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18 April 2018, Volume 22 Issue 11 Previous Issue    Next Issue

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Application of lower edge of teardrop on restoring anatomical hip center height in total hip arthroplasty   Lu Yu-feng, Guo Wan-shou, Sun Wei, Liu Lin, Xu Peng 2018, 22 (11):  1641-1646.  doi: 10.3969/j.issn.2095-4344.0156 Abstract ( 574 )   PDF (800KB) ( 327 )   Save BACKGROUND: The position of acetabular prosthesis is very important in total hip arthroplasty; its ideal position is to restore its anatomical hip center of rotation. As the inferior edge of the teardrop is an important stable imaging marker, it is of great significance to evaluate the position of acetabular cup and guide the correct intraoperative placement of prosthesis. OBJECTIVE: To investigate the effect of the lower edge of the teardrop on restoring anatomical hip center height in total hip arthroplasty. METHODS: Medical records and anteroposterior images of 107 unilateral total hip arthroplasty with normal contralateral acetabulum and lower edge of cup at the same level as lower edge of the teardrop were reviewed. Center height and horizontal distance as well as cup inclination and anteversion were measured radiographically. The paired t test was used to compare data between left and right sides of hip center height. Scatterplots and Pearson’s correlation coefficients were used to evaluate the association between the difference of the height of two hip centers, cup anteversion and inclination angle. RESULTS AND CONCLUSION: (1) The height of cup center was significantly higher than that of contralateral hip joint center (P < 0.001). Whereas 93.4% (100 cases) of absolute differences between them were in the range from 0 mm to 5 mm, only 6.6% (7 cases) were more than 5 mm. (2) However, when the lower edge of cup was 1.5-2.0 mm inferior to the lower edge of the teardrop, there was no statistical differences between them (P=0.345 and 0.331). (3) There was a weak correlation between the difference of the height of two hip centers with inclination and anteversion (r=0.376, 0.310, P < 0.001). (4) The position of cup with its inferior edge 1.5-2.0 mm below the inferior edge of the teardrop can exactly replicate the anatomic hip center. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Total hip arthroplasty in lateral decubitus position based on direct anterior minimum invasive surgery Ye Shan-shan, Gao Hui, Zhang Yu, He Chun-lei 2018, 22 (11):  1647-1652.  doi: 10.3969/j.issn.2095-4344.0157 Abstract ( 457 )   PDF (1104KB) ( 148 )   Save BACKGROUND: Direct anterior minimum invasive surgery (DAMIS) total hip arthroplasty has been considered as the total hip arthroplasty that is most consistent with the minimally invasive standards. In theory, there is a low incidence of complications in the DAMIS total hip arthroplasty. However, because minimally invasive surgery demands high surgery skills, the incidence rate of complications is high in the early period of its learning curve. Lateral decubitus position DAMIS was considered to provide a better perspective, so that, the incidence of surgical complications may be reduced. OBJECTIVE: To explore the feasibility of lateral decubitus position DAMIS for total hip arthroplasty. METHODS: Totally 62 cases from the Department of Orthopedics, First Affiliated Hospital of Gannan Medical University between April 2013 and April 2016 were retrospectively analyzed, and randomly assigned to two groups: lateral decubitus position group (n=31) and supine position group (n=31). Incision length, operative time, intraoperative blood loss, acetabular cup angle, hospital stay, Harris scores, Visual Analogue Scale score, and SF-36 score were compared between the two groups. Complications at postoperative 1 year were recorded. RESULTS AND CONCLUSION: (1) Operative time was longer and intraoperative blood loss was more in the lateral decubitus position group than in the supine position group (P < 0.05). There were no statistically significant differences in incision length and hospital stay between the two groups (P > 0.05). (2) There were no significant differences in the incidence of postoperative complications between the two groups (P > 0.05). (3) There were no significant differences in the anteversion and abduction angles of acetabular cup between the two groups (P > 0.05). (4) There were no significant differences in Harris hip score, Visual Analogue Scale score, and SF-36 the quality of life scores between the two groups before surgery and 1 year after surgery (P > 0.05). (5) In conclusion, DAMIS total hip arthroplasty can abandon special traction bed when patients are in lateral decubitus position. The short-term effects are the same with supine DAMIS total 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 Figures and Tables | References | Related Articles | Metrics

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Application of iASSIST-assisted total knee arthroplasty in the treatment of genu varum or genu valgus Huang Chen-yu, Liu Shuai, Tian Shu-chang, Yao Qing-qiang, Wang Li-ming 2018, 22 (11):  1653-1658.  doi: 10.3969/j.issn.2095-4344.0158 Abstract ( 543 )   PDF (891KB) ( 197 )   Save BACKGROUND: Compared with conventional total knee arthroplasty (TKA), for patients with genu varum or genu valgus, indications, prosthesis choice, surgical accuracy and perioperative management during TKA should be paid more attention. OBJECTIVE: To compare the clinical effectiveness of iASSIST-assisted TKA and traditional TKA in the treatment of genu varum or genu valgus. METHODS: Twenty-one patients with genu varum or genu valgus undergoing TKA were selected, and were then randomized into two groups: iASSIST-assisted TKA (group A) or traditional TKA (group B). The surgical accuracy was compared between two groups by measuring the knee valgus angle of patients, and the angle between prosthesis components on the coronal and sagittal planes. Besides, the intraoperative blood loss, operation time, postoperative drainage, restored alignment, postoperative complications, hospitalization time, as well as Visual Analogue Scale and American Knee Society scores were recorded to assess the clinical effectiveness. RESULTS AND CONCLUSION: (1) The deviation of hip-knee-ankle angle, frontal femoral component angle, frontal tibial component angle, lateral femoral component angle and lateral femoral component angle in the two groups was less than 3°, and the group A exhibited better corrective efficacy. (2) The operation time in the group A was significantly longer than that in the group B; the hospitalization time in the group was significantly shorter than that in the group B; the restored alignment in the group A was significantly superior to that in the group B; the postoperative drainage, as well as Visual Analogue Scale and American Knee Society scores at 1 day and 1 week postoperatively in the group B were significantly superior to those in the group A (all P < 0.05). There were no significant differences in the intraoperative blood loss, incidence of complications, as well as Visual Analogue Scale and American Knee Society scores at postoperative 2 weeks and 1 and 3 months between two groups (P > 0.05). (3) These results manifest that for the patients with genu varum or genu valgus, both iASSIST-assisted TKA and traditional TKA can obtain satisfactory surgical accuracy, and the former has advantage in restricting the alignment of lower limbs. However, the long-term efficacy needs to be explored in depth.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Correlation of synovectomy with blood loss and knee joint function in primary total knee arthroplasty Li Jian-feng, Cui Xue-wen 2018, 22 (11):  1659-1664.  doi: 10.3969/j.issn.2095-4344.0159 Abstract ( 436 )   PDF (778KB) ( 163 )   Save BACKGROUND: In recent years, knee arthroplasty is a relatively mature method for the treatment of various advanced osteoarthritis, and has good clinical efficacy. However, there is still a lot of controversy about whether to retain the synovial membrane. OBJECTIVE: To analyze the effect of synovectomy in primary total knee arthroplasty on the blood loss and knee joint function in the patients with knee osteoarthritis. METHODS: Sixty patents with knee osteoarthritis were included, involving 25 males and 35 females, with an age of 55-70 years, and were then randomly divided into two groups (n=30 per group). The patients underwent total knee arthroplasty with (experimental group) or without (control group) synovectomy. The operation time, dominant, hidden and total bold loss, and hospitalization time were recorded. The Visual Analogue Scale scores at baseline, postoperative 3 days, 4 and 12 months were detected; the Hospital for Special Surgery scores at baseline, postoperative 4 and 12 months were determined. RESULTS AND CONCLUSION: (1) The operation time, as well as the dominant, hidden and total bold loss in the experimental group were significantly more than those in the control group (P < 0.05). There was no significant difference in hospitalization time between two groups (P > 0.05). (2) The Visual Analogue Scale scores at beseline and postoperative different time points showed no significant difference between two groups, and the postoperative scores were significantly improved in both groups (P < 0.05). (3) No significant difference was found in the Hospital for Special Surgery scores between two groups at baseline and postoperative different time points, and the postoperative scores in both groups were significantly higher than those at baseline (P < 0.05). (4) These results imply that the removal of synovial membrane during total knee arthroplasty can induce large amount of blood loss, and has no effect on the knee function in the patients with knee osteoarthritis. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Influence of the artificial disc size on cervical artificial disc replacement Song Qing-peng, Tian Wei, He Da, Han Xiao, Wang Jin-chao, Li Zu-chang, Feng Xiao 2018, 22 (11):  1665-1670.  doi: 10.3969/j.issn.2095-4344.0160 Abstract ( 508 )   PDF (831KB) ( 162 )   Save BACKGROUND: The size of artificial disc is not exactly identical to cervical vertebral endplate. However, the effect of implant size on cervical disc replacement has not yet been clearly identified. OBJECTIVE: To evaluate the effect of Bryan disc size on cervical artificial disc replacement. METHODS: Totally 71 patients with cervical degenerative disease underwent single-level Bryan disc replacement from December 2003 to December 2007 were enrolled. The average age was (45.90±8.12) years old, and all patients were followed up for more than 10 years. The artificial disc size was measured using lateral X-ray films, and expressed as (Bryan artificial disc’s footprint sagittal diameter×2) / (upper endplate sagittal diameter + lower endplate’s sagittal diameter)×100%. X-ray films were photographed to measure motion range of the treated segment before surgery, 3 months after surgery, and during final follow-up. Clinical outcomes, including Japanese Orthopaedic Association score, Neck Disability Index and Odom’s scores, were evaluated before and after operation. Observational indexes of different disc sizes (≥95% and <95% groups) were compared and analyzed. RESULTS AND CONCLUSION: (1) There were 49 patients in the ≥95% group and 22 patients in the <95% group. (2) At 3-month follow-up, range of motion was significantly smaller in the <95% group than in the ≥95% group (P < 0.01). At the final follow-up, range of motion was significantly smaller in the <95% group than in the ≥95% group (P < 0.05). (3) At final follow-up, improvement rate of Japanese Orthopaedic Association score was (70.65±32.58)% in the <95% group and (68.83±38.85)% in the ≥95% group, and no significant difference was detected between the two groups (P > 0.05). (4) At final follow-up, Neck Disability Index decreased by (10.82±7.50)% in the <95% group, and (12.61±8.51)% in the ≥95% group, and no significant difference was detected between the two groups (P > 0.05). (5) At final follow-up, Odem’s score results showed excellent in 10 cases (45%), good in 9 cases (41%) and average in 3 cases (14%) in the <95% group; and excellent in 26 cases (53%), good in 20 cases (41%) and average in 3 cases (6%) in the ≥95% group, and no significant difference was detected between the two groups (P > 0.05). (6) Results suggest that different sizes of artificial disc replacement have obtained good functional recovery, but small artificial disc may impact the range of motion. We should try to avoid placing the artificial disc smaller than 95%. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Efficacy of elastic intramedullary nail versus locking plate fixation in the treatment of middle clavicle fracture   Peng Lin-bo, Chen Xiao-bin, Zhang Jian-zheng, Wang Xiao-wei, Sun Tian-sheng 2018, 22 (11):  1671-1676.  doi: 10.3969/j.issn.2095-4344.0161 Abstract ( 380 )   PDF (821KB) ( 143 )   Save BACKGROUND: For the treatment of middle clavicle fractures, elastic intramedullary nailing has gradually gained everyone's approval because of its small incision and short operation time. Locking plate fixation is currently the main surgical treatment. At present, there are a few comparative studies on the results of the two surgical treatments, but the results are still controversial. In particular, there is a lack of comparative studies on long-term efficacy and complications. OBJECTIVE: To compare clinical results and complications of locking plate and elastic intramedullary nailing for middle clavicular fracture. METHODS: A retrospective analysis of 85 patients with middle clavicular fractures who were hospitalized at the Army General Hospital of Second Medical College of Southern Medical University from June 2014 to June 2015 undergoing surgeries was performed. They were divided into two groups randomly: locking plate group (n=62) and elastic intramedullary nailing group (n=23). The incision length, operation time, blood loss and time of hospital staying were compared between the two groups. Regular follow-up, radiography assessment and postoperative complications and shoulder function score were measured. RESULTS AND CONCLUSION: (1) Incision length, operation time, blood loss and time of hospital staying were significantly better in the elastic intramedullary nailing group than in the locking plate group (P < 0.05). (2) The complications of the elastic intramedullary nailing group were significantly lower than that of the locking plate group (P < 0.05). The main complications of locking plate group were superficial wound infection, hypesthesia in the local incision and implant protuberance. Only two patients in the intramedullary nailing group experienced complications. (3) The healing rate of elastic intramedullary nailing group was higher than that of the locking plate group, which was not statistically significant (P > 0.05). (4) The DASH scores and the Constant-Murley scores of the two groups after operation were not statistically significant (P > 0.05). (5) The elastic intramedullary nailing and locking plate are both effective methods for the treatment of middle clavicular fracture. Incision length, operation time, blood loss and average length of hospital stay have obvious advantages; the incidence of complications is low; and recovery is fast in the elastic intramedullary nailing group. However, elastic nail may stimulate the local skin, causing some impact for the patients’ daily life.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Elastic intramedullary nail for treating 22-A fracture in the forearm of adults Chen Hao, Li Min-ying, Pan Jun-xi, Li Shao-shuo, Wan Lu-chao, Sun Han-qiao, Zhao Jing-tao 2018, 22 (11):  1677-1682.  doi: 10.3969/j.issn.2095-4344.0162 Abstract ( 413 )   PDF (802KB) ( 287 )   Save BACKGROUND: Elastic intramedullary nail is commonly used in the treatment of fractures of children, but few studies concern the elastic intramedullary nail for treating fractures in adults. OBJECTIVE: To investigate the repair effect of elastic intramedullary nail in the treatment of 22-A fracture in forearm of adults. METHODS: From January 2015 to April 2016, a total of 21 adult patients with the 22-A fracture (35 fractures) were treated with manipulative reduction and elastic intramedullary nail fixation in the First Affiliated Hospital of Guangzhou University of Chinese Medicine. The follow-up time was 12-18 months. Radiographs were taken and the guidance of the limb function training was given at regular intervals. The Andserson scoring system was used to evaluate the patients’ forearm limb function. Fracture healing, elbow, wrist joint activity and forearm rotation were recorded. The satisfactory questionnaires were recorded. The patients were divided into three grades as satisfaction, general satisfaction and dissatisfaction; simultaneously, reasons were recorded. RESULTS AND CONCLUSION: (1) The Andserson scoring was satisfactory in 16 cases accounted for 76%, general satisfaction in 3 cases accounted for 14%, dissatisfaction in 2 cases accounted for 10%. (2) Wrist joint activity increased from (172±4)° before the operation to (181±3)° at the end of the follow-up. Elbow joint activity increased from (102±18)° before the operation to (124±13)° at the end of the follow-up. Forearm rotation activity increased from (84±11)° before the operation to (155±13)° at the end of the follow-up (P < 0.05). (3) In the follow-up of the 21 patients, 13 patients were satisfied with the result of surgery; 5 patients were generally satisfied; 2 patients were dissatisfied because the limited limb functions; and 1 patient was dissatisfied because of the nail irritability; the dissatisfaction rate accounted for 14%. (4) Elastic intramedullary nail can obtain affirmative effect in the treatment of adult 22-A fracture of the forearm; and clinical application should be based on the type of fracture.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Comparison of three internal fixation methods for treatment of intertrochanteric fracture of the femur in elder patients Cao Jun, Hu Pan-yong, Cai Bao-ta, Yang Shao-an 2018, 22 (11):  1683-1688.  doi: 10.3969/j.issn.2095-4344.0163 Abstract ( 430 )   PDF (872KB) ( 161 )   Save BACKGROUND: At present, the treatment methods for intertrochanteric fracture of the femur in the aged are in two ways: Intramedullary fixation and extramedullary fixation. The advantages of intramedullary fixation with simple operation, small trauma and few complications have become the gold standard for the treatment of intertrochanteric fracture in the femur in the aged. OBJECTIVE: To explore the clinical curative effects of three internal fixation methods: dynamic hip screw, proximal femoral nail antirotation, and intramedullary nail InterTan in the treatment of intertrochanteric fractures of the femur in the aged.  METHODS: A retrospective analysis of 120 cases of intertrochanteric fractures from January 2010 to January 2016 was performed. The patients were randomly divided into dynamic hip screw group (n=40), proximal femoral nail antirotation group (n=60) and InterTan group (n=20). The operative time, intraoperative blood loss, incision length, hospitalization time, postoperative weight-bearing time, fracture healing time, Harris score, and intraoperative and postoperative complications were recorded and compared among the three groups. RESULTS AND CONCLUSION: (1) Operative time, intraoperative blood loss, and incision length were significantly better in the InterTan group and proximal femoral nail antirotation group than in the dynamic hip screw group (P < 0.05). Above indexes were not significantly different between InterTan and proximal femoral nail antirotation groups (P > 0.05). (2) Postoperative weight-bearing time, fracture healing time, and Harris score one month after operation were significantly better in the InterTan group than in the proximal femoral nail antirotation and dynamic hip screw groups; above indexes were better in the proximal femoral nail antirotation group than in the dynamic hip screw group (P < 0.05). (3) Hospitalization time and Harris score at 6 and 12 months after operation were not significantly different among the three groups (P > 0.05). (4) The incidence rate of intraoperative and postoperative complications was significantly lower in the InterTan group and proximal femoral nail antirotation group than in the dynamic hip screw group (P < 0.05). (5) In summary, compared with dynamic hip screw system, proximal femoral nail antirotation and InterTan system are characterized by small trauma, simple operation, quick recovery, and fewer complications, and show good clinical therapy in the treatment of intertrochanteric fracture. Compared with proximal femoral nail antirotation system, InterTan system shows better fracture reduction and stability, shorter healing time, and better biomechanical advantages. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Fenestration and debridement combined with percutaneous minimally invasive fibula implantation in the treatment of senile degenerative osteonecrosis of the femoral head: a study protocol for a non-randomized controlled trial   Li Li-xun, Qin Di 2018, 22 (11):  1689-1694.  doi: 10.3969/j.issn.2095-4344.0164 Abstract ( 282 )   PDF (755KB) ( 173 )   Save BACKGROUND: Osteonecrosis of the femoral head is one of the common forms of senile degenerative osteoarthropathy. The hip preservation surgery techniques that are currently commonly used include femoral head fenestration, debridement and bone grafting through an anterior approach, and debridement and impaction bone grafting with fibula support through a lateral approach with subtrochanter drilling. These two techniques cause great trauma to the patients, and surgery costs are high. Femoral head collapse occurs easily after surgery. The course inhibition of necrosis of the femoral head and repair effect are not ideal. OBJECTIVE: This study hopes to develop a new repair method that can make up for the shortcomings of conventional hip preservation surgery. We will observe the therapeutic effect of fenestration and debridement combined with percutaneous minimally invasive fibula implantation. This low-cost procedure for senile osteonecrosis of the femoral head should have little intraoperative trauma. We will determine if it also prevents postoperative femoral head collapse. METHODS: This is a prospective, multicenter, non-randomized, controlled, clinical trial. Seventy patients (117 hips) with senile degenerative osteonecrosis of the femoral head will be recruited from the Hebei Provincial Youfu Hospital and the Third Hospital of Hebei Medical University, Shijiazhuang, China. The patients will be allocated into three groups according to the repair method. (1) Patients in the drilling debridement group will undergo conventional debridement and impaction bone grafting with fibula support through a lateral approach with subtrochanter drilling. (2) Patients in the fenestration debridement group will undergo conventional femoral head fenestration, debridement, and bone grafting through an anterior approach. (3) Patients in the combination repair group will undergo fenestration, debridement, and impaction bone grafting combined with percutaneous minimally invasive fibula implantation. Each group will include 39 hips. Follow-up will be conducted for 12 months. The primary outcome measure is the incidence of femoral head collapse on the affected side at 12 months after surgery. The secondary outcome measures are intraoperative blood loss, operation time, hospital costs, and Harris hip score for hip function before surgery and 6 and 12 months after surgery and the incidence of adverse reactions at 6 and 12 months after surgery. DISCUSSION: Our results can verify whether the effect of fenestration and debridement combined with percutaneous minimally invasive fibula implantation is better than those of the other two types of conventional hip preservation techniques in the treatment of senile osteonecrosis of the femoral head. In addition, we will validate whether the combined method clearly inhibits postoperative femoral head collapse and improves hip function. This trial has been approved by the Ethics Committee of Third Hospital of Hebei Medical University of China (approval number: KE2016-011-1). The study protocol will be conducted in accordance with the Declaration of Helsinki, formulated by the World Medical Association. Written informed consent will be obtained from all participants. This trial was designed in January 2014. Ethics approval was done in December 2014. The recruitment of subjects will begin in June 2018. Samples and data will be collected from June 2018 to June 2019. Outcome measures will be analyzed in August 2019. This trial will be completed in December 2019. 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: ChiCTR1800015124). 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Anatomical and biomechanical characteristics of sternoclavicular joint Yang Kun, Wu Tian-hao, Li Gen, Yang Yun-kang, Ge Jian-hua, Bai Rui, Xiang Fei-fan, Sun Yuan-lin 2018, 22 (11):  1695-1700.  doi: 10.3969/j.issn.2095-4344.0165 Abstract ( 507 )   PDF (1039KB) ( 577 )   Save BACKGROUND: The clinical experience of the treatment of the sternoclavicular joint dislocation and peripheral fracture is relatively lacking, but its incidence is increasing yearly. At present, there are few studies on the anatomy and biomechanics of the sternoclavicular joint in and outside China, and no systematic anatomical measurements of the sternoclavicular joint are reported. OBJECTIVE: To provide a biological reference for the clinical diagnosis and treatment of sternoclavicular joint dislocation or peripheral fractures by studying the anatomy and biomechanics of the sternoclavicular joint. METHODS: (1) A total of 16 specimens (32 sides) of adult antiseptic and moist cadaveric specimens were selected. The complete manubrium, bilateral clavicle and surrounding tissues of sternoclavicular joint were anatomically separated, and repair to bone-ligament-bone specimen models. (2) The areas of manubrium articular surface and the medial clavicular articular surface of all specimens were measured by the ink pattern combined with grid counting method. (3) The morphological features of the anterior and posterior sternoclavicular ligaments of the specimens in this group were observed, and the length, width and thickness were measured and analyzed statistically. (4) The left and right sternoclavicular joints of each specimen were randomly paired into A and B groups. Group A received simply cutting of anterior sternoclavicular ligament. Group B received simply cutting of posterior sternoclavicular ligament. Before and after cuting off the ligament, the anterior and posterior load experiments were performed on the anatomical sites with the same force arm length and perpendicular to the distal clavicle. The angles of joints and load-angle regression line slopes were compared between the two groups in the anterior and posterior directions load. RESULTS AND CONCLUSION: (1) The area of articular surface of manubrium (239.00±28.78 mm2) was smaller than the area of medial articular surface of the clavicle (482.56±44.89 mm2), and the difference was statistically significant (t=-40.105, P < 0.001). (2) The length, width and thickness of the anterior sternoclavicular ligament were (17.56±1.94 mm), (15.54±1.42 mm) and (1.93±0.32 mm), and the length, width and thickness of the posterior sternoclavicular ligament were (17.21±1.86 mm), (15.97±1.17 mm), and (2.07±0.29 mm) respectively; there was no significantly statistical difference in the length, width and thickness between them (P > 0.05). (3) Before cutting the ligaments, when the loads were 2, 4, 6, 8, and 10 N, the angle backwards of joint caused by loads in the forward direction was less than the angle of forwards of joints caused by loads in the backward direction, but only when the loads were 6, 8, and 10 N, the difference between them was statistically significant (P < 0.05). The slope of the regression line of load-angle for the loads in the forward direction was less than the slope of the regression line of load-angle for the loads in the backward direction, with statistical difference (F=31.413, P < 0.001). After the ligaments were cut, when the loads were 2, 4, 6, 8 and 10 N in the forward direction in group A and group B, the backward angulation of joint in group A was less than that in group B (P < 0.05). The slope of the load-angled regression line in group A was less than that in group B (F=52.224, P < 0.001). When the loads in the backward direction in group A and group B were 2, 4, 6, 8 and 10 N, the forward angulation of joint in group A was greater than that in group B (P < 0.05), and the slope of the load-angled regression line in group A was greater than that in group B (F=12.503, P=0.008). (4) These results suggest that contact area between the articular surface of the medial clavicle and the articular surface of the manubrium is narrow, which determines the instability of the joint itself. The sternoclavicular ligament is extremely important for maintaining the joint stability. The forward angulation of joint restriction effect of sternoclavicular ligament was weaker than that of the backward angulation, also because of the joint in the anatomical position of the natural forward angulation, so the sternoclavicular joint was prone to anterior dislocation. It is necessary to pay attention to the repair and reconstruction of sternoclavicular ligament when sternoclavicular joint dislocation or peripheral fractures are treated by operations. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Application value of three-dimensional printing personalized navigation template in posterior lower cervical pedicle screw placement Hao Shen-shen, Liu Zhi-bin, Wang Fei, Liu Yan-xiong, Liu Rong-rong, Ao Le, Yang Cui-ping, Li Xia 2018, 22 (11):  1701-1706.  doi: 10.3969/j.issn.2095-4344.0166 Abstract ( 281 )   PDF (1086KB) ( 165 )   Save BACKGROUND: Posterior pedicle screw fixation of lower cervical spine has many advantages. However, because of the special anatomy of pedicle, the technical requirements of nailing placement are high and it is also a challenge to surgeons. The application of three-dimensional (3D) printing technology can help to complete screw placement, and has certain advantages. OBJECTIVE: To introduce the method of 3D printing personalized navigation template assisted posterior lower cervical pedicle screw fixation and evaluate its clinical application value. METHODS: Totally 20 patients with lower cervical spine pedicle screw internal fixation who were treated from June 2015 to December 2016 in Affiliated Hospital of Yan’an University were retrospectively analyzed. Before the surgery, the patient's lower cervical spine CT data was introduced into the relevant software and the 3D printing personalized navigation template assisted nailing pedicle screw was designed. The number of screws inserted was recorded. After the operation, CT scan was used to calculate the accuracy rate of screw placement. Preoperative and postoperative cervical spine Visual Analogue Scale score and spinal function score of Japanese Orthopedic Association were used to evaluate the clinical effect of cervical nerve. RESULTS AND CONCLUSION: (1) All patients were followed up for 3 months postoperatively. (2) 3D printing personalized navigation template assisted 132 pedicle screws. The precise insertion rate was 94.7%. Among them, 125 screws were at grade 0 (94.7%, 125/132), 3 screws grade 1 (2.3%, 3/132), 4 screws grade 2 (3.0%, 4/132), no screw grade 3. (3) At postoperative 1 and 3 months, the neck shoulder Visual Analogue Scale score and spinal function score of Japanese Orthopedic Association of the patients were significantly improved      (P < 0.05), but there was no significant difference (P > 0.05), compared with those at preoperative. (4) In summary, 3D printing personalized navigation template assisted cervical pedicle screw placement had the high insertion rate and satisfactory clinical efficacy. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Establishment and significance of a three-dimension finite element model of the whole cervical spine (C0-T1) in normal human   Liu Wei-cong, Chen Xiong-sheng, Zhou Sheng-yuan, Chen Bo，Xu Zheng 2018, 22 (11):  1707-1712.  doi: 10.3969/j.issn.2095-4344.0167 Abstract ( 581 )   PDF (849KB) ( 563 )   Save BACKGROUND: The spine structural unit of the cervical spine is a common site of degeneration and trauma. Establishing a good cervical spine model is of great practical significance for studying the biomechanical changes of cervical vertebrae under various conditions, preventing and treating cervical injuries, and improving the treatment methods of neck and effects.  OBJECTIVE: To establish a three-dimension finite element model of the whole cervical spine (C0-T1) in normal human and provide a good experimental application basis for further biomechanical research. METHODS: A healthy adult volunteer was selected as the object for data collection. The original data obtained by 256-row CT thin layer scanning, which then has been extracted and edited by software to implement reverse reconstruction. The three-dimensional finite element model of whole cervical spine (C0-T1) was established by the numerical simulation. The range of motion at various directions and mechanical characteristics were verified. RESULTS AND CONCLUSION: The model had 208 631 nodes and 660 876 solid elements. The range of motion in all directions was good. In addition to the larger C0-C1 mobility, all the rest of the segmental motions were consistent with previous literatures. The geometric and biomechanics characters of three-dimensional finite element model of the whole cervical spine (C0-T1) were highly similar to the intact one. The validation of the model was positive.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Clinical significance of anatomic parameters of acetabular anterior column of normal male and female adults by digital measurement Wang Jian, Yun Wen-ke, Li Ge-dang, Cai Yong-qiang, Zhang Shao-jie, Enhejirigala, Wang Xing, Wang Wei, Wang Hai-yan, Gao Shang, Wang Jian-zhong, Wang Zhi-qiang, Gao Ming-jie, Ma Jie-rong, Li Xiao-he 2018, 22 (11):  1713-1718.  doi: 10.3969/j.issn.2095-4344.0168 Abstract ( 466 )   PDF (817KB) ( 284 )   Save BACKGROUND: Acetabulum anterior column shape is complex, and closed to femoral artery, and femoral nerve. Fixed screws easily went into the acetabulum. Currently, there was less data on quantitative anatomy data of pelvic acetabulum fracture with anterior column plate internal fixation. OBJECTIVE: To compare the pelvis gender differences by analyzing digital anatomical features of normal adult acetabulum anterior column section through digital three-dimensional reconstruction and measurement. METHODS: Totally 30 normal adults (half male and half female) received pelvic CT scans, and data were obtained. Using Materialise Mimics Innovation Suite 16.0 software, the boundary of the pelvis was used as reference line for sectioning. The obturator groove, iliopubic eminence, anterior inferior iliac spine, and the anterior superior iliac spine were used as a reference mark. In 15 males and 15 females (30 sides), the corresponding boundary line from obturator groove to the anterior superior iliac spine of acetabular anterior column was sliced into 5 mm-thick sections. The tangent line was vertical to the boundary line. The tangent plane was vertical to the upper plane of the anterior column. The angle and length of each section 5, 10, 15 mm points from the boundary line to the acetabulum, and the perpendicular distance from anterior and posterior edges of the acetabulum to anterior inferior iliac spine, iliopubic eminence and the pubic tubercle. RESULTS AND CONCLUSION: (1) Acetabular anterior column from the obturator groove to the anterior superior iliac spine section was not significantly different (P > 0.05). (2) No matter in males or females, the tangent angle of the fifth layer section was minimum, and the tangent length of the sixth layer section was longest. The length and angle of the second slice at 5 mm point were not significantly different between males and females. However, above indexes in others were significantly larger in females than in males (P < 0.05). (3) Results indicated that in different fracture ranges and different fixation plate positions, the angle and length of pedicle screws are dynamic, so we only selected in accordance with above range, but cannot fix in a certain value. The design of the most accurate and effective placement angle and length should be aimed at nailing design parameters for each individual patient. The use of Mimics software can be used for three-dimensional reconstruction of CT data of adult acetabular anterior column fracture, and can measure the number of indexes, and provide a theoretical reference for the clinical diagnosis and treatment of acetabular anterior column fracture. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Modeling and simulation of human lower limb skeletal muscle based on UG and ADAMS Liu Yun-ting, Guo Hui, Huang Jiang-cheng 2018, 22 (11):  1719-1724.  doi: 10.3969/j.issn.2095-4344.0169 Abstract ( 427 )   PDF (1013KB) ( 400 )   Save BACKGROUND: Skeletal muscle system is the driving force to reveal the change of human body movement, and its modeling is the key technology of human body modeling. OBJECTIVE: To establish models of skeletal muscle of human lower limb based on UG and ADAMS. METHODS: Body size parameters of the lower limbs of six men were measured. According to the collected motion parameters of the lower limbs, ground reaction force (ground support) and electromyogram signal of lower limb muscle group, ADAMS with the dynamics and kinematics simulation was conducted to get simulation parameters, such as ground reaction force, joint force, and link point displacement. Simulation value was compared with the measured value. Finally, MATLAB was used for simulation analysis. RESULTS AND CONCLUSION: It is concluded that the measured ground reaction force, joint angles, and link point displacement had very significant linear correlation with ADAMS simulation data. The simulation results show that a model of human lower limb skeletal muscle established by UG and ADAMS can effectively solve the tedious multi-rigid-body dynamics problems through the simulation calculation. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of intertrochanteric fractures in older adults based on Hypermesh 14.0 and LS-DYNA software He Xiang-xin, Lin Zi-ling, Li Peng-fei, Du Gen-fa, Sun Wen-tao, Chen Xin-min, Liang Zi-yi 2018, 22 (11):  1725-1730.  doi: 10.3969/j.issn.2095-4344.0170 Abstract ( 372 )   PDF (885KB) ( 190 )   Save BACKGROUND: At present, finite element analysis can be used to judge intertrochanteric fractures, but mostly limited in the distribution of stress. Finite element model of various intertrochanteric fractures has not been reported in detail. OBJECTIVE: To build various types of intertrochanteric fracture models with Hypermesh 14.0 and LS-DYNA software to simulate the falling-induced external force on proximal femur, and to evaluate the effect of models, and to analyze the biomechanical mechanism of intertrochanteric fractures. METHODS: Normal side CT image data of one case of elderly intertrochanteric fracture were collected and imported into Mimics software to establish the proximal femur geometric models, were then analyzed and operated by LZ-DYNA solver after imported into Geomagic studio 2013 and Hypermesh 14.0 for smoothing and meshing. Before analysis, the material parameters were set, the boundary conditions were confirmed, and given the loading parameters. The operating results were checked in Hyper View. RESULTS AND CONCLUSION: (1) The distribution of stress of proximal femur exactly matched to the previous study. EvansⅠtype intertrochanteric fracture model was obtained under continuous shear stresses, and six types of fractures were obtained by adjusting the load. (2) These results manifest that based on the Hypermesh 14.0 and LS-DYNA software, the finite element can well simulate the intertrochanteric fractures, and shear stress plays an important role in intertrochanteric fractures, which can provide experimental basis for the prevention and treatment of intertrochanteric fractures. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Three-dimensional simulation and simulated mechanical test of individual femoral prosthesis Li Kang, Jiang Yan, Tian Da-wei, Liu Xiang-yang 2018, 22 (11):  1731-1736.  doi: 10.3969/j.issn.2095-4344.0171 Abstract ( 374 )   PDF (998KB) ( 283 )   Save BACKGROUND: A study combined medical CT technology and digital three-dimensional (3D) interactive control system Mimics software and computer simulation software tools for 3D reconstruction and simulation reconstruction of the femur. Customized individualized femoral prosthesis has high matching degree with human body structure, and has high application value in clinical research. OBJECTIVE: To investigate the application value of 3D simulation of femoral prosthesis in artificial femoral prosthesis replacement. METHODS: Totally 82 cases, who received femoral prosthesis replacement from July 2014 to June 2016 in Taihe Hospital of Shiyan, were enrolled and randomly assigned to three groups: personalized group (n=28), cementless group (n=27) and cemented group (n=27). Different types of femoral prosthesis were designed in each group. 3D model reconstruction in femur was designed using medical CT technology combined with computer. Prosthesis implantation was simulated in computer, and the relevant information was recorded. Simulated operation was conducted on the mechanical experiment of femoral prosthesis in the biped and single foot loads so as to provide the most suitable operation plan. The possible risk was forecasted and assessed for preoperative preparation.  RESULTS AND CONCLUSION: (1) In the simulation of mechanical experiment, under double foot and single foot loads, after prosthetic replacement, stress in the femur was significantly better in the personalized group than in the cementless group and cemented group (P < 0.05). (2) After replacement, normal stress and shear stress were significantly better in the personalized group than in the cementless group and cemented group (P < 0.05). (3) The initial, horizontal and vertical micromovement was significantly better in the personalized group than in the cementless group and cemented group (P < 0.05). (4) In summary, the use of computer technology and 3D CT software can make individualized femoral prosthesis for patients. Compared with the cementless and cemented prostheses, personalized prosthesis has obvious advantages in stress distribution, interface stress and initial micromovement.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Three-dimensional finite element analysis on splint fixation for treating ulnar styloid process fracture Li Yong-yao, Cheng Hao, Zhao Yong, Liu Guang-wei, Cheng Yong-zhong, Guan Ji-chao 2018, 22 (11):  1737-1742.  doi: 10.3969/j.issn.2095-4344.0172 Abstract ( 382 )   PDF (898KB) ( 322 )   Save BACKGROUND: Distal radius fractures are often accompanied by the ulna styloid process fractures, and the treatment of the ulna styloid process fracture is disputed in clinic. Manipulative reduction and splint fixation is a common method to treat such diseases. The mechanism of intervention on ulnar styloid process is difficult to obtain in the corpse mechanics experiments. In recent years, the finite element analysis method has been widely used in the field of orthopedics, which has opened up a way for the study of orthopedic disease. OBJECTIVE: To explore the biomechanical mechanism of splint intervention on ulnar styloid fracture by finite element analysis, and to provide the basis for clinical treatment choice. METHODS: A three-dimensional finite element model of normal wrist joint was established based on the forearm and wrist CT images of a healthy volunteer. The validity of the model was verified by comparing with the experimental data in the literature. On this basis, four wrist joint finite element models with and without splint fixation for ulnar styloid type I and type II fractures were established. Under axial compression, lateral extension, pronation and supination working conditions, the changes of the relative displacement of the distal radioulnar joint and the ulnar styloid fracture broken end were analyzed. RESULTS AND CONCLUSION: (1) A three-dimensional finite element model of normal wrist joint was established and validated, and the other four models were established based on this model. (2) In pronation and supination conditions, the relative displacement values of the ulnar and radial joints in the ulnar styloid type I and II fracture models were greater than those in the normal wrist joint model, and the displacement was smaller in the type I fracture model than in the type II fracture model; the displacement was significantly reduced after the intervention on the two fracture models by the splint. (3) In the lateral tension, pronation and supination conditions, the displacement values of the ulnar styloid fracture end in the ulnar styloid type I fracture model were smaller than in the type II fracture model, and the displacement values were significantly reduced after the intervention by the splint. Under the remaining conditions, the change of the above values was not obvious. (4) In conclusion, the stability of distal radioulnar joint became worse after ulnar styloid fracture, and the stability of distal radioulnar joint after type I fracture was less than that after type II fracture. As an elastic fixation method, splint can increase the stability of the wrist ulnar column during the treatment. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Measurement and clinical significance of lumbar pedicle CT imaging parameters Guan Zhe-heng, Yang Hui-lin, Luo Zong-ping, Cui Xu-dong, Pan Xiao-yu, Yan Mo-qi, Wang Yi-fan, Lu Ji-hang 2018, 22 (11):  1743-1748.  doi: 10.3969/j.issn.2095-4344.0173 Abstract ( 546 )   PDF (1113KB) ( 249 )   Save BACKGROUND: Although more and more accurate and personalized detection and assistive tools are used in the field of orthopedics with the development of technology, the preoperative CT is still the first-line examination choice of many orthopedic surgeons. Therefore, to master the lumbar spine CT imaging performance is not only the basis of spine surgeons, but also the cornerstone of spinal nail surgery. OBJECTIVE: Through CT imaging technique, we measured the parameters of lumbar pedicle imaging, and understood its internal structure as the basis for the choice of screws, in order to improve the safety and accuracy of nail surgery. METHODS: Totally 36 cases without lumbar vertebrae-related disease undergoing lumbar vertebra and abdominal cavity CT scan were randomly selected, including 20 males and 16 females at the age of (43.3±12.3) years. PACS was used to reconstruct lumbar vertebrae, and the related imaging parameters were measured. RESULTS AND CONCLUSION: (1) There was no significant difference between the left and right sides of the pedicle for paired t-test (P > 0.05). (2) Pedicle sagittal angle had downward trend, the level of change was small; L4 increased relative to L3; L5 level was minimum at the average of -1.3°. Pedicle transverse angle had gradually increased trend, and maximum at L5; the average was 25.4°. (3) The length of the pedicle channel increased first and then decreased in the lumbar segment; the longest average was 52.2 mm in the L2 segment, the shortest at L5, with an average of 47.4 mm. (4) The pedicle height was slightly narrowed at L1-L3 levels; the smallest was 15.4 mm (L3 mean), and reached the maximum in the L5 at 22.7 mm (L5 mean). Cancellous bone height also showed the same trend, the minimum in the L3 at 10.2 mm, the maximum in the L5 at 17.9 mm. (5) Lumbar pedicle width showed an upward trend, L1 minimum of 7.7 mm, L5 maximum of 12.5 mm. Cancellous bone width also became a similar upward trend; the narrowest L1, averagely 4.9 mm; the maximum L5, averagely 8.5 mm. (6) Overall, the upper lumbar pedicle channel was slender, while the lower lumbar spine was slightly short. (7) The parameters of the pedicle can be used as the basis for selecting the appropriate screw. At the same time, lumbar pedicle morphology has a certain difference, and there is a certain law. Accurately grasping its structure and image characteristics of pedicle screw fixation is the basis of surgery. The preoperative imaging data collection and assessment, combined with the general situation of patients, and the development of personalized programming, will help in improving the safety and accuracy of screw placement. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Morphology of intervertebral disc in Chinese adults evaluated using computer tomography three-dimensional imaging   Xiao Kan-kan, Li Bing, Peng Xiao-zhong, Zhuo Xiang-long, Xie Chao-xian 2018, 22 (11):  1749-1755.  doi: 10.3969/j.issn.2095-4344.0174 Abstract ( 493 )   PDF (894KB) ( 188 )   Save BACKGROUND: The artificial disc requires a height, a width, and a shape as much as possible to be similar to the original intervertebral disc in order to perfectly distribute the load. At present, most of the data are from foreign countries or measured using X-ray and magnetic resonance imaging, but there are some shortcomings. OBJECTIVE: To diagnose the spinal disease and provide data for the design of a native lumbar disc device by measuring the normal lumbar intervertebral disc using computer tomography (CT). METHODS: A total of 2 235 patients who underwent lumbar CT examination in Liuzhou Worker’s Hospital from January 2012 to May 2017 were collected and analyzed. There were 62 cases, including 45 males and 17 females, after being strictly met the inclusion and exclusion criteria. From the age of 20, they were divided into four groups: 20-30, 31-40, 41-50 and more than 50 years old. The range was from L1 to S1. The measurement index include intervertebral disc anteroposterior diameter, transerverse diameter, disc volume, sagittal anterior, middle and posterior height, coronal left and right height, and interverterbral angle. RESULTS AND CONCLUSION: (1) In terms of age, there was a statistically significant difference in measurement indexes between L1/2, L2/3 and L3/4 (P < 0.05). Therefore, the factor of age should be taken into account. However, there was no statistically significant difference between L4/5 and L5/S1 segments (P > 0.05). (2) There was a statistical difference between the anterior and middle height of the sagittal position in L4/5 and L5/S1 (P < 0.05). (3) There were statistical differences between the angles of L2/3, L3/4, L4/5, L5/S1 intervertebral space (P < 0.05), but the difference of angle between L4/5 and L5/S1 was the most. (4) There was no statistical difference in the height between the left and right sides of the coronal position (P > 0.05). (5) There was statistical difference between the anteroposterior and transverse diameters of the disc on the adjacent cross section (P < 0.05). (6) The results showed that the lower the segment, the smaller the statistical difference between each group. It is indicated that the age difference should be considered on the L1/2, L2/3, and L3/4 segments in the design of lumbar disc or interbody fusion. The lumbar artificial intervertebral disc can be placed in the middle or side. The artificial disc should be designed into the wedge shape instead of a rectangle. These will provide a good anatomical basis for the design of domestic lumbar artificial intervertebral discs.    中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Real-time shear wave elastography and multimodal imaging for analyzing anatomical features of foot plantar fascia   Li Ping, Wang Xing-guo, Wang Dong-hai, Guo Fang-fang, Wu Dan-ni 2018, 22 (11):  1756-1761.  doi: 10.3969/j.issn.2095-4344.0175 Abstract ( 449 )   PDF (1033KB) ( 220 )   Save BACKGROUND: In the clinic, 25%-35% heel pain is mostly caused by plantar fasciitis. Previous studies mainly focused on plantar fasciitis with heel pain caused by flat foot and the growth of calcaneus bone spur. There are no reports on other reasons for plantar fasciitis in large-sample studies. OBJECTIVE: Using the real-time shear wave elastography, CT scan and X-ray, the anatomic site and thickness of normal two-dimensional ultrasound standard flat plantar aponeurosis were identified to analyze the relationship between plantar elastic characteristics and plantar arch angle from non-weight-bearing to weight-bearing position so as to explore the correlation of plantar fasciitis with plantar elastics and plantar arch angle. METHODS: Fifty healthy volunteers (feet) were selected as the healthy control group. 100 cases of plantar fasciitis (one foot) were selected as the case group. Plantar arch angle from non-weight-bearing to weight-bearing position was obtained using X-ray and CT scan to identify anatomic site of plantar aponeurosis in both groups. Two-dimensional ultrasound and real-time shear wave elastography were utilized to obtain thickness and elastic modulus of plantar aponeurosis. RESULTS AND CONCLUSION: (1) From non-weight-bearing to weight-bearing, arch angle change value was (16.4±4.5)° in the healthy control group and (10.5±3.5)° in the case group. Significant differences in arch angle change were detected between the two groups (P < 0.01). (2) Thickness of plantar fascia was obviously smaller in the healthy control group (2.4±0.3) mm than in the case group (3.5±0.9) mm. Elastic modulus of plantar fascia was obviously larger in the healthy control group (30.1±1.3) kPa than in the case group (9.1±1.2) kPa. Thickness of plantar fascia and elastic modulus of plantar fascia were significantly different between the two groups (P < 0.01). (3) In summary, real-time shear wave elastography combined with CT and X-ray images can investigate the morphological and elastic characteristics of the plantar aponeurosis from many aspects. Arch angle change is strongly associated with elastic modulus of plantar fascia. The decreased elastic modulus of plantar fascia is possibly one of the reasons for arch angle change from non-weight-bearing to weight-bearing conditions, and is probably one of reasons for plantar fasciitis with heel 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 Figures and Tables | References | Related Articles | Metrics

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Finite element analysis applied in the biomechanical study of hallux valgus: reliability and room for improvement Zhang Zhan-yue, Dong Le-le, Zuo Qiang, Guo Peng-nian, Lv Guo-dong, Liu Rui 2018, 22 (11):  1762-1767.  doi: 10.3969/j.issn.2095-4344.0176 Abstract ( 393 )   PDF (771KB) ( 152 )   Save BACKGROUND: Hallux valgus is a common orthopedic disease, and its causes are complex and treatment is varied. The mechanical analysis of hallux valgus is an issue of concern. The finite element analysis makes it predictable to treat hallux valgus. OBJECTIVE: To explore the clinical application of finite element analysis in biomechanical study of hallux valgus. METHODS: The first author searched CNKI and PubMed databases from January 1980 to March 2017 using the key words of “finite element, hallux valgus” in English and Chinese, respectively. The repetitive, irrelevant and low-quality articles were excluded. Finally 33 eligible articles were included in accordance with the inclusion criteria, and the critical issues of finite element analysis applied in hallux valgus were reviewed. RESULTS AND CONCLUSION: (1) There are many researches concerning finite element of hallux valgus, which mostly require physicians to work with engineers. These methods are already very mature, but most of the model and material properties of the data come from foreign researches. (2) The finite element analysis is important and reliable for the etiology of hallux valgus, preoperative planning and prognosis. (3) The finite element model of the hallux valgus is only used on static analysis and gait cycle analysis, the modeling details and definition of material properties still need to be improved. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Application prospect and value of finite element modeling in lumbar spondylolysis Xu Ze-chuan, Wei Bing, Yang Hong-sheng, Cao Zong-rui, Yan Xiao-hu, Li Yu-gang, Chang Shan 2018, 22 (11):  1768-1773.  doi: 10.3969/j.issn.2095-4344.0177 Abstract ( 325 )   PDF (942KB) ( 133 )   Save BACKGROUND: With the continuous development of finite element method in biomechanics of orthopedics, the study of spine-related diseases by finite element method has become the main research direction nowadays. Especially, the stress analysis of internal fixation of the spine, the mechanical effect of different internal fixation and the development of new internal fixation are the current hot spot. Spondylolysis is a common disease of the spine. Especially when anatomical bone defects occur, the pathological model and biomechanics of the spine after surgery have corresponding mechanical changes. OBJECTIVE: To review the method of establishing spondylolysis models, the verification of the models and the pplication of finite element models of spondylolysis in various fields, and to summarize the application prospect and value of finite element modeling in lumbar spondylolysis. METHODS: The first author used computer to search the PubMed database and China Journal Full-text Database from January 1998 to December 2016 for related articles. Key words were “finite element, lumbar spine, isthmus, model”. A total of 123 related articles were retrieved and 53 articles met the inclusion criteria. RESULTS AND CONCLUSION: (1) At present, finite element analysis of spondylolysis can well reflect the mechanical condition of internal bone. The finite element model of spondylolysis can be used to evaluate the structure and shape of lumbar spine (such as the defect isthmus), the material properties of different anatomical sites (lamina terminalis, cancellated bone and cortical bone) as well as the load of the spine under different exercise states. In particular, stress analysis of the internal structure of the vertebral body and the ancillary structures of the spine (such as disc and articular process) has obvious advantages. (2) In addition, the reconstruction data of the finite element model are derived from the original CT of the patient, and the simulation is high. Compared with the in vitro experiments, the finite element simulation of spondylolysis is reliable and can reduce the damage to the experimental subjects caused by external forces and radiation, and can effectively avoid medical ethics problem. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Classification characteristics and clinical application of lumbar interspinous distraction system   Lu Jun-feng, Wang Bao-dong, Cao Yang 2018, 22 (11):  1774-1780.  doi: 10.3969/j.issn.2095-4344.0178 Abstract ( 487 )   PDF (842KB) ( 161 )   Save BACKGROUND: With the disadvantages of lumbar fusion surgery complications and adjacent vertebral degeneration aggravating against the normal lumbar biomechanical characteristics, lumbar dynamic fixation technology in line with the normal lumbar biomechanics emerges as the times require. Lumbar interspinous distraction system as a representative of lumbar dynamic fixation technique has attracted extensive attentions of the field of spine surgery. OBJECTIVE: To review the current research progress of lumbar interspinous distraction system. METHODS: The first author retrieved in CNKI database and Wanfang database with the key words of “lumbar interspinous distraction device, interspinous distraction system, biomechanics, clinical application, lumbar interspinous distraction system complications”, and searched PubMed database and SpringerLink database with the key words of “lumbar spine, interspinous process implant, interspinous devices, biomechanics, clinical application, postoperative complications”. Recent studies were included after excluding the repeated studies. Finally, 55 studies were included, with 45 English studies and 10 Chinese studies. RESULTS AND CONCLUSION: (1) Lumbar distraction system core design concept was for expanding the interspinous space in the responsible segment and limiting their activities, which increases the spinal canal and foramen area, reduces intervertebral pressure, relieves nerve compression, can recover segmental stability to a certain degree, but does not significantly impact the motion range of adjacent segments. Simultaneously, it effectively avoids mechanical stimulation to the spinal cord and nerve root by opening the vertebral canal, replaces adjacent segments applied to the responsible section or combined application to fusion segments, and improves clinical symptoms and prevents the occurrence of adjacent vertebra disease. (2) Lumbar interspinous distraction device can effectively reduce stress load of intervertebral disc and small articular process, and maintain motion range of the corresponding segment. However, stress of the implant itself and upper and lower spinous process of the treated segments increases, warning that there is an increased risk of fracture of spinous process and fatigue fracture of the implant. (3) All kinds of lumbar interspinous distraction device have good clinical effect in short and medium follow-up. (4) The clinical curative effect of the distraction device can be comparable to spine fusion surgery. It is operated under local anesthesia, has small trauma, short operation time, quick recovery, short hospitalization time, less complications after surgery, retains lumbar motion range and prevents adjacent vertebral disease. Nevertheless, the device has some disadvantages, such as high medical cost, high revision rate, and inaccurate clinical effect. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Asymptomatic bacteriuria before arthroplasty Zhang Qing-yu, Gao Fu-qiang, Sun Wei 2018, 22 (11):  1781-1785.  doi: 10.3969/j.issn.2095-4344.0179 Abstract ( 319 )   PDF (801KB) ( 153 )   Save BACKGROUND: Hematogenous spread of urinary tract infection is one of the causes of infection after arthroplasty. The significance of a special portion of urinary tract infection, namely asymptomatic bacteriuria in arthroplasty is little reported. OBJECTIVE: To explore the correlation of preoperative asymptomatic bacteriuria and infection after arthroplasty and evaluate the benefits of screening and treating asymptomatic bacteriuria. METHODS: The researchers searched PubMed, Embase, the Cochrane Library and CNKI databases to collect the clinical studies on asymptomatic bacteriuria before arthroplasty. Then, data extraction, quality assessment of the literature, and result analysis were conducted. RESULTS AND CONCLUSION: Finally, seven eligible articles were included. (1) Preoperative asymptomatic bacteriuria is significantly associated with the occurrence of postoperative prosthetic infection, but it is not a causal relationship. (2) Patients with asymptomatic bacteriuria have a high rate of superficial wound infection but no evidence shows that urinary infection is the direct source of contamination. (3) Asymptomatic bacteriuria is an indicator of increased susceptibility to infection after arthroplasty. (4) Treating asymptomatic bacteriuria before arthroplasty cannot decrease the incidence of various postoperative infectious complications. (5) Current clinical evidence does not support the routine screening and treatment of asymptomatic bacteriuria before arthroplasty. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Perioperative hidden blood loss in unilateral total knee arthroplasty: problems and characteristics Wang Yun-long, Zhen Ping 2018, 22 (11):  1786-1791.  doi: 10.3969/j.issn.2095-4344.0180 Abstract ( 287 )   PDF (928KB) ( 165 )   Save BACKGROUND: The hidden blood loss is the main reason for anemia after knee arthroplasty, which will delay wound healing, increase infection, prolong rehabilitation time, improve the cost of medicine, and seriously affect clinical outcome. OBJECTIVE: To summarize the new conceptions and methods about decreasing perioperative hidden blood loss of knee arthroplasty, and to provide help for the prevention of hidden blood loss in total knee arthroplasty. METHODS: We retrieved CNKI and PubMed for articles concerning perioperative hidden blood loss following total knee arthroplasty published from January 2005 to February 2017. We choose different controlled clinical trials about the method of preventing hidden blood loss. Key words were “knee arthroplasty, hidden blood loss, artificial joint”. RESULTS AND CONCLUSION: (1) Hidden blood loss during total knee arthroplasty was associated with many factors. (2) The following factors might reduce hidden blood loss: using the tranexamic acid, reducing the duration of tourniquet, raising the operated knee in a certain extent after operation, and gauging imaging data of the affected knee exactly before operation. (3) Free fatty acids were also responsible for the hidden blood loss. (4) Computer assisted surgery could not reduce the quantity of hidden blood loss, but help patient recovery. (5) The scholars have not reach an agreement about hidden blood loss in total knee arthroplasty, so the research will go continue. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Heterotopic ossification after artificial disc replacement: problems and prospects Zhao Bin-xiu, Sun Yu 2018, 22 (11):  1792-1797.  doi: 10.3969/j.issn.2095-4344.0181 Abstract ( 622 )   PDF (892KB) ( 224 )   Save BACKGROUND: In the past ten years, because of the complications such as adjacent vertebral diseases after the discectomy and interbody fusion fixation, the artificial cervical disc replacement gradually replaces part of intervertebral disc and interbody fusion with internal fixation, and has become a new choice of a surgical treatment of spinal degenerative diseases resection; however, heterotopic ossification after the artificial intervertebral disc replacement as a postoperative problem has attracted the field attention. OBJECTIVE: To review the domestic and foreign research progress on heterotopic ossification after artificial disc replacement. METHODS: The first author retrieved PubMed database, Chinese Journal Full-text Database for related articles published from November 1973 to May 2017. The key words were “cervical vertebrae, artificial disc replacement, heterotopic ossification, research progress”. A total of 216 articles were retrieved, and 45 articles met the inclusion criteria. RESULTS AND CONCLUSION: (1) Heterotopic ossification had a certain occurrence rate after artificial disc replacement. The susceptible factors and preventive measures were still controversial. (2) Future research regarding heterotopic ossification after artificial intervertebral disc replacement mainly focused on the development of biomechanics, molecular level and degenerative change. It is expected that in the near future, artificial disc that is more suitable for human spine biomechanics environment will appear; heterotopic ossification after artificial disc replacement will be more in-depth 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 Figures and Tables | References | Related Articles | Metrics

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Efficacy and safety of topical versus intravenous tranexamic acid on total knee arthroplasty: a meta-analysis    Shi Zhi-gang, Han Bing, Fu Yu, Wang Yin-sheng, Li Jun, Jing Jue-hua 2018, 22 (11):  1798-1804.  doi: 10.3969/j.issn.2095-4344.0182 Abstract ( 236 )   PDF (823KB) ( 283 )   Save BACKGROUND: Total knee arthroplasty is usually administered by intravenous and topical ways. The two ways have been the focus of research in reducing perioperative blood loss and blood transfusion rate. OBJECTIVE: To evaluate the effects of topical tranexamic acid versus intravenous tranexamic acid on blood loss and blood transfusion rate after total knee arthroplasty and analyze whether they increased the occurrence of postoperative thromboembolic events. METHODS: Electronic databases: PubMed, Embase, Cochrane library, Wanfang and CNKI from inception to 1 August 2016 were searched for studies on the use of tranexamic acid after total knee arthroplasty. The studies meeting the criteria were included. The quality of the included studies was evaluated. Extracted data were analyzed using Revman 5.3 software for meta-analysis. RESULTS AND CONCLUSION: (1) Twelve randomized controlled trials involving 1 159 patients (548 cases of topical application; 611 cases of intravenous injection) were included. (2) There were no significant differences in perioperative total blood loss (WMD=-4.22, 95%CI: -10.87–2.43, P > 0.05), postoperative drainage (MD=25.03, 95%CI: -30.58-80.63, P > 0.05), postoperative hemoglobin decline (MD=0.54, 95%CI: 0.11–0.98, P > 0.05), blood transfusion rate (RR=1.15, 95CI: 0.82-1.61, P > 0.05) and incidence of deep venous thrombosis (RR=1.22, 95% CI: 0.512.89, P > 0.05). (3) The best timing for intravenous injection and optimal dose for topical application remain to be further verified. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics