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08 March 2017, Volume 21 Issue 7 Previous Issue    Next Issue

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Preoperative application of alprazolam for patients with anxiety and depression and pain after total knee arthroplasty: its safety and effectiveness   Liang Xin, Wang Heng, Li Xian-rong 2017, 21 (7):  985-992.  doi: 10.3969/j.issn.2095-4344.2017.07.001 Abstract ( 727 )   PDF (981KB) ( 408 )   Save BACKGROUND: Psychological factors could influence the degree of pain after total knee arthroplasty. However, the effects of perioperative psychological intervention on postoperative pain and joint function are rarely reported. OBJECTIVE: To study the efficacy and safety of alprazolam for patients with anxiety and depression before total knee arthroplasty. METHODS: Sixty-one patients with anxiety and depression before unilateral total knee arthroplasty were recruited. The patients were given the treatment of alprazolam (experimental group) or placebo (control group) at 2 weeks preoperatively. Baseline data were collected, preoperative anxiety and depression were assessed with Hamilton Anxiety Scale and Beck Depression Inventory, perioperative pain at rest and in activity at each time point was evaluated, postoperative NSAIDs drugs and intravenous self-control analgesia pump usage were recorded, the peripheral neurotransmitters were detected by ELISA, short- and mediate-term joint fuction was evaluated through Western Ontario and McMaster Universities Osteoarthritis Index and Knee Society Score after joint replacement, patient satisfaction and in-hospital relevant indexes and adverse reactions were detected. RESULTS AND CONCLUSION: (1) After the application of alprazolam, anxiety and depression were improved notablely, and the levels of 5-hydroxytryptamine and γ-aminobutyric acid in peripheral blood were increased at 2 weeks. (2) The visual analogue scale scores at rest in the experiemntal group were significnatly lower than those in the control group at 12 hours, 1, 2, 3, 5 and 7 days postoperatively (P < 0.05); the visual analogue scale scores in activity in the experiemntal group were significnatly lower than those in the control group at 12 hours, 1, 2, 3, and 5 days postoperatively (P < 0.05). (3) Analgesia pump and analgesic drug usage in the experiemntal group were significantly less than those in the control group, and the analgesic drug dosage and preoperative anxiety depression were correlated. (4) There were no significant differences in the Western Ontario and McMaster Universities Osteoarthritis Index and Knee Society Score between two groups. (5) The patient satisfaction, sleep index and hospitation time in the experimental group were superior to those in the control group. No obvious adverse reactions occurred during medication. (6) Our results suggest that for patients diagnosised with anxiety and depression before total knee replacement, the preoperative application of alprazolam can alleviate anxiety and depression, improve perioperative pain at rest and in activity, reduce postoperative analgesia drug useage, and increase patient satisfaction. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Influencing factors for pain after total knee arthroplasty Shi Bin, An Jing, Chen Long-gang, Zhang Nan, Tian Ye 2017, 21 (7):  993-997.  doi: 10.3969/j.issn.2095-4344.2017.07.002 Abstract ( 600 )   PDF (668KB) ( 543 )   Save BACKGROUND: Pain is the main reason for the recovery of knee function after total knee arthroplasty. OBJECTIVE: To explore and analyze the influencing factors of pain after total knee arthroplasty. METHODS: 160 patients with knee osteoarthritis underwent total knee arthroplasty. At 12, 24 and 48 hours after total knee arthroplasty, patients were evaluated with visual analogue scale (VAS) and knee function was assessed with KSS score preoperatively and 90 days postoperatively. Factors, including operation time, age, gender, body mass index, anesthesia method, and preoperative score of KSS were analyzed by Pearson correlation and multiple linear regression. These statistics method also was used to analyze the relationship between the postoperative 90 days score of KSS and postoperative VAS score at each time point. RESULTS AND CONCLUSION: (1) Pearson correlation analysis and multiple linear regression analysis showed that operation time, gender, and body mass index had been correlated positively with VAS score at 12, 24 and 48 hours postoperatively. (2) Patient age had been correlated negatively with VAS score at 12, 24 and 48 hours postoperatively. (3) VAS score at 12, 24 and 48 hours postoperatively had been correlated negatively with KSS score at 90 days postoperatively. (4) Gender, operation time, body mass index and age are all the influencing factors of the pain after total knee arthroplasty. Pain after total knee arthroplasty affects the recovery of knee function. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Impact of local compression cryotherapy combined with continuous passive motion on the early functional recovery after total knee arthroplasty   Wang Xian-xun 2017, 21 (7):  998-1003.  doi: 10.3969/j.issn.2095-4344.2017.07.003 Abstract ( 573 )   PDF (913KB) ( 644 )   Save BACKGROUND: Early rehabilitation training is beneficial for the functional recovery after total knee arthroplasty (TKA), and its effectiveness can be enhanced through ice compression that can partly alleviate the postoperative pain. OBJECTIVE: To explore the effect of local compression cryotherapy combined with continuous passive motion on the early functional recovery after TKA. METHODS: 106 patients undergoing TKA from February 2013 to February 2015 were enrolled, and randomly divided into observation and control groups (n=53 per group) according to the admission time and simple sampling. The control group was given continuous passive motion, while the observation group was subjected to local compression cryotherapy combined with continuous passive motion. The swelling degree, visual analogue scale scores, hospital for special knee surgery scores, and efficacy were compared between two groups. RESULTS AND CONCLUSION: (1) The swelling degree and visual analogue scale scores in the observation group were significantly lower than those in the control group at 24 and 48 hours after surgery (P < 0.01). (2) At 2 weeks after surgery, all indicators except muscle strength were significantly improved in both two groups (P < 0.05-0.01); the pain, function, activity, stability and total scores of hospital for special surgery knee scores in the observation group were significantly higher than those in the control group, and the reduction project scores were significantly lower than those in the control group (P < 0.05). (3) After followed up for 6 months, the excellent rate of knee joint function in the observation group was significantly higher than that in the control group (87% versus 70%, P < 0.05). (4) These results suggest that local compression cryotherapy combined with continuous passive motion can improve early pain and swelling degree, and promote the functional recovery after TKA. 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 two methods for reducing blood loss during total knee arthroplasty Lu Yao-jia, Xiong Chuan-zhi, Li Xiao-lei, Hu Han-sheng, Chen Gang, Wang Qiang, Lu Zhi-hua 2017, 21 (7):  1004-1008.  doi: 10.3969/j.issn.2095-4344.2017.07.004 Abstract ( 479 )   PDF (938KB) ( 221 )   Save BACKGROUND: Reducing blood loss could help to prevent the complications of total knee arthroplasty, relieve the swelling and discomfort postoperatively and accelerate the rehabilitation. OBJECTIVE: To explore the methods for reducing blood loss during total knee arthroplasty. METHODS:Totally 63 patients undergoing primary unilateral total knee arthroplasty were divided into two groups. Group 1 included 27 patients who received the conventional surgical techniques using tourniquet during the whole procedure with wound drainage, as control group. Group 2 included 36 patients who received the modified procedure only using tourniquet during prosthesis implantation without wound drainage, as experimental group. In the experimental group, we stitched the capsule closely. The preoperative and postoperative hemoglobin, decrease of hemoglobin, knee pain score, range of motion blood transfusion rate and wound healing were compared between the two groups.  RESULTS AND CONCLUSION: (1) There was no significant difference in preoperative hemoglobin between the two groups. At 1, 4 and 7 days postoperatively, the hemoglobins were significantly lower in the control group than in the experimental group, and the decreases of hemoglobins were significantly lower in the control group than in the experimental group. (2) Knee pain score was not significantly different between the two groups. (3) The range of motion of the knee was significantly larger in the experimental group than in the control group at 7 days. (4) Blood transfusion rate was 18.5% in the control group, and wound healing was poor in one patient. There was no transfused case and wound problem in the experimental group. All wounds were healed normally. (5) There was no infection or hematoma in two groups. (6) With the modified procedure, we could reduce blood loss during total knee arthroplasty without blood transfusion after surgery, which was helpful to postoperative rehabilitation.  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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Supercapsular percutaneously-assisted total hip approach for the elderly with femoral neck fractures: study protocol for a prospective, open-label, randomized, controlled clinical trial   Wu Liang-hao, Yu Bao-qing, Chen Fan-cheng 2017, 21 (7):  1009-1014.  doi: 10.3969/j.issn.2095-4344.2017.07.005 Abstract ( 415 )   PDF (1031KB) ( 388 )   Save BACKGROUND: Artificial hip replacement by the posterolateral approach is generally introduced as a treatment for femoral neck fracture in the elderly, but it is limited by the need for a large incision, cutting off the extortor, and postoperative hip dislocation. The supercapsular percutaneously-assisted total hip (SuperPATH) approach was developed based on the original lateral approach. The SuperPATH approach for hip replacement is characterized by the reduced chance of damaging blood vessels and nerves, reducing intraoperative blood loss, retaining all the joint capsules and supinator, and significantly reducing the incidence of postoperative hip dislocation. OBJECTIVE: We hypothesized that the SuperPATH approach for hip replacement can achieve better efficacy in the elderly with femoral neck fractures and promote the recovery of postoperative hip function compared with the posterolateral approach. METHODS/DESIGN: This is a prospective, single-center, open-label, randomized controlled clinical trial that will be completed at the Pudong Hospital of Fudan University, Shanghai, China. Forty patients with femoral neck fractures were randomly divided into two groups to undergo femoral head replacement by the SuperPATH approach in the experimental group, and by the conventional posterior approach in the control group. The follow-up period is 1 week and 6 months. The main outcome measures are Harris hip scores at baseline, and at 1 week and 6 months postoperatively to assess functional recovery of the hip. Secondary outcome measures to evaluate the advantages of the SuperPATH approach include the length of surgical incision, intraoperative blood loss, operative time, 24-hour postoperative drainage, and hospital stay. Other outcome measures include the incidence of adverse reactions at 1 week and 6 months after surgery. The study protocol was approved by the Ethics Committee of the Pudong Hospital of Fudan University, China, and 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. DISCUSSION: The aim of this trial is to test our hypothesis that the SuperPATH approach is safer and more reliable for hip functional recovery compared with the posterolateral approach for the artificial hip replacement in femoral neck fractures of the elderly.  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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Association between psychological resilience and acute mental disorders after total knee arthroplasty Yuan Wei, Zhao Hui, Ding Zhe-ru, Wu Yu-li, Wu Hai-shan, Qian Qi-rong 2017, 21 (7):  1015-1019.  doi: 10.3969/j.issn.2095-4344.2017.07.006 Abstract ( 499 )   PDF (995KB) ( 241 )   Save BACKGROUND: Postoperative acute mental disorders refer to patients without mental disorders suffer from neurological dysfunction after surgery. OBJECTIVE: To analyze the association between psychological resilience and postoperative acute mental disorders after total knee arthroplasty (TKA). METHODS: Convenience sampling, the Chinese Version of Connor and Davidson’s resilience scale (CD-RISC), was used to measure the levels of psychological resilience in 832 patients undergoing TKA. The questionnaire covered three dimensions: tenacity, self-improvement and optimism. The incidence of postoperative acute mental disorders was observed after operation. RESULTS AND CONCLUSION: (1) The CD-RISC scores of the patients with TKA surgery were (57.64±10.07), lower than the average scores of the elderly community in China. 20 (2.4%) patients had postoperative acute mental disorders. (2) Pearson correlation analysis demonstrated the negative correlation between the levels of resilience and the incidence of postoperative acute mental disorders (r= -2.43, P < 0.05). (3) Patients with lower psychological resilience levels had a higher incidence of postoperative acute mental disorders. Developing psychological resilience may become an important strategy to reduce the occurrence of postoperative acute mental disorders. 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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New bone fixation plate for the repair of avulsion fracture of the tibial attachment of the posterior cruciate ligament: study protocol for a prospective, open-label, self-controlled, clinical trial   Chen Guang-dong, Cao Tong-jun, Li Jian 2017, 21 (7):  1020-1024.  doi: 10.3969/j.issn.2095-4344.2017.07.007 Abstract ( 363 )   PDF (1131KB) ( 302 )   Save BACKGROUND: Avulsion fractures of the tibial attachment of the posterior cruciate ligament have been repaired using open reduction and rivet fixation, hollow screw fixation, or arthroscopic reconstruction of the posterior cruciate ligament. These methods ignore the importance of early tension reconstruction of the posterior cruciate ligament, so their efficacies are uncertain. Determining the optimal fixation method and how best to restore knee stability remain controversial. OBJECTIVE: To observe the stability of new bone fixation plate for the repair of avulsion fracture of the tibial attachment of the posterior cruciate ligament. METHODS/DESIGN: We will conduct a prospective, single-center, self-controlled, clinical trial at the Cangzhou Central Hospital, Hebei Province, China. Fracture fragments and the injured posterior cruciate ligament will be exposed in 20 patients with avulsion fracture of the tibial attachment of the posterior cruciate ligament through a posterior approach and open reduction. The posterior cruciate ligament will be reconstructed with a new type of bone plate. All patients will be followed for 3 and 12 months. Primary outcome: The Hospital for Special Surgery knee score will be used to evaluate knee function preoperatively and 3 and 12 months postoperatively. Secondary outcomes: Lysholm Knee Scoring Scale, X-ray, computed tomography, and magnetic resonance imaging will be used to assess knee morphology preoperatively and 3 and 12 months postoperatively. Patient satisfaction will also be assessed at 3 and 12 months postoperatively. The study protaol was registered at clinicaltrials.gov.NCT03059368. The study protocol has been approved by the Ethics Committee of Cangzhou Central Hospital of China. All protocols will be conducted in accordance with Declaration of Helsinki, formulated by the World Medical Association. Written informed consent will be provided by all participants. DISCUSSION: This trial will evaluate a newly-designed plate fixation device for early tension reconstruction of the posterior cruciate ligament to repair avulsion fractures of the tibial attachment of the posterior cruciate ligament and restore knee stability. This trial will verify the plate’s efficacy, provide an experimental basis for treating avulsion fractures of the tibial attachment of the posterior cruciate ligament, and provide a method of maximizing knee stability. 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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Acu-Loc®2 volar distal radius bone plate system for repairing type C fracture of distal radius    Chen Qun-qun, Qiao Rong-qin, Duan Rui-qi, Hu Nian-hong, Li Zhao, Shao Min 2017, 21 (7):  1025-1030.  doi: 10.3969/j.issn.2095-4344.2017.07.008 Abstract ( 664 )   PDF (1235KB) ( 276 )   Save BACKGROUND: Distal radius C fractures belong to multiple fractures in the joint. Its treatment should recover various angles and joint surface continuity outside the joint. The recovery of palmar tilt angle, radial inclination angle and radial height is also very important for treating distal radius. OBJECTIVE: To study the changes in palmar tilt angle, radial inclination angle and radial height after type C fractures of the distal radius repaired with Acu-Loc®2 VDR bone plate system. METHODS: From May 2015 to March 2016, 11 cases of type C distal radial fractures were treated with Acu-Loc®2 VDR bone plate system. Preoperatively, the palmar tilt angle was -31° to -4° (-12.45° on average), and the radial inclination angle was 6° to 18° (11.18° on average), and the radial height was 1.92 mm to 8.68 mm (5.28 mm on average). X-ray films were observed at postoperative 4, 8 and 12 weeks and half a year in all patients. Palmar tilt angle, radial inclination angle and radial height were measured and observed using anteroposterior and lateral X-ray films during final follow-up. Wrist function was assessed with Gartland-Werley score. RESULTS AND CONCLUSION: (1) 11 patients were followed and the postoperative follow-up ranged from 7 months to 15 months. X-ray films showed that the union of fractures was achieved in 6-8 weeks (6.5 weeks on average). No infection or internal fixation failure occurred. The articular facets were smooth in 10 patients and a little poor was found in 1 case (< 2 mm). (2) After operation, the palmar tilt angle was 8° to 15° (11.55° on average) (P < 0.05); the radial inclination angle was 22° to 27° (23.18° on average) (P < 0.05); the radial height was 8.01 mm to 13 mm (11.03 mm on average) (P < 0.05). (3) The results were excellent in 8 cases, good in 2 cases, and poor in 1 cases according to Gartland-Werley wrist function assessment; the excellent and good rate was 91%. (4) Acu-Loc®2 VDR bone plate fixation can provide reliable fixation and effective support for type C distal radius fractures, which can recover the palmar tilt angle, the radial inclination angle and the radial height, so the Acu-Loc®2 VDR bone plate is an ideal method to treat type C fractures of the distal radius.  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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A new low elastic modulus of beta titanium alloy Ti2448 spinal pedicle screw fixation affects thoracic stability: biomechanical analysis Huang Xiang-wang, Liu Hong-zhe 2017, 21 (7):  1031-1035.  doi: 10.3969/j.issn.2095-4344.2017.07.009 Abstract ( 486 )   PDF (858KB) ( 579 )   Save BACKGROUND: A new type of medical titanium alloy Ti2448 (Ti-24Nb-4Zr-7.9Sn) is by far the lowest initial modulus of titanium alloy, with the initial modulus of about 40 GPa, the average Young’s modulus < 20 GPa, and tensile strength of about 900 MPa; human tissue biocompatibility and mechanical compatibility are excellent. OBJECTIVE: To investigate the biomechanical properties of a new low elastic modulus spinal pedicle screw fixation system and compare it with Ti6Al4V pedicle screw. METHODS: Totally 60 fresh human cadaveric thoracic vertebrae were randomly selected: on one side, pedicle new low modulus Ti2448 pedicle screws, as the experimental group; on the other side, pedicle screw Ti6Al4V, as control group. The maximum bending load and maximum load displacement, maximum torque and maximum axial pulling force of the two groups were detected. RESULTS AND CONCLUSION: There was no significant difference in the maximum bending load, maximum load displacement, maximum torque and maximum pulling force between the two groups. The results show that the maximum bending strength, the maximum torque and maximum pullout force in low elastic modulus of Ti2448 pedicle screw fixation system are consistent with the Ti6Al4V screws, which can meet the needs of internal fixation on spinal biomechanics strength.   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 model for biomechanical analysis of stress in knee inversion and external rotation after posterior cruciate ligament rupture Xie Qiang 2017, 21 (7):  1036-1040.  doi: 10.3969/j.issn.2095-4344.2017.07.010 Abstract ( 442 )   PDF (762KB) ( 380 )   Save BACKGROUND: The incidence of posterior cruciate ligament injury combined with other knee ligament injuries is relatively high, but studies on the internal dynamic stress change of these ligaments are still rare. OBJECTIVE: To simulate three-dimensional finite element model of the normal human knee and the complete posterior cruciate ligament rupture (III injury), calculate and analyze the stress distribution and changes of the medial collateral ligament, the lateral collateral ligament and the anterior cruciate ligament in the normal knee model and the complete posterior cruciate ligament rupture model. METHODS: We collected CT and MRI images of the healthy male right knee, and established three-dimensional finite element model of the normal human knee by using E-feature Biomedical Modeler, and ANSYS software. The simulation of a flexion moment at 0°, 30°, 60°, varus/valgus and internal/external rotation torque was applied on the established three-dimensional finite element model of the normal knee. The stress of posterior cruciate ligament, lateral collateral ligament, anterior cruciate ligament and medial collateral ligament was analyzed. During simulation of complete posterior cruciate ligament rupture, the stress of lateral collateral ligament, anterior cruciate ligament and medial collateral ligament was analyzed. RESULTS AND CONCLUSION: Three-dimensional finite element biomechanical analysis data revealed that after posterior cruciate ligament rupture, the stress of lateral collateral ligament during inversion and external rotation of the knee joint obviously increased, but the stress of anterior cruciate ligament and medial collateral ligament slightly altered. These findings suggested that posterior cruciate ligament rupture may cause secondary injury to other ligaments of the knee joint, and further support the importance of the dynamic stability of the knee 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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Multilevel finite element analysis on the biological tribology damage of water on bone tissue   He Ze-dong, Zhao Jing, Chen Liang-yu, Li Ke, Weng Jie 2017, 21 (7):  1041-1045.  doi: 10.3969/j.issn.2095-4344.2017.07.011 Abstract ( 368 )   PDF (931KB) ( 324 )   Save BACKGROUND: Many studies reported the relationship of the mechanical properties and water content about bone tissue, which is one of organizations containing the lowest water content on human body. Researches on effect of water on biological tribology behavior of bone tissue have been rarely reported and are the experimental study generally. OBJECTIVE: To explore the influence and the damage mechanism of water on biological tribology behavior of bone tissue, by comparing multiscale numerical model established with the experiment.   METHODS: Dehydration of the bone tissue was studied by nanoindentation test and both reciprocating sliding and impact wear tests. A multi-scale finite element model was constructed under a flat-on-ball configuration. RESULTS AND CONCLUSION: The viscoelasticity and the tribological properties of bone tissue significantly decreased as well as the different wear mechanisms under applied loading after drying. The analytical results indicated that there were high stress condition, which incurred the micro-crack initiation and the appearance of peeling and wear, around the Haversian canal, circumferential lamellas and the interstitial tissues. Meso-scale: dehydration weakened the function of absorption and interruption of stress, which facilitated crack extension in pore. Micro-scale: the high stress gradient of structure of canaliculi and lacunae is an important cause of tissue damage.  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 reconstruction based on DICOM data and its application for orthopedic implants Li Jing, Yang Long, Wang Jian-ji, Liu Qin, Zou Qiang, Sun Yu, Ma Min-xian, Ye Chuan 2017, 21 (7):  1046-1051.  doi: 10.3969/j.issn.2095-4344.2017.07.012 Abstract ( 524 )   PDF (808KB) ( 809 )   Save BACKGROUND: The output of computed tomography (CT) is Digital Imaging and Communications in Medicine (DICOM), whereas the input of three-dimensional (3D) printing is an object Standard Template Library model represented by a triangular mesh. The process of data handing and forrmat conversion are keys to the combination of these two techniques. OBJECTIVE: To explore how to convert CT data into a stereoscopic 3D model efficiently. METHODS: The DICOM in Medicine format data of the patients with femoral fractures were edited and produced by Mimics. We made a 3D model by adjusting the parameters of the 3D printer slicing software, and discussed the significance of 3D model in medical field, especially orthopedics. RESULTS AND CONCLUSION: Mimics software is the bridge to connect two-dimensional CT scan images and 3D images, to create a 3D model by editing the data of DICOM which comes from the CT scanner, with a 3D printing technology. The 3D Model can help doctors for routine clinical diagnosis and treatment, to improve the communication between doctors and patients and the quality of clinical medical teaching. 3D printing also makes medicine more personalized, remote, minimally invasive, and promote the development of medicine to the direction of digital medicine. 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 finite element analysis of digital splint Jiang Zi-wei, Huang Feng, Cheng Si-yuan, Zheng Xiao-hui, Sun Shi-dong, Zhao Jing-tao, Cong Hai-chen,Sun Han-qiao, Dong Hang 2017, 21 (7):  1052-1056.  doi: 10.3969/j.issn.2095-4344.2017.07.013 Abstract ( 403 )   PDF (799KB) ( 303 )   Save BACKGROUND: Splint fixation was a common treatment for limb fracture, but there were some limitations, such as lack of individual difference, easy to lose and being unable to self-adjusting. OBJECTIVE: To explore the design method of digital splint and related finite element analysis. METHODS: Forearms were scanned with CT; periphery parameters were extracted, followed by reverse modeling and modifying. The digital splint models were constructed. Material attribute and mechanical loading were conducted. The limb length, maximum stress and displacement of the bone, soft tissue and splint were calculated by finite element analysis. RESULTS AND CONCLUSION: The digital splint has favorable tight attaching and balanced stress to skin, and which keeps well stability for the micro-motion fracture ends. Our study indicated that better tight attaching splint could be designed by digital modeling technology. Favorable fracture fixation and mechanical property could be also achieved. 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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Clinical efficacy of preoperative osteotomy designs using paper-cut technology versus photoshop software for ankylosing spondylitis with kyphosis Wang Fei, Liu Zhi-bin, Tao Hui-ren, Zhang Jian-hua, Li Chang-hong, Cao Qiang, Zheng Jun, Liu Yan-xiong, Qu Xiao-peng 2017, 21 (7):  1057-1063.  doi: 10.3969/j.issn.2095-4344.2017.07.014 Abstract ( 674 )   PDF (1105KB) ( 342 )   Save BACKGROUND: There are various kinds of design methods about preoperative osteotomy of ankylosing spondylitis with kyphosis, but each has their own errors and limitations. A convenient, precise and available method needs to be developed.  OBJECTIVE: To compare the clinical efficacy of two different preoperative osteotomy designs using paper-cut and photoshop software for ankylosing spondylitis with kyphosis. METHODS: Thirty-nine patients suffering ankylosing spondylitis with kyphosis undergoing osteotomy in the Department of Spinal Surgery, Affiliated Hospital of Yan’an University between June 2009 and January 2015 were enrolled, and randomly allotted to paper-cut (n=19) and photoshop (n=20) groups, followed by the preoperative osteotomy design, respectively. All patients were followed for 12-40 months to compare the postoperative osteotomy angle error and correction efficacy at the last follow-up between groups. RESULTS AND CONCLUSION: (1) The postoperative osteotomy angle error in the photoshop group was significantly smaller than that in the paper-cut group (P < 0.05). (2) At the last follow-up, the key parameters of sagittal spine and pelvis (sagittal vertical axis, Cobb angle and pelvic tilt) showed significant differences between groups (P < 0.05). (3) The Oswestry disability index and Scoliosis Research Society-22 questionnaire scores in the photoshop group were significantly superior to those in the paper-cut group at the last follow-up (P < 0.05), while the visual analog scale scores did not differ significantly between groups (P > 0.05). (4) To conclude, compared with the osteotomy design using traditional paper-cut splice, the photoshop software can achieve a smaller osteotomy angle error and better postoperative balance of spinal sagittal plane, thus providing precise osteotomy for surgeons to obtain proper correction. 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 anatomy of lumbar spinous process tilt angle of adults in northeast China: prodinding reference for pedicle screw insertion   Li Peng, Li Hong-wei, Wang Shuang, Wang Hai-zhou 2017, 21 (7):  1064-1068.  doi: 10.3969/j.issn.2095-4344.2017.07.015 Abstract ( 609 )   PDF (779KB) ( 232 )   Save BACKGROUND: Posterior lumbar fusion using pedicle screw-rod system fixation is the main surgical method for various lumbar diseases, and the accuracy of pedicle screw insertion is the key to success. Spinous processes are superficial in position, which serve as a anatomical landmark providing significant reference. OBJECTIVE: To analyze the anatomical classification of spinous process tilt of adult in northeast China, and to discuss the feasibility of it as the reference of anatomical landmark in pedicle screw fixation. METHODS: The tilt angle of spinous processes of 97 adults in northeast China was measured, and spinous processes of lumbar vertebrae were then classified. All subjects underwent simulative operation to determine the optimal insertion angle, measure the angle between pedicle screw and the spinous process, or standard sagittal plane for comparative analysis. RESULTS AND CONCLUSION: (1) The results were as follows: the distribution of type I was 75.1%, and 20.9% of type II, 2.3% of type III, 1.7% of type IV. Moreover, there were no significant differences in the angle between pedicle screw and the spinous process, or standard sagittal plane. (3) These findings suggest that lumbar spine angle varies in different individuals, which shouldbe defined through relative examinations. Additionally, spinous process can be a reference in pedicle screw inserting operation. 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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Establishment of a three-dimensional finite element model of ankylosing spondylitis kyphosis Li Hui, Ma Jun-yi, Ma Yuan, Zhu Xu 2017, 21 (7):  1069-1073.  doi: 10.3969/j.issn.2095-4344.2017.07.016 Abstract ( 368 )   PDF (729KB) ( 447 )   Save BACKGROUND: The full three-dimensional finite element model can not only establish a realistic three-dimensional model, but also can simulate the osteotomy on the model. Analysis of biomechanics guides the clinical operation. OBJECTIVE: To establish a three-dimensional finite element model of ankylosing spondylitis kyphosis and provide an effective digital platform for further studies. METHODS: A 30-year-old male patient with ankylosing spondylitis kyphosis participated voluntarily in the current study. CT images obtained from CT transverse scanning from C1 to the sacrococcyx were imported into Mimics 17.0 software to establish a three-dimensional geometric model of the posterior spine. The geometric model was then imported into Studio Geomagic 2013 software. For the subsequent optimization of image processing, the posterior spine convex geometry was established on the three-dimensional geometric model. We used Unigraphics NX 8.5 to establish the spinal kyphosis surface model, then added modeling of calcification of the ligaments, partial resection of useless sacral bone, and finally, imported the model into ANSYS 15.0 finite element analysis software, then added the ligaments and set the parameters of the material, generating a complete three-dimensional finite element model of ankylosing spondylitis. RESULTS AND CONCLUSION: A three-dimensional finite element model of complete ankylosing spondylitis was successfully established. Using the ten-node approach, we generated 398 370 tetrahedral elements, and 668 538 nodes. This will provide a reliable digital platform for the next step of biomechanical 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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Establishment of simulating three-dimensional model of China-Japan Friendship Hospital Classification for L type osteonecrosis of the femoral head Ling Guan-han, Ou Zhi-xue, Yao Lan, Wen Li-chun, Wang Guo-xiang, Lin Heng-feng 2017, 21 (7):  1074-1079.  doi: 10.3969/j.issn.2095-4344.2017.07.017 Abstract ( 453 )   PDF (845KB) ( 395 )   Save BACKGROUND: Anterior and lateral columns of the femoral head integrity and stability have been reported to present a positive correlation with the prognosis of the osteonecrosis of the femoral head (ONFH) and efficacy of hip preserving. China-Japan Friendship Hospital Classification stressed that the retention of the anterior and lateral columns of the femoral head was of great importance to avoid the femoral head collapse, but there is little reported on its three-dimensional (3D) digital model. OBJECTIVE: To explore the method of establishing highly-simulated 3D model of China-Japan Friendship Hospital Classification for ONFH. METHODS: 3D reconstruction of normal and necrotic femoral head was established according to the CT and MRI of individuals with normal femoral head. A healthy adult male volunteer was selected and his CT image was collected; three adult male patients with types L1, L2 and L3 ONFH were selected, whose MRI images were obtained, respectively. 3D solid models were established based on CT and MRI data on Mimics 15.0, Geomagic Studio 13, Geomagic Design X, Solidworks2014 and Abauqus6.14 software. RESULTS AND CONCLUSION: A highly-simulated 3D model of L type ONFH was established, including the cortical and cancellous bones of ilium and proximal femur, articular cartilage, necrotic articular cartilage, muscles, joint capsule and ligaments. It clearly showed the spatial structures of L type ONFH, by which different surgical programs could be compared in a virtual environment for selecting an appropriate treatment strategy to improve the success rate of hip preserving. The highly-simulated 3D model paves ways for surgical simulation and biomechanical 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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Collapsed femoral head measured by X-ray and CT before hip replacement: study protocol for a single-center, open-label and diagnostic trial   Qin Di, Shang Yong-wei, Li Hui-jie, Han Yong-tai 2017, 21 (7):  1080-1085.  doi: 10.3969/j.issn.2095-4344.2017.07.018 Abstract ( 519 )   PDF (923KB) ( 429 )   Save BACKGROUND: To determine the non- or collapsed osteonecrosis of the femoral head (ONFH) and degree of collapse, can help surgeons design reasonable treatment strategy for patients with ONFH. In China, articular cartilage collapse less than or greater than 2 mm, is a basis for choosing palliative surgery or hip replacement. However, the measurement of collapsed ONFH before replacement has not yet been confirmed. OBJECTIVE: To predict the collapse of femoral head before replacement by CT and X-ray examinations, and to compare with the intraoperative excised femoral head specimens. METHODS: This was a single-center, open-label and diagnostic trial, which was finished at the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China. Eighty-six patients with unilateral ONFH undergoing total hip replacement were recruited, and allocated into three groups, such as X-ray, CT and specimen groups. The X-ray group underwent X-ray examination at anteroposterior pelvic (bilateral hips) at 1 week before surgery, the CT group received CT scan at bilateral hips at 1 week before surgery, and the specimen group was subjected to the removal of affected femoral head, and then directly measured using ruler and vernier caliper. Primary outcome was the sensitivity of these three methods for measuring collapsed femoral head. Secondary outcomes were the specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of these three methods for the diagnosis of collapsed femoral head and the diagnostic accuracy; the diagnostic consistence of CT and X-ray examinations; the height of the lateral, middle and external femoral head measured by three methods. The study was approved by the Ethics Committee of the Third Hospital of Hebei Medical University, China, and 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: In this study, the height of femoral head was measured and analyzed in all-dimensional and multi-angle manner based on intraoperative removed specimens, so as to make an accurate prediction for collapsed femoral head, thus providing imaging reference for surgeons prior to choosing an appropriate operative scheme.   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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Assessing the degree of necrotic femoral head, and association of blood supply with pathlogical changes: study protocol for a diagnostic animal trial   Fu Wei-min, Wang Ben-jie 2017, 21 (7):  1086-1091.  doi: 10.3969/j.issn.2095-4344.2017.07.019 Abstract ( 513 )   PDF (976KB) ( 942 )   Save BACKGROUND: The imaging methods of evaluating the volume of necrotic femoral head are based on Kerboul angle and necrosis index revealed on X-ray, as well as CT and MRI three-dimensional reconstruction, but the accuracy of each method is different, and none is widely accepted. Additionally, the association of the volum and degree of necrotic femoral head with the status of blood supply to the femoral head remain unclear. OBJECTIVE: To evaluate the accuracy of each imaing method for assessing different stages of femoral head necrosis, and to confirm a convenient method used for measuring the volum of necrotic femoral head. METHODS: This diagnostic in vivo animal trial was finished in the Affiliated Zhongshan Hospital of Dalian University, Liaoning Province, China. The canine models of steroid-induced necrosis of femoral head were prepared, and received CT and MRI examinations, followed by three-dimensional reconstruction combined with Micro-CT to make accurate diagnosis; the degree of necrotic femoral head and its association with the status of blood supply were evaluated through angiography and histopathological examination. All above outcome measures were compared with the Association Research Circulation Osseous to testify the consistency of this precise method with traditional methods. The experiment follows the national guidelines for the Care and Use of Laboratory Animals, and “Consensus author guidelines on animal ethics and welfare” by the international Association for Veterinary Editors (IAVE). The article was prepared in accordance with the “Animal Research: Reporting of In Vivo Experiments Guidelines” (ARRIVE Guidelines). RESULTS AND CONCLUSION: The aim of the study is to obtain a accurate measurement method by detecting different stages of osteonecrosis using different imaging techniques, which enables surgeons make exact diagnosis and clinical stage of osteonecrosis, thus desiging standardized treatment program. 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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Morphological characteristics of hips in children with developmental dislocation of the hip: three-dimensional reconstruction of computed tomography scan Hao Yun, He Jin-peng 2017, 21 (7):  1092-1097.  doi: 10.3969/j.issn.2095-4344.2017.07.020 Abstract ( 438 )   PDF (782KB) ( 612 )   Save BACKGROUND: The development of hip joint in children with developmental dislocation of the hip (DDH) has been evaluated by X-ray plain film, which mainly presents Shen Tong’s line continuity and epiphyseal nucleus position. There is still a lack of quantitative and objective evaluation methods. OBJECTIVE: To evaluate the rotation center and dislocation degree in DDH children by using three-dimensional (3D) computed tomography (CT). METHODS: Preoperative 3D CT was performed for 16 unilateral DDH from December 2010 to December 2014 in Tongji Hospital of Huazhong University of Science and Technology, with 4 males and 12 females, at the mean age of (4.42±2.59) years. There were 10 cases on the left side and 6 cases on the right side. 3D digital models were constructed by analysis. The 3D coordinate system was established with reverse engineering software. In 3D coordinate system, using inverse solution method of sphere fitting engineering, the rotation center of the acetabulum, the rotational center of the femoral head, and the radius of ossification were constructed. Ossific radius ratio and dislocation length were calculated.  RESULTS AND CONCLUSION: (1) The acetabulum has the same point as the rotation center with the head of femur, and no significant difference in X, Y, and Z coordinates was detected (Px > 0.05, Py > 0.05, Pz > 0.05). However, it is not the same condition in ipsilateral acetabular rotation center and femoral head rotation center, showing significant differences (Px=0.052, Py < 0.05, Pz < 0.05). (2) There were no significant differences in ossific radius between the healthy and affected sides (P > 0.05). The ossific radius was (21.37±4.42) mm and (20.14±3.14) mm on the healthy and affected sides of the femoral head (P < 0.05). (3) There was no significant difference in ossific radius ratio between healthy and affected sides (0.544±0.069 and 0.522±0.088; P > 0.05). (4) The dislocation length was 8.64-35.28 mm, mean (19.47±7.84) mm. (5) These findings suggest that 3D CT reconstruction can construct 3D digital models of DDH children. Thus, the accurate rotation center of the hip can be identified so as to precisely measure the dislocation length.  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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Associations between alpha angle and herniation pit on oblique axial magnetic resonance imaging in asymptomatic hip joints of adults Zhang Wen-qiang, Ding Qian, Zhang Na 2017, 21 (7):  1098-1103.  doi: 10.3969/j.issn.2095-4344.2017.07.021 Abstract ( 690 )   PDF (881KB) ( 326 )   Save BACKGROUND: Recent studies have found that femoral neck angle α in patient with femoral neck hernial fossa increased significantly. However, whether the femoral neck hernia fossa can be used as imaging diagnostic indicator for femoroacetabular impingement syndrome remains controversial. OBJECTIVE: To evaluate the association between alpha angle and herniation pit in asymptomatic hip joints, influencing factors of the above indexes, and to provide evidence for the diagnosis of hip impingement syndrome. METHODS: Adults with asymptomatic hip joints from September 2013 to December 2015 were retrospectively studied. Alpha angles were measured on oblique axial MRI images. The incidence and size of herniation pit were determined by MRI. Size measures, prevalence, and statistical analyses were conducted regarding its association with age, gender, laterality (right or left hip). Intra- and inter-observer consistency was determined by intra-class correlation coefficient. RESULTS AND CONCLUSION: (1) 105 patients with asymptomatic hips were included, and 185 sides of hip MRI images were obtained. The range of age was 18-80 years old. The prevalence of herniation pit in asymptomatic hips was 21.6%. (2) The range of alpha angle was 27.6°–65.0°. Alpha angles of hip joints of 17 cases were ≥ 55°. (3) There was no association between alpha angle ≥ 55° and the size of herniation pit (P > 0.05). The prevalence of herniation pit was not correlated with age, gender and affected side (P=0.160, 0.157, 0.110). Inter-observer consistency of alpha angle was 0.523 between first measurements of first vs. second observer, respectively. Intra-observer consistency of alpha angle was 0.654, respectively. (4) There is no association between alpha angle ≥ 55 degrees and presence of herniation pit or demographic variables (age, gender and affected side). The presence of herniation pit and the increased alpha angle need to be interpreted with caution. Clinical symptoms and other examinations should be used in the diagnosis of hip impingement syndrome.  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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Morphological characteristics for the magnetic resonance imaging assessment of discoid lateral meniscal tears in children   Sun Xiao-xin1, Zhou Wei2, Zuo Shu-ping3, Liu Hao1, Song Jing-feng1, Liang Chun-yu1 2017, 21 (7):  1104-1109.  doi: 10.3969/j.issn.2095-4344.2017.07.022 Abstract ( 580 )   PDF (781KB) ( 268 )   Save BACKGROUND: Currently, the morphologic characteristics of the torn discoid lateral meniscus remain unclear, and morphological indexes used to evaluate the discoid lateral meniscus tears still need to be explored. OBJECTIVE: To discuss the specificity and sensitivity of discoid lateral meniscal tears in children using morphological indexes.  METHODS: Seventy-three patients (seventy-six knees) with torn discoid lateral meniscus underwent arthroscopy and MRI data of knee examinations were retrospectively reviewed. All MR images were double-blinded, independently, retrospectively analyzed by attending radiologist (doctor A) and sports physician (doctor B). The following morphological signs of discoid lateral meniscus, such as a internal displaced free edge sign, a hypertrophic free edge sign and a hypertrophied-horn sign, were selected to evaluate the discoid lateral meniscus tears. The likelihood of the discoid lateral meniscus tears was analyzed on basis of arthroscopic findings constituted the gold standard. Sensitivity, specificity and accuracy of MRI diagnosis of the discoid lateral meniscus tears by two physicians were calculated, and the consistency of diagnosis results by two physicians was evaluated using the Kappa statistics. RESULTS AND CONCLUSION: (1) The sensitivity, specificity and accuracy in the diagnosis of discoid lateral meniscus tears by internal displaced free edge sign for doctor A were 19%, 94% and 53%, respectively, and for doctor B were 21%, 97% and 55%. (2) The sensitivity, specificity and accuracy in the diagnosis of discoid lateral meniscus tears by hypertrophic free edge sign for doctor A were 52%, 100% and 74%, respectively, and for doctor B were 57%, 97% and 75%. (3) The sensitivity, specificity and accuracy in the diagnosis of discoid lateral meniscus tears by hypertrophied-horn sign for doctor A were 26%, 97% and 58%, respectively, and for doctor B were 24%, 100% and 58%. (4) The sensitivity, specificity and accuracy in the diagnosis of discoid lateral meniscus tears by binding morphological index for doctor A were 86%, 91% and 87%, respectively, and for doctor B were 88%, 94% and 91%. (5) The Kappa statistics for discoid lateral meniscus tears respectively demonstrated a good inter-observer agreement (K > 0.75, P < 0.001). (6) These findings suggest that single morphological index used to evaluate the discoid lateral meniscus tears shows a good specificity, but which also shows a low sensitivity, while a binding morphological index can significantly improve the diagnostic sensitivity. Morphological characteristics may be reliable indexes to evaluate the discoid lateral meniscal tears in children.    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 between the changes in lower limb power line and pain area in the knee osteoarthritis patients: imaging evaluation   Lin Han-wen, Wen Jun-mao, Huang Chao-yuan, Zhou Chi, Tang Hong-yu 2017, 21 (7):  1110-1114.  doi: 10.3969/j.issn.2095-4344.2017.07.023 Abstract ( 543 )   PDF (834KB) ( 1082 )   Save BACKGROUND: The change of the axial angle of the lower limb is related to the occurrence and development of osteoarthritis. OBJECTIVE: To analyze the correlation between the change of lower limb power line and pain area in the knee osteoarthritis patients. METHODS: Totally 65 knee osteoarthritis patients were selected as pain group and 30 healthy people were selected as control group. All the participants took anteroposterior and lateral knee radiographs through PACS imaging systems to collect six imaging indexes, including install index, the degree of tibiofemoral joint subluxation, tibiofemoral inside and outside joint clearance ratio, femoral angle, tibial angle and tibiofemoral angle. Knee osteoarthritis patients in pain group were divided into two common clinical pain areas which were proparea and medial area. RESULTS AND CONCLUSION: (1) The insall index, the degree of tibiofemoral joint subluxation, tibiofemoral inside and outside joint clearance ratio between knee osteoarthritis patients in pain group and people in healthy control group had significant differences. There was no statistical significance in the femoral angle, tibial angle and tibiofemoral angle. (2) In terms of the comparison between proparea and medial area in knee osteoarthritis patients in pain group, tibiofemoral joint subluxation degree was statistically different. (3) These findings suggest that there was a higher patella in knee osteoarthritis patients who were in pain, more severe in the degree of tibiofemoral joint subluxation, and more limited in tibiofemoral inside and outside joint clearance ratio. The degree of tibiofemoral joint subluxation of proparea was more severe than medial area in pain group. 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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Periprosthetic osteolysis induced by wear particles: research progress of calcineurin/activated T cell nuclear factor signaling pathway   Zhang Yun-ge, Song Ke-guan 2017, 21 (7):  1115-1122.  doi: 10.3969/j.issn.2095-4344.2017.07.024 Abstract ( 466 )   PDF (896KB) ( 592 )   Save BACKGROUND: Periprosthetic osteolysis and subsequent aseptic loosening are most common reasons for revision after total joint replacements. Recently studies found that calcineurin/activated T cell nuclear factor (CN/NFAT) signaling pathway plays important roles in the pathogenic process of wear-induced inflammation and osteolysis. OBJECTIVE: To summarize CN/NFAT effects on wear particles-induced osteolysis, and to provide new ideas and new theories for osteolysis-related diseases. METHODS: We retrieved PubMed for studies published from January 1980 to June 2016. The key words were “CN/NFAT, CN/NFAT signaling pathways, wear particles, osteolysis, osteoclasts, osteoblast”. Finally, 72 studies were analyzed and explored according to inclusion and exclusion criteria. RESULTS AND CONCLUSION: The pathogenesis of osteolysis involves the activation of macrophages by wear particles and the release of various proinflammatory cytokines. Bone is continuously renewed through a dynamic balance between bone resorption and formation and is the fundamental basis for maintaining normal bone mass and architecture by osteoclasts and osteoblasts. In this process, CN/NFAT signaling pathway is the signal transduction pathway involved in the differentiation of Ca2+ and nuclear factor kappa B receptor ligand. Osteoclasts play a significant role in both physiological and pathological bone resorption, and receptor activator of nuclear factor-κB ligand is the key cytokine that induces osteoclastogenesis. 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 research and progress of three-dimensional printing technology in joint replacement   Liu Wei, Huang Jian 2017, 21 (7):  1123-1130.  doi: 10.3969/j.issn.2095-4344.2017.07.025 Abstract ( 420 )   PDF (818KB) ( 685 )   Save BACKGROUND: Three-dimensional (3D) printing technology is a new rapid prototyping and rapid manufacturing technology. OBJECTIVE: Through the analysis of the related papers, the paper summarizes and discusses the research progress of 3D printing technology, the prospect of application in joint replacement and the status quo and development trend of 3D printing technology in joint replacement. METHODS: The relevant literature was retrieved by the first author with the China Journal Full-text Database (CNKI) and PubMed database from 1985 to 2015. The key words were “3D printing technology, rapid prototyping, arthroplasty, joint replacement”. The included 81 articles were analyzed. RESULTS AND CONCLUSION: Basic research and clinical application of 3D printing technology and joint replacement technology are becoming more and more popular. 3D printing further optimizes in the communication and teaching in joint replacement, and avoids intraoperative and postoperative complications. According to the needs of different teaching materials, 3D printing can print out different parts of the real body with different characteristics of print by 3D printer. The surgical simulation exercises with 3D limb printing different materials are the best way to improve the operation skills. 3D printing technology in the osteotomy guide precision has basically completed multicenter clinical trial, and toward to the clinical application of small scale stage. The construction of individualized treatment plan and the application of active biological organs by 3D printing technology will become the new research direction of joint replacement.    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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Status and role of three-dimensional printing technology in spine surgery   Liu Jian-kun, Deng Shu-cai 2017, 21 (7):  1131-1136.  doi: 10.3969/j.issn.2095-4344.2017.07.026 Abstract ( 684 )   PDF (771KB) ( 618 )   Save BACKGROUND: Spine has a variety of morphological structures and complicated adjacent location, so the surgery to treat spinal abnormality is a difficult. Three-dimensional (3D) printing technology can transform 3D digital model into physical model, which has been widely used in the field of medicine, even popularized gradually in spine surgery. OBJECTIVE: To summarize the application and status of 3D printing technology in spine surgery, and to make a prospect. METHODS: The first author retrieved CNKI, Baidu Xueshu, Google Scholar, WanFang and PubMed databases for the articles published from 2010 to 2016 using the keywords of “3D printing technology, spine surgery, navigation template, spine physical model, pedicle screw, individualized implants, clinical teaching” in Chinese and English, respectively. Finally 29 eligible literatures were enrolled for further analysis in accordance with the inclusion and exclusion criteria. RESULTS AND CONCLUSION: 3D printing technology has been extensively applied in spine surgery, and shows rapid development in preoperative diagnosis, intraoperative navigation, communication, teaching, graft production, implant customization, bone tissue engineering and other aspects. With the development of society, and medical imaging, 3D printing technology will be more promising in the field of medicine, especially in spine 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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Research progress of the influence of alcohol on the local microenvironment of femoral head Xi Li-cheng, Li Hong-yu 2017, 21 (7):  1137-1142.  doi: 10.3969/j.issn.2095-4344.2017.07.027 Abstract ( 452 )   PDF (1001KB) ( 389 )   Save BACKGROUND: The pathogenesis of alcoholic avascular necrosis remains unclear. OBJECTIVE: To introduce the physiological structure and pathologic changes induced by alcohol of the microenvironment of femoral head, and to review the research status of the influence of alcohol on the microenvironment of femoral head. METHODS: A computer-based online research of PubMed database for clinical and basic studyies concerning the effect alcohol on the microenvironment of femoral head published from 1990 to 2016. The pathological changes of alcoholic osteonecrosis of the femoral head were overviewed. RESULTS AND CONCLUSION: There are various theories about the pathogenesis of alcoholic osteonecrosis of the femoral head, but the essence is the disturbance of blood circulation in femoral head, and long-term decrease in the nutrients and oxygen supplying of bone leading to bone degeneration and necrosis. Large-dose intake of alcohol will induce the imbalance of oxidation and anti-oxidation system, which dose harm to the microenvironment of femoral head. The change of oxygen supplying accelerates the necrosis of femoral head, the weakened differentiation of bone marrow mesenchymal stem cells into osteoblasts and the disturbance of bone resorption-formation imbalance finally result in the necrosis and collapse of femoral head. It is expected to provide a new therapeutic strategy for delaying or preventing the early femoral head necrosis by controlling the microenvironment of femoral head. 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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Acetabular liner wear of cross-linked versus conventional polyethylene for total hip arthroplasty: a meta-analysis   Ye Xiang-yang, Sun Xiang, Tang Li-xin, Zhen Ping, Geng Bin, Wang Hua-lei, Zhao Yu-guo 2017, 21 (7):  1143-1148.  doi: 10.3969/j.issn.2095-4344.2017.07.028 Abstract ( 353 )   PDF (931KB) ( 629 )   Save BACKGROUND: Aseptic loosening occurs after long-term total hip replacement, which directly affects the service life and prospective efficacy of artificial joints. The particles produced by artificial joint wear lead to the surrounding bone dissolved, further cause loosening, among which, polyethylene particles because of acetabular liner wear stand out. OBJECTIVE: To systematically assess the acetabular liner wear, loosening and osteolysis caused by cross-linked polyethylene or conventional polyethylene after total hip arthroplasty. METHODS: A computer-based research of Medline, EMbase, CBM, CNKI, CqVip, WanFang databases before December 2015 and Cochrane (3rd issue, 2011) was performed in accordance with the retrieval strategy made by Cochrane collaboration. A manual retrieval of related bone journals and conference papers was conducted. Eleven randomized controlled trials about the wear caused by cross-linked polyethylene or conventional polyethylene after total hip arthroplasty were enrolled based on inclusion criteria, followed by a Meta-analysis using RevMan 5.0 software. RESULTS AND CONCLUSION: (1) Eleven randomized controlled trials involving 952 patients were included. (2) Meta-analysis showed that the acetabular liner wear rate of cross-linked polyethylene was significantly lower than that of conventional polyethylene at 5 years postoperatively [MD=-0.07, CI(-0.09, -0.05), I2=93%, P < 0.000 01]; the large heterogeneity was decreased [MD=-0.06, 95%CI (-0.07, -0.04), I2=39%, P < 0.000 01] after three research removed through sensitivity analysis. (3) The osteolysis rate in the cross-linked polyethylene group was significantly lower than that in the conventional polyethylene group [RR=0.39, 95%CI (0.27, 0.57), I2=0%, P < 0.000 01]. (4) These results suggest that the cross-linked polyethylene liners exhibit reduced radiological wear and osteolysis, but the mean follow-up of 5 years (1.8 to 8.0) cannot meet the long-term requirements. Therefore, multi-central, large sample size and high-quality randomized controlled trials are needed to testify the efficacy and safety of cross-linked polyethylene. 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