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18 December 2017, Volume 21 Issue 35 Previous Issue    Next Issue

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Unicompartmental knee arthroplasty used for advanced spontaneous osteonecrosis of the knee Feng En-hui, Mai Xiu-jun, Huang Yong-ming, Cao Zhen-wu, Chen Kang-yao, Su Hai-tao 2017, 21 (35):  5577-5582.  doi: 10.3969/j.issn.2095-4344.2017.35.001 Abstract ( 323 )   PDF (1552KB) ( 221 )   Save BACKGROUND: Unicompartment knee replacement is more popular for small trauma, rapid recovery, low less complications and almost normal knee mechanics, and has been used to repair unicompartmental knee diseases. At abroad, unicompartmental knee arthroplasty for advanced spontaneous osteonecrosis of knee (SONK) has obtained satisfactory outcomes, but its long-term efficacy and safety are not known in China. OBJECTIVE: To explore the short-term effectiveness of unicompartmental knee arthroplasty for advanced SONK. METHODS: Clinical data of 12 SONK patients (12 knees) admitted between January and August 2015 were analyzed retrospectively. Unicompartmental knee arthroplasty was operated by the same surgical team using the 3rd generation of Oxford® Unicompartmental Knee. The Visual Analogue Scale, femorotibial angle, range of motion of the knee and Hospital for Special Surgery scores were used to evaluate the curative efficacy at 3, 6, 12, and 18 months postoperatively. RESULTS AND CONCLUSION: (1) All patients were followed up for 12-18 months. The incision in all patients achieved primary union, and no infection, lower limb venous thrombosis or fracture occurred. (2) At the end of follow-up, the Visual Analogue Scale scores were significantly reduced from preoperative (6.67±0.78) to (1.75±0.97); the Hospital for Special Surgery scores were significantly increased from preoperative (63.92±7.27) to (91.67±2.87); the femorotibial angle changed from preoperative (178.28±3.38)° to (176.82±2.37)°(All P < 0.05). But the range of motion of the knee joint did not differ significantly before and after surgery. (3) That is to say, unicompartmental knee arthroplasty obtains satisfactory short-term efficacy in the treatment of advanced SONK.    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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Local application of different doses of tranexamic acid without drainage reduces blood loss after total knee arthroplasty   Duan Guo-qing, Ren Chun-feng 2017, 21 (35):  5583-5588.  doi: 10.3969/j.issn.2095-4344.2017.35.002 Abstract ( 414 )   PDF (1088KB) ( 275 )   Save BACKGROUND: Total knee arthroplasty (TKA) is an effective method for the end-stage knee osteoarthritis, which can obviously relieve pain and improve function. But a large amount of postoperative blood loss is a serious complication, how to reduce postoperative blood loss is still a difficulty. OBJECTIVE: To explore the efficacy of local application of different doses of tranexamic acid without drainage on the blood loss after TKA. METHODS: 150 patients with osteoarthritis who underwent TKA were randomly divided into three groups (n=50 per group). Group A received the intra-articular injection of tranexamic acid (2 g) plus 50 mL of normal saline; group B received the intra-articular injection of tranexamic acid (1 g) 50 mL of normal saline; group C received the intra-articular injection of 50 mL of normal saline. The drainage tube was not used in all patients. The number of hemoglobin, the number of patients undergoing blood transfusion, intraoperative blood loss, external blood loss, hidden blood loss, total blood loss and postoperative 3 hour-related blood coagulation indexes were recorded and compared among groups. Additionally, the incision infection and deep vein thrombosis were observed. RESULTS AND CONCLUSION: (1) The difference of hemoglobin among groups was significant (F=7.218-7.516, P=0.000). (2) The number of blood transfusion in the groups A, B and C was 2, 5 and 9, respectively, which had significant differences (χ2=25.753, P=0.000). (3) The intraoperative blood loss had no significant difference among groups (F=1.206, P=5.283). The difference in the postoperative external blood loss, postoperative hidden blood loss and total postoperative blood loss among groups was significant (F=14.389, P=0.000; F=7.158, P=0.009; F=6.752, P=0.012). Moreover, the hemostatic effect was in a dose-dependent manner. (4) There were no significant differences in the postoperative 3-hour-related blood coagulation indexes among groups (P > 0.05). (5) There was no deep vein thrombosis at 1 week postoperatively, and no deep vein thrombosis or pulmonary embolism occurred within postoperative 3 months in the three groups. (6) To conclude, topical application of tranexamic acid without drainage can significantly reduce perioperative blood loss, blood transfusion rate, and does not increase the incidence of complications, and the hemostatic effect is in a dose-dependent manner. 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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Short-term treatment outcome of the trabecular monoblock metal tibial components versus conventional cemented tibial components in total knee arthroplasty Li Guo-qing, Mohetaer•Momin, Ma Jun 2017, 21 (35):  5589-5594.  doi: 10.3969/j.issn.2095-4344.2017.35.003 Abstract ( 478 )   PDF (1192KB) ( 196 )   Save BACKGROUND: Porous tantalum metal has been recognized for its effective initial stability and superior bone consolidation in artificial hip/knee reversions. However, the application of the trabecular monoblock metal tibial components in the primary total knee arthroplasty (TKA) still remains controversial. Some scholars think that the non-bone cement fixation of TKA affects the life of prosthesis, and even the soft tissue is easy to be adhered with the porous metal, which results in the stiffness or pain of the knee joint after surgery. OBJECTIVE: To compare the short-term clinical efficacy of the trabecular monoblock metal and conventional cemented tibial components in TKA. METHODS: Fourteen patients undergoing unilateral TKA with trabecular monoblock metal tibial components non-bone cement porous tantalum tibial platform, and 14 patients with TKA using conventional cemented tibial components were enrolled. All patients suffered from advanced knee osteoarthritis, and were followed up for 1-3 years to correct the clinical and radiological data. RESULTS AND CONCLUSION: (1) No case underwent secondary surgery. (2) The clinical and function American Knee Society Score scales, the range of motion of the knee during flexion and extension, and femorotibial angle at last follow-up did not differ significantly between two groups (P > 0.05). (3) Radiological results revealed no aseptic loosening of the prosthesis, or subsidence and displacement of the tibial platform during follow-up. (4) These findings suggest that the application of trabecular monoblock metal tibial components in TKA can obtain similar clinical and radiological outcomes with the conventional cemented tibial components, but the long-term survival rate of the prosthesis still needs to be further explored.    中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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LINK fixed-bearing versus Oxford mobile-bearing unicompartmental knee arthroplasty for medial unicompartment knee osteoarthritis    Lu Ming-feng, Hu Guang-bing, Li Ze-hui, Cao Xue-wei 2017, 21 (35):  5595-5602.  doi: 10.3969/j.issn.2095-4344.2017.35.004 Abstract ( 645 )   PDF (2303KB) ( 284 )   Save  BACKGROUND: In the treatment of unicompartmental knee osteoarthritis, unicompartmental knee arthroplasty has the advantages of less blood loss, less trauma, quick recovery, maximum retention of bone mass, low cost, fewer complications and higher patient satisfaction. However, for the mobile bearing and the fixed bearing, the choice of single condylar prosthesis is till controversial. OBJECTIVE: To investigate the difference of LINK fixed-bearing and Oxford mobile-bearing unicompartment arthroplasty in relieving knee joint pain, reconstruction of the knee joint function, correct the knee joint deformity for medial unicompartment knee osteoarthritis, thus providing the basis for selecting a better prosthesis. METHODS: Ninety patients with medial unicompartment knee osteoarthritis undergoing unicompartmental knee arthroplasty in the Department of Joint Surgery, Guangdong Provincial Hospital of TCM from December 2014 to June 2016 were analyzed retrospectively, followed by allotted into Oxford mobile-bearing and LINK fixed-bearing groups (n=45 per group). The preoperative and postoperative pain level, range of motion of the knee, complications, and limb alignment were assessed. The range of motion and function of the knee were evaluated by Knee Society Score system. RESULTS AND CONCLUSION: (1) The two kinds of prosthesises both could obtain good clinical effectiveness. (2) There was no significant difference in the Knee Society Score, Visual Analogue Scale scores, or the range of motion of the knee between two groups (P > 0.05). (3) No complications such as deep vein thrombosis, prosthesis loosening and joint revision were found in both groups. (4) The correction of limb alignment showed significant difference between two groups (P < 0.05). The corrective femorotibial angle in the Oxford mobile-bearing group was larger than that in the LINK fixed-bearing group. (5) These findings manifest that under the precondition of strictly mastering the indications, both fixed-bearing and Oxford mobile-bearing unicompartment arthroplasties can effectively relieve the pain and improve the function of knee joint in the treatment of unicompartmental knee osteoarthritis. Oxford mobile-bearing prosthesis exhibits advantage in restoring the limb alignment; the movable platform lower limb alignment correction angle is often bigger than fixed platform correction angle, but may accelerate the lateral cartilage wear. 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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Unicompartmental knee arthroplasty for anterior-medial unicompartmental knee osteoarthritis: a 6-month follow-up   Su Jun, Sun Chang-ying, Lu Shi-jin, Chang Ting-jie 2017, 21 (35):  5603-5608.  doi: 10.3969/j.issn.2095-4344.2017.35.005 Abstract ( 405 )   PDF (5283KB) ( 225 )   Save BACKGROUND: Unicompartmental knee arthroplasty (UKA) has been widely applied in the treatment of anterior-medial osteoarthritis of the knee and is widely recognized as one of the most effective treatments. OBJECTIVE: To explore the short-term efficacy of UKA for anterior-medial unicompartmental knee osteoarthritis. METHODS: Clinical data of 42 patients (48 knees) with anterior-medial unicompartmental knee osteoarthritis undergoing UKA in Heping Hospital Affiliated to Changzhi Medical College from May 2014 to May 2016 were analyzed retrospectively. The preoperative and postoperative last follow-up Hospital for Special Surgery, the Knee Society Score, Western Ontario and Macmaster scores, as well as the range of motion of the knee were compared through clinic reexamination or telephones to evaluate the short-term efficacy. RESULTS AND CONCLUSION: (1) The follow-up time was 6-24 months. (2) The pain of the medial knee joint was relieved in different degrees, and there were significant differences in the Hospital for Special Surgery, the Knee Society Score, Western Ontario and Macmaster scores, as well as the range of motion of the knee between preoperation and postoperation (P < 0.05). (3) No lower limb deep vein thrombosis, pulmonary embolism, infection, meniscus dislocation or prosthesis loosening occurred. (4) To conclude, UKA exhibits less trauma, rapid recovery and less complications in the treatment of anterior-medial unicompartmental knee osteoarthritis, which obtains good short-term efficacy, and its long-term efficacy needs to be studied in depth. 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 body mass index and serum lipid levels in blood management of arthroplasty in elderly patients   Yan Jian-feng, Li Qiang, Yang Zong-hua 2017, 21 (35):  5609-5615.  doi: 10.3969/j.issn.2095-4344.2017.35.006 Abstract ( 312 )   PDF (1207KB) ( 189 )   Save BACKGROUND: At present, the number of patients with arthroplasty is increasing year by year. The perioperative hemorrhage is the short-term complication, which severely affects the patient’s prognosis and increasing the risk for other complications. More blood transfusions or hemostasis measures are included in the perioperative blood management programs, but with different effects and adverse reactions. OBJECTIVE: To analyze the relationship of body mass index (BMI) and blood lipid level with blood transfusion rate in the perioperative period of arthroplasty and provide evidence for perioperative blood transfusion management of total knee arthroplasty. METHODS: The patients undergoing total hip arthroplasty or total knee arthroplasty at the Changshu No. 2 People’s Hospital from 2011 to 2015 were recruited in accordance with the exclusion and inclusion criteria. The basic data of the participants were collected, and all patients accepted arthroplaties. The blood transfusion rate, pre-estimated blood loss, and percentage of blood loss and postoperative complications were recorded and analyzed; the BMI and blood lipid levels were recorded. Correlation analysis and regression analysis were conducted by the statistical software. RESULTS AND CONCLUSION: (1) Totally 513 patients were included in the study, with the mean age of (76.1±9.2) years old, 124 cases in normal BMI group, 229 cases in overweight group, and 160 cases in obesity group. (2) The blood transfusion rate showed significant difference among groups (P=0.002, P=0.002). There were significant differences in the blood loss and percentage of blood loss among groups (All P=0.001), suggesting that with BMI increasing, there was a decrease in blood transfusion rate and percentage of blood loss, and a increase in total blood loss. (3) The incidence of deep infection of the incision was correlated with BMI (P=0.043), and the incidence of other complications was not related to BMI. (4) In the total hip arthropalsty, the total cholesterol level was negatively related to the blood transfusion rate and percentage of blood loss (r=-0.278, P=0.021; r=-0.329, P=0.034), and the triglyceride level was negatively related to the blood transfusion rate (r=-0.449, P=0.014). In the total knee arthroplasty, the total cholesterol level was negatively related to the blood transfusion rate and percentage of blood loss (r=-0.341, P=0.006; r=-0.489, P=0.017). (5) For the blood transfusion rate in the total hip arthroplasty, BMI, total cholesterol and triglyceride levels were the protective factors, and in the total knee arthroplasty, the protective factors were BMI and total cholesterol level. (6) In summary, the blood transfusion rate is negatively related to the BMI, total cholesterol and triglyceride levels in patients undergoing total hip or knee arthroplasty. Patients with higher BMI have a higher total blood loss, lower percentage of blood loss and higher incidence of postoperative deep infection. The above indexes can be used as predictive indexes for the perioperative blood management in joint 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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Vertebral fixation with minimally invasive HXN pedicle screw system for thoracolumbar fractures Wang Jing-yu, Dong Yu-zhen, An Yong-bo, Cui Ming-xing, Li Qing-jiang 2017, 21 (35):  5616-5621.  doi: 10.3969/j.issn.2095-4344.2017.35.007 Abstract ( 379 )   PDF (1272KB) ( 208 )   Save BACKGROUND: Open reduction and internal fixation have been used to treat thoracolumbar fractures, which possesses good efficacy, but causes large trauma and many complications. Minimally invasive treatment like Wiltse operative approach and Sextant, Zina system also has many defects such as large incision, insufficient fixed strength, limited orthopedic forces. OBJECTIVE: To access the effect of vertebral fixation with HXN pedicle screw system in the treatment of thoracolumbar fractures. METHODS: Totally 68 cases of thoracolumbar fractures admitted in the Department of Orthopedics, the First Affiliated Hospital of Xinxiang Medical University from October 2014 to December 2016 were randomly divided into two groups: the patients in group A received minimally invasive pedicle screw fixation with HXN system and those in group B were subjected to open reduction and internal fixation. The perioperative indexes (blood loss), Visual Analogue Scale scores, Oswestry Disability Index, anterior vertebral height, and Cobb angle were detected to compare the curative efficacy between two groups. RESULTS AND CONCLUSION: (1) All patients were followed up for 3-24 months. (2) There were no significant differences in the operation time, intraoperative fluoroscopy times between two groups (P > 0.05), and the blood loss in the group B was significantly more than that in the group A (P < 0.05). (3) The preoperative Visual Analogue Scale and Oswestry Disability Index scores showed no significant differences between two groups (P > 0.05), and the postoperative and last follow-up scores were significantly decreased (P < 0.05), but the group A had lower scores than those in the group B (P < 0.05). (4) The anterior vertebral height and Cobb angle were significantly improved postoperatively (P < 0.05); at the last follow-up, both indexes had no obvious loss and showed no significant difference between two groups (P > 0.05). (5) The incision healed well in the group A, while there were two cases of incision infection in the group B. No screw loosening, displacement or rupture occurred during follow-up. (6) These results suggest that the minimally invasive HXN pedicle screw system for thoracolumbar fracture not only has the advantages of fewer traumas, less blood loss, low incidence of incision infection, pain relief, but also is safe and easy to operate, which obtains good fixation stability and can achieve the same curative effect with the open 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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Determination of thoracic pedicle screw parameters by superior facet in normal adults: an imaging study Lu Zheng-hao, Li Ji-peng, Zhou Jing-hua, Wang Wei-guo 2017, 21 (35):  5622-5629.  doi: 10.3969/j.issn.2095-4344.2017.35.008 Abstract ( 377 )   PDF (1408KB) ( 208 )   Save BACKGROUND: In the existing thoracic pedicle screw fixation technique, superior facet or combined with transverse process and the imaginary transverse and sagittal section are used as the reference mark of pedicle screw entry point and angle, respectively, which still remain controversial. Because of the effect of position deviation and subjective judgment during surgery, screw misplacement and severe complications often occur, which limit the clinical application and promotion of the technique. At present, it is very important to select a single bony mark, which is not affected by the patient’s position, and is easy to judge, as the reference mark of screw entry point and angle. OBJECTIVE: To explore the feasibility of taking superior facet as a single bony mark to determine thoracic pedicle screw parameters in normal adults by measuring 3D reconstruction CT image and it’s corresponding relationships. METHODS: 3D reconstruction CT images of the thoracic spine in 30 normal adults were selected and the basic parameters, entry angle parameters and entry depth parameters were directly determined on specific reconstructed CT images of T1-T12.The basic parameters included the vertical distance from the entry point to the midline, the vertical distance from the outer edge of superior facet to the midline and superior facet base width. Entry point parameters were indirectly calculated by the basic parameters, including transversal point-facet distance, entry point ratio and sagittal point-facet distance, which was the horizontal distance from entry point to outer edge of superior facet, the ratio of transversal point-facet distance to superior facet base width, and the longitudinal distance from entry point to the base of superior facet. Entry angle parameters included transversal axis-facet angle and sagittal axis-facet angle, which is the transversal and sagittal angle between the axis of pedicle and the surface of facet. Entry depth parameter included safety screw length, which is the distance from entry point to anterior vertebral cortex along the axis of pedicle. Mean and standard deviation were counted and statistics difference was compared.  RESULTS AND CONCLUSION: (1) Using CT technology of 3D reconstruction, T1-T12 thoracic transversal section through bilateral pedicle axis, transversal section through the base of the superior facet, which parallel to the bilateral pedicle axis, and oblique sagittal section through homolateral pedicle axis were successfully obtained. (2) The statistical results of the basic parameters were as follows: the left and right vertical distances between T1-T12 from the entry point to the midline were (14.6±2.6) and (14.5±2.5) mm, the vertical distance from the outer edge of superior facet to the midline were (15.7±1.9) and (15.7±2.0) mm, and superior facet base width were (8.8±1.3) mm and (8.8±1.1) mm, respectively. There was no significant difference in the measured values between two sides of the above parameters (P=0.343, 0.214, 0.467). (3) The statistical results of pedicle screw parameters were as follows: the left and right transversal point-facet distance between T1-T12 were (1.2±1.3) and (1.3±1.4) mm, entry point ratio were (14.3±17.0)% and (13.6±16.1)%, sagittal point-facet distance were (3.4±0.8) and (3.3±0.9) mm, transversal axis-facet angle were (92.4±4.7)° and (92.6±5.0)°, sagittal axis-facet angle were (91.8±4.1)° and (91.7±3.6)°, and safe screw length were (40.7±4.8) and (40.4±4.6) mm, respectively. There was no significant difference in the measured values between two sides of the above parameters (P=0.073, 0.084, 0.310, 0.265, 0.241, 0.175). (4) These results indicate that taking thoracic superior facet as a single anatomic landmark to determine pedicle screw parameters is simple and feasible in normal adults, and they correlate with each other, which can be used as a new method for choosing screw parameters. 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 the dynamic stabilization using Bioflex System on the intervertebral height in young patient with single-level lumbar disc herniation Feng Hua-long, He Sheng-hua, Lai Ju-yi, Huang Fei-qiang 2017, 21 (35):  5630-5635.  doi: 10.3969/j.issn.2095-4344.2017.35.009 Abstract ( 252 )   PDF (1339KB) ( 218 )   Save BACKGROUND: The age of patients with lumbar disc herniation tends to younger, and choosing which surgical method for young patients is a difficult in clinic. OBJECTIVE: To investigate the curative efficacy and imaging characteristics of the dynamic stabilization using Bioflex System for young patients with single-level lumbar disc herniation. METHODS: Eighty patients diagnosed for single level lumbar disc herniation in Shenzhen Hospital of Chinese Medicine from October 2013 to November 2015 were randomly divided into experimental and control groups (n=40 per group). The patients in the experimental group underwent dynamic stabilization using Bioflex System, and the controls received percutaneous transthoracic discectomy. The Visual Analogue Scale and Japanese Orthopedic Association scores and Oswestry Disability Index were used to evaluate the clinical efficacy. The ventral and dorsal intervertebral disc height, distance between spinous processes, and the maximum height between intervertebral foramens were measured through digital radiography, CT and MRI examinations at baseline, 3, 6, and 12 months of follow-up. The operation time, intraoperative blood loss and complications were compared between groups. RESULTS AND CONCLUSION: (1) At 12 months postoperatively, the restoration of the ventral and dorsal intervertebral disc height, distance between spinous processes, and the maximum height between intervertebral foramens in the experimental group were significantly superior to those in the control group (P < 0.05). (2) The Visual Analogue Scale and Japanese Orthopedic Association scores and Oswestry Disability Index scores were significantly improved in both groups (P < 0.05); all above scores did not differ significantly between two groups at 3 and 6 months postoperatively (P > 0.05); and all above scores in the experimental group were significantly superior to those in the control group at 12 months postoperatively (P < 0.05). (3) The operation time and intraoperative blood loss in the experimental group were significantly lower than those in the control group (P < 0.05). (4) There were no significant differences in the incidence of complications between two groups (P > 0.05). (5) These results show that although percutaneous transthoracic discectomy has advantages on the operation time and intraoperative blood loss; the two surgical methods show no significant differences in the early curative efficacy and complications. Besides, in terms of long-term efficacy, Bioflex System can significantly alleviate pain, restore intervertebral height, and prevent degeneration of the intervertebral disc and adjacent vertebrae. 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 fixation combined with intervertebral fusion for lumbar spondylolithesis: whether restoring disc height affects the biomechanics and spinal function Wang Li, Qiu Nan-hai, Yu Ming 2017, 21 (35):  5636-5643.  doi: 10.3969/j.issn.2095-4344.2017.35.010 Abstract ( 394 )   PDF (1544KB) ( 198 )   Save BACKGROUND: According to the current most prevailed posterior pedicle screw reduction and Cage fusion for spondylolisthesis, the previous focus is to restore the vertebral sagittal displacement, and whether restoring disc height is needed and the degree of recovery remain unclear. Moreover, there is still a lack of better quantitative indicators to restore the disc height. OBEJCTIVE: By comparing the surgery of lifting reduction, to study the clinical effect of distraction and lifting reduction combined with posterior intervertebral fusion in the treatment of lumbar spondylolisthesis. METHODS: Sixty patients with L5 spondylolisthesis located in L5/S1 were selected, and were divided into two groups based on the surgery methods (n=30 per group): group A (single lifting reduction group) and group B (lifting and distracting reduction group). The patients in the group B were given distracting reduction amid insertion of 12 mm-height Cage; while the patients in the group A were subjected to lifting reduction, and intervertebral fusion with 8 mm-height Cage. The general information and the Visual Analogue Scale, Japanese Orthopaedic Association and Oswestry Disability Index scores at baseline, postoperative 1 month and last follow-up, as well as the postoperative correction and bone fusion were recorded. Additionally, the clinical effectiveness was assessed by Macnab score. RESULTS AND CONCLUSION: (1) At postoperative 1 month and last follow-up, the disc height, disc height/vertebral height, neuroforamen height and clinical effectiveness in the group B were superior to those in the group A (P < 0.05). (2) To conclude, the pedicle screw system combined with posterior intervertebral cage fusion for spondylolisthesis, can rapidly restore the disc height, contribute to restructure better biomechanics of spine. Furthermore, it significantly improves clinical systems, is easy to operate, and achieves better efficacy; therefore, it is recommended firstly.  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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Efficacy and safety of a digital navigation template combined with cervical pedicle screw implantation: study protocol for a prospective, single-center, self-controlled, clinical trial   Wei Wei, Xing Long-yan, Jiao Jia-xun, Zhao Lei, Lu Ai-qing 2017, 21 (35):  5644-5648.  doi: 10.3969/j.issn.2095-4344.2017.35.011 Abstract ( 363 )   PDF (1043KB) ( 232 )   Save BACKGROUND: Cervical pedicle screw fixation is a reliable method for the treatment of traumatic and non-traumatic cervical instability and cervical disc removal and fixation; however, the operation risks and the failure rate of screw insertion are still high. At present, the digital navigation template with digital computer technology, used in the department of orthopedics, has the advantages of accurate screw insertion and a small error in the screw insertion depth. OBJECTIVE: To observe the clinical efficacy and safety of the digital navigation template combined with cervical pedicle screw implantation. METHODS: This is a prospective, single-center, self-controlled, clinical trial. Thirty-two patients with cervical spondylosis will be recruited from the Harrison International Peace Hospital, Hebei Province, China. Before surgery, a three-dimensional (3D) navigation model of the cervical vertebrae will be designed by 3D reconstruction. The navigation template will be generated by 3D printing. The cervical pedicle screws will be implanted according to preoperatively designed models and the screw positions will be observed by computerized tomography (CT) after surgery. The patients will be followed up for 40 months. The primary outcome measure is the excellent and good rate of screw position 40 months after implantation. The secondary outcome measures include the Visual Analog Scale score, American Spinal Injury Association classification, cervical X-ray and CT images before implantation and 40 months after implantation, and the incidence of adverse reactions 40 months after implantation. The protocols have been approved by the Ethics Committee of the Harrison International Peace Hospital in China (approval number: 20120630). The study protocol has been conducted in accordance with the Declaration of Helsinki, formulated by the World Medical Association. Written informed consent will be obtained from all participants. The recruitment of subjects will begin in December 2017. Samples and data will be collected from December 2017 to April 2019. Outcome measures will be analyzed in October 2020. This trial will be completed in November 2020. The results of the trial will be reported in a scientific conference or disseminated in a peer-reviewed journal. This trial has been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR-ONC-17013481). DISCUSSION: We will verify a high success rate of cervical pedicle screw implantation using the digital navigation template. The operation is simple and quick, with good efficacy and safety. Figures and Tables | References | Related Articles | Metrics

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Minimally invasive percutaneous fixation with cannulated compression screw for young patients with femoral neck fracture   Wang Yong-an, Yu Bao-qing, Zhou Jian-hua, Ao Rong-guang, Qu Wei 2017, 21 (35):  5649-5654.  doi: 10.3969/j.issn.2095-4344.2017.35.012 Abstract ( 368 )   PDF (2532KB) ( 209 )   Save BACKGROUND: Screw fixation is mainly used in the treatment of femoral neck fractures in the youth; therefore, how to reduce surgical trauma, retain sufficient blood supply and reduce postoperative complications becomes so important. OBJECTIVE: To study the efficacy of minimal invasive percutaneous fixation with cannulated compression screws for young patients with femoral neck fracture and its impact on the length of bilateral lower limbs and hip joint function. METHODS: Thirty patients with femoral neck fracture admitted in the Shanghai Pudong Hospital Affiliated to Fudan University from January 2009 to December 2012, were selected as experimental group, followed by subjected to minimal invasive percutaneous traction bed-assisted closed reduction with cannulated compression screws. Meanwhile, 28 cases of femoral neck fracture admitted from January 2006 to December 2009, were given open reduction with square muscle grafting and cannulated screw fixation (control group). The efficacy, intraoperative blood loss, operation time, hospital stay, fracture healing time and incidence of complications were observed. Additionally, the length of bilateral lower limbs and Harris hip scores at 3 months and 1 year postoperatively were compared between two groups. RESULTS AND CONCLUSION: (1) All patients were followed up for 24-60 months. (2) The excellent and good rate in the experimental and control groups was 90% and 93%, respectively, which showed no significant difference between two groups (χ2=0.007, P > 0.05). (3) The intraoperative blood loss, operation time, and hospital stay in the experimental group were significantly less than those in the control group (P < 0.01); while, the fracture healing time, incidence of complications as well as length of bilateral lower limbs and Harris hip scores at 3 months and 1 year postoperatively did not differ significantly between two groups (P > 0.01). (4) These results suggest that the minimal invasive percutaneous fixation with cannulated compression screws applied in the treatment of young patients with femoral neck fracture exhibits satisfactory efficacy, good reduction, less trauma and rapid postoperative recovery, which is available for all types of young femoral neck fracture.   中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Arthroscopic treatment with canulated screw fixation through very high-posteromedial portal approach versus double bundle suture fixation for avulsion fracture of tibial attachment of posterior cruciate ligament Wang Xin-min, Liu Fei, Zhao Hai-xia, Wang Wei, Wang Jian-quan 2017, 21 (35):  5655-5660.  doi: 10.3969/j.issn.2095-4344.2017.35.013 Abstract ( 397 )   PDF (1210KB) ( 225 )   Save BACKGROUND: This team modified the arthroscopic reduction and internal fixation with canulated screw through very high-posteromedial portal approach to perform direct compression. Thus, the pressure of the fracture block is evenly distributed on the healing line, and the operation is convenient and fixed firmly, but its clinical effect remains to be further confirmed. OBJECTIVE: To compare the clinical outcome of arthroscopic reduction and internal fixation with canulated screw through very high-posteromedial portal approach and double bundle suture fixation for avulsion fracture of the tibial attachment of posterior cruciate ligament. METHODS: From January 2011 to May 2017, 60 cases of the avulsion fracture of posterior cruciate ligament (transverse diameter of fracture block > 10 mm) were treated operatively at the Orthopedics and Arthroscopic Ward Two, First Hospital of Qinhuangdao, China. According to different modes of operation in different periods, patients were assigned to two groups. In the canulated screw group (n=31), patients were treated with canulated screw through very high- posteromedial portal approach. In the suture group (n=29), patients were treated with double bundle suture fixation through posteromedial portal approach. General conditions were compared between the two groups. Knee function was assessed with the Intemational Knee Documentation Committee and Lysholm scores. Knee stability was evaluated with KT-2000 and posterior drawer test. RESULTS AND CONCLUSION: (1) All the patients were followed up (range 6-12 months). (2) The average operation time was (63.49±3.97) minutes in the canulated screw group and (87.28±3.46) minutes in the suture group (P < 0.05). At 3 months after surgery, all the patients were healed. (3) At the final follow-up, in the canulated screw group, the negative rate of posterior drawer test was 90%. Lysholm scores were 94.89±4.75. IKDC scores were 94.01±3.25. In the suture group, the negative rate of posterior drawer test was 90%. Lysholm scores were 95.56±3.63. IKDC scores were 95.52±4.72. No significant difference was determined between the two groups (P > 0.05). (4) KT-2000 measurement results revealed that there were no significant differences between the surgical knee and the normal knee in both groups (canulated screw group: (2.53±1.02) mm versus (2.12±0.83) mm; suture group: (2.65±0.82) mm versus (2.19±0.63) mm (P > 0.05). Moreover, no significant difference was detected in the affected knee of KT-2000 results between the two groups. (5) Both arthroscopic reduction with canulated screw through very high-posteromedial portal approach and double bundle suture fixation can achieve satisfactory clinical outcomes, but arthroscopic reduction with canulated screw through very high-posteromedial portal approach in patients with fracture block diameter > 10 mm can result in shorter operation time, more reliable fixation, and thus permit an early postoperative functional exercise. 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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Efficacy and safety of longitudinal approach versus tarsal sinus approach for treating displaced intra-articular calcaneal fractures Zhang Bin, Yang Xiao-fei, Yang Zhi-gang, Chen Jing, Hua Jiao, Yuan Feng-lai 2017, 21 (35):  5661-5667.  doi: 10.3969/j.issn.2095-4344.2017.35.014 Abstract ( 431 )   PDF (1175KB) ( 203 )   Save BACKGROUND: The key point of the displaced intra-articular calcaneal fractures is to accurately and effectively reset the intra-articular calcaneal fractures and effectively reduce the incidence of incision-related complications. Currently, the minimally invasive approach has been widely used in the treatment of calcaneal fractures. OBJECTIVE: To compare the clinical outcomes and safety of minimally invasive longitudinal approach and minimally invasive tarsal sinus approach for displaced intra-articular calcaneal fractures. METHODS: A prospective, single center, open-label, randomized, controlled clinical trial is conducted. 200 patients with displaced intra-articular calcaneal fractures will be randomly divided into minimally invasive approach group and tarsal sinus approach group, with 100 cases in each group, and treated with minimally invasive longitudinal approach and tarsal sinus approach repair, respectively. Follow-up time will be 5 weeks, 4, 8, 12, 36 months after surgery. The primary outcome is the excellent and good rate of American Orthopaedic Foot and Ankle Society score at 5 weeks, 4, 8, 12 and 36 months after operation. Secondary outcomes are operative time, CT and X-ray images preoperatively and 5 weeks, 4, 8, 12, 36 months postoperatively at the injury site, and the incidence of adverse reactions 5 weeks, 4, 8, 12, 36 months postoperatively. The trial has been approved by Ethics Committee of Wuxi Third People's Hospital. The study is in line with the Declaration of Helsinki developed by the World Medical Association. Participants will be informed and sign consent for the protocol and procedure. Trial ethics approval [Approved by: Wuxi Third People's Hospital, Approval No. 20140402-2] was conducted in April 2014. The sample and data collection will be from January 2018 to October 2019, and the indicator analysis time and test completion time will be December 2019. The results will be reported in scientific meetings or published in peer-reviewed journals. The trial has registered in China Clinical Trial Register (registration number: ChiCTR-IOR-17013697). DISCUSSION: The trial will compare minimally invasive tarsal sinus approach and minimally invasive longitudinal approach for the treatment of displaced intra-articular calcaneal fractures to clarify the characteristics and clinical application range of the two minimally invasive techniques.  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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Modified minimally invasive internal fixation with cannulated screws through tarsal sinus versus traditional extended lateral “L-shape” incision with plate fixation for calcaneal fractures Huang Sheng, Shen Peng-cheng, Xu Hao, Zhu Li-fan, Weng Feng-biao, Hou Qing-fan 2017, 21 (35):  5668-5672.  doi: 10.3969/j.issn.2095-4344.2017.35.015 Abstract ( 377 )   PDF (1119KB) ( 235 )   Save BACKGROUND: Open reduction and internal fixation is commonest surgical method for calcaneal fractures, but its postoperative complications are troublesome. Thereafter, choosing an appropriate treatment scheme is of great significance for reducing postoperative complications and promoting patients’ functional recovery. OBJECTIVE: To compare the curative efficacy of the modified minimally invasive internal fixation with cannulated screws through tarsal sinus and traditional extended lateral “L-shape” incision with plate fixation for calcaneal fractures. METHODS: Sixty-eight cases of unilateral calcaneal fractures (Sanders II and III) were selected, followed by treated with modified minimally invasive internal fixation with cannulated screws through tarsal sinus (modified group, n=33) or traditional extended lateral “L-shape” incision with plate fixation (traditional group, n=35). The operation time, blood loss, and Visual Analogue Scale scores were compared between two groups; the preoperarive and postoperative American Orthopedic Foot and Ankle Society scores, Bohler angle, and Gissane angle as well as postoperative complications were detected and compared between both groups. Besides, the postoperative pain, range of motion, and ankle stability were evaluated. RESULTS AND CONCLUSION: (1) The American Orthopedic Foot and Ankle Society scores at 6 months postoperatively in both two groups were significantly higher than those at baseline, and the scores in the modified group were significantly higher than those in the traditional group (P < 0.05). (2) The Bohler angle, Gissane angle, and calcaneal width in the modified group were significantly improved compared with the traditional group at 1 week, 6 and 12 months postoperatively (P < 0.05). (3) Compared with the traditional group, the operation time, blood loss, and Visual Analogue Scale scores in the modified group were significantly improved (P < 0.05). (4) The incidence of complications in the modified group was significantly lower than that in the traditional group (P < 0.05). (5) These results manifest that compared with the traditional extended lateral “L-shape” incision with plate fixation for calcaneal fractures, the modified minimally invasive internal fixation with cannulated screws through tarsal sinus can significantly alleviate pain, and improve the range of motion and stability of the ankle 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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Biomechanical characteristics of the screw fixation at the fracture level for A3.3 by AO classification thoracolumbar burst fracture   Huang Zhong-fei, Chen Yuan-ming, Chen Ke, Wang Xun, Wan Jian, Wen Yong-fu 2017, 21 (35):  5673-5678.  doi: 10.3969/j.issn.2095-4344.2017.35.016 Abstract ( 288 )   PDF (1309KB) ( 228 )   Save BACKGROUND: Treatment strategy for vertebral burst fracture remains controversial because of its complex morphological changes. There is a lack of knowledge concerning the fixation of thoracolumbar burst fracture (A3.3 by AO classification). OBJECTIVE: To investigate the biomechanical characteristics of thoracolumbar burst fracture (A3.3 by AO classification) after screw fixation, thereby providing reference for choosing an appropriate placement method. METHODS: (1) Three-dimensional motion test: the samples were divided into complete set (group A), L1 burst fracture (A3.3 by AO classification) (group B), trans-vertebral fixation (group C), screw fixation at the unilateral fracture level (group D), screw fixation at the bilateral fracture levels (group E), and screw fixation at the bilateral upper fracture levels (F). Several swine spinal specimens served as group A, L1 was modeled into A3.3 by AO classification fracture after three-dimensional motion. (2) The compressive stiffness test: one fresh specimen served as complete group (group A), B, C, D, E, and F groups underwent compressive stiffness test. RESULTS AND CONCLUSION: (1) Three-dimensional motion tests: the range of motion in the group B was significantly decreased after C, D, E, and F fixations (P < 0.05). Compared with groups C, D and E, the range of motion at the directions of anteflexion, left flexion, right flexion, left and right rotation in the group F was significantly increased in the group F (P < 0.05); the range of motion in the groups E and D was significantly smaller than that in the groups C and F (P < 0.05); there was no significant difference between groups D and E (P > 0.05). (2) The stiffness in the other groups was significantly higher than that in the group B, especially group E, and the groups D and A did not differ significantly. (3) These results indicate that the fixation at the unilateral fracture level and bilateral fracture levels both can significantly improve the stability of thoracolumbar burst fracture (A3.3 by AO classification), and the former can reduce the economical burden and placement complications.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Stress distribution on the humeroradial joint after ulnar osteotomy based on finite element analysis and I-Scan Stress Distribution Test system He Qian-wei, Wei Li, Hu Ying-yu, Feng En-hui, Deng Wan-xi, Zhou Sheng-long, Chen Hai-yun 2017, 21 (35):  5679-5684.  doi: 10.3969/j.issn.2095-4344.2017.35.017 Abstract ( 310 )   PDF (1685KB) ( 186 )   Save BACKGROUND: Ulnar osteotomy is firstly recommended for the therapy of Monteggia fracture in children. But, there is still a lack of biomechanical evidence to confirm its efficacy and safety. OBJECTIVE: To analyze the stress distribution on the humeroradial joint after ulnar osteotomy and to provide evidence for confirming the angular size and mechanism for ulnar osteotomy. METHODS: Nine elbow joints were subjected to different positions of physiological, posterior 15° and posterior 30° osteotomy, followed by loaded at different flexion angles in the neutral, pronation and supination positions, respectively, and then the detailed stress distribution and area in the humeroradial joint were obtained using I-Scan Stress Distribution Test system. One elbow joint was scanned by three-dimensional reconstruction CT and the three-dimensional finite element model was established by ANSYS software. The model was loaded with the same conditions based on the I-Scan Test system. RESULTS AND CONCLUSION: (1) I-Scan Test system showed that the stress concentration area was in the medial side of humeroradial joint when elbow joint extended after the posterior osteotomy. Following the buckling angle of elbows increased, the area of stress concentration was changed to posterior and stress and contact area of humeroradial joint decreased correspondingly. An increase of stress and decrease of contact area appeared after posterior osteotomy compared with physiological osteotomy. (2) According to the finite element analysis, after posterior 15° and 30° osteotomy, pressure of humeroradial joint concentrated in medial-posterior region and the stress was increased. (3) To conclude, ulnar posterior 30° osteotomy is superior to 15° in reducing the incidence of radial head redislocation of Monteggia fracture, but may induce osteoarthritis of humeroradial 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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Musculoskeletal multi-body dynamic simulation on patient-specific hip bone after surgery and gait simulation   Li Xing, Wang Hong-fu, Luo Wei, Cheng Bo, Wang Jun-yuan, Liu Feng 2017, 21 (35):  5685-5690.  doi: 10.3969/j.issn.2095-4344.2017.35.018 Abstract ( 430 )   PDF (1235KB) ( 222 )   Save BACKGROUND: The biomechanical properties of the hip bone are complex in vivo that requires a more efficient and accurate method for the finite element analysis.  OBJECTIVE: To develop a musculoskeletal multi-body dynamic model of the patient-specific hip joint after surgery and simulate gait, and to explore the biomechanics of the hip joint. METHODS: CT data of the patient’s hip joint postoperatively were collected, three-dimension reconstruction underwent in MIMICS, and materialization and position matched on Geomagic Studio and meshed on Hypermesh. A musculoskeletal multi-body dynamic model of the patient-specific hip joint was established using AnyBody software and simulated the normal movements during walking, then export the muscle force, oint forces, joint moment as the Boundary conditions in finite element analysis. Then, the muscle forces, joint forces and torque were obtained and imported to be the boundary conditions for finite element analysis. The stress and strain values and concentration parts were measured on Abauqus during walking. RESULTS AND CONCLUSION: (1) The maximum value of the joint force in the three directions of the hip joint was 600, 2 000, 100 N at 2.1 seconds. (2) The ilium force was almost only in the Y direction, and the maximum value was 1 000 N. (3) The maximum stress on the hip joint was about 12 MPa at 30% of the gait cycle and the maximum relative displacement was 0.5 mm. (4) To conclude, the stress of the hip after surgery is mainly concentrated on the vicinity of the sacroiliac joint, postersuperior of the acetabulum, middle region of iliac bone, and upper zone of pubic bone; the stress of the hip is higher than that of the normal hip, and the activity intensity should be paid attention during 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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Finite element analysis of posterior anatomical locking plate for distal tibia Wang Hai-yan, Xu Gui-cun, Cai Yong-qiang, Li Zhi-jun, Zhang Shao-jie, Gao Shang, Wang Xing, Li Xiao-he 2017, 21 (35):  5691-5696.  doi: 10.3969/j.issn.2095-4344.2017.35.019 Abstract ( 402 )   PDF (893KB) ( 232 )   Save BACKGROUND: The posterior anatomical locking plate has obtained excellent fixing performance in the treatment of complex fractures of the distal tibia; however, there are many drawbacks such as nail and plate broken, and the related rules are never reported. OBJECTIVE: To establish a finite element model of posterior anatomical locking plate for distal tibia and to provide references for its design and improvement. METHODS: The imaging data of a male patient aged 34 years old (body mass: 68 kg) with fracture on the left distal tibia were imported into Mimics16.01 software, and the proposed reconstruction parts were determined based on the default threshold of the software. The files were imported into the Ansys11.0 software, the distal tibial surface was fixed, and a force of 340 N was vertically loaded on the supine surface of the horizontal section of the large tibial shaft. RESULTS AND CONCLUSION: There was completely connected with the stepped surface of nut and screw thread portion in locking steel plate. The strain on the plate depended on the stress values. The posterior anatomical locking plate for distal tibia was more favorable for the fixation at the fracture site and could reduce the fixed plate and screws loosening, both of which could affect the fixed efficacy.  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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Ankle fusion by plating through an anterior approach followed by posterolateral approach: a three-dimensional finite element analysis Xie Qiang 2017, 21 (35):  5697-5702.  doi: 10.3969/j.issn.2095-4344.2017.35.020 Abstract ( 272 )   PDF (1704KB) ( 264 )   Save BACKGROUND: End-stage ankle arthritis will cause sustained pain of the ankle joint, which severely affects patients’ life quality. Surgical treatment is necessary when conservative method is invalid, and ankle fusion is the gold standard for end-stage ankle arthritis. OBJECTIVE: To establish a three-dimensional finite element model of ankle fusion by anterior plating, followed by a posterolateral screw, thus analyzing the biomechanical changes. METHODS: CT data of normal people were imported into the relevant software to establish a three-dimensional finite element model of the ankle, and simulated ankle fusion by software processing. Subsequently, the models of ankle fusion by anterior plating system and combined posterolateral screws were established, and a three-dimensional finite element analysis was performed under neutral position, dorsiflexion, intorsion and extorsion. RESULTS AND CONCLUSION: The maximum displacement and stress under dorsiflexion, intorsion and extorsion in the combined model were significantly decreased compared with the simple model, and the values under neutral position showed no significant changes in the two methods. Additionally, the stress distribution did not differ significantly between two models. To conclude, plates combined with screws significantly improve the stability and safety of fusion. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Biomechanical characteristics of percutaneous kyphoplasty versus percutaneous vertebroplasty for spinal sandwich fracture by finite element analysis Wang Ji-bo 2017, 21 (35):  5703-5708.  doi: 10.3969/j.issn.2095-4344.2017.35.021 Abstract ( 314 )   PDF (1140KB) ( 268 )   Save BACKGROUND: Percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) have been shown to obtain satisfactory clinical efficacy in the treatment of spinal sandwich fracture compared with conventional conservative method, but a further investigation on the related biomechanical characteristics is required. OBJECTIVE: To compare the biomechanics characteristics of PVP and PKP for spinal sandwich fracture. METHODS: The finite element models of PVP and PKP were constructed based on the finite element model of spinal sandwich fracture. The deformation and stress distribution characteristics were analyzed after loaded. RESULTS AND CONCLUSION: After PVP for L1, T11 sandwich fracture, the stiffness at the thoracic and lumbar segments, the maximum stress and deformation at the sandwich vertebrae showed no obvious improvement, and the stress concentration at the anterior column of sandwich vertebrae was not improved significantly (from 26.12 Mpa to 23.37 Mpa, reduced by 10.53%). Meanwhile, PKP significantly increased the stiffness at the thoracic and lumbar segments, the maximum stress and deformation of the sandwich vertebrae were significantly decreased (from 27.15 Mpa to 17.52 Mpa, reduced by 36.71%). 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 the “one trunk-three branches” classification based on three-dimensional CT reconstruction in the treatment of pelvic and acetabular fractures Chen Hua, Li Feng, Xu Yang-ping 2017, 21 (35):  5709-5714.  doi: 10.3969/j.issn.2095-4344.2017.35.022 Abstract ( 262 )   PDF (1706KB) ( 212 )   Save BACKGROUND: There is no systematic classification method that can completely, accurately and directly reflect the characteristics of pelvic and acetabular fractures. Three-dimensional (3D) CT reconstruction technique provides more imaging evidences for the diagnosis of pelvic and acetabular fractures. OBJECTIVE: To introduce the “one trunk-three branches” classification for pelvic and acetabular fractures based on 3D CT reconstruction, and to evaluate its clinical effect. METHODS: Forty-seven cases of pelvic and acetabular fractures were enrolled, involving 18 cases of “single trunk or single branch” fracture, 18 cases of “one trunk-one branch”, 7 cases of “one trunk-two branches”, and 4 cases of “one trunk-three branches”. Based on the “one trunk-three branches” classification, the surgical approaches included improved Stoppa, posterior iliac-lumbar, iliac fossa and K-L approaches, and one or combined approaches were recommended. The order of approach and fixation was as follows: trunk first followed by branch, and another approach was necessary when the conjoint branches did not achieve simultaneous reduction. The clinical efficacy was evaluated through postoperative follow up. RESULTS AND CONCLUSION: (1) The average operation time of the fractures of single trunk or one branch, one trunk-one, one trunk-two branches and one trunk-three branches was 75.2, 88.5, 97.4, and 115.8 minutes, respectively; the average blood loss was 321.2, 360.4, 450.5, and 650 mL, respectively. (2) According to the criteria described by Matta, 25 of the reductions were graded excellent, 20 were graded good, and 2 were poor, and the excellent and good rate was 96%. (3) All patients were followed up for 12-35 months, and the follow-up rate was 87%. The mean healing time was 2.9 months (2.7-4.2 months), and the mean weight bearing time was 3.8 months (2.5-5.6 months). (4) At the last follow up, the clinical outcomes (Majeed criteria) were 16 excellent, 25 good, 4 average and 2 poor, and the excellent and good rate was 87%; the clinical outcomes (Merle d’Aubigne-Postel) were 15 excellent, 24 good, 6 average, and 2 poor, and the excellent and good rate was 83%. None of complications occurred. (5) These results manifest that the “one trunk-three branches” classification for pelvic and acetabular fractures based on 3D CT reconstruction is helpful for designing an appropriate treatment scheme, and choosing optimal surgical approach and fixation order, thereby promoting the functional recovery of the pelvis and acetabulum. 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 lower cervical pedicle screw fixation   Hao Shen-shen, Liu Zhi-bin, Wang Fei 2017, 21 (35):  5715-5720.  doi: 10.3969/j.issn.2095-4344.2017.35.023 Abstract ( 318 )   PDF (1131KB) ( 205 )   Save BACKGROUND: The lower cervical pedicle screw fixation is the most stable internal fixation of the cervical spine in biomechanics, which can penetrate the anterior, middle and posterior columns of the spine, effectively restore the sagittal sequence of the cervical spine, provide strong internal fixation and high fusion rate. OBJECTIVE: To review the relevant information of the anatomical structure of lower cervical pedicle, the biomechanical property of screw fixation, and three-dimensional printing technology-assisted screw placement at home and abroad. METHODS: PubMed and CNKI databases were searched for the articles concerning lower cervical pedicle screw fixation from January 1990 to January 2017. The key words were “lower cervical, pedicle screw, 3D printing technology” in Chinese and English, respectively. Totally 193 articles were researched, and the repetitive research, case report and meta-analysis were excluded. RESULTS AND CONCLUSION: (1) Finally 52 eligible articles were enrolled for result analysis. (2) Although it has a very high risk to fix lower cervical pedicle screw, the risk could be minimized or avoided through fully individualized evaluation preoperatively and precise fixation intraoperatively. So the lower cervical pedicle screw fixation has high clinical value.  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 joint infection following total knee arthroplasty: its bacteriological characteristics and treatment strategies   Cui Ke-ke, Yang Wei-yi, Liu Jun, Pan Jian-ke, Zhang Bao-qing, Cao Xue-wei 2017, 21 (35):  5721-2576.  doi: 10.3969/j.issn.2095-4344.2017.35.024 Abstract ( 297 )   PDF (1176KB) ( 180 )   Save BACKGROUND: Periprosthetic infection after total knee arthroplasty (TKA) has become the most serious complication. However, there is still a lack of clinical study on the distribution of pathogenic bacteria. Therefore, understanding the distribution characteristics of the main pathogenic bacteria is critical for preventing and treating postoperative infection. OBJECTIVE: To analyze the bacteriological characteristics in the patients with periprosthetic joint infection following TKA, so as to provide reference for early prevention and treatment. METHODS: CNKI, VIP, WanFang and PubMed databases were retrieved for the literature concerning periprosthetic infection following TKA published before 2016. The incidence of periprosthetic joint infection after TKA was statistically analyzed. RESULTS AND CONCLUSION: (1) 103 articles were included, involving 1 399 patients. (2) The main pathogenic bacteria were Staphylococcus aureus, coagulase negative Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Streptococcus and Enterococcus. There is no significant difference in the distribution of bacteria at home and abroad. Treatment strategies are divided into conservative and surgical treatments. (3) The key for successfully preventing and treating periprosthetic infection after TKA lies in the multiple disciplinary team collaboration, understanding the distribution of bacteria, early diagnosis and active preventive measurements, as well as rational treatment strategies. 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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Risk factors for periprosthetic joint infection after hip or knee arthroplasty in Mainland of China: a meta-analysis   Tie Xiao-jia, Zhao Meng, Han Ya-jun, Zhang Jing, Zhao He-yi, Ma Guo-ju 2017, 21 (35):  5727-5732.  doi: 10.3969/j.issn.2095-4344.2017.35.025 Abstract ( 361 )   PDF (1171KB) ( 214 )   Save BACKGROUND: Periprosthetic joint infection (PJI) is a serious and catastrophic complication after hip or knee arthroplasty. With aging population increasing, more patients will undergo hip or knee arthroplasty. Studies have shown that the risk for PJI following arthroplasty is different in different populations. OBJECTIVE: To evaluate the risk factors for PJI after hip or knee arthroplasty in Mainland of China through a meta-analysis, thereby providing reference for the prevention and control of postoperative PJI. METHODS: A computer-based search of WanFang, CNKI, VIP, CBM, PubMed, Cochrane, Embase and Medline databases was performed and the literatures concerning the risk factors for PJI after hip or knee arthroplasty in Mainland of China published before September 2016 were collected by manual retrieval and retrospective approach. All the literatures were screened based on the inclusion and exclusion criteria, followed by data extraction and analyzed on Stata 12.0 software. RESULTS AND CONLUSION: (1) Finally 14 literatures were included, including 417 patients with PJI. (2) The results of the meta-analysis showed that the risk factors for PJI after hip or knee arthroplasty including the complication of diabetic mellitus, long-term use of steroids, long operation time (> 90 minutes), age (> 65 years), and history of hip or knee surgery. (3) To conclude, PJI after hip or knee arthroplasty is related to multiple factors, so physicians should pay attention to these factors to reduce the incidence of PJI. 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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Injured vertebra pedicle screw fixation versus short-segment pedicle instrumentation for thoracolumbar fracture: a meta-analysis Mo Ling, Lin Shun-xin, Liang De, Zhang Shun-cong, Yang Zhi-dong, Cui Jian-chao, Jiang Xiao-bing, Jin Da-xiang 2017, 21 (35):  5733-5740.  doi: 10.3969/j.issn.2095-4344.2017.35.026 Abstract ( 268 )   PDF (2069KB) ( 220 )   Save BACKGROUND: Posterior internal fixation is one of the most common methods for thoracolumbar fractures. There is a lack of systematic evaluation about the efficacy of injured vertebra pedicle screw fixation (IVPSF) versus short-segment pedicle instrumentation (SSPI) for thoracolumbar fracture. OBJECTIVE: To compare the clinical outcomes of IVPSF and SSPI for single thoracolumbar fracture through a meta-analysis. METHODS: A computer-based on-line research of PubMed, Medline, Embase, Cochrane Library, CNKI, and WanFang databases was performed for the studies regarding IVPSF versus SSPI for thoracolumbar fracture from 1990 to 2016. The randomized controlled trials and cohort studies were collected based on the strict criteria of inclusion and exclusion. A meta-analysis was conducted on Revman5.3 sofeware. RESULTS AND CONCLUSION: (1) Eleven articles were enrolled, including 5 English and 6 Chinese ones, involving 689 patients (328 cases for IVPSF and 361 cases for SSPI). (2) The meta-analysis indicated that the operation time, blood loss and mean hospital stay showed no significant differences between two groups. IVPSF showed more effective than SSPI in the kyphotic angle correction and anterior vertebral height recovery at postoperation and 1-5 years of follow-up. Moreover, the incidence of postoperative fixation failure in IVPSF was lower than that in SSPI. (3) These findings suggest that IVPSF that reduces the postoperative fixation failure rate for thoracolumbar fractures provides better kyphosis correction and restoration of anterior vertebral height at post-operation and 1-5 years of follow-up.   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