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    28 January 2018, Volume 22 Issue 3 Previous Issue    Next Issue
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    Association of thrombelastogram with postoperative hemorrhage after total joint arthroplasty by structural equation modeling  
    Zhang Ying-bin, Xu Jie, Weng Jian-hao, Li Deng, Cai Zhi-qing, Huang Yu-lin, Su Bao-hua, Ma Ruo-fan
    2018, 22 (3):  329-335.  doi: 10.3969/j.issn.2095-4344.0026
    Abstract ( 399 )   PDF (1154KB) ( 350 )   Save

    BACKGROUND: Postoperative anticoagulant therapy after hip and knee arthroplasties has been included in the perioperative management guidelines. However, the application of anticoagulant drugs accompanies with the risk of bleeding. Routine coagulation tests provide limited information about the quality of clots because they identify only the first stage of clotting, while thrombelastography provides a comprehensive assessment of coagulation function. But its practicality remains controversial and the research for bleeding after joint replacement is little reported.

    OBJECTIVE: To explore the distribution of thrombelastography parameters (time to initial fibrin formation, clotting time, α angle, and maximum amplitude) and to analyze the correlation of the four parameters with postoperative blood loss, thereby providing guidance for improving the safety and effectiveness of anticoagulant therapy.
    METHODS: Totally148 patients with detection of thrombelastogram after arthroplasty from August 2015 to March 2017 in Sun Yat-sen Memorial Hospital, Sun Yat-sen University were enrolled, including 76 cases of total hip arthroplasty and 72 cases of total knee arthroplasty. Thrombelastography data were collected on day 1 postoperatively, and the perioperative blood loss was calculated. Structural equation modeling of each group was constructed to investigate the relationship of four parameters and total blood loss.
    RESULTS AND CONCLUSION: (1) In the structural equation modeling of hip and knee arthroplasties, the root mean square error of approximation was less than 0.08, goodness-of-fit index, adjusted goodness-of-fit index, normed fit index and comparative fit index was all higher than 0.9, and Parsi-mony goodness-of-fit index was less than 2, so the theoretical model was matched with the data. (2) There was a correlation of postoperative hemorrhage with time to initial fibrin formation, clotting time, α angle, and maximum amplitude. (3) That is to say, thrombelastogram can be used as an efficient tool in predicting bleeding after hip and knee arthroplasties. Future study based on this research will further verify the correlation and provide more information for its clinical practice.

    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
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    Management of perioperative blood loss applied in unicompartment knee arthroplasty  
    Cui Ke-ke, Yang Wei-yi, Liu Jun, Pan Jian-ke, Zhang Bao-qing, Zhang Xiao-liang, Cao Xue-wei
    2018, 22 (3):  336-342.  doi: 10.3969/j.issn.2095-4344.0027
    Abstract ( 318 )   PDF (1096KB) ( 278 )   Save

    BACKGROUND: Unicompartment knee arthroplasty (UKA) is gradually applied in the treatment of knee osteoarthritis, and the management of perioperative blood loss is a hot spot in clinical research. It is very important to control perioperative blood loss and changes in hemoglobin level for postoperative rapid recovery.

    OBJECTIVE: To investigate the changes in the blood-related indexes during the management of perioperative blood loss in UKA, so as to provide technical reference and data reference for clinical application.
    METHODS: Clinical data 70 patients undergoing UKA at the Department of Bone and Joint of Guangdong Provincial Hospital of Chinese Medicine from January to December 2015 were analyzed retrospectively, and received the management of perioperative blood loss. The operation time, intraoperative blood loss, postoperative drainage volume, total blood loss and rate of blood transfusion were recorded; the preoperative hemoglobin, albumin, coagulation indexes, D-dimer, erythrocyte sedimentation rate and C-reactive protein were investigated. The effect of operation on the postoperative blood loss and drainage volume was analyzed. 
    RESULTS AND CONCLUSION: (1) The operation time was (89.36±19.89) minutes, intraoperative blood loss was (39.71±23.64) mL, postoperative drainage volume was (56.21±34.21) mL, and rate of autologous blood transfusion was 0. (2) The operation time exerted no effect on the intraoperative blood loss (P=0.685 7), but affected on the postoperative drainage volume (P=0.021 6). (3) The total postoperative blood loss was little, and the blood loss did not differ significantly at 3 hours, 1, 3 and 7 days postoperatively (P > 0.05). (4) There was a slight decline in hemoglobin on days 1-3 after surgery, and then returned slowly; the erythrocyte sedimentation rate and C-reactive protein increased rapidly within 1 day after surgery and declined within 1-3 days; the D-dimer rapidly increased on day 1 after surgery, then rapidly decreased on days 1-3, and then slowly increased on days 3-7; the plasma total protein and albumin were stable and fluctuated in the normal range within 1-3 days. (5) These results suggest that the UKA had short operation time, few total blood loss and slight fluctuation, and the blood-related indexes exhibit different fluctuations. Moreover, the preoperative management of blood loss can reduce the total blood loss and rate of blood transfusion. 

    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
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    Unicompartmental knee arthroplasty versus total knee arthroplasty in the same patient with bilateral unicompartment knee osteoarthritis  
    Lu Ming-feng, Li Ze-hui, Zhu Dong-ping, Cao Xue-wei, Niu Wei
    2018, 22 (3):  343-349.  doi: 10.3969/j.issn.2095-4344.0028
    Abstract ( 529 )   PDF (1038KB) ( 443 )   Save

     BACKGROUND: In the treatment of unicompartmental knee osteoarthritis, unicompartmental knee arthroplasty (UKA) has the advantages of less blood loss, less trauma, quick recovery, maximum retention of bone mass, low cost, few complications and high patient satisfaction. However, it has not been extensively accepted by orthopedic surgeons.

    OBJECTIVE: To investigate the clinical effect and imaging changes of UKA versus total knee arthroplasty (TKA) in the same patient with bilateral unicompartment knee osteoarthritis.
    METHODS: A total of 38 patients with bilateral unicompartment knee osteoarthritis undergoing UKA and TKA were selected, and all the cases were performed by the same surgeon. Among them, 10 cases were replaced at the same time, and 28 cases were in staging surgery. The clinical data of the patients were collected, including the preoperative and postoperative Knee Society Score sores, the range of motion of the knee, and limb alignment, and postoperative complications. Comparison between bilateral knee joints was conducted by paired t test.
    RESULTS AND CONCLUSION: (1) All patients were followed up for 3-36 months, and no aseptic prosthesis loosening, unexplained pain or other complications occurred. (2) The postoperative Knee Society Score sores in UKA and TKA were significantly higher than those before surgery, and the scores did not differ significantly between UKA and TKA at each time point (P > 0.05). (3) The range of motion of the knee in the UKA group was significantly larger than that in the TKA group at the last follow-up postoperatively (P < 0.05). (4) The limb alignment was improved in both groups, which showed no significant difference at different time points (P > 0.05). (5) Totally 20 patients felt preference for UKA, 18 patients preferred TKA, and most patients were satisfied with the surgical efficacy. (6)There were no significant differences in the Knee Society Score, range of motion of the knee, hip-knee-ankle angle and femorotibial angle at the last follow-up between staging and same time arthroplasties. (7)These findings imply that for patients with bilateral unicompartment knee osteoarthritis, both UKA and TKA can correct the lower limb force line, correct the limb alignment similarly, but UKA holds advantages in less trauma, high patient’s satisfaction, and good functional recovery, so it should be selected firstly. Notably, staging or same time surgery makes no effect on the clinical effectiveness. 

    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
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    Intravenous versus articular injection of tranexamic acid for reducing hemorrhage after unilateral total knee arthroplasty
    Chen Guan-hong, Qin Lei, Huang Hui, Wang Zhan, Ma Jia-chao, Xu Ying, Zhai Xi-cheng
    2018, 22 (3):  350-355.  doi: 10.3969/j.issn.2095-4344.0029
    Abstract ( 389 )   PDF (915KB) ( 464 )   Save

    BACKGROUND: The perioperative hemorrhage of knee surgeries is a difficulty in clinic, and the efficacy of tranexamic acid to reduce postoperative bleeding has attracted more attention, but choosing which administrations remains controversial.

    OBJECTIVE: To investigate the efficacy of tranexamic acid by intravenous injection or articular injection for reducing the perioperative hemorrhage of total knee arthroplasty.
    METHODS: Sixty patients undergoing unilateral total knee replacement were enrolled, and were then randomized into three groups (n=20 per group): no tranexamic acid administration (group A); intravenous dropping of 15 mg/kg tranexamic acid before tourniquet application plus 10 mg/kg tranexamic acid at 3 hours postoperatively (group B); articular injection of 50 mL saline diluted with 1 g tranexamic acid through a drainage tube (group C). Two-hour closure of drainage tube was performed in all patients. The postoperative dominant and hidden blood loss, blood transfusion rate, pulmonary embolism as well as lower extremity deep venous thrombosis were recorded.
    RESULTS AND CONCLUSION: (1) The dominant and hidden blood loss in the groups B and C were significantly less than those in the group A (P < 0.05); the dominant blood loss showed no significant difference between groups B and C (P > 0.05); the group B exhibited a significantly less hidden blood loss compared with group C (P < 0.05). (2) The blood transfusion rate in the groups B and C was significantly lower than that in the group A (P < 0.05). (3) No pulmonary embolism or lower extremity deep venous embolism occurred during 3-month follow-up. (4) That is to say, tranexamic acid can obviously reduce perioperative blood loss and blood transfusion rate without pulmonary embolism or lower extremity deep venous thrombosis, and intravenous administration exerts better clinical effectiveness. 

    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
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    Efficacy of intravenous versus topical administration of tranexanmic acid in primary total knee arthroplasty
    Hu Wen-hao
    2018, 22 (3):  356-361.  doi: 10.3969/j.issn.2095-4344.0030
    Abstract ( 328 )   PDF (868KB) ( 273 )   Save

    BACKGROUND: Blood loss is a significant concern for patients undergoing total knee arthroplasty (TKA). Increasing evidence has shown that tranexamic acid is effective in decreasing perioperative blood loss in TKA.

    OBJECTIVE: To compare the efficacy of two methods of tranexanmic acid administration on the perioperative blood loss in primary TKA.
    METHODS: Totally 105 patients with unilateral knee osteoarthritis undergoing TKA were randomly allocated to three groups: 1 g of tranexanmic acid was administered intravenously before and after wound closure (group A); 2 g of tranexanmic acid in 20 mL of normal saline was injected into the articualr cavity through the drainage after wound closure and the tube was clamped for 4 hours (group B); no tranexanmic acid administration (group C). The intraoperative blood loss, hemoglobin level at postoperative 24 and 48 hours, postoperative drainage volume and incidence of deep venous thrombosis were recorded.
    RESULTS AND CONCLUSION: (1) The intraoperative blood loss and postoperative drainage volume in the groups A and B were significantly less than those in the group C (P < 0.05); the postoperative hemoglobin level in the group A was higher than that in the group B; the postoperative drainage volume in the group B was less than that in the group A; the total blood loss in the group A was significantly less than that in the group B (P < 0.05). (2) None patient appeared with lower limb deep venous thrombosis. (3) These findings indicate that intravenous and topical administration of tranexamic acid can significantly reduce the perioperative blood loss in primary TKA, and cannot increase the risk of thrombosis.

    中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
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    Comparison of effects between artificial joint replacement and proximal femoral nail anti-rotation for treatment of unstable intertrochanteric femoral fracture in elderly patients
    Lan Tian, Shan Zhan, Wu Jin-chun
    2018, 22 (3):  362-367.  doi: 10.3969/j.issn.2095-4344.0031
    Abstract ( 378 )   PDF (844KB) ( 231 )   Save

    BACKGROUND: Both proximal femoral nail anti-rotation (PFNA) and joint replacement in treatment of intertrochanteric femoral fracture can guarantee early bed removal and reduce long-term bed complications, but there are still more controversies in the selection of indications for the two methods.

    OBJECTIVE: To observe the differences in clinical effects of artificial joint replacement and PFNA in treatment of unstable intertrochanteric femoral fracture in elderly.
    METHODS: Totally 56 patients with Evans-Jensen types III-V intertrochanteric femoral fracture aged older than 65 years were enrolled in this study. Follow-up was conducted for 12 months. 11 cases did not complete follow-up visit. Among the remaining 45 cases, 27 patients were treated with artificial joint replacement, and 18 patients were treated with PFNA. Operation time, intraoperative blood loss, and postoperative weight-bearing time were compared between the two groups. Postoperative hip function was compared using Harris score between both groups. Postoperative complications were evaluated by clinical and radiological manifestations in both groups within 1 year after surgery.
    RESULTS AND CONCLUSION: (1) Operation time and postoperative weight-bearing time were shorter in artificial joint replacement group than in the PFNA group (t=5.596, t=14.142, P < 0.05). (2) At postoperative 1, 3 and 6 months, Harris score was significantly higher in the artificial joint replacement group than in the PFNA group (t=8.301, t=10.017, t=8.593, P < 0.05). Harris score was similar between the two groups at postoperative 1 year (t=1.541, P > 0.05). (3) The total incidence of complications was 22% in artificial joint replacement group and 23% in PFNA group; there were no statistical differences between the two groups (χ2=0.180, P > 0.05). (4) For elderly patients with unstable intertrochanteric femoral fracture, artificial joint replacement and PFNA can obtain satisfactory effect. The operation time of artificial joint replacement is short, and early weight-bearing contributes to reducing long-term bed 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
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    Artificial ankle arthroplasty versus ankle joint fusion for traumatic ankle arthritis: efficacy and safety
    Xu Jun, Xie Lin
    2018, 22 (3):  368-373.  doi: 10.3969/j.issn.2095-4344.0032
    Abstract ( 505 )   PDF (930KB) ( 293 )   Save

    BACKGROUND: At present, artificial ankle arthroplasty and arthroscopic ankle fusion can be used in the treatment of severe traumatic arthritis, but which kind of treatment can make patients more benefit is not conclusive.

    OBJECTIVE: To explore the clinical efficacy and safety of artificial ankle arthroplasty and ankle joint fusion in the treatment of traumatic ankle arthritis.
    METHODS: A retrospective study was conducted in 64 ankles of 64 patients with traumatic ankle arthritis who were treated by conservative treatment in Nanjing Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine from January 2012 to December 2015. They were divided into observation group and control group according to the surgical procedure accepted by the patients. In the observation group, 26 patients (26 ankles) underwent artificial ankle arthroplasty. In the control group, 38 patients (38 ankles) received ankle arthrodesis. The operation status, hospitalization time, postoperative complications, revision rate, limp rate and post-discharge follow-up were recorded and compared between the two groups. The preoperative and postoperative ankle Kofoed score, Visual Analogue Scale (VAS) score and the American Orthopedic Foot and Ankle Society Score (AOFAS) score were evaluated and compared between the two groups.
    RESULTS AND CONCLUSION: (1) The operation time of the control group was significantly higher than that of the observation group (P < 0.05). The intraoperative blood loss, operation cost and postoperative hospital stay were significantly higher in the observation group than in the control group (P < 0.05). (2) The scores of Kofoed, VAS and AOFAS were significantly higher at 6 months and 1 year after operation than those before operation in the two groups (P < 0.05). There was no significant difference in the scores of Kofoed, VAS and AOFAS between the two groups (P > 0.05). The Kofoed score and the AOFAS score were significantly better in the observation group than in the control group at 6 months and 1 year after operation (P < 0.05). There was no significant difference in VAS score between the two groups at 6 months and 1 year after operation (P > 0.05). (3) The postoperative infection rate, incision healing rate, fibrous adhesions and ankle pain or swelling rate were significantly lower in the control group than those in the observation group (P < 0.05). (4)The revision rate of the control group was significantly lower than that of the observation group at 1 year, but the degree of mild claudication was significantly higher than that of the observation group (P < 0.05). (5) In conclusion, arthroscopic ankle joint fusion has the advantages of small trauma, low cost and short postoperative hospital stay, but it has higher limp rate after operation. Artificial ankle joint fusion has the advantages of improving ankle joint function and activity. However, its postoperative revision rate and the incidence of partial complications are relatively high. Therefore, in the practical application, we should take full account of the patient's condition, age and economic conditions, choose the optimal treatment program, and actively avoid all kinds of postoperative complications, and improve the quality of life after surgery.

    中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
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    Efficacy of the modified incision versus standard incision in proximal femoral nail antirotation for femoral intertrochanteric fractures  
    Wang Hai-zhou, Liu Jun, Li Xi-wen, Chen Hai-yun, Pan Jian-ke, Gao Shi-hua
    2018, 22 (3):  374-379.  doi: 10.3969/j.issn.2095-4344.0033
    Abstract ( 331 )   PDF (954KB) ( 181 )   Save

    BACKGROUND: Proximal femoral nail antirotation (PFNA) is the most commonly used internal fixation for femoral intertrochanteric fracture. However, a large amount of hidden blood loss makes negative effect on the functional recovery postoperatively.

    OBJECTIVE: To compare the clinical efficacy of the modified incision and standard incision in PFNA for femoral intertrochanteric fracture.
    METHODS: Sixty-nine patients with femoral intertrochanteric fractures were analyzed retrospectively, and were then divided into two groups, followed by treated with modified incision of PFNA (group A) or standard incision of PFNA (group B). The postoperative biomechanical stability, fracture healing time, complications, Harris scores at the last follow-up, proximal incision length, operation time, and blood loss were compared between two groups. 
    RESULTS AND CONCLUSION: (1) All the patients were followed up for more than 12 months. The fracture healing time, Harris scores at the last follow-up and incidence of postoperative complications did not differ significantly between two groups. (2) The intraoperative blood loss, total blood loss and total blood transfusion in the group A were significantly less than those in the group B (P < 0.05). (3) The proximal incision length and operation time in the group A were significantly shorter than those in the group B. (4) These results manifest that in the treatment of femoral intertrochanteric fracture, both methods exhibit good biomechanical properties and stability. Notably, compared with the standard incision method, the modified incision method has less trauma, shorter operation time, less blood loss and blood transfusion.

    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
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    Effect of acetabular defect on hip stress in adults: three-dimensional finite element analysis
    Tian Feng-de, Zhao De-wei, Li Dong-yi, Guo Lin, An Ning, Zhang Yao, Hao Rui-hu, Cui Da-ping
    2018, 22 (3):  380-384.  doi: 10.3969/j.issn.2095-4344.0034
    Abstract ( 348 )   PDF (898KB) ( 242 )   Save

    BACKGROUND: Acetabular defect is one of the typical characteristics of adult developmental dysplasia of the hip. The acetabular defect caused an insufficient coverage to the femoral head, which means the contact area between them decreased and the pressure increased. Stress concentration could quicken hip wear and lead to arthritis or dislocation of the hip. Till now, there is no accepted objective criterion about what degree defect could lead to biomechanics changes in the hip.

    OBJECTIVE: To analyze the influence of different degrees of acetabular defect on the stress distribution of hip joint by using three-dimensional finite element method, and provide theoretical guidance for clinical treatment of hip dysplasia.
    METHODS: CT thin layer scanning data of normal adult hip were selected. Hip dysplasia models with varying degrees of bone defect were built by using Mimics15.0 and Hypermesh software. Von Mises stress distribution on the subchondral bone of the hip was analyzed by using Ansys10.0 software in the case of single foot touchdown.
    RESULTS AND CONCLUSION: Each model result was consistent with the actual situation. The maximum Von Mises stress value appeared at the top of the acetabulum dome and medial posterior femoral neck. When simulating one leg standing, the smaller the CE angle, the greater the maximum Von Mises stress on femoral head was; and acetabulum increased from 2.768 MPa and 3.029 MPa with 30° CE angle to 11.075 MPa and 15.322 MPa with 5° CE angle. This change was more obvious when CE angle was less than 15°. These findings confirmed that acetabular defect increases the peak stress of the hip joint, and the greater the defect, the greater the stress was. It is suggested that clinical intervention should be done as early as possible in patients with acetabular defect.

    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
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    Stress relaxation mechanics characteristics of femoral prosthesis after simulating hip replacement
    Wang Gang, Li Xin-ying, Zhang Shu-quan, Li Ya-jun
    2018, 22 (3):  385-391.  doi: 10.3969/j.issn.2095-4344.0035
    Abstract ( 275 )   PDF (903KB) ( 286 )   Save

    BACKGROUND: The previous biomechanical study of hip and hip replacement mostly analyzed the compressive, flexural and torsional mechanical properties and the three-dimensional finite element mechanics after prosthesis placement. There are few reports about the stress relaxation characteristics after femoral implant replacement.

    OBJECTIVE: To compare and analyze two kinds of artificial prostheses after hip replacement from the angle of rheology by simulating femoral stress relaxation experiment so as to provide stress relaxation characteristics parameters. 
    METHODS: Eight femoral samples were randomly selected as the conventional prosthesis group. The specimen was fixed to the operation platform. The specimens were taken from the part of 1.5 cm above trochanter minor to trochanter major. After removal of the femoral head and most of the femoral neck, cancellous bone distal to the femoral section was removed. Medullary cavity was dredged from the distal side of trochanter major to determine the position of medullary cavity. The medullary cavity hammer was used to expand the medullary cavity. The detritus inside was removed. An additional eight femoral specimens were randomly taken for femoral neck prosthesis group. Two groups of samples were placed on the workbench, and experiment was conducted at increased strain speed of 50%/min. The time was set at 7 200 s, and 100 data were collected.
    RESULTS AND CONCLUSION: (1) Stress relaxation amount was 0.384 MPa at 7 200 s in normal femur as previously reported. The stress relaxation amount was 0.379 MPa and 0.362 MPa in the conventional prosthesis group and femoral neck prosthesis group. The stress relaxation amount was significantly larger in the femoral neck prosthesis group than in the conventional prosthesis group at 7 200 s (P < 0.05). (2) Two groups of stress relaxation data were obtained and stress relaxation equation was established by three parameters of the model. It is conducive to clarify the stress relaxation characteristics of different implants into the femur. (3) Femoral neck prosthesis group and conventional prosthesis group have different stress relaxation mechanics. Due to the retention of the femoral neck, less impact was found on the stress relaxation mechanics.
     
    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
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    Mechanical stability after plating ankle arthrodesis based on three-dimensional finite element analysis
    Xie Qiang, Wang Zhi-hui, Liu Wen-yi, Gao Yun-feng, Xue Xin-xin
    2018, 22 (3):  392-397.  doi: 10.3969/j.issn.2095-4344.0036
    Abstract ( 373 )   PDF (1047KB) ( 263 )   Save

    BACKGROUND: Plating ankle arthrodesis includes anterior and lateral plating methods, but there is some lack of knowledge about their differences in biomechanics.

    OBJECTIVE: To establish the three-dimensional models of anterior and lateral plating ankle arthrodesis through three-dimensional finite element technique, simulate human gait, and to analyze its biomechanical stability and safety.
    METHODS: The geometrical morphology of ankle joint was reconstructed based on the normal human ankle CT data. The models of anterior and lateral plating ankle arthrodesis were established using finite element analysis software Abaqus 2016, and the biomechanical changes after exerting stress at the positions of intorsion, extorsion, dorsiflexion, and neutral were analyzed.
    RESULTS AND CONCLUSION: (1) The maximal displacement and stress distribution under different stress were compared between two models by three-dimensional element analysis, and there was no significant difference in the stability between two models. (2) The abilities of resistance to intorsion and dorsiflexion stresses of the lateral plating model were slightly better than those of the anterior plating model, but the resistance to extorsion stress of the lateral plating model was lower than that of the anterior plating model; the stress peak both concentrated on the plate-screw connections. (3) The plate, screw and bone mass of the anterior plating model showed the maximum stress peak under intorsion stress, and broken plates and nails usually occur. (4) The lateral plating presented with peak stress under extorsion stress.

    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
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    Finite element analysis of the human upper cervical vertebrae under high-speed post-impact condition
    Liu Ying-xuan, Chen Ling-feng, An Mei-wen
    2018, 22 (3):  398-403.  doi: 10.3969/j.issn.2095-4344.0037
    Abstract ( 465 )   PDF (980KB) ( 363 )   Save

    BACKGROUND: Highway accidents increase year by year, and the most vulnerable area is the neck. Finite element analysis can be used to study the mechanical mechanism of cervical injury. Most of researches focus on the optimization of the model and low-speed collision conditions, but the association of neck injury with cervical tension stress is little reported.

    OBJECTIVE: To explore the mechanical mechanism of neck injuries caused by traffic accidents, and to compare the von Mises and axial stress of the cervical vertebrae.
    METHODS: A cervical spine model including cervical vertebrae, intervertebral disc, ligament, muscle, facet joint was set up. The model was validated based on the experimental data of the former impact volunteers. The dynamic response of the cervical vertebrae was achieved using the finite element method (80, 120, and 160 km/h).
    RESULTS AND CONCLUSION: (1) The established upper cervical model had a high biosimulation, which could be used in studies on the cervical injury and each part injury caused by traffic accidents. (2) Under high-speed post-impact condition, the cervical injury became severe with speed increasing, especially C4 level. (3) The axial stress was more available to assess the injury of cancellous bone than von Mises. (4) After high-speed post-impact, the vertebrae diaplaced, especially at 120 km/h, thereby causing articular separation and fracture, further inducing nerve root injury. 

    中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
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    Effect of cervical rotatory direction on the displacement of cervical disc and the volume of intervertebral foramen in a three-dimensional finite element model  
    Huang Xue-cheng, Ye Lin-qiang, Liang De, Wang Qian-li, Yu Wei-bo, Jiang Xiao-bing
    2018, 22 (3):  404-408.  doi: 10.3969/j.issn.2095-4344.0038
    Abstract ( 319 )   PDF (1609KB) ( 202 )   Save

    BACKGROUND: Cervical spondylotic radiculopathy could be effectively treated by cervical rotatory manipulation, but the symptoms may be exacerbated when rotated to the wrong direction.

    OBJECTIVE: To simulate the cervical rotatory manipulation in left/right rotation by three-dimensional finite element, and then investigate the effect of this manipulation on the displacement of cervical disc and the volume of intervertebral foramen so as to provide a basis for effectiveness and safety of cervical rotatory manipulation in treating cervical spondylotic radiculopathy.
    METHODS: With Mimics10.01, Geomagic Studio and Solidworks 14.0 software, a three-dimensional geometric CAD model of C5-6 was developed from the CT scan images of a 25-year-old normal adult female. The model was imported into Ansys Workbench 14.5, and a three-dimensional finite element model was verified and simulated the cervical rotatory manipulation. The cervical rotatory manipulation was decomposed by principium of manipulation in left lateral flexion and rotated to the left/right side. The parameter of mechanics was analyzed with the finite element system. The change of displacement in cervical disc and volume in intervertebral foramen simultaneously were displayed during simulating the manipulation.
    RESULTS AND CONCLUSION: In left lateral flexion and rotated to the left side, the posterior part of the left side of annulus fibers was expanded 0.46 mm into posterior, and the posterior part of the right side of annulus fibers was retracted 0.77 mm. The volume of left intervertebral foramen became small and the right side became large. However, in left lateral flexion and rotated to the right side, the posterior part of the left side of annulus fibers was retracted 0.71 mm, and the posterior part of the right side of annulus fibers was expanded 0.43 mm into posterior. The volume of left intervertebral foramen became large and the right side became small. Therefore, the posterior part of the rotated side of cervical disc was expanded into posterior, while the posterior part of the contralateral side of cervical disc was retracted. The volume of intervertebral foramen in rotated side became small, while the volume of intervertebral foramen in contralateral side became large. We should rotate to the contralateral side when cervical spondylotic radiculopathy was treated with cervical rotatory manipulation. 

    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
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    Finite element analysis of the stress distribution of spinal fusion versus non-fusion surgeries
    Liu Xiao, Liu Yao-sheng, Liu Shu-bin
    2018, 22 (3):  409-414.  doi: 10.3969/j.issn.2095-4344.0039
    Abstract ( 478 )   PDF (1222KB) ( 231 )   Save

    BACKGROUND: At present, traditional interbody fusion is still the main method for lumbar degeneration, and non-fusion treatment has achieved rapid development in recent years, but the effects of two kinds of methods on the lumbar biomechanics deserve a further study.

    OBJECTIVE: To explore the load distribution on the degenerative lumbar vertebrae, and pathogenesis of lumbar spine degeneration through finite element analysis; and to compare the stress distribution on the lumbar vertebrae and treatment outcomes after fusion and non-fusion surgeries.
    METHODS: The finite element models of four groups were established, respectively, based on the CT images, including normal lumbar spine, lumbar intervertebral disc herniation, and lumbar spine after fusion and non-fusion surgeries. The four groups were modeled in neutral position, lateral flexion, flexion and rotation by workbench 17.0, and the finite element analysis of stress and statics was conducted.
    RESULTS AND CONCLUSION: (1) The finite element analysis of degenerative lumbar spine showed that the stress of intervertebral disc mainly concentrated on the posterior part of the annulus fibrosus. The degenerative annulus fibrosus easily became thin under stress, thus affecting the lumbar stability. (2) The comparative analysis results found that the finite element results of the lumbar spine after non-fusion surgery were closer to those of the normal lumbar spine. Therefore, non-fusion surgery can achieve better repair outcomes in the treatment of lumbar vertebral degeneration.

    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
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    Finite element analysis of vertebral column decancellation for treatment of ankylosing spondylitis kyphosis   
    Xie Jiang, Li Li, Ma Jun-yi, Sui Jiang-tao, Zhu Xu, Ma Yuan
    2018, 22 (3):  415-419.  doi: 10.3969/j.issn.2095-4344.0040
    Abstract ( 331 )   PDF (1423KB) ( 176 )   Save

    BACKGROUND: Kyphosis in ankylosing spondylitis is a kind of spinal sagittal imbalance; due to center of gravity displaced and complicated biomechanical properties of the spine, the spinal biomechanics after kyphosis correction is little reported.

    OBJECTIVE: To establish a three-dimensional finite element model of the spine after osteotomy for kyphosis.
    METHODS: A three-dimensional finite element model of kyphosis in ankylosing spondylitis was established, simulating three kinds of osteotomy orthopedic programs (osteotomy angle in 20°, 30° and 40°), and the orthopedic effect and biomechanics were analyzed.
    RESULTS AND CONCLUSION: (1) The three-dimensional finite element model of finite element model of kyphosis in ankylosing spondylitis was established successfully, and simulated three kinds of osteotomy orthopedic programs at the angles of 20°, 30°, and 40°. (2) The best osteotomy angle was 30°, the stress distribution was less, and the stress on the T12, L1, L2, L4, L5, S1 and rod was 7.346 1, 11.952, 72.783, 81.368, 28.144, 41.114, and 109.69 MPa, respectively. (3) Under 30°osteotomy angle, the postoperative Cobb angle is 1.4°, which not only obtains better orthopedic effect, but also reduces the incidence of complications caused by stress concentration.

    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
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    Anatomic measurement regarding the effect of proximal interphalangeal joint motion on the tension of the zone I extensor tendon  
    Wang Chao-dong, Wang Jian-ye, Wang Yu, Xian Ming-bo
    2018, 22 (3):  420-425.  doi: 10.3969/j.issn.2095-4344.0041
    Abstract ( 384 )   PDF (1152KB) ( 167 )   Save

    BACKGROUND: Many conservative and surgical techniques for mallet finger have been described. Most of them have reached an agreement, but the fixation of the proximal interphalangeal joint has not reached a consensus.

    OBJECTIVE: To discuss the effect of proximal interphalangeal joint motion on the tension of the zone I extensor tendon and to search the fixation position of proximal interphalangeal joint at the minimum tension of the zone I extensor tendon through measuring extensor tendon so as to provide reference for selecting optimal fixation position in the treatment of mallet finger.
    METHODS: The maximal passive flexion angles of the distal interphalangeal joint of the index, middle, ring and little fingers were measured in 20 cadaver hands when the proximal interphalangeal joint flexed at 0°, 20°, 40°, 60°, 80° and 100°. An incision was made over the back of the distal interphalangeal joint to expose the zone I extensor tendon. The extensor tendon was incised laterally at the level of the distal interphalangeal joint with the distal interphalangeal joint fixed in extension position to make a mallet finger. A Kirschner wire was used to pierce through and perpendicular to the distal phalangeal basement as a sign. Paralleling to this sign, the zone I extensor tendon was marked and its relative distance to the sign was measured as the sliding distance of the extensor. The widest gap between the tendon edges and the tendon sliding distance were recorded, while the proximal interphalangeal joint was in extension and 20°, 40°, 60°, 80° and 100° flexion positions.
    RESULTS AND CONCLUSION: (1) The maximal passive flexion angle of the distal interphalangeal joint increased with the proximal interphalangeal joint flexion increased. (2) The gap between the extensor tendon edges in zone I reduced when the angle of proximal interphalangeal joint increased. The proximal extensor tendon gliding distance increased, while the proximal interphalangeal joint flexion increased. The gap between the extensor tendon edges in zone I was (1.322 8±1.0788 9) mm when the proximal interphalangeal joint was in extension position. The proximal extensor tendon glided distally, when the proximal interphalangeal joint flexed to 100° with an average sliding distance of (1.540 5±0.690 70) mm. (3) The zone I extensor tendon has the maximal tension while the proximal interphalangeal joint is in extension position. The tension in the zone I extensor tendon reduced when the angle of proximal interphalangeal joint increased. The tension in the zone I extensor tendon was minimal when the proximal interphalangeal joint flexed to 100°. 

    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
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    Tibial anteroposterior axis measured by CT scan in optimizing tibial prosthesis rotation during total knee arthroplasty
    Zhang Lei, Lian Kai, Peng Hao, Chen Sen
    2018, 22 (3):  426-431.  doi: 10.3969/j.issn.2095-4344.0042
    Abstract ( 414 )   PDF (1375KB) ( 189 )   Save

    BACKGROUND: The osteotomy and prosthesis placement of the traditional total knee arthroplasty is mostly done by visual measurement and lacks more precise measurements.

    OBJECTIVE: To identify rotational alignment of tibial prosthesis using preoperative calculation of tibial anteroposterior axis by CT scan and to compare the clinical efficacy of tibial prosthesis placement in traditional total knee arthroplasty.
    METHODS: Data of 50 patients with knee osteoarthritis who underwent primary total knee arthroplasty in Department of Orthopedics, Renmin Hospital of Wuhan University from January 2014 to April 2015 were retrospectively analyzed. All patients were randomly divided into two groups: 23 cases (25 knees) received preoperative CT to measure the tibial anteroposterior axis in CT assistant group; 27 cases (29 knees) received the method of medial 1/3 of the tibial tubercle in traditional surgery group. We recorded operative time and hospital time, pre- and post-operative Hospital for Special Surgery score, patellar score, knee range of motion and Visual Analogue Scale score. At 3 days after surgery, X-ray images were obtained to measure tibial valgus β and tibial slope valgus θ. All operations were performed by the same team.
    RESULTS AND CONCLUSION: (1) All patients were followed up. There was no significant difference between two groups in the general information (P > 0.05). (2) Operative time, tibial valgus β and tibial slope valgus θ assessed in CT assistant group were better than in traditional surgery group (P < 0.05); there was no significant difference in hospital time between the two groups (P > 0.05). (3) There was no significant difference in Hospital for Special Surgery score, patellar score, range of motion, and Visual Analogue Scale score between the two groups pre-operatively, 1 and 3 months after operation (P > 0.05). However, above indexes were better in the CT assistant group than in the traditional surgery group at 6 months after operation (P < 0.05). (4) Results indicated that the tibial anteroposterior axis measured by CT for guiding tibial prosthesis position was more precise than the traditional surgery to make the femur prosthesis and the tibial prosthesis have better rotating alignment. 

    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
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    Distribution of Modic changes and its relationship with cervical degeneration in patients with neck and shoulder pain
    Li Wen-xuan, Yu Bao-long, Zhang Pei, Li Rui-feng, Jia Yan-bo
    2018, 22 (3):  432-437.  doi: 10.3969/j.issn.2095-4344.0043
    Abstract ( 385 )   PDF (793KB) ( 181 )   Save

    BACKGROUND: There are many studies on Modic changes in patients with lumbar degenerative disease and low back pain. However, few studies facus on epidemiological distribution and related factors of Modic changes in cervical spine, and its epidemiology and influencing factors remain unclear.

    OBJECTIVE: To study the morbidity and distribution of Modic changes in patients with cervical and shoulder pain and its correlation with gender, age and cervical degeneration.
    METHODS: Totally 430 patients admitted in the Second Affiliated Hospital of Inner Mongolia Medical University and undergoing cervical MRI and CT examination due to neck and shoulder pain between December 2014 and December 2016 were retrospectively analyzed, involving 197 males and 233 females, aged 19-78 years (mean age: 50.3 years). The morbidity and segmental distribution of Modic changes and its correlation with age, sex, cervical intervertebral disc degeneration and facet joint degeneration were analyzed.
    RESULTS AND CONCLUSION: (1) Among 2 150 disc segments of 430 patients, 348 segments (16.2%) of 67 patients (15.6%) appeared with Modic changes: 73 (3.4%) segments were type I, 243 (11.3%) were type II, and 32 (1.5%) were type III. (2) By application of chi-square test, Modic changes were most common at the C5/6 segment; older than 40 years and Pfirrmann disc degeneration grade III were relevant factors, while gender and facet joint degeneration were not.

    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
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    Digital screw path analog measurement of C4-6 posterior fixation parameters in adolescents aged 12-14 years and its clinical significance
    Zhang Kai, Chen Xiao-xing, Zhang Hai-xia, Zhang Chuan-wei, Wang Hai-yan
    2018, 22 (3):  438-443.  doi: 10.3969/j.issn.2095-4344.0044
    Abstract ( 368 )   PDF (1300KB) ( 168 )   Save

    BACKGROUND: For recent decades, there has been a younger tendency in age of occurrence of the cervical spondylosis, and posterior fusion is the main method for cervical degeneration and injury, but no relevant fixation parameters are available in clinical practice for adolescents.

    OBJECTIVE: To measure the anatomical parameters of C4-6 posterior fixation in the adolescents aged 12-14 years after three-dimensional reconstruction. 
    METHODS: Twenty-one adolescents aged 12-14 years, who underwent cervical examination at the Affiliated Hospital of Inner Mongolia Medical University and Department of Orthopedics of the Second Hospital of Ulanqab between January 2014 and December 2016 were randomly selected, and the CT data of the C4-6 were collected, and then imported into Mimics16.01 software for three-dimensional reconstruction. We measured the anteroposterior and transverse diameters and the heights of the vertebral body, anteroposterior and transverse diameters of the transverse foramina, angles of the left and right pedicle axes to sagittal and horizontal axes, and left and right pedicle axis lengths.
    RESULTS AND CONCLUSION: (1) Both anteroposterior and transverse diameters of the transverse foramina were increased with vertebral level incveasing. Both angles of pedicle axis to sagittal and horizontal axes, and pedicle axis lengths were increased with vertebral level. The anteroposterior diameter of the vertebral body at C4-6 was in the range of 6.0-8.0 mm, the transversal diameter was in 25.0°-30.0°, the angle between the posterior screw and the horizontal axis was 29.0°-35.0°; in the sagittal plane, the angle to the sagittal axis was no more than 5°; and the pedicle screw path length was in 6-7 mm. (2) These results show the anatomical parameters of C4-6 posterior fixation in the adolescents aged 12-14 years are successfully obtained by three-dimensional reconstruction.

    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
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    Three-dimensional reconstruction of pelvic CT in guiding iliac nail implantation
    Li Chun-guang, Tian Ning, Li Pi-bao, Shi En-dong, Cui Hai-yin, Yin Zu-dong, Cheng Lin
    2018, 22 (3):  444-449.  doi: 10.3969/j.issn.2095-4344.0045
    Abstract ( 524 )   PDF (924KB) ( 200 )   Save

    BACKGROUND: Iliac screw implantation has no unified standard. Because of the large individual differences, preoperative pelvic three-dimensional (3D) CT reconstruction can measure the diameter, depth and angle of the screws, which increases the placement accuracy.

    OBJECTIVE: To measure the screw placement-related data by pelvic 3D CT reconstruction, so as to guide the screw placement and improve its accuracy.    
    METHODS: Fifty patients with pelvic lesions or fractures admitted in Shandong Provincial Third Hospital from January 2013 to December 2016 were selected, and the pelvis was scanned with CT and then was reconstructed. The point A (the intersection of S1 posterior sacral posterior wall and posterior superior iliac spine) was as the screw placement point, and three paths were measured on the point: posterior superior iliac spine path (AD path); anterior inferior iliac spine path (AC path); top of greater sciatic notch to the acetabular roof (AB path). On the plane of these three pathes, the section was made on the iliac bone, respectively; in each section, the channel for iliac nail was designed.
    RESULTS AND CONCLUSION: (1) In the same path, there was no significant difference in the path length of the screw between male and female patients (P > 0.05). Paired t test showed that the diameter and length depth and angle of the screws were significantly different between AD and AC paths, AC and AD (P < 0.05). (2) There was no significant difference in the inclination angle of the spiral channel between male and female patients (P > 0.05). The inclination angle of the spiral channel and lateral angle at different paths showed significant difference between male and female patients (P < 0.05). (3) To conclude, 3D reconstruction of pelvis CT can be used to measure the length, diameter and angle of the iliac screw, and to guide the surgical treatment. 

    中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
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    Lumbar intervertebral disc degeneration assessed by the nine-point system with X-ray
    Zhao Yin, Zhou Sheng-yuan, Yuan Bo, Xu Guo-feng, Xu Zheng, Lv Bi-tao, Jia Lian-shun, Chen Xiong-sheng
    2018, 22 (3):  450-455.  doi: 10.3969/j.issn.2095-4344.0046
    Abstract ( 573 )   PDF (1513KB) ( 233 )   Save

    BACKGROUND: The X-ray 9-point grading system is established based on cervical disc degeneration and its suitability for evaluation of lumbar disc degeneration has not been validated.

    OBJECTIVE: To investigate the feasibility of the evaluation of lumbar intervertebral disc degeneration using the 9-point grading system with X-ray, and to explore its clinical application value. 
    METHODS: The correlation between 9-point grading system and Pfirrmann system was statistically analyzed. Magnetic resonance imaging (MRI) and X-ray images of 172 cases with lumbar disc degeneration or simple lumbago, who were treated in the Shanghai Changzheng Hospital from June 2013 to June 2016, were retrospectively analyzed. The MRI scores of lumbar disc degeneration were evaluated according to Pfirrmann standard, and the X-ray scores were evaluated according to 9-point grading system. The two groups of scores were respectively analyzed by the correlation and regression tests via Spearman rank sum test with SPSS software. 
    RESULTS AND CONCLUSION: (1) MRI scores (the independent variable X): 2 cases scored 1; 8 cases scored 2; 55 cases scored 3; 84 cases scored 4; 23 cases scored 5. X-ray scores (the dependent variable Y): 2 cases scored 0; 6 cases scored 1; 21 cases scored 2; 43 cases scored 3; 40 cases scored 4; 26 cases scored 5; 16 cases scored 6; 8 cases scored 7; 7 cases scored 8; 3 cases scored 9. (2) The Spearman correlation test showed that significant positive correlation was found between Pfirrmann system and 9-point grading system (P < 0.01). Significance test of correlation coefficient proved that there was significant linear correlation between Pfirrmann system and 9-point grading system. Further regression analysis showed the linear regression between Pfirrmann system and 9-point grading system. (3) These findings suggested that Pfirrmann system and X-ray 9-point grading system had a good consistency in evaluating lumbar disc degeneration. As a scientific, fast and effective evaluation method, the X-ray 9-point grading system has a certain reference value in the diagnoses of lumbar degenerative diseases. 

    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
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    AxiaLif application in lumbosacral vertebral fusion
    Shu Xiao-lin, Song Xi-zheng
    2018, 22 (3):  456-463.  doi: 10.3969/j.issn.2095-4344.0047
    Abstract ( 325 )   PDF (1366KB) ( 273 )   Save

    BACKGROUND: Lumbosacral vertebral fusion operation is an important treatment for lumbosacral vertebral degenerative disease. Traditional open surgery has great trauma; postoperative recovery time is longer; there are more complications. To reduce the damage to normal tissue and increase the rate of healing, scholars in and outside China improve the lumbar spine fusion surgery, and lumbar fusion becomes a tendency of the development of minimally invasive surgery. In 2004, Cragg introduced lumbosacral vertebral axial fusion (AxiaLIF, axial lumbar intervertebral fusion). The operation is through posterior rectal wall and presacral space approach, axially nailing for fusion of L5/S1. Muscle, ligament and blood vessels of the spine were retained. Mechanical stability was similar to that of traditional fusion. Osseous fusion rate was high at the operation segment. This is in line with the concept of minimally invasive surgery of the spine.

    OBJECTIVE: To summarize the advantages and disadvantages of traditional and present fusion techniques from traditional lumbar fusion and present lumbar fusion angle, and to explore the application of AxiaLIF in lumbosacral fusion.
    METHODS: We retrieved PubMed, Web of Science, and Springer database with the English key words of “Axial interbody fusion and (properties or evaluation), biomechanics, spine mechanical test, spine and (kinematics or motion)”, and Chinese Journal Full-Text Database with the Chinese key words of “Axial fusion, biomechanics research assessment, biomechanics, anterior sacral space, minimally invasive spine” for studies concerning lumbar fusion, complications, biomechanics, and humanistic medicine that had been published in recent 5 years. Repetitive studies were excluded, and 46 studies were analyzed and discussed.
    RESULTS AND CONCLUSION: In the past 90 years, scholars in and outside China had studied the methods of lumbar fusion from various levels, analyzed and summarized the advantages and disadvantages of various operative methods, and identified the indications of lumbar spinal fusion. By comparing characteristics of open surgery and minimally invasive surgery, this study suggested that minimally invasive lumbar fusion has become a trend. In-depth understanding of biomechanical stability, complications, and postoperative recovery time after AxiaLIF is still a long way to go in future medical research.

    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
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    Particle-associated periprosthetic osteolysis after hip arthroplasty: the underlying biological mechanisms
    Li Wen-bo, Song Ke-guan
    2018, 22 (3):  464-470.  doi: 10.3969/j.issn.2095-4344.0048
    Abstract ( 390 )   PDF (1182KB) ( 239 )   Save

    BACKGROUND: Loosening of the sterile prosthesis in joint replacement is a simple radiological phenomenon, but a complex immune process. The abrasive particles produced by the implant usually lead to osteolysis, which is known as particle-associated periprosthetic osteolysis.

    OBJECTIVE: To summarize the characteristics of particle-associated periprosthetic osteolysis in order to provide reference for early identification and treatment, thereby improving the patients’ prognosis.
    METHODS: The first author retrieved PubMed database for the articles addressing particle-associated periprosthetic osteolysis using the English keywords of “wear particles, particle-associated periprosthetic osteolysis”.
    RESULTS AND CONCLUSION: (1) Osteolysis can induce bone resorption, but the relevant clinical, animal and in vitro studies have shown that particle-associated periprosthetic osteolysis involves various biological reactions, not only osteoclasts, and the bioactivity highly depends on the property and quantity. (2) Although total hip arthroplasty has achieved rapid progression, particle-associated periprosthetic osteolysis and aseptic loosening are still the main factors for the life of prosthesis. (3) Biomarkers can be used as simple and objective diagnostic and prognostic criteria for osteolysis after total hip arthroplasty. (4) Further research is needed to identify new biomarkers in periprosthetic osteolysis to develop new treatments to reverse or inhibit the particle-associated biological response.

    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
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    Treatment strategies for infection after hip arthroplasty in the elderly patients
    Shi Zhi-yong, Zhang Xue-yun, Chen Feng, Wang Fei, Guo Zhi
    2018, 22 (3):  471-477.  doi: 10.3969/j.issn.2095-4344.0049
    Abstract ( 333 )   PDF (1042KB) ( 193 )   Save

    BACKGROUND: Hip arthroplasty has become mature, but infection after arthroplasty is a serious complication.

    OBJECTIVE: To analyze the clinical characteristics and treatment outcomes of infection after hip arthroplasty, thus providing reference for improving the diagnosis and treatment of postoperative infection.
    METHODS: A computer-based online search of CNKI, WanFang, PubMed and Medline databases from 2006 to 2016 was conducted using the keywords of “hip arthroplasty, infection” in English and Chinese, respectively. Clinical data of 20 patients with infection after hip arthroplasty in three hospitals from January 2006 to January 2016 were analyzed retrospectively.
    RESULTS AND CONCLUSION: (1) Two-stage revision is considered to be the main method for treating infection after hip arthroplasty. The duration of antibiotic therapy remains controversial. The increased bacterial resistance is difficult, especially the widespread use of vancomycin after hip arthroplasty. (2) Staphylococcus aureus is the highest proportion of strains detected, up to 30%, followed by 25% for staphylococcus epidermidis, 20% for coagulase-negative staphylococcal and 75% for staphylococcus in the three hospitals. Gram-negative bacteria mainly contain pseudomonas aeruginosa, enterobacter cloacae and hemolytic streptococcus. (3) To conclude, antibiotics should be timely adjusted according to antibiotic susceptibility results after hip arthroplasty.

    中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
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    Meta-analysis of excellent and good rate and complication of Endobutton plate versus clavicular hook plate for treating acromioclavicular joint dislocation
    Song Xin, Maimaitishawutiaji•Maimaiti, Yilihamu•Tuoheti, Maihemuti•Yakufu, Chen Hong-tao, Abudusalamu•Abudukelimu, Luo Xiao-ying
    2018, 22 (3):  478-485.  doi: 10.3969/j.issn.2095-4344.0050
    Abstract ( 370 )   PDF (1384KB) ( 226 )   Save

    BACKGROUND: At present, there are many ways to treat acromioclavicular joint dislocation, mainly based on clavicular hook plate, but the anatomical reconstruction of the trapezoid ligament and conoid ligament of the acromioclavicular ligament is the most important trend in the treatment of acromioclavicular joint dislocation. Endobutton plate has been widely promoted in recent years. A large number of randomized controlled trials and retrospective study showed that it has better efficacy and lower incidence of complications compared with the clavicular hook plate.

    OBJECTIVE: To evaluate the excellent and good rate and the short-term incidence of complication between Endobutton plate and clavicular hook plate in the treatment of acromioclavicular joint dislocation.
    METHODS: The Cochrane Library (1966-06/2017-05), PubMed (1966-06/2017-05), MEDLINE (1966-02/2017-05), EMbase (1984-01/2017-05), CNKI (1979-01/2017-05), VIP (1989-01/2017-05), and Wanfang (1982-01/2017-05) databases were searched by computer. Simultaneously, six major Chinese orthopedic journals were retrieved by hand, and the references included in the related articles were consulted. Randomized controlled trials addressing Endobutton plates and clavicular hook plates for the treatment of acromioclavicular joint dislocation were collected. The literatures were screened for inclusion criteria, and their qualities were evaluated. Meta-analysis was performed using RevMan 5.3 software.
    RESULTS AND CONCLUSION: (1) A total of 13 randomized controlled trials containing 800 patients were included in the study. 394 patients were treated with Endobutton plate and 406 patients with clavicular hook plate as controls. Among which, only one study was compared in three different ways; the rest were compared between Endobutton plate and clavicular hook plate. (2) Meta-analysis showed that the excellent and good rate of Endobutton plate was superior to that of clavicular hook plate in the treatment of acromioclavicular joint dislocation (P < 0.000 01). Compared with clavicular hook plate, the incidence of incision infection, acromioclavicular joint pain, limited activity and redislocation were lower in Endobutton plate (P=0.02, < 0.001, < 0.00001, 0.03). (3) These findings suggested that the effect of Endobutton plate was better than that of clavicular hook plate in the treatment of acromioclavicular joint dislocation. The incidences of incision infection, acromioclavicular joint pain, limited mobility, and redislocation were lower in Endobutton plate than in the clavicular hook plate. Although the article included many randomized controlled trials, the qualities of these articles are limited. We still need to design more strictly large-sample randomized controlled trials to increase the credibility of the evidence. 

    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
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    Analgesic effect of femoral nerve block versus adductor canal block after total knee arthroplasty: a meta-analysis
    Wang Yin, Wang Xing-bo, Guo Shi-fang, Yang Qing-shan, Chen Zhi-xin
    2018, 22 (3):  486-492.  doi: 10.3969/j.issn.2095-4344.0051
    Abstract ( 361 )   PDF (1389KB) ( 232 )   Save

    BACKGROUND: In recent years, extensive studies on the pain management after total knee arthroplasty (TKA) have identified different ways of analgesia. Among which, femoral nerve block (FNB) is the standard antalgic method post-TKA for its effective analgesia, but it may reduce the muscle strength of the quadriceps after TKA and cause serious consequences. Adductor canal block (ACB) is a novel antalgic method that provides fast functional recovery and good ability of pain control after TKA.

    OBJECTIVE: To compare the functional recovery and ability of pain control of ACB and FNB after TKA through a meta-analysis.
    METHODS: Databases of WanFang, CNKI, PubMed, Web of Science, and Embase were searched for the literature concerning the analgesia and functional recovery after TKA published before March 2017. The articles were evaluated according to the Cochrane system and a meta-analysis was conducted on Revman 5.1.
    RESULTS AND CONCLUSION: (1) Twelve articles were included involving 802 patients with 872 knees. (2) Meta-analysis results showed that compared with FNB, ACB significantly reduced the Visual Analogue Scale scores at rest at 8 hours postoperatively (P < 0.001) and significantly improved the muscle strength of quadriceps femoris (P < 0.001) and motor capacity (Timed Up and Go test) (P < 0.05); but the scores at rest at 24 and 48 hours postoperatively, and the scores in activity at postoperative different time points, usage of opioids, and hospitalization time did not differ significantly between two groups. (3) ACB can achieve better analgesia at the early period (8 hours) after TKA, better motor capacity and stronger muscle strength of the quadriceps femoris; thereafter, it is a substitute for FNB 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
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