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    28 December 2020, Volume 24 Issue 36 Previous Issue    Next Issue
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    Changes in cervical sagittal balance after three-dimensional printing ACT titanium cage in anterior cervical discectomy with fusion
    Yang Xu, Zhao Xiaofeng, Qi Detai, Wang Xiaonan, Jin Yuanzhang, Zhou Runtian, Zhao Bin
    2020, 24 (36):  5741-5748.  doi: 10.3969/j.issn.2095-4344.2916
    Abstract ( 463 )   PDF (595KB) ( 115 )   Save

    BACKGROUND: Anterior cervical discectomy with fusion is a commonly used surgical approach in clinical practice. However, there is a great controversy on the choice of implants. Three-dimensional printing titanium trabecula material has superior biological characteristics and is very suitable for bone implants.

    OBJECTIVE: To investigate changes of radiographic parameters in sagittal plane and clinical scores using three-dimensional printing ACT titanium cage in anterior cervical discectomy with fusion.

    METHODS: A retrospective analysis was conducted in 60 single-segment cervical spondylosis patients undergoing anterior cervical discectomy with fusion. All patients were grouped according to fusion type. The 30 patients in the control group used poly-ether-ether-ketone fusion cage. The 30 patients in the trial group used three-dimensional printing ACT titanium cage. Operation time, intraoperative blood loss, intraoperative C-arm fluoroscopy, Japanese Orthopaedic Association scores, visual analogue scale score for pain as well as neck disability index were recorded. The sagittal parameters of the cervical standing radiographs were measured at pre-operation, 3 days, 3 months after operation and the last follow-up, including height of operation segment, angle of operation segment, C2-7 Cobb angle, C2-7 sagittal vertical axis and T1 slope. The fusion rate of the interbody fusion cage was judged according to the US FDA and Kandziora standards. The correlation among these imaging parameters at various time points was analyzed using Pearson correlation analysis.

    RESULTS AND CONCLUSION: (1) All cases were followed up for 15 to 49 months. (2) Operation time was shorter, intraoperative blood loss, the number of intraoperative C-arm fluoroscopy were less in the trial group than in the control group. At the last follow-up, the Japanese Orthopaedic Association score increased significantly compared with preoperatively, the visual analogue scale and the neck disability index scores decreased significantly (P < 0.05); there was no significant difference between the two groups. (3) The height of operation segment, angle of operation segment, C2-7 Cobb angle, and T1 slope increased in both groups 3 days and 3 months after surgery and the last follow-up compared with those preoperatively (P < 0.05). At 3 months after surgery and the last follow-up, the height of operation segment, angle of operation segment, C2-7 Cobb angle, and T1 slope were higher in the trial group than in the control group (P < 0.05). (4) Positive correlations were presented between C2-7 Cobb angle and angle of operation segment with T1 slope, angle of operation segment and T1 slope, T1 slope and C2-7 sagittal vertical axis at various time points (P < 0.01). However, negative correlations were found between C2-7 sagittal vertical axis and C2-7 Cobb angle (P < 0.01). (5) Clinical symptoms are relieved, the height and angle of operation segment and cervical curve can be corrected after anterior cervical discectomy with fusion by using both poly-ether-ether-ketone cage and three-dimensional printing ACT titanium cage. The three-dimensional printing ACT titanium cage shortens the operation time, reduces the intraoperative blood loss, the number of C-arm fluoroscopy, and has advantages in maintaining the height, angle of operation segment, and the physiological lordosis of the cervical spine.

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    True acetabulum morphology of Crowe type IV developmental dysplasia of the hip based on three-dimensional surgical simulation
    Kang Peng, Zhang Fangxin, Maihemuti·Yakufu, Wei Weitao, Yilihamu·Toheti, Aierken·Amudong
    2020, 24 (36):  5749-5754.  doi: 10.3969/j.issn.2095-4344.2903
    Abstract ( 440 )   PDF (468KB) ( 45 )   Save

    BACKGROUND: Patients with Crowe type IV developmental dysplasia of the hip have a greater degree of hip anatomy deformity. Three-dimensional images have unique advantages in reflecting the morphological characteristics of the true acetabulum and evaluating acetabular parameters. Therefore, it is necessary to qualitatively and quantitatively evaluate three-dimensional morphological analysis of the true acetabularity of Crowe type IV developmental dysplasia of the hip.

    OBJECTIVE: To explore the morphological characteristics of true acetabulum in patients with Crowe type IV developmental dysplasia of the hip based on three-dimensional surgical simulation technology.

    METHODS: Twenty patients (22 hips) of Crowe type IV developmental dysplasia of the hip and 22 normal controls (22 hips) were included in the study. The original CT data were imported into Mimics software, and a three-dimensional digital visual model of the acetabulum was established. The three-dimensional surgical simulation technology was used to reconstruct the true acetabulum, determine the true acetabular rotation center, and describe the characteristics of the acetabular morphology. Acetabular anteversion angle and acetabular abduction angle were measured in 3-matic software. Qualitative and quantitative three-dimensional morphological analysis was conducted in the true acetabulum of Crowe type IV developmental dysplasia of the hip.  

    RESULTS AND CONCLUSION: (1) The true morphology of the Crowe type IV dysplasia group was a triangle with a narrow upper and lower width. The ideal center for simulating the cup placement was approximately above the posterior bone wall. (2) Acetabular anteversion angle in the Crowe type IV dysplasia group (35.07±3.09)° was significantly increased compared with the control group (15.89±3.14)°, and the difference was statistically significant (P < 0.05). (3) Acetabular abduction angle in the Crowe type IV dysplasia group (46.87±2.73)° was larger than in the control group (43.88±2.60)°, and the difference was statistically significant (P < 0.05). (4) The morphological characteristics of true acetabulum in developmental dysplasia of the hip patients can be comprehensively assessed by using three-dimensional surgical simulation technology. Developmental dysplasia of the hip patients must carefully carry out individualized preoperative planning before performing total hip arthroplasty.

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    Effect of tip-apex distance and calcar referenced tip-apex distance on the stability of intertrochanteric fractures treated with cephalomedullary nailing assessed by the finite element method
    Qiao Wen, Lü Xin, Liu Jinyuan, Zhang Jing, Li Yuanyuan, Kong Lingbao
    2020, 24 (36):  5755-5763.  doi: 10.3969/j.issn.2095-4344.2917
    Abstract ( 396 )   PDF (590KB) ( 47 )   Save

    BACKGROUND: Tip-apex distance is widely used to predict lag screw cut-out. However, some clinical studies found that lag screw is more stable when it is positioned in the infero-central zone of femoral head in the frontal plane, so in order to find more appropriate position of lag screw, calcar referenced tip-apex distance was proposed. However, the application value of calcar referenced tip-apex distance needs more verification.

    OBJECTIVE: According to the standard formula of tip-apex distance and calcar referenced tip-apex distance, lag screw is put into different quadrants of femoral head. The finite element method was used to assess and compare the stability of the models.

    METHODS: A left femur finite element model was established using the data of computed tomography scan. The finite element model of Zimmer Natural Nail was established via 3D scanner and modeling. The lag screw was inserted into five different areas of the femoral head (posterior-superior, anterior-superior, anterior-inferior, posterior-inferior and central) according to tip-apex distance (15, 20, 25, 30, and 35 mm), so 24 internal fixation models were established. The calcar referenced tip-apex distance was calculated when lag screw was put into central area. Sixteen models of calcar referenced tip-apex distance were established when the lag screw was put into posterior-superior, anterior-superior, anterior-inferior and posterior-inferior quadrants of the femoral head. Thereafter, each finite element model was given a vertical downward force to compare the stability of the femoral head of the model established by the standards of tip-apex distance and calcar referenced tip-apex distance.

    RESULTS AND CONCLUSION: (1) Putting the lag screw into the femoral head according to the standard formula of tip-apex distance, the maximum axial displacement of the femoral head relative to the model without lag screw was 0.008 205 5 mm when the lag screw was located in the anterior-superior position of femoral head and the tip-apex distance was 35 mm. When the lag screw was located in the posterior-inferior position of the femoral head and the tip-apex distance was 20 mm. The difference value of maximum axial displacement relative to the model without lag screw was maximum 0.023 524 0 mm. Putting the lag screw into the femoral head according to the standard formula of calcar referenced tip-apex distance, the maximum axial displacement of the femoral head relative to the model without lag screw was minimum 0.008 794 1 mm when the lag screw was located in the anterior-superior position of femoral head and the calcar referenced tip-apex distance was 37.886 mm. When the lag screw was located in the posterior-inferior position of the femoral head and the calcar referenced tip-apex distance was 25.256 mm, the difference value of maximum axial displacement relative to the model without lag screw was maximum 0.023 183 2 mm. (2) Higher maximum principal stress was found in the posterior-inferior quadrant of femoral head. The average value was 82.339 4 MPa when the lag screws were put into the femoral head according to the standard formula of tip-apex distance and 79.118 8 MPa when the lag screws were put into the femoral head according to the standard formula of calcar referenced tip-apex distance. When lag screws were located in the posterior-inferior quadrant of the femoral head, the maximum principal stress at the proximal femur decreased to 49.535 9 MPa when the lag screws were put into the femoral head according to the standard formula of tip-apex distance and 49.642 8 MPa when the lag screws were put into the femoral head according to the standard formula of calcar referenced tip-apex distance. It is concluded that the calcar referenced tip-apex distance did not show a significant advantage over the tip-apex distance as an evaluation factor of stability in the treatment of intertrochanteric fractures with the intramedullary nail. The stability of the proximal femur of fracture is more affected by the position of the lag screw, which is best when it is in the posterior-inferior area quadrant of the femoral head.

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    Biomechanical characteristics of the modified memory alloy internal fixator for separation of pubic symphysis
    Zhou Jun, Gong Yusuo, Li Shenghua, Zhu Yanguo
    2020, 24 (36):  5764-5767.  doi: 10.3969/j.issn.2095-4344.2908
    Abstract ( 301 )   PDF (460KB) ( 31 )   Save

    BACKGROUND: The memory alloy itself has unique shape memory properties and excellent histocompatibility, which is currently made into various internal fixators widely for the surgical treatment of the fretting joint and the fracture site.

    OBJECTIVE: To investigate the biomechanical characteristics of the modified memory alloy internal fixator for separation of pubic symphysis.

    METHODS: Models of pubic symphysis separation injury were established in 10 pelvic specimens and randomly divided into two groups for fixation. Models in the observation group were fixed with the modified memory alloy internal fixator for separation of pubic symphysis after reduction. The models in the control group were fixed with dynamic compression plate after reduction. A universal biomaterial testing machine was used for biomechanical testing. The horizontal, anteroposterior and vertical displacements of the pubic symphysis were recorded.

    RESULTS AND CONCLUSION: (1) There was no loosening or fracture of internal fixation in both groups. (2) The horizontal displacement of the observation group was smaller than that of the control group under different loads (P < 0.05). (3) The anteroposterior displacement of the observation group was smaller than that of the control group under different loads (P < 0.05). (4) The vertical displacement of the observation group was smaller than that of the control group under different loads (P < 0.05). (5) The experimental results show that the tensile force of the modified memory alloy internal fixator for separation of pubic symphysis against horizontal and anteroposterior directions is better than that against dynamic compression plate, which resistance to vertical shear force is better than that of dynamic compression plate.

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    Biomechanical advantages of percutaneous endoscopic lumbar discectomy for lumbar disc herniation
    Tuerhongjiang·Abuduresiti, Meng Xiangyu, Maihemuti·Yakufu, Wang Tiantang, Xieraili·Maimaiti, Dai Jifang, Wang Wei
    2020, 24 (36):  5768-5773.  doi: 10.3969/j.issn.2095-4344.2907
    Abstract ( 423 )   PDF (560KB) ( 34 )   Save

    BACKGROUND: There are many operative methods for lumbar disc herniation; all kinds of operations have advantages and disadvantages. The biomechanical study of spine by finite element analysis can guide the clinical work.

    OBJECTIVE: To establish L3-5 three-dimensional finite element model and analyze the effect of different surgical methods on the mechanics of the spine after discectomy.  

    METHODS: A 35-year-old volunteer with no history of lumbar disease was selected. Lumbar CT data were obtained to build a finite element model and verify the validity. Five models of L3/L5 spine were established, including L3/L5 normal spine model as the model I, small fenestration operation as a model II, microendoscopic discectomy as model III, percutaneous endoscopic lumbar discectomy as model IV, and facet removal operation as model V. Stress distribution of L4/L5 vertebrae, intervertebral disc, left and right articular cartilages and displacement of L4 vertebrae were measured under seven loading conditions.  

    RESULTS AND CONCLUSION: (1) The three-dimensional finite element model was effective. Model was effective by analysis of variance. (2) The stress concentration was low and the lowest instability of model III and IV by paired comparison. Model IV had the least effect on vertebral body in L4 vertebral body stress. Model III and IV had the least effect on vertebral stability in the displacement of L4 vertebral body. (3) From load modes, the less stress was received by the intervertebral disc when the joint damaged small, and the model IV was the smallest. The left articular process cartilage, models III and IV both maintained joint integrity. Under the right and left rotation load of on the right side, the greater stress received when the joint on the surgical side maintained more complete, so model IV was larger. On the contrary, the bilateral tilted load was in contrast, and the model V was largest. L4-vertebral had the smallest equivalent stress in model IV. The displacement was obvious when the joint damaged more. Models III and IV had the smallest displacements and were close to model I. (4) It is indicated that surgical model of percutaneous endoscopic lumbar discectomy has the smallest stress distribution in the vertebral body, intervertebral disc, and articular process, and has obvious advantages. The displacements of microendoscopic discectomy and percutaneous endoscopic lumbar discectomy are more stable than other surgical models. There is no difference between the two. Therefore, percutaneous endoscopic lumbar discectomy is currently an ideal technique.

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    Plantar feature region division based on biomechanical data
    Lü Jie, Nie Zhichao, Zhang Yanhai, Ding Hao, Liu Yang, Yang Geer, Guo Shijun, Lü Dan, Peng Anmin
    2020, 24 (36):  5774-5778.  doi: 10.3969/j.issn.2095-4344.2898
    Abstract ( 454 )   PDF (603KB) ( 334 )   Save

    BACKGROUND: The current division of the plantar area is usually based on anatomy, without considering the unique plantar biomechanics factors of each individual, and unable to reflect the personalized characteristics of each individual’s plantar stress.

    OBJECTIVE: To classify the plantar region from the perspective of biomechanics, and to obtain the map of plantar region that can reflect the stress characteristics of individual planta.

    METHODS: Taking a normal person walking as an example, the change of plantar pressure distribution with time was obtained by using F-scan insole pressure measurement system. Based on biomechanical data, the characteristic regions of the soles of the foot were divided by cluster analysis to form a personalized map of the soles of the foot.

    RESULTS AND CONCLUSION: Based on biomechanical data, the personalized map of plantar region division obtained by the cluster analysis can be used as an index to reflect the characteristics of the individual’s plantar stress. A small number of sensors located at the geometric center of the plantar feature area can better reflect the characteristics of the individual’s plantar stress during the movement.

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    Energy consumption and gait characteristics of overweight adults
    Lu Qi
    2020, 24 (36):  5779-5784.  doi: 10.3969/j.issn.2095-4344.2901
    Abstract ( 398 )   PDF (421KB) ( 65 )   Save

    BACKGROUND: Many studies have investigated gait modification in obese people; however, no research has been carried out in gait and energy cost of overweight subjects.

    OBJECTIVE: To compare the energy consumption and gait characteristics of overweight and normal weight groups, and explore the relationship between body composition and gait parameters.

    METHODS: Seventy-five male subjects were divided into two groups according to body mass index: the control group (n=40, body mass index: 18.5-23.9 kg/m2), the overweight group (n=35, body mass index: 24.0-27.9 kg/m2). The body composition data of all subjects were measured before the test. All participants wore IDEEA-III to walk on the treadmill for 10 minutes at the set speed of 3.5 and 4.5 km/h respectively. The parameters such as step length, stride length, cadence, single leg support time, double leg support time, and gait cycle were recorded. Metabolic cost of walking of the subjects was measured and recorded by the metabolic chamber. The use of human subjects was approved by the review committee of Jiangsu Research Institute of Sports Science. All subjects signed the informed consent.

    RESULTS AND CONCLUSION: (1) There was no significant difference in age and height between the two groups, and there was significant difference in other body composition indexes (P < 0.05). (2) At the speed of 3.5 km/h, the pulling power, swinging power, ground force reaction, foot landing control, and cadence in the overweight group were significantly higher than in the control group (P < 0.05). The gait cycle and the angle of foot before leaving the ground were significantly lower in the overweight group than in the control group (P < 0.05). There was no significant difference in other gait parameters. (3) At the speed of 4.5 km/h, single leg support time was lower in the overweight group than in the control group; the double leg support time was higher in the overweight group than in the control group; and the gait cycle time was lower in the overweight group than in the control group, with significant difference (P < 0.05). Compared with the control group, pulling power and cadence were higher, and the angle of foot off the ground was lower in the overweight group (P < 0.05). (4) At the speed of 3.5 km/h, only body mass index and body fat percentage were related to the angle of foot off the ground. At the speed of 4.5 km/h, single leg support time and double leg support time were more highly correlated with body mass index and body mass. The body fat percentage was more correlated to the angle of foot off the ground. When the speed was too slow, the gait of overweight people could not be changed, but when the speed was fast, the gait changes obviously. Regardless of the speed, metabolic cost of walking and metabolic cost of walking after standardized body mass in the overweight group were higher than in the control group.

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    Mobile bearing and fixed bearing unicompartmental knee arthroplasty for medial knee osteoarthritis
    Liu Shaohua, Zhou Guanming, Chen Xicong, Xiao Keming, Cai Jian, Zeng Huiliang
    2020, 24 (36):  5785-5792.  doi: 10.3969/j.issn.2095-4344.2930
    Abstract ( 608 )   PDF (674KB) ( 36 )   Save

    BACKGROUND: Unicompartmental knee arthroplasty prostheses are mainly divided into two different types: mobile bearing and fixed bearing. Due to the different design concepts and surgical methods of the two platform prostheses, there are still some differences and controversies regarding the choice of two different platform prostheses.

    OBJECTIVE: To compare the clinical effects of mobile bearing and fixed bearing unicompartmental knee arthroplasty in the treatment of medial interventricular osteoarthritis of knee joint.

    METHODS: From February 2014 to February 2015, 154 patients who were diagnosed with osteoarthritis of the medial compartment of the knee joint and underwent unicompartmental knee arthroplasty at the Foshan Hospital of Traditional Chinese Medicine were selected. Among them, there were 54 male and 100 female patients, aged 56-81 years old. Among them, 100 patients received unicompartmental knee arthroplasty with mobile bearing (mobile bearing group) and 54 patients received unicompartmental knee arthroplasty with fixed bearing (fixed bearing group). The complications were recorded. After the operation, the visual analogue scale score, knee motion range, knee function and clinical KSS score were followed up. The X-ray films (tibiofemoral angle, hip knee ankle angle, tibial posterior angle) were reexamined to evaluate the force line correction of the lower limbs. The research meets the ethical requirements of Foshan Hospital of Traditional Chinese Medicine (fsz20130642).

    RESULTS AND CONCLUSION: (1) 154 patients were followed up for 60-72 months postoperatively. (2) The visual analogue scale score, knee motion range, knee function and clinical KSS score in the last follow-up of the two groups were significantly improved (P < 0.05), and there was no significant difference between the two groups (P > 0.05). (3) The tibiofemoral angle, hip knee ankle angle and tibial caster angle in the last follow-up of the two groups were significantly improved (P < 0.05). The corrected values of tibiofemoral angle and hip knee ankle angle in the mobile bearing group were higher than those in the fixed bearing group (P < 0.05). There was no significant difference in the corrected values of tibial caster angle between the two groups (P > 0.05). There was no significant difference in the distribution of Kennedy and white in the mechanical axis of the lower limbs between the two groups (P > 0.05). (4) In the mobile bearing group, there were one case of prosthesis loosening and two cases of pad dislocation. (5) The results showed that there was no significant difference in the mid-term follow-up clinical results between the two kinds of platform single condylar replacement prosthesis in the treatment of medial compartment osteoarthritis of the knee, but the angle of force line correction of the lower extremity was larger in the mobile bearing unicompartmental knee arthroplasty than in the fixed bearing, which was more advantageous in the restoration of the anatomical axis of the lower extremity. The incidence of complications after the two kinds of unicompartmental knee arthroplasty was low. The incidence of complications was higher in the mobile bearing than that of fixed bearing during the mid-term follow-up. The main complications in the middle stage of mobile bearing were prosthesis loosening and pad dislocation.

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    Hemostatic effect and safety of intravenous combined with topical administration of tranexamic acid on unicompartmental knee arthroplasty
    Deng Zengfa, He Zhiyong, Liu Kang, Yu Xinping, Liang Jianji, Wang Jinjun, Li Chen, Guo Zhouyang
    2020, 24 (36):  5793-5799.  doi: 10.3969/j.issn.2095-4344.2899
    Abstract ( 305 )   PDF (537KB) ( 31 )   Save

    BACKGROUND: More and more patients are undergoing unicompartmental knee arthroplasty. Tranexamic acid has been injected into the articular cavity in unicompartmental knee arthroplasty in the past, and effects of intravenous combined with topical administration of tranexamic acid in unicompartmental knee arthroplasty have not been studied.

    OBJECTIVE: To investigate the hemostatic effect and safety of intravenous combined with topical administration of tranexamic acid in unicompartmental knee arthroplasty.

    METHODS: A retrospective analysis was conducted on the medical records of 48 patients with knee

    osteoarthritis who underwent primary unilateral unicompartmental knee arthroplasty in the First Department of Orthopedics of Zhongshan People’s Hospital from June 2015 to December 2019. The patients were divided into two groups according to perioperative use of tranexamic acid. The 30 patients in the experimental group received intravenous infusion of 1.0 g tranexamic acid before surgery and 0.5 g tranexamic acid mixed with cocktail before closing the incision. The 18 patients in the control group did not receive tranexamic acid before surgery or cocktail with tranexamic acid before closing the incision. The dominant, hidden and total blood loss of the two groups, the loss of hemoglobin and hematocrit on day 2 after the operation, the number of blood transfusion cases, the duration of postoperative and total hospital stay, and any complications within 30 days after the operation were compared and analyzed.

    RESULTS AND CONCLUSION: (1) The dominant, hidden and total blood loss, and the loss of hemoglobin and hematocrit were significantly less in the experimental group than in the control group on day 2 after surgery, with statistically significant differences (P < 0.05). (2) There was no statistically significant difference between the two groups in the number of blood transfusions, postoperative and total hospital stay and any complications within 30 days after surgery (P > 0.05). (3) The results confirmed that the intravenous combined with topical administration of tranexamic acid in the unicompartmental knee arthroplasty has obvious hemostatic effect, and has a certain safety. 

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    Early analgesic effect of cocktail periarticular injection versus femoral nerve block in total knee arthroplasty: a single-center randomized double-blind control
    Zhang Ye, Feng Shuo, Zhang Yu, Sun Jianning, Shi Sifeng, Chen Xiangyang
    2020, 24 (36):  5800-5805.  doi: 10.3969/j.issn.2095-4344.2909
    Abstract ( 473 )   PDF (595KB) ( 131 )   Save

    BACKGROUND: It has been controversial whether the early analgesic effect and patient satisfaction of cocktail periarticular injection in total knee arthroplasty are better than femoral nerve block.

    OBJECTIVE: To compare the early clinical effect with cocktail periarticular injection and femoral nerve block in total knee arthroplasty.

    METHODS: From March to December 2019, 70 cases with chronic knee osteoarthritis were collected from Affiliated Hospital of Xuzhou Medical University. The patients were randomly divided into two groups. In the observation group (n=35), patients received total knee arthroplasty. Cocktail solution was injected into the posterior capsule, bilateral collateral ligament areas, and the subcutaneous tissue of the incision. After the incision was closed, cocktail solution was injected into the drainage tube. In the control group (n=35), patients received total knee arthroplasty. The femoral nerve block was performed after the incision was closed. Postoperative visual analogue scale scores for pain, knee active activity and analgesic satisfaction of patients were assessed within 14 days after surgery. The study was approved by ethics committee of Affiliated Hospital of Xuzhou Medical University.

    RESULTS AND CONCLUSION: (1) At 2, 3 and 5 days postoperatively, the visual analogue scale pain scores of the observation group were significantly lower than those of the control group (P < 0.05); there was no significant difference at other time points (P > 0.05). (2) The knee flexion of observation group was statistically greater than control group at 2 and 3 days postoperatively (P < 0.05); there was no significant difference at other time points (P > 0.05). (3) Totally 23 of 35 patients in the observation group were satisfied with the analgesic effect and 10 of the 35 patients in the control group were satisfied with the analgesic effect. The differences between the groups were significant (P < 0.05). (4) Acute analgesia was observed 20 times in the observation group after operation, and 36 times in the control group. (5) The results showed that cocktail periarticular injection analgesia was superior to femoral nerve block analgesia in knee arthroplasty, which could improve the active motion and satisfaction of the knee in the early postoperative period. It was conducive to the early postoperative recovery of the knee.

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    Application of perioperative pulse irrigation combined with tranexamic acid in total knee arthroplasty
    Zhou Zhi, Xiong Yaqiong
    2020, 24 (36):  5806-5811.  doi: 10.3969/j.issn.2095-4344.2904
    Abstract ( 435 )   PDF (554KB) ( 32 )   Save

    BACKGROUND: Perioperative blood loss in total knee arthroplasty can affect the quick recovery of patients.

    Many studies have proved that tranexamic acid can reduce perioperative blood loss in total knee arthroplasty, but there is still controversy and no unified view.

    OBJECTIVE: To investigate the effect of pulse irrigation combined with topical use of tranexamic acid on perioperative blood loss, inflammatory response and complications in total knee arthroplasty.

    METHODS: Totally 63 patients with unilateral knee osteoarthritis including 19 males and 44 females, aged 60 to 75 years, who were treated in the Huaian First Hospital Affiliated to Nanjing Medical University from August 2018 to December 2019, were selected. The patients were randomly divided into two groups according to the envelope balloting method. In the experimental group, 32 patients received intraoperative pulse irrigation combined with topical use of tranexamic acid in the total knee arthroplasty. In the control group, 31 patients received conventional irrigation combined with topical use of tranexamic acid in the total knee arthroplasty. Total perioperative blood loss and hidden blood loss were calculated, and the number of transfusions and blood transfusion volume were recorded. Serum inflammatory factors and coagulation function were detected 1 and 7 days postoperatively. Color ultrasonography was performed to check deep venous thrombosis in the lower extremities on day 7 after surgery. The research plan was approved by the Ethics Committee of Huaian First Hospital Affiliated to Nanjing Medical University.

    RESULTS AND CONCLUSION: (1) Total perioperative blood loss, hidden blood loss and transfusion rate of the experimental group were lower than those of the control group (P < 0.05). (2) At 1 and 7 days after the operation, c-reactive protein, tumor necrosis factor-α and interleukin-6 in the experimental group were lower than those in the control group (P < 0.05). (3) There was no significant difference in prothrombin time, activated partial thrombin time and international standardized ratio between the two groups (P > 0.05). (4) There was no deep vein thrombosis in the two groups. (5) The results have shown that compared with conventional irrigation combined with topical use of tranexamic acid, pulse irrigation combined with topical use of tranexamic acid could significantly reduce total and hidden blood loss in the perioperative period of total knee arthroplasty, reduce the blood transfusion rate, and reduce the inflammatory response after knee arthroplasty.

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    Application of tranexamic acid combined with tourniquet optimization program in total knee arthroplasty
    Peng Ruhui, Zhou Dechun
    2020, 24 (36):  5812-5817.  doi: 10.3969/j.issn.2095-4344.2931
    Abstract ( 393 )   PDF (491KB) ( 187 )   Save

    BACKGROUND: The use of tourniquets during knee replacements has received widespread attention and controversy in recent years. Recently, some scholars have proposed an optimized application plan of tourniquet during operation, which is conducive to speeding up postoperative recovery of patients.

    OBJECTIVE: To observe the clinical effect of tranexamic acid combined with tourniquet optimization program

    during total knee arthroplasty.

    METHODS: Sixty patients with knee osteoarthritis who were admitted to the Traditional Chinese Medicine Hospital of Meishan City from March 2018 to December 2019 were included, including 20 males and 40 females. They were divided into two groups using random number table method (n=30 per group). The observation group received total knee arthroplasty, and a tourniquet was used from implantation of the prosthesis to bone cement hardening (optimization of the tourniquet). The control group received total knee arthroplasty, and the tourniquet was used throughout the treatment. The dosage and method of tranexamic acid in the two groups were the same. Serum hemoglobin, leukocytes, and C-reactive protein levels were detected at 1, 3, and 7 days postoperatively. Visual analogue scale scores were used to assess pain at 1, 3, 7 and 1 month postoperatively. At 3, 7 days and 1 month, the HSS score was used to assess knee function. The trial was approved by the ethics committee of Traditional Chinese Medicine Hospital of Meishan City.

    RESULTS AND CONCLUSION: (1) The hemoglobin value of the observation group at 1 day was lower than that of the control group (P < 0.05), and there was no significant difference between the two groups at other time points (P > 0.05). (2) Leukocyte count was lower in the observation group than that of the control group at 3 and 7 days (P < 0.05), and there was no significant difference between the two groups at 1 day after operation (P > 0.05). (3) C-reactive protein level was lower at 1 and 3 days after operation in the observation group than in the control group (P < 0.05), and there was no significant difference between the two groups at 7 days after the operation. (4) The visual analogue scale score at 3 days after surgery in the observation group was lower than that in the control group (P < 0.05), and there was no significant difference at the other two time points between the two groups (P > 0.05). (5) There was no significant difference in HSS scores between the two groups at various time points (P > 0.05). (6) The results showed that the optimal use of tranexamic acid combined with tourniquet can relieve pain and inflammation levels after total knee arthroplasty, which is of great significance for early recovery of the patients.

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    Comparison of internal fixation and joint replacement for treating intertrochanteric fractures of cerebral infarction hemiplegia side in older adults
    Zhang Qingzhu, Wan Qian, Yin Xuelian, Hou Jing, Zhang Yi
    2020, 24 (36):  5818-5824.  doi: 10.3969/j.issn.2095-4344.2900
    Abstract ( 409 )   PDF (567KB) ( 48 )   Save

    BACKGROUND: Intertrochanteric fracture of cerebral infarction hemiplegia side in older adults is a special type of intertrochanteric fracture. There are three surgical treatments: intramedullary fixation, plate fixation, and joint replacement. However, there are few related literatures about it, which are inconclusive and controversial.

    OBJECTIVE: To compare the clinical efficacy of Intertrochanteric Antegrade Nailing System (InterTAN, Smith & Nephew), proximal femoral locking compression plate and cemented hemiarthroplasty in the treatment of senile cerebral infarction with hemiplegic intertrochanteric fracture.

    METHODS: Clinical data of 88 cases of intertrochanteric femoral fractures combined with hemiplegia due to cerebral infarction treated in the Affiliated Hospital of Chengde Medical University from October 2010 to October 2017 were retrospectively analyzed. The subjects were divided into three groups according to treatment methods. There were 24 patients in the InterTAN group, and 35 patients in the proximal femoral locking compression plate group, and 29 patients in the arthroplasty group. Operation time, intraoperative blood loss, hemoglobin differences before and after operation, postoperative bed rest time, perioperative complication rate, and Harris score at 6 and 12 months after operation were compared among the three groups.

    RESULTS AND CONCLUSION: (1) Operation time was shorter in the InterTAN group than that in the proximal femoral locking compression plate group and the replacement group (P < 0.05). Intraoperative blood loss in the InterTAN group was least, followed by the proximal femoral locking compression plate group. Intraoperative blood loss in the arthroplasty group was most; the difference was statistically significant (P < 0.05). The difference of hemoglobin before and after the operation was lower in the proximal femoral locking compression plate group than in the InterTAN group and arthroplasty group (P < 0.05). Postoperative bed rest time in the proximal femoral locking compression plate group was significantly longer than that in the InterTAN group and arthroplasty group (P < 0.05). (2) The total Harris score of the hip joint at 6 months in the arthroplasty group was highest, followed by the InterTAN group, and it was lowest in the proximal femoral locking compression plate group; significant differences were found among the three groups (P < 0.05). The total Harris score of the hip joint in the proximal femoral locking compression plate group at 12 months after operation was significant lower than that in the InterTAN group and arthroplasty group (P < 0.05). (3) The incidence of postoperative complications in the InterTAN group, proximal femoral locking compression plate group and replacement group were 21%, 34% and 21%, respectively, with no significant difference (P > 0.05). (4) It is concluded that compared with proximal femoral locking compression plate, InterTAN and cemented hemiarthroplasty in the treatment of senile cerebral infarction with hemiplegic intertrochanteric fracture have shorter postoperative bed rest time and better postoperative hip function recovery, which can be used as the preferred choice. However, cemented hemiarthroplasty has a faster recovery of hip function than InterTAN in the short term.

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    Comparison of bipolar long-stalk artificial femoral head replacement and proximal femoral nail antirotation in the treatment of intertrochanteric fracture of senile femur
    Zhang Jian, Yang Yang, Gong Taifang, Zhang Jiang, Yu Yunxiang
    2020, 24 (36):  5825-5831.  doi: 10.3969/j.issn.2095-4344.2932
    Abstract ( 482 )   PDF (607KB) ( 65 )   Save

    BACKGROUND: Intertrochanteric fractures of the femur are one of the most common fractures in the elderly. For the treatment of intertrochanteric fractures, early surgical treatment is now generally advocated by orthopedic surgeons, mainly bipolar long-stalk artificial femoral head replacement and proximal femoral nail antirotation. Both of the two schemes can well ensure the patients’ out-of-bed activities and reduce the complications during the stay in bed. However, there is still a great controversy on the indications of the two schemes.

    OBJECTIVE: To analyze the clinical differences between bipolar long-stalk artificial femoral head replacement and proximal femoral nail antirotation in the treatment of intertrochanteric fractures in elderly patients.

    METHODS: Totally 200 patients aged older than 75 years old with Tronzo-Evans II-V femoral fractures were enrolled, and followed up for 12 months. Eleven cases lost to follow up. Totally 189 cases completed the follow-up. Among them, there were 95 cases of bipolar long-stalk artificial femoral head replacement and 94 cases of proximal femoral nail antirotation. Perioperative parameters, such as operation time, intraoperative blood loss, postoperative time of getting out of bed (beginning load bearing, complete load bearing), preoperative and postoperative coagulation function, complications during hospitalization and length of stay, were compared between the two groups. The postoperative hip function of the two groups was compared according to Harris functional score. Clinical and radiographic data were used to compare the complications within 12 months after surgery between the two groups.

    RESULTS AND CONCLUSION: (1) The operation time and postoperative weight-bearing time (starting to get out of bed after surgery, and the time to get out of bed completely after surgery) of the bipolar long-stalk artificial femoral head replacement group were lower than those of the proximal femoral nail antirotation group (P < 0.05). (2) Harris scores at 1, 2, 3 and 6 months after operation were higher in the bipolar long-stalk artificial femoral head replacement group than in the proximal femoral nail antirotation group (P < 0.05). Harris scores of the two groups were similar with no significant difference (P > 0.05). (3) Regarding postoperative complications, the incidence of lower extremity venous thrombosis and pulmonary infection had significant difference between the two groups (P < 0.05). Wound infection and secondary operation had no significant difference between the two groups (P > 0.05). Overall incidence of complications was 20% in the bipolar long-stalk artificial femoral head replacement group and 72% in the proximal femoral nail antirotation group; the difference between the two groups was statistically significant (P < 0.05). (4) It is concluded that for elderly patients with unstable intertrochanteric fractures, both bipolar long-stalk artificial femoral head replacement and proximal femoral nail antirotation internal fixation can achieve satisfactory results. However, the operation time of bipolar long-stalk artificial femoral head replacement is short, and early load bearing can be achieved, which is helpful to reduce long-term best-related complications, is in line with the idea of quick recovery, and can improve the quality of life of the patients. 

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    Effect of headless reduction screws and common headless compression screws in the treatment of medial malleolus fractures
    Zheng Jiang, Chen Erdong, Chen Mingcan, Li Kainan
    2020, 24 (36):  5832-5836.  doi: 10.3969/j.issn.2095-4344.2336
    Abstract ( 582 )   PDF (487KB) ( 234 )   Save

    BACKGROUND: The headless reduction screw is an improved hollow screw. The clinical data are few compared with the common headless compression screws in the treatment of internal malleolus fracture.

    OBJECTIVE: To compare the postoperative effects of headless reduction screws and common headless compression screws in the treatment of medial malleolus fractures.

    METHODS: Totally 100 patients with medial malleolus fracture at the Department of Orthopedics, Affiliated Hospital to Chengdu University from July 2016 to October 2018 were retrospectively analyzed. Patients in the headless reduction screw group (n=50) were treated with headless reduction screw for internal fixation. Patients in the common headless compression screw group (n=50) were treated with common headless compression screws. Ankle radiographic examination was performed in each group after surgery to assess fracture healing time, complications, and AOFAS score.

    RESULTS AND CONCLUSION: (1) There was no significant difference in fracture healing time and AOFAS score between the two groups 6 weeks to 18 months after surgery (P > 0.05). (2) Analysis of complications: delayed healing appeared in one case 7 months after operation, and internal fixation fracture in one case 12 months after operation in the headless reduction screw group. Wound infection appeared in one patient 2 days after operation, vein thrombosis in one patient 3 months after operation, delayed healing in two patients 6 and 9 months after operation, overpressure in one patient 1 day after operation, and internal irritation in one patient 5 months after operation in the common headless compression screw group. There was no statistical difference in the number of complications between the two groups (P > 0.05). The number of complications was less in the headless reduction screw group than in the common headless compression screw group. (3) These results conclude that the clinical effect of applying headless reduction screw is similar to that of common headless compression screw group in the treatment of medial malleolus fracture. Headless reduction screws can reduce the complications properly.

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    CT measurement of posterior part of atlantoaxial anatomical structures and design of atlantoaxial interlaminar fusion cage
    Zou Xiaobao, Ma Xiangyang, Wang Binbin, Yang Haozhi, Ge Su, Chen Yuyue, Zhang Shuang, Ni Ling, Xia Hong, Wu Zenghui
    2020, 24 (36):  5837-5842.  doi: 10.3969/j.issn.2095-4344.2933
    Abstract ( 461 )   PDF (464KB) ( 57 )   Save

    BACKGROUND: Atlantoaxial lateral mass joint fusion cage has always been a focus of research, but its implant operation is too risky. At present, there is no widely used atlantoaxial fusion cage.

    OBJECTIVE: To investigate the anatomical feasibility of CT image and preliminary design of posterior atlantoaxial interlaminar fusion cage in adults.

    METHODS: Measurement of atlantoaxial three-dimensional CT of 100 adult cases (50 males and 50 females) was performed, including C1 unilateral posterior arch length, C1 posterior arch width, C2 unilateral lamin length, C2 lamina thickness and the distance of C1 posterior arch higher edge to C2 lamin lower edge. CT measurement data of posterior part of atlantoaxial structure were analyzed, and atlantoaxial interlaminar fusion cage was designed.

    RESULTS AND CONCLUSION: (1) The C1 unilateral posterior arch length of man and woman was (23.41±1.48) mm and (22.23±1.25) mm respectively, and the C1 posterior arch width was (6.00±0.96) mm and (5.28±0.78) mm respectively, and the C2 unilateral lamin length was (18.54±2.23) mm and (17.31±0.91) mm respectively, and the C2 lamina thickness was (5.12±1.31) mm and (4.98±1.26) mm, respectively. The distance of C1 posterior arch higher edge to C2 lamin lower edge was (32.63±2.76) mm and (31.39±4.04) mm, respectively. (2) There were no statistically significant differences in the bilateral measurement data of different genders (P > 0.05). The C1 unilateral posterior arch length, C1 posterior arch width and C2 unilateral lamin length in men were larger than those in women, and the differences were statistically significant (P < 0.05). There were no statistically significant differences in the C2 lamina thickness and the distance of C1 posterior arch higher edge to C2 lamin lower edge of different genders (P > 0.05). (3) CT measurement data suggested that atlantoaxial interlaminar fusion cage is feasible. (4) Preliminary design of atlantoaxial interlaminar fusion cage was successful, and obtained the national patent. (5) It is suggested that atlantoaxial interlaminar fusion cage has application feasibility and can be used in posterior atlantoaxial screw-rod fixation and fusion to improve the fusion rate of bone graft.

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    Action mechanism of Wuwei Xiaodu Yin in the treatment of periprosthetic joint infection based on network pharmacology
    Zhang Haitao, Xin Pengfei, Feng Wenjun, Cao Houran, Chen Jinlun, Deng Peng, Jie Ke, Ge Yingjie, Peng Xinyu, Li Jie, Zeng Jianchun, Zeng Yirong
    2020, 24 (36):  5843-5849.  doi: 10.3969/j.issn.2095-4344.2906
    Abstract ( 488 )   PDF (569KB) ( 35 )   Save

    BACKGROUND: Wuwei Xiaodu Yin has been used to treat periprosthetic joint infection in clinic, but its molecular mechanism is not clear due to the complexity of its active ingredients.

    OBJECTIVE: To investigate the action mechanism of Wuwei Xiaodu Yin in the treatment of periprosthetic joint infection.

    METHODS: The active compounds and targets of Wuwei Xiaodu Yin were obtained by using Bioinformatics Analysis Tool for Molecular Mechanism of Traditional Chinese Medicine (BATMAN-TCM) database. The disease targets corresponding to periprosthetic joint infection were obtained by using GeneCards and OMIM database. The intersection of the two was taken to obtain the Wuwei Xiaodu Yin-periprosthetic joint infection disease intersection target. The STRING online database was used to construct the protein-protein interaction network. Core genes were screened according to degree value. The intersection genes were fed into Cytoscape 3.7.2 software to construct the Wuwei Xiaodu Yin-target-periprosthetic joint infection visual network map. Furthermore, by means of DAVID online tool, the gene ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment of the intersection target were analyzed to explore the actin mechanism of Wuwei Xiaodu Yin control over periprosthetic joint infection.

    RESULTS AND CONCLUSION: A total of 37 active compounds were predicted from the BATMAN-TCM platform, with 914 target sites. A total of 286 periprosthetic joint infection target genes were screened from GeneCards and OMIM databases. Totally 39 drug and disease intersection targets were obtained by intersection, and 16 core genes were obtained by screening. (2) GO analysis results showed that the biological function of intersection target mainly included positive regulation of chemokine biosynthetic process, protein kinase B signaling, inflammatory response, lipopolysaccharide-mediated signaling pathway, negative regulation of cytokine secretion involved in immune response and so on. Molecular functions included cytokine activity, growth factor activity, ICAM-3 receptor activity, type III transforming growth factor beta receptor binding, and prostaglandin-endoperoxide synthase activity. Cell composition mainly included extracellular space, cell surface, external side of plasma membrane, extracellular region, and integrin alphaL-beta2 complex. (3) KEGG pathway enrichment showed that above targets were mainly related to rheumatoid arthritis, malaria, cytokine-cytokine receptor interaction, American trypanosomiasis, leishmaniasis, inflammatory bowel disease, amoebiasis, tumor necrosis factor signaling pathway, tuberculosis, and natural killer cell mediated cytotoxicity. (4) The action mechanism of Wuwei Xiaodu Yin in treating periprosthetic joint infection disease is characterized by multiple effective compounds, multiple action pathways and multiple target genes, providing new ideas and new directions for subsequent experiments. 

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    Biomechanical study of the effect of femoral anatomy on knee arthroplasty
    Li Chao, Cheng Jingbo, Feng Mingli
    2020, 24 (36):  5850-5857.  doi: 10.3969/j.issn.2095-4344.2914
    Abstract ( 392 )   PDF (614KB) ( 64 )   Save

    BACKGROUND: Joint arthroplasty has become one of the main methods in the treatment of severe knee disease. The effect of femur shape on joint arthroplasty has been paid more and more attention. The influence of femur shape on biomechanics after joint arthroplasty was analyzed by finite element method.

    OBJECTIVE: To summarize the anatomical characteristics of femur and the research progress of knee arthroplasty, and to analyze the influence of different femur shapes on the biomechanics of knee arthroplasty by finite element method.  

    METHODS: The key words were “femur shape, femur anatomical shape, femur side arch angle, knee

    osteoarthritis, knee arthroplasty, total knee arthroplasty, unicompartmental knee arthroplasty, biomechanics, finite element analysis”. A computer was used to retrieve Wanfang, VIP, CNKI, PubMed, Elsevier and Web of Science. Through the preliminary screening of reading titles and abstracts, the literatures with low relevance to the theme were excluded, and 102 literatures were finally included for the result analysis.

    RESULTS AND CONCLUSION: (1) The femur shape has great difference in different race and sex. (2) The different shape of femur has influence on the insertion point of femoral intramedullary positioning rod, osteotomy angle of femoral valgus, and osteotomy angle of tibia. (3) Compared with the early biomechanical analysis, the finite element analysis method is practical and flexible in vitro experiment, with strong operability and has become the first choice of orthopedic biomechanics research. The finite element analysis method has a unique advantage in the influence of femur shape on knee arthroplasty, which has been paid more and more attention.

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    Mechanism of delayed union and nonunion of the docking site after bone transport and standardized clinical application technology
    Yin Haiyang, Zhang Yonghong
    2020, 24 (36):  5858-5863.  doi: 10.3969/j.issn.2095-4344.2905
    Abstract ( 432 )   PDF (571KB) ( 75 )   Save

    BACKGROUND: Bone transport technology is one of the commonly used technologies for the treatment of large bone loss. However, the delayed union and nonunion rate of the docking site during the treatment is high and needs to be solved urgently.

    OBJECTIVE: To summarize the current reports on delayed union and nonunion of the docking site after limb

    bone transport, to clarify the current treatment methods, existing problems and future research directions.

    METHODS: The PubMed, CNKI, and Wanfang Med Online Database were searched for relevant literatures on bone transport and docking site published from January 2009 to December 2019. The English and Chinese search key words were “docking site, bone transport, distraction osteogenesis”.

    RESULTS AND CONCLUSION: (1) Bone transport is the gold standard for the treatment of long bone defects in the limbs, especially in the case with infection. Delayed union and nonunion of the docking site are the common complications. The incidence rate in the literature is 73%, at a high level overall. (2) There are many reasons that lead to delayed union and nonunion of the docking site, including reduction of the area of contact, incarceration of soft tissue in the gap, and poor blood supply. (3) Prevention should focus on preoperative evaluation, precise operation, regular postoperative review, and early intervention. The treatment method is mainly based on incision and bone grafting. In addition, surgery under arthroscopy, combined fixation with plates, intramedullary pins, and non-surgical treatment are derived. It can assist extracorporeal shock wave therapy, electromagnetic field stimulation, hyperbaric oxygen therapy, and gene therapy. (3) “Accordion” technique is one of the conservative treatment methods. It has the advantages of fewer traumas, low cost, and no bone grafting. However, the “accordion” technique schemes are different; there are few cases reported; and the mechanism is not clear, which limits the further promotion of the technology. (4) In the future, the clinical research should be further expanded, and the mechanism of the technology should be studied in depth. The unified operation scheme should be optimized to further promote the “accordion” technique application.

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    Risk factors for prosthetic dislocation after total hip arthroplasty: recent progress
    Zhu Dongming, Zhang Zhen, Zhang Jie, Yan Lianqi
    2020, 24 (36):  5864-5870.  doi: 10.3969/j.issn.2095-4344.2934
    Abstract ( 306 )   PDF (580KB) ( 125 )   Save

    BACKGROUND: Prosthetic dislocation after total hip arthroplasty is a problem faced by joint surgery. With the rapid development of joint surgery techniques, the problem of postoperative prosthetic dislocation has become increasingly important. Research by scholars in and outside China has found that there are potential factors in preoperative evaluation and planning, surgical methods and postoperative rehabilitation leading to the occurrence of postoperative prosthetic dislocation. The understanding of related risk factors is becoming more comprehensive.

    OBJECTIVE: To summarize the latest research progress on the risk factors of prosthetic dislocation after total hip arthroplasty, and provide reference for clinical treatment.

    METHODS: The computer was used to search CNKI, Wanfang, PubMed and Embase databases from January 1970 to September 2019. The search terms were “total hip arthroplasty, prosthesis, postoperative dislocation, risk factors”. Relevant articles were consulted, and finally 77 literatures were included to analyze the results.

    RESULTS AND CONCLUSION: (1) The risk factors for postoperative dislocation after total hip arthroplasty include incomplete preoperative evaluation and planning, unreasonable surgical methods, and unscientific postoperative rehabilitation. (2) The prosthetic dislocation after total hip arthroplasty will seriously affect the surgical effect. Therefore, precautions should be taken in each link before, during and after the operation to avoid the occurrence of dislocation.

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    Comparative clinical efficacy of cortical bone trajectory screw and pedicle screw fixation in posterior lumbar interbody fusion: a meta‑analysis
    Chen Haoyan, Xiao Zenglin, Wang Dongping, Xie Weixing, Jin Daxiang
    2020, 24 (36):  5871-5879.  doi: 10.3969/j.issn.2095-4344.2911
    Abstract ( 411 )   PDF (654KB) ( 42 )   Save

    BACKGROUND: Currently, pedicle screw fixation is widely used in posterior lumbar interbody fusion. However, due to its shortcomings such as the need of extensive muscle dissection, and invasion of adjacent joints, since 2009, cortical screws were introduced to administrate posterior lumbar interbody fusion in order to reduce intraoperative blood loss and related surgical complications. At present, there are some shortages in the meta-analyses comparing cortical screws with pedicle screws in the use of posterior lumbar interbody fusion, such as including studies with the inconsistent operative methods, or including studies with relatively short follow-up time, or analyses with a rather small sample sizes.

    OBJECTIVE: To compare the clinical efficacy of cortical bone trajectory screw and pedicle screw fixation in posterior lumbar interbody fusion.

    METHODS: The computer was used to search for studies of comparing clinical efficacy of cortical bone trajectory screw fixation and pedicle screw fixation in posterior lumbar interbody fusion in PubMed, Embase, Web of Science, China Biology Medicine disc, China National Knowledge Infrastructure and Wanfang database from January 2009 to January 1, 2020. The data in each research were extracted and sorted into tables. The research data were meta-analyzed and synthesized by RevMan 5.3 software.

    RESULTS AND CONCLUSION: (1) A total of 12 articles that met the study criteria, including 2 randomized controlled trials and 10 cohort studies with 929 patients were included in the analysis database. Quality assessment indicated that the included studies had relatively high quality. (2) Meta-analysis results indicated that compared with pedicle screw group, intraoperative blood loss (MD=-68.77, 95%CI: -84.33 to -53.21), operation time (MD=-28.96, 95%CI: -53.11 to -4.82), hospitalization time (MD=-1.59, 95%CI: -2.58 to -0.59) and perioperative complications (OR=-1.95, 95%CI: -4.11-0.20) were statistically significant in the cortical bone trajectory screw group (P < 0.05). Postoperative visual analogue scale back pain score, visual analogue scale leg pain score, Oswestry Dysfunction Index, Japanese orthopaedic association score, long-term complications and fusion rate were not statistically significant. (3) Above data verified that compared with pedicle screw, cortical bone trajectory screw in posterior lumbar interbody fusion can reduce intraoperative blood loss, shorten the operation time and hospitalization time and reduce perioperative complications. However, more prospective, large-scale randomized controlled trials are still needed to provide first-class evidence for verification.

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    Meta-analysis of 3D printing-assisted posterior osteotomy for spinal deformity
    Wu Ronghai, Zhou Junde, Chen Peiyou, Yuan Liyi, Huang Junlin, Liang Zeqian, Wang Huimin
    2020, 24 (36):  5880-5885.  doi: 10.3969/j.issn.2095-4344.2912
    Abstract ( 296 )   PDF (514KB) ( 76 )   Save

    BACKGROUND: 3D printing technology was more and more widely used in spine surgery, and it had a good auxiliary surgery effect. However, there is currently no evidence-based medical evidence to confirm the efficacy and safety of 3D printing-assisted posterior osteotomy for spinal deformities.

    OBJECTIVE: To systematically evaluate the efficacy of 3D printing-assisted posterior osteotomy in the treatment of spinal deformity.

    METHODS: Such databases as PubMed, Embase, Cochrane Library, CNKI, Wanfang, VIP, and CBM were searched from their inception to December 2019 for the research investigating 3D printing in the treatment of spinal deformity. English and Chinese search terms were “3D printing”, “rapid prototyping”, “spinal deformity”. Literature review, data extraction, and quality evaluation were performed independently by two researchers.The meta-analyses were performed using the RevMan 5.3 software.

    RESULTS AND CONCLUSION: (1) Six literatures involving 282 patients were included. There were 139 cases in the 3D printing group and 143 cases in the conventional group. (2) Meta-analysis results showed that in the 3D printing group, the operation time and surgical radiation exposure time were shorter, and intraoperative blood loss was less than in the conventional group (P < 0.05). (3) Cobb angle, Cobb angle correction rate, screw placement accuracy, and Oswestry disability index were all superior to the conventional group (P < 0.05). (4) In terms of complications, the difference was not statistically significant between the 3D printing group and conventional group (P > 0.05). (5) Above data verified that 3D printing-assisted posterior osteotomy can significantly reduce operation time and intraoperative blood loss and improve the surgical effect.

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    Factors for the recurrence of lumbar disc herniation after percutaneous transforaminal endoscopic discectomy: a meta-analysis
    Qian Yuzhang, Wang Nan, Dong Yuqi, Xie Lin, Kang Ran
    2020, 24 (36):  5886-5896.  doi: 10.3969/j.issn.2095-4344.2915
    Abstract ( 383 )   PDF (831KB) ( 117 )   Save

    BACKGROUND: Percutaneous transforaminal endoscopic discectomy is a minimally invasive technique for the treatment of lumbar disc herniation. It is widely accepted by patients, because it has the advantages of less trauma, more complete bone structure retention, and faster postoperative recovery. However, some patients are reported recurrence after percutaneous transforaminal endoscopic discectomy, and there are still controversies about the factors affecting its recurrence.

    OBJECTIVE: To identify the risk factors for the recurrence of lumbar disc herniation after percutaneous transforaminal endoscopic discectomy by meta-analysis

    METHODS: A comprehensive search was conducted for the studies published until February 2020 on the factors for the recurrence of lumbar disc herniation after percutaneous transforaminal endoscopic discectomy in the CNKI, Wanfang, VIP and CBM, PubMed, Cochrane Library and EMbase databases. Two or three evaluators independently searched, screened, extracted data, and included the documents meeting the inclusion criteria. Literature quality was assessed using Newcastle Ottawa scale score. Meta-analysis was carried out with RevMan 5.3 software.

    RESULTS AND CONCLUSION: (1) A total of 606 articles were retrieved, and 11 studies were included after screening, including 7 high-quality articles and 4 medium-quality articles. (2) The recurrence of lumbar disc herniation after percutaneous transforaminal endoscopic discectomy has nothing to do with sex, age, type of herniation, position, operative segment, operation program, drinking, hypertension, and hyperlipidemia (P > 0.05). (3) The recurrence is related to body mass index (OR=1.91, 95%CI: 1.20-3.04, P=0.006), Pfirrmann rating (OR=0.40, 95%CI: 0.19-1.87, P=0.02), removal of nucleus pulposus during operation (OR=3.17, 95%CI:1.51-6.69, P=0.002), fiber ring breakage (OR=1.93, 95%CI: 1.03-3.63, P=0.04), Modic change (OR=3.11, 95%CI: 1.87-5.18, P=0.04), diabetes mellitus (OR=2.06, 95%CI:1.12-3.77, P=0.02), and activity intensity (OR=4.45, 95%CI:2.65-7.48, P < 0.001). (4) These results suggest that body mass index, Pfirrmann rating, removal of nucleus pulposus during operation, fiber ring breakage, Modic change, smoking, diabetes mellitus and postoperative working intensity may be the risk factors for the recurrence of lumbar disc herniation after percutaneous transforaminal endoscopic discectomy. However, the above conclusions need to be included in more high-quality literature for further study and verification.

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