ( 374 )   PDF (768KB) ( 322 )   Save BACKGROUND: At present, finite element analysis technology can set up the model, predict diagnosis, treatment design, as well as surgical plan, and can be used in the treatment of necrosis of femoral head. OBJECTIVE: To sum and discuss recent progress in clinical and experimental research regarding biomechanical study in osteonecrosis of femoral head by using finite element analysis. METHODS: A computer-based retrieval was performed by the authors (Hong Guo-ju and Zhou Guang-quan) in PubMed, Google, SpringerLink, ChinaNational Knowledge Infrastructure databases for literatures published from January 2010 to December 2015. The key words were “(finite element analysis OR finite element) AND (osteonecrosis OR osteonecrosis of femoral head)”. Inclusive criteria: studies with contents closely related to this paper; original papers with reliable topics and evidence; or papers with clear points and all-round analysis and both studies in vitro and in vivo. RESULTS AND CONCLUSION: A total of 27 studies were included. The articles in the latest five years related to femoral head osteonecrosis and finite element analysis application were concentrated on. We summarized the latest research progress and problems, including the applied research carried out in the femoral head osteonecrosis clinical cases, innovational skills, so as to point out the direction of future research in the finite element analysis. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Application of “enhanced recovery after surgery” in the perioperative period of total knee arthroplasty Zhu Shi-bai, Zhai Jie, Jiang Chao, Ye Can-hua, Chen Xi, Weng Xi-sheng, Qian Wen-wei 2017, 21 (3):  456-463.  doi: 10.3969/j.issn.2095-4344.2017.03.024 Abstract ( 448 )   PDF (1119KB) ( 310 )   Save BACKGROUND: Fast track surgery, also called enhanced recovery after surgery, is a series of optimal measures adopted during the perioperative period on the basis of evidence-based medicine, to reduce the physical and mental trauma brought to the patient and accelerate their recovery. It has become the research focus of orthopedic clinic as the surgery and anesthesia skills are improved a lot in recent years, especially the articular surgery, which has been widely used in clinics. OBJECTIVE: To summarize the clinical study of the application of optimal measures in joint replacement surgery both at home and abroad in recent years. METHODS: The first author searched related articles in PubMed and Chinese Journal Full-text Database from January 1997 to September 2016. The key words were “joint replacement, enhanced recovery after surgery, multi-mode analgesia, diet management, steroid hormones”. 81 articles were found at last and one monograph was included. RESULTS AND CONCLUSION: (1) We found that the recovery plan reduced the hospital stays of the patients from 4-12 days to 1-3 days, including pre-operative health education, shortening fasting and water-depriving duration before surgery, super-anesthesia before surgery and do not place catheter; adopting general anesthesia and appropriate adductor canal to relieve the pain, and stopping bleeding using tranexamic acid during operation; multi-mode analgesia, faster function exercise after anesthesia recovery, and drinking water in early phase after surgery during the perioperative period of joint replacement surgery conducted by the cooperation of surgeon, anesthetist, nurse and nutritionist. There were no significant improvements of postoperative complications rate and rehospitalization rate. (2) The research found that, enhanced recovery after surgery is suitable for most of the patients receiving joint replacement surgery, including those in advanced age, combined heart and lung disease before surgery, type 2 diabetes and smoking and drinking before 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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Intravenous combined with topical application of tranexamic acid in primary total hip arthroplasty: a meta-analysis of efficacy and safety Wei Zhi-hui, Zhang Zhong-zu, Zhang Ming-hua 2017, 21 (3):  464-470.  doi: 10.3969/j.issn.2095-4344.2017.03.025 Abstract ( 324 )   PDF (1168KB) ( 241 )   Save BACKGROUND: In the total hip arthroplasty, intravenous and topical tranexamic acid can significantly reduce the perioperative blood loss and blood transfusion rate, but at present, the clinical application of tranexamic acid is still controversial. OBJECTIVE: Cochrane system evaluation method is applied on the efficacy and safety of intravenous combined with topical application versus single-dose intravenous application of tranexamic acid in the total hip arthroplasty. METHODS: We searched the Cochrane Library, PubMed, Ovid, EMBASE, CBM, Wanfang, VIP and CNKI database, from inception to July 2016 and retrieval of randomized controlled trials concerning intravenous combined with topical application and single dose intravenous application of tranexamic acid during total hip arthroplasty. Total blood loss, intraoperative blood loss, postoperative blood loss, blood transfusion rate, thrombosis, operation time, and length of hospital stay were analyzed by meta-analysis. RESULTS AND CONCLUSION: (1) There were seven randomized controlled trials with 620 patients. (2) Meta-analysis results indicated that total blood loss, intraoperative blood loss, postoperative blood loss, and blood transfusion rate were significantly better in the combination group than in the single dose group (P < 0.05). There were no significant differences in thrombosis, operation time, and length of hospital stay between the two methods (P > 0.05). (3) These results suggested that compared with the single dose of intravenous application, intravenous combined with topical application, can significantly reduce the loss of blood volume and blood transfusion rate and did not increase the rate of thrombosis. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Effect of remnant preservation on recovery of knee proprioception in arthroscopic anterior cruciate ligament reconstruction: a meta-analysis   Zhang Tai-liang, Zhang Lei, Lian Zhi-ming, Yang Guang-zhong 2017, 21 (3):  471-477.  doi: 10.3969/j.issn.2095-4344.2017.03.026 Abstract ( 286 )   PDF (1387KB) ( 212 )   Save BACKGROUND: Arthroscopic anterior cruciate ligament (ACL) reconstruction is the conventional surgical treatment at present for patients with severe anterior cruciate ligament injury or fracture. However, the opinions varies about whether the ACL remnant should be preserved, and its impact on the knee proprioception gets more and more attention． OBJECTIVE: To compare the influence of arthroscopic ACL reconstruction with remnant preservation or not on the proprioception of the knee joint using a meta-analysis. METHODS: We retrieved randomized controlled studies on arthroscopic ACL reconstruction with remnant preservation or not from 2001 to 2016. Meta-analysis was used to compare postoperative threshold to detection of passive motion (TTDPM), passive angle regeneration test, joint position sense and KT-1000/2000, IKDC, and Lysholm scores between remnant preservation or not.  RESULTS AND CONCLUSION: (1) A total of 11 randomized controlled trials were included. (2) The meta-analysis results showed that postoperative TTDPM [OR=-0.50,95%CI(-0.74, -0.26), P < 0.0001], passive angle reproduction [OR=-0.13, 95%CI(-0.26, -0.01), P=0.03 < 0.05] and Lysholm scores [OR=1.25, 95%CI(0.63, 2.06), P=0.0002], IKDC scores (OR=1.28, 95%CI([0.27, 2.28], P=0.01] in preserving-remnant were superior to removing-remnant for arthroscopic ACL reconstruction. However, there were no statistically significant differences in KT1000/2000 scores [OR=-0.05, 95%CI(-0.13, 0.03), P=0.24] and joint position sense [OR=-0.30, 95%CI(-0.79, 0.18), P=0.22]. (3) In the arthroscopic ACL reconstruction, retained stump postoperative proprioception recovered well and can obtain satisfactory clinical effect. However, prospective large-sample long-term randomized controlled trials are needed for verification. 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 clinical outcome of intramedullary nails versus locking plates for two-part proximal humerus fracture Wang Lei, Wang Feng-feng, Ma Yan-hui, Zhang Jie, Hu Fang, Ma Gai-ping, Liu Mei-mei, Ma Zhang-wen 2017, 21 (3):  478-484.  doi: 10.3969/j.issn.2095-4344.2017.03.027 Abstract ( 416 )   PDF (1322KB) ( 239 )   Save BACKGROUND: Intramedullary nails and locking plates are widely used for two-part proximal humerus fracture. Which is better for two types of implants in patients remains controversial. OBJECTIVE: To determine the clinical outcome of intramedullary nails versus locking plates for two-part proximal humerus fracture according to Cochrane Meta analysis. METHODS: We searched PubMed, SCI, Embase, the Cochranel Library and CBMdisc, VIP information, Wanfang Database, and CNKI for randomized controlled trials and quasi-randomized controlled trials on intramedullary nails and locking plates for two-part proximal humerus fracture. RevMan 5.2 software was used to analyze operation time, intraoperative blood loss, fracture healing time, postoperative complications (heterotopic ossification, pain, screw penetration, necrosis of humeral head), and Constant Score.  RESULTS AND CONCLUSION: Six articles of clinical controlled trials were included with 259 patients. 131 patients received intramedullary nails, and 128 patients received locking plates. Meta-analysis displayed that no significant difference in fracture healing time, heterotopic ossification, pain, necrosis of humeral head and Constant Score was detected between intramedullary nails and locking plates for two-part proximal humerus fracture. Operation time, intraoperative blood loss, and screw penetration were significantly less in the fixation with intramedullary nails than that in locking plates (P < 0.05). These findings suggested that compared with locking plates, intramedullary nails method for two-part proximal humerus fractures could reduce screw penetration.  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 posterior laminectomy and instrumented fusion versus laminoplasty in treatment of multilevel cervical spondylotic myelopathy Zha Yuan-yu, Yang Yang, Chen Shu-zhen, Wei Ren-xiong, Zhang Shu-wei, Jin Wei 2017, 21 (3):  485-492.  doi: 10.3969/j.issn.2095-4344.2017.03.028 Abstract ( 437 )   PDF (1349KB) ( 256 )   Save BACKGROUND: Many studies concern the comparison of posterior laminectomy and instrumented fusion and posterior laminoplasty for multilevel cervical spondylotic myelopathy, but the sample size of many studies has limitations. There is lack of objective evaluation on advantages and disadvantages of two surgical methods. OBJECTIVE: To compare the efficacy and safety of posterior laminectomy and instrumented fusion and laminoplasty in the treatment of multilevel cervical spondylotic myelopathy. METHODS: A systematic search of all the studies published was conducted on the PubMed, Cochrane Central, EMbase, the ISI Web of Knowledge Database, CMB, CNKI, VIP and Wanfang databases. Randomized and non-randomized controlled trials that compared between posterior laminectomy and instrumented fusion and laminoplasty for multilevel cervical spondylotic myelopathy were identified. Meta-analyses were performed in postoperative Japanese Orthopaedic Association scores, cervical range of motion, cervical curvature index, incidence of C5 nerve root paralysis and incidence of axial symptoms. RESULTS AND CONCLUSION: (1) Fourteen studies involving 1 024 patients were included. Among the patients, 519 underwent laminectomy and instrumented fusion and 505 underwent laminoplasty. (2) The results of the meta-analysis indicated that, compared with laminectomy and instrumented fusion group, laminoplasty group had advantages of a lower incidence of C5 palsy [RR=2.24, 95%CI(1.33，3.75), Z=3.05, P < 0.05] and small degree of cervical rotation injury [SMD=-0.71, 95%CI(-2.21，-1.2), Z=6.63, P < 0.05]. However, the two groups had no statistical difference in postoperative Japanese Orthopaedic Association score, cervical curvature index and the incidence of axial symptoms. (3) These results suggested that both laminectomy and instrumented fusion and laminoplasty were demonstrated to be effective for multilevel cervical spondylotic myelopathy. Laminoplasty had obvious advantages of decreasing the degree of cervical rotation injury and lowering incidence of C5 palsy. However, in the process of clinical diagnosis and treatment, the patient’s condition should be combined. The long-term clinical efficacy of the technology needs more clinical work to confirm.  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