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28 December 2021, Volume 25 Issue 36 Previous Issue    Next Issue

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Design and clinical application of personalized cervical spine correction pillow with three-dimensional printing Wei Haoxin, Wang Caiping, Deng Qian, Song Yan, Wang Xiaowen, Wang Jinwu 2021, 25 (36):  5741-5746.  doi: 10.12307/2021.335 Abstract ( 760 )   PDF (1254KB) ( 281 )   Save BACKGROUND: Abnormal changes of cervical curvature are common in cervical spondylosis. Although conservative treatment is the main treatment for cervical spondylosis, symptomatic treatment is adopted in most cases, and the correction of abnormal cervical curvature is ignored in conservative treatment.   OBJECTIVE: To observe the clinical effect on cervical spondylosis treated by three-dimensional (3D) printing personalized cervical vertebra correction pillow combined with health education of cervical spondylosis, thermal physiotherapy, and oral drugs in early treatment. METHODS:  A total of 33 patients with cervical spondylosis admitted in Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine from July 2019 to December 2020 were selected as the research objects. Based on health education for cervical spondylosis, thermal therapy, and routine oral drugs in early treatment, all patients were asked to use 3D printing personalized cervical vertebra correction pillow during sleep, for 24 continuous weeks. The improvement of cervical curvature (Borden’s method), the Neck Disability Index, Visual Analogue Scale score and Pittsburgh Sleep Quality Index before and after treatment were observed and the overall clinical efficacy was evaluated.   RESULTS AND CONCLUSION: Compared with baseline data, Borden value of cervical curvature was significantly increased in the patients after 24-week treatment (P < 0.05). After treatment, Neck Disability Index, Visual Analogue Scale score and Pittsburgh Sleep Quality Index were all significantly decreased (P < 0.05). After treatment, the total effective rate of clinical efficacy was 88%. These findings indicate that based on the health education of cervical spondylosis, thermal physiotherapy and oral drugs in early treatment, the use of 3D printing personalized cervical vertebra correction pillow during sleep at night can effectively correct and restore the cervical physiological curvature, reduce the pain of patients’ neck and shoulder muscles and improve sleep quality, which is an effective method for the treatment of patients with cervical spondylosis with abnormal cervical curvature. Figures and Tables | References | Related Articles | Metrics

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Application of preoperative virtual simulation plan based on three-dimensional printing technology for complex acetabular fractures: a prospective randomized controlled study Song Yuanzheng, Ma Hongli, Li Wei, Man Jia, Lin Feng, Zhang Yudong 2021, 25 (36):  5747-5752.  doi: 10.12307/2021.336 Abstract ( 501 )   PDF (1416KB) ( 185 )   Save BACKGROUND: The treatment of complex acetabular fractures is still one of the most challenging tasks for orthopedic surgeons. Accurate fracture assessment and preoperative planning are very important for good reduction. Computer-aided virtual surgery program and three-dimensional (3D) printing of patient-specific pre-contoured plates provide an accurate and reasonable surgical plan for complex acetabular fractures.   OBJECTIVE: To evaluate the feasibility, accuracy and effectiveness of preoperative virtual simulation plan based on 3D printing technology in the surgical treatment of complex acetabular fractures. METHODS:  From March 2018 to August 2020, 28 patients with complicated acetabular fractures were selected from Department of Orthopedic Trauma, Tengzhou Central People’s Hospital and randomly divided into two groups. The 13 cases in the experimental group were treated with preoperative virtual simulation plan based on 3D printing technology; pre-contoured plates for open reduction and internal fixation of steel plate. The 15 cases in the control group were treated with traditional treatment plan: open reduction and internal fixation of steel plate. Intraoperative condition and postoperative curative effect were compared between the two groups.   RESULTS AND CONCLUSION: (1) The operation time, intraoperative blood loss, intraoperative blood transfusion, intraoperative fluoroscopy times and intraoperative instrument time of the experimental group were all less than those of the control group, with significant difference (P < 0.05). There was no significant difference in hospitalization time between the two groups (P > 0.05). (2) Patients in both groups were followed up for 6-18 months. The incidence of complications and fracture healing time in the experimental group were better than those in the control group, and the difference was statistically significant (P < 0.05). (3) Matta imaging score of fracture reduction quality immediately after operation and Merle d’Aubigne & Postel score of hip joint function at the last follow-up in the experimental group were higher than those in the control group, with significant difference (P < 0.05). (4) It is suggested that the preoperative virtual simulation plan based on 3D printing technology is feasible and accurate, which provides an effective means for preoperative planning and precise fixation of complex acetabular fractures, thus improving the postoperative effect. Figures and Tables | References | Related Articles | Metrics

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A short-term evaluation of three-dimensional printed guide plate assisted hollow screw in the treatment of non-displaced femoral neck fracture Wang Sizhe, Gao Haiyan, Lan Xiaoquan, Wang Pan, Huang Haoran, Wang Jinyu, Ma Jianlin 2021, 25 (36):  5753-5758.  doi: 10.12307/2021.337 Abstract ( 486 )   PDF (1195KB) ( 188 )   Save BACKGROUND: Hollow screw treatment of femoral neck fractures is a common standard clinical operation. Combined with three-dimensional (3D) printing for surgical operations, the most typical one of the individualized surgical tools is the surgical guide plate. The guide plate not only can reduce the risk of screw penetration and cortical fracture, but also the screw placement is more accurate and efficient than traditional methods.   OBJECTIVE: To explore the short-term clinical effects of hollow screws in the treatment of non-displaced femoral neck fractures with the assistance of 3D printed guide plates. METHODS:  A retrospective analysis of 60 patients diagnosed with non-displaced femoral neck fractures in Qingdao Chengyang People’s Hospital of Shandong First Medical University from October 2016 to October 2019 was conducted. The surgical methods were all treated with hollow screw internal fixation. The patients were divided into study group and control group according to whether 3D printing was used or not (n=30 per group). The study group received 3D printed guide plates to assist screw placement, and the control group received traditional guides or freehand screw placement. The postoperative follow-up was 12 months. The operation time, the number of intraoperative fluoroscopy, the Harris score, the screw placement rate, and the distance between the three hollow screws and the femoral neck cortex were compared between the two groups.   RESULTS AND CONCLUSION: (1) All the enrolled cases were followed up effectively, and the operation was successfully completed without complications, such as vascular and nerve injury. (2) The operation time of the study group was significantly shorter than that of the control group. The number of intraoperative fluoroscopy and the shortest distance of the hollow screw talar cortex of study group were better than those of the control group. There was a significant difference between the two groups (P < 0.05). (3) The occupancy rates of screw placement of the study group were better than those of the control group, but the difference between the groups was not statistically significant (P > 0.05). (4) The difference in Harris scores at the last follow-up between the two groups was not statistically significant (P > 0.05). (5) The results show that the 3D printed guide plate assisted hollow screws for the treatment of non-displaced femoral neck fractures can save operation time, reduce the number of intraoperative fluoroscopy, reduce blood loss, and optimize the spatial distribution of hollow screws while achieving good surgical results. Preventing the screws from returning and improving the fixing strength, the short-term clinical effect is obvious. Figures and Tables | References | Related Articles | Metrics

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Safety and effectiveness of multi-modal image fusion combined with intelligent robotic arm to establish vertebral augmentation channels Wang Xiuting, Wang Yongkang, Sun Jian, Wang Jian, Li Sisheng 2021, 25 (36):  5759-5764.  doi: 10.12307/2021.338 Abstract ( 546 )   PDF (1792KB) ( 188 )   Save BACKGROUND: Multi-modal medical image fusion technology is currently mostly used for clinical diagnosis, pathological change tracking and treatment, and radiotherapy, but the combined intelligent robotic arm assisted vertebral body augmentation is rarely used in clinical application.   OBJECTIVE: To evaluate the safety and effectiveness of multi-modal image fusion combined with intelligent robotic arm assisted in establishing vertebral augmentation channels. METHODS:  Sixty-two patients with osteoporotic vertebral compression fracture vertebral augmentation were included in this study and randomly divided into two groups. The 31 cases in the trial group underwent multi-modal image fusion by mechanical arm to build the vertebral strengthening channel. The 31 cases in the control group underwent conventional method to establish the vertebral strengthening channel. Vertebral augmentation was performed with the same bone cement injection under the same rules. The number of intraoperative index, postoperative pain score, and number of re-fractures of injured vertebrae were recorded. Statistical analysis was conducted to evaluate the results.   RESULTS AND CONCLUSION: (1) The puncture time, fluoroscopy times, total dose of radiation exposure, puncture adjustment times, bone cement leakage, positioning time, and visual analogue scale score of pain 1 day after operation in the trial group were significantly lower than those in the control group (P < 0.001). The excellent and good rates of puncture accuracy, bone cement injection volume, and bone cement dispersion were significantly higher in the trial group than those in the control group (P < 0.001). The number of positioning fluoroscopy was not significantly different between the two groups. (2) No infection occurred in patients of the two groups. In the control group, one patient was found with cement emboli in the double pulmonary arteries; one patient had no long-term relief of postoperative pain; and three patients were diagnosed with re-fracture of injured vertebra due to pain reissue MRI examination within 6 months. No such complications were seen in the trial group during follow-up. (3) It is concluded that the establishment of vertebral enhancement channel assisted by multi-modal image fusion and intelligent robotic arm can improve the accuracy of pedicle localization and puncture and the effect of vertebral augmentation, and effectively reduce the number of fluoroscopy, radiation exposure dose and the occurrence of complications; it is safe and reliable. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of the effect of different cancellous bone volume fraction on the apparent mechanical response of proximal femur Yang Ruimin, Wu Wenzheng, Zheng Yongze, Zheng Xiaohui 2021, 25 (36):  5765-5770.  doi: 10.12307/2021.339 Abstract ( 590 )   PDF (2705KB) ( 276 )   Save BACKGROUND: The assessment of fracture risk still depends on bone mineral density testing. However, it ignores other mechanisms that affect fractures, including three-dimensional bone structures and material properties on multiple scales. Although bone mineral density provides useful information, its value in predicting fracture risk is limited.   OBJECTIVE: A three-dimensional finite element model of proximal femur with different cancellous bone volume fractions was constructed to explore the effect of bone volume fraction on the apparent mechanical response of proximal femur. METHODS:  The CT data of a volunteer’s proximal femur were collected and imported into Mimics to reconstruct the three-dimensional model in DICOM format. The osteoporotic cortical bone and cancellous bone were given corresponding material parameters. Then, the model was imported into Abaqus and the finite element model with 35%, 30%, 25%, 20% and 15% cancellous bone volume fractions was constructed by uniform deletion of the script. A reference point was established above the femoral head and a concentrated load was applied to the area of contact with the acetabulum above the femoral head to analyze the difference of mechanical response of the proximal femur under orthostatic stress.   RESULTS AND CONCLUSION: (1) Under the condition of standing load, the tensile stress on the upper and outer side of the femoral neck was always greater than the compressive stress on the medial and inferior side of the neck. With the decrease of cancellous bone volume fraction, the tensile stress and compressive stress of proximal femur increased gradually, and the maximum tensile stress and maximum compressive stress of 15% model were 1.91 times and 1.42 times of 35% model, respectively. The maximum principal strain increased by 4.76 times, and the overall stiffness of the femur decreased by 58%. (2) Under the condition of standing on one foot, the cortical bone of the femur bore more stress than the cancellous bone, and the cancellous bone played an indispensable role in the overall elastic response of the femur. (3) With the decrease of the volume fraction of cancellous bone, the tensile stress of the lateral superior side of the femoral neck increased greatly. The region of the lateral superior side of the neck is the most significant area of bone mass loss, and it is also in the area of stress concentration under the fall load. This suggests whether the relevant parameters of the lateral superior side of the neck (such as bone mineral density and volume fraction) may become a more sensitive index for predicting brittle femoral neck fracture, which is worth further exploring. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of lumbar vertebrae under the pull-out strength of screw in cortical bone trajectory technique Ren Hangning, Jurat·Matrozi, Paerhati·Rexiti, Luo Huiqing 2021, 25 (36):  5771-5776.  doi: 10.12307/2021.340 Abstract ( 528 )   PDF (1442KB) ( 203 )   Save BACKGROUND: Pedicle screw fixation is the preferred surgical treatment for clinical treatment of lumbar degenerative disease currently. However, there is a great possibility of screw loosening after the traditional cortical bone trajectory pedicle screw placement scheme, which may cause fixation failure or non-fusion of bone graft.   OBJECTIVE: To compare biomechanical properties of novel cortical bone trajectory screw and cortical bone trajectory screw in lumbar vertebrae under pull-out strength by finite element method. METHODS:  Based on the extracted computed tomography of patients with osteoporosis, the finite element model of L1-L5 full vertebral body functional unit osteoporosis was established. The novel cortical bone trajectory screw and cortical bone trajectory screw were simulated. The stress distribution and maximum stress value of bone around the screw track of the two methods were measured and compared under a certain actual rotation pull-out strength.   RESULTS AND CONCLUSION: (1) Under the same fixation mode, the stress distribution of vertebrae in the novel cortical bone trajectory group and cortical bone trajectory group was significantly different under the same load state. Compared with cortical bone trajectory group, the volume of the stress zone and the stress concentration point were significantly reduced, which could significantly increase the stability of the inserted screw in the novel cortical bone trajectory group. (2) Different screw paths brought different bone mineral densities, which directly affected the mechanical properties of internal fixation screws in lumbar spine. (3) Different shapes and sizes of L1-L5 bone led to different mechanical properties and performance. It can be seen that the novel cortical bone trajectory technology has advantages over the cortical bone trajectory technology. The novel cortical bone trajectory technique is a preferred method for lumbar internal fixation in patients with osteoporosis. Figures and Tables | References | Related Articles | Metrics

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Biomechanical properties of the OmniSpan device versus the RapidLoc device for meniscus repair Zhang Qiang, Yue Xianhu, Zhang Shu, Gu Mingyong, Li Rui 2021, 25 (36):  5777-5781.  doi: 10.12307/2021.341 Abstract ( 537 )   PDF (2741KB) ( 382 )   Save BACKGROUND: Meniscus tears are commonly encountered in clinical practice. Many meniscus repair devices have been designed and compared in biomechanical experiment and clinical practice, but to our knowledge, the OmniSpan device has not been compared with the RapidLoc device in biomechanical configurations.   OBJECTIVE: To compare the biomechanical characteristics of the OmniSpan device with the RapidLoc device in meniscus repair. METHODS:  Twenty fresh porcine menisci were randomly assigned to the RapidLoc device group (n=10) and the OmniSpan device group (n= 10). Longitudinal vertical tear was created in the menisci and was subjected to repair according to its grouping. RapidLoc device adopted single point suture according to the operation guideline with a total of two stitches. OmniSpan device adopted cross suture with a total of two stitches. Once repaired, the specimen was subjected to cyclic loading with the tensile force between 5 N and 20 N at a rate of 30 mm/min for 500 cycles. Displacement was recorded at a load of 5 N. Loading to failure was performed at a rate of 30 mm/min, and maximum failure load and stiffness were recorded and evaluated after the experiment.   RESULTS AND CONCLUSION: (1) In cyclic loading experiment, the average displacement was (1.47±0.09) mm and (1.63±0.08) mm for the OmniSpan and RapidLoc devices at a load of 5 N after cycles of 500, respectively. This difference was significant (P=0.000 8). (2) The OmniSpan device repairs exhibited higher maximum failure load compared with the RapidLoc device repairs [(257±52) N vs. (210±35) N, P=0.029 5]. There was no significant difference between two groups with respect to stiffness (P=0.339 0). (3) The results of this study indicate that when addressing a longitudinal meniscus tear, the OmniSpan device shows better biomechanical properties than the RapidLoc device. Surgeons may use the OmniSpan instead of the RapidLoc as all-inside meniscus repair devices for their patients. Figures and Tables | References | Related Articles | Metrics

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Intramedullary nail versus shoulder hemiarthroplasty for proximal humeral fractures with varus deformity: a retrospective non-random small-sample advantage analysis Wang Qingwei, Wang Huasong, Huang Jifeng, Shi Huafeng, Hu Shouyong, Xie Hui 2021, 25 (36):  5782-5786.  doi: 10.12307/2021.342 Abstract ( 552 )   PDF (1271KB) ( 155 )   Save ACKGROUND: Early surgical treatments, mainly including internal fixation and joint replacement, are favored for unstable or significantly displaced proximal humeral fractures in clinical practice. However, there is still a controversy on the specific regimen for elderly osteoporotic patients.   OBJECTIVE: To compare the clinical outcomes of Trigen intramedullary nailing versus shoulder hemiarthroplasty for varus proximal humeral fractures. METHODS:  A retrospective study was performed on 54 patients with varus proximal humerus fractures treated with intramedullary nailing or shoulder hemiarthroplasty in the General Hospital of Central Theater Command from January 2016 to January 2019. There were 22 males and 32 females. According to the different treatment methods, all the patients were divided into two groups: 35 patients in the intramedullary nail group and 19 patients in the shoulder hemiarthroplasty. Operation time, intraoperative blood loss, length of hospital stay and shoulder joint mobility, Visual Analogue Scale score, Constant-Murley shoulder joint score, and complications at the last follow-up were recorded and compared between two groups.   RESULTS AND CONCLUSION: There was no significant difference in the preoperative data between the intramedullary nail group and the shoulder hemiarthroplasty group (P > 0.05), and they were comparable. The operation time of the intramedullary nail group [(59.6±14.3) minutes] was significantly shorter than that in the shoulder hemiarthroplasty group [(95.7±17.2) minutes] (P < 0.05). The intraoperative blood loss in the intramedullary nail group [(78.5±18.9) mL] was significantly lower than that in the shoulder hemiarthroplasty group [(203.7±23.1) mL] (P < 0.05). There were no significant differences in hospitalization time and follow-up time between the two groups (P > 0.05). The intramedullary nail group was superior to the shoulder hemiarthroplasty group in shoulder mobility and Constant-Murley shoulder joint score at the last follow-up, and the differences were statistically significant (P < 0.05). There were no significant differences in Visual Analogue Scale score and complications at the last follow-up between the two groups (P > 0.05). To conclude, both intramedullary nail and shoulder hemiarthroplasty are effective surgical procedures for proximal humeral fracture with varus deformity. Intramedullary nailing is more invasive, with better recovery of shoulder function. Figures and Tables | References | Related Articles | Metrics

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Structural bone grafting in revision total hip arthroplasty with Paprosky IIIA acetabular defect Xu Zhiqing, Zhuang Zhikun, Gong Zhibing, Wu Rongkai, Lin Hanghui, Wu Zhaoke 2021, 25 (36):  5787-5791.  doi: 10.12307/2021.343 Abstract ( 387 )   PDF (1196KB) ( 135 )   Save BACKGROUND: Revision total hip arthroplasty with serious bone defect of acetabulum is complicated problem with technical challenges to joint surgeons, because of prosthetic installation difficulties, poor initial stability, postoperative prosthesis loosening.   OBJECTIVE: To evaluate the effectiveness of structural bone grafting in revision total hip arthroplasty with Paprosky IIIA acetabular defect. METHODS:  Between January 2010 and January 2018, 15 patients (15 hips) with Paprosky IIIA acetabular defect underwent revision total hip arthroplasty by structural bone grafting. All patients underwent revision total hip arthroplasty, with intramedullary reconstruction of the acetabulum with allogeneic femoral head during operation and weight-bearing walking in strict accordance with the rehabilitation program after operation. Standardized hip radiographs were assessed postoperatively 7 days, and at 6 months, 1 year and annually thereafter. The following outcomes were assessed: acetabulum cup coverage, bone graft coverage, the height and horizontal distance of center of hip rotation, bone graft healing and absorption, bone ingrowth, cup loosening, periprosthetic osteolysis, and Harris hip score.   RESULTS AND CONCLUSION: (1) All patients were followed up for 2.5-10.0 years. The Harris score of the hip joint at the last follow-up was (83.2±5.8) points; compared with the preoperative data (25.3±5.3) points, the difference was significant (t=28.739, P=0.000). (2) The coverage rate of the acetabular cup was 91.7%-100% at postoperative 7 days, with an average of (95.6±2.2)%. The coverage rate of the bone graft at postoperative 7 days was 21.5%-53.2%, with an average of (37.4±10.0)%. (3) The horizontal displacement of the hip joint rotation center at postoperative 7 days was (5.8±1.7) mm; compared with the preoperative data (8.2±3.9) mm, the difference was significant (t=-2.128, P=0.042). At postoperative 7 days, vertical displacement of the center of rotation was (4.8±2.1) mm; compared with (22.2±4.2) mm before operation, the difference was significant (t=-14.321, P=0.000). (4) From 6 months to 1 year after surgery, 4 cases (4 hips) had mild absorption of allogeneic femoral heads, and the absorption was all located in the lateral non-stress distribution area, and did not affect the stability of the acetabular cup. In 15 cases (15 hips), trabecular bone connection could be found in allogeneic femoral head and acetabular bone junction. At the last follow-up, allogeneic femoral head and acetabular bone presented bone union, no nonunion. (5) Fifteen patients (15 hips) showed bone ingrowth into acetabula cup, and no acetabular loosening occurred at latest follow-up. No osteolysis was observed in acetabular zone. There were no complications in all patients, without deep vein thrombosis, infection, neurological damage, or dislocation. (6) It is concluded that structural bone grafting in revision total hip arthroplasty with Paprosky IIIA acetabular defect can effectively restore acetabular bone defects and reconstruct acetabulum. The eccentricity and rotation center of the hip joint recovered well; the hip joint function was good after operation; and good prosthesis stability was obtained; the early and mid-term clinical efficacy was satisfactory, but the long-term efficacy needs further clinical follow-up observation. Figures and Tables | References | Related Articles | Metrics

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Predicting the possibility of blood transfusion after total knee arthroplasty based on machine learning algorithm Chen Chaofeng, He Dadong, Liang Jincheng, He Zhijun 2021, 25 (36):  5792-5797.  doi: 10.12307/2021.344 Abstract ( 579 )   PDF (1076KB) ( 174 )   Save BACKGROUND: To maintain the hemodynamic stability of patients with total knee replacement, blood transfusion is necessary, but this is often accompanied by adverse reactions. Studying the risk factors of blood transfusion after total knee replacement can help determine which patients need blood transfusion, which is conducive to preoperative evaluation and clinical decision-making.   OBJECTIVE: To establish a prediction model based on a machine learning algorithm and explore its predictive value in predicting the possibility of blood transfusion after total knee replacement. METHODS:  The clinical data after total knee arthroplasty in the panyu hospital of chinese medicine from January 2012 to December 2019 were retrospectively analyzed, and divided the patients into a non-transfusion group and a blood transfusion group according to whether blood transfusion was performed after the operation. The data of sex, age, body mass index, preoperative hemoglobin, ASA anesthesia score, anesthesia mode, operation duration, operation type, smoking history, past medical history, and the use of insulin were compared between the two groups. The above-mentioned potential influencing factors were incorporated into logistic regression, support vector machine, random forest and XGBoost algorithm to establish four kinds of prediction model, obtain the importance of predictive variables and draw receiver working curve, and test the predictive value of the model.   RESULTS AND CONCLUSION: (1) We included a total of 634 samples, including 527 untransfused total knee arthroplasty patients and 107 total knee arthroplasty patients requiring transfusion. (2) Combining the four models, the top five prediction importance scores were hemoglobin, age, operation length, body mass index and operation type were the top five variables with the highest correlation. (3) The areas under the curve of logistic regression, support vector machine, random forest and XGBoost algorithm were 0.816, 0.864, 0.773 and 0.888, respectively. By comparison, the XGBoost algorithm performed best. (4) It is concluded that the machine learning model based on XGBoost algorithm can accurately predict the risk of blood transfusion in patients after total knee arthroplasty, which is conducive to preoperative evaluation and clinical decision-making. Hemoglobin, age, length of surgery, body mass index, and type of surgery may be important predictors of the risk of transfusion after total knee arthroplasty. Figures and Tables | References | Related Articles | Metrics

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Effect of crossing acupoints of the same name of hands and feet on pain after total knee arthroplasty Ma Chenghao, Huang Hai, Lü Ruonan, Qin Zuohai, Wang Hao, Nie Zhixing, Han Dapeng, Ouyang Guilin 2021, 25 (36):  5798-5803.  doi: 10.12307/2021.345 Abstract ( 615 )   PDF (1149KB) ( 523 )   Save BACKGROUND: The degree of pain after total knee arthroplasty has reached moderate and severe. Electroacupuncture as an effective measure for the treatment of pain after total knee arthroplasty has been widely used in clinic.   OBJECTIVE: To explore the effect of electroacupuncture on pain after total knee arthroplasty in patients with knee osteoarthritis based on crossing acupoints of the same name of hands and feet. METHODS:  In a randomized controlled design, 82 patients with knee osteoarthritis scheduled for unilateral total knee arthroplasty were randomly divided into control group (n=41) and treatment group (n=41). The control group was given the routine postoperative analgesia program, and the treatment group was treated with electroacupuncture combined with the method of crossing acupoints of the same name of hands and feet on the routine analgesia scheme. The intervention time was from the first day to the fifth day after operation. The tenderness threshold, visual analogue scale score, pressing times of patient-controlled analgesia pump, additional use of analgesics, Hospital for special surgery score of knee joint, hospital anxiety and depression scale score, and adverse events were recorded and evaluated. The clinical trial was approved by the Ethics Committee of Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine on May 5, 2020. Ethics approval number: 2020-k-40. The trial participants had informed consent to the trial scheme and process, and signed an informed consent form for the clinical trial.   RESULTS AND CONCLUSION: (1) After 3 and 5 days of treatment, the tenderness threshold of the treatment group was higher than that of the control group (P < 0.05). (2) After 3 and 5 days of treatment, the visual analogue scale score of the treatment group was lower than that of the control group (P < 0.05). (3) After 48 hours of treatment, the number of pressing times of patient-controlled analgesia pump in the treatment group was lower than that of the control group (P < 0.05). (4) After 5 days of treatment, the dose of extra analgesics in the treatment group was lower than that in the control group (P < 0.05). (5) After 3 and 5 days of treatment, the Hospital for special surgery score of the treatment group was higher than that of the control group (P < 0.05). (6) After 3 and 5 days of treatment, the hospital anxiety and depression scale score of the treatment group was lower than that of the control group (P < 0.05). (7) After 5 days of treatment, there was no significant difference in adverse events and abnormal acupuncture between the two groups (P > 0.05). (8) It is concluded that electroacupuncture combined with the method of crossing acupoints of the same name of hands and feet can reduce the pain after total knee arthroplasty in patients with knee osteoarthritis, promote the rehabilitation of knee joint function and reduce the use of analgesics, which is safe and effective. Figures and Tables | References | Related Articles | Metrics

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Feasibility of atlantoaxial pedicle screw or lateral mass screw fixation in preschool children Xiong Feng, Li Kun, Zhou Shuyu, Wang Peng, Dang Yexing, Li Zhijun, Zhang Shaojie 2021, 25 (36):  5804-5809.  doi: 10.12307/2021.346 Abstract ( 331 )   PDF (1295KB) ( 112 )   Save BACKGROUND: In the treatment of occipitocervical atlas fractures, pedicle or lateral mass internal fixation is usually performed for adult fractures. There are no anatomic data on the development of common internal fixation screws in atlas in pre-school age children.   OBJECTIVE: To investigate the feasibility of 3.50 mm screw placement in atlas pedicle or lateral mass in 1-6-year-old children by observing morphological structure of atlas. METHODS:  Head and neck imaging data of 54 children aged 1-6 years were collected from Affiliated Hospital of Inner Mongolia Medical University, Second Affiliated Hospital of Inner Mongolia Medical University and Chifeng Hospital, and divided into three groups (1-2 year-old group, 3-4 year-old group, 5-6 year-old group). Three-dimensional reconstruction was performed by importing DICOM data into MIMICS17.0. All parameters of atlas were measured by measuring tools in image data and reconstruction model, and analyzed statistically.   RESULTS AND CONCLUSION: (1) Atlas parameters had no statistical difference between left and right sides in each group (P > 0.05). Each index of atlas was on the rise along with the age growth. The pedicle width, pedicle nail into point away from the center line of the horizontal distance, pedicle angle, tail angle, lateral horizontal diameter, side piece into the nail points away from the center line of the horizontal distance, lateral block angle, and the upper tilting angle were statistically significant among groups (P < 0.05). (3) The main limiting factor of pedicle was pedicle width and pedicle height. Measurement results showed that the pedicle width > pedicle height. Pedicle heights were (4.23±0.46), (5.09±0.46), and (5.47±0.69) mm in the 1-2 year-old group, 3-4 year-old group, and 5-6 year-old group, respectively. There was no obvious limitation of lateral mass screws. (4) It is indicated that 3.50 mm screws can be inserted into the pedicle or lateral mass of atlas in children aged 1-6 years, but the angle, position and length should be different in children of different ages. Imaging scan and individualized surgical plan should be carried out for clinical operation. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional printing motion-preserving cervical joint system implantation for treatment of cervical myelopathy: the first case report Cai Xuan, Qin Jie, He Xijing, Dong Jun, Zhang Ting, Yang Wenlong, Wang Xiongxun, Wang Zili, Wang Dong, Li Haopeng, He Gaole, Lu Teng, Li Lingjiang 2021, 25 (36):  5810-5813.  doi: 10.12307/2021.347 Abstract ( 472 )   PDF (1650KB) ( 657 )   Save BACKGROUND: At present, fusion surgery must be performed to reconstruct the stability of the cervical spine after anterior cervical corpectomy. However, fusion sacrifices the mobility of the surgical segment of the cervical spine. Simultaneously, many articles report the potential long-term problems such as adjacent segment degeneration in fusion surgery. We have done some research and exploration on the preservation of cervical segmental motor function after anterior cervical corpectomy. Combined with three-dimensional printing technology, we have developed “artificial cervical vertebrae-intervertebral disc complex”, referred to as the motion-preserving cervical joint system.   OBJECTIVE: To explore the short-term clinical effect of three-dimensional printing motion-preserving cervical joint system implantation in the treatment of two patients with cervical spondylotic myelopathy. METHODS:  In view of the loss of motor function of cervical spine segments and the degeneration of adjacent segments after traditional anterior cervical corpectomy operation, in December 2020, a self-developed three-dimensional printing motion-preserving cervical joint system implantation technology was used to treat two patients with cervical spondylotic myelopathy. The patients were followed up for 16 weeks at the time of submission (april 2021). Visual analogue scale score and JOA score were used to evaluate the patient’s pain and neurological recovery at 1, 6, 12, and 16 weeks after the operation. Imaging techniques such as dynamic position X-rays and three-dimensional CT were used to evaluate the position of prosthesis and the preservation of cervical spine motion function. The occurrence of surgery-related complications was observed and recorded during the patient follow-up period. This study was approved by the Ethics Committee of Xi’an International Medical Center Hospital (approval No. 202012).   RESULTS AND CONCLUSION: (1) The pain and numbness of the two patients were significantly reduced the next day after the operation, and the muscle strength of the limbs was partially restored. (2) At 1, 6, 12, and 16 weeks postoperative follow-up, the patient’s limb muscle strength, visual analogue scale score, and JOA score were significantly improved compared with preoperatively, and the head and neck movement function was good. During the follow-up, no intra-incision hematoma, recurrent laryngeal nerve injury, esophageal injury, cerebrospinal fluid leakage, incision infection, or screw loosening occurred. (3) At 1, 6, 12, and 16 weeks postoperative follow-up, X-ray examination showed that the cervical spine physiological curvature was well restored, and the intervertebral height was maintained well. 3D-CT showed that the prosthesis components and the cervical spine bones were in good fit. The dynamic position X-ray showed that the prosthesis endplate component had a certain angle of opening and closing changes during flexion, extension and lateral flexion, and there was no cervical spine instability, indicating that the prosthesis retained part of the cervical spine motion function. (4) It is concluded that motion-preserving cervical joint system can retain the function of intervertebral movement on the basis of reconstructing the stability of the cervical spine. Figures and Tables | References | Related Articles | Metrics

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Surface electromyography characteristics of lower limbs in heterogeneous gait environment Zhang Peng, Zhang Junxia 2021, 25 (36):  5814-5820.  doi: 10.12307/2021.348 Abstract ( 581 )   PDF (1778KB) ( 316 )   Save BACKGROUND: Human walking is closely related to the changes of the surface electromyography signal of the lower limbs, but the difference of electromyography signal under the heterogeneous gait environment has not been studied in depth.   OBJECTIVE: To quantitatively analyze the differences of surface electromyography signals of lower limb muscles in heterogeneous gait environments, and study muscle characteristics of lower limb muscles in different phases in heterogeneous footpaths. METHODS:  Twenty healthy male subjects were recruited. The surface electromyography signals of lower limb muscles were collected in the environment of straight road, curve road, ramp, and stairs. A complete gait cycle was divided into four phases: the first dual support phase (0%-12%), the single support phase (13%-48%), and the second dual support phase (49%-60%) and swing phase (61%-100%). The muscle activation timing and difference of surface electromyography signal in different gait environments were studied through one-way analysis of variance. This study was approved by the Research Ethics Committee of Tianjin University of Science & Technology.   RESULTS AND CONCLUSION: (1) The study showed that compared with the straight path environment, in the process of making turn, the internal and external rotation muscles (Biceps Femoris, Gastrocnemius Medialis, Tibialis Anterior) of hip joint and ankle joint were used to complete the turn. When going upstairs and uphill, in the stage of single support phase, Vastus Lateralis and Vastus Medialis had the most significant difference (P < 0.05), and muscle strength increased significantly. In the second double support phase, the amplitude of Gastrocnemius Medialis increased significantly. When going downstairs and downhill, in the first dual support phase, Vastus Lateralis and Vastus Medialis were required to exert additional assistance. In the single support phase, the amplitudes of Gastrocnemius Medialis and Semitendinosus were significantly increased. In the second double support phase, the amplitude of Gastrocnemius Medialis decreased significantly. (2) The research results can provide reference value for the research and development of the control system of lower limb rehabilitation walking aid. Figures and Tables | References | Related Articles | Metrics

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Relationship between area ratio of interbody autograft and intervertebral fusion rate Tang Qiang, Zhong Dejun, Wang Qing, Liao Yehui, Tang Chao, Ma Fei 2021, 25 (36):  5821-5826.  doi: 10.12307/2021.349 Abstract ( 474 )   PDF (1413KB) ( 218 )   Save BACKGROUND: At present, it is considered that the volume of intervertebral bone graft is one of the factors affecting the intervertebral fusion rate, but the same volume of intervertebral bone graft leads to different release area of intervertebral bone graft and endplate due to individual differences, and the impact of release area of intervertebral bone graft and endplate on the intervertebral fusion rate is rarely analyzed.   OBJECTIVE: To investigate the effect of area ratio of interbody autograft on intervertebral fusion rate during posterior lumbar interbody fusion. METHODS:  Clinical data of 93 patients who underwent posterior lumbar interbody fusion in Department of Spinal Surgery, Affiliated Hospital of Southwest Medical University from January 2017 to December 2018 were retrospectively analyzed. The preoperative intervertebral space height, upper and lower endplate area, Oswestry disability index and visual analogue scale score, Cage size and the amount of autologous bone, and area of autologous bone graft (the area of autologous bone contacting the upper and lower endplates) were recorded, and the average value was calculated. According to the percentage of autogenous bone graft area in the total endplate area measured one week after operation, they were divided into group A (area ratio of interbody autograft < 16%), group B (16% ≤ area ratio of interbody autograft ≤ 24%) and group C (area ratio of interbody autograft > 24%). X-ray and CT examinations were performed at 6 and 12 months and the last follow-up. The direction of cage placement was observed in the three groups. The height of intervertebral space, the area ratio of intervertebral autograft bone graft, brantigan score, Oswestry disability index and visual analogue scale score were recorded at the follow-up. The measurement was performed by two spine surgeons, and repeated at an interval of one week to test inter observer and intra observer reliability. The effect of the area of autologous bone graft on the intervertebral fusion rate was compared and analyzed.   RESULTS AND CONCLUSION: (1) The inter observer and intra observer reliabilities were 0.924 and 0.913, respectively. (2) All patients were followed up for more than 12 months. There were no significant differences in age, gender and surgical segment among the three groups (P > 0.05). There were no significant differences in preoperative intervertebral height, Oswestry disability index and visual analogue scale score among the three groups (P > 0.05). (3) There were 27 cases in group A, including 26 cases of oblique placement and 1 case of transverse placement, 32 cases in group B, including 2 cases of oblique placement and 30 cases of transverse placement, 34 cases in group C, 1 case of oblique placement and 33 cases of transverse placement. (4) There was no significant difference in the amount of intraoperative autologous bone extraction among the three groups (P > 0.05), and the average height of intervertebral space in group A was higher than that in group B and group C one week after operation (P=0.022, P=0.00). The area of autogenous bone graft in group A was smaller than that in group B and group C (P=0.000, P=0.000). (5) At 6 and 12 months after operation, the fusion rate in group A (70.4%, 88.9%) was lower than that in group B (84.4%, 100%) and group C (88.2%, 100%), and the Brantigan score in group A was lower than that in group B (P=0.027, P=0.020) and group C (P=0.018, P=0.001). (6) At the last follow-up, there was no significant difference in Oswestry disability index and visual analogue scale score among the three groups (P > 0.314). The height loss of intervertebral space in group A was greater than that in group B and group C (P=0.007, P=0.013). The increased area of intervertebral fusion in group A was lower than that in group B and group C (P=0.003, P=0.000). There was no significant difference in fusion rate and Brantigan score among groups A, B and C (P=0.902, P=0.712). (7) It is suggested that the percentage of an area ratio of interbody autograft in the total endplate area greater than or equal to 16% can effectively improve the interbody fusion rate and reduce the risk of late intervertebral space collapse. Figures and Tables | References | Related Articles | Metrics

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Correlation between the retention angle of the anterior and lateral wall of the femoral head and the progression of the femoral head collapse Yan Xinhao, Pang Fengxiang, Zhong Yuan, Chen Xiaojun, He Xiaoming, Hong Zhinan, Li Ziqi, Luo Zhihong, He Wei, Wei Qiushi 2021, 25 (36):  5827-5831.  doi: 10.12307/2021.350 Abstract ( 511 )   PDF (1265KB) ( 101 )   Save BACKGROUND: At present, many methods are used to predict the collapse of femoral head after necrosis in clinical practice, with the purpose of providing reference for the selection of subsequent treatment methods. However, the current prediction methods are not accurate enough or practical in clinical practice. This has also prompted more researchers in the field of femoral head necrosis to search for a way to assess the risk of femoral head collapse.   OBJECTIVE: To evaluate the correlation between the preservation of the anterior and lateral wall of the femoral head and the progression of femoral head collapse. METHODS:  Data of 53 patients (76 hips) with osteonecrosis of the femoral head (stages ARCO II and ARCO III A) undergoing non-surgical hip preservation treatment, who were diagnosed in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from August 2012 to February 2019, were retrospectively analyzed. The retention angle of the anterior and lateral wall of the femoral head was measured on the X-ray imaging system to analyze the correlation between retention angle and collapse. The specificity and sensitivity of the angle in predicting collapse were evaluated by receiver operating characteristic curve.   RESULTS AND CONCLUSION: (1) All cases were followed up clinically for 3-83 months. During the last follow-up, 27 hips (36%) affected femoral head collapse as the collapse group; 49 hips (64%) that did not affect collapse were classified as non-collapse group. (2) The results of independent sample t-test showed that the retention angle of anterior and lateral wall was significantly correlated with collapse. (3) In receiver operating characteristic curve, the retention angle of the anterior and lateral wall of the femoral head had high specificity and sensitivity. (4) It was found that patients with osteonecrosis of the femoral head with small retention angle of the anterior and lateral wall were more likely to collapse, indicating that there was a certain correlation between the retention angle of the anterior and lateral wall of the femoral head and the progression of collapse of the femoral head. Therefore, this angle can be used as a reference index for collapse prediction to some extent. Figures and Tables | References | Related Articles | Metrics

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Evaluation of natural resorption of herniated cervical intervertebral disc with different degrees of degeneration after cervical microendoscopic laminoplasty by three-dimensional volume method Li Long, Zhang Chunlin, Shao Chenglong, Yan Xu, Wang Yongkui, Liu Xiaokang, Li Dongzhe 2021, 25 (36):  5832-5837.  doi: 10.12307/2021.351 Abstract ( 563 )   PDF (1145KB) ( 291 )   Save BACKGROUND: Previous studies have suggested that the resorption of herniated nucleus pulposus of herniated cervical intervertebral disc is related to the type and location of herniation. It is unclear whether the degree of degeneration of herniated cervical intervertebral disc will affect the occurrence of resorption of herniated nucleus pulposus phenomenon.   OBJECTIVE: To observe the absorption of intervertebral discs with different degrees of degeneration after cervical microendoscopic laminoplasty, and analyze its characteristics and possible mechanism, providing a more reasonable strategy and basis for the treatment of cervical spondylotic myelopathy. METHODS:  Retrospective study was conducted to analyze the general data and imaging data of 54 patients with cervical spondylotic myelopathy who underwent cervical microendoscopic laminoplasty from January 2014 to January 2020 in the First Affiliated Hospital of Zhengzhou University. Miyazaki grading criteria were used to evaluate the degree of cervical disc degeneration and grouping. Three-dimensional volume method was used to measure the volume of cervical herniated discs before operation and at the last follow-up. The absorption rate and absorption ratio were used to evaluate the occurrence of resorption of herniated nucleus pulposus. The Japanese Orthopaedic Association score was used to evaluate the clinical efficacy.   RESULTS AND CONCLUSION: (1) All the 54 patients were followed up, including 29 males and 25 females, aged 54.81±9.76 years old. The course of disease was 10.54 ± 8.48 months. The follow-up time was 10 days to 76 months. (2) A total of 159 cervical herniated discs were observed, of which 87.42% (139/159) were absorbed to varying degrees. (3) Due to the small number of grades I and V, they were not included in the statistical analysis. The absorption rate and absorption ratio of grade II degeneration group, grade III degeneration group and grade IV degeneration group were (40.60±25.72)%, (36.12±18.30)%, (37.49±27.95)% and 85.42%(41/48), 89.23%(58/65), 87.50%(35/40), respectively, and there was no significant difference between the groups (P > 0.05). (4) Among the 139 herniated cervical discs with resorption of herniated nucleus pulposus, 77.70% (108/139) had no change in degeneration grade, and 22.30% (31/139) had an increase in degeneration grade; among them, 22 changed from grade II to grade III, and 9 changed from grade III to grade IV. (5) In 54 cases of cervical spondylotic myelopathy, 20 cases were excellent; 27 cases were good; and 7 cases were fair; and the excellent and good rate was 87%. (6) The results show that the resorption of herniated nucleus pulposus phenomenon after cervical microendoscopic laminoplasty has nothing to do with the degree of degeneration of the herniated cervical intervertebral disc. It suggests that the cervical microendoscopic laminoplasty can cause long-term and stable resorption of herniated nucleus pulposus in cervical spondylotic myelopathy patients with different degeneration of herniated cervical discs, which is beneficial to improve the long-term treatment effect. It provides a new strategy and basis for the treatment of cervical spondylotic myelopathy. Figures and Tables | References | Related Articles | Metrics

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One-stage reconstruction of the lateral wall of comminuted reverse oblique intertrochanteric fractures: how to improve the biomechanical stability of bone after repair Wu Zhonghan, Xu Xinzhong, Zhang Jisen, Zhao Yao, Ye Shuming, Yu Shuisheng, Sun Jian, Jing Juehua 2021, 25 (36):  5838-5843.  doi: 10.12307/2021.352 Abstract ( 430 )   PDF (1026KB) ( 149 )   Save BACKGROUND: Since the beginning of the 21st century, one-stage repair of the lateral wall has become a problem to be considered in the internal fixation of femoral intertrochanteric fractures with lateral wall injury with the continuous improvement of the understanding of the anatomical structure of the proximal femur. OBJECTIVE: To review common surgical methods for reconstruction of the lateral wall of comminuted reverse oblique intertrochanteric fractures (AO/OTA classification system: type A3.3 fracture) in recent years, compare the advantages and disadvantages of different treatment options, and look forward to the development direction of reestablishment of the lateral wall. METHODS: The author searched databases including Wanfang, CNKI and PubMed for domestic and foreign relevant articles with key words “type A3.3, comminuted, reverse oblique intertrochanteric fractures, lateral wall, internal fixation operation, repairment and reconstruction” in Chinese and English. The search time was from 2014 to 2021 and a total of 69 articles were selected for review.  RESULTS AND CONCLUSION: (1) For comminuted reverse oblique intertrochanteric fractures, simple extramedullary fixation can reestablish the lateral wall while having a better anti-rotation performance, but brings more soft tissue exfoliations and poorer biomechanical performance. (2) Intramedullary fixation combined with extramedullary fixation inevitably destroys soft tissues and the blood supply, but it has the advantages of maintaining biomechanical stability, the low failure rate, and the significant better effect of improving the function of hip joint than that of simple extramedullary fixation. (3) Among them, the osteosynthesis that proximal femoral nail antirotation combined with minimally invasive percutaneous plate represents intramedullary combined with limited extramedullary fixation, and it effectively reduces the trauma of combined fixation and has the best comprehensive curative effect, and also reveals the prospects based on the rationale of minimal invasion. Figures and Tables | References | Related Articles | Metrics

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Application of wearable inertial sensor in evaluating the function of human knee joint Zhou Xiaoxiang, Liao Xinyu, He Lu, Liu Dejian, Wang Guoliang, Jia Di, He Chuan, Li Yanlin 2021, 25 (36):  5844-5850.  doi: 10.12307/2021.353 Abstract ( 988 )   PDF (1169KB) ( 555 )   Save BACKGROUND: With the acceleration of the global aging process and the scientific rehabilitation plan of postoperative patients, we urgently need an effective and low-cost solution for early diagnosis of limb diseases. Inertial sensor has attracted much attention in recent years, because of its small size, low cost and high accuracy compared with the gold standard (3D motion capture system). Such wearable devices that monitor joint activity and health can record and extract important parameters to treat exercise-related problems as soon as possible. OBJECTIVE: To summarize the application and progress of wearable inertial sensors in the evaluation of knee function in recent years, and look forward to the future development prospects and challenges in this field. METHODS: Search words were “wearable, inertial sensors, knee Joint, rehabilitation, kinesiology” in English and Chinese. Relevant literature on inertial sensor evaluation of knee joint published from 2005 to 2021 was searched by computer in CNKI, Wanfang database, PubMed and FMRS database. Systematic summary, summary and analysis were conducted to comprehensively describe the new progress and challenges in the research on inertial sensor evaluation of human knee joint.  RESULTS AND CONCLUSION: The inertial sensor is expected to track and evaluate knee joint function in a non-invasive way, which can be used for dynamic evaluation of fall detection and prevention, athlete performance evaluation and rehabilitation progress. Inertial sensors contribute to the early diagnosis of limb diseases and carry out more effective medical intervention when needed to promote the early functional recovery of postoperative patients. Although great progress has been made in the application of wearable inertial sensor to evaluate the function of human knee joint, some problems limit and hinder its clinical application. In the future, more work is needed to improve the acceptance of the system from a medical, user and business point of view. Figures and Tables | References | Related Articles | Metrics

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Participation and regulatory mechanism of interleukin-1 during bone metabolism Wang Jing, Lang Xuemei, Wang Weiqun, Zhang Hanxiang, Zhang Yi, Wang Xin 2021, 25 (36):  5851-5858.  doi: 10.12307/2021.354 Abstract ( 778 )   PDF (1603KB) ( 1468 )   Save BACKGROUND: Two isoforms of interleukin-1, interleukin-1α and interleukin-1β, which have similar bioactivity, have been shown to have significant effects on bone metabolism and have been shown to induce differentiation of osteoblasts or osteoclasts. OBJECTIVE: To summarize the relationship between interleukin 1 and osteoblasts or osteoclasts, and to understand the mechanism of interleukin 1 in bone metabolism, so as to provide theoretical reference for new osteogenic programs. METHODS: CNKI and PubMed were searched for articles related to the mechanism of interleukin-1 in osteoblasts and osteoclasts. A total of 74 articles were included for review analysis.  RESULTS AND CONCLUSION: Interleukin 1, as a multifunctional cytokine in vivo, has a profound effect on both osteogenic and osteoclastic metabolism. (1) Interleukin 1 is closely related to the differentiation, activation and survival of osteoclasts. It can not only exert osteoclast effect directly through RANKL/RANK, but also reduce the production of osteoprotectin and indirectly stimulate osteoclast formation by upregulation of prostagland E2 and macrophage colony stimulating factor. In addition, the multinucleated maturation of osteoclasts was also closely related to interleukin 1. (2) It has been found that interleukin 1β not only affects the differentiation of osteoblasts, but also indirectly regulates osteogenic metabolism by affecting osteoblast-related proteins. (3) Recent studies have shown that interleukin 1β can regulate the structure of blood clots and thus affect early bone healing, which provides a useful reference for our study of interleukin 1β. (4) Therefore, this review is expected to further understand the specific mechanism of interleukin 1 involved in bone metabolism and provide theoretical reference for good osteogenesis strategies. Figures and Tables | References | Related Articles | Metrics

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Periprosthetic joint infection of hip and knee Li Shuyuan, Chen Leilei, Huang Linfeng, Zhao Heran, Wu Suwen, Jiang Yuankang 2021, 25 (36):  5859-5866.  doi: 10.12307/2021.355 Abstract ( 551 )   PDF (1137KB) ( 187 )   Save BACKGROUND: Joint arthroplasty of hip and knee significantly improves the quality of life of patients, but periprosthetic joint infection has always been the most serious complication of the operation, and it is also one of the most challenging problems in the field of joint surgery. OBJECTIVE: To summarize the etiology, epidemiology, risk factors, diagnosis and treatment of periprosthetic joint infection on hip and knee, focusing on the diagnosis and treatment, in order to provide reference for clinical treatment of periprosthetic joint infection on hip and knee. METHODS: The articles from the establishment of the database to 2021 were searched in PubMed, Web of Science, CNKI and Wanfang databases. According to the selecting criteria related to the diagnosis and treatment of periprosthetic joint infection of hip and knee joint, screening and analysis were carried out to exclude the articles with poor correlation with the topic and repetitive and obsolete articles. The articles included in the study contained original research, reviews, clinical trials, meta-analysis, and case reports. A total of 890 articles were retrieved. Totally 97 articles were finally included after excluding the poorly related, repetitive and obsolete articles.  RESULTS AND CONCLUSION: After summarizing and analyzing these articles, it is found that: (1) At present, there are no clear criteria for diagnosis and treatment of periprosthetic joint infection of hip and knee joint. (2) The sensitivity and specificity of current diagnostic criteria for hip and knee joint periprosthetic joint infection are still low, so it is necessary to develop more accurate, simpler and faster diagnostic methods. (3) Two-stage revision is still the gold standard for the treatment of periprosthetic infection of hip and knee joint, which has the advantages of wide indication and high eradication rate of infection. (4) In recent years, biotherapy for inhibition and destruction of bacterial biofilm is gradually becoming a new treatment, but most of them are in basic research and clinical applications are not universal. Its long-term efficacy and safety remain to be determined. Figures and Tables | References | Related Articles | Metrics

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Correlation between traditional Chinese medicine syndrome types of femoral head necrosis and hip joint morphology Tang Shuo, Hou Decai 2021, 25 (36):  5867-5871.  doi: 10.12307/2021.356 Abstract ( 592 )   PDF (1065KB) ( 532 )   Save BACKGROUND: Avascular necrosis of the femoral head has always been a problem that is difficult to solve in orthopedics, and it is still difficult to be completely cured with the development of medicine. The development of the disease is irreversible, and the treatment is relatively difficult. For patients with early pain, the characteristic treatment of traditional Chinese medicine is effective and has unique advantages. However, the development of individualized treatment of hip protection methods requires a more comprehensive grasp, to evaluate the impact of other potential adverse factors, and to improve the overall grasp of the clinical treatment of femoral head necrosis rate. OBJECTIVE: To follow-up literature on the relationship between traditional Chinese medicine (TCM) syndromes of femoral head necrosis and hip joint morphology, to evaluate the conservative treatment for the prognosis of femoral head necrosis. METHODS: Using “femoral head necrosis TCM syndrome type; hip joint morphology” as Chinese search terms and “TCM syndrome type of femoral head necrosis; hip morphology” as English search terms, articles were searched in CNKI, VIP, Wanfang, and PubMed databases from 2012 to 2020. The related articles on the relationship between TCM syndromes of femoral head necrosis and hip joint morphology were explored.  RESULTS AND CONCLUSION: (1) At present, surgical methods are mostly used for the occurrence of femoral head necrosis. However, abnormal symptoms such as pain before femoral head necrosis should be treated in time to save the femoral head and delay the development of the disease. If it is not taken seriously, it will seriously affect the hip joint and cause hip arthritis, so only hip replacement surgery can be performed. (2) By consulting the literature, we learned that the TCM syndromes of femoral head necrosis are divided into kidney deficiency and blood stasis type, qi stagnation and blood stasis type, and phlegm and blood stasis blocking collaterals type. (3) Hip joint morphology changes mainly include central edge angle, acetabular angle (Sharp angle), acetabular depth, acetabular anteversion angle, acetabular abduction angle, acetabular diameter, acetabular diameter, anteroposterior diameter and other data indicators. (4) The diagnosis method is closely integrated, taking advantage of the advantages together, so as to provide more powerful support for the improvement of the clinical efficacy of hip-preserving treatment of avascular necrosis of the femoral head. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional finite element analysis of the oblique-pulling manipulation on lumbar disc herniation in different body positions Lu Yu, Zheng Taicai, Wang Qi, Zhang Jing, Cheng Qiang, Ji Futao, Yin Benjing, Bao Chaoyu, Jia Tao, Li Jizheng, Li Jubao 2021, 25 (36):  5872-5877.  doi: 10.12307/2021.357 Abstract ( 595 )   PDF (1272KB) ( 271 )   Save BACKGROUND: Oblique-pulling manipulation showed great effectiveness in treating patients with lumbar disc herniation, and had been extensively used in clinic; however, the biomechanics and efficacy of the oblique-pulling manipulation in different positions are still undefined.   OBJECTIVE: To analyze the biomechanical effect of the oblique-pulling manipulation in different body positions of lumbar disc herniation using three-dimensional finite element, so as to guide its treatment and associated clinical work. METHODS:  A three-dimensional finite element model of L4-5 was developed from the CT scan images of a volunteer. The oblique-pulling manipulation was simulated to study the influence in different positions (anteflexion 30°, neutral position 0° and extension 10°) on the stress on the intervertebral disc, including the nucleus pulposus and annulus fibrosus, and the changes in the displacement between the intervertebral disc and the nerve root under the oblique-pulling manipulation.   RESULTS AND CONCLUSION: (1) Under the oblique-pulling manipulation in different body positions: anteflexion 30°, neutral position 0°, and extension 10°, the stress in the intervertebral disc nucleus pulposus was significantly reduced; the most obvious reduction occurred when the extension was 10°. (2) Under the oblique-pulling manipulation in different body positions: anteflexion 30°, neutral position 0°, and extension 10°, the stress on the annulus was increased; the most obvious increase occurred when the extension was 10°. (3) When anteflexion was 30°, the disc was far away from the nerve root under oblique-pulling manipulation, which helps to relieve the symptoms of nerve compression. However, in the extension of 10°, the opposite is true. Figures and Tables | References | Related Articles | Metrics

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Conservative treatment, open reduction, percutaneous minimally invasive plate internal fixation and intramedullary nail fixation in the treatment of humeral shaft fractures: a network meta-analysis Xiong Chen, He Guiping, Zhang Kun, He Xiao, Yang Jiarui, He Changjun, Wang Xiaolong, Wang Chen, Shi Zhengwei, Zhu Yangjun, Heng Lisong 2021, 25 (36):  5878-5887.  doi: 10.12307/2021.358 Abstract ( 359 )   PDF (2232KB) ( 126 )   Save OBJECTIVE: The main methods for the treatment of humeral shaft fractures are conservative treatment, open reduction and internal fixation, percutaneous minimally invasive plate internal fixation and intramedullary nail fixation, but the best treatment is still unclear. The network meta-analysis was used to compare the efficacy of conservative treatment, open reduction and internal fixation, percutaneous minimally invasive plate internal fixation and intramedullary nail fixation in the treatment of humeral shaft fractures. METHODS:  A randomized controlled study on the treatment of humeral shaft fractures was searched in CNKI, Wangfang, VIP, Chinese BioMedical Literature Database, PubMed, EMbase, The Cochrane library and Web of Science. The search period was from inception to January 2021. The “bias risk assessment” tool recommended by Cochrane Collaboration Network was used to evaluate the quality of the literature. The RevMan 5.4 software and Stata 15.0 software were used to draw the graph and analyze the data of the network Meta.   RESULTS: (1) A total of 23 randomized controlled trials were included. A total of 1 220 patients with humeral shaft fractures were divided into experimental group and control group. The control group was treated conservatively, and the experimental group was treated with open reduction and internal fixation, percutaneous minimally invasive plate internal fixation and intramedullary nail fixation. (2) Literature quality evaluation was included: 5 articles were of high quality and the other 18 were of low quality. (3) In terms of DASH score, the order of network Meta was as follows: open reduction and internal fixation > conservative > percutaneous minimally invasive plate internal fixation > intramedullary nail fixation. In terms of CMS score, the order of network Meta was as follows: open reduction and internal fixation > percutaneous minimally invasive plate internal fixation > conservative > intramedullary nail fixation. In terms of bone nonunion, the order of network Meta was as follows: percutaneous minimally invasive plate internal fixation > open reduction internal fixation > intramedullary nail fixation > conservative treatment. In terms of fracture healing time, the order of network Meta was as follows: percutaneous minimally invasive plate internal fixation > intramedullary nail fixation > open reduction and internal fixation > conservative. The network Meta order of iatrogenic radial nerve injury was conservative > percutaneous minimally invasive plate fixation > intramedullary nail fixation > open reduction and internal fixation. The order of total complications of network Meta was conservative > percutaneous minimally invasive plate internal fixation > open reduction and internal fixation > intramedullary nail fixation.  CONCLUSION: A comprehensive analysis of the results of the network meta-analysis of the four intervention measures showed that the upper limb function DASH score and shoulder CMS score of the affected limb after open reduction and internal fixation were the best, but the incidence of complications was relatively high. More high-quality randomized controlled trials are needed to ensure the reliability of the results. Figures and Tables | References | Related Articles | Metrics

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Meta-analysis of postoperative complications of circular external fixation and internal fixation with steel plate for the treatment of tibial plateau fractures Song Lei, Zhang Hui, Zhao Yangfei, Sun Haiyu 2021, 25 (36):  5888-5896.  doi: 10.12307/2021.359 Abstract ( 418 )   PDF (1450KB) ( 220 )   Save OBJECTIVE:  There are still controversies about the postoperative complications of circular external fixation and open reduction and internal fixation with steel plates for the treatment of tibial plateau fractures. Evidence-based medicine methods are needed to evaluate the pros and cons of the two treatments. This article compared the clinical effects of circular external fixation and open reduction and internal fixation with steel plate in the treatment of tibial plateau fractures. METHODS: Computer was used to to collect articles on relevant internal and external fixation for the treatment of complex tibial plateau fractures in PubMed, EMbase, Cochrane Library, CNKI, Wanfang and other databases. Two independent investigators screened the literature and collected the literature according to the standards. The Cochrane scoring standard was used to evaluate the quality of the randomized controlled trials, and the NOS scale was used to evaluate the quality of the cohort study. After relevant data were extracted, the RevMan 5.3 software was used for meta-analysis.   RESULTS:  (1) Finally, 14 articles were included: 3 articles were randomized controlled trials, and 11 articles were cohort studies, with a total of 882 patients. 436 cases in the observation group received internal fixation with steel plate, and 446 cases in the control group received circular external fixation. (2) Literature quality evaluation results showed that 3 randomized controlled trials were all medium-and high-quality literature. Among 11 cohort studies, 3 were high-quality literature; 7 were higher-quality literature; and 1 was medium-quality literature. (3) Meta-analysis results showed that compared with external fixation, open reduction and internal fixation could significantly reduce the total postoperative infection rate (OR=0.31, 95%CI: 0.17-0.57, P=0.000 1) and the superficial infection rate (OR=0.28, 95%CI:0.13-0.58, P=0.000 7) and fracture malunion rate (OR=0.40, 95%CI:0.21-0.75, P=0.004) and adverse event rate (OR=0.26, 95%CI:0.16-0.42, P < 0.000 01); but did not reduce the deep infection rate (OR=0.64, 95%CI:0.34-1.19, P=0.16), the incidence of secondary osteoarthritis (OR=0.66, 95%CI:0.39-1.12, P=0.12), the rate of secondary operations (OR=0.69, 95%CI:0.39-1.22, P=0.20), postoperative knee stiffness incidence (OR=0.92, 95%CI:0.32-2.67, P=0.89), postoperative nerve injury rate (OR=0.38, 95%CI:0.10-1.45, P=0.16), postoperative thrombosis rate (OR=0.29, 95%CI: 0.08-1.08, P=0.06) and fracture nonunion rate (OR=0.80, 95%CI:0.19-3.35, P=0.76). The results of subgroup analysis of fracture malunion showed that Hoffmann external fixation was more likely to cause articular surface malunion (OR=0.13, 95%CI: 0.04-0.39, P=0.000 3).   CONCLUSION: In the treatment of tibial plateau fractures, plate internal fixation is superior to circular external fixation in terms of superficial infection, fracture malunion and total infection rate. However, Hoffman external fixation is more likely to cause abnormal healing of the articular surface. Figures and Tables | References | Related Articles | Metrics

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Efficacy of posterior cruciate ligament retaining versus posterior stabilized prostheses in total knee arthroplasty: a systematic review and a meta-analysis Wan Dadi, Duan Xiangrui, Fan Xinchao, Yuan Ye, Huang Teng, Pan Dikang, Liu Jingyan, Li Xicheng 2021, 25 (36):  5897-5904.  doi: 10.12307/2021.360 Abstract ( 455 )   PDF (1756KB) ( 170 )   Save BACKGROUND: When performing total knee arthroplasty, one is faced with the choice of posterior cruciate ligament retaining prosthesis or posterior stabilized prosthesis. However, which prosthesis is more advantageous cannot be completely determined.   OBJECTIVE: To investigate the safety and efficacy of posterior cruciate ligament retaining prosthesis and posterior stabilized prosthesis in total knee arthroplasty.   METHODS: Databases, including Cochrane Library, PubMed, Web of Science, EMbase, CNKI, Wanfang, VIP and CBM, were searched for clinical studies on posterior cruciate ligament retaining and posterior stabilized for total knee arthroplasty. The risk of bias in randomized controlled trials was assessed using the Cochrane Risk of Bias Assessment Tool. The quality of literature in retrospective case-control studies was assessed using the Newcastle-Ottawa Scale. RevMan 5.3 software was used for meta-analysis.  RESULTS: A total of 11 studies (seven randomized controlled trials and four retrospective case-control trials were of high quality) were included, including 765 patients undergoing total knee arthroplasty, including 386 posterior cruciate ligament retaining prostheses and 379 posterior stabilized prostheses. The results of the meta-analysis showed that the range of motion of knee joint was larger one year after the posterior stabilized prosthesis (WMD=-0.94, 95%CI:-1.69 to -0.20, P=0.01]; the angle of knee joint extension was smaller one year after surgery (WMD=-0.33, 95%CI:-0.61 to -0.05, P=0.02], and the angle of flexion was larger one year after surgery (SMD=-0.62, 95%CI:-1.20 to -0.04, P=0.03]. (2) The total postoperative blood loss of posterior cruciate ligament retaining prosthesis was less than posterior stabilized prosthesis (WMD=-126.86, 95%CI:-231.03 to -22.69, P=0.02]. WOMAC score was lower for posterior cruciate ligament retaining prosthesis 1 year after surgery (SMD=-0.29, 95%CI:-0.55 to -0.04, P=0.02]. The operative time of posterior cruciate ligament retaining prosthesis was longer than posterior stabilized prosthesis (WMD=4.29, 95%CI:2.13-6.46, P=0.0001]. (3) Postoperative three months HSS score, postoperative 1 year AKS clinical scoring, and postoperative complications were not statistically significant between the two groups (P > 0.05).   CONCLUSION: In total knee arthroplasty, posterior stabilized prosthesis was better than posterior cruciate ligament retaining prosthesis in the range of knee motion and operative time. Total blood loss was less and the recovery of knee function was better in posterior cruciate ligament retaining prosthesis than those in the posterior stabilized prosthesis. Each type of prosthesis has its own advantages, and the surgeon can choose according to individual differences for the patient. Figures and Tables | References | Related Articles | Metrics