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    28 May 2021, Volume 25 Issue 15 Previous Issue    Next Issue
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    Biomechanical characteristics of a sleeve-type guided growth rod in a six-degree-of-freedom joint robot 
    Xue Jingbo, Zhu Bin, Li Zepeng, Wang Cheng, Ouyang Zhihua, Yan Yiguo
    2021, 25 (15):  2297-2302.  doi: 10.3969/j.issn.2095-4344.3811
    Abstract ( 325 )   PDF (784KB) ( 81 )   Save
    BACKGROUND: The treatment of early-onset scoliosis is difficult. The traditional growth rod system has proved its therapeutic effect, but it requires repeated surgical interventions, and the incidences of spontaneous fusion, surgical site infection, rod rupture and other complications are high. Therefore, a kind of growth rod system is needed, which not only can correct the physiological curve of the spine, but also allow the spine to grow while avoiding multiple surgical interventions and reducing spontaneous fusion.   
    OBJECTIVE: To evaluate the biomechanical properties of a sleeve-type guided growth rod in a six-degree-of-freedom joint robot. 
    METHODS: Eight spine specimens of the immature pigs were respectively instrumented with the sleeve-type guided growth rod system and the traditional pedicle screw internal fixation system, and a six-degree-of-freedom joint robot was used to test the immature pig spine specimens in the flexion-extension, lateral bending and axial rotation for flexibility test. 
    RESULTS AND CONCLUSION: (1) In the range of motion test, there was no significant difference between the sleeve-type guided growth rod system and the traditional pedicle screw system (P > 0.05). The lateral bending range of motion was (30.50±5.32)° and (28.25±4.24)° respectively, and the difference was statistically significant (P < 0.05). The axial rotation range of motion was (67.88±9.55)° and (35.25±5.09)° respectively, and the difference was statistically significant (P < 0.05). (2) In the neutral zone stiffness test, the difference at the flexion and extension between the neutral stiffness of the sleeve-type guided growth rod system and the traditional pedicle screw rod system was not statistically significant (P=0.914, 0.207). The neutral zone stiffness of the axial rotation was (0.05±0.01) N•m/(°) and (0.08±0.01) N•m/(°), and the difference was statistically significant (P=0.003). (3) It is concluded that compared with the traditional pedicle screw rod system, the range of motion of the sleeve-type guided growth rod system has increased in the axial rotation and lateral bending. At the same time, the stiffness of the specimen instrumented with the sleeve-type guided growth rod system was lower than when instrumented with the traditional pedicle screw rod system for axial rotation. 
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    Spatiotemporal, kinematic and kinetic characteristics of gait in children with genu valgus
    Li Yang, Jiang Shuyun, Li Yiying, Yu Yan, Lu Xiaoying, Wang Danci
    2021, 25 (15):  2303-2308.  doi: 10.3969/j.issn.2095-4344.3814
    Abstract ( 457 )   PDF (680KB) ( 144 )   Save
    BACKGROUND: Genu valgus as a major deformity of children’s lower limbs may appear abnormal manifestations in the early stage of growth and development. However, the current research mainly focuses on the surgical treatment, and the research on the gait of children with genu valgus is relatively lacking.   
    OBJECTIVE: To provide scientific basis for the early evaluation and treatment through the systematic analysis of the gait characteristics of children with genu valgus. 
    METHODS: Fifty children with genu valgus and 50 healthy volunteers were selected. According to the occurrence of genu valgus, the subjects were divided into 3-6 years old and 7-12 years old. Three-dimensional gait analysis system was used to collect the kinematic, dynamic and spatiotemporal parameters of each subject. The gait parameters of children with genu valgus were compared with those of healthy children to summarize the gait characteristics. 
    RESULTS AND CONCLUSION: (1) In terms of spatiotemporal parameters, the step length, forward velocity and step width of children with genu valgus decreased, while the single support time of children aged 7-12 increased. (2) In terms of kinematic parameters, the angle of foot pronated and genu valgus increased; the angle of tibia internal rotation increased; the maximum extension angle of hip joint decreased; and the angle of foot clearance decreased in children with genu valgus in stance phase; the maximum plantar flexion angle and the range of ankle joint flexion also decreased in children aged 7-12 years old. (3) In terms of dynamics, the ground reaction force in vertical direction decreased when the foot was off the ground; the maximum power of ankle and knee joint of children at the age of 3-6 decreased; and the moment of knee valgus decreased; the ground reaction force in vertical direction decreased and the power of hip joint decreased during the loading response period of children at the age of 7-12. (4) The results show that the walking efficiency and stability of children with genu valgus decreases, the lower limb propulsion ability decreases, and the line alignment is abnormal in ankle and knee joints. In children with knee valgus of low age, the compensatory abnormal movement of hip joint and the functional decline of lower limb muscle group are more obvious; in children with knee valgus of mature gait, the abnormal compensation of hip joint is reduced, but the abnormal line alignment of ankle and knee joint always exists. 

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    Biomechanical properties of three types of posterior single-segment fixation for type II Hangman’s fracture
    Ruan Hanjiang, Jin Genyang, Li Xinwu, Yao Jian, Wu Peng, Zhang Yin, Zhang Shuai, Xiao Jun
    2021, 25 (15):  2309-2314.  doi: 10.3969/j.issn.2095-4344.3812
    Abstract ( 305 )   PDF (727KB) ( 221 )   Save
    BACKGROUND: Single-segment common C2 pedicle screw has the characteristics of weak tension and poor stability of isolated fixation with two screws in the treatment of Hangman’s fracture.   
    OBJECTIVE: To analyze the biomechanical properties of three posterior single-segment internal fixation methods for type II Hangman’s fractures with three-dimensional finite element method, and to explore the value of the new internal fixation system in the treatment of type II Hangman’s fractures. 
    METHODS: The imaging data of a healthy adult male upper cervical spine were obtained by CT scanning. A three-dimensional finite element model of the normal upper cervical spine (C0-3) was established by software (Mimics 10.01 and Abaqus 6.12), and its availability was verified. Based on the availability verification, the model of type II Hangman’s fracture was established, and then three kinds of internal fixation models were established: Model A: common pedicle screws model, Model B: new pedicle screws model, Model C: new pedicle screws + “Ω” transverse model. The range of motion and the stress of the implanted screw of the each model under different working conditions were compared. 
    RESULTS AND CONCLUSION: (1) The range of motion of each segment of C0-3 under different working conditions was smaller than the normal model, and the largest difference was in the rotation direction of C2-3, which was increased by 0.6°, 0.8° and 0.8° in the three internal fixation models A, B, and C. There was no statistically significant difference in range of motion between the three internal fixation models and the normal model (P > 0.05). (2) The order of the maximum stress of the three groups of internal fixation implants in each working condition was as follows: Group A > Group B > Group C, and the screw stress concentration point was in the middle of the screw. The three internal fixation models of the difference in maximum stress were statistically significant by statistical analysis (P < 0.05). (3) New pedicle screws + “Ω” transverse internal fixation has better anti-fatigue characteristics and could retain the physiological activity of the cervical spine to the greatest extent. It is a well type that can be used to treat type II Hangman’s fracture internal fixation. 

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

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    Characteristics and changes of plantar pressure of healthy men aged 3-35 years old during natural walking 
    Lin Qinqin, Li Ruoming, Geng Yuanwen, Yuan Hang, Yang Xiaoli
    2021, 25 (15):  2315-2320.  doi: 10.3969/j.issn.2095-4344.3804
    Abstract ( 394 )   PDF (649KB) ( 75 )   Save
    BACKGROUND: The plantar pressure characteristics of the human body can effectively reflect the structure, function, mechanical characteristics, and posture control status of the foot. Age is an important factor that affects the characteristics of normal people’s plantar pressure.   
    OBJECTIVE: To analyze the parameters such as plantar contact time, pressure impulse, contact area, peak pressure, peak pressure and other parameters of natural gait of 3-35 year-old healthy men, and to explore the differences and trends of plantar pressure characteristics of 3-35 year-old healthy men. 
    METHODS: 200 healthy males were selected as the research objects. There were the group of 3-6 years old preschool children (group A), the group of 7-12 years old school children (group B), the group of 13-18 years old children (group C), the group of 19-25 years old youth (group D), and the group of 26-35 years old adult (group E), each group of 40 people. The Belgian foot scan USB plantar pressure detection system was used to detect the plantar pressure of the five groups of subjects under natural gait. The plantar dynamic contact time, pressure impulse, contact area, peak pressure, and peak pressure were observed. The implementation of the research plan complied with the relevant ethical requirements of Yanshan University for research. All subjects and their family members signed informed consent. 
    RESULTS AND CONCLUSION: (1) The plantar contact time in the first phalange of toes (T1), metatarsal bones 1-5 (MH1-5), heel medial (RFM), and heel lateral (RFL) regions increased significantly with age (P < 0.05). (2) The plantar maximum pressure impulse mainly appeared in the T1, MH1, and MH3 regions, and the minimum pressure impulse appeared in the foot arch medial (MFM) region. The average plantar pressure impulse in the T1, MH1-4, RFM, and RFL regions increased significantly with age (P < 0.05). (3) The area of plantar contact increased significantly with age in T1, MH1-4, RFM, and RFL regions (P < 0.05). (4) The peak of plantar pressure increased significantly in the MH1-4 areas of the A-D groups (P < 0.05), and decreased significantly in the E group (P < 0.05). The peak of plantar pressure in the MH1, MH5, RFM, and RFL was fluctuating. The maximum pressure peak of the sole was concentrated in the MH1-3 areas. (5) The peak of plantar pressure increased significantly with age in the MH1-4 areas. The MH5, MFM, and MFL areas showed a volatility trend. The T1-5, RFM, and RFL areas increased significantly in the A-C groups and decreased significantly in the D and E groups. The pressure peaks in groups B, C, D, and E were significantly higher than those in group A (P < 0.05). It is indicated that with age, healthy men aged 3-35 years old have a longer plantar contact time under natural gait, and the largest plantar contact area shifts from the first phalanx to the inside of the heel. With the development of the foot, the weight-bearing parts of the foot appear heavy in the front and light in the back. Forefoot plantar pressure parameters increase, and the maximum pressure, impulse, and pressure on the plantar region are concentrated on the first, second, and third metatarsal bones. Therefore, in view of the change characteristics of plantar pressure parameters from preschoolers to mature years, choosing the corresponding shoes for daily life and exercise can effectively prevent foot injuries. 

    中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

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    Finite element analysis of novel femoral neck system for unstable femoral neck fractures
    Fan Zhirong, Su Haitao, Zhou Lin, Huang Huida, Zhou Junde, Jiang Tao, Liu Zitao
    2021, 25 (15):  2321-2328.  doi: 10.3969/j.issn.2095-4344.3810
    Abstract ( 488 )   PDF (1241KB) ( 118 )   Save
    BACKGROUND: Treatment strategies for femoral neck fractures include cannulated screw fixation, dynamic hip screw fixation, intramedullary nail fixation, locking plate fixation, and hip replacement. However, the best treatment for Pauwels type III femoral neck fractures is still controversial.   
    OBJECTIVE: To analyze the biomechanical characteristics of a novel femoral neck system for unstable femoral neck fractures by using a three-dimensional finite element analysis method. 
    METHODS: The CT imaging data of the femur of a healthy volunteer were selected and imported into the medical three-dimensional reconstruction software Mimics 21.0 to obtain the original three-dimensional model of the femur. The model was exported to an STL format file and imported into the Geomagic Wrap2017 software for optimization so as to construct femoral cortical bone and cancellous bone structure. The optimized model was imported into Solidworks2017 software, and the 3D model of Pauwels type III femoral neck fracture was reconstructed through Boolean operation. The Pauwels angles are set to 50°, 60° and 70°, respectively. Solidworks2017 software was used to establish three types of internal fixation models (femoral neck system, positive triangular hollow screw, and inverted triangular hollow screw) based on clinical fixation procedures and engineering geometric data modeling. Finally, Abaqus2017 software was used for meshing. After applying load and data calculation, the stress distribution, peak stress and maximum displacement of femur and internal fixation were analyzed in each model. 
    RESULTS AND CONCLUSION: (1) No matter what the angle of the fracture, the stress of the proximal femur in the three internal fixation models was mainly distributed near the medial femoral talus and spread to the surroundings. Among them, the inverted-triangular hollow screw group had the largest stress. The femoral neck system group had the smallest stress. (2) Regardless of the angle of the fracture, the stress of the internal fixation device in the three internal fixation models was mainly distributed on the middle surface of the screw near the fracture line, and the inverted triangle hollow screw group had the least stress, and the femoral neck system group had the largest stress. (3) No matter what the angle of the fracture, the peak displacement of the femur in the three internal fixation models was mainly concentrated on the top of the femoral head. Among them, the peak displacement was the largest in the inverted triangular hollow screw group, and the smallest in the femoral neck system group. (4) No matter what angle of fracture, the peak displacement of the internal fixation device in the three internal fixation models was mainly at the top of the screw. The peak displacement was the largest in the positive triangle hollow screw group, and the smallest in the femoral neck system group. (5) The results show that the biomechanical stability of the femoral neck system for the treatment of unstable femoral neck fractures is better than that of hollow screws, and the risk of internal fixation failure is lower than that of hollow screws. 

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    Finite element analysis of two internal fixation methods for treating extra-articular proximal tibial fractures
    Han Shichong, Li Chang, Xing Haiyang, Ge Wenlong, Wang Gang
    2021, 25 (15):  2329-2333.  doi: 10.3969/j.issn.2095-4344.3815
    Abstract ( 484 )   PDF (768KB) ( 98 )   Save
    BACKGROUND: With the development of intramedullary nail technique, use of intramedullary nailing to treat proximal tibia fractures has gradually increased. However, it is not so clear about the biomechanical stability of intramedullary nails and double locking plate fixation of proximal tibial fractures.   
    OBJECTIVE: To simulate extra-articular comminuted proximal tibia fracture using three-dimensional finite element, and to analyze biomechanical characteristics of intramedullary nailing and bilateral locking plate fixation under different forces. 
    METHODS: The finite element model of the extra-articular comminuted proximal tibia fracture was established by using the CT tibial data. According to the principle of internal fixation, the proximal tibia bilateral locking plate and proximal tibia intramedullary nail were assembled. The finite element analysis method was used to analyze the displacement and stress of the two internal fixation methods of the comminuted proximal tibia fracture under different loading conditions. 
    RESULTS AND CONCLUSION: (1) Under the axial load, in the intramedullary nail model, the stress of internal fixation and the tibia was minimal. The displacement of the fractured end was smallest. The stress of the internal fixation was mainly concentrated near the fractured end, and the stress distribution was more uniform in the intramedullary nail model. (2) Under the three-point bending load, in the intramedullary nail model, the stress of internal fixation and the tibia was minimal, but the displacement of the fractured end was higher than the double-plate model. Stress concentration occurred at the intersection of the third locking nail and the main nail at the proximal end of the intramedullary nail. The internal fixation stress was mainly concentrated around the locking screw on both sides of the steel plate. (3) Under the torsional force, the internal fixation system of the intramedullary nail model bore the smallest stress and generated the smallest fracture end displacement. The internal fixation stress was evenly distributed at the intersection of each locking nail and the main nail in the intramedullary nail model. The stress of the double steel plate was mainly concentrated on the contact surface of the lateral steel plate and the proximal tibia. (4) The results demonstrate that the intramedullary nail has better resistance to axial loading and torsional loading for comminuted extra-articular fractures of the proximal tibia. However, the double locking plate is more advantageous when it is against bending. 
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    Finite element analysis of transposition of posterior tibial tendon for foot drop
    He Shaobo, Liu Jichao, Yang Lifeng, Ding Yongfeng, Li Wujian
    2021, 25 (15):  2334-2340.  doi: 10.3969/j.issn.2095-4344.3823
    Abstract ( 451 )   PDF (1014KB) ( 72 )   Save
    BACKGROUND: The transposition of the posterior tibial tendon is the gold standard for the treatment of foot drop caused by irreversible damage to the common peroneal nerve. There are many reports on its clinical efficacy, but there has been a lack of detailed finite element force analysis.
    OBJECTIVE: To reconstruct the three-dimensional finite element model of foot drop caused by common peroneal nerve injury, analyze mechanical characteristics and verify with traditional experience
    METHODS: (1) CT data of a male patient with left foot drop caused by left common peroneal nerve injury were collected and imported in the software to reconstruct foot and ankle bones with a series software, such as MIMICS, Cero, Abaqus, and ANSYS. (2) Ten young volunteers were enrolled. Their muscle strengths were measured by electrical trigger potentiometer and the root mean square amplitude of surface electromyogram–RMS were calculated. (3) The finite element model of the normal foot was established by limiting material parameters of every part. Based on this model, we simulated the foot drop state caused by total injury of the common peroneal nerve. (4) The posterior tibial tendon transposition, entocuneiform, mesocuneiform, and ectocuneiform were identified as the tendon anchored points. The foot was fixed at dorsiflexion position 10° through the transferent tendon, and the tibialis posterior muscle strength would drop one level after the transposition. (5) After analysis of finite element on the two droop states of three different anchoring positions, the ankle dorsiflexion angles, internal and external rotation angles, and the maximum stress of the transposition of the tendon were calculated under these nine conditions. The implementation of the research program meets the ethical requirements of 3201 Hospital Affiliated to Xi'an Jiaotong University. All patients were fully informed and agreed to the trial process.
    RESULTS AND CONCLUSION: (1) Dorsiflexion and plantar flexion angles of the normal foot model were close to and less than the limit angle (Dorsiflexion 25.62° < 27°, plantar flexion 43.67° < 45°). The dorsiflexion angle of the pendulous foot model was -44.65°, which was close to the research subject's dorsiflexion angle of -47°. (2) Tendon transposition anchored on the mesocuneiform had maximum correction angle and minimum stress of the tendon; tendon transposition anchored on the ectocuneiform had the worst effect of correction of deformity, maximum stress of the tendon and effect of mildly valgus ankle joint; anchored on the entocuneiform had effect of varus ankle joint. (3) The stress concentration of the tendon after transposition was near the anchor point where the tendon touched the bone. (4) Results indicate that the ankle biomechanical model established by the finite element can preliminarily simulate normal foot and drop foot which was caused by common peroneal nerve injury. Making mesocuneiform as anchor point in the treatment of foot drop deformity means better orthopedic effect about drop foot. This conclusion is similar to traditional experience. Individualized treatment regimens should be emphasized. The results of individual stress analysis may not be applicable to all patients.

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    Changes in sagittal parameters of cervical spine after double-segment artificial cervical disc replacement and anterior cervical discectomy and fusion
    Chen Jiang, Li Jinyu, Zheng Chenying, Bai Chunxiao, Zhang Fan, Liu Chuyin, Zhao Xueqian, Yuan Qiaomei, Di Xueshi, Kang Shengqian, Jia Yusong
    2021, 25 (15):  2341-2346.  doi: 10.3969/j.issn.2095-4344.3799
    Abstract ( 363 )   PDF (1100KB) ( 60 )   Save
    BACKGROUND: Cervical biomechanics has become a focus of research in recent years. Exploring the influence of different surgical methods on cervical sagittal position parameters can better optimize preoperative surgical plan design and achieve better clinical efficacy.   
    OBJECTIVE: To investigate the effects of double-segment cervical total disc replacement and anterior cervical discectomy and fusion on sagittal parameters in the treatment of cervical spondylosis. 
    METHODS: Ninety cases of cervical spondylosis of two adjacent segments of nerve root type or spinal cord type from October 2014 to December 2018 at Dongzhimen Hospital of Beijing University of Chinese Medicine were retrospectively analyzed. Of them, 45 cases received double-segment cervical total disc replacement (replacement group), and 45 cases received double-segment anterior cervical discectomy and fusion (fusion group). The sagittal parameters of the cervical vertebra at preoperation and the last follow-up were measured, including segment angle, C2-C7 Cobb angle, C2-C7 sagittal axial distance and T1 slope. The difference between the two groups was compared before and after operation. Pearson correlation was used to analyze the correlation between imaging parameters before and after surgery. This trial was approved by the Ethics Committee of Dongzhimen Hospital of Beijing University of Chinese Medicine.  
    RESULTS AND CONCLUSION: (1) The operative segment angle, C2-C7 Cobb angle, C2-C7 sagittal axial distance and T1 inclination angle in the final follow-up of the replacement group were all increased compared with those before the surgery (P < 0.05), and the above indicators in the final follow-up of the fusion group were not significantly changed compared with those before the surgery (P > 0.05). The operative segment angle and C2-C7 Cobb angle in the replacement group were higher than those in the fusion group (P < 0.05). (2) Before surgery, T1 inclination angle of the replacement group was positively correlated with segmental angle, C2-C7 Cobb angle and C2-C7 sagittal axial distance (P < 0.05), while C2-C7 Cobb angle was positively correlated with segmental angle (P < 0.05). At the last follow-up, T1 inclination angle was positively correlated with segment angle and C2-C7 Cobb angle (P < 0.05), and segment angle was positively correlated with C2-C7 Cobb angle (P < 0.05). (3) Before (or after) surgery, T1 inclination angle of fusion group was positively correlated with segmental angle, C2-C7 Cobb angle and C2-C7 sagittal axial distance (P < 0.05), while C2-C7 Cobb angle was positively correlated with segmental angle of fusion group (P < 0.05). (4) The results showed that compared with cervical discectomy and fusion therapy, double-segment artificial intervertebral disc replacement therapy had advantages in restoring segmental angle and sagittal position parameters of cervical spondylopathy.
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    Comparison of the effects of total hip arthroplasty with different interface prostheses in the treatment of elderly hip diseases
    Liu Pengran, Jiao Rui, Tao Jin, Chen Hui, Dai Jihang, Yan Lianqi
    2021, 25 (15):  2347-2351.  doi: 10.3969/j.issn.2095-4344.3809
    Abstract ( 405 )   PDF (1034KB) ( 55 )   Save
    BACKGROUND: Total hip arthroplasty is an effective method for the treatment of hip joint diseases such as femoral head necrosis and femoral neck fracture. The choice of prosthetic interface materials during the operation is the most important factor affecting the survival rate of the prosthesis.   
    OBJECTIVE: To compare the postoperative efficacy of ceramic on ceramic hip prosthesis and ceramic on polyethylene hip prosthesis in elderly patients of total hip arthroplasty. 
    METHODS: Sixty patients with femoral neck fracture and aseptic necrosis of the femoral head, who were treated in the Subei People’s Hospital of Jiangsu Province from February 2017 to February 2018, aged ≥ 45 years old, were selected in this study. Among them, 22 were treated with ceramic on ceramic hip prosthesis and 38 were treated with the ceramic on polyethylene hip prosthesis. At 1 week, 1, 3, 6, and 12 months after surgery, hip joint function scores and complications were counted. The trial was approved by the Ethics Committee of Subei People’s Hospital of Jiangsu Province (approval No. 2019112).  
    RESULTS AND CONCLUSION: (1) There was no significant difference in hip function scores between the two groups at different time points after surgery (P > 0.05). (2) There were two cases of joint noise in the ceramic on ceramic group and one case of peripheral nerve injury in the ceramic on polyethylene group. There was no significant difference in the incidence of joint noise and peripheral nerve injury between the two groups (P > 0.05). (3) The results showed that both the ceramic on ceramic and ceramic on polyethylene hip prosthesis can provide good curative effect and hip function reconstruction after total hip arthroplasty, and there was no significant difference in the incidence of postoperative complications between the two groups.  
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    Direct repair of medial collateral ligament injury combined with brace in total knee arthroplasty
    Liu Kun, Xu Hao, Wang Yingzhen, Zhang Haining, Fang Yuan, Xiang Shuai, Lü Chengyu
    2021, 25 (15):  2352-2357.  doi: 10.3969/j.issn.2095-4344.3800
    Abstract ( 389 )   PDF (653KB) ( 207 )   Save
    BACKGROUND: Medial collateral ligament injury in total knee arthroplasty is a rare but serious complication. There are different opinions on the treatment of medial collateral ligament injury.   
    OBJECTIVE: To analyze the injury site of medial collateral ligament in primary total knee arthroplasty and evaluate the curative effect of local suture repair combined with brace protection and support after injury. 
    METHODS: A retrospective analysis of 14 cases of iatrogenic medial collateral ligament injury during total knee arthroplasty in Department of Joint Surgery, Affiliated Hospital of Qingdao University from January 2016 to January 2018 (trial group) was conducted. All cases were treated with local suture repair combined with brace protection for 6 weeks. 110 cases without injury of medial collateral ligament in the same period were selected as controls (control group). The location of medial collateral ligament injury was recorded and the causes of injury were analyzed. Range of motion and American knee society knee score were compared between the two groups before and after operation. 
    RESULTS AND CONCLUSION: (1) Totally 12 cases of medial collateral ligament injury, including 11 cases of anterior bundle and 1 case of posterior bundle, who experienced transverse injury; and 2 cases of tibial avulsion. (2) Range of motion of the knee joint in the trial group and the control group was significantly improved after operation compared with preoperation (P < 0.05), and there was no significant difference between the two groups in range of motion at 2 months and 1 year after operation (P > 0.05). (3) At the last follow-up, American knee society knee score was significantly higher in the trial and control groups compared with preoperation (P < 0.05); however, there was no significant difference between the two groups (P > 0.05). (4) In the first total knee arthroplasty, the injury of the anterior bundle and body of the medial collateral ligament was the main injury, and the direct repair of the ligament combined with the protection of the post-operative brace for 6 weeks can achieve a good therapeutic effect, without the use of restrictive prosthesis, ligament reconstruction and other complex surgical treatment.

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    In vitro experiment of tetrandrine on the model of osteolysis induced by wear particles around the prosthesis
    Liu Zige, Liu Xinrui, Li Yan, Song Guorui, Zhang Chen, Chen Desheng
    2021, 25 (15):  2358-2363.  doi: 10.3969/j.issn.2095-4344.3803
    Abstract ( 417 )   PDF (1142KB) ( 49 )   Save
    BACKGROUND: There are few domestic studies on the formation and differentiation of osteoclasts induced by wear particles by tetrandrine.   
    OBJECTIVE: To explore the positive effect of tetrandrine on the osteolysis model of mouse RAW264.7 macrophages induced by titanium particles under different concentrations. 
    METHODS: Mouse RAW264.7 macrophages were divided into five groups for culture: blank group, experimental group (0.1 g/L titanium particle suspension), and low, medium, and high concentration drug groups (component+0.1, 0.5, and 1.0 μmol/L tetrandrine). CCK-8 assay was used to detect the proliferative activity of RAW264.7. The anti-tartaric acid phosphatase staining method and the phalloidin staining method were used to detect the function and number of mature osteoclasts. The enzyme-linked immunosorbent assay was used to detect the cell supernatant expression of tumor necrosis factor-α and matrix metalloproteinase-9. RT-PCR was applied to detect mRNA expression of activated T cell nuclear factor c1, tumor necrosis factor-α, and matrix metalloproteinase 9. Western blot assay was utilized to detect the levels of phosphorylated proteins of nuclear factor κB p65 and IκBα. 
    RESULTS AND CONCLUSION: (1) Compared with the blank group, the various concentrations of tetrandrine had no effect on the proliferation of RAW264.7 cells (P > 0.05). (2) In the control group, more bigger, wine red, and F-actin ring stained with fluorescent green multinucleated osteoclasts were observed, and after treatment with different concentrations of tetrandrine, the number of osteoclast cells decreased significantly (P < 0.05); and the size of F-actin ring decreased with the increase of drug concentration. (3) Compared with the blank group, IκBα and nuclear factor κB p65 and their phosphorylation levels, tumor necrosis factor-α, matrix metalloproteinase-9 cell culture supernatant protein expression, activated T cell nuclear factor c1 mRNA, tumor necrosis factor-α mRNA, matrix metalloproteinase-9 mRNA expression levels were significantly increased in the experimental group (P < 0.05). Tetrandrine reduced the expression of the above indexes in a concentration-dependent manner. (4) In summary, tetrandrine can have a positive effect on the in vitro osteolysis model of mouse RAW264.7 macrophages induced by titanium particles by inhibiting the nuclear factor κB signaling pathway. 
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    Statistical decision tree model analysis on hidden blood loss in the perioperative period of thoracolumbar burst fracture accompanied with neurological deficiency 
    Gao Zhixiang, Xiao Cong, Yang Hongtao, Meng Xiangyu
    2021, 25 (15):  2364-2369.  doi: 10.3969/j.issn.2095-4344.3817
    Abstract ( 279 )   PDF (771KB) ( 52 )   Save
    BACKGROUND: Some studies have shown that there is a high rate of hidden blood loss during spinal surgery, but the risk factors of hidden blood loss have not been described. In this study, the related factors were analyzed and the high risk factors were screened out.
    OBJECTIVE: To analyze the relevant factors of hidden blood loss in the perioperative period of thoracolumbar burst fracture accompanied with neurological deficiency. 
    METHODS: The clinical data of 85 patients with thoracolumbar burst fracture and neurological deficiency received spinal surgery treatment in Sixth Affiliated Hospital of Xinjiang Medical University from September 2016 to January 2019 were analyzed. The patients’ data including age, gender, ethnic group, hypertension, diabetes, coronary heart disease, history of smoking and drinking, free fatty acid (total cholesterol, triglyceride), operation time, length of surgical incision, the amount of crystalloid solution during operation, the amount of colloidal solution during operation, autologuous blood injection, homologous blood transfusion, postoperative recovery rate of vertebral height, time window of surgical treatment (< 48 hours, ≥ 48 hours), the segment of fractured vertebra and the segment of operative fixation were recorded. Gross was adopted to calculate the volume of hidden blood loss. Logistic regression analysis was used to further discuss risk factors for hidden blood loss.
    RESULTS AND CONCLUSION: (1) There were 66 males and 19 females with an average age of (40.75±12.42) years in the total 85 cases of the patients with thoracolumbar burst fracture and neurological deficiency. The estimated total blood loss volume was (1 030.84±115.45) mL. The volume of hidden blood loss was (484.57±98.38) mL. The volume of hidden blood loss accounted for 47.05% of the total blood loss volume in theory. (2) The results of single-factor and multivariate Logistic regression analysis showed that age, triglyceride > 1.63 mmol/L  and cholesterol > 5.76 mmol/L, extended surgical incision and surgical time window < 48 hours, and smoking history were the independent risk factors for positive hidden blood loss during the perioperative period (P < 0.05). (3) The decision tree model analysis of SPSS 24.0 and ROC area under the curve verified that when the age was > 48 years, sensibility and specificity were 76.0% and 88.4% respectively, with a certain diagnostic accuracy. (4) It is concluded that hidden blood loss accounts for a high proportion in the perioperative period of the spine. Age > 48 years, slightly-high cholesterol and triglyceride, extended surgical incision, surgical time window < 48 hours, and combined with smoking history turn out to be the high risk factors for positive hidden blood loss.
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    Effect of lumbopelvic sagittal parameters on secondary adjacent vertebral fracture after percutaneous kyphoplasty for osteoporotic vertebral compression fracture
    Zhang Le, Pan Bin, Ruan Ruxin, Guo Kaijin
    2021, 25 (15):  2370-2374.  doi: 10.3969/j.issn.2095-4344.3805
    Abstract ( 335 )   PDF (642KB) ( 52 )   Save
    BACKGROUND: In recent years, some scholars consider that the secondary adjacent vertebral fracture after percutaneous kyphoplasty may be related to the sagittal imbalance caused by changes in lumbopelvic alignment.   
    OBJECTIVE: To explore the effect of lumbopelvic sagittal parameters on secondary adjacent vertebral fracture after percutaneous kyphoplasty in patients with lumbar osteoporotic vertebral compression fracture. 
    METHODS: The clinical data of 67 patients with single segmental lumbar osteoporotic vertebral compression fractures who had undergone percutaneous kyphoplasty from January 2017 to January 2019 at the Affiliated Hospital of Xuzhou Medical University were recruited for retrospectively analysis. Of them, 32 patients suffered from secondary adjacent vertebral fracture, and 35 patients did not suffer from secondary vertebral fracture. The lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, sacrum pubic incidence and sacrum pubic posterior angle were compared between the secondary group and non-secondarygroup according to the postoperative lumbar posteroanterior and lateral radiographs, and the correlation between lumbar parameter and pelvic parameter in the secondary group was also analyzed. The study was approved by Ethics Committee of the Affiliated Hospital of Xuzhou Medical University. 
    RESULTS AND CONCLUSION: (1) Both groups were followed up for more than 1 year. (2) The lumbar lordosis, pelvic incidence, sacral slope, sacrum pubic incidence and sacrum pubic posterior angle in the secondary group were less than those in the non-secondary group (P < 0.05). There was no significant difference in pelvic tilt between the two groups (P > 0.05). (3) Pearson correlation analysis showed that lumbar lordosis was correlated with pelvic incidence, sacrum pubic incidence and sacrum pubic posterior angle (P < 0.01), but was not related to pelvic tilt and sacral slope (P > 0.05). (4) The results showed that smaller lumbar lordosis and sacral slope can increase the risk of secondary adjacent vertebral fracture after percutaneous kyphoplasty in patients with single segmental lumbar osteoporotic vertebral compression fractures. The larger pelvic incidence, sacrum pubic incidence, and sacrum pubic posterior angle are protective factors against secondary adjacent vertebral fracture after percutaneous kyphoplasty in patients with single segmental lumbar osteoporotic vertebral compression fractures. 
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    Medium-and long-term follow-up of Salter pelvic osteotomy and implant fixation for children with developmental hip dislocation
    Liu Yongyu, Xu Jingli, Lin Tianye, Wu Feng, Shen Chulong, Xiong Binglang, Zou Qizhao, Lai Qizhong, Zhang Qingwen
    2021, 25 (15):  2380-2384.  doi: 10.3969/j.issn.2095-4344.3813
    Abstract ( 315 )   PDF (653KB) ( 44 )   Save
    BACKGROUND: Developmental dislocation of the hip in children is a common clinical orthopedic hip disease in children. The short-term follow-up effect of Salter pelvic osteotomy is satisfactory. At present, there is still no medium- and long-term clinical follow-up research in China.   
    OBJECTIVE: To explore the medium- and long-term clinical effects and complications of Salter pelvic osteotomy in the treatment of developmental hip dislocation in children. 
    METHODS: A retrospective analysis of 65 cases (70 hips) of children with developmental hip dislocation admitted from January 2010 to March 2015 in First Affiliated Hospital of Guangzhou University of Chinese Medicine was performed with open reduction, Salter pelvic osteotomy or Salter pelvic osteotomy combined with femur proximal osteotomy (locking compression plate fixation) treatment. According to Tonnis scale, there were degree I in 10 hips, degree II in 17 hips, degree III in 12 hips, and degree IV in 31 hips. Preoperative and postoperative central margin angle, acetabular index, Sharp angle and acetabular depth were observed. The postoperative efficacy was evaluated by McKay function standard and Severin standard of X-ray films. 
    RESULTS AND CONCLUSION: (1) All 65 patients were followed up for 5.1-10.2 years. (2) The postoperative acetabular index and Sharp angle were significantly lower than those before the operation; and the central margin angle and acetabular depth were significantly increased compared with the preoperative data. The differences were statistically significant (P < 0.05). (3) In last follow-up after operation, according to Mckay functional evaluation criteria, the excellent and good rate was 97%. According to the final X-ray Severin evaluation standard, the excellent and good rate was 90%. (4) Necrosis of the affected femur occurred in three patients, relocation of the hip in one patient, proximal femoral deformity in one patient, and sensory abnormalities in the affected limb in one patient. (5) The Salter pelvic osteotomy for children with developmental dislocation of the hip has a satisfactory medium- and long-term clinical effect, which can effectively improve the patient’s acetabular coverage and improve hip function. 
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    Knowledge mapping of three-dimensional printing in biomedical field based on VOSviewer
    Song Yahan, Wu Yunxia, Fan Daoyang
    2021, 25 (15):  2385-2393.  doi: 10.3969/j.issn.2095-4344.3818
    Abstract ( 524 )   PDF (1577KB) ( 185 )   Save
    BACKGROUND: In recent years, three-dimensional (3D) printing technology is widely used in various fields, and its application in the medical field is also increasing, which provides a new direction for the development of medical research.   
    OBJECTIVE: To analyze the literature of 3D printing in biomedical field in recent 5 years, and illustrate the current research status, hot spots and development trends by using knowledge mapping analysis. 
    METHODS: PubMed database was retrieved for related literature on 3D printing in biomedical field published from 2015 to 2020, and the citation relationship between articles was obtained from the core collection of web of science by PMID. The tool of bibliometrics and VOSviewer were used to analyze the author, organization, country and key words, and draw knowledge mapping. 
    RESULTS AND CONCLUSION: (1) A total of 3 471 articles were included. A trend toward an increasing number of publications in recent 5 years was evident. According to the index trend line, the number of papers will keep growing. In the future, the research of 3D printing in biomedical field will continue to attract the attention of researchers. (2) Among the 22 core journals identified, the percent of journals with JCR Q ≥ 2 was 81.8%, and the quality of journals was high. (3) According to the keyword co-occurrence clustering results, the current research was divided into four categories: clinical application, tissue engineering scaffold, application in the field of pharmaceutical preparations, and 3D bioprinting. (4) VOSviewer knowledge mapping analysis showed that the selection of biomedical 3D printing tissue scaffold materials and scaffold microstructure design were the focus and hotspot in recent years and the basis of expanding clinical application of tissue engineering. (5) It was a trend from single to multiple composite materials in scaffold materials. The 3D microstructure of scaffolds, including porosity, pore size and interconnected pore structure, played a key role in enhancing cell viability and promoting tissue growth. (6) The preparation of bioink with cell activity was the focus of 3D bioprinting research, including the properties of biomaterial scaffolds, such as hydrogel, alginate and extracellular matrix, cross-linking and stiffness of scaffolds, and stem cell printing. (7) In the application of 3D printing pharmaceutical preparations, the personalized setting of drug delivery system is realized through the hotspot research, such as drug preparation printing technology, polymer, nanoparticles, and microfluidic chip. 
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    Mechanical analysis on the position difference of short-stemmed prosthesis in hip arthroplasty
    Li Yonghe, Wang Xiankang, Meng Yu, Liu Lu, Zhang Chunqiu, Ye Jinduo
    2021, 25 (15):  2394-2399.  doi: 10.3969/j.issn.2095-4344.3798
    Abstract ( 409 )   PDF (979KB) ( 66 )   Save
    BACKGROUND: In recent years, total hip arthroplasty has been widely developed, and most patients have achieved satisfactory results at the initial stage. However, complications after total hip arthroplasty in clinical practice were still a major problem for doctors and patients, and the excellent implant position has become the key to evaluate the replacement effect.    
    OBJECTIVE: To investigate the influence of different implant position of short-stemmed prosthesis on hip arthroplasty, and to provide guidance for doctors' surgical implementation. 
    METHODS: The full cycle gait simulation was carried out by using human dynamics software to obtain the load-bearing conditions of hip joint. The finite element model of hip joint replacement was established by simulating different implantation locations, that is, the position of human strength line and the position of internal and external deviation of 3° and 5°. The stress changes of femur and short-stemmed prosthesis and the strain changes of polyethylene liner in different total hip arthroplasty models were calculated and analyzed. 
    RESULTS AND CONCLUSION: (1) In gait, the joint force and angle of the hip joint changed periodicity with time 1.17 s a period, and the total joint force reached a peak value of about 700 N at 0.4 s. (2) No matter how the angle of internal and external deviation changes, the stress value of the lower part of the lesser trochanter and the lateral end of the femur were higher than those of the position of the human physical line, and internal deviation had a greater impact on the stress of the femur than external deviation. (3) The maximum tensile and compressive stress of the prosthesis was lower than that of the internal and external deviation. (4) The maximum compressive strain of polyethylene liner was the smallest at 3° external deviation, reaching 2 198 με. The maximum compressive strain at other angles was higher than that at the human physical line. The maximum value reached 7 348 με at 5° internal deviation, which was 2.08 times as high as that of position of the human physical line, it would aggravate the liner wear. (5) In total hip arthroplasty, different implant position will have a great impact on the mechanical environment of femur, prosthesis and liner. During the operation, the prosthesis should be as close as possible to the human physical strength line. 
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    Analysis of collapse and related factors in the treatment of ARCO I-II non-traumatic necrosis of femoral head with porous tantalum rod
    Su Jingyang, Zhang Yaojie, Cao Bin, Hao Xuewei, Li Xiao, Han Yongtai
    2021, 25 (15):  2400-2404.  doi: 10.3969/j.issn.2095-4344.3807
    Abstract ( 356 )   PDF (683KB) ( 63 )   Save
    BACKGROUND: Porous tantalum rod implantation combined with core decompression in the treatment of early non-traumatic necrosis of the femoral head has a good effect, but there are still reports of femoral head collapse after treatment with an incidence of 2%-56%.   
    OBJECTIVE: To explore the collapse status and influencing factors of porous tantalum rod after treatment of association research circulation osseous (ARCO) stage I-II non-traumatic osteonecrosis of the femoral head. 
    METHODS: The medical record data of 77 patients with non-traumatic necrosis of the femoral head in ARCO stage I-II, who were enrolled in First Hospital of Shijiazhuang City from May 2014 to April 2018 and treated with porous tantalum rod, were retrospectively analyzed. There were 58 males and 19 females, aged 22-58 years. The collapse of femoral head was observed during follow-up after operation. The clinical and surgical data of the patients were recorded, such as sex, age, etiology, side, location and scale of necrosis area, ARCO stage, implantation position of tantalum rod (the distance between the top of tantalum rod and the center of necrosis, the distance ratio between tantalum rod and the cortex on both sides of the border area of femoral head and neck). The clinical and surgical data were analyzed by univariate analysis. Binary multivariate logistic regression analysis was used to screen out the independent influencing factors of the collapse after the treatment of ARCO stage I-II non-traumatic necrosis of the femoral head with porous tantalum rod. This study was approved by the Ethics Committee of First Hospital of Shijiazhuang City (approval No. 201403011). 
    RESULTS AND CONCLUSION: (1) Seventy-seven patients were followed up for 3-60 months, including 23 cases of femoral head collapse and 54 cases of no collapse. (2) The results of univariate analysis showed that there was no significant difference in sex, age, lesion side, ARCO stage, and the distance ratio between tantalum rod and the cortex on both sides of the border area of femoral head and neck between collapse group and non-collapse group (P > 0.05). There were significant differences in etiology, location and scale of necrosis area, and the distance between the top of tantalum rod and the center of necrosis between the two groups (P < 0.05). (3) The results of binary multivariate logistic regression analysis showed that steroid induced necrosis of femoral head, necrosis area located in the load-bearing area, C1 type of necrosis area location and the distance between the top of tantalum rod and necrotic center were the independent factors of collapse after treatment of ARCO I-II non-traumatic necrosis of femoral head with porous tantalum rod [OR=7.977, 95%CI(1.031, 61.708), P=0.047; OR=7.248, 95%CI(1.563, 34.548), P=0.012; OR=16.028, 95%CI(1.074, 239.267), P=0.044; OR=2.310, 95%CI(1.388, 3.845), P=0.001]. (4) Reuslts suggest that the short-term clinical effect of porous tantalum rod was good in the treatment of non-taumatic necrosis of femoral head in ARCO I-II stage. Steroid induced necrosis of femoral head, necrosis area, location of necrosis and the distance from the top of tantalum rod to the necrosis center were the influencing factors of collapse after the treatment of non-traumatic necrosis of femoral head in ARCO I-II stage.

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    Effect of the third fragment on the healing of femoral shaft fractures after intramedullary nailing fixation
    Mao Guoshu, Zhou Min, Li Xiaoming, Zhou Zihong, Yin Qudong
    2021, 25 (15):  2405-2409.  doi: 10.3969/j.issn.2095-4344.3808
    Abstract ( 329 )   PDF (600KB) ( 45 )   Save
    BACKGROUND: It was reported that the incidence of nonunion for femoral shaft fractures with third fragment after intramedullary nailing fixation was higher than that without third fragment. Therefore, the displacement or morphology of the third fragment was related to bone nonunion.   
    OBJECTIVE: To investigate the effect of third fragment on the healing of femoral shaft fractures after intramedullary nailing fixation. 
    METHODS: Fifty-two cases of femoral shaft fractures with third fragment treated with intramedullary nailing fixation in Wuxi No. 2 Chinese Medicine Hospital and Wuxi People's Hospital from January 2009 to April 2018 were retrospectively analyzed. There were 32 males and 20 females, the age ranged from 16 to 69 years old. X-ray films were taken to measure the length, distal and proximal displacement of the third fragment. According to the length of the third segment, the patients were divided into three groups: Group A (1.0-3.9 cm), Group B (4.0-7.9 cm) and Group C (≥ 8 cm). According to the displacement of the proximal (P) and distal (D) of the third fragment, the patients were divided into three groups: Group D 1, Group P 1 (0-9 mm) , Group D 2, Group P 2 (10-19 mm), Group D 3, and Group P 3 (≥ 20 mm). After 12 months of follow-up, the fracture healing was determined. If the fracture did not heal for 12 months, it was determined as nonunion. The influence of the third fragment morphology on difficult healing was analyzed by Logistic regression. The study was approved by the Ethics Committee of Wuxi No. 2 Chinese Medicine Hospital and Wuxi People’s Hospital. 
    RESULTS AND CONCLUSION: (1) After 12 months of follow-up, 41 of 52 patients healed, the healing rate was 79%. (2) There was no significant difference in the distal displacement of the third fragment among groups A, B and C (P > 0.05), and the difference in the proximal displacement was not significant (P > 0.05). There was no significant difference in nonunion rate and healing time among the three groups (P > 0.05). (3) According to the displacement of the proximal and distal of the third fragment, the greater the distal or proximal displacement, the lower the fracture healing rate and the longer the healing time; there were significant differences in healing rate and healing time among the three groups (P < 0.05). The differences between the group with displacement < 1 cm and other groups were significant (P < 0.05). (4) Logistic regression analysis showed that the length of the third fragment had no significant effect on fracture healing (P > 0.05); however, the distal and proximal third fragment displacement had significant influence on fracture healing (P < 0.05). (5) The displacement of the third fragment has influence on the bone healing. Open or close reduction or fixation of the third fragment should be performed when the displacement is more than 1 cm. 
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    Correlation of infrapatellar fat pad edema with trochlear and patellofemoral joint morphology: MRI evaluation
    Chen Xiaolong, Zhao Heng, Hu Rong, Luo Guanghua, Liu Jincai
    2021, 25 (15):  2410-2415.  doi: 10.3969/j.issn.2095-4344.3816
    Abstract ( 508 )   PDF (697KB) ( 148 )   Save
    BACKGROUND: Previous studies have suggested that edema of the lateral superior infrapatellar fat pad is caused by friction between the patellar tendon and the lateral condyle of the femur, but the relationship between lateral superior infrapatellar fat pad edema and the shape of the pulley and the arrangement of the patellofemoral joint is not clear.    
    OBJECTIVE: To evaluate the correlation between patellofemoral joint alignment, pulley shape, and lateral superior infrapatellar fat pad edema on MRI.
    METHODS: The MRI images of knee joint taken by the First Affiliated Hospital of South China University from July 2018 to October 2019 were analyzed retrospectively. Patellofemoral joint alignment (patellar offset, patellar tilt angle and Insall-Salati ratio), pulley shape (pulley groove angle, external pulley angle, medial inclination angle and pulley angle) and SIFP edema were evaluated by MRI images of the knee joint. The arrangement of the patellofemoral joint and the shape of the pulley were divided into quartiles and the presence or absence of SIFP was determined. Logistic regression model was used to determine the relationship between patellofemoral joint arrangement, pulley shape and SIFP edema by adjusting age, sex, and body mass index. 
    RESULTS AND CONCLUSION: (1) Finally, 161 patients were included, of which 60 cases (37.3%) developed SIFP edema. (2) Trochlear angle, Insall-Salati ratio and patellofemoral deviation were positively correlated with edema of lateral superior infrapatellar fat pad (P < 0.001). (3) Compared with the knee joint measured in the lowest quartile, the trochlear angle, Insall-Salati ratio and patellofemoral offset in the highest quartile were 7.4 times (95%CI: 1.39, 5.12) more likely to develop SIFP edema, 8.1 times (95%CI: 3.27, 24.5) and 16.2 times (95%CI: 4.1, 28.8), respectively. (4) In middle-aged and elderly patients with anterior knee pain or suspected knee osteoarthritis, increased pulley angle and high patella and patellar offset may indicate edema of the lateral superior infrapatellar fat pad.
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    Quadrilateral plate fractures: research progress of implant treatment
    Yang Youwei, Feng Wei
    2021, 25 (15):  2416-2422.  doi: 10.3969/j.issn.2095-4344.3819
    Abstract ( 309 )   PDF (655KB) ( 90 )   Save
    BACKGROUND: There is a consistent debate in the medical community about the implant treatment of quadrilateral plate fractures, and it is also a hot spot in the treatment of acetabular fractures in recent years.
    OBJECTIVE: To review the progress of implant treatment and related research on quadrilateral plate fracture at home and abroad in recent years.
    METHODS: Using “quadrilateral plate, quadrilateral surface, quadrilateral area” as Chinese and English retrieval words, 84 related articles were searched in CNKI and PubMed databases from January 2000 to July 2019. According to the inclusion and exclusion criteria, 64 were selected for literature review.

    RESULTS AND CONCLUSION: There are many implants for the treatment of quadrilateral plate fractures and each has different advantages and disadvantages. The actual choice requires the comprehensive consideration of clinicians, flexible grasp of indications, and the selection of more suitable surgical techniques and implants in order to achieve the best therapeutic effect. More systematic methods involving tetragonal fracture classification will play a positive role in the clinician’s high-quality preoperative planning, and can also provide guidance for the selection of internal fixation implants. The biomechanical analysis is still not systematic, and it cannot be compared more carefully and cannot be further analyzed. However, the relevant research results show that the mainstream methods such as anterior column reconstruction plate and square screw fixation are reliable methods of implant fixation. Many new technologies have begun to emerge in acetabular fractures involving the quadrilateral region. Smaller intraoperative injuries, shorter operation time and more accurate intraoperative auxiliary system will become the trend of such operations.

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    Meta-analysis of repairing pronator muscle after metacarpal plate fixation of distal radius fracture
    He Xiangzhong, Chen Haiyun, Lü Yang, Liu Jun, Huang Junhan, Gao Shihua, Guan Jianhao, Wang Yangfa
    2021, 25 (15):  2423-2429.  doi: 10.3969/j.issn.2095-4344.3820
    Abstract ( 371 )   PDF (1240KB) ( 50 )   Save
    OBJECTIVE: In recent years, a large number of articles have reported whether to repair pronator muscle after metacarpal plate fixation of distal radius fracture, but the effectiveness and clinical benefits of repairing pronator muscle are still controversial. Thus, this meta-analysis evaluated the clinical effect of repairing pronator muscle after metacarpal plate fixation of distal radius fracture. 
    METHODS: We searched the related randomized controlled trials on the repair of pronator muscle after metacarpal plate fixation of distal radius using the computer in CNKI, Wanfang, VIP, China Biology Medicine disc, PubMed, Embase, and Cochrane Library. The search date was from January 2001 to January 2020. Data extraction and quality evaluation to all the documents that are in accordance with the inclusion were carried out. The methodological quality of 14 randomized controlled trials was evaluated by modified Jadad scale. The DASH score, visual analogue scale score, ulnar deviation angle, dorsal extension angle, pronation angle, supination angle and pronation muscle strength were analyzed by RevMan 5.3 software for meta-analysis.
    RESULTS: (1) A total of 11 randomized controlled trials were included. (2) The follow-up time of 3 months is short-term, 3-12 months is medium-term, and longer than 1 year is long-term. (3) Meta-analysis results demonstrated that the DASH score (MD=-0.79, 95%CI:-1.50 to -0.09, P=0.03), short-and medium-term  visual analogue scale score (MD=-3.04, 95%CI:-3.53 to -2.55, P < 0.000 01; MD=-1.69, 95%CI:-1.99 to -1.39, P < 0.000 01), long-term dorsal extension angle (MD=5.15, 95%CI:2.50-7.80, P=0.000 1), medium-and long-term pronation angle (MD=1.83, 95%CI:0.69-2.96, P=0.002; MD=1.81, 95%CI:0.32-3.30, P=0.02), mid-term pronation muscle strength (MD=1.35, 95%CI:0.90-1.80, P < 0.000 01) and ulnar deviation angle (MD=4.28, 95%CI:3.26-5.31, P < 0.000 01) in the group of repairing pronator muscle after metacarpal plate fixation were better than those in the group without repairing pronator muscle. There was no significant difference in long-term DASH score, short-term dorsal extension angle and short- and long-term supination angle between the two groups (P > 0.05). 
    CONCLUSION: After metacarpal plate fixation of distal radius fracture, combined repair of pronator muscle on the basis of internal fixation may further enhance the medium-and long-term joint motion angle, reduce the patients’ medium-and short-term pain, and enhance the patients’ medium-and short-term joint function after operation, and enhance the patient’s sense of experience after operation. However, due to the limited number of literature included, more large samples and high-quality randomized controlled trials are needed to provide further effective data.
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    Efficacy and safety of tranexamic acid and epsilon-aminocaproic acid in reducing perioperative blood loss during total knee arthroplasty: a meta-analysis 
    Chen Wang, Feng Shuo, Zhang Yu, Chen Xiangyang
    2021, 25 (15):  2430-2436.  doi: 10.3969/j.issn.2095-4344.3821
    Abstract ( 340 )   PDF (802KB) ( 63 )   Save
    OBJECTIVE: There are few comparative studies on tranexamic acid and epsilon-aminocaproic acid in the perioperative period of total knee arthroplasty. The purpose of this study is to compare the perioperative differences between the two drugs in total knee arthroplasty, and systematically evaluate the safety and effectiveness of the two drugs. 
    METHODS: We searched by keywords on the databases of Cochrane Library, PubMed, Web of Science, CNKI, Wanfang, and VIP, and used software Endnote X9 for data screening and selection, software Review Manager 5.3 for data analysis and draw funnel and forest plots. This mete-analysis included seven studies that directly compared the primary and secondary clinical outcomes of tranexamic acid and epsilon-aminocaproic acid. 
    RESULTS: (1) Of the seven studies included, 1 508 patients received the tranexamic acid and 1 956 patients received epsilon-aminocaproic acid. (2) The differences between the tranexamic acid group and the epsilon-aminocaproic acid group in terms of total blood loss, discharge hemoglobin, and erythrocyte units transfused were statistically significant (P < 0.05); and the tranexamic acid group was better than the epsilon-aminocaproic acid group. (3) There were no differences in the primary results such as intraoperative blood loss, erythrocyte volume loss, hematocrit drop, transfusion units per patient, number of blood transfusion, drain output and the secondary results such as length of stay, tourniquet time, operative time, pulmonary complications, cardiac complications, and number of readmission between the two groups (P > 0.05). 
    CONCLUSION: This meta-analysis proves that both anti-fibrinolytic drugs showed similar efficacy in reducing intraoperative blood loss, erythrocyte volume loss, drain output and complications. However, tranexamic acid is significantly better than epsilon-aminocaproic acid in reducing total blood loss, discharge hemoglobin, and erythrocyte units transfused.
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    Efficacy of arthroscopy combined with sodium hyaluronate for knee osteoarthritis: a meta-analysis
    Li An’an, Chen Jiayun, Chen Jin, Song Min, Li Congcong, Ye Guozhu, Wu Gaoyi, Lin Wenzheng, Cai Yuning, Liu Wengang
    2021, 25 (15):  2437-2444.  doi: 10.3969/j.issn.2095-4344.3801
    Abstract ( 326 )   PDF (2084KB) ( 82 )   Save
    OBJECTIVE: Knee arthroscopy has a good effect on mild to moderate knee osteoarthritis, but the lavage fluid will take away a lot of the original synovial fluid. It is still controversial whether synovial fluid can be further improved by postoperative injection of sodium hyaluronate. This study is designed to evaluate the efficacy of arthroscopy combined with sodium hyaluronate compared with arthroscopy alone for knee osteoarthritis.
    METHODS: The relevant literature was searched from CNKI, Wangfang, VIP, CBM, PubMed, Web of Science, EMBASE, and Cochrane Library from inception to March 27, 2020. The randomized controlled trials on arthroscopy combined with sodium hyaluronate for knee osteoarthritis were included. Included studies were evaluated using the Cochrane system evaluation method. Meta-analysis was performed using RevMan 5.3 software. The primary outcomes included Lequesne score, Lysholm score, WOMAC score, and visual analogue scale score. The secondary outcomes included tumor necrosis factor-α, interleukin-1β, and interleukin-6 in synovial fluid.
    RESULTS: A total of 31 randomized controlled trials were included with 1 350 cases. Meta-analysis results showed that in primary outcomes: (1) Lequesne score was better in the combined group than that in the control group at 1 week after surgery (MD=-0.33, 95%CI: 0.67 to -0.00, P=0.05), after the full treatment course (MD=-1.00, 95%CI:-1.34 to -0.66, P < 0.000 01), 3 months after surgery (MD=-1.04, 95%CI:-1.44 to -0.64, P < 0.000 01). (2) Lysholm score was better in the combined group than that in the control group at 1 week after surgery (MD=5.84, 95%CI:4.79-6.88, P < 0.000 01), after the full treatment course (MD=9.21, 95%CI:6.93-11.49, P < 0.000 01), 3 months after surgery (MD=9.14, 95%CI:6.34-11.94, P < 0.000 01), half year after surgery (MD=10.14, 95%CI: 6.50-13.78, P < 0.000 01), 1 year after surgery (MD=11.54, 95%CI:9.92-13.16, P < 0.000 01). (3) WOMAC score was better in the combined group than that in the control group at 1 year after surgery (MD=-18.38, 95%CI:-28.53 to -8.23, P=0.000 4). Visual analogue scale score was better in the combined group than that in the control group at 1 week after surgery (MD=-0.91, 95%CI:-1.11 to -0.72, P < 0.000 01), after the full treatment course (MD=-0.97, 95%CI:-1.23 to -0.72, P < 0.000 01), 3 months after surgery (MD=-0.41, 95%CI: -0.52 to -0.31, P < 0.000 01). (4) Lequense score was better in the combined group after the full treatment course compared with that after only one week (MD=1.47, 95%CI: 1.14-1.80, P < 0.000 01). (5) The combined group could better reduce the contents of tumor necrosis factor-α, interleukin-1β, and interleukin-6 in the synovial fluid (P ≤ 0.05), which could better control the inflammation. 
    CONCLUSION: Arthroscopy combined with sodium hyaluronate can achieve a better short- and medium-term curative effect in knee osteoarthritis than arthroscopy alone. However, more high-quality studies are needed to verify the above conclusions.
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    Masquelet technique in treatment of infectious nonunion: a meta-analysis
    Xu Canhong, Meng Lin, Dong Panfeng, Zhan Huasong, Song Shilei
    2021, 25 (15):  2445-2452.  doi: 10.3969/j.issn.2095-4344.3822
    Abstract ( 432 )   PDF (772KB) ( 144 )   Save
    OBJECTIVE: At present, a large number of clinical studies have confirmed that Masquelet technology is effective and safe in the treatment of infectious bone nonunion, but most studies belong to retrospective case analysis, and the sample size is small, and there is still insufficient evidence-based evidence. Meta-analysis in the effectiveness and safety of Masquelet technique in treating infectious nonunion was conducted.
    METHODS: A computer was used to comprehensively search PubMed, Embase, The Cochrane Libraray, Web of Science and China Biology Medicine Database, CNKI, Wanfang, and VIP databases for randomized or non-randomized controlled trials of Masquelet technique in the treatment of infectious nonunion published from inception to May to 2020. After literature screening, data extraction, and quality evaluation according to inclusion and exclusion criteria, RevMan 5.3 software was used to perform meta-analysis of outcome indicators. 
    RESULTS: (1) A total of 12 articles were included, all of which were non-randomized controlled studies. According to the MINORS scoring scale, five articles were high-quality articles and seven articles were medium-quality articles. (2) Meta-analysis showed that: compared with Ilizarov group, average postoperative healing time (MD=-9.80, 95%CI:-14.17 to -5.43), complication rate (RR=0.44, 95%CI:0.35-0.55), and medical expenses (MD=-0.70, 95%CI:-1.13 to -0.28) were statistically significant in the Masquelet group (P < 0.05). However, excellent and good rate of clinical efficacy, excellent and good rate of affected limb function, and number of operations were not statistically significant between the two groups (P > 0.05). (3) Compared with the stage I bone graft group, the Masquelet group had a significant difference in the bone healing rate (RR=1.37, 95%CI:1.15-1.62, P=0.000 4) (P < 0.05), but complication rate and infection control rate were not statistically significant between them (P > 0.05). 
    CONCLUSION: Both Masquelet technique and Ilizarov technique can achieve good curative effect in the treatment of infectious bone nonunion. However, compared with Ilizarov technique, Masquelet technique has the advantages of fewer complications, shorter healing time and lower cost, and the bone healing rate is better than the first-stage bone graft. Thus, Masquelet technology is a reliable and safe treatment for infectious nonunion, but this conclusion needs more high-quality, multi-center, large-sample randomized controlled studies to further confirm.
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    Efficacy and safety of tranexamic acid combined with rivaroxaban in primary total knee and hip arthroplasties: a meta-analysis
    Gao Fenghe, Chen Tongying, Lin Jiebin, Liang Zujian
    2021, 25 (15):  2453-2460.  doi: 10.3969/j.issn.2095-4344.3824
    Abstract ( 341 )   PDF (791KB) ( 71 )   Save
    OBJECTIVE: Tranexamic acid can effectively reduce bleeding during total knee arthroplasty or total hip arthroplasty. However, it may increase the risk of venous thromboembolism. Rivaroxaban can effectively prevent the incidence of venous thromboembolism, but it is associated with bleeding complications. This meta-analysis aims to investigate the safety and efficacy of tranexamic acid combined with rivaroxaban when used in total knee arthroplasty and total hip arthroplasty. 
    METHODS: The “tranexamic acid, rivaroxaban, total hip arthroplasty, total hip replacement, total knee arthroplasty, total knee replacement” were used as the search term for English; and “tranexamic acid, rivaroxaban, total knee replacement, total hip replacement” as the search term for Chinese. Clinical trials concerning tranexamic acid and rivaroxaban in total knee arthroplasty and total hip arthroplasty were collected from CNKI, Wanfang Data, PubMed, EMBASE, Cochrane Library and Web of Science databases from inception to May 2020. The quality of included studies was evaluated by RevMan 5.3 software for meta-analysis. The primary outcome measures were total blood loss, hemoglobin reduction, and blood transfusion rate; the secondary outcome measures were the incidence of wound complications and the incidence of deep vein thrombosis.
    RESULTS: Nine randomized controlled trials involving 1 795 cases were included. The results of this meta-analysis showed that (1) compared with rivaroxaban group, total blood loss (MD=-216.66, 95%CI:-262.23 to -171.08, P < 0.005), hemoglobin reduction (MD=-0.53, 95%CI:-0.73 to -0.34, P < 0.005), blood transfusion rate (RR=0.28, 95%CI:0.18-0.42, P < 0.05), and the incidence of wound complications (RR=0.52, 95%CI:0.40-0.69, P < 0.05) were significantly lower in the tranexamic acid + rivaroxaban group. (2) There was no significant difference between two groups in the incidence of deep venous thrombosis (RR=-0.88, 95%CI:(0.46-1.67), P=0.69). 
    CONCLUSION: The application of tranexamic acid combined with rivaroxaban in the total knee arthroplasty and total hip arthroplasty can effectively reduce total blood loss, hemoglobin reduction, blood transfusion rate, and the incidence of wound complications, but do not increase the incidence of deep venous thrombosis. However, the number and quality of included studies were limited. Therefore, more scientifically designed, large sample, multi-center clinical randomized controlled trials are needed for further verification.  
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