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    28 September 2021, Volume 25 Issue 27 Previous Issue    Next Issue
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    Relationship between inclination angle of the transverse osteotomy line and the strength of hallux valgus orthopedic in Scarf osteotomy: analysis of three-dimensional bone reconstruction
    Wang Wencheng, Zhang Xingfei, Xu Yajun
    2021, 25 (27):  4265-4270.  doi: 10.12307/2021.180
    Abstract ( 306 )   PDF (1679KB) ( 35 )   Save
    BACKGROUND: Scarf osteotomy is an osteotomy of the metatarsal shaft, and the orthopedic force is strong, and the effect of osteotomy is significant, but the orthopedic often fluctuates greatly due to the change of the vetex line of the osteotomy and the angle of the osteotomy, causing undercorrection or overcorrection. Three-dimensional reconstruction software has unique advantages in three-dimensional model reconstruction, osteotomy simulation and index measurement. Therefore, it is necessary to quantify the influence of the osteotomy angle of the Scarf osteotomy line on the strength of orthopedic.  
    OBJECTIVE: To analyze the influence of the inclination angle of the transverse osteotomy line on the strength of hallux valgus correction during Scarf osteotomy using 3-matic software.
    METHODS:  From May 2018 to September 2020, 14 patients diagnosed with hallux valgus were admitted to the Department of Foot and Ankle Surgery, Wuxi Ninth Hospital, Soochow University, with 21 feet, aged 22 to 76 years old. With the aid of a simulated weight-bearing stent, the simulated weight-bearing CT images of the feet of patients with hallux valgus were obtained. Three-dimensional bone model was constructed in Mimics software, imported in 3-matic software to simulate Scarf osteotomy of the first metatarsal, adjust the different osteotomy angles of the transverse osteotomy line to simulate osteotomy. The relevant indexes of postoperative hallux valgus were measured, and compared with the measurement results of the same individual and the same index. The changing trend of each measured value was analyzed.  
    RESULTS AND CONCLUSION:  (1) The inclination angle of the transverse osteotomy line of Scarf osteotomy has significant differences with the hallux valgus angle change rate, first-second intermetatarsal angle change rate, lateral intermetatarsal angle change rate and metatarsal head height change rate (P < 0.05). (2) At the same time, the change rate of lateral intermetatarsal angle and metatarsal head height increased significantly when the inclination angle of the osteotomy line was in the range of 20°-25°, and the change rate of hallux valgus angle and intermetatarsal angle was significantly increased in the range of 15°-20°. (3) It is concluded that using computer-assisted technology for preoperative simulation planning to provide a personalized and precise method for the correction of hallux valgus deformity, which is beneficial to reduce the incidence of surgical complications such as metastatic metatarsalgia, and increase the intensity of osteotomy orthopedic and the safety of osteotomy, improve patient satisfaction, reduce the learning curve of surgeons, and provide guidance and theoretical basis for clinical surgical treatment of hallux valgus.
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    Biomechanical properties of reverse obliquity intertrochanteric fracture in the elderly treated with three different intramedullary fixations of ZNN nail, Gamma 3 nail and InterTan nail
    Chen Jian, Ma Jianxiong, Lu Bin, Bai Haohao, Wang Ying, Ma Xinlong
    2021, 25 (27):  4271-4276.  doi: 10.12307/2021.181
    Abstract ( 309 )   PDF (1296KB) ( 116 )   Save
    BACKGROUND: Intramedullary nail Gamma 3, compression interlocking intramedullary nail InterTan and intramedullary nail ZNN have good clinical effect in the treatment of intertrochanteric fractures, but the difference of mechanical stability of three kinds of implants is not clear.  
    OBJECTIVE: To perform biomechanical properties of anatomical intramedullary nail ZNN, intramedullary nail Gamma 3 and compression interlocking intramedullary nail InterTan for elderly reverse obliquity intertrochanteric fractures.
    METHODS:  Three-dimensional finite element analysis was carried out to unstable intertrochanteric fractures models (AO31-A3.1) which fixed with ZNN, Gamma 3 and InterTan. The observed indicators were the distribution, maximum value and position of the Von Mises stress and the displacement, maximum value and position and the maximum crack distances of the fracture surface of the model.  
    RESULTS AND CONCLUSION: (1) The peak values of stresses of the implant in the three groups were 364.8 MPa (ZNN), 364.9 MPa (Gamma 3) and 97.01 MPa (InterTan); the stress was lowest in the model InterTan. (2) The peak values of stresses of the femur of the three groups were 171.8 MPa (ZNN), 824.8 MPa (Gamma 3) and 29.51 MPa (InterTan); the stress was highest in the model Gamma 3. (3) The maximum amount of displacement was 3.768 mm in model ZNN, 3.862 mm in model Gamma 3 and 3.542 mm in model InterTan. Their locations were the same which located in the femoral head vertex. The maximum crack distances of the fracture surface of models were 0.08 mm, 0.09 mm and 0.02 mm in ZNN, Gamma 3 and InterTan, respectively. The maximum amount of displacement and the maximum crack distances were obviously smaller in model InterTan than in models ZNN and Gamma 3. (4) For reverse obliquity intertrochanteric fractures, finite element analysis showed that the InterTan implant provided significantly resistance to femoral head varus collapse, with the best mechanical properties, followed by ZNN internal fixation, and finally Gamma 3 internal fixation.
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    Correlation between hip geometric mechanics and lifestyle habits in postmenopausal women
    Ye Yunjin, Ge Jirong, Chen Juan, Li Jianyang, Chai Hao, Xie Lihua
    2021, 25 (27):  4277-4282.  doi: 10.12307/2021.182
    Abstract ( 236 )   PDF (1207KB) ( 46 )   Save
    BACKGROUND: There are many reports about bone mineral density in the study of osteoporosis, but it still cannot fully explain the problems of bone strength and fracture. This paper studies bone strength through hip mechanics, hoping to supplement the existing research.  
    OBJECTIVE: To understand the impact of postmenopausal women’s lifestyle habits on hip geometry and mechanics.
    METHODS:  Totally 648 postmenopausal women were selected. The subjects used dual-energy X-ray digital bone density to scan the lumbar spine (L1-L4) and left hip joint (total hip, proximal femur), and obtained the corresponding bone mineral density value and five parameters of hip geometric mechanics: bone cross-sectional area, cross-sectional rotational inertia, cross-sectional flexural modulus, cortical thickness and buckling stress ratio. Linear analysis was conducted to analyze the correlation of lifestyle habits with bone mineral density and hip geometry mechanics.  
    RESULTS AND CONCLUSION: (1) Analysis of factors affecting bone density: Age, drinking more than two cups of coffee per day, and the number of pregnancies were negatively correlated with bone density (P < 0.05); body weight, body mass index, and moderate-intensity exercise were positively correlated with bone density (P < 0.05). (2) Factor analysis of affecting hip geometric mechanics: age and daily coffee consumption were negatively correlated with cross-sectional area, cross-sectional rotational inertia, cross-sectional flexural modulus, and cortical thickness (P < 0.05). Age, daily coffee consumption and less than one cup of milk per day were positively correlated with buckling stress ratio (P < 0.05). Body weight, height, and sunshine duration greater than 3 hours and moderate-intensity exercise were positively correlated with cross-sectional area, cross-sectional rotational inertia, cross-sectional flexural modulus, cortical thickness (P < 0.05). Body mass index was negatively correlated with buckling stress ratio (P < 0.05). (3) It is indicated that drinking coffee every day is not conducive to bone health; proper exercise can help bone health; sunshine time greater than 3 hours can increase bone strength.

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    Establishment and validation of a finite element model of sacral lumbarization in adolescents
    Wu Xuehai, Wang Xing, Zhang Shaojie, Xu Xuebin, Shi Jun, Wang Tieying, Li Zhijun
    2021, 25 (27):  4283-4288.  doi: 10.12307/2021.183
    Abstract ( 271 )   PDF (12028KB) ( 14 )   Save
    BACKGROUND: Lumbar sacralization will cause changes in the vertebral body segments, resulting in low back pain during exercise. Epidemiological studies showed that the incidence of lumbar sacralization in adolescents is increasing year by year. 
    OBJECTIVE: To establish a three-dimensional finite element model of adolescent patients with lumbar sacral vertebrae, and to analyze the mechanical properties and stress-strain rules of lumbar vertebrae under simulated normal exercise conditions, so as to provide mechanical basis for the treatment of low back pain caused by sacral lumbarization in clinic. 
    METHODS: The CT images of a 16-year-old male teenager with sacral lumbarization were selected, and the three-dimensional model of lumbar data was established by mimics16.0, and the three-dimensional digital medical modeling method was introduced into Geomagic Studio and ANASYS WorkBench software to establish the finite element model of the lower lumbar and sacral segments of the intervertebral disc. The biomechanical test of the model was carried out by applying the moment of 2 N•mm to simulate the movement of flexion, extension, left bending and right bending after loading normal human body load, and the mechanical changes of displaced vertebrae under various working conditions were analyzed to explore the mechanical characteristics of lumbar sacral vertebrae in adolescents. This trial was approved by the Ethics Committee of Inner Mongolia Medical University (approval No. YKD2018015) on March 5, 2018.
    RESULTS AND CONCLUSION: During extension and flexion, the stress of L5 and S1 pedicles was significantly greater than that of scoliosis. The direction of stress change of the migration S1 pedicle was the same as that of normal adult L5 pedicle isthmus. In juvenile patients with sacral lumbarization, during lumbar spine movement, the stress on the S1 pedicle isthmus was significantly greater than that on the L5 pedicle isthmus, and the facet joints and intervertebral discs bore greater stress. It is concluded that for adolescents with complete sacral lumbarization, as the stress on the transitional vertebrae increases during lumbar activities, it is more likely to cause fatigue fractures and isthmic fissures, while the facet joints and intervertebral discs are more stressed, making them prone to regression change.
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    Titanium plate placement for internal fixation of slopes in children aged 1-6 years: digital morphological analysis of mechanical support
    Li Kun, Li Zhijun, , Zhang Shaojie, Gao Shang, Wang Xing, Sun Hao, He Yujie, Wang Haiyan, Cai Yongqiang, , Xu Xuebin
    2021, 25 (27):  4289-4293.  doi: 10.12307/2021.184
    Abstract ( 242 )   PDF (1212KB) ( 56 )   Save
    BACKGROUND: Occipital neck instability is caused by bone or soft tissue structural abnormalities or injuries. In clinical practice, patients with posterior or anterior upper cervical bone fractures in the occipital neck region need to undergo anterior skull slope internal fixation, which is currently used in adults. Up to now, there is no common developmental anatomy data (size and position of titanium plate for internal fixation) of children in this area at home and abroad for reference.
    OBJECTIVE: To study the slope and adjacent anatomical structures of children aged 1-6 years, and to provide detailed information for placement of titanium plates for internal fixation of slopes.
    METHODS:  The original cervical CT data of 110 children aged 1-6 years were divided into three groups: 1-2-year group (n=30), 3-4-year group (n=39) and 5-6-year group (n=41). Mimics software was used for three-dimensional reconstruction to measure the parameters such as the length of the extracranial slope, the length of the intracranial slope, the width of the bottom of the slope, and the distance between the pharyngeal tuberculum and the bottom of the slope.  
    RESULTS AND CONCLUSION: (1) The mean slope of each parameter was on the rise along with the age growth. Differences in intracranial slope length, intracranial external adjustment pillow cartilage combined with distance from the bottom of the slope, slope bottom width, pharynx nodules from the bottom of the slope distance, and broken hole inside edge distance were significant among the three groups (P < 0.05). Slope top width was significantly different between 5-6-year group and the 1-2-year and 3-4-year groups (P < 0.05). The slope angle of cervical spine was not significantly different among the three groups (P > 0.05). (2) The dimensions of titanium plates for internal fixation placed on the slope were: the top width of titanium plate was 8 mm; the middle width was 19.1 mm; the bottom width was 26.9 mm; and the length was 23.7 mm in the 1-2-year group. The top width of titanium plate was 8.1 mm; the middle width was 20.6 mm; the bottom width was 31.3 mm; and the length was 26.5 mm in the 3-4-year group. The top width of titanium plate was 10.4 mm; the middle width was 22 mm; the bottom width was 37.3 mm; and the length was 28 mm in the 5-6-year group. (3) According to the analysis of slope area parameters, the sizes of titanium plates placed on slopes for children aged 1-6 years were obtained, which helped clinicians master the slope anatomical structure and improve the safety of titanium plates placed.
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    Accuracy and reproducibility of three-dimensional planning based on CT data for predicting prosthesis type and osteotomy in total hip arthroplasty
    Huo Jiabang, Zhao Chang, Huang Guangxin, Wang Xinjie, Bu Yufan, Zhu Jinjian, Cai Daozhang
    2021, 25 (27):  4294-4299.  doi: 10.12307/2021.185
    Abstract ( 300 )   PDF (1339KB) ( 81 )   Save
    BACKGROUND: The correct choice of prosthesis size and accurate biomechanical reconstruction are important factors affecting the postoperative function of total hip arthroplasty. Accurate preoperative planning can provide information for accurate reconstruction in advance. Osteotomy distance and tip shoulder distance are important reference indexes for femoral stem implantation depth and intraoperative control of the length of both lower limbs. Preoperative planning measurement is very important.  
    OBJECTIVE: To assess the accuracy and reproducibility of three-dimensional (3D) preoperative planning simulation of primary total hip arthroplasty based on hip CT data.
    METHODS:  We retrospectively analyzed medical records of 50 patients (52 hips) who underwent primary total hip arthroplasty with cementless prosthesis. The data of each patient’s preoperative double hip CT thin-layer scanning were collected and imported into Mimics 19.0 software in DICOM format for 3D modeling of the hip joint. The 3D scanner was used to scan each size of prosthesis sample. The 3D PINNACLE cup, SUMMIT and CORAIL prosthesis models were established by Geomagic Studio 2012 software. The prosthesis models were imported into Mimics software to simulate prosthesis implantation on the established hip joint model. After placing the prosthesis, the prosthesis model was recorded, and the femoral neck osteotomy distance and tip shoulder distance were measured. Similarly, the osteotomy height and tip shoulder distance were measured postoperatively, and the results of 3D preoperative planning were compared with the actual results after operation. Pearson Correlation Coefficient was used to determine the correlation between variables before and after planning.  
    RESULTS AND CONCLUSION: (1) The accuracy of 3D preoperative planning based on CT data in planning the cup, the stem, combining both the cup and the stem was 92%, 96% and 94%, respectively. (2) The osteotomy distance and the tip shoulder distance before and after the operation had strong repeatability (osteotomy distance: r=0.825, P < 0.05, tip shoulder distance: r=0.862, P < 0.05). Partial correlation coefficient analysis showed that the correlation between preoperative and postoperative osteotomy distance and tip shoulder distance was still strong (osteotomy distance: r’=0.783, P < 0.05; tip shoulder distance: r’=0.843, P < 0.05). The absolute error of osteotomy distance was (0.07±1.64) mm, and the absolute error of tip shoulder distance was (-0.24±1.58) mm. (3) It is concluded that 3D preoperative planning based on CT data not only has high accuracy in predicting the size of prosthesis, but also can accurately reconstruct the osteotomy distance and tip shoulder distance. 3D preoperative planning has good reproducibility in primary total hip arthroplasty, which can provide good reference value for surgeons in clinical practice, so as to avoid intraoperative and postoperative complications.

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    Prediction algorithm of hospitalization duration after total knee arthroplasty based on machine learning
    Chen Chaofeng, Shi Yuxiong, Liang Jincheng, He Zhijun, He Dadong
    2021, 25 (27):  4300-4306.  doi: 10.12307/2021.186
    Abstract ( 354 )   PDF (1921KB) ( 60 )   Save
    BACKGROUND: The length of hospital stay after total knee arthroplasty is closely related to the prognosis of patients, but the related factors that affect the length of hospital stay have not been studied in depth.  
    OBJECTIVE: The prediction model of length of stay after total knee arthroplasty was established based on clinical data. Seven machine learning algorithms were used to construct the model, evaluate the effectiveness of different algorithms, and obtain the most relevant influencing factors of length of stay.
    METHODS:  Through the hospital medical record system, a total of 777 patients who underwent total knee arthroplasty that met the inclusion criteria from January 2012 to December 2019 were collected. The patient’s clinical data and past medical history were entered in detail. Seven kinds of machine learning, such as logistic regression, multiple adaptive regression, K-nearest neighbor, support vector machine, random forest, extreme gradient extraction algorithm, and artificial neural network, were used to build an algorithm model, and the 10-fold cross-validation method is used to verify the effectiveness of the model. The area under the receiver operating characteristic curve, accuracy, sensitivity, specificity, accuracy and F1 score of the seven models were calculated and compared. The importance of the predictive variables of the artificial neural network model, the neural network architecture and draw heat maps related to the traits were evaluated.  
    RESULTS AND CONCLUSION: (1) We included a total of 777 samples, including 618 patients who were hospitalized for less than or equal to 6 days and 159 patients who were hospitalized for more than 6 days. (2) There were significant differences in age, preoperative hemoglobin, operation method, diabetes history, ischemic heart disease history, cerebrovascular disease history and blood transfusion between the two groups (P < 0.05). (3) Logistic regression, multiple adaptive regression, K-nearest neighbor, support vector machine, random forest, extreme gradient algorithm and artificial neural network area under the receiver operating characteristic curve were 0.770, 0.778, 0.609, 0.570, 0.594, 0.586, and 0.903 in sequence. The prediction efficiency of artificial neural network was the best. Simultaneously, through the comparison of accuracy, sensitivity, specificity, precision and F1 score, it is found that the artificial neural network performs best, followed by logistic regression and multiple adaptive regression algorithms. (4) In the artificial neural network model, the length and age of surgery were the most important among the predictors, leading the other predictors, and the history of heart failure, cardiovascular disease, ischemic heart disease, surgical methods, hemoglobin, blood transfusion, insulin use, history of diabetes, and obstructive sleep apnea were less important than the first two, but they were still highly correlated predictors. The neural network architecture also confirms the importance of these factors. (5) It is concluded that the three machine learning algorithms of artificial neural network, logistic regression and multiple adaptive regression algorithm can be used to predict the length of hospitalization after total knee arthroplasty, but the prediction effect of artificial neural network was more than that of logistic regression and meta-adaptive regression algorithm accurate. The length of surgery, age, history of heart failure, cardiovascular disease, ischemic heart disease, surgical method and hemoglobin are closely related to the length of hospitalization in the artificial neural network model. Simultaneously, using the neural network model can personally predict the patient. The artificial neural network prediction model has a high recognition efficiency, which helps to improve the utilization rate of hospital beds and better plan the length of hospital stay.
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    Mechanics calculation method of lumbar spine considering muscle factors
    Guan Tianmin, Chen Xiangyu, Zhu Ye
    2021, 25 (27):  4307-4311.  doi: 10.12307/2021.187
    Abstract ( 238 )   PDF (1361KB) ( 57 )   Save
    BACKGROUND: Paravertebral muscles play an important role in maintaining spinal balance. The finite element model of skeletal muscle is more close to the biomechanical environment of human body. However, the muscle modeling in the finite element analysis of the spine is more complex or the muscle force is simplified in the current finite element analysis of the spine.  
    OBJECTIVE: To quickly establish the paravertebral muscle model and analyze loading of muscle force.
    METHODS:  Based on the principle of reverse engineering, the three-dimensional reconstruction of the spine model was carried out through CT image data. The spring stiffness of the longest lumbar muscle and ligament in the erector spinalis muscle was calculated through the elastic modulus, muscle cross-sectional area and average length of muscle line. The muscle modeling was carried out through the upper and lower attachment points, and the biomechanical verification of the established finite element model was carried out. The lumbar spine was simulated by applying a bending moment of 4 N•m for flexion and extension, left and right lateral bending, left and right rotation.  
    RESULTS AND CONCLUSION: (1) Biomechanical verification showed that L4-L5 showed elastic properties under axial load. (2) Through the analysis of lumbar flexion and extension, left-right lateral bending and left-right rotation, a finite element model of skeletal muscle was established, which was consistent with the range of motion of lumbar spine. (3) The finite element model of lumbar spine with muscle tissue conforms to the biomechanical characteristics of human body, which provides a reference for analyzing the changes of the spine under orthopedic force.
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    Correlation between clinical stage of unilateral knee osteoarthritis and double plantar pressure
    Wang Xin, Luo Wen, Huang Wenze, Xu Yanfei, Ai Yuanliang, Xia Yubo, Zhou Xiaohan, Wang Tao, Guo Ying
    2021, 25 (27):  4312-4317.  doi: 10.12307/2021.188
    Abstract ( 336 )   PDF (1439KB) ( 122 )   Save
    BACKGROUND: Plantar pressure is the reaction force exerted by the plantar region in the vertical direction under the action of gravity when the human body is standing still or walking dynamically. Correlation analysis of plantar pressure at different stages of knee osteoarthritis may provide evidence for early intervention and guidance of conditioning for knee osteoarthritis.  
    OBJECTIVE: To investigate the changes of plantar pressure in different stages of unilateral knee osteoarthritis, and to provide relevant basis for the occurrence and development of unilateral knee osteoarthritis.
    METHODS:  Unilateral knee osteoarthritis patients in the Department of Orthopedics and Traumatology, the Third Affiliated Hospital of Yunnan University of Chinese Medicine from October 2018 to December 2019 were collected for clinical staging according to clinical symptoms combined with radiology Kellgren-Lawrence classification, including 29 cases in the early stage, 32 cases in the middle stage and 27 cases in the later stage. LorAn plantar pressure tester was used to collect plantar pressure. Static pressure included anterior pressure, posterior pressure, left pressure, right pressure ratio and pelvic rotation. The dynamic pressure was taken as “characteristics of footsteps”, including pressure ratio in thumb, 2nd-5th toe (T2-5), 1st-5th (M1-5) metatarsal, middle foot, medial heel and lateral heel, to study the correlation between clinical staging and plantar pressure.  
    RESULTS AND CONCLUSION: (1) In the static pressure distribution, there were significant differences in left pressure, right pressure and pelvic rotation among the three groups (P < 0.05). There were significant differences in T1, T2-5, M2, M5 and lateral heel on the affected side and M2, M3 and M4 on the healthy side (P < 0.05). (2) In static pressure, left pressure, right pressure, pelvic rotation and dynamic “characteristic foot” on M5, middle foot, and lateral heel of the affected side, and M2, M3, and M4 on the healthy side were positively correlated with clinical stage (P < 0.05). (3) In the static pressure, the left pressure and the right pressure, as well as the dynamic “characteristic feet” on the T1 and T2-5 of the affected side were negatively correlated with the clinical stage (P < 0.05). (4) The ordered multiple Logistic regression analysis showed that T2-5, M5, lateral heel and M3 on the affected side of characteristic feet were independent factors influencing clinical stages of knee osteoarthritis (β=-0.329, 0.333, 0.199, 0.654; P < 0.05). (5) The results showed that with the progression of knee osteoarthritis staging, the distribution of “static pressure” gradually tended to the uninjured side, and the rotation degree of the pelvis gradually increased to increase the compensatory capacity of the foot. The “dynamic pressure” on the affected side was distributed outward, and the pressure proportion of T1-5 was reduced, which provided stronger motivation for the departure stage. The “dynamic pressure” of the healthy side is distributed forward and outward to promote the center of gravity to move forward and reduce the load of the affected side knee joint.
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    Application of SLR-PLUS biological lengthened revision stem in the revision of aseptic loosening of femoral prosthesis
    Lu Yiqing, He Bin, Wang Boyao, Qin Hu, Fan Lei, Wang Yunhua
    2021, 25 (27):  4318-4321.  doi: 10.12307/2021.189
    Abstract ( 202 )   PDF (1189KB) ( 47 )   Save
    BACKGROUND: Revision hip joint is a kind of surgical treatment that causes failure of hip joint replacement for various reasons. Selecting appropriate revision prosthesis and surgical method are the conditions to restore good joint function of patients.  
    OBJECTIVE: To investigate the clinical effect of SLR-PLUS biotype extended rectangular stalk in the revision of femoral prosthesis with aseptic loosening.
    METHODS:  Sixteen patients undergoing revision of the hip joint admitted to the Second Affiliated Hospital of Nanjing Medical University from June 2017 to December 2018 were included. The reason for the revision was aseptic loosening of the femoral side prosthesis, including 7 males and 9 females, aged 63-82 years. All patients underwent SLR-PLUS biologic long rectangular handle revision surgery, and imaging assessment and hip function assessment were performed postoperatively. All patients gave informed consent to the treatment plan. The trial was approved by the Ethics Committee of the Second Affiliated Hospital of Nanjing Medical University.  
    RESULTS AND CONCLUSION: (1) All the 16 patients successfully completed the operation without complications such as hip joint infection, dislocation and deep venous thrombosis of lower limbs. After the operation, all patients’ blood sedimentation and C-reactive protein levels were reduced to normal levels without signs of infection. The patients were followed up for 6-30 months after operation. (2) The imaging examination at 12 weeks after the operation and the last follow-up showed that the prosthesis was in good position; no new transparent belt appeared around the prosthesis; and the femoral prosthesis was well matched with the surrounding bone. (3) Harris score of hip joint function 12 weeks after operation was higher than that before operation in 16 patients (P < 0.05), and the excellent and good rate reached 94%. (4) The results showed that SLR-PLUS biotype extended rectangular handle revision treatment for femoral side prosthesis aseptic loosening of hip joint has good immediate stability and medium-term stability, and the curative effect is satisfactory.
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    Transverse acetabular ligament as a marker for acetabular prosthesis anteversion in total hip arthroplasty
    Li Long, Wang Hailong, Kang Peng, Chen Shengguo, Yilihamu•Tuoheti
    2021, 25 (27):  4322-4326.  doi: 10.12307/2021.190
    Abstract ( 305 )   PDF (1366KB) ( 49 )   Save
    BACKGROUND: There are a variety of reference standards for the placement of acetabular prosthesis in hip arthroplasty at present. Many surgeons only rely on visual measurement of standard anteversion abduction angle when fixing acetabular prosthesis. The transverse acetabular ligament was used as a reference point in this study.  
    OBJECTIVE: To study the value of transverse acetabular ligament as a marker of acetabular anteversion in total hip arthroplasty.
    METHODS:  The anatomic descriptive study of transverse acetabular ligament was carried out on fresh hip joint specimens to determine its course and position of starting and ending points, so as to provide the basis for the reconstruction of transverse acetabular ligament in three-dimensional reconstruction. Totally 192 adults (384 hips) with normal joints undergoing hip CT scan were selected, including 84 males and 108 females, at the age of > 18 years. A radiologist and an orthopedic surgeon diagnosed that bilateral acetabulum morphology was normal, without tumor, deformity, or severe osteophyte. Acetabular transverse ligament anteversion was measured in CT digital three-dimensional reconstruction. The results were compared with those of Lewinnek safe area and bony acetabulum.  
    RESULTS AND CONCLUSION: (1) Transverse acetabular ligament bridged the acetabular notch to form a complete circle. When the highest point of acetabulum was defined as 12 o'clock, transverse acetabular ligament was roughly located between 6 o'clock and 9 o'clock (taking the left side as an example). (2) The mean anteversion angle of transverse acetabular ligament was (12.9 ± 3.3)°, and the anteversion angle of three hips (6%) was beyond the safe area defined by Lewinnek (15±10)°. The average acetabular anteversion was (17.7±3.8)°, which was 4.7° larger than that of transverse acetabular ligament. (3) There was a significant correlation between transverse acetabular ligament anteversion and acetabular anteversion (r=0.759, P < 0.01). (4) It is concluded that in the hip joint with normal acetabular morphology, the alignment of transverse acetabular ligament anteversion and acetabular anteversion is not completely consistent, but there is an obvious correlation between them. Therefore, transverse acetabular ligament can be used as an anatomical marker for locating acetabular cup anteversion in total hip arthroplasty.
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    Tourniquet use in the first half-course of total knee arthroplasty does not affect postoperative functional outcomes or pain: a prospective, randomized controlled trial
    Hu Shouye, Yang Zhi, Hao Yangquan, Lu Chao, Zhang Qiong, Zhang Weisong, Zhu Yujie, Peng Kan
    2021, 25 (27):  4327-4332.  doi: 10.12307/2021.191
    Abstract ( 273 )   PDF (2352KB) ( 31 )   Save
    BACKGROUND: Tourniquets use in total knee arthroplasty was highly controversial.  
    OBJECTIVE: To optimize operative program in total knee arthroplasty by making a comparison on rehabilitation of postoperative patients between two strategies: front half (released after the prosthesis was placed) or no tourniquet use.
    METHODS:  Two hundred patients with unilateral knee osteoarthritis were randomized to undergo total knee arthroplasty either with a tourniquet use in the first half-course (first half-course tourniquet group, 100 patients) or no tourniquet use (no tourniquet group, 100 patients). Primary outcome measures were functional assessment testing using the Timed Up & Go test and Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score, and 12-Item Short Form Health Survey scores. Secondary outcome measures included the stair-climb test, blood loss, operation time, surgical field visualization, and range of motion. Outcome measures were completed preoperatively, in the hospital, and postoperatively at a first (4 and 5 weeks postoperatively) and a second follow-up (6 and 7 months postoperatively).  
    RESULTS AND CONCLUSION: (1) Postoperative knee joint function of both groups improved significantly compared with those before surgery (P < 0.05). (2) The incidence rate of thigh numbness of front-half tourniquet use group was higher during hospitalization (P < 0.05). However, average perioperative blood loss was less (P < 0.001) and visualized surgical field was wider (P < 0.001). (3) At first follow-up, knee joint extension degree was bigger (P=0.03) and the mean Knee Injury and Osteoarthritis Outcome Score associated with living quality were both higher in front-half tourniquet use group than those of no tourniquet use group (P=0.03). (4) At the second follow-up, although patients in the non-tourniquet use group climbed stairs faster, there was no statistical significance between the two groups (P=0.08). Other assessment results also presented no statistical difference between these two groups. (5) It is concluded that in spite of high incidence rate of thigh numbness which may not cause adverse effects, first half-course tourniquet use in total knee arthroplasty reduces blood loss and provides wider surgical field visualized. This strategy in total knee arthroplasty was safe and effective and can also advance the application of rapid recovery mode.
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    Percutaneous endoscopic lumbar discectomy for the treatment of high iliac crest L5/S1 disc herniation
    Cui Guanyu, Shu Xiong, Liu Yajun, Sun Yuqing, He Da, Liu Bo, Tian Wei
    2021, 25 (27):  4333-4338.  doi: 10.12307/2021.192
    Abstract ( 261 )   PDF (1185KB) ( 39 )   Save
    BACKGROUND:  In clinic, percutaneous endoscopy is applied more and more in the treatment of lumbar disc herniation. However, in the case of high iliac L5/S1 disc herniation, difficulty and uncertainty of the operation increase as the obstruction of the high iliac crest.  
    OBJECTIVE: To summarize and analyze indications, advantages and disadvantages of lateral transforaminal percutaneous endoscopy and posterior interlaminar percutaneous endoscopy for treatment of high iliac crest L5/S1 disc herniation.
    METHODS:  Medical records were retrospectively analyzed in 99 patients undergoing discectomy by percutaneous endoscopy. There were 31 high iliac crest L5/S1 disc herniation cases treated by lateral transforaminal percutaneous endoscopy (group A), and 33 high iliac crest L5/S1 disc herniation cases treated by posterior interlaminar percutaneous endoscopy (group B), and 35 normal iliac L5/S1 disc herniation cases treated by lateral transforaminal percutaneous endoscopy (group C). Operation time, times of X-ray fluoroscopy, complications during operation and after operation were recorded. Visual analogue scale scores of the patients in pre-operation, 1-day post-operation, 3-month post-operation, 2-year post-operation were applied to evaluate severity of the lower limb pain. Oswestry disability index was applied to evaluate the lumbar function of the patients. Macnab criteria were used to evaluate the clinical efficacy at 2 years follow-up.  
    RESULTS AND CONCLUSION: (1) The operation time of group A and group C was significantly longer than that of group B (P < 0.05), but there was no significant difference between group A and group C (P > 0.05). (2) Times of X-ray fluoroscopy of group A and group C were significantly more than those of group B (P < 0.05); the times of X-ray fluoroscopy of group A were more than those of group C, but the difference was not significant (P > 0.05). (3) Visual analogue scale scores and Oswestry disability index of lower limb pain at each time point after operation in each group were significantly lower than those before operation (P < 0.05). There was no significant difference among the three groups (P > 0.05). (4) According to MacNab standard, the excellent and good rate of groups A, B and C was 97% at 2 years follow-up. (5) Results suggest that for patients with high iliac crest L5/S1 disc herniation, operation time and times of X-ray fluoroscopy of lateral transforaminal percutaneous endoscopy were more than posterior interlaminar percutaneous endoscopy. Operation time and times of X-ray fluoroscopy of lateral transforaminal percutaneous endoscopy in the treatment of high iliac crest L5/S1 disc herniation were more than the normal iliac crest L5/S1 disc, but the difference was not significant. For the treatment of high iliac crest L5/S1 disc herniation, posterior interlaminar percutaneous endoscopy was superior to lateral transforaminal percutaneous endoscopy in a certain sense, but in practice, we should consider the position of the herniation at the same time.
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    Risk factors for impingement between the femoral stem tip and the distal femoral cortex after first total hip arthroplasty
    Zhang Yang, Wang Dasai, Wang Qiang
    2021, 25 (27):  4339-4343.  doi: 10.12307/2021.193
    Abstract ( 277 )   PDF (1170KB) ( 29 )   Save
    BACKGROUND: With the continuous development of total hip arthroplasty, both doctors and patients are constantly pursuing higher quality surgical results. However, high-quality total hip arthroplasty not only requires the skilled skills of the doctor, but also has a certain impact on the femoral configuration of the patient.  
    OBJECTIVE: To analyze the risk factors of the impingement between the femoral stem tip and the distal femoral cortex, so as to provide effective references for preoperative planning of total hip arthroplasty.
    METHODS:  A retrospective analysis was performed in data of 160 patients of primary total hip arthroplasty from January 2018 to January 2020. All surgeries were conducted by an experienced director of orthopedic surgeon using the buttock posterolateral approach. Postoperative anteroposterior and lateral X-ray images or CT images were observed by two orthopedic surgeons via medical image archiving and communication system or Mimics 20.0. The femoral handle sophisticated and distal femoral cortical contact or penetration was defined as the impact. There were 139 patients, including 56 males and 83 females, with a mean age of (68.1±12.3) years (range, 26-92 years). The gender, age, height, body mass, body mass index and femoral stem length (all LK.LCU stem), femoral stem insertion angle (the angle between the long axis of femoral stem and the long axis of femoral stem), femoral anterior arch angle, femoral lateral arch angle and femoral medullary cavity type were recorded. Above data were analyzed by difference analysis and Logistic regression analysis.  
    RESULTS AND CONCLUSION: (1) Among the 139 patients undergoing primary total hip arthroplasty, 32 (23%) had impact, including 6 males and 26 females. The average age was (68.13±10.90) years old (range, 46-85 years); body mass index (22.48±3.39) kg/m2. (2) Regression analysis suggested that factors associated with distal femoral cortical impingement included gender (P=0.036), height (P=0.018), implant angle (P=0.047), anterior femoral arch angle (P=0.000), and lateral femoral arch angle (P=0.003). (3) It is concluded that female patients with short stature, large angle of anterior femoral arch and lateral femoral arch or excessively large angle of femoral prosthesis implantation are likely to cause the femoral stalk tip impingement with the femoral cortex.
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    Values of alpha defensin and C-reactive protein in synovial fluid in the diagnosis of periprosthetic infection
    He Shengcai, Jiang Chengdan, Jing Chunxiang, Luo Minyi, Ma Xingfa, Li Jiazhou, Pan Huashan
    2021, 25 (27):  4344-4347.  doi: 10.12307/2021.194
    Abstract ( 243 )   PDF (1025KB) ( 26 )   Save
    BACKGROUND: Peri-prosthesis infections are one of the most common and serious complications of knee/hip replacement, accounting for 25% of total knee replacement failures and 16% of total hip replacement failures. Therefore, timely and accurate diagnosis of periarticular prosthesis infection has important clinical significance.  
    OBJECTIVE: To evaluate the diagnostic effects of α defensin and C-reactive protein on periprosthetic infections.
    METHODS:  Patients with pain following primary or revision joint surgery from September 2014 to September 2016 were selected for alpha defenesin and C-reactive protein testing in synovial fluid. The results were compared with Muscular Skeletal Infection Society standard, and the positive predictive value and negative predictive value were calculated. The trial was approved by the Ethics Committee of Guangzhou University of Chinese Medicine (approval No. K[2020]064) on August 7, 2020.  
    RESULTS AND CONCLUSION: The sensitivity and specificity of α defensin test combined with synovial fluid C-reactive protein positive test were 81.1% (95% CI: 64.8%-92.0%) and 95.9% (95% CI: 91.3%-98.5%). The sensitivity and specificity of α defensin and C-reactive protein in synovial fluid were 73.0% (95% CI: 55.9%-86.2%) and 99.3% (95% CI: 96.2%-99.9%). It is concluded that both α defensin and C-reactive protein in synovial fluid can be used in the diagnosis of periarticular infection.
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    Comparison of the efficacy and biocompatibility of two anterior acetabular approaches with low-profile reconstruction plate fixation in the treatment of acetabular fractures involving quadrilateral area
    Zhu Yin, Sheng Xiaolei, Sha Weiping, Zhang Xingxiang, Wang Jin, Zhu Xianwei, Wang Liming, Yan Fei
    2021, 25 (27):  4348-4353.  doi: 10.12307/2021.195
    Abstract ( 269 )   PDF (1205KB) ( 37 )   Save
    BACKGROUND: Conservative treatment for acetabular fractures involving quadrilateral areas was usually adopted, but with the in-depth research on the acetabular fractures and the development of orthopedic implants, surgical treatment is currently advocated. The anterior acetabular surgical approach includes the iliac-groin approach, the modified Stoppa approach, and the pararectus abdominis approach. It is of great clinical significance to select a more reasonable surgical approach.  
    OBJECTIVE: To compare the clinical efficacy and biocompatibility of the low-profile reconstruction plate through the pararetus approach and through the ilioinguinal approach for acetabular fractures involving quadrilateral areas.
    METHODS:  Clinical data of 41 patients with acetabular fracture involving quadrilateral area treated in Zhangjiagang Hospital Affiliated to Soochow University from January 2015 to October 2019 were retrospectively analyzed. All patients were assigned to pararetus approach group (n=21) and ilioinguinal approach group (n=20), and received low-profile reconstruction plate fixaiton. Relevant clinical indicators during perioperative period were recorded in the two groups. During follow-up, Matta imaging assessment criteria were used to evaluate the effect of fracture reduction. Modified Merle d’Aubigné-Postel criteria were used to assess the function of affected hips, and visual analogue scale was used to evaluate the pain degree of hip joint, and statistical analysis was conducted.  
    RESULTS AND CONCLUSION: (1) Totally 41 patients were followed up for more than 6 months. (2) The pararetus approach group was significantly better than the ilioinguinal approach group in incision length, fracture exposure time, operation time, blood loss and postoperative complications (P < 0.05). (3) Visual analogue scale scores were significantly lower in both groups at postoperative 6 months than that at postoperative 3 months (P < 0.05). The visual analogue scale scores in the pararetus approach group were significantly better than those in the ilioinguinal approach group during the follow-up of 3 and 6 months (P < 0.05). (4) The modified Merle d’Aubigné-Postel score was significantly higher in both groups at postoperative 6 months than that at postoperative 3 months (P < 0.05). The modified Merle d’Aubigné-Postel score was significantly higher in the pararetus approach group than that of the ilioinguinal approach group at the follow-up of 3 and 6 months (P < 0.05). (5) The difference of fracture healing time and satisfaction degree of fracture reduction had no statistical significance between two groups (P > 0.05). (6) Both anterior acetabular approaches with low-profile reconstruction plate can achieve good biocompatibility for acetabular fractures involving quadrilateral area. It is indicated that for acetabular fractures involving quadrilateral area, the placement of low-profile reconstruction plates through the pararectus approach has less trauma, higher safety, easier operation and better clinical efficacy.
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    Fixation of the modified Pauwels type Ⅲ femoral neck fractures in young adults with percutaneous hollow compression screw combined with medial buttress plate: 2-year follow-up
    Ren Sijun, Cao Zhipeng, Xu Rao, Ru Jiangying
    2021, 25 (27):  4354-4360.  doi: 10.12307/2021.196
    Abstract ( 272 )   PDF (1411KB) ( 25 )   Save
    BACKGROUND: Although materials and technologies of internal fixation have been improved significantly, the treatment of Pauwels III fractures of femoral neck in young adults remains a challenging and controversial issue.  
    OBJECTIVE: To explore the early effect of percutaneous hollow compression screw combined with medial buttress plate via direct anterior approach for modified Pauwels type III femoral neck fractures in young adults, causes of main complications and problems in perioperative period need to be paid attention to.
    METHODS:  Clinical data of 18 young adults of modified Pauwels type III femoral neck fractures in young adults treated with percutaneous hollow compression screw combined with medial buttress plate via direct anterior approach in Affiliated Hospital of Yangzhou University from November 2016 to November 2018 were retrospectively analyzed in this retrospective study. The data, including time from injury to admission, time from injury to operation, operation time, postoperative partial-weight bearing time and full-weight bearing time, imaging bone healing time and clinical bone healing time, were all required to be carefully recorded. According to the results of X-ray and CT examination, the failure of internal fixation, bone non-unions, femoral neck shortening, and aseptic necrosis of the femoral head were assessed. It was necessary to further perform MRI if having suspected the occurrence of aseptic necrosis of the femoral head. Meanwhile, the reduction quality and functional recovery of the affected hips, at immediately, 3, 6, 12, and 24 months after surgery, were evaluated respectively by Garden's alignment index and the Harris score.  
    RESULTS AND CONCLUSION: (1) In all 18 patients, the average follow-up time was 24-36 months. The average image bone healing time and clinical bone healing time were (4.3±1.1) months (3.8-6.1 months) and (5.8±0.9) months (4.9-8.2 months), respectively. (2) There was no significant difference in Garden’s alignment index on the anteroposterior and lateral X-rays of the affected hip immediately, 3, 6, 12, and 24 months after surgery (P > 0.05). (3) At 3, 6, 12, and 24 months after surgery, the Harris scores and total scores of the affected hip were all significantly higher than those before surgery (P < 0.05). Compared with 3 months after surgery, the Harris scores and total scores of the affected hip were all significantly improved at 6, 12, and 24 months after surgery (P < 0.05). Compared with 6 months after surgery, the hip function, range of motion and total Harris score were all significantly improved at 12 and 24 months after surgery (P < 0.05). (4) The wounds of all patients healed at the first level, and there were no complications such as nonunion, deep venous thrombosis, hypostatic pneumonia, or bed sore. Two cases of patients had withdrawals of hollow compression screw accompanied with shortening of the femoral neck after surgery (about 8 mm), but the clinical bone healing was successfully completed. Aseptic necrosis of the femoral head occurred in one patient concomitant with hip dysfunction 2 years postoperatively, who was revised subsequently by total hip arthroplasty via original direct anterior approach. One patient experienced obvious pain during the hyperflexion of the hip joint, and the symptoms were relieved 3 months after the primary operation without special treatment. 
    (5) The all outcomes indicated that fixation of percutaneous hollow compression screw combined with medial buttress plate via direct anterior approach in young adults with modified Pauwels type III femoral neck fractures can achieve the anatomical reduction and fixation of the fractures under direct vision, and its early effect is satisfactory. However, it is required to control surgical indications and strengthen perioperative management strictly so as to prevent the occurrence of major complications, such as nonunion and aseptic necrosis of the femoral head.
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    Proximal femoral nail antirotation and proximal sliding compression and positive support reduction in the treatment of intertrochanteric fractures in older adults
    Wang Xiang, Zhou Yejin, Li Yekui, Sheng Zhen
    2021, 25 (27):  4361-4367.  doi: 10.12307/2021.197
    Abstract ( 278 )   PDF (1801KB) ( 33 )   Save
    BACKGROUND: Proximal femoral antirotation intramedullary nailing is currently the preferred internal fixator for the treatment of intertrochanteric fractures of the femur. The use of different types of tail caps in non-anatomical reduction may have an impact on the surgical efficacy.  
    OBJECTIVE: To investigate the clinical effect of proximal sliding compression technique in the treatment of elderly intertrochanteric fractures of the femur with proximal femoral nail antirotation internal fixation and positive supportive reduction.
    METHODS:  Clinical data of 76 cases of elderly intertrochanteric fractures of the femur, who were treated in Department of Orthopedics and Traumatology, the Third Affiliated Hospital of Anhui Medical University (the First People’s Hospital) from August 2016 to August 2019 using proximal femoral nail antirotation treatment and positive support in intraoperative reduction, were retrospectively analyzed. The patients were divided into two groups according to the presence and absence of proximal sliding compression technology. The 42 cases in the sliding compression group received sliding compression technique at the proximal end. The 34 cases in the non-sliding pressure group received conventional treatment at the proximal end. Operation time, intraoperative blood loss, changes in femoral neck length immediately and 6 months after surgery, tip-apex distance change, fracture healing time, incidence of postoperative complications, and hip Harris function score were compared between the two groups at 1 year after surgery.  
    RESULTS AND CONCLUSION: (1) There was no significant difference between the two groups in gender, age, side, cause of injury, fracture type and other general data (P > 0.05), and the data of the two groups were comparable. (2) There were no significant differences between the sliding pressure group and the non-sliding pressure group in operation time, intraoperative blood loss, changes in femoral neck length immediately and 6 months after surgery, tip-apex distance change, postoperative complication rate, and hip joint Harris function score at 1 year after surgery (P > 0.05). (3) However, the fracture healing time [(6.79±0.81) weeks] in the sliding pressure group was significantly shorter than that of the non-sliding pressure group [(7.88±1.07) weeks], with a significant difference (P < 0.05). (4) It was suggested that proximal femoral nail antirotation internal fixation should be applied to the treatment of senile intertrochanteric fractures. When anatomical reduction cannot be achieved, the medial cortex should strive to achieve positive supportive reduction, and the proximal application of sliding compression technology can significantly shorten the fracture healing time.
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    Proximal humerus locking plate combined with allogeneic bone graft in the treatment of proximal humerus osteoporotic fractures
    Pan Dongxu, Yang Jing, Li Yaohua, Liu Yuzhang, Duan Yonggang, Zhong Aiyun, Tang Xiaolong, Ding Yingqi
    2021, 25 (27):  4368-4373.  doi: 10.12307/2021.198
    Abstract ( 215 )   PDF (1805KB) ( 29 )   Save
    BACKGROUND: The incidence of proximal humerus osteoporotic fractures increases year by year. Fracture repair is difficult because of the greatly reduced resistance caused by osteoporosis.  
    OBJECTIVE: To investigate the clinical effect of proximal humerus locking plate combined with allogeneic bone transplantation (an effective method of augmentation fixation) in the treatment of proximal humerus osteoporotic fracture.
    METHODS:  A total of 50 elderly patients with proximal humerus osteoporotic fracture from December 2013 to November 2018 in the Second Affiliated Hospital of Hebei North University were divided into group A (n=30) and group B (n=20) according to different surgical methods. In group A, proximal humerus locking plate supplemented by allogeneic bone transplantation was used for strengthening fixation, while in group B, proximal humerus locking plate was used alone. The changes of post-operative neck shaft angle, the loss of humeral head height, the time of fracture healing, and the shoulder joint function before and after operation were compared between the two groups, and the complications between the two groups were recorded.  
    RESULTS AND CONCLUSION: (1) Compared with group B, group A had no significant reduction in postoperative humeral neck shaft angle compared with normal group (t=5.226, P < 0.001), the loss of humeral head height was significantly reduced (t=2.609, P=0.012), and the healing time of proximal humerus fracture was significantly shortened (t=2.036, P=0.047). (2) Three months after surgery, the scores of pain, function, movement limitation and anatomic reduction in the two groups were all significantly increased compared with those before surgery (t=4.731, 6.707, 4.370, 6.196, P < 0.01), and the scores in the group A were significantly better than those in the group B. The excellent and good rate was 90% (27/30) in group A, significantly higher than 60% (12/20) in group B (χ2=6.294, P=0.012). (3) After a follow-up of three months after surgery, there were no cases of infection due to allogeneic bone transplantation in group A, and two patients experienced transient fever. There were two cases of shoulder joint stiffness, and the complication rate of surgery was 7%. In group B, internal fixation failure occurred in one case, screw penetration occurred in one case, steel plate fracture occurred in one case, and shoulder joint stiffness occurred in three cases. The complication rate was 30%. The incidence of complications in group A was significantly lower than that in group B (χ2=4.861, P=0.027). (4) It is indicated that the method of allogeneic bone transplantation combined with proximal humerus locking plate strengthening fixation can significantly promote the healing of proximal humerus osteoporotic fractures and improve the motor function of shoulder joint, with less complications. The clinical effect is obviously superior to that of using proximal humerus locking plate alone.
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    Risk factors for joint stiffness after volar plate fixation for distal radius fractures
    Cheng Wenjing, Ding Guozheng, Xie Jiabing, Wang Lin
    2021, 25 (27):  4374-4378.  doi: 10.12307/2021.199
    Abstract ( 345 )   PDF (1329KB) ( 71 )   Save
    BACKGROUND: The treatment of volar plate fixation for distal radius fractures has been widely recognized. However, the current research on wrist stiffness and risk factors after volar plate fixation is still unclear.  
    OBJECTIVE: To understand the stiffness of the radiocarpal joint after distal radius fractures and explore the related risk factors for joint stiffness.
    METHODS:  A retrospective analysis was conducted in 125 patients with distal radius fractures who underwent surgical volar plate treatment in The First Affiliated Hospital of Wannan Medical College from May 2016 to July 2019. The general data of the patients and postoperative follow-up data were statistically analyzed. The degree of swelling of wrist joint before operation was evaluated. Fracture types and ulnar styloid process fractures were collected from preoperative X-ray films. Palmar inclination, ulnar declination and radial height were measured by X-ray films during the follow-up of 12 months after operation. The motion of radial wrist joint after operation was evaluated by goniometer. If the range of motion of flexion and extension did not exceed half of the contralateral, it was considered that there was radial wrist joint stiffness. Univariate analysis showed that P < 0.2 was a potential risk factor for joint stiffness, and then multivariate Logistic regression model was used.  
    RESULTS AND CONCLUSION: (1) During follow-up, about 1/3 of distal radius fractures patients developed radiocarpal joint stiffness after volar locking plate fixation. (2) Univariate analysis showed that age (P=0.13), osteoporosis (P=0.02), preoperative swelling (P=0.01), fracture type (AO classification) (P=0.01), intra-articular fractures (P=0.01), postoperative palm inclination (P=0.05), and postoperative external fixation (P =0.19) were potential risk factors for joint stiffness after volar plate internal fixation for distal radius fractures. (3) Further Logistic regression analysis showed that fracture type (AO classification) (OR=1.21, 95%CI:0.98-1.56), intra-articular fractures (OR=1.17, 95%CI:1.06-1.97), preoperative swelling (OR=1.28; 95%CI: 1.12-1.85), osteoporosis (OR=1.32, 95%CI:0.86-1.77) and postoperative palm inclination (OR=1.46, 95%CI:1.01-1.89) were the independent risk factors for joint stiffness after volar plate internal fixation of distal radius fractures. (4) It is indicated that for patients with such risk factors, adequate preoperative evaluation, accurate preoperative planning, and timely and appropriate preventive treatment measures during postoperative follow-up are worthy of attention by orthopedic surgeons.
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    Screw internal fixation and conservative treatment of posterior ankle fractures: differences in ankle joint function and plantar pressure
    He Yi, Zheng Cong, He Minhui, Lu Ruijun, Huang Jianrong
    2021, 25 (27):  4379-4385.  doi: 10.12307/2021.200
    Abstract ( 231 )   PDF (1822KB) ( 36 )   Save
    BACKGROUND: When the posterior malleolus fracture involves less than 25% of the articular surface area, whether it should be actively treated with internal fixation or conservative treatment has been controversial.  
    OBJECTIVE: To evaluate the impact of screw fixation and conservative treatment on the ankle joint function and plantar pressure of posterior malleolus fractures involving 10%-25% of the articular surface area of the distal tibia.
    METHODS:  From March 2017 to May 2020, patients with three ankle fractures treated in The Fifth Affiliated Hospital of Guangzhou Medical University received computed tomography to measure the area of the posterior malleolus fracture involving 10%-25% of the distal tibia articular surface area. The patients were randomized into two groups. The 62 cases in the internal fixation group were treated with screws and 53 cases in the non-internal fixation group were treated with C-arm X-ray machine fluoroscopy assisted downward manual reduction. Plain radiographs were used to evaluate the healing of posterior ankle fractures, and the visual analogue scale score, the American Orthopaedic Association ankle-hindfoot scale score and plantar pressure evaluation results were used clinically.  
    RESULTS AND CONCLUSION:  (1) There was no significant difference in the visual analogue scale scores of the two groups at 3 months after surgery (P > 0.05). The visual analogue scale scores of the internal fixation group were significantly lower than those in the non-internal fixation group at 6 and 12 months after the operation (P < 0.05). The visual analogue scale scores of the two groups were significantly reduced at 3, 6 and 12 months after surgery (P < 0.05). (2) There was no significant difference in the American Orthopaedic Association ankle-hindfoot function score between the two groups at 3 months after operation (P > 0.05). American Orthopaedic Association ankle-hindfoot function score of the internal fixation group was better than those in the non-internal fixation group at 6 and 12 months after the operation (P < 0.05). The American Orthopaedic Association ankle-hindfoot function scores were significantly improved in the two groups at 3, 6 and 12 months after surgery (P < 0.05). (3) Three months after the operation, the plantar pressure of the affected side of the two groups (full foot, hind foot, midfoot, and forefoot) was significantly lower than that in the contralateral foot (P < 0.05). At 6 months postoperatively, the plantar pressure of the whole foot and forefoot of the affected foot in the internal fixation group was lower than that of the contralateral foot (P < 0.05). There was no significant difference in the plantar pressure of the affected side (hind foot and midfoot) and the contralateral foot (P > 0.05). The plantar pressure of the affected side of the non-internal fixation group (full foot, hind foot, midfoot, and forefoot) was significantly lower than that of the uninvolved foot (P < 0.05). At 12 months after operation, there was no significant difference between the plantar pressure of the affected side (full foot, hind foot, midfoot, and forefoot) and the plantar pressure of the unaffected side between the two groups (P > 0.05). (4) It is indicated that in posterior malleolus fractures involving 10%-25% of the distal articular surface of the tibia, screw internal fixation has a better effect on fracture healing and maintenance of ankle alignment, and improves early clinical results. It is recommended that posterior malleolus fractures involving 10%-25% of the distal tibial articular surface can be actively treated with screw internal fixation.
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    Correlation between axial trunk rotation angle and Cobb angle in different ages, genders, and types of idiopathic scoliosis patients
    Yuan Wangshu, Chen Lixia, Shen Jianxiong, Yu Keyi
    2021, 25 (27):  4386-4389.  doi: 10.12307/2021.201
    Abstract ( 299 )   PDF (1008KB) ( 26 )   Save
    BACKGROUND: At present, the measurement of axial trunk rotation angle is widely used to screen scoliosis. Whether this method is suitable for all types of scoliosis is still uncertain.  
    OBJECTIVE: To study the correlation between axial trunk rotation angle and Cobb angle in different ages, genders, and types of idiopathic scoliosis patients, and provide theoretical basis for screening of idiopathic scoliosis.
    METHODS: Totally 203 idiopathic scoliosis patients aged from 4 to 18 years old were measured in Cobb angle and axial trunk rotation angle. According the age, gender and type, 203 subjects were divided into different groups, and the correlation between Cobb angle and axial trunk rotation angle was calculated in each group.  
    RESULTS AND CONCLUSION: (1) There was a moderate correlation between axial trunk rotation angle and Cobb angle in 203 patients with idiopathic scoliosis (r=0.581, P=0.000). (2) According to age, there was no correlation between Cobb angle and axial trunk rotation angle in 4-9 years old idiopathic scoliosis patients (r=0.516, P=0.155). There was a moderate correlation between the two angles in patients aged 10-18 years (r=0.455, P=0.000). (3) According to type, there was a strong correlation between the axial trunk rotation angle and Cobb angle in patients with type I single curve (r=0.739), a moderate correlation between the two angles in patients with type II double curve (r=0.431), and a weak correlation between the two angles in patients with type III triple curve (r=0.399). The correlation decreased between axial trunk rotation angle and Cobb angle with the increase of the number of side bends. (4) According to gender, the correlation between Cobb angle and axial trunk rotation angle was higher in male patients (r=0.601) than that in female patients (r=0.598).
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    Imaging analysis of the correlation between tibial tuberosity-trochlea groove distance and femoral trochlea morphology
    Zhou Yuanbo, Huang Wenliang, Wang Jindong
    2021, 25 (27):  4390-4394.  doi: 10.12307/2021.202
    Abstract ( 386 )   PDF (1220KB) ( 23 )   Save
    BACKGROUND: Femoral trochlear dysplasia is the most important risk factor for patellofemoral instability. There is no consistent conclusion as to whether the morphology of femoral trochlear is determined by congenital genes or related to the stimulation of the patellofemoral compression. The tibial tuberosity-trochlea groove distance can affect the pressure of the patellofemoral joint, so the relationship between the tibial tuberosity-trochlea groove distance and femoral trochlear morphology was analyzed to verify whether the trochlear morphology is related to the stress stimulation of patella.  
    OBJECTIVE: To investigate the relationship between tibial tuberosity-trochlea groove distance and trochlea morphology.
    METHODS:  A total of 154 CT scans from June to August 2019 in Second Affiliated Hospital of Luohe Medical College were analyzed retrospectively. There were 80 males and 74 females, aged 18-55 years. Based on Dejour trochlea classification, the subjects were divided into two groups: trochlea dysplasia group (types A-D) and normal group (sulcus angle ≤ 145°). Researchers measured tibial tuberosity-trochlea groove distance and radiologic parameters characterizing the form of trochlea, including sulcus angle, the lateral trochlea slope, trochlea height (medial, central, lateral), trochlea depth, and trochlea facet asymmetry. The Man-whitney U test was used to evaluate differences in tibial tuberosity-trochlea groove distance between trochlea group and normal group. Pearson correlation analysis was performed between tibial tuberosity-trochlea groove distance and parameters of trochlea morphology.  
    RESULTS AND CONCLUSION: Trochlea dysplasia group showed higher values for tibial tuberosity-trochlea groove distance than normal group (P < 0.001). Tibial tuberosity-trochlea groove distance significantly correlated with most trochlea parameters evaluated, including sulcus angle (r=0.487, P < 0.001), the lateral trochlea slope (r=-0.286, P < 0.001), medial trochlea height (r=-0.174, P=0.031), trochlea depth (r=-0.299, P < 0.001), trochlea facet asymmetry (r=-0.301, P < 0.001), and Dejour trochlea type (r=0.496, P < 0.001). No correlation was found in lateral trochlea height (r=0.001, P=0.993) and central trochlea height (r=0.102, P=0.210). These findings showed that tibial tuberosity-trochlea groove distance is significantly related to the trochlear dysplasia. This result supports the hypothesis that the stimulation of the patellofemoral compression can affect the development of trochlea, and provides a theoretical basis for the clinical treatment of children with patellofemoral instability.
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    Internal fixation and arthroplasty for femoral neck fracture in the elderly: how to reflect individualized precision treatment
    Wang Debin, Bi Zhenggang
    2021, 25 (27):  4395-4400.  doi: 10.12307/2021.203
    Abstract ( 270 )   PDF (1125KB) ( 33 )   Save
    BACKGROUND: Surgical treatment has become the main method for the treatment of femoral neck fractures in the elderly, but the choice of internal fixation and arthroplasty is still the focus of great debate.
    OBJECTIVE: To analyze and summarize the research progress of internal fixation and arthroplasty for the femoral neck fracture in the elderly.
    METHODS: The first author used the Chinese and English search terms “femoral neck fracture, internal fixation, arthroplasty, the elderly” in Web of Science, PubMed and China National Knowledge Infrastructure (CNKI) to search the relevant literature collected from January 2001 to August 2020. The relevant documents were screened and sorted out, and the included relevant articles were reviewed in detail. 
    RESULTS AND CONCLUSION: Internal fixation and arthroplasty are the main surgical methods for elderly femoral neck fracture, both of which have their own advantages, so how to choose is still unclear. Because arthroplasty can make the elderly patients with femoral neck fracture move underground as soon as possible after operation and avoid a series of adverse consequences caused by long-term bed rest. Arthroplasty has almost become the “pronoun”. In addition, fracture type is also an important factor. Usually, the Garden i and ii tend to open reduction and internal fixation, while arthroplasty is used for Garden type III and IV. This is not absolute. In addition to severe comminution and irreducible reduction, the elderly patients with good constitution, undamaged blood supply of femoral head and strong fracture healing ability usually give priority to internal fixation. At the same time, it is necessary to pay attention to how to fix it effectively, and if necessary, to combine the Pauwels angle. Therefore, in addition to age and/or fracture type, issues such as femoral head blood flow, bone quality, bone healing ability, physical conditions, personal wishes and customs also influence the choice of surgical approach. The multi-factor comprehensive analysis advocated by many scholars pays more attention to the individual particularity, which reflects the individualized precise treatment, and is also one of the directions for further in-depth research on the surgical treatment of femoral neck fractures in the elderly.
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    Development status and strategy of outpatient total knee arthroplasty
    Kang Bo, Wang Jindong
    2021, 25 (27):  4408-4414.  doi: 10.12307/2021.205
    Abstract ( 245 )   PDF (1228KB) ( 46 )   Save
    BACKGROUND: With the development of total knee arthroplasty and the application of the concept of enhanced recovery after surgery in total knee arthroplasty, patients with total knee arthroplasty now have lesser trauma, fewer bleeding, faster recovery and effectively shorten length of stay. Some patients can even be discharged on the same day of surgery. Outside China, many hospitals have carried out outpatient total knee arthroplasty in the Ambulatory Surgery Center. In China, the outpatient total knee arthroplasty is still in the exploratory stage, and there are relatively few reports about it.
    OBJECTIVE: To describe the development status and strategies of outpatient total knee arthroplasty by referring to the relevant literature of outpatient total knee arthroplasty, so as to provide some ideas for the implementation of outpatient total knee arthroplasty in China.
    METHODS: These articles of outpatient total knee arthroplasty from the inception of the database to September 2020 were retrieved from CNKI, Wanfang, PubMed and Web of Science databases by computer. The search words in Chinese and English were “total knee arthroplasty”, “total joint arthroplasty”, “arthroplasty, replacement, knee”, “outpatient”, “same-day discharge”, “ambulatory surgical procedures”. Finally, 61 articles were included to analyze the results. 
    RESULTS AND CONCLUSION: (1) The proportion of outpatient total knee arthroplasty in foreign countries was rapidly growing each year. It is relatively safe to perform outpatient total knee arthroplasty on strictly selected patients and the incidence of postoperative complications and readmission was low. (2) At present, some domestic third-level grade-A hospitals have achieved that some patients are discharged on the first day after surgery, and even some patients can be discharged on the same day of surgery. (3) This means that there are certain conditions for carrying out outpatient total knee arthroplasty in China.
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    Meta-analysis of complications and functional recovery of the hip after total hip arthroplasty in patients with systemic lupus erythematosus
    Hong Xuezhi, Liu Lei, Yao Yunqian, Jiang Yuxin, Xu Jia, Mo Hanyou
    2021, 25 (27):  4415-4420.  doi: 10.12307/2021.206
    Abstract ( 289 )   PDF (1741KB) ( 102 )   Save
    OBJECTIVE: With the development of diagnosis and treatment technology, the survival rate of patients with systemic lupus erythematosus is significantly improved, resulting in an increasing number of patients with chronic complications such as osteonecrosis of the femoral head requiring total hip arthroplasty. This article systematically evaluated the complications of total hip arthroplasty in patients with systemic lupus erythematosus and compared the Harris score before and after operation.
    METHODS: A computer search of PubMed, CNKI, Wanfang and Cochrane Library databases published from the inception of the database to August 31, 2020 for patients with systemic lupus erythematosus who underwent total hip arthroplasty was conducted. The literature quality was evaluated by the National Institute for Clinical excellence and Castle-Ottawa scale. Postoperative complications and Harris score after total hip arthroplasty were collected. Revman 5.3 software was used for statistical analysis.  
    RESULTS: (1) A total of 20 articles were included, with 15 series studies and 5 control studies, containing 657 patients with systemic lupus erythematosus. Total hip arthroplasty was performed in 802 places, with the youngest age being 16 years old; average follow-up time was 53.3 months. (2) There were 235 complications after systemic lupus erythematosus + total hip arthroplasty. The top 5 included  blood transfusion 52 times (22.1%), deep venous thrombosis 21 times (8.9%), wound infection 18 times (7.7%), prosthesis dislocation 17 times (7.2%) and wound hematoma 16 times (6.8%). Compared with the control group, the risk of complications in systemic lupus erythematosus + total hip arthroplasty patients significantly increased (P < 0.001). (3) The mean Harris score increased from 43.7 preoperatively to 89.5 at last follow-up in systemic lupus erythematosus + total hip arthroplasty patients. (4) Meta-analysis results showed that Harris score was higher after operation than that before operation in systemic lupus erythematosus + total hip arthroplasty patients (MD=45.73, 95%CI:42.0-49.4, P < 0.01). There was no significant difference in Harris score between systemic lupus erythematosus + total hip arthroplasty patients and non-systemic lupus erythematosus + total hip arthroplasty patients (MD=-0.84, 95%CI:-2.1-0.41, P=0.19).
    CONCLUSION: The main postoperative complications of systemic lupus erythematosus + total hip arthroplasty patients were bleeding, deep venous thrombosis and incision infection, and the postoperative hip function increased significantly. Therefore, total hip arthroplasty can be used as the choice of surgical treatment for patients with systemic lupus erythematosus combined with advanced avascular necrosis of the femoral head. However, the results need to be verified by large samples and prospective studies. 
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    Total hip arthroplasty versus artificial femoral head replacement for the effect of displaced femoral neck fracture: a meta-analysis of 14 randomized controlled trials
    Lü Hui, Huang Denghua, Zou Longfei, Xue Hao, Xie Zonghui, Yu Peigen, Tan Meiyun
    2021, 25 (27):  4421-4428.  doi: 10.12307/2021.207
    Abstract ( 226 )   PDF (1278KB) ( 92 )   Save
    OBJECTIVE: Displaced femoral neck fracture is a common fracture in the elderly, but the method of operation is still controversial. Previous meta-analysis has some shortcomings such as low quality of research and few cases. This study compared the efficacy of total hip arthroplasty and artificial femoral head replacement in the treatment of displaced femoral neck fracture by meta-analysis. 
    METHODS: PubMed, EMbase, Cochrane Library, Google Scholar, CNKI, Wanfang and VIP databases were searched by computer from January 1970 to June 2020. The key words were “femoral neck fracture, hemiarthroplasty, total hip arthroplasty” in English and Chinese. All articles about the comparative study of total hip arthroplasty and artificial femoral head replacement in the treatment of displaced femoral neck fracture were searched. Two researchers independently screened the literature according to the inclusion and exclusion criteria, extracted data, and evaluated the risk of literature bias according to Cochrane Handbook. Stata 14.0 statistical software and the updated Meta-Analysis software package were used to analyze the outcome measures.
    RESULTS: (1) A total of 14 randomized controlled trials, containing 10 original studies and 4 extended follow-up data, were included in this article. A total of 2 523 patients with displaced femoral neck fracture were included. The experimental group was treated with total hip arthroplasty and the control group was treated with artificial femoral head replacement. The overall quality of the literature was high. (2) The results of meta-analysis showed that the dislocation rate (RR=0.450, 95%CI:0.306-0.661, P < 0.001), Harris score (WMD=-5.527, 95%CI:-7.952 to -3.103, P < 0.001), and EQ-5D score (WMD=-0.055, 95%CI:-0.075 to -0.034, P < 0.001) in the total hip arthroplasty group were higher than those in the artificial femoral head replacement group. However, the second operation rate of total hip arthroplasty group was lower than that of artificial femoral head replacement group (RR=1.741, 95%CI:1.253-2.419, P=0.001). There was no statistical difference in 2-year mortality (RR=1.025, 95%CI:0.845-1.243, P=0.804), postoperative infection rate (RR=0.896, 95%CI:0.789-1.017, P=0.505), and incidence of systemic complications (RR=0.896, 95%CI:0.789-1.017, P=0.090) between the two groups.  
    CONCLUSION: The available clinical evidence shows that total hip arthroplasty has better hip movement function and lower secondary operation rate. For patients with displaced femoral neck fracture who are in good physical condition, can move alone before fracture, and have good cognitive function, total hip arthroplasty has more advantages than artificial femoral head replacement.
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