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18 July 2019, Volume 23 Issue 20 Previous Issue    Next Issue

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Whether direct anterior approach for total hip arthroplasty is a risk factor of eccentric reaming to the anterior column of the acetabulum? Su Lianbin, Feng Eryou, Zhang Yiyuan, Zhuo Youguang, Xiao Lili, Wang Wulian, Lin Feitai 2019, 23 (20):  3117-3123.  doi: 10.3969/j.issn.2095-4344.1192 Abstract ( 351 )   PDF (650KB) ( 85 )   Save BACKGROUND: Direct anterior approach has been reported to be associated with a risk of reaming the anterior column of the acetabulum, but there is little evidence supporting this opinion. OBJECTIVE: To reveal differences in the bone stock of the anterior and posterior columns between the direct anterior approach and the posterolateral approach in total hip arthroplasty by CT measurement. METHODS: Sixty cases of primary total hip arthroplasty through direct anterior approach (n=30) or posterolateral approach (n=30) at Fuzhou Second Hospital of Xiamen University from October 2015 to December 2017 were enrolled. The cross-sectional area of the anterior and posterior column of the acetabulum, the height of the anterior and posterior column, acetabular diameter, and anteversion were measured by CT. All researchers had 5-10 years of clinical experience, and the surgeons were associate chief physicians or above. The trial has been approved by the Ethics Committee of Fuzhou Second Hospital of Xiamen University on June 1, 2017. All patients signed the written informed consents. RESULTS AND CONCLUSION: (1) The postoperative cross-sectional area of the anterior and posterior column of the acetabulum, and the height of the anterior and posterior column in the two groups were less than those at baseline (P < 0.05), the acetabular diameter was larger than that at baseline (P < 0.01), and the anteversion showed no significant difference (P > 0.05). The area of the anterior column in the direct anterior approach group was higher than that in the posterolateral approach group (P < 0.05), and other parameters were insignificantly different between two groups (P > 0.05). (2) In summary, compared with posterolateral approach in total hip arthroplasty, direct anterior approach leads to increased area of the anterior column, and made no effect on other parameters. Thereafter, direct anterior approach is not a risk factor for eccentric reaming the anterior column of acetabulum, and the conclusion needs to be confirmed by multicenter, prospective randomized controlled trials. Figures and Tables | References | Related Articles | Metrics

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Optimized use of tourniquet in total knee arthroplasty   Zhao Juntao, Zheng Chengsheng, Wang Bo 2019, 23 (20):  3124-3129.  doi: 10.3969/j.issn.2095-4344.1233 Abstract ( 396 )   PDF (1223KB) ( 102 )   Save BACKGROUND: Pneumatic tourniquet can reduce bleeding in operation area and provide clear surgical visual field. However, because of its many collateral injuries, scholars at home and abroad have more controversies on the application of tourniquet. OBJECTIVE: To investigate the clinical efficacy of optimized use of tourniquet in total knee arthroplasty. METHODS: Clinical data of 96 patients with osteoarthritis who underwent primary unilateral total knee arthroplasty at the People’s Hospital of Hebi from December 2016 to June 2018 were retrospectively analyzed. The patients were divided into two groups according to the strategy of tourniquet. The control group (n=56) was treated with tourniquet before osteotomy and removed after bone cement fixation. The observation group (n=40) used tourniquet only in bone cement fixation. The operation time, tourniquet usage time, intraoperative blood loss, postoperative blood loss, and incidence of complications were recorded. The Visual Analogue Scale score, Hospital for Special Surgery score, range of motion of the knee joint, swelling of the affected limb, quadriceps muscle strength recovery and surgical satisfaction at postoperative 3 days were evaluated and compared. RESULTS AND CONCLUSION: (1) There was no significant difference in the operation time and total blood loss between two groups (P > 0.05). The tourniquet usage time in the observation group was significantly shorter than that in the control group (P < 0.05). The intraoperative blood loss in the observation group was higher than that in the control group, and the postoperative blood loss and hidden blood loss in the observation group were lower than those in the control group (P < 0.05). (2) The postoperative Visual Analogue Scale score, range of motion of the knee joint, Hospital for Special Surgery score, the swelling rate of the affected limbs, straight leg raise to 45°, and postoperative satisfaction in the observation group were significantly higher than those in the control group (P < 0. 05). (3) The incidence of postoperative complications in both groups showed no significant difference (P > 0.05). (4) In summary, the optimized use of tourniquet can reduce postoperative pain, swelling and drainage, promote the recovery of muscle strength and joint function, improve the satisfaction of patients, and has no significant effect on the total blood loss of total knee arthroplasty, but it can increase the intraoperative blood loss. Figures and Tables | References | Related Articles | Metrics

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Self-control versus continuous passive motion exercise following primary total knee arthroplasty Zhang Hui, Liu Biquan, Li Hong, Liu Jingjun, Gan Yuyun, Li Lunlan, Yin Zongsheng 2019, 23 (20):  3130-3135.  doi: 10.3969/j.issn.2095-4344.1234 Abstract ( 346 )   PDF (1253KB) ( 100 )   Save BACKGROUND: Functional exercise after total knee arthroplasty is critical for the recovery of knee joint function. Continuous passive motion exercise used to be a standard exercise method, but its effect is controversial, and self-controlled exercise can achieve satisfactory functional recovery. OBJECTIVE: To explore the difference between self-control and continuous passive motion function exercise during hospitalization following total knee arthroplasty. METHODS: Eighty patients who underwent primary unilateral total knee arthroplasty were divided into two groups (n=40/group), and then underwent active self-control and continuous passive motion functional exercise at postoperative 24 hours. The study was approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University, and all participants signed the informed consents. The baseline data, hospitalization time, drainage volume, hemoglobin level, and range of motion and Visual Analog Scale score at rest at 1, 3, 5 and 7 days post-operation were evaluated and compared between two groups. RESULTS AND CONCLUSION: (1) There was no significant difference in the baseline data between two groups (P > 0.05). (2) Postoperative Visual Analog Scale score at rest, maximum extension angle, hospitalization time, hemoglobin level and hematocrit showed no significant difference between two groups (P > 0.05). (3) The maximal flexion angle at 7 days post-operation and circumference of knee joint at 3 days post-operation in the active self-control group were significantly superior to those in the continuous passive motion group (P < 0.05). (4) These results indicate that there is no significant difference between self-control method and the traditional continuous passive motion function exercise following total knee arthroplasty. Continuous passive motion cannot be used as a routine method, and self-control function exercise can meet the clinical needs. Figures and Tables | References | Related Articles | Metrics

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Clinical application of individualized tourniquet pressure in primary total knee arthroplasty Zhou Jianguo, Hu Weiquan, Bi Shengrong, Hu Bijuan, Liu Shiwei, Xiong Long, Qian Rui 2019, 23 (20):  3136-3142.  doi: 10.3969/j.issn.2095-4344.1235 Abstract ( 422 )   PDF (1497KB) ( 98 )   Save BACKGROUND: Total knee arthroplasty is a routine surgical procedure for joint surgery. Tourniquet has been widely used in total knee arthroplasty. However, there is no unified understanding of how to select the appropriate tourniquet pressure, and whether the selection of appropriate individual tourniquet pressure is helpful to the enhanced rehabilitation of patients undergoing total knee arthroplasty needs further investigation. OBEJCTIVE: To investigate the clinical efficiency and complications of individualized tourniquet pressure in patients undergoing primary total knee arthroplasty. METHODS: One hundred patients with primary unilateral total knee arthroplasty were enrolled and randomly divided into trial and control groups, 50 in each group. The limb occlusion pressure was determined as tourniquet pressure by Doppler ultrasound in the trial group, while 70 kPa pressure was chosen as tourniquet pressure in the control group. All patients signed the informed consents and the study was approved by the ethics committee of the hospital. The intraoperative blood loss, postoperative drainage volume, hidden blood loss, total blood loss and the incidence of deep venous thrombosis were recorded. The Visual Analogue Scale score, range of motion of knee joint and lower extremity swelling at 1, 3 and 5 days after surgery, and the Hospital for Special Surgery score at 1 month after surgery were compared. RESULTS AND CONCLUSION: (1) The Visual Analogue Scale scores at rest and in activity at 1 and 3 days after surgery and in activity at 5 days after surgery in the trial group were significantly lower than those in the control group (P < 0.05). There was no significant difference in the Visual Analogue Scale scores at rest at 5 days after surgery between two groups (P > 0.05). (2) The lower extremity swelling at 1 and 3 days after surgery in the trial group was significantly lighter than that in the control group (P < 0.05), and there was no significant difference at 5 days after surgery between two groups (P > 0.05). (3) There was no significant difference in the range of motion of knee joint at 1, 3, and 5 days after surgery between two groups (P > 0.05). (4) There was no significant difference in the Hospital for Special Surgery score, intraoperative blood loss, postoperative drainage volume, hidden blood loss and total blood loss at 1 month after surgery between two groups (P > 0.05). (5) These results indicate that the individualized tourniquet pressure assisted by Doppler ultrasound contributes to relieving early pain and lower extremity swelling after primary total knee arthroplasty, and can accelerate the functional recovery. Figures and Tables | References | Related Articles | Metrics

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Comparison of one-year follow-up effectiveness between high tibial osteotomy and unicompartmental knee arthroplasty for treating medial compartment osteoarthritis of the knee Chen Ruihong, Ge Hongqing, Chen Wenzhi 2019, 23 (20):  3143-3147.  doi: 10.3969/j.issn.2095-4344.1199 Abstract ( 400 )   PDF (2240KB) ( 88 )   Save BACKGROUND: Patients with medial compartment osteoarthritis of the knee often receive unicompartmental knee arthroplasty or high tibial osteotomy treatment. However, which one is the optimal choice remains controversial. OBJECTIVE: To compare the short-term effectiveness of high tibial osteotomy and unicompartmental knee arthroplasty in the treatment of medial compartment osteoarthritis of the knee. METHODS: Thirty-eight patients with medial compartment osteoarthritis of the knee from May 2016 to August 2017 were enrolled. Eighteen patients were treated with high tibial osteotomy, and 20 patients were treated with unicompartmental knee arthroplasty. Tegner activity score and Lysholm knee score were compared to assess the functional recovery of knee joint. The femorotibial angle was measured on X-ray, and the cartilage degeneration of each compartment was evaluated.  RESULTS AND CONCLUSION: (1) All incision healed primarily in both groups. All patients were followed up for 1.0-2.8 years in the high tibial osteotomy group and 1.0-3.2 years in the unicompartmental knee arthroplasty group. (2) There were significant differences in the Tegner activity score, Lysholm knee score, and femorotibial angle in the two groups before and after operation, showing that both groups could improve mobility function and correct deformity (P < 0.05). There was no significant difference in all above indexes between two groups (P > 0.05). (3) These results indicate that both high tibial osteotomy and unicompartmental knee arthroplasty can achieve good short-term effectiveness for treating medial compartment osteoarthritis of the knee; however, the long-term effectiveness needs further investigation. Figures and Tables | References | Related Articles | Metrics

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A finite element analysis of loading velocity affecting femoral neck fracture propagation Zheng Liqin, Lin Ziling, Chen Xinmin, Liang Ziyi, Li Musheng, Zheng Yongze 2019, 23 (20):  3148-3152.  doi: 10.3969/j.issn.2095-4344.1180 Abstract ( 341 )   PDF (1433KB) ( 125 )   Save BACKGROUND: It is a dynamic development in fracture, but the traditional finite element method cannot precisely predict the fracture initiation, crack process, the stress, strain and crack propagation. OBJECTIVE: To simulate and investigate the influence of fall load velocity on crack propagation in femoral neck fracture. METHODS: CT data of femur from a healthy volunteer were collected and imported to Mimics 19.0 software, after region growing, editing, smoothing and wrapping, a three-dimensional finite element model of proximal femur was created. The primary model was imported in Hypermesh 14.0 for meshing of trabecular and cortical bone, defining material properties, setting boundary conditions, simulating fall in internal rotation and adduction, and loaded with load-time function (F1=2 500t; F2=(10 000/3)t; F3=5 000t; F4=10 000t). The integrated K file was finally calculated in LS-DYNA. RESULTS AND CONCLUSION: (1) The initial crack started at the inferior-posterior of femoral neck with a velocity-dependent manner in primary length. (2) The maximum stress distributed on the inferior-posterior of femoral neck but with a negative correlation between loading velocity in distributing region from intertrochanteric to neck. (3) The compressive strain mainly demonstrated on the inferior-posterior of femoral neck that consistent with the propagation of crack. (4) Higher the loading rate was, earlier the damage began, fewer the time needed to fracture, faster the crack developed, and rougher the fracture line were and larger the Pauwels angle formed. (5) In summary, fall loading rate is an important exogenous factor in femoral neck fracture propagation, which affects hip fracture types. Figures and Tables | References | Related Articles | Metrics

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Manipulation analysis of Mongolian osteopathy based on finite element model of ulna and radius Li Zhongxian, Ji Yucheng, Weng Yujie, Ning Pengfei 2019, 23 (20):  3153-3157.  doi: 10.3969/j.issn.2095-4344.1132 Abstract ( 446 )   PDF (1241KB) ( 81 )   Save BACKGROUND: Mongolian osteopathy is famous for the complicated manipulation and theoretical complexity. Combined with the finite element fracture model of ulnar and radial fractures, relevant reports have been illustrated, but there is a lack of study on Mongolian medical osteopathic manipulation in terms of mechanical characteristics. OBJECTIVE: To simulate the force of various fractures of ulna and radius using Mimics Research and ABAQUS, to establish the model of ulnar and radial fractures, and to evaluate the effect and analyze the manipulation mechanism of the corresponding fractures. METHODS: A 35-year-old volunteer was selected to obtain the CT image data of the right forelimb. The data were imported into Mimics 17.0 software to establish the geometric model of the radius and ulna. After pre-processing by 3-Matic Studio, the material parameters were set up by ABAQUS 6.14 software; the mesh was divided, and the load parameters were assigned for analysis and calculation. RESULTS AND CONCLUSION: (1) The stress distribution of the fracture model of the ulna and radius was highly consistent with previous studies of the forearm. The mechanical models of direct, indirect and torsional violence were obtained in the direction of stress. After adjusting the mechanical parameters of bone, the fracture models of different ages could be simulated. (2) These results indicate that the finite element model based on Mimics and ABAQUS is feasible, which can simulate the fracture of ulna and radius, and the direction of stress load plays an important role in determining the manipulation of Mongolian osteopathy. The above conclusions can provide a manual reference for the treatment of fractures of ulna and radius with Mongolian osteopathy. Figures and Tables | References | Related Articles | Metrics

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Individualized design and clinical application of metacarpophalangeal joint prosthesis: a one-case report Zhong Hua, Liu Jun, Cai Guoxiang, Duan Shaoyin 2019, 23 (20):  3164-3169.  doi: 10.3969/j.issn.2095-4344.1200 Abstract ( 379 )   PDF (1491KB) ( 91 )   Save BACKGROUND: Clinically, most of the metacarpophalangeal joints are directly amputated after severe injury. This study is mainly aimed at the treatment of severe destruction of metacarpophalangeal joint (individualized prosthesis arthroplasty), in order to restore some functions of hand. OBJECTIVE: Three-dimensional-printing technology and mechanical processing were used to produce prosthesis of metacarpophalangeal joint with medical-grade polyether-ether-ketone material, then to discuss their individualized design, manufacture and clinical application. METHODS: (1) One man with sprained right hand by machine, at the age of 64 years. Both hands were scanned with spiral CT before surgery, then the prosthesis of right metacarpophalangeal joint was designed with computer aid and three-dimensional reconstructed. This study was performed in strict accordance with the Declaration of Helsinki formulated by the World Medical Association. This study was approved by the Ethics Committee of the Second Hospital of Jilin University on 16 August 2017 (approval No. (2018) (133)). (2) The remained bone and the prosthesis individualized designed for metacarpophalangeal joint of right hand were three-dimensional-printed, then mechanical processed, produced the prosthesis of individualized design for metacarpophalangeal joint. (3) Preoperative simulation was conducted using the printed models, and then the metacarpophalangeal joint prosthesis was implanted. RESULTS AND CONCLUSION: (1) The prosthesis was designed and produced based on the CT scanning data. It was anastomosed with the mother bone perfectly. Surgery reconstruct finished the recovery of anatomical morphology of the right hand and the flap was transplanted to cover the prosthesis. (2) In summary, the design and application of individualized metacarpophalangeal joint prosthesis is realized by three-dimensional printing combined with machining technology, which provides a method for repairing metacarpophalangeal joint. The clinical application of the technique may become a new trend of bone repair and arthroplasty. Figures and Tables | References | Related Articles | Metrics

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Relationship between bone marrow edema and “survival with collapse” of osteonecrosis of the femoral head assessed by X-ray    Chen Qunqun, Zhou Chi, He Wei 2019, 23 (20):  3170-3175.  doi: 10.3969/j.issn.2095-4344.1236 Abstract ( 419 )   PDF (1271KB) ( 90 )   Save BACKGROUND: Bone marrow edema is commonly seen after the collapse of osteonecrosis of the femoral head, which is may be an important imaging index for assessing the “survival with collapse” of osteonecrosis of the femoral head. OBJECTIVE: To analyze the relationship between the bone marrow edema after the collapse of osteonecrosis of the femoral head and the changes of femoral head imaging, and to explore the significance of bone marrow edema in the treatment of osteonecrosis of the femoral head of “survival with collapse”. METHODS: The case data were obtained from the Specialist Department of Osteonecrosis of the Femoral Head at the First Affiliated Hospital of Guangzhou University of Chinese Medicine (2012-2016), who recorded in the non-surgical treatment of osteonecrosis of the femoral head in the “Guangdong Provincial Dominant Disease (Osteonecrosis of the Femoral Head) Breakthrough Project”. Sixty cases (81 hips) with collapsed osteonecrosis of the femoral head, 43 males with 61 hips and 17 females with 20 hips, were followed up. The patients were grouped according to the improved bone marrow edema grade: no bone marrow edema (grade 0, 15 hips), mild bone marrow edema (grades 1 and 2, 37 hips), severe bone marrow edema (grade 3, 29 hips). Informed consents were obtained from all patients, and the study was approved by the Ethics Committee of the hospital. All patients were treated with Chinese medicine, and underwent functional exercise. Frog-leg X-ray films of hip joint were examined every 3 months. The collapse, head-acetabulum match and joint stability on frog-leg X-ray films were observed. The influence of bone marrow edema grade on the X-ray changes after the collapse of osteonecrosis of the femoral head was analyzed. RESULTS AND CONCLUSION: (1) Sixty cases (81 hips) had complete follow-up data. The follow-up time was 4-72 months. (2) By the χ2 test of R*C, different bone marrow edema grades would significantly affect the progress of frog-log X-ray after collapse (collapse, head-acetabulum match, and joint stability) (P < 0.05). (3) In summary, bone marrow edema is widely observed after the collapse of osteonecrosis of the femoral head, and bone marrow edema will fully affect the X-ray changes after collapse. The higher the bone marrow edema grade, the higher the probability of the collapse, head-acetabulum match and joint stability of the frog-leg X-ray films. Bone marrow edema is an important imaging indicator to assess the prognosis of collapse of osteonecrosis of the femoral head. Figures and Tables | References | Related Articles | Metrics

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Influence of active and passive stretching on blood oxygen in ligament and muscle assessed using near-infrared spectroscopy   Hu Tiantian, Wu Jinpeng, Yue Ping, Yang Qinlao, Wang Jun 2019, 23 (20):  3176-3181.  doi: 10.3969/j.issn.2095-4344.1160 Abstract ( 394 )   PDF (1451KB) ( 110 )   Save BACKGROUND: There are many evaluation studies on the efficacy of different stretch methods such as static and dynamic stretches, but the objective index of modern scientific standards, especially physiological indicators are absent. Moreover, the underlying mechanism is not yet clear. OBJECTIVE: To measure and verify the effects of static tensions (active and passive stretching) on the muscle blood flow and blood oxygen by using near-infrared spectroscopy, and to explore the mechanism of stretching from the aspect of physiological ischemia/reperfusion. METHODS: Ten young healthy subjects (3 males and 7 females) with a mean age of (28±5) years were enrolled. NIRS Oximeter which integrated three-wavelength LED light sources was used to detect the blood oxygen in the muscle tissue under stretching and contraction under active stretching and passive stretching. The indicators included the oxyhemoglobin, deoxyhemoglobin, and total blood volume at baseline, during stretching and after intervention. RESULTS AND CONCLUSION: (1) The blood oxyhemoglobin level of the muscles in stretched state was obviously increased with total blood volume increasing. The total blood volume, deoxyhemoglobin and oxyhemoglobin in contractile muscles were suppressed significantly and the increasing degree of blood indexes were less than that after the stretching exercise. (2) The increases of total blood volume and oxyhemoglobin after active stretching exercise were higher than those after passive stretching, which could promote blood microcirculation and hemodynamic activity, increase local blood oxygen and the flexibility of tissue, accelerate local tissue repair or enhance the tissue function. (3) These results indicate that near-infrared spectroscopy to detect tissue blood oxygen is expected to be an objective index for verifying tissue regeneration and rehabilitation. Figures and Tables | References | Related Articles | Metrics

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Musculoskeletal ultrasound evaluates the pathological features and inflammatory lesions of rheumatoid finger arthritis   Hu Xiaoli, Gu Ying, Cai Yan, Xie Jin, Liu Chan 2019, 23 (20):  3182-3187.  doi: 10.3969/j.issn.2095-4344.1197 Abstract ( 401 )   PDF (1202KB) ( 165 )   Save BACKGROUND: Pathological change of rheumatoid arthritis is a dynamic process, and selecting appropriate radiology is of great significance for assessing disease progress and making treatment scheme. Musculoskeletal ultrasound as an emerging technology has good application value in the diagnosis and treatment of disease. OBJECTIVE: To study the clinical significance of musculoskeletal ultrasound in the evaluation of pathological features and inflammatory lesions of rheumatoid arthritis. METHODS: Sixty patients with rheumatoid arthritis were selected, underwent musculoskeletal ultrasound and MRI, and 450 fingers were examined. The detection rates of three typical pathological features of synovial hyperplasia, joint effusion and bone erosion were recorded. The serum indexes (high-sensitivity C-reactive protein, erythrocyte sedimentation rate and rheumatoid factor) were detected. The hypersensitivity C-reaction protein, erythrocyte sedimentation rate and rheumatoid factor of the patients with different grades of synovial thickness and synovial blood flow signal were compared. The resistance index of artery in the synovium was compared between active and inactive patients. RESULTS AND CONCLUSION: (1) The detection rates of synovial hyperplasia, joint effusion and bone erosion by musculoskeletal ultrasound were 71.33%, 55.78% and 27.33%, respectively. The detection rates by MRI were 74.44%, 45.33% and 29.78% respectively. There was no significant difference in the detection rate of synovial hyperplasia and bone erosion between two methods (P > 0.05), but the detection rate of joint effusion by musculoskeletal ultrasound was higher than that by MRI (P < 0.05). (2) Spearman correlation analysis showed that synovial thickness was not correlated with high-sensitivity C-reactive protein, erythrocyte sedimentation rate and rheumatoid factor (r=0.463, 0.813, 0.459, P > 0.05), and synovial blood flow signal was positively correlated with high-sensitivity C-reactive protein, erythrocyte sedimentation rate and rheumatoid factor (r=0.623, 0.498, 0.591, P < 0.05). (3) The resistance index of artery in the synovium of active patients was lower than that of inactive patients (P < 0.05). (4) To conclude, musculoskeletal ultrasound has considerable benefit for the evaluation of pathological features of rheumatoid arthritis with MRI, but it has higher application value. Musculoskeletal ultrasound can reflect the inflammatory condition through detecting the thickness of the synovial membrane, blood flow signal and the resistance index of artery in the synovium, and it is important to evaluate the disease condition and make the treatment plan. Figures and Tables | References | Related Articles | Metrics

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Fracture healing mechanism at molecular signaling pathway and cellular levels Yang Nan, Chen Yueping, Zhang Xiaoyun 2019, 23 (20):  3188-3194.  doi: 10.3969/j.issn.2095-4344.1156 Abstract ( 334 )   PDF (1258KB) ( 84 )   Save BACKGROUND: Nonunion and delayed union of fractures not only cause great troubles to individuals and families, but bring huge financial burden to the society. The optimal fracture treatment requires understanding of the complex physiological process of fracture healing. OBJECTIVE: To explore and compare the fracture healing mechanism by reviewing the relevant literature, so as to provide new idea for clinical diagnosis and treatment. METHODS: CNKI, WanFang, VIP and PubMed databases were retrieved with the keywords of “fracture healing, nonunion, inflammation, signaling pathways, osteoclasts, osteoblast, BMP, Wnt, Hedgehog, PTH” in Chinese and English, respectively. The articles concerning the molecular/signaling pathway/cell of fracture healing mechanism, the repetitive studies were excluded, and finally 46 eligible articles were enrolled for analysis. RESULTS AND CONCLUSION: (1) By summarizing and discussing the mechanism of fracture healing from the aspects of inflammation stage, signal pathway and cell, we found that the contradiction between clinical and early scientific research (such as adverse reactions) can be unified in deep research. (2) However, the current research results cannot solve all clinical problems due to the complicated mechanisms of fracture healing. (3) The interaction between different molecules makes it difficult to find a clinically significant marker for the clinical diagnosis of early nonunion. (4) It is necessary to develop more sophisticated experimental equipment and design more rigorous scientific research programs to serve the clinical practice. (5) However, according to the current research results, we can consider cooperating with biomimetic delivery of signals for bone tissue engineering to make the original isolated, planar and static research results have three-dimensional dynamics more in line with the clinical treatment needs, which is the future direction. Figures and Tables | References | Related Articles | Metrics

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Massage therapy on lumbar disc herniation performed by radar plot: an overview of systematic reviews Huang Fan, Zhao Siyi, Di Anqi, Yang Yunying, Zeng Haiting, Wen Junmao, Fan Zhiyong, Guo Rusong, Wu Shan 2019, 23 (20):  3195-3200.  doi: 10.3969/j.issn.2095-4344.1237 Abstract ( 360 )   PDF (1082KB) ( 93 )   Save BACKGROUND: There have been a number of systematic reviews/meta-analysis of massage in the treatment of lumbar disc herniation at domestic and overseas, but the quality of the studies varies. OBJECTIVE: To evaluate the study quality of systematic reviews/meta-analysis of massage in the treatment of lumbar disc herniation based on evaluation of radar plot, thus providing the high-quality evidence reference for clinical practice. METHODS: Databases of CNKI, CBM, VIP, WanFang, PubMed, EMBASE and the Cochrane Library were searched from inception to November 2018 for the systematic reviews/meta-analysis of massage in the treatment of lumbar disc herniation. Two reviewers independently screened literature and extracted data. All studies were evaluated in aspects of publication year, design type, homogeneity, publication bias, AMSTAR methodological quality score and PRISMA quality score. Optimized radar plots were drawn on Excel 2010 and Adobe Illustrator CC. RESULTS AND CONCLUSION: (1) Five systematic reviews and three meta-analyses were enrolled, and the quality of the average rank scored 5.75. Of which, the research type, homogeneity, and publication bias had higher evaluation scores, and the publication year, the AMSTAR scale and PRISMA scale scores are lower. (2) In summary, a part of studies about systematic reviews/meta-analysis of massage in the treatment of lumbar disc herniation are good and rigorous. However, quality of some studies is poor. It is recommended to refer to the AMSTAR scale and PRISMA scale for reporting, and strictly control the design type, homogeneity, and publication bias to improve report integrity. Figures and Tables | References | Related Articles | Metrics

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Diagnosis, treatment and research advances of sacroiliac joint dislocation Huang Junneng, He Yufeng, Liu Hao, He Zitong, Wu Bingjie, Zhao Xiayun 2019, 23 (20):  3201-3206.  doi: 10.3969/j.issn.2095-4344.1193 Abstract ( 718 )   PDF (1143KB) ( 84 )   Save BACKGROUND: The incidence of sacroiliac joint dislocation has become high and complicated. As a result, the treatment methods are various. In the meantime, certain misdiagnosis is caused. OBJECTIVE: To summarize the treatment progress of sacroiliac joint dislocation at home and abroad. METHODS: PubMed and CNKI databases were retrieved with the keywords of “dislocation of sacroiliac joint, treatment” for the articles related to various treatment methods and research progresses of sacroiliac joint dislocation from 2006 to June 2018. Then a summary analysis was conducted. RESULTS AND CONCLUSION: (1) As a common clinical disease, the dislocation of sacroiliac joint is frequently misdiagnosed and the treatment methods are various. As a major treatment method, manual restitution can achieve good treatment effects for sacroiliac joint dislocation. (2) Additionally, rehabilitation exercise is an important treatment method. (3) By making a comprehensive description of the pathogenesis and treatment methods for sacroiliac joint dislocation, suitable treatment methods are discussed to provide reference for future research on sacroiliac joint dislocation. Figures and Tables | References | Related Articles | Metrics

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Newest research progress of hidden bleeding in senile intertrochanteric fracture    Chen Yang, Yuan Yi, Zhang Haijun, Zhang Bo, Yang Chao, Luo Hao 2019, 23 (20):  3207-3212.  doi: 10.3969/j.issn.2095-4344.1198 Abstract ( 317 )   PDF (1047KB) ( 87 )   Save BACKGROUND: Studying and controlling hidden blood loss, and ultimately reducing the adverse effects of hidden blood loss on the treatment of intertrochanteric fractures in the elderly, can obviously improve and guide the treatment process, and contribute to rapid recovery, improve prognosis, and reduce mortality. OBJECTIVE: To review the history, status, calculation process and affecting factors of hidden blood loss, so as to provide theoretical guidance for surgical treatment of senile intertrochanteric fractures. METHODS: Databases of PubMed, Ovid and CNKI were searched for the articles related to surgical treatment of intertrochanteric fractures in middle-aged and older adults between 1960 and 2018. The keywords were “aged people, intertrochanteric fracture, hidden bleeding” in English and Chinese, respectively. Forty-three articles were included for review in accordance with the inclusion and exclusion criteria. RESULTS AND CONCLUSION: (1) There are various surgical treatments of intertrochanteric fractures, and all have disadvantages and disadvantages, so individualized method is recommended. (2) Pathogenesis of hidden bleeding remains controversial, and still needs in-depth study. (3) Sex, body mass index and surgical approach are considered to the factors that increase the hidden bleeding, and other factors required to be investigated further. Figures and Tables | References | Related Articles | Metrics

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Causes and treatment strategies of anterior knee pain after total knee arthroplasty Liu Xin, Xiang Chuan 2019, 23 (20):  3213-3219.  doi: 10.3969/j.issn.2095-4344.1144 Abstract ( 472 )   PDF (1230KB) ( 79 )   Save BACKGROUND: Total knee arthroplasty is the first choice for end-stage knee joint diseases, but postoperative knee pain affects the daily life of the patients, which reduces the patient satisfaction. OBJECTIVE: To review the causes, mechanisms and treatment strategies of anterior knee pain after total knee arthroplasty.  METHODS: PubMed, CNKI and WanFang databases before August 2018 were retrieved with the keywords of “total knee arthroplasty, anterior knee pain” in English and Chinese, respectively. Sixty eligible articles were included to systematically summarize the causes, mechanisms and treatment strategies of anterior knee pain after total knee arthroplasty. RESULTS AND CONCLUSION: (1) Anterior knee pain after total knee arthroplasty can be caused by a variety of factors, including individual characteristics, prosthesis design, surgical techniques, mechanical factors, and infection. (2) Appropriate treatments are selected according to different etiologies. (3) Reasonable preoperative education, meticulous preoperative planning, improved prosthetic design and surgical techniques, and correct postoperative rehabilitation exercises, can effectively reduce the occurrence of anterior knee pain. Figures and Tables | References | Related Articles | Metrics

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Newest progress in diagnosis and treatment of anterior cruciate ligament combined with medial collateral ligament injury Wang Hao, Chen Guojian, Liang Haibo, Feng Xinjian, Cen Liangjue, Han Jie, Qin Zhi, Zhu Shengwang, Zeng Feng, Li Shuzhen 2019, 23 (20):  3220-3228.  doi: 10.3969/j.issn.2095-4344.1153 Abstract ( 479 )   PDF (1558KB) ( 88 )   Save BACKGROUND: Anterior cruciate ligament injury combined with medial collateral ligament injury is common in the clinic. OBJECTIVE: To summarize the treatment of anterior cruciate ligament combined with medial collateral ligament injury of knee joint by consulting relevant papers. METHODS: The first author retrieved the relevant literatures from CNKI (January 1982 to June 2018) and PubMed (January 1970 to June 2018) databases on August 1, 2018. The keywords were “knee, anterior cruciate ligament injury, injury of medial collateral ligament, treatment” in Chinese and English, respectively. The types of articles included research articles, review, perspective, empirical exchange and case report. RESULTS AND CONCLUSION: At present, the treatment concept of anterior cruciate ligament combined with medial collateral ligament injury is maturing. The surgical reconstruction methods of anterior cruciate ligament and medial collateral ligament are various, and the therapeutic effect has been improved. But there are some problems, such as the selection of the length of the force arm of the ligament and the anatomical weight of the anterior cruciate ligament. With the development of science and technology, accurate localization of anterior cruciate ligament combined with medial collateral ligament injury by computer technology will come true. At the same time, with the development of three-dimensional printing technology, the appearance of three-dimensional ligament will improve the efficiency of surgery, thereby improving the curative effect and further increasing the postoperative patient satisfaction. Figures and Tables | References | Related Articles | Metrics

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Application of platelet-rich plasma in repair of Achilles tendon injury Zhao Maosheng, Feng Guochao, Deng Yinshuan, Zhen Ping 2019, 23 (20):  3229-3234.  doi: 10.3969/j.issn.2095-4344.1238 Abstract ( 458 )   PDF (1110KB) ( 111 )   Save BACKGROUND: Platelet-rich plasma therapy provides a new direction for the healing and repair of Achilles tendon injury. Its application has become a hot topic in recent years at home and abroad, showing a good application prospect. OBJECTIVE: To review the mechanism of action of platelet-rich plasma therapy at home and abroad and the current status and research progress of the treatment of Achilles tendinopathy. METHODS: A computer-based retrieval of CNKI, WanFang, and PubMed databases was performed for related articles published from January 2009 to September 2018. The keywords were “platelet-rich plasma (PRP), tendinopathy, Achilles tendinitis, Achilles tendon rupture, growth factor” in Chinese and English, respectively. The articles related to platelet-rich plasma therapy, healing and repair of Achilles tendinopathy, for summary and result analysis. RESULTS AND CONCLUSION: Forty-five eligible articles were included for analysis. The concentration of growth factors is the key to the treatment of Achilles tendon injury. Compared with conservative treatment and simple surgery, platelet-rich plasma therapy holds better imaging performance, functional scoring and quality of life. However, there is no uniform standard for preparation, concentration and injection method of platelet-rich plasma therapy in Achilles tendon injury. Platelet-rich plasma therapy still lacks clear and rigorous clinical guidelines. Figures and Tables | References | Related Articles | Metrics

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Diagnosis and treatment of deltoid ligament injury of ankle joint Wang Guixin, He Jinquan 2019, 23 (20):  3235-3241.  doi: 10.3969/j.issn.2095-4344.1191 Abstract ( 558 )   PDF (1154KB) ( 101 )   Save BACKGROUND: In the medial tissue of ankle joint, the deltoid ligament of ankle joint is the most important mechanical structure, which plays an important role in maintaining the stability of ankle joint. The diagnosis and treatment of acute and chronic deltoid ligament injury of ankle remain controversial. OBJECTIVE: To review the advance in the diagnosis and treatment of deltoid ligament injury of ankle joint. METHODS: A computer-based retrieval of PubMed, CNKI, and VIP databases was conducted for the literature concerning the diagnosis and treatment of ankle triangular ligament injury published from January 2000 to December 2018, and articles published recently or published in authoritative journals were selected in priority. The keywords were “ankle, deltoid ligament, management” in English and Chinese, respectively. A total of 310 documents were searched, and 48 of them met the inclusion criteria. RESULTS AND CONCLUSION: The anatomy and function of the deltoid ligament of ankle joint, injury mechanism, diagnosis method and treatment of acute and chronic injury were summarized and discussed, and the latest progress in diagnosis and treatment of the deltoid ligament injury of ankle joint was systematically elaborated. The deltoid ligament of ankle plays an important role in maintaining the stability of medial ankle joint. Moreover, misdiagnosis or misdiagnosis of deltoid ligament injury may lead to severe ankle deformity and ankle osteoarthritis. The triangular ligament injury and instability of the medial ankle joint can be diagnosed by X-ray, MRI, ultrasound and arthroscopic exploration of the ankle. Surgical treatment of deltoid ligament injury is still controversial. Stress test under anesthesia provides us with a basis for judgment, especially, the repair of the deltoid ligament is crucial in the presence of the inferior tibiofibular syndesmosis. In addition, wire anchor technique has become the most widely used technique for repairing deltoid ligament. However, chronic deltoid ligament injury usually requires the reconstruction of deltoid ligament with autologous or allogenic tendons to restore the stability of ankle joint. Figures and Tables | References | Related Articles | Metrics

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Application of digital technology in the study on flat feet: three-dimensional model reconstruction and biomechanical analysis   Zhang Xingfei, Wang Wencheng, Xu Yajun 2019, 23 (20):  3242-3247.  doi: 10.3969/j.issn.2095-4344.1146 Abstract ( 398 )   PDF (1172KB) ( 111 )   Save BACKGROUND: The purpose of the surgery for flat feet is to correct the deformity, to restore the medial longitudinal arch and to improve the foot and ankle function. However, it is not sufficient to satisfy the need of individualized treatment, only referring to two-dimensional data and the surgeon’s experience, so over-correction or under-correction usually occurs. The development of digital technology in medicine has greatly promoted the progress in orthopedics, including three-dimensional reconstruction, three-dimensional printing, surgical simulation and surgical navigation. This technologies have been widely used in shoulder joint, elbow joint, hip joint, keen joint and spine in recent years, but studies on flat feet are relatively rare. OBJECTIVE: To review the application status of digital technology in flat feet. METHODS: Databases of WanFang, CNKI, VIP and PubMed databases between January 2000 and September 2018 were searched. The keywords were “flat feet, digital technology, three-dimensional, finite element” in Chinese and English, respectively. Totally 882 articles were retrieved, and finally 49 eligible articles were included. RESULTS AND CONCLUSIONS: (1) The application of digital technology in flat feet mainly includes three-dimensional reconstruction, analyzing bone morphology, spatial position relationship and joint movement characteristics, establishing finite element model and stress analysis. (2) The three-dimensional flat feet model with high definition possesses obvious advantages in biomechanical research. (3) Digital guidance in flat feet osteotomy surgery is still rare and it is expected to improve the effect of flat feet surgery by referring to the research in some other orthopedic fields. Figures and Tables | References | Related Articles | Metrics

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Biological therapy in rotator cuff injury Liu Yan, Yu Xi, He Hongchen, He Chengqi, He Jing 2019, 23 (20):  3248-3254.  doi: 10.3969/j.issn.2095-4344.1052 Abstract ( 605 )   PDF (1236KB) ( 84 )   Save BACKGROUND: Platelet-rich plasma has no significant impact on functional outcomes and repair integrity, but may be advantageous in small and medium tears of rotator cuff. Further studies should focus on leukocyte-rich versus poor preparations and the use of platelet-rich plasma in patients that are high risk for repair failure. OBJECTIVE: To summarize the current status and progress of basic research and clinical trials on biologic adjuvants in the repair of rotator cuff, and to review the latest scientific findings. METHODS: A computer-based search of PubMed, MedLine, and Springerlink databases was performed for relevant articles published from 2008 to 2018 with the keywords of “biological therapy, biotherapy, RCT, rotator cuff tear”. Initially, 168 articles were retrieved, and finally 32 eligible articles were included for result analysis. RESULTS AND CONCLUSION: Biologic and synthetic patches or augments provide mechanical stability for large and massive rotator cuff tears and decrease re-tear rate. Mesenchymal stem cells can improve healing rate without an impact on outcomes. Cytokines and growth factors are promising in animal experiments, but need to be verified by clinical trials. In massive or revision repairs, allograft or synthetic patch augmentation should be considered. Platelet-rich plasma may be available for small tears. Further investigations are needed to evaluate the value of mesenchymal stem cells and various chemical signals. Figures and Tables | References | Related Articles | Metrics

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In situ tissue engineering in the field of bone and cartilage repair: application and problems   Zhang Jun, You Qi, Zou Gang, Ge Zhen, Liu Yi 2019, 23 (20):  3255-3260.  doi: 10.3969/j.issn.2095-4344.1149 Abstract ( 386 )   PDF (917KB) ( 63 )   Save BACKGROUND: In situ tissue engineering technology has obvious advantages compared with the traditional tissue engineering technology and exhibits good effects in promoting tissue regeneration and bone/cartilage repair. OBJECTIVE: To review the application and problems of in situ tissue engineering technology in bone/cartilage repair METHODS: A computer-based search of CNKI, PubMed, and Elsevier was performed for relevant articles concerning the application of in situ tissue engineering in the field of bone and cartilage repair published from January 2000 to November 2018. The keywords were “in situ tissue engineering, bone, cartilage, bone defects, cartilage repair, tissue engineering” in Chinese and English, respectively. The article types were review, basic and clinical studies. RESULTS AND CONCLUSIONS: In situ tissue engineering technology is a technology developed for regeneration and restoration based on traditional tissue engineering technology, which has achieved good results in the repair of bone injury. It does not rely on exogenous seed cells and has the ability to repair bone damage by various new scaffold materials which possesses unique structure and physicochemical properties. These scaffold materials can recruit stem cells around the damaged site to migrate to the injured site and complete the in situ repair of bone damage. In situ tissue engineering technology provides new ideas and directions for cartilage damage repair, and has new application value in cartilage injury repair. The main purpose is to use the implanted scaffold material to induce the local microenvironment, and induces the peripheral cells to migrate to the lesion site to play a repairing role. Figures and Tables | References | Related Articles | Metrics

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Meta-analysis of total shoulder arthroplasty with stemmed prosthesis versus stemless prosthesis for treating shoulder osteoarthritis Wang Wei, Zhou Haonan, Zhang Yu, Wang Chenglong, Xie Chengxin, Yin Dong 2019, 23 (20):  3261-3267.  doi: 10.3969/j.issn.2095-4344.1195 Abstract ( 298 )   PDF (1338KB) ( 135 )   Save BACKGROUND: The clinical effects of total shoulder arthroplasty in the treatment of shoulder osteoarthritis is remarkable, and some controlled studies aim at confirming the clinical effects of stemmed and stemless prostheses for treating shoulder osteoarthritis, but the results need to be investigated further. OBJECTIVE: To systematically evaluate the effects of the clinical outcomes of stemmed versus stemless total shoulder arthroplasty in the treatment of shoulder osteoarthritis. METHODS: Databases of PubMed, SpringerLink, Web of Science, EBSCO, The Cochrane Library, EMBASE, CNKI, WanFang and VIP for the randomized controlled trials and non-randomized controlled trials of stemmed versus stemless total shoulder arthroplasty in the treatment of shoulder osteoarthritis published before September 2018. The methodological quality of the included studies was evaluated. Meta-analysis was conducted on RevMan 5.3 software that the Cochrane Collaboration provided to compare the differences of effectiveness between stemmed and stemless total shoulder arthroplasty in the treatment of shoulder osteoarthritis. RESULTS AND CONCLUSION: (1) A total of five studies were included, including three randomized controlled studies and two non-randomized clinical controlled studies, with a total of 182 patients, and 190 shoulders (this study was analyzed by shoulder count). (2) Meta-analysis results showed that the stemless prosthesis group had shorter operation time and less postoperative blood loss than the stemmed prosthesis group. (3) The postoperative Constant score in the stemless prosthesis group was lower than that in the stemmed prosthesis group. After excluding one low-quality literature by sensitivity analysis, there was no significant difference in the postoperative Constant score between two groups. (4) No significant difference was found in the activities of daily living scores, strength scores, pain scores, range of motion of shoulder joint, and shoulder flexion and abduction between two groups. (5) These results indicate that the short- and mid-term effects of stemmed versus stemless total shoulder arthroplasty in the treatment of shoulder osteoarthritis are comparable, but stemless total shoulder arthroplasty can shorten the average operation time and reduce the blood loss after surgery. Figures and Tables | References | Related Articles | Metrics

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Efficacy and safety of intravenous tranexamic acid in the operative treatment of calcaneal fractures: a meta-analysis Zhang Shuai, Ge Wenlong, Li Chang, Han Shichong, Wang Gang, Ren Wenjun 2019, 23 (20):  3268-3274.  doi: 10.3969/j.issn.2095-4344.1190 Abstract ( 437 )   PDF (6186KB) ( 114 )   Save BACKGROUND: The use of tranexamic acid in calcaneal fracture surgery can reduce the intraoperative and postoperative blood loss, reduce the incidence of incision complications, but cannot increase the rate of thrombosis. However, the clinical studies of tranexamic acid used in calcaneal fracture at home and abroad are few, and the small-sampled and low-quality trials lead to different results and poor credibility. OBJECTIVE: To evaluate the efficacy and safety of intravenous tranexamic acid in calcaneal fracture surgery by meta-analysis. METHODS:The Cochrane Library, Embase, PubMed, CNKI, VIP and WanFang databases were searched, and high-quality prospective randomized controlled studies using tranexamic acid in calcaneal fracture surgery were collected. Quality evaluation and data extraction in the included literatures were conducted. Meta-analysis was performed on intraoperative blood loss, postoperative drainage volume, postoperative hemoglobin, postoperative coagulation function (prothrombin time and activated partial thromboplastin time), incision complications and vascular adverse events in the tranexamic acid group and the normal saline group using RevMan 5.3 software provided by the Cochrane system. RESULTS AND CONCLUSION: Seven articles were enrolled, including one in English and six in Chinese. There were 469 patients in total, 234 in the tranexamic acid group and 235 in the normal saline group. Meta-analysis results showed that: (1) The intraoperative blood loss and postoperative drainage volume in the tranexamic acid group were lower than those in the normal saline group [MD=-14.54, 95%CI (-25.08, -1.00), P=0.04; MD=-106.41, 95%CI (-134.91, -77.91), P < 0.000 01]. (2) The postoperative hemoglobin value in the tranexamic acid group was significantly higher than that in the normal saline group [SMD=1.21, 95%CI (0.38, 2.24), P=0.004]. (3) There was no significant difference in the prothrombin time or activated partial thromboplastin time postoperatively between two groups [MD=0.30, 95%CI (-0.09, 0.68), P=0.13; MD=1.08, 95%CI (-0.17, 2.33), P=0.09]. (4) The incidence of complications in the tranexamic acid group was lower than that in the normal saline group [RR=0.26, 95%CI (0.15, 0.42), P < 0.000 01]. No significant difference was found in the incidence of postoperative gastrointestinal bleeding, deep vein thrombosis, or acute coronary syndrome [RR=1.22, 95%CI (0.39, 3.83), P=0.74]. To conclude, tranexamic acid can effectively reduce the blood loss in the operation of calcaneal fracture, reduce the postoperative incision complications, and does not increase the incidence of postoperative deep vein thrombosis and other related vascular events. Tranexamic acid is safe and effective in calcaneal fracture surgery. Figures and Tables | References | Related Articles | Metrics

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Association between COL9A2 gene polymorphisms and intervertebral disc degeneration in Asian: a meta-analysis   Li Pengfei, Wang Tao, Ma Xinlong 2019, 23 (20):  3275-3280.  doi: 10.3969/j.issn.2095-4344.1158 Abstract ( 407 )   PDF (1227KB) ( 91 )   Save BACKGROUND: Sequencing of the human genome has found that gene mutation will lead to structural changes of intervertebral disc and increase the risk for degeneration. OBJECTIVE: To investigate the association of rs12077871, rs12722877, and rs7533552 polymorphisms in the COL9A2 gene with intervertebral disc degeneration by meta-analysis. METHODS: Databases of PubMed, Web of Science, CNKI and WanFang were searched for the articles addressing the association of rs12077871, rs12722877, and rs7533552 polymorphisms in the COL9A2 gene with intervertebral disc degeneration published before July 2018. The quality of the included studies was evaluated according to the principle of STREGA, and 6 articles involving 2 874 participants were eligible for inclusion and exclusion criteria. Distribution characteristics of different alleles and genotypes in the intervertebral disc degeneration (case group) and non-intervertebral disc degeneration (control group) underwent meta-analysis on Stata 12.0 software. RESULTS AND CONCLUSION:(1) The results of meta-analysis showed that there was no significant differences association between the genotypes and allele frequency of rs12077871, rs12722877, and rs7533552 polymorphisms in COL9A2 gene and intervertebral disc degeneration. (2) Therefore, the rs12077871, rs12722877, and rs7533552 polymorphisms in COL9A2 gene are not associated with intervertebral disc degeneration in Asian. But, more high-quality multi-center and large-sampled case control studies are required to verify the conclusion. Figures and Tables | References | Related Articles | Metrics