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28 December 2019, Volume 23 Issue 36 Previous Issue    Next Issue

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Total joint arthroplasty in the treatment of advanced hemophilia A arthropathy Gao Qiang, Liu Wei, Li Jiale, Jing Juehua, Yao Yunfeng 2019, 23 (36):  5741-5746.  doi: 10.3969/j.issn.2095-4344.1942 Abstract ( 388 )   PDF (26022KB) ( 98 )   Save BACKGROUND: Hemophilia arthritis is the dysfunction of multiple joints caused by hemophilia, in which the incidence of hip and knee joint is high. Total joint arthroplasty is an effective method for the treatment of hemophilia arthritis, which can improve the quality of life of patients, reduce the dysfunction of affected limbs and prolong the life span of patients. OBJECTIVE: To investigate the clinical efficacy of total joint arthroplasty in the treatment of advanced hemophilia A arthropathy. METHODS: The clinical data of 14 patients with advanced hemophilia A arthropathy (11 knees and 9 hips) from June 2015 to February 2019 were analyzed retrospectively. Totally 11 knees underwent total knee arthroplasty, and 9 hips underwent total hip arthroplasty. All patients were male with a mean age of 38.6±9.9 years. One case received intraoperative transfusion of 300 mL, and two cases received blood transfusion of 200 mL after operation. In the perioperative period, the coagulation factor replacement therapy was used to select (500 IU) recombinant human coagulation factor Ⅷ, perioperatively. The detection of factor Ⅷ inhibitors was zero. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Knee function after total knee arthroplasty was assessed using the Hospital for Special Surgery Knee Score and the American Knee Society Score. Hip function was evaluated after total hip arthroplasty by Harris score. Visual analogue score and the activity of the factor Ⅷ were compared before and after operation. Bleeding, infection and prosthetic loosening were observed. RESULTS AND CONCLUSION: (1) Fourteen patients were followed-up for 12-45 months. No complications such as revision, prosthetic loosening or joint infection were found in all patients after operation. (2) The Hospital for Special Surgery score was increased from (30.1±9.5) preoperatively to (82.1±10.7) after one-year follow-up. The clinical score of Knee Society Score was increased from (29.1±15.4) preoperatively to (89.3±7.0) after one-year follow-up, and the functional score of Knee Society Score was increased from (18.6±13.6) preoperatively to (72.3±16.6) after one-year follow-up. The Harris score of total hip arthroplasty was increased from (34.6±10.7) preoperatively to (85.8 ±4.8) after one-year follow-up (P < 0.05). The visual analogue score was decreased from (6.0±2.4) preoperatively to (1.0±0.9) after one-year follow-up, and the activity of the factor Ⅷ was increased from (1.9±2.0)% preoperatively to (108.6±20.7)% on the first day after operation (P < 0.05). (3) The clinical efficacy of total joint arthroplasty under coagulation factor substitution for advanced hemophilia A arthropathy is outstanding. It can significantly improve the joint function, correct deformation, reduce pain, and improve the long-term quality of life of the patients. Figures and Tables | References | Related Articles | Metrics

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Relationship between intra-articular infusion combined with peri-articular injection of tranexamic acid and postoperative blood loss after total knee arthroplasty Bao Hongbo, Sun Li, Tian Xiaobin, Chen Long, Li Senlei, Yang Xianteng, Wang Shaobin, Cai Jian 2019, 23 (36):  5747-5752.  doi: 10.3969/j.issn.2095-4344.1894 Abstract ( 287 )   PDF (25725KB) ( 114 )   Save BACKGROUND: Tranexamic acid is a synthetic amino acid, and can block the lysine binding site of plasminogen to reduce fibrinolysis and blood loss. It is widely used to reduce perioperative bleeding in total knee arthroplasty. OBJECTIVE: To evaluate the effect of intra-articular infusion combined with peri-articular injection versus intra-articular infusion of tranexamic acid on blood loss after total knee arthroplasty.   METHODS: Totally 75 patients with unilateral knee osteoarthritis who underwent total knee arthroplasty were randomly divided into two groups. Both groups were intravenously injected with normal saline 250 mL+tranexamic acid 1 g 30 minutes before surgery. For the intra-articular infusion group, peri-articular injection with 100 mL cocktail was performed after the closure of articular capsule and intra-articular infusion with tranexamic acid (3.0 g+normal saline 50 mL) was also performed after surgery. For the intra-articular infusion combined with peri-articular injection group, peri-articular injection with 100 mL cocktail+1.5 g tranexamic acid was performed after the closure of articular capsule and intra-articular infusion with normal saline 50 mL+3.0 g tranexamic acid was also performed after surgery. Patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The 24-hour drainage, blood loss, coagulation function, visual analogue scale score, knee joint mobility, blood transfusion rate, incision infection rate, pulmonary embolism and deep vein thrombosis were recorded on the third day after operation.   RESULTS AND CONCLUSION: (1) The intra-articular infusion combined with peri-articular injection group resulted in less postoperative 24-hour drainage volume and 3rd day’s blood loss postoperatively (P < 0.05). (2) There was no obvious statistical difference in range of motion, visual analogue scale score, and coagulation function between two groups (P > 0.05). (3) There was only one patient who received the transfusion treatment in intra-articular infusion group. There was no wound infection, deep venous thrombosis or pulmonary embolism in the two groups. (4) These findings demonstrated that intra-articular infusion combined with peri-articular injection of tranexamic acid can significantly reduce the postoperative blood loss in total knee arthroplasty without increasing the risk of thrombosis. Figures and Tables | References | Related Articles | Metrics

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Intravenous and intraarticular tranexamic acid can reduce blood loss and inflammatory response during cemented posterior cruciate ligament-retaining unilateral total knee arthroplasty Wu Xingyuan, Zhang Guoru, Liu Tang, Zhou Caisheng 2019, 23 (36):  5753-5759.  doi: 10.3969/j.issn.2095-4344.1962 Abstract ( 420 )   PDF (29922KB) ( 91 )   Save BACKGROUND: A large number of literatures have confirmed that the use of tranexamic acid in total knee arthroplasty can effectively reduce perioperative bleeding, but there is no consensus on which tranexamic acid is most used. Little is reported on the changes of related inflammatory factors in blood after tranexamic acid is given. OBJECTIVE: To investigate the effects of different tranexamic acid administration methods on perioperative blood loss and inflammatory response in total knee arthroplasty. METHODS: Ninety patients who underwent unilateral total knee arthroplasty due to knee osteoarthritis from June 2016 to June 2018 were included in this study. They were randomly divided into three groups, 30 in each group using the envelope lottery method. All of them received cemented posterior cruciate ligament-retaining unilateral total knee arthroplasty. In group A, patients were treated by intravenous infusion of tranexamic acid. In group B, intraarticular injection of tranexamic acid was performed. In group C, both intravenous and intraarticular administration of tranexamic acid was used. Perioperative total blood loss and occult blood loss were calculated, and the number of patients receiving blood transfusion and the volume of blood transfused were recorded. Fibrinogen level, prothrombin time, activated partial thromboplastin time, and the levels of inflammatory factors C-reactive protein and interleukin-6 were measured before and 1, 3 and 7 days after surgery. Deep vein thrombosis was examined at 1 week after surgery. All patients were followed up for 6 months to determine the occurrence of deep vein thrombosis and pulmonary embolism. This study was approved by the Medical Ethics Committee of the Third People’s Hospital of Hainan Province, China.   RESULTS AND CONCLUSION: (1) Total perioperative blood loss in groups A and B was significantly higher than that in group C (P < 0.05). There were no significant differences in occult blood loss and blood transfusion rate among the three groups (P > 0.05). (2) There were no significant differences in fibrinogen level, prothrombin time and activated partial thromboplastin time among three groups before surgery and at 1, 3 and 7 days after surgery (P > 0.05). (3) In each group, C-reactive protein and interleukin-6 levels at 1 and 3 days after surgery were significantly higher than those before surgery (P < 0.05), and there were no significant differences in C-reactive protein and interleukin-6 levels among three groups (P > 0.05). (4) At 7 days after surgery, the levels of C-reactive protein and interleukin-6 in each group decreased to the levels before surgery, and there were no significant differences among three groups (P > 0.05). Vascular ultrasound examination of the both lower limbs showed no deep vein thrombosis at 1 week after surgery. After 6 months of follow-up, there were no cases of deep venous thrombosis and pulmonary embolism in the lower limbs. (5) The results suggest that compared with simple intravenous or intraarticular administration of tranexamic acid, combined intravenous and intraarticular administration of tranexamic acid can greatly reduce total perioperative blood loss and does not increase the risk of developing deep vein thrombosis after total knee arthroplasty. Different administration methods of tranexamic acid have no obvious effects on inflammatory response. Figures and Tables | References | Related Articles | Metrics

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Influence of the concept of fast track surgery on the physiological and psychological rehabilitation of patients undergoing total knee arthroplasty Han Guangtao, Li Haohuan 2019, 23 (36):  5760-5765.  doi: 10.3969/j.issn.2095-4344.1991 Abstract ( 385 )   PDF (24287KB) ( 148 )   Save BACKGROUND: Studies have shown that fast track surgery has a positive effect on the treatment of patients, but at present, there are few studies on the effect of the concept of fast track surgery on the physiological and psychological rehabilitation of total knee arthroplasty patients.   OBJECTIVE: To explore the effect of fast track surgery on physical and psychological rehabilitation of patients undergoing total knee arthroplasty. METHODS: Sixty patients with severe knee arthritis undergoing total knee arthroplasty in the Renmin Hospital, Wuhan University from May 2017 to January 2019 were retrospectively analyzed. According to the surgery methods and ideas adopted before and after operation, patients were grouped. Patients who received fast track surgery according to the fast track ideas were involved in the fast track surgery group, including preoperative education, intraoperative fluid management and postoperative functional exercise. Patients with the same operation but conventional rehabilitation were divided into the conventional rehabilitation group. Hospitalization time, hospitalization cost, postoperative complications, nursing satisfaction during hospitalization, Zung anxiety self-rating scale, Zung depression and visual analogue score were compared between the two groups. RESULTS AND CONCLUSION: (1) Compared with the conventional rehabilitation group, the length of stay was decreased, and the nursing satisfaction during the hospitalization was increased in the fast track surgery group (P < 0.05). (2) In terms of complications within 1 month after surgery, the incidence of urinary tract infection and lower extremity venous thrombosis was lower in the fast track surgery group than that in the conventional rehabilitation group (P < 0.05). (3) Compared with the conventional rehabilitation group, Zung anxiety, Zung depression and visual analogue score were decreased in the fast track surgery group (P < 0.05). (4) The results confirmed that the application of fast track surgery in total knee arthroplasty can accelerate the recovery of patients, improve patients’ satisfaction with treatment, and relieve anxiety and depression. Figures and Tables | References | Related Articles | Metrics

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Effects of intravenous tranexamic acid infusion combined with articular cavity injection on pain and early rehabilitation after knee arthroscopy Wang Hairuo, Liu Xi, Li Mingjin, Chen Xiaohua, Liang Ting, Ding Yongqing, Tang Xiaoli, Wang Ji, Ma Huixu 2019, 23 (36):  5766-5771.  doi: 10.3969/j.issn.2095-4344.1996 Abstract ( 368 )   PDF (26159KB) ( 104 )   Save BACKGROUND: Tranexamic acid could reduce bleeding after knee joint replacement, but there is still lack of reports about tranexamic acid on pain after arthroscopy. OBJECTIVE: To investigate the effect of intravenous tranexamic acid infusion combined with articular cavity injection on pain and early rehabilitation after knee arthroscopy. METHODS: From November 2016 to January 2018, 105 patients with meniscus injury who underwent knee arthroscopy in Chongqing General Hospital were included. The patients were randomly divided into injection group (simple articular cavity injection group), combined group (intravenous drip combined with articular cavity injection group) and control group. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Visual analog scale score at rest was assessed at 6, 12, 24, 48, 72 hours postoperatively. Visual analog scale score at exercise was evaluated at 1, 3, 5, 7 days postoperatively. Range of motion of the knee was detected at 1, 3, 5, 7 days postoperatively. The number of use cases and dosage of remedial dizocine were recorded. Lysholm knee function score was compared before operation and during follow up after operation. RESULTS AND CONCLUSION: (1) Visual analog scale score at rest was significantly higher in the injection group than in the combined group at 6, 12, 24 hours postoperatively (P < 0.05). There was no statistical difference at the rest time points (P > 0.05). (2) Visual analog scale score at exercise was higher in the injection group than in the combined group at 1 and 3 days (P < 0.05). There was no statistical difference at the rest time points (P > 0.05). (3) The dosage of remedial dizocine was less in the combined group than in the injection group  (P < 0.05). The range of motion of the knee was smaller in the injection group than in the combined group at 1, 3, 5, 7 days (P < 0.05). (4) There was no significant difference in Lysholm score between the injection group and the combined group in the last follow-up (P > 0.05). (5) Results suggested that intravenous tranexamic acid infusion combined with articular cavity injection can effectively relieve the early postoperative pain of arthroscopy and promote the early recovery of knee joint function. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional printing technique-assisted total hip arthroplasty for developmental dysplasia of the hip in adults Chen Yong, Zhang Bin 2019, 23 (36):  5772-5776.  doi: 10.3969/j.issn.2095-4344.1895 Abstract ( 448 )   PDF (20058KB) ( 155 )   Save BACKGROUND: Total hip arthroplasty is the ultimate treatment for adult developmental dysplasia of the hip in the late stage of disease. However, due to the complicated anatomical variation of developmental dysplasia of the hip patients, the traditional total hip arthroplasty faces great challenges.   OBJECTIVE: To explore the effectiveness and safety of three-dimensional (3D) printing technology-assisted total hip arthroplasty in the treatment of developmental dysplasia of the hip. METHODS: Twenty patients with developmental dysplasia of the hip, who underwent primary total hip arthroplasty in Department of Orthopedics, Central Hospital Affiliated to Shenyang Medical College from January 2016 to June 2018, were randomly divided into two groups. The 10 patients in the 3D printing group underwent total hip arthroplasty assisted by 3D printing technology, and 10 patients in the traditional operation group underwent traditional total hip arthroplasty. The operation time, blood loss, occurrence of complication, visual analog scale score and Harris hip joint function score before and 6 months after operation were recorded. RESULTS AND CONCLUSION: (1) Compared with the traditional operation group, the operation time and blood loss in the 3D printing group were significantly shortened, with significant differences (P=0.000). (2) Visual analog scale score and Harris hip joint function score were significantly higher at 6 months after operation than that before operation in both groups (P=0.000). (3) There was no significant difference in visual analog scale score and Harris hip joint function score between the two groups 6 months after operation (P > 0.05). (4) No complication occurred in both groups. (5) These results indicate that both 3D printing technology-assisted total hip arthroplasty and traditional total hip arthroplasty can achieve good clinical effects in the treatment of developmental dysplasia of the hip, but 3D printing technology combined with total hip arthroplasty has shorter operation time and less blood loss. Figures and Tables | References | Related Articles | Metrics

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SuperPATH approach for hip replacement for femoral neck fractures in elderly patients: a short-term follow-up Zhang Xing, Xu Zhonghua, Xie Hua, He Jin, Zhu Aiping, Zhao Yinbi 2019, 23 (36):  5777-5781.  doi: 10.3969/j.issn.2095-4344.1997 Abstract ( 382 )   PDF (22504KB) ( 113 )   Save BACKGROUND: The study of minimally invasive hip arthroplasty has been a hotspot, and SuperPATH approach has gradually been considered as a real minimally invasive technique, but there is still no long-term follow-up study on the clinical efficacy of this approach. OBJECTIVE: To explore short-term follow-up results of SuperPATH approach for hip replacement in the treatment of femoral neck fractures in elderly patients. METHODS: From January 2016 to February 2018, 78 elderly patients with femoral neck fractures were treated with SuperPATH approach for hip replacement in Jintan Hospital Affiliated to Jiangsu University. There were 36 males and 42 females aged from 75 to 86 years old with an average age of 82.4 years old. Fractures were classified according to Garden classification, including 52 cases of type Garden Ⅲ and 26 cases of type Garden Ⅳ. Surgical risk was evaluated before operation. Totally 30 patients received total hip arthroplasty and 48 patients received prosthetic replacement. Bioprosthesis was used in 58 cases and cement prosthesis in 20 cases. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Hip joint functions of patients with different age period, Garden classification, hip replacement type, and prosthesis type were evaluated by using Harris score. RESULTS AND CONCLUSION: (1) Seventy-six patients were followed up from 13 to 38 months. According to Harris score, 22 cases were excellent, 50 cases were good and 4 cases were average in the final follow-up. The excellent and good rate was 95%. (2) In the final follow-up, Harris score was (86.91±1.03) in patients aged from 75 to 79 years old, (84.02±2.26) in patients aged more than 80 years old, and had significant differences between two groups (t=6.730, P=0.000). (3) In the final follow-up, Harris score was (85.33±4.21) in the Garden Ⅲ group, and (85.05±3.29) in the Garden Ⅳ group, and there was no significant difference between two groups (t=2.875, P=0.247). (4) In the final follow-up, Harris score was (83.19±5.24) in the prosthetic replacement group, and (82.75±4.88) in the total hip replacement group, and there was no significant difference in Harris score between the two groups (t=1.525, P=0.108). (5) Harris score was (82.34±6.24) in the cement prosthesis group, and (82.69±5.79) in the uncemented prosthesis group, and there was no significant difference in Harris score between the two groups (t=2.978, P=0.219). (6) During follow-up, one patient occurred hip joint dislocation on the operation side due to fall, and no dislocation occurred again after manual reduction. (7) Through long-term follow-up, treatment of femoral neck fracture in elderly patients by SuperPATH approach for hip arthroplasty can obtain good therapeutic effect. Furthermore, there was no significant difference in efficacy between patients with different Garden classification, hip replacement type, and hip prosthesis type. It shows that the approach has obvious advantages in minimally invasive and has a good application prospect. Figures and Tables | References | Related Articles | Metrics

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Influential factors on femoral head avascular necrosis after screw internal fixation for femoral neck fracture of Pauwels type III Chen Haihong, Zhang Qingwen, Gao Dawei, Lin Zhijiong, Deng Bin, Zhang Huiliang 2019, 23 (36):  5782-5787.  doi: 10.3969/j.issn.2095-4344.1947 Abstract ( 395 )   PDF (25677KB) ( 101 )   Save BACKGROUND: In recent years, the incidence of Pauwels type III fractures has increased, and the treatment plan is not clear, and the avascular necrosis of femoral head is easy to occur after surgery compared with Pauwels type I and II fractures. Analysis of related risk factors is of great significance for preventing avascular necrosis of femoral head after surgery. OBJECTIVE: To evaluate the influential factors for femoral head avascular necrosis after screw internal fixation for femoral neck fracture of Pauwels type III. METHODS: Clinical data of 216 patients with Pauwels type III femoral neck fracture who were admitted to Zhongshan Hospital of Traditional Chinese Medicine from January 2010 to December 2016 were analyzed retrospectively. Risk factors related to femoral head avascular necrosis after screw internal fixation were evaluated by univariate and multivariate logistic regression analysis. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. RESULTS AND CONCLUSION: (1) In 216 patients with femoral neck fracture of screw fixation, the incidence of the femoral head avascular necrosis was 12.5%. (2) The sex, body mass index, fracture to surgery time, presence of diabetes, hypertension, and femoral head avascular necrosis had no obvious correlation (P > 0.05). The patient’s age, preoperative traction, surgical plan, reset quality, full load time, and internal fixation removal time were all related factors for the femoral head avascular necrosis after screw internal fixation for femoral neck fracture (P < 0.05). (3) The age greater than 55 years old, preoperative traction, hollow screw internal fixation, Garden III, type IV reset quality, and complete weight bearing within 3 months after surgery were risk factors for the femoral head avascular necrosis after screw internal fixation for femoral neck fracture (P < 0.05). (4) The risk factors of the femoral head avascular necrosis after screw internal fixation for femoral neck fracture of Pauwels type III are the age greater than 55 years old, preoperative traction, hollow screw internal fixation, Garden III, type IV reset quality, and complete weight bearing within 3 months after surgery. Effective control of these factors can reduce and prevent postoperative avascular necrosis of the femoral head. Figures and Tables | References | Related Articles | Metrics

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Design and biomechanical analysis of hollow titanium rod supporting the femoral head to prevent collapse Hu Changbo, Yang Xinming, Zhang Ying 2019, 23 (36):  5788-5793.  doi: 10.3969/j.issn.2095-4344.1958 Abstract ( 329 )   PDF (75136KB) ( 103 )   Save BACKGROUND: Among many methods for the treatment of early femoral head necrosis, the clinical application of hollow titanium rod has been recognized by many scholars. However, the in vitro biomechanical analysis of hollow titanium rod supporting the lesion area of the femoral head to prevent its collapse has not been reported. OBJECTIVE: To design the hollow titanium rod preventing the collapse of the femoral head and investigate its biomechanical feasibility, providing a theoretical basis for clinical application.   METHODS: Fifteen normal adult femoral specimens were randomly divided into three groups (5 specimens in each group): normal group (group A), core decompression group (group B), core decompression + hollow titanium rod placement group (group C). When the specimen was placed in a biomechanical machine, pressure was applied to the top of the femoral head and gradually increased until the femoral head collapsed. The strain value of femoral trochanteric fossa (a), femoral moment (b), and femoral greater trochanter (c) was measured. The maximum load (failure limit point load) was recorded when the femoral head collapsed and statistical data were compared among a, b and c. RESULTS AND CONCLUSION: (1) When the load of group A reached 300 N, there was no statistically significant difference in the strain values among a, b and c (P > 0.05). When the load of group B reached 300 N, there was no significant difference in strain values between a and b (P > 0.05). However, the strain value at c was significantly greater than that at a and b (P < 0.05). The strain value at a and b in Group A was significantly greater than that in group B, and the train value at c in group A was significantly lower than that in group B (P < 0.05). (2) There was no significant difference in strain value at a, b and c in group C (P > 0.05). The strain value at a and b in group C was significantly greater than that in group B, and the train value at c in group C was significantly lower than that in group B (P < 0.05). There were no significant differences in the strain values at a, b and c between group A and group C (P > 0.05). (3) The load at the failure limit point of the femoral head caused by compression was different among three groups. The load at the failure limit point of group B was significantly lower than that in group A and group C (P < 0.05). There was no significant difference in load at the failure limit point between group A and group C (P > 0.05). (4) These results suggest that hollow titanium rod used to support the femoral head has many design advantages and meets the humanized needs of clinical patients. Hollow titanium rod placement can effectively change the stress distribution of the femoral head under load after decompression of the core, so that the biomechanical properties are close to the normal distribution and have a good supporting effect, which can effectively prevent femoral head collapse and provide a biomechanical basis for the clinical application of hollow titanium rod in the treatment of early osteonecrosis of the femoral head. Figures and Tables | References | Related Articles | Metrics

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Finite element simulation of cut-out failure of proximal femoral nail anti-rotation for intertrochanteric fracture Zheng Liqin, Chen Xinmin, Zhang Biao, Li Musheng, Liang Ziyi, Zheng Yongze, Lin Ziling 2019, 23 (36):  5794-5799.  doi: 10.3969/j.issn.2095-4344.1896 Abstract ( 476 )   PDF (26067KB) ( 98 )   Save BACKGROUND: Spiral blade cut-out is the main failure in proximal femoral nail anti-rotation. Generally, it is based on Von Mises stress to evaluate the fixation failure risk and the primary zone in finite element analysis with a disadvantage that cannot directly demonstrate the development of failure. Element erosion method is designed to show the crack propagation in component in engineering which will have an important role in studying internal fixation failure. OBJECTIVE: To simulate biomechanical process of cut-out failure of proximal femoral nail anti-rotation for intertrochanteric fracture.   METHODS: CT data of femur from a healthy volunteer were collected and imported to Mimics 19.0 software. After region growing, editing, smoothing and wrapping, a three-dimensional finite element model of proximal femur was created and polished in Geomagic Studio. Proximal femoral nail anti-rotation model was created in SolidWorks based on the specification and matched with the polished femoral according to the surgical protocol. Component including proximal femoral nail anti-rotation and femur was imported in Hypermesh for tetrahedron meshing and fracture constructing as AO31-A2.1. After setting material content and friction coefficient, K file was finally solved in LS-DYNA. RESULTS AND CONCLUSION: (1) Femoral neck fragment slid to shaft and lesser trochanter until medial cortical contact, breakdown of cancellous bone surrounding helical blade causing varus and rotational movement of femoral head. The varus was translated faster than rotational movement with a positive support of lesser trochanter, while conversely with a negative support of lesser trochanter. Finally, these led to internal fixation failure. (2) When failure began, stress distributed on the lateral wall and under lesser trochanter, and then stress increased on lesser trochanter and dispersed over intertrochanteric region. (3) Failure strain mainly concentrated on the contact surface between helical blade and lateral wall, femoral neck and lesser trochanter, lesser trochanter and femoral shaft. (4) Femoral neck and lesser trochanter were the unstable part with the most significant displacement, especially on the posterior of femoral head. (5) Results indicate that failure of AO31-A2.1 fracture fixed by proximal femoral nail anti-rotation is compound, including crispation, varus and rotation. Figures and Tables | References | Related Articles | Metrics

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Effect of distal locking system with core drill in the treatment of femoral shaft fracture with intramedullary nail Tao Yong, Jiang Ting, Tian Kechao 2019, 23 (36):  5800-5805.  doi: 10.3969/j.issn.2095-4344.1436 Abstract ( 486 )   PDF (22493KB) ( 73 )   Save BACKGROUND: Accurate and rapid insertion of distal locking nail of femoral intramedullary nail is still a difficult problem. The distal locking accuracy of common intramedullary nail is low, with long time-consuming and intensive radiation. OBJECTIVE: To investigate the characteristics and efficacy of intramedullary nailing with core drill distal locking system in the treatment of adult femoral shaft fractures.    METHODS: From January 2014 to December 2016, patients with femoral shaft fracture undergoing treatment of supine position with anterograde intramedullary nail in the Third Affiliated Hospital of Anhui Medical University were retrospectively analyzed. They were treated with core drill distal locking system intramedullary nail (n=21; observation group) and common intramedullary nail (n=17; control group). Both groups of patients signed informed consent to the treatment and trial plan. This study was approved by the Hospital Ethics Committee. The clinical effects of the two groups were compared.   RESULTS AND CONCLUSION: (1) Compared to the control group, the operation time was shorter [(191.76±25.04) minutes vs. (156.90± 23.36) minutes]; the distal locking operation time was shorter [(1 223.47±165.92) seconds vs. (497.19±82.78) seconds]; the fluoroscopy times were less [(22.18±3.05) times vs. (12.81±2.64) times]; the blood loss was less [(371.18±129.42) mL vs. (192.86±83.13) mL]; location accuracy rate of distal locking nail was high [79.41% vs. 95.24%] in the observation group, showing significant differences (P < 0.05). (2) The healing time of fracture was similar and the functional recovery of hip and knee joint was similar between the two groups (P > 0.05). (3) All cases were followed up for 14 to 27 months. No fracture of internal fixator occurred. All patients achieved bone healing. (4) In the observation group, one case had superficial infection, which healed well after strengthening dressing change and anti-infection treatment. In the control group, one case had superficial infection, and the fracture healed well after strengthening dressing change and anti-infection treatment. One case of distal screw loosening was not treated specially, and the healing was achieved by prolonging the loading time and follow-up time. (5) It is indicated that core drill distal locking intramedullary nail for femoral shaft fracture has shorter locking operation time, higher accuracy, fewer fluoroscopy times, less blood loss during operation. The clinical effect is satisfactory. Figures and Tables | References | Related Articles | Metrics

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Biomechanical analysis of three kinds of implants fixation for split type greater tuberosity fracture of humerus Zhang Degang, Sun Jianyun, Wang Zhaolin, Liu Dong, Zhang Xinjun 2019, 23 (36):  5806-5810.  doi: 10.3969/j.issn.2095-4344.1993 Abstract ( 429 )   PDF (16796KB) ( 146 )   Save BACKGROUND: Split fracture of greater tubercle of humerus is usually fixed with screw and tension band. The pull of supraspinatus muscle and infraspinatus muscle on the greater tubercle can easily cause the fracture to move upward and backward, resulting in reduction loss, acromial impingement and external rotation disorder. These two kinds of fixation strength are limited, which is not conducive to early functional exercise of patients, and shoulder joint dysfunction is prone to occur after operation. OBJECTIVE: To determine the strongest internal fixation method for split type greater tuberosity fracture of humerus by hook plate, screw and tension band technique using biomechanical test. METHODS: A new split type greater tuberosity fracture model was established with 30 fresh pig humerus with supraspinatus muscle (purchased from local abattoir). The models were divided into three groups (n=10 per group). The fracture of the greater tuberosity was fixed by hook plate, screw and tension band technique. The supraspinatus muscle was pulled. The loads required to produce 3 mm and 5 mm of displacement, as well as complete failure were recorded in the three groups. RESULTS AND CONCLUSION: (1) The load required to produce 3 mm and 5 mm displacement was (510±114) N and (932±159) N in the hook plate group, (170±57) N and (284±82) N in the screw group, (98±48) N and (158±72) N in the tension band group. Under the same displacement, the force required by hook plate group was greater than that of screw group and tension band group (P < 0.05). (2) The average failure load of hook plate group was significantly higher than that of screw group and tension band group [(1 050±286), (470±108), (285±89) N, P < 0.05]. (3) The results have demonstrated that the hook plate has better biomechanical stability than screw and tension band fixation for split type greater tuberosity fracture, which provides a better choice for clinical treatment of split type greater tuberosity fracture. Figures and Tables | References | Related Articles | Metrics

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Comparison of limited fusion and full curve fusion for mild lumbar degenerative scoliosis with stenosis He Da, Zhao Jingwei, Liu Bo, Tian Wei 2019, 23 (36):  5811-5817.  doi: 10.3969/j.issn.2095-4344.1897 Abstract ( 332 )   PDF (28597KB) ( 71 )   Save BACKGROUND: Lumbar mild degenerative scoliosis with stenosis is a common disease; however, there is still controversy regarding to the surgical fixation range. OBJECTIVE: To comparatively analyze the imaging and clinical effects of full curve fusion and limited fusion in patients with lumbar spinal stenosis accompanied by degenerative scoliosis. METHODS: The historical cohort study consisted of 94 patients. Inclusion criteria were: degenerative scoliosis with Cobb’s angle over 10 degrees and not above 30 degrees. The main symptoms included low back pain, weakness of lower limbs or claudication. According to the length of fixed segments, they were divided into two groups: full curve fusion group (46 cases) and limited fusion group (48 cases). All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Visual Analog Score of pain, Oswestry Disability Index, Roland Morris Scores and Japanese Orthopaedic Association Scores were assessed. Patient data including age, operation time, blood loss, length of instrumented segments, and Cobb angle were also analyzed. RESULTS AND CONCLUSION: (1) The full curve fusion group had 1 more vertebra instrumented than the limited fusion group (P < 0.01). Although the operation time and bleeding volume of the full curve fusion group were greater than those of the limited fusion group, there was no significant difference (P > 0.05). (2) There was no significant difference in Cobb angle in the limited fusion group before and after operation (t=0.885, P=0.388). Cobb angle in the full curve fusion group was corrected from preoperatively (16.5±4.7) degrees to the final follow-up (9.2±6.2) degrees (t=7.095, P < 0.001). (3) Visual Analog Score of pain, Oswestry Disability Index, Roland Morris Scores and Japanese Orthopaedic Association Scores were significantly improved postoperatively compared with those preoperatively in both full curve fusion and limited fusion groups (all P ≤ 0.005). These indicated that the quality of life of patients after operation was significantly improved regardless of the type of surgery. There was no significant difference between the two groups (P > 0.05). In addition, the analysis of items of Oswestry Disability Index and Japanese Orthopaedic Association Scores found that compared with the limited fusion group, the walking ability was improved in the limited fusion group (P < 0.05). (4) Overall, the patients in the full curve fusion group had higher satisfaction at the final follow-up, but there was no significant difference in the problems between the two groups (P > 0.05). (5) It is suggested that there is no significant difference in the function and satisfaction of patients with lumbar spinal stenosis with mild degenerative scoliosis after full curve fusion and limited fusion, and the efficacy was comparable. Figures and Tables | References | Related Articles | Metrics

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Minimally invasive transforaminal lumbar interbody fusion through Quadrant channel for treatment of lumbar degenerative diseases Huang Qun, Sheng Xiaolei, Yan Fei, Zhou Zhiping, Zhu Xianwei 2019, 23 (36):  5818-5823.  doi: 10.3969/j.issn.2095-4344.1935 Abstract ( 380 )   PDF (24239KB) ( 73 )   Save BACKGROUND: Traditional transforaminal lumbar interbody fusion (TLIF) surgery for lumbar degenerative diseases is effective, but it will lead to adverse intraoperative hemorrhage and slow postoperative recovery because of severe trauma. With the continuous development of minimally invasive techniques in spinal surgery, minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) through the Quadrant channel is gradually applied in the treatment of lumbar degenerative diseases. OBJECTIVE: To compare the clinical efficacy of MIS-TLIF versus traditional TLIF in the treatment of lumbar degenerative diseases． METHODS: A total of 54 patients with the lumbar degenerative diseases who received treatment from January 2015 to July 2016 in Zhangjiagang First People’s Hospital, Soochow University were retrospectively analyzed. These patients were randomly assigned to receive MIS-TLIF through the Quadrant channel (n=24) or traditional TLIF (n=30). All patients provided written informed consent and the study was approved by Medical Ethics Committee of Zhangjiagang First People’s Hospital. The length of surgical incision, operation time, intraoperative blood loss, and postoperative drainage volume were compared between these two groups. In addition, prior to surgery, and 3 days, 3, 6, 12 months after surgery, Visual Analogue Scale score with 0 indicating no pain and 10 representing most severe pain was recorded. Oswestry disability index was recorded prior to surgery and 3, 6, and 12 months after surgery. RESULTS AND CONCLUSION: (1) All 54 patients successfully completed the surgery. (2) Intraoperative blood loss, length of incision, postoperative drainage volume were significantly lower in the MIS-TLIF group than in the traditional TLIF group (P < 0.05); but the operation time was longer (P < 0.05). (3) There were no significant differences in Visual Analogue Scale score and Oswestry disability index pre-surgery between MIS-TLIF and traditional TLIF groups (P > 0.05). At 3 days and 3 months after surgery, Visual Analogue Scale score in the MIS-TLIF group was significantly lower than that in the traditional TLIF group (P < 0.05). However, no significant difference in Visual Analogue Scale score was observed between these two groups at 6 months and 1 year after surgery (P > 0.05). At 3 months after surgery, Oswestry disability index in the MIS-TLIF group was significantly lower than that in the traditional TLIF group (P < 0.05). However, there was no significant difference in Oswestry disability index between these two groups at 6 months and 1 year after surgery (P > 0.05). (4) Postoperative imaging follow-up showed satisfactory surgical results and good interbody fusion. (5) These results suggest that MIS-TLIF through Quadrant channel is a minimally invasive operation for the treatment of lumbar degenerative diseases, and has the advantages of less intraoperative blood loss, less trauma and early postoperative rehabilitation compared with the traditional TLIF. Figures and Tables | References | Related Articles | Metrics

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Digital design of personalized scoliosis orthopedic braces based on 3D printing technology Zhang Yufang, Guan Tianmin, Guo Qiaoge, Zhang Yufen, Guo Yanli 2019, 23 (36):  5824-5829.  doi: 10.3969/j.issn.2095-4344.1994 Abstract ( 905 )   PDF (23329KB) ( 154 )   Save BACKGROUND: The design and manufacture of traditional spinal brace have the disadvantages of poor fit and long processing cycle. The use of computer-aided design and 3D printing of the spinal brace has the advantages of individualization, accurate correction position and short design time. OBJECTIVE: This study combines computer aided engineering, biomechanical analysis and fused deposition modeling technology to propose a feasible scheme of 3D printing for spine brace. METHODS: A finite element model of an adolescent idiopathic scoliosis patient based on human anatomy was constructed in volunteers with idiopathic scoliosis. Based on patient profile information and three-point stress principle, brace model was parameterized and its biomechanical properties were analyzed. The patient signed the informed consent. This study was approved by the Hospital Ethics Committee. The brace was optimized by finite element analysis to obtain the optimal brace model. The brace model was printed by 3D printing technology. Finally, the wearing evaluation of patients was carried out. RESULTS AND CONCLUSION: (1) The biomechanical properties of wearing brace were analyzed by finite element method to predict its corrective effect. Ten groups of different sizes of tightening force were applied to the position of thoracic and lumbar scoliosis. The maximum correction rates of thoracic and lumbar scoliosis were 78% and 82%, respectively. (2) Topology optimization analysis of brace was carried out by setting 10 groups of optimization parameters. According to the results, the brace was reduced properly, and then the model was transferred to a 3D printer to print the brace quickly. (3) The patient wore brace and gave feedback. According to the feedback of evaluation, the spine brace designed digitally is more suitable for patients and has higher correction rate. (4) The scheme of making spine brace by using 3D printing is feasible, and it can provide reference for the follow-up application of 3D printing brace in clinical rehabilitation. Figures and Tables | References | Related Articles | Metrics

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Biomechanical advantage of Waveflex semi-rigid internal fixation for lumbar disc herniation Gan Donghao, Qiao Quanlai, Chen Deqiang, Tan Guoqing, Xue Haipeng, Xu Zhanwang 2019, 23 (36):  5830-5835.  doi: 10.3969/j.issn.2095-4344.1959 Abstract ( 341 )   PDF (25984KB) ( 81 )   Save BACKGROUND: Lumbar dynamic fixation is mostly studied in early clinical studies, but there are few studies on the efficacy and mechanical mechanism of mid-stage fixation. OBJECTIVE: To evaluate the clinical efficacy of Waveflex internal fixation system and analyze its biomechanical advantages, so as to lay a foundation for clinical application and theory research of dynamic fixation. METHODS: Retrospective analysis was performed in patients who underwent nucleus pulposus excision and semi-rigid internal fixation in the Department of Orthopedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine from September 2015 to October 2018. All patients signed informed consent. This study was approved by the Ethics Committee of Affiliated Hospital of Shandong University of Traditional Chinese Medicine, China. The corresponding subjective function and objective imaging indexes of the patients in this group before, after and at the last follow-up were statistically analyzed to evaluate the clinical efficacy of implantation of semi-rigid internal fixation. The complete and implanted semi-rigid internal fixation model of the lumbar spine was constructed and finite element analysis was performed to evaluate the biomechanical properties of the Waveflex semi-rigid internal fixation model. The safety and effectiveness were verified by clinical statistical observation. RESULTS AND CONCLUSION: (1) Waveflex semi-rigid fixation can effectively improve the symptoms of patients, maintain lumbar stability and mobility, and the clinical effect is positive. (2) The system can construct the ladder stress distribution, effectively reduce the stress of the surgical segment, and delay lumbar degeneration. (3) In general, the Waveflex semi-rigid internal fixation can maintain the stability of the fixed segment and has a certain range of motion, which can effectively slow down the degeneration of the fixed segment. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional visualization and quantitative analysis of microvessels in rat cervical spinal cord using barium sulfate perfusion combined with micro-CT scanning Liu Yapu, Lin Junyu, Yang Zhou, Wu Xiuhua, Wu Xiaoliang, Zhu Qing’an 2019, 23 (36):  5836-5840.  doi: 10.3969/j.issn.2095-4344.1999 Abstract ( 391 )   PDF (22231KB) ( 98 )   Save BACKGROUND: Vascular structure is an important basis for maintaining cervical spinal cord function. To evaluate the involvement of microvessels in cervical spinal cord injury and treatment, it is necessary to carry out a good three-dimensional visualization and accurate quantitative analysis of the normal cervical spinal cord microvascular structure, but there are few reports about it. OBJECTIVE: To investigate the three-dimensional visualization and quantitative analysis of normal cervical spinal cord microvascular structure in rats by barium sulfate perfusion combined with micro-CT scanning, and to lay a foundation for the later evaluation of the involvement degree of microvessels in cervical spinal cord injury and the measurement of therapeutic effect. METHODS: Five adult male SD rats weighing 280-320 g were included. All animal operation procedures were implemented in accordance with the relevant national guidelines for the use of laboratory animals, and were approved by the Animal Use Ethics Committee of Southern Medical University. After rats were deeply anesthetized, vascularization was performed with warm heparin normal saline, polyformaldehyde and barium sulfate perfusion through cardiac puncture. Cervical spinal cord tissue was taken and placed in micro-CT for scanning and three-dimensional reconstruction. Quantitative analysis of the ratio of microvascular volume to tissue volume, ratio of vascular surface area to tissue volume, number of blood vessels, diameter of blood vessels, separation degree of blood vessels, connectivity density, structural model index and the number, percentage and volume of microvessels with different diameters were quantitatively analyzed. RESULTS AND CONCLUSION: (1) After three-dimensional reconstruction and visualization, the microvascular structure in the cervical spinal cord was clearly visible, showing the anterior and posterior arteries of the cervical spinal cord as well as several branch arteries. (2) Quantitative analysis results of microvascular index showed that ratio of microvascular volume to tissue volume was 0.022±0.002; ratio of vascular surface area to tissue volume was (52.370±6.271) mm-1; number of blood vessels was (0.604±0.076) mm-1; diameter of blood vessels was (0.040±0.005) μm; separation degree of blood vessels was (1.762±0.255) μm; connectivity density was (2.661±0.757) mm-3; structural model index was (4.400±0.129). The number, percentage and volume of microvessels in cervical spinal cord with different diameters were quantified successfully. (3) Barium sulfate perfusion combined with micro-CT scanning can achieve three-dimensional visualization and accurate quantitative analysis of normal cervical spinal cord microvascular structure in rats, laying a good foundation for the later evaluation of the involvement of microvessels during cervical spinal cord injury and the measurement of therapeutic effect. Figures and Tables | References | Related Articles | Metrics

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Stress characteristics after fixation in herringbone position in children with developmental dislocation of the hip by finite element analysis Cai Zhencun, Piao Chengzhe, Zhou Hongyu, Sun Ming, Gao Zhenhuai 2019, 23 (36):  5841-5845.  doi: 10.3969/j.issn.2095-4344.1909 Abstract ( 362 )   PDF (20459KB) ( 93 )   Save BACKGROUND: The fixed position after reduction of the children developmental dislocation of the hip remains controversial. Large abduction angle of the hip joint has been shown to contribute to the joint stability after reduction, but larger abduction angle will cause abnormal biomechanics, and high pressure in the acetabulum, thus further inducing femoral head necrosis. Herringbone position is commonly used in clinical practice, but its biomechanical properties are unclear. OBJECTIVE: To investigate the stress distribution of the hip joint after fixation in herringbone position in children developmental dislocation of the hip by finite element analysis, and to explore the optimal position in clinic. METHODS: The CT data of pelvis and proximal femur were collected from a patient with unilateral developmental dislocation of the hip at the Central Hospital of Shenyang Medical College, and imported into Mimics 15.0 software to reconstruct the three-dimensional finite element model of bilateral hip joints after region growing, editing, smoothing and wrapping. Meshing, material property definition, boundary setting and loading were conducted on Hypermesh 12.0 software to simulate hip joint fixed in herringbone position and calculate the stress distribution. The Von Mises stress distribution and mechanical displacement nephograms of pelvis, acetabulum and proximal femur were obtained, the mechanical properties were evaluated. The average contact pressure between femoral head and acetabulum, maximal contact pressure, and contact area were calculated. RESULTS AND CONCLUSION: (1) After fixed in the herringbone position, the average contact pressure between femoral head and acetabulum, maximal contact pressure, and maximal Von Misas value of the femoral head at the affected side were higher than those at the unaffected side, and the contact area at the affected sided was lower than that at the unaffected side. The contact area, maximal contact pressure, and maximal Von Misas value of the femoral head showed significant differences (P < 0.05). (2) To conclude, for children with developmental dislocation of the hip, abnormal biomechanical distribution occurs on the affected hip joint after fixed in the herringbone position, and high pressure between femoral head and acetabulum is easy to induce femoral head necrosis. This trial was approved by the Medical Ethics Committee, the Central Hospital of Shenyang Medical College in 2018 (approval No. 20180987). Figures and Tables | References | Related Articles | Metrics

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Effects of different body positions and traction weights on hip bursa pressure after femoral neck fracture Liu Dahai, Li Haibo, Gou Yongsheng, Li Liang 2019, 23 (36):  5846-5849.  doi: 10.3969/j.issn.2095-4344.1898 Abstract ( 393 )   PDF (14730KB) ( 74 )   Save BACKGROUND: In the cases of femoral neck fracture, the surgical reduction and fixation of femoral neck fracture have been well achieved, but there are still many patients with femoral head necrosis, which may be related to the influence of hip bursa pressure on femoral head blood supply. OBJECTIVE: To investigate the effect of different treatment methods on internal pressure of hip joint capsule after femoral neck fracture. METHODS: From January 2013 to December 2017, 120 cases diagnosed as simple femoral neck fracture and Garden type I-IV were collected in the Department of Orthopedics, the First People’s Hospital of Chengdu Shuangliu District. The intrathecal pressure of hip joint was measured in different positions of lower limbs (neutral position, internal rotation 30°, external rotation 30°, external rotation 50°, external extension 30°, and neutral position traction of 3-6 kg). This study was approved by the Medical Ethics Committee, the First People’s Hospital of Chengdu Shuangliu District on January 11, 2013. RESULTS AND CONCLUSION: In different positions of affected limb, the intracapsular pressure of hip joint was the smallest when the external rotation was 30°, and the maximum when the internal rotation was 30°. Among the different types of femoral neck fractures, the internal pressure of hip bursa of Garden type III and IV was significantly higher than that of Garden type I-II. With the increase of traction weight, the pressure in hip capsule increased gradually. It is suggested that placing the affected limb in external rotation of 30° without traction after femoral neck fracture can significantly reduce the internal pressure of hip joint capsule. Figures and Tables | References | Related Articles | Metrics

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Bilateral pedicle screw fixation combined with interbody fusion for lumbar disc herniation: objective evaluation of CT imaging Zheng Songwen, Meng Yi, Long Yuhan, Xu Zhe, Zhang Yonghua 2019, 23 (36):  5850-5855.  doi: 10.3969/j.issn.2095-4344.1944 Abstract ( 426 )   PDF (27342KB) ( 91 )   Save BACKGROUND: For patients with significant lumbar instability, surgical resection of the herniated intervertebral disc and enlargement of the narrowed nerve root canal are needed to relieve the compression of the lumbar nerve root. Simultaneously, internal fixation and bone graft fusion are needed to restore the stability of the spine when resecting the herniated intervertebral disc and enlarging the nerve root canal so as to relieve the symptoms of lumbar and leg pain caused by compression of lumbar nerve root caused by instability factors. Some studies believe that CT examination can accurately reflect whether the intervertebral disc protrusion occurs, and clearly show the shape, size and location of the intervertebral disc protrusion. OBJECTIVE: CT imaging was used to evaluate clinical efficacy of bilateral pedicle screw fixation combined with interbody fusion for lumbar disc herniation. METHODS: Data of 80 cases of lumbar disc herniation treated in Dalian Municipal Central Hospital from August 2015 to July 2017 were retrospectively analyzed. All patients received bilateral pedicle screw fixation combined with interbody fusion. This study was approved by the Ethics Committee of Dalian Central Hospital on June 30, 2018. RESULTS AND CONCLUSION: (1) The operation was successfully performed in all patients. All patients were followed up. (2) The Visual Analogue Scale scores of low back and leg pain at 1, 3 months and final follow-up were significantly lower than those before operation (P < 0.05). (3) With the prolongation of time, the excellent and good rate of MacNab treatment in patients with lumbar disc herniation gradually increased (P < 0.05). (4) The ventral height of the intervertebral disc, the dorsal height of the intervertebral disc, the maximum height of the intervertebral foramen and the apex of the spinous process were significantly higher after treatment than that before treatment (P < 0.05). Imaging displayed that after treatment, the lumbar vertebral angle gradually recovered, and the intervertebral space height recovered. CT examination showed that the pedicle screw fixation was good, no breakage or loosening. Before and after treatment, there was a negative correlation of the ventral height of intervertebral disc, the dorsal height of intervertebral disc, the maximum height of intervertebral foramen, the distance between the apex of spinous process with Visual Analogue Scale score of low back pain and Visual Analogue Scale score of leg pain (P < 0.05). (5) Bilateral pedicle screw placement combined with vertebral fusion for the treatment of lumbar disc herniation has a significant clinical effect. CT imaging can be used not only to assess the condition but also to assess the ventral height of the intervertebral disc, the dorsal height of the intervertebral disc, the maximum height of the intervertebral foramen and the apex of the spinous process, the angle recovery of the lumbar spine, the location of the screw placement, and to identify whether the screw loosened or ruptured, and to evaluate the clinical efficacy. Figures and Tables | References | Related Articles | Metrics

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Radiological analysis of oropharyngeal airway space after posterior internal fixation for the atlantoaxial dislocation Chen Xingjie, Yi Honglei, Chen Xuqiong, Wu Zenghui, Ma Xiangyang, Ai Fuzhi, Wang Jianhua, Zhang Kai, Xia Hong 2019, 23 (36):  5856-5860.  doi: 10.3969/j.issn.2095-4344.1450 Abstract ( 346 )   PDF (21545KB) ( 68 )   Save BACKGROUND: The posterior atlantoaxial internal fixation may also cause dysphagia, dyspnea and even airway obstruction, but there is no clear factor affecting the stenosis of oropharyngeal airway. OBJECTIVE: To investigate the effect of posterior internal fixation surgery for atlantoaxial dislocation on the oropharyngeal airway space. METHODS: Forty patients with atlantoaxial dislocation under posterior internal fixation surgery were retrospectively included. All patients signed informed consent. This study was approved by the Hospital Ethics Committee. The narrowest oropharyngeal airway space, atlantodental interval, occipito-C2 angle, prevertebral soft tissue thickness and C2–C6 angle were measured in lateral cervical plain radiographs of neutral position before and after operation. The changes of postoperative data and their effects on the narrowest oropharyngeal airway space were analyzed. RESULTS AND CONCLUSION: (1) Except C2–C6 angle and prevertebral soft tissue thickness, other data were significantly different after operation compared with those before operation (P < 0.01). Among them, the narrowest oropharyngeal airway space and atlantodental interval were reduced; and occipito-C2 angle was increased. (2) The atlantodental interval (β=0.524) and occipito-C2 angle (β=0.477) had the greatest effect on the narrowest oropharyngeal airway space. (3) Results suggested that posterior reduction and internal fixation of atlantoaxial dislocation patients may lead to oropharyngeal airway stenosis. Especially for patients with obvious atlantoaxial dislocation before operation, intensive monitoring is needed to prevent dyspnea and dysphagia. Figures and Tables | References | Related Articles | Metrics

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Rotational positioning of femoral prosthesis in total knee arthroplasty Zeng Feng, Li Shuzhen 2019, 23 (36):  5861-5867.  doi: 10.3969/j.issn.2095-4344.1978 Abstract ( 299 )   PDF (43437KB) ( 83 )   Save BACKGROUND: Femoral prosthesis placement with correct osteotomy in total knee arthroplasty is crucial to the success of the operation. OBJECTIVE: To review the research progress of femur plus other in total knee arthroplasty by referring to relevant papers for summary. METHODS: We retrieved the relevant literatures from CNKI, WanFang and PubMed databases. The keywords were “knee; arthroplasty; femoral prosthesis; rotational alignment; measuring resection; gap balance; computer aided navigation; 3D printing; robotics” in Chinese and English, respectively. Retrieval time was from January 1976 to January 2019. The types of articles included clinical research, basic research, review, and experience exchange. RESULTS AND CONCLUSION: The rotation of the femoral prosthesis positioning in total knee arthroplasty can be measured by method of bone cutting and gap balance method, but computer aided navigation technology, 3D printing technology and robotics due to a variety of factors in clinic cannot be used widely. It is still based on traditional bone cutting method until now. With the development of science and technology and the introduction of concept of minimally invasive, it is believed that in the near future, computer aided navigation technology, 3D printing technology and robot technology will be widely used in clinic, thereby speeding up the development of total knee arthroplasty, and improving clinical efficacy after arthroplasty. Figures and Tables | References | Related Articles | Metrics

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Application and significance of joint puncture in the diagnosis and treatment of periprosthetic joint infection Li Cheng, Andrej Trampuz 2019, 23 (36):  5868-5874.  doi: 10.3969/j.issn.2095-4344.1945 Abstract ( 396 )   PDF (42181KB) ( 60 )   Save BACKGROUND: The diagnosis of periprosthetic joint infection is one of the difficulties and key points in clinical research. Joint puncture is a commonly used method in the preoperative diagnosis of periprosthetic joint infection, because it is simple and easy to spread. In recent years, synovial fluid examinations have been gradually used in clinical diagnosis, but there remain many disputed issues. OBJECTIVE: To summarize latest research progress of synovial fluid analysis in the diagnosis of periprosthetic joint infection in and outside China. METHODS: Publications in English and Chinese from 2008 to 2018 were searched by the first author for studies regarding joint puncture in the diagnosis of periprosthetic joint infection from the electronic databases of PubMed, Web of Science, and CNKI using the following keywords: periprosthetic joint infection, prosthetic joint infection, synovial fluid, joint puncture, and articular puncture. Five hundred and eighty-four articles were identified by the literature search. By reading the literature title, abstract and full text, 52 studies were included in our review paper. RESULTS AND CONCLUSION: (1) Preoperative joint puncture is an indispensable part of the diagnosis of periprosthetic joint infection. (2) Until now, there is no single test that can diagnose periprosthetic joint infection alone; however, combining several examination methods can improve diagnostic accuracy. (3) Joint puncture under ultrasonic guidance has several advantages over fluoroscopy and standard methods. (4)  Although several new methods have certain advantages in the diagnosis of periprosthetic joint infection, conventional testing of blood culture bottles and leukocyte counts still have an irreplaceable role in the diagnosis of periprosthetic joint infection.   Figures and Tables | References | Related Articles | Metrics

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Treatment strategies for spinal metastases: advantages of 3D printing and precise treatment Cui Jiaming, Yang Dazhi 2019, 23 (36):  5875-5881.  doi: 10.3969/j.issn.2095-4344.1977 Abstract ( 336 )   PDF (40253KB) ( 63 )   Save BACKGROUND: The life expectancy of patients with spinal metastases is relatively limited. Currently, there is no standard for decision-making on the treatment of spinal metastases. OBJECTIVE: To review the latest advances in the diagnosis, assessment and treatment of spinal metastases. METHODS: From January 2010 to December 2018, related literatures on the treatment of spinal metastases and spinal metastases were searched by computer in PubMed, China National Knowledge Infrastructure and WanFang databases. The search keywords of Chinese were “spinal metastases, disease assessment, treatment” and English search keywords “spinal metastases, prognosis, treatment”. RESULTS AND CONCLUSION: (1) A total of 61 eligible literatures were included. (2) Due to the limited life expectancy of patients with spinal metastases and the hidden onset of the disease, the source, malignancy and clinical manifestations of the tumors are diverse; accurate assessment and reasonable treatment strategies are important for good prognosis. (3) Traditional open surgery has a tendency to combine minimally invasive surgery with post-operative adjuvant therapy because of its large trauma, high intraoperative bleeding and high incidence of post-operative complications. (4) With the development of computer science and biomaterials, the latest 3D printing technology has been applied in the treatment of spinal metastases and gradually developed. Accurate resection of spinal metastases has become a new trend of surgery. (5) Of course, the control of primary tumors and the treatment of systemic conditions are still the cornerstone of the treatment of spinal metastases. Multidisciplinary is the necessary to achieve the best therapeutic effect. Figures and Tables | References | Related Articles | Metrics

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Role of microphthalmia-associated transcription factor and its signaling pathway in the differentiation of osteoclasts Ji Qiushi, Dong Ming, Xu Nuo, Jiang Long, Niu Weidong 2019, 23 (36):  5882-5888.  doi: 10.3969/j.issn.2095-4344.1264 Abstract ( 381 )   PDF (43641KB) ( 56 )   Save BACKGROUND: Microphthalmia-associated transcription factor (MITF) is found to encode a member of a well-known family of transcription factors, but its analysis may still be in its infancy. MITF is essential for the physiology and pathology of different organs, including eyes, ears, immune system, melanoma, especially bone and skin. OBJECTIVE: To introduce the discovery of the MITF locus and clone, MITF up-regulating expression of genes involved in osteoclast activity and regulating the development of osteoclasts by cell fusion, knock out MITF to inhibit osteoclast differentiation, and the role of MITF and its signaling pathway in the differentiation of osteoclasts. METHODS: The keywords of “MITF, bone destruction, osteoclast, osteoblast, microphthalmia-associated transcription factor, cathepsin K, nuclear factor-κB, receptor activator for nuclear factor-κB ligand” in Chinese and English, respectively, were used to retrieve relevant literature from CNKI and PubMed databases from 2000 to 2018. The literature was screened and analyzed. RESULTS AND CONCLUSION: Forty-three eligible articles were enrolled. (1) MITF is essential for the differentiation of multiple cell lines, and its specificity is obtained by interaction with lineage-specific cofactors and their response to specific signal cascades. (2) MITF plays an important role in the differentiation of osteoclasts, and it can promote bone destruction. (3) Studying the mechanism of action of MITF in bone destruction and changes in bone microenvironment can be a key target for the treatment of this series of bone destruction diseases. Figures and Tables | Related Articles | Metrics

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Clinical efficacy of unicompartmental knee arthroplasty between robotic-assisted and conventional manual methods: a meta-analysis Gao Yangyang, Che Xianda, Han Pengfei, Liang Bin, Li Pengcui 2019, 23 (36):  5889-5895.  doi: 10.3969/j.issn.2095-4344.1899 Abstract ( 321 )   PDF (21807KB) ( 57 )   Save BACKGROUND: In the past, the main end-stage treatment of osteoarthritis was joint replacement surgery. In recent years, with the prevalence of the concept of knee-protection and the continuous development of internal fixation materials and surgical techniques, unicompartmental replacement, a minimally invasive technique, has been widely used in the treatment of patients with single-chamber osteoarthritis. OBJECTIVE: To compare the efficacy of unicompartmental knee arthroplasty in osteoarthritis patients using robotic-assisted or traditional manual methods by meta-analysis systematically. METHODS: We searched for clinical control studies published from 1999 to March 2019. The retrieved databases included Embase, PubMed, Central, Cinahl, PQDT, CNKI, CQVIP, Wanfang, Cochrane Library, CBM and other databases. Five outcomes including tibial component implantation accuracy, femoral component implantation accuracy, tibiofemoral component safety zone, operation time and complications were selected to compare the efficacy differences between robotic-assisted techniques and traditional manual methods systematically. RESULTS AND CONCLUSION: (1) According to the above retrieval strategies, eight foreign literatures were included. (2) By comparison, we found that the robotic-assisted unicompartmental knee arthroplasty was superior to manual methods in the accuracy of tibial component placement [95%CI (-2.13, -0.63), P=0.000 3], femoral component placement [95%CI (-2.49, -0.32), P=0.01] and the tibiofemoral component safety zone [95%CI (1.05, 17.57), P=0.04] with significant statistical difference. (3) Although robotic assistant technology took longer operation time [95%CI (12.58, 42.33), P=0.000 3], it did not increase the incidence of complications [95%CI (0.75, 3.71), P=0.21]. (4) In unicompartmental replacement surgery, robotic assistant technology has higher accuracy and does not increase the incidence of complications. It is a more ideal surgical method than traditional manipulation. These conclusions need to be validated by a larger sample and a higher quality randomized controlled study. Figures and Tables | References | Related Articles | Metrics

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Multiloc intramedullary nail versus PHILOS locking plate in the treatment of proximal humerus fracture: a meta-analysis Fang Zhirong, Jiang Tao, Hong Weiwu, Huang Yongquan, Peng Jiajie, Liu Zitao, Zhou Lin, Liang Yihao, Su Haitao 2019, 23 (36):  5896-5904.  doi: 10.3969/j.issn.2095-4344.1961 Abstract ( 410 )   PDF (27791KB) ( 97 )   Save BACKGROUND: Proximal humerus fracture is the third major fracture type after hip fracture and distal radius fracture in the elderly. The treatment of proximal humeral fractures is diverse. The latest research in recent years has found that the third-generation multi-dimensional locking humeral intramedullary nail system has shown good clinical results in the treatment of proximal humeral fractures, but the current optimal treatment for proximal humeral fractures remains controversial. OBJECTIVE: To systematically evaluate the clinical efficacy of Multiloc intramedullary nail versus PHILOS locking plate in the treatment of proximal humeral fractures. METHODS: The electronic databases of CNKI, Wanfang, VIP, PubMed, Embase, and the Cochrane library, which last updated in February, 2019, were searched for clinical controlled trials regarding Multiloc intramedullary nail versus PHILOS locking plate in the treatment of proximal humerus fracture. The methodological quality of each publication was critically appraised using the Newcastle-Ottawa Scale appraisal tool and a meta-analysis was performed with the Cochrane Collaboration's Rev Man 5.3 software. RESULTS AND CONCLUSION: (1) Eight studies including 267 patients were analyzed. (2) The results of meta-analysis revealed that Multiloc intramedullary nail group had significantly better outcomes in Constant score (MD=1.98(0.65, 3.31), P=0.004), American Shoulder and Elbow Surgeons shoulder score [MD=3.59(1.61, 5.57), P=0.000 4], external rotation (MD=4.55(2.19, 6.91), P=0.000 2), operation time [MD=-13.11(-25.47, -0.74), P=0.04), healing time [SMD=-0.46(-0.47, -0.18), P=0.001), and blood loss [MD=-66.44(-102.25, -36.62), P < 0.000 1) than the PHILOS plate group. (3) However, there were no significant differences in Visual Analogue Scale scores, anterior flexion and uplifting flexion, and adverse reactions between the Multiloc intramedullary nail and PHILOS plate groups (P > 0.05). (4) Results of meta-analysis showed that compared with PHILOS locking plate, Multiloc intramedullary nail had the advantages of shorter operation time, less bleeding, quicker recovery of shoulder function, and faster healing time, but the incidence of postoperative acromion impingement, screw cut, humeral head necrosis and varus deformity was similar between these two groups. Relatively speaking, Multiloc intramedullary nails have a better clinical outcome than PHILOS locking plate. Figures and Tables | References | Related Articles | Metrics