Loading...

Table of Content

    28 August 2019, Volume 23 Issue 24 Previous Issue    Next Issue
    For Selected: Toggle Thumbnails
    Correlation of local skin temperature of knee joint with C-reactive protein, interleukin 6 and erythrocyte sedimentation rate after primary unilateral total knee arthroplasty
    Zang Wenhao, Song Jian, Teng Xueren, Zhang Qiliang
    2019, 23 (24):  3773-3779.  doi: 10.3969/j.issn.2095-4344.1287
    Abstract ( 377 )   PDF (1050KB) ( 94 )   Save
    BACKGROUND: Periprosthetic infection is a most serious complication after total knee arthroplasty. It often causes the increase of local skin temperature. Skin temperature measurement is convenient and easy to implement.
    OBJECTIVE: To understand the association of local skin temperature of the affected knee joint, with C-reactive protein, interleukin 6 and erythrocyte sedimentation rate after primary unilateral total knee arthroplasty without complications.
    METHODS: Seventy patients undergoing primary unilateral total knee arthroplasty without complications at Department of Bone and Joint, Qingdao Municipal Hospital from January 2017 to January 2018 were selected. Informed consents were obtained from all patients and the study was approved by the Ethics Committee of the hospital. The local skin temperatures of both knee joints were measured at preoperative 1 day, and postoperative 1, 3, 6, 9, and 12 days and 1, 2, 3, 6, 9, and 12 months. The fasting blood samples were collected at baseline and 1, 3, 6, 9, and 12 days and 1, 2, and 3 months postoperatively to detect the C-reactive protein, interleukin 6 and erythrocyte sedimentation rate. The data were analyzed statistically.
    RESULTS AND CONCLUSION: (1) Skin temperature of the affect knee at postoperative 1, 3, 6, 9, and 12 days and 1, 2, 3, and 6 months was significantly higher than the baseline and the healthy knee (P < 0.05), and showed no significant difference at postoperative 9 and 12 months (P > 0.05). Skin temperature of both knees reached a peak at 1 day postoperatively, which gradually declined in the following nine months and returned to normal at 9 months postoperatively. (2) The interleukin 6 level at 1, 3, 6, and 9 days postoperatively was higher than preoperatively (P < 0.05), and returned to normal at 12 days postoperatively. C-reactive protein level at 1, 3, 6, 9, and 12 days postoperatively was higher than preoperatively (P < 0.05), and returned to normal at 1 month postoperatively. Interleukin 6 and C-reactive protein levels both reached a peak at 1 day postoperatively. Erythrocyte sedimentation rate at 1, 3, 6, 9, and 12 days and 1 month postoperatively was higher than preoperatively (P < 0.05), and returned to normal at 2 months postoperatively. Erythrocyte sedimentation rate reached a peak at 6 days postoperatively. (4) These results indicate that knee temperature, C-reactive protein, interleukin 6 and erythrocyte sedimentation rate have normal fluctuation, increase after surgery and return to normal gradually after total knee arthroplasty without complication. Changes of skin temperature are correlated with inflammatory indexes. The degree of inflammatory response can be assessed by detecting changes in skin temperature and it can be used to monitor early infection. Furthermore, it is not necessary to worry about the increased knee temperature if there are no other evidence of infection.
    Figures and Tables | References | Related Articles | Metrics
    Relationship of lower limb alignment and component alignment with outcomes and implant loosening rate after total knee arthroplasty
    Yang Shuo, Feng Shuo, Xu Chongjun, Tang Jinlong, Pei Fang, Zha Guochun, Chen Xiangyang
    2019, 23 (24):  3780-3785.  doi: 10.3969/j.issn.2095-4344.1288
    Abstract ( 436 )   PDF (960KB) ( 112 )   Save
    BACKGROUND: There is still much controversy about the lower limb alignment after total knee arthroplasty. There are few studies on the relationship between lower limb alignment and clinical outcome in Chinese patients.
    OBJECTIVE: To analyze the relationship of limb alignment (angle of femoral and tibial mechanical alignment), coronal alignment of the femoral component (distal medial angle of femoral prosthesis) and coronal alignment of the tibial component (proximal medial angle of tibial prosthesis) with clinical outcome and implant loosening rate after total knee arthroplasty in patients with knee osteoarthritis.
    METHODS: Data of 118 patients (139 knees) with knee osteoarthritis after first total knee arthroplasty from March 2015 to December 2016 were retrospectively analyzed. All patients signed the informed consent. The study was approved by the Hospital Ethics Committee. The long-leg weight-bearing radiographs were taken and the angle of femoral and tibial mechanical alignment (angle of femoral and tibial mechanical alignment), distal medial angle of femoral prosthesis (distal medial angle of femoral prosthesis), proximal medial angle of tibial prosthesis (proximal medial angle of tibial prosthesis) were measured before and after surgery. The postoperative follow-up of the knee range of motion and Hospital for Special Surgery scores were used to evaluate the clinical outcome after total knee arthroplasty. Standard radiographs were subsequently obtained at follow-up in order to look for signs of wear and or lucency using the EWALD classification. The relationship of limb alignment (angle of femoral and tibial mechanical alignment), femoral alignment (distal medial angle of femoral prosthesis), and tibial alignment (proximal medial angle of tibial prosthesis) with clinical outcome and implant loosening rate after total knee arthroplasty was analyzed.
    RESULTS AND CONCLUSION: (1) All the 118 patients (139 knees) were followed up for 35.8 ± 6.2 months. No complications such as osteolysis, loosening of the prosthesis and prosthesis fracture were found. (2) For the limb alignment, there were significant differences in the Hospital for Special Surgery scores between the neutral group and the varus group and the valgus group (P < 0.05), and the neutral group score was highest. (3) As for femoral component alignment, the difference of the Hospital for Special Surgery scores was statistically significant between the neutral group and the valgus group (P < 0.05), and the score in the neutral group was higher. (4) As for tibial component alignment, there were no significant differences in postoperative Hospital for Special Surgery scores among the three groups (P > 0.05). (5) The traditional neutral alignment [angle of femoral and tibial mechanical alignment = (180±3)°] was still recommended for the recovery alignment after total knee arthroplasty. The residual postoperative varus and valgus alignment should be avoided as much as possible. In the short-term follow-up, the postoperative limb alignment had no effect on the loosening of the prosthesis.
    Figures and Tables | References | Related Articles | Metrics
    A three-dimensional femoral head necrosis classification system based on biplanar (frontal and frog-leg lateral) X-ray images: Biomechanics Laboratory of Guangzhou University of Chinese Medicine Classification system  
    Cai Miaoxin, Yang Bin, Deng Peng, Ge Yingjie, Guo Fuming, Liang Zhenghui, Zhai Pei, Pang Zhihui, Fan Yueguang
    2019, 23 (24):  3786-3791.  doi: 10.3969/j.issn.2095-4344.1330
    Abstract ( 356 )   PDF (2367KB) ( 100 )   Save
    BACKGROUND: Three-dimensional information of osteonecrosis of the femoral head is critical for the treatment planning. The geometry and loading condition of the anterolateral of the femoral head can influence the progression of collapse. However, current assessment using radiography cannot reveal the relevant information and thus may hinder understanding for accurate treatment planning.
    OBJECTIVE: To visualize the three-dimensional necrotic site and area based on a biplanar X-ray, to advance the three-dimensional division of femoral head and make new classification method, so as to guide clinical practice.
    METHODS: We established a three-dimensional five-column classification system for osteonecrosis of the femoral head according to the load/stress transfer profile of the femoral head during daily activities, and the abnormal stress boundaries and threshold values during the onset and collapse progression of osteonecrosis of the femoral head. The classification system is further optimized as “anterolateral column classification system” by the geometry information of the anterolateral columns acquired from the frog-leg lateral and frontal images. The classification is named as the “Biomechanics Laboratory of Guangzhou University of Chinese Medicine Classification system”.
    RESULTS AND CONCLUSION: This study describes the classification principle, method and standard of “Biomechanics Laboratory of Guangzhou University of Chinese Medicine Classification system” in detail. Through a case study, the advantages of the new system are highlighted. The new system can easily and accurately assess the condition and prognosis of osteonecrosis of the femoral head that provides effective guidelines for treatment planning.
    Figures and Tables | References | Related Articles | Metrics
    Comparison of the efficacy of intramedullary nail fixation assisted by orthopedic robot navigation and traditional surgery for intertrochanteric fractures  
    Tan Zhe, Li Kainan, Lan Hai
    2019, 23 (24):  3792-3797.  doi: 10.3969/j.issn.2095-4344.1290
    Abstract ( 391 )   PDF (2226KB) ( 129 )   Save
    BACKGROUND: Intramedullary nail fixation for intertrochanteric fractures assisted by orthopedic robot navigation is a new surgical method, and there are few studies comparing with traditional intramedullary nailing.
    OBJECTIVE: To compare the efficacy of intramedullary nail fixation for intertrochanteric fractures assisted by orthopedic robot navigation and traditional surgery, and to analyze the advantages and disadvantages of intramedullary nail fixation for femoral intertrochanteric fractures assisted by orthopedic robot navigation.
    METHODS: From April 2015 to December 2017, 59 patients with intertrochanteric fracture were collected from Department of Orthopedics, Affiliated Hospital of Chengdu University. According to the method of operation, there were two groups. Among them, 28 cases underwent intramedullary nail fixation assisted by orthopedic robot navigation (orthopedic robot surgery group), and 31 cases underwent traditional intramedullary nail fixation (traditional surgery group). All patients signed informed consent. The protocol was approved by the Ethics Committee of Affiliated Hospital of Chengdu University. The operation time, the times of intraoperative fluoroscopy, the frequency of guide pin inserted into femoral marrow cavity, and the amount of intraoperative bleeding were recorded and compared between groups. One year after operation, fracture healing and hip function were observed.
    RESULTS AND CONCLUSION: (1) Compared with the traditional surgery group, the operation time was shorter; the times of intraoperative fluoroscopy was fewer; the frequency of guide pin inserted into femoral marrow cavity was lower; the amount of surgical bleeding was less; and the one-time success rate of the guide pin inserted into femoral marrow cavity was higher in the orthopedic robot surgery group (all P < 0.05). (2) One year after surgery, fracture healing was observed in both groups, and no internal fixator failure or fracture displacement occurred. The Harris score of hip joint in the orthopedic robot surgery group was higher than that in the traditional surgery group (P < 0.05). There was no significant difference in excellent and good rate between the two groups (P > 0.05). (3) Intramedullary nail fixation for intertrochanteric fractures assisted by orthopedic robot navigation is a better ideal method with short operation time, less trauma, and less radiation during operation.
    Figures and Tables | References | Related Articles | Metrics
    Analgesia efficacy of dexmedetomidine combined with ropivacaine for adductor canal block after total knee arthroplasty  
    Tan Zhengling, Chen Junxing, Su Zhiyuan, Liu Xianbao, Lu Xiaoqin, Wang Le
    2019, 23 (24):  3798-3804.  doi: 10.3969/j.issn.2095-4344.1289
    Abstract ( 450 )   PDF (2555KB) ( 116 )   Save
    BACKGROUND: Most patients will suffer from severe pain after total knee arthroplasty. How to relieve postoperative pain and reduce postoperative complications is the key to promote early and rapid rehabilitation for patients.
    OBJECTIVE: To observe the analgesic effect of dexmedetomidine combined with ropivacaine for adductor canal block in patients undergoing arthroscopic total knee arthroplasty.  
    METHODS: Forty patients who underwent primary unilateral total knee arthroplasty between October 2017 and September 2018 were randomly divided into two groups (n=20/group), followed by treated by 30 mL 0.375% ropivacaine, and 30 mL 0.375% ropivacaine + 1.5 µg/kg dexmedetomidine, respectively. Both groups received adductor canal block. The study was approved by the Ethics Committee of the Third Affiliated Hospital of Guangzhou Medical University on October 31, 2018, approval number: [2018]170. All patients signed the informed consents, and the surgical department and surgeons had the qualifications for arthroplasty. General anesthesia was conducted, and the operation time and intraoperative blood loss were recorded. The mean arterial pressure, heart rate, oxyhemoglobin saturation, and Ramsay score and numeric pain rating scale score at rest and in activity at 2, 4, 6, 12, 24, and 48 hours after surgery were detected. Opioids consumption, anesthesia related adverse effects, the expression levels of C-reactive protein and interleukin-6 in the serum were detected at 48 hours after surgery.
    RESULTS AND CONCLUSION: (1) The Ramsay score at postoperative 2-48 hours in the ropivacaine + dexmedetomidine group was significantly higher than that in the ropivacaine group (P < 0.05). (2) The postoperative numeric pain rating scale score at rest in both groups decreased with time (P < 0.05), and the score at each time point in the ropivacaine + dexmedetomidine group was significantly lower than that in the ropivacaine group (P < 0.05). (3) The postoperative numeric pain rating scale score in activity in both groups decreased with time (P < 0.05), and the score at 12, 24 and 48 hours in the ropivacaine + dexmedetomidine group was significantly lower than that in the ropivacaine group (P < 0.05). (4) The heart rate at postoperative 24 hours in the ropivacaine + dexmedetomidine group was decreased significantly compared with the ropivacaine group (P < 0.05). (5) Six patients in the ropivacaine group and one patient in the ropivacaine + dexmedetomidine group acquired additional use of dolantin (100 mg/times) within postoperative 24 hours (P < 0.05). Two patients in the ropivacaine group and three patients in the ropivacaine + dexmedetomidine group acquired additional use of dolantin once within postoperative 48 hours (P > 0.05). (6) There was one patient who suffered nausea in the ropivacaine group, and two who reported xerostomia. Two patients in the ropivacaine + dexmedetomidine group experienced nausea and xerostomia, and one patient suffered sinus bradycardia (heart rate=49 beats/min). (7) The postoperative expression level of serum C-reactive protein in the ropivacaine + dexmedetomidine group was significantly lower than that in the ropivacaine group (P < 0.05), and there was no significant difference in the interleukin-6 level between two groups (P > 0.05). (8) To conclude, the analgesic effect of dexmedetomidine combined with ropivacaine on adductor canal block after total knee arthroplasty is significantly better than that of ropivacaine alone, and no significant adverse reactions are observed.
    Figures and Tables | References | Related Articles | Metrics
    Comparison of three implants for treating intertrochanteric fractures of cerebral infarction hemiplegia side in older adults   
    Zhang Qingzhu, Fan Qi, Yin Xuelian, Wang Pengcheng, Hou Jing, Feng Zhen, Shi Litao, Zhang Zhongyan, Li Aihua, Wan Qian
    2019, 23 (24):  3805-3811.  doi: 10.3969/j.issn.2095-4344.1178
    Abstract ( 410 )   PDF (1123KB) ( 121 )   Save
    BACKGROUND: Proximal femoral nail anti-rotation and the locking compression plate are common methods for treating intertrochanteric fractures in the elderly. At the same time, some scholars believe that the cemented hemiarthroplasty can achieve good curative effect. However, there are still many controversies in the surgical treatment of intertrochanteric fractures of cerebral infarction hemiplegia side in the elderly.
    OBJECTIVE: To compare the clinical efficacy of cemented hemiarthroplasty, proximal femoral nail anti-rotation and locking compression plate for senile intertrochanteric fractures of cerebral infarction hemiplegia side.
    METHODS: Ninety-six patients with senile intertrochanteric fractures of cerebral infarction hemiplegia side at Affiliated Hospital of Chengde Medical University and the Third Hospital of Hebei Medical University from June 2010 to January 2017 were enrolled. There were 38 males and 58 females, aged ≥ 65 years, 29 patients were treated with cemented hemiarthroplasty, 32 patients were treated with proximal femoral nail anti-rotation, and 35 patients were treated with proximal femoral locking compression plate. The operation time, intraoperative blood loss, hemoglobin difference before and after surgery, postoperative bed rest time, postoperative complication rate and hip Harris scores at 6 and 12 months postoperatively were compared among groups.
    RESULTS AND CONCLUSION: (1) The operation time in the anti-rotation intramedullary nail group was shorter than that in the cemented hemiarthroplasty and locking compression plate groups (P < 0.05). The intraoperative blood loss in the cemented hemiarthroplasty group was more than that in the anti-rotation intramedullary nail and the locking compression plate groups (P < 0.05). The anti-rotation intramedullary nail group had longer bed rest time than the cemented hemiarthroplasty and the locking compression plate groups (P < 0.05), and the difference of hemoglobin before and after surgery was lower than that in the cemented hemiarthroplasty and locking compression plate groups (P < 0.05). (2) There was no difference in the incidence of complications among groups (P > 0.05). (3) The Harris score at 6 months postoperatively in the cemented hemiarthroplasty group was higher than that in the anti-rotation intramedullary nail and the locking compression plate group (P < 0.05). The Harris score at 12 months postoperatively in the cemented hemiarthroplasty and the anti-rotation intramedullary nail groups was higher than that in the locked compression plate group (P < 0.05). (4) These results suggest that compared with the locking compression plate, the cemented hemiarthroplasty and anti-rotation intramedullary nail for treating senile intertrochanteric fractures of cerebral infarction hemiplegia side, can shorten postoperative bed rest time, and good postoperative hip function recovery, can be used as a priority. Arthroplasty due to intraoperative bleeding, surgical risk is relatively increased, so individualized assessment and treatment are required.
    Figures and Tables | References | Related Articles | Metrics
    Hip-preserving efficacy of ultra-early rehabilitation after bone grafting through surgical dislocation approach in osteonecrosis of the femoral head
    Chen Haicheng, Yuan Yingjia, Huang Chuyao, Chen Guoming, Wei Qiushi, Chen Cong, Zhou Chi
    2019, 23 (24):  3812-3818.  doi: 10.3969/j.issn.2095-4344.1231
    Abstract ( 491 )   PDF (1261KB) ( 120 )   Save
    BACKGROUND: Postoperative rehabilitation of osteonecrosis of the femoral head has been shown to promote the recovery of hip joint function.
    OBJECTIVE: To explore the effect of ultra-early rehabilitation after bone grafting through surgical dislocation approach in osteonecrosis of the femoral head.
    METHODS: Thirty-two cases of young and middle-aged ARCOIII patients with avascular necrosis of femoral head were included, and randomly divided into the trial and control groups (n=16/group). All patients signed the informed consents and the study was approved by the Ethics Committee of the hospital, approval number:[2015]010. Two groups were treated with Yuan’s Shengmai Chenggu tablets and bone grafting via surgical hip dislocation. The control group received routine postoperative rehabilitation training, and the trial group was treated with ultra-early rehabilitation training. Joint recovery was evaluated with Visual Analogue Scale score, and Harris hip score. Femoral head collapse over 4 mm was the end event. The Visual Analogue Scale score at postoperative 3, 7 and 14 days, and Harris hip score at postoperative 1, 3 and 6 months were recorded.
    RESULTS AND CONCLUSION: (1) The Visual Analogue Scale score at postoperative 3, 7 and 14 days in the trial and control groups was decreased (both P < 0.01). The postoperative pain was alleviated with rehabilitation time in the two groups and the Visual Analogue Scale score at postoperative 7 and 14 days in the trial group was significantly lower than that in the control group (P < 0.05). (2) The Harris hip score at postoperative 1, 3 and 6 months in the trial group was gradually increased (P < 0.01). The Harris hip score at postoperative 3 and 6 months in the trial group was significantly higher than that in the control group (P < 0.01). (3) To conclude, ultra-early rehabilitation can improve the functional recovery after hip-preserving surgery of osteonecrosis of the femoral head to some extent, and standardized rehabilitation process can promote the postoperative functional recovery in patients with osteonecrosis of the femoral head.
    Figures and Tables | References | Related Articles | Metrics
    Efficacy and safety of small-incision open reduction and internal fixation with absorbable screws for anterior cruciate ligament tibial eminence avulsion fractures: a self-controlled clinical trial protocol and pilot study results  
    Yang Xiaoguang, Wang Yingzhen
    2019, 23 (24):  3819-3823.  doi: 10.3969/j.issn.2095-4344.1292
    Abstract ( 354 )   PDF (840KB) ( 96 )   Save
    BACKGROUND: Anterior cruciate ligament tibial eminence avulsion fractures are repaired via early open reduction. Choosing the best fixation method in accordance with the bone size can effectively promote restoration of the cruciate ligament to its normal anatomical position and achieve bone healing. The use of absorbable screws for internal fixation of anterior cruciate ligament tibial eminence avulsion fractures reportedly promotes fracture healing, but the efficacy and safety need further clarification.
    OBJECTIVE: The present study aims to observe the efficacy and safety of open reduction and internal fixation with absorbable screws through a small incision in the repair of anterior cruciate ligament tibial eminence avulsion fracture.
    METHODS: This prospective, single-center, self-controlled trial will include 72 patients with anterior cruciate ligament tibial eminence avulsion fractures. Open reduction and internal fixation with absorbable screws will be performed through a small incision. All patients will be followed up at 3, 6, and 12 months postoperatively. This study was approved by the Medical Ethics Committee of No. 1 Hospital of Longnan City, China in December 2014 (approval number: S2014-064-02). Protocol version is (1.0). Written informed consent regarding the study protocol and surgery procedure will be obtained from the participants’ family members or the participants themselves. This study was registered with the Chinese Clinical Trial Registry on March 13, 2019 (registration number: ChiCTR1900021865).
    RESULTS AND CONCLUSION: The primary outcome measure is the recovery of knee function assessed by the Lysholm Knee Scoring Scale score at 12 months postoperatively. Secondary outcome measures are the Lysholm Knee Scoring Scale scores preoperatively and 3 and 6 months postoperatively, the International Knee Documentation Committee scores, knee range of motion, knee morphology on radiographs and MR images preoperatively and 3, 6, and 12 months postoperatively, and the incidences of adverse reactions 3, 6, and 12 months postoperatively. In our pilot study involving 50 patients with anterior cruciate ligament tibial eminence avulsion fractures (50 knees) from October 2015 to January 2018, no patient had joint stiffness or fracture redisplacement on radiography 3 months postoperatively. The mean knee range of motion was significantly larger at 6 months postoperatively compared with preoperatively (P < 0.05). Lysholm Knee Scoring Scale scores and International Knee Documentation Committee scores were significantly improved 6 months postoperatively compared with preoperatively (P < 0.05). This trial will assess the efficacy and safety of open reduction and internal fixation with absorbable screws through a small incision to restore knee function in patients with anterior cruciate ligament tibial eminence avulsion fracture.
    Figures and Tables | References | Related Articles | Metrics
    Correlation of surface electromyogram signals of the apex vertebral paraspinal muscle with Cobb angle and axial trunk rotation angle in adolescent idiopathic scoliosis patients 
    Yuan Wangshu, Chen Lixia, Shen Jianxiong, Wang Hai, Yu Keyi, Liu Ying, Zhou Jingya, Lin Youxi
    2019, 23 (24):  3824-3828.  doi: 10.3969/j.issn.2095-4344.1223
    Abstract ( 435 )   PDF (813KB) ( 155 )   Save
    BACKGROUND: The progress of adolescent idiopathic scoliosis is evaluated mainly by X-ray films, but there are many drawbacks in repeated exposure to X-rays, and more methods are urgently needed to improve the diagnosis and treatment process.
    OBJECTIVE: To determine whether the muscle function of the paraspinal muscles on both sides of the apical vertebrae is balanced by collecting the surface electromyographic activity signal of the paraspinal muscles on both sides of the apical vertebrae in adolescent idiopathic scoliosis, and to explore the correlation of the root mean square contrast value with the Cobb angle and the axial trunk rotation angle on both sides so as to provide a new method for the clinical diagnosis of adolescent idiopathic scoliosis.
    METHODS: Eighty-nine patients with adolescent idiopathic scoliosis were selected, with an average age of (14.78±2.20) years. The root mean square values, Cobb angle and axial trunk rotation angle of the paraspinal muscles on both sides of the apical vertebrae were collected. The root mean square contrast values of the paravertebral muscles on both sides of the apical vertebrae were calculated. The correlation of the root mean square contrast value with Cobb angle and axial trunk rotation angle on both sides of the apical vertebrae was analyzed.
    RESULTS AND CONCLUSION: (1) The root mean square value of the vertebral paraspinal muscles of the adolescent idiopathic scoliosis was significantly higher than that of the concave side (P=0.022). (2) In all adolescent idiopathic scoliosis patients, the Cobb angle was correlated with the axial trunk rotation angle (r=0.613, P ≤ 0.001), and the root mean square contrast value was correlated with the axial trunk rotation angle (r=0.269, P=0.011). (3) In patients with mild to moderate adolescent idiopathic scoliosis, there was a positive correlation between the root mean square contrast value and the Cobb angle and axial trunk rotation angle. (4) These results indicate that the muscle function of the paraspinal muscles on both sides of the apical vertebrae in adolescent idiopathic scoliosis patients is unbalanced. In patients with mild to moderate adolescent idiopathic scoliosis, the root mean square contrast value of the vertebral paraspinal muscle and the axial trunk rotation angle can indirectly determine the Cobb angle.
    Figures and Tables | References | Related Articles | Metrics
    Prediction of hip fracture in Parkinson’s disease with the combination of geometric structure of proximal femur and bone mineral density   
    Wang Wuhua, Liu Xudong, Hu Ling
    2019, 23 (24):  3829-3833.  doi: 10.3969/j.issn.2095-4344.1232
    Abstract ( 471 )   PDF (818KB) ( 86 )   Save
    BACKGROUND: Patients with Parkinson’s disease have a high risk of falls and low bone density, so the incidence of fracture increases. It is important to understand the risk factors associated with hip fracture and predict risk.
    OBJECTIVE: To investigate the variations of hip bone mineral density and geometric structure of proximal femur in patients with Parkinson’s disease, and to predict the risk for hip fracture.
    METHODS: Sixty-two cases of Parkinson’s disease and 70 cases of osteoporotic non-Parkinson’s disease at the First People’s Hospital of Fuzhou as Parkinson’s disease group were collected from the First People’s Hospital of Fuzhou, and 90 healthy controls matched for sex and age were enrolled. All patients assigned the informed consents, and the study was approved by the Ethics Committee of the First People’s Hospital of Fuzhou. The bone mineral density and geometric structure parameters of proximal femur were measured by dual-energy X-ray absorptiometry and hip structural analysis software and their correlations were analyzed by Pearson correlation analysis.
    RESULTS AND CONCLUSION: (1) There was no significant difference in the neck shaft angle and cross-sectional moment among groups (P > 0.05). (2) The Parkinson’s disease group had decreased cross sectional area and cortical thickness, and increased upper buckling ratio compared with the non-Parkinson’s disease and healthy control groups (P < 0.05). (3) Bone mineral density showed positive correlation with cross sectional area and cortical thickness, and showed negative correlation with bucking ratio (P < 0.01). Bone mineral density had no correlation with neck shaft angle and cross-sectional moment of inertia both (both P > 0.05). (4) These results indicate that Parkinson’s disease patients have low bone mineral density, decreased cross sectional area and cortical thickness, and high upper buckling ratio, which may increase the risk for hip fracture. Incidence of hip fracture is associated with the bone mineral density of hip and changed geometric structure of proximal femur.
    Figures and Tables | References | Related Articles | Metrics
    Finite element evaluation of the stability of the elbow joint in the “terrible triad injury” by two surgical methods  
    Song Chao, Ding Zhihong, Yin Tao, Li Zhenshi, Wu Liang, Zhou Wenchao, Xu Bo, Liu Yue, Kong Dece, Yang Tieyi, Zhang Yan
    2019, 23 (24):  3834-3839.  doi: 10.3969/j.issn.2095-4344.1293
    Abstract ( 429 )   PDF (759KB) ( 112 )   Save
    BACKGROUND: The ‘terrible triad injury” of the elbow joint is a serious complex fracture and dislocation. It is worthwhile to study on stability of the elbow joint by repairing the medial collateral ligament structure instead of the fixation of the coronal process.
    OBJECTIVE: To compare the mechanical value of different flexion angles of the elbow joint under two modes of fixing ulnar coronoid process and repairing medial collateral ligament based on the stability reconstruction of the lateral column of the elbow joint and to evaluate the effect of two surgical methods on the stability of the elbow joint by establishing a finite element model of the “terrible triad injury” of the elbow joint.
    METHODS: Using data of the elbow joint CT and MRI, command stream files were generated from the computer. The elbow joint solid model was established and meshed. To compare the elbow joint stability, by simulating whether the medial collateral ligament was repaired or not after fracture, and the coronoid process was fixed or not, longitudinal load was applied to analyze the stress distribution on the elbow joint surface under various working conditions.
    RESULTS AND CONCLUSION: (1) The maximum stress of the normal elbow joint surface was 0.78 MPa when the elbow joint was extended to 0°. If the 1/3 coronoid process fracture was fixed, and the medial collateral ligament was not repaired, the maximum stress of the articular surface of the model was 0.84 MPa. If the coronoid process fracture was not fixed, the medial collateral ligament was repaired, the maximum stress of the articular surface was also 0.84 MPa. (2) When the elbow joint was flexed 30°, the maximum stress of the articular surface of the normal elbow joint model was 2.02 MPa. If the 1/3 coronoid process fracture was fixed, and the medial collateral ligament was not repaired; the maximum stress of the joint surface was 2.02 MPa. If the coronoid process fracture was not fixed, the medial collateral ligament was repaired, and the maximum stress was 2.07 MPa. (3) The maximum displacement of the normal elbow joint surface was 0.14 mm when the elbow joint was straight. If the 1/3 coronoid process fracture was fixed, and the medial collateral ligament was not repaired, the maximum displacement of the articular surface of the model was 0.15 mm. If the coronoid process fracture was not fixed, the medial collateral ligament was repaired, the maximum displacement of the articular surface of the elbow joint model was 0.16 mm. (4) When the elbow joint was flexed 30°, and the maximum displacement of the articular surface of the normal elbow joint model was 0.52 mm. If the 1/3 coronoid process fracture was fixed, and the medial collateral ligament was not repaired, and the maximum displacement was 0.52 mm. If the coronoid process fracture was not fixed, the medial collateral ligament was repaired, and the maximum displacement was 0.51 mm. (5) The above results show that the experiment has successfully established the finite element model of the “terrible triad injury” of the elbow joint. If the 1/3 coronoid process fracture is fixed, the medial collateral ligament is not repaired, and the maximum stress and displacement of the articular surface of the model were slightly smaller than those of the normal model. If the coronoid process fracture is not fixed, only the medial collateral ligament is repaired, and the maximum stress and displacement of the articular surface of the elbow joint model are greater or substantially equal to the values of the normal model. Biomechanical studies suggest that the medial collateral ligament can replace the fixation of the coronoid process fracture and reconstruct the stability of the elbow joint on the basis of the stability reconstruction of the lateral column of the elbow joint.
    Figures and Tables | References | Related Articles | Metrics
    Correlation between degenerative lumbar spondylolisthesis and spinal stenosis and muscle volume around the vertebral body: CT and MRI data analysis  
    Rong Feilong, Yin Ruofeng, Feng Mengmeng, Zhang Boyin, Liu Yi, Zhao Baolin
    2019, 23 (24):  3840-3845.  doi: 10.3969/j.issn.2095-4344.1294
    Abstract ( 319 )   PDF (880KB) ( 111 )   Save
    BACKGROUND: Previous studies have focused on the relationship between degenerative lumbar spondylolisthesis and low back pain and paraspinal muscle volume, and there are few studies on lumbar spinal stenosis and paraspinal muscle volume.
    OBJECTIVE: To compare the differences in the cross-sectional areas of paravertebral muscles and psoas muscles between degenerative lumbar spondylolisthesis, degenerative lumbar spinal stenosis and control group.
    METHODS: A retrospective analysis of the imaging data of 90 female patients undergoing abdominal or lumbar CT and MRI scans from January 2017 to August 2018 was performed. The patients were divided into group A, lumbar spinal stenosis at L4/5, group B, lumbar spondylolisthesis at L4/5 and group C (control group), no lumbar disease or symptoms. All patients signed the informed consents and the study was approved by the ethics committee of the hospital. MRI images of the axial position through the lower edge of the L3, 4, 5 vertebrae were selected to measure the muscle cross-sectional area. The vertebral body axial image was measured through the lower edge of the L3, 4, 5 bilateral pedicles to measure the cross-sectional area of the vertebral body. The Image-PRO Plus 6.0 software was used to calculate the cross-sectional area of the target muscle and vertebral body in the image, and results were compared.
    RESULTS AND CONCLUSION: (1) There was no significant difference in the age distribution among groups (P=0.986). (2) There were no significant differences in the cross-sectional areas of psoas muscle and paraspinal muscle between groups A and B (P > 0.05), while the cross-sectional areas in the groups A and B were significantly less than those in the group C (P < 0.001). (3) There were no significant differences in vertebral cross-sectional areas among groups (P > 0.05). (4) In summary, in L4/5 single segment of degenerative lumbar spinal stenosis and degenerative lumbar spondylolisthesis patients, at L3, L4, L5 vertebral body lower level, the lower extremity cross-sectional areas and paraspinal muscle cross-sectional areas were decreased compared with the control group, with consistency, but the mechanisms of muscle reduction may not be exactly the same.
    Figures and Tables | References | Related Articles | Metrics
    Correlation between facet joint effusion in magnetic resonance imaging and lumbar stability after interspinous and degenerative lumbar spondylolisthesis
    Ma Junfeng, Wang Wei, Wang Zikuo, Jiang Zehua, Long Mingxing, Yuan Jianjun, Zhu Rusen, Hu Wei, Zhang Xueli
    2019, 23 (24):  3845-3851.  doi: 10.3969/j.issn.2095-4344.1295
    Abstract ( 720 )   PDF (959KB) ( 128 )   Save
    BACKGROUND: Clinically, the diagnosis of lumbar spine stability in patients with lumbar spondylolisthesis is mostly based on lumbar lateral flexion and extension X-ray, but this examination has certain limitations, so it is necessary to find a reliable predictor of lumbar stability.
    OBJECTIVE: To evaluate the correlation between facet joint effusion and lumbar stability after interspinous and degenerative lumbar spondylolisthesis by retrospectively analyzing patients’ imaging data.
    METHODS: A total of 108 patients with L4-5 lumbar spondylolisthesis in Department of Spinal Surgery, Tianjin People’s Hospital from December 2016 to January 2018 were analyzed retrospectively. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The patients were divided into non-effusion group (n=55) and effusion group (n=53) according to the presence and absence of intra-articular effusion of intervertebral facet joint based on lumbar MRI. The two groups were comparatively analyzed. In the effusion group, the correlation between the effusion width of bilateral facet joint and the dynamic slip index of sagittal vertebra, the rotation degree of sagittal vertebral body, bilateral degeneration index of facet joint, intervertebral disc degeneration index were statistically analyzed separately.
    RESULTS AND CONCLUSION: (1) Compared with the effusion group, the instability rate was lower; the dynamic slip volume, dynamic slip index, and the sagittal rotation degree were less; and the degeneration degree of facet joint and intervertebral disc was higher in the non-effusion group (P=0.000). (2) There was a linear positive correlation between the width of effusion of bilateral facet joints and the dynamic slip index of the sagittal vertebral body, the rotation degree of the sagittal vertebral body in the effusion group (r=0.710, P=0.000; r=0.452, P=0.001). There was a linear negative correlation between the width of effusion of bilateral facet joints and the degeneration index of bilateral facet joint and intervertebral disc in the effusion group (r=-0.630, P=0.000; r=-0.648, P=0.000). (3) The presence of effusion in the facet joint on MRI in degenerative lumbar spondylolisthesis patients suggested instability. The total fluid accumulation of the facet joint in the segment of spondylolisthesis was positively correlated with the translation instability and rotation instability of the lumbar vertebrae. There was a negative correlation between the volume of effusion of bilateral facet joints and the degree of degeneration of intervertebral disc and facet joints.
    Figures and Tables | References | Related Articles | Metrics
    Degenerative changes of lumbar facet joint in patients with lumbar spinal stenosis by MRI
    Huang Guangxi, Liu Yan, Chen Wenzhi
    2019, 23 (24):  3852-3856.  doi: 10.3969/j.issn.2095-4344.1230
    Abstract ( 375 )   PDF (830KB) ( 89 )   Save
    BACKGROUND: Lumbar spinal stenosis is a common disease in the clinic, and the imaging manifestations and etiology are complex. There are few studies on the degeneration of lumbar facet joints, which needs further investigation.
    OBJECTIVE: To investigate the relationship between lumbar facet joint arthritis and lumbar facet joint angle in cross-sectional observation of MRI in patients with lumbar spinal stenosis.
    METHODS: In T2WI of MRI, L4/5 and L5/S1 segment bilateral lumbar facet joint angle of 120 patients with lumbar spinal stenosis was assessed and we measured the lumbar facet joint angle grade on both sides. Then, the changes of bilateral lumbar facet joint angle of different segments and lumbar facet joint angle MRI were observed. Finally, the relationship among them was analyzed. Informed consents were obtained from all patients, and the study was approved by the Ethics Committee of the hospital.
    RESULTS AND CONCLUSION: (1) There were significant differences between L4/5 and L5/S1 in the angle of lumbar facet on the left and right sides of the same segment (P < 0.05). (2) There was no significant difference in the number of bilateral cases between lumbar facet joint angle groups with different grades of the same segment (P > 0.05), while there were significant differences in the angle of bilateral lumbar facet joints (P < 0.05). (3) For lumbar facet angle, it showed no correlation with age, gender and body mass index in the two segments (P > 0.05), while lumbar facet joint angle grade on the left showed little correlation with gender and body mass index (P < 0.05), and there was a negative correlation between lumbar facet angle and lumbar facet joint angle grade (P < 0.05). (4) In summary, there is a negative correlation between lumbar facet angle and lumbar facet joint angle in patients with lumbar spinal stenosis. The more severe lumbar facet joint angle is, the more sagittal the lumbar facet joint is. The pathological changes of them are important imaging features of spinal stenosis, providing evidence for clinicians to understand the influence of paravertebral structural degeneration correctly and deeply.
    Figures and Tables | References | Related Articles | Metrics
    Magnetic resonance imaging in the assessment of hallux valgus deformity: changes in the structure and position of the metatarsophalangeal joints
    Guo Juan, Qian Lixia, Wang Xiaodong
    2019, 23 (24):  3857-3861.  doi: 10.3969/j.issn.2095-4344.1296
    Abstract ( 555 )   PDF (745KB) ( 82 )   Save
    BACKGROUND: At present, the diagnosis of hallux valgus mainly depends on clinical examination and weight-bearing and non-weight-bearing X-ray films of the foot to evaluate the structural changes of the first metatarsal bone and phalanges and the first and second metatarsal bones. There are limitations in the changes of the internal bone, metatarsophalangeal joint capsule and surrounding soft tissues. Magnetic resonance imaging can not only show structural changes, but also display other concurrent changes.
    OBJECTIVE: To study the value of magnetic resonance imaging in the diagnosis of hallux valgus.
    METHODS: Totally 187 patients, who underwent foot magnetic resonance imaging, were enrolled in this study. The hallux valgus angle and the first and second metatarsal angles were measured by foot X-ray. Thus, 57 patients with hallux valgus (60 feet) were diagnosed as hallux valgus deformity. The changes of toe position and structure, bone, articular capsule and soft tissue, and magnetic resonance imaging performance were analyzed. All patients signed informed consent. The study was approved by the Hospital Ethics Committee.
    RESULTS AND CONCLUSION: (1) There was no statistical difference between hallux valgus magnetic resonance imaging and weight-bearing and non-weight-bearing anteroposterior X-ray hallux valgus measurements (P > 0.05). The intermetatarsal angle measurements of magnetic resonance imaging were smaller than those of weight-bearing anteroposterior X-ray films (P < 0.05). (2) Magnetic resonance imaging showed that hallux valgus deformity not only had changes in the structure and position of the first metatarsophalangeal joint, but also had different degrees of pathological changes in bone, joint capsule and adjacent soft tissues. (3) 40% (24/60) patients had subarticular bone marrow edema and cystic degeneration of the first metatarsal or phalangeal bone; 28% (17/60) patients had pollicidal bursitis; 30% (18/60) patients had hydrocele of the first metatarsophalangeal joint; and 12 feet had two or three kinds of bone and soft tissue changes simultaneously. (4) Our results indicated that magnetic resonance imaging can reveal change of structure and position of metatarsophalangeal joint in hallux valgus deformity, evaluate the pathological changes and degree of hallux valgus bone, articular capsule and soft tissue, and comprehensively assess the severity of hallux valgus.
    Figures and Tables | References | Related Articles | Metrics
    Interspinous process device Coflex treats degenerative lumbar spinal stenosis: research progress and finite element analysis
    Xiao Yongchuan, Liang Chuandong, Xu Zechuan, Li Yugang, Chang Shan
    2019, 23 (24):  3862-3867.  doi: 10.3969/j.issn.2095-4344.1224
    Abstract ( 349 )   PDF (743KB) ( 103 )   Save
    BACKGROUND: Traditional lumbar fusion and internal fixation technology brings various postoperative complications; therefore, non-fusion technology is increasingly used in clinical practice. Interspinous process device Coflex has unique biomechanical advantage compared with conventional lumbar fusion and internal fixation technology. With the continuous improvement of Coflex prosthesis, it will have a bright prospect in the future.
    OBJECTIVE: To review the clinical effect, biomechanics, finite element analysis, complications and latest advances of Coflex in the treatment of lumbar spinal stenosis.
    METHODS: CNKI, WanFang, Sinomed, PubMed, SpringerLink, SCIE, CSCI and IEEE Xplore Digital Library databases between 2005 and 2018 were retrieved using the keywords of “lumbar spine, biomechanics, lumbar spinal stenosis, Coflex, finite element analysis” in Chinese and English, respectively. The studies on clinical investigation, biomechanical analysis and finite element analysis of Coflex in the treatment of degenerative lumbar spinal stenosis were included, and repeated studies were excluded. Finally 34 eligible articles were selected for review by reading the abstract, including 9 Chinese and 25 English articles.
    RESULTS AND CONCLUSION: (1) The effect of Coflex interspinous dynamic device is similar to the same type of interspinous device. Coflex has certain advantages compared with traditional lumbar fusion and internal fixation technology, which has little trauma, short time, rapid recovery, preserves the activity of the surgical segments and can delay the degeneration of adjacent segments and reduces the occurrence of vertebral disease to some extent. (2) In terms of biomechanics, Coflex can retain the activity of the responsible segments, reduce the load on the disc and the facet of the responsible segments, indirectly increase the height of the intervertebral foramen, and alleviate the clinical symptoms. (3) Stress nephogram of three-dimensional finite element analysis shows that Coflex has a significant load-bearing effect on the discs and facets of the responsible segments, and can reduce the intervertebral disc and small joint stress of adjacent segments. Finite element analysis can simulate different in vivo mechanical environments, analyze the changes of mechanical distribution in different research objects, activities and load-bearing units before and after Coflex placement. It is a reproducible and effective method, but the finite element analysis only simulates local mechanics. Its scope is limited, and it is easy to cover the real complications of Coflex. (4) Coflex will cause complications such as internal fixation loosening, spinous process fractures, recurrence of degenerative diseases, and heterotopic ossification, leading to secondary surgery. There is no specific standard for the use of Coflex, and the application scope has not been completely unified. Therefore, the clinical application of Coflex still needs further exploration.    
    Figures and Tables | References | Related Articles | Metrics
    Arthroplasty for treating intertrochanteric femur fractures in older adults: advantages and disadvantages
    Zhao Chengli
    2019, 23 (24):  3868-3874.  doi: 10.3969/j.issn.2095-4344.1221
    Abstract ( 356 )   PDF (825KB) ( 83 )   Save
    BACKGROUND: Due to the aging of society, the incidence of intertrochanteric fractures in the elderly has increased, and its treatment methods are diverse. Active surgical treatment, early-term ground movements, and reduction of postoperative complications are the basic principles of the treatment. The surgical methods include internal fixation and arthroplasty. Arthroplasty is only used in severe comminuted fracture with severe osteoporosis. In recent years, arthroplasty has been applied for treating intertrochanteric femur fractures in the elderly at abroad and home, but there are still controversies about the efficacy and safety. As one of the treatment methods, arthroplasty has gradually attracted the attention of clinical orthopedic surgeons as its prominent advantages.
    OBJECTIVE: To review the experience of arthroplasty at home and abroad in the surgical treatment of intertrochanteric femur fractures in the elderly, so as to provide an option for orthopedic surgeons in the treatment of intertrochanteric fractures in the elderly.
    METHODS: A computer-based retrieval of PubMed, Web of science, WanFang, and CNKI databases for the articles published from January 2000 to October 2018. The keywords were “intertrochanteric fractures of the femur, the elderly, artificial joint replacement, fracture treatment” in English and Chinese, respectively.
    RESULTS AND CONCLUSION: (1) Seventy-five articles were retrieved, and 60 eligible articles were included. (2) Hip arthroplasty exhibits a satisfactory short-term efficacy in the treatment of intertrochanteric femur fractures in the elderly. However, indications and contraindications for arthroplasty must be clarified before surgery. (3) Domestic and foreign literatures have not reached agreement on the treatment of intertrochanteric femur fractures in the elderly. The related clinical trials are few and there is a lack of multi-center large-sample clinical trials, which require to be investigated in depth.
    Figures and Tables | References | Related Articles | Metrics
    Correlation between miRNA and pathological development of osteoarthritis
    Wang Jicheng, Yi Zhi
    2019, 23 (24):  3875-3881.  doi: 10.3969/j.issn.2095-4344.1297
    Abstract ( 404 )   PDF (754KB) ( 167 )   Save

    BACKGROUND: More and more studies have shown that miRNA plays an important regulatory role in the pathological development of osteoarthritis.
    OBJECTIVE: To review the correlation between miRNA and the pathological development of osteoarthritis.
    METHODS: A computer-based search of CNKI and PubMed databases was conducted for the articles concerning miRNA and osteoarthritis published before December 2018. The keywords were “osteoarthritis, miRNA” in Chinese and English, respectively. 
    RESULTS AND CONCLUSION: miRNA is closely related to the pathogenesis of osteoarthritis. Abnormal expression of miRNA is involved in chondrocyte proliferation and apoptosis, articular cartilage extracellular matrix homeostasis, chondrocyte inflammation and joint pain in osteoarthritis. Abnormally expressed miRNA can be used as a marker for early diagnosis of osteoarthritis. As a regulatory gene, miRNA has broad prospects in molecular targeted therapy of osteoarthritis.

    Figures and Tables | References | Related Articles | Metrics
    Molecular biological characteristics of hereditary multiple exostoses
    Wu Donghua, He Dawei
    2019, 23 (24):  3882-3888.  doi: 10.3969/j.issn.2095-4344.1298
    Abstract ( 421 )   PDF (786KB) ( 87 )   Save
    BACKGROUND: Low incidence of hereditary multiple exostoses leads to few lines for clinical research, and difficulty in duplicating cellular and animal models delay the studies on the pathogenesis.
    OBJECTIVE: To summarize the research progress of pathological changes, molecular mechanisms and signaling pathways of hereditary multiple exostoses.
    METHODS: By consulting relevant researches at home and abroad and researching the genetic website, we integrated related content and opinions.
    RESULTS AND CONCLUSION: (1) Hereditary multiple exostoses are an autosomal dominant hereditary skeletal disease characterized by multiple bone neoplasms covered by cartilages that grow outward from the metaphysis of long tubular bones. The clinical symptoms that are related to factors such as location, size and shape are variable. (2) The disease is genetically heterogeneous and is mainly associated with mutations in the tumor suppressor genes Exostosin-1 or Exostosin-2 of the EXT family. The occurrence of the disease is mainly associated with heparin sulfate and its downstream signaling pathways in the molecular level. (3) We have summarized the researches on hereditary multiple exostoses in the past decades and paved the way for future investigation.
    Figures and Tables | References | Related Articles | Metrics
    Surgical treatment and reconstruction strategy of knee valgus deformity  
    Qin Gang, Liu Xiong, He Kaiyi, Du Mindong, Zeng Ping, Li Jinyi
    2019, 23 (24):  3889-3894.  doi: 10.3969/j.issn.2095-4344.1299
    Abstract ( 414 )   PDF (765KB) ( 82 )   Save
    BACKGROUND: Knee valgus deformity is often accompanied by bone and soft tissue changes. There are many treatments, such as distal femoral varus osteotomy, supracondylar acetabular osteotomy, total knee arthroplasty, which can correct valgus deformity and restore the normal mechanical axis of lower limbs. Its advantages, disadvantages and indications are different, and corresponding treatment methods should be selected according to the specific conditions of different patients.
    OBJECTIVE: To review the research progress of various surgical methods for treating genu valgus deformity at home and abroad in recent years.
    METHODS: A computer-based search was conducted in PubMed and CNKI databases from January 2000 to December 2018 with the keywords of “knee joint, valgus deformity, distal femoral varus osteotomy, supracondylar dome osteotomy, total knee arthroplasty, surgery, treatment” in English and Chinese, respectively. A total of 247 relevant literatures were retrieved, and 47 articles were eligible for the inclusion criteria.
    RESULTS AND CONCLUSION: (1) Valgus deformity is often associated with some characteristic changes in bone and soft tissue. There are a variety of treatments, for example, distal femoral varus osteotomy, supraorbital iliac crest osteotomy, total knee arthroplasty. They can correct valgus deformity and restore the normal mechanical axis of the lower extremities. Their advantages and disadvantages and indications are different, so different patients should choose appropriate treatment according to the severity of deformity, length of disease history, age and so on. (2) Distal femoral varus osteotomy is suitable for young people and can effectively prevent or delay the occurrence and development of osteoarthritis. There are many kinds of internal fixators for osteotomy, such as Ilizarov external fixator, Puddu plate, Tomofix plate and intramedullary nail, which have their advantages and disadvantages. (3) However, for patients with knee valgus who have already developed intra-articular diseases, the effect of simple distal femoral varus osteotomy is often unsatisfactory. Supracondylar acetabular osteotomy combined with arthroscopy can effectively solve this problem. (4) Total knee arthroplasty is often the best choice for patients with advanced knee arthritis. According to the severity and pathological changes of valgus deformity of the knee joint, the operative approach of total knee replacement is decided. For patients with abnormal patellar track and severe lateral structural contracture, the lateral approach is used and the medial approach is used instead. The choice of prosthesis is also very important, which directly affects the curative effect and life span after operation. The internal and external soft tissue imbalance restores the articular force line by releasing the balance, but the specific soft tissue release strategy is still controversial. The joint and soft tissue of the patient should be considered comprehensively.
    Figures and Tables | References | Related Articles | Metrics
    Dynesys dynamic internal fixation for treating lumbar degenerative diseases: relationship between biomechanical characteristics and adjacent segment degeneration
    Huang Daoyu
    2019, 23 (24):  3895-3900.  doi: 10.3969/j.issn.2095-4344.1267
    Abstract ( 374 )   PDF (653KB) ( 86 )   Save
    BACKGROUND: With the innovation on the internal fixation technique of lumbar vertebrae, the Dynesys system is another choice for treating degenerative diseases of lumbar spine. It is one of the most common non-fusion techniques in clinical application. Dynesys dynamic internal fixation system is to maintain the stability of the spine, to retain the physiological activity of the fixed segment, and prevent the adjacent segment degeneration, but its effect on the adjacent segment is still unknown.
    OBJECTIVE: To analyze the research status and clinical treatments of the lumbar degenerative diseases in Dynesys internal fixation.
    METHODS: PubMed database was retrieved using the keywords of “lumbar degenerative disease, treatment/therapy, Dynesys dynamic stabilization system/Dynesys” for the articles published between 2002 and 2018. The biomechanics, clinical efficacy and adjacent segment degeneration of the lumbar spine were recorded after reading the retrieved literature.
    RESULTS AND CONCLUSION: (1) Dynesys dynamic stabilization system, as the most widely used non-fusion technology, which can obtain similar clinical efficacy with fusion. (2) Existing evidence shows that Dynesys internal fixation can maintain spinal stability, preserve partial motion of diseased vertebral segments, and reduce the load of facet joints and intervertebral disk pressure. (3) During long-term follow-up, complications such as screw loosening and poor correction of lumbar lordosis often occur after Dynesys internal fixation. (4) In addition, whether the degeneration of adjacent segments after rigid fixation is a natural development process or the role of internal fixation remains controversial. Long-term follow-up and large-sample studies are needed to clarify the mechanism.
    Figures and Tables | Related Articles | Metrics
    Clinical outcomes of SuperPATH approach versus traditional posterior approach in total hip arthroplasty: a meta-analysis
    Che Xianda, Han Pengfei, Gu Xiaodong, Gao Yangyang, Chen Taoyu, Li Pengcui
    2019, 23 (24):  3901-3908.  doi: 10.3969/j.issn.2095-4344.1300
    Abstract ( 344 )   PDF (1048KB) ( 130 )   Save
    BACKGROUND: SuperPATH approach in total knee arthroplasty has many advantages over traditional surgery, but whether it has the same good efficacy as traditional posterior approach is still controversial.
    OBJECTIVE: To compare the clinical efficacy between SuperPATH approach and traditional posterior approach in the treatment of total hip arthroplasty by meta-analysis.
    METHODS: The clinical controlled trials published from 2016 to 2018 were retrieved. The retrieval was performed in the databases of Embase, PubMed, Central, Cinahl, PQDT, Cochrane Library, CNKI, VIP, WanFang and CBM. Review Manager 5.3 software was used for data analysis.
    RESULTS AND CONCLUSION: (1) Sixteen eligible articles were included. (2) Results analysis showed that the SuperPATH approach was superior to traditional posterior approach in Harris hip score [95%CI (3.34, 5.90), P < 0.001], and operation time [95%CI (3.30, 20.26), P=0.007]. (3) The SuperPATH approach was inferior to posterior approach in range of motion [95%CI (1.28, -1.40), P < 0.000 1], Visual Analogue Scale score [95%CI (-2.99, -1.49), P < 0.001], incision length [95%CI (-7.00, -4.70), P < 0.001], and blood loss [95%CI (-131.97, -92.87), P < 0.001]. (4) The first weight-bearing time in the SuperPATH approach was shorter than that in the posterior approach [95%CI (-93.94, -64.55), P < 0.001]. (5) These results indicate that the SuperPATH approach in total hip arthroplasty can achieve better effect than traditional posterior approach, especially in Harris hip score, Visual Analogue Scale score, incision length, blood loss, and first weight-bearing time.
    Figures and Tables | References | Related Articles | Metrics
    Whether antibiotic treatment is necessary for treating asymptomatic bacteriuria in the perioperative period of joint arthroplasty: a meta-analysis
    He Long, Zhang Chaofan, Xu Zhiyang, Huang Zida, Fang Xinyu, Li Wenbo, Zhang Wenming
    2019, 23 (24):  3909-3915.  doi: 10.3969/j.issn.2095-4344.1225
    Abstract ( 332 )   PDF (1010KB) ( 91 )   Save
    BACKGROUND: Periprosthetic joint infection is a serious and catastrophic complication after joint arthroplasty. For asymptomatic bacteriuria, during perioperative period of joint arthroplasty, many doctors choose oral antibiotics. However, the previous research on whether asymptomatic bacteriuria will cause periprosthetic joint infection has no consensus, and the effect of antibiotics is unknown.
    OBJECTIVE: To investigate whether asymptomatic bacteriuria is a risk factor for periprosthetic joint infection and whether antibiotic treatment is effective by meta-analysis.
    METHODS: Through systematic research based on computer of major foreign and Chinese databases, such as PubMed, Ovid, Cochrane Library, EMBASE, CNKI, WanFang, VIP, and CMB databases, and manual research, literature traceability was performed. The articles concerning the effect of asymptomatic bacteriuria on the prognosis of joint arthroplasty published before May 2018 was searched. Literature screening, quality evaluation and data extraction were performed according to the Cochrane system, and analysis was undergone on Review Manager 5.3 software.
    RESULTS AND CONCLUSION: (1) Nine articles were enrolled, involving 29 844 cases of joint arthroplasty, including 2 366 cases of asymptomatic bacteriuria. (2) Periprosthetic joint infection had a significantly higher incidence in the asymptomatic bacteriuria group than that in the non-asymptomatic bacteriuria group (OR=3.15, 95%CI: 1.23-8.02, P=0.02). (3) Seven in the nine articles reported the use of antibiotics for treating perioperative asymptomatic bacteriuria, and there was no significant difference in the incidence of periprosthetic joint infection between two groups (OR=1.64, 95%CI: 0.84-3.23, P=0.15). (4) To conclude, the occurrence of asymptomatic bacteriuria in the perioperative period of joint arthroplasty is a risk factor for periprosthetic joint infection, and the use of antibiotics for asymptomatic bacteriuria does not change the incidence of periprosthetic joint infection.
    Figures and Tables | References | Related Articles | Metrics
    Treatment efficacy of cementless versus cemented prosthesis in primary total knee arthroplasty: a meta-analysis  
    Zhao Jiangbo, Tian Jianing, Li Yan, Chen Desheng
    2019, 23 (24):  3916-3923.  doi: 10.3969/j.issn.2095-4344.1301
    Abstract ( 432 )   PDF (1296KB) ( 91 )   Save
    BACKGROUND: For patients who need total knee arthroplasty, whether to use cementless or cementless fixation, which fixation method has more advantages in clinical efficacy, functional activity and prosthesis survival rate are controversial.
    OBJECTIVE: To compare the efficacy of cementless and cemented fixations in primary total knee arthroplasty by meta-analysis in order to evaluate the best fixation method.
    METHODS: PubMed, EMbase, Cochrane Library, CNKI, WanFang and CBM databases were searched. All randomized controlled trials on the efficacy of cementless and cemented fixations in primary total knee arthroplasty before June 2018 were collected. Two researchers independently screened the literature according to the inclusion and exclusion criteria, then extracted data, and conducted quality evaluation. RevMan 5.3 software was used for meta-analysis.
    RESULTS AND CONCLUSION: (1) Seven randomized controlled trials were included, involving 743 patients. (2) Meta-analysis results showed that there was no significant difference in the primary measurement outcome, survival rate of prosthesis [RR=1, 95%CI (0.98, 1.02), P=0.90]. (3) Secondary measurement outcomes, Knee Society Score [MD=0.28, 95%CI (-1.04, 1.61), P=0.68], Western Ontario and McMaster Universities Osteoarthritis Index score [MD=1.63, 95%CI (-0.17, 3.43), P=0.08], blood loss (intraoperative bleeding + drainage) [MD=408.52, 95%CI (-102.18, 919.22), P=0.12], incidence of joint infection [RR=0.97, 95%CI (0.34, 2.73), P=0.95] had no significant difference between two groups. The range of motion in the cementless group was superior to the cemented group [MD=3.46, 95%CI (1.12, 5.80), P=0.004]. Cementless fixation was better than bone cement fixation in clear line [RR=1.67, 95%CI (1.14, 2.46), P=0.009]. (4) In summary, for patients undergoing primary total knee arthroplasty, the effect of cementless fixation is similar to that of cemented fixation, but both of them have certain advantages in terms of joint range of motion and clear line.
    Figures and Tables | References | Related Articles | Metrics
    Clinical effect of locking plate versus anterograde intramedullary nail in the treatment of adult humeral shaft fractures: a meta-analysis
    Wang Lei, Li Zilong, Yuan Binbin, Wu Qingwei, Tang Fengming
    2019, 23 (24):  3924-3930.  doi: 10.3969/j.issn.2095-4344.1226
    Abstract ( 297 )   PDF (878KB) ( 115 )   Save
    BACKGROUND: Most of the published meta-analysis literatures do not distinguish the type of plate used, nor do distinguish anterograde or retrograde intramedullary nail placement. The clinical guiding significance is poor, and further research is needed.
    OBJECTIVE: To compare the clinical outcomes of locking plate and anterograde intramedullary nail in the treatment of adult humeral shaft fracture by meta-analysis in recent years, so as to guide the clinical practice.
    METHODS: Related articles in databases of CNKI, VIP, WanFang, PubMed, EMBase, and Cochrane Library were retrieved. The operation time, intraoperative bleeding volume, postoperative upper limb function and the postoperative adverse reactions were compared between locking plate and anterograde intramedullary nail groups using RevMan 5.3 software.
    RESULTS AND CONCLUSION: Twelve articles were included, all of which were randomized controlled clinical trials with 982 patients (485 patients treated with locking plate and 497 with anterograde intramedullary nail). The meta-analysis results showed that the comparison of operation time was carried out in nine articles; the comparison of intraoperative bleeding volume was carried out in seven articles; the comparison of postoperative upper limb function was carried out in seven articles, and the comparison of postoperative adverse reactions was carried out in six articles. The included articles showed that the treatment of adult humeral shaft fractures with anterograde intramedullary nail and locking plate was significant in the operation time (MD=23.98, 95%CI: 20.27-27.68, P < 0.01), the intraoperative bleeding volume (MD=98.16, 95%CI: 82.43-113.90, P < 0.01) and the postoperative upper limb function (OR=0.49, 95%CI: 0.27-0.89, P=0.02). The anterograde intramedullary nail was more advantageous than the locking plate. There was no significant difference between intramedullary nail and locking plate groups in the postoperative adverse reactions (OR=1.38, 95%CI: 0.79-2.41, P=0.26). In summary, the clinical effect of intramedullary nail in the treatment of humeral shaft fracture is not inferior to that of plate and screw fixation.
    Figures and Tables | Related Articles | Metrics
    Intravenous infusion versus local application of tranexamic acid in primary unilateral total hip arthroplasty: a meta-analysis
    Lu Zhan, Shi Junlong, Liu Peidong, Lei Hongwei, Yang Ziquan
    2019, 23 (24):  3931-3936.  doi: 10.3969/j.issn.2095-4344.1265
    Abstract ( 388 )   PDF (832KB) ( 80 )   Save
    BACKGROUND: The effect of tranexamic acid on hemostasis in total hip arthroplasty has been recognized by more and more scholars. However, its safe and effective application still remains controversial.
    OBJECTIVE: To compare the efficacy about intravenous infusion and topical application concerning tranexamic acid in the primary unilateral total hip arthroplasty.
    METHODS: Cochrane Library, PubMed, Embase, CNKI and WanFang databases were retrieved for the articles published before November 2018. For discovering all the required literature, all relevant papers and references in the included literature were consulted. All the papers included were strictly assessed by selection as well as exclusion criteria, in order to evaluate their conformity with the project and their quality. Finally, a meta-analysis of eligible studies was conducted.
    RESULTS AND CONCLUSION: (1) Nine eligible studies were included (improved Jadad score ≥ 4 points) discussed by 3 researchers. (2) This study showed that intravenous infusion had an advantage over local application [WMD=-4.08, 95%CI (-5.99, -2.17), P < 0.01] on the effect of tranexamic acid reducing the postoperative change of hemoglobin. (2) No significant difference occurred between intravenous infusion and local application in total perioperative blood loss [WMD=-26.10, 95%CI (-56.96, 4.76), P=0.10], transfusion rate [RR=0.92, 95%CI (0.62, 1.35), P=0.66], postoperative risk of deep venous thrombosis in lower extremities [RR=1.26, 95%CI (0.34, 4.65), P=0.72], postoperative risk of pulmonary embolism [RR=2.96, 95%CI (0.12, 71.38), P=0.50] and postoperative incidence of incision complications [RR=0.78, 95%CI (0.40, 1.52), P=0.47]. (4) In summary, tranexamic acid with intravenous infusion can reduce perioperative hemoglobin changes, with no increase in postoperative risk of deep venous thrombosis in lower extremities, pulmonary embolism and poor incision healing. As a result, tranexamic acid in intravenous infusion is recommended when primary unilateral hip arthroplasty is conducted.     
    Figures and Tables | References | Related Articles | Metrics