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    28 March 2020, Volume 24 Issue 9 Previous Issue    Next Issue
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    Learning curve and early clinical results of total hip arthroplasty with MAKO robot assisted posterolateral approach
    Cui Keze, Guo Xiang, Han Guibin, Chen Yuanliang, Liu Yiheng, Zhong Haibo
    2020, 24 (9):  1313-1317.  doi: 10.3969/j.issn.2095-4344.2403
    Abstract ( 606 )   PDF (19754KB) ( 168 )   Save

    BACKGROUND: With the maturity of total hip arthroplasty, the need for operative accuracy is highly increasing to get better operative results. The joint replacement technique assisted by MAKO robot makes the precision of the operation possible. However, this technology has a certain learning curve, and early replacement results and complications should be the major concern.

    OBJECTIVE: To analyze the learning curve and early clinical results of total hip arthroplasty through the posterolateral approach assisted by the MAKO robot.

    METHODS: From March 2017 to March 2018, 26 patients undergoing hip arthroplasty via posterolateral approach assisted by MAKO robots in West Hospital (Haikou Orthopedics and Diabetes Hospital), Haikou Hospital, Xiangya School of Medicine, Central South University, including 12 males and 14 females, were retrospectively analyzed. The problems and early clinical outcomes of hip replacement in the early learning curve were focused on.

    RESULTS AND CONCLUSION: The operation time was 56-155 minutes, mean (87.0 ± 16.1) minutes. The dominant bleeding was 220-850 mL, mean (336±246) mL. The acetabular abduction angle was (41.3±2.7)°. The acetabular anteversion angle was (16.4±3.4)°. The difference in lower limb length was (1.0±2.0) mm, and the femoral offset error value was (1.6±0.6) mm. Intraoperative femoral fractures occurred in one case. No infection, sciatic nerve injury or wound-related complications occurred. The weight bearing time was 3-6 weeks, mean (3.8±2.1) weeks. Harris score was (92.1±4.7) 3 months after surgery. It is indicated that the MAKO robot-assisted total hip arthroplasty via posterolateral approach showed that patient’s postoperative pain improved; the function recovered quickly; the clinical results were good; the operation time decreased with the proficiency; the prosthesis position was within the safe range; and the blood loss was within the acceptable range.

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    Direct anterior approach versus anterolateral approach in total hip arthroplasty: comparison of early postoperative patient’s perception 
    Milalimmu•Multiza, Zhao Wei, Varesjiang•Nyyaz, Yuan Hong, Wang Li
    2020, 24 (9):  1318-1323.  doi: 10.3969/j.issn.2095-4344.2469
    Abstract ( 381 )   PDF (28972KB) ( 24 )   Save

    BACKGROUND: Total hip arthroplasty can significantly alleviate pain in patients with end-stage hip disease and improve the joint function. Different surgical approaches have their own advantages and disadvantages. As a popular approach, direct anterior approach is to expose the hip joint through the fascia lata muscle and the sartorius muscle gap, which is in line with the concept of minimally invasive surgery, and has the advantages of small damage to soft tissue and quick recovery after arthroplasty. However, it has a certain learning curve, which requires the surgeons to have certain experience.

    OBJECTIVE: To compare the perception of the elderly with unilateral femoral head fracture undergoing total hip arthroplasty through direct anterior approach and anterolateral approach.

    METHODS: Forty-two patients (42 hips) with unilateral femoral head fracture in Orthopedic Center, Xinjiang Uygur Autonomous Region People’s Hospital from January 2017 to June 2018 were enrolled, and all patients underwent total hip arthroplasty. The patients were randomized into two groups, including 21 patients (21 hips) in anterolateral approach group and 21 patients (21 hips) in direct anterior approach group. The patients signed the informed consents and the study was approved by the Hospital Ethics Committee. The incision length, operation time and blood loss were recorded. The Harris hip joint score, and Oxford Hip scores at 1 week, 1 and 3 months postoperatively were compared. The prosthesis location and complications were observed.

    RESULTS AND CONCLUSION: (1) The hospitalization time in the direct anterior approach group was significantly shorter than that in the anterolateral approach group (P < 0.001). The incision length in the direct anterior approach group was significantly less than that in the anterolateral approach group (P < 0.001). The operation time and intraoperative blood loss in the direct anterior approach group were significantly lower than those in the anterolateral approach group (P < 0.001). (2) The 1-minute walking distance in the direct anterior approach group was longer than that in the anterolateral approach group at postoperative 1 and 2 days (P < 0.001). The Visual Analogue Scale scores at postoperative 1 and 2 days in the direct anterior approach group were significantly lower than those in the anterior approach group (P < 0.05). (3) After 3-month follow-up, the acetabular prosthesis abduction angle and anteversion angle showed no significant difference between two groups (P > 0.05). (4) The Harris hip and Oxford Hip scores at 1 week after surgery in the direct anterior approach group were significantly higher than those in anterolateral approach group (P < 0.05). The scores at postoperative 3 months showed no significant difference between two groups (P > 0.05). (5) One case in the direct anterior approach group and two cases in the anterolateral approach group appeared with bursitis surrounding with the incision and pain, which disappeared after local sealing. One patient in the direct anterior approach group developed subcutaneous hematoma, and healed at postoperative 3 weeks. One case in the direct anterior approach suffered from inner thigh skin numbness. (6) These results indicate that at early postoperative period, patients in anterolateral approach group are feeling better than those in direct anterior approach group. Although direct anterior approach has the advantages of small incision, less pain at the early postoperative period and fast recovery, it has a certain learning curve, with a longer operation time and more blood loss.

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    Application value of 3D printing guide plate in SuperPATH technology for elderly hip arthroplasty: retrospective study and evidence analysis of literature retrieval
    Zhao Weibiao, He Ziwei, Li Ji, Li Yi
    2020, 24 (9):  1324-1330.  doi: 10.3969/j.issn.2095-4344.2496
    Abstract ( 356 )   PDF (26504KB) ( 143 )   Save

    BACKGROUND: Hip arthroplasty is now an effective method of effectively solving the problem of femoral neck fracture in the elderly, but there is a risk of big trauma, high joint dislocation and postoperative complications.

    OBJECTIVE: To explore the application value of 3D printing guide plate in hip arthroplasty in the elderly by retrospective study and literature retrieval.

    METHODS: (1) Clinical data of 25 elderly patients with femoral neck fracture undergoing hip arthroplasty from February 2017 to October 2018 in Liaoning Jinqiu Hospital were retrospectively analyzed. In the guide plate group, 13 patients received hip arthroplasty using 3D printing guide plate. In the non-guide plate group, printing guide plate was not used in 12 cases. The application value of SuperPATH technique with 3D printing guide plate in hip arthroplasty in the elderly was observed. (2) Wanfang database was retrieved by the first author for studies published from 2000 to 2019. The key words were “3D, hip”. According to the inclusion criteria, 31 articles were selected to analyze the application value of 3D printing guide plate in hip arthroplasty in the elderly.

    RESULTS AND CONCLUSION: (1) The results of retrospective analysis showed that the operation time and the times of X-ray fluoroscopy were less in the guide plate group than those in the non-guide plate group (P < 0.05). Intraoperative blood loss and Harris score of hip function at the final follow-up were not significantly different between the two groups (P > 0.05). (2) Literature search results showed that 3D guide plates could be used to compensate for some defects of surgery in hip arthroplasty. There are many approaches to implement joint arthroplasty. Both conventional and minimally invasive approaches have direct anterior approach and posterolateral approach. According to several literature analysis, direct anterolateral approach can reduce trauma, and minimally invasive approach can reduce the risk of surgery. (3) The above results show that the use of 3D printing guide plate in elderly hip arthroplasty can reduce the operation time and the times of intraoperative X-ray fluoroscopy, and the effect is better. 3D guide plate has application value in hip arthroplasty, and it has advantages in combination with minimally invasive techniques. 

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    Relationship of extrusion and elevation of blood-expelling methods during total knee arthroplasty with postoperative complications  

    Yin Jiandong, Wang Xinling, Zuo Biao, Li Nongyi
    2020, 24 (9):  1331-1336.  doi: 10.3969/j.issn.2095-4344.2508
    Abstract ( 447 )   PDF (28943KB) ( 39 )   Save

    BACKGROUND: At present, extrusion is widely used in total knee arthroplasty. Studies have shown that extrusion can aggravate early pain and increase the risk of complications after operation. Therefore, a safer and more effective method it is urgently needed in clinic.

    OBJECTIVE: To observe the effects of elevation and extrusion of blood-expelling method on clinical outcomes during total knee arthroplasty.

    METHODS: Sixty-four patients who were scheduled to undergo unilateral total knee arthroplasty for the first time were randomly divided into two groups. During total knee arthroplasty, the control group received extrusion method, while the experimental group received elevation method. The main outcomes of the two groups were compared: visual analogue scale score, knee joint swelling, C-reactive protein, serum creatine kinase activity and postoperative complications; secondary outcomes: tourniquet use time, Hospital for Special Surgery score, and SF-36 score.       

    RESULTS AND CONCLUSION: (1) Visual analogue scale scores in the experimental group were significantly lower than those in the control group on the first day, the seventh day, the first month and the third month after operation (P < 0.05). (2) Knee swelling, serum creatine kinase and C-reactive protein increased in both groups after operation, but the increase in experimental group was significantly lower than that in control group (P < 0.05). (3) In terms of postoperative complications, the incidences of tension vesicles and deep vein thrombosis in the control group were higher than those in the experimental group (P < 0.05). The total complication rate was significantly higher in the control group than in the experimental group (P < 0.05). (4) There was no significant difference in tourniquet use time between the two groups (P > 0.05). (5) Hospital for Special Surgery score and SF-36 score were assessed at 1, 3 and 6 months. The results showed that it was better than before, but there was no significant difference between the two groups (P > 0.05). (6) In conclusion, elevation of blood-expelling method could alleviate early pain response, reduce inflammation reaction and soft tissue injury, and decrease the incidence of skin tension blisters and thromboembolism. It is in line with the concept of rapid recovery. Therefore, during total knee arthroplasty, elevation of blood-expelling method is a safer and more effective method than extrusion.

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    Total knee arthroplasty for rheumatoid arthritis: knee function and biochemical index changes
    Zhou Qi, Gao Yi, Wei Kang, Li Jun, Xu Jianda, Jiang Yang, Qu Yuxing
    2020, 24 (9):  1337-1341.  doi: 10.3969/j.issn.2095-4344.2441
    Abstract ( 552 )   PDF (22209KB) ( 151 )   Save

    BACKGROUND: Previous studies on the clinical efficacy of total knee arthroplasty in the treatment of rheumatoid arthritis have been reported, but the effects of total knee arthroplasty on joint function and related biochemical parameters in patients with rheumatoid arthritis are little reported. Thereafter, more clinical evidence is needed.

    OBJECTIVE: To analyze the effect of total knee arthroplasty on joint function and related biochemical indicators in patients with rheumatoid arthritis.

    METHODS: Clinical data of 64 patients with 64 knees who underwent total knee arthroplasty were retrospectively analyzed. Comparative analysis of Hospital for Special Surgery, range of motion of the knee joint and quality of life scores before and 1 year after surgery was conducted. Changes of biochemical indicators such as C-reactive protein, rheumatoid factor and erythrocyte sedimentation rate were detected. The incidence of complications at 1 month after surgery was recorded. The study was approved by the Ethical Committee of Changzhou Traditional Chinese Medicine Hospital, and all patients signed the informed consents.

    RESULTS AND CONCLUSION: (1) Compared with the baseline levels, the Hospital for Special Surgery score, range of motion of the knee joint and quality of life scores at 1 year after surgery was significantly increased (P < 0.01), and the levels of C-reactive protein, rheumatoid factor and erythrocyte sedimentation rate were significantly decreased (P < 0.01). (2) One patient developed infection and two patients developed deep vein thrombosis of the lower extremity, which was relieved after symptomatic treatment. These results imply that total knee arthroplasty has a good clinical effect on rheumatoid arthritis, which can improve knee function and reduce the levels of C-reactive protein, rheumatoid factor and erythrocyte sedimentation rate, and has good safety.

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    Comparison between anterior cervical discectomy and fusion using Zero-P and traditional anterior cervical plate plus cage for treating two-level cervical spondylosis 
    Yu Bin, Peng Yinxiao, Xue Li, Qin Hui, Liang Yijian
    2020, 24 (9):  1342-1347.  doi: 10.3969/j.issn.2095-4344.2490
    Abstract ( 499 )   PDF (25975KB) ( 35 )   Save

    BACKGROUND: Anterior cervical discectomy and fusion is a classic surgical procedure for the treatment of cervical spondylosis. At present, we can use a Zero-P interbody fusion fixture and a traditional cervical anterior plate plus cage as an internal fixation material. The Zero-P has less postoperative esophageal interference and lower incidence of postoperative dysphagia compared with traditional anterior cervical plate fixation. Besides, the Zero-P could avoid the risk of excessively long or poorly placed plate injury to adjacent segmental intervertebral discs.

    OBJECTIVE: To compare the safety and effectiveness between two-level anterior cervical discectomy and fusion using Zero-P and using traditional anterior cervical plate plus cage.

    METHODS: Clinical data of sixty patients who underwent two-level anterior cervical discectomy and fusion in the Chengdu Third People’s Hospital from May 2016 to May 2018 were retrospectively analyzed. The patients were divided into Zero-P group (Zero-P fusion, n=30) and plate group (anterior cervical plate fixation combined with cage implantation, n=30). All patients in the two groups had informed consent to the treatment plan. This study was approved by the hospital ethics committee. The Japanese orthopedic association score, neck disability index score and Bazaz swallowing function score were used to evaluate the clinical efficacy. Cervical X-ray and cervical CT scans were performed to assess cervical curvature, observe bone graft fusion, and implant displacement, loosening and breakage.

    RESULTS AND CONCLUSION: (1) All surgeries were successfully completed in 60 patients. The wounds healed in stage I after operation. There were no serious complications such as nerve injury, esophageal fistula, and cerebrospinal fluid leakage. (2) During the follow-up, there was no significant difference in neck disability index, Japanese orthopedic association score and bone graft fusion rates between the two groups (P > 0.05). (3) The incidence and severity of dysphagia in the Zero-P group were lower than those in the plate group at various time points after operation (all P < 0.05). (4) The overall curvature and operative segments curvature were better in the plate group than in the Zero-P group 6 months after surgery and in final follow-up (P < 0.05). (5) Two-level anterior cervical discectomy and fusion using Zero-P is a safe and effective operative method. The operation time, bleeding volume, number of fluoroscopy and postoperative dysphagia incidence were better than the traditional anterior cervical plate plus cage fixation system, but it is not as good as the traditional anterior cervical plate plus cage system in the curvature of the cervical spine. Zero-P is not recommended for patients with obvious abnormal cervical curvature before operation. 

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    Design and application of fulcrum screws for atlantoaxial dislocation
    Ge Su, Zou Xiaobao, Ma Xiangyang, Wang Binbin, Yang Haozhi, Zhang Shuang, Ni Ling, Chen Yuyue, Xia Hong, Wu Zenghui
    2020, 24 (9):  1348-1352.  doi: 10.3969/j.issn.2095-4344.2509
    Abstract ( 327 )   PDF (22170KB) ( 45 )   Save

    BACKGROUND: Atlantoaxial dislocation often needs surgery for reduction, and posterior screw-rod fixation fusion is the most commonly used surgery. However, the current screw-rod fixation system often increases the reduction effect by increasing the degree of curvature of connecting rod, causing great difficulty of placing rod, which increases the probability of spinal cord injury.

    OBJECTIVE: To evaluate the preliminary results of fulcrum screws for atlantoaxial dislocation.

    METHODS: From January 2017 to December 2018, 11 patients with atlantoaxial dislocation were selected from General Hospital of Southern Theater Command of PLA, including 4 males and 7 females, at the age of 8-51 years. All patients were treated with posterior screw-rod fixation fusion: Conventional posterior cervical screws were implanted on both sides of the atlas and pivot screws were implanted on both sides of the axis. Atlantodental interval and Japanese Orthopaedic Association scores were recorded before and after operation. Patients were followed up and underwent X-ray and CT to estimate reduction, fixation and bone graft fusion. This study was approved by the Ethics Committee of General Hospital of Southern Theater Command of PLA.

    RESULTS AND CONCLUSION: (1) Eleven patients underwent operations successfully without vertebral artery or spinal nerve injury. (2) All patients were followed up for 3-12 months, with an average of 6 months. The symptoms of neck pain and neurological dysfunction were improved in varying degrees. All patients obtained atlantoaxial bone fusion, with an average fusion time of 6 months. (3) At postoperative 1 week, X-ray and CT images showed that atlantoaxial reduction was satisfactory and internal fixation was in good position. (4) Atlantodental interval reduced from preoperatively (6.8±1.5) mm to postoperatively (2.4±0.9) mm (t=17.854, P=0.000). Japanese Orthopaedic Association score increased from preoperatively (14.1±1.3) to postoperatively (15.9±0.9) (t=-10, P=0.000). (5) No complication occurred during follow-up, without recurrence or dislocation. (6) These results showed that using fulcrum screw in posterior screw-rod fixation fusion has an effective reduction for treating atlantoaxial dislocation and its preliminary clinical effects are satisfactory.

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    Percutaneous vertebroplasty through unilateral and bilateral pedicle approaches and unilateral pedicle extrapedicle approach for the treatment of thoracolumbar vertebral compression fractures: bone cement perfusion volume and cement leakage rate 
    Zhang Zhiwei, Li Li, Huang Ziyu, Wu Duoyi, Gan Farong, Ye Baofei, Zhang Yan, Zhang Taibiao, Hu Wanjun
    2020, 24 (9):  1353-1358.  doi: 10.3969/j.issn.2095-4344.2215
    Abstract ( 272 )   PDF (28388KB) ( 48 )   Save

    BACKGROUND: Percutaneous vertebroplasty is clinically performed mainly through unilateral and bilateral pedicle approaches and unilateral pedicle extrapedicle approach. However, there are still disputes on the clinical effect and complications of the three approaches.

    OBJECTIVE: To compare the clinical effect of percutaneous vertebroplasty in the treatment of thoracolumbar vertebral compression fractures among three approaches.

    METHODS: Seventy-eight patients with thoracolumbar vertebral compression fractures who received treatment in Hainan Provincial Hospital of Traditional Chinese Medicine, China between January 2016 and January 2018 were included in this study. These patients consisted of 30 males and 48 females and were aged 40-71 years. Twenty patients received bone cement perfusion through the unilateral pedicle approach (unilateral pedicle group), 35 patients received bone cement perfusion through the bilateral pedicle approach (bilateral pedicle group), and 23 patients received bone cement perfusion through the unilateral pedicle extrapedicle approach (unilateral pedicle extrapedicle group). Bone cement perfusion volume and cement leakage rate were recorded. All patients were followed up for 1 year. The Visual Analogue Scale score, Oswestry Disability Index, vertebral height reconstruction rate, Cobb angle improvement, patient satisfaction and complications were compared among the three groups. This study was approved by the Hospital Ethics Committee, Hainan Provincial Hospital of Traditional Chinese Medicine, China (approval No. HKL20151203).

    RESULTS AND CONCLUSION: (1) Bone cement perfusion volume in the bilateral pedicle group was significantly lower than that in the unilateral pedicle and unilateral pedicle extrapedicle groups (P < 0.05). Bone cement perfusion volume in the unilateral pedicle extrapedicle group was significantly lower than that in the unilateral pedicle group (P < 0.05). (2) There were no significant differences in vertebral height reconstruction rate, Cobb angle improvement and patient satisfaction among the three groups (P > 0.05). At 1 year after surgery, Visual Analogue Scale score and Oswestry Disability Index were significantly lower than those before surgery in each group (P < 0.05). (3) Cement leakage rate in the bilateral pedicle group was significantly lower than that in the unilateral pedicle and unilateral pedicle extrapedicle groups (P < 0.05). Cement leakage rate in the unilateral pedicle extrapedicle group was significantly lower than that in the unilateral pedicle group (P < 0.05). (4) The fracture rate of adjacent vertebral bodies in the bilateral pedicle group was significantly lower than that in the unilateral pedicle group (P < 0.05). (5) These results suggest that three approaches of vertebroplasty and bone cement injection for treatment of thoracolumbar vertebral compression fractures can achieve better clinical efficacy. Bilateral pedicle approach can significantly reduce the incidence of cement leakage and adjacent vertebral fractures compared with the unilateral pedicle approach and unilateral pedicle extrapedicle approach.

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    Relationship between blood loss of proximal femoral nail anti-rotation fixation and local use combined with intravenous injection of tranexamic acid 
    Zheng Zhihui, Chen Sheng, Guan Keli, Zheng Xun, Chen Haibo, Zeng Qingqiang
    2020, 24 (9):  1359-1364.  doi: 10.3969/j.issn.2095-4344.2459
    Abstract ( 428 )   PDF (28881KB) ( 48 )   Save

    BACKGROUND: Tranexamic acid has been shown to effectively reduce dominant and hidden blood loss in patients undergoing proximal femoral nail antirotation fixation, and it is safe and effective. At present, the use of tranexamic acid in this operation is mainly divided into intravenous infusion and local intramedullary perfusion; intravenous infusion can be divided into single use or multiple uses, and most of the local use is single use. For the combined local use with intravenous infusion is rarely reported. However, the combined use of tranexamic acid in hip and knee arthroplasties has been proven to be safe and effective.

    OBJECTIVE: To explore the effectiveness and safety of intravenous combined with local application of tranexamic acid on the perioperative blood loss in proximal femoral nail antirotation.

    METHODS: Ninety patients with intertrochanteric fracture who underwent proximal femoral nail antirotation in Shantou Hospital of Traditional Chinese Medicine from January 2016 to December 2018 were enrolled, and randomly divided into combined, intravenous and local groups (n=30/group). All patients signed the informed consents and the study was approved by the hospital ethical committee. In the combined group, tranexamic acid (20 mg/kg dissolved in 20 mL normal saline) was injected intravenously at 30 minutes before surgery, followed by femoral intracavitary injection of tranexamic acid (1 g, dissolved in 20 mL normal saline) after proximal femoral nail antirotation. Intravenous group only underwent intravenous injection of tranexamic acid. Local group only received femoral intracavitary injection of tranexamic acid. The total blood loss, dominant blood loss, hidden blood loss, International Normalized Ratio, prothrombin time, activated partial thromboplastin time, blood transfusion rate and the incidence of deep venous thrombosis were counted and compared in the three groups.

    RESULTS AND CONCLUSION: (1) The total blood loss in the combined group was significantly less than that in the intravenous and local groups (P < 0.01), while the difference between intravenous and local groups was insignificant (P > 0.05). (2) The hidden blood loss in the combined group was significantly less than that in the intravenous and local groups (P < 0.001). The difference of hidden blood loss between intravenous and local groups was insignificant (P > 0.05). (3) There was no significant difference in the dominant blood loss among groups (P > 0.05). (4) The International Normalized Ratio, prothrombin time, and activated partial thromboplastin time before and after surgery showed no significant difference among groups (P > 0.05). (5) The blood transfusion rate showed no significant difference among groups (P > 0.05). (6) None presented with deep venous thrombosis. (7) These results suggest that compared with single intravenous and intracavitary injection of tranexamic acid, their combination can obviously reduce total and hidden blood loss of proximal femoral nail antirotation without increasing the risk of deep venous thrombosis. In addition, single intravenous and intramedullary injection of tranexamic acid has no significant difference in total or hidden blood loss.

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    New application of Endobutton suspension plate in hallux valgus deformity 
    Li Guijun, Huang Kai, An Jinyu, Zhang Lei, Gao Libo, Gao Lei, Wu Yixiong, Lu Jiajun
    2020, 24 (9):  1365-1370.  doi: 10.3969/j.issn.2095-4344.2471
    Abstract ( 416 )   PDF (23558KB) ( 257 )   Save

    BACKGROUND: Hallux valgus is a complex deformity. There is no gold standard for the treatment of hallux valgus. Osteotomy is highly recommended at present, but there are many complications. Whether we can correct hallux valgus without osteotomy is a new attempt in our group.

    OBJECTIVE: To explore the efficacy of an Endobutton suspension plate treatment for hallux valgus deformity.

    METHODS: From April 2013 to August 2018 at Department of Orthopedics, Changzhou Tumor Hospital Affiliated to Soochow University, 26 cases of hallux valgus were treated with Endobutton suspension plate, without osteotomy. All patients signed the informed consents and the study was approved by the hospital ethics committee. The hallux valgus angle and angle between metatarsal 1 and 2 were detected preoperatively and postoperatively. The American Orthopaedic Foot & Ankle Society score was detected at 12 months postoperatively.

    RESULTS AND CONCLUSION: (1) All patients were followed up from 8 to 38 months. (2) The hallux valgus angle (28.95±4.12)° and angle between metatarsal 1 and 2 (15.82±1.81)° preoperatively were significantly decreased to (14.15±3.60)° and (7.88±0.90)° postoperatively (both P < 0.01). (3) The American Orthopaedic Foot & Ankle Society score at 12 months after surgery (89.15±7.81) was significantly higher than that at baseline (62.08±7.10) (P < 0.01). (4) In summary, Endobutton suspension fixation between metatarsal 1 and 2 for treating hallux valgus is a viable treatment option.

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    Mechanical responses of the degenerated lumbar spines with different degrees at low frequency vibration generated by vehicle driving using finite element analysis 
    Liu Jie, Fan Ruoxun, Gao Jiazi, Zeng Sheng, Liu Jun
    2020, 24 (9):  1371-1377.  doi: 10.3969/j.issn.2095-4344.2491
    Abstract ( 427 )   PDF (29543KB) ( 42 )   Save

    BACKGROUND: Long-term exposure to low-frequency vibration environment generated by vehicle driving is harmful to human lumbar health, and parts of drivers have suffered from lumbar degeneration. However, the damage mechanism of low-frequency vibration generated by vehicle driving on degenerated lumbar spines with different grades has not been studied clearly.

    OBJECTIVE: To determine the effects of low-frequency vibration on the degenerated lumbar spines with different degrees by comparing the mechanical responses of the same lumbar spine under the vibrations at different frequencies and different lumbar spines under the same vibration.

    METHODS: To simulate the mechanical responses of lumbar spines under low-frequency vibration, four typical finite element models of human lumbar spine with different degrees of degeneration were established, and low-frequency vibrations generated by vehicle driving were applied on these models.

    RESULTS AND CONCLUSION: (1) The damping effects of four lumbar spines were better under a short period of vibration, but the mechanical properties of the moderately and severely degenerated lumbar spines degraded significantly when the vibration time was long. Therefore, the drivers with moderately and severely degenerated lumbar spines were not suitable for long-term low-frequency vibration. (2) As the degree of lumbar degeneration aggravated, the lumbar natural frequency gradually decreased. (3) Excluding the resonant frequency, the changes in the mechanical properties of the same lumbar spine under the vibrations at different frequencies were tiny, suggesting that no differences in the mechanical performance of lumbar spine existed when driving on different well-paving roads in one vehicle.

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    Digital evaluation of finite element model for percutaneous kyphoplasty with bone cement injection
    Wang Yiya, Zhang Han, Lan Hai
    2020, 24 (9):  1378-1383.  doi: 10.3969/j.issn.2095-4344.2224
    Abstract ( 375 )   PDF (23635KB) ( 39 )   Save

    BACKGROUND: The treatment principle, long-term therapeutic effects, and complications of percutaneous kyphoplasty are closely related to biomechanics. Its biomechanics have attracted wide attention.

    OBJECTIVE: To establish a virtual digital evaluation system for biomechanical changes and bone cement leakage after percutaneous kyphoplasty and bone cement injection.

    METHODS: Percutaneous kyphoplasty with bone cement injection was performed based on previously established three-dimensional model of L3-L5. The model was processed using the software Abaqus2016 for finite element analysis. The effects of bone cement injection model, injection pressure, and injection volume on the stress of fractured L4 vertebral endplate were analyzed.

    RESULTS AND CONCLUSION: (1) After simulated percutaneous kyphoplasty with bone cement injection, the stress of L4 fractured vertebral endplate decreased significantly under the partial pressure of cement. Different injection methods had no significant effect on the stress of fractured L4 vertebral endplate (P > 0.05), but bilateral injection made the distribution of bone cement more uniform and produced the best effect. (2) Different injection pressures had no significant effect on the stress of fractured L4 vertebral endplate (P > 0.05), but with the increase of injection pressure, the distribution of bone cement was more dispersed and leakage was more likely to occur. (3) With increase in bone cement injection dose, the stress of fractured L4 vertebral endplate gradually decreased (P < 0.05). The physiological stiffness of the vertebral body could not be restored when 2 mL of bone cement was injected. The distribution of bone cement was more concentrated when 4 mL of bone cement was injected. The breakdown point was reached when 8 mL of bone cement was injected. (4) After injection of bone cement, the upper endplate of the lower vertebral body was more prone to suffer from fracture than the lower endplate of the upper vertebral body. (5) These results suggest that the stress of L4 vertebral endplate shifted obviously after simulated surgery compared with before surgery, that is, the stress of L4 upper endplate increased and that of L4 lower endplate decreased. Different injection methods had little effect on the surgical results, but the distribution of bone cement injected bilaterally was more uniform, which reduced the incidences of re-fracture and collapse. Lower injection pressure could reduce the risk of cement leakage after surgery. Injection of 4 mL bone cement can restore good stiffness and physiological curvature of the diseased vertebra, without reaching the yield point or causing refracture. 

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    Finite element analysis of different fixation methods for poor medial column support proximal humeral fracture 
    Liu Yan, Ge Hongqing, Guan Hua, Chen Wenzhi
    2020, 24 (9):  1384-1389.  doi: 10.3969/j.issn.2095-4344.2510
    Abstract ( 416 )   PDF (24742KB) ( 48 )   Save

    BACKGROUND: The medial column fracture of the proximal humeral fracture is a type of fracture with high postoperative complications after internal fixation. Proximal humeral internal locking system is widely used in the proximal humeral fracture. The biomechanical stability of two different internal fixation models for the treatment of the poor medial column support proximal humeral fractures with proximal humeral internal locking system and proximal humeral internal locking system with fibular allograft augmentation is still unclear.

    OBJECTIVE: To investigate the biomechanical stability of the proximal humeral internal locking system and proximal humeral internal locking system with fibular allograft augmentation in the poor medial column support proximal humeral fracture with finite element analysis, and to compare the difference in fixation modes in humeral calcar supporting screws under different fixing methods.

    METHODS: The proximal CT data of osteoporosis were obtained. According to the 5-mm osteotomy of the humerus, the posterior medial column of the humerus was established and divided into two groups. Group A was the proximal humeral internal locking system plate group, in which the A1 group was placed in the proximal end of the plate, the A2 group was the E screw missing, the A3 group was the D screw missing; the B group received the proximal humeral internal locking system plate combined with fibular allograft augmentation, and all screws was placed in the proximal end of the plate in the B1 group. In the B2 group, E screw was missing; in the B3 group, D screw was missing. The three-dimensional finite element method was used to analyze the biomechanical stability of different groups of models under indirect violence.

    RESULTS AND CONCLUSION: (1) In terms of structural stability, B group was significantly better than A group. The structural stability of A1 group and A3 group of A group was comparable and better than that in A2 group. In B group, the structural stability of B1 group and B2 group was comparable and superior to B3 group. (2) For the poor medial column support proximal humeral fracture, the mechanical stability of the proximal humeral internal locking system plate combined with fibular allograft augmentation was better than that of the proximal humeral internal locking system plate alone. When the fibular support was combined, the screw placement in the proximal end of the plate is optimal, and D screw has an important stabilizing effect on the support of the poor medial column support proximal humeral fracture.

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    Mechanical simulation analysis of static finite element models of the femur with different material assignments
    Yan Jiying
    2020, 24 (9):  1390-1394.  doi: 10.3969/j.issn.2095-4344.2511
    Abstract ( 413 )   PDF (23060KB) ( 361 )   Save

    BACKGROUND: Different bone materials have different properties. Therefore, to simplify the model and improve the analysis efficiency in biomechanical analysis, many scholars have adopted different assignment methods to the bone model in the biomechanical simulation research. The distribution of material properties will have a great influence on the results of biomechanical analysis.

    OBJECTIVE: Three kinds of finite element models of the femur were established by different material attribute assignment methods, and the finite element simulation analysis was carried out to explore the influence of different material assignment methods on the biomechanical simulation analysis of femur finite element.

    METHODS: Volunteer femur CT scanning data were collected and imported into Mimics medical image processing software in DICOM format to reconstruct the femur model. Three different material attributes were assigned to the models, including uniform material assignment, skin cancellous bone assignment and gray scale assignment. The models were imported into finite element analysis Abaqus 6.14 software to set the same load and boundary conditions for stress and displacement analysis.

    RESULTS AND CONCLUSION: (1) The stress values of the three kinds of models differed slightly and were all in a reasonable range. (2) Whereas, the maximum stress of homogeneous assigned model and the model assigned according to cortical-cancellous bone assembly model mainly distributed in the diaphysis region, while the maximum stress distributed in the femoral neck region for the gray value assigned model. (3) The displacement value of cortical-cancellous bone assigned model was essentially in agreement with the gray value assigned model. The homogeneous assigned femoral model possessed the minimum displacement value and the value was about 40% different from the other two models. (4) The grayscale method can better reflect the biomechanical characteristics of human femur, so as to more accurately simulate the real biomechanical characteristics of real femur, which also provides an important theoretical basis for the finite element simulation modeling of orthopedic biomechanics. 

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    Development and biomechanical study of a new sternoclavicular hook plate
    Lin Wang, Wang Yingying, Lin Weimin, Xu Shenggui, Huang Qilong, Guo Weizhong, Lin Chengshou
    2020, 24 (9):  1395-1399.  doi: 10.3969/j.issn.2095-4344.2495
    Abstract ( 368 )   PDF (20831KB) ( 108 )   Save

    BACKGROUND: At present, most of the treatment of unstable dislocation of sternoclavicular joint is to insert the hook plate of acromioclavicular joint into the cavity of sternal bone marrow or put it behind the sternum. The difficulty of operation is increased because of the insufficient application of steel plate, which reduces the effect of joint reduction.

    OBJECTIVE: The research team has developed a new type of sternoclavicular hook plate (Patent No. ZL201520515237.3), and compared the biomechanical properties of acromioclavicular hook plate and new sternoclavicular hook plate to fix sternoclavicular joint from the aspect of biomechanics.

    METHODS: The sternum and clavicle at both ends of the sternoclavicular joint were replaced with a rectangular artificial bone. Eighteen pairs of artificial sternoclavicular joints were randomly divided into two groups. In control group (n=6), the plate screw hole section of the shortest segment 3-hole common acromioclavicular hook plate was fixed to the artificial clavicle end; and the hook end was placed on the back side of the artificial sternum. Load and displacement changes in artificial sternal fractures were measured with MTS biomaterial test system. In the experimental group (n=12), the plate screw hole section of the shortest rod section 2 hole new sternoclavicular hook plate was fixed to the artificial clavicle end; and the hook end was inserted into the artificial sternum. The MTS biomaterial test system was used to detect changes in load and displacement of the anterior cortical bone (n=6) and posterior cortical bone (n=6).

    RESULTS AND CONCLUSION: In the control group, the mean of maximum destructive force was (390±51) N. The mean of maximum destructive force of anterior cortical bone was (421±55) N. In the experimental group, the mean of maximum destructive force of posterior cortical bone was (437±56) N. There were no significant differences between the three groups (P > 0.05). Results indicated that the new sternoclavicular hook plate did not increase the risk of sternum fracture, and it was a safe and effective internal fixation material.
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    Relationship between a linear black signal area of STIR image in MRI of osteoporotic thoracolumbar fracture and the size of external force
    Zhong Yuanming, Luo Man, Tang Fubo, Tang Cheng
    2020, 24 (9):  1400-1404.  doi: 10.3969/j.issn.2095-4344.2512
    Abstract ( 521 )   PDF (23317KB) ( 232 )   Save

    BACKGROUND: With the aging of the society, the number of patients with osteoporotic vertebral fracture is increasing, mainly manifesting compression fracture of thoracolumbar body, which seriously affects the daily life of the elderly. Therefore, to study the relationship between the degree of external force and the performance of osteoporotic thoracolumbar body fracture on MRI STIR is to provide a better basis for clinical diagnosis and treatment.

    OBJECTIVE: To explore the relationship between the size of external force and a linear black signal area of STIR image in MRI of thoracic and lumbar osteoporosis vertebral compression fractures.

    METHODS: The hospitalized patients, who were diagnosed as thoracic and lumbar osteoporosis vertebral compression fractures, were retrospectively analyzed from September 2013 to September 2016 at the Department of Spine Surgery of The First Affiliated Hospital of Guangxi University of Chinese Medicine. All cases in the three groups were diagnosed as osteoporosis by quantitative CT (bone mineral density ≤ 80 mg/cm3). All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The patients were divided into three groups according to the different trauma history: Non-obvious external force group (without apparent cause or external force), low energy group (sprains, bent down to lift heavy objects, and carrying heavy items), high energy group (flat road down hips touchdown, falls, and bruise). Gender, age, fracture site (thoracic lumbar segment and non-thoracic lumbar segment), the number of the vertebrae and the position where would they occur with a linear black signal area of STIR image in MRI were analyzed in each group. Age was analyzed by analysis of variance. Gender, fracture site and the number of the vertebrae and the position were analyzed by Pearson chi-square test.

    RESULTS AND CONCLUSION: (1) All the 782 cases were included in the three groups. There were 334 in the non-obvious external force group, which a linear black signal area of STIR image in MRI existed in 114 cases. There were 186 cases in low energy group, which a linear black signal area of STIR image in MRI existed in 124 cases. There were 262 cases in high energy group, which a linear black signal area of STIR image in MRI existed in 87 cases. (2) The age, gender, fracture site and the number of the vertebrae and the position in three groups were not statistically significantly different among the three groups (P > 0.05). (3) There were significant differences in a linear black signal area of STIR image in MRI among the three groups (P < 0.05) (α´=0.05/3=0.017). Significant differences were found as compared the low energy group with non-obvious external force group and high energy group (P < 0.017). No significant difference was determined between non-obvious external force group and high energy group (P > 0.017). (4) The occurrence rate of linear black signal area of STIR image in MRI was 66.7% and higher than other groups (43.1% and 33.2%). (5) In the history of trauma, low energy in external force has more opportunity to cause a linear black signal area of STIR image in MRI than non-obvious external force and high energy; and they often occur in thoracic and lumbar osteoporosis vertebrae.

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    Differences in relative parameters of acetabulum in hip arthroplasty between CT horizontal plane and CT true pelvic plane
    Deng Biyong, Deng Bixiang
    2020, 24 (9):  1405-1409.  doi: 10.3969/j.issn.2095-4344.2470
    Abstract ( 423 )   PDF (24959KB) ( 250 )   Save

    BACKGROUND: The accuracy of acetabular prosthesis placement during total hip arthroplasty has a direct effect on postoperative hip function, stability and service life. Unreasonable placement of the cup may lead to adverse events, so CT imaging should be emphasized.

    OBJECTIVE: To analyze the differences of acetabular parameters in hip arthroplasty between the horizontal and true pelvic planes on CT images, and to determine the possible impact on surgery outcomes.

    METHODS: Seventy-two cases of pelvic soft tissue disease were selected. All patients signed the informed consents, and the study was approved by the hospital ethics committee. The anteversion angle, acetabular angle, acetabular depth, acetabular width, femoral head midpoint-acetabular margin angle, abduction angle between the true pelvic plane and the horizontal plane were measured by CT positioning film and its scanning image. CT software was selected to reconstruct the three-dimensional image, and then scanned vertically with the true pelvic plane. The above parameters were measured in the same way. The differences of parameters between left and right acetabulum and two planes were compared by paired t test. Spearman correlation analysis was used to analyze the correlation between the angles between the two reference planes and the difference between the measured parameters. 

    RESULTS AND CONCLUSION: (1) There was no significant difference in the values of the left and right acetabular parameters between the horizontal plane and the true pelvic plane (P > 0.05). (2) The pelvic tilt angle was positively correlated with the femoral head midpoint-acetabular margin angle and the acetabular anteversion angle between the two reference surfaces, and negatively correlated with the acetabular angle and acetabular depth. (3) Our results suggest that during the CT scan of the supine position, the pelvis is accompanied by a rotation condition. The parameters of the true pelvis plane as a reference are inaccurate with the directly measured acetabular parameters. Therefore, attention should be paid to the preparation of the surgical plan before surgery.

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    Establishment of normal foot and common foot disease models using three-dimensional finite element method and biomechanical analysis
    He Xiaoyu, Wang Chaoqiang, Zhou Zhiping, Zhang Zhongning, Lai Caosheng, Ruan Kangming, Li Xueli, Zhao Dewei
    2020, 24 (9):  1410-1415.  doi: 10.3969/j.issn.2095-4344.2479
    Abstract ( 330 )   PDF (21939KB) ( 222 )   Save

    BACKGROUND: In the field of trauma orthopedics, three-dimensional finite element analysis is only a routine means of biomechanical evaluation and internal fixator design and optimization in the treatment of internal fixation of fractures, but also provides new directions for the basic and clinical researches of trauma orthopedics.

    OBJECTIVE: To establish a three-dimensional finite element model of normal foot, flatfoot, equinus, and foot fracture and to undergo biomechanical analysis.

    METHODS: One healthy volunteer and patients with flatfoot, equinus, and foot fracture were selected. Their feet were scanned by CT. Three-dimensional finite element modeling and biomechanical analysis were performed by using computer three-dimensional imaging technology according to the CT data. The stress distribution and stress values of each model were then obtained for comparative analysis. The study was approved by the Ethics Committee of Mindong Hospital Affiliated to Fujian Medical University.

    RESULTS AND CONCLUSION: The three-dimensional finite element models of normal foot, flatfoot, equinus, and foot fracture were established and biomechanical analysis was performed. In the patients with flatfoot, the stress values of the metatarsus and tarsus were significantly increased compared with the normal values. The stress of the equinus was mainly concentrated around the ankle joint, especially on the talus surface. The simple metatarsus fracture had little effect on the stress changes in the tarsus area. The stress in the tarsus area of the Lisfranc injured patients was increased more obviously than in the normal feet. In this study, the three-dimensional finite element modeling and biomechanical analysis of the foot combines computer technology with clinical practice, which provides reference for biomechanical research of human foot. The numericalization of the mechanical data of different foot conditions by mechanical analysis provides important mechanical basis for the clinical treatment of the foot.

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    Application of robot in orthopedic surgery: reliability and room for improvement
    Cao Xuhan, Bai Zixing, Sun Chengyi, Li Yanle, Sun Weidong
    2020, 24 (9):  1416-1421.  doi: 10.3969/j.issn.2095-4344.2513
    Abstract ( 559 )   PDF (35673KB) ( 45 )   Save

    BACKGROUND: Orthopedic surgery robot is a new medical device which integrates many disciplines and fields, such as medicine, electronic informatics and mechanical physics. It is an important development direction of modern medical informationization, programmable control and intellectualization, and has a wide application prospect in orthopedic surgery.

    OBJECTIVE: To explore the application reliability and room for promotion of robots in orthopedic surgery.

    METHODS: CNKI, VIP, WanFang and PubMed databases were retrieved by using the keywords of “robot, orthopedics, surgery, accuracy” in Chinese and English, respectively for the articles published before June 2019. Forty-nine eligible articles were enrolled based on inclusion criteria. The key problems of surgery robot in orthopedics were reviewed.

    RESULTS AND CONCLUSION: (1) There are many researches on orthopedic surgical robots, and the methods are mature, but the domestic research on surgical robots is still in the primary stage compared with developed countries. (2) The technology of orthopedic surgical robots is moving towards the directions of human-machine intelligence, image refinement, morphological refinement, non-invasive surgery, and remote controllable fluidization. (3) Promoting independent research and development of orthopedic surgical robots, formulating industry standards and clinical standards in an all-round way will be an important direction for the development of intelligent medical devices and equipment in China.           

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    Risk factors for stress fracture of lower limbs and future research direction
    Zhao Yanxu, Zhang Zhao, Luo Dong, Li Manglai, Wang Jing, Fang Jie, Jiang Wen, Feng Yong, Peng Jiang, Xu Wenjing, Wang Yu, Wang Aiyuan, Zhang Minze
    2020, 24 (9):  1422-1429.  doi: 10.3969/j.issn.2095-4344.2460
    Abstract ( 503 )   PDF (46324KB) ( 45 )   Save

    BACKGROUND: Stress fractures of lower limbs are common for recruits and athletes, and affect their training to different extent.

    OBJECTIVE: To summarize the risk factors for the occurrence and development of stress fracture of lower extremity, then to raise the awareness of stress fracture of lower extremity and provide ideas for its prevention.

    METHODS: A computer-based search was conducted in PubMed, WanFang and CNKI databases from January 2009 to July 2019 with the keywords of “stress fracture, fatigue fracture, overuse injury, risk factors, recruits” in English and Chinese, respectively. A total of 786 relevant articles were retrieved, and 76 articles were eligible for the inclusion criteria.

    RESULTS AND CONCLUSION: (1) Sex and history of stress fracture have been identified as risk factors for stress fracture. Future studies should be inclined to identify the specific roles of other risk factors in the development of stress fracture. (2) In addition, biomechanical factors are likely to affect the occurrence of stress fracture of the lower limbs of recruits. (3) Therefore, improving the abnormal biomechanical parameters of the lower extremity during the training of recruits can develop a method to prevent the stress fracture of the lower limbs, and reduce the incidence of stress fracture through appropriate management.

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    Progress in the study of appearance, material and fixation band of splint for distal radius fracture
    Yan Wei, Jiang Tao, Wu Changgui, Kong Bo, Xi Xiaobing
    2020, 24 (9):  1430-1434.  doi: 10.3969/j.issn.2095-4344.2514
    Abstract ( 442 )   PDF (31516KB) ( 89 )   Save

    BACKGROUND: With the aging of the population, the incidence of distal radius fracture is gradually increasing. Non-operative external fixation splint can reduce the economic burden, mental burden and prevent surgical trauma. Therefore, the study of external fixation splint for distal radius fracture has important clinical value and significance.

    OBJECTIVE: To summarize the research status of distal radius fracture fixation splints and to lay a foundation for further research.

    METHODS: The first author searched the CNKI, Wanfang and VIP database, PubMed, Embase and Web of Knowledge for studies regarding external fixation splint for distal radius fracture published from 2000 to 2019. The key words were “distal radius fracture, external fixation, splint” in Chinese and English.

    RESULTS AND CONCLUSION: (1) The improved design of the shape, material and fixation band of the traditional small splint is the key direction of splint research at present. The improved design of splint shows great advantages in clinical application. (2) With the advancement of social science and technology, the emergence of new materials, new technologies and the deepening of biomechanical research, distal radius fracture fixation splint integrated with the elements of modern science and technology is the development trend of small splint in the future. 

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    Meta-analysis of total knee arthroplasty guided by kinematic alignment and mechanical alignment 
    Zhao Chuntao, Qing Mingsong, Yu Langbo, Peng Jiachen
    2020, 24 (9):  1435-1442.  doi: 10.3969/j.issn.2095-4344.2494
    Abstract ( 470 )   PDF (28253KB) ( 58 )   Save

    BACKGROUND: Although mechanical alignment technique ensures the long-term survival rate of knee arthrosis, some patients are still not satisfied with the effect of total knee arthroplasty and the function of knee joint after operation.

    OBJECTIVE: Meta-analysis was used to evaluate the effect of kinematic alignment technique and mechanical alignment technique in the guidance of total knee arthroplasty.

    METHODS: The literature of clinical controlled study of kinematic alignment and mechanical alignment in the guidance of total knee arthroplasty published from the date of establishment to July 2019 was searched in Chinese Biomedical Literature Database, Wanfang data, CNKI, VIP data, PubMed, Cochrane Library, and Embase. The literature was screened, and evaluated; data were extracted. Review Manager 5.3 software was used for statistical analysis.

    RESULTS AND CONCLUSION: (1) A total of 945 cases were included in 12 articles, including 470 cases in kinematic alignment group and 475 cases in mechanical alignment group. (2) The results of meta-analysis showed that the operation time was shorter in the kinematic alignment group than in the mechanical alignment group [MD=-15.44, 95%CI(-27.16, -3.71)]. Western Ontario and McMaster University Osteoarthritis Index was better in the kinematic alignment group than in the mechanical alignment group [MD=-8.40, 95%CI(-15.39, -1.40)]. Oxford knee score was better in the kinematic alignment group than in the mechanical alignment group [MD=4.72, 95%CI(0.24, 9.21)]. Distal angle of mechanical lateral femur and proximal angle of mechanical medial tibia were significantly larger in the mechanical alignment group than in the kinematic alignment group (all P < 0.05). (3) There was no difference in average hospitalization day, maximum walking distance before discharge, knee society score, knee joint straightening angle and postoperative complications between kinematic alignment group and mechanical alignment group (all P > 0.05). (4) The function of knee joint after kinematic alignment for guiding total knee arthroplasty was better than that in mechanical alignment group. However, the imaging and perioperative results were similar, and the incidence of complications was not increased after operation. It is suggested that kinematic alignment may be a lower extremity force alignment method to guide total knee arthroplasty. 

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    Meta-analysis of the effectiveness of cold therapy after total knee arthroplasty
    Liu Yu, Zhang Nanxin, Dai Liqun, Ying Wei
    2020, 24 (9):  1443-1448.  doi: 10.3969/j.issn.2095-4344.2488
    Abstract ( 527 )   PDF (21510KB) ( 55 )   Save

    BACKGROUND: The use of cold therapy to promote rehabilitation after total knee arthroplasty has a certain theoretical basis, but whether cold therapy can reduce bleeding, reduce pain, and promote early recovery of activity is still controversial.

    OBJECTIVE: To evaluate the effectiveness of cold therapy in total knee arthroplasty in reducing postoperative bleeding, reducing pain, and promoting recovery of motion range using meta-analysis.

    METHODS: Medline, EMBASE, Cochrane, China Biomedical Literature Database, CNKI, Wanfang and other databases were searched to find randomized controlled trials of cold therapy and other rehabilitation therapies after total knee arthroplasty. Data were extracted. Statistical analysis was performed using Revman 5.3. Effect values were combined.

    RESULTS AND CONCLUSION: (1) A total of 10 randomized controlled trials were included, including 1 070 patients. The experimental group received cold therapy after total knee arthroplasty, and the control group received other rehabilitation therapies. (2) Meta-analysis showed that compared with other rehabilitation therapies, cold therapy after replacement alleviated postoperative pain [MD=-0.75, 95%CI (-1.29, -0.21), P=0.006], reduced hemoglobin drop [MD=-12.11, 95%CI (-17.66, -6.56), P < 0.000 1]. However, cold therapy could not reduce the amount of opioids usage [MD=0.01, 95%CI (-0.15, -0.16), P=0.92], or improve joint motion range [MD=6.58, 95%CI (-0.54, 13.70), P=0.07]. (3) The results show that the application of cold therapy after total knee arthroplasty can effectively relieve pain and reduce the drop of postoperative hemoglobin, but has no significant effect on reducing the application of opioid analgesics or improving motion range.

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    Safety of steroid-containing cocktail periarticular injection after knee arthroplasty: a meta-analysis
    Huang Yong, Zhu Weimin, Lu Wei, Ouyang Kan, Peng Liangquan, Liu Haifeng, Li Hao, Feng Wenzhe, Xu Jian, Zhong Mingjin, Chen Kang, Li Ying, Deng Zhenhan
    2020, 24 (9):  1449-1456.  doi: 10.3969/j.issn.2095-4344.2515
    Abstract ( 417 )   PDF (32984KB) ( 67 )   Save

    BACKGROUND: Steroids have strong anti-inflammatory, anti-emetic and analgesic effects and are widely used in perioperative analgesia. Studies have shown that periarticular injection of steroid-containing cocktail analgesic therapy in knee arthroplasty can relieve postoperative pain, improve knee activity, and reduce complications. However, the other studies show that steroids can increase the risk of postoperative infection, and tendon rupture. Therefore, the safety and efficacy of steroid-containing cocktail periarticular injection in knee arthroplasty is still controversial.

    OBJECTIVE: To evaluate the safety and efficacy of steroid-containing cocktail periarticular injection after knee arthroplasty by meta-analysis.

    METHODS: The published literatures were searched on the databases of PubMed/Medline, Cochrane Central Register of Controlled Trials, and EMBASE until April 2019. All randomized controlled trials of topical steroid analgesia after knee arthroplasty were collected and eligible articles were screened. Two researchers independently assessed the risk of bias and methodological quality of included studies by the Cochrane 5.0. The outcome data were extracted and a meta-analysis was conducted by Review Manager 5.2 software.

    RESULTS AND CONCLUSION: (1) A total of 10 randomized controlled articles involving 820 patients were included. (2) The meta-analysis showed that visual analogue scale score was lower in the steroid group than in the control group at postoperative 1 day [MD=-1.52, 95%CI(-2.94, -0.10), P=0.04]. Motion range was higher in the steroid group than in the control group at postoperative 1, 2, 3, 4 and 5 days [MD=11.57, 95%CI(9.85, 13.30), P < 0.000 01; MD=9.03, 95%CI(6.67, 11.38), P < 0.000 01; MD=5.73, 95%CI(0.85, 10.60), P=0.02; MD=5.53, 95%CI(0.68, 10.38), P=0.03); MD=5.90, 95%CI(0.87, 10.93), P=0.02]. Morphine use was less in the steroid group than in the control group [MD=-7.94, 95%CI(-14.35, -1.53), P=0.02]. Hospital stay was shorter in the steroid group than in the control group [MD=-0.98, 95%CI(-1.25, -0.71), P < 0.000 01]. Straight leg raising took less time in the steroid group than in the control group [MD=0.65, 95%CI(-0.86, 0.44), P < 0.000 01]. Postoperative C-reactive protein level was lower in the steroid group than in the control group [WMD=-4.82, 95%CI(7.41, 2.23), P=0.000 3]. Knee society score and complication rate were not significantly different between the two groups. (3) To conclude, the periarticular injection of steroid-containing cocktails after knee arthroplasty is safe and effective.

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    Meta-analysis of radial head arthroplasty versus open reduction and internal fixation for treating radial head fractures
    Cheng Caitong, Han Pengfei, Wu Taiyong, Li Jian, Fu Haijun, Wang Yushan, Feng Yi
    2020, 24 (9):  1457-1463.  doi: 10.3969/j.issn.2095-4344.2472
    Abstract ( 374 )   PDF (24653KB) ( 59 )   Save

    BACKGROUND: In the treatment of radial head fractures, complications such as nonunion and internal fixation are inevitable in open reduction and internal fixation, resulting in chronic pain and dysfunction of the elbow joint. In order to reduce surgical complications and improve the success rate of surgery, radial head replacement surgery came into being.

    OBJECTIVE: To systematically compare the effects of radial head arthroplasty and open reduction and internal fixation in the treatment of Mason type III and IV radial head fractures by meta-analysis.

    METHODS: The search included clinical controlled studies published at home and abroad between 1999 and March 2019, with or without randomization and blinding. The databases included Embase, PubMed, Central, Cinahl, PQDT, CNKI, VIP, WanFang, Cochrane Library, and CBM. Magazine contents and references were manually retrieved to find grey references such as unpublished academic papers, and chapters in monographs. The language was not limited. All relevant articles were searched. If necessary, the articles were translated. The forearm rotation motion, forearm flexion mobility, postoperative joint function score, postoperative imaging evaluation results, postoperative complications and reversion cases were used as measurement outcomes so as to sufficiently compare the curative effects of arthroplasty and open reduction and internal fixation for treating Mason III type and IV of radial capitulum fracture.

    RESULTS AND CONCLUSION: (1) According to the above search strategy, 301 related articles were retrieved. (2) By reading the title and abstract, 146 irrelevant articles were excluded, and 155 related articles were screened initially. The full text was further read and screened strictly according to the inclusion criteria and exclusion criteria, and finally seven foreign articles were included. (3) In the Beoberg-Morrey scoring system [95%CI (7.96, 23.14), P < 0.000 1], flexion and extension range [95%CI (3.72, 13.13), P=0.000 4], forearm pronation activity [95%CI (2.09, 3.18), P < 0.000 01], rotation range of motion [95%CI (2.80, 17.45), P=0.007], radial head arthroplasty was superior to open reduction and internal fixation. The number of postoperative complications in the radial head arthroplasty was less than that in the open reduction and internal fixation group [95%CI (0.15, 0.57), P=0.000 3]. (4) In summary, in the treatment of Mason type III and IV radial head fractures, radial head arthroplasty is superior to open reduction and internal fixation.

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    Microscope-assisted versus traditional anterior cervical approach for cervical spondylopathy: a meta-analysis
    Luo Haitao, Cheng Zujue, Lü Shigang, Xiao Juexian, He Wei, Huang Kai, Fan Yanghua, Zhu Xingen
    2020, 24 (9):  1464-1470.  doi: 10.3969/j.issn.2095-4344.2516
    Abstract ( 405 )   PDF (26224KB) ( 249 )   Save

    BACKGROUND: In China, although microscope-assisted anterior cervical decompression has been performed by many spine surgeons in recent years, the application of microscope still needs to be further promoted in China. Therefore, it is necessary to systematically evaluate and analyze the clinical efficacy of cervical spondylopathy by comparing patients under microscope-assisted anterior cervical approach to traditional anterior cervical approach. As a result, it can provide the evidence for clinical decision in these cervical spondylopathy patients.

    OBJECTIVE: To systematically evaluate the effect between microscope-assisted anterior cervical approach and traditional anterior cervical approach in cervical spondylopathy patients.

    METHODS: Databases such as Medline, Embase, PubMed, Web of science, CBM, Wangfang databases, VIP, and CNKI were searched from inception to July 2019 to find literature related to microscope-assisted anterior cervical approach and traditional anterior cervical approach in treatment of cervical spondylopathy. Two investigators evaluated the researches independently and compared the operative time, intraoperative blood loss, the preoperative and postoperative Japanese Orthopedic Association score, neurological success rate, the preoperative and the postoperative visual analogue scale score, and the complication rates between two groups. The quality of the included literature was evaluated by the modified Jadad scale, the modified Newcastle Ottawa score and the methodological index for non-randomized-studies. The correlative clinical outcome in inclusive research was analyzed systematically by using Stata 12.0 Software.

    RESULTS AND CONCLUSION: (1) Twelve studies were accorded with the inclusion criteria, containing 892 cases (438 cases in the microscope-assisted group, while 454 cases in the traditional group). (2) There were no significant differences in the preoperative Japanese Orthopedic Association score (WMD=-0.100, 95%CI(-0.459, 0.259), P=0.585), operative time (WMD=6.852, 95%CI(-0.446, 14.149), P=0.066), the preoperative and postoperative visual analogue scale score (WMD=0.293, 95%CI(-0.023, 0.608), P=0.069; WMD=-0.718, 95%CI(-1.495, 0.059), P=0.070) between two groups. (3) Postoperative Japanese Orthopedic Association score (WMD=1.310, 95%CI(0.621, 1.998), P < 0.001), the rate of neurological success (WMD=4.639, 95%CI(0.294, 8.984), P=0.036) in the microscope-assisted group were higher than those in the traditional group. The intraoperative blood loss (WMD=-18.068, 95%CI(-24.504, -11.632), P < 0.001) and the rate of complication (RR=1.068, 95%CI(1.012, 1.126), P=0.002) in the microscope-assisted group were significantly lower than those in the traditional group. (4) Performing anterior cervical approach under microscope has a better clinical effect than using traditional anterior cervical approach in the treatment of cervical spondylopathy, but more high-quality clinical studies are needed to verify it. 

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    Efficacy and characteristics of parecoxib and celecoxib in the treatment of pain after orthopedic surgery: a meta-analysis 
    Deng Jinman, Fang Guanjun, Wang Yu, Ding Shaobo
    2020, 24 (9):  1471-1476.  doi: 10.3969/j.issn.2095-4344.2489
    Abstract ( 694 )   PDF (23736KB) ( 47 )   Save

    BACKGROUND: Improper management of postoperative pain will seriously affect the recovery of patients, leading to a high disability rate. Celecoxib and parecoxib are selective cyclooxygenase 2 inhibitors, and have good analgesic effects. However, there is no comparison between the two in the treatment of postoperative pain in orthopedics department.

    OBJECTIVE: To systematically evaluate the efficacy of parecoxib and celecoxib in the treatment of postoperative pain in orthopedic surgery.

    METHODS: Databases including CNKI, CBM, Wanfang Data, PubMed and the Cochrane Library were searched from inception to June 2019. The randomized controlled trials regarding the efficacy of parecoxib versus celecoxib in the treatment of pain after orthopedic surgery were collected. Data were extracted and the quality of the study was evaluated. RevMan 5.3 software and Stata 12.0 software were used for result analysis.

    RESULTS AND CONCLUSION: (1) Seven randomized controlled trials were involved, containing 524 patients undergoing orthopedic surgery. The experimental group was treated with parecoxib and the control group with celecoxib. (2) Meta-analysis results showed that at 24, 48 and 72 hours after surgery, compared with celecoxib, parecoxib significantly reduced visual analogue scale scores [MD=-0.86, 95%CI=(-1.30, -0.42), P=0.000 1; MD=-0.81, 95%CI=(-1.43, -0.20), P=0.009; MD=-0.32, 95%CI=(-0.48, -0.17), P < 0.000 1], and decreased the dosage of central analgesics [SMD=-2.12, 95%CI=(-2.90, -1.34), P < 0.000 01]. (3) Results suggested that compared with celecoxib, parecoxib significantly reduced postoperative pain and the dose of central analgesics after orthopedic surgery.

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