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    28 July 2021, Volume 25 Issue 21 Previous Issue    Next Issue
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    Comparison of motion range of cervical spine after two cervical manipulations based on motion capture technique
    Lin Dongxin, Huang Xuecheng, Qin Qingguang, Yang Yang, Deng Yuping, Tan Jinchuan, Wang Mian, Su Weiwei, Huang Tao, Huang Wenhua
    2021, 25 (21):  3281-3285.  doi: 10.3969/j.issn.2095-4344.3864
    Abstract ( 554 )   PDF (640KB) ( 147 )   Save
    BACKGROUND: Cervical rotation manipulation has a positive effect on the treatment of cervical spondylotic radiculopathy, but improper use of manipulation can easily cause adverse consequences. By comparing the inclined pull manipulation and rotation-traction manipulation that are commonly used in clinical practice and have a set of standard operating procedures, it provides clinical safety guidance for the manipulation. 
    OBJECTIVE: To measure the difference in range of motion of cervical spine in the inclined pull manipulation and rotation-traction manipulation by motion capture technology, and to investigate the movement characteristics and the safety of two kinds of manipulations.
    METHODS: Totally 20 healthy subjects (10 males and 10 females) were selected and randomly divided into two groups. The 10 subjects (5 males and 5 females) in each group were subjected to inclined pull manipulation (group 1) and rotation-traction manipulation (group 2), respectively, to measure the active and passive movements of cervical spine and the range of motion of the subphysiological areas. This study was approved by the Medical Ethics Committee of Shunde Hospital Affiliated to Guangzhou Medical University.
    RESULTS AND CONCLUSION: The active and passive ranges of motion of the group of inclined pull method and the group of rotation-traction manipulation were not significantly different (P > 0.05). The range of motion in the subphysiological region of the group of inclined pull method was larger than that in the group of rotation-traction manipulation; the range of motion in the left subphysiological region was larger than that in the right region in the group of inclined pull method (P < 0.05). However, the range of motion in the subphysiological region was similar between both sexes (P > 0.05). The range of motion in the subphysiological region was similar between the left and right sides between both sexes in the group of rotation-traction manipulation (P > 0.05). It is concluded that the subphysiological area of cervical rotation-traction manipulation is smaller than that of inclined pull method, and the technique is more stable and balanced.
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    Treatment of plantar fasciitis with extracorporeal shock wave and corticosteroid injection: comparison of plantar pressure and gait
    Jiang Hai, Yu Yu, Liu Zhicheng, Zhang Qiliang
    2021, 25 (21):  3286-3291.  doi: 10.3969/j.issn.2095-4344.3863
    Abstract ( 556 )   PDF (613KB) ( 157 )   Save
    BACKGROUND: Both extracorporeal shock wave therapy and corticosteroid injection therapy can be used to treat plantar fasciitis, but there is no study comparing the efficacy of the two methods by plantar pressure and gait analysis. 
    OBJECTIVE: To compare the clinical efficacy of extracorporeal shock wave therapy and corticosteroid injection in the treatment of plantar fasciitis through plantar pressure and gait analysis.
    METHODS: Patients with unilateral plantar fasciitis were randomly divided into extracorporeal shock wave group and corticosteroid group, with 26 cases in each group. Extracorporeal shock wave group was treated with extracorporeal shock wave for 5 times, each time 2 000 times, frequency 5-10 Hz, treatment pressure 120-250 kPa, energy flow density 0.12-0.16 mJ/mm2. The corticosteroid group was treated with 2% lidocaine and compound betamethasone injection once. The trial was approved by the Ethics Committee of Qingdao Municipal Hospital on December 3, 2018 with the approval number of 2018 LSZ No. 048. 
    RESULTS AND CONCLUSION: (1) All 52 patients completed the treatment and were followed up effectively. (2) There was no significant difference in general information between the two groups before treatment. There was no significant difference in visual analogue scale score, plantar pressure distribution and gait between the two groups before treatment. (3) Compared with those before treatment, the visual analogue scale score, plantar pressure distribution and gait of the two groups were significantly improved at 1 day, 1 and 3 months after treatment. (4) One day after treatment, compared with extracorporeal shock wave group, the visual analogue scale score of corticosteroid group was significantly lower; the bipedal pressure difference was significantly reduced; and the single support phase of the affected foot and the step length/height of healthy foot were significantly increased. One month after treatment, the visual analogue scale score, plantar pressure distribution and gait of the two groups were similar between the two groups. Three months after treatment, the improvement of visual analogue scale score, the decrease of bipedal pressure difference, the extension of single support phase of affected feet and the increasing of healthy foot step length / height in extracorporeal shock wave group were significantly better than those in corticosteroid group. (5) The results showed that both extracorporeal shock wave therapy and corticosteroid injection could relieve the pain and improve the function of the affected foot after treatment. Corticosteroid injection had a rapid onset and a short course of treatment, and the efficacy was weakened 3 months after treatment. The effect of extracorporeal shock wave therapy is slow and the course of treatment is long, and it was more effective than corticosteroid injection 3 months after treatment.
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    Biological response of Co2+ to preosteoblasts during aseptic loosening of the prosthesis
    Jiang Shengyuan, Li Dan, Jiang Jianhao, Shang-you Yang, Yang Shuye
    2021, 25 (21):  3292-3299.  doi: 10.3969/j.issn.2095-4344.3873
    Abstract ( 454 )   PDF (1044KB) ( 154 )   Save
    BACKGROUND: Aseptic loosening of prosthesis is the main long-term complication after artificial joint replacement. Metal ions have been proven to be one of the causes of aseptic loosening. How to control and mitigate aseptic loosening is an issue of concern. 
    OBJECTIVE: To observe the biological response of preosteoblasts challenged with Co2+ during aseptic loosening of the prosthesis. 
    METHODS: (1) In vitro: Preosteoblasts (MC3T3-E1) of mice were co-cultured with osteoblast induction solution of mice containing different concentrations of Co2+ for 72 hours, respectively, and induced into osteoblast cells. The cell proliferation was tested by MTT assay and the cytotoxicity of different concentrations of Co2+ was measured with the activity of lactate dehydrogenase. The concentration of alkaline phosphatase protein was used to detect the transformation ability of preosteoblasts. RT-PCR was performed to detect the mRNA expression of related factors.        (2) In vivo: titanium nails were implanted into the proximal tibia of mice. The mice were divided into three groups. Mice in the stable control group were implanted with titanium nails. Mice in the loosening control group were implanted with titanium nails and cobalt-chromium particles. Mice in the cobalt ion group were implanted with titanium nails and cobalt-chromium particles and injected with cobalt-stimulated preosteoblasts. Bone mineral density around prosthesis was detected by MicroCT scanning immediately after surgery. Five weeks later, the bone density around the prosthesis was measured again. The mice were sacrificed and the affected knee joints were dissected for the pull-out test. The tissue after nail pull was stained with hematoxylin and eosin. The looseness of the prosthesis was determined by the force of the nail pull. The degree of inflammation was reflected by the thickness of the membrane between the prosthesis and the bone interface. The number of osteoclasts in the tissues around the prosthesis was observed by anti-tartrate acid phosphatase staining. 
    RESULTS AND CONCLUSION: (1) In vitro results: As the concentration of Co2+ increasing, the proliferation of preosteoblasts was decreasing. Co2+ had a significant inhibitory effect on serum alkaline phosphatase expression by preosteoblasts. Co2+ promoted monocyte chemoattractant protein-1, tumor necrosis factor-α, interleukin-6, receptor activator of nuclear factor κB ligand, nuclear factor of activated T cells c1 mRNA expression, and inhibited osteoprotegerin and osteoblast specific transcription factor Osterix mRNA expression. Low concentrations of Co2+ (62 μmol/L) promoted low density lipoprotein receptor-related protein-5 and Runx2 mRNA expression, but high concentrations of Co2+ (500 μmol/L) inhibited their expression. (2) In vivo results: MicroCT scan showed that the mice in cobalt ion group had the lowest bone mineral density (P < 0.05). In the cobalt ion group, the shear force required for pull-out test was significantly lower than that in the control group (P < 0.05).  Hematoxylin-eosin staining showed that the formation of periprosthetic inflammatory reaction membrane was significant in the cobalt ion group; stimulation of preosteogenic cells by bivalent cobalt ions may exacerbate the inflammatory response around the prosthesis. (3) These results indicated that osteoblasts can play an important role in the aseptic loosening of the prostheses. Co2+ stimulated preosteoblastic cells play an important regulatory role in the differentiation and maturation of osteoclasts.  
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    Relationship between tibio-femoral mechanical axis deviation on coronal plane and early joint function recovery after total knee arthroplasty
    Mieralimu•Muertizha, Ainiwaerjiang•Damaola, Lin Haishan, Wang Li
    2021, 25 (21):  3300-3304.  doi: 10.3969/j.issn.2095-4344.3857
    Abstract ( 378 )   PDF (596KB) ( 163 )   Save
    BACKGROUND: Total knee arthroplasty is the most effective treatment method for the end-stage knee diseases. However, the influence of the neutral alignment of lower limb on coronal plane on the clinical outcomes after surgery is still controversial.
    OBJECTIVE: To investigate the effect of tibio-femoral mechanical axis deviation degree on coronal plane on the joint function and clinical outcomes after total knee arthroplasty. 
    METHODS: Sixty patients with primary knee osteoarthritis aged (66.8±5.0) years from the People’s Hospital of Xinjiang Uygur Autonomous Region from January 2015 to December 2017 who underwent unilateral total knee arthroplasty were retrospectively analyzed. At the last follow-up, full-length radiographs were taken and tibio-femoral mechanical axis values were measured. The patients were divided into three groups: neutral position group (0° ≤ included angle ≤ 3°, n=25), mild deviation group (3°-6°, n=21), and severe deviation group (included angle > 6°, n=14) according to the tibio-femoral mechanical axis during the last follow-up. OKS, visual analogue scale score, and SF-12 health questionnaire scores were also compared among the three groups at the last follow-up. The trial was approved by the hospital ethics committee. 
    RESULTS AND CONCLUSION: (1) There were no incision healing problems, deep vein thrombosis, periprosthesis infection, prosthesis loosening, or other complications during the follow-up in the three groups. (2) There was no significant difference in OKS and visual analogue scale scores among the three groups (P > 0.05). The SF-12 health questionnaire scores of severe deviation group were lower than those of the other two groups (P < 0.05). (3) The results showed that when the tibio-femoral mechanical axis deviated from the center of the line of lower limbs by 3°-6° after total knee arthroplasty, there was no significant influence on the postoperative function and quality of life of the patients. Deviation from the center of the line of lower limbs by more than 6° may have a corresponding impact on the postoperative clinical outcomes of patients.   
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    Computer-navigated versus conventional one-stage bilateral total knee arthroplasty
    Zheng Kai, Li Rongqun, Sun Houyi, Zhang Weicheng, Li Ning, Zhou Jun, Zhu Feng, Wang Yijun, Xu Yaozeng
    2021, 25 (21):  3305-3312.  doi: 10.3969/j.issn.2095-4344.3866
    Abstract ( 369 )   PDF (1045KB) ( 55 )   Save
    BACKGROUND: Failure of total knee arthroplasty is mainly related to the poor prosthesis position, bad lower limbs alignment and imbalanced soft tissue. However, conventional total knee arthroplasty is difficult to achieve high accuracy, repeatability and personalized operation, because it relies too much on the experience and visual inspection of the surgeon. 
    OBJECTIVE: To explore the early clinical efficacy between computer-navigated and conventional total knee arthroplasties under one-stage bilateral surgery.  
    METHODS: Totally 21 patients (42 knees) with knee arthritis, who were treated with one-stage bilateral total knee arthroplasty in Department of Orthopedics, the First Affiliated Hospital of Soochow University  from June to December 2019, were prospectively enrolled in this study. The patients randomly underwent computer-navigated total knee arthroplasty for one knee and conventional total knee arthroplasty for the contralateral knee. The duration of operation, length of incision, and drainage volume were compared between the two sides. Lower limb alignment hip-knee-ankle angle α, deviation of goal alignment, mechanical lateral distal femoral angle β, sagittal femoral component angle δ, medial proximal tibial angle γ, tibial posterior slope angle ε, femoral-patella angle Q, and femoral notching were compared between the two sides after operation. Hospital for Special Surgery score, Western Ontario and McMaster Universities Osteoarthritis Index score at 3, 14 days, 1, 3, and 6 months, Forgotten Joint Score at 6 months, patients’ satisfaction, and complications were compared between the two sides. The clinical trial was registered in Chinese Clinical Trial Registry with the registration number of ChiCTR2000033499. 
    RESULTS AND CONCLUSION: (1) The duration of operation in navigation group (88.95±15.45) minutes was longer compared with conventional group (78.25±13.83) minutes (P < 0.05). The incision length in the navigation group (15.08±0.86) cm was longer than that in the conventional group (13.44±0.86) cm (P < 0.05). (2) Both groups obtained good results of prosthetic position, while the navigation group achieved less deviation of goal alignment compared with conventional group (P < 0.05). In patients with a preoperative mechanical axis deviation of >15°, the reconstructed alignment was more precise in navigation group (P < 0.05). (3) The Hospital for Special Surgery score at 3 and 6 months was higher in the navigation group compared with the conventional group (P < 0.05). There was no statistically significant difference in Hospital for Special Surgery score, Western Ontario and McMaster Universities Osteoarthritis Index score, and Forgotten Joint Score between the two groups during the rest follow-up (P > 0.05). (4) The results confirmed that computer-navigated total knee arthroplasty obtained more accurate goal alignment compared with the conventional total knee arthroplasty, especially for those who had severe lower limb deformities before surgery, and showed certain early functional advantages. However, the duration of operation and length of incision were prolonged in computer-navigated total knee arthroplasty.
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    Feasibility of internal fixation removal of intertrochanteric fractures in elderly patients based on fracture mechanics
    Cai Qunbin, Yang Lijuan, Li Qiumin, Chen Xinmin, Zheng Liqin, Huang Peizhen, Lin Ziling, Jiang Ziwei
    2021, 25 (21):  3313-3318.  doi: 10.3969/j.issn.2095-4344.3869
    Abstract ( 344 )   PDF (919KB) ( 53 )   Save
    BACKGROUND: The number of patients with femoral intertrochanteric fractures treated with proximal femoral nail anti-rotation is increasing. For patients who require removal of internal fixation after fracture healing, how to evaluate the standard of removal of internal fixation? Is bone grafting necessary after removal of internal fixation? When and how to do postoperative rehabilitation? There is little research on it in and outside China.
    OBJECTIVE: Based on fracture mechanics, the feasibility of removal of proximal femoral anti-rotation intramedullary nailing after intertrochanteric fracture was analyzed, so as to provide certain reference basis and risk prediction for clinicians to evaluate the feasibility of fixation removal after intertrochanteric fracture in elderly patients.
    METHODS: CT data of one volunteer were imported into Mimics 19.0 and Geomagic studio 2017 software to extract and optimize the three-dimensional model of the right femur. SolidWorks 2017 software was used to draw the internal fixation model and assemble it with femur model according to the standard operation technology. After deleting the internal fixation, the legacy of femoral bone tunnel model was imported into Hypermesh software 14.0. After meshing, defining different cortical bone, cancellous bone, and trabecular bone stress, models A-F was obtained based on Singh1-6. After setting material properties parameters, boundary conditions and loading, data were submitted into LS-DYNA software for solution, respectively. Finally, the operation result was checked in HYperview 14.0 software. The experiment was approved by the Ethics Committee of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine on March 14, 2019 (hospital ethics approval No. Y [2019] 164).
    RESULTS AND CONCLUSION: (1) The initial fracture stress of models A-C and models D-F was similar, but the overall stress of models A-F was significantly smaller than that of models D-F. The overall fracture stress of models A-F presented an increasing trend, while the initial fracture time presented a decreasing trend. (2) From the loading stress to the complete fracture of the femoral neck, the overall number of cancellous bone with fracture disappearance in the six models was relatively small, and the medial femoral moment was the main supporting structure. (3) In models A-F, femoral neck fractures were formed, and Pauwels angle and varus angle of the femoral head showed a decreasing trend. (4) The more severe the osteoporosis in patients, the more likely the secondary fracture would occur after the removal of proximal antirotation intramedullary nail in the femoral trochanteric fracture. (5) For patients with severe osteoporosis, the proximal femoral anti-rotation intramedullary nail can be removed by crushing bone grafting to fill in bone tunnel and to increase stability.
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    Effect of repeated intravenous tranexamic acid in the perioperative period of proximal femoral nail antirotation for femoral intertrochanteric fracture
    Wang Hao, Wang Yitao, Lü Zexiang, Li Tengfei, Wang Shaolong, Wang Yehua
    2021, 25 (21):  3319-3323.  doi: 10.3969/j.issn.2095-4344.3859
    Abstract ( 428 )   PDF (635KB) ( 122 )   Save
    BACKGROUND: There is still no uniform standard for the optimal use of tranexamic acid in proximal femoral nail antirotation for femoral intertrochanteric fracture.
    OBJECTIVE: To investigate the effect and safety of repeated intravenous tranexamic acid in the perioperative period of proximal femoral nail antirotation in patients with femoral intertrochanteric fracture. 
    METHODS: Totally 100 patients with intertrochanteric fracture treated by proximal femoral nail antirotation in the Affiliated Hospital of Xuzhou Medical University from September 2017 to June 2020 were randomly divided into three groups. In the single-dose group, 33 patients were given tranexamic acid 1.0 g intravenously half an hour before operation. In the repeated-dose group, 35 patients were given the same medicine as the single-dose group before operation, and repeated intravenous drip of tranexamic acid 1.0 g at 3 and 6 hours after operation. In the control group, 32 patients were given an equal volume of physiological saline half an hour before operation. The baseline data, operation time, intraoperative blood loss, postoperative drainage volume, perioperative hemoglobin, hematocrit, C-reactive protein and interleukin-6 were collected from the three groups. Color Doppler ultrasound examination of lower extremity deep vein was conducted; and the total blood loss, hidden blood loss and thrombosis rate were calculated before and 7 days after operation.
    RESULTS AND CONCLUSION: (1) Total blood loss was significantly lower in the repeated-dose group (499.20±189.80) mL than that in the single-dose group (722.33±241.76) mL and control group (859.41±165.03) mL (P < 0.05). The hidden blood loss was significantly lower in the repeated-dose group (359.03± 208.57) mL than that in the single-dose group (544.73±290.69) mL and control group (719.22±204.08) mL (P < 0.05). (2) Compared with C-reactive protein and interleukin-6 in three groups after operation, the inflammatory indexes in repeated-dose group were the lowest and those in the control group were the highest (P < 0.05). (3) There was no pulmonary embolism in the three groups, and the lower extremity thrombosis was asymptomatic intermuscular venous thrombosis. There were two cases (2/32) in the control group, four cases (4/33) in single-dose group, and three cases (3/35) in repeated-dose group. The difference was not statistically significant (P < 0.05). (4) It is indicated that repeated use of tranexamic acid in the perioperative period of proximal femoral nail antirotation can further reduce the hidden blood loss, and reduce the inflammatory reaction without increasing the risk of thrombosis.
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    Clinical significance of preoperative planning assisted unicompartmental knee arthroplasty with digital imaging system for fixed-bearing prosthesis
    Yu Yinghao, Zhao Jijun, Liu Dongcheng, Chen Yuhao, Feng Dehong
    2021, 25 (21):  3324-3331.  doi: 10.3969/j.issn.2095-4344.3867
    Abstract ( 497 )   PDF (1087KB) ( 57 )   Save
    BACKGROUND: Unicompartmental knee arthroplasty is the preferred treatment for end-stage medial compartment osteoarthritis. Numerous factors influence the placement of LINK fixed-bearing prosthesis. Does angle deviation have an effect on postoperative clinical efficacy? Can preoperative digital image planning reduce the deviation?
    OBJECTIVE: Unicompartmental knee arthroplasty with LINK fixed-bearing prosthesis assisted by digital imaging system is used to treat medial compartment osteoarthritis patients. This thesis is to investigate the clinical significance of preoperative planning for prosthesis placement, and to clarify the relationship between deviation angle and clinical efficacy.
    METHODS: From October 2017 to January 2020, 28 patients (32 knees) with medial compartment osteoarthritis who underwent LINK fixed-bearing unicompartmental knee arthroplasty in Department of Orthopedics of 2Wuxi People’s Hospital were analyzed retrospectively. They were divided into planning group (n=17; 18 knees) and conventional group (n=11; 14 knees) on the basis of whether the preoperative imaging planning was carried out. The incidence of patellar impact and bounce was reviewed. The varus or valgus angle of femoral prosthesis (A angle), the flexion and extension angle of femoral prosthesis (B angle), the varus or valgus angle of tibial prosthesis (E angle), the posterior slope angle of tibial prosthesis (F angle) and the line of prosthetic loosening were measured on the reexamined X-ray. The angle variation rate, loosening rate and prosthesis deviation score were calculated and recorded in succession. The range of motion, the score of hospital for special surgery and the complications of knees were also followed up.
    RESULTS AND CONCLUSION: (1) The 32 knees were followed up for 6-33 months. (2) No indication of patellar impact or bounce occurred in both groups. (3) In planning group, A angle was measured at [3.90 (-0.66, 6.78)]°, with B angle [4.33 (2.01, 8.05)]°, E angle [-3.28 (-7.61, -0.13)]° and F angle [0.30 (-2.74, 2.50)]°. While in conventional group, A angle was measured at [2.75 (-2.73, 8.29)]°, with B angle [6.45 (1.55, 18.30)]°, E angle [-3.05 (-6.73, 0.54)]° and F angle [3.30 (-2.35, 6.71)]°. (4) The deviation scores of B angle, femoral prosthesis and total prosthesis in planning group were significantly lower than those in conventional group (P < 0.05). There came out to be no obvious differences in tibial prosthesis scores between planning group and conventional group (P > 0.05). (5) In contrast to preoperative period, last follow-up demonstrated apparent improvements in both range of motion and hospital for special surgery scores of two groups (P < 0.05). However, no specific evidence seemed to exist to certify the difference in range of motion and hospital for special surgery scores between two groups at the latest follow up (P > 0.05). (6) A significant negative correlation was verified between A angle deviation score and hospital for special surgery score (r=-0.533, P=0.002). (7) No complications occurred in planning group, while one case in conventional group developed prosthesis loosening and underwent revision. (8) The results confirmed that digital imaging system-assisted preoperative planning can improve the accuracy of prosthesis placement of LINK fixed bearing and reduce the angle deviation. The deviation of A angle from femoral prosthesis has great impacts on postoperative knee functions. 
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    Factors affecting the height of early intervertebral space after lumbar interbody fusion via lateral approach
    Zhao Hongshun, A Jiancuo, Wang Deyuan, Xu Zhihua, Gao Shunhong
    2021, 25 (21):  3332-3336.  doi: 10.3969/j.issn.2095-4344.3868
    Abstract ( 421 )   PDF (645KB) ( 63 )   Save
    BACKGROUND: Mechanical loading could naturally cause postoperative disc height loss. Two main reasons causing this phenomenon were yielding of the polyaxial screw head and settling of the cage to the endplate. When cage subsidence appeared, significant reduction in the interbody space would emerge, which would compromise the indirect decompression.
    OBJECTIVE: To analyze the factors affecting the disc height loss after lateral lumbar interbody fusion in the early follow-up.
    METHODS: Totally 37 patients (22 males and 15 females with the mean age of 62.3±9.2 years) with degenerated lumber disease, who were treated with single or multi segmental lateral lumbar interbody fusion combined with posterior internal fixation in Qinghai Red Cross Hospital from January to December 2018, were included in this study. There were totally 72 fusion segments. Anterior disc height, posterior disc height, mean disc height, disc space angle, and segmental angle were measured on lateral plain X-ray images before, immediately, 1, 3, and 6 months after operation. The correlation of disc height loss with age, constructed segment length, preoperative lordosis, postoperative lordosis, disc height, cage parameters, and cage position was analyzed.
    RESULTS AND CONCLUSION: (1) Cage placement in lateral lumbar interbody fusion significantly increased anterior disc height, posterior disc height, mean disc height, and disc space angle after surgery (P < 0.05). (2) There was a significant positive correlation between disc height parameters, especially the amount of mean disc height increase, and disc height loss after operation (r=0.413, P < 0.05). (3) Segments demonstrating significant height loss (≥25%) also achieved remarkable height increase immediately after operation, which increased by 135.6% from (4.5±3.0) mm to (10.5±5.3) mm. Otherwise, segments with height loss less than 25% had only 57.4% in postoperative height increase. (4) The greater the postoperative disc height increase, the greater the disc height loss across early follow-up. (5) Therefore, it is important to achieve a proper intervertebral space height rather than overcorrection when determining surgical strategy for lateral lumbar interbody fusion. 
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    Proximal femoral nail antirotation combined with posteromedial wall reconstruction for the treatment of type A2 intertrochanteric fracture in the elderly
    Tian Kechao, Wang Lei, Tao Yong, Yao Tao
    2021, 25 (21):  3337-3342.  doi: 10.3969/j.issn.2095-4344.3856
    Abstract ( 312 )   PDF (694KB) ( 76 )   Save
    BACKGROUND: Elderly with femoral intertrochanteric fractures experienced more adverse events after surgical treatment, such as such as coxa vara, screw penetration, and hip pain. In recent years, study on the posterior medial wall of intertrochanteric femur has been deepened. The reconstruction and fixation of the posteromedial wall have gradually been used in clinical work. 
    OBJECTIVE: To investigate the application characteristics and efficacy of posteromedial wall reconstruction in surgical treatment of A2 type intertrochanteric fractures of the elderly.
    METHODS: The medical records of 75 patients with type A2 intertrochanteric fractures who were treated with proximal femoral nail antirotation in Third Affiliated Hospital of Anhui Medical University from March 2016 to March 2020 were retrospectively analyzed. Patients undergoing posteromedial wall and fixation served as trial group (n=32) and those without reconstruction as control group (n=43). After long-term follow-up, the Harris function score, fracture healing time, full weight bearing time, and adverse events of the two groups were compared.
    RESULTS AND DISCUSSION: (1) Operation time and intraoperative blood loss had no significant difference in both groups (P > 0.05). (2) Compared with the control group, the fracture healing time was early; Harris hip function scores were high at postoperative 1, 3, and 6 months; complications were less in the trial group; and the above differences were statistically significant (P < 0.05). (3) Follow-up data were obtained from both groups for more than 12 months. One case of sciatic nerve injury occurred in the trial group. In the trial group, there was one case of sciatic nerve injury, which was numb on the back of the foot on the same side after injury, and returned to normal after oral medication. In the control group, there were six cases of coxa vara, three cases of screw penetration, and one case of heterotopic ossification. (4) The results showed that after the reconstruction and fixation of the posteromedial wall, the patients could get down to the ground early and experience effective recovery of the hip function, with less postoperative adverse events and satisfactory clinical effect. 
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    Therapeutic effects of different fixation methods of fragment of the dorsal ulnar of distal radius fracture
    Wu Shitong, Ning Rende, Fang Run, Bi Chenghao
    2021, 25 (21):  3343-3348.  doi: 10.3969/j.issn.2095-4344.3853
    Abstract ( 419 )   PDF (668KB) ( 70 )   Save
    BACKGROUND: In recent years, the effect of reduction and fixation of medial ulnar dorsal fracture block on the recovery of wrist function after operation has attracted more attention from clinicians.
    OBJECTIVE: To compare the clinical effect of different fixation methods for distal radius fractures.
    METHODS: From August 2018 to June 2019, 53 patients with closed distal radius fractures were selected from the Department of Orthopedics, the Third Affiliated Hospital of Anhui Medical University (with ulnar dorsal fracture block). Of these, 23 were men, and 30 were women. The A group (n=22) was treated with palmar approach, while B group (n=31) was treated with metacarpal plate combined with dorsal closed reduction ulnar dorsal fracture block. The carpal radiographs were taken to observe the changes of distal palmar inclination angle, ulnar deviation angle, radius height and displacement of ulnar dorsal fracture block. The functional recovery of carpal joint was evaluated by Gartland-Werley wrist function scoring system, and the irritation and injury of extensor tendon around wrist joint were observed. This study was approved by the Ethics Committee of Anhui Medical University.
    RESULTS AND CONCLUSION: (1) Totally 53 patients received 10-14 months of follow-up, without incision infection or obvious vascular and nerve injury. (2) At 2 days after operation and the last follow-up, there was no significant difference in palmar inclination angle, ulnar deviation angle, and radius height between the two groups (P > 0.05). (3) Gartland-Werley wrist function score showed that there was no significant difference in the excellent and good rate of wrist function between the two groups at the last follow-up (P > 0.05). (4) A group had lower incidence of late displacement of distal ulnar dorsal fracture block than B group (P < 0.05), and there was no significant difference in the incidence of wrist extensor tendon irritation or injury between the two groups (P > 0.05). (5) The results showed that both palmar approach plate-assisted dorsal approach and palmar approach plate combined with dorsal closed reduction and fixation can achieve satisfactory results in the treatment of ulnar dorsal fracture block of distal radius fracture. However, the metacarpal approach plate assisted with the fixation of the dorsal approach can effectively prevent the displacement of the fracture block of the dorsal ulnar side.
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    Comparison of preoperative three-dimensional reconstruction simulation and intraoperative drawing of femoral osteotomy to measure rotation angle in vitro 
    Lin Tianye, Yang Peng, Xiong Binglang, He Xiaoming, Yan Xinhao, Zhang Jin, He Wei, Wei Qiushi
    2021, 25 (21):  3349-3353.  doi: 10.3969/j.issn.2095-4344.3850
    Abstract ( 322 )   PDF (671KB) ( 129 )   Save
    BACKGROUND: Clinical treatment of the increased anteversion angle of the femoral neck in developmental dysplasia of the hip is often achieved by rotating osteotomy at the upper end of the femur, and how to accurately control the rotation angle and displacement during the operation is the key to the success of the operation.
    OBJECTIVE: To compare the value of two femoral osteotomy rotation angle measurement methods in the correction of the anteversion angle of the femoral neck by three-dimensional reconstruction simulation before operation and intraoperative line drawing.
    METHODS: Normal adult femur specimens were taken for external rotation osteotomy. In the line drawing group, formulas were used to calculate the anterior inclination angle of the upper end of the femur by 2, 4, 6, and 8 mm (total 8 groups). The rotation osteotomy operation was completed. CT scan was used to measure the actual postoperative anteversion angle. In the preoperative simulation group, three-dimensional reconstruction of the intact femoral specimen was performed, and the calculated anteversion angle was performed by Solidworks to simulate the femoral osteotomy rotation to a specific angle before surgery. The surface displacement (arc length) of the femoral osteotomy end was measured, and then a rotary osteotomy was performed on the femoral specimen according to the arc length. The actual anteversion angle obtained after the CT scan was measured. The actual postoperative femoral neck anteversion angle and the calculated femoral neck anteversion angle were compared and analyzed in both groups.
    RESULTS AND CONCLUSION: (1) The actual measured anteversion angle after the line drawing group was (8.4±26.2)°, and the calculated preoperative anteversion angle was (10.3±26.5)°; there was a significant difference between the two (P < 0.05). (2) The actual measured anteversion angle in the preoperative simulation group was (10.4±26.6)°, which was not significantly different from the calculated preoperative anteversion angle (10.3±26.5)° (P > 0.05). (3) The results showed that three-dimensional reconstruction pre-simulation and intraoperative line-drawing method to guide femoral rotation osteotomy can effectively correct the excessive femoral anteversion angle. The preoperative simulation of three-dimensional reconstruction has smaller errors than the intraoperative line-drawing method. The preoperative simulation of three-dimensional reconstruction can make the femoral rotation osteotomy more precise, personalized and intelligent.   
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    Three-dimensional CT analysis of the treatment of thoracic disc herniation by percutaneous endoscopic posterolateral approach: establishment of a good osseous channel
    Li Yuefei, Li Rui, Ren Jiabin, Liu Xin, Sun Ning, Liu Weike, Bi Jingwei, Sun Zhaozhong
    2021, 25 (21):  3354-3359.  doi: 10.3969/j.issn.2095-4344.3855
    Abstract ( 323 )   PDF (918KB) ( 34 )   Save
    BACKGROUND: There are few domestic and foreign literature reports on the treatment of thoracic disc herniation by percutaneous endoscopy, and the operative indications, technical points and technical limitations of this technique have not been thoroughly expounded.
    OBJECTIVE: To guide the treatment of thoracic disc herniation by the percutaneous endoscopic posterolateral approach through three-dimensional CT imaging. 
    METHODS: Thirteen patients with thoracic disc herniation admitted to the Affiliated Hospital of Binzhou Medical College from August 2017 to March 2020 were included. Thoracic computed tomography myelograhy examination was performed and three-dimensional CT images of thoracic vertebra were reconstructed. (1) Measuring articular process under the lower edge and articular process on the lateral margin of intersection point (Y) to the lateral edge of dura mater (a), medial margin of articular process (b), lower endplate of upper vertebra (c), and distance of upper endplate of lower vertebra (d), angle between lateral margin of dura mater to medial margin of vertebral arch root and vertebral body centerline (g), angle between the lateral edge of dura mater to posterior midline of the vertebral bodies and vertebral body centerline (h). At the level of the scapula (T1/2-T6/7), the angle between the medial edge of the vertebral arch root to the medial edge of the scapula and the midline of the vertebral body was measured in cross section (i). In the 3D view of the software, a 7.5-mm 3D cylindrical guide plate was created according to the working channel, and the osseous structure of the guide plate to the inner edge channel of the vertebral arch root was observed, and the range of facet joint defect (j) was measured. (2) All the 13 patients underwent thoracic discectomy via percutaneous endoscopic posterolateral approach. Visual analogue scale score, Japanese Orthopedic Association thoracic spinal function score, Oswestry disability index and modified MacNab were used to evaluate the clinical efficacy. The study was approved by the Ethics Committee of Binzhou Medical University Hospital.
    RESULTS AND CONCLUSION: (1) There was no significant difference in the distance from Y point of T2/ 3-T10/11 vertebral body to the lateral edge of the dura mater (P > 0.05). There was no significant difference in the distance from Y point of the T1/2-T10/11 vertebral body to the medial edge of the facet joint (P > 0.05). (2) Y point on the sagittal plane of the T1/2 vertebral body was projected above the intervertebral space, while Y point on the sagittal plane of the other segments was projected at the level of intervertebral space. (3) T1/2 vertebral body h < i, guide plate abduction without scapula barrier; T2/3-T4/5 vertebral body h > i, the guide plate was blocked by the scapula during abduction. (4) Visual analogue scale, Japanese Orthopedic Association thoracospinal function scale and Oswestry disability index score of the 13 patients in the last follow-up were significantly improved compared with those before surgery (P < 0.05); the excellent and good rate after modified MacNab was 92%. (5) The posterior lateral approach of percutaneous endoscopy was applicable to paracentral soft thoracic disc herniation due to the deep location of T1/2-T4/5 segments, which were blocked by the shoulder blades and the work passage was limited in extension. In T5/6-T11/12 segments, this technique is applicable to various types and properties of thoracic disc herniation (except for giant type). (6) Results confirm that Y point can be used as a marker of bone localization under endoscope, and its constant projection on the sagittal surface is at the level of intervertebral space (except T1/2). The different bone structure of each thoracic vertebra segment should be removed to establish the bone channel. The treatment of thoracic disc herniation by percutaneous endoscopic posterolateral approach is effective, safe and feasible.
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    Effect and molecular mechanism of Honeysuckle-Rhizoma coptidis in the treatment of periprosthetic joint infection based on molecular docking and network pharmacology
    Zhang Haitao, Chen Jinlun, Zhu Xingyang, Zeng Huiliang, Li Jie, Sun Xiaobo, Qi Xinyu, Zeng Jianchun, Zeng Yirong
    2021, 25 (21):  3360-3367.  doi: 10.3969/j.issn.2095-4344.3870
    Abstract ( 463 )   PDF (2033KB) ( 197 )   Save
    BACKGROUND: Studies have shown that various monomers of Honeysuckle and Rhizoma coptidis are effective in the treatment of periprosthetic joint infections. There are many studies on the individual effects of Honeysuckle and Rhizoma coptidis, but the common pharmacological mechanism of Honeysuckle and Rhizoma coptidis is rarely reported.
    OBJECTIVE: To explore the potential effective components, targets and action mechanisms of Honeysuckle-Rhizoma coptidis in the treatment of periprosthetic joint infection based on molecular docking network pharmacology. 
    METHODS: The effective components and target genes of Honeysuckle and Rhizoma coptidis were screened by traditional Chinese medicine system pharmacology database and analysis platform. The GeneCards and On-line Mendelian Inheritance in Man were used to obtain the targets for periprosthetic joint infection. The intersection of the two was taken to obtain the Honeysuckle, Rhizoma coptidis-periprosthetic joint infection disease intersection target. The protein-protein interaction (PPI) network was constructed through the STRING database, and the “CytoNCA” plug-in in Cytoscape 3.7.2 software was used for topology analysis and core target screening of the PPI network. Afterwards, through Cytoscape 3.7.2 software, the network of “traditional Chinese medicine - active component -intersection target-disease”, “active component -intersection target” and “pathway -enrichment gene” was constructed. DAVID was used to analyze the Gene Ontology (GO) function of the intersection target and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment. The affinity between the active components and the target was verified by molecular docking. 
    RESULTS AND CONCLUSION: (1) Through data screening, 14 effective components and 183 corresponding targets of Honeysuckle, 9 effective components of Rhizoma coptidis and 158 corresponding targets were obtained for periprosthetic joint infection. (2) In addition, 286 genes related to periprosthetic joint infection and 37 genes related to drug and disease were obtained. 17 core genes (such as interleukin 6) were screened by PPI network. (3) GO function enrichment showed that there were 59 biological functions of Honeysuckle-Rhizoma coptidis in the treatment of periprosthetic infection, including 44 biological processes, 6 cellular components and 9 molecular functions. (4) A total of 17 signal pathways were screened by enrichment of KEGG pathway. (5) The results of molecular docking showed that quercetin, luteolin, and kaempferol had good affinity with interleukin 6, matrix metalloproteinase 9 and interleukin 1β. (6) Results verified that Honeysuckle-Rhizoma coptidis is characterized by multiple effective compounds (such as quercetin and luteolin), multiple action pathways (such as Chagas disease and Toll-like receptor signaling pathway) and multiple target genes (such as prostaglandin-endoperoxide synthase 2 and interleukin 6) in the treatment of periprosthetic infection. These compounds, target genes and pathways can coordinate the therapeutic effect of drugs. In addition, quercetin was also found as a potential active ingredient, which provides a new direction and new idea for further research.
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    Imaging evaluation of the hip-knee-ankle angle and osteoarthritis progression before and after partial meniscectomy for degenerative medial meniscus posterior root tear
    Peng Chao, Liu Yunpeng, Hua Guojun, Yang Jiaji, Wang Xingliang, Wang Xiaolong
    2021, 25 (21):  3368-3373.  doi: 10.3969/j.issn.2095-4344.3862
    Abstract ( 425 )   PDF (702KB) ( 113 )   Save
    BACKGROUND: Partial meniscectomy can effectively reduce the mechanical symptoms of degenerative medial meniscus posterior root tear, but it cannot prevent the progression of knee osteoarthritis, which may be related to the effect of lower limb force line on prognosis. 
    OBJECTIVE: To investigate the correlation between the progression of knee osteoarthritis and the hip-knee-ankle angle in patients with degenerative medial meniscus posterior root tears after partial meniscectomy.
    METHODS: The medical records of 138 patients with degenerative medial meniscus posterior root tears treated by partial meniscectomy in 904 Hospital of the Joint Service Support Force of Chinese PLA from January to December 2014 were analyzed retrospectively. The average follow-up was (5.53±0.58) years. Patients were divided into group A (hip-knee-ankle angle > 176.2°, n=77) and group B (hip-knee-ankle angle ≤ 176.2°, n=61) according to the best truncation value of hip-knee-ankle angle before operation. Receiver operator characteristic (ROC) curve was used to analyze the predictive value of preoperative hip-knee-ankle angle to postoperative American special surgery hospital score HSS. Spearman correlation analysis was used to explore the correlation between preoperative hip-knee-ankle angle and postoperative final HSS value. The width of knee medial joint space and Kaglan-Lawrence classification were compared between the two groups. The trial was approved by the Ethics Committee of 904 Hospital of the Joint Service Support Force of Chinese PLA (approval No. 2018-10-002). 
    RESULTS AND CONCLUSION: (1) The ROC curve showed that the preoperative hip-knee-ankle angle had a certain predictive value to the postoperative American special surgery hospital score HSS, and the area under the curve was 0.75. (2) Univariate Logistics regression analysis results showed that hip-knee-ankle angle and preoperative course of disease were influencing factors for postoperative HSS score. Multivariate Logistics regression analysis results showed that preoperative hip-knee-ankle angle was an independent risk factor for HSS score (P < 0.01), while body mass index and preoperative course of disease did not affect the correlation between hip-knee-ankle angle and HSS score. (3) Spearman correlation analysis results showed that the preoperative hip-knee-ankle angle was positively correlated with postoperative HSS score (r=0.472, P < 0.01). The greater the preoperative hip-knee-ankle angle and the higher the preoperative HSS score, the better the prognosis. (4) The width of postoperative joint space in group A was larger than that in group B (P < 0.01), and the degree of Kaglan-Lawrence grade in group A was lower than that in group B (P < 0.05), indicating progression of postoperative osteoarthritis in group A was slower than that in group B. (5) The results showed that for patients with degenerative medial meniscus posterior root tears, partial meniscectomy was not suitable if the hip-knee-ankle angle was ≤ 176.2°. Partial meniscectomy could be performed if the hip-knee-ankle angle was > 176.2°, but relevant risk factors should be carefully considered.
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    Visualization analysis of traumatic osteoarthritis research hotspots and content based on CiteSpace
    Ren Wenbo, Liao Yuanpeng
    2021, 25 (21):  3374-3381.  doi: 10.3969/j.issn.2095-4344.3852
    Abstract ( 386 )   PDF (1047KB) ( 121 )   Save
    BACKGROUND: Post-traumatic osteoarthritis is a frequently-occurring and common disease in the field of sports medicine. International research on it is increasing year by year. However, domestic research on its current status, research strength, research hotspots and trends is still relatively lacking.
    OBJECTIVE: Citespace visualization analysis software was used to draw a knowledge map and combine the literature to explore the current research hotspots, research ideas, research power distribution and main research content in the field of post-traumatic osteoarthritis, in order to provide ideas and reference for subsequent research experts and scholars in this field.
    METHODS: Based on the CiteSpace visualization analysis software, the relevant research literature published from January 1, 2010 to March 24, 2020 was searched in the core collection database of Web of Science with “traumatic arthritis”, “post traumatic arthritis” and “traumatic osteoarthritis” as keywords. Visualization analysis and drawing of scientific knowledge maps, integrated maps and data results, and combined with literature were carried out to analyze and discuss the number of articles, the distribution of research disciplines, the main research strength, research hotspots and research literature.
    RESULTS AND CONCLUSION: (1) The research of post-traumatic osteoarthritis has gradually attracted the attention and value of scholars. In the past ten years, the literature has shown an overall upward trend. The research power is mainly developed in the Western developed countries, and the United States is in an absolute leading position. (2) The research disciplines are mainly orthopedics, rheumatology, surgery and other disciplines with a trend of multidisciplinary research. Research results are mainly dominated by research institutions and scholars in developed countries in North America. The amount of publications of Chinese scholars in this field is second only to the United States, but its academic influence is relatively low. (3) Through keywords, emergent keywords and co-citation keywords in the literature, it can be seen that the research hotspots of post-traumatic osteoarthritis mainly include anterior cruciate ligament injury, chondrocytes, and knee joint injury. There are many research angles, and after functional reconstruction, development mechanism, prevention and treatment targets of anterior cruciate ligament injury and post-traumatic osteoarthritis are the main entry points of current literature research in this field. In addition, knee joint and articular cartilage are the main research sites of current research of post-traumatic osteoarthritis. (4) Analysis of the research literature in the past 11 years shows that early detection and intervention of post-traumatic osteoarthritis to prevent or delay the progress of post-traumatic osteoarthritis, the specific clinical application of targeted therapy and the improvement of standardized and quantitative evaluation technology of post-traumatic osteoarthritis are its future research directions. 
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    Research and application of biological three-dimensional printing technology in the field of precision medicine: analysis of Chinese and English literature
    Pan Xuan, Zhao Meng, Zhang Xiumei, Zhao Jie, Zhai Yunkai
    2021, 25 (21):  3382-3389.  doi: 10.3969/j.issn.2095-4344.3871
    Abstract ( 600 )   PDF (1299KB) ( 72 )   Save
    BACKGROUND: Biological three-dimensional (3D) printing technology has been extensively utilized in numerous fields of biomedicine. However, not many cases have been successfully transformed into clinical trials. It is still in the development stage in precision medicine. This technology reveals great potential in realizing individualized medical treatment, changing the existing treatment process, and helping pharmaceutical and medical companies develop more accurate drugs. Furthermore, it is expected to accomplish the closed-loop from individualized information collection and diagnosis to individualized medical product preparation and precise treatment scheme.
    OBJECTIVE: To analyze the current research and hotspots of biological 3D printing technology in precision medicine.
    METHODS: Web of Science and Wanfang databases were searched for literature on 3D printing technology in precision medicine published from January 2015 to August 2020. The retrieval results received scientific quantitative analysis through big data analysis tools, mathematical statistics, computer semantic analysis, visualization software, and database analysis and retrieval.
    RESULTS AND CONCLUSION: (1) The amount of studies on 3D printing technology in the field of precision medicine gradually increases from 2015 to 2020. (2) The United States has the largest amount of publications, and its cooperation with other countries also occupies a core position. The research in China is also active in this field. (3) The institution that published the most papers in the world in the past five years is the University of California system, while the Chinese Academy of Sciences and Shanghai Jiao Tong University are the Chinese institutions with the highest number of publications. (4) Biofabrication and Chinese Journal of Tissue Engineering Research are the journals with the largest number of publications in the world and in China, respectively. (5) The hotspots of biological 3D printing technology in precision medicine mainly include bioinks, microfluidics, orthopedics, tissue/organ regeneration, and drug development. The research results published in Chinese journals are mainly concentrated in the fields of orthopedics, tissue engineering, clinical teaching, and medical models. (6) As one of the most revolutionary and influential advanced tools, biological 3D printing has achieved some accomplishments in regenerative medicine and organ transplantation. It has become an excellent scientific research tool in tissue engineering, stem cells, and cancer, and has created a way for precision medicine from medical imaging, preoperative plan to implant design and manufacture through digital tools. 
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    Quantitative measurement of resorption of cervical herniated disc after cervical microendoscopic laminoplasty by two-dimensional distance method and three-dimensional volume method
    Wu Yanyu, Zhang Chunlin, Shao Chenglong, Yan Xu, Liu Xiaokang, Wang Yongkui, Li Dongzhe
    2021, 25 (21):  3390-3394.  doi: 10.3969/j.issn.2095-4344.3858
    Abstract ( 374 )   PDF (716KB) ( 48 )   Save
    BACKGROUND: Recent literature reported that patients with cervical herniated disc after cervical microendoscopic laminoplasty had extensive natural resorption of herniated nucleus pulposus, but there was still no unified measurement method for cervical herniated disc.  
    OBJECTIVE: The methods by two-dimensional distance and three-dimensional volume were used to respectively measure and observe the resorption of herniated nucleus pulposus phenomenon after cervical microendoscopic laminoplasty, so as to evaluate and select a more accurate and reliable method. 
    METHODS: Retrospective analysis was performed in 20 patients who underwent cervical microendoscopic laminoplasty in the Department of Orthopedics, First Affiliated Hospital of Zhengzhou University from June 2013 to November 2019, including 11 males and 9 females, aged 31 to 63 years old (averagely 51 years old), with a course of 1 to 11 months (averagely 4 months). Two-dimensional distance method and three-dimensional volume method were used to measure the degree of cervical herniated disc, and the absorption ratio, absorptivity, absorbancy, re-herniation ratio and re-herniation rate were used to evaluate the measurement results. 
    RESULTS AND CONCLUSION: (1) The patients were followed up for 6 to 34 months, with 67 cervical herniated discs in 20 cases. In the two-dimensional distance group, resorption of cervical herniated discs after surgery occurred in 56 patients. In the three-dimensional volume group, resorption of cervical herniated discs after surgery occurred in 61 patients. The absorption ratios of the two were 84% and 91%, respectively, and the difference was not significant (P > 0.05). The absorptivities of the two groups respectively were 12.30%-71.24% and 7.71%-87.80% in the two-dimensional distance group and three-dimensional volume group, respectively. (2) In the two-dimensional distance group and the three-dimensional volume group, the small absorption ratio, the medium absorption ratio and the large absorption ratio respectively were 49% (33/67), 34% (23/67), 0 (0/67) and 36% (24/67), 49% (33/67) and 6% (4/67),  and the differences in absorbancy between the two groups were statistically significant (P < 0.05). (3) The average absorptivity of the two-dimensional distance group and the three-dimensional volume group was 31% and 42% respectively. However, there was significant difference in the absorptivity between the two-dimensional distance group and the three-dimensional volume group (P < 0.05). (4) In the two-dimensional distance group and the three-dimensional volume group, the re-protrusion ratios respectively were 1.49% (1/67) and 0. The re-herniation rate was 12.18% in the two-dimensional distance group. (5) The excellent and good rate of cervical microendoscopic laminoplasty patients was 85% (17/20). No aggravation or death occurred. (6) It is indicated that the three-dimensional volume method is more accurate and more suitable for quantitative observation of cervical herniated disc volume than the two-dimensional distance method, which can provide reliable basis for the diagnosis and treatment of cervical spondylotic myelopathy.
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    Advantages and significance of S2 alar iliac screw fixation in sacropelvic fixation
    Liu Gang, Yang Qiang, Hao Yonghong, Deng Shucai
    2021, 25 (21):  3395-3400.  doi: 10.3969/j.issn.2095-4344.3861
    Abstract ( 585 )   PDF (662KB) ( 164 )   Save
    BACKGROUND: In the surgical treatment of spinal deformities and tumors, the firm and stable fixation of the lumbosacral junction is a task that must be completed in the operation, and it is a relatively great challenge. The incidence rate of postoperative complications (such as pseudarthrosis, failure of internal fixation and loosening) is high. The mechanical strength of the bone tissue in the sacrum is low, and the high load in the lumbar vertebrae and pelvis increases the risk of internal fixation pullout, which further leads to the loosening of the instrument. Although there are some of the most effective surgical techniques, the complexity of surgical techniques often leads to unsatisfactory clinical results
    OBJECTIVE: To summarize the latest research progress on the sacropelvic fixation and clinical applications of the S2 alar iliac (S2AI) screws, and provide a reference for clinical treatment.
    METHODS: The computer was used to search articles published from 2005 to 2020 in CNKI, Wanfang, and PubMed. The search terms were “S2 alar iliac screw, S2AI, iliac screw, sacropelvic fixation, alar iliac screw” in English and Chinese. Relevant articles were consulted, and finally 43 articles were included for analysis.
    RESULTS AND CONCLUSION: (1) Sacral pelvic fixation, such as ilium and S2AI screw, was added to the lower end of long segmental fixation of the spine to solve the above-mentioned related complications. (2) S2AI screw placement technique plays an important role in stabilizing sacroiliac joint. Because of its unique screw placement method, it avoids screw dislocation, reduces postoperative sacroiliac joint pain and reduces the risk of reoperation. (3) As a new technology of spinal and pelvic fixation, S2AI screw has many advantages and clinical significance, but due to the complex and diverse structure of sacroiliac joint and individual differences of patients, there are still related problems in clinical application of S2AI screw.
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    Local infiltration anesthesia versus femoral nerve block for pain control and safety after total knee arthroplasty: a meta-analysis
    Deng Zhibo, Li Zhi, Wu Yahong, Mu Yuan, Mu Yuexi, Yin Liangjun
    2021, 25 (21):  3401-3408.  doi: 10.3969/j.issn.2095-4344.3854
    Abstract ( 462 )   PDF (1368KB) ( 98 )   Save
    OBJECTIVE: Local infiltration anesthesia and femoral nerve block are very prevalent anesthesia methods after total knee arthroplasty. However, which one was optimal in pain control was still controversial. The difference of components in local infiltration anesthesia led to great bias in outcomes, which may be one reason for the inconsistent results in the past. We took a systematic review to compare the efficacy and safety of femoral nerve block with the local infiltration anesthesia that use the fixed drug compositions (local anesthetics + nonsteroid anti-inflammatory drugs + epinephrines) for total knee arthroplasty.
    METHODS: Randomized controlled trials concerning local infiltration anesthesia and femoral nerve block on pain control after total knee arthroplasty from PubMed, Embase, Cochrane Library, Web of Science and Viod were searched until June 30, 2020 by using the following terms “total knee arthroplasty, local infiltration analgesia, periarticular infiltration, femoral nerve block”. The quality of the included study was assessed using the Cochrane risk of bias table. The data were analyzed by RevMan 5.3 software for meta-analysis. The evaluation indexes contained main pain outcomes, secondary functional outcomes, and complications.  
    RESULTS: (1) A total of 9 studies including 514 patients were included, all of which were randomized controlled trials. The literature quality evaluation indicated that the quality of the included literatures was relatively high. (2) The pooled data indicated that there was no significant difference in visual analogue scale score at 24 hours on rest, 48 hours on rest, 24 hours on motion and 48 hours on motion, opioid consumption at 48 hours, range of motion at 24 and 48 hours, length of hospital stay, 6-minute walk test at 6 weeks, rate of infection and rate of nausea and vomiting between two groups (P > 0.05). However, the local infiltration anesthesia consumed significantly less opioid than femoral nerve block at 24 hours (MD=-4.09, 95%CI:-6.10 to -2.08, P < 0.000 1). 
    CONCLUSION: Local infiltration anesthesia with the fixed compositions was superior to femoral nerve block in pain control of acute phase after total knee arthroplasty, and there was no significant difference in knee function recovery and complications. Considering that local infiltration anesthesia was easier to operate and less expensive, we recommended local infiltration anesthesia as the optimal pain management after total knee arthroplasty. 
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    Efficacy of anterolateral minimally invasive approach versus traditional posterolateral approach in total hip arthroplasty: a meta-analysis
    Fu Panfeng, Shang Wei, Kang Zhe, Deng Yu, Zhu Shaobo
    2021, 25 (21):  3409-3415.  doi: 10.3969/j.issn.2095-4344.3851
    Abstract ( 336 )   PDF (1286KB) ( 119 )   Save
    OBJECTIVE: Anterolateral minimally invasive approach in total hip arthroplasty has some advantages over traditional posterolateral approach, but whether it has the same good efficacy as posterolateral approach is still controversial. This article conducted a meta-analysis comparing clinical outcomes of anterolateral minimally invasive approach and traditional posterolateral approach for total hip arthroplasty.
    METHODS: The clinical controlled trials published from inception to June 2020 were searched in major databases, including PubMed, Embase, The Cochrane Library, Web of science, CNKI, VIP, Wanfang Data, and CBM. Suitable studies were selected according to inclusion and exclusion criteria. The quality of included studies was evaluated strictly and the data were extracted. RevMan 5.3 software was used for data analysis. 
    RESULTS: Totally 14 studies (7 randomized controlled trials and 7 cohort studies) were included, with 1 160 cases. All studies were evaluated of high quality. (2) Meta-analysis results showed that anterolateral minimally invasive approach was superior to posterolateral approach in incision length (MD=-6.61, 95%CI: -7.38 to -5.84), P < 0.000 01), intraoperative blood loss (MD=-139.03, 95%CI:-169.36 to -108.69), P < 0.000 01), length of hospital stay (MD=-3.19, 95%CI: -4.14 to -2.24), P < 0.000 01), first weight-bearing time (MD=-4.34, 95%CI:-4.80 to -3.89), P < 0.000 01), Harris hip score (MD=6.37, 95%CI:4.81-7.93), P < 0.000 01) and total complication rate (OR=0.43, 95%CI:0.28-0.68), P=0.000 3]. There was no statistical difference in the operation time (MD=-1.12, 95%CI:-11.03-8.78), P=0.82] and the abduction angle of hip joint (MD=0.67, 95%CI:-0.22-1.55), P=0.14].
    CONCLUSION: Anterolateral minimally invasive approach can better ensure the safety and effectiveness of total hip arthroplasty, reduce complications and promote the recovery of hip joint function after surgery. Thus, anterolateral minimally invasive approach is a superior approach which can achieve better effect than posterolateral approach. More evaluation indicators such as postoperative pain score, hospital expenses and postoperative dislocation rate of hip still need further study and analysis.
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    Meta-analysis of the postoperative effects of robot-assisted unicompartmental knee arthroplasty versus conventional surgery
    Ren Xingyu, Zhang Yi, Xu Haoran, Fan Bin, Dai Shifeng, Liang Chunyu
    2021, 25 (21):  3416-3422.  doi: 10.3969/j.issn.2095-4344.3874
    Abstract ( 410 )   PDF (758KB) ( 102 )   Save
    OBJECTIVE: Total knee arthroplasty has been a common treatment for single-compartment osteoarthritis for some time. Less invasive unicompartmental knee arthroplasty has not been widely available due to low survival rates, but with the development of robot-assisted unicompartmental knee arthroplasty, this goal has become more promising. This study observed the postoperative effects and differences between robot-assisted unicompartmental knee arthroplasty and traditional unicompartmental knee arthroplasty in the treatment of osteoarthritis by means of meta-analysis.
    METHODS: Relevant databases including Wanfang, VIP, CNKI, EMBASE, PubMed, Cochrane Library, and Web of Science were searched by computer in English and Chinese, and the time was from database inception to June 2020. Quality of retrieved articles was assessed. The outcome indicators included operation time, postoperative complications, implant accuracy, posterior slope and revision rate. Meta-analysis of the collected data was carried out using the RevMan 5.3 software provided by the Cochrane Collaboration. 
    RESULTS: (1) A total of 11 articles were included. There were three randomized controlled trials, one low risk bias, one medium risk bias, and one high risk bias. There were four cohort studies and four case-control studies with NOS score above 6, which were of high quality. (2) Meta-analysis results showed that robot-assisted unicompartmental knee arthroplasty was superior to traditional surgery in the accuracy of the tibial component placement (MD=-1.32, 95%CI: -1.74 to -0.91, P < 0.000 01), the accuracy of the femoral component placement (MD=-1.71, 95%CI: -2.82 to -0.61, P=0.002), the postoperative tibial posterior slope (MD=-2.40, 95%CI: -2.80 to -2.22, P < 0.000 01), and the revision rate (RR=0.34, 95%CI:0.16-0.72, P=0.005). (3) Although robot-assisted unicompartmental knee arthroplasty took longer time (MD=11.53, 95%CI:5.12-17.94, P=0.000 4), it did not increase the incidence of surgical complications (RR=0.86, 95%CI:0.45-1.64, P=0.65). 
    CONCLUSION: When performing unicompartmental knee arthroplasty, robot-assisted unicompartmental knee arthroplasty has higher prosthesis positioning accuracy, better postoperative tibial inclination and lower revision rate without increasing the incidence of complications. It is a surgical method that is more ideal than traditional surgical methods, and is worthy of further discussion in clinical practice, but the above conclusions still need to be verified by large-sample and high-quality randomized controlled studies.
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    Bankart pepair versus Bristow-Latarjet procedure for recurrent anterior instability of the shoulder: a meta-analysis
    Wang Yanjiao, Wang Rui, Sun Luning
    2021, 25 (21):  3423-3430.  doi: 10.3969/j.issn.2095-4344.3860
    Abstract ( 546 )   PDF (1150KB) ( 41 )   Save
    OBJECTIVE: Shoulder is the most unstable joint in the whole body, and the anterior instability caused by anterior dislocation of shoulder is the highest in all shoulder instabilities. Bankart pepair and Bristow-Latarjet procedure are both viable options for the treatment of recurrent anterior shoulder instability. However, since there is lack of systematic review of these two techniques, this article compared the clinical outcome of Bankart pepair and Bristow-Latarjet procedure in the treatment of recurrent anterior instability of shoulder by meta-analysis.
    METHODS: Electronic searches were performed using PubMed, Ovid, Embase, Cochrane, CNKI, Wanfang, and VIP databases for retrospective case-control study or randomized controlled trial of anterior shoulder instability with Bankart repair and Bristow-Latarjet surgery. The data of binary variables (overall recurrence, revision surgery, and total complications), continuous variables (constant external rotation activity and Rowe score) and summary of the return to function findings after surgery were analyzed. Retrospective case-cohort studies used the NOS bias risk assessment standard recommended by Cochrane Collaborative Network to evaluate the quality of retrieved literatures, while randomized controlled trial study used the modified Jadad scale to evaluate the quality of literature. Literature screening, literature quality evaluation and data extraction were carried out independently by two researchers. Meta-analysis was conducted using RevMan 5.3 software. 
    RESULTS: (1) A total of 11 articles were included, containing 10 retrospective case-cohort studies and 1 randomized controlled trial study; research evidence is low-level. This study includes 1 308 patients, 190 cases of open Bankart repair, 583 cases of arthroscopic Bankart repair and 535 cases of open Bristow-Latarjet procedure. (2) Meta-analysis showed that compared with open or arthroscopic Bankart repair, the recurrence rate after Bristow-Latarjet procedure was lower (RR=3.64, 95%CI:1.79-7.39); Rowe score was higher (WMD=-4.00, 95%CI:-4.68 to -3.31, P < 0.000 01). (3) The total complication rate of open or arthroscopic Bankart repair was lower than Bristow-Latarjet procedure, but there was no significant difference between the two procedures (RR=0.57, 95%CI:0.26-1.26, P=0.16). (4) Though incidence of revision surgery (RR=1.42, 95%CI:0.82-2.46, P=0.21), limitation of external rotation (WMD=-2.43, 95%CI:-5.40-0.54, P=0.11), and postoperative recovery to preinjury working status or activity ability suggested that Bristow-Latarjet procedure was better than open or arthroscopic Bankart repair, but there was no significant difference (P > 0.05).
    CONCLUSION: In terms of the recurrent rate and the ability recovery, Bristow-Latarjet procedure may be a better option compared with Bankart repair technique for the treatment of anterior instability of the shoulder, while the complication rate is relatively high. For professional athletes involved in collision or contact sports, Bristow-Latarjet surgery may be a better option for the treatment of anterior shoulder instability. Due to the limited quality of the inclusion studies, a host of randomized controlled trial studies should be conducted in the future to confirm this result.
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    Comparison of the effects of arthroscopic double-row suture fixation and suture bridge fixation for rotator cuff injury: a meta-analysis 
    Jiang Lingkai, Wei Lei, Dong Zhengquan, Gu Xiaodong, Li Pengcui
    2021, 25 (21):  3431-3437.  doi: 10.3969/j.issn.2095-4344.3872
    Abstract ( 482 )   PDF (738KB) ( 75 )   Save
    OBJECTIVE: Suture bridge fixation technology is a new rotator cuff repair technology. However, there is a big difference between the results of double row suture and clinical technique. This study explored the clinical value of arthroscopic double row suture fixation and suture bridge fixation in the repair of rotator cuff injury.
    METHODS: A computer was used to search PubMed, Web of Science, Embase, CNKI, Wanfang, and China Biomedical System databases for articles on arthroscopic double row suture fixation and suture bridge fixation in the repair of rotator cuff injury published from July 2010 to July 2020. The Cochrane manual was used to assess the quality of randomized controlled trials, and the NOS scale was used to assess the quality of cohort studies. The data in each study were extracted and organized into tables. RevMan 5.3 software was used for meta-analysis and synthesis of the study data.
    RESULTS: (1) A total of 10 articles and 735 patients were included in the analysis, of which one article was a randomized controlled trial and nine articles were a retrospective cohort study. The literature quality assessment indicated that the included literature was of high quality. (2)  Meta-analysis results showed that compared with the double row suture fixation technique, the suture bridge technique had advantages at Constant score (MD=1.11, 95%CI:0.12-2.09, P=0.03), postoperative visual analogue scale score (MD=-0.20, 95%CI:-0.35 to 0.19, P=0.000 2), postoperative tearing rate (OR=0.28, 95%CI:0.14-0.55, P=0.000 2), and operation time (MD=-14.0, 95%CI:-20.54 to -7.47, P < 0.000 1). There was no significant difference in postoperative University of California, Los Angeles score, postoperative rating scale of the American shoulder and elbow surgeons score, and postoperative range of motion.
    CONCLUSION: The arthroscopic suture bridge technique may have better shoulder function stability, higher application safety and less pain than double row suture fixation. More prospective, large-sample randomized controlled studies are still needed to provide first-level evidence to verify.
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    Meta-analysis of comparison of the effect of tibial fixation using absorbable screws and metal screws in anterior cruciate ligament reconstruction with autologous hamstrings
    Xiong Xiaolong, Wang Guangji, Fang Yehan, Du Xiufan, Hang Hui, Ye Zhifang
    2021, 25 (21):  3438-3444.  doi: 10.3969/j.issn.2095-4344.3865
    Abstract ( 394 )   PDF (977KB) ( 94 )   Save
    OBJECTIVE: In recent years, it has been reported that both absorbable screws and metal screws can achieve satisfactory clinical efficacy in the tibial fixation with autologous hamstring reconstruction for anterior cruciate ligament. It is necessary to conduct a meta-analysis on the two screw fixation methods. This study observed and compared the clinical outcomes of absorbable versus metal screws in the autologous hamstring tendon reconstruction of anterior cruciate ligament. 
    METHODS: The PubMed, The Cochrane Library, EMbase, MEDLINE (Ovid), CBM, CNKI, VIP, Baidu Scholar, and Wanfang medical databases were searched, and relevant Chinese and English orthopedic journals were searched manually. All relevant randomized control trials of absorbable versus metal screws fixation in the autologous hamstring tendon reconstruction for anterior cruciate ligament were collected. The searched period was from database inception to August 2020. Through literature screening, literature evaluation and data extraction, randomized controlled trials were assessed using the Cochrane Collaboration's recommended risk assessment tool for bias and the Jadad scale, and meta-analysis was conducted in RevMan 5.3 software.
    RESULTS: (1) Eight randomized controlled trials were included, with 472 patients, including 237 cases fixed with absorbable screws and 235 cases fixed with metal screws. The risk of study bias was assessed as low risk, and the modified Jadad score was above 4, indicating high-quality studies. (2) The results of meta-analysis showed there were no statistically significant differences in postoperative anterior cruciate ligament rerupture, Lysholm score, IKDC normal grading, KT-1000, Lanchman test, Pivot test and postoperative infection between the absorbable screw group and the metal screw group (P > 0.05). However, the metal screw group had an advantage in bone ingrowth compared to the absorbable screw group (RR=0.16, 95%CI:0.03-0.84, P=0.03].
    CONCLUSION: The effects of stability and function recovery of the knee after operation between the absorbable screw group and metal screw group were comparable in the tibial fixation of autologous hamstring reconstruction for anterior cruciate ligament, but metal screws are more conducive to bone ingrowth than absorbable screws. In clinics, metal screws can be recommended to replace absorbable screws for fixation, but there are few included studies, and more evidence of randomized controlled trials is needed.
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