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28 May 2022, Volume 26 Issue 15 Previous Issue    Next Issue

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Biomechanical properties of trabecular bone prosthesis with triply periodic minimal surfaces unit structure Liu Qingbo, Su Zhiyang, Wang Hengfeng, Zhao Yu, Lyu Jia 2022, 26 (15):  2297-2301.  doi: 10.12307/2022.579 Abstract ( 472 )   PDF (1551KB) ( 44 )   Save BACKGROUND: Three-dimensional printed trabecular bone structure is one of the emerging technologies, and the unique structural and biomechanical properties can meet the clinical needs of more patients, which has become one of the development directions of precision medicine in the future. However, application of this technology is still in its preliminary stage and little is reported on its theoretical application.   OBJECTIVE: To establish a biomechanical finite element model of trabecular bone prosthesis based on triply periodic minimal surfaces unit structure, and to analyze the biomechanical differential properties of different curved surface structures. METHODS:  The curved sheet structure was generated according to the function formula in Matable software, and then trabecular bone prosthesis with the triply periodic minimal surfaces unit structure was designed by Magics 19.0. The tetrahedral mesh was divided in ABAQUS to simulate the stress environment of the human body in standing position. The stress distribution and displacement were analyzed and the biomechanical differences in the host environment were compared.   RESULTS AND CONCLUSION: S, D and G curved surface structures had no significant difference in porosity and biomechanical performance. Compared with the traditional structures, they had obvious changes and better biomechanical properties. The porosity of porous structure determined the biomechanical properties of the prosthesis. The composite layer of the porous prosthesis had interlayer bonding, which was prone to stress mutation. The porous structure could greatly reduce the severe stress shielding effect between the implant and the host bone. Figures and Tables | References | Related Articles | Metrics

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Effect of loading mode on stress distribution in head and neck of the femoral stem Xie Fei, Jia Peng, Liu Jiaxin, Liu Lu, Zhang Chunqiu, Ye Jinduo 2022, 26 (15):  2302-2306.  doi: 10.12307/2022.580 Abstract ( 460 )   PDF (1625KB) ( 43 )   Save BACKGROUND: At present, the model and loading mode used in the numerical calculation of the femoral stem are not consistent with the experimental standard. The current finite element calculation standard of the femoral stem, ASTM F2996-2013/YY/T 1714 2020, specifies that the computational model for the femoral stem prosthesis of the hip joint is a single femoral stem, and the loading mode is the rigid zone loading. The model specified in the experimental standard YY/T 0809.6-2018/ISO7206:2013 includes femoral stem, ball head and platen, and the loading mode is displacement loading. Inconsistency between computational and experimental models leads to a large difference between the calculation and experimental results. When the computational model is consistent with the experimental model and the same loading mode is used in the two models, the difference between the two model results is significantly reduced. This indicates that the computational model and its loading mode designed based on ASTM F2996-2013/YY/T 1714 2020 still have obvious defects.   OBJECTIVE: To investigate the effect of different loading modes on stress distribution in the head and neck of the femoral stem, reduce the error of calculation results and experimental results, and replace the existing standard of numerical calculation of the femoral stem by the ball head pressing plate model and displacement loading mode, thereby improving the calculation accuracy. METHODS:  Numerical simulation: The rigid zone loading and displacement loading were applied to the two computational models of single femur stem and femur stem ball head pressing plate by using the finite element analysis software ANSYS APDL, respectively, to obtain the law of stress distribution in the head and neck of the femoral stem under the two models and different loading modes. Electrical testing: the strain value was obtained through a strain sheet attached at the stem neck when the femoral prosthesis stem was loaded by the ball head pressing plate. The computational model and loading mode close to the experimental results were determined by comparing the calculation results with the experimental results.   RESULTS AND CONCLUSION: The femoral stem ball head pressing plate model showed a stress peak of 504 MPa at the neck of the femoral stem under displacement loading mode. The maximum tensile stress was mainly concentrated on the lateral head and neck, and the maximum compressive stress was mainly concentrated on the medial head and neck. The single femoral stem model showed a stress peak of 562 MPa at the neck of the femoral stem under the rigid zone loading. The maximum tensile stress was mainly concentrated on the lateral head and neck, the maximum compressive stress was mainly concentrated on the medial head and neck, and the stress distribution law was close to that of the displacement loading mode. In the electrical testing, the strain value was -581.96 με on the medial head and neck and 666.00 με on the lateral head and neck. The inner strain value was -834.91 με and the outer strain value was 724.32 με under the displacement loading mode corresponding to the position of strain sheet. Under the rigid zone loading, the inner strain value was -992.32 με, and the outer strain value was 1 006.97 με. To conclude, the results of the ball head pressing plate model and the displacement loading mode are relatively close to the experimental results and should be used as the standard for the finite element calculation of the femur stem. Figures and Tables | References | Related Articles | Metrics

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Effect of forearm weight-bearing on spatiotemporal parameters and joint angles of the lower limbs in patients with Parkinson’s disease during walking Wang Hujun, Wang Yingpeng, Fang Boyan, Jin Zhaohui, Qi Lin, Zhang Qiaorong, Wang Congxiao, Qie Shuyan 2022, 26 (15):  2307-2311.  doi: 10.12307/2022.581 Abstract ( 435 )   PDF (1567KB) ( 42 )   Save BACKGROUND:  Abnormal gait is the most common motor symptom in patients with Parkinson’s disease. There are various gait training methods; however, there are no reports on the forearm weight-bearing gait training methods.   OBJECTIVE: To evaluate the changes in patients with Parkinson’s disease before and after forearm weight-bearing, and to investigate the influence of forearm weight-bearing on the gait of patients with Parkinson’s disease by using three-dimensional gait analysis method. METHODS:  Thirty patients with idiopathic Parkinson’s disease and thirty age-matched healthy subjects were selected to measure their three-dimensional gait parameters during normal walking and forearm weight-bearing walking. Stride frequency, stride speed, stride time, stride length time, single support phase, double support phase, stride length, and other spatiotemporal parameters were compared between two walking modes. Statistical Parametric Mapping was used to determine the difference between two walking modes in the joint angles and curves of the hip, knee, and ankle during the whole gait cycle.   RESULTS AND CONCLUSION: There were significant differences in stride frequency, stride speed, stride time, single support period, and stride length between two walking modes for patients with Parkinson’s disease (P < 0.05). Whereas, healthy subjects presented with no significant differences in these spatiotemporal parameters between two walking modes (P > 0.05). Compared with normal walking, lower extremity hip flexion and extension angle of patients with Parkinson’s disease were significantly increased in 5%-23% and 87%-100% gait cycles (P < 0.05). The angles of knee flexion and extension were significantly increased in 9%-25% and 88%-98% gait cycles (P < 0.05). The angles of ankle flexion and extension were increased in 92%-100% gait cycle (P < 0.05). For patients with Parkinson’s disease undergoing forearm weight-bearing walking training, the spatiotemporal parameters, including stride frequency, stride speed, stride time, stride length, as well as the angle curves of the hip, knee, and ankle joints became close to those of healthy subjects. To conclude, the spatiotemporal parameters and the joint angles of the hip, knee and ankle joint will change in patients with Parkinson’s disease during forearm weight-bearing walking, and this change can occur throughout the whole gait cycle. Forearm weight-bearing can immediately improve the walking ability of patients with Parkinson’s disease, which is expected to be one of the gait training methods for Parkinson’s disease rehabilitation. Upper limb strength training may also affect the lower limb rehabilitation of patients with Parkinson’s disease. Figures and Tables | References | Related Articles | Metrics

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Application of three-dimensional printed osteotomy guide plate in knee arthroplasty in osteoarthritis patients with concomitant femoral deformity Liu Fatai, Yang Jinshun, Zhong Weibin 2022, 26 (15):  2312-2316.  doi: 10.12307/2022.582 Abstract ( 339 )   PDF (8955KB) ( 46 )   Save BACKGROUND: For complex knee osteoarthritis, traditional surgical instruments for osteotomy positioning technology can easily lead to poor placement of artificial total knee arthroplasty prostheses. Personalized three-dimensional printed osteotomy guide plate can achieve accurate osteotomy and prosthesis placement.   OBJECTIVE: To investigate the early clinical effects of total knee arthroplasty with personalized three-dimensional printed osteotomy guide plates in the treatment of advanced knee osteoarthritis with femoral deformities. METHODS:  Thirty-one patients with severe knee osteoarthritis combined with femoral deformity admitted to the Fifth Affiliated Hospital of Guangzhou Medical University from June 2016 to May 2020 were enrolled in the study. There were 14 males and 17 females, which aged 54-88 years old. A personalized three-dimensional printed osteotomy guide plate was used to assist in total knee arthroplasty surgery. Imaging measurement was conducted before treatment and at 3 days after treatment, to measure the included angle between femur and tibia mechanical axis, posterior condylar angle, patella transverse axis-femoral transepicondylar axis angle. American Hospital of Special Surgery score, Visual Analogue Scale score and range of motion of the knee joint were measured and assessed before and at 6 and 12 months after treatment.   RESULTS AND CONCLUSION: All the 31 patients were followed up for more than 12 months, and no adverse advents related to implant materials occurred during the trial and follow-up. At 3 days after treatment, the included angles between the femur and tibia mechanical axis, posterior condylar angle, and patella transverse axis-femoral transepicondylar axis angles were lower than those before treatment in all the patients (all P=0.000). At 6 and 12 months after treatment, the American Hospital of Special Surgery score and the range of motion of the knee were higher than those before treatment in all the patients (P < 0.05), while the Visual Analogue Scale scores were lower than those before treatment (P < 0.05). Therefore, total knee arthroplasty with the assistance of three-dimensional printed personalized osteotomy guide plates can relieve joint pain, improve joint function, restore lower limb force lines and femoral rotation alignment, and improve patellar trajectory in patients with advanced knee osteoarthritis combined with femoral deformities. Figures and Tables | References | Related Articles | Metrics

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Application of three-dimensional printing medical-industrial outpatient clinics in digital medical education Zheng Kun, Xu Yuanjing, Yu Wenqiang, Ren Fuchao, Deng Qian, Wang Jinwu, Dai Kerong 2022, 26 (15):  2317-2322.  doi: 10.12307/2022.583 Abstract ( 518 )   PDF (1191KB) ( 77 )   Save BACKGROUND: The combination of three-dimensional (3D) printing and medical workers in outpatient and digital medical education is constantly improving and developing. The application of 3D printing medical-industrial outpatient mode to the clinical practice and teaching of digital medicine will be an innovative combination during the rapid development of 3D printing. This new mode will also further promote the development of applied medicine. OBJECTIVE: To compare the advantages of 3D printing integrated medicine-industry outpatient clinic with traditional medical teaching and 3D printing medical teaching, and expounds in detail the clinical practice teaching case of 3D printing medical worker combination clinic of the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. METHODS: The teaching methods of traditional medicine and 3D printing medicine were investigated and compared with 3D printing integrated medicine-industry outpatient clinic at Shanghai Ninth People’s Hospital affiliated to Shanghai Jiao Tong University in terms of “teaching, education, digital medicine”. We discussed the composition of 3D printing integrated medicine-industry outpatient clinic, investigated the development of 3D printing items, and summarized the number of participants who had participated in the training of 3D printing integrated medicine-industry outpatient clinic as well as the number of international conferences held in the 3D printing clinic center of Shanghai Ninth People’s Hospital from January 2018 to January 2021, thereby expounding the important role of 3D printing integrated medicine-industry outpatient clinic in the development of digital medical education.   RESULTS AND CONCLUSION: The traditional medical education that proceeds in a large classroom is boring, in which students are easy to lose their attention and difficult to master knowledge comprehensively. 3D printing medical education could improve the understanding of abstract content in medical education, but there is a lack of clinical translation potential in 3D printing. 3D printing medical-industrial outpatient clinics could cultivate the transformation thinking of medical-industrial talents, train the students’ ability to transform scientific research achievements, and help the smooth implementation of clinical research achievements.  3D printing medical-industrial outpatient clinics at Shanghai Ninth People’s Hospital has successfully produced personalized orthoses for patients, with the characteristics of interdisciplinary interaction, medical and industrial talent interaction, and system training. It took the lead in the development and exploration of 3D printing medical-industrial outpatient clinic in the clinical practice and teaching of digital medicine, and has achieved good results. At present, there are 42 Master/MD candidates and 137 trainees in the 3D printing medical-industrial outpatient clinic. It has held 10 international conferences on rehabilitation medicine and engineering, and 6 international conferences on the clinical transformation of advanced technologies in rehabilitation medicine and engineering, all of which have a profound impact on the development of 3D printing digital medicine education over the world. To conclude, the teaching mode based on 3D printing medical-industrial outpatient clinics is not only beneficial to training students’ scientific research and innovation ability guided by clinical needs, but also conducive to the development of cutting-edge disciplines such as translational medicine, tissue engineering, rehabilitation engineering and biomedical engineering. Figures and Tables | References | Related Articles | Metrics

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Effect of knee ligamentous laxity on patient satisfaction after total knee arthroplasty: a medium to long-term follow-up Xia Peige, Yin Li, Wang Haitao, Zhang Yi, Qiao Renqiu, Kong Zhiheng, Zhao Hongbo, Shi Xiangyu 2022, 26 (15):  2323-2329.  doi: 10.12307/2022.584 Abstract ( 496 )   PDF (2105KB) ( 36 )   Save BACKGROUND: Appropriate soft tissue laxity is required for a successful total knee arthroplasty; however, different patients present with different soft tissue changes after surgery.   OBJECTIVE: To investigate the effect of knee ligamentous laxity on patient satisfaction during medium and long-term follow-up after total knee arthroplasty, and to preliminarily test the effectiveness of measuring knee ligamentous laxity based on length measurement. METHODS:  A total of 107 patients who underwent total knee arthroplasty in the First Affiliated Hospital of Zhengzhou University and had been followed up for 5-10 years after surgery were selected. Stress X-rays were taken in each patient, and the coronal laxity of the bilateral knee joints was measured by different methods. Method A: The knee joint laxity was expressed by the sum of the changes in the distance between the medial and lateral openings of the knee joint in the varus and valgus stress test: A1 group (≥ 0 mm and ≤ 5 mm, n=23), A2 group (> 5 mm and ≤ 7 mm, n=38), A3 group (> 7mm and ≤ 9 mm, n=24), and A4 group (> 9 mm, n=22). Method B: The knee joint laxity was expressed by the sum of the knee joint varus and valgus angles in the varus and valgus stress test: B1 group (≥ 0° and ≤ 4°, n=20), B2 group (> 4° and ≤ 6°, n=31), B3 group (> 6° and ≤ 9°, n=23), and B4 group (> 9°, n=33). Method C: The difference in laxity between the knee joints described in Method A was calculated to indicate the difference in laxity between the bilateral knee joints: C1 group (≤ -5 mm, n=22), C2 group (> -5 mm and ≤ -1 mm, n=33), C3 group (> -1 mm and ≤ 1 mm, n=32), and C4 group (> 1 mm, n=20). Method D: The difference in the laxity between the knee joints in Method B was calculated to indicate the difference in laxity between the knee joints: D1 group (≤ -3°, n=27), D2 group (> -3° and ≤ 0°, n=33), D3 group (> 0° and ≤ 3.5°, n=27), and D4 group (> 3.5°, n=20). The Oxford knee score and the modified Lysholm score were used for knee function assessment, to find out the soft tissue laxity range with the highest patient satisfaction. By comparing the sensitivity and specificity of Methods A and B, we could get a better measurement method in this follow-up. By analyzing the results of Methods C and D, the influence of difference in laxity between the bilateral knee joints on patient satisfaction could be explained.   RESULTS AND CONCLUSION: In Method A, there were significant differences in Oxford knee scores and modified Lysholm scores among groups (P < 0.05), and the range of the best function was 5-9 mm. In Method B, there were significant differences in Oxford knee scores and modified Lysholm scores among groups (P < 0.05), and the range of the best function was 4°-9°. In Method C, there was no significant difference in Oxford knee scores and modified Lysholm scores among groups (P > 0.05). In Method D, there were significant differences in the Oxford knee scores and the modified Lysholm scores (P < 0.05), and the range of the best function was -3°-3.5°. The sensitivity in Method A was slightly lower than that in the Method B, but the specificity was higher than that in Method B. These findings indicate that the range of knee joint laxity with the highest patient satisfaction in 5-10 years after total knee arthroplasty is 4°-9° when measured by angle, and 5-9 mm when measured by length. Length and angle measurements have similar effectiveness in measuring the coronal laxity of the knee joint. When the knee joint laxity is expressed in angle, the smaller the angle difference, the higher the patient’s satisfaction. When the difference is significant, the satisfaction of patients whose knee joint laxity on the surgical side is higher than that on the contralateral side is worse. When the knee joint laxity is expressed in length, the difference in laxity between the bilateral knee joints is not well denoted. Figures and Tables | References | Related Articles | Metrics

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Tuina prevents deep venous thrombosis of the lower limbs after total knee arthroplasty Zhao Chi, Xu Hui, Kang Bingxin, A Xinyu, Xie Jun, Sun Songtao, Shen Jun, Xiao Lianbo, Shi Qi 2022, 26 (15):  2330-2336.  doi: 10.12307/2022.585 Abstract ( 477 )   PDF (1326KB) ( 89 )   Save BACKGROUND: With the update of artificial biomaterials and surgical techniques, total knee arthroplasty has become a reliable surgical method for the treatment of severe knee osteoarthritis. It can effectively relieve joint pain and stiffness, correct joint deformity, and restore joint function in patients with knee osteoarthritis. However, total knee arthroplasty can produce a large wound in such patients, and destroy the blood circulation environment. The blood flow is then slow and coagulated, forming a hypercoagulable state in the body and further inducing deep vein thrombosis, which seriously impacts surgical efficacy and patient satisfaction. Serious patients have the risk of developing fatal pulmonary embolism, which is a clinical problem concerned by joint surgical experts all over the world.   OBJECTIVE: To observe the efficacy of Tuina in preventing lower extremity deep venous thrombosis after total knee arthroplasty for knee osteoarthritis. METHODS:  Using a randomized controlled design, 98 patients with knee osteoarthritis scheduled for primary unilateral total knee arthroplasty were randomly divided into Tuina group and control group (n=49 per group). The control group was treated with oral rivaroxaban tablets after operation, and the Tuina group was treated with Tuina on the basis of oral rivaroxaban tablets. The intervention time was set from the 1st day to the 14th day after operation. The femoral vein stasis index, the incidence of deep venous thrombosis, D-dimer value, pressure pain thresholds, American Knee Society Score, thigh and calf circumference difference, and adverse events were recorded. The clinical trial protocol was approved by the Ethics Committee of Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine on May 16, 2020 (approval No.2020-K-43). Patients who participated in the clinical trial were fully informed of the study protocol and process. Informed consent was signed prior to the start of the clinical trial. This clinical trial was registered at Chinese Clinical Trial Registry on June 4, 2020 (http://www.chictr.org.cn/listbycreater.aspx, ChiCTR2000033537).   RESULTS AND CONCLUSION: After 14 days of intervention, the total femoral vein stasis index in the Tuina group was significantly lower than that in the control group (P < 0.05). After 14 days of intervention, the incidence of deep venous thrombosis in the Tuina group was lower than that in the control group, but there was no significant difference between the two groups (P > 0.05). After 14 days of intervention, the D-dimer value of the Tuina group was significantly lower than that of the control group (P < 0.05). After 14 days of intervention, pressure pain thresholds at medial and lateral points of the knee joint in the Tuina group were significantly higher than those in the control group (P < 0.05). After 14 days of intervention, the American Knee Society Score of the Tuina group was significantly higher than that of the control group (P < 0.05). After 14 days of intervention, the circumference difference of thigh and calf in the Tuina group was significantly lower than that in the control group (P < 0.05). No adverse events occurred in both groups. To conclude, Tuina is safe and reliable, which can improve the lower limb femoral vein stasis state, reduce the D-dimer value, reduce thigh and calf circumference difference, improve joint pain, and promote joint function rehabilitation. Figures and Tables | References | Related Articles | Metrics

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Lag screw path for fixation of sacroiliac joint dislocation through S1 pedicle Li Jinglian, Zhang Hongfei, Yan Jiapeng, Zhou Jiabin, Yu Hao 2022, 26 (15):  2337-2341.  doi: 10.12307/2022.586 Abstract ( 375 )   PDF (6917KB) ( 57 )   Save BACKGROUND: Percutaneous sacroiliac screw fixation has become the preferred method for the treatment of sacroiliac joint dislocation. However, at present, the screw is mostly inserted parallel to the horizontal plane. This method of screw placement has relatively high risk, which is easily affected by human pelvis variation, and is difficult to achieve double-screw fixation. Therefore, a new internal fixation method should be developed.   OBJECTIVE: To simulate the internal fixation of the sacroiliac joint using a lag screw of 7.3 mm in diameter in a three-dimensional model of the pelvises, followed by measurement and statistical analysis, thus to determine the best iliac screw entry point and spatial angle. METHODS:  Mimics 21.0 software was used for three-dimensional remodeling based on computed tomography data of the pelvis in 60 cases. From the top of the buttocks as close as possible to the upper edge of the iliac crest, a 7.3 mm lag screw was inserted through the S1 pedicle to the midpoint of the upper 1/3 of the S1 vertebral body (the screw was inserted entirely from the caudal direction), and the second lag screw was inserted 5-8 mm below the first screw on the coronal plane. All cases must meet the requirements for safe placement of double screws, then the deviation angles between the axis of the first lag screw and the horizontal plane, sagittal plane, and coronal plane were measured in the software, and the position of the iliac screw entry point was observed and analyzed.   RESULTS AND CONCLUSION: Screw entry point was slightly outside the vertical tangent to the inner edge of the small pelvis. The optimal angles of the screw placement path to the horizontal, sagittal and coronal planes were α (12.56±6.14)°, β (66.42±5.45)° and γ (18.68±5.09)° in males, respectively, and were α (9.78±5.31)°, β (69.46±5.34)°, and γ (16.86±5.94)° in females, respectively. There were significant differences in α and β between male and female, but not in γ. The sacroiliac screw could be inserted entirely from the caudal direction, at a relatively stable spatial angle. The entry point of the ilia was positioned slightly outside the vertical tangent of the inner edge of the small pelvis on the anteroposterior projection plane, and the variation was small. To conclude, insertion of two parallel screws can be achieved in most patients. Therefore, the caudal insertion of sacroiliac screw can be used as a clinical screw entry method. Figures and Tables | References | Related Articles | Metrics

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Comparison of fracture healing and complications after internal fixation in patients with intertrochanteric fracture with and without concomitant sarcopenia Xu Junjie, Li Yehai, Liu Qing, Wang Jian, Liang Junsheng, Liu Hefeng, Dai Ru 2022, 26 (15):  2342-2346.  doi: 10.12307/2022.587 Abstract ( 351 )   PDF (1158KB) ( 70 )   Save BACKGROUND: Sarcopenia is closely related to the occurrence of hip fractures. As sarcopenia is gradually recognized and studied, enough emphasis should be placed on patients with intertrochanteric fractures combined with sarcopenia, to further improve the curative effect on elderly femoral intertrochanteric fractures and reduce complications.   OBJECTIVE: To investigate fracture healing and complications after internal fixation in patients with intertrochanteric fracture concomitant with sarcopenia or not. METHODS:  A total of 128 patients with intertrochanteric fractures who underwent anti-rotation intramedullary fixation at the Department of Orthopedics in Chaohu Hospital of Anhui Medical University from January 2014 to December 2020 were selected, of which 61 patients were without sarcopenia, and 67 patients were with sarcopenia. The postoperative pain (visual analogue scale score), blood loss, fracture healing time, hospital stay, complications, and Harris hip score were statistically analyzed in the two groups.   RESULTS AND CONCLUSION: Of the 128 patients, 67 (52.3%) were diagnosed with sarcopenia. Compared with the non-sarcopenia group, patients in the sarcopenia group had longer hospital stays (P < 0.05), a higher incidence of complications (P < 0.05), and a lower Harris hip score (P < 0.05). The visual analogue scale scores of sarcopenia patients were higher than those of non-sarcopenia patients on the 1st and 3rd days after surgery (P < 0.05). To conclude, the incidence of sarcopenia is higher in patients with intertrochanteric fractures, and sarcopenia is a risk factor for poor prognosis in patients with intertrochanteric fractures, which should be spotlighted. Figures and Tables | References | Related Articles | Metrics

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Effect of platelet-rich plasma with bioceramic system on the treatment of ARCO stage II osteonecrosis of the femoral head Chai Le, Ding Xiao, Wang Bin, Chen Xu, Guo Jiarui, Zhu Guangpu, Yu Jinwei 2022, 26 (15):  2347-2351.  doi: 10.12307/2022.588 Abstract ( 555 )   PDF (1566KB) ( 57 )   Save BACKGROUND: The bioceramic system can guide the blood supply near the greater trochanter and the femoral neck to the femoral head through the porous structure, thereby promoting the repair of osteonecrosis and partially restoring the mechanical properties of the femoral head and neck. It has been widely used in the treatment of early osteonecrosis of the femoral head. Platelet-rich plasma has a certain positive effect on the treatment of early osteonecrosis of the femoral head.   OBJECTIVE: To investigate the clinical effect of platelet-rich plasma with the bioceramic system on the treatment of Association Research Circulation Osseous (ARCO) stage II osteonecrosis of the femoral head. METHODS: Sixty patients with ARCO stage II osteonecrosis of the femoral head who were admitted to the Second People’s Hospital of Jiaozuo City from July 2016 to May 2020 were randomly divided into two groups (n=30 per group): a control group and a test group. Patients in the control group received bioceramic system implantation. Patients in the test group received autologous platelet-rich plasma with bioceramic system implantation. After the treatment, the anteroposterior X-ray film of the affected limb was regularly reviewed to determine the morphological changes of the femoral head; and the severity of pain and hip joint function of patients in the two groups were compared.   RESULTS AND CONCLUSION: Both groups of patients were followed up for 12 months. There was one patient in the test group and five patients in the control group who developed femoral head collapse. After hip arthroplasty, these six patients were excluded from the trial. Finally 54 patients were included in the result analysis. During the follow-up period, 54 patients had no material host reaction. In the test group, the visual analogue scale scores were all lower than those in the control group at 3, 6, and 12 months after treatment (P < 0.05), and the hip function scores were all higher than those in the control group at 3, 6, and 12 months after treatment (P < 0.05). To conclude, platelet-rich plasma combined with the bioceramic system is a minimally invasive treatment for ARCO stage II osteonecrosis of the femoral head, which can promote the repair of osteonecrosis and effectively improve the hip pain and joint function in such patients. Figures and Tables | References | Related Articles | Metrics

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Pauwels type III femoral neck fracture treated with three and four cannulated screws assisted by robot navigation Wang Jiaqi, Luo Xiaozhong, Tong Yi, Shi Weixiang, Ding Yong, Zhou Xin, Wu Gang 2022, 26 (15):  2352-2355.  doi: 10.12307/2022.589 Abstract ( 387 )   PDF (1830KB) ( 29 )   Save BACKGROUND: At present, three cannulated screws cannot provide enough stability for Pauwels type III femoral neck fracture. Four cannulated screws can provide better stability than three cannulated screws, but the space of the femoral neck is narrow and the screw drilling is extremely easy to fail. Robot navigation technology can effectively solve this problem.   OBJECTIVE: To compare the clinical efficacy of three and four cannulated screws under robot navigation for Pauwels type III femoral neck fractures. METHODS:  The clinical data of 72 cases of Pauwels type III femoral neck fracture treated with cannulated screws fixation assisted by robot navigation in Zigong Fourth People’s Hospital from July 2013 to May 2020 were collected, including 37 males and 45 females, at the age of 16-66 years old. Forty-two cases were fixed with three screws and thirty cases with four screws. The operation time, number of needle insertions, number of intraoperative fluoroscopy, blood loss, incision length, wound healing, fracture healing rate, fracture reduction, femoral head necrosis, hip Harris Score, and full weight-bearing time were recorded in both groups.   RESULTS AND CONCLUSION: All 72 patients were followed up after operation. All incisions were healed by first intention. There were no incision infection cases, and the fracture healing rate was 100%. Femoral head necrosis occurred in three cases in the three-screw group. There was no femoral head necrosis in the four-screw group. No adverse reactions caused by cannulated screws occurred during the follow-up. There was no significant difference between the two groups in the number of needle placements, blood loss, and fracture reduction (P > 0.05). Compared with the three-screw group, the four-screw group had longer operation time, more intraoperative fluoroscopy, and longer incision length (P < 0.05). Compared with the three-screw group, the fracture healing time and the time of full weight-bearing were shortened in the four-screw group (P < 0.05). The Harris score of hip joint in the four-screw group was higher than that in the three-screw group at 6 months after surgery (P < 0.05). Results have indicated that compared with three cannulated screws by the assistance of robot navigation, the four cannulated screws for the treatment of Pauwels type III femoral neck fractures have shorter fracture healing time, shorter time of full weight-bearing, and better hip joint function. Figures and Tables | References | Related Articles | Metrics

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Orthopedic robot-assisted cortical bone trajectory screw internal fixation for the treatment of lumbar degenerative diseases Lin Shu, Hu Jiang, Wan Lun, Tang Liuyi, Wang Yue, Yu Yang 2022, 26 (15):  2356-2360.  doi: 10.12307/2022.590 Abstract ( 418 )   PDF (1702KB) ( 67 )   Save BACKGROUND: Traditional pedicle screw has the risk of screw loosening in osteoporotic lumbar spine internal fixation, and cortical bone trajectory screw fixation can increase the holding power of screws, which can improve the accuracy of screw placement and reduce radiation injury with the assistance of orthopedic robots.   OBJECTIVE: To compare the accuracy and safety of robot-assisted and manual cortical bone trajectory screw fixation in the treatment of lumbar degenerative diseases with osteoporosis. METHODS:  The clinical data of 39 patients with lumbar spine diseases and osteoporosis admitted from January 2018 to April 2020 were retrospectively analyzed. According to the different operation methods, the patients were divided into a robot group (n=19) and a manual group (n=20). The data of operation time, fluoroscopy frequency, fluoroscopy dose, intraoperative blood loss, incision length, hospitalization costs, and accuracy of screw placement were collected. Japanese Orthopedic Association scores were also used to compare preoperative and postoperative lumbar nerve function. This study protocol was approved by the Medical Ethics Committee of Sichuan Provincial People’s Hospital (approval No. 2019[298]). RESULTS AND CONCLUSION: Compared with the manual group, the operation time was shorter, and intraoperative fluoroscopy frequency and fluoroscopy dose were significantly lower in the robot group (P < 0.05). The robot group had significantly longer incision length and higher hospitalization cost than the manual group (both P < 0.05). There was no significant difference between the two groups of patients in intraoperative blood loss and Japanese Orthopedic Association scores before, 3 months and 6 months after operation (P > 0.05). Accuracy of screw placement was 93% (71/76) in the robot group and 80% (64/80) in the manual group, and there was a significant difference between the two groups (P=0.014). To conclude, robot-assisted screw placement can reduce operation time, fluoroscopy frequency, fluoroscopy dose and increase accuracy of placement, compared with manual cortical bone trajectory screw fixation. Figures and Tables | References | Related Articles | Metrics

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Scavenging effect of hypochlorous acid on bacterial biofilm on the surface of orthopedic internal fixation devices Liang Jinzheng, Shao Xinxin, Du Shaohua, Dai Shuangwu 2022, 26 (15):  2367-2371.  doi: 10.12307/2022.592 Abstract ( 777 )   PDF (3978KB) ( 41 )   Save BACKGROUND: Biofilm formation during the infection of orthopedic fixation devices is a very difficult clinical problem. Hypochlorous acid, as a highly effective disinfectant, can destroy the bacterial biofilm, which may be helpful for treating infection of orthopedic fixation devices.   OBJECTIVE: To study the scavenging effect of hypochlorous acid on bacterial biofilm on the surface of orthopedic fixation devices after soaking and perfusion for different time in vitro. METHODS: Staphylococcus aureus and Pseudomonas aeruginosa were colonized on orthopedic steel fixation devices for 3 days, and then the bacterial biofilm formed, which was confirmed by scanning electron microscope. Orthopedic fixation devices with two kinds of bacterial biofilms were soaked in hypochlorous acid for 0, 5, 10, and 20 minutes, or perfused with 6 L of a mixed solution of hypochlorous acid and saline (every 3 L of saline with addition of 120 mL of hypochlorous acid) for 20 minutes. The morphology of bacterial biofilms was observed under scanning electron microscope, and the scavenging effect on the bacterial biofilm on the surface of orthopedic internal fixation devices was then evaluated.   RESULTS AND CONCLUSION: Pseudomonas aeruginosa: Under the scanning electron microscope, the bacterial biofilm plaques on the surface of the internal fixation device that was not soaked in hypochlorous acid solution were large and thick, and the colonies were densely concentrated. After 5, 10, and 20 minutes soaking in hypochlorous acid, the bacterial biofilm plaque area was gradually decreased and became thinner. Perfusion with 6 L of a mixture of hypochlorous acid and saline for 20 minutes could remove the bacterial biofilm. Staphylococcus aureus: The performance under the scanning electron microscope was consistent with the biofilm of Pseudomonas aeruginosa. To conclude, prolonging the soaking time or a mixed perfusion can enhance the scavenging effect of hypochlorous acid on the bacterial biofilm on the surface of internal fixation devices. By soaking in hypochlorous acid for a sufficient time, the bacterial biofilm colonized on the surface of orthopedic internal fixation devices can be degraded and destroyed, thus achieving the purpose of disinfection. Figures and Tables | References | Related Articles | Metrics

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Sensitivity and specificity of coronal computed tomography reconstruction and traditional methods for determining screw loosening in spinal internal fixation Hu Weiran, Song Yuepeng, Shi Xinge, Ma Haohao, Wang Hongqiang, Zhang Kai, Gao Kun, Shao Jia, Gao Yanzheng 2022, 26 (15):  2372-2376.  doi: 10.12307/2022.593 Abstract ( 579 )   PDF (1825KB) ( 46 )   Save BACKGROUND: Pedicle screw loosening is a serious complication of spinal internal fixation, and previous reports on the determination of screw loosening still focused on computed tomography (CT) axial images.   OBJECTIVE: To compare the sensitivity and specificity of coronal CT reconstruction using traditional methods, including X-ray and axial CT images, in determining screw loosening. METHODS: This study enrolled a total of 23 patients who underwent spinal revision surgery in Henan Provincial People’s Hospital, including 17 patients with degenerative diseases and 6 patients with fractures. There were 14 patients with short segmental fixation and 9 patients with long segmental fixation. Coronal CT reconstruction and traditional X-ray and axial CT images were used to determine pedicle screw loosening preoperatively. Two doctors read the film independently without interfering with each other. Preoperative assessment was made for loosening of all fixation devices. A total of 171 screws were detected intraoperatively by digital torsion meter, and whether the screws were loose was determined according to the torsion. The sensitivity and specificity of the two methods were calculated separately. The clinical study was carried out in accordance with the Helsinki Declaration and the relevant ethical requirements of Henan Provincial People’s Hospital. Patients were informed of the treatment and signed an informed consent form.   RESULTS AND CONCLUSION: A total of 171 screws were examined, of which 69 screws were loose, and the loosening rate was 40.1%. The torsion force was (13.9±17.2) Ncm for loose screws and (154.9±72.3) Ncm for unloosened screws. The sensitivity, specificity, and accuracy of coronal CT reconstruction were 76.2%, 89.8%, and 80.1%, respectively. The sensitivity, specificity, and accuracy of the traditional method were 63.7%, 79.3%, and 69.0%, respectively. The sensitivity, specificity, and accuracy of the coronal CT reconstruction were higher than those of the traditional method (P < 0.05). The intra-observer correlation coefficients of the two methods were both greater than 0.75, indicating a good consistency between the two methods. To conclude, coronal CT reconstruction is simple and convenient, which can improve the accuracy of screw loosening determination after spinal internal fixation. Figures and Tables | References | Related Articles | Metrics

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High-frequency ultrasound-guided manual reduction and small splint external fixation in the treatment of stable fractures of the distal radius Zhou Yulan, Yuan Dechao, Li Ying, Gao Tao, Zeng Jian, Yin Chongfang, Yang Jilan 2022, 26 (15):  2377-2381.  doi: 10.12307/2022.594 Abstract ( 455 )   PDF (2698KB) ( 40 )   Save BACKGROUND: Manual reduction with external fixation using small splint for stable distal radius fracture can achieve satisfactory results, but there is some blindness. Development of musculoskeletal ultrasound provides the possibility for ultrasound-assisted reduction of fractures, which improves the quality and successful rate of reduction.   OBJECTIVE: To evaluate the feasibility of high-frequency ultrasound-guided manual reduction combined with small splint fixation in the treatment of stable fractures of the distal radius. METHODS:  One hundred patients who were diagnosed with unilateral stable distal radius fracture at Zigong Fourth People’s Hospital from January 2020 to July 2020 were randomly divided into two groups (n=50 per group): an experimental group and a control group. Patients in the experimental group received high-frequency ultrasound-guided manual reduction and small splint fixation, and patients in the control group received the closed reduction and small splint fixation. Wrist function was evaluated by modified Green and O'Brien scoring systems, and radiological findings were evaluated by modified Sanniento scoring method. The initial reduction success rate, wrist function scores, and imaging scores were compared between the two groups during 12-month follow-up.   RESULTS AND CONCLUSION: The success rate of initial reduction in the experimental group was significantly better than that in the control group (P < 0.05). The excellent rate of imaging evaluation was 90.0% and 62.0% in the experimental group and the control group, respectively, immediately after reduction, and there was a significant difference between the two groups (P < 0.05). At 2 months after reduction, the excellent rate of imaging evaluation was 80.0% and 56.0% in the experimental group and the control group, respectively, and there was a significant difference between the two groups (P < 0.05). At 2 months after reduction, the excellent rate of wrist function evaluation was 10.0% and 8.0% in the experimental group and the control group, respectively, and there was no significant difference between the two groups. At 12 months after reduction, the excellent rate of wrist function evaluation was 90.0% and 66.0% in the experimental group and the control group, respectively, and there was a significant difference between the two groups (P < 0.05). All these findings indicate that the high-frequency ultrasound-guided manual reduction with small splint fixation can improve the reduction success rate and quality, and improve the wrist function in patients with stable fracture of the distal radius. Figures and Tables | References | Related Articles | Metrics

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Imaging analysis of risk factors for knee anterior cruciate ligament injury Zhang Wei, Liu Yunpeng, Wang Xingliang, Peng Chao, Hua Guojun 2022, 26 (15):  2361-2366.  doi: 10.12307/2022.591 Abstract ( 415 )   PDF (1342KB) ( 44 )   Save BACKGROUND: Relevant studies have shown that anterior cruciate ligament rupture may be related to the anatomical morphology of the distal femur and proximal tibia.   OBJECTIVE: To investigate the correlation between anterior cruciate ligament rupture and the match between the tibial intercondylar eminence and the femoral intercondylar fossa. METHODS:  A total of 74 male soldier patients who were admitted at the 904 Hospital of the Joint Logistics Support Force from January 2016 to March 2021 and suffered unilateral knee injuries or discomfort due to non-contact mechanism were selected. According to X-ray and magnetic resonance imaging findings, they were divided into two groups (n=37 per group): an anterior cruciate ligament rupture group and an intact anterior cruciate ligament group. Width index of the intercondylar fossa was detected using coronal magnetic resonance imaging, and the morphology of the intercondylar fossa was observed using axial magnetic resonance imaging. In X-ray, posteroanterior films were used to detect the width, lateral and medial height of the tibial intercondylar eminence. Ratio of the width of the tibial intercondylar eminence to the width of the intercondylar fossa was used to describe the match between the tibial intercondylar eminence and the femoral intercondylar fossa.   RESULTS AND CONCLUSION: There was no significant difference between the two groups in the width of femoral bicondyle, the lateral and medial heights of the tibial intercondylar eminence (P > 0.05). The width of the intercondylar fossa, the width index of the intercondylar fossa, the width of the tibial intercondylar eminence, and the ratio of the width of the tibial intercondylar eminence to the width of the intercondylar fossa in the anterior cruciate ligament rupture group was lower than that in the intact anterior cruciate ligament group (P < 0.05). The A-shaped intercondylar fossa was more common in the anterior cruciate ligament rupture group, and the U-shaped intercondylar fossa was more common in the intact anterior cruciate ligament group. Univariate Logistic regression analysis showed that the width of the intercondylar fossa, the width index of the intercondylar fossa, the morphology of the intercondylar fossa, the parameters of the tibial intercondylar eminence, and the ratio of the width of the tibial intercondylar eminence to the width of the intercondylar fossa were all the influencing factors for anterior cruciate ligament rupture (P < 0.05). Multivariate Logistic regression analysis showed that the ratio of the width of the tibial intercondylar eminence to the width of the intercondylar fossa was an independent risk factor for anterior cruciate ligament rupture (P < 0.05). Receiver operating characteristic curve showed that the ratio of the width of the tibial intercondylar eminence to the width of the intercondylar fossa had a certain predictive value for anterior cruciate ligament rupture. To conclude, the ratio of the width of the tibial intercondylar eminence to the width of the intercondylar fossa is an independent risk factor for anterior cruciate ligament rupture. It has a certain predictive value for anterior cruciate ligament rupture. The worse the match between the tibial intercondylar eminence and the femoral intercondylar fossa is, the higher the risk of anterior cruciate ligament rupture is. Figures and Tables | References | Related Articles | Metrics

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Effects of Zishen Jiangu Recipe on bone microstructure and bone mineral density in ovariectomized rats with osteoporosis Lin Xiaosheng, Han Linjing, Wu Keliang, Zhang Zhen, Wang Hongbo, Xiao Qinghua, Du Genfa, Zhu Jianzong 2022, 26 (15):  2382-2386.  doi: 10.12307/2022.595 Abstract ( 409 )   PDF (1670KB) ( 40 )   Save BACKGROUND: Zishen Jiangu Recipe is an in-hospital consensus prescription for the treatment of osteoporosis in Shenzhen Integrative Medicine Hospital. It has achieved good clinical results in the early stage, but its mechanism underlying treatment of osteoporosis is still unclear.   OBJECTIVE: To investigate the therapeutic effect of Zishen Jiangu Recipe on osteoporosis by in vivo experiments in an ovariectomized rat model. METHODS:  Eighty female Sprague-Dawley rats were randomly divided into a surgery group (n=68) and a sham surgery group (n=12). Rat osteoporosis models were established by ovariectomy inthe surgery group. Three months after the surgery, six rats were randomly selected from each group to test the bone mineral density. After successful modeling, the remaining 62 rats in the surgery group were randomly divided into a model group, a low-dose Zishen Jiangu Recipe group, a medium-dose Zishen Jiangu Recipe group, a high-dose Zishen Jiangu Recipe group, and an alendronate sodium group. Rats in low, medium-, and high-dose Zishen Jiangu Recipe groups were given Zishen Jiangu Recipe at doses of 9.375, 18.75, and 37.5 g/kg per day, respectively. Rats in the alendronate group were given 1.02 g/kg alendronate per day, and rats in the sham surgery and model groups were given an equal volume of normal saline by gavage. After 3 months of intervention, rats in each group were killed after anesthesia, and the tibia was separated for Micro-CT bone scan, hematoxylin-eosin histopathological staining and bone mineral density detection. The femur was taken and subjected to a three-point bending test. And the levels of serum alkaline phosphatase, osteocalcin, and tartrate resistance acid phosphatase 5b were determined by enzyme-linked immunosorbent assay. This experiment was approved by the Animal Ethics Committee of Guangzhou University of Chinese Medicine.   RESULTS AND CONCLUSION: Three months after ovariectomy, the bone mineral density of the rats in the surgery group was significantly reduced, which confirmed that the osteoporosis model was successfully established. After 3 months of intervention, compared with the model group, the levels of serum alkaline phosphatase, osteocalcin, and tartrate resistance acid phosphatase 5b were significantly reduced in the medium- and high-dose Zishen Jiangu Recipe groups and the alendronate group, indicating that Zishen Jiangu Recipe could reduce the high turnover state of the bone in ovariectomized rats. After the intervention, the bone mineral density, the number and thickness of bone trabeculae were increased, the distance between the bone trabeculae was reduced, and the bone strength was significantly increased in the medium- and high-dose Zishen Jiangu Recipe groups. These findings indicate that Zishen Jiangu Recipe can improve bone microstructure, increase bone mineral density, and reduce the risk of fractures. Figures and Tables | References | Related Articles | Metrics

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Levels of histone modification in promoter of NOD-like receptor family pyrin domain-containing protein 3 in synovial fibroblasts of osteoarthritis Wang Jian, Gu Sanjun, Liu Yu, Zhao Kai, Li Haifeng 2022, 26 (15):  2387-2393.  doi: 10.12307/2022.596 Abstract ( 399 )   PDF (1550KB) ( 38 )   Save BACKGROUND: 1,25(OH)2D3 deficiency can exacerbate osteoarthritis. Previous studies have shown that 1,25(OH)2D3 regulates the proliferation and apoptosis of synovial fibroblasts in arthritis, but has unclear effect on the regulation of inflammasome pathway in synovial fibroblasts. OBJECTIVE: To determine the expression level of NOD-like receptor family pyrin domain-containing protein 3 (NLRP3) inflammasome pathway in osteoarthritic synovial fibroblasts and to explore the effect of 1,25(OH)2D3 on regulating NLRP3 inflammasome pathway and its specific mechanism. METHODS: Synovial tissue samples from patients with or without osteoarthritis were clinical collected for primary cell culture. Protein and mRNA expression levels of NLRP3, caspase recruitment domain and Caspase-1 in primary synovial fibroblasts were detected. Additionally, primary synovial fibroblasts were stimulated by 1,25(OH)2D3 in vitro for 24 hours. The protein expression of NLRP3, caspase recruitment domain and Caspase-1 was then detected. The levels of H3K4me3, H2AK119Ub, and H3K27me3 in the promoter region of NLRP3 were detected by chromatin immunoprecipitation technique. Small interfering RNA technique was applied to knock down the expression level of vitamin D receptor in synovial fibroblasts, and the primary cells were stimulated by 1,25(OH)2D3 in vitro for 24 hours. Subsequently, the protein expression of NLRP3, caspase recruitment domain, and Caspase-1 was detected.  RESULTS AND CONCLUSION: Compared with non-osteoarthritis patients, NLRP3 inflammasome pathway associated proteins (NLRP3, caspase recruitment domain, and Caspase-1) were overexpressed in synovial fibroblasts of osteoarthritis patients, and the transcription level of NLRP3 in osteoarthritis patients was significantly higher than that in non-osteoarthritis patients (P < 0.01). Compared with non-osteoarthritis patients, 1,25(OH)2D3 significantly inhibited the transcription level of NLRP3 and activation of NLRP3 inflammasome pathway in synovial fibroblasts of osteoarthritis patients in vitro (P < 0.05). Knockdown of vitamin D receptor could attenuate the inhibitory effect of 1,25(OH)2D3 on NLRP3 transcription and abate its inhibitory effect on the activation of NLRP3 inflammasome pathway. These findings suggest that 1,25(OH)2D3 exerts an inhibitory effect on NLRP3 transcriptional expression mainly by upregulating the levels of H3K27me3 and H2AK119Ub and inhibiting the level of H3K4me3 in NLRP3 promoter region. Figures and Tables | References | Related Articles | Metrics

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Correlation between body composition and bone mineral density in middle-aged and elderly people Yuan Jiayao, Lin Yanping, Lin Xiancan, Huang Jiachun, Chen Tongying, Lin Shi, Lian Xiaohang, Wan Lei, Huang Hongxing 2022, 26 (15):  2394-2399.  doi: 10.12307/2022.597 Abstract ( 528 )   PDF (1384KB) ( 48 )   Save BACKGROUND: Osteoporosis can easily lead to a decline in the self-care ability of middle-aged and elderly people, and an increase in mortality and related medical expenses. The relationship among the main body components of the human body (fat, muscle, and bone) has not been clarified. Therefore, it is necessary to study their relationship and identify potential predictors of osteoporosis in patients.   OBJECTIVE: To investigate the correlation between body composition and bone mineral density of the middle-aged and elderly people. METHODS:  A total of 109 middle-aged and elderly people were selected as subjects, and their heights, body mass and other information were recorded. The dual-energy X-ray bone densitometer was used to detect the bone mineral density and body composition. According to the results of body mineral density, the subjects were divided into an osteoporosis group and a non-osteoporosis group. The distribution and relationship of basic data, bone mineral density, bone mineral content, lean mass and fat mass of each part were analyzed between the two groups. Chi-square test was used to detect the ratio of osteoporosis in different sexes, and Pearson correlation analysis was used to obtain the correlation degree of each factor and bone mineral density.   RESULTS AND CONCLUSION: Women were more likely to suffer from osteoporosis. The age of the osteoporosis group was significantly higher than that of the non-osteoporosis group. Body mass, body mass index, bone mineral density, bone mineral content (overall, head, trunk, lower limbs), lean mass (overall, head, trunk, lower limbs), and fat mass (overall, head, upper limbs, lower limbs) in the osteoporosis group were significantly lower than those in the non-osteoporosis group. Pearson correlation analysis indicated that the bone mineral density of middle-aged and elderly people was significantly positively correlated with height, body mass, bone mineral content (overall, head, trunk, upper limbs, lower limbs), lean mass (overall, head, trunk, lower limbs) and fat mass (head), and negatively correlated with age. Therefore, osteoporosis is more common in women, and the middle-aged and elderly people with osteoporosis are older. Their bone mineral content, lean mass and fat mass of each part are lower than those without osteoporosis. The bone mineral density of the middle-aged and elderly people is highly correlated with the bone mineral content and lean mass of each part. Therefore, body composition can be used as an indirect reference index to evaluate the bone health status. Bone mineral content, lean mass and fat mass of each part have certain influence on the bone mineral density. Figures and Tables | References | Related Articles | Metrics

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Angiogenesis regulation in bone repair: new ideas and new methods Peng Huizhen, Cai Mingxiang, Liu Xiangning 2022, 26 (15):  2400-2405.  doi: 10.12307/2022.598 Abstract ( 639 )   PDF (1153KB) ( 177 )   Save BACKGROUND: Angiogenesis is a key component of bone reconstruction. Promoting bone vascularization thereby can accelerate bone repair. There are numerous research methods for promoting angiogenesis, and significant progress has been made in the field of bone defect repair in recent years.   OBJECTIVE: To review several cutting-edge methods and developments in promoting angiogenesis and repairing bone defects in recent years, as well as their applications in bone tissue engineering. METHODS:  The first author used the Chinese search terms “angiogenesis, osteogenesis, bone defect, tissue engineering, exosomes” and English search terms “angiogenesis, osteogenesis, bone defect, exosomes, vascularization” to find relevant publications in CNKI, WanFang, PubMed, and Web of Science databases. After screening and excluding articles irrelevant to the research purpose and repetitive articles, 69 articles were finally selected for review.   RESULTS AND CONCLUSION: At present, promising results have been achieved in the bone defect remodeling research. Bone vascularization can be promoted by growth factors, delivery genes, biologically active ions, small molecule active peptides, and Chinese medicine monomers. Each has its own advantages and challenges, and faces different challenges. The synthesis of small molecule active peptides has low cost, high efficiency and safety, with obvious advantages. It has the potential to generate new ideas and methods for vascularization in bone tissue engineering. Figures and Tables | References | Related Articles | Metrics

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Research hotspots of pressure training in rehabilitation and visualized analysis of relevant literature data in the past 10 years Chen Keyi, Wang Dingxuan, Zhao Sike, Xia Zhangrong 2022, 26 (15):  2406-2411.  doi: 10.12307/2022.599 Abstract ( 442 )   PDF (1723KB) ( 47 )   Save BACKGROUND: As a popular training method, pressure training was mainly involved in the field of sports training at the beginning, and in recent years, it has been gradually applied in the field of rehabilitation as a new method of sports rehabilitation. However, there are controversies in this field from the application to the mechanism. OBJECTIVE: To investigate the research ideas and trends of pressure training in the field of sports rehabilitation, analyze its research trends and hot spots, and provide new ideas and theoretical basis for future research directions. METHODS: The literature related to the application of pressure training in the field of rehabilitation from 2010 to 2021 was retrieved through the Web of Science. Then the visual analysis software of Cite Space V based on Java platform was used to analyze the retrieved literature, mainly focusing on the nation/region, institutions, authors, and co-cited literature, which were visualized and analyzed to summarize the research hotpots in the last 10 years through knowledge graph.  RESULTS AND CONCLUSION: In the past 10 years, research on the application of pressure training in the field of rehabilitation has been on the rise, mainly about more influential results published in the United States and Japan, while China’s influence in this field needs to be improved. In this field, pressure training has been widely used in the elderly and knee osteoarthritis disease. Knee osteoarthritis disease has always been a hot spot in this field. In recent 2 years, there have been new research applications, including intervention for post-menopausal women and patients with chronic low back pain. The future research direction of pressure training in the field of rehabilitation can focus on sports rehabilitation for more different groups and diseases, and also can explore the safety of training programs applied in different populations and diseases. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of the knee joint: research hotspots and trends Li Zhishuai, Zhang Hongqian, Li Li, Han Xinwen, Feng Jing 2022, 26 (15):  2412-2418.  doi: 10.12307/2022.600 Abstract ( 553 )   PDF (2145KB) ( 87 )   Save BACKGROUND: Finite element analysis has been widely used in the knee joint due to its visualization and noninvasion. International research in this field has been increasing year by year, and the finite element analysis model has achieved fruitful results and gradually diversified. However, less is reported on the research status, hot spots and trends of finite element analysis of the knee joint. OBJECTIVE: To analyze the current research status, hot spots and trends of finite element technology used in the knee joint in recent 10 years using visual analysis method. METHODS: The core collection of Web of Science was used as the data source to search for relevant literature on the subject of finite element analysis and knee joints from 2011 to 2020. CiteSpace.5.7.R2 software was used to conduct scientific knowledge map analysis and literature review on the research related to the application of finite element technology in the knee joint.  RESULTS AND CONCLUSION: After deduplication, a total of 1 026 articles were included. In the past 10 years, the number of published papers and citation  frequency in this field has increased year by year, with a total of 11 088 citations. A total of 256 journals have published articles related to this field. The research fields of the included journals are concentrated in biophysics, engineering, computer science, and orthopedic surgery. JOURNAL OF BIOMECHANICS published the most papers in this field. A total of 328 institutions and 342 authors from 62 countries have published related studies. The top three countries with the most publications are the United States, China, and England in sequence. The top three institutions with the most publications are Yonsei University and Yonsei Sarang Hospital in South Korea, and the University of Eastern Finland. Professor Kyoungtak Kang’s team has the largest number of publications. Key word analysis shows that the finite element analysis in knee joint research mainly focuses on articular cartilage, osteoarthritis, knee replacement, meniscus resection, biomechanics, component research, etc. In the past 4 years, knee revision, unicompartmental knee arthroplasty, and malalignment have become frontier issues. The research direction has gradually developed from the initial experimental research to the clinical decision-oriented research in the past 10 years. The research content has shifted from the establishment, optimization, and verification of models to the exploration of surgical prostheses, surgical approaches, and repair materials. Research on the development of materials/prosthesis performance, auxiliary knee arthroplasty/implantation and other repair technologies will become the future development trend in this field. Figures and Tables | References | Related Articles | Metrics

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Network pharmacology and molecular docking analysis on Taohong Siwu Decoction for rheumatoid arthritis and osteoarthritis based on the concept of “Treating Different Diseases with the Same Therapeutic Principle” Wang Xinyuan, Huang Xiabing, Li Juan, Deng Xin 2022, 26 (15):  2419-2425.  doi: 10.12307/2022.601 Abstract ( 553 )   PDF (21436KB) ( 49 )   Save BACKGROUND: Taohong Siwu Decoction has become one of the most widely used clinical prescriptions for promoting blood circulation and removing blood stasis in Chinese medicine, and it is also a typical prescription for treating different diseases with the same treatment. However, the chemical components of traditional Chinese medicine compounds are complex, and the clinical efficacy is manifested by the synergy of its multiple components, multiple targets, and multiple pathways. The integrality, systemicity, and emphasis on drug interactions of network pharmacology are similar to the basic characteristics of traditional Chinese medicine. The use of network pharmacology and bioinformatics to explain the relationship between the classic prescription and the possible potential component-target-pathway-disease of the disease is a key issue that needs to be explored in the modern application of the prescription.   OBJECTIVE: To explore the molecular mechanism of Taohong Siwu Decoction in the treatment of rheumatoid arthritis and osteoarthritis based on the idea of “Treating Different Diseases with the Same Therapeutic Principle” by using network pharmacology, bioinformatics, and molecular docking methods. METHODS:  The GEO database was used to screen the targets that interact with rheumatoid arthritis and osteoarthritis. Cytoscape was used to visualize the compound-target network. The DAVID database was used for GO and KEGG enrichment analysis, and the core targets were molecularly docked.   RESULTS AND CONCLUSION: Totally 44 effective compounds were screened; 201 targets related to rheumatoid arthritis and osteoarthritis. GO and KEGG analyses were mainly related to AGE-RAGE, MAPK, and IL-17 signaling pathways. The molecular docking verification experiment demonstrated that Taohong Siwu Decoction is mainly used to treat rheumatoid arthritis and osteoarthritis through effective compounds, such as hederin, paeoniflorin, β-carotene, and stigmasterol. It is concluded that Taohong Siwu Decoction treats rheumatoid arthritis and osteoarthritis through IL-17 signaling pathway, AGEs/AGE-RAGE signaling pathway, TNF signaling pathway, MAPK signaling pathway, and Toll-like receptor signaling pathway to promote the balance between pro-apoptotic and anti-apoptotic signals, reduces the secretion of inflammatory cytokines, thereby delaying or improving the degeneration of bone and articular cartilage, which provides new ideas and new methods for the study regarding the mechanism of action of Taohong Siwu Decoction in the treatment of rheumatoid arthritis and osteoarthritis. Figures and Tables | References | Related Articles | Metrics

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Effect and application of nerve growth factor in the treatment and repair of osteoarthritis Zhang Yong, Li Feifei, Wang Buyu, Huang Wenliang, Deng Jiang 2022, 26 (15):  2426-2431.  doi: 10.12307/2022.602 Abstract ( 646 )   PDF (1347KB) ( 53 )   Save BACKGROUND: The main pathological change of osteoarthritis is cartilage degeneration. The current means of treatment of osteoarthritis is very limited. With the development of interdisciplinary science in recent years, tissue engineering brings new hope for the repair and reconstruction of cartilage degeneration. Nerve growth factor plays an important role in the physiological and pathological processes of multiple systems and organs in the body. In recent years, it has been found that nerve growth factor is closely related to the occurrence and development of osteoarthritis.   OBJECTIVE: To explore the research progress of nerve growth factor in osteoarthritis in recent years from the aspects of nerve growth factor’s effects on cartilage, subchondral bone, synovium, and pain. It was envisaged that nerve growth factor could be used as a bioactive factor or cytokine in tissue engineering to repair bone and cartilage, providing new thoughts and ideas for the treatment of osteoarthritis. METHODS:  In PubMed, Web of Science, CNKI, and WanFang databases, search terms used were “nerve growth factor, TrkA, osteoarthritis, chondrocyte, cartilage degeneration, subchondral bone, synovium, pain” in English and Chinese. Basic and clinical studies on the mechanisms of nerve growth factor in osteoarthritis were searched from January 1, 2010 to July 1, 2021.   RESULTS AND CONCLUSION: Nerve growth factor promoted the differentiation of stem cells, maintained the phenotype of chondrocytes, and promoted the expression of chondrocytes to maintain the characteristics of cartilage. Nerve growth factor promoted osteogenic expression in a variety of ways, inducing or aggravating the occurrence and development of osteoarthritis, but some studies suggest that subchondral bone repair is beneficial to cartilage repair. Synovium promoted nerve growth factor expression and participated in the pain of osteoarthritis. Synovium also indirectly promoted the expression of cartilage degradation protein under the stimulation of inflammatory factors. Nerve growth factor is the main signal factor causing pain. The use of nerve growth factor antibody has a good and definite effect on the pain of osteoarthritis, but its use is limited by serious side effects, and the mechanism of its occurrence is explored. It may still become the most potential analgesic drugs in the future. Figures and Tables | References | Related Articles | Metrics

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Complications of reverse shoulder arthroplasty for proximal humeral fractures: periprosthetic bone resorption and aseptic prosthesis loosening Li Jianan, Lin Fengsong, Bu Guoyun, Yang Tao, Wei Wanfu 2022, 26 (15):  2432-2438.  doi: 10.12307/2022.603 Abstract ( 467 )   PDF (1527KB) ( 40 )   Save BACKGROUND: Proximal humeral fracture is a common disease in older adults with osteoporosis. Increasing scholars prefer reverse shoulder arthroplasty in the treatment of comminuted proximal humeral fractures with or without dislocation of the shoulder. However, periprosthetic bone resorption and aseptic prosthesis loosening cannot be ignored. OBJECTIVE: To review the research progress in periprosthetic bone resorption and aseptic prosthesis loosening in patients with proximal humeral fractures after reverse shoulder arthroplasty, and to analyze the influencing factors. METHODS: PubMed, Web of Science, and CNKI databases were searched for articles related to aseptic prosthesis loosening, which were published from December 2000 and July 2021. The search terms were “proximal humeral fracture, reverse shoulder arthroplasty, complication, osteolysis, and aseptic loosening” in English and Chinese, respectively. Finally, 53 articles were included for review.  RESULTS AND CONCLUSION: The average time for periprosthetic bone resorption and loosening following reverse shoulder arthroplasty is about 6 years. According to the classification of prosthetic components, periprosthetic bone resorption and loosening can be mainly divided into prosthesis stem and prosthesis base plate types. After reverse shoulder arthroplasty, periprosthetic bone absorption and aseptic prosthesis loosening result from the stimulation of periprosthetic wear particles, periprosthetic stress, and periprosthetic inflammation. After reverse shoulder arthroplasty, the incidence of bone resorption and loosening around the prosthesis stem is higher than that around the prosthesis base plate. However, the bone resorption and loosening around the prosthesis base plate often require reoperation or revision surgery. Patient factors (including patient age, gender, underlying disease conditions, etc.) and physician factors (including prosthesis selection, prosthesis fixation method, placement angle, postoperative targeted anti-osteoporosis, rehabilitation program, etc.) can lead to periprosthetic bone resorption or aseptic loosening after reverse shoulder arthroplasty of proximal humeral fractures. There are four methods to reduce the incidence of periprosthetic bone resorption and prosthesis loosening in the future: selecting the appropriate prosthesis for different patients, performing targeted surgical operations, individualized rehabilitation programs after replacement, and targeted intervention measures after replacement. Figures and Tables | References | Related Articles | Metrics

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Animal models of knee joint stiffness: modeling methods and characteristics Liao Yingying, Zhang Xin, Wen Chenghong, Chen Ke, Zhou Hui, Gou Qingchun 2022, 26 (15):  2439-2445.  doi: 10.12307/2022.604 Abstract ( 446 )   PDF (1188KB) ( 106 )   Save BACKGROUND: Knee joint stiffness is a common post-traumatic dysfunction, which is an urgent problem to be solved. To establish an ideal animal model of knee joint stiffness is the basis for studying the pathological mechanism of knee joint stiffness and is also important for exploring the treatment of knee joint stiffness. OBJECTIVE: To review the methods of establishing animal models of knee joint stiffness and to summarize the selection of animals, different fixation methods, fixation time and successful cycle, thereby providing experimental basis for its related research. METHODS: The literatures published from 2000 to 2020 were searched in the databases of CNKI, VIP, WanFang, PubMed, and Embase with the keywords of “knee stiffness, knee contracture, animal model” in Chinese and “knee stiffness, stiff knee, stiff knee, animal model” in English. Finally 49 references were included for review.  RESULTS AND CONCLUSION: At present, researchers mainly use surgical methods and non-surgical methods for modeling, that is, surgical methods: through surgery with or without knee articular surface injury, internal fixation is used to cause postoperative traumatic joint stiffness; non-surgical methods: simple external fixation or violent injury external fixation is used to obtain the animal model of knee joint stiffness. In clinical practice, knee joint stiffness caused by immobilization after lower limb fracture is very common. For knee joint stiffness caused by lower limb fracture that does not affect the knee joint surface, the surgical fixation of extra-articular injury can be selected for modeling. For knee joint stiffness caused by knee joint articular surface injury, intra-articular injury fixation can be selected for modeling. The method of surgical fixation has the advantages of short modeling time, high efficiency, and good stability, but there are high requirements for aseptic conditions. To date, it has been widely used in the structural changes and efficacy observation of knee joint stiffness, and orthopedic brace intervention. The model of simple external fixation such as plaster and splint is easy to operate, avoids surgical trauma, and has relative advantages in simulating the disease development of knee joint stiffness. This model can be used to observe the pathological changes of joint stiffness at different stages, and the disadvantages are that the fixation is easy to loosen, slip, or nibble during the process of animal activities, the modeling time is too long, and the fixation is easy to fail. Fixation after violent injury can simulate knee joint stiffness caused by immobilization after periarticular soft tissue injury and is suitable for the study on the efficacy and screening of conservative treatment. In summary, the most ideal way to model knee joint stiffness is knee hyperextension+intra-articular surgical trauma+fixation. Through knee hyperextension to damage the posterior capsule of the knee joint and fenestration in the femoral condyle to simulate intra-articular fractures, this modeling method using Kirschner wire internal fixation has a short modeling time, high success rate, and good stability. Figures and Tables | References | Related Articles | Metrics

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The role of spleen tyrosine kinase in bone remodeling Chen Yiyuan, Yang Qian, Wu Saixuan, Zhang Mi, Dong Ming, Liu Tingjiao, Niu Weidong 2022, 26 (15):  2446-2453.  doi: 10.12307/2022.605 Abstract ( 598 )   PDF (1411KB) ( 63 )   Save BACKGROUND: Spleen tyrosine kinase (Syk) was initially thought to be a hematopoietic cell-specific kinase involved in a variety of hematopoietic cell responses and immune receptor signal transmission. In recent years, studies have shown that Syk and its signaling pathway are closely related to bone remodeling, and the effect and mechanism of Syk inhibitors on bone tissue have also received extensive attention. OBJECTIVE: To review the role of Syk and its signaling pathway in bone remodeling, thereby providing ideas for bone repair and clinical treatment. METHODS: We searched the relevant articles in CNKI and PubMed databases with the keywords of “Syk, bone, osteoclast, osteoblast, inhibitor” in Chinese and English, respectively. Finally, 68 articles met the criteria for review.  RESULTS AND CONCLUSION: Syk is widely expressed in non-hematopoietic cells such as osteoclasts and osteoblasts, and plays a key role in cell morphogenesis, growth, migration and survival. Bone is constantly remodeled through osteoblast-mediated bone matrix formation and mineralization as well as osteoclast-mediated mineralized bone matrix degradation, which is essential for maintaining normal bone structure and function. Syk and its signaling pathway promote osteoclast differentiation and inhibit osteoblast differentiation in the process of bone remodeling. Finally, they promote the occurrence and development of bone remodeling. Syk inhibitors can improve the symptoms of bone and inflammatory diseases, especially in the aggressive and destructive stages of these diseases. Current research on Syk inhibitors is mainly focused on autoimmune and inflammation, and further exploration in bone and bone diseases is still warranted. Moreover, improving the selectivity of Syk inhibitors is also the focus of future research. Figures and Tables | References | Related Articles | Metrics

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Integrative neuromuscular training for injury prevention of lower extremity in athletes: a meta-analysis Zhai Haiting, Li Cheng, Xia Jixiang, Wei Hongwen, Qin Shuang 2022, 26 (15):  2454-2460.  doi: 10.12307/2022.606 Abstract ( 694 )   PDF (1329KB) ( 156 )   Save OBJECTIVE: To evaluate the effect of integrative neuromuscular training for injury prevention of lower extremity in athletes using meta-analysis method, to provide the optimal dose-response of integrative neuromuscular training to prevent injuries in athletes.  METHODS: CNKI, WanFang, PubMed, Web of Science, and The Cochrane Library databases were searched for articles regarding effect of integrative neuromuscular training for injury prevention of lower extremity published from January 1, 2000 to June 20, 2021. The key words were “integrative neuromuscular training, neuromuscular training, neuromuscular warm-up, prevent, reduce, sports injury, lower limb injury” in Chinese, and “integrative neuromuscular training, neuromuscular training, neuromuscular warm-up, neuromuscular, prevent, reduces, lower limb injuries, injury, sport injuries” in English. The Review Manage 5.3 software was used to analyze the included articles. Subgroup analysis was performed in five variables, including training volume, frequency per week, period, sample size, and gender. Random effects model and global effect size were utilized to examine the heterogeneity and publication bias.  RESULTS: Totally 14 randomized controlled trials were included, with 15 932 subjects. (1) Meta-analysis results showed an overall risk reduction of 39% for the lower limbs (RR=0.61, 95% CI:0.53-0.69). (2) Subgroup analysis found that training volume of 16-20 minutes, training frequencies of 2-3 times per week, interventions for 4-6 months revealed the largest risk reduction. (3) The sample size of 50-1 000 produced better effects comparable to those with larger sample size. (4) Integrative neuromuscular training had a significant effect on the prevention of lower limb sports injury in males.  CONCLUSION: (1) Integrative neuromuscular training can effectively prevent athletes' lower limb sports injuries. Heterogeneity between articles can be explained by the country of origin of the subjects. (2) Integrative neuromuscular training with exercise volume of 16-20 minutes, 2-3 times per week for 4-6 months can achieve the optimal preventive effect. Figures and Tables | References | Related Articles | Metrics