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28 April 2020, Volume 24 Issue 12 Previous Issue    Next Issue

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Comparison of cervical motion range and curvature after C3 laminectomy and mini-titanium plate fixation after single-door vertebroplasty Chen Yuyue, Zou Xiaobao, Ma Xiangyang, Wang Binbin, Yang Haozhi, Ge Su, Zhang Shuang, Ni Ling, Xia Hong, Wu Zenghui 2020, 24 (12):  1805-1809.  doi: 10.3969/j.issn.2095-4344.2542 Abstract ( 547 )   PDF (22479KB) ( 121 )   Save BACKGROUND: Axial symptoms often occur in patients after posterior cervical single-door vertebroplasty. Some studies have proposed a modified surgical method to remove C3 lamina and retain cervical semisacinous muscle on C2 spinous to reduce the occurrence of axial symptoms after surgery. OBJECTIVE: To compare the clinical effects, cervical motion range and curvature of C3 laminectomy and mini-titanium plate fixation after single-door vertebroplasty. METHODS: Totally 43 patients with cervical spondylosis were selected from the General Hospital of Southern Theater Command of PLA from June 2012 to June 2017, including 25 males and 18 females. Among them, 27 patients underwent C3-6 or C3-7 single-door mini-titanium fixation vertebroplasty as fixation group and 16 patients underwent C4-6 or C4-7 single-door mini-titanium fixation vertebroplasty through posterior approach after C3 laminectomy as resection group. Preoperatively, 6 months postoperatively and at final follow-up, JOA score, cervical motion range, and C2-7 Cobb angle were compared between the two groups. This study was approved by the Ethics Committee of General Hospital of Southern Theater Command of PLA. RESULTS AND CONCLUSION: (1) All 43 patients successfully underwent the operation without vascular or spinal cord injury. (2) JOA score was higher in the two groups at postoperative 6 months and final follow-up than that preoperatively (P < 0.05). There was no significant difference in JOA scores between the two groups before and after surgery (P > 0.05). (3) Motion range in the two groups was smaller at postoperative 6 months and final follow-up than that preoperatively (P < 0.05). Motion range was smaller in the fixation group than in the resection group at postoperative 6 months and final follow-up (P < 0.05). (4) C2-7 Cobb angle in the two groups was smaller at postoperative 6 months and final follow-up than that preoperatively (P < 0.05). C2-7 Cobb angle was smaller in the fixation group than in the resection group at postoperative 6 months and final follow-up (P < 0.05). (5) There was no hypersensitivity, rejection or immune response in the two groups. (6) Results indicate that C3 laminectomy and mini-titanium plate fixation have the same effect on improving neurological function, but the removal of C3 lamina can more effectively prevent the reduction of postoperative cervical motion range and curvature. Figures and Tables | References | Related Articles | Metrics

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Immediate stress and strain analysis of posterior pedicle screw fixation combined with different fusion cages in C5/6 discectomy of simulated pig cervical vertebrae  Feng Tao, Zhang Hong, Ren Hu, Li Ximing, Pan Shuo, Wang Xiaojing, Yu Dahai 2020, 24 (12):  1810-1816.  doi: 10.3969/j.issn.2095-4344.2563 Abstract ( 431 )   PDF (25919KB) ( 89 )   Save BACKGROUND: Posterior decompression and pedicle screw fixation combined with interbody fusion is a method for the treatment of cervical vertebral degenerative lesions. There are few reports on the measurement of strain electricity in simulating C5/6 intervertebral disc fusion after pedicle screw removal.  OBJECTIVE: To analyze stress and strain immediately after C5/6 discectomy, pedicle screw fixation combined with interbody fusion.  METHODS: Eighteen fresh pig cervical specimens were randomly divided into three groups: bone cage fusion group, PEEK fusion group, and titanium mesh fusion group (n=6). Each group simulated C5/6 discectomy and pedicle screw fixation, and then different fusion cages were used for interbody fusion. Before and after fusion, the resistance strain gauges were attached under the vertebral body at the position of pedicle screw fixation, at the edge of vertebral body at the fusion position of fusion cage, at the edge of adjacent vertebral body. The strain values of each sample were measured under the compression state by static resistance strain gauge. The stress values at each measurement point before and after fusion in posterior fixation with pedicle screws for cervical vertebrae in each group were calculated by material mechanics formula. RESULTS AND CONCLUSION: (1) Under the same load, the strain and stress of each measurement point in the titanium mesh fusion group were smaller than those in the bone cage fusion group and the PEEK fusion group, and the difference was significant (P < 0.05). (2) Under the same load, the strain and stress of each test point in the bone cage fusion group were larger than those in the PEEK fusion group, and the difference was significant (P < 0.05). (3) These results confirm that simulated C5 discectomy in vitro, posterior pedicle screw fixation and implantation of different fusion cages have different changes of stress and strain. The selection of appropriate interbody fusion cage can reduce the effect of stress concentration on adjacent segments. Figures and Tables | References | Related Articles | Metrics

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Inverse arch roof breaking technique combined with pedicle screw and bone graft in the treatment of thoracolumbar burst fractures Zhu Fuliang, Zheng Daoming, Shi Yubo, Wang Yunguo, Ni Dongkui, Li Lijun, Jiang Zhuyan, Haimiti·Abuduaini, Xue Yuan 2020, 24 (12):  1817-1822.  doi: 10.3969/j.issn.2095-4344.2548 Abstract ( 531 )   PDF (28079KB) ( 83 )   Save BACKGROUND: The morbidity rate of thoracolumbar burst fracture is high; however, the simple posterior distraction and reduction technique has poor patient satisfaction on maintaining vertebral height and reducing complications. Therefore, we attempt to explore a better therapeutic regimen. OBJECTIVE: To assess the efficacy of inverse arch roof breaking technique combined with pedicle screw and bone graft in treatment of thoracolumbar burst fractures. METHODS: This was a retrospective study of 78 patients with thoracolumbar burst fractures. All the patients suffered from fresh closed fractures, and all of them were operated by posterior approach. The time from injury to surgery ranged from 4 to 14 days, with an average of 7.8 days. They were randomly assigned to two groups. The 38 cases in the simple distraction group were treated with simple vertebra pedicle screw-rod system distraction and reduction fixation. The 40 cases in the inverse arch roof breaking and bone graft group were treated with inverse arch roof breaking technique combined with pedicle screw and bone graft in fractured vertebra. All patients signed the informed consent. The study was approved by the Hospital Ethics Committee. Operation time, intraoperative blood loss, fracture healing time, anterior height ratio of injured vertebrae, Cobb angle, visual analogue score, Barthel Index and postoperative complications were measured between the two groups.  RESULTS AND CONCLUSION: (1) The follow-up period for all patients was 10-22 months. (2) Operation time and intraoperative blood loss were better in the simple distraction group than in the inverse arch roof breaking and bone graft group (P < 0.01). (3) The ratio of anterior height of injured vertebra and Cobb angle were significantly different between the two groups (P < 0.01). Above indexes were better in the inverse arch roof breaking and bone graft group than in the simple distraction group. (4) There were significant differences in fracture healing time and life activity function (Barthel index) between the two groups (P < 0.01), and above indexes were better in the inverse arch roof breaking and bone graft group than in the simple distraction group. (5) No deep infection was found in both groups. There were no complications such as internal fixation failure and excessive loss of vertebral height in arch roof breaking and bone graft group. In the simple distraction group, there were 3 cases of screw pull-out because of failed internal fixation, 2 cases of titanium rod breakage, and 10 cases of obvious vertebral height loss. (6) These findings suggest that compared with simple distraction and reduction fixation, inverse arch roof breaking technique combined with pedicle screw and bone graft can provide bony support to compression center of fractured vertebra. The efficacy was identified in reconstructing the height of anterior and middle columns. This method has the advantages of high mechanical strength, strong vertebral height maintenance, high bone healing rate and few complications, which will be the ideal choice in the treatment of thoracolumbar burst fracture. Figures and Tables | References | Related Articles | Metrics

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Early- and mid-term effects of trans-injured and cross-injured vertebra pedicle screw fixation in the treatment of thoracolumbar fractures  Xu Yong, Guan Zhong, Li Yongxia, Chen Feng, Ren Lei 2020, 24 (12):  1823-1828.  doi: 10.3969/j.issn.2095-4344.2550 Abstract ( 543 )   PDF (27179KB) ( 84 )   Save BACKGROUND: The bone trabecula of the vertebral body cannot be fully recovered, and the mechanical stability of the sagittal position of the spinal column is affected. The anti-bending force and the anti-torsion force of the short-segment fixation of fractured vertebra are obviously increased. The bearing load of various activities such as flexion, extension, and rotation of the vertebral body is increased. The stability of the injured vertebra is better maintained, and favorable conditions are created for fracture healing. OBJECTIVE: To compare the early- and mid-term follow-up results of trans-injured and cross-injured vertebra pedicle screw fixation in the treatment of thoracolumbar fractures.  METHODS: Eighty-eight patients with thoracolumbar vertebrae fracture treated in Affiliated Hospital of Qinghai University from April 2017 to April 2018 were divided into trans-injured vertebra group and cross-injured vertebra group according to the treatment plan. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Intraoperative blood loss, operation time, postoperative bed rest time, postoperative site infection, and subcutaneous hematoma were analyzed in both groups. Visual analogue scale score, Oswestry Disability Index, anterior edge height ratio and kyphosis Cobb angle were compared before surgery, 6 and 12 months after surgery between the two groups. RESULTS AND CONCLUSION: (1) The operation time was longer and intraoperative blood loss was higher in the trans-injured group than those in the cross-injured group, but the postoperative bed rest time was shorter in the trans-injured group than that in the cross-injured group (P < 0.05). (2) There was no significant difference in visual analogue scale score, Oswestry Disability Index, anterior edge height ratio and kyphosis Cobb angle between the two groups preoperatively and 2 weeks after the operation (P > 0.05). (3) At 6 and 12 months after surgery, visual analogue scale score and Oswestry Disability Index were lower in the trans-injured group than in the cross-injured group; anterior edge height ratio was larger in the trans-injured group than in the cross-injured group; kyphosis Cobb angle was smaller in the trans-injured group than in the cross-injured group (all P < 0.05). (4) Incidence of complications was higher in the cross-injured group (30%) than in the trans-injured group (7%) (P=0.001). (5) The treatment of thoracolumbar fracture with trans-injured pedicle screw can not only effectively restore and maintain the injured vertebral height and kyphosis Cobb angle, restore the physiological height and curvature of vertebral body, but also the incidence of postoperative complications is low, which can effectively improve the prognosis of patients and improve the quality of life of patients. Figures and Tables | References | Related Articles | Metrics

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Risk factors of adjacent vertebral collapse after kyphoplasty with cement injection in older adult women Wu Bin, Bai Fenghua, Lin Mingxia, Lin Jianping 2020, 24 (12):  1829-1834.  doi: 10.3969/j.issn.2095-4344.2249 Abstract ( 532 )   PDF (24141KB) ( 257 )   Save BACKGROUND: Up to now, there are no reports on the risk factors of adjacent vertebral fractures after kyphoplasty with bone cement injection in older adult women in Haikou city or Hainan province of China. OBJECTIVE: To investigate the risk factors of adjacent vertebral collapse (fracture) in older adult women with osteoporotic vertebral compression fractures after kyphoplasty with cement injection. METHODS: 192 older adult women with osteoporotic vertebral compression fractures, aged 61-84 years, who underwent kyphoplasty with bone cement injection during January 2015-October 2018 in Hainan General Hospital, were included in this study. General indexes, orthopedic indexes, and the incidence of adjacent vertebral fractures within 3 months after surgery were recorded. The correlation between patient’s medical records and adjacent vertebral fractures after surgery was analyzed. This study was approved by the Medical Ethics Committee of Hainan General Hospital of China (approval No. 20180917). RESULTS AND CONCLUSION: (1) Adjacent vertebral fractures occurred in 53 patients (68 vertebrae) within 3 months after surgery. The incidence of adjacent vertebral fractures was 27.60%. (2) Univariate analysis showed that age, body mass index, menopausal age, diabetes mellitus, bone mineral density T value, the number of augmented vertebral bodies, bone cement extravasation, amount of bone cement and use of zoledronic acid after surgery could affect the occurrence of adjacent vertebral fractures after kyphoplasty (P < 0.05). Smoking, drinking, menarche age, pregnancy, times of delivery, hypertension, history of glucocorticoid, degree of vertebrae compression, surgical approach, and distribution of bone cement did not affect the occurrence of adjacent vertebral fractures after kyphoplasty (P > 0.05). (3) Multivariate logistic analysis showed that age (≥ 75 years old), bone mineral density T value (< -4.5), bone cement extravasation, and the number of augmented vertebral bodies were risk factors for adjacent vertebral fractures (P < 0.05). Menopausal age (≥ 47 years old) and use of zoledronic acid after surgery were protective factors for adjacent vertebral fractures (P < 0.05). (4) The results showed that in older adult women with osteoporotic vertebral compression fractures treated by kyphoplasty, in addition to age, bone mineral density T value, bone cement extravasation, the number of augmented vertebral bodies, and anti-osteoporosis treatment, premature menopause should also be paid attention to. Figures and Tables | References | Related Articles | Metrics

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Relationship of age, pathological grade, and implants with perioperative mortality in patients with hip fracture  Pi Ying, Tian Jing 2020, 24 (12):  1835-1840.  doi: 10.3969/j.issn.2095-4344.2500 Abstract ( 414 )   PDF (24320KB) ( 130 )   Save BACKGROUND: Up to now, the research on the mortality rate of hip fracture after operation mainly focuses on 30 days to 1 year and longer. However, there are few studies on early postoperative mortality of hip fracture.  OBJECTIVE: To compare the differences between survived and dead patients at 72 hours after surgery, and to explore the risk factors associated with 72-hour postoperative mortality in hip fracture patients. METHODS: Clinical data of 2 811 hip fracture patients admitted to Zhujiang Hospital of Southern Medical University from January 2013 to December 2018 were retrospectively analyzed, including surgical treatment and conservative treatment. The patient’s age ranged from 15 to 101 years old. This study compared the differences between the survival group and death group within 72 hours after surgery. According to the outcome, the patients were divided into survival group and death group. The patient’s medical records were collected, including gender, age, preoperative ASA classification, preoperative walking ability score, preoperative cognitive level, whether to take anticoagulants orally, fracture classification, operation mode, internal plant species, operation time, blood transfusion volume, anesthesia mode, and postoperative complications. The diagnosis of each observation factor was based on the clinical diagnosis of medical records. The survival status, cause of death, intraoperative and postoperative complications were recorded within 72 hours after operation. The patients were followed up by telephone within half a year after operation. RESULTS AND CONCLUSION: (1) Forty-seven patients received conservative treatment, and 1 patient died 24 hours after admission; totally 2 764 patients were included in the study. (2) The average age was 72.5 years, including 2 035 females and 729 males. The mortality rate within 72 hours after operation was about 0.90% (25 patients). (3) In the 72-hour postoperatively death group, the proportion of patients with advanced age, ASA grade 3 or above, pre-traumatic walking ability limitation and cognitive impairment was higher (P < 0.05). (4) In the 72-hour survival group, more patients received surgical treatment within 48 hours of injury (P < 0.05). (5) The incidence of implant-related complications was higher in the death group than in the survival group, but the difference between the two groups was not statistically significant (P > 0.05). (6) In conclusion, great attention has been paid to the optimization of the management of patients undergoing hip fracture surgery and its concomitant effect on survival. Our study found that the increased risk of death within 72 hours after hip fracture surgery is associated with advanced age, ASA grade 3 or above, limited walking ability before injury, cognitive impairment and more than 48 hours after injury; however, it is not related to the type of implant of the patient. The information provided in this study can be used to assess patients with the highest risk of death within 72 hours after surgery. On the basis of this study, it may be necessary to further collect multi-center, more detailed data to assess the impact of various factors on the postoperative mortality of hip fracture patients, and to identify high-risk factors affecting the early postoperative mortality. Figures and Tables | References | Related Articles | Metrics

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Stability of the femoral neck and internal fixation with bone cement and steel plate after curettage for benign proximal femoral lesions  Yang Zhaoxin, Niu Mengye, Liu Yuexing, Cao Haiying, Kong Lingwei, Zhao Jingxin, Jin Yu 2020, 24 (12):  1841-1846.  doi: 10.3969/j.issn.2095-4344.2501 Abstract ( 440 )   PDF (21662KB) ( 78 )   Save BACKGROUND: For benign bone tumor patients, the life cycle is long. To reduce the incidence of complications and improve the quality of life after surgery through surgery is the common goal of physicians. The quality of life of patients can be increased through discussing the operation mode and prognosis of benign tumor patients, choosing the reasonable operation mode, predicting and reducing the risk of secondary fracture. OBJECTIVE: To analyze the femoral neck force after different surgical methods using finite element technique in the analysis of benign proximal femoral lesions, and to assess the stability of the femoral neck and the risk of fracture after different surgical procedures for cases with a wide range of lesions. METHODS: According to preoperative CT data of lesion sites in 10 subjects with benign tumor of proximal femur, three-dimensional model of internal fixation with bone cement and steel plate after focal curettage (group A) and three-dimensional model of treating with bone cement after focal curettage (group B) were set in this study. Finite element technique was used to simulate the maximum force of the femoral neck when walking. The stress peaks of the femoral neck were compared after surgery between the two groups. The risk of fracture at this location was assessed. Patients signed the informed consent. This study was approved by the Ethics Committee of Chengde Medical College. RESULTS AND CONCLUSION: (1) The stress was significantly lower in the group A than in the group B (P=0.007 < 0.05). (2) The local stress of the model was reasonable in the group A. Ten patients were operated with the protocol of the group A. An additional 17 patients with proximal femur benign lesions who met the requirements but refused to enter the finite element experiment were treated with the surgical program of the group A. (3) The patients were followed up for 14-42 months. During the follow-up, no new fracture was found in the operation area, and the internal fixation device was firm without fracture. At 12 months postoperatively, the mean Musculoskeletal Tumor Society score of all patients was (26.12±2.28). (4) The finite element technology for simulating the stress evaluation and postoperative follow-up verified that the treatment of proximal femur benign tumor with bone cement and steel plate internal fixation after curettage is more reasonable and effective. The scheme can effectively reduce the risk of secondary fracture and enhance the stability in the surgical area. Figures and Tables | References | Related Articles | Metrics

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Treatment of femoral shaft fracture with lateral traction frame closed reduction and intramedullary nail fixation Yuan Ye, Huang Wenliang, Xu Lin, Ruan Shiqiang, Wang Shiqiang 2020, 24 (12):  1847-1852.  doi: 10.3969/j.issn.2095-4344.2519 Abstract ( 464 )   PDF (27553KB) ( 197 )   Save BACKGROUND: At present, there are relatively few studies on the closed reduction of intramedullary nail treatment for femoral shaft fractures. OBJECTIVE: To investigate the effect of closed reduction and intramedullary nailing in the treatment of femoral shaft fractures in the lateral position. METHODS: From January 2015 to October 2018, 54 patients with femoral shaft fractures were treated with intramedullary nailing at Department of Orthopedics and Traumatology, the Third Affiliated Hospital of Zunyi Medical University. The patients were randomly assigned to three groups, including 17 cases in the supine mechanical traction group, 17 cases in the lateral artificial traction group, and 20 cases in the lateral mechanical traction group. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Closed reduction success rate, operation time, intraoperative blood loss, fracture healing time, and hospital for special surgery knee score at 6 months after surgery were compared in the three groups. RESULTS AND CONCLUSION: (1) All patients were followed up for 6 to 15 months. (2) The success rate of fracture closure was 100% in the lateral mechanical traction group, 82% in the lateral artificial traction group, and 59% in the supine mechanical traction group. There was no significant difference between supine mechanical traction group and lateral artificial traction group (P > 0.05). The success rate was significantly higher in the lateral mechanical traction group than in the supine mechanical traction group (P=0.002). There was no significant difference between the lateral mechanical traction group and the lateral artificial traction group (P > 0.05). (3) No significant difference was found in operation time between the supine mechanical traction group and the lateral artificial traction group (P > 0.05). The operation time was significantly shorter in the lateral mechanical traction group than in the supine mechanical traction group and lateral artificial traction group (P < 0.05). (4) Intraoperative blood loss was significantly more in the supine mechanical traction group than in the lateral artificial traction group (P=0.02) and lateral mechanical traction group (P=0.001). No significant difference was determined in intraoperative blood loss between the lateral artificial traction group and lateral mechanical traction group (P > 0.05). (5) Fracture healing time was significantly longer in the supine mechanical traction group than in the lateral artificial traction group (P=0.030) and lateral mechanical traction group (P < 0.001). There was no significant difference in fracture healing time between the lateral artificial traction group and the lateral mechanical traction group (P > 0.05). (6) No significant difference in hospital for special surgery knee score at 6 months after surgery was detected among the three groups (P > 0.05). (7) These results suggested that application of lateral recumbent traction frame closure and intramedullary nailing for the treatment of femoral shaft fractures has the advantages of high success rate, short operation time, less intraoperative blood loss and short fracture healing time. It is worthy of clinical application. Figures and Tables | References | Related Articles | Metrics

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Treatment of simple posterolateral tibial plateau collapse fracture with beta-tricalcium phosphate combined with T-shaped locking plate Zhu Yin, Ni Shanjun, Wang Jin, Huang Yunzhong, Zhang Jinkun, Ge Jianfei 2020, 24 (12):  1853-1858.  doi: 10.3969/j.issn.2095-4344.2239 Abstract ( 480 )   PDF (27261KB) ( 219 )   Save BACKGROUND: Simple posterolateral tibial plateau collapse fracture is very rare in the clinic. The displaced collapse fracture in this area must be anatomically reduced, filled with suitable materials, and fixed with internal fixators. OBJECTIVE: To evaluate the stability, clinical results and biocompatibility of modified posterolateral approach to treat simple posterolateral tibial plateau collapse fracture with beta-tricalcium phosphate combined with T-shaped locking plate. METHODS: Fifteen patients with simple posterolateral tibial plateau collapse fractures who received surgical treatment between June 2013 and December 2017 in Zhangjiagang Hospital Affiliated to Soochow University. These patients included 8 males and 7 females, aged 25-53 years. All of them received surgical treatment with beta-tricalcium phosphate combined with T-shaped locking plate through the modified posterolateral approach. After surgery, they were followed up for 12 months. X-ray examination was performed to evaluate fracture healing and internal fixation. Reduction effect was evaluated by Rasmussen radiology score. Knee function and stability were evaluated by HSS knee function score, Lachman test, pivot-shift test and lateral stress test. This study was approved by Medical Ethics Committee, Zhangjiagang Hospital Affiliated to Soochow University, China (approval No. 201305KS001). RESULTS AND CONCLUSION: (1) All patients underwent anatomical reduction of knee fractures, and the fracture healing time was 9-14 weeks. At 12 months after surgery, β-tricalcium phosphate was completely absorbed and replaced by new bone, and repair of bone defect was satisfactory. (2) There were no significant differences in posterior tibia angle, varus angle, Rasmussen imaging collapse score and Rasmussen imaging total score between 12 months after surgery and immediately after surgery in 15 patients (P > 0.05). (3) At 12 months after surgery, the HSS score of the knee joint was 89-100, and Lachman test, pivot-shift test and lateral stress test results were negative in 15 patients. (4) During the follow up period, infection around implants, allergic reaction, immune reaction, or rejection reaction was not observed. (5) These findings suggest that treatment of simple posterolateral tibial plateau collapse fracture through the modified posterolateral approach with β-tricalcium phosphate combined with T-shaped locking plate exhibits good repair effects and biocompatibility.  Figures and Tables | References | Related Articles | Metrics

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Computer navigation-assisted surgical treatment with osteotomy for upper thoracic kyphosis He Da, Li Zuchang, Zhao Jingwei, Tian Wei 2020, 24 (12):  1859-1863.  doi: 10.3969/j.issn.2095-4344.2549 Abstract ( 370 )   PDF (22353KB) ( 101 )   Save BACKGROUND: The biomechanical characteristics of kyphosis of the upper thoracic vertebra are unique. Decompression and internal fixation are relatively difficult. Previous relevant studies and case reports are few, and there is a lack of research on correction of kyphosis of the upper thoracic section with the assistance of computer navigation. OBJECTIVE: To explore the clinical effect of computer navigation-assisted surgical treatment of upper thoracic kyphosis by screws and osteotomy. METHODS: Totally 18 patients with kyphotic deformity of the spine (T1-T4) were admitted in Beijing Jishuitan Hospital from June 2011 to June 2018, including 11 males and 7 females, aged 12 to 59 years. They were all treated with computer-assisted surgical treatment with PSO osteotomy. Local Cobb angle of the upper thoracic kyphosis was determined during final follow-up. Cervical visual analogue scale, Nurick grades, EMS scores and satisfaction of the surgery were evaluated. This study was approved by the Ethics Committee of Beijing Jishuitan Hospital (approval No. 201709-23). RESULTS AND CONCLUSION: (1) A total of 18 patients were followed up for 6-90 months at an average time of (33.73±35.33) months. (2) The local Cobb angle of 18 patients at the last follow-up was significantly improved [(47.32±9.92)°, (24.01±7.64)°, P < 0.001]. Cervical visual analogue scale score at the last follow-up was significantly lower than that before surgery (3.64±2.16, 0.73±1.01, P < 0.001). Nurick score at the last follow-up was significantly lower than that before surgery (2.91±0.94, 0.82±1.47, P < 0.001). EMS score at the last follow-up was significantly higher than that before surgery (14.45±0.93), 17.09±1.45, P < 0.001). (3) Surgical satisfaction was excellent (n=16) or good (n=2). (4) At the last follow-up, 18 patients had no adverse reactions related to implants, and the wound healed well without screw loosening. (5) The results showed that reasonable osteotomy correction with computer-assisted surgery and PSO osteotomy could effectively treat kyphosis of upper thoracic segment. Figures and Tables | References | Related Articles | Metrics

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Application of 3D printing technology in preoperative planning of scapular fracture Zhang Han, He Bin, Wang Boyao, Qin Hu, Wang Yunhua, Fan Lei 2020, 24 (12):  1864-1869.  doi: 10.3969/j.issn.2095-4344.1987 Abstract ( 467 )   PDF (26318KB) ( 236 )   Save BACKGROUND: The current internal fixation surgery for scapula fractures is limited by the complex anatomical structure of scapula, which is often difficult to operate, with much bleeding and time-consuming. OBJECTIVE: To observe the clinical efficacy of the application of 3D printing technology in scapula fracture surgery. METHODS: The clinical data of 28 cases (aged 34-70 years) with scapula fractures in the Second Affiliated Hospital of Nanjing Medical University from January 2016 to December 2018 were analyzed retrospectively. Among them, 14 cases were treated after routine preparation (control group). Another 14 patients underwent 64-slice thin-slice CT scanning and 3D reconstruction. The fracture model was printed with 3D printing technology. The surgical approach was designed and the internal fixation was customized before the operation (3D printing group). The operation time, intraoperative blood loss and intraoperative X-ray frequency of the two groups were recorded. Imaging data were followed up six weeks after the operation. The treatment effects were evaluated according to the Hardegger shoulder joint function assessment standard. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. RESULTS AND CONCLUSION: (1) All the 28 operations were successfully completed. The operation time, intraoperative blood loss and X-ray frequency of the 3D printing group were all less than those of the control group (P < 0.05). (2) The excellent and good rate of the 3D printing group was higher than that of the control group (P < 0.05). (3) The operative approach and internal fixation used in the 3D printing group were consistent with the preoperative design. The application of 3D printing technology in the surgical treatment of scapula fractures can help surgeons better understand the characteristics of scapula fractures and make surgical plans, reduce the difficulty of surgery, obtain more accurate reduction, reduce the duration of surgery, intraoperative bleeding and intraoperative X-ray fluoroscopy, and improve the surgical efficacy.  Figures and Tables | References | Related Articles | Metrics

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Construction and evaluation of 3D printing simulation model for lumbar surgery Yuan Dechao, Wu Chao, Deng Jiayan, Wang Xiangyu, Li Tao, Tan Lun, Wang Wei, Luo Min 2020, 24 (12):  1870-1874.  doi: 10.3969/j.issn.2095-4344.2545 Abstract ( 544 )   PDF (20479KB) ( 87 )   Save BACKGROUND: 3D printed bone model was widely used in clinical teaching and simulated surgery training, but it did not pay enough attention to the construction of soft tissue, and the simulation was poor, which cannot reflect the soft tissue exposure process. OBJECTIVE: To explore the feasibility of constructing a simulated lumbar spine surgery model based on 3D printing technology for the training of lumbar pedicle screw placement in junior orthopedic surgeons. METHODS: The solid model of the lumbar spine was printed at the same proportion based on 3D printing technology, and the model of simulated lumbar spine surgery was constructed with plasticine and cloth. Thirty orthopedic residents performed lumbar pedicle screw placement alone on the simulated model, and performed once a day for 10 consecutive days. They recorded the operation time, and evaluated the accuracy of screw placement by postoperative CT scan. By comparing the operation time and screw placement accuracy of the operators in the early stage (the first 5 times) and the later stage (the last 5 times), all above parameters were statistically analyzed. This study was approved by the Ethics Committee of Zigong Fourth People’s Hospital.  RESULTS AND CONCLUSION: (1) In the early stage (the first 5 times), the average operation time was (100.00+12.67) minutes. In the later stage (the last 5 times), the average operation time was (83.50+10.14) minutes, and the difference was statistically significant (t=20.67, P=0.00). (2) The success rate of former screw placement (including grade I and II screw placement) was 88.53%, and the failure rate (grade III screw placement) was 11.47%. The success rate and failure rate of latter screw placement were 97.47% and 2.53%, respectively, with statistically significant difference (χ2=20.68, P=0.00). (3) The simulated model of lumbar spine surgery based on 3D printing technology has high simulation and feasibility, and can be used for the training of lumbar pedicle screw placement in junior orthopedic surgeons.  Figures and Tables | References | Related Articles | Metrics

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3D printing pre-operation assisted with custom-made plate for internal fixation of femoral shaft fractures after poliomyelitis Zhang Shijian, Yang Chaoqun, Qi Haotian, Liu Zhaojie, Wang Hongchuan, Tian Wei, Jia Jian 2020, 24 (12):  1875-1880.  doi: 10.3969/j.issn.2095-4344.2552 Abstract ( 399 )   PDF (28707KB) ( 69 )   Save BACKGROUND: Patients with poliomyelitis often have abnormalities in the femur and the conventional plant matching degree of fracture is low. There are few reports on individualized treatment for severe deformity of femoral shaft fracture in poliomyelitis. OBJECTIVE: To summarize the clinical features of femoral shaft fracture in poliomyelitis and discuss the operative outcome of 3D printing pre-operation assisted with custom-made plate.  METHODS: From May 2015 to May 2018, data of 19 patients with poliomyelitis surgically treated with 3D printing pre-operation assisted with custom-made plate were retrospectively analyzed. There were 11 males and 8 females with an average age of 52.5 years (range, 38-62 years). There were 7 cases on the left side, and 12 cases on the right side. According to AO/OTA classification of femoral shaft fracture, there were type A1 in 6 cases, type A2 in 3 cases, type A3 in 1 case, type B1 in 4 cases, type B2 in 4 cases and type C1 in 1 case. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The 3D printed 1:1 femur model and custom-made plate were designed. Operation was simulated in vitro in femoral model. The placement of the plate was identified. The direction and length of the screws were measured and recorded. The final internal fixation of fracture was performed according to the pre-operation results. Hip and knee functions in the affected limb were assessed based on Harris evaluation criterion and hospital for special surgery knee score evaluation criterion. RESULTS AND CONCLUSION: (1) All 19 patients were followed up for 12-18 months. Bone healing was obtained in all fractures, with a healing time of 5-12 months, averaging 6.6 months. (2) Harris score was (84.95±5.18) before injury, and (84.42±4.83) 1 year after operation. Hospital for special surgery knee score was (84.53±4.36) before injury, and (83.63±3.90) 1 year after operation. Statistical analysis showed no statistical difference between the two groups before and after the injury (P > 0.05). (3) All patients had no internal fixation loosening or fracture. One patient had delayed bone healing and healed after iliac bone grafting. One patient developed wound infection after surgery, and received adequate drainage. Wound was healed after intravenous application of sensitive antibiotics. (4) Patients with poliomyelitis often have abnormalities in the femur with varying degrees of osteoporosis. For femoral shaft fractures that cannot be fixed with conventional internal fixation, 3D printing pre-operation combined with custom-made steel plate provides a new choice for the treatment of femoral shaft fractures in poliomyelitis.  Figures and Tables | References | Related Articles | Metrics

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Application and comparison of personalized 3D printing with preoperative simulation and traditional method in high tibial osteotomy  Chen Jinguo, Chen Guoxian, Lin Zongjin, Xu Guosong, Chen Weiyi, You Fengyuan 2020, 24 (12):  1881-1885.  doi: 10.3969/j.issn.2095-4344.2544 Abstract ( 421 )   PDF (19406KB) ( 322 )   Save BACKGROUND: High tibial osteotomy is a classic operation for the treatment of early simple medial compartment osteoarthritis of the knee. Three-dimensional (3D) printing can be used to make personalized surgical tools. We have used 3D printing technology to assist high tibial osteotomy for the treatment of knee osteoarthritis. OBJECTIVE: By comparing traditional methods, to analyze the advantages and disadvantages of the high tibial osteotomy assisted by personalized 3D printing osteotomy combined with arthroscopic debridement for the treatment of osteoarthritis of the knee with varus deformity. METHODS: Totally 47 cases undergoing lateral closed wedge high tibial osteotomy combined with knee joint debridement were randomly assigned to two groups. The 3D printing osteotomy group (n=21) received personalized 3D printing osteotomy. The traditional osteotomy group (n=26) received traditional osteotomy. The operation time, number of intraoperative C-arm fluoroscopy and blood loss, limb alignment on the affected side 1 month after surgery, and Hospital of Special Surgery scores on the affected side knee joints at 1, 3, 6, 12 and 24 months after surgery were compared between the two groups. This study was approved by the Ethics Committee of First Hospital of Putian City. All patients signed the informed consent. RESULTS AND CONCLUSION: (1) The intraoperative 3D printing osteotomy module was consistent with the preoperative simulated place. (2) The operation time was significantly shorter in the 3D printing osteotomy group than in the traditional osteotomy group [(69.71±3.17), (92.92±5.91) minutes, t=-17.21, P < 0.01]. The number of C-arm fluoroscopy was significantly less in the 3D printing osteotomy group than in the traditional osteotomy group [(5.71±1.62), (18.15±3.00) times, t=-18.12, P < 0.01]. Blood loss was significantly less in the 3D printing osteotomy group than in the traditional osteotomy group [(275.24±53.82), (507.69±45.19) mL, t=-16.10, P < 0.01]. (3) There was no difference between the two groups in the limb alignment on the affected side at 1 month after operation and the Hospital of Special Surgery score on the affected knee at 24 months after operation (all P > 0.05). (4) In conclusion, compared with traditional osteotomy, personalized 3D printing-assisted osteotomy in lateral closed wedge high tibial osteotomy can significantly shorten the operation time, reduce the number of intraoperative C-arm fluoroscopy and the amount of blood loss, but there is no significant difference in knee function between the two groups at 2 years after surgery. Figures and Tables | References | Related Articles | Metrics

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Comparison of biomechanical characteristics of lumbar spine after unilateral and bilateral internal fixation Lu Xiangdong, Zhao Yibo, Wang Shaowei, Zhao Xiaofeng, Zhao Bin 2020, 24 (12):  1886-1890.  doi: 10.3969/j.issn.2095-4344.2566 Abstract ( 405 )   PDF (22985KB) ( 159 )   Save BACKGROUND: Pedicle screw fixation is the preferred surgical treatment for clinical treatment of lumbar degenerative disease currently. The stability of pedicle screw fixation system can be evaluated from the perspective of biomechanics and finite element method is more and more popular in analyzing stress of pedicle screw fixation of vertebral body for researchers. OBJECTIVE: To analyze the stress and displacement changes of human lumbar spine in bending movement from the biomechanical point of view when unilateral and bilateral pedicle screws are fixed, providing theoretical reference for practical clinical application. METHODS: Three-dimensional models were established based on CT data of the volunteers. The volunteers signed the informed consent. This study was approved by the Hospital Ethics Committee. Abaqus software was used to simulate the actual stress conditions. Finite element analysis of lumbar spine flexion was performed during unilateral and bilateral pedicle screw fixation. The stress and displacement of lumbar vertebra, disc and pedicle screw were observed under two fixation methods. RESULTS AND CONCLUSION: (1) Under bilateral fixation, the stress on the left screw was 22.2 MPa, and the stress on the right screw was 21.14 MPa, which was far less than the stress of the screw under unilateral fixation (79.19 MPa). The stress of intervertebral disc in unilateral fixation was 87% larger than that in bilateral fixation; the stress of vertebral body in bilateral fixation was 72% smaller than that in unilateral fixation. (2) From the perspective of displacement, the displacement of screw, lumbar disc and centrum under bilateral fixation were 53%, 55% and 62% smaller than that under unilateral fixation, respectively. (3) Therefore, from the mechanical point of view, bilateral pedicle screw fixation has less stress level, which is friendlier to the human body than unilateral fixation and thus more conducive to the recovery of patients. Figures and Tables | References | Related Articles | Metrics

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Finite element simulation and biomechanical analysis of fully endoscopic precisely laminectomy decompression Jiang Qiang, Ding Yu, Liu Jinyu, Cao Shiqi, Lu Zhengcao 2020, 24 (12):  1891-1896.  doi: 10.3969/j.issn.2095-4344.2520 Abstract ( 411 )   PDF (24175KB) ( 75 )   Save BACKGROUND: Minimally invasive endoscopic decompression is currently used in the treatment of lumbar spinal stenosis, but there are few studies on the scope of precise laminectomy under the microscope. OBJECTIVE: To explore the influence of precise decompression with different laminectomy zones on lumbar range of motion and stress distribution using the entire degenerative lumbar finite element model. METHODS: A patient with lumbar spinal stenosis was randomly selected. Based on CT data, the lumbar L4-5 segment finite element model (M1) was established using relevant biomechanical software, and the validity was verified. After that, the finite element simulation of fully endoscopic precisely laminectomy decompression operation was performed. Combined with pathological classification of lumbar spinal stenosis, personalized laminectomy decompression aiming at different L4-5 segment stenosis was established, specifically including L4 lamina margin and partial facet joint resection model (M2), L5 lamina margin and partial facet joint resection model (M3), L4/5 lamina margin and partial facet joint resection model (M4), M4 + “Over-the-Top” contralateral partial facet joint resection model (M5), and L4/5 lamina margin and over 50% facet jointresection model (M6). The same boundary loading was applied to the various finite element models. The lumbar range of motion and equivalent stress of intervertebral discs were compared under six conditions including flexion, extension, left and right flexion, left and right rotation. RESULTS AND CONCLUSION: (1) Compared with the entire M1 model, ranges of motion of M2, M3, M4 and M5 models were similar under various conditions, but range of motion of M6 model was significantly increased to 151%-264% scope, especially in the extension and rotational conditions. (2) In terms of the equivalent stress of disc, the M2, M3, M4 and M5 models showed no obvious increasing trend at the anterior, left and right regions under various working conditions. The largest increase of the equivalent stress at posterior and middle disc regions was 53% maximally, but with no significant stress concentration. However, the equivalent stress in total disc regions showed a significant increasing trend in M6 model, especially in flexion condition with the maximum three times of M1 model. (3) Results suggest that extensive laminectomy can significantly affect the stability of the lumbar spine, with the intervertebral disc stress increase at the corresponding segment which is more likely to accelerate segmental degeneration. Minimally invasive endoscopic decompression is precise and controllable. The personalized decompression schemes can be adopted for different types of lumbar spinal stenosis to ensure the surgery effect and effectively maintain the biomechanical characteristics of the segments. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis and in vitro biomechanical experiment of new domestic lumbar interspinous process distraction device  Wang Baodong, Hou Jichun, He Renke, Cao Yang 2020, 24 (12):  1897-1904.  doi: 10.3969/j.issn.2095-4344.2526 Abstract ( 577 )   PDF (32463KB) ( 214 )   Save BACKGROUND: The non-fusion system of lumbar interspinous process distraction device provides a new treatment option for lumbar degenerative diseases. However, at present, the clinical application and research of lumbar interspinous process distraction device are reported insufficiently in China, especially for the domestic lumbar interspinous process distraction device. OBJECTIVE: To verify the scientific nature and effectiveness of the new domestic lumbar interspinous process distraction device through finite element analysis and in vitro biomechanical experiment of goat lumbar spine. METHODS: (1) Finite element analysis of new domestic lumbar interspinous process distraction device: L2-L5 three-dimensional model of vertebral body was established based on normal adult lumbar CT data. From then on, new domestic lumbar interspinous process distraction device model, new lumbar interspinous process distraction device model of lumbar non fusion system were successively built. The mechanical conditions were given under the physiological conditions of lumbar spine. Biomechanical analysis was carried out before and after the new domestic lumbar interspinous process distraction device was implanted. (2) In vitro biomechanical analysis of new domestic lumbar interspinous process distraction device: the lumbar vertebrae (L1-L5) of 24 adult male goats were obtained, and the new domestic lumbar interspinous process distraction device was implanted between the L3-4 spinous process. Before and after the placement of the lumbar interspinous process distraction device, the lumbar motion range and the pressure of the intervertebral disc under the flexion, extension, lateral bending and rotation of the lumbar specimens were detected. RESULTS AND CONCLUSION: (1) After the new lumbar interspinous process distraction device was implanted, the motion range and the pressure of the intervertebral disc of responsible segment were reduced, while the adjacent segments’ mobility and the pressure of the intervertebral disc were almost unaffected. It was theoretically verified that the new domestic lumbar interspinous process distraction device could provide the biomechanical basis for the treatment of the lumbar degenerative diseases, and contribute to the theoretical reference for the prevention of the clinical diseases. (2) In the state of extension, the motion range of L3-4 vertebral body after implanting the new lumbar interspinous process distraction device was significantly lower than that before implantation (P < 0.05). There was no significant difference between L2-3 and L4-5 vertebral body after implanting the new lumbar interspinous process distraction device and that before implantation (P > 0.05). In the state of flexion, lateral bending and rotation, there was no significant difference between L2-3, L3-4 and L4-5 vertebral body after implanting the lumbar interspinous process distraction device and that before implantation (P > 0.05). In the state of extension, the pressure of intervertebral disc after L3-4 vertebral body implantation was significantly lower than that before implantation (P < 0.05). There was no significant difference between L2-3 and L4-5 vertebral body implantation and that before implantation (P > 0.05). In the state of flexion, lateral bending and rotation, there was no significant difference between L2-3, L3-4 and L4-5 vertebral body implantation and that before implantation (P > 0.05). (3) The results showed that the scientific nature and validity of the new domestic lumbar interspinous process distraction device was verified by three-dimensional finite element analysis and in vitro animal lumbar specimens experiment, which provided a strong basis for the animal experiment, clinical experiment, clinical application and clinical production of the new domestic lumbar interspinous process distraction device. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional finite element analysis of the biomechanical changes of the lumbar spine after the combination of intervertebral fusion with dynamic internal fixation of the interspinous process in the lumbosacral region Cao Liangliang, Xu Jianguang, Mei Wei 2020, 24 (12):  1905-1910.  doi: 10.3969/j.issn.2095-4344.2543 Abstract ( 467 )   PDF (24837KB) ( 74 )   Save BACKGROUND: The Topping-off technique, which combines lumbar fusion with the dynamic internal fixation system (Coflex), can not only reduce the pressure, but also protect the adjacent segments. There is no relevant mechanical analysis performed on the rationality of the application of Topping-off technique to young patients with the need for fusion on the lumbosacral region and adjacent degenerated segments. OBJECTIVE: To establish a finite element model of Topping-off surgery on the lumbosacral junction and to analyze the biomechanical changes of the adjacent segments and the range of motion trend of the lumbar spine. METHODS: A healthy young male volunteer with no previous history of low back pain or congenital malformations was randomly selected for thin-slice CT scanning after signed the informed consent. The image information was imported into the computer and the whole lumbar spine model as the healthy group model was established by analyzing the image information through Mimics, Geomagic Studio 12.0, HyperMesh and Abaqus successively. After verifying the effectiveness of the model, the moderate degeneration model of intervertebral disc was established by changing the material properties of L4-S1 discs on the basis of the healthy model, and the fusion model and Topping-off model were respectively established on the basis of the degeneration model. After applying 400 N compressive load and 10 N•m momentum to the four groups of models, the variation trends of range of motion from L2 to L5 and the stress changes of L4/L5 intervertebral disc, nucleus pulposus and facet joints were calculated respectively. RESULTS AND CONCLUSION: (1) Compared with the degeneration model, the lumbar range of motion of Topping-off model and fusion model decreased, and the Topping-off model decreased more significantly than the fusion model. (2) The range of motion of fusion model L4-L5 increased significantly and the range of motion of L2/L3 and L3/L4 segments did not change significantly. Compared with the degeneration model, the L4-L5 range of motion of Topping-off model decreased, and range of motion of the L2/L3 and L3/L4 levels increased to some extent in the flexion and extension positions. (3) Compared with the degeneration model, the stress on the disc, nucleus pulposus and facet joint of the fusion model L4-L5 increased in four positions of flexion, extension, rotation and bending, while the fiber stress on the Topping-off model decreased significantly in all four positions. (4) These results suggest that Topping-off technology can not only reduce the stress on the upper adjacent degenerative intervertebral disc, nucleus pulposus and facet joints, but also reduce the hyperactivity of the adjacent segments and increase the range of motion of other upper segments, thereby compensating the lumbar spine mobility and delaying the degeneration of upper adjacent segments. Figures and Tables | References | Related Articles | Metrics

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Effect of different defect areas of medial femoral condyle cartilage on peripheral cartilage stress: three-dimensional finite element analysis Zhang Yeming, Wu Di, Zhang Ling, Liu Min, Yu Yong, Cui Jiewen, Yuan Bingqian, Li Qing 2020, 24 (12):  1911-1916.  doi: 10.3969/j.issn.2095-4344.2528 Abstract ( 524 )   PDF (23645KB) ( 109 )   Save BACKGROUND: Although it has been found in many studies that three-dimensional finite element analysis can be used in the study of knee joint biomechanics, there are few researches on different defect areas of medial condyle cartilage of the femur.  OBJECTIVE: To analyze the stress change trend of perimeter articular cartilage before and after the occurrence of different defect areas of medial femoral condyle cartilage, providing biomechanical data for patients with knee medial femoral condyle cartilage defect. METHODS: One normal adult had been selected to establish a three-dimensional finite element model. Material mechanical properties were input to Abaques software with divided grid model. After controlling boundary condition with mechanical load, structural nonlinear finite element was calculated. First, the load stress distribution of knee cartilage and meniscus was observed under normal stress. Articular cartilage stress distribution was observed with load conditions in different defects (0, 6, 8, 10, 12, 14, 16, 18 and 20 mm) of medial femoral condyle. The stress changes on the cartilage were analyzed during the defect of medial femoral condyle. This study was approved by the Ethics Committee of First Affiliated Hospital of Kunming Medical University. The volunteer signed the informed consent. RESULTS AND CONCLUSION: (1) Material properties, boundary conditions and the introduction of loads were defined successfully. The stress cloud chart and its stress data were obtained from different diameter defects of cartilage in medial condyle of knee joint. According to statistical analysis, the stress on the femoral condyle and tibial plateau cartilage had significant changes compared with no defects when the medial femoral condyle cartilage had defects of 10 mm (area 0.78 cm2) and 12 mm (area 1.13 cm2). (2) The stress change trend of the cartilage of the medial condyle of the knee joint under the condition of different diameter defects was calculated based on the analysis of the application of three-dimensional finite element method. (3) Results suggest that the defect with the diameter of 10 mm (area 0.78 cm2) of medial femoral condyle may be the minimum diameter advised for operation intervention of cartilage repair.    Figures and Tables | References | Related Articles | Metrics

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Role and efficacy of Picture Archiving and Communication System-assisted preoperative planning in total knee arthroplasty Liu Dongcheng, Zhao Jijun, Zhou Zihong, Wu Zhaofeng, Yu Yinghao, Feng Dehong 2020, 24 (12):  1917-1922.  doi: 10.3969/j.issn.2095-4344.2527 Abstract ( 396 )   PDF (28063KB) ( 82 )   Save BACKGROUND: In clinical application, Picture Archiving and Communication System gradually replaces the traditional preoperative planning mode of acetate template measurement on film, which can accurately obtain the parameters needed in the operation of total knee arthroplasty. OBJECTIVE: To evaluate the usage of Picture Archiving and Communication System in planning and assessment pre- and post-operatively in total knee arthroplasty. METHODS: Severe knee osteoarthritis patients who undertook total knee arthroplasty in Wuxi People’s Hospital affiliated to Nanjing Medical University from March 2016 to March 2018 were included in the study. The patients were randomly divided into two groups. In the trial group (n=32), osteotomy was performed by Picture Archiving and Communication System, and then patients were implanted with knee prosthesis. In the control group (n=32), the osteotomy was performed according to the X-ray film, and then the artificial knee joint prosthesis was implanted. The trajectory of the tibia was tested during the operation. Anteroposterior and lateral X-ray films of the knee and the whole length films of the lower limbs were reexamined postoperatively. Tibial plateau inclination angle and valgus or varus angle were measured through Picture Archiving and Communication System. Recovery of lower limb alignment was assessed. Hospital for special surgery knee score on the affected side was analyzed to evaluate the recovery of joint function at postoperative 1, 3 and 12 months. This study was approved by the Ethics Committee of Wuxi People’s Hospital affiliated to Nanjing Medical University. RESULTS AND CONCLUSION: (1) The satisfaction rate of lower limb alignment and the excellent and good rate of patellar movement trajectory were higher in the trial group than in the control group (100%, 91%; 100%, 94%, P < 0.05). There was no significant difference between the two groups in the satisfaction rate of osteotomy (P > 0.05). (2) Hospital for special surgery knee score was higher in the trial group than in the control group at postoperative 1 and 3 months [(80.5±9.06), (74.0±6.42), P < 0.05; (89.5±4.11), (82.5±6.09), P < 0.05]. There was no significant difference in the score at postoperative 12 months (P > 0.05). (3) No complications or adverse reactions related to implant occurred after operation. (4) Results indicated that personal osteotomy data can be obtained through Picture Archiving and Communication System in the total knee arthroplasty so as to improve the accuracy of osteotomy, better correct the lower limb alignment, obtain excellent patellar trajectory, and obtain better early curative effect of operation. The follow-up results within 1 year were satisfactory. The long-term effect remains to be further observed. Figures and Tables | References | Related Articles | Metrics

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Imaging analysis of ossification of the nuchal ligament with cervical curvature and segmental stability Lu Weiqiang, Yuan Feng, Chen Jiacheng 2020, 24 (12):  1923-1928.  doi: 10.3969/j.issn.2095-4344.2565 Abstract ( 508 )   PDF (26990KB) ( 146 )   Save BACKGROUND: In degenerative cervical spondylosis associated with cervical curvature straightening or segmental instability, ossification of the nuchal ligament caused by chronic injury of the nuchal ligament is very common. OBJECTIVE: To investigate the correlation between ossification of the nuchal ligament and cervical curvature and segmental stability of the cervical spine.  METHODS: Data of 109 patients with degenerative cervical spondylosis, who were treated in Department of Spinal Surgery of Affiliated Hospital of Xuzhou Medical University from October 1, 2017 to October 31, 2018, were retrospectively analyzed. There were 61 male patients and 48 female patients, who aged 30 to 81 years old at a mean age of (55.8±11.1) years. All patients signed the informed consent. This study was approved by the Ethics Committee of Affiliated Hospital of Xuzhou Medical University. The patients underwent the X-ray examinations of cervical spine. The imaging observation included the distribution and degree of ossification of the nuchal ligament and the change of cervical physiological curvature and segment stability. The patients were divided into ossification group and non-ossification group according to whether or not the patients had ossification of the nuchal ligament. Gender, age, cervical curvature and lower cervical stability were compared between the two groups. Pearson correlation analysis was used to compare the relationship between the degree of ossification of the nuchal ligament and cervical curvature and cervical stability. Binary Logistic regression analysis was applied to evaluate the significant risk factors for the development of ossification of the nuchal ligament. RESULTS AND CONCLUSION: (1) Of 109 patients with degenerative cervical spondylosis, 56 patients with ossification of the nuchal ligament and ossification involved 83 cervical segments in ossification of the nuchal ligament patients, most of which were C4-5 (39.8%) and C5-6 (42.2%). (2) There was significant difference in age, C2-C7 Cobb angle, Jackson physiological stress curve, parameter angular displacement and horizontal displacement between the ossification group and non-ossification group (P< 0.05). The degree of ossification of the nuchal ligament was positively correlated with angular displacement (r=0.486, P < 0.05). (3) The incidence of ossification of the nuchal ligament was significantly higher in patients with lower cervical instability (P < 0.05). Age and lower cervical instability parameter angular displacement were significant risk factors for the development of ossification of the nuchal ligament. (4) Patients with ossification of the nuchal ligament are more likely to have cervical curvature straightening and lower cervical instability, especially in the segment instability. In the diagnosis and treatment of degenerative cervical spondylosis, the existence of ossification of the nuchal ligament causes corresponding attention. Figures and Tables | References | Related Articles | Metrics

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Wounds repaired by flap transfer after total knee arthroplasty Chen Jianguo, Qian Wenwei, Peng Huiming 2020, 24 (12):  1929-1934.  doi: 10.3969/j.issn.2095-4344.2507 Abstract ( 432 )   PDF (35391KB) ( 83 )   Save BACKGROUND: Wound complications probably result in severe soft tissue defects after total knee arthroplasty, which brings orthopedic surgeon a big challenge. Some treatment options, such as frequent sterile dressings changes, persistent drainage, minor or thorough debridement, negative pressure wound therapy and split-thickness skin grafts, fail to help those quite large and deep wounds around the knee, with exposed fascia or prosthesis, bone, joint, tendon, large vessels and nerve, heal by secondary intention. Under these situations, orthopedic surgeon should consult plastic surgery and propose flap re-construction. OBJECTIVE: To introduce some types of flaps for orthopedic surgeon, so as to help orthopedic surgeon understand and chose flaps logically, and reduce severe consequences caused by soft tissue defect wounds. METHODS: The first author retrieved databases of PubMed, Medline, Wanfang and CNKI for the articles concerning wounds repaired by flap transfer after total knee arthroplasty published before 2019. The key words were “flap, knee, wound” in Chinese and English, respectively. Initially 668 articles were retrieved and 45 eligible articles were included in accordance with the inclusion and exclusion criteria for analysis. RESULTS AND CONCLUSION: (1) Flap reconstruction is widely applied in plastic surgery. It is significant for orthopedic surgeon to recognize the characteristics of each flap. (2) Selecting and designing suitable type of flap according to the three-dimensional structure and position of wounds is helpful for repairing soft tissue defect, reducing the risks of prosthesis exposure, periprosthetic infection, prosthesis removal and even amputation after total knee replacement after total knee arthroplasty. Figures and Tables | References | Related Articles | Metrics

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Types and advantages of spinal implants in percutaneous kyphoplasty Gao Jian’an, Chen Xi, Zhang Longsheng, Liao Wenbo 2020, 24 (12):  1935-1940.  doi: 10.3969/j.issn.2095-4344.2525 Abstract ( 679 )   PDF (37773KB) ( 106 )   Save BACKGROUND: Percutaneous kyphoplasty is of breakthrough significance in minimally invasive treatment of vertebral compression fractures, but it also has shortcomings, such as bone cement leakage, limited height recovery of the vertebral body, and increased risk of fracture of adjacent vertebral bodies. In recent years, a variety of spinal implants have been developed, and the application of these implants in the treatment of vertebral compression fractures in percutaneous kyphoplasty has achieved good clinical efficacy, and is beneficial to reduce the complications of traditional percutaneous kyphoplasty. OBJECTIVE: To describe the types and characteristics of various spinal implants and explore their clinical applications in percutaneous kyphoplasty. METHODS: CNKI, PubMed and Elsevier were retrieved for relevant literature. The key words were “percutaneous kyphoplasty, spinal implants, vertebral stents, vertebral compression fractures”. Relevant articles published from January 2000 to June 2019 were reviewed, including review, basic research and clinical research. Preliminary screening was conducted by reading the article title and abstract, and the literatures with low relevance to the article topic were excluded. According to the inclusion and exclusion criteria, 62 articles were finally included for analysis. RESULTS AND CONCLUSION: (1) Spinal implants used in percutaneous kyphoplasty include VBS stent, Jack vertebra expander, SKY bone expander system, Osseofix system, SpineJack, KIVA system and memory alloy vertebral stent. (2) They are modified and developed on the basis of classic percutaneous kyphoplasty to achieve the same clinical efficacy while minimizing complications such as cement leakage, loss of vertebral height, and increased risk of adjacent vertebral body fracture.  Figures and Tables | References | Related Articles | Metrics

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Research and application of artificial cervical disc Li You, Zheng Bengbeng, Wang Jiaming, Ma Yongsheng 2020, 24 (12):  1941-1948.  doi: 10.3969/j.issn.2095-4344.2522 Abstract ( 934 )   PDF (49348KB) ( 121 )   Save BACKGROUND: For patients with cervical spondylosis who fail to receive conservative treatment, cervical anterior decompression and fusion has always been the gold standard for surgical treatment. Since its use, it has been widely recognized by clinicians for its simple and convenient intraoperative operation and significant relief of pathological segmental symptoms after surgery. As time goes by, the problem of degeneration of surgery adjacent segments and loss of mobility of the replacement segments is gradually exposed. At the same time, the patient’s requirements for postoperative rehabilitation and quality of life are constantly improving, and surgical technology continues to develop rapidly. This type of surgery cannot meet the clinical needs. Therefore, total cervical disc replacement surgery comes into being, which can solve the related problems caused by anterior cervical decompression and fusion, and the clinical effect is better than previous one. OBJECTIVE: To review the research status of artificial cervical intervertebral discs, to focus on its clinical effects and structure, and to prospect its improvement and development direction of artificial development direction. METHODS: A compute-based retrieval of CNKI, WanFang and PubMed databases was conducted for articles published between January 1995 and August 2019. The keywords were “non-fusion technique, artificial intervertebral disc, clinical efficacy, structure” in Chinese and English, respectively. The articles related to artificial cervical intervertebral disc were selected, and the latest experimental and clinical researches were preferred. RESULTS AND CONCLUSION: (1) Through analyzing the main artificial cervical discs on the market, the research of artificial cervical discs will focus on materials, structures, implantation devices and surgical approaches of prosthesis. The domestic cervical disc will be designed based on the anatomical features of the Chinese cervical spine. (2) It is believed that the future cervical disc replacement surgery will achieve a satisfactory clinical effect, and its postoperative complications will be significantly reduced, which can meet the requirements of Chinese people. Figures and Tables | References | Related Articles | Metrics

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Locking plate in the treatment of proximal humeral fractures involving humeral calcar: effective support, complications and functional recovery Xu Peng, Su Ping, Li Xuedong, Rui Yongjun 2020, 24 (12):  1949-1956.  doi: 10.3969/j.issn.2095-4344.2551 Abstract ( 756 )   PDF (51005KB) ( 77 )   Save BACKGROUND: Saving the humeral head is a challenge when the proximal humerus is fracture in orthopedic trauma, and how to obtain medial column support is a hot topic in recent years. OBJECTIVE: To summarize the general concept, clinical significance and function, the common injury mechanism of humeral calcar, and the progress using locking plate so as to improve the clinicians’ understanding for the humeral calcar and to reduce the occurrence of surgical complications. METHODS: From 2004 to 2019, Wanfang, CNKI, VIP, PubMed, Web of Science, and Springer Link about the treatment and research progress of proximal medial wall of the humerus were searched by the first author. The key words were “proximal humeral fracture, Philos, infermedial screw, calcar screw, fibular allograft, middle support” in English, and “proximal humeral fracture, humeral spur, medial column, plate, fibular allograft” in Chinese. The references were retrieved by hand. Finally, 51 studies were used for review according to the inclusion and exclusion criteria. RESULTS AND CONCLUSION: (1) The range of the humeral calcar region is still unclear. There is no uniform classification standard for fractures involving the humeral calcar region. X-ray films show that calcar fracture patterns are often inconsistent with the actual fracture situation, which is often a complex fracture. Lack of understanding and paying litter attention to the humeral calcar region is the main reason of iatrogenic injury and the failure to get a good repair. (2) Treatment using the locking plate is still the preferred method for proximal humerus fracture. Meanwhile, it is a feasible method that using the screw, the allogeneic iliac bone graft, the bone cement or the medial plate to reconstruct the medial column if there is a “repairable medial wall”. Getting anatomical reduction of the internal wall and effective support of the medial column during operation can help to reduce postoperative complications. However, the use of the medial buttress plate requires further research to verify. It is critical important to repair the rotator cuff for the medial column support. (3) The range of the humeral calcar region needs to be unified. Understanding the humerus calcar is essential for the treatment of proximal humeral fracture. Only by mastering the fracture mode of the humerus calcar and choosing the most appropriate surgical procedure before surgery, meanwhile，achieving anatomical reduction of the medial wall and the effective support of the medial column during operation can reduce the postoperative complications of the fracture. Repairing of the rotator cuff carefully during operation is indispensable for patients to obtain better shoulder function. Figures and Tables | References | Related Articles | Metrics

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Research and development of fluoroscopy for the detection of dorsal screw penetration in the fixation of distal radius fracture with volar locking plate Wang Haonan, Wen Shuzheng, Wang Jihong, Hao Zengtao, Fan Dongsheng, Jing Shangfei, Han Chaoqian, Wang Yongfei, Wang Xiaolong, Yin Chao, Jiang Dong 2020, 24 (12):  1957-1961.  doi: 10.3969/j.issn.2095-4344.2518 Abstract ( 458 )   PDF (31491KB) ( 202 )   Save BACKGROUND: Although the incidence of irritation, abrasion and rupture of the extensor tendon at the dorsal carpal side of the distal radius caused by internal fixation with volar locking plate is not high, these complications seriously affect the quality of life of the patients. OBJECTIVE: To summarize the latest progress of intraoperative fluoroscopy in the treatment of distal radius fracture with volar locking plate. METHODS: Using the English key words “volar locking plate, distal radius fracture, radiological method”, the authors retrieved PubMed for 160 relevant studies published from 2000 to 2019. Using the Chinese key words “fluoroscopy, distal radius fracture, volar plate”, the authors searched Wanfang database for 7 relevant studies published from 2000 to 2019. This paper reviewed the literature of intraoperative fluoroscopy in the treatment of distal radius fracture with volar locking plate.  RESULTS AND CONCLUSION: (1) There are various methods of intraoperative fluoroscopy during volar locking plate fixation for distal radius fracture, such as standard anteroposterior view, lateral view, carpal canal method, skyline, dorsal tangent view and radial groove view. (2) The above common methods still have some limitations in detecting the problem of posterior screw penetration in volar locking plate fixation. The complications such as irritation, abrasion and rupture of the extensor tendon of the dorsal wrist still occur, and the problems brought by the secondary and multiple operations to the patients’ life and economy should also be paid attention to. (3) More appropriate intraoperative detection methods should be found, in order to reduce the incidence of complications caused by the internal fixation of the posterior screw with the locking plate on the palmar side. Figures and Tables | References | Related Articles | Metrics

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Application and progress of three-dimensional printing technology in hip arthroplasty Guo Yu, Feng Dehong, Wang Ling, Li Yaxin, Wang Zhidong, Yang Huilin 2020, 24 (12):  1962-1968.  doi: 10.3969/j.issn.2095-4344.2564 Abstract ( 423 )   PDF (45773KB) ( 76 )   Save BACKGROUND: Three-dimensional (3D) printing technology is a new rapid prototyping technology, which has been initially applied in orthopedics, especially in the clinical application of hip replacement surgery. OBJECTIVE: To summarize the application status, existing problems and future development direction of 3D printing technology in hip arthroplasty. METHODS: The relevant articles published between January 2000 and March 2019 were retrieved from PubMed, CNKI and WanFang databases. The keywords were “3D printing, rapid prototyping, additive manufacturing, computer aided, computer-assisted, hip, hip replacement, hip arthroplasty, revision hip arthroplasty” in English and Chinese, respectively. Initially, 1 833 articles were retrieved, and finally 105 eligible articles were included for result analysis in accordance with the inclusion and exclusion criteria. RESULTS AND CONCLUSION: (1) In the clinical application of hip replacement surgery, 3D printing technology is mainly used to make anatomical models for clinical teaching or preoperative plan, patient-specific surgical guides, customized implants or prostheses. (2) The advantages of 3D printing technology can make up for the deficiency of traditional treatment, and it can help to optimize the surgical plan, shorten the operation time, decrease the bleeding, reduce postoperative complications, improve the accuracy of surgery and clinical results. (3) Individualized treatment with 3D printing technology will become a new direction in hip arthroplasty. Figures and Tables | References | Related Articles | Metrics