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    28 September 2018, Volume 22 Issue 27 Previous Issue    Next Issue
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    Multimodal analgesia of total knee arthroplasty: analgesic effect of morphine versus cocktail  
    Li Guo-qing, Wang Tian-xing, Mohetaer•Momin, Ma Jun, Wang Yang
    2018, 22 (27):  4265-4270.  doi: 10.3969/j.issn.2095-4344.0338
    Abstract ( 420 )   PDF (651KB) ( 156 )   Save

    BACKGROUND: Multimodal analgesia effectively alleviates pain by additives and synergistic effect various drugs. It can avoid drug dependence and reduce adverse reactions caused by drug overdose.

    OBJECTIVE: To analyze the analgesic effect of morphine versus cocktail in multimodal analgesia of total knee arthroplasty (TKA).
    METHODS: Totally 148 patients undergoing primary unilateral TKA were enrolled. The patients were assigned by analgesic modes: group A (n=50) received the epidural injection of 3 mg of morphine before epidural tube removed; group B (n=46) was given the epidural injection of 3 mg of morphine and local injection of cocktail surrounding the knee joint before epidural tube removed; group C (n=52), received the epidural injection of same volume of normal saline and local injection of cocktail surrounding the knee joint. The patients in each group had the osteoarthritis and limited range of movement preoperatively. The postoperative Visual Analogue Scale score, muscle strength, nausea, vomiting, pruritus, and the first urination time were compared among groups.
    RESULTS AND CONCLUSION: (1) The postoperative Visual Analogue Scale scores at rest and in activity in the group C were significantly higher than those in the groups A and B at 6 and 12 hours (P < 0.05). The q test results showed that the scores showed no significant differences between groups B and C (P > 0.05). The scores at 24 and 36 hours did not differ significantly among groups (P > 0.05). The administration rate of dezocine showed no significant difference among groups (P > 0.05). (2) The muscle strength at postoperative 6 and 12 hours in the group C was significantly higher than that in the groups A and B (P < 0.05), and no significant difference was found between groups A and B through q test (P > 0.05). (3) The incidences of urinary retention, nausea, vomiting and pruritus in the group C were significantly less than those in the groups A and B (P < 0.05), and there was no significant difference between groups A and B (P > 0.05). (4) In summary, in multimodal analgesia of TKA, epidural anesthesia of local injection of cocktail without morphine can significantly improve the early muscle strength, and reduce the complications of urinary retention, nausea, vomiting and pruritus.

    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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    Rehabilitation satisfaction of Taohong Siwu Decoction combined with acupoint moxibustion applied in older adults after total knee arthroplasty  
    Jin Rui, Liu Ying, Yao Yao, Liu Ya-fei, Tao Hui, Du Shan-shan, Chen Hui, Liu Jun
    2018, 22 (27):  4271-4276.  doi: 10.3969/j.issn.2095-4344.0339
    Abstract ( 385 )   PDF (719KB) ( 161 )   Save

    BACKGROUND: With the “Bio-Psycho-Social” paradigm, rehabilitation after total knee arthroplasty (TKA) has shifted from “Disease” to “Patient-Centered” to improve surgical safety and patient satisfaction. The core concept of modern rapid rehabilitation is based on the concept of people-oriented, and is the concrete practice of medical and humane care. How to pay more attention to the psychological rehabilitation of patients after replacement, elimination of pain, functional recovery, improve the comfort of treatment, orthopedic physicians need to push innovation and research in depth in our country.

    OBJECTIVE: To investigate the effect of acupoint moxibustion combined with Taohong Siwu Decoction on the rehabilitation satisfaction of the patients after TKA.
    METHODS: Totally 186 older adults after undergoing TKA were enrolled at Lanzhou General Hospital of PLA from January 2015 to December 2016. The patients were divided into three groups: conventional group, Taohong Siwu Decoction group and combination group. The conventional group was given subcutaneous injection of low molecular weight heparin calcium, 4 000 U, once daily, conventional nurse and rehabilitation, oral administration of 200 mg of celecoxib, twice daily (7 days a course). The Taohong Siwu Decoction group received the same treatment with the conventional group, and was given Taohong Siwu Decoction (400 mL), twice daily. The combination group was given acupuncture and moxibustion on the basis of the first two treatments. The pain index was recorded at baseline, 7 and 90 days postoperatively. The Spitzer quality of life and QLQ-C30 scores at postoperative 90 days were compared among groups to assess the quality of life and rehabilitation satisfaction.
    RESULTS AND CONCLUSION: (1) Compared with the conventional group, the pain index in the Taohong Siwu Decoction and combination groups was significantly decreased at 7 and 90 days postoperatively (P < 0.01). There was significant difference in each index between Taohong Siwu Decoction and combination groups at different time points (P < 0.01). (2) Compared with the conventional group, the quality of life and rehabilitation satisfaction of the patients in the Taohong Siwu Decoction and combination groups were significantly improved (P < 0.01), but there was no significant difference between Taohong Siwu Decoction and combination groups (P > 0.05). (3) In summary, Taohong Siwu Decoction combined with acupoint moxibustion can alleviate the pain, and improve satisfaction and quality of life of the patients undergoing TKA. Based on the conventional treatment of low molecular weight heparin calcium for preventing deep venous thrombosis, the combination of Taohong Siwu Decoction and acupoint moxibustion exhibits excellent results in improving quality of life and satisfaction. 

    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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    Total knee arthroplasty combined with individualized soft tissue balance technique for valgus knee deformity: an analysis of 32 cases  
    Wang Bai-sheng, Zhang Jing-dong, Han Wen-feng, Liu Xin-wei, Wang Ning, Liu Hai-li, Li Ru-zhen
    2018, 22 (27):  4277-4281.  doi: 10.3969/j.issn.2095-4344.0285
    Abstract ( 327 )   PDF (637KB) ( 220 )   Save

    BACKGROUND: Although the incidence of valgus deformity is less than the varus deformity, the operation is more difficult and the technical requirements are higher. The techniques of osteotomy and soft tissue balance are most difficult to grasp, and there is no unified technical specification at home and abroad.

    OBJECTIVE: To analyze the individualized soft tissue balance technique and early clinical efficacy of total knee arthroplasty for severe knee valgus deformity.
    METHODS: A retrospective analysis was made in 32 cases (35 knees) undergoing primary total knee arthroplasty in the General Hospital of Shenyang Military Region from September 2013 to May 2016. All patients underwent standardized osteotomy and individualized soft tissue balance technique by patellar medial approach. The postoperative effects were evaluated by the range of motion of knee joint, the postoperative femorotibial angle and the Hospital for Special Surgery knee score.
    RESULTS AND CONCLUSION: (1) All patients were followed up for 16-44 months. (2) The range of motion of knee joint was increased from (62.1±15.8)° to (108.7±25.9)° at the last follow-up. The femorotibial angle was reduced from (28.6±7.0)° to (6.7±2.2)° at the last follow-up. The Hospital for Special Surgery knee score was increased from 26.8±7.6 to 86.9±18.5 at the last follow-up (P < 0.05). (3) Three cases (three knees) had the symptoms of medial instability of the knee joint, two cases (two knees) had the symptoms of general peroneal paralysis postoperatively, and all recovered. (4) These findings imply that total knee arthroplasty with individualized soft tissue balance technique for valgus deformity can obviously relieve the pain and restore the lower limb alignment, and clinical results are satisfactory.

    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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    Rational application of tranexamic acid and drainage tube in total knee arthroplasty
    Zhang Li-qing, Wei Kai-bin, Zhu Ben-ke, Wang Qiang, Li Chun-pu
    2018, 22 (27):  4282-4287.  doi: 10.3969/j.issn.2095-4344.0340
    Abstract ( 262 )   PDF (620KB) ( 137 )   Save

    BACKGROUND: Currently, large amount of blood loss after total knee arthroplasty (TKA) is an issue of concern in clinic, and tranexamic acid administrated by various ways is used to reduce postoperative blood loss. Drainage tubes are commonly placed postoperatively; however, there are no confirmed assessments on the local application of tranexamic acid without drainage tube placement.

    OBJECTIVE: To observe the effects of topical application of tranexamic acid on the blood loss after TKA, and to explore the reasonable application method of drainage tube.
    METHODS: Ninety patients with unilateral TKA were randomly divided into three groups. The patients in group A received the intraarticular injection normal saline (50 mL), drainage tube was placed postoperatively, and closed for 4 hours; group B: the mixture of 50 mL of normal saline and 1.6 g of tranexamic acid was injected into the articular cavity, drainage tube was placed and closed for 4 hours; group C: the mixture of 50 mL of normal saline and 1.6 g tranexamic acid was injected into the articular cavity without drainage tube placed. The intraoperative blood loss was recorded. In the first two days postoperatively, the hemoglobin, drainage volume, blood transfusion volume and the number of blood transfusion were recorded daily. The total blood loss and hidden blood loss were calculated. The number of deep vein thrombosis of the lower extremity was recorded at 7 days postoperatively. All patients were followed up.
    RESULTS AND CONCLUSION: (1) The baseline data and intraoperative blood loss showed no significant differences among groups (P > 0.05). (2) The postoperative total blood loss and the number blood transfusion in the groups B and C were significantly less than those in the group A (P < 0.05), while the differences between groups B and C had no significance (P > 0.05). (3) The drainage volume in the group B was significantly less than that in the group A (P < 0.05). (4) The hidden blood loss did not differ significantly among groups (P > 0.05). (5) None of deep venous thrombosis was observed. (6) These results suggest that topical application of tranexamic acid after TKA can significantly reduce the drainage volume and total blood loss, and can decrease the rate of blood transfusion, but cannot significantly reduce the hidden blood loss, nor will it increase the incidence of deep venous thrombosis. With topical application of tranexamic acid, the drainage tube placement is not needed, so the method is simple, safe and effective.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Tranexamic acid combined with iron sucrose reduces blood transfusion in primary total hip arthroplasty: a prospective, randomized, controlled trial
    Xi Ying-long, Duan Yu-ping, Yang Qing, Yang Yi, Zhang Zheng-xue, Zhao Xiao-dong, Zhou Jun-jie, Yang Jia
    2018, 22 (27):  4288-4293.  doi: 10.3969/j.issn.2095-4344.0341
    Abstract ( 355 )   PDF (726KB) ( 137 )   Save

    BACKGROUND: Tranexamic acid is a commonly used hemostatic drug in hip arthroplasty, iron sucrose is used for perioperative anemia, and the clinical effect and safety of their combination need to be studied further.

    OBJECTIVE: To investigate the clinical efficacy and safety of tranexamic acid combined with iron sucrose in total hip arthroplasty (THA).
    METHODS: Among 263 patients undergoing THA at Department of Orthopedics, the First Affiliated Hospital of Kunming Medical University from September 2016 to September 2017, 174 patients were enrolled, and randomly assigned to tranexamic acid combined iron group (combination group), tranexamic acid group and iron group (n=58 per group). The level of hemoglobin and hematocrit were recorded at admission, preoperative 1 day, and postoperative 1, 3, and 5 days postoperatively were recorded. The thrombin time, activated partial thromboplastin time, fibrinogen and D-dimer level were detected at admission and postoperative 1 day. The intraoperative blood loss, postoperative drainage volume and postoperative blood transfusion were recorded. The preoperative blood volume and total blood loss were calculated.
    RESULTS AND CONCLUSION: (1) There was no significant difference in the baseline data among groups (P > 0.05). (2) The level of hemoglobin at preoperative 1 day in the combination and iron groups was significantly higher than that in the tranexamic acid group (P < 0.05). The postoperative level of hemoglobin in the combination was significantly higher than that in the other two groups (P < 0.05). (3) The postoperative blood transfusion and total blood loss in the combination group were significantly lower than those in the other two groups (P < 0.05). (4) The coagulation indicators and D-dimer level did not differ significantly among groups (P > 0.05). (5) There were no complications such as articular infection, deep venous thrombosis, and pulmonary embolism during follow-up. (6) To conclude, tranexamic acid combined with iron sucrose can effectively improve the perioperative hemoglobin concentration, and reduce the total blood loss and postoperative blood transfusion, without thrombosis and other complications, which is effective and safe.

    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 verification and improved design of the new traction splint for distal radius fractures
    Yan Wei, Kong Bo, Jiang Tao, Jia You-ji1, Xi Xiao-bing
    2018, 22 (27):  4294-4299.  doi: 10.3969/j.issn.2095-4344.0342
    Abstract ( 469 )   PDF (776KB) ( 191 )   Save

    BACKGROUND: New traction splint is developed base on “elastic fixation” theory of traditional splint and “minimal movement” theory of promoting fracture healing, which exhibits broad application values and prospects in the treatment of distal radius fractures.

    OBJECTIVE: To explore the performance of the new traction splint by clinical research, and to improve its deficiencies.
    METHODS: Forty patients with distal radius fractures were randomly divided into trial (new traction splint) and control (plaster fixation) groups (n=20 per group). The X-ray films of the wrist joint were performed immediately, 2 and 6 weeks postoperatively to compare the fracture healing. PACS system was used to measure the height of radius, palm inclination and ulnar deviation immediately and 6 weeks postoperatively. The pain and swelling degree at 0, 3, 7 and 14 days were compared. The wrist function was assessed according to Gartland and Werley evaluation system.
    RESULTS AND CONCLUSION: (1) The speed of fracture healing and swelling relief in the trial group were significantly better than those in the control group (P < 0.05). (2) The curative efficacy at postoperative 6 weeks in the trial group was significantly superior to that in the control group (P < 0.05), and the curative efficacy showed no significantly between two groups at postoperative 3 months. (3) There was no significant difference in the height of radius, palm inclination and ulnar deviation after reduction and 6 weeks after fixation between two groups (P > 0.05). The change value of palm inclination in the control group was slightly superior to that in the trial group. (4) Different degrees of complications occurred in both groups, but the incidence of severe complications in the trial group was lower than that in the control group. (5) Our findings indicate that the new traction splint has obvious advantages and definite curative effect in the treatment of distal radius fracture, but there are many shortcomings. It needs to be improved in the aspects of light weight, shape, traction structure and inner lining.
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    Shoulder function after humeral head arthroplasty for complex fracture of humerus: 1 year of follow-up
    Dai Hai-feng, Chang Qian-kun, Chen Yong-liang, Li Jia, Xu Cong, Lü Yong-ming
    2018, 22 (27):  4300-4304.  doi: 10.3969/j.issn.2095-4344.0343
    Abstract ( 404 )   PDF (505KB) ( 137 )   Save

    BACKGROUND: The surgical methods and treatment criteria for proximal humeral fractures remain controversial. The postoperative recovery of shoulder function is affected by various factors.

    OBJECTIVE: To explore the factors for the functional recovery of shoulder joint after humeral head arthroplasty for proximal humeral fractures. 
    METHODS: Fifty-three cases of proximal humeral fractures admitted in Affiliated Hospital of Chengde Medical University from May 2012 to April 2017 were included, and all patients underwent humeral head arthroplasty. The shoulder joint function was evaluated at 1 year postoperatively. Logistic regression analysis was carried out on the related factors such as sex, age, type of fracture, degree of osteoporosis, injury to operation time, surgical approach, position of the prosthesis, the healing of greater and lesser tuberosities of humers, adminstration of osteoporosis drugs, and the time of beginning functional exercise. 
    RESULTS AND CONCLUSION: (1) After 1 year of follow-up, Logistic regression analysis showed that the factors affecting the functional recovery of the shoulder joint after arthroplasty were the degree of osteoporosis, surgical approach, position of the prosthesis, the healing of greater and lesser tuberosities of humerus, and the administration of osteoporotic drugs. (2) To conclude, the position of the prosthesis is a controllable factor, so an appropriate position should be chosen as far as possible. Preoperative assessment of the degree of osteoporosis is necessary, and the use of anti-osteoporotic drugs postoperatively contributes to the functional recovery. Additionally, the healing of greater and lesser tuberosities of humers is helpful to the functional recovery of the rotator cuff.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Comparison of the biomechanical characteristics of the locking reconstruction plate through different placement methods for transverse fracture of the acetabulum  
    Zhong Xiao, Jia Xu-feng, Huang Guang-ping, Zhou Qing-zhong
    2018, 22 (27):  4305-4310.  doi: 10.3969/j.issn.2095-4344.0324
    Abstract ( 295 )   PDF (614KB) ( 150 )   Save

    BACKGROUND: Locking reconstruction plate is used in the internal fixation of acetabular fractures in a variety of ways, and different fixation methods have certain advantages. However, the biomechanical characteristics of different internal fixation methods are little reported.

    OBJECTIVE: To compare the biomechanical differences of locking compression plate with different internal fixation methods in the treatment of acetabular transverse fracture.
    METHODS: Forty adult semipelvic specimens were used to make the transverse acetabular fracture model, and then randomly divided into four groups. Anterior column fixation group received simple iliac anterior column locking reconstruction plate fixation; posterior column fixation group received locking compression plate fixation of anterior column reconstruction; the anterior column combined fixation group received iliac anterior column locking reconstruction plate fixation, while the posterior column implanted with one lag screw; posterior column combined fixation group received locking reconstruction plate internal fixation in the posterior column and one screw placement in the anterior column. The horizontal and longitudinal displacements of the fracture end under the loads of 600, 1 400 and 1 800 N were detected, and the axial stiffness was calculated.
    RESULTS AND CONCLUSION: (1) The horizontal displacement of the fracture end under the loads of 600, 1 400 and 1 800 N in the anterior column and posterior column combined fixation groups was significantly lower than that in the anterior column and posterior column fixation groups (P < 0.05). There was no significant difference between anterior column and posterior column combined fixation groups, and the horizontal displacement in the anterior column fixation group was significantly smaller than that in the posterior column fixation group (P < 0.05). (2) The longitudinal displacement of the fracture end under the loads of 600, 1 400 and 1 800 N in the anterior column and posterior column combined fixation groups was significantly lower than that in the anterior column and posterior column fixation groups (P < 0.05). There was no significant difference between anterior column and posterior column combined fixation groups, and the longitudinal displacement in the anterior column fixation group was significantly smaller than that in the posterior column fixation group (P < 0.05). (3) The axial stiffness under the loads of 600, 1 400 and 1 800 N in the anterior column and posterior column combined fixation groups was significantly lower than that in the anterior column and posterior column fixation groups (P < 0.05). There was no significant difference between anterior column and posterior column combined fixation groups, and the longitudinal displacement in the anterior column fixation group was significantly smaller than that in the posterior column fixation group (P < 0.05). (4) These results indicate that for transverse acetabular fractures, locking compression plate combined with lag screw fixation shows better biomechanical stability than the single locking reconstruction plate internal fixation; and iliac bone anterior locking compression plate internal fixation reconstruction exhibits better biomechanical stability than the posterior column fixation.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Clinical feasibility of the transpedicular positioning of the sacroiliac screw guider
    Shen Ming-quan, Yang Tie-yi, Wang Zhi
    2018, 22 (27):  4311-4315.  doi: 10.3969/j.issn.2095-4344.0344
    Abstract ( 378 )   PDF (616KB) ( 107 )   Save

    BACKGROUND: Transpedicular positioning of the sacroiliac joint guider is more effective than traditional operation in the treatment of posterior pelvic annulus fracture. It not only shortens the operation time and intraoperative fluoroscopy, but also improves the surgical safety.

    OBJECTIVE: To evaluate the clinical feasibility of the transpedicular positioning of the sacroiliac screw guider,  and to provide basic data for clinical application.
    METHODS: In five cases of human cadaver pelvis (10 sacroiliac joints), 10 sacroiliac screws were implanted into S1 through sacroiliac joint under the guidance of the self-designed sacroiliac screw guider. The safety of placement was confirmed by fluoroscopy.
    RESULTS AND CONCLUSION: (1) All the sacroiliac screws were implanted accurately, and none of them broke through the anterior cortical bone or entered the spinal canal. (2) The pedicle screws were used to guide the sacroiliac joint guidance with stable screw placement, and satisfactory efficacy. (3) These results indicate that transpedicular localization of sacroiliac screws in the treatment of posterior pelvic ring fractures shows high accuracy, good fixation effect, and can decrease operation risk, significantly reduce intraoperative fluoroscopy, reduce the requirements for the operator, and shorten the learning curve, which can be widely used 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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    Historical evolution of sacroiliac joint malposition based on bibliometric analysis
    Zhang Shao-qun, Li Nai-qi, Qi Ji, Li Yi-kai
    2018, 22 (27):  4316-4321.  doi: 10.3969/j.issn.2095-4344.0345
    Abstract ( 388 )   PDF (682KB) ( 161 )   Save

    BACKGROUND: Sacroiliac joint malposition named disorder, and there are many kinds of treatments. However, the current domestic researches on the sacroiliac joint malposition are still lack of objective, quantitative summary and analysis.

    OBJECTIVE: To analyze the history and development of sacroiliac joint malposition related studies, and to explore the research status and prospects.
    METHODS: CNKI, WanFang and VIP databases were retrieved for the literature about sacroiliac joint malposition published before December 31, 2016. The keywords were “sacroiliac joint malposition, sacroiliac joint subluxation, sacroiliac joint derangement, sacroiliac joint dysfunction and synovial interposing of sacroiliac joint”. The publication time, literature type, journal distribution, nomenclature of sacroiliac joint malposition and its treatment, and high-frequency were analyzed by bibliometrics.
    RESULTS AND CONCLUSION: (1) Totally 1 096 articles were retrieved initially, and finally 472 articles were enrolled based on the inclusion and exclusion criteria. (2) The study of sacroiliac joint malposition reached a peak in 2013 (37 articles (7.8%). From 2000 to 2016, a total of 354 papers were published (75.0%). (3) There were most periodical papers (89.4%) in the literature, followed by conference papers (8.7%). Among them, clinical researches accounted for 71.8%, while basic researches accounted for only 1.9%. (4) The 472 papers were distributed in 159 kinds of journals, and the Journal of Chinese Manipulation & Rehabilitation Medicine, the Journal of Traditional Chinese Orthopedics and Traumatology and the China Journal of Orthopaedics and Traumatology published more articles than other periodical, amounting 13.3%, 5.2% and 4.0%, respectively. (5) The sacroiliac joint malposition related studies named after Sacroiliac Joint Malposition accounted for 33.3%, named after Sacroiliac Joint Subluxation accounted for 27.1%, and named after Sacroiliac Joint Derangement accounted for 23.7%. (6) Manipulative techniques/Chiropractic techniques/Massage techniques/Tui-Na therapy were the most frequent keywords. (7) In the treatment of sacroiliac joint malposition, Tui-Na treatment accounted for 60.50%, acupuncture combined with Tui-Na treatment accounted for 7.1%, Tui-Na treatment combined with Chinese medicine accounted for 2.9%, higher than other treatment methods. (8) These results imply that in the past 40 years, the overall study of sacroiliac joint malposition shows an upward trend. Since 2000, the sacroiliac joint malposition researches have entered a hot period, but the researches are mainly based on clinical researches, lacking basic researches. In China, the nomenclature of sacroiliac joint malposition is confused, but mainly named after Sacroiliac Joint Malposition and Sacroiliac Joint Subluxation. Tui-Na treatment is the main treatment of sacroiliac joint malposition, but the basic researches on the treatment mechanism are few, which needs an in-depth investigation. 

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Effect of adolescent interlocking intramedullary nail on the proximal femur in the treatment of femoral shaft fractures  
    Lu Yu-nan, Wang Wen-tao, Pan Yuan-cheng, Chen Shun-you
    2018, 22 (27):  4322-4326.  doi: 10.3969/j.issn.2095-4344.0346
    Abstract ( 410 )   PDF (1381KB) ( 116 )   Save

    BACKGROUND: The treatment of femoral shaft fractures in adolescents is under discussion. Femoral shaft fracture treated using adolescent interlocking intramedullary nail is seldom reported.

    OBJECTIVE: To observe the proximal femoral changes in adolescent femoral shaft fractures after treated using adolescent interlocking intramedullary nail.
    METHODS: Clinical data of 18 patients with femoral shaft fractures undergoing treatment of adolescent interlocking intramedullary nail from February 2014 to August 2016 at Fuzhou Second Hospital, Xiamen University were analyzed retrospectively. The uninjured side was used as control group, and the radiographs at last follow-up were analyzed to assess the incidence of osteonecrosis of the femoral head, valgus deformity of coxa as well as stenosis of femoral neck. The geometric parameters of bilateral proximal femurs were measured by imaging processing software, and then compared between two sides. Additionally, the Nonarthritic Hip Score was used to assess the hip joint function at the last follow-up.
    RESULTS AND CONCLUSION: (1) All patients were followed up for 16-46 months. All achieved bony union, and none of osteonecrosis of the femoral head, valgus deformity of coxa or stenosis of femoral neck occurred. (2) There were no significant differences in the geometric parameters of proximal femur and the Nonarthritic Hip Score between injured and uninjured sides (all P > 0.05). (3) Our findings indicate that adolescent interlocking intramedullary nail can achieve satisfactory results in the treatment of femoral shaft fractures without 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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    Digital design of night-time scoliosis brace
    Huang Ya-xiang, Zhao Zi-ping, Wang Zhi-guo, Liao Qi-ming, Xie Yin-hao, Zhang Ping
    2018, 22 (27):  4327-4331.  doi: 10.3969/j.issn.2095-4344.0347
    Abstract ( 518 )   PDF (734KB) ( 307 )   Save

    BACKGROUND: Traditional scoliosis brace has been extensively used in clinical practice, but the comfortability, cost and fabrication efficiency need to be improved.

    OBJECTIVE: To explore the method of designing the night-time scoliosis brace using three-dimensional (3D) software.
    METHODS: Eight female patients with adolescent idiopathic scoliosis undergoing brace treatment at the Outpatient Department of the Liwan Hospital of the Third Affiliated Hospital of Guangzhou Medical University were included. The patient’s trunk was scanned by 3D scanner to establish a model. Simple processing in Artec studio and saving as the STL format was import into Geomagic for further processing, then the model was imported into Solidworks to operate virtual orthopedics after exactitude surface was finished and finally imported into the 3-matic, Magics for the geometry design of the brace.
    RESULTS AND CONCLUSION: (1) The preliminary design of the personalized night-time scoliosis brace was completed. (2) In summary, Geomagic, Solidworks and 3-matic software can be used to design the night-time brace conveniently and quickly on the computer, and lay a foundation for the 3D printing brace in the future.

    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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    Virtual design of trajectory of cervical crossing laminar screw
    Sun Yue-rong, Wang Tian-rui, Pan Rong-fang, Wang Yan, Ren Chong-min, Zhang Guo-qing, Chen Bo-hua, Yue Bin
    2018, 22 (27):  4332-4336.  doi: 10.3969/j.issn.2095-4344.0348
    Abstract ( 377 )   PDF (671KB) ( 200 )   Save

    BACKGROUND: Entry point and trajectory of C2 crossing laminar screw can affect its clinical effect and safety.

    OBJECTIVE: To explore the structural basis of application of C2 crossing laminar screw in China and the suitable entry point and trajectory using Mimics software through three-dimensional reconstruction, virtual design and measurement.
    METHODS: Totally 400 cases of cervical CT data were collected between February 2012 and July 2016 at the Affiliated Hospital of Qingdao University. Three-dimensional reconstruction and virtual entry point and trajectory of C2 crossing laminar screw (3.5 mm in diameter) were performed using Mimics 15.0. C2 morphology and screw trajectory were measured.
    RESULTS AND CONCLUSION: (1) There were significant differences in the height and thickness of the C2 laminae and spinous process between sexes (P < 0.05), which could support the application of C2 crossing laminar screw. (2) Zone 5.0–6.0 mm posterior to the spinal canal was recommended as a feasible entry point due to the maximum success rate (92.1% in men, 86.1% in women) and maximum safe angle range. (3) These results suggest that domestic adults have appropriate anatomical basis for C2 crossing laminar screw, and zone 5.0–6.0 mm posterior to the spinal canal was recommended as a feasible entry point.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Unilateral placement combined with short-segment five-screw fixation for unstable thoracolumbar fractures  
    Chang Bu-qing, Feng Hu, Yu Chao-jiang, Shan Hong-jian, Hu Meng-zi, Li Zi-ang, Bu Xiang-bo, Gao Xiao, Jiang Yun-chang
    2018, 22 (27):  4337-4341.  doi: 10.3969/j.issn.2095-4344.0349
    Abstract ( 330 )   PDF (637KB) ( 107 )   Save

    BACKGROUND: Thoracolumbar fractures are the most common spinal fractures. Young and middle-aged thoracolumbar fractures are mostly caused by violent force. Traditional long-segment fixation has been replaced by short-segment transcranial vertebral fixation, but short-segment fixation is easy to cause the loss of the height of the injured vertebra. The fixation method using five nails and three vertebral bodies has gradually become the main surgical method.

    OBJECTIVE: To investigate the surgical outcomes of posterior approach unilateral placement combined with short-segment five-screw fixation for unstable thoracolumbar fractures.          
    METHODS: Data of forty-three patients with single-segment thoracolumbar fractures undergoing posterior approach unilateral placement combined with short-segment five-screw fixation at the Affiliated Hospital of Xuzhou Medical University from January 2012 to December 2015, and followed up for more than 1 year were analyzed retrospectively. The Cobb angle and vertebral anterior height were measured according to the X-ray of the preoperative, postoperative and last follow-up. The ratio of vertebral anterior height was calculated. The fixation and dissection of the internal fixators were observed, the operation time and blood loss were recorded, and the Visual Analogue Scale scores were used to evaluate the preoperative and postoperative pain.
    RESULTS AND CONCLUSION: (1) All 43 patients underwent surgery successfully. The operation time was 60-125 minutes (80 minutes on average). The intraoperative blood loss was (50-400) mL (160 mL on average). (2) The preoperative vertebral body height ratio was significantly increased at postoperative 2 weeks and last follow-up compared with the baseline (t=10.15, 9.57, P < 0.05), and the ratio showed no significant difference between postoperative 2 weeks and last follow-up (t=0.42, P > 0.05). (3) Compared with the baseline, the Cobb angle at postoperative 2 weeks and last follow-up was significantly decreased (t=8.46, 7.81, P < 0.05). There was no significant difference in the Cobb angle between postoperative 2 weeks and last follow-up (t=0.93, P > 0.05). (4) The Visual Analogue Scale scores at postoperative 2 weeks were significantly lower than those at baseline (P < 0.05). (5) All patients had no complications such as fracture or prolapse of internal fixators. (6) In summary, unilateral placement combined with short-segment five-screw fixation for unstable thoracolumbar fractures can reduce the Cobb angle, and reconstruct the vertebral body height with few complications. The clinical outcomes are satisfactory.

    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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    Predictive factors of refractures located in adjacent vertebrae after bone cement augmentation
    Huang Tian-ji, Zhang Shi-yang, Lu Chao
    2018, 22 (27):  4342-4347.  doi: 10.3969/j.issn.2095-4344.0350
    Abstract ( 287 )   PDF (525KB) ( 123 )   Save

    BACKGROUND: Percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) are effective treatments for osteoporotic vertebral compression fractures (OVCF), but studies have suggested that augmented vertebrae may lead to refracture located in adjacent vertebrae.

    OBJECTIVE: To identify the characteristics and predictive factors of the adjacent and non-adjacent refractures after PKP and PVP. 
    METHODS: A retrospective analysis of 187 single-segment OVCF patients undergoing PKP or PVP was conducted. Clinical, imaging and surgical data were recorded and analyzed by chi-square, t test and Mann Whitney U test. The variants with P value < 0.2 were used for multiple logistic regression analysis. 
    RESULTS AND CONCLUSION: (1) Among 187 cases, 41 patients suffered refractures, and the total refracture rate was 21.9%. Twenty-three patients (56.1%) had refractures in the adjacent vertebrae, and 18 patients (43.9%) had refractures in the non-adjacent vertebrae. (2) The first fracture in thoracolumbar segment was the independent predictive factor for adjacent refratures in augmented vertebrae (P=0.017). Others (age, sex, height, body mass, presence or absence of diabetes mellitus, anti-osteoporosis treatment, history of fractures, cement leakage into interbody, cement diffusion, the bone cement volume injected, performed PKP or PVP, the percentage of anterior vertebral height restoration, the correction of the Cobb angle, bone mineral density, above or below of the refractured vertebrae compared to the augmented one) are not associated with the adjacent or non-adjacent refractures. 

    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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    Peek Prevail anterior cervical interbody fusion for herniation of cervical intervertebral disc: a 12-month follow-up
    Li Guo, He Yue, Gu Zu-chao, Zhang Yu, Liu Jin
    2018, 22 (27):  4348-4353.  doi: 10.3969/j.issn.2095-4344.0351
    Abstract ( 517 )   PDF (789KB) ( 201 )   Save

    BACKGROUND: Treatment outcomes of anterior cervical discectomy and fusion (ACDF) for cervical spondylosis are confirmed. The use of anterior plates increases fusion rates but may be associated with high rates of postoperative dysphagia and adjacent segment degeneration. A new Peek Prevail interbody device is designed to provide stability during spinal fusion.

    OBJECTIVE: To analyze the short-period clinical outcome of the Peek Prevail anterior cervical interbody fusion for cervical spondylosis.
    METHODS: From August 2014 to May 2015, 31 patients with cervical spondylosis implanted with Peek Prevail cervical interbody device in ACDF procedure were included. All patients underwent single-segmental fusion. The Visual Analogue Scale, Japanese Orthopaedic Association and neck disability index were assessed at baseline and postoperatively. The incidence of postoperative dysphagia was evaluated using Bazaz dysphagia index. The signal strength of the adjacent intervertebral disc and adjacent paraspinal muscle was measured on MRI, and signal-noise ratio was calculated to assess the degeneration of adjacent intervertebral disc at baseline and 1 year postoperatively. Cervical X-ray examination was regularly reviewed, the short-term efficacy was evaluated by observing the intervertebral space and cage loosening and subsidence.
    RESULTS AND CONCLUSION: (1) All 31 patients were followed up for 12-15 months. (2) The average operation time was (63.0±12.5) minutes and average intraoperative blood loss was (25.0+7.4) mL. There were three (mild in two and medium in one patient) patients complaining of dysphagia at 2 days post-operation. All the symptoms of three cases disappeared after symptomatic treatment within 2 weeks. (3) All patients had a satisfactory improvement of neurologic outcome. The Visual Analogue Scale scores were decreased from 8.2±1.5 preoperatively to 2.4±1.2 at 12 months postoperatively (P < 0.05). The Japanese Orthopaedic Association scores at baseline and postoperative 12 months were 9.5±2.2 and 16.7±1.1 (P < 0.05). The neck disability index was improved from 44.2±3.4 preoperatively to 11.3±1.0 at 12 months postoperatively (P < 0.05). The signal-noise ratio of adjacent intervertebral disc at baseline and 12 months postoperatively was 20.3±2.1 and 19.1±1.8 (P > 0.05). (4) There were no complications such as cage and screw loosening, shifting and subsidence. (5) The results suggest that the Peek Prevail interbody fusion system is reliable and efficient for herniation of cervical intervertebral disc. The incidence of postoperative dysphagia is low, cannot accelerate the degeneration of adjacent intervertebral discs and short-term clinical results are satisfactory.

    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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    Mechanical stability of different internal fixations for complex pelvic fractures by finite element analysis
    Wang Xu-jin, Fang Shi-yuan, Xu Lei, Yang Jia-zhao
    2018, 22 (27):  4354-4358.  doi: 10.3969/j.issn.2095-4344.0352
    Abstract ( 414 )   PDF (729KB) ( 156 )   Save

    BACKGROUND: Open reduction and internal fixation can be used for different types of pelvic fractures, which can reduce the incidence of complications. However, there is a lack of mechanical study on its fixation effect.

    OBJECTIVE: To investigate the mechanical stability of different kinds of internal fixations for complex pelvic fractures by finite element analysis.
    METHODS: One healthy man was selected. Two-dimensional CT data were obtained by 64-slice spiral CT scan. The data were obtained by medical digital imaging and stored by communication format. The finite element model of the pelvis was established using the software of Mimics, Geomagic studio and Abaqus, and the finite element model of the complex pelvic fracture was established. Three kinds of internal fixators were implanted to treat the pelvic fracture, and then 500 N vertical load was applied to the sacrum. The corresponding mechanical parameters were calculated, and the mechanical stability of different internal fixation methods was compared.
    RESULTS AND CONCLUSION: (1) The displacement of a point in the normal three-dimensional finite element model of pelvis was 0.53 mm, and the stress load was normal, the force displacement of the sacroiliac joint was similar to the previous finite element biomechanical analysis, suggesting that the finite element model was established successfully. (2) Under the vertical load of 500 N, the maximal stress of screw fixation was 440.85 MPa, which was concentrated on the fracture parts. The maximum stress of the reconstructed bone plate was 1 332.56 MPa, concentrating on the nail-plate connection. The maximum force of the outer stent was 1 834.85 MPa, concentrating on the nail-plate connection. (3) Under the vertical load of 500 N, the order of strain distribution, overall displacement, and separation displacement values was as follows: screw fixation < reconstructed bone plate < outer stent (all P < 0.05). (4) These results indicate that the screw fixation obtains the best stability for complex pelvic fractures compared with other methods through finite element analysis. In clinical practice of pelvic fractures, individualized treatment is 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
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    Mechanical stability of external fixator versus metacarpal plate for Rolando fracture by three-dimensional finite element analysis  
    Ai Deng-chao, Lu Yun
    2018, 22 (27):  4359-4363.  doi: 10.3969/j.issn.2095-4344.0353
    Abstract ( 365 )   PDF (682KB) ( 110 )   Save

    BACKGROUND: The incidence of Rolando fracture is high, and there is no unified theory for the selection of external fixation and internal fixation plate.

    OBJECTIVE: To compare the mechanical stability of the external fixator and metacarpal plate by establishing the three-dimensional (3D) finite element models, so as to provide a theoretical basis for the clinical treatment of Rolando fracture.
    METHODS: One healthy adult volunteer was selected, and the wrist joint was scanned by CT and MRI. The data were imported into Mmics 10.0, and the 3D model of the first and the second metacarpal and trapezium was established. All data were imported into Geomagic studio 10 for editing, and then transferred into ANSYS 12.0. Micro external fixator, the micro metacarpal bone plate model and Rolando fracture type in the clinical treatment principle of the two kinds of fixation methods were constructed. Each model was built following appropriate unit type, and then given 100 N of vertical load in the first metacarpal fracture distal, and the maximum displacement was detected.
    RESULTS AND CONCLUSION: (1) In the external fixation group, the relative displacement and total displacement of the maximum and minimum values of palm ulnar fracture end were 2.033, 0.201, 5.674, and 0.548 mm, were 2.537, 0.405, 4.479, 0.127 mm on the dorsolateral fracture end, respectively. In the plate group, the relative displacement and total displacement of the maximum and minimum values of palm ulnar fracture end were 0.385, 0.133, 0.595, 0.163 mm, were 0.278, 0.164, 0.501, 0.142 mm on the dorsal lateral fracture end, respectively. The differences were significant between two groups (P < 0.05). (2) To conclude, metacarpal plate is an ideal method for Rolando 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
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    Osteonecrosis of the femoral head after femoral neck fractures induced by biomechanical factors: testified by dog models of internal fixation for unilateral femoral neck fracture  
    Wang Hai-yang, Lin Yan-bin, Yu Guang-shu
    2018, 22 (27):  4364-4368.  doi: 10.3969/j.issn.2095-4344.0354
    Abstract ( 374 )   PDF (633KB) ( 153 )   Save

    BACKGROUND: Biomechanical factors play an important role in the pathogenesis of osteonecrosis of the femoral head (ONFH) after femoral neck fracture, but there is a lack of experimental evidence.

    OBJECTIVE: To explore the roles of biomechanical factors in the development of ONFH following femoral neck fracture.
    METHODS: Twelve healthy adult rural dogs received the vertical osteotomy at the middle femoral neck and screw fixation to establish the internal fixation model of unilateral femoral neck fracture. At 6 weeks after modeling, X-ray was performed to confirm the fracture healing of all animal models. The model dogs were randomized into blank control, combination (screw removal and bone grafting) and experimental (screw removal) groups (n=4 per group). Six weeks later, all dogs were executed, and the histological observation and the evaluation of bone histomorphometry were performed on the osseous tissue of the femoral neck Ward triangle.
    RESULTE AND CONCLUSION: (1) Histological observation showed that the bone trabecula in the blank control group was large and dense with continuous structure. In the combination group, the trabeculae were tremendous and tabular with dense distribution and continuous structure. In the experimental group, the bone trabecula was thin, sparse, disorganized and partially fractured. (2) The percent trabecular area and trabecular thickness were highest in the combination group, followed by blank control group, and lowest in the experimental group (P < 0.05). The order of trabecular separation was as follows: combination group < blank control group < experimental group (P < 0.05). The trabecular number in the combination group was significantly more than that in the experimental group (P < 0.05). Compared with the blank control group, the trabecular number in the combination and experimental groups showed no significant difference (both P > 0.05). (3) These results indicate that the decrease in biomechanical properties of femoral head after the femoral neck fracture healing can result in the changes of absorption and microfracture of the bone trabeculae, further induces collapse and necrosis of the femoral head.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Design of axial screw for lumbosacral vertebrae and the biomechanical analysis
    Zeng De-hui, Wang Wen-jun, Zhang Wei, Song Xi-zheng, Yang Wen-ren, Xiang Liang, Hou Wei
    2018, 22 (27):  4369-4374.  doi: 10.3969/j.issn.2095-4344.0325
    Abstract ( 287 )   PDF (666KB) ( 189 )   Save

    BACKGROUND: Percutaneous lumbar sacral anterior column internal fixation system (AxiaLIF) through anterior sacral approach has been applied in clinical practice in the United States and Europe and has achieved good clinical efficacy. However, there are some problems such as internal fixator subsidence, and poor in controlling rotation ability. 

    OBJECTIVE: The axial screw of lumbosacral vertebra was designed according to the anatomic data of lumbar lateral radiographs and CT cross-sectional measurements from Chinese healthy populations, and then three-dimensional movement and axial compression tests were conducted on biospecimens in vitro, and the stability of the fixed segment and the axial compressive stiffness were evaluated by biomechanical analysis.
    METHODS: Six fresh adult spine specimens (L3-S5 segments) were selected, then the biomechanical tests were performed sequentially in normal, isthmic fracture, conventional axial screw fixation, and self-designed axial screw fixation groups. The L5/S1 segment in each experimental group was measured under flexion, left flexion and left rotation, and axial compressive displacement was tested.
    RESULTS AND CONCLUSION: (1) In the three-dimensional movement experiment, the range of motion in the isthmic fracture group was significantly larger than that in the normal group in flexion and extension and left rotation (P < 0.05). There was no significant difference between isthmic fracture and normal groups in left bend direction (P > 0.05). (2) The range of motion in the conventional and self-designed axial screw fixation groups was significantly smaller than that in the normal group in flexion and extension and left lateral direction (P < 0.05), but the range of motion in left rotation direction showed no significant difference (P > 0.05). There was no significant difference in the range of motion between conventional and self-designed axial screw fixation groups (P > 0.05). (3) In the axial load compression test of 1 000 N, the order of compression displacement was as follows: self-designed axial screw fixation group < conventional axial screw fixation group < normal group < isthmic fracture group (P < 0.05). (4) According to the mechanical formula EF=P/vL and compression displacement results, the axial compressive stiffness values were calculated, which the highest value was in the self-designed axial screw fixation group, followed by conventional axial screw fixation group, normal group, and the lowest in the isthmic fracture group (P < 0.05). (5) These results indicate that the self-designed axial screw in all directions of motion can significantly improve the stability of the lumbosacral motion under posterior column instability, which is comparable to that of the common axial screws. But it is obviously better than common axial screw in axial compressive stiffness, which provides an effective solution for the prevention of segment subsidence and loss of lordosis in the fixation of the vertebral column with axial screws.
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    Biomechanical comparison of acetabular contact characteristics after acetabular transverse posterior wall fractures treated with three kinds of internal fixation  
    Lan He-jun, Zhao Zhen-wei, Jia Chun, Fu Jiu-yang
    2018, 22 (27):  4375-4379.  doi: 10.3969/j.issn.2095-4344.0238
    Abstract ( 242 )   PDF (747KB) ( 129 )   Save

    BACKGROUND: Acetabular transverse posterior wall fractures are a common type of complex acetabular fracture, and mainly treated by open reduction and internal fixation. The main internal fixation device includes posterior column reconstruction plate, posterior column reconstruction plate combined with anterior column lag

    screw and posterior wall screw, posterior column locking reconstruction plate combined with posterior wall semi cortical screw.
    OBJECTIVE: To measure and explore the stress characteristics of acetabular articular surface after acetabular transverse posterior wall fractures treated by three kinds of internal fixation methods by pressure-sensitive technique.
    METHODS: Totally 12 fresh adult pelvic specimens were divided into 3 groups (n=4) by random number table method according to different fixation methods. Group A: Acetabular posterior column reconstruction plate combined with anterior column tension screw fixation was performed; group B: acetabular posterior column reconstruction plate combined with anterior column tension screw and posterior wall tension screw fixation was conducted; group C: acetabular posterior column locking reconstruction plate fixation was carried out. The femoral head pressure sensitive tablets, which were prepared as “lancet”, were affixed to the femoral head and subjected to axial load test at single stand standing. The stress concentration area and peak stress of the acetabular articular surface were measured in each group.
    RESULTS AND CONCLUSION: When the load was 600 N, the stress concentration area of acetabular articular surface in group A was significantly smaller than that in groups B and C. The peak stress value of articular surface of group A was significantly higher than that of group B and group C. There was no significant difference in stress concentration area and peak stress between groups B and C (P > 0.05). These results indicated that during internal fixation for acetabular transverse posterior wall fractures, posterior column reconstructive plate combined with anterior column pull screw, posterior wall screw and locking reconstruction plate combined with posterior wall semi cortical screw can increase the contact area of the acetabular articular surface, and reduce the acetabular stress concentration after fixation. The biomechanical characteristics of posterior acetabular posterior column locking reconstruction plate in the treatment of acetabular transverse posterior wall fractures are identical to that of acetabular posterior column reconstruction plate combined with the anterior column tension screw and posterior wall tension screw fixation.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Biomechanical characteristics of the patients with functional ankle instability when landing on the slope
    Song Fa-ming, Wang Chun
    2018, 22 (27):  4380-4386.  doi: 10.3969/j.issn.2095-4344.0355
    Abstract ( 420 )   PDF (772KB) ( 181 )   Save

    BACKGROUND: Leaping maintains the correct arrangement and stability of joint by closed-loop (neural control after landing) and open loop control (neural control before landing). The stabilization mechanism of the ankle feedback is poor in functional ankle instability (FAI) patients. However, the characteristics of the nerve reaction in FAI patients are still unclear.

    OBJECTIVE: To explore the ankle joint kinematics of the FAI patients landing on the slope and the electromyographic activation of the relevant muscle, so as to reveal the nerve response mechanism of the FAI patients who cannot recover the proper posture through the muscles surrounding ankle joint.
    METHODS: Eleven unilateral FAI patients and 11 healthy female participants with similar age were recruited. The motion capture and surface electromyography test system were conducted synchronously. The kinematics and myoelectric parameters at 200 ms before and after landing on the slope were collected using relevant software, and statistical analysis was performed on SPSS 17.0 software.
    RESULTS AND CONCLUSION: (1) The activation of gastrocnemius of the affected side in the FAI patients before landing was significantly higher than that of the healthy side (P < 0.05), and there was no significant difference in the anterior tibial muscle, peroneus longus and soleus muscles between sides (P > 0.05). The average sagittal plane plantar flexion of the affected side was significantly higher than that of the healthy side (P < 0.05), and other angles were insigificantly different between sides (P > 0.05). (2) The activation of peroneus longus of the affected side in the FAI patients after landing was significantly lower than that of the healthy side (P < 0.05), and there was no significant difference in the anterior tibial muscle, gastrocnemius and soleus muscles between sides (P > 0.05). The kinematics parameters after landing showed no significant differences between sides (P > 0.05). (3) The activation of peroneus longus of the affected side in the FAI patients before landing was significantly higher than that of the two sides in healthy controls (P < 0.05), and there was no significant difference in the anterior tibial muscle, gastrocnemius and soleus muscles between groups (P > 0.05). The activation of the four muscles after landing showed no significant difference between two groups (P > 0.05). (4) The angles of the bilateral joints before and after landing did not differ significantly between two groups (P > 0.05). (5) In summary, neither open nor closed loop mechanism is conducive to the landing on the slope, and the difference is insignificant between FAI and healthy people. Therefore, the assessment protocol on motion control based on open-loop neural mechanism needs to be further studied and developed.

    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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    Arthroscopic single-tunnel single-bundle versus three-tunnel double-bundle grafts for anterior cruciate ligament reconstruction: stability and movement of the knee joint  
    Wang Xin-min, Liu Fei, Zhao Hai-xia, Wang Wei, Wang Jian-quan
    2018, 22 (27):  4387-4392.  doi: 10.3969/j.issn.2095-4344.0356
    Abstract ( 453 )   PDF (740KB) ( 155 )   Save

    BACKGROUND: Our group has designed the arthroscopic anterior cruciate ligament (ACL) reconstruction using Femoral-Intrafix system in order to restore the rotary stability of knee joint and function of ACL. But its clinical efficacy has not been confirmed.

    OBJECTIVE: To retrospectively evaluate the functional recovery of knee joint after reconstructed using single-tunnel single-bundle versus three-tunnel double-bundle with Femoral-Intrafix system.
    METHODS: Clinical data of 60 patients with ACL injury from June 2013 to June 2015 were analyzed retrospectively. Hamstring tendon autografts were used for all patients. Among them, 30 patients received single-tunnel single-bundle reconstruction, the Endobutton was performed at the femoral site and the Milagro interference screw was used for tibial tunnels (control group); another 30 patients adopted three-tunnel double-bundle reconstruction with Femoral-Intrafix system, the Femoral Intrafix System was used to fix the graft at the femoral site, and the Milagro interference screws were used for tibial tunnels (trial group). The perioperative indexes were recorded. The anterior drawer test, Lachman test, pivot shift test, Lysholm and International Knee Documentation Committee scores at baseline and last follow-up were detected to evaluate the functional recovery of ACL.
    RESULTS AND CONCLUSION: (1) All patients were followed up with an average of (25±4) and (28±3) months in the control and trial groups, respectively. (2) No patients had screw exfoliation, deep vein thrombosis, ligament rerupture or articular infection. (3) The range of motion of the knee joint was restored. The positive rates of anterior drawer test, Lachman test and pivot shift test in the two groups were significantly lower than those before reconstruction (P < 0.05), and the positive rates in the trial group were significantly lower than those in the control group (P < 0.05). (4) The Lysholm and International Knee Documentation Committee scores at last follow-up in the two groups were significantly improved compared with the baseline (P < 0.05), and the scores showed no significant differences between two groups (P > 0.05). (5) These results indicate that both of the two methods can obtain satisfactory short-term outcomes in anterior cruciate ligament reconstruction, and can improve the stability and movement of the knee joint. But the three-tunnel double-bundle with Femoral-Intrafix system can obtain better rotary stability of knee joint after reconstruction.

    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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    Changes in the flexion and extension muscle strength and motor function of the knee joint after anterior cruciate ligament reconstruction  
    Liu Zhi-cheng, Li Yan, Zhang Qi-liang
    2018, 22 (27):  4393-4399.  doi: 10.3969/j.issn.2095-4344.0279
    Abstract ( 367 )   PDF (744KB) ( 144 )   Save

    BACKGROUND: Although the effect of anterior cruciate ligament (ACL) reconstruction is good, the postoperative muscle strength is still absent and the motor function cannot be fully recovered.

    OBJECTIVE: To observe the muscle strength and functional performance of the affected limbs after ACL reconstruction using semitendonosus and gracilis as a autograft, so as to guide the rehabilitation of patients with ACL reconstruction.
    METHODS: Totally 150 patients with ACL injuries participated in this study. All patients underwent ACL reconstruction using semitendonosus and gracilis as an autograft and rehabilitation. Extension and flexion torques were measured for the injured and healthy limbs at postoperative 3, 6, 9 and 12 months, and the quadriceps strength symmetry index, hamstring/quadriceps ratio were measured. The single hop test, the 6-m timed hop test, crossover hop test and the side-to-side hop test were conducted at 6 and 12 months postoperatively. The changes of muscle strength and motor function with time were analyzed and evaluated.
    RESULTS AND CONCLUSION: (1) Of the 150 patients, only 118 patients completed all tests, and 32 patients (21.3 %) lost to follow up. (2) The average quadriceps strength of the affected side at 3, 6, 9, and 12 months postoperatively was (64.01±4.45)%, (77.97±5.04)%, (84.25±5.14)% and (86.98±5.28)% of the healthy side, respectively. The average hamstring strength of the affected side at 3, 6, 9, and 12 months postoperatively was (81.58±3.12)%, (91.06±3.72)%, (96.48±3.87)% and (97.59±3.77)% of the healthy side, respectively. Repeated measurement test confirmed that the flexor/extensor strength gradually recovered with time (F=27.23, P=0.00). (3) Muscle strength recovered quickly between 3 and 6 months (P < 0.05). The quadriceps strength of involved limb was still significantly lower than the uninvolved limb after 12 months (P < 0.05). The hamstring muscle was not significantly different from the uninvolved limb after 12 months (P > 0.05). (4) At 3, 6, 9 and 12 months postoperatively, hamstring/quadriceps ratios were significantly higher than the healthy limb (P < 0.05). (5) At 6 months postoperatively, results of the single hop test, crossover hop test, the side-to-side hop test and the 6-m timed hop test were lower than 90% of the healthy limb. At 12 months postoperatively, results of the single hop test and the 6-m timed hop test were higher than 90% of the healthy limb, but crossover hop test and the side-to-side hop test were still lower than 90% of the healthy limb. (6) These results manifest that the best period for the restoration of flexion and extension strength is 3-6 months postoperatively. The extensor muscle strength, hamstring/ quadriceps strength ratios and sport ability of the patients are not completely restored to normal at 12 months postoperatively.

    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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    Interaction effect of spino-pelvic parameters and progress of L5 isthmic spondylolisthesis
    Long Fa-yu, Chen Yao-wu, Zhong Zhao-ming, Wu Qian, Zheng Shuai, Chen Jian-ting
    2018, 22 (27):  4400-4404.  doi: 10.3969/j.issn.2095-4344.0357
    Abstract ( 365 )   PDF (620KB) ( 141 )   Save

    BACKGROUND: Progress of L5 isthmic spondylolisthesis determined based on the spino-pelvic sagittal parameters has been drawn much attention, but has not been confirmed. Their interactions have not been summarized.

    OBJECTIVE: To investigate the correlations of spino-pelvic parameters and degeneration of L5/S1 intervertebral disc with spondylolisthesis rate in L5 isthmic spondylolisthesis, and to explore the interaction between spino-pelvic parameters and progress of spondylolisthesis.
    METHODS: Eighty-three patients with L5 isthmic spondylolisthesis from September 2013 to September 2017 were included. All the patients aged from 21 to 79 years, body mass was from 43 to 91 kg, including 30 males and 53 females. The lumbar lordosis (LL), pelvic incidence (PI) and spondylolisthesis rate were measured on the lateral lumbar X-ray, and the patients were then assigned based on these indexes. L5/S1 intervertebral disc degeneration was measured on lumbar sagittal MRI using the modified Pfirrmann grading system.
    RESULTS AND CONCLUSION: (1) Grouped by PI, the degeneration of disc and LL were the severest in the PI > 60° group, followed by normal (PI: 45°-60°) group, and the lowest in the PI < 45° group. The spondylolisthesis rate in the PI > 60° group was significantly higher than that in the PI < 45° group. (2) Grouped by degeneration of disc, highly severe group had significantly greater spondylolisthesis rate than that in the low severe group and mild-moderate groups, and the low severe group had significantly greater spondylolisthesis rate than that in the mild-moderate group. LL in the highly severe group was significantly greater than that in the low severe and mild-moderate groups, and there was no significant difference between low severe and mild-moderate groups. (3) As for LL, there was no significant difference between group with < 25% spondylolisthesis rate and group with 25%-50% spondylolisthesis rate. (4) Spino-pelvic parameters interact with progress of L5 isthmic spondylolisthesis. PI is closely related to lumbar morphology, degeneration of L5/S1 disc and progress of spondylolisthesis. Degeneration of L5/S1 disc probably affects lumbar morphology and progress of spondylolisthesis. Mild and moderate spondylolisthesis cannot change the LL probably. Clinically surgeons should pay more attention on patients with great PI.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Imaging types of double-column die-punch fracture of the distal radius: fracture classification and mechanical mechanism  
    Xi Bin, Yang Ying, Li Dong-cheng, Ding Yan-ping, Yin Qu-dong
    2018, 22 (27):  4405-4409.  doi: 10.3969/j.issn.2095-4344.0358
    Abstract ( 649 )   PDF (644KB) ( 441 )   Save

    BACKGROUND: According to the three-column theory, there are single-column and double-column die-punch fractures of the distal radius. The single-column die-punch fracture has been reported, but there is a lack of study on double-column die-punch fracture.

    OBJECTIVE: To explore the characteristics and imaging types of double-column die-punch fracture of the distal radius as well as the value of the new classification.
    METHODS: A retrospective analysis of imaging data was made in 498 cases of double-column die-punch fracture of the distal radius between June 2007 and June 2017. According to the imaging characteristics of the fracture, the patients were divided into types of metaphysis, articular surface and mixed. Two radiologists were chosen and independently typed the fractures in 100 cases of double-column die-punch fracture of the distal radius, and agreement was analyzed with Kappa statistics.
    RESULTS AND CONCLUSION: (1) In 498 cases of double-column die-punch fracture of the distal radius, type of metaphysis was found in 130 cases, type of articular surface in 156 cases and mixed type in 212 cases, and all were categorized. (2) The inter-observer Kappa coefficient was 0.823-0.868 and the intra-observer Kappa coefficient was 0.868-0.900, showing high consistency. (3) According to AO classification of fracture, the type of articular surface belonged to type B or type C, type of metaphysis and the mixed type belonged to type C. (4) These results suggest that the new imaging typing of double-column die-punch fracture of the distal radius well reflects the mechanical characteristics and fracture site, meets the principle of AO classification, has high consistency and provides reference for clinical treatment and prognosis judgment.

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
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    Fat embolism after arthroplasty
    Li Teng-qi, Sun Wei, Wang Yun-ting
    2018, 22 (27):  4410-4416.  doi: 10.3969/j.issn.2095-4344.0359
    Abstract ( 365 )   PDF (743KB) ( 205 )   Save

    BACKGROUND: For the etiology, pathogenesis, clinical manifestations, diagnosis, treatment and prevention of fat embolism after arthroplasty, scholars have put forward various theories and performed a large number of experiments. However, there is still no criteria and guidance about its diagnosis and treatment.

    OBJECTIVE: To review the diagnosis and treatment of fat embolism, thus providing clues for the studies on fat embolism.
    METHODS:PubMed database was retrieved for the literature published from 2010 to 2017 with the keywords of “fat embolism, fat embolism syndrome, total hip arthroplasty, total knee arthroplasty, joint replacement”. Finally, 38 eligible articles were included for retrospective analysis.
    RESULTS AND CONCLUSION: (1) Lipid droplet formation is caused by a variety of factors, and when it appears in circulatory system, fat embolism syndrome occurs. The pathogenesis still remains unclear; and mechanical theory and chemical theories are acceptable. The manifestations of fat embolism syndrome are non-specific, from asymptomatic to sudden death, which makes its diagnosis difficult and there are no unified diagnostic criteria. (2) Physical examinations such as X-ray, CT, ultrasound, and MRI have their own merits. Until now the treatments are mainly anti-inflammatory, anticoagulant, thrombolysis cardiotonic and other supportive treatments. (3) Given this, prevention is critical, and intramedullary depressurization, intramedullary canal irrigation and glucocorticoid may be the newest direction.

    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 printing technology applied in knee diseases: prosthesis matching and surgical planning  
    Huang You-yi, Yuan Wei
    2018, 22 (27):  4417-4422.  doi: 10.3969/j.issn.2095-4344.0360
    Abstract ( 382 )   PDF (719KB) ( 154 )   Save

    BACKGROUND: Three-dimensional (3D) printing, as a new technology, has been extensively applied in bones, especially the surgeries of knee diseases. 3D printing significantly improves the disease diagnosis accuracy, success rate of surgery and patients’ satisfaction.

    OBJECTIVE: To summarize the clinical outcomes and problems of 3D printing in the treatment of knee diseases.
    METHODS: CNKI and PubMed databases were retrieved with the keywords of “3D printing, distal femur fracture, fracture of tibial plateau, knee osteoarthritis, knee tumor, joint replacement” in English and Chinese, respectively, for the articles published from July 1999 to July 2018. Totally 167 articles were searched, and finally 57 eligible articles were enrolled for review in accordance with the inclusion and exclusion criteria.
    RESULTS AND CONCLUSION: 3D printing combined with CT and MRI can copy any complex structures and a fully matched prosthesis. Its application in the arthroplasty of distal femoral fracture, tibial plateau fractures, knee osteoarthritis, bone tumors has remarkably improved the postoperative patients’ satisfaction and
    reduced the postoperative complications. It plays an important role in helping the communication between doctors and patients, increasing the diagnosis accuracy, preoperative planning and individualized 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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    Screw fixation versus plate fixation for posterior malleolus fracture: a meta-analysis  
    Chai Hao, Wu Ting, Shu Li, Zhang Lei
    2018, 22 (27):  4423-4428.  doi: 10.3969/j.issn.2095-4344.0361
    Abstract ( 361 )   PDF (1385KB) ( 136 )   Save

    BACKGROUND: It is still controversial about which is the best internal fixation method for posterior malleolus fracture. Some scholars believe that plate fixation shows satisfactory efficacy than screw fixation. But other scholars insist screw fixation for posterior malleolus fracture.

    OBJECTIVE: To compare the efficacy and safety of posterior malleolus fracture with screw fixation and plate fixation through a meta-analysis.
    METHODS: A computer-based online search was conducted in Medline, Embase, PubMed, Embase, CNKI, VIP and WanFang databases by using the keywords of “posterior malleolus AND fracture AND Screw AND Plate AND RCT OR quasi-RCT OR CCT” in English and Chinese, respectively to screen the relevant literature published from January 1995 to December 2017. A meta-analysis was performed using Revman 5.3 software provided by Cochrane Collaboration.
    RESULTS AND CONCLUSION: (1) Nine trials were included. (2) The meta-analysis results showed that there were no significant differences in the American Orthopaedic Foot & Ankle Society scores (OR=-2.23, 95%CI (-4.95, 0.94), P=0.11) and the incidence of arthritis (OR=0.11, 95%CI (-0.06, 0.28), P=0.21) between two groups at 12 months postoperatively. (3) The fracture healing time (OR=0.36, 95%CI (0.14, 0.58), P=0.001) and malreduction (OR=0.07, 95%CI (0.03, 0.11), P=0.000 3) in plate fixation were superior to screw fixation. (4) The operation time (OR=-14.97, 95%CI (-29.09, -0.84), P=0.04), and intraoperative blood loss (OR=-0.52, 95%CI (-0.84, -0.20), P=0.001) in screw fixation were less than those in plate fixation. (5) These results show that plate fixation exhibits superiority in the fracture healing time and the incidence of malreduction in the treatment of posterior malleolus fracture. The screw fixation is minimally invasive. Because part of the literature is not high-quality randomized controlled trails, bias may exist, and more high-quality randomized controlled trials are required.

    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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