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    28 September 2020, Volume 24 Issue 27 Previous Issue    Next Issue
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    Bone cement augmented proximal femoral nail antirotation for type A3.3 intertrochanteric femoral fractures in elderly: a finite element analysis

    Chen Xinmin, Luo Sijia, Xia Zhuowei, Lin Ziling, Zheng Liqin, Li Musheng
    2020, 24 (27):  4265-4271.  doi: 10.3969/j.issn.2095-4344.2795
    Abstract ( 393 )   PDF (861KB) ( 34 )   Save

    BACKGROUND: Osteoporosis and fracture type are two important reasons for the failure of internal fixation of proximal femoral nail antirotation. Type AO31-A3.3 intertrochanteric fracture, because of its involvement in the lateral wall, greatly increased the instability of the fracture. In addition, the elderly are mostly osteoporosis patients, so failure and postoperative complications of internal fixation of proximal femoral nail antirotation in the elderly with type AO31-A3.3 intertrochanteric fracture are higher.  

    OBJECTIVE: To explore the difference of biomechanics between bone cement augmented and common proximal femoral nail antirotation in the treatment of type AO31-A3.3 intertrochanteric fracture.

    METHODS: CT data of one 75-year-old volunteer with intertrochanteric fracture were selected to import 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. The model was imported into Hypermesh 14.0 software to cut the bone to obtain the type AO31-A3.3 model with common proximal femoral nail antirotation. The cancellous bone around the proximal end of the screw blade was redefined as bone cement, which is the model of bone cement augmented proximal femoral nail antirotation. The material property parameters, boundary conditions and applied loads were set up and stored as K files respectively and imported into LS-DYNA software for solution.  

    RESULTS AND CONCLUSION: (1) Compared with the common proximal femoral nail antirotation, the treatment of the elderly type AO31-A3.3 intertrochanteric fracture with the bone cement augmented proximal femoral nail antirotation has the advantages of lighter cutting degree of the screw blade, smaller varus, rotation angle and displacement of the femoral head and neck bone block, and better biomechanical effect. (2) The complete lateral wall can effectively support the femoral head and neck bone block and resist the skull and neck bone block as the lateral action point of three-point support. The pronation and rotation tendency can effectively prevent the head and neck screws from withdrawing. (3) The strong anchoring force of bone cement can stabilize the screw blade, enhance the internal action point of three-point support, and conduct and disperse the pressure.

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    Establishment and mechanical analysis of the finite element model of the type Frykman VIII fracture of the distal radius with steel plate fixation
    Li Yongyao, Zhao Yong, Cheng Hao, Xu Huiqing, Wei Xu, Liu Guangwei, Cheng Yongzhong, Cui Xin
    2020, 24 (27):  4272-4277.  doi: 10.3969/j.issn.2095-4344.2782
    Abstract ( 331 )   PDF (768KB) ( 38 )   Save

    BACKGROUND: Generally, the treatment of distal radius fractures or joint dislocations is generally valued in clinical practice, but little attention is paid to the ulnar styloid fracture, and whether the ulnar styloid fracture needs to be fixed is controversial. In the study of orthopedic biomechanics, the selection of cadaver model may encounter some problems, such as different selection criteria of cadaver model and different mechanical measurement methods.  

    OBJECTIVE: Based on Mimics software, the finite element simulation model of type Frykman VIII fracture of the distal radius fixed by plate and screw was constructed using finite element analysis. The working condition and load were set for mechanical analysis. It is hoped to provide a reference for the choice of the repair plan of this kind of fracture.

    METHODS: A three-dimensional finite element model of normal wrist joint was established based on the forearm and wrist CT images of a healthy volunteer. After debugging the model, Von Mises stress of the distal radius was obtained by loading the 100 N stress in the axial direction, and the validity of the model was verified by comparing with the experimental data in the literature. Two kinds of finite element models of Frykman VIII fracture with ulnar styloid type I and type II fractures were established by using finite element software to divide the mesh, cut and mold, and the model of plate and screw fixation of distal radius was assembled. Setting load under rotating working conditions, we analyzed the changes of the stress distribution of the steel plate unit in two models, and the relative displacement of the distal radioulnar joint as well as the ulnar styloid fracture broken end.

    RESULTS AND CONCLUSION: (1) A three-dimensional finite element model of normal wrist joint was established and validated, and the other two models of type Frykman VIII fracture of the distal radius with ulnar styloid type I and type II fractures fixed by plate and screw were established based on this model. (2) Under the same rotating load, this study showed that the stress and stress distribution of the steel plate unit in the steel plate fixation model of Frykman VIII fracture of the distal radius combined with ulnar styloid type I fracture were smaller than those of the fracture model combined with type II fracture of styloid process of ulna; the relative displacement values of the distal radioulnar joint and the ulnar styloid fracture broken end were smaller than the latter too. (3) The three-dimensional finite element model of wrist joint constructed in this study can be used to analyze the mechanical mechanism of wrist fracture. The results of finite element analysis showed that the fracture of styloid process of ulna in Frykman VIII fracture of the distal radius would affect the stability of the distal radioulnar joint, especially in the case of ulnar styloid type II fracture, which can provide a certain clinical reference for the selection of operation scheme of such fracture. 

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    Finite element analysis of cervical spine (C2-C7) with degenerated disc under normal loading and massage
    Wang Yu, Lei Jianyin, Xin Hao, Luo Lin, Li Zhiqiang
    2020, 24 (27):  4278-4284.  doi: 10.3969/j.issn.2095-4344.2774
    Abstract ( 357 )   PDF (946KB) ( 31 )   Save

    BACKGROUND: Massage is a cost-effective treatment for cervical spondylosis. When the cervical vertebrae with different degenerative degree of intervertebral disc are massaged, the massage strength will have different effects because of the different degenerative degree, and improper manipulation of massage may also cause damage to the degenerative cervical vertebrae. At present, the related research is still lacking.

    OBJECTIVE: To investigate the mechanism of mechanical changes of cervical vertebrae with different degrees of disc degeneration under normal load and massage, and to explore the influence of massage rotation angle on different degrees of disc degeneration, so as to provide operational guidance for cervical vertebrae with different degrees of disc degeneration.

    METHODS: The finite element model of three-dimensional human cervical vertebrae (C2-C7) with high geometric similarity and accuracy and 2 million grids was established. The model with different degrees of cervical vertebrae degradation was obtained by changing the parameters of intervertebral disc. The finite element method was used to explore the mechanical mechanism of different degenerative degrees of intervertebral disc under the action of massage.  

    RESULTS AND CONCLUSION: (1) After degeneration, the stress of intervertebral disc was redistributed; the bearing capacity of nucleus pulposus decreased; the bearing capacity of annulus fibrosus increased significantly; and the joint stress also increased. (2) Under normal load condition, the stress concentration area of the fiber ring was mainly located at the posterior side of the cervical spine. With the increase of degradation degree, the stress concentration region extended inward from the edge and the area increased. (3) The stress concentration area of fiber ring was mainly at the back and left and right sides with massage angle. The higher the degree of degradation, the greater the stress concentration area and the greater the stress value was. (4) When the massage was in rotation phase, the higher the degree of degeneration, the smaller the axial displacement and the smaller the deformation ability of the disc was. (5) C4-5 intervertebral disc degeneration will affect the maximum stress and joint contact force of the vertebral body (C4, C5) of the segment, and the stress value increases with the degree of degradation, but the degradation has no obvious effect on other segments. (6) Combined with the stress safety and deformation ability, the rotation angle should be reduced according to the degree of degradation.

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    Finite element analysis of double-segment and single-segment vertebral column decancellation and vertebral column resection osteotomy for ankylotic kyphosis

    Duan Yanji, Chen Xiao, Zhou Yongqiang, Huang Kai, Shen Donglan, Ma Yuan
    2020, 24 (27):  4285-4290.  doi: 10.3969/j.issn.2095-4344.2792
    Abstract ( 306 )   PDF (799KB) ( 33 )   Save

    BACKGROUND: Single-segment and double-segment osteotomies are often used to treat ankylotic kyphosis. However, the selection of preoperative strategies, especially for segmental and osteotomy methods, often depends on clinical experience. At present; there are few reports on the biomechanics of double-segment vertebral column decancellation and vertebral column resection osteotomy.

    OBJECTIVE: To establish a two-segment osteotomy model for ankylotic kyphosis, and to compare and discuss the total displacement of the spine, stress analysis of the internal fixation system, and equivalent stress intensity of the osteotomy contact surface.

    METHODS: MIMICS software and Geomagic studio software were used to establish two kinds of models of ankylotic kyphosis with vertebral column resection osteotomy and vertebral column decancellation. Each kind of model was divided into single-segment osteotomy and double-segment osteotomy, i.e., L1 single-segment vertebral column resection osteotomy model, L1 single-segment decancellated osteotomy model, L2 single-segment vertebral column resection osteotomy model, L2 single-segment vertebral column decancellation model, T12L2 double-segment vertebral column resection osteotomy model, T12L2 double-segment vertebral column decancellation model, T12L3 double-segment vertebral column resection osteotomy model, and T12L3 double-segment vertebral column decancellation model. ANASYS software was imported to load model. The whole spine displacement, pedicle screw, connecting rod, and bone interface equivalent stress nephogram were recorded under different conditions of osteotomy.

    RESULTS AND CONCLUSION: (1) Whether it was vertebral column decancellation or vertebral column resection osteotomy model, the total spinal displacement of single-segment osteotomy was less than that of double-segment osteotomy. The displacement of vertebral column resection osteotomy was less than that of vertebral column decancellation in both single- and double-segment osteotomy models. L2 single-segment vertebral column resection osteotomy model had minimal displacement. (2) Whether it was vertebral column decancellation or vertebral column resection osteotomy model, equivalent stress of the single-segment osteotomy was less than that of the double-segment osteotomy. The equivalent stress of the internal fixation device of the vertebral column resection osteotomy was less than that of vertebral column decancellation in both single- and double-segment osteotomy models. The equivalent stress of the internal fixation device of the L1 single-segment vertebral column resection osteotomy was smallest. (3) The equivalent stress of the osteotomy contact surface of all single-segment osteotomy models was smaller than 28 MPa. In the two-segment osteotomy model, the equivalent stress of the osteotomy contact surface of the vertebral column resection osteotomy was less than that of vertebral column decancellation. (4) These results suggest that the biomechanical stability of the single-segment osteotomy model was better than that of the double-segment osteotomy model. The stability of vertebral column resection osteotomy was better than that of vertebral column decancellation. 

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    A finite element model of full endoscope lumbar fenestration and biomechanical characteristics
    Liu Jinyu, Ding Yu, Jiang Qiang, Cui Hongpeng, Lu Zhengcao
    2020, 24 (27):  4291-4296.  doi: 10.3969/j.issn.2095-4344.2783
    Abstract ( 393 )   PDF (948KB) ( 29 )   Save

    BACKGROUND: The effective treatment of lumbar spinal stenosis with total endoscopic decompression is a breakthrough frontier technology. Compared with open surgery, it has the characteristics of fewer traumas, controllable operation, and fewer complications, but it reported less in finite element biomechanics.

    OBJECTIVE: To establish a finite element model of full endoscope lumbar fenestration and to investigate the effects of decompression range and nucleus pulposus removal on lumbar range of motion and stress distribution of disc.

    METHODS: CT scan data of a case of L4-5 segmental lumbar spinal stenosis were collected and imported in Mimics 20.0 software. A finite element model M of L4-5 lumbar spinal stenosis in degenerative lumbar spine was established. The model M was imported into 3-matic for surgical simulation, i.e., unilateral disc resection of the small joints 1/2 and 1/4 model M1, bilateral joints 1/2 and 1/2 resection of intervertebral disc model M2, and unilateral disc and articular process of 1/4 model M3. In the ANSYS software, the mechanical comparative analysis was conducted in four kinds of models under six working conditions of the same pure couple moment, including forward bending, backward extension, left bending, right bending, left rotation and right rotation, and the same load of the intervertebral disc.

    RESULTS AND CONCLUSION: (1) Compared with the spinal M model, the range of motion of M1 model was similar under six working conditions, but the range of motion of M2 and M3 was significantly increased than that of M, especially under the left/right flexion and forward/backward flexion working conditions, which was 130%-200% of the overall activity of M model. (2) In terms of the stress of intervertebral disc, M1 model showed no obvious upward trend of the effect force in the posterior region, central region and right region of intervertebral disc under various working conditions. The equivalent stress in the left region and front region of intervertebral disc increased to a maximum of 63%, but there was no significant stress concentration. In the M2 and M3 models, the equivalent stress of intervertebral discs in all regions showed a significant increased trend. (3) Endoscopic minimally invasive surgery is accurate and controllable for different types of lumbar spinal stenosis decompression surgery. The resection of facet joints and the removal of nucleus pulposus by less than 1/2 have little influence on the biomechanical stability of the corresponding segments. The successful and reliable finite element modeling of lumbar lamina fenestration can provide an important method and basis for the follow-up biomechanical study of lumbar surgery.

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    Biomechanical characteristics of transforaminal lumbar interbody fusion combined with different pedicle screw fixation methods in single-segment lumbar spine and adjacent segments
    Hou Jichun, Cao Yang
    2020, 24 (27):  4297-4304.  doi: 10.3969/j.issn.2095-4344.2793
    Abstract ( 305 )   PDF (753KB) ( 30 )   Save

    BACKGROUND: Decompression-fixation-fusion is the key to spinal surgery since early effective fixation to achieve intervertebral fusion can restore spinal stability in lumbar degenerative disease.

    OBJECTIVE: To compare biomechanical stability of fusion segment and adjacent segments of bilateral pedicle screw fixation, unilateral pedicle screw fixation and unilateral pedicle screw combined with contralateral translaminar facet screw fixation under transforaminal lumbar interbody fusion.

    METHODS: Eighteen fresh calf L3-5 specimens were selected. Different forms of fixation were conducted under transforaminal lumbar interbody fusion. The specimens were divided into group A (complete specimens) and group B (bilateral pedicle screws), group C (unilateral pedicle screws), and group D (unilateral pedicle screw combined with contralateral translaminar facet screw). The range of motion of adjacent segment L3-4 and fusion segment L4-5 in six directions of backward extension, forward bending, left bending, right bending, left rotation and right rotation and the stiffness of fusion segment L4-5 were tested.

    RESULTS AND CONCLUSION: (1) For the range of motion of fusion segment L4-5, the stability was highest in the group B in six directions, followed by group D, which showed similar results in rotation in the group B (P > 0.05). The stability of right curvature and left rotation in group C was insufficient, and there was no significant difference in range of motion between group A and group C (P > 0.05). The range of motion in group A was largest and the stability was worst in the six motion directions. (2) For the stiffness value of fusion segment L4-5, the stiffness value of group B was largest in six directions, which was significantly different from other groups (P < 0.05). The stiffness values of group C and group D under left and right rotations were significantly different (P < 0.05). The stiffness values of group A in the six motion directions were lowest. (3) For the range of motion of adjacent segment L3-4, the range of motion of six directions in group B was largest, and the adjacent segment bore the largest load, which was significantly different from other three groups (P < 0.05). There was no significant difference between group D and groups C and A in the range of motion of other directions except left and right rotations (P > 0.05). There was no significant difference between group C and group A in the range of motion of six directions (P > 0.05). (4) The results showed that the motion ramge of unilateral pedicle screw fixation in the right and left rotation directions was large in the early stage, which was close to that of the complete specimen group. There is a shortage of stability, so we need to use it carefully and grasp the indications strictly. Unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation improves the disadvantages of asymmetric fixation of unilateral pedicle screw, increases the stability of rotation and lateral bending, and avoids the influence of bilateral pedicle screw fixation on adjacent segments, thus becoming an effective clinical surgical treatment.

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    Modified knee spreader combined with minimally invasive percutaneous plate internal fixation for complex tibial plateau fractures
    Wu Cai, Luo Tian, Zeng Qinghu, Peng Chengzhong, Liao Tao, Wang Lele, Zeng Zhao
    2020, 24 (27):  4305-4309.  doi: 10.3969/j.issn.2095-4344.2832
    Abstract ( 388 )   PDF (845KB) ( 35 )   Save

    BACKGROUND: Studies have shown that the adjuvant use of long bone distraction device for unstable tibial plateau fractures achieved satisfactory results, but the safety of its use of long bone distraction device is not high, and the device could easily lead to soft tissue damage.

    OBJECTIVE: To compare the clinical efficacy of modified knee joint spreader combined with minimally invasive percutaneous plate internal fixation and traditional incision reduction plate internal fixation for the treatment of complex tibial plateau fractures.

    METHODS: A total of 71 patients with complicated tibial plateau fractures admitted to Xiangdong Hospital Affiliated to Hunan Normal University from January 2016 to January 2018 were included, including 48 males and 23 females. The 34 patients in the experimental group received modified knee spreaders combined with minimally invasive percutaneous plate internal fixation treatment. The 37 patients in the control group received traditional open reduction and plate internal fixation. The incision length, operation time, intraoperative blood loss, hospital stay, the time of fracture healing and the incidence of postoperative complications were compared between the two groups. Knee HSS scores were assessed at 1 month and at the last follow-up. The trial was approved by the Ethics Committee of Xiangdong Hospital Affiliated to Hunan Normal University.

    RESULTS AND CONCLUSION: (1) The operation time, intraoperative blood loss, incision length, and hospital stay were shorter in the experimental group than in the control group (P < 0.05). There was no significant difference in fracture healing time between the two groups (P > 0.05). (2) One case of joint stiffness and one case of traumatic arthritis were found in the experimental group. One case of postoperative infection, five cases of joint stiffness, one case of traumatic arthritis and one case of loosening of the internal fixation were found in the control group. The incidence of complications in the experimental group was less than that in the control group (P < 0.05). (3) Seventy-one patients were followed up for 10-14 months. The knee function HSS score of the experimental group at 1 month after operation was significantly better than that of the control group (P < 0.05). There was no significant difference in the HSS scores during the final follow-up between both groups (P > 0.05). (4) The results showed that compared with the traditional open reduction and internal fixation, the modified knee spreader combined with minimally invasive percutaneous plate internal fixation for complex tibial plateau fractures can improve the operation efficiency, reduce surgical trauma, reduce the incidence of postoperative complications, and shorten hospital stay for patients. 

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    Advantages of individualized open wedge high tibial osteotomy in treatment of medial compartment knee osteoarthritis
    Yu Yinghao, Zhao Jijun, Liu Dongcheng, Zhou Zihong, Wu Zhaofeng, Feng Dehong
    2020, 24 (27):  4310-4316.  doi: 10.3969/j.issn.2095-4344.2803
    Abstract ( 426 )   PDF (812KB) ( 36 )   Save

    BACKGROUND: Open wedge high tibial osteotomy can achieve significant clinical efficacy for patients with medial compartment knee osteoarthritis and genu varus. However, Fujisawa point has been recognized as a reference for the correction of lower limb alignment. Can individualized orthopedics in lower limb alignment obtain better clinical efficacy?

    OBJECTIVE: To explore short-term efficacy of individualized orthopedics in lower limb alignment for medial compartment knee osteoarthritis through open wedge high tibial osteotomy.

    METHODS: Totally 46 patients with medial compartment knee osteoarthritis treated by open wedge high tibial osteotomy from June 2016 to May 2018 in Department of Orthopedics, Wuxi People's Hospital were enrolled in this study. X-ray and MRI were used to evaluate the knee and I-III degeneration grades were classified. Patients at Grade I and II were randomly divided into individualized orthopedics group and control group with 16 cases in each group. Patients at grade III were classified as Fujisawa group with 14 cases. In the individualized orthopedics group, mild grade I and moderate grade II respectively corrected lower limb alignment to 50% and 55% of lateral tibial plateau, while control group and Fujisawa group all corrected the alignment to 62.5% point. Postoperative lower limb alignment, pre- and post-operative range of motion, femoral-tibial angle and medial proximal tibial angle of the knee were measured and evaluated. The hospital for special surgery score and the Western Ontario and McMaster Universities osteoarthritis index score were followed up before operation, 3, 6 and 12 months after operation, while postoperative self-satisfaction of patients was also compared.

    RESULTS AND CONCLUSION: (1) All patients were followed up for 12 months. (2) Three groups achieved satisfactory lower limb alignment. Range of motion and medial proximal tibial angle increased and femoral-tibial angle decreased at postoperative stage (P < 0.05). (3) Over time, hospital for special surgery scores increased and Western Ontario and McMaster Universities osteoarthritis index scores decreased statistically in three groups (P < 0.05). Compared to control group, hospital for special surgery scores of the individualized orthopedics group were improved 3 and 6 months postoperatively (P < 0.05), while Western Ontario and McMaster Universities osteoarthritis index scores of the individualized orthopedics group decreased significantly 3 and 6 months after operation (P < 0.05). There were no obvious differences in hospital for special surgery and Western Ontario and McMaster Universities osteoarthritis index scores at 12 months between the control and individualized orthopedics groups (P > 0.05). (4) All patients were satisfied with the surgical efficacy. Postoperative self-satisfaction scores of individualized orthopedics group were superior to that of control group (P < 0.05). (5) According to the results, individualized open wedge high tibial osteotomy is benefit to obtain early functional rehabilitation of the knee through accurate correction of lower limb alignment. It can also improve patient satisfaction.

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    Comparison of robot-assisted drilling decompression and traditional surgery for treatment of aseptic necrosis of femoral head
    Luo Jin, Lan Hai, Yan Yajing
    2020, 24 (27):  4317-4321.  doi: 10.3969/j.issn.2095-4344.2804
    Abstract ( 294 )   PDF (707KB) ( 30 )   Save

    BACKGROUND: To delay the further aggravation of early femoral head necrosis, drilling decompression of the femoral head is a better treatment method. However, traditional trepanation and decompression of the femoral head is traumatic.

    OBJECTIVE: To compare the difference in the effect between robot-assisted drilling decompression and traditional surgery for aseptic necrosis of femoral head.


    METHODS: Forty patients with aseptic necrosis of the femoral head were included for retrospective comparative analysis. According to the treatment plan, they were divided into two groups. Eighteen cases (26 femoral heads) in the robot group were treated with drilling decompression assisted by robots. Among them, 13 cases (18 femoral heads) were in Ficat stage I and 5 cases (8 femoral heads) were in Ficat stage II. The traditional surgery group consisted of 22 patients (29 femoral heads). Among them, 15 patients (19 femoral heads) were in Ficat stage I and 7 patients (10 femoral heads) in Ficat stage II. Incision, times of intraoperative fluoroscopy, intraoperative blood loss, times of intraoperative puncture and operation time were compared between the two groups. Harris score was used before and 1, 3, and 6 months after operation to evaluate the hip effect.

    RESULTS AND CONCLUSION: (1) All cases were followed up for 6 months. (2) Incision, times of intraoperative fluoroscopy, intraoperative blood loss, times of intraoperative puncture and operation time were better in the robot group than in the traditional surgery group (P < 0.05). (3) Harris score was not significantly different 1, 3 and 6 months after surgery in the two groups (P > 0.05). (4) Compared with the traditional surgery, robot-assisted drilling decompression has no obvious advantage in the treatment of aseptic necrosis of the femoral head. However, its operation incision is small; the number of intraoperative fluoroscopy is small; the trauma is small; and the operation is safer and minimally invasive. 

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    Three-dimensional printed navigation template assisted core decompression and bone grafting for treatment of ARCO stage II non-traumatic femoral head necrosis
    Chen Dongdong, Hao Yangquan, Zhang Gaokui, Li Huanhuan, Wang Qiuxia, Lu Chao
    2020, 24 (27):  4322-4327.  doi: 10.3969/j.issn.2095-4344.2772
    Abstract ( 338 )   PDF (795KB) ( 36 )   Save

    BACKGROUND: Core decompression and bone grafting is the main postoperative method in the treatment of ARCO stage II non-invasive necrosis of the femoral head, but there are risks of inaccurate location, incomplete or excessive removal of necrotic bone.

    OBJECTIVE: To observe the accuracy and safety of three-dimensional (3D) printed navigation template assisted core decompression and bone grafting in the treatment of ARCO stage II non-traumatic femoral head necrosis.

    METHODS: Eighty patients (96 hips) of ARCO stage II non-traumatic femoral head necrosis were enrolled from January to November 2017 in Honghui Hospital Affiliated to Xi’an Jiaotong University. The patients were randomly divided into two groups. In the 3D group, 40 cases (48 hips) received 3D printed navigation template assisted core decompression and bone grafting. In the control group, 40 cases (48 hips) received core decompression and bone grafting (no navigation template). All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The operation time, intraoperative fluoroscopy, and intraoperative blood loss were recorded, and X-ray examination results at 3, 6, 12, and 24 months after operation were observed. The femoral head survival rate, hip Harris score, and pain visual analogue scale score were evaluated. The efficacy was compared.

    RESULTS AND CONCLUSION: (1) Compared with the control group, the operation time was shortened from (132.57±14.86) minutes to (82.63±10.31) minutes; the number of intraoperative fluoroscopy was reduced from (16.80±2.15) times to (4.93±1.36) times; blood loss was reduced from (143.23±17.98) mL to (75.64±16.23) mL in the 3D group. Operation time, number of fluoroscopy, and blood loss were superior in the 3D group than in the control group (P < 0.05). (2) The 24-month follow-up of imaging showed that only 2 cases of the femoral head collapsed in the 3D group, but the hip joint function was acceptable. There was no artificial hip arthroplasty and the femoral head survival rate was 96%. In the control group, femoral head collapsed in 9 cases. Four of them had total hip arthroplasty due to limited hip joint activity, and the femoral head survival rate was 81%. The survival rate of the femoral head in the 3D group was higher than that in the control group (P=0.024). (3) Compared with the control group, Harris score and visual analogue scale score were improved in the 3D group (P < 0.05). (4) Applying 3D printed navigation template to core decompression and bone grafting for ARCO stage II non-traumatic femoral head necrosis can reduce the operation time, intraoperative fluoroscopy and blood loss, and improve the accuracy and safety of intraoperative positioning. 

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    Absorbable rod or titanium alloy screws for Mason type II radial head fractures
    Yang Xiao, Mei Wei, Zhang Wei
    2020, 24 (27):  4328-4332.  doi: 10.3969/j.issn.2095-4344.2794
    Abstract ( 469 )   PDF (681KB) ( 91 )   Save

    BACKGROUND: At present, open reduction and internal fixation is an effective method for the treatment of Mason type II radial head fracture. The selection of internal fixation includes screws, micro plates, Kirschner wires, absorbable rods or nails. The clinical efficacy reported is inconsistent.

    OBJECTIVE: To compare the clinical efficacy of titanium alloy screws or absorbable rod for the internal fixation of Mason type II radial head fractures.

    METHODS: Totally 25 patients with radial head fractures were collected from January 2016 to February 2017 in Sichuan Provincial People’s Hospital, including 16 males and 9 females, at the age of 38-61 years. All



    patients received open reduction and internal fixation. Of them, 13 cases received titanium alloy screws, and 12 cases received absorbable rod. X-ray images were obtained during follow-up to identify fracture healing time. During the final follow-up, visual analogue score, elbow motion range, Mayo elbow joint function score and Broberg-Morrey scores were compared between the two groups. The study was approved by the Ethics Committee of Sichuan Provincial People’s Hospital·Sichuan Academy of Medical Sciences.

    RESULTS AND CONCLUSION: (1) There was no significant difference in fracture healing time between the absorbable rod group (2.35±0.92 months) and titanium alloy screw group (2.10±0.47 months) (P > 0.05). (2) In the final follow-up, there was no significant difference in Mayo elbow joint function score and Broberg-Morrey scores between the two groups (P > 0.05). (3) In the final follow-up, there was no significant difference in elbow flexion, extension, supination, and pronation angle between the two groups (P > 0.05). (4) In the final follow-up, there was no significant difference in visual analogue score between the two groups (P > 0.05). (5) These results indicate that the absorbable rod and titanium alloy screws can obtain satisfactory treatment outcomes for Mason type II radial head fractures. However, the absorbable rod can avoid the secondary operation for removing internal fixators, and the adverse impact of stress shielding.

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    T2-mapping quantitative imaging technique based on sequence optimization in the ankle talus osteochondral injury
    Li Wei, Chu Zhanfei, Yu Zechen, Yu Jinghong, Jia Yanbo, Wang Zongbo
    2020, 24 (27):  4333-4337.  doi: 10.3969/j.issn.2095-4344.2799
    Abstract ( 465 )   PDF (687KB) ( 57 )   Save

    BACKGROUND: At present, DWI, DTI, T1-mapping, T2-mapping, and T2*-mapping are commonly used in cartilage functional imaging sequences in both scientific research and clinic. T2-mapping is often used for the quantitative analysis of cartilage, but it was obviously limited due to the long scanning time and poor experience of the patient.

    OBJECTIVE: To quantitatively evaluate the talar cartilage injury degree of chronic lateral ankle instability patients by sequence optimized T2-mapping quantitative imaging technique.

    METHODS: Totally 53 cases of chronic ankle instability (case group) and 46 healthy subjects (control group) were from the Second Affiliated Hospital of Inner Mongolia Medical University. They underwent conventional Magnetic Resonance Imaging and optimal T2-mapping quantitative imaging scanning. The total talar cartilage was divided into six compartments: internal anterior, internal medial, internal posterior, lateral anterior, lateral center and lateral posterior. Six T2 values were totally taken as each partition had one T2 value. The experiment was approved by the Ethics Committee of Inner Mongolia Medical University.

    RESULTS AND CONCLUSION: The T2 values of internal anterior, internal medial, internal posterior areas of case group were higher than those of control group (P < 0.05). The T2 values of lateral anterior, lateral center and lateral posterior areas had no significant difference between the two groups (P > 0.05). The results showed that the talus cartilage injury mainly occurred in the internal talus in patients with chronic lateral ankle instability. The cartilage damage degree could be quantitatively evaluated by magnetic resonance T2-mapping imaging technique. It is possible that T2-mapping based on sequence optimization can be used in functional image routine scan. 

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    Prevalence rate and high-risk factors of preoperative lower-limb deep venous thrombosis in patients with hip fracture
    Wei Yong, Li Jun, Zhang Yong, Yu Hao, Xie Jia
    2020, 24 (27):  4338-4342.  doi: 10.3969/j.issn.2095-4344.2756
    Abstract ( 495 )   PDF (598KB) ( 56 )   Save

    BACKGROUND: Patients with hip fracture are prone to be complicated with deep vein thrombosis of the lower extremity during the perioperative period, but there are few studies on the occurrence of deep vein thrombosis of the lower extremity in patients with hip fracture, especially the risk factors of deep vein thrombosis before surgery are not clear.  

    OBJECTIVE: To explore the preoperative prevalence rate of lower-limb deep venous thrombosis in patients with hip fracture, and to investigate the high-risk factors of lower-limb deep venous thrombosis in patients with hip fracture.

    METHODS: A retrospective analysis was performed in 242 cases of hip fracture admitted to the Second Hospital of Anhui Medical University from January 2017 to December 2018, including 99 males and 143 females, with an average age of 69.1 years. There were 189 cases of femoral neck fracture and 53 cases of intertrochanteric fracture. All patients signed the formed consent. This study was approved by the Hospital Ethics Committee. All patients had no contraindications to anticoagulation. After admission, they were given prophylactic anti-coagulation with low molecular heparin. According to the results of color Doppler ultrasound examination of blood vessels in both lower limbs, the patients were divided into the lower-limb deep venous thrombosis group and the lower-limb non-deep venous thrombosis group (intraluminal filter placement before surgery for lower-limb deep venous thrombosis). Risk factors for thrombosis received univariate analysis, including age, sex, fracture type (femoral neck fractures and intertrochanteric fractures), time from injury to operation, laboratory examination (hematocrit, fibrinogen, D-dimer, and hemoglobin), and combination with chronic diseases (hypertension and diabetes). Multivariate logistic regression analysis was used to determine independent risk factors.

    RESULTS AND CONCLUSION: (1) Among 242 patients with hip fracture, 58 patients (24%) experienced lower-limb deep venous thrombosis. (2) There was no significant difference in gender, fracture type, D-dimer, fibrinogen, and combination with chronic diseases (hypertension and diabetes) between the lower-limb deep venous thrombosis group and the lower-limb non-deep venous thrombosis group (P > 0.05). The age, the time from injury to operation, and hemoglobin level were statistically significant between the two groups (P < 0.05). (3) Multivariate regression analysis showed that age ≥ 70 years old and time from injury to operation ≥ 5 days were independent risk factors for lower-limb deep venous thrombosis in patients with hip fracture. (4) It is indicated that patients with hip fracture are prone to lower-limb deep venous thrombosis even under the condition of prophylactic anticoagulant therapy. Among them, the elderly patients and the longer waiting time before surgery are the high-risk factors for thrombosis.

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    Adding hormone in cocktail promotes rapid recovery after unicompartmental knee arthroplasty
    Yue Ju’an, Zhang Qidong, Huang Cheng, Guo Wanshou, Wang Weiguo, Wang Randong
    2020, 24 (27):  4343-4348.  doi: 10.3969/j.issn.2095-4344.2757
    Abstract ( 372 )   PDF (676KB) ( 36 )   Save

    BACKGROUND: Postoperative pain is a common clinical problem in unicompartmental knee arthroplasty, and severe pain can affect postoperative efficacy. Hormone is a common and effective anti-inflammatory drug, and there is some controversy over whether to add hormone to the local injection of cocktail in unicompartmental knee arthroplasty.

    OBJECTIVE: To evaluate the effectiveness of adding hormones to the cocktail to promote rapid recovery after unicompartmental knee arthroplasty.  

    METHODS: Osteoarthritis patients receiving unilateral unicompartmental knee arthroplasty from October 2017 to March 2019 were randomly divided into a hormone group (local injection of cocktail + 40 mg triamcinolone acetonide) and a control group (local injection of cocktail + equivalent normal saline). Visual analogue scale score, fentanyl consumption, knee function, inflammatory indicators, adverse reactions and complications were observed in both groups after surgery.  

    RESULTS AND CONCLUSION: (1) Finally, 80 patients were included in the study (n=40 in each group). There was comparability between the two groups (P > 0.05). (2) The static and dynamic visual analogue scale scores of patients in the hormone group at 1, 2 and 3 days after surgery were significantly lower than those in the control group (P < 0.05). (3) The dosage of fentanyl in the hormone group was significantly lower than that in the control group at 48 hours after surgery (P < 0.05). (4) At 1, 3, 5 days and 3 months after surgery, the knee flexion range of motion in the hormone group was higher than that of the control group (P < 0.05). (5) Hospital for Special Surgery score of knee in the hormone group was higher than that in the control group at 3 months after surgery (P < 0.05). There was no statistically significant difference in Hospital for Special Surgery scores of the knee between two groups at 6 months after surgery (P > 0.05). (6) C-reactive protein levels at 3 days and interleukin-6 levels at 24 hours after surgery in the hormone group were significantly lower than those in the control group (P < 0.05). (7) The incidence of complications in the hormone group was significantly lower than that in the control group (P < 0.05). (8) Addition of hormones in the cocktail can effectively promote the rapid recovery after unicompartmental knee arthroplasty.

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    Mechanism and progress of exosomes in the treatment of nonunion
    Lai Yu, Han Jie
    2020, 24 (27):  4349-4355.  doi: 10.3969/j.issn.2095-4344.2801
    Abstract ( 298 )   PDF (798KB) ( 46 )   Save

    BACKGROUND: Bone nonunion is a common complication after fracture, which brings great distress to patients. With the continuous development of exosomal technology, exosomes gradually show their advantages in the treatment of nonunion, which has become a new research direction in medical work.

    OBJECTIVE: To summarize the researches in and outside China and explore the role of exosomes in the treatment of nonunion.



    METHODS: The authors retrieved related Chinese articles published from 2003 to 2019 in Wanfang database, CNKI and VIP database with the key words of “exosomes, nonunion, bone remodeling, bone regeneration, vascular injury, osteoblasts, osteoclasts” and related English articles published from 2003 to 2019 in PubMed with the key words of “exosomes, nonunion, bone remodeling”. Totally 50 articles were selected based on inclusion and exclusion criteria.

    RESULTS AND CONCLUSION: (1) In recent years, more and more attention has been paid to the study of exosomes on bone nonunion. MiRNAs and proteins in exosomes can affect bone nonunion by affecting the differentiation of osteocytes. (2) Studies have found that exosomes can treat bone nonunion by regulating bone remodeling, promoting vascular repair, and improving systemic diseases. (3) However, the current research on exosomes is still in the experimental stage. The specific method of how to better apply it to clinical treatment needs further exploration.

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    Concept, mechanism and problem of gene therapy for osteoarthritis
    Hu Zhongling, Li Binbin, Cui Yishuang, Wang Qian, Zhang Hui, Li Qijia, Wang Zhiqiang
    2020, 24 (27):  4356-4363.  doi: 10.3969/j.issn.2095-4344.2717
    Abstract ( 362 )   PDF (823KB) ( 68 )   Save

    BACKGROUND: Specific gene expression at specific injury sites enhances cell regeneration.

    OBJECTIVE: To summarize the concept of gene therapy, to review the strategies of gene therapy and the mechanism of gene therapy for osteoarthritis, and to introduce the research direction of gene therapy.

    METHODS: Extensive consulted the literature on osteoarthritis gene therapy and related content in foreign databases such as PubMed and Science Direct. The key words were “Gene therapy, Cartilage, Cartilage repair, Osteoarthritis, Expression vectors, miRNA”. Above data were analyzed and summarized.

    RESULTS AND CONCLUSION: Gene therapy for osteoarthritis can be applied to all aspects of the pathogenesis of osteoarthritis and affect the metabolism of related substances. The target gene is delivered to



    the target cells through viral or non-viral vectors. At present, the focus of gene therapy is to accelerate cell repair and reduce inflammatory response. At the same time, multiple choices of gene vectors and target genes provide better individualized treatment options. The specific mechanism of gene therapy for osteoarthritis in clinic is not clear, and there is the possibility of gene mutation, which needs to be further studied to verify the safety.

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    Advantages and learning curve of direct anterior approach in total hip arthroplasty
    Liu Tiansheng, Su Bin
    2020, 24 (27):  4364-4369.  doi: 10.3969/j.issn.2095-4344.2775
    Abstract ( 349 )   PDF (760KB) ( 51 )   Save

    BACKGROUND: With the trend of minimally invasive and “rapid rehabilitation” in modern surgery, direct anterior approach is preferred by orthopedic surgeon in recent years.

    OBJECTIVE: To review the direct anterior approach’s history, surgical indications, patients’ selection, surgical methods, common complications, surgery advantages and learning curves, to provide ideas for the rapid rehabilitation of hip arthroplasty.

    METHODS: PubMed, Wanfang database, and CNKI were retrieved for articles addressing total hip arthroplasty through direct anterior approach published from 1956 to 2020. Key words were minimally invasive, direct anterior approach, total hip arthroplasty, enhanced recovery after surgery, complication, learning curve” in Chinese and English. Finally, 67 articles met the criteria for review.



    RESULTS AND CONCLUSION: (1) The direct anterior approach is an ideal minimally invasive surgical path because of it walks in the fascia gap and it is a truly neuromuscular interface with no damage to important muscles and nerve blood vessels. (2) Direct anterior approach has advantages of quicker recovery, less postoperative pain, short hospital stay and high patient satisfaction. However, because most doctors in our country have changed their surgical approach to direct anterior approach, direct anterior approach still has shortages, such as long learning curve and high rate of early complications.

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    Anatomic progress of pubic symphysis and biomechanical characteristics of internal fixation
    Gong Yusuo, Zhou Jun, Li Shenghua, Zhu Yanguo
    2020, 24 (27):  4371-4375.  doi: 10.3969/j.issn.2095-4344.2802
    Abstract ( 464 )   PDF (785KB) ( 34 )   Save

    BACKGROUND: The separation injury of pubic symphysis is most commonly associated with severe pelvic fracture injuries. Because the anatomical position of the pubic symphysis is deep, and the curative effect is often unsatisfactory. Anatomical and biomechanical studies are necessary to better guide clinical diagnosis and treatment.

    OBJECTIVE: To summarize and analyze the anatomical characteristics and biomechanical research status of pubic symphysis, and to provide some benefits for the clinical treatment of pubic symphysis separation.



    METHODS: The authors retrieved CNKI, VIP, and PubMed with the key words of “separation of pubic symphysis” and “biomechanics” for articles published from April 1984 to February 2020. Relevant literature was selected by title and abstract, and the titles and abstracts of the references were read. The related literatures were selected again and the duplicate literatures were eliminated.

    RESULTS AND CONCLUSION: There were 57 eligible literatures, and 33 were finally included. (1) The present anatomical study mainly focuses on the structure of pubic symphysis and its adjacent ligaments. (2) Because of the position of pubic symphysis, no further study was carried out. The precise distribution of the starting and ending points of the peripheral ligaments and muscles, and the precise nerve and blood distribution need further study. (3) There have been relatively few studies of pubic symphysis biomechanics, and they vary widely. It needs to be deeply studied and agreed upon. (4) With the development of finite element, the biomechanics focus on the treatment of pubic symphysis. (5) Due to good mechanical stability, the reconstructed plate and the hollow screw are used as common fixation for pubic symphysis separation. However, percutaneous hollow screw fixation has become the trend in the future because of its minimal invasion.

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    Effect of advanced glycation end products on metabolism of bone tissue cells
    Liu Chang, Wang Na, Li Yukun, Xue Peng
    2020, 24 (27):  4376-4382.  doi: 10.3969/j.issn.2095-4344.2776
    Abstract ( 396 )   PDF (658KB) ( 42 )   Save

    BACKGROUND: With the research and development of bone tissue engineering, it has been found that advanced glycation end products can accumulate in bone tissue and affect the structure and biomechanical properties of bone. At present, many researchers have discovered that advanced glycation end products/receptor for advanced glycation end products can induce pathological changes of osteoblasts, osteoclasts and osteocytes through special mechanisms, thereby leading to imbalance of bone reconstruction, decrease of bone strength and increase of fracture incidence.

    OBJECTIVE: To review the effects of advanced glycation end products on bone biomechanics and the mechanism of advanced glycation end products/receptor for advanced glycation end products on bone tissue cells.

    METHODS: The first author searched the relevant articles regarding the effect of advanced glycation end products/receptor for advanced glycation end products on metabolism of bone tissue cells published in PubMed, Web of Science and Medline database from January 2005 to July 2019. The results were limited to English literatures.

    RESULTS AND CONCLUSION: Finally, 54 representative literatures were selected for summary. The effects of advanced glycation end products on collagen cross-linking can significantly reduce bone strength. Advanced glycation end products/receptor for advanced glycation end products affects bone metabolism through pathological mechanism changes of bone tissue cells, which results in essential changes of bone tissue cells. Finally, it will lead to imbalance of bone metabolism and increase of bone fragility. The osteoporosis is directly related to the activity change of bone tissue cells, but the specific mechanism needs further study. The change of this special mechanism may provide a unique pathological mechanism, diagnosis methods, treatment and prevention strategies for osteoporosis in the future.

    Key words: advanced glycation end products; receptor for advanced glycation end products; bone collagen molecule; cross-linking; bone tissue cells; bone strength; bone quality; osteoporosis

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    Mechanism of ribosome biogenesis and exercise adaptation of skeletal muscle hypertrophy
    Yang Jun, Zhang Shaosheng
    2020, 24 (27):  4383-4388.  doi: 10.3969/j.issn.2095-4344.2755
    Abstract ( 485 )   PDF (707KB) ( 70 )   Save

    BACKGROUND: Research evidence shows that skeletal muscle contractile activity can induce ribosomal biogenesis, which plays an important role in the control of skeletal muscle mass.

    OBJECTIVE: To review the main mechanism of ribosome biogenesis in skeletal muscle hypertrophy, upstream regulatory signals of ribosomal biogenesis in skeletal muscle, and effect of exercise on ribosomal biogenesis, and to explore the ribosome biogenesis mechanism of exercise-induced skeletal muscle hypertrophy.



    METHODS: Relevant studies about exercise, skeletal muscle hypertrophy and ribosome biogenesis in CNKI, Wanfang, and PubMed databases were searched. The key words were “exercise, resistance training, skeletal muscle hypertrophy, protein synthesis, ribosome biogenesis” in English and Chinese. Relevant literatures published from 1999 to 2019 were searched and screened according to inclusion and exclusion criteria.

    RESULTS AND CONCLUSION: (1) Ribosome biogenesis as a main source of translational capacity plays an important role in muscle growth. (2) A single bout of resistance exercise can promote the ribosome biogenesis. However, cumulative bouts of resistance exercise eventually lead to the accumulation of mature rRNAs, leading to increased concentration of total RNA, which promote the growth of skeletal muscle. (3) Ribosome biogenesis may be the key molecular mechanism for the regulation of skeletal muscle hypertrophy induced by resistance training. (4) Moderate-volume resistance training led to adaptations to resistance training. This hypertrophy was associated with volume-dependent regulation of total RNA. This suggests that ribosomal biogenesis regulates the dose-effect relationship between training volume and muscle hypertrophy.

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    Meta-analysis of locking plate combined with fibular allograft and locking plate alone in the treatment of proximal humeral fractures
    Tu Dongpeng, Yu Yikang, Liu Zheng, Fan Xin, Zhang Wenkai, Xu Chao
    2020, 24 (27):  4389-4397.  doi: 10.3969/j.issn.2095-4344.2796
    Abstract ( 288 )   PDF (783KB) ( 74 )   Save

    BACKGROUND: The best treatment of proximal humeral fracture has always been controversial. Open reduction and internal fixation with locking plate is a common method for the treatment of proximal humeral fractures. In recent years, many studies have pointed out that locking plate combined with fibular allograft can obtain better rigid structure.

    OBJECTIVE: To evaluate the clinical efficacy of locking plate and locking plate combined with fibular allograft in the treatment of proximal humeral fractures.

    METHODS: CNKI, Wanfang database, VIP, PubMed, EMBASE, and Cochrane Library were searched for articles concerning locking plate and locking plate combined with fibular allograft for proximal humeral fractures published from inception to January 2020 for quality evaluation. International Cochrane collaboration RevMan 5.0 software was used for meta-analysis. The difference in American shoulder and elbow surgeons score, Constant score, humeral head height loss value, the change of humeral neck angle, incidence of postoperative complications, secondary surgery rate, screw cutout rate, and humeral head necrosis rate were compared between the locking plate group and locking plate combined with fibula group.

    RESULTS AND CONCLUSION: (1) Eight studies were included with a total of 623 patients. (2) Results analysis showed that there were significant differences between the locking plate group and locking plate combined with fibula group in American shoulder and elbow surgeons score (95%CI:4.29-6.84, P < 0.05), Constant score (95%CI:6.46-15.10, P < 0.05), humeral head height loss value (95%CI: -3.24--2.07, P < 0.05), the change of humeral neck angle (95%CI:-7.20--5.95, P < 0.05), incidence of postoperative complications (95%CI:0.18-0.51, P < 0.05), and screw cutout rate (95%CI:0.13-0.65, P < 0.05). (3) However, there was no significant difference between the two groups in secondary surgery rate (95%CI:0.13-1.14, P > 0.05) and humeral head necrosis rate(95%CI:0.41-2.11, P > 0.05). (4) Locking plate combined with fibula with simple locking plate in American shoulder and elbow surgeons score, Constant score, humeral head height loss value, neck stem Angle values, the incidence of postoperative complications, and screw cutout rate has a better clinical effect, but does not have significant difference in the second operation rate or humeral head avascular necrosis. 

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    A network meta-analysis of different surgical methods in the treatment of lumbar disc herniation
    Xiang Xi, Si Qunchao, Cheng Weiyi, Cao Ping, Zheng Jinpeng, Hu Bing
    2020, 24 (27):  4398-4405.  doi: 10.3969/j.issn.2095-4344.2797
    Abstract ( 514 )   PDF (837KB) ( 55 )   Save

    BACKGROUND: At present, there are many surgical methods for the treatment of lumbar disc herniation, and the therapeutic effects have their own advantages. Although there are many meta-analyses to compare the therapeutic effects of the two surgical methods, there is no comparison of the therapeutic effects of several surgical methods.

    OBJECTIVE: To compare the differences of different surgical methods in the treatment of lumbar disc herniation by network meta-analysis.

    METHODS: PubMed, Embase, Cochrane Library, Ovid and CNKI were searched, and randomized controlled trials or retrospective studies on different surgical methods for the treatment of lumbar disc herniation were collected. According to the inclusion and exclusion criteria established in advance, the quality of included randomized controlled trials was evaluated, and the data were analyzed by STATA 15.0 software.

    RESULTS AND CONCLUSION: A total of 42 studies, 5 156 patients and 9 surgical treatments were included. Surgical treatments contain total disc replacement, lumbar disc fusion, standard open discectomy, microendoscopic discectomy, microdiscectomy, percutaneous endoscopic lumbar discectomy, chemonucleolysis, automatic percutaneous lumbar discectomy and percutaneous laser disc decompression. The results of network meta-analysis showed that (from best to worst): (1) There was no significant difference in leg pain relief, and the rank probability was percutaneous laser disc decompression > microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > standard open discectomy > microdiscectomy > lumbar disc fusion > total disc replacement. (2) There was no significant difference in low back pain relief, and the rank probability was total disc replacement > lumbar disc fusion > microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > microdiscectomy > percutaneous laser disc decompression > standard open discectomy. (3) There was no significant difference in Oswestry disability index scores, and the rank probability was microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > standard open discectomy > microdiscectomy > total disc replacement > lumbar disc fusion. (4) There were some statistical differences in the success rate, and the rank probability was total disc replacement > lumbar disc fusion > microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > standard open discectomy > percutaneous laser disc decompression > microdiscectomy > chemonucleolysis > automatic percutaneous lumbar discectomy. (5) There was no significant difference in reoperation rate, and the rank probability was total disc replacement > lumbar disc fusion > microdiscectomy > microendoscopic discectomy > standard open discectomy > percutaneous endoscopic lumbar discectomy > percutaneous laser disc decompression > chemonucleolysis > automatic percutaneous lumbar discectomy. (6) There were some statistical differences in incidence of complications, and the rank probability was percutaneous endoscopic lumbar discectomy > automatic percutaneous lumbar discectomy > standard open discectomy > microdiscectomy > percutaneous laser disc decompression > microendoscopic discectomy > total disc replacement > lumbar disc fusion > chemonucleolysis. Results suggested that microendoscopic discectomy and percutaneous endoscopic lumbar discectomy are effective in all aspects. Disc replacement and lumbar disc fusion are the best in success rate of operation. Chemonucleolysis is poor in success rate of operation, reoperation rate and complications rate. Percutaneous automatic discectomy is poor in success rate of operation and reoperation rate. 

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    Effectiveness and safety of osteochondral allograft transplantation in the knee joint: a meta-analysis
    Hua Kunchi, Feng Jiangtao, Hu Yongcheng
    2020, 24 (27):  4406-4413.  doi: 10.3969/j.issn.2095-4344.2742
    Abstract ( 338 )   PDF (882KB) ( 87 )   Save

    BACKGROUND: Osteochondral allograft transplantation for the treatment of knee articular cartilage defects is one of the longest clinical methods. Although this method is widely used in clinical practice and is trusted by orthopedic surgeons, it still lacks evidence-based medicine support.

    OBJECTIVE: To investigate the efficacy of osteochondral allograft transplantation in the knee joint, systematic review and meta-analysis of all available data, and evaluate the efficacy and safety of osteochondral allograft as a transplant substitute in knee joint surgery.

    METHODS: Literature search was conducted in PubMed/Medline, EMBASE, Cochrane Collaboration Library, China National Knowledge Infrastructure and Wanfang Database. The application of osteochondral allograft in knee joint transplantation was searched and selected according to the literature inclusion criteria. Articles whose data can be extracted and meta-analyzable were mainly selected.

    RESULTS AND CONCLUSION: (1) Twenty-five studies met the inclusion criteria and were all case series studies. The patient reported that osteochondral allograft can be used as a graft material to repair knee joint defects. A total of 1 081 patients (1 111 knees) were included in the study. The age of onset was 11-75 years old, with an average age of 34.41 years. The proportion of women was about 40.81%. The follow-up period was 4-384 months, with an average of 76.8 months. (2) In these studies, donors received a minimum age of 10 years and a maximum of 65 years. According to the donor age range and number of studies, donors aged 15-45 were the primary targets. (3) The overall success rate after surgery was 74%, and the overall secondary operation rate was 17%. The success rate of unipolar surgery was 74.44% (501/673); the success rate of bipolar surgery was 50.94% (27/53). The success rate of unipolar surgery was significantly higher than that of bipolar surgery (χ2=13.679, P < 0.05). (4) Treatment complications occurred in 67 patients (13.14%, 67/510). Common complications were persistent pain at the surgical site (15 cases), graft fracture or fragmentation (12 cases). (5) These results indicate that osteochondral allograft is an effective and safe substitute for knee joint transplantation. The overall success rate is 74% and the secondary operation rate is 17%. It is a treatment with high success rate and low risk of reoperation.

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    Systematic evaluation and meta-analysis of extracorporeal shock wave therapy in the treatment of knee osteoarthritis
    Huangfu Zhimin, Wei Daiqing, Ao Yunong
    2020, 24 (27):  4414-4420.  doi: 10.3969/j.issn.2095-4344.2800
    Abstract ( 328 )   PDF (790KB) ( 47 )   Save

    BACKGROUND: Related studies have shown that extracorporeal shock wave therapy has a positive effect on the treatment of knee osteoarthritis, but its effectiveness in treating knee osteoarthritis is not very clear, and

    the final results of various related studies are not same.

    OBJECTIVE: To analyze the efficacy of extracorporeal shock wave therapy for knee osteoarthritis using meta-analysis.

    METHODS: Chinese and English databases were searched in detail from inception to December 2019. The inclusion criteria were developed based on the Prisma principle to screen the randomized controlled trial of extracorporeal shock wave therapy for knee osteoarthritis. The treatment method of the experimental group was extracorporeal shock wave therapy or extracorporeal shock wave therapy combined with drugs and arthroscopic debridement. The treatment method of the control group was one of drug treatment, ultrasound treatment, laser treatment, exercise therapy, arthroscopy or blank control. The quality of the included literature was evaluated according to the Cochrane Handbook 5.1 bias risk assessment tool. Relevant data were analyzed using RevMan v5.3 software.

    RESULTS AND CONCLUSION: (1) A total of 21 randomized controlled trials were included, with a total of 1 736 patients with knee osteoarthritis, including 895 in the experimental group and 841 in the control group. (2) Meta-analysis shows that the visual analogue scale score of the experimental group was lower than that of the control group [SMD=-1.18, 95%CI(-1.42, -0.95), Z=9.75, P < 0.000 01]. Joint motion range was greater in the experimental group than in the control group [SMD=-1.69, 95%CI(-2.01, -1.36), Z=10.16, P < 0.000 01]. WOMAC score was lower in the experimental group than in the control group [SMD=-9.66, 95%CI(-13.12, -6.20), Z=5.47, P < 0.000 01]. (3) The results show that extracorporeal shock wave therapy for knee osteoarthritis has a certain positive effect on pain relief and joint motion range. However, the number of cases included in this study is small, and subsequent large-scale multi-center studies are needed to further clarify the relevant utility.

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    Therapeutic effects of platelet-rich plasma versus hyaluronic acid for knee osteoarthritis: a meta-analysis
    Wang Yangfa, Liu Jun, Pan Jianke, Gao Shihua, Huang Junhan, Li Huiwen, He Xiangzhong, Chen Haiyun
    2020, 24 (27):  4421-4428.  doi: 10.3969/j.issn.2095-4344.2771
    Abstract ( 433 )   PDF (861KB) ( 80 )   Save

    BACKGROUND: Hyaluronic acid is a commonly used drug in the treatment of knee osteoarthritis, and platelet-rich plasma is a research hotspot in recent years. There is still controversy on the comparison of the effectiveness and safety between them.

    OBJECTIVE: To systematically assess the efficacy and safety of platelet-rich plasma and hyaluronic acid for knee osteoarthritis through a meta-analysis.

    METHODS: The authors systematically retrieved the databases of CNKI, VIP, Wanfang, CBM, PubMed, EMBase and Cochrane Library for randomized controlled trials regarding platelet-rich plasma versus hyaluronic acid for knee osteoarthritis published from inception to January 2020. Quality assessment was conducted on eligible randomized controlled trials. A meta-analysis was performed in WOMAC score, IKDC score, visual analogue scale score, Lequesne index and adverse events using RevMan 5.3 software.

    RESULTS AND CONCLUSION: (1) Totally 21 randomized controlled trials were eventually includedinvolving 1 872 knees including 963 patients in the platelet-rich plasma group and 909 patients in the hyaluronic acid group. (2) Meta-analysis results showed that WOMAC scores were significantly lower in the platelet-rich plasma group than in the hyaluronic acid group at 3, 6 and 12 months after treatment [MD=-5.84, 95%CI(-10.11, -1.57), P=0.007; MD=-9.48, 95%CI(-13.02, -5.95), P < 0.000 01; MD=-10.47, 95%CI(-13.95, -7.00), P < 0.000 01]. Visual analogue scale scores were lower in the platelet-rich plasma group than in the hyaluronic acid group at 6 and 12 months after treatment [MD=-5.02, 95%CI(-8.87, -1.18), P=0.01; MD=-3.33, 95%CI(-4.89, -1.76), P < 0.000 1]. IKDC scores were higher in the platelet-rich plasma group than in the hyaluronic acid group at 3, 6, and 12 months after treatment [MD=7.10, 95%CI(3.88, 10.32), P < 0.000 1; MD=7.88, 95%CI(5.12, 10.65), P < 0.000 01; MD=6.85, 95%CI(2.50, 11.19), P=0.002]. Lequesne Index scores were lower in the platelet-rich plasma group than in the hyaluronic acid group at 6 and 12 months after treatment [MD=-0.82, 95%CI(-1.31, -0.32), P=0.001; MD=-2.37, 95%CI(-2.93, -1.81), P < 0.000 01]. No significant difference was found in adverse event rates between the two groups [OR=1.46, 95%CI(0.94, 2.24), P=0.09]. (3) The results show that compared with hyaluronic acid, platelet-rich plasma can relieve pain, improve function, improve the quality of life of patients with knee osteoarthritis, and the effect is more lasting. 

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