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    28 August 2020, Volume 24 Issue 24 Previous Issue    Next Issue
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    Morphological differences in the hip of femoral head necrosis with different traditional Chinese medicine syndromes observed with 3D graphics: feasibility of non-surgical hip preservation
    Lin Tianye, Yang Peng, Wei Qiushi, Xu Jingli, Zou Qizhao, Xiong Binglang, Lai Qizhong, Zhao Heran, Chen Zhenqiu, He Wei, Zhang Qingwen
    2020, 24 (24):  3773-3779.  doi: 10.3969/j.issn.2095-4344.2716
    Abstract ( 425 )   PDF (760KB) ( 635 )   Save

    BACKGROUND: Some studies have found a certain relationship between the distribution of traditional Chinese medicine syndrome types and the morphological differences in femoral head necrosis.

    OBJECTIVE: To observe the morphological differences of hip joints of different types of traditional Chinese medicine syndromes with femoral head necrosis through 3D graphics, and to evaluate the efficacy of standardized and comprehensive non-surgical hip preservation for femoral head necrosis.

    METHODS: From December 2016 to February 2017, 73 femoral head necrosis patients (108 hips) treated with non-surgical hip preservation in the First Affiliated Hospital of Guangzhou University of Chinese Medicine were enrolled in this study. According to the syndrome type of traditional Chinese medicine, the patients were divided into the kidney deficiency and blood stasis group (47 hips), the accretion group (30 hips) and the Qi stagnation and blood stasis group (31 hips). X-ray films and CT spiral scans of both hips were taken to measure the central hip angle, Sharp angle, upper and lower acetabular diameter, anteroposterior diameter, and acetabularity depth, acetabular abduction angle, and acetabular anteversion angle. Totally 88 cases (131 hips) of femoral head necrosis treated with standardized comprehensive hip preservation from December 2016 to February 2017 in the First Affiliated Hospital of Guangzhou University of Chinese Medicine underwent traditional Chinese medicine, physical therapy, and functional exercise. The clinical function of hips was diagnosed by visual analogue scale and Harris scores, and the necrosis in the treatment area was evaluated by X-ray films. This study was approved by the Ethics Committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine, approval No. Y[2019]118.

    RESULTS AND CONCLUSION: (1) X-ray films showed significant differences in Sharp angle and central edge angle among the three groups (P < 0.01). Among them, the sharp angle was largest; the central edge angle was smallest in the kidney deficiency and blood stasis group. The Sharp angle was smallest and the central edge angle was largest in the Qi stagnation and blood stasis group. (2) CT spiral scan showed that there was a difference in abduction angle between the three groups (P < 0.001), of which the kidney deficiency and blood stasis group was largest. Acetabularity depth was smaller in the kidney deficiency and blood stasis group than in the Qi stagnation and blood stasis group (P < 0.05). There was no significant difference in the upper and lower acetabular diameters, anteroposterior diameters, and acetabular anteversion angles of the three groups. (3) After 2 years of comprehensive hip-sparing treatment, 88 patients had significantly improved pain and hip function. Imaging results showed an improvement of 89 hips and 21 unchanged hips, with an improvement rate of 67.9%. (4) The results showed that there was a difference in hip joint morphology between different syndrome types. The development of the acetabulum of kidney deficiency and blood stasis type was poorer than that of Qi stagnation and blood stasis type and accretion type. Standardized and comprehensive non-surgical hip-sparing treatment of femoral head necrosis in the early and middle stages can significantly improve the symptoms of patients in the short term.

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    Comparison of 3D printing assisted osteotomy of distal femur and osteotomy of distal femur in the treatment of genu valgus osteoarthritis
    You Fengyuan, Chen Guoxian, Lin zongjin, Xu Guosong, Chen Weiyi, Chen Jinguo
    2020, 24 (24):  3780-3785.  doi: 10.3969/j.issn.2095-4344.2743
    Abstract ( 397 )   PDF (800KB) ( 68 )   Save

    BACKGROUND: Closed osteotomy of distal femur has a good effect in the treatment of genu valgus osteoarthritis, but the angle of osteotomy cannot be measured directly during the operation. It is necessary to correct the force line through repeated fluoroscopy and adjustment of osteotomy amount. Improper operation may cause iatrogenic rotation deformity.

    OBJECTIVE: To compare the effect of 3D printing assisted osteotomy of distal femur with conventional osteotomy of distal femur in the treatment of knee osteoarthritis.

    METHODS: From January 2014 to February 2018, 28 patients (37 knees in total) with osteoarthritis caused by genu valgus aged 28-60 years were enrolled from the First Hospital of Putian City. All patients were randomly divided into two groups. Patients in the control group (11 cases, 16 knees) were treated with conventional closed osteotomy of distal femur combined with locking compression plate implantation. Patients in the experimental group (17 cases, 21 knees) were treated with 3D printing module assisted with closed osteotomy of distal femur combined with locking compression plate. The operation time and times of fluoroscopy were recorded. The KOOS score, femorotibial angle, lateral angle of distal femur and fracture healing time were compared between the two groups before and after treatment. The experiment was approved by the Ethics Committee of the First Hospital of Putian City.

    RESULTS AND CONCLUSION: (1) Operation time and the times of fluoroscopy in the experimental group were less than those in the control group (P < 0.001). (2) In the KOOS score, the scores of pain, symptoms, daily life, sports entertainment and quality of life in the two groups were significantly improved after surgery compared with those before surgery (P < 0.01). There was no significant difference in the scores of pain, symptoms, daily life, sports entertainment and quality of life between the two groups (P > 0.05). (3) Femorotibial angle and lateral angle of distal femur in both groups were larger than those before operation (P < 0.01). There was no significant difference between the two groups in femorotibial angle and lateral angle of distal femur (P > 0.05). (4) There was no significant difference in the healing time between the two groups (P > 0.05). (5) The results showed that closed osteotomy of the distal femur can achieve good results in the treatment of genu valgus osteoarthritis. 3D printing technology can simplify the osteotomy operation, reduce the operation time, and the times of fluoroscopy.

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    Three-dimensional printing combined with virtual surgical design in the treatment of complex Pilon fractures
    Liang Zhou, Wen Lichun, He Zhong, Huang Zheng, Li Kaijing, Yang Xiaoping, Liang Shihe, Pang Gexiong
    2020, 24 (24):  3786-3791.  doi: 10.3969/j.issn.2095-4344.2744
    Abstract ( 438 )   PDF (729KB) ( 59 )   Save

    BACKGROUND: Pilon fractures are mainly vertical compression violence involving the tibia distal articular surface fracture, especially the high-energy damage Pilon fracture. Pilion fracture is characterized by obvious fracture displacement, different levels of compression, crushing at stem epiphyseal end, unstable height, primary articular cartilage injury and uneven joint surface. Because it is difficult to treat, and holds various complications and high morbidity, it becomes a challenge in the field of orthopedics. Good preoperative planning and design can reduce the occurrence of complications and obtain good clinical treatment outcomes.

    OBJECTIVE: To explore the clinical effect of three-dimensional printing technology combined with virtual surgery design in the treatment of complex Pilon fractures.

    METHODS: Eighty-eight patients with complex Pilon fracture at Yulin Orthopedics Hospital of Chinese and Western Medicine from August 2017 to November 2018 were selected and divided into two groups (three-dimensional printing group, n=38; control group, n=50). The three-dimensional printing group was treated with three-dimensional printing technology combined with virtual surgery design, and the control group was treated with conventional surgery. The operation time, blood loss, incision length, one-time successful placement rate, postoperative ankle function recovery and healing were recorded.

    RESULTS AND CONCLUSION: (1) The three-dimensional printing group was superior to the control group in terms of operation time, blood loss, incision length, one-time successful placement rate, reduction satisfaction (Burwell-Charnley fracture reduction radiology evaluation), functional recovery degree (Mazur ankle joint score) after 12-month follow-up and wound healing (P < 0.05). (2) To conclude, compared with conventional surgery, three-dimensional printing combined with virtual surgery design for treating complex Pilon fractures can shorten the operation time, reduce surgical trauma and blood loss, and achieve satisfactory fracture reduction and functional recovery.

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    Application of semi-automatic spinal surgery robot system in spinal surgery
    Lin Yunzhi, Fang Guofang, Li Xiuwang, Wu Jiachang, Wu Mingjie, Tan Liang, Lai Guohua, Ye Zhuofeng, Sang Hongxun
    2020, 24 (24):  3792-3796.  doi: 10.3969/j.issn.2095-4344.2745
    Abstract ( 647 )   PDF (652KB) ( 98 )   Save

    BACKGROUND: Spinal surgical robots are mainly imported from countries outside China. The overall level of automation is still low. Domestic robot’s core technology still has some difficulties to conquer. Domestic robots are in the ascendant. The cost of spinal surgical robots is too expensive to apply in clinic practice. Our research group has developed Orthobot spinal surgical robot system for spine surgery with Shenzhen Xinjunte Company, which may be of great significance to the development of domestic surgical robots.

    OBJECTIVE: To explore the safety and effectiveness of the application of Orthobot semi-automatic spine surgery robot system in spine surgery in swine lumbar experimental model by analyzing its feasibility so as to optimize surgical procedures.

    METHODS: Totally 12 swine lumbar samples (L1-L6) were randomly divided into 2 groups. In the experimental group (6 cases), pedicle screw path was planned under the three-dimensional CT data after matching the pre-operative CT images and intra-operative C-arm film. Orthobot spinal surgical robot system was used to locate the pedicle start point automatically and to drill a hole with Kirschner wire into the pedicle. Pedicle screw path was prepared through the Kirschner wire. In the control group (6 cases), X-ray perspective data of C-arm machine during operation were directly used, and the screw path was planned under the two-dimensional X-ray data. The surgical planning time, Kirschner wire implantation time, X-ray exposure time, and total operation time were recorded for further analysis. The accuracy and the excellent and good rate of pedicle screw implantation were evaluated by CT scan according to Abul-Kasimhierarchy grading system. 

    RESULTS AND CONCLUSION: (1) The planning time and the total operation time of single pedicle screw path preparation were lower in the experimental group than in the control group (P < 0.001). X-ray exposure time and Kirschner wire implantation time were not significantly different between the two groups (P > 0.05). (2) Post-operation CT evaluation showed that the excellent and good rate of pedicle screw path preparation was significantly better in the experimental group 96.7% (58/60) than in the control group 85.0% (51/60) (P < 0.05). (3) Results suggested that compared with intraoperative C-arm, the application of Orthobot semi-automatic spine surgery robot system combined with preoperative CT and intraoperative C-arm has high accuracy, safeness and effectiveness. However, the registration and matching time of the system is increased and the total operation time is long.

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    Robot-assisted unilateral-decompression minimally invasive transforaminal lumbar interbody fusion for radiographic bilateral lumbar stenosis
    Jiang Shudong, Ren Longxi, Guo Han, Liang Dehua, Zhang Tongtong, Liu Zheng
    2020, 24 (24):  3797-3802.  doi: 10.3969/j.issn.2095-4344.2720
    Abstract ( 428 )   PDF (861KB) ( 69 )   Save

    BACKGROUND: In the elderly patients with degenerative lumbar spinal stenosis, bilateral nerve root canal stenosis commonly shows only one side of symptoms. There is still controversy about whether or not decompression is needed on the side without symptoms or with less symptoms and how to operate.

    OBJECTIVE: To explore the safety and efficacy of robot-assisted unilateral-decompression using minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) technique by investigating a series of cases with the radiographic bilateral lumbar canal stenosis presenting with unilateral symptoms and by comparing clinical decompression effect and imaging changes before and after operation.

    METHODS: Cases with radiographic bilateral lumbar canal stenosis presenting with unilateral symptoms subjected to unilateral decompression on the affected side, interbody fusion and bilateral fixation after robot-assisted MIS-TLIF in the same treatment group were retrospectively analyzed. Operation time, intraoperative blood loss and complications were recorded. The vertebral canal cross-sectional area, intervertebral foramen height, intervertebral space height, and lumbar lordosis angle were examined before and after surgery. Visual analogue scale scores for low back pain and leg pain were assessed before and after surgery. Oswestry disability index was used to assess lumbar function before and after surgery. Macnab criteria were used to evaluate the efficacy at the final follow-up after surgery.

    RESULTS AND CONCLUSION: (1) Operation time was 110-235 minutes, averagely 169.4 minutes. Intraoperative blood loss was 70-180 mL, averagely 112.4 mL. (2) After 3-8 months of follow-up, the visual analogue scale scores of low back pain and lower extremity pain 1 month after surgery and in final follow-up were significantly lower than those before operation (both P < 0.01). (3) Oswestry disability index 1 month after surgery and in final follow-up was significantly lower than that before operation (both P < 0.01). (4) In the final follow-up, MacNab criteria results showed that clinical results were excellent in 15 cases, good in 17 cases and average in 3 cases with the excellent and good rate of 91%. (5) Vertebral canal cross-sectional area, intervertebral foramen height, and intervertebral space height were significantly increased after surgery compared with those before surgery (all P < 0.01). Lumbar lordosis angle was increased after surgery compared with that before surgery, but was not significantly different (P > 0.05). (6) It is concluded that robot-assisted unilateral-decompression MIS-TLIF obtained satisfactory effect in bilateral lumbar canal stenosis patients presenting with unilateral symptoms.

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    Identification of the hot sub-fields of tissue engineering and technological strength assessment based on patent analysis
    Zhang Ting, Chen Juan, Lu Yan, Ouyang Zhaolian, Chi Hui
    2020, 24 (24):  3803-3807.  doi: 10.3969/j.issn.2095-4344.2738
    Abstract ( 362 )   PDF (649KB) ( 110 )   Save

    BACKGROUND: Patent is the most effective carrier of technological information. Preliminary study evaluates the strength of technology development in this field from the angle of patent quantity and quality, regional distribution of patent applicants, countries/regions of patent acceptance, patent applicants, inventors, and technical fields

    OBJECTIVE: To identify the hot sub-fields of tissue engineering through patent analysis, show their technological strength, reveal China’s level globally, and also clarify the competition between China and United States on the basis of previous research.

    METHODS: Combining qualitative analysis with quantitative analysis, the hot sub-fields of tissue engineering were identified based on the patsnap patent database. It analyzes from three perspectives: patent application, invention patent grant, and tripartite patent application, and demonstrates the scale and growth rate of technology development in the hot sub-fields from the perspective of the patent number and quality.

    RESULTS AND CONCLUSION: (1) There are four hot sub-fields in the field of tissue engineering: bone, skin, nerve, and cornea; each has its own characteristics. Bone tissue engineering is relatively large-scale. (2) The scale in the skin and nerve sub-fields is limited; corneal tissue engineering has not yet reached a certain amount of scale, but the output of technological achievements with high-quality and high-market value is high. (3) The technological scale and growth rate in the field of bone tissue engineering in China are much bigger and faster than those in the United States, and it also has accumulated a certain number of high-quality technological achievements. The technological scales of skin and nerve sub-fields in China exceed those in United States, and high-quality technological outputs are about twice that in United States. The technological scale and high-quality achievements in the corneal tissue engineering in China are far beyond those in the United States. (4) China’s high-market-value achievements in the hot sub-fields of tissue engineering are still far behind the United States.

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    Osteoporosis effects on the treatment of intertrochanteric fracture of femur with proximal femoral anti- rotation intramedullary nail: a finite element simulation
    Huang Peizhen, Chen Xinmin, Zheng Liqin, Lin Ziling, Dong Hang, Cai Qunbin, Li Musheng, Zheng Yongze
    2020, 24 (24):  3808-3814.  doi: 10.3969/j.issn.2095-4344.2746
    Abstract ( 571 )   PDF (1015KB) ( 73 )   Save

    BACKGROUND: Proximal femoral anti-rotation intramedullary nail for treating intertrochanteric fracture is widely used in clinical practice, but there are still some cases of failure of internal fixation after operation, and osteoporosis of proximal femur is considered as an important reason. Singh index is an important index to evaluate the severity of osteoporosis in the proximal femur. Based on the Singh index, it is of great significance to explore the effect of different degrees of osteoporosis on the treatment of intertrochanteric fracture with anti- rotation intramedullary nail in the proximal femur, so as to reduce the failure rate of internal fixation and increase the success rate of operation.

    OBJECTIVE: To explore the effect of different osteoporosis on the treatment of intertrochanteric fracture with proximal femoral anti-rotation intramedullary nail, so as to provide new ideas and experimental basis for clinical treatment of intertrochanteric fracture.

    METHODS: CT data of one patient with intertrochanteric fracture of the left femur were imported into Mimics 19.0 and Geomagic studio 2017 software to extract and optimize the three-dimensional model of the right femur. SolidWorks 2017 software was used to draw the internal fixation model and assemble it with the femur model according to the standard operation technology, and import it into HyperMesh 14.0 software in STEP format to cut the bone according to AO-2.1 type of intertrochanteric fracture. Trabecular bone based on Singh index 1-6 was established to obtain six models of A-F. Material property parameters, boundary conditions and applied loads were set. Finally, the data were stored as K files and imported into LS-DYNA software for solution.

    RESULTS AND CONCLUSION: (1) When the femoral head was stressed, the spiral blade in the bone block of the femoral head and neck of Singh 6-Singh 1 was cut, the common bone trabecula disappeared, the stress bone trabecula wrapped with the spiral blade did not disappear, but loaded with certain stress, so that the spiral blade still had a large contact area and holding force, maintained the reduction of the fracture, and reduced the varus and rotation of the bone block of the femoral head and neck. (2) From Singh 6-Singh 1, with the disappearance of stress bone trabecula, the more serious osteoporosis is, the more likely failure will be in the treatment of intertrochanteric fracture with proximal femoral anti-rotation intramedullary nail. (3) The spongy bone trabeculae, especially the stress bone trabeculae, play an important role in maintaining the elastic stability of the proximal femur by resisting and buffering the bending strain.

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    Cementing the apical and terminal pedicle screw applied in osteoporotic spine with lumbosacral degenerative disease: a finite element analysis
    Guo Huizhi, Tang Yongchao, Liang De, Zhang Shuncong, Yang Zhidong, Yuan Kai, Guo Danqing, Li Yongxian, Mo Guoye
    2020, 24 (24):  3815-3820.  doi: 10.3969/j.issn.2095-4344.2747
    Abstract ( 466 )   PDF (931KB) ( 77 )   Save

    BACKGROUND: Cement-augmented pedicle screw is an effective fixation for osteoporotic spine, and it is important to reduce the rate of cement leakage.

    OBJECTIVE: To evaluate the stability of cementing the apical and terminal pedicle screw applied in osteoporotic spine with lumbosacral degenerative disease by finite element analysis.

    METHODS: An intact finite element model of L2-5 segment was established by using CT scan data of one normal male volunteer. After verifying the validity of the intact model, the cementing apical and terminal pedicle screw and cement-augmented pedicle screw models of double/multi-level segment fixation were established, respectively. A 150 N vertical axial pre-load was imposed on the superior surface and a 10 N·m moment was applied on the superior surface along the radial direction to simulate six different physiological motions: flexion, extension, left bending, right bending, left rotation, and right rotation. The different of range of motion, cage stress, and pedicle screw stress on fixed segments were compared between models.

    RESULTS AND CONCLUSION: (1) The validity showed that the range of motion of the intact model was similar to cadaveric studies in all directions. (2) The range of motion of cementing the apical and terminal pedicle screw group was slightly larger than that of cement-augmented pedicle screw group and the difference between the two groups was less than 0.15°. The two fixation methods could maintain the similar stability of the operation segment. (3) The difference of the cage stress and instrument stress was also small between the two groups. (4) These results suggest that compare with cement-augmented pedicle screw, cementing the apical and terminal pedicle screw can increase the approximate stability in double-level and multi-level segment fusion. The cementing the apical and terminal pedicle screw procedure may reduce the risk of cement leakage and patient costs, and offer a useful alternative to the cement-augmented pedicle screw procedure.

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    Finite element analysis of different fixation methods for mandibular defects reconstructing with fibula flaps
    Ji Haihong, Dong Qiang
    2020, 24 (24):  3821-3827.  doi: 10.3969/j.issn.2095-4344.2748
    Abstract ( 530 )   PDF (949KB) ( 152 )   Save

    BACKGROUND: Segmental defect of mandible is often caused by tumor, trauma and other reasons. Simultaneous mandibular defect by vascularized fibular flap is the most important repair method at present. It is not only useful for the reconstruction with titanium plates, but also useful for small titanium plates for fixation. Clinical retrospective studies have shown that there is no significant difference in postoperative complication rate between patients with the two fixation methods, but relevant biomechanics studies are still lacking at present.

    OBJECTIVE: The three-dimensional finite element analysis was used to analyze the stress distribution and stability on mandibular segmental defects simulated fibular flaps grafted with reconstruction plates and miniplates fixation.

    METHODS: A healthy adult male with complete dentition was selected for CT scan and data were input into the computer to reconstruct the mandible and dentition model. Three types of 3D models were built for mandibular defects dependent on Jewer’s classification, including models H (loss of lateral mandible, mandibular angle, ascending branch of mandible, and condyles), L (loss of unilateral mandible) and C (loss of bilateral mandible chin). Mechanical distribution features and stability of fixation with reconstruction plates and miniplates were comparatively studied after fibular repair of mandibular segmental defects.

    RESULTS AND CONCLUSION: (1) The stress graphs showed that stress was mostly higher in surrounding areas of normal mandibles such as condyle, condylar neck, mandibular angle, molar and titanium screws. In particular, the stress was highest near mandibular angles. (2) For type-H defect, the great stress was generated near the mandibular angles when mandible was reconstructed with reconstruction plate, and the stress value was 185 MPa. The stress values approximately ranged from 117 to 135 MPa on type-H and type-L defects with miniplates. The maximum stress of fibula block was less than 30.4 MPa, and the maximum stress of titanium nail was 56.2 MPa. (3) The relative displacements approximately varied between 15 μm and 18 μm on the fracture sides after repair with type-H and type-L defects with miniplates and reconstruction plates. Almost no relative displacement was generated on the fracture sides after type-C mandibular defects. (4) Both titanium reconstruction plates and titanium miniplates could meet biomechanical requirements for fibular repair of H, C, and L defects.

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    Simulation accuracy of cortical bone fracture based on different types of strain criterion
    Wang Weijun, Liu Jie, Liu Jun, Jia Zhengbin, Fan Ruoxun
    2020, 24 (24):  3828-3833.  doi: 10.3969/j.issn.2095-4344.2749
    Abstract ( 355 )   PDF (771KB) ( 39 )   Save

    BACKGROUND: Cortical bone crack caused by accident or other external factors is one of the main causes of fracture, so the mechanism of crack formation and propagation for cortical bone under different loads should be understood primarily to avoid fracture. Bone specimens may be destructed in experiments, which can lead to a difficulty to observe the interior mechanical state of bone structure before and after fracture. Therefore, it is important to find a finite element method that can accurately simulate the processes of cortical bone crack formation, propagation, and fracture. Current simulations mainly use the principal strain or the equivalent strain to determine the mechanical state of the element in the finite element model and to perform fracture simulation, but there are few studies on the simulation accuracy when using these two types of strains.

    OBJECTIVE: To testify the simulation accuracy of cortical bone fracture with the principal strain and the equivalent strain.

    METHODS: The principal strain and the equivalent strain were applied to perform the three-point bending simulation, and the simulation results were compared with the experimental results to determine which strain was more accurate.

    RESULTS AND CONCLUSION: (1) The failure time of the cortical bone simulated by the principal strain was significantly later than that obtained by the equivalent strain. (2) Compared with the experimental results, it was found that the simulation results obtained by equivalent strain were closer to the experimental results. (3) Therefore, simulating cortical bone crack and fracture using the equivalent strain is accurate.

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    Total hip arthroplasty for senile femoral neck fractures: SuperPATH approach versus traditional posterolateral approach
    Hu Zhengxia, Lan Hai, Yuan Jin, Li Kainan
    2020, 24 (24):  3834-3839.  doi: 10.3969/j.issn.2095-4344.2750
    Abstract ( 564 )   PDF (725KB) ( 114 )   Save

    BACKGROUND: In recent years, there are many minimally invasive approaches for total hip arthroplasty. CHOW et al. operated the total hip arthroplasty with SuperPATH approach (supercapsular percutaneously assisted total hip arthroplasty) in 2010, which has the characteristics of not cutting off extortor and retaining the hip joint capsule. This approach is beneficial to early postoperative activities for patients, and has a lower risk for hip joint dislocation compared with other approaches.

    OBJECTIVE: To compare and analyze the short-term clinical outcomes of SuperPATH and traditional posterolateral total hip arthroplasty in the treatment of senile femoral neck fractures.

    METHODS: This study retrospectively analyzed 72 patients aged over 65 years old with femoral neck fractures from August 2017 to March 2019 in Affiliated Hospital of Chengdu University. The patients were grouped according to patients’ wishes. Of them, 30 cases received total hip arthroplasty through SuperPATH approach; 42 cases received total hip arthroplasty through posterolateral approach. Operation time, intraoperative blood loss, declined value of hemoglobin in 4 days of postoperation and time to weight-bearing activity were recorded between two groups. Hip Harris score after 1, 2 weeks and 3 months postoperation was used to assess the recovery of hip function.

    RESULTS AND CONCLUSION: (1) All patients were followed up for 3-6 months. (2) In the second week after operation, all the patients were discharged without complications such as deep vein thrombosis, sciatic nerve injury, periprosthetic fracture, periprosthetic loosening or periprosthetic infection. In the posterolateral approach group, there were two patients with posterior dislocation of the hip, all of whom were treated by manual reduction under general anesthesia. (3) Compared with the posterolateral approach group, operation time was longer; the declined value of hemoglobin in 4 days of postoperation was significantly lesser; time to weight-bearing activity was earlier in the SuperPATH approach group (P < 0.01). However, intraoperative blood loss was not significantly different between the two groups (P > 0.05). (4) Harris score was significantly higher in the SuperPATH approach group than in the posterolateral approach group at 1 and 2 weeks after operation (P < 0.01). Harris score was not significantly different between the two groups at 3 months (P > 0.05). (5) It is concluded that total hip arthroplasty through SuperPATH approach is a minimally invasive operation, can effectively reduce surgical injury, accelerate hip function recovery, and reduce the postoperative pain and discomfort of hip joint and the incidence of dislocation of hip joint in the treatment of senile femoral neck fractures compared with posterolateral approach. Nevertheless, because of the difficulty of operation, the long learning curve and the prolongation of operation time, intraoperative blood loss has not been significantly reduced. The operation by experienced surgeons can effectively reduce the incidence of complications.

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    Application of ROM technique in rotational alignment of tibial prosthesis during knee arthroplasty
    Li Yetian, Liu Fuen, Yin Li, Zhang Hui, Lu Ming, Gao Weilu, Yin Zongsheng​
    2020, 24 (24):  3840-3845.  doi: 10.3969/j.issn.2095-4344.2739
    Abstract ( 382 )   PDF (750KB) ( 52 )   Save

    BACKGROUND: The ROM technique has been widely used to determine the rotational alignment of tibial prosthesis in total knee arthroplasty, but the accuracy of this technique remains controversial. However, there is no report on the influencing factors of ROM technique.

    OBJECTIVE: To explore the influencing factors of ROM technique in determining the rotational alignment of tibial prosthesis in total knee arthroplasty.

    METHODS: Totally 61 patients underwent unilateral knee arthroplasty, including 18 males and 43 females, aged between 55 and 78 years. All patients were diagnosed as knee osteoarthritis before operation. All operations were performed with the posterior cruciate-stabilizing total knee prostheses. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The rotational orientation of the tibial prosthesis was determined by the ROM technique with closed and unclosed medial retinaculum. A line from the center of the posterior cruciate ligament to the medial border of the patellar tendon was used as the anteroposterior axis of tibia (Akagi line). The angles between the anteroposterior axis of tibia and lines determined by the ROM technique were measured to identify the classification of  patellar track so as to decide whether the classification of patellar track, closing and unclosing medial retinaculum are the influencing factors of ROM technology.

    RESULTS AND CONCLUSION: (1) The angles between the Akagi line and lines determined by the ROM technique respectively were (0.5±2.5)°, (-0.9±2.6)°, and (-3.9±3.4)° for the unclosed medial retinaculum and (0.6±2.3)°, (-0.3±2.2)°, and (-1.5±2.9)° for the closed medial retinaculum. (2) For type III patellar track, the angle between line determined by the ROM and Akagi line was significantly internal rotation compared with type I and type II patellar track (P < 0.05). (3) For type I and type II patellar track, whether the medial retinaculum was closed or not had no significant effect on the rotational alignment of tibia prosthesis determined by ROM technology (P > 0.05). For type III patellar track, closing the medial retinaculum could significantly reduce the difference between Akagi line and the line determined by ROM technology (P < 0.05). (4) These results indicate that for type I and type II patellar track, ROM technique can accurately locate the rotational alignment of tibial prosthesis in total knee arthroplasty, and closing or unclosing the medial retinaculum will not affect the accuracy of the results. As to type III patellar track, whether or not the medial retinaculum is closed may lead to failure in determining the rotation alignment of the tibial prosthesis.

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    Effect of nighttime total knee arthroplasty on prognosis
    Du Changling, Li Jian, Zhang Shoutao, Meng Tao, Wang Jianming, Liu Mingting, Ren Qiang, Shi Hui
    2020, 24 (24):  3846-3850.  doi: 10.3969/j.issn.2095-4344.2707
    Abstract ( 472 )   PDF (598KB) ( 42 )   Save

    BACKGROUND: Whether nighttime surgery will affect the safety and prognosis of patients has been controversial.

    OBJECTIVE: To compare the safety and prognosis of daytime surgery versus nighttime surgery in patients receiving total knee arthroplasty.

    METHODS: Data of 712 patients who received unilateral total knee arthroplasty from January 2015 to January 2018 in the Binzhou Medical University Hospital were retrospectively analyzed. Of the patients, 615 cases were treated by total knee arthroplasty during daytime hours (8:00-18:00) and the other 97 patients were treated by total knee arthroplasty during nighttime hours (18:01-7:59). The perioperative and postoperative conditions of the two groups of patients were compared. This study was approved by the Medical Ethics Committee of Binzhou Medical University Hospital, China (approval No. LW2016013).

    RESULTS AND CONCLUSION: (1) Perioperative period: The operation time in the nighttime surgery group was shorter than that in the daytime surgery group (P < 0.05). The amount of intraoperative bleeding and 24 hours postoperative drainage were more in the nighttime surgery group than that in the daytime surgery group (P < 0.05) There was no statistically significant difference in blood transfusion rate, the incidence of deep vein thrombosis, postoperative infection rate, postoperative periprosthetic infection rate, postoperative fever rate, and length of hospital stay between the two groups (P > 0.05). (2) Prognosis: There was no significant difference in motion range and knee joint function KSS score between the two groups (P > 0.05). (3) The results showed that nighttime surgery did not increase the incidence of adverse reactions after total knee arthroplasty, and did not affect the prognosis of patients.

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    Application of elastic compression bandage after first total knee arthroplasty
    Zhang Chenglong, Hu Chuan, Zhang Ming, Guo Xianglin, Sun Kang
    2020, 24 (24):  3851-3856.  doi: 10.3969/j.issn.2095-4344.2737
    Abstract ( 524 )   PDF (695KB) ( 387 )   Save

    BACKGROUND: It is still lack of sufficient clinical evidence whether the patients can benefit from the routine use of elastic bandages after total knee arthroplasty.

    OBJECTIVE: To explore whether the use of elastic compression bandage after first total knee arthroplasty is beneficial to the prognosis of patients. 

    METHODS: Totally 60 knee osteoarthritis patients who received bilateral knee arthroplasty in the Department of Joint Surgery, West Coast Hospital Branch of Affiliated Hospital of Qingdao University were selected from September 2017 to September 2018. One limb of the patient was covered with a general surgical dressing, while an elastic bandage was applied from the instep to the middle of the thigh (elastic compression bandage group). One limb was covered only with a general surgical dressing (control group). All patients signed the informed consent. The study was approved by the Hospital Ethics Committee. Circumference (thigh, knee and calf), flexural activity (range of motion) and visual analogue scale of the lower extremities were measured at 1, 2, 3 and 7 days after the operation by professionals who were not involved in patient management. Drainage volume 24 hours after operation and the occurrence of complications within 30 days after operation were recorded.

    RESULTS AND CONCLUSION: (1) At 1, 2, 3, and 7 days after surgery, circumference of thigh, knee and calf was smaller in the elastic compression bandage group than in the control group. Range of motion of the knee was better in the elastic compression bandage group than in the control group (P < 0.001). (2) At 1 and 2 days after surgery, resting visual analogue scale scores were higher in the elastic compression bandage group than in the control group (P < 0.001). At 7 days, resting visual analogue scale scores were lower in the elastic compression bandage group than in the control group (P < 0.001). No significant difference in visual analogue scale scores was found between the two groups at 3 days. Sports visual analogue scale scores in the elastic compression bandage group were higher than in the control group at 1 and 2 days (P < 0.001). However, no significant difference in sports visual analogue scale scores was detected between the two groups at 3 and 7 days. (3) There was no difference in wound-healing complications between the two groups, but the sample size was too small for meaningful statistical analysis. (4) There was a statistically significant difference in drainage volume between the two groups at 24 hours after surgery. (5) No deep infection, venous thrombosis or reoperation occurred within 30 days. (6) It is concluded that the application of elastic compression bandage from the instep to the middle of the thigh after the first total knee arthroplasty can effectively reduce the swelling of the operative limb and postoperative blood loss, increase the flexion and extension of the operative limb, which is conducive to the rapid recovery after the operation. It is worth popularizing and applying.

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    Imaging changes in spinal-pelvic sagittal alignment in sitting and standing positions in degenerative lumbar spondylolisthesis patients
    Liu Yang, Xu Baoshan, Xu Haiwei, Li Ning, Jiang Hongfeng, Wang Tao, Liu Yue
    2020, 24 (24):  3857-3861.  doi: 10.3969/j.issn.2095-4344.2706
    Abstract ( 423 )   PDF (591KB) ( 64 )   Save

    BACKGROUND: Spinal-pelvic sagittal alignment is important for the diagnosis and treatment of degenerative lumbar spondylolisthesis. However, the current study of the spine-pelvic sagittal alignment in patients with degenerative lumbar spondylolisthesis is limited to the standing position. There is no relevant report on the spine-pelvic sagittal alignment under the sitting position.

    OBJECTIVE: To analyze imaging data of sitting-standing spine-pelvic sagittal alignment in patients with degenerative lumbar spondylolisthesis, and to determine the sagittal alignment of spine change in degenerative lumbar spondylolisthesis patients from standing position to sitting position.

    METHODS: Totally 44 patients with degenerative lumbar spondylolisthesis (12 males, 32 females; age, 50-84 years) were enrolled from Tianjin Hospital from March to September 2019. All patients took X-rays of the spine in standing and sitting positions. Through the hospital image archiving and communication system, spinal and pelvic parameters were measured, including pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, thoracic kyphosis, and sagittal vertical axis. The parameters were compared between standing posture and sitting posture. By using Pearson’s correlation test, differences of relationship between spinal and pelvic parameters in standing versus sitting position were discussed. This study was approved by the Ethics Committee of Tianjin Hospital.

    RESULTS AND CONCLUSION: (1) When moving from standing to sitting position, in 44 degenerative lumbar spondylolisthesis patients, pelvic tilt increased [(21.3±10.1)°, (34.0±10.4)°, P < 0.001]; sacral slope decreased [(31.5±8.6)°, (20.8±12.7)°, P < 0.001]; lumbar lordosis reduced [(40.9±14.6)°, (25.8±15.0)°, P < 0.001]; sagittal vertical axis increased [(43.0±43.4), (75.0±34.8) mm, P < 0.001]; pelvic incidence and thoracic kyphosis did not significantly changed (P > 0.05). (2) Whether standing or sitting position, lumbar lordosis was correlated with other parameters (P < 0.05). When changing from standing to sitting position, the correlation between sacral slope and sagittal vertical axis disappeared (P > 0.05), but lumbar lordosis was also correlated with sagittal vertical axis (P < 0.05). (3) When the degenerative lumbar spondylolisthesis patients change from standing position to sitting position, the sagittal configuration of spine pelvis shows that the pelvis rotates back around the bilateral femoral heads; the pelvis shows a backward leaning state; the physiological curvature of lumbar spine becomes shallow; and the sagittal balance axis of spine moves forward.

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    Possibility of treating large bone defect and reducing the amount of autogenous bone using Masquelet technique
    Wang Zhao, Yan Shi
    2020, 24 (24):  3862-3869.  doi: 10.3969/j.issn.2095-4344.2751
    Abstract ( 351 )   PDF (804KB) ( 58 )   Save

    BACKGROUND: Masquelet technique is one of the effective methods to repair large bone defects. This technique requires the use of more autologous bone in the second stage of surgical treatment. However, the source of autologous bone is limited and the complications in the donor area are inevitable. How to reduce the use of autologous bone is an urgent problem to be solved.

    OBJECTIVE: By combining with the development status of induced membrane technology at home and abroad, this review introduced some effective methods to reduce the amount of autologous bone in induced membrane technology, including filling bone graft replacement materials and some special surgical methods.

    METHODS: The first author used a computer to retrieve the literature published in PubMed, CNKI and Wanfang databases from January 1996 to September 2019. The search terms were “Masquelet technique; induced membrane; bone transport technique; autologous bone; bone defect; bone graft; 3D printing; tissue engineering”.

    RESULTS AND CONCLUSION: Since the emergence of the Masquelet technique, the technique has been constantly improved and innovated by scholars. However, there is no international consensus on how to reduce the use of autologous bone in the second stage of Masquelet technique. At present, each of improvement methods has its own advantages and disadvantages, and clinicians need to choose according to objective conditions. The method proposed by Jong-Keon Oh, using gelfoam as the bone grafting center and the peripheral ring for bone grafting, is simple and practical. Tissue engineering technology has potential for development. With the further study of seed cells and scaffold materials, it will gradually replace the existing treatment schemes. According to the existing research, the research direction of Masquelet technique in the future can be roughly summarized into four directions: The improvement of membrane technology, the improvement of surgical methods, the application of combined materials, and the application of 3D printing and tissue engineering technology. These directions need further exploration and development by scholars.

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    Advantages and improvement strategies of Ilizarov technique in the treatment of tibial bone defect
    He Guoyu, Zhang Yonghong, Wang Dong
    2020, 24 (24):  3870-3876.  doi: 10.3969/j.issn.2095-4344.2752
    Abstract ( 618 )   PDF (833KB) ( 190 )   Save

    BACKGROUND: Ilizarov technique has obvious advantages in the treatment of tibial bone defect and can be used to treat various types of tibial bone defect. However, there are still many shortcomings in this technology, which need to be solved urgently.

    OBJECTIVE: To review the advantages, shortcomings and improvement strategies of Ilizarov technique in the treatment of tibia bone defect.

    METHODS: PubMed, CNKI and Wanfang databases from 1971 to 2019 were retrieved with the key words of “bone defect, bone transport, accordion maneuver, ultrasonography, energy spectrum CT, pin site infection” in English and Chinese, respectively. Totally 57 eligible articles were included to systematically summarize the advantages, shortcomings and improvement strategies of Ilizarov technique in the treatment of tibia bone defect.

    RESULTS AND CONCLUSION: (1) Ilizarov technology has obvious advantages in the treatment of the tibia bone defect, combined with soft tissue injury, infection and deformity of the tibia bone defect. (2) New disinfectants, accordion technology, color Doppler ultrasound and energy spectrum CT are effective treatment methods for complications of bone transport technology, such as pin site infection, poor mineralization of new bone in the transfer area, and difficulty in healing at the docking site. These methods can reduce the incidence of complications. (3) It is still necessary to improve the existing treatment techniques or choose new methods to further reduce the incidence of complications.

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    Superiority of tissue-engineered bone technology for treating bone defects
    Qin Yuxing, Ren Qiangui, Shen Peifeng
    2020, 24 (24):  3877-3882.  doi: 10.3969/j.issn.2095-4344.2705
    Abstract ( 656 )   PDF (732KB) ( 140 )   Save

    BACKGROUND: With the constant development of current society, traumatic bone injury caused by the traffic and other accidents becomes more and more common. Bone defect scope is increasingly extend, and the treatment results in the long cycle, the high cost, and the uncontrolled effect, accompanied with infections, bone nonunion and other complications, which not only causes the painfulness of the patient physically and mentally, but also is a difficult problem and challenge for orthopedic surgeons at the same time.

    OBJECTIVE: To analyze the advantages and disadvantages of traditional treatments and their latest progress, and focus on the research progress and advantages of tissue engineering technology in treating bone defect.

    METHODS: The author took “bone defect, bone transplantation, tissue engineering, induced membrane technology, bone transfer technology, endothelial progenitor cells, 3D printing technology” as the key words, and data were summarized by searching CNKI, Wanfang and PubMed databases. Totally 120 related literatures were retrieved. Through reading the title, abstract and part of the literature content, the outdated, ambiguous and repetitive literatures were excluded. Finally, 49 literatures meeting the inclusion criteria were selected for review.

    RESULTS AND CONCLUSION: (1) Traditional bone defect treatment has certain defects. The emergence of bone tissue engineering technology is expected to become one of the most effective ways for bone defect. (2) Seed cells have good osteogenic properties and can secrete some important factors. (3) Scaffold material can provide mechanical strength for patients in early stage, and has advantages of good biocompatibility, bone induction, and controllable degradation. (4) The urgent problem of vascularization is also being solved gradually, which can bring good news to the patients with bone defect.

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    Related factors and biomechanical characteristics of lumbar facet joint degeneration
    Wen Wangqiang, Xu Haoxiang, Zhang Zepei, Miao Jun
    2020, 24 (24):  3883-3889.  doi: 10.3969/j.issn.2095-4344.2753
    Abstract ( 548 )   PDF (796KB) ( 75 )   Save

    BACKGROUND: Lumbar facet joint degeneration has become the focus of scholars’ research in recent years. Understanding the risk factors of lumbar facet joint degeneration plays a key role in preventing and reducing the damage to spine health. Moreover, comprehending its anatomy has important guiding significance for the treatment of spine-related diseases and related operations.

    OBJECTIVE: To briefly describe the anatomy and histological characteristics of the lumbar facet joints, and summarize the risk factors of lumbar facet joints degeneration.

    METHODS: A computer-based search of CNKI, Wanfang database, VIP database, PubMed, Elsevier and Web of Science was performed with the search terms “lumbar facet joint, joint capsule, articular direction, eneurosis, osteoarthritis, biomechanics, low back pain, intervertebral disc degeneration, lumbar spondylolisthesis, lumbar degenerative scoliosis” for articles published from March 2018 to September 2019. Review, basic research and clinical research were screened by reading title and abstract. The studies with low relevance to the subject were excluded, and 60 studies were included in the final analysis.

    RESULTS AND CONCLUSION: (1) The main risk factors for lumbar facet joint degeneration include age, gender, abnormal stress, articular surface orientation, joint asymmetry, lumbar segment and disc degeneration. (2) When the joints degenerate, it can cause low back pain, disc degeneration, lumbar spondylolisthesis, degenerative scoliosis and other clinical diseases, which seriously affect people’s daily life and work, and reduce people’s living quality. Therefore, lumbar facet joints should not be ignored in the treatment of spine-related diseases.

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    Hot spots of animal models of cervical spondylotic myelopathy
    Chen Sheng, Liu Jianhang, Liu Bentao, Zhang Zhaojian, Li Benche, Zhang Fan, Li Dongfei
    2020, 24 (24):  3890-3896.  doi: 10.3969/j.issn.2095-4344.2709
    Abstract ( 512 )   PDF (767KB) ( 63 )   Save

    BACKGROUND: Cervical spondylotic myelopathy is one of the most serious types of cervical spondylosis. The histopathological study of cervical spondylotic myelopathy is not very clear, mainly because of the lack of ideal animal models.

    OBJECTIVE: To review the common methods of making cervical spondylotic myelopathy model, and analyze and evaluate the different methods of making the model, so as to promote the improvement and perfection of cervical spondylotic myelopathy animal models in the future. 

    METHODS: The “cervical spondylotic myelopathy, cervical spinal compression, animal model” in Chinese and English, respectively were used as keywords. The first author retrieved the literature concerning construction methods of cervical spondylotic myelopathy animal model in CNKI, Wanfang, VIP, PubMed, Medline and Embase databases from 2000 to 2019, and all data were filtered for analysis and evaluation.    

    RESULTS AND CONCLUSION: (1) There are many construction methods of cervical spondylotic myelopathy animal model at present, which can be divided into two types: dynamic modeling methods and static modeling methods, and their advantages and disadvantages coexist. (2) Screw compression is the most common construction method of cervical spondylotic myelopathy animal models, which has the advantages of strong controllability and short modeling cycle, but the damage to cervical spinal cord of animals is more serious and has a high fatality rate. The technology of expansion material compression method is difficult, but it has a high success rate and high reliability. It needs to be further improved and promoted. (3) At present, the construction methods of cervical spondylotic myelopathy animal model still have many disadvantages, and need to be improved on the basis of previous modeling by researchers, so as to realize good reproducibility, repeatable and scalable animal model making and provide a better clinical theoretical basis for cervical spondylotic myelopathy in the future.

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    Occurrence and high risk factors of post-traumatic stress disorder related to orthopedic surgery
    Yan Yan, Cheng Chongjie, Zhang Qidong, Wang Weiguo, Guo Wanshou
    2020, 24 (24):  3897-3903.  doi: 10.3969/j.issn.2095-4344.2713
    Abstract ( 455 )   PDF (731KB) ( 51 )   Save

    BACKGROUND: In recent years, with the continuous progress of orthopedic surgery technology and the rapid increase in the number of orthopedic surgery, more and more attention has been paid to the postoperative rehabilitation of patients. As a common mental disorder after orthopedic surgery, the occurrence of post-traumatic stress disorder is related to demographic characteristics, psychosocial factors, trauma characteristics, past mental status and perioperative cardiovascular indicators. At the same time, previous studies have shown that postoperative post-traumatic stress disorder is closely related to the rehabilitation of patients.

    OBJECTIVE: By consulting the related literature of post-traumatic stress disorder and postoperative rehabilitation after orthopedic surgery in recent years, this paper analyzed the occurrence, high risk factors and the relationship between post-traumatic stress disorder and postoperative rehabilitation after orthopedic surgery, in order to guide the early diagnosis and intervention of postoperative post-traumatic stress disorder.

    METHODS: The first author and the second author searched the related articles in PubMed database, Embase database, China National Knowledge Infrastructure (CNKI) and Wanfang database from January 1990 to October 2019 with the English key words of “orthopedic, surgery/operation, PTSD, risk factor, rehabilitation” and the Chinese words of “orthopedics, surgery, PTSD, high risk factors, rehabilitation”. A total of 94 articles were retrieved, of which 56 met the inclusion criteria.

    RESULTS AND CONCLUSION: (1) According to the type of operation, about 15%-40% of orthopedic patients may have varying degrees of post-traumatic stress disorder after surgery, and the incidence of post-traumatic stress disorder after lower limb amputation is highest. (2) Youth, female, low income, low education, lack of social support, high genetic susceptibility, poor psychological state before operation, poor psychological elasticity, hypotension, high heart rate and high pain sensitivity are all high risk factors for post-traumatic stress disorder after orthopedic surgery. (3) There is no clear correlation between the severity of preoperative trauma and the trauma of the operation itself and the occurrence of postoperative post-traumatic stress disorder, but the surgery with great influence on the ability of life and work after operation easily causes post-traumatic stress disorder. (4) Patients with postoperative post-traumatic stress disorder may have poor long-term prognosis.

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    Multiple evaluation of radar plot on acupuncture for lumbar disc herniation: a systematic review/meta-analysis
    Qiu Mingwang, Fang Wanyi, Song Jiaying, Huang Fan, Zhao Siyi, Wen Junmao, Tian Qiang, Fan Zhiyong, Guo Rusong, Wu Shan
    2020, 24 (24):  3904-3910.  doi: 10.3969/j.issn.2095-4344.2740
    Abstract ( 490 )   PDF (954KB) ( 245 )   Save

    BACKGROUND: At present, there are few reports on systematic evaluation/meta reevaluation of acupuncture for lumbar disc herniation through radar plot in and outside China, which are insufficient to provide references for clinical decision-making.

    OBJECTIVE: To evaluate systematic reviews/meta-analysis of acupuncture in the treatment of lumbar disc herniation qualitatively and quantitatively by using the multiple evaluation thinking of radar plot so as to provide visual and scientific decision-making means for clinical practice and medical research.

    METHODS: Computer retrieval was performed in eight Chinese and English databases to collect data of systematic reviews/meta-analysis of acupuncture in the treatment of lumbar disc herniation. The retrieval time was from database establishment to August 2019. Moreover, the multiple evaluations were carried out from six dimensions, including publiscation year, research type, A Measurement Tool to Assess systematic Reviews (AMSTAR) 2 methodological quality score, Preferred Reporting Items for Systematic Reviews and Meta-Analys is (PRISMA) quality score, homogeneous, and publication bias risk so as to calculate average rank score. The quality of all included outcome indicators was graded using GRADE evidence quality assessment tools. Excel 2013 was used to draw and optimize the radar plot for intuitive analysis.

    RESULTS AND CONCLUSION: A total of 11 qualified studies were included. According to data extraction, the radar plot showed that the included 11 articles scored 6.95 in the quality of the average rank. Some issues were found such as item registration, structured abstract, search strategy, exclusion literature list, and publication bias. Grading of recommendations assessment, development and evaluation (GRADE) evidence quality scores are low, with very low quality as the main reason. The literature quality of systematic reviews/meta-analysis of acupuncture in the treatment of lumbar disc herniation was not high. The methodological quality and reporting quality should be improved and continuously strengthened in order to further improve the quality of literature. As a visual and effective method of graphic evaluation, the radar plot can show the distribution of required data intuitively and concisely.

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    Zolidronic acid combined with percutaneous kyphoplasty in the treatment of osteoporotic compression fractures: a meta-analysis of bone density improvement, recurrent vertebral fractures prevention, and long-term efficacy evaluation
    Li Kaiming, Zhu Liguo, Zhang Qing, Li Linghui, Xie Rui, Chen Ming, Liang Long, Lin Chengyu, Hou Xiaozhou
    2020, 24 (24):  3911-3917.  doi: 10.3969/j.issn.2095-4344.2721
    Abstract ( 417 )   PDF (1087KB) ( 99 )   Save

    BACKGROUND: The clinical application of zoledronic acid in the treatment of osteoporosis lacks systematic scientific evaluation and evidence-based basis. Therefore, the clinical efficacy of zoledronic acid combined with percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture is still uncertain.

    OBJECTIVE: To systematically evaluate the efficacy of zoledronic acid combined with percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture.

    METHODS: A computer search of all randomized controlled studies and clinical trials of zolidronic acid combined with percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fracture published in CNKI, Wanfang, VIP, CBM, PubMed and Cochrane prior to September 2019 was performed. The experimental group was treated with zoledronic acid and percutaneous kyphoplasty, while the control group was treated with percutaneous kyphoplasty. Literature screening and data extraction were conducted by the two researchers independently. The quality of the included randomized controlled trials was evaluated one by one according to the Cochrane collaboration standards. Meta-analysis was performed on RevMan 5.3 for those that met the inclusion criteria.

    RESULTS AND CONCLUSION: (1) Five randomized controlled trials were included, including 175 in the experimental group and 184 in the control group. (2) Meta-analysis results showed that the bone mineral density was higher in the experimental group than in the control group [MD=0.12, 95%CI(0.08, 0.17), P < 0.000 01]. The visual analogue scale score was lower in the experimental group than that of the control group 6 and 12 months after treatment [MD=0.46, 95%CI(0.18, 0.75), P=0.002; MD=0.85, 95%CI(0.20, 1.50), P=0.01]. At 1 year after treatment, Oswestry disability index was lower in the experimental group than in the control group [MD=6.59, 95%CI(4.77,8.41), P < 0.000 01]. Bone cement leakage rate and recurrence rate of vertebral fractures were lower in the experimental group than in the control group [OR=0.22, 95%CI(0.08, 0.59), P=0.003; OR=0.18, 95%CI(0.07, 0.50), P=0.000 8]. Vertebral height recovery and kyphotic Cobb angle were not significantly different between the two groups [MD=0.65, 95%CI(-0.27, 1.56), P=0.16; MD=-0.60, 95%CI(-2.45, 1.25), P=0.53]. (3) Results showed that compared with percutaneous kyphoplasty alone, zoledronic acid combined with percutaneous kyphoplasty has significant advantages in improving bone mineral density, reducing the recurrence rate of vertebral fracture, improving the long-term clinical symptoms of patients, preventing the bone cement leakage, but a large number of high-quality multi-center randomized controlled studies are still needed to provide more sufficient evidence in the later stage.

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    Meta-analysis of independent risk factors for surgical site infection after spinal surgery
    Qin Zuoheng, Li Lijun, Ni Dongkui
    2020, 24 (24):  3918-3924.  doi: 10.3969/j.issn.2095-4344.2754
    Abstract ( 428 )   PDF (966KB) ( 50 )   Save

    BACKGROUND: The risk factors of surgical site infection after spinal surgery are diverse and complex. At present, there is still a great controversy on the study of the risk factors of postoperative infection of spine.

    OBJECTIVE: To systematically evaluate the independent risk factors of surgical site infection after spinal surgery, and to provide theoretical basis for the prevention and treatment of surgical site infection. 

    METHODS: Between January 2004 and June 2019, the Chinese and foreign databases were retrieved. According to the inclusion and exclusion criteria, we collected case-control and cohort studies on independent risk factors for surgical site infection after surgery. After extraction of available data, independent risk factors (hypertension, diabetes, obesity, smoking, history of surgery) for the merger OR value and 95%CI were calculated by using the fixed effect model and random effect model for meta-analysis. The consistency of the results was compared. The reliability of the merge result was analyzed.

    RESULTS AND CONCLUSION: (1) A total of 19 articles were included, with 1 008 cases of surgical site infection, and the control group contained 7 527 cases. (2) The independent risk factors for merger OR value (95%CI) from high to low in turn were diabetes (OR=3.24, 95%CI: 2.09-5.02), obesity (OR=2.99, 95%CI: 1.77-5.05), surgical history (OR=2.12, 95%CI: 1.79-2.50), hypertension (OR=1.90, 95%CI: 1.34-2.69), and smoking (OR=1.85, 95%CI: 1.39-2.48). (3) Results indicated that diabetes, hypertension, obesity, smoking and surgical history are all independent risk factors for the occurrence of surgical site infection after spinal surgery, and each independent risk factor is positively correlated with the occurrence of surgical site infection after spinal surgery.

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    Meta-analysis of efficacy of oral versus intravenous tranexamic acid in reducing blood loss after total knee and hip arthroplasties
    Lin Jiebin, Shi Yuling, Gao Fenghe, Liang Zujian
    2020, 24 (24):  3925-3930.  doi: 10.3969/j.issn.2095-4344.2722
    Abstract ( 309 )   PDF (579KB) ( 76 )   Save

    BACKGROUND: Tranexamic acid can effectively reduce the blood loss of total knee or hip arthroplasties. Tranexamic acid can be administered in a variety of ways; however, there is still much controversy about the best use of tranexamic acid.

    OBJECTIVE: To compare the efficacy and safety between oral and intravenous tranexamic acid for blood loss after total knee and hip arthroplasties.

    METHODS: Randomized controlled trials concerning oral tranexamic acid and intravenous tranexamic acid for reducing blood loss after total knee and hip arthroplasties were retrieved from PubMed, Cochrane Library, Embase and Web of Science databases from inception to May 2019. The data were extracted for the methodological quality. Then meta-analysis was conducted by Revman 5.3 software.

    RESULTS AND CONCLUSION: Nine randomized controlled trials involving 1 080 cases were included. The results of this meta-analysis showed that there were no significant differences in total blood loss [MD=1.43, 95%CI(-40.02-42.88), P=0.95], postoperative hemoglobin decline [MD=-0.03, 95%CI(-0.11-0.05), P=0.45], transfusion rate [RR=0.91, 95%CI(0.55-1.49), P=0.70], deep vein thrombosis rate[RR=0.43, 95%CI(0.11-1.64), P=0.22], or hospitalization time [MD=0.00, 95%CI(-0.03-0.03), P=0.93] between two groups. These results indicate that oral tranexamic acid shows comparable efficacy to that of the intravenous forms after total knee and hip arthroplasties. However, due to the low number and limited quality of included studies, more randomized controlled trials with large samples should be rigorously designed to verify the conclusion.

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    Safety of intraarticular corticosteroid injections after arthroscopic shoulder surgery: a systematic review and meta-analysis
    Fan Zhirong, Su Haitao, Jiang Tao, Zhou Junde, Peng Jiajie, Hong Weiwu, Zhou Lin, Huang Huida
    2020, 24 (24):  3931-3936.  doi: 10.3969/j.issn.2095-4344.2715
    Abstract ( 394 )   PDF (626KB) ( 113 )   Save

    BACKGROUND: Intraarticular injection of corticosteroids after arthroscopic shoulder surgery is one of the effective methods to relieve shoulder pain and stiffness after surgery. However, whether the use of corticosteroids will increase the complications associated with arthroscopic shoulder surgery is still controversial.

    OBJECTIVE: To evaluate the safety and clinical efficacy of corticosteroid injections after arthroscopic shoulder surgery.

    METHODS: The electronic databases including PubMed, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for clinical controlled trials of corticosteroid injection into the articular cavity after arthroscopic shoulder surgery from the inception of the databases to September 2019. Data extraction and quality appraisement were performed independently by two investigators according to inclusion and exclusion criteria. Merging and analysis of effect quantities was conducted on RevMan 5.3 software.

    RESULTS AND CONCLUSION: (1) A total of six comparative studies were included. A total of 7 418 patients were enrolled, of which 3 920 were in the corticosteroid injections group and 3 498 in the control group. (2) Meta-analysis showed that there was no significant difference in tear rate, Constant score, ASES score and UCLA score between the two groups [OR=0.71, 95%CI[0.45, 1.13], P=0.15; MD=-0.99, 95% CI(-12.44, 10.46), P=0.87; MD=-0.12, 95%CI(−1.80, 1.56), P=0.89; MD=−1.46, 95%CI(−3.22, 0.30), P=0.10]. The infection rate of corticosteroid injections group was higher than that of control group (P < 0.05). There was no significant difference in infection rate between the two groups 2-4 months after arthroscopy (P > 0.05). (3) The results showed that the injection of corticosteroids did not increase the rate of postoperative tear, but the injection of corticosteroids within one month after the operation would increase the rate of postoperative infection. Therefore, when using corticosteroids after the operation, clinicians should weigh the advantages and disadvantages according to the actual situation of patients, and pay attention to avoid injecting intraarticular hormone treatment within 1 month after operation.

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