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    28 January 2020, Volume 24 Issue 3 Previous Issue    Next Issue
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    Artificial femoral head arthroplasty versus proximal femoral nail antirotation for the injured lateral wall intertrochanteric fracture in elderly adults 
    Han Bing, Liu Hongbin, Zhang Chuankai, Sun Yiyan, Feng Hui, Zhao Riguang, Wang Ying
    2020, 24 (3):  329-334.  doi: 10.3969/j.issn.2095-4344.2405
    Abstract ( 420 )   PDF (25446KB) ( 104 )   Save

    BACKGROUND: For the treatment of intertrochanteric fracture in elderly patients, if there is no operative contraindication, surgical treatment is recommended. Operative methods include internal fixation and joint replacement. Surgical techniques are mature, but the choice of surgical methods is controversial.

    OBJECTIVE: To compare the efficacy of artificial femoral head arthroplasty and proximal femoral nail antirotation in elderly patients with injured lateral wall femoral intertrochanteric fracture so as to provide the basis of clinical method selection and to provide the original data for the systematic analysis of large sample.

    METHODS: According to the case criterion, 48 cases of AO classification of type A2.2, A2.3 intertrochanteric fractures were selected in Department of Orthopedics, the 71 Group Army Hospital of Chinese PLA from January 2012 to December 2017. They were divided into femoral head arthroplasty group (n=29) and proximal femoral nail antirotation group (n=19). All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The patients were followed up for 1-3 years. Operation time, bleeding volume, hospitalization expenses, the incidence of complications, and Harris hip score at 1 month and 1 year after the surgery were compared between the two groups.

    RESULTS AND CONCLUSION: (1) After statistical analysis, operation time was significantly shorter in the femoral head arthroplasty group than in the proximal femoral nail antirotation group (P < 0.05). There was no statistically significant in bleeding volume between the two groups (P > 0.05). The cost of hospitalization was significantly more in the femoral head arthroplasty group than in the proximal femoral nail antirotation group (P < 0.05). (2) Harris hip score was significantly better in the femoral head arthroplasty group than in the proximal femoral nail antirotation group at 1 month after operation (P < 0.05). There was no significant difference in Harris hip score between the two groups at 1 year after operation (P > 0.05). (3) There was no significant difference in the incidence of complications between the two groups (P > 0.05). (4) For the patients over 70 years old with intertrochanteric fracture of injured lateral wall, artificial femoral head replacement has the advantages of early getting out of bed, high quality of life and quick recovery of joint function. It is suggested to choose artificial femoral head replacement first.

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    Mid-long-term effect of only placed expandable interbody fusion cage in the treatment of lumbar spinal stenosis with vertebral instability using micro-endoscopic discectomy system
    Zhang Chunlin, Shang Lijie, Yan Xu, Cao Zhengming, Shao Chenglong, Feng Yang
    2020, 24 (3):  335-341.  doi: 10.3969/j.issn.2095-4344.2406
    Abstract ( 366 )   PDF (33723KB) ( 60 )   Save

    BACKGROUND: The incidence of lumbar spinal stenosis with vertebral instability is increasing year by year, which can cause symptoms such as waist and leg pain, lower limbs feeling numbness and intermittent claudication. In recent years, scholars have tried various minimally invasive treatment methods to further reduce the trauma and complications of surgery. The improvement of the clinical effect of minimally invasive surgery for lumbar spinal stenosis with vertebral instability is an important issue to be solved.

    OBJECTIVE: To evaluate the mid-long-term effect of only placed expandable interbody fusion cage in the treatment of lumbar spinal stenosis with vertebral instability using micro-endoscopic discectomy system.

    METHODS: A retrospective, self-control clinical trial was conducted in the First Affiliated Hospital of Zhengzhou University from 2012 to 2014. Totally 35 patients with lumbar spinal stenosis combined with vertebral instability were treated by only placed expandable interbody fusion cage using micro-endoscopic discectomy system. This study was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University.

    RESULTS AND CONCLUSION: (1) All 35 patients were followed-up for 60-85 months, mean (70.17±5.40) months. Among these patients, lumbar interbody fusion in 1 segment, 2 segments and 3 segments was performed in 6, 20 and 9 cases, respectively. A total of 73 intervertebral spaces were fused. (2) The mean operation time was 53.49±9.13 minutes (range, 35-75 minutes). The mean blood loss was 114.86±54.23 mL (range, 50-250 mL). (3) Dural rupture occurred in one case during operation and then hypotensive cranial pressure headache occurred after operation. Headache gradually eased after the patient received rehydration and analgesic treatment for 3 days. Poor incision healing occurred in one case after operation and then healed well after one-week vacuum sealing drainage technique. (4) The Visual Analogue Scale scores, Oswestry Disability Index, and height of intervertebral space were significantly decreased at 1 week, 6 months, 1 year, 2 years after surgery and the final follow-up compared to the preoperative ones. At 6 months after the operation, 31(42.5%) intervertebral spaces reached a strong fusion, 25(34.2%) possible fusion, and 17(23.3%) did not reach fusion. At 1 year after surgery, 51(69.9%) intervertebral spaces achieved a strong fusion and 22(30.1%) achieved possible fusion. At 2 years after surgery, 57(78.1%) intervertebral spaces achieved a strong fusion and 16(21.9%) achieved possible fusion. During final follow-up, 62(84.9%) intervertebral spaces achieved a strong fusion and 11(15.1%) achieved possible fusion. (5) At the last follow-up, cage migration was found in one case. The patient was not treated because of symptomless. (6) Unilateral approach only placed expandable interbody fusion cage by using micro-endoscopic discectomy system is a safe and reliable minimally surgical method, which has a good mid-long-term effect on lumbar spinal stenosis with vertebral instability. 

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    Comparison of the short-segment and long-segment cement-augmented pedicle screw fixation for osteoporotic thoracolumbar fracture: a finite element study
    Luo Peijie, Yuan Kai, Li Daxing, Zhang Shuncong, Guo Huizhi, Tang Yongchao, Zhou Tengpeng, Guo Danqing, Li Yongxian, Mo Guoye
    2020, 24 (3):  342-347.  doi: 10.3969/j.issn.2095-4344.1926
    Abstract ( 387 )   PDF (23373KB) ( 74 )   Save

    BACKGROUND: Pedicle screw fixation combined with cement-augmented is an effective method for the treatment of severe osteoporotic vertebral fractures, but there is no uniform standard. The range of fixed segments is one of the focuses of clinical controversy.

    OBJECTIVE: To establish a three-dimensional finite element model of the short-segment and long-segment cement-augmented pedicle screw fixation for osteoporotic thoracolumbar fracture, and to analyze the biomechanical characteristics of adjacent segment structures, fractured vertebral bodies and internal fixation devices.

    METHODS: The T9-L5 segment of a volunteer without obvious degenerative disease was selected for CT scan. The CT images of Dicom format were obtained, and the engineering software was imported to establish a finite element geometric model to simulate the thoracolumbar fracture and the short-segment and long-segment cement-augmented pedicle screw fixation models. The relevant material parameters were set and the biomechanical characteristics of the two groups were compared and analyzed.

    RESULTS AND CONCLUSION: (1) The stress on the vertebrae was mainly concentrated on the periphery of the vertebral body and the small facet of the attachment. In the four directions flexion, extension, left-sided and right-sided curvature, the maximum stress of the proximal and distal adjacent vertebrae in the long-segment group was greater than that in the short-segment group. The stress of the intervertebral disc was mainly concentrated in the peripheral annulus. The maximum stress of the proximal and distal adjacent intervertebral discs was greater in the short-segment than in the long-segment, but the high stress area of the long-segment was larger than that of the short-segment. Therefore, long-segment fixation might accelerate the degeneration of adjacent segments. (2) The vertebral bodies of the long-segment group and the short-segment group were displaced to different extents, and the displacements in the left and right directions were the most obvious. In the six movement directions, the displacement and maximum stress of the injured segment of the short-segment group were greater than those of the long-segment group. So the long-segment fixation could better maintain the stability of the fractured vertebra. (3) The stress on the internal fixing device was mainly concentrated on the screws at both ends and the part of the rod. The maximum stress of the long-segment group was greater than that of the short-segment group, but the main stress area of the screws at both ends was smaller compared with the short-segment group. 

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    Factors influencing the prognosis of central cord syndrome treated with drug therapy and titanium plate fixation
    Zhang Hui, Xu Nanwei, Nong Luming, Tang Xueming, Zhou Xindie, Jiang Wei
    2020, 24 (3):  348-353.  doi: 10.3969/j.issn.2095-4344.2407
    Abstract ( 539 )   PDF (830KB) ( 55 )   Save

    BACKGROUND: In the treatment of central cord syndrome, it is difficult to predict the degree of nerve recovery because of the different speeds and degrees of nerve recovery. The treatment of central cord syndrome, especially the treatment methods, is still controversial.

    OBJECTIVE: To investigate the factors influencing the prognosis of central cord syndrome treated with drug therapy and titanium plate fixation.

    METHODS: A retrospective analysis of 243 patients with central cord syndrome who were admitted to Changzhou Second People’s Hospital Affiliated to Nanjing Medical University from June 2012 to June 2017 was performed. According to therapeutic schedule, the patients were divided into two groups. In the titanium plate group, 152 cases were treated with titanium plate fixation, and 91 cases in the drug treatment group were treated with drugs. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Neurological function was assessed using American Spinal Injury Association and Japanese Orthopedic Association criteria. American Spinal Injury Association and Japanese Orthopedic Association scores were recorded for all patients within 24 hours of treatment, 6, 12, and 24 months after treatment. The age, treatment, and gender factors were included in the prognostic single factor analysis at 6 and 24 months after treatment of cervical spinal cord syndrome. After that, age, treatment and gender factors were included in the multivariate logistic regression analysis of prognosis at 6 and 24 months after treatment of cervical spinal cord syndrome.

    RESULTS AND CONCLUSION: (1) 243 patients were followed up for at least 24 months and recovered well after treatment. (2) American Spinal Injury Association and Japanese Orthopedic Association scores were lower in the drug treatment group than in the titanium plate group at 6 months after treatment (P=0.001 2, 0.000 0). However, American Spinal Injury Association and Japanese Orthopedic Association scores were higher in the drug treatment group than in the titanium plate group at 24 months after treatment (P=0.037 4, 0.047 8). (3) The prognosis of central cord syndrome after 6 months of treatment was related to the age and treatment of the patients (P=0.007 2, P < 0.000 1). Moreover, drug treatment and age greater than 50 years were associated with poor prognosis in patients with central cord syndrome at 6 months after treatment (P=0.043, P=0.010). (4) The prognosis at the 24-month follow-up of central cord syndrome was correlated with the patient’s treatment (P=0.004 3). Moreover, the drug treatment was associated with prognosis at the 24-month follow-up of central cord syndrome (P=0.021). (5) Results indicated that at the time of titanium plate fixation, the recovery rate was faster in 6 months than that of drug treatment. However, at 24 months follow-up after treatment, the recovery effect of drug treatment was better than that of titanium plate fixation. At 6 months after treatment, the prognosis was related to the treatment mode and age, but at 24 months after treatment, the prognosis was related to the treatment mode.

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    Outcomes of Endobutton and Rigidfix femoral fixation methods with hamstring autograft in anterior cruciate ligament reconstruction 
    Zhao Lilian, Lu Mingfeng, Xing Jisi, He Lilei, Xu Ting, Wang Changbing
    2020, 24 (3):  359-365.  doi: 10.3969/j.issn.2095-4344.2409
    Abstract ( 352 )   PDF (32149KB) ( 47 )   Save

    BACKGROUND: The choice of fixation is an important factor affecting the prognosis of anterior cruciate ligament reconstruction. Endobutton and Rigidfix are two kinds of femoral end suspension fixators which are widely used at present. Their advantages are high fixation strength, large contact area between tendon and bone tunnel, and conducive to tendon-bone healing. However, it is still controversial whether there are differences in clinical efficacy and bone tunnel enlargement between the two fixation methods.

    OBJECTIVE: To analyze the outcomes of two different femoral fixation methods (Endobutton and Rigidfix) with hamstring autograft in anterior cruciate ligament reconstruction.

    METHODS: A retrospective analysis was performed on the data of 270 cases which accepted the anterior cruciate ligament reconstruction and second arthroscopic look from June 2015 to December 2017. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The patients were divided into two groups according to the method of femoral end fixation. The Endobutton femoral fixed reconstruction was performed in Endobutton group (150 cases). The Rigidfix femoral fixed reconstruction was performed in Rigidfix group (120 cases). Reconstruction of anterior cruciate ligament was done using autologous semitendinosus and gracilis tendon. All cases were fixed with Bioabsorbable Interference Screw and AO hollow nail bolt pile fixing screw at the tibial tunnel. The diameter of bone tunnel was also measured by MRI. The knee joint function recovery and stability were evaluated by Lysholm score, International Knee Documentation Committee score, Tenger score table, drawer test, Lachman test, axle shift test, and KT-1000 joint measuring instrument. Second-look arthroscopic evaluation was performed in all patients, focusing on continuity of the reconstructed anterior cruciate ligament, the synovial coverage and the prevalence of abnormal structure at 1 year after surgery. 

    RESULTS AND CONCLUSION: (1) All patients were followed up for 14 to 44 months. (2) Tunnel widening was significantly increased in the Endobutton group than in the Rigidfix group at 1 year after surgery (< 0.05). (3) In both groups after operation, Lysholm scores, Tegner scores, and International Knee Documentation Committee scores had obviously improvement at 1 year after surgery compared with that before surgery (P < 0.05). No significant difference was found between two groups after operation (P > 0.05). (4) At 1 year after surgery, the range of motion of knee joint was not significantly different between the two groups (P > 0.05). (5) There was no significant difference between the two groups in drawer test, Lachman test and axle shift test (P > 0.05). The side-to-side difference of KT-1000 in the Endobutton group was (1.12±1.20) mm, while that of KT-1000 in Rigidfix group was (1.23±0.91) mm. There was no significant difference between the two groups (P > 0.05). (6) Secondary arthroscopic examination showed that there were 1 case of complete graft absorption, 11 cases of graft wear in Endobutton group, 2 cases of complete graft absorption and 15 cases of graft wear in Rigidfix group. There was no significant difference between the two groups (P > 0.05). (7) There were 59 excellent cases, 61 good cases, 30 poor cases in Endobutton group, 47 excellent cases, 49 good cases and 24 poor cases in Rigidfix group. There was no significant difference between the two groups (P > 0.05). (8) The incidence of complication was 2.6% in the Endobutton group and 6.6% in the Rigidfix group, and no significant difference was found between the two groups (P > 0.05). (9) The results suggested that Endobutton and Rigidfix had the same clinical outcome. There was no significant difference in the coverage and continuity of synovial synovial membrane between the second look grafts. However, compared with Rigidfix transverse screw system, Endobutton fixation at the femoral end is more likely to cause bone tunnel enlargement. 

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    Wrist arthroscopy-assisted titanium internal fixator for the treatment of complex distal radius fractures
    Yang Shun, Chen Keyi, Cheng Yabo, Xiang Wang, Zhang Jing, Gu Hongji, Chi Haotian
    2020, 24 (3):  366-371.  doi: 10.3969/j.issn.2095-4344.2410
    Abstract ( 491 )   PDF (667KB) ( 77 )   Save

    BACKGROUND: Traditional complex of diagnosis and treatment of distal radius fractures, did not get the repair in time and clinical misdiagnosis is not uncommon, become an important reason for the wrist joint pain and dysfunction. Wrist joint complexity assisted treatment of distal radius fractures can more accurately judge complexity of the distal radius fracture damage. The microscopic surgery can protect the blood supply, can also repair intra-articular ligament, cartilage injury, and along with all the dislocation, fracture of carpal bone fixed effectively.

    OBJECTIVE: To retrospectively analyze clinical effects of distal radial anatomical locking plate for complex distal radius fractures by joint arthroscopy.

    METHODS: Totally 19 patients with complex distal radius fractures, who were treated in the Department of Trauma and Hand Surgery, Sichuan Provincial Orthopedic Hospital from September 2016 to May 2018, were included in this study. According to AO classification, there were B2 type in 1 patient, B3 type in 2 patients, C1 type in 5 patients, C2 type in 7 patients and C3 type in 4 patients. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Open reduction and internal fixation with anatomical locking plate of distal radius assisted by wrist arthroscopy were used to repair the intercarpal interosseous ligaments and triangular fibrocartilage complex, and to fix the wrist fracture. At 1 year after treatment, the range of wrist motion, grip strength, radial height, palm inclination angle and ulnar angle were compared with the healthy side, and the functional evaluation was conducted with Mayo wrist score.

    RESULTS AND CONCLUSION: (1) Nineteen patients received postoperative follow-up. The healing time of distal radius was 5-12 months, with an average of 7 months. (2) At 1 year after surgery, no significant difference was detected in the range of wrist motion, grip strength, radial height, palm inclination angle and ulnar angle (> 0.05). (3) The Mayo wrist score was excellent in 9 cases, good in 8 cases, and average in 2 cases, with the excellent and good rate of 90%. (4) Treatment of complex distal radius fractures with distal radial anatomical locking plate by wrist arthroscopy can accurately restore the stability of the joint, and simultaneously repair the fracture with cartilage damage and intra-articular ligament, which is conducive to early functional exercise and has a satisfactory effect.

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    Removal of transepiphyseal plate after fixation for a certain period of time: growth inhibition of epiphyseal plate after a period of observation
    Cui Qingda, Wang Haige, Zhao Haijun, Liu Wei, Bi Zhenggang
    2020, 24 (3):  372-377.  doi: 10.3969/j.issn.2095-4344.2411
    Abstract ( 255 )   PDF (28773KB) ( 54 )   Save

    BACKGROUND: Clinically, children with metaphyseal and periepiphyseal fractures are more common. Internal fixation of the tarsal plate has a more important role in stabilizing the fracture. However, after a certain period of internal fixation, the fixator was taken out. After a certain period of observation, the recovery of the epiphyseal plate was rarely reported.

    OBJECTIVE: To design an animal model of epiphyseal plate fracture and observe the growth and inhibition of epiphyseal plate after removal of the transepiphyseal steel plate implanted with locking plate for a period of time.

    METHODS: The 5 mm fracture models of the distal epiphyseal plate of the right femur in 32 young rabbits were established. They were randomly divided into four groups with eight rats in each group. The same type of steel plate and screw was used. Internal fixation of transepiphyseal plate was conducted at periplate fracture line. The internal fixator was removed 2, 4, 8, and 12 weeks after operation. The rabbits were sacrificed after 2 weeks of observation. The femoral specimens were obtained, and the femoral length was measured. The thickness of epiphyseal plate and the number of mast cells were measured by pathological section. Morphological changes of mast cells and epiphyseal plate thickness were observed. The fracture model was used as the experimental group and the distal epiphyseal plate of the left femur was used as the control group.

    RESULTS AND CONCLUSION: (1) After 2 weeks of internal fixation, the steel plate was removed in the experimental group and the observation was continued for 2 weeks. There was no significant difference in femoral length, epiphyseal thickness and mast cell count between the experimental group and the control group. (2) In the experimental group, the internal fixator was removed at 4, 8 and 12 weeks and the plate was observed for 2 weeks. Compared with the control group, the femoral length, epiphyseal thickness and mast cell count in the experimental group were not completely restored to normal, and the difference was significant (P < 0.05). (3) On the premise that the internal fixator did not injure the epiphyseal plate, the transepiphyseal plate was taken out at the initial stage of internal fixation (≤ 2 weeks), and the plate was observed for 2 additional weeks. The growth and development of the epiphyseal plate were not significantly affected by appropriate pressure. (4) If the pressure limitation lasts for too long (≥ 4 weeks), the time of internal fixation for epiphyseal plate pressure limitation is too long. Although the plate is removed in time, the indexes such as limb length, epiphyseal plate thickness and mast cell count cannot be completely restored to normal, which can lead to partial or complete blockade of epiphyseal plate growth, resulting in limb deformity and stagnation of epiphyseal plate development.

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    Meta-plate and mini-plate internal fixation for the treatment of anterior comminuted coronal plane Pilon fractures
    Wei Daiqing, Li Cui, Xiang Feifan, Deng Yong, Lu Xiaobo, Xu Yangbo
    2020, 24 (3):  378-382.  doi: 10.3969/j.issn.2095-4344.2412
    Abstract ( 360 )   PDF (672KB) ( 48 )   Save

    BACKGROUND: Pilon fractures usually happened during severe injury, associated with compression and comminution of metaphysis and soft tissue injury and primary articular cartilage damage in varying degrees.The treatment is difficult and the prognosis is relatively poor.

    OBJECTIVE: To explore the clinical effect of application of meta-plate and mini-plate internal fixation for the treatment of anterior comminuted coronal plane Pilon fractures. 

    METHODS: From January 2013 to June 2017, 17 patients of closed anterior comminuted coronal plane Pilon fractures were admitted in Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University. There were 7 males and 10 females, aged from 24 to 62 years, with an average age of 41.3 years. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Preoperative CT scans and three-dimensional reconstruction confirmed that the main fracture line was in coronal plane and multiple fragments of distal tibial metaphysis were displaced obviously. According to Rüedi-Allgöwer classification, there were 3 cases of type II and 14 cases of type III. Fracture fragments of articular surface were fixed with transverse metacarpophalangeal mini-plate and screws, and the distal tibial coronal fractures were fixed with anterior meta-plate. The ankle and hind foot score of the American Orthopaedic Foot and Ankle Society was used to evaluate the function after surgery.

    RESULTS AND CONCLUSION: (1) The 17 patients were followed up for 12 to 28 months. All incisions healed in the first stage without complications such as wound infection, skin necrosis, failure of internal fixation and neurovascular injury. Only one patient had redness on the edge of the incision after operation and healed after swelling reduction and dressing change. (2) Fractures healed within 3 to 6 months without delayed union or nonunion. (3) At the last follow-up, the American Orthopaedic Foot and Ankle Society ankle and hind foot score was excellent in 10 cases, good in 5 cases, and average in 2 cases. The excellent and good rate was 88%. (4) The application of transverse mini-plate and screws fixation can effectively support and fix the fracture fragments of articular surface. Combined with anterior meta-plate of distal tibia for the treatment of anterior comminuted coronal plane Pilon fractures can achieve good therapeutic effect, and strengthen biomechanical stability.
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    Biomechanical characteristics on ball games for male youth with different body mass index based on AnyBody simulation and electromyogram test
    Pang Bo, Ji Zhongqiu, Jiang Guiping, Zhang Zihua, Li Jiahui
    2020, 24 (3):  383-389.  doi: 10.3969/j.issn.2095-4344.1906
    Abstract ( 396 )   PDF (29045KB) ( 58 )   Save

    BACKGROUND: Anybody’s musculoskeletal modeling system simulates the relationship between human skeleton, muscle and environment by using mathematical modeling technology. It can study the reverse dynamics of human body and obtain the maximum muscle strength of three lower limb joints.

    OBJECTIVE: To study the lower extremity muscle strength values of 24 male college students with different body mass indexes in one cycle of sitting Swiss ball, and to compare the mean root-mean-square of the subjects in sitting Swiss ball and bench. 

    METHODS: Twenty-four male college students were divided into normal group, overweight group and obesity group according to body mass index. BTS 3D infrared motion capture system, Kistler 3D dynamometer and BTS surface electromyography system were used to record the dynamic and electromyographic parameters simultaneously. The differences in muscle force and electromyographic parameters between different groups were qualitatively compared by one-way analysis of variance, and the mean differences were compared by quantitative difference analysis.

    RESULTS AND CONCLUSION:(1) In terms of muscle strength, from sitting to standing, compared with the obese group, the normal group showed significant differences in rectus femoris, semimememial muscle, biceps femoris longhead, popliteal muscle, soleus muscle and tibial anterior muscle (P < 0.05, 0.47 ≤ QD < 0.80), and the quadratus femoris muscle and pectineus muscle showed significant differences (< 0.01, QD ≥ 0.80). There was a significant difference in muscle strength of quadratus femoris between the obese group and the overweight group (P < 0.05, 0.47 ≤ QD < 0.80). From standing to sitting, there were significant differences in muscle strength of sartorus, extensor pollicis, and gastrocneum between the normal group and the obese group (P< 0.05, 0.47 ≤ QD < 0.80). (2) In terms of root-mean-square electromyogram value, from sitting to standing, the biceps femoris and gastrocnastus muscles in the normal group were significantly different from those in the obese group (P < 0.05, 0.47 ≤  QD < 0.80); from standing to sitting, rectus femoris muscles in the normal group were significantly different from those in the obese group (P < 0.05,  0.47 ≤ QD < 0.80). In the Swiss ball sitting state, from sitting to standing, the tibial anterior muscle and biceps femoris were significantly different between the normal group and the obese group (P < 0.05, 0.47 ≤ QD < 0.80). From standing to sitting, the electromyogram values of gastrocnemius muscle and right erector spine muscle were significantly different between the normal group and the obese group (P < 0.05, 0.47 ≤ QD < 0.80). These findings indicated that (1) In each group of BMI, the dominant muscle generation from sitting to sitting was gluteus medius muscle, vastus lateralis muscle, biceps longus muscle, rectus femoris muscle, gastrocnemius muscle, tibia anterior muscle and soleus muscle; and from standing to sitting, gluteus medius muscle, vastus lateralis muscle, biceps longus muscle, gastrocnemius muscle, tibia anterior muscle and soleus muscle. (2) Compared with the sitting stool, the subjects had higher root-mean-square of tibial anterior muscle, rectus femoris muscle, biceps femoris muscle and gastrocnemius muscle when sitting Swiss ball.

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    Three-dimensional model analysis of trabecular acetabular cup and solid acetabular cup 
    Wang Hui, Zhang Yazhou, Shi Lifang
    2020, 24 (3):  390-394.  doi: 10.3969/j.issn.2095-4344.2413
    Abstract ( 427 )   PDF (21820KB) ( 80 )   Save

    BACKGROUND: Hip arthroplasty is most effective method to treat hip diseases such as femoral head necrosis, osteoarthritis, hip dysplasia and femoral neck fracture in the elderly. Therefore, it is necessary to study the biomechanical behaviors of hip arthroplasty.

    OBJECTIVE: To simulate the contact stress and Von Mise stress values and distributions of trabecular acetabular cup and solid acetabular cup by finite element analysis method, and to predict its effects on prosthesis and hip joint.

    METHODS: Two hip joint component models with different structures, trabecular acetabular cup and solid acetabular cup were designed in 3-Matic Research 11.0 software. The well-designed models were imported to Hypermesh 14.0 software to divide meshes and assign material properties. Finite element analysis software Abaqus 6.13 was used to simulate the stress values and distributions of both models.

    RESULTS AND CONCLUSION: The results of this study showed that the stress of the trabecular acetabular cup was scattered and distributed widely. The solid acetabular cup is prone to stress concentration, and the stress distribution is concentrated near the point of stress. Compared with the solid acetabular cup and the trabecular acetabular cup, the latter has larger contact area of stress distribution and more uniform stress distribution, which can reduce the wear between hip prostheses and the risk of aseptic loosening of hip prostheses.
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    Comparison of finite element models of osteonecrosis of the femoral head based on CT gray-assigned method
    Xue Zhipeng, Li Taixian, Li Yan, He Haijun, Huang Zeqing, Sun Jigao, Chen Weiheng
    2020, 24 (3):  395-400.  doi: 10.3969/j.issn.2095-4344.2414
    Abstract ( 499 )   PDF (26763KB) ( 85 )   Save

    BACKGROUND: Previous studies have reported that femoral head finite element models are mostly modeled with single or few samples for specific biomechanical research, but there is little research on model stability.

    OBJECTIVE: To compare the models of normal femoral head and osteonecrosis of the femoral head with multiple samples, and to analyze the accuracy and stability of the models through the comparison of stress distribution and mechanical parameters, so as to provide mechanical basis for prevention and treatment of collapse of osteonecrosis of the femoral head.

    METHODS: Totally 20 sides uncollapsed of osteonecrosis of the femoral head one year of non-surgical treatment were selected as the experimental group, and the healthy side of 20 patients with unilateral osteonecrosis of the femoral head were set as the normal group. The CT data of the femoral head were collected to establish the finite element model. The stress distribution of normal femoral head and osteonecrosis of the femoral head, the maximum equivalent stress and the maximum total deformation at the weight-bearing area of the femoral head were observed and compared. This study was approved by the Medical Ethics Committee of Wangjing Hospital of China Academy of Chinese Medical Sciences. Patients signed the informed consent. 

    RESULTS AND CONCLUSION: (1) The finite element models of normal proximal femur, non-necrotic proximal femur and necrotic bone were established. The number of elements and nodes were 502 568±114 196, 692 608±154 678; 449 954±125 824, 623 311±171 401; 19 133±13 167, 27 577±19 131, respectively. (2) When the load was set by simulating one-foot standing position, the cloud image showed that when 2.5 times body weight applied to the weight-bearing area of the femoral head; the surface stress of the weight-bearing area of the normal femoral head was uniform. The stress was uniformly distributed in the femoral head along the stress trabeculae, and the calcar femorale bears the most. The stress concentration area appeared on the surface of the weight-bearing area and the necrotic area of osteonecrosis of the femoral head. The stress was scattered and distributed on the inner and outer sides of the femoral neck and the femoral head of osteonecrosis of the femoral head produced more deformation than the normal femoral head. (3) The maximum total deformation of the weight-bearing area of the osteonecrosis of the femoral head and the normal femoral head was (4.14±1.31) mm and (1.36±0.22) mm and the maximum equivalent stress was (1.94±0.77) MPa and (0.75±0.19) MPa, respectively, and with statistically significance (P < 0.05). Moreover, two groups of data tend to be concentrated and the models are stable. Through the comparison of multi-sample normal femoral head and osteonecrosis of the femoral head, the CT gray-assigned method reflects the actual mechanical properties of osteonecrosis of the femoral head, and has good accuracy and stability. 

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    Pathogenesis and clinical treatment progress of Kienbock’s disease
    Qu Xiaolong, Chen Tianyi, Zheng Bo, Cao Zongrui, Jiang Tao
    2020, 24 (3):  401-407.  doi: 10.3969/j.issn.2095-4344.1998
    Abstract ( 702 )   PDF (888KB) ( 139 )   Save


    BACKGROUND: Kienbock’s disease is aseptic necrosis of the lunate bone due to various causes, and its pathogenesis is unknown. Because the soft tissue around the wrist articular surface is small, so it leads to poor blood supply, and the progressive necrosis is irreversible. Early specificity is poor, clinical diagnosis rate is low, and late teratogenicity and disability rate is high. The clinical diagnosis and treatment are complicated, and there are many procedures, but there is no accurate guidance.
    OBJECTIVE: To review the current research status of mechanism, stage and clinical diagnosis of Kienbock’s disease, to summarize the clinical treatment of Kienbock’s disease in recent years, so as to discuss the clinical efficacy of various programs and provide guidance for clinical diagnosis and treatment.
    METHODS: A computer-based online search of PubMed and CNKI databases from 1970 to 2019 was conducted. Key words were “Kienbock’s disease, lunate bone, necrosis, mechanism, treatment” in English and Chinese, respectively. About 900 articles were retrieved, and 52 articles eligible for the inclusion and exclusion criteria were included for review.
    RESULTS AND CONCLUSION: (1) The pathogenesis of Kienbock’s disease is unknown, its etiology is complex, and researchers believe that anatomy and biomechanics, and individual factors are main causes, which still need further research. (2) The Lichtman stage is widely used in Kienbock’s disease classification. The latest breakthrough in arthroscopy is expected to form a new classification standard, which can be diagnosed by X-ray, CT or MRI combined with “triple sign”. It has poor early specificity, so the rate of misdiagnosis is high, and it should be identified with wrist diseases. (3) Early-stage Kienbock’s disease usually receive conservative treatment, and advanced stage tends to undergo surgical programs, including free vascularized bone graft, the lumate resection + tendon tamponade, radial wedge and shortening osteotomy, scaphotrapeziotrapezoid fusion, proximal row carpectomy, and bone cement prosthesis replacement, and the follow-up outcomes are different, so there is still no perfect treatment program.

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    Mechanism of PI3K/AKT signaling pathway regulating osteonecrosis of the femoral head
    Song Shilei, Chen Yueping, Zhang Xiaoyun
    2020, 24 (3):  408-415.  doi: 10.3969/j.issn.2095-4344.2415
    Abstract ( 765 )   PDF (778KB) ( 134 )   Save

    BACKGROUND: In recent years, with the deepening of medical research, it has been found that PI3K/AKT signaling pathway has a regulatory effect on vascular repair regeneration, osteoblast differentiation and proliferation, and osteoclast bone differentiation. This is very important for the treatment of femoral head necrosis.

    OBJECTIVE: To provide a brief overview of the main research progress in mechanisms of PI3K/AKT signaling pathway regulating femoral head necrosis in recent years, aiming to provide new ideas for the treatment of osteonecrosis of the femoral head in the future.

    METHODS: PubMed and MEDLINE database, Wanfang, CNKI, WIPO and CBM database were searched from 2012 to 2019, for relevant domestic and foreign literatures, including: (1) epidemiological study of osteonecrosis of the femoral head and related pathogenesis; (2) PI3K/AKT pathway related mechanism; (3) research literature on the effects of PI3K/AKT on factors related to vascular repair and regeneration; (4) research literature on the regulation of PI3K/AKT on osteoblast differentiation and proliferation-related factors; (5) literature on the regulation of PI3K/AKT on functional factors related to osteoclast differentiation. A total of 62 literatures were included for analysis and summary.

    RESULTS AND CONCLUSION: (1) The PI3K/AKT signaling pathway has been proven to be effective in the regulation of vascular repair regeneration, osteoblast differentiation, proliferation, apoptosis and osteoclast differentiation. After understanding these pathways, research and development of related drugs to improve the success rate of early conservative treatment of osteonecrosis of the femoral head have great development prospects and potential, opening up a new path for future orthopedic surgeons to treat osteonecrosis of the femoral head, and bringing new hope to patients and their families. (2) According to the different osteonecrosis of the femoral head conditions of patients, how to use PI3K/AKT signaling pathway to guide treatment becomes a breakthrough point and challenge of this technology, and more research is needed later.

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    Meta-analysis of efficacy and safety of short-stem versus long-stem hip arthroplasty 
    Liu Changlu, Ma Libo, Liu Xiaomin, Huang Jian
    2020, 24 (3):  416-421.  doi: 10.3969/j.issn.2095-4344.1931
    Abstract ( 607 )   PDF (23135KB) ( 56 )   Save

    BACKGROUND: Short hip arthroplasty has the characteristics of less trauma, stable prosthesis, biomechanics and better bone retention. However, short-stem prosthesis is not widely used in hip arthroplasty at present, and the specific benefits of the population are still unclear.

    OBJECTIVE: To evaluate the efficacy and safety of long- and short-stem hip arthroplasty for treating femoral head necrosis.

    METHODS: Clinical randomized controlled trials of long-and short-stem hip arthroplasty were collected from PubMed database, Embese database, Medline database, Web of Science database and Cochrane library database. RevMan 5.3 software was used for meta-analysis of studies that met the inclusion criteria.

    RESULTS AND CONCLUSION: (1) Nine randomized controlled trials were involved in this study. 747 patients were divided into two groups: 383 long-stem hips and 364 short-stem hips. (2) Meta-analysis showed that hip Harris score was higher in the short-stem hip group than in the long-stem hip group at 6 months and more after surgery [MD=5.74, 95%CI(3.20, 8.27), P < 0.05; MD=4.16, 95%CI(2.36, 5.97), P < 0.05]. WOMAN index score was significantly improved in the short-stem hip group compared with the long-stem hip group after surgery [MD=10.37, 95%CI(5.71, 15.03), P < 0.05]. NRS score for hip pain was significantly improved in the short-stem hip group compared with the long-stem hip group after surgery [MD=0.54, 95%CI(0.18, 0.90), P < 0.01]. There was no significant difference in incision infection, dislocation, unequal length of lower limbs and loosening of prosthesis between the two groups compared with bone mineral density at 6 months and over 6 months after operation [OR=0.40, 95%CI(0.13, 1.22), P > 0.05; MD=-0.02, 95%CI(-0.08, 0.03), P > 0.05; MD=-0.10, 95%CI(-0.16, 0.04), P > 0.05]. (3) These results indicated that short-stem hip arthroplasty is an effective method for the treatment of femoral head necrosis. It can relieve pain, restore joint function as soon as possible and improve surgical effect, especially for young patients with better bone.

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    Clinical pathways in total hip or knee arthroplasty as compared with traditional pathways: a meta-analysis
    Dong Rui, Lin Hansheng
    2020, 24 (3):  422-427.  doi: 10.3969/j.issn.2095-4344.2416
    Abstract ( 439 )   PDF (27031KB) ( 48 )   Save

    BACKGROUND: Hip and knee arthroplasty has been widely carried out in various levels of hospitals. The amount of hip and knee joint surgery has increased year by year. The surgical methods and techniques have reached a difficult time. Promoting the clinical pathway is an effective method to improve the treatment effect.

    OBJECTIVE: To systemically evaluate the difference between the clinical pathways and conventional pathways in total hip arthroplasty and total knee arthroplasty.

    METHODS: Clinical trials about the comparison of conventional and clinical pathways in total hip arthroplasty and total knee arthroplasty were searched in MEDLINE, Cochrane Library, EMbase, and CNKI. Study selection, data collection and evaluation of methodological quality were undertaken by two reviewers independently. The Cochrane Collaboration’s RevMan 5.0 was used for data analyses.

    RESULTS AND CONCLUSION: (1) Totally 17 clinical trials meeting research design criteria were included in this analysis, including 13 semi-randomized controlled trials and 4 randomized controlled trials. (2) The incidence of complications in the traditional method group was higher than that in the clinical pathway group [OR=0.63, 95%CI(0.53, 0.74), P < 0.000 01]. (3) Pain visual analogue scale score [MD=1.49, 95%CI(0.69, 2.85), P=0.001], postoperative Harris hip score [MD=19.31, 95%CI(-13.98, -4.92), P < 0.000 1], and 5-year prosthesis survival rate [OR=0.59, 95% CI (0.36, 0.98), P=0.04] were better in the clinical pathway group than in the traditional method group. (4) There was no significant difference in postoperative mean deviation of mechanical axes of lower limbs after total knee arthroplasty in both groups [MD=0.00, 95%CI(-0.14, 0.14), P=0.99]. (5) Results showed that compared with traditional technique, hip and knee arthroplasty patients who entered the clinical pathway had better clinical efficacy, fewer complications and better joint function after operation.

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    Outcomes and metal ion levels of Birmingham hip resurfacing versus total hip arthroplasty: a systematic review and meta-analysis
    Fan Zhirong, Huang Yongquan, Peng Jiajie, Hong Weiwu, Zhong Degui, Su Haitao, Liu Zitao, Jiang Tao
    2020, 24 (3):  428-437.  doi: 10.3969/j.issn.2095-4344.2417
    Abstract ( 477 )   PDF (38778KB) ( 62 )   Save

    BACKGROUND: Total hip arthroplasty is the gold standard for the end stage of elderly hip disease, but Birmingham hip resurfacing has become an effective alternative to total hip arthroplasty for young people with high levels of exercise. Whether Birmingham hip resurfacing has an advantage over total hip arthroplasty is still inconclusive.

    OBJECTIVE: To systematically review the efficacy and metal ion level of Birmingham hip resurfacing and total hip arthroplasty.

    METHODS: The electronic databases of PubMed, EMBASE, Cochrane library, and Web of Science, which last updated on November 30, 2018, were searched for clinical control study of Birmingham hip resurfacing and total hip arthroplasty. Literature data were extracted and literature quality was evaluated. Meta-analyses were performed with RevMan 5.3 software.

    RESULTS AND CONCLUSION: (1) Twelve studies were identified with a total of 2 317 patients (n=1 279 in Birmingham hip resurfacing group and n=1 038 in total hip arthroplasty group). (2) Meta-analysis results demonstrated that in the primary outcome measures, the Birmingham hip resurfacing group did not differ from the total hip arthroplasty group during short-term follow-up (RR=0.13, 95% CI [0.02, 1.01], P=0.05), but Birmingham hip resurfacing had a lower revision rate during long-term follow-up (RR=0.27, 95% CI [0.15, 0.50], < 0.000 1). (3) In the functional scores of secondary outcome measures, the Birmingham hip resurfacing group was superior to total hip arthroplasty in short-term follow-up Harris hip scores and modified Harris hip scores (< 0.05). However, there was no significant difference between the two groups in the long-term follow-up Harris hip score and University of California, Los Angeles score and the Western Ontario and McMaster University score at any time (P > 0.05). (4) Finally, in the metal ion level, whether it was short-term follow-up or long-term follow-up, there was no significant difference between Birmingham hip resurfacing and total hip arthroplasty (P < 0.05). While at the Cr ion level, there was no significant difference between Birmingham hip resurfacing and total hip arthroplasty in short-term follow-up (P=0.55), but long-term follow-up showed that Birmingham hip resurfacing released more Cr ions than total hip arthroplasty after surgery, and the difference between the groups was statistically significant (P=0.03). (5) In conclusion, compared with total hip arthroplasty, Birmingham hip resurfacing has a smaller revision rate and overall complication, a better hip function score, but its Cr ion level is higher. This conclusion still needs further a great amount of large-sample, multi-center, high-quality randomized controlled trials to verify its correctness. 

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    Clinical efficacy and complications of short versus long segments of internal fixation for the treatment of degenerative scoliosis: a meta-analysis
    Sun Jian, Fang Chao, Gao Fei, Wei Laifu, Qian Jun
    2020, 24 (3):  438-445.  doi: 10.3969/j.issn.2095-4344.2418
    Abstract ( 333 )   PDF (27827KB) ( 58 )   Save

    BACKGROUND: Currently, surgical methods for the treatment of degenerative scoliosis include simple decompression and decompression combined with internal fixation. However, there is still controversy over the choice of fixation and fusion segment in surgery, which requires more reliable evidence-based medical evidence for reference.

    OBJECTIVE: To evaluate the clinical efficacy and complication of short versus long segments of internal fixation for the treatment of degenerative scoliosis using meta-analysis.

    METHODS: CNKI, Wanfang Database, VIP, CBM, EMBase, PubMed, Web of Science, and Cochrane Library were searched to collect the randomized and non-randomized controlled studies which compared long fusion with short fusion in the treatment of degenerative scoliosis from inception to February 2019. Relevant conference papers and authoritative journals in the field were retrieved manually. The quality of the included studies was assessed by two evaluation members according to the Cochrane collaboration network standard or the Newcastle-Ottawa Scale. The included studies were analyzed by using RevMan 5.3 software.

    RESULTS AND CONCLUSION: (1) A total of 20 articles were included, involving a sample of 1 329 individuals. Long segment group consisted of 601 cases, and short segment group consisted of 728 cases. (2) The meta-analysis results showed that long-segment internal fixation surgery had better improvement of coronal Cobb angle (P=0.000 4), coronal balance (P=0.000 2), Oswestry disability index (P=0.003) and visual analogue scale score (P < 0.000 01). However, the incidence of implant failure (P=0.01) and dural tear (P=0.01) in short segment group was lower than that in long segment group. The short segment group had small trauma and shorter hospital stays after surgery (P < 0.000 1). (3) There was no statistical difference in other therapeutic indicators and complications between the two groups (P > 0.05). (4) These findings verify that long-segment internal fixation is superior to short-segment internal fixation in the correction of scoliosis, but the recovery is slow and the incidence of some complications after operation is high. It should be considered comprehensively when selecting specific surgical procedures.
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    Accuracy of robot-assisted and fluoroscopy-guided pedicle screw placement: a meta-analysis
    Gao Yangyang, Che Xianda, Han Pengfei, Liang Bin, Li Pengcui
    2020, 24 (3):  446-452.  doi: 10.3969/j.issn.2095-4344.2423
    Abstract ( 345 )   PDF (649KB) ( 74 )   Save

    BACKGROUND: Traditional fluoroscopy-guided pedicle screw fixation is not highly accurate and can lead to serious surgical complications. To reduce surgical complications and improve the success rate of surgery, robotic assistive technology emerges as the times require.

    OBJECTIVE: To compare the difference of robot-assisted and fluoroscopy-guided pedicle screw placement using meta-analysis. 

    METHODS: The study included clinical controlled trials on robot-assisted and fluoroscopy-guided pedicle screw placement published in and outside China from December 2008 to December 2018. The retrieval was performed in the online databases include Embase, PubMed, Central, CNKI, CQVIP, Wanfang, and CBM. Keywords used for search were robot assisted, fluoroscopy guided, conventional, freehand, pedicle screw in English and Chinese. After the data were extracted, statistical software Review Manager 5.3 was used for data-analysis.

    RESULTS AND CONCLUSION: (1) Based on the above search strategy, 1 615 studies were retrieved, and 13 were included. (2) Statistical analysis found that placement accuracy in the robot-assisted group was better than that of the fluoroscopy group [95%CI(1.55, 4.06), P=0.000 2]. Radiation intensity in the fluoroscopy group was lower than that in the robot-assisted group [95%CI(0.42, 0.82), P < 0.001], and the difference was statistically significant. (3) However, the incidence of complications [95%CI(0.23, 4.65), P=0.96] and revised surgery [95%CI(0.03, 3.17), P=0.33] were not statistically significant between the robot-assisted group and the fluoroscopy group. Intraoperative fluoroscopy time was similar between the two groups [95%CI(-38.55, 78.26), P=0.51]. Postoperative back pain [95%CI(-0.58, 0.38), P=0.68], leg pain score [95%CI(-0.20, 0.19), P=0.94] and operation time [95%CI(-6.33, 53.02), P=0.12] were also similar between the two groups, and the differences were not statistically significant. (4) Compared with fluoroscopy, robot-assisted technique has higher pedicle screw placement accuracy, especially under percutaneous conditions. Inevitably, the intraoperative radiation intensity is also more than conventional fluoroscopy.

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    Comparison of seven surgical interventions for lumbar disc herniation: a network meta-analysis#br#
    Feng Fan, Cai Yi, Li Yingbo, Dong Junli, Wu Qun, Fan Yongzhi, Yan Hong
    2020, 24 (3):  453-459.  doi: 10.3969/j.issn.2095-4344.2419
    Abstract ( 490 )   PDF (30408KB) ( 119 )   Save

    BACKGROUND: With the rapid development of intervertebral disc interventional technology, surgical treatment of lumbar disc herniation has made great progress, but at the same time, surgeons and patients have more choices. Therefore, it is particularly important to compare the efficacy and safety of new surgical methods and traditional widely accepted treatment methods. Traditional meta-analysis cannot classify the advantages and disadvantages of various surgical methods.

    OBJECTIVE: To evaluate the efficacy and safety of seven surgical interventions for the treatment of lumbar disc herniation using network meta-analysis.

    METHODS: We performed a Bayesian-framework network meta-analysis of randomized controlled trials to compare seven surgical interventions for people with lumbar disc herniation, including percutaneous endoscopic lumbar discectomy, standard open discectomy, standard open microsurgical discectomy, chemonucleolysis, microendoscopic discectomy, percutaneous laser disc decompression, and automated percutaneous lumbar discectomy. The eligible randomized controlled trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase and Google scholar. Data from three outcomes (success rate, complication rate, and reoperation rate) were independently extracted by two assessors.

    RESULTS AND CONCLUSION: (1) A total of 29 randomized controlled trials (31 literatures) including 3 146 participants were finally included into this article. (2) Our Meta-analysis provides hierarchies of these seven interventions. For the success rate, the rank probability is as follows (from best to worst): percutaneous endoscopic lumbar discectomy > standard open discectomy > standard open microsurgical discectomy > chemonucleolysis > microendoscopic discectomy > percutaneous laser disc decompression > automated percutaneous lumbar discectomy. (3) For the complication rate, the rank probability is as follows (from best to worst): percutaneous endoscopic lumbar discectomy > standard open microsurgical discectomy > standard open discectomy > microendoscopic discectomy > percutaneous laser disc decompression > chemonucleolysis > automated percutaneous lumbar discectomy. (4) For the reoperation rate, the rank probability is as follows (from best to worst): standard open microsurgical discectomy > standard open discectomy > microendoscopic discectomy > percutaneous laser disc decompression > percutaneous endoscopic lumbar discectomy > chemonucleolysis > automated percutaneous lumber discectomy. (5) This meta-analysis provides evidence that percutaneous endoscopic lumbar discectomy might be the best choice to increase the success rate and decrease the complication rate. Moreover, standard open microsurgical discectomy might be the best option to drop the reoperation rate. Automated percutaneous lumbar discectomy might lead to the lowest success rate and the highest complication rate. It is hoped that one-to-one randomized controlled trials of high quality will further validate the results of this study.

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    Risk factors for proximal junctional kyphosis after spinal deformity surgery: a meta-analysis
    Zhang Jian, Wang Xiaojian, Qin Dean, Zhao Zhongtao, Liang Qingyuan, An Qijun, Song Jiefu
    2020, 24 (3):  460-468.  doi: 10.3969/j.issn.2095-4344.2420
    Abstract ( 437 )   PDF (36332KB) ( 62 )   Save

    BACKGROUND: Proximal junctional kyphosis is a common complication after spinal deformity surgery, which can lead to a variety of adverse clinical outcomes. Therefore, it is necessary to analyze the risk factors that may lead to proximal junctional kyphosis after surgery, in order to expand our understanding of proximal junctional kyphosis and provide guidance for its prevention.

    OBJECTIVE: To evaluate the risk factors of proximal junctional kyphosis after spinal deformity surgery using meta-analysis.

    METHODS: A systematic literature search was performed using PubMed, EMbase, Cochrane, CNKI and Wanfang Medical Database (up to May 2019). The quality of literatures was assessed and selected according to the inclusion criteria and exclusion criteria. Relevant data were extracted. RevMan 5.3 software was used for data analysis and the data were dealt by meta-analysis. The meta-analysis results were evaluated.

    RESULTS AND CONCLUSION: (1) This study included 26 studies involving 4 498 patients of whom 921 with proximal junctional kyphosis. The incidence of proximal junctional kyphosis after spinal orthopedic surgery was 25%. (2) There were significant differences between the proximal junctional kyphosis and non-proximal junctional kyphosis groups in age, body mass index, osteoporosis, number of surgical vertebral bodies, the upper instrumented vertebra to the thoracolumbar segment (T10-L1), the lower instrumented vertebra to the sacrum/pelvis/ilium, postoperative proximal kyphosis angle, lumbar lordosis and sagittal vertical axis, changes in proximal kyphosis angle, lumbar lordosis and sagittal vertical axis (P < 0.05). (3) There were no significant differences in gender, osteotomy, combined surgery, preoperative proximal kyphosis angle or preoperative lumbar lordosis (P > 0.05). (4) Our meta-analysis showed that age, body mass index, osteoporosis, the number of operative vertebrae > 5 at fixation segment, the upper instrumented vertebra internal fixation to thoracolumbar segment (T10-L1), the lower instrumented vertebra fixation to sacrum/pelvis/ilium, postoperative proximal kyphosis angle, lumbar lordosis and sagittal vertical axis, changes in proximal kyphosis angle, lumbar lordosis and sagittal vertical axis were the main risk factors for proximal junctional kyphosis. The incidence of proximal junctional kyphosis can be reduced by intervening the high-risk population and making the suitable surgical procedures. Proximal junctional kyphosis was due to a variety of non-surgical and surgical factors. More rigorous epidemiological studies are needed to provide reliable evidence for reducing the incidence of proximal junctional kyphosis.

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    Meta-analysis of the efficacy of platelet-rich plasma combined with cannulated screw fixation for the treatment of femoral neck fracture
    Chen Xiang, Wei Dong, Zhao Ruipeng, Li Pengcui, Wei Xiaochun
    2020, 24 (3):  469-476.  doi: 10.3969/j.issn.2095-4344.2421
    Abstract ( 336 )   PDF (30368KB) ( 67 )   Save

    BACKGROUND: Numerous studies have reported the effectiveness of platelet-rich plasma in promoting and improving bone healing. However, due to the limitations of methods, follow-up and study design, many orthopedicians still doubt the clinical effect of platelet-rich plasma combined with cannulated screw fixation in the treatment of fracture and nonunion.

    OBJECTIVE: To evaluate the difference in efficacy between platelet-rich plasma combined with cannulated screw fixation and simple cannulated screw fixation in the treatment of femoral neck fracture using meta-analysis system.

    METHODS: The Cochrane Library, PubMed, Wanfang Medical Network, China National Knowledge Infrastructure, and China Journal Full-text Database were used to search and collect clinical randomized controlled trials of platelet-rich plasma combined with cannulated screw fixation and cannulated screw fixation for the treatment of femoral neck fractures. Two reviewers independently evaluated the quality of the included studies, extracted data and checked each other. Meta-analysis was utilized to analyze the collected data with RevMan 5.3 software.

    RESULTS AND CONCLUSION: (1) Seven clinical randomized controlled trials were selected for meta-analysis, totally 760 patients. There were 380 cases undergoing platelet-rich plasma combined with cannulated screw fixation and 380 cases undergoing cannulated screw fixation. (2) The meta-analysis showed that compared with the cannulated screw fixation group, fracture healing time was shorter [MD=-1.86, 95%CI(-2.97, -0.75), P=0.001]; healing rate was higher [OR=6.51, 95%CI(3.36, 12.62), P < 0.000 01]; necrosis rate was lower [OR=0.25, 95%CI(0.15, 0.44), P < 0.000 01]; Harris scores at 1, 3, 6, 9, and 12 months postoperatively were higher [MD=4.95, 95%CI(4.12, 5.77), P < 0.000 01; MD=19.78, 95%CI(18.45, 21.11), P < 0.000 01; MD=17.16, 95%CI(10.39, 23.92), P < 0.000 01; MD=12.66, 95%CI(10.60, 14.71), P < 0.000 01; MD=10.17, 95%CI(5.98, 14.36), P < 0.000 01] in the platelet-rich plasma combined with cannulated screw fixation group. (3) Platelet-rich plasma combined with cannulated screw fixation for femoral neck fracture is more effective than that of cannulated screw fixation alone. Combined treatment can accelerate the fracture healing of patients, improve the healing rate, reduce necrosis rate, and promote the recovery of postoperative hip joint function.

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    A meta-analysis of expandable intramedullary nail versus interlocking intramedullary nail for treatment of femoral shaft fracture
    Wang Wei, Xie Chengxin, Zhou Haonan, Zhang Yu, Wang Chenglong, Yin Dong
    2020, 24 (3):  477-484.  doi: 10.3969/j.issn.2095-4344.2422
    Abstract ( 300 )   PDF (30853KB) ( 68 )   Save

    BACKGROUND: A large number of studies have confirmed that expandable intramedullary nails and interlocking intramedullary nails have a good effect in repairing limb fractures. However, for the treatment of femoral shaft fractures, the advantages and disadvantages of the two kinds of fixation methods are not inconclusive.

    OBJECTIVE: To systematically review the safety and effectiveness of expandable intramedullary nail and interlocking intramedullary nail for treatment of femoral shaft fracture.

    METHODS: A computer-based online search was conducted in PubMed, Web of Science, EBSCO, The Cochrane Library, CNKI, VIP and Wanfang databases to screen the relevant clinical controlled trials of expandable intramedullary nail versus interlocking intramedullary nail for the treatment of femoral shaft fractures. Two reviewers screened the literature according to the strict inclusion criteria, and assessed the research quality of the finally included literatures, and extracted the data. Meta-analysis was performed using Stata 13.0 software.

    RESULTS AND CONCLUSION: (1) A total of 7 studies (3 randomized controlled and 4 non-randomized controlled trials) were included, involving 492 patients. Expandable intramedullary nailing group contained 246 patients. Interlocking intramedullary nailing contained 246 patients. (2) The results of meta-analysis showed that compared with the interlocking intramedullary nailing group, fracture healing time, operation time, fluoroscopy time and hospital stay were shorter in the expandable intramedullary nailing group [SMD=-0.87, 95%CI(-1.20, -0.54), P=0; SMD=-2.45, 95%CI(-3.33, -1.58), P=0; SMD=-2.83, 95%CI(-3.68, -1.97), P=0; SMD=-0.96, 95%CI(-1.73, -0.18), P=0.016]. Intraoperative blood loss was less in the expandable intramedullary nailing group than that in the interlocking intramedullary nailing group [SMD=-4.12, 95%CI(-6.38, -1.87), P=0]. There was no significant difference in the rate of bone nonunion or delayed healing and the overall incidence of complications between the two groups. (3) Therefore, we theoretically believe that expandable intramedullary nailing is more advantageous than interlocking intramedullary nailing in the treatment of femoral shaft fractures, but the postoperative recovery is similar. Limited to the quality of the methodology of this study, it fails to consider the effect of the type of fracture and the interference of the field. The results need to be treated with caution, and more randomized controlled trials are needed to confirm.
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    Suture-Button fixation and screw fixation for the treatment of distal tibiofibular syndesmosis injury: a meta-analysis
    Tian Chenyang, Chen Bin, Sun Zhengtao, Wang Xinjun, Sun Haiyu
    2020, 24 (3):  485-492.  doi: 10.3969/j.issn.2095-4344.1950
    Abstract ( 421 )   PDF (78195KB) ( 72 )   Save

    BACKGROUND: In the clinical treatment of distal tibiofibular syndesmosis injury, Suture-Button fixation technique can achieve similar results to, even better results than, those of screws, but it cannot fully recover the anatomical reduction and activity to those before injury. However, the optimal treatment of distal tibiofibular syndesmosis injury is still controversial.

    OBJECTIVE: To systematically evaluate Suture-Button fixation and screw fixation for the treatment of distal tibiofibular syndesmosis injury.

    METHODS: EMBASE, Cochrane database, PubMed database, Wanfang database, and CNKI were searched to retrieve randomized or non-randomized controlled trials regarding Suture-Button fixation and screw fixation for the treatment of distal tibiofibular syndesmosis injury published from January 2005 to January 2019. The quality of the included studies was strictly evaluated. Relevant data were extracted. A meta-analysis of all outcome measures was performed using RevMan 5.3 software.

    RESULTS AND CONCLUSION: (1) Twelve studies were included, including 4 randomized controlled trials and 8 cohort studies, involving 564 patients. (2) Meta-analysis results showed that Suture-Button fixation had shorter full weight-bearing time [WMD=-1.50, 95%CI(-2.08, -0.92), P < 0.05] than screw fixation method. Suture-Button fixation resulted in better AOFAS scores than screw fixation at 3, 6, 12, and 24 months after surgery [WMD=6.50,95%CI(3.41, 9.58), P < 0.05; WMD=2.87, 95%CI(0.75, 4.98), P < 0.05; WMD=2.67, 95%CI(0.09, 5.24), P < 0.05; WMD=5.79, 95%CI(1.41, 10.18), P < 0.05]. There were no significant differences in operation time, tibiofibular overlap at the last follow-up, tibiofibular clear space at the last follow-up, and the incidence of total postoperative complications after surgery between two fixation methods (P > 0.05). (3) These findings suggest that compared with screw fixation, Suture-Button fixation for the treatment of distal tibiofibular syndesmosis injury leads to better recovery of ankle joint function and an earlier time point for full weight bearing and does not need to consider the risk of screw fracture during the surgery. In addition to screw fixation, Suture-Button fixation is an effective way to treat distal tibiofibular syndesmosis injury. 
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