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28 January 2022, Volume 26 Issue 3 Previous Issue    Next Issue

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Biomechanical stability of endoscopic transforaminal lumbar interbody fusion with unilateral pedicle screw combined with contralateral translaminar facet screw fixation Lin Boying, Shen Mao 2022, 26 (3):  329-333.  doi: 10.12307/2022.053 Abstract ( 473 )   PDF (1142KB) ( 75 )   Save BACKGROUND: Endoscopic transforaminal lumbar interbody fusion is a breakthrough technique for effective treatment of lumbar degenerative diseases. It has the advantages of less trauma, fast recovery, less bleeding, clear vision of water medium, decompression of nerve roots under direct vision, and treatment of the endplate under direct vision to increase the fusion rate. At present, there are few researches on the internal fixation based on endoscopic transforaminal lumbar interbody fusion.   OBJECTIVE: To observe the effect of unilateral pedicle screw combined with contralateral translaminar facet screw fixation, unilateral pedicle screw fixation, and bilateral pedicle screw fixation on the biomechanics of lumbar vertebra after endoscopic transforaminal lumbar interbody fusion and to verify the reliability and effectiveness of unilateral pedicle screw combined with contralateral translaminar facet screw fixation. METHODS:  By establishing an element model of endoscopic transforaminal lumbar interbody fusion, the effects of unilateral pedicle screw combined with contralateral translaminar facet screw fixation, unilateral pedicle screw fixation, and bilateral pedicle screw fixation on the overall displacement of the model, stress of intervertebral fusion cage and pedicle screw, and stress-strain of adjacent discs were analyzed.   RESULTS AND CONCLUSION: (1) Compared with unilateral pedicle screw combined with contralateral translaminar facet screw fixation, overall displacement, screw and rod system stress, and intervertebral cage stress were significantly increased in models with unilateral pedicle screw fixation. (2) Overall displacement, screw and rod system stress, and intervertebral cage stress were basically the same under six operating conditions between the bilateral pedicle screw fixation and unilateral pedicle screw combined with contralateral translaminar facet screw fixation. (3) There was no significant difference in the stress of the adjacent intervertebral disc under the three fixation methods, and the change trend was basically the same. (4) It is confirmed that unilateral pedicle screw combined with contralateral translaminar facet screw fixation have good biomechanical properties. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional model analysis of tibial plateau fracture lines Deng Zhaoyang, Yang Zhaohui 2022, 26 (3):  334-339.  doi: 10.12307/2022.054 Abstract ( 687 )   PDF (1326KB) ( 89 )   Save BACKGROUND: Due to complex fracture types and unsatisfactory treatment results of tibial plateau fracture, the surgical approach and treatment methods are often unclear. The common clinical classification of tibial plateau fracture is different, which brings some difficulties to the choice of clinicians. In recent years, with more and more application of fracture mapping technology in clinical research, more and more studies on tibial plateau fracture mapping have been conducted.   OBJECTIVE: To reconstruct the three-dimensional model of tibial plateau fracture and to analyze the characteristics of fracture lines. METHODS: A retrospective study was conducted in 133 cases of tibial plateau fractures. The original imaging data of patients were collected and used to reconstruct fracture model in Mimics 17.0 software. The reconstructed fracture model was reduced and fitted to the standard template and all fracture lines were delineated and superimposed on the standard template in 3-matic 9.0 software.   RESULTS AND CONCLUSION: (1) Most patients of tibial plateau fracture were aged between 43 and 52 years (33.1%). Fractures in male patients mainly occurred between 43 and 52 years old (35.4%), and the average peak age of onset was 47 years; fractures in female patients mainly occurred between 53 and 62 years (40.7%), and the average peak age of onset was 52 years old. (2) The fracture line of lateral tibial plateau (81.8%) was more than that of medial plateau (31.4%). Fracture lines tended to occur mainly on the inner part of the lateral condyle that extended to the junctional zone between Gerdy’s tubercle and the tibial tubercle (75.9%), as well as intercondylar eminence (71.5%). There were three secondary fracture lines: One ran from the intercondylar eminence to the front of the fibular head (21.2%). The second line took an outer arc along the outer edge of the anterolateral tibial plateau (13.8%). The third line ran from the anteromedial to the posterolateral that extended to lateral tibial plateau (15.3%). Fracture lines were less likely to occur in the tibial tubercle (13.1%), the Gerdy’s tubercle (10.9%), the posteromedial fragment (8.6%), and tibiofibular articular surface (7.3%). (3) Results have showed that tibial plateau fracture has its own predilection sites. In clinical work, individual analysis and treatment are needed instead of relying entirely on a certain fracture type. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional finite element analysis of Daogaijinbei manipulation on lumbar intervertebral disc biomechanics Li Yanting, Chen Jian, Liu Menglan, Ren Manman, Zhong Weihong, Chen Changxing 2022, 26 (3):  340-343.  doi: 10.12307/2022.055 Abstract ( 590 )   PDF (1431KB) ( 74 )   Save BACKGROUND: The South Shaolin technique uses the essence of martial arts in bone and tendon and massage techniques to form a unique Chinese bone injury treatment technique. Research has found that the South Shaolin tendon and chiropractic technique has a significant effect on the treatment of lumbar disc herniation.   OBJECTIVE: To analyze the biomechanical effects of Daogaijinbei manipulation on the lumbar intervertebral disc by using the three-dimensional finite element method. METHODS:  A healthy young male volunteer was selected to construct a three-dimensional finite element model of the lumbar spine (L1-L5) based on the CT scan results. The stress distribution and variation of lumbar intervertebral disc under different jacking heights were calculated by simulating loading Daogaijinbei manipulation on the validated lumbar spine model.   RESULTS AND CONCLUSION: (1) The maximum average stress of each lumbar intervertebral disc was about 9.2 MPa after being pushed by a total displacement of 10 cm in L3, and there was stress concentration in some units of the L4-5 intervertebral disc. (2) With the increase of the jacking height, the stress of each intervertebral disc presented an approximate linear growth trend. The stress values of each intervertebral disc were: 1.36-7.36 MPa in L1-2 intervertebral disc, 1.64-7.82 MPa in L2-3 intervertebral disc, 1.52-9.20 MPa in L3-4 intervertebral disc, and 1.25-8.71 MPa in L4-5 intervertebral disc. The stress distribution was: L3-4 > L4-5 > L2-3 > L1-2. (3) The stress variation of lumbar intervertebral disc increased from nucleus pulposus to the edge, and the maximum stress was in the anterior side of annulus fibrosus. (4) During Daogaijinbei manipulation, the overall stress distribution of the lumbar intervertebral disc is consistent and gradually increasing, which suggests that manipulation should be done little by little to ensure patients’ safety. Figures and Tables | References | Related Articles | Metrics

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reliability of flat feet evaluated by foot posture index and its application in three-dimensional printing insoles Song Yan, Zheng Kun, Wei Haoxin, Lu Dezhi, Xu Yuanjing, Wang Xiaowen, Wang Jinwu 2022, 26 (3):  344-349.  doi: 10.12307/2022.056 Abstract ( 595 )   PDF (1140KB) ( 159 )   Save BACKGROUND: Many foreign studies have discussed the reliability of foot posture index, but few domestic studies have discussed the reliability of foot posture index applied to patients with flat feet, nor the application of foot posture index in three-dimensional (3D) printed insoles.   OBJECTIVE: To explore the reliability of foot posture index in the foot posture of patients with flat foot, to predict the injury of foot and ankle posture function in patients with flat foot, and to provide a theoretical basis for the design of 3D printing personalized orthopedic insole. METHODS:  Forty patients with flat feet aged 6-60 years were selected from the Department of Orthopedics, the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from May to November 2020. These patients were divided into two groups according to age: 20 cases in group of children aged 6-18 years; 20 cases in group of adults aged 19-60 years. Two raters (rater 1 and rater 2) were trained by FPI-6 system, and then the foot posture was evaluated for the first time. The rater 1 was evaluated for the second time within seven days after the first evaluation. The intra group correlation coefficient was calculated to evaluate the test-retest reliability and inter tester reliability. The protocols were in accordance with Declaration of Helsinki and the relevant ethical requirements of Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (approval No. 2016-124-T73; approval date: 2016-10-26). All subjects and guardians read and signed the informed consent before participating.   RESULTS AND CONCLUSION: (1) The test-retest reliability of foot posture index was higher than 0.75 except for the curvature of lateral malleolus, with high reliability. The ICC value of lateral malleolus was between 0.4 and 0.74, with moderate reliability (P < 0.05). The inter rater reliability and the total score of foot posture index showed that ICC was more than 0.75 except for the upper and lower curvature of the lateral malleolus, which was highly reliable, and the ICC value of the upper and lower curvature of the lateral malleolus was between 0.4 and 0.74, with medium reliability (P < 0.05). (2) The test-retest reliability and interrater reliability of adult foot posture index were moderate to highly reliable (P < 0.05). (3) The results show that foot posture index is moderate to highly reliable in adults and children with flatfoot. Foot posture index can be used to evaluate Chinese children and adults with flatfoot and grade the severity of flatfoot. The high reliability of foot posture index can provide a theoretical basis for the design of 3D printing insole and the evaluation of treatment effect. Figures and Tables | References | Related Articles | Metrics

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Coverage of the acetabular cup under different perspective angles: assessing the position of the total hip arthroplasty prosthesis for complex types of hip dysplasia Wang Jinzi, Ding Hai, Zhang Heng, Chang Wenju, Liu Fendou 2022, 26 (3):  350-353.  doi: 10.12307/2022.057 Abstract ( 674 )   PDF (1280KB) ( 59 )   Save BACKGROUND: The coverage of acetabular cup is used to evaluate the inclusiveness and stability of the acetabular cup after total hip arthroplasty. Plain radiograph examination of the hip is a common method to detect acetabular cup coverage during or after total hip arthroplasty. Different perspective angles may affect the measurement and evaluation of acetabular cup coverage.   OBJECTIVE: To explore the relationship between the coverage of the acetabular cup under different perspectives after total hip arthroplasty. METHODS:  Five three-dimensional printed synthetic pelvic specimens were taken, and 52 mm diameter acetabular cup prosthesis was placed by polishing the right acetabulum to prepare different acetabular cup coverage models. The prepared pelvis model was fixed with the right acetabulum as the center under the C-arm machine for fluoroscopy. By rotating the C-arm machine, the right hip joint was seen through the front view, 15°, 30°, and 45° axial position films and left 15°, 30°, and 45° oblique films. The coverage of the acetabular cup under different perspective angles was calculated by Photoshop2019 software to compare the difference between the acetabular cup coverage under the different angles of the axial and oblique films and the orthographic film.   RESULTS AND CONCLUSION: (1) In the test of the acetabular cup coverage of the axial film, as the axial perspective angle was tilted upward; the coverage of the acetabular cup gradually increased, and was significantly higher in the upper 45° axial film group than that in the hip orthographic film group [increased (6.72±1.57)%, P=0.009]. (2) In the oblique film acetabular cup coverage test, as the perspective angle tilted to the left, the coverage rate showed a downward trend. The coverage was significantly lower in the left 45° oblique film group than that in the hip joint orthographic film group [decreased (5.56±1.91)%, P=0.021]. (3) Results confirm that there are differences in the coverage of the acetabular cup under different oblique perspective angles. The greater the upward axial tilt angle, the greater the cup coverage, and the greater the contralateral tilt angle, the less cup coverage. It is indicated that for patients undergoing total hip arthroplasty, attention should be paid to the intraoperative fluoroscopy angle. For complicated types of total hip arthroplasty patients, 45° oblique films can be shown during or after the operation to further evaluate the position and coverage of the cup. Figures and Tables | References | Related Articles | Metrics

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Risk factors for recurrent prosthesis dislocation after total hip arthroplasty through posterolateral approach Li Kai, Liu Zhendong, Li Xiaolei, Wang Jingcheng 2022, 26 (3):  354-358.  doi: 10.12307/2022.058 Abstract ( 494 )   PDF (1135KB) ( 64 )   Save BACKGROUND: Recurrent prosthetic dislocation after total hip arthroplasty with posterolateral approach is one of the serious complications that affect the quality of life of patients, and it is also a problem faced by clinicians. At present, the analysis of the influencing factors of repetitive prosthesis dislocation is still relatively small, so the reason for the concurrent repetitive prosthesis dislocation is not clear in the academic circles.   OBJECTIVE: To analyze the risk factors of recurrent prosthetic dislocation after total hip arthroplasty through posterolateral approach. METHODS:  142 patients who underwent total hip arthroplasty through posterolateral approach in Subei People’s Hospital of Jiangsu Province were collected. According to the dislocation within 2 years after operation, patients were divided into non-dislocation group (n=54), single dislocation group (n=50), and repeated dislocation group (n=38). The risk factors that may lead to postoperative dislocation of the prosthesis and the development of repetitive prosthesis dislocation were collected and analyzed. Logistic regression analysis was used to analyze the factors affecting repetitive prosthesis dislocation, and then to summarize the relevant independent risk factors.   RESULTS AND CONCLUSION: (1) There was no significant difference in gender, chronic disease history, and body mass index among the three groups of patients (P > 0.05). There were significant differences in age, history of early dislocation, history of neurological diseases, femoral prosthesis diameter, acetabular abduction angle, and femoral anteversion angle and whether it was normal (P < 0.05). (2) Compared with the single dislocation group, patients in the repeated dislocation group had a significantly higher probability of early dislocation, neurological disease and abnormal anteversion angle (P < 0.05), and the diameter of the femoral head prosthesis was significantly reduced (P < 0.05). (3) Logistic regression analysis showed that the patient’s age, history of neurological diseases, history of early dislocation, whether the femoral anteversion angle was normal, and the diameter of the femoral head were correlated with repeated prosthetic dislocations after total hip arthroplasty (P < 0.05). (4) The results showed that the patient’s advanced age, whether the first dislocation was an early dislocation, whether it was complicated by neurological disease, whether the femoral anteversion angle was normal, and the diameter of the femoral head may be risk factors for recurrent prosthesis dislocation after total hip arthroplasty through posterolateral approach. Figures and Tables | References | Related Articles | Metrics

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Early gait changes after total hip arthroplasty through direct anterior approach and posterolateral approach Wang Chong, Zhang Meiying, Zhou Jian, Lao Kecheng 2022, 26 (3):  359-364.  doi: 10.12307/2022.059 Abstract ( 546 )   PDF (1581KB) ( 187 )   Save BACKGROUND: Total hip arthroplasty is a commonly used method for the treatment of hip osteoarthritis. Both direct anterior approach and posterolateral approach can achieve good results in total hip arthroplasty. The current research mainly focuses on the advantages and disadvantages of two surgical approaches. The use of gait analysis technology to study the early postoperative gait of patients is less.   OBJECTIVE: The gait analysis technique was used to compare the gait changes of patients undergoing total hip arthroplasty with the direct anterior approach and the posterolateral approach in different time periods, and to explore the early postoperative rehabilitation effect of the two approaches. METHODS:  The 66 patients with unilateral hip osteoarthritis who were treated with total hip arthroplasty at Qingdao Municipal Hospital from September 2019 to June 2020 were selected in this study, and divided into posterolateral approach group (n=33) and direct anterior approach group (n=33) according to the random number table method. The gait analysis technique was used to compare the changes of patients’ gait in the two groups before surgery, 1, 3, and 6 months after surgery. This study was approved by Ethics Committee of Qingdao Municipal Hospital.   RESULTS AND CONCLUSION: (1) At 1 month after surgery, stride length, pace, pace frequency and lateral support of patients in both groups were significantly improved compared with those before surgery (P < 0.05). (2) At 3 months after surgery, stride length, pace, pace frequency, and lateral support were increased in the two groups compared with 1 month after surgery (P < 0.05). (3) There was no statistical significance in stride length, stride speed, stride frequency, and support phase of the affected side in the direct anterior approach group at 3 and 6 months after surgery (P > 0.05). The stride length, stride speed, stride frequency, and support phase of the affected side were increased in the posterolateral approach group at 6 months compared with that at 3 months (P < 0.05). (4) At 1 and 3 months after surgery, the stride length, stride frequency, stride speed and support phase of affected side in the direct anterior approach group were better than those in the posterolateral approach group (P < 0.05). At 6 months after operation, there was no significant difference between the two groups (P > 0.05). (5) It is indicated that both surgical approaches can significantly improve patients’ gait, and direct anterior approach can better promote the recovery of hip function and early exercise of patients. Figures and Tables | References | Related Articles | Metrics

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Comparison of kinematic alignment and mechanical alignment to guide gait after total knee arthroplasty Pan Hao, Zhao Huihui, Wang Jiangjing, Wang Feng, Wang Peng, Shi Qiuling, Guo Jin, Li Lin, Liu Guoqiang 2022, 26 (3):  365-370.  doi: 10.12307/2022.060 Abstract ( 575 )   PDF (1149KB) ( 107 )   Save BACKGROUND: At present, the alignment methods commonly used in knee arthroplasty include mechanical alignment and kinematic alignment. The imaging and functional evaluation of the two surgical methods have been studied to some extent, but the gait conditions of patients with the two surgical methods have been studied.   OBJECTIVE: To explore the difference in kinematic alignment and mechanical alignment to guide gait analysis after total knee arthroplasty. METHODS:  From January 2017 to June 2019, 50 hospitalized patients with inverted knee osteoarthritis were selected. According to the operation method, they were divided into kinematic alignment group (25 cases) and mechanical alignment group (25 cases). The patient’s knee Hospital for special surgery score, visual analogue scale score, and gait parameters (stride speed, stride frequency, stride length, stance and swing phase flexion angle, varus angle, internal and external rotation angle and adduction torque) were used as reference indicators. Follow-up time was 1 year.   RESULTS AND CONCLUSION: (1) All patients successfully completed the follow-up, without incision infection, pulmonary embolism, joint dysfunction or other complications. (2) Compared with that before operation, visual analogue scale score and Hospital for special surgery score were significantly improved at 1 year after operation in both groups (P < 0.05). Hospital for special surgery score and visual analogue scale score were not significantly different between the two groups at 1 year after operation (P > 0.05). (3) Except swing phase varus or valgus angle, the gait parameters of the two groups were significantly improved at 1 year after operation compared with those before operation (P < 0.05). There was no statistical difference in stride frequency, standing phase, swing phase flexion and extension, internal and external rotation angle and swing phase varus or valgus angle (P > 0.05). There were significant differences in stride speed, stride length, varus or valgus angle and adduction torque in standing phase (P < 0.05). (4) It is concluded that both kinematic alignment-total knee arthroplasty and mechanical alignment-total knee arthroplasty can significantly improve the postoperative function and gait of the knee joint. However, some patients with kinematic alignment-total knee arthroplasty have residual physiological varus after surgery, but it can more effectively reduce the knee adduction torque, so as to obtain a good treatment effect. Figures and Tables | References | Related Articles | Metrics

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Tension of 3D printed controllable tension band and skin regeneration of skin defect model rats Maihemuti•Yakufu, Sun Qinqin, Chen Hongtao, Liu Xu, Yiliyaer•Abudusimu, Abudushalamu•Abudukelimu, Liu Jianjiang 2022, 26 (3):  371-375.  doi: 10.12307/2022.061 Abstract ( 472 )   PDF (2462KB) ( 91 )   Save BACKGROUND: Although the tension band technique can stimulate skin regeneration to repair skin defects, it has been successfully applied in clinical practice and has achieved satisfactory results, but the most suitable tension intensity for skin regeneration is still inconclusive.   OBJECTIVE: To discuss the effect of different tension intensities on skin regeneration in rat models of skin defect. METHODS:  Male SD rats aged 3 months old were selected as experimental animals. The back skin of SD rats was fixed by the 3D printed oval skin fixing device to establish rat models of skin defect wound on the back, and the 3D printed tension band device was fixed on the edge of the skin. The silicone loop was installed on the principle of tying shoelaces, and different tension parameters (0, 0.2, 1 N) of the silicone loop were adjusted by the tension detector. The changes in the area of the skin defect were observed immediately, 3, and 7 days after model establishment. At 7 days after the surgical procedure, histological sections of the skin at the edge of the wound were taken for immunohistochemical staining of CD31 and vascular endothelial growth factor to observe the effect of different tension stimulation on skin regeneration.   RESULTS AND CONCLUSION: (1) Appropriate tension stimulation could effectively stimulate skin proliferation and healing; skin defect wounds without tension stimulation could expand with the contracture of the skin edge and increase the area of the skin defect, which was not conducive to the treatment of skin defects. (2) Tension stimulation was not the bigger the better. Simultaneously, the wound shrinkage speed of 0.2 N tension group was faster than that of 1 N tension group. In 1 N tension group, the skin around the wound was sclerotic and the elasticity was decreased. It was considered that the larger tension led to skin ischemia. (3) The number of microvessels in the 0.2 N tension group was significantly increased, and the expression of vascular endothelial growth factor was significantly higher than that of the 0 N tension and 1 N tension groups, indicating that tension stimulation could promote the formation of microvessels and increase the expression of vascular endothelial growth factor, but high tension stimulation (1 N in this study) is not conducive to the formation of skin capillaries around the skin defect and is not conducive to wound healing. (4) It is concluded that appropriate tension can cause extensive reconstruction of extracellular matrix in local skin. By inducing angiogenesis, it can improve the supply of nutrients for local cell metabolism and promote the reorganization of cytoskeleton. This process has strict requirements on the size of tension. Figures and Tables | References | Related Articles | Metrics

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Correlation between blood loss during primary total knee arthroplasty and hypoalbuminemia and hypocalcemia after arthroplasty Qu Pengfei, Wang Huisheng, Li Xi 2022, 26 (3):  376-382.  doi: 10.12307/2022.062 Abstract ( 447 )   PDF (1278KB) ( 116 )   Save BACKGROUND: Even under the concept of enhanced recovery after surgery, most elderly patients undergoing primary total knee arthroplasty have hypocalcemia and hypoalbuminemia in the short term after surgery. Therefore, it is necessary to explore the causes and early warning factors to implement early intervention, thereby trying to avoid the negative effects caused by the above complications.   OBJECTIVE: To investigate the total blood loss and the incidence of hypoalbuminemia and hypocalcemia after primary total knee arthroplasty, further explore the correlation between the amount of blood loss and the changes of albumin and serum calcium before and after surgery. METHODS:  The medical records of 184 patients who underwent primary unilateral total knee arthroplasty in the Department of Sports Medicine and Joint Surgery, People’s Hospital of Liaoning Province from January 2019 to October 2020 were collected and retrospectively analyzed. Gross formula was used to calculate blood loss. Pearson correlation was used to analyze the correlation between the changes of serum calcium and albumin before and after operation and the age of patients, and the correlation between the amount of blood loss after operation and the length of operation, the changes of albumin, and the changes of serum calcium. The linear regression equation was established with the changes of albumin and serum calcium before and after operation as independent variables and the blood loss as dependent variables. Finally, the optimal linear regression equation model was established by multiple linear regression analysis (stepwise method) with the changes of albumin and serum calcium before and after operation as independent variables and the blood loss as dependent variables.   RESULTS AND CONCLUSION: (1) The incidence of hypoproteinemia after primary total knee arthroplasty was 59.8%, and the incidence of hypocalcemia after arthroplasty was 76.6%. (2) Non-major component blood transfusion had no effect on changes in albumin and serum calcium before and after arthroplasty. (3) There was a significant positive correlation between the changes in serum calcium and albumin before and after arthroplasty and the age of the patient. There was a very significant positive correlation of the amount of blood loss after surgery with the change in albumin after arthroplasty and the change in serum calcium after arthroplasty. (4) Linear regression analysis results showed the correlation between theoretical blood loss and changes in serum calcium: Y=41.294+2 313.383X, R2(after adjustment)=0.459; correlation between theoretical blood loss and changes in blood albumin Y=57.084+59.392X, R2(after adjustment)=0.406. Using blood loss (Y) as the dependent variable and serum calcium change (X1) and albumin change (X2) as independent variables, the optimal linear regression equation was established: Y=-30.91+1 548.931X1+30.029X2, R2 (after adjustment)=0.511. (5) It is indicated that according to the physical condition of the elderly patients who are expected to have a large amount of blood loss, the intervention measures can be implemented to maintain the stability of albumin and calcium ion in the perioperative period. The elderly patients who receive primary total knee arthroplasty whose preoperative albumin test results are lower than 42.44 g/L should strengthen nutrition, formulate the corresponding dietary plan or oral/intravenous albumin supplement. It is necessary to use calcium orally or intravenously in elderly patients who have received primary total knee arthroplasty and preoperative serum calcium test results are lower than 2.398 mmol/L in order to prevent hypocalcemia and hypoalbuminemia. Figures and Tables | References | Related Articles | Metrics

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Postural control ability during stair ascent and descent in older female Tai Chi exerciser: biomechanical analysis on dual-task paradigm Wang Jiangna, Sun Wei 2022, 26 (3):  383-389.  doi: 10.12307/2022.063 Abstract ( 438 )   PDF (1763KB) ( 71 )   Save BACKGROUND: Stair walking is an external factor that causes elderly people to fall, and the decline in posture control ability caused by dual-task interference is an internal factor that causes elderly people to fall. Tai Chi has been recognized for its ability to improve single-task posture control and prevent falls, but its effect on the ability to control stair-walking posture under dual-task interference is still unknown.   OBJECTIVE: To investigate the effects of walking up and down stairs with dual-task interference, the type of people (between groups) and the type of task (within groups) on body stability, lower limb joint motion and mechanical characteristics. METHODS:  Totally 20 women in Tai Chi Group, 20 women in brisk walking group, and 20 healthy elderly women in control group were included. They were tested on walking up and down stairs, including single task, cognitive task, manual task, and combined task. The kinematic and dynamic data of walking were collected simultaneously by Vicon motion capture system and Kistler force measurement system.   RESULTS AND CONCLUSION: (1) Regarding physical stability indicators, compared with single task, the distance between the center of mass and the center of pressure and the distance between the center of mass and the center of pressure were significantly increased (P=0.002, P=0.021), and the height of lifting foot (P=0.018) was significantly decreased in the control group. In the Tai Chi group, only the distance of climbing stairs and lifting feet decreased significantly (P=0.034); and in the Tai Chi group, the distance between the front and back of the centroid and the inside and outside of the centroid was significantly smaller than that in the control group (P=0.041, P=0.006); the foot-lifting distance of walking down stairs was significantly greater than that of the control group (P <  0.001). (2) In terms of lower limb, hip, knee and ankle joint kinematics, in the movement and combination task conditions, in the control group, ankle joint straddle angle increased significantly during ascent (P < 0.001); the ankle joint movement amplitude decreased significantly (P < 0.001), and the straddle angle increased significantly during descent (P < 0.001). The range of motion of ankle was significantly increased during ascent in the Tai Chi group (P < 0.001). In the task paradigm, the range of motion of ankle in the Tai Chi group was significantly larger than that in the control group (P=0.005, P=0.012), and the angle of stride was significantly smaller than that in the control group (P=0.033, P=0.021). (3) Compared with the single task, the peak values of hip extension moment and knee extension moment were significantly decreased (P < 0.001), and the peak value of knee extension moment was significantly increased during ascent (P < 0.001); and the joint torque of lower limb was significantly decreased during descent (P < 0.001). The peak value of knee extension moment in the Taiji group was significantly higher than that in the control group (P < 0.001). (4) It is indicated that long-term Tai Chi exercises can help elderly women strengthen neuromuscular control of lower limbs and increase the height of stepping over steps, thereby enhancing body stability control, resisting dual-task interference, and reducing the risk of falls. Figures and Tables | References | Related Articles | Metrics

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Changes in kinematic parameters after unicompartmental knee arthroplasty and high tibial osteotomy Liu Shaohua, Zhou Guanming, Chen Xicong, Xiao Keming, Cai Jian, Liu Xiaofang 2022, 26 (3):  390-396.  doi: 10.12307/2022.064 Abstract ( 525 )   PDF (1351KB) ( 186 )   Save BACKGROUND: Unicompartmental knee arthroplasty and high tibial osteotomy are two effective methods for the treatment of medial compartment osteoarthritis of the knee. However, there is still a lack of medium and long-term efficacy observation, and there is no study to analyze and compare the postoperative kinematic parameters of the two. OBJECTIVE: To investigate the clinical efficacy and kinematic parameters of unicompartmental knee arthroplasty and high tibial osteotomy in the treatment of medial compartment osteoarthritis of the knee. METHODS:  Clinical data of 97 patients with osteoarthritis in the medial compartment of the knee who were admitted to the Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine from January 2016 to June 2017 and met the inclusion criteria were retrospectively collected. According to different surgical methods, they were divided into two groups, including 49 cases in unicompartmental knee arthroplasty group and 48 cases in high tibial osteotomy group. The range of motion, Lysholm knee score, Tegner knee motion score and tibiofemoral angle of the two groups were recorded and compared before operation and 1, 2, 3 years after operation. Simultaneously, Opti-Knee three-dimensional motion analysis system was used to record the three-dimensional six degree of freedom range of motion of knee joint during gait before and 1, 2, 3 years after operation.   RESULTS AND CONCLUSION: (1) Both groups of patients healed by first intention and had no complications related to endophytes. All patients were followed up. (2) The range of motion, Tegner knee score, Lysholm knee score, tibiofemoral angle and knee kinematics parameters of the two groups were significantly improved 3 years after operation (P < 0.05). However, there was no significant difference in above indexes between the two groups (P > 0.05). (3) It is suggested that both unicompartmental knee arthroplasty and high tibial osteotomy can effectively improve knee joint function and correct deformity, and can effectively improve gait parameters for patients with medial compartment osteoarthritis of knee joint. The curative effect of the two methods is similar, but the long-term efficacy needs further study. Figures and Tables | References | Related Articles | Metrics

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Mobi-C combined with ROI-C fusion cage versus ROI-C fusion cage alone for the treatment of two-level cervical spondylosis: midterm efficacy follow-up Zhang Qi, Xiong Yang, Yu Xing, Yang Yongdong, Song Jiawei, Qiu Ziye, Ma Yukun, Jiang Guozheng, Feng Ningning, Wang Shuyang 2022, 26 (3):  397-402.  doi: 10.12307/2022.065 Abstract ( 439 )   PDF (1246KB) ( 82 )   Save BACKGROUND: Previous studies have reported that anterior cervical hybrid surgery (Hybrid surgery) combined with partial artificial discs and fusion prostheses can obtain satisfactory early and mid-term clinical results, but for different prostheses, its application and clinical efficacy are still unclear.   OBJECTIVE: To compare the clinical and radiological outcomes of treating two-level cervical spondylosis using Mobi-C combined with ROI-C in a hybrid surgery with anterior cervical discectomy and fusion and ROI-C alone. METHODS:  Ninety-one patients with contiguous two-level cervical degenerative disc diseases, who were treated at Third Department of Orthopedics, Dongzhimen Hospital from March 2015 to May 2016 and received at least 4 years of effective follow-up, were included in this study. Among them, 48 cases underwent anterior cervical hybrid surgery as hybrid group; and 43 cases underwent anterior cervical discectomy and fusion as anterior cervical discectomy and fusion group. The following indicators were compared between the two groups. Clinical outcomes included visual analogue scales score for neck and upper limb pain, modified Japanese orthopaedic association, Neck disability index, patient satisfaction at preoperatively, 2 weeks postoperatively and the last follow-up. Radiological outcomes included C2-C7 range of motion, Mobi-C index level range of motion, range of motion at superior adjacent level, range of motion at inferior adjacent level, curvature of the operated levels, subsidence rate and fusion rate at ROI-C index levels preoperatively, 1 month postoperatively and the last follow-up.   RESULTS AND CONCLUSION: (1) Clinical outcomes: At the last follow-up, scores of the two groups were significantly improved compared with preoperatively (P < 0.05), but the differences between groups were not significant (P > 0.05). (2) Radiological outcomes: At the last follow-up, the C2-C7 global range of motion in the hybrid group was significantly larger than that in the anterior cervical discectomy and fusion group [(40.84±15.19)° vs. (30.78±12.10)°, P < 0.05]. The curvature of the operated levels in both groups was improved significantly after surgery (P < 0.05), but there was no significant difference between the two groups (P > 0.05). There was no significant difference in range of motion of adjacent segments between the two groups (P > 0.05). The subsidence rates of ROI-C fusion were 26.09% and 36.00% in the hybrid group and anterior cervical discectomy and fusion group, respectively; and no significant difference was found between the two groups (P > 0.05). (3) It is indicated that Mobi-C combined with ROI-C is a safe and effective method for the treatment of contiguous double-level cervical spondylosis. It is not inferior to that of anterior cervical discectomy and fusion in the middle-stage clinical treatment, and it has certain advantages for retaining cervical movement. Bone resorption may be an integral component in the early stage of bony fusion in the ROI-C cage index level. Related Articles | Metrics

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Cortical bone trajectory in elderly patients with osteoporosis of lumbar disease Cai Feng, Yu Bo, Zeng Duo, Chen Qincan, Liao Qi 2022, 26 (3):  403-407.  doi: 10.12307/2022.066 Abstract ( 406 )   PDF (1544KB) ( 59 )   Save BACKGROUND: In patients with lumbar spine disease combined with osteoporosis, the loss of bone mass and the destruction of trabecular bone structure reduce the holding power of traditional pedicle screws, which can easily cause complications, such as screw loosening, fracture, and loss of vertebral body height. It is one of the common reasons for the failure of lumbar spine surgery.   OBJECTIVE: To explore the effect of cortical bone trajectory in osteoporosis of lumbar disease. METHODS:  From January 2019 to February 2020, 60 patients with osteoporosis of lumbar disease in the Third Affiliated Hospital of Nanchang University were randomly divided into two groups. The control group received the fixation with traditional pedicle screw. The observation group received the fixation with cortical bone screws. Both groups were treated with posterior lumbar fusion. Operation time, intraoperative blood loss, postoperative drainage volume, vertebral fusion rate after operation, and any related complications were recorded in the two groups. Japanese Orthopaedic Association scores were compared preoperatively and 3 and 6 months postoperatively.   RESULTS AND CONCLUSION: (1) There was no statistically significant difference in the fusion rate between the two groups (P > 0.05). (2) Operation time, intraoperative blood loss, and postoperative drainage volume were better in the observation group than those in the control group (P < 0.05). (3) After surgery, in the control group, complications occurred in six patients, including failure of internal fixation in two cases, infection in two cases and cerebrospinal fluid leakage in two cases. There was no complication in the observation group. (4) Japanese Orthopaedic Association scores were better in the observation group than those in the control group at 3 and 6 months postoperatively (P < 0.05). (5) It is indicated that compared with traditional pedicle screw fixation, cortical bone trajectory can not only significantly improve the symptoms of lumbar disease, but also reduce operation time, intraoperative blood loss and postoperative drainage volume, and reduce intraoperative complications. Figures and Tables | References | Related Articles | Metrics

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Effects of robot-assisted percutaneous minimally invasive pedicle screw placement in oblique lumbar interbody fusion Feng Shuo, Liu Bo, He Da 2022, 26 (3):  408-413.  doi: 10.12307/2022.067 Abstract ( 471 )   PDF (1396KB) ( 89 )   Save BACKGROUND: The technique of oblique lumbar interbody fusion has become increasingly mature, but when pedicle screw internal fixation is performed through posterior approach, the fluoroscopy-assisted pedicle screw insertion using a traditional open technique still brings greater trauma to the patient. With the advancement of technology, robot-assisted surgery systems have provided clinicians with new options.   OBJECTIVE: To explore the clinical outcomes of percutaneous robot-assisted minimally invasive pedicle screw insertion in an oblique lumbar interbody fusion procedure. METHODS:  Totally 78 patients with lumbar degenerative disease who attended Department of Spinal Surgery, Beijing Jishuitan Hospital were treated with oblique lumbar interbody fusion. When lumbar pedicle screw internal fixation was performed through posterior approach, 36 cases (trial group) underwent percutaneous robot-assisted minimally invasive pedicle screw insertion, and 42 cases (control group) underwent fluoroscopy-assisted open invasive screw insertion. The difference in operation time, visual analogue scale score, Oswestry disability index, intraoperative and postoperative blood loss was compared between the two groups.   RESULTS AND CONCLUSION: The operative time of trial group was shorter than that of control group (P < 0.05). The postoperative visual analogue scale score of the trial group was lower than that of the control group (P < 0.05). The amount of intraoperative and postoperative blood loss in the trial group was less than that in the control group (P < 0.05). It is concluded that robot-assisted pedicle screw insertion in oblique lumbar interbody fusion can shorten the operative time, reduce intraoperative blood loss, lessen risk of surgical complications, and reduce the soft tissue damage of lumbar spine. Figures and Tables | References | Related Articles | Metrics

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Stability of balloon dilation with injectable calcium sulfate cement for tibial plateau fractures Chen Jinmin, Chen Suisheng, Ding Jing, Xia Baoquan, Luo Xiaojia, Lu Chenghai 2022, 26 (3):  414-418.  doi: 10.12307/2022.068 Abstract ( 402 )   PDF (1301KB) ( 70 )   Save BACKGROUND: A metaphyseal cavity will be left after reduction of the tibial plateau collapse fractures. It is an urgent problem to stuff the cavity effectively and maintain satisfied support.   OBJECTIVE: To compare the stability of different minimally invasive treatment of Schatzker type III tibial plateau fracture. METHODS:  Totally 32 proximal tibia specimens were harvested and were randomly divided into four groups. Specimens were left intact as control group. The remaining three groups uniformly made fresh cadaver models of Schatzker type III tibial plateau fractures. Standard group received conventional treatment of percutaneous reduction by leverage and fixed with two cancellous screws. Bone cement group was reduced with percutaneous balloon distension and strengthened by injectable calcium sulfate cement. Bone cement screw group was reduced with percutaneous balloon distension and strengthened with injectable calcium sulfate cement and two cancellous screws. Stiffness and displacement with 350 N loading, stiffness and loading with 3 mm displacement, and displacement with maximum loading were compared. The position of fractures, bone cement and screws were observed.   RESULTS AND CONCLUSION: (1) Under 350 N, the displacement comparison among the groups: control group < bone cement screw group < bone cement group < standard group, the difference was significant (P < 0.05). Comparison of stiffness among groups: control group > bone cement screw group > bone cement group > standard group, the difference was significant (P < 0.05). (2) With 3 mm displacement, load comparison among groups: bone cement screw group > control group > bone cement group > standard group, the difference was significant (P < 0.05). Comparison of stiffness among groups: bone cement screw group > control group > bone cement group > standard group, the difference was significant (P < 0.05). (3) It is concluded that calcium sulfate cement could provide good filling capacity in tibial plateau fractures. Combined with cancellous screws, its support and stability could be improved. There is clinical value for percutaneous balloon distension with calcium sulfate cement in minimally invasive treatment of depressed tibial plateau fracture. Figures and Tables | References | Related Articles | Metrics

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Evaluation value of cervical sagittal plane sequence parameters on pain, cervical function and clinical efficacy in patients with cervical spondylotic myelopathy Cao Sheng, Kong Lingwei, Xu Kun, Sun Zhijie 2022, 26 (3):  419-424.  doi: 10.12307/2022.069 Abstract ( 428 )   PDF (1265KB) ( 79 )   Save BACKGROUND: Cervical spondylotic myelopathy is induced by the degeneration of the intervertebral junction structure of the cervical spine. The sequence parameters of the sagittal plane of the cervical spine can directly reflect the degeneration of cervical spondylotic myelopathy, which may provide reference for clinical evaluation of the condition and treatment effect.   OBJECTIVE: To explore the correlation of the changes of cervical sagittal plane sequence parameters and pain degree and cervical function in patients with cervical spondylotic myelopathy, and to analyze its value in clinical efficacy evaluation. METHODS:  From January 2019 to January 2020, 80 cervical spondylotic myelopathy patients in Affiliated Hospital of Chengde Medical College were selected as the trial group, and 80 asymptomatic adult volunteers during the same period were selected as the control group according to the 1∶1 principle. The parameters of the cervical spine sagittal plane sequence [C2-7 Cobb's angle, T1 tilt angle, cervical sagittal axial distance, ratio of C2-7 Cobb’s angle to T1 tilt angle (C2-7/T1)] were compared between the two groups. The relationship between the parameters of the cervical spine sagittal plane sequence and the occurrence of cervical spondylotic myelopathy was analyzed. After follow up for 6 months, according to the Japanese Orthopaedic Association score, they were divided into excellent group (Japanese Orthopaedic Association score improvement rate ≥ 50%) and non-excellent group (Japanese Orthopaedic Association score improvement rate < 50%). The clinical data of patients with different curative effects, the pain (visual analogue scale) score before and after the operation, the Japanese Orthopaedic Association score, and the changes in the parameters of the cervical sagittal plane sequence were compared. The correlation between the cervical spine sagittal sequence parameters and visual analogue scale, Japanese Orthopaedic Association scores and curative effect was analyzed, and the receiver operating characteristic curve was used to evaluate the evaluation value of each parameter to curative effect.   RESULTS AND CONCLUSION: (1) The C2-7 Cobb’s angle and C2-7/T1 of the trial group were smaller than those of the control group. T1 tilt angle and cervical sagittal axial distance were greater in the trial group than those of the control group (P < 0.05). C2-7 Cobb’s angle, T1 tilt angle, cervical sagittal axial distance, and C2-7/T1 were significantly correlated with the occurrence of cervical spondylotic myelopathy (P < 0.05). (2) The comparison of the compression segment, operation method, visual analogue scale and Japanese Orthopaedic Association scores before operation, 1 and 6 months after operation of patients in the excellent and non-excellent groups showed statistically significant differences (P < 0.05). (3) The C2-7 Cobb’s angle and C2-7/T1 of the excellent group before operation, 1 and 6 months after the operation were greater than those of the non-excellent group. T1 tilt angle and cervical sagittal axial distance were lower in the excellent group than those of the non-excellent group (P < 0.05). (4) Visual analogue scale score was positively correlated with T1 tilt angle and cervical sagittal axial distance before operation, 1 and 6 months after operation, and negatively correlated with C2-7 Cobb’s angle and C2-7/T1. Japanese Orthopaedic Association score was positively correlated with C2-7 Cobb’s angle and C2-7/T1 before operation, 1 and 6 months after operation, and negatively correlated with T1 tilt angle and cervical sagittal axial distance (P < 0.05). (5) After controlling for other factors such as compression segment and operation method, C2-7 Cobb’s angle, T1 tilt angle, cervical sagittal axial distance, and C2-7/T1 before operation, 1 and 6 months after operation were still significantly related to the curative effect (P < 0.05). (6) The area under curve value of the combined predictive efficacy of cervical spine sagittal sequence parameters at 6 months after surgery was 0.872, which was greater than that of any parameter alone. (7) It is suggested that the sequence parameters of cervical sagittal plane are closely related to the visual analogue scale and Japanese Orthopaedic Association scores of cervical spondylotic myelopathy patients. They are independent factors that affect the surgical results of such patients. The combined examination can provide references for early clinical evaluation of surgical results and improvement of surgical plans. Figures and Tables | References | Related Articles | Metrics

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Semi-quantitative MRI evaluation of cartilage degeneration in early knee osteoarthritis Zhang Jian, Lin Jianping, Zhou Gang, Fang Yehan, Wang Benchao, Wu Yongchang 2022, 26 (3):  425-429.  doi: 10.12307/2022.070 Abstract ( 516 )   PDF (1360KB) ( 96 )   Save BACKGROUND: Knee osteoarthritis is a common chronic and aseptic inflammation of the knee joint. Its pathological changes start from the articular cartilage. The current diagnosis of this disease mainly depends on clinical manifestations and imaging. However, when the cartilage undergoes pathological changes, the clinical manifestations and X-ray films often show negative results, so MRI has become an important non-invasive examination to identify articular cartilage degeneration.   OBJECTIVE: To explore the application value of MRI Osteoarthritis Knee Score in the early cartilage degeneration knee osteoarthritis. METHODS:  Seven Wuzhishan miniature pigs were selected to establish knee osteoarthritis models. Every pig was narcotized, and the anterior cruciate ligament was dissected and stripped in experimental knees. Only the joint capsule of knee in control knees was opened. The joint capsule, subcutaneous tissue and skin were sutured in all knees, and anti-infection treatment was given after operation. At 26 weeks, MRI screening and MRI Osteoarthritis Knee Score were performed on the experimental and control knee joints. Total MRI Osteoarthritis Knee Score was equal to any defect score + full-thickness defect score.   RESULTS AND CONCLUSION: (1) In the comparison of size of any cartilage loss scores, the experimental side and the control side had statistical differences in the scores of the lateral femur, medial tibia, and lateral tibia (P < 0.05). (2) In the comparison of the full-thickness cartilage loss score, the experimental side and the control side had statistical differences in the scores of each region of the knee joint (P < 0.05). (3) In the comparison of the total scores of articular cartilage injury, the scores of the knee joints of the experimental side and the control side were statistically different (P < 0.05). The scores of femoral region and tibial region were statistically different between the experimental side and the control side (P < 0.05). (4) There was a statistically significant difference in the sub-division scores of the medial femoral area on the experimental side of the knee joint (P < 0.05), and there was no statistical difference in the scores of the other sub-divisions of lateral femur, lateral tibia, medial tibia (P > 0.05). (5) It is indicated that the MRI Osteoarthritis Knee Score system can quantify and analyze knee osteoarthritis cartilage degeneration, and refine the ladder treatment of knee osteoarthritis. It is worth promoting and using in clinical work. Figures and Tables | References | Related Articles | Metrics

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Imbalance of mechanical properties about bilateral shoulder and neck muscle in patients with cervical spondylotic radiculopathy using MyotonPRO Chen Weijian, Chen Zehua, Wu Jiatao, Xu Xuemeng, Du Jianping 2022, 26 (3):  430-434.  doi: 10.12307/2022.071 Abstract ( 519 )   PDF (1251KB) ( 46 )   Save BACKGROUND: Studies had shown that the mechanical properties of the shoulder and neck muscles in cervical spondylotic radiculopathy are altered and correlated with the degree of symptoms.   OBJECTIVE: To compare the mechanical properties of upper trapezius and sternocleidomastoid muscle in cervical spondylotic radiculopathy patients by MyotonPRO, and to explore the causes of shoulder and neck muscle imbalance in cervical spondylotic radiculopathy patients so as to provide a basis for the prevention and treatment of the disease and rehabilitation exercises. METHODS:  Totally 25 patients with cervical spondylotic radiculopathy and 25 normal people matched with baseline data were selected. MyotonPRO was used to measure the tension and hardness of sternocleidomastoid muscle and superior trapulus muscle for comparison. The muscle performance imbalance of cervical spondylotic radiculopathy patients and normal people was compared by calculating the asymmetry index. Visual analogue scale score and Northwick Park Neck Pain Questionnaire scores of cervical spondylotic radiculopathy patients were collected for correlation analysis.   RESULTS AND CONCLUSION: (1) The mean values of upper trapezius and sternocleidomastoid muscle tension and stiffness on both sides of cervical spondylotic radiculopathy group were higher than those of the healthy group. The upper trapezius tension and stiffness of the affected side were higher than those of the contralateral side in the cervical spondylotic radiculopathy group, and the differences were statistically significant (all P < 0.05). (2) The upper trapezius and sternocleidomastoid muscle tension and stiffness asymmetry indexes in cervical spondylotic radiculopathy group were significantly different from those in the healthy group (all P < 0.05). These indicated that the muscle tension and stiffness in the cervical spondylotic radiculopathy group were higher than those in the normal group. (3) Visual analogue scale score and Northwick Park Neck Pain Questionnaire score were significantly positively correlated with upper trapezius tension and stiffness (all P < 0.05). (4) Due to the influence of local soft tissue inflammation, pain and posture, cervical spondylotic radiculopathy patients usually show increased tension and stiffness of the superior trapezius muscle and sternocleidomastoid muscle. There is an obvious imbalance of tension and stiffness of the left and right sides. This change in muscle mechanics was positively correlated with pain and quality of life. Therefore, in the prevention and treatment of cervical spondylotic radiculopathy, attention should be paid to the imbalance of muscle tension and stiffness, and the imbalance should be corrected. Figures and Tables | References | Related Articles | Metrics

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Relationship between glenoid version angle and degenerative rotator cuff full-thickness tear: matched case control trial Wu Yafei, Zhu Liang, Ren Qiujian, Li Daen, Li Dadi, Gao Xuren, Guo Kaijin 2022, 26 (3):  435-439.  doi: 10.12307/2022.072 Abstract ( 390 )   PDF (1168KB) ( 82 )   Save BACKGROUND: Rotator cuff tear is a common cause for shoulder pain and dysfunction. The morphology of scapular glenoid has always been an important research topic of degenerative rotator cuff tear.   OBJECTIVE: To explore the relationship between glenoid version angle, scapular glenoid size and degenerative rotator cuff full-thickness tear. METHODS:  In a matched case-control study, 36 patients with full-thickness rotator cuff tears diagnosed by MRI and shoulder arthroscopy in the Affiliated Hospital of Xuzhou Medical University from February 2020 to February 2021 were selected as the trial group. The 36 patients with non-shoulder diseases in the same period were selected as the control group according to the age, sex and number of the subjects. Chest CT was performed on admission in both groups. The glenoid version angle and anteroposterior diameter of scapular glenoid were measured by the same orthopedic surgeon on the chest CT, and the difference of the glenoid version angle between the two groups was statistically analyzed.   RESULTS AND CONCLUSION: (1) The glenoid version angle: in the trial group (-3.5±4.6)°, compared with the control group (-1.9±3.9)°, there was a more obvious posterior inclination (P < 0.05). (2) In the trial group, the anteroposterior diameter of the scapular glenoid was (26.8±3.3) mm. In the control group, the anteroposterior diameter of the scapular glenoid was (27.2±3.6) mm (P > 0.05). (3) The shoulder joints of the control group were divided into left and right groups, and the results showed that the left scapular glenoid version angle was (-1.85±5.42)°, and the right scapular glenoid version angle was (-2.01±6.18)°. There was no significant difference between the two groups (P > 0.05). (4) When the patients were divided into groups according to sex, the results showed that there was a significant difference in the anteroposterior diameter of the scapular glenoid between males and females (P < 0.05). (5) It is concluded that there is no significant correlation between the size of the scapular glenoid (anteroposterior diameter) and the full-thickness tear of the rotator cuff, but results found the size characteristics of the scapular glenoid, the consistency of the left and right shoulders, and the significant differences between men and women. It is believed that it can provide guidance for the design of shoulder prosthesis in Chinese. There is a significant correlation between the glenoid version angle and the full-thickness rotator cuff tear. Excessive retroversion of the scapular glenoid may be a risk factor for degenerative full-thickness rotator cuff tear. Measuring the glenoid version angle is helpful for the diagnostic evaluation of full-thickness rotator cuff tear. Figures and Tables | References | Related Articles | Metrics

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Correlation analysis between the morphological changes of ankle acupoints and the ankle function after ankle fracture surgery Liu Yubo, Zhang Huizeng, Zhang Tongrun, Sui Gengyi, Ma Nan, Cheng Xu, Gao Xupeng, Xu Jing, Wang Chaoliang 2022, 26 (3):  440-445.  doi: 10.12307/2022.073 Abstract ( 583 )   PDF (1285KB) ( 168 )   Save BACKGROUND: The recovery of joint anatomical morphology after ankle fracture surgery has a great impact on the range of motion and joint function. Previous studies only focused on the postoperative height recovery of ankle acupoints, so it is of great significance to study the correlation between the morphological changes of ankle acupoints and the functional changes after fracture surgery.   OBJECTIVE: To explore the correlation between the morphological changes of ankle acupoints, ankle joint function and ankle joint range of motion after ankle joint fracture surgery, and analyze the prognostic factors of ankle joint function. METHODS:  A total of 268 patients with unilateral ankle fractures admitted to General Hospital of Jizhong Energy Xingtai Mining Group Co., Ltd. from January 2017 to December 2018 were included in this study. According to the Mazur scoring method, the function of the affected ankle joint of all patients was scored and grouped: 132 cases in the excellent group (93-100 scores), 65 cases in good group (87-92 scores), and 71 cases in average and poor group (< 87 scores). The difference between the morphological indicators (width, depth, sagittal angle and coronal angle of the ankle acupoint) on the affected side and the uninfected side of the patients was compared in different groups at the last follow-up. Pearson correlation was used to analyze the correlation between the morphological change indicators of ankle acupoints, ankle joint function and ankle joint range of motion. Multivariate ordered logistic regression was used to analyze the related independent risk factors affecting the recovery of the patient’s ankle joint function.   RESULTS AND CONCLUSION: (1) Compared with the healthy side, the width and depth of the ankle acupoint on the affected side, as well as the coronal and sagittal angles were significantly increased (P < 0.001); and the patient’s dorsiflexion range of motion, plantar flexion range of motion, dorsiflexor strength, and strength of plantar flexor muscles decreased significantly on the affected side (P < 0.001). (2) At the last follow-up, there were statistically significant differences in the ankle acupoint width, ankle acupoint depth, coronal angle, and sagittal angle difference between the affected side and the healthy side of the three groups of patients in the excellent, good, average and poor groups (P < 0.001). (3) Pearson correlation analysis showed that the width of the ankle acupoint, the depth of the ankle acupoint, the coronal angle, and the sagittal angle of the affected side of the patient were significantly negatively correlated with the degree of dorsiflexion range of motion, plantar flexion range of motion, dorsiflexor strength, and plantar flexor strength (P < 0.05). (4) The results of multiple ordered logistic regression analysis showed that age > 60 years old, fracture classification, starting recovery time > 7 days, no calcaneal traction, and ankle acupoint morphology indicators (the width of ankle acupoints on the affected side and the uninfected side, the depth of ankle acupoints, and the coronal position angle and sagittal angle difference) were independent factors that affect the functional recovery of patients with ankle fractures after surgery, and not conducive to the recovery of ankle joint function. (5) Above results confirmed that there was a negative correlation of ankle hole shape change with the function of ankle joint and ankle range of motion. The ankle hole width, ankle hole depth, coronal and sagittal position angle difference between the affected side and the healthy side increased. Older age, no calcaneal traction, late rehabilitation training time, and type C fractures were independent risk factors for the knee joint function decline. Therefore, clinical attention should be paid to these patients. Figures and Tables | References | Related Articles | Metrics

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Application of 4D bioprinting in tissue engineering Guan Jian, Jia Yanfei, Zhang Baoxin , Zhao Guozhong 2022, 26 (3):  446-455.  doi: 10.12307/2022.074 Abstract ( 757 )   PDF (1445KB) ( 336 )   Save BACKGROUND: 3D bioprinting has become a crucial research field of tissue engineering with the unceasing development of science and technology. Nevertheless, some limitations cannot be resolved. 4D bioprinting is the most emerging technology, and has become the major solution for the next generation of tissue engineering. OBJECTIVE: To introduce the materials and methods of 4D bioprinting in accordance with various shape transformation principles, and to explore the application of 4D bioprinting to tissue engineering and the current challenges. METHODS: “4D bioprinting, 4D biofabriation, printing, smart materials, smart scaffold, shape memory polymers, tissue engineering” in Chinese and English were utilized as search terms. A total of 127 related articles published from January 1, 2016 to January 1, 2021 were retrieved from CNKI, PubMed, and SCIE databases. After screening out by the first author and adding high-quality references, 106 articles were included for review.  RESULTS AND CONCLUSION: (1) 4D bioprinting, the latest emerging technology, combines the concept of time with 3D bioprinting as the fourth dimension. 4D bioprinting can create complex and functional structures. (2) 4D bioprinting can make dynamic 3D biological structures by using smart materials. These structures can alter shape under various stimuli. (3) The functional transformation and maturation of printed cell structures are also considered a form of 4D bioprinting. (4) This technology provides an unprecedented potential for tissue engineering. In the field of biomedicine, although this technology has attracted great attention, more research and development are needed to realize clinical application, because it is still in the emerging stage. Figures and Tables | References | Related Articles | Metrics

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Pathogenesis of femoral head necrosis after internal fixation of femoral neck fractures in young adults Liang Haoran, Zhou Xin, Yang Yanfei, Niu Wenjie, Song Wenjie, Ren Zhiyuan, Wang Xueding, Liu Yang, Duan Wangping 2022, 26 (3):  456-460.  doi: 10.12307/2022.075 Abstract ( 404 )   PDF (1142KB) ( 98 )   Save BACKGROUND: The prevention of femoral head necrosis after femoral neck internal fixation in young adults is still a challenge in the field of orthopedics. The pathogenesis of femoral head necrosis after internal fixation of femoral neck fractures in young adults is still a topic of discussion. OBJECTIVE: To review the pathogenesis of femoral head necrosis after internal fixation of femoral neck fractures in young adults. METHODS: PubMed, EMbase, Wanfang database, VIP and CNKI were retrieved for related articles on femoral necrosis after internal fixation of femoral neck fractures in young and middle-aged people published from 2010 to 2021 by computer. The keywords were “femoral neck fracture, femoral head necrosis, finite element analysis, mechanics, stress, screws, implants, blood supply, molecular biology, genes” in Chinese and English.  RESULTS AND CONCLUSION: After internal fixation of femoral neck fractures in young adults, whether the internal fixation is removed or not can lead to the occurrence of femoral head necrosis. When the internal fixation is taken out, it is easy to cause micro fractures or even fractures again. When the internal fixation is not removed, with the long-term retention of the internal fixation, a large amount of sclerotic bone is formed around the internal fixation, which may be one of the important mechanical mechanisms of femoral head necrosis and rapid collapse after femoral neck fracture in young adults. Through literature analysis of different fracture models and different types of internal fixation, it can be seen that although the inverted triangle structure is the best treatment method, it is still inevitable that the stress concentration will lead to the formation of sclerotic bone, and ultimately lead to the necrosis and collapse of the femoral head. Therefore, we propose to take the nails at the right time before the formation of hardened bone around the internal fixation, and insert a new type of high-strength, degradable, microporous structure, and promote osteogenesis and vascularization, to avoid stress concentration. Internal fixation is used to inhibit the formation of sclerotic bone, which can stop the occurrence of femoral head necrosis. Figures and Tables | References | Related Articles | Metrics

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Application of intramedullary nailing in the treatment of long tubular bone fractures of the extremities: reaming and non-reaming Liu Zemin, Lü Xin 2022, 26 (3):  461-467.  doi: 10.12307/2022.076 Abstract ( 527 )   PDF (1846KB) ( 115 )   Save BACKGROUND: With the advantages of central fixation, elastic fixation and avoiding stress shielding, intramedullary nail is often used in the treatment of long tubular bone fractures of extremities. The choice of reaming and non-reaming before intramedullary nail implantation has its own advantages and disadvantages, and there is no consensus at present. OBJECTIVE: To summarize the controversial points of reaming and non-reaming, as well as the application status and development direction of intramedullary nail reaming and non-reaming in the treatment of long tubular bone fractures of extremities. METHODS: PubMed, Web of science, CNKI and Wanfang database were searched from January 1900 to March 2021 with the key words of “intramedullary reaming nail, non-reaming nail, femur, tibia, humerus” in Chinese and English, and the full text was searched by manual search. After inclusion and exclusion criteria screening, 57 articles were included in the final review.  RESULTS AND CONCLUSION: (1) In the treatment of long tubular bone fractures, reamed and non-reamed intramedullary nail fixations have their own advantages and disadvantages. Reaming operation time is longer, and the risk of pulmonary cerebral embolism is high, but the patients heal quickly and the risk of postoperative locking nail fracture is small, while the time of non-reaming operation is relatively short. (2) The increase of intramedullary pressure and pulmonary cerebral embolism caused by reaming are common in femoral shaft fractures, high speed and slow reaming can reduce the increase of intramedullary pressure and further reduce the risk of pulmonary cerebral embolism. (3) Reaming converts the centrifugal blood flow of the shaft into centripetal blood flow. Simultaneously, the local release of growth factors that promote fracture healing can enhance the osteogenesis of the fracture site. (4) Compared with non-reaming, moderate reaming can be placed into a larger diameter intramedullary nail to increase the contact area of the parietal bone and improve the overall biomechanical stability. (5) Reaming will lead to the destruction of intramedullary blood supply, but extramedullary blood supply will be compensated to make up for the lack of intramedullary blood supply. (6) Fractures of distal humerus were fixed with reamed intramedullary nail in order to avoid iatrogenic fracture. Because of its large medullary diameter and reduced bone strength, the effect of non-reamed intramedullary nail is better for elderly femoral intertrochanteric fracture. For femoral shaft fracture, because of abundant surrounding soft tissue, it can provide good blood supply. For the sake of cost-effectiveness analysis and avoiding the risk of infection, the effect of non-reamed intramedullary nail is better for open tibial fracture. Closed tibial fracture after reaming has the advantages of fast fracture healing, high excellent and good rate, early functional exercise and so on. Reamed intramedullary nail is recommended for the treatment of closed tibial fracture. Figures and Tables | References | Related Articles | Metrics

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Development and application of hexapod external fixator in the treatment of lower limb deformity Zhang Xingdong, Zhang Yonghong, Wang Dong 2022, 26 (3):  468-473.  doi: 10.12307/2022.077 Abstract ( 603 )   PDF (1204KB) ( 106 )   Save BACKGROUND: The number of patients with osteomyelitis, bone defects, and lower extremity deformities due to open fractures of the lower limb has increased significantly, leading to an increasing use of Ilizarov circular external fixators. Although the Ilizarov circular external fixator has achieved good results in the treatment of these conditions, there are still many defects. OBJECTIVE: To summarize the progress of the development and application of hexapod external fixator in the treatment of lower limb deformity. METHODS: Articles from PubMed, CNKI and Wanfang database from february 2001 to february 2021 were retrieved with the key words of “hexapod external frame, taylor spatial frame, ortho-SUV, truelok-Hex” in both English and Chinese. Fifty articles were included, and the application progress of the hexapod external fixator in the treatment of lower limb deformity was reviewed.  RESULTS AND CONCLUSION: (1) The application of circular external fixator in the treatment of extremities fracture and limb deformity that are not suitable for internal fixation has achieved positive results, and can be used to pull bone and regenerate soft tissue following the tension-stress rule, curing various diseases that cannot be treated by traditional orthopedic technology. (2) The Ilizarov circular fixator suffers from defects such as long treatment cycle, complex operation and high requirement on physician experience. (3) The main feature of the hexapod external fixator is that it forms a virtual hinge through six adjustable telescopic struts to realize multi-plane deformities and correct simultaneously, and there is no need to replace the hinge during the treatment. With the help of computer software, the accuracy of correction is improved significantly, and the residual rate of malformation is reduced significantly. (4) The hexapod external fixator has been widely used in the treatment of lower limb non-union, bone defect, clubfoot, joint deformity and other diseases, and can significantly reduce the incidence of postoperative complications compared with the Ilizarov circular external fixator. (5) The shortcomings of the hexapod external fixator, such as poor stability, misuses, difficult learning process and high price, make it unable to be further popularized. (6) In the future, it is necessary to improve the prescription software, reduce the influence of human factors, gradually realize intellectualize and informationize hexapod external fixator. Also, it is critical to achieve independent research and development and reduce the cost of use so as to make hexapod external fixator being widely used. Figures and Tables | References | Related Articles | Metrics

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Screw placement in posterior route pedicle on subaxial cervical spine: how to improve the therapeutic effect with the development of artificial intelligence Li Lu, Tang Wen 2022, 26 (3):  474-479.  doi: 10.12307/2022.078 Abstract ( 503 )   PDF (1205KB) ( 85 )   Save BACKGROUND: Because of its excellent biomechanical advantages, pedicle screw of subaxial cervical spine is widely used in various cervical spine diseases caused by trauma, tumors and deformities. How to improve the accuracy of nail placement and reduce postoperative complications has been hotspots in the research of the placement technology of the pedicle screw of subaxial cervical spine. OBJECTIVE: To review relevant domestic and foreign articles, to review the related anatomical characteristics of the placement technology of the pedicle screw of subaxial cervical spine, the biomechanical characteristics of pedicle screw of subaxial cervical spine and the research on the screw placement technology in and outside china, and to analyze the advantages and disadvantages of each placement technology. METHODS: Relevant articles in PubMed, Web of Science, CNKI, Wanfang and other databases were searched using “cervical, pedicle” in English, and “cervical vertebrae, pedicle” in Chinese as search terms. Related Chinese articles published from January 2015 to December 2020 and related English articles published in the past 5 years were searched. Finally, 52 articles were included, including 22 Chinese articles and 30 English articles.  RESULTS AND CONCLUSION: (1) Regarding the thickness and strength of the cortex, the inner wall of the pedicle was higher than that of the outer wall. The abduction angle of the pedicle gradually decreased from C3-C7. The shape of the pedicle was similar to an ellipsoid. The distance between the upper edge of the pedicle and the upper nerve root gradually increased from C3-C7, and the distance between the lower edge of the pedicle and the inferior nerve root gradually decreased from C3-C7. The anterior lateral wall of the pedicle was close to the vertebral artery; and the anterior medial wall of the pedicle was close to the epidural sinus. (2) The penetrating force of the inner wall of the pedicle was greater than the other three side walls. In terms of direct extraction force, pedicle screws were superior to intervertebral foraminal screws and lateral mass screws. In terms of fatigue extraction force, pedicle screws and intervertebral foraminal screws were better than lateral mass screws. (3) At present, screw placement in posterior route pedicle on subaxial cervical spine mainly included freehand screw placement, computer-assisted screw placement, 3D printing guide-assisted screw placement, and surgical robot-assisted screw placement. However, various screw placement techniques have certain drawbacks. In the future, freehand screw placement technology will still be the mainstream of the subaxial cervical pedicle placement technology. With the improvement of technical level and the support of artificial auxiliary equipment, artificial intelligence assisted screw placement technology will become the future development direction. Figures and Tables | References | Related Articles | Metrics

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Open reduction and internal fixation versus circular external fixation for tibial plateau fractures: a meta-analysis Yang Ruijia, Jiang Lingkai, Dong Zhengquan, Wang Yunfei, Ma Zhou, Cong Linlin, Guo Yanjing, Gao Yangyang, Li Pengcui 2022, 26 (3):  480-486.  doi: 10.12307/2022.079 Abstract ( 482 )   PDF (2823KB) ( 96 )   Save OBJECTIVE: Tibial plateau fractures are more prone to postoperative complications and adverse reactions. At present, the most commonly used surgical methods for the treatment of tibial plateau fractures are open reduction with internal fixation and circular external fixators. There are few comparative studies on the prognosis of the two surgical methods. There are many controversies about the choice of surgical method. This article evaluates the clinical efficacy of open reduction internal fixation and circular external fixation for tibial plateau fractures through meta-analysis.   METHODS:  From 2005 to 2020, PubMed, EMbase, Cochrane Library, Wanfang, CNKI, and VIP databases related to open reduction and internal fixation and circular external fixation in the treatment of tibial plateau fractures were searched by computer for clinical randomized controlled trials and retrospective cohort studies. After reading and screening the literature, in turn, the retrospective cohort studies that met the screening requirements were evaluated using the Newcastle-Ottawa Scale. The risk of bias in the randomized controlled trials was evaluated using the Cochrane Handbook standard. RevMan 5.3 software was used to conduct meta-analysis of the data.   RESULTS: (1) A total of 11 articles were included. Among them, 374 patients used open reduction and internal fixation; 316 patients used circular external fixation. Two randomized controlled case trials mentioned random methods. Nine retrospective cohort studies evaluated the literature quality according to the Newcastle-Ottawa Scale, including 3 articles with 8 points, 5 articles with 7 points, 1 article with 6 points; the quality of the literature was good, and the data had good authenticity and reliability. (2) The results of meta-analysis showed that the range of motion (MD=-4.83, 95%CI:-7.01 to -2.65, P < 0.000 1) and postoperative infection rate (OR=0.22, 95%CI:0.13-0.40, P < 0.000 01) in the open reduction and internal fixation group were better than those in the circular external fixation group. The length of hospital stay in the circular external fixation group was better than that in the open reduction and internal fixation group (MD=8.01, 95%CI:7.05-8.96, P < 0.000 01). (3) There was no significant difference in poor postoperative healing, postoperative osteoarthritis, postoperative knee varus, and RSS score between open reduction and internal fixation group and circular external fixation group (P > 0.05). CONCLUSION: in the treatment of tibial plateau fractures, compared with the circular external fixation, the open reduction and internal fixation has a lower risk of postoperative infection and better postoperative range of motion, but patients repaired by the circular external fixation have a shorter hospital stay. Figures and Tables | References | Related Articles | Metrics

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Meta-analysis of efficacy and safety of Jack kyphoplasty for osteoporotic vertebral compression fractures Zhong Yuanming, He Bingkun, Wu Zhuotan, Wu Sixian, Wan Tong, Zhong Xifeng 2022, 26 (3):  487-492.  doi: 10.12307/2022.080 Abstract ( 453 )   PDF (1738KB) ( 60 )   Save OBJECTIVE: Both Jack kyphoplasty and balloon kyphoplasty have satisfactory results in the treatment of osteoporotic vertebral compression fractures. However, whether the two methods are better or not is still controversial. Thus, this study systemically evaluated the efficacy and safety of Jack vertebral dilator-kyphoplasty and balloon-kyphoplasty in the treatment of osteoporotic vertebral compression fracture.  METHODS: Wanfang, VIP, CNKI, PubMed, EMBASE, the Cochrane Library, CBM and other databases were searched by computer before July 2020. The clinical controlled studies on Jack kyphoplasty and balloon kyphoplasty in the treatment of osteoporotic vertebral compression fracture were collected. After two evaluators independently selected literature, extracted data and evaluated the quality of methodology included in the study (according to Cochrane Handbook and NOS scale), meta-analysis was carried out by using Stata/SE 12.0 software. RESULTS: (1) Seven articles were included; the quality of the three randomized controlled trial articles was grade B, and the NOS scores of four cohort studies were greater than 5. A total of 473 patients were included in the final analysis, including 229 cases in Jack kyphoplasty group and 244 cases in balloon kyphoplasty group. (2) The results of meta-analysis showed that Jack kyphoplasty was better than balloon kyphoplasty in terms of Cobb angle (MD=-2.2, 95%CI:-4.07 to-0.36, P=0.001). Jack kyphoplasty was higher than balloon kyphoplasty in terms of anterior vertebral height (MD=2.02, 95%CI:1.08-2.96, P=0.000). Jack kyphoplasty was lower than balloon kyphoplasty in terms of cement leakage rate (RR=0.32, 95%CI:0.15-0.68, P=0.003). There were no significant differences in postoperative visual analogue scale score (MD=-0.07, 95%CI:-0.26-0.13, P > 0.05), bone cement injection (MD=-0.08, 95%CI:-0.21-0.06, P > 0.05], operation time (MD=-0.51, 95%CI:-4.85-3.83, P > 0.05], and intraoperative blood loss (MD=0.44, 95%CI:-0.47-1.35, P > 0.05) between the two groups.   CONCLUSION: Compared with balloon kyphoplasty, Jack kyphoplasty has more advantages in reducing Cobb angle, improving anterior height of vertebral body and reducing cement leakage rate. However, this conclusion still needs to be further confirmed by large-sample and multi-center randomized controlled trials. Figures and Tables | References | Related Articles | Metrics