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18 November 2019, Volume 23 Issue 32 Previous Issue    Next Issue

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Relationship between femoral head diameter and edge load under dynamic micro-separation of ceramic hip joints Lian Chao, Zhang Maorong, Wang Junyuan, Cheng Bo, Liu Feng 2019, 23 (32):  5085-5091.  doi: 10.3969/j.issn.2095-4344.1480 Abstract ( 389 )   PDF (960KB) ( 98 )   Save BACKGROUND: The dynamic computational model of artificial hip joints can effectively simulate the dynamic separation of femoral head and acetabular cup and explore edge contact between the head and cup. OBJECTIVE: To study the effect of the femoral head diameter on the edge load under dynamic micro-separation of hip joints, to provide a basis for biomechanical analysis of ceramic hip joints corresponding to early high wear problems caused by edge loading, and provide theoretical analyses for hip prosthesis design and clinical application. METHODS: Using the previously validated method, the dynamic model of artificial hip joint for edge contact based on Adams dynamic simulation software was used to predict dynamic micro-separation and edge contact force in the gait cycle of the hip joint. RESULTS AND CONCLUSION: (1) The maximum contact force of the edge loading under micro-separation of the cup and femoral head slightly reduced as the femoral head size increased. (2) The severity of edge contact was computed as the product of the edge contact force and its acting time. The severity parameter of φ36 mm head was 0.6% larger than that of φ28 mm one. The parameter of diameter 55 mm hip was 2.7% larger than that of φ28 mm and φ36 mm heads. (3) The change of the ceramic hip femoral head size has negligible effect on the edge loading. Figures and Tables | References | Related Articles | Metrics

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Efficacy of structural bone graft for reconstruction of acetabulum in total hip arthroplasty in patients with developmental dysplasia of hips and severe acetabular defect Yang Jian, Liang Can, Zhang Huizhong 2019, 23 (32):  5092-5096.  doi: 10.3969/j.issn.2095-4344.1397 Abstract ( 287 )   PDF (18042KB) ( 85 )   Save BACKGROUND: For patients with acetabular defect, it may be difficult to place the prosthesis in total hip replacement because of insufficient coverage. Structural bone graft reconstruction of acetabulum can make the prosthesis achieve coverage and stability, but how to obtain better coverage of bone graft is the key to affect the curative effect. OBJECTIVE: To observe the curative effect of structural bone graft reconstruction for total hip arthroplasty in patients with developmental dysplasia of hips and severe acetabular defects, and to assess the effect of bone graft coverage on repair. METHODS: Totally 80 patients (100 hips) with severe acetabular defects and hip dysplasia admitted to Department of Bone and Joint Surgery, Gaozhou City Hospital of Traditional Chinese Medicine from February 2010 to February 2016 were selected as the research objects. All patients underwent total hip arthroplasty, with intramedullary reconstruction of the acetabulum with autologous femoral head during operation. The pelvis was examined by X-ray during follow-up. Harris scores were compared between preoperative, postoperative 1 and 2 years. Group allocation was conducted according to graft coverage (≥ 70%, 65%-69%, < 65% in the groups Ⅰ, Ⅱ and Ⅲ, respectively). RESULTS AND CONCLUSION: (1) Postoperative X-ray evaluation showed that the position of acetabular prosthesis was ideal and the healing of acetabular bone graft was good. Among them, 8 cases had slight bone resorption at the outer edge of acetabular prosthesis, but no prosthesis loosening was found during follow-up. (2) Harris scores 1 year and 2 years after surgery were significantly higher than those before surgery (P=0.000). (3) Host bone coverage was (73.25±1.40)%, and bone graft coverage was (26.75±0.94)% in the Ⅰ group. In the Ⅱ group, there were 32 cases (38 hips) with host bone coverage from 65% to 69%; the host bone coverage was (67.15±0.57)%, and bone graft coverage (32.75±0.46)%. In the Ⅲ group, there were 20 cases (27 hips) with host bone coverage < 65%; the host bone coverage was (55.22±1.10)%, and bone graft coverage (44.78±0.85)%. There was no significant difference in Harris score between Ⅰ group andⅡ group at 1 and 2 years after operation. Harris scores were lower in the Ⅲ group than in the Ⅰ and Ⅱ groups (P=0.000). (4) For patients with developmental dysplasia of hips and severe acetabular defects, reconstruction of the acetabulum with total hip arthroplasty may get a more satisfactory effect. This study was approved by the Ethics Committee of Gaozhou City Hospital of Traditional Chinese Medicine on January 12, 2019 (approval No. GZSZYY83741002). Figures and Tables | References | Related Articles | Metrics

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Risk factors for postoperative delirium in elderly patients after total hip arthroplasty Gao Zhixiang, Jiang Yishan, Long Nengji, Xiao Cong 2019, 23 (32):  5097-5102.  doi: 10.3969/j.issn.2095-4344.1343 Abstract ( 419 )   PDF (648KB) ( 110 )   Save BACKGROUND: Delirium is easy to occur in elderly patients after total hip arthroplasty, so it is necessary to identify the risk factors of postoperative delirium. OBJECTIVE: To investigate the risk factors of postoperative delirium in elderly patients after total hip arthroplasty. METHODS: Data of patients over 60 years old who underwent total hip arthroplasty in the Third Hospital of Mianyang from May 2016 to December 2018 were retrospectively analyzed. Perioperative data were collected. According to the presence and absence of delirium after operation, the patients were divided into non-delirium group and delirium group. The risk factors of postoperative delirium were analyzed. RESULTS AND CONCLUSION: (1) The incidence of delirium was 26% (96 cases) after total hip arthroplasty in 365 patients. (2) Univariate analysis showed that age, sex, coronary heart disease, chronic obstructive pulmonary disease, type of disease, cognitive impairment, sleep disorder, anxiety, American Society of Anesthesiologists score, nutritional impairment, weak GFI index, leukocyte count before and after operation, erythrocyte specific volume after operation, hemoglobin level after operation, C-reactive protein after operation and intraoperative blood loss were significantly different between the two groups (P < 0.05). (3) Multivariate Logistic regression analysis showed that age (OR=1.19, 95%CI: 1.12-1.25), American Society of Anesthesiologists score (OR=8.03, 95%CI: 4.54-14.21), GFI score (OR=2.14, 95%CI: 1.78-2.57), postoperative C-reactive protein (OR=1.07, 95%CI: 1.05-1.09), combined with chronic obstructive pulmonary disease (OR=0.43, 95%CI: 0.26-0.69), total hip arthroplasty for femoral neck fracture (OR=3.67, 95%CI: 2.23-6.13) were high risk factors for postoperative delirium after total hip arthroplasty in the elderly (P < 0.05). (4) ROC curve analysis displayed that when age > 71 years old, American Society of Anesthesiologists score > 2, weakness GFI score ≥ 5, and C-reactive protein > 47 mmol/L, all of them had good specificity and sensitivity, which has certain clinical value in predicting postoperative delirium. Figures and Tables | References | Related Articles | Metrics

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Comparison of early outcomes of minimally invasive SuperCap approach and conventional posterolateral approach for femoral head replacement Wu Mingzhou, Li Rongqun, Zhou Jun, Zhang Lianfang, Zhu Feng, Wang Yijun, Sun Houyi, Zhang Weicheng, Xu Yaozeng 2019, 23 (32):  5103-5109.  doi: 10.3969/j.issn.2095-4344.1461 Abstract ( 409 )   PDF (26829KB) ( 84 )   Save BACKGROUND: Compared with the traditional posterolateral approach, the SuperCap approach for the treatment of femoral neck fractures has the advantageous of short incision, less damage to the soft tissue around the hip joint during the operation, no need for dislocation, and the patients can do postoperative functional exercise more early. OBJECTIVE: To compare the short-term clinical outcomes of minimally invasive SuperCap approach and posterolateral approach. METHODS: A total of 48 cases from October 2016 to April 2018 were collected, including 24 cases of SuperCap approach (SuperCap group) and 24 cases of conventional approach (conventional group). Operation time, length of incision, intraoperative blood loss, postoperative blood transfusion, postoperative hospital stay and complications were recorded in both groups. The hip joint function was evaluated before surgery and 1, 3, 5, 7, 14, 30, 90, and 180 days after surgery by the use of Visual Analogue Scale and HHS. The time up and go test, timed stair climb test, and short performance physical battery test were conducted at 3, 5, 7, 14, 30, 90, and 180 days after surgery. RESULTS AND CONCLUSION: (1) The length of incision in the SuperCap group was shorter than that in the conventional group (P < 0.05). There was no significant difference in the operation time, intraoperative blood loss, postoperative blood transfusion and postoperative hospital stay between the two groups (P > 0.05). (2) One case suffered from deep vein thrombosis in the SuperCap group and two cases suffered from deep vein thrombosis in the conventional group. No complications such as infection, dislocation, prosthesis loosening, sciatic nerve injury and paralysis occurred in the two groups. (3) The Visual Analogue Scale scores of the SuperCap group were lower than that of the conventional group (P < 0.05). The HHS scores at 1, 3 and 5 days after operation were higher in the SuperCap group than in the conventional group (P < 0.05). There was no difference in above scores at the other time points between the two groups (P > 0.05). (4)The results of the time up and go test on the 5th day after operation in the SuperCap group were better than that in the conventional group (P < 0.05). The results of the timed stair climb test on the 14th and 30th days after operation were better in the SuperCap group than that in the conventional group (P < 0.05). The results of the short performance physical battery test within 30 days after operation were better in the SuperCap group than that of the conventional group (P < 0.05). (5) The results showed that compared with the traditional approach, SuperCap approach has the advantages of short incision, small intraoperative soft tissue injury, rapid recovery of hip joint function, light pain, and good coordination of hip muscles. Figures and Tables | References | Related Articles | Metrics

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ISObar TTL dynamic fixation system in the treatment of double-segment lumbar disc herniation: 8-year follow-up Cao Zongrui, Zheng Bo, Qu Bo, Jiang Tao, Qu Xiaolong, Chen Tianyi, Zhang Xiuli 2019, 23 (32):  5110-5116.  doi: 10.3969/j.issn.2095-4344.1463 Abstract ( 415 )   PDF (29108KB) ( 85 )   Save BACKGROUND: In patients with double-segment disc herniation complicated with lumbar instability, we need to strengthen and fuse the severely degenerative segments, but the adjacent segments will have excessive movement displacement and flexion and extension angles. The degeneration of adjacent segments will accelerate. The instability of the vertebral body will be aggravated. The hyperplasia of the articular processes and the herniated discs will always plague clinicians and patients. OBJECTIVE: To observe the efficacy of the ISObar TTL dynamic fixation system versus rigid nail system in the treatment of double-segment lumbar disc herniation and lumbar instability.   METHODS: 130 cases of double-segment lumbar disc herniation and lumbar instability were analyzed, including 72 cases of L3/4-L4/5 and 58 cases of L4/5-L5/S1. The laminae decompression and posterior bone graft fusion were performed for severely degenerative segment. For lightly degenerative segments, ISObar TTL dynamic fixation (68 cases; trial group) and traditional nail fixation (62 cases; control group) were performed. Two groups of patients signed the informed consent. This study was approved by the Hospital Ethics Committee. End of death. The patients were followed up for at least 8 years. Disc degeneration was assessed using the modified Pfirrmann eight-level grading system preoperatively, 1 week, 4 years, and 8 years postoperatively. Visual Analogue Scale was utilized to assess the improvement in waist and leg pain. RESULTS AND CONCLUSION: (1) Compared with preoperatively, waist and leg pain and Visual Analogue Scale scores were significantly improved 1 week, 4 years, and 8 years postoperatively in the trial and control groups (P < 0.05). No significant difference in waist and leg pain and Visual Analogue Scale scores was determined preoperatively and 1 week postoperatively in both groups (P > 0.05). Waist and leg pain and Visual Analogue Scale scores were significantly lower in the trial group than in the control group 4 and 8 years postoperatively (P < 0.05). (2) Compared with preoperatively, no significant difference in the modified Pfirrmann eight-level grading system was detected 1 week, 4 years, and 8 years postoperatively in the fusion segment of the trial and control groups (P > 0.05). There was no significant difference in the modified Pfirrmann eight-level grading system in the fusion segment between the trial and control groups preoperatively, 1 week, 4 years, and 8 years postoperatively (P > 0.05). (3) Compared with preoperatively, the modified Pfirrmann eight-level grading system was significantly improved 1 week, 4 years, and 8 years postoperatively in the trial and control groups (P < 0.05). The modified Pfirrmann eight-level grading system was not significantly different between the trial and control groups preoperatively and 1 week postoperatively (P > 0.05). The modified Pfirrmann eight-level grading system score was significantly lower in the trial group than in the control group 4 and 8 years postoperatively (P < 0.05). (4) The symptoms of double-segment lumbar disc herniation were remarkably improved with ISObar TTL dynamic fixation system and a rigid nail system during 8-year follow-up. However, ISObar TTL dynamic fixation system can relieve waist and leg pain more obviously, and can reduce the degeneration of adjacent intervertebral discs 4 and 8 years postoperatively. Figures and Tables | References | Related Articles | Metrics

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TightRope system versus clavicular hook plate in the treatment of Neer type II distal clavicle fractures using arthroscopy Wu Cheng, Xia Yaqing, Wang Jianji, Liu Riguang, Fan Jiannan 2019, 23 (32):  5117-5125.  doi: 10.3969/j.issn.2095-4344.1495 Abstract ( 456 )   PDF (31155KB) ( 85 )   Save BACKGROUND: TightRope device has been widely used for acromioclavicular dislocation. Outside China, a few studies have reported that TightRope device is used for Neer type ll distal clavicle fractures. However, it is less reported in comparison with the traditional treatment of clavicular hook plate. OBJECTIVE: To observe and compare the clinical results after the arthroscopic treatment using TightRope system and after open repair using clavicular hook plate in Neer type ll distal clavicle fractures. METHODS: Between October 2015 and February 2018, 26 cases of Neer type ll distal clavicle fractures were admitted to this study in the Affiliated Hospital of Guizhou Medical University. In the TightRope system group, 12 cases underwent arthroscopic treatment using TightRope system. In the clavicular hook plate group, 14 cases underwent open repair using clavicular hook plate. From hospitalization to 1 year after surgery, the perioperative indexes, pain scores, shoulder function scores, radiologic outcomes and complications were collected and compared between the two groups. RESULTS AND CONCLUSION: The scores of the Oxford Shoulder Score, University of California at Los Angeles, and Constant-Murley Score were better in the TightRope system group than those in the clavicular hook plate group at 6 and 12 months postoperatively (P < 0.05). The range of forward flexion and abduction motion of the shoulder was significantly better in the TightRope system group than in the clavicular hook plate group at 3 and 6 months postoperatively (P < 0.05). One patient in the TightRope system group showed a poor healing of the fracture ends 3 months postoperatively. At 6 months postoperatively, the fracture was healed well. In the clavicular hook plate group, one elderly patient had nonunion; two patients had significant shoulder pain; and one patient had limited shoulder abduction. These complications alleviated gradually after removing the hook plate. These results demonstrated that the arthroscopic treatment using TightRope system is a minimally invasive surgical procedure, and characterized by minor wound, light pain, good functional recovery, and not requiring secondary surgery to remove internal implant, and high patient satisfaction. This study was approved by the Clinical Trial Ethics Committee, the Affiliated Hospital of Guizhou Medical University on May 15, 2019 (approval number: 2019LS226). Figures and Tables | References | Related Articles | Metrics

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Wrist join function and resetting quality of type C distal radius fractures patients: a comparison of Kirschner wire external fixator, external fixator and volar approach plate internal fixation Zhuo Jin, Wang Shasha, Chen Qiqiang, Cao Xianchang, Zhang Zhongwei 2019, 23 (32):  5126-5132.  doi: 10.3969/j.issn.2095-4344.1981 Abstract ( 485 )   PDF (26937KB) ( 92 )   Save BACKGROUND: The recovery process, wrist join function and resetting quality of different fixation methods for type C distal radial fractures are different. The comparisons among different fixation methods are lack of sufficient evidence, and there is still some controversy.   OBJECTIVE: To investigate the effects of Kirschner wire external fixator, external fixator and volar approach plate internal fixation on the recovery process, wrist join function and resetting quality of type C distal radius fractures patients. METHODS: The clinical data of type C distal radius fracture patients who were treated in Hainan Provincial People’s Hospital from January 2016 to December 2017 were retrospectively analyzed. Totally 93 patients were followed up. Among them, 32 patients underwent Kirschner wire external fixator fixation (Kirschner wire external fixator group), 21 patients underwent external fixator fixation (external fixator group), and 40 patients underwent volar approach plate internal fixation (volar approach plate internal fixation group). All patients signed informed consent. This study was approved by the Hospital Ethics Committee. The clinical operation indexes, recovery process, excellent and good rate of wrist joint function and fracture reduction quality of the three groups were compared and analyzed. The patients’ satisfaction and complications were recorded. RESULTS AND CONCLUSION: (1) The operation time, hospitalization time and fracture healing time of Kirschner wire external fixator group and external fixator group were shorter than those of volar approach plate internal group (F=200.589, 100.379, 14.282, all P < 0.05). (2) At 6 months after operation, the excellent and good rate of wrist joint in volar approach plate fixation group was higher than that in Kirschner wire external fixator group and external fixator group (χ2=6.541, P < 0.05). (3) At 12 months after operation, the palmar inclination and ulnar deviation of the volar approach plate internal fixation group were greater than those of the Kirschner wire external fixator group and external fixator group (F=87.622, 33.077, all P < 0.05). (4) The incidence of complications in Kirschner wire external fixator group and external fixator group was lower than that in volar approach plate internal fixation group (χ2=6.455, P < 0.05). (5) Results suggested that the clinical effects of three fixation methods for patients with type C distal radius fractures are satisfactory. Among them, the Kirschner wire external fixator and external fixator have the advantages of shorter operation time, shorter quicker healing, and lower incidence of complications. The resetting quality of the Kirschner wire external fixator is better than that of external fixator. While the volar approach plate internal fixation owns higher early good rate and better resetting quality. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of the four and three cannulated screws combined with buttress plate fixation for the treatment of Pauwels III femoral neck fractures Yin Hao, Zhou Enchang, Pan Zhengjun, Chen Guang, Jiang Hua 2019, 23 (32):  5133-5137.  doi: 10.3969/j.issn.2095-4344.1479 Abstract ( 363 )   PDF (20476KB) ( 95 )   Save BACKGROUND: Femoral neck fracture was mainly fixed by three cannulated screws. Some scholars have proposed that Pauwels III femoral neck fracture should be fixed with three cannulated screws and one antiwhirl screw to enhance the stability of fracture ends. Others suggested that open reduction should be used to treat Pauwels III fracture. Three cannulated screws combined with buttress plate of medial femoral neck is another treatment option. It was believed that open reduction could achieve anatomical reduction of the fracture end, reduce the pressure of the articular capsule, and not increase the destruction of the blood supply of the femoral head. The biomechanical effects of the two internal fixation methods have not been reported. OBJECTIVE: To compare the biomechanical stability and stress of the four cannulated screws and three cannulated screws combined with buttress plate fixation for the treatment of the Pauwels III femoral neck fractures. METHODS: The CT imaging results and internal fixation data of a 25-year-old healthy male volunteer were imported into the Mimics software using reverse modeling technique. The participant signed the informed consent. The protocol was approved by the Hospital Ethics Committee. Finally, finite element models of Pauwels III femoral neck fractures fixed with four cannulated screws and three screws cannulated screws combined with buttress plate were established respectively. An axial load of 500 N was applied on the femoral head to simulate one leg standing in Abaqus software. The maximum displacement, maximum Von Mises stress and stress distribution were compared between the two models. RESULTS AND CONCLUSION: (1) The maximum displacement was 0.71 mm in four screws model, and 0.43 mm in the three screws combined with buttress plate model. (2) Von Mises stress peak was 436.6 MPa and 227.2 MPa in four and three screws combined with buttress plate models respectively. The stress distribution of the three screws combined with the plate group was more uniform, and more in line with the biomechanical characteristics of the normal femur. (3) Both two kinds of internal fixation methods demonstrate good fixation effect. The three cannulated screws combined with buttress plate model provide better stability and uniform stress distribution compared with four cannulated screws. The three cannulated screws combined with buttress plate is a good choice for the treatment of Pauwels III femoral neck fracture.  Figures and Tables | References | Related Articles | Metrics

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Multivariate Logistic regression analysis of prognosis of posterolateral condylar fractures of tibial plateau treated with posterolateral buttress fixation Yu Jian, Xu Gang, Sun Hong, Yin Zhaoyang, Sheng Luxin, Li Leiming, Sun Xiao, Huo Yongfeng 2019, 23 (32):  5138-5145.  doi: 10.3969/j.issn.2095-4344.1478 Abstract ( 266 )   PDF (30408KB) ( 104 )   Save BACKGROUND: The treatment of the posterolateral condyle fracture involving the tibial plateau has always been controversial, mainly focusing on the surgical indications of the posterolateral support fixation. It is hoped that this study can provide help for the solution of this problem. OBJECTIVE: To study the effect of posterolateral buttress fixation on prognosis of patients with posterolateral condyle fracture of tibial plateau. METHODS: Follow-up survey was conducted in patients with posterolateral condylar fracture of tibial plateau treated surgically in the First People’s Hospital of Lianyungang from January 2011 to December 2016. The Hospital for Special Surgery score of knee joint was used as the observational index. The imaging differences of anteroposterior diameter of posterolateral bone mass, posterolateral tibial plateau obliquity, posterolateral cortex comminution, proximal fibula fracture and medial condyle fracture were taken as mixed factors. Multivariate regression analysis was used to study the effect of posterolateral buttress fixation on the prognosis of patients. RESULTS AND CONCLUSION: (1) The data of 200 patients were obtained with a follow-up time of 12-24 months. The Hospital for Special Surgery score of the knee joint at the last survey was from 62 to 95, mean 85.1 ± 5.8. (2) Univariate analysis showed that anteroposterior diameter of posterolateral bone mass, posterior tilt angle of lateral tibial plateau, proximal fibular fracture, medial condylar fracture, and posterolateral buttress fixation were correlated with Hospital for Special Surgery score after operation for tibial plateau fracture involving posterolateral condyle (P < 0.05). (3) Multivariate stratified analysis further confirmed that posterolateral buttress fixation could improve the Hospital for Special Surgery score of knee joint in patients with anterolateral bone mass diameter < 20 mm, proximal fibular fracture, and the posterolateral tibial plateau inclination angle ≥15° in one-year follow-up (P < 0.01). However, no significant difference was found in the Hospital for Special Surgery score and satisfaction level of the patients with posterolateral bone mass no less than 20 mm. (4) Compared with anterolateral raft plate fixation, posterolateral buttress fixation can significantly improve the Hospital for Special Surgery score of patients with anterolateral bone mass diameter less than 20 mm in one-year follow-up. It is recommended that posterolateral buttress fixation could be used for such patients. For the proximal fibula fracture and the posterolateral tibial plateau condylar fracture with the posterolateral tibial plateau inclination angle no less than 15°, the posterolateral buttress fixation can also improve the good rate one year after operation, which is recommended as a reference index. Figures and Tables | References | Related Articles | Metrics

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Mechanical changes of percutaneous kyphoplasty and percutaneous vertebroplasty in the treatment of thoracolumbar compressive fractures in three-dimensional vertebral models Guo Dahua, Wang Yuhui, Ye Qianqu, Liu Wenhao, Yang Bo, Ye Linqiang 2019, 23 (32):  5146-5150.  doi: 10.3969/j.issn.2095-4344.1492 Abstract ( 416 )   PDF (23931KB) ( 81 )   Save BACKGROUND: Compared with general fractures, thoracolumbar fractures in the elderly have different pathological changes and are often accompanied by other systemic diseases. Percutaneous vertebroplasty and percutaneous kyphoplasty are the most commonly used surgical methods. The choice of different surgical methods is related to the incidence of re-fracture after operation. How to choose an effective internal fixation system and surgical methods is very important to reduce the failure of surgical treatment of thoracolumbar fractures in the elderly. OBJECTIVE: To study and compare the finite element mechanics of lumbar vertebral compression fracture by establishing 3D vertebral digital model and thoracolumbar compression fracture model. METHODS: A 56-year-old male patient with low back pain (later diagnosed as lumbar muscle strain) had no abnormal vertebral shape and a 54-year-old male patient with thoracolumbar vertebral compression fracture induced by osteoporosis were selected in this study. The two patients signed informed consent. This study was approved by the Hospital Ethics Committee. CT data of T12-L1 segments were obtained. Based on CT data of volunteers with low back pain, a three-dimensional digital model of vertebral body was established by using Mimics 10.0 software. Three-dimensional finite element analysis software Ansys 12.0 was used to establish the three-dimensional solid model of the vertebral body. L1 of vertebral compression fracture in finite element model of normal vertebral body was simulated with reference to fracture patient data. On this basis, the procedures of percutaneous vertebroplasty and percutaneous kyphoplasty were simulated to record Von Mises stresses and the deformation of different parts of the model under different loads. RESULTS AND CONCLUSION: (1) Compared with the results of in vitro biomechanical test, the experimental results of this model were basically consistent with those of in vitro (P > 0.05). (2) Under vertical and forward bending, backward extension, lateral bending and right-handed loads, the deformations of T12 and L1 were significantly smaller in percutaneous kyphoplasty models than those of preoperative compressive fracture models and percutaneous vertebroplasty treatment models (P < 0.05). There was no significant difference in the spinal deformations of T12-L1 under various loads between percutaneous vertebroplasty models and preoperative models (P > 0.05). (3) The maximum stress of T12 and L1 was significantly lower in percutaneous kyphoplasty models than in preoperative models and percutaneous vertebroplasty models under vertical and forward bending, backward extension, lateral bending and right-handed loads (P < 0.05). There was no significant difference in the maximum stress of T12 and L1 between percutaneous vertebroplasty models and preoperative models under various loads (P > 0.05). (4) The deformation and stress of T12 and L1 segments of percutaneous kyphoplasty models were significantly less than those of preoperative compressive fracture models and percutaneous vertebroplasty models under vertical and forward bending, backward extension, lateral bending and right-handed loads. These suggest that percutaneous kyphoplasty can significantly increase the thoracolumbar stiffness of the spine, while percutaneous vertebroplasty has no significant effect on the thoracolumbar stiffness. Figures and Tables | References | Related Articles | Metrics

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Biomechanical comparison of personalized titanium femoral prosthesis fabricated by three-dimensional printing to four types of cementless prosthesis Liu Hongwei, Jiang Junfeng, Zhang Yunkun, Xu Nanwei, Wang Caimei, Zhang Wen 2019, 23 (32):  5151-5157.  doi: 10.3969/j.issn.2095-4344.1399 Abstract ( 392 )   PDF (816KB) ( 129 )   Save BACKGROUND: The vigorous development of metal three-dimensional (3D) printing additional manufacturing technology has brought new opportunities for the development of personalized prosthesis in orthopedics, but whether its biomechanical properties meet the clinical needs remains to be further studied. OBJECTIVE: To explore the biomechanical characteristics of titanium femoral prosthesis fabricated by electron beam melting 3D metal printing to four types of cementless prosthesis as SR modular prosthesis, rectangular prosthesis, cylindrical prosthesis and tapered prosthesis.   METHODS: The STL files of personalized femoral prosthesis, SR modular prosthesis, cylindrical prosthesis, rectangle prosthesis and tapered femoral prosthesis were exported to UG 8.0 software. Three-dimensional model was reconstructed and bad point and cavity were repaired to get the satisfied 3D STL format files. The digitized femoral prosthesis was implanted into femoral medullary cavity in accordance with the standard operative requirements. The five femoral prostheses with finite element mesh and node were divided by using Ansys 10.0 software and the prosthetic materials were assigned. The biomechanical characteristics of the five kinds of femoral prosthesis including stress distribution, interface stress, initial micromovement and stress shielding in simulating two states as bipedal standing still and walking slowly were compared.   RESULTS AND CONCLUSION: (1) Stress distribution: When standing still with double feet, positive stress of 3D printing personalized femoral prosthesis was only slightly higher than the tapered prosthesis (10.83%). Compared with SR modular prosthesis, the positive stresses of rectangle prosthesis and tapered femoral prosthesis were lower 45.65%, 15.20% and 41.18%, respectively. Compared with the SR modular prosthesis, personalized femoral prosthesis shear stresses of rectangle prosthesis, cylindrical prosthesis and tapered femoral prosthesis were lower 58.53%, 38.91%, 15.64% and 37.55%. When in low-speed walking condition, the positive stress of personalized prosthesis was lower than SR modular prosthesis and higher than the other three types of standardized prosthesis. Shear stress was lower than SR and rectangular prosthesis (25.78%, 62.50%) and higher than cylindrical and tapered prostheses (35.74%, 15.82%). (2) Stress shielding: When standing still with double feet, the rate of proximal stress shielding of personalized femoral prosthesis was minimum, lower than the SR, rectangular, cylindrical and tapered prostheses about 56.21%, 41.88%, 23.92% and 17.98%, respectively. When in low-speed walking condition, the rate of proximal stress shielding of personalized femoral prosthesis was minimum, lower than the SR, rectangular, cylindrical and tapered prostheses about 56.84%, 31.10%, 20.45% and 16.69%, respectively. (3) Prosthesis micromotion: When standing still with double feet, horizontal micromotion of personalized femoral prosthesis was higher than the other femoral stems, the maximum value was  26.4 μm, in the micromotion range of bone ingrowth; the vertical micromotion was lower than the other four prostheses. When in low-speed walking condition, the horizontal micromotion femoral prosthesis was higher than the other femoral prosthesis, the maximum micromotion value was 172 μm; the vertical micromotion was slightly lower than cylindrical prosthesis (1.45%) and slightly higher than SR, rectangular, and tapered prostheses (16.10%, 23.67%, 1.54%) respectively. (4) The stress shielding of proximal femur by electron beam melting metal 3D printing femoral prosthesis is lower than that of the other four types of standard prosthesis and stress distribution is better than SR modular prosthesis. The initial micromovement is slightly higher than that of other standard prosthesis, but it is within the range of bone in-growth. Figures and Tables | References | Related Articles | Metrics

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Application of three-dimensional digital operation planning to individualized adolescent idiopathic scoliosis surgery Fu Yu, Zhang Yunfeng, Su Baoke, Zhao Yan, Xin Daqi, Wang Haiyan, Xu Yangyang, Zhang Cong, Wang Yidan, Wang Xing, Gao Shang, En He, Cai Yongqiang, Wang Jianzhong, Wang Zhiqiang, Gao Mingjie,Li Zhijun, Ma Jierong, Li Xiaohe 2019, 23 (32):  5158-5163.  doi: 10.3969/j.issn.2095-4344.1982 Abstract ( 257 )   PDF (24753KB) ( 88 )   Save BACKGROUND: Adolescent idiopathic scoliosis is the most common form of scoliosis. Spinal anatomical changes caused by malformation make the risk of clinical screw fixation high. OBJECTIVE: To investigate the method to establish a digital virtual surgery planning system for adolescent idiopathic scoliosis. METHODS: One 17-year-old patient with adolescent idiopathic scoliosis was selected and underwent 16-slice spiral CT scan in Department of Spine, the Second Affiliated Hospital of Inner Mongolia Medical University. Three-dimensional reconstruction of CT data was conducted using Mimics 16.0 software. Navigation template design and three-dimensional printing were performed after measuring the diameter, length of transpedicular screw and angle after fixation. Surgical screw fixation was performed with navigation template, and the effect of screw placement was evaluated after CT scan. RESULTS AND CONCLUSION: Three-dimensional reconstruction was conducted in the patient’s spine. Navigation templates were designed using software reverse engineering design function to prevent the screw from penetrating the anterior cortex of the vertebral body and the inner and outer cortical bone of the pedicle. Three-dimensional printing of deformity of navigation template was conducted and it was used in spinal orthopedic surgery. Postoperative evaluation showed that no screw penetrated the cortex and the accuracy of screw placement was 100%. The results showed that the successful rate of screw placement was high for patients with idiopathic scoliosis by using three-dimensional digital reconstruction design navigation template. The patient and her family member signed the informed consent. This study was approved by the Ethics Committee of Inner Mongolia Medical University in April 2014 (approval No. 20140408).   Figures and Tables | References | Related Articles | Metrics

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A gait recognition approach based on surface electromyography and triaxial acceleration signals Hao Jinghan, Yang Peng, Chen Lingling, Geng Yanli 2019, 23 (32):  5164-5169.  doi: 10.3969/j.issn.2095-4344.1493 Abstract ( 537 )   PDF (22178KB) ( 89 )   Save BACKGROUND: Due to frequent accidents and physical diseases, a large number of people have lost the ability to walk. How to gradually restore the walking ability of these patients through motion recognition of the human body with an exoskeleton walker has gradually become a hot topic in the field of medical rehabilitation engineering. OBJECTIVE: To improve the recognition rate of human gait by fusion of surface electromyography signals and triaxial acceleration signals at classifier level. METHODS: An approach based on combining surface electromyography signals and triaxial acceleration signals was proposed to recognize five different kinds of basis daily gait patterns, including walking on the ground, going up stairs, going down stairs, going up slope and going down slope. The surface electromyography signals of five channels in the lower limbs and triaxial acceleration signals at the thighs and calves were collected. After signal pre-processing, the features of fusion signals were extracted. A classifier based on two-stream Hidden Markov Model was constructed to train the classifier. The classifier was trained and tested with test set to obtain the recognition accuracy. RESULTS AND CONCLUSION: (1) Five basic gait patterns were identified. The experiment obtained an average recognition accuracy of 94.32%, which was 4.15% higher than the accuracy by adopting surface electromyography signal only (average 90.17%), and 9.60% higher than the accuracy by adopting acceleration signal only (average 84.72%). (2) The results showed that more useful movement information could be obtained by combining surface electromyography signal and acceleration signal, which can help improve the recognition accuracy. Figures and Tables | References | Related Articles | Metrics

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Finite element fracture mechanics analysis of gluteus medius muscle active response to osteoporotic femoral neck fracture Sun Wentao, Lin Ziling, Li Fan, Hong Dinggang, Zhou Jianfei, Pang Xianghua, Wei Huaiji, Xu Panfeng, Wang Xiaopeng 2019, 23 (32):  5170-5174.  doi: 10.3969/j.issn.2095-4344.1466 Abstract ( 302 )   PDF (763KB) ( 94 )   Save BACKGROUND: There are no relevant reports in the world, which protective action response of muscle stress in elderly patients is also an important factor affecting hip fracture. OBJECTIVE: To investigate the mechanism of gluteus medius muscle on osteoporotic femoral neck fracture by finite element fracture mechanics. METHODS: A 87-year-old woman was diagnosed as a femoral neck fracture at the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine. The three-dimensional finite element model of hip and gluteus medius was reconstructed, and the material assignment was simulated to simulate the following three different states: before muscle activation; M1 model is defined as the femoral head and sagittal position were at an angle of 20 degrees and 500 N load was applied from the top down; after muscle activation, M2 model is external rotation of the hip joint by 5 degrees on the basis of the M1 model; in contrast to M2, the last M3 model was hip extension by internal rotation by 5 degrees. The three models were introduced into the finite element post-processing software LS-DYNA to calculate the fracture model of the femoral neck fracture based on the stress-strain curve before and after the active response of the gluteus medius muscle. The fractures before and after the three finite element fracture models were compared and analyzed. RESULTS AND CONCLUSION: (1) M2, M3 model comparison of gluteal muscle active response: M3 model did not present femoral neck fracture after 5 degrees internal abduction, but fractured in the femoral constrained area. In the M2 model, femoral neck fractures still occurred after the external abduction of the hip was rotated 5 degrees. (2) Compared with the M1 and M2 models, the femoral neck fractures occurred in both cases, and the time of femoral neck fractures was T=22.5 ms. According to the degree of fracture displacement M1 model fracture crack GardenⅡ type, but M2 model fracture crack Garden Ⅲ type, more serious than the M1 model shift. (3) To conclude, after the initiative response of gluteus medius muscle, muscle contraction caused by changes in hip posture may be the impact of fracture of the elderly femoral neck fracture factors. Figures and Tables | References | Related Articles | Metrics

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Biomechanical characteristics of hybrid strategies of two noncontiguous levels of cervical spondylosis: a finite element analysis Peng Jiajie, Wu Jianglin, Zhou Lin, Huang Yongquan, Fan Zhirong, Zhong Degui, Su Haitao 2019, 23 (32):  5175-5180.  doi: 10.3969/j.issn.2095-4344.1499 Abstract ( 366 )   PDF (23925KB) ( 125 )   Save BACKGROUND: For treatments of contiguous levels of cervical spondylosis, there are lots of clinical reports about it, either by using anterior cervical discectomy and fusion (ACDF), anterior cervical discectomy and arthroplasty (ACDA) or hybrid surgery. However, it is a controversial topic for treatments of noncontiguous levels of cervical spondylosis with increasing number of clinical reports. OBJECTIVE: To investigate the biomechanical effects of different strategies to provide guidance for clinical treatment, we performed a finite element analysis on four surgical strategies for two noncontiguous levels of cervical spondylosis. METHODS: The imaging data of C2-7 of a healthy female volunteer were collected by a 64-row spiral CT machine. The data were imported into Mimics to build three-dimensional models and solid models. The inp file was exported after the three-dimensional models were meshed. The volunteer signed informed consent. The protocol was approved by the Hospital Ethics Committee. The models of intervertebral disc, ligament and artificial intervertebral disc were established by using Hypermesh. The inp files were than imported into ABAQUS for materialization, contact pairs, load settings, constraint boundaries, and analysis.  RESULTS AND CONCLUSION: (1) The stress was concentrated in the fixed segments of the ACDF&ACDF model. The activities of fixed segments were reduced, and the range of motion of adjacent segments was increased compensatorily. (2) The range of motion of displacement segments increased in the ACDA&ACDA model. Part of the activities of the normal segments was compensated by the artificial disc, but the intervertebral stress was most consistent with the results of normal model. (3) For the adjacent segment, the retention of range of motion of ACDF&ACDA model was better than the ACDA&ACDF model. (4) However, as for the replacement segment, the increased degree of range of motion of the ACDA&ACDF model was greater than the ACDF&ACDA model. (5) It is concluded that the ACDA&ACDA strategy is the best choice for addressing neurological symptoms while ensuring overall cervical range of motion. The ACDF&ACDA strategy is a compromise strategy to avoid the of stress concentration in the lower segment, followed by the ACDA&ACDF strategy. The ACDF&ACDF strategy is the last consideration due to the compensatory potential risk in the range of motion of adjacent segments. Figures and Tables | References | Related Articles | Metrics

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Establishment of finite element dynamic simulation models of cervical spine facet joint in a 8-year-old child Feng Huimei, Liu Lu, Zhang Shaojie, Ma Yuan, Wang Xing, Li Zhijun 2019, 23 (32):  5181-5187.  doi: 10.3969/j.issn.2095-4344.1453 Abstract ( 307 )   PDF (25142KB) ( 111 )   Save BACKGROUND: School-age children are not equal proportion of “small adults”. Their cervical vertebra morphological development, physiological characteristics and mechanical changes are not proportional to adult shrinking; all have their own characteristics and rules. The facet joints of the cervical vertebrae (hereinafter referred to as “cervical facets”) bear the load of flexion, extension, compression, pull, shear and torsion within a certain range of cervical vertebrae. This structure is characterized by the movement of the cervical spine. It plays an important role in maintaining the stability of cervical spine and normal physiological activity. OBJECTIVE: A dynamic finite element model of the whole cervical vertebra (including intervertebral disc, cartilage and ligament) was established in an 8-year-old child. The load and stress distribution of C2-7 facet joints were analyzed under six dynamic conditions and between different vertebrae. This study aims to investigate the contribution of dynamic stress on cervical spine movement, to predict the risk of cervical spine injury under different motion conditions, and to predict the correlation between the position and the stress characteristics of the joint process, and to explore the finite element mechanics of cervical vertebra in the child.   METHODS: A fresh 8-year-old boy cervical spine specimen fixed by formalin (no obvious trauma deformity, provided by the Body Donation Room of Anatomy Volunteers of Inner Mongolia Medical University), weighing 30 kg, was selected. The whole cervical spine was scanned with 64-slice CT high-resolution, and the images of 0.625 mm slice thickness were imported into Mimics 16.0 software in DICOM format to establish, optimize and mesh the 3D models of the whole cervical vertebrae, intervertebral discs and ligaments. The Mimics software saved the generated inp format file to import into the Abaqus software. Materials assigned to finite element models of different anatomical structures of cervical vertebrae by reference to literature analysis Attributes were loaded under six dynamic conditions (the ligaments were simulated with the Truss unit in Abaqus), and the stress profiles of C2-7 joints were analyzed. RESULTS AND CONCLUSION: This study effectively established the dynamic finite element model of simulation, which had important practical significance for guiding the neck development and health care, physiological activities, medical diagnosis and treatment and sports rehabilitation of school-age children. The dynamic stress model of the cervical vertebrae process in the child was established by simulation. There was significant difference in the distribution of 75% Mises stress between left and right articular processes, including anterior flexion, extension, and left rotation. The stress value of the left and right articular process was not statistically significant, and the contribution of the stress to the whole cervical vertebrae was different among different intervertebral sequences (different states of the upper and lower articular process, the same ventral articular process, regional difference between the left and the right). Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of three different fixation methods for distal tibial fracture Jia Junfeng, Tang Chengjie, Yue Jintao, Li Feng 2019, 23 (32):  5188-5194.  doi: 10.3969/j.issn.2095-4344.1496 Abstract ( 415 )   PDF (771KB) ( 98 )   Save BACKGROUND: The biomechanical properties of distal tibial intramedullary nails and locking plates are relatively rare. OBJECTIVE: Three-dimensional finite element analysis was used to analyze internal fixation and bone under different stresses with three different fixation schemes.  METHODS: The digital technique was used to construct the distal tibial medial and lateral locking plate and and torsion force to simulate the force and displacement of the internal fixation and tibial fracture model under different stress conditions. distal tibial nail model. The model combination was set according to the principle of internal fixation. The model of the medial plate fixation was model 1. The model of the lateral plate of the tibia was model 2. The fixed model of intramedullary nail was model 3. The three models received the loading mode of axial lateral force. RESULTS AND CONCLUSION: Different fixation methods of distal tibial fractures had different characteristics of internal fixation when giving different directions of force. (1) When the axial force was given, the medial plate and fracture model of the distal tibia were uniformly stressed and the displacement was minimal. The stability was the best. There was no significant difference in the stability of the lateral tibial plate and the tibial bone marrow nail, but the lateral fixation of the distal tibia took more force. (2) When the internal fixation of the three forces bore similar strength, the fracture model of the intramedullary nail had to bear more strength; but the outer plate of the distal tibia had the largest displacement and poor stability. (3) When the model was torsion, the medial plate of the distal tibial fracture bore the greatest strength compared with other internal fixation methods. The distal plate fixation at the distal end of the humerus bore the minimum torsional force. In the intramedullary nail fixation method, the tibia itself shared more force. The displacement was largest, and its stability was worst. (4) It is concluded that the medial plate fixation of the distal tibial fracture is more stable than the distal lateral plate and intramedullary nail. The internal fixation and the tibia are more uniform and the stability is better. This study was approved by the Ethics Committee of Sichuan Provincial Orthopedic Hospital. Figures and Tables | References | Related Articles | Metrics

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Standardized treatment of infection around the prosthesis after joint replacement Liu Sijie, E Xiaoqiang, Pan Qi, Yao Guijun 2019, 23 (32):  5195-5202.  doi: 10.3969/j.issn.2095-4344.1462 Abstract ( 398 )   PDF (44237KB) ( 100 )   Save BACKGROUND: Although perioperative management of arthroplasty has resulted in a standardized process, the infection around the prosthesis after arthroplasty is still a difficult problem that has not been solved completely. There is still no consensus on treatment options for infection around the prosthesis after joint replacement. With the increasing number of patients, there is an urgent need for standardized treatment options with guidance significance. OBJECTIVE: To review the research progress of peripheral infection of prosthesis after joint replacement in foreign countries in recent years. METHODS: The first author applied computer to retrieve the relevant articles of PubMed and Springerlink databases from 1998 to 2019. The key words were “joint replacement; periprosthetic joint infection; progress in diagnosis and treatment”. A total of 400 relevant literatures were retrieved and 50 documents met the inclusion criteria. RESULTS AND CONCLUSION: (1) With the proposal of new serum markers such as alpha-defensin and leukocyte esterase and D-dimer, novel nuclear medical testing methods and the use of metabolomics and proteomics, periprosthetic joint infection can be found and diagnosed with early infection biomarkers. (2) In addition, new techniques can be used to disrupt biofilms, microbial reproduction processes and quantitative molecular methods to improve the accuracy of pathogen identification. (3) With the advent of these periprosthetic joint infection treatments, a rapid, accurate, and economical approach may make it easy to clearly diagnose and develop pathogens, so many cases can choose to be renovated in one phase. If soft tissue conditions are poor or do not meet the conditions of the first phase of renovation, the two-phase renovation can be entered. (4) Identifying pathogenic microorganisms, which can be treated with sensitive drugs, is well prepared for the two-phase renovation, which will be of epoch-making significance for periprosthetic joint infection treatment.   Figures and Tables | References | Related Articles | Metrics

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Total knee arthroplasty for osteoarthritis with femoral bowing: comparison of conventional method and computer-assisted navigation Qing Mingsong, Peng Jiachen, Yang Lidan, Zhao Chuntao 2019, 23 (32):  5203-5208.  doi: 10.3969/j.issn.2095-4344.1460 Abstract ( 306 )   PDF (686KB) ( 85 )   Save BACKGROUND: Studies have shown that the femoral bowing angle is strongly associated with the distal femoral valgus angle, so the distal femoral valgus angle can vary with the angle of the femoral bowing. If the preoperative plan is inadequate or not aware of the problem, it will affect the postoperative lower limb alignment and the position of femoral prosthesis and affect clinical outcomes. Either conventional or computer-assisted navigation surgery can often be used in patients with total knee arthroplasty for this type of end-stage knee osteoarthritis. OBJECTIVE: To review the causes, definitions and effects of the presence of the femoral bowing, and compare the intraoperative osteotomy and postoperative outcomes in the two surgical methods for knee osteoarthritis with femoral bowing in total knee arthroplasty. METHODS: A computer-based search of CNKI, PubMed, and WanFang was performed for retrieving articles concerning the application of arthroplasty in the end-stage knee arthritis with femoral bowing published from August 1997 to May 2018. The keywords were “knee arthritis, femoral bowing, total knee arthroplasty/replacement, computer-assisted navigation, limb alignment” in Chinese and English, respectively. After initial screening of titles and abstracts and exclusion of irrelevant articles, 51 eligible articles were included in final analysis according to the inclusion and exclusion criteria. RESULTS AND CONCLUSION: (1) The incidence of femoral bowing in Asians is higher than that of Western Europeans and other Westerners, and vitamin D and calcium intake should be strengthened. (2) There is a strong correlation between the femoral bowing and the distal femoral valgus angle. Conventional cutting angle may affect the lower limb alignment and prosthesis placement. (3) Compared with the conventional method, computer-assisted navigation total knee arthroplasty can more accurately reconstruct the postoperative lower limb alignment and accurately place the position the prosthesis. (4) In the two surgical procedures, navigation has more advantages in rebuilding the coronal lower limb alignment, but it cannot bring satisfactory clinical outcomes. Before degeneration, it has its own deformity, and then it returns to the neutral position, and may not get satisfied clinical outcomes. Figures and Tables | References | Related Articles | Metrics

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Subchondral bone cysts in osteoarthritis: abnormal reconstruction of subchondral bone Lu Jinwei, Chen Xi, Ye Chenyi, He Rongxin, Tang Lan, Yu Yunxian 2019, 23 (32):  5209-5215.  doi: 10.3969/j.issn.2095-4344.1400 Abstract ( 825 )   PDF (44575KB) ( 111 )   Save BACKGROUND: Osteoarthritis is one of the most common chronic diseases in orthopedics. Pathological changes in subchondral bone, characterized mainly as abnormal remodeling, manifested as subchondral bone marrow lesions and subchondral bone cysts, have been revealed their significance in the pathogenesis and progression of osteoarthritis by recent studies. Pathological changes in subchondral bone may precede which in cartilage and even aggravate it. Given the paucity of studies on subchondral bone cyst, an insight into subchondral bone cyst’s pathogenesis and clinical significance may contribute to novel diagnosis and therapy of osteoarthritis in terms of subchondral bone. OBJECTIVE: To summarize the advances in researches on the etio-pathogenic hypothesis, pathological traits, clinical significance, clinical diagnosis and therapy of subchondral bone cysts in osteoarthritis. METHODS: Computer-based searches of PubMed and Embase databases before January 2019 with the mesh terms of “(osteoarthritis OR osteoarthrosis OR osteoarthropathy) AND (subchondral cyst OR pseudocyst OR intraosseous cyst OR bone cyst)” were conducted by two co-first authors. Articles’ language was set as “English”. A total of 1 224 articles were retrieved after excluding the duplicate ones. 58 articles were eligible for the inclusion criteria to which 11 articles were retrieved manually in addition, thus 69 articles were included eventually. RESULTS AND CONCLUSION: (1) Subchondral bone marrow lesions may be the “predisposed change” of subchondral bone cyst, two of which belong to the respective stage of one pathological process. (2) Subchondral bone cyst may result from the inflammatory bone absorption and subsequent reactive bone formation. (3) Subchondral bone cyst is evidently correlated with cartilage degeneration and joint pain. (4) Non-steroidal anti-inflammatory drugs, anti-absorptive drugs, subchondroplasty, and bone grafting during arthroplasty may ameliorate subchondral bone marrow lesions or subchondral bone cyst. Further large sample clinical trials are warranted. Figures and Tables | References | Related Articles | Metrics

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Individualized treatment of knee osteoarthritis Meng Wei 2019, 23 (32):  5216-5220.  doi: 10.3969/j.issn.2095-4344.1342 Abstract ( 394 )   PDF (30605KB) ( 79 )   Save BACKGROUND: Knee osteoarthritis can be divided into primary and secondary osteoarthritis. The etiology of primary osteoarthritis is still unclear. Although there are many treatments, they all have their indications and disadvantages. OBJECTIVE: To compare and analyze the advantages and the best indications of diagnosis and treatment of knee osteoarthritis, so as to provide basis and guidance for clinical work and scientific research. METHODS: PubMed and Wanfang databases published from 2009 to 2018 were retrieved by the first author. The key words were “knee osteoarthritis, treatment, high tibial osteotomy, unicompartmental knee arthroplasty, total knee arthroplasty” in English and Chinese. Artificial screening was conducted according to the selection criteria to exclude the poor correlation and duplicate and obsolete literature, and finally 24 articles were included. RESULTS AND CONCLUSION: (1) At present, the most advanced viewpoint is to adopt different treatment methods in the treatment of knee osteoarthritis, such as high tibial osteotomy, unicondylar replacement and total knee replacement, to integrate the methods of “knee protection” and “knee replacement”. (2) For patients with knee osteoarthritis, individual conditions should be comprehensively evaluated and individualized treatment scheme should be put forward—stepped treatment of knee osteoarthritis, taking into account both joint-preserving therapy and joint replacement therapy. Moreover, consideration should be given to the relief of pain and protection of function, survival rate of prosthesis and patient satisfaction so as to choose the treatment ladder that is really suitable for patients. (3) Therefore, an objective, targeted and individualized optimal scheme still needs to be formulated in the systematic diagnosis and treatment of knee osteoarthritis. It is still necessary to further explore the practice in the future clinical and research work.  Figures and Tables | References | Related Articles | Metrics

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Application and progress of finite element analysis in scoliosis biomechanical research Sun Fengyuan, Li Zongyuan, He Xi, Yang Zongde 2019, 23 (32):  5221-5226.  doi: 10.3969/j.issn.2095-4344.1494 Abstract ( 362 )   PDF (655KB) ( 220 )   Save BACKGROUND: Finite element analysis has been used commonly in the biomechanics research of scoliosis due to the process of computing technology. OBJECTIVE: To review the application and progress of three-dimensional finite element analysis applied in the study of biomechanics of scoliosis, and to summarize its development process and characteristics, and look forward to its development prospects and directions in order to play a guiding role in the biomechanical study of scoliosis. METHODS: The first author retrieved the PubMed, Web of Science, and Wanfang Database with the computer for studies published from 1998 to 2019. The key words were FEA, finite element analysis, 3D FEA, scoliosis, adolescent idiopathic scoliosis, AIS. Studies with poor quality and repetitive studies were excluded, and 48 articles were finally included for review. RESULTS AND CONCLUSION: (1) Literature review found that three-dimensional finite element analysis has a lot of practice in the study of scoliosis biomechanics, and important progress has been made. (2) It has been widely used in simulating external fixator, optimizing surgical procedure and predicting prognosis, but less in etiology. (3) The development direction of three-dimensional finite element analysis is to further improve the fine structure simulation of the model, optimize the simulation of the biomechanical characteristics of non-linear elements, improve the simulation of spinal growth and compensatory effects, so as to establish a more realistic three-dimensional finite element model and improve the reliability of finite element analysis. Figures and Tables | References | Related Articles | Metrics

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Cognition of degenerative lumbar scoliosis and its orthopedic fusion and fixation Zhang Kefeng, Liu Yang, Zhang Cunxin, Lü Chaoliang 2019, 23 (32):  5227-5232.  doi: 10.3969/j.issn.2095-4344.1988 Abstract ( 418 )   PDF (711KB) ( 68 )   Save BACKGROUND: Degenerative lumbar scoliosis is one of the common causes of lower back pain and intermittent claudication. It is one of the focus research of spinal degenerative diseases in recent years. OBJECTIVE: To review the cognition and treatment methods of degenerative lumbar scoliosis at home and abroad in recent years, and to provide reference for the treatment of degenerative lumbar scoliosis. METHODS: The articles related to the degenerative lumbar scoliosis, spondylolisthesis, spinal instability, scoliosis, and spinal deformity published between December 1987 and December 2018 were retrieved by computer. The keywords were “degenerative scoliosis, interbody fusion, internal fixation, operative treatment, pedicle screw” in Chinese and English, respectively. Totally 42 articles were enrolled based on the inclusion and exclusion criteria. RESULTS AND CONCLUSION: (1) The main indications for adult degenerative scoliosis surgery are low back pain, radiation pain in lower limbs, numbness and claudication caused by intervertebral foramen stenosis. (2) When choosing the surgical methods, the main symptoms and potential diseases should be carefully evaluated. Not only to reduce symptoms, but also to minimize postoperative complications. (3) Due to the progression of postoperative scoliosis, decompression alone is usually not curable. In the case of small Cobb angle, minimal rotational deformity, light coronal and sagittal imbalances, decompression plus segmentary fixation and fusion can be used. In the case of large Cobb angle and coronal sagittal imbalance, decompression and lengthening segmentary orthopaedic fusion fixation may be selected. (4) Any surgery for adult degenerative scoliosis has a higher incidence of complications, so the risks and benefits of surgery should be carefully considered before selecting a surgical approach. Figures and Tables | References | Related Articles | Metrics

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Systematic reviews of the accuracy of musculoskeletal ultrasound in the diagnosis of lateral epicondylalgia Wang Yuan, Nie Fang, Wang Ting, Li Yan, Xu Ping 2019, 23 (32):  5233-5239.  doi: 10.3969/j.issn.2095-4344.1263 Abstract ( 575 )   PDF (36645KB) ( 94 )   Save BACKGROUND: Musculoskeletal ultrasound has the advantages of non-invasiveness, real-time dynamics and good repeatability, and has been gradually used in the diagnosis of lateral epicondylalgia. However, its diagnosis accuracy has not been confirmed. OBJECTIVE: To explore the accuracy of musculoskeletal ultrasound in the diagnosis of lateral epicondylalgia for providing evidence for clinical practice. METHODS: The trials about musculoskeletal ultrasound in the diagnosis of lateral epicondylalgia were searched in the databases of PubMed, EMbase, The Cochrane Library (Issue 6, 2018), CNKI, CBM and WanFang from inception to June 1, 2018. Two researchers independently screened literatures according to inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies by using the Quality Assessment of Diagnostic Accuracy Studies tool. Then meta-analysis was performed by using Meta-Disc 1.4 software and Stata 12.0 tool. RESULTS AND CONCLUSION: Seventeen articles were included. The random effects model was used to analyze the heterogeneity among the results of studies. The subgroup results of meta-analysis showed that the pooled sensitivity, specificity for gray-scale ultrasonography diagnosis lateral epicondylalgia was 0.81 (95%CI 0.76 to 0.85), 0.79 (95%CI 0.73 to 0.85), respectively. The pooled sensitivity, and specificity for gray-scale ultrasonography combined power Doppler ultrasonography diagnosis lateral epicondylalgia was 0.69 (95%CI 0.64 to 0.73), and 0.82 (95%CI 0.76 to 0.86), respectively. In summary, gray-scale ultrasonography holds high sensitivity and specificity in the diagnosis of lateral epicondylalgia. But it still needs more studies to validate the result because the limitation of quality and quantity of the included studies. Figures and Tables | References | Related Articles | Metrics

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Different interventions and implants for the functional recovery and complications of displaced midshaft clavicular fractures: a network meta-analysis Chen Zhe, Shi Qingyang, Gao Zhuo, Peng Yingying, Wang Yongqing 2019, 23 (32):  5240-5248.  doi: 10.3969/j.issn.2095-4344.1476 Abstract ( 324 )   PDF (1065KB) ( 94 )   Save BACKGROUND: There are many treatments for displaced midshaft clavicular fractures. However, there are few studies on different treatments for the evaluation of displaced midshaft clavicular fractures. Therefore, systematic analysis is carried out for different interventions. OBJECTIVE: To systematically review the efficacy and safety of different interventions for the treatment of displaced midshaft clavicular fractures. METHODS: PubMed, EMbase and Cochrane Central databases were searched by computer to retrieve randomized controlled trials of different interventions for the treatment of displaced midshaft clavicular fractures. The search time was from the inception to December 2018. Two researchers conducted literature screening and data extraction, and evaluated the risk of bias in the included studies. Data analysis was performed using R 3.5.1 and the risk assessment map was generated by RevMan 5.3 software. RESULTS AND CONCLUSION: A total of 23 randomized controlled trials involving 2 234 patients were included. (1) In terms of Constant score: The network meta-analysis showed that the plate (locking plate, non-locking plate) was superior to the sling, and the difference was statistically significant. Probability ranking results showed that intramedullary pins, non-locking plates, and elastic intramedullary nails were superior to others. (2) In terms of DASH scores: The results of the network meta-analysis showed that the comparison of the two interventions in the treatment of displaced midshaft clavicle fractures showed no statistical difference. (3) In terms of nonunion rate: The results of network meta-analysis showed that elastic intramedullary nails, non-locking plates, and locking plates were superior to the nonoperative treatments (sling, figure-of-eight bandage), and the differences were statistically significant. Probability sorting results showed that elastic intramedullary nails, non-locking plates, and locking plates were superior to others. (4) In terms of infection rate: The results of network analysis showed that intramedullary nails (elastic intramedullary nails, intramedullary pins) were superior to plates (locking plates, non-locking plates), and the differences were statistically significant. Probability sorting results showed that intramedullary pins and elastic intramedullary nails were superior to others. (5) In terms of healing time: The results of network analysis showed that elastic intramedullary nails were superior to slings, and non-locking plates were superior to slings, and the difference was statistically significant. Probability ranking results showed that intramedullary pins, non-locking plates, and elastic intramedullary nails were superior to others. (6) Based on the results of network meta-analysis, probability ordering and node resolution analysis of functional scores, nonunion rate, infection rate, and healing time, this study considers that elastic intramedullary nail is the first choice for the treatment of displaced midshaft clavicular fractures. Figures and Tables | References | Related Articles | Metrics