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28 March 2022, Volume 26 Issue 9 Previous Issue    Next Issue

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Biomechanical analysis of different ways of inserting Steinmann Pins into the femoral head Xu Xinzhong, Wu Zhonghan, Yu Shuisheng, Zhao Yao, Xu Chungui, Zhang Xin, Zheng Meige, Jing Juehua 2022, 26 (9):  1313-1317.  doi: 10.12307/2022.420 Abstract ( 454 )   PDF (2853KB) ( 120 )   Save BACKGROUND: For people of different ages, femoral neck fractures have different fracture line characteristics and different treatment strategies. It has become a common challenge for orthopedic scholars that how to improve the quality of reduction and avoid osteonecrosis of the femoral head and failure of internal fixation in surgical treatment. Through mechanical tests of models of the femoral head and neck, we expect to obtain the relevant data and point out the direction for the improvement of reduction stability and reduction quality.   OBJECTIVE: To obtain the mechanical characteristics of different ways of inserting Steinmann Pins into the femoral head through the static anti-pull-out test and the fatigue test. METHODS:  The Steinmann Pins with model ZLW02SJA produced by Tianjin Zhengtian Medical Equipment Co., Ltd., with a specification of φ3.5*300 mm, and a sample material of 317 stainless steel, were selected for the study according to two steps. Step 1: Static tensile test was the test that inserted one or two Steinmann Pins into the Sawbone with corresponding depth in the femoral head. The direction could be from front to back or from greater trochanter of femur into the femoral head, and the total kind of solution combinations was eight. The Steinmann Pins were injected into the specified depth. The pullout force of the Steinmann Pins was tested with the speed of 20 mm/min, and the pullout force was recorded. Step 2: Fatigue tensile test. The average pullout force of the first eight tests was summarized; 75% of the two maximum pullout forces were taken for fatigue tensile test.   RESULTS AND CONCLUSION: (1) Through static tensile tests, it is concluded that the two schemes with the best pullout force were scheme 5 and scheme 7. In scheme 5 whose direction was from front to back into the femoral head: the thickness of cortical bone was 4.3 mm. The thickness of cancellous bone was 25.7 mm. The number of Steinmann Pins was 2. Insertion depth was 2/3 of femoral head. In scheme 7 whose direction was from greater trochanter of femur into the femoral head, the thickness of cortical bone was 3.0 mm; the thickness of cancellous bone was 26.3 mm; and the number of Steinmann Pins was 2. Insertion depth was 2/3 of femoral head. (2) After that, 75% of the maximum pullout force of the two schemes was selected for at least 300 fatigue cycles, and both schemes could complete the fatigue test. The most stable inserting mode of Steinmann Pins was scheme 5, which had a large pullout force, so it could produce stable traction relatively with the femoral head in the process of reduction of the femoral head. (3) Results verified that static tensile tests and fatigue tests showed that the insertion of two Steinmann Pins was better than that of one Steinmann Pin, and the insertion of two Steinmann Pins behaved better in inserting from front to back rather than inserting from lateral greater trochanter. Figures and Tables | References | Related Articles | Metrics

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Biomechanical analysis of non-uniform material femur under different loads Wei Guoqiang, Li Yunfeng, Wang Yi, Niu Xiaofen, Che Lifang, Wang Haiyan, Li Zhijun, Shi Guopeng, Bai Ling, Mo Kai, Zhang Chenchen, Xu Yangyang, Li Xiaohe 2022, 26 (9):  1318-1322.  doi: 10.12307/2022.421 Abstract ( 598 )   PDF (2274KB) ( 90 )   Save BACKGROUND: The current femoral finite element model analyzes only the biomechanical studies at a single load, and the stress strain distribution of the bones under different load conditions helps to evaluate and predict the disease recovery and improve the surgical results.   OBJECTIVE: Through the establishment of a three-dimensional model of the femur, to explore the mechanical behavior of the proximal femur in different postures of the human body, and clarify the risk area of femur fracture. METHODS:  Based on the CT image data of the human femur, Mimics, Geomagic Studio, Hypermesh and Abaqus and other three-dimensional reconstruction softwares were used to establish a finite element model of the femur. Along the direction of gravity, on the coronal and sagittal planes of the femur, the shape surfaces were angled at -20°, -10°, 0°, +10°, +20°, a total of five groups of working conditions, and the femoral head exerted a force of 300 N. The lower part of the femur added a fixed constraint. At different positions of the femur, the distribution characteristics of stress and strain were observed under angular physiological load.   RESULTS AND CONCLUSION: The stress and strain of the femur peaked at +10° in the coronal plane and -20° in the sagittal plane. The overall distribution of femoral stress values was femoral shaft > subtrochanteric > femoral neck; the overall distribution of femoral strain values was femoral shaft > femoral neck > subtrochanteric. The stress value and strain value of the femur could increase under the standing position of 10° hip adduction and 20° of hip abduction, and the load on the overall mechanics of the femur could increase. Figures and Tables | References | Related Articles | Metrics

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Relationship between revascularization and internal microstructure changes in osteonecrosis of the femoral head Li Huo, Wang Peng, Gao Jianming, Jiang Haoran, Lu Xiaobo, Peng Jiang 2022, 26 (9):  1323-1328.  doi: 10.12307/2022.422 Abstract ( 502 )   PDF (2022KB) ( 77 )   Save BACKGROUND: One of the pathological features of osteonecrosis of the femoral head is damage to the blood circulation of the femoral head, which leads to osteonecrosis and microfracture of the femoral head. The exact pathophysiological mechanism is not completely clear, but it is generally believed that it is closely related to interruption of the intraosseous circulation and death of the bone tissue. Osteonecrosis of the femoral head mainly includes ischemia and the subsequent repair process. However, few studies have explored the relationship between ischemia and repair in occurrence and development of osteonecrosis of the femoral head.   OBJECTIVE: To analyze changes in blood perfusion during the repair of osteonecrosis of the femoral head through dynamic contrast enhanced-MRI and thereby to clarify the changes in blood perfusion and the corresponding internal microstructure during osteonecrosis of the femoral head repair. METHODS:  Dynamic contrast enhanced-MRI technique was used to scan each subject. Region of interest was drawn in the necrotic area, repair reaction area and normal area (femoral neck or greater trochanter) of osteonecrosis of the femoral head patients. For each region of interest, we got the corresponding contrast medium concentration, and calculated the semi-quantitative parameters of the corresponding curve (peak intensity, peak time, area under the curve, and initial slope). The “origin” software was used for data processing, the contrast media data of the region of interest of patients with osteonecrosis of the femoral head was obtained, and the statistical results of the contrast medium were compared with the results of optical microscope on the corresponding decalcified sections to explore the changes of the internal structure of osteonecrosis of the femoral head in different stages.   RESULTS AND CONCLUSION: (1) The statistical analysis showed that the average concentration of contrast medium in the repair reaction area of osteonecrosis of the femoral head was significantly higher than that in other areas (P < 0.05). (2) The statistical analysis showed that the maximum peak intensity value, area under the curve and initial slope of curve of concentration of contrast medium were significantly higher than those in other areas (P < 0.05). With the progression of the disease and the occurrence of collapse, this gap was more obvious. (3) Histological analysis showed that the bone trabecular structure in the reparative reaction area was continuous before collapse. With the occurrence of collapse, trabecular absorption increased, surrounded by a large amount of fibrous granulation tissue and neovascularization. (4) The results showed that the blood perfusion in the repair reaction area of osteonecrosis of the femoral head is significantly higher than that in other areas, and the increase in blood perfusion in the repair reaction area becomes more obvious with the occurrence of collapse. The increase in blood perfusion in the repair reaction area accelerates trabecular absorption in this area, which is closely related to the occurrence of osteonecrosis and collapse of the femoral head. Figures and Tables | References | Related Articles | Metrics

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Effect of splintage and Shenxiaosan cataplasm on fracture healing in rabbits with radial fracture model Li Rui, Shi Wen, Yang Shicai, Lü Linwei, Zhang Chunqiu 2022, 26 (9):  1329-1333.  doi: 10.12307/2022.423 Abstract ( 408 )   PDF (1938KB) ( 38 )   Save BACKGROUND: At present, the main clinical methods for the treatment of long bone fractures were external fixation with plaster or splint, and internal fixation such as bone plate or intramedullary nail, simultaneously taking drugs to accelerate fracture healing or applying drugs to the affected area.   OBJECTIVE: To investigate whether splintage combined with Shenxiaosan cataplasm could improve the rehabilitation of radial shaft fracture. METHODS:  Eighteen New Zealand white rabbits were used to make a complete fracture model of the left radius, and divided into three groups. No intervention was conducted in the non-intervention group. Models in the splintage group were fixed with splintage. Models in the splintage adjuvant Shenxiaosan group received external fixation with splintage, and adjuvant external application of Shenxiaosan cataplasm (change dressing once a day) (n=6 per group). At 2, 4 and 6 weeks after surgery, the callus position was taken to prepare the sample, and the roughness and particle of callus were measured by atomic force microscope.   RESULTS AND CONCLUSION: (1) In the splintage group and splintage adjuvant Shenxiaosan group, the rough surface and obvious granular structure of the callus could be clearly observed. These mineral particles were attached to the collagen fibers and presented fish scales. The collagen structure of the splintage adjuvant Shenxiaosan group was much smaller than splintage group. (2) As the healing time increased, the size of bone callus mineral particles gradually decreased. The size of bone mineralization particles in the splintage adjuvant Shenxiaosan group during the same period was 47.5%-69.6% smaller than that of the splintage group. At the same time, as the healing time went on, the roughness of the callus gradually decreased. The roughness of the callus in the splintage adjuvant Shenxiaosan group 2 weeks after the operation was about 69% smaller than that of the splintage group, and the roughness of the callus in the two groups tended to be similar at 6 weeks after the operation. (3) It is indicated that Shenxiaosan cataplasm had a promoting effect on fracture healing. Figures and Tables | References | Related Articles | Metrics

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Extracorporeal circulation compression perfusion in the reconstruction of limb microcirculation from the mechanism of mechanical and chemical signal transduction Gao Lei, Qin Xinyuan, Nie Xin, Wang Lei, Wang Jiangning 2022, 26 (9):  1334-1340.  doi: 10.12307/2022.424 Abstract ( 462 )   PDF (6403KB) ( 50 )   Save BACKGROUND: Preliminary work applied extracorporeal circulation and pressurized perfusion to treat ischemic lesions. While establishing lower extremity collateral circulation, it also improved the distal microcirculation of the extremities by increasing the blood perfusion volume of the lower extremities. This technique has achieved good clinical results.   OBJECTIVE: To explain the principle of extracorporeal circulation compression perfusion in the reconstruction of limb microcirculation from the mechanism of mechanical and chemical signal transduction by designing an animal model of diabetes with peripheral arterial disease. METHODS:  The models of diabetes mellitus complicated with peripheral arterial disease were established in 24 Bama miniature pigs and were randomly divided into four groups (n=6): blank control group, model group, extracorporeal circulation perfusion group (close to normal limb mean arterial pressure perfusion) (normobaric perfusion group), and extracorporeal circulation compression perfusion group (twice mean arterial pressure perfusion) (compression perfusion group). The limb blood flow of the four groups of experimental animals was measured at six time points: successful establishment of the model, 30 minutes of perfusion, 1 hour of perfusion, 2 hours of perfusion, 5 hours of perfusion, and 7 hours of perfusion. Arterial blood samples of experimental animals were taken to detect the contents of interleukin-8, nitric oxide and endothelin-1 by enzyme-linked immunosorbent assay. Two weeks after the end of the experiment, the tibialis anterior muscle of the right hindlimb was stained with hematoxylin and eosin to observe the capillary density. The tibialis anterior muscle of the right hindlimb was taken from the right hindlimb, and the relative expression of vascular endothelial growth factor A/ vascular endothelial growth factor receptor 2 protein was detected by western blot assay.   RESULTS AND CONCLUSION: (1) The skin blood flow of the compression perfusion group was significantly higher than that of other three groups after 7 hours of perfusion (P < 0.05). The serum nitric oxide level in compression perfusion group was significantly higher than that in the other three groups (P < 0.05). The serum endothelin-1 value in compression perfusion group was significantly higher than that in the model group, lower than that in blank control group and normal pressure perfusion group (P < 0.05). The serum interleukin-8 level in compression perfusion group was higher than that in the model group and lower than that in the blank control group and normal pressure perfusion group, and the difference was statistically significant (P < 0.05). (2) Two weeks after the end of the experiment, pathological examination showed that the microvessel density count of tibialis anterior muscle tissue in compression perfusion group (18.33±1.51)/mm2 was significantly higher than that in the other three groups (P < 0.05). The relative expression of vascular endothelial growth factor A/ vascular endothelial growth factor receptor 2 protein in the tibialis anterior muscle tissue in the compression perfusion group was significantly higher than that in the other three groups (P < 0.05). (3) By increasing the perfusion compression and increasing the shear force of blood flow to vascular endothelial cells, the shear force acted as a mechanical stimulation signal to initiate complex mechanical and chemical signal transduction so as to promote the formation of collateral circulation, thereby effectively improving microcirculation. Figures and Tables | References | Related Articles | Metrics

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Classification and reduction strategies for irreducible intertrochanteric femoral fracture based on anatomy Yuan Jiabin, Zhu Zongdong, Tang Xiaoming, Wei Dan, Tan Bo, Xiao Chengwei, Zhao Ganlinwei, Liao Feng 2022, 26 (9):  1341-1345.  doi: 10.12307/2022.425 Abstract ( 641 )   PDF (2430KB) ( 77 )   Save BACKGROUND: How to achieve satisfactory reduction quickly, minimally invasively and effectively is difficult in the operation of irreducible intertrochanteric femoral fracture. Fracture classification helps to formulate a reasonable reduction plan before surgery, but a simple and feasible classification of irreducible intertrochanteric femoral fracture is still lacking currently.   OBJECTIVE: To explore the classification and reduction strategy of irreducible intertrochanteric femoral fracture based on anatomy. METHODS:  The clinical data of 531 patients with irreducible intertrochanteric fracture treated in Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital from June 2006 to May 2020 were analyzed retrospectively, including 187 males and 344 females, at the age of 60-101 years old. According to whether the greater trochanter/lesser trochanter was connected to the proximal end of the fracture, the irreducible intertrochanteric fractures were divided into type I (proximal free), type II (greater trochanter connected), type III (lesser trochanter connected), and type IV (both greater and lesser trochanters connected). Periosteum stripper, hemostatic forceps and/or bone hook were used to assist the reduction, and InterTan or proximal femoral nail anti-rotation was used for internal fixation. X-ray films were taken during postoperative follow-up to assess the quality of fracture reduction and fracture healing. At the last follow-up, the patient’s hip function recovery was assessed by Harris score.   RESULTS AND CONCLUSION: (1) Among the 531 cases of irreducible femoral intertrochanteric fractures, the types I, II, III, and IV were 357, 87, 13, and 74 cases respectively, and 489 cases (92.1%) achieved satisfactory reduction. (2) Of the 531 patients, 26 were lost to follow-up, and 23 died of pneumonia, heart failure and other causes before the fracture healing. 482 patients were followed up for more than one year, and all fractures healed with an average time of 4.7 months. (3) During the postoperative follow-up, there was no adverse event related to internal fixation materials. (4) At the last follow-up, the Harris score of 482 patients was 95.7±4.8, of which 433 cases (89.8%) had excellent evaluation results. (5) These results confirm that for irreducible intertrochanteric fractures, satisfactory reduction and hip joint function can be obtained by adopting our classification and reduction techniques. Figures and Tables | References | Related Articles | Metrics

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Stress and displacement of normal lumbar vertebra and posterior structure with different elbow pressing methods Lü Qianyi, Chen Xinyi, Zheng Huie, He Haolong, Li Qilong, Chen Chutao, Tian Haomei 2022, 26 (9):  1346-1350.  doi: 10.12307/2022.426 Abstract ( 465 )   PDF (3942KB) ( 116 )   Save BACKGROUND: Elbow pressing method is the common manipulation of massage. The forces on the lumbar vertebra are different with different angle elbow pressing methods and improper manipulation may aggravate the disease. Currently, the relevant research needs to be further improved.   OBJECTIVE: Using the method of finite element analysis, to observe the distribution of stress, the distribution and direction of displacement at L4-L5 vertebra and posterior structure of lumbar model with different angle elbow pressing methods, and to investigate the safest and most suitable angle of elbow pressing method so as to provide reference for clinical practice. METHODS:  CT images of a 25-year-old healthy male volunteer were obtained. A normal lumbar finite element model was established using Mimics, Geomagic Studio, Solidworks, Hypermesh, and ABAQUS softwares. The elastic modulus and Poisson’s ratio of nucleus pulposus and annulus fibrosus were changed to establish the left and back protrusion of lumbar intervertebral disc. The pressing position was the projection of the protrusion’s body surface. The pressing force was 400 N, and the pressing was simulated once every 15° until 165° from left to right. The distribution of stress, the distribution and direction of displacement in the vertebral body and posterior structure of finite element models with normal and lumbar disc herniated lumbar spine were observed under the different angle elbow pressing methods. The implementation of the research protocol complied with the relevant ethical requirements of the First Affiliated Hospital of Hunan University of Chinese Medicine, and the subjects signed informed consent to the test process and use.   RESULTS AND CONCLUSION: (1) Compared with the normal lumbar spine model, the range of stress concentration in the posterior structure of the lumbar disc herniation model was larger, such as articular joints, pedicles, and simulated compression parts. Many stress concentrations occurred, such as back and side of the lower part of the right lamina of L4 and the lower part of the L5 vertebral body. (2) When the angle of the elbow was 15°-45°, the stress of the lumbar disc herniation model was mainly concentrated on the right side. (3) When the pressing angle was 30°-60°, the largest displacement distribution was the L4 bilateral superior articular process. Moreover, the vertebral body and its rear structure would shift forward and right. (4) Compared with different angle elbow pressing methods, when the angle of the elbow was 30°-45°, the load on the affected vertebral body was smaller, and the safety was higher. The position of the L4-L5 lumbar facet joints can be adjusted to restore the normal biology of the spine mechanical status. This conclusion is recommended for clinical reference. Figures and Tables | References | Related Articles | Metrics

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Construction and verification of a full spine biomechanical model of adolescent scoliosis Zhang Yufang, Lü Meng, Mei Zhao 2022, 26 (9):  1351-1356.  doi: 10.12307/2022.427 Abstract ( 599 )   PDF (1743KB) ( 139 )   Save BACKGROUND: At this stage, the biomechanical model of scoliosis patients is too simplified. A complete finite element model of the patient’s trunk bone-muscle has not been established, and the modeling of the mechanical properties of soft tissue is lacking.   OBJECTIVE: To establish a real finite element model of the scoliosis trunk with detailed anatomical structure and verify its effectiveness. METHODS:  A case of 11-year-old adolescent with scoliosis was selected. The original data in .DICOM format were obtained by 64 slice spiral CT scanning. The finite element model of the trunk was established and its effectiveness was verified. The simulation results of the lumbosacral segment model and the trunk model were compared and verified with the experimental results in the published articles. The implementation of the research scheme meets the relevant ethical requirements of Hebi People’s Hospital (hospital ethical approval No. YK2019015).   RESULTS AND CONCLUSION: (1) Model establishment: The finite element model of the whole trunk consisted of more than 8.47 million elements and 1.69 million nodes. (2) Validation of lumbosacral segment model: The average stiffness of the established model under flexion, extension, lateral flexion and torsion was 7.15, 2.56, and 1.92 N•m/(°), which was between the experimental results reported in the articles. Load results were consistent with the experimental values in the articles. (3) Verification of the trunk model: Under the action of the three band tensions (20, 40, and 60 N), the changes in the stress values of the spine were within the middle value of the experimental results reported in the articles. (4) One constructed adolescent scoliosis trunk biomechanical model with detailed anatomical structure, verified by the validity of the biomechanical model, is reliable, reasonable, true, and intuitive to display the complex bone and soft tissue structure of the human body. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of biomechanical changes in the osteoarthritis knee joint in different gait flexion angles Zhang Jichao, Dong Yuefu, Mou Zhifang, Zhang Zhen, Li Bingyan, Xu Xiangjun, Li Jiayi, Ren Meng, Dong Wanpeng 2022, 26 (9):  1357-1361.  doi: 10.12307/2022.428 Abstract ( 556 )   PDF (2057KB) ( 68 )   Save BACKGROUND: Patients with mild knee osteoarthritis are prone to induce pain and aggravation of arthritis during daily gait walking. At present, the changes in the biomechanical behavior of the internal knee joints of such patients under the gait flexion angle are not very clear. There are few reports in the literature.   OBJECTIVE: Based on the proven finite element model of the mild osteoarthritis knee joint, according to the change of gait cycle and knee flexion angle, to simulate the knee flexion behavior at four angles of 0°, 10°, 20°, and 30°, and to study the stress distribution characteristics and contact area changes of femoral cartilage, tibial cartilage, and meniscus. METHODS:  The material properties of the finite element model of the mild osteoarthritis knee joint were defined. The boundary conditions and the axial load were determined under different knee flexion angles. By analyzing the Mises stress, Tresca stress, and contact area of the non-bone tissue in the tibiofemoral joint, the biomechanical behavior changes inside the knee joint were studied.   RESULTS AND CONCLUSION: The results of finite element analysis showed that as the knee flexion angle increased, the peak Mises stress and the peak Tresca stress on the meniscus, femoral cartilage, and tibial cartilage showed a relatively increasing trend. The total contact area of the tibiofemoral joint showed a decreasing trend, and the medial meniscus subluxation caused the lateral peak to be larger than the medial peak. Meanwhile, the contact area of the medial compartment decreased and the contact area of the lateral compartment increased. When the knee flexion angle reached 20° and 30°, the peak of Mises stress and the peak of Tresca stress appeared. Results showed that when the knee flexion angle of the mild osteoarthritis knee joint changed, the internal stress and contact area change characteristics changed because of the medial meniscus subluxation. The medial contact area decreased; the peak stress increased; and the lateral contact area increased. The peak stress increased and the increase was greater than the inside. The breakdown of the internal load balance of the joint may increase the risk of articular cartilage degeneration and promote the aggravation of knee osteoarthritis. Figures and Tables | References | Related Articles | Metrics

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Construction and biomechanical analysis of ankle joint finite element model in gait cycle Bai Zixing, Cao Xuhan, Sun Chengyi, Yang Yanjun, Chen Si, Wen Jianmin, Lin Xinxiao, Sun Weidong 2022, 26 (9):  1362-1366.  doi: 10.12307/2022.429 Abstract ( 560 )   PDF (1323KB) ( 82 )   Save BACKGROUND: The ankle joint is one of the most important load-bearing joints in the human body and plays an important role in walking. At present, there is a lack of research on the stress of the ankle joint in the gait cycle.   OBJECTIVE: To analyze the stress and area changes of the ankle joint during the gait cycle based on the finite element analysis method. METHODS:  First, an ankle finite element model was constructed with Mimics 16.0 software and Rapidform XOR3 64 software. The stress and contact area of this ankle joint model were compared with Anderson’s finite element model to verify the effectiveness of the model. Finally, ABAQUS finite element analysis software was used to simulate the stress state of the ankle joint during the gait cycle in a balanced standing condition and the pre-swing condition. By comparing the stress changes in different conditions in the same area, the role of the ankle joint in the gait cycle was analyzed to explore the changes in ankle stress under joint instability.   RESULTS AND CONCLUSION: (1) The ankle joint finite element model constructed in this study included 44 551 units and 16 718 nodes, and verified its validity and rationality. (2) Balanced standing conditions: The main stresses were concentrated in the anterior fibula ligament (A, B), anterior tibiotalar ligament (C, D), the proximal end of the posterior tibial ligament (F), and the lower surface of the tibiotalar joint (H). The maximum stress at the ankle joint was at the proximal attachment point (F) of the posterior tibiofibular ligament, which was 10.670 MPa. The minimum stress was at the medial malleolus tibial articular surface (J), which was 2.965 MPa. (3) The pre-oscillation condition: The main stress was concentrated in the anterior fibula ligament (A, B), tibialis anterior ligament (C, D), inferior surface of the tibiotalar joint (H), and articular surface of the lateral malleolus talus (K). The maximum stress of the ankle joint was at the proximal end of the tibial anterior ligament (D), which was 23.00 MPa. The minimum stress was at the proximal attachment point (F) of the posterior tibial ligament, which was 3.478 MPa. (4) It is concluded that the finite element model of the ankle joint constructed in this study highly restores the mechanical environment of the ankle joint, clarifies the stress law of the ankle joint during the gait cycle, and provides ideas for the diagnosis and treatment of clinical ankle joint-related diseases and postoperative rehabilitation. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of different Kirschner wire tension bands on transverse patella fractures during gait cycle Liu Feng, Feng Yi 2022, 26 (9):  1367-1371.  doi: 10.12307/2022.430 Abstract ( 487 )   PDF (3274KB) ( 111 )   Save BACKGROUND: There are few studies on dynamic biomechanical analysis of Kirschner wire tension band steel wire in different winding methods for the treatment of transverse patella fractures.   OBJECTIVE: To analyze the biomechanical difference between the “8”-shaped Kirschner wire tension band fixation and the “0”-shaped Kirschner wire tension band for the treatment of transverse patella fractures in the complete gait cycle using three-dimensional reconstruction technology. METHODS:  Based on the CT scan data of the human knee joint, Mimics, Geomagic Studio, Hypermesh and Abaqus and other three-dimensional reconstruction softwares were used to establish the “8” and “0” shape Kirschner wire tension band to treat the finite element model of the patella transverse fracture. A complete gait cycle of the knee joint after surgery was simulated by loading the material properties, setting boundary conditions, applying loads and other operations. The difference in displacement and stress between the two fixed models was analyzed.   RESULTS AND CONCLUSION: (1) In the complete gait cycle, the change of stress value was positively correlated with the change of buckling angle, and the maximum stress reached at 70% of the gait cycle. In the same gait instant, the stress of each component of the “0” model was less than that of the “8” model. (2) The displacement value of each component of the two models increased with the increase of the flexion angle during a complete cycle, and reached the peak displacement at 70% of the gait cycle. In the same gait instantaneously, the “0”-shaped model was different. The displacement values of the components were all smaller than those in the “8” model. At the peak of the displacement, the displacement values of the patella, Kirschner wire and steel wire of the “0” model were 10%, 11%, and 13% smaller than those of the “8” model. (3) The results show that during the complete gait cycle, the high stress areas of the two tension band models are mainly concentrated near the patella fracture line and the contact part of the internal fixation, but the stress peak value of each component in the “0” model is less than “8”-shaped model, and it is better than the “8”-shaped tension band model in terms of the stability of the fracture end and internal fixation, and has a better biomechanical effect. Figures and Tables | References | Related Articles | Metrics

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Design for posterior atlantoaxial internal fixation system with fusion cage based on imaging data Pan Baoshun, Fang Zhen, Gao Mingjie, Fang Guiming, Chen Jinshui 2022, 26 (9):  1372-1376.  doi: 10.12307/2022.431 Abstract ( 401 )   PDF (1402KB) ( 83 )   Save BACKGROUND: The report for posterior atlantoaxial fusion cage is few and there are still many shortages. There is a lack of fusion cages with convenient operation, large bone graft area and stable bone grafting.   OBJECTIVE: To design a posterior atlantoaxial internal fixation system with fusion cage according to the anatomical characteristics and study its feasibility. METHODS:  The imaging data of 100 cases (50 males and 50 females) of normal posterior arch of atlas and axis lamina were collected. The sagittal plane was used to measure the height and the thickness of the posterior arch of atlas, the slope of the axis lamina, the height of the posterior inferior margin of atlas to the upper margin of the axis, and the height of the atlantoaxial intervertebral space. The distance between the lateral margin of the pedicle of the atlas on both sides and the distance from the posterior tubercle to this line were measured to calculate the radius of the lateral margin of the posterior arch. The point which was 4 mm to the posterior tubercle was taken as the nailing point to measure the inserting length of the screw and the angle between the screw and the middle line of the posterior arch. The anatomic parameters were analyzed to design the posterior atlantoaxial internal fixation system with fusion cage.   RESULTS AND CONCLUSION: (1) The height from the lower edge of the posterior arch of atlas to the upper edge of the axis spinous process was (19.07±2.73) mm. The height of the atlantoaxial intervertebral space was (6.83±2.01) mm. The slope of the axis lamina was (58.34±7.60)°. The radius of the lateral edge of the posterior arch of atlas was (26.77±2.14) mm. The height of the posterior tubercle of atlas was (10.45±1.61) mm. The thickness of the posterior tubercle of atlas was (8.12±1.57) mm. The inserting length of the posterior arch screw of atlas was (11.21±1.61) mm, and the angle was (53.34±6.30)°. The data difference between the two sides had no statistical significance. (2) According to the measurement of the imaging data, the design of the atlantoaxial internal fixation system is successful and is applied for the national patent. The atlantoaxial internal fixation system with fusion cage provides a new fixation method for posterior atlantoaxial internal fixation. Figures and Tables | References | Related Articles | Metrics

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Variable-angle zero-notch anterior interbody fusion system in the treatment of cervical spondylotic myelopathy: 30-month follow-up Yao Xiaoling, Peng Jiancheng, Xu Yuerong, Yang Zhidong, Zhang Shuncong 2022, 26 (9):  1377-1382.  doi: 10.12307/2022.432 Abstract ( 742 )   PDF (2284KB) ( 155 )   Save BACKGROUND: At present, anterior cervical discectomy and fusion is the “gold standard” for treatment of cervical spondylosis. The cervical zero-notch anterior interbody fusion cage is gradually being promoted and applied in clinical practice, with good clinical efficacy and imaging results.   OBJECTIVE: To evaluate the mid-term outcome of cervical spondylotic myelopathy treated with variable-angle zero-notch anterior interbody fusion system. METHODS:  Totally 81 patients with cervical spondylotic myelopathy treated in First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2015 to January 2018 were included in this study. Among them, 42 patients received anterior cervical discectomy and decompression and fusion using variable-angle zero-notch anterior interbody fusion system (trial group); 39 patients received anterior cervical discectomy and decompression and fusion using traditional titanium plate-cage system (control group). Visual Analog Scale score, Japanese Orthopaedic Association score, Cobb-C angle and Cobb-S angle of cervical spine, interbody fusion, and complications were compared between the two groups. The protocols were approved by the Ethics Committee of First Affiliated Hospital of Guangzhou University of Chinese Medicine (approval No. JY2020199).   RESULTS AND CONCLUSION: (1) Visual Analog Scale score and Japanese Orthopaedic Association score were significantly improved after surgery compared with those before surgery in both groups (P < 0.05). No significant differences in Visual Analog Scale score and Japanese Orthopaedic Association score were detected between the two groups (P > 0.05). (2) Cobb-S angle was significantly improved at 3 days and 30 months after surgery compared with that before surgery in both groups (P < 0.05). Cobb-C angle was significantly improved at 3 days after surgery compared with that before surgery in the trial group (P < 0.05). Cobb-C angle was significantly improved at 3 days and 30 months after surgery compared with that before surgery in the control group (P < 0.05). (3) The rate of complete fusion was 98% in the trial group and 100% in the control group. (4) The rate of the fusion cage sinking in the trial group was higher than that in the control group (24%, 3%, P < 0.05); the incidence of postoperative dysphagia was lower than that in the control group (2%, 38%, P < 0.05); and the incidence of adjacent intervertebral disc degeneration was lower than that in the control group (2%, 18%, P < 0.05). (5) The results have shown that variable-angle zero-notch anterior interbody fusion system for cervical spondylotic myelopathy can effectively improve the symptoms and reduce postoperative complications. However, the incidence of fusion cage sinking was higher than that of traditional titanium plate-cage system. The change of the overall curvature of the cervical spine needs long-term observation and follow-up. The mid-term efficacy of the operation is generally good. Figures and Tables | References | Related Articles | Metrics

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Feasibility of axial transpedicle screw internal fixation in children aged 1 to 6 years Li Kun, Gao Erke, Xiong Feng, Wang Xing, Wu Danqi, Li Zhijun, Zhang Shaojie, Liu Yanan, Duo Lan, Li Ziyu 2022, 26 (9):  1383-1387.  doi: 10.12307/2022.433 Abstract ( 432 )   PDF (1311KB) ( 64 )   Save BACKGROUND: Internal screw fixation is often required for the treatment of specific axial pedicle fractures in the occipito-atlanto-axial complex region and is widely used in adults. However, there are no anatomic data on the development of the axial pedicle with common internal fixation in children aged 1 to 6 years.   OBJECTIVE: To investigate the feasibility of 3.50 mm perpedicle screw internal fixation of axial vertebrae in children aged 1 to 6 years. METHODS:  Totally 45 children aged 1 to 6 years were selected and divided into three groups: 1-year-old group, 3-year-old group, 5-6-year-old group, with 15 cases in each group. The original cervical CT data were obtained. The width of the upper, middle and lower edges of the vertebral pedicle, the height and length of the vertebral pedicle, the inclination angle and the upclination angle of the screw were measured after three-dimensnioal reconstruction. In each case, the related index parameters of bilateral pedicle were measured, and each parameter index was measured three times, and the average value was taken.   RESULTS AND CONCLUSION: (1) All the indexes of axial pedicle showed an increasing trend with age, except the upper inclination and inner inclination. (2) The width of the upper edge of the vertebral pedicle, the width of the middle edge of the vertebral pedicle and the width of the lower edge of the vertebral pedicle were significantly different among the same age groups. (3) The main limiting factors of axial pedicle screw insertion and stability were the median edge width and length of the vertebral pedicle. The median edge width of the vertebral pedicle was (4.26±0.68) mm in 1-year-old group, (4.92±0.83) mm in 3-year-old group, and (6.26±1.26) mm in 5-6-year-old group. The pedicle length was (12.38±2.10) mm in 1-year-old group, (21.00±5.39) mm in 3-year-old group, and (24.62±1.11) mm in 5-6-year-old group. (4) These results confirm the feasibility of inserting 3.50 mm screws in the axial pedicle of children aged 1-6 years. The screw placement methods should be different in different age groups. Figures and Tables | References | Related Articles | Metrics

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Risk factors for traumatic central cord syndrome underlying with cervical spondylotic myelopathy Wu Liang, Wang Qiang, Wang Wenbo, Xin Tianwen, Xi Kun, Tang Jincheng, Xu Jingzhi, Chen Liang, Gu Yong 2022, 26 (9):  1388-1394.  doi: 10.12307/2022.434 Abstract ( 530 )   PDF (1468KB) ( 132 )   Save BACKGROUND: Some patients with cervical spondylotic myelopathy suffer from certain low-energy trauma or only a single hyperextension movement of the neck, and then their neurological symptoms deteriorate, showing typical symptoms of traumatic central cervical syndrome. Although the overall prognosis is good, many patients still have some sequelae.   OBJECTIVE: To analyze the risk factors of traumatic central cervical syndrome in patients with cervical spondylotic myelopathy suffering from low-energy trauma, and the correlation with neurological dysfunction. METHODS:  Between January 2012 and December 2016, the clinical data of 181 cervical spondylotic myelopathy patients, treated in the First Affiliated Hospital of Soochow University, with a history of low-energy trauma were retrospectively analyzed. According to whether traumatic central cervical syndrome occurred, patients were divided into appearing group (68 cases) and non-appearing group (113 cases). The potential risk factors and their correlations with the neurological function of traumatic central cervical syndrome were analyzed, including patients’ general condition, clinical manifestations and imaging findings. This study was approved by the Medical Ethics Committee of First Affiliated Hospital of Soochow University (approval No. (2021)053).   RESULTS AND CONCLUSION: (1) Average age and gender were not statistically significant between the two groups (P > 0.05). However, the incidence of hyperextension injury in appearing group was more than in non-appearing group (P < 0.05). (2) Ratios of axial pain, weakness of proximal lower limb, proprioception dysfunction and hand sensory dysfunction were not statistically significant between the two groups (P > 0.05). Hand muscle weakness, hypermyotonia, tendon hyperreflexia and positive pathological signs in the appearing group were higher than those in the non-appearing group (P < 0.05). (3) The C2-7 Cobb angle of the appearing group was lower than that of the non-appearing group (P < 0.05), and the proportion of instability, rigid/mixed ratio and “anterior-posterior clamp type” in the appearing group were higher than those in the non-appearing group (P < 0.05). Both spinal stenosis and cervical spinal cord compression were higher in the appearing group than those in the non-appearing group (P < 0.05). With higher proportions of maximum canal compromise >50% and maximum spinal cord compression >25%, the maximum canal compromise and maximum spinal cord compression in the appearing group were both greater than those in the non-appearing group (P < 0.05). The ratio, length and grade 2 of intramedullary high signal intensity in appearing group were higher than those in the non-appearing group (P < 0.05). (4) Logistic regression analysis indicated that the possible risk factors for traumatic central cervical syndrome were hyperextension injury, intrinsic hand strength, hypermyotonia, positive pathological signs, poor cervical curvature, spine instability, compression type, compression source, maximum canal compromise, maximum spinal cord compression and intramedullary high signal intensity. (5) The correlation analysis indicated that age, intrinsic hand muscle strength, lower limb muscle tone, pathological signs, cervical curvature, cervical stability, maximum canal compromise, maximum spinal cord compression and intramedullary high signal intensity were significantly negatively correlated with neurological function scores (P < 0.05). Figures and Tables | References | Related Articles | Metrics

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Volume changes of cervical herniated discs after open-door laminoplasty and conservative treatment as assessed by three-dimensional volume method Lu Pan, Zhang Chunlin, Wang Yongkui, Yan Xu, Dong Chao, Yue Yisen, Li Long, Zhu Andi 2022, 26 (9):  1395-1401.  doi: 10.12307/2022.435 Abstract ( 356 )   PDF (2450KB) ( 61 )   Save BACKGROUND: Open-door laminoplasty is the most commonly used posterior cervical decompression surgery. The volume change of cervical herniated disc has always been a hot topic. It has been reported the phenomenon of resorption of herniated nucleus pulposus after open-door laminoplasty. However, most of these observations are qualitative studies. There is no literature on the quantitative observation of postoperative cervical herniated disc volume by three-dimensional volume method.   OBJECTIVE: To compare and analyze the changes of cervical herniated disc volume after open-door laminoplasty and conservative treatment. METHODS:  The data of 61 patients who underwent open-door laminoplasty and 63 patients who received conservative treatment in the Department of Orthopedics, First Affiliated Hospital of Zhengzhou University from 2014 to 2020 were collected retrospectively. Three-dimensional volume method was used to measure the cervical herniated disc volume of the two groups at the first time before treatment and the last follow-up after treatment. The consistency of the measurement results was tested and the changes were analyzed. The interval between two measurements of all patients was at least 3 months. The absorption ratio and absorption rate, re-protrusion ratio and re-protrusion rate of cervical herniated disc were used as the measurement results. When the absorption rate of herniated cervical intervertebral disc was greater than 5.00% (or the re-protrusion rate was less than -5.00%), it is considered that the cervical herniated disc experienced absorption (or re-herniation).   RESULTS AND CONCLUSION: (1) Changes in cervical herniated disc volume in the open-door group: There were 176 cervical herniated discs in 61 patients. Among them, 96 cervical herniated discs were absorbed; the absorption ratio was 54.6% (96/176), and the absorption rate was 5.0%-55.2%. In addition, 46 cervical herniated discs were re-protruded; the ratio of re-protrusion was 26.1% (46/176), and the re-protrusion rate was -5.9% to -77.9%. There was no change in the volume of the other 34 cervical herniated discs. According to the Odom criteria, the results were excellent in 17 cases and good in 28 cases, and the excellent and good rate was 73.8% (45/61). (2) Changes in cervical herniated disc volume in the conservative treatment group: There were 171 cervical herniated discs in 63 patients. Among them, 55 cervical herniated discs were absorbed; the absorption ratio was 32.2% (55/171), and the absorption rate was 5.3%-50.7%. Another 83 cervical herniated discs were re-protruded, with a re-protrusion ratio of 48.5% (83/171), and a re-protrusion rate of -5.4% to  -219.8%. There was no change in the volume of the other 33 cervical herniated discs. According to the Odom criteria, the results were excellent in 12 cases and good in 21 cases, and the excellent and good rate was 52.4% (33/63). (3) Three-dimensional volume measurement was an accurate method to observe cervical herniated disc (ICC=0.818). In the open-door group, 6 patients showed varying degrees of re-protrusion of all cervical herniated discs; 13 patients showed resorption of herniated nucleus pulposus; 6 patients showed volume unchanged, and the remaining 36 patients showed the coexistence of those three phenomena. In the conservative treatment group, 32 patients showed varying degrees of re-protrusion in all cervical herniated discs; 5 patients showed resorption of herniated nucleus pulposus; and 7 patients showed volume unchanged, the remaining 19 patients showed the coexistence of the three phenomena. (4) It is concluded that three-dimensional volume method is an accurate and reliable method to observe the changes of cervical herniated disc volume after open-door laminoplasty. Half of the cervical herniated disc after open-door laminoplasty showed slight reduction, which was easy to be ignored, and a few showed moderate and severe re-protrusion, which may lead to further progression of symptoms, indicating that open-door laminoplasty is an effective surgical intervention, but there is a risk of cervical herniated disc re-protrusion, which needs to be further improved. Figures and Tables | References | Related Articles | Metrics

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Correlation of the electromyography ratio of the paraspinal muscles on the convex and concave sides with Cobb angle, apical vertebra translation, and coronal balance distance in adolescent idiopathic scoliosis patients Wang Shuai, Wang Liancheng, Zhang Shuhao, Li Fuli, Dong Jiaxing, Zhang Yajie 2022, 26 (9):  1402-1406.  doi: 10.12307/2022.436 Abstract ( 477 )   PDF (1238KB) ( 55 )   Save BACKGROUND: At present, there is a lack of research on paraspinal electromyography in adolescent idiopathic scoliosis, so there is an urgent need for related research to improve the theoretical system of paraspinal electromyography in patients with scoliosis.   OBJECTIVE: To analyze electromyographic changes of paraspinal muscles on both sides of the spine in adolescent idiopathic scoliosis patients in a resting state and standing position, and analyze the correlation of electromyography ratio of paraspinal muscles on convex and concave sides with Cobb angle, apical vertebra translation, and coronal balance distance. METHODS:  A total of 21 adolescent idiopathic scoliosis patients were selected from the Scoliosis Clinic of Tianjin Hospital. Root mean square values of paraspinal muscles on both sides of the spine were recorded by Canadian T7550 surface electromyography in a resting state and standing position. The correlation between its variation and coronal plane parameters in patients with scoliosis was analyzed. The protocol complied with the Declaration of Helsinki and the relevant ethical requirements of Tianjin Hospital. The patients and guardians participating in the research had informed consent to the test and the trial process.   RESULTS AND CONCLUSION: (1) Root mean square values of the convex side of the main curve and the concave side of the adolescent idiopathic scoliosis patients in the standing position and resting state were significantly different (P=0.005). Root mean square values of the convex side of the main curve were greater than those of the concave side, and the root mean square values of the convex side of the apical cone were significantly greater than those of the concave side. (2) There was a strong positive correlation between root mean square ratio of convex-concave side and Cobb angle in patients in standing and resting state (r=0.620, P=0.003); there was a moderate correlation with apical vertebra translation (r=0.443, P=0.044); however, there was a correlation with coronal plane equilibrium distance (r=-0.430, P=0.052). (3) These results indicate that in patients with adolescent idiopathic scoliosis, the tension of paravertebral muscles on the concavo-convex side was obviously unbalanced when maintaining a standing position, and the tension on the convex side was stronger, which was most obvious in the apical cone region. The ratio of root mean square on the concave-convex side of paravertebral muscles in patients with adolescent idiopathic scoliosis in standing and resting states increased with the increase of Cobb angle and apical vertebra translation. As scoliosis increases and the cone offset increases, the difference in the muscle tension required to maintain the trunk in an upright position becomes more pronounced. Figures and Tables | References | Related Articles | Metrics

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Comparison of advantages between unilateral multidirectional curved and straight vertebroplasty in the treatment of thoracolumbar osteoporotic vertebral compression fracture Jiang Huanchang, Zhang Zhaofei, Liang De, Jiang Xiaobing, Yang Xiaodong, Liu Zhixiang 2022, 26 (9):  1407-1411.  doi: 10.12307/2022.437 Abstract ( 465 )   PDF (2578KB) ( 205 )   Save BACKGROUND: In recent years, the new method of curved vertebroplasty had been applied in clinic. It remains unclear whether there is any advantage over the traditional straight approach.   OBJECTIVE: To investigate the advantages of unilateral multidirectional curved vertebroplasty in the treatment of thoracolumbar osteoporotic vertebral compression fractures by comparing with two kinds of straight vertebroplasty. METHODS:  From January 2017 to December 2019, 85 patients with osteoporotic vertebral compression fractures undergoing thoracolumbar vertebroplasty in Guangzhou Huadu District People’s Hospital (Huadu Hospital, Southern Medical University) were enrolled in this study. There were 21 males and 64 females at the age of 65 to 91 years. They were divided into group A (unilateral multidirectional curved; n=25), group B (unilateral straight line; (n=32), and group C (bilateral straight line; n=28). The bone cement injection volume, leakage rate, refracture rate, and bone cement good distribution rate were compared among groups. The vertebral height compression ratio, local kyphotic Cobb angle, visual analogue scale at 1 day and 12 months after surgery, and Oswestry Dysfunction Index at 12 months were compared among the three groups. The protocols were approved by the Ethics Committee of Guangzhou Huadu District People’s Hospital (Huadu Hospital, Southern Medical University).   RESULTS AND CONCLUSION: (1) The bone cement injection volume in group B was less than that in groups A and C (P < 0.05). The refracture rate was higher in group B than that in groups A and C (P < 0.05). The leakage rate in group A was lower than that in groups B and C (P < 0.05). The bone cement good distribution rate was higher in group A than that of group B. (2) The vertebral height compression ratio and local kyphotic Cobb angle of the three groups were lower after the operation than those before the operation (P < 0.05). The vertebral height compression ratio and local kyphotic Cobb angle of group A were lower than groups B and C at 12 months after operation (P < 0.05). (3) The postoperative visual analogue scale scores and Oswestry Dysfunction Index of the three groups were lower than those before the operation (P < 0.05). There was no significant difference in the visual analogue scale scores of the three groups at 1 day and 12 months after surgery (P > 0.05). There was no significant difference in the Oswestry Dysfunction Index at 12 months after the operation among the three groups (P > 0.05). (4) Both curved and straight vertebroplasty could achieve good short-term clinical results, but unilateral multi-directional vertebroplasty had more advantages in reducing bone cement leakage and maintaining vertebral height and Cobb angle. Figures and Tables | References | Related Articles | Metrics

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Correlation between spine-pelvic sagittal parameters and prognosis of vertebroplasty in the treatment of thoracolumbar osteoporotic vertebral compression fractures Yu Chengxiang, Liu Lehong, Li Wenbo, Chen Jinshi, Ran Chunlei, Wang Zhongping 2022, 26 (9):  1412-1417.  doi: 10.12307/2022.438 Abstract ( 565 )   PDF (1324KB) ( 59 )   Save BACKGROUND: Relevant studies have shown that the sagittal parameters of the spine and pelvis of patients with thoracolumbar osteoporotic compression fractures change to varying degrees, which can lead to an imbalance of the thoracolumbar spine.   OBJECTIVE: To investigate the correlation between the sagittal parameters of the spine and pelvis and the prognosis of vertebroplasty in the treatment of thoracolumbar vertebral compression fractures. METHODS:  Totally 66 patients with vertebral compression fractures undergoing vertebroplasty in the Chongqing Sanbo Chang’an Hospital from May 2017 to June 2019 at the age of 61-79 years were enrolled and included in the observation group. Before operation and 3 months after operation, the patient’s pain and improvement of pelvic function were evaluated by visual analog scale score and Oswestry dysfunction index. The sagittal parameters, Cobb angle, and Beck index of the spine and pelvis were measured by X-rays of the whole spine. Sixty healthy subjects of the same age group (control group) were selected, and the sagittal parameters of the spine and pelvis were measured by X-rays of the spine and pelvis. This study was approved by the Ethics Committee of Chongqing Sanbo Chang’an Hospital (approval No. [2017]52; approval date: 2017-04-26).   RESULTS AND CONCLUSION: (1) The visual analog scale score and Oswestry dysfunction index of the observation group were significantly improved 3 months after operation (P < 0.05), and the Cobb angle and Beck index were significantly better than those before the operation (P < 0.05). (2) The pelvic tilt was greater in the observation group than that of the control group (P < 0.05), and the pelvic incidence, sacral slope, lumbar lordosis, thoracic kyphosis, vertical misalignment axis were all smaller in the observation group than those of the control group (P < 0.05). In the observation group, the pelvic tilt was smaller at 3 months after operation than that before operation (P < 0.05), and the pelvic incidence, sacral slope, lumbar lordosis, thoracic kyphosis, and vertical misalignment axis were all greater than those before operation (P < 0.05). (3) Pearson correlation analysis showed that preoperative pelvic incidence angle, pelvic tilt, lumbar lordosis and total effective rate, postoperative visual analogue scale score, Oswestry dysfunction index, Cobb angle and Beck index were correlated (P < 0.05). There was no significant difference between the above-mentioned indicators and the control group at 3 months after operation (P > 0.05). (4) Results indicate that vertebroplasty has a good curative effect in the treatment of vertebral compression fractures. It can significantly relieve pain, correct the pathological curvature of the spine and pelvis, and restore the balance of the spinal column. Figures and Tables | References | Related Articles | Metrics

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Correlation between lumbar posterior muscle and local kyphosis in patients with degenerative thoracolumbar kyphosis Bao Xianguo, Gao Zengxin, Wu Zhanpo, Chen Youmin, Cheng Qinghua, Lu Haitao, Guo Changzheng, Xu Shuai 2022, 26 (9):  1418-1423.  doi: 10.12307/2022.439 Abstract ( 402 )   PDF (1384KB) ( 125 )   Save BACKGROUND: The relationship between the content of paraspinal muscle and kyphotic severity in patients with degenerative thoracolumbar kyphosis has not been determined yet. Recently, a fresh concept of lumbar crossing indentation value was introduced as a simple method for the measurement of paraspinal muscle.   OBJECTIVE: To identify the characteristics of lumbar paraspinal muscles in patients with degenerative thoracolumbar kyphosis, and to explore the relationship between thoracolumbar kyphosis and body mass index and between thoracolumbar kyphosis and the content of lumbar paraspinal muscles. METHODS:  Totally 90 patients with degenerative thoracolumbar kyphosis (degenerative thoracolumbar kyphosis group) and 62 volunteers without spine deformity (control group) were retrospectively enrolled from June 2015 to June 2020 in the Department of Spine Surgery, Lishui District People’s Hospital with well-matched demographics. The two groups were matched in terms of demographics. Thoracolumbar kyphosis and lumbar lordosis were obtained on the X-ray of the whole spine. Lumbar crossing indentation value was introduced to evaluate the content of the lumbar paraspinal muscles, which was measured from T12-L1 to L4-L5 at T2-MRI axial imaging. Both groups were separately divided into three subgroups of normal weight, overweight and obesity according to body mass index. Degenerative thoracolumbar kyphosis patients were divided into three subgroups of increased lumbar lordosis, normal lumbar lordosis and decreased lumbar lordosis.   RESULTS AND CONCLUSION: (1) The mean lumbar crossing indentation value in degenerative thoracolumbar kyphosis group was less than control group (P < 0.01). Lumbar crossing indentation value showed an increasing trend from T12/L1 to L4/L5 in both groups (P < 0.01). (2) In control group, mean lumbar crossing indentation value in male was larger than that in female (P < 0.05) and mean lumbar crossing indentation value in normal group was less than ones with overweight or obesity (P < 0.05). (3) In the degenerative thoracolumbar kyphosis group, mean lumbar crossing indentation value was not significantly different in both sexes. Significant differences were found in lumbar crossing indentation value in T12-L1 and L1-L2 at different body mass indexes (P=0.003, P=0.009). In degenerative thoracolumbar kyphosis group, mean lumbar crossing indentation value in lumbar lordosis-increased subgroup was larger than that of lumbar lordosis-normal and lumbar lordosis-decreased subgroups (P < 0.01). (4) There was no relationship between thoracolumbar kyphosis and body mass index in both groups. Body mass index was positively correlated to mean lumbar crossing indentation value in control group (P=0.003) with mean lumbar crossing indentation value=0.32×body mass index. Thoracolumbar kyphosis and mean lumbar crossing indentation value were negatively correlated (P < 0.001) in degenerative thoracolumbar kyphosis group with lumbar crossing indentation value=13.75-0.48× thoracolumbar kyphosis. For all cases, there was a relationship of mean lumbar crossing indentation value= 5.45+0.21× body mass index -0.41× thoracolumbar kyphosis. (5) It is indicated that degenerative thoracolumbar kyphosis patients had a less lumbar crossing indentation value than controls. There was no relationship between the severity of thoracolumbar kyphosis and body mass index, while lumbar crossing indentation value and thoracolumbar kyphosis were mutually predictable. Figures and Tables | References | Related Articles | Metrics

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Reconstruction of Paprosky III type acetabular defect by autogenous iliac bone block combined with titanium plate: providing a strong initial fixation for the prosthesis Xue Yadong, Zhou Xinshe, Pei Lijia, Meng Fanyu, Li Jian, Wang Jinzi 2022, 26 (9):  1424-1428.  doi: 10.12307/2022.440 Abstract ( 376 )   PDF (4992KB) ( 120 )   Save BACKGROUND: In recent years, new progress has been made in the treatment of Paprosky III acetabular defects at home and abroad. Commonly used reconstruction methods include tantalum metal pads, acetabular strengthening cups-reinforcing rings, cemented acetabular prostheses, reconstruction steel plates, and titanium metal mesh.   OBJECTIVE: To investigate the clinical efficacy of using autogenous iliac bone blocks in combination with titanium plate to reconstruct Paprosky III type of acetabular defects in revision total hip arthroplasty. METHODS:  Totally 15 patients with severe acetabular defects reconstruction utilizing autogenous iliac bone blocks combined with titanium plates, including 9 men and 6 women, with age of 47-78 years, were selected from June 2012 to August 2020 from First Affiliated Hospital of Bengbu Medical College. Clinical manifestations and postoperative X-ray characteristics of the patients were observed. The Harris hip score and visual analogue scale score prior to operation and at the last follow-up visit were evaluated. The anteverted angle and abduction angle of the postoperative acetabular cup were recorded. The changes of center-edge angle of hip joint and acetabular angle were measured 1 week after surgery and at the last follow-up. The incidence of postoperative complications was observed. This study was approved by the Ethics Committee of First Affiliated Hospital of Bengbu Medical College.   RESULTS AND CONCLUSION: (1) All of the 15 patients were successfully operated and followed up for 12 to 60 months. Among them, one case had symptoms of lateral femoral cutaneous nerve injury, but no plate fracture, osteolysis, infection, or periprosthetic fracture occurred. (2) Harris hip score and visual analogue scale score were significantly improved during the last follow-up in 15 patients (P < 0.05). (3) The anteversion angle and abduction angle of the acetabular cup were (16.96±0.76)° and (41.64±0.81)°, respectively, both of which were within the safety range in 15 patients. One week post surgery and at the last follow-up, the center-edge angle and acetabular angle were not significantly different in 15 patients (P > 0.05). (4) It is concluded that for patients with Paprosky III acetabular bone defects, acetabular ring reconstructed by autogenous iliac bone and allogeneic grain bone combined with titanium plate can restore anatomic structure of the hip joint, which provides a strong initial fixation for the prosthesis, finally obtaining satisfactory clinical outcomes. Figures and Tables | References | Related Articles | Metrics

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Application of stable and enhanced lined hip joint system in total hip arthroplasty in elderly patients with femoral neck fractures complicated with hemiplegia Zhuang Zhikun, Wu Rongkai, Lin Hanghui, Gong Zhibing, Zhang Qianjin, Wei Qiushi, Zhang Qingwen, Wu Zhaoke 2022, 26 (9):  1429-1433.  doi: 10.12307/2022.441 Abstract ( 379 )   PDF (9980KB) ( 73 )   Save BACKGROUND: For elderly patients with femoral neck fractures with hemiplegia, the economic cost of using restrictive acetabular linings in total hip arthroplasty is relatively low and has a strong anti-dislocation mechanism, which can theoretically restore the patient’s lower limb function and reduce occurrence of posterior dislocation.   OBJECTIVE: To investigate the short-term clinical efficacy and feasibility of total hip arthroplasty with restrictive lining in elderly patients with femoral neck fractures with hemiplegia. METHODS: Seven elderly patients with femoral neck fractures and hemiplegia admitted to the Quanzhou Orthopedic-Traumatological Hospital of Fujian University of Traditional Chinese Medicine from March 2015 to January 2019 were enrolled, including three males and four females, at the age of 66-77 years old. Pinnacle ES Stable and Enhanced Lined Hip Joint System was used for total hip arthroplasty. The operation time and blood loss were recorded. The function of the hip joint was evaluated by Harris score. The loosening and dislocation of the prosthesis were observed by imaging examination. This study was approved by the Ethics Committee of Quanzhou Orthopedic-Traumatological Hospital of Fujian University of Traditional Chinese Medicine.   RESULTS AND CONCLUSION: (1) The operation time of seven patients was (77.1±14.4) minutes, and the intraoperative blood loss was (350±119) mL. (2) All seven patients were followed up without drop out, and the follow-up time was (32.9±9.0) months. During follow-up, there were no signs of prosthesis loosening or polyethylene wear, and no complications, such as pulmonary embolism, dislocation, and infection. At the last follow-up, the Visual Analogue Scale score of seven patients was 0, and the average Harris score was (80.3±6.2). (3) It is a reasonable and effective method to treat the hemiplegia elderly patients undergoing total hip arthroplasty using the stable and enhanced lined hip joint system for femoral neck fractures. Figures and Tables | References | Related Articles | Metrics

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Advantage and disadvantage of robot-assisted sacroiliac screw placement and traditional fluoroscopy in orthopedic surgery Li Canhui, Wu Zhengjie, Zeng Yanhui, He Yinghao, Situ Xiaopeng, Du Xuelian, Hong Shi, He Jiaxiong 2022, 26 (9):  1434-1438.  doi: 10.12307/2022.442 Abstract ( 527 )   PDF (1281KB) ( 92 )   Save BACKGROUND: Patients with pelvic fractures are often accompanied by sacroiliac joint separation, and the most effective surgical treatment for this condition is the placement of sacroiliac screws. At present, the commonly used nail placement method is mainly for the surgeon to place it by hand under fluoroscopy. The accuracy and safety are poor, and the screw position after surgery is closely related to the experience of the surgeon. Orthopedic surgical robot-assisted sacroiliac screw placement is an advanced surgical method recently. However, due to the high cost of robots and limited clinical applications, there are currently many controversies regarding the safety and reliability of the operation.   OBJECTIVE: To investigate the clinical effect of robot-assisted sacroiliac screw placement. METHODS:  A total of 95 patients with pelvic fractures treated in Foshan Hospital of Traditional Chinese Medicine from January 2018 to January 2020 were reviewed. Among them, 48 patients underwent percutaneous sacroiliac screw placement and 47 patients underwent robot-assisted sacroiliac screw placement. The operation time of sacroiliac screw placement, the number of postoperative complications, Matta score, Majeed score, and Merle D 'Aubigne and Postel score were compared between the two groups.   RESULTS AND CONCLUSION: (1) The operation time of the robot-assisted sacroiliac screw placement group was significantly shorter than that in the percutaneous sacroiliac screw placement group (P < 0.05). The incidence of complications was significantly lower in the robot-assisted sacroiliac screw placement group than that in the percutaneous sacroiliac screw placement group (P < 0.05). Five cases of internal fixation failure and three cases of fracture nonunion were found in the percutaneous sacroiliac screw placement group. One case of fracture nonunion was found in the robot-assisted sacroiliac screw placement group. The healing of the above cases was finally achieved by replacing internal fixation. (2) The excellent and good rates of Matta score, Majeed score, and Merle D 'Aubigne and Postel score were significantly higher in the robot-assisted sacroiliac screw placement group than those in the percutaneous sacroiliac screw placement group (P < 0.05). (3) The fluoroscope time was significantly shorter in the robot-assisted sacroiliac screw placement group (7.2±1.5) s/times than that in the percutaneous sacroiliac screw placement group (25.7±7.6) s/times (P < 0.05). (4) The results showed that the robot-assisted sacroiliac screw placement had the advantages of short operation time and high accuracy. Figures and Tables | References | Related Articles | Metrics

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Human salivary components and osteoporosis/osteopenia Zhu Chan, Han Xuke, Yao Chengjiao, Zhou Qian, Zhang Qiang, Chen Qiu 2022, 26 (9):  1439-1444.  doi: 10.12307/2022.443 Abstract ( 790 )   PDF (1261KB) ( 111 )   Save BACKGROUND: Osteoporosis is a critical public health issue among the world. Early screening and diagnosis for high-risk groups can effectively prevent the occurrence of osteoporosis related fractures. As a non-invasive and safe strategy, saliva is expected to be alternative choice in the diagnosis and prognosis of diseases. OBJECTIVE: To investigate the potential salivary diagnostic markers through systematically reviewing the current studies of salivary component analysis in osteoporosis/osteopenia. METHODS: Databases, including PubMed, EMbase, The Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical database (VIP), Wanfang database, and Chinese Biomedical database (CBM), were searched from inception to June 1, 2021 to collect all related trials. Grey literature was also searched. All relevant studies involving salivary component and osteoporosis/bone mass analysis were obtained to evaluate its methodological quality and to screen tests that met the inclusion and exclusion criteria; methodological quality was evaluated; baseline characteristics, diagnostic methods, observation indicators, and test results were recorded.  RESULTS AND CONCLUSION: A total of eight relevant trials were selected in this review. Among them, there were five cross-sectional studies (two high-quality articles and three medium-quality articles) and three case-control studies (one high-quality article and two medium-quality articles). Eight included trials focused on 12 salivary components, including salivary minerals (Calcium, Zinc, Phosphorus, Copper), typical bone turnover markers (alkaline phosphatase, osteocalcin, CTX, P1NP), bioactive peptides (Ghrelin, Obestatin, α-defensins) and salivary pH value. Salivary calcium might be the most promising salivary markers for osteoporosis; nevertheless, the relationship between salivary cortisol and bone mass deserves further study. Figures and Tables | References | Related Articles | Metrics

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Role and therapeutic implications of pyroptosis in intervertebral disc degeneration Zhang Haobo, Zhao Yunan, Yang Xuejun 2022, 26 (9):  1445-1451.  doi: 10.12307/2022.444 Abstract ( 731 )   PDF (1334KB) ( 164 )   Save BACKGROUND: Pyroptosis is a newly discovered type of pro-inflammatory programmed cell necrosis. It is found that cell pyroptosis plays an important role in the occurrence and development of intervertebral disc degeneration. OBJECTIVE: To review the research progress on the molecular mechanism of pyroptosis, the role of pyroptosis in intervertebral disc degeneration, provide new ideas for the study of the mechanism of intervertebral disc degeneration, and provide new targets for the treatment of intervertebral disc degeneration. METHODS: A computed-based online retrieval of PubMed, Wanfang, and CNKI databases were conducted with the keywords of “Pyroptosis, Intervertebral disc degeneration, Nucleus pulposus, Caspase-1, NLRP3, Gasdermin D, IL-1β” in English and Chinese, respectively. Finally, 66 articles were selected to review.  RESULTS AND CONCLUSION: (1) The typical activation pathway of cell pyroptosis plays an important role in the process of intervertebral disc degeneration. A variety of signal molecules stimulate intervertebral disc cells to activate NLRP3 and then activate caspase-1. Finally, it causes the production of IL-1β, which eventually leads to pyroptosis and increased extracellular matrix catabolism, so as to promote intervertebral disc degeneration. (2) Signal molecules in the process of pyrolysis include chemical stimulation (such as lipopolysaccharide, reactive oxygen species, advanced glycation end products, interleukin-1β and tumor necrosis factor-α) and mechanical stimulation (such as mechanical stretching). (3) A variety of signaling pathways are activated in the process of cell pyroptosis, such as nuclear factor-κB pathway and Wnt/ β-catenin pathway.  (4) The occurrence of pyroptosis can be inhibited by different action targets, such as nuclear factor-κB inhibitor Bay11-7082, SN50, NLRP3 inhibitor MCC950, exosomes derived from mesenchymal stem cells miRNA-410, and melatonin. (5) The detailed mechanism of cell pyroptosis leading to intervertebral disc degeneration is still unclear, and the role of atypical cell pyroptosis pathway in intervertebral disc degeneration still needs to be further explored. (6) The therapeutic effect of cytolytic targeted drugs on intervertebral disc degeneration has been verified in cell and animal models, but it has not been applied in clinic. (7) With the further research, targeted drugs for pyroptosis may become a promising treatment strategy for degenerative disc disease. Figures and Tables | References | Related Articles | Metrics

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Osteoarthritis and mitochondrial abnormalities Jin Tao, Liu Lin, Zhu Xiaoyan, Shi Yucong, Niu Jianxiong, Zhang Tongtong, Wu Shujin, Yang Qingshan 2022, 26 (9):  1452-1458.  doi: 10.12307/2022.445 Abstract ( 841 )   PDF (9568KB) ( 132 )   Save BACKGROUND: Osteoarthritis is a chronic and progressive joint degenerative disease associated with multiple factors, and the role of mitochondria in osteoarthritis should not be ignored.   OBJECTIVE: To review the current relevant literature, summarize the relationship between mitochondria and osteoarthritis, understand the mechanism of mitochondrial damage in the pathogenesis of osteoarthritis, and provide theoretical reference for the treatment of osteoarthritis through mitochondrial pathway. METHODS:  The key words were “mitochondria; mitochondrial; osteoarthritis; ostarthritis; ostearthritis”. The retrieval formula was “(mitochondria) OR (mitochondrial) AND (osteoarthritis) OR (ostarthritis) OR (ostearthritis)” on PubMed database. 455 articles published from 2000 to 2021 were primarily retrieved. According to the inclusion and exclusion criteria, 61 articles were finally included for review.   RESULTS AND CONCLUSION: (1) Mitochondria play a key role in osteoarthritis. Abnormal mitochondrial REDOX can inhibit matrix synthesis, activate matrix metalloproteinase to degrade matrix components, induce cytokine production and chondrocyte apoptosis, and promote cartilage degeneration. Lack of biogenesis leads to accelerated prechondrocyte catabolism. When the kinetics is abnormal, damaged mitochondria accumulate, which leads to the inability of mitochondria to produce enough biological energy, regulate calcium and maintain a REDOX state, thereby accelerating the development of osteoarthritis. When mitosis is damaged, the dysfunctional mitochondria cannot be cleared in time, leading to the disorder of mitochondrial dynamic balance. Genetic abnormalities lead to increased mitochondrial respiration and glycolysis, increased production of free radicals and pro-inflammatory cytokines, and increased apoptosis resulting in chondrocyte dysfunction. However, abnormal calcium regulation will lead to excessive production of reactive oxygen species, mitochondrial depolarization and decreased mitochondrial membrane potential, which will lead to chondrocyte apoptosis. (2) In the treatment of osteoarthritis, drugs targeting endogenous AMPK, SIRT and Parkin, as well as exogenous antioxidants that can inhibit mitochondrial apoptosis and enhance mitochondrial dynamics are expected to become potential drugs for the early treatment of osteoarthritis. Figures and Tables | References | Related Articles | Metrics

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Mechanism and prospects of regulating lymphatic reflux function in the treatment of rheumatoid arthritis Zhang Lichuang, Xu Hao, Ma Yinghui, Xiong Mengting, Han Haihui, Bao Jiamin, Zhai Weitao, Liang Qianqian 2022, 26 (9):  1459-1466.  doi: 10.12307/2022.446 Abstract ( 616 )   PDF (1958KB) ( 392 )   Save BACKGROUND: In recent years, studies have found that pathological process of rheumatoid arthritis is closely related to the immune response in the articular cavity, but it is not clear how immune cells participate in and regulate the pathological changes of rheumatoid arthritis. In addition, the lymphatic vessels around the joint have the function of reflux inflammatory factors and immune cells, which are also closely related to the changes of intra-articular microenvironment. Therefore, the study on the relationship between lymphatic reflux function and intra-articular immune response has gradually become a hot topic in this field. OBJECTIVE: To review the research on the regulation of lymphatic reflux function in the treatment of rheumatoid arthritis. METHODS: Chinese and English search terms “Rheumatoid arthritis, lymphedema, lymphatic drainage, lymphatic system” were used to search the relevant articles on China National Knowledge Infrastructure, PubMed, and Web of Science from January 2000 to April 2021. Finally, 67 related articles were included for review.  RESULTS AND CONCLUSION: (1) The process of lymphatic reflow disorders exists in the process of rheumatoid arthritis. Severe people even experienced the lymphatic edema of the limbs. Targeted lymphatic reflux function can be used as a new intervention measures for treating rheumatoid arthritis. (2) Many studies have found that inflammatory responses in microenvironments can promote local lymphatic production. Tumor necrosis factor α secreted by macrophages causes lymphatic endothelial cells to produce endothelial growth factor C. Endothelial growth factor C acts on lymphatic endothelial cell proliferation, lymphatic tube increase, and lymphatic reflux compensatory reinforcement. (3) Long-term inflammatory response will inhibit lymphatic smooth muscle contraction. The mechanism may be that lymphatic endothelial cells highly express nitric oxide synthase, promote lymphatic endothelial cells to increase nitric oxide, which affects the contraction of lymphatic hemmus cells. (4) Immunization of lymphatic reflow mainly reflected in the formation of lymphatic tubes. The formation of lymphatic vessels is commonly regulated by macrophages and T cells. The known mechanism is that macrophages can secrete endothelial growth factor C to stimulate lymphatic production, and T cells secrete gamma-interferon to inhibit excessive proliferation of lymphatic tubes, but precise mechanisms still need further study. (5) In addition to basic research, many clinical reports have also pointed out that there is a phenomenon of lymphatic reflow disorders in rheumatoid arthritis. Even after joint replacement, this chronic lymphatic return barrier cannot be resolved. (6) Many basic studies have found that regulating lymphatic reflux will delay the process of rheumatoid arthritis, so the lymphatic tube is expected to be a new target for the treatment of inflammatory diseases. At present, the drugs that target lymphatic reflow disorders are still less. Only individual research finds that Etanercept Solutionfor, B cell depletion or local injection endothelial growth factor C can improve lymphatic return. Moreover, drugs with anti-phrochlorism have better efficacy to promote lymphatic return. The effective monomer composition in the future Chinese medicine may become targeted new drugs that promote lymphatic return. Figures and Tables | References | Related Articles | Metrics

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Traditional Chinese medicine injection for promoting blood circulation in prevention of deep vein thrombosis after orthopedic surgery: network meta-analysis Jing Jinpeng, Zhang Yue, Liu Xiaomin, Liu Yi 2022, 26 (9):  1467-1476.  doi: 10.12307/2022.447 Abstract ( 600 )   PDF (3731KB) ( 176 )   Save OBJECTIVE: Clinical studies have found that traditional Chinese medicine injections can effectively prevent deep vein thrombosis in patients after orthopedic surgery. However, there are many types of traditional Chinese medicine injections in clinical application, and there is still a lack of comparative studies among different types of injections. In this study, network meta-analysis was used to evaluate the efficacy and safety of traditional Chinese medicine injections for the prevention of deep vein thrombosis in patients after orthopedic surgery.   METHODS:  Randomized controlled trials of traditional Chinese medicine injections for the prevention of deep vein thrombosis in patients after orthopedic surgery were searched from CNKI, Wanfang, VIP, Chinese Biomedical Literature Service System, PubMed, Embase and Cochrane Library until March 2021. Outcome indicators were the incidence of deep vein thrombosis, prothrombin time, activated partial thromboplastin time, fibrinogen, D-dimer, and safety evaluation (the occurrence of adverse reactions). The quality of the included articles was evaluated using the Cochrane Systematic Reviewer's Manual Version 5.1.0 randomized controlled trials risk of bias assessment tool and modified Jadad score. After data extraction, RevMan 5.3, Stata 16.0 and ADDIS 1.16.8 softwares were used for data analysis.   RESULTS: (1) A total of 1 685 articles were retrieved, and 67 randomized controlled trials involving a total of 6 052 patients were finally included, involving 11 kinds of Chinese medicine injections, and the intervention measures were all controlled studies of activating blood circulation combined with conventional western medicine and conventional western medicine. (2) The quality of the included articles was generally low, and the modified Jadad scores were all ≤ 3, indicating low quality studies. (3) The results of mesh meta-analysis showed that in terms of reducing the incidence of deep vein thrombosis, a total of 11 traditional Chinese medicine injections were involved, and the top three were conventional western medicine combined with Shuxuetong injection (0.440)>   combined with Danhong injection (0.104) > combined with Safflower Yellow injection (0.103). In terms of prolongation of prothrombin time, a total of 10 traditional Chinese medicine injections were involved, and the top three best were conventional western medicine combined with Honghua injection (0.354) > combined with Danhong injection (0.275) > combined with Xuesaitong injection (0.109). In terms of prolongation of activated partial thromboplastin time, a total of nine traditional Chinese medicine injections were involved, and the top three were conventional western medicine combined with Honghua injection (0.405) > combined with Kudeizi injection (0.256) > combined with Danhong injection (0.098). In terms of reducing fibrinogen, a total of eight traditional Chinese medicine injections were involved, and the top three best were conventional western medicine combined with Kudezi injection (0.248) > combined with Xuesaitong injection (0.231) > combined with Honghua injection (0.216). In terms of reducing D-dimer, a total of 10 traditional Chinese medicine injections were involved, and the top three best were conventional western medicine combined with Miltiorrhiza and Ligustrazine injection (0.235) > combined with Shuxuetong injection (0.232) > combined with Kudezi injection (0.190). In terms of safety, a total of nine Chinese medicine injections were involved, and the top three were conventional western medicine combined with Ginkgo Leaf Extract and Dipyridamole injection (0.482), combined with Safflower Yellow injection (0.169) and combined with salvianolate injection (0.140).  CONCLUSION: Based on existing randomized controlled trial evidence: (1) On the basis of conventional application of western medicine, combined use of traditional Chinese medicine injection can effectively prevent deep vein thrombosis in patients after orthopedic surgery. (2) Shuxuetong injection was the best in reducing the incidence of deep vein thrombosis. Honghua injection was the best in prothrombin time and activated partial thromboplastin time. Kudeizi injection was the best in reducing fibrinogen. Miltiorrhiza and Ligustrazine injection was the best in reducing D-dimer. Ginkgo Leaf Extract and Dipyridamole injection was the best in safety evaluation.  Figures and Tables | References | Related Articles | Metrics