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18 August 2018, Volume 22 Issue 23 Previous Issue    Next Issue

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Effects of close reduction intramedullary nailing fixation on perioperative venous thrombosis-related indicators   Li Ming, Wan Fa-qing, Zhang Ying-hua, Jia Tang-hong, Luo Gong-zeng, Ju Liang, Huang Shou-guo 2018, 22 (23):  3609-3614.  doi: 10.3969/j.issn.2095-4344.0255 Abstract ( 328 )   PDF (703KB) ( 169 )   Save BACKGROUND: In recent years, closed femoral intramedullary nail has been widely used in the treatment of femoral fractures. Especially, in elderly patients, the advantage of closed femoral intramedullary nail is obvious. OBJECTIVE: To evaluate the effects of close reduction and open reduction intramedullary nailing fixation on blood coagulation and D-dimer in the treatment of aged femur fractures so as to assess the risk of deep venous thromboembolism after closed femoral intramedullary nail fixation.  METHODS: Totally 95 old femur fracture patients were selected at the Linyi Central Hospital from October 2013 to July 2016. They were treated with close reduction and open reduction intramedullary nailing fixation. RESULTS AND CONCLUSION: Compared with open reduction, intraoperative blood loss was lower (P < 0.05); mean operation time was shorter (P < 0.05); prothrombin time was longer (P < 0.05); plasma fibrinogen was lower (P < 0.05); plasma D-dimer content was less (P < 0.05) in the close reduction group. These findings indicate that close reduction intramedullary nailing fixation is an effective therapeutic method in the treatment of aged femur fractures, can reduce hemagglutination index after fixation, and reduce the risk of deep venous thromboembolism.  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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Tossy Ⅲ acromioclavicular joint dislocation treated with two anchors to reconstruct coracoclavicular ligament Han Bing, Zhang Chuan-kai, Liu Hong-bin, Sun Yi-yan, Zhao Ri-guang, Wang He-hong, Wang Ying 2018, 22 (23):  3615-3620.  doi: 10.3969/j.issn.2095-4344.0229 Abstract ( 479 )   PDF (713KB) ( 210 )   Save BACKGROUND: How to reconstruct the rostral clavicular ligament to make it more suitable for the biomechanical characteristics of acromioclavicular joint and do not need to remove the internal fixator is a problem that scholars have been thinking about. OBJECTIVE: To explore the clinical effect of two anchors to reconstruct coracoclavicular ligament in treatment of Tossy Ⅲ acromioclavicular joint dislocation. METHODS: Eighteen patients with Tossy Ⅲ acromioclavicular joint dislocation were treated with two anchors to reconstruct coracoclavicular ligament from January 2012 to July 2016. All patients were followed up for 1 year. Acromioclavicular clavicle end gap was measured using X-ray films before treatment, 1 week, 2 months and 1 year after treatment. Shoulder joint function was evaluated by the Neer scoring system before treatment and 1 year after treatment.  RESULTS AND CONCLUSION: (1) Acromioclavicular clavicle end gap significantly reduced between the preoperation and 1 week after surgery (P < 0.05). Acromioclavicular clavicle end gap significantly enlarged between 1 week and 2 months after surgery (P < 0.05). There was not statistically significant difference in the gap between 2 months after surgery and 1 year after surgery (P > 0.05). There was not statistically significant difference in the gap between injured and uninjured sides 2 months after surgery (P > 0.05). There was not statistically significant difference in the gap between injured and uninjured sides 1 year after surgery (P > 0.05). (2) Neer scores significantly increased 1 year after surgery compared with that before surgery (P < 0.05). (3) These findings confirmed that coracoclavicular ligament reconstruction using two 5 mm-diameter anchors in treatment of Tossy Ⅲ acromioclavicular joint dislocation can obtain satisfactory effect.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Microsurgery anterior cervical discectomy and fusion for cervical degenerative diseases with bony compression Wo Jin, Yuan Feng 2018, 22 (23):  3621-3627.  doi: 10.3969/j.issn.2095-4344.0329 Abstract ( 428 )   PDF (791KB) ( 175 )   Save BACKGROUND: Anterior cervical discectomy and fusion (ACDF), is a classic treatment of cervical degenerative diseases, but narrow surgical field and difficult bone decompression often result in insufficient decompression. Spinal microscope with high magnification making the surgical field clear has its unique advantage during ACDF. OBJECTIVE: To compare the clinical outcomes of microsurgery ACDF (MACDF) and ACDF for cervical degenerative diseases, so as to investigate the clinical results of microsurgery. METHODS: Forty-one patients from June 2015 to June 2016 were enrolled, 24 patients underwent MACDF, and 17 patients underwent ACDF. The osteophyte of spinal canal of cervical was measured on CT, and then the spinal canal occupation ratio was calculated. The Japanese Orthopedic Association (JOA) scoring system was used to evaluate the neurological status at 1 week, 3, 6 and 12 months postoperatively, and the JOA recovery rate was calculated. The incision length, intraoperative blood loss and postoperative volume of drainage were recorded and compared. RESULTS AND CONCLUSION: (1) According to preoperative data, the two groups did not differ with respect to age, sex, level of radiculopathy and preoperative JOA score. (2) Compared with the ACDF group, the postoperative spinal canal occupation ratio was significantly decreased, the JOA scores and JOA recovery rate at 1 week, 3, 6 and 12 months postoperatively were significantly improved, and the incision length, intraoperative blood loss and postoperative volume of drainage were significantly reduced in the MACDF group (P < 0.05). (3) There were two (8%) cases of dysphagia in the MACDF group. In the ACDF group, there were two (12%) cases of dysphagia, one (6%) case of hoarseness, and two cases (12%) of skin hematoma. The incidence of complications did not differ significantly between groups (P > 0.05). (4) To conclude, the MACDF is restored significantly than ACDF in bleeding volume, the incision length and efficacy of bone decompression, which are in accordance with the principle of minimally invasive surgery.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Application value of cortical bone trajectory screws in osteoporotic lumbar posterior fusion surgery Hao Shen-shen, Li Chang-hong, Liu Zhi-bin, Wang Fei 2018, 22 (23):  3628-3633.  doi: 10.3969/j.issn.2095-4344.0310 Abstract ( 411 )   PDF (738KB) ( 174 )   Save BACKGROUND: Conventional pedicle screw fixation is not appropriate for osteoporotic lumbar posterior fusion surgery, because of screw loosening, displacement, and prolapse, and pedicle fractures caused by screw-broken cortical bone. OBJECTIVE: To introduce the application of cortical bone trajectory (CBT) screws in the posterior lumbar fusion surgery of osteoporosis and to evaluate its application value. METHODS: Clinical data of 16 patients with degenerative lumbar spine undergoing CBT screws combined with posterior lumbar fusion surgery were retrospectively analyzed. The operation time, intraoperative blood loss, intraoperative and postoperative complications were recorded. The preoperative, postoperative and last-follow-up Visual Analogue Scale scores were used to assess the pain and the Japanese Orthopaedic Association score was used to assess the lumber function. The bone graft fusion and fusion rate at the last follow-up were observed and calculated, respectively. RESULTS AND CONCLUSION: (1) The surgery was successful in each patient. No complications such as nerve and blood vessel injuries, and the screw failure caused by insufficient screw holding force or nail path damage occurred. There was none case of screw loosening, shedding, or displacement during follow-up. (2) The operation time was (168.5±37.1) minutes and the intraoperative blood loss was (184.2±25.9) mL. (3) The Visual Analogue Scale and Japanese Orthopaedic Association scores postoperatively and at last follow-up were significantly improved compared with those at baseline (P < 0.05), and the scores showed no significant differences postoperatively and last follow-up (P > 0.05). (4) At the last follow-up, the fusion cages were in place, and fusion was satisfactory with a fusion rate of 100%. (5) In summary, the combination of CBT screws and posterior lumbar fusion surgery in the treatment of osteoporotic lumbar degenerative lesions can obtain a good fixation effect without screw-related complications, so it is a satisfactory placement 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 Figures and Tables | References | Related Articles | Metrics

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Continuous negative pressure drainage for treating wound infection after posterior lumbar spine cage fusion and pedicle screw fixation   Xu Zhun, Yan Yi-guo, Wang Cheng, Xue Jing-bo, Wang Ming, Shu Xiao-lin, Wang Wen-jun 2018, 22 (23):  3634-3639.  doi: 10.3969/j.issn.2095-4344.0243 Abstract ( 263 )   PDF (714KB) ( 187 )   Save BACKGROUND: The treatment effect of deep infection of early wound after posterior lumbar fusion is related to the adequacy of wound drainage. OBJECTIVE: To discuss the effect of continuous negative pressure drainage on early wound deep infection after posterior lumbar spine fusion. METHODS: Totally 20 patients with deep wound infection in early stage after posterior lumbar spine fusion were treated with debridement and drainage from August 2012 to December 2016, and the conservative treatment was invalid. 10 patients in the conventional drainage group were drained by drainage tube and the other 10 patients in the negative pressure drainage group were drained by drainage tube connected with the continuous negative pressure. The wound healing time and interbody fusion time were compared between the two groups. Before debridement, 3 days and 3 months after surgery, Visual Analogue Scale score was compared, and the results of the microbiological culture were also observed. RESULTS AND CONCLUSION: (1) All patients in two groups healed after debridement. The wound healing time was significantly faster in the negative pressure drainage group than that in the conventional drainage group (P < 0.05). (2) The interbody fusion time was not significantly different between the conventional drainage group and negative pressure drainage group. (3) Visual Analogue Scale scores were not significantly different between the two groups before surgery and 3 months after surgery. The Visual Analogue Scale scores were significantly lower in the negative pressure drainage group than in the conventional drainage group (P < 0.05). (4) For microbial cultures, the positive results were found in 16 patients and the negative results were found in 4 patients. (5) Results suggested that continuous negative pressure drainage can shorten the time of treating the wound infection after the posterior lumbar spine fusion and relieve the early pain.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Comparison of strengthened transvertebral pedicle screw internal fixation and internal fixation plus percutaneous vertebroplasty in the treatment of thoracolumbar vertebral fractures Zhang Cai-yi, Zuo Cai-hong, Tao Zhong-liang, Zhang Qing, Wang Shao-gang, Wang Sheng, Dai Lian-sheng 2018, 22 (23):  3640-3646.  doi: 10.3969/j.issn.2095-4344.0232 Abstract ( 411 )   PDF (772KB) ( 188 )   Save BACKGROUND: Four screws plus two bars internal fixation combined with percutaneous vertebroplasty and strengthened pedicle screw internal fixation (five or six screws) are commonly surgical procedures for thoracolumbar burst or compression fractures. OBJECTIVE: To compare clinical efficacy between strengthened transvertebral pedicle screw internal fixation and internal fixation plus percutaneous vertebroplasty in treatment of single thoracolumbar vertebral fractures, and to optimize operation scheme. METHODS: Totally 76 patients with thoracolumbar vertebral fracture treated from July 2013 to December 2015 were respectively studied, who were divided into A (39 cases) and B (37 cases) groups according to different surgeries. Group A received strengthened transvertebral pedicle screw internal fixation scheme; group B received conventional internal fixation plus percutaneous vertebroplasty scheme. Operation indexes, variations on anterior and posterior vertebral height, kyphosis correction, pain degree and postoperative complications were compared between the two groups. RESULTS AND CONCLUSION: (1) All patients were operated successfully. Intraoperative blood loss, time of out-of-bed activity postoperatively and hospital stay were significantly different between the two groups (P > 0.05). Operation time was significantly longer in the group A than in group B (P < 0.05). (2) Postoperative vertebral height, spinal curvature and pain degree were reduced to different degrees in both groups. Since 3 months after operation, no obvious vertebral height loss appeared in both groups. At postoperative 7 days, 1, 3 and 12 months, vertebral height compression rate, height recovery rate, posterior convex angle, kyphosis correction rate and Visual Analogue Scale were not significantly different between the two groups (P > 0.05). (3) Bone cement leakage occurred in two cases (5%) in group B, but it did not leak into spinal canal. During follow-up, there were no internal fixation failure or nerve injury cases in both groups. In group B, one case (3%) developed adjacent vertebral fracture. There was no adjacent vertebral fracture in group A. (4) These findings confirmed that strengthened transvertebral pedicle screw internal fixation and conventional internal fixation plus percutaneous vertebroplasty had similar efficacies in treatment of thoracolumbar single vertebral fracture, and the former had no risk of bone cement leakage and had less influence on adjacent vertebra. 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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Lumbar interbody fusion with interspinous dynamic fixation: a finite element analysis Ma Liang, Xu Yong-tao, She Yuan-ju 2018, 22 (23):  3647-3653.  doi: 10.3969/j.issn.2095-4344.0226 Abstract ( 370 )   PDF (779KB) ( 288 )   Save BACKGROUND: Degeneration of adjacent segments after lumbar fusion is a common complication. Preliminary studies have found that the use of interspinous stabilization system alone limits the excessive activity of the implant segments, decreases disc pressure and avoids the degeneration of adjacent segments. However, it is still unclear whether it is necessary to implant the interspinous stabilization system at the proximal segment of the fusion segment to prevent the degeneration of adjacent segments. OBJECTIVE: To investigate the biomechanical properties of the adjacent segment after the lumbar interbody fusion with the interspinous dynamic stabilization system through a finite element analysis. METHODS: The vertebrae at L1-pelvical levels were scanned by 64 slice spiral CT, and the data were imported into the Mimics software to generate a three-dimensional (3D) surface model. The 3D solid model was established using the SolidWorks software, and the L4-5 pedicle screw, interbody cage and Coflex system model were constructed in Solidworks software. Posterior lumbar interbody fusion (PLIF) model and PLIF with the Coflex interspinous dynamic stabilization model (PLIF + Coflex model) were simulated, followed by model assignment and analysis. RESULTS AND CONCLUSION: When the models were loaded with flexion, extension, lateral flexion, and rotation loads, the bending stiffness of the PLIF and PLIF + Coflex models was close to the complete model. The maximal von Mises stress on the L3/4 intervertebral disc of PLIF + Coflex model decreased obviously and decreased most significantly under posterior extension. The maximal von Mises stress on the L5/S1 intervertebral disc of two models was increased compared with the complete model. The range of motion of the L3/4 of the PLIF + Coflex model was decreased under flexion, extension and rotation than that of the PLIF model, which was not obvious under lateral flexion. Therefore, the dynamic fixation of PLIF + Coflex can effectively reduce the maximal von Mises stress of the intervertebral disc and restrict the excessive activity of the proximal segment and protect the proximal adjacent segment. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Influence of muscle forces on lumbar internal fixation system using the finite element analysis Zhao Peng-fei, Chen Ling, Men Yu-tao 2018, 22 (23):  3654-3658.  doi: 10.3969/j.issn.2095-4344.0277 Abstract ( 313 )   PDF (694KB) ( 151 )   Save BACKGROUND: Internal fixation system is a commonly used method for lumbar spine injury. The role of lumbar muscle strength and choosing a sagittal angle are the main factors affecting the success rate of internal fixation, which should pay much attention. OBJECTIVE: To explore the influence of muscle forces under different postures on the internal fixation system when the ploy axial pedicle screws were installed in different sagittal angles. METHODS: A finite element model of lumbar spine (L3 and L4) was developed based on the L3 and L4 MRI data from a healthy adult man and assembled with ploy axial pedicle screw internal fixation system in different sagittal angles. Then, three loading schemes were designed to study the distribution of stress and displacement in anteflexion, extension and lateral bending: scheme 1: loaded without gravity, following loads, or erector spinae force; scheme 2: loaded with gravity and following loads, without erector spinae force; scheme 3: loaded with gravity, following loads, and erector spinae force. The stress and displacement of each part under different conditions were compared. RESULTS AND CONCLUSION: (1) In anteflexion, the stress was in a decent tendency in each scheme. In extension, the stress in the schemes 1 and 2 was decreased firstly and then increased, and the stress in the scheme 3 was kept on a descent tendency. In lateral bending, the stress in the scheme 1 was firstly increased and then decreased, and the stress in the schemes 2 and 3 was firstly decreased and then increased. (2) The displacement in the sagittal angles (0°-5°) was on a rise, and then began to decrease. (3) The scheme 1 revealed the lowest displacement. (4) These results indicate that the muscle force can increase the stress of the internal fixation system under each condition and the intradiscal pressure. However, the stress in each part is related to the motion of lumbar spine. Moreover, the effect of muscle force should be taken into account according to the different sagittal angles. 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 minimally invasive osteotomy with 8-shaped bandage external fixation of hallux valgus Li Yan-le, Chang Cheng, Yue Xiao-hua, Bai Zi-xing, Sun Jia-qi, Cong Yan, Wen Jian-min, Sun Wei-dong 2018, 22 (23):  3659-3664.  doi: 10.3969/j.issn.2095-4344.0270 Abstract ( 373 )   PDF (858KB) ( 232 )   Save BACKGROUND: Hallux valgus is one of the common foot deformities, and seriously affects the quality of life of patients. The traditional surgical treatment adopts large incision and direct vision orthopedic surgery. The patient suffers great pain and recovery is slow. With the progress and development of minimally invasive technology, minimally invasive treatment of hallu valgus with traditional Chinese medicine and western medicine is widely used, and it has the advantages of small incision, quick recovery and early walking. OBJECTIVE: To measure the pressure around osteotomy of hallux valgus with 8-shaped bandage external fixation in walking, standing, active and passive functional exercise. METHODS: SPI FREE FORM single point pressure measurement system with 32 channels was used to measure the pressure of the osteotomy of hallux valgus of the patients in walking, standing, active plantar flexion, active back extension, passive plantar flexion and passive dorsiflexion with 8-shaped bandage external fixation in a 24-year-old patient at 4 weeks after treatment. RESULTS AND CONCLUSION: By analyzing the pressure around osteotomy of hallux valgus with 8-shaped bandage external fixation in walking, standing, active and passive functional exercise, the middle of toe web always kept great pressure; and all but in standing, the dorsal pressure of the metatarsal head was greater than that of the metatarsal head. Besides, the lateral pressure of the toe web was greater than the medial pressure of the metatarsal head except in passive plantar flexion. These results verify that after minimally invasive osteotomy in hallux valgus, 8-shaped bandage external fixation can maintain the distal osteotomy of hallux plantar flexion displacement and neutral position, and effectively maintain the stability of the osteotomy, which is beneficial to fracture healing. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Reliability of BTS three-dimensional motion capture system in gait analysis Guo Yong-liang, Feng Chong-rui, Zhang Xin-fei 2018, 22 (23):  3665-3669.  doi: 10.3969/j.issn.2095-4344.0190 Abstract ( 517 )   PDF (627KB) ( 172 )   Save BACKGROUND: Three-dimensional motion capture system plays an increasingly important role in determining the program of treatment and checking the outcome of therapy in clinic. OBJECTIVE: To investigate the reliability of temporal-spatial parameters and kinematic parameters taken by three-dimensional (3D) motion capture system (BTS Bioengineering, Milan, Italy). METHODS: Totally 28 young volunteers were recruited for gait analysis with 3D motion capture system by two evaluators, A and B. The parameters which consisted of speed, step length, step width, cadence and the angle of the pelvis, the hip, the knee and the ankle at sagittal, horizontal, and coronal planes were recorded. Data were compared within the group evaluated by the same evaluator, and data were compared among groups evaluated by two evaluators. The reliability was analyzed using ICC.  RESULTS AND CONCLUSION: (1) Retest and interdetector reliability was poor in pelvic movement and ankle movement in the horizontal plane. The remaining parameters showed good correlation of the retest and interdetector reliability such as temporal-spatial and kinematic parameters, motion range at three planes, ankle sagittal, frontal planes within and between groups (ICC > 0.75). (2) Results indicate that the temporal-spatial and kinematic obtained from BTS 3D motion capture has clinically acceptable intertrial repeatability, except the movement of pelvis and ankle in the horizontal plane. It can be used in clinical research in mostly abnormal gait analysis. 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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Correlations between hypertrophy of lumbar ligamentum flavum and sagittal spinopelvic balance evaluated by radiography Peng Jia-jie, Zhong De-gui, Wang Jun, Lai Jun-hui, Huang Yong-quan, Su Hai-tao 2018, 22 (23):  3670-3674.  doi: 10.3969/j.issn.2095-4344.0322 Abstract ( 385 )   PDF (597KB) ( 213 )   Save BACKGROUND: The pathogenesis of hypertrophy of lumbar ligamentum flavum is complex, and whether it is related to the sagittal spinopelvic balance remains unclear. OBJECTIVE: To investigate the relationship between hypertrophy of lumbar ligamentum flavum and sagittal spinopelvic balance parameters. METHODS: A retrospective analysis of the clinical data of 38 patients with lumbar degenerative diseases admitted to hospital from January 2015 to December 2017 was conducted. The sagittal spinopelvic balance parameters, including thoracic kyphosis, lumbar lordosis, sacral slope, pelvic incidence, pelvic tilt, sagittal vertical axis, were measured on the full-length radiographs in standing position. The thickness of lumbar ligamentum at L1-2, L2–3, L3–4, L4–5, L5–S1 was measured on the axial T2-weighed MR images at the facet joint level. In order to analyze the relationship between hypertrophy of lumbar ligamentum flavum and sagittal spinopelvic balance parameters, patients were divided into normal group (thickness of ligamentum ≤ 3 mm) and hypertrophy group (thickness of ligamentum > 3 mm) RESULTS AND CONCLUSION: (1) There was no significant difference in the sex and body mass index between two groups at each segment (P > 0.05), but age showed significant difference (P < 0.05). (2) There was significant difference in the thoracic kyphosis at L1-2 between groups (P < 0.05). There were significant differences in the thoracic kyphosis and pelvic tilt at L2-3 between groups (P < 0.05). There was no significant difference in the thoracic kyphosis at L3-4 between groups (P=0.054). There was significant difference in the lumbar lordosis at L4-5 (P < 0.05). The parameters at L5-S1 showed no significant difference between groups. (3) There was a negative correlation between L5-S1 thickness and sagittal vertical axis (r=-0.33, P < 0.05). (4) To conclude, hypertrophy of ligamentum flavum is closely related to the sagittal spinopelvic balance parameters. 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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Axial loading to predict the posture deviation of the tibial fragment elongated with Ilizarov external fixation Li Kai, Tan Qi, Zhang Tao, Hou Shu-jun, Liu Yan-shi, Zhang Xing-peng 2018, 22 (23):  3675-3680.  doi: 10.3969/j.issn.2095-4344.0246 Abstract ( 399 )   PDF (1571KB) ( 217 )   Save BACKGROUND: It is difficult to predict the spatial displacement accurately and timely during the elongation of tibia in the osteotomy by using Ilizarov external fixation. OBJECTIVE: To load axial load, simulate the acquisition of three-dimensional (3D) models with Ilizarov external fixation by finite element analysis software (ANSYS), establish the calculation method of the axial relative displacement, and provide theoretical basis and adjustment method for clinical monitoring the quality of osteotomy length. METHODS: The 3D model was built in Mimics by using CT scan of the bone-Ilizarov external fixator (four-bar eccentric distribution) in a patient. The model was optimized in Solidworks. The tibia elongation was assumed to be 20 mm. The model was established according to the horizontal displacement of distal fragment in coronal sections (0, 4, 7, 10, 13 and 16 mm). The axial force of Ilizarov external fixator was set to 200 N and it was analyzed by finite element method through ANSYS static module. The coordinate position of net force was calculated according to the load data, and the magnitude and direction of the tibial osteotoma were calculated. RESULTS AND CONCLUSION: (1) The models of different horizontal displacement of the distal fragment in coronal section (0, 4, 7, 10, 13 and 16 mm) were loaded. The horizontal offset (0.8, 2.9, 5.4, 8.3, 11.8, 14.9 mm) and errors (0.8, 1.1, 1.6, 1.7, 1.2, 1.1 mm) were calculated respectively. (2) When the calculation error was not less than 1.7 mm, the displacement direction of the distal fragment could be determined, which provided a quantitative basis for clinical treatment; it calculated the external fixed adjustment method and corrected the deformity. (3) In conclusion, the model of Ilizarov external fixation is analyzed by using finite element method, and the mathematical model is established to calculate the axial offset of the distal fragment. When the calculation error is not less than 1.7 mm, the distal fragment displacement can be determined according to the coordinate position of net force, which can guide the regulation of Ilizarov external fixation in clinic, and avoid bone lengthening 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 Figures and Tables | References | Related Articles | Metrics

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Stratification of injuries to the lateral collateral ligament of the ankle using ultrasound: protocol of a prospective, single-center, diagnostic trial and preliminary results Huang Dan, He Xiu-zhen, Yang Xu-huan, Peng Si-min, Wu Ying-xian 2018, 22 (23):  3681-3686.  doi: 10.3969/j.issn.2095-4344.0289 Abstract ( 384 )   PDF (617KB) ( 216 )   Save BACKGROUND: Patients with ankle sprain most commonly experience injuries to the lateral collateral ligament (LCL) complex, which affects the stability and function of the ankle. Early diagnosis of LCL complex injuries is extremely important. In clinical practice, magnetic resonance imaging (MRI) displays the soft tissues of the ankle well, but it is expensive and cannot be used for real-time evaluation. Ultrasound (US) has the advantages of ease of operation, low cost, and real-time capability. Some studies have reported on the stratification of injuries to the LCL complex using US. However, there is controversy regarding the injury grading. OBJECTIVE: To investigate the grading of LCL complex injuries (sprain, partial tear, and complete tear) using US. METHODS: Seventy patients with suspected ankle sprain who have an acute ankle sprain history and present with surgical indicators will be scheduled to receive ankle ligament repair surgery in the Guangzhou Orthopedics Hospital, China. On the day after admission, these patients will undergo US and MRI of the injured ankle prior to ankle ligament repair surgery (test group). The contralateral ankle will be included in the control group and will also undergo MRI and US examination prior to surgery. MRI or surgical results will be used as the gold standard for diagnosing LCL complex injuries. The feasibility of stratification of LCL complex injuries (sprain, partial tear, and complete tear) using US will be evaluated. Outcome measures and preliminary results: The primary outcome measure of this study is the sensitivity of US in the diagnosis of complete LCL complex tear. The secondary outcome measures are the sensitivity of US in the diagnosis of sprain and partial tear of the LCL complex; the specificity, positive predictive value, negative predictive value, accuracy, area under the ROC curve (AUC), and cut-off value of US in the diagnosis of sprain, partial tear, and complete tear of the LCL; and US imaging for the anatomy of the LCL complex. The results of 53 patients with acute ankle sprain included in the preliminary study suggest that there is no significant difference in the type of injuries to the talofibular ligament and calcaneofibular ligament between ultrasound diagnosis results and surgical or MRI findings (P > 0.05). This study was approved by Medical Ethics Committee of Guangzhou Orthopedics Hospital, China in May, 2018 (approval No. 2018-05). This study protocol will be performed in strict accordance with the Declaration of Helsinki. The personal information and data of the testing subjects participating in the clinical trials will be confidential and will be protected in accordance with applicable laws and regulations. The study protocol was designed in February 2018. Patient recruitment will begin in August 2018 and end in August 2019. Data collection will begin in August 2018. Data analysis will be performed in December 2019. The study will end in March 2020. Results will be disseminated through presentations at scientific meetings and/or by publication in a peer-reviewed journal. This trial was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800016244). Protocol version (1.0). DISCUSSION: The results of this study will reveal whether US has a higher diagnostic value than MRI in the diagnosis of injuries to the LCL complex, and can correctively diagnosis and identify LCL complex injuries (sprain, partial tear, and complete tear). 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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Predictive analysis of severity of hip arthritis using platelet-to-lymphocyte ratio: study protocol for a cross-sectional study and preliminary results Jiao Xiu, Zhu Ai-qing 2018, 22 (23):  3687-3691.  doi: 10.3969/j.issn.2095-4344.0323 Abstract ( 312 )   PDF (595KB) ( 211 )   Save BACKGROUND: Inflammatory changes play an important role in the pathogenesis of hip arthritis. However, there are currently no available effective inflammatory markers for the prediction of the severity of hip arthritis. Platelet-to-lymphocyte ratio (PLR) has been shown to be correlated with the severity of rheumatoid arthritis, psoriatic arthritis, and colon cancer. OBJECTIVE: This study hypothesizes that PLR is correlated with the severity of hip arthritis and it can be used as a marker for evaluating the severity of hip arthritis. METHODS: This study will include 260 patients with hip arthritis from the wards of Yantai Affiliated Hospital of Binzhou Medical University, China. These patients will consist of 130 patients with mild and moderate hip arthritis (Kellgren-Lawrence Grading Scale grade 1-2; mild and moderate hip arthritis group) and 130 patients with severe hip arthritis (Kellgren-Lawrence Grading Scale grade 3-4; severe hip arthritis group). At the same time, this study will include 130 healthy controls (control group). On the day of admission, patient’s clinical data will be collected, and blood biochemistry test and hip X-ray examination will be also performed. The primary outcome measure will be PLR. The secondary outcome measures are platelet count; lymphocyte count; X-ray morphology of the hip; Logistic regression analysis results of risk factors for the severity of hip arthritis; area under the ROC curve, cut-off value, sensitivity, and specificity of PLR in the prediction of the severity of hip arthritis. Study design has been completed at the time of submission. A pilot study involving 182 patients with hip arthritis, consisting of 98 patients with mild and moderate hip arthritis and 84 patients with severe hip arthritis, was performed between January 2014 and June 2017 at Yantai Affiliated Hospital of Binzhou Medical University. Logistic regression analysis of this pilot study revealed that diabetes, age, increased body mass index, and increased PLR were associated with aggravation of hip arthritis and were also the independent risk factors of this disorder. The study was approved by the Ethics Committee of the Yantai Affiliated Hospital of Binzhou Medical University in June 2018 (approval No. 20180601001). The study will be performed in accordance with the relevant laws and regulations of the Declaration of Helsinki. All the participants will be fully informed of the study protocol and experimental process, and provide written informed consent with the premise of fully understanding the treatment plan. This study was designed in April 2018. Patient recruitment and data collection will be initialized in October 2018, and completed in March 2019. Data analysis will be conducted in April 2019. The study will be completed in May 2019. The results of this study will be disseminated in peer-reviewed journals or presented at scientific meetings. This trial was registered in the Chinese Clinical Trial Registry with registration No. ChiCTR1800016820 (protocol version 1.0). DISCUSSION: This study will indicate the correlation between PLR and the severity of hip arthritis; PLR has very high severity, specificity, and accuracy in the prediction of the severity of hip arthritis; the optimal cut-off value of PLR in the prediction of the severity of hip arthritis based on the ROC curve. 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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Comparable long-term outcomes of single-bundle versus double-bundle anterior cruciate ligament reconstruction: a 10-year retrospective study Zeng Hui-liang, Feng Wen-jun, Li Ping, Chen Jin-lun, Zeng Jian-chun, Li Jie, Deng Peng, Wu Ke-liang, Ye Peng-cheng, Jie Ke, Cao Hou-ran, Zeng Yi-rong 2018, 22 (23):  3692-3697.  doi: 10.3969/j.issn.2095-4344.0269 Abstract ( 313 )   PDF (605KB) ( 111 )   Save BACKGROUND: In recent years, the application of single-bundle anterior cruciate ligament (ACL) reconstruction technique has been gradually increased and obtained good clinical results, but there exists anterior and rotational instability. Biomechanical study has shown that double-bundle ACL reconstruction could increase knee stability. However, there is no long-term follow-up study on the comparison of clinical outcomes of the two technologies. OBJECTIVE: To compare knee function and clinical outcomes at postoperative 10 years in patients undergoing single-bundle and double-bundle ACL reconstruction, and to assess the differences of efficacies between the two techniques. METHODS: The retrospective study included 47 patients receiving single-bundle and double-bundle ACL reconstruction in the Orthopedic Center of First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2007 to September 2009. Patients were divided into single-bundle group and double-bundle group according to the reconstruction method. Preoperative and postoperative evaluation included physical examination (Lachman test, pivot shift test and anterior drawer test), knee function scores (Lysholm and Tegner scores) and Isokinetic strength test (Hamstring/Quadriceps muscle strength ratio). RESULTS AND CONCLUSION: No positive signs were found in the postoperative physical examination between both groups. Lysholm score and Tegner score after surgery were significantly higher at postoperative 10 years than that preoperatively in both groups. However, Lysholm and Tegner scores were similar, and isokinetic strength test results were identical between both groups. Both single-bundle and double-bundle anterior cruciate ligament reconstruction could improve knee function, and the clinical effects were similar between the two groups.  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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Percutaneous transforaminal endoscopic discectomy for treatment of degenerative lumbar disc herniation in older adult patients: study protocol for a randomized controlled trial and preliminary results Xu Li-chen, Xu Wei-bing, Yang Dong-fang, Zhang Hai-bin 2018, 22 (23):  3698-3702.  doi: 10.3969/j.issn.2095-4344.0295 Abstract ( 335 )   PDF (625KB) ( 145 )   Save  BACKGROUND: Percutaneous transforaminal endoscopic discectomy (PTED) is a major minimally invasive surgical method for the treatment of degenerative lumbar disc herniation. The choice of posture for patients undergoing PTED is controversial. Surgeons tend to perform PTED with the patient in the prone position rather than in the lateral position. Little is documented on which posture has higher efficacy and safety. OBJECTIVE: To investigate the efficacy and safety of the prone position versus lateral position for older adult patients undergoing PTED for the treatment of degenerative lumbar disc herniation. METHODS: This study will include 168 older adult patients with degenerative lumbar intervertebral disc herniation who receive treatment in the Department of Spine Surgery, Dalian Municipal Central Hospital Affiliated to Dalian Medical University, China. These patients will be randomized to undergo PTED in either the prone or lateral position (n= 84 patients in each surgical position). After surgery, all patients will be followed up for 2, 6, and 12 months. The primary outcome is the Oswestry Disability Index at 12 months postoperatively. This index is used to evaluate the improvement in low back pain. The secondary outcomes are the Oswestry Disability Index preoperatively (at baseline) and at 2 and 6 months postoperatively; X-ray morphology of the lumbar spine, visual analog scale score, and Japanese Orthopaedic Association (JOA) score preoperatively and at 2, 6, and 12 months postoperatively; modified MacNab grade at 2, 6, and 12 months postoperatively; partial pressures of oxygen and carbon dioxide preoperatively, intraoperatively, and 1 hour postoperatively; mean arterial pressure, Likert score, and times and doses of vasopressor used intraoperatively; and the incidence of recurrent lumbar intervertebral disc herniation and incidence of adverse reactions 12 months postoperatively. The results of 54 patients included in a pilot study of PTED showed that regardless of use of the prone position (n=26) or lateral position (n=28), the visual analog scale score and Oswestry Disability Index at 2 months postoperatively were significantly lower than those before surgery (P < 0.05). Intraoperative arterial blood gas analysis revealed that the partial pressures of oxygen and carbon dioxide were significantly different between patients in the prone and lateral positions (P < 0.05). This study was approved by Medical Ethics Committee of Dalian Municipal Central Hospital Affiliated to Dalian Medical University, China in May 22, 2018 (approval No. 2018-012-01). 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 December 2017. Patient recruitment will begin in August 2018 and end in August 2019. Data analysis will begin in October 2020 and end in November 2020. Results will be disseminated through presentations at scientific meetings and/or by publication in a peer-reviewed journal. This trial was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800016399). Protocol version (1.0). DISCUSSION: Based on the pilot study, future studies involving larger sample sizes are needed to investigate the short- and medium-term efficacy and safety of the prone versus lateral position for patients undergoing PTED for degenerative lumbar intervertebral disc herniation and to identify a better surgical posture suitable for older adult patients.  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 aspirin discontinuation on the risk of cardiovascular and cerebrovascular events and lower limb venousthrombosis and bleeding in the perioperative period of cervical surgery Zhang Cheng-gui, Wang Guo-dong, Sun Jian-min, Liu Le 2018, 22 (23):  3703-3709.  doi: 10.3969/j.issn.2095-4344.0244 Abstract ( 424 )   PDF (571KB) ( 180 )   Save BACKGROUND: Traditional view holds that aspirin should be discontinued at least 5 to 7 days before spinal surgery to reduce the risk of intraoperative bleeding and postoperative epidural hematoma. However, in recent years, it has been reported that aspirin discontinuation before surgery may increase the risk of serious cardiovascular or cerebrovascular complications. In fact, studies about whether to stop aspirin before cervical surgery is still blank. Therefore, there is no consensus on whether or not to discontinue aspirin before the cervical surgery. OBJECTIVE: To explore the effects of discontinuing aspirin on the risk of cardiovascular, cerebrovascular events and lower limb venous thrombosis and bleeding in the perioperative period of cervical surgery. METHODS: This study collected 601 patients undergoing cervical surgical procedures in the Shandong Provincial Hospital, Shandong University from January 2012 to January 2015, and finally 440 cases were included according to the inclusion criteria. Patients who were aspirin users (n=22) were divided into 2 groups depending on whether to discontinue aspirin before the cervical surgery. The aspirin discontinuation group (n=10) discontinued their aspirin use 5 to 7 days before surgery, while the aspirin continuation group (n=12) continued aspirin use in the perioperative period. Totally 418 patients who did not use aspirin before surgery were selected as the control group. The risk of cardiovascular and cerebrovascular events and lower limb venous thrombosis was quantitatively classified in the three groups and they were divided into low risk group and high risk group according to the criteria. The differences of risk of cardiovascular and cerebrovascular events and lower limb venous thrombosis were evaluated in each group.  RESULTS AND CONCLUSION: (1) Of the 440 patients with cervical surgery, 22 patients (5%) had long-term aspirin use history. (2) The prevalence of hypertension, cardiovascular disease and cerebrovascular diseases in the aspirin group was higher than that in the control group. There was no difference in the prevalence of diabetes among the three groups. (3) There were no significant differences in the intraoperative blood loss, postoperative drainage, operation time, postoperative blood transfusion and postoperative plasma transfusion among the three groups. (4) The aspirin discontinuation group may have a higher incidence of cerebral infarction and pulmonary embolism than in the aspirin continuation group. (5) The aspirin continuation before the cervical surgery is safe in the perioperative period of cervical surgery and it is necessary to continue aspirin use to reduce the incidence of intraoperative and postoperative 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 Figures and Tables | References | Related Articles | Metrics

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Development and biomechanical properties of occipital atlantoaxial complex in 0-6-year-old children: a finite element analysis   Feng Hui-mei, Wang Xing, Zhang Shao-jie, Xu Yang-yang, Su Bao-ke, Li Kun, Wang Hai-yan, Li Xiao-he, Li Zhi-jun 2018, 22 (23):  3710-3715.  doi: 10.3969/j.issn.2095-4344.0309 Abstract ( 312 )   PDF (856KB) ( 419 )   Save BACKGROUND: All types of severe trauma, malformations, tumors, tuberculosis, and inflammation in 0-6 years old children can easily cause damage to the occipital atlantoaxial complex. When the injury compresses the medulla oblongata, the upper cervical cord, nerves, and blood vessels, surgical correction is needed to restore the mechanical stability of the area. Given that this period of children have different development characteristics from adolescents and adults, the design of internal fixators through anterior, posterior or lateral approaches, orthopedic fixation and mechanical mechanism have not been studied in-depth and unified at home and abroad. OBJECTIVE: To analyze the morphological development and mechanical mechanism of occipital atlantoaxial complex morphological characteristics in children aged 0-6 years, and to enrich the database of developmental morphological, imaging, and microstructural mechanics of Chinese, and to provide reference for prevention, diagnosis of the disease and treatment and internal fixation device design, research and development. METHODS: A computer-based retrieval of PubMed, CNKI and WanFang databases was performed for the articles published between January 2004 and December 2017. The keywords were “0-6 years old, pediatric, occipital atlantoaxial complex, anatomy, biomechanical” in English and Chinese, respectively. Eighty-two articles were retrieved, and 58 articles were eligible for the inclusion criteria. RESULTS AND CONCLUSION: (1) The complex anatomy of the vertebral and skull bases in Children aged 0-6 years is more subtle and highly variable, and the adjacent relationship is complex. Therefore, the adult or juvenile screw-related technical data cannot be applied in developing children, and the surgical risk is very high. Thus, improving the accuracy of nail placement and reducing the error rate have become the key for whether internal fixation can be widely utilized in the occipital atlantoaxial complex surgeries. (2) The severe injury of occipital atlantoaxial complex in 0-6 years old children should be treated with internal fixation, and posterior internal fixation is a commonly used method. Because accompanied with a variety of deformities, and the bone structure is different among children, internal fixation becomes very difficult.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Perioperative analgesia in total knee arthroplasty: measures and countermeasures Dou Zhe, Yang Yun, Huang Jian 2018, 22 (23):  3716-3722.  doi: 10.3969/j.issn.2095-4344.0287 Abstract ( 306 )   PDF (723KB) ( 168 )   Save BACKGROUND: Total knee arthroplasty has already become the most effective and ideal method for the treatment of end-stage knee disease worldwide. However, total knee arthroplasty is very traumatic and often accompanied by severe pain. The previous data indicate that 60% patients after total knee arthroplasty feel severe pain, and 30% patients feel moderate pain. The emergence of pain is a very complicated process with many factors involved. How to reduce postoperative pain and quickly restore joint function has become a hot research topic in recent years. OBJECTIVE: To review research progress and development trend of perioperative analgesia in total knee arthroplasty. METHODS: We retrieved the related literatures about the analgesia of knee arthroplasty from January 1990 to December 2017 in WanFang database, CNKI database and PubMed database by using the key words of “knee arthroplasty, knee joint, analgesia, multimode analgesia, preemptive analgesia, fast recovery, patient controlled analgesia, COX-2 inhibitor, femoral nerve block, adductor canal block, periarticular injection, cold therapy” in Chinese, and “knee arthroplasty, analgesia, knee joint, fast track, multimode analgesia, patient controlled analgesia, non-steroidal anti-inflammatory drugs, peripheral nerve block, periarticular injection, cold therapy” in English. Totally 2 306 articles were retrieved. After screening, finally 59 articles meeting the inclusion and exclusion criteria were included. RESULTS AND CONCLUSION: (1) The pathophysiological mechanism of pain after total knee arthroplasty is very complex and is caused by multiple factors and links. (2) There are many clinical analgesic ideas for total knee arthroplasty, including fast recovery, multimodal analgesia and preemptive analgesia, and these ideas have been gradually implemented in clinical practice. (3) There are many clinical analgesic methods for total knee arthroplasty, including patient-controlled analgesia, non-steroidal anti-inflammatory drugs analgesia, peripheral nerve block analgesia, periarticular multimodal drug injection and cold therapy. These analgesic methods have their own advantages and disadvantages. (4) At present, multi-mode analgesia has been approved by most clinicians, but the best pain management program is still controversial. Regarding the choice of the analgesic method, we should weigh the pros and cons, and take the individual characteristics of patients and the existing technical methods into consideration. 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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Distal femoral fractures: Fixation and individualized treatment Zhang Peng, Bi Zheng-gang 2018, 22 (23):  3723-3729.  doi: 10.3969/j.issn.2095-4344.0233 Abstract ( 474 )   PDF (775KB) ( 122 )   Save BACKGROUND: In view of the anatomy of the distal femur, most patients require surgical treatment, and conservative treatment is only applicable to a very small number of patients. OBJECTIVE: To explain the latest treatment options for distal femoral fractures, and to provide a basis for the selection of various repair methods by comparing the clinical and biological data published in the literature.  METHODS: The first author searched the articles from the PubMed database and the Chinese National Knowledge Infrastructure published from January 1990 to December 2016. The key words were “distal femoral fracture, treatment”. A total of 75 related articles were retrieved and 51 articles met the inclusion criteria. RESULTS AND CONCLUSION: (1) Treatment options for distal femoral fractures include: external fixator, angle fixation device, steel plate, intramedullary nail, and joint replacement. (2) Fixation technology continues to develop, and there are various fixation ways for distal femoral fracture. Setting individualized treatment and choosing the right way can achieve good results. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Diagnosis and treatment of inferior tibiofibular joint injury and screw fixation: advances and problems   Chen Hong-jun, Bi Zheng-gang 2018, 22 (23):  3730-3735.  doi: 10.3969/j.issn.2095-4344.0292 Abstract ( 396 )   PDF (651KB) ( 154 )   Save BACKGROUND: Inferior tibiofibular joint is critical for sustaining the stability of ankle joint. However, misdiagnosis of inferior tibiofibular joint injury delays its diagnosis, thus resulting in sustained pain, traumatic arthritis, instability of ankle joint and other complications. OBJECTIVE: To review the diagnosis and treatment of inferior tibiofibular joint injury and cortical screw fixation. METHODS: A computer-based search of PubMed database was conducted for the articles published from January 1950 to December 2015 concerning the diagnosis and treatment of inferior tibiofibular joint injury and cortical screw fixation. The keywords were “syndesmosis injury, syndesmotic screw, evaluation, management”. About 100 articles were retrieved and finally 59 articles were eligible for the inclusion criteria. RESULTS AND CONCLUSION: (1) Unstable inferior tibiofibular joint injury requires surgical fixation, and cortical screw fixation is widely considered as the optimal one. (2) Patients with high fibular fracture and positive for Hook test intraoperatively should be fixed with inferior tibiofibular cortical screws. If the inferior tibiofibular joint is in god stability, inferior tibiofibular cortical screws are not recommended. For inferior tibiofibular joint injury combined with lateral/medial malleolus fracture and complete deltoid ligament, inferior tibiofibular joint avulsion fracture, or complete ligaments, only anatomical reduction is needed. (3) Ankle injuries should obtain much attention, so careful clinical examination, and appropriate radiographs are needed to make early diagnosis and accurate treatment of inferior tibiofibular joint injury, in order to improve patient prognosis and quality of life. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Criteria for choosing different implants in the treatment of distal radius fractures Cui Meng-meng, Hu Hai, Cui Hai-yong, Zhao Long-fei, He Xiao-di, Cheng Hao-jie 2018, 22 (23):  3736-3743.  doi: 10.3969/j.issn.2095-4344.0308 Abstract ( 344 )   PDF (820KB) ( 277 )   Save BACKGROUND: There are various methods for treating fractures and treatment outcomes are different. Thereafter, a review is needed to investigate the optimal implants in the treatment of distal radius fractures. OBJECTIVE: To review the different options of implants in the treatment of distal radius fractures. METHODS: A computer-based retrieval of PubMed (from January 2000 to March 2018) and CNKI (from January 1979 to December 2017) databases was conducted for the related literature. The keywords were “distal radius fracture, Colles fracture, Smith fracture, Barton Fracture and operation” in English and Chinese, respectively. Totally 70 eligible articles were included. RESULTS AND CONCLUSION: (1) Distal radius fractures are commonly seen in clinical practice. The purpose of treatment is to recover the function of the wrist joint by restoring the anatomy of the articular surface. (2) There is no method that can treat all types of distal radius fractures, and sometimes a single surgical procedure cannot completely treat complicated distal radius fractures. (3) There is no uniform treatment standard in clinical practice. By summarizing the foregoing, a unified treatment standard for the system is obtained. (4) Therefore, according to the specific fracture type, degree of displacement, age, complications, and functional requirements of the patient, an optimal and individualized plan is established for each patient. (5) For partial complicated fractures of the distal radius, combined treatment with a variety of implants will often achieve satisfactory results. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Posterior malleolar fractures: how to choose in the face of diversified treatment?   Zhang Yong-duo, Pan De-yue, Li Xue-liang, Zhao Wen-zhi 2018, 22 (23):  3744-3750.  doi: 10.3969/j.issn.2095-4344.0154 Abstract ( 276 )   PDF (756KB) ( 225 )   Save BACKGROUND: Ankle joint is the largest heavy-load joint in human body. As an intra-articular fracture, the mechanism of injury is complicated which can occur with ligament injury and joint dislocation. The posterior malleolar fracture occurs in 7%-44% of the ankle fractures. The prognosis is usually unsatisfactory when the fracture involves the posterior malleolar because of traumatic arthritis. The treatment of posterior malleolus fracture is important for recovering ankle joint function, but the specific classification and treatment of the posterior ankle fracture are still controversial. OBJECTIVE: To summarize and discuss the classification and treatment options for posterior malleolus fractures. METHODS: First author searched literature from CNKI (2000/2017) and Medline database (2000/2017). The key words were “malleolar fractures, posterior malleolar fractures, distal tibial fracture, Pilon fracture, classification, biomechanical, diagnosis, treatment” in Chinese and English. The guiding role for clinical treatment was introduced by summing up the anatomy and biomechanic characteristic of the ankle and damage mechanism, classification, treatment methods, surgical approach and fixed way of the posterior malleolar fractures. RESULTS AND CONCLUSION: Totally 1 890 papers were searched and 35 papers were chosen according to the inclusion and exclusion criteria. The results show that individuals with posterior malleolus fracture are significantly different and rarely appear alone, and often accompanied by internal or external malleolus fractures or tibial and fibular fractures. At present, the classification of posterior malleolus fracture is complicated and the significance of various types of guided clinical treatment is different. Also, the treatment of posterior malleolus fracture is varied and each type of treatment is not sufficient. At this stage, a new mode of parting is needed to guide the clinical treatment of the posterior malleolus 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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Efficacy and safety of drainage placement after primary total knee arthroplasty: a meta-analysis   Tang Jian, Wang Ren-chong, Tang Zhong-fei, Li Bai-chuan 2018, 22 (23):  3751-3758.  doi: 10.3969/j.issn.2095-4344.0286 Abstract ( 423 )   PDF (729KB) ( 141 )   Save BACKGROUND: Total knee arthroplasty (TKA) has been extensively applied in treatment of advanced knee joint disease, because it can effectively alleviate pain and reconstruct knee function. However, whether drainage is needed after TKA remains controversial. OBJECTIVE: To evaluate the clinical curative effect and complications whether drainage placement after primary TKA by meta-analysis . METHODS: PubMed, Embase, Cochrane Library, WanFang and CNKI databases were retrieved for the randomized controlled trials (RCTs) and quasi-randomized controlled trial (qRCTs) concerning whether drainage placement is needed after primary TKA. Data from the relevant studies were collected and analyzed by Revman 5.3 software. The outcome indexes included postoperative hemoglobin, blood transfusion rate, blood loss, allogeneic blood transfusion, Visual Analogue Scale score, range of motion of the knee joint, knee function score, complications, and deep venous thrombosis. RESULTS AND CONCLUSION:(1) Twelve articles were included, including 9 RCT trials and 3 qRCT trials, involving 836 patients (429 cases of receiving drainage, 407 cases receiving no drainage). (2) The results of meta-analysis showed that the postoperative hemoglobin (MD=-7.20, 95% CI (-11.02, -3.38), P=0.000 2), blood transfusion rate (RR=1.93, 95 %CI (1.50, 2.49), P < 0.000 01), blood loss (MD=293.73, 95%CI (217.47, 369.99), P=0.000 01), and allogeneic blood transfusion (MD=284.70, 95%CI (77.64, 491.76), P=0.007) showed significant differences between groups. However, the postoperative 1st day Visual Analogue Scale score (MD=-0.02, 95%CI (-0.38, 0.34), P=0.92), the 7th day Visual Analogue Scale score (MD=-0.06, 95%CI (-0.27, 0.15), P=0.86), Knee Society Score (MD=0.10, 95%CI (-2.03, 2.23), P=0.93), range of motion of the knee joint (MD= -2.77, 95%CI (-8.27, 2.72) , P=0.32), postoperative complications (RR=0.77, 95%CI (0.57, 1.05), P=0.10), and deep venous thrombosis (RR=1.60, 95%CI (0.64, 3.96), P=0.31) did not differ significantly between groups. (3) In summary, drainage placement in primary TKA will increase the postoperative blood loss, blood transfusion rate and blood transfusion, but it will not improve the function of the knee, alleviate postoperative pain and postoperative complications, so postoperative drainage is not recommended. 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 knee arthroplasty with and without preservation of the infrapatellar fat pad:  a meta-analysis   Jie Ke, Deng Peng, Zeng Jian-chun, Feng Wen-jun, Zeng Hui-liang, Wu Ke-liang, Zeng Yi-rong 2018, 22 (23):  3759-3765.  doi: 10.3969/j.issn.2095-4344.0790 Abstract ( 596 )   PDF (823KB) ( 321 )   Save BACKGROUND: During total knee arthroplasty, the infrapatellar fat pad is usually resected to enhance surgical exposure and install the prosthesis easily. However, it is still controversial whether the infrapatellar fat pad is removed or retained in the clinic. OBJECTIVE: To systematically assess the effectiveness and safety of the excision and preservation of infrapatellar fat pad during total knee arthroplasty. METHODS: Wanfang Data, CNKI, CBM, VIP, Cochrane Library, Pubmed and EMbase were researched for the clinical controlled trials from the database establishment to August 2017 according to inclusion and exclusion criteria. The included data were extracted and quality was evaluated. Meta-analysis was performed by using RevMan 5.3 software. RESULTS AND CONCLUSION: (1) Totally 12 clinical controlled trials with 1 478 knees were included. (2) Meta-analysis results showed that infrapatellar fat pad excision could significantly increase shortening of the patellar tendon, compared with the infrapatellar fat pad preservation at the follow-up period of 12 to 18 months and 28 to 38 months postoperatively [MD=2.90, 95%CI (2.21, 3.58), P < 0.000 01; MD=2.65, 95%CI (1.96, 3.35), P < 0.000 01]. However, the difference of shortening of the patellar tendon between two groups within 1 to 2 months and 6 months postoperatively was not statistically significant (P > 0.05). (3) Anterior knee pain, American knee society knee score, hospital for special surgery knee score and Insall-Salvati ratio were not significantly different between the two groups (P > 0.05). (4) Infrapatellar fat pad, especially the dense vascular position, should be preserved as much as possible and protected from injury during total knee arthroplasty. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Percutaneous kyphoplasty and pedicle screw fixation in the treatment of senile osteoporotic thoracolumbar compression fracture: a meta-analysis Qin Qi, Shi Chen-hui, Wang Wei-shan, Dai Yi, Zhao Jia-rui, Gao Peng, Zhang Bin 2018, 22 (23):  3766-3772.  doi: 10.3969/j.issn.2095-4344.0242 Abstract ( 407 )   PDF (717KB) ( 156 )   Save BACKGROUND: Percutaneous kyphoplasty and pedicle screw fixation are commonly used methods for treatment of senile osteoporotic vertebral compression fractures. The choice of surgical approach is still controversial. More evidence-based medicine is needed to evaluate the advantages and disadvantages of both procedures.  OBJECTIVE: To evaluate the clinical effects of percutaneous kyphoplasty and pedicle screw fixation in the treatment of senile osteoporotic vertebral compression fractures using meta-analysis. METHODS: We performed a systematic search of CNKI, Wanfang Data, VIP, CBM, EMBASE, PubMed, Chinese database Cochrane Library by computer as well as some relevant conference papers by hand to collect the randomized and non-randomized controlled studies concerning percutaneous kyphoplasty and pedicle screw fixation for treating senile osteoporotic vertebral compression fractures before May 2017. The quality was assessed by two evaluation members according to the Cochrane collaboration network standard one by one. The studies meeting the inclusion criteria were analyzed using RevMan5.3 software. RESULTS AND CONCLUSION: A total of 7 articles were included in the study, including 596 patients. Meta-analysis results showed that: compared with pedicle screw fixation, operation time was shorter [MD=-100.09, 95%CI(-161.63, -38.56), P=0.001]; intraoperative blood loss was less [MD=-309.86, 95%CI(-500.16, -119.57), P=0.001]; Visual Analogue Scale score of postoperative pain relief was more obvious [MD=-2.55, 95%CI(-4.19, -0.91), P=0.002]; recovery of postoperative vertebral compression rate was better [MD=-9.39, 95%CI(-11.93, -6.86), P < 0.000 01] during percutaneous kyphoplasty. Postoperative Oswestry Disability Index score was not statistically significant [MD=-2.76, 95%CI (-7.78, 2.26), P=0.28] between the two groups. Postoperative Cobb angle decreased in both groups, but no significant difference was found between them [MD=-1.42, 95%CI(-4.09, 1.25), P=0.30]. These findings verify that no significant difference in postoperative Cobb angle or Oswestry Disability Index score was found between percutaneous kyphoplasty and pedicle screw fixation. Percutaneous kyphoplasty has advantages in operation time, intraoperative blood loss, postoperative pain relief, and recovery of postoperative vertebral compression rate. However, our conclusion still needs to be confirmed by large-sample multi-center randomized controlled 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