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28 January 2021, Volume 25 Issue 3 Previous Issue    Next Issue

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Mechanical stability of medial support nail in treatment of severe osteoporotic intertrochanteric fracture Nie Shaobo, Li Jiantao, Sun Jien, Zhao Zhe, Zhao Yanpeng, Zhang Licheng, Tang Peifu 2021, 25 (3):  329-333.  doi: 10.3969/j.issn.2095-4344.2942 Abstract ( 506 )   PDF (679KB) ( 293 )   Save BACKGROUND: The medial support nail restored the triangular stable structure of the proximal femur through the reconstruction of the medial femoral support. The early finite element analysis and biomechanics showed that the stability of the nail was better than that of the commonly used proximal femoral nail antirotation, but the specific performance in the model of severe osteoporosis was unknown. OBJECTIVE: To compare the biomechanical differences between medial support nail and proximal femoral nail antirotation in the treatment of severe osteoporotic intertrochanteric fractures without medical support. METHODS: The medial unsupported intertrochanteric fracture model was made of artificial bone with severe osteoporosis. Axial and torsional failure experiments were conducted after the medial support nail and the proximal femoral nail antirotation were respectively fixed, and the axial stiffness and torsional stiffness of the two under axial and torsional loads were recorded. RESULTS AND CONCLUSION: (1) Axial failure experiment showed that the ultimate load  yield load and axial stiffness of the medial support nail group were all greater than those of the proximal femoral nail antirotation group, but there was no significant difference between the two groups (P  > 0.05). (2) The torsional failure experiment showed that the torsional stiffness of the medial support nail group was higher than that of the proximal femoral nail antirotation group (P < 0.05). (3) The findings confirmed that the mechanical stability of the medial support nail, especially torsion resistance, is better than that of the proximal femoral nail antirotation, which may be a good choice for the treatment of severe osteoporotic intertrochanteric fracture. Figures and Tables | References | Related Articles | Metrics

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Biomechanical analysis of elastic nail combined with end caps and wire fixation for long oblique femoral shaft fractures Tan Jiachang, Yuan Zhenchao, Wu Zhenjie, Liu Bin, Zhao Jinmin 2021, 25 (3):  334-338.  doi: 10.3969/j.issn.2095-4344.2965 Abstract ( 431 )   PDF (632KB) ( 200 )   Save BACKGROUND: The use of elastic nails to treat children with unstable fractures or heavier children often results in shortening, angular or rotational deformities. OBJECTIVE: To provide a theoretical basis for internal fixation choice for femoral long oblique fracture by elastic nails combined with end caps or wire using biomechanical test. METHODS: An identical length oblique midshaft fracture was created in eight small adult cadaveric femurs harvested from four donors. Two 3.5-mm titanium elastic nails were introduced intramedullary into all femur models. According to the different fracture fixations, all models were divided into four groups (group A: titanium elastic nail, group B: titanium elastic nail+wire, group C: titanium elastic nail+caps, group D: titanium elastic nail+wire+caps). Nondestructive axial compression, four-point bending and torsion tests were conducted. Stiffness, displacement and torque were analyzed. RESULTS AND CONCLUSION: (1) In the axial compression tests, stiffness was increased by 509% and displacement was decreased by 74% using the titanium elastic nail+cap combination compared with titanium elastic nail alone (group A) (P < 0.01). (2) The titanium elastic nail+wire combination (group B) showed larger stiffness (P < 0.01) and smaller displacement (P < 0.01) in the sagittal plane bending test; and as well as larger stiffness (P < 0.01) and smaller displacement (P < 0.01) in coronal plane bending test; and larger stiffness in torsion test (P < 0.01). The end caps with wire in group D improved the stiffness significantly in all directions. (3) The results have demonstrated that end caps fixation helps to increase the axial stability of the long oblique fracture model, and combined wire fixation increases the structural stability under torsional and bending loads, which provides a good reference for clinical treatment of children with unstable femoral shaft fractures. Figures and Tables | References | Related Articles | Metrics

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Biomechanical characteristics of the lumbar disc after fatigue injury Xie Zhifeng, Liu Qing, Liu Bing, Zhang Tao, Li Kun, Zhang Chunqiu, Sun Yanfang 2021, 25 (3):  339-343.  doi: 10.3969/j.issn.2095-4344.2936 Abstract ( 645 )   PDF (813KB) ( 198 )   Save BACKGROUND: Lumbar disc herniation is a common clinical disease, and its pathological basis is disc degeneration. Long-term mechanical load is considered to be an important cause of lumbar disc degeneration. Because the occurrence of lumbar disc herniation is strongly associated with its mechanical state, it is necessary to further study the stress/strain behavior in the lumbar disc to provide inspiration for preventing lumbar disc herniation. OBJECTIVE: To analyze the effect of fatigue loading on mechanical properties of the whole and different regions of the intervertebral disc. METHODS: The freshly slaughtered sheep lumbar intervertebral discs L1-L2, L3-L4, and L5-L6 were obtained and made into experimental samples. The experimental samples were fixed on the experimental platform through the upper and lower vertebrae, and a quasi-static compression-cyclic loading compression-quasi-static compression experiment was performed. The L3-L4 motion segment was cut parallel to the sagittal plane, and the non-contact digital image correlation technique was used to record the internal deformation of the lumbar disc during compression.  RESULTS AND CONCLUSION: (1) The results showed that all lumbar intervertebral discs exhibited non-linear load-displacement and stress-strain characteristics. (2) Effect of fatigue loading: The Young’s modulus of the lumbar intervertebral disc increased significantly after fatigue loading. (3) Impact of segment changes: The Young’s modulus changed with segment changes as follows: L5-L6 segments < L3-L4 segments < L1-L2 segments. (3) Effect of loading rate: Comparing the mechanical properties under the compression rate of 0.01 mm/s and 0.1 mm/s, it could be seen that with the increase of the compression rate, the Young’s modulus of the intervertebral disc increased significantly. (5) Internal displacement distribution: Fatigue loading had a significant effect on the internal displacement distribution of the lumbar disc under compression. Before fatigue loading, the axial displacement in upper afferent fiber was largest, and the radial displacement in inner afferent fiber was slightly smaller than that in outer afferent fiber. After fatigue loading, the axial displacement in upper afferent fiber was smallest, and the radial displacement in inner afferent fiber was significantly smaller than in outer afferent fiber. (6) The research work in this article has important theoretical guiding significance for preventing lumbar disc herniation in daily life.  Figures and Tables | References | Related Articles | Metrics

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Comparison of gait characteristics between young and elderly people under dual tasks using three-dimensional gait analysis Yang Fengjiao, Wang Xiangbin, Hou Meijin, Yu Jiao, Li Zhenhui, Fu Shengxing, Lin Ziling, Liu Benke 2021, 25 (3):  344-349.  doi: 10.3969/j.issn.2095-4344.2967 Abstract ( 611 )   PDF (710KB) ( 2313 )   Save BACKGROUND: Dual-task walking is more common in daily life, and more challenging than single-task walking. It is more conducive to find potential gait abnormalities in daily life activities. It is widely used to evaluate the changes in motor performance and gait control when attention is distracted. OBJECTIVE: The three-dimensional gait analysis system was applied to compare the difference of gait characteristics under dual-task walking between healthy young people and elderly people so as to provide reference for preventing the elderly people from falling.  METHODS: In the youth group, there were 21 cases aged (24.57±2.27) years old and with the height of (1.64±0.08) m. In the elderly group, there were 25 cases aged (62.72±2.39) years old and with the height of (1.60±0.07) m. The two groups of subjects performed the calculation task of “minus 1 (reciprocal) starting from any number within 100” during level walking. Motion Analysis system and Visual 3D software were applied to collect and analyze the gait data. The differences of gait spatiotemporal and kinetic parameters between the two groups were compared when performing dual-task walking. RESULTS AND CONCLUSION: (1) Spatiotemporal parameters: Compared with youth group, both stride length [(1.14±0.09) m vs. (1.20±0.07) m, P < 0.05] and right step length [(0.57±0.04) m vs. (0.60±0.04) m,  P < 0.01] were smaller in the elderly group. (2) Kinetic parameters: Compared with the youth group, the left second peak hip abduction moment was higher [(0.94±0.1) Nm/kg vs. (0.86±0.16) Nm/kg,  P < 0.01]; the left ankle plantar flexor moment was lower [(1.27±0.11) Nm/kg vs. (1.35±0.15) Nm/kg,  P < 0.05]; and bilateral ankle valgus muscle moments were lower [(0.31±0.14) Nm/kg vs. (0.45±0.16) Nm/kg,  P < 0.01; (0.38±0.15) Nm/kg vs. (0.51±0.14) Nm/kg,  P < 0.01] in the elderly group. (3) These results suggest that the walking automation ability of the elderly group was lower than youth group during dual-task walking. Dual-task walking mainly affects the hip and ankle joints of the elderly, which may be related to the challenge of dual-task walking to the elderly so that they could adapt the corresponding compensatory mode to maintain stability. The characteristics of gait changes in the elderly under dual tasks can be considered as a reference for the prevention of falls. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional gait of patients with developmental dysplasia of hip undergoing total hip arthroplasty with high hip center Zhang Yu, Feng Shuo, Yang Zhi, Zhang Ye, Sun Jianning, An Lun, Chen Xiangyang 2021, 25 (3):  350-355.  doi: 10.3969/j.issn.2095-4344.2963 Abstract ( 430 )   PDF (677KB) ( 157 )   Save BACKGROUND: For patients with Crowe II and III developmental dysplasia of hip combined with severe hip osteoarthritis, total hip arthroplasty is still controversial whether to choose acetabular anatomical reconstruction or high hip rotation center reconstruction. OBJECTIVE: To compare the differences in gait characteristics between the reconstruction technique of the high hip center and the anatomical hip center during total hip arthroplasty. METHODS: Forty patients with Crowe II-III developmental dysplasia of hip with unilateral hip disease from January 2014 to July 2017 were selected. All patients received total hip arthroplasty, of which 20 cases underwent acetabular anatomical reconstruction, and another 20 patients underwent high hip center reconstruction. The patients were followed up for more than 2 years after arthroplasty for gait analysis. The study was approved by Ethics Committee of Affiliated Hospital of Xuzhou Medical University.   RESULTS AND CONCLUSION: (1) Spatiotemporal parameters: The pace, stride frequency, step length, single leg support time, single leg swing time, and double leg support time of the two groups of surgical side and non-surgical side were similar. There was no significant difference in pace, stride frequency, step length, one-leg support time, one-leg swing time, and two-leg support time between the two groups (P > 0.05). (2) Kinematic parameters: The maximum extension of the hip joint on the surgical side of the high reconstruction group was lower than that on the non-surgical side (P < 0.01). The maximum hip flexion and hip flexion and extension range of the two groups on the surgical side were lower than those on the non-surgical side (P=0.01). The maximum extension of the hip joint and hip flexion and extension range in the high reconstruction group were lower than those in the anatomical reconstruction group (P < 0.05). The maximum flexion of the hip joint, maximum knee flexion, knee flexion and extension range, and maximum dorsiflexion of the ankle, the maximum plantar flexion of the ankle, and the range of ankle dorsiflexion were not significantly different between the two groups (P > 0.05). (3) Kinetic parameters: The longitudinal peak of the plantar reaction force on the surgical side of the high reconstruction group was higher than that of the anatomical reconstruction group (P < 0.05). There was no significant difference between the internal and external peaks of the plantar reaction force and the front and back peaks of the two groups on the surgical side (P > 0.05). (4) The results show that in patients with developmental dysplasia of hip, total hip arthroplasty using high hip center reconstruction can obtain gait parameters similar to anatomical hip center reconstruction. However, compared with patients undergoing anatomical hip rotation center reconstruction, patients with high hip center reconstruction had limited hip flexion and extension range movement and greater longitudinal force on the hip. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of locking screw assisted acetabular cup fixation Chen Lu, Zhang Jianguang, Deng Changgong, Yan Caiping, Zhang Wei, Zhang Yuan 2021, 25 (3):  356-361.  doi: 10.3969/j.issn.2095-4344.2985 Abstract ( 714 )   PDF (867KB) ( 129 )   Save BACKGROUND: The main reason for the failure after total hip arthroplasty is aseptic loosening of the prosthesis. The traditional acetabular cup fixation method is still controversial in maintaining the initial stability of the acetabular cup. It is a new method that can be considered to further improve the fixation method of the acetabular cup to increase its stability. OBJECTIVE: To analyze the feasibility and superiority of locking screw assisted acetabular cup fixation.  METHODS: The digital model of acetabular cup and screws were reconstructed and assembled by software Solidworks. The Von-Mises and shear stress of the acetabular cup and screw by three methods, including acetabular cup, acetabular cup with ordinary cancellous bone screw, and acetabular cup with locked cancellous bone screw, were compared. RESULTS AND CONCLUSION: (1) The finite element model of the established acetabular cup and screw had excellent geometric similarity and could be used for finite element analysis. (2) The acetabular cups with locking screws received less Von-Mises and shear stress than other methods. (3) The locking screws could bear higher stress than ordinary screws and effectively dispersed the shear stress of acetabular cups. (4) It is concluded that the combination of locking screws to fix the acetabular cup can effectively prevent the instability of the acetabular cup and the loosening of the prosthesis; it can better provide stability for the acetabular cup and the mechanical environment that the bone tissue grow in the later stage. The acetabular cups with locking screws have obvious advantages than other ordinary screw, which has the limited bearing capacity and low anti-acetabular cup shear force. Figures and Tables | References | Related Articles | Metrics

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Comparison of the standard and long-stem bone cement prosthesis replacement in the treatment of intertrochanteric fractures in elderly patients Cheng Shigao, , Wang Wanchun, Jiang Dong, Li Tengfei, Li Xun, Ren Lian 2021, 25 (3):  362-367.  doi: 10.3969/j.issn.2095-4344.2947 Abstract ( 516 )   PDF (700KB) ( 186 )   Save BACKGROUND: The choice of standard femoral prosthesis or lengthened femoral prosthesis for the treatment of femoral intertrochanteric fracture in the elderly with hemihip replacement has always troubled clinicians.  OBJECTIVE: To compare the short-term clinical efficacy of standard and long-stem prosthesis replacement in the treatment of elderly comminuted intertrochanteric Jensen V fractures. METHODS: Data of 216 elderly patients with comminuted intertrochanteric femoral Jensen V fractures undergoing bone cement artificial half hip arthroplasty in Loudi Central Hospital from January 2008 to January 2019 were retrospectively analyzed. According to the type of prosthesis, the patients were divided into standard stem prosthesis placement group (n=92) and long-stem prosthesis replacement group (n=124). According to the fracture situation, the wire Kirschner wire was used to reduce the trochanteric fracture. At 1 year after surgery, Hariss score of the hip joint was evaluated. X-ray examination was used to observe imaging manifestations around the prosthesis. RESULTS AND CONCLUSION: (1) Two patients in the standard stem prosthesis placement group died; three patients in the long-stem prosthesis replacement group died. The remaining patients were followed up for 12-24 months. (2) At 1 year after surgery, Hariss scores were (88.6±2.9) in the standard stem prosthesis placement group with an excellent and good rate of 83.3%, and (86.9±2.7) in the long-stem prosthesis replacement group with an excellent and good rate of 82.6%; no significant difference was found between the two groups (P > 0.05). (3) In the standard stem prosthesis placement group, one case affected femoral greater trochanteric fracture nonunion; two cases had femoral small trochanteric fracture nonunion; two cases experienced Brooker’s grade 1 heterotopic ossification. In the long-stem prosthesis replacement group, one case affected femoral greater trochanteric fracture nonunion; three cases had femoral small trochanteric fracture nonunion; two cases experienced Brooker’s grade 1 heterotopic ossification. There was no significant difference in the incidence of complications between the two groups (P > 0.05). (4) It is indicated that the short-term clinical efficacy of standard and long-stem cement-type prosthesis replacement in the treatment of Jensen V type trochanteric fracture in elderly patients is satisfactory, with no statistical difference, but the long-term effect remains to be studied. Figures and Tables | References | Related Articles | Metrics

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A mid-term clinical follow-up of unicompartmental knee arthroplasty with fixed bearing Wang Weigang, Yang Zhidong, Feng Zongquan, Wang Ding 2021, 25 (3):  368-373.  doi: 10.3969/j.issn.2095-4344.2986 Abstract ( 521 )   PDF (769KB) ( 151 )   Save BACKGROUND: Most of the domestic and foreign literatures reported the mid-term and long-term effects of the unicompartmental knee arthroplasty of the mobile bearing, but few reported the mid-term and long-term clinical effects of the unicompartmental knee arthroplasty of the fixed bearing. Simultaneously, most of the studies did not analyze the knee function recovery and the lower limb force line change at different time points after the fixed bearing unicompartmental knee arthroplasty, and also ignored the follow-up of the patients’ self-feeling after the unicompartmental knee arthroplasty.  OBJECTIVE: To explore the mid-term clinical effect of fixed bearing unicompartmental knee arthroplasty in the treatment of medial compartment osteoarthritis of knee joint and to observe the change of force line of lower limbs.  METHODS: From January 2014 to January 2015, a retrospective analysis was made of the data of 66 patients diagnosed as osteoarthritis of the medial compartment of the knee in the Department of Arthritis, Foshan Hospital of Traditional Chinese Medicine. According to the inclusion and exclusion criteria, 66 patients were included, including 18 males and 48 females, aged (62.36±16.33) years. The American Knee Society knee score and the hospital for special surgery knee score were used to assess the knee function before and 1, 3 and 5 years after the operation. Visual analogue scale score was utilized to evaluate the severity of knee. Forgotten joint score was used to assess the subjective feeling of prosthesis after unicompartmental knee arthroplasty. Hip-knee-ankle angle and tibiofemoral angle were measured using X-ray films before treatment and at follow-up to evaluate the force line of weight-bearing lower limbs. RESULTS AND CONCLUSION: (1) The postoperative follow-up time was 5-6 years, averagely 5.5 years. The incision healed in the first stage. There was no early complication such as joint infection or lower extremity deep vein thrombosis, and there was no prosthesis loosening, dislocation or other diseases of the contralateral compartment and patellofemoral joint. (2) The American Knee Society knee score clinical score, American Knee Society knee score function score, hospital for special surgery knee score, knee motion range and visual analogue scale score were lower at 1, 3 and 5 years after operation than those before treatment (P < 0.05). The American Knee Society knee score clinical score, American Knee Society knee score function score, knee motion range and visual analogue scale score at 3 and 5 years after operation were significantly lower than those at 1 year after operation (P < 0.05). There was no significant difference in American Knee Society knee score clinical score, American Knee Society knee score function score, knee motion range and visual analogue scale score between 3 and 5 years postoperatively (P > 0.05). (3) Forgotten joint score was higher at 3 and 5 years after treatment than that at 1 year after treatment (P < 0.05); and there was no significant difference between 3 and 5 years postoperatively (P > 0.05). (4) Hip-knee-ankle angle and tibiofemoral angle were significantly improved after treatment in all patients compared with those before treatment (P < 0.05). There was no significant difference in hip-knee-ankle angle and tibiofemoral angle at 1, 3 and 5 years postoperatively (P > 0.05). (5) The results show that the mid-term clinical effect of unicompartmental knee arthroplasty with fixed bearing is satisfactory, and the degree of self-prosthesis is high. After treatment, the force line of lower limbs was improved, and there was no significant change in the 5-year follow-up. Figures and Tables | References | Related Articles | Metrics

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Risk assessment of contralateral knee arthroplasty after unilateral total knee arthroplasty Zheng Li, Li Dadi, Hu Weifan, Tang Jinlong, Zhao Fengchao 2021, 25 (3):  374-379.  doi: 10.3969/j.issn.2095-4344.2987 Abstract ( 471 )   PDF (740KB) ( 95 )   Save BACKGROUND: After total knee arthroplasty, some patients will receive the contralateral total knee arthroplasty again, but the influencing factors of contralateral knee surgery are not clear at present.  OBJECTIVE: To evaluate the risk ratio of contralateral knee to total knee arthroplasty in patients with osteoarthritis of both knees after total knee arthroplasty, and to analyze the risk factors of contralateral total knee arthroplasty by clinical and radiographic indicators.   METHODS: Data of 193 patients admitted to Affiliated Hospital of Xuzhou Medical University from 2013 to 2015 with bilateral knee osteoarthritis and undergoing unilateral total knee arthroplasty (follow-up time of 1-66 months) were retrospectively analyzed. The patients were divided into bilateral arthroplasty and unilateral arthroplasty groups based on whether the contralateral knee joint was replaced. K-M survival analysis was used to evaluate the risk ratio of contralateral knee total knee arthroplasty. Age, gender, body mass index, primary surgical side, non-operative knee Hospital for Special Surgery score, pain, mechanical axis perpendicular angle, medial and lateral joint space, femoral tibial angle, hip knee ankle angle, and Kellgren-Lawrence grade at initial surgery were used to assess the risk of contralateral total knee arthroplasty.   RESULTS AND CONCLUSION: (1) Fifty-eight patients (30.1%) received contralateral total knee arthroplasty. The risk of nonoperative knee surgery at 1 year was 8%, and the risk of nonoperative knee surgery at 5 years was 32%. (2) The K-L grade was highly correlated with the risk of future nonoperative total knee arthroplasty (P < 0.001). The mean survival time of the nonoperative knee with K-L grade 4 was 45.7 months, and the 5-year surgical risk was 44.3%.  (3) Age, gender, initial surgery side and body mass index, medial and lateral joint space, and hip knee ankle angle were not risk factors for progression to contralateral total knee arthroplasty. Nonoperative knee mechanical axis perpendicular angle (risk ratio=1.437, P < 0.001), femoral tibial angle (risk ratio=1.232, P < 0.001) and K-L classification (risk ratio=2.110, P=0.005) were independent risk factors. Patients with femoral tibial angle ≥185.8° and mechanical axis perpendicular angle ≥2.75° had a higher risk of contralateral total knee arthroplasty (P < 0.001). (4) The preoperative Hospital for Special Surgery score of the bilateral arthroplasty group was significantly lower than that of the unilateral arthroplasty group (P=0.039). Visual analogue scale pain score in the preoperative bilateral arthroplasty group was significantly higher than that in the unilateral arthroplasty group (P=0.013). At 6 months postoperatively, Hospital for Special Surgery score was improved in both groups, but still lower in the bilateral arthroplasty group than that in the unilateral arthroplasty group (P=0.003). (5) Not all patients with bilateral knee osteoarthritis need to receive contralateral total knee arthroplasty after unilateral total knee arthroplasty, and patients with severe knee osteoarthritis (K-L grade 4) are at high risk of needing contralateral total knee arthroplasty. Preoperative contralateral knee mechanical axis perpendicular angle, femoral tibial angle, Hospital for Special Surgery score and pain degree can be used as important factors to recommend patients or arrange a reoperation plan. Figures and Tables | References | Related Articles | Metrics

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Relationship of pathogenic bacteria distribution with drug resistance and treatment cycle for periprosthetic joint infection after total joint arthroplasty Ma Rui, Wang Jialin, Wu Mengjun, Ge Ying, Wang Wei, Wang Kunzheng 2021, 25 (3):  380-385.  doi: 10.3969/j.issn.2095-4344.2966 Abstract ( 429 )   PDF (610KB) ( 132 )   Save BACKGROUND: Understanding the characteristics of bacteriology in periprosthetic joint infection and choosing specific anti-infective drugs are very important to control the periprosthetic joint infection. The results of bacterial culture and antimicrobial susceptibility test can provide important reference for diagnosis and treatment.  OBJECTIVE: To investigate the distribution and drug resistance of pathogenic bacteria in periprosthetic joint infection patients, and analyze the effect of bacterial culture results on the treatment period.  METHODS: A retrospective analysis was conducted on 59 patients who underwent artificial joint revision between September 2015 and September 2019. The infection time, results of bacterial culture and antimicrobial susceptibility test, antibiotics application duration, prosthesis-free interval, total length of hospital stay from infection to renovation, recovery time of erythrocyte sedimentation rate and C-reactive protein were collected. The pathogenic bacteria distribution, drug resistance situation and the effect of the pathogenic bacteria and bacterial resistance on antibiotics application duration, prosthesis-free interval, and days in hospital were analyzed.  RESULTS AND CONCLUSION: (1) Among the 59 patients with periprosthetic joint infection, there were 31 cases of hip joint and 28 cases of knee joint. The highest proportion of periprosthetic joint infection phase was delayed infection (49%). The pathogenic bacteria were cultured from 35 cases, and the positive rate of bacterial culture was 59%. (2) Among the cultured pathogens, staphylococcus aureus accounted for the highest proportion (29%). (3) The pathogenic bacteria of 18 patients were antibiotic resistant, and the drug resistance rate reached 51%. (4) The bacterial cultured negative group had longer prosthesis-free interval and longer recovery times of erythrocyte sedimentation rate and C-reactive protein than those of the positive group (P  < 0.05). (5) Compared with the group with sensitive antibiotics, the duration of antibiotic application and recovery times of erythrocyte sedimentation rate and C-reactive protein were longer in the group with resistant antibiotics (P < 0.05). (6) In this study, the positive rate of bacterial culture in periprosthetic joint infection patients was not high, but the resistance rate of pathogenic bacteria was relatively high; the treatment period with positive pathogenic bacteria and sensitive antibiotics was shorter. Figures and Tables | References | Related Articles | Metrics

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Effect of tranexamic acid combined with carbazochrome sodium sulfonate on blood loss and safety after total knee arthroplasty Lü Zexiang, Wu Jutai, Jiang Jian, Feng Xiao, Li Tengfei, Wang Yehua 2021, 25 (3):  386-390.  doi: 10.3969/j.issn.2095-4344.2948 Abstract ( 815 )   PDF (654KB) ( 114 )   Save BACKGROUND: The application of tranexamic acid in knee and hip arthroplasty can reduce blood loss safely and effectively. As a kind of hemostatic agent for strengthening blood vessels, the hemostasis process of carbazochrome sodium sulfonate does not depend on the coagulation system of human body, so it has better security. OBJECTIVE: To explore the safety and blood loss of tranexamic acid combined with carbazochrome sodium sulfonate in total knee arthroplasty. METHODS: From July 2018 to December 2019, 67 patients with knee osteoarthritis were selected from the Affiliated Hospital of Xuzhou Medical University, including 18 males and 49 females. They were randomly divided into two groups. The observation group (n=32) received intravenous injection of tranexamic acid before total knee arthroplasty, followed by intravenous injection of carbazochrome sodium sulfonate after total knee arthroplasty. The control group (n=35) received intravenous injection of tranexamic acid before total knee arthroplasty, followed by intravenous injection of saline after total knee arthroplasty. The total blood loss, hidden blood loss, maximum hemoglobin drop, blood transfusion rate, incidence of thrombotic events (lower limb intermuscular vein thrombosis, deep vein thrombosis and pulmonary embolism), perioperative fibrinolytic parameters (fibrin and fibrinogen degradation products, D-dimer), inflammation markers (C-reactive protein, interleukin-6) were compared between the two groups. The study was approved by Medical Ethics Committee of Affiliated Hospital of Xuzhou Medical University. RESULTS AND CONCLUSION: (1) The decrease of total blood loss, hidden blood loss and maximum hemoglobin drop in the observation group was less than those in the control group (P < 0.05). (2) The levels of fibrin and fibrinogen degradation products, D-dimer in the observation group 1 day after surgery were lower than those in the control group (P < 0.05), and there was no significant difference between the two groups on day 3 after operation (P > 0.05). (3) The C-reactive protein level of the observation group was lower than that of the control group on day 1 and day 3 after surgery (P < 0.05), and the level of interleukin-6 on day 1 after surgery was lower than that of the control group (P < 0.05). There was no significant difference in the level of interleukin-6 between the two groups on day 3 after surgery (P > 0.05). (4) There was no blood transfusion, deep venous thrombosis of lower limbs or pulmonary embolism in the two groups during their hospitalization. (5) The results showed that tranexamic acid combined with carbazochrome sodium sulfonate can further reduce the total blood loss, hidden blood loss and hemoglobin drop of patients after total knee arthroplasty, reduce the inflammatory reaction, and do not increase the risk of thrombosis, so it was safe. Figures and Tables | References | Related Articles | Metrics

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Evaluation of internal fixation with proximal femoral nail antirotation in elderly knee osteoarthritis patients with femoral intertrochanteric fractures Lü Jiaxing, Bai Leipeng, Yang Zhaoxin, Miao Yuesong, Jin Yu, Li Zhehong, Sun Guangpu, Xu Ying, Zhang Qingzhu 2021, 25 (3):  391-396.  doi: 10.3969/j.issn.2095-4344.2945 Abstract ( 383 )   PDF (605KB) ( 276 )   Save BACKGROUND: Proximal femoral nail antirotation is a commonly used internal fixation system for the treatment of femoral intertrochanteric fracture in the elderly. Simultaneously, the elderly are often associated with knee osteoarthritis, which may affect the postoperative effect of femoral intertrochanteric fracture. OBJECTIVE: To investigate the effect of knee osteoarthritis at the fracture side on the efficacy of postopenxtine proximal femoral nail antirotation in elderly femoral intertrochanteric fractures. METHODS: Totally 92 patients aged over 65 years old with femoral intertrochanteric fractures treated with proximal femoral nail antirotation internal fixation were divided into five groups according to the preoperative knee X-ray Kellgren-Lawrence grade: grade 0 as group A (13 cases), grade I as group B (18 cases), grade II as group C (23 cases), grade III as group D (22 cases), and grade IV as group E (16 cases). The hospitalization time, postoperative complications, postoperative landing time, fracture healing time, hip Harris score and Barthel index score of daily living ability at 1, 3 and 6 months after operation were recorded in the five groups. This study was approved by the Ethics Committee of Affiliated Hospital of Chengde Medical University. RESULTS AND CONCLUSION: (1) There was no significant difference in the length of hospital stay among the five groups (P > 0.05). (2) The postoperative landing time and fracture healing time of group D and group C were longer than those in group A, group B, and group C (P < 0.05). (3) The number of postoperative complications of group C was more than those in group A and group B (P < 0.05). The number of postoperative complications of group D and group E was more than that in group A, group B and group C (P < 0.05). (4) The scores of Harris and Barthel index of group C and D were lower than those in group A and B at 1, 3 and 6 months after operation (P < 0.05). The scores of Harris and Barthel index of group E was lower than those in group A, group B, group C and group D at 1, 3 and 6 months after operation (P < 0.05). (5) The results showed that the higher the grade of knee osteoarthritis, the greater the influence on the postoperative efficacy of proximal femoral nail antirotation in the treatment of elderly patients with femoral intertrochanteric fracture. It is manifested by increased postoperative complications, prolonged postoperative landing time and fracture healing time, and the decrease of hip function and ability of daily living. Figures and Tables | References | Related Articles | Metrics

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Herbert screw internal fixation for treating adult osteochondritis dissecans of the knees Wang Xiaofei, Teng Xueren, Cong Linyan, Zhou Xu, Ma Zhenhua 2021, 25 (3):  397-402.  doi: 10.3969/j.issn.2095-4344.2988 Abstract ( 635 )   PDF (835KB) ( 145 )   Save BACKGROUND: Osteochondritis dissecans of the knee in adults may lead to local instability of articular cartilage and subchondral bone. If it is not treated in time, it will have a secondary impact on articular cartilage, and the probability of osteoarthritis of knee joint is significantly increased. At present, there is no clear treatment plan.  OBJECTIVE: To investigate the clinical effect of knee arthroscopy combined with Herbert bidirectional compression screw internal fixation for osteochondritis dissecans of the knee.   METHODS: Adult patients who met the diagnostic criteria of osteochondritis dissecans of the knee from June 2014 to September 2018 were retrospectively analyzed, and those with other knee joint diseases were excluded. There were 43 patients treated, including 25 males and 18 females. All patients were treated with knee arthroscopy combined with Herbert two-way compression screw internal fixation. All patients were adults, aged 18-53 years, with an average age of (29.00±4.62) years. All patients had unilateral knee joint disease, including 19 cases of the left limb and 24 cases of the right limb. Before treatment and at final follow-up, knee motion range was compared. Visual analogue scale score was used to evaluate knee pain. Knee Lysholm score was used to evaluate knee function.  RESULTS AND CONCLUSION: (1) Of the 43 patients, 35 completed the follow-up time of more than 1 year, and the follow-up time was 12-20 months, with an average of (14.0±2.5) months. None of the patients had related complications. (2) Knee joint pain and function improved significantly in all patients after surgery. The mean knee motion range before operation was (109.57±12.45)°, and (126.39±13.73)° at the final follow-up (t=-56.72, P < 0.001). Visual analogue scale score was (5.53±1.47) before surgery and (0.79±1.35) (t=-137.51, P < 0.001) after surgery. Mean Lysholm score was (58.27±10.51) before surgery, and (89.36±5.43) postoperatively (t=-163.65, P < 0.001). (3) Knee arthroscopy combined with Herbert’s two-way compression screw internal fixation for adult osteochondritis dissecans of knee has reliable fixation and small surgical trauma, which can significantly improve knee function, and the clinical effect is satisfactory. Figures and Tables | References | Related Articles | Metrics

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Comparison of three different internal fixation methods in treatment of ipsilateral femoral neck and shaft fracture Xiang Feifan, Ye Junwu, Zhang Xihai, Ge Jianhua, Tang Lian, Yang Yunkang 2021, 25 (3):  403-408.  doi: 10.3969/j.issn.2095-4344.2950 Abstract ( 560 )   PDF (756KB) ( 611 )   Save BACKGROUND: Ipsilateral femoral shaft and neck fracture is a rare clinical injury, and its treatment has attracted more and more attention from scholars. At present, there are many internal fixation methods. OBJECTIVE: To retrospectively analyze efficacy of three internal fixation methods in the treatment of ipsilateral femoral shaft and neck fracture, and its indications. METHODS: Thirty-three cases of ipsilateral femoral neck and shaft fracture treated by three different internal fixation implants between January 2015 and September 2018 were retrospectively studied. Patients were divided into three groups according to different internal fixation: intramedullary nail only group (group A; n=11), retrograde nail with cannulated screw group (group B; n=10) and plate with cannulated screw group (group C; n=12). The general clinical data, the intraoperative situations, the postoperative follow-up conditions and complications were compared among the three groups. RESULTS AND CONCLUSION: (1) There was no significant difference between the three groups with regard to age, gender, cause of injury, AO fracture classification, Garden classification and average time from injury to surgery (P > 0.05). (2) There were statistically significant differences among the three groups in incision length (P < 0.05); no significant difference in incision length was found between the groups A and B (P > 0.05); the incision length was smaller in groups A and B than in group C (P < 0.05). There were no significant differences among the three groups in operation time and intraoperative blood loss (P > 0.05). (3) There were no significant differences among the three groups in time to bony union in both femoral shaft and neck, complication rate, and excellent and good rate of Harris hip score (P >  0.05). (4) Femoral neck fracture delayed healing occurred in one case of the group A; re-fracture occurred in one case of the group B; and the fracture end was located under the femoral tuberosity; screw loosening occurred in one case of the group C. (5) It is indicated that all three internal fixation methods can achieve good therapeutic effects. The operator can choose the skilled internal fixation method according to the specific conditions of the patient. Figures and Tables | References | Related Articles | Metrics

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Minimally invasive transforaminal lumbar interbody fusion in the treatment of sciatic scoliosis caused by lumbar disc herniation: a 2-year follow-up of coronal and sagittal balance Liang Yan, Zhao Yongfei, Zhu Zhenqi, Liu Haiying, Mao Keya 2021, 25 (3):  409-413.  doi: 10.3969/j.issn.2095-4344.2964 Abstract ( 385 )   PDF (996KB) ( 282 )   Save BACKGROUND: The sciatic scoliosis is considered as a compensatory attempt of the body to relieve nerve irritation. If dealt with inappropriate and delayed, it may be developed in structural scoliosis. There was controversial about the treatment of such cases. OBJECTIVE: To compare the safety and effectiveness of single-level open versus minimally invasive transforaminal lumbar interbody fusion in the treatment of sciatic scoliosis caused by lumbar disc herniation. METHODS: Data of 47 patients with sciatic scoliosis caused by lumbar disc herniation who were treated in Peking University People’s Hospital from January 2010 to January 2014 were retrospectively analyzed. The main symptom was severe back and lower limb pain, complicated with trunk tilt. Twenty-five patients underwent single-level open transforaminal lumbar interbody fusion therapy (open group). Twenty-two patients underwent minimally invasive transforaminal lumbar interbody fusion therapy (minimal invasion group). The single-level surgery was conducted in both groups. The patients were followed up for at least 2 years. The clinical effects and photographic parameters were compared between the two groups.  RESULTS AND CONCLUSION: (1) There was no significant difference in age, gender, spinal levels operated and all the coronal and sagittal parameters preoperatively between the two groups (P > 0.05). (2) There was no significant difference in operation time between the two groups (P > 0.05). The amount of bleeding, postoperative time to the ground, and average length of hospital stay were better in the minimal invasion group than in the open group (P < 0.05). (3) Clinical efficacy score: Compared with preoperatively, visual analogue scale score and Oswestry disability index were significantly improved in both groups at 6 months and 2 years after operation (P < 0.05). No significant difference was found at the same time point in both groups (P > 0.05). (4) Balance of coronal plane and sagittal plane: The deformity at 2 years after operation was significantly improved compared with that before operation (P < 0.05). There was no significant difference between the two groups at the same time point (P > 0.05). (5) Solid fusion was achieved in both groups. (6) It is concluded that minimally invasive transforaminal lumbar interbody fusion in the treatment of single-level sciatic scoliosis caused by lumbar disc herniation obtained similar effect as open fusion. Moreover, it has the advantages of less bleeding, faster recovery and shorter hospital stay. Figures and Tables | References | Related Articles | Metrics

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Research status and development trend of bibliometrics and visualization analysis in the assessment of femoroacetabular impingement Fan Yinuo, Guan Zhiying, Li Weifeng, Chen Lixin, Wei Qiushi, He Wei, Chen Zhenqiu 2021, 25 (3):  414-419.  doi: 10.3969/j.issn.2095-4344.2910 Abstract ( 483 )   PDF (751KB) ( 142 )   Save BACKGROUND: Exploring the research status and development trend of femomacetabular impingement, and finding out the research direction and hot spot of femomacetabular impingement are helpful for domestic scholars to grasp the latest information in this field and explore the most cutting-edge treatment direction. OBJECTIVE: To explore the research status and the development trend of femoroacetabular impingement in the world.  METHODS: The science citation index of Wed of Science core collection was used to retrieve English literature on femoroacetabular impingement from January 1, 2005 to February 20, 2020. The bibliometric methods were used to conduct data statistics and analysis. Meanwhile, VOS viewer software was used for visualization conversion to analyze the research status and the development trend of femoroacetabular impingement.  RESULTS AND CONCLUSION: (1) Totally 3 158 literatures were included. The literatures concerning global scientific research of femoroacetabular impingement are increasing year by year. The number of the United States published is largest. The United States makes the greatest contribution in the world, ranking the top (1 659 papers), whose number of the citations (37 019 papers) and H index (87 papers) are the highest. The number of literatures is 43 in China. It ranks 14 and the citations are 301; H index is 9. (2) ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY who contributed the largest number of relevant literatures (426 papers) is more than of the second magazine (287 papers) named AMERICAN JOURNAL OF SPORTS MEDICINE. UNIV BERN (University of Bern) and HOSP SPECIAL SURG (Hospital for Special Surgery) are two institutions which have the largest amount of research publications. (3) Currently, the research topics on femoroacetabular impingement are focusing on five areas, including epidemiology, disease progression, diagnosis, treatment and prognosis. In recent years, the primary field of research is treatment and the hip arthroscopic operation becomes a research hotspot. (4) From the analysis on the current development trend of femoroacetabular impingement, there is still very big exploration space in this area and the number of published literatures continuous increases. The United States remains a leader in this field. The further study is required in China. In recent years, the research direction focuses on the aspect of treatment of femoroacetabular impingement. Hip arthroscopic operation is research focus on femoroacetabular impingement. Figures and Tables | References | Related Articles | Metrics

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Biological reconstruction of large bone defects after resection of malignant tumor of extremities He Jie, Chang Qi 2021, 25 (3):  420-425.  doi: 10.3969/j.issn.2095-4344.2941 Abstract ( 442 )   PDF (673KB) ( 450 )   Save BACKGROUND: With the development of medical technology, limb salvage surgery for malignant bone tumors has gradually become the main trend, so various biological reconstruction methods can be cited in the clinic.  OBJECTIVE: To review the biological reconstruction of large bone defects after resection of malignant tumor of extremities.  METHODS: The literature about the biological reconstruction of large bone defects after resection of malignant tumor of extremities was reviewed in PubMed, Web of Science, Wanfang, and CNKI from 2000 to 2020 by the first author using computer. The English key words were “malignant bone tumor, bone defect, biological reconstruction, limb salvage”, and the Chinese key words were “malignant bone tumor, limb salvage, biological reconstruction”. The documents that did not match the central words were eliminated, and the advantages and disadvantages of various biological reconstruction surgery methods were summarized.  RESULTS AND CONCLUSION: (1) Analyzing the in-situ devitalized tumor-bearing bone, biological reconstruction after resection of juxta-articular osteosarcoma segmental bone tumor, each has its advantages and disadvantages. Surgeons should choose different operation methods based on its different indications. (2) Biological reconstruction provides vital methods for limb salvage of malignant tumor of extremities. Figures and Tables | References | Related Articles | Metrics

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Advantages and disadvantages of repairing large-segment bone defect Xing Hao, Zhang Yonghong, Wang Dong 2021, 25 (3):  426-430.  doi: 10.3969/j.issn.2095-4344.2902 Abstract ( 654 )   PDF (651KB) ( 334 )   Save BACKGROUND:  The treatment of large-segment bone defect has always been a major problem in clinical orthopedics. The treatment of large-segment bone defect is characterized by long treatment time, high difficulty and high cost. Therefore, it is of great clinical value and significance to study the treatment of large-segment bone defect. OBJECTIVE: To review the current methods of repairing large-segment bone defect and their advantages and disadvantages.  METHODS: PubMed, CNKI and Wanfang databases before April 2020 were retrieved by the first author with the keywords of “bone defect, bone repair, bone graft, intramedullary nail technology, Masquelet, bone transport, vascularized bone graft, bone tissue engineering” in English and Chinese, respectively. Forty eligible articles were included to systematically summarize the repair methods and their advantages and disadvantages in the treatment of large-segment bone defect. RESULTS AND CONCLUSION: (1) Currently, the scope of large bone defects is not clearly defined. In clinical practice, long bone defects with poor healing ability and difficult healing by traditional fixation and autogenous bone graft can be regarded as large-segment bone defect according to experience. (2) There are many repair methods, and different methods can play their unique advantages in the treatment process. However, the disadvantages and related complications of different methods should be paid attention to when choosing the treatment method, so as to improve the bone healing rate. (3) It is still necessary to improve and standardize the existing treatment technology of large-segment bone defect to obtain a more satisfactory treatment effect. Figures and Tables | References | Related Articles | Metrics

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A new strategy for the treatment of osteonecrosis of the femoral head Zeng Xianghong, Liang Bowei 2021, 25 (3):  431-437.  doi: 10.3969/j.issn.2095-4344.2943 Abstract ( 600 )   PDF (661KB) ( 545 )   Save BACKGROUND: Research evidence shows hip arthroplasty has become the final treatment of osteonecrosis of femoral head, but early- and middle-stage osteonecrosis of femoral head or young patients often give priority to hip preservation treatment, including conservative treatment and surgical treatment. OBJECTIVE: To summarize the progress of hip preservation in the treatment of osteonecrosis of femoral head. METHODS: The literature about hip-preserving treatment of osteonecrosis of femoral head in PubMed, VIP, CNKI and Web of Science databases from 2010 to March 2020 was searched by computer. The key words were “osteonecrosis of femoral head, hyperbaric oxygen, pulsed electromagnetic fields, extracorporeal shock wave, hip arthroscopy, core decompression, stem cell transplantation, non-vascularized free bone grafting, vascularized free bone grafting, porous tantalum rod implantation, intertrochanteric osteotomy, medication”. A total of 197 articles were retrieved, and the full text was consulted. According to the inclusion criteria, 59 articles were included for result analysis.  RESULTS AND CONCLUSION: (1) Drug therapy should be used cautiously because of its potential side effects and insufficient research. (2) Physiotherapy is effective for early lesions, and it has the advantages of non-invasion and convenient operation. (3) At present, there are different types of hip preservation surgery. Core decompression is the basic therapy for the treatment of osteonecrosis of femoral head, but it is seldom used alone. At present, it is often treated in combination with other hip preservation therapies. Osteotomy has higher requirements in the selection of patients’ indications and surgical skills, so it should be chosen carefully in clinic. There are some problems in porous tantalum rod implantation, such as long operation time, large blood loss and difficulty of hip replacement in the later stage. Stem cells and arthroscopic therapy show good results, and the research process should be accelerated. Vascularized bone grafting has a good effect on both middle- and late-stage patients. Figures and Tables | References | Related Articles | Metrics

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Application of 3D printing technology in fracture and deformity of foot and ankle Huang Youyi, Yuan Wei 2021, 25 (3):  438-442.  doi: 10.3969/j.issn.2095-4344.2940 Abstract ( 571 )   PDF (651KB) ( 393 )   Save BACKGROUND: The anatomical structure of the foot and ankle is complex. There are many extensor and flexor tendons passing through the foot and ankle, which is adjacent to many blood vessels and nerves. The foot and ankle play an important role in human walking, jumping and squatting. As the ankle joint itself is the most distal load-bearing joint of the limb, it is difficult to achieve satisfactory therapeutic effect by traditional methods to treat complex periankle fractures (such as severe comminuted trimalleolar fractures and Pilon fractures), or various severe ankle deformities (such as talipes equinovarus, hallux valgus, and flatfoot). Fortunately, in recent years, 3D printing technology has significantly improved the success rate and patient satisfaction of the above diseases. OBJECTIVE: To summarize the current situation of 3D printing technology in the treatment of ankle fracture and deformity. METHODS: The computer was used to search CNKI, PubMed database. Chinese search terms were “3D printing technology, ankle surgery, ankle fracture, ankle deformity, orthopedics”. The English search terms were “3D printing, foot and ankle surgery, ankle fracture, foot and ankle deformity, orthopedic surgery”. The retrieval period was from January 2000 to February 2020. A total of 105 articles were retrieved. According to the inclusion and exclusion criteria, 55 articles were finally included for review. RESULTS AND CONCLUSION: (1) Through the simulation operation of foot and ankle surgery on 3D physical model, the operator’s proficiency in the operation can be improved. Simultaneously, according to the needs of the operation, individual surgical instruments can be made to improve the success rate of the operation. (2) Compared with the traditional foot orthosis, 3D printing technology can make foot orthosis more suitable for human body structure. Figures and Tables | References | Related Articles | Metrics

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Comparison of the advantages and disadvantages of multiple implants in treatment of traumatic dislocation of sternoclavicular joint Zhou Jihui, Li Xinzhi, Zhou You, Huang Wei, Chen Wenyao 2021, 25 (3):  443-448.  doi: 10.3969/j.issn.2095-4344.2938 Abstract ( 574 )   PDF (651KB) ( 187 )   Save BACKGROUND: Traumatic dislocation of sternoclavicular joint is a rare disease in orthopedics, which can cause misdiagnosis and improper treatment. Its operation technology is constantly improving, mainly because of the improvement of the internal objects.  OBJECTIVE: To explore the new progress in the diagnosis and treatment of traumatic dislocation of sternoclavicular joint, and to summarize the key points and the advantages and disadvantages of operation with various implants.  METHODS: The Chinese database of Wanfang and China National Knowledge Infrastructure was searched by the first author. The key words were “dislocation of sternoclavicular joint; biomechanics; implants; internal fixation; tendon reconstruction; complications; prognosis”. Simultaneously, the English database of PubMed was searched, with the search term of “dislocation of sternoclavicular joint; biomechanics; implant; internal fixation; tendon reconstruction; complications; prognosis”. The retrieval period was from July 2010 to February 2020.  RESULTS AND CONCLUSION: (1) Traumatic dislocation of sternoclavicular joint is a kind of trauma which is easy to be missed and may be fatal. Computed tomograhy and B-ultrasound can be used to confirm the diagnosis. Magnetic resonance imaging can show the damage of mediastinum structure. (2) Surgical treatment methods include Kirschner wire tension band internal fixation, hook plate internal fixation, locking plate internal fixation, ligament strengthening and reconstruction technology, joint replacement and so on. The fixation strength of Kirschner wires and steel wires is unsatisfactory and its complication rate is high, but they can be used in juvenile patients. The cross joint steel plate does not meet the biomechanical requirements of the fretting joint, so it is difficult to achieve firm fixation. The hook steel plate belongs to the built-in object of elastic fixation, and the disadvantage lies in the abrasion and stimulation of the bone caused by the tail hook structure. More and more attention has been paid to ligament reconstruction technology, which not only meets the needs of strength, but also conforms to the characteristics of biomechanics. Figures and Tables | References | Related Articles | Metrics

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Hot issues in clinical application of dynamic contrast-enhanced magnetic resonance imaging in orthopedics Yu Langbo, Qing Mingsong, Zhao Chuntao, Peng Jiachen 2021, 25 (3):  449-455.  doi: 10.3969/j.issn.2095-4344.2937 Abstract ( 624 )   PDF (675KB) ( 378 )   Save BACKGROUND: Although traditional plain scan and enhanced magnetic resonance imaging has been used for skeletal muscle imaging for many years, it is not enough to evaluate the microscopic changes of diseased tissue or the activity of diseased tissue. Dynamic contrast-enhanced magnetic resonance imaging can capture this information and advantages are shown in orthopedic imaging examination.  OBJECTIVE: To review the progress of dynamic contrast-enhanced magnetic resonance imaging in orthopedics clinics. METHODS: The relevant documents from January 1900 to February 2020 were retrieved in the CNKI database, PubMed database, Web of Science and Wanfang database by computer. The search terms were “dynamic contrast-enhanced magnetic resonance imaging; skeletal muscle tumor; arthritis; spine; fracture” in Chinese, and “dynamic contrast enhanced magnetic resonance imaging (DCE-MRI); osteomuscular tumor; arthritis; spinal surgery; fracture” in English.  RESULTS AND CONCLUSION: (1) At present, there is a general lack of consensus on the best scanning method for acquiring dynamic contrast-enhanced magnetic resonance imaging images and the ideal method for analyzing such images in clinical applications. The parameter analysis methods are mainly qualitative, semi-quantitative and quantitative analysis. (2) Dynamic contrast-enhanced magnetic resonance imaging has been widely used in non-invasive detection, qualitative and therapeutic monitoring of different diseases such as heart failure, breast cancer, prostate cancer, renal rejection and liver tumors. The clinical application in orthopedics is not mature enough, but has unlimited potential: It can be used to assess the blood flow after femoral neck fracture and to predict the viability of the femoral head, the regional perfusion of nonunion after fracture, bone perfusion of arthritis and other entities, and detection of deformed blood vessels. Compared with conventional imaging, in contrast, dynamic contrast-enhanced magnetic resonance imaging can also better assess the relationship between changes in lumbar spine perfusion, disc degeneration, and endplate perfusion at different stages. Figures and Tables | References | Related Articles | Metrics

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Meta-analysis of the efficacy and safety of percutaneous curved vertebroplasty and unilateral pedicle approach percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture Zhong Yuanming, Wan Tong, Zhong Xifeng, Wu Zhuotan, He Bingkun, Wu Sixian 2021, 25 (3):  456-462.  doi: 10.3969/j.issn.2095-4344.2946 Abstract ( 429 )   PDF (781KB) ( 260 )   Save OBJECTIVE: It remains disputed whether percutaneous curved vertebroplasty and unilateral pedicle approach percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture. This study systematically analyzed the efficacy and safety of percutaneous curved vertebroplasty and unilateral pedicle approach percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture.  METHODS: A computer-based online search of Wanfang, VIP, CNKI, PubMed, EMBASE, The Cochrane library, and CBM was performed to retrieve randomized controlled trial studies regarding percutaneous curved vertebroplasty and unilateral pedicle approach percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture published before January 2020. Related papers were manually searched. After two evaluators independently selected literature, data were extracted and the quality of methodology included in the study was evaluated. Meta-analysis was carried out by using Stata/SE 12.0 software. RESULTS: (1) A total of eight randomized controlled trials were conducted, including 628 patients, of whom 394 were treated with percutaneous curved vertebroplasty and 404 with unilateral pedicle approach percutaneous vertebroplasty. (2) The meta-analysis results showed that visual analogue scale score [MD=-0.20, 95%CI(-0.28, -0.12), P < 0.05], the leakage rate of bone cement [RR=0.30, 95%CI(0.15, 0.58), P < 0.05], and the total distribution rate of bone cement in the center of vertebral body [RR=1.27, 95%CI(1.12, 1.45), P < 0.05] were better in the percutaneous curved vertebroplasty group than those in the unilateral pedicle approach percutaneous vertebroplasty group. (3) There was no significant difference in Oswestry disability index score [MD=-4.83, 95%CI (-9.71, 0.05), P=0.052], operation time [MD=-1.45, 95%CI(-5.91, 2.82), P=0.488]and X-ray exposure times [MD=-0.70, 95%CI(-2.11, 0.71), P=0.33] between the two methods.   CONCLUSION: Percutaneous curved vertebroplasty exhibits significant advantages in analgesic effect, low leakage rate of bone cement and the high total distribution rate of bone cement in the center over unilateral pedicle approach percutaneous vertebroplasty. Therefore, a large number of high-quality multicenter randomized controlled trials are needed to provide more evidence. Figures and Tables | References | Related Articles | Metrics

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Meta-analysis of the effect of double Endobutton and clavicular hook plate on the treatment of acromioclavicular dislocation Li Yang, Zhang Mingyong 2021, 25 (3):  463-470.  doi: 10.3969/j.issn.2095-4344.2939 Abstract ( 642 )   PDF (875KB) ( 310 )   Save OBJECTIVE: Because the double Endobutton plate has more advantages than the clavicle hook plate in the treatment of acromioclavicular joint dislocation, and the trauma is small; it does not need to be removed through secondary surgery. Thus, it has been widely used in clinical practice in recent years.  Meta-analysis was used to investigate whether there were differences in the treatment of acromioclavicular dislocation between double Endobutton plate and clavicle hook plate so as to provide effective guidance for clinical treatment. METHODS: The database Cochrane library, PubMed, EBSCO, CNKI, VIP and Wanfang were searched from the database inception to January 2020. All the literatures related to the treatment of acromioclavicular dislocation with double Endobutton plate and clavicle hook plate were collected. The literatures were selected according to the inclusion and exclusion criteria to extract the data and to carry out the relevant analysis. The literatures that meet the requirements were screened out. The quality of the selected relevant literatures was assessed. All outcome indicators were analyzed by RevMan 5.3 software.  RESULTS: (1) A total of 38 articles were included, and the total number of cases was 2 199, of which 1 035 cases were in the double Endobutton plate group and 1 164 cases were in the clavicle hook plate group. (2) The results showed that the double Endobutton plate group was superior to the clavicle hook plate group in the excellent and good rate [RR=1.19, 95%CI(1.13, 1.26), P < 0.000 01], operation time [MD=10.54, 95% CI(6.09, 15.00), P < 0.000 01], intraoperative blood loss [MD=-14.83, 95%CI(-20.54,-9.13), P < 0.000 01], hospitalization time [MD=-1.44, 95%CI(-2.65,-0.23), P=0.02], incision length [MD=-2.87, 95%CI (-3.60, -2.14), P < 0.000 01], hospitalization cost [MD=-2 442.10, 95% CI(-4 466.34, -417.86), P=0.02], shoulder pain after operation [RR=0.34, 95%CI(0.22, 0.53), P < 0.000 01], visual analogue scale score [MD=-0.85, 95% CI(-1.28, -0.41), P=0.000 2], final Constant-Murley score at 6 months postoperatively [MD=8.82, 95%CI(1.91, 15.72), P=0.01; MD=6.66, 95%CI(4.46, 8.86), P < 0.000 01].  CONCLUSION: The treatment of Rockwood III type and above acromioclavicular joint dislocation with double Endobutton plate is superior to that clavicular hook plate. It has the advantages of short operation time, less intraoperative blood loss, less trauma, short hospitalization time and less cost, and good functional recovery of shoulder joint after operation. Figures and Tables | References | Related Articles | Metrics

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Intramedullary nail fixation versus plate fixation in the treatment of displaced midshaft clavicular fractures in adults: a meta-analysis Li Yanle, Yue Xiaohua, Wang Pei, Nie Weizhi, Zhang Junwei, Tan Yonghai, Jiang Hongjiang 2021, 25 (3):  471-476.  doi: 10.3969/j.issn.2095-4344.2949 Abstract ( 440 )   PDF (749KB) ( 210 )   Save OBJECTIVE: At present, many studies have proved that intramedullary nail and steel plate internal fixation is a better way to treat displaced midshaft clavicular fracture. However, there are relatively few comparative studies on the advantages and disadvantages of the two methods, and there are still many controversies. Through the meta-analysis of related literature, the efficacy and safety of intramedullary nail and steel plate in the treatment of adult displaced midshaft clavicular fracture were systematically evaluated.  METHODS: Through computer retrieval of PubMed, Embase, Cochrane Library, CNKI, Wanfang and VIP databases from the inception to January 2020, the literature of randomized controlled trials meeting the inclusion and exclusion criteria of intramedullary nail and steel plate in the treatment of adult displaced midshaft clavicular fracture was collected and screened, and the quality evaluation and data extraction were carried out. The operation time, incision length and upper limb function score, Constant-Murley score, and fracture healing time were used as the evaluation indexes of meta-analysis. Meta-analysis was performed using ReMan 5.3 software.  RESULTS: (1) Eight valuable articles were retrieved, among which 283 patients were treated with intramedullary nail and 271 patients were treated with steel plate internal fixation. (2) The meta-analysis results showed that the intramedullary nail group was superior to the steel plate group in terms of operation time [MD=-19.63, 95%CI(-22.72,-16.54)], incision length [MD=-3.31, 95%CI(-5.78, -0.85)], and fracture healing time [MD=-1.53, 95%CI(-2.73, -0.33)]. (3) No significant difference was found in upper limb function score [MD=-1.91, 95%CI(-5.48, 1.66)] and Constant-Murley score [MD=-0.58, 95%CI(-4.63, 3.47) between the intramedullary nail group and the steel plate group after surgery.  CONCLUSION: The results of meta-analysis showed that intramedullary nail was superior to steel plate in the operation time, incision length and fracture healing time in the treatment of displaced midshaft clavicular fracture. The above results can provide evidence for clinical use of intramedullary nail instead of steel plate internal fixation in the treatment of displaced midshaft clavicular fracture.   Figures and Tables | References | Related Articles | Metrics

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Interlocking intramedullary nail for proximal femur versus proximal femoral anti-rotation intramedullary nail or proximal femoral anti-rotation intramedullary nail of Asian for intertrochanteric fractures in older adults: a meta-analysis Liu Chang, Han Shufeng 2021, 25 (3):  477-485.  doi: 10.3969/j.issn.2095-4344.2989 Abstract ( 454 )   PDF (879KB) ( 311 )   Save OBJECTIVE: The most commonly used intramedullary fixation systems for the treatment of elderly intertrochanteric fractures include the proximal femoral anti-rotation intramedullary nail (PFNA), the proximal femoral anti-rotation intramedullary nail of Asian (PFNA-II) and interlocking intramedullary nail for proximal femur (Inter-TAN), but the clinical effect of the three in the treatment of A2 and A3 type intertrochanteric fractures is still controversial. Meta-analysis was used to compare the clinical efficacy of Inter-TAN, PFNA, and PFNA-II in the treatment of unstable intertrochanteric fractures in the elderly.   METHODS: A computer was used to search databases such as Cochrane, Embase, PubMed, Sinomed, CNKI, Wanfang, and VIP to collect and compare the literatures of Inter-TAN, PFNA, and PFNA-II in the treatment of elderly unstable intertrochanteric fractures. The search period was from the establishment of the database to December 2019. Two reviewers independently read the screening literature, extracted data and evaluated the quality. Meta-analysis was performed using RevMan5.3 software.  RESULTS: (1) A total of eight studies were included, with 1 349 patients, including two randomized controlled studies and six cohort studies. The evidence level was ≥ III. (2) Meta-analysis showed that the operation time and intraoperative fluoroscopy time  were longer, and intraoperative blood loss was more in the Inter-TAN group than those of the PFNA-II group [MD=-16.60, 95%CI (-23.22, -9.99),  P  < 0.05; MD=-1.85, 95%CI (-2.53, -1.16),  P  < 0.05; MD=-9.83, 95%CI  (-12.66, -6.99),  P < 0.000 01], with no significant difference compared with PFNA group (P > 0.05). There was no significant difference in tip-apex distance, length of hospital stay, and Harris score of Inter-TAN group compared with PFNA group and PFNA-II group (P > 0.05). The incidence of postoperative screw cut-out in the Inter-TAN group was less than in the PFNA group and the PFNA-II group [OR=6.47, 95%CI(2.79, 15.00), P < 0.05; OR=5.88, 95%CI(1.29, 26.69), P < 0.05]. The incidence of hip or thigh pain in the Inter-TAN group was less than that in the PFNA group and the PFNA-II group [OR=2.57, 95%CI(1.19, 5.52), P  < 0.05; OR=3.20, 95%CI(-1.56, 6.55), P  < 0.05]. Postoperative femoral shaft fractures in the Inter-TAN group were less than those in the PFNA group and PFNA-II group [OR=3.87, 95%CI(1.75, 8.57), P  < 0.05; OR=7.06, 95%CI(1.24, 40.07), P  < 0.05]. The incidence of postoperative secondary surgery in the Inter-TAN group was less than in the PFNA group [OR=4.10, 95%CI(2.45, 6.86), P  < 0.05], and there was no significant difference compared with PFNA-II group (P  > 0.05). CONCLUSION: For patients with osteoporosis and poor stability, Inter-TAN can provide better stability and reduce postoperative complications. For patients with poor general conditions and greater surgical risk, PFNA-II internal fixation can be selected. Figures and Tables | References | Related Articles | Metrics

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Systematic review and meta-analysis of bone morphogenetic protein for the treatment of acute tibial fracture Xie Chengxin, Wang Wei, Wang Chenglong, Li Qinglong, Yin Dong 2021, 25 (3):  486-492.  doi: 10.3969/j.issn.2095-4344.2944 Abstract ( 397 )   PDF (732KB) ( 103 )   Save objective: Bone morphogenetic proteins have the function of inducing and promoting bone growth and formation. However, there is controversy between the research results of the treatment of acute tibial fracture with bone morphogenetic proteins, which makes the effect of bone morphogenetic proteins unclear. Meta-analysis was used to systematically evaluate the efficacy and safety of bone morphogenetic proteins for the treatment of acute tibial fracture. METHODS: PubMed, Elsevier, Web of Science, Cochrane Library, CNKI and Wanfang databases were searched to retrieve the clinical controlled trials of bone morphogenetic proteins for acute tibial fracture published before February 2020. Quality evaluation, bias risk assessment and data extraction of the included literatures were performed. Meta-analysis of outcome indicators was performed using RevMan 5.1 software provided by Cochrane system.  RESULTS: (1) Seven articles were enrolled for meta-analysis, including six randomized controlled trials and one cohort study. A total of 1 256 cases of acute tibial fracture were included, with 793 cases in bone morphogenetic protein group and 463 cases in control group. (2) Meta-analysis results showed that bone morphogenetic proteins could not significantly improve the healing rate (P=0.07), but reduce the secondary intervention rate [RR=0.64, 95%CI(0.49, 0.84), P=0.001]. The application of bone morphogenetic proteins had no significant effect on postoperative pain, infection, hardware failure, edema and swelling           (P > 0.05). Bone morphogenetic proteins significantly increased the incidence of heterotopic ossification and soft tissue calcification [RR=2.89, 95%CI(1.40, 5.95), P=0.004]. As for patients with open tibial fractures, bone morphogenetic proteins significantly improved the healing rate [RR=1.16, 95%CI(1.04, 1.30), P=0.009].  CONCLUSION: On the basis of conventional treatment, the application of bone morphogenetic proteins significantly reduces the secondary intervention rate and is more suitable for the auxiliary treatment of complex open tibial fracture. In addition, the higher rate of heterotopic ossification and soft tissue calcification is related to bone morphogenetic protein. Figures and Tables | References | Related Articles | Metrics