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    08 October 2019, Volume 23 Issue 28 Previous Issue    Next Issue
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    Total hip arthroplasty by direct anterior approach in the lateral position in the treatment of ankylosed hips: early therapeutic effects
    Cheng Wendan, Wu Han, Zhang Jisen, Zhang Xin, Zhang Shuo, Li Ziyu, Wu Yibo, Bai Wenyi, Jing Juehua
    2019, 23 (28):  4429-4434.  doi: 10.3969/j.issn.2095-4344.1337
    Abstract ( 392 )   PDF (674KB) ( 150 )   Save
    BACKGROUND: Total hip arthroplasty in the treatment of advanced hip ankylosis can restore the motion function of hip joint, relieve pain and improve the quality of life of patients. However, due to the special anatomical and pathophysiological abnormalities of ankylosing hip joint, it is particularly difficult to expose the acetabular side and install the prosthesis correctly. To obtain good acetabular exposure, lateral approach combined with greater trochanter osteotomy and anterior-posterior combined approach were used to obtain full exposure. However, these approaches inevitably damaged the long-term disused atrophic peri-hip muscles of ankylosing hip patients. The direct anterior approach is through the gap between tensor fasciae latae and sartorius muscle. It is the most minimally invasive approach for total hip arthroplasty. The acetabular side is fully exposed. At the same time, it has the advantages of less soft tissue injury and fast recovery after replacement.
    OBJECTIVE: To investigate the clinical efficacy of total hip arthroplasty with direct anterior approach in the lateral position in the treatment of ankylosis hip.
    METHODS: A retrospective analysis was performed on the clinical data of 12 patients (17 hips) who underwent total hip arthroplasty with direct anterior approach in the lateral position for the treatment of hip ankylosis from November 2016 to May 2018. Length of incisions, operation time, intraoperative blood loss, prosthesis position, straight leg-raising time, visual analogue scale score, range of motion, Harris hip score and adverse reactions were recorded. This study was approved by the Ethics Committee of the Second Affiliated Hospital of Anhui Medical University (approval number: (2018)7).
    RESULTS AND CONCLUSION: (1) The average incision length, operative time, intraoperative blood loss and straight leg-raising time of 12 patients (17 hips) were (11.12±1.69) cm, (122.47±25.40) minutes, (279.41±135.85) mL and (9.59±4.62) days, respectively. (2) The prosthesis was in good position. The average forward angle was (15.76±2.84)°; average abducent angle was (40.00±3.45)°. (3) Compared with that before replacement, Harris score and range of motion remarkably increased, but visual analogue scale score obviously decreased, after replacement, and gradually improved with prolonged time. (4) One case of proximal femur fracture occurred and was fixed with wire binding intraoperatively; the fracture healed and the hip function recovered well 3 months later. No complications occurred such as infection, deep vein thrombosis, fat embolism, prosthesis loosening, limb length inequality and joint dislocation. (5) Total hip arthroplasty with direct anterior approach in the treatment of hip ankylosis in the lateral position is safe and effective, which has the advantages of small trauma, quick recovery of hip function, and can expose acetabulum fully and installed prosthesis properly, and the early clinical efficacy is satisfied.
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    Feasibility of preoperative ratio of C-reactive protein to albumin for assessing the prognosis of older adults with hip fracture undergoing arthroplasty or internal fixation
    Lu Qilin, Cai Xianhua, Shang Ranran, Chen Yanzhao, Xie Wei, Chen Xiongwei, Wu Haiyang
    2019, 23 (28):  4435-4439.  doi: 10.3969/j.issn.2095-4344.1133
    Abstract ( 397 )   PDF (20095KB) ( 120 )   Save
    BACKGROUND: Preliminary studies have shown that preoperative serum levels of C-reactive protein and albumin can predict the mortality in elderly patients with hip fracture within 1 year after surgery, but there has not been a report on the clinical value of combined evaluation.
    OBJECTIVE: To investigate the effect of preoperative ratio of serum C-reactive protein to albumin on prognosis of elderly patients with hip fracture.
    METHODS: The serum levels of C-reactive protein and albumin in 155 patients with hip fractures undergoing internal fixation or arthroplasty were detected, and the ratio of C-reactive protein/albumin was measured. According to the median value of 2.37, patients were divided into high ratio group and low ratio group. The relationship between C-reactive protein/albumin and clinical data was analyzed. The Kaplan-Meier method was used for survival analysis. The Cox risk model was used to analyze the prognostic factors of hip fracture in elderly patients.
    RESULTS AND CONCLUSION: (1) Patients in the high ratio group were older, had higher C-reactive protein level, more chronic lung disease and American Society of Anesthesiologists grade III/IV ratio, and lower albumin level compared with the low ratio group (P < 0.05). (2) The mortality rate (20.65%) in the high ratio group was significantly higher than that in the low ratio group (11.84%) (χ2=7.053, P=0.008). (3) Age, American Society of Anesthesiologists classification and C-reactive protein/albumin ratio were independent risk factors for elderly patients with hip fracture. (4) In summary, the preoperative C-reactive protein/albumin ratio in elderly patients with hip fracture has a certain value in predicting the survival rate within 1 year after operation. High preoperative C-reactive protein/albumin ratio suggests poor prognosis.
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    Risk assessment of hemiarthroplasty and internal fixation of proximal femoral nail antirotation for treating hip fractures in older adults
    Zuo Sili
    2019, 23 (28):  4440-4445.  doi: 10.3969/j.issn.2095-4344.1329
    Abstract ( 324 )   PDF (22126KB) ( 92 )   Save
    BACKGROUND: Methods of hip fracture repair include arthroplasty and proximal femoral nail antirotation placement. Whether Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity is feasible for risk assessment before bone surgeries needs to be investigated.
    OBJECTIVE: To compare the preoperative prediction and actual mortality in senile hip fracture treated with different implants based on Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity, so as to explore the clinical application value of the scoring system.
    METHODS: One hundred and sixty-six cases of hip fractures with the age of above 70 years admitted in the Zhengzhou Orthopaedics Hospital from January 2016 to January 2017 were collected, and assigned into hemiarthroplasty group (bipolar artificial femoral head replacement, n=85, femoral neck fracture), and proximal femoral nail antirotation group (n=81, intertrochanteric fracture). All patients signed the informed consents, and the study was approved by the ethics committee of the hospital. The total mortality rate of 166 patients was calculated, and then the actual mortality rate in the two groups was calculated. The predictive mortality rate of all patients and two groups was calculated by Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity system. The actual and predictive data were compared and analyzed.
    RESULTS AND CONCLUSION: (1) The actual mortality rate of 166 patients (including 12 cases of death) was 7.2%, and the predictive mortality rate was 5.4%. (2) The actual mortality rate in the hemiarthroplasty group (totally 85 cases, 4 cases of death) was 4.7%, and the predictive mortality rate was 3.5%. (3) The actual mortality rate in the proximal femoral nail antirotation group (totally 81 cases, 8 cases of death) was 9.9%, and the predictive mortality rate was 6.2%. (4) There was no significant difference in the actual mortality rate and predictive mortality rate (P > 0.05). (5) In summary, Portsmouth-Physiological and Operative Severity Score system for the Enumeration of Mortality and Morbidity system can objectively and effectively predict the risk of the older adults with hip fractures undergoing hemiarthroplasty and internal fixation of proximal femoral nail antirotation.
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    Application of enoxaparin to perioperative period of hemiarthroplasty for femoral neck fracture in the older adults
    Chen Yan, Duan Jianwei, Zhang Meng
    2019, 23 (28):  4446-4450.  doi: 10.3969/j.issn.2095-4344.1451
    Abstract ( 328 )   PDF (21217KB) ( 116 )   Save
    BACKGROUND: Venous thrombosis is a serious perioperative complication in elderly patients with hip fracture. It is necessary to select an effective intervention program to reduce its risk.
    OBJECTIVE: To compare the effects of enoxaparin and rivaroxaban on intraoperative hemorrhage and postoperative deep venous thrombosis during perioperative period of hemiarthroplasty in elderly patients with femoral neck fracture.
    METHODS: A total of 95 patients with femoral neck fractures aged 65 years and older were enrolled in the Department of Orthopedics, Beijing Jiangong Hospital from January 2016 to January 2018. These patients were assigned to two groups. Patients in the control group (n=43) were orally administered rivaroxaban once a day during the perioperative bed rest, and the drug was discontinued once on the operation day. Patients in the trial group (n=52) were given a subcutaneous injection of enoxaparin during the perioperative bed rest, and the drug was stopped 12 hours before the operation. Informed consent was obtained from all patients. This study was approved by the Hospital Ethics Committee. The intraoperative blood loss, postoperative blood loss, perioperative dominant and occult blood loss, postoperative bleeding rate and incidence of postoperative deep venous thrombosis were compared between the two groups.
    RESULTS AND CONCLUSION: (1) There was no significant difference in the amount of intraoperative blood loss, postoperative blood loss, perioperative dominant blood loss, postoperative bleeding rate, and incidence of postoperative deep venous thrombosis between the two groups (P > 0.05). (2) However, the perioperative occult blood loss in the trial group was less than that in the control group (P < 0.05). (3) It is suggested that enoxaparin is safe and reliable in the perioperative period of hemiarthroplasty for femoral neck fracture. Compared with rivaroxaban, enoxaparin can reduce the occult blood loss during the perioperative period.
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    Usage strategy of optimized tourniquet in enhanced recovery after total knee arthroplasty
    Peng Chenjian, Du Bin, Sun Guangquan, Liu Xin, He Bing
    2019, 23 (28):  4451-4455.  doi: 10.3969/j.issn.2095-4344.1220
    Abstract ( 360 )   PDF (21682KB) ( 102 )   Save
    BACKGROUND: Tourniquets used in total knee arthroplasty can reduce intraoperative bleeding, maintain clear surgical field, and increase the stability of the prosthesis, but can cause adverse reactions such as ischemia/reperfusion injury, local paralysis of the tourniquet, swelling, and pain. Therefore, how to optimize the usage strategy during surgery to maximize the benefit of tourniquet application has become a hotspot.
    OBJECTIVE: To compare and analyze the effects of different tourniquet usage strategies on enhanced recovery after total knee arthroplasty.
    METHODS: Eighty-six patients with osteoarthritis who underwent primary total knee arthroplasty at Affiliated Hospital of Nanjing University of Chinese Medicine from July 2017 to May 2018 were randomly divided into two groups. Whole process group used tourniquet in the whole process from cut to prosthesis implantation (n=43) and optimized group used tourniquet only when the prosthesis was implanted (n=43). The operation time, tourniquet usage time, and blood loss were recorded. The swelling degree of knee joint at postoperative 1, 3, 5, and 7 days was measured. The Hospital for Special Surgery score, Visual Analog Scale score, Hamilton Anxiety and Depression Scale, and social objective and subjective support score were detected before discharge.  
    RESULTS AND CONCLUSION: (1) There was no significant difference in the operation time between two groups (P > 0.05). The tourniquet usage time in the whole process group was significantly longer than that in the optimized group (P < 0.05). (2) There was insignificant difference in the total blood loss between two groups. The intraoperative blood loss in the whole process group was significantly less than that in the optimized group (P < 0.05), and the postoperative drainage volume and hidden blood loss were more than those in the optimized group (P < 0.05). (3) The swelling degree of knee joint at postoperative 3 and 5 days in the optimized group was significantly lower than that in the whole process group (P < 0.05). (4) The Hospital for Special Surgery score, and social objective and subjective support score in the optimized group were significantly higher than those in the whole process group, and the Visual Analog Scale score, and Hamilton Anxiety and Depression Scale were significantly lower than those in the whole process group (P < 0.05). (5) There was no significant difference in the incidence of complications between two groups (P > 0.05). (6) Our results manifest that optimization of tourniquet usage can reduce hidden blood loss, alleviate postoperative pain, inflammation reaction and swelling degree, and effectively control patients, negative emotions.
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    Restrictive use and non-use tourniquets during total knee arthroplasty
    Wang Xinling, Tan Biao, Yin Jiandong, Zuo Biao
    2019, 23 (28):  4456-4460.  doi: 10.3969/j.issn.2095-4344.1341
    Abstract ( 411 )   PDF (17923KB) ( 106 )   Save
    BACKGROUND: A comparison of the postoperative effects of the use of tourniquet has been reported, but few literatures have clearly indicated differences in the effects of restrictive use of tourniquets and no use of tourniquets.
    OBJECTIVE: To investigate the effects of restrictive use and non-use of tourniquet in patients undergoing preliminary total knee arthroplasty within enhanced recovery after surgery mode.
    METHODS: Totally 90 patients who underwent total knee arthroplasty in Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from July 2017 to December 2018 were enrolled. The patients were randomly divided into three groups (n=30 per group) according to the method of the tourniquet during the operation. In the restrictive use group, after the osteotomy was completed, only the tourniquet treatment was applied when the prosthesis was installed, and the knee joint prosthesis was successfully placed and the cement was hardened. In the second half use group, after the osteotomy was completed, the tourniquet was used when the prosthesis was installed until the incision was sutured and pressure-wrapped. In the non-use group, no inflated tourniquet was used during operation. The same perioperative management and rehabilitation training were used in all patients of each group. Hemoglobin, C-reactive protein, visual analogue scale scores and HSS score were observed and compared between groups.
    RESULTS AND CONCLUSION: (1) Compared with the restrictive use group and the non-use group, the knee visual analogue scale scores and C-reactive protein level at 1 and 3 days after operation and the hemoglobin level at 1 day after operation both increased in the second half use group (P < 0.05); however, the knee HSS scores at 3 and 7 days decreased (P < 0.05). (2) There were no significant differences in visual analogue scale score, HSS score, C-reactive protein, and hemoglobin levels between the restrictive use group and the non-use group after surgery. (3) There was no significant difference in the early postoperative rehabilitation between the restrictive use and non-use tourniquet, but the use of tourniquets in the second half would aggravate early postoperative pain.
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    Correlation factors for allogeneic blood transfusion after total knee arthroplasty
    Xin Chaofei, Xu Jianzhong, Zhao Shixin, Tian Jinxiang, Chang Yingjian, Shi Jianming
    2019, 23 (28):  4461-4467.  doi: 10.3969/j.issn.2095-4344.1266
    Abstract ( 337 )   PDF (29726KB) ( 107 )   Save
    BACKGROUND: Due to massive blood loss during perioperative period, some patients need to receive allogeneic blood transfusion after total knee arthroplasty, which is risky. How to reduce the rate of allogeneic blood transfusion after total knee arthroplasty has become an issue of concern in clinical practice.
    OBJECTIVE: To investigate the rate of allogeneic blood transfusion after total knee arthroplasty, and analyze its risk factors, thus reducing the rate of allogeneic blood transfusion in patients with total knee arthroplasty.
    METHODS: Totally 687 patients undergoing total knee arthroplasty at the First Affiliated Hospital of Zhengzhou University from January 2014 to May 2018 were analyzed retrospectively. Patients were divided into non-allogeneic (n=490) and allogeneic blood transfusion (n=197) groups according to whether they had allogeneic blood transfusion after total knee arthroplasty. The postoperative indexes related to allogeneic blood transfusion were recorded. Potential risk factors for allogeneic transfusion were analyzed statistically via univariate and multivariate regression analysis. The study was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University in March 2019.
    RESULTS AND CONCLUSION: (1) Totally 197 (28.7%) patients of 687 received allogeneic blood transfusion after total knee arthroplasty. (2) The differences were significant in the age, sex, pre-diagnosis, pre-hemoglobin level, pre-hematocrit and drainage tube placement between two groups (P < 0.05). (3) Age, sex, pre-hemoglobin level, pre-hematocrit and drainage tube placement were significantly different between two groups in multivariate regression analysis (P < 0.05). (4) These results indicate that aged female, pre-anemia, pre-hematocrit less than the normal level and postoperative drainage tube placement are independent risk factors for increasing the allogeneic blood transfusion rate after total knee arthroplasty. Patients who were with rheumatoid arthritis and whose postoperative mean arterial pressure has a reduction of ≥ 20 mm Hg have an increased postoperative blood transfusion rate. There is no significant difference in the allogeneic blood transfusion rate between simultaneous bilateral, staged bilateral total knee arthroplasties and unilateral total knee arthroplasty.
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    Correlation of anesthesia methods with serum melatonin mass concentration and delirium during recovery in elderly patients undergoing knee arthroplasty
    Jiao Yuxia, Zhou Qun, Fan Kaile, Li Dongbai
    2019, 23 (28):  4468-4473.  doi: 10.3969/j.issn.2095-4344.1467
    Abstract ( 326 )   PDF (25441KB) ( 100 )   Save
    BACKGROUND: The incidence of postoperative delirium in senile patients is high, and the mechanism is still unclear. To study the mechanism and try to reduce the occurrence of postoperative delirium in senile patients is an important problem for anesthesiologists to solve.
    OBJECTIVE: To investigate the relationship between serum melatonin concentration and delirium in recovery stage in elderly patients undergoing knee arthroplasty, and to compare the effects of different anesthesia on serum melatonin concentration.
    METHODS: Patients undergoing knee replacement were randomly divided into two groups: general anesthesia group and general anesthesia + femoral nerve block anesthesia group. All patients signed the informed consent. The study was approved by the Hospital Ethics Committee. The serum concentration of melatonin was measured before and at the end of operation when all anesthetic drugs were infused. The occurrence of recovery delirium was evaluated according to the nursing delirium screening scale immediately after removal of the larynx mask.
    RESULTS AND CONCLUSION: (1) There was no significant difference in the incidence of delirium between general anesthesia + femoral nerve block anesthesia group and general anesthesia group (P > 0.05), but the score of delirium in general anesthesia + femoral nerve block anesthesia group was significantly lower than that in general anesthesia group (P < 0.05). (2) There was no significant difference in melatonin mass concentration between pre-and post-operation in general anesthesia + femoral nerve block anesthesia group (P > 0.05). Melatonin mass concentration was significantly decreased after operation compared with that before operation in the general anesthesia group (P < 0.05). (3) Difference of melatonin mass concentration was significantly less in the general anesthesia + femoral nerve block anesthesia group than in the general anesthesia group before and after operation (P < 0.05). (4) Spearman correlation analysis demonstrated that there was a negative correlation between delirium score during recovery stage and postoperative melatonin mass concentration (r=-0.429, P < 0.05). There was a positive correlation between delirium score during recovery stage and the difference of melatonin mass concentration (r=0.741,  P < 0.05). (5) General anesthesia combined with femoral nerve block anesthesia could remarkably decrease delirium score during recovery stage in elderly patients undergoing knee arthroplasty. The mechanism may be related to inhibition of the reduction of serum melatonin mass concentration.
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    ROI-C versus traditional fusion cage combined with titanium plate in treatment of cervical spondylosis: cervical stability reconstruction and intervertebral fusion
    Song Sheng, Sun Zhenzhong, Jiang Weimin, Liu Xueguang, Zhuang Yin
    2019, 23 (28):  4474-4478.  doi: 10.3969/j.issn.2095-4344.1468
    Abstract ( 552 )   PDF (657KB) ( 103 )   Save
    BACKGROUND: Anterior cervical discectomy and fusion is classical and satisfactory for the treatment of cervical spondylosis, but there are still many problems. ROI-C designed with the concept of “zero-notch” has been widely used in clinical practice in recent years, but there are few comparative studies between ROI-C and traditional surgical treatment.
    OBJECTIVE: To compare and analyze the clinical effect of ROI-C and traditional fusion cage combined with titanium plate in the operation of cervical spondylosis.
    METHODS: From April 2012 to December 2015, 47 cases underwent anterior cervical decompression spondylotic myelopathy fusion and internal fixation surgery. They were divided into two groups. Patients in the titanium plate group (n=18) were treated by traditional fusion combined therapy with titanium plate. Patients in the ROI-C group (n=29) were treated by ROI-C fusion treatment. Informed consent was obtained from all patients. This study was approved by the Hospital Ethics Committee. Intraoperative blood loss, the number of C-arm fluoroscopy, operation time, postoperative complications and intervertebral fusion were recorded. Visual Analogue Scale score and Japanese Orthopaedic Association score were evaluated before and after operation.
    RESULTS AND CONCLUSION: (1) All patients were followed up regularly for 12-16 months. Clinical symptoms and spinal cord function of all patients were remarkably improved. Neither of the two groups had implant loosening or displacement or secondary surgery. (2) At the last follow-up, the operative segments were fused, but there was no significant difference between the two groups (P > 0.05). (3) Operation time, intraoperative blood loss and the number of C-arm fluoroscopy during operation were better in the ROI-C group than in the titanium plate group (P < 0.05). (4) Visual Analogue Scale score and Japanese Orthopaedic Association score were better after operation than those before operation in both groups, but no significant difference was found between the two groups at various time points (P > 0.05). (5) ROI-C and the traditional fusion cage with titanium plate can obtain good clinical curative effect in anterior cervical spine surgery. There was no significant difference in effective recovery of intervertebral space height, cervical stability reconstruction and interbody fusion. Nevertheless, ROI-C group has obvious advantages in operation time, intraoperative blood loss and avoidance of complications caused by plate implantation. It is hopeful that ROI-C will replace the traditional fusion cage combined with titanium plate.
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    Short-segment percutaneous pedicle screw instrumentation for the treatment of thoracolumbar fractures: bilateral fracture level and cross-fracture level
    Wang Jinning, Song Dawei, Qiao Yusen, Yang Yan, Zou Jun, Zhang Linlin, Geng Dechun, Yang Huilin, Wu Guizhong, Ni Li
    2019, 23 (28):  4479-4484.  doi: 10.3969/j.issn.2095-4344.1469
    Abstract ( 379 )   PDF (23588KB) ( 103 )   Save
    BACKGROUND: At present, the clinical follow-up data of posterior short-segment percutaneous pedicle screw for thoracolumbar fractures are limited, and there is still some controversy about whether the injured vertebra should be placed with screw.
    OBJECTIVE: To investigate the short-term effectiveness of short-segment percutaneous pedicle screw instrumentation for the treatment of thoracolumbar fractures.
    METHODS: Totally 27 patients, who suffered from thoracolumbar fractures and underwent short-segment percutaneous pedicle screw instrumentation, were retrospectively analyzed. These patients were divided into two groups: bilateral fracture level screw group and cross-fracture level instrumentation group. Informed consent was obtained from all patients. This study was approved by the Hospital Ethics Committee. Visual analogue scale score and Oswestry disability index were used to access clinical outcomes. Relative fracture-level vertebral body height and Cobb angle were used to access the reduction situation of fractured vertebrae.
    RESULTS AND CONCLUSION: (1) All surgeries were completed successfully. Patients in the bilateral fracture level screw group were followed up for 8-20 months. Patients in the cross-fracture level instrumentation group were followed up for 5-17 months. No complications such as internal fixation fracture or reduction loss were observed. (2) Visual analogue scale score and Oswestry disability index were significantly improved after operation in both groups (P < 0.05). No significant difference was found between the two groups (P > 0.05). (3) Relative fracture-level vertebral body height and Cobb angle were improved after operation when compared to pre-operative data of both groups (P < 0.05). The difference between groups presented no statistically difference (P > 0.05). (4) During short-term follow-up, the short-term effectiveness of short-segment percutaneous pedicle screw instrumentation is proven to have satisfactory effect; no significant difference was observed between bilateral fracture level screw and cross-fracture level instrumentation.
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    Angle of upper terminate plate parallel line of thoracolumbar vertebral body against the line between the percutaneous anatomic landmarks of the highest point of the spinous process
    Ma Jian, Zhang Meng, Liu Huan, Wang Shouguo
    2019, 23 (28):  4485-4490.  doi: 10.3969/j.issn.2095-4344.1326
    Abstract ( 301 )   PDF (23952KB) ( 99 )   Save
    BACKGROUND: Placement of thoracolumbar pedicle screws needs high technology and radiation exposure. Large amount of radiation makes serious effects on patients and the surgeons.
    OBJECTIVE: To introduce a percutaneous pedicle screw placement technique with reference to the percutaneous anatomic landmarks of the highest point of the spinous process, so as to effectively reduce intraoperative radiation exposure.
    METHODS: One hundred cases of normal thoracolumbar MRI were recruited and were divided into normal weight group and obese group. The angle of connection between the percutaneous anatomic landmarks of the highest point of the spinous process and the corresponding line between the parallel lines of the endplate was measured. At the same time, 100 cases of thoracolumbar MRI with thoracolumbar fracture were collected and divided into normal weight group and obese group. The same method was used to measure the angle between the two lines in adjacent vertebral segments (T12 and L1). The measured angle values of the fracture group and the normal group were compared and analyzed statistically to obtain the angle of the line between percutaneous anatomic landmarks of the highest point of the spinous process and the upper terminate plate.
    RESULTS AND CONCLUSION: (1) The angle of the parallel lines of the endplate against the line between percutaneous anatomic landmarks of the highest point of the spinous process was 87-95° at T1-L4 in the normal weight group, while the angle was 86-94° at T8-L2 in the obese group. The average angle was 90°. (2) The measured angle in thoracolumbar fracture group was around 90°. There was no significant difference between the normal group and the fracture group (P > 0.05). (3) In summary, if we keep the connection angle between the line between percutaneous anatomic landmarks of the highest point of the spinous process and the pedicle screws is about 90° in the thoracolumbar vertebral fracture fixation surgical procedure, we basically can ensure that the pedicle screw parallel to the upper terminate plate. The method of this percutaneous pedicle screw placement with reference to the percutaneous anatomic landmarks of the highest point of the spinous process is a safe, effective technique for treating the spinal fracture.
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    Pulse radiofrequency combined with regular calcium supplement in the treatment of thoracic and back pain caused by osteoporotic vertebral compression fractures
    Nie Huiyong, Zhang Dandan, Bu Gang, Wang Suoliang, Lü Jun
    2019, 23 (28):  4491-4496.  doi: 10.3969/j.issn.2095-4344.1455
    Abstract ( 410 )   PDF (26212KB) ( 109 )   Save
    BACKGROUND: Thoracic and dorsal pain caused by osteoporotic vertebral compression fractures is very common in clinic. Conventional treatment methods include medicine, physiotherapy, calcium supplement and local nerve block. They all have certain therapeutic effects, but the pain recurs shortly after drug withdrawal. As a technique for treating this kind of pain, pulsed radio frequency has a remarkable short-term effect, but it lacks standardized treatment for osteoporosis, and its long-term effect is not good.
    OBJECTIVE: To investigate the therapeutic effect of pulsed radio frequency combined with guideline calcium supplement on thoracic spinal nerve root pain caused by osteoporotic vertebral compression fracture.
    METHODS: The 110 patients with osteoporotic vertebral compression fractures were randomly divided into two groups, with 55 cases in each group. Informed consent was obtained from patients of the two groups. This study was approved by the Hospital Ethics Committee. Pulsed radiofrequency group received pulsed radiofrequency treatment for vertebral compression fracture corresponding to dorsal root ganglion of spinal nerve. Nerve block group received nerve block treatment for corresponding dorsal root ganglion of spinal nerve. Both groups were treated with calcium carbonate D3, calcitonin and zoledronic acid for osteoporosis. Visual Analogue Scale and Oswestry Dysfunction Index results were compared between the two groups before and 1, 3, 6 and 12 months after treatment. The N-terminal propeptide of human procollagen type I and tartrate-resistant acid phosphatase isomer 5b levels were compared between the two groups.
    RESULTS AND CONCLUSION: (1) The Visual Analogue Scale score and Oswestry Dysfunction Index were significantly improved in both groups after 1, 3, 6 and 12 months of treatment compared with those before treatment (P < 0.05). In 1 month after operation, there was no significant difference between the two groups (P > 0.05). In 3, 6 and 12 months after operation, the improvement of Visual Analogue Scale score and Oswestry Dysfunction Index in the pulsed radiofrequency group was better than that in the nerve block group (P < 0.05). (2) There was no significant difference in bone metabolism indexes N-terminal propeptide of human procollagen type I and tartrate-resistant acid phosphatase isomer 5b between the two groups at 1 month after operation and before operation (P > 0.05). N-terminal propeptide of human procollagen type I and tartrate-resistant acid phosphatase isomer 5b in the two groups were significantly improved at 3, 6 and 12 months after operation (P < 0.05). (3) Pulse radio frequency combined with guideline calcium supplement in the treatment of chest and back pain caused by osteoporotic vertebral compression fractures can not only noticeably reduce pain and improve the quality of life, but also fundamentally improve osteoporosis, with satisfactory short-term and long-term results.
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    Garden I-II femoral neck fracture treated with closed reduction and cannulated compression screw internal fixation: lateral position versus horizontal position
    He Xiangzhong, Yang Wenbin, Lü Yang, Huang Junhan, Gao Shihua, Chen Haiyun, Liu Jun, Yu Xiubing
    2019, 23 (28):  4497-4502.  doi: 10.3969/j.issn.2095-4344.1291
    Abstract ( 398 )   PDF (889KB) ( 74 )   Save
    BACKGROUND: Cannulated compression screw internal fixation is most common method for treating femoral neck fractures. Conventional supine position is difficult to carry out in primary hospitals because of its dependence on the traction bed, so it is difficult to be promoted.
    OBJECTIVE: To compare the efficacy of lateral and horizontal positions with cannulated compression screw for the treating femoral neck fracture, and to provide evidence for intraoperative position selection.
    METHODS: A retrospective analysis of 64 patients with Garden I-II femoral neck fractures admitted in the Second Affiliated Hospital of Guangzhou University of Chinese Medicine/Guangdong Provincial Hospital of Chinese Medicine from January 2013 to December 2015 was conducted. All patients were treated with cannulated screw fixation, and divided into two groups according to different positions (n=32 per group). The patients signed the informed consents and the study was approved by the ethics committee of hospital. Control group was given internal fixation treatment on the traction bed under the horizontal position, and trial group was treated with internal fixation on the ordinary operating bed (non-traction bed) under the lateral position. The surgical trauma (operation time, length of incision, intraoperative blood loss), treatment outcomes (post-bed time, fracture healing time and Harris score at postoperative 6 months) and complications were compared between two groups.
    RESULTS AND CONCLUSION: (1) All patients were followed up for more than 6 months, and all achieved fracture healing. (2) The incision length, intraoperative blood loss, post-bed time, Harris score at postoperative 6 months and incidence of complications showed no significant difference between two groups (P > 0.05). (3) The operation time and preoperative waiting time in the trial group were significantly less than those in the control group, and the fluoroscopy times was significantly more than that in the control group (P < 0.01). (4) There was no significant difference in the incidence of postoperative complications between two groups (P > 0.05). (5) In summary, the treatment of femoral neck fracture with closed reduction and cannulated compression screw in the lateral and supine positions is similar in promoting postoperative hip function recovery, and no serious postoperative complications occur. Lateral position can effectively shorten the preoperative preparation time from anesthesia to incision, but the intraoperative radiation amount is higher than that in the horizontal position.
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    Research status and development trend of bibliometrics and visualization analysis in the assessment of Perthes disease
    Shen Yingshan, Gong Shuidi, He Xiaoming, Pang Fengxiang, Chen Xiaojun, Li Weifeng, Chen Lixin, Yang Fan, Yang Peng, Chen Zhenqiu, He Wei, Wei Qiushi
    2019, 23 (28):  4503-4509.  doi: 10.3969/j.issn.2095-4344.1470
    Abstract ( 404 )   PDF (915KB) ( 93 )   Save
    ACKGROUND: Perthes disease has been widely concerned since it was discovered. Research and exploration of the disease are also deepening.
    OBJECTIVE: To explore the current research and development trend of Perthes disease in the worldwide.
    METHODS: The scientific citation index of Wed of Science core collection was used to retrieve literature on Perthes disease from 1994 to 30 July, 2018, and to use the bibliometric method to conduct data statistics and analysis. Using Vos viewer software was used to carry out visual transformations such as document coupling analysis and co-occurrence analysis, and the research status and development trend of Perthes disease in the worldwide was analyzed.
    RESULTS AND CONCLUSION: (1) Totally 1 106 researches were included. The global research direction and research publications are increasing yearly. Among them, the United States remains a leader in this field of research, whose number of citations and H index are the highest, far exceeding the second country. (2) The publications of "JOURNAL OF PEDIATRIC ORTHOPAEDICS" magazines ranked the top, to 125 publications. (3) “TEXAS SCOTTISH RITE HOSP CHILDREN” is the organization that contributed the most in the literature. (4) The current research direction can be divided into five categories: disease assessment, disease characteristics, disease diagnosis, pathogenesis and necrosis", of which “inflammation” and “ischemic osteonecrosis” research is a new point of concern in recent years. (5) The prediction from the current global trends indicates that we have many directions to explore this disease, and the number of corresponding literature publications will continue to increase. Among them, the United States maintains a clear leading position in this field. The current research focuses on “disease characteristics” in Perthes disease, and "score" are recently new concerns in this field.
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    Comparison of the effect and stability of rigid or flexible external fixator in inducing healing tissue formation at fracture site in mice
    Li Hongyuan, Wang Liang
    2019, 23 (28):  4510-4515.  doi: 10.3969/j.issn.2095-4344.1452
    Abstract ( 372 )   PDF (22573KB) ( 87 )   Save
    BACKGROUND: Internal fixation with intramedullary nails is the most commonly used technique for closed femoral fractures, but external fixators are needed to stabilize open fractures in order to maintain rotational stability. Because the load acting on the fracture and the stability of the fixator determine the relative displacement of the broken end of the bone, the device may affect the physiological load of the operative limb, and then affect the healing.
    OBJECTIVE: To compare the effects of different stiffness external fixators on the formation and stability of fracture healing tissues in mice, in order to find a new way of effective fracture fixation treatment.
    METHODS: We introduced such a model using rigid and flexible external fixators with considerably different stiffness (axial stiffness of 17.9 and 0.76 N/mm, respectively). Both fixators were used to stabilize a 0.5 mm osteotomy gap in the femur of C57B/6 mice. Three-point bending tests, μCT, and histomorphometry demonstrated a different healing pattern after 21 days.
    RESULTS AND CONCLUSION: (1) Flexural stiffness of the rigid group was significantly reduced by 28.1% compared with the control intact bone, while flexural fixation reduced the flexural rigidity to 18.9% of the intact bone with no significant difference between the two groups after 21 days (P > 0.05). (2) Compared with the rigid group, the volume of the whole callus of the flexible group was more than doubled, and the maximum diameter also significantly increased (P < 0.05); while the bone volume fraction significantly decreased (P < 0.05). (3) Histological analysis showed that the numbers of braided bone, laminar bone and cartilage in the callus in the flexible group were significantly higher than those of the rigid group (P < 0.05). (4) The selected rigid and flexible fixations with different stiffness both lead to callus formation, but healing is delayed under flexible fixation.
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    MR anatomical variation of sacroiliac joints
    Zhao Heng, Hu Rong, Liu Jincai, Luo Guanghua, Qing Weipeng, Peng Zhaojie
    2019, 23 (28):  4516-4521.  doi: 10.3969/j.issn.2095-4344.1472
    Abstract ( 603 )   PDF (24166KB) ( 105 )   Save
    BACKGROUND: In previous studies, only X-ray or CT imaging was used to describe the anatomical variations of the sacroiliac joint, but MRI has not provided a unified and specific description.
    OBJECTIVE: To describe the MRI characteristics of anatomical variations of sacroiliac joints and observe the potentially misleading MR imaging characteristics.
    METHODS: The MRI findings of the First Affiliated Hospital, University of South China in the past two years were retrospectively analyzed. One of the objectives was to describe potentially misleading edema or structural changes associated with anatomical variations in sacroiliac joints. Patients meeting the Assessment in Ankylosing Spondylitis International Society criteria were excluded in this study to ensure that signal intensity changes were not associated with sacroiliac arthritis.
    RESULTS AND CONCLUSION: (1) 158 patients were finally included in the study, among which 40 patients showed unilateral or bilateral anatomical variation in sacroiliac joints. Iliosacral complex and sacral defect were found in 17 cases and 22 cases respectively, solitary hyperosteogeny in 1 case, and sacroiliac joint deformity in 23 cases. There are two kinds of anatomical variations of sacroiliac joints in the same patient. No cases of accessory sacroiliac joints and unhealed ossification center were found. (2) Abnormal changes in the structure and/or edema of the opposite bone were often observed in the sacroiliac joints. The appearance of sacroiliac complex and sacral defects may be related to the presence of blood vessels protruding along the surface of the bone. (3) The results showed that anatomical variations of sacroiliac joints were relatively common on MRI, especially in women. These variations may be accompanied by changes in signal strength that are not necessarily inflammatory in nature but may be congenital.
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    Contact pressure of knee prosthesis under different loads with deviation angles by finite element analysis
    Xiang Changxin, Ji Binping, Chen Weiyi, Wang Changjiang, Guo Yuan
    2019, 23 (28):  4522-4528.  doi: 10.3969/j.issn.2095-4344.1471
    Abstract ( 365 )   PDF (1476KB) ( 106 )   Save
    BACKGROUND: After artificial knee joint replacement, some patients have low postoperative satisfaction because of the failure of the prosthesis. The early failure of the knee prosthesis is caused by the early wear of the polyethylene component, the loosening and the instability of the prosthesis, which are affected by the contact pressure of the prosthesis.
    OBJECTIVE: To study the effect of load offset angle on contact pressure, contact area and contact pressure distribution on the polyethylene insert during gait circle.
    METHODS: The model of the knee prosthesis was introduced into the Abaqus three-dimensional finite element software. The axial force of gait load was offset by 0°, 1°, 2°, 3°, 4°, 5° and 6° to form seven working conditions. The contact pressure, contact area and contact pressure distribution of the polyethylene insert were studied under different working conditions.
    RESULTS AND CONCLUSION: (1) The contact pressure of the polyethylene insert increases with the augment of the axial load deviation angle during the gait circle. (2) As the axial load shifting to the outside, the contact area between the polyethylene insert and the medial condyle decreases, and the contact area with the lateral condyle increases. (3) Through the contact pressure distribution cloud map, it is found that the contact position gradually moves toward the edge of the tibial tray, and stress concentration occurs at the contact position between the tibial tray and the lateral condyle. (4) The load deviation caused by the poor malalignment will cause the contact pressure on the polyethylene component to increase significantly, and will change the original contact area and contact position. If the knee prosthesis is in the above-mentioned poor mechanical environment for a long time, it will lead to the failure of the knee prosthesis.
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    Finite element analysis of biomechanical properties of a novel posterior interlamina fusion cage
    Zou Xiaobao, Ma Xiangyang, Yang Haozhi, Ge Su, Chen Yuyue, Xia Hong, Wu Zenghui
    2019, 23 (28):  4529-4534.  doi: 10.3969/j.issn.2095-4344.1340
    Abstract ( 430 )   PDF (23898KB) ( 112 )   Save
    BACKGROUND: With the increase of surgical amount in atlantoaxial spine, the problem of bone graft fusion has also been respected. Regardless of atlantoaxial anterior or posterior fusion cage, although the study of atlantoaxial fusion cage has never stopped, but because of the surgical technical difficulties, surgical risk, immature design, and many other reasons, there is still no related atlantoaxial fusion cage can be applied to clinic. Posterior atlantoaxial interlamina fusion cage is a new type that can be used with posterior screw-rod internal fixation system, but its biomechanical properties still need to be further studied.
    OBJECTIVE: To evaluate the biomechanical characteristics of a new posterior atlantoaxial interlamina fusion cage by establishing a three-dimensional finite element model of the atlantoaxial interlamina fusion cage combined with posterior screw-rod internal fixation system.
    METHODS: CT scan was used to obtain the image information of occipital and atlantoaxial of a healthy adult. Finite element analysis software was used to create a three-dimensional finite element analysis model of atlantoaxial interlaminar fusion cage combined with posterior screw-rod internal fixation system, and stress changes and stress nephogram of atlantoaxial interlaminar fusion cage under different motion states were analyzed.
    RESULTS AND CONCLUSION: (1) The finite element model had good geometric similarity, including 206 745 elements and 72 496 nodes. (2) The maximum stress of atlantoaxial interlaminar fusion cage device was concentrated at the bone implant site of micro-titanium nail, and the maximum stress value under the condition of left and right rotation was higher than that under other conditions. (3) The stress of the posterior screw-rod system was mainly concentrated at the screw-bone junction and the screw-rod junction of the screw, and the maximum stress was generated around the root of the screw into the bone. (4) These results suggest that the mechanical stability of the new posterior atlantoaxial interlaminar fusion cage device is good, and it is a simple and safe type of atlantoaxial fusion cage device, which makes no influence on the stress of the posterior screw-rod system and is worthy of further investigation.
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    Finite element analysis of transoral anterior atlantoaxial plate fixation in a teenager
    Zhang Bin, Li Zhijun, Ning Pengfei, Liu Ying, Cao Li, Zhang Fengying, Li Xiaohe
    2019, 23 (28):  4535-4540.  doi: 10.3969/j.issn.2095-4344.1336
    Abstract ( 338 )   PDF (625KB) ( 135 )   Save
    BACKGROUND: Compared with other vertebral bodies, atlantoaxial vertebra has unique anatomical and functional differences. If atlantoaxial vertebra is damaged, traditional posterior fixation cannot achieve the desired effect, as the main load-bearing part of atlantoaxial vertebra is anterior and middle columns, so more effective fixation methods need to be explored.
    OBJECTIVE: To investigate the mechanical parameters of transoral anterior atlantoaxial fixation plate by finite element analysis, in order to provide information for application and improvement of the fixation system for this age group.
    METHODS: Imaging data were collected from one randomly selected patient (male, 12 years of age, 52 kg, with non-skull base atlantoaxial disease) who met the experimental criteria and underwent imaging in the Second Affiliated Hospital of Inner Mongolia Medical University since February 2016. Imaging data were reconstructed using Mimics 16.01 software. The plate for anterior atlantoaxial fixation was designed with Pro/ENGINEER 4.0 software according to the atlantoaxial anatomical diameters of the patient. The reconstructed three-dimensional model of the plate and screws was introduced into Mimics 16.01 and registered according to the requirements of a typical transoral anterior approach, followed by surface and volume mesh generation and material assignment. A 60-N load was applied vertically and a 15 N • m moment was applied at the surface to simulate anterior flexion, posterior extension, and lateral bending. Stresses at the screws and rods were measured. This study was approved by the Ethics Committee of Inner Mongolia Medical University on January 24, 2017 (approval number: 20170124).
    RESULTS AND CONCLUSION: A total of 14 541 volume meshes and 5 247 nodes were generated on the three-dimensional atlantoaxial reconstruction mode. At the root of the upper screw, the maximum stress was observed in anterior flexion (54.21 ± 4.32 MPa, F=69.15, P < 0.05). At both the root and the tip of the lower screw, the maximum stress was observed in lateral bending, both presenting significant differences (root: 69.22 ± 4.12 MPa, F=89.34, P < 0.05; tip: 87.15 ± 6.57 MPa, F=57.23, P < 0.05). In anterior flexion and posterior extension, the stress was higher at the upper than the lower screw roots (P < 0.05); and in lateral bending, the stress was higher at the lower than the upper screw roots. In anterior flexion, posterior extension, and lateral bending, the stress was higher at the tip than the root of the lower screw, all presenting significant differences (P < 0.05). The transoral anterior atlantoaxial plate fixation system has a reasonable stress distribution in the adolescent and can withstand the stress of normal atlantoaxial movements.
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    Biomechanical changes of lower lumbar spine stress under different gaits by simulation analysis
    Deng Jianquan, Chen Jinjun, Liang Hongsheng, Chen Xiaoyu
    2019, 23 (28):  4541-4545.  doi: 10.3969/j.issn.2095-4344.1335
    Abstract ( 410 )   PDF (19170KB) ( 91 )   Save
    BACKGROUND: Clinical conservative treatment can easily lead to the recurrence of lumbar disc herniation. Backward walking is a popular rehabilitation exercise method for the treatment of lumbar disc herniation. After clinical guidance treatment, patients walk backwards and follow up statistics, confirming that walking backwards is an effective rehabilitation exercise therapy.
    OBJECTIVE: Based on biomechanics, the significance of backward walking for lumbar rehabilitation was explored by finite element analysis.
    METHODS: The three-dimensional model of lumbar spine was established based on CT images, and then the mechanical conditions of lumbar spine were simulated. The finite element method was used to examine the role of backward walking in the treatment of lumbar disc herniation from the mechanical point of view.
    RESULTS AND CONCLUSION: (1) The displacement of L1-L2 intervertebral disc was only 1/2 of that of the gait, and the stress of the intervertebral disc was greatly reduced when walking backwards. (2) The stress of L1-L2 intervertebral disc during gait progression was 2.35 times as much as that during walking backwards. (3) Therefore, the changes of stress and displacement of lumbar spine and intervertebral disc are smaller than that of normal gait, which reduces the pressure on nucleus pulposus and helps the recovery of patients with lumbar disc herniation.
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    Biomechanical testing of the locking axial lumbosacral interbody fusion
    Yi Guoliang, Wang Shankun, Song Xizheng
    2019, 23 (28):  4546-4551.  doi: 10.3969/j.issn.2095-4344.1328
    Abstract ( 273 )   PDF (25853KB) ( 87 )   Save
    BACKGROUND: In the 21st century, domestic and foreign scholars have carried out a lot of basic and clinical researches on L5-S1 simple axial fusion internal fixation, which prove that its technology is minimally invasive, is conducive to the successful fusion of bone grafting and can meet the physiological needs of human body, but its anti-rotation fixation is poor. Therefore, a new internal fixation device that is both minimally invasive and stable is needed.
    OBJECTIVE: To evaluate the biomechanical stability of the locking axial lumbosacral interbody fusion, so as to provide experimental data for future clinical usage.
    METHODS: Five fresh human lumbar spines (L3-S5) were tested by applying pure moments. Each specimen was tested for the following order: normal control group; bilateral spondylolysis; locking AxiaLIF and bilateral spondylolysis; AxiaLIF and bilateral spondylolysis; AxiaLIF, bilateral pedicle screws and bilateral spondylolysis. The L5/S1 range of motion was obtained by applying pure moments in flexion, extension, lateral bending, axial rotation and axial compression loaded with 300 N force. The study was approved by the ethics committee of the hospital.
    RESULTS AND CONCLUSION: (1) Spondylolysis significantly increased the range of motion in flexion-extension and axial rotation compared with the normal control group (P < 0.05). The two groups showed no significant difference in the lateral bending (P > 0.05). (2) Three kinds of fixation ways significantly reduced the range of motion in flexion-extension and lateral bending compared with the normal control group (P < 0.05). In flexion-extension, the combined fixation and locking AxiaLIF groups significantly reduced the range of motion compared with the screw group (P < 0.05), and there was no significant difference between combined fixation and locking AxiaLIF groups (P > 0.05). (3) In lateral bending, the range of motion in the locking AxiaLIF ROM group had no significant difference compared with the other fixation groups (P > 0.05), but the combined group significantly reduced the range of motion compared with the screw group (P < 0.05). (4) Locking AxiaLIF and combined groups significantly reduced the range of motion in axial rotation compared with the normal control group (P < 0.05), and there was no significant difference between screw and normal control groups (P > 0.05). Screw group significantly increased the range of motion in axial rotation compared with the combined group (P < 0.05). In the locking group, there was no significant difference between left axial rotation and right axial rotation (P > 0.05). (5) Three fixation groups significantly increased the axial compressive stiffness compared with the normal control group (P < 0.05), but there was no significant difference among three fixation groups (P > 0.05). (6) These results indicate that the locking axial lumbosacral interbody fusion can significantly enhance the stability of lumbosacral vertebral instability in all loading modes. It provides an effective solution for the question that the AxaiLIF has a poor stability in axial rotation.
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    Three-dimensional finite element analysis of spine tuberculosis debridement treated by single-segment fixation with short pedicle screw
    Li Xiang, Si Jianwei
    2019, 23 (28):  4552-4557.  doi: 10.3969/j.issn.2095-4344.1401
    Abstract ( 310 )   PDF (874KB) ( 113 )   Save
    BACKGROUND: Single-segment short pedicle screw has been applied in the surgical treatment of spinal tuberculosis in clinical practice and achieves satisfactory efficacy, but whether the biomechanical efficacy of this fixation method is reliable remains unclear. Although existing studies have proven that short pedicle screw can achieve reliable fixation effect, its research method is limited to animal bone in vitro simulation experiment, and cannot truly reflect the biomechanical characteristics of human spine. 
    OBJECTIVE: To establish the three-dimensional finite element model of single-segment short pedicle screw fixation after the complete removal of T12-L 3 spinal tuberculosis foci, and to undergo the mechanical analysis, thereby verifying its spinal stability.
    METHODS: One healthy adult male volunteer with no history of spinal disease was selected. CT scanning of the 1 mm thick intervertebral layer was performed continuously, and the image data were derived and saved in DICOM format. Mimics 20.0, Geomagic Studio, and Pro/E 5.0 software were used to establish three pedicle screw fixation models of the spine. Finite element analysis was performed using Abaqus software. A torque of 10 Nm was applied at the same stress point to make the vertebral body bend forward, extend backward, bend left and right side and rotate, and the axial displacement and the maximum deflection angle were measured.
    RESULTS AND CONCLUSION: Applying the same load and boundary conditions to the three models, the results showed that: (1) There was no significant difference between the results of the model with additional internal fixation and the normal vertebral body model. (2) In terms of axial displacement, the single-segment short screw was less than 10% different from the normal vertebral body model. (3) In terms of the maximum deflection angle, the data of the two models were the most different in the post-extension state, and the single-segment model was 18% larger than the normal model. (4) The cross-segment screw fixation model was lower than the normal vertebral body model in both axial displacement and maximum deflection angle. (5) Compared between two kinds of internal fixation model, single-segment short nail model axial displacement was 16% larger than cross section long nail model. The difference between the two fixed models is the greatest at the maximum deflection angle and the backward extension state. The single-segment fixation was 38% more than cross section, and the difference of data in other states was small. The results of the two fixed line model statistical tests showed no significant difference. (6) These results indicate that the fixation method of single-segment short pedicle screw can achieve reliable biomechanical efficiency and maintain the immediate stability of the spine after the complete removal of the tuberculosis focus in the spine.
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    Three-dimensional digital morphological characteristics of the facet joint of the lower cervical spine in children aged 4-6 years
    He Yujie, Zhang Shaojie, Li Zhijun, Li Xiaohe, Wang Haiyan, Wang Xing, Xu Yangyang, Gao Mingjie, Li Kun, Dai Lina
    2019, 23 (28):  4558-4563.  doi: 10.3969/j.issn.2095-4344.1473
    Abstract ( 409 )   PDF (24486KB) ( 91 )   Save
    BACKGROUND: Zygapophysial joints of cervical vertebra is also called intervertebral facet joint. It is a synovial joint like the large joints of the body. In recent years, anatomical and biomechanical studies have shown that zygapophysial joints injuries and degeneration is one of the most common causes of chronic neck pain. Existing studies on this joint have focused on adolescents and adults.
    OBJECTIVE: The morphological parameters of children's inferior cervical zygapophysial joints were measured to explore their developmental rules and morphological characteristics, and finally to provide anatomical parameters for clinical zygapophysial joint screw fixation.
    METHODS: Totally 32 cases of children aged 4-6 years old with no changes in vertebral bone structure such as bone destruction, tumor, deformity or fracture in the inferior cervical spine and no previous spine related surgery were selected for three-dimensional reconstruction after cervical spiral CT scanning. Guardian signed the informed consent. This study was approved by the Hospital Ethics Committee. Morphological measurement and statistical analysis of C3-C7 zygapophysial joints were conducted.
    RESULTS AND CONCLUSION: (1) For children cervical zygapophysial joint articular surfaces in both height and width, between the adjacent two vertebrae, the lower articular surface was smaller than the upper articular surface, so it can be inferred that the size of the upper articular surface was always larger than that of the lower articular surface. According to the height to width ratio, the articular surface of the superior facet of the lower cervical spine in children aged 4-6 years was nearly elliptic from C3-C7; the articular surface of the inferior facet from C3-C7 was nearly circular. The transition from circular to elliptic shape had not yet been formed. (2) The trend of high change in facet joint was from the lowest point of C2-C7 in the C4 segment, and the overall trend was first down and then up. (3) The zygapophysial joints first rose and then fell, and there was no significant difference between the upper supraspinal spacing and the lower one except in the C5 segment, and the maximum value was reached. In C3 and C4 segments, the supraspinal spacing was less than the inferior one, and in C6 and C7 segments, the supraspinal spacing was remarkably greater than the inferior one, which may be related to the gravity transfer and cervical spine activities.
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    Finite element analysis of three-dimensional entity reconstruction of hip joint based on CT image and hip bearing capacity data
    Gao Yaodong, Duan Yuxing, Guo Pengnian
    2019, 23 (28):  4564-4569.  doi: 10.3969/j.issn.2095-4344.1331
    Abstract ( 428 )   PDF (19853KB) ( 122 )   Save
    BACKGROUND: Due to complex anatomical structure and stress of hip, traditional X-ray and CT scanning have some limitations in the diagnosis of hip.
    OBJECTIVE: To find an accurate and fast reconstruction method for the entity model of biological skeleton based on CT image, and to study the stress of the human hip bone, and to establish the optimized hip joint model before operation for three-dimensional printing.
    METHODS: CT images of hip joint were obtained from one patient (the study was approved by the Ethics Committee of First Affiliated Hospital of Baotou Medical College, and the subject signed the informed consent). The model optical images of human body were developed by medical Mimics software. The reverse design steps of “original CT image-image processing-surface reconstruction-materialization” were adopted. The necessary forward design method needed therein. Firstly, using the core medical Mimics software, the CT image of hip joint was found out from the optical image and noise point, and the vector tomography image was obtained. After carefully separating the image, the multi-layer image was fitted to form three-dimensional image structure. Then in Geomagic software, the surface fitting of the model is completed, and at the same time, Generate surfaces and materialize. In Geomagic Studio software, in order to achieve the precision of the model, it is necessary to make the surface smooth and curve smooth by command, and to meet the requirements of subsequent finite element analysis. Finally, the mesh division, model assignment and finite element analysis of hip joint are completed in Abaqus software. At this point, all the data conversion from the original CT to the entity is completed. At the same time, the Anybody software was used to simulate the human gait simulation, and the data were applied to the finite element analysis of ABAQUS.
    RESULTS AND CONCLUSION: The simplest method was used to complete the reconstruction of CT images, and a good hip model was obtained by Geomagic surface fitting. The important data of hip bearing capacity were obtained by Anybody inverse dynamics analysis. Finite element analysis verifies this result.
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    Synovial chondromatosis: how to improve the diagnosis accuracy and clearance rate of tumor cells
    Kong Lingyao, Li Tao, Zeng Xinglin, Li Jian, Xiong Yan
    2019, 23 (28):  4570-4575.  doi: 10.3969/j.issn.2095-4344.1227
    Abstract ( 497 )   PDF (33935KB) ( 107 )   Save

    BACKGROUND: The diagnosis and treatment methods of synovial chondromatosis develop rapidly. Physical examination, CT and MRI are considered as the important methods to diagnose the synovial chondraomatosis, but MRI and CT are more extensively applied in clinical practice. Arthroscopic surgery is a conventional treatment method. The article focuses on the diagnosis and treatment research progress of synovial chondromatosis in recent 5 years and proposes a protocol and suggestions for future research.
    OBJECTIVE: To summarize the latest progress of diagnosis and treatment of synovial chondromatosis.
    METHODS: PubMed and Embase databases from 2012 to 2018 were searched. The keywords were “chondromatosis, synovial, diagnosis, therapy, imaging diagnosis” in English. The research progress in the diagnosis and treatment of synovial chondromatosis were summarized in aspects of physical examination, MRI and arthroscopic surgery.
    RESULTS AND CONCLUSION: Totally 569 papers were retrieved and 34 articles eligible for inclusion and exclusion criteria were included. MRI is a common method to diagnose the joint diseases, but due to its false positive rate, we should combine with physical examination to enhance diagnosis rate of synovial chondromatosis. As for the therapy, how to improve clearance rate of tumor still needs further investigation.

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    Preoperative clinical evaluation and surgical indication selection strategy of high tibial osteotomy
    Hou Senrong, Pan Jianke, Yang Weiyi, Luo Minghui, Huang Hetao, Zeng Lingfeng, Lin Jiongtong, Han Yanhong, Liu Jun
    2019, 23 (28):  4576-4583.  doi: 10.3969/j.issn.2095-4344.1456
    Abstract ( 662 )   PDF (49288KB) ( 116 )   Save
    BACKGROUND: High tibial osteotomy, unicondylar knee arthroplasty and total knee arthroplasty are the treatments for the end stage of knee osteoarthritis. With the continuous in-depth clinical research of knee joint and the increasing awareness of knee-protection, high tibial osteotomy has gradually become popular among clinicians. However, clinicians from different countries and regions have different understanding of the preoperative clinical evaluation and indications of high tibial osteotomy, so there are also some differences in the efficacy.
    OBJECTIVE: This article studied the related research progress of high tibial osteotomy at home and abroad, discussed the problems that should be paid attention to in clinical evaluation before high tibial osteotomy and the selection of surgical indications, in order to provide some reference for clinical treatment of knee osteoarthritis and knee deformity by high tibial osteotomy.
    METHODS: A comprehensive search was conducted on CNKI, WanFang, VIP, and CBM, as well as PubMed, The Cochrane Library, Web of Science database, EMBASE, and OVID. The Chinese and English search terms were “high tibial osteotomy, indication, HTO”, and “high tibial osteotomy, indication”, respectively, to retrieve all relevant literature published from the establishment of the database to December 2018. The writing method was to make a deep analysis and summary of the clinical evaluation and surgical indications before high tibial osteotomy.
    RESULTS AND CONCLUSION: (1) A total of 84 articles were included in this review. (2) The results show that there are great differences in clinical evaluation and indication of high tibial osteotomy before operation, so there has been a great controversy in the evaluation of high tibial osteotomy, unicondylar knee arthroplasty and total knee arthroplasty. (3) Nevertheless, with the deepening of the research, clinical evaluation and indication selection of high tibial osteotomy are becoming more and more stringent, and the post-operative satisfaction of high tibial osteotomy is much higher than before.
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    postoperative blood loss of intertrochanteric fracture: a meta-analysis
    Zhong Yanchun, Liu Lulin, Xiao Jianhua, Ouyang Xunyan, Huang Weimin, Liu Wuyang
    2019, 23 (28):  4584-4592.  doi: 10.3969/j.issn.2095-4344.1268
    Abstract ( 443 )   PDF (30321KB) ( 106 )   Save
    BACKGROUND: Tranexamic acid has been widely used in joint arthroplasty, which not only reduces perioperative blood loss, but also does not increase the risk of venous thrombus. It is reported that the use of tranexamic acid in the surgery of intertrochanteric fractures has similar effects. However, these studies are small-sample trials, and the results are still controversial. It is necessary to systematically evaluate and analyze the clinical researches about the tranexamic acid on reducing the intraoperative and postoperative blood loss of intertrochanteric fracture.
    OBJECTIVE: To investigate the effectiveness and safety of tranexamic acid for reducing the intraoperative and postoperative blood loss of intertrochanteric fracture.
    METHODS: PubMed, Cochrane Library, EMbase, CBM, CNKI, VIP and WanFang databases were searched for the randomized controlled trials and prospective cohort studies addressing tranexamic acid reducing intraoperative and postoperative blood loss of intertrochanteric fracture from inception to October 5, 2018. The literature selection, data extraction, and evaluation of bias risk of the studies were performed independently by two authors. Meta-analysis was conducted using RevMan 5.3 software.
    RESULTS AND CONCLUSION: Thirteen studies were enrolled, including 12 randomized controlled trials and 1 prospective cohort, involving 1 353 cases of intertrochanteric fracture (676 in tranexamic acid group, and 677 in placebo group). Meta-analysis results showed that compared with the placebo group, tranexamic acid applied in the surgery of intertrochanteric fractures, could significantly reduce the intraoperative and postoperative total blood loss (MD=-228.92, 95%CI: -300.93 to -156.91, P < 0.000 01), intraoperative blood loss (MD=-23.74, 95%CI: -40.91 to -6.56, P=0.007), the hidden blood loss (MD=-153.36, 95%CI: -179.21 to -127.50, P < 0.000 01) and increase the postoperative hemoglobin (MD=6.9, 95%CI: 5.44 to 8.44, P < 0.000 01), hematocrit levels (MD=1.44, 95%CI: 0.86 to 2.03, P < 0.00001) and reduce the postoperative blood transfusion rate (OR=0.48, 95%CI: 0.36 to 0.63, P < 0.000 01). Additionally, tranexamic acid did not increase the postoperative D-dimer levels (SMD=-0.13, 95%CI: -0.58 to 0.32, P=0.57), or the incidence of venous thrombosis (OR=1.41, 95%CI: 0.79 to 2.52, P=0.24). Tranexamic acid made no effect on the operation time (MD=-0.16, 95% CI: -1.31 to 1.00, P=0.79) and postoperative mortality (OR=1.61, 95%CI: 0.78 to 1.33, P=0.2). These results indicate that it is safe and effective to use tranexamic acid for reducing intraoperative and postoperative blood loss of intertrochanteric fracture. However, multi-center large-sample randomized controlled trials are required to confirm the conclusions, because of limitations in study counts and quality.
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