Loading...

Table of Content

    28 February 2021, Volume 25 Issue 6 Previous Issue    Next Issue
    For Selected: Toggle Thumbnails
    Evaluation of knee stability after simulated reconstruction of the core ligament of the posterolateral complex
    Zhong Hehe, Sun Pengpeng, Sang Peng, Wu Shuhong, Liu Yi
    2021, 25 (6):  821-825.  doi: 10.3969/j.issn.2095-4344.2381
    Abstract ( 394 )   PDF (743KB) ( 55 )   Save
    BACKGROUND: Injury of the posterolateral complex of the knee joint is a common type of multiple ligament injuries of the knee joint. The reconstruction of the posterolateral complex can restore the posterior and lateral stability of the knee joint and rebuild the stability of the knee joint. 
    OBJECTIVE: To discuss the feasibility and clinical effect of modified LaPrade method for functional reconstruction of posterolateral complex of knee with autograft peroneus longus tendon. 
    METHODS: Fourteen patients with posterolateral complex and posterior cruciate ligament injuries who were treated in the Department of Orthopedics, Affiliated Hospital of Zunyi Medical University from October 2014 to March 2017 were enrolled in this study. Posterior cruciate ligament and posterolateral complex were simultaneously constructed in stage one. The injury of the posterolateral complex of the knee joint was Fanelli type C. Modified LaPrade method was used to functional reconstruction of posterolateral complex of knee with peroneus longus tendon. The anatomy and function of the core ligament of the posterolateral complex was simulated. Follow-up time was beyond 1 year. The tibia posterior displacement on stress radiographs, lateral compartment gapping on varus stress radiographs at 0° knee extension, and external rotation angle of tibia at 30° knee flexion were compared before and after surgery. The joint function was evaluated according to the score of International Knee Documentation Committee and Lysholm Knee score.
    RESULTS AND CONCLUSION: (1) All patients were followed up for 12-18 months. All patients had no knee-length restriction, with flexion limitation in some patients. (2) At the last follow-up, the tibia posterior displacement on stress radiographs, lateral compartment gapping on varus stress radiographs and external rotation angle of tibia at 30° knee flexion were reduced from preoperation, with statistically significant differences (P=0.000). (3) The International Knee Documentation Committee function was corrected from D preoperatively to A in 8 cases and B in 6 cases postoperatively. The average Lysholm score was increased from (32.4±5.6) preoperatively to (82.7±6.4) postoperatively, and the differences were statistically significant (P=0.000). (4) It is indicated that with peroneus longus tendon, the anatomy and function of the core ligament of the posterolateral complex were simulated by modified LaPrade method to functional reconstruction of posterolateral complex of knee, and the postoperative knee function recovered well.
    Figures and Tables | References | Related Articles | Metrics
    Biomechanical comparison of three different plate fixation methods for acetabular posterior column fractures in standing and sitting positions
    Xu Yulin, Shen Shi, Zhuo Naiqiang, Yang Huilin, Yang Chao, Li Yang, Zhao Heng, Zhao Lu
    2021, 25 (6):  826-830.  doi: 10.3969/j.issn.2095-4344.2382
    Abstract ( 429 )   PDF (736KB) ( 61 )   Save
    BACKGROUND: Studies have shown that there are differences in the biomechanics of different internal fixation methods to fix the acetabular posterior column fracture.
    OBJECTIVE: To simulate the acetabular posterior column fracture and evaluate the stability of the acetabular posterior column with three fixation methods.
    METHODS: Thirty-six cadaveric hemipelvic specimens were collected to establish models of acetabular posterior column fracture. The models were randomly divided into three groups, and were fixed by three different fixation methods: (short iliosciatic plate in group A, traditional posterior plate in group B, and long iliosciatic plate in group C; n=12 per group). Mechanical loads were applied vertically in standing and sitting positions. The fracture ends displacement and biomechanical stability were evaluated by using image displacement method. 
    RESULTS AND CONCLUSION: (1) In the standing position, the relative displacement of the fracture ends of the three groups was positively correlated with the load; there was no statistically significant difference in the displacement of the fracture ends under the same load in the three groups (P > 0.05). When loaded with a load of 1 800 N, the relative displacement of each group of models did not exceed 3 mm. (2) In the sitting position, the relative displacement of the fracture end was positively correlated with the size of the load; the relative displacement of the three groups under the same load was significantly different        (P < 0.05). Under the same load, the relative displacement of group B was greater than that of groups A and C; the relative displacement of group A under 100-500 N load was greater than that of group C, and the relative displacement under 600 N load was smaller than that of group C. (3) The results suggested that the iliosciatic plate fixation of the acetabular posterior column fracture can provide the same biomechanical stability as the traditional posterior column steel plate, and the rigidity of the fixed structure is high, which can meet the postoperative rehabilitation needs.
    Figures and Tables | References | Related Articles | Metrics
    Relationship between tip-apex distance and stability of intertrochanteric femoral fractures with proximal femoral anti-rotation nail: a finite element analysis
    Cai Qunbin, Zou Xia, Hu Jiantao, Chen Xinmin, Zheng Liqin, Huang Peizhen, Lin Ziling, Jiang Ziwei
    2021, 25 (6):  831-836.  doi: 10.3969/j.issn.2095-4344.2383
    Abstract ( 346 )   PDF (1042KB) ( 84 )   Save
    BACKGROUND: The proximal femur anti-rotation intramedullary nail is an ideal internal fixation method for the treatment of intertrochanteric fractures, but there is still a 6% to 21% failure rate of internal fixation. Tip-apex distance is considered as an important cause of postoperative proximal femur anti-rotation intramedullary nail failure. Tip-apex distance is the sum of the distance from the tip of lag screw to the vertex of femoral head measured on anteroposterior and lateral X-ray films. Most scholars now believe that the tip-apex distance of head pulp nail ≤ 25 mm has a good prognosis, but there is still a lot of controversy.

    OBJECTIVE: To investigate the biomechanical differences of the treatment of intertrochanteric femoral fractures by proximal femoral anti-rotation intramedullary nail with different tip-apex distances and provide a new idea and experimental basis for the clinical treatment of intertrochanteric fractures. 

    METHODS: CT data of one volunteer were imported into Mimics 19.0 and Geomagic studio 2017 software to extract and optimize the three-dimensional model of the right femur. SolidWorks 2017 software was used to draw the internal fixation model and assemble it with the AO2.1 type fracture femur model in different tip-apex distance according to the standard operation technology. Totally four models with tip-apex distance of 15, 20, 25, and 30 mm were obtained and imported into HyperMesh 14.0 software to mesh. The four models were imported into Abaqus 2016 software in inp format to set up with material property parameters, boundary conditions and applied loads. Finally, operation results were viewed in the visualization module.  

    RESULTS AND CONCLUSION: (1) When tip-apex distance was too large (30 mm) or too small (15 mm), the stress at the proximal femur was reduced, but the displacement of the femur head and neck fragment and the lesser trochanter fragment was larger and the inversion was more serious. When tip-apex distance was in the middle (20, 25 mm), the displacement and varus of femoral head and neck fragment were small, and the lesser trochanteric fragment was basically unshifted. (2) In the treatment of intertrochanteric femur fractures, tip-apex distance should be adjusted to 20-25 mm to reduce displacement and obtain a better biomechanical effect.
    Figures and Tables | References | Related Articles | Metrics
    Changes in dynamic stability, motor coordination and joint mechanics of the lower extremity during stair descent and performing phone task
    Wang Jiangna, Zheng Huifen, Sun Wei
    2021, 25 (6):  837-843.  doi: 10.3969/j.issn.2095-4344.2384
    Abstract ( 357 )   PDF (956KB) ( 69 )   Save
    BACKGROUND: The coupling and coordination control of the multi-link rigid body of human body is the key to stable walking. It is reported that the use of cell phones greatly increases the chance of falling down stairs when walking; however, it lacks the analysis of the dynamic stability, motion coordination and joint mechanics of the lower limbs when walking down stairs with cell phone intervention.  
    OBJECTIVE: To investigate the effects of cell phone on coupling control strategy of the multi-link rigid body in lower extremity during stair descent. 
    METHODS: Twenty healthy university students were recruited and conducted the stair descent under no-interference (single task) and cell phone (phone task) randomly. Using the method of synchronous acquisition of 3D kinematics and dynamics, the kinetic and kinematic data were synchronously collected to acquire the parameters of stair descent under both conditions. 
    RESULTS AND CONCLUSION: (1) The intervention of phone task significantly reduced the dynamic stability in anterior-posterior/media-lateral direction, the first knee extension moment peak, the first dorsiflexion moment peak, the second hip flexion moment peak in sagittal plane during stance phase, and significantly increased the mean and standard deviation of hip-knee/knee-ankle relative phase angles during swing phase. (2) It is concluded that when the gait of human body changes from time to time, the coupling control ability of multi-link rigid bodies decreased and the risk of falling increased. (3) The intervention of phone task reduces the supporting moment of lower limbs in the supporting phase, reduces the stability of adjacent joint coordination control in the swinging phase, reduces the dynamic stability in front, back and inside directions, and increases the risk of falling.
    Figures and Tables | References | Related Articles | Metrics
    Advantages of robot assisted percutaneous biopsy in the diagnosis of spinal lesions
    Zhang Wei, Hu Jiang, Tang Liuyi, Wan Lun, Yu Yang, Lin Shu, Tang Zhi, Wang Fei
    2021, 25 (6):  844-848.  doi: 10.3969/j.issn.2095-4344.2385
    Abstract ( 447 )   PDF (871KB) ( 56 )   Save
    BACKGROUND: Robot assisted orthopedic surgery has been gradually popularized in clinical practice, and its application fields include spine, joint, trauma and sports medicine, which are precise and minimally invasive. However, there are few reports on the application of robot assisted puncture biopsy in the diagnosis and treatment of spinal lesions.  
    OBJECTIVE: To explore the clinical value of percutaneous biopsy assisted by orthopedic surgical robot in the diagnosis of spinal lesions.  
    METHODS: The clinical data of 38 patients with spinal lesions treated in Sichuan Provincial People’s Hospital from November 2018 to January 2020 were analyzed retrospectively. All patients underwent percutaneous biopsy assisted by TINAVI orthopedic surgery robot. The biopsies were sent to the pathology department for histopathological examination. 
    RESULTS AND CONCLUSION: (1) The successful rate of biopsy was 100% in 38 samples. Of them, 21 cases affected metastases; 4 cases had primary malignant tumors; 5 cases suffered from borderline tumors; 5 cases had benign tumors; and 3 cases experienced non-specific inflammatory reaction. (2) The average operation time was (37.11±5.65) minutes, and no complications occurred in all patients. (3) Robot assisted percutaneous biopsy is a safe, rapid, minimally invasive and accurate method for the diagnosis of spinal lesions.
    Figures and Tables | References | Related Articles | Metrics
    Application of 3D printed interbody fusion cage for cervical spondylosis of spinal cord type: half-year follow-up of recovery of cervical curvature and intervertebral height
    Liu Zhengpeng, Wang Yahui, Zhang Yilong, Ming Ying, Sun Zhijie, Sun He
    2021, 25 (6):  849-853.  doi: 10.3969/j.issn.2095-4344.2386
    Abstract ( 343 )   PDF (768KB) ( 75 )   Save
    BACKGROUND: Recent clinical studies have found that during the implantation of biomaterials, the internal environment of the body will change to a certain extent, and different levels of immunity and stress responses will occur. There are also obvious differences in the immune and stress responses of different biological materials. 
    OBJECTIVE: To investigate the effect of 3D printed interbody fusion cage on patients with cervical spondylosis of spinal cord type and its effect on serum cortisol and norepinephrine levels. 
    METHODS: Sixty-three patients with cervical spondylotic myelopathy who were admitted to the Affiliated Hospital of Chengde Medical University from July 2015 to July 2018 were selected, including 40 males and 23 females, aged 30-78 years old. The patients were randomly divided into a research group (n=31) and a control group (n=32) according to a random number table. All patients received anterior cervical decompression and bone graft fusion and internal fixation. Patients in the research group were implanted with 3D printed intervertebral fusion cage during operation. The patients in the control group were implanted with polyetheretherketone interbody fusion cage and allogeneic bone. The operation and complications of the two groups were compared. Serum cortisol and norepinephrine levels were detected before and 1 and 3 days after operation. Cervical curvature and intervertebral height were measured before surgery, 1 week, and 6 months after surgery. Axial symptoms were counted at 6 months after surgery. The trial was approved by the Ethics Committee of the Affiliated Hospital of Chengde Medical University. 
    RESULTS AND CONCLUSION: (1) Operation time, intraoperative blood loss and hospitalization time were not significantly different between the two groups (P > 0.05). (2) Among 31 cases, there were 1 case of screw loosening and 1 case of implant movement in the research group. Among 32 cases, there were 3 cases of screw loosening, 3 cases of immune rejection, 2 cases of implant movement, and 1 case of implant collapse in the control group. The incidence of complications was lower in the research group than that in the control group (P < 0.05). (3) At 1 and 3 days after operation, the levels of cortisol and norepinephrine were higher in both groups than those before surgery (P < 0.05), but above levels were lower in the research group than in the control group (P < 0.001). (4) The cervical curvature and intervertebral height at 1 week and 6 months after operation in both groups were higher than those before surgery (P < 0.05), and above indexes were higher in the research group than in the control group (P < 0.05). (5) The axial symptom in the research group was lighter than that in the control group at 6 months after operation (P < 0.05). (6) The results show that the application of 3D printed interbody fusion cage to cervical spondylotic myelopathy can reduce complications, promote the recovery of cervical curvature and intervertebral height, and improve the stability of cervical spine, and the body’s stress response and axial symptoms are mild.
    Figures and Tables | References | Related Articles | Metrics
    Comparison of total knee arthroplasty and unicompartmental knee arthroplasty in treatment of traumatic osteoarthritis
    Zhao Zhongyi, Li Yongzhen, Chen Feng, Ji Aiyu
    2021, 25 (6):  854-859.  doi: 10.3969/j.issn.2095-4344.2387
    Abstract ( 458 )   PDF (742KB) ( 45 )   Save
    BACKGROUND: The incidence of traumatic osteoarthritis is increasing in recent years. At present, total knee arthroplasty and unicondylar arthroplasty are commonly used in clinical treatment, and their therapeutic effects still need to be verified. 
    OBJECTIVE: To compare effects between total knee arthroplasty and unicompartmental knee arthroplasty on the patients with traumatic knee osteoarthritiss.
    METHODS: A total of 102 patients with bilateral traumatic osteoarthritis were treated in the Affiliated Hospital of Qingdao University between January 2016 and June 2018. The patients were divided into total knee arthroplasty group and unicompartmental knee arthroplasty group (n=51 for each group). Operation indexes (operation time, intraoperative blood loss, decrease of hemoglobin 48 hours after operation, proportion of patients receiving blood transfusion during perioperative period, total length of stay and hospitalization cost) were compared between the two groups. Visual analogue scale score, American knee society knee score, and The Western Ontario and McMaster Universities osteoarthritis index were compared before surgery and 2 weeks, 3 and 6 months after surgery. The postoperative complications and subjective satisfaction after 6 months of follow-up were compared between the two groups. 
    RESULTS AND CONCLUSION: (1) Operation time, intraoperative blood loss and decrease in hemoglobin at 48 hours after surgery were significantly lower in the unicompartmental knee arthroplasty group than those in the total knee arthroplasty group. The proportion of blood transfusion during perioperative period was significantly lower in the unicompartmental knee arthroplasty group than that in the total knee arthroplasty group. Total length of stay and hospitalization cost were significantly less in the unicompartmental knee arthroplasty group than those in the total knee arthroplasty group (P < 0.05). (2) There was no significant difference in visual analogue scale score, American knee society knee score, and The Western Ontario and McMaster Universities osteoarthritis index between the unicompartmental knee arthroplasty group and the total knee arthroplasty group before surgery (P > 0.05). Compared with those before surgery, visual analogue scale score and American knee society knee score were significantly lower; and The Western Ontario and McMaster Universities osteoarthritis index was significantly higher in both groups at 2 weeks, 3 and 6 months after surgery (P < 0.05). Visual analogue scale score, American knee society knee score, and The Western Ontario and McMaster Universities osteoarthritis index were significantly better in the unicompartmental knee arthroplasty group than those in the total knee arthroplasty group at various time points after surgery (P < 0.05). (3) During the 6-month follow-up, subjective satisfaction was significantly higher in the unicompartmental knee arthroplasty group than that in the total knee arthroplasty group (P < 0.05). (4) Complications: In the total knee arthroplasty group, there were 3 cases of postoperative infection and 2 cases of deep vein thrombosis, and the total incidence of postoperative complications was 10%. In the unicompartmental knee arthroplasty group, there was 1 case of postoperative infection, and the total incidence of postoperative complications was 2%. The incidence of postoperative complications in unicompartmental knee arthroplasty group was lower than that in total knee arthroplasty group, but the difference was not statistically significant (P > 0.05). (5) Unicompartmental knee arthroplasty in treatment of traumatic knee osteoarthritis has obvious advantages, can reduce length of stay and hospitalization cost, and patients have high satisfaction after operation. Unicompartmental knee arthroplasty is beneficial to the postoperative recovery of patients, and can be used as the first choice for clinical treatment of traumatic osteoarthritis.
    Figures and Tables | References | Related Articles | Metrics
    Influence of anterior cruciate ligament defect on the mid-term outcome of fixed-bearing unicompartmental knee arthroplasty
    Liu Shaohua, Zhou Guanming, Chen Xicong, Xiao Keming, Cai Jian, Liu Xiaofang
    2021, 25 (6):  860-865.  doi: 10.3969/j.issn.2095-4344.2388
    Abstract ( 356 )   PDF (793KB) ( 75 )   Save
    BACKGROUND: Fixed-bearing unicompartmental knee arthroplasty has become an effective method for the treatment of medial single-compartment osteoarthritis of the knee joint. In recent years, with the continuous development of the design of unicompartmental prosthesis and surgical techniques, age, body mass idex and patellofemoral joint lesions are no longer the absolute contraindication for fixed-bearing unicompartmental knee arthroplasty. However, it is still controversial whether anterior cruciate ligament defects affect the survival rate of fixed-bearing unicompartmental knee arthroplasty.  
    OBJECTIVE: To investigate the clinical effect and revision rate of unicompartmental knee arthroplasty in the patients with medial univentricular osteoarthritis and anterior cruciate ligament deficiency.
    METHODS: A total of 268 patients with single-compartment osteoarthritis of the medial knee joint admitted to Foshan Hospital of Traditional Chinese Medicine from March 2014 to March 2016 were selected, including 111 males and 157 females, who were all treated with fixed-bearing unicompartmental knee arthroplasty. According to preoperative MRI and intraoperative exploration, the patients were divided into anterior cruciate ligament defect group (n=45) and anterior cruciate ligament intact group (n=223). After 4-6 years of follow-up, the survival rate of the prosthesis was counted. The knee function was evaluated by hospital for special surgery knee score and Tegner scores. Hip knee ankle angle and posterior slope angle were analyzed to evaluate the lower limb alignmentthe. Six degrees of freedom kinematic parameters of the knee joint were obtained by the three-dimensional dynamic evaluation system guided by infrared light to evaluate objectively knee joint function after operation. The study was approved by Ethics Committee of Foshan Hospital of Traditional Chinese Medicine (approval No. 20140317).  
    RESULTS AND CONCLUSION: (1) Complications such as postoperative persistent pain and progressive arthritis of lateral compartment occurred in both groups. The rate of revision was 4.40% in anterior cruciate ligament defect group and 4.03% in anterior cruciate ligament intact group. There was no significant difference between the two groups (P > 0.05). (2) At the last follow-up, there was no significant difference in hospital for special surgery knee score, Tegner score, hip knee ankle angle and posterior slope angle between the two groups (P > 0.05). (3) At the last follow-up, the data of six degrees of freedom were similar between the two groups, including knee varus angle, flexion and extension angle, internal and external rotation angle, up and down displacement, internal and external displacement, anteroposterior displacement movement (P > 0.05). (4) The results showed that during the follow-up period, unicompartmental knee arthroplasty has the same surgical effect and prosthesis survival rate in anterior cruciate ligament defect patients with stable knee joint as that of patients with intact anterior cruciate ligament.
    Figures and Tables | References | Related Articles | Metrics
    Analgesic effect of cocktail therapy combined with femoral nerve block on total knee arthroplasty
    Zhang Nianjun, Chen Ru
    2021, 25 (6):  866-872.  doi: 10.3969/j.issn.2095-4344.2389
    Abstract ( 372 )   PDF (894KB) ( 49 )   Save
    BACKGROUND: Total knee arthroplasty is an important measure to save the function of knee joint, but the postoperative pain caused great pain to patients. On the background of multimodal analgesia, cocktail therapy and femoral nerve block are widely used in clinic, and the analgesic effect is exact; however, the analgesic effect and safety of the two methods used together are unknown, so more clinical evidence is needed. 
    OBJECTIVE: To study the effect and safety of analgesic and functional recovery of cocktail therapy combined with femoral nerve block after total knee arthroplasty. 
    METHODS: Totally 100 patients undergoing primary unilateral total knee arthroplasty were enrolled. One hundred patients were randomly divided into two groups (n=50 per group) according to the table of random numbers. Group A was given cocktail therapy combined with femoral nerve block; group B received the injection of same volume of normal saline surrounding the knee joint combined with femoral nerve block. The postoperative resting-state visual analogue scale score, knee joint range of motion, global pain scale, and incidences of adverse reactions were compared between groups. The time and frequency of analgesic drugs were recorded. 
    RESULTS AND CONCLUSION: (1) The postoperative visual analogue scale score at rest in the group A was significantly lower than that in the group B at 24, 36 and 48 hours postoperatively (P < 0.05). The scores at 12 and 72 hours did not differ significantly between groups (P > 0.05). (2) The knee joint range of motion on postoperative 1 and 3 days in the group A was significantly higher than that in the group B (P < 0.05), and no significant difference was detected at 14 days, 1 and 3 months postoperatively (P > 0.05). (3) At 3 months after operation, there was no significant difference in the Global Pain Scale between the two groups (P > 0.05). (4) There was no significant difference in incidences of adverse reactions and additional analgesics between the two groups (P > 0.05). (5) In summary, cocktail therapy combined with femoral nerve block can relieve the early resting pain after total knee arthroplasty, and improve the activity of knee joint in the early stage, which is safe and effective.
    Figures and Tables | References | Related Articles | Metrics
    Hemostatic effect of topical tranexamic acid infiltration in cementless total knee arthroplasty
    Yuan Jun, Yang Jiafu
    2021, 25 (6):  873-877.  doi: 10.3969/j.issn.2095-4344.2390
    Abstract ( 382 )   PDF (595KB) ( 57 )   Save
    BACKGROUND: Topical tranexamic acid in cemented total knee arthroplasty has been shown to significantly reduce perioperative blood loss, thereby reducing the need for blood transfusion. However, few studies have focused on whether the hemostatic effect of topical tranexamic acid is still effective under the mixed fixation mode (femoral prosthesis compression fixation, tibial prosthesis bone cement fixation). 
    OBJECTIVE: To investigate the effect of topical tranexamic acid on blood loss after total knee arthroplasty using hybrid fixation.
    METHODS: From January 2017 to December 2018, 208 patients receiving primary total knee arthroplasty were retrospectively collected. Among these patients, 132 patients in the hybrid fixation group (First Affiliated Hospital of the Fourth Military Medical University) underwent total knee arthroplasty using hybrid fixation, and 76 patients in the cemented fixation group (Affiliated Hospital of Traditional Chinese Medicine, Southwest Medical University) received total knee arthroplasty with cemented fixation. These patients were sub-classified based on whether or not receiving topical tranexamic acid. The 24-hour drainage volume, blood transfusion rate, the difference in preoperative and postoperative hemoglobin levels, and complications were taken into account for assessing the hemostatic effect of topical tranexamic acid. 
    RESULTS AND CONCLUSION: (1) Among all the patients and patients having hybrid fixation, there was no significant difference in age, gender, body mass index, and operation duration between the patients treated with and without tranexamic acid (P > 0.05). (2) Topical tranexamic acid significantly decreased drainage volume, blood loss, and blood transfusion rate whether patients received hybrid fixation or cemented fixation (P < 0.05). In the hybrid fixation group, patients receiving topical tranexamic acid had remarkably lower drainage volume, blood loss, and blood transfusion rate than patients without topical tranexamic acid. Meanwhile, overall blood loss in the hybrid fixation group was a little higher than that in the cemented fixation group. (3) No severe complications such as thrombosis or rejection were reported in both groups. (4) In conclusion, topic tranexamic acid is as effective in decreasing blood loss and blood transfusion rate for total knee arthroplasty with hybrid fixation as with cemented fixation.
    Figures and Tables | References | Related Articles | Metrics
    Bone cement pedicle screw fixation and fusion in the treatment of degenerative spinal disease with osteoporosis: one-year follow-up
    Hou Guangyuan, Zhang Jixue, Zhang Zhijun, Meng Xianghui, Duan Wen, Gao Weilu
    2021, 25 (6):  878-883.  doi: 10.3969/j.issn.2095-4344.2391
    Abstract ( 365 )   PDF (1411KB) ( 62 )   Save
    BACKGROUND: Even pedicle screw fixation system is commonly used in spinal surgery, elderly patients with high bone fragility lack of bone elasticity, insufficient holding power of pedicle screw. Thus, there is a risk of loosening and pulling out the screws, leading to failure of spine reduction and fixation. Thus, we need to explore new method to increase the stability of the pedicle screw system. 
    OBJECTIVE: To explore the long-term effect of pedicle screw internal fixation with bone cement in the treatment of different types of lumbar degenerative diseases with osteoporosis.
    METHODS: Sixty patients suffering from degenerative spinal disease with the complication of osteoporosis were randomly assigned to control group and trial group (n=30 per group). Before adopting the treatment of bone cement pedicle screw fixation and fusion, all patients had taken pre-operation examination, X-ray, CT and MRI scan. The patients in the control group were treated with conventional pedicle screw technology, and those in the experimental group were treated with bone cement on the basis of the conventional pedicle screw technology. Visual analogue scale score and Oswestry disability index were compared between the two groups 1 day before surgery, 1 week, 6 months, and 1 year after surgery. Complications were observed after surgery to evaluate the effect of the operation. 
    RESULTS AND CONCLUSION: (1) At 1 week, 6 months and 1 year after surgery, the visual analogue scale score and Oswestry disability index were significantly better than those of pre-operation (P < 0.05). Visual analogue scale score and Oswestry disability index were significantly lower at 6 months and 1 year after surgery than those 1 week after surgery (P < 0.05). Visual analogue scale score and Oswestry disability index were significantly lower at 1 year than those at 6 months after surgery (P < 0.05). (2) Visual analogue scale score and Oswestry disability index were better in the trial group than those in the control group at 6 months and 1 year after surgery (P < 0.05). (3) The incidence of internal fixation rod loosening was lower in the trial group than that in the control group. (4) It is concluded that bone cement pedicle screw fixation and fusion in the treatment of degenerative spinal disease with osteoporosis can effectively improve the clinical symptoms and reduce the occurrence of complications. It is safe and effective in clinical application, and the long-term treatment effect is acceptable.
    Figures and Tables | References | Related Articles | Metrics
    Factors influencing the efficacy of lumbopelvic internal fixation in the treatment of traumatic spinopelvic dissociation
    He Li, Tian Wei, Xu Song, Zhao Xiaoyu, Miao Jun, Jia Jian
    2021, 25 (6):  884-889.  doi: 10.3969/j.issn.2095-4344.2392
    Abstract ( 442 )   PDF (850KB) ( 70 )   Save
    BACKGROUND: Traumatic spinopelvic dissociation severely damages the stability of the lumbosacral region, with many treatment complications, poor prognosis and many influencing factors. 
    OBJECTIVE: To analyze the influencing factors of clinical efficacy of lumbopelvic internal fixation with nail-rod system treatment of traumatic spinopelvic dissociation.
    METHODS: Complete data of 16 patients with traumatic spinopelvic dissociation from Tianjin Ninghe Hospital between September 2009 and September 2018 were analyzed retrospectively. All patients received lumbopelvic internal fixation with nail-rod system. There were 12 cases with nerve injury, of which 10 cases were treated with sacral nerve decompression. Two cases had no responsible fracture block on imaging and were not treated. Postoperative effect of treatment was evaluated according to the evaluation criterion of Japanese Orthopaedic Association and radiographic measurements of pelvic incidence and British Medical Research Council neurological function. Univariate statistical analysis was performed in the correlation between age, gender, timing of surgery, reduction quality, comorbid injury, degree of nerve injury and postoperative functional score. Among them, linear correlation analysis was conducted between age and Japanese Orthopaedic Association score. The correlation of gender, timing of surgery, reduction quality, comorbid injury, and degree of nerve injury with Japanese Orthopaedic Association score was analyzed with the Chi-square test.  
    RESULTS AND CONCLUSION: (1) All patients were followed up for 17-38 months. (2) Postoperative evaluation results of Japanese Orthopaedic Association score showed that 4 cases were rated excellent, 5 good, 4 fair and 3 poor. (3) Imaging measurements showed that the pelvic incidence improvement rate of flexion sacral fracture was 78%, and the neutral type and extension type did not improve. (4) British Medical Research Council results demonstrated that neurological injuries were recovered of “excellent” in 5 cases, “good” in 4 and “no changes” in 3 patients. Clinical recovery rate of neurological injury was 75%. (5) Statistical analysis showed that the degree of nerve injury and accompanying anterior pelvic ring injury affected the surgical outcome. (6) It is indicated that the efficacy of surgical treatment of traumatic spinopelvic dissociation is affected by many factors. Based on the treatment of combined injury, the traumatic spinopelvic dissociation should be treated operatively with lumboiliac fixation early to maintenance the stability of spin-pelvic and pelvic ring, and exact decompression for neurological injuries is the key to achieve a satisfactory curative effect.
    References | Related Articles | Metrics
    Combined variable stress plate internal fixation affects changes of bone histiocyte function and bone mineral density at the fractured end of goat femur
    Yang Weiqiang, Ding Tong, Yang Weike, Jiang Zhengang
    2021, 25 (6):  890-894.  doi: 10.3969/j.issn.2095-4344.2393
    Abstract ( 297 )   PDF (836KB) ( 83 )   Save
    BACKGROUND: The common straight plate can affect the biomechanical conduction of fracture ends, and the combined variable stress plate can retain the continuous biomechanical stimulation of the fracture end, affect the changes of bone tissue cell function and bone mineral density, and promote fracture healing. 
    OBJECTIVE: To investigate the effects of internal fixation with two kinds of plates on bone tissue cell function and bone mineral density in experimental goat femoral fracture healing.
    METHODS: Thirty healthy adult goats were raised in normal environment, and used to successfully construct the models of right lower limb femur fracture. The models were randomly divided into the experimental group (given the combined variable stress plate fixation) and the control group (given the common straight steel plate fixation) (n=15 per group). Serum levels of bone specific alkaline phosphatase, osteocalcin and tartrate resistant acid phosphatase activity were determined at 4, 8, and 12 weeks after surgery in both groups. The goats were sacrificed in batches, and the femoral stump tissue was taken for bone mineral density and histopathological observation.  
    RESULTS AND CONCLUSION: (1) At 4 and 8 weeks, the serum bone specific alkaline phosphatase in the experimental group increased faster than that in the control group, but it was significantly lower than that in the control group at 12 weeks (P < 0.05). (2) At 4 weeks after surgery, the serum osteocalcin of the experimental group was higher than that of the control group, but lower than that of the control group at 12 weeks (P < 0.05). (3) At 4 and 8 weeks after operation, the serum tartrate resistant acid phosphatase activity of the experimental group was significantly higher than that of the control group, but lower than that of the control group at 12 weeks (P < 0.05). (4) At 8 and 12 weeks after operation, the bone mineral density of the fracture end in the experimental group was significantly higher than that of the control group (P < 0.05), while the bone mineral density of the experimental group and the control group increased gradually at 4, 8 and 12 weeks (P < 0.05). (5) At 4 and 8 weeks, the number of osteoblasts of the experimental group was significantly higher than that of the control group. At 8 weeks, the number of osteoclasts of the experimental group was significantly higher than that of the control group. At 12 weeks, the number of osteoblasts and osteoclasts of the experimental group was significantly lower than that of the control group (P < 0.05). (6) Combined variable stress plate fixation can produce continuous compressive stress at the fracture end of goat femur, stimulate the change of the number of bone tissue cells, lead to the secretion of corresponding bone tissue cell functional protein, promote the formation of callus, accelerate the reconstruction of callus, and promote the fracture healing.
    Figures and Tables | References | Related Articles | Metrics
    Arthroscopic treatment of greater tuberosity avulsion fractures with anterior shoulder dislocation using the double-row suture anchor technique
    Zhang Lei, Ma Li, Fu Shijie, Zhou Xin, Yu Lin, Guo Xiaoguang
    2021, 25 (6):  895-900.  doi: 10.3969/j.issn.2095-4344.2394
    Abstract ( 535 )   PDF (775KB) ( 56 )   Save
    BACKGROUND: In clinic, there are various fixation methods for greater tuberosity avulsion fractures of the humerus. If the fixation of the greater tubercle is unsatisfactory, it will lead to the absorption of the greater tubercle as the mechanical core of the shoulder joint, resulting in serious shoulder joint dysfunction. 
    OBJECTIVE: To explore the curative effect of the treatment of anterior dislocation of shoulder joint with greater tuberosity avulsion fractures of the humerus by double-row suture anchors under shoulder arthroscope.
    METHODS: A retrospective study was conducted in 20 patients with anterior dislocation of the shoulder and avulsion fracture of the greater tuberosity of the humerus in Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University who underwent arthroscopic double-row suture anchors from January 2016 to October 2018. After operation, systematic shoulder joint function exercise was performed, and joint function evaluation and pain score were regularly followed up. The functional recovery was compared before and after operation. 
    RESULTS AND CONCLUSION: (1) The incisions of all patients healed in stage I, without complications such as infection, loosening of anchor pin, or nerve injury. After one-year follow-up, there was no significant subacromial impact in all patients. (2) At 1, 3, 6 and 12 months postoperatively, the Constant-Murley score and the University of California at Los Angeles shoulder rating scale score were significantly different (P < 0.05); and the score of each time point was better than that of the previous time point (P < 0.05). (3) At 1 month after surgery, the resting and activity visual analogue scale scores were significantly lower than before surgery (P < 0.05); the displacement distance of greater tuberosity fracture was significantly less than that before operation (P < 0.05). (4) One year after operation, the range of motion of shoulder joint such as flexion, abduction, external rotation and adduction recovered well. (5) It is indicated that arthroscopic double-row suture anchors can effectively restore the displacement of the greater tuberosity fractures, and achieve a good fixation of the rotator cuff tendon injury, promote healing, and relieve patients’ pain, which is conductive to early shoulder functional exercise.
    Figures and Tables | References | Related Articles | Metrics
    Simple HyProCure subtalar stabilization in treatment of adolescent flexible flatfoot combined with painful accessory navicular bone
    Wu Gang, Chen Jianwen, Wang Shilong, Duan Xiaoran, Liu Haijun, Dong Jianfeng
    2021, 25 (6):  901-905.  doi: 10.3969/j.issn.2095-4344.2395
    Abstract ( 558 )   PDF (673KB) ( 181 )   Save
    BACKGROUND: HyProCure subtalar stabilization has been widely used in the treatment of flexible flatfoot, but there is no unified treatment for adolescent flexible flatfoot with painful accessory navicular bone. 

    OBJECTIVE: To evaluate the effectiveness of HyProCure subtalar stabilization for adolescent flexible flatfoot combined with painful accessory navicular bone. 

    METHODS: Between January 2015 and September 2019, 24 cases (39 feet) of adolescent flexible flatfoot combined with painful accessory navicular bone were treated with HyProCure subtalar stabilization in National Rehabilitation Hospital. There were 13 males (22 feet) and 11 females (17 feet) with the age of 5-15 years. Visual analogue scale score and American Orthopaedic Foot & Ankle Society (AOFAS) ankle and foot function score were used to evaluate the effectiveness. The talus-the first metatarsal angle (Meary’s angle), the talus-the second metatarsal angle, calcaneal inclination angle (Pitch angle), the talar declination angle, calcaneal valgus angle, talonavicular coverage angle, and talocalcaneal angle were measured on the X-ray films. This study was approved by the Ethics Committee of National Rehabilitation Hospital.  

    RESULTS AND CONCLUSION: (1) All incisions of 24 patients healed well in the first stage. Two cases (2 feet) had tarsal sinus pain; one case (1 foot) appeared with mild hindfoot varus and insufficient weight-bearing under the 1st metatarsal head, also one case (1 foot) complained mild painful remain at local site. (2) All 24 patients were followed up for 6-36 months. No case suffered from hardware failure or hardware removal. (3) At last follow-up, visual analogue scale score was significantly decreased compared with that before surgery (P < 0.01); AOFAS ankle and foot function score was significantly increased compared with that before surgery (P < 0.01). (4) At last follow-up, Meary’s angle, the talus-the second metatarsal angle, Pitch angle, the talar declination angle, calcaneal valgus angle, talonavicular coverage angle, and talocalcaneal angle in 24 patients were significantly improved compared with that before surgery (P < 0.01 or P < 0.05). (5) The results suggested that HyProCure subtalar stabilization is effective for adolescent flexible flatfoot combined with painful accessory navicular bone in short term. 
    Figures and Tables | References | Related Articles | Metrics
    Type L1 steroid-induced osteonecrosis of the femoral head through femoral head and neck junction decompression by fenestration: a single-center prospective clinical study
    Liu Lihua, Sun Wei, Wang Yunting, Gao Fuqiang, Cheng Liming, Li Zirong, Wang Jiangning
    2021, 25 (6):  906-911.  doi: 10.3969/j.issn.2095-4344.2396
    Abstract ( 386 )   PDF (671KB) ( 44 )   Save
    BACKGROUND: Osteonecrosis of the femoral head is a refractory disease in department of orthopedics. Especially with steroid-induced osteonecrosis, incidence rate is high, and it is easy to collapse. Increasing knowledge of hormone necrosis will help early identification and intervention, and choose reasonable treatment measures to improve prognosis.  
    OBJECTIVE: To investigate the clinical effects and influencing factors in the treatment of different kinds of steroid-induced osteonecrosis of the femoral head of CJFH type L1 patients through femoral head and neck junction decompression by fenestration and bone grafting.
    METHODS: Clinical data of 82 patients (106 hips) with CJFH type L1 steroid-induced osteonecrosis of the femoral head, who underwent femoral head and neck junction decompression by fenestration in China-Japan Friendship Hospital, were  analyzed. The clinical effect evaluation consisted of two parts: Harris hip score system, the observation of bilateral hip joint and frog position film. Clinical endpoint events were marked by poor Harris hip score < 70, progressive collapse of the femoral head with/without obvious clinical manifestation. Univariate and multivariate analyses were used to analyze the influence of gender, age, etiology, preoperative ARCO stage, onset time and preoperative Harris score on prognosis. 
    RESULTS AND CONCLUSION: (1) All patients were followed up, and the mean duration was 3-51 months. (2) Based on Harris hip score of the last follow-up, the results were excellent in 4 hips, good in 33 hips, fair in 50 hips, and poor in 19 hips. The excellent and good rate was 34.9% (37/106). Harris hip score was higher in the final follow-up (83.1±14.3) than that before surgery (64.4±9.8) (P < 0.05). (3) Imaging results demonstrated that there were 15 hips with progressive collapse of the femoral head, and 6 hips without obvious clinical symptoms. (4) The 26 hips were classified as clinical failed. Univariate and multivariate analyses showed that preoperative Harris hip score < 70 was the independent risk factor for prognosis of osteonecrosis of the femoral head (P < 0.05). There was no significant difference among different types of steroid-induced osteonecrosis of the femoral head. (5) The method through femoral head and neck junction decompression by fenestration and bone grafting has a good effectiveness in patients with type L1 steroid-induced osteonecrosis of the femoral head in short and medium terms, but preoperative Harris hip score < 70 is a risk factor affecting the prognosis of hip preservation.
    Figures and Tables | References | Related Articles | Metrics
    Accuracy of target bone segments in personalized differential modeling and simulation of CT scanning parameters at fracture end
    Yuan Xinping, Shao Yanbo, Wu Chao, Wang Jianling, Tong Liangcheng, Li Ying
    2021, 25 (6):  912-916.  doi: 10.3969/j.issn.2095-4344.2397
    Abstract ( 321 )   PDF (1044KB) ( 150 )   Save
    BACKGROUND: CT scan and differential modeling are used to analyze the fracture end, which is an effective method to judge the degree of bone healing. To obtain the high precision of differential modeling and simulation, how to select the optimal CT scanning parameters needs further research and analysis. 
    OBJECTIVE: To compare the effects of different CT scanning parameters on modeling accuracy in personalized differential modeling analysis, to verify the accuracy and effectiveness of personalized differential modeling in the reduction of simulated target bone segments, and to explore the research value of this method in judging the degree of bone healing of long canals of lower extremities.
    METHODS: The model of internal fixation was established with porcine femur. Four groups of 80 kV-300 mA (group A-low dose), 120 kV-335 mA (group B-automatic tube current control system), 140 kV-300 mA (group C-manual setting comparison) and 140 kV-80 mA (group D-high kV and low mA) were used to scan the same object with the same pitch, slice thickness and environment. The scanning data of each group were selected, the same CT value range was used, and the differential modeling analysis method was used to model the target bone segment. The average area and maximum area of metal artifacts in CT scanning images, the average CT value, volume and maximum wall thickness peak after differential modeling analysis, the radiation amount under four groups of scanning conditions were compared to determine the reduction of metal artifacts, modeling accuracy and radiation, so as to select the optimal CT scanning parameters.  
    RESULTS AND CONCLUSION: (1) Artifact measurement method results: In group A, there were many metal artifacts, which obviously obstructed bone tissue, and had a possibility of missed diagnosis. In group D, there were minimal metal artifacts, less occlusion around bone tissue, but poor image contrast and high fog. The difference between group B and group C lay in the clarity of images, and the accuracy of diagnosis was basically the same. Therefore, the order of artifact size was as follows: group A > group B > group C > Group D. (2) Differential modeling analysis results: In group B, because of the smaller artifact and less loss of CT value, the simulated model was more close to the reality. Moreover, group B adopted the automatic tube current control system, which could obviously show that the radiation amount was smaller and more protective for patients. (3) It is confirmed that the CT scan under the condition of group B can effectively reduce the interference caused by metal artifacts, better retain the original information of CT gray value, and retain the density information of the target bone segment to the maximum extent. Therefore, when establishing differential modeling, the CT automatic tube current control system is used as the optimal CT scanning parameter, which not only improves the simulation accuracy of personalized differential modeling, but also increases the accuracy of calculation.
    Figures and Tables | References | Related Articles | Metrics
    Application of anatomic intramedullary nail in tubular bone fractures of limbs: stronger holding force and anti-rotation ability
    Zhang Jing, Wang Bin, Lü Xin
    2021, 25 (6):  917-922.  doi: 10.3969/j.issn.2095-4344.2398
    Abstract ( 357 )   PDF (635KB) ( 81 )   Save
    BACKGROUND: Tubular bone fractures of limbs are common in traumatic orthopedics, among which anatomic intramedullary nailing has been gradually applied in clinical treatment in recent years, and has achieved good curative effect.
    OBJECTIVE: To summarize the application characteristics, advantages and development direction of anatomic intramedullary nailing in tubular bone fractures of limbs.
    METHODS: PubMed, Web of science, CNKI, Wanfang and VIP were searched for articles published from January 1900 to May 2020. The key words were “tubular bone, anatomic intramedullary nail, ulna, radius, humerus, femur, tibia, fibula” in Chinese and English. Totally 379 articles were initially examined, and 34 were finally included for review and analysis according to inclusion and exclusion criteria.
    RESULTS AND CONCLUSION: (1) The development history and application characteristics of anatomic intramedullary nailing in tubular bone of limbs were introduced in this paper, which was considered to have a broad clinical prospect. (2) Intramedullary nailing is gradually replacing external fixation in the treatment of tubular bone fracture, and anatomical intramedullary nailing will become the first choice of treatment. (3) Anatomic intramedullary nailing provides a better choice for intramedullary fixation of tubular bones of limbs and reduces the occurrence of related complications because its main nailing structure is more in line with the unique design of tubular bone marrow cavity of human body and the combination of distal and proximal screws with the main nailing to provide stronger holding force and anti-rotation ability. (4) The anatomic intramedullary nails have been applied in foreign countries and later in China. For example, the ZNN anatomic intramedullary nails produced by Zimmer Company in the United States are mostly used in the treatment of lower limb tubular bone fractures. In China, the anatomic intramedullary nails have just been introduced into the treatment of hip fractures (intertrochanteric and subtrochanteric fractures) and are rarely used in the treatment of tibial shaft fractures. (5) In the future, the new generation of anatomic intramedullary nails will combine biological detection, information sensing and other technologies more efficiently, so as to realize the technology and intelligence of materials.
    Figures and Tables | References | Related Articles | Metrics
    Research progress in biomechanical stability of lateral lumbar interbody fusion
    Song Chengjie, Chang Hengrui, Shi Mingxin, Meng Xianzhong
    2021, 25 (6):  923-928.  doi: 10.3969/j.issn.2095-4344.2399
    Abstract ( 440 )   PDF (544KB) ( 120 )   Save
    BACKGROUND: Lateral lumbar interbody fusion has become more and more widely used in clinic. Biomechanical research on lateral lumbar interbody fusion is increasing.
    OBJECTIVE: To summarize the biomechanical research progress of lateral lumbar interbody fusion and expect to provide some guidance for clinicians to use lateral lumbar interbody fusion in the treatment of lumbar spine diseases. 
    METHODS: CNKI, Wanfang, and PubMed databases were retrieved. The Chinese key words were “lateral lumbar interbody fusion, extreme lateral interbody fusion, direct lateral interbody fusion, finite element, biomechanics”. The English key words were “lateral lumbar interbody fusion, direct lateral interbody fusion, extreme lateral interbody fusion, oblique lumbar interbody fusion, finite element, biomechanics”. Finally, 32 articles were included for review.
    RESULTS AND CONCLUSION: (1) Current biomechanical research on lateral lumbar interbody fusion mainly includes comparison between lateral lumbar interbody fusion and anterior-posterior surgery, stability of different internal fixation methods of lateral lumbar interbody fusion, incidence of adjacent vertebral disease after lateral lumbar interbody fusion, and research on new internal fixations of lateral lumbar interbody fusion. (2) The biomechanical stability of lateral lumbar interbody fusion is similar to that of anterior lumbar interbody fusion and posterior lumbar interbody fusion, and is better than that of transforaminal lumbar interbody fusion. Clinicians can give priority to lateral lumbar interbody fusion when choosing the operation methods. (3) Bilateral pedicle screw rods and lateral plate and spinous plate joint fixation has the best biomechanical performance. It is recommended that clinicians use this two internal fixation methods as the first choice. (4) Although there are many biomechanical studies on lateral lumbar interbody fusion, there are few basic biomechanical studies between extreme lateral interbody fusion and oblique lateral interbody fusion, because extreme lateral interbody fusion is through the transpsoas muscle approach, and oblique lateral interbody fusion is through the anterior approach of the psoas major muscle. Whether the psoas major has an effect on the biomechanical stability after lateral lumbar interbody fusion deserves to be further studied.
    Figures and Tables | References | Related Articles | Metrics
    Guiding role and prospect of staging and classification combined collapse prediction method for osteonecrosis of femoral head
    Liu Zhao, Xu Xilin, Shen Yiwei, Zhang Xiaofeng, Lü Hang, Zhao Jun, Wang Zhengchun, Liu Xuzhuo, Wang Haitao
    2021, 25 (6):  929-934.  doi: 10.3969/j.issn.2095-4344.2400
    Abstract ( 356 )   PDF (649KB) ( 51 )   Save
    BACKGROUND: Osteonecrosis of the femoral head is a common disabling disease in orthopedics. The development of the disease is difficult to be reversed, and improper treatment methods can easily lead to the collapse of the femoral head, leading to the partial or complete loss of hip function, which seriously affects the life of patients.
    OBJECTIVE: To summarize the methods of collapse assessment and prediction, and to propose that the combination of them can provide more accurate evidence for the selection of treatment.
    METHODS: PubMed was searched with the key words of “staging and classification, ONFH, collapse prediction, assessment”. CNKI and Wanfang database were retrieved using the key words of “staging classification, femoral head necrosis, collapse prediction”. The search time was from January 1991 to January 2020. Articles unrelated with the research and repetitive one were excluded, and finally 62 articles met the criteria for review. 
    RESULTS AND CONCLUSION: (1) The classification and staging of osteonecrosis of the femoral head can effectively evaluate the existence and degree of collapse, but still have their limitation on prediction of collapse occurrence. (2) The combined application of collapse prediction method can improve the accuracy of the evaluation. The specific combination effect still needs further studies.
    Figures and Tables | References | Related Articles | Metrics
    Pathogenesis of hormonal osteonecrosis of the femoral head and the target effect of related signaling pathways
    Li Shibin, Lai Yu, Zhou Yi, Liao Jianzhao, Zhang Xiaoyun, Zhang Xuan
    2021, 25 (6):  935-941.  doi: 10.3969/j.issn.2095-4344.4001
    Abstract ( 440 )   PDF (806KB) ( 198 )   Save
    BACKGROUND: The early stage of avascular necrosis of the femoral head is difficult to find, easy to be ignored and misdiagnosed. Due to the relatively poor medical conditions in some areas, the treatment is often delayed, resulting in a high rate of late disability.
    OBJECTIVE: To summarize the related literature in and outside China, and the research on the pathogenesis of hormonal osteonecrosis of the femoral head and related signal pathway so as to understand the pathogenesis.
    METHODS: The databases of CNKI, Wanfang and VIP were retrieved in Chinese with the key words of “necrosis of femoral head, glucocorticoid, pathogenesis, apoptosis, signal pathway, lipid metabolism disorder, BMSCs, Wnt/β-catenin”. PubMed and MEDLINE databases were retrieved in English with the key words of “ANFH, glucocortioids, pathogenesis, cell apoptosis, signal path, lipid metabolism disorder, BMSCs, Wnt/β-catenin”. The articles regarding the pathogenesis of hormonal osteonecrosis of the femoral head were collected. Finally, 57 articles were included according to the inclusion and exclusion criteria.
    RESULTS AND CONCLUSION: (1) The pathogenesis of steroid-induced femoral head necrosis is the result of a combination of multiple mechanisms and factors. Currently, the accepted theories mainly include intravascular coagulation, lipid metabolism disorder, osteoporosis and cell apoptosis. However, the pathological process has not yet been fully elucidated and further in-depth research is needed. (2) At present steroid-induced femoral head necrosis has not been completely cured because its pathogenesis has not been clearly identified. The reason for this difficulty may be that animal models in a large number of experiments at present cannot satisfactorily simulate the complex pathological changes and mechanisms of human femoral head necrosis. It is hoped that animal models of femoral head necrosis can be further improved in future experiments on steroid-induced femoral head necrosis. (3) On the basis of fully understanding the pathogenesis of steroid-induced femoral head necrosis, rational clinical use of glucocorticoids and preventive and intervention measures may be the key to prevent femoral head necrosis. In addition, speeding up the research on relevant signal pathways will help investigators find targets for the prevention and treatment of steroid-induced femoral head necrosis, and hopefully find more effective therapeutic schemes.
    Figures and Tables | References | Related Articles | Metrics
    Effect of implant selection and approach on support in the operation of posterolateral tibial plateau fractures
    Kong Lingbao, Lü Xin
    2021, 25 (6):  942-947.  doi: 10.3969/j.issn.2095-4344.4002
    Abstract ( 379 )   PDF (610KB) ( 47 )   Save
    BACKGROUND: Posterolateral tibial plateau fracture is a special type of tibial plateau fracture. Because of its special anatomical location, there are many kinds of surgical approaches and implants used in the treatment in and outside China, but no consensus has been reached.
    OBJECTIVE: To summarize various surgical approaches and implants by analyzing the local anatomical structure and fracture types of the posterolateral tibial plateau.
    METHODS: The databases of Wanfang Medical Network, China National Knowledge Infrastructure and PubMed were searched by computer. Using the keywords of “tibial plateau fracture; posterolateral tibial plateau fracture; internal fixation; surgical approach” in Chinese and English. According to the inclusion and exclusion criteria, 54 related articles were finally included and summarized.
    RESULTS AND CONCLUSION: There are local structures of common peroneal nerve, anterior tibial artery and fibular head on the posterolateral tibial plateau, which will affect the operation. The commonly used fracture types are Schatzker, AO/ATO, three-column classification systems and posterior column 4 zone. Posterior column 4 zone has a more definite guiding effect on posterolateral tibial plateau fractures. There are many kinds of surgical approaches and internal plants for the treatment of posterolateral tibial plateau fractures, and the optimal selection should be made according to the fracture characteristics. For simple posterolateral tibial plateau fractures, the posterolateral approach has a certain advantage over other approaches. Posterolateral supporting plate has a better supporting effect on posterolateral shear fracture of tibial plateau.
    Figures and Tables | References | Related Articles | Metrics
    Intravenous, topical tranexamic acid alone or their combination in total knee arthroplasty: a meta-analysis of randomized controlled trials
    Huang Dengcheng, Wang Zhike, Cao Xuewei
    2021, 25 (6):  948-956.  doi: 10.3969/j.issn.2095-4344.4003
    Abstract ( 378 )   PDF (1051KB) ( 121 )   Save
    OBJECTIVE:The optimal route of administration of tranexamic acid remains controversial in total knee arthroplasty. This study performed a meta-analysis to evaluate the effectiveness and safety of combined administration of intravenous and topical tranexamic acid. 
    METHODS: A systematic literature search was conducted in PubMed, Embase, Medline, Web of Science, and Cochrane Library database until May 2019 to identify randomized controlled trials of comparing intravenous or topical administration of tranexamic acid and their combination. The search terms include “total knee arthroplasty, total knee replacement, TKA, TKR, tranexamic acid, TXA”. Cochrane bias risk assessment tool was used to evaluate literature quality. Data were analyzed using RevMan 5.3 software. The main outcome measures were total blood loss, drainage volume, maximum drop of hemoglobin, and postoperative hemoglobin level. The secondary outcome measures were the transfusion rate, the incidence of deep vein thrombosis and the incidence of pulmonary embolism.
    RESULTS: (1) A total of 9 randomized controlled trials involving 1 220 patients were included in the meta-analysis. (2) Meta-analysis results suggested that compared with intravenous administration group, total blood loss (MD=-213.15, 95%CI:-241.23 to -185.08, P < 0.000 01), drainage volume (MD=-40.00, 95%CI:-62.34 to -17.65, P=0.000 5], maximum drop of hemoglobin (MD=-0.65, 95%CI:-1.01 to -0.30, P=0.002), and postoperative hemoglobin level (MD=0.86, 95%CI:0.48-1.24, P < 0.000 1) were better than in the combined group. There was no significant difference between the two groups in the transfusion rate, the incidence of deep vein thrombosis and the incidence of pulmonary embolism (P > 0.05). (3) Compared with the topical administration group, total blood loss (MD=-94.24, 95%CI:-123.83 to -64.66, P < 0.000 01), maximum drop of hemoglobin (MD=-0.64, 95%CI:-0.93 to -0.35, P < 0.000 1) and transfusion rate (OR=0.31, 95%CI:0.13-0.74, P=0.009) were better in the combined group. No significant difference was found in drainage volume, the incidence of deep vein thrombosis and the incidence of pulmonary embolism between the two groups (P > 0.05).  
    CONCLUSION: The combined intravenous and topical tranexamic acid can further reduce surgical blood loss, hemoglobin drop and drainage, and will not lead to an increase in the incidence of adverse events such as deep vein thrombosis and pulmonary embolism. The combined use of tranexamic acid is more effective and safer when comparing with topical or intravenous tranexamic acid alone.
    Figures and Tables | References | Related Articles | Metrics
    Electroacupuncture for pain control after total knee arthroplasty: a meta-analysis
    Li Yan, Wang Pei, Deng Donghuan, Yan Wei, Li Lei, Jiang Hongjiang
    2021, 25 (6):  957-963.  doi: 10.3969/j.issn.2095-4344.4004
    Abstract ( 550 )   PDF (1184KB) ( 137 )   Save
    OBJECTIVE: Electroacupuncture has been commonly used in clinical practice for pain after total knee arthroplasty, but its effects and safety remain controversial. The efficacy and safety of electroacupuncture in the treatment of pain after total knee arthroplasty were systematically evaluated.
    METHODS: PubMed, Embase, Cochrane Library, SinoMed, CNKI, VIP and Wanfang databases were searched to collect randomized controlled trials on electroacupuncture in the treatment of pain after total knee arthroplasty from inception to December 31, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was performed by RevMan 5.3 software. 
    RESULTS: (1) A total of six studies involving 304 patients were included. (2) The results of meta-analysis showed that compared with control group, the experimental group had significantly lower visual analogue scale scores at 3 days [MD=-0.67, 95%CI(-1.01 to -0.33), P < 0.001], 7 days [MD=-0.60, 95%CI (-0.88 to -0.33), P < 0.001), 14 days [MD=-0.97, 95%CI(-1.74 to -0.21), P < 0.05) and end point of clinical trial (MD=-0.67, 95%CI(-1.04 to -0.30), P < 0.001), respectively, after total knee arthroplasty. There were no significant differences in visual analogue scale scores at 1 day after total knee arthroplasty [MD=-0.12, 95%CI(-0.64, 0.40), P > 0.05). (3) The incidence of postoperative vertigo was significantly lower in the trial group than that in the control group [OR=0.28, 95%CI(0.10, 0.78), P < 0.05]. (4) The incidence of postoperative vomiting was not significantly different between the trial and control groups [OR=0.83, 95%CI(0.37, 1.87), P > 0.05].
    CONCLUSION: Electroacupuncture has obvious advantages in the treatment of pain after total knee arthroplasty, which can significantly relieve the pain reaction of patients at 3, 7, 14 days and the end point of clinical trial, and can reduce the incidence of postoperative vertigo, but it cannot reduce the incidence of postoperative vomiting and pain at 1 day after total knee arthroplasty. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions. 
    Figures and Tables | References | Related Articles | Metrics
    Platelet-rich plasma combined with microfracture versus microfracture in the treatment of knee cartilage lesions: a meta-analysis
    He Xiangzhong, Chen Haiyun, Liu Jun, Lü Yang, Pan Jianke, Yang Wenbin, He Jingwen, Huang Junhan
    2021, 25 (6):  964-969.  doi: 10.3969/j.issn.2095-4344.4005
    Abstract ( 417 )   PDF (736KB) ( 138 )   Save
    OBJECTIVE: A large number of recent studies reported that microfracture combined with platelet-rich plasma has a good effect on osteochondral injury. This study systematically evaluated the clinical effect of arthroscopic platelet-rich plasma combined with microfracture versus microfracture in the treatment of knee cartilage lesions.
    METHODS: A randomized controlled trial of arthroscopic platelet-rich plasma combined with microfracture in the treatment of knee cartilage lesions was searched in CNKI, Wanfang Database, VIP Database, Chinese Biomedical Literature Database, PubMed, Embase and Cochrane Library. The date was from January 2001 to March 2020. The data were extracted and the quality of the included literature was evaluated, and the Rev-Man5.3 software was used for meta-analysis.
    RESULTS: (1) A total of seven randomized controlled trials were included, and the modified Jadad scale results showed that the scores of four studies were ≥ 4, which were high-quality literatures, and the scores of three studies were < 4, which were low-quality literatures. (2) Meta-analysis showed that the visual analogue scale score at 6 and 12 months, IKDC score at 12 and 24 months, Lysholm score at 12 and 24 months and WOMAC score at 12 months in the platelet-rich plasma combined with microfracture group were better than those in the microfracture group [MD=-0.40, 95%CI(-0.75, -0.05), Z=2.26, P=0.02; MD=-0.59, 95%CI(-0.86, -0.32), Z=4.30, P < 0.000 1; MD=7.70, 95%CI(4.22, 11.18), Z=4.34, P < 0.000 1; MD=10.99, 95%CI(6.79, 15.19), Z=5.13, P < 0.000 01; MD=4.98, 95%CI(2.31, 7.64), Z=3.66, P=0.000 3; MD=5.35, 95%CI(1.94, 8.77), Z=3.07, P=0.002; MD=-9.30, 95%CI(-16.50, 2.11), Z=2.53, P=0.01]. There was no significant difference in visual analogue scale score 24 months after operation and IKDC score 6 months after operation between the two groups (P > 0.05).
    CONCLUSION: Platelet-rich plasma combined with microfracture for knee cartilage lesions can reduce the pain in the short and medium terms, enhance the joint function in the medium and long terms, and improve the postoperative experience. However, due to the limited number of included articles, more large-sample and high-quality randomized controlled trials are needed to provide further effective data. 
    Figures and Tables | References | Related Articles | Metrics
    Meta-analysis of clinical efficacy and safety of antibiotic artificial bone in the treatment of chronic osteomyelitis
    Hua Haotian, Zhao Wenyu, Zhang Lei, Bai Wenbo, Wang Xinwei
    2021, 25 (6):  970-976.  doi: 10.3969/j.issn.2095-4344.2968
    Abstract ( 571 )   PDF (671KB) ( 56 )   Save
    OBJECTIVE: Chronic osteomyelitis is a difficult orthopedic disease. The treatment process is complicated and prolonged. It is easy to relapse. At present, studies have confirmed that antibiotic artificial bone is effective in treating chronic osteomyelitis, but there is still no evidence-based basis. This study systematically evaluated the clinical efficacy and safety of antibiotic artificial bone in the treatment of chronic osteomyelitis. 
    METHODS: The authors searched relevant literature in CNKI, Wanfang, VIP, CBM, PubMed, and Cochrane Llibrary databases. The limit of searching time was from inception to April 2020. Randomized controlled trials on the use of antibiotic artificial bones for chronic osteomyelitis were collected according to the criteria for inclusion and exclusion. Two researchers independently screened, evaluated, and extracted the retrieved documents. The quality evaluation was carried out according to the Cochrane evaluation manual and the NOS scale. The literature data were analyzed using RevMan 5.3 software through a meta-analysis. 
    RESULTS: (1) Two randomized controlled clinical trials evaluated moderately biased quality, and 11 retrospective studies evaluated high-quality literature. A total of 744 patients were included in 13 clinical control trials, including 387 patients in the treatment group and 357 patients in the control group. (2) The results of meta-analysis showed that the treatment group had significant differences from the control group in terms of infection clearance rate, fracture healing rate, fracture healing time, incision healing time, treatment efficiency, length of stay, reoperation rate, complication rate and recurrence rate, and the treatment group was superior to the control group (P < 0.05). 
    CONCLUSION: Antibiotic artificial bone treatment of chronic osteomyelitis can improve the treatment efficiency, shorten the treatment time, better control infection, and reduce complications and recurrence rate. This conclusion also needs a larger sample and higher quality randomized controlled trials to verify.
    Figures and Tables | References | Related Articles | Metrics
    Intraoperative intravenous application of tranexamic acid reduces perioperative bleeding in multilevel posterior spinal surgery: a meta-analysis
    Zhan Fangbiao, Cheng Jun, Zou Xinsen, Long Jie, Xie Lizhong, Deng Qianrong
    2021, 25 (6):  977-984.  doi: 10.3969/j.issn.2095-4344.4006
    Abstract ( 357 )   PDF (789KB) ( 49 )   Save
    OBJECTIVE: Tranexamic acid as a synthetic antifibrinolytic agent has been used in hip replacement, gastrointestinal surgery, neurosurgery, obstetrics and gynecology, cardiac surgery, and various nasal operations to reduce bleeding. In recent years, tranexamic acid has also been used in spinal surgery. Meta-analysis was used to evaluate whether intraoperative intravenous tranexamic acid reduced the incidence of perioperative bleeding and transfusion events in multilevel posterior spinal surgery compared with placebo.
    METHODS: The randomized controlled trials of tranexamic acid in the use of PubMed, Cochrane Library and EMBASE in multi-segment posterior spinal surgery were searched by computer. Tranexamic acid was used intravenously in the experimental group and placebo was used in the control group. Two reviewers screened all the retrieved literature according to the inclusion and exclusion criteria. The literature quality was evaluated with the modified Jadad scale and meta-analysis was performed with the Review Manager 5.3 software. 
    RESULTS: (1) A total of nine randomized controlled trials were included in this study. The score of the modified Jadad scale showed 7 points in 6 articles, 6 points in 1 article, 4 points in 1 article and 3 points in 1 article. (2) Meta-analysis showed that the amount of postoperative drainage, intraoperative blood loss, intraoperative erythrocyte recovery, incidence of transfusion events, and total perioperative blood loss in the tranexamic acid group were all lower than those in the placebo group [MD=-102.70, 95%CI(-141.25, -64.15), Z=5.22, P < 0.000 01; MD=-23.23, 95%CI(-44.00, -2.47), Z=2.19, P=0.03; MD=-139.36, 95%CI(-275.23, -3.49), Z=2.01, P=0.04; OR=0.52, 95%CI(0.33, 0.84), Z=2.71, P=0.007; MD=-228.98, 95%CI[-399.75, -58.22], Z=2.63, P=0.009]. Preoperative hemoglobin, hematocrit, immediate postoperative hemoglobin, hospital stay, and operation time had no significant difference between the two groups (P > 0.05).
    CONCLUSION: Intravenous tranexamic acid can reduce the total perioperative blood loss, intraoperative blood loss, postoperative drainage, intraoperative erythrocyte recovery and the incidence of transfusion events in posterior spinal multilevel surgery. However, due to the limited quantity and quality of the included studies, the above conclusions still need to be verified by more high-quality large-sample studies.
    Figures and Tables | References | Related Articles | Metrics