Loading...

Table of Content

    28 June 2021, Volume 25 Issue 18 Previous Issue    Next Issue
    For Selected: Toggle Thumbnails
    Application of three-dimensional printing guide plate in total knee arthroplasty for patients with varus and valgus deformity
    Huang Chenyu, Tang Cheng, Wei Bo, Li Jiayi, Li Xuxiang, Zhang Huikang, Xu Yan, Yao Qingqiang, Wang Liming
    2021, 25 (18):  2789-2793.  doi: 10.3969/j.issn.2095-4344.3834
    Abstract ( 345 )   PDF (718KB) ( 37 )   Save
    BACKGROUND: In recent years, three-dimensional (3D) printing technology has been widely used in the fields of navigation fracture internal fixation, spinal screw implantation and huge bone defect repair and reconstruction. However, there are few reports on the application of 3D printing navigation template in total knee arthroplasty for patients with varus and valgus knee joint. 
    OBJECTIVE: To compare the effect of 3D printing surgical guide plate assisted total knee arthroplasty and traditional total knee arthroplasty in the treatment of knee varus and valgus osteoarthritis.
    METHODS: Totally 39 patients with knee osteoarthritis were selected in Nanjing Hospital Affiliated to Nanjing Medical University from January 2019 to February 2020, including 18 females, 21 males, aged 55-83 years old, and randomly divided into two groups. Patients in the trial group (n=20) underwent total knee arthroplasty with 3D printing guide plate. Patients in the control group (n=19) underwent traditional total knee arthroplasty. X-ray films were taken after operation to measure the coronal tibial component angle, sagittal tibial component angle, coronal femoral component angle, sagittal femoral component angle, hip-knee-ankle angle, and angle of lower limb force line. The hospitalization time, operation time, intraoperative blood loss, and postoperative drainage volume were recorded in both groups. Visual analogue scores and American knee society knee scores were performed at 1 day, 1 week, 2 weeks, 1 month and 3 months after operation. The trial was approved by the Ethics Committee of Nanjing Hospital Affiliated to Nanjing Medical University.
    RESULTS AND CONCLUSION: (1) The deviation values of coronal tibial component angle, sagittal tibial component angle, coronal femoral component angle, sagittal femoral component angle and hip-knee-ankle angle in the two groups were all < 3°, and the adjustment effect of the trial group on the angle of lower limb force line was better than that of the control group (P < 0.05). (2) The operation time, intraoperative blood loss and postoperative drainage volume of the trial group were less than those of the control group (P < 0.05). There was no significant difference in hospital stay between the two groups (P > 0.05). (3) The visual analogue scale scores of the trial group at 1 day and 1 week after operation were lower than those of the control group (P < 0.05), and the American knee society knee scores were higher than that of the control group (P < 0.05). (5) The results showed that for patients with severe varus and valgus of the knee joint, 3D printing surgical guide plate assisted knee arthroplasty improved the operation accuracy and saved the intraoperative time.
    Figures and Tables | References | Related Articles | Metrics
    Early analgesia of cocktail therapy after total knee arthroplasty with enhanced recovery after surgery program
    Li Shangzhi, Zheng Dezhi, Liu Jun
    2021, 25 (18):  2794-2798.  doi: 10.3969/j.issn.2095-4344.3826
    Abstract ( 226 )   PDF (612KB) ( 24 )   Save
    BACKGROUND: Although cocktail therapy is widely used to relieve pain after total knee arthroplasty, the analgesic effect of different combination schemes has not been fully confirmed.
    OBJECTIVE: To observe the efficacy of cocktail therapy on analgesia after total knee arthroplasty with enhanced recovery after surgery program.
    METHODS: Sixty patients with severe knee osteoarthritis who underwent unilateral total knee arthroplasty at Tianjin Hospital from January to May 2019 were enrolled. According to the principle of double-blind randomization, they were divided into two groups, 30 cases in each group. Patients in the trial group were injected with cocktail formula drugs around the joints in the operation, while patients in the control group did not receive any treatment. Static pain visual analogue scale scores of knee joints at 6, 12, 24, 48, and 72 hours, the maximum flexion of the knee joint at 48 and 72 hours, the initial time of the straight leg-raising, and postoperative opioid remedy analgesia rate and postoperative complications were compared between the two groups. 
    RESULTS AND CONCLUSION: (1) The visual analogue scale scores of the trial group were significantly lower than those of the control group at 6 and 12 hours after operation (both P < 0.001), and the postoperative analgesic rate of opioids was significantly lower in the trial group than that of the control group (P < 0.001). (2) There were no statistically significantly differences in the preoperative general data, visual analogue scale scores at 24, 48, and 72 hours, knee maximum flexion at 48 and 72 hours, the time of the straight leg-raising, and postoperative complications (both P > 0.05). (3) The results indicate that cocktail therapy in total knee arthroplasty is safe and effective for early postoperative analgesia with enhanced recovery after surgery program.
    Figures and Tables | References | Related Articles | Metrics
    Finite element analysis of cortical bone trajectory screw fixation on adjacent segments
    Wei Yuanbiao, Guo Huizhi, Zhang Shuncong
    2021, 25 (18):  2799-2804.  doi: 10.3969/j.issn.2095-4344.3840
    Abstract ( 198 )   PDF (792KB) ( 56 )   Save
    BACKGROUND: In recent years, cortical bone trajectory screws have been used as a new type of spinal internal fixation; it can significantly increase the pull-out strength in lumbar vertebra and achieve similar biomechanical stability to traditional trajectory pedicle screw. However, the influence of cortical bone trajectory screws on adjacent segments has not been evaluated. 
    OBJECTIVE: To compare the influence of cortical bone trajectory screws and traditional trajectory pedicle screw on adjacent intervertebral disc and facet joint. 
    METHODS: An intact finite element model of L3 to sacrum was constructed by using CT scan data of normal male volunteers. After verifying the validity of the intact lumbosacral model, the traditional trajectory pedicle screw and cortical bone trajectory screws models of L4-5 level segment fixation were reconstructed, respectively. The material properties of the models were set up. The influences of the two internal fixation instruments on the motion range of adjacent segments, disc stress and facet joint of the upper and lower adjacent segments (L3-4 and L5-S1) were compared.
    RESULTS AND CONCLUSION: (1) The finite element validity showed that the model could simulate the physiological activities of normal lumbar spine well. (2) The difference of the two fixation models in adjacent segments was small (<10%) in motion range and the Von Mises stress of the intervertebral disc. As for the Von Mises stress of adjacent facet joints, the stress at L4 superior articular process in cortical bone trajectory screws model was less than that of traditional trajectory pedicle screw model in all working conditions, especially in left and right rotations (reduced by 30.1% and 15.9%, respectively). The maximum equivalent stress of at L5 inferior articular process in the cortical bone trajectory screws model increased by 10.4%, 20%, 9.6% and 2.7% compared with the traditional trajectory pedicle screw model in flexion, extension, left bending and left rotation, respectively, and decreased by 24.5% and 7.4% in right bending and right rotation, respectively. (3) Overall, the influences of the two instruments on the motion range and disc stress of adjacent segments were similar, but compared with traditional trajectory pedicle screw fixation, cortical bone trajectory screws reduced the stress of cephalic adjacent facet and increased the stress of caudal adjacent facet joints.
    Figures and Tables | References | Related Articles | Metrics
    Application of head-neck ratio in the treatment of femoral neck fracture in aged patients with artificial femoral head replacement
    Song Kaikai, Du Gangqiang, Li Peng, Jiang Shengyuan, Gong Zhihao, Zhang Zhiwei, Zhang Kai
    2021, 25 (18):  2805-2809.  doi: 10.3969/j.issn.2095-4344.3841
    Abstract ( 238 )   PDF (730KB) ( 32 )   Save
    BACKGROUND: Hip replacement has become the main treatment for femoral neck fracture in the elderly at present, but there is no simple, effective or reproducible method to reduce the incidence of unequal length of lower limbs.
    OBJECTIVE: To investigate the effectiveness of head-neck ratio in balancing the difference of lower extremity length in femoral neck fracture replacement.
    METHODS: From January 2017 to March 2019, 132 aged patients undergoing unilateral artificial femoral head replacement for femoral neck fracture were selected as the research object. From January 2017 to February 2018, 68 cases were treated by traditional method of equilibrium of lower limb length, known as the traditional group. From March 2018 to March 2019, 64 patients with head and neck for spell equilibrium in lower limb length were included in the improved group. The operation time, hospital stay, postoperative double lower limbs length difference, the last follow-up function Harris hip score and complications after surgery were selected for retrospective analysis in both groups.
    RESULTS AND CONCLUSION: (1) All patients were followed up for 6-20 months. (2) There were no statistically significant differences between the modified group and the traditional group in operation time, hospital stay, and postoperative complications (P > 0.05), but the improved group (4.56±3.07) mm had a significant advantage over the traditional group (6.09±3.31) mm in the balanced length of lower limbs, and the difference between the two groups was statistically significant (P < 0.05). (3) At the last follow-up, Harris score of hip function in the improved group (92.36±3.35) points was higher than that in the traditional group (91.09±3.41) points, and the difference between the two groups was statistically significant (P < 0.05). (4) These results indicate that artificial femoral head replacement for elderly patients with unilateral femoral neck fracture using head-neck ratio is simple and effective. It is effective in balancing the unequal length of lower limbs after surgery and promoting the recovery of hip function.
    Figures and Tables | References | Related Articles | Metrics
    Numerical analysis of the mechanical behaviors of cartilage in various levels of osteoarthritis in a gait cycle
    Han Lei, Liu Haiying, Zhang Hao
    2021, 25 (18):  2810-2815.  doi: 10.3969/j.issn.2095-4344.3842
    Abstract ( 346 )   PDF (1082KB) ( 33 )   Save
    BACKGROUND: The mechanical environment of cartilage with osteoarthritis at all levels has a certain influence on the development of osteoarthritis. Computer simulation provides a method to quantify the mechanical environment of knee joint cartilage, which makes it possible to study the mechanical behavior of osteoarthritis cartilage by finite element method.
    OBJECTIVE: To study the stress distribution of cartilage and the change rule of fluid velocity in cartilage of healthy adults and cartilage with osteoarthritis at all levels through numerical simulation so as to explore the mechanical behaviors of cartilage with osteoarthritis at gait cycle.
    METHODS: The knee joint data of healthy adults were obtained by CT and MRI scanning, and the three-dimensional finite element model of the whole knee joint was established by Abaqus software. The software HyperMesh was used to divide the mesh of the total knee joint, and the binding relationship and interaction between internal components of the knee was set. By changing the material properties of cartilage and adjusting the time length of each phase and the angle between femur and tibial plateau, the cartilage load and boundary conditions of healthy adults and osteoarthritis at all levels could be set in the model.
    RESULTS AND CONCLUSION: (1) The simulation results showed that the mean Mises stress and the change curves of fluid velocity in the femur cartilage and tibia cartilage increased firstly and then decreased in the gait cycle. (2) Compared with healthy adults, the Mises stress of cartilage in patients with osteoarthritis at all levels continually decreased with duration of disease. The flow velocity of fluid in cartilage firstly increased and then decreased when it developed to osteoarthritis grade 3, and the change range of Mises stress and fluid flow velocity of cartilage with osteoarthritis at all levels decreased. (3) Therefore, with the continuous development of osteoarthritis, the fluid flow velocity increased, the Mises stress decreased and the range of joint surface stress changes decreased in a gait cycle, which lead to the weakening of joint bearing and cushioning capacity.
    Figures and Tables | References | Related Articles | Metrics
    Finite element analysis of screw-bone anti-pullout in four models of anterior lower cervical fixation in children
    Qu Xingyue, Zhou Jianqiang, Xu Xuebin, Zhang Shaojie, Li Zhijun, Wang Xing
    2021, 25 (18):  2816-2821.  doi: 10.3969/j.issn.2095-4344.3843
    Abstract ( 328 )   PDF (2096KB) ( 22 )   Save
    BACKGROUND: Anterior internal fixation of lower cervical spine in children has been applied clinically. However, the unique developmental morphology, physiological characteristics and mechanical changes of children’s cervical vertebrae are significantly different from those of adults. It is easy for screw fixation to loosen, shift and pull-out in clinical application, so it is necessary to carry out screw-bone pull-out test analysis for different screw internal fixation methods in children. 
    OBJECTIVE: To compare the superiority of the four screw internal fixation systems in the anterior model of the lower cervical spine in children using finite element analysis.
    METHODS: The cervical spine image data were collected from the multislice spiral CT scanning of corpse specimen of a 6-year-old normal girl (with informed consent of family members), and the three-dimensional finite element model of normal C4 was constructed by using software such as Mimics 16.01, Pro/E 5.0, Geomagic Studio 2015, Hypermesh 14.0 and Abaqus 6.14. On the basis of C4 model, four kinds of screw fixation models were established, i.e., anterior cervical bicortical pedicle screw internal fixation (ACBS), anterior cervical single cortical pedicle screw internal fixation (ACSS), anterior cervical vertebral screw internal fixation (ACVS) and anterior cervical Orion screw internal fixation (ACOS). The screw pull-out stress peak value and the stress value of each part of the screw were analyzed. 
    RESULTS AND CONCLUSION: (1) The stress peak of screw pull-out resistance was in order from high to low: ACBS group > ACSS group > ACVS group > ACOS group. (2) In the process of pulling out the screws of the four internal fixation models, the front part of the screw rod bore the greatest stress, and the stress was attenuated during the process of transferring to the tip. (3) The four internal fixation models had the highest stress peak in the vertebral body, and the pedicle internal fixation was more stable than the internal fixation alone. (4) The peak stress of the cervical spine and the peak of the screw stress in the ACBS group were higher than those of the other groups, and the holding power was better. The cervical spine stress peak and screw stress peak in ACSS group were higher than those in ACVS group and ACOS group, and there was no difference between ACVS group and ACOS group. (5) The results showed that bicortical pedicle screw internal fixation was superior to the anterior cervical screw extraction in children.   
    Figures and Tables | References | Related Articles | Metrics
    Three-dimensional printing combined with subtalar arthroscope assisted reduction and internal fixation with percutaneous screw with mechanical arm for calcaneal fractures
    Liu Yanzi, Gao Wuchang
    2021, 25 (18):  2822-2826.  doi: 10.3969/j.issn.2095-4344.3844
    Abstract ( 215 )   PDF (754KB) ( 20 )   Save
    BACKGROUND: The treatment of calcaneal fracture has a long history. Traditional L-shaped approach is the most widely used surgical approach, fully exposed, but with a high postoperative complication rate. How to achieve accurate internal fixation of calcaneal fracture while reducing postoperative complications is the current direction of medical research. Three dimensional (3D) printing, arthroscopy, and robotic-assisted surgery offer new ideas for treatment.
    OBJECTIVE: To explore the clinical effect of 3D printing combined with subtalar arthroscope assisted reduction and internal fixation with percutaneous screw assisted by mechanical arm for calcaneal fractures. 
    METHODS: Totally 62 patients with Sanders II and Sanders III calcaneal fractures were enrolled and divided into two groups. The observation group (n=30) received 3D printing combined with subtalar arthroscope assisted reduction and internal fixation with percutaneous screw assisted by mechanical arm. The traditional group (n=32) received traditional L-shaped approach. Preoperative waiting time, surgical time, accuracy of screw placement, fluoroscopy times, blood loss, incidence of postoperative complications, fracture healing time, calcaneal width, Bohler angle, Gissane angle, visual analogue scale scores, and Maryland scores were recorded and compared between the two groups.
    RESULTS AND CONCLUSION: (1) The preoperative waiting time, surgical time, fluoroscopy times, blood loss, incidence of postoperative complications, and fracture healing time of the observation group were all less than those of the traditional group (P < 0.05). (2) The precision rate of screw placement in the observation group was much higher than that in the traditional group (P < 0.05). (3) Visual analogue scale scores and Maryland scores had no significant difference between the two groups (P > 0.05). (4) It is indicated that 3D printing combined with subtalar arthroscope assisted reduction and internal fixiation with percutaneous screw assisted by mechanical arm for calcaneal fractures is minimally invasive, with short preoperative waiting time, short operation time, accurate screw placement, low postoperative complications and less healing time; it is a reliable treatment for calcaneal fractures.
    Figures and Tables | References | Related Articles | Metrics
    Sanders type III calcaneal fractures: reliability of posterior facet screw fixation combined with lateral column screw fixation
    Wu Kai, Lin Jian, Huang Yinjun, Wang Qiugen, Huang Jianhua, Weng Shiyang
    2021, 25 (18):  2827-2832.  doi: 10.3969/j.issn.2095-4344.3827
    Abstract ( 246 )   PDF (747KB) ( 21 )   Save
    BACKGROUND: For Sanders type III calcaneal fractures, the classic “L-type” large incision often causes postoperative skin necrosis and other complications. Some scholars have shown that the use of mini plate through the tarsal sinus incision can significantly reduce the incision problems and achieve the same curative effect. However, there is still a lack of biomechanical verification.
    OBJECTIVE: Biomechanical tests were carried out on Sanders III cadaveric model to verify the effectiveness and reliability of posterior facet screw fixation combined with lateral column screw fixation.
    METHODS: Sanders III intra-articular calcaneal fracture models were established on five adult cadaveric lower limb specimens. The high flexible F3 plate system was used to fix the posterior articular surface, and two cannulated screws were used to support the inner and outer columns respectively. At the same time, the anterior calcaneal bone mass (block A), the medial posterior articular surface bone mass (bone block M), the lateral posterior articular surface bone mass (bone block L), and the posterior calcaneal bone block (bone block P) were labeled with rigid body. The relative distances between the bone fragments were marked as AM, AL, AP, ML, MP, LP. Then, 800 N cyclic load test and 2 000 N ultimate load test were carried out on the biomechanical test platform. Simultaneously, the displacement between the rigid bodies of each bone block was tracked by using the Qualisys motion capture system, and the data were recorded and analyzed by using the software of Qualisys track manager.
    RESULTS AND CONCLUSION: (1) In 800 N cyclic load test, the median displacements of AM, AL, AP, ML, MP and LP were 1.60, 1.68, 2.45, 2.20, 1.20 and 2.00 mm, and the average values were 1.99, 2.05, 2.05, 2.48, 1.17 and 1.97 mm. (2) Under the limit load of 2 000 N, the median displacements of AM, AL, AP, ML, MP and LP were 2.10, 1.85, 2.40, 2.10, 1.50 and 1.70 mm, and the average values were 2.09, 1.88, 2.44, 2.10, 1.59 and 1.69 mm. (3) The internal fixation system of all specimens withstood the load and maintained its integrity and reliability in both tests. There was no broken nail, no screw withdrawal or plate bending. Only one hollow nail was slightly bent in one case. (4) The internal fixation effect and biomechanical strength of the posterior facet screw fixation combined with lateral column screw fixation meet the design expectations. It is a reliable and effective method to treat sanders III calcaneal fractures with minimally invasive treatment.
    Figures and Tables | References | Related Articles | Metrics
    Effects of intravenous tranexamic acid combined with periarticular multipoint injection of tranexamic acid cocktail on blood loss and pain after total knee arthroplasty
    Liu Jinlei, Yin Li, Zhang Yi, Wang Haitao, Li Zhuangyan, Xia Peige, Qiao Renqiu
    2021, 25 (18):  2833-2839.  doi: 10.3969/j.issn.2095-4344.3835
    Abstract ( 279 )   PDF (755KB) ( 25 )   Save
    BACKGROUND: Total knee arthroplasty can produce a lot of blood loss and severe pain. How to effectively reduce blood loss and pain after total knee arthroplasty has become an urgent problem for joint surgeons.
    OBJECTIVE: To observe the effects of intravenous tranexamic acid combined with periarticular multipoint injection of tranexamic acid cocktail on blood loss and pain after total knee arthroplasty.
    METHODS: Totally 90 patients who underwent primary unilateral total knee arthroplasty admitted to the Department of Orthopedics of the First Affiliated Hospital of Zhengzhou University from June 2018 to May 2019 were selected and randomly divided into three groups (n=30) according to the envelope method. Patients in the group A were intravenously injected with tranexamic acid (1 g:100 mL) combined with periarticular multipoint infiltration injection of 50 mL normal saline before the implantation of prosthesis. Patients in the group B were intravenously injected with tranexamic acid (1 g:100 mL) combined with periarticular multipoint infiltration injection of 50 mL cocktail (0.3 mL epinaphrine, 10 mL ropivacaine, 0.5 mL morphine, 39.2 mL normal saline) before the implantation. Patients in the group C were intravenously injected with tranexamic acid (1 g:100 mL) combined with periarticular multipoint infiltration injection of cocktail complex tranexamic acid (1 g:10 mL), a total of 50 mL, before the implantation. Total blood loss, drainage volume, hidden blood loss, maximum hemoglobin decline, transfusion rate and transfusion volume, visual analogue scale at rest and activity at 1, 3, 7, and 14 days after surgery, and incidence of deep vein thrombosis and other adverse events were compared among the three groups.
    RESULTS AND CONCLUSION: (1) In terms of blood loss, total blood loss, recessive blood loss, drainage volume and postoperative maximum hemoglobin decline in group C were all lower than those in the other two groups, with statistically significant differences (P < 0.05). It was worth mentioning that the drainage volume of group B was lower than that of group A, with statistically significant difference (P < 0.05). (2) For postoperative analgesia, visual analogue scale scores of group B and group C at rest on day 1, 3 and 7 were significantly lower than those of group A (P < 0.05), and the difference between group B and group C was not statistically significant (P > 0.05). Visual analogue scale scores at rest at 14 days after surgery showed no statistically significant difference among the three groups (P=0.898). During the activity, visual analogue scale scores of group B and group C at 1 and 3 days after surgery were significantly lower than group A (P < 0.05), but there was no statistically significant difference between group B and group C (P > 0.05). There was no statistically significant difference in visual analogue scale scores of the three groups at 7 and 14 days after surgery (P > 0.05). (3) There was no significant difference in blood transfusion rate and volume among the three groups (P > 0.05). (4) No deep vein thrombosis or other adverse events occurred in the three groups. (5) The results show that intraoperative intravenous tranexamic acid combined with periarticular multipoint infiltration injection of tranexamic acid cocktail can effectively reduce the blood loss, with effective early analgesia, and the analgesia effect is better when the patient is resting after the operation. There is no increased risk of deep vein thrombosis and other adverse events when the proposed therapy is applied to the patients. 
    Figures and Tables | References | Related Articles | Metrics
    Effectiveness of Tuina in the treatment of pain after total knee arthroplasty in patients with knee osteoarthritis
    Xu Hui, Kang Bingxin, Gao Chenxin, Zhao Chi, Xu Xirui, Sun Songtao, Xie Jun, Xiao Lianbo, Shi Qi
    2021, 25 (18):  2840-2845.  doi: 10.3969/j.issn.2095-4344.3845
    Abstract ( 367 )   PDF (695KB) ( 61 )   Save
    BACKGROUND: The pain of patients after total knee arthroplasty seriously affects the efficacy of surgery and patient satisfaction, which is a clinical problem concerned by joint surgery experts all over the world.
    OBJECTIVE: To observe the efficacy of Tuina in the treatment of pain after total knee arthroplasty in patients with knee osteoarthritis. 
    METHODS: In a randomized controlled design, 134 patients with unilateral knee osteoarthritis scheduled for total knee arthroplasty were randomly divided into two groups: Tuina group (n=67) and control group (n=67). The control group was treated with routine postoperative analgesia, and the Tuina group was treated with Tuina on the basis of the control group. The intervention time was set from the first day to the seventh day after operation. The pressure pain threshold, visual analogue scale score, times of patient-controlled analgesia, additional dose of analgesics, range of motion of knee joint, Hamilton anxiety scale score, and adverse events were recorded in the two groups. The study was approved by the Ethics Committee of Shanghai Guanghua Integrated Chinese and Western Medicine Hospital on October 12, 2019, approval No. 2019-K-24. All participants gave informed consent to the trial protocol and process, and signed informed consent. This study was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/searchproj.aspx, ChiCTR1900027810) on November 29, 2019.
    RESULTS AND CONCLUSION: (1) After 3 and 7 days of intervention, the pressure pain threshold in the Tuina group was higher than that in the control group (P < 0.05). (2) After 3 and 7 days of intervention, the visual analogue scale score in the Tuina group was lower than that in the control group (P < 0.05). (3) The pressing times of patient-controlled analgesia after 2 days of intervention and the additional dose of analgesics after 7 days of intervention in the Tuina group were less than those in the control group (P < 0.05). (4) After 3 and 7 days of intervention, the range of motion of knee joint in the Tuina group was better than that in the control group (P < 0.05). (5) After 3 and 7 days of intervention, the Hamilton anxiety scale score in the Tuina group was lower than that in the control group (P < 0.05). (6) There were no adverse events in both groups. (7) It is indicated that Tuina can improve the local pain threshold of knee after total knee arthroplasty in patients with knee osteoarthritis, reduce the use of analgesics, and promote the rehabilitation of knee, which is safe and reliable. 
    Figures and Tables | References | Related Articles | Metrics
    Analysis on relative factors affecting pyrexia following total hip replacement
    Chen Deng, Zhang Yaxin, Dai Jihang, Chen Duoyun, Sun Yu
    2021, 25 (18):  2846-2850.  doi: 10.3969/j.issn.2095-4344.3846
    Abstract ( 503 )   PDF (623KB) ( 33 )   Save
    BACKGROUND: Postoperative pyrexia has also been a problem for orthopedic surgeons. 
    OBJECTIVE: To analyze the related factors of pyrexia after total hip replacement.
    METHODS: The medical records of 140 patients undergoing hip replacement from June 2018 to December 2019 in Northern Jiangsu People’s Hospital  were collected. The body temperature of all patients measured routinely in the hospital was axillary temperature, and postoperative fever was defined as temperature > 38 °C. The relationship between postoperative pyrexia and preoperative, intraoperative and postoperative factors was retrospectively analyzed. Among them, preoperative factors are: age, sex, hypertension, diabetes, body mass index, preoperative hemoglobin, preoperative leukocytes, preoperative albumin, preoperative C-reactive protein, whether to take nonsteroidal anti-inflammatory drugs before surgery, whether it was nebulized before surgery; intraoperative factors: anesthesia method, operation time, and bleeding volume; postoperative factors: postoperative catheterization, postoperative blood transfusion, hemoglobin on the first day after surgery, leukocytes on the first day after surgery, albumin on the first day and C-reactive protein on the first postoperative day.
    RESULTS AND CONCLUSION: (1) According to whether there was fever after operation, it was divided into non-pyrexia group (n=100) and pyrexia group (n=40). (2) Univariate analysis results: In the measurement data, the age of non-pyrexia group was higher than that of pyrexia group; the operation time of non-pyrexia group was shorter than that of pyrexia group; and the C-reactive protein of non-pyrexia group was lower than that of pyrexia group on the first day after surgery, and the difference was statistically significant (P < 0.05). In the count data, there were statistical differences between non-pyrexia and pyrexia groups in intraoperative anesthesia and albumin level on the first postoperative day (P < 0.05). (3) The statistically significant single factor was analyzed by multivariate binary logistic regression analysis, and it was found that four independent factors were closely related to fever after hip replacement: operation time (OR=1.024, P=0.032), C-reactive protein on the first postoperative day (OR=1.014, P=0.045), and intraoperative anesthesia method (OR=3.303, P=0.035), and the above indexes were risk factors. The level of albumin on the first postoperative day (OR=0.337, P=0.045) was a protective factor. (4) It is concluded that pyrexia after artificial hip replacement is significantly related to operation time, intraoperative anesthesia method, C-reactive protein on the first postoperative day, and albumin level on the first postoperative day.
    Figures and Tables | References | Related Articles | Metrics
    Kyphoplasty versus vertebroplasty in the treatment of osteoporotic vertebral compression fracture in the elderly: a comparison of vertebral height recovery
    Sun Yiqiang, Xing Jianqiang, Li Xuecheng, Wang Xin, Tian Shenglan, Zhao Zihao, Geng Xiaopeng
    2021, 25 (18):  2851-2855.  doi: 10.3969/j.issn.2095-4344.3806
    Abstract ( 261 )   PDF (1313KB) ( 27 )   Save
    BACKGROUND: Percutaneous kyphoplasty and vertebroplasty are the main minimally invasive treatment methods for osteoporotic vertebral compression fracture, but which one is the best treatment method is still controversial.   
    OBJECTIVE: To prospectively research the efficacy of percutaneous kyphoplasty in the treatment of single-segment osteoporotic vertebral compression fracture in restoring vertebral height. 
    METHODS: From January 2017 to December 2018, 86 patients with single-segment osteoporotic vertebral compression fracture were included into this study and divided into two groups (n=43) by random number for percutaneous kyphoplasty and percutaneous vertebroplasty, respectively. Visual analogue scale, Oswestry disability index, vertebral height recovery and Cobb angle change were compared between the two groups. This trial was approved by the Ethics Committee of Binzhou Medical University Hospital. 
    RESULTS AND CONCLUSION: (1) Visual analogue scale scores and Oswestry disability index in the two groups were significantly reduced at postoperative 3 days compared with those before operation (P < 0.05), but there was no statistically difference between the two groups (P > 0.05). (2) The height and Cobb angle of the involved vertebrae in the two groups were significantly improved at 3 days after operation compared with those before operation (P < 0.05), but there was no statistical difference between the two groups (P > 0.05). (3) The vertebral height of percutaneous kyphoplasty group increased after balloon distraction compared with that before surgery (P < 0.05), but the vertebral height was decreased after the balloon was removed and was lower than when the balloon was expanded (P < 0.05). (4) Results indicate that both percutaneous kyphoplasty and percutaneous vertebroplasty can effectively relieve the pain of patients with osteoporotic fractures and improved their daily life functions. There is no significant difference between the two methods in restoring vertebral height and reducing kyphosis of the involved vertebrae. 
    Figures and Tables | References | Related Articles | Metrics
    Relationship between the intraoperative endplate injury and cage retropulsion after lumbar interbody fusion 
    Zhang Mingyan, Liu Xiangyang, Chang Lei, Chen Jing, Shen Xiongjie, Liu Bin, Peng Shuai, Zhang Chao, Wu Huanyu, Zhu Feng, Mou Haipin
    2021, 25 (18):  2856-2862.  doi: 10.3969/j.issn.2095-4344.3836
    Abstract ( 329 )   PDF (875KB) ( 29 )   Save
    BACKGROUND: Lumbar interbody fusion has received remarkable results in lumbar degenerative illnesses; however, some of cage retropulsion has occurred. There is no unified understanding of the reasons why cage retropulsion has happened postoperatively, which may be related to age, sex, body mass index, preoperative diagnosis, multi-segmental fusion, operative segment, cage position, small cage, pear-shaped intervertebral disc, osteoporosis, and unilateral screw fixation. In clinical practice, the authors found that most of the patients with cage retropulsion could affect the injury of the posterior edge of the fusion segment on CT after operation. Therefore, this paper discusses the relationship between the end plate injury and cage retropulsion. 
    OBJECTIVE: To investigate the causes of cage retropulsion after lumbar interbody fusion, and analyze the relationship between the intraoperative endplate injury and cage retropulsion. 
    METHODS: The data of 1 823 patients undergoing lumbar interbody fusion from three clinical medical centers from January 2014 to December 2018 were retrospectively analyzed, including 21 cases in the cage retropulsion group and 1 802 cases in the non-cage retropulsion group. The t-test was used to compare the age and multiple fusion segments between the two groups. χ2 test was used to compare sex, preoperational diagnosis, and operational segments between the two groups. Totally 21 matched groups were organized; each had one cage retropulsion case and four non-cage retropulsion patients, who had the same sex and similar age (<±2 years); and the fusion segments contained the cage retropulsion segment in the cage retropulsion patient. Multifactor conditional logistic regression analysis was used to look over the risk factors of cage retropulsion in 21 matched groups. The potential risk factor involved the logistic analysis was the injury of endplate (≥ 5 mm), pear disk, BMI, small cage, and the posterior location of the cage.  
    RESULTS AND CONCLUSION: (1) The average age of patients in the cage retropulsion group was 63.3 years, and that in the non-cage retropulsion group was 58.7 years; t-test showed significant difference (P < 0.05). However, the average number of fusion segments was 1.9 and 1.8 in the cage retropulsion group and the non-cage retropulsion group, respectively, with no significant difference by t-test (P=0.664); there was no significant difference in sex, preoperative diagnosis and surgical segments between the two groups by χ2 test (P > 0.05). (2) Multifactor conditional logistic regression analysis results indicated that the endplate injury (≥ 5 mm), pear-shape intervertebral disc and the posterior cage location were significant risk factors related to cage retropulsion (all P < 0.05; OR(95%CI)=54.9(23.8-126.7), 64.9(12.2-346.4) and 21.2(10.1-44.6). (3) These findings show that the endplate injury ((≥ 5 mm) is correlated with postoperative cage retropulsion, which is a risk factor for cage retropulsion. It is suggested that large reamer (12#) should not be used repeatedly to clean intervertebral disc, especially for patients with severe degeneration of nucleus pulposus, narrow intervertebral space and pear-shaped intervertebral disc.
    References | Related Articles | Metrics
    Difference between proximal humeral locking plate and cannulated screw fixation in the treatment of Mutch type II fracture of greater tuberosity of humerus
    Liu Gang, Zhang Baolu, Shi Jie, Bao Dingsu, Zeng Shengqiang, Deng Kai, Liu Yang, Wang Guoyou, Fu Shijie
    2021, 25 (18):  2863-2868.  doi: 10.3969/j.issn.2095-4344.3829
    Abstract ( 179 )   PDF (821KB) ( 17 )   Save
    BACKGROUND: In recent years, proximal humeral locking plate has achieved good results in the treatment of proximal humeral fractures. However, there are few reports of locking plate application in Mutch type II greater tuberosity split fractures.
    OBJECTIVE: To exploit the clinical effect of Mutch type II greater tuberosity split fractures of proximal humerus with open reduction and internal fixation with locking plate of proximal humerus. 
    METHODS: From May 2009 to June 2018, 40 patients (29 males and 11 females) with Mutch type II GT split fractures were treated in the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University. They were randomly divided into two groups. The observation group received internal fixation with locking plate of proximal humerus (n=20). The control group received cannulated screw fixation (n=20). The fracture healing and shoulder joint function were followed up after operation. Shoulder joint function was assessed by American Shoulder and Elbow Surgeon (ASES) score, Constant-Murley score (CMS), University of California, Los Angeles  (UCLA) shoulder score, and visual analogue scale score. The trial was approved by the Ethics Committee of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University (approval No. SWMUTCMJ-2017-09-10). 
    RESULTS AND CONCLUSION: (1) After 1 year of follow-up, there were no complications such as plate or screw loosening or broken. In the observation group, there were one case of malunion of large tuberosity and one case of shoulder joint pain. In the control group, there were three cases of malunion of large tuberosity, two cases of upward movement of large tubercle and two cases of shoulder joint pain. (2) At 1-year follow-up, the CMS score and UCLA score of the observation group were higher than those of the control group (P < 0.05). ASES score and VAS score showed no significant difference (P > 0.05). (3) The results showed that proximal humeral locking plate internal fixation in the treatment of Mutch II type fracture of greater tuberosity of humerus can achieve strong fixation and restore the displacement of greater tuberosity fracture. However, we still have to take an eye in complication.
    Figures and Tables | References | Related Articles | Metrics
    Cannulated screw combined with buttress plate in treatment of Pauwels III femoral neck fracture in middle-aged and young adults
    Wei Feng, Zhou Yejin, Yao Tao, Shan Tao
    2021, 25 (18):  2869-2874.  doi: 10.3969/j.issn.2095-4344.3830
    Abstract ( 246 )   PDF (871KB) ( 26 )   Save
    BACKGROUND: For Pauwels type III femoral neck fracture, it is not clear which internal fixation method is more advantageous.
    OBJECTIVE: To compare the efficacy of direct anterior approach combined with medial buttress plate and simple cannulated screw for treatment of Pauwels III type femoral neck fracture in middle-aged and young adults. 
    METHODS: Totally 76 young and middle-aged and young patients with Pauwels III type femoral neck fracture in The Third Affiliated Hospital of Anhui Medical University (Hefei First People’s Hospital) from January 2015 to January 2019 were retrospectively analyzed. There were 42 males and 34 females, at the age of (44.5±6.6) years. Totally 35 patients in the observation group were treated with cannulated screws combined with medial buttress plate. In the control group, 41 cases were fixed with cannulated screws only. The fracture healing time, Harris hip score, visual analogue scale score, and the incidence of complications were observed during follow-up. The trial was approved by the Ethics Committee of The Third Affiliated Hospital of Anhui Medical University (approval No. LYPD2018(20)). 
    RESULTS AND CONCLUSION: (1) The postoperative follow-up time of the two groups ranged from 16 to 18 months (averagely 17.24 months). The fracture healing time of the observation group was shorter than that of the control group (P < 0.05). (2) In the observation group, among 32 cases, there were 1 case of incision infection and 1 case of internal fixation failure, and the incidence of complications was 9%. In the control group, among 42 cases, there were 2 cases of fracture nonunion, 2 cases of delayed union of fracture, 5 cases of internal fixation failure and 4 cases of femoral head necrosis, and the incidence of complications was 32%. The difference in the incidence of complications between the two groups was significant (P < 0.05). (3) The excellent and good rate of Harris hip score in the observation group was higher than that in the control group (82%, 73%, P < 0.05). (4) The visual analogue scale score of the observation group was lower than that of the control group at 3 and 6 months after operation (P < 0.05). (5) Results suggest that clinical effect of direct anterior approach cannulated screw combined with medial buttress plate fixation in the treatment of Pauwels III femoral neck fracture in young and middle-aged adults is better than that of simple cannulated screw fixation, which can promote fracture healing and recovery of hip function, and reduce the occurrence of complications.  
    Figures and Tables | References | Related Articles | Metrics
    Risk of complications of early postoperative weight-bearing after internal fixation of intracapsular femoral neck fractures: 2-year follow-up
    Li Haifeng, Liu Yu, Yin Qudong, Sun Zhenzhong, Rui Yongjun, Gu Sanjun
    2021, 25 (18):  2875-2880.  doi: 10.3969/j.issn.2095-4344.3837
    Abstract ( 331 )   PDF (704KB) ( 29 )   Save
    BACKGROUND: Traditional internal fixation has a high incidence of postoperative complications in the treatment of femoral neck fractures, and early rehabilitation and weight-bearing are not advocated. Percutaneous compression plate is a new internal fixation method for the treatment of femoral neck fractures, which allows early rehabilitation and weight-bearing. The short and medium-term follow-up results showed that the risk of complications such as nonunion and head necrosis did not increase. 
    OBJECTIVE: To investigate whether early postoperative weight-bearing after internal fixation of intracapsular femoral neck fractures may be taken and increases the risk of postoperative complications. 
    METHODS: From January 2012 to December 2017, 90 patients with intracapsular femoral neck fractures undergoing internal fixation in the Wuxi No.9 People’s Hospital were retrospectively studied. According to the methods of internal fixation, they were divided into two groups, and each group had 45 cases. Hollow compression screws group was fixed with three hollow compression screws and taking late weight-bearing. The percutaneous compression plate group was fixed with percutaneous compression plate and taking early gradual weight-bearing. Fracture healing, internal fixation failure, head necrosis, and hip functional recovery (Harris score) were observed in both groups. Internal fixation failure, nonunion, and head necrosis were considered as overall complication. Multivariate Logistic regression was used to analyze the relationship between overall complication and age, sex, course of disease, fracture type, Pauwel angle and internal fixation method.
    RESULTS AND CONCLUSION: (1) All patients were followed-up for more than 2 years. There were 5 cases of internal fixation failure, 6 cases of nonunion, 6 cases of head necrosis and 17 cases of overall complication in hollow compression screws group; while 5 cases of head necrosis, and 5 cases of overall complication without internal fixation failure or nonunion in percutaneous compression plate group. The internal fixation failure, nonunion and overall complication in percutaneous compression plate group were significantly lower than those in hollow compression screws group (P=0.011, 0.021, 0.006). The head necrosis occurred earlier in hollow compression screws group than that in percutaneous compression plate group. In terms to the head necrosis rate, there was no significant difference in the final follow-up between the two groups (P=0.748). (2) The hip functional recovery in percutaneous compression plate group was better than that in hollow compression screws group at 6 and 12 months postoperatively (P=0.000, 0.001). However, there were no significant differences at 24 months and the last follow-up between the two groups (P=0.174, 0.285). (3) Multiple Logistic Regression analysis showed that internal fixation method was the only statistically significant risk factor for overall complication. Probability of occurrence of overall complication was reduced by 73.9% in percutaneous compression plate group than that in hollow compression screws group (OR=0.261, P=0.034). (4) It is the performance of the internal fixator, not the early postoperative weight-bearing, which is related to the postoperative complications of intra-articular femoral neck fractures; the key factor to reduce the risk of postoperative complications is the reliable stable internal fixator with sliding compression effect.
    Figures and Tables | References | Related Articles | Metrics
    Application of three-dimensional reconstructive CT versus X-ray in postoperative evaluation of bone tunnel and graft status after single bundle anterior cruciate ligament near-isometric reconstruction
    Zheng Weipeng, Wei Hewei, Liu Zhijun, Wan Lei, Chen Sheng, Liao Zhihao, Hu Weijian
    2021, 25 (18):  2881-2886.  doi: 10.3969/j.issn.2095-4344.3832
    Abstract ( 242 )   PDF (747KB) ( 19 )   Save
    BACKGROUND: The imaging evaluation of anterior cruciate ligament reconstruction mostly through two-dimensional X-ray has disadvantages of non-solid and large measurement error, while three-dimensional reconstructive CT (3D-CT) has higher accuracy for postoperative evaluation.
    OBJECTIVE: To evaluate the accuracy of bone tunnel position and graft status after anterior cruciate ligament near-isometric reconstruction measured by 3D-CT and X-ray. 
    METHODS: From January 2016 to December 2019, 31 patients with arthroscopic anterior cruciate ligament reconstruction were selected from the Third Affiliated Hospital of Guangzhou University of Chinese Medicine, including 28 males and 3 females, at the age of 20-47 years. All patients were subjected to anterior medial approach to locate the bone tunnel of femur and anterior cruciate ligament near-isometric reconstruction. 3D-CT and X-ray examination were performed within one week after the operation to observe the condition of graft and bone tunnel. The position of bone tunnel in tibia and femur was measured by Klos method and Bernard method respectively. The trial was approved by the Ethics Committee of the Third Affiliated Hospital of Guangzhou University of Chinese Medicine.
    RESULTS AND CONCLUSION: (1) 3D-CT clearly showed the bone tunnel after anterior cruciate ligament reconstruction. The 31 patients had complete bone tunnel wall, (21.71±2.16) mm for femoral end graft and (14.23±1.78) mm for tibial end graft (excluding extrusion screw part). The internal fixator and graft ligament could also be observed. (2) X-ray films showed that the position of tibial tunnel was (44.17±5.23)% in sagittal plane and (43.05±4.58)% in coronal plane. The position of femoral tunnel was (28.75±4.59)% in Blumensaat line level and (38.23±8.71)% in height from the top of intercondylar fossa. 3D-CT showed that the position of tibial tunnel was (42.41±6.93)% in sagittal plane and (43.66%±4.12)% in coronal plane; the position of femoral tunnel was (32.41±6.33)% in blumensaat line level and (41.53±6.51)% in height from the top of intercondylar fossa. There was significant difference in tunnel position between the two methods at Blumensaat line level (P=0.011). (3) The results show that there are some differences between 3D-CT and X-ray films in the evaluation of bone tunnel position after anterior cruciate ligament near-isometric reconstruction. 3D-CT measurement can objectively and accurately reflect the condition of bone tunnel and graft state. 
    Figures and Tables | References | Related Articles | Metrics
    Clinical application and breakthrough of three-dimensional printing based on medical imaging technology
    Du Xueting, Yang Yang, Huang Wenhua, Chen Wubiao
    2021, 25 (18):  2887-2894.  doi: 10.3969/j.issn.2095-4344.3828
    Abstract ( 266 )   PDF (812KB) ( 69 )   Save
    BACKGROUND: As an extension of the “materialization” of image technology, three-dimensional (3D) printing is inseparable between the two. To meet the needs of clinical application, the combination of different principles of imaging technology and 3D printing technology makes it more possible in medical application. 
    OBJECTIVE: To summarize the progress of medical application research of the combination of different imaging principles and 3D printing, and analyze its advantages and disadvantages.
    METHODS: The relevant articles from the databases of Web of Science, PubMed, CNKI, SinoMed and Wanfang were searched by computer. The subject headings “3D printed, Three-dimensional printing, Additional Manufacturing, Ultrasonography, Ultrasound, MRI, Magnetic Resonance Imaging, CT, Computed Tomography, PET/CT, SPECT/CT, Radiotherapy, Digital Subtraction, DSA” in English and “3D printing, ultrasound, MRI, radiotherapy, nuclear medicine” in Chinese were retrieved in the past five years, and finally 61 articles were included for review. 
    RESULTS AND CONCLUSION: (1) This paper summarizes the medical application of 3D printing based on different types of image data, which is mainly divided into clinical application, equipment application and teaching application. The advantages and disadvantages of different image data sources are discussed and the difficulties in the combination of the two are summarized. (2) At present, the clinical application of medical 3D printing based on radiological imaging is wide, and the use is relatively mature. (3) With the in-depth application of 3D printing technology, non-ionized imaging methods such as MRI and ultrasound also show great potential in the application.
    Figures and Tables | References | Related Articles | Metrics
    Research status and clinical application of artificial knee joint testing machine
    Liu Jiahui, Zhang Zhongjiu, Jia Dianxiang, Zhai Aoqing, Niu Guangyun, Jiang Haibo
    2021, 25 (18):  2895-2901.  doi: 10.3969/j.issn.2095-4344.3831
    Abstract ( 242 )   PDF (728KB) ( 41 )   Save
    BACKGROUND: Knee joint testing machine research can improve the performance of knee joint prosthesis, provide guarantee for clinical replacement surgery, and increase the success rate of surgery.
    OBJECTIVE: To analyze the current status of research on knee joint testing machine at home and abroad, explore the shortcomings of the testing machine at present and the research direction of knee testing machine in the future.
    METHODS: The computer searched CNKI, Wanfang, ScienceDirect and other domestic and foreign databases. The Chinese and English keywords were “knee replacement, joint testing machine, knee testing machine”.
    RESULTS AND CONCLUSION: The research level of domestic knee joint testing machines is not high, and most of the testing machines are imported from abroad. The research of domestic scholars on knee testing machine is still in the ability to simulate the motion condition of knee prosthesis in human body, and it is only the simulation of motion condition, while the foreign research has entered a deeper level. In terms of wear test standards, due to the late start of domestic research, there is still a lack of test standards suitable for Asian sports, and there are deficiencies in the quantification of daily mechanical movements. Combining the needs of real experiments and the characteristics of the human body, the research of the knee testing machine should increase research efforts in several aspects such as the fidelity of the test environment, the similarity of the geometric shape of the prosthesis, and the influence of the involved motion.
    Figures and Tables | References | Related Articles | Metrics
    Value of respiratory tract management and fiberoptic bronchoscopy in traumatic cervical spinal cord injury
    Ren Bingkai, Zheng Yibin, Huang Leiwen, Wu Fanhui, Yang Dong
    2021, 25 (18):  2902-2907.  doi: 10.3969/j.issn.2095-4344.3825
    Abstract ( 236 )   PDF (704KB) ( 46 )   Save
    BACKGROUND: Patients with cervical spinal cord injury will have serious complications in the early stage, of which respiratory complications are the most common. Therefore, respiratory tract management is particularly important for the rehabilitation of patients with cervical spinal cord injury.
    OBJECTIVE: To introduce the neuroanatomical and pathological features of cervical spinal cord injury, and to summarize the multiple treatments of respiratory complications in patients with cervical spinal cord injury and the application of fiberoptic bronchoscopy in patients with cervical spinal cord injury in recent years.
    METHODS: By inputting the key words of “cervical spinal cord injury, pulmonary infection, respiratory tract management, antibiotics, nerve transfer, tracheotomy, mechanical ventilation, fiberoptic bronchoscope, pneumonia” in Chinese and “cervical spinal cord injury, fibrobronchoscopy, bronchoalveolar lavage, tracheotomy, pneumonia” in English, we searched the CNKI, Wanfang, SinoMed, PubMed, and Web of Science for the related literature on the application of fiberoptic bronchoscopy in spinal cord injury in recent years. Through the preliminary screening of reading titles and abstracts, the articles with low relevance to the topic were excluded, and a total of 57 articles were included for review. 
    RESULTS AND CONCLUSION: (1) At present, the treatment strategies of respiratory complications in patients with cervical spinal cord injury include supine position and use of abdominal band, respiratory training, mechanically assisted cough, mechanical ventilation, tracheotomy, diaphragm pacemaker, nerve transfer technique, fibrobronchoscopic sputum suction and bronchoalveolar lavage, and antibiotics use. (2) At present, the positive effects of early tracheotomy, non-invasive ventilation and auxiliary cough on patients with high spinal cord injury have been gradually recognized by the academic circles, which can improve the respiratory function of patients, while posture, respiratory training, and auxiliary cough have been widely used in clinical practice and achieved satisfactory results. (3) In recent years, bronchofiberscope suction and bronchoalveolar lavage have been widely used in the treatment of patients with pulmonary infection, and have a good therapeutic effect. For patients with cervical spinal cord injury with respiratory complications, fiberoptic bronchoscopy and bronchoalveolar lavage can also improve dyspnea and pulmonary function, which may become a new direction of diagnosis and treatment of cervical spinal cord injury patients.
    Figures and Tables | References | Related Articles | Metrics
    Efficacy and safety of tourniquet application in total knee arthroplasty and only at the time of cementing: a meta-analysis
    Deng Bo, Hong Hainan, Fan Yongyong, Cai Guoping, Feng Xingbing, Hong Zhenghua
    2021, 25 (18):  2908-2914.  doi: 10.3969/j.issn.2095-4344.3833
    Abstract ( 211 )   PDF (725KB) ( 29 )   Save
    OBJECTIVE: The use of tourniquets can reduce intraoperative blood loss during total knee arthroplasty, which can increase the stability of the prosthesis. The use of tourniquet includes the use of tourniquet in the whole process and the use of tourniquet in part of the operation. How to use tourniquet is still controversial. Meta-analysis was used to evaluate the efficacy and safety of tourniquet in total knee arthroplasty and only at the time of cementing.
    METHODS: We searched randomized controlled trials involving different tourniquet use techniques during total knee arthroplasty and only when installing prosthesis through PubMed, the Cochrane Library, the Chinese National Knowledge Infrastructure Database, and the Wanfang database. Relevant data were extracted and analyzed using RevMan 5.3 software to evaluate the difference of related outcomes between the two groups. 
    RESULTS: (1) A total of 624 patients from 11 randomized controlled trials were included. Among them, 322 patients used tourniquet during the whole procedure, and 302 patients used tourniquet only at the time of cementing. (2) The results of the meta-analysis showed that compared with the group using tourniquet only at the time of cementing, intraoperative blood loss and hospital for special surgery knee score were lower [MD=-175.38, 95%CI (-243.26, -107.50), P < 0.000 1; MD=-9.20, 95%CI(-17.82, -1.13), P=0.03]; postoperative drainage volume, hidden blood loss, visual analogue scale score of knee joint incision on the first day after operation, incidence of secondary complications and incidence of deep venous thrombosis of lower extremity were higher [MD=65.71, 95%CI(41.45, 89.97), P < 0.000 1; MD=141.44, 95%CI(63.46, 219.42), P=0.004; MD=0.35, 95%CI(0.06, 0.64), P=0.02; MD=2.53, 95%CI(1.42, 4.52), P=0.002; MD=2.68, 95%CI(1.22, 5.87), P=0.01] in the group that used a tourniquet during the entire surgical procedure. There was no significant difference in operation time, total blood loss, visual analogue scale score of knee joint incision at postoperative 2 and 3 days, and blood transfusion rate between the two groups (P > 0.05).
    CONCLUSION: Compared with the use of tourniquet during the entire surgical procedure, tourniquet use only at the time of cementing can reduce the postoperative blood loss, drainage volume and hidden blood loss, as well as early postoperative knee incision pain, obtain better knee function, reduce the incidence of complications and the incidence of lower extremity deep vein thrombosis.
    Figures and Tables | References | Related Articles | Metrics
    Meta-analysis of bipolar and unipolar hemiarthroplasties for displaced femoral neck fracture in the elderly patients
    Yuan Jiaqin, Luan Fujun, Chen Yangfan, Deng Yi, Li Bo
    2021, 25 (18):  2915-2922.  doi: 10.3969/j.issn.2095-4344.3847
    Abstract ( 268 )   PDF (1342KB) ( 28 )   Save
    OBJECTIVE: In hemiarthroplasty, the choice of prosthesis is particularly important, which directly affects the success rate of operation and postoperative complications. Hemiarthroplasty can be divided into bipolar hemiarthroplasty and unipolar hemiarthroplasty. This study systematically evaluated the clinical efficacy and safety of bipolar hemiarthroplasty and unipolar hemiarthroplasty in the treatment of displaced femoral neck fractures in the elderly so as to provide evidence-based support for prosthesis decision-making in hemiarthroplasty. 
    METHODS: The databases including PubMed, The Cochrane Library, OVID, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP database were searched to collect clinical randomized controlled trials of bipolar hemiarthroplasty and unipolar hemiarthroplasty for displaced neck femoral neck fractures in elderly patients at home and abroad. The Cochrane Handbook risk assessment tool was used to evaluate the quality of the included studies. The results of the included studies were meta-analyzed by RevMan 5.3 software. 
    RESULTS: (1) Eighteen randomized controlled clinical trials with high quality were included, with a total of 1 988 fractures patients, including 998 cases in bipolar hemiarthroplasty group and 990 cases in unipolar hemiarthroplasty group. (2) There were no statistically significant differences in mortality, dislocation of prosthesis, loosening of prosthesis, local infection, hip pain, general complication, and surgical informations between bipolar hemiarthroplasty and unipolar hemiarthroplasty (P > 0.05). (3) Harris score was higher in the bipolar hemiarthroplasty group than that in the unipolar hemiarthroplasty group (MD=1.77, 95%CI:0.94-2.61, P < 0.001). The rate of acetabular erosion in bipolar hemiarthroplasty group was lower than that in unipolar hemiarthroplasty group (RR=0.25, 95%CI:0.13-0.47, P < 0.000 1). However, two studies have reported that bipolar implants may be more costly.
    CONCLUSION: Compared with unipolar hemiarthroplasty, bipolar hemiarthroplasty has lower acetabular wear rate and better recovery of hip function in elderly patients with displaced fem-oral neck fracture. However, whether bipolar prosthesis has better economic benefits than uni-polar prosthesis needs further evaluation in the future.
    Figures and Tables | References | Related Articles | Metrics
    Meta-analysis on middle clavicle fracture treated with Ortho-Bridge System and locking plate
    Wu Tong, Xiong Ying, Li Huanlong, Chen Yong, Liu Luyun, Zhang Long, Qin Jing, Md Ariful Haque
    2021, 25 (18):  2923-2929.  doi: 10.3969/j.issn.2095-4344.3838
    Abstract ( 307 )   PDF (708KB) ( 24 )   Save
    OBJECTIVE: Locking plate is the most commonly used method for the treatment of middle clavicle fracture at present. Ortho-Bridge System is a new type of internal fixation device, which has not been used for a long time. However, many domestic scholars have published many clinical studies to compare the efficacy of the two, but there is no unified opinion. This study compared the efficacy of Ortho-Bridge System and locking plate in the treatment of middle clavicle fracture by meta-analysis. 
    METHODS: A computer-based online search was conducted in PubMed, Medline, The Cochrane Library, MSTC FMRS foreign medical information platform, Ovid Medical Journal Full-text Database, VIP, CNKI, Wanfang digital journal and other platforms to collect the randomized controlled trials published from January 2010 to April 2020 on the treatment of middle clavicular fracture with the combination of Ortho-Bridge System and locking plate. According to the inclusion and exclusion criteria, Jadad scale and MINORS scale were used to evaluate the quality of the included articles. After quality evaluation and data extraction, the operation time, intraoperative blood loss, fracture healing time, complications and 1-year postoperative shoulder joint function score were selected as the evaluation indicators for meta-analysis. The results of the included studies were meta analyzed by RevMan 5.2 software provided by Cochrane Collaboration Network.
    RESULTS: (1) A total of nine Chinese and foreign articles were included in this study, including three randomized controlled trials and six non randomized controlled trials. A total of 613 patients with middle clavicle fractures were included, including 280 cases in the Ortho-Bridge System group and 333 cases in the locking plate group. (2) Meta-analysis results showed that there was no significant difference in postoperative shoulder function (MD=3.23, 95%CI:0.13-6.33, P=0.04). However, the Ortho-Bridge System group was better than the locking plate group in operation time (MD=-4.62, 95%CI:-9.08 to -0.16, P=0.04), intraoperative blood loss (MD=-15.29, 95%CI:-15.81 to -14.47, P < 0.000 01), fracture healing time (MD=-2.88, 95%CI:-3.10 to -2.65, P < 0.000 01), and overall complications (OR=0.21, 95%CI:0.09-0.48, P=0.000 2).
    CONCLUSION: Ortho-Bridge System and locking plate can achieve the expected results in the treatment of mid clavicle fracture. There was no significant difference in shoulder function between the two methods. In terms of operation time, intraoperative blood loss, fracture healing time and overall complications, Ortho-Bridge System has certain advantages over locking plate. However, due to the influence of methodological quality of this study, the results need to be treated with caution, and more large sample and multi center randomized controlled trials are needed to confirm.
    Figures and Tables | References | Related Articles | Metrics
    Nicardipine controlled hypotension applied to perioperative blood loss in orthopedics: a meta-analysis
    Zhong Yuanming, Fu Xiaopeng, Xu Wei, Zhao Qingrui, Huang Yong, Ye Weiquan
    2021, 25 (18):  2930-2937.  doi: 10.3969/j.issn.2095-4344.3839
    Abstract ( 222 )   PDF (769KB) ( 24 )   Save
    OBJECTIVE: The advantages and disadvantages of nicardipine are still controversial now. Some studies have reported that nicardipine used in orthopedic perioperative period reduces blood loss, but does not increase the risk of blood clots. However, these studies are small-sample trials, in the meantime, the results are still controversial. This paper discussed the effect of nicardipine on perioperative blood loss and blood transfusion in orthopedic department by meta-analysis. 
    METHODS: PubMed, Web of Science, ClinicalTrials, Cochrane library, CNKI, CBM, Wanfang and VIP databases were retrieved by computer for randomized controlled trials of nicardipine in reducing perioperative blood loss in orthopedics published from inception to February 15, 2020. The application of nicardipine in orthopedic perioperative bleeding was searched, and selected according to the inclusion criteria. The literature that could be extracted and analyzed by meta-analysis should be focused on (i.e., including the main outcome measure: intraoperative blood loss; or secondary outcome measures: incidence of adverse reactions, awake time, operation time, postoperative extubation time, postoperative hemoglobin concentration, intraoperative blood transfusion volume, and one or more items of hematocrit). After screening the literature, extracting data and assessing the risk of bias included in the study, the Stata12.0 software was used for meta-analysis.  
    RESULTS: Nine randomized controlled trials included 521 orthopedic surgery cases, with 275 cases in the nicardipine group and 246 patients in the control group. Results of meta-analysis showed that compared with other control groups included in this meta-analysis, (1) nicardipine reduced perioperative blood loss (SMD=-1.430, 95%CI: -2.570 to -0.290, P < 0.05); (2) nicardipine reduced the incidence of adverse reactions (OR=0.360, 95%CI: 0.130-1.020, P < 0.05), possibly prolonged patients’ awake time (SMD=0.936, 95%CI: 0.220-1.653, P < 0.001); (3) nicardipine may prolong the postoperative extubation time (SMD=1.889, 95%CI: 1.544-2.233, P < 0.001). (4) There was no significant effect on operation time, postoperative hemoglobin concentration, intraoperative blood transfusion volume and postoperative hematocrit (P > 0.05). 
    CONCLUSION: Nicardipine controlled hypotension is an effective method to reduce perioperative blood loss in orthopedic department. Nicardipine is safe for controlled hypotension in orthopedic perioperative period. However, it may prolong the awake time and extubation time of some patients. Therefore, clinicians should be more cautious when using this method. However, the above conclusions still need to be further confirmed by higher quality, large sample and multi-center randomized controlled trials.
    Figures and Tables | References | Related Articles | Metrics
    Meta-analysis of the efficacy of robot-assisted and traditional manual implantation of cannulated screws in the treatment of femoral neck fracture
    Yang Kun, Fei Chen, Wang Pengfei, Zhang Binfei, Yang Na, Tian Ding, Zhuang Yan, Zhang Kun
    2021, 25 (18):  2938-2944.  doi: 10.3969/j.issn.2095-4344.3849
    Abstract ( 282 )   PDF (736KB) ( 51 )   Save
    OBJECTIVE: At present, the hollow screw internal fixation of femoral neck fracture mainly depends on the bare-handed placement of screws by clinicians under fluoroscopic monitoring. Due to the different experience of each doctor and the instability of manual operation, it is difficult to ensure that each screw can obtain a satisfactory position. At the same time, repeated fluoroscopy increases radiation damage to medical staff and patients. This paper compares the clinical efficacy of robot-assisted and traditional manual hollow nail internal fixation in the treatment of femoral neck fracture.
    METHODS: A computer was used to retrieve the PubMed, Embase, Cochrane Library, CNKI, Wanfang, and VIP databases. The retrieval time was from the inception of the database to July 2020. To search the literature at home and abroad on the comparative study of the efficacy of robot-assisted and traditional hand-implanted hollow nail internal fixation in the treatment of femoral neck fracture. Two researchers independently screened the literature according to the inclusion and exclusion criteria, extracted data, and strictly evaluated the quality of the included literature. Meta-analysis was performed with RevMan 5.3 software, including operation time, intraoperative blood loss, functional score, fracture healing time and complications.
    RESULTS: (1) Through literature retrieval and according to inclusion and exclusion criteria, eight retrospective cohort studies were included in the study. (2) A total of 659 patients were included in the robot assisted group (n=315) and traditional operation group (n=344). (3) The results of meta-analysis showed that in the robot assisted group, the operation time (MD=-8.71, 95%CI:-12.08 to -5.34), the amount of intraoperative blood loss (MD=-18.17, 95%CI:-27.55 to -8.80), the number of intraoperative fluoroscopy (MD=-20.86, 95%CI:-31.68 to -10.04), the number of intraoperative guide needle drilling (MD=-9.64, 95%CI:-13.23 to -6.06), and the final follow-up hip Harris score (MD=2.87, 95%CI:0.56 to 5.18) were significantly better than those in the traditional operation group (P < 0.05). There may be a significant difference in the fracture healing time (MD=-0.24, 95%CI:-0.47 to -0.000) between the two groups (P=0.05). There was no significant difference in the excellent and good rate (OR=2.25, 95%CI:0.88-5.73), screw loosening rate (OR=0.19, 95%CI:0.02-1.59), and fracture healing rate (OR=2.41, 95%CI:0.68-8.52) between the two groups (P > 0.05).
    CONCLUSION: The use of robot-assisted cannulated screw internal fixation in the repair of femoral neck fracture can reduce the number of intraoperative fluoroscopy so as to reduce the radiation injury to medical staff and patients, shorten the operation time and reduce the amount of intraoperative blood loss during operation. It has more advantages in reducing surgical trauma and is more conducive to the recovery of postoperative hip joint function, but this method cannot improve the fracture healing effect; more high-quality randomized controlled trials are needed for verification in the future.
    Figures and Tables | References | Related Articles | Metrics
    Meta-analysis of safety and effectiveness of proximal fibular osteotomy and high tibial osteotomy in the treatment of knee osteoarthritis
    Huang Zeling, Shi Shanni, He Junjun, Gao Hongjian, Ge Haiya, Hong Zhenqiang
    2021, 25 (18):  2945-2952.  doi: 10.3969/j.issn.2095-4344.3848
    Abstract ( 290 )   PDF (793KB) ( 20 )   Save
    OBJECTIVE: Proximal fibular osteotomy and high tibial osteotomy are both effective approaches to treat knee osteoarthritis by presenting different advantages, but the choice of the two surgical approaches is still controversial in clinical practice. This article systematically evaluated the safety and effectiveness of proximal fibular osteotomy compared with high tibial osteotomy for treatment of knee osteoarthritis.
    METHODS: The databases including PubMed, Cochrane Library, Web of Science, CNKI, VIP and Wanfang were searched by computer for clinical studies on proximal fibular osteotomy versus high tibial osteotomy in the treatment of knee osteoarthritis. After screening of literature, the data extraction, and the evaluation of the quality of the literature were conducted. The modified the Jadad Scale was used to evaluate the quality of randomized controlled trials. The Newcastle-Ottawa quality evaluation Scale was used to evaluate the quality of cohort studies. RevMan 5.3 software was applied into the research outcome data statistical analysis. For indicators with significant heterogeneity, the heterogeneity was reduced by excluding some literatures deviating from the forest plot, and then combined analysis was carried out. Simultaneously, funnel plot was also drawn to analyze the publication bias of the included studies. 
    RESULTS: (1) Totally 13 articles were included, including 12 in Chinese and 1 in English, with a total of 878 patients. (2) The literature quality evaluation showed that among the nine randomized controlled trials, four articles were of high quality and five articles were of low quality, and among the four retrospective cohort studies, three articles were of high quality and one article was of low quality. (3) Meta-analysis results showed that visual analogue scale scores at 3 months (MD=0.07, 95%CI: -0.05-0.20, P=0.25), visual analogue scale scores at 6 months (MD=0.03, 95%CI:-0.16-0.21, P=0.78) after surgery, HSS scores at 3 months (MD=-1.08, 95%CI: -2.41-0.25, P=0.11) and HSS scores at 6 months (MD=-0.68, 95%CI:-1.80-0.45, P=0.24) after surgery showed no significant differences. However, compared with the high tibial osteotomy group, the mean operative time (MD=-36.76, 95%CI:-38.20 to -35.33, P < 0.000 01), intraoperative blood loss (MD=-2.10, 95%CI:-2.35 to -1.84, P < 0.000 01) and hospital stay (MD=-4.31, 95%CI:-4.63 to -3.98, P < 0.000 01) of the proximal fibular osteotomy group were significantly less, and the incidence of postoperative complications was lower (OR=0.46, 95%CI:0.22-0.97, P=0.04).
    CONCLUSION: Proximal fibular osteotomy has the same short-term efficacy as high tibial osteotomy in the treatment of knee osteoarthritis, but proximal fibular osteotomy can reduce the operation time, intraoperative blood loss and postoperative complications. Clinically, proximal fibular osteotomy is preferred for patients with many complications and poor operation tolerance. However, due to the limited quality and follow-up time of the included studies, more high-quality clinical studies with multi centers, large samples and long follow-up time are needed for verification.
    Figures and Tables | References | Related Articles | Metrics