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28 April 2021, Volume 25 Issue 12 Previous Issue    Next Issue

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Biomechanical comparison of atlantoaxial crossed rod and parallel rod fixation technique for C2 unilateral lamina screws Qiu Feng, Xu Xilin, Ma Xiangyang, Fang Zhouqun, Jiang Weicheng, Tian Shuzhao, Zheng Zelong 2021, 25 (12):  1805-1809.  doi: 10.3969/j.issn.2095-4344.3777 Abstract ( 273 )   PDF (1099KB) ( 82 )   Save BACKGROUND: The biomechanical stability of the screw-rod fixation system by C1 bilateral pedicle screws and C2 lamina screws was slightly insufficient. Posterior atlantoaxial fixation with screw-rod forms an approximate “II” shape or “H” increasing transverse-link for better stability. Crossed rod, constituted by connecting rods to the contralateral screws, forms an approximate “X” shape. This fixed construct just likes multi-triangles, whose stability is best, may further enhance the stability.  OBJECTIVE: To evaluate the three-dimensional biomechanical stability of the fixation technique for the crossed rod and parallel rod by the C1 bilateral pedicle screws combined with C2 one pedicle screw and the other lamina screw.   METHODS: Six fresh adult craniocervical specimens were used to test the biomechanical stability. All the specimens were fixed using C1 bilateral pedicle screws and C2 left pedicle screw and right lamina screw. The specimens were observed sequentially in three groups. The unstable group was not fixed. The parallel rod group was fixed by parallel rod connection. The crossed rod group was fixed by the crossed bar connection. The three-dimensional range of motion of the occipital axis was measured on a three-dimensional spinal motion testing machine.  RESULTS AND CONCLUSION: (1) The two internal fixation methods were better in the crossed rod and parallel rod groups than in the unstable group on flexion-extension, lateral bending and left and right axial rotation (P < 0.05). (2) The stability of the crossed rod group was equal to that of the parallel rod group on flexion-extension and lateral bending (P > 0.05). (3) The stability of the crossed rod group was better than that in the parallel rod group on left and right axial rotation (P < 0.05). (4) When the fixation with C1 bilateral pedicle screws and one C2 pedicle screw and the other lamina screw is used, crossed rod fixation can further enhance the axial rotation stability.    Figures and Tables | References | Related Articles | Metrics

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Different configurations of anterior double-plate fixation in types B and C of sacroiliac joint dislocation: a finite element analysis Shu Hui, Huang Xiaowei 2021, 25 (12):  1810-1814.  doi: 10.3969/j.issn.2095-4344.3778 Abstract ( 334 )   PDF (831KB) ( 33 )   Save BACKGROUND: High-energy violence can lead to instability of pelvic ring structure. The primary purpose of surgical treatment of pelvic injury is to restore the continuity and stability of posterior pelvic ring as much as possible. To obtain anatomical reduction, anterior plate fixation can be used to maintain the stability of posterior pelvic ring.  OBJECTIVE: To investigate the correlation between the configuration of anterior double-plate fixation and the biomechanical stability and to find the optimal configuration for anterior double-plate fixation for the treatment of type B and type C sacroiliac dislocation. METHODS: A three-dimensional finite element model of the intact pelvic ring was established and validated. Then type B and type C sacroiliac dislocation models were constructed based on the intact pelvic model. Seven kinds of anterior plates with different angular orientation from 0° to 90° were implanted in two types of ipsilateral dislocated pelvic modes. The stability of models of sacroiliac joint dislocation fixed with different anterior plate configurations was recorded and analyzed.   RESULTS AND CONCLUSION: (1) For type B and C sacroiliac joint dislocation, the maximal translation was 0.96 mm and 0.92 in 0°-fixation models. The minimum translation occurred in 75°-fixation model of 0.18 mm. (2) The maximal flexion was also found in 0°-fixation model of 2.05° in type B and of 1.9° in type C dislocation, and the minimum flexion existed in 60°-fixation model of 0.06°. (3) As for lateral bending, the minimal lateral bending occurred in 30°-fixation model of 0.01° in type B dislocation and in 45°-fixation model with the value of 0.11° in type C dislocation. (4) It is concluded that the angle of anterior double-plate fixation ranging from 45° to 75° demonstrated superior stability in both types B and C sacroiliac dislocation. Figures and Tables | References | Related Articles | Metrics

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Analysis of various degrees of freedom of the hip movement based on motion capture technology Zhang Haifeng, Zhao Can, Liu Meixiao, Song Cuirong, Pang Yin 2021, 25 (12):  1815-1819.  doi: 10.3969/j.issn.2095-4344.3784 Abstract ( 416 )   PDF (751KB) ( 240 )   Save BACKGROUND: The hip joint is a complex structure, and plays an important role in supporting weight and daily activities, and there is no objective way to assess its athletic ability. OBJECTIVE: To analyze the time and space parameters of hip joint in the process of motion around sagittal axis, coronal axis and vertical axis, and to summarize the variation rules of motion parameters. METHODS: Thirty subjects were selected to capture the movement track of hip forward flexion, backward extension, abduction, adduction, rotation in, rotation out and reduction through three-dimensional motion capture system, calculate and analyze the maximum amplitude and angle changes in different degrees of freedom movement. RESULTS AND CONCLUSION: (1) By establishing the motion model of the hip joint to obtain the range of motion of the hip in the sagittal plane, coronal plane and horizontal plane. The extreme values of the motion of each plane were calculated. (2) The angle-time change curve of the motion of the hip in different planes was exported. The change rule of the motion of the hip was summarized: the flexion and extension range of the hip on sagittal plane was much larger than the adduction and abduction of the coronal plane and inward and outward rotation on a horizontal plane. The angular acceleration of the hip joint was larger in the active stages of forward flexion, backward extension, abduction and outward rotation, and the acceleration was smaller in the resetting movement. (3) The establishment of kinematic model based on motion capture technology and the analysis of kinematic data can provide some references for the accurate assessment of hip function, and the prevention or rehabilitation of injuries, sports training, biomechanical analysis and other studies. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional-printing assisted total hip arthroplasty for individualized treatment of adult developmental dysplasia of the hip Zhang Nianjun, Liu Xiaofang, Zhou Guanming, Su Yao, Hong Shi 2021, 25 (12):  1820-1825.  doi: 10.3969/j.issn.2095-4344.3770 Abstract ( 420 )   PDF (974KB) ( 98 )   Save BACKGROUND: Total hip arthroplasty is the most effective method for the treatment of middle and late developmental dysplasia of the hip. The anatomical structure of developmental dysplasia of the hip patients is malformed, and acetabulum reconstruction is the difficulty of operation. At present, three-dimensional (3D) printing technology is used to reconstruct the pelvis model and guide the preoperative planning, but the direction and depth of the file have not been well solved. Thus, we will further mine the CT scan data of pelvis, and make a guide device using 3D printing technology to guide the direction of the file.   OBJECTIVE: To investigate the clinical effect of 3D-printing assisted individualized total hip arthroplasty for adult developmental dysplasia of the hip. METHODS: Thirty patients with developmental dysplasia of the hip were included and randomly divided into two groups (n=15 per group). In the observation group, 3D pelvis model and operation guide plate were made through 3D printing technology to develop individual operation plan. In the control group, the operation was completed according to the routine operation process. The operation time, intraoperative blood loss, and Harris score of hip joint in the last follow-up were compared between the two groups, and the difference of abduction angle, vertical and horizontal distance with the design value was compared to evaluate the accuracy of acetabular prosthesis placement.  RESULTS AND CONCLUSION: (1) There was no significant difference in the abduction angle, Harris score during the last follow-up and horizontal distance between the two groups after surgery (P > 0.05). (2) The operation time and intraoperative blood loss of the observation group were significantly less than those of the control group (P < 0.05). (3) The vertical difference between the two groups was statistically significant (P < 0.05), and the design deviation of the observation group was smaller. (4) It is indicated that with the help of 3D printing technology, preoperative observation of personalized 3D model was used to enhance the understanding of the anatomical variation of developmental dysplasia of the hip. During the operation, the guiding function of acetabular prosthesis was used to improve the accuracy of acetabular prosthesis placement, shorten the operation time and reduce the amount of intraoperative blood loss. Figures and Tables | References | Related Articles | Metrics

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Computer design combined with three-dimensional printing template for spinal orthopedics can improve surgical accuracy and correction effect Liu Zhengpeng, Wang Yahui, Ming Ying, Sun He 2021, 25 (12):  1826-1830.  doi: 10.3969/j.issn.2095-4344.3785 Abstract ( 305 )   PDF (726KB) ( 118 )   Save BACKGROUND: The difficulty of orthopedic surgery for spinal deformity lies in how to determine the position of the vertebral pedicle of the deformed vertebral body. It is difficult to achieve accurate positioning using traditional CT, X-ray examination and other methods, which affects the surgical effect. Recent research shows that computer technology and three-dimensional (3D) printing templates have advantages in improving positioning and nail placement.  OBJECTIVE: To explore the effect of computer design combined with 3D printing template on spinal orthopedics on surgical accuracy and correction effect.  METHODS: A prospective single-blind randomized controlled study was performed in 73 patients with spinal deformities undergoing orthopedic surgery in the Affiliated Hospital of Chengde Medical College from February 2016 to February 2019. According to the random number table, they were divided into two groups. In the trial group (n=36), computer design combined with 3D printing template was used in orthopedic surgery. In the control group (n=37), conventional orthopedic surgery was applied. The operation situation, the correction rate of Cobb angle, the success rate of nail placement, and the incidence of complications were compared in the two groups. Follow-up was performed for 12 months after operation. Oswestry disability index was compared between the two groups before and 12 months after operation.  RESULTS AND CONCLUSION: (1) The operation time of the trial group was shorter than that of the control group. The number of intraoperative X-ray fluoroscopy and intraoperative blood loss were less in the trial group than those in the control group (P < 0.05). (2) The correction rate of Cobb angle was significantly higher in the trial group (89%) than that in the control group (70%) (P < 0.05). The success rate of nail placement was significantly higher in the trial group (100%) than that in the control group (81%) (P < 0.05). (3) There was no statistically significant difference in the incidence of postoperative complications between the two groups (P > 0.05). (4) The scores of social activities, sleep quality, daily activities, and pain in each dimension of the Oswestry disability index of the two groups 12 months after operation were lower than those before surgery, and those scores in the trial group were lower than those in the control group (P < 0.05). (5) These results suggest that computer design combined with 3D printing templates for spinal orthopedic surgery can shorten the operation time, reduce surgical trauma, reduce the number of intraoperative X-ray fluoroscopy, improve surgical accuracy and correction effect, and reduce the degree of postoperative dysfunction. Figures and Tables | References | Related Articles | Metrics

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Simulation analysis of wear performance for tibial insert of unicompartmental knee arthroplasty prosthesis under gait load Wang Xiankang, Zhang Yuejing, Yang You, Liu Jun 2021, 25 (12):  1831-1835.  doi: 10.3969/j.issn.2095-4344.3775 Abstract ( 410 )   PDF (997KB) ( 56 )   Save BACKGROUND: At present, finite element analysis is mostly used in the simulation study of wear of the total knee prosthesis pad.   OBJECTIVE: To study the effect of shape optimization for the tibial insert of the unicompartmental knee prosthesis on wear performance using finite element analysis.  METHODS: Based on the Archard wear theory, the wear finite element model of the unicompartmental knee prosthesis was established. The contact pressure and wear performance of the tibial insert before and after optimization were studied.  RESULTS AND CONCLUSION: (1) Under the condition of ISO standard gait load, for the contact pressure, the tibial insert contact pressure before and after optimization was 54.7 MPa and 37.2 MPa, respectively, and the tibial insert contact pressure was reduced by 32%. For linear wear, the linear wear of the tibial insert before and after optimization was 4.38×10-5 mm and 3.15×10-5 mm, respectively, and the linear wear depth of the tibial insert was reduced by 28%. (2) The results show that the liner wear performance can be significantly improved after optimization. The results of the study have practical significance for unicompartmental knee tibial insert design, wear performance assessment and clinical application. Figures and Tables | References | Related Articles | Metrics

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Lateral unicompartmental knee arthroplasty and total knee arthroplasty for treating lateral single compartment knee osteoarthritis  Wang Feng, Ju Xiaocong, Wang Bing, Sun Haining 2021, 25 (12):  1836-1841.  doi: 10.3969/j.issn.2095-4344.3771 Abstract ( 451 )   PDF (812KB) ( 43 )   Save BACKGROUND: Lateral single compartment knee osteoarthritis has a low incidence of degenerative diseases of the knee. Total knee arthroplasty in the treatment of lateral single compartment knee osteoarthritis has achieved considerable clinical efficacy. As a new technology, lateral monocondylar knee replacement has seldom been reported in terms of surgical strategy and clinical efficacy in the treatment of lateral single compartment knee osteoarthritis.  OBJECTIVE: To compare the clinical efficacy of lateral unicompartmental knee arthroplasty and total knee arthroplasty for lateral unicompartmental knee osteoarthritis.   METHODS: Clinical data of 39 patients with lateral unicompartmental knee osteoarthritis were retrospectively analyzed from October 2016 to October 2018 in the PLA 960 Hospital. According to the surgical plan, the patients were divided into two groups, including 20 patients in the lateral unicompartmental knee arthroplasty group and 19 patients in the total knee arthroplasty group. Perioperative incision healing and postoperative prosthesis survival were followed up. The changes of femorotibial angle of the affected knee were measured before and after operation. The patients’ acceptance of the two methods was statistically compared. The operation time, total blood loss, muscle strength of quadriceps femoris before operation, and the time of going to the ground after operation were compared between the two groups. Visual analogue scale score and Hospital for Special Surgery score were recorded before and after surgery.   RESULTS AND CONCLUSION: (1) Perioperative situation: Intraoperative exploration found that a patient scheduled undergoing lateral unicompartmental knee arthroplasty to change the total knee arthroplasty due to anterior cruciate ligament rupture. One patient with diabetes in the lateral unicompartmental knee arthroplasty group had delayed healing of the incision, and one patient in the total knee arthroplasty group had delayed healing due to the liquefaction of fat. The remaining incisions healed normally. (2) Follow up after discharge: One patient in the total knee arthroplasty group died of lung cancer in the second year after operation, and the remainder was normal. The two-year survival rate was 97%. (3) Changes in femorotibial angle before and after surgery: The postoperative valgus angles of the two groups were between 5°-10°, and the lower extremity vertical line recovered well. There was no statistical difference in the femorotibial angle changes between the two groups before and after surgery (P > 0.05). (4) 54% of patients were more willing to undergo lateral unicompartmental knee arthroplasty, and 41% of patients respected the doctor’s suggestion that both surgical methods could be accepted. (5) The operation time, intraoperative and postoperative total blood loss and postoperative time of going to the ground in lateral unicompartmental knee arthroplasty group were better than those in total knee arthroplasty group (P < 0.05). There was no significant difference in preoperative muscle strength of quadriceps femoris, preoperative and postoperative visual analogue scale score, and Hospital for Special Surgery score between the two groups (P > 0.05). (6) Two surgical schemes have considerable clinical effects in the treatment of lateral compartment osteoarthritis. Compared with total knee arthroplasty, the lateral unicompartmental knee arthroplasty has less blood loss and shorter operation time, quick recovery and other advantages, so lateral unicompartmental knee arthroplasty is more suitable for the treatment of patients with osteoarthritis who meet the indications of lateral unicompartmental knee arthroplasty. Figures and Tables | References | Related Articles | Metrics

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Mobilization with movement facilitates early functional recovery after fixed-bearing posterior stabilized total knee arthroplasty Lin Yi, Feng Jierong, Luo Xingwen 2021, 25 (12):  1842-1846.  doi: 10.3969/j.issn.2095-4344.3776 Abstract ( 438 )   PDF (791KB) ( 50 )   Save BACKGROUND: Early rehabilitation intervention is beneficial for the functional recovery after total knee arthroplasty. Mobilization with movement can alleviate the postoperative pain and improve the knee function to maximal extent.  OBJECTIVE: To explore the effect of mobilization with movement on the early dysfunction and joint function after posterior stabilized total knee arthroplasty.  METHODS: Seventy patients with fixed-bearing posterior stabilized total knee arthroplasty from May 2017 to April 2020 in Shunde Hospital of Southern Medical University were randomly divided into control group and treatment group. The patients in the control group were given rapid rehabilitation intervention, while those in the treatment group were subjected to mobilization with movement combined with rapid rehabilitation intervention. The western Ontario and McMaster universities osteoarthritis index and the hospital for special knee surgery scores were compared between the two groups 1 day, 2 and 4 weeks after total knee arthroplasty.   RESULTS AND CONCLUSION: (1) At 2 and 4 weeks postoperatively, the indicators of the two groups of patients were significantly improved compared with those 1 day after treatment, and the difference was significant (P < 0.05). All indicators except muscle strength of the hospital for special knee surgery scores were significantly different in both groups at 2 and 4 weeks after total knee arthroplasty (P < 0.05). (2) At 2 and 4 weeks postoperatively, the pain, function, range of motion, stability, flexion deformity and total scores of the hospital for special knee surgery in the treatment group were significantly higher than those in the control group. Western Ontario and McMaster universities osteoarthritis index and the reduction project scores of the hospital for special knee surgery scores were significantly lower in the treatment group than those in the control group (P < 0.05). (3) The results suggest that mobilization with movement combined with rapid rehabilitation intervention can improve the functional recovery at early phase after total knee arthroplasty.    Figures and Tables | Related Articles | Metrics

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Safety evaluation of tranexamic acid in reducing perioperative blood loss in high tibial osteotomy Ma Zhen, Liang Da, Wu Xiaolin, Zhong Wei 2021, 25 (12):  1847-1852.  doi: 10.3969/j.issn.2095-4344.3786 Abstract ( 446 )   PDF (660KB) ( 167 )   Save BACKGROUND: Tranexamic acid is widely used for its good hemostatic effect in orthopedic surgery, and it is the most mature application in hip and knee arthroplasties. However, the impact on perioperative blood loss of high tibial osteotomy and the risk of deep venous thrombosis is unknown. OBJECTIVE: To explore the effect of tranexamic acid on the perioperative blood loss of high tibial osteotomy and the risk of deep venous thrombosis.   METHODS: From June 2017 to December 2019, 76 patients with knee osteoarthritis who underwent high tibial osteotomy in the First Department of Joint Surgery of the Affiliated Hospital of Weifang Medical University were selected as the research subjects. The 76 patients were randomly divided into two groups (n=38). Tranexamic acid saline injection (1 g, 100 mL) was given intravenously 30 minutes before the operation in the trial group, and the same amount of saline was given intravenously in the control group. General perioperative data such as age, sex ratio, body mass index, hemoglobin, hematocrit, fibrinogen, prothrombin time, and activated partial prothrombin time were recorded in both groups. The two groups of patients were operated by the same group of physicians, and the internal fixation was made by the same company. The operation time, intraoperative blood loss and postoperative drainage, blood transfusion, hemoglobin and hematocrit at 1, 3, and 5 days after surgery, coagulation index at 3 days surgery, and venous thrombosis of the lower limbs at 5 days after surgery were recorded. Total blood loss, hidden and dominant blood loss were calculated.  RESULTS AND CONCLUSION: (1) The perioperative general information was not statistically significant between the two groups (P > 0.05). There was no significant difference in the operation time between the two groups (P > 0.05). (2) The total blood loss, hidden and dominant blood loss and postoperative drainage volume in the trial group were less than those in the control group (P < 0.05). There was no significant difference in intraoperative blood loss between the two groups (P > 0.05). There was a statistically significant difference in the maximum reduction in hemoglobin and the maximum reduction in hematocrit after surgery between the two groups (P < 0.05). (3) One case in the control group was treated with blood transfusion, accounting for 3%. There was no blood transfusion treatment in the trial group, and the difference between the two groups was not statistically significant (P > 0.05). (4) There was no statistically significant difference in fibrinogen, activated partial prothrombin time and prothrombin time between the two groups at 1, 2, and 3 days after surgery (P > 0.05). (5) One case of urinary tract infection occurred in the control group after high tibial osteotomy, and no other obvious complications occurred. At 5 days after the operation, the color Doppler ultrasound of the lower extremities was reexamined. No deep vein thrombosis of the lower extremities was found in the two groups (P > 0.05). (6) It is concluded that intravenous application of tranexamic acid before high tibial osteotomy in knee osteoarthritis patients can reduce the total blood loss during perioperative period, especially the hidden blood loss, and it will not increase the risk of deep venous thrombosis of the lower extremities.  Figures and Tables | References | Related Articles | Metrics

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Sensitivity and specificity of D-dimer in the diagnosis of chronic periprosthetic infection after hip replacement Liu Yongyu, Xu Jingli, Lin Tianye, Wu Feng, Shen Chulong, Xiong Binglang, Zou Qizhao, Lai Qizhong, Zhang Qingwen 2021, 25 (12):  1853-1857.  doi: 10.3969/j.issn.2095-4344.3787 Abstract ( 263 )   PDF (689KB) ( 54 )   Save Figures and Tables | References | Related Articles | Metrics

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Stability of three-dimensional motion of spine with long-segment posterior fixation at different screw densities Xue Jingbo, Li Zepeng, Wang Cheng, Ouyang Zhihua, Li Xuelin, Yan Yiguo, Wang Wenjun 2021, 25 (12):  1858-1863.  doi: 10.3969/j.issn.2095-4344.3788 Abstract ( 348 )   PDF (768KB) ( 100 )   Save BACKGROUND: Spinal posterior orthopedic pedicle screw internal fixation has become the most common clinical treatment for adolescent idiopathic scoliosis, but the use of high density nail placement can cause greater trauma and increase medical costs.  OBJECTIVE: Using the six-degree-of-freedom joint robot, the biomechanical test of the pig spine with different posterior nail density was carried out to investigate the effect of different posterior nail density on the three-dimensional motion stability of the spine.  METHODS: In eight pig spine specimens, the model of total pedicle screw fixation (100% fixation) was first prepared. Afterwards, the pedicle screws were reduced in turn. Pedicle screws of different densities were placed in turn (82%, 64%, and 36%). Finally, the spine without pedicle screw fixation was used as the blank control group. A six-degree-of-freedom joint robot was used to test the flexibility of each group of pig spine specimens in flexion position, lateral bending position and axial rotation position.  Results and conclusion: (1) In flexion position and lateral bending position, there was no significant difference in range of motion of the spine specimens between the whole screw internal fixation group (100%) and the partial pedicle screw density group (82%, 64%, and 36%) (P > 0.05). (2) In the axial rotation test, the stability of axial rotation was significantly reduced in the 36% pedicle screw group compared to the total screw fixation group and the 82% and 64% pedicle screw fixation groups (P < 0.001). (3) When the 64% pedicle screw fixation group was added to the transverse connecting rod fixation, the range of motion of axial rotation of the spine specimen was significantly reduced (P < 0.05). (4) It is indicated that limited reduction of nail density of pedicle screws does not adversely affect the stability of posterior segment fixation. Figures and Tables | References | Related Articles | Metrics

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Minimally invasive percutaneous plate osteosynthesis and elastic nail system in the treatment of distal tibiofibular fracture in adults  Wang Lei, Qi Rong, Li Jia, Qiu Zhixue, Wang Kai, Suo Nanangxiu 2021, 25 (12):  1864-1868.  doi: 10.3969/j.issn.2095-4344.3772 Abstract ( 437 )   PDF (740KB) ( 33 )   Save BACKGROUND: Minimally invasive treatment of distal tibiofibular fractures has always been a hot spot in clinical research. Closed reduction and minimally invasive fixation is a real minimally invasive treatment, but there are deficiencies in long-term follow-up. OBJECTIVE: To explore the efficacy of minimally invasive percutaneous plate osteosynthesis (MIPPO) technology and elastic nail system in the treatment of tibiofibular fracture in adults.  METHODS: Twenty-five adult patients with distal tibiofibular fractures were treated with MIPPO technique combined with elastic intramedullary nailing. AO classification: There were 18 cases of type A, 7 cases of type B, and 0 case of type C. All patients were given symptomatic treatment after operation, and the patients were instructed to carry out rehabilitation training of lower limb function. X-ray films were taken at 1, 3, 6, and 12 months after operation, and the weight-bearing time was determined according to the fracture healing. At the last follow-up, Johner-Wruhs score and Phillips score were used to evaluate ankle function. RESULTS AND CONCLUSION: (1) After 15-28 months of follow-up, all patients had limited weight bearing of lower limbs (10 kg) after 8 weeks of the operation. (2) The fracture healing time of AO type A patients was significantly shorter than that of AO type B patients (P < 0.05). (3) According to Johner-Wruhs criteria at the last follow-up, 21 cases were excellent and 4 cases were good. (4) The ankle joint function was evaluated according to the Phillips score at the last follow-up after operation. Totally 19 cases were excellent, 4 cases were good, and 2 cases were average. Among them, the total excellent and good rate of Phillips score at the last follow-up was 94% in AO type A patients, and 86% in AO type B patients; the difference was significant (P < 0.05). (5) There were no incision problems, nonunion of fracture ends, failure of internal fixation or other complications in all patients. (6) It is concluded that MIPPO technology and elastic nail system in the treatment of tibiofibular fracture has high healing rate, and fast functional recovery. It conforms to the principle of rapid trauma recovery, and this method is more advantageous in AO type A patients.  Figures and Tables | References | Related Articles | Metrics

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Safety of reducing nausea and vomiting by intravenous infusion of tropisetron hydrochloride after internal fixation with proximal femoral nail antirotation Chen Sheng, Zheng Zhihui, Guan Keli, Li Xiaowu, Cai Peibiao, Chen Haibo, Zheng Xun, Zeng Qingqiang 2021, 25 (12):  1869-1873.  doi: 10.3969/j.issn.2095-4344.3774 Abstract ( 359 )   PDF (624KB) ( 44 )   Save BACKGROUND: Tropisetron hydrochloride has been shown to effectively reduce postoperative nausea and vomiting in patients undergoing proximal femoral nail antirotation fixation, and it is safe and effective. At present, the use of tropisetron in this operation is mainly added to patient controlled intravenous analgesia or intravenous drip after the operation. However, the comparison of two administration methods of tropisetron is rarely reported.  OBJECTIVE: To investigate the effectiveness and safety of different administration methods of tropisetron hydrochloride for reduction of postoperative nausea and vomiting in proximal femoral nail antirotation. METHODS: Ninety patients with intertrochanteric fracture of femur who underwent proximal femoral nail antirotation admitted in Shantou Hospital of Traditional Chinese Medicine from July 2018 to March 2020 were randomly divided into two groups (n=45). Patients in the group A (intravenous drip administration group) were given tropisetron hydrochloride 5 mg + normal saline 100 mL by intravenous drip immediately after the operation, and the patient controlled intravenous analgesia pump (tropisetron hydrochloride was not added into the pump) was used. Patients in the group B (patient controlled intravenous analgesia pump group) were given 100 mL normal saline by intravenous drip immediately after the operation, and the patient controlled intravenous analgesia pump (5 mg tropisetron hydrochloride was added into the pump) was used. The pain score, sedative score, postoperative nausea and vomiting score and postoperative nausea and vomiting incidence at 1, 6, 12, 24, and 48 hours after the operation of two groups were counted and compared.   RESULTS AND CONCLUSION: (1) The pain score and sedative score of the two groups were not statistically significant (P > 0.05) at various time points. (2) The postoperative nausea and vomiting score and postoperative nausea and vomiting incidence of group A were significantly less than those in the group B at 1 and 6 hours after the operation (P < 0.05). The differences in postoperative nausea and vomiting score and postoperative nausea and vomiting incidence of the two groups were not statistically significant at 12, 24, and 48 hours after the operation (P > 0.05). (3) There was no significant difference in incidence of adverse reactions between the two groups (P > 0.05). (4) Compared with added tropisetron hydrochloride to patient controlled intravenous analgesia pump, postoperative intravenous drip administration of tropisetron hydrochloride can quickly reduce the occurrence of nausea and vomiting after proximal femoral nail antirotation fixation.  Figures and Tables | References | Related Articles | Metrics

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Mini-locking titanium plate system fixation in the treatment of carpal scaphoid fracture Wu Shengxiang, Liu Yuan, Lu Shuai 2021, 25 (12):  1874-1878.  doi: 10.3969/j.issn.2095-4344.3789 Abstract ( 451 )   PDF (698KB) ( 70 )   Save BACKGROUND: The basic principles of carpal scaphoid fracture treatment are immediate rigid fixation, restoration of biomechanical properties, reconstruction of anatomical structure and blood supply. Due to its unique anatomical characteristics and blood supply, it is prone to missed diagnosis and nonunion. OBJECTIVE: To explore the treatment effect of a mini-locking titanium plate system on carpal scaphoid fracture, and analyze its clinical application prospects. METHODS: Forty patients with carpal scaphoid fractures were included and randomly assigned to two groups. Patients in the trial group were fixed with mini-lock titanium plate system (n=20). Patients in the control group were fixed with double-thread hollow countersunk titanium nail (n=20). Perioperative indicators (operation time, intraoperative fluoroscopy and postoperative hospital stay) were observed. Fracture healing time was recorded every month during follow-up. Visual analogue scale score of local pain and wrist function score (Mayo score) were evaluated preoperatively, 3, 8 and 12 months postoperatively.  RESULTS AND CONCLUSION: (1) Both groups of patients completed more than 12 months of follow-up. The double-threaded hollow countersunk titanium nail was placed with internal fixation in the control group, and the mini-lock titanium plate system was taken out of the internal fixation for rehabilitation training in the trial group at 6 months postoperatively. (2) Among the two groups of perioperative indicators, the trial group had an advantage in terms of operation time and intraoperative fluoroscopy (P < 0.05), and there was no significant difference in the length of postoperative hospital stay (P > 0.05). (3) In terms of fracture healing time, the time of the trial group was short (P < 0.05). (4) At 1-year follow-up, there was no significant difference in visual analogue scale score or wrist function score (Mayo score) between the two groups (P > 0.05). (5) It is indicated that the use of a mini-locking titanium plate system for surgical treatment of the carpal scaphoid has certain clinical feasibility. Its relatively stable fixation system can achieve fracture anatomical reduction, strong anti-rotation ability, short fracture healing time, and the patient’s clinical efficacy is positive. This surgical plan is a surgical operation under direct vision, which reduces the difficulty of the operation and the number of fluoroscopy. Figures and Tables | References | Related Articles | Metrics

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A 5-year follow-up on sagittal alignment and radiological outcomes of consecutive three-level anterior cervical discectomy and fusion and hybrid surgery  Ma Long, Tan Xiaoxin, Sun Guoshao 2021, 25 (12):  1879-1885.  doi: 10.3969/j.issn.2095-4344.3769 Abstract ( 471 )   PDF (915KB) ( 157 )   Save BACKGROUND: In the treatment of single- and double-level cervical spondylosis, anterior cervical discectomy and fusion and hybrid surgery can restore local cervical lordosis, and play a role in the overall sequence of the cervical spine, but the role of this conclusion in three-level surgery is still unclear. OBJECTIVE: To compare sagittal alignment, radiological parameters and clinical outcomes between three-level hybrid surgery and anterior cervical discectomy and fusion on cervical spondylotic myelopathy. METHODS: Totally 93 patients with three-level cervical spondylotic myelopathy, who were treated in the Pingdingshan First People’s Hospital from February 2007 to September 2013, were enrolled in this study. Among them, 32 patients underwent anterior cervical discectomy and fusion (anterior cervical discectomy and fusion group); 36 patients underwent single-level disc replacement and double-level hybrid surgery (HS1 group); 25 cases underwent double-level disc replacement and single-level hybrid surgery (HS2 group). X-ray films of cervical spine were taken during the follow-up. Sagittal alignment of cervical spine (C2-C7 cervical lordosis, C2-C7 sagittal vertical axis, and T1 slope) and anatomical parameters (range of motion, upper and lower adjacent range of motion, operated-segment lordosis, and adjacent segment degeneration) were analyzed. Neck disability index and Japanese Orthopedic Association score were used to assess clinical outcomes. This study was approved by the Ethics Committee of Pingdingshan First People’s Hospital.  RESULTS AND CONCLUSION: Ninety-three patients were followed up for a mean of (76.4±9.0) months. (1) There was no significant difference in parameter values of cervical sagittal alignment among the three groups in the final follow-up (P > 0.05). There was no significant difference in the value of each parameter among the three groups at the final follow-up compared with the change before the operation (P > 0.05). (2) There was no significant difference in anatomical parameter values of the cervical spine at the final follow-up among the three groups (P > 0.05), and there was no significant difference in the values of the parameters among the three groups at the final follow-up compared with the preoperative changes (P > 0.05). (3) The neck disability index and Japanese Orthopedic Association score at the final follow-up of the three groups were significantly improved compared with preoperatively (P < 0.05), but there was no significant difference among the three groups (P > 0.05). (4) Correlation analysis showed that there was no clear correlation of cervical spine anatomical parameters and neck disability index with Japanese Orthopedic Association score between postoperative and final follow-up. (5) The results showed that for three-level cervical spondylotic myelopathy, anterior cervical discectomy and fusion and hybrid surgery have achieved a clear mid-term and long-term effect, and there is no clear correlation between anatomical parameters and clinical outcomes, so artificial disc prosthesis implantation is not necessary. Figures and Tables | References | Related Articles | Metrics

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Anatomical and morphological characteristics of knee joint in hemophilic arthritis patients with three-dimensional CT and X-ray films Pei Tianlong, Wang Yongkang, Wu Wenjie, Zhao Hong, Wang Longsheng 2021, 25 (12):  1886-1890.  doi: 10.3969/j.issn.2095-4344.3782 Abstract ( 400 )   PDF (619KB) ( 29 )   Save OBJECTIVE: To provide reference data for the design of knee prosthesis for hemophilic arthritis patients through the measurement of knee three-dimensional CT anatomical morphological parameters and X-ray.  METHODS: A retrospective analysis of 46 cases of knee thin-section CT images and X-ray anteroposterior stand-up radiograph of lower limbs was conducted, including 23 cases of hemophilia patients and 23 cases of ordinary patients. Age, sex, height, body mass and body mass index were collected. Those patients were measured by three-dimensional software for the femoral lateral anteroposterior diameter, width of lateral condyle, femoral medial anteroposterior diameter, width of medial condyle, tibial anteroposterior diameter, tibial mediolateral width, tibial medial anteroposterior line, and tibial lateral anteroposterior. The following measurements were obtained on anteroposterior stand-up radiograph of lower limbs: the anatomical femoral-tibial angle, lateral distal femoral angle, and medial proximal tibial angle. The morphological differences between the two groups were compared and analyzed. RESULTS AND CONCLUSION: (1) The tibial medial anteroposterior line, tibial anteroposterior diameter, the anatomical femoral-tibial angle, and medial proximal tibial angle were smaller in the hemophiliac group than those in the ordinary group, and there were significant difference (P < 0.05). (2) The femoral lateral anteroposterior diameter and femoral medial anteroposterior diameter of the hemophiliac group were both smaller than those in the ordinary group; while width of lateral condyle and width of medial condyle were larger in the hemophiliac group than those in the ordinary group (P < 0.001). (3) The results showed that the anatomical morphology of proximal tibia and distal femur in the hemophiliac group was different from that in the ordinary group. The proximal medial wear of tibia was more severe in the hemophiliac group than in the control group, while the distal medial and lateral femoral condyles were wider in the hemophiliac group than in the ordinary group. In addition, the aspect ratio of the distal femur is relatively small. Figures and Tables | References | Related Articles | Metrics

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Analysis of development trends of global three-dimensional bio-printing technology based on patent information Fan Qingtao, Du Yun, Zhou Lei 2021, 25 (12):  1891-1897.  doi: 10.3969/j.issn.2095-4344.3779 Abstract ( 363 )   PDF (1081KB) ( 95 )   Save BACKGROUND: Three-dimensional (3D) bio-printing provides a new way to solve the problem of organ donor scarcity in the field of tissue engineering and regenerative medicine. OBJECTIVE: To analyze the development trend of global 3D bio-printing technology, technology research and development hotspot, regional layout and cooperation trend, and main innovation subjects based on patent information. METHODS: Using Derwent Innovation as the data source, this paper conducts analysis on items of patent annual distribution, technology research and development hotspots, priority countries, and innovation subjects with tools of Derwent Data Analyzer and Excel.  RESULTS AND CONCLUSION: (1) 3D bio-printing technology has entered a period of rapid development after 2013. 3D bio-printing equipment, technology and processes, biomedical materials, and polymer materials are the main hotspots. Medical model construction, medical implants, drug delivery, printing materials, 3D printing methods, craftsmanship and processes, medical devices and equipment are the core technologies in this field. The most prolific countries are China, the United States, and Korea. (2) The United States is the leader in core technology and product. Although China has a large number of patents, the occupancy of core technology patents is not high, and the quality and influence of patents need to be improved. (3) Foreign countries attach great importance to the layout of patents in the international market. China has fewer foreign patent applications and its global competition awareness is relatively lacking. (4) There are certain differences between countries in the concerned technical fields. Chinese research is focused on areas such as 3D printing equipment, systems, and tissue engineering scaffolds. From the perspective of innovation subject, foreign countries are dominated by enterprises and have a good industrial foundation, while universities are dominated and basic research is valued in China. Figures and Tables | References | Related Articles | Metrics

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Application advantages of three-dimensional printing technology and finite element analysis in scoliosis correction  Zhou Chen, Xing Wenhua 2021, 25 (12):  1898-1903.  doi: 10.3969/j.issn.2095-4344.3781 Abstract ( 656 )   PDF (639KB) ( 86 )   Save BACKGROUND: Scoliosis is a common spinal deformity disease in spinal surgery, which often occurs in many children and adolescents. Severe scoliosis brings physical and psychological damage to patients, and receiving appropriate surgical treatment has become an effective way to solve the problem. OBJECTIVE: To review the research background and development of three-dimensional (3D) printing technology and finite element analysis, and summarize and conclude that the widespread use of 3D printing technology and finite element analysis has promoted the development of spinal orthopedics. METHODS: Using “Scoliosis, 3D printing, finite element analysis” as the English search term, a computer was used to retrieve 200 related documents from 2000 to 2020 in the PubMed database; “Scoliosis, 3D printing, finite element analysis” were used as Chinese search terms, a computer was used to retrieve 11 related documents from 2000 to 2020 in CNKI database. This paper reviews the related literature of 3D printing technology and finite element analysis applied to scoliosis correction research.  RESULTS AND CONCLUSION: Finally, 52 articles were included for review and analysis. (1) 3D printing technology can effectively combine finite element methods to simulate spinal orthopedic surgery to predict and analyze the stress changes between implants and adjacent structures, assist medical staff in preoperative planning and guide the surgical process, and reduce intraoperative bleeding and reduce the risk of corresponding complications. (2) 3D printing technology and finite element analysis have certain limitations; their cost is relatively expensive, and a complete database has not yet been formed, which may have a certain impact on the treatment of patients. (3) In short, although 3D printing technology and finite element method have shortcomings, they have important contributions to scoliosis correction, and their development prospects in the medical field are worth looking forward to. Figures and Tables | References | Related Articles | Metrics

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Optimization application for internal fixation strategy and three-dimensional printing technique of posterolateral tibial plateau fracture Wang Debin, Bi Zhenggang 2021, 25 (12):  1904-1910.  doi: 10.3969/j.issn.2095-4344.3773 Abstract ( 337 )   PDF (662KB) ( 37 )   Save BACKGROUND: For posterolateral tibial plateau fracture due to the complex anatomical relationship of its location, there are often some controversial issues in choice of surgical approach and internal fixation strategy. In addition, with the development of three-dimensional (3D) printing technique in clinical work, it has had a positive impact on surgical treatment of posterolateral tibial plateau fracture.  OBJECTIVE: To summarize and prospect the research progress of surgical treatment of posterolateral tibial plateau fracture in surgical approach, internal fixation strategy and 3D printing technique in recent years.  METHODS: The first author used Chinese and English search terms to search the relevant literature collected in the Web of Science, PubMed and CNKI databases from May 2011 to May 2020. The keywords were “tibial plateau, posterolateral, fracture, approach, internal fixation, 3D printing” in English and Chinese. The relevant literature was screened and sorted out, and conducted a detailed review. RESULTS AND CONCLUSION: (1) Surgical approaches of posterolateral tibial plateau fracture are mainly non-osteotomy and trans-osteotomy, of which there are many types of non-osteotomy. (2) The posterolateral approach is a direct approach, and the surrounding anatomical structure is relatively complex. Lateral and anterolateral sites can be treated with anterolateral tibial plateau fracture and the anterolateral approach does not involve important blood vessel and nerves. The posterior median approach can reveal the entire posterior tibial plateau. The posteromedial approach can be an auxiliary approach. If combined with the anterior-lateral approach, it can reveal almost the entire tibial plateau. (3) Although the osteotomy approach can increase the surgical field, it carries the complications. (4) There are many types of internal fixation materials with their own characteristics, and internal fixation method has also been improved. (5) 3D printing technique facilitates the formulation of surgical approaches and internal fixation strategies as well as research and testing of biomechanics aspects of internal fixation materials and methods. (6) In the future, it is still necessary to reach the optimal surgical access standard for posterolateral tibial plateau fracture. The new internal fixation materials not only require biomechanical testing, but also require a large number of clinical application effect analysis. Figures and Tables | References | Related Articles | Metrics

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Application of digital technology in the treatment of hallux valgus Wang Wencheng, Zhang Xingfei, Xu Yajun 2021, 25 (12):  1911-1916.  doi: 10.3969/j.issn.2095-4344.3783 Abstract ( 443 )   PDF (610KB) ( 136 )   Save BACKGROUND: Surgical treatment of hallux valgus includes bone surgery and soft tissue balance surgery. At present, many surgical plans are made based on the experience of the surgeon. There are many surgical methods for hallux valgus, and the pathological changes are complex and diverse. No surgery can perfectly solve all the problems of hallux valgus, and the surgical effect is not accurate, and the learning curve is also long. OBJECTIVE: To explore the application of digital technology in the treatment of hallux valgus. METHODS: Databases of PubMed, Wanfang, and CNKI were searched. The key words were “hallux valgus; digital technology; biomechanics; finite element; digital orthopedics; osteotomy” in Chinese and English. Retrieval time was from January 2000 to May 2020. Among 571 articles in English and 350 articles in Chinese, 42 articles were selected according to the inclusion criteria for review. RESULTS AND CONCLUSION: (1) When clinical treatment of hallux valgus is performed, the software is used to reconstruct the three-dimensional simulation model, to simulate the operation under different working conditions, and to analyze the orthopedic effect. This has a clear guiding significance for preoperative planning and is helpful to reduce the incidence of postoperative complication of hallux valgus and optimize the orthopedic effect. (2) The use of computer software for three-dimensional modeling and finite element plantar stress analysis has obvious advantages for the study of biomechanical mechanisms and the evaluation of postoperative clinical efficacy. (3) The clinical application of three-dimensional printed hallux valgus osteotomy guide plate and bone model can enable the patients with hallux valgus to get more accurate and personalized treatment.  Figures and Tables | References | Related Articles | Metrics

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Application of tourniquet affects thickness of bone cement penetration in total knee arthroplasty: a meta-analysis Song Min, Lu Chao, Chen Jin, Wu Gaoyi, Li Congcong, Li Anan, Ye Guozhu, Lin Wenzheng, Cai Yuning, Liu Wengang, Xu Weipeng 2021, 25 (12):  1917-1923.  doi: 10.3969/j.issn.2095-4344.3790 Abstract ( 319 )   PDF (718KB) ( 45 )   Save OBJECTIVE: The tourniquet is currently widely used in total knee arthroplasty. However, whether the application of tourniquet can increase the thickness of bone cement around the prosthesis, thereby increasing the stability and long-term survival of the prosthesis, is still unclear. This article intends to determine whether the use of tourniquet will increase the penetration thickness of bone cement through meta-analysis. METHODS: Cochrane Library, Medline, Embase, PubMed, CNKI Chinese database, Wanfang database and other databases were retrieved to search the randomized controlled trials of whether the tourniquet was used in total knee arthroplasty from inception to April 21, 2020. The test that met the standard was evaluated using Cochrane system evaluation method, and meta-analysis was performed using RevMan 5.2 software. The main outcome indicators were bone cement penetration thickness and visual analogue scale score; and the secondary outcome indicators were blood loss, blood transfusion rate, postoperative hemoglobin reduction, and complications. RESULTS: (1) Finally, 11 randomized controlled trials were included. A total of 863 patients were included, containing 432 patients with tourniquet and 431 patients without tourniquet in total knee arthroplasty. (2) Meta-analysis results showed that intraoperative use of tourniquet could effectively increase the bone cement penetration thickness around the tibial part of the prosthesis (MD=0.22, 95%CI:0.12-0.31, P < 0.000 01), but increased the incidence of complications (OR=4.02, 95%CI:2.11-7.67, P < 0.001), increased postoperative pain (MD=1.14, 95%CI:0.30-1.98, P=0.008). Reducing blood loss, blood transfusion rate and postoperative hemoglobin reduction had no significant significance (P > 0.05).  CONCLUSION: The application of tourniquet in total knee arthroplasty can increase the thickness of bone cement around the tibial part of the prosthesis, and may increase the long-term survival rate of the prosthesis. However, limited to the current literature quality and sample size, the above conclusions need more high-quality research to verify. Figures and Tables | References | Related Articles | Metrics

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Fixed-bearing prosthesis versus mobile-bearing prosthesis during total knee arthroplasty for different follow-up periods: a meta-analysis Wang Xin, Lin Xiaodong, Liu Hongliang, Huang Zexin, Xu Shuchai, Chen Bojian 2021, 25 (12):  1924-1929.  doi: 10.3969/j.issn.2095-4344.3791 Abstract ( 271 )   PDF (1142KB) ( 109 )   Save BACKGROUND: Total knee arthroplasty is one of the most successful methods for treating knee osteoarthritis in the elderly. Compared with fixed-bearing prosthesis, mobile-bearing prosthesis has the theoretical advantages of reducing the wear of the prosthesis and increasing the range of motion. Most of the above studies found no significant difference between the two.  OBJECTIVE: To evaluate the differences of clinical effects between fixed-bearing and mobile-bearing prosthesis in total knee arthroplasty through meta-analysis.   METHODS: The databases of CNKI, Wanfang, VIP, CBM, PubMed, EMBase and Cochrane Library were systematically retrieved. The literature was strictly selected according to the inclusion criteria. We collected high-quality randomized controlled trials of total knee arthroplasty patients, who were operated with fixed-bearing or mobile-bearing prosthesis. The Cochrane Collaboration manual was used to evaluate the risk of bias and the modified Jadad score scale was utilized to evaluate the quality of the literature. The relevant data were extracted according to the primary outcome measures: Knee Society score, knee Knee Society score function score; and secondary outcome measures: range of motion, Oxford knee score and revision rate. The relevant data were analyzed with RevMan 5.3 software.   RESULTS: Fifteen randomized controlled trials were eligible for meta-analysis. According to the modified Jadad rating scale, there were 4 articles with 6 points, 10 articles with 5 points and 1 article with 4 points. There are 1 277 samples in the fixed-bearing group and 1 244 in the mobile-bearing group. Meta-analysis results demonstrated that (1) there was no statistically significant difference in Knee Society score-knee score, range of motion, Oxford knee score, and revision rates between the two groups using fixed-bearing and mobile-bearing prostheses in the short-term follow-up (< 5 years) subgroup (P > 0.05). The Knee Society score-function score in the mobile-bearing group was superior to that in the fixed-bearing group (MD=-2.26, 95%Cl: -4.71 to -0.34, P=0.02). (2) In the subgroup of long-term follow-up (≥ 5 years), there was no significant difference between the two groups in Knee Society score-knee score, Knee Society score-function score, and revision rate (P > 0.05). Range of motion in the mobile-bearing group was better than that in the fixed-bearing group (MD=-3.60, 95%Cl: -6.99 to -0.21, P=0.04). CONCLUSION: in total knee arthroplasty, whether in short-term follow-up or mid-to-long-term follow-up, mobile-bearing prosthesis is not much different from fixed-bearing prosthesis in most respects. However, there is weak evidence that the improvement of knee joint function after knee arthroplasty with mobile-bearing prosthesis is slightly better than that with fixed-bearing prosthesis. Most of the articles were followed up in short and medium terms. More high-quality, large-sample and multi-center randomized controlled trials are needed to verify the reliability of the conclusions. Figures and Tables | References | Related Articles | Metrics

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Meta-analysis of efficacy and safety of bone filling bag vertebroplasty and percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture#br# Zhong Yuanming, Wan Tong, Zhong Xifeng, Wu Zhuotan, He Bingkun, Wu Sixian 2021, 25 (12):  1930-1935.  doi: 10.3969/j.issn.2095-4344.3792 Abstract ( 438 )   PDF (794KB) ( 79 )   Save OBJECTIVE: It remains disputed whether there is a difference in efficacy and safety between bone filling bag vertebroplasty and percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture. This study systematically analyzed the efficacy and safety of bone filling bag vertebroplasty and percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture. METHODS: A computer-based online search of CNKI, Wanfang, VIP, EMBASE, PubMed, CBM, and The Cochrane library was performed to retrieve randomized controlled trial studies and cohort studies regarding bone filling bag vertebroplasty and percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture published before March 2020. Moreover, related papers were retrieved manually. After two evaluators independently selected literature, extracted data and evaluated the quality of methodology included in the study, meta-analysis was carried out by using Stata/SE 12.0 software.  RESULTS: (1) A total of seven articles were included, with 709 patients, of whom 321 were treated with bone filling bag vertebroplasty and 388 with percutaneous vertebroplasty. The quality of the two randomized controlled trials was grade B. The scores of NOS in two cohort studies were 8. The other three cohorts scored 7 on the NOS scale. (2) The meta-analysis results showed that there were significant differences between the two methods in reducing Cobb angle (MD=-1.92, 95%CI:-2.15 to -1.68, P < 0.05) and the leakage rate of bone cement (RR=0.15, 95%CI:0.07-0.30, P < 0.05). There was no significant difference between the two methods in reducing visual analogue scale score (MD=-0.03, 95%CI:-0.12-0.06, P=0.521) and Oswestry disability index (MD=0.16, 95%CI:-0.93-1.26, P=0.770).  CONCLUSION: Compared with the conventional percutaneous vertebroplasty, bone filling bag vertebroplasty has a significant advantage in improving Cobb angle and reducing the leakage rate of bone cement. The clinical therapeutic effects of the two methods are similar in visual analogue scale score and Oswestry disability index. In view of the limited quality of the included literature, more high-quality multicenter randomized controlled trials are needed to provide evidence support for the above conclusion. Figures and Tables | References | Related Articles | Metrics

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Meta-analysis of risk factors associated with adjacent segment degeneration after lumbar posterior fusion Zhang Tengfei, Wang Kun, Zhu Yanyu, Mei Wei, Wang Qingde 2021, 25 (12):  1936-1943.  doi: 10.3969/j.issn.2095-4344.3793 Abstract ( 351 )   PDF (873KB) ( 69 )   Save OBJECTIVE:  With the development of the lumbar pedicle internal fixation system, lumbar posterior fusion has been widely used in the treatment of degenerative diseases of the lumbar spine. Adjacent segment degeneration is one of the long-term complications after lumbar fusion. There are many risk factors affecting postoperative adjacent segment degeneration, some of which are still controversial, so it is necessary to conduct systematic analysis. Thus, this study investigated the risk factors of adjacent segment degeneration after posterior lumbar fusion. METHODS: A comprehensive computer search was conducted for PubMed, The Cochrane Library, Embase, CNKI, Wanfang, and VIP database. The major orthopedic journals with high impact factors in and outside China were manually searched. The search term mainly included “lumbar fusion”, “adjacent segment degeneration”, “factors”, “ASD” and “risk factors”. The search period was from the database inception to March 2020, including the single-factor or multi-factor analysis of adjacent segment degeneration after lumbar posterior fusion. Literature quality was strictly evaluated using NOS scale after literature was screened according to inclusion and exclusion criteria. The primary outcome measure was age ≥ 60 years. Secondary outcome measures included: gender (female), smoking history, body mass index, osteoporosis, preoperative presence of adjacent segment degeneration, surgical approach of posterior lumbar interbody fusion, fusion segment > 1, laminectomy, and floating fusion. Among them, body mass index was a continuous variable index, and the rest were binary variables. Relevant data were extracted and statistically analyzed using Revman 5.3 software. RESULTS: (1) A total of 18 literatures were included, among which 14 were of high quality, 4 were of medium quality, 17 were case control studies, and 1 was retrospective cohort study. A total of 568 patients with adjacent segment degeneration after lumbar posterior fusion were included, and 2 936 patients in the control group were included. (2) Age ≥ 60 years (OR=2.59, 95%CI:1.83-3.67), P < 0.000 01), smoking history (OR=1.63, 95%CI(1.17-2.26), P=0.004], body mass index (OR=3.54, 95%CI: 2.67-4.41), P < 0.000 01), preoperative presence of adjacent segment disc degeneration (OR=3.68, 95%CI: 2.85-4.76), P < 0.000 01), fusion segment > 1 (OR=1.82, 95%CI: 1.39-2.38), P < 0.000 1) were strongly correlated with adjacent segment degeneration after posterior lumbar fusion. (3) Age ≥ 60 years (OR=2.62, 95%CI:1.71-4.02, P < 0.000 01), preoperative presence of adjacent segment intervertebral disc degeneration (OR=4.45, 95%CI:3.08-6.44), P < 0.000 01), and fusion segment > 1 (OR=1.56, 95%CI:1.06-2.31), P=0.03] were independent risk factors for adjacent segment degeneration after lumbar posterior fusion.   CONCLUSION: The gender, osteoporosis, operation method, laminectomy, and floating fusion had no obvious correlation with adjacent segment degeneration. However, the above conclusions need to be verified by large-sample and high-quality clinical studies. Figures and Tables | References | Related Articles | Metrics

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Low-intensity pulsed ultrasound in treatment of fractures: a systematic review and meta-analysis Xia Sijie, Liao Qi 2021, 25 (12):  1944-1950.  doi: 10.3969/j.issn.2095-4344.3794 Abstract ( 476 )   PDF (1253KB) ( 55 )   Save OBJECTIVE: Although many randomized trials have shown that low-intensity pulsed ultrasound can promote fracture healing, important evaluation results such as small sample size and subjective differences of statisticians are inconsistent. This study aimed to evaluate the efficacy of low-intensity pulsed ultrasound in the treatment of fractures.  METHODS: PubMed, Cochrane Library, Embase, CNKI, Wanfang Medical Network, VIP databases, and Nanchang University Library were searched to collect randomized controlled studies on the impact of low-intensity pulsed ultrasound on fracture treatment from March 1999 to March 2020. Two evaluators independently conducted quality evaluation, data extraction and cross-check on the included studies. Finally, RevMan 5.3 software was used to perform meta-analysis on the relevant data. RESULTS: (1) A total of 11 randomized controlled trials were included, including 1 515 patients. The 765 patients in the trial group were treated with low-intensity pulsed ultrasound, and the 750 patients in the control group were treated with placebo or only ordinary instrument treatment group. (2) Meta-analysis showed that healing time of fracture was shorter in the trial group than that in the control group [MD=-17.92, 95%CI(-28.44, -7.41), P=0.000 8]. There was no significant difference in incidence of nonunion and delayed union after fracture, time to return to full load, time to return to work, clinical standard fracture healing time, incidence of nonunion and delayed union of upper limb and lower limb, quality of life improvement and pain reduction (P > 0.05).  CONCLUSION: Low-intensity pulsed ultrasound can shorten the healing time of fracture. Figures and Tables | References | Related Articles | Metrics

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Dexmedetomidine combined with local anesthetic for brachial plexus block: a systematic review and meta-analysis Wang Shao, Yuan Dajiang, Li Yanyan, Li Xiaoya 2021, 25 (12):  1951-1958.  doi: 10.3969/j.issn.2095-4344.3780 Abstract ( 377 )   PDF (815KB) ( 39 )   Save OBJECTIVE: The current research sample on the effect of dexmedetomidine in brachial plexus block is small and the results are inconsistent. Meta-analysis was used to evaluate the effect of dexmedetomidine combined with local anesthetics on brachial plexus block. METHODS: In PubMed, Embase, Cochrane Library, CNKI, Wanfang Medical Network, and VIP database, the authors searched for related literature published from inception to December 2019 based on keywords such as dexmedetomidine, and brachial plexus block. The type of study included was clinical randomized controlled trials. The subjects were patients over 18 years old who received brachial plexus blockade. The intervention was dexmedetomidine combined with local anesthetics. Two researchers independently screened the literature. The Cochrane systematic review manual was used for literature quality evaluation, and Revman5.3 software was used for meta-analysis. The main outcome measures included the duration of analgesia and the duration of exercise block, and the secondary outcome measure was adverse events. Weighted mean difference and relative risk were used as the combined effects. RESULTS:  (1) A total of 24 articles were included, with 1 612 samples. One article did not mention randomness, 11 did not mention allocation concealment, and 6 did not mention blind method. (2) Both perineural (WMD=182.91, 95%CI:129.85-235.96, P < 0.001) and intravenous dexmedetomidine (WMD=180.47, 95%CI:83.01-277.93, P=0.000 3) could effectively prolong analgesic duration. Perineural application could also extend the duration of motor block (WMD=147.57, 95%CI:120.81-174.33, P < 0.001). (3) Compared with the intravenous group, the perineural group had an advantage in extending the duration of analgesia (WMD=69.24, 95%CI:24.92-113.56, P=0.002) and the duration of motor block (WMD=74.35, 95%CI:47.68-101.01, P < 0.001). (4) After applying dexmedetomidine, the most common adverse event was bradycardia (RR=5.08, 95%CI:3.25-7.93, P < 0.001).  CONCLUSION: Dexmedetomidine combined with local anesthetic can significantly prolong the duration of brachial plexus block, but simultaneously increase the incidence of bradycardia. In terms of duration of analgesia and duration of exercise block, peri-brachial plexus administration is superior to intravenous administration. However, this article also has the shortcomings of high heterogeneity and low quality of the included literature. Therefore, more large-scale multicenter high-quality randomized controlled trials are still needed for further verification in the future. Figures and Tables | References | Related Articles | Metrics

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A meta-analysis of clinical efficacy of preoperative use of three-dimensional printing in the treatment of tibial plateau fractures Li Yang, Min Shengwei, Xie Feng, Zhang Mingyong 2021, 25 (12):  1959-1968.  doi: 10.3969/j.issn.2095-4344.3795 Abstract ( 356 )   PDF (1034KB) ( 163 )   Save OBJECTIVE: Because of the complex structure around the tibial plateau and the difficulty in treatment after the occurrence of fracture, it is very helpful to understand the location and type of fracture in detail before operation. The rise of three-dimensional (3D) printing technology, the virtual data can be transformed into a solid model, so that the operator can perform surgical exercises before operation, thus improving the quality of operation. Through meta-analysis and comparison of the difference between the preoperative use of 3D printing technology and the routine operation without 3D printing technology in the treatment of tibial plateau fracture, it provides the basis for its clinical application. METHODS: The Cochrane library, PubMed, EBSCO, cambridge science abstracts (CSA), CNKI, VIP, and Wanfang databases were searched. The retrieval was all from inception to April 30, 2020). All related articles concerning the 3D printing auxiliary operation with the 3D printing technology of conventional surgical treatment of tibial plateau fractures were collected. Through keyword search, the literature was screened according to the inclusion and exclusion criteria. The Cochrane system evaluator manual and NOS score were used to evaluate the quality of the included literature, and data were extracted. The primary outcome measures (operation time, intraoperative blood loss, fracture healing time, HSS score and excellent and good rate, Rasmussen score and excellent and good rate) and secondary outcome measures (postoperative complications, anatomic reduction rate and intraoperative fluoroscopy times) were analyzed using RevMan 5.3 software.   RESULTS: Thirty articles with high quality were included, and the total number of cases was 1 564, including 757 in 3D printing group and 807 in routine group. The meta-analysis results showed that (1) the operation time (SMD=-2.14, 95%CI:-2.46 to -1.81, P < 0.000 01), intraoperative blood loss (SMD=-1.44, 95%CI:-1.66 to -1.23, P < 0.000 01), HSS 6 months postoperatively and last HSS score (SMD=0.68, 95%CI:0.44-0.92, P < 0.000 01; SMD=0.96, 95%CI:0.79-1.13, P < 0.000 01), Rasmussen score (SMD=2.34, 95%CI:1.68-3.00, P < 0.000 01), the excellent and good rate of HSS and Rasmussen scores (OR=3.85, 95%CI:2.33-6.36, P < 0.000 01; OR=2.96, 95%CI:1.43-6.09, P=0.003), and the anatomical reduction rate (RR=1.49, 95%CI:1.21-1.83, P=0.000 2) were better in the 3D printing group than those in the routine group. (2) Bone healing time (SMD=-1.68, 95%CI:-2.21 to -1.16, P < 0.000 01), incidence of postoperative complications (RR=0.31, 95%CI:0.20-0.49, P < 0.000 01], and number of intraoperative fluoroscopy (SMD=-1.77, 95%CI:-2.65 to -0.88, P < 0.000 01) were less in the 3D printing group than those in the routine group.  CONCLUSION: The clinical effect and prognosis of 3D printing auxiliary surgical treatment of tibial plateau fractures were better than conventional surgery. However, it is necessary to carry out large-scale multi-center high-quality clinical trials in the future. Figures and Tables | References | Related Articles | Metrics