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08 February 2019, Volume 23 Issue 4 Previous Issue    Next Issue

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Intraoperative and postoperative blood loss and levels of C-reactive protein and interleukin-6 after local application of tranexamic acid in total hip arthroplasty Zhao Hongshun, A Jiancuo, Gao Shunhong, Li Yonggang, Guo Liping 2019, 23 (4):  493-498.  doi: 10.3969/j.issn.2095-4344.1028 Abstract ( 408 )   PDF (1329KB) ( 116 )   Save BACKGROUND: There are many studies addressing the effect of intravenous injection of tranexamic acid before total hip arthroplasty on the dominant and hidden blood loss. But its effects on the levels of interleukin-6 and C-reactive protein are rarely reported.  OBJECTIVE: To investigate the effects of local application of tranexamic acid on the blood loss and levels of interleukin-6 and C-reactive protein in the perioperative period of total hip arthroplasty. METHODS: Seventy-five patients undergoing primary unilateral total hip arthroplasty at Qinghai Red Cross Hospital from January 2015 to January 2017 were enrolled. The patients were randomized into treatment group (n=37, intravenous injection of tranexamic acid after prosthesis placed) and control group (n=38, intravenous injection of the same volume of normal saline). The intraoperative blood loss, postoperative drainage volume, total blood loss, hidden blood loss, blood transfusion volume and transfusion rate were compared between two groups. The hemoglobin, hematocrit, the levels of C-reactive protein and interleukin-6 at baseline and different time points postoperatively were measured. The complications like fever or lower extremity venous thrombosis were recorded. RESULTS AND CONCLUSION: (1) The postoperative drainage volume, total blood loss, hidden blood loss, postoperative blood transfusion volume and blood transfusion rate in the treatment group were significantly lower than those in the control group (P < 0.05). (2) The hemoglobin and hematocrit in the treatment group were significantly higher than those in the control group at 3 hours, 1, 3 and 7 days postoperatively (P < 0.05). (3) At postoperative 3 hours, 1 and 3 days, the levels of C-reactive protein and interleukin-6 were gradually increased in both groups, especially the control group (P < 0.05). (4) No fever, infection, or deep venous thrombosis of the lower extremities was observed in both groups. (5) To conclude, intravenous injection of tranexamic acid can reduce the blood loss after total hip arthroplasty safely and effectively, and also can reduce the levels of C-reactive protein and interleukin-6. 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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Anticoagulant effect of low-molecular-weight heparin versus rivaroxaban after arthroplasty assessed by thromboelastography   Jian Changchun, Chen Yu, Chen Cheng, Hu Ning, Huang Wei 2019, 23 (4):  499-504.  doi: 10.3969/j.issn.2095-4344.1029 Abstract ( 476 )   PDF (1298KB) ( 101 )   Save BACKGROUND: Low-molecular-weight heparin and rivaroxaban are commonly used anticoagulant drugs after hip and knee arthroplasties. Low-molecular-weight heparin may cause decrease in platelets, and rivaroxaban has been shown to make no effect on platelets. Both of them have been shown to decrease the incidence of deep venous thrombosis, while these choices in clinic still remain controversial. OBJECTIVE: To evaluate the coagulation function of patients undergoing hip or knee arthroplasty after anticoagulation using low-molecular-weight heparin or rivaroxaban by thromboelastograph, and to analyze the differences in anticoagulant effect and platelet count between two drugs. METHODS: A prospective study was conducted, including 397 patients undergoing unilateral knee or hip arthroplasty at the Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University from 2014 to 2017. The patients were randomly divided into two groups, 195 patients in the low-molecular-weight heparin group received subcutaneous injection of low molecular weight heparin (4 000 IU) at 12 hours postoperatively. 202 patients in the rivaroxaban group received 10 mg of rivaroxaban orally at 12 hours postoperatively. Thromboelastograph and platelet count were performed at baseline, 1, 3, 5 and 7 days postoperatively. The differences of proportion of hypercoagulability and platelet count were compared between two groups at different time points, and the reason was analyzed. RESULTS AND CONCLUSION: (1) In the low-molecular-weight heparin group, the proportion of patients with hypercoagulability increased gradually from 1 to 7 days after surgery, which reached to 93.1% on day 7. In the rivaroxaban group, the proportion of patients with hypercoagulability on day 3 was lower than that on day 1 after surgery, and the proportion of hypercoagulability increased gradually during the 3-7 days, which reached to 75.3% on day 7. There was significant difference in the proportion of hypercoagulability between two groups (P < 0.05). (2) The average platelet count in both groups decreased slightly than that at baseline. However, the average platelet count increased during 3-7 days after surgery, and the count on day 7 was significantly higher than the baseline level. The average platelet count in the rivaroxaban group was significantly higher than that in the low-molecular-weight heparin group (P < 0.05). (3) Thromboelastograph results indicate that the anticoagulant effect of rivaroxaban is better than that of low-molecular-weight heparin after hip and knee arthroplasties, and the latter may inhibit the reactivity of platelet counts after 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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Spinal stability of intervertebral grafting reinforced by five or six augmenting screws versus transvertebral grafting reinforced by four augmenting screws for thoracolumbar vertebral fractures Zhou Yu, Liu Yuehong, Liu Shuping, Chen Xi, Qin Wei, Li Qifeng 2019, 23 (4):  505-511.  doi: 10.3969/j.issn.2095-4344.1030 Abstract ( 399 )   PDF (1350KB) ( 81 )   Save BACKGROUND: Lost of reduction and broken nails usually occur following traditional transvertebral fixation. Intervertebral pedicle fixation can obtain satisfactory curative effectiveness, but its medium- and long-term outcomes still need to be testified by abundant clinical trials. OBJECTIVE: To compare the stability between intervertebral grafting reinforced by five or six augmenting screws and transvertebral grafting reinforced by four augmenting screws in the treatment of single-segment thoracolumbar fractures. METHODS: Fifty-six patients with single-segment thoracolumbar fractures were divided into intervertebral fixation group (n=29, intervertebral grafting reinforced by five or six augmenting screws) and transvertebral fixation group (n=27, transvertebral grafting reinforced by four augmenting screws). The operation time, intraoperative blood loss, hospitalization time, anterior vertebral height, Cobb angle, pain degree and daily life function were compared between two groups. RESULTS AND CONCLUSION: (1) All patients were followed up for more than 3 years. (2) The operation time in the intervertebral fixation group was significantly longer than that in the transvertebral fixation group (P < 0.05). (3) The anterior vertebral height and kyphosis at 1 week, 3 months and last follow-up were significantly improved compared with the baseline. The degree of vertebral compression and loss of sagittal Cobb angle in the intervertebral fixation group were significantly superior to those in the transvertebral fixation group at the last follow-up (P < 0.05). (4) The symptoms of low back pain and daily living function in the two groups were significantly relieved after surgery. The Visual Analogue Scale and Oswestry Disability Index scores in the intervertebral fixation group were significantly better than those in the transvertebral fixation group at the last follow-up (P < 0.05). (5) During follow-up, no nerve root injury, or rod loosening, broking or dropping occurred. Only one case in the transvertebral fixation group suffered from adjacent vertebral fracture. (6) Our findings indicate that both the fixation methods can well restore the height of the injured vertebra and the Cobb angle, but intervertebral fixation can effectively reconstruct the spinal physiological sequence and restore its stability.  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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Multiple posterior lumbar interbody fusion and posterolateral fusion instrumentation for thoracolumbar kyphosis and osteoporotic fracture in older adults   Li Qingsong, Liu Shaoyu, Yin Zongsheng 2019, 23 (4):  512-517.  doi: 10.3969/j.issn.2095-4344.1031 Abstract ( 413 )   PDF (1398KB) ( 108 )   Save BACKGROUND: With aged trend of population in China becoming severe, the incidence of osteoporosis fracture with thoracolumbar kyphosis is increasing. Whether osteotomy is required or not still remains a controversy. OBJECTIVE: To evaluate the clinical efficacy and improvement in sagittal vertical axis after multiple posterior lumber interbody fusion and posterolateral fusion instrumentation for patients with osteoporotic fracture with thoracolumbar kyphosis. METHODS: Totally 90 cases of senile osteoporosis were included in the retrospective study. Operation group included 40 patients suffering osteoporosis and thoracolumbar kyphosis who underwent anti-osteoporosis treatment and multilevel posterior lumbar interbody fusion and posterolateral fusion instrumentation. Control group included 50 patients with osteoporotic without kyphosis. The Oswestry Disability Index and Visual Analogue Scale scores were compared between two groups after follow-up. Spinoplevic parameters, such as thoracic kyphosis angle, lumbar lordosis angle, sagittal vertical axis, pelvic title and pelvic incidence were compared to evaluate the improvement in the sagittal vertical axis. The quality of life was evaluated with the Japanese Osteoporosis Quality of Life Questionnaire scores. RESULTS AND CONCLUSION: (1) The Visual Analogue Scale and Oswestry Disability Index scores in the operation group were improved significantly compared the baseline. (2) The postoperative thoracic kyphosis angle, sagittal vertical axis, and pelvic title in the operation group were significantly improved compared with the baseline. (3) The postoperative posture, figure scores, and fear and physiological scores in the operation group were significantly improved compared with the baseline, but lower than those in the control group (P < 0.05). There were no significant differences in the pain and health scores between two groups postoperatively (P > 0.05). (4) These results indicate that spinal alignment and quality of life are significantly improved after corrective spinal surgery using multilevel posterior lumber interbody fusion and posterolateral fusion for patients with osteoporosis and thoracolumbar kyphosis.  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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Mini-plate, Herbert screw and absorbable rod in the internal fixation of Mason type II radial head fractures Dong Haichao, Xu Xin, Li Peinan, Chen Changjian, Zheng Lianjie 2019, 23 (4):  518-524.  doi: 10.3969/j.issn.2095-4344.1032 Abstract ( 511 )   PDF (1350KB) ( 103 )   Save BACKGROUND: Absorbable material is a new type of internal fixation material in orthopedics, and its application is still a controversy in the clinic. Absorbable materials can degrade by themselves, and can avoid secondary trauma surgery, which exhibit a significant advantage in the treatment of Mason type II radial head fracture. OBJECTIVE: To explore the short- and long-term effects of the internal fixation using mini-plate, Herbert screw and absorbable rod in the treatment of Mason type II radial head fracture, and to provide guidance for clinical treatment. METHODS: The clinical data of 93 patients with Mason type II radial head fractures admitted at Department of Joint Surgery, the Second Hospital of Dalian Medical University from March 2010 to February 2016 were collected. All patients received incision and internal fixation surgery using mini-plate (21 cases), Herbert screw (39 cases) and absorbable rod (30 cases). The operative indexes (operation time, intraoperative blood loss), fracture healing time and treatment cost were compared. Visual Analogue Scale and Broderg-Morrey elbow function scores were recorded. The complications were evaluated. RESULTS AND CONCLUSION: (1) Ninety patients were followed up for 2.2-8.2 years, with an average of 5.1 years. There was no significant difference in the operation time, intraoperative blood loss or fracture healing time among groups (P > 0.05). (2) The Broderg-Morrey scores postoperatively in each group were gradually increased with time (P < 0.05), and the excellent and good rate of scores showed no significant difference among groups (P > 0.05). (3) The postoperative Visual Analogue Scale scores in each group were gradually decreased with time (P < 0.05). The scores in the absorbable rob group at 3 days, 1 and 2 weeks postoperatively were significantly lower than those in the other two groups (P < 0.05). (4) There was no significant difference in the adverse reaction rate among groups (P > 0.05). (5) The treatment costs in the mini-plate and Herbert screw groups were significantly higher than those in the absorbable rod group (P < 0.05). (6) Our findings suggest that absorbable rod for the repair of Mason type II radial head fracture has the similar effect with traditional mini-plate and Herbert screw, but it can effectively alleviate pain and reduce adverse reactions and treatment costs.  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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Significance of preserving anterior cruciate ligament stump for the stability of knee joint   Feng Xinyuan, Bai Lunhao 2019, 23 (4):  525-531.  doi: 10.3969/j.issn.2095-4344.1033 Abstract ( 530 )   PDF (1243KB) ( 119 )   Save BACKGROUND: Anterior cruciate ligament preservation reconstruction has been introduced to improve clinical outcomes and biotherapy. However, the effect of stump preservation and injury influence, its impact on reconstruction, and the efficacy of this technique remain uncertain. OBJECTIVE: To investigate the effect of arthroscopic anterior cruciate ligament reconstruction on the recovery of proprioception in patients with anterior cruciate ligament injury by preserving ligament stump. METHODS:A retrospective analysis of 80 patients with anterior cruciate ligament injury admitted at the Department of Sports Medicine in Shengjing Hospital of China Medical University between January 2016 and March 2017 was performed. All patients underwent arthroscopic reconstruction of anterior cruciate ligament with autologous parasagittal tendon as a graft, including 40 cases of preserving-remnant, and 40 cases of removing-remnant. All patients were followed up for more than 12 months to evaluate the knee joint function and recovery of proprioception. RESULTS AND CONCLUSION: (1) The postoperative Lysholm and International Knee Documentation Committee scores were significantly improved in both groups, and the postoperative forward movement of the tibia, threshold to detection of passive activity, passive angle reproduction were all significantly reduced compared with the baseline (P < 0.05). (2) In the preserving-remnant group, the Lysholm and International Knee Documentation Committee scores at postoperative 3 months were significantly higher than those in the removing-remnant group, and threshold to detection of passive activity, and passive angle reproduction were lower than those in the removing-remnant group (P < 0.05). (3) There were no significant differences in the forward movement of the tibia by Kneelax system and plantar pressure at 3 and 12 months postoperatively between two groups (P > 0.05). (4) In summary, preserving-remnant in arthroscopic anterior cruciate ligament reconstruction can improve the early recovery of proprioception, and obtain satisfactory clinical efficacy.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Efficacy of arthroscopic surgery for discoid lateral meniscus injury in knee joint: a single-center, self-control trial Mai Jianjun, Xu Bin, Tu Jun, Wu Lei 2019, 23 (4):  532-537.  doi: 10.3969/j.issn.2095-4344.1034 Abstract ( 421 )   PDF (1240KB) ( 122 )   Save BACKGROUND: Discoid meniscus injury is a rare form of abnormal meniscus morphology with unknown pathogenesis. The complete disc-shaped meniscus is more prone than incomplete disc-shaped meniscus to tearing and adverse reactions such as joint degeneration and osteochondritis. Moreover, its clinical efficacy is not satisfactory. Arthroscopic meniscus surgery can enhance the stability of the meniscus and provide sufficient cushioning pressure to prevent recurrent meniscal tears. OBJECTIVE: To investigate the efficacy of arthroscopic surgery for discoid meniscus injury in knee joint and analyze risk factors that influence the efficacy of arthroscopic surgery.  METHODS:This single-center, self-control study, will include 196 patients with discoid meniscus injury who will receive arthroscopic meniscus repair (Stryker) from December 2018 to December 2019 at the Department of Sports Trauma and Arthroscopy, First Affiliated Hospital of Anhui Medical University of China. This surgical procedure will include meniscus plasty and subtotal meniscectomy. After surgery, all included patients will be followed up for 6–18 months. Surgical efficacy will be evaluated by Lysholm score. Patients will be divided into an excellent-and-good group (Lysholm score ≥ 85) and a poor group (Lysholm score < 85). This study was approved by the Medical Ethics Committee, First Affiliated Hospital of Anhui Medical University (approval No. PJ2018-02-03) on February 5, 2018. The version of the study protocol is 1.0. Patients and their family members will volunteer to participate in this study. Written informed consent will be obtained from each patient. RESULTS AND CONCLUSION: The primary outcome measure of this study is the change in excellent-and-good rate of Lysholm score that reflects knee joint function measured at the last follow-up in patients undergoing arthroscopic meniscus surgery. Secondary outcome measures are Lysholm score; Outerbridge grade of chondral lesion; knee joint morphology by magnetic resonance images before surgery and at the last follow-up; age, sex, lesion region, and course of disease before surgery; and incidence of adverse reactions at the last follow-up. Clinical data from 115 patients with discoid meniscus injury (115 knees) who received treatment from April 2015 to September 2016 were retrospectively analyzed. (1) Six to eighteen months of follow-up of 115 patients revealed a significant difference in Lysholm scores before surgery (65.8±9.39) and at the last follow-up (89.15±7.45; P < 0.05). Postoperative Lysholm scores were excellent in 32 patients, good in 61 patients, fair in 18 patients, and poor in 4 patients, with an excellent-and-good rate of 80.9%. There were 93 excellent and good patients and 22 unsatisfied patients. (2) Knee joint infection did not occur in any patient. There were four patients with lateral interstitial pain and two patients with lateral instability of the knee joint. (3) Logistic regression analysis revealed that course of disease, age, and Outerbridge grade of chondral lesion were risk factors that influenced the efficacy of arthroscopic meniscus surgery. Results from this study hope to confirm that arthroscopic surgery for discoid meniscus injury is a definitive treatment technique. Patient age and the degree of chondral lesion are closely related with efficacy, so it is recommended that patients with symptomatic discoid meniscus injury undergo surgery as soon as possible. This trial had been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800019182) on October 30, 2018. 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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Stress-strain relations of single-level vertebrae compression fracture in rabbits Li Zhou, Han Shibing, Zhang Yuwen, Guo Yuan, Zhang Xushu 2019, 23 (4):  538-544.  doi: 10.3969/j.issn.2095-4344.1035 Abstract ( 399 )   PDF (5058KB) ( 97 )   Save BACKGROUND: Spine is the central axis of the body, and has complex structure and versatile functions. Spinal injury will not only affect the sensory and movement systems, but may even result in life-long disability or life-threatening injuries. OBJECTIVE: To analyze the stress-strain relations of the rabbit vertebrae obtained by uniaxial compression, and to explore the effects of rabbit age, body weight, and vertebral body type on the vertebral load, stress, and strain in order to provide biomechanical guidance to spinal compression fractures. METHODS: Axial and lateral compression experiments of the vertebral body were performed through a material properties tester, strain gauges were attached to the ventral middle part of the vertebral bodies, and the data such as the load of the tester and the strain were recorded. The sectional area of vertebrae was obtained by CT scanning for rabbit spine. RESULTS AND CONCLUSION: (1) The rabbit age had a significant effect on the ultimate load, and with age increasing, the ultimate load of most of vertebrae could bear was increased. (2) The vertebral body at the turning point of spine physiological bending was liable to fracture or damage. (3) Our results can be employed to validate the finite element analysis model of rabbit vertebral compression.  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 function of calcified cartilage zone based on finite element analysis Chen Kaining, Ye Qing, Nong Mingshan, Luo Liuning, Yang Xing, Chen Cheng, Wang Fuyou 2019, 23 (4):  545-550.  doi: 10.3969/j.issn.2095-4344.0571 Abstract ( 399 )   PDF (4304KB) ( 104 )   Save BACKGROUND: Calcified cartilage zone is important for the stable connection between soft hyaline cartilage and hard subchondral bone. But the biomechanical role of calcified cartilage zone played in this process is poorly understood. OBJECTIVE: To explore the biomechanical role of calcified cartilage zone using finite element analysis. METHODS: Human normal femoral condyle specimen from a volunteer was obtained. According to the principle of bionics, a three-dimensional finite element model of osteochondral tissue was created with three compositions: hyaline cartilage, calcified cartilage zone and subchondral bone. The compression load (0.5-3.0 MPa) and shear load (0.1-0.5 MPa) were applied to the model respectively in order to analyze the stress distributions of three compositions. RESULTS AND CONCLUSION: Under compression load and shear load, the maximum stress of hyaline cartilage was 0.15-0.86 MPa and 0.58-0.74 MPa, respectively. The maximum stress of calcified cartilage zone was 0.33-1.91 MPa and 1.27-1.62 MPa, respectively. The maximum stress of subchondral bone was 0.55-3.22 MPa and 2.36-2.98 MPa, respectively. Finite element analysis reveals the biomechanical role of calcified cartilage zone through the feature of its stress distribution. It mediates the load transfer from hyaline cartilage to subchondral bone in a stepwise-increase way, so that the load can transfer smoothly in three compositions of osteochondral tissue.  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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Numerical simulation of bifurcating blood vessel flow under overload Bao Mixia, Zhou Ping, Guo Feng, Wang Jia 2019, 23 (4):  551-555.  doi: 10.3969/j.issn.2095-4344.0573 Abstract ( 518 )   PDF (1171KB) ( 116 )   Save BACKGROUND: Human body has a certain tolerance limit to overload, so load beyond certain strength will cause damage to the human body. The effect of overload on the flow of blood vessels is an important medical topic in manned space. OBJECTIVE: To study the flow patterns of pulsating blood vessels under unconventionally gravity load in a typical three-dimensional model of cervical artery. METHODS: Based on normal pulse cycle, we considered 0.85 seconds as pulsating blood supply cycle. The blood flow ratio of main vessels and branch vessels was 7:3. Based on Fluent software, the effects of gravity overload on the flow characteristics of typical blood vessels were analyzed by adding gravity load (1 G of overload at direction of X+; 2 G of overload at direction of Y+) to the momentum source of the control equation. RESULTS AND CONCLUSION: The changes of transient flow field structure and shear stress of wall under gravity overload were obtained. Because of the influence of Y+ direction of overload, the bifurcating vessels had obvious difference in velocity distribution, size of reflux region and shear stress distribution at different time. Under the effect of overweight load, the blood flow in the main blood vessel decreased and serious reflux occurred. The shear stress on the wall of the branching blood vessel was obviously higher than that on the main blood vessel. 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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Gait characteristics of youth with chronic non-specific low back pain: spatio-temporal and kinetic parameters Chen Xiaolan, Wang Lin, Liang Xiaotian, Li Yu1, Liu Haitao, Wang Bo, He Hui, Liu Chunyu 2019, 23 (4):  556-561.  doi: 10.3969/j.issn.2095-4344.1036 Abstract ( 397 )   PDF (1208KB) ( 112 )   Save BACKGROUND: Chronic non-specific low back pain seriously affects people’s working and life. Gait training does help to treat chronic low back pain. Studying the gait of chronic non-specific low back pain patients can help us design more targeted gait re-education content. OBJECTIVE: To find the gait characteristics of young chronic non-specific low back pain patients by comparing the spatio-temporal parameters and mechanical parameters of gait among between healthy youth and youth with chronic non-specific low back pain, so as to provide a reference for the diagnosis and rehabilitation of chronic non-specific low back pain. METHODS: Sixty-five volunteers were enrolled, including 30 healthy youth (control group), and 35 youth with chronic non-specific low back pain (trial group). The gait during normal movement was detected using LORAN 2-m footscan plantar pressure plate and gait testing system. RESULTS AND CONCLUSION: (1) The step length symmetry index, standing phase symmetry index and single-support phase symmetry index in the trial group were significantly higher than those in the control group (all P < 0.01). (2) The spatio-temporal parameters of gait between two sides in the control group showed no significant differences (all P > 0.05). In the trail group, the step length and foot angle deviation of the right side were significantly higher than those of the left side (P < 0.01, P < 0.05). The standing phase and single support time of the right side were significantly longer than those of the left side (all P < 0.01). (3) The vertical ground reaction force symmetry index of initial double-support, single-support, and final double-support in the trial group were all significantly higher than that in the control group (P < 0.05, P < 0.01, P < 0.05). (4) In summary, the youth with chronic non-specific low back pain are more likely to have asymmetrical gait than healthy youth. Youth with chronic non-specific low back pain are preferred to support by dominant limbs. In gait re-education for youth with chronic non-specific low back pain, asymmetrical limb support mode should be adjusted.  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Anatomical differences in three-dimensional finite element model of difficult airway patients Xie Yuchen, Chen Wendong, Ma Li 2019, 23 (4):  562-566.  doi: 10.3969/j.issn.2095-4344.1037 Abstract ( 367 )   PDF (1057KB) ( 94 )   Save BACKGROUND: Three-dimensional models are more and more applied in medical fields with technology development. Airway management is a key for anesthesia; however, litter is reported on the three-dimensional finite element models of normal human airways. OBJECTIVE: To reconstruct the three-dimensional finite element model of human airway based on MRI data, and to analyze the anatomical differences in difficult airway three-dimensional model. METHODS: Twenty patients with normal airways and 20 patients with difficult airways were enrolled, and then the MRI two-dimensional imaging data of head and neck were obtained. A three-dimensional solid digital model including the entire mandible, hyoid bone and upper airway was reconstructed using Mimics 10.01. Measurement software was used to measure related indicators. At the same time, normal human body surface markers were measured to obtain relevant data to compare with the measured indexes of the model, and the differences in normal and difficult airway anatomy were analyzed. RESULTS AND CONCLUION: (1) The measured value of mandibular distance in the three-dimensional model group was significantly smaller than that in the body surface measurement group in normal airway patients (P < 0.01). The measured value of mandibular distance in the three-dimensional model group was higher than that in the body surface measurement group in patients with difficult airway (P > 0.05). The measured value of mandibular angle in the three-dimensional model group was higher than that in the body surface measurement group of normal airway patients (P > 0.05). (2) In supine and sniffing positions, the oropharyngeal angle and minimal sagittal cross-sectional area in the normal airway group were significantly higher than those in the difficult airway group (P < 0.05). There was no significant difference in the minimal coronal cross-sectional area between two groups (P > 0.05). (3) These results suggest that the human airway data obtained by MRI can establish a realistic and reliable three-dimensional finite element model, and the model can accurately analyze the anatomical differences with difficult airways, which provides reference for predicting difficult airways 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 Figures and Tables | References | Related Articles | Metrics

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Mechanic property evaluation of medical Kirschner wire’s large deflection bending Wang Hailong, Lü Ying, An Meiwen, Hou Chunsheng 2019, 23 (4):  567-572.  doi: 10.3969/j.issn.2095-4344.1038 Abstract ( 461 )   PDF (5761KB) ( 90 )   Save BACKGROUND: When Kirschner wire is used for clinical traction and correction, the precise quantification and safety assessment of the treatment plan are particularly important. OBJECTIVE: To analyze the mechanical properties and stability of medical Kirschner wire in large deflection bending state by experimental and theoretical analysis, and to evaluate the rationality of using the elastic force as a traction orthodontic solution. METHODS: The large deflection bending (type U deformation) experiment of the same batch of Kirschner wires with different diameters and lengths was carried out. Combining with the experimental data, the mechanical process was analyzed, and the formula for the elastic force of large deflection bending under different parameters was fitted. RESULTS AND CONCLUSION: (1) Elastic force of type U Kirschner wire was a function of the size factor (D4/L2) of Kirschner wire and time (t), which was stable over time. (2) To conclude, the elastic force produced by Kirschner wire’s large deflection is stable during treatment, and it is a reasonable plan for the traction of orthodontic treatment. This study provides theoretical support for the precise quantification of type U Kirschner wire in clinical application and provides reference for similar applications of type U Kirschner wire. 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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Anatomic measurement and clinical significance of the lumbosacral nerve roots Zhu Aiguo, Zhang Feng, Zhu Jianwei, Jin Guohua 2019, 23 (4):  573-577.  doi: 10.3969/j.issn.2095-4344.1039 Abstract ( 777 )   PDF (4657KB) ( 123 )   Save BACKGROUND: Reconstruction of low lumbar vertebrae using subtotal vertebrectomy through posterior approach can result in severe damage to lumbosacral plexus. OBJECTIVE: To explore the distance between lumbosacral nerve roots and the relationship between the lumbosacral plexus and lumbar vertebrae in the coronary plane, providing anatomical basis for the reconstruction of low lumbar vertebrae by subtotal vertebrectomy through posterior approach. METHODS: Posterior dissections of the lumbosacral plexus and corresponding vertebrae were performed bilaterally on 20 adult cadavers. We measured the distance from the inferior border of the superior nerve root to the superior border of the next-most inferior nerve root was measured, at the point where the nerve roots emerged from the common dural sac; the distance along each nerve root from its emergence from the common dural sac to its first connection with the plexus of the adjacent root, and these measurements were taken at L2-L5 bilaterally. The height and diameter of the posterior margin of L3-L5 vertebrae, and the angle between the nerve root and dural sac from L3 to L5 bilaterally were measured.  RESULTS AND CONCLUSION: The mean area of the unilateral lumbosacral plexus at L3 was about 30 mm2 smaller than the corresponding hemivertebrate in the coronary plane. The mean area of the unilateral lumbosacral plexus at L4 was about 100-150 mm2 larger than the corresponding hemivertebrate in the coronary plane. The area of the lateral lumbosacral plexus at L5 was about 15 mm2 in males larger than the corresponding hemivertebrate in the coronary plane, and it was about 180 mm2 in females. In summary, reconstruction of low lumbar vertebrae by subtotal vertebrectomy at L3, L4 and L5 through posterior approach is feasible without the risk of damaging the surrounding nervous structures, especially at L4. 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 | Related Articles | Metrics

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Measurement of paravertebral muscle indicators on MRI in the patients with osteoporotic vertebral fracture and its clinical significance   Liu Bin, Liu Xiangyang, Wang Guoping, Shen Xiongjie, Chang Lei, Peng Shuai, Zhang Mingyan 2019, 23 (4):  578-583.  doi: 10.3969/j.issn.2095-4344.1040 Abstract ( 525 )   PDF (5135KB) ( 153 )   Save BACKGROUND: Etiology of osteoporotic vertebral fracture is a combination of multiple factors. Bone loss, falls and previous fracture history are considered to be the main risk factors, but the specific pathogenesis remains to be further studied. OBJECTIVE: To measure the indicators of paravertebral muscles on MRI in patients with osteoporotic vertebral fracture and to investigate its correlation with the occurrence of vertebral fracture. METHODS: Ninety-five patients with osteoporotic vertebral fracture patients and with complete clinical data admitted in Hunan Provincial People’s Hospital from June 2014 to December 2017 were enrolled. The cross sectional area of paravertebral muscles and the fatty degeneration ratio were examined and assessed through MRI. The measurement parameters were as follows: the cross sectional area of bilateral multifidi and erector spinae, the cross sectional area of vertebral body, the degree of lumbar vertebrae muscles, and the fatty degeneration ratio. The fracture group was divided into single fracture and multiple fracture groups according to the number of fractured vertebrae. Meanwhile, 32 osteoporosis patients without fracture were enrolled as control group. Independent sample t test was used to compare the differences in the MRI indicators of the paravertebral muscles in the three groups. RESULTS AND CONCLUSION: (1) Compared with the control group, the cross sectional areas of bilateral multifidi and erector spinae in the single fracture and multiple fracture groups were decreased significantly (P < 0.05). There was no significant difference between two fracture groups (P > 0.05). (2) There was no significant difference in the cross sectional area of vertebral body between two groups (P > 0.05). (3) Compared with the control group, the degree of lumbar vertebrae muscles in the single fracture and multiple fracture groups was significantly reduced (P < 0.05). However, there was no significant difference between two fracture groups (P > 0.05). (4) The fatty degeneration ratio in the multiple fracture group was significantly higher than that in the control group (P < 0.05). There was no significant difference among the other groups (P > 0.05). (5) In summary, the number and quality of the paravertebral muscles in the patients with osteoporotic vertebral fracture are lower than those in the osteoporotic patients without fracture, suggesting that the degeneration of lumbar paravertebral muscles may be a potential risk factor for osteoporotic vertebral 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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Magnetic fields applied in the field of bone biolegy: confirmed and unconfirmed problems Zhang Lingyu, Jiang Jingyi, Fan Yubo, Zheng Lisha 2019, 23 (4):  584-590.  doi: 10.3969/j.issn.2095-4344.1041 Abstract ( 325 )   PDF (1230KB) ( 107 )   Save BACKGROUND: As a noninvasive physical factor, magnetic fields have been investigated for many years, and have been applied in clinic for bone biological field. However, their biological effect, underlying mechanism and model of application need to be studied in depth.  OBJECTIVE: To review the research progress and trend of magnetic fields in bone biology from four aspects: animal models, cells, mechanism and clinical application. METHODS: The first author searched the literature in PubMed, WOS, CNKI and WanFang databases from 2012 to 2018. The keywords were “magnetic fields, bone fracture, osteoporosis/osteopenia, bone healing, bone growth, arthritis, osteoblasts, mesenchymal stem cells” in English and Chinese, respectively. Totally 103 articles were firstly acquired and finally 51 eligible articles were selected for analysis. RESULTS AND CONCLUSION: Magnetic fields can affect the balance between osteoblasts and osteoclasts, regulate bone metabolism and osteogenesis, enhance bone biomechanical properties, as well as accelerate the repair of osteoporosis, non-union fractures, osteoarthritis and soft tissue injuries. The combination of magnetic field and other methods such as materials, drugs, or exercise can improve the curative efficiency. Wnt, RANK, MAPK and other signaling pathways play critical roles in magnetic field-mediated osteogenesis. However, the best conditions for magnetic field to promote osteogenesis and the detailed mechanism require to be further studied. The potential or long-term effects of magnetic field on the human body are not yet fully understood. Importantly, the magnetic field parameters should be carefully chosen 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 Figures and Tables | References | Related Articles | Metrics

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Clinical application of bone morphogenetic proteins in bone and cartilage tissue engineering Tang Xianneng, Chen Yueping, Zhang Xiaoyun 2019, 23 (4):  591-596.  doi: 10.3969/j.issn.2095-4344.0584 Abstract ( 387 )   PDF (1104KB) ( 120 )   Save BACKGROUND: Since the Urist et al. from the USA found that bone morphogenetic proteins contribute to bone regrowth in 1965, bone induction has been a hot spot worldwide. In recent years, the study on bone morphogenetic proteins in China has also entered the clinical trial stage. OBJECTIVE: To review the clinical application and research progress of bone morphogenetic proteins in bone and cartilage tissue engineering. METHODS: “Bone morphogenetic protein, bone tissue engineering, cartilage tissue engineering, osteoarthritis, fracture, nonunion, bone defect, osteonecrosis of femoral head, gene therapy” in English and Chinese, respectively were used as keywords. The first author retrieved the literature concerning the clinical application of bone morphogenetic proteins in bone and cartilage in PubMed, Medline, Embase, CNKI, WanFang, and VIP databases from 2000 to 2018. A total of 62 eligible articles were included after excluding repeated studies. RESULTS AND CONCLUSION: From five aspects including arthritis, fracture, bone nonunion, bone defect; femoral head necrosis and gene therapy, clinical researches and outcomes of BMPs in bone and cartilage tissue engineering are summarized. Bone morphogenetic proteins possess strong bone-inducing active osteogenic factor, which can not only promote bone growth, but also promote the repair of cartilage, tendons and ligaments. Because of its high effectiveness and safety, it has been highly regarded in recent years. A variety of transforming growth factors mutually applied in bone and cartilage tissue engineering will become a hot spot in orthopedic research, which needs further investigation. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 Figures and Tables | References | Related Articles | Metrics

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Application and research progress of platelet-rich plasma in bone tissue regeneration   Tang Qiyuan, Ma Yaping, Zhang Bin, Luo Nanning, Wang Xin, Zhang Yi 2019, 23 (4):  597-605.  doi: 10.3969/j.issn.2095-4344.1042 Abstract ( 355 )   PDF (1058KB) ( 115 )   Save BACKGROUND: Platelet concentrates have been found to be a kind of platelet-rich plasma obtained by centrifugation of autologous whole blood, and has the ability to promote tissue healing. Platelet-rich plasma, as the first generation of platelet concentrates, can facilitate osteogenesis. OBJECTIVE: To review the preparation, and classification of platelet-rich plasma, release of platelet-derived growth factor and its promoting function and clinical application of bone regeneration, so as to provide theoretical basis for further investigation on the effect and clinical application of platelet-rich plasma in bone regeneration. METHODS: CNKI and PubMed databases were retrieved using the keywords of “platelet-rich plasma, bone defect, bone regeneration, growth factors” in English and Chinese, respectively for the articles published from July 1970 to July 2018. Totally 136 articles were searched. The preparation and classification of platelet-rich plasma, the release of platelet-derived growth factor and promote bone regeneration effect and clinical applications were summarized. RESULTS AND CONCLUSION: Platelet-rich plasma is a plasma product with different concentrations of platelets obtained by controlling centrifugation. It is derived from peripheral blood and has the advantages of abundant source, convenient material, simple preparation and absorbability. Platelet-rich plasma not only has the effect of hemostasis, but contains various high concentrations of growth factors and fibrin, which provides a beneficial growth environment and scaffold for cells and tissues. Moreover, it can stimulate soft tissue regeneration, promote early closure of wound, and provides the environment for a variety of inflammatory factor repair and prevents infection. Platelet-rich plasma can accelerate the repair of damaged or bone defects. Combined with other therapies in regenerative medicine, it provides new ideas for promoting healing and shortening healing time, especially has a broad prospect in the repair of bone, cartilage and tendon.  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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Bone morphologic protein signaling pathway in bone regeneration and repair: accurate regulation and treatment targets Liu Junyin, Feng Wei, Xie Yingchun, Li Yuwan, Zeng Jitao, Liu Ziming, Tu Xiaolin 2019, 23 (4):  606-612.  doi: 10.3969/j.issn.2095-4344.1043 Abstract ( 435 )   PDF (1093KB) ( 97 )   Save BACKGROUND: Bone repair and regeneration is a difficulty in the treatment of bone diseases. Bone morphogenetic proteins can regulate bone mass and are critical for regulating bone homeostasis and bone regeneration. OBJECTIVE: To review the research progress of bone morphogenetic protein signal pathway in bone regeneration and repair. METHODS: Databases of CNKI, PubMed, Elsevier Science Direct, and Web of Science were retrieved with the keywords of “bone morphogenetic protein, Smads, tissue engineering, bone defect, bone repair, bone disease, progress in research” in English and Chinese, respectively from 1990 to 2018. Related literature on bone morphogenetic protein signaling pathways in bone regeneration was searched. After initial screening, eligible articles were further summarized and analyzed. RESULTS AND CONCLUSION: Bone morphogenetic protein molecules play an important role in the growth and development of long bone, cartilage, tendon and joints. Bone morphogenetic proteins 2 and 7 have been applied in the treatment of fracture nonunion, delayed union, and spine fusion, but bone morphogenetic protein regulation in the bone regeneration and repair still needs a further investigation. Roles of bone morphogenetic proteins and its related molecules in bone regeneration have made great progress. Precise regulation of bone morphogenetic protein signals may become a potential therapeutic target for bone diseases.  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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Mechanism of bone growth factors regulating fracture healing and their application in bone regeneration and repair   Feng Yang, Chen Yueping, Zhang Xiaoyun, Dong Panfeng, Zhuo Yinghong, Lan Jiao, Hu Qinglei, Tang Xianneng 2019, 23 (4):  613-620.  doi: 10.3969/j.issn.2095-4344.0381 Abstract ( 461 )   PDF (1216KB) ( 133 )   Save BACKGROUND: Biocomposite vector inducing the expression of bone growth factors in the fracture parts can effectively shorten the fracture healing time. OBJECTIVE: To review the related literatures and to summarize the mechanism and application progress of bone growth factors regulating fracture healing. METHODS: CNKI, VIP, WanFang and PubMed databases were retrieved with the keywords of “BGF, FGF, PDGF, TGF-β, BMP, VEGF, IGF” in English and Chinese, respectively. The articles concerning mechanism and application of bone growth factors regulating fracture healing were included, the repetitive studies were excluded, and finally 58 eligible articles were enrolled. RESULTS AND CONCLUSION: Different kinds of bone growth factors are originated from different tissues, and have their own characteristics and action mechanisms. They produce local and systematic synergistic effect by paracrine and autocrine, and bind to the receptors in target cells, further activating the signaling pathways, promoting cell functions, thus affecting cell migration, proliferation, production, differentiation even apoptosis. Therefore, bone growth factors can effectively promote bone healing and treat bone defects. But bone growth factors exhibit shortcomings such as short half-life period and protein inactivation. Optimizing the design and delivery method as well as developing novel biomaterials to effectively overcome all above problems can contribute to bone regeneration and repair. 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 spondylolisthesis: status and prospects of implant treatment Li Xianzhou, Wang Qian, Zhang Cunxin 2019, 23 (4):  621-627.  doi: 10.3969/j.issn.2095-4344.1044 Abstract ( 590 )   PDF (1074KB) ( 125 )   Save BACKGROUND: Spondylolisthesis is a most common cause of lumbocrural pain, which has been a hotspot in spinal degenerative diseases. OBJECTIVE: To summarize the surgical methods of lumbar spondylolisthesis at home and abroad, thus providing references for surgical scheme of spondylolisthesis. METHODS: The articles related to the surgical methods of spondylolisthesis, spinal instability and scoliosis published between January 1966 and December 2017 were retrieved from CNKI and PubMed databases. The keywords were “spondylolisthesis, interbody fusion, internal fixation, operative treatment, pedicle screw” in English and Chinese, respectively. Totally 53 eligible articles were enrolled based on the inclusion and exclusion criteria. RESULTS AND CONCLUSION: (1) There are various ways to the surgical treatment of spondylolisthesis and each of them has advantages and disadvantages. Combined surgery can obtain relatively good results. (2) Choosing an operation method not only needs to consider the patient requirements, but also needs to consider what kind of operation is more adept for the surgeons. (3) There is no a surgical method that can be recognized to be superior to the others. 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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Rehabilitation strategy after anterior cruciate ligament reconstruction using autologous hamstring tendon Qin Huasheng, Pan Weimin, Li Ran, Li Xintong, Qu Lei, Zhu Xinrui 2019, 23 (4):  628-635.  doi: 10.3969/j.issn.2095-4344.1045 Abstract ( 480 )   PDF (1254KB) ( 98 )   Save BACKGROUND: Rehabilitation after anterior cruciate ligament reconstruction is critical for the recovery of patients’ daily life and motor ability. However, the strategy of anterior cruciate ligament reconstruction with hamstring tendon as graft remains controversial, because of the decrease of hamstring muscle strength and the long-time of reconstructing blood supply. OBJECTIVE: To review the rehabilitation methods after anterior cruciate ligament reconstruction using autologous hamstring tendon, and to clarify the status of related methods at home and abroad. METHODS: The first author retrieved the articles addressing various rehabilitation methods and research progress of rehabilitation of anterior cruciate ligament after hamstring transplantation in the databases of PubMed, MEDLINE, Cochrane, CINAHL and CNKI from January 2002 to June 2018. The key words were “anterior cruciate ligament, anterior cruciate ligament reconstruction, hamstring tendon, rehabilitation, research progress, protective devices, joint movement training, functional training, down time, load, proprioceptive” in English and Chinese, respectively. RESULTS AND CONCLUSION: The commonly used rehabilitation methods after anterior cruciate ligament reconstruction using autologous hamstring tendon include: (1) wearing early muscle recovery stage protective device, early pain and swelling control are conducive to sports rehabilitation. Load timing, joint activity training and muscle strength, proprioception, gait, and core training have good curative effect. In early-term treatment, we should focus on pain control and keep knee joint in extending position, and keep the stability of the implant. (2) At the middle-stage, we aim at restoring the range of the motion in flexion and extension and gait, and focus on keeping the stability of the implant.  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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Sealing of intramedullar femoral canal for blood loss after total knee arthroplasty: a meta-analysis Lu Chao, Liu Wengang, Wu Huai, Ye Guozhu, Chen Guocai, Chen Jin 2019, 23 (4):  636-642.  doi: 10.3969/j.issn.2095-4344.0614 Abstract ( 285 )   PDF (1485KB) ( 101 )   Save BACKGROUND: Total knee arthroplasty is a mature technique for end-stage knee osteoarthritis. The problem of postoperative blood loss has always been a hot issue in clinical discussion. Whether the intramedullar femoral canal is sealed during operation and its effect on blood loss in total knee arthroplasty remain controversial. OBJECTIVE: To evaluate the clinical effect of sealing of intramedullar femoral canal for reducing postoperative blood loss in total knee arthroplasty by meta-analysis. METHODS: English databases such as Cochrane Library, Medline, Embase, PubMed, and Web of science, and Chinese databases such as CBM, VIP, WanFang, and CNKI were retrieved for clinical controlled trials concerning whether the intramedullar femoral canal was sealed during total knee arthroplasty. The retrieval time was from database creation to July 2018. The outcome indexes included operation time, 24-hour drainage, intraoperative blood loss, 24-, and 72-hour hemoglobin reduction, blood transfusion rate, and complications. RESULTS AND CONCLUSION: (1) Ten articles were included, including 11 clinical controlled trials, involving 1 190 patients (665 cases underwent autologous bone or cement sealing in the intramedullar femoral canal, and 525 cases were not treated with occlusion in the intramedullar femoral canal). (2) The results of meta-analysis showed that sealing of intramedullar femoral canal in total knee arthroplasty reduced the amount of intraoperative blood loss (MD=-16.11, 95%CI=(-23.51, -8.71), P < 0.001), 24-hour drainage (MD=-128.05, 95%CI=(-212.06, -44.04), P < 0.001), 24-hour hemoglobin reduction (MD=-0.58, 95%CI=(-1.08, 0.08), P=0.02), blood transfusion rate (OR=0.50, 95%CI=(0.36, 0.68), P < 0.001) and complications (OR=0.44, 95%CI=(0.21, 0.91), P < 0.05). The operation time (P=0.2) and 72-hour hemoglobin reduction (P=0.9) did not differ significantly between groups. (3) These results indicate that based on the existing evidence, sealing of intramedullar femoral canal in total knee arthroplasty can effectively control visible blood loss, reduce drainage, reduce blood transfusion rate and complications, and it is worthy of promotion. 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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Tranexamic acid plus drain-clamping reduces blood loss in total knee arthroplasty: a meta-analysis Zhang Yan, Kan Quan, Zhang Junwei, Wang Baohua, Ping Shaohua 2019, 23 (4):  643-649.  doi: 10.3969/j.issn.2095-4344.1046 Abstract ( 332 )   PDF (1575KB) ( 117 )   Save BACKGROUND: Clinical effects of tranexamic acid plus drain-clamping to reduce blood loss in total knee arthroplasty still remain uncertain. OBJECTIVE: To systematically review the clinical effects of tranexamic acid plus drain-clamping to reduce blood loss in total knee arthroplasty. METHODS: PubMed, EMBASE, The Cochrane Library, CNKI, VIP and WanFang databases were searched for the clinical trials addressing tranexamic acid plus drain-clamping versus other methods in total knee arthroplasty from January 2008 to June 2018. Two authors independently screened the literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality. The primary measurement outcome was the number of patients with blood transfusion. The secondary outcomes were total blood loss, drainage volume, decrease in hemoglobin, and the incidence of deep venous thrombosis. Changes in these outcomes were analyzed by a meta-analysis on RevMan 5.3 software. RESULTS AND CONCLUSION: (1) Twelve studies with 1 220 patients were included. (2) Meta-analysis results showed that the number of patients with blood transfusion in the trial group was significantly less than that in the control group [RR=0.35, 95%CI (0.23, 0.52), Z=5.22, P < 0.05]. (3) The total blood loss [MD=-325.45, 95%CI (-445.12, -205.78), Z=5.33, P < 0.05], drainage volume [MD=-269.85, 95%CI (-334.78, -204.93), Z=8.15, P < 0.05], and the decrease in hemoglobin [MD=-0.91, 95%CI (-1.23, -0.58), Z＝5.46, P < 0.05] in the trial group were significantly lower than those in the control group. The incidence of deep venous thrombosis in the trial group was slightly lower than that in the control group [RR＝0.40, 95%CI (0.08, 2.05), Z=1.09, P > 0.05]. (4) These results show that compared with the control group, tranexamic acid plus drain-clamping can significantly reduce perioperative blood loss in total knee arthroplasty. The number and the quality of the included studies are far from perfect, so more high-quality randomized controlled trials are needed to identify the optimal dose of tranexamic acid and the clamping hours.  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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Selection of injury segments in a rat model of spinal cord injury: network meta-analysis Wei Weibing, Zou Zhilong, Zhou Binbin, Li Bolin, Qin Jingyu, Feng Zhenfen, Li Jiannan, Ye Liangying,Wu Rongmi 2019, 23 (4):  650-656.  doi: 10.3969/j.issn.2095-4344.1047 Abstract ( 400 )   PDF (1352KB) ( 103 )   Save BACKGROUND: Allen’s weight-drop method has become a safe and effective modeling method, and choosing the injury segments of the spinal cord is an important factor for establishing ideal animal models of spinal cord injury. OBJECTIVE: To compare the the similarities and differences in the effectiveness of spinal cord injury at T8, T9, T10, T11, and T12 in Sprague-Dawley rats by network meta-analysis, thus providing evidence for the selection of lesion segments in rat models of spinal cord injury. METHODS: PubMed, CNKI, VIP and WanFang databases were searched with the keywords of “spinal cord injuries, rats, models, animal, BBB scores” in English and Chinese, respectively for the literature published before June 5, 2018. The inclusion criteria were as follows: the modeling method of spinal cord injury was Allen's weight-drop (25 g·cm) method, rats only undergoing laminectomy were included in sham operation group, and low extremity function was assessed by Basso Beattie Bresnahan scores at 3, 7, 14 and 28 days. The order of the effectiveness of spinal cord injury at T8, T9, T10, T11, and T12 was compared by network meta-analysis. RESULTS AND CONCLUSION: (1) Nineteen studies were included, involving 703 rats. (2) Basso Beattie Bresnahan scores in the spinal cord injury rats at different segments at 3, 7, 14 and 28 days were significantly decreased compared with the sham operation group (P ≤ 0.05). (3) Spinal cord injury at T10 showed largest effect on Beattie Bresnahan scores. (4) The order of effectiveness of spinal cord injury at different segments was: T10 > T9 > T11 > T8 > T12 > sham operation.  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