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28 April 2019, Volume 23 Issue 12 Previous Issue    Next Issue

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Different reconstruction methods of proximal femur in cementless long-stem hip arthroplasty for unstable femoral intertrochanteric fractures in older adults: a comparative study Deng Yu, Xia Yuxin, Bai Xinwen, Qi Wei 2019, 23 (12):  1805-1811.  doi: 10.3969/j.issn.2095-4344.1120 Abstract ( 536 )   PDF (1564KB) ( 70 )   Save BACKGROUND: Treatment of unstable intertrochanteric fractures in the elderly by cementless long-stem hip arthroplasty requires the reconstruction of the important structure of proximal femur, but the reconstruction methods remain controversial. OBJECTIVE: To compare the clinical efficacy of proximal femur reconstruction using different methods in cementless long-stem hip arthroplasty for senile unstable femoral intertrochanteric fractures. METHODS: A retrospective study of 52 older adults with unstable femoral intertrochanteric fractures undergoing cementless long-stem hip arthroplasty at Chongqing Orthopedic Hospital of Traditional Chinese Medicine from March 2015 to April 2017 was conducted. All patients belonged to types III, IV, and V according to Evans classification, and bone mineral density of lumbar spine T value was less than -2.5. The patients were divided into groups A (n=25, fixed by Kirschner wire and tension band wearing) and B (n=27, fixed by steel wire and non-absorbable suture). The operation duration, intraoperative blood loss, incision length, independent weight-bearing time, postoperative complications and Harris scores at 1, 3, 6 and 12 months postoperatively were compared. RESULTS AND CONCLUSION: (1) The operation time and intraoperative blood loss in the group A were significantly higher than those in the group B (P < 0.01). (2) There was no significant difference in the incision length or postoperative independent weight-bearing time between two groups (P > 0.05). (3) The incidence of postoperative complications in the group A was significantly higher than that in the group B (P < 0.05). (4) The Harris hip scores at 1, 3, 6 and 12 months showed no significant differences between two groups (P > 0.05). (5) In summary, steel wire and non-absorbable suture applied in the cementless long-stem hip arthroplasty for senile unstable femoral intertrochanteric fractures can significantly shorten the operation time, reduce intraoperative blood loss and decrease the postoperative complications. Figures and Tables | References | Related Articles | Metrics

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Allogeneic cortical bone plate combined with locking plate for Vancouver type B1 and C osteoporotic periprosthetic femoral fractures after hip arthroplasty in older adults Gong Zhibing, Wu Zhaoke, Zhang Huantang, Xu Zhiqing, Zhuang Zhikun, Zhang Qianjin 2019, 23 (12):  1812-1817.  doi: 10.3969/j.issn.2095-4344.1109 Abstract ( 353 )   PDF (1513KB) ( 88 )   Save BACKGROUND: With the rapid growth of hip arthroplasty, the number of periprosthetic femoral fractures is increasing yearly. Because most of patients are older adults complicated with severe osteoporosis, the treatment is difficult, which is a challenge for clinical joint surgeons. OBJECTIVE: To evaluate the curative effectiveness of allogeneic cortical bone plate combined with locking plate for Vancouver type B1 and C osteoporotic periprosthetic femoral fractures after hip arthroplasty. METHODS: Clinical data of 13 patients with Vancouver type B1 and C osteoporotic periprosthetic femoral fractures after hip arthroplasty at Quanzhou Orthopedic-Traumatological Hospital of Fujian University of Traditional Chinese Medicine between August 2014 and July 2017 were collected. All patients were treated with allogeneic cortical bone plate combined with locking plate, also with anti-osteoporosis treatment. The joint function was assessed by Harris hip score. The fracture and allogenic bone plate healing, prosthesis and internal fixation position, and prosthetic loosening were evaluated by X-ray. RESULTS AND CONCLUSION: (1) The follow-up time was 12-46 months. (2) The Harris hip score at postoperative 6 months was significantly higher than that at 1 month postoperatively (t=-13.38, P=0.000). The score at last follow-up was significantly higher than that at 6 months postoperatively (t=-5.59, P=0.01). (3) All fractures were healed at 6 months after operation, no loosening of prosthesis or internal fixator was found, bone plate of allograft healed with host bone, and different degrees of modeling were observed at the last follow-up. All patients could walk painlessly. (4) These results indicate that allogeneic cortical bone plate combined with locking plate for Vancouver type B1 and C osteoporotic periprosthetic femoral fractures after hip arthroplasty shows good clinical efficacy. Figures and Tables | References | Related Articles | Metrics

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Risk factors associated with titanium cage subsidence after anterior single-level subtotal corpectomy and interbody fusion using titanium cage   Tang Fubo, Zhou Jinyan, Zhang Yisheng, Zhong Yuanming, Li Zhifei, Mo Yi 2019, 23 (12):  1818-1823.  doi: 10.3969/j.issn.2095-4344.1121 Abstract ( 361 )   PDF (1077KB) ( 102 )   Save BACKGROUND: Anterior single-level subtotal corpectomy and interbody fusion using titanium cage is a good method for anterior decompression of spinal cord, which can prevent the disease development and achieve satisfactory short-term curative efficacy. However, postoperative titanium cage subsidence is a commonest complication, and its risk factors still remain controversial, which is an issue of concern. OBJECTIVE: To study the risk factors for titanium cage subsidence after anterior single-level subtotal corpectomy and interbody fusion using titanium cage. METHODS: A retrospective analysis of 81 patients undergoing anterior single-level subtotal corpectomy and interbody fusion using titanium cage at First Affiliated Hospital of Guangxi University of Chinese Medicine from March 2012 to March 2016 was performed. The baseline data (sex, age, bone mineral density, bone mass index, history of smoking and disease type), intraoperative data (tilt angle, depth and type of titanium cage, angle of nail plate angle), and postoperative data (neck collar fixation time and postoperative working posture) were recorded. At 3 days and end of the follow-up (24 months) postoperatively, the cervical vertebrae underwent X-ray examination, and divided into titanium cage subsidence group (decreased height > 2 mm) and titanium cage non-subsidence group (decreased height < 2mm) according to the decreased height of the fused vertebrae. Univariate analysis between two groups was conducted on statistical software, and the factors with differences were included in the logistic regression analysis to obtain the risk factors related to the titanium cage subsidence. RESULTS AND CONCLUSION: (1) All patients completed the trial, including 24 cases of titanium cage subsidence and 57 cases of titanium cage non-subsidence. (2) The sex, age, body mass index, occupational distribution, history of smoking, and postoperative working posture showed no significant difference between two groups (P > 0.05). There were significant differences in the bone mineral density, title angel, depth and types of titanium cage, angle of nail plate, and postoperative neck collar fixation time between two groups (P < 0.05). (3) Multivariate logistic regression analysis showed that the short fixation time of the neck collar was the risk factor for titanium cage subsidence (P < 0.05). The increase of the tilt angle of titanium cage was closely related to the titanium cage subsidence (P < 0.05). (4) To conclude, the fixation time of the neck collar and the tilt angle of the titanium cage are important risk factors for titanium cage subsidence, which should be highly valued in the clinic, so as to reduce the incidence of titanium cage subsidence and improve the postoperative efficacy. Figures and Tables | References | Related Articles | Metrics

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Design of locking compression plate through transoral approach Li Xiaofeng, Xie Furong, Zhan Long, Yang Yuan 2019, 23 (12):  1824-1828.  doi: 10.3969/j.issn.2095-4344.1103 Abstract ( 300 )   PDF (1189KB) ( 70 )   Save BACKGROUND: There is a lack of plate for single-segment fixation through transoral approach to treat atlas fracture. OBJECTIVE: To develop a locking compression plate through transoral approach based on the clinical practice and anatomical data of atlas. METHODS: The anatomic parameters of atlas from 96 normal adults were measured with PACS system and CT image system, including width of anterior arch of atlas, height of anterior tubercle of atlas, length of the lateral mass, length of the atlas, middle height of the lateral mass, the extraversion angle of lateral mass of atlas (α), the radian (θ) of anterior arch of atlas, and inter membrane space. The data were statistically analyzed by SPSS 18.0 software in order to design the locking compression plate through transoral approach. RESULTS AND CONCLUSION: (1) The width of anterior arch of atlas was (8.85±1.47) mm, height of anterior tubercle of atlas was (12.49±2.28) mm, length of the lateral mass was (20.14±1.54) mm, length of the atlas was (39.68±2.29) mm, middle height of the lateral mass was (9.98±1.48) mm, the extraversion angle of lateral mass of atlas (α) was (13.92±1.90)°, the radian (θ) of anterior arch of atlas was (147.32±4.53)° and inter membrane space was (3.12±0.49) mm. (2) The locking compression plate through transoral approach was successfully designed, and obtained national patent. (3) To conclude, the locking compression plate through transoral approach meets the requirement of atlas morphology, not only rebuilds the stability of anterior arch of the atlas, but also restores the height of the atlas complex, and preserves the structure function of the upper atlas effectively. Figures and Tables | References | Related Articles | Metrics

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Placement position of artificial vertebral pedicle screws based on the anatomical structure of lumbar nerve roots    Gu Jianhua, Shi Zhicai 2019, 23 (12):  1829-1833.  doi: 10.3969/j.issn.2095-4344.1112 Abstract ( 352 )   PDF (1106KB) ( 94 )   Save BACKGROUND: Artificial vertebra is the best choice for the reconstruction of the spinal structure after posterior total laminectomy. However, there is no connection between the vertebral body and the vertebral pedicle, and vertebral body displacement often occurs, resulting in serious complications. OBJECTIVE: To explore the effect of anatomical position of lumbar nerve root on the pedicle screw placement of the artificial vertebral body. METHODS: Ten fresh frozen cadavers were selected, excluding major lumbar diseases and operation history. After the laminectomy and removal of partial pedicle and ligamentum flavum, we marked and measured the anatomical position. The best position of pedicle screw was explored. RESULTS AND CONCLUSION: (1) The height of the vertebral body measured was significantly different (P < 0.05). (2) However, on the pedicle line, the ratio of the distance between the midpoint of the nerve root to the lower endplate of the upper vertebral body and the upper endplate of the lower vertebra was constant. There was no significant difference between males and females (P > 0.05). There was no significant difference among L1-5 segments (P > 0.05). (3) After complete laminectomy, the best position of the lumbar pedicle screw is at the center of the middle of the nerve root and the lower endplate of the upper vertebral body, that is, the middle and upper 1/3 of the height of the artificial vertebral body. Figures and Tables | References | Related Articles | Metrics

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Short-term follow-up of dynamic hip screw versus proximal femoral nail anti-rotation for type AO/OTA A1 intertrochanteric femoral fracture in older adults Tian Youyong, Wang Zhiyong 2019, 23 (12):  1834-1839.  doi: 10.3969/j.issn.2095-4344.1090 Abstract ( 339 )   PDF (1291KB) ( 95 )   Save BACKGROUND: There are many studies concerning the treatment outcomes of dynamic hip screw and proximal femoral nail anti-rotation for unstable intertrochanteric fractures. However their effects on the treatment of stable intertrochanteric fractures in the elderly are rarely reported.  OBJECTIVE: To compare and evaluate the clinical efficacy of dynamic hip screw and proximal femoral nail anti-rotation for stable (AO/OTA type A1) intertrochanteric fractures in the elderly. METHODS: Fifty-eight patients with AO/OTA type A1 intertrochanteric femoral fracture and aged older than 60 years admitted at Shanxi Fenyang Hospital from January 2013 to January 2017 were analyzed retrospectively. The patients were treated with dynamic hip screw (n=20) and proximal femoral nail anti-rotation (n=38), and followed up for 6-24 months. The operation time, intraoperative blood loss, hospitalization time, fracture healing time, postoperative pain relief time, clinical fracture healing time, weight-bearing activity at postoperative 3 months, hip joint function at postoperative 6 months, and postoperative complications were compared. RESULTS AND CONCLUSION: (1) The mean operation time, mean blood loss, mean hospitalization time and postoperative pain relief time in the proximal femoral nail anti-rotation group were significantly superior to those in the dynamic hip screw group (P < 0.05). (2) There was no significant difference in the fracture healing time (t=0.040, P > 0.05) and weight-bearing activity at postoperative 3 months (χ2=0.030, P > 0.05) between two groups. (3) There was no significant difference (t=0.845, P > 0.05) in the Harris hip scores between two groups at 6 months after operation. (4) No significant difference was found in the incidence of complication between two groups. (5) In summary, for type AO/OTA A1 intertrochanteric fractures in the elderly, the two treatments have similar clinical outcomes, but proximal femoral nail anti-rotation fixation shows shorter operation time, less blood loss, shorter hospitalization time and quicker pain relief after surgery. So it is the preferred implant for this type of fractures. Figures and Tables | References | Related Articles | Metrics

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Intertrochanteric femoral fractures: an epidemiological analysis of 618 cases Guo Jinchao1, Cao Yuan2, Huang Junling1, Ma Jiajia1, Ma Chuang1 2019, 23 (12):  1840-1845.  doi: 10.3969/j.issn.2095-4344.1110 Abstract ( 428 )   PDF (1238KB) ( 91 )   Save BACKGROUND: Epidemiological characteristics of the intertrochanteric femoral fractures in Urumqi of Xinjiang Uygur Autonomous Region are rarely reported. Moreover, there is a lack of the epidemiological survey on the incidence, treatment and short-term prognosis. OBJECTIVE: To study the epidemiological characteristics of the intertrochanteric femoral fractures of the inpatients, so as to provide a scientific basis for strategic study on the prevention and treatment of the intertrochanteric femoral fractures. METHODS: Clinical data of 618 patients with intertrochanteric femoral fractures admitted in the First Affiliated Hospital of Xinjiang Medical University from January 2007 to December 2017 were analyzed retrospectively. The patient characteristics, injury time and causes, treatment methods, intraoperative indexes, hospitalization time, hospitalization costs and mortality at 6 months after treatment were collected for analyzing the epidemiological characteristics. SPSS 22.0 software was used for data analysis. RESULTS AND CONCLUSION: (1) There were significant differences in distribution of the intertrochanteric femoral fractures in terms of age and sex (P < 0.05). The amount of patients aged ≥ 61 years was most, accounting for 81.39%. The left side was more than right side (1.04:1). The proportion of male patients was more than female patients (1.01:1). (2) The number of patients increased with time increasing (P < 0.05). Season distribution of injury showed significant difference (P < 0.01), most injured in winner (44.5%). (3) The number of patients from Urumqi accounted for most, 300 cases (48.54%). (4) There was significant difference in the distribution of injury cause (P < 0.05), and slip was the leading cause (78.64%). Distribution of injury cause was significantly different at different ages and sexes (P < 0.05). (5) There was no significant difference in time distribution from injure to surgery in patients with different ages (P > 0.05). (6) Surgery was the predominant management approaches, accounting for 89.32%. At 6 months after surgery, the mortality rate of surgical treatment was significantly lower than that of conservative treatment (P < 0.05). (7) In summary, the distribution of the intertrochanteric femoral fractures of the inpatients has unique characteristics in aspects of age, sex, area distribution, injury causes, injury time, time from injury to surgery, treatment methods, and mortality at 6 months after treatment, which is worthy of further strategic study on prevention and treatment of the intertrochanteric femoral fractures. Figures and Tables | References | Related Articles | Metrics

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Four internal fixation methods of proximal femoral nail, locking compression plate, dynamic hip screw, and Gamma nail for treating senile intertrochanteric fractures   Huang Weiyan, Peng Jiewei, Wan Ming, Zheng Xiaoming, Wang Kangzhen 2019, 23 (12):  1846-1852.  doi: 10.3969/j.issn.2095-4344.1122 Abstract ( 339 )   PDF (1216KB) ( 100 )   Save BACKGROUND: The types of complications and recovery of different surgical procedures for intertrochanteric fractures vary. The clinically commonly used internal fixation method lacks a comprehensive summary. OBJECTIVE: To investigate the effects of proximal femoral nail antirotation, proximal femoral locking compression plate, dynamic hip screw and Gamma nail in the treatment of elderly intertrochanteric fractures. METHODS: A retrospective analysis of 178 elderly patients with intertrochanteric fractures admitted at Zhongshan Hospital of Traditional Chinese Medicine from March 2014 to March 2017 was performed. The patients were divided into proximal femoral nail group (n=41), proximal femoral locking compression plate group (n=44), dynamic hip screw group (n=48) and Gamma nail group (n=45) according to the internal fixation. The clinical data of patients were collected and arranged, the intraoperative and postoperative conditions were recorded. The recovery of hip joint function, and the occurrence of postoperative complications were observed. The excellent and good rate of postoperative curative effect was compared. RESULTS AND CONCLUSION: (1) The operation time, incision length, intraoperative blood loss and transfusion in the proximal femoral nail group were significantly lower than those in the other three groups (F=87.741, P=0.000; F=650.796, P=0.000; F=1 890.363, P=0.000; F=452.550, P=0.000). The fracture healing time in the proximal femoral nail group was earlier than that in the other three groups (F=24.731, P=0.000). (2) The incidence of complications in the proximal femoral nail group was significantly lower than that in the proximal femoral locking compression plate group (χ2=4.571, P=0.033), dynamic hip screw group (χ2=3.928, P=0.047), and Gamma nail group (χ2=4.398, P=0.036). (3) The Harris hip scores in the proximal femoral nail group were higher than those in the other three groups (F=24.842, P=0.000), and the excellent and good rate was higher than that in the other three groups (χ2=12.363, P=0.006). (4) In summary, the clinical effects of four internal fixation methods for elderly patients with intertrochanteric fractures are satisfactory. Among them, proximal femoral nail has the advantages of shorter operation time, less intraoperative blood loss, and quicker healing. The postoperative hip joint function recovery is better after using proximal femoral nail antirotation than proximal femoral locking compression plate, dynamic hip screw, and Gamma nail. Figures and Tables | Related Articles | Metrics

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Application of three-dimensional printing point-contact guide template in percutaneous vertebroplasty for thoracolumbar osteoporotic vertebral compression fractures   Zhang Jiayuan, Zhou Quan, Zhao Jiali, Zhang Ming, Fang Tao, Wang Xinhong, Pan Wei 2019, 23 (12):  1853-1858.  doi: 10.3969/j.issn.2095-4344.1123 Abstract ( 324 )   PDF (1473KB) ( 113 )   Save BACKGROUND: Some scholars used three-dimensional printing technology to design and manufacture percutaneous guide templates to assist pedicle puncture, which reduces the times of fluoroscopy and operation time and increases the safety in percutaneous vertebroplasty (kyphosis). However, such guide templates are all “surface-contact guide templates”, and the guide templates need to be completely adhere to the skin during application. The change of the patient’s body position often causes the guide templates and the skin to not completely fit, and needs to be adjusted so many times or even loses the purpose of guiding. There were few studies on three-dimensional printing point-contact guide templates for percutaneous pedicle positioning. OBJECTIVE: To explore the clinical effect of three-dimensional printing point-contact guide template in the treatment of thoracolumbar osteoporotic vertebral compression fractures with percutaneous vertebroplasty. METHODS: Forty patients with single-segment osteoporotic vertebral compression fractures in Affiliated Huai’an Hospital of Xuzhou Medical University from January 2017 to April 2018 were enrolled, and were randomly divided into control and trial groups (n=20 per group). The control group underwent traditional percutaneous vertebroplasty, and the trial group received percutaneous vertebroplasty with the aid of three-dimensional printing point-contact guide templates. The times of fluoroscopy and the time before the surgical needle reached the ideal puncture position, the total times of intraoperative fluoroscopy, the operation time, and the Visual Analog Scale scores at baseline and 1 day postoperatively were recorded. RESULTS AND CONCLUSION: Both groups of patients successfully completed the operation. The times of fluoroscopy and the time before the surgical needle reached the ideal puncture position, the total times of intraoperative fluoroscopy, and the operation time in the trial group were significantly lower than those in the control group (P < 0.05). The postoperative Visual Analog Scale scores in both groups were significantly lower than those at baseline (P < 0.05). These results indicate that the three-dimensional printing point-contact guide templates assisting the thoracolumbar osteoporotic vertebral compression fracture with percutaneous vertebroplasty, can facilitate the accurate placement of the needle, reduce the times of fluoroscopy and shorten the operation time. Figures and Tables | References | Related Articles | Metrics

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Value of three-dimensional printed fracture model in the repair of complicated distal femoral fractures   Huang Zhiyong, Su Liping, Lan Xiaoquan, Guo Qiang, Ma Jianlin, Huang Jiajun, Zhao Dunxu, Xing Jianlong, Ji Xiang, Zhao Ming 2019, 23 (12):  1859-1863.  doi: 10.3969/j.issn.2095-4344.1124 Abstract ( 293 )   PDF (1363KB) ( 88 )   Save BACKGROUND: Three-dimensional printing has been shown to be available for the auxiliary technology in various bone fractures, but whether it can be applied in the surgery of complicated distal femoral fracture remains unclear. OBJECTIVE: To investigate the value of three-dimensional printed fracture models in the repair of complicated distal femoral fractures. METHODS: One hundred and seven patients with complicated distal femoral fractures and received surgical treatment at the Qingdao Hospital Affiliated to Taishan Medical University were included. Among them, 51 patients underwent conventional internal reduction (conventional group) and 56 patients underwent three-dimensional printing technology before reduction (three-dimensional printing group). All patients were followed up for 1.0-1.5 years. RESULTS AND CONCLUSION: (1) Compared with the conventional group, the operation time, blood loss, times of fluoroscopy, postoperative drainage volume and hospitalization time were significantly decreased in the three-dimensional printing group (P < 0.05). (2) X-ray immediately postoperatively showed fracture reduction, 85.7% satisfaction in the three-dimensional printing group, slightly higher than that in the conventional group (78.4%) (P > 0.05). (3) There was no significant difference in the healing time between two groups (P > 0.05). The excellent and good rate in Hospital for Special Surgery scores at 1 year postoperatively in the three-dimensional printing group (91.1%) was slightly higher than that in the conventional group (84.3%) (P > 0.05). (4) The total incidence of adverse reaction in the three-dimensional printing group (12.5%) was significantly lower than that in the conventional group (31.4%) (P < 0.05). (5) Our results indicate that three- dimensional printing technique can reduce the operation time, and intraoperative blood loss, same treatment outcomes and good safety for complicated distal femoral fractures compared with the conventional surgery. Figures and Tables | References | Related Articles | Metrics

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Accuracy and clinical efficacy of three-dimensional printing and navigation technology assisted lumbar cortical bone trajectory screw placement Wang Xiji, Zhang Yongyuan, Yang Ruize, Hao Dingjun, Sun Honghui 2019, 23 (12):  1864-1869.  doi: 10.3969/j.issn.2095-4344.1125 Abstract ( 321 )   PDF (3075KB) ( 102 )   Save BACKGROUND: Lumbar cortical bone trajectory screw is available for the osteoporotic and obese patients, but un-armed placement exhibits high failure rate and risk, long learning duration and difficulty in grasping.    OBJECTIVE: To compare the accuracy of three-dimensional printing and intraoperative navigation technology assisted lumbar cortical bone trajectory screw placement and unarmed placement, and to explore the advantages of three-dimensional printing technology and intraoperative navigation technology in lumbar surgery.    METHODS: Thirty-two patients with lumbar degenerative diseases and osteoporosis who treated with lumbar cortical bone trajectory screw fixation at Tangdu Hospital, The Military Medical University of Air Forces from January 2017 to January 2018 were enrolled and randomized into three groups. The patients in the three-dimensional printing group (n=10) were placed the lumbar cortical bone trajectory screws by intraoperative pre-printed nail guide. The patients in the navigation group (n=12) were placed the lumbar cortical bone trajectory screws under the aid of navigation. The patients in the unarmed group (n=10) completed the routine examination before surgery and the nails were placed by experience. All patients undertook postoperative CT scans. The accuracy of the nails was divided into four grades according to the degree of screw penetration to assess the accuracy of placement. The perioperative status of the patients in each group was statistically analyzed.    RESULTS AND CONCLUSION: (1) The three-dimensional printing group had 44 cortical bone trajectory screws being inserted (2 L3 screws, 18 L4 screws and 24 L5 screws), 38 of them were classified as grade 0, 6 were grade 1, and no grade 2 or grade 3 was identified. A total of 52 cortical bone trajectory screws were placed in the navigation group (6 L3 screws, 20 L4 screws and 26 L5 screws), 47 of them were classified as grade 0, 5 as grade 1, and no grade 2 or grade 3 was identified. The unarmed group had 40 cortical bone trajectory screws being inserted (4 L3 screws, 16 L4 screws and 20 L5 screws), 27 of them were classified as grade 0, 8 as grade 1, 3 as grade 2, and 2 as grade 3. (2) There were significant differences in the accuracy of nail placement among groups (P=0.010). There was no significant difference between three-dimensional printing and navigation groups (P=0.540), and both groups were better than the unarmed group (P=0.034; P=0.005). (3) The average hospitalization time in the navigation group was less than that in the three-dimensional printing and unarmed groups (P=0.001; P=0.009). The three-dimensional printing group had less intraoperative blood loss than that in the unarmed group (P=0.005), while the operation time was longer than that in the other two groups (P=0.004; P=0.026). (4) One patient in the unarmed group occurred with cerebrospinal fluid leakage, and the other patients had no vascular or neurological complications associated with nail placement. All patients in the three groups did not have displacement loosening or fracture after operation. (5) Our findings suggest that using three-dimensional printing technology and intraoperative navigation can help lumbar cortical bone trajectory screw placement in the treatment of lumbar degenerative disease with osteoporosis. The accuracy of screw placement is high, which can effectively reduce the rate of poor nail placement and prevent postoperative complications. Three-dimensional printing technology can reduce the amount of intraoperative blood loss, and the navigation technology has the advantage in shortening average hospitalization time. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional printing orthopedic implants combined with low-intensity whole-body vibration load repairs bone defect and contributes to osseointegration Li Li, Zhao Yiting, He Shikai 2019, 23 (12):  1870-1874.  doi: 10.3969/j.issn.2095-4344.1111 Abstract ( 332 )   PDF (648KB) ( 98 )   Save BACKGROUND: How to improve the integration of titanium alloy implant with bones and repair results is an important issue in the treatment of bone defects. OBJECTIVE: To study the effects of three-dimensional printed orthopedic implants combined with low-intensity whole-body vibration load on bone defect repair and osseointegration. METHODS: Twenty-four male New Zealand white rabbits were selected for establishing the model of lateral condyle of femur, and randomly divided into observation and control groups (n=12 per group). The control group was treated with porous titanium alloy implants by three-dimensional printing technique, while the observation group was treated with low-intensity whole-body vibration load on the basis of the control group. The morphological parameters, mineralization, osseointegration, and maximal extraction force of rabbit bone tissue were compared between two groups. RESULTS AND CONCLUSION: (1) At 6 and 12 weeks of whole-body vibration stimulation, the parameters of bone tissue in the observation group were better than those in the control group. The relative volume of trabecular bone, trabecular thickness and trabecular bone in the observation group were significantly higher than those in the control group. The resolution and relative trabecular bone surface area in the observation group were significantly lower than those in the control group (P < 0.05). (2) After 6 and 12 weeks of whole-body vibration stimulation in the observation group, the mineralization area ratio, mineralization deposition rate, bone formation rate and maximum extraction force were significantly higher than those in the control group, and the maximum extraction force in the two groups was significantly higher at 12 weeks than that at 6 weeks (P < 0.05). (3) These results indicate that three-dimensional printing of orthopedic implants combined with low-intensity whole-body vibration load can effectively promote the growth of bone tissue, accelerate the repair of bone defects, and improve the effect of osseointegration. Figures and Tables | References | Related Articles | Metrics

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Anatomical measurement of the sacral nailing by digital virtual technology Jia Wenchao, Xue Fei, Feng Wei, Jia Yanfei 2019, 23 (12):  1875-1880.  doi: 10.3969/j.issn.2095-4344.1102 Abstract ( 358 )   PDF (1246KB) ( 84 )   Save BACKGROUND: The surgeons are prone to leak a sacral fracture because of its junction with the spine and pelvis. Misdiagnosis and improper treatment of sacral fracture can cause further nerve injury and later lumbar sacral deformity, and its orthopedic operation is difficult and the curative effect is not as good as fresh fracture. Thereafter, early diagnosis and treatment of sacral fracture are very important. OBJECTIVE: To carry out digital anatomic study of sacral part placement points using digital virtual technology, so as to provide guidance for clinical treatment. METHODS: Sixty cases of adult pelvis CT scan (the ratio of men and women was 1:1) were selected randomly. The three-dimensional model was reconstructed by Mimics 16.0 software, and the measured points were selected. Then the related data were measured on the horizontal and sagittal planes, separately. RESULTS AND CONCLUSION: (1) The midpoint of the interconnections between the lower edge of the L5 and the upper margin of the posterior sacral hole of the S1 was allowed. (2) The midpoint of the line between the lower margin of the sacral hole and the upper margin of the lower sacral posterior orifice, namely the pedicle point of the longitudinal multi scholar, allowed the nail to be placed equally. (3) The differences in the other measurements were insignificant (P > 0.05). (4) To conclude, the digital simulation technique is used to measure the nail point of the sacrum, and the depth and angle of the nailed points of each point can be used as a reference for the treatment of sacral 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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Effect of stiffness change of calcified cartilage zone on the stress of osteochondral structure using finite element analysis   Chen Kaining, Nong Mingshan, Ye Qing, Luo Liuning, Yang Xing, Chen Cheng, Wang Fuyou 2019, 23 (12):  1881-1886.  doi: 10.3969/j.issn.2095-4344.1126 Abstract ( 306 )   PDF (8373KB) ( 63 )   Save BACKGROUND: From childhood to adulthood, and to old age, the stiffness of calcified cartilage zone increases gradually. But it is poorly understood that the effect of stiffness change of calcified cartilage zone on the stress of articular osteochondral structure. OBJECTIVE: To investigate the effect of stiffness change of calcified cartilage zone on the stress of articular osteochondral structure using finite element analysis. METHODS: A finite element model of osteochondral structure was established with hyaline cartilage, calcified cartilage zone and subchondral bone. Then, by simulating the features of childhood, adulthood and old age, three corresponding finite element models were created: calcified cartilage zone soft model, calcified cartilage zone normal model, and calcified cartilage zone hard model. Compression loads (0.5-3.0 MPa) were respectively applied to the three models so as to compare the stress distributions of three layers among three models. RESULTS AND CONCLUSION: (1) When calcified cartilage zone became hard, the maximum stress of itself was 26.51% more than normal, whereas the maximum stress of hyaline cartilage was similar to the normal. (2) When calcified cartilage zone became soft, the maximum stress of itself and hyaline cartilage was 52.09% and 33.93% less than normal, respectively. Besides, the calcified cartilage zone soft model would be out of action when the compression load was higher than 1.0 MPa. (3) In summary, hardened calcified cartilage zone suffers more stress than normal and does no effect on the stress of hyaline cartilage. Softened calcified cartilage zone renders the stresses of itself and hyaline cartilage to be much less than normal and allows osteochondral structure to bear small compression loads. Figures and Tables | References | Related Articles | Metrics

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Effect of cancellous bone on the biomechanics of osteoporotic femoral head fracture under dynamic loading: a finite element analysis   Zheng Liqin, Lin Ziling, Li Pengfei, Chen Xinmin, Sun Wentao, He Xiangxin, Liang Ziyi, Li Musheng 2019, 23 (12):  1887-1892.  doi: 10.3969/j.issn.2095-4344.1091 Abstract ( 512 )   PDF (1414KB) ( 78 )   Save BACKGROUND: The finite element model of hip fracture is simplified into a solid, linear or nonlinear isotropic material. The finite element analysis of hip fracture is based on the stress distribution under static load to predict the location of the fracture, but the exact starting point of the fracture and the process of bone fracture are still not objectively simulated and observed. OBJECTIVE: To investigate the role of cancellous bone in hip fracture and the biomechanical mechanism under dynamic load. METHODS: CT image data of a healthy volunteer’s femur were collected and imported to Mimics software to construct the three-dimensional model. The primary model was imported in Hypermesh to reconstruct a simplified solid model consisting of cortex, cancellous bone, stress trabecular and models were assigned with material property parameters. A load function was set as F=2 500 t, t ≤ 2 s (MPa), the angulation between loading and coronal plane, sagittal plane and horizontal plane was 30°, respectively. Greater trochanter and shaft were constrained. Then, the solver file was exported to LS-DYNA for calculation. The location and moment of initial crack, time-stress curves were recorded in Hyperview. RESULTS AND CONCLUSION: (1) Crack extension started at the posterior of femoral neck in solid model, while at the inferior in hollow and simulation models. The initial crack of the simulation model was smaller than that of solid and hollow model. (2) The Von Mises of each model distributed on the posterolateral side of the femoral neck, and the hollow and simulation models distributed around intertrochanteric region. (3) Initial crack developed at the middle of Von Mises part in solid model, while others developed at the edge of the Von Mises part beneath the femoral neck. (4) All models simulated an impaction of fracture fragments with a wider angle in hollow and solid models. A flat fracture line extended on femoral neck in solid model, on the contrary, hollow and simulation model showed a more rough fracture line both on femoral neck and intertrochanteric region. (5) The stress maximized at the moment of the initial damage and then declined at different rates in all models; the solid one was the highest and steepest, and simulation model showed the most gentle decrease and symmetric stress of compression and tension in time-stress curves. (6) To conclude, the cancellous bone may demonstrate a synergistic effect with cortex during the hip fracture. Figures and Tables | References | Related Articles | Metrics

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Design and biomechanical analysis of the femur proximal modular intercalary prosthesis Zhong Junqing, Hu Yongcheng 2019, 23 (12):  1893-1897.  doi: 10.3969/j.issn.2095-4344.1092 Abstract ( 384 )   PDF (1432KB) ( 71 )   Save BACKGROUND: There are few studies on the biomechanical characteristics of large segment bone defects caused by femur proximal tumor resection filled with prosthesis, and the feasibility of prosthesis remains controversial. OBJECTIVE: To explore the feasibility of femur proximal modular intercalary prosthesis from a biomechanical perspective. METHODS: Image data of the total femur were acquired by CT for three-dimensional reconstruction in Mimics 10.01 software. The reconstructed femur in IGES format was imported into Abaqus 6.91 software to undergo the finite element analysis. Femur proximal modular intercalary prosthesis was used to reconstruct the proximal femur, central diaphysis and distal femur and loaded by the normal walking force, and then the peak stress and stress nephogram were obtained. RESULTS AND CONCLUSION: (1) After diaphysis defect reconstructed by femur proximal modular intercalary prosthesis, the bone cement stress peak did not exceed the fatigue strength itself. Cortical bone stress peak did not exceed the maximum compressive stress peak itself. Stress concentration of the femur proximal modular intercalary prosthesis appeared at the junction of the prosthesis and bone-sectional and rebuild part of the prosthesis. (2) In summary, the femur proximal modular intercalary prosthesis reconstructs the femoral diaphysis defect, which is consistent with the requirements of human biomechanics, so it can be applied in clinical practice. Figures and Tables | References | Related Articles | Metrics

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Biomechanics characteristics of Colles distal radius fracture based on finite element analysis Zhang Chaoju, He Chuan, Chen Hongwei, Pang Qixiong, Wan An, Liu Daodong, Tsang WWN, Li Xiaolin 2019, 23 (12):  1898-1902.  doi: 10.3969/j.issn.2095-4344.1127 Abstract ( 367 )   PDF (845KB) ( 137 )   Save BACKGROUND: Incidence of distal radius fracture caused by fall in older adults is high in the clinic. Studying the pathogenesis and preventing fracture in view of biomechanics are critical, but is little reported. OBJECTIVE: To explore the biomechanical characteristics of Colles distal radius fracture. METHODS:A healthy male 29-year-old volunteer was selected, and CT scanning of the forearm, wrist and hand was taken. CT data were imported into Mimics 10.01 software to establish the finite element model of distal radius fracture in extended wrist. Palm side of the model was restricted, and imposed a speed load at 2 m/s and vertical direction. Afterwards, the stress distribution on the soft tissues and bones of wrist was observed. RESULTS AND CONCLUSION: A real and effective finite element model of the distal radius fracture in extended wrist was established. After loading, the stress of soft tissues mainly concentrated on the hypothenar of palm and wrist dorsal region. The stress of bones mainly concentrated on the bottom of ulna and radius. Stress on the dorsal radius was largest. The volar stress mainly concentrated on the middle and low segments of ulna and radius and middle of wrist. The stress of ulna and radius was asymmetry. These results can be used for the explaining the mechanism of Colles distal radius fractures and provide the biomechanical basis for the prevention of fall-induced fracture. Figures and Tables | References | Related Articles | Metrics

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Biomechanical analysis of foot crush injury based on finite element model Zhang Hong, Fan Yali, Yang Donghao, Ren Guoshan, Zhou Yuning, Yan Zhanping 2019, 23 (12):  1903-1907.  doi: 10.3969/j.issn.2095-4344.1118 Abstract ( 487 )   PDF (1701KB) ( 70 )   Save BACKGROUND: Mechanical distribution and damage of foot bones under rolling condition are simulated by using the established foot finite element digital model. OBJECTIVE: To simulate the crush injury by using the three-dimensional finite element model of foot, and to explore a new technique for studying the stress and damage of human foot by finite element method. METHODS: Foot (bones and joints from toe to distal tibia and distal fibula) of one female volunteer underwent CT scanning. The three-dimensional reconstructed digital model was imported into the ANSYS 13.0 software. The finite element mechanical analysis of simulating crush injury was carried out by setting 100, 200, 500 and 1 000 N of pressure, and solving the test calculation. RESULTS AND CONCLUSION: (1) Under rolling condition, the stress of foot bones was increased with pressure increasing, and the maximum stress occurred on the anteromedial heel. (2) Metatarsal stress mainly concentrated on the first, second and third metatarsuses. (3) Tarsal stress mainly concentrated on the joints between tarsus and metatarsus, and joints between tarsuses. (4) With the pressure increasing, the stress gradually concentrated on the medial side of tarsometatarsal joint. The stress of medial cuneiform bone was larger than the other tarsuses. (5) Finite element stress analysis of tarsometatarsal joint under simulated crush injury shows that the maximum stress and the site of the strain in the case of crush injury is consistent with that of the patients with clinical tarsal injury, and indirectly confirms the reliability of the finite element model, which can provide a digital platform for the study on tarsal and plantar joint damage. Figures and Tables | References | Related Articles | Metrics

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Clinical complications and analysis of internal fixation through the second iliac crest screw technique   He Chenyang, Wu Yonggang, Zhao Yan 2019, 23 (12):  1908-1914.  doi: 10.3969/j.issn.2095-4344.1128 Abstract ( 398 )   PDF (1395KB) ( 104 )   Save BACKGROUND: The second iliac crest screw technique was first proposed in 2007 as an alternative to traditional tibial screws. This technique has less tissue dissection and can be directly docked with the pedicle screw of the superior vertebral body without the need for a connecting rod, special pre-bending and additional connecting rods and holds deep entry points. It has been widely used in spinalpelvic fixation. OBJECTIVE: To summarize new advances in the second iliac crest screw technique and provide new ideas for clinical complication prevention. METHODS: WanFang, CNKI and PubMed databases were retrieved for related literature published from 1990 to 2018. The keywords were “the second iliac crest screw, iliac screws, complication, infection, loose screws, screw break, proximal junctional kyphosis, PJK, sacroiliac joint degeneration, screw protruding, incision split” in Chinese and English, respectively. The old and repeated views were excluded, and the eligible articles were included for review. RESULTS AND CONCLUSION: Forty-six articles were included. (1) The second iliac crest screw is similar in biomechanical strength to iliac screws. (2) The incidence of complications such as loosening, rupture, wound infection, and symptomatic screw protrusion of the second iliac crest screw is significantly lower than that of the tibial screw. (3) The degeneration of the sacroiliac joint degeneration and pseudoarticular formation of borderline kyphosis is close to that of the tibial screw. Most of the screws with a rupture of the second iliac crest screw are concentrated at 8 mm or less, and the fracture position is mostly at the neck where the screw head and the nail body meet. In addition, the uninsertion of the S1 screw is also a risk factor for S2AI broken nails. (4) Implantation of S2AI cannot result in sacroiliac joint degeneration. (5) Choosing shorter, thicker screws for clinical placement of S2AI and proper reinforcement of the screw neck during production may help prevent S2AI fracture. Figures and Tables | References | Related Articles | Metrics

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Clinical problems of single photon emission computed tomography/CT applied in accurate diagnosis and location of spinal surgery Lin Yujiang, Lin Yong, Wang Dechun, Yang Limin, Wei Jianwei 2019, 23 (12):  1915-1920.  doi: 10.3969/j.issn.2095-4344.1129 Abstract ( 373 )   PDF (2431KB) ( 148 )   Save BACKGROUND: MRI has some limitations in the accurate diagnosis and localization of some diseases in spine surgery. With the wide application of single photon emission computed tomography/CT in spine surgery, it has unique value and advantages in clinical diagnosis and localization. OBJECTIVE: To evaluate the application value of single photon emission computed tomography/CT in accurate diagnosis and location of spine surgery. METHODS: The imaging examination of single photon emission computed tomography/CT and X-ray, CT and MRI of the patients at Eastern Branch of Qingdao Municipal Hospital from January to December 2017 were compared. The advantages and problems of single photon emission computed tomography/CT in the diagnosis and localization of lumbar facet joint disorder, thoracolumbar vertebral compression fracture, postoperative lumbar and back pain, and spinal malignant tumors were summarized and analyzed. RESULTS AND CONCLUSION: (1) Due to high sensitivity, single photon emission computed tomography/CT has a unique advantage in lumbar facet joint disorder, postoperative lumbar back pain, and early diagnosis of spinal malignant tumors. (2) However, there is a false positive rate in the diagnosis of thoracolumbar vertebral compression fracture, but there is a false negative rate in the diagnosis of spinal tumors with osteolytic destruction. (3) Single photon emission computed tomography/CT is of great value in the clinical application of precise diagnosis and location in spine surgery. Figures and Tables | References | Related Articles | Metrics

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Regulation of PI3K/Akt/mTOR signaling pathway on autophagy in steroid-induced avascular necrosis of the femoral head Li Yunlong, Zhao Zhenqun, Liu Wanlin 2019, 23 (12):  1921-1929.  doi: 10.3969/j.issn.2095-4344.1130 Abstract ( 818 )   PDF (1083KB) ( 87 )   Save BACKGROUND: Studies at home and abroad have shown that autophagy is correlated with steroid-induced avascular necrosis of the femoral head. Controlling PI3K/Akt/mTOR signaling pathway may regulate autophagy, which has a certain therapeutic effect on the disease. OBJECTIVE: To summarize and discussion the latest research progress of autophagy in steroid-induced avascular necrosis of the femoral head by introducing the regulation of PI3K/Akt/mTOR signaling pathway on autophagy and the relationship between autophagy and steroid-induced avascular necrosis of the femoral head. METHODS: Relevant articles published from 2008 to 2018 were retrieved from PubMed, Web of science and WanFang databases. The keywords were “steroid, necrosis of the femoral head, autophagy, signal pathway” in English and Chinese, respectively. The old and duplicate articles were excluded, and 83 articles were included for analysis and discussion. RESULTS AND CONCLUSION: (1) PI3K/Akt/mTOR signaling pathway is an inhibitory pathway, which can negatively regulate autophagy. Activating this pathway can inhibit autophagy. On the contrary, inhibiting this pathway can induce autophagy. (2) Hormone-induced apoptosis and autophagy are related to its dosage. Low dose of hormone can activate autophagy, while high dose of hormone can induce apoptosis. (3) Autophagy has two-way effect on steroid-induced avascular necrosis of femoral head. Positive effect is to improve steroid-induced avascular necrosis of femoral head. Negative effect is to induce steroid-induced avascular necrosis of femoral head and accelerate its deterioration. Figures and Tables | References | Related Articles | Metrics

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Role of neutrophil extracellular traps in venous thromboembolism Zhao Jingbin, Zhang Xiaopeng, Zhou Dong 2019, 23 (12):  1930-1935.  doi: 10.3969/j.issn.2095-4344.1583 Abstract ( 557 )   PDF (1106KB) ( 111 )   Save BACKGROUND: In recent years, the incidence of venous thromboembolism has increased yearly. Some studies have found that neutrophil extracellular traps participate in the initiation and growth stages of thrombosis, and have close relationship with endothelial cells, platelets and coagulation pathways embolism. OBJECTIVE: To explore the relationship between neutrophil extracellular traps and venous thromboembolism, and to find a new direction in the diagnosis and treatment of venous thromboembolism. METHODS: Databases of WanFang, CNKI, VIP, PubMed, Web of Science and Medline were searched with the keywords of “neutrophil extracellular traps, venous thromboembolism, deep vein thrombosis, pulmonary embolism” in Chinese and “NETs, VTE, DVT, PE” in English for the literature concerning neutrophil extracellular traps and venous thromboembolism published from 2004 to March 2018. The types of literature included journal article, conference literature, dissertation and review. RESULTS AND CONCLUSION: Initially 1 226 articles were retrieved involving 1 094 English and 132 Chinese articles, and finally 50 eligible articles were enrolled for summarization based on the inclusion and exclusion criteria. The formation of a neutrophil extracellular trap is a cascade cell death program called NETosis, which is a cell death mode that is different from apoptosis and necrosis. The neutrophil extracellular trap is involved in the initiation and growth stages of thrombosis. Activation of endothelial cells and release of Weibel-Palade bodies play an important role in the initial stage of thrombosis. The neutrophil extracellular trap serves as a scaffold for platelet adhesion and aggregation. The Neutrophil extracellular trap also participates in the coagulation process via endogenous and exogenous pathways.  Figures and Tables | References | Related Articles | Metrics

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Research and advances of physical therapy based on biomechanics Jiang Yong, Zheng Yili, Xu Shengjia 2019, 23 (12):  1936-1942.  doi: 10.3969/j.issn.2095-4344.1131 Abstract ( 484 )   PDF (1006KB) ( 107 )   Save BACKGROUND: Effect of physical therapy can implicate its integral effect in modulating cellular behavior and subsequent tissue adaptation. The relationship between movement biomechanics, physical therapy, and subsequent cellular and tissue mechanoadaptation is not well established in the literature. OBJECTIVE: To summarize the mechanism of physical therapy: mechanical transduction from organ to cell and extracellular matrix formation and organ remodeling/construction. METHODS: The relevant articles were searched in PubMed and MEDLINE database from 1994 to 2018. The keywords were “mechanobiology, mechanotherapy, mechanotransduction, mechanical stimuli, biomechanical, physical therapy, exercise therapy, manual therapy, rehabilitation, tissue engineering, tissue regeneration” in English. RESULTS AND CONCLUSION: (1) Totally 142 articles were searched, and 57 eligible articles were enrolled after excluding the repetitive and irrelevant articles. (2) Mechanical stimuli can be controlled at physiological levels that encourage and stimulate constructive tissue adaptation and remodeling through physical therapy. (3) By directing loading regimens to specific sites, and having an understanding of the mechanotransduction and mechanobiological response, physical therapy can promote healing and rehabilitation. (4) Exercise therapies, manual mobilization and other physical stimulation modes (joint loading and dynamic hydraulic stimulation) used in physical therapy may be tailored to facilitate the recruitment, migration and targeted lineage commitment of stem cells, to expedite tissue regeneration, and optimal remodeling such that healed tissues meet or exceed their native mechanical strength. Figures and Tables | References | Related Articles | Metrics

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Early versus delayed reconstruction of anterior cruciate ligament injuries in children and adolescents is associated with the risks of meniscus and articular cartilage injury: a meta-analysis   Gu Xiaodong, Zhao Ruipeng, Che Xianda, Li Pengcui, Wei Xiaochun 2019, 23 (12):  1943-1948.  doi: 10.3969/j.issn.2095-4344.1027 Abstract ( 463 )   PDF (1111KB) ( 99 )   Save BACKGROUND: Surgical treatment is mostly advocated in children and adolescents with anterior cruciate ligament injury, but the impact of surgical timing and different surgical timing on the risk of secondary meniscus and cartilage injury is still controversial. OBJECTIVE: To evaluate the effects of early or delayed anterior cruciate ligament reconstruction on the risk of secondary meniscus and articular cartilage injury in children and adolescents. METHODS: A computer-based online search was conducted in Medline, Embase, Cochrane Library, WanFang, and CNKI databases until March 2018. The articles about anterior cruciate ligament rupture in children or adolescents (< 19 years old) undergoing ligamentous reconstruction, and injuries of meniscus and knee cartilage at different operation times were collected in accordance with the inclusion and exclusion criteria. Meta-analysis was performed using Review Manager 5.3 software. RESULTS AND CONCLUSION: Five articles involving 849 patients were included. Meta-analysis showed that early anterior cruciate ligament reconstruction after anterior cruciate ligament rupture in children and adolescents could significantly reduce the risk of medial meniscus injury (OR=0.40, 95%CI 0.25-0.67, P=0.000 4). At the same time, the risk of secondary lateral meniscus injury in early ligament reconstruction was reduced (OR=0.70, 95%CI 0.53-0.93, P=0.01). In terms of articular cartilage injury, compared with delayed reconstruction, early reconstruction could reduce the incidence of injuries of femoral condyle cartilage (OR=0.25, 95%CI 0.12-0.53, P=0.000 3), tibial plateau cartilage (OR=0.41, 95%CI 0.25-0.67, P=0.000 4) and patellofemoral joint cartilage (OR=0.35, 95%CI 0.16-0.77, P=0.009). In summary, for children and adolescents with anterior cruciate ligament rupture, early anterior cruciate ligament reconstruction can reduce the incidence of secondary medial and lateral meniscus, femoral condyle cartilage, tibial plateau cartilage and patellofemoral cartilage injuries.  Figures and Tables | References | Related Articles | Metrics

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Methods for establishing rat models of spinal cord injury: a meta-analysis Wei Weibing, Zhou Binbin, Li Bolin, Qin Jingyu, Feng Zhenfen, Li Jiannan 2019, 23 (12):  1949-1954.  doi: 10.3969/j.issn.2095-4344.0561 Abstract ( 348 )   PDF (1350KB) ( 98 )   Save BACKGROUND: A safe and effective spinal cord injury rat model with high clinical similarity is important for the studies on changes in the pathophysiology and anatomy of spinal cord injury. There are various modeling methods, so choosing which one still remains controversial. OBJECTIVE: To compare the efficacy and mortality of various models of spinal cord injury contusion type, compression type, ischemic injury type, and transverse type using a meta-analysis so as to provide evidence for establishing rat models of spinal cord injury. METHODS: Databases of PubMed, CNKI, VIP and WanFang were searched for the literature concerning spinal cord injury modeling methods published before March 11, 2018. The literature screening and data extraction were conducted. Mesh analysis was performed on Stata and Winbug software to obtain the efficacy results. RESULTS AND CONCLUSION: A total of 17 eligible articles were included, involving 506 Sprague-Dawley rats. The order of the effectiveness of spinal cord injury model was as follows: transverse > contusion > compression > ischemic injury. The order of mortality was as follows: transverse > contusion > compression > ischemic injury. Figures and Tables | References | Related Articles | Metrics

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Combination of alendronate sodium tablets and ossotide for injection for primary osteoporosis: a meta-analysis   Lin Jiyong, Huang Lan, Liang Fengzhen, Shang Yuzhi, Zhang Qinghuai, Fang Gang, Pang Yuzhou 2019, 23 (12):  1955-1960.  doi: 10.3969/j.issn.2095-4344.1051 Abstract ( 298 )   PDF (1211KB) ( 90 )   Save BACKGROUND: Alendronate combined with injection of ossotide has been extensively applied in the treatment of primary osteoporosis, but there is still lack of evidence-based medicine. OBJECTIVE: To systematically evaluate the efficacy and safety of alendronate combined with injection of ossotide for primary osteoporosis. METHODS: Cochrane, Web of Science, PubMed, CBM, CNKI, WanFang, and VIP databases were retrieved for the articles published from August 2008 to August 15, 2018. Literature screening, data extraction, and quality evaluation were conducted by two reviewers. Meta-analysis was undergone on Review manager 5.3 software. RESULTS AND CONCLUSION: (1) Thirteen randomized controlled trials involving 1 579 patients were included, including trial group (n=792, alendronate sodium tablets + ossotide for injection + calcium carbonate and vitamin D3 tablets, or alendronate sodium tablets + ossotide for injection) and control group (n=787, alendronate sodium tablets + calcium carbonate and vitamin D3 tablets, or calcium carbonate and vitamin D3 tablets). The results of meta-analysis showed that the OR value of cohort effect was 5.67, and 95%CI was [4.02, 8.00]. The efficacy between two groups was differently different (P < 0.000 01). The effective rate in the trial group (94.44%) was higher than that in the control group (74.97%). The total curative efficacy of alendronate sodium tablets combined with ossotide for injection in the treatment of primary osteoporosis was significantly superior to the control group. (2) Alendronate sodium tablets combined with ossotide for injection can improve the curative efficacy in the treatment of primary osteoporosis. However, due to the low quality of literature, unclear clinical trial randomized methods, and follow-up deficiency, the treatment outcome of the combination of alendronate sodium tablets and ossotide for injection for primary osteoporosis still needs a further investigation. Figures and Tables | References | Related Articles | Metrics

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Minimally invasive percutaneous plate osteosynthesis versus open reduction internal fixation through dehopectoral approach for proximal humeral fracture: a meta-analysis    Shu Li, Ju Xiaochen, Wu Ping, Zhang Lei 2019, 23 (12):  1961-1968.  doi: 10.3969/j.issn.2095-4344.1113 Abstract ( 343 )   PDF (1344KB) ( 85 )   Save BACKGROUND: Conventional deltopectoral approach for reduction and internal fixation is widely used in clinical practice. Anterolateral deltoid-split approach is a new technique emerging in recent years, and whether it has advantages in the treatment of proximal humeral fractures remains controversial. OBJECTIVE: To compare the efficacy of minimally invasive percutaneous plate osteosynthesis versus open reduction internal fixation through dehopectoral approach for proximal humeral fracture using a meta-analysis. METHODS: Medline, EMBASE, the Cochrane Library, Cochrane Register, CBM, and CNKI databases were retrieved for the clinical trials concerning the efficacy of percutaneous plate osteosynthesis versus open reduction internal fixation through dehopectoral approach for proximal humeral fracture published from January 1995 to December 2017. The studies were screened according to the inclusion and exclusion criteria and methodology quality was performed. A meta-analysis was conducted on and Review Manager 5.3.2 software. RESULTS AND CONCLUSION: (1) Twenty-one studies involving 1 625 patients (minimally invasive group, n=808; conventional group, n=817) were included. (2) The meta-analysis results showed that the minimally invasive group was significantly superior to the conventional group in the operation time, intraoperative blood loss, postoperative Visual Analogue Scale scores, fracture healing time, the incidence of humeral head osteonecrosis, and the Constant scores at postoperative 3 months (P < 0.05). (2) There were no significant differences in the Constant scores at postoperative 12 months and complications between two groups (P > 0.05). (4) In summary, compared with the traditional open reduction internal fixation, minimally invasive percutaneous plate osteosynthesis has advantages of minimal trauma and short-term effects. There is no significant difference in the long-term curative effect or complications. Due to part of the literature is not high-quality randomized controlled trails, the conclusion may exist bias; therefore, more high-quality randomized controlled trials are required to draw more reliable conclusions. Figures and Tables | References | Related Articles | Metrics