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    08 March 2018, Volume 22 Issue 7 Previous Issue    Next Issue
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    Dynamic simulation of the edge load caused by the separation of the ceramic cup and femoral head  
    Feng Li, Wang Jun-yuan, Liu Feng, Cheng Bo
    2018, 22 (7):  985-990.  doi: 10.3969/j.issn.2095-4344.0106
    Abstract ( 344 )   PDF (1436KB) ( 146 )   Save

    BACKGROUND: The edge load contact caused by joint separation causes great stress concentration and then produces a large amount of wear. The edge contact caused by hip joint separation is a dynamic process of femoral head touching the rim of the acetabulum and sliding into the acetabulum quickly, so a dynamic contact mechanical model is needed.

    OBJECTIVE: To obtain the dynamic mechanical simulation model of ceramic acetabulum under the edge load contact, so as to provide the contact mechanics foundation for the wear analysis of hip joint under the condition of edge load, and provide theoretical basis for prosthesis design and surgeon operation.
    METHODS: By using 3D modeling software SolidWorks and dynamic simulation software ADAMS, edge load contact dynamics simulation model of ceramic femoral head and acetabular cup was established to verify the edge load contact deformation by numerical method. The effects of acetabular abduction angle and initial separation distance on edge load contact were analyzed.
    RESULTS AND CONCLUSION: (1) The contact stiffness coefficient used in the model is reasonable and effective. This model can be used to study the parameters that influence the edge load contact of hip joints. (2) The excessive cup inclination angle and initial separation distance will increase the severity of the edge load. (3) Acetabular cup inclination angle and initial separation distance are two important factors that affect the edge load contact.

    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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    Cemented versus cementless hemiarthroplasty for femoral neck fractures in the elderly  
    Guan Ming-qiang, Zhu Zhi-xia, Zhou Guan-ming
    2018, 22 (7):  991-996.  doi: 10.3969/j.issn.2095-4344.0107
    Abstract ( 432 )   PDF (2925KB) ( 138 )   Save

    BACKGROUND: Hemiarthroplasty is widely recommended for the treatment of femoral neck fractures in elderly patients, but it is controversial in choosing cemented or cementless fixation types.

    OBJECTIVE: To compare the clinical effects of cemented hemiarthroplasty with cementless hemiarthroplasty for the treatment of femoral neck fractures in elderly and to provide a scientific basis for the selection of clinical prosthesis.
    METHODS: 167 elderly patients with femoral neck fractures undergoing hemiarthroplasty in the Foshan Hospital of Traditional Chinese Medicine from March 2013 to March 2015 were enrolled in this study. According to the type of prosthesis, patients were divided into cementless group (n=81) and cemented group (n=86). The operation time, intraoperative blood loss, hemoglobin levels 1 day after surgery, reoperation rate, mortality and complications at 1 year after surgery were compared. After surgery, clinical function of hip joint was assessed by Harris scoring system. The pain was evaluated by Visual Analogue Scale.
    RESULTS AND CONCLUSION: (1) All patients were followed up for ≥ 12 months. (2) The operation time in the cementless group was significantly shorter than that in the cemented group (P < 0.01). (3) There was no significant difference in the intraoperative blood loss and hemoglobin levels at postoperative 1 day (P > 0.05). (4) There were no significant differences in Harris hip scores and Visual Analogue Scale score at various time points between both groups (P > 0.05). (5) The incidence of thigh pain in cementless group was slightly higher than that in cemented group at 1 week, 1 and 6 months after operation, but the differences were not statistically significant (P > 0.05). Two patients died from myocardial infarct in the cementless group, and one patient died from pulmonary infection in the cemented group. The mortality was not significantly different at postoperative 1 year between the two groups (P > 0.05). No complications, such as prosthesis loosening and sinking, periprosthetic fracture, and periprosthetic infection, which needed to be refurbished, occurred in both groups. (6) Our findings suggest that both cemented and cementless hemiarthroplasties can obtain satisfactory effect in the treatment of femoral neck fractures in the elderly patients. Cementless hemiarthroplasty can significantly shorten operation time. 

    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 the stability of direct anterior approach versus posterolateral approach in minimally invasive total hip arthroplasty   
    Gao Yi, Qu Yu-xing, Zhou Qi, Wang Bin, Zheng Chong, Luo Li-li
    2018, 22 (7):  997-1002.  doi: 10.3969/j.issn.2095-4344.0108
    Abstract ( 423 )   PDF (1269KB) ( 141 )   Save

    BACKGROUND: At present, minimally invasive total hip arthroplasty is gradually developed, and becomes one of the representative types of total hip arthroplasty. The direct anterior approach is characterized by small tissue injury, low postoperative complications and rapid postoperative recovery. Compared with other approaches, there is still a lot of controversy on whether the approach can obtain better early and long-term effects.

    OBJECTIVE: To compare the clinical effect of direct anterior approach and posterolateral approach in minimally invasive total hip arthroplasty.
    METHODS: Totally 88 patients with minimally invasive total hip arthroplasty from September 2015 to September 2016 in the First Department of Orthopedics, Changzhou City Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine were selected as the subjects. The patients were divided into direct anterior approach group and posterolateral approach group, with 44 patients in each group. The incision length, operation time, postoperative drainage volume, blood transfusion volume, hemoglobin difference before and after operation, time of bed walking, postoperative acetabular abduction angle and acetabular anteversion angle were recorded and compared. Blood sedimentation rate, C-reactive protein levels, complications (infection, vascular injury and hip dislocation), hip function Harris score preoperatively, postoperatively 1, 3, and 6 months were analyzed.
    RESULTS AND CONCLUSION: (1) There was no significant difference in the postoperative acetabular abduction angle and acetabular anteversion angle between both groups (P > 0.05). (2) The average operation time of the patients in the direct anterior approach group was significantly longer than that in the posterolateral approach group (P < 0.05). The length of incision, intraoperative blood loss, postoperative drainage volume, hemoglobin difference, postoperative erythrocyte sedimentation rate, postoperative C-reactive protein and time of bed walking were significantly lower in direct anterior approach group than in posterolateral approach group (P < 0.05). (3) Harris score of direct anterior approach group was significantly higher than that of posterolateral approach group (P < 0.05). There was no significant difference in Harris score between the two groups before and 6 months after operation (P > 0.05). (4) There was no significant difference in postoperative complications between the two groups (P > 0.05). (5) There is no significant difference in the efficacy during 6-month follow-up and postoperative complications between posterolateral approach and direct anterior approach, but the direct anterior approach is less traumatic, with faster postoperative recovery, higher joint stability, more consistent with minimally invasive surgery and the concept of rapid 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
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    Application of recombinant human erythropoietin combining with tranexamic acid in perioperative period of minimally invasive total hip arthroplasty  
    Zhang Han, Hu Zheng-xia, Lan Hai
    2018, 22 (7):  1003-1008.  doi: 10.3969/j.issn.2095-4344.0109
    Abstract ( 392 )   PDF (1224KB) ( 137 )   Save

    BACKGROUND: Minimally invasive total hip arthroplasty is less invasive and has less tissue injury than traditional approach. However, perioperative anemia is still common, affecting hip function recovery and increasing patient burden.

    OBJECTIVE: To assess the curative effects of recombinant human erythropoietin on hemorrhagic anemia after minimally invasive total hip arthroplasty.
    METHODS: Clinical data of 35 patients undergoing SuperPATH minimally invasive total hip arthroplasty in the Department of Orthopedic Surgery, the Affiliated Hospital/Clinical Medical College of Chengdu University were collected. The patients were divided into the control group (n=17) and the erythropoietin group (n=18) according to the presence and absence of erythropoietin. The patients in the erythropoietin group were subcutaneously injected with recombinant human erythropoietin 3 days before replacement, once a day, lasting to 8 days after operation, for 12 consecutive days. During erythropoietin administration, iron sucrose was added once a day. Tranexamic acid 1 g was intravenously infused 0.5 hour before replacement, and 1 g for washing medullary cavity during replacement. The patients in the control group only took iron sucrose, once a day, adding tranexamic acid through intravenous infusion 0.5 hour before replacement. Levels of hemoglobin and hematocrit were monitored on the day of admission, the preoperative 3 days, the operation day, the postoperative 4 days and the postoperative 8 days. The operation time, blood loss, Visual Analogue Scale pain score 4 days before and after replacement and Harris hip function score before replacement, 4 and 8 days after replacement were recorded.
    RESULTS AND CONCLUSION: (1) Baseline data were not significantly different between the two groups (P > 0.05). (2) Visual Analogue Scale pain score significantly decreased 4 days after replacement in both groups (P < 0.05), and was not significantly different between both groups at various time points (P > 0.05). Harris hip score was not significantly different before and 1 day after replacement between the two groups (P > 0.05). At 4 days after replacement, Harris hip score was significantly higher in the erythropoietin group than in the control group (P < 0.05). Mean blood loss and operation time were not significantly different between the two groups (P > 0.05). (3) Levels of hemoglobin and hematocrit were not significantly different on the day of admission and 1 day before replacement (P > 0.05). Levels of hemoglobin and hematocrit were higher in the erythropoietin group than in the control group during emergency examination, 4 and 8 days after replacement (P < 0.05). The changes in levels of hemoglobin and hematocrit were consistent in different groups. The decreased trend was smooth, but the increased trend was relatively steep in the erythropoietin group. (4) Results confirmed that recombinant human erythropoietin combined with iron sucrose combined adding tranexamic acid, can effectively improve the anemia in perioperative period of minimally invasive total hip arthroplasty. Moreover, hemoglobin levels can increase to the stable and normal levels. 

    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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    Application of hypobaric ropivacaine spinal anesthesia and nerve block anesthesia in hip surgery of elderly patients
    Hao Chun-xiang, Han Chun-ji, Chen Guo-qing, Liu Shu-yun, Zhang Chang-sheng
    2018, 22 (7):  1009-1003.  doi: 10.3969/j.issn.2095-4344.0110
    Abstract ( 387 )   PDF (1052KB) ( 111 )   Save

    BACKGROUND: The rational choice of anesthesia for the elderly patients with hip surgery not only ensures the smooth operation, but also significantly reduces the incidence of postoperative complications.

    OBJECTIVE: To compare the clinical anesthetic effects between combined lumbar plexus-sciatic nerve block and hypobaric ropivacaine spinal anesthesia in hip joint surgery of elderly patients.
    METHODS: Forty patients who were scheduled for hip joint surgery, at the age of 65-99 years old, American Society of Anesthesiologists grades II-III, were enrolled and randomly allocated to two groups: nerve block (n=20) and spinal anesthesia (n=20). In nerve block group, combined lumber plexus-sciatic nerve block was performed directed by a nerve stimulator under the guidance of ultrasound. In spinal anesthesia group, patients received single-dose hypobaric ropivacaine spinal anesthesia at L3-4 interspace. Hemodynamic changes, anesthetic effects and perioperative adverse effects were recorded in both groups before and after anesthesia.
    RESULTS AND CONCLUSION: (1) The patients’ heart rate and mean artery pressure in each group did not change significantly before and after anesthesia in the nerve block and spinal anesthesia groups (P > 0.05). (2) The onset time of anesthesia in spinal anesthesia group was significantly faster than that in nerve block group (P < 0.01). Hypobaric ropivacaine spinal anesthesia had a better analgesic effect during the surgery, which did not need extra intravenous anesthetics. The duration of motor and sense block was significantly longer in nerve block group than in spinal anesthesia group (P < 0.01). However, five patients in spinal anesthesia group needed extra intravenous anesthetics to finish the surgery. (3) No side effects were found in both nerve block and spinal anesthesia groups. (4) These indicated that compared to combined lumbar plexus-sciatic nerve block, hypobaric ropivacaine spinal anesthesia can provide a better analgesic effect during the hip joint surgery with stable hemodynamics. Moreover, hypobaric ropivacaine spinal anesthesia dose not increase the incidence of complications and has very good clinical application prospects.

    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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    Short-term outcomes of displaced femoral neck fractures treated with hemiarthroplasty using direct anterior approach  
    Li Gang, Wang Yue
    2018, 22 (7):  1014-1019.  doi: 10.3969/j.issn.2095-4344.0111
    Abstract ( 449 )   PDF (1540KB) ( 146 )   Save

    BACKGROUND: Posterolateral approach is the conventional approach which has been used in the treatment of displaced femoral neck fractures treated by hemiarthroplasty. The clinical curative effect of hemiarthroplasty through a direct anterior approach which has gradually developed is still controversial.

    OBJECTIVE: To compare the clinical effects of displaced femoral neck fractures treated with hemiarthroplasty using direct anterior approach and posterolateral approach.
    METHODS: A total of sixty-five patients with displaced femoral neck fracture were selected between January 2014 and January 2016 and randomly divided into two groups. The two groups were treated with hemiarthroplasty using direct anterior approach (direct anterior approach group) and posterolateral approach (posterolateral approach group) respectively. Intraoperative and postoperative clinical data, preoperative and final follow-up Harris score and complications were observed between the two groups. The health-related quality of patients’ life was evaluated by using the EQ-5D index.
    RESULTS AND CONCLUSION: Surgical time, length of incision, intraoperative blood loss and postoperative drainage volume in direct anterior approach group were superior over posterolateral approach group (P < 0.05). No statistical differences were observed in postoperative time in bed and incision healing time between the two groups (P > 0.05). (2) Postoperative pain score in direct anterior approach group was superior over posterolateral approach group at 5-18 months of follow-up (P > 0.05). Harris score was higher in the direct anterior approach group than in the posterolateral approach group (P < 0.05). (3) No significant difference in health-related quality of patients’ life was determined between the two groups (P > 0.05). (4) There were one case with incision swelling in direct anterior approach group, one case with prosthesis dislocation and one case with periprosthetic fracture in posterolateral approach group. Pulmonary embolism or venous thrombosis of the lower extremities was not found in both groups. (5) These results suggest that both direct anterior approach and posterolateral approach can promote the recovery of hip function, and have good early clinical curative effects. Direct anterior approach is superior over posterolateral approach with the advantages of minor trauma and less bleeding, but it requires skilled operation technique. 

    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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    Short-term effectiveness of single-level Isobar TTL dynamic internal fixation in the treatment of lumbar degenerative diseases  
    Tian Yi-xing, Bao Zhao-hua, Zou Jun, Ji Yi-ming, Mei Xin, Pan Jun, He Wen-ye, Yang Hui-lin
    2018, 22 (7):  1020-1025.  doi: 10.3969/j.issn.2095-4344.0052
    Abstract ( 435 )   PDF (1205KB) ( 114 )   Save

    BACKGROUND: The short-term effects of dynamic internal fixation and whether dynamic internal fixation system can prevent or delay the process of adjacent level degeneration after lumbar surgery remain in controversy.

    OBJECTIVE: To investigate the short-term clinical effectiveness of single-level Isobar TTL dynamic internal fixation in the treatment of degenerative lumbar diseases.
    METHODS: Data of 20 patients who suffered from lumbar degenerative diseases and underwent posterior decompression combined with single-level Isobar TTL dynamic internal fixation, including 11 male patients and 9 female patients, were retrospectively analyzed; the average age of these patients was 47.4 (35-62) years old. Visual analog scale, Japanese Orthopaedic Association scores and Oswestry disability index were used to assess clinical outcomes. Disc height, range of motion, and University of California at Los Angeles Grading Scale were measured on X-ray films to evaluate the status of disc degeneration on both dynamic fixed segment (index segment) and superior adjacent segment.
    RESULTS AND CONCLUSION: All follow-up patients successfully completed the operation. The average follow-up time was 14.4 (12-27) months. No blood vessels, nerve injury, loose internal fixation or rupture occurred. At the last follow-up, Visual Analog Scale, Japanese Orthopaedic Association scores and Oswestry Disability Index were significantly improved (P < 0.05); range of motion of dynamic fixation segment reduced (P < 0.05) as compared with that before surgery. Intervertebral height of dynamic fixation segments and University of California at Los Angeles Grading Scale classification were not significantly different between follow-up and before surgery (P > 0.05). Intervertebral height of superior adjacent segment, intervertebral range of motion and University of California at Los Angeles Grading Scale classification were not significantly different (P > 0.05). These results indicate that single-level Isobar TTL dynamic internal fixation proved to have satisfactory clinical outcomes in the treatment of lumbar degenerative diseases. During follow-up, disc degeneration on either index segment or superior adjacent segment is not accelerated. 

    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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    Related factors for dysphagia after single-level anterior cervical descectomy and fusion
    Lu Ying-jie, Bao Wei-guo, Zou Jun, Zhou Feng, Jiang Wei-min, Yang Hui-lin, Zhang Zhi-ming, Zhu Xue-song
    2018, 22 (7):  1026-1031.  doi: 10.3969/j.issn.2095-4344.0112
    Abstract ( 359 )   PDF (1316KB) ( 148 )   Save

    BACKGROUND: Patients with anterior cervical discectomy and fusion have a high incidence of dysphagia, which may be associated with a variety of factors. The specific mechanism remains unclear.

    OBJECTIVE: To explore the related factors of dysphagia after single-level anterior cervical discectomy and fusion.
    METHODS: We retrospectively analyzed patients with cervical degenerative disc disease receiving single-level anterior cervical discectomy and fusion in First Affiliated Hospital of Soochow University from January 2011 to January 2015. During hospitalization, basic patient data and surgery-related data were recorded, including operation time, intraoperative blood loss, surgical segment, internal fixation device and the use of recombinant human bone morphogenetic protein-2. The cervical alignment and prevertebral soft tissue swelling were measured preoperatively and 3 days postoperatively. At 1, 3, 6, 12, and 24 months postoperatively, the Bazaz swallowing function scoring system was used to assess the swallowing of the patients.
    RESULTS AND CONCLUSION: A total of 262 patients undergoing single-level anterior cervical discectomy and fusion were involved. The incidence of dysphagia at 1, 3, 6, 12, and 24 months postoperatively was 35.9%, 22.9%, 15.6%, 11.5% and 9.2% respectively. Univariate analysis showed that gender, operation time and course length were associated with postoperative dysphagia. Logistic multivariate regression analysis showed that the duration of operation (≥ 3 hours), female and course length (≥ 8 months) were risk factors for dysphagia after anterior cervical descectomy and fusion. Operation time and female may be associated with early and middle dysphagia postoperatively, and the course length may be associated with chronic dysphagia. Prevertebral soft tissue swelling and other factors are not related to dysphagia after single-level anterior cervical discectomy and fusion. Risk factors for dysphagia after multi-level fusion should be further studied.

    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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    Non-surgical spinal decompression system versus conventional traction device for treating lumbar disc herniation through surface electromyography  
    Feng Xian-xuan, Xu Yi-ming, Cai Yun, Bai Yue-hong
    2018, 22 (7):  1032-1037.  doi: 10.3969/j.issn.2095-4344.0113
    Abstract ( 532 )   PDF (1152KB) ( 238 )   Save

    BACKGROUND: Non-surgical spinal decompression system can be used for the treatment of diseased intervertebral discs and avoid contraction and resistance of paravertebral muscle during traction. At present, there is lack of analysis of the efficacy of non-surgical spinal decompression in the treatment of lumbar disc herniation through surface electromyography.

    OBJECTIVE: To compare the effect of non-surgical spinal decompression system DRX9000 with conventional traction device in the treatment of lumbar disc herniation through surface electromyography.
    METHODS: Totally 60 patients with lumbar disc herniation were randomly divided into DRX9000 group and general traction group, with 30 cases in each group. The patients in DRX9000 group were treated with non-surgical spinal decompression system DRX9000 and the patients in general traction group were treated with conventional tractor. All patients underwent surface electromyography examination of erector spinal muscle and multifidus muscle before and after all treatment to evaluate the strength and fatigue of paravertebral muscle. The Visual Analogue Scale and Japanese Orthopaedic Association scores were used to assess the degree of pain and impairment due to lumbar disc herniation.
    RESULTS AND CONCLUSION: (1) After all of the treatment, the average electromyogram and mean power frequency slope of affected erector spinal muscle and multifidus muscle in both groups were increased than those before treatment (P < 0.05). The data of DRX9000 group were significantly higher than that of the general traction group (P < 0.05). (2) After all the treatment, the Visual Analogue Scale score decreased and the Japanese Orthopaedic Association score increased in both groups at the end of treatment compared with before treatment (P < 0.05). The Visual Analogue Scale score of DRX9000 group was significantly lower than that of the general traction group (P < 0.05) and the Japanese Orthopaedic Association score of DRX9000 group was significantly higher than that of the general traction group (P < 0.05). (3) These results showed that non-surgical spinal decompression system could effectively improve paravertebral muscle activity and muscle strength, lessen muscle fatigue, relieve pain, and improve function in patients with lumbar disc herniation, and its effect is obviously better than that of general traction.

    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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    Measurement of vertebral “shell” volume after thoracolumbar fracture reduction  
    Zhong Ze-li, Hu Hai-gang, Lin Xu, Tan Lun, Wu Chao, Zeng Jun, Deng Jia-yan
    2018, 22 (7):  1038-1043.  doi: 10.3969/j.issn.2095-4344.0114
    Abstract ( 438 )   PDF (1407KB) ( 144 )   Save

    BACKGROUND: Posterior screw rod system reduction and internal fixation is often used to treat thoracolumbar fractures (T11-L2). However, the “shell” phenomenon is focused on imaging findings and lacks of in-depth clinical research.

    OBJECTIVE: To explore the new method of “shell” volume measurement of vertebral body after thoracolumbar fractures reduction, and to evaluate the effect of different “shell” sizes on clinical treatment.
    METHODS: From January 2013 to December 2015, 72 patients with thoracolumbar fractures were treated in the No. 4 People’s Hospital of Zigong City retrospectively. The patients with vertebral "shell" were retrospectively analyzed. Clinical and imaging data (X ray, CT and MRI) were collected. Compression degree of anterior border of the vertebral body, Cobb angle, Visual Analogue Scale score and reduction-related complication were recorded and analyzed. The volumes of vertebral “shell” and the injured vertebral body were measured by Mimics software. The volume ratio of shell/injured vertebral body was calculated. The healing of vertebral “shell” was followed up and observed. 
    RESULTS AND CONCLUSION: (1) Among the 72 patients, there were 16 cases with a shell/injured vertebral volume ratio of < 5% (group A), 30 cases with the volume ratio of 5%-10% (group B), and 26 cases with volume ratio of > 10% (group C). (2) The “shell” healing: The “shell” nonunion rate was significantly lower in the groups A and B than in the group C (P < 0.05); and significant differences were not determined between groups A and B (P > 0.05). (3) Compression degree of the anterior border of the injured vertebral body: No significant difference was found in groups A, B and C before and right after reduction (P > 0.05). The compression was significantly higher in the groups A and B than in group C at final follow-up (P < 0.05). (4) Cobb angle was not significantly different in groups A, B and C before and right after reduction and during final follow-up (P > 0.05). (5) Visual Analogue Scale score was not significantly different between groups A and B and group C right after reduction (P > 0.05). The Visual Analogue Scale score was significantly better in the groups A and B than in the group C (P < 0.05). (6) Occurrence of complications: In the group A, one case affected incision exudate. In the group B, one case experienced incision infection and one case suffered from screw loosening. In the group C, two cases affected screw loosening, and one case experienced unilateral connecting rod fracture. No significant difference in complications was detected among groups A, B and C (P > 0.05). (7) Results indicate that the “shell” nonunion rate was high when vertebral shell/injured vertebral body volume ratio > 10%; loss of posterior vertebral height and chronic lumbago and back pain easily appeared. The measurement of the volume of vertebral "shell" plays an important role in clinical prognosis and treatment options of thoracolumbar judgment.

    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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    Polyaxial pedicle screw via minimally invasive intermuscular space approach in treatment of lumbar spondylolisthesis: short-term efficacy and safety  
    Xu Jia-xin
    2018, 22 (7):  1044-1049.  doi: 10.3969/j.issn.2095-4344.0115
    Abstract ( 387 )   PDF (1140KB) ( 243 )   Save

    BACKGROUND: Traditional posterior lumbar interbody fusion has been proven to be effective for the treatment of lumbar spondylolisthesis. The traditional surgery has a high requirement for internal fixation instruments, and it is difficult to popularize, and it has the disadvantage of serious injury to back muscles.

    OBJECTIVE: To investigate the short-term efficacy and safety of polyaxial pedicle screw via minimally invasive intermuscular space approach in treatment of lumbar spondylolisthesis.
    METHODS: Totally 96 patients with lumbar spondylolisthesis received diagnosis and surgery in Third Hospital, Hebei Medical University from August 2015 to August 2016. They were divided into traditional surgery group and minimally invasive polyaxial pedicle screw group by random number table, with 48 cases in each group. Traditional surgery group received midline incision pedicle screw insertion through traditional lumbar posterior approach. Minimally invasive polyaxial pedicle screw group received minimally invasive polyaxial pedicle screw insertion through bilateral posterior lumbar intermuscular approach. Operation time and intraoperative blood loss were compared between the two groups. At 6 months after follow-up, Visual Analogue Scale scores and Oswestry Disability Index were recorded before surgery, 1 and 3 days, 2 weeks, 1, 3 and 6 months after surgery between the two groups. The reduction rate of spondylolisthesis, fusion rate, and incidence of complications after surgery were analyzed 1, 3 and 6 months after surgery.
    RESULTS AND CONCLUSION: (1) The perioperative indexes in minimally invasive polyaxial pedicle screw group were significantly better than those in traditional surgery group (P < 0.05). (2) Visual Analogue Scale scores and Oswestry Disability Index were significantly lower in the minimally invasive polyaxial pedicle screw group than those in traditional surgery group at 3 days, 2 weeks, 1, 3 and 6 months after surgery (P < 0.05). (3) The reduction rate and the fusion rate were significantly higher in the spondylolisthesis in minimally invasive polyaxial pedicle screw group than those in traditional surgery group at 1, 3 and 6 months after surgery (P < 0.05). (4) The incidence was significantly lower in the minimally invasive polyaxial pedicle screw group than in the traditional surgery group (4% versus 17%; P < 0.05). (5) Results indicated that polyaxial pedicle screw via minimally invasive intermuscular space approach in treatment of lumbar spondylolisthesis is safe and reasonable, which can improve perioperative indexes, reduce lumbar disability and relieve patients’ pain.

    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 percutaneous and open pedicle screw system in the treatment of multilevel thoracolumbar fractures: the accuracy of screw placement   
    Luo Peng-gang, Jin Da-di, Wu Zeng-zhi, Ling Hua-jun, Lin Wei-wen, Zhong Si-long
    2018, 22 (7):  1050-1055.  doi: 10.3969/j.issn.2095-4344.0116
    Abstract ( 388 )   PDF (1158KB) ( 141 )   Save

    BACKGROUND: Multilevel thoracolumbar fractures are mainly treated with percutaneous pedicle screw and open pedicle screw system, but the treatment effect of different systems and the accuracy rate of screw placement are controversial, resulting in the lack of uniform standards for choosing the treatment method.

    OBJECTIVE: To evaluate the effect of percutaneous pedicle screw and open pedicle screw system in the treatment of multilevel thoracolumbar fractures and to evaluate the accuracy of the screw placement.
    METHODS: Totally 90 patients with multilevel thoracolumbar fractures were divided into open pedicle screw group (n=43 cases) and percutaneous pedicle screw group (n=47) according to different surgical methods. Open pedicle screw group was treated with open pedicle screw treatment, and percutaneous pedicle screw group was treated with percutaneous pedicle screw. Comprehensive effects were analyzed by comparing perioperative indicators (operation time, postoperative drainage volume, and incision length) imaging index (anterior vertebral height percentage, posterior vertebral height percentage, sagittal Cobb angle), postoperative complications, and pedicle screw accuracy.
    RESULTS AND CONCLUSION: (1) The amount of bleeding, postoperative drainage volume, and incision length were less (shorter) in the percutaneous pedicle screw group compared with the open pedicle screw group (P < 0.05). However, operation time and the number of undergoing fluoroscopy were longer (more) in the percutaneous pedicle screw group than in the open pedicle screw group (P < 0.05). (2) Anterior vertebral height percentage and posterior vertebral height percentage were higher in the percutaneous pedicle screw group than in the open pedicle screw group (P < 0.05). Sagittal Cobb angle was smaller in the percutaneous pedicle screw group than in the open pedicle screw group (P < 0.05). (3) At 2 months after surgery, the complication rate was significantly lower in the percutaneous pedicle screw group (4%) than in the open pedicle screw group (14%) (P < 0.05). (4) The accuracy rate of pedicle screw was significantly higher in the percutaneous pedicle screw group (92.1%; 279 screws) than in the open pedicle screw group (77.0%; 257 screws) (P < 0.05). (5) Results indicated that percutaneous pedicle screw fixation is characterized by less trauma and rapid recovery in the treatment of multilevel thoracolumbar fractures. It is helpful for the reduction of the injured vertebra, the maintenance of vertebral height; the safety and the accuracy of screw placement are high.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Geometric features of proximal closing wedge osteotomy in the treatment of hallux valgus  
    Mao Wei, Zhang Jian-zhong, Sun Chao, Wang Xian-jun, Li Hai-tao
    2018, 22 (7):  1056-1065.  doi: 10.3969/j.issn.2095-4344.0117
    Abstract ( 428 )   PDF (1536KB) ( 167 )   Save

    BACKGROUND: With the wide application of the proximal closing wedge osteotomy in treatment of hallux valgus deformity, the metatarsal shortening and metatarsal elevation are constantly being mentioned. Scholars even think that the operation is complicated, the technical requirements are high, and the incidence of complications is high, and other osteotomy should be used instead. However, through literature research and clinical experience, it is found that the facts are not completely the case.

    OBJECTIVE: To perform geometric study of the plane and the physical model of the proximal closing wedge osteotomy so as to reasonably evaluate the effect of this technique on metatarsal shortening and metatarsal elevation. 
    METHODS: The research was divided into four stages, in which the first three stages were plane geometric researches, with weight-bearing frontal image of the patient with hallux valgus as the research materials; the fourth one was solid geometric research, with plaster model of the first metatarsal bone as the research material. In research I (Stage I), the changes in 1/2 inter-metatarsal angle, length of the first metatarsal and distal metatarsal articular angle were learnt through angle adjustment after clipping when the distance from the wedge osteotomy vertex to medial border of the first tarsometatarsal joint was different (B, A, C, D respectively from the near to the distant, with a distance of 10 mm). In research II (Stage II), the changes in 1/2 inter-metatarsal angle, length of the first metatarsal and distal metatarsal articular angle were learnt through angle adjustment after clipping when the distance from the wedge osteotomy vertex to medial and lateral connection of the first tarsometatarsal joint was same, and the distance from the wedge osteotomy vertex to axis of the first metatarsal bone was different. In research III (Stage III), the changes in the above-mentioned research indexes were studied through angle adjustment after clipping when the wedge osteotomy vertex and wedge angle were fixed, but the proximal osteotomy line slope was different. Research IV (Stage IV) was the simulated osteotomy comparison, osteotomy perpendicular to metatarsal backbone or perpendicular to the horizontal plane was conducted on the model through plaster casting, and then osteotomy section was closed; the changes in elevation of the metatarsal head, 1/2 inter-metatarsal angle and length of the first metatarsal bone were measured.
    RESULTS AND CONCLUSION: (1) Results of plane geometry: The closer the wedge osteotomy vertex was to the proximal end, the larger the correction gained was and the smaller the changes in the distal metatarsal articular angle were, but the shortening was more obvious. Moreover, the closer the wedge osteotomy vertex was to the axis of the metatarsal bone, the smaller the shortening was; if only the proximal osteotomy line was different, the indices were the same. (2) Results of stereoscopic geometry: In the case of the same osteotomy angle, the cuneiform bone of the same angle was intercepted, and the degree of correction was obviously greater than that of the plane geometry. This should be related to the thickness of the osteotomy saw and the loss of bone mass caused by the osteotomy. The metatarsal bone was significantly higher after correction when perpendicular to the metatarsal stem compared with that perpendicular to the horizontal surface. In 1/2 inter-metatarsal angle, the difference between the two was only 1°. In metatarsal shortening, it was smaller when perpendicular to the metatarsal stem compared with that perpendicular to the horizontal surface. (3) In conclusion, a. the optimal wedge osteotomy vertex is not at the medial border of the joint but is 1 cm from the medial border of the joint; then, it will approach the axis of the metatarsal. In this way, good correction, steady fixation and further reduction of metatarsal shortening can be achieved. b. The optimal direction of the oscillating saw blade is perpendicular to horizontal plane; however, an approximately perpendicular position to the horizontal plane is acceptable. It does not affect the effect of orthopedics, and further reduces the metatarsal shortening. When the bony closure is closed, the distal end of the metatarsal bone is taken to avoid the elevation of the metatarsal bone with a 2 mm step with the proximal end. c. The angle selection of proximal osteotomy surface can be placed on the metatarsal stem according to the internal fixation condition, and it can also form an acute angle with the metatarsal stem, so that the effect of osteotomy will not be changed.

    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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    Imaging and histological changes of the healing process of experimental sheep femoral fracture using different fixation methods  
    Feng Li-ping, Yang Wei-qiang, Ding Tong, Zhang Fu-mei, Jiang Zhen-gang, Wang Pei-shan
    2018, 22 (7):  1066-1071.  doi: 10.3969/j.issn.2095-4344.0118
    Abstract ( 496 )   PDF (2486KB) ( 186 )   Save

    BACKGROUND: Ordinary bone plate fixation is prone to have "stress shielding" effect, and combined variable stress plate fixation can reduce the "stress shielding" effect of the plate, and promote the normal bone healing, reduce the complications caused by ordinary steel and shorten the fracture healing time.

    OBJECTIVE: To explore the effects of different internal fixation methods on the imaging and histology in the healing process of experimental sheep femoral fracture.
    METHODS: Thirty-two healthy adult goats were randomly divided into the experimental group and the control group with 16 cases in each group. The fractured animal model was constructed by femoral osteotomy. The experimental group and the control group were treated with combined variable stress plate and ordinary straight plate respectively for fixation. The X-ray, CT and histological methods were used to observe and compare callus 4, 8 and 12 weeks after fixation.
    RESULTS AND CONCLUSION: (1) X-ray examination results showed that the fracture lines of the two groups were gradually from obscured to complete healing at 4 to 12 weeks after fixation, and the gap between the fracture ends was significantly reduced. When internal fixator was taken out, the callus around fracture end was little and hard and the bone plate was without callus coverage in the experimental group. There were a large number of callus covered in bone plate and large bone callus around the plate in the control group. (2) CT examination results showed that CT value and callus cross-sectional area value were gradually increased in two groups at 4 to 12 weeks after treatment. The values in the experimental group at 4, 8 and 12 weeks after treatment were significantly higher than those in the control group (P < 0.05), and the diameter of medullary cavity in the control group at 8 and 12 weeks after treatment was significantly higher than that in the experimental group (P < 0.05). The cortical bone thickness was significantly lower in the control group than that in the experimental group (P < 0.05). (3) Histological examination showed that compared with the control group, the fracture line was healed and the intramedullary fibrous callus was reduced and was sparse, and most of callus was absorbed and marrow cavity recanalization appeared in the experimental group. (4) The results show that combined variable stress plate fixation can provide a stable biomechanical environment for early healing of femoral fractures, reduce the stress shielding effect of steel plate and promote the callus formation, thereby helping fracture healing. 

    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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    Effects of different doses of microwave therapy on adjacent tissue of titanium alloy implants after fracture surgery
    Wang Gang, Xu Yi-ming, Ye Dong-mei, Fu Teng-fei, Zou Yu-zhen, Feng Xian-xuan, Bai Yue-hong
    2018, 22 (7):  1072-1077.  doi: 10.3969/j.issn.2095-4344.0119
    Abstract ( 487 )   PDF (4291KB) ( 172 )   Save

    BACKGROUND: Microwave treatment is a common physical therapy method that can increase the temperature and blood circulation of deep tissues, and is used for improving fracture repair. However, microwave treatment cannot be used if there is surgically implanted metal plate or screw.

    OBJECTIVE: To observe the dame of microwave treatment to the tissues surrounding the titanium alloy implants.
    METHODS: Forty-four New Zealand white rabbits were randomized into experimental and control groups. The model of the fracture at the middle of the femur was established in all rabbits, and the rabbits in the experimental group were implanted with titanium alloy internal fixation systems. A 30-day microwave treatment (2 450 MHz, 20 W or 40 W, 20 minutes daily) was applied to the fracture site in all rabbits at 3 days after operation.
    RESULTS AND CONCLUSION: After 20 W of wave microwave treatment, the temperature of tissues around the implants showed no significant increase or severe heat injury. While, 40 W of wave microwave treatment significantly increased the temperature of tissues around the implants and the tissue was damaged severely. Our results indicate that, the low-dosage microwave treatment may be a promising method in the rehabilitation therapy of fractures with titanium alloy internal fixation.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    A new fixation and reconstruction method versus arthroscopic reconstruction for treating avulsion fracture at the tibial insertion of the knee posterior cruciate ligament: study protocol for a non-randomized controlled trial and preliminary results
    Chen Guang-dong, Zhang Yang, Ni Yong-jian, Du Hong-mei, Cao Tong-jun, Shan Zhong-lin
    2018, 22 (7):  1078-1083.  doi: 10.3969/j.issn.2095-4344.0120
    Abstract ( 297 )   PDF (1397KB) ( 135 )   Save

    BACKGROUND: Arthroscopic reconstruction for treatment of avulsion fracture at the tibial insertion of the knee posterior cruciate ligament (PCL) can minimize surgical trauma to the largest degree. However, its implants have relatively poor stability; therefore, functional exercise cannot be performed in the early stages after surgery, which is inconducive to knee function recovery. It is extremely challenging to perform traditional open reduction with internal fixation to repair avulsion fractures at the tibial insertion of the knee PCL. Often, the crushed bones cannot be firmly fixed, leading to a poor repair effect.

    OBJECTIVE: To design a new inverted “L”-shaped incision in the popliteal fossa through which bone plates were inserted to fix the crushed bones and to reconstruct PCL tension, facilitating knee function recovery; to compare the therapeutic effects of this new fixation and reconstruction method, and arthroscopic reconstruction for treating avulsion fracture at the tibial insertion of the knee PCL.
    METHODS: A prospective, single-center, non-randomized controlled trial. One hundred and eighty patients (knees) with avulsion fracture at the tibial insertion of the knee PCL will be assigned to two groups based on treatment methods: arthroscopic reconstruction group (n = 90; fracture fixation and repair under the arthroscope) and new method group (n = 90; bone plates will be inserted through an “L”-shaped incision in the popliteal fossa to fix the crushed bones and reconstruct PCL tension). After surgery, these patients will be followed up for 6 weeks, 6 months, and 12 months.
    RESULTS AND CONCLUSION: The primary outcome measure is the excellent and good rate of knee function recovery at 12 months after surgery as evaluated by Lysholm Knee Scoring Scale score (Herein referred to as Lysholm score). The secondary outcome measures are the excellent and good rate of knee function recovery before surgery, 6 weeks and 6 months after surgery; Lysholm score before surgery, 6 weeks, 6 months and 12 months after surgery; Hospital for Special Surgery (HSS) knee score, Visual Analogue Scale (VAS) score, posterior drawer test negative rate, X-ray morphology of the knee before surgery, and 6 weeks, 6 months, and 12 months after surgery and; incidence of adverse events at 6 weeks, 6 months and 12 months after surgery. Results of a preliminary study involving 62 patients (knees) with avulsion fracture at the tibial insertion of the knee PCL showed that posterior drawer test negative rate and Lysholm score were significantly higher in the new method group compared to the arthroscopic reconstruction group (P < 0.05) at 3 months after surgery. This study will be performed to compare the therapeutic effects of bone plate insertion through an “L”-shaped incision made in the popliteal fossa to fix the crushed bones and to reconstruct PCL tension, and traditional fracture fixation and repair under the arthroscope to treat avulsion fracture at the tibial insertion of the knee PCL. We believe that the former method will be superior to the latter one because it can fix the avulsion fracture more firmly, facilitating knee function recovery. This study was approved by Medical Ethics Committee of Cangzhou Central Hospital of China (approval No. 2017-120-01). This study will be performed in strict accordance with the Declaration of Helsinki formulated by the World Medical Association. Participants provided signed informed consent prior to participation in the study. This study was designed in December 2017. Patient recruitment and data collection will begin in April 2018. Patient recruitment will end in June 2019. Data analysis will be performed in August 2020. The study will be completed in October 2020. Results will be disseminated through presentations at scientific meetings and/or by publication in a peer-reviewed journal. This trial was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800015026). The version of this study protocol is (1.0).

    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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    Effectiveness and safety of arthroscopic debridement for treatment of degenerative knee osteoarthritis in the elderly patients: study protocol for non-randomized controlled clinical trial  
    Lu Yong-chun, Bi Bo, Xiang Yong-sheng, Du Xiang-yang
    2018, 22 (7):  1084-1089.  doi: 10.3969/j.issn.2095-4344.0121
    Abstract ( 382 )   PDF (1011KB) ( 141 )   Save

    BACKGROUND: The treatment of degenerative knee osteoarthritis is mainly to relieve pain, restore knee function, improve quality of life, delay knee replacement, and reduce the number of revisions. Knee replacement is currently the most common treatment for this disease, but it costs much, has great trauma and high risk, often results in prosthesis loosening and peripheral infection, and has many adverse reactions.

    OBJECTIVE: We hypothesize that knee-preserving arthroscopic debridement for treatment of knee degenerative osteoarthritis in the elderly patients costs less, is effective, safe, and reliable.
    METHODS:A total of 212 elderly patients (knees) with degenerative knee osteoarthritis who receive treatment in the Second Hospital of Chaoyang (Liaoning Province, China) will be included in this study. These patients will be assigned to two groups according to patient’s conditions and wishes (n = 106/group). In the control group, intra-articular injection of sodium hyaluronate will be performed, followed by oral administration of non-steroidal anti-inflammatory drugs, conventional physiotherapy, and quadriceps functional exercise. In the arthroscopic debridement group, arthroscopic debridement will be performed followed by oral administration of non-steroidal anti-inflammatory drugs, conventional physiotherapy, and quadriceps functional exercise. All patients will be followed up for 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years.
    RESULTS AND CONCLUSION: The primary outcome measure is the percentage of the number of patients with Hospital for Special Surgery (HSS) knee score ≥ 85 points at 2 years after surgery, which will be used to evaluate knee function recovery. The secondary outcome measures are the percentage of the number of patients with HSS knee score ≥ 85 points before surgery, 1 week, 1 month, 3 months, 6 months, and 1 year after surgery; HSS score, Visual Analogue Scale (VAS) score, The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee range of motion, hospitalization costs, and knee X-ray morphology before surgery, 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years after surgery, medical costs after 2 years of treatment, incidence of adverse reactions at 1 week, 1 month, 3 months, 6 months, 1 year and 2 years after surgery. Findings from this study will reveal whether arthroscopic debridement for the treatment of degenerative knee osteoarthritis in the elderly patients has advantages of less adverse reactions, low treatment costs, and can effectively restore knee function. This trial has been approved by the Second Hospital of Chaoyang, Liaoning Province, China (approval number: 2017-08-01). All protocols will be in accordance with Declaration of Helsinki, formulated by the World Medical Association. Written informed consent will be provided by participants. This trial was designed in June 2017. The recruitment of subjects and data collection will begin in June 2018. The recruitment of subjects will be finished in December 2018. Outcome measures will be analyzed in June 2021. This trial will be completed in August 2021. The results of the trial will be reported in a scientific conference or disseminated in a peer-reviewed journal. This trial had been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800015208). The version of this study protocol is (1.0).  

    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 finite element analysis on stress distribution after greater trochanter bone flap for treating osteonecrosis of the femoral head  
    Zhang Tian-yi, Dong Wei, Mi Pan-pan, Kong Fan-lin, Zhu Jun, Wu Jian-wei, Qiao Jin-huan, Fan Guo-feng, Tian Feng-de
    2018, 22 (7):  1090-1095.  doi: 10.3969/j.issn.2095-4344.0122
    Abstract ( 352 )   PDF (1005KB) ( 138 )   Save

    BACKGROUND: Three-dimensional finite element analysis has been used by many scholars from department of orthopedics, but the results of postoperative evaluation of hip preserving treatment for osteonecrosis of femoral head are different.

    OBJECTIVE: To study the biomechanical changes of the femoral head and the biomechanical changes of the proximal femur after greater trochanter bone flap for the treatment of femoral head necrosis using three-dimensional finite element method, and to verify the mechanical safety and effectiveness.
    METHODS: One case of unilateral femoral head necrosis in ARCOIII stage undergoing parallel vascularized greater trochanter bone flap transplantation was selected. Computed Tomography data of proximal femur were collected before and 6 months after the operation, and preserved in DICOM format. With the aid of computer technology, professional medical modeling software, MIMICS and HYPERMESH, were used to establish the three-dimensional geometric models of the proximal femur. These models were divided into normal group, necrosis group and repair group. Finite element analysis software ANSYS was utilized to simulate human body standing and movement in different situations. The model was divided by free mesh, and given material parameters to establish normal proximal femur, femoral head necrosis and bone defect. Greater trochanter bone flap was applied in repairing three-dimensional finite element model of bone defect. Loads were loaded on different finite element models. The maximum displacement of the femoral head and the stress distribution in the proximal femur of the three groups were observed under different loading models.
    RESULTS AND CONCLUSION: (1) Under the same load, the maximum displacement of the three sets of models was 0.61 mm in the normal group, 0.66 mm in the necrosis group, and 0.61 mm in the repair group, respectively. Maximum Von Mises stress was greater in necrosis model than in the normal molding. The maximum Von Mises stress gradually decreased in the repair model, and was close to normal value. (2) Three groups of models showed stress concentration above the rotor in femoral neck region. The maximum stress in the trochanteric position was higher in necrosis models than in normal models. The maximum stress in this region gradually increased after repair, but was still lower than the failure stress of bone. (3) The results confirm that the maximum stress and the maximum displacement are closer to the normal value after greater trochanter bone flap for treatment of osteonecrosis of the femoral head. The greater trochanter is safe and reliable for repairing bone defect of femoral head.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Finite element analysis for self-made femoral head brace device in the treatment of early femoral head necrosis
    Yang Li-feng, Xiao Dong-min, Peng Chun-lei, Li Kang-hua, Yang Bin-hui, Liu Feng-hu, Wei Yong-kun, Zhang Bo, Li Wu-jian, Zheng Jin-zhe, Wang Wei-gang
    2018, 22 (7):  1096-1101.  doi: 10.3969/j.issn.2095-4344.0123
    Abstract ( 353 )   PDF (3175KB) ( 121 )   Save

    BACKGROUND: Core decompression for early adult ischemic necrosis of femoral head gets the identity of most scholars, but the postoperative femoral head easily experiences collapse. How to prevent collapse is still a problem to be solved currently.

    OBJECTIVE: To perform biomechanical analysis of femoral head ischemic necrosis by using the finite element method and to provide biomechanical basis for the treatment of early adult femoral head necrosis.
    METHODS: One fresh femur specimen died of accidental death in youth and young adults was obtained, and no deformity or fracture was found. X-ray confirmed that it did not have tumor or osteoporosis. Spiral CT was used to scan normal femoral head and neck, pulp core decompression of femoral head and neck, brace device placement and bone-graft of femoral head and neck for acquiring image data from the proximal to distal vertical longitudinal axis. Scanning data were input in the Mimics software. Finite element method was utilized for biomechanical analysis of femoral head and neck of three models.
    RESULTS AND CONCLUSION: (1) The stress dispersal and downward conduction of normal femoral head was concentrated in the shaft of the femur and the tensile stress was concentrated in the rotor socket. (2) After pulp core decompression, the stress concentration, displacement and strain increased in the weight-bearing area of femoral head. (3) The stress of the internal bracing was similar to that of normal femoral head. (4) The stress of weight bearing area of femoral head is concentrated, and the strain is increased, so that weight bearing area is easy to collapse after pulp core decompression. The more stress distribution, more bearing load and less strain of implant and bone graft model, are conformed to the normal mechanical properties of the normal femoral head and neck. 

    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 resection versus vertebral column decancellation in treatment of ankylosing spondylitis kyphosis  
    Xie Jiang, Zhang Yu-kun, Li Li, Ma Jun-yi, Ma Yuan, Sui Jiang-tao, Ma Yong, Li Hui
    2018, 22 (7):  1102-1107.  doi: 10.3969/j.issn.2095-4344.0124
    Abstract ( 293 )   PDF (1277KB) ( 94 )   Save

    BACKGROUND: Sagittal imbalance makes significant effect on spinal biomechanics, and choosing osteotomy for ankylosing spondylitis depends on its biomechanics characteristics.

    OBJECTIVE: To establish a three-dimensional (3D) finite element model of kyphosis in ankylosing spondylitis treated by osteotomy on software, and to analyze its biomechanical properties, thus providing theoretical basis for clinical practice.
    METHODS: A 3D finite element model of kyphosis in ankylosing spondylitis was established based on CT data, and the predetermined angle of the osteotomy at L2 was measured. Afterwards, vertebral column decancellation and vertebral column resection were stimulated, and then the biomechanical parameters were analyzed.
    RESULTS AND CONCLUSION: (1) The 3D finite element models of kyphosis in ankylosing spondylitis treated by vertebral column decancellation or vertebral column resection at L2 were established successfully. (2) Finite element analysis on Ansys workbench 15.0 showed that the vertebral column decancellation (948 874, 1 564 477 nodes) and vertebral column resection (931 969, 1 548 812 nodes) were meshed and analyzed by 10-node tetrahedron solid element. (3) After loaded, the stress values of the vertebral column decancellation were higher than those of vertebral column resection; the equivalent stress on the screw was 40.946, 67.26, 493.64, 304.05, 75.359, and 146.31 MPa; the equivalent stress on the titanium rob was 391.01 MPa. (4) These results suggest that both two methods can reconstruct the sagittal balance, but vertebral column decancellation exhibits significantly higher stress values. Indeed, the incidence of internal fixation failure and complications in vertebral column decancellation is higher than that in vertebral column resection at the same segment and angle.

    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 finite element analysis of pediclesubtraction osteotomy for ankylosing spondylitis with kyphotic deformity
    Li Li, Xie Jiang, Ma Yuan, Li Hui
    2018, 22 (7):  1108-1113.  doi: 10.3969/j.issn.2095-4344.0125
    Abstract ( 355 )   PDF (1215KB) ( 101 )   Save

    BACKGROUND: The effect of pediclesubtraction osteotomy is obvious, and the incidence of correction degree loss is low. So, it has been the first choice for the correction of ankylosing spondylitis with kyphotic deformity.

    OBJECTIVE: To establish a three-dimensional finite element model of ankylosing spondylitis with kyphotic deformity by computer aided software, and to analyze the biomechanical characteristics.
    METHODS: A ankylosing spondylitis patient with kyphotic deformity was selected, and spinal full-length anteroposterior images were photographed, and the patient received magnetic resonance imaging. A three-dimensional model of ankylosing spondylitis with kyphotic deformity was established, and then a three-dimensional finite element model of ankylosing spondylitis with kyphotic deformity was generated. Three different types of models were established for three different surgeries at the osteotomy angle of 20°, 30° and 40°. Correction effect and biomechanics were analyzed.
    RESULTS AND CONCLUSION: (1) A three-dimensional finite element model of ankylosing spondylitis with kyphotic deformity was successfully established at the osteotomy angle of 20°, 30° and 40°. The maximum principal stresses of three different screw titanium rods were 54.632, 194.230, 394.860 Mpa. (2) Three different surgeries were successfully simulated. The correction degree of the model 3 was optimal, but the stress distribution was large; displacement was obvious. After internal fixation, the complications of stability and internal fixation failure increased. The model 2 had good correction degree, appropriate stress distribution, and decreased complications of fixation failure. 

    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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    Accuracy of lumbar pedicle screw implantation based on three-dimensional printing navigation modules  
    Wang Wei, Li Qing-bo, Cai Lei, Wang Da-wei, Liu Wei-jun
    2018, 22 (7):  1114-1119.  doi: 10.3969/j.issn.2095-4344.0126
    Abstract ( 396 )   PDF (1168KB) ( 134 )   Save

    BACKGROUND: The surgical procedure of pedicle screw placement in the lumbar spine requires a long time to confirm the insertion position of the pedicle screw by using X-ray images. The clinical application of computer-aided navigation techniques is limited, due to the high cost of auxiliary navigation system and complicated operation.

    OBJECTIVE: Based on three-dimensional printing navigation module of lumbar pedicle screw implantation in patients with fracture of lumbar spine, to verify the accuracy and feasibility of the navigation module into lumbar pedicle screws.
    METHODS: According to CT data of 50 patients with fracture of lumbar vertebra, the data were loaded into Mimics to establish a three-dimensional model of the lumbar spine. On the basis of the established model of pedicle screw navigation module, lumbar entity model and navigation module were made using three-dimensional printing technology. First of all, navigation module was preoperatively embedded in the lumbar spine specimen entity to simulate pedicle screw test. Second, screw navigation module was applied to assist lumbar pedicle screw insertion in lumbar vertebra during the operation. After operation, the effectiveness of the screw implantation was assessed using CT examination and X-ray.
    RESULTS AND CONCLUSION: (1) The designed navigation module with 12 pedicle screws was inserted into lumbar vertebra. CT examination showed that screw position was good on the internal side of lumbar pedicle; no screws perforated the pedicle cortex. (2) Experiments showed that the accuracy of pedicle screws inserted into lumbar vertebra was relatively high. The direction and the site of the screws were basically identical to the preoperative simulation results. (3) Based on three-dimensional printing navigation module, the accuracy of pedicle screw implantation into the vertebral vertebra was high, and could realize accurate implantation of individualized pedicle screws. The minimally invasive surgery method is relatively simple and has the very vital significance. 

    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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    Role of macrophage polarization in periprosthetic osteolysis: its research status and advance
    Gong Dong, Zhen Ping, Wang Rong
    2018, 22 (7):  1120-1125.  doi: 10.3969/j.issn.2095-4344.0127
    Abstract ( 495 )   PDF (988KB) ( 127 )   Save

    BACKGROUND: In terms of both phenotype and function, macrophages have remarkable heterogeneity. In respond to various environmental cues or under different pathophysiologic conditions, macrophages can be polarized into different phenotypes, that is, pro-inflammatory M1 phenotypes (classical activated marcrophage) or anti-inflammatory M2 phenotypes (alternative activated marcrophage). Macrophage polarizatinton has been found to play an important role in periprosthetic osteolysis.

    OBJECTIVE: To summarize the research status and new progress of the concept of macrophage polarization, the relationship between osteolysis as well as treatment methods of osteolysis.
    METHODS: A computer-based online retrieval was performed for the literature concerning macrophage polarization and periprosthetic osteolysis in PubMed and CNKI databases published from January 1999 to March 2017. Unrelated researches on macrophage polarization were excluded. The keywords were “macrophage polarization, wear particles, and osteolysis” in English and Chinese, respectively.
    RESULTS AND CONCLUSION: (1) The periprosthetic osteolysis after artifical joint replacement has a close relationship with macrophage, but few studies have been carried out from the respect of macrophage polarization. Most of researches are still on in vitro observation or experimental stage. (2) Current researches mainly show that macrophages can be polarized into different phenotypes by stimulation of wear particles and cytokines, the peri-implant macrophage phenotype has M1 characteristics and some cytokines can induce macrophages polarization to M2 type with anti-inflammatory characteristics. This conclusion has a broad prospect, but the related mechanisms still remain unclear, which need a further exploration.

    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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    Intramedullary nailing for proximal tibial fractures: anatomy, biomechanics and design principles of the nail 
    Zhao Zhi-hui, Ren Lin-hui, Li Yi, Lu Feng-cheng, Kifayat Ullah, Basanta Sapkota, Wang Yong-qing
    2018, 22 (7):  1126-1132.  doi: 10.3969/j.issn.2095-4344.0128
    Abstract ( 595 )   PDF (1217KB) ( 164 )   Save

    BACKGROUND: The complexity of the anatomic structure of proximal tibia made it difficult for treatment with intramedullary nailing and rate of complications was high. With the improved design and fixation technique of the intramedullary nails, the excellent and good rate of application of this technique is also increasing. Using intramedullary nailing to treat proximal tibial fractures is getting popular.

    OBJECTIVE: To summarize the latest techniques of intramedullary nailing for proximal tibial fractures.
    METHODS: 742 literatures were retrieved with keywords of “proximal tibial fracture” and “intramedullary nail” in English and Chinese respectively from PubMed, Web of science, WanFang and CNKI database. By analyzing their titles and summaries, based on the relevance to the subject, 57 articles were selected for this review after excluding 685 articles.
    RESULTS and CONCLUSION: (1) Due to the complexity of the anatomic structure of the proximal tibia and the limitations of both the fixation techniques and the structure of traditional intramedullary nails, rates of complications were high when intramedullary techniques were used to treat proximal tibial fractures. (2) With the development of intramedullary nail technique, newly designed intramedullary nails appeared, which increased proximal intramedullary nails, improved the position and direction of lock pin. Holding power was strong on the proximal fracture blocks. (3) The introduction of techniques such as combining with plates, Poller screws and improved approval increased the strength of the fixation of proximal tibial fractures. (4) Most of the biomechanical tests have proven that compared to other techniques, intramedullary nailing provides better stability. The intramedullary nailing has advantages of being minimal invasion, less blood transport damage, strong fixation, early postoperative activity and short healing time. It is especially effective for multi-level tibial fractures and proximal tibial fractures with severe soft tissue damages. (5) Deep knowledge of the anatomic structure of the proximal tibia and nailing procedure can help surgeons achieve satisfactory clinical results.

    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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    Precision medicine of osteonecrosis of the femoral head: concepts and patterns
    Zhou Ming-wang, Deng Chang, Li Sheng-hua, Fu Zhi-bin
    2018, 22 (7):  1133-1139.  doi: 10.3969/j.issn.2095-4344.0129
    Abstract ( 304 )   PDF (1576KB) ( 157 )   Save

    BACKGROUND: In recent years, precision medicine has become a hot topic in the medical field. The application of precision medicine to osteonecrosis of the femoral head is wider than before.

    OBJECTIVE: To summarize the current status and progress of precision medicine to osteonecrosis of the femoral head.
    METHODS: A computer-based search of PubMed and CNKI databases was performed for literatures about application and prospect of precision medicine for osteonecrosis of the femoral head in and outside China published within the past 10 years using the keywords of “precision medicine, osteonecrosis of the femoral head, three dimensional (3D) printing, computer assisted navigation, minimal invasive, gene” in English and Chinese.
    RESULTS AND CONCLUSION: (1) In the study on the prevention and treatment of osteonecrosis of the femoral head, 3D printing technology, computer assisted navigation technology, precision minimally invasive orthopedic technology, research and treatment of gene are four effective ways to achieve precise and personalized healthcare. (2) The appearance of precision medicine, a novel medicinal model, enriches the treatment of osteonecrosis of the femoral head and enhances the curative efficacy of the disease. It brings the new dawn to the patient and provides some new clues for medical workers and researchers engaged in the clinical and basic researches of osteonecrosis of the femoral head.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral fractures: a meta-analysis  
    Gao Zhi-xiang, Li Chun, Li Lei, Huang Wei-min
    2018, 22 (7):  1140-1148.  doi: 10.3969/j.issn.2095-4344.0130
    Abstract ( 339 )   PDF (1619KB) ( 144 )   Save

    BACKGROUND: Minimally invasive surgery is the main method for senile osteoporotic vertebral fractures, and percutaneous kyphoplasty (PKP) has been rapidly popularized. As the conventional bilateral transpedicular puncture needs a longer operation time and higher costs, unilateral transpedicular puncture is gradually applied in clinic. However, the long-term clinical efficacy of unilateral and bilateral PKP remains controversial.

    OBJECTIVE: To evaluate the effectiveness and safety of unilateral and bilateral PKP for osteoporotic vertebral fractures through a meta-analysis.
    METHODS: A computer-based retrieval of PubMed, Cochrane Library, Embase, Engineering Village, Web of Science, Wiley, OVID, Google Scholar, WanFang, CNKI and VIP databases was performed for the randomized controlled trials of unilateral and bilateral PKP for osteoporotic vertebral fractures through meta-analysis. Date and language of studies were not limited. Two reviewers screened the retrieved studies in accordance with the inclusion and exclusion criteria. The quality of the studies was evaluated by a modified Jadad scale prior to the meta-analysis on Review Manager 5.2 software.
    RESULTS AND CONCLUSION: (1) Finally, 956 patients from 11 randomized controlled trials were included and divided into two groups, unilateral group (n=483) and bilateral group (n=473) (1:1). (2) The meta-analysis results showed that the operation time in the unilateral group was significantly better than that in the bilateral group (MD=-20.38, 95%CI(-24.10, -16.65), P < 0.000 01); the dose and duration of intraoperative radiation exposure to the patients in the unilateral group were less than those in the bilateral group; the bone cement used in the unilateral group was significantly less than that in the bilateral group (P < 0.000 01); the incidence of bone cement leakage in the unilateral group was less than that in the bilateral group (P=0.005); there were no significant differences in the Visual Analogue Scale scores, vertebral height restoration, Cobb angle of the fractured vertebra and re-fracture rate of the adjacent vertebrae between two groups during long-term follow-up. (3) Compared with bilateral PKP, unilateral PKP exhibits a shorter operation time, less intraoperative radiation exposure and a lower incidence of bone cement leakage in the treatment of osteoporotic vertebral fractures, so it is a safer surgical method.
     
    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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