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28 July 2020, Volume 24 Issue 21 Previous Issue    Next Issue

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Effect of different stretching durations on adjacent lumbar segments: changes in intervertebral disc stress and displacement Li Min, Dong Honglin, Wang Guizhen, Yan Peichun 2020, 24 (21):  3281-3286.  doi: 10.3969/j.issn.2095-4344.2571 Abstract ( 469 )   PDF (23947KB) ( 209 )   Save BACKGROUND: In contrast to traditional drafting techniques, the superposition structure of the bed air column of spinal manipulation contributes to controlling the duration of traction. Finite element analysis is used to calculate the stress of adjacent lumbar segments with different traction durations. It provides a better theoretical basis for lumbar traction prescription in clinical spinal manipulative bed. OBJECTIVE: To analyze the stress and distribution of adjacent lumbar segments with different traction durations using the finite element analysis when the spine manipulation bed is used for traction. METHODS: A healthy male volunteer, aged 26 years, with a height of 174 cm and a weight of 60 kg, was selected, who was fully informed of the study protocol and signed an informed consent. The study protocol was approved by the Ethics Committee of Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine with an approval No. 2016XJS-001-01. According to the CT images of volunteers T12-S1, an effective three-dimensional finite element model of the lumbar spine was established. By means of three-dimensional finite element analysis, the stress changes of the lumbar vertebrae and facet joint adjacent to the L3 were calculated when the traction was maintained for 10, 20 and 30 seconds respectively. The internal law and mechanism of the changes were analyzed and discussed. RESULTS AND CONCLUSION: (1) When the pushing height was 5 cm and the action time was 1.25-17 seconds, the stress value of adjacent lumbar segments increased continuously. For the intervertebral disc, the stress value was 4.60-5.68 MPa for L2-L3, and 5.26-6.61 MPa for L3-L4; for the facet joint, the stress value was 7.01-8.67 MPa for L2-L3 and 5.22-6.50 MPa for L3-L4. (2) The stress of adjacent vertebral segments and facet joints remained basically unchanged after pushing for more than 24 seconds. Therefore, when the spine manipulation bed acts on the lumbar spine, it will not damage the adjacent lumbar segments, and the duration of action should be between 25 and 30 seconds. Figures and Tables | References | Related Articles | Metrics

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Transmission efficiency of Ilizarov external fixator orthopedic force based on coordinate transformation theory Hu Xiangyu, Su Peng, Zhang Li, Li Jian, Qin Sihe, Fan Yubo 2020, 24 (21):  3287-3292.  doi: 10.3969/j.issn.2095-4344.2679 Abstract ( 346 )   PDF (26007KB) ( 108 )   Save BACKGROUND: The study on the mechanism of force conduction of Ilizarov bone external fixator is of great significance for clinical orthodontics of the knee varus, the knee valgus and the tibial fracture. OBJECTIVE: To explore the force conduction mechanism of Ilizarov bone external fixator and the force changes of each orthopedic force in the process of tibia correction, and to objectively evaluate the overall use effect of the external fixator. METHODS: According to the structure of the external fixator, the coordinate transformation matrix relations were established, and the mathematical transformation relationship between the holding force and the pulling tension was obtained. A special laboratory bench was set. The experiment of tibia correction was conducted. The load on the external fixator and the variation of the orthotic force were measured. The theoretical value of the tension at the broken bone is calculated and compared with the actual value of the tension measured by the six-dimensional force sensor. The curve of efficiency of force transmission during correction was obtained. RESULTS AND CONCLUSION: (1) During the correction, the structure of the Ilizarov bone external fixator resulted in the interaction and restriction of its adjustment rod and support rod. When one adjustment force increased, the other adjustment force would decrease. (2) The efficiency of force transmission was increased greatly in the early stage, and then stabilized at about 50%. The experimental results could evaluate the overall correction effect of the external fixator. (3) Theoretical calculation and experiment of the tension at the broken bone due to the loss during the force transmission process were different in the result curves, but from the experimental results, it could be indicated that the overall force change trend of the adjustment force, supporting force, the theoretical value of the tension and the actual value of the tension was basically the same, indicating the validity of the theoretical calculations and experimental results. The evaluation results can provide a reference for the optimal design of Ilizarov’s external fixation architecture and the precise control of tibial orthopedic surgery. Figures and Tables | References | Related Articles | Metrics

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Mongolian osteopathy in the treatment of ulna-radius fractures: finite element analysis of mechanical principle  Li Zhongxian, Ji Yucheng, Weng Yujie, Ning Pengfei 2020, 24 (21):  3293-3298.  doi: 10.3969/j.issn.2095-4344.2681 Abstract ( 479 )   PDF (24470KB) ( 43 )   Save BACKGROUND: Mongolian osteopathy is famous for the complicated manipulation and theoretical complexity. Combined with the finite element model of ulna-radius fractures, the analysis on the manipulation of osteopathy has not been reported at home and abroad. OBJECTIVE: To simulate the force of various ulna-radius fractures and establish the model of ulna-radius fractures, to analyze the effect, and to analyze the manipulation mechanism of Mongolian osteopathy on the corresponding fractures. METHODS: One 35-year-old volunteer was selected to obtain the CT image data of the right forelimb after signed the informed consent. The geometric model of the radius and ulna was established based on the parameters of bone tissue. The material mesh was divided, and the load parameters were assigned for analysis and calculation. Based on the common causes of Colles and Smith fractures, the osteopathy manipulation was evaluated by combined with “force to force” of Mongolian osteopathy. RESULTS AND CONCLUSION: (1) The stress distribution of the model of ulna-radius fractures is highly consistent with previous studies of the forearm. The mechanical models of Colles and Smith fractures were obtained in the direction of stress. After adjusting the mechanical parameters of bone, the fracture models of four different ages could be simulated. (2) These results indicate that the finite fracture model is feasible. Meta-analysis could simulate the ulna-radius fractures, and provide a manual reference for treating ulna-radius fractures with “force-to-force” theory in Mongolian osteopathy. Figures and Tables | References | Related Articles | Metrics

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Effect of meniscus injury on the biomechanical properties of knee joint under gait cycle Wu Zheng, Ren Jing, Wan Jianshan, Sun Rong, Wu Chengcong, Liu Keting, Liu Tao, Ou Hua 2020, 24 (21):  3299-3303.  doi: 10.3969/j.issn.2095-4344.2678 Abstract ( 506 )   PDF (23081KB) ( 372 )   Save BACKGROUND: The biomechanical characteristics of knee meniscus have been studied extensively at home and abroad, but most of them focus on the knee flexion motion. The finite element analysis of biomechanics of knee joint meniscus under the complete gait cycle is not yet perfect. OBJECTIVE: To understand the mechanism of biomechanical changes after meniscus injury in the complete gait cycle by comparing the lateral meniscus tear model with the healthy meniscus model. METHODS: Based on the CT scan data of healthy adult knee joints, a finite element model of healthy knee joint including tibia, meniscus and articular cartilage was established. The lateral meniscus tear of knee joint was constructed based on the healthy model. The biomechanical mechanism of lateral meniscus tear in the knee during complete gait cycle was explored and compared with the healthy knee model. RESULTS AND CONCLUSION: (1) The instantaneous stress variation of the tibia cartilage during the complete gait cycle was consistent in both models. The tibial cartilage stress at each instant in the meniscus tear model was higher than that of the healthy meniscus model. The maximum stress values of tibia cartilage in the meniscus tear model and the healthy meniscus model was 30 and 20.5 MPa. (2) The instantaneous stress variation of the meniscus during the complete gait cycle was consistent in both models. The meniscus stress at each instant in the meniscus tear model was higher than that of the healthy meniscus model. The maximum stress values of meniscus in the meniscus tear model and the healthy meniscus model was 69.8 and 41.3 MPa. (3) In the first 60% of the gait cycle, the maximum stress distribution of the tibia cartilage in the meniscus tear model was much larger than that in the healthy model, and as the gait cycle grew, the contact range gradually spread to the outer edge of the cartilage. After 60% of the gait cycle, the stress on the tibia cartilage was small, and the distribution range of the maximum stress was also small. (4) The stress distribution of the healthy medial meniscus was basically the same in the two models, while the maximum stress distribution of the torn outer meniscus was wider than that of the healthy medial meniscus. A more severe stress concentration phenomenon occurred around the crack, and with the gait cycle, the stress concentration area gradually shifted toward the crack near the anterior corner of the meniscus. (5) These results suggest that the meniscus is an important load-bearing component in human knee joint. From the perspective of biomechanics, the hazard of the meniscus injury on the human knee joint can be observed more intuitively. Figures and Tables | References | Related Articles | Metrics

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Incidence of femoral neck shortening after internal fixation of femoral neck fracture and prognostic factors Mu Shuai, Xiao Peng, Zhang Jianliang, Hou Weiguang 2020, 24 (21):  3304-3309.  doi: 10.3969/j.issn.2095-4344.2649 Abstract ( 470 )   PDF (28897KB) ( 92 )   Save BACKGROUND: Internal fixation with cannulated screws is the most commonly used treatment for femoral neck fracture, but some patients may have the phenomenon of femoral neck shortening after surgery, and even cause the occurrence of postoperative dysfunction of the hip joint. OBJECTIVE: To investigate the incidence, clinical features, prognosis and influencing factors of femoral neck shortening after internal fixation of femoral neck fracture. METHODS: One hundred and eleven cases of femoral neck fracture treated by cannulated screw internal fixation at three orthopedic hospitals in Chengdu from January 2012 to March 2017 were retrospectively analyzed. All patients signed the informed consents and the study was approved by the ethics committee of the hospital. Femoral neck shortening was as the prognostic indicator. The incidence, occurrence time and main clinical characteristics of femoral neck shortening after surgery were recorded. Univariate chi-square test was used to analyze the correlation between sex, age, Garden type, Garden index, bone mineral density T value, Singh index, time from injury to operation, weight-bearing time and the femoral neck shortening after surgery. Statistically significant factors were included in the multivariate Logistic regression model. RESULTS AND CONCLUSION: (1) The incidence of femoral neck shortening was 48.6% (54/111), with 31.5% (35/111) of 10-19 mm shortening and 5.4% (6/111) of ≥ 20 mm shortening. (2) The occurrence time of femoral neck shortening was mainly within 6 months after surgery, accounting for 76%. (3) The clinical manifestations of the femoral neck shortening mainly included pain during weight-bearing, dysfunction of hip movement and claudication. The analysis results showed that the moderate pain (67%) was dominant in the shortening group, and no pain/mild pain (86%) was dominant in the non-shortening group; the incidence of hip motion limitation in the shortening group was higher than that in the non-shortening group (68% vs. 21%); and the incidence of claudication in the shortening group was higher than that in the non-shortening group (61% vs. 18%); the differences were significant (all P < 0.05). (4) Univariate and multivariate Logistic regression analysis showed that Garden classification of fracture was type III and IV, Garden index was grade III and IV, bone mineral density T value ≤ -2.5, weight-bearing time ≤ 2 months were independent risk factors for femoral neck shortening after reduction and internal fixation of femoral neck fracture. Therefore, there is a high risk of femoral neck shortening after internal fixation with cannulated nails for femoral neck fractures, which mainly occurs within 6 months after surgery. Figures and Tables | References | Related Articles | Metrics

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Curative efficacy of proximal femoral nail antirotation versus intertrochanteric antegrade nail for treating intertrochanteric fracture in older adults Huang Zhaoguo, Zhang Caiyi, Zhang Qing, Wang Sheng, Wang Shaogang, Li Jun, Tao Zhongliang, Zuo Caihong 2020, 24 (21):  3310-3314.  doi: 10.3969/j.issn.2095-4344.2700 Abstract ( 467 )   PDF (23447KB) ( 222 )   Save BACKGROUND: Proximal femoral nail is the first choice for treating intertrochanteric fractures. The studies concerning proximal femoral nail for senile intertrochanteric fractures mainly focus on proximal femoral nail antirotation/proximal femoral nail antirotation II, Gamma 3 and intertrochanteric antegrade nail. OBJECTIVE: To investigate the clinical efficacy of proximal femoral nail antirotation II versus intertrochanteric antegrade nail in the treatment of intertrochanteric fracture in the elderly. METHODS: Forty-two cases of senile intertrochanteric fractures at Department of Orthopedics, First People’s Hospital of Xuancheng City from January 2016 to December 2018 were included, involving 15 males and 27 females, aged 65-90 years. Among which, 22 patients received internal fixation using proximal femoral nail antirotation II and 20 patients using intertrochanteric antegrade nail. The operation time, intraoperative blood loss, fracture healing time, postoperative complications and the hip function scores at last follow-up were compared. The study was approved by the Ethics Committee of First People’s Hospital of Xuancheng City, approval No. (2015)(17). RESULTS AND CONCLUSION: (1) The operation time in the proximal femoral nail antirotation group was shorter than that in the intertrochanteric antegrade nail group [(69.4±11.5), (90.0±9.7) minutes, P < 0.05]. The intraoperative blood loss in the proximal femoral nail antirotation group was less than that in the intertrochanteric antegrade nail group [(70.6±10.0), (86.5±11.1) mL, P < 0.05]. (2) There was no significant difference in the fracture healing time between two groups [(4.3±0.5), (4.1±0.4) months, P > 0.05]. (3) In the proximal femoral nail antirotation group, three cases suffered from pain at the affected limb, and one case of coxa vara deformity. One case in the intertrochanteric antegrade nail group appeared with pain at the affected limb. The postoperative incidence of complications between two groups showed no significant difference (18.2%, 5.0%, P > 0.05). (4) No significant difference was found in the Harris scores at the last follow-up between two groups (90.3±2.8, 91.5±2.4, P > 0.05). (5) There were no fracture adverse reactions related to internal fixation materials in the two groups. (6) In summary, proximal femoral nail antirotation II and intertrochanteric antegrade nail internal fixation are effective methods for intertrochanteric fractures in the elderly. However, proximal femoral nail antirotation II has short operation time and few intraoperative blood losses. Figures and Tables | References | Related Articles | Metrics

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Hemostatic and anticoagulant effects of proximal femoral nail anti-rotation in repairing elderly patients with intertrochanteric fractures during perioperative period Gao Zhaopeng, Gao Ming, Jiang Zhen, Zhang Qinming, Jia Dailiang, Wang Haibin 2020, 24 (21):  3315-3320.  doi: 10.3969/j.issn.2095-4344.2701 Abstract ( 452 )   PDF (717KB) ( 54 )   Save BACKGROUND: At present, there is no consensus and guideline for balanced hemostasis and anticoagulation in elderly patients with intertrochanteric fractures. There are few related literatures on the perioperative hemostasis and anticoagulation management of tranexamic acid combined with rivaroxaban in elderly patients with intertrochanteric fractures. OBJECTIVE: To investigate the effects of tranexamic acid combined with rivaroxaban on perioperative hemorrhage, blood transfusion, postoperative venous thrombosis in elderly patients with intertrochanteric fractures. METHODS: Sixty elderly patients with intertrochanteric fractures were enrolled and scheduled to undergo proximal femoral nail anti-rotation surgery. All patients received rivaroxaban 10 mg/d anticoagulant until 24 hours before operation. All patients were divided into two groups. Patients in the test group were intravenously injected with 1.0 g of tranexamic acid. Patients in the control group were intravenously injected with the same volume of glucose solution. Surgical blood loss, blood transfusion, and venous thrombosis prior to discharge were compared in the two groups. RESULTS AND CONCLUSION: (1) The blood loss in the test group was significantly lower than that in the control group (P < 0.05). There was no significant difference in venous thrombosis before discharge between the two groups. (2) Three patients in the test group received blood transfusions, and seven patients in the control group received blood transfusions. (3) The results confirm that tranexamic acid combined with rivaroxaban not only reduces perioperative blood loss in elderly patients with intertrochanteric fractures, but also does not increase the risk of venous thrombosis. Figures and Tables | References | Related Articles | Metrics

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Morphological analysis of optimal selection of lumbar pedicle screws in adolescents aged 12-15 years Xu Yangyang, Zhang Kai, Li Zhijun, Zhang Yunfeng, Su Baoke, Wang Xing, Wang Lidong, Wang Yidan, He Yujie, Li Kun, Wang Haiyan, Li Xiaohe 2020, 24 (21):  3321-3328.  doi: 10.3969/j.issn.2095-4344.2652 Abstract ( 603 )   PDF (1137KB) ( 318 )   Save BACKGROUND: A large amount of literature has been published on the vertebral pedicle morphology at thoracolumbar segments in adults, but little is known about the morphology of pedicles in adolescents, especially in Asian populations. Adolescent spine disorders are increasing and there are few precise morphological studies. OBJECTIVE: To investigate the anatomy of lumbar vertebrae of adolescents aged 12-15 years in Inner Mongolia, provide detailed information for pedicle screw placement, determine the safe and appropriate screw size, and provide data reference for screw size design. METHODS: The normal chest and lumbar CT data of 65 adolescents aged 12-15 years in Inner Mongolia were collected and divided into two groups, 31 cases of 12-13 years old, and 34 cases of 14-15 years old. The raw data of the thoracic and lumbar vertebrae images scanned continuously were imported into Mimics 21.0 for analysis and measurement in DICOM format. Pedicle width, pedicle height, transverse diameter, longitudinal diameter, pedicle length, pedicle outer declination, pedicle maximum external angle, pedicle head inclination, and pedicle area were measured. RESULTS AND CONCLUSION: (1) The L1-L4 pedicle width in the two groups was less than pedicle height, and pedicle width and pedicle height at L5 were similar. The pedicle width determined the screw diameter, which was larger in males than in females. (2) In 12-13 years old, the screw length at L1-L5 was between 40-45 mm. In 14-15 years old, the screw length was between 40-45 mm at L1-L4, and 45-50 mm at L5. (3) The laws of the two groups were the same. The transverse diameter of spinal canal was significantly larger than longitudinal diameter of spinal canal (P < 0.05), and there was no significant difference between men and women. (4) The transverse pedicle angle: In 12-13 years old, L1-L2 had small change, L2-L5 gradually increased; in 14-15 years old, L1-L5 gradually increased; it is larger in males than in females in both groups. (5) Maximum transverse pedicle angle: The two groups had the same law. L1-L5 gradually increased, and decreased with age. There was no significant difference between left and right sides and sexes. There was significant difference among different ages (P < 0.05). (6) The sagittal pedicle angle: The in 12-13 years old, 3°-8°; in 14-15 years old, 0°-5°. The value decreased with age, and there was significant difference between men and women in L3-L4 (P < 0.05). (7) Pedicle area: The two groups had the same rules. L1-L5 gradually increased, and L4-L5 had a clear trend of change. (8) Analysis of pedicle parameters showed that the size of the screws in the lumbar vertebrae of normal adolescents was suitable for the clinician to grasp the anatomy of the lumbar spine and improve the accuracy of clinical operation. Figures and Tables | References | Related Articles | Metrics

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Zero-profile anterior cervical ROI-C cage versus traditional fusion cage combined with titanium plate in treatment of two-level cervical spondylotic myelopathy Zhang Junhui, Xu Hualiang, Chang Hong, Lin Zhujian, Song Yancheng 2020, 24 (21):  3329-3335.  doi: 10.3969/j.issn.2095-4344.2702 Abstract ( 531 )   PDF (30811KB) ( 68 )   Save BACKGROUND: Self-locking self-stabilizing zero-profile cage ROI-C is advanced from the traditional titanium plate fusion cage, but the systematic studies on ROI-C internal fixation system applied in the comprehensive evaluation of two-level cervical spondylotic myelopathy are few. OBJECTIVE: To comprehensively evaluate the clinical efficacy of small-incision anterior cervical self-locking self-stabilizing zero-profile cage ROI-C in the treatment of two-level cervical spondylotic myelopathy. METHODS: Fifty-seven patients with two-level cervical spondylotic myelopathy at the First Affiliated Hospital of Guangdong Pharmaceutical University from September 2016 to March 2018 were selected, including 30 males and 27 females, aged 34-77 years old. Of which, 33 patients underwent small-incision anterior cervical self-locking self-stabilizing zero-profile fusion cage ROI-C implantation (observation group), and another 24 patients received small-incision cervical anterior titanium internal fixation (control group). The JOA score, Neck Disability Index, Odom criteria, Visual Analogue Scale score, dysphagia degree, Cobb angle of cervical lordosis, angle of fusion segment, and disc height and cervical fusion rate were assessed at 2 weeks and 1, 3, 6, and 12 months after surgery. The study was approved by the Ethics Committee of the First Affiliated Hospital of Guangdong Pharmaceutical University. RESULTS AND CONCLUSION: (1) There was no significant difference in the Odoms criteria between two groups (P > 0.05). All 57 patients were followed up for 12 months after surgery. No internal fixation loosening or vertebral structure changes were found. No complications such as loosen and broken of titanium plate occurred. (2) Postoperative JOA score, Neck Disability Index, and Visual Analogue Scale in the two groups were significantly improved compared with those before surgery (P < 0.05), but there was no significant difference between two groups (P > 0.05). (3) The incidence of dysphagia at 2 weeks and 1 month in the observation group was significantly lower than that in the control group (P < 0.05). There was no significant difference between two groups at 3, 6, and 12 months after surgery (P > 0.05). (4) The Cobb angle of cervical lordosis, angle of fusion segment, and disc height were significantly improved in both groups after surgery (P < 0.05), but there was no significant difference between two groups (P > 0.05). (5) The cervical fusion rate at the last follow-up in both groups was > 95%, and the fusion effect was good. There was no significant difference in the fusion rate at different time points between two groups (P > 0.05). (6) These results indicate that the small-incision anterior cervical self-locking self-stabilizing Zero-profile interbody fusion ROI-C and anterior titanium plate internal fixation exert significant effects in the treatment of two-level cervical spondylotic myelopathy. However, ROI-C can reduce the incidence of postoperative dysphagia. Figures and Tables | References | Related Articles | Metrics

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Total knee arthroplasty through a midvastus approach reduces postoperative adverse reactions and accelerates functional recovery of the knee Yan Xianke 2020, 24 (21):  3336-3340.  doi: 10.3969/j.issn.2095-4344.2664 Abstract ( 373 )   PDF (17255KB) ( 71 )   Save BACKGROUND: Medial parapatellar approach has become the standard technique for total knee arthroplasty. However, recent studies have reported superior results in functional recovery using midvastus approach. OBJECTIVE: To evaluate the early functional outcomes of medial parapatellar and midvastus approaches. METHODS: This was a prospective, randomized, double-blind, and controlled trial. Fifty patients receiving total knee arthroplasty were randomized into two groups: medial parapatellar approach and midvastus approach. The same type of implants was used in both groups. The Visual Analogue Scale scores were recorded. The range of motion, quadriceps strength and proprioception were assessed at 3 and 6 weeks after surgery. RESULTS AND CONCLUSION: (1) The Visual Analogue Scale scores at rest and in active in the midvastus approach group were significantly lower than those in the medial parapatellar approach group. (2) The average quadriceps strength in the midvastus approach group was significantly better than that in the medial parapatellar approach group. (3) The postoperative quadriceps proprioception in the midvastus approach group was better than that in the medial parapatellar approach group. The range of motion was similar in both groups. (4) Therefore, during early rehabilitation, the midvastus approach is superior to the medial parapatellar approach, and no adverse effects associated with this method are observed. Figures and Tables | References | Related Articles | Metrics

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Application of task-state fMRI in evaluating disease severity and prognosis of cervical spondylotic myelopathy  Song Yancheng, Kang Liqing, Shen Canghai, Liu Fenghai, Feng Yongjian 2020, 24 (21):  3341-3346.  doi: 10.3969/j.issn.2095-4344.2703 Abstract ( 411 )   PDF (27647KB) ( 262 )   Save BACKGROUND: Blood oxygenation level dependent functional MRI (BOLD-fMRI) has proven to be a powerful tool for studying the functional change of the brain. In task-state fMRI study, the functional reorganization of sensory and motor cortex has been observed in patients with cervical spondylotic myelopathy. OBJECTIVE: To discuss the correlations between task-state fMRI measurements with clinical symptoms and surgical outcomes of cervical spondylotic myelopathy. METHODS: Eighty-two patients with cervical spondylotic myelopathy undergoing posterior cervical decompression (cervical spondylotic myelopathy group) and forty-five healthy volunteers (normal group) were recruited from January 2018 to January 2019. All subjects underwent fMRI and performed a finger-tapping paradigm with the right hand. The Japanese Orthopaedic Association score was used to evaluate the function of the spinal cord. Japanese Orthopaedic Association score recovery rate less than 50% was defined as a poor result. RESULTS AND CONCLUSION: (1) Japanese Orthopaedic Association score was significantly improved after surgery in the cervical spondylotic myelopathy group compared with that before surgery (P < 0.05). (2) The volume of activation (VOA) in the left precentral gyrus was significantly higher in the cervical spondylotic myelopathy group than in the normal group preoperatively (P < 0.05). There were no significant differences in the VOA in the left postcentral gyrus between cervical spondylotic myelopathy and normal groups (P > 0.05). Before surgery, VOA ratio (left precentral gyrus/left postcentral gyrus) was significantly higher in the cervical spondylotic myelopathy group than in normal group (P < 0.05). (3) In 6-month follow-up, the VOA in the left precentral gyrus was significantly reduced compared with that preoperatively in the cervical spondylotic myelopathy group (P < 0.05). There were no significant differences in the VOA in the left postcentral gyrus compared with that preoperatively (P > 0.05). VOA ratio was significantly decreased compared with that preoperatively (P < 0.05). (4) Correlation analysis revealed that the VOA in the left precentral gyrus and left postcentral gyrus and VOA ratio were significantly correlated with preoperative Japanese Orthopaedic Association score and postoperative Japanese Orthopaedic Association score recovery rate (P < 0.05). The absolute value of correlation coefficient of VOA ratio with preoperative Japanese Orthopaedic Association score and postoperative recovery rate was largest. (5) Receiver operating characteristic curve analysis showed that the area under the curve value for the VOA ratio was 0.803, indicating strong predictive discrimination, and the cut-off value was 3.621. The area under the curve value for Japanese Orthopaedic Association score was 0.751, and the cut-off value was 8. The predictive effect of VOA ratio was higher than Japanese Orthopaedic Association score. (6) The results indicate that the VOA in the left precentral gyrus and left postcentral gyrus was negatively correlated with severity of clinical symptoms (Japanese Orthopaedic Association score). Preoperative VOA ratio can effectively predict the recovery of spinal cord function after operation in patients with cervical spondylotic myelopathy.  Figures and Tables | References | Related Articles | Metrics

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CT multiple-level reconstruction for preoperational estimation of facet joint violation in lumbar percutaneous pedicle screw placement Zhang Xiaoyun, Bi Shuxiong, Hao Shuai 2020, 24 (21):  3347-3352.  doi: 10.3969/j.issn.2095-4344.2683 Abstract ( 397 )   PDF (27704KB) ( 36 )   Save BACKGROUND: Percutanoues pedicle screw internal fixation is widely used for treating lumbar disease. Because the surgery is guided by the C-arm, it is hard to control the position between screws and facet joint to cause the facet joint violation completely. Body mass index > 29.9 kg/m2, facet joint angle > 35°and age < 65 years old are considered as the high risk factors for percutaneous pedicle screw injury of articular processes. Due to the different positional relationship between the pedicle axis of the lumbar spine and the articular process joint, there is no related report on whether the destruction of the articular process joint by screws is different. OBJECTIVE: To investigate the significance of lumbar CT multi-planar reconstruction for preestimating facet joint violation in lumbar percutaneous pedicle screw placement. METHODS: One hundred patients with lumbar fracture and degenerative disease who underwent percutaneous pedicle screw placement were selected. All patients signed the informed consents and the study was approved by the ethics committee of the hospital. The position line of the oblique axial view, oblique sagittal view and oblique coronal view was adjusted to reconstruct the section of pedicle. A circle with the 6.5 mm of position line of the oblique coronal view as its center to check the relationship between the circle and facet joint served as preoperation group. CT examination was performed after surgery for evaluating the degree of facet joint violation by screws and served as postoperation group. The amount of screws which damage the facet joint of different vertebrae between two groups and the damage rate among vertebrae in each group were compared. RESULTS AND CONCLUSION: (1) Totally 478 screws were placed, 109 (22.8%) screws violated facet joints in the preoperation group, and the amount of circles which violated facet joint was 6 (6.8%), 9 (10.5%), 19 (18.3%), 30 (30.0%), and 45 (45.0%) from L1-L 5. (2) 115 (24.1%) screws violated facet joints in the postoperation group, the amount of circles which violated facet joint was 10 (11.4%), 7 (8.1%), 15 (14.4%), 26 (26.0%) and 41 (41.0%) from L1-L 5. (3) The P values of McNamara test of different vertebrae were 0.08 (L1), 0.22 (L2), 0.20 (L3), 0.05 (L4) and 0.08 (L5). There was no significant difference between two groups. (4) The results of Kappa test were 0.67 (L1), 0.80 (L2), 0.80 (L3), 0.87 (L4) and 0.92 (L5). The damage rate among vertebrae in each group had significant differences (P=0.000). (5) To conclude, the relationship between percutanoues pedicle screw and facet joint could be recognized by lumbar CT multiple level reconstruction, which provides a reliable method for preestimating the possibility of facet joint damage caused by the percutanoues pedicle screw. Figures and Tables | References | Related Articles | Metrics

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Tranexamic acid controls postoperative hidden blood loss in senile intertrochanteric fracture  Yu Dongming, Hu Song, Yang Xiaozhong, Zou Yi, Chen Yong, Hu Bo, Gao Daxin 2020, 24 (21):  3353-3357.  doi: 10.3969/j.issn.2095-4344.2650 Abstract ( 347 )   PDF (25314KB) ( 103 )   Save BACKGROUND: In the elderly patients with intertrochanteric fractures, a large amount of hidden bleeding appears after surgery, so reducing hidden bleeding has become an important problem to be solved urgently. OBJECTIVE: To evaluate the effect of preoperative intravenous injection of tranexamic acid on the hidden blood loss after proximal femoral nail antirotation implantation. METHODS: Eighty-two cases of senile intertrochanteric fractures at Department of Traumatic Orthopedics of Guang’an People’s Hospital from July 2018 to July 2019 were selected, and all the patients underwent internal fixation with proximal femoral nail antirotation. The patients were allocated into two groups based on usage of tranexamic acid (n=41/group). In trial group, intravenous injection of tranexamic acid (10 mg/kg) was conducted during anesthesia, and control group was given the same volume of normal saline via vein. Blood routine examination was conducted at baseline and 1, 3 and 5 days postoperatively to count the level of hemoglobin and hematocrit. The total blood loss was calculated by Gross equation. The transfusion rate and postoperative incidence of thrombosis were recorded. RESULTS AND CONCLUSION: (1) There was no significant difference in the dominant blood loss between two groups (P > 0.05). (2) The perioperative actual total blood loss and postoperative hidden blood loss in the trial group were significantly lower than those in the control group (P < 0.05). (3) Three cases of blood transfusion (7%) in the trial group, and eight cases (24%) in the control group (P < 0.05). (4) No thrombosis occurred in both groups. (5) These findings suggest that preoperative intravenous infusion of tranexamic acid can effectively reduce the hidden blood loss after proximal femoral nail antirotation implantation, and does not increase the risk of postoperative thrombosis. Figures and Tables | References | Related Articles | Metrics

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Study characteristics and tendency of platelet-rich plasma globally by bibliometrics and visualization analysis  Xing Dan, Yuan Ting, Zhao Yu, Lin Jianhao 2020, 24 (21):  3358-3362.  doi: 10.3969/j.issn.2095-4344.2680 Abstract ( 473 )   PDF (17872KB) ( 126 )   Save BACKGROUND: Platelet-rich plasma has been shown to promote tissue repair and regeneration. OBJECTIVE: To evaluate the current status and hotspot of platelet-rich plasma globally by bibliometrics. METHODS: In the database of web of science, “platelet rich plasma” was used as keyword to research relevant researches published before December 25, 2018. The retrieved articles were indexed and analyzed according to country/region, institution, publication year, and publication name. Excel 2007 was used for descriptive statistics. VOS viewer (Leiden University, Netherlands) software was used to analyze and draw all the retrieved items. The main evaluation indicators were co-occurrence relationship, mutual citation relationship, co-citation relationship, and cooperation relationship map. RESULTS AND CONCLUSION: (1) Totally 8 499 studies on platelet-rich plasma were retrieved, and the number and citations increased gradually. (2) Number of studies on platelet-rich plasma ranked top 3 countries are the United States, Italy, and Japan. (3) The subject direction and research fields of platelet-rich plasma mainly involve five aspects: basic research on growth factor function, research on bone regeneration, clinical research in cartilage or osteoarthritis, platelet function research, and stem cells. (4) The analysis results based on big data suggest that platelet-rich plasma is mainly applied in orthopedics, especially cartilage regeneration and osteoarthritis, which will be the focus of future research and technology investment. Figures and Tables | References | Related Articles | Metrics

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Research and application of tissue optical clearing technique Tian Ting, Yang Zhaoyang, Li Xiaoguang 2020, 24 (21):  3363-3371.  doi: 10.3969/j.issn.2095-4344.2662 Abstract ( 651 )   PDF (58177KB) ( 686 )   Save BACKGROUND: Whole-body cell analysis of organisms is one of the major challenges in biomedicine. Tissue optical clearing technique combined with optical imaging and image processing technique can make the whole organ or the body transparent rapidly for structural and cellular analyses, providing a very promising solution for the application of advanced optical technique in life science.  OBJECTIVE: To analyze the principle and process of tissue optical clearing technique, to summarize the research progress of tissue optical clearing technique, to present imaging technology for tissue clearing, and to discuss the application of tissue optical clearing technique in biomedical researches. METHODS: The first author searched relevant literatures in PubMed database with the keywords of “tissue optical clearing technique, tissue optical clearing, whole-body imaging and 3D imaging”. A total of 168 articles were initially retrieved. After sorting and screening systematically, 72 literatures were included for analysis, summary and discussion. RESULTS AND CONCLUSION: Current tissue optical clearing protocols are divided into two groups: solvent-based clearing methods and hydrophilic reagent-based clearing methods. Tissue clearing is usually conducted by the following steps: (a) tissue fixation, (b) permeabilization, (c) decolorization, and (d) refractive index matching. Tissue optical clearing technique can rapidly transform tissue into an optically transparent form, improving imaging depth and contrast. Combined with microscope imaging techniques such as confocal, two-photon and light sheet microscopes, tissue clearing can achieve 3D imaging of the whole organ or body at cellular resolution, accelerating the process of whole-body cell analysis of organisms. Tissue optical clearing technique will continue to evolve in the future, promote the development of new clearing reagents and clearing optimized microscopes, further enhance the acquisition of structural and molecular information from intact systems and contribute to the comprehensive understanding of whole biological systems.  Figures and Tables | References | Related Articles | Metrics

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Research progress and development space of microRNA in the process of intervertebral disc degeneration Hu Baoyang, Yang Xuejun 2020, 24 (21):  3372-3378.  doi: 10.3969/j.issn.2095-4344.2682 Abstract ( 379 )   PDF (40136KB) ( 54 )   Save BACKGROUND: Full-understanding of the mechanism of microRNA (miRNA) in the process of intervertebral disc degeneration at the cellular and molecular levels can provides new idea for the early prevention or treatment of a series of spinal diseases to intervertebral disc degeneration. OBJECTIVE: To summarize the research status of the role of miRNA in the cause and mechanism of intervertebral disc degeneration. METHODS: A computed-based online retrieval of PubMed, Wanfang and CNKI databases was conducted with the keywords of “miRNA, intervertebral disc degeneration, extracellular matrix, apoptosis, autophagy, cartilage endplate, nucleus pulposus, fibrous ring” in English and Chinese, respectively. Finally 58 eligible articles were included for review. RESULTS AND CONCLUSION: The role of miRNA in intervertebral disc degeneration has been widely studied, and some of the specific mechanisms have been verified. Most of the studies are limited to the nucleus pulposus, and there are few reports on cartilage endplate and annulus fibrosus. With the in-depth study of miRNA, there is still much space for clinical research. Figures and Tables | References | Related Articles | Metrics

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Advantages and disadvantages of common methods of hip-conserving surgery for osteonecrosis of femoral head Gu Changyuan, Du Bin, Sun Guangquan, Liu Xin, Lü Paiyun 2020, 24 (21):  3379-3386.  doi: 10.3969/j.issn.2095-4344.2654 Abstract ( 537 )   PDF (49188KB) ( 69 )   Save BACKGROUND: There are many methods for the treatment of non-traumatic necrosis of the femoral head. In the clinical treatment, various stages of necrosis are the decisive factors for the choice of operation. In the past, there are many studies about the effectiveness of various techniques, but few studies concern the causes of failure or risk assessment. OBJECTIVE: To explore whether other internal and external factors affect the success rate of hip preservation besides necrosis stage. METHODS: The first author retrieved PubMed, Web of Science, Medline, CNKI and Wanfang database for related studies published from 2010 to 2019. The key words were “osteonecrosis of femoral head, core decompression, non-vascularized bone grafting, vascularized free bone grafting, porous tantalum rod implantation, osteotomy, biological agents, cytotherapy” in English, and “hip-conserving surgery, hip preservation, core decompression, bone graft without blood vessel, bone graft with blood vessel, porous tantalum rod placement, osteotomy, biologics, cell therapy” in Chinese. A total of 214 articles were retrieved, and the full text was consulted. Based on the inclusion and exclusion criteria, 70 articles were finally included for analysis and summary. RESULTS AND CONCLUSION: (1) The advantages and disadvantages of each hip-conserving surgery should be evaluated. (2) Although core decompression is simple, it should not be used alone; the lateral column should be reserved properly when the non-vascularized bone transplantation is used to clean up the dead bone, so as to deal with the mechanical weakening; the blood loss and fracture risk are higher when the vascularized bone transplantation is converted to total hip replacement; the stress concentration is easily caused by tantalum rod implantation, and the clinical application is less. (3) Osteotomy, as a kind of hip-conserving surgery with great trauma, should be planned in detail for patients’ age, body mass index, and necrotic range, besides considering the necrotic stage. (4) The risk of total hip replacement should be considered in the long run no matter which operation. (5) The combination of various surgical methods and biological agents may achieve better results. Figures and Tables | References | Related Articles | Metrics

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Failure of articular cartilage repair Zhang Yu, Yu Chengqiang, Wu Youcai, Ou Yufu, Wei Jianxun 2020, 24 (21):  3387-3393.  doi: 10.3969/j.issn.2095-4344.2606 Abstract ( 490 )   PDF (41262KB) ( 52 )   Save BACKGROUND: Articular cartilage has complex biological characteristics and high durability; therefore, natural degeneration or trauma may lead to irreversible damage of its structure and function. Repair and treatment of articular cartilage injury is an urgent problem in clinic. OBJECTIVE: To report the most common risk factors for failure of articular cartilage repair and their incidence, and to analyze the most important factors influencing the choice of specific surgical treatment for failure of cartilage repair. METHODS: The relevant articles were searched in PubMed and MEDLINE database from 2007 to 2019. The keywords were “articular cartilage, repair, clinic/clinical failure, surgery” in English. Initially, 343 articles were retrieved, and 38 articles were included for final analysis. RESULTS AND CONCLUSION: (1) Microfracture and mosaicplasty have significant failure rates in the early and middle stages after articular cartilage repair, while autologous chondrocyte implantation (ACI) and osteochondral allograft (OCA) transplantation are two effective methods for articular cartilage repair. (2) For the failure of articular cartilage repair, OCA transplantation might be a safe choice in the past. However, a higher re-failure rate of articular cartilage repair has been found in patients undergoing a failed OCA transplantation. For the patients who have failed ACI or matrix-induced ACI, further treatment with ACI or matrix-induced ACI is acceptable. In addition, patients with a history of subchondral bone marrow stimulation have a higher failure rate of ACI. (3) Treatments for cartilage repair failure depend on the type of surgical failure and area and site of cartilage defect. OCA transplantation is the most reliable method for the treatment of cartilage repair failure in subchondral bone marrow stimulation patients. ACI or matrix-induced ACI have shown acceptable therapeutic effect in patients who have suffered cartilage repair failure. When dealing with cartilage repair failure, special attention should be paid to the conditions of subchondral bone. Figures and Tables | References | Related Articles | Metrics

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Molecular signaling pathways in the occurrence and development of osteoarthritis Liao Jianzhao, Zhang Xiaoyun, Zhang Xuan 2020, 24 (21):  3394-3400.  doi: 10.3969/j.issn.2095-4344.2607 Abstract ( 537 )   PDF (41469KB) ( 232 )   Save BACKGROUND: Osteoarthritis is a refractory degenerative disease that seriously affects patients’ quality of life, and brings a heavy financial burden to their families. Nowadays, treatments for osteoarthritis can only alleviate symptoms, improve joint function in a short period of time, but cannot prevent or reverse the pathological process of osteoarthritis. To date, there are no prophylactic or regenerative therapies for osteoarthritis. The signaling pathway can explain the occurrence and development of disease at the molecular level. Therefore, the regulation of signaling pathway can be used as a potential treatment for osteoarthritis. OBJECTIVE: To review the occurrence and development of osteoarthritis, aiming at providing new ideas for clinical diagnosis, treatment and deeper understanding of diseases in the future. METHODS: CNKI, Wanfang, VlP, CBMdisc, PubMed and MEDLINE databases were retrieved respectively with the keywords of “osteoarthritis; signaling pathway; EGFR; Hedgehog; NF-kB; Notch” in Chinese and English, and included literature reports regarding the signaling pathways related to osteoarthritis published in 2008-2019 were retrieved.  RESULTS AND CONCLUSION: Normal articular cartilage function depends on the regulation of multiple signaling pathways, and the occurrence and development of osteoarthritis are also regulated by corresponding signaling pathways, providing deep understanding of osteoarthritis at the molecular level and new ideas for clinical diagnosis and treatment. Regulation of signaling pathways through drug action and gene modification is a potential treatment for osteoarthritis. However, there is a common problem in related research: most of the research on signaling pathway is isolated, and the occurrence and development of osteoarthritis may involve the joint action of multiple signal pathways. Therefore, further research is needed on the synergy of signaling pathways. Figures and Tables | References | Related Articles | Metrics

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Interpretation of American Osteopathic Association Guidelines for osteopathic manipulative treatment of nonspecific low back pain Xie Rui, Zhu Liguo, Yu Jie, Li Kaiming, Zhuang Minghui, Chang Xiaojuan, Dai Wenkang 2020, 24 (21):  3401-3408.  doi: 10.3969/j.issn.2095-4344.2613 Abstract ( 446 )   PDF (45874KB) ( 42 )   Save BACKGROUND: Low back pain is one of the common orthopedic diseases, and nonspecific low back pain accounts for a very large proportion of all low back pains in clinic. In order to better treat the disease, in 2016, the American Orthopaedic Association developed a clinical guide for the osteopathic manipulative treatment of nonspecific low back pain. OBJECTIVE: To let orthopedic doctors, other doctors, other health professionals and third-party payers know the evidence of potential suggestions on the proper use of osteopathic manipulative treatment, so as to help clinical orthopedists to provide therapeutic reference for non-specific low back pain as well as to learn from the scientific and rigorous design ideas and evaluation methods in the guides. METHODS: The guideline is a revised version based on the previous guideline and the latest high-quality meta-analyses. It is determined that osteopathic manipulative treatment is an effective treatment for nonspecific low back pain with clear recommended level. In this paper, the definition, evaluation methods, specific contents of the guideline and results of evidence-based medicine regarding the clinical practice in China were analyzed and discussed. RESULTS AND CONCLUSION: Seventeen studies were included in the guidelines, which systematically evaluated the effect of osteopathic manipulative treatment for acute and chronic nonspecific low back pain, as well as for nonspecific low back pain in pregnant and postpartum women. After treatment, great improvement was achieved in pain relief and functional recovery. The final suggestion by the American Orthopaedic Association is to use osteopathic manipulative treatment for low back pain. The treatment method is safe and scientific, which can be generalized in China. Figures and Tables | References | Related Articles | Metrics

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Mechanism of autophagy in osteosarcoma Li Shibin, Zhang Xiaoyun, Zhang Xuan 2020, 24 (21):  3409-3415.  doi: 10.3969/j.issn.2095-4344.2663 Abstract ( 404 )   PDF (35406KB) ( 52 )   Save BACKGROUND: Autophagy may be a tumor-inhibiting factor at the early stage of carcinogenesis, while at late stage, it may support or promote the tumor growth and spread, and may contribute to drug resistance. OBJECTIVE: To review the related literature at home and abroad, summarize the relationship between autophagy and osteosarcoma, and explore the mechanism of autophagy in osteosarcoma and its therapeutic prospect. METHODS: CNKI, Wanfang, VIP and PubMed databases were retrieved with the keywords of “autophagy, chemotherapy, autophagy related factors, osteosarcoma, apoptosis, drug resistance” in Chinese and English, respectively. The articles related to the mechanism of autophagy in bone tumors were included. The literature was screened according to the selection criteria, and the repetitive and the long-standing literature were excluded. Fifty-two articles were included for review and analysis. RESULTS AND CONCLUSION: (1) Autophagy may be an important factor in promoting and preventing cancer, and its effect varies with the occurrence of development of tumor. (2) The full understanding and regulation of autophagy pathway can significantly improve the potential of tumor therapy. (3) Considering the importance of autophagy in tumor biology, research on autophagy-regulated miRNA will help us to better understand malignant tumors and may discover new disease markers and treatment strategies. (4) The above conclusion still needs a lot of scientific research and reasonable experiments to confirm. Figures and Tables | References | Related Articles | Metrics

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Biological oxygen-carrying therapeutic agents: roles and applications NafeishaSimayi, Chen Lizhi, Wang Xiangmeng, Huang Wenhua 2020, 24 (21):  3416-3422.  doi: 10.3969/j.issn.2095-4344.2575 Abstract ( 761 )   PDF (40573KB) ( 41 )   Save BACKGROUND: Although blood donation by healthy people can relieve the urgent need of clinical blood to some extent, it is impossible to fundamentally solve the problem of blood shortage and blood safety by relying solely on blood donation by healthy people. OBJECTIVE: In combination with the significance of the development of biological oxygen-carrying therapeutics, to expound the unique characteristics of biological oxygen-carrying therapeutics, and to summarize the research status and application progress of biological oxygen-carrying therapeutics in recent years, in order to provide a certain theoretical basis for further research on the role and clinical application of biological oxygen carrying therapeutic agents. METHODS: The authors searched the relevant articles published from January 2015 to August 2019 in the databases of CNKI, Wanfang and PubMed. The keywords were “blood substitute, hemoglobin oxygen carrier, artificial blood, oxygen-carrying therapeutic agent” in English and Chinese. Types of search literature included original research and reviews. Initially 418 articles were included, and finally 46 eligible articles were classified and reviewed. RESULTS AND CONCLUSION: The biological oxygen-carrying therapeutic agent has a good clinical effect. It can maintain blood osmotic pressure, acid-base balance and blood volume, and also has good oxygen-carrying capacity. It can deliver oxygen to local hypoxic tissue for a long time. It is also easy to store and transport. Biological oxygen-carrying therapeutic agents have been widely used in surgery, which are of great help to expand blood volume and accelerate postoperative recovery. Therefore, the development of biological oxygen-carrying therapeutic agents is of great significance for surgical trauma and resuscitation, hemorrhagic shock, malignant anemia, myocardial infarction and other diseases. It shows a good clinical application prospect. Figures and Tables | References | Related Articles | Metrics

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Systematic evaluation and meta-analysis of total hip arthroplasty with three-dimensional printing model in preoperative planning Yan Yan, Zhao Yan, Fu Fanyu, He Haijun 2020, 24 (21):  3423-3429.  doi: 10.3969/j.issn.2095-4344.2704 Abstract ( 338 )   PDF (25884KB) ( 46 )   Save BACKGROUND: Three-dimensional (3D) printing-assisted total hip arthroplasty plays an important role in preoperative planning, intraoperative guidance and positioning, and production of individualized implants. It has important clinical significance for the treatment of hip joint diseases. OBJECTIVE: To evaluate the clinical efficacy of preoperative planning using 3D printed models to assist total hip arthroplasty by systematic evaluation and meta-analysis. METHODS: PubMed, Embase, Cochrane Libray, CNKI, Wanfang databases were retrieved electronically for the articles published before December 2019. The keywords were “hip arthroplasty, hip replacement, THA, 3D printing, three dimensional printing” in Chinese and English, respectively. The clinical controlled trials of 3D printed models versus non-3D printed models to assist total hip arthroplasty in the treatment of hip joint diseases were enrolled. The literature was screened according to the inclusion and exclusion criteria; data were extracted; and the quality of the included studies was evaluated using the Cochrane 5.1.0 bias risk assessment tool, followed by data analysis using RevMan 5.3 software. RESULTS AND CONCLUSION: (1) Fourteen controlled studies were included, involving 601 participants, including 279 cases in the 3D group and 322 cases in the traditional surgery group. (2) Meta-analysis results showed that during the first hip arthroplasty, the operation time in the 3D group was shorter than that in the traditional surgery group [SMD=-0.89, 95%CI (-1.15, -0.64), P < 0.05]. There was no significant difference in the Harris score between two groups [SMD=0.64, 95%CI (-0.26, 1.54), P > 0.05]. During revision surgery, the operation time in the 3D group was shorter than that in the traditional surgery group [SMD=-1.39, 95% CI (-1.92, -0.86), P < 0.05], and Harris score was higher than that in the traditional surgery group [SMD=1.51, 95%CI (-0.05, 2.96), P < 0.05]. The intraoperative blood loss and postoperative drainage volume in the 3D group were less than those in the traditional surgery group [SMD=-1.90, 95%CI (-2.82, -0.99), P < 0.05; SMD=-2.87, 95%CI (-3.36, -2.37), P < 0.05]. The anteversion angle and abduction angle in the 3D group were closer to the preoperative design angle compared with the traditional surgery group [SMD=-1.24, 95%CI (-1.57, -0.91), P < 0.05; SMD=-1.71, 95%CI (-2.96, -0.45), P < 0.05]. (3) These results show that compared with traditional total hip arthroplasty, 3D printing assisted total hip arthroplasty can significantly shorten the operation time, reduce the amount of intraoperative blood loss and postoperative drainage, improve the accuracy of total hip arthroplasty, and can better relieve pain, and improve the quality of life. However, due to the low quality of the included literature, high-quality large-sample, multi-center randomized controlled trials are still needed to confirm the clinical efficacy. Figures and Tables | References | Related Articles | Metrics

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Meta-analysis of barbed suture versus traditional suture in primary total knee arthroplasty Ma Xin, Zhang Wenhui, Yang Yuping, Yuan Zhiguo 2020, 24 (21):  3430-3437.  doi: 10.3969/j.issn.2095-4344.2651 Abstract ( 427 )   PDF (26895KB) ( 38 )   Save BACKGROUND: A new barb suture has been extensively applied in clinical practice of surgery and has achieved good efficacy. However, its application in total knee arthroplasty is little, and the treatment efficacy remains controversial. OBJECTIVE: To collect the related studies for systematic analysis, so as to provide evidence for the use of barbed suture in total knee arthroplasty. METHODS: PubMed, EMBASE, Cochrane library, CBM, CNKI, Wanfang and VIP databases were retrieved by two researchers independently for the randomized controlled trials on barbed suture and traditional suture applied in total knee arthroplasty published before June 2019. Literature quality was assessed using the randomized controlled trials bias risk assessment tool recommended by the Cochrane manual, and meta-analysis was performed using RevMan 5.3 software. RESULTS AND CONCLUSION: (1) Eight randomized controlled trials were included, involving 1 004 knees. (2) The results showed that barbed suture could significantly shorten the wound closure time [MD=-5.17, 95%CI(-6.26, -4.09), P < 0.000 01] and reduce the total cost of wound closure [SMD=-1.66, 95%CI(-2.58, -0.75), P=0.000 4], and incidence of acupuncture injury [RR=0.14, 95%CI(0.03, 0.78), P=0.02]. (3) There was no significant difference in the postoperative complications [RR=0.96, 95%CI(0.65, 1.42), P=0.85], and suture breakage [RR=4.58, 95%CI(0.16, 128.29), P=0.37], range of motion at postoperative 6 weeks and 3 months [MD=-0.74, 95%CI(-4.19, 2.71), P=0.67]; [MD=-0.30, 95%CI(-2.62, 2.02), P=0.80] or American Knee Society Knee Score at postoperative 6 weeks [MD=-0.22, 95%CI(-3.10, 2.66), P=0.88]. The American Knee Society Knee Score at postoperative 3 months was better in the barbed suture group [MD=-2.04, 95%CI(-3.92, -0.15), P=0.03]. (4) To conclude, barbed suture is a fast, low-cost, safe and effective method in primary total knee arthroplasty, which is worthy of clinical use. More randomized controlled trials and long follow-up are needed to confirm this conclusion. Figures and Tables | References | Related Articles | Metrics

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Effect of electro-acupuncture on pain relief and joint function in patients with knee osteoarthritis: a meta-analysis Chen Rilan, Deng Kaifeng, Wei Xingcheng, Wang Hengsheng, Feng Jiaoqun, Yan Jiaxing, Gao Qianqian, Ma Yinglu, Zhu Ying 2020, 24 (21):  3438-3444.  doi: 10.3969/j.issn.2095-4344.2605 Abstract ( 523 )   PDF (29458KB) ( 280 )   Save BACKGROUND: Numerous clinical data have shown that electro-acupuncture in the treatment of knee osteoarthritis has the advantages of fast onset, good therapeutic effect and less side effects, but there is a lack of multicenter large-sample clinical research regarding the treatment of knee osteoarthritis. OBJECTIVE: To systematically evaluate the effect of electro-acupuncture on pain relief and joint function in patients with knee osteoarthritis by meta-analysis. METHODS: The literatures related to clinical randomized controlled trials of electro-acupuncture treatment of knee osteoarthritis were retrieved in CNKI, Wanfang, VIP, PubMed, Embase and Cochrance Library database from the inception to June 2019. After literature screening, a meta-analysis of included studies was carried out using Review Manager 5.3. RESULTS AND CONCLUSION: Finally, 11 articles were included in the study, with 721 cases of knee osteoarthritis. There were 366 cases in the electro-acupuncture group and 361 in the control group with routine acupuncture or drug treatment. Compared with the control group, the total effective rate, cure rate, visual analogue scale score, WOMAC score and ISOA score in the electro-acupuncture group were significantly higher than those in the control group [odds ratio (OR)=3.22, 95% confidence interval (CI)(2.13, 4.87), Z=5.53, P < 0.000 01; OR=2.73, 95%CI(1.80, 4.15), Z=4.72, P < 0.000 01; mean difference (MD)=-1.00, 95%CI(-1.71, -0.30), Z=2.80, P=0.005; MD=-7.69, 95%CI(-10.31, -5.07), Z=5.75, P < 0.000 01; MD=-2.22, 95%CI(-3.74, -0.70), Z=2.86, P=0.004]. Based on the evidence of meta-analysis, the short-term effect of electro-acupuncture on knee osteoarthritis is definite, and electro-acupuncture can play a positive effect on pain symptoms and joint function of knee osteoarthritis patients with few adverse reactions. Considering small sample size, low-quality literatures and possible presence of bias factors, further investigations on more high-quality randomized controlled trials are warranted. Figures and Tables | References | Related Articles | Metrics