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    28 May 2020, Volume 24 Issue 15 Previous Issue    Next Issue
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    Establishing morphological database of lower limbs for providing appropriate clinical postoperative prosthesis socket
    Wu Xiaoqi, Li Ding, Huang Xuecheng, Huang Wenhua
    2020, 24 (15):  2297-2302.  doi: 10.3969/j.issn.2095-4344.2579
    Abstract ( 221 )   PDF (26064KB) ( 19 )   Save

    BACKGROUND: At present, the prosthesis is made by three steps: taking, trimming and shaping. Because the process of trimming is manual, it is closely related to the experience and technology of clinical technicians. If the prosthesis is not beautiful, it is difficult to make full contact between the receiving cavity and the residual limb.

    OBJECTIVE: To collect MRI data of thigh in healthy volunteers, evaluate the anatomical symmetry of thigh amputation range (10-25 cm above knee joint space), and establish MRI data as a database so as to provide reference data for patients with lower limb amputation to match the appropriate prosthesis after operation.

    METHODS: Totally 40 healthy volunteers were recruited and basic information was collected, including age, height, weight, the circumference of the knee, the circumference of the knee at 5 cm, the circumference of the knee at 10 cm, and the circumference of the knee at 15 cm. All volunteers signed the informed consent. This study was approved by the Hospital Ethics Committee. Three-dimensional reconstruction was carried out in thigh amputation range. Taking the surface area and volume of the model as parameters, the thighs of each volunteer were anatomically measured. Three-dimensional reverse engineering software was used to analyze the three-dimensional deviation of the measurement results so as to conduct quantification and visualization of the thigh symmetry.

    RESULTS AND CONCLUSION: (1) Self symmetric analysis: Regarding the surface area, the maximal percent difference between the left and right thigh amputation was no more than 0.56% (P=0.109). Regarding the volume, the maximal percent difference between the left and right thigh amputation was no more than 1.19% (P=0.182). Results of the three-dimensional deviation analyses showed that the maximal mean negative deviation was -1.47 mm, while the maximal mean positive deviation was 1.14 mm. Moreover, the three-dimensional deviation distribution of 40 subjects was within 2 mm (78.02%), between 2.1 and 3.0 mm (20.97%), and more than 3 mm (1.01%). (2) Allogeneic symmetric analysis: Results of the three-dimensional deviation analyses showed that the maximal mean negative deviation was -1.97 mm, while the maximal mean positive deviation was 1.89 mm. (3) The results confirmed that adult bilateral thigh amputation range has a high degree of anatomical symmetry. When differences between two adults’ right thighs are no more than 2 cm in the circumference of the knee, the circumference of the knee at 5 cm, the circumference of the knee at 10 cm, and the circumference of the knee at 15 cm, their surface profiles of thigh amputation ranges are considered to be highly similar, but are not associated with gender, height and weight.

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    Comparison of occult blood loss after unicompartmental knee arthroplasty and total knee arthroplasty
    Peng Chao, Liu Yunpeng, Wang Xiaolong, Wang Xingliang, Yang Jiaji, Hua Guojun
    2020, 24 (15):  2303-2309.  doi: 10.3969/j.issn.2095-4344.2586
    Abstract ( 170 )   PDF (625KB) ( 43 )   Save

    BACKGROUND: The intraoperative blood loss of unicompartmental knee arthroplasty is lower than that of total knee arthroplasty, but the difference of postoperative occult blood loss between them has not been widely studied.

    OBJECTIVE: To compare the difference of occult blood loss between unicompartmental knee arthroplasty and total knee arthroplasty, and to analyze whether patients with preoperative anemia can also undergo unicompartmental knee arthroplasty without the risk of blood transfusion.

    METHODS: 148 patients with knee osteoarthritis treated in 904 Hospital of the Joint Service Support Force of Chinese PLA from January 2014 to December 2016 were selected. Among them, 58 cases underwent unicompartmental knee arthroplasty and 90 cases underwent total knee arthroplasty. Hemoglobin levels and hematocrit were measured before and 1, 4, 21 and 42 days after operation, and the occult blood loss and blood transfusion rate were calculated. The trial was approved by the Ethics Committee of 904 Hospital of the Joint Service Support Force of Chinese PLA (approval No. 2019-01-03).

    RESULTS AND CONCLUSION: (1) The hemoglobin level of unicompartmental knee arthroplasty group was higher than that of total knee arthroplasty group at 1 and 4 days after operation (P < 0.01). There was no significant difference in hemoglobin level between the two groups before operation and 21, 42 days after operation (P > 0.05). (2) Hematocrit in the unicompartmental knee arthroplasty group was higher than that in the total knee arthroplasty group at 1 and 4 days after operation (P < 0.01). There was no significant difference in hematocrit between the two groups before operation and 21, 42 days after operation (P > 0.05).(3) From day one to day four after surgery, there was no occult blood loss in the female of unicompartmental knee arthroplasty group, and the average occult blood loss in the male was 4 g/L. The average occult blood loss was 10 g/L in female and 7 g/L in male in total knee arthroplasty group. The occult blood loss in male and female in unicompartmental knee arthroplasty group was lower than that in total knee arthroplasty group (P < 0.05 or P < 0.01). (4) The blood transfusion rate was 0% in unicompartmental knee arthroplasty group and 4.4% in total knee arthroplasty group. In patients with preoperative moderate anemia (hemoglobin 60-89 g/L), there was no need for blood transfusion in unicompartmental knee arthroplasty group (n=3), but blood transfusion was needed in 2 of 6 patients in total knee arthroplasty group (33%). (5) The results showed that unicompartmental knee arthroplasty had obvious advantages over total knee arthroplasty in postoperative occult blood loss.

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    Change of related functions and double lower limb length after total knee arthroplasty
    Tang Jinlong, Yang Guanjie, Liu Lei, Xu Shizhuang, Zhao Fengchao
    2020, 24 (15):  2310-2316.  doi: 10.3969/j.issn.2095-4344.2585
    Abstract ( 362 )   PDF (32090KB) ( 17 )   Save

    BACKGROUND: There are many reasons for poor function after knee arthroplasty. Leg length discrepancy is one of them. The extent of influence on the function of knee joint after arthroplasty has not been fully studied.

    OBJECTIVE: To analyze the change degree, possible influencing factors and functional changes of leg length discrepancy in patients after total knee arthroplasty.

    METHODS: Totally 107 patients (124 knees), including 23 males and 84 females, were included from October 2016 to September 2018, who entered the Department of Orthopedics of Affiliated Hospital of Xuzhou Medical University for total knee arthroplasty. There were 90 cases of unilateral total knee arthroplasty (90 knees) and 17 cases of bilateral total knee arthroplasty (34 knees). Three cases (6 knees) of bilateral total knee arthroplasty received separate treatment with an interval of more than 6 months, and entered the unilateral knee group. Therefore, there were 93 cases (96 knees) in the unilateral knee group, and 14 cases (28 knees) in the bilateral knee group. Patients signed the informed consent. This study was approved by the Hospital Ethics Committee. At preoperative and postoperative 10 days and 6 months, full length anteroposterior radiographs were taken, and the length of the lower limb and hip-knee-ankle angle were measured and recorded. Angle of knee flexion contracture was measured and the hospital for special surgery knee score was recorded.

    RESULTS AND CONCLUSION: (1) The length of patients’ lower limbs was increased by the correction of deformities after total knee arthroplasty. The length of lower limbs 10 days after surgery was longer than that at 6 months after surgery. The lower limbs of 70.2% of the patients were increased 10 days after total knee arthroplasty, and 79.0% of the patients were increased 6 months after total knee arthroplasty. (2) At 10 days and 6 months postoperatively, the postoperative corrected flexion contracture angles were positively correlated with the change of postoperative lower limb length. (3) Limb lengthening on the operative side was positively correlated with increased hospital for special surgery knee score after surgery. (4) The incidence of leg length discrepancy before and after surgery was almost equal: 45.1% preoperatively, 55.3% 10 days postoperatively, and 46.0% 6 months postoperatively. (5) The leg length discrepancy preoperatively and 6 months postoperatively was influenced by the difference of deformities between the pair of limbs. Preoperative influencing factors were the difference of hip-knee-ankle angle and flexion contracture of both lower limbs. The difference value of flexion contracture of both lower limbs was the factor affecting the leg length discrepancy 6 months after surgery. Leg length discrepancy before surgery and 6 months after surgery was affecting the difference of hospital for special surgery knee score between lower limbs.

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    Application of computer navigation in total knee arthroplasty
    Jiang Zheng, Yin Zongsheng, Lu Ming, Hu Bo
    2020, 24 (15):  2317-2322.  doi: 10.3969/j.issn.2095-4344.2593
    Abstract ( 205 )   PDF (25031KB) ( 27 )   Save

    BACKGROUND: With the development of precision medicine, knee replacement under navigation has been paid more and more attention. Precision medicine allows for more accurate implant placement and better limb alignment. However, precision medicine can also make surgery much longer.

    OBJECTIVE: To evaluate the application of Aesculap Ortho-Pilot non-image-dependent wireless navigation in total knee arthroplasty.

    METHODS: Data of 42 patients with unilateral knee osteoarthritis admitted to the First Affiliated Hospital of Anhui Medical University from April to November 2017 were retrospectively collected. First total knee arthroplasty was conducted by the same surgeon. According to surgical methods, the patients were divided into two groups: the navigation group (n=21) received a total knee arthroplasty under the assistance of Ortho-Pilot non-image-dependent wireless navigation, and the non-navigation group (n=21) received a regular total knee arthroplasty. Operation time and drainage volume were recorded in both groups. X-ray film of weight bearing was taken 12 months after operation. Mechanical axis of the lower extremity, the mechanical proximal medial proximal angle of the mechanical shaft of the tibia, the distal lateral angle of the femoral mechanical axis, sagittal tibial component angle and the number of alignment deviation of the lower extremity (>3°) were compared between the two groups. Knee range of motion and Hospital for Special Surgery knee score were evaluated. This study was approved by the Ethics Committee of First Affiliated Hospital of Anhui Medical University.

    RESULTS AND CONCLUSION: (1) Operation time was longer in the navigation group than in the non-navigation group (P < 0.05). Postoperative drainage was less in the navigation group than in the non-navigation group (P < 0.05). (2) At postoperative 12 months, the variables of mechanical axis of the lower extremity, lateral angle of the distal end of the mechanical axis of the femur, and angular separation of the component of the sagittal tibia were smaller in the navigation group than in the non-navigation group (P < 0.05). There was no significant difference in the quantity of lower limb alignment > 3° and the variables of medial angular separation of proximal end of the mechanical axis of the tibia between the two groups (P > 0.05). (3) At postoperative 12 months, the range of motion was larger in the navigation group than in the non-navigation group (P < 0.05). There was no significant difference in Hospital for Special Surgery knee score between the two groups (P > 0.05). (4) Results suggested that total knee arthroplasty assisted by computer navigation can improve the accuracy of lower limb alignment, accuracy of prosthesis placement and knee range of motion. However, the operation time was improved, so the advantages and disadvantages should be considered comprehensively.

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    Combination of measured resection and gap balancing technique used in femoral component rotation in total knee arthroplasty 
    Lu Bin, Yang Wolong, Gao Shengshan, Xie Yang, Li Suwan, Hu Wangyang, Wang Jinhua
    2020, 24 (15):  2323-2328.  doi: 10.3969/j.issn.2095-4344.2568
    Abstract ( 246 )   PDF (25887KB) ( 24 )   Save

    BACKGROUND: Total knee arthroplasty is effective in managing end-stage knee disease. Measured resection and gap balancing are two different techniques. Both of two have advantages and disadvantages. A technique has been developed that combines the benefits of measured resection and gap balancing to optimize the clinical effect of total knee arthroplasty.

    OBJECTIVE: To evaluate the operation and early clinical effect in total knee arthroplasty about the combination of measured resection and gap balancing technique used in femoral component rotation.

    METHODS: Totally 30 patients were treated with the combination of measured resection and gap balancing technique in total knee arthroplasty from September 2016 to December 2018, including 4 males and 26 females, at the age of 46-81 years. There were 24 cases of osteoarthritis with varus and 2 cases of osteoarthritis with valgus. There were 4 cases of rheumatoid arthritis with valgus. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Effects were evaluated by Visual Analogue Scale, Hospital for Special Surgery score, femorotibial angle and range of motion before surgery and during final follow-up.

    RESULTS AND CONCLUSION: (1) The incision healed in the first stage after operation. No early complications occurred, such as infection, vascular nerve injury, deep venous thrombosis of the lower extremities and periprosthetic fracture. (2) Totally 30 patients were followed up for 6-30 months. (3) Visual Analogue Scale, Hospital for Special Surgery score, range of motion and femorotibial angle were improved during final follow-up compared with those before surgery (< 0.05). (4) Surgeons should be familiar with measured resection and gap balancing technique in total knee arthroplasty, and then use the combination of two techniques based on the specific situation of patients to obtain better soft tissue balance and prosthesis position. The combination technique is easy to master and can be operated with traditional osteotomy tools. Thus, good short-term effect can be achieved.  

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    Comparison of short-term outcomes between unicompartmental knee arthroplasty and posterior cruciate ligament-retaining total knee arthroplasty
    Han Mengguang, Qi Yusen, Han Zhen, Tian Weichao, Zhang Xingxu, Yang Yang ​
    2020, 24 (15):  2329-2334.  doi: 10.3969/j.issn.2095-4344.2602
    Abstract ( 229 )   PDF (476KB) ( 71 )   Save

    BACKGROUND: Unicompartmental knee arthroplasty and posterior cruciate ligament-retaining total knee arthroplasty are effective for people who were subjected to medial compartment lesions of the knee; however, the short-term effect of middle-aged and elderly people living in mountainous area needs further exploration.

    OBJECTIVE: To investigate the short-term efficacy of unicompartmental knee arthroplasty and posterior cruciate ligament-retaining total knee arthroplasty in middle-aged and elderly people with medial compartment osteoarthritis of knee joint in Chengde.

    METHODS: A total of 67 middle-aged and elderly patients with medial compartment osteoarthritis of the knee were selected from January 2017 to February 2019 in the Department of Joint Surgery, Affiliated Hospital of Chengde Medical College. Totally 31 patients in group A were treated with unicompartmental knee arthroplasty and 36 patients in group B were treated with posterior cruciate ligament-retaining total knee arthroplasty. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Intraoperative blood loss, postoperative blood transfusion, postoperative hemoglobin decline, hematocrit and C-reactive protein at postoperative 1 and 3 days, and Forgotten Joint Scores at 1, 3, and 6 months and 1 year after surgery were observed and compared between the two groups.

    RESULTS AND CONCLUSION: (1) The perioperative hemoglobin decline, intraoperative blood loss, and blood transfusion rate were significantly lower, and postoperative hospitalization date was significantly shorter in group A than those in group B (P < 0.05). (2) There was no significant difference in C-reactive protein between the two groups at 1 and 3 days after operation (P > 0.05). (3) The Forgotten Joint Scores in group A were significantly higher than those in group B at 1, 3, and 6 months and 1 year after operation (P < 0.01). (4) No complications such as lower extremity venous thrombosis, pulmonary embolism and infection occurred in both groups. (5) In summary, unicompartmental knee arthroplasty has the advantages of less intraoperative bleeding, lower transfusion rate, and higher degree of Forgotten Joint Scores for the middle-aged and elderly patients with medial compartment lesions in mountainous areas.

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    A novel cement-reinforced screw combined with locking plate fixation versus humeral head arthroplasty in the treatment of osteoporotic fractures of the proximal humerus  

    She Rongfeng, Zhang Yi, Wang Yuanzheng, Zhang Bin, Chen Peng, Huang Qixiang​
    2020, 24 (15):  2335-2341.  doi: 10.3969/j.issn.2095-4344.2627
    Abstract ( 236 )   PDF (29002KB) ( 22 )   Save

    BACKGROUND: To solve the complications such as screw cut-out, loosening, and insufficient holding force that may occur during internal fixation of osteoporotic fractures, a new cement-reinforced screw combined with PHILOS plate is currently used to treat osteoporotic fracture of the proximal humerus. However, there are few reports on the clinical efficacy of this technique in the treatment of osteoporotic fractures of the proximal humerus in China.

    OBJECTIVE: To compare the clinical efficacy of a novel cement-reinforced screw combined with locking plate fixation and artificial humeral head replacement in the treatment of osteoporotic fractures of the proximal humerus.

    METHODS: Twenty-two patients with osteoporotic fractures of the proximal humerus admitted to at Guizhou Provincial People’s Hospital from February 2017 to March 2019 were enrolled, including 8 males and 14 females, aged 68-88 years. Ten patients underwent open reduction using new cement-reinforced screws combined with locking plate internal fixation (internal fixation group), and 12 patients underwent humeral head arthroplasty (humeral head arthroplasty group). The operation time, intraoperative blood loss, and intraoperative and postoperative complications were compared. The Visual Analogue Scale and Constant scores of the shoulder joint were detected at 6 months after surgery. All patients received a postoperative anti-osteoporosis treatment. The study was approved by the Ethics Committee of Guizhou Provincial People’s Hospital, approval No. 2017(02).

    RESULTS AND CONCLUSION: (1) Twenty-two patients were followed up for 6-15 months, an average of (9.0±1.6) months. (2) No toxicity reaction of bone cement or embolism occurred in both groups. One case of postoperative shoulder stiffness occurred in the internal fixation group. There were no complications in both groups, such as incision infection, heterotopic ossification, delayed healing, and screw cut-out. (3) The operation time and intraoperative blood loss in the internal fixation group were significantly less than those in the humeral head arthroplasty group (P < 0.05). (4) The Visual Analogue Scale and the excellent and good rate of Constant scores of the shoulder joint at 6 months after surgery showed no significant differences between two groups (P > 0.05). (5) In summary, the novel cement-reinforced screw technique combined with locking plate internal fixation has similar clinical efficacy with humeral head arthroplasty. Therefore, this new technique is an alternative internal fixation method for some patients scheduled for shoulder joint arthroplasty.

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    Comparison of percutaneous reduction by leverage combined with minimally invasive internal fixation and “L” incision internal fixation in the treatment of calcaneal fracture  

    Zheng Zhihui, Cai Peibiao, Guan Keli, Li Xiaowu, Zheng Xun, Chen Haibo, Zeng Qingqiang
    2020, 24 (15):  2342-2348.  doi: 10.3969/j.issn.2095-4344.2521
    Abstract ( 238 )   PDF (29095KB) ( 27 )   Save

    BACKGROUND: Intra-calcaneal fractures involving subtalar joints account for about 75% of all calcaneal fractures. Surgical treatment of displaced intra-articular calcaneal fractures is superior to non-surgical treatment. However, the timing of treatment, surgical indications, incision selection, and bone grafting are still controversial. The classical “L” approach is gradually replaced by minimally invasive internal fixation because of its high incision complications.

    OBJECTIVE: To compare the clinical effect of minimally invasive internal fixation and “L” incision for the treatment of Sanders II and III calcaneal fractures. 

    METHODS: Sixty patients with Sanders II or III calcaneal fractures from January 2016 to January 2019 in the Second Department of Orthopedics, Shantou Hospital of Traditional Chinese Medicine were randomly divided into minimal invasion group (n=32) and “L” incision group (n=28). The patients in the minimal invasion group and “L” incision group received percutaneous reduction by leverage combined with minimally invasive internal fixation and “L” incision internal fixation treatment, respectively. At 6 months after operation, the curative effect of the two groups was evaluated according to the American Orthopedic Foot and Ankle Society score. Preoperative waiting days, the operation time, the length of stay and the complication incidence were compared between the two groups. Böhler angle and Gissane angle were measured and compared preoperatively, postoperatively and during the final follow-up.

    RESULTS AND CONCLUSION: (1) The excellent and good rate of American Orthopedic Foot and Ankle Society score was 91% in the minimal invasion group and 93% in the “L” incision group (P > 0.05). (2) The postoperative Böhler angle and Gissane angle were significantly improved in both groups (P < 0.05). At postoperative 1 day, Gissane angle of two groups was equivalent (P > 0.05). Böhler angle was better in the “L” incision group than in the minimal invasion group (P < 0.05). At the final follow-up, both groups had different degrees of decrease in Böhler angle and Gissane angle (P > 0.05). (3) The preoperative waiting days and the length of stay were longer in the “L” incision group than those in the minimal invasion group (P < 0.05). The operation time was shorter in the “L” incision group than in the minimal invasion group (P < 0.05). (4) The incidence of complications was lower in the minimal invasion group (9%) than in the “L” incision group (32%) (P < 0.05). (5) Compared with the traditional “L” incision open reduction and internal fixation, the treatment of Sanders II and III calcaneal fractures with percutaneous reduction by leverage combined with minimally invasive internal fixation are satisfactory, with less trauma and complications. It is worth being recommended in clinic.

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    Comparative analysis on biomechanical stability of the lateral fixation of the upper thoracic vertebrae through the middle axillary approach and the traditional anterior plate fixation  

    Shi Dongdong, Li Xiaofeng, Xiong Huojie, Hu Feng, Zhao Jinmin, Chen Qianfen
    2020, 24 (15):  2349-2354.  doi: 10.3969/j.issn.2095-4344.2584
    Abstract ( 131 )   PDF (26581KB) ( 24 )   Save

    BACKGROUND: With the comprehensive promotion of spinal internal fixation technology, the remodeling of spinal mechanical stability has attracted more and more attention. Lateral internal fixation via axillary midline transthoracic approach for the treatment of upper thoracic vertebra lesion is a new surgical approach. Currently, the research on the biomechanics of upper thoracic vertebra after fixation is relatively rare.

    OBJECTIVE: To evaluate whether the reconstruction of upper thoracic vertebrae via axillary midline transthoracic approach can achieve the requirements of biomechanical stability by biomechanical analysis of three-dimensional motion stability and load-bearing strength of upper thoracic vertebrae in lateral and anterior internal fixation models.

    METHODS: The C7-T6 spine and bilateral rib cage joint specimens were obtained from 12 human cadaveric bodies, and the three-dimensional motion stability test of the complete upper thoracic vertebrae model was performed and recorded as a complete vertebral body group. Subsequently, the specimens were randomly divided into two groups, and the traditional front plate internal fixation (front internal fixation group) and the axillary line into the thoracic cavity side plate internal fixation models (lateral internal fixation group) were established, respectively, with six specimens in each group. Three-dimensional motion test, vertical pressure test and vertical pressure failure test were performed. This study was approved by the Ethics Committee of Second Affiliated Hospital of Guangxi Medical University (approval No. 2017(KY-0080)).

    RESULTS AND CONCLUSION: (1) The load of left vertebral body group under left/right flexion, flexion/posterior extension and left/right rotational motion was smaller than that of lateral internal fixation group and anterior internal fixation group (P < 0.01). The load in the front internal fixation group under left/right rotational motion was smaller than that in the lateral internal fixation group (P < 0.05). There was no significant difference between the left/right flexion and the flexion/rear extension between the anterior internal fixation group and the lateral internal fixation group (P > 0.05). (2) When the load reached 600 N, the vertebral body sinking displacement of the front internal fixation group was smaller than in the lateral internal fixation group [(1.39±0.20), (2.15±0.17) mm, P < 0.01]. (3) There was no significant difference in the maximum intensity load between the anterior internal fixation group and the lateral internal fixation group [(1 839.70±122.45), (1 798.65±120.21) N, P=0.571]. (4) Results showed that the axillary midline transthoracic approach was in the lateral steel plate. The fixation is stable and meets the biomechanical needs of spinal reconstruction.

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    Spinal stability in patients with lumbar spinal tuberculosis with anterior double titanium mesh support bone grafting and posterior pedicle screw fixation  

    Yin Zhenyu, Song Jingang, Cui Yikun, Pu Jinsong
    2020, 24 (15):  2355-2360.  doi: 10.3969/j.issn.2095-4344.2624
    Abstract ( 192 )   PDF (24814KB) ( 17 )   Save

    BACKGROUND: Conventional anterior debridement and bone graft fusion for lumbar spinal tuberculosis have a great trauma, and bring more complications. The double titanium mesh support bone graft combined with posterior pedicle internal fixation reconstruction can significantly improve the prognosis of lumbar spinal tuberculosis. There is no clinical study to compare the efficacy between the two surgical methods.

    OBJECTIVE: To compare the efficacy of lumbar spinal tuberculosis via anterior double titanium mesh support bone graft combined with posterior pedicle internal fixation and conventional anterior debridement and bone graft fusion.

    METHODS: Case history data of 40 patients with lumbar spinal tuberculosis were retrospectively collected from the Department of Spinal Surgery, Mianyang Central Hospital, Southwest Medical University from May 2015 to March 2018. The patients were divided into experimental group and control group (n=20) according to the operation. Patients in the experimental group were treated with the anterior double titanium mesh support bone graft combined with the posterior pedicle screw fixation reconstruction. Patients in the control group were treated with anterior debridement and bone graft fusion. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee.

    RESULTS AND CONCLUTION: (1) Lumbar spinal tuberculosis could be effectively treated with both surgical methods. (2) Compared with the control group, the operation time was shorter; the intraoperative blood loss was less; and the bone graft fusion was faster in the experimental group. (3) With prolongation of the postoperative time, the erythrocyte sedimentation rate and the sagittal Cobb angle of the lesion segment gradually decreased in the two groups. The erythrocyte sedimentation rate and the sagittal Cobb angle of the lesion segment in the experimental group were slightly lower than those in the control group. (4) After treatment, the classification of the American Spinal Cord Injury Association was improved in some patients. (5) The incidence of adverse reactions in the experimental group was lower than that of the control group. (6) The results suggest that double titanium mesh support bone graft combined with posterior pedicle internal fixation reconstruction can effectively improve the stability of the diseased vertebrae, and the treatment effect on lumbar spinal tuberculosis is better than conventional anterior lesion removal and bone graft fusion internal fixation.

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    Finite element analysis of lumbar interbody fusion combined with adjacent-segment semi-rigid fixation  

    Wang Xiao, Tan Guoqing, Xue Haipeng, Xu Zhanwang
    2020, 24 (15):  2361-2367.  doi: 10.3969/j.issn.2095-4344.2580
    Abstract ( 213 )   PDF (76864KB) ( 18 )   Save

    BACKGROUND: The clinical occurrence of lumbar degenerative diseases is often accompanied by multi-segments lesions. To slow down the degeneration of adjacent segments after lumbar fusion, lumbar hybrid surgery has become a better choice. In the past clinical observation, WavefleX system has achieved a certain effect on single segment. Its application in lumbar hybrid surgery lacks the support of biomechanical research results.

    OBJECTIVE: To analyze the biomechanical effects of lumbar fusion combined with WavefleX system on adjacent segments by the finite element method.

    METHODS: A 64-row Siemens spiral CT machine was used to scan the lumbar spine of a stationary supine volunteer with a scanning range of T11-S1. This voluntter signed the informed consent. This study was approved by the Hospital Ethics Committee. L3-5 horizontal scanning data were imported into the Mimics medical image processing software and the Geomagic studio reverse engineering software for processing. L3-5 lumbar spine solid model was constructed in the CAD software SCDM. On the basis of L3-5 lumbar model, posterior lumbar interbody fusion model and Hybrid model were constructed respectively. Assignment and load loading were conducted in three models. The finite element analysis was carried out under the conditions of forward flexion, backward extension, lateral flexion and rotation.

    RESULTS AND CONCLUSION: (1) Compared with posterior lumbar interbody fusion model, the stress value of L3-4 disc in Hybrid model decreased significantly in forward flexion, backward extension, lateral flexion and rotation, and the maximum value decreased about 46% in extension. (2) Compared with posterior lumbar interbody fusion model, the range of motion of L3-4 segment in Hybrid model decreased significantly, with an average decrease of about 26%, which was smaller than that of the complete model under all conditions. (3) Under each load, the stress nephogram showed that there was an obvious stress concentration on the connecting rod of WavefleX system, and the stress at the U-shaped groove concave of the elastic system on both sides was significantly increased. (4) Displacement nephogram showed the placement of WavefleX system in Hybrid model, which made its forward bending center moved back to the elastic structure. (5) The above results show that posterior lumbar interbody fusion + WavefleX semi-rigid fixation can effectively reduce the stress of the last adjacent segment of the disc and limit the excessive activity, maintain the normal movement characteristics of the lumbar spine to a certain extent. 

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    Finite element analysis to verify the rationality of bone cement combined with plate internal fixation for benign proximal femoral lesions
    Yang Zhaoxin, Niu Mengye, Lü Jiaxing, Cao Haiying, Kong Lingwei, Zhao Jingxin, Jin Yu
    2020, 24 (15):  2368-2373.  doi: 10.3969/j.issn.2095-4344.2632
    Abstract ( 194 )   PDF (27485KB) ( 26 )   Save

    BACKGROUND: For the patients with benign osteopathy, the patients usually get a good life cycle after surgical treatment. Through continuous improvement of the operation mode, the stress of the proximal femur after the operation of benign osteopathy is studied by using the finite element analysis. The risk of pathological fracture and secondary fracture is predicted and reduced. To explore the best operation and prognosis is of great significance for prolonging and improving the quality of life of patients.

    OBJECTIVE: Three-dimensional finite element technique was used to analyze the different surgical models of benign proximal femoral lesions. The differences of different surgical models were compared and the rationality and effectiveness of internal fixation were verified. The reliability of the finite element model was verified in the follow-up of patients after operation.

    METHODS: Preoperative CT examination was conducted in 10 patients with benign proximal femoral lesions who met the inclusion criteria. Three models of limbs scraping (group A), cavity internal nail re-infusion bone cement (group B) and intracavitary bone cement joint plate screw (group C) were established by MIMICS. The maximum stress values of the left and right side windows of the cortical model of group A, B and C were measured under simulated conditions, and the stress values of the three groups were compared. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee.

    RESULTS AND CONCLUSION: (1) The comparison of the maximum stress values of the anterior and posterior sides of the cortical fenestration in the three groups of models was group A > group B > group C (P < 0.05). The risk of fracture was high in group A, and the risk of fracture in group B was large. The stress in group C was controlled within a reasonable range, and the risk of fracture was low. (2) Therefore, 10 subjects underwent the treatment in group C. The prognosis was good and there were no secondary fractures. The Musculoskeletal Tumor Society score was 27-30 points 1 year after surgery. (3) The model stress is prone to increase the local stress after opening the window. After adding bone cement and steel plate, the stress value of the model window is significantly reduced. After the benign lesions of the proximal femur are scraped, the stress of the fenestration can be effectively reduced by placing the bone cement and the steel plate, and the fracture probability at the surgical site is significantly reduced. Steel plate placement is reasonable.

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    Accuracy of bone tunnel in anterior cruciate ligament reconstruction using electromagnetic navigation system
    Jia Guoqing, Yu Zhiping, Hu Pengyu, Zhang Haiqing, Cong Haibo
    2020, 24 (15):  2374-2380.  doi: 10.3969/j.issn.2095-4344.2601
    Abstract ( 184 )   PDF (31241KB) ( 19 )   Save

    BACKGROUND: Accuracy and repeatability of bone tunnel in anterior cruciate ligament reconstruction has been a difficult point in surgery. As a new navigation technology, electromagnetic navigation system can realize three-dimensional positioning in application, hoping to make up for the mistakes made by surgeons.

    OBJECTIVE: To evaluate the feasibility and accuracy of a new electromagnetic navigation system in anterior cruciate ligament reconstruction.

    METHODS: Totally 30 cases of fresh frozen knee joint were treated with anterior cruciate ligament amputation to prepare knee joint specimens with anterior cruciate ligament rupture. They were randomly divided into two groups, using magnetic channel navigation combined with arthroscopy (navigation group) and traditional arthroscopy (control group). Postoperative lateral radiography of knee joint was performed to observe the exit position of bone tunnel in two groups, to measure the position of the middle of the tibial tunnel on the tibial plateau, to measure the α angle between the Blumensaat line and the axis of the tibial tunnel, and to measure the position of the femoral tunnel on the Blumensaat line.

    RESULTS AND CONCLUSION: (1) In the navigation group, the lateral X-ray radiographs of knee joint extension showed that the front edge of all tibial tunnels was slightly behind of Blumensaat line, avoiding intercondylar collision. In control group, two cases were located slightly ahead of Blumensaat line. (2) The distance (a) between the Blumensaat line at the level of tibial plateau and the front edge of the tibial tunnel, the ratio of a to width of tibial plateau anteroposterior diameter (c) and alpha angles of tibial tunnel were smaller in the navigation group than in the control group (P < 0.05). This increased the accuracy of tibial tunnel positioning. (3) There was no significant difference in the location of the tibial tunnel between the two groups (P=0.323). However, the range of the central position of the tunnel (38.1%-53.8%) was slightly lower in the navigation group than that in the control group (30.4%-56.4%). The range of a distance (0.1-3.2 mm) in the navigation group was smaller than that in the control group (-2.1-5.7 mm), and the location of bone marrow tract was more stringent, which increased the repeatability of location tibial tunnel. (4) The position of femoral tunnel was in the position of the posterior upper quadrant (4/4) in all navigation groups and in 13 cases of the control group. The position of femoral tunnel in the navigation group was more backward compared with the control group (P=0.001). The femoral tunnel in the navigation group could ensure the stability of the knee. (5) In the cadaveric knee joint experiment, magnetic navigation technology can be used to assist the location of bone tunnel in anterior cruciate ligament reconstruction, increase the accuracy and repeatability of bone tunnel, but there are still artificial and magnetic channel navigation system errors, which still need to be improved in clinical application.

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    Application of mineralized collagen modified bone cement in the treatment of osteoporotic vertebral compression fractures
    Jiang Wenkang, Geng Wei, Xu Yingying, Yang Xiaomei, Ren Hangling, Zhang Jingtao, Ma Jinzhu
    2020, 24 (15):  2381-2386.  doi: 10.3969/j.issn.2095-4344.2603
    Abstract ( 213 )   PDF (30077KB) ( 32 )   Save

    BACKGROUND: Simple bone cement is easy to cause refracture of adjacent vertebra due to its high hardness. Currently, a material that can reduce the incidence of adjacent vertebra fracture is urgently needed.

    OBJECTIVE: To observe the clinical efficacy of percutaneous vertebroplasty using mineralized collagen modified bone cement.

    METHODS: Totally 60 patients with fresh single osteoporotic vertebral compression fractures who underwent percutaneous vertebroplasty were randomly divided into two groups, with 30 cases in each group. Patients in the simple bone cement group were given polymethyl methacrylate bone cement. Patients in the modified bone cement group were given mineralized collagen modified bone cement mixed with artificial bone repair material and simple polymethyl methacrylate bone cement. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The follow-up time was 6-12 months. The clinical effect was assessed by the visual analogue scale, Oswestry Disability Index, Cobb angle and percentage of vertebral anterior edge height before surgery, at 2 days after surgery and during the last follow-up. Postoperative complications were recorded. 

    RESULTS AND CONCLUSION: (1) All patients underwent successful operation. A total of four patients were found to have different degrees of bone cement leakage, and none of the patients presented obvious clinical discomfort symptoms. (2) Compared with pre-operation, visual analogue scale and Oswestry Disability Index were significantly improved (P < 0.05); the height of the anterior border of the injured vertebrae and the Cobb angle of the kyphosis were not significantly changed (P > 0.05) at 2 days after operation and during the last follow-up in the two groups. There were no significant differences in above indexes between the two groups at the same time point (P > 0.05). (3) The number of adjacent fractures in the simple bone cement group was more than that in the modified bone cement group, but there was no statistically significant difference in the incidence of adjacent vertebral fractures between the two groups (P > 0. 05). (4) It is confirmed that compared with simple bone cement, mineralized collagen modified bone cement has no obvious disadvantages. In addition, mineralized collagen modified bone cement can give better biological properties while ensuring the strength of bone cement support and reducing pain. Further studies are needed to reduce the incidence of adjacent vertebral fractures.

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    Compression fracture simulation of osteoporotic trabecular bone in ovariectomized rats
    Wu Yuhang, Zheng Liqin, Zhang Biao, Li Fan, Chen Xinmin, Li Musheng, Zheng Yongze, Lin Ziling
    2020, 24 (15):  2387-2392.  doi: 10.3969/j.issn.2095-4344.2622
    Abstract ( 244 )   PDF (24852KB) ( 35 )   Save

    BACKGROUND: At present, related finite element models have been used to simulate the femoral fracture, and the effects of loading rate, loading angle and cancellous bone on the fracture of hip have been discussed. However, the fracture simulation of trabecula is still lack of relevant research.

    OBJECTIVE: To simulate the biomechanical process of osteoporotic trabecular compression fracture in ovariectomized rats.

    METHODS: The right femur of ovariectomized rats was scanned at the distal end of femur by Micro-CT. The microstructure parameters and three-dimensional model of the region of interest of the rat femur were obtained. After geometric optimization in Geomagic Studio, they were pretreated in HyperMesh 14.0, including volume mesh division, setting material property parameters, boundary conditions, setting load of 1 200 N, acting time of 2 ms, and they were calculated in LS-DYNA software.

    RESULTS AND CONCLUSION: (1) The bone trabeculae in the region of interest showed uneven spatial distribution. (2) The bone trabeculae with small volume and small number first presented deformation fracture, and the plate shape and bone trabeculae with large volume finally demonstrated fracture collapse. (3) The change trend of von Mises stress was roughly the same as that of bone trabeculae fracture collapse. (4) The fracture collapse process of bone trabeculae in the region of interest included vertical collapse and horizontal torsion, in which the degree and rate of horizontal torsion were lower than that of vertical collapse, making the size and rate of cross-section torsion angle less than that of coronal plane angle. (5) The increase and peak value of shear stress of failure unit were smaller than Von-mises stress. (6) These results indicate that fracture collapse of bone trabecula is a complex process, including deformation and angle of different planes.

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    Effect of platelet-rich plasma on blood coagulation indexes after hip preserving surgery for osteonecrosis of the femoral head
    Luo Zhihong, Yang Fan, Yang Peng, Chen Xiaojun, Gong Shuidi, Pang Fengxiang, He Xiaoming, Shen Yingshan, Li Weifeng, Chen Lixin, Wei Qiushi, He Wei, Chen Zhenqiu
    2020, 24 (15):  2393-2398.  doi: 10.3969/j.issn.2095-4344.2589
    Abstract ( 252 )   PDF (28364KB) ( 25 )   Save

    BACKGROUND: It was found that platelet-rich plasma injection can change the coagulation function of patients with osteonecrosis of the femoral head.

    OBJECTIVE: To investigate the effect of platelet-rich plasma injection on coagulation parameters in patients with osteonecrosis of the femoral head after hip preserving surgery, and to evaluate the risk factors of vascular embolism after surgery.

    METHODS: Totally 75 cases of osteonecrosis of the femoral head treated by drilling and decompression of the femoral head, removing the dead bone in the femoral head and supporting with fibula allograft were selected in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from December 2016 to September 2018. According to whether platelet-rich plasma injection was used during the operation, the patients were divided into two groups. The platelet-rich plasma group contained 42 cases (42 hips). The control group (33 cases, 35 hips) did not use platelet-rich plasma. The other treatments in the two groups were the same. The changes of blood coagulation indexes before and after operation were continuously observed in the two groups.

    RESULTS AND CONCLUSION: (1) Patients in both groups were followed up for 3 months. (2) Levels of fibrinogen and D-dimer were significantly increased in both groups. However, levels of fibrinogen and D-dimer in one week after operation in the platelet-rich plasma group were 52.5% and 47.0% higher than those in the control group, indicating platelet-rich plasma led to hypercoagulability and a possible high risk of vascular embolism. (3) There were significant differences in prothrombin time, activated partial thromboplastin time and international standardized ratio, but there was no significant clinical significance in both groups. (4) The use of platelet-rich plasma had no effect on platelet level or C-reactive protein. 

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    Ultrastructural changes of tibial subchondral bone in patients with knee osteoarthritis: CT evaluation
    Luo Xiaofei, Wei Xuan, Wang Jinliang, Wang Shaohua, Li Zhe, Bai Yu
    2020, 24 (15):  2399-2404.  doi: 10.3969/j.issn.2095-4344.2588
    Abstract ( 203 )   PDF (23749KB) ( 15 )   Save

    BACKGROUND: More and more attention has been paid to the role of subchondral bone changes in knee osteoarthritis. However, previous studies mainly focused on animal experiments. Animals and humans have certain differences, so it is very necessary to obtain relevant data directly in human joints.

    OBJECTIVE: To evaluate the difference of subchondral plate and subchondral bone ultrastructure between normal patients and patients with knee osteoarthritis by CT technique, so as to explore the role of subchondral bone in the occurrence and development of knee osteoarthritis.

    METHODS: CT scan data of 30 patients with knee osteoarthritis (knee osteoarthritis group) and 30 patients without knee osteoarthritis (non-knee osteoarthritis group) were collected from the Department of Imaging of Zhengzhou Orthopedic Hospital from July 2016 to July 2018. Subchondral plate and subchondral bone ultrastructure of medial and lateral tibial plateau was compared between the two groups using MIMICS software. This study was approved by the Ethics Committee of Zhengzhou Orthopedic Hospital on June 10, 2016 (approval No. 2016 004).

    RESULTS AND CONCLUSION: (1) Compared with the non-knee osteoarthritis group, bone density was significantly increased and porosity was significantly decreased in the subchondral bone plate in the knee osteoarthritis group in both the lateral and medial parts, while the medial part of subchondral bone plate thickness was significantly thicker than that in the non-knee osteoarthritis group. (2) There were also significant changes in subchondral trabeculae in the knee osteoarthritis group, which showed that the thickness of subchondral trabeculae in the lateral part and the medial part of the subchondral bone in the knee osteoarthritis group was significantly increased compared with the non-knee osteoarthritis group. Meanwhile, in the medial part, the degree of cancellous bone separation in the knee osteoarthritis group was significantly lower than that in the non-knee osteoarthritis group. Structure model index and connectivity density in the knee osteoarthritis group were significantly lower than those of the non-knee osteoarthritis group. (3) Results show that the change of tibial subchondral bone plate and subchondral cancellous bone in knee osteoarthritis patients mainly lies in the destruction of ultrastructure homeostasis. This change may be one of the causes of knee osteoarthritis.

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    Efficacy of 3D printing technology-assisted virtual surgical planning in acetabular fracture fixation
    Zhang Zhongyan, Qi Tongning, Mu Huaizhao, Wang Yu, Jin Yu
    2020, 24 (15):  2405-2409.  doi: 10.3969/j.issn.2095-4344.2570
    Abstract ( 204 )   PDF (24061KB) ( 47 )   Save

    BACKGROUND: Acetabular fracture is considered to be one of the most challenging fractures because of its complex anatomical structure, which makes it more difficult to treat. At present, open reduction and internal fixation are still the standard treatment methods for displaced acetabular fractures. The patient-specific pre-contour reconstruction template made by three-dimensional (3D) printing technology combined with preoperative virtual surgery plan can reduce the invasiveness of surgery and simplify the operation process.

    OBJECTIVE: To evaluate the effect of 3D printing combined with virtual surgical planning in the treatment of acetabular fractures compared with traditional reduction and reconstruction of acetabular fractures.

    METHODS: Totally 25 patients were selected from Affiliated Hospital of Chengde Medical College from October 1, 2017 to March 1, 2018, including 14 males and 11 females, at the age of 21-60 years old. They were divided into experimental group (n=12) and control group (n=13) by computer random grouping method. In the experimental group, printing technology combined with virtual pre-contour reconstruction plate fixation was performed. In the control group, intraoperative contour reconstruction plate fixation was conducted after reduction. Postoperative X-ray and non-contrast CT scan was used to analyze fracture reduction in two groups. After the operation, the patients in the two groups were followed up for visual analogue scale score, Majeed function score and complications. This study was approved by the Ethics Committee of Affiliated Hospital of Chengde Medical College (approval No. LL007).

    RESULTS AND CONCLUSION: (1) X-ray films showed that the reduction effect of the experimental group was better than that of the control group (P=0.038). Non-contrast CT images showed that the reduction displacement difference of the experimental group was better than that of the control group before and after operation [(12.43±7.58) mm, (9.408±8.27) mm, P < 0.05]. (2) At 6-12 months after surgery, visual analogue scale scores were lower in the experimental group than in the control group [(1.6±0.6), (3.3±1.3), P < 0.05]. There were no significant differences in Majeed function scores between the two groups in the final follow-up (P=0.079). (3) Complications, such as delayed healing, failure of internal fixation or deep vein thrombosis, were not found; and no biocompatibility adverse reactions related to the implanted device occurred in the two groups after surgery. (4) Results suggested that 3D printing technology assisted virtual operation plan can improve the reduction quality in the fixation of acetabular fracture, improve the operative effect of acetabular fracture, and reduce the postoperative pain of patients. 

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    Mapping knowledge domains of bibliometrics regarding percutaneous vertebroplasty and percutaneous kyphoplasty based on VOSviewer
    Huang Tianji, Yang Shengdong, Lin Hao, Zhang Chunyang, Deng Zhongqi, Zhong Weiyang, Luo Xiaoji
    2020, 24 (15):  2410-2417.  doi: 10.3969/j.issn.2095-4344.2620
    Abstract ( 204 )   PDF (30559KB) ( 41 )   Save

    BACKGROUND: Percutaneous vertebroplasty and percutaneous kyphoplasty are widely used minimally invasive surgery for vertebral compression fractures, spinal primary tumor and spinal metastasis. However, there were no bibliometric studies and mapping knowledge domains study regarding percutaneous vertebroplasty and percutaneous kyphoplasty.

    OBJECTIVE: To summarize and identify the papers related to percutaneous vertebroplasty and percutaneous kyphoplasty, and mapping knowledge domains of percutaneous vertebroplasty and percutaneous kyphoplasty.

    METHODS: Web of Science was retrieved for studies published from 1985 to 2018. The key words were TS = vertebroplasty OR kyphoplasty. All data were input into the Microsoft Excel 2016 and VOSviewer to identify publication number, publication year, publication country, publication organization, publication source, author, sum of times cited (including and excluding self-citation), average cited times and H-index. VOSviewer software was used to analyze the co-cited references, the co-cited authors and the co-occurrence of key words, and mapping knowledge domains.

    RESULTS AND CONCLUSION: (1) The research regarding percutaneous vertebroplasty and percutaneous kyphoplasty is one of the important research areas in spine surgery research domains. (2) USA dominates the research regarding percutaneous vertebroplasty and percutaneous kyphoplasty. The qualities of papers from Switzerland and England are relatively high while those from China and Italy are relatively low. (3) Some of the organizations that published most papers and high-quality papers include Mayo Clinic, Suzhou University, Johns Hopkins University, Cleveland Clinic Foundation and University of Bern. (4) Some of the journals that published most papers and high-quality papers include SPINE, EUROPEAN SPINE JOURNAL, AMERICAN JOURNAL OF NEURORADIOLOGY, JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. (5) Some of the authors that published most papers and high-quality papers include YANG HL, KALLMES DF, PFLUGMACHER R, DERAMOND H, CHIRAS J, FERGUSON SJ and MASALA S. (6) The key contents of percutaneous vertebroplasty and percutaneous kyphoplasty include osteoporotic vertebral compression fracture, tumor, bone cement, surgery, biomechanics and refracture. 

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    Focused research of dynamic contrast-enhanced magnetic resonance imaging in bone and joint  

    Huang Xuejie, Chang Xiaodan, Zhao Dewei
    2020, 24 (15):  2418-2424.  doi: 10.3969/j.issn.2095-4344.2621
    Abstract ( 194 )   PDF (49426KB) ( 139 )   Save

    BACKGROUND: As a non-invasive detection method, dynamic contrast-enhanced magnetic resonance imaging is widely used in the field of tumor. It can be used for the differentiation of benign and malignant tumors, the grading of tumor grade and the prediction and evaluation of prognosis. In recent years, the application research in the field of bone and joint has gradually become a hot spot, which can be used in the determination of bone marrow blood perfusion, the evaluation of bone tissue activity, the early detection of bone perfusion abnormality and the evaluation of blood circulation of joint inflammatory lesions.

    OBJECTIVE: To summarize the technical situation of dynamic contrast-enhanced magnetic resonance imaging and its application research in bone and joint.

    METHODS: The keywords were “(bone OR joint) AND (dynamic contrast-enhanced MRI) OR dynamic contrast-enhanced magnetic resonance imaging) OR DCE-MRI” in English and Chinese, respectively. The first author searched PubMed, Springerlink and China National Knowledge Infrastructure databases for the articles published between 1984 and 2019. The relevant literature was reviewed on the application of dynamic contrast-enhanced magnetic resonance imaging in bone and joint in recent years. Finally, 55 articles were summarized and analyzed.

    RESULTS AND CONCLUSION: (1) At present, dynamic contrast-enhanced magnetic resonance imaging technology and data processing have not been standardized. T1WI imaging is mainly used in bone and joint. Qualitative, semi-quantitative and full quantitative analysis of its data is feasible. (2) Qualitative analysis and semi-quantitative analysis are simple and easy to operate. Quantitative indicators are clear, can objectively describe the shape of the curve, but cannot reflect the concentration of contrast agent between tissues and blood vessels, and are easily affected by the sequence of scanning parameters, so cannot detect the pharmacokinetic information of tissue. Quantitative analysis can obtain the concentration changes and generation parameters of contrast media between substructures in tissues, and evaluate the microangiogenesis and function of tissues. (3) Dynamic contrast-enhanced magnetic resonance imaging can noninvasively evaluate the microcirculation perfusion of bone and joint. It has certain reference value for the discussion of the pathogenesis, diagnosis and differential diagnosis, prediction of prognosis, evaluation of curative effect and choice of treatment of many bone and joint diseases.

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    New advance of in vitro and in vivo studies on lumbar intervertebral disc biomechanics
    Xu Haoxiang, Wen Wangqiang, Zhang Zepei, Miao Jun
    2020, 24 (15):  2425-2432.  doi: 10.3969/j.issn.2095-4344.2628
    Abstract ( 250 )   PDF (48581KB) ( 233 )   Save

    BACKGROUND: Clinical systems caused by degenerative disc disease are one of the largest health worldwide problems. Changes of biomechanics of lumbar disc play important difference in the development of degenerative disc disease.

    OBJECTIVE: To briefly describe the anatomical and histological features of lumbar intervertebral discs, and to review the research methods and progress in lumbar intervertebral disc biomechanics in recent years.

    METHODS: A computer-based online retrieval of CNKI, Wanfang, VIP, PubMed, Elsevier and Web of Science databases was conducted with the keywords of “biomechanics, intervertebral disc, lumbar spine, finite element analysis, imaging, MRI, BFIS, DSXS” in Chinese and English, respectively. The articles were firstly screened by reading the title and abstract, and 67 eligible articles were included for result analysis after excluding irrelevant articles.

    RESULTS AND CONCLUSION: (1) The research on lumbar disc biomechanics is mainly divided into in vitro research and in vivo research. (2) In vitro studies include animal specimens, human cadavers and finite element analysis. The design of in vitro experiment is flexible and maneuverable, but it is separated from human physiological environment and the mechanical properties of materials are different. After long-term verification, the applicability of the experiment in human body is screened out. (3) In vivo studies mainly record the changes of the force shape of disc movement in vivo in real time through imaging methods, which is real and reliable. However, limited by the development of imaging technology, it needs to be used reasonably. The new biplanar fluorescent imaging system and dynamic stereo-radiography system have unique advantages in this field, which attracted much attention. 

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    Debridement antibiotics irrigation and implant retention for the treatment of acute infection after total knee arthroplasty  

    Xu Changbo, Yin Li, Wang Haitao, Zhang Yi
    2020, 24 (15):  2433-2439.  doi: 10.3969/j.issn.2095-4344.2569
    Abstract ( 242 )   PDF (39491KB) ( 32 )   Save

    BACKGROUND: Compared with revision surgery, debridement antibiotics irrigation and implant retention for treatment of periprosthetic joint infection has the advantages of fewer traumas, shorter time, and lower cost. However, the indications and perioperative management are still controversial.

    OBJECTIVE: To review the application of preoperative indication, intraoperative operation and postoperative antibiotic application of debridement antibiotics irrigation and implant retention for the periprosthetic joint infection.

    METHODS: PubMed, Web of Science, Embase, and The Cochrane Library database were retrieved from 2000 to 2018. The key words were “total knee arthroplasty, periprosthetic joint infection, diagnose, treatment”. Chinese literature was searched in the Wanfang database and CNKI from 2000 to 2018, and the key words were “arthroplasty, postoperative infection, debridement antibiotics irrigation and implant retention”. Relevant literatures were screened, and the success rate of retained prosthesis in the treatment of infection after joint replacement was counted. The most accurate diagnostic criteria and the most effective treatment methods were summarized.

    RESULTS AND CONCLUSION: At present, there is no unified international standard for the diagnosis of periprosthetic joint infection after joint replacement. Many organizations have put forward some consensus and guidelines. Parvizi et al. proposed new diagnostic criteria for periprosthetic joint infection based on other consensus and guidelines, which is highly sensitive and specific, and has been accepted by most people. Debridement antibiotics irrigation and implant retention is suitable for patients with stable and well-fixed prosthesis, short symptom duration, good soft tissue, and no sinus tract formation. During the operation, the infected necrotic tissue and the suspected infected tissue should be thoroughly removed. The iodine-blood water should be soaked for half an hour; the new gasket should be replaced; and the sterilized towel should be replaced with a new set of surgical tools. According to the results of postoperative culture, sensitive antibiotics were combined and rifampin was taken orally out of hospital for 4 months. Debridement antibiotics irrigation and implant retention is the best method for the treatment of periprosthetic joint infection, and has the advantages of less pain, less cost, high acceptance and avoiding revision. 

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    Role and significance of anterior cruciate ligament injury in the development of post-traumatic knee osteoarthritis
    Han Guangtao, Li Haohuan, Gao Feng
    2020, 24 (15):  2440-2446.  doi: 10.3969/j.issn.2095-4344.2629
    Abstract ( 208 )   PDF (40889KB) ( 22 )   Save

    BACKGROUND: Anterior cruciate ligament has the function of stabilizing the knee joint and restricting the tibiofemoral joint in the translation and rotation of the tibia. Most patients with anterior cruciate ligament reconstruction have an increased risk of knee pain and knee instability. Knee osteoarthritis after trauma is a serious complication of anterior cruciate ligament injury. Knee osteoarthritis is a chronic progressive disease, and the mechanism of osteoarthritis after anterior cruciate ligament injury remains unclear.

    OBJECTIVE: To review the relationship between anterior cruciate ligament injury and the risk factors of post-traumatic knee osteoarthritis, so as to provide guidance for the treatment of post-traumatic knee osteoarthritis.

    METHODS: The first author searched related articles in PubMed database from the establishment of the database to October 2019. The key words were “ACL injury, traumatic knee osteoarthritis, ACL reconstruction, meniscus status, body mass index, cartilage injury, age, graft selection, time interval between injury and surgery”. A total of 123 articles were retrieved, and 66 articles were eligible for the inclusion criteria.

    RESULTS AND CONCLUSION: (1) Meniscus status, body mass index, cartilage damage, age, graft selection, and time between injury and surgery may influence the development of post-traumatic knee osteoarthritis. (2) Although anterior cruciate ligament reconstruction is primarily performed to restore stability after anterior cruciate ligament rupture, a long-term goal of the process is to reduce the risk of knee osteoarthritis and maintain long-term joint health. (3) Meniscus resection in patients with anterior cruciate ligament rupture accompanied by meniscus injury is also the cause of knee osteoarthritis, which is likely to be caused by weakened endurance and kinematic changes of the joint.

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    Graft selection for acetabular labrum reconstruction under arthroscopy
    Chen Xingzhen, Duan Guoqing
    2020, 24 (15):  2447-2452.  doi: 10.3969/j.issn.2095-4344.2561
    Abstract ( 226 )   PDF (42303KB) ( 169 )   Save

    BACKGROUND: Currently, surgical treatment for acetabular labrum injury includes debridement, repair, refixation and acetabular labrum reconstruction. Labrum reconstruction is a newly developed surgical method, which uses autograft or allograft to repair labrum defect. At present, there are many options for graft repair, and the recent follow-up shows that this method can well restore the structure and function of the labrum, and has certain advantages over debridement, excision, and repair. However, no study has shown the long-term effect of reconstruction, and which situation and which graft are more suitable.

    OBJECTIVE: To review graft selection of acetabular labrum reconstruction under arthroscopy.

    METHODS: PubMed and GeenMedica databases were retrieved for studies on acetabular labrum reconstruction published from 2000 to 2019, especially in the past 10 years. The key words were “labrum, reconstruction, graft, hip, acetabulum”.

    RESULTS AND CONCLUSION: (1) There are a number of options for graft repair, including autograft (iliotibial band, gracilis and semitendinosus, quadriceps tendon, rectus femoris tendon, joint capsule) and allograft (peroneus brevis, tensor fascia lata). Recent follow-up shows that these grafts can restore labrum structures and hip movement. (2) However, as an emerging surgical procedure, there is currently a lack of long-term follow-up and prospective comparative studies to prove the long-term effects of reconstruction and prove which grafts are more suitable in which conditions. (3) In future studies, we need to compare the medium and long-term efficacy of different grafts for clinical selection. With the development of science and technology, the problem of artificial composite materials has been solved, and will become a more promising alternative. 

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    In-depth discussion on the treatment of terrible triad of the elbow  

    Li Ningxin, Yang Zhaohui
    2020, 24 (15):  2453-2460.  doi: 10.3969/j.issn.2095-4344.2625
    Abstract ( 289 )   PDF (48702KB) ( 24 )   Save

    BACKGROUND: The diagnosis and treatment of the terrible triad of the elbow have achieved a breakthrough.

    OBJECTIVE: To introduce the definition, basic anatomy, stable structure, injury mechanism and classification of terrible triad of the elbow, and to discuss the treatment plan deeply.

    METHODS: The first author searched PubMed, CNKI and Wanfang databases for the articles published before September 2019. The keywords were “terrible triad of the elbow, elbow joint, fracture dislocation” in English and Chinese, respectively. A large number of articles concerning the terrible triad of the elbow in recent years were reviewed, and the treatment strategy was summarized.

    RESULTS AND CONCLUSION: For the terrible triad of the elbow, the operator must carefully check the patient before operation, carefully analyze the imaging examination results and three-dimensional printed model, and accurately judge the bone structure of the elbow and degree of ligament injury. During the operation, the stability of the radial head, the fracture of the coronoid process and the injury of the lateral ligament complex are usually reconstructed through a single lateral approach or a combination of internal and external approaches. Then, the stability of elbow joint is tested to determine whether it is necessary to repair the medial ligament complex or use the hinged external fixator to restore the stability of elbow joint. Early active rehabilitation is needed. The above systematic treatment can reduce postoperative complications, accelerate fracture healing, and improve elbow joint function and patients’ quality of life.

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