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28 November 2020, Volume 24 Issue 33 Previous Issue    Next Issue

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Robot-guided percutaneous kyphoplasty in treatment of multi-segmental spinal metastases Lin Shu, Hu Jiang, Wan Lun, Tang Liuyi, Wang Yue, Yu Yang, Zhang Wei 2020, 24 (33):  5249-5254.  doi: 10.3969/j.issn.2095-4344.2883 Abstract ( 347 )   PDF (601KB) ( 38 )   Save BACKGROUND: Percutaneous kyphoplasty for multi-segmental spinal metastases has some problems, such as long operation time, high fluoroscopic dose, and easy leakage of bone cement. Robot-guided percutaneous kyphoplasty can optimize surgery and reduce the incidence of complications. OBJECTIVE: To evaluate the safety and advantage of robot-guided percutaneous kyphoplasty in treatment of multi-segmental spinal metastases.   METHODS: The clinical data of 43 cases with multi-segmental spinal metastases with no signs of nerve injury from January 2018 to April 2019 were analyzed retrospectively. According to the different operation methods, the patients were divided into robot-guided group (22 cases) and traditional fluoroscopy group (21 cases). There was no significant difference in gender, age, number of diseased vertebrae, source of primary tumor and preoperative visual analogue scale score between the two groups (P > 0.05), with comparability. The data of operation time, fluoroscopy frequency, fluoroscopy dose, the incidence rate of pedicle wall breaking, angle of penetration, and leakage of bone cement were collected in both groups. Visual analogue scale score, the midline vertebral height and Cobb angle were compared preoperatively, 2 days postoperatively, and during the final follow-up between the two groups. RESULTS AND CONCLUSION: (1) The number of diseased vertebrae in the robot-guided group and traditional fluoroscopy group was 79 and 70, respectively. (2) The average operation time, fluoroscopy frequency and fluoroscopy dose in the robot-guided group were significantly lower than those in the traditional fluoroscopy group, and the difference was statistically significant (P < 0.001). (3) The incidence rate of pedicle wall breaking was 6% in the robot-guided group and 21% in the traditional fluoroscopy group, and the difference was statistically significant (χ2=6.040, P=0.014). (4) The angle of penetration in the robot-guided group was larger than those in the traditional fluoroscopy group (P < 0.001). (5) The leakage rate of bone cement in the robot-guided group was lower than in the traditional fluoroscopy group (8%, 23%,χ2=6.869, P=0.009). (6) There was no significant difference in visual analogue scale score, the midline vertebral heights and Cobb angle between the two groups before and 2 days after operation and during the final follow-up (P > 0.05). (7) It is indicated that robot-guided percutaneous kyphoplasty in treatment of multi-segmental spinal metastases can reduce operation time, reduce fluoroscopy frequency, reduce fluoroscopy dose, have good accuracy of penetration and low leakage rate of bone cement.  Figures and Tables | References | Related Articles | Metrics

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Design and implementation of an adolescent idiopathic scoliosis orthosis design expert system based on fuzzy logic Zhao Dezhu, Guan Tianmin, Wu Bin, Mei Zhao 2020, 24 (33):  5255-5261.  doi: 10.3969/j.issn.2095-4344.2342 Abstract ( 488 )   PDF (542KB) ( 64 )   Save BACKGROUND: In recent years, artificial intelligence technology has been widely used in various fields of the medical industry, effectively assisting doctors in the diagnosis and treatment of patients. In the conservative treatment of adolescent idiopathic scoliosis, artificial intelligence technology can be applied to the design of adolescent idiopathic scoliosis orthosis, thereby shortening the manufacturing cycle of adolescent idiopathic scoliosis orthosis. OBJECTIVE: To design and implement an adolescent idiopathic scoliosis orthosis design expert system based on fuzzy logic. With the help of the expert system, it can help physicians to design adolescent idiopathic scoliosis orthosis quickly and effectively.   METHODS: The adolescent idiopathic scoliosis orthosis design expert system is developed through the hybrid programming of C Language Integrated Production System and C++. The main function modules of adolescent idiopathic scoliosis orthosis design expert system include fuzzy inference engine, agenda, knowledge base management system, knowledge base, fact base, interpreter, and human-computer interface. Aiming at the uncertain information in the design of scoliosis orthosis, the knowledge representation of adolescent idiopathic scoliosis orthosis design is realized by fuzzy set theory, and the reasoning of adolescent idiopathic scoliosis orthosis design is realized by fuzzy reasoning based on certainty factor. The feasibility of the design method of adolescent idiopathic scoliosis orthosis design expert system based on fuzzy logic was verified by the treatments of two cases of adolescent idiopathic scoliosis patients. RESULTS AND CONCLUSION: (1) The adolescent idiopathic scoliosis orthosis design expert system improved the design efficiency of scoliosis orthosis by 50% and the deviation rates between the reasoning values and the actual operation values of experts were less than 10%. (2) Therefore, the adolescent idiopathic scoliosis orthosis design expert system can assist physicians to design adolescent idiopathic scoliosis orthosis quickly and effectively.  Figures and Tables | References | Related Articles | Metrics

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Establishment and validation of the finite element model of ossification of the posterior longitudinal ligament of the cervical spine with interbody fusion Wang Qi, Li Hui 2020, 24 (33):  5262-5266.  doi: 10.3969/j.issn.2095-4344.2890 Abstract ( 417 )   PDF (479KB) ( 45 )   Save BACKGROUND: The etiology of ossification of the posterior longitudinal ligament of the cervical spine is still unclear, which is different from the normal shape and mechanical properties of the cervical spine, making the biomechanical study of ossification of the posterior longitudinal ligament of the cervical spine a difficulty. OBJECTIVE: To establish a three-dimensional (3D) finite element model of ossification of the posterior longitudinal ligament of the cervical spine with interbody fusion and verify its effectiveness. METHODS: A volunteer was selected from Department of Orthopedics, Affiliated Hospital of Yuncheng Nursing Vocational College. Totally 719 DICOM format images of cervical spine during CT scans were imported into Mimics modeling software. A preliminary 3D model was constructed in stl format. Geomagic Studio 2013 software was used to refine the 3D model to smooth out noise and generate NURBS. The surface model is then imported into the finite element analysis software Ansys workbench 15.0, adding ligaments and intervertebral discs, meshing, assigning material properties, and simulating six kinds of human cervical spine activities. They were compared with references. RESULTS AND CONCLUSION: (1) The 3D finite element model of ossification of the posterior longitudinal ligament of the cervical spine with interbody fusion consisted of 7 cervical vertebral bodies, 1 thoracic vertebral body, 5 intervertebral discs, and ligaments, totally 320 512 nodes and 180 905 units. The appearance was realistic; the detail reduction was high; and the cervical posterior longitudinal ligament bone had good geometric similarity. (2) In flexion and extension, left and right lateral bending, axial rotation activity compared with the reference, there is no difference. (3) The 3D finite element model of ossification of the posterior longitudinal ligament of the cervical spine with interbody fusion has good mechanical and geometric similarity.  Figures and Tables | References | Related Articles | Metrics

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A biomechanical analysis of low back pain Young Lihjier, Ouyang Lin, Chen Dingwei, Lin Qi 2020, 24 (33):  5267-5271.  doi: 10.3969/j.issn.2095-4344.2848 Abstract ( 477 )   PDF (659KB) ( 215 )   Save BACKGROUND: Low back pain is a disease that is very easy to occur in human beings. The causes are complex, and the pathogenesis is still not fully elucidated. OBJECTIVE: To make a detailed mechanical analysis of the causes of lower back pain. METHODS: Based on the principle of biomechanics, the 3D mechanical simulation of L4 and its small joints on both sides was carried out by using Matlab and Photoshop. The slip force of L3-L4 intervertebral disc when people with different body masses bend at different angles and extract different weights, and the percentage of stress transferred to the joint capsule in different degrees of disc degeneration were analyzed. RESULTS AND CONCLUSION: (1) The pressure on L4 when it bends to move the object can decrease nonlinearly with the increase of the bending angle. The greater the bending angle, the smaller the pressure on L4 is. When stooping to carry goods, the pressure on L4 is directly proportional to the mass of human body or goods. (2) When a person bends down to 75°, the strength of psoas major muscle can be 20 times of the body weight due to the generation of circular stress, and the same repeated action can make the muscle fatigue, and then cause damage. The degeneration of the intervertebral disc can enlarge the stress of the surrounding tissues by about four times, and cause stress injury to these tissues. Figures and Tables | References | Related Articles | Metrics

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ICB orthotic insole can correct balance, walking ability and biological force line of lower limbs in children with spastic diplegia Liu Shuai, Sun Qiangsan 2020, 24 (33):  5272-5276.  doi: 10.3969/j.issn.2095-4344.2341 Abstract ( 429 )   PDF (611KB) ( 117 )   Save BACKGROUND: The improvement of balance and walking ability of children with spastic diplegia has always been the key and difficult point in the rehabilitation treatment of children. The treatment time is long and the effect is not ideal. ICB orthotic insole is a new customizable rehabilitation assistant tool, which is used to diagnose and improve the biomechanical problems. There are few reports about ICB orthotic insole used in the rehabilitation of children with spastic diplegia in China. OBJECTIVE: To investigate the effect of ICB orthotic insole on balance, walking ability and correction of biological force line of lower limbs in children with spastic diplegia. METHODS: Totally 96 children with spastic diplegia were divided into observation group and control group, 48 cases in each group. The control group was given the corresponding routine rehabilitation treatment according to the condition of limb dysfunction. The observation group was wearing ICB orthopedic insole for orthopedic treatment besides routine rehabilitation treatment. Before treatment and 6 months after treatment, biomechanical parameters of lower limbs, Berg Balance Scale, GMFM88 D and E functional areas were used to evaluate the recovery of balance and walking ability of the two groups. RESULTS AND CONCLUSION: After treatment, resting calcaneal stance position, malleolar position, hip range of motion, Berg Balance Scale score, and GMFM88 scores of the two groups were significantly improved compared with those before treatment (P < 0.05). Intergroup comparison displayed that after treatment, the above indexes in the observation group were significantly better than those in the control group (P < 0.05). The results confirm that ICB orthopedic insole can be used as an important auxiliary means of rehabilitation treatment to correct the biological force line of lower limbs, improve the balance and walking ability of children with spastic diplegia. Figures and Tables | References | Related Articles | Metrics

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Total knee arthroplasty in the treatment of knee valgus deformity Zhang Zhaoming, Lin Tianye, Chen Leilei, Yang Peng, Xu Jingli, Chen Zhenqiu, He Wei, Zhang Qingwen 2020, 24 (33):  5277-5282.  doi: 10.3969/j.issn.2095-4344.2888 Abstract ( 420 )   PDF (513KB) ( 54 )   Save BACKGROUND: The cases of knee valgus deformity are rare and the operation is difficult. At present, the technical specifications of osteotomy and soft tissue balance at home and abroad are not uniform. OBJECTIVE: To investigate the curative effect of total knee arthroplasty in the treatment of knee valgus deformity. METHODS: A retrospective analysis of patients with primary knee arthroplasty for knee valgus admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2010 to August 2016 was performed. Individualized soft tissue release, precise osteotomy, appropriate prosthesis, and surgical approach were selected according to the patient’s condition. Western Ontario and McMaster Universities Osteoarthritis Index, knee society score, femorotibial angle, knee motion range, and EQ-5D scale score were evaluated before and 3 years after operation. X-ray films were reviewed regularly to observe whether the knee joint was loose or displaced. Survival rate and complications were recorded. RESULTS AND CONCLUSION: (1) A total of 32 patients (32 knees) were enrolled. The follow-up period was 3-9 years. (2) The clinical and functional scores of knee society during the 3-year follow-up were significantly higher than those before surgery, and the differences were statistically significant (P < 0.05). There were no differences in clinical and functional scores of knee society in different deformity groups before surgery. The clinical and functional scores of knee society in different deformity groups at 3 years after operation were significantly different (P < 0.05). The mild deformity group and the moderate deformity group had higher scores than the severe deformity group. (3) The EQ-5D at 3 years after surgery was significantly increased than that before surgery, and the difference was statistically significant (P < 0.05). There were no differences in EQ-5D in different deformity groups before surgery. There were statistically significant differences in EQ-5D in different deformity groups at 3 years after operation. The mild deformity group and the moderate deformity group had better improvement than the severe deformity group. (4) Western Ontario and McMaster Universities Osteoarthritis Index at 3 years after surgery was significantly lower than that before surgery, and the difference was statistically significant (P < 0.05). There were no differences in Western Ontario and McMaster Universities Osteoarthritis Index between different deformity groups before surgery. There were statistically significant differences in Western Ontario and McMaster Universities Osteoarthritis Index in different deformity groups after surgery (P < 0.05). The mild deformity group and the moderate deformity group had lower index than the severe deformity group. (5) Knee motion range increased significantly after replacement. Compared with preoperatively, the difference was statistically significant (P < 0.05). There was no difference in knee motion range between different deformity groups after surgery (P > 0.05). (6) During the follow-up, the knee prosthesis was well fixed, no loosening or dislocation, no obvious deep vein thrombosis, no prosthesis infection. The survival rate of the prosthesis was 100%. (7) Under the guidance of individualized soft tissue balance technique and precise osteotomy, the selection of appropriate knee prosthesis for total knee arthroplasty in the treatment of knee valgus deformity is safe and effective, and the medium- and long-term results are satisfactory. Figures and Tables | References | Related Articles | Metrics

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Movable platform unicompartmental knee arthpoplasty for spontaneous osteonecrosis of knee: a five-year follow-up Niu Guoqing, Peng Zhihao, Wen Jianqiang, Pan Yaocheng, Lu Guoliang 2020, 24 (33):  5283-5288.  doi: 10.3969/j.issn.2095-4344.2891 Abstract ( 409 )   PDF (662KB) ( 70 )   Save BACKGROUND: Spontaneous osteonecrosis of knee joint mainly affects the medial condyle of femur and is a good indication for unicompartmental knee arthpoplasty. However, the therapeutic effect after unicompartmental knee arthpoplasty is still controversial. OBJECTIVE: To explore the clinical effect of movable platform unicompartmental knee arthpoplasty for knee spontaneous osteonecrosis in 5-year follow-up. METHODS: From January 2014 to January 2015, the data of patients diagnosed as spontaneous osteonecrosis of medial compartment of knee joint and treated with unicompartmental knee arthpoplasty of mobile platform in the Department of Arthrology of Foshan Hospital of Traditional Chinese Medicine were analyzed retrospectively. Totally 64 patients were included according to the inclusion and exclusion criteria. The data of age, sex, body weight, necrotic site, Koshino stage and necrotic volume were collected and analyzed. Knee maximum range of motion, American Special surgery Hospital score, Oxford knee joint score and visual analogue scale pain score were used to evaluate knee function before and during follow-up. Preoperative and follow-up evaluations of the lower extremity line of force were performed through full-length X-ray films of both lower extremities, and the presence of complications was observed. RESULTS AND CONCLUSION: (1) Sixty-two patients affected femoral metatarsal necrosis; two patients had medial tibial plateau necrosis; 40 patients had Koshino stage III; 24 cases had stage IV; lesion volume was 5.62 to 32.52 cm3; 45 cases had small-area necrosis; and 14 cases had middle area necrosis. There were five cases of large-area necrosis. (2) All the patients were healed by stage I. The follow-up period was 60-72 months. One patient had dislocation of the polyethylene liner 3 months after surgery and was used again for surgery. The function was good after thickening the pads. Two patients showed loosening of the prosthesis 4 years after the operation, and were revised to total knee replacement. The remaining patients had no infection, dislocation of the prosthesis, loosening of the prosthesis, venous thrombosis of the lower limbs, pulmonary embolism, and cardiovascular and cerebrovascular accidents, or post-traumatic psychiatric disorders during the follow-up. (3) American Special surgery Hospital score, Oxford knee joint score, knee joint maximum range of motion, and visual analogue scale pain score were significantly improved at the last follow-up than before surgery, and the difference was statistically significant (P < 0.05). (4) At the last follow-up, hip-knee-ankle angle and tibiofemoral angle were significantly improved than before surgery (P < 0.05). The lower limb force line was corrected. (5) It is concluded that the treatment of spontaneous osteonecrosis of knee with movable platform unicompartmental knee arthpoplasty has the advantages of less trauma, more bone mass retention, quick recovery, obvious improvement of lower limb force line, good joint function after operation, and satisfactory mid-term effect.  Figures and Tables | References | Related Articles | Metrics

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Stability of the acetabular cup in different positions to repair acetabular dysplasia Zhao Yang, Chen Shirong 2020, 24 (33):  5289-5294.  doi: 10.3969/j.issn.2095-4344.2340 Abstract ( 411 )   PDF (540KB) ( 31 )   Save BACKGROUND: In the treatment of severe acetabular dysplasia with total hip arthroplasty, it is still controversial whether the cup of the hip prosthesis should be placed in the true acetabulum or not. OBJECTIVE: To analyze the stability of acetabular cup in different positions by simulating the process of total hip arthroplasty with digital orthopedics. METHODS: Pelvic CT imaging data of eight patients with acetabular dysplasia (Crowe III) were collected. The pelvic and acetabular cups of patients were reconstructed using Mimics and Solidworks software. According to the size of the patient’s own acetabulum, a suitable acetabular prosthesis was installed at the position of the true acetabulum. The acetabular cup prosthesis was moved up to 20 mm in increments of 2 mm in order to compare the effective CE angle and the coverage of acetabular cup with different heights of acetabulum prosthesis. RESULTS AND CONCLUSION: (1) When the acetabular cup was moved up to 14 mm above the true acetabulum, the maximum effective CE angle was (28.90±1.31)° and the corresponding acetabular cup diameter was (42.00±1.94) mm. There was no significant difference between the effective CE measured at 16, 18 and 20 mm above the true acetabulum (P > 0.05); there was significant difference between the other groups (P < 0.05). (2) When the acetabular cup was moved up to 12 mm above the true acetabulum, coverage rate of the acetabular cup was highest (93.16±1.04)%. At this time, the corresponding acetabular cup diameter was (43.00±1.73) mm, and there was no significant difference in the coverage rate of the acetabular cup measured at 14, 16, and 18 mm above the true acetabulum (P > 0.05); there was significant difference between the other groups (P < 0.05). (3) The correlation analysis showed that the effective CE angle was positively correlated with the coverage rate of acetabular cup as the position of acetabular cup moved up. (4) The results showed that the more stable acetabular cup would be obtained in the total hip arthroplasty by appropriately moving up the rotation center to treat acetabular dysplasia (Crowe III) without using structural bone transplantation. Figures and Tables | References | Related Articles | Metrics

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Effectiveness of artificial intelligent laser location system in reducing the location time and radiation dose of vertebroplasty Wang Xiuting, Li Sisheng, Sun Jian, Zhang Genyuan, Liu Fayin, Zhang Jintao 2020, 24 (33):  5295-5299.  doi: 10.3969/j.issn.2095-4344.2892 Abstract ( 380 )   PDF (585KB) ( 72 )   Save BACKGROUND: Studies have reported that the radiation exposure dose of percutaneous vertebroplasty is 10 times that of other spinal operations. According to the two-dimensional image, the C-arm alone cannot provide more information about the injured vertebrae. There are technical defects in the process of positioning puncture during the guide operation, which has potential safety risks for both doctors and patients. Therefore, how to improve the positioning accuracy and reduce or avoid the exposure of radiation dose is a consensus. OBJECTIVE: To evaluate the effectiveness of an artificial intelligent laser location system in reducing the location time and radiation dose in vertebroplasty procedures. METHODS: Eighty-six cases with osteoporotic vertebral compression fracture were randomly divided into two groups. Forty-three cases in the trial group were located on the body surface with C-arm fluoroscopy assisted by the artificial intelligent laser location system, and the remaining 43 cases in the control group were treated with regular C-arm fluoroscopy alone. For each procedure, radioscopy frequency, radiation dose and location puncture time were recorded. The radiation dose was documented using a Hitachi-Aloka Medical external dosimeter. RESULTS AND CONCLUSION: (1) Location radioscopy frequency, radioscopy frequency of puncture, and total radiation dose were less, and the mean procedure time was shorter in the trial group compared with the control group (P < 0.001). (2) The puncture accuracy of the trial group was 65% higher than that of the control group. (3) In both groups, no polymethyl methacrylate leakage into the spinal canal, chest or abdominal cavity, no pulmonary embolism or infection occurred. (4) It is concluded that the C-arm assisted artificial intelligent laser location system applied in percutaneous vertebroplasty improves the accuracy of location in percutaneous vertebroplasty, effectively reduces the radioscopy frequency and radiation exposure dose, and shortens the location puncture time. This system is simple and easy to learn. During the procedure, the patient’s body should be prevented from shifting.  Figures and Tables | References | Related Articles | Metrics

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Comparison of lumbar-pelvic sagittal parameters after single-level and double-level posterior lumbar interbody fusion Wei Yangyang, Chen Jiacheng, Sun Jun, Wang Qiuan, Yuan Feng 2020, 24 (33):  5300-5306.  doi: 10.3969/j.issn.2095-4344.2893 Abstract ( 385 )   PDF (633KB) ( 32 )   Save BACKGROUND: Posterior lumbar intervertebral fusion is a classic surgical procedure for the treatment of degenerative lumbar spondylolisthesis. It has the advantages of improving lumbar lordosis, increasing the height of the intervertebral space, resetting the spondylolisthesis, and improving the quality of life of patients. OBJECTIVE: To investigate the effect of single-level and double-level posterior lumbar interbody fusion for low-grade degenerative lumbar spondylolisthesis on lumbar-pelvic sagittal parameters, and analyze the influencing factors of lumbar-pelvic sagittal parameters.  METHODS: A retrospective analysis of 68 patients with degenerative lumbar spondylolisthesis treated with single-level or double-level low-grade (I-II degree) posterior lumbar interbody fusion using polyetheretherketone interbody fusion cage from January 2014 to September 2017 was conducted. According to the fusion segment, the patients were divided into single-level group (n=37) and double-level group (n=31). Before and at the last follow-up, X-ray films of lumbar spine with bilateral femoral head standing position were taken to compare the lumbar-pelvic sagittal parameters, the subsidence rate of fusion cage and bone fusion of the two groups. RESULTS AND CONCLUSION: (1) The patients in both groups successfully completed the operation and were followed up. All patients were followed up for 12-40 months. (2) The vertebral slip indexes in the single-level group and the double-level group were significantly improved compared with those before surgery (P < 0.05), and there was no significant difference in the improvement between the two groups (P > 0.05). (3) Compared with the preoperation, the pelvic tilt angle was significantly reduced (P < 0.05), and the sacral slope was significantly increased (P < 0.05), but the difference between the two groups was not statistically significant (P > 0.05). (4) Compared with the preoperation, the lumbar lordosis, lower lumbar lordosis, and lumbar lordosis distribution index in the two groups were significantly increased (P < 0.05); and the increase value of the double-level group was significantly higher than that of the single-level group (P < 0.05). (5) Compared with preoperation, L5 incident, L5 slope, L1 axis and S1 distance were significantly reduced (P < 0.05), and the decrease in the double-level group was significantly greater than that of single-level group (P < 0.05). (6) There was no significant difference in the cage subsidence rate between the two groups (P > 0.05). Bone fusion was achieved in all patients at the last follow-up. (7) Low-grade degenerative lumbar spondylolisthesis can improve sagittal balance through posterior lumbar interbody fusion. The sagittal parameters of lumbar spine and pelvis were more significant after double segment fusion. Figures and Tables | References | Related Articles | Metrics

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Hidden blood loss during posterior lumbar interbody fusion in lumbar spinal stenosis patients with and without rheumatoid arthritis Wang Jing, Xu Shuai, Liu Haiying 2020, 24 (33):  5307-5314.  doi: 10.3969/j.issn.2095-4344.2877 Abstract ( 325 )   PDF (594KB) ( 100 )   Save BACKGROUND: In addition to intraoperative bleeding and postoperative drainage after posterior approach for lumbar spinal stenosis, there is a large amount of hidden blood loss. Patients combined with rheumatoid arthritis may affect perioperative bleeding, especially hidden blood loss, which has not been reported before. OBJECTIVE: To compare intraoperative blood loss, postoperative drainage and hidden blood loss of posterior lumbar interbody fusion on lumbar spinal stenosis in patients with rheumatoid arthritis and non-rheumatoid arthritis and identify the risk factors of hidden blood loss in patients with rheumatoid arthritis. METHODS: Totally 65 patients diagnosed as lumbar spinal stenosis with rheumatoid arthritis (rheumatoid arthritis group) and 87 patients without rheumatoid arthritis (non-rheumatoid arthritis group) were retrospectively enrolled. All patients were treated with posterior decompression fusion and posterolateral fusion with internal fixation system of pedicle screw + titanium rod + interbody fusion cage. Posterolateral autogenous bone grafting was performed during the operation. The extracted measures included demographic characteristics, rheumatoid arthritis-related parameters such as rheumatoid arthritis duration, Steinbrocker classification and anti-rheumatoid arthritis drugs as well as information on operation and blood loss. Intraoperative blood loss, postoperative drainage and hidden blood loss were the primary outcomes. The secondary measures included operation time, preoperative and postoperative hematocrit and hemoglobin, the number of anemia pre- and post-operatively, autologous blood and allogeneic blood transfusion. RESULTS AND CONCLUSION: (1) The mean age and bone mass index were (65.97±8.02) years and (25.76±3.68) kg/m2 of patients in rheumatoid arthritis group. The gender ratio, age and number of surgical segments were all matched between the rheumatoid arthritis and non-rheumatoid arthritis groups. (2) The mean duration was (16.78±12.73) years in the rheumatoid arthritis group, of which the most common anti-rheumatoid arthritis drug was single or combined disease-modifying anti-rheumatic drugs. There was no statistical difference in the number of pedicle screws and interbody cages between the two groups, so was the incidence of perioperative complications. (3) The primary outcomes showed that there was no statistical difference in total blood loss, intraoperative blood loss and postoperative drainage between the two groups. Hidden blood loss and the proportion of hidden blood loss were lower in non-rheumatoid arthritis group than in the rheumatoid arthritis group (P < 0.001, 0.012). Stratified analysis based on the number of surgical levels suggested hidden blood loss and the proportion of hidden blood loss in non-rheumatoid arthritis group was superior to those of rheumatoid arthritis group in long-segment surgery (≥ 3 segments). (4) The secondary outcomes showed the change of hematocrit was lower in the non-rheumatoid arthritis group (P=0.021) than in rheumatoid arthritis group, but the reduction of hemoglobin was not significantly different between the two groups. In addition, there was no significant difference in neoformative and grade-aggravated anemia, as well as the number of allogeneic blood transfusion and operation time. (5) Multiple linear regression analysis of hidden blood loss in the rheumatoid arthritis group showed high Steinbrocker classification, non-taking disease-modifying anti-rheumatic drugs, large change of hemoglobin and allogeneic blood transfusion were independent risk factors. (6) It is concluded that there were no differences in total blood loss, intraoperative blood loss, postoperative drainage and operation time between rheumatoid arthritis group and non-rheumatoid arthritis group. Hidden blood loss and the proportion of hidden blood loss in total blood loss were higher in the rheumatoid arthritis group than in the non-rheumatoid arthritis group, especially in long-segment surgery. The high Steinbrocker classification, non-taking disease-modifying anti-rheumatic drugs, large change of hemoglobin and allogeneic blood transfusion were independent risk factors for hidden blood loss in the rheumatoid arthritis group.  Figures and Tables | References | Related Articles | Metrics

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Comparison of external fixator-assisted reduction and locking plate internal fixation and simple locking plate internal fixation in the treatment of type C distal radius fractures Chen Xiaojun, Luo Tao, Ou Changliang, He Zhiyu, Zhou Xin, Tang Xincheng, Mo Deping, Zou Yonggen 2020, 24 (33):  5315-5320.  doi: 10.3969/j.issn.2095-4344.2894 Abstract ( 293 )   PDF (633KB) ( 82 )   Save BACKGROUND: The single volar locking plate internal fixation is often used for type C distal radius fractures. However, some patients still fail to achieve good fracture reduction, and the grip strength of the affected limb is significantly weakened. How to restore the length of the radius and maintain the reduction and internal fixation during the operation is challenging. OBJECTIVE: To compare the clinical efficacy of external fixator-assisted reduction and locking plate internal fixation and simple locking plate internal fixation in the treatment of type C distal radius fractures. METHODS: A retrospective analysis was conducted in 93 patients with type C distal radius fractures who underwent surgical treatment from March 2017 to August 2019. There were 49 cases in the external fixator-assisted group, with an average follow-up period of (14.95±5.64) months (range, 6-30 months); there were 44 cases in the simple plate group, with an average follow-up period of (15.38±6.27) months (range, 6 to 24 months). The preoperative general information, surgical related indicators, postoperative follow-up X-ray measurements and wrist function were compared and analyzed between the two groups. RESULTS AND CONCLUSION: (1) The operation time, incision length, and number of X-ray exposures in the external fixator-assisted group were less than those in the simple plate group, and the differences were statistically significant (P < 0.05). (2) During the postoperative follow-up, the degree of radial height recovery in the external fixator-assisted group was better than that of the simple plate group, and the difference was statistically significant (P < 0.05). There was no statistical difference in the recovery of palm tilt and ulnar deviation between the two groups (P > 0.05). (3) On the second day after operation, the visual analogue scale score of the external fixator-assisted group was higher than that of the simple plate group, and the difference was statistically significant (P < 0.05). (4) At 1-year follow-up, the degree of grip strength recovery in the external fixator-assisted group was better than that in the simple plate group, and the difference was statistically significant (P < 0.05). (5) The results show that both methods can effectively reduce and fix type C distal radius fractures, and restore wrist function. The external fixator-assisted group has advantages such as shorter operation time, less trauma, less X-ray radiation, and better grip strength in comparison to the simple plate group.  Figures and Tables | References | Related Articles | Metrics

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Effect of healing of ulnar styloid fracture on joint function after distal radius fracture surgery Ye Shuming, Xu Chungui, Zhang Jisen, Xu Xinzhong, Xu Youjia, Jing Juehua 2020, 24 (33):  5321-5325.  doi: 10.3969/j.issn.2095-4344.2847 Abstract ( 473 )   PDF (475KB) ( 113 )   Save BACKGROUND: Distal radius fractures are often accompanied by a fracture of the ulnar styloid process in clinical practice. For distal radius fractures with surgical indication, open reduction and internal fixation are generally performed. Treatment of ulnar styloid fracture has been controversial. OBJECTIVE: To observe the effect of ulnar styloid fracture healing on the recovery of wrist joint function after internal fixation of distal radius fracture. METHODS: Thirty-nine patients with distal radius fracture combined with ulnar styloid fracture in the Second Affiliated Hospital of Anhui Medical University from June 2016 to January 2019 were enrolled. There were 24 males and 15 females with the age from 23 to 67 years old. All patients were treated with distal radius locking plate fixation. The results of the follow-up review on anteroposterior radiograph were used to determine the healing of the distal radius fractures. According to the healing status of ulnar styloid at the last follow-up, the patients were divided into healing group (n=20) and non-healing group (n=19). The palmar tilt, ulnar inclination and radial height were compared between the two groups based on anteroposterior radiograph and that were compared to the healthy side. The wrist flexion and extension activities, forearm rotation range, and Gartlant-Werley wrist function scores were detected. The study was approved by the Ethics Committee of the Second Affiliated Hospital of Anhui Medical University. RESULTS AND CONCLUSION: (1) There was one case of ulnar-sided wrist pain in the healing group and two cases in the non-healing group; the difference was not statistically significant between the two groups (P > 0.05). There was no significant difference in fracture healing time between the two groups (P > 0.05). (2) At the last follow-up, palmar tilt and ulnar inclination of the healing group and the non-healing group were smaller than that of the healthy side (P < 0.05). However, there was no significant difference in radial height between the healthy side and the affected side (P > 0.05). There was no significant difference in the above indicators between the two groups (P > 0.05). (3) At the last follow-up, the flexion and extension range of the wrist joint in the healing group and the non-healing group were smaller than that on the healthy side (P < 0.05). There was no significant difference in the forearm rotation range between the healthy side and the affected side (P > 0.05). There was no significant difference in the above indicators between the two groups (P > 0.05). (4) At the last follow-up, there was no significant difference in the Gartlant-Werley wrist function scores or the excellent and good rate between the two groups (P > 0.05). (5) The results show that the healing of ulnar styloid fracture may not affect the rehabilitation of wrist joint after distal radius fracture fixation. The ulnar styloid process fracture can only be treated conservatively. Figures and Tables | References | Related Articles | Metrics

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Wrist arthroscopy combined with 2.7 mm titanium osteotomy plate fixation in treatment of ulnar impaction syndrome Chen Keyi, Yang Shun, Cheng Yabo, Xiang Wang, Zhang Jing, Chi Haotian 2020, 24 (33):  5326-5331.  doi: 10.3969/j.issn.2095-4344.2884 Abstract ( 518 )   PDF (536KB) ( 39 )   Save BACKGROUND: Due to the lack of understanding of the pathogenesis, ulnar impaction syndrome often referred to as carpitis, which delays the treatment of patients and causes severe carpal dysfunction. OBJECTIVE: To retrospectively analyze the effect of arthroscopy combined with 2.7 mm titanium osteotomy plate fixation for treating the ulnar impaction syndrome. METHODS: From March 2017 to September 2019, 12 patients with ulnar impaction syndrome were treated in the Department of Wrist, Sichuan Provincial Orthopedics Hospital. All patients received arthroscopy combined with 2.7 mm titanium osteotomy plate fixation to repair the intercarpal ligament, articular cartilage damage, and trigonal fibrocartilage complex. Ulna variation value, visual analogue scale score, modified Mayo score were compared preoperatively and 1 year postoperatively. RESULTS AND CONCLUSION: (1) All the 12 patients were followed up after the operation, and bone healing was achieved. The healing time was 5-11 months, with an average of 6 months. (2) The ulna variation was (3.3±1.3) mm preoperatively, and (-0.4±0.6) mm postoperatively. The modified Mayo score was (59.2±10.6) preoperatively and (78.3±11.6) 1 year postoperatively. The effect was excellent in seven patients, good in four patients and fair in one patient. Visual analogue scale score was (5.2±0.7) preoperatively and (3.2±2.5) 1 year postoperatively. The pain was completely relieved in nine patients after surgery and significantly relieved in two patients. There were significant differences in the above indexes before and after operation (P < 0.05). (3) It is confirmed that wrist arthroscopy can clearly diagnose the ulnar impaction syndrome and the combination with 2.7 mm titanium osteotomy plate can save the operation time, reduce the rate of bone nonunion, relieve the wrist pain and improve the function of the wrist, which is conducive to early functional exercise and satisfactory effect.  Figures and Tables | References | Related Articles | Metrics

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Double-strand suture anchor in the treatment of tibiofibular syndesmosis injury Weng Shiyang, Wu Kai, Lin Jian, Huang Yinjun, Wang Qiugen, Huang Jianhua 2020, 24 (33):  5332-5337.  doi: 10.3969/j.issn.2095-4344.2339 Abstract ( 543 )   PDF (491KB) ( 37 )   Save BACKGROUND: The injury of tibiofibular syndesmosis ligament often leads to traumatic arthritis and ankle instability and other sequelae if the diagnosis or treatment of tibiofibular syndesmosis ligament injury is not timely. At present, there is no clear report on the treatment of tibiofibular syndesmosis ligament injury with anchor. OBJECTIVE: To retrospectively analyze the clinical efficacy and safety of double-strand anchor in the treatment of tibiofibular syndesmosis injury. METHODS: From July 2016 to October 2018, 30 cases of ankle fracture with lower tibiofibular syndesmosis injury were treated in South Hospital of First People’s Hospital Affiliated to Shanghai Jiao Tong University. The patients were randomly assigned to two groups (n=15). In the experimental group, the lower tibiofibular syndesmosis was fixed with double strands of suture anchors. In the control group, the lower tibiofibular syndesmosis was fixed with screw. Age, gender, and preoperative swelling degree of the ankle joint were preoperatively recorded. Three-dimensional CT images of the ankle and X-ray anteroposterior and lateral images of the ankle were captured. X-ray films of ankle joint were obtained 1 day and 1.5, 3, 6, 12 months after operation. American Orthopaedic Foot and Ankle Society scores were assessed at 3, 6 and 12 months after surgery. RESULTS AND CONCLUSION: (1) All surgical incisions healed at stage I, and no complications such as lower limb venous thrombosis, infection, nonunion of bone, loose anchor was found. (2) At 3, 6 and 12 months after surgery, there was no significant difference in American Orthopaedic Foot and Ankle Society scores between the two groups. American Orthopaedic Foot and Ankle Society scores were significantly higher than that before surgery in both groups (P < 0.05). (3) Within one year after the operation, 5 cases (33%) in the experimental group and 2 cases (13%) in the control group showed the enlargement of tibiofibular syndesmosis. (4) Results suggested that double-strand suture anchor treatment of tibiofibular syndesmosis injury has a certain effect, and high safety. However, there is a high probability of reseparation of tibiofibular syndesmosis post-operation.  Figures and Tables | References | Related Articles | Metrics

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Treatment of senile osteoporotic patella fractures with double tension band Li Yanqiang, Pan Deyue, Nan Feng, Han Xin 2020, 24 (33):  5338-5342.  doi: 10.3969/j.issn.2095-4344.2895 Abstract ( 388 )   PDF (605KB) ( 89 )   Save BACKGROUND: At present, tension band system is widely used in the treatment of patellar fracture. However, for elderly patients due to osteoporosis and fracture comminution, the stability of patella with traditional tension band fixation is weak, and it is easy to have some problems, such as loss of fracture reduction, and fracture displacement. OBJECTIVE: To explore the feasibility of double tension band in the treatment of osteoporotic patella fractures in the elderly. METHODS: Fifteen elderly patients with fresh osteoporotic patellar fracture treated in the Department of Orthopedic Trauma of the Second Affiliated Hospital of Dalian Medical University from January 2016 to May 2018, including 6 males and 9 females, aged 60-74, were treated with double tension band internal fixation and were not fixed after operation. The time of fracture healing, the occurrence of complications, the range of motion of knee joint and the clinical curative effect score of Bostman patellar fracture were recorded. The study was approved by the Ethics Committee of the Second Affiliated Hospital of Dalian Medical University. RESULTS AND CONCLUSION: (1) All 15 cases of patellar fracture healed, and the healing time was 2.0-3.0 months. (2) During the follow-up of 12-18 months, all 15 patients had no wound infection, knee joint stiffness, pain and discomfort, fracture re-displacement, loosening and prolapse of internal fixator. (3) At the last follow-up, the range of motion of the knee joint of 15 patients was (127.5±5.8)°, and the range of flexion was reduced by (8.7±6.5)° compared with the healthy side. The functional score of Bostman patellar fracture was excellent in 13 cases and good in 2 cases, with an excellent and good rate of 100%. (4) The results show that the treatment of senile osteoporotic patellar fracture with double tension band fixation can meet the requirements of functional rehabilitation immediately after operation; the fracture fixation is stable and the functional recovery of knee joint is satisfactory. Figures and Tables | References | Related Articles | Metrics

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Total arthroscopy-assisted reduction and internal fixation with cannulated screws for Sanders II and III calcaneal fractures Shen Guodong, Zou Yunxuan, Zhang Hongning, Li Xue, Yang Kangyong, Lai Zhibin, Zhu Yongzhan 2020, 24 (33):  5343-5348.  doi: 10.3969/j.issn.2095-4344.2852 Abstract ( 355 )   PDF (521KB) ( 35 )   Save BACKGROUND: In recent years, arthroscopy has been widely used in the treatment of calcaneal fractures, but it is often used to treat Sanders type I and II fractures, or as an auxiliary means of complex calcaneal fracture reduction and intraarticular injury exploration and cleaning.   OBJECTIVE: To explore the effect of total arthroscopy-assisted reduction and internal fixation with cannulated screws for treatment of Sanders II and III calcaneal fractures. METHODS: From December 2016 to November 2018, 42 patients (42 feet) of Sanders II and III calcaneal fractures treated in Foshan Hospital of Traditional Chinese Medicine as the research subjects were divided into two groups according to the surgical plan. Patients in the total arthroscopy group (n=21) received total arthroscopy-assisted reduction and internal fixation with cannulated screws. Patients in the tarsal sinus approach group (n=21) received internal fixation of calcaneus anatomical plate through tarsal sinus approach. At 12 months after surgery, adverse reactions were recorded. X-ray films were reexamined. Böhler angle and Gissane angle were examined, and Maryland score and AOFAS ankle/hindfoot score were evaluated. This study was approved by the Ethics Committee of Foshan Hospital of Traditional Chinese Medicine. RESULTS AND CONCLUSION: (1) Preoperative preparation time and average hospital stay were longer in the tarsal sinus approach group than in the total arthroscopy group (P < 0.05). There was no injury of posterior tibial vessels, tibial nerve or sural nerve, and no infection of soft tissue in the incision in the total arthroscopy group. In the tarsal sinus approach group, there were three feet with superficial skin infection, one foot with gastrocnemial nerve injury, and no deep incision infection or necrosis. (2) At 12 months after operation, Böhler and Gissane angles in both groups were better than before surgery (P < 0.05), but there was no significant difference between the two groups (P > 0.05). (3) Perimeter of the ankle was significantly reduced after surgery than before surgery in both groups (P < 0.05), and motion range of ankle flexion and extension was significantly increased after surgery than before surgery in both groups (P < 0.05). The perimeter of the ankle was smaller in the total arthroscopy group than in the tarsal sinus approach group at 1 month after surgery (P < 0.05). Motion range of ankle flexion and extension was not significantly different at postoperative 1 year in both groups (P > 0.05). (4) At postoperative 12 months, Maryland scores and AOFAS ankle/hindfoot scores were not significantly different between the two groups (P > 0.05). (5) Compared with internal fixation of calcaneus anatomical plate through tarsal sinus approach, total arthroscopy-assisted reduction and internal fixation with cannulated screws for the treatment of Sanders II and III calcaneal fractures can promote the recovery of the patient’s foot function and reduce postoperative complications. Figures and Tables | References | Related Articles | Metrics

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Tibiofibular syndesmosis reduction after screw fixation of ankle fracture evaluated by CT imaging Wang Dong, Zeng Debin, Lin Qiao, Liu Kehui 2020, 24 (33):  5349-5353.  doi: 10.3969/j.issn.2095-4344.2896 Abstract ( 388 )   PDF (447KB) ( 83 )   Save BACKGROUND: Assessing tibiofibular ligament combined anatomical reduction is important for the surgical treatment of ankle fractures, and the large difference in the incidence of malreduction in the study may be due to inconsistent measurement and definition of malreduction. OBJECTIVE: To observe the changes of tibiofibular joint reduction over time 1 year after tibiofibular joint screw fixation and screw removal for ankle fractures, and to evaluate the incidence of poor tibiofibular joint reduction.   METHODS: Twenty-nine patients with tibiofibular screw fixation for ankle fractures were evaluated. The lower tibiofibular joint screw was removed 6 weeks after fracture surgery. CT scan images were used to evaluate the reduction of the lower tibiofibular region within two weeks after fracture surgery and one year after screw removal. The differences of the anterior and posterior distances of the tibiofibula, anteroposterior fibula translation, and fibular rotation were measured. RESULTS AND CONCLUSION: (1) The mean anterior tibiofibular distance after combined fixation was (0.8±1.4) mm, and increased to (1.8±1.1) mm within 1 year after screw removal (P=0.001). (2) After the combined fixation of the lower tibiofibular joint, the anterior tibiofibular distance of the ankle joint was maladjusted in four cases, among which three cases had the ankle joint widened and one case had the ankle joint too tight. In one year, there were eight cases of malreduction of the ankle joint and all of the ankle joints were enlarged. Other measurements did not change over time. (3) According to the definition of poor reduction, the incidence of poor reduction after lower tibiofibular joint fixation was 10%-51%, and the incidence of poor reduction was 20%-62% 1 year after screw removal. The difference in the incidence of poor reduction was statistically significant (P=0.01, 0.03). (4) It is indicated that within 1 year after removal of the tibiofibular screw, the anterior tibiofibular distance widened, but there was no significant difference in translation or rotation in other directions. The repeatability of measurement by different observers is good, and the incidence of malreduction varies with different measurement methods. Figures and Tables | References | Related Articles | Metrics

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Correlation of saggital parameters of cervical and thoracic junction areas in asymptomatic adults Cao Bin, Zuo Yuqiang, Du Hanyang, Yu Haiquan, Su Jingyang, Meng Haoyong 2020, 24 (33):  5354-5357.  doi: 10.3969/j.issn.2095-4344.2830 Abstract ( 376 )   PDF (392KB) ( 62 )   Save BACKGROUND: The sagittal balance of the spine in the cervical and thoracic junction areas is not only related to the sagittal balance of the whole spine, but also related to the sagittal balance of the cervical spine. OBJECTIVE: To investigate the correlation of sagittal parameters in cervical and thoracic junction areas in asymptomatic adults. METHODS: Totally 120 asymptomatic adults were enrolled from January 2017 to December 2018 from the Medical Examination Center, Second Hospital of Hebei Medical University. Age ranged from 23-79 years. The patients were divided into group A (21-40 years old), group B (41-60 years old) and group C (61-80 years old), with 40 persons in each group. DR images of lateral cervical spine were taken, and the following imaging parameters were measured: C2-C7 sagittal vertical axis, head center of gravity to C7 sagittal vertical axis, thoracic inlet angle, neck tilt, T1 slope and the cranial tilt. RESULTS AND CONCLUSION: (1) There were significant differences among the three groups in the C2-C7 sagittal vertical axis, head center of gravity to C7 sagittal vertical axis, thoracic inlet angle, neck tilt, T1 slope and the cranial tilt (P < 0.05); there were also significant differences between the two groups (P < 0.05). Thoracic inlet angle, neck tilt, and T1 slope increased with age. (2) The correlation analysis showed that there was a positive correlation between the thoracic inlet angle, neck tilt, T1 slope and age (r=0.622, r=0.439, r=0.533, all P < 0.001). There was a positive correlation between the thoracic inlet angle and T1 slope (r=0.569, P < 0.001). There was negative correlation between the thoracic inlet angle, T1 slope and C2-C7 sagittal vertical axis (r=-0.725, r=-0.352, all P < 0.001). (3) The results showed that the thoracic inlet angle, neck tilt, carnial tilt and T1 slope increased with age, and the thoracic inlet angle, neck tilt and T1 slope were positively correlated with age. Figures and Tables | References | Related Articles | Metrics

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Anatomical characteristics of acromioclavicular joint and joint discs Wang Zhizhou, Zhang Hailong, Chen Jian, Ye Zheng, Yang Yuanqing, Ying Zhengran 2020, 24 (33):  5358-5365.  doi: 10.3969/j.issn.2095-4344.2880 Abstract ( 689 )   PDF (599KB) ( 40 )   Save BACKGROUND: At present, most clinicians believed that shoulder diseases such as acromioclavicular joint dislocation and subacromial impact syndrome, have a great relationship with the anatomic shape of the acromioclavicular joint. However, there are few morphological data on acromioclavicular joints in and outside China, especially for the anatomical study of acromioclavicular joint disc. Simultaneously, the acromioclavicular joint belongs to the micro-movement joint and participates in the joint movement of the shoulder joint. There are many clinical methods of acromioclavicular dislocation surgery, the most popular surgical methods are rigid fixation, and do not retain their micro-movement characteristics and the motion characteristics of the clavicle and scapula. Among them, the choice of joint discs is not a large multicenter controlled study in and outside China. OBJECTIVE: To study the anatomy of the acromioclavicular joint and joint discs in order to diagnose and treat shoulder diseases. METHODS: The morphology and tissue structure of 58 acromioclavicular joint corpses (provided by the Department of Anatomy, Tongji University) were studied. A total of 58 acromion, 58 clavicles and 36 joint discs (including complete and incomplete) were obtained. BIGLIANI acromicular morphology typing, DEPALMA clavicle morphological typing, and EMURA acromioclavicular joint disc typing were used to obtain the frequency of joint discs under each acromion and clavicle combination and hematoxylin-eosin staining (provided by Shanghai Putuo District People’s Hospital). RESULTS AND CONCLUSION: (1) Among 58 corpses of acromioclavicular joints, there were 15 cases of type 1 acromioclavicular joints, with the highest proportion being 25.9%, and 4 cases of type 3a, with the lowest proportion being 6.9%. (2) There was 32 type I acromion, with the highest proportion of 55.2%, 3 type III acromion, with the lowest proportion of 5.2%. (3) There were 27 type I clavicle, with the highest proportion of 46.6%, 9 type III clavicle, with the lowest proportion of 15.5 %. (4) Type I and type II acromion combined with type I clavicle accounted for a large proportion, which were 24.1% and 22.4%, respectively, and type III acromion had a minimum proportion of type I clavicle of 0%. (5) Type 1 and type 2b joint discs accounted for the largest proportion under the combination of type I acromion and type I clavicle, which were 35.7% and 28.6% respectively. Type 2a and type 1 joint discs under the combination of type II acromion and type I clavicle presented the largest proportions 38.5% and 23.1%. (6) Hematoxylin-eosin staining could be found in tissue sections. The extracellular matrix in the articular disc was clearly discernible. The cells were full in morphology, and rich in cytoplasm, suggesting chondrocytes, which were the main components of fibrocartilage formation. In addition, part of the periosteum fiber layer can be seen from the top and bottom of the joint capsule to the inside of the joint disc. It is considered to form a joint disc structure, that is, the joint disc is composed of chondrocytes near the bone surface and a fiber layer away from the bone surface. Figures and Tables | References | Related Articles | Metrics

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Comparison of knee geometry between Chinese Han people and American Caucasians Gong Heng, Huang Bin, Fu Ligong, Liu Huawei, Chen Lianxu 2020, 24 (33):  5366-5370.  doi: 10.3969/j.issn.2095-4344.2897 Abstract ( 783 )   PDF (508KB) ( 67 )   Save BACKGROUND: Some studies have shown that the anterior and posterior diameters and transverse diameters of the proximal tibia of the Chinese knee are smaller than those of the Caucasian in the United States, so there are some differences in the morphology of the knee, so the phenomenon of low matching degree often occurs when the imported prosthesis system is applied to the Chinese.   OBJECTIVE: To measure the geometric parameters of the distal femur and the proximal tibia of Chinese and American, compare the differences. METHODS: The 50 Chinese Han patients planned to undergo anterior cruciate ligament reconstruction in the Department of Orthopedics, Beijing Tsinghua Changgung Hospital and 40 Caucasian patients planned for anterior cruciate ligament reconstruction at the University of Pittsburgh Sports Medicine Center were selected. The knee joints of 90 subjects were scanned by Computed Tomography. Three-dimensional reconstruction was performed by AW Volume Share 5 software. The Geomagic software was used to measure the parameters of the distal femur and proximal tibia. RESULTS AND CONCLUSION: (1) In the measurement parameters of the proximal femur, the inner and outer diameters of the lateral tibial plateau in Chinese were smaller than those of the American (P=0.027), and the posterior inclination of the lateral tibial plateau was greater in Chinese than that of the American (P < 0.05). There was no significant difference in the inner and outer diameters of the tibial plateau, the outer diameter of the medial tibial plateau, the anteroposterior diameter of the medial tibial plateau, the anteroposterior diameter of the lateral tibial plateau, and the posterior inclination angle of the medial tibial plateau between the two groups (P > 0.05). (2) In the measurement parameters of the distal femur, the transverse diameter of the distal femur, the medial and lateral diameters of the lateral condyle, the anteroposterior diameter of the medial condyle, the anteroposterior diameter of the lateral condyle, and the height of the intercondylar fossa were all less in Chinese than those of the American (P < 0.05); the valgus angle of the Chinese femur was greater than that of the American (P < 0.05). There was no significant difference in the inner and outer diameters of the medial condyle, the width of the intercondylar notch and the width of the trochlear groove between the two groups (P > 0.05). (3) There are some differences in many parameters of knee morphology between Chinese and American. It is necessary to design more individualized knee joint prosthesis for Chinese. Figures and Tables | References | Related Articles | Metrics

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Perioperative management strategy without drainage tube after total knee arthroplasty Hou Senrong, Yang Weiyi, Luo Minghui, Pan Jianke, Huang Hetao, Zeng Lingfeng, Liu Jun, Liang Guihong 2020, 24 (33):  5371-5378.  doi: 10.3969/j.issn.2095-4344.2889 Abstract ( 322 )   PDF (731KB) ( 144 )   Save BACKGROUND: In recent years, with the improvement of total knee arthroplasty technology, the shortening of operation time, the application of hemostatic drugs during and after operation, the total loss of blood is decreasing, and the postoperative drainage flow is also decreasing. The theory of postoperative rapid rehabilitation emerges at the historic moment, and the placement of drainage tube is once again a hot issue for orthopedic doctors. More than a few doctors think that the placement of drainage can be cancelled routinely, and drainage seems to be nonexistent. OBJECTIVE: To review the previous literature, to summarize the relevant problems of drainage placement after total knee arthroplasty and provide relevant experience of drainage management. METHODS: Literature retrieval includes Chinese databases such as CNKI, Wanfang, VIP, China biomedical literature database, and English databases such as PubMed, the Cochrane Library, Web of Science, EMBASE, and Ovid. The Chinese key words were “drainage, knee arthroplasty”. The English key words were “total knee arthroplasty, drainage”. All the literature related to the theme from inception to February 2020. The factors that need to be considered comprehensively in all aspects of perioperative period without drainage tube after total knee replacement were summed up. RESULTS AND CONCLUSION: (1) The placement of drainage tube is closely related to the final result of operation and the occurrence of postoperative complications such as hemorrhage, hematoma, thrombus and infection. (2) At present, conventional placement of drainage tube is not recommended after total knee arthroplasty, but it does not mean that there is no need for management. In fact, it puts forward higher requirements for the management of clinical doctors and nurses in all aspects of perioperative period, including but not limited to the selection of indications before surgery, surgical operation, tourniquet use, intraoperative and postoperative drug use, and physical therapy use.  Figures and Tables | References | Related Articles | Metrics

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Imaging evaluation after minimally invasive total hip arthroplasty Zhang Yuda, Wang Changyao, Wang Xiangyu 2020, 24 (33):  5379-5384.  doi: 10.3969/j.issn.2095-4344.2337 Abstract ( 333 )   PDF (39014KB) ( 58 )   Save BACKGROUND: Complications are unavoidable after minimally invasive total hip arthroplasty. At present, the imaging methods commonly used in clinical postoperative evaluation are diverse, and each has advantages and disadvantages. OBJECTIVE: To introduce the application value and research progress of X-ray, CT, MRI and other imaging examination in the evaluation of curative effect after minimally invasive total hip arthroplasty. METHODS: The first author retrieved the literature published in the PubMed, CNKI, and Wanfang database from 2000 to 2020. The key words were “surgical injury, MRI, minimally invasive, muscle trauma” in English, and “minimally invasive total hip arthroplasty, imaging, evaluation, muscle injury” in Chinese. The characteristics of different approaches of minimally invasive total hip arthroplasty and the imaging examination results of their effects on hip muscles were summarized and analyzed. RESULTS AND CONCLUSION: (1) X-ray is the first choice for reexamination of patients after total hip arthroplasty. (2) Single photon emission CT of bone is not easy to be affected by metal artifacts, and shows higher sensitivity and specificity in patients with joint replacement. (3) MRI is the gold standard for the evaluation of peripheral muscle groups, especially muscle morphological changes. (4) The level of serum inflammatory cytokines, as a marker of muscle injury, is a specific and objective method for evaluating minimally invasive total hip arthroplasty. (5) Minimally invasive total hip arthroplasty can greatly avoid the incision or separation of muscles and tendons and reduce the risk of hip dislocation and fat liquefaction and necrosis after operation. Because of the weakening of muscle repair and regeneration ability in elderly patients, minimal invasion in total hip arthroplasty has a unique clinical position. Imaging examination plays an important role in the evaluation of minimally invasive surgery.  Figures and Tables | References | Related Articles | Metrics

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Prevention and sequential therapies combined with drugs for postmenopausal osteoporosis Sun Guoping, Luo Xuanxiang, Pan Bin 2020, 24 (33):  5385-5390.  doi: 10.3969/j.issn.2095-4344.2338 Abstract ( 459 )   PDF (523KB) ( 119 )   Save BACKGROUND: In postmenopausal women, a rapid increase in bone resorption due to decreased estrogen levels leads to an imbalance between bone resorption and bone formation, increasing the risk of osteoporosis and associated fractures. However, current clinical interventions are not sufficient to inhibit long-term bone loss and increased risk of fracture. In recent years, it has become an inevitable trend to treat postmenopausal osteoporosis with timely and effective prevention and sequential combination of anti-osteoporosis drugs. OBJECTIVE: To summarize the literature on the prevention of postmenopausal osteoporosis and the anti-osteoporosis drug therapy, and introduce the progress of the clinical preventive measures and the common anti-osteoporosis drug combination sequential treatment of postmenopausal osteoporosis. METHODS: The author retrieved the relevant articles in CNKI, Wanfang and PubMed databases from January 2009 to December 2019 in January 2020. The search words were “postmenopausal osteoporosis, prevention, drug therapy, medication” in Chinese and English respectively. Finally, 41 articles were selected according to inclusion and exclusion criteria for analysis and discussion. RESULTS AND CONCLUSION: (1) Postmenopausal women should receive the test of bone mineral density and osteoporosis was prevented by changes in diet and lifestyle to reduce the risk of fractures. (2) Compared with single drugs, combination with sequential therapies can be more effective in the treatment of postmenopausal osteoporosis, which has far-reaching significance for the treatment of postmenopausal osteoporosis. Figures and Tables | References | Related Articles | Metrics

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Research progress regarding the toxicity of tranexamic acid to cartilage Han Kangjie, Lan Tong, Gao Hong 2020, 24 (33):  5391-5396.  doi: 10.3969/j.issn.2095-4344.2887 Abstract ( 500 )   PDF (604KB) ( 100 )   Save BACKGROUND: Tranexamic acid has been widely used in orthopedic surgery as a hemostatic drug. However, after arthroscopic surgery, the cartilage, tendons and ligaments are directly exposed to tranexamic acid. It is necessary to reiterate the importance of cartilage again. OBJECTIVE: To analyze the effect of topical tranexamic acid on cartilage through the existing experimental research and clinical data. METHODS: Related documents were searched in CNKI, WANFANG MED ONLINE, and PubMed by computer. The retrieval time was from the inception of the database to February 10, 2020. The Chinese and English key words were “tranexamic acid, arthroscopy, cartilage, toxicity”. RESULTS AND CONCLUSION: The dosage of clinical tranexamic acid is still based on the experience of physicians. There is great controversy regarding its safe administration concentration and exposure time. There is a lack of precise clinical guidelines. Based on the existing in vitro experiments, it was found that between 25-50 g/L, there should be a concentration that is safest for cartilage biological activity. Before there are further clinical evidences, it should be recommended that the local concentration of tranexamic acid should not exceed 25 g/L. When using tranexamic acid for washing, the mass concentration should not exceed 70 g/L. Regarding the most appropriate mass concentration of tranexamic acid for topical application, further research and clinical trials are still needed to better clarify its safety in topical use.  Figures and Tables | References | Related Articles | Metrics

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Efficacy and safety of percutaneous kyphoplasty versus posterior short-segment fixation with vertebra augmentation for Kummell’s disease: a meta-analysis Zhan Fangbiao, Xie Lizhong, Zou Xinsen, Long Jie, Cheng Jun, Zhang Xianwei 2020, 24 (33):  5397-5404.  doi: 10.3969/j.issn.2095-4344.2346 Abstract ( 314 )   PDF (868KB) ( 48 )   Save BACKGROUND: Because the single percutaneous kyphoplasty for treating Kummell’s disease brought the uneven distribution and displacement of bone cement. Current research has recommended a posterior short-segmental fixation combined with vertebra cement augmentation for Kummell’s disease. OBJECTIVE: To evaluate the effectiveness and safety of percutaneous kyphoplasty or posterior short-segmental fixation combined with vertebral body bone cement augmentation for Kummell’s disease using meta-analysis. METHODS: PubMed, the Cochrane Library, Web of Science database, EMBASE, Chinese biomedical literature database, China National Knowledge Infrastructure, VIP and Wanfang database were retrieved for randomized controlled trials, case-control studies and cohort studies regarding percutaneous kyphoplasty and posterior short-segmental fixation combined with vertebra bone cement augmentation (posterior spinal fixation + bone cement) for Kummell’s disease. The retrieval period was from the database establishment to February 1, 2020, and the retrieval languages were Chinese and English. All the retrieved literature was screened according to inclusion and exclusion criteria by two reviewers. NOS scale was used to evaluate the literature quality, and then Review Manager 5.3 software was used for meta-analysis. RESULTS AND CONCLUSION: (1) Four articles were finally included, with 200 patients, including 108 in the percutaneous kyphoplasty group and 92 in the posterior spinal fixation + bone cement group. (2) Meta-analysis showed that operation time was significantly shorter and intraoperative blood loss was less in the percutaneous kyphoplasty group than in the posterior spinal fixation + bone cement group [MD=-82.83, 95%CI(-144.43, -21.24), Z=2.64, P=0.008; MD=-204.44, 95%CI(-210.97, -197.92), Z=61.43, P < 0.000 01]. Incidence of perioperative complications was lower in the percutaneous kyphoplasty group than in the posterior spinal fixation + bone cement group [OR=0.15, 95%CI(0.03, 0.91), Z=2.07, P=0.04]. Incidence of bone cement leakage was higher in the percutaneous kyphoplasty group than in the posterior spinal fixation + bone cement group [RR=1.99, 95%CI(1.03, 3.88), Z=2.03, P=0.04]. There were no significant differences in visual analogue scale score, Oswestry disability index and kyphosis angle between the two groups in the last follow-up (P > 0.05). (3) The results suggest that percutaneous kyphoplasty and posterior spinal fixation + bone cement are effective and safe in the treatment of Kummell’s disease. Percutaneous kyphoplasty can reduce the operation time, intraoperative blood loss and perioperative complications. The two methods have their own advantages and disadvantages, which should be selected by clinicians according to the individual situation of patients. Figures and Tables | References | Related Articles | Metrics

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Associations between vitamin D receptor gene polymorphisms and osteoarthritis: a meta-analysis Feng Chengqin, Zeng Ping, Luo Jun, Liu Jinfu, Huang Jiaxing 2020, 24 (33):  5405-5412.  doi: 10.3969/j.issn.2095-4344.2833 Abstract ( 339 )   PDF (500KB) ( 209 )   Save BACKGROUND: There is a close relationship between vitamin D receptor and osteoarthritis, and vitamin D receptor gene polymorphism is considered to be able to regulate vitamin D receptor, thus affecting the occurrence of osteoarthritis. However, the existing research is still controversial. OBJECTIVE: To identify the association between vitamin D receptor gene polymorphism and osteoarthritis. METHODS: A systematic search was conducted on PubMed, Web of Science, EMbase, Cochrane Library, CBM, CNKI, Wanfang and VIP for studies published from inception to October 2019. All studies that provided vitamin D receptor (ApaI, BsmI, TaqI, and FokI) polymorphism data were retrieved. All statistical analyses were processed using Stata 14.0. RESULTS AND CONCLUSION: (1) Twenty-one articles involving 7 109 patients were enrolled, including 3 123 patients with osteoarthritis and 4 006 controls (non-osteoarthritis). (2) Meta-analysis results showed that there were associations between vitamin D receptor BsmI polymorphisms and osteoarthritis in the Europe population [(BB vs. bb: OR=1.677, 95% CI(1.051, 2.676), P=0.030; BB vs. Bb+bb: OR=1.780, 95%CI(1.175, 2.697), P=0.007], but there were only three studies. There were associations between vitamin D receptor FokI polymorphism and osteoarthritis in the Asian population [(FF vs. Ff+ff: OR=0.609, 95%CI(0.410, 0.907), P=0.015]. There were only three studies. There was no significant association between vitamin D receptor (TaqI and ApaI) polymorphism and osteoarthritis and no significant correlation between the results after exclusion of heterogeneity. (3) The meta-analysis results suggested that vitamin D receptor (ApaI, BsmI,TaqI and FokI) gene polymorphism might not be significantly correlated with osteoarthritis.  Figures and Tables | References | Related Articles | Metrics