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28 June 2020, Volume 24 Issue 18 Previous Issue    Next Issue

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Biomechanical characteristics of lumbosacral vertebra with unidirectional axial fusion fixation system Yi Guoliang, Song Xizheng, Shu Xiaolin 2020, 24 (18):  2789-2793.  doi: 10.3969/j.issn.2095-4344.2653 Abstract ( 247 )   PDF (24429KB) ( 92 )   Save BACKGROUND: It is very important to apply a new technique of minimally invasive, firm fixation and antirotation in the treatment of lumbosacral degenerative diseases. OBJECTIVE: To provide theoretical basis for clinical application by biomechanical study on the treatment of lumbosacral vertebra instability with unidirectional axial fusion internal fixation system. METHODS: Six fresh adult lumbosacral specimens were selected, and the lumbosacral motion segments (L3-S5) were intercepted and divided into the following five groups: The intact normal control group (N group), bilateral isthmus fissure group (UN group), bilateral isthmus fissure + spur axial fusion internal fixation group (A group), bilateral isthmus fissure + axial screw fixation group (B group), bilateral spondylolysis + axial screw fixation alone + pedicle screw fixation on both sides group (C group). The three-dimensional motion range of flexion, lateral bending and rotation of segment L5/S1 in each group of internal fixation was compared with the axial compression resistance. RESULTS AND CONCLUSION: (1) The stability of fixed mode in A, B and C groups was better than that in the N group and the UN group under different directions of motion, and there were statistically significant differences between the groups (P < 0.05). (2) There was no significant difference in the anterior flexion, posterior flexion and lateral flexion between A, B and C groups (P > 0.05). (3) In the left and right direction of rotation, the three-dimensional motion range of rotation in the A group was significantly reduced compared with that in the B group, and there was no significant difference between A group and C group (P > 0.05). (4) The lumbosacral vertebra unidirectional axial fusion internal fixation system has good biomechanical stability and strong anti-rotation ability, and is expected to be used in clinic. Figures and Tables | References | Related Articles | Metrics

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Mechanical stability of the fracture at the junction of lumbar vertebral body and pedicle after implantation with different diameters of pedicle screws   Zong Zhiguo, Liu Su, Ma Pengpeng, Zhang Xin, Li Wei, Su Feng, Zhang Chunlin, Guo Jianwen, Wen Yi 2020, 24 (18):  2794-2798.  doi: 10.3969/j.issn.2095-4344.2656 Abstract ( 351 )   PDF (22122KB) ( 172 )   Save BACKGROUND: Most scholars believe that the fracture of the lumbar spine and pedicle is stable, and transvertebral pedicle screw implantation can improve the stability of fractures. However, the diameter of the transvertebral pedicle screw, mechanical stability and safety of the vertebrae still remain controversial. OBJECTIVE: To analyze the effect of pedicle screws of different diameters and pedicle cortex on the mechanical stability of the fractured vertebrae and pedicle by three-dimensional finite element method. METHODS: Based on normal adult L2-L3 CT DICOM data, a mimics software was used to establish a model of the fracture at L2 vertebral body and the pedicle. At the same time, a three-dimensional model of L3 vertebra was created. The L2-L3 model was imported into 3-matic in stl format, and a model of pedicle screws with different diameters (diameter of 6.5 and 6.0 mm, and length of 45 mm) was established. The model was imported into ansys after the material attributes were assigned in the mimics software. A vertical load of 500 N was applied to the upper surface of the L2 vertebral body to simulate the biomechanical performance of a adult with standard body mass after implantation with transvertebral pedicle screw with different diameters under upright condition. RESULTS AND CONCLUSION: (1) After implantation with 6.0 mm screw, the equivalent load on the lower, upper, inner, and outer walls of the pedicle at the junction of the lumbar vertebra and the pedicle was (1.28±0.62), (0.95±0.18), (0.62±0.37), and (0.36±0.16) MPa, respectively. The difference was significant among groups (F=4.298, P < 0.05). (2) After implantation with 6.5 mm screw, the equivalent load on the lower, upper, inner, and outer walls of the pedicle at the junction of the lumbar vertebra and the pedicle was (1.82±0.76), (1.11±0.18), (0.93±0.38), and (0.43±0.14) MPa, respectively. The difference was significant among groups (F=7.034, P < 0.05). (3) The equivalent load on the lower, upper, inner, and outer walls of the 6.5 mm pedicle screw model was significantly higher than that on the 6.0 mm pedicle screw model (P < 0.05). (4) These results imply that the larger the pedicle screw is, the greater the load on the cortical bone at the junction of the lumbar vertebra and the pedicle is, and the stronger the holding force is. The load on the upper, lower, inner and outer walls of the pedicle is positively related to its cortical thickness. The cortical bone of the inferior wall is thickest, the equivalent load it bears is largest, and the cortical bone of the outer wall is thinnest, and it has the smallest equivalent load. The closer the pedicle screw is to the lower medial wall within the pedicle, the stronger the holding force and the better the stability. The closer it is to the upper and outer side walls, the smaller the gripping force and the worse the stability. However, the placement of nails on the upper and outer walls is safer than the placement of nails on the lower inner wall, and the pros and cons need to be weighed in accordance with the experience of the surgeon during placement. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of femoral neck fracture with different degrees of posterior-inferior bone defect after cannulated screw internal fixation Zhang Chengbao, Yu Runze, Yu Defu, Chen Tao, Zhang Biao, Shen Zheng, Yu Shui, Xu Youjun, Chen Peng, Wang Shaohua, Xu Zhonglin 2020, 24 (18):  2799-2804.  doi: 10.3969/j.issn.2095-4344.2623 Abstract ( 360 )   PDF (25036KB) ( 45 )   Save BACKGROUND: Cannulated screw fixation is the first choice for the treatment of fresh femoral neck fracture. However, in the patients with bone defect, the mechanical conduction and stability of the proximal femur are obviously changed, which easily leads to the failure of internal fixation, nonunion or delayed healing of the fracture, so the study of biomechanics has important clinical significance. OBJECTIVE: To explore the biomechanical changes of proximal femur with posterior-inferior bone defect using finite element analysis, compare the biomechanical effect of cannulated screws with different configurations in treatment of adductive femoral neck fractures. METHODS: Original DICOM data of CT scan of proximal femur in an adult healthy male volunteer were obtained. MIMICS 10.01 software and Rhino3D NURBS software were used to make the models of femoral neck fracture with different degrees of posterior-inferior bone defects (no defect model, small defect model, medium defect model and large defect model). Two configurations of cannulated screws (inverted triangle and positive triangle) were used in four models. Mesh generation and material property assignment were conducted after assembly. The coupling relationship was established between the center and the surface of the femoral head by ABAQUS 6.12 software. The load and constraints of slow walking were applied to all models.  RESULTS AND CONCLUSION: (1) The inner side of the femoral neck was subjected to compressive stress, and the lateral side was subjected to tensile stress for the non-defect model. The stress distribution of the femoral head was more uniform. With the increase of the degrees of posterior-inferior bone defect, the stress peak value of femoral head, femoral neck pressure side and tension side, and cannulated screw tail were increased gradually. (2) With the increase of the defect degree, the peak value of the stress on the pressure side of the cannulated screw increased gradually. In the middle and large defect models, the stress in the inverted triangle group was higher than in the regular triangle group (P < 0.05), and there was no difference between the two groups in the other models (P > 0.05). (3) With the increase of the defect degree, the peak stress on tension side of cannulated screw increased gradually. In the model of no defect and small defect, the stress in the regular triangle group was higher than in the inverted triangle group (P < 0.05). In the large defect model, the stress in the regular triangle group was lower than in the reverted triangle group (P < 0.05). In the middle defect model, there was no difference between the two groups. (4) With the increase of the defect degree, the peak stress of femoral head increased gradually. There was no significant difference between the inverted triangle group and the regular triangle group in the three models (P > 0.05). (5) With the increase of the defect degree, the peak value of stress in the tail of cannulated screw increased gradually. In the small, medium and large defect models, the stress in the inverted triangle group was higher than in the regular triangle group (P < 0.05). No significant difference was found between the two groups in models without bone defect (P > 0.05). (6) Results suggested that different degrees of posterior-inferior bone defects could obviously affect the biomechanical properties of the proximal femur. For femoral neck fracture with no defect or lesser degree of defect, the biomechanical effect of inverted triangle was superior to regular triangle. For femoral neck fracture with big defect, the biomechanical effect of regular triangle was superior to inverted triangle.  Figures and Tables | References | Related Articles | Metrics

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Three-dimensional finite element biomechanical analysis of stage II adult acquired flatfoot deformity after medial column stabilization Liu Fushenghua, Xu Jian, Zhao Bingcheng, Wei Gehan, Qin Wenbao 2020, 24 (18):  2805-2810.  doi: 10.3969/j.issn.2095-4344.2626 Abstract ( 296 )   PDF (25857KB) ( 48 )   Save BACKGROUND: Flatfoot is a commonly seen disease in foot and ankle surgery, and stage II adult acquired flatfoot is mostly seen in clinic, so this stage is a key to treatment. However, medial column instability occurs in stage II adult acquired flatfoot, which is an important cause for arch collapse. Medial column stabilization can correct the deformity to great extent, but there is a lack of biomechanical study to assess the effect of medial column stabilization on the whole foot. OBJECTIVE: To investigate the biomechanical effects of medial column stabilization on stage II adult acquired flatfoot. METHODS: A three-dimensional finite element model of stage IIa and IIb adult acquired flatfoot was established. Geomagic software, Solidwork software and Abaqus software were used to simulate medial column stabilization operation (naviculocuniform joint fusion, tarsometatarsal joint fusion, and both fusion). The maximum pressure of plantar soft tissue, medial column bone and medial ligaments was compared before and after simulated single-foot weight loading. Meanwhile, the related parameters were measured to carry out a comprehensive comparison. RESULTS AND CONCLUSION: (1) The maximum plantar stress was located under the first metatarsal head after the simulated medial column stabilization operation. The maximum plantar stress increased significantly after the medial column stabilization in stage IIa flatfoot model, but did not change significantly after the medial column stabilization in stage IIb model. (2) After medial column fusion, the stress of the corresponding joint was reduced, but increased for the other joints of the first metatarsal column. (3) The stress of medial ligament and plantar fascia was not alleviated after medial column fusion. (4) These results indicate that simple medial column stabilization surgery cannot reduce the pressure of medial column of flatfoot in stage II acquired flatfoot adults. It can only be used as a combined surgery to stabilize joints with excessive motion and correct the deformity of supination of forefoot. Figures and Tables | References | Related Articles | Metrics

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Minimally invasive treatment of hallux valgus with bandage for external fixation: finite element analysis of stability of the osteotomy end  Bai Zixing, Cao Xuhan, Sun Chengyi, Chen Si, Hu Haiwei, Wen Jianmin, Li Yanle, Lin Xinxiao, Sun Weidong 2020, 24 (18):  2811-2816.  doi: 10.3969/j.issn.2095-4344.2666 Abstract ( 480 )   PDF (23306KB) ( 469 )   Save BACKGROUND: The clinical effect of minimally invasive treatment of hallux valgus is significant. The osteotomy end is stabilized only by external fixation of the bandage. There is currently no research on the stability of the osteotomy end. OBJECTIVE: To study the effect of minimally invasive treatment of the “8” bandage external fixation on the stress and displacement of the osteotomy end in the balanced standing condition after hallux valgus. METHODS: In the minimally invasive treatment of the “8” bandage external fixation finite element model after the hallux valgus operation, three vertical axes (X-axis, Y-axis, Z-axis) were established with the first tibial osteotomy as the center. The X-axis and Y-axis were parallel to the horizontal plane of the foot, pointing to the medial and anterior sides of the foot respectively. The Y axis was perpendicular to the horizontal plane of the foot, pointing upwards. The four nodes defining the distal osteotomy surface were A1 on the upper side, B1 on the outer side, and C1 on the outer side, and D1 on the inner lower side. The proximal end osteotomy surface corresponded to four nodes as A2, B2, C2 and D2. The displacement was positive when it coincided with the direction of the coordinate axis, and negative when it was opposite. Through the finite element analysis, the direction and magnitude of the stress and displacement of the distal and proximal nodes of the osteotomy surface in the balanced standing condition were obtained. RESULTS AND CONCLUSION: (1) The finite element model of the “8” bandage after minimally invasive treatment of hallux valgus was used in a balanced standing condition. The maximum stress at the osteotomy end was at the dorsal side of the osteotomy surface (B2), which was 0.632 MPa. (2) The first principal stress at the osteotomy surface was at Z-axis. The direction was opposite to the Z-axis, and was the same as the total stress, which was a compressive stress. The shear force was the largest on the XY plane, and the maximum stress was at the dorsal inner side (A2) of the proximal osteotomy surface, which was 0.058 MPa. (3) The major displacements of the distal and proximal ends of the first patella osteotomy were on the X-axis, and the displacements were on the medial condyle (D1) of the osteotomy surface, i.e., -1.002 mm and medial condyle (A2), and 0.621 mm, respectively. (4) The results confirm that the external fixation of “8” bandage can maintain the stability of the osteotomy end after minimally invasive treatment of hallux valgus, and is conducive to the healing of the osteotomy end. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional finite element analysis of fibula implantation for China-Japan Friendship Hospital type osteonecrosis of femoral head Ling Guanhan, Li Yongbin, Pan Xuewen, Lin Hengfeng, He Ke, Li Yuanchun, Lu Baiyu, Chen Changlin 2020, 24 (18):  2817-2822.  doi: 10.3969/j.issn.2095-4344.2655 Abstract ( 417 )   PDF (27137KB) ( 45 )   Save BACKGROUND: It is reported that the hip-conserving effect of osteonecrosis of femoral head is closely related to the retention of lateral column. The classification of China-Japan Friendship Hospital is based on the three-column structure, and the prediction accuracy of femoral head collapse is high. OBJECTIVE: To establish a three-dimensional finite element model for China-Japan Friendship Hospital classification of femoral head necrosis, and to analyze the mechanical changes of fibula implantation in each classification by finite element method, and to explore the significance of lateral column retention in hip preservation, so as to provide a basis for precise prediction of collapse of the classification. METHODS: Three groups of 11 kinds of three-dimensional finite element models of normal femoral head, China-Japan Friendship Hospital type femoral head necrosis (type M, type C, type L1, type L2, type L3) and fibula implantation were established. The finite element analysis was carried out by ANSYS software. The maximum stress, maximum displacement and load transfer mode of proximal femur were observed in each group. RESULTS AND CONCLUSION: (1) In the necrosis group, the strain was the largest, and the displacement was different due to the different types of necrosis. The displacement changes were as follows: Type M < type C < type L1 = type L2 < type L3. The displacement recovery of fibula implantation group was lower than that of the normal group, and the displacement recovery was different due to the different necrosis types. The displacement changes were as follows: Type M < type C < type L1 < type L2 < type L3. The reduction range of the displacement of the repaired necrotic femoral head gradually decreased from the lateral column to the medial column, which was lower than the maximum displacement of the normal femoral head. (2) The peak value of the stress nephogram of the loading area of the femoral head after necrosis was higher than that of the normal group. The peak value of necrotic type M was nearly normal. The peak value of necrotic type C was 74.5% higher than that of the normal group, and the peak value of necrotic type L was more than 100% higher than that of the normal group. The peak value of necrotic type M after operation was not only 14.2% lower than that before operation, but also was lower than that of the normal group. The peak value of necrotic type C after operation was 5.3% lower than that before operation, but higher than that of normal group. The peak value of necrosis type L after operation was lower than that before operation, but significantly higher than the normal level. (3) The load transfer in the normal femoral head was continuous. The conduction path was from the lateral column of the femoral head to the femoral moment. In the necrosis group, the internal load transfer of types M and C femoral head was continuous, and the conduction of type M was basically consistent with normal. The stress of type C conduction to femoral moment was reduced. The load transfer of L1, L2 and L3 type femoral head was interrupted. The stress changed in cliff type, and was unable to transmit to femoral moment, resulting in stress concentration in load area of the femoral head. A certain effective load transfer mode was reconstructed in the femoral head of the fibula implantation group, and the stress concentration at the femoral moment occurred in all types of conduction. Part of the load was transferred to the femoral moment through fibula, and the normal load transfer mode was partially restored. (4) China-Japan Friendship Hospital type fibula placement can prevent the collapse of the femoral head to a certain extent. The location and size of the necrosis area are very important. The closer the necrosis is to the lateral column, the easier it is to collapse and the more difficult it is to repair. The retention of the lateral column is an important factor for accurate prediction of the collapse of the femoral head. Figures and Tables | References | Related Articles | Metrics

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Safety and feasibility of a new 3D printing template designed for bilateral anterior cervical transpedicular screws placements Xiao Qiang, Li Xiaodan, Liu Jingli, Zeng Jihuan, Deng Liang 2020, 24 (18):  2823-2828.  doi: 10.3969/j.issn.2095-4344.2636 Abstract ( 464 )   PDF (23532KB) ( 38 )   Save BACKGROUND: Anterior cervical transpedicular screws placement technique provides nice mechanical stability and is of very promising application prospects. However, the technology is difficult to operate and has a high risk, and has not been widely used. OBJECTIVE: To design a new three-dimensional (3D) printing template for bilateral anterior cervical transpedicular screws placements and assess its feasibility and safety in anterior cervical pedicle screw placement. METHODS: Six cadaveric cervical specimens, including three males and three females, were used in this experiment. Data of thin layer CT scanning of the specimens were saved in DICOM format and then imported into Mimics 17.0 software. Following 3D reconstructions of the cervical spine, guiding holes for C3-C7 bilateral anterior cervical transpedicular screws trajectories were designed; pedestals for the guiding holes were then designed via reversely thickening the bony structure of the anterior and 1/2 superior-anterior surface of vertebral body, and 1/2 anterior joint surface of bilateral processus uncinatus. Practical objects of the templates were obtained via 3D printing and were then used for guiding bilateral anterior cervical transpedicular screws replacements from C3 to C7. CT scanning was conducted again and the accuracy of anterior cervical transpedicular screws replacements was evaluated from sectional CT images. The difference of deviational angles on axial plane (α1, α2) and sagittal plane (β1, β2) between real and simulated trajectories were compared in Mimics 17.0 software. RESULTS AND CONCLUSION: (1) A total of 60 anterior cervical transpedicular screws were successfully inserted; 57 screws were completely located in pedicles and were judged as grade 0, representing an accuracy of 95.0%. The other three anterior cervical transpedicular screws perforated from pedicles, including grade 1 perforation in two screws (3.3%) and grade 2 perforation in one screw (1.7%). (2) By comparing real and simulated trajectories, the medical and lateral deviational angles were (0.867±0.787)° and (0.783±0.792)°, respectively (P > 0.05); the cephalad and caudal deviational angles were (1.362±1.380)° and (1.314±1.300)°, respectively (P > 0.05). (3) With the help of the 3D printing template designed in this study, bilateral anterior cervical transpedicular screws replacements could be smoothly carried out at high inserting safety. Figures and Tables | References | Related Articles | Metrics

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Robot-assisted percutaneous reduction and minimally invasive internal fixation for treating Schatzker II-III tibial plateau fracture Fu Xuefei, Zhang Shijian, Zhao Baoshuang, Liu Qixin, Wu Lei, Du Bosong, Li Siyuan, Qi Chao, Yang Chaoqun, Weng Nengyuan, Zhang Tao 2020, 24 (18):  2829-2835.  doi: 10.3969/j.issn.2095-4344.2639 Abstract ( 323 )   PDF (29798KB) ( 183 )   Save BACKGROUND: Accurate and minimally invasive surgery procedure has become the pursuit of the current surgical goals. With the rapid development of intelligent robots, the precise and minimally invasive treatment of fractures has become an irresistible trend. OBJECTIVE: To evaluate the clinical efficacy of robot-assisted percutaneous reduction and minimally invasive internal fixation for Schatzker II-III tibial plateau fractures. METHODS: Clinical data of patients with Schatzker II-III tibial plateau fractures who received robot- (n=22, robot-assisted group) and traditional fluoroscopy (n=26, traditional group)-assisted internal fixation at Tianjin Hospital from April 2017 to August 2018 were analyzed retrospectively. All patients suffered from unilateral, closed, and fresh tibial plateau fractures. Statistical indicators included: incision length, operation time, intraoperative blood loss, number of fluoroscopy, one-time success rate of screw, hospitalization time, fracture healing time, total weight-bearing time and postoperative complications. At the last follow-up, the range of motion of knee was recorded. The function of knee was evaluated by Rasmussen’s imaging and clinical score. RESULTS AND CONCLUSION: (1) There was no significant difference in the baseline data between two groups (P > 0.05). (2) Compared with the traditional group, the robot-assisted group was better in the intraoperative blood loss, incision length, number of fluoroscopy, total number of drilled screws for fixation, average hospitalization time, fracture healing time, total weight-bearing time, and one-time success rate of fixation screw placement (P < 0.05). There was no significant difference in the operation time between two groups (P=0.932). (3) The range of motion of knee and Rasmussen clinical function score in the robot-assisted group were superior to those in the traditional group (P < 0.05). (4) There were fewer postoperative complications in the robot-assisted group compared with traditional group. (5) These results indicate that robot-assisted percutaneous reduction and minimally internal fixation for the treating Schatzker II-III tibial plateau fracture are satisfactory. It has obvious advantages in minimally invasive surgery, precise reduction, rigid fixation and accelerated postoperative rehabilitation.  Figures and Tables | References | Related Articles | Metrics

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Early acute complications after total knee arthroplasty in patients with rheumatoid arthritis Shen Rui, Hu Chuan, Wang Cui, Rao Huili, Ding Tao, Sun Kang, Tian Shaoqi 2020, 24 (18):  2836-2841.  doi: 10.3969/j.issn.2095-4344.2648 Abstract ( 283 )   PDF (29353KB) ( 89 )   Save BACKGROUND: The number of rheumatoid arthritis patients undergoing total knee arthroplasty is increasing, but the postoperative early complications and related risk factors have not been reported. OBJECTIVE: To investigate the early acute complications and the risk factors after primary total knee arthroplasty in patients with rheumatoid arthritis. METHODS: Data of 300 patients (337 knees) with rheumatoid arthritis who received primary total knee arthroplasty at Affiliated Hospital of Qingdao University from September 2013 to May 2019 were retrospectively analyzed. There were 62 males and 238 females, with an age of (65.61±8.40) years old. All patients signed the informed consent, and the study was approved by the ethics committee of the hospital. The baseline data, comorbidities, preoperative examination, surgical data, other data of hospitalization and follow-up data were recorded. The risk factors of complications were analyzed. The receiver operating characteristic curve was used to assess the predictive value of risk factors for postoperative complications within 30 days after surgery in rheumatoid arthritis patients. RESULTS AND CONCLUSION: (1) Nine cases (3.33%) affected acute complications within 30 days after surgery. (2) Multivariate Logistic regression analysis showed that operation time, age, duration of disease and preoperative cerebrovascular disease were independent risk factors for postoperative complications within 30 days after total knee arthroplasty in rheumatoid arthritis patients. (3) Compared with the non-complication group, in the complication group, the operation time was longer (OR=1.023, 95%CI: 1.001-1.045, P=0.037), the age was increased (OR=1.163, 95%CI: 1.025-1.319, P=0.019), the duration of disease was longer (OR=1.110, 95%CI: 1.031-1.195, P=0.006), and the proportion of preoperative cerebrovascular disease was increased (OR=31.736, 95%CI: 4.053-248.517, P=0.001). (4) The receiver operating characteristic curve to predict the complications in patients with rheumatoid arthritis within 30 days after total knee arthroplasty showed that the area under the curve of age, duration of disease and operation time were 0.693, 0.865 and 0.685, respectively.  Figures and Tables | References | Related Articles | Metrics

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Effect of body mass index on the early-term hip functional recovery after total hip arthroplasty by three-dimensional gait analysis  Chen Haopeng, Xie Hui, Fu Weimin, Wang Benjie, Zhao Dewei 2020, 24 (18):  2842-2847.  doi: 10.3969/j.issn.2095-4344.2667 Abstract ( 443 )   PDF (25707KB) ( 122 )   Save BACKGROUND: The impact of obesity on total hip arthroplasty has been discussed. However, there is a lack of follow-up study on the patients with different body mass indexes using three-dimensional gait analysis. OBJECTIVE: To investigate the effect of body mass index on the early-term functional recovery after total hip arthroplasty by three-dimensional gait analysis. METHODS: Sixty patients who underwent total hip arthroplasty at Department of Joint Surgery of Affiliated Zhongshan Hospital of Dalian University from January 2017 to June 2018 were enrolled. According to the body mass index at admission, they were divided into overweight group (body mass index ≥ 25 kg/m2) and normal group (body mass index < 25 kg/m2), n=30/group. All patients signed the informed consents and the study was approved by the ethics committee of the hospital. The clinical data such as surgical site, age, sex, height, body mass, and operating time were collected. At 6 months postoperatively, three-dimensional gait analysis was used to collect the time-distance parameters (stride length, stride frequency, mean velocity), kinetic parameters, and kinematic parameters to evaluate the hip joint function. RESULTS AND CONCLUSION: (1) There was no significant difference in the surgical site, sex proportion and age between two groups (P > 0.05). The operation time in the overweight group was significantly longer than that in the normal group (P=0.000). (2) In terms of time-distance parameters, there was no significant difference in the stride length, stride frequency and mean velocity between two groups. The stride length in the overweight group was smaller than that in the normal group (1.08±0.18 vs. 1.35±1.45 m). (3) The range of motion of each planes of hip joint in the overweight group was significantly less than that in the normal group (P < 0.05). (4) In terms of kinetic parameters, the peak torque of hip flexion in the overweight group was significantly less than in the normal group (P=0.011). There was no significant difference in the peak torque of hip extension between two groups (P=1.000). (5) To conclude, obesity has certain effect on the early functional recovery after total hip arthroplasty. Figures and Tables | References | Related Articles | Metrics

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Comparison of direct anterior approach and posterolateral approach in supine position for total hip arthroplasty  Li Yongwang, He Rongli, Zhang Qian, An Ming, Qi Hui, Ma Wenhai, Song Xingjian, Sun Junying 2020, 24 (18):  2848-2854.  doi: 10.3969/j.issn.2095-4344.2631 Abstract ( 355 )   PDF (26043KB) ( 63 )   Save BACKGROUND: The posterolateral approach is the most commonly used surgical approach for total hip arthroplasty. In recent years, total hip replacement by direct anterior approach has been applied in clinic gradually, and has achieved good treatment outcomes. OBJECTIVE: To compare the clinical efficacy of the direct anterior approach in supine position and the posterolateral approach in supine position for total hip arthroplasty． METHODS: Ninety patients undergoing unilateral primary total hip arthroplasty at Baoding Municipal First Center Hospital from April 2015 to April 2019 were included, including 35 males and 55 females, aged 35-70 years. The patients were divided into direct anterior approach group (n=45) and posterolateral approach group (n=45) by the random number table method. Postoperative follow-up was used to evaluate the Harris hip scores, Visual Analogue Scale scores, initial fixation mass of prosthesis and safe range of the cup. The study was approved by the Ethics Committee of Baoding Municipal First Center Hospital. RESULTS AND CONCLUSION: (1) Ninety patients were followed up for 3-51 months, with an average 14 months. There were 2 cases of intraoperative great trochanteric fracture, 1 case of femoral lateral cutaneous nerve injury, 4 cases of femoral nerve injury, and 20 cases of tensor fascia lata injury. No such complications occurred in the posterolateral approach group. (2) The direct anterior approach group showed significant superior outcomes compared with the posterolateral approach group in the Harris hip scores and Visual Analogue Scale scores at 1 month after surgery (P < 0.05). The scores showed no significant differences between two groups at the last follow-up (P > 0.05). (3) In the direct anterior approach group, the femoral prosthesis of 44 hips was in neutral position, and 1 hip was in varus position. The initial fixation quality of all prosthesis was excellent. In the posterolateral approach group, the femoral prosthesis of 43 hips was in neutral position, 2 hips were in varus position and all prosthesis initial fixation quality was excellent. No significant difference was found between two groups (P > 0.05). (4) The ratio of acetabular cups in the safety range of Lewinnek in the direct anterior approach group was higher than that in the posterolateral approach group (100%, 82%, P < 0.05). (5) These results imply that compared with the posterolateral approach, direct anterior approach in supine position for total hip arthroplasty can significantly reduce postoperative pain, promote postoperative early rapid recovery, obtain more accurate angle of the acetabular prosthesis, and be more conducive to the equalization of both lower limbs. It is a safe and reliable approach. However, direct anterior approach has certain technical difficulty and needs a learning curve. And there are some complications different from other approaches.  Figures and Tables | References | Related Articles | Metrics

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Auxiliary positioning of a new positioning device in internal fixation of femoral neck fracture with cannulated screws Du Gangqiang, Jiang Shengyuan, Fu Guan, Li Peng, Jiang Jianhao, Zhang Kai, Jia Long, Gong Zhihao, Song Kaikai, Yang Shuye 2020, 24 (18):  2855-2860.  doi: 10.3969/j.issn.2095-4344.2640 Abstract ( 278 )   PDF (25387KB) ( 55 )   Save BACKGROUND: At present, the application of intelligent positioning devices such as orthopedic robots and computer navigation systems in closed reduction surgery for femoral neck fractures is gradually developed, and grassroots hospitals still need a cheap auxiliary positioning device. OBJECTIVE: To investigate the effect of a Kirschner wire positioning device for assisted localization in internal fixation of femoral neck fracture with cannulated screws. METHODS: Fifty-four cases of femoral neck fracture treated in Binzhou Medical University Hospital from February 2016 to March 2018 were retrospectively analyzed. The patients were allocated into the two groups, 28 patients who received traditional cannulated screws internal fixation were in the traditional group, and 26 patients who received assisted localization internal fixation with cannulated screws were in the assisted localization group. The angle, direction and distance of the Kirschner wire could be quantified and fine-tuned, assisted with accurate positioning, and the placement of the cannulated screws was guided. Clinical and imaging data were compared between two groups. RESULTS AND CONCLUSION: (1) All patients received surgery successfully. No intraoperative complications such as vascular or nerve injury occurred. Postoperative image showed good fracture reduction, cannulated screw distribution, angle and position. (2) The operation time in the assisted localization group (49.27±4.86) minutes was shorter than that in the traditional group (59.64±8.02) minutes (P < 0.01). The number of fluoroscopy in the assisted localization group was significantly lower than that in the traditional group (P < 0.01). (3) There was no significant difference between two groups in the follow-up time, fracture healing time and Harris score at the last follow-up (P > 0.05). The excellent and good rate of Harris score in the assisted localization group was 89%. (4) No necrosis of femoral head occurred during the follow-up, and the rate of late necrosis should be followed up. (5) Our findings suggest that Kirschner wire positioning device can assist in quantitative positioning and guide the placement of cannulated screw in the internal fixation of femoral neck fracture. It can effectively improve the positioning efficiency, reduce the number of fluoroscopy, avoid repeatedly adjusting the penetration to damage femoral neck bone, and promote the recovery of patients. Figures and Tables | References | Related Articles | Metrics

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Percutaneous screw fixation versus traditional plate fixation for treating pubic branch fracture Li Jiale, Zhang Yong, Gao Qiang, Li Jun, Yao Yunfeng 2020, 24 (18):  2861-2866.  doi: 10.3969/j.issn.2095-4344.2630 Abstract ( 490 )   PDF (24882KB) ( 46 )   Save BACKGROUND: Fracture of the pubic branch is a common type of anterior pelvic ring injury. Fixation of the pubic branch fracture can reduce the stress level of the posterior pelvic ring fixation system and reduce the separation of the pubic symphysis, which is beneficial to the stability of the pelvic ring. Both percutaneous screw fixation and traditional open reduction and internal fixation can be used to fix pubic branch fractures, but which method is better has not been confirmed. OBJECTIVE: To compare the efficacy of percutaneous screw fixation with conventional open reduction and plate fixation for pubic branch fracture. METHODS: Sixty-five patients of pubic branch fracture undergoing the surgical treatment at the Second Hospital of Anhui Medical University between January 2014 and December 2018 were included. The patients were randomly divided into percutaneous screw fixation group (n=33) and open reduction and plate fixation group (n=32). The patients signed the informed consents and the study was approved by the ethics committee of the hospital. The number of cases, sex, age, fracture classification, and American Society of Anesthesiologists score had no significant difference between two groups. The operation time, total blood loss, postoperative transfusion cases, incision length, postoperative discharge time and complications in both groups were recorded. Postoperative Matta score, Visual Analogue Scale score before and after surgery, and Majeed score during follow-up were recorded. RESULTS AND CONCLUSION: (1) Thirty patients in both groups were followed up, which was 8-59 months in the percutaneous screw fixation group, and 8-57 months in the open reduction and plate fixation group. (2) The percutaneous screw fixation group had smaller incision, lower incision infection rate, less bleeding, and shorter postoperative hospitalization time (P < 0.05). (3) Postoperative Visual Analogue Scale scores in both groups were decreased compared with the baseline levels (P < 0.05). The scores at postoperative 3 days in the percutaneous screw fixation group were significantly lower than those in the open reduction and plate fixation group (P < 0.05). The scores at postoperative 6 months were insignificant difference between two groups (P > 0.05). (4) The excellent and good rate of Matta score in the percutaneous screw fixation group was less than that in the open reduction and plate fixation group, and the difference was insignificant (P > 0.05). (5) There was no significant difference in the Majeed score at postoperative 6 months between two groups (P > 0.05). (6) Our results indicate that percutaneous screw fixation can achieve the same good effect as traditional plate fixation, and has the advantages of less trauma and faster postoperative recovery compared with traditional plate fixation. Figures and Tables | References | Related Articles | Metrics

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Correlation of cortical bone thickness and X-ray gray value in different planes of proximal femur with brittle fracture of female hip  Qin Haikuo, Luo Shixing 2020, 24 (18):  2867-2872.  doi: 10.3969/j.issn.2095-4344.2638 Abstract ( 445 )   PDF (29408KB) ( 34 )   Save BACKGROUND: With the aging of population, brittle fracture diseases have attracted more and more attention from clinicians. Bone mineral density detection cannot meet the risk assessment of brittle fracture. As one of the new directions and methods to evaluate the risk of brittle fracture, cortical thickness has been studied and discussed by more and more scholars. OBJECTIVE: To explore the correlation of bone cortical thickness values and X-ray gray values in different planes of proximal femur with hip brittle fracture in women aged over 50 years old under X-ray DR photography, so as to evaluate the most appropriate measurement plane for predicting the risk of hip brittle fracture in women among different planes of proximal femur. METHODS: According to the inclusion criteria, relevant clinical data of 100 female patients aged over 50 years old who underwent X-ray DR pelvic radiograph examination at Department of Radiology of the Ninth Affiliated Hospital of Guangxi Medical University from July 2018 to June 2019 were collected. All patients signed the informed consents and the study was approved by the ethics committee of the hospital. The measurement planes of cortical thickness of the proximal femur were designed to be the middle part of femoral neck, within 1 cm above the lesser trochanter, and within 1 cm below the lesser trochanter, with a total of three groups of measurement planes. The gray value of X-ray was measured by taking the line between the middle point of the great rotor and the small rotor as the rectangular diagonal line to take the rectangular area for measurement. RESULTS AND CONCLUSION: (1) Women aged 50-64 years were as group A (n=50) and those aged 65 years and older were as group B (n=50). (2) The cortical thickness and X-ray gray value within 1 cm below the lesser trochanter, and within 1 cm above the lesser trochanter in the group B were significantly lower than those in the group A; fracture rate was higher in group A than in group B (P < 0.05). There was no significant difference in the cortical thickness of middle part of the femoral neck between two groups (P > 0.05). (3) On the whole, cortical thickness values were highest in the within 1 cm below the lesser trochanter, followed by within 1 cm above the lesser trochanter and lowest in the middle part of the femoral neck (P < 0.05). (4) The correlation coefficient of cortical thickness and X-ray gray value of the within 1 cm below the lesser trochanter and within 1 cm above the lesser trochanter and age to brittle fracture was -0.303, -0.205, -0.272, and 0.346 (P < 0.05). There was no significant correlation between cortical thickness of middle part of the femoral neck and brittle fracture (P > 0.05). (5) The difference of cortical thickness within 1 cm below the lesser trochanter and within 1 cm above the lesser trochanter between fracture and non-fracture groups in the group A was significant (P < 0.05). There was no significant difference in each index between fracture and non-fracture groups in the group B (P > 0.05). At the age above 50 years, the difference of cortical thickness and X-ray gray value in each measured plane between fracture and the non-fracture groups was significant (P < 0.05). (6) To conclude, the cortical thickness becomes thinner and the gray value of X-ray becomes smaller, and the possibility of brittle fracture of hip becomes higher. When assessing the risk of hip fracture in women aged over 50 years using cortical thickness of the proximal femur, measurement within 1 cm below the lesser trochanter is recommended. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional computed tomography evaluation of L5 pedicle screw fixation shielding by iliac wing width and height  Zhang Shuai, Ouyang Jianyuan, Peng Xuelian, Wang Song, Wang Qing 2020, 24 (18):  2873-2878.  doi: 10.3969/j.issn.2095-4344.2560 Abstract ( 439 )   PDF (26476KB) ( 37 )   Save BACKGROUND: Previous scholars often graded the height of iliac spine according to X-ray films. The quality of X-ray images is greatly affected by the photographic equipment and position. Simultaneously, X-ray film transforms the three-dimensional relationship between the iliac wing and the L5 pedicle into a planar relationship. The overlap of bone structure makes it difficult to identify anatomic markers. Especially, the combination with osteoporosis, calcification of paravertebral artery, and stasis of intestinal contents in the elderly will further affect the observation of bone structure on X-ray films. OBJECTIVE: To observe the degree of the entry point in L5 pedicle screw fixation shielded by the width and height of the iliac wing using the three-dimensional computed tomography reconstruction technique. METHODS: According to the inclusion and exclusion criteria, 350 CT images of L1-S2 region were selected as the study object. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The degree of the entry point in L5 pedicle screw fixation shielded by the width of the iliac wing in central axis layer of the horizontal axis was analyzed using the three-dimensional computed tomography reconstruction technique and divided into levels 0, I, II, and III. The degree of the entry point in L5 pedicle screw fixation shielded by the height of the iliac wing in central axis layer of the oblique sagittal plane was analyzed and also divided into levels 0, I, II, and III. Level 0 indicates that the entry point of L5 pedicle screw is not shielded by the iliac wing, and levels I, II, and III indicate increasing degrees of entry point of L5 pedicle screw shielding by the iliac wing. The difference in the effect of width and height of the iliac wing on the shielding degree of entry point in L5 pedicle screw was compared between males and females.  RESULTS AND CONCLUSION: (1) In 80.0% of patients (280/350), the entry point of L5 pedicle screw was not shielded by the width of the iliac wing. In 20.0% (70/350) of patients, the entry point of L5 pedicle screw was shielded by the width of the iliac wing. In all, 27.3% (49/179) were male, including 27 with level I shielding, 14 with level II shielding, and 8 with level III shielding; 12.3% (21/171) were female, including 12 with level I shielding, 7 with level II shielding, and 2 with level III shielding. (2) In 80.6% (68/350) of patients, the entry point of L5 pedicle screw was not shielded by the height of the iliac wing. In 19.4% (68/350) of patients, the entry point of L5 pedicle screw was shielded by the height of the iliac wing. In all, 24.0% (43/179) of these patients were male, including 23 cases with level I shielding, 16 cases with level II shielding, and 4 with level III shielding; 14.6% (25/171) were female, including 13 with level I shielding, 8 with level II shielding, and 4 with level III shielding. (3) The degree of entry point of L5 pedicle screw shielding by the width of the iliac wing on the horizontal axis was not exactly the same as that of the height of the iliac wing on the sagittal axis of the L5 pedicle screw in the same patient. In this study, there were 70 patients with wide iliac wings and 68 patients with high iliac wings; the degrees of shielding by the width and height of the iliac wing were the same in 35 cases and different in 44 cases. (4) The degree of entry point of L5 pedicle screw shielding by the width and height of the iliac wing was greater in males than in females. (5) The results confirmed that the incidence of entry point of L5 pedicle screw shielding by the iliac wing width and height was 20.0% and 19.4%, respectively. The degree of entry point of L5 pedicle screw shielding by the width and height of the iliac wing was greater in males than females. The degree of entry point of L5 pedicle screw shielding by the iliac wing width along the horizontal axis was not completely consistent with that of L5 pedicle screw shielding on the oblique sagittal plane. It is of great significance to evaluate the relationship between iliac wing and L5 pedicle screw entry point by three-dimensional computed tomography reconstruction before operation for improving the safety of L5 pedicle screw placement and decision-making of operation. Figures and Tables | References | Related Articles | Metrics

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Meta-analysis of the effect of acupoint injection on pain improvement and joint function in patients with knee osteoarthritis   Deng Kaifeng, Shang Xinyang, Zhu Shengwang, Li Shuzhen, Zhu Ying, Chen Rilan 2020, 24 (18):  2879-2887.  doi: 10.3969/j.issn.2095-4344.2641 Abstract ( 536 )   PDF (31982KB) ( 77 )   Save BACKGROUND: A large number of clinical research data show that acupoint injection has the advantages of good therapeutic effect and few adverse reactions in the treatment of knee osteoarthritis, but there is a lack of related multicenter and large-sample clinical trial. OBJECTIVE: To evaluate the effect of acupoint injection on the pain improvement and joint function in patients with knee osteoarthritis by meta-analysis. METHODS: CNKI, Wanfang, VIP, CBM, PubMed, Embase and Cochrane Library databases were searched for the randomized controlled trials concerning the acupoint injection for treating knee osteoarthritis published before May 2019. The observation group was acupoint injection or acupoint injection combined with other treatments. The control group was the treatments different from acupoint injection. The language was either in Chinese or English. After screening, the data included in the study were extracted by Review Manager 5.3 software for meta-analysis. RESULTS AND CONCLUSION: (1) Sixteen randomized controlled trials were included, involving 1 287 patients (648 cases in the observation group, and 639 cases in the control group). (2) Meta-analysis results showed that the overall effective rate, cure rate, Lysholm score and Japanese Orthopaedic Association scores in the observation group were significantly higher than those in the control group [OR=3.23, 95%CI (2.19, 4.76), Z=5.91, P < 0.000 01; OR=1.86, 95%CI (1.35, 2.58), Z=3.74, P=0.000 2; MD=7.87, 95%CI (2.66, 13.08), Z=2.96, P=0.003; MD=9.16, 95%CI (4.18, 14.13), Z=3.61, P=0.000 3]. The Visual Analogue Scale score, WOMAC score, Lequesne index score, and the incidence of adverse reactions between two groups showed no significant difference [MD=-1.11, 95%CI (-2.29，0.07), Z=1.84, P=0.07; MD=-7.56, 95%CI (-17.26，2.14), Z=1.53, P=0.13; MD=-0.46, 95%C I(-1.62, 0.71), Z=0.77, P=0.44; OR=1.31, 95%CI (0.31, 5.57), Z=0.37, P=0.71]. (3) These results indicate that the efficacy of acupoint injection for treating knee osteoarthritis is accurate. Because the literature quality included in the study is not high and bias may exist, more high-quality randomized controlled trials are still needed to verify the conclusions. Figures and Tables | References | Related Articles | Metrics

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Observation of herniated cervical intervertebral disc volume based on quantitative volume measurement “monitoring” based on PACS software Zhang Chunlin, Liu Yang, Shang Lijie, Yan Xu, Ning Yongming, Li Dongzhe, Dong Chao, Cao Zhengming 2020, 24 (18):  2888-2892.  doi: 10.3969/j.issn.2095-4344.2633 Abstract ( 290 )   PDF (22693KB) ( 87 )   Save BACKGROUND: Herniated cervical intervertebral disc volume measurement is an important parameter for quantitative evaluation of cervical disc degeneration, but it faces a lot of problems such as different measurement standards and the undefined measurement error range. OBJECTIVE: To investigate the accuracy of PACS software in measuring cervical disc volume, provide reliable measurement methods and accurate data support for clinical observation and research on cervical disc volume change and degeneration. METHODS: The error rate was obtained by repeated measurements of the normal saline with a known volume of 5.0 mL by means of PACS software. With reference to this error rate, volume changes of cervical disc herniation before and after cervical microendoscopic laminoplasty were “monitored” and analyzed in 30 cases. This study was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University (approval No. 2019-KY-274) on September 26, 2019.  RESULTS AND CONCLUSION: (1) For the measurement of normal saline with known volume, it was found that the error rate of measurement by PACS software was ±5%, suggesting that the measurement of cervical disc volume by PACS software is a simple and accurate method. (2) After cervical microendoscopic laminoplasty, there were 70 patients with reduced cervical disc volume reduction absorption rate of 5%-100%, and the absorption ratio was 76.1% (70/92). The volume increased by 11, but the increase was not more than 5% in the patients with cervical disc herniation after treatment. (3) The spontaneous disappearance or reduction of the herniated cervical disc after cervical microendoscopic laminoplasty was as early as 7 days, and the longest was 76 months. (4) The effects were excellent in 11 cases, good in 15 cases, and fair in 4 cases. The excellent and good rate was 86.7%.  Figures and Tables | References | Related Articles | Metrics

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Value of quantitative MRI T2WI parameters in predicting surgical outcome of thoracic ossification of the ligamentum flavum Shen Canghai, Feng Yongjian, Song Yancheng, Liu Gang, Liu Zhiwei, Wang Ling, Dai Haiyang 2020, 24 (18):  2893-2899.  doi: 10.3969/j.issn.2095-4344.2658 Abstract ( 351 )   PDF (32866KB) ( 72 )   Save BACKGROUND: MRI has high sensitivity to thoracic myelopathy, which can assess the spinal cord injury by morphology and magnitude of cervical spinal cord compression. Additionally, it is a valuable tool for the prognosis evaluation of thoracic spinal stenosis. OBJECTIVE: To explore the value of quantitative MRI T2WI parameters in predicting surgical outcome of thoracic ossification of the ligamentum flavum, and to establish the prediction model of poor prognosis, so as to provide reference for prognosis evaluation. METHODS: From January 2010 to January 2019 at Cangzhou Central Hospital, clinical and imaging data of 87 cases of thoracic ossification of the ligamentum flavum treated by thoracic laminectomy were reviewed retrospectively. According to the JOA recovery rate at 6-month follow-up, the patients were divided into good recovery group (≥ 50%) and poor recovery group (< 50%). Age, sex, duration of disease, JOA score, Sato type of ossification, maximum spinal cord compression, cross-sectional area, distribution of hyperintense signal, signal intensity ratio, intramedullary signal size, local kyphosis, kyphosis correction, number of decompressed levels and incidence of cerebrospinal fluid were compared between two groups. Univariate analysis was used to analyze indicators with significant differences. Receiver operating characteristic curve was plotted to analyze prognosis. Areas under the curve and cut-off values were recorded. The independent predictors of poor recovery were estimated through multivariate logistic regression analysis and the prediction model was established. RESULTS AND CONCLUSION: (1) The duration of disease, JOA score, maximum spinal cord compression, cross-sectional area, signal intensity ratio and intramedullary signal size showed significant difference between good recovery and poor recovery groups (P < 0.05). (2) Receiver operating characteristic curve analysis showed that the area under the curve of the duration of disease, JOA score, maximum spinal cord compression, cross-sectional area, signal intensity ratio and intramedullary signal size was 0.670, 0.733, 0.647, 0.715, 0.753 and 0.765 respectively. The cut-off value was duration of 13 months, score 4, 29.8%, 0.25 cm2, 1.593 and 13.64 mm respectively. The duration of disease and maximum spinal cord compression had low discrimination power (the area under the curve < 0.7) in predicting poor recovery, whereas the JOA score, cross-sectional area, signal intensity ratio and intramedullary signal size had moderate discrimination power (the area under the curve 0.7-0.9). The area under the curve indicates good ability of signal intensity ratio and intramedullary signal size in combination (the area under the curve=0.791). (3) Logistic multivariate regression analysis showed that JOA score, cross-sectional area and combination of signal intensity ratio and intramedullary signal size were independent risk factors of poor recovery. A predicting model was built according to the result of the logistic regression analysis. It was shown that the area under the curve of this model was 0.890, which was significantly higher than that of the JOA score, cross-sectional area and combination of signal intensity ratio and intramedullary signal size (P < 0.05). (4) Combination of signal intensity ratio and intramedullary signal size had higher predictive ability than other MRI parameters. JOA score, together with quantitative MRI T2WI parameters may have a better predictive value for the risk of poor recovery in patients with thoracic ossification of the ligamentum flavum. Figures and Tables | References | Related Articles | Metrics

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Relationship between vertebral instability caused by intravertebral clefts and neurologic injury  Sun Yiqiang, Wang Xiushuang, Li Jianjun, Wang Xin, Zhao Zihao, Xing Jianqiang, Tian Lin, Geng Xiaopeng 2020, 24 (18):  2900-2905.  doi: 10.3969/j.issn.2095-4344.2668 Abstract ( 403 )   PDF (25123KB) ( 38 )   Save BACKGROUND: The details of clinical symptoms of osteoporotic vertebral fracture with intravertebral clefts are poorly understood at present. OBJECTIVE: To investigate the relationship between clinical symptoms and imaging features of osteoporotic vertebral fracture with intravertebral clefts. METHODS: Clinical data of 168 patients with single-level osteoporotic vertebral fracture with intravertebral clefts were retrospectively analyzed. The clinical symptoms were evaluated by Visual Analogue Scale score and Oswestry Disability Index. The incidence of delayed neurologic deficit was recorded. X-ray was used to measure the local kyphosis angle and vertebral instability, and CT was used to diagnose the posterior wall fracture of the vertebral body. The relationship between clinical symptoms and imaging features of osteoporotic vertebral fracture with intravertebral clefts was analyzed. RESULTS AND CONCLUSION: (1) The Visual Analogue Scale score and Oswestry Disability Index were 7.7±1.6 and (62.9±19.2)%, respectively. Delayed neurologic deficit occurred in 37 patients (22.0%). Local kyphosis angle and vertebral instability was (16.8±7.7)° and (7.9±4.4)°, respectively. The incidence of posterior wall fracture was 89.8%. (2) The Visual Analogue Scale and Oswestry Disability Index were significantly correlated with vertebral instability (r=0.33, P < 0.001; r=0.53, P < 0.001), but had weak correlation with local kyphosis angle (r=-0.16, P=0.03; r=-0.16, P=0.03). (3) The incidence of vertebral instability in patients with delayed neurologic deficit was significantly higher than that in patients without delayed neurologic deficit (P < 0.001), but there was no difference in local kyphosis angle between two groups (P=0.18). All patients with delayed neurologic deficit had posterior wall fracture, but only 2/3 patients with posterior wall fracture had delayed neurologic deficit. (4) In summary, vertebral instability is one of the factors leading to clinical symptoms of osteoporotic vertebral fracture patients with intravertebral clefts. The vertebral instability may be the main cause of delayed neurologic deficit. In order to treat back pain and delayed neurologic deficit effectively, it is important to control vertebral instability of osteoporotic vertebral fracture patients with intravertebral clefts. Figures and Tables | References | Related Articles | Metrics

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X-ray evaluation of the location and etiology of calcaneal spurs  Wu Kai, Liao Liqing, Li Yikai 2020, 24 (18):  2906-2910.  doi: 10.3969/j.issn.2095-4344.2587 Abstract ( 429 )   PDF (20800KB) ( 44 )   Save BACKGROUND: A large number of studies in and outside China have confirmed that the occurrence of calcaneus spur is related to plantar fasciitis, osteoarthritis and other diseases. For the etiology of calcaneus spur, two hypotheses have been proposed, which are “vertical compression” and “vertical traction”, but they have not been confirmed. OBJECTIVE: To analyze morphology and location of calcaneal spurs so as to analyze the etiology of calcaneal spurs. METHODS: Totally 831 complete dry calcaneal specimens and 222 cases of X-ray films were randomly selected, including 33 cases aged 18-30 years, 97 cases aged 31-50 years, 83 cases aged 51-70 years, and 9 cases aged 71-90 years. Morphology and location of calcaneal spurs were observed. The length and width of the calcaneal spurs were measured directly by vernier caliper. The length of the calcaneal spurs was measured by using the related software in the calcaneus lateral X-ray film. The implementation of the research program was in line with the ethical requirements of Southern Medical University. The calcaneal specimens used in the experiment were provided by the Department of Anatomy of Southern Medical University and were donated voluntarily by the donors. RESULTS AND CONCLUSION: (1) There were 142 specimens of calcaneal spur in the calcaneal specimens and 82 cases of calcaneal spurs in the lateral X-ray films. The highest point of 88.1% of achilles tendon spurs was in lateral edge of the calcaneus, and the plantar spurs were all located in the medial nodule of the calcaneus. (2) X-ray films showed that the average age of the spur-free population was (42.9±14.2) years, and the average age of the population with spurs was (54.0±13.4) years. The average age of patients with Achilles tendon spur was (42.3±14.9) years. The difference between spur-free population and population with spurs was statistically significant (P < 0.05). The difference between the average age of the spur-free population and the individuals with Achilles tendon spurs was not statistically significant (P > 0.05). (3) Calcaneal specimen showed that the shape of Achilles tendon spur was vertical ridge, and the plantar spur was lamellar. (4) Results indicated that the incidence rate of spurs in X-ray films was significantly higher than that in specimens. The calcaneal spur was mainly in lateral edge of the Achilles tendon attachment, and the plantar spurs were all located in the medial nodule of the calcaneus. The incidence of calcaneal spur is different in different age groups, suggesting that the Achilles tendon spur may be caused by longitudinal traction and the plantar spur may be caused by vertical compression. Figures and Tables | References | Related Articles | Metrics

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Selection and discussion of the best treatment strategy for different types of rotator cuff injury Zhao Di, Han Yanhong, Pan Jianke, Zhao Jinlong, Lin Jiongtong, Huang Hetao, Liu Jun 2020, 24 (18):  2911-2918.  doi: 10.3969/j.issn.2095-4344.2635 Abstract ( 397 )   PDF (51246KB) ( 350 )   Save BACKGROUND: At present, the treatment of rotator cuff injury is still an emphasis and hotspot in orthopedics clinical research. Although the therapies of rotator cuff injury are constantly innovating and improving, there is still a lack of unified standards and understanding, and each treatment has different strengths, weaknesses and indications. OBJECTIVE: To provide more ideas for orthopedic clinicians to treat rotator cuff injury by summarizing the indications of different therapies of rotator cuff injury. METHODS: A computer-based online research of PubMed, Embase, The Cochrane Library and ClinicalKey databases was performed for relevant articles published from 1990 to 2019 with the keywords of “rotator cuff tear, rotator cuff injury, therapeutic, treatment and therapies”. The unrepresentative and over-dated articles and studies that did not meet the inclusion criteria were excluded, and finally 77 eligible articles were included for analysis and summary. RESULTS AND CONCLUSION: (1) The treatments of rotator cuff injury can be divided into conservative treatments and surgical treatments, in which surgical treatments mainly include rotator cuff debridement, superior articular capsule reconstruction, reverse shoulder arthroplasty, and subacromial balloon spacer. In the choice of these treatments, different types of rotator cuff injury have different indications. (2) It is worth noting that massive rotator cuff injury is still a challenge in clinical treatment due to the high surgical failure rate and postoperative retear rate. However, with the rapid development of material science and tissue engineering, the new adjuvant therapy technologies have been gradually applied in clinical practice, and have become the focus in the field of rotator cuff injury. Figures and Tables | References | Related Articles | Metrics

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New idea of tissue engineering technology in the treatment of osteonecrosis of femoral head Xia Tianwei, Liu Jinzhu, Shi Le, Gao Runzi, Wei Wei, Zhang Chao, Shen Jirong 2020, 24 (18):  2919-2925.  doi: 10.3969/j.issn.2095-4344.2657 Abstract ( 332 )   PDF (43256KB) ( 255 )   Save BACKGROUND: Osteonecrosis of femoral head is a difficult disease in orthopedics, and head-preserving surgery is adopted in the early stage, especially bone grafting, in which autogenous bone and allogenic bone are commonly used as bone graft materials. However, autogenous bone transplantation is traumatic and has limited source of donor bone. Although there are abundant sources of allogeneic bone, there are serious immunologic rejection and absorption risks. With the development of tissue engineering technology, osteonecrosis of femoral head treatment has entered a new mode.  OBJECTIVE: To review the research status and new progress of tissue engineering technology in the treatment of osteonecrosis of femoral head. METHODS: PubMed database and CNKI database from 2000 to 2019 were searched by the first author. The key words were “osteonecrosis of femoral head, tissue engineering technology, mesenchymal stem cells, biomaterials, growth factor, bone grafting, hip preserving” in English and Chinese. Meta-analysis and repetitive articles were excluded. A total of 53 literatures related to tissue engineering techniques for the treatment of osteonecrosis of femoral head were included. RESULTS AND CONCLUSION: With the development of cytology and material science, great progress has been made in the treatment of osteonecrosis of femoral head with tissue engineering technology. It includes different kinds of gene-modified mesenchymal stem cells for repairing osteonecrosis, 3D printing and nanotechnology for scaffold materials, and the relationship between the expression of growth factor and osteonecrosis of femoral head. The ideal scaffold complex should be close to the biological characteristics of the organism itself. It can provide support for the necrotic area through effective biomechanical properties, thus reducing the pressure of necrotic area, promoting capillary repair and regeneration, and differentiation and proliferation of osteoblasts combined with cytokines, so as to complete the regeneration of new bone in necrotic area. However, most of these studies are still in the animal experimental stage. With the rapid development of nanotechnology, clinical medicine and tissue engineering, the full performance artificial manufacturing of bionic bone graft materials will be expected to be born, which will bring good news to hip patients. Figures and Tables | References | Related Articles | Metrics

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Macrophages can regulate bone homeostasis and erythropoiesis: problems and prospects Wei Xing, Song Lei 2020, 24 (18):  2926-2931.  doi: 10.3969/j.issn.2095-4344.2669 Abstract ( 370 )   PDF (40587KB) ( 54 )   Save BACKGROUND: Regulation of erythropoiesis in the bone marrow microenvironment is a carefully orchestrated process dependent upon systemic and local cues. Systemic erythropoietin production by renal interstitial cells plays a critical role in maintaining erythropoietic homeostasis. Increasing evidences have shown that erythropoietin and erythropoiesis can alter skeletal homeostasis, suggesting a functional relationship between the regulation of erythropoiesis and bone homeostasis. In recent years, macrophages play a regulatory role in erythropoietin, bone homeostasis and erythropoiesis. OBJECTIVE: To summarize the research advance concerning the role of macrophages in erythropoiesis and bone homeostasis. METHODS: PubMed, Medline, Web of Science, Wanfang and CNKI databases were retrieved with the keywords of “erythropoiesis, macrophage, erythropoietin, bone formation, bone homeostasis” in English and Chinese, respectively for relevant articles published from January 1999 to October 2019. Finally 48 articles eligible for inclusion and exclusion criteria were included for further analysis. RESULTS AND CONCLUSION: As key local components of the bone marrow microenvironment and erythropoietic niche, macrophage subsets play important roles in both processes. Peritoneum macrophages, glial macrophages and liver resident macrophages promote the production of erythropoietin in renal interstitium. Bone marrow macrophages or osteoma, osteoclasts and central macrophages regulate bone homeostasis, and further promote erythropoiesis. Figures and Tables | References | Related Articles | Metrics

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Robot-assisted and fluoroscopy-guided pedicle screw placement: a meta-analysis Xu Zhaojian, Han Pengfei, Wu Zhuangzhuang, Zhao Bin, Wang Yongfeng 2020, 24 (18):  2932-2938.  doi: 10.3969/j.issn.2095-4344.2670 Abstract ( 347 )   PDF (25150KB) ( 99 )   Save BACKGROUND: Computer navigation system and orthopedic surgery robot have been developed rapidly in spine surgery in recent years, but the operation effect of computer navigation or navigation robot is still questioned. OBJECTIVE: To compare the difference in robot-assisted and fluoroscopy-guided pedicle screw placement. METHODS: The study included clinical trials published in and outside China from August 2008 to August 2019. The retrieval was performed in the online databases including Embase, PubMed, CNKI, and Wanfang Data. Key words in Chinese were: robot assisted, fluoroscopy guided, pedicle screw, pedicle nail, pedicle screw rod, pedicle internal fixation. Search strategy was: pedicle screw AND robot assisted OR fluoroscopy guided. Key words in English were: Robot assisted, Fluoroscopy guided, Pedicle screw, Pedicle stick, Pedicle screw fixation. Search strategy was: “Pedicle screw” OR “Pedicle stick” OR “Pedicle screw fixation” AND “Fluoroscopy guided” OR “Robot assisted”. After data extraction, statistical software Review Manager 5.3 was used for data analysis.  RESULTS AND CONCLUSION: (1) Based on the above search strategy, 357 studies were retrieved. A total of 19 trials were included, containing 17 English studies and 2 Chinese studies. (2) Meta-analysis results displayed that the accuracy of placement of the robot-assisted group was superior to that of the fluoroscopy-guided group [95%CI(1.82, 2.52), P < 0.001]. Number of surgical complications [95%CI(0.25，0.69), P=0.0006] and revision number [95%CI(0.23，0.71), P=0.002] were less in the robot-assisted group than in the fluoroscopy-guided group. (3) When evaluating pedicle screw placement, robot-assisted has higher pedicle screw placement accuracy, fewer complications and fewer revisions, and is superior to traditional fluoroscopy-guided technique in accuracy and safety. Considering the expensive price and complex operation steps of navigation robot technology, the selection of specific nail placement method should still follow the principle of individualized treatment. Figures and Tables | References | Related Articles | Metrics

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Transtarsal sinus incision and traditional L-shaped incision for calcaneal fractures: a systematic evaluation and meta-analysis  Hong Weiwu, Su Haitao, Peng Jiajie, Fan Zhirong, Zhou Junde, Huang Yongquan 2020, 24 (18):  2939-2944.  doi: 10.3969/j.issn.2095-4344.2637 Abstract ( 474 )   PDF (23645KB) ( 39 )   Save BACKGROUND: Calcaneal fractures account for approximately 60% of all tarsal fractures, and 75% of calcaneal fractures are intra-articular. Surgical treatment can restore the shape and function of calcaneus well. In recent years, transtarsal sinus incision has been recognized and applied by clinicians, but the choice of surgical approach for calcaneal fractures is still controversial. OBJECTIVE: To systematically evaluate the efficacy and surgical safety of transtarsal sinus incision and traditional L-shaped incision in the treatment of calcaneal fracture. METHODS: PubMed, Cochrane, EMbase, CNKI, VIP and Wanfang databases were searched by computer for all randomized controlled trials comparing transtarsal sinus incision with traditional L-shaped incision in the treatment of calcaneal fractures. The retrieval time was from the establishment of the database to April 2019. The meta-analysis was carried out with RevMan 5.3 software after literature screening and data extraction based on inclusion criteria and exclusion criteria. RESULTS AND CONCLUSION: (1) A total of 522 patients were enrolled in 7 randomized controlled trials. (2) Meta-analysis results showed that there was no significant difference in Bohler angle [MD=0.14, 95%CI (-0.54, 0.81), P > 0.05], Gissane angle [MD=-0.19, 95%CI (-1.36, 0.98), P > 0.05] and Maryland score [MD=-0.25, 95%CI (-3.41, 2.91), P > 0.05] between the two incisions at the last follow-up. (3) American Orthopaedic Foot and Ankle Society score [MD=6.39, 95%CI(-0.09, 12.87), P=0.05] might be different. (4) Compared with the traditional L-shaped incision, the tarsal sinus incision had certain advantages in shortening the operation time [MD=-14.98, 95%CI (-23.90, -6.06), P=0.001 < 0.05], and lower incidence of postoperative complications [OR=0.18, 95%CI (0.08, 0.38), P < 0.000 1]. (5) For Sanders II and III calcaneal fractures, the transtarsal sinus incision has no obvious advantage over the traditional L-shaped incision in terms of curative effect. However, because the transtarsal sinus incision has a relatively small wound, it has the advantages of relatively short operation time and relatively low incidence of complications after operation. This suggests that the tarsal sinus incision is safe. However, due to the small sample size of the included study, the above conclusions still need to be verified by clinical trials with higher quality and larger sample size. Figures and Tables | References | Related Articles | Metrics

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Network meta-analysis on effectiveness of fire needle, warm acupuncture, and electroacupuncture in the treatment of knee osteoarthritis Zhang Jinhuan, Chen Yirong, Lan Kai, Hu Liyu, Yu Haibo 2020, 24 (18):  2945-2952.  doi: 10.3969/j.issn.2095-4344.2634 Abstract ( 387 )   PDF (31805KB) ( 64 )   Save BACKGROUND: Acupuncture has different forms as a kind of therapy, mainly warm acupuncture, fire needle and electroacupuncture, but the balance of effectiveness and safety between these measures remains unclear. OBJECTIVE: To compare the effectiveness of warm acupuncture, fire needle and electroacupuncture in the intervention of knee osteoarthritis by network meta-analysis. METHODS: The Embase, Cochrane Library, PubMed, CNKI, Wanfang, VIP and CBMdisc databases were searched for the clinical randomized controlled trials of warm acupuncture, fire needle and electroacupuncture in the treatment of knee osteoarthritis published before September 20, 2019. RevMan 5.3 and Stata 14.0 were used for data analysis. RESULTS AND CONCLUSION: A total of 2 871 patients with knee osteoarthritis were included in 34 randomized controlled trials. The results of meta-analysis showed that (1) the total clinical effective rate in the fire needle group (OR=1.08, 95%CI: 1.00-1.17, P < 0.05) and warm acupuncture group (OR=1.08, 95%CI: 1.02-1.14, P < 0.05) was better than that in the electroacupuncture, and the total effective rate of the three acupuncture treatments was better than that of western medicine, especially fire needle. (2) In the aspect of improving the Visual Analogue Scale scores, the fire needle (MD=-2.12, 95%CI: -3.52 to -0.71, P < 0.05), warm acupuncture (MD=-1.31, 95%CI: -2.33 to -0.29, P < 0.05), and electroacupuncture (MD=-1.17, 95%CI: -2.19 to -0.16), P < 0.05) were superior to western medicine, especially fire needle. (3) In terms of reducing WOMAC scores, fire needle (MD=-15.38, 95%CI: -27.88 to -2.87, P < 0.05), warm acupuncture (MD=-11.48, 95%CI: -16.45 to -6.51, P < 0.05), and electroacupuncture (MD=-7.29, 95%CI: -11.86 to -2.72, P < 0.05) were superior to western medicine, especially fire needle. (4) In summary, comprehensive comparison of three kinds of acupuncture, in the treatment of knee osteoarthritis, fire needle is the first choice. However, it still needs to be confirmed by more high-quality randomized controlled trials.  Figures and Tables | References | Related Articles | Metrics