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    28 March 2021, Volume 25 Issue 9 Previous Issue    Next Issue
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    Biomechanical analysis of different fixation methods of pedicle screws for thoracolumbar fracture
    Xu Feng, Kang Hui, Wei Tanjun, Xi Jintao
    2021, 25 (9):  1313-1317.  doi: 10.3969/j.issn.2095-4344.4017
    Abstract ( 163 )   PDF (742KB) ( 78 )   Save
    BACKGROUND: Percutaneous fixation of thoracolumbral and lumbar fractures has been relatively mature, and there are many clinical fixation methods at present. However, due to the lack of a fixation method that can take the mechanical effect and operability into account, the clinical efficacy is different.  
    OBJECTIVE: To study the biomechanical properties of lumbar vertebrae under the different kinds of pedicle screw fixation.
    METHODS: Twenty-four cases of fresh multi-segment lumbar vertebrae of pigs were randomly divided into eight groups and modeled: groups A1 and A2 were fixed with six universal screws; groups B1 and B2 were fixed with four one-way screws and two universal screws; groups C1 and C2 were fixed with six uniplanar pedicle screw; groups D1 and D2 were fixed with four one-way screws. The biomechanics of eight groups was measured by universal testing machine. Four groups of A1, B1, C1 and D1 performed static experiments, while A2, B2, C2 and D2 performed fatigue experiments. 
    RESULTS AND CONCLUSION: (1) All the four internal fixations could effectively fix lumbar fractures. The maximum load of the screw fixation at the fracture level was significantly higher in the screw placement group than that of unscrew placement group. Group C1 had the largest load, and group D1 had the smallest load, and there were significant differences among the four groups (P < 0.05). (2) Groups A1, B1, C1 and D1 conducted pressurized buttoning experiments, and the three groups B1, C1 and D1 all completed the buttoning experiments three times. The A1 group showed the slip of the nail tail when pressurized 300 N. The reduction effect of group C1 was better than that of groups A1, B1 and D1, and the difference was statistically significant (P < 0.05). The reduction effect of group B1 was better than that of groups A1 and D1, and the difference was statistically significant (P < 0.05). There was no significant difference in reduction effect between groups A1 and D1. (3) There was no significant difference in the anterior vertebral body height in groups B2, C2 and D2 after loading compared with that before loading. After loading, the anterior vertebral body height in group A2 was significantly lower than that before loading (P < 0.05). (4) All three kinds of pedicle screws can bear most of the stress of thoracolumbar vertebra, and the screw placement mode of injured vertebra can provide more effective stability and better shape recovery of injured vertebra. The effect of the uniplanar pedicle screw is better than that of the other three fixation screws.
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    Von Mises stress on the influence of pelvic stability by precise sacral resection and clinical validation
    Jiang Yong, Luo Yi, Ding Yongli, Zhou Yong, Min Li, Tang Fan, Zhang Wenli, Duan Hong, Tu Chongqi
    2021, 25 (9):  1318-1323.  doi: 10.3969/j.issn.2095-4344.3751
    Abstract ( 197 )   PDF (789KB) ( 56 )   Save
    BACKGROUND: Sacral resection has now become the accepted treatment of choice for malignant tumors of the sacrum. There are few biomechanical studies on whether fractures or sacroiliac joint spondylolisthesis will occur after simple sacral resection, and there is no consensus on whether the weight can be fully loaded after subtotal sacral resection and when to rebuild.
    OBJECTIVE: To contrast clinical research and analyze Von Mises stress to provide a credible theoretic basis about which level of sacrectomy without spinopelvic reconstruction is acceptable for pelvic stability through the biomechanical testing of intact pelvis and models of pelvis after subdivided sacrectomy.
    METHODS: (1) Biomechanical research: Six fresh normal adult human cadaveric L5-pelvis specimens were chosen. Compressive stress loaded on the specimens was increased by 200 N, until 1 000 N, at the speed of 1.4 mm/min. The change of Von Mises stress was measured to the same pelvic specimens on intact sacrum and groups of subdivided sacrectomy. The differences were compared between groups of data. (2) Clinical studies: Totally 15 patients diagnosed with high sacral tumor with tumor resection between January 2012 and June 2019 were enrolled, including 6 males and 9 females with an average age of 46.40±14.94 years. According to preoperative MRI examination, the extent of sacral involvement was determined, and the size of sacral resection was determined. No reconstruction was performed after operation. Postoperative function and complications were recorded.  
    RESULTS AND CONCLUSION: (1) Biomechanical research: With the growth of the sacrum resection plane, Von Mises stress had different increases at different test points, particularly by 1/4 S1 to 1/2 S1, which were apparently different with that in other groups (P < 0.05). Compared with group 2/3 S2 and group 1/3 S2, the change of Von Mises stress at point A in group S1-2 was not statistically significant. (2) Clinical results: Among the 15 patients, 4 patients retained the intact S1 vertebral body during the operation (resection of the S1-S2 intervertebral space, as in the biomechanics experiment S1-2 group); sacrum was resected in 3 patients as the group 2/3 S2 during the operation, and sacrum was resected in 2 patients during the operation as group 1/3 S2; and the S1 and S2 vertebrae were kept intact in 6 patients (as resection in the S2-3 group). The mean score of musculoskeletal tumor society was 25.27±3.79. All patients were able to walk, nine without walking aids, six with walking aids, one of them developed residual sacral fracture. (3) With the growth of the sacrum resection plane, Von Mises stress at residual sacrum rapidly rose. When the sacrum was resected by S1-S2 intervertebral space, the stability of the pelvic ring was acceptable without spinopelvic reconstruction. 
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    Effect of pronated foot posture on proprioception and postural stability based on foot posture index
    Chen Zehua, Ye Xiangling, Chen Weijian, Du Jianping, Liu Wengang, Xu Xuemeng
    2021, 25 (9):  1324-1328.  doi: 10.3969/j.issn.2095-4344.3757
    Abstract ( 289 )   PDF (630KB) ( 143 )   Save
    BACKGROUND: Studies outside China have shown that there is a certain relationship between foot posture and posture stability.
    OBJECTIVE: Based on foot posture index scale system, to compare the effect of pronated foot posture on postural stability and proprioception.  
    METHODS: Thirty healthy youths aged from 20 to 30 years old were enrolled, and divided into two groups according to the right foot posture index: pronated group (foot posture index > 5) and neutral group (0 ≤ foot posture index < 5) (n=15 per group). The leg standing with single leg for a longer time was defined as the dominant leg, and the other was the non-dominant leg. The length and area of center of pressure sway were evaluated by dynamic and static balance instrument. The average trajectory error and completion time of lower limbs were recorded during proprioception measurement. This study was approved by the Guangdong Second Traditional Chinese Medicine Hospital [YEZY(2019)LS50]. 
    RESULTS AND CONCLUSION: (1) In 30 subjects, center of pressure sway length in dominant leg was significantly lower than that in non-dominant leg (P < 0.01), whereas average trajectory error was significantly larger in dominant leg than that in non-dominant leg (P < 0.05). However, there was no significant difference in center of pressure sway area and completed time between two legs (P > 0.05). (2) When tested with single-leg (right side) static stance, sway area and length of pressure center were larger in pronated group than that in neutral group (P < 0.05), but proprioception including average trajectory and completed time was not significantly different between the two groups (P > 0.05). (3) When tested with two-leg static stance, sway length of pressure center was larger in pronated group than that in neutral group (P < 0.05); sway area of pressure center was not significantly different between the two groups (P > 0.05). (4) Results confirmed that foot posture exerts a significant effect on postural stability. Pronated foot can reduce postural stability, which will increase sports injury and the risk of fall in the elder.
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    Digital design and effect evaluation of three-dimensional printing scoliosis orthosis
    Lu Dezhi, Mei Zhao, Li Xianglei, Wang Caiping, Sun Xin, Wang Xiaowen, Wang Jinwu
    2021, 25 (9):  1329-1334.  doi: 10.3969/j.issn.2095-4344.3758
    Abstract ( 290 )   PDF (804KB) ( 70 )   Save
    BACKGROUND: At present, the traditional orthosis manufacturing technology needs a lot of time and materials. The larger expansion coefficient of gypsum and the springback of material cooling will reduce the accuracy of orthosis. Therefore, the application of computer-aided design technology and three-dimensional printing technology in the field of orthosis is booming.   
    OBJECTIVE: Based on the concept of multidisciplinary collaboration, a new scoliosis orthopedic device was designed and manufactured by optical scanning, computer-aided design and 3D printing, and its correction effect was evaluated.   
    METHODS: Seven adolescent idiopathic scoliosis patients, who were treated in the Three-Dimensional Printing Center of Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University between March and October 2019, were enrolled in this study. The patient’s trunk was scanned with three-dimensional scanner. Virtual orthopedic treatment was conducted in Rodin4D software. Data were imported into Magics to carry out the hollow out design of orthosis, which was made by three-dimensional printing technology. Seven patients were followed up for 6 months after wearing orthopedic devices for more than 20 hours every day. The scoliosis before and after intervention was analyzed to observe the clinical efficacy. 
    RESULTS AND CONCLUSION: (1) The contactless iPad scanner was successfully used for mold taking. The orthopedic model was designed in the French Rodin4D software, and the orthopedic model was hollowed-out by the Magics software. A suitable three-dimensional printed personalized scoliosis orthopedic device was produced through three-dimensional printing. (2) All the seven patients were improved significantly. Cobb angle before treatment was (29.43±7.68)°, and the angle of trunk inclination was (11.57±2.76)°. At 6 months after treatment, Cobb angle was (8.71±5.96)° (corrected 72%), and the angle of trunk inclination was (3.57±2.57)° (corrected 70%). The Cobb angle and angle of trunk inclination were significantly different before and after treatment (P < 0.01). (3) The digital medicine and 3D printing technology are applied in the field of rehabilitation AIDS, based on the concept of multidisciplinary collaboration. The production of personalized scoliosis orthopedic program is feasible, and the orthopedic rehabilitation effect is remarkable. 
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    Application of three-dimensional printing model in surgical resection and reconstruction of cervical tumor
    Zhang Tongtong, Wang Zhonghua, Wen Jie, Song Yuxin, Liu Lin
    2021, 25 (9):  1335-1339.  doi: 10.3969/j.issn.2095-4344.3759
    Abstract ( 176 )   PDF (737KB) ( 56 )   Save
    BACKGROUND: The anatomical structure of cervical spine is complex, and the important structures of blood vessels, nerves, esophagus and trachea are adjacent to the tumor. The operation is difficult.   
    OBJECTIVE: To explore the application of three-dimensional (3D) printing model in surgical resection and reconstruction of cervical tumor.  
    METHODS: Eleven patients with cervical tumors, who were treated in the Gansu Provincial Hospital from September 2016 to December 2018, were selected, including 7 males and 4 females, at the age of 35-68 years. Eleven patients were scanned by cervical CT before operation. The image information obtained by CT was saved in DICOM format, and then the data were imported into Mimics 3D modeling software to reconstruct the 3D model. Finally, the reconstruction results were imported into the 3D printer in STL format, and the 1∶1 anatomical model was printed layer by layer according to the 3D model. According to the 3D printed model, the surgical resection and reconstruction plan of cervical tumor was made. After 6-12 months of follow-up, the visual analogue scale score and Oswestry dysfunction index were compared before and after surgery. This study was approved by the Ethics Committee of Gansu Provincial Hospital.  
    RESULTS AND CONCLUSION: (1) Eleven cases were operated successfully, and no serious complications such as spinal cord, nerve root and vertebral artery injury occurred; postoperative X-ray reexamination showed that the lesion site was completely removed, and the implant was in a good position without loosening. (2) The visual analogue scale score and Oswestry dysfunction index of eleven patients were significantly improved in 1 week, 1 and 3 months after operation (P < 0.05). (3) The results showed that 3D printing model could make a complete resection and reconstruction plan before operation, including the specific resection scope, fixed segment, screw and steel plate size, familiar with the anatomical relationship between the focus and the surrounding tissue, avoid the injury of important nerves and blood vessels during operation, reduce the risk of operation and improve the clinical effect. 
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    Risk factors for myocardial infarction following primary total joint arthroplasty
    Zhang Yu, Tian Shaoqi, Zeng Guobo, Hu Chuan
    2021, 25 (9):  1340-1345.  doi: 10.3969/j.issn.2095-4344.4010
    Abstract ( 181 )   PDF (674KB) ( 55 )   Save
    BACKGROUND: Myocardial infarction is one of the catastrophic complications after total joint arthroplasty. However, the risk factors and predictive model have not been reported in previous research after total joint arthroplasty. 
    OBJECTIVE: To study the incidence and risk factors of myocardial infarction after total joint arthroplasty, and develop a nomogram for predicting the myocardial infarction after total joint arthroplasty.
    METHODS: We retrospectively reviewed the data of 5 746 patients who underwent total hip arthroplasty or total knee arthroplasty in the Affiliated Hospital of Qingdao university and the People’s Hospital of Xixiu District between September 2013 and July 2017. The baseline characteristic, preoperative comorbidities, preoperative examinations, operative data, other hospital information and follow-up data were collected, recorded and were used to analyze the risk factors of myocardial infarction. In addition, a nomogram was developed based on the independent risk factors for predicting the myocardial infarction after total joint arthroplasty, and receiver operating characteristic curve and calibration curve were used to evaluate the nomogram. 
    RESULTS AND CONCLUSION: Forty-eight patients affected myocardial infarction within 14 days after total joint arthroplasty, and the incidence of myocardial infarction was 0.8%. Multivariate Logistic analysis indicated that age-adjusted Charlson Comorbidity Index, anesthesia type and atrial fibrillation were independent risk factors for postoperative myocardial infarction (P < 0.05). The risk of myocardial infarction in patients with age-adjusted Charlson Comorbidity Index ≥ 5 was higher than patients with age-adjusted Charlson Comorbidity Index < 5. The risk of myocardial infarction in patients receiving general anesthesia was higher than that of patients receiving epidural/lumber anesthesia. The risk of myocardial infarction in patients combined with atrial fibrillation was higher than that in patients without it. Receiver operating characteristic curve showed that the nomogram has a high degree of discrimination (AUC=0.730, 95%CI: 0.661-0.799), and the calibration curve showed that the model had a high degree of calibration. A predictive model based on age-adjusted Charlson Comorbidity Index, anesthesia type and atrial fibrillation can accurately predict the myocardial infarction following total joint arthroplasty.
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    Correlation of total knee arthroplasty efficacy with satisfaction and personality characteristics
    Li Dadi, Zhu Liang, Zheng Li, Zhao Fengchao
    2021, 25 (9):  1346-1350.  doi: 10.3969/j.issn.2095-4344.4007
    Abstract ( 146 )   PDF (638KB) ( 37 )   Save
    BACKGROUND: Patients’ postoperative satisfaction is determined by many factors, and psychological factors may play an important role; at present, few studies have shown the effect of personality classification on patient satisfaction and clinical outcome after total knee arthroplasty. Identifying and determining these factors in patients can carry out educational intervention and expectation management according to the specific personality types of patients, so as to improve overall satisfaction.
    OBJECTIVE: To investigate the impact of personality traits on the subjective outcome of total knee arthroplasty.
    METHODS: We investigated 108 patients undergoing total knee arthroplasty. Patients were divided into satisfied group (n=82) and unsatisfied group (n=26) based on the patient satisfaction obtained during the follow-up. The Eysenck Personality Questionnaire-Revised Short Scale for Chinese was used to test the personality characteristics of patients. Knee-specific measurements included the American Hospital for Special Surgery Knee Score, Knee Society Score (clinical and functional scores) and the visual analogue scale score before and one year after surgery.
    RESULTS AND CONCLUSION: (1) None of the follow-up patients had postoperative complications requiring revision surgery. 76% of patients were satisfied and 24% were not satisfied. (2) Among them, personality characteristics were divided into four types: 93% of patients with “extroversion-stable” personality were satisfied and 7% were dissatisfied; 40% of patients with “extroversion-unstable” personality were satisfied, and 60% were dissatisfied; 87% of patients with “introverted-stable” personality were satisfied and 13% were dissatisfied; 47% of patients with “introverted-unstable” personality were satisfied and 53% were dissatisfied; the difference was statistically significant (P < 0.05). (3) At 1 year postoperatively, American Hospital for Special Surgery Knee Score was significantly higher in the satisfied group than in the unsatisfied group (P < 0.05). Visual analogue scale score was significantly lower in the satisfied group than in the unsatisfied group (P < 0.05). Clinical and functional scores of Knee Society Score were not significantly different between the satisfied and unsatisfied groups        (P > 0.05). (4) Multivariate Logistic regression analysis showed that patient personality and postoperative pain were independent risk factors that affected patient satisfaction. (5) It is concluded that personality characteristics may affect patient satisfaction and clinical outcomes after total knee arthroplasty. Therefore, the personality characteristics of patients may be a useful predictor of satisfaction after total knee arthroplasty. This feature is important for patients preparing for total knee arthroplasty, because we can provide targeted education and management to improve their prognosis.
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    Factors affecting fall fear in the first movement of elderly patients after total knee or hip arthroplasty
    Wei Wei, Li Jian, Huang Linhai, Lan Mindong, Lu Xianwei, Huang Shaodong
    2021, 25 (9):  1351-1355.  doi: 10.3969/j.issn.2095-4344.3760
    Abstract ( 178 )   PDF (612KB) ( 36 )   Save
    BACKGROUND: Hip and knee arthroplasty is currently the fundamental measure to improve the severe joint dysfunction and pain caused by elderly hip and knee joint diseases. However, the fear of falling seriously affects the time for elderly patients to go to the ground, and it is clear that the elderly patients with hip and knee arthroplasty are afraid of falling. The occurrence factors have important guiding significance for the early clinical intervention of such patients.   
    OBJECTIVE: To explore the factors influencing the fear of falling during the first ambulation after total knee arthroplasty and total hip arthroplasty in elderly patients.  
    METHODS: 242 elderly patients who underwent hip and knee arthroplasty in Wuming Hospital, Guangxi Medical University from January 2015 to January 2019 were selected as the study subjects, and the incidence of fall fear was observed. The risk factors of fall fear were analyzed by single factor and multi-factor Logistic analysis. 
    RESULTS AND CONCLUSION: (1) The incidence of fall fear was 65.6%. (2) The univariate analysis showed that there was no significant difference in gender and education level between patients with and without fear of falling (P > 0.05). There were significant differences in age, type of replacement, past fall history, pain score, anxiety, depression, types of chronic diseases and visual impairment between patients with and without fall fear (P < 0.05). (3) The multivariate Logistic analysis showed that age (≥70 years old), visual analogue scale pain score of 7-10, anxiety and past fall history were risk factors for falling fear (P < 0.05). (4) It is suggested that elderly patients have a higher incidence of fear of falling when going to the ground for the first time after hip and knee arthroplasties. Post-operative pain, anxiety, age and history of falling are risk factors affecting fear of falling. Clinical attention should be paid to these risk factors in order to alleviate fear of falling and promote early recovery. 
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    Hemostatic effect and safety of intravenous drip of tranexamic acid combined with topical application of cocktail containing tranexamic acid in total knee arthroplasty
    Wang Jinjun, Deng Zengfa, Liu Kang, He Zhiyong, Yu Xinping, Liang Jianji, Li Chen, Guo Zhouyang
    2021, 25 (9):  1356-1361.  doi: 10.3969/j.issn.2095-4344.3755
    Abstract ( 222 )   PDF (662KB) ( 41 )   Save
    BACKGROUND: The perioperative blood loss of total knee arthroplasty is large. The “cocktail” containing tranexamic acid has the dual function of hemostasis and analgesia. However, how to further reduce blood loss with intravenous tranexamic acid is still worth exploring.   
    OBJECTIVE: To compare the hemostatic effect and safety of tranexamic acid combined with different intravenous applications of tranexamic acid in total knee arthroplasty under the premise of using “cocktail” containing tranexamic acid. 
    METHODS: Data of 62 patients with osteoarthritis, who underwent primary unilateral total knee arthroplasty in the First Department of Orthopedics of Zhongshan People’s Hospital from June 2017 to September 2019, were retrospectively analyzed and divided into three groups. In the Group A, 26 patients administrated “cocktail” containing tranexamic acid before closing the wound. In the Group B, 25 patients administrated intravenously 1.0 g tranexamic acid before cutting skin on the basis of group A. In the Group C, 11 patients administrated intravenously 1.0 g tranexamic acid on the basis of group B 3 hours postoperatively. Dominant, hidden, and total blood loss, postoperative hemoglobin biggest loss, blood transfusion rate, postoperative hospital stay and postoperative complications were compared and analyzed among three groups.
    RESULTS AND CONCLUSION: (1) In terms of blood loss (including total, hidden, intraoperative, postoperative and dominant) and the maximum loss of hemoglobin, both groups B and C were lower than group A, with statistically significant differences (P < 0.05); there were no significant differences between group B and group C (P > 0.05). (2) There were no statistically significant differences in blood transfusion rate and postoperative hospital stay among three groups (P > 0.05). (3) There were no statistically significant differences among the three groups in the incidence of wound complications, articular effusion, and complications of intermuscular vein thrombosis (P > 0.05). No lower limb deep vein thrombosis or pulmonary embolism was found in the three groups. (4) The results showed that intravenous administration of 1.0 g tranexamic acid before cutting skin and combination with “cocktail” containing 0.5 g tranexamic acid before closing the wound can have obvious hemostatic effect. However, intravenous administration of 1.0 g tranexamic acid 3 hours postoperatively failed to further reduce the bleeding; moreover, the first two administrations did not increase the postoperative complications, and had certain security.
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    Influencing factors of knee flexion limitation after total knee arthroplasty with posterior stabilized prostheses
    Xiao Guoqing, Liu Xuanze, Yan Yuhao, Zhong Xihong
    2021, 25 (9):  1362-1367.  doi: 10.3969/j.issn.2095-4344.3761
    Abstract ( 197 )   PDF (638KB) ( 32 )   Save
    BACKGROUND: Total knee arthroplasty is an important treatment for patients with ineffective conservative treatment or terminal knee osteoarthritis, but its surgical effect and patients’ satisfaction still need to be improved. Range of motion is an important parameter to evaluate patients' postoperative function and satisfaction.   
    OBJECTIVE: To investigate the influencing factors of knee flexion limitation after total knee arthroplasty with posterior stabilized prostheses. 
    METHODS: From January 2010 to December 2018, 117 patients with knee osteoarthritis were treated in the Second Affiliated Hospital of Chengdu Medical College/Nuclear Industry 416 Hospital, including 29 males and 88 females, all of whom received total knee arthroplasty. After a follow-up of more than 6 months, single factor analysis and Logistic regression analysis were performed on the influencing factors (surgical factors: postoperative joint line height change, postoperative tibial plateau retroversion, femoral condyle offset ratio change; non-operative factors: age, body mass index, preoperative HSS score, preoperative joint range of motion, preoperative visual analogue scale score, and postoperative active exercise) of postoperative knee flexion limitation to identify the independent impact factors of flexion limitation after total knee arthroplasty. The reaserch was approved by the Ethics Committee of the Second Affiliated Hospital of Chengdu Medical College/Nuclear Industry 416 Hospital.  
    RESULTS AND CONCLUSION: (1) Single factor analysis showed that the patient’s age, body mass index, preoperative HSS score, preoperative range of motion, preoperative visual analogure scale score, postoperative active exercise and postoperative joint line height change had a significant effect on postoperative knee flexion function (all P < 0.05). (2) Logistic regression analysis: body mass index [OR=0.131, 95%CI (0.065,0.261), P < 0.001], preoperative HSS score [OR=4.297, 95%CI (2.139,8.634), P < 0.001], and preoperative range of motion [OR=10.612, 95%CI (6.565,17.153), P < 0.001] were non-operative independent influencing factors for patients with limited knee flexion after total knee arthroplasty. postoperative joint line height change [OR=0.255, 95%CI(0.167,0.387), P < 0.001] was an independent surgical influencing factor for patients with limited knee flexion after total knee arthroplasty. Body mass index and postoperative joint line height change were negatively correlated with postoperative knee flexion function; and preoperative HSS score and preoperative range of motion were positively correlated with postoperative knee flexion function. (3) The results showed that knee flexion function after total knee arthroplasty with posterior stabilized prostheses had correlations with patient's body mass index, preoperative HSS score, preoperative range of motion and postoperative joint line height change. 
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    Relationship of lower limb force line and the progression of lateral compartment arthritis after unicompartmental knee arthroplasty with mobile bearing
    Peng Zhihao, Feng Zongquan, Zou Yonggen, Niu Guoqing, Wu Feng
    2021, 25 (9):  1368-1374.  doi: 10.3969/j.issn.2095-4344.3762
    Abstract ( 183 )   PDF (728KB) ( 31 )   Save
    BACKGROUND: The long-term follow-up report shows that the progress of lateral compartment osteoarthritis is an important reason for the revision of unicompartmental knee arthroplasty, and the force line of lower limbs is considered to be an important factor leading to the progress of lateral compartment osteoarthritis after unicompartmental knee arthroplasty.
    OBJECTIVE: To explore the influence of lower limb force line on the progression of lateral compartment arthritis in unicompartmental knee arthroplasty with mobile bearing.
    METHODS: From March 2014 to March 2017, a retrospective analysis was conducted in 84 patients who underwent unicompartmental knee arthroplasty in the Department of Arthrology, Foshan Hospital of Traditional Chinese Medicine. Kellgren-Lawrence X-ray grading was used to evaluate the osteoarthritis of the lateral compartment during the follow-up. According to whether osteoarthritis of the lateral compartment was more advanced than that of the operation during the last follow-up, it was divided into the advanced group and the non-advanced group. The force lines of the lower limbs, such as hip-knee-ankle angle and Kennedy area distribution of the mechanical axis of the lower limbs, were compared between the two groups. Simultaneously, the knee joint function of the two groups was compared by the Hospital for Special Surgery knee score, visual analogue scale score of the knee joint, and motion range of the knee. The relationship between the changes of lower extremity force lines and the progress of lateral compartment arthritis was analyzed.
    RESULTS AND CONCLUSION: (1) All patients were followed up for 36-72 months, and no complications such as infection, poor wound healing, periprosthetic fracture, polyethylene gasket dislocation occurred. (2) Among the 84 patients, 27 cases were in the advanced group and 57 cases were in the non-advanced group. Significant differences in Hospital for Special Surgery knee score and visual analogue scale score were detected at the last follow-up between the advanced group and the non-advanced group (P < 0.05). There was no significant difference in knee motion range between the two groups at the last follow-up (P > 0.05). (3) At the last follow-up, the average hip-knee-ankle angle in the advanced group was (-1.02±3.13)°, while that in the non-advanced group was (3.94±1.56)°. The difference between the two groups was statistically significant (P < 0.05). Meanwhile, there was a significant difference in hip-knee-ankle angle between the last follow-up and the preoperation between the two groups (P < 0.05). (4) The regional distribution of lower limb mechanical axis Kennedy was compared between the two groups at the last follow-up, and the difference was statistically significant (P < 0.05). The postoperative lower limb force lines were mostly located in zone 3 and C in the advanced group, and mostly located in zone 2 in the non-advanced group. (5) Good lower limb alignment is the key factor affecting the clinical efficacy after unicompartmental knee arthroplasty with mobile bearing. Average varus angle of mechanical axis was approximately 3.94° in patients with well-functioning unicompartmental knee arthroplasty at follow-up, whereas patients for progression of osteoarthritis were in more valgus (mean 1.02° of valgus).
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    Correlation between the level of serum n-3 polyunsaturated fatty acids and quadriceps weakness in the early stage after total knee arthroplasty
    Huang Zexiao, Yang Mei, Lin Shiwei, He Heyu
    2021, 25 (9):  1375-1380.  doi: 10.3969/j.issn.2095-4344.3763
    Abstract ( 187 )   PDF (628KB) ( 28 )   Save
    BACKGROUND: Previous studies have shown that early quadriceps weakness aggravation is associated with ischemia and reperfusion resulting from surgical trauma and/or tourniquet use after total knee arthroplasty, while intake of sufficient amounts of dietary n-3 polyunsaturated fatty acids can limit tissue damage associated with ischemia and reperfusion. 
    OBJECTIVE: To explore the correlation between the level of serum n-3 polyunsaturated fatty acids and quadriceps weakness in the early stage after total knee arthroplasty. 
    METHODS: A total of 66 patients with knee joint osteoarthritis admitted to the Second Affiliated Hospital of Hainan Medical University from March 2018 to March 2020 were selected. All of them received total knee arthroplasty. On postoperative day 1, serum n-3 polyunsaturated fatty acids levels were measured. Quadriceps strength, knee pain during quadriceps testing, and knee circumference were measured on preoperative day 1 and postoperative day 4. According to the testing result of quadriceps strength, the patients were divided into high quadriceps weakness group (<-63.7%, n=33) and low quadriceps weakness group (≥ -63.7%, n=33). Serum n-3 polyunsaturated fatty acids levels, knee pain during quadriceps testing, and knee circumference were compared between two groups. The correlation between the level of serum n-3 polyunsaturated fatty acids and quadriceps weakness was explored by Pearson correlation analysis. The influencing factors of quadriceps weakness were explored by multivariate Logistic regression analysis. The study was approved by the Ethics Committee of the Second Affiliated Hospital of Hainan Medical University. 
    RESULTS AND CONCLUSION: (1) Compared with preoperatively, the quadriceps muscle strength decreased significantly, knee pain increased, and knee circumference increased after total knee arthroplasty in 66 patients (P < 0.01). (2) The level of n-3 polyunsaturated fatty acids and quadriceps strength in high quadriceps weakness group were lower than those in low quadriceps weakness group (P < 0.05). Knee pain was more serious in high quadriceps weakness group than that in low quadriceps weakness group (P < 0.05). The knee circumference was longer in high quadriceps weakness group than that in low quadriceps weakness group (P < 0.05). (3) Pearson correlation analysis showed that serum n-3 polyunsaturated fatty acids level was significantly positively correlated with quadriceps weakness (r= 0.356, P=0.004). (4) Multivariate logistic regression analysis showed that serum n-3 polyunsaturated fatty acids levels, knee pain, knee swelling and body mass index were independent influencing factors for quadriceps weakness after total knee arthroplasty (P < 0.05). (5) These results indicate that the level of serum n-3 polyunsaturated fatty acids was independent protective factors for quadriceps weakness after total knee arthroplasty.
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    Safety and effectiveness of topical application of tranexamic acid to reduce drainage of elderly femoral neck fractures after total hip arthroplasty
    Zhang Chong, Liu Zhiang, Yao Shuaihui, Gao Junsheng, Jiang Yan, Zhang Lu
    2021, 25 (9):  1381-1386.  doi: 10.3969/j.issn.2095-4344.3756
    Abstract ( 159 )   PDF (625KB) ( 28 )   Save
    BACKGROUND: Topical application of tranexamic acid can reduce the drainage after total hip arthroplasty for degenerative diseases. However, there are few reports on the application of tranexamic acid in primary total hip arthroplasty for simple elderly femoral neck fracture.   
    OBJECTIVE: To analyze the safety and effectiveness of topical application of tranexamic acid to reduce drainage of elderly femoral neck fractures after total hip arthroplasty. 
    METHODS: Forty-five elderly femoral neck fractures patients undergoing total hip arthroplasty in the Zhengzhou People’s Hospital from January to December 2019 were enrolled in this study, including 19 males and 26 females at the age of 59-82 years old. Twenty-one patients in the observation group were injected with tranexamic acid retrogradely through the drainage tube after total hip arthroplasty. Twenty-four patients in the control group were injected with normal saline retrogradely through the drainage tube after total hip arthroplasty. The postoperative drainage volume and adverse events were recorded; the wound healing was closely observed; and the coagulation function was checked. This study was approved by the Medical Ethics Committee of Zhengzhou People’s Hospital. 
    RESULTS AND CONCLUSION: (1) All patients’ incisions healed grade A, and no myocardial infarction, cerebral infarction, pulmonary embolism, or deep vein thrombosis of the lower extremities occurred. (2) At postoperative 3 days, total drainage and hemoglobin loss were less in the observation group than those in the control group (P < 0.05). (3) Activated partial prothrombin time, prothrombin time, thrombin time, and fibrinogen were not significantly different between the two groups after surgery (P > 0.05). (4) Results suggested that topical application of tranexamic acid in total hip arthroplasty for elderly femoral neck fractures is safe and effective. It can significantly reduce postoperative drainage without affecting coagulation function.
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    Minimally invasive transforaminal lumbar interbody fusion for treatment of single-segment lumbar spinal stenosis improves lumbar-pelvic balance
    Yao Rubin, Wang Shiyong, Yang Kaishun
    2021, 25 (9):  1387-1392.  doi: 10.3969/j.issn.2095-4344.4013
    Abstract ( 138 )   PDF (828KB) ( 29 )   Save
    BACKGROUND: More and more studies have shown that lumbar-pelvic parameters are closely related to the clinical effect and adjacent segment degeneration after lumbar fusion, but the effect of minimally invasive transforaminal interbody fusion on lumbar-pelvic parameters is not clear.   
    OBJECTIVE: To evaluate the effect of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) on the lumbar-pelvic imaging parameters in patients with single-segment lumbar spinal stenosis.
    METHODS: The clinical data of 85 patients with single-segment lumbar spinal stenosis treated by MIS-TLIF and open-TLIF in the First Affiliated Hospital of Dali University from January 2015 to January 2017 were retrospectively analyzed, including 39 cases of MIS-TLIF operation (MIS-TLIF group) and 46 cases of open-TLIF operation (open-TLIF group). On the standing lateral lumbar X-ray containing bilateral femoral heads: lumbar lordosis, segmental lordosis, height of the intervertebral disc, the L1 axis and S1 distance, pelvic incidence, pelvic tilt, and sacral slope were measured, and the difference between pelvic incidence−lumbar lordosis and the ratio of lumbar lordosis/pelvic incidence were calculated. 
    RESULTS AND CONCLUSION: (1) During the last follow-up, lumbar lordosis, height of the intervertebral disc, and sacral slope were increased in both groups compared with preoperative parameters, but pelvic tilt was decreased compared with preoperatively, and the difference was significant (P < 0.05). Lumbar lordosis, segmental lordosis, height of the intervertebral disc, pelvic incidence, pelvic tilt, sacral slope and the L1 axis and S1 distance were not significantly different between the two groups during the last follow-up (P > 0.05). (2) During the last follow-up, lumbar lordosis, segmental lordosis, height of the intervertebral disc, pelvic incidence, pelvic tilt, sacral slope, and the L1 axis and S1 distance were not significantly different compared with preoperative parameters (P > 0.05). (3) The difference between pelvic incidence−lumbar lordosis was significantly decreased at the last follow-up compared with preoperative parameters in the two groups    (P < 0.05). The ratio of lumbar lordosis/pelvic incidence was significantly increased at the last follow-up compared with preoperative parameters in the two groups, especially in the open-TLIF group (P < 0.05). However, the difference between pelvic incidence−lumbar lordosis and the ratio of lumbar lordosis/pelvic incidence were not significantly different between the two groups (P > 0.05). (4) Above results indicated that for single-segment lumbar spinal stenosis, MIS-TLIF has the same effect as open-TLIF in recovery of lumbar lordosis, intervertebral height, and improving lumbar-pelvic balance.
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    Posterior lumbar interbody fusion for degenerative lumbar spondylolisthesis: prediction of functional prognosis of patients based on spinopelvic parameters
    Wang Haiying, Lü Bing, Li Hui, Wang Shunyi
    2021, 25 (9):  1393-1397.  doi: 10.3969/j.issn.2095-4344.4009
    Abstract ( 161 )   PDF (640KB) ( 26 )   Save
    BACKGROUND: Surgery is a common way to treat degenerative lumbar spondylolisthesis, but some patients have poor postoperative health and quality of life. The relationship between preoperative spine pelvic parameters and postoperative healthy quality of life is not clear. 
    OBJECTIVE: To investigate the preoperative predictors of postoperative poor improvement in healthy life quality for patients with degenerative lumbar spondylolisthesis based on spinopelvic parameters.  

    METHODS: A retrospective analysis was performed on 186 patients with degenerative lumbar spondylolisthesis who met the criteria and underwent posterior lumbar interbody fusion surgery from June 2014 to September 2017, including 87 males and 99 females. (1) All patients were examined by the whole spine X-ray films in a standing position and sagittal spinopelvic parameters were measured, including pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, thoracic kyphosis, L4 slope, L5 slope, and sagittal vertical axis. (2) At the last postoperative follow-up, SF-36 was used to evaluate the healthy life quality of the patients, and the patients were divided into good group and poor group according to this score. The basic data and spinopelvic parameters of the two groups were compared and the preoperative predictors of poor quality of life were analyzed by Logistic regression and receiver operating characteristic curve analysis. 

    RESULTS AND CONCLUSION: (1) All cases were followed up for 20 to 26 months, with an average of 24 months. (2) There were 127 cases in the good group and 59 cases in the poor group, with poor improvement in quality of life accounting for 32%. Group comparison revealed that sacral slope, lumbar lordosis, pelvic tilt, and sagittal vertical axis were larger in the poor group than in the good group (P < 0.05). There was no significant difference in sacral slope, L4 slope, L5 slope, and thoracic kyphosis between the two groups (P > 0.05). (3) Logistic regression analysis identified three preoperative predictors: pelvic incidence (P < 0.001), pelvic tilt (P < 0.001) and sagittal vertical axis (P=0.026). (4) Receiver operating characteristic curve analysis showed that pelvic incidence > 52.18°, pelvic tilt > 25.23°, and sagittal vertical axis > 3.84 cm were risk factors for poor improvement in quality of life in postoperative patients, and the AUC value of pelvic tilt (0.944) was the largest. Sufficient attention should be paid to patients with preoperative risk factors. 

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    A prospective study on the application of staged lumbar motion chain rehabilitation based on McKenzie’s technique after lumbar percutaneous transforaminal endoscopic discectomy
    Lü Zhen, Bai Jinzhu
    2021, 25 (9):  1398-1403.  doi: 10.3969/j.issn.2095-4344.4008
    Abstract ( 271 )   PDF (673KB) ( 52 )   Save
    BACKGROUND: Lumbar percutaneous transforaminal endoscopic discectomy can decompress nerve root compression caused by herniated lumbar disc. Postoperative rehabilitation not only includes the recovery of surgical trauma, but also the recovery of lumbar muscle damage accompanied by lumbar disc herniation and the recovery of pelvic-leg function imbalance. 
    OBJECTIVE: To evaluate the effectiveness and feasibility of staged rehabilitation program of lumbar motor chain based on McKenzie’s technique after lumbar percutaneous transforaminal endoscopic discectomy.
    METHODS: Totally sixty-two patients with lumbar disc herniation who were treated in the Beijing Bo’ai Hospital of China Rehabilitation Research Center from January 2012 to December 2018 underwent percutaneous transforaminal endoscopic discectomy. The patients were randomly divided into experimental group and control group, 31 cases in each group. The experimental group performed remote staged rehabilitation guidance based on McKenzie’s technology according to pre-set rehabilitation program for postoperative rehabilitation of lumbar motion chain: 2-6 weeks after operation as the first stage, 7-12 weeks as the second stage and 13-24 weeks as the third stage. Control group received regular postoperative rehabilitation. Visual analogue scale score, Japanese Orthopaedic Association score, Oswestry Disability Index, and SF-36 score were assessed in both groups pre-rehabilitation and 6, 12, and 24 weeks post-rehabilitation. Cross sectional area of the multifidus of the lumbar spine was detected under MRI 12 weeks post-rehabilitation. Gait analysis was conducted 24 weeks post-rehabilitation by using three-dimensional motion acquisition and analysis system. This study was approved by the Ethics Committee of Beijing Bo’ai Hospital of China Rehabilitation Research Center (approval No. 2019-011-1). 
    RESULTS AND CONCLUSION: (1) After rehabilitation, visual analogue scale score, Japanese Orthopaedic Association score, Oswestry Disability Index, and SF-36 score were improved to different degrees in both groups compared with those before rehabilitation. Visual analogue scale score and Oswestry Disability Index were lower in the experimental group than those in the control group at 6 and 12 weeks (P < 0.05). Japanese Orthopaedic Association score was higher in the experimental group than in the control group at 6 weeks (P < 0.05). At 6, 12, and 24 weeks, SF-36 score was higher in the experimental group than that in the control group (P < 0.05). (2) No significant difference in cross sectional area of the multifidus of the lumbar spine was found between the two groups (P > 0.05). (3) Gait analysis exhibited that the ratio of left to right in the supporting phase of the experimental group was higher than that of the control group at 24 weeks         (P < 0.05). (4) Results suggest that the staged rehabilitation program after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation is in line with the characteristics of postoperative recovery of lumbar disc herniation, and has good effectiveness and feasibility.
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    Type A3.3 femoral intertrochanteric fracture with augmented proximal femoral nail anti-rotation in the elderly: finite element analysis of the optimal amount of bone cement
    Chen Xinmin, Li Wenbiao, Xiong Kaikai, Xiong Xiaoyan, Zheng Liqin, Li Musheng, Zheng Yongze, Lin Ziling
    2021, 25 (9):  1404-1409.  doi: 10.3969/j.issn.2095-4344.4014
    Abstract ( 165 )   PDF (778KB) ( 44 )   Save
    BACKGROUND: Osteoporosis and fracture type are two important reasons for the postoperative failure of proximal femoral nail anti-rotation. The treatment of elderly patients with type AO31-A3.3 femoral intertrochanteric fractures by bone cement augmented proximal femoral nail anti-rotation can effectively reduce the failure rate, but the specific amount of bone cement injected remains to be discussed. 
    OBJECTIVE: To investigate the optimal amount of bone cement in the treatment of type A3.3 intertrochanteric femur fracture with augmented proximal femoral nail anti-rotation in elderly. 
    METHODS: CT data of one volunteer were imported into Mimics 19.0 and Geomagic studio 2017 to extract and optimize the three-dimensional model of the right femur. Internal fixation model was drawn and assembled with femur model according to the standard operation technology, then imported into Hypermesh 14.0 software to simulate type AO31-3.3 intertrochanteric femur fracture. The spongy bone around the proximal helical blade was redefined as bone cement, obtaining A, B and C models with 2.2 mL, 4.2 mL, and 6.4 mL of bone cement, respectively. The material property parameters, boundary conditions, and applied loads were set and imported into LS-DYNA software for solution. 
    RESULTS AND CONCLUSION: (1) There was no significant difference in the inversion and rotation angles of the head and neck fragment and the overall stress in three models, but the blade cutting in model B and model C was severe and the helical blade was broken, while the blade cutting in model A was slight and did not break. (2) The strong anchoring force of bone cement could stabilize the helical blade, but easily led to local stress concentration. (3) The amount of bone cement injected into the proximal femoral nail anti-rotation for the treatment of type A3.3 intertrochanteric femur fracture in elderly should not be too much, and less than 3 mL may have the best biomechanical effect.  
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    Effect of degree of initial deformity of impacted femoral neck fractures under 65 years of age on femoral neck shortening
    Du Xiupeng, Yang Zhaohui
    2021, 25 (9):  1410-1416.  doi: 10.3969/j.issn.2095-4344.3752
    Abstract ( 224 )   PDF (727KB) ( 31 )   Save
    BACKGROUND: Non-surgical treatment for impacted femoral neck fractures is a strategy rarely used at present. Hollow screw internal fixation is the main treatment for impacted femoral neck fractures. Studies on impacted femoral neck fractures so far have focused on treatment patterns and risk factors affecting internal fixation failure, but the effect of initial degree of deformity of impacted femoral neck fractures on postoperative femoral neck shortening was not studied.    
    OBJECTIVE: To analyze the relationship between the degree of shortening and initial deformity of impacted femoral neck fractures after hollow screw fixation in patients under 65 years of age and the effect of femoral neck shortening on hip function.  
    METHODS: Fifty-three impacted femoral neck fractures patients with complete medical records were included, and treated with three hollow screws for internal fixation. The patients were followed up for 12-24 months. Hip Harris score was used to evaluate the recovery of function. The posterior inclination angle, valgus angle, and Pauwels angle of the affected femoral head were measured by X-ray examination of pelvis and hip joint before treatment. X-ray films of pelvis were taken at the last follow-up to calculate the percentage of joint-coarsal distance decrease representing the degree of femoral neck shortening. Not less than 30% is significantly shortened (SFNS) and less than 30% is not significantly shortened (NSFNS). The related factors of neck shortening and the effect on hip function were analyzed.
    RESULTS AND CONCLUSION: (1) All 53 patients healed without adverse events such as femoral head necrosis. Seven cases (13.2%) had obvious neck shortening. (2) Independent-sample t-test found that neck shortening was associated with valgus angle (P=0.000), posterior dip angle (P=0.001) and body mass index (P=0.001). Logistic regression analysis found that valgus angle was a significant predictor of neck shortening (P=0.041). (3) The hip Harris score decreased with the increase of femoral neck shortening. The hip Harris scores were (82.57±5.12) and (94.15±4.03) in the SFNS group and NSFNS group, respectively, with significant difference. (4) It is indicated that the degree of valgus deformity is an independent risk factor for neck shortening in impacted femoral neck fractures, and femoral neck shortening is associated with hip function. 
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    Arthroscopic suture bridge technique with suture anchor in the treatment of acromioclavicular dislocation
    Zhang Shangpu, Ju Xiaodong, Song Hengyi, Dong Zhi, Wang Chen, Sun Guodong
    2021, 25 (9):  1417-1422.  doi: 10.3969/j.issn.2095-4344.3764
    Abstract ( 384 )   PDF (705KB) ( 34 )   Save
    BACKGROUND: There is no uniform standard for acromioclavicular dislocation. Clavicular hook plate fixation is a commonly used fixation method clinically, but minimally invasive ligament reconstruction technology and arthroscopic surgery have become a research hotspot.   
    OBJECTIVE: To observe the application value of suture bridge with thread anchor under arthroscopy in the treatment of acromioclavicular dislocation. 
    METHODS: Patients with Tossy type III acromioclavicular dislocation who were admitted to Department of Orthopedic Surgery of General Hospital of Jizhong Energy Xingtai Mining Group between January 2016 and April 2018 were selected as the subjects. The patients were randomly divided into two groups. The patients in the arthroscopy group were treated with arthroscopic suture bridge technique with suture anchor for reduction and fixation, while those in the clavicle hook plate group were treated with clavicular hook plate for internal fixation. The length of surgical incision, duration of surgery, hospitalization time and time to return to work of both groups were recorded. The shoulder function was evaluated according to the Lazzcano criterion of curative effect at 3, 6 and 12 months after surgery. The visual analogue scale score of shoulder pain, abduction and raising, forward bend and raising were compared between the two groups. All patients were followed up for 1 year to record the occurrence of complications. This study was approved by the Medical Ethics Committee of General Hospital of Jizhong Energy Xingtai Mining Group. All subjects signed the informed consent.  
    RESULTS AND CONCLUSION: (1) There was no significant difference in the duration of surgery between the two groups (P > 0.05). The surgical incision, hospitalization time and time to return to work of the arthroscopy group were significantly better than those of the clavicle hook plate group (P < 0.01). (2) According to the Lazzcano criterion of curative effect, the excellent and good rate of curative effect in the arthroscopy group (84%) was significantly better than that in the clavicle hook plate group (66%) at 3 months after surgery (P < 0.05). The excellent and good rates of curative effect in the arthroscopy group at 6 and 12 months after surgery were higher than those in the clavicle hook plate group (P > 0.05). (3) Visual analogue scale scores of the two groups showed a decreasing trend at 3, 6 and 12 months after surgery (P < 0.01). The visual analogue scale score of arthroscopy group was significantly lower than that of the clavicle hook plate group at the same time point (P < 0.01). (4) Angles of abduction and raising, forward bend and raising of both groups showed an increasing trend at 3, 6 and 12 months after surgery (P < 0.01). The angles of abduction and raising, forward bend and raising of the arthroscopy group were larger than those of the clavicle hook plate group at the same time point (P < 0.01). (5) The 1-year follow-up results showed that the incidence of complications in the arthroscopy group (6%) was significantly lower than that in the clavicle hook plate group (63%) (P < 0.01). (6) Compared with clavicular hook plate fixation, the technique of suture anchors under arthroscopy has the advantages of small trauma, quick recovery, fewer complications and no need to remove endografts again. Meanwhile, the surgery can also clearly diagnose the concomitant lesions in the joints and treat them when necessary, so as to improve the treatment effect. 
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    Imaging evaluation of short-segment fixation and fusion for degenerative lumbar scoliosis assisted by highly selective nerve root block
    Liang Yan, Zhao Yongfei, Xu Shuai, Zhu Zhenqi, Wang Kaifeng, Liu Haiying, Mao Keya
    2021, 25 (9):  1423-1427.  doi: 10.3969/j.issn.2095-4344.4011
    Abstract ( 179 )   PDF (814KB) ( 30 )   Save
    BACKGROUND: Short- or long-segment fixation is still controversial in the treatment of adult degenerative lumbar scoliosis.
    OBJECTIVE: To investigate the effectiveness and feasibility of accurate treatment of short-segment fixation in adult degenerative lumbar scoliosis patients assisted by highly selective nerve root block. 
    METHODS: Thirty-five patients with adult degenerative lumbar scoliosis treated in Chinese PLA General Hospital and People’s Hospital of Peking University from May 2014 to September 2017 were analyzed retrospectively, including 14 males and 21 females aged (64.2±8.1) years. The fixation segments were determined by a highly selective nerve root block. All patients were subjected to transforaminal lumbar interbody fusion. During the follow-up, visual analogue scale score and Oswestry disability index were evaluated. Parameters including lumbar curvature Cobb angle, lumbar lordosis angle, sacral slope, and pelvic tilt and interbody fusion condition were obtained by imaging; and complications were recorded. This study was approved by the Ethics Committee of Chinese PLA General Hospital and People’s Hospital of Peking University. 
    RESULTS AND CONCLUSION: (1) Of the 35 patients, 27 underwent single-segment minimally invasive transforaminal lumbar fusion, 5 underwent double-segment minimally invasive transforaminal lumbar fusion, and 3 underwent three-segment minimally invasive transforaminal lumbar fusion. (2) The follow-up time of 35 patients was (25.6±1.5) months. All patients achieved the grade I fusion. Within 3 months, there were 3 cases of dural tear and cerebrospinal fluid leakage, 1 case of lower-extremity muscular venous thrombosis, 1 case of pneumonia and 1 case of wound fat liquefaction. Three months later, there was 1 case of adjacent segment degeneration; no nerve injury or nonunion, no screw or titanium rod breakage. (3) Visual analogue scale score, Oswestry disability index, Cobb angle, lumbar lordosis angle, sacral slope, and pelvic tilt at the last follow-up were significantly improved in 35 patients compared with those before surgery  (P < 0.01). (4) Short-segment precision treatment of adult degenerative lumbar scoliosis with highly selective nerve root block can achieve good clinical effect. 
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    Underlying targets and mechanism of Taohong Siwu Decoction in prosthetic joint infection on network pharmacology
    Yuan Jiawei, Zhang Haitao, Jie Ke, Cao Houran, Zeng Yirong
    2021, 25 (9):  1428-1433.  doi: 10.3969/j.issn.2095-4344.4012
    Abstract ( 206 )   PDF (1127KB) ( 36 )   Save
    BACKGROUND: Taohong Siwu Decoction has a good effect in the treatment of periprosthetic infection after joint replacement, and can improve the function of joint movement. However, most present studies focus on the antibacterial effect of single drug and its components in the prescription, and there is little research on the compound and other mechanisms.  
    OBJECTIVE: To explore the mechanism of Taohong Siwu Decoction in the treatment of periprosthetic joint infection.  
    METHODS: Ingredients and target genes of Semen Persicae, Carthami Flos, Rehmanniae Radix Praeparata, Paeoniae Radix Alba, Angelicae Sinensis Radixand and Chuanxiong Rhizoma were screened by Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform. Periprosthetic joint infection-related target genes were obtained from the human gene database (GeneCards). Cytoscape3.7.2 was used for constructing a “Drug-Ingredient-Target-Disease” network. The key target genes were introduced into the STRING to construct protein-protein interaction network. We analyzed the mechanism by Kyoto Encyclopedia of Genes and Genomes and Gene Ontology biological enrichment analysis. 
    RESULTS AND CONCLUSION: (1) Totally 15 active components, such as quercetin, luteolin and kaempferol, were screened from Taohong Siwu Decoction, which acted on 34 key genes, such as vascular endothelial growth factor A, tumor necrosis factor, and interleukin-6. (2) Gene Ontology function enrichment showed that the biological process and function of Taohong Siwu Decoction were concentrated in positive regulation of biological process, response to chemical stimulus, response to stress, and regulation of apoptosis. (3) Kyoto Encyclopedia of Genes and Genomes pathway enrichment showed that the treatment of periprosthetic joint infection by Taohong Siwu Decoction mainly involved pathways in cancer, AGE-RAGE signaling pathway, fluid shear stress and atherosclerosis, inflammatory bowel disease and cytokine-cytokine receptor interaction pathway. (4) Through the study of network pharmacology, it is found that Taohong Siwu Decoction could treat periprosthetic joint infection by inhibiting bacterial growth and improving hemorheology, which provided a preliminary theoretical basis for the application of “activating circulation and removing blood stasis” in periprosthetic joint infection and a new idea for subsequent experiments.  
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    Heterotopic ossification after acetabular fracture fixation: risk factors, prevention and treatment progress
    Zhang Chao, Lü Xin
    2021, 25 (9):  1434-1439.  doi: 10.3969/j.issn.2095-4344.3754
    Abstract ( 189 )   PDF (595KB) ( 49 )   Save
    BACKGROUND: Heterotopic ossification is a common complication of acetabular fracture. Its pathogenesis is still not completely clear, and it is mainly caused by skeletal muscle trauma, hip surgery or nervous system injury. From the research in the past 10 years, the risk factors for ectopic ossification after acetabular fracture surgery are numerous, but its prevention and treatment are controversial.
    OBJECTIVE: To summarize the relevant literature on the diagnosis, prevention and treatment of ectopic ossification after acetabular fracture surgery in recent years and the risk factors that may affect the prognosis, so as to provide a basis for the clinical prevention and treatment of ectopic ossification after acetabular fracture surgery.
    METHODS: The databases of Wanfang Medical Network, CNKI and PubMed were searched using computer. The key words were “heteropic ossification; acetabular fractures surgery; NSAIDs; risk factors; radiotherapy; treatment” in Chinese and English. According to the inclusion and exclusion criteria, 67 related articles were finally included and summarized.
    RESULTS AND CONCLUSION: (1) Although the etiology of heterotopic ossification is not fully understood, it is generally accepted that the formation of heterotopic ossification is determined by both systemic factors and local tissue changes. The risk factors of heterotopic ossification are various, and some preventive measures should be taken for high-risk patients. (2) The prevention of heterotopic ossification after acetabular fracture surgery mainly includes drug, radiotherapy and combined prevention, among which drug prevention, especially non-steroidal anti-inflammatory drugs, is still the most economical and effective prevention method. (3) The treatment of heterotopic ossification is mainly ectopic bone resection and hip arthroplasty. The corresponding treatment methods based on the biomolecular mechanism are still in the stage of animal experimental research, but it points out the direction for the treatment of heterotopic ossification. (4) Among the existing treatment methods, surgery is recognized as the most effective treatment.
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    Multiple problems in the selection of implants for patellar fracture
    Zhou Jihui, Li Xinzhi, Zhou You, Huang Wei, Chen Wenyao
    2021, 25 (9):  1440-1445.  doi: 10.3969/j.issn.2095-4344.4015
    Abstract ( 211 )   PDF (620KB) ( 55 )   Save
    BACKGROUND: Patellar fracture is a common injury in orthopedics. There is no recognized gold standard for the implants. The improvement of the implants and the progress of the technology are the research hotspot in recent years.
    OBJECTIVE: To review the new progress of internal fixation for patellar fracture, and to explore the principles and advantages and disadvantages of various surgical treatment methods, so as to guide the clinical choice of the appropriate direction of internal fixators.
    METHODS: Wanfang and China National Knowledge Infrastructure were searched by the first author. The Chinese key words were “patella fracture, classification, biomechanics, internal fixator, internal fixation, complications, prognosis”. Simultaneously, PubMed was searched with the English search terms of “patellar fracture, classification, biomechanics, implants, internal fixation, tendon reconstruction, complications, prognosis”. The retrieval period was from July 2005 to February 2020. A total of 516 documents were retrieved. According to the inclusion and exclusion criteria, 47 documents were selected and summarized. 
    RESULTS AND CONCLUSION: (1) The patellar fracture with knee extension function damage and articular surface damage should be treated by operation. The operation should not only consider the flatness of articular surface, but also consider the separation and displacement trend caused by the traction of quadriceps femoris tendon and patella ligament. (2) There are many kinds of implants for patella fracture, but there is no unified gold standard. (3) Implants for surgical treatment of patellar fracture include steel wire, Kirschner wire, suture, anchor, and steel plate. All kinds of built-in products are improved and innovated continuously.
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    Related problems in anatomy mechanics, injury characteristics, fixed repair and three-dimensional technology application for olecranon fracture-dislocations
    Wang Debin, Bi Zhenggang
    2021, 25 (9):  1446-1451.  doi: 10.3969/j.issn.2095-4344.3753
    Abstract ( 183 )   PDF (622KB) ( 214 )   Save
    BACKGROUND: Olecranon fracture-dislocations are complicated fractures and dislocations of the elbow, which adds certain challenges to clinical diagnosis and treatment. Although the continuous improvement of medical standards has made some progress in the clinical diagnosis and treatment of olecranon fracture-dislocations, some controversial issues need to further discuss.
    OBJECTIVE: To consult and sort out the relevant literature about the clinical diagnosis and treatment of olecranon fracture-dislocations, and give a summary. 
    METHODS: The first author searched the relevant documents collected by Web of Science, PubMed and CNKI databases from 2000 to 2020. The key words were “olecranon; elbow; fracture dislocation; 3D printing” in English and Chinese. The massive relevant literature was reviewed and collected. The literature was classified and analyzed from the aspects of anatomical mechanics, injury characteristics, diagnostic typing and surgical treatment. 
    RESULTS AND CONCLUSION: (1) The anatomy of the olecranon, coronoid process, radial head, and the anatomical mechanical characteristics between the soft tissues affect the clinical diagnosis and treatment of olecranon fracture-dislocations. (2) Both anterior and posterior dislocations have their own injury characteristics and are easily confused with Monteggia fractures. Accurate grasp of physical examination and auxiliary imaging examination is conducive to clinical diagnosis. (3) The posterior midline approach is more commonly used, and other approaches should be combined if necessary. Proper fixation and repair of bone and soft tissue, as well as timely auxiliary external fixator, are conducive to improving the clinical efficacy of olecranon fracture-dislocations. (4) However, the damage mechanism of the rear olecranon fracture-dislocations needs to be further explored, and whether to establish independent classification of olecranon fracture-dislocations needs further discussion. The effectiveness of the indirect fixation of the coronoid process behind the olecranon still needs further research. (5) In addition, the emerging three-dimensional printing technology is of great significance for preoperative planning and simulation of bone trauma, and will be more conducive to the development of clinical diagnosis and treatment of olecranon fracture-dislocations. 
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    Hip arthroplasty versus proximal femoral nail antirotation for intertrochanteric fractures in older adults: a meta-analysis
    Chen Junming, Yue Chen, He Peilin, Zhang Juntao, Sun Moyuan, Liu Youwen
    2021, 25 (9):  1452-1457.  doi: 10.3969/j.issn.2095-4344.4016
    Abstract ( 152 )   PDF (710KB) ( 52 )   Save
    OBJECTIVE: At present, it has become a consensus that elderly patients with femoral intertrochanteric fracture should be treated by surgery. The main surgical methods are hip arthroplasty and proximal femoral nail antirotation. There are many reports on the clinical effects of these two surgical methods, but which surgical treatment is the better choice under different conditions is still controversial. The clinical efficacy and safety of hip arthroplasty and proximal femoral nail antirotation in the treatment of intertrochanteric fractures in the elderly were evaluated by meta-analysis.
    METHODS: The databases of PubMed, Cochrane Library, Embase, CNKI, Wanfang and VIP were searched to screen and compare the clinical randomized controlled trials of hip arthroplasty and proximal femoral nail antirotation in the treatment of elderly femoral intertrochanteric fractures from 2000 to 2020. The quality of the research was evaluated independently according to the evaluation tools recommended by the Cochrane system evaluator manual 5.3. Operation time, intraoperative blood loss, hospital stay, first weight bearing time, postoperative Harris function score, postoperative orthopedic complications and postoperative medical complications were selected as evaluation indexes. According to the results, the forest plot was drawn by RevMan 5.3 software, and the data were analyzed.
    RESULTS: After screening, a total of eight articles were included, containing three English articles and five Chinese articles, all of which were clinical randomized controlled trials. There were 8 articles of grade B, including 716 patients. The results of meta-analysis showed that the operation time of the proximal femoral nail antirotation group was shorter (WMD=15.48, 95%CI:7.78-23.19, P < 0.05), the intraoperative blood loss was less (WMD=104.61, 95%CI:58.86-150.36, P < 0.05), and the initial weight-bearing time of the hip arthroplasty group was shorter (WMD=-12.16, 95%CI:-18.68 to -5.63; P < 0.05). There was no significant difference in postoperative average hospital stay, Harris function score, postoperative orthopedic complications and postoperative medical complications.
    CONCLUSION: For elderly patients with intertrochanteric fracture, artificial hip arthroplasty can accelerate the functional recovery of hip joint, shorten the time of bed rest, and enable patients to carry out weight-bearing exercise in the early stage. With the continuous progress of artificial hip arthroplasty and the development of minimally invasive technology, the trauma caused by operation is getting smaller and smaller. Under the premise of strengthening perioperative management (such as strengthening preoperative preparation and postoperative management, shortening operation time, reducing bleeding, and actively dealing with basic diseases), compared with proximal femoral nail antirotation, hip arthroplasty has more advantages in the treatment of femoral intertrochanteric fractures in the elderly.
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    Meta-analysis of the efficacy and safety of tranexamic acid in open spinal surgery
    Chen Jinping, Li Kui, Chen Qian, Guo Haoran, Zhang Yingbo, Wei Peng
    2021, 25 (9):  1458-1464.  doi: 10.3969/j.issn.2095-4344.3765
    Abstract ( 166 )   PDF (784KB) ( 34 )   Save
    OBJECTIVE: The perioperative optimization measures of accelerated rehabilitation surgery run through the whole hospitalization period of patients with open spinal surgery. The clinical efficacy and safety of tranexamic acid in open spinal surgery were evaluated using meta-analysis.
    METHODS: Databases of PubMed, Embase, Ovid, Cochrane Library, CNKI, CBM, Wanfang, and VIP were searched. According to the inclusion and exclusion criteria, ten prospective randomized controlled trials were obtained. Endnote software was utilized to manage the literature. The extracted data were analyzed using Revman 5.3 software for meta-analysis, mainly analyzing the intraoperative blood loss, postoperative blood loss, total perioperative blood loss, postoperative hemoglobin, operation time, length of hospital stay, blood transfusion rate, and thrombotic complications by using tranexamic acid in open spinal surgery.
    RESULTS: (1) A total of 10 high-quality prospective randomized controlled studies were included in 802 patients. (2) Meta-analysis results showed that tranexamic acid significantly reduced intraoperative blood loss (MD=-210.38, 95%CI: -267.31 to -153.45, P < 0.000 01), postoperative drainage (MD=-113.40, 95%CI: -126.97 to -99.83, P < 0.000 01), total perioperative blood loss (MD=-266.85, 95%CI: -351.18 to -182.52, P < 0.000 01), and postoperative hemoglobin loss (SMD=0.20, 95%CI: 0.02-0.38, P=0.03) compared with the control group, with significant difference. Moreover, the length of hospital stay (MD=-1.09, 95%CI: -1.86 to -0.32, P=0.006) significantly reduced, and blood transfusion rate (RR=0.61, 95%CI: 0.48 to 0.79, P=0.000 1) significantly reduced. Operation time (MD=-7.75, 95%CI: -16.65 to 1.15, P=0.09) did not shorten. (3) There was no significant difference in the incidence of thrombotic complications between the tranexamic acid group and the control group (RR=0.92, 95%CI: 0.47 to 1.82, P=0.81).
    CONCLUSION: Tranexamic acid can significantly reduce the perioperative blood loss of open spine surgery, shorten hospital stay, lower blood transfusion rate, and is safe and reliable. The use of tranexamic acid in open spinal surgery can promote enhanced recovery of patients after surgery; the initial dose of tranexamic acid is 10-15 mg/kg, maintenance dose 1.0-2.0 mg/kg per hour. It may be the best solution for intravenous tranexamic acid in open spine surgery.
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    Treatment of displaced intra-articular calcaneal fractures with cannulated screws and plates: a meta-analysis of 15 randomized controlled trials
    Hu Kai, Qiao Xiaohong, Zhang Yonghong, Wang Dong, Qin Sihe
    2021, 25 (9):  1465-1470.  doi: 10.3969/j.issn.2095-4344.3766
    Abstract ( 205 )   PDF (718KB) ( 28 )   Save
    OBJECTIVE: Displaced intra-articular calcaneal fractures are the most common type of calcaneal fracture. Cannulated screw fixation and plate fixation are commonly used methods. However, the differences in therapeutic effectiveness between cannulated screw fixation and plate fixation are still unclear. Thus, this study compared the effect of percutaneous cannulated screw fixation and plate fixation in the treatment of intra-articular calcaneal fractures. 
    METHODS: The authors searched for randomized controlled trials on displaced intra-articular calcaneal fractures fixated with cannulated screws or plates in the following electronic databases: PubMed, Cochrane Library, Embase, Web of Science, and CNKI. The retrieval time limit was from the establishment of the database to December 2019. The retrieved literatures were screened according to inclusion and exclusion criteria. Quality evaluation was performed to extract effective data. Meta-analysis was conducted using RevMan 5.3 software.
    RESULTS: Fifteen randomized controlled studies were included with 1 438 patients with calcaneal fractures. The risk bias evaluation of the included literature showed that the overall quality of literature was above average. Meta-analysis results show that (1) plate fixation group was better than cannulated screw fixation group in terms of Bohler’s angle (MD=0.69, 95%CI:0.27-1.10, P=0.001) and Gissane’s angle (MD=0.95, 95%CI:0.16-1.74, P=0.02) (P < 0.05). (2) Compared with plate fixation, cannulated screw fixation showed a significant reduction in the operation time (MD=-23.92, 95%CI: -25.40 to -22.44, P <         0.000 01) and postoperative complications (OR=0.28, 95%CI:0.19-0.41, P < 0.000 01) (P < 0.05). (3) There was no statistically significant difference between the cannulated screw fixation group and the plate fixation group in terms of calcaneal height (MD=0.43, 95%CI:-0.17-1.03, P=0.16) and AOFAS score (MD=0.61, 95%CI:-0.35-1.58, P=0.21). 
    CONCLUSION: Above data concluded that Bohler’s and Gissane’s angles in the plate fixation group are better than those in the cannulated screw fixation group, while the cannulated screw fixation technology has the advantages of short operation time and low complication rate.
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    Comparison of the short-term efficacy of extracorporeal shock wave therapy for middle-aged and elderly knee osteoarthritis: a meta-analysis
    Huang Dengcheng, Wang Zhike, Cao Xuewei
    2021, 25 (9):  1471-1476.  doi: 10.3969/j.issn.2095-4344.3767
    Abstract ( 208 )   PDF (739KB) ( 77 )   Save
    OBJECTIVE: To compare the effectiveness of extracorporeal shock wave therapy with other treatments in relieving knee osteoarthritis pain and improving knee function in the elderly.
    METHODS: A computer search was performed on PubMed, Embase, CNKI, and SinoMed databases to compare the efficacy of extracorporeal shock wave with the energy density of 0, non-steroidal drugs, and sodium hyaluronate for knee osteoarthritis. The search period was from the inception of the database to March 2020. Simultaneously, the obtained reference index was looked up. According to the incision and exclusion criteria, two researchers independently screened the literature. Visual analogue scale and The Western Ontario and McMaster Universities Osteoarthritis Index were the primary outcomes, and the Lequensne score was the secondary outcome. Cochrane bias risk assessment tool was used to evaluate literature quality. Data analysis was performed by RevMan 5.3 software.
    RESULTS: (1) Twelve articles were included with a total of 1 040 patients, and all of them were randomized controlled trails. (2) Meta-analysis results showed that compared with the blank control, extracorporeal shock wave therapy could relieve the pain score of patients with knee osteoarthritis (MD=-2.00, 95%CI: -2.25 to -1.75, P < 0.000 01), improve The Western Ontario and McMaster Universities Osteoarthritis Index (MD=-8.45, 95%CI:-14.83 to -2.07, P=0.009) and Lequesne score (MD=-2.39, 95%CI:-4.24 to -0.54, P=0.01), with significant differences. (3) There was no significant difference between the group of extracorporeal shock wave and the group of non-steroidal drugs in terms of pain relief (MD=0.01, 95%CI:-0.48-0.51, P=0.95), but the effect of extracorporeal shock wave on improving knee function was better than that of non-steroidal drugs (MD=-6.56, 95%CI:-8.24 to -4.87, P < 0.000 01). (4) The knee pain (MD=0.22, 95%CI: 0.18, 0.25, P < 0.000 01) and The Western Ontario and McMaster Universities Osteoarthritis Index (MD=-1.29, 95%CI:-3.61 to -0.74, P=0.003) were improved in the group of extracorporeal shock wave compared with the group of sodium hyaluronate. (5) There was no significant difference in the scores of Lequesne (MD=-0.21, 95%CI:-1.09-0.67, P=0.64) between the group of extracorporeal shock wave and the group of sodium hyaluronate in terms of pain relief. 
    CONCLUSION: Compared with oral non-steroidal anti-inflammatory drugs and intra-articular sodium hyaluronate injection, extracorporeal shock wave shows a better clinical effect on relieving knee osteoarthritis pain and improving knee joint function. The above conclusions need to be verified through higher quality and larger sample clinical trial result.
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