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    08 July 2018, Volume 22 Issue 19 Previous Issue    Next Issue
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    Common bipolar femoral head by SuperPATH approach for senile femoral neck fractures
    Xia Liang-zheng, Li Sheng-hua, Yuan Zhong-shan, Deng Ying-hu, Zhu Dong-qi, Ye Wen-sheng, Xu An-ping, Yu Tao, Huang De-ning
    2018, 22 (19):  2953-2960.  doi: 10.3969/j.issn.2095-4344.0282
    Abstract ( 395 )   PDF (930KB) ( 204 )   Save

    BACKGROUND: Traditional posterolateral bipolar prosthetic replacement has a large incision and needs to cut the external rotator muscles, and the rehabilitation time is long. SuperPATH has a small incision, is minimally invasive and articular capsule is retained, which can accelerate the rehabilitation, but needs expensive special equipments and prosthesis. It is feasible to popularize the modified artificial bipolar femoral head through SuperPATH approach.

    OBJECTIVE: To compare the curative effectiveness between SuperPATH approach and posterolateral approach with artificial bipolar femoral head, and to investigate the surgical technique and efficacy of modified artificial bipolar femoral head through SuperPATH approach in the treatment of senile femoral neck fracture.
    METHODS: Sixty-two patients with senile femoral neck fracture admitted from March 2015 to June 2017 were randomly divided into trial (n=30) and control (n=32) groups. The trial group was treated with advanced instruments, conventional bipolar femoral head using SuperPATH approach, and the control group was treated with conventional bipolar femoral head by posterolateral approach. The length of incision, operation time, intraoperative blood loss, change in hemoglobin, ambulation time, Visual Analogue Scale score and Harris Hip Score were compared to evaluate the curative efficacy.
    RESULTS AND CONCLUSION: (1) All patients were followed up for 10-38 months. (2) There was a significant difference in the incision length, intraoperative blood loss, hemoglobin before and after operation, ambulation time, Visual Analogue Scale score at 1 week postoperatively, and Harris Hip Score at postoperative 1 and 3 months between two groups (P < 0.05), and the trial group was better than the control group. (3) The operation time in the trial group was significantly longer than that in the control group (P < 0.05). (4) There was no significant difference in the Visual Analogue Scale score at 3 months postoperatively and Harris Hip Score at postoperative 6 months between two groups (P > 0.05). (5) These findings indicate that after the improvement, the common bipolar femoral head replacement performed by SuperPATH approach in the treatment of senile femoral neck fracture has advantages of smaller incision, less trauma and less blood loss compared with the posterolateral approach, which alleviate postoperative pain and shorten hospitalization time. Therefore, it is recommended in clinical practice.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Efficacy and safety of artificial total disc replacement in the treatment of lumbar degenerative diseases
    Chen Jun, Wu Guang-hui
    2018, 22 (19):  2961-2967.  doi: 10.3969/j.issn.2095-4344.0192
    Abstract ( 323 )   PDF (696KB) ( 188 )   Save

    BACKGROUND: At present, lumbar fusion, which is widely used in the treatment of lumbar degenerative diseases, usually leads to lumbar stiffness and acceleration of adjacent segment degeneration. Non fusion, such as total disc replacement, is an effective way to avoid these problems, but there are some disputes about the value and indications.

    OBJECTIVE: To evaluate the efficacy and safety of total disc replacement in the treatment of lumbar degenerative diseases.
    METHODS: Totally 97 cases of degenerative diseases of the lumbar spine were treated by surgical treatment, and they were divided into 2 groups according to the operation methods. 55 cases underwent lumbar fusion surgery in the fusion group and 42 cases underwent artificial total disc replacement in the replacement group. All patients were followed up for 6 years. The Visual Analogue Scale (VAS) score, Oswestry Dysfunction Index (ODI), and the incidence of complication were compared between the two groups before and after the operation.
    RESULTS AND CONCLUSION: (1) There were no significant differences in general information, VAS score, and ODI between the two groups before operation (P > 0.05). (2) The operation time and postoperative hospital stay in the replacement group were significantly shorter than that in the fusion group, and the amount of bleeding during operation was significantly lower in the replacement group than that in the fusion group (P < 0.01). (3) The scores of VAS and ODI in two groups were significantly lower after operation than those before operation (P < 0.01). The VAS score and ODI in the replacement group were significantly lower than that in the fusion group at postoperative 6 months and 1 year after operation (P < 0.01). (4) The incidence of complications in the replacement group (2%) was significantly lower than that in the fusion group (5%) (P < 0.05). (5) In conclusion, artificial total disc replacement for the treatment of degenerative lumbar disease can effectively relieve the pain of lumbago and leg, improve the lumbar function and have better medium-term and long-term effects. 

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Correlation of intraoperative ligament stability with functional outcomes following total knee arthroplasty
    Liu Qing-kuan, Wang Guo-dong, Wang Cheng-qun, Kong Ying, Niu Shuai-shuai, Ma Long-fei
    2018, 22 (19):  2968-2973.  doi: 10.3969/j.issn.2095-4344.0281
    Abstract ( 328 )   PDF (676KB) ( 129 )   Save

    BACKGROUND: The extent of ligament laxity should be achieved during total knee arthroplasty (TKA) and the relationship between ligament laxity and knee function are still uncertain.
    OBJECTIVE: To investigate association of the intraoperative ligament laxity and functional outcomes after TKA.

    METHODS: Medial and lateral ligament laxities were measured intraoperatively in extension 0°and flexion 30°, and the patients were then divided into seven groups based on the ligament laxity, group 1 (0-1.0 mm), group 2 (1.0-2.0 mm), group 3 (2.0-3.0 mm), group 4 (3.0-    4.0 mm), group 5 (4.0-5.0 mm), group 6 (5.0-6.0 mm) and group 7 (> 6.0 mm). The knee function was evaluated by Knee Injury and Osteoarthritis Outcome Score (KOOS), the Knee Society Clinical Rating System (KSS) and the Oxford Knee Score (OKS) at baseline and 2 years postoperatively.
    RESULTS AND CONCLUSION: (1) Totally 362 patients completed the 2-year follow-up. (2) The postoperative KOOS, KSS and OKS scores were significantly improved compared with the baseline. (3) There was a significant difference in the KSS score among groups (F=16.273, P=0.000), and the scores were best in the groups 3 and 4. The postoperative OKS scores showed significant difference among groups (F=3.103, P=0.006), and the scores were lowest in the group 3. Medial and lateral ligament laxity 1.0-2.0 mm in extension 0° and ligament laxity 2.0-3.0 mm/3.0-4.0 mm in flexion 30° showed the optimal KSS and OKS scores. (4) The range of motion of the knee joint exhibited significant difference among groups (F=4.227, P=0.000), which was largest in the groups 6 and 7. (5) Group 3 exhibited good functional outcome under activities of daily living and quality of life subscores in KOOS. (6) To conclude, in order to improve the functional results after TKA, orthopedic surgeons should monitor ligament laxity intraoperatively 1.0-2.0 mm in extension and 2.0-3.0 mm in flexion 30°.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Clinical outcomes of three- or four-part complex proximal humerus fractures: hemiarthroplasty versus locking plate fixation
    Feng Shuo, Zha Guo-chun, Guo Kai-jin, Yang Zhi, Chang Bu-qing, Yang Shuo, Xu Chong-jun, Chen Xiang-yang
    2018, 22 (19):  2974-2980.  doi: 10.3969/j.issn.2095-4344.0228
    Abstract ( 287 )   PDF (753KB) ( 173 )   Save

    BACKGROUND: There is controversy over the choice of hemiarthroplasty or locking plate fixation for the treatment of three- or four-part complex proximal humerus fractures.

    OBJECTIVE: To compare the clinical outcomes and difference between hemiarthroplasty and locking plate fixation in the treatment of three- or four-part complex proximal humerus fractures
    METHODS: Clinical data of 73 patients with three or four parts complex proximal humerus fractures were retrospectively analyzed. 22 cases underwent hemiarthroplasty, and 51 cases received locking proximal humeral plate fixation. The preoperative data, surgery-related indicators, postoperative complications and shoulder Constant-Murley score were analyzed and compared between the two groups.
    RESULTS AND CONCLUSION: (1) Totally 73 patients were followed up for 6 to 24 months. (2) Compared with the hemiarthroplasty group, the operation time was longer; the postoperative drainage volume increased and the hemoglobin decreased significantly in the locking plate fixation group (P < 0.05). (3) The overall complication rate (35%) in the locking plate fixation group was higher than that in the hemiarthroplasty group (23%), but no significant difference was found. (4) The total Constant-Murley score in the locking plate group was significantly higher than that in the hemiarthroplasty group in final follow-up post operation (P < 0.05). (5) In three-part fractures patients, Constant-Murley score was significantly higher in the locking plate fixation group than in the hemiarthroplasty group (P < 0.05). Operation time was longer and a decrease in hemoglobin level was lower in the locking plate fixation group than in the hemiarthroplasty group (P < 0.05). (6) In four-part fractures patients, no significant difference in Constant-Murley score was determined between the two groups (P > 0.05). However, operation time was longer; a decrease in hemoglobin level was lower; and in the incidence of complications was higher in the locking plate fixation group than in the hemiarthroplasty group (P < 0.05). (7) In conclusion, the shoulder joint function of overall the three- or four-part fracture of the proximal humerus fractures treated with locking plate was better than that of the hemiarthroplasty. The clinical outcome of locking plate internal fixation for the three-part proximal humerus is superior to that of hemiarthroplasty. For the four-part fracture, there is not much difference between the two treatments, but locking plate internal fixation has longer operation time, more bleeding and higher incidence of complications.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Minimally invasive treatment of Neer 2-part surgical neck fractures of the proximal humerus: Phlios plate versus Multiloc intramedullary nail   
    Zou Yi-yuan, Xiang Ming, Chen Hang, Li Yi-ping, Yang Guo-yong, Hu Xiao-chuan
    2018, 22 (19):  2981-2987.  doi: 10.3969/j.issn.2095-4344.0290
    Abstract ( 340 )   PDF (889KB) ( 213 )   Save

    BACKGROUND: For minimally invasive treatment of proximal humerus fractures, locking plates and intramedullary nails are a good choice, but there is still a lot of controversy about which internal fixation is better.

    OBJECTIVE: To evaluate the clinical effectiveness of Phlios plate versus Multiloc intramedullary nail using minimally invasive technique for Neer 2-part surgical neck fractures of the proximal humerus.
    METHODS: Data of 21 patients with Neer 2-part surgical neck fractures of the proximal humerus undergoing the treatment of Phlios plate (n=11) and Multiloc intramedullary nail (n=10) admitted from February 2013 to June 2016 were analyzed retrospectively. The baseline data and surgical indexes in each group were compared. The fracture healing time, range of motion of the shoulder joint, American Shoulder and Elbow Surgeons scores, Constant-Murley scores and Visual Analogue Scale scores were recorded and compared at 1, 3, 6, 9 and 12 months, and above years postoperatively.
    RESULTS AND CONCLUSION: (1) All 21 patients were followed up for 12-36 months, the Phlios plate patients were followed up for 12-36 months, and the Multiloc intramedullary nail patients were followed up for 12-24 months. (2) There was no significant differences in the fracture healing time at the last follow-up between two groups (P=0.389). (3) There were no significant differences in the Visual Analogue Scale scores at the last follow-up between two groups (P=0.292). (4) There were no significant differences in the anteflexion up-lift angle and extorsion at the last follow-up between two groups (P > 0.05), but the abduction angle in the Phlios plate group was significantly higher than that in the Multiloc intramedullary nail group (P=0.014). (5) The American Shoulder and Elbow Surgeons and Constant-Murley scores at the last follow-up did not differ significantly between two groups (P > 0.05). (6) No fractures nonunion, wound infection, delayed union, acromion impingement, screw pullout, rotator cuff injury, or axillary nerve injury occurred. (7) Our results suggest that either Phlios plate fixation or Multiloc Intramedullary nail fixation for 2-part surgical neck fractures of the proximal humerus can obtain satisfactory fixation outcomes. 

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Reduction with proximal femur nail anti-rotation in lateral position for unstable femoral intertrochanteric fracture
    Kang Yi-feng, Xu Yong-qiang, Feng Si-yin, Huang Yan, Yan Ge, Wang Yu-si
    2018, 22 (19):  2988-2993.  doi: 10.3969/j.issn.2095-4344.0260
    Abstract ( 371 )   PDF (756KB) ( 176 )   Save

    BACKGROUND: Unstable femoral intertrochanteric fractures often fail to get a good reduction using a traction bed, which usually needs auxiliary reduction by open reduction or other minimally invasive reduction techniques.

    OBJECTIVE: To explore the treatment outcomes of proximal femur nail anti-rotation (PFNA) on patients with unstable intertrochanteric fracture in lateral position.
    METHODS: Data of 84 patients with unstable intertrochanteric fractures admitted from May 2013 to August 2015 were analyzed retrospectively. They were acute fractures, and classified by AO classification, including 26 cases of type A2 and 58 cases of A3. The patients were then divided into two groups (n=42 per group): group A received manual reduction in lateral position, and group B received reduction on a traction bed in horizontal position. The quality of fracture reduction, failure rate of closed reduction, operation time, intraoperative blood loss, fluoroscopy times, healing time and Harris scores at 1 year postoperatively were recorded for comparative analysis. 
    RESULTS AND CONCLUSION: (1) Compared with the group B, in the group A, the quality of reduction was improved, the operation time was reduced by 13 minutes, intraoperative blood loss was reduced by 50.65 mL, fluoroscopy times was reduced by 18.59 times, and the Harris score at 1 year postoperatively was increased by 10.58, and the differences were significant (P < 0.05). (2) In summary, the PFNA in lateral position for reduction of unstable intertrochanteric fractures can shorten the operation time, reduce intraoperative blood loss and improve the reduction efficacy, thus exhibiting a more obvious advantage compared with the traction bed.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Transforaminal lumbar interbody fusion for degenerative disc diseases: relationship between body mass index and revision rate  
    Xu Li-chen, Xu Wei-bing, Yang Dong-fang, Zhang Hai-bin
    2018, 22 (19):  2994-2999.  doi: 10.3969/j.issn.2095-4344.0317
    Abstract ( 451 )   PDF (615KB) ( 195 )   Save

    BACKGROUND: With the increase of obesity population, more intension has been focused on its influence on spinal surgery, especially revision. However, effect of obesity on the revision after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) remains unclear.

    OBJECTIVE: To explore whether body mass index (BMI) of the patients with lumbar degenerative diseases will impact the revision rate following MIS-TLIF.
    METHODS: Totally 143 patients undergoing single-segment MIS-TLIF were enrolled. The patients were allocated into four groups based on BMI: normal group (BMI < 25 kg/m2), overweight group (BMI of 25-29.9 kg/m2), obesity I group (BMI of 30-34.9 kg/m2), and obesity II-III group (BMI ≥ 35 kg/m2). The low back pain Visual Analogue Scale score at baseline, 6, 12 weeks, and 6 months postoperatively, and Oswestry Disability Index at postoperative 6 months were recorded. Age, sex and modified Charlson Comorbidity Index were analyzed by linear regression. The correlation of BMI with revision rate was evaluated by multivariate Cox proportional hazards model.
    RESULTS AND CONCLUSION: (1) The treatment outcomes of MIS-TLIF were satisfactory. (2) The postoperative low back pain Visual Analogue Scale scores were significantly improved, and the postoperative scores and Oswestry Disability Index showed no significant differences among groups. (3) Increasing BMI manifested association with more preoperative comorbidities (P=0.001) and longer operation time (P=0.000). (4) Cox proportional hazards model revealed that increasing BMI was not the independent risk factor for revision rate following MIS-TLIF (P=0.299). (5) Our results indicate that increasing BMI is not a risk factor for revision procedures within 2 years after MIS-TLIF. Therefore, surgeons need not be anxious about high BMI patients after MIS-TLIF for its potential high revision rate.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Three methods for reducing back pain in older adult patients with age-related osteoporotic vertebral compression fractures of the thoracolumbar spine: protocol for a 2-year follow-up non-randomized controlled trial and preliminary results
    Wang Kai, Li Chun-liang, Zhu Hai-yong, Wang Yu, Zhang Zhi-jin
    2018, 22 (19):  3000-3004.  doi: 10.3969/j.issn.2095-4344.0304
    Abstract ( 336 )   PDF (636KB) ( 180 )   Save

    BACKGROUND: Osteoporotic vertebral compression fracture of the thoracolumbar spine is clinically manifested as back pain. Percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) are the preferred treatment methods of this disorder. Our previous results showed that PKP and PVP can effectively reduce the back pain in patients with age-related osteoporotic vertebral compression fracture of the thoracolumbar spine at 6 months post-surgery. Little is documented about longer follow-up for back pain relief after PKP and PVP.

    OBJECTIVE: A prospective, non-randomized, controlled trial was design to investigate the long-term and medium-term back pain relief of PKP, PVP and non-surgical treatment in older adult patients with age-related osteoporotic vertebral compression fracture of the thoracolumbar spine, and analyze the risk factors of back pain.
    METHODS: This study will include 900 older adult patients with age-related osteoporotic vertebral compression fracture of the thoracolumbar spine scheduled to receive treatment in Qinghai Provincial People’s Hospital and assign them to receive PKP, PVP or non-surgical (rehabilitation training and traditional Chinese medicine) treatments (n=300 per treatment method). These included patients were followed up at 1 week, 1, 3, 6, 12, and 24 months. The primary outcome measure of this study is incidence of back pain at 24 months post-surgery. The secondary outcome measures are incidence of back pain at 1 week, 1, 3, 6 and 12 months post-surgery; Visual Analogue Score, Oswestry Disability Index, Japanese Orthopedic Association score, and X-ray morphology of the thoracolumbar spine at baseline (prior to surgery) and at 1 week, 1, 3, 6, 12 and 24 months post-surgery; incidence of adverse events at 1 week, 1, 3, 6, 12 and 24 months post-surgery.Results of 621 older adult patients with osteoporotic vertebral compression fracture of the thoracolumbar spine included in a pilot study revealed that at 6 months post PKP or PVP, Visual Analogue Score and Oswestry Disability Index were significantly decreased compared with prior to surgery, and the incidence of back pain was only 15%. In addition, the risk factors of back pain are bone cement leakage (direction, volume and scope) and adverse reactions (P < 0.05). This study was approved by Medical Ethics Committee of Qinghai Provincial People’s Hospital, China in April 2017 (approval No. RM006G). This study protocol will be performed in strict accordance with the Declaration of Helsinki. Written informed consent will be obtained from the participants. The study protocol was designed in March 2017. Patient recruitment and data collection will begin in September 2018 and end in September 2019. Data analysis will begin in October 2021 and end in November 2021.Results will be disseminated through presentations at scientific meetings and/or by publication in a peer-reviewed journal. This trial was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800016493). Protocol version (1.0).
    DISCUSSION: Findings from this study hope to help identify PKP, PVP or non-surgical treatment has the best back pain relief in older adult patients with age-related osteoporotic vertebral compression fracture of the thoracolumbar spine.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Accuracy of three kinds of pattern recognition models in the diagnosis of nerve root compression in lumbar disc herniation  
    Li Xiang-rong, Cheng Lin, Xi Jia-ning, Li Wei
    2018, 22 (19):  3005-3013.  doi: 10.3969/j.issn.2095-4344.0318
    Abstract ( 384 )   PDF (936KB) ( 622 )   Save

    BACKGROUND: Nerve root compression of lumbar disc herniation is difficult to diagnose. Pattern recognition technology combined with surface electromyography will provide new ideas for improving the diagnostic accuracy of compressed nerve roots.

    OBJECTIVE: To establish the recognition model of the nerve root compression of lumbar disc herniation through three kinds of pattern recognition methods, and to analyze the diagnostic accuracy of the models.
    METHODS: Twenty-four cases of disc herniation at L4/L5 segments combined with L5 nerve root compression and 23 cases of disc herniation at L5/S1 segments combined with S1 nerve root compression from October 2015 to October 2016 were enrolled. The surface electromyography parameters were collected and the Logistic regression equation, decision tree and artificial neural network were used to establish the identification model of compressed nerve roots. The sensitivity, specificity and diagnosis accuracy of the three models were calculated. The diagnosis accuracy was compared by receiver operating characteristic curve.
    REEULTS AND CONCLUSSION: (1) The logistic regression model had established the three models and the accuracy increased from 85.7% to 100%, with an average of 93.6%, and the sensitivity and specificity of the model was 0.98 and 0.92, respectively. (2) The Chi-squared Automatic Interaction Detector showed an accuracy of 42.86%-85.71%, with an average of 66.43%, the sensitivity and specificity of the model was 0.77 and 0.56, respectively. (3) The Classification and Regression Tree showed an accuracy of 57.14%-85.71%, with an average of 72.14%, the sensitivity and specificity of the model was 0.71 and 0.73, respectively. (4) The neural network model showed an accuracy of 85.7%-100%, with an average of 92.14%, and the sensitivity and specificity of the model were 0.93 and 0.92, respectively. (5) The area under the Receiver Operating Characteristic Curve was used to evaluate the three models, and the neural network was 0.98, the logistic regression was 0.97, and the decision tree was 0.90. (6) These results indicate that both neural network model and the logic regression model show satisfactory results in recognition of the compressed nerve roots, which are superior to MRI. The neural network model is more stable and it may be a more suitable auxiliary method for the diagnosis of nerve root compression. The Logistic regression model is suitable when no neural network diagnostic model is established. The decision tree shows a good performance in the screening of risk factors, and which can be combined with other methods to improve the recognition accuracy.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Biomechanical analysis of human balance and buffer capacity of ankle joint when dropping from height after taping
    Shi Yu, Liao Yong-hua, Luo Jiong
    2018, 22 (19):  3014-3020.  doi: 10.3969/j.issn.2095-4344.0291
    Abstract ( 414 )   PDF (695KB) ( 175 )   Save

    BACKGROUND: Preliminary studies have indicated that ankle taping can increase the ankle stability, and protect ankle joint from sprain. Thereafter, wearing ankle brace or ankle taping has been widely used in sports training, competition and fitness activities of athletes and the general public. However, few documents can be used to investigate whether any other adverse events may occur when the ankle joint taping is used in the prevention of exercise-induced injury in views of sports and kinetics.

    OBJECTIVE: To investigate the effect of ankle taping on the balance ability and buffer capacity of high impact in the healthy youth and the underlying mechanisms, so as to set up a correct concept for athletes or general sporting people how to use the taping, and provide reference for avoiding sport-induced injuries and enhancing sports performance.
    METHODS: Twenty-one healthy subjects were recruited. The static balance and dynamic balance at high altitude, ground reaction force and load rate of lower extremities before and after placement were evaluated by high-speed photography and three-dimensional force measuring plate. The method of repeated measurement of variance was used to deal with the related indexes.
    RESULTS AND CONCLUSION: (1) Taping played no effects on the high touchdown moment for ankle plantar flexion movement angle and foot angle, but taping could effectively limit the foot posterior maximum valgus angle and the foot heel angle of the center of gravity speed dropped to zero. (2) Taping could significantly reduce the buffer period, the first and second stages of ankle joint angular displacement and angular displacement of foot heel movements, prolong buffer time, shorten the first stage of the overall percentage of buffer time. (3) Taping significantly affected the shutting standing performance on one foot, increasing the pressure center swing amplitude, but had no influence on the balance state from height dropping. (4) After taping when posture sway, the time to peak ground reaction force in vertical direction was significantly shortened, the impact force peak in vertical direction was on a decline, but the impact load rate significantly increased. (5) These results indicate that ankle taping will change the sway pattern, effectively limit the maximum valgus angle, reduce angular displacement of foot and ankle joint, and enhance the stability of ankle joint when dropping from height. The mechanisms underlying taping effects on the dynamic and static balance abilities need to be studied further, but taping significantly shortens the time to peak ground reaction force, thereby increasing the force loading rate, which may increase the risk of lower extremity injury.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    How fatigue affects loads and balance ability of lower extremity joints from leaping to ground?
    Gui Zhu, Yuan Yi-wen, Sha Yan
    2018, 22 (19):  3021-3026.  doi: 10.3969/j.issn.2095-4344.0283
    Abstract ( 343 )   PDF (615KB) ( 176 )   Save

    BACKGROUND: Ability of muscle control will be decreased when human body is in fatigue. However, the loads and balance ability of lower extremity joints from leaping to ground after fatigue are unclear.

    OBJECTIVE: To investigate the effect of fatigue on the kinematics, dynamics and dynamic and static balance of the lower extremity joints in athletes, so as to provide an important reference for preventing sports injuries.
    METHODS: Sixteen elite male volleyball players were induced to suffer from muscle fatigue using the closed kinetic chain action. Corresponding motion parameters of leaping dynamics, kinematics and plantar pressure center measured by Vicon infrared image acquisition system and three-dimensional force were collected.
    RESULTS AND CONCLUSION: (1) The maximal hip flexion angle, the movement range and the range of motion of knee joint after fatigue were significantly lower than those before fatigue (P < 0.05). (2) The time to maximum knee flexion was decreased significantly after fatigue than that before fatigue, and the maximum ground reaction force was significantly increased after fatigue (P < 0.05). (3) The dynamic and static balance in the center of pressure offset radius, velocity and the cover area were significantly increased after fatigue (P < 0.05). (4) These results indicate that the subjects tend to take a relatively stiff action for leaping after fatigue, in order to maintain a stable posture as soon as possible. The balance ability is significantly reduced after fatigue. As a result, the impact force from leaping to ground cannot be effectively reduced, thereby increasing the risk of sports injuries.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Three-dimensional finite element analysis on the novel absorbable screw and traditional screw for fixing Lange-Hansen type 1 medial malleolus fracture  
    Chen Fan-cheng, Yu Bao-qing, Shi Ji-fei, Ao Rong-guang, Zhang Xu, Li De-jian, Qian Zhi
    2018, 22 (19):  3027-3032.  doi: 10.3969/j.issn.2095-4344.0793
    Abstract ( 393 )   PDF (707KB) ( 169 )   Save

    BACKGROUND: Poly L-lactic acid, as a novel biological material, has been used in the field of orthopedics with good histocompatibility. Poly L-lactic acid can be absorbed by tissue, without secondary surgery, and do not react with the surrounding tissue. The elastic modulus of the absorbable material is close to the bone, which is more beneficial to the healing of the fracture. However, biomechanical aspects of absorbable screws have not been adequately described in the present literature.

    OBJECTIVE: To investigate the feasibility of novel absorbable screw fixation in repair of Lauge-Hansen type 1 medial malleolus fractures using three-dimensional finite element technology.
    METHODS: A Lange-Hansen type 1 medial malleolus fracture models were established by using the CT scan data, and fixed by the novel absorbable screws, novel metal screws and traditional metal screw. Finite element analysis software was used to get the stress value and displacement.
    RESULTS AND CONCLUSION: (1) There were totally 36 240 units, 7 660 nodes in the novel absorbable screw fixation model under 450 N force; the maximum stress of screws was 46.78 MPa; the maximum displacement was 0.239 mm; the maximum displacement of the distal fracture was 0.248 mm. (2) There were totally 36 240 units, 7 660 nodes under 450 N force in the novel type metal screws fixation model; the maximum stress of screws was 46.49 MPa; the maximum displacement was 0.223 mm; the maximum displacement of the distal fracture was 0.214 mm. (3) There were totally 41 236 units, 8 121 nodes under 450 N force in the traditional metal screws fixation model; the maximum stress of screws was 59.08 MPa; the maximum displacement was 0.182 mm; the maximum displacement of the distal fracture was 0.207 mm. (4) The novel absorbable screws used in Lange-Hansen type 1 medial malleolus fracture obtained uniform total stress distribution, and small possibility of screw breakage. (5) The experiment verifies the biomechanical feasibility of absorbable screws for simple medial malleolus fracture. For Lange-Hansen type 1 medial malleolus fracture, novel absorbable screw is an alternative choice for clinical doctors.

     
    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Three-dimensional classification and collapse prediction in osteonecrosis of the femoral head based on China-Japan Friendship Hospital classification
    Zhou Si-jia, Jiang Wen-xue
    2018, 22 (19):  3033-3038.  doi: 10.3969/j.issn.2095-4344.0256
    Abstract ( 404 )   PDF (611KB) ( 177 )   Save

    BACKGROUND: Predictive accuracy of collapse of the femoral head is strongly associated with the classification of osteonecrosis of the femoral head (ONFH). The China-Japan Friendship Hospital (CJFH) classification of ONFH based on three pillars is sensitive in predicting collapse of the femoral head, but it is only analyzed in two dimensions. There is little reported on the three-dimensional classification based on the CJFH classification.

    OBJECTIVE: To investigate the advantage of the three-dimensional classification of the three pillars structure and the value of its prediction of collapse in ONFH by establishing the new classification.
    METHODS: The MRI and CT data of 106 hips (68 cases) diagnosed as ONFH were selected. The femoral head was divided into a medial, central and lateral three-pillars structure three-dimensionally in accordance with the CJFH classification. Three-dimensional CJFH (3D-CJFH) was established based on the size and location of the necrotic area and the three-dimensional classification. All 106 hips were classified according to 3D-CJFH classification and CJFH classification, respectively. The collapse rates of the different types were obtained and compared between the two classifications.
    RESULTS AND CONCLUSION: (1) 3D-CJFH classification was composed of type A (the medial type), type B (the central type) and type C (the lateral type), amongst which the type C consisted of type C1 (all pillars were involved with some normal in lateral pillar), type C2 (the whole lateral pillars and partial central pillar) and type C3 (the whole femoral head). (2) The collapse rates of type A (5.6%), type B (8.0%) and type C (58.7%) of 3D-CJFH classification were different, and the collapse rates of type C1 (25.0%), type C2 (75.0%) and type C3 (96.3%) of this classification were also different. Similarly, the collapse rates of type A (5.3%), type B (13.8%) and type C (59.3%) of CJFH classification were different, and the collapse rates of type C1 (32.3%), type C2 (75.0%) and type C3 (95.7%) of CJFH classification were also different. (3) The collapse rates of type A and C3 in 3D-CJFH classification were higher than that in CJFH classification. The collapse rates of type B and C1 in 3D-CJFH classification were lower than that in 3D-CJFH classification after comparison. The collapse rate of type C2 in the two classifications revealed no statistically significant difference. The collapse rate of type C in 3D-CJFH classification was lower compared with that in 3D-CJFH classification. (4) The results in this study demonstrate that prediction results of femoral head collapse are similar between 3D-CJFH and CJFH classifications, but the former is more consistent with the 3D biomechanical properties of femoral head. 3D-CJFH classification paves ways for three-dimensional diagnosis and prediction of femoral head collapse for necrosis.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Offshoring index, moving up index and teardrop baseline offshoring index of the femoral head for diagnosis of adult acetabular dysplasia: study protocol for a self-controlled, diagnostic trial and preliminary results  
    Qin Di, Hu Shi-wei, Li Hui-jie, He Li-ying, Wu Xiao-bo, Wu Tao, Ma Wen-hui, Han Yong-tai
    2018, 22 (19):  3039-3043.  doi: 10.3969/j.issn.2095-4344.0284
    Abstract ( 359 )   PDF (544KB) ( 185 )   Save

    BACKGROUND: Acetabular dysplasia often accompanies by acetabular bone hyperplasia and osteonecrosis of the femoral head. These pathological changes can alter the position of the center of the femoral head. Thus, measurement errors will be generated on the anteroposterior radiographs of the adult pelvis involving centre-edge angle, acetabular angle (Sharp angle), and acetabular head index, eventually resulting in the inaccurate diagnosis of acetabular dysplasia.

    OBJECTIVE: To verify three novel X-ray indicators, including offshoring index (OFI), moving up index (MUI) and teardrop baseline offshoring index (TBOI) of the femoral head. All data will be expressed as relative ratios, as we expect to make an accurate diagnosis through avoiding the generation of errors resulting from measurement angles.
    METHODS: A trial will be conducted at the Third Hospital of Hebei Medical University in China. Two hundred adult patients (100 females and 100 males) undergoing pelvic X-ray examinations will be enrolled as the study population. X-ray images of the affected and healthy pelvic sides will be measured and analyzed using Photoshop CS5 software. Primary outcome measure is the sensitivity of OFI of the femoral head for diagnosing adult acetabular dysplasia. Secondary outcome measures include the specificity, positive and negative predictive values, and positive and negative likelihood ratios of OFI of the femoral head for diagnosing adult acetabular dysplasia as well as the rate of correct diagnosis; specificity and sensitivity, positive and negative predictive values, and positive and negative likelihood ratios of MUI of the femoral head for diagnosis of adult acetabular dysplasia as well as the rate of correct diagnosis; specificity and sensitivity, positive and negative predictive values, and positive and negative likelihood ratios of TBOI of the femoral head for diagnosis of adult acetabular dysplasia as well as the rate of correct diagnosis; correlation of OFI, MUI and TBOI to centre-edge angle, Sharp angle and acetabular head index; and risk factors for hip function as analyzed by logistic regression analyses. In our pre-tests, pelvic X-ray data from 241 male patients showed that the OFI, MUI and TBOI were (86.8±0.6)%, (75.8±2.0)% and (76.2±0.5)%, which were certainly correlated to centre-edge angle, Sharp angle and acetabular head index. This trial has been approved by the Medical Ethics Committee of Third Hospital of Hebei Medical University of China (approval number: KE2016-011-1). The study protocol will be performed in accordance with the Declaration of Helsinki, formulated by the World Medical Association. Written informed consent will be obtained from all participants. 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: ChiCTR1800016375). Protocol version (1.0).
    DISCUSSION: This study is designed to verify that three new X-ray indicators, OFI, MUI and TBOI, as diagnostic indicators for adult acetabular dysplasia can increase diagnostic accuracy and effectively avoid diagnostic errors in comparison with the centre-edge angle, Sharp angle and acetabular head index.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Application of three-dimensional printed antibiotic bone cement spacer in infected hip after hip arthroplasty for senile and infirm patients  
    Li Yuan-hui, Zeng Mian-dong, Yin De-long, Hu Han-sheng, Yu Sheng-hua, Wang Zhao
    2018, 22 (19):  3044-3048.  doi: 10.3969/j.issn.2095-4344.0191
    Abstract ( 388 )   PDF (624KB) ( 192 )   Save

    BACKGROUND: Infection after hip arthroplasty was a catastrophic complication for the senile and infirm patients. It was difficult for such patients to effectively control infection and retain certain hip function.

    OBJECTIVE: To investigate the method and effect of three-dimensional (3D) printed antibiotic bone cement spacer as the terminal treatment of infection after hip arthroplasty for the senile and infirm patients.
    METHODS: Between January 2014 and December 2016, the 3D printed antibiotic bone cement spacer of femoral head was used as the terminal treatment for four senile and infirm patients with artificial joint infection after hip arthroplasty. The wound healing, hip X-ray examination, infection indicators, Harris score, Visual Analogue Scale score were assessed postoperatively.
    RESULTS AND CONCLUSION: (1) All patients were followed up for 8-35 months. In the four cases, wound healing without residual fistula was seen at postoperative 2 weeks. No revisions were performed at the last follow-up in four patients. Among them, one patient died of uremia-induced multiple organ failure at postoperative 9 months. (2) The infections were effectively controlled and the functions of hip were mostly retained after treatments by the 3D printed antibiotic bone cement spacer of femoral head. (3) Visual Analogue Scale score decreased from preoperatively (8.0±1.5) points to the last follow-up (2.0±1.4) points (P < 0.05). Harris score increased from preoperatively (41.6±4.2) points to the last follow-up (75.8±6.3) points (P < 0.05). (4) These findings conclude that 3D printed antibiotic bone cement spacer of femoral head can be used for effectively controlling hip infection and retaining most function of hip, for the senile and infirm patients with joint infection after hip arthroplasty. It can also be used as the ultimate treatment.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Application of three-dimensional printing-assisted osteotomy versus traditional osteotomy in total knee arthroplasty  
    Wang Xuan, Yu Zhuo-li, Ji Nan, Wang Shuang, Fan Jing-xu, Qiao Yue-yue
    2018, 22 (19):  3049-3054.  doi: 10.3969/j.issn.2095-4344.0305
    Abstract ( 604 )   PDF (825KB) ( 256 )   Save

    BACKGROUND: Total knee arthroplasty has been developed for many years. With the development of material science and biomechanics, the material and design of knee prosthesis have become mature. In recent years, with the emergence of three-dimensional (3D) printing technology, and its gradual application in medical field, 202th Hospital of PLA has developed the knee arthroplasty with 3D printing-assisted osteotomy.

    OBJECTIVE: To understand the advantages and disadvantages of 3D-printed osteotomy in total knee arthroplasty by comparing with the traditional osteotomy method.
    METHODS: Data of the eligible patients with unilateral knee osteoarthritis undergoing primary arthroplasty at Department of Orthopedics, 202th Hospital of PLA from May 2014 to December 2016 were analyzed retrospectively. Twenty-seven patients underwent 3D printed osteotomy (group A), and 32 patients underwent traditional osteotomy method (group B). The operation time, intraoperative blood loss and postoperative drainage were compared. The Hospital for Special Surgery scores and range of motion of knee joint were evaluated at 1, 3 and 6 months postoperatively. The postoperative limb alignment (angle between the line of the femoral head center and knee joint center and the line of the anatomical axis of tibia) was measured.
    RESULTS AND CONCLUSION: (1) Guide plates of 3D-printed osteotomy all matched with the knee joint. (2) In the group A, the operation time, intraoperative blood loss and postoperative drainage were reduced. (3) There were no significant differences in the Hospital for Special Surgery scores at 1, 3 and 6 months postoperatively between two groups (P > 0.05). (4) The range of motion of knee joint showed no significant difference at 1, 3 and 6 months postoperatively between two groups (P > 0.05). (5) The limb alignment angle in the groups A and B was (179.37±2.03)° and (178.86±2.58)°, respectively, and the difference was insignificant (P > 0.05). (6) These results suggest that 3D-printed osteotomy applied in total knee arthroplasty can significantly shorten the operation time, reduce perioperative blood loss, contribute to perioperative blood management, and play no effect on the limb alignment and joint function within 6 months.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Design and application of an individual puncture guide device fabricated by three-dimensional printing technology   
    Yang Jun, Yang Qun, Wang Bo, Liu Yang, Zhang Rui, Jiang Chang
    2018, 22 (19):  3055-3060.  doi: 10.3969/j.issn.2095-4344.0791
    Abstract ( 341 )   PDF (771KB) ( 151 )   Save

    BACKGROUND: Frequent preoperative fluoroscopic localization of transforaminal endoscopic surgery is harmful to both doctors and patients, so it is necessary to minimize or avoid preoperative fluoroscopy.
    OBJECTIVE: To design and built an individual transforaminal endoscopic puncture positioning device using three-dimensional (3D) printing technology and to explore its feasibility of clinical application, the accuracy of the puncture, operation time and the fluoroscopy times.
    METHODS: We used Mimics 19.0 to build lumbar model based on the preoperative CT scan data. We simulated the direction and position of the working channel and measured the angle of the working channel, and then puncture guide device was built by 3D printing technology. Forty-five patients undergoing percutaneous endoscopic lumbar discectomy were included in this retrospective study. These patients were divided into two groups. Those received individual puncture guide device were regarded as guide device group (n=22), and those undergoing conventional method were considered as traditional group (n=23). The operation time, puncture times, fluoroscopy times, Visual Analogue Scale scores and Japanese Orthopaedic Association scores were recorded and compared.
    RESULTS AND CONCLUSION: (1) The average puncture times was 1.27 ± 0.63 in guide device group and 3.69 ± 0.70 in traditional group, and there were significant differences between two groups (P < 0.001). (2) The fluoroscopy times was 11.59 ± 2.04 in guide device group and 20.39 ± 1.80 in traditional group, and there were significant differences between two groups (P < 0.001). (3) The operation time was 75.44 ± 11.89 minutes in guide device group and 87.39 ± 12.51 minutes in traditional group; there were significant differences between the two groups (P=0.001). (4) Regarding curative effect, there was no significant difference in low back pain and lower extremity pain Visual Analogue Scale and Japanese Orthopaedic Association scores between two groups. (5) The transforaminal endoscopic individual puncture guide device can be constructed by 3D printing technology according to preoperative imaging data. The guiding device can improve the accuracy of puncture during surgery, and effectively reduce the fluoroscopy and puncture times. Thus, it has certain clinical application feasibility.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程

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    Treatment outcomes of three-dimensional printing technology for foot and ankle fractures by junior versus senior physicians  
    Zhu Ya-hui, Fu Bing-jin, Yin Gang, Wang Chao, Sun Guang-chao, Deng Ming-ming, Du Rui, Yang Jia-lin, Zhu Xiao-dong
    2018, 22 (19):  3061-3066.  doi: 10.3969/j.issn.2095-4344.0306
    Abstract ( 328 )   PDF (643KB) ( 196 )   Save

    BACKGROUND: Three-dimensional (3D) printing technology has been extensively applied in foot and ankle surgeries, and it has achieved satisfactory treatment outcomes. However, whether its effect on the physicians with different seniority levels is different remains unknown.

    OBJECTIVE: To analyze the difference of 3D printing technology effects on physicians engaged in foot and ankle surgeries with different seniority levels.
    METHODS: Patients with a fracture of the foot and ankle admitted in the Affiliated Hospital of Binzhou Medical University from January 2015 to February 2017 were randomly assigned to different groups according to treatment using traditional technique or 3D printing technology by junior physicians and senior physicians, respectively: junior traditional group, junior 3D group, senior traditional group, and senior 3D group. The operation time, intraoperative blood loss, intraoperative fluoroscopy times, postoperative complications, postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores were recorded and compared.
    RESULTS AND CONCLUSION: (1) Eighty-nine eligible patients were included in the study, 29 patients were lost to follow-up for various reasons, and the remaining 60 patients completed the follow-up. All patients fracture healed at 3 months postoperatively. (2) The junior 3D group was significantly superior to the junior traditional group in the operation time, intraoperative bleed loss and intraoperative fluoroscopy time in the treatment of calcaneal fractures and three ankle fractures (P < 0.05). (3) There was no significant difference between senior traditional and senior 3D groups in the operation time, intraoperative bleed loss and intraoperative fluoroscopy time in the treatment of calcaneal fractures, metatarsal fracture and three ankle fractures. (4) Three cases of incision infection were found, including one case of superficial tissue infection in the junior 3D and senior traditional groups, and one case of deep infection in the junior traditional group. (5) There were no significant differences in the AOFAS scores between senior and junior groups (P > 0.05). (6) These results indicate that 3D printing technology plays a significant effect on the junior physicians in the operation time, intraoperative blood loss, and intraoperative fluoroscopy times. While, in terms of complications and functional recovery, the differences are slight between physicians.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Application of pelvic deformity measurement software combined with three-dimensional printing in clinical teaching of pelvic reduction frame technology under CBL teaching mode  
    Zhang Gong-zi, Yao Qi, Peng Ye, Wang Xiang, Zhang Li-hai
    2018, 22 (19):  3067-3071.  doi: 10.3969/j.issn.2095-4344.0307
    Abstract ( 311 )   PDF (643KB) ( 173 )   Save

    BACKGROUND:The newly developed pelvic deformity measurement software can increase the accuracy rate of pelvic displacement. It also breaks through the learning difficulties of pelvic reduction frame under the practice of CBL teaching mode and three-dimensional (3D) printing technology.

    OBJECTIVE: To explore the application of pelvic deformity measurement software combined with 3D printing technology in the teaching of pelvic reduction frame under CBL teaching mode.
    METHODS: A total of 96 advanced training physicians and postgraduates at the First Ward of Orthopedics, Chinese PLA General Hospital, China from 2015 to 2016 were divided into traditional teaching group (n=53) and new teaching model group (n=43) according to the duration of study in the hospital. The new teaching model group underwent preoperative planning using pelvic deformity measurement software and guided by CBL teaching mode. The actual operation was simulated and testing was conducted on the 3D-printed model. The teaching results in the two groups were assessed.
    RESULTS AND CONCLUSION: (1) The new teaching model group was significantly superior to the traditional teaching group in the teaching attraction, the understanding of typical pelvic fractures, the ability to make surgical plans for pelvic closed reduction, the number of operation exercises required for external operations, overall satisfaction, and practical training assessment (P < 0.05). (2) To conclude, under the guidance of CBL teaching mode, using pelvic deformity measurement software to help determine preoperative planning, the new teaching mode that simulated actual operation on a 3D printing model is applied in clinical teaching of pelvic reduction frame, which can strengthen students’ enthusiasm for learning and improve the understanding of pelvic fracture and the ability to plan for surgery, and allow students to quickly master the use of pelvic reduction frame.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Compensatory mechanism of cervical sagittal alignment in patients with neck-low back pain
    Zhang Guang-ming, Ruan Zhi-yong, Hu Rong-sheng, Chen Nong, Gao Ru-feng, Pan Fu-gen
    2018, 22 (19):  3072-3076.  doi: 10.3969/j.issn.2095-4344.0789
    Abstract ( 333 )   PDF (600KB) ( 168 )   Save

    BACKGROUND: Neck pain is a very common symptom, but it is still difficult to diagnose the etiology of neck pain. The relationship between neck pain and cervical sagittal alignment remains controversial.

    OBJECTIVE: To investigate the possible compensatory mechanism of cervical sagittal alignment in patients with neck-low back pain.
    METHODS: The patients with neck-low back pain were examined by neck and lumbar X-ray. The control group contained the patients with neck pain and without volunteers with cervical symptoms. The X-ray examination of the cervical spine was performed. Each group included 50 patients. Cervical-thoracic lateral radiographs were taken to analyze the following parameters: Occiput-C2 angle; C2-C7 angle; C2-C7 sagittal vertical axial (SVA), (center gravity of head, CGH)-C7 SVA; T1 slope. All parameters were expressed by 95% confidence interval, and the C0-C2 angle, C2-C7 angle, C2-C7 SVA and CGH-G7 SVA distance between groups were analyzed by t test.
    RESULTS AND CONCLUSION: (1) The value of the Occiput-C2 angle was 12.4°-20.7°; C2-C7 angle was 5.6°-15.1°; T1 slope was 21.3°-25.8°; C2-C7 SVA was 14.2-20.8 mm; CGH-C7 SVA was 9.5-17.5 mm; C0-C2 angle + C2-C7 angle was 23.1°-30.7°; C2-C7 SVA -CGH-C7 SVA was 1.4-6.6 mm in patients with neck-low back pain. (2) The value of the Occiput-C2 angle was 15.6°-18.6°; C2-C7 angle was 7.7°-13.1°; T1 slope was 23.1°-26.0°; C2-C7 SVA was 13.5-17.7 mm; CGH-C7 SVA was 10.5-17.2 mm; C0-C2 angle + C2-C7 angle was 25.3°-29.6°; C2-C7 SVA -CGH-C7 SVA was -0.5-4.6 mm in patients with neck back pain. (3) The Occiput-C2 angle was 11.8°-17.9°; C2-C7 angle was 7.7°-13.9°; T1 slope was 21.7°-24.5°; C2-C7 SVA was 12.1-18.5 mm; CGH-C7 SVA was 6.4-15.3 mm; C0-C2 angle + C2-C7 angle was 24.1°-28.8°; the distance between C2-C7 SVA and CGH-C7 SVA was 1.9-7.4 mm in patients without symptoms. (4) There was no statistical significance in each parameter between males and females in each group (P > 0.05); and no significant difference in each parameter was determined between groups (P > 0.05). (5) In summary, there were no significant differences in the sagittal cervical parameters among patients with neck-low back pain and those with neck pain and those without symptoms. There was no specificity in the sagittal alignment compensation of the cervical spine in patients with neck-low back pain. More sensitive sagittal parameters should be studied.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Advances in diagnosis of periprosthetic infection after arthroplasty
    Hu Xue-feng, Zuo Qiang, Wei Lei
    2018, 22 (19):  3077-3084.  doi: 10.3969/j.issn.2095-4344.0261
    Abstract ( 363 )   PDF (783KB) ( 148 )   Save

    BACKGROUND: Arthroplasty is an ideal treatment for advanced joint diseases, but joint infection usually occurs. Accurate early diagnosis can promptly take the correct treatment, reduce complications, and improve prognosis and the patients’ quality of life. How to accurately diagnose the periprosthetic infection after arthroplasty is a challenge.

    OBJECTIVE: To summarize the research progress in the diagnosis of periprosthetic infection at home and abroad in recent years.
    METHODS: A computer-based search of PubMed and CNKI databases from January 1998 to December 2016 with the keywords of “arthroplasty, periprosthetic joint infection, diagnosis, culture, synovial biopsy, microbial identification, inflammatory markers, histopathology, markers, Alpha-Defensin, PCR, imaging” in English and Chinese, respectively. A total of 122 related articles were retrieved and 75 articles were eligible for the inclusion criteria.
    RESULTS AND CONCLUSION: (1) There are many diagnostic methods and each method has its own advantages and disadvantages. Different researchers have concluded that the conclusions are different or even contradictory. The appropriate thresholds for the relevant tests and the optimization of laboratory confusion still exist. There is no one recognized as the best method. (2) Interestingly, biomarkers are a major breakthrough with high accuracy, simplicity and practicability. Currently, it has become a hot spot in international medicine. However, there is a lack of multi-center large sample research, which has not yet been affirmed by consensus and guidelines. (3) Orthodontists and researchers should focus on finding a recognized simple, accurate and applicable detection method.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Hemostatic agents in total knee arthroplasty: safety, curative efficacy and cost-effectiveness  
    Gao Cheng-zhe, Qu Yan-long
    2018, 22 (19):  3085-3090.  doi: 10.3969/j.issn.2095-4344.0276
    Abstract ( 394 )   PDF (713KB) ( 454 )   Save

    BACKGROUND: To accelerate the rehabilitation and reduce the incidence of complications, perioperative blood management measures of total knee arthroplasty (TKA) are gradually gaining much attention. Perioperative hemostatic agents are considered as a key part of blood management measures and have become the hotspot in the field of bone and joint surgeries.

    OBJECTIVE: To summarize the research progress of hemostatic agents in TKA and to evaluate the feasibility of these agents.
    METHODS: A computer-based retrieval of PubMed and CNKI databases was performed with the keywords of “knee arthroplasty, blood loss, tranexamic acid, epinephrine, fibrinogen, platelet-rich plasma” in English and Chinese, respectively. The literature concerning the application of hemostatic agents in TKA published from January 1985 to July 2017 was reviewed and analyzed. Totally 350 articles were searched initially, and finally 55 articles eligible for the inclusion and exclusion criteria were included for result analysis.
    RESULTS AND CONCLUSION: (1) Perioperative TKA is always accompanied by massive bleeding, which will affect postoperative rehabilitation, even needs to be improved by allogeneic blood transfusion. Therefore, reducing postoperative blood loss and blood transfusion rate becomes crucial. (2) In recent years, perioperative hemostatic agents, such as tranexamic acid, epinephrine, fibrinogen agents and platelet-rich plasma, have been increasingly used in clinical practice. Tranexamic acid has been shown to have good effectiveness and safety with best cost-effectiveness. The combination of diluted epinephrine and tranexamic acid can obviously reduce the blood loss and blood transfusion rate after TKA. (3) However, there is a lack of criteria for hemostatic agent application, and more high-quality clinical trials are needed to guide clinical practice.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Biomechanical properties of the lumbar pedicle screws by finite element analysis
    Wei Bing, Xu Ze-chuan, Chang Shan
    2018, 22 (19):  3091-3096.  doi: 10.3969/j.issn.2095-4344.0258
    Abstract ( 337 )   PDF (698KB) ( 182 )   Save

    BACKGROUND: Stability is the main criterion for evaluating pedicle screws, and biomechanics is the specific standard for evaluating the stability and value of the internal fixation system. In recent years, the finite element analysis has been widely used in biomechanical studies of normal human limbs and soft tissues, fracture mechanics, biomechanics of orthopedic internal fixators, stress shielding of implants, and design of internal fixators.

    OBJECTIVE: To systematically analyze the biomechanical properties of lumbar pedicle screws by exploring the structural parameters of pedicle screws, implantation methods and screw system through a finite element method.
    METHODS: The first author retrieved PubMed and CNKI databases for the literature published before December 2016 with the keywords of “lumbar vertebrae, pedicle screw, finite element analysis, biomechanics” in English and Chinese, respectively. Forty-five eligible articles were enrolled after excluding the repetitive studies, consisting of 15 Chinese articles and 30 English ones.
    RESULTS AND CONCLUSION: (1) Finite element method applied in the stress analysis of spinal internal fixators is of great significance for choosing a correct surgical approach and appropriate internal fixators. (2) With the rapid development of technology, digital radiography and computer as well as cross-link of medicine and mechanics, an ideal spinal model will be established soon. (3) It is helpful for the individualized treatment, and the combination of finite element analysis and clinical application is an irresistible trend 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
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    Current status of postoperative quality of life in patients with tibial plateau fracture
    Yuan Liang, Lü Yang, Zhou Fang
    2018, 22 (19):  3097-3102.  doi: 10.3969/j.issn.2095-4344.0259
    Abstract ( 370 )   PDF (723KB) ( 147 )   Save

    BACKGROUND: Orthopedic surgeons have been treating tibial plateau fractures more often with the aim of fracture reduction and recovering knee joint function, while the patients’ quality of life is relatively less concerned. However, patients not only emphasize the knee function, also have a certain expectation of the overall quality of life. In the field of traumatic orthopedics, the quality of life is attracting the attention of scholars. More and more attention has been paid to the quality of life of patients with tibial plateau fractures.

    OBJECTIVE: To discuss the quality of life of patients with tibial plateau fractures and its evaluation scales, and to explore the current research status.
    METHODS: The literature about the quality of life of tibial plateau fractures published in the PubMed and WanFang databases was retrieved, and the obtained literature was read and screened. The keywords were ”fracture of tibial plateau, fractures of tibial plateau, tibial plateau fracture,tibial plateau fractures, fracture tibial plateau, Shinbone platform bone fracture, tibial plateau, proximal tibial, tibial proximal fracture, proximal tibial fractures, proximal tibia fracture, tibia proximal fracture, quality of life, health related quality of life” in English and Chinese, respectively.
    RESULTS AND CONCLUSION: (1) The most commonly used scale for quality of life assessment of patients with tibial plateau fractures is the SF-36 health survey. (2) Most studies focused on complex tibial plateau fractures. (3) The quality of life of patients with complex tibial plateau fractures may be lower than the normal population, but this is not very sure in all studies. (4) Different age groups of patients with tibial plateau fracture quality of life may have different quality of life. (5) There have been a lot of controversies in different studies, and clinical researches of high quality are still needed.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Tranexamic acid reduces perioperative blood loss in thoracolumbar posterior fusion: a meta-analysis
    Zhong De-gui, Wang Wen-hao, Lü Yang, Chen Shan-chuang, Mai Xiu-jun, Huang Yong-ming, Huang Yong-quan, Hou Qiu-ke, Su Hai-tao
    2018, 22 (19):  3103-3109.  doi: 10.3969/j.issn.2095-4344.0271
    Abstract ( 321 )   PDF (617KB) ( 164 )   Save

    BACKGROUND: Tranexamic acid has been reported to reduce perioperative blood loss in thoracolumbar posterior fusion, but these studies are small-sample trials. Therefore, it is necessary to systematically evaluate the studies at home and abroad addressing that tranexamic acid can reduce blood loss after thoracolumbar posterior fusion.

    OBJECTIVE: To investigate the effectiveness and safety of tranexamic acid for reducing the perioperative blood loss in thoracolumbar posterior fusion.
    METHODS: Databases of Cochrane Library, PubMed, EMbase, Medline, CNKI, CBM, WanFang and VIP were searched to retrieve the randomized clinical trials concerning the effects of tranexamic acid in thoracolumbar posterior fusion. The quality of the studies was performed by two researchers, and meta-analysis was conducted using RevMan 5.3 software.
    RESULTS AND CONCLUSION: Nine studies were enrolled, including 363 cases in tranexamic acid group and 341 cases in placebo group. Compared with the placebo group, venous injection of tranexamic acid after thoracolumbar posterior fusion, could significantly reduce the intraoperative blood loss (MD=-50.57, 95%CI: -78.69- -22.44), postoperative volume of drainage (MD=-109.45, 95%CI: -124.50- -94.39), perioperative blood transfusion (OR=0.51, 95%CI: 0.31-0.85), and shorten the operation time (MD=-6.28, 95%CI: -12.01- -0.56). Additionally, tranexamic acid did not increase the incidence of deep venous thrombosis (OR=0.46, 95%CI: 0.10-2.06). Tranexamic acid also could reduce the preoperative total blood loss (MD=-184.53, 95%CI: -224.66- -144.40). These results indicate that venous injection of tranexamic acid in thoracolumbar posterior fusion can reduce intraoperative, postoperative blood loss and blood transfusion, with a good effectiveness and safety. However, multi-center large-sample randomized controlled trials are required to support the argument, because of potential bias in the included 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
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    Comparison of efficacy of lateral decubitus and supine position in treatment of elderly unstable intertrochanteric fractures with proximal femoral nail antirotation
    Lü Yang, Wang Hai-zhou, Zhong De-gui, Liu Jun, Chen Hai-yun, Pan Jian-ke
    2018, 22 (19):  3110-3116.  doi: 10.3969/j.issn.2095-4344.0253
    Abstract ( 405 )   PDF (715KB) ( 158 )   Save

    BACKGROUND: Proximal femoral nail antirotation is widely used in the treatment of intertrochanteric fracture of the femur because of its advantages of high stability, small trauma and quick recovery after operation. However, there is no comparative study on evidence based medicine of the difference in the efficacy between the two postures of proximal femoral nail antirotation.

    OBJECTIVE: To compare the clinical efficacy of lateral decubitus with manual traction versus supine position with traction bed in treatment of elderly unstable intertrochanteric fractures with proximal femoral nail antirotation by meta-analysis.
    METHODS: Studies on femoral intertrochanteric fractures in the elderly using closed internal fixation with proximal femoral nail antirotation were retrieved by computer. Quality of the studies was assessed. The meta-analysis was conducted by using the RevMan 5.3 software.
    RESULTS AND CONCLUSION: (1) A total of 8 articles including 661 patients, of which 330 cases were treated in lateral decubitus with manual traction while 331 cases treated in supine position with traction bed, were carefully enrolled in the study. (2) The meta-analysis results showed that lateral decubitus had advantages over supine position in shortening operative preparation time [MD=-7.58, 95%CI (-14.42, -0.74), P < 0.05], shortening operation time [SMD=-0.81, 95%CI (-1.01, -0.61), P < 0.000 1], reducing length of incision [MD=-1.92, 95%CI (-2.17, -1.67), P < 0.000 1], reducing surgical blood loss volume [MD=-24.51, 95%CI (-42.22, -6.79), P=0.007 < 0.01], increasing the number of X-ray fluoroscopy [MD=2.82, 95%CI (0.91, 4.72), P=0.004 < 0.01]. However, there were no statistical differences between them in the results of Harris Hip Score at 6 months [MD=0.55, 95%CI (-0.77, 1.86), P > 0.05]. (3) Results suggested that lateral decubitus with manual traction has advantages over supine position with traction bed, but the best surgical position in proximal femoral nail antirotation should be chosen according to various factors in the treatment of intertrochanteric fractures in the elderly.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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