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28 May 2018, Volume 22 Issue 15 Previous Issue    Next Issue

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Changes of related cytokine levels before and after minimally invasive total hip replacement Ma Chen-xi, Li Zhong 2018, 22 (15):  2297-2302.  doi: 10.3969/j.issn.2095-4344.0216 Abstract ( 341 )   PDF (1159KB) ( 204 )   Save BACKGROUND: Compared with conventional total hip replacement, minimally invasive total hip replacement has some advantages, such as small incision, less blood loss, light pain, low incidence of dislocation, and short rehabilitation period. However, changes in post-displacement stress and in vivo metabolism-related serological indicators have not been systematically reported. OBJECTIVE: To observe cytokines and curative effect before and after minimally invasive total hip replacement and conventional total hip replacement. METHODS: We selected 178 patients who underwent unilateral total hip replacement in the Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University from January 2015 to January 2017. They were randomly divided into observation group (89 cases) and control group (89 cases). The control group was treated by total hip arthroplasty through the standard invasive posterolateral approach. The observation group was treated by total hip arthroplasty through the minimally invasive anterolateral approach. The related operation indexes were recorded in two groups. Harris score was analyzed preoperatively, 1, 3, 6 and 12 months after surgery. The serum levels of interleukin (IL)-1, IL-6, IL-10, tumor necrosis factor (TNF)-α and procalcitonin were measured by enzyme linked immunosorbent assay preoperatively, 1 and 3 days after surgery. RESULTS AND CONCLUSION: (1) All patients were followed up for 12 months. (2) Age, sex, body mass index and joint replacement site were not significantly different in both groups (P > 0.05). (3) The operation time, hospital stay and incision length in the observation group were shorter than those in the control group. The blood loss, blood transfusion, and postoperative drainage in the observation group were less than those in the control group (P < 0.05). (4) Harris Score increased at various time points after replacement in both groups. Harris score was significantly higher in the observation group than in the control group at 1 and 3 months after surgery (P < 0.05). (5) The serum levels of IL-1, IL-6, IL-10, TNF-α and procalcitonin in the observation group were significantly lower than in the control group 1 and 3 days after surgery. (6) These findings confirm that minimally invasive total hip arthroplasty has better curative effect than conventional total hip arthroplasty, and can reduce related cytokine levels, and is more conducive to the rapid recovery of lower extremity motor function.   中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Rivaroxaban and low molecular heparin in prevention of deep venous thrombosis and blood loss after total hip arthroplasty in elderly patients Bai Yun-fei, Fang Ti-gang, Sun Rui 2018, 22 (15):  2303-2308.  doi: 10.3969/j.issn.2095-4344.0189 Abstract ( 383 )   PDF (1142KB) ( 194 )   Save BACKGROUND: Deep venous thrombosis and blood loss are common complications after total hip arthroplasty in elderly patients. Thus, it needs to pick valid treatments to reduce the harm in the clinical treatment. OBJECTIVE: To compare and observe the effects of rivaroxaban and low molecular heparin on preventing deep venous thrombosis and blood loss after total hip arthroplasty in elderly patients.  METHODS: 196 cases in Department of Orthopedics, General Hospital of Shuicheng Mining Group of Guizhou Province treated by unilateral total hip arthroplasty were enrolled between January 2015 and January 2017. They were randomly divided into observation group (98 cases) and control group (98 cases). The observation group was treated with oral rivaroxaban 6 hours after surgery for 2 consecutive weeks. The control group was subcutaneously injected with low molecular heparin injection 6 hours after surgery for 5 consecutive weeks. The coagulation index was measured by automatic coagulation analyzer at preoperative, 1 day, 1 and 2 weeks after surgery. Deep venous thrombosis was evaluated in the two groups. The caliber sizes of superficial femoral vein and popliteal vein were measured by color Doppler ultrasound before surgery, 1, 2, 3 and 4 weeks after surgery. Blood loss was recorded in the two groups. RESULTS AND CONCLUSION: (1) The difference in serum D-dimer levels was statistically significant 1 and 2 weeks after surgery in both groups (P < 0.05). Serum D-dimer levels were lower in the observation group than in the control group. (2) The incidence of deep venous thrombosis was lower in the observation group than in the control group (P < 0.05). (3) The caliber size of superficial femoral vein and popliteal vein was significantly different 1, 2, 3 and 4 weeks after surgery in both groups (P < 0.05). The caliber size of superficial femoral vein and popliteal vein was larger in the observation group than in the control group. (4) Hidden blood loss and total blood loss were significantly different between the two groups (P < 0.05). The hidden blood loss and total blood loss were higher in the observation group than in the control group. (5) Results suggest that rivaroxaban has a positive meaning for prevention of deep venous thrombosis after total hip arthroplasty in elderly patients. However, hidden blood loss is worthy of attention. 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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Hemiarthroplasty and reconstruction of the greater trochanter with cerclage band in the treatment of intertrochanteric fracture in elderly patients   Zhao Qing-bin, Wang Li, Ha Baxi•Kaken, Zhao Wei, Yuan Hong 2018, 22 (15):  2309-2314.  doi: 10.3969/j.issn.2095-4344.0224 Abstract ( 391 )   PDF (1131KB) ( 182 )   Save BACKGROUND: Many domestic and foreign literatures have reported that half hip replacement for unstable intertrochanteric fractures in the elderly has achieved good results, but the unstable intertrochanteric fracture with hemiarthroplasty is difficult to reconstruct the greater trochanter, and its reconstruction method is still controversial. OBJECTIVE: To discuss short-term effect of bipolar hemiarthroplasty and reconstruction of the femoral greater trochanter with cerclage band in the treatment of intertrochanteric fracture in elderly patients.  METHODS: Clinical data of 15 elderly patients with intertrochanteric fracture undergoing bipolar hemiarthroplasty, and reconstruction of the femoral greater trochanter with cerclage band in the Xinjiang Uygur Autonomous Region People's Hospital were retrospectively analyzed. Posterolateral approach was selected. The patients were followed up in out-patient clinic yearly at postoperative 1, 3, 6 and 12 months. Fracture healing was judged using X-ray films, and the possibility of infection was observed. Hip function was evaluated using Harris scoring. Subjective satisfaction of patients was recorded. RESULTS AND CONCLUSION: (1) All patients walked within 3 days after operation. All patients were reviewed on time within a year. Postoperative X-ray revealed that the sample achieved initial stability, and had achieved fracture healing of greater trochanter. Blood examination did not show infection index. (2) The Harris score was (86.3±5.8) in final follow-up. Subjective satisfaction of patients was good. (3) In summary, bipolar hemiarthroplasty and reconstruction of the femoral greater trochanter with cerclage band in the treatment of intertrochanteric fracture in elderly patients can obtain good therapeutic effect, and it can achieve good prosthesis stability and large trochanter fracture reduction and 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 Figures and Tables | References | Related Articles | Metrics

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Middle- and short-term follow-up of biological artificial femoral head replacement in elderly patients with proximal femoral fracture of chronic renal disease   Zuo Wei-min, Yang Long, Wang Jian-ji, Ye Chuan 2018, 22 (15):  2315-2320.  doi: 10.3969/j.issn.2095-4344.0759 Abstract ( 338 )   PDF (1261KB) ( 152 )   Save BACKGROUND: Fracture of the proximal femur is common in the elderly. Biological artificial femoral head replacement is one of the main methods of surgical treatment, but in the patients with chronic renal disease, the surgical efficacy and safety are variously reported. OBJECTIVE: To analyze the middle- and short-term effects of biological artificial femoral head replacement in elderly patients with proximal femoral fracture of chronic renal disease. METHODS: Biological artificial femoral head replacement was used to treat 53 patients with proximal femoral fractures (aged 75 years and over). They were divided into two groups according to renal function: chronic renal disease group (n=25) and non-chronic renal disease group (n=28). Operation time, intraoperative blood loss, intraoperative blood transfusion, postoperative drainage volume of 24 hours, and partial and complete weight-bearing time, hospitalization time, hospitalization expenses and complications were compared between the two groups. Harris hip joint function score, dual energy X-ray bone density, prosthesis loosening, periprosthetic osteolysis and implant survival rate were compared in the two groups during follow-up. RESULTS AND CONCLUSION: (1) In the non-chronic renal disease group, one patient died of respiratory failure at 1 month after replacement, and one case was refurbished at 3 months after replacement. In the chronic renal disease group, one patient died of cardiopulmonary failure at 3 months after replacement. Other patients in both groups were followed up for 1-8 years. The repair efficacy was satisfactory. (2) The excellent and good rate of hip function Harris score was 83% and 85% at 6 months after operation in chronic renal disease group and non-chronic renal disease group, respectively (P > 0.05). (3) No significant differences in operation time, blood loss, the volume of drainage 24 hours after the operation, the partial and complete weight-bearing time and dual energy X-ray bone density were determined between the two groups. The blood transfusion was larger; hospitalization time was longer; hospitalization expenses were more in the chronic renal disease group compared with the non-chronic renal disease group. (4) Patients in the two groups experienced different degrees of osteolysis, but no obvious prosthesis loosening was found. One patient in the non-chronic renal disease group underwent revision because of repeated dislocation of the prosthesis. The survival rates of the prosthesis in the chronic renal disease group and non-chronic renal disease group were 100% and 96% respectively (P > 0.05). (5) For elderly patients with proximal femoral fracture of chronic renal disease, the biological artificial femoral head replacement obtained good repair efficacy, and the function of the limbs was improved obviously with careful preoperative preparation. 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 aspirin for venous thromboembolism after total knee arthroplasty   Zhang Hang, Zhang Zhi-qiang, He Qiang, He Yun-li, Zhang Qian, Feng Zhe, Li Yan, He Sen 2018, 22 (15):  2321-2326.  doi: 10.3969/j.issn.2095-4344.0730 Abstract ( 490 )   PDF (1111KB) ( 201 )   Save BACKGROUND: The best prevention strategy for venous thrombosis (VTE) is currently controversial, especially for patients with high risk of total knee arthroplasty. There are no fully safe, effective and inexpensive thrombus prevention drugs. OBJECTIVE: To study the efficacy and safety of aspirin in preventing venous thrombosis after total knee arthroplasty. METHODS: 300 patients undergoing primary unilateral total knee arthroplasty from September 2014 to December 2016 were randomly divided into two groups: conventional anticoagulation group and risk stratification group (n=150 per group), including 88 males and 212 females at the age of 49-85 years old. The conventional anticoagulation group received low molecular weight heparin for prevention and treatment. Risk stratification group was stratified according to the risk of venous thrombosis. 64 patients with low risk were treated with aspirin and 86 patients with high risk were treated with low molecular weight heparin. Complications were analyzed within 90 days after surgery, including deep venous thrombosis, pulmonary embolism, wound infection, bleeding and death. RESULTS AND CONCLUSION: (1) Complications occurred in 39 cases (13%) within 90 days after follow-up. The total incidence of symptomatic deep vein thrombosis complications was 2% in 6 cases, and 19 cases (6.33%) had wound complications. There were 3 cases (2%) of symptomatic deep vein thrombosis in conventional anticoagulation group and 3 cases (2%) in risk stratification group. (2) The incidence of symptomatic deep vein thrombosis, proximal deep vein thrombosis and distal deep vein thrombosis and pulmonary embolism were 1.56% (1 case), 1.56% (1 case), 4.68% (3 cases), and 0% respectively in patients treated with aspirin. The incidence of symptomatic deep vein thrombosis, proximal deep vein thrombosis and distal deep vein thrombosis and pulmonary embolism in patients receiving low molecular weight heparin were 2.12% (5 cases), 0.85% (2 cases), 5.08% (12 cases) and 0.42% (1 case), respectively. There was no significant difference between the two groups (P > 0.05). (3) There were 11 cases of wound complications in the conventional anticoagulation group and 8 cases in the risk stratification group (χ² = 506, P = 0.318). (4) The incidences of wound-related complications (wound delayed healing, superficial wound infection and deep wound infection) were 1.56% (1 case), 0% and 1.56% (1 case) respectively in patients receiving aspirin, and 5.51% (13 cases), 1.27% (3 cases) and 0.42% (1 case) in patients receiving low molecular weight heparin. (5) Results suggested that aspirin and low molecular weight heparin can effectively prevent the occurrence of deep vein thrombosis. For low-risk patients, aspirin multi-mode thrombosis prevention is safe and effective. 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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Effects of reverse total shoulder arthroplasty versus open reduction and internal plate fixation for the treatment of nonunions of proximal humeral fractures in the elderly   Luo Deng-ke, Chen Ken, Qin Ping, Zhou Na-xin, Yu Ji-zhe, Zou Ji, Chen He-qiang, Xiao Qi-san 2018, 22 (15):  2327-2332.  doi: 10.3969/j.issn.2095-4344.0187 Abstract ( 371 )   PDF (1240KB) ( 192 )   Save BACKGROUND: Proximal humeral fracture is a common disease of fall injury in the elderly, because of bone nonunion after treatment with a variety of factors such as senile osteoporosis. Currently, the use of reverse total shoulder arthroplasty has achieved good clinical effect, but has certain limitations. OBJECTIVE: To compare and observe the clinical effects of reverse total shoulder arthroplasty and open reduction and internal plate fixation in the treatment of nonunion of proximal humeral fractures. METHODS: Totally 120 cases of nonunion of proximal humeral fractures were randomly divided into observation group and control group, with 60 cases in each group. The observation group received reverse total shoulder arthroplasty (replacement of artificial shoulder joint). The control group received open reduction and internal plate fixation. RESULTS AND CONCLUSION:(1) Follow-up results: At 3 years after surgery, the pain score was lower in the observation group than that in the control group (P < 0.05). Constant daily activities, range of activities, strength test score, Constant total score, satisfaction and hospitalization expenses were higher in the observation group than in the control group. Functions of flexion, laterotorsion and intorsion were better in the observation group than those in the control group (P < 0.05). (2) Adverse reactions: At 3 years after surgery, 26 and 22 cases had adverse reaction in the observation group and the control group respectively. (3) The results show that the clinical effect of the elders’ nonunion of proximal humeral fracture treated with reverse total shoulder arthroplasty is quite good, and the pain degree and shoulder function are obviously improved. The curative effect of reverse total shoulder arthroplasty is better than that of open reduction and internal plate 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 Figures and Tables | References | Related Articles | Metrics

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Posterior lumbar dynamic stabilization system in the treatment of degenerative lumbar spinal stenosis: efficacy and safety   Deng Yong, Xiang Jing 2018, 22 (15):  2333-2339.  doi: 10.3969/j.issn.2095-4344.0728 Abstract ( 406 )   PDF (1121KB) ( 225 )   Save BACKGROUND: Lumbar posterior dynamic stabilization system is a new nonfusion method for the treatment of lumbar degenerative disease, mainly including interspinous dynamic fixation system and the posterior pedicle fixation device. Wallis system and Dynesys system are representative of two different fixation systems. There is little study on above two fixation systems in the treatment of degenerative lumbar spinal stenosis. OBJECTIVE: To compare the effectiveness and safety of Wallis system interspinous fixation, Dynesys system transpedicular fixation and fusion in the treatment of degenerative lumbar spinal stenosis. METHODS: Totally 79 cases of degenerative lumbar spinal stenosis voluntarily receiving the surgery were divided into three groups according to fixation mode. In the fusion group, 30 cases underwent full decompression combined with posterior lumbar interbody fusion. In the Wallis group, 25 cases underwent full decompression combined with interspinous Wallis fixation. In the Dynesys group, 24 cases underwent full decompression combined with pedicle screw fixation with Dynesys system. The follow-up data of all patients were complete at postoperative 3 years. RESULTS AND CONCLUSION: (1) There was no significant difference in baseline data, intraoperative bleeding and postoperative drainage volume among the three groups (P > 0.05). The operation time of the fusion group was obviously longer than in the other two groups (P < 0.05). (2) There were no significant differences between the Wallis group and the Dynesys group in spinal function scores, visual analogue score of the low back pain, the Oswestry dysfunction index and the imaging measurement indexes (P > 0.05). The spinal function score and Oswestry dysfunction index of the fusion group were significantly decreased at postoperative 3 years (P < 0.01). The spinal function score and Oswestry dysfunction index of the Wallis and Dynesys groups at 1 month after operation were significantly lower than that in the fusion group (P < 0.01). The operation range of the three groups decreased significantly after operation (P < 0.01). Compared with the fusion group, the range of adjacent segments increased significantly in the Wallis group and the Dynesys group; and the intervertebral height, the height of the intervertebral foramen and the area of the intervertebral foramen in the three groups were significantly higher than those before the operation (P < 0.01). (3) There were no significant differences among the three groups in the evaluation of the clinical efficacy and the incidence of complications (P > 0.05). It was shown that lumbar posterior dynamic stabilization system (Wallis and Dynesys systems) internal fixation for degenerative lumbar spinal stenosis can effectively relieve low back pain and maintain lumbar function and activity, and the short-term curative effect is reliable. 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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U-shape titanium screw-rod fixation system with bone grafting for the treatment of pure lumbar spondylolysis Sun Lu-kun, Xu Chun-tao, Liu Hua, Yan Bing-xiang, Yue Han-yu, Wang Ping-shan 2018, 22 (15):  2340-2344.  doi: 10.3969/j.issn.2095-4344.0794 Abstract ( 365 )   PDF (6995KB) ( 205 )   Save BACKGROUND: When conservative treatment of pure lumbar spondylolysis is ineffective, segmental fixation and bone grafting is a commonly used method. However, surgical methods are various, and have some controversies. OBJECTIVE: To investigate the effectiveness of U-shape titanium screw-rod fixation system with bone grafting for pure lumbar spondylolysis. METHODS: Data from 15 patients with pure lumbar spondylolysis or without mild spondylolisthesis, who were treated with U-shape titanium screw-rod fixation system and bone grafting in the Department of Orthopedics of Jinan Military General Hospital from May 2012 to May 2016, were retrospectively reviewed. Operation time, intraoperative blood loss and postoperative drainage were observed. The lumbar spine X-ray, CT, Visual Analogue Scale and Oswestry Disability Index were compared before operation, 3, 6 and 12 months after operation. RESULTS AND CONCLUSION: (1) The operation time was (115.0±18.8) minutes, the intraoperative blood loss was (280.0±84.3) mL, and the postoperative drainage was (61.0±19.6) mL. (2) By Visual Analogue Scale and Oswestry Disability Index during following-up, pain symptoms and function were significantly improved (P < 0.05). (3) No secondary spondylolisthesis, adjacent vertebral degeneration, internal fixation fracture, loosening, infection or nerve injury occurred during the follow-up. (4) All patients had bony union. The healing time range was 6-12 months, with an average of 8.2 months. (5) In summary, U-shape titanium screw-rod fixation system with bone grafting is a good choice for the treatment of pure lumbar spondylolysis. 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 laminectomy combined with lumbar pedicle screw fixation for treatment of lower back and leg pain in older adult patients with degenerative lumbar spinal stenosis: study protocol for a self-control trial and preliminary results   Li Chun-liang, Guo Qiang, Qin Feng, Yan Wen-qi, Zhu Hai-yong, Wang Kai 2018, 22 (15):  2345-2349.  doi: 10.3969/j.issn.2095-4344.0247 Abstract ( 387 )   PDF (1040KB) ( 214 )   Save BACKGROUND: Senile degenerative lumbar spinal stenosis typically manifests clinically as lower back and leg pain caused by compression of the nerve root. Conventional total laminectomy for degenerative lumbar spinal stenosis can quickly alleviate a patient’s symptoms, but produces an unsatisfactory therapeutic effect because of spinal instability caused by degenerative spondylolisthesis, and also has many adverse reactions. OBJECTIVE: The purpose of this study is to investigate whether total laminectomy combined with lumbar pedicle screw fixation for treatment of senile degenerative lumbar spinal stenosis can effectively reduce lower back and leg pain caused by compression of the nerve root, increase lumbar spine stability, and reduce adverse reactions.  METHODS: A prospective, single-center, self-control, interventional trial. One hundred and sixty older adult patients with degenerative lumbar spinal stenosis who will receive treatment at the Department of Orthopedics, Qinghai Provincial People’s Hospital, China will be included in this study. All patients will undergo total laminectomy combined with lumbar pedicle screw fixation, with follow-up at 3, 6, 9, and 12 months post-surgery. RESULTS AND CONCLUSION: The primary outcome measure of this study is recovery rate in Japanese Orthopedic Society (JOA) score at 12 months post-surgery, which is used to evaluate improvements in patients lower back and leg pain. Secondary outcome measures of this study include changes in JOA score, spinal canal diameter, lumbar spine morphology displayed on computed tomography images, and incidence of adverse events post-surgery. Results of a preliminary study involving 71 older adult patients with degenerative lumbar spinal stenosis who received the same treatment showed that at 3 months post-surgery, JOA score and spinal canal diameter were significantly increased compared with before surgery (P < 0.05). Findings from this study may provide clinical evidence supporting that total laminectomy combined with lumbar pedicle screw fixation is a safe and reliable method for treatment of senile degenerative lumbar spinal stenosis because it rapidly alleviates lower back and leg pain and provides spine stability. This study was approved by Medical Ethics Committee of Qinghai Provincial People’s Hospital of China (approval No. QHY201602G). 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 August 2018. Data analysis will be performed in October 2019. The study will be completed in December 2019. Results will be disseminated through presentations at scientific meetings and/or by publication in a peer-reviewed journal. The version of this study protocol is (1.0). This trial was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800014726). 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Modified posterior lumbar interbody fusion augmented with bone cement in the treatment of senile degenerative lumbar spondylolisthesis: study protocol for a self-controlled trial   Ren Rong, Guo Qi-fa, Li Zhao-wei, Li Ze-qing, Tang Bao-ming 2018, 22 (15):  2350-2354.  doi: 10.3969/j.issn.2095-4344.0248 Abstract ( 238 )   PDF (1119KB) ( 173 )   Save BACKGROUND: Posterior lumbar interbody fusion is the main repair method for senile degenerative lumbar spondylolisthesis. For elderly patients with osteoporosis, single screw rod system fixation regularly results in dislocation. The incidence of implant loosening is high, and therefore, effective internal fixation is not achieved. OBJECTIVE: This study will use the modified posterior lumbar interbody fusion procedure combined with bone cement augmentation for the treatment of senile degenerative lumbar spondylolisthesis so as to increase the stability of the vertebral body, make the fixator firm, and to maximize the recovery of postoperative motor function. METHODS: Totally 113 patients with senile degenerative lumbar spondylolisthesis, aged 65-70 years, irrespective of sex, will be recruited from the Department of Orthopedics of Affiliated Hospital of Qinghai University of China. The patients will be treated with modified posterior lumbar interbody fusion combined with bone cement augmentation. Follow-up will be performed at 3 and 12 months. The primary outcome measure is recovery of motor function as indicated by the postoperative Oswestry Disability Index score at 12 months. The secondary outcome measures are the change in the rate of excellent and good Oswestry Disability Index scores (comparing preoperative scores with the 4-month postoperative scores), Visual Analogue Scale scores, intervertebral space height, foraminal height, the preoperative and 4 and 14 months postoperative slip distance and slip angle, incidence of adverse reactions, success rate of vertebral fusion, and incidence of secondary slip 4 and 14 months postoperatively. This trial has been approved by the Medical Ethics Committee of Affiliated Hospital of Qinghai University of China (approval number: QHY023G). The study protocol will be proformed 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 October 2017. The recruitment of subjects and data collection will begin in June 2018. The recruitment will be finished in December 2018. Outcome measures will be analyzed in January 2020. This trial will be completed in February 2020. 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: ChiCTR1800015335). Protocol version (1.0). DISCUSSION: This trial aims to observe the efficacy of modified posterior lumbar interbody fusion combined with bone cement augmentation in the treatment of senile degenerative lumbar spondylolisthesis and to validate whether the procedure is safe and reliable. 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 autogenous tendon reconstruction with coracoclavicular ligament combined with hook plate and simple hook plate fixation in the treatment of acromioclavicular joint dislocation Song Sheng, Sun Zhen-zhong, Yin Fei, Wei Xu-ming, Liu Xue-guang, Zhuang Yin, Zhou Ming 2018, 22 (15):  2355-2360.  doi: 10.3969/j.issn.2095-4344.0792 Abstract ( 500 )   PDF (3035KB) ( 182 )   Save BACKGROUND: Hook plate is usual and satisfactory for the treatment of acromioclavicular joint dislocation, but there are still many problems. The comparative analysis is seldom reported between reconstruction of coracoclavicular ligament by autogenous tendon combined with hook plate and simple hook plate. OBJECTIVE: To compare the clinical efficacy of reconstruction of coracoclavicular ligament combined with hook plate and simple hook plate fixation for acromioclavicular joint dislocation. METHODS: A total of 38 patients with acromioclavicular dislocation were randomly divided into two groups. The patients were treated with plantar tendon “V” reconstruction with coracoclavicular ligament combined with hook plate fixation (combination group) and with a simple hook plate fixation (simple hook plate group). We compared the operation time, blood loss, hospitalization days, average hospitalization costs, the time taken for internal fixation, the motion range of shoulder joint at postoperative 12 months, the Constant-Murley function score, the reduction of shoulder joint and the Visual Analogue Scale scores between the two groups. RESULTS AND CONCLUSION: (1) Patients in both groups were followed up for 12 months. In the combination group, the hook plate was removed at postoperative 3 months. In the simple hook plate group, the hook plate was removed at approximately postoperative 12 months. In follow-up, no dislocation appeared in both groups. (2) No significant difference in hospitalization days, motion range of shoulder joint, Constant-Murley function score, the reduction of shoulder joint and the Visual Analogue Scale scores was determined between the two groups (P > 0.05). (3) Operation time was longer; blood loss was more; and average hospitalization costs were higher in the combination group than in the simple hook plate group (P < 0.05). (4) These findings indicate that plantar tendon reconstruction of coracoclavicular ligament combined with hook plate meets biomechanical requirements in the treatment of acromioclavicular joint dislocation. The plate can be removed early using a fixator. The lower extremity has an incision, but the follow-up results are satisfactory. Simple hook plate fixation for acromioclavicular joint dislocation takes a long time, and can obtain average effect, but there is the risk of re-dislocation (this case does not experience re-dislocation). The appropriate treatment can be chosen according to the patient’s condition, needs, and economic conditions. 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 tranexamic acid on reducing perioperative blood loss in patients with intertrochanteric fracture   Jin Zhi-chao, Zheng Xiao-hui, Yu Xiang, Lü Di, Mo Ying-jie, Wu Wen-zheng, Ouyang Chongzhi, Huang Ze-qing 2018, 22 (15):  2361-2366.  doi: 10.3969/j.issn.2095-4344.0188 Abstract ( 396 )   PDF (1186KB) ( 146 )   Save BACKGROUND: Proximal femoral nail anti-rotation is widely used to treat various intertrochanteric fractures. Although its operation trauma is small, and the blood loss of perioperative period is still large. Tranexamic acid has been gradually used to reduce the bleeding of intertrochanteric fracture. The effectiveness and safety of reducing blood loss during perioperative period were not reported. OBJECTIVE: To explore the safety and efficacy of tranexamic acid on perioperative blood loss in patients with intertrochanteric fracture undergoing proximal femoral nail anti-rotation. METHODS: One hundred and eight patients with intertrochanteric fracture undergoing proximal femoral nail anti-rotation were selected from First Affiliated Hospital, Guangzhou University of Chinese Medicine between January 2015 and January 2017. Among all the subjects, 52 patients who received the operation before January 2016 served as the control group and 56 patients who received the operation after January 2016 were selected as the treatment group. Half an hour before operation, patients in the treatment group received 1 g tranexamic acid dissolved in 250 mL normal saline by intravenous dropping; patients in the control group just received 250 mL normal saline by intravenous dropping. The bleeding volume, blood transfusion volume, hemoglobin, hematocrit, coagulation index, D-dimer levels and complications were compared between the two groups. RESULTS AND CONCLUSION: (1) During perioperative period, actual blood loss, intraoperative blood loss, dominant blood loss, recessive blood loss, volume of drainage, blood transfusion volume and blood transfusion rate were lower in the treatment group than in the control group (P < 0.05). (2) There was no statistically significant difference in the hemoglobin and hematocrit between the two groups before operation (P > 0.05). The hemoglobin and hematocrit of the two groups gradually decreased after the operation, and there was a slight improvement in the fifth day after surgery. At postoperative 2 hours, 1, 3 and 5 days, the hemoglobin and hematocrit of the treatment group were higher than in the control group (P < 0.05). At preoperation and each time point postoperation, prothrombin time, activated partial thromboplastin time, and fibrinogen levels were not statistically significant between the two groups (P > 0.05). Postoperative D-dimer levels in the two groups were significantly higher than preoperation, and there was a return on the fifth day. There was no statistically significant difference between groups at preoperation and each time point of postoperation (P > 0.05). (3) The results suggest that the tranexamic acid can effectively reduce the dominant and recessive blood loss in patients with the intertrochanteric fracture, and it is safe and effective.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Biomechanical study of different fixation with hollow screws in spinal laminoplasty Wang Lin-feng, Lu Cheng-wu, Ye Hong, Chen Xiao-jie, Qiu Bi-cheng 2018, 22 (15):  2367-2372.  doi: 10.3969/j.issn.2095-4344.0227 Abstract ( 462 )   PDF (1147KB) ( 187 )   Save BACKGROUND: Spinal lamina reimplantation assisted hollow screw laminoplasty has achieved good clinical efficacy. The search literature found that there is no research at home and abroad on the biomechanical properties of unilateral and bilateral hollow screw fixation. OBJECTIVE: To evaluate the biomechanical property of different fixation with hollow screws in artificial and goat vertebrate laminoplasty. METHODS: A laminoplasty was conducted by using hollow screws. Based on the artificial vertebrate laminoplasty model, new models were generated by simulating unilateral screws fixation with a depth of screw insertion 5 mm (A group), unilateral screw fixation with a depth of screw insertion 8 mm (B group) and bilateral screw fixation with a depth of screw insertion 5 mm (C group). Based on the goat vertebrate laminoplasty model, new models were generated by simulating unilateral screws fixation (A group) and bilateral screw fixation (B group). The pull-out strength and static pressure were tested in the biomechanical testing machine with a sensor. RESULTS AND CONCLUSION: (1) In the artificial vertebrate model, the average pull-out strength of the group B was stronger than that of the groups A and C (P < 0.01); the average pull-out strength of the group A was stronger than that of group C (P < 0.01), the difference was statistically significant (P < 0.05). However, the average static compression of the group A and group B was similar; the average static compression of the group C was lower than that of the groups A and B, and the difference was statistically significant (P < 0.01). (2) In the goat vertebrate model, the average pull-out strength and static compression of the group A were stronger than that of the group B, and the difference was statistically significant (P < 0.05). (3) Results suggest that unilateral screw fixation in the artificial and goat vertebrate laminoplasty can provide sufficient pull-out strength and static compression, and the biomechanical strength is positively related to the depth of the screw. 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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Construction of fresh cervical vertebral artery determination model: influence of variant positions on vertebral artery flow     Feng Min-shan, Yin Xun-lu, Zhu Li-guo, Zhang Fa-yao, Liu Guang-wei, Zhan Jia-wen, Yin He, Gao Chun-yu, Li Jian 2018, 22 (15):  2373-2377.  doi: 10.3969/j.issn.2095-4344.0249 Abstract ( 394 )   PDF (1313KB) ( 198 )   Save BACKGROUND: As a reliable biomechanical model, human fresh isolated cervical specimens provide the basis for studying the pathogenesis of cervical vertigo from the perspective of blood flow of vertebral artery. There is a lack of an in vitro cervical model that can simulate the physiological state of the cervical vertebrae and achieve complex posture, as well as can measure the blood flow of vertebral artery. OBJECTIVE: To study the influence of variant position of human fresh isolated cervical vertebrae on the blood flow of vertebral artery in vitro through constructing the fresh specimen of cervical vertebral artery determination model. METHODS: Six human fresh isolated cervical specimens were selected for constructing the vertebral artery determination model. The pressure of human vertebra artery was simulated by pressure pump. The change of normal saline height was measured by digital motion capture system dynamically under different positions. RESULTS AND CONCLUSION: (1) Eight vertebral arteries in the six models were in good condition. (2) The vertebral artery flow under neutral position was significantly richer than that under contralateral rotation-anteflexion and ipsilateral/contralateral rotation-postexion (P < 0.05). (3) The vertebral artery flow under contralateral rotation-anteflexion and rotation-postexion was significantly poorer than that under natural position, ipsilateral rotation and ipsilateral rotation-anteflexion (P < 0.05). (4) In summary, the cervical vertebral artery determination model is constructed successfully that can simulate the influence of the position on vertebral artery flow. Additionally, different positions of rotation make a different effect on vertebral artery flow. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Digital simulation and clinical application of acetabular anterior column fracture fixation with plate   Wang Jian, Yun Wen-ke, Li Ge-dang, Cai Yong-qiang, Li Xiao-he 2018, 22 (15):  2378-2383.  doi: 10.3969/j.issn.2095-4344.0183 Abstract ( 370 )   PDF (1830KB) ( 173 )   Save BACKGROUND: The anatomical structure of the pelvis is complex, and it is difficult to be fixed. Misplacement of screws can lead to severe complications. Therefore, exploring an efficient, simple, and economic individualized design of surgical staple parameters has become a key issue in the fixation of the acetabular anterior column fracture.  OBJECTIVE: To design parameters on the anterior column of acetabulum fracture reconstruction plate internal fixation for preoperative design using CT scan data, and to compare with conventional steel plate fixation.  METHODS: Forty patients with acetabular anterior column fracture were randomly assigned to two groups: digital design group (n=20) and conventional surgery group (n=20). The digital design group received pelvic CT scanning for data acquisition. Materialise Mimics Innovation Suite 16.0 software was used for digital simulation of anterior acetabular fracture plate fixation. The conventional surgery group received conventional steel plate fixation. Operation time, blood loss and healing time were compared between the two groups. Anatomic reduction ratio and hip function score were compared between the two groups at postoperative 16 weeks. RESULTS AND CONCLUSION: (1) Operation time, blood loss, healing time, anatomic reduction ratio and hip function score were better in the digital design group than in the conventional surgery group (P=0.00). (2) Results suggest that compared with the conventional surgery group, acetabular anterior column fractures of digital three-dimensional operation design has a good effect on reducing operation time and blood loss and elevating fixation effect, and can provide reference data for 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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Accuracy of three-dimensional reconstruction models using Arigin 3D Pro and Mimics software programs Cao Gui-ping, Zhang Ming-jiao, Liu Fei, Lian Qin, Xu Xian-hui 2018, 22 (15):  2384-2389.  doi: 10.3969/j.issn.2095-4344.0729 Abstract ( 727 )   PDF (1929KB) ( 221 )   Save BACKGROUND: With the improvement of medical imaging technology, the visualization of human anatomy has been further developed; the role of three-dimensional (3D) reconstruction in medical treatment is also becoming increasingly prominent. Mimics is the most widely used medical image reconstruction software. Arigin 3D Pro is a recently developed 3D reconstructed medical software system based on 3D printing. OBJECTIVE: To study the accuracy of 3D reconstruction models obtained by using Arigin 3D Pro and Mimics with medical images. METHODS: The image data of liver, spine, knee joint and heart were selected, and the deviations of two software reconstruction models were analyzed based on the 3D model reconstructed by Mimics. Totally 10 cases of skull and 1 case of femoral comminuted fracture image data were selected and reconstructed. Each reconstruction model was measured with 10 groups of feature sizes to evaluate the differences between the two software programs. RESULTS AND CONCLUSION: Arigin 3D Pro and Mimics were used to reconstruct the liver, spine, knee and heart data. The mean ± standard deviation of model deviations were (0.93 ± 1.05), (0.36 ± 0.74), (0.45 ± 0.74), (0.18 ± 0.41) mm. It took 3 minutes and 35 minutes for Arigin 3D Pro and Mimics to reconstruct the liver model respectively, and both software reconstructed other models for less than 1 minute. There was no statistically significant difference between the feature sizes of the two software for the 3D reconstruction models of skull and femoral comminuted fracture data (P > 0.05). The 3D reconstruction model of Arigin 3D Pro is comparable to that of Mimics. For the liver model, the reconstructed time of Arigin 3D Pro is significantly shorter than that of Mimics. 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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Relationship between hip tuberculosis course and total hip arthroplasty Ma Yong-hai, Zhen Ping, Shao Long-long, Wang Wei 2018, 22 (15):  2390-2395.  doi: 10.3969/j.issn.2095-4344.0758 Abstract ( 296 )   PDF (1311KB) ( 240 )   Save BACKGROUND: Hip tuberculosis was second to that of the spine. A great number of cases were diagnosed hip tuberculosis every year. The early stage of hip tuberculosis is difficult to be diagnosed, and the X-ray images often show no abnormal signs. When there is an abnormal sign on X-ray, the extent of bone destruction is generally more than 50%. Selection of treatment methods for the patients with hip tuberculosis is the important issue in face of every clinician. OBJECTIVE: To review various types of research progress in clinical treatment of hip tuberculosis in recent years, and to provide reference for clinical treatment of hip tuberculosis. METHODS: We retrieved database of PubMed and CNKI for studies concerning clinical treatment of hip tuberculosis published from January 1969 to March 2017. Key words were “tubercular arthritis, hip, total hip replacement, treatment”. After removal of repetitive or irrelevant articles, 42 articles were finally included. RESULTS AND CONCLUSION: (1) In the treatment, current emphasis was on mobility with stability at the hip. (2) Adults with advanced arthritis should be informed and discussed the various treatment modalities including the joint replacement. (3) With the development of artificial arthroplasty, total hip replacement was the preferred choice for patients with advanced hip tuberculosis. More and more surgeons were taking up the challenge of putting the total hip arthroplasty in the active stage of the disease. 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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Femoral revision of the hip: reason, type and different techniques Feng Shuo, Zha Guo-chun, Guo Kai-jin, Chen Xiang-yang 2018, 22 (15):  2396-2406.  doi: 10.3969/j.issn.2095-4344.0760 Abstract ( 369 )   PDF (4751KB) ( 223 )   Save BACKGROUND: Total hip arthroplasty has been widely used in clinical practice, and achieved good clinical efficacy. However, with the yearly increased number of patients receiving primary arthroplasty, the number of revision hip arthroplasty patients has increased. However, hip arthroplasty is one of the most difficult hip surgery, and it is challenging. OBJECTIVE: To review the causes of femoral revision of the hip arthroplasty, the classification of the femoral bone defect, and the type of prosthesis available in the clinical revision, and the clinical effect of the different prosthesis, so as to provide reference for femoral revision. METHODS: CNKI, Web of Science, and PubMed were searched for the literatures published between January  1975 and August 2017 with the key words of “Revision total hip arthroplasty, Femur revision, Cemented femoral revision, Cemenless femoral revision Reoperation, Porous-coated stems, Modular, tapered stem, Wagner SL revision Stem”. RESULTS AND CONCLUSION: (1) A total of 1 041 articles were retrieved. After reading the abstract, unrelated and repeated studies were excluded. Finally, 109 studies were included. Of them, there were 106 English studies and 3 Chinese studies. Femoral revision was analyzed and summarized. (2) Femoral revision of the hip is still the future challenges facing the joint surgeon. We continue to strive to overcome the direction. Although the current material science and surgical technology are now rapidly developed, only the analysis of the reasons for the revision of the femoral side, identifying the femoral side bone defect classification, mastering the treatment of different defects and the application of the principle of prosthesis type, making reasonable femoral revision program is the key to success according to the patient's age and activity. 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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Concepts, characteristics and values of precision medicine in the field of orthopedics Li Sheng-hua, Deng Chang, Zhou Ming-wang, Fu Zhi-bin 2018, 22 (15):  2407-2413.  doi: 10.3969/j.issn.2095-4344.0739 Abstract ( 379 )   PDF (1389KB) ( 147 )   Save BACKGROUND: Precision medicine pays attention to the depth characteristics of the disease and the high precision of the treatment, and is a precise and accurate personalized approach of the diagnosis and treatment of the disease. In recent years, it has gradually become the hotspot of the medical field. As a new concept of medicine and medical model, its value in clinical treatment of orthopedics has been gradually highlighted. OBJECTIVE: To summarize the current status and progress of precision medicine in the field of orthopedics. METHODS: A computer-based search of PubMed and CNKI databases was performed for literatures about application and prospect of precision medicine in the field of orthopedics in and outside China published within the past 10 years using the keywords of “precision medicine, Orthopedics, bone, 3D printing, computer assisted navigation, minimal invasive, gene”. RESULTS AND CONCLUSION: (1) In the study on the prevention and treatment of the disease of orthopedics, 3D printing technology, computer assisted navigation technology, precision minimally invasive orthopedic technology, and gene research are four effective way to achieve precise and personalized healthcare. (2) The appearance of precision medicine, a novel medicinal model, enriches the treatment of the disease in the field of orthopedics and enhances the curative efficacy of the disease. Precision medicine brings the new dawn to the patient and provides some new clues for medical workers and researchers engaged in the clinical and basic research of the disease in the field of orthopedics. 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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Management of bone defects in total knee arthroplasty Liang Hao-dong, Pan Jian-ke, Xie Hui, Huang He-tao, Han Yan-hong, Lin Jiong-tong, Liu Jun 2018, 22 (15):  2414-2420.  doi: 10.3969/j.issn.2095-4344.0736 Abstract ( 782 )   PDF (1585KB) ( 179 )   Save BACKGROUND: Bone defects are one of the most important challenges that surgeons have to manage in total knee arthroplasty. The reasonable treatment method can guarantee the effect of the repair operation. OBJECTIVE: To review the relevant literatures concerning bone defects treated by primary total knee arthroplasty and revision total knee arthroplasty, and to analyze the optimal managements for different types of bone defects. METHODS: Relevant literatures were identified in China National Knowledge Infrastructure, Wanfang data, Vip, PubMed, Medline, and Web of Science. The key words were “total knee arthroplasty, total knee replacement, revision total knee arthroplasty, bone loss, bone defect, bone deficiency, management”. The included studies were analyzed and summarized. RESULTS AND CONCLUSION: (1) Sixty-two studies regarding total knee arthroplasty for bone defects were included, without recognized standards on the type of bone defects. AORI is the most widely used classification for bone defects. (2) Pre-operated detailed evaluation including laboratory and radiographic examination, and accurate diagnosis are the key to success. (3) Management of bone defect was similar in tibia and femur, but there is still no standard classification and management of patellar bone defect. (4) Using stem fixation whenever a femoral or tibial component is revised can improve clinical outcome. (5) Through detailed evaluation, accurate diagnose and appropriate classification of bone defect, selection, according to the characteristics of different strategies, the age of the patient and the needs of life, can get a good clinical result. 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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Animal models in periprosthetic osteolysis Gong Dong, Wu Guo-tai, Zhen Ping 2018, 22 (15):  2421-2426.  doi: 10.3969/j.issn.2095-4344.0757 Abstract ( 301 )   PDF (1101KB) ( 139 )   Save BACKGROUND: There are a variety of methods for establishing periprosthetic osteolysis animal model, and the models established by different methods and with different animals have their own characteristics. OBJECTIVE: To review the research profiles of the periprosthetic osteolysis and the characteristics of the various models, and to provide a reference for the related research. METHODS: The relevant articles on the periprosthetic osteolysis animal models were searched in PubMed from January 1999 to May 2017, with the key words of “animal model, osteolysis” in English by the computer. Similarly, Chinese Journal Full-text Database was retrieved for related articles published from January 1999 to May 2017, with the key words of “animal model, osteolysis” in Chinese. Articles that were unrelated to the periprosthetic osteolysis animal model were excluded. Classic and recently published articles were selected. RESULTS AND CONCLUSION: (1) The artificial induced animal models are the principal means to establish animal models of periprosthetic osteolysis and they have been widely used in the study of periprosthetic osteolysis pathogenesis, pathological process and treatment.      (2) Small-animal models present many advantages: inexpensive to purchase, high physiological turnover, controlled source, homogenous and established genetic background. However, a limitation of these small-animal models is that the temporal pattern of osteolysis is different from the long-term osteolysis that occurs in patients. (3) The large animal model is more similar to the bone dissolution process around the human prosthesis, but the cost is high; the breeding is difficult; the operation requirement is hard. Thus, its widespread use is limited. (4) Furthermore, innovative models that combine the advantages of both are also constantly explored. Overall, the selection of models should be based on research conditions and needs to be considered. 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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Meta-analysis of risk factors of the surgical site infection through lumbar posterior approach Zhong De-gui, Liu Qi-yu, Mai Xiu-jun, Wang Wen-hao, Lai Jun-hui, Huang Yong-ming, Huang Yong-quan, Hou Qiu-ke, Su Hai-tao 2018, 22 (15):  2427-2436.  doi: 10.3969/j.issn.2095-4344.0250 Abstract ( 397 )   PDF (1674KB) ( 209 )   Save BACKGROUND: Surgical site infection is the main complication after posterior lumbar surgery, which not only increases the patient’s hospitalization time, financial burden and physical pain, but also increases the difficulty for the clinical medical staff, delays the recovery of postoperative patients, even leads to deaths. Therefore, it is important to analyze the factors related to the infection of the surgical site after posterior lumbar surgery. OBJECTIVE: To analyze the risk factors of the surgical site infection after lumbar posterior approach in China. METHODS: Studies about the surgical site infection after lumbar posterior approach were retrieved by computer. The quality of the studies was evaluated by reading the full text. Heterogeneity was analyzed using RevMan 5.3 software. Meta analysis was used to analyze the combined effect. RESULTS AND CONCLUSION:(1) Totally 20 studies with 423 cases of surgical site infection and 13 995 cases of non-infection were included. (2) Meta-analysis univariate analysis results: body mass index ≥ 27 kg/m2 [OR=3.82, 95%CI(2.47, 5.91), P < 0.000 01], age ≥ 60 years [OR=1.99, 95%CI(1.44, 2.76), P < 0.000 1], intraoperative blood loss ≥ 300 mL [OR=3.98, 95%CI(2.50, 6.33), P < 0.000 01], subcutaneous fat thickness [MD=5.35, 95%CI(3.58, 7.12), P < 0.000 01], number of segments ≥ 3 [OR=3.83, 95%CI(2.02, 7.26), P < 0.000 1], operation time ≥ 180 minutes [OR=2.96, 95%CI(2.06, 4.27), P < 0.000 01], preoperative serum protein < 35 g/L [OR=2.37, 95%CI(1.63, 3.46), P < 0.000 01], and diabetes [OR=2.88, 95%CI(2.22, 3.74), P < 0.000 01] were risk factors for surgical site infection after lumbar posterior approach. (3) Multivariate analysis results: body mass index ≥ 27 kg/m2 [OR=3.21, 95%CI(1.97, 5.22), P < 0.000 01], subcutaneous fat thickness [MD=5.35, 95%CI(3.58, 7.12), P < 0.000 01], preoperative serum protein < 35 g/L [OR=3.73, 95%CI(2.30, 6.04), P < 0.000 01], and diabetes [OR=3.35, 95%CI(1.75, 6.42), P=0.003] were independent risk factors for surgical site infection after lumbar posterior surgery. (4) Results showed that body mass index ≥   27 kg/m2, subcutaneous fat thickness, preoperative serum protein < 35 g/L, and diabetes are independent risk factors for surgical site infection after lumbar posterior approach in China. Due to the number of cases of surgical site infection and its methodological quality during the study, the above conclusions still need to be confirmed by more large-scale, high-quality studies to provide reliable evidence for perioperative management.   中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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A meta-analysis of risk factors of postoperative delirium of elderly hip fracture patients in China Lü Yang, Liu Qi-yu, Liu Jun, Chen Hai-yun, Pan Jian-ke, Li Xi-wen 2018, 22 (15):  2437-2445.  doi: 10.3969/j.issn.2095-4344.0251 Abstract ( 503 )   PDF (1802KB) ( 169 )   Save BACKGROUND: At present, there is no consensus on the risk factors for delirium after hip fracture in the elderly, and there is no risk prediction system that can effectively assess the risk of delirium after hip fracture in the elderly. OBJECTIVE: To identify the risk factors of postoperative delirium of elderly hip fracture. METHODS: Studies about delirium of elderly hip fracture patients were retrieved by computer. Quality of the studies was assessed. Analysis of sensitivity and heterogeneity was performed by RevMan 5.3 software and cumulative effects were calculated by either fixed or random effects models. RESULTS AND CONCLOUSION: (1) Totally 15 studies included 872 cases of delirium and 3 221 cases of non-delirium. (2) The results of meta-analysis showed that: univariate analysis indicated that preoperative cognitive dysfunction [pooled OR=4.99, 95%CI(2.66, 9.37), P=0.000], age [pooled MD=3.60, 95%CI(2.21, 5.00), P=0.000], preoperative complications ≥ 3 [pooled OR=2.83, 95%CI(2.12, 3.79), P=0.000], preoperative hemoglobin < 100 mg/L [pooled OR=2.09, 95%CI(1.17, 3.76), P=0.01], preoperative albumin < 35 g/L [pooled OR=2.29, 95%CI(1.77, 2.97), P=0.01], general anesthesia [pooled OR=2.17, 95%CI(1.41, 3.34), P=0.000 4], the type or treatment of hip fracture [pooled OR=1.36, 95%CI(1.04, 1.78), P=0.02], operation time [pooled OR=2.88, 95%CI(1.42, 5.82), P=0.003], and intraoperative blood loss [pooled MD=36.97, 95%CI(25.74, 48.19), P=0.000] were the risk factors of postoperative delirium of elderly hip fracture patients. (3) Multivariate analysis showed that preoperative cognitive dysfunction [pooled=4.94, 95%CI(2.23, 10.95), P=0.000], age [pooled MD=2.84, 95%CI(1.89, 3.78), P=0.000], preoperative complications ≥ 3 [pooled OR=3.05, 95%CI(2.11, 4.41), P=0.000], general anesthesia [pooled OR=4.29, 95%CI(1.40, 13.14), P=0.01], and operation time ≥ 2.5 hours [pooled OR=2.62, 95%CI(1.68, 4.08), P=0.000] were independent risk factors for postoperative delirium of elderly hip fracture patients. (4) In conclusion, the independent risk factors of postoperative delirium of elderly hip fracture patients are preoperative cognitive dysfunction, age, preoperative complications ≥ 3, general anesthesia and operation time ≥ 2.5 hours. The type of fracture, preoperative waiting time, and type of operation are not related to postoperative delirium. However, due to the low quantity and quality of the included literature, the conclusion needs the support from many high-quality studies. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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A meta-analysis of pneumatic tourniquet used in total knee arthroplasty Gu Pei-lun, Dong Jin-bo, Wang Wei-shan, Chen Lei, Yu Hong-tao, Li Yue-jun, Gao Peng, Wang Kai 2018, 22 (15):  2446-2452.  doi: 10.3969/j.issn.2095-4344.0155 Abstract ( 456 )   PDF (1272KB) ( 137 )   Save BACKGROUND: Pneumatic tourniquet can reduce the amount of bleeding during operation, but simultaneously, pneumatic tourniquet will bring perioperative adverse reactions. It is still controversial whether to use a pneumatic tourniquet during total knee arthroplasty. OBJECTIVE: To evaluate the effect and safety of pneumatic tourniquet in total knee arthroplasty. METHODS: We searched PUBMED, EMBASE, the Cochrane Library, CNKI, Wanfang before July 2017 for randomized controlled trials regarding the effect of pneumatic tourniquet in total knee arthroplasty. Data were extracted and analyzed by using Revman 5.3 software. RESULTS AND CONCLUSION: Totally 18 studies were included. Meta-analysis suggested that the use of pneumatic tourniquet could reduce the total amount of blood loss in the total knee arthroplasty, shorten operation time, but could increase postoperative pain and thrombosis incidence (P < 0.05). There was no statistically significant difference in HSS score and range of motion of the knee at 7 days after operation  (P > 0.05). These results confirm that the use of a pneumatic tourniquet in total knee arthroplasty can reduce the total blood loss, shorten the operation time, but have no effect on knee function 7 days after total knee arthroplasty, but will increase postoperative pain and thrombosis incidence. 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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Meta-analysis on clinical outcomes of the SuperPATH approach versus traditional approach in hip arthroplasty Li Jian, Qiu Bing, Zhen Dong 2018, 22 (15):  2453-2460.  doi: 10.3969/j.issn.2095-4344.0194 Abstract ( 448 )   PDF (1316KB) ( 213 )   Save BACKGROUND: Some clinical randomized controlled trials are trying to answer the clinical effects of SuperPATH approach and traditional approach in hip replacement, but the conclusions of present studies are different. OBJECTIVE: To compare the clinical outcomes between SuperPATH approach and traditional approach in hip arthroplasty. METHODS: The randomized controlled trials about SuperPATH approach and traditional approach in hip arthroplasty published before July 2017 were searched in the PubMed, EMbase, EBSCO, Cochrane Library, and CNKI. Some published references were hand-searched. Two reviewers independently screened the literatures, extracted the data and evaluated methodological quality. Meta-analysis was conducted by Revman 5.3 software. RESULTS AND CONCLUSION: Eight randomized controlled trials (involving 483 cases) were involved in this analysis. The SuperPATH approach group consisted of 228 cases; the traditional approach group consisted of 255 cases. Meta-analysis results demonstrated that compared with traditional approach group, operation time was longer; incision was shorter; hip joint score was higher at postoperatively 3 months; Visual Analogue Scale scores were lower at postoperatively 1, 3 and 7 days; intraoperative blood loss and postoperative drainage volume were less in the SuperPATH approach group. No significant difference was found in postoperative complications, postoperative anteversion angle, and postoperative abduction angle, and hip score at postoperatively 1 and 6 months. These findings suggested that the total short-term effects in SuperPATH approach was better than that of traditional approach in hip arthroplasty. Long-term clinical outcomes require further investigation. 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