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    28 February 2020, Volume 24 Issue 6 Previous Issue    Next Issue
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    Design and clinical application of personalized antibiotic cement spacer of knee joint
    Wang Hong, Wu Quan, Tang Geng, Zhang Gong
    2020, 24 (6):  821-826.  doi: 10.3969/j.issn.2095-4344.2445
    Abstract ( 495 )   PDF (24411KB) ( 84 )   Save

    BACKGROUND: Periprosthetic infection of the knee is one of the most serious complications after total knee arthroplasty. Second-stage revision is recognized as the “gold standard” of treatment. The placement of antibiotic cement spacer during the interval of the second operation not only increases the concentration of antibiotics, but also increases the joint activity of patients. At present, the fabrication methods of spacer are different. There are some shortcomings such as low articular surface fit, low fabrication accuracy, unstable structure and low strength, which cannot well fit the patient’s physiological structure. How to design personalized spacer and maintain knee joint stability after surgery is a difficulty in its clinical application.

    OBJECTIVE: To design the structure of personalized spacer using finite element analysis and to make a spacer by three-dimensional printing technology for applied clinically.

    METHODS: Based on CT data of knee joint from patients undergoing total knee arthroplasty, the prosthesis, femur and tibia were reconstructed by Mimics software. According to the amount of osteotomy and the shape of the prosthesis, a personalized spacer structure was designed. The stress of the spacer in different gaits was analyzed by finite element method. The silicone mould of the occupier was fabricated by three-dimensional printing technology and used in clinical application.

    RESULTS AND CONCLUSION: (1) According to the amount of osteotomy and the shape of knee prosthesis, the structure of femoral side occupier and the tibial side occupier were designed. In order to prevent the dislocation of the spacer, the groove depth of the tibial side occupier was (4-6 mm) and the anterior end height was (10-14 mm). (2) The results of finite element analysis showed that the maximum stress of the femoral side occupier was 13.6 MPa at 90 degrees of flexion, and that of the tibial side occupier was 7.99 MPa at 90 degrees of flexion. The stress was reasonable and the structural strength of the spacer meets the requirements. (3) Silica gel mould of spacer was made by three-dimensional printing technology. The surface of spacer was smoother and the fit degree was increased. (4) The clinical results showed that the personalized spacer had good joint mobility and stability. (5) The spacer made by this method is fast, simple and saves operation time. It provides a new choice for clinical application of knee joint spacer.
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    Evaluation of balance function of unicompartmental and total knee arthroplasties for treating unicompartmental knee osteoarthritis 
    Tan Biao, Zuo Biao, Huang Yong
    2020, 24 (6):  827-832.  doi: 10.3969/j.issn.2095-4344.2446
    Abstract ( 430 )   PDF (24396KB) ( 61 )   Save

    BACKGROUND: Unicompartmental knee osteoarthritis can be treated clinically with either total or partial knee arthroplasty. In the choice of treatment methods, a variety of factors lead to significant differences. There is little reliable evidence to guide the clinical surgical options.

    OBJECTIVE: To compare the short-term curative effect of unicompartmental and total knee arthroplasties in the treatment of unicompartmental osteoarthritis and to explore the effects of two treatment methods on the balance function of patients.

    METHODS: This was a perspective trial. The patients with unicompartmental knee osteoarthritis were divided into unicompartmental knee arthroplasty group (22 cases, 23 knees) and total knee arthroplasty group (30 cases, 30 knees) based on surgical method. All patients signed the informed consents and the study was approved by the hospital ethical committee. The operation time, hospitalization time, Hospital for Special Surgery score, and the range of motion of the knee joint were compared between two groups to evaluate the early efficacy. The patients’ balance function was evaluated using the Tecnobody Proprioception Test System, Timed Up and Go test, and Berg Balance Scale before and 3 months after surgery.

    RESULTS AND CONCLUSION: (1) Compared with the total knee arthroplasty group, the unicompartmental knee arthroplasty group had shorter operation time and hospitalization time (P < 0.001). (2) At 3 months after surgery, there was no significant difference in the Hospital for Special Surgery score, range of motion of the knee joint, Timed Up and Go test or Berg Balance Scale score between two groups (P > 0.05). The Tecnobody Proprioception Test System scores at 3 months after surgery in the unicompartmental knee arthroplasty group were significantly higher than those in the total knee arthroplasty group (P < 0.001). (3) These results indicate that both unicompartmental and total knee arthroplasties have satisfactory short-term results in the treatment of unicompartmental knee osteoarthritis. Unicompartmental knee arthroplasty is superior to total knee arthroplasty in terms of operation time, hospitalization time, and balance function recovery.
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    Severity of patellofemoral osteoarthritis does not affect the prognosis of total knee arthroplasty with patella retention
    Xu Changbo, Zhang Yi, Yin Li
    2020, 24 (6):  833-838.  doi: 10.3969/j.issn.2095-4344.2447
    Abstract ( 425 )   PDF (27056KB) ( 43 )   Save

    BACKGROUND: There is no uniform standard on whether the patella is replaced in total knee arthroplasty. There are many control studies on patella replacement versus non-replacement, but few studies compare the prognosis of non-replacement patella according to the severity grade of patellofemoral arthritis.

    OBJECTIVE: To compare the effects of patellofemoral arthritis on prognosis of total knee arthroplasty with patella retention according to the severity of patellofemoral arthritis, 

    METHODS: One hundred and ninety-two cases of total knee arthroplasty who received patella retention with Depuy Synthes prosthesis in the First Affiliated Hospital of Zhengzhou University from January 2016 to January 2017 were retrospectively analyzed, and the follow-up time was more than 2 years. According to the Lwano classification system, the imaging severity of patellofemoral arthritis was graded into mild group (0-I period, n=83) and severe group (phase II-IV, n=109). All patients signed the informed consents and the study was approved by the hospital ethics committee. Clinical prognosis was assessed by Knee Society Score, functional score, Feller score and anterior knee pain score. The imaging prognosis was assessed by patella tilt angle, fit angle, patella displacement distance and patellar ligament ratio. The statistical method of t test was used to analyze the clinical and imaging results before and after surgery.

    RESULTS AND CONCLUSION: (1) One patient had persistent anterior knee pain, and one patient had wound effusion and secondary healing after debridement. The remaining patients achieved first-stage healing. (2) There were significant differences in the preoperative functional scores and Knee Society Score between mild and severe groups (P < 0.05). No significant differences were found in postoperative functional scores or Knee Society Score between two groups (> 0.05). (3) There was a significant difference between two groups in the patella tilt angle, fit angle and patella displacement distance before surgery (< 0.05). There were no significant differences in above indexes after surgery between two groups (> 0.05). (4) In summary, after at least 2 years of follow-up, the severity of patellofemoral arthritis makes no effect on the clinical and imaging prognosis of patients undergoing total knee arthroplasty with patella retention. Even in patients with severe patellofemoral arthritis, a good prognosis is obtained after total knee arthroplasty with patella retention.

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    Effectiveness and safety of modified sliding chute bone graft plus hollow screw fixation for tibiotalar joint fusion
    Han Xinguang, Yin Zhijiang, Wang Xiangcheng, Yang Chenyu, Shang Jian
    2020, 24 (6):  839-842.  doi: 10.3969/j.issn.2095-4344.2426
    Abstract ( 403 )   PDF (17354KB) ( 71 )   Save

    BACKGROUND: Tibiotalar joint fusion ways are various, and it is a difficulty in necrotic tibiotalar joint fusion. There are few comparative studies on the repair outcomes of each implant.

    OBJECTIVE: To compare the effectiveness and safety of modified sliding chute bone graft plus hollow screw fixation with simple screw internal fixation and plate internal fixation for tibiotalar joint fusion.

    METHODS: Fifty-six patients who underwent tibiotalar joint fusion were included, including 16 cases of screw fixation, 22 cases of plate fixation and 18 cases of modified sliding chute bone graft plus hollow screw fixation. Ankle function was compared after simple screw internal fixation, plate internal fixation and modified sliding chute bone graft plus hollow screw fixation. The ankle foot scoring system of American Orthopedic Foot and Ankle Society was used for evaluation. At the same time, the operation time, brace fixation time and fusion time of the three surgical methods were compared. The gait at the last follow-up was compared. The average follow-up time was 2.4 years. The experiment met the ethical requirements of the First Affiliated Hospital of Harbin Medical University. All patients provided written informed consent for study participation.

    RESULTS AND CONCLUSION: (1) All the patients obtained exactly bony fusion. Compared with the plate fixation group, the slide bone grafting group had significant advantages in the fusion time and the last gait (P < 0.05), and the screw fixation group had significant advantages in the operation time (P < 0.05). (2) Using the ankle foot scoring system of American Orthopedic Foot and Ankle society, there was no significant difference between the sliding chute bone graft group and the plate fixation group, but both groups were significantly better than the screw fixation group (P < 0.05). (3) Adverse events had not been found in each group. (4) These results suggest that modified sliding chute bone graft plus hollow screw fixation for ankle joint fusion can effectively improve ankle joint fusion rate compared with single screw fixation, which is effective and safe.

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    A comparative study of mini-locking plate and external fixator in the treatment of comminuted cuboid fracture
    Wang Min, Ma Wenze, Li Wencheng, Liang Cai, Wang Jinhui
    2020, 24 (6):  843-849.  doi: 10.3969/j.issn.2095-4344.2424
    Abstract ( 445 )   PDF (27204KB) ( 47 )   Save

    BACKGROUND: Open reduction internal fixation and external fixation are two main surgical treatments for comminuted cuboid fractures. With the development of internal fixation devices, especially the appearance of mini-locking plate, the therapeutic effect of internal fixation has been improved.        

    OBJECTIVE: To compare the clinical and imaging effects of mini-locking plate and external fixator in the treatment of comminuted cuboid fracture.          

    METHODS: The data of 43 patients with comminuted cuboid fracture admitted to the Department of Orthopedics, Tianjin Port Hospital from January 2013 to March 2018 were retrospectively analyzed. According to different treatment methods, the patients were divided into two groups: 23 cases in the mini-locking plate group and 20 cases in the external fixator group. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The patients in both groups were confirmed as comminuted cuboid fracture by CT and three-dimensional reconstruction scan before operation. Bone graft support of allograft was performed during the operation, and the external fixator was removed within 3-4 months after operation. At the last follow-up, bilateral standing and anteroposterior and lateral X-ray examination was performed to compare the loss of height, length, width, lateral longitudinal arch angle, calcaneal fifth metatarsal angle, Maryland foot score, American Orthopedic Foot and Ankle Society Score and the incidence of complications between the two groups. 

    RESULTS AND CONCLUSION: (1) All patients were followed up for more than one year. (2) There were no significant differences in height loss of cuboid bone, width loss, last lateral longitudinal arch angle, and calcaneal fifth metatarsal angle between the two groups (P > 0.05). (3) There were significant differences in the loss of cuboid bone length, Maryland foot score and American Orthopedic Foot and Ankle Society Score and the incidence of complications between the two groups (< 0.05). Mini-locking plate group was superior to the external fixator group in above indexes. (4) These findings indicated that mini-locking plate and external fixator are effective methods for the treatment of comminuted cuboid fracture. Micro-locking plate has more advantages in maintaining the length of cuboid bone, clinical function and reducing complications. With the prolongation of time, stable foot and good function can be achieved.           

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    Treatment of ulnar coronoid process fractures in complex elbow injury with plate fixation through an anterior approach 
    Feng Weilou, Li Shuhao, Zhang Kun, Zhu Yangjun, Heng Lisong, Li Zijun, Zhang Jun, Feng Dongxu
    2020, 24 (6):  850-855.  doi: 10.3969/j.issn.2095-4344.1934
    Abstract ( 397 )   PDF (26734KB) ( 38 )   Save

    BACKGROUND: Ulnar coronoid process has special anatomy and it is adjacent to vascular nerve. It is characterized by weak fixation, unstable recurrence, postoperative elbow joint stiffness and pain. These make the treatment of ulnar coronoid process fracture, in particular in complex elbow joint injuries, challenged.

    OBJECTIVE: To investigate the efficacy of internal fixation with steel plate through an anterior approach on ulnar coronoid process Regan-Morrey type II or type III fracture in complex elbow injury.

    METHODS: Sixteen patients with complex elbow injury and ulnar coronoid process fractures who underwent open reduction and internal fixation were followed up between September 2012 and May 2017. Among these patients, 11 patients had Regan-Morrey type II fracture, 5 patients had Regan-Morrey type III fracture, 14 patients had humeral head fracture, and 2 patients had ulnar olecranon fracture. All patients provided written informed consent. This study was approved by the Medical Ethics Committee of Hong Hui Hospital, China. Ulnar coronoid process fractures were reduced and fixed with steel plate through the space between the median nerve and the radial artery using an anterior approach. At the same time, all radial humeral head and olecranon fractures were treated by internal fixation.

    RESULTS AND CONCLUSION: All patients acquired acceptable reduction and firm fixation of fractured fragments. All of them were followed up for 13-28 months. At the final follow-up, solid osseous union was confirmed for all coronoid fractures. The average time to radiologic union was 16.5 weeks. The mean flexion-extension arc was 113.4°, the flexion contracture was 13.8°, and further flexion was 127.2°. The mean pronation arc was 72.5°. The mean supination arc was 74.7°, and the mean forearm rotation arc was 146.9°. 11 patients achieved functional arc of motion. All patients were satisfied with the treatment with the mean Mayo Elbow Performance score of 90.3 points. 11 patients achieved excellent elbow performance and 5 patients achieved good elbow performance. These results suggest that ulnar coronoid process fractures in complex elbow injury can be treated successfully with an anterior surgical approach. This approach allows for accurate and rigid internal fixation with steel plate and early functional exercise, resulting in a reasonable outcome.
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    CT localization on suprascapular nerve and clinical application value in arthroscopic Bristow-Latarjet
    Yuan Shengchao, Tan Zhichao, Lin Fuchun, Du Erzhu, Guo Jinhua, Yang Chun
    2020, 24 (6):  856-861.  doi: 10.3969/j.issn.2095-4344.2448
    Abstract ( 257 )   PDF (27762KB) ( 32 )   Save

    BACKGROUND: The Bristow-Latarjet technique is a reliable treatment for recurrent anterior shoulder instability. However, it as been reported 1.6% of patients suffering nerve injury. Thereafter, the all-arthroscopic Latarjet procedure has been gaining popularity, but the surgeon is unable to palpate the nerves, and their localization, so protection is a difficulty.

    OBJECTIVE: To investigate the CT localization of suprascapular nerve on the posterosuperior scapular neck, and to improve the safety and quality in Bristow-Latarjet surgery.

    METHODS: This study was carried out on 12 normal formalin fixed adult cadaveric upper limb specimens (8 males and 4 females). The study was in accordance with the ethical requirements of Dongguan Hospital of Traditional Chinese Medicine. The nerve trunk and branches were marked with developing lines to examine the position and course of nerve on the posterosuperior scapular neck. CT localization was used to measure the distance, angle and height ratio to glenoid from the superior pole of scapula, spinoglenoid notch, the entry point of outermost nerve branch to anterior and posterior margin of the glenoid, through internally and externally rotating 45 degrees of should joints. The data were statistically analyzed.

    RESULTS AND CONCLUSION: (1) Pearson correlation analysis: the height of glenoid was positively correlated with the distance from the spinoglenoid notch and entrance point to the articular surface. (2) Comparison between internal and external rotation 45 degrees: distance of superior pole of scapula and angles showed no significant difference (all P > 0.05). There were significant differences in the distance and angle in the spinoglenoid notch (all P < 0.01), but height ratio was not significantly different (P > 0.05). There were significant differences in distance, angle, and height ratio at entrance point (all P < 0.01), suggesting that external rotation had larger angle and safer range of distance than internal rotation. (3) In the position of internal and external rotation 45 degrees, the distance, angle and height ratio of spinoglenoid notch and entrance point showed significant differences (P < 0.01), indicating that compared with spinoglenoid notch, the angle between entrance point and articular surface was smaller, the distance from entrance point to articular surface was shorter, and the height ratio was higher. (4) Therefore, external rotation is recommended in the case of internal fixation of the bony tunnel for the posterior glenoid so as to reduce the incidence of nerve injury.

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    Design of the prosthetic socket and the finite element analysis of the interfacial stress
    Wang Xiaohui, Wang Kun, Hu Zhiyong, Tian Hongliang
    2020, 24 (6):  862-868.  doi: 10.3969/j.issn.2095-4344.2442
    Abstract ( 492 )   PDF (25958KB) ( 50 )   Save

    BACKGROUND: Biomechanical properties of the residual limb-socket interface not only have a direct impact on the fit of the prosthesis, but also the basis for optimal design of the socket structure. Combining digital design technology with rehabilitation medical engineering will effectively improve the efficiency and quality of the prosthesis socket.

    OBJECTIVE: The reverse-positive combined modeling method was used to design a custom-made socket model for patients with calf amputation to evaluate the interfacial stress between the residual limb and the socket. The socket was iteratively designed. The optimized model was produced by three-dimensional printing to improve traditional hand-made socket methods.

    METHODS: Two patients with calf amputation were selected (Volunteers of the Inner Mongolia Honorary Military Rehabilitation Center). According to the CT scan image of the patient’s residual limb, Mimics was used for image processing, and then Geomagic and UG were used to obtain the geometric model of the residual limb. Through the use of the computer-aided design software Fusion360, the socket was forward modeled according to the different tolerances of the tissue structure of the various parts of the residual limb. The Mooney-Revlin superelastic model was used to define the material properties of the soft tissue, and the finite element analysis of the residual limb-socket interface stress was performed. The iterative design of the socket was carried out according to the feedback of the results, and the acceptance socket model after re-modification was evaluated. Three-dimensional printing produced a socket, which received experimental measurements.

    RESULTS AND CONCLUSION: (1) The stress of the interface between the socket and the residual limb after iterative design was analyzed, and the stress values of the residual limbs were lower than the pain threshold, which met the design standard and could achieve functional transferability and safety comfort. (2) Two patients wearing three-dimensional printing made the socket adaptability and stability, and the walking symmetry was significantly improved compared with the hand-made socket, meeting the biomechanical requirements of the residual limb. (3) A complete design, evaluation and manufacturing system for the prosthetic lumen was established.
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    Digital measurements of the anatomical parameters of pedicle-rib unit screw fixation in thoracic vertebrae of preschoolers
    He Yujie, Wang Haiyan, Li Zhijun, Li Xiaohe, Cai Yongqiang, Dai Lina, Xu Yangyang, Wang Yidan, Xu Xuebin
    2020, 24 (6):  869-876.  doi: 10.3969/j.issn.2095-4344.2435
    Abstract ( 418 )   PDF (33191KB) ( 40 )   Save

    BACKGROUND: Pedicle screw internal fixation has been widely used in the lumbar spine, and fixed application in thoracic vertebra has gradually been accepted. Considering the narrow thoracic pedicle, especially at T3-T9, pedicle screw always punctures the cortex and important adjacent structures. To avoid serious complications, researchers developed the external pedicle approach from the costal transverse process joint and the costal vertebra joint to the vertebral body, and then others designed a similar screw entry method, which can provide enough safe paths as long as the ribs are not penetrated. At present, the existing studies mainly focus on the upper and middle thoracic vertebrae in adults.

    OBJECTIVE: To measure the anatomical parameters of pedicle-rib unit screw fixation in thoracic vertebrae of preschoolers, and to explore their developmental regularity and morphological characteristics at different age groups and sexes, so as to provide theoretical basis for clinical practice.

    METHODS: Sixty-seven preschoolers aged 7-12 years old without bone destruction, tumor, deformity, degeneration or fractures at the spine and no history of spine related surgery were selected. Three-dimensional reconstruction was conducted after spiral CT scanning. The morphological structure of pedicle-rib unit was observed. The transverse diameter, length, inclination angle and safety angle range of pedicle-rib unit screw were measured and analyzed statistically to investigate the feasibility of screw on anatomy. All guardians of the children signed the informed consents, and the study was approved by the hospital ethical committee.

    RESULTS AND CONCLUSION: (1) The transverse diameter of the thoracic pedicle-rib unit was increased with age, and decreased first and then increased with the increase of vertebral sequence. The transverse diameter in males was larger than in females at the same age. (2) The length of pedicle-rib screw channel was significantly different in different age groups (P < 0.05), which showed a significant increase with age and a trend of first increase and then decrease with the increase of vertebral sequence. (3) Pedicle-rib unit screw placement showed that safety angle range was 18°-25°, including maximum safety scope in T1, followed by T10, minimum in T4 and T5. (4) Thus, security angle range of pedicle-rib unit screw in children is narrower than that in adults. Compliance with the adult standards in screw placement may cause severe nerve damage to the nerves and blood vessels, so preoperative individualized screw placement should be carried out according to the CT results.

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    Digital three-dimensional morphology of cervical joint facet in 7-12-year-old children

    Liu Lu, Wang Xing, Kang Xiaoyan, Li Guihua, Li Xiaohe, Gao Shang, Cai Yongqiang, Zhang Shaojie, Li Zhijun
    2020, 24 (6):  877-881.  doi: 10.3969/j.issn.2095-4344.2449
    Abstract ( 366 )   PDF (23331KB) ( 74 )   Save

    BACKGROUND: Lots of researches by domestic and foreign scholars have confirmed that the asymmetry of facet joint surface or the articular angles might cause the degeneration of the facet joints, and the articular spondylolisthesis. But most of the studies focus on the adult. It has been confirmed that the most common cause of the cervical disease, of the osteoarthritis, of the neurovascular compression or even the paralysis is the pathological changes of facet joint for people as they grow older. There are few studies on the facet joints in children.

    OBJECTIVE: To explore the cervical joint facet morphology development characteristics and age-related changes by collecting the CT scanning data of cervical vertebrae in children aged 7-12 years old, three-dimensional reconstruction and cervical facet joint morphology measurement and analysis.

    METHODS: Through collecting the data of multi-layers spiral CT scan of children in the First Affiliated Hospital and Second Affiliated Hospital of Inner Mongolia Medical University and Inner Mongolia International Mongolian Hospital from September 2013 to September 2015, 99 cases of cervical structures were selected. Then DICOM format of original data were imported in Mimics software for three-dimensional reconstruction. Morphological measurement was conducted on the three-dimensional model. The study was approved by the Ethical Committee of Inner Mongolia Medical University on March 11, 2015, approval No. YKD2015049.

    RESULTS AND CONCLUSION: (1) The length of children cervical joint facet was on a rise with age and a decreasing trend with ordinal number of vertebrae. (2) The width of children middle upper cervical joint facet showed “V” type. The width of children lower cervical joint facet increased with the increase of vertebral order. (3) The trend of distance between articular tubercles was “spike” shape. (4) The coronal angle of joint facet presented to be “V” shape. (5) The sagittal angle of joint facet was in inverted “V” shape. (6) In summary, there is no asymmetry of articular process in the morphological characteristics of cervical facet joints in 7-12-year-old children.

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    Biomechanical analysis of computer assisted-two cannulated screw fixation for treating femoral neck fracture 
    Shen Hongquan, Lu Hui, Zhang Xiaohua, Guo Jinwei, Yang Bowen, Yu Luxin, Zhu Ming
    2020, 24 (6):  882-887.  doi: 10.3969/j.issn.2095-4344.2450
    Abstract ( 493 )   PDF (23678KB) ( 111 )   Save

    BACKGROUND: There are two kinds of cannulated screws (single- and double-headed) in clinic. Common single-headed cannulated compression screw is easy to cause shortened femoral neck, and screw dropping occurs usually when osteoporosis; thereafter, choosing single- or two-headed cannulated compression screw in the treatment of femoral neck fracture remains controversial.

    OBJECTIVE: To investigate the biomechanical effects of two double-headed and ordinary (single-headed) cannulated compression screws and different spatial configurations in the treatment of femoral neck fractures by finite element analysis.  

    METHODS: The original DICOM data were obtained by collecting a thin layer CT scan of the proximal femur of a healthy adult volunteer (male, 30 years old). The proximal femoral model was established in MIMICS10.01 software. The model was imported into the UG 8.0 software to establish the femur neck fracture model (Pauwels angle 60°). A three-dimensional model of double-headed and ordinary cannulated compression screw was obtained by three-dimensional scanning modeling. In the UG 8.0 software, the femoral neck fracture assembly modeling was performed according to the horizontal and vertical distribution of two screws. The established model was introduced into the ANSYS 14.5 software to calculate the opening angle of the femoral neck fracture, the relative displacement of the fracture end and the stress distribution. 

    RESULTS AND CONCLUSION: (1) In terms of biomechanical stability: the opening angle and displacement of the fracture end in the two screws in the horizontal position group were smaller than those in the vertical position group. The opening angle and displacement of the double-headed cannulated compression screw group were smaller than those in the ordinary cannulated compression screw. (2) Stress distribution: the stress distribution of the two screws was different. The stress distribution on the screw in the double-headed group was more dispersed than that in the ordinary group, and some stress was transmitted to the tail of the screw. In the ordinary group, the stress on the screw was mainly concentrated on the fracture end. There was also a difference in the stress distribution between horizontal and vertical position groups. When the two screws were horizontally fixed, the stress distribution on the front screw was more concentrated, while the vertical position was mainly concentrated on the upper one. (3) These results imply that the double-headed cannulated compression screw is more stable and reliable than the ordinary cannulated compression screw in the treatment of femoral neck fracture. The horizontal fixation of the two screws has better biomechanical stability than the vertical fixation. Therefore, the clinical application of double-head compression screws can be used to treat femoral neck fractures. When two screws are selected, horizontal fixation should be used.

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    Biomechanical characteristics of bridge-link type combined internal fixation system with mixed-rod versus double-rod in the treatment of femoral and tibial fractures
    Wang Liang, Huang Zhaozhao, Yu Jiaona, Gu Weidong, Wang Ren, Qian Zhiyi
    2020, 24 (6):  888-892.  doi: 10.3969/j.issn.2095-4344.1189
    Abstract ( 353 )   PDF (24016KB) ( 133 )   Save

    BACKGROUND: The double-rod of bridge-link type combined internal fixation system belongs to eccentric fixation, which may lead to the weakening of longitudinal fixation and the decrease of transverse anti-torsion after operation.

    OBJECTIVE: To compare the biomechanical characteristics of bridge-link type combined internal fixation system with mixed-rod and double-rod in the treatment of femoral and tibial fractures.

    METHODS: Twenty human long bone diaphysis models were made by 40 short polyformaldehyde materials. Of these, 10 were fixed by mixed-rod, and the rest with bridge-link type combined internal fixation system. Axial compression tests and radial torsion tests were carried out (five models were selected from each group). The changes of axial compression forces and displacements and transverse torque and angle were observed. The maximum load was recorded when the curve had a break point or in a horizontal state, and then the yield load was calculated.

    RESULTS AND CONCLUSION: (1) When the axial compression load was ≤ 2 000 N, and with same displacement, the axial compression yield load in the mixed-rod group was larger than that in the bridge-link type combined internal fixation system group. When the axial compression load was > 2 000 N, and with the same displacement, the axial compression yield load in the bridge-link type combined internal fixation system group was larger than that in the mixed-rod group. The maximum axial compression yield load in the bridge-link type combined internal fixation system group was larger than that in the mixed-rod group [(2 420.60±5.67), (2 721.40±5.80) N, t=-82.885, P=0]. (2) When the radial torsional yield load was ≤ 50 N•m, and with the same angle, the torque in the mixed-rod group was less than that in the bridge-link type combined internal fixation system group. When the radial torsional yield load was > 50 N•m, and with the same angle, the torsion in the mixed-rod group was greater than that in the bridge-link type combined internal fixation system group. The maximum radial torsional yield load in the mixed-rod group was larger than that in the bridge-link type combined internal fixation system group [(101.85±2.97), (85.41±2.82) N•m, t=8.985, P=0]. (3) These results indicate that the mixed-rod and of bridge-link type combined internal fixation system can be used to fix the fractures strongly, but the mixed-rod is more stable and reliable, thus it is easier to promote fracture healing. The fracture end is easy to create slight movement after the fracture is fixed with transverse mixed-rod, which is in accordance with elastic fixation. The maximum anti-torsion and anti-fatigue performance is better than the double-rod, which prevents from breakage.

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    Biomechanical characteristics of the distal radius fracture based on three-dimensional finite element model of ulna and radius
    Xia Changjiang, Yuan Zhifeng, Fang Ning
    2020, 24 (6):  893-897.  doi: 10.3969/j.issn.2095-4344.2451
    Abstract ( 390 )   PDF (24863KB) ( 103 )   Save

    BACKGROUND: In recent years, most qualitative studies on the mechanism of distal radius fracture are limited to two-dimensional analysis, which is susceptible to many factors, resulting in unsatisfactory results. The use of CT data to establish a three-dimensional finite element model can better evaluate human skeletal variation.

    OBJECTIVE: To establish a three-dimensional finite element model of the radius and ulna, to test the biomechanics of distal radius fracture and to study the mechanism of distal radius fracture.

    METHODS: Left upper limb of one 50-year-old healthy female was selected to obtain CT imaging data from distal humerus to middle carpal joint. The three-dimensional finite element model of radius and ulna was established by using three-dimensional finite element analysis software Ansys 16.0. The force load of wrist back extension, palm flexion, ulnar deviation, and radial deviation were simulated. The stress of each part of the model under different loads was observed and recorded. The fracture formation and crack direction of distal radius at different model angles were analyzed.

    RESULTS AND CONCLUSION: (1) When the wrist joint was in dorsal extension position, the compressive stress at the midpoint of the dorsal radial margin of the forearm pronation and forearm supination increased with the increase of the dorsal extension angle, the tension stress on the volar radius of the forearm pronation and forearm supination increased with the increase of the dorsal extension angle. (2) When the wrist joint was in the metacarpal flexion position, the tension stress at the midpoint of the dorsal radius of the forearm pronation and the forearm supination increased with the increase of the metacarpal flexion angle. The compressive stress on the volar radius of the forearm pronation and forearm supination increased with the increase of the palmar flexion angle. (3) When the forearm was pronated dorsiflexion and supinated metacarpal flexion, the radial crack first appeared on the side of the maximum tension on the surface of the distal radius at the junction of cancellous bone and dense bone, the fracture crack developed along the distal metacarpal to the proximal dorsal end and at an angle of 45 degrees to the bone axis. (4) When the forearm was pronated metacarpal flexion and supinated dorsiflexion, the radial crack first appeared on the side of the maximum tension on the surface of the distal radius at the junction of cancellous bone and dense bone, the fracture crack developed along the far back end to the proximal palmar side and at an angle of 45 degrees to the bone axis. (5) To conclude, with the force load on wrist dorsal extension, metacarpal flexion, ulnar deviation, and radial deviation, the fracture first occurs on the maximum surface tension side of the distal radius at the junction of cancellous bone and dense bone, the direction of the crack is related to the directions of shear stress and tension stress. 
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    Correlation of parameters of lordosis type cervical spine saggital plane in asymptomatic adults
    Cao Bin, Zuo Yuqiang, Li Cunrui, Kang Weifeng, Yu Haiquan, Su Jingyang
    2020, 24 (6):  898-902.  doi: 10.3969/j.issn.2095-4344.2428
    Abstract ( 385 )   PDF (21433KB) ( 193 )   Save

    BACKGROUND: Normal sagittal balance of cervical spine is the key to cervical spine orthopedic surgery. As the complexity of the anatomical structure and physiological function of the cervical spine, accurate measurement of sagittal balance parameters and correlation between parameters become an important reference for preoperative planning and postoperative evaluation of curative effect. Current research focuses on patients with clinical symptoms of cervical syondylosis.

    OBJECTIVE: To investigate the correlation of parameters of lordosis type cervical spine saggital plane in asymptomatic adults.

    METHODS: Cervical anteroposterior and lateral DR images of 120 adult patients with asymptomatic lordosis type cervical spine were retrospectively analyzed. The subjects were divided into three groups according to age: group A (21-40 years), group B (41-60 years), and group C (61-80 years). The sagittal parameters of the cervical spine were measured, including C2-C7 sagittal vertical axis (C2-C7 SVA), central of gravity to C7 sagittal vertical axis (CG-C7 SVA), T1 slope, C0-C2 Cobb angle and C2-C7 Cobb angle. The correlation between different imaging parameters and age was analyzed. This study was approved by the Ethics Committee, First Hospital of Shijiazhuang and Second Hospital of Hebei Medical University. All subjects signed the informed consent.

    RESULTS AND CONCLUSION: (1) C2-C7 SVA (F=11.188, P < 0.001), CG-C7 SVA (F=6.132, P=0.003) and T1 slope (F=11.682, P < 0.001) were significantly different among different groups. There was no significant difference in C0-C2 Cobb angle (F=1.178, P=0.311) and C2-C7 Cobb angle (F=0.860, P=0.426). (2) T1 slope was (51.63±5.85)°, (54.66±5.58)° and (57.48±4.74)° in groups A, B and C, respectively. Linear correlation analysis showed that T1 slope was positively correlated with age (r=0.533, P < 0.001). T1 slope was positively correlated with C2-C7 Cobb angle (r=0.561, P < 0.001). These results indicated that T1 slope increased with age in asymptomatic cervical lordosis adults. Moreover, Tslope was positively correlated with age. 


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    Four-dimensional space events of fracture healing
    Liu Zhendong, Qin Sihe
    2020, 24 (6):  903-910.  doi: 10.3969/j.issn.2095-4344.2452
    Abstract ( 517 )   PDF (39460KB) ( 84 )   Save

    BACKGROUND: Fracture fixation and surgical procedures have a very important impact on the final outcome of fracture healing, but the adverse outcome of fracture healing is the result of the combined action of surgical procedures and a series of four-dimensional space events.

    OBJECTIVE: To explore the four-dimensional space events in fracture healing.

    METHODS: China National Knowledge Infrastructure and Medline were retrieved, with the key words of “fracture healing, femoral fracture, stress shielding, fracture and blood flow” in Chinese and English. Retrieval of relatively macroscopic factual descriptions corresponds to the four-dimensional space events of fracture healing process, including logically supported and refuted evidence. Combined with literature review, the main four-dimensional space events after fracture fixation were analyzed.

    RESULTS AND CONCLUSION: The main four-dimensional space events after fracture fixation include blood flow tides, mechanical and biological impulses, grinding disc effect of small gap in hard tissue, stress shielding effect and four-dimensional space drift effect of internal fixation material. Fractures and surgical trauma are accompanied by months of super-compensatory blood flow tides, so there is no ischemia in the macro-level after fracture surgery, but the grinding disc effect will occur in the small gap of hard tissue under unstable condition, resulting in contusion injury and micro-ischemia in the fracture gap. Stress shielding effect caused by too strong fixation is an important reason for refracture after internal fixation removal and bone atrophy and thinning after internal fixation. The small axial drift of plate fixation screw may have important theoretical significance. It has “intelligent” axial dynamic effect, which can make the stress shared by plate gradually decrease with the healing of fracture. Discussing the four-dimensional space events of fracture healing will provide basic logic for the regulation of fracture healing and distraction osteogenesis.
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    Application advantages and prospect of three-dimensional printing technology in the diagnosis and treatment of posterior column fracture of tibial plateau
    Gao Di, Zhang Qing, Liu Rong
    2020, 24 (6):  911-916.  doi: 10.3969/j.issn.2095-4344.2434
    Abstract ( 412 )   PDF (33540KB) ( 100 )   Save

    BACKGROUND: Application of three-dimensional printing technology provides an effective supplementary means for minimally invasive and individualized surgery of posterior column fracture of tibial plateau.

    OBJECTIVE: To summarize the present situation of diagnosis and treatment of posterior column fracture of tibial plateau, and to look forward to the effect of three-dimensional printing technology in the diagnosis and treatment of posterior column fracture of tibial plateau.

    METHODS: A computer-based retrieval of CNKI, WanFang, and PubMed databases was conducted using the keywords of “the fracture of tibial plateau, posterior column, 3D printing technology” in Chinese and English, respectively. Totally 210 articles were retrieved, and 56 eligible articles were finally included for review based on inclusion and exclusion criteria. The detailed contents included classification of posterior column fracture of tibial plateau, surgical treatment, application status of three-dimensional printing technology and postoperative rehabilitation.

    RESULTS AND CONCLUSION: Posterior column fracture of tibial plateau is a special type of plateau fracture, so the traditional method may lead to misdiagnosis. However, the solid model based on three-dimensional printing can directly make diagnosis, and analyze the injury mechanism and classification. In the treatment of posterior column fracture of tibial plateau, there are various traditional surgical approaches to choose: the posterior approach (postmedial approach, posterolateral approach), backward medial inverted “L” into the approach, anterolateral/anterolateral approach, anterolateral posterolateral combined approach, arthroscopy minimally invasive treatment and so on, but have not been unified yet. The application of three-dimensional printing technology has further improved the diagnosis and classification of posterior column fracture of tibial plateau, and provides a reference for preoperative guidance of personalized surgical plan, surgical approach selection, estimation of intraoperative bone implant volume and postoperative rehabilitation. 
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    Internal fixation strategies for different lateral wall types of intertrochanteric fractures of the femur
    Guo Tianqing, Xue Fei, Feng Wei
    2020, 24 (6):  917-923.  doi: 10.3969/j.issn.2095-4344.2453
    Abstract ( 442 )   PDF (45813KB) ( 54 )   Save

    BACKGROUND: The importance of the lateral wall of the femoral trochanter in the intertrochanteric fracture has been paid more and more attention. The research on the classification of the external wall in guiding clinical operation has become a hot issue.

    OBJECTIVE: To review the treatment strategies of different lateral wall types of intertrochanteric fractures, and the selection of the built-in materials, provide reference and help for future clinical research.

    METHODS: The first author searched the Chinese database of Wanfang and China National Knowledge Infrastructure with the keywords of “intertrochanteric fracture of femur; lateral wall of femoral trochanter; fracture classification; fracture fixation, internal; implant; intramedullary fixation; extramedullary fixation; complications; elderly; prognosis”. Meanwhile, PubMed English database was retrieved with the keywords “intertrochanteric fracture of femur; lateral wall of femoral trochanter; fracture classification; fracture fixation, internal; implant; intramedullary fixation; extramedullary fixation; complications; elderly; prognosis”. The retrieval time was from May 2009 to May 2019. A total of 166 literatures were retrieved. According to the inclusion and exclusion criteria, 47 literatures were selected as the research object and summarized.

    RESULTS AND CONCLUSION: (1) During the surgical treatment of intertrochanteric fracture of the femur, intramedullary fixation system and extramedullary fixation system have their own advantages and disadvantages. After full analysis of lateral femoral trochanter wall classification and reasonable preoperative evaluation, it is a combination of theory and practice. Signing, correctly assessing the severity of fractures and judging the prognosis, and fully preoperative evaluation can greatly help the patient’s treatment effect and prognosis. (2) It is a basic quality of doctors and a responsible attitude towards patients to formulate different treatment plans according to their economic conditions and physical qualities. “Individualization” has become the future development trend. (3) There are still many disputes in the treatment of intertrochanteric fractures. More clinical research and data support are needed in the future to solve and improve it. 

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    Systematic review of triangle versus inverted triangle-configurated cannulated screws in the treatment of femoral neck fractures
    Ruan Zhe, Zhu Yong, Lin Zhangyuan, Long Haitao, Zhao Ruibo, Lu Bangbao, Sun Buhua, Cheng Liang, Zeng Min, Zhao Shushan
    2020, 24 (6):  924-930.  doi: 10.3969/j.issn.2095-4344.2429
    Abstract ( 485 )   PDF (23986KB) ( 226 )   Save

    BACKGROUND: The use of three cannulated screws is the preferred method for the treatment of femoral neck fractures for many years. However, some clinical studies have explored the clinical efficacy of triangular and inverted triangular hollow screw internal fixation in the treatment of femoral neck fracture, but the conclusions are not consistent.

    OBJECTIVE: To systematically review the efficacy of triangle and inverted triangle-configurated cannulated screws in the treatment of femoral neck fractures.

    METHODS: The PubMed, Cochrane Library, EMbase, CNKI and WanFang Database were searched up to May 2018, for studies concerning the efficacy of three cannulated screws fixation for femoral neck fractures. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. The meta-analysis and trial sequential analysis were performed by using RevMan 5.3 software and TSA 0.9 respectively.

    RESULTS AND CONCLUSION: (1) A total of 8 cohort studies involving 1 150 patients were included. (2) The results of meta-analysis showed that compared with the inverted triangle group, the triangle group was inferior in operation time [MD=12.30, 95%CI(4.83, 19.77), P < 0.01] and blood loss during the operation [MD=12.44, 95%CI(6.56, 18.32), P < 0.01]. However, there were no statistical differences between the two groups in femoral head osteonecrosis rate [OR=0.66, 95%CI(0.34, 1.29), P=0.22], nonunion rate [OR=1.37, 95%CI(0.86, 2.18), P=0.18] and the Harris scores in the final follow-up [OR=1.29, 95%CI(0.58, 2.26), P=0.53]. (3) Current evidence shows that inverted triangle group is superior to triangle group in shorting operation time and reducing blood loss. Nevertheless, there was no significant difference in femoral head osteonecrosis rate, nonunion rate, and the Harris scores < 70 in the final follow up. Because the inclusion of the study is mainly cohort study, and there is a large bias, so the above conclusions need to be verified by more multi-center randomized controlled trials.

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    Meta-analysis of the efficacy of medial femoral support plate combined with cannulated screws in the treatment of Pauwels type III femoral neck fracture
    Chen Xiang, Wei Dong, Ren Guangzong, Li Pengcui, Wei Xiaochun
    2020, 24 (6):  931-937.  doi: 10.3969/j.issn.2095-4344.2454
    Abstract ( 362 )   PDF (29294KB) ( 54 )   Save

    BACKGROUND: In recent years, some scholars have proposed the use of medial femoral neck support plate combined with cannulated screw internal fixation to treat Pauwels type III femoral neck fracture. This method can reduce the incidence of complications such as nonunion of the femoral neck fracture and femoral head necrosis. However, it is still controversial whether this treatment can accelerate fracture healing and reduce femoral head necrosis in clinic.

    OBJECTIVE: Meta-analysis was performed to evaluate the difference in the efficacy of femoral medial support plate combined with cannulated screw internal fixation and simple cannulated screw internal fixation for the treatment of Pauwels type III femoral neck fracture.

    METHODS: Cochrane Library, PubMed, Wanfang Medical Network, China National Knowledge Infrastructure, and China Journal Full-text Database were used to search for and collect the clinical Chinese and English literature of the trials regarding Pauwels III femoral neck fracture treated with internal femoral support plate combined with cannulated screw internal fixation and simple cannulated screw internal fixation. Two evaluators independently conducted quality evaluation, data extraction and cross-checking of the included studies, and finally performed meta-analysis on the collected data using RevMan 5.3 software.

    RESULTS AND CONCLUSION: (1) After screening, 5 related clinical trials were included, including 4 randomized controlled trials and 1 retrospective cohort study, for a total of 243 patients with Pauwels III femoral neck fracture. (2) Meta-analysis results showed that compared with simple cannulated internal fixation, operation time was longer [MD=23.19, 95%CI(8.32, 38.06), P=0.002], intraoperative blood loss was more [MD=83.48, 95%CI(32.08, 134.89), P=0.001], and healing time was shorter [MD=-1.56, 95%CI(-1.89, -1.24), P < 0.000 01], the incidence of complications was lower [RD=-0.07, 95%CI(-0.11, -0.02), P=0.003], and hip Harris score was higher [MD=7.39, 95%CI(3.18, 11.60), P=0.000 6] in the femoral medial support plate combined with cannulated screw internal fixation. However, there was no statistically significant difference in the excellent and good rate of hip function between the two treatments [OR=1.29, 95%CI(0.02, 74.86), P=0.90]. (3) In the treatment of Pauwels type III femoral neck fracture, compared with simple cannulated nail fixation, cannulated screws combined with medial support plate can shorten healing time, reduce postoperative complications and elevate postoperative Harris score.

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    Meta-analysis of intramedullary nail and locking plate in the treatment of proximal humeral fractures
    Chen Jintao, Han Shufeng
    2020, 24 (6):  938-946.  doi: 10.3969/j.issn.2095-4344.2425
    Abstract ( 419 )   PDF (32619KB) ( 226 )   Save

    BACKGROUND: Proximal humeral fractures are one of the most common types of upper limb fractures in adults. With the aging of the population, the incidence of proximal humeral fractures has been increasing in recent years, and its treatment is still controversial.

    OBJECTIVE: To compare the clinical efficacy of locking plate and intramedullary nail in the treatment of proximal humeral fractures using meta-analysis.

    METHODS: We retrieved PubMed, the Cochrane Library, Embase, CNKI, Wanfang, and VIP database to collect studies on intramedullary nail and locking plate in the treatment of proximal humeral fractures. In accordance with the inclusion and exclusion criteria, studies were included. Data were extracted from the included studies. Continuous variables (Constant score, operation time, blood loss) and binary classification variables (total complications, postoperative infection, screw cutout and internal fixation failure, humerus head necrosis, secondary surgery, and acromial impact) were analyzed, and considered as evaluation indexes for the meta-analysis. Statistical software Stata12.0 was used to analyze the data. 

    RESULTS AND CONCLUSION: (1) A total of 8 articles and 891 patients were included, and 9 data were analyzed. (2) The amount of blood loss (SMD=-1.82, 95%CI: -2.77–-0.87, P < 0.001) and operation time (SMD=-1.47, 95%CI: -2.13–-0.80, P < 0.001) in the intramedullary nail group were superior to those in the locking plate group. The remaining results were not statistically significant between the two groups (P > 0.05). (3) These results confirmed that intramedullary nailing is superior to locking plate in operation time and intraoperative blood loss in the treatment of proximal humeral fractures. The results were similar in total complication rate, common complication rate and postoperative recovery of shoulder joint function between the two groups.

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    Intramedullary fixation versus plate fixation in the treatment of displaced mid-shift clavicle fractures: a meta-analysis
    Liang Jie, Xiang Feifan, Yang Kun, Sun Yuanlin, Zhou Wei, Xiang Yong, Yang Yunkang
    2020, 24 (6):  947-955.  doi: 10.3969/j.issn.2095-4344.2455
    Abstract ( 328 )   PDF (32938KB) ( 44 )   Save

    BACKGROUND: Elastic intramedullary nail and steel plate are two commonly used instruments for clavicle fracture, However, there are few comparative studies on the advantages and disadvantages of them.

    OBJECTIVE: To systematically evaluate the treatment effects of intramedullary fixation or plate fixation for displaced mid-shift clavicle fractures.

    METHODS: Articles about the treatment effects of intramedullary fixation or plate fixation for displaced mid-shift clavicle fractures were searched in PubMed, Embase, Science Direct and Cochrane Library, CNKI, WanFang and VIP databases from inception to March 2017. Two reviewers independently screened the articles, extracted data and evaluated the bias risk in the included studies according to the inclusion and exclusion criteria. Meta-analysis was performed using ReMan 5.3 software.

    RESULTS AND CONCLUSION: (1) A total of 21 studies were included, with 859 patients in the intramedullary fixation group and 831 patients in the plate fixation group. (2) The result of meta-analysis showed that the operation time [MD=-18.62, 95%CI (-20.75, -16.49)], blood loss [MD=-56.23, 95%CI (-68.02, -62.44)], incision length [MD=-5.53, 95%CI (-6.56, -4.49)], hospitalization time [MD=-1.01, 95%CI (-1.13, -0.89)], and healing time [MD=-1.39, 95%CI (-1.98, -0.80)] in the intramedullary fixation group were better than those of the plate fixation group. (3) At 6 months after surgery, the Disabilities of the Arm, Shoulder and Hand scores in the intramedullary fixation group were better than those in the plate fixation group (P < 0.05). The scores showed no significant difference between two groups at 12 months after surgery. (4) Major complications [OR=0.61, 95%CI (0.39, 0.93)] in the intramedullary fixation group were less than those in the plate fixation group. Minor complications and implant removal were similar between two groups. (5) Meta-analysis results imply that elastic intramedullary nail fixation for treating displaced mid-shift clavicle fractures is superior to plate fixation in surgery-related indexes, functional recovery and fracture healing, which can provide effective evidence for its clinical application.

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    Surgical staples and skin closure tape in primary total knee arthroplasty: a systematic review and meta-analysis
    He Zongru, Zhang Wenhui, Cheng Mingxia, Yang Yuping, Yan Peijing, Liu Jie, Yang Kehu, Qian Yaowen
    2020, 24 (6):  956-961.  doi: 10.3969/j.issn.2095-4344.2427
    Abstract ( 400 )   PDF (22283KB) ( 52 )   Save

    BACKGROUND: Skin closure with surgical staplers has been widely used in total knee arthroplasty. In recent years, a new kind of skin closure tape has also achieved good results in total knee arthroplasty. There is no clear report on which method of skin closure is better.

    OBJECTIVE: To statistically analyzed the effect of two skin closure techniques in total knee arthroplasty.

    METHODS: The two researchers independently searched the relevant literature in PubMed, Cochrane library, EMBASE, Chinese Biomedicine Database, China National Knowledge Infrastructure, Wanfang Data and the VIP Chinese Sci-tech Journal Database. The retrieval time was from inception to April 2019. The literature was screened and finally included in the study.

    RESULTS AND CONCLUSION: A total of four studies were included, both of which were the literature in English. (1) In terms of the primary index, the re-admission rate of skin closure tape (RR=0.68, 95%CI:0.49-0.95, P=0.03) could be reduced compared with the staple. However, there was no significant difference in the incidence of complications between the two (RR=0.85, 95%CI:0.27-2.64, P=0.77). (2) In the aspect of secondary indexes, skin closure tape could relieve pain, save time and cost, and have good cosmetic effect though there was no significant difference in the removal time of closed materials between the two. (3) Results indicated that according to the existing literature, compared with surgical staples, skin closure tape is a less painful skin closure method with fewer complications in total knee arthroplasty. Because of the limited sample size, more studies and longer follow-up time are needed to confirm this conclusion. 

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    Systematic evaluation of the efficacy and safety of collum femoris preserving prosthesis in total hip arthroplasty 
    Huang Hetao, Pan Jianke, Yang Weiyi, Zeng Lingfeng, Liang Guihong, Liu Jun
    2020, 24 (6):  962-967.  doi: 10.3969/j.issn.2095-4344.2456
    Abstract ( 380 )   PDF (26334KB) ( 47 )   Save

    BACKGROUND: Total hip arthroplasty with femoral neck prosthesis is being accepted by more and more doctors, but the effect of femoral neck prosthesis preservation or not on total hip arthroplasty is still uncertain.

    OBJECTIVE: To systematically evaluate the efficacy and safety of collum femoris preserving prosthesis in total hip arthroplasty.

    METHODS: CBM, CNKI, VIP, WanFang, PubMed, Embase and The Cochrane Library databases were searched systematically. The deadline was March 1, 2018. All clinical controlled trials collum femoris preserving prosthesis in total hip arthroplasty were collected and methodological quality was evaluated one by one. RevMan 4.2 software was used for systematic evaluation.

    RESULTS AND CONCLUSION: (1) Four studies were included, involoing 302 patients. Because there were few studies and patients involved, and the outcome evaluation indicators were quite different, meta-analysis cannot be conducted, only descriptive systematic evaluation was performed. (2) Three studies compared the efficacy of two surgical methods in improving Harris score. Two of them considered that total hip arthroplasty with collum femoris preserving prosthesis was significantly better than total hip arthroplasty with non-collum femoris preserving prosthesis (P < 0.05). The other one considered that there was no significant difference between two surgical methods in improving Harris score (P > 0.05). (3) Two studies compared the efficacy of two surgical methods in improving the range of motion of the joint. One study showed that total hip arthroplasty with collum femoris preserving prosthesis was significantly better than total hip arthroplasty with non-prosthesis (P < 0.05). The other showed that there was no significant difference between the two surgical methods in improving the range of motion of the joint (P > 0.05). (4) One study showed that bone loss around the prosthesis in the total hip arthroplasty group with prosthesis was significantly less than that in the total hip arthroplasty group without collum femoris preserving prosthesis at 1 year postoperatively (P < 0.05). (5) One study found that the collum femoris preserving prosthesis in total hip arthroplasty group was superior to the non-collum femoris preserving prosthesis in total hip arthroplasty group in improving the Visual Analogue Scale at 1 year postoperatively (P < 0.05). (6) Two studies showed that no adverse prosthetic events such as loosening or sinking occurred at 1 year after total hip arthroplasty. (7) Two studies compared the differences in operation time and intraoperative bleeding volume, which showed no significant difference between two groups (P > 0.05). (8) One study found that the total amount of bleeding in total hip arthroplasty group with collum femoris preserving prosthesis was higher than that in total hip arthroplasty group without collum femoris preserving prosthesis (P < 0.05). (9) In summary, total hip arthroplasty with collum femoris preserving prosthesis has advantages in improving Harris score, decreasing the Visual Analogue Scale score and that bone loss around the prosthesis. More rigorous research is needed to increase the intensity of evidence.

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    Meta-analysis of open reduction and internal fixation versus total elbow arthroplasty for distal humeral fracture in the elderly  

    Wen Yangning, Han Xiaoqiang, Feng Chao, Sun Haibiao
    2020, 24 (6):  968-975.  doi: 10.3969/j.issn.2095-4344.2457
    Abstract ( 452 )   PDF (27746KB) ( 80 )   Save

    BACKGROUND: The most common surgical procedure for the treatment of distal humeral fracture in the elderly is open reduction and internal fixation and total elbow arthroplasty. There is still a lack of systematic evaluation of the efficacy between the two methods, and further research is needed to better guide clinical work.

    OBJECTIVE: To compare the clinical efficacy of open reduction and internal fixation combined with total elbow arthroplasty in the treatment of elderly patients with distal humeral fractures.

    METHODS: The computer was used to retrieve information in databases such as PubMed, The Cochrane Library, EMBASE, ScienceDirect, CNKI, Wanfang, and VIP. An observational cohort study or randomized controlled trial was performed in the study of open reduction and internal fixation/total elbow arthroplasty for the treatment of elderly patients with distal humeral fractures. The search period was 1998-2018. Studies were read and screened; data were extracted and the quality of the study was assessed by two persons independently. Data analysis was performed using RevMan 5.3.

    RESULTS AND CONCLUSION: (1) A total of 10 studies were included in 1 069 patients. (2) Meta-analysis results showed that total elbow arthroplasty group was superior to the open reduction and internal fixation group in the incidence of total complications (OR=1.67, 95%CI: 1.19–2.35, P=0.003), Mayo elbow performance score at the last follow-up (MD=-12.68, 95%CI: -16.60 to -8.77, < 0.000 01), flexion and extension of elbow joint (MD=-14.64, 95%CI: -19.56 to -9.71, P < 0.000 01), disabilities of the arm, shoulder, and hand questionnaire (MD=12.99, 95%CI: 6.47–19.51, P < 0.000 1). (3) The mean operation time, infection, heterotopic ossification, and complications/reoperation were not statistically significant between the two groups (P> 0.05). (4) These results confirmed that the total complication rate of the total elbow arthroplasty group was lower than that of the open reduction and internal fixation group, and the elbow joint function was better than that of the open reduction and internal fixation group. For elderly patients with distal humeral fracture, the degree of osteoporosis is different, and the articular surface is difficult to be effectively reset. The treatment of total elbow arthroplasty should be considered.

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    Risk factors for fractures secondary to percutaneous kyphoplasty: a meta-analysis 
    Liu Qun, Sun Dongdong, Gao Lilan, He Zhijiang, Sun Minglin
    2020, 24 (6):  976-984.  doi: 10.3969/j.issn.2095-4344.2458
    Abstract ( 381 )   PDF (29864KB) ( 95 )   Save

    BACKGROUND: Percutaneous kyphosis is improved on the basis of vertebroplasty, which can well restore the height of compressed vertebral body and reduce bone cement leakage. In recent years, it has been widely used in the treatment of osteoporotic vertebral compression fracture. However, it is often reported that there are recurrent fractures of the enhanced vertebral body and adjacent vertebral body after surgery, and the related factors affecting the recurrent fracture are still controversial.

    OBJECTIVE: To identify the risk factors for the fractures secondary to percutaneous kyphoplasty for treating osteoporotic vertebral compression fractures in the elderly by meta-analysis.

    METHODS: A comprehensive search was conducted for the studies published from January 2009 to April 2019 on the risk factors for secondary fractures after percutaneous kyphoplasty in the Cochrane Library, PubMed, CBM, CNKI and WanFang databases and manually as well. After the relevant data were extracted, statistical analysis was carried out with RevMan 5.3 software.

    RESULTS AND CONCLUSION: (1) The secondary fracture after percutaneous kyphoplasty for osteoporotic vertebral compression fracture was related to age [WMD=1.87, 95%CI (0.79, 2.95), P < 0.05], bone mineral density [WMD=-0.46, 95%CI (-0.61, -0.31), P< 0.05], bone cement leakage [OR=2.68, 95% CI (2.11, 3.39), P < 0.000 01], correction of kyphosis angle after primary operation [WMD=2, 95% CI (0.34, 3.66), P=0.02] and recovery rate of vertebral height after primary operation [WMD=5.25, 95% CI (2.16, 8.34), P=0.000 9]. (2) The secondary fracture after percutaneous kyphoplasty for osteoporotic vertebral compression fracture was not related to sex [OR=0.83, 95% CI (0.67, 1.02), > 0.05], body mass index [WMD=-0.27, 95% CI (-1.06, 0.51), P=0.49], cement volume [WMD=0.06, 95% CI (-0.21, 0.32), P=0.68], surgical approach [OR=0.87, 95%CI (0.61,1.25), P=0.46], primary fracture was thoracolumbar segment (T11-L2) [OR=1.48, 95% CI (0.93, 2.38), P=0.1]. (3) These results suggest that age, bone mineral density, bone cement leakage, correction of kyphosis angle after primary operation and recovery rate of vertebral height after primary operation may be the risk factors closely correlative to the secondary fracture after percutaneous kyphoplasty. There has not been enough evidence to support the associations between the secondary fracture and sex, body mass index, cement volume, surgical approach or thoracolumbar spine, and the above conclusions need to be studied and verified by more high quality literature in the future.

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