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28 February 2022, Volume 26 Issue 6 Previous Issue    Next Issue

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Effect of force line changes on lower limb joints after medial open wedge high tibial osteotomy Xu Kuishuai, Zhang Liang, Chen Jinli, Ren Zhongkai, Zhao Xia, Li Tianyu, Yu Tengbo 2022, 26 (6):  821-826.  doi: 10.12307/2022.159 Abstract ( 425 )   PDF (2437KB) ( 85 )   Save BACKGROUND: After the medial open wedge high tibial osteotomy, the deformity of lower limb force line moving inward and knee varus can be corrected, which will inevitably lead to compensatory changes in the position of adjacent joints to adapt to the new force line. Up to now, there are relatively few studies to systematically and comprehensively measure the compensatory changes of hip joint, patellofemoral joint, ankle joint and other adjacent joints from the perspective of imaging.   OBJECTIVE: To analyze the compensatory changes of hip joint, patellofemoral joint, and ankle joint caused by the changes of lower limb force line from the perspective of imaging after medial open wedge high tibial osteotomy. METHODS:  The imaging data of 49 patients who underwent medial open wedge high tibial osteotomy in Affiliated Hospital of Qingdao University from June 2016 to December 2019 were retrospectively analyzed. To evaluate the efficacy of lower limb line correction after medial open wedge high tibial osteotomy, hip-knee-ankle angle, lateral distal femoral angle, medial proximal tibial angle, joint line convergence angle, weight bearing line ratio, and tibial posterior slope were measured in all patients with preoperatively and immediately postoperatively and at the end of the follow-up. To evaluate the compensatory changes of hip joint, patellofemoral joint, and ankle joint after medial open wedge high tibial osteotomy, the hip abduction angle, tibial plafond inclination angle, talar inclination angle, Caton-Deschamps index, lateral patellar shift, lateral patellar tilt, medial space of patellofemoral joint, and lateral space of patellofemoral joint were measured in all patients before treatment and after the last follow-up.   RESULTS AND CONCLUSION: (1) After medial open wedge high tibial osteotomy, the lower extremity line correction of the patients was satisfactory, and there was statistical significance in the comparison of hip-knee-ankle angle, medial proximal tibial angle, joint line convergence angle, and weight bearing line ratio before and immediately after the operation, and in the last follow-up (P < 0.05). (2) There was no increase in tibial posterior slope after medial open wedge high tibial osteotomy, and there was no significant difference between tibial posterior slope before and after treatment (P > 0.05). (3) The hip adduction was aggravated after treatment, and the difference between preoperative and last follow-up of hip abduction angle was statistically significant (P < 0.05). An ankle varus was corrected after treatment, and the difference between tibial plafond inclination angle and talar inclination angle before surgery and the last follow-up was statistically significant (P < 0.05). (4) The position of patella decreased after treatment, and the difference of Caton-Deschamps index between preoperative and postoperative data was statistically significant (P < 0.05), but there was no anteroposterior and lateral displacement, or patella tilt (P > 0.05). Figures and Tables | References | Related Articles | Metrics

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Comparison of different reference methods for force line correction in open wedge high tibial osteotomy Liu Dongcheng, Zhao Jijun, Zhou Zihong, Wu Zhaofeng, Yu Yinghao, Chen Yuhao, Feng Dehong 2022, 26 (6):  827-831.  doi: 10.12307/2022.160 Abstract ( 489 )   PDF (1359KB) ( 101 )   Save BACKGROUND: Open wedge high tibial osteotomy is one of the most effective surgical methods for the treatment of medial compartment knee osteoarthritis. Clinically, the distraction angle is routinely adjusted by force bar and fluoroscopy during the operation, but there is a risk of over-correction. Through the preoperative planning of the Picture Archiving and Communication Systems, can a better line of force of the lower extremities be obtained without fluoroscopy during the operation?   OBJECTIVE: To clarify the feasibility and reliability of the gap width reference method by comparing the accuracy of the two reference methods of force line correction in open wedge high tibial osteotomy. METHODS:  The patients with knee osteoarthritis who underwent open wedge high tibial osteotomy in Wuxi People’s Hospital Affiliated to Nanjing Medical University from August 2018 to August 2020 were reviewed. According to different reference methods of osteotomy, they were divided into two groups. In the conventional group (n=16), the correction angle was calculated by the whole length film of the lower limb before operation, and the osteotomy distraction height was calculated by the conversion table according to the angle. During the operation, the distraction angle was adjusted by force pole and X-ray perspective, so that the force bar passed through the target force line. In the planning group (n=12), the height of osteotomy needed to be distracted was directly calculated by Picture Archiving and Communication Systems before operation, and it was directly stretched to the height measured before operation after osteotomy, which was not adjusted by force bar X-ray during operation. The operation time of the two groups was compared; the difference between the postoperative force line and the target force line (converted into an angle) was evaluated. The tilt angle of tibial plateau was compared between the two groups after operation. American knee society score was calculated at 1 and 3 months after operation.   RESULTS AND CONCLUSION: (1) The operation time in the planning group was shorter than that in conventional group, and the difference was significant (P < 0.05). (2) There was a significant difference between the postoperative lower limb force line and the target force line between the two groups (P < 0.05). The deviation between the force line and the target force line obtained after operation in planning group was smaller than that in conventional group. There was no significant difference in the absolute value of the difference between the postoperative force line and the target force line between the two groups (P > 0.05). There was no significant difference in the increase of tibial plateau posterior inclination angle between the two groups (P > 0.05). (3) There were 0 cases of hinge point fracture in both conventional group and planning group during the perioperative period. (4) American knee society score of planning group was higher than that of conventional group at 1 and 3 months after operation. The difference was significant (P < 0.05). (5) The results show that through the reference of osteotomy and correction of open wedge high tibial osteotomy by Picture Archiving and Communication Systems, there is little difference between the postoperative force line and the target force line, and the incidence of excessive valgus can be reduced. It can achieve a good early clinical effect, shorten the operation time and reduce unnecessary fluoroscopy during the operation, but the follow-up time is insufficient, and the medium- and long-term effect remains to be further observed. Figures and Tables | References | Related Articles | Metrics

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Kinematics characteristics of lower limb joints of young men running wearing knee pads Shao Yangyang, Zhang Junxia, Jiang Meijiao, Liu Zelong, Gao Kun, Yu Shuhan 2022, 26 (6):  832-837.  doi: 10.12307/2022.161 Abstract ( 482 )   PDF (1686KB) ( 60 )   Save BACKGROUND: With the frequent occurrence of lower extremity sports injuries, people’s attention to the prevention of sports injuries continues to increase. A comprehensive understanding of the changes in the kinematic characteristics of the dominant and non-dominant lower limb joints when young men wear knee pads for running plays an important role in preventing lower extremity injuries.   OBJECTIVE: To analyze the impact of knee pads on the knee, ankle, and hip joints, and make recommendations for healthy young people to choose knee pads to prevent joint injuries caused by sports from the perspective of kinematic characteristics. METHODS:  Totally 15 healthy male subjects were recruited to run with three typical knee pads (patella belt, open type, sleeve type) on a specific experimental path. Infrared camera and biomechanics force plate equipment were used to collect knee, ankle, and hip joint kinematics data. Matlab and Minitab were utilized to process and analyze the kinematics data by writing specific programs.   RESULTS AND CONCLUSION: (1) Wearing an open knee pad significantly reduced the range of flexion and extension motion of the knee joint, significantly increased the range of ankle joint internal and external rotation motion, and significantly reduced the range of hip flexion and extension motion. (2) Wearing sleeve-type knee pads significantly reduced the range of knee joint internal rotation and external rotation movement, and significantly reduced the range of inversion and valgus movement of the dominant side ankle joint and the range of movement of internal and external rotation, and the flexion and extension range of the dominant hip joint. (3) It is concluded that wearing knee pads not only affects the knee joints, but also affects the ankle and hip joints. Wearing different types of knee pads has different effects on the ankle and hip joints on the dominant side and the non-dominant side. It is recommended that young people wear sleeve knee pads to prevent joint injuries. Figures and Tables | References | Related Articles | Metrics

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Mechanical stability of Sanders II type calcaneal fractures fixed by two internal fixation methods Wen Mingtao, Liang Xuezhen, Li Jiacheng, Xu Bo, Li Gang 2022, 26 (6):  838-842.  doi: 10.12307/2022.162 Abstract ( 672 )   PDF (2153KB) ( 83 )   Save BACKGROUND: For Sanders type ii calcaneal fractures, the “L-shaped” incision with locking plate internal fixation often causes complications such as necrosis of the surgical incision flap. The internal fixation with hollow screws after prying and resetting can well avoid this problem, but there is still a lack of evaluation of the effect of internal fixation.   OBJECTIVE: To compare and study the fixation effect and mechanical stability of the two fixation methods for Sanders II type calcaneal fractures based on the finite element analysis method. METHODS:  One male volunteer (25 years old, height 175 cm, weight 75 kg) was screened, and a full-thickness continuous scan was performed from the middle part of the tibia to the whole foot by tomographic CT scan. Based on CT scan data, a complete three-dimensional finite element analysis model of the calcaneus was established. The Sanders II type calcaneal fracture was simulated, and locking plate fixation (locking plate group) and hollow screw compression fixation (hollow screw group) were performed after prying reduction. The stress distribution, displacement and fracture displacement performance of the two fixation methods were compared under the same constraints and loads on the two sets of models.   RESULTS AND CONCLUSION: (1) The stress of hollow screw internal fixation was concentrated near the fracture line contact, and maximum Von Mises stress reached 53.948 MPa. The displacement of the horizontal hollow screw was larger than that of the longitudinal screw, and the maximum displacement was up to 0.175 37 mm. The fixed stress and displacement of the locking steel plate were concentrated near the screw hole in the middle of the steel plate. The maximum Von Mises stress reached 129.95 MPa. The fracture line displacement of the hollow screw group (0.015 77 mm) was smaller than that of the locking plate group (0.021 03 mm). (2) The maximum stress of the two sets of internal fixation was lower than the yield strength of the material. (3) The two groups of calcaneal models had the largest displacement near the subtalar joint. (4) It is concluded that hollow screws and locking plate internal fixation for the treatment of Sanders II type calcaneal fractures have good stability. Pry reduction hollow screw internal fixation has the advantages of reducing postoperative complications. It is the recommended method of internal fixation for Sanders II type calcaneal fractures. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of stress distribution of acetabular prosthesis in the Lewinnek safety zone Wang Hailong, Li Long, Maihemuti·Yakufu, Chen Hongtao, Liu Xu, Yilihamu·Tuoheti 2022, 26 (6):  843-847.  doi: 10.12307/2022.163 Abstract ( 450 )   PDF (1442KB) ( 104 )   Save BACKGROUND: Lewinnek et al. proposed a “safety zone” concept for acetabular cup position [Abduction angle (40±10)°, anteversion angle (15±10)°]. Although this concept has been widely accepted, it has been lack of further biomechanical study regarding influence of acetabular prosthesis on acetabular bone and prosthetic stress distribution in the safety zone.   OBJECTIVE: To investigate the stress distribution of the acetabular bone and cup (ceramic on ceramic versus metal on polyethylene) with regard to the Lewinnek safety zone using the three-dimensional finite element analysis method. METHODS:  One healthy volunteer received CT scan. The three-dimensional geometric model of the pelvis was established. Eighteen kinds of different cup position model of hip replacement were established with regard to the Lewinnek safety zone. The stress distribution along the acetabular bone and the different implant materials were studied by means of applying 390 N force. The protocol was performed in accordance with the Declaration of Helsinki and the relevant ethical requirements of Sixth Affiliated Hospital of Xinjiang Medical University.   RESULTS AND CONCLUSION: By applying finite element static vertical force, within the Lewinnek zone: (1): if the cup was positioned in 5° anterversion, 50° abduction (whether it was ceramic on ceramic or metal on polyethylene), the peak stress and the stress zone of the cup were smallest. Under the same anterversion and abduction, the peak stress of the cup did not change significantly. (2) With regard to the stress distribution of the head and liner, the peak stress and the stress zone of the head and the liner were smallest in the metal on polyethylene group, in which the stress was not affected by the position of the cup. (3) The results indicated that within the Lewinnek safety zone, if the cup was positioned in 5° anterversion, 50° abduction, the metal on polyethylene group had the advantage of having the smallest peak stress and the stress zone of the cup, head and the liner. Moreover, the stress was not affected by the position of the cup, and was significantly smaller than the ceramic on ceramic scheme, which can provide clinical reference. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of the effect of femoral component rotation on patellofemoral joint contact pressure in total knee arthroplasty Huang Hao, Hong Song, Wa Qingde 2022, 26 (6):  848-852.  doi: 10.12307/2022.164 Abstract ( 587 )   PDF (1136KB) ( 74 )   Save BACKGROUND: Patellofemoral joint complications are common after total knee arthroplasty. Rotational malalignment of the femoral component will affect the consistency of the patellofemoral joint, thus causing the changes of contact pressure and kinematics of the patellofemoral joint.   OBJECTIVE: To study the changes of patellofemoral joint contact pressure during knee flexion when femoral component was placed at different rotation angles by means of finite element analysis. METHODS:  The three-dimensional models of the knee joint were developed according to the CT and MRI scanning data of right knee of the volunteer. The femoral component was placed from 6° internal rotation to 9° external rotation (external rotation 3°, 6°, 9°, rotation 0°, internal rotation 3°, 6°) relative to the surgical transepicondylar axis (the line between the medial femoral condyle groove and the most prominent point of the lateral femoral condyle) in 3° increments, while tibial component was 0° rotated relative to the Akagi (the line between the medial edge of the patellar tendon and the center of the posterior cruciate ligament) during the total knee arthroplasty. The finite element models of the knee were established by meshing the three-dimensional models. The patellofemoral joint contact pressure of each knee joint model was obtained during the flexion.   RESULTS AND CONCLUSION: (1) The patellofemoral joint contact pressure increased in all groups during the knee flexion. The contact pressure in the group of 3° external rotation femoral component was lower than that of 0° rotation group. The contact pressure of patellofemoral joint increased with the increase of external rotation degree of component when the degree of femoral component external rotation was greater than 3°. The contact pressures in the group of 3° internal rotation of femoral component and the group of 6° internal rotation were significantly higher than those of the other groups, and the highest was in the 6° internal group. (2) Results showed that during the total knee arthroplasty, 3° external rotation of femoral component relative to surgical transepicondylar axis may reduce the patellofemoral joint contact pressure, while excessive external rotation femoral component may lead to the increase of patellofemoral joint contact pressure. The internal rotation of femoral component should be avoided during the total knee arthroplasty. The imbalance of greater than 3° internal rotation may lead to the increase of patellofemoral joint contact pressure and increase the risk of prosthesis wear and knee pain. Figures and Tables | References | Related Articles | Metrics

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Extended finite element modeling analysis of femoral neck fracture based on ABAQUS software Zheng Yongze, Zheng Liqin, He Xingpeng, Chen Xinmin, Li Musheng, Li Pengfei, Lin Ziling 2022, 26 (6):  853-857.  doi: 10.12307/2022.165 Abstract ( 601 )   PDF (3370KB) ( 195 )   Save BACKGROUND: Compared with clinical tools based on facial bone mineral density, finite element model strength analysis under specific load conditions is more and more used to improve fracture risk assessment. However, most finite element models are limited to the estimation of bone strength and the location of possible fractures, but cannot model the fracture process itself.   OBJECTIVE: The crack of femoral neck fracture was simulated by extended finite element method in ABAQUS, and the crack initiation position and crack propagation path were determined based on the criterion of maximum principal stress and fracture energy. METHODS:  The CT data of the proximal femur of a healthy volunteer were collected and imported into Mimics to reconstruct the three-dimensional model in DICOM format. The corresponding material parameters of osteoporotic cortical bone and cancellous bone were given. Static analysis was initially performed to assess bone stress distribution and identify fracture risk areas. Based on the stress results and excluding the elements near the boundary, the enrichment area which allowed fracture to occur in extended finite element method analysis was defined. When the principal stress exceeded 116 MPa, the crack initiation occurred in the element, which could predict crack location and evolution process.   RESULTS AND CONCLUSION: (1) Static analysis: Under the standing load, the stress concentration appeared in the femoral neck, and the maximum equivalent stress was 711.8 MPa. According to the fourth strength theory, the yield strength of the cortical bone of the femur was 116 MPA, and irreversible plastic failure would occur in the femoral neck under the current load. In addition, the maximum principal stress was concentrated on the lateral side of the femoral neck, and the maximum value was higher than that of 116 MPa. (2) Crack propagation analysis: The generation of crack was a process of accumulating energy. When the stress increased and exceeded the threshold, the unit damage began to appear at the upper and outer part of the femoral neck. At this time, it was in the state of viscous crack and still had the ability to resist fracture. As the stress continued to increase, the element failed completely. At this time, the stress around the crack surface and the tip decreased rapidly, and the stress concentration was distributed to both sides of the element. The crack extended to the anterior superior and posterior inferior direction of the femoral neck, and finally formed the fracture of the femoral neck. (3) The proximal femoral fracture model based on fracture mechanics could predict not only the elastic behavior, but also the fracture crack path under standing load. It emphasized the importance of fully calibrating fracture criteria and evaluated the effects of mechanical properties and critical principal stress. Compared with the modeling method of strength theory, this method provides more information about the mechanism of fracture crack propagation and is helpful to explore the potential risk of fracture. Figures and Tables | References | Related Articles | Metrics

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Positive effect of supracondylar femoral osteotomy on the correction of knee varus based on three-dimensional reconstruction and finite element analysis Li Shuo, Su Peng, Zhang Li, Wu Qiulong, Hu Xiangyu, Lai Yuliang 2022, 26 (6):  858-863.  doi: 10.12307/2022.166 Abstract ( 456 )   PDF (1815KB) ( 46 )   Save BACKGROUND: Studying the effect of supracondylar femoral osteotomy in treatment of varus knee from the direction of biomechanics can have a positive effect on the understanding of the surgical treatment of knee varus deformity by osteotomy.   OBJECTIVE: Based on the CT data, the preoperative and postoperative three-dimensional models of the knee joint of supracondylar femoral osteotomy are constructed. A modeling method of tissue is introduced. The feasibility of the method and the positive effect of supracondylar osteotomy of femur was verified through biomechanical analysis. METHODS:  The preoperative and postoperative CT data of a patient with supracondylar femoral osteotomy surgery were selected at random to establish the knee bone model based on image segmentation, and the three-dimensional model of the knee meniscus and major ligaments between knee joints was established based on contour extension. After meshing and material definition, the load was applied under the same working condition (1 000 N, in the direction of lower limb force line), and the finite element simulation was carried out on the preoperative and postoperative model. Compared with the research results, the feasibility of modeling method was tested. The stress difference at the proximal tibia and the changes of stress peak point with time of preoperative and postoperative knee joint were studied.   RESULTS AND CONCLUSION: (1) The postoperative peak of medial tibia was 2.334 MPa and the lateral tibia peak value was 2.819 MPa. The differences of stress from the previous scholars were contrasted to test the effectiveness of the model and the feasibility of the modeling method. (2) The preoperative peak tibial stress was 7.085 MPa, which was higher than the postoperative peak tibial stress (2.819 MPa). Meanwhile, with the change of time, the stress concentration of tibia before operation was more obvious, and the stress concentration of tibia after operation had been improved. (3) Results indicated that supracondylar femoral osteotomy had a positive effect on the correction of varus knee. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of different angles of nail placement in sagittal plane of spinal fracture Wei Bing, Chang Shan 2022, 26 (6):  864-869.  doi: 10.12307/2022.167 Abstract ( 426 )   PDF (3069KB) ( 90 )   Save BACKGROUND: For patients with spinal fractures, when the surgeon adopts the method of posterior implantation and nail placement, different angles will be adopted according to his own habits, but which angle is better for the postoperative effect is not yet clear.   OBJECTIVE: To establish a finite element model of thoracolumbar vertebral body fracture to explore the influence of pedicle screws placed at different angles in the sagittal plane on spinal stability. METHODS:  Three young and middle-aged patients with fresh compression fractures of the lumbar 1 vertebral body were selected. The fracture model was constructed by finite element software (lumbar 1 vertebral body fracture, T12-L2 model), and the HyperMesh assembly screw was used to establish the model of the L1 fracture at three different angles (sagittal plane is parallel to the upper endplate; obliquely upward endplate 7°; obliquely downward endplate 7°) in the sagittal plane. Various loads were applied to the model, and biomechanical analysis of its force was conducted.   RESULTS AND CONCLUSION: In the vertical state, the maximum displacement of the vertebral body after different nail placement methods all appeared on the surface of the thoracic 12 vertebral body. In the torsion state, the maximum displacement of the vertebral body all moved back to the upper vertebral body in the posterior column part and the upper part of the connecting rod. In the forward flexion state, the maximum displacement of the vertebral body occurred at the front edge or the posterior column part of the thoracic 12 vertebral body. In the extension state, the maximum displacement of the vertebral body was mainly concentrated in the posterior column of the thoracic 12 vertebral body. In the scoliosis state, the larger displacement of the vertebral body was mainly concentrated on the scoliosis side of the thoracic 12 vertebral body. In the same state, the body displacement of all vertebrae with the oblique upward screw is the smallest, indicating that the vertebral body will be more stable if the screw is placed at an angle of 7°. Figures and Tables | References | Related Articles | Metrics

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Establishment and validation of finite element model of lower cervical spine in 6-year-old children Liu Yuhang, Zhou Jianqiang, Xu Xuebin, Qu Xingyue, Li Ziyu, Li Kun, Wang Xing, Li Zhijun, Li Xiaohe, Zhang Shaojie 2022, 26 (6):  870-874.  doi: 10.12307/2022.168 Abstract ( 421 )   PDF (1351KB) ( 114 )   Save BACKGROUND: There are few finite element models of children’s cervical spine due to the unique developmental characteristics of children’s cervical spine and the complexity of its anatomical structure.   OBJECTIVE: To establish a three-dimensional finite element model of cervical spine in children to simulate and analyze the neck mechanics before clinical operation. METHODS:  The cervical spine images of 6-year-old normal girl cadaver specimens were collected. The three-dimensional finite element model of C3-C7 was constructed by using the software of Mimis 16.01, Pro/E 5.0, Geomagic Studio 2015, HyperMesh 14.0, and Abaqus 6.14, and the model was verified by the displacement and activity of each working condition. The protocol was performed in accordance with the relevant ethical requirements of Inner Mongolia Medical University (approval No. YKD2016063; approval date: 2016-03-07). The corpse specimens were provided by the volunteer cadaver donation room of Inner Mongolia Medical University, and the donor’s family members gave informed consent to the experiment.   RESULTS AND CONCLUSION: (1) The three-dimensional finite element model of C3-C7 vertebrae in normal girls was successfully established. (2) The intervertebral mobility of the finite element model of cervical vertebrae in children under flexion, extension, left and right lateral flexion and left and right rotation conditions was consistent with the existing literature data, which confirmed the effectiveness of the model. (3) The results showed that the established finite element model of lower cervical vertebrae in children could provide model reference for clinical cervical surgery. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis on the effect of implant length and diameter on initial stability under different bone conditions Gao Wenbo, Ma Zongmin, Li Shuxian, Nie Xiuji 2022, 26 (6):  875-880.  doi: 10.12307/2022.169 Abstract ( 660 )   PDF (3826KB) ( 118 )   Save BACKGROUND: At present, there is no comprehensive study on the influence of bone quality, implant diameter, and length on initial stability.   OBJECTIVE: The micromotion size of the implant-bone interface under load was used as the initial stability evaluation index to study the influence of bone quality, implant length, and diameter on the initial stability. METHODS:  Mandibular models of bone types I, II, III, and IV were established, according to the bone classification method proposed by Zarb and Lekholm. Implant models with different diameters and lengths were established, referring to Straumann implant parameters. The implant diameters were 3.3, 4.1, and 4.8 mm; the lengths were 6, 8, 10, and 12 mm. Using the finite element method, the model was loaded with two typical chewing loads (100, 250 N), and the micromotion distribution of the implant-bone interface in each group of models was analyzed and compared under the two loads. The research plan was conducted in accordance with the Declaration of Helsinki and the relevant ethical requirements of the School of Mechanical Engineering, Dalian University. The subjects had fully informed consent and signed the “Informed Consent” for the collection of image data.   RESULTS AND CONCLUSION: (1) The peak of the micromotion of the implant-bone interface appeared in the cortical bone area when the better bone jaws were loaded with a vertical load. The peak of the micromotion of the implant-bone interface appeared in the cancellous bone area when the poor bone jaws were loaded with a vertical load. Under oblique loading, the peaks of micromotion generated by the implant-bone interface in the four types of bone mandibles were all in the cortical bone area. (2) In the four loading modes, the initial stability of the implant decreased with the weakening of bone. The initial stability of the implant increased with the increase of the diameter and length of the implant; and the diameter of the implant had an effect on the initial stability of the implant and its influence was greater than that of the length. Figures and Tables | References | Related Articles | Metrics

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Digital measurement and analysis of the distal femur in adults with secondary knee valgus deformity Yuan Jing, Sun Xiaohu, Chen Hui, Qiao Yongjie, Wang Lixin 2022, 26 (6):  881-885.  doi: 10.12307/2022.170 Abstract ( 376 )   PDF (1287KB) ( 56 )   Save BACKGROUND: The surgical method for knee valgus deformity is osteotomy around the knee joint or total knee arthroplasty. Osteotomy around the knee joint needs three-dimensional shaping. The type of artificial total knee arthroplasty prosthesis and the degree of matching with the knee joint affect the long-term effect after arthroplasty. Femoral condyle osteotomy shaping usually requires the support of femoral condyle data. Nowadays, prosthesis systems designed by westerners have a relatively high usage rate in China, but cannot achieve the best results in the Chinese.   OBJECTIVE: To explore the anatomical abnormalities of the femoral condyle, and provide anatomical data for total knee arthroplasty or osteotomy of knee valgus deformity. METHODS:  Totally 41 adult patients (53 knees) with knee valgus deformity were detected with CT scan. The obtained images were imported into Mimics 17.0 software, and digital three-dimensional model was established. The anatomical parameters were measured, and the distribution and correlation were analyzed. The knee joint parameters between knee valgus deformity patients and healthy normal knee in single deformity patients (control group, n=29) were compared.   RESULTS AND CONCLUSION: (1) Compared with the control group, epicondylar angle was not significantly different in the valgus group (P > 0.05). Medial mechanical femoral angle, distal condylar angle, and poster condylar angle were significantly increased in the valgus group (P < 0.05). (2) Measurement results of the surface profile of the femoral condyle showed that femoral condyle data were significantly lower in the valgus group than that in the control group (P < 0.05). No significant difference in femoral medial condyle data was found between the valgus and control groups (P > 0.05). (3) The distance between the center of the femoral condyle and the condyle line of the femoral condyle was significantly lower in the valgus group than that in the control group (P < 0.05). (4) These findings indicate that the morphological changes of the femoral lateral condyle of adult secondary knee valgus deformity are more significant, but the morphological changes of the femoral medial condyle are not obvious. The femoral condyle axis is used as a reference for adult secondary valgus total knee arthroplasty. The data obtained can help intraoperative positioning and improve the treatment effect. Figures and Tables | References | Related Articles | Metrics

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Reliability and accuracy of digital software in measuring osseous markers related to stiff clubfoot Liu Wei, Li Fei, Li Lubing, Wang Xue, Wang Chengwei 2022, 26 (6):  886-891.  doi: 10.12307/2022.171 Abstract ( 425 )   PDF (2663KB) ( 64 )   Save BACKGROUND: Stiff clubfoot is a complex three-dimensional abnormal structural deformity. It is difficult to accurately evaluate the deformity degree of stiff clubfoot by two-dimensional plain film and physical examination.   OBJECTIVE: To explore the reliability and accuracy of 3-Matic software in measuring the related indexes of stiff clubfoot. METHODS:  Totally 14 patients (20 feet) with stiff clubfoot were prospectively selected from February 2018 to March 2021 in the Sixth Affiliated Hospital of Xinjiang Medical University. The 3D model of bone under weight-bearing condition was reconstructed by Mimics software according to the CT images of weight-bearing position. The central axis of the required bone was fitted by 3-Matic. The images of weight-bearing positive position, lateral position and calcaneal axial position were obtained by selective projection function. The related indexes of rigid equinovarus were measured. The related indexes of 14 adult patients with stiff clubfoot were measured by 3-Matic software measurement and routine X-ray measurement, and the statistical differences of the two groups were compared. This study was approved by the Ethics Committee of Xinjiang Medical University. All patients signed the informed consent.   RESULTS AND CONCLUSION: (1) There was no significant difference between the positive talus-calcaneal angle and the talus-first metatarsal angle measured by the two methods (P > 0.05), but there was significant difference between the calcaneal-cuboid angle measured by the two methods (P < 0.05). There was no significant difference between the two methods in lateral calcaneal-talus angle, tibial-calcaneal angle, talus-first metatarsal angle, and calcaneal-fifth metatarsal angle (P > 0.05). There was no significant difference in the axial tibial-calcaneal angle between the two methods (P > 0.05). (2) It is concluded that the central axis of the required bone can be accurately generated by using 3-Matic software, and then the accurate measurement of related indexes can be realized. The related bone and its central axis can be selectively projected during the measurement, and the ghosting interference can be eliminated. The measurement result is stable and reliable, and has the advantages of intuitive and clear observation. Figures and Tables | References | Related Articles | Metrics

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Total knee arthroplasty with posterior cruciate ligament retaining prosthesis in the treatment of knee osteoarthritis with knee valgus deformity Zhou Jianguo, Liu Shiwei, Yuan Changhong, Bi Shengrong, Yang Guoping, Hu Weiquan, Liu Hui, Qian Rui 2022, 26 (6):  892-897.  doi: 10.12307/2022.172 Abstract ( 653 )   PDF (9532KB) ( 37 )   Save BACKGROUND: Studies have shown that the use of posterior cruciate ligament retaining prosthesis in total knee arthroplasty can retain more proprioception, reduce the stress of patellofemoral joint, enhance the function of quadriceps femoris through the rolling of femoral rear wheel, increase the range of motion of knee joint, make the gait of patients more normal, and improve the satisfaction of patients.   OBJECTIVE: To explore the clinical efficacy of total knee arthroplasty with posterior cruciate ligament retaining prosthesis in the treatment of knee osteoarthritis with knee valgus deformity. METHODS:  From November 2018 to December 2020, data of 30 patients (all single knee arthroplasty) with knee osteoarthritis and genu valgus deformity who underwent primary total knee arthroplasty with posterior cruciate ligament retaining prosthesis in the Department of Joint Surgery of the Affiliated Ganzhou Hospital of Nanchang University were retrospectively analyzed. The knee valgus angle and range of motion of 30 patients were measured before operation and 2 weeks and 3 months after operation, and the knee function was evaluated by HSS. The study has been approved by the Ethics Committee of the Affiliated Ganzhou Hospital of Nanchang University (approval No. TY-ZKY2021-009-01).   RESULTS AND CONCLUSION: (1) The knee valgus angle of 30 patients at 2 weeks and 3 months after operation was less than that before operation (P < 0.05), and there was no significant difference in knee valgus angle between 3 weeks and 3 months after operation (P > 0.05). (2) The range of motion of knee joint in 30 patients at 2 weeks and 3 months after operation was higher than that before operation (P < 0.05). There was no significant difference in range of motion of knee joint between 3 weeks and 3 months after operation (P > 0.05). (3) The overall HSS scores of 30 patients at 2 weeks and 3 months after operation were higher than those before operation (P < 0.05), and there was no significant difference in overall HSS scores between 3 weeks and 3 months after operation (P > 0.05). (4) The results showed that total knee arthroplasty with posterior cruciate ligament retaining prosthesis can effectively correct the deformity of knee joint, reduce the pain of knee joint, improve the muscle strength of affected limb, and significantly improve the range of motion and function of knee joint, showing significant clinical effect. Figures and Tables | References | Related Articles | Metrics

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Effect of tourniquet combined with exsanguination band use on short-term lower extremity venous thrombosis after knee arthroscopy Yang Yang, Li Naxi, Zhang Jian, Wang Mian, Gong Taifang, Gu Liuwei 2022, 26 (6):  898-903.  doi: 10.12307/2022.173 Abstract ( 480 )   PDF (2228KB) ( 81 )   Save BACKGROUND: The incidence of lower extremity deep venous thrombosis after knee arthroscopy is between 0.27% and 17.5%, so it is of great significance to actively prevent the occurrence of lower extremity deep venous thrombosis after knee arthroscopy.   OBJECTIVE: To investigate the effect of using exsanguination band under routine tourniquet during knee arthroscopy on the incidence of lower extremity venous thrombosis in the early postoperative period. METHODS:  Totally 200 patients between the ages of 40 and 60 years who underwent knee arthroscopic surgery in the Taihe Hospital of Hubei Medical College from June 2019 to December 2020 were included, including 100 patients in the driven blood band group and 100 patients in the leg raising driven blood group. Pressure tourniquet was used to stop bleeding in both groups after blood evacuation. Blood coagulation was detected in both groups 1 day before operation, 1, 3, 7, and 14 days after operation. Color Doppler ultrasound of the lower extremity veins was performed 2 days after the operation to evaluate the occurrence of lower extremity vein thrombus. Motion range of the knee was compared between the two groups at 1, 3, and 7 days after operation. This study was approved by the Taihe Hospital of Hubei Medical College (approval No. 2021KS096).   RESULTS AND CONCLUSION: (1) Prothrombin time, activated partial thromboplastin time, and D-dimer level were increased after operation compared with those before operation in both groups. Prothrombin time, activated partial thromboplastin time, and D-dimer level were increased at 1, 3 and 7 days postoperatively in the driven blood band group compared with the leg raising driven blood group (P < 0.05). There was no significant difference between the two groups at 14 days postoperatively (P > 0.05). (2) Color Doppler ultrasound examination showed that there was no deep venous thrombosis in the lower extremities between the two groups, but there were more intermuscular venous thrombosis in the lower extremities. The incidence of intermuscular venous thrombosis was higher in the driven blood band group than that in the leg raising driven blood group (28%, 16%, P < 0.05). (3) There was no significant difference in motion range of the knee after operation in both groups (P > 0.05). (4) Results suggest that tourniquet combined with exsanguination band use can aggravate the hypercoagulable state of patients after knee arthroscopy, which increases the incidence of intermuscular venous thrombosis in the lower extremities and the risk of secondary pulmonary embolism caused by this, but will not increase the incidence of deep vein thrombosis in the lower extremities after surgery. Figures and Tables | References | Related Articles | Metrics

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Precise screw placement of 3D printing model and orthopedic robot in spinal deformity Song Yuxin, Zhang Tongtong, Niu Jianxiong, Wang Zengping, Wen Jie, Zhang Qunli, Xue Wen, Liu Lin 2022, 26 (6):  904-907.  doi: 10.12307/2022.174 Abstract ( 413 )   PDF (1221KB) ( 104 )   Save BACKGROUND: Spinal deformities lead to changes in the normal anatomical structure of the pedicle, and it is more difficult to insert pedicle screws during the correction of spinal deformities.   OBJECTIVE: To investigate the accuracy of screw placement and single screw placement time in orthopedic surgery with 3D printing model and orthopedic robot. METHODS:  Totally 40 patients with spinal deformity were divided into two groups according to different surgical approaches. In the observation group, 18 patients were placed with pedicle screw assisted by orthopedic robot; i.e., in the process of open surgery, the robot was used to plan the pedicle screw paths; the manipulator reached the designated position; the guide needle and screw were placed. In the control group, 22 cases were implanted with pedicle screw assisted by 3D model. According to Gertzbein-Robbins classification standard, the accuracy of screw placement was evaluated. The time of single screw placement was recorded, and the accuracy and time of single screw placement were compared between the two groups. The protocol was performed in accordance with Declaration of Helsinki and the relevant ethical requirements of the Gansu Provincial Hospital.   RESULTS AND CONCLUSION: (1) There was no significant difference in the accuracy of screw placement between the two groups (P > 0.05). The accuracy of class A screw was significantly higher in the observation group 85.9%(256/298) than that in the control group 79.9%(283/354) (P < 0.05). The accuracies of class B, class C and class D screw were not significantly different between the two groups (P > 0.05). (2) The time of single screw placement was not significantly different between the observation group and the control group [(4.01±0.61), (3.74±0.44), P > 0.05]. (3) It is concluded that orthopedic robot assisted pedicle screw placement can significantly improve the accuracy of class A screw placement, which is highly accurate, effective and feasible. Figures and Tables | References | Related Articles | Metrics

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Mid-term effect of Isobar EVO non-fusion dynamic fixation in the treatment of adjacent segment disease after lumbar fusion Song Jiawei, Yang Yongdong, Yu Xing, Yang Jizhou, Wang Fengxian, Qu Yi, Bi Lianyong 2022, 26 (6):  908-913.  doi: 10.12307/2022.175 Abstract ( 462 )   PDF (1614KB) ( 73 )   Save BACKGROUND: The treatment of adjacent spondylopathy after lumbar fusion is a research hotspot in spine surgery. Traditional surgery to extend the fusion segment may accelerate the reappearance of adjacent segment disease. The non-fusion pedicle screw system based on pedicle screws has shown excellent short- and mid-term results in the treatment of lumbar degenerative diseases and the prevention of adjacent segment degeneration. However, reports on the use of non-fusion technology to treat adjacent segment disease after lumbar fusion need to be studied urgently.   OBJECTIVE: To assess the postoperative outcome of non-fusion dynamic stabilization in situ with the Isobar EVO System for adjacent segment disease. METHODS:  Patients with adjacent segment disease who were re-operated at Dongzhimen Hospital from July 2013 to December 2017 due to ineffective conservative treatment were selected. Fifteen patients with adjacent segment disease who received Isobar EVO in situ non-fusion dynamic stabilization treatment were enrolled. Medical records, surgical reports, and X-ray imaging studies were reviewed. The following two groups of indicators were compared before and after operation: low back pain visual analogue scale score and lower limb pain visual analogue scale score, Oswestry Disability Index, SF-36 scale physical health score, range of motion of the operative segment, the motion of the upper adjacent segment, the lordotic angle of the operative segment and the angle of lumbar spine, the disc of height index at surgical segment, and the disc of height index at superior segment.   RESULTS AND CONCLUSION: Fifteen patients completed at least 3 years of follow-up. (1) Clinical results: At the last follow-up, the scores were significantly improved compared with those before the operation (P < 0.05), but there was no significant difference between different periods of the follow-up (P > 0.05). (2) Imaging measurement: At the last follow-up, mean range of motion of the segment was significantly reduced compared with that before the operation [(3.16±0.45)° vs. (6.32±1.81)°, P < 0.05]; the average motion range of the superior segment was significantly increased compared with that before the operation [(5.51±1.22)° vs. (4.87±1.47)°, P < 0.05]. The lumbar lordosis angle was significantly increased compared with that before the operation [(30.95±8.96)°vs. (27.12±9.67)° , P < 0.05 ]; the lordosis angle of the operation segment was significantly increased than that before the operation [(11.32±4.86)° vs. (10.14±6.44)°, P < 0.05]. Disc of height index at surgical segment was significantly higher than that before the operation (33.23±3.83 vs. 32.79±4.06, P < 0.05). However, disc of height index at superior segment was not statistically different from preoperatively (P > 0.05). There was no statistically significant difference in above indexes between each period of follow-up after operation (P > 0.05). In all cases, there was no loosening of the internal body during the follow-up period, and no adjacent segment disease occurred again. (3) It is concluded that Isobar EVO non-fusion dynamic fixation is an effective way to treat adjacent segment disease, and the clinical effect is obvious. The follow-up results for more than 3 years after surgery show that this operation can prevent the occurrence of adjacent segment disease after reoperation to a certain extent. The long-term effect needs to be supported by the results of further follow-up and higher-level evidence-based medicine. Figures and Tables | References | Related Articles | Metrics

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A novel slidable pedicle screw-rod system for lumbar tuberculosis: promoting bone graft fusion by producing stress stimulation to fused segment Yang Jun, Yang Qun, Zhang Rui, Jiang Chang 2022, 26 (6):  914-918.  doi: 10.12307/2022.176 Abstract ( 452 )   PDF (1190KB) ( 63 )   Save BACKGROUND: The treatment of lumbar tuberculosis mainly includes conservative and surgical treatments. Patients who present with obvious bone destruction and neurological symptoms need surgical treatment. Bone graft fusion combined with pedicle screw internal fixation is one of the main surgical methods.   OBJECTIVE: To investigate the clinical effect and safety of a novel slidable pedicle screw-rod system in the treatment of lumbar tuberculosis. METHODS:  Data of eighteen patients with lumbar tuberculosis who underwent lumbar fusion using the novel slidable pedicle screw-rod system at the First Affiliated Hospital of Dalian Medical University from November 2017 to November 2019 were collected. There were 11 males and 7 females, aged 37-71 years by average 55.2 years. The Japanese Orthopaedic Association score, Visual Analogue Scale score and American Spinal Injuries Association grading were used to assess the recovery of lumbar function after treatment, while X-ray and CT were used to evaluate the fusion situation and the height variation of the fused segment.   RESULTS AND CONCLUSION:  (1) All the 18 patients were successfully followed up for 6-18 months. (2) The Visual Analogue Scale score dropped significantly at 3 and 6 months postoperatively, while the Japanese Orthopaedic Association (JOA) score was increased significantly (P < 0.05). (3) Imaging results revealed that the height of the fused segment decreased postoperatively, and became stabilized about 6 months after operation; however, there were no neurologic symptoms and no nail stick falling or fracture. (4) To conclude, the novel slidable pedicle screw-rod system can provide a satisfactory outcome in the treatment of lumbar tuberculosis and promote the decompression segment fusion effectively. Figures and Tables | References | Related Articles | Metrics

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External spinal fixation elastic stress in the treatment of jumping spinal fracture Guo Xiaohui, Song Xizheng, Xiang Hanrui, Kang Zhaorong, Li Daming, Kang Yu, Hu Jun, Sheng Kai 2022, 26 (6):  919-923.  doi: 10.12307/2022.177 Abstract ( 479 )   PDF (2823KB) ( 127 )   Save BACKGROUND: At present, non-fusion internal fixation is usually used in the treatment of jumping spinal fracture which is prone to severe degeneration of adjacent intervertebral discs, broken nails, broken rods, and difficulties in spine stiffness and recovery. In particular, it is impossible to avoid the second internal fixation removal operation, resulting in re-injury of the tissue.   OBJECTIVE: To analyze the clinical effect of external fixation of spinal elastic stress in the treatment of jumping spinal fracture. METHODS:  Sixty-five patients with jumping spinal fracture from First Affiliated Hospital of University of South China and Guochang Bi Orthopedics and Traumatology Hospital of Chongqing from July 2016 to July 2019 were selected, including 37 males and 28 females, aged 20-55 years old. They were divided into two groups according to the treatment methods. The control group (n=32) received pedicle screw insertion and internal fixation, and the trial group (n=33) received external fixation and elastic stress treatment. The anterior edge high loss rate, Oswestry dysfunction index, visual analogue scale score, and callus formation were compared between the two groups before and after surgery. This study was approved by the Ethics Committee of First Affiliated Hospital of University of South China and Guochang Bi Orthopedics and Traumatology Hospital of Chongqing.   RESULTS AND CONCLUSION: (1) The high loss rate of anterior edge of injured vertebra after surgery was lower than that before surgery in both groups (P < 0.05). The high loss rate of the anterior edge of the injured vertebra was lower in the trial group than that in the control group at 1 week and 3 months after operation (P < 0.05). (2) Postoperative Oswestry disability index and visual analogue scale score in both groups were lower than those before surgery (P < 0.05). Oswestry disability index and visual analogue scale score were lower in the trial group than those in the control group at 1 week and 3 months after surgery (P < 0.05). (3) The callus formation rate in the trial group was higher than that in the control group at 3 and 12 months after surgery (P < 0.05). (4) The results showed that the external fixation of the spine with elastic stress was more effective than that of the traditional pedicle screw in the treatment of jumping spinal fractures. Figures and Tables | References | Related Articles | Metrics

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Quantification of the objective index of lumbar disc herniation with body surface topography map: three-dimensional angulation of the elastically fixed turning point of the lower back curve Ma Chao, Wang Fei, Liu Xiaomin, Wang Ziyun, Xu Kui, Yang Wendong, Feng Wei 2022, 26 (6):  924-928.  doi: 10.12307/2022.178 Abstract ( 400 )   PDF (1422KB) ( 148 )   Save BACKGROUND: The back morphology of patients with lumbar disc herniation presents characteristic manifestations. At present, the judgment of lumbar type is mainly through observation and qualitative description. Professor Feng Tianyou summed up the four steps of “lumbar types” from the perspective of observation: the lumbar curve becomes flat, the lumbosacral upward movement, the rotary basin-buttock, and the rotary waist and chest.   OBJECTIVE: To measure the three-dimensional angulation at the turning point of low back curve between type-III/IV and type-I/II patients and analyze the feasibility of judging lumbar type by three-dimensional angulation. METHODS:  A total of 110 hospitalized patients with lumbar intervertebral disc herniation were enrolled sequentially, including 70 cases of type-I/II patients and 40 cases of type-III/IV patients. The topographic map of the patient’s back surface was collected through the human spine morphology evaluation system. The analysis software was used to measure the patient’s three-dimensional angulation. The stability of three-dimensional angulation was preliminarily determined. The difference and diagnostic critical value of three-dimensional angulation between type-III/IV and type-I/II patients were calculated, and the authenticity of 3D angle formation was evaluated.   RESULTS AND CONCLUSION: (1) The index was stable, and there was no statistical significance in the comparison of the three times for three-dimensional angulation measurement data (P > 0.05). (2) There was significant difference in three-dimensional angulation between type-III/IV and type-I/II patients. Coronal angulation of type-III/IV was 11.04° on average, which was much larger than that of type-I/II (median 1.24°). Sagittal angulation of type-III/IV was 9.02° on average, which was much larger than that of type-I/II (mean 2.96°). Axial angulation of type-III/IV was 9.65° on average, which was much larger than that of type-I/II (mean 3.01°). (3) According to the ROC curve, the diagnostic critical value of three-dimensional angulation (coronal, sagittal, and axial) in III/IV-type patients were 5.43°, 4.77°, and 4.83°, respectively. The authenticity of the three-dimensional angulation results was reliable. The coronal, sagittal, and axial angulation results showed that the sensitivity was 86.66%, 93.33%, and 86.66%; the specificity was 95.23%, 85.72%, and 90.47%. The Youden index was 0.818, 0.790, and 0.771. The total compliance rate was 91.66%, 88.88%, and 88.88%. (4) In this study, three-dimensional topographic map technology of human back surface was used to analyze the feasibility of judging the lumbar type by three-dimensional angulation. It was found that the index had good stability, especially could reflect the characteristics of the rotary basin-buttock, and the rotary waist and chest. Figures and Tables | References | Related Articles | Metrics

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Establishment of prediction model of blood transfusion after proximal femoral nail anti-rotation fixation of femoral intertrochanteric fracture in elderly adults He Shiping, Jia Dazhou, Li Xiaolei, Wang Qiang 2022, 26 (6):  929-933.  doi: 10.12307/2022.179 Abstract ( 350 )   PDF (1200KB) ( 106 )   Save BACKGROUND: Proximal femoral nail anti-rotation is widely used in the treatment of elderly patients with femoral intertrochanteric fracture. Its surgical injury is small and the fixation is reliable, but the perioperative blood loss is still large. The proportion of patients who need blood transfusion after operation is still high, which has been bothering orthopedic surgeons.   OBJECTIVE: To explore the related risk factors of blood transfusion after proximal femoral nail anti-rotation fixation of femoral intertrochanteric fracture in the elderly, and to establish and verify a nomogram prediction model to provide guidance for early identification of postoperative high-risk blood transfusion patients. METHODS:  The perioperative clinical data of patients with femoral intertrochanteric fracture treated with proximal femoral nail anti-rotation in the Department of Traumatic Orthopedics of Subei People’s Hospital of Jiangsu Province from January 2016 to December 2020 were analyzed retrospectively. According to whether the patients received blood transfusion or not, the patients were divided into transfusion group and non-transfusion group. Univariate and multivariate Logistic regression analyses were performed to explore the independent risk factors for postoperative blood transfusion. According to the results of multiple factors, a nomogram prediction model was established, and the ROC curve and calibration curve were drawn to evaluate the prediction performance and consistency.   RESULTS AND CONCLUSION: (1) Totally 366 patients were included in the study, with 142 patients in the transfusion group, and the probability of postoperative blood transfusion was 38.8%. (2) Univariate analysis showed that age, type of fracture, preoperative hemoglobin, preoperative albumin, time from injury to operation, type of anesthesia and intraoperative blood loss were related to postoperative blood transfusion (P < 0.05). (3) Multivariate Logistic regression analysis showed that fracture type, preoperative albumin, preoperative hemoglobin and intraoperative blood loss were independent risk factors for blood transfusion (all P < 0.05). (4) The ROC curve showed that the area under the curve for predicting the risk of postoperative blood transfusion by the model was 0.95, and the slope of the calibration curve was close to 1, indicating that the model had good differentiation and accuracy. (5) The prediction model of postoperative blood transfusion in elderly patients with femoral intertrochanteric fracture based on the results of multivariate Logistic analysis can provide scientific guidance for clinical orthopedic surgeons and further ensure the perioperative safety of such patients. Figures and Tables | References | Related Articles | Metrics

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Stability of patellar claw versus loop plate combined with patellar claw for the treatment of comminuted fractures of the lower pole of the patella  Duan Chao, Shang Xiaoqiang, Duan Xianglin, Yang Ping, Tao Shengxiang 2022, 26 (6):  934-937.  doi: 10.12307/2022.180 Abstract ( 327 )   PDF (1974KB) ( 117 )   Save BACKGROUND: After the comminuted fracture of the lower pole of the patella is sutured with the patellar ligament, the patellar concentrator can also increase the holding power of the lower pole. Some scholars report that the internal fixation method is firmly fixed without loosening, and early rehabilitation can be performed, but it is irritating risk of soft tissue and damage to cartilage.   OBJECTIVE: To study the mechanical stability of loop plate combined with patellar claw technique in the treatment of the comminuted fracture of the inferior patella through the cadaver biomechanical experiment. METHODS:  Totally six fresh adult cadavers were selected, including 12 knee joints, which were made into the model of comminuted fracture of the lower pole of patella by swing saw. One side of patella was fixed by loop plate combined with poly patella claw to form the experimental mechanical model. The other side was fixed by poly patella claw to form the experimental mechanical model. The loading test was carried out on the patella ligament. The maximum tension of 1 mm and 2 mm of fracture end separation was recorded respectively by loading load, and statistical analysis was performed. The experimental study was approved by the Plenary Meeting of the Ethics Committee of Wuhan Red Cross Hospital (approval No. 20161201).   RESULTS AND CONCLUSION: (1) The maximum tension of 1 mm and 2 mm was (254.35±9.14) N and (274.23±15.06) N in the loop plate combined with patellar claw fixation group, respectively. The maximum tension of 1 mm and 2 mm was (106.00±4.79) N and (120.62±5.73) N in the patellar claw fixation group, respectively. The maximum tension of the loop plate combined with patellar claw fixation group was significantly higher than that of the patellar claw fixation group (P < 0.001). (2) The findings indicate that the treatment of comminuted fracture of the lower patella with loop plate combined with patellar claw is stable, safe and reliable in biomechanics, and can be used for passive rehabilitation exercise in the early stage. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of the treatment of hallux valgus deformity by microplate combined with super strong suture elastic fixation Li Guijun, Fang Xiaohui, Kong Weifeng, Yuan Xiaoqing, Jin Rongzhong, Yang Jun 2022, 26 (6):  938-942.  doi: 10.12307/2022.181 Abstract ( 416 )   PDF (2112KB) ( 61 )   Save BACKGROUND: At present, the osteotomy is the mainstream surgical method, and there are many complications. Elastic fixation between the first and second metatarsals is a new surgical method for hallux valgus.   OBJECTIVE: Using the method of finite element analysis, the treatment of hallux valgus with fixation between the first and second metatarsals was studied, which provided theoretical data for clinical treatment. METHODS:  CT data of a female patient with hallux valgus in Changzhou Tumor Hospital Affiliated to Soochow University were collected to establish a finite element model of hallux valgus. Three surgical sites were divided into group A (from the base of the distal first metatarsal to the base of the distal second metatarsal); group B (from the base of the distal first metatarsal to the middle segment of the second metatarsal); group C (from the base of the distal segment of the first metatarsal to the base of the proximal segment of the second metatarsal). The first metatarsal and the second metatarsal were fixed respectively to correct the hallux valgus angle to 9 degrees in the three groups to analyze stress and deformation after fixation. The protocol was conducted in accordance with relevant ethical requirements of Changzhou Tumor Hospital (approval No. 2019-SY-031; date: 2019). Patients and their family signed the informed consent.   RESULTS AND CONCLUSION: (1) After implementing the surgical plan at the three groups of surgical sites, in group A, the total foot stress was 202.43 MPa, and the deformation was 1.71 mm; the first metatarsal stress was 37.38 MPa, and the deformation was 1.71 mm; the second metatarsal stress was 1.16 MPa, and the deformation was 0.005 mm. In group B, the stress of the whole foot was 220.58 MPa, and the deformation was 1.47 mm; the first metatarsal stress was 29.26 MPa, and the deformation was 1.47 mm; the second metatarsal stress was 0.94 MPa, and the deformation was 0.004 5 mm. In group C, the total foot stress was 141.94 MPa, and the deformation was 1.07 mm; the first metatarsal stress was 23.62 MPa, and the deformation was 1.07 mm; the second metatarsal stress was 1.43 MPa, and the deformation was 0.003 2 mm. (2) The results showed that the surgical site from the base of the distal first metatarsal to the base of the distal second metatarsal or the middle segment of the second metatarsal had higher deformation ability, which was more conducive to the correction of hallux valgus angle. Figures and Tables | References | Related Articles | Metrics

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A comparative study of imaging parameters and quality of life scores between subtypes of lumbar spondylolisthesis Li Yuqiao, Sun Tianwei, Ma Bin, Zhou Zhaohong, Dong Runbei, Wu Haiyang 2022, 26 (6):  943-948.  doi: 10.12307/2022.182 Abstract ( 375 )   PDF (1718KB) ( 101 )   Save BACKGROUND: Previous studies have reported the comparison of the sagittal parameters of the spine and pelvis between patients with lumbar spondylolisthesis and the normal population, but comparative studies on the differences in imaging parameters between patients with different subtypes of lumbar spondylolisthesis and their impact on the quality of life scores are relatively scarce.   OBJECTIVE: To analyze the differences in imaging parameters between subtypes of lumbar spondylolisthesis and its relationship with quality of life. METHODS:  This study retrospectively analyzed 63 patients with lumbar spondylolisthesis. These patients were divided into degenerative lumbar spondylolisthesis group (n=35) and isthmic spondylolisthesis group (n=28). Spine and pelvic imaging parameters, including sagittal vertebral axis, lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, pelvic incidence-lumbar lordosis matching, lumbar 1 plumb line, upper lumbar curve, and lower lumbar curve, and functional score (health related quality of life score) were analyzed between the two groups. The protocols were in accordance with the relevant ethical requirements of Declaration of Helsinki and Tianjin People’s Hospital. The patients signed informed consent.   RESULTS AND CONCLUSION: (1) In the study of preoperative imaging parameters, sagittal vertebral axis was significantly higher in the degenerative lumbar spondylolisthesis group than that in the isthmic spondylolisthesis group. Pelvic tilt, lumbar lordosis, upper lumbar curve, and lower lumbar curve were significantly lower in the degenerative lumbar spondylolisthesis group than those in the isthmic spondylolisthesis group (all P < 0.05 or P < 0.01). The other imaging indications showed no significant differences between the two groups. (2) Pelvic tilt was significantly lower in patients with visual analogue scale (low back pain) score ≤3 than that in patients scoring > 3 (P=0.026, P=0.047). (3) There was no significant difference in imaging indexes between the two groups of patients with preoperative Oswestry disability index > 40 and those with Oswestry disability index ≤40. (4) The results have shown that there are significant differences in sagittal biomechanics between degenerative lumbar spondylolisthesis and isthmic fissure lumbar spondylolisthesis. Pelvic tilt was significantly lower in patients with visual analogue scale (low back pain) score ≤3 than that in patients scoring > 3. Figures and Tables | References | Related Articles | Metrics

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Effects of posterior single open-door laminoplasty and anterior cervical corpectomy fusion on cervical sagittal balance parameters in the treatment of multilevel cervical spondylotic myelopathy Li Jian, Bao Zhengqi, Zhou Pinghui, Zhu Ruizhi, Li Zhixiang, Wang Jinzi 2022, 26 (6):  949-953.  doi: 10.12307/2022.183 Abstract ( 398 )   PDF (1223KB) ( 80 )   Save BACKGROUND: Posterior single open-door laminoplasty (LAMP) and anterior cervical corpectomy fusion (ACCF) can effectively treat cervical spondylotic myelopathy. However, the two treatments have different effects on the postoperative cervical spine sagittal balance.   OBJECTIVE: To compare the effects of LAMP and ACCF on cervical sagittal balance parameters in the treatment of multilevel cervical spondylotic myelopathy. METHODS:  Seventy patients with multilevel cervical spondylotic myelopathy in First Affiliated Hospital of Bengbu Medical College from August 2017 to August 2020 were enrolled in this study. There were 40 cases in ACCF group and 30 cases in LAMP group. Lateral cervical X-ray films were taken before operation and during follow-up. C2-7 Cobb angle, C2-7 sagittal vertical axis, and T1 inclination angle were compared between the two groups. This study was approved by the Ethics Committee of First Affiliated Hospital of Bengbu Medical College.   RESULTS AND CONCLUSION: (1) Compared with preoperatively, there was no significant change in the T1 inclination angle between the two groups at 10 months after surgery (P > 0.05). There was no significant difference between the two groups in the T1 inclination angle at the 10-month postoperative period (P > 0.05). (2) Compared with preoperatively, the C2-7 Cobb angle of patients in the ACCF group increased at 10 months after surgery (P < 0.05), and the C2-7 Cobb angle of patients in the LAMP group decreased at 10 months after surgery (P < 0.05). The C2-7 Cobb angle of patients in the ACCF group was greater than that of the LAMP group at 10 months after surgery (P < 0.05). (3) Compared with preoperatively, C2-7 sagittal vertical axis in the ACCF group decreased at 10 months after the operation (P < 0.05), and C2-7 sagittal vertical axis increased in the LAMP group at 10 months after the operation (P < 0.05). The C2-7 sagittal vertical axis of the ACCF group was smaller than that of the LAMP group at 10 months after surgery (P < 0.05). (4) In the ACCF group, the postoperative C2-7 Cobb angle and C2-7 sagittal vertical axis changes in patients with high T1 inclination angle were not significantly different from those in patients with low T1 inclination angle (P > 0.05). In the LAMP group, the changes of C2-7 Cobb angle and C2-7 sagittal vertical axis in patients with high T1 inclination angle were greater than those in patients with low T1 inclination angle (P < 0.05). (5) The findings showed that compared with LAMP, ACCF in the treatment of multilevel cervical spondylotic myelopathy can avoid cervical kyphosis, better maintain the physiological curvature of the cervical spine and improve the sagittal balance of the cervical spine. To avoid postoperative sagittal balance decompensation of cervical vertebra, ACCF is more suitable than LAMP for the treatment of cervical spondylotic myelopathy with high T1 inclination angle. Figures and Tables | References | Related Articles | Metrics

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Establishment of cervical bone age equation for male adolescents aged 8-16 years old in Hohhot based on thin-slice CT Yi Xinrong, Jia Fuquan, He Xin, Zhang Shaojie, Ren Xiaoyan, Li Zhijun 2022, 26 (6):  954-958.  doi: 10.12307/2022.184 Abstract ( 480 )   PDF (1301KB) ( 74 )   Save BACKGROUND: At present, the most classic domestic bone age assessment method is the wrist bone, but this method has disadvantages such as poor reproducibility and susceptibility to the level of the assessor, so it is difficult to carry out in most areas. Through the establishment of the cervical vertebra bone age equation, it provides a reference for the development of bone age identification in this area.   OBJECTIVE: To explore the application of quantitative indicators to establish the cervical vertebra bone age equation for adolescent male in Hohhot and to provide references for skeletal age identification. METHODS:  The thin-slice CT data of 151 normal male adolescents aged 8-16 years with cervical spine were selected and randomly divided into two groups. 111 cases in the first group were used as the data of the bone age prediction equation; 40 cases in the second group were used as the test data of the equation. The two-dimensional and three-dimensional parameters of the cervical spine were measured and analyzed. Multiple linear regression was used to make the bone age equation based on two-dimensional morphological parameters or two-dimensional and three-dimensional morphological parameters. Pearson correlation analysis was used to test the correlation between the bone age and the age of life calculated by the regression equation to compare the accuracy of the prediction before and after the introduction of three-dimensional parameters. The protocols were in accordance with the Declaration of Helsinki and the relevant ethical requirements of the Inner Mongolia Medical University. The subjects and guardians had fully informed consent to the testing and data collection.   RESULTS AND CONCLUSION: (1) The cervical spine age equations based on two-dimensional parameters and two-dimensional and three-dimensional joints were Y=4.454+1.443×D3+0.544×PH4 (D3 is the height of the depression of the lower edge of the C3 vertebral body; PH4 is the height of the posterior edge of the C4 vertebral body); Y=5.422+1.393×D3+0.413×AH3 (AH3 is the height of the anterior edge of the C3 vertebral body). After correlation analysis, the bone age calculated by the two equations was highly correlated with the age of life, and the r values were 0.905 and 0.833, respectively (all P < 0.01). (2) The goodness of fit and prediction accuracy of the bone age equation based on two-dimensional parameters were higher than the bone age equation based on two-dimensional and three-dimensional joint parameters. (3) Results confirmed that through the quantitative index of slice CT, it was found that the height of the lower edge of C3 vertebra and the height of the posterior edge of C4 vertebra were closely related to the bone age of male adolescents in Hohhot area.  Figures and Tables | References | Related Articles | Metrics

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Foot bone self-regulation under weight-bearing standing analyzed by medical imaging measurement Gao Yi, Ma Yue, Zhao Zeyu 2022, 26 (6):  959-962.  doi: 10.12307/2022.185 Abstract ( 408 )   PDF (1853KB) ( 86 )   Save BACKGROUND: Through the combination of traditional X-ray technology, digital software and anatomy, the visually obtained images of the human foot bones are easy to observe and measure the changes in the bones of the foot. At present, relevant domestic and foreign researches focus on pathological conditions of foot and plantar pressure distribution, and there are few studies on the changes of foot bones under weight-bearing conditions.   OBJECTIVE: To explore the changes in the foot bones in the standing state. METHODS: Totally 100 healthy young male students were selected. Special software developed by Criminal Investigation Police University of China for footprint measurement was used to measure the characteristics of the foot bones in the X-ray. Data of the human foot bones in normal and weight-bearing states were recorded.   RESULTS AND CONCLUSION: (1) Compared with the normal standing state, the weight-bearing state had a significant increase in the foot bone length, width, and the difference in the length of the second and fifth metatarsal bones (P < 0.01). (2) Compared with the normal standing state, the weight-bearing state had no significant effect on the hallux abduction angle, the little toe varus angle, and the length difference between the first and second metatarsals (P > 0.05), with stability. It can be used in medical foot bone and joint measurement research and forensic examination and identification. (3) The change of hallux valgus angle before and after loading was used to distinguish mild hallux valgus patients from healthy people. Figures and Tables | References | Related Articles | Metrics

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MRI evaluation of graft maturity and knee function after anterior cruciate ligament reconstruction with autogenous bone-patellar tendon-bone and quadriceps tendon Yang Kuangyang, Wang Changbing 2022, 26 (6):  963-968.  doi: 10.12307/2022.186 Abstract ( 498 )   PDF (1972KB) ( 131 )   Save BACKGROUND: Anterior cruciate ligament reconstruction usually uses bone-patellar tendon-bone, quadriceps tendon or hamstring tendon as grafts. The maturity of the intra-articular graft is the key to patient’s movement recovery after the anterior cruciate ligament reconstruction.   OBJECTIVE: To analyze the potential differences associated with graft maturity between bone-patellar tendon-bone and quadriceps tendon autografts after anterior cruciate ligament reconstruction. METHODS:  Sixty patients undergoing anterior cruciate ligament reconstruction in Foshan Hospital of Traditional Chinese Medicine from June 2018 to January 2020 were selected, including 50 males and 10 females, at the age of 17-42 years old. Twenty-seven patients were in the autologous bone-patellar tendon-bone group, and 33 patients were in the quadriceps tendon group. At 3, 6 and 12 months after ligament reconstruction, the signal/noise quotient of the three regions of the femoral side, the middle and the tibial side of the graft were compared between the two groups. The international knee documentation committee knee evaluation form, Lysholm score, and bilateral KT-1000 difference at 3, 6, and 12 months after surgery were compared between the two groups. The differences of knee gait were compared between the two groups at 12 months after ligament reconstruction. This study was approved by the Ethics Committee of Foshan Hospital of Traditional Chinese Medicine (approval No. 2018003).   RESULTS AND CONCLUSION: (1) At 3, 6, and 12 months after ligament reconstruction, there was no significant difference in the signal/noise quotient values at 3, 6 and 12 months after the operation of the femoral side and the middle segment (P > 0.05). The signal/noise quotient was higher in the quadriceps tendon group than that in the bone-patellar tendon-bone group (P > 0.05). (2) At 3, 6 and 12 months after ligament reconstruction, there were no statistically significant differences in knee IKDC, Lysholm score, and KT-1000 between the two groups (P > 0.05). (3) There were no statistically significant differences in knee gait analysis between the two groups at 12 months after ligament reconstruction (P > 0.05). (4) Results suggest that the maturity of the graft after anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft is superior to that of quadriceps tendon, but the difference in maturity does not affect the functional recovery of patients after ligament reconstruction. Figures and Tables | Related Articles | Metrics

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Anterior cruciate ligament rupture and patellofemoral joint stability before sagittal and axial measurement using MRI Li Jie, Zhang Haitao, Chen Jinlun, Ye Pengcheng, Zhang Hua, Zhou Bengen, Zhao Changqing, Sun Youqiang, Chen Jianfa, Xiang Xiaobing, Zeng Yirong 2022, 26 (6):  969-972.  doi: 10.12307/2022.187 Abstract ( 406 )   PDF (1133KB) ( 74 )   Save BACKGROUND: Anterior cruciate ligament rupture is one of the important causes of knee instability. There are few reports on the relationship between anterior cruciate ligament rupture and patellofemoral joint stability.   OBJECTIVE: To discuss the relationship between anterior cruciate ligament rupture and patellofemoral stability. METHODS:  This was a retrospective case-control study. A total of 65 cases of complete rupture of the anterior cruciate ligament confirmed by knee arthroscopy were set as the study group; 65 healthy persons  participating in physical examination were set as the normal group. The parameters related to patellofemoral joint instability were measured in sagittal and axial MRI of the knee and compared between the two groups. The implementation of the study scheme was in accordance with the relevant ethical requirements of the First Affiliated Hospital of Guangzhou University of Chinese Medicine, and the subjects and their families gave full informed consent to the study process.   RESULTS AND CONCLUSION: (1) The results tibial tubercle-femoral block spacing was shorter in the study group than that in the normal group (P < 0.05). Patellar tilt angle was significantly larger in the study group than that in the normal group (P < 0.05). (2) There was no statistically significant difference in baseline patella between the two groups (P > 0.05). The baseline value of trochlear and patella trochlear index was significantly lower in the study group than those in the normal group (P < 0.05). (3) It is concluded that completely anterior cruciate ligament rupture can decrease tibial tubercle-trochlear groove distance, increase the patellar tilt angle, rise patellar alta, and change the stability of the patellofemoral joint. It may be the potential risk factor for the patellofemoral arthritis. Figures and Tables | References | Related Articles | Metrics

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Internal fixation failure after proximal femoral nail antirotation: causes and reoperation strategies Zhang Xinlong, Ci Wentao, Luo Kaiwen, Yan shi 2022, 26 (6):  973-979.  doi: 10.12307/2022.188 Abstract ( 495 )   PDF (1240KB) ( 178 )   Save BACKGROUND: The proximal femoral nail antirotation has significant advantages in the treatment of intertrochanteric fractures, but there is still a 3.35%-31.08% failure rate of internal fixation. Internal fixation failures are not only of various types, but also of complex causes. Therefore, to summarize and analyze the causes of the failure of various proximal femoral nail antirotation internal fixations, and to clarify the boundary between the selection of long nails and short nails as well as the secondary surgical strategies after the failure of postoperative internal fixation is the key to better targeted prevention of the corresponding internal fixation failure and subsequent treatment in clinical practice. OBJECTIVE: To investigate the causes of various types of internal fixation failure secondary surgical strategies after the application of proximal femoral nail antirotation for the treatment of intertrochanteric fractures. METHODS: To search the relevant documents from January 2010 to May 2021 on PubMed, CNKI and Wanfang databases, with English search terms as “intertrochanteric fractures, risk factors, failure of internal fixation, PFNA, nonunion of fracture, cut out, cut in, helical blade position, osteoporosis, long and short intramedullary, revision surgery”. Chinese search terms were “intertrochanteric fracture, PFNA, failure of internal fixation, helical blade cut-out, periprosthetic fracture, non-union of fracture, osteoporosis, long and short intramedullary, revision surgery”. In addition, the reasons for the failure of various types of internal fixation and secondary surgical strategies after proximal femoral nail antirotation treatment of intertrochanteric fracture of femur were summarized.  RESULTS AND CONCLUSION: The six common types of internal fixation failure after proximal femoral nail antirotation surgery are helical blade cut out, hip varus, fracture nonunion, head nail withdrawal, internal fixation fracture, and fracture around the implant. (1) Improper placement of the blade, poor reduction of the neck shaft angle and anteversion angle, unstable fracture type, severe osteoporosis and high age are the main reasons for blade cut out. (2) Hip varus can be caused by postoperative lack of support of the medial femur due to a bone defect in the posterior medial part of the proximal femur, or secondary to other types of fixation failure, which can be avoided by delaying the loading time. (3) Fracture nonunion is affected by systemic and local factors, and the use of distal locking nails should be carefully considered. (4) Osteoporosis is the most common cause of blade withdrawal. In patients with severe osteoporosis, it is necessary to use a long-tailed cap to fix the spiral helical during the operation and delayed the postoperative loading time. (5) Failure of internal fixation may result from poor reduction, bone nonunion, and unstable fractures with distal locking nails and a mismatch between implant and bone. (6) Fractures around the implant are often associated with the mismatch between the bone marrow cavity and the intramedullary nail, the deviation of the main nail entry point, resulting in increased cortical impingement rate and local stress concentration. Clinically, the appropriate length of the main nail should be selected to avoid the occurrence of the “middle trousers effect”. (7) Except for some special cases, it is recommended that clinicians choose short nails for fixation. In addition, the choice of long and short intramedullary nails for A3 type intertrochanteric fractures is a direction that orthopedic surgeons need to continue to explore in the future. (8) For the reoperation strategy after the failure of proximal femoral nail antirotation internal fixation, it is a good choice to determine the second revision strategy from three aspects: the degree of femoral head destruction, the fracture site and the bone defect. Figures and Tables | References | Related Articles | Metrics

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Improvement of the treatment effect of osteoporotic fractures: research status and strategy analysis Peng Kun 2022, 26 (6):  980-984.  doi: 10.12307/2022.189 Abstract ( 515 )   PDF (1253KB) ( 111 )   Save BACKGROUND: With the increasing aging of China’s population, the number of people with osteoporotic fracture is also gradually increasing. How to improve the treatment effect and improve people’s healthy living standards is attracting the attention of clinicians, engineers and researchers. OBJECTIVE: To review the research progress of improving the treatment effect of osteoporotic fracture, and propose a improvement plan of treatment effect. METHODS: The relevant articles were searched from Wanfang Medical Database, CNKI Database, PubMed Database, and Elsevier Database by computer. The search terms were “osteoporosis, fractures, surgical treatment, implants, anti-osteoporosis treatment, growth factors” in Chinese and English. The time was limited from 2010 to 2020. Finally, 48 articles were included for review.  RESULTS AND CONCLUSION: (1) At present, the therapeutic effect can be improved by optimizing surgical treatment and anti-osteoporosis treatment. The surgery of bone compression can improve fusion degree between the short-term implant and fracture site bone tissue. The use of locking plate fixation technology can improve the growth and recovery of bone tissue at the fracture site. During the operation, autogenous bone, allogeneic bone, artificial bone materials, and ceramic materials were used as implants, which could fill the bone defect, but there were still some problems , such as limited donor, secondary operation, immune rejection, and insufficient biological activity. (2) Biodegradable polymeric materials, with good biosecurity, biocompatibility, plasticity, and remodelability, are hotspot in the research of osteoporotic fracture repair materials. (3) The introduction of Epimedium, bisphosphonates, and other drugs achieved better therapeutic effect than surgery alone. (4) Mechano growth factor-Ct24E as a typical force growth factor is conducive to improving the therapeutic effect, which promotes the adhesion, proliferation, differentiation and mineralization of osteoblasts. (5) Individually designed orthopedic implants need to have a three-dimensional structure that conforms to the formation of bone tissue. Three-dimensional printing technology can provide a physical structure that matches the patient’s fracture site. (6) In addition, after comprehensively analyzing the therapeutic effects of four aspects, including surgical procedures, implants, drugs, and growth factors, the author thinks that using force growth factor, anti-osteoporosis drug, biodegradable polymer, composite implants, and the application of three-dimensional printing technology together, and cooperating with the surgical treatment of advanced technology, can promote the growth of bone tissue, improve bone quality, enhance fusion, and obtain proper three-dimensional structure, and achieve comprehensive improvement of the treatment effect of osteoporotic fractures. Figures and Tables | References | Related Articles | Metrics