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    28 October 2020, Volume 24 Issue 30 Previous Issue    Next Issue
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    Accuracy of 3D printing navigation template in pedicle screw placement for idiopathic scoliosis
    Li Hongke, Hao Shenshen, Wang Pengcheng, Yang Hongjie, Dong Shengli, Liu Shuai, Wang Fei, Liu Zhibin
    2020, 24 (30):  4757-4762.  doi: 10.3969/j.issn.2095-4344.2839
    Abstract ( 375 )   PDF (879KB) ( 442 )   Save

    BACKGROUND: Idiopathic scoliosis surgery is difficult and requires a long operation time. Using 3D printing navigation templates to assist in nail placement can reduce the difficulty of surgery, optimize the operation of nail placement, and improve the effect of nail placement, which has significant advantages.

    OBJECTIVE: To evaluate the application of 3D printing navigation template assisted screw placement in the pedicle screw internal fixation of idiopathic scoliosis.

    METHODS: Clinical data of 17 cases of idiopathic scoliosis treated by pedicle screw fixation from January 2018 to August 2019 were retrospectively analyzed. Among them, eight patients were treated with 3D printing navigation template assisted screw placement (3D group), while nine patients were treated with conventional screw placement (conventional group). CT scan was used to evaluate the level and acceptability of screw placement after surgery. The time of nail placement, the times of intraoperative X-ray fluoroscopy, the amount of nailing bleeding, the level of nail placement, the acceptable rate of nail placement, the rate of secondary nail placement, the rate of main bending correction and the complications related to nail placement were compared between the two groups.

    RESULTS AND CONCLUSION: (1) All the 17 patients successfully completed the operation of nail placement, and there were no complications related to nail placement in blood vessel and nerve injury. One case of back pain and one case of lower extremity pain were found in the conventional group, and the symptoms disappeared after symptomatic treatment. (2) The time of nail placement, the times of intraoperative X-ray fluoroscopy and the amount of nailing bleeding in the 3D group were less than those in the conventional group, and the difference was statistically significant (P < 0.05). (3) The level and acceptability of nail placement in the 3D group were higher than those in the conventional group, and the rate of secondary nail placement in the 3D group was lower than that in the conventional group, with statistical significance (P < 0.05). (4) There was no significant difference in the rate of main bending correction between the two groups (P > 0.05). (5) 3D printing navigation template can reduce the difficulty of screw placement and improve the effect of screw placement during pedicle screw internal fixation of idiopathic scoliosis.

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    3D printed orthopedic cast combined with Zicao oil promotes the recovery of wrist joint function after distal radius fracture
    Hu Chaoyan, Wu Zhifang, Huang Fei, Yu Runai, Xie Peiyi, Chen Yanjun, Luo Yiwen
    2020, 24 (30):  4763-4768.  doi: 10.3969/j.issn.2095-4344.2840
    Abstract ( 520 )   PDF (822KB) ( 273 )   Save

    BACKGROUND: 3D printing external fixation fixture can make individualized external fixation scheme for fracture patients and is easy to wear. Zicao oil (a Chinese traditional medicine oil) for trauma treatment has the effect of reducing swelling and removing blood stasis to assist the rehabilitation treatment of fracture. The combination of the two could benefit the rehabilitation of patients with fracture conservative treatment.

    OBJECTIVE: To investigate the clinical application value of the 3D printed orthopedic cast combined with Zicao oil in the treatment of distal radial fracture, hoping to provide a basis for the further study of a combined Chinese and western medicine treatment scheme for the recovery of wrist function after distal radius fractures.

    METHODS: Sixty-four patients with distal radial fracture were selected and randomly divided into two groups. Patients in the trial group received 3D-printed cast combined with Zicao oil treatment after manual reduction. Patients in the control group received traditional splint cast combined with Zicao oil after manual reduction. The Jakim scoring for distal radial fracture treatment, as well as pain degree, swelling degree, wrist range of motion, grasping ability and deformity degree were evaluated and compared 2 weeks after removal of external fixation in both groups.

    RESULTS AND CONCLUSION: (1) The excellent and good rate was 94% in the trial group and 78% in the control group. There was significant difference between the two groups (P < 0.01). (2) At 2, 4, 8 and 14 days after treatment, the scores of wrist range of motion and visual analogue scale were significantly better than those before treatment (P < 0.01). At different time points after treatment, the scores of wrist range of motion and visual analogue scale in the trial group were significantly better than those in the control group (P < 0.05). (3) The swelling degree of the trial group was better than that of the control group 2, 4, 8 and 14 days after treatment (P < 0.05). (4) The results show that 3D printed cast combined with Zicao oil is effective in the treatment of distal radius fracture, can effectively improve the function of wrist joint, reduce the pain of patients and improve the quality of rehabilitation.

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    Finite element analysis of intervention of splint to ulnar column in the treatment of type Frykman VIII fracture of distal radius
    Li Yongyao, Zhao Yong, Cheng Hao, Xu Huiqing, Wei Xu, Liu Guangwei, Cheng Yongzhong, Cui Xin
    2020, 24 (30):  4769-4774.  doi: 10.3969/j.issn.2095-4344.2831
    Abstract ( 361 )   PDF (834KB) ( 74 )   Save

    BACKGROUND: Through clinical research, we found that in the treatment of distal radius fracture combined with ulnar styloid process fracture, the proportion of complications of ulnar column after manual reduction and splint fixation was smaller than that of patients who only received open reduction and internal fixation of distal radius. We deemed that the wrist joint was treated as a whole in the treatment cycle, the splint as elastic fixation could provide the relative stability of the ulnar column and reconstruct the stability of the three columns of the wrist.

    OBJECTIVE: To explore the biomechanical mechanism of splint intervention on the ulnar column after type Frykman VIII fracture of the distal radius by finite element analysis.

    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. Two kinds of finite element models of type Frykman VIII fracture of the distal radius with ulnar styloid type I and type II fractures were established by using finite element software to divide the mesh, cut and mold. On this basis, four wrist joint finite element models with splint fixation and steel plate fixation for type Frykman VIII fracture of the distal radius were established. Under axial compression, lateral extension, pronation and supination working conditions, stress distribution and relative displacement of the distal radioulnar joint, displacement and direction of the ulnar styloid fracture broken end were analyzed.  

    RESULTS AND CONCLUSION: (1) The stress values of the ulnolunate ligament, ulnotriquetral ligament, and the palmar dorsal radioulnar ligament in the model of type Frykman VIII fracture of the distal radius with ulnar styloid type I fracture after splint intervention were lower than those in the model after plate intervention in the lateral tension, pronation and supination conditions. (2) In the pronation and supination conditions, the relative displacement values of the distal radioulnar joints in type Frykman VIII fracture of the distal radius models with ulnar styloid type I and type II fractures after splint intervention were smaller than those in the models after plate intervention. (3) In the lateral tension, pronation and supination conditions, the relative displacement values of the ulnar styloid fracture broken end in type Frykman VIII fracture of the distal radius models with ulnar styloid type I and type II fractures after splint intervention were smaller than those in the models after plate intervention. (4) The finite element study shows that distal radioulnar joint stability becomes worse after type Frykman VIII fracture of the distal radius, which is more obvious in the model with ulnar styloid type II fracture. In the treatment of this kind of fracture, compared with the simple internal fixation of distal radius fracture, the splint as elastic fixation takes the wrist joint as a whole in the treatment cycle and provides the relative stability of the ulnar column, thus further revealing the advantages of the splint elastic fixation.

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    Three-dimensional finite element analysis of the influence of bone cement dispersion type on the stress of adjacent vertebrae after vertebroplasty
    Chen Rongbin, Bai Jie, Li Yong, Zhang Jinxin, Lu Yao, Wu Zhaodian
    2020, 24 (30):  4775-4781.  doi: 10.3969/j.issn.2095-4344.2841
    Abstract ( 313 )   PDF (1080KB) ( 45 )   Save

    BACKGROUND: The fracture of adjacent vertebrae after vertebroplasty has been widely concerned. The finite element study of the influence of three cement diffusion types on the stress change of adjacent vertebrae after vertebroplasty has not been reported at home and abroad.

    OBJECTIVE: To analyze the stress changes of the adjacent vertebrae of the affected vertebrae under different loads using the finite element method.

    METHODS: Based on the original CT data of one L1 vertebral compression fracture patient and three L1 vertebral consolidation patients with bone cement distributed in the form of dispersion, mixture and agglomeration, the finite elements of T11-L2 vertebral functional unit compression fracture and three types of bone cement dispersion were established by dividing grids, defining material attributes and assembling models, using software such as Mimics 19.0, Geomagic Studio 2013 and SolidWorks 2017. The models underwent three levels of pressure 0.3 MPa (low pressure), 1.0 MPa (medium pressure) and 4.0 MPa (high pressure) and four load directions of forward bending, backward extension, lateral bending and rotation, respectively. The stress distribution of T12 and L2 vertebrae under different pressures and loads was observed.

    RESULTS AND CONCLUSION: (1) The increase of the stress of the adjacent vertebrae was positively correlated with the increase of the axial stress after the injection of bone cement. (2) The maximum stress of the adjacent vertebrae was significantly higher than that of the diffusion type and the mixed type under the four loading directions of the agglomerate type of bone cement, and the stress of the mixed type of the adjacent vertebrae was lower than that of the agglomerate type and the diffusion type under the forward bending and lateral bending loads. (3) The results showed that the agglomerate type of bone cement is an important factor leading to the increase of the stress of the adjacent vertebrae. The mixed cement distribution may reduce the risk of adjacent vertebral fractures.

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    Analysis and prediction of related factors of single-level cervical total disc replacement
    He Li, Xu Shuai, Xu Song, Zhao Xiaoyu, Pang Shilong, Miao Jun, Liu Haiying, Liang Yan
    2020, 24 (30):  4782-4788.  doi: 10.3969/j.issn.2095-4344.2823
    Abstract ( 419 )   PDF (800KB) ( 88 )   Save

    BACKGROUND: There is limited anterior cervical spine space. Incomplete hemostasis or drainage during artificial cervical total disc replacement can incur a series of complications. Preoperative factors can directly affect the amount of bleeding during spine surgery, while there are no publications aiming at cervical artificial disc replacement.

    OBJECTIVE: To analyze influencing factors on operation time and hemorrhage in patients undergoing single cervical total disc replacement.

    METHODS: Fifty-six patients with cervical spondylosis who underwent cervical total disc replacement from October 2012 to December 2017 in Department of Spine Surgery, Peking University People’s Hospital, were retrospectively enrolled. Pre- and intra-operative related parameters were measured. Primary outcomes included operation time, intraoperative blood loss and postoperative drainage. The secondary outcomes included demographic data such as sex, male and hypertension; surgery-related information such as operated segment, types of cervical spondylosis and artificial prosthesis; parameters in X-ray plain films such as the motion range and cervical lordosis of C2-C7 and index segment, the height of intervertebral disc, MRI classification (Modic classification and Pfirrmann classification) and preoperative functional score. The analysis was performed between primary and secondary outcomes as well as among primary outcomes.

    RESULTS AND CONCLUSION: (1) The average age of 56 patients (30 males and 26 females) was 48.2±9.8 years; operation time, intraoperative bleeding and postoperative drainage were 73.2±13.4 minutes, 51.8±41.2 mL and 7.8±5.3 mL, respectively. (2) There were no differences both in operation time and intraoperative blood loss in terms of demographics, while the drainage was statistically different in various ages (P=0.030). (3) The operation time of Prestige-LP implantation was statistically shorter than that of Mobi-C and Prodisc-C (P < 0.05). There was a positive correlation between the intermittent on taking (nonsteroidal antiinflammatory drugs) and intraoperative blood loss (r=0.310, P=0.020). The higher intervertebral disc of the operation segment was, the longer operation time was (P=0.028). (4) There was a significant difference in more intraoperative blood loss with osteoporosis compared to the normal ones (P=0.039); while the rest radiological parameters in X-ray were in no relation to primary outcomes, neither were in MRI degree, Modic change and Pfirrmann classification. (5) There was a positive correlation between operation time and intraoperative blood loss (P=0.010) and postoperative drainage (P=0.001). (6) These indicate that the height of intervertebral space can prolong operation time. Osteoporosis is a risk factor for intraoperative blood loss. The longer the operation time is, the more intraoperative blood loss and postoperative drainage will be.

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    Comparison of placement or non-placement of drainage tube after intravenous drip of tranexamic acid in total hip arthroplasty
    Wang Wangren, Shi Junjun, Huang Lingan, Zhang Zhiqiang
    2020, 24 (30):  4789-4794.  doi: 10.3969/j.issn.2095-4344.2842
    Abstract ( 501 )   PDF (641KB) ( 48 )   Save

    BACKGROUND: The purpose of placing drainage tube after total hip arthroplasty is to drain the accumulated blood in the hip, so as to accelerate the recovery of patients. However, since tranexamic acid has been infused intravenously during the operation, and the effect of blood loss can be reduced exactly. It remains poorly understood that whether it is necessary to place a drainage tube routinely after the operation.

    OBJECTIVE: To investigate whether the drainage tube should be placed on the basis of hemostasis by intravenous drip of tranexamic acid in total hip arthroplasty.

    METHODS: From June 2017 to March 2019, 132 patients with primary unilateral total hip arthroplasty admitted to the Second Hospital of Shanxi Medical University were selected. During the operation, tranexamic acid was infused intravenously. Drainage tube was placed in 62 patients (drainage group) after total hip arthroplasty, and not placed in 70 patients (non-drainage group). The blood loss, blood transfusion rate, blood transfusion volume, hemoglobin value and complications were compared between the two groups. The average hospital stay of the two groups was compared. Harris score of hip joint was followed up after operation. The experiment was approved by the Ethics Committee of the Second Hospital of Shanxi Medical University.

    RESULTS AND CONCLUSION: (1) There was no significant difference in blood loss, blood transfusion rate, blood transfusion volume, and hemoglobin value between the two groups (P > 0.05). (2) There was no significant difference in deep vein thrombosis of both lower limbs between the drainage group (four cases) and the non-drainage group (two cases) (P > 0.05). (3) There were three cases of bleeding, three cases of infection, two cases of swelling and ecchymosis in the drainage group, and one case of bleeding and one case of swelling and ecchymosis in the non-drainage group. There were significant differences in incision complications between the two groups (P < 0.05). (4) Average hospital stay was longer in the drainage group than in the non-drainage group (P < 0.05). (5) There was no significant difference in Harris score of the hip joint between the two groups at 1, 3 and 6 months after operation (P > 0.05). (6) The results showed that there was no need to place drainage tube after intravenous drip of tranexamic acid during total hip arthroplasty.

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    Platelet count as a novel potential predictor of periprosthetic joint infection
    Cao Houran, Deng Peng, Ye Pengcheng, Jie Ke, Zeng Jianchun, Feng Wenjun, Chen Jinlun, Qi Xinyu, Li Jie, Tan Xueqiu, Zhang Haitao, Zeng Yirong
    2020, 24 (30):  4795-4801.  doi: 10.3969/j.issn.2095-4344.2836
    Abstract ( 365 )   PDF (563KB) ( 34 )   Save

    BACKGROUND: Obtaining synovial fluid for diagnostic test of periprosthetic joint infection is invasive and painful to patients. Platelet count is a regular blood test which has been used as a possible predictor of several infectious diseases. Presumably, it could be one of the indicators of periprosthetic joint infection.

    OBJECTIVE: To identify the accuracies of platelet combined with white blood cell, erythrocyte sedimentation rate or C-reactive protein in the diagnosis of periprosthetic joint infection.

    METHODS: Patients undergoing revision arthroplasty from March 2013 to December 2018 in the First Affiliated Hospital of Guangzhou University of Chinese Medicine were retrospectively enrolled. A diagnosis of periprosthetic joint infection was confirmed in 77 patients according to the criterions from the Musculoskeletal Infection Society; the remaining 137 patients were confirmed as aseptic cases. White blood cell, erythrocyte sedimentation rate, or C-reactive protein and platelet count were compared between the two groups. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated.

    RESULTS AND CONCLUSION: The platelet values were significantly increased in periprosthetic joint infection cases. Sensitivity and specificity of the platelet for periprosthetic joint infection were 64.94% and 86.13%, respectively. Platelet demonstrated a higher accuracy when compared to erythrocyte sedimentation rate and C-reactive protein. In such cases, the platelet shows a certain reference value in confirming the diagnosis of periprosthetic joint infection. Platelet was enough used as adjunct diagnostic tool in patients suspected with periprosthetic joint infection. 

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    Comparison of early joint amnesia degree after posterior cruciate-retaining and posterior stabilized total knee arthroplasty
    Zhang Hui, Li Hong, Li Yetian, Lu Ming, Yin Li, Gao Weilu, Liu Jingjun, Liu Biquan, Yin Zongsheng
    2020, 24 (30):  4802-4806.  doi: 10.3969/j.issn.2095-4344.2824
    Abstract ( 410 )   PDF (677KB) ( 43 )   Save

    BACKGROUND: Clinical long-term follow-up showed that there is no obvious difference in knee range of

    motion, 10-15 year prosthesis survival rate, and main clinical manifestations after replacement of posterior cruciate-retaining and posterior stabilized prostheses. However, the debate over the superiority and inferiority of the two knee prostheses remains.

    OBJECTIVE: To compare the differences of early functional recovery of patients with unilateral knee osteoarthritis after posterior cruciate-retaining and posterior stabilized prosthesis replacement.

    METHODS: A total of 60 patients with knee osteoarthritis admitted to the First Affiliated Hospital of Anhui Medical University from July 2018 to September 2019 were selected, including 13 males and 47 females, aged 46-83 years old. Of them, 30 patients received posterior cruciate-retaining prosthesis replacement, and 30 patients received posterior stabilized prosthesis replacement. At 3 months after operation and at the last follow-up, joint amnesia score, knee function HSS score, visual analogue scale score, and knee motion range were assessed. The study was approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University.    

    RESULTS AND CONCLUSION: (1) Sixty patients were followed up for 5-16 months, and no complications such as periprosthetic infection, loosening, dislocation, or stiffness occurred during the follow-up. (2) At 3 months after surgery and at the last follow-up, joint amnesia score, HSS scores, visual analogue scores, and knee motion range were not significantly different between the two groups (P > 0.05). (3) The results showed that joint amnesia score was not significantly different in early stage after the posterior cruciate-retaining and posterior stabilized prosthesis replacement for unilateral knee osthoarthritis. 

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    Advantages and disadvantages of internal fixation with suture anchors and locking plate in the treatment of the greater tuberosity fracture
    Wang Qiang, Gu Yong, Chen Liang
    2020, 24 (30):  4813-4817.  doi: 10.3969/j.issn.2095-4344.2827
    Abstract ( 621 )   PDF (654KB) ( 50 )   Save

    BACKGROUND: Open reduction and internal fixation with locking plate is wildly used in treatment of the greater tuberosity fracture, but certain disadvantages still existed.

    OBJECTIVE: To compare the effects of open reduction and internal fixation with suture anchors and locking plate in the treatment of the greater tuberosity fracture.

    METHODS: A retrospective review of 33 patients with greater tuberosity fracture treated with open reduction and internal fixation between January 2016 and December 2018 was conducted. According to internal fixation method, the patients were divided into anchor group (n=7) and plate group (n=26), which received open reduction + suture anchor fixation and open reduction + locking plate fixation. Operation time, incision length, intraoperative blood loss, postoperative displacement of fracture mass, and Constant-Murley score 1 and 3 months after surgery and in final follow-up were compared between the two groups. Adverse reactions were recorded in the two groups.

    RESULTS AND CONCLUSION: (1) Operation time was shorter in the anchor group (73.1±10.5 minutes) than in the plate group (98.2±11.9 minutes). Incision length was shorter in the anchor group (7.3±1.1 cm) than in the plate group (14.9±1.7 cm). Intraoperative blood loss was less in the anchor group (45.0±7.1 mL) than in the plate group (141.0±25.9 mL) (P < 0.05). (2) Postoperative displacement of fracture mass was larger in the anchor group (3.0±1.8 mm) than in the plate group (1.1±2.3 mm) (P < 0.05). (3) There was no significant difference in Constant-Murley score between the two groups 1 and 3 months after surgery and in final follow-up (P > 0.05). (4) All results suggest that compared with locking plate fixation, suture anchor fixation is easier to be operated with small trauma in the treatment of the greater tuberosity fracture. 

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    A new minimally invasive spreader combined with less invasive stabilization system for proximal tibial fractures
    Huang Junming, Liu Xiaoming, Li Jiman, Zhong Weibin, Liu Yu, Zhu Haodong
    2020, 24 (30):  4818-4823.  doi: 10.3969/j.issn.2095-4344.2822
    Abstract ( 386 )   PDF (827KB) ( 62 )   Save

    BACKGROUND: The traditional surgical treatment of proximal tibial fractures has extensive dissection of the fracture site, and affects local blood circulation, increases the incidence of delayed union and nonunion. In recent years, the rising minimally invasive internal fixation system can protect the local soft tissue and blood circulation to the maximum extent, and provide better conditions for fracture healing. The application of new spreader also solves the problems of stability and durability of traditional manual traction reduction, and the combination of the two is gradually concerned.

    OBJECTIVE: To explore the effect of a new minimally invasive spreader assisted reduction and less invasive stabilization system for the treatment of proximal tibial fractures.

    METHODS: Twenty-two patients with proximal tibial fractures treated from May 2016 to October 2019 were studied and randomly assigned to control group and observation group (n=11 per group). Patients in the control group were treated with conventional manipulative reduction and conventional incision plate internal fixation. Patients in the observation group were treated with a new minimally invasive spreader assisted reduction and less invasive stabilization system. This study was approved by the Ethics Committee of Fifth Hospital, Guangzhou Medical University.

    RESULTS AND CONCLUSION: Compared with the control group, Rasmussen knee function score was better in the observation group at the last follow-up. Intraoperative blood loss, operation time, length of hospital stay, and weight-bearing time in the observation group were better than those in the control group. Postoperative complications such as joint limitation and delayed fracture healing were less in the observation group than in the control group. However, the healing time was not statistically significant between the two groups. Moreover, infection of the incision and loosening and fracture of the internal fixator were not statistically significant between the two groups. These indicated that the application of a new minimally invasive spreader combined with less invasive stabilization system for proximal tibial fractures can reduce surgical reduction time and local soft tissue damage, which is beneficial to early functional exercise and can reduce postoperative complications.

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    Biomechanical analysis of sagittal plane balance of type IIIA ankylosing kyphosis reconstructed by different osteotomy segments
    Li Hui, Gao Xiaoling, Ma Yuan
    2020, 24 (30):  4824-4828.  doi: 10.3969/j.issn.2095-4344.2798
    Abstract ( 268 )   PDF (823KB) ( 40 )   Save

    BACKGROUND: Orthopedic technique of ankylosing kyphosis is more mature. The surgeons can also choose different osteotomy methods according to the patients’ bending type and bending degree. However, due to the lack of widely recognized classification system, the description of ankylosing kyphosis and the formulation of operation strategy are confused.

    OBJECTIVE: To establish a three-dimensional finite element model of kyphosis osteotomy in ankylosing spondylitis using computer-aided software and analyze its biomechanical characteristics.

    METHODS: Image data of a patient with ankylosing kyphosis of type IIIA with strong 301 classification were obtained to establish a three-dimensional finite element model of ankylosing kyphosis. The osteotomy angles of T12, L1, L2 and L3 different segments were measured. Osteotomy of cancellous bone was simulated. The model after osteotomy was fixed with nail bar system. Biomechanical characteristics were analyzed.

    RESULTS AND CONCLUSION: (1) The closer the osteotomy segment was to the tail end, the greater the screw stress was, and the order of the screw stress distribution was L3 > L2 > L1 > T12. The stress distribution characteristics of different osteotomy segments were the same. The screw stress was concentrated on the adjacent upper/lower two segments of the osteotomy segment, and was significantly greater than that of other segments. (2) The order of the titanium rod stress was L2 > L3 > L1 > T12. (3) The closer the bone segment was to the head, the greater the stress was, and the order of the stress was T12 > L1 > L2 > L3. (4) The results show that for the type IIIA ankylosing kyphosis, the better degree of orthopedic can be obtained by selecting L2 osteotomy segment, and the complications caused by the concentration of internal fixation stress distribution can be reduced. 

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    Comparison of small-incision extreme lateral interbody fusion and minimally invasive transforamen interbody fusion for lumbar degenerative diseases
    Wang Shicheng, Pan Lei, Li Jie, Xue Houjun, Chen Weixiong, Lei Yu
    2020, 24 (30):  4829-4834.  doi: 10.3969/j.issn.2095-4344.2825
    Abstract ( 300 )   PDF (847KB) ( 48 )   Save

    BACKGROUND: Small-incision extreme lateral interbody fusion and minimally invasive transforamen interbody fusion are widely used to treat patients with lumbar degenerative diseases because of easy operation technology and less serious complications. However, for patients with lumbar degenerative diseases who meet the indications of both surgical methods, how to choose surgical methods needs further study.

    OBJECTIVE: To compare the clinical outcome between small-incision extreme lateral interbody fusion and minimally invasive transforamen interbody fusion in patients with lumbar degenerative diseases.

    METHODS: Seventy-six patients with single-segment lumbar degenerative diseases treated from June 2016 to December 2017 were retrospectively analyzed. The patients were divided into small-incision extreme lateral interbody fusion group and minimally invasive transforamen interbody fusion group. Operation time, intraoperative blood loss, postoperative visual analogue scale, Oswestry dysfunction index, Japanese Orthopedic Association score, complications, anterior convex angle of lumbar fusion segment, intervertebral height and intervertebral displacement were compared between the two groups.

    RESULTS AND CONCLUSION: (1) Operation time and intraoperative blood loss were better in the small-incision extreme lateral interbody fusion group than in the minimally invasive transforamen interbody fusion group (P < 0.05). (2) The incidence of complications was significantly higher in the small-incision extreme lateral interbody fusion group (19%) than in the minimally invasive transforamen interbody fusion group (10%) (P < 0.05). (3) There were no significant differences in visual analogue scale, Oswestry dysfunction index, Japanese Orthopedic Association score, intervertebral height, and anterior convex angle of fusion segment after surgery between the two groups (P > 0.05). (4) At the last follow-up, the anterior convex angle of fusion segment was larger in the small-incision extreme lateral interbody fusion group than in the minimally invasive transforamen interbody fusion group. The intervertebral height of fusion segment was higher in the small-incision extreme lateral interbody fusion group than in the minimally invasive transforamen interbody fusion group (P < 0.05). There was no significant difference in intervertebral displacement between the two groups (P > 0.05). (5) Both small-incision extreme lateral interbody fusion and minimally invasive transforamen interbody fusion can treat lumbar degenerative diseases effectively. Small-incision extreme lateral interbody fusion is superior to minimally invasive transforamen interbody fusion in terms of operation time, intraoperative blood loss and maintaining the anterior convex angle and intervertebral height of lumbar fusion segment, but incidence of complications is higher.

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    Application of personalized osteotomy guide plate in medial pivot knee prosthesis replacement based on MRI and three-dimensional CT
    Li Xuxiang, Zhang Huikang, Wei Bo, Yao Qingqiang, Xu Yan, Tang Cheng, Wang Liming
    2020, 24 (30):  4835-4840.  doi: 10.3969/j.issn.2095-4344.2807
    Abstract ( 424 )   PDF (757KB) ( 78 )   Save

    BACKGROUND: Personalized positioning guide plate based on three-dimensional CT data can improve the accuracy of posterior-stabilized prosthesis joint replacement, but bone structure reconstruction based on three-dimensional CT scan data ignores the thickness of distal femoral articular cartilage, which will affect the use of personalized osteotomy guide plate and the clinical effect of total knee arthroplasty.

    OBJECTIVE: To investigate the safety, accuracy and early clinical efficacy of three-dimensional printed screw positioning guide based on MRI and three-dimensional CT assisted medial pivot-total knee arthroplasty in the treatment of osteoarthritis.

    METHODS: A total of 110 patients with knee osteoarthritis admitted to Department of Orthopedics, Nanjing Hospital Affiliated to Nanjing Medical University from February 2018 to April 2019 were selected. All patients received medial pivot-total knee arthroplasty, and were randomly assigned to two groups. The 58 patients in the experimental group completed knee osteotomy with the assistance of personalized osteotomy guide plate based on MRI and three-dimensional CT. The 52 patients in the control group completed knee osteotomy with the traditional intramedullary and extramedullary positioning methods. The operation time and intraoperative blood loss of the two groups were recorded. Postoperative follow-up was conducted to review the X-ray films. KSS score of knee function and the visual analogue scale score were evaluated.

    RESULTS AND CONCLUSION: (1) 110 patients were followed up for 6-10 months without serious postoperative complications. (2) The operation time and intraoperative blood loss in the experimental group were less than those in the control group (P < 0.01). (3) According to the reexamination of X-ray at 1 month after surgery, the deviation between the postoperative values and the theoretical design values of hip-genus-ankle angle, coronal femoral component angle, coronal tibial component angle and sagittal tibial component angle were all smaller in the experimental group than those of the control group (P < 0.01). (4) KSS score of knee joint function in the experimental group 1, 3 and 6 months after the surgery was higher than that in the control group (P < 0.05). There was no significant difference in visual analogue scale score between the two groups (P > 0.05). (5) The results showed that the personalized osteotomy guide plate assisted internal axial knee prosthesis replacement based on MRI and three-dimensional CT could effectively improve the accuracy of prosthesis placement and shorten the operation time. The method was safe and feasible, and the early clinical effect was satisfactory. 

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    Radiomics for diagnostic value of osteoporosis in female patients based on lumbar magnetic resonance imaging
    He Li, Liu Zhai, Gao Zhimei, Liu Chunying, Zhao Junlu, Ren Qingyun
    2020, 24 (30):  4841-4846.  doi: 10.3969/j.issn.2095-4344.2846
    Abstract ( 395 )   PDF (665KB) ( 48 )   Save

    BACKGROUND: Magnetic resonance imaging (MRI) plays an increasingly important role in the diagnosis of osteoporosis. As a new method of image analysis, radiomics has potential clinical significance in the diagnosis of osteoporosis.

    OBJECTIVE: To explore the diagnostic value of osteoporosis based on lumbar MRI imaging model.

    METHODS: Fifty female patients who underwent both lumbar-spine MRI and dual-energy X-ray absorptiometry in Outpatient Department of First Hospital of Hebei Medical University from February 2017 to October 2018 at the age of 40-84 years were enrolled in this study. Dual-energy X-ray absorptiometry showed 28 osteoporosis patients, and 22 normal bone mineral density. In the sagittal plane T1WI and T2WI images of lumbar MRI, five consecutive layers in the middle of L2-4 vertebral body were selected for image segmentation; radiomics features were extracted; diagnostic models were constructed. Combined with clinical risk factors, the clinical-radiomics model was constructed. The area under the receiver operating characteristic curve was used to assess the model performance. The experiment was approved by the Ethics Committee of First Hospital of Hebei Medical University.

    RESULTS AND CONCLUSION: (1) The 396 × 3 features were extracted from T1WI, T2WI and combined sequences respectively in 50 subjects. After feature dimensionality reduction, four features of T1WI sequence, six features of T2WI sequence and four features of T1WI and T2WI combined sequence were screened out respectively. After diagnostic model establishment, the areas under the receiver operating characteristic curve of T1WI and T2WI models were 0.810 and 0.820, respectively. The area under the receiver operating characteristic curve of combined T1WI+T2WI model was 0.937, which was higher than that of a independent sequence. (2) Combining the T1WI + T 2WI radiomics features with clinical data, the diagnostic model suitable for female combined with clinical factors was constructed, and the area under the receiver operating characteristic curve of clinical-radiomics model was 0.960. (3) The results showed that the radiomics features based on routine lumbar MRI can distinguish osteoporosis from normal bone mass, and the clinical-radiomics diagnosis model based on clinical and radiomics features can improve the diagnostic efficiency, which is valuable for diagnosis of osteoporosis.

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    Design and application status of three-component total ankle replacement prosthesis
    Wang Songbo, Ling Ming, Wang Jicheng, Liu Shizhang
    2020, 24 (30):  4847-4853.  doi: 10.3969/j.issn.2095-4344.2834
    Abstract ( 399 )   PDF (689KB) ( 40 )   Save

    BACKGROUND: The early total ankle replacement has been abandoned for long times due to the insufficient understanding of the ankle joint biomechanics, higher implant failure rates and complications. With the updating of the design concept about ankle prosthesis, total ankle replacement surgery is now more and more popular among surgeons. At present, the three-component total ankle replacement prosthesis is considered to be more in line with the normal biomechanical requirements of the ankle joint, and has been gradually promoted for clinical application.

    OBJECTIVE: To understand the biomechanics of the ankle joint, summarize the design features of the three-component total ankle joint replacement prostheses, and summarize experience for further prosthetic design.

    METHODS: The first author used a computer to search CNKI and PubMed for the literature on total ankle replacement prostheses from inception to February 2020. The key words were “total ankle replacement prosthesis design, STAR prosthesis, HINTEGRA prosthesis, BOX prosthesis”.

    RESULTS AND CONCLUSION: (1) The STAR, HINTEGRA, and BOX prostheses have shown acceptable survival rates and clinical results in clinical applications; however, a large number of cases and long-term follow-up were also required. (2) The designs of the three kinds of total ankle replacement prostheses all focus on restoring the anatomy of the physiological ankle joint, reproducing the axis of motion of the ankle joint, being compatible with the geometry of the ligament, and reducing the mechanical alignment of the tissue around the ankle joint. (3) To achieve maximum ligament compatibility, the articular surface design of the prosthetic component must be two physiological anatomic shapes or two non-physiological anatomic shapes. (4) There is a significant difference between the shape of the Chinese ankle and that of Caucasian. We are looking forward to design and develop a more suitable prosthesis for Chinese peoples.

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    Clinical significance of external wall of femoral intertrochanteric fracture and the treatment of internal fixation
    Tao Jin, Xiong Guirun, Liu Pengran, Jiao Rui, Li Xiaolei, Yan Lianqi
    2020, 24 (30):  4854-4859.  doi: 10.3969/j.issn.2095-4344.2821
    Abstract ( 529 )   PDF (745KB) ( 65 )   Save

    BACKGROUND: The concept of the lateral wall as a hot area has emerged in recent years, and has great guiding significance for the treatment of intertrochanteric fractures.

    OBJECTIVE: To review the definition, scope, thickness of the lateral wall and its important role in the surgical treatment of intertrochanteric fractures.

    METHODS: The authors searched Wanfang, CNKI, PubMed, and Web of Science. The search terms were

    “intertrochanteric fracture, lateral wall, fracture fixation” in Chinese and English. The retrieved documents were sorted, analyzed and summarized.

    RESULTS AND CONCLUSION: (1) The definition, scope, thickness and measurement method of the lateral wall and its clinical significance were sorted out. (2) Classification criteria based on lateral intertrochanteric fractures of the femur were summarized. (3) In terms of treatment, four kinds of treatment methods: extramedullary fixation, intramedullary fixation, artificial joint replacement and other treatment methods were listed. Causes and treatment of fracture of lateral wall during and after operation were analyzed. (4) The results showed that the integrity of the lateral wall directly affected the stability of the internal fixation, even the success of the internal fixation. The complete lateral wall can prevent the distal femur from moving inward and the head pin from withdrawing, and prevent the coxa varus deformity. Clinicians should make use of detailed imaging examination, analyze fracture types, comprehensively consider various factors, and select appropriate repair methods.

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    Role of periosteum in fracture healing and bone tissue repair
    Jiang Shengyuan, Gong Zhihao, Song Kaikai, Du Gangqiang, Li Peng, Zhang Kai
    2020, 24 (30):  4860-4865.  doi: 10.3969/j.issn.2095-4344.2828
    Abstract ( 541 )   PDF (683KB) ( 52 )   Save

    BACKGROUND: The periosteum is involved in fracture healing and bone tissue repair because it contains cells with osteogenic potential, and its role in repairing bone defects has become a focus of current research.

    OBJECTIVE: To review the role of periosteum in fracture healing and bone tissue repair.

    METHODS: A computer-based online search of China National Knowledge Infrastructure database and PubMed was performed for articles regarding the role of periosteum in fracture healing and bone tissue repair published from January 1964 to December 2019. Key words included “periosteum, bone healing, periosteum cells” in English and Chinese. Finally, a total of 48 articles were included to review.

    RESULTS AND CONCLUSION: (1) The integrity of periosteum plays an important role in fracture healing and bone tissue repair, and has been widely used in bone tissue engineering due to its good osteogenic properties, excellent material properties and barrier effect. (2) The mechanism of periosteum in the process of distraction

    ostegogenesis is still controversial. It has been confirmed that absence of periosteum does not affect the osteogenic effect of mandibular defects, but the role of periosteum in osteogenic effect of limb defects remains to be further studied.

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    Action mechanism of bone remodeling imbalance in osteoporosis and relevant medical treatment strategy
    Yan Wei, Wang Zhonghan, Liu He
    2020, 24 (30):  4866-4874.  doi: 10.3969/j.issn.2095-4344.2843
    Abstract ( 458 )   PDF (932KB) ( 111 )   Save

    BACKGROUND: Currently, bone remodeling imbalance is considered as a core reason leading to osteoporosis. An effective early intervention is performed to regulate bone remodeling imbalance at initial stage that can reverse osteoporosis and improve prognosis to some extent. Antiresorptive and anabolic agents are two types of anti-osteoporosis drugs addressing bone remodeling imbalance. Therefore, investigating the mechanism of bone remodeling imbalance is essential to guide medical treatment in osteoporosis. In addition, clinical application and therapeutic effect between antiresorptive and anabolic agents urgently need to be systematically summarized and may serve as a guide for clinical medication.

    OBJECTIVE: To review mechanism of bone remodeling imbalance in osteoporosis, summarize action mechanism of antiresorptive and anabolic agents in regulating bone remodeling imbalance, and compare their clinical effects so as to give clinical medical guidance.

    METHODS: Related articles were searched in PubMed databases, Web of Science and CNKI from inception to February 2020. The key words were “osteoporosis, bone remodeling, antiresorptive, anabolic, bisphosphonate, RANKL inhibitor, PTH analogue, anti-sclerostin antibody” in English and Chinese. Initially, 144 articles were searched, and according to the inclusion and exclusion criteria, 84 eligible articles were included in final analysis.

    RESULTS AND CONCLUSION: (1) Bone remodeling is activated by bone damaging. Reversible and irreversible deficits are two bone reforming types followed by remodeling. (2) The reversible one goes through bone resorption, bone refilling and secondary mineralization process for 3 months and new forming bone exhibits high mechanical strength. (3) The irreversible deficit occurred after bone remodeling imbalance that bone forming rate is much lower than resorption rate. Although there is certain amount of new forming bone generated in breaking area but the bone quality is unsatisfied, which tends to break again. (4) Bisphosphonates and RANKL inhibitors belong to antiresorptive agents, and are capable to reduce bone resorption, but bone forming mass is also decreased accordingly. (5) In addition, anabolic agents including PTH analogues and anti-sclerostin antibodies are benefit for reconstructing damaged bone structure, especially haversian canal, and significantly promote bone quality and mechanical property as well.

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    Anatomical changes and imaging manifestations of childhood developmental dysplasia of the hip
    Liu Junyan, Pan Shinong
    2020, 24 (30):  4875-4881.  doi: 10.3969/j.issn.2095-4344.2837
    Abstract ( 376 )   PDF (837KB) ( 47 )   Save

    BACKGROUND: Developmental dysplasia of the hip is a common hip developmental deformity in children.

    Clinical treatment of developmental dysplasia of the hip differs in different periods. Early treatment has better efficacy, fewer complications, and better long-term prognosis. It can reduce the recurrence rate, reduce economic pressure, and improve the quality of life. Therefore, early diagnosis of developmental dysplasia of the hip is becoming more and more important clinically.

    OBJECTIVE: To review the research progress of anatomical changes and imaging manifestations of developmental dysplasia of the hip.

    METHODS: “DDH, Anatomy, X-ray Radiography, CT, MRI, Ultrasound” were used as English search terms. “Developmental hip dysplasia; anatomy; X-ray photography; CT; MRI, ultrasound” were used as Chinese search terms. The authors searched English databases such as PubMed and Springerlink, and Chinese databases such as Wanfang and CNKI from January 1990 to December 2019. Irrelevant and repetitive articles were excluded, and finally 55 articles were included for review.

    RESULTS AND CONCLUSION: Imaging diagnosis as a non-invasive examination method has become the preferred examination method for the diagnosis of developmental dysplasia of the hip, and its anatomical changes are more conducive to clinical imaging diagnosis. Routine X-ray examination can be used for rapid screening of developmental dysplasia of the hip. MRI helps to distinguish the early signal changes of soft tissue structure and bony structure. Three-dimensional CT can evaluate the acetabular bone structure changes from multiple angles, excluding the obstruction caused by posture factors. Ultrasonography is more sensitive to fluid and can also perform early screening of developmental dysplasia of the hip. Thus, different imaging examinations have their advantages and complement each other to improve the early diagnosis rate of developmental dysplasia of the hip.

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    Involvement and significance of large transmembrane protein Piezo1 in orthopedic related diseases
    He Qi, Zhang Gangyu, Wang Haibin, Chen Peng
    2020, 24 (30):  4882-4888.  doi: 10.3969/j.issn.2095-4344.2838
    Abstract ( 624 )   PDF (761KB) ( 224 )   Save

    BACKGROUND: Recent studies found that mesenchymal stem cells, osteoblasts and osteoclasts, cartilage cells, nucleus pulposus cells, and osteosarcoma cells can receive mechanical stimulation from extracellular environment through Piezo1 protein so as to activate cell signal transduction pathways, affecting cell proliferation, differentiation, migration and apoptosis, which determines physiological and pathological processes of physiological structure of bone, joint degeneration, and fracture healing.

    OBJECTIVE: To review Piezo1 related to osteoporosis and degenerative osteoarthropathy, summarize the latest advances by reviewing the latest discovery of Piezo1 in other orthopedic diseases, and provide ideas for novel treatment strategies for orthopedic related diseases.

    METHODS: A computer search was conducted on the literatures related to the research progress of Piezo1 in orthopedic diseases in CNKI and PubMed from inception to January 2020. The Chinese keywords were “mechanically sensitive ion channel proteins, osteoporosis, degenerative osteoarthropathy, orthopedic diseases”, and the English keywords were “Piezo1, osteoporosis, degenerative osteoarthropathy, orthopedic diseases”. A full web search was conducted, and finally 60 literatures were included for review and discussion.

    RESULTS AND CONCLUSION: (1) Piezo1 can release biological signals and regulate osteoclast activity during the development of osteoporosis by directly detecting the mechanical load in osteoblastic lineage cells. (2) In the progression of degenerative osteoarthropathy, Piezo1 on the cartilage cell membrane was able to effectively recognize stimuli of different strengths and types of external mechanical stress and eventually induce chondrocyte apoptosis. (3) In bone metabolic diseases, degenerative arthritis of joints and other orthopedic diseases, Piezo1 is involved in the pathological process of the disease. The emergence of Piezo1 provides a more specific molecular basis for the application of mechanical stimulation in orthopedics, opens a new thinking and perspective, and also lays a “hint” for the future dual drug administration and precision medicine.

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    A meta-analysis of efficacy and complications of 3D printing-assisted surgery for Schatzker IV-VI tibial plateau fractures
    Weng Nengyuan, Zhang Tao, Li Kainan, Lan Hai, Zhang Jinli, Fu Xuefei, Liu Qixin, Lin Qingyun
    2020, 24 (30):  4889-4897.  doi: 10.3969/j.issn.2095-4344.2835
    Abstract ( 345 )   PDF (992KB) ( 55 )   Save

    BACKGROUND: Although 3D printing technology has been gradually applied in the operation of tibial plateau fracture, there are still few reports about 3D printing assisted operation of Schatzker IV-VI tibial plateau fracture. Thus, it is necessary to make a meta-analysis and evaluation of the application value and complications of 3D printing assisted operation of Schatzker IV-VI tibial plateau fracture compared with traditional operation.

    OBJECTIVE: To evaluate the effect of 3D printing technology on therapeutic effect and complications of Schatzker IV-VI type tibial plateau fractures by meta-analysis.

    METHODS: PubMed, Cochrane Library, Web of Science, CNKI, CBM, and Wanfang databases were systematically searched by computer until December 2019. Two researchers independently screened the literature, evaluated the quality and extracted the data. The included literature was statistically analyzed using Stata 15.0 software.

    RESULTS AND CONCLUSION: (1) A total of 15 Chinese literatures were included, including a total of 758 patients, of which 342 underwent surgery assisted by 3D printing technology, 416 underwent traditional surgical treatment. (2) The results of meta-analysis showed: operation time [SMD=-2.023, 95%CI=-2.418~-1.628, P < 0.05], intraoperative blood loss [SMD=-1.981, 95%CI=-2.489~ -1.474, P < 0.05], intraoperative fluoroscopy [SMD=-3.183, 95%CI=-5.758~-0.608, P < 0.05], fracture healing time [SMD=-0.797, 95%CI=-1.504~-0.090, P < 0.05], and complication rate [RR=0.383, 95%CI=0.215~0.680, P < 0.05] were significantly lower in the 3D printing group than in the traditional group. (3) The Hospital for Special Surgery score at 6 months [RR=0.779, 95%CI=0.510~1.048, P < 0.05], the Hospital for Special Surgery score at 12 months [RR=0.603, 95%CI=0.334~0.871, P < 0.05], the excellent and good rate of Hospital for Special Surgery [RR=1.206, 95%CI=1.092~1.331, P < 0.05], and the excellent and good rate of Rasmussen score [RR=1.178, 95%CI=1.037~1.338, P < 0.05] were significantly better in the 3D printing group than in the traditional group. (4) The 3D printing technology in Schatzker type IV-VI tibial plateau fracture surgery has the advantages of shortening operation time, lessening intraoperative blood loss, few complications, less intraoperative fluoroscopy, and fast healing, which can improve the precision of tibial plateau fractures and postoperative knee function recovery.

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    Comparison of three-dimensional printing-assisted pedicle screw placement and traditional surgery for lumbar spondylolisthesis: a meta-analysis
    Zhou Junde, Fan Zhirong, Su Haitao, Peng Jiajie, Zhou Lin, Hong Weiwu, Huang Huida
    2020, 24 (30):  4898-4904.  doi: 10.3969/j.issn.2095-4344.2829
    Abstract ( 334 )   PDF (844KB) ( 90 )   Save

    BACKGROUND: With the development of three-dimensional (3D) printing technology, it has been widely used in spinal surgery. However, whether 3D printing-assisted surgery for lumbar spondylolisthesis has an advantage over traditional surgery is still controversial.

    OBJECTIVE: To compare the clinical efficacy and safety of 3D printing-assisted versus conventional surgery for the treatment of lumbar spondylolisthesis using system evaluation.

    METHODS: Randomized controlled trials about 3D printing technology for lumbar spondylolisthesis in CNKI, Wanfang database, CBM, VIP, PubMed, Cochrane Library, Embase, and Web of Science were searched via computer from inception to November 16, 2019. The retrieved literatures were screened according to predefined inclusion and exclusion criteria, and quality evaluation was performed. Then, the available data were extracted and analyzed with the Stata 11.0 software.

    RESULTS AND CONCLUSION: (1) Six randomized controlled trials including 394 cases were included. Among them, 201 cases were assigned to the 3D printing-assisted group and 193 cases to the conventional group. (2) Meta-analysis results showed that the 3D printing-assisted group proved significantly superior to the conventional group regrading the operation time [WMD=-38.17, 95%CI(-43.93, -32.41), P=0.00], intraoperative blood loss [WMD=-61.61, 95%CI(-69.19, -54.03), P=0.00], the frequency of fluoroscopy [WMD=-4.89, 95%CI(-6.38, -3.41), P=0.00] and the screw placement accuracy [OR=3.89, 95%CI(2.43, 6.25), P=0.00]. (3) However, in terms of the postoperative visual analogue scale scores [WMD=-0.47, 95%CI(-1.21, 0.27), P=0.215], Oswestry disability index [WMD=-1.41, 95%CI(-2.87, 0.05), P=0.058], Japanese Orthopaedic Association scores [WMD=1.02, 95%CI(-0.68, 2.72), P=0.240] and the rate of complications [OR=0.37, 95%CI(0.12, 1.11), P=0.075], no statistically significant differences were found between the two groups. (4) In conclusion, the application of 3D printing technology in the surgical treatment of lumbar spondylolisthesis has the advantage of shortening the operation time, reducing intraoperative blood loss and frequency of fluoroscopy and improving the accuracy of the screw placement. 

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    A meta-analysis of high tibial osteotomy and monocondylar replacement for treating medial interventricular osteoarthritis of the knee
    Bai Hao, Sun Haibiao, Han Xiaoqiang, Xue Jiangang
    2020, 24 (30):  4905-4913.  doi: 10.3969/j.issn.2095-4344.2844
    Abstract ( 406 )   PDF (1353KB) ( 42 )   Save

    BACKGROUND: The most common surgical methods for the treatment of medial interventricular osteoarthritis of the knee are high tibial osteotomy and monocondylar replacement, and systematic evaluation of the difference in efficacy between the two is still lacking.

    OBJECTIVE: To compare the clinical efficacy of high tibial osteotomy and monocondylar replacement in the treatment of medial interventricular osteoarthritis of the knee.

    METHODS: PubMed, The Cochrane library, EMBASE, ScienceDirect, CNKI, Wanfang, and VIP were searched by computer. Literature was collected on observational cohort studies or randomized controlled trials comparing high tibial osteotomy/monocondylar replacement in the treatment of medial interventricular osteoarthritis of the knee, with a retrieval period from 2000 to 2019. Two people independently read and screened literature, extracted data and evaluated the quality of the study. RevMan 5.3 software was used for data analysis.

    RESULTS AND CONCLUSION: (1) A total of 13 studies were included, with 711 patients. (2) Meta-analysis results showed that the knee range of motion of high tibial osteotomy group (MD=-5.47, 95%CI: -9.53 to -1.41, P=0.008) was significantly better than that of monocondylar replacement group. Lysholm knee score (MD=0.84, 95%CI: 0.29 to 1.39, P=0.003) in the monocondylar replacement group at the last follow-up was significantly better than that of the high tibial osteotomy group. (3) There were no significant differences between the two groups in the incidence of postoperative complications, revision rate of total knee replacement, postoperative infection rate, degeneration rate of patellofemoral articular cartilage, degeneration rate of lateral compartment, excellent and good rate, and tibiofemoral angle after surgery (P > 0.05). (4) It is concluded that in the treatment of medial interventricular osteoarthritis of the knee according to the indications of operation, high tibial osteotomy can obtain similar complications, postoperative revision rate of total knee arthroplasty, postoperative infection, degeneration rate of patellofemoral articular cartilage, degeneration rate of the lateral compartment, excellent and good rate, postoperative tibial angle as monocondylar replacement, but the postoperative motion range of high tibial osteotomy is better than that of monocondylar replacement, while monocondylar replacement enables better knee function. 

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    Systematic review and meta-analysis on the effect of resistance training on bone mineral density in postmenopausal women with osteoporosis
    Zhao Zhonghai, Yan Tong, Li Hongqiu, Pan Hai
    2020, 24 (30):  4914-4920.  doi: 10.3969/j.issn.2095-4344.2845
    Abstract ( 638 )   PDF (690KB) ( 94 )   Save

    BACKGROUND: Resistance training has been shown to help improve bone mineral density in postmenopausal women with osteoporosis. However, it remains to be studied whether the exercise mode, training intensity, training time, and training frequency of resistance training, and the combination with different modes (such as aerobic exercise) is better.

    OBJECTIVE: To evaluate the effect of resistance training on bone mineral density in postmenopausal women with osteoporosis.

    METHODS: Randomized controlled trials related to resistance training intervention on bone mineral density in postmenopausal women with osteoporosis were collected. Subjects were divided into resistance training group and blank control group. PubMed, EMBASE, Web of Science, CNKI and Wanfang database were retrieved from inception to December 2019, and relevant references of included literatures were searched. Two researchers screened the literature according to inclusion and exclusion criteria and valid data were extracted for quality evaluation. The included literature data were meta-analyzed by RevMan5.3 software.

    RESULTS AND CONCLUSION: (1) Finally, 23 randomized controlled trials were included. The risk bias evaluation results of the included literatures showed that the overall literature quality was above medium. (2) The results of meta-analysis showed that compared with the blank control group, the resistance training group had significant effect on the improvement of bone mineral density of lumbar spine [SMD=0.02, 95%CI (0.01,0.03), P < 0.000 1], bone mineral density of total hip [SMD=0.25, 95%CI (0.06, 0.44), P=0.03], bone mineral density of femoral neck [SMD=0.28, 95%CI (0.12,0.04), P=0.000 5], and bone mineral density of greater trochanter [SMD=0.02, 95%CI (0.00, 0.03), P=0.02]. (3) Resistance training is beneficial to maintain the bone mineral density level of postmenopausal women with osteoporosis, and can be an important part of exercise therapy for postmenopausal women with osteoporosis.

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