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28 June 2022, Volume 26 Issue 18 Previous Issue    Next Issue

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Biomechanical properties of traditional trajectory screw technique and modified cortical bone trajectory technique: a finite element analysis Zhou Zhihao, Alafate·Kahaer, Wang Yixi, Liu Dongshan, Xieraili·Maimaiti, Shi Wenjie, Paerhati·Rexiti 2022, 26 (18):  2789-2794.  doi: 10.12307/2022.682 Abstract ( 358 )   PDF (1609KB) ( 70 )   Save BACKGROUND: Based on the shortcomings of the existing cortical bone trajectory, we proposed a new screw trajectory of modified cortical bone trajectory, but it is not clear how the actual mechanical performance of the modified cortical bone trajectory is.   OBJECTIVE: To compare the biomechanical difference of screws between modified cortical bone trajectory and traditional trajectory in osteoporotic lumbar spine by finite element method. METHODS:  CT scan data of four human osteoporosis specimens were obtained. The finite element model of L4 vertebral body was established, and the screw model was created. The screws with specifications (diameter=4.5, 5.0, 5.5, 6.0, length=40 mm) were selected for modified cortical bone trajectory, and (diameter=6.0, 6.5, length=45 mm) for traditional trajectory. Firstly, the safety of screws was tested in turn. Those who caused damage to the cortical bone of pedicle during screw placement were excluded. After determining the safe diameter, the pull-out strength, screw stability, and vertebral body stability were analyzed.   RESULTS AND CONCLUSION: (1) Screw safety test: When traditional trajectory (diameter=6.5 mm) and modified cortical bone trajectory (diameter=6.0 mm) were implanted, there was a risk of bone destruction, and there was no risk for other diameter screws. Therefore, the above two diameter screws were excluded from subsequent tests. The safety diameter of traditional trajectory was 6.0 mm, and that of modified cortical bone trajectory was 4.5, 5.0, and 5.5 mm. (2) Pullout force: The force of traditional trajectory (diameter=6.0 mm) was lower than that of modified cortical bone trajectory (diameter=5.5, 5.0, 4.5 mm) (P < 0.05). (3) Screw stability: The load-displacement ratio of modified cortical bone trajectory (diameter=5.5, 5.0 mm) in the upper, down, left and right directions was greater than that of traditional trajectory (diameter=6.0 mm) (P < 0.05). (4) Vertebral stability: The load-displacement ratio of modified cortical bone trajectory (diameter=5.5 mm) was greater than that of traditional trajectory (diameter=6.0 mm), and the load-displacement ratio of modified cortical bone trajectory (diameter=5.0 mm) under flexion and extension conditions was greater than that of traditional trajectory (diameter=6.0 mm) (P < 0.05). (5) Results have verified that in L4 vertebral body, considering the safety and mechanical properties of the screw, modified cortical bone trajectory (diameter=5.0 mm) is an ideal common diameter choice. Figures and Tables | References | Related Articles | Metrics

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Biomechanical evaluation of Kummell’s disease model fixed with novel bone cement screw system Zhan Yi, Wang Biao, Ma Yuli, He Simin, Sun Honghui, Hao Dingjun 2022, 26 (18):  2795-2800.  doi: 10.12307/2022.683 Abstract ( 321 )   PDF (1826KB) ( 37 )   Save BACKGROUND: Delayed post-traumatic vertebral osteonecrosis (Kummell’s disease) is a special type of osteoporotic vertebral fracture, which was first reported by the German doctor Kummell in 1891. At present, there is a high probability of complications such as bone cement loosening and displacement after treatment with bone cement filling.   OBJECTIVE: To analyze the biomechanical effect of new bone cement screw combined with vertebroplacty in the treatment of thoracolumbar Kummell’s disease. METHODS:  Fifty sheep spine specimens were selected and scanned using computed tomography to ensure that the specimens had no vertebral deformity. All sheep spine segments from T12 to L2 were selected, and a Kummell’s disease intravertebral vacuum cleft model was made at the L1 segment, followed by treatment with bone cement augmentation. According to the ways of bone cement filling, the specimens were randomly divided into a vertebroplasty group, a vertebroplasty with unilateral pediculoplasty group, a vertebroplasty with bilateral pediculoplasty group, a unilateral bone cement screw with vertebroplasty group, and a bilateral bone cement screw with vertebroplasty group. There were five groups in each of the following experiments: three-dimensional stability biomechanics test and maximum axial compression test. All the specimens underwent postoperative computed tomography examination to determine whether the screw position was ideal and whether the vertebral body was damaged or not. In the three-dimensional stability biomechanics test, we measured the activity of bone cement in specimens under six motion states, including anteflexion, posterior extension, left flexion, right flexion, and left and right axial rotations. In the maximum axial pressure test, we detected the maximum axial pressure that the bone cement could withstand when it was under pressure until the bone cement was displaced.   RESULTS AND CONCLUSION: Postoperative imaging examination of all specimens showed that all the screws were positioned normally, and there were no undesirable phenomena such as poor stability and inserting new bone cement screw into the spinal canal. The unilateral or bilateral bone cement screw with vertebroplasty groups had the smallest degree of mobility under the motion states of anteflexion, posterior extension, left and right flexion, and had better biomechanical stability, with a significant difference from the other three groups (P < 0.05). However, there was no significant difference between the unilateral and bilateral novel bone cement screw with vertebroplasty groups (P > 0.05). Therefore, unilateral and bilateral new cement screws could achieve similar cement stabilization effects. Compared with the other three groups, the unilateral and bilateral new bone cement screw with vertebroplasty groups had better compressive capacity of bone cement, in which the bone cement could withstand greater axial pressure and had better stability (P < 0.05). The bilateral new bone cement screw with vertebroplasty group could bear the largest pressure under vertical force, followed by unilateral novel bone cement screw with vertebroplasty group. To conclude, the novel bone cement screw can increase the stability of bone cement and avoid the loosening and displacement of bone cement in the treatment of Kummell’s disease of the thoracolumbar spine. Figures and Tables | References | Related Articles | Metrics

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Biomechanical stability of crossed-rod fixation and parallel-rod fixation of atlantoaxial posterior screw-rod system Wang Datian, Qiu Feng 2022, 26 (18):  2801-2806.  doi: 10.12307/2022.684 Abstract ( 382 )   PDF (1723KB) ( 26 )   Save BACKGROUND: Preliminary study has shown that the crossed rod fixation of the short segment screw rod fixation system composed of C1 bilateral pedicle screws and C2 unilateral lamina screw can increase its axial rotation stability. Therefore, posterior atlantoaxial crossed rod fixation may be a simple and effective new internal fixation framework. Whether in the screw rod system composed of C2 bilateral lamina screws or bilateral pedicle screws, the connection mode of crossed rod may further enhance the biomechanical stability of its structure compared with the traditional parallel rod.   OBJECTIVE: To evaluate the biomechanical stability of the fixation technique for the crossed rod and parallel rod by the C1 bilateral pedicle screws combined with C2 bilateral lamina screws or bilateral pedicle screws. METHODS:  Six fresh adult craniocervical specimens were used to test the biomechanical stability. Following intact state and under destabilization testing, C1 bilateral pedicle screws, C2 bilateral lamina screws and bilateral pedicle screws were implanted in each specimen. The specimens were then tested in the following sequence: C2 bilateral laminar screws + parallel rod, C2 bilateral laminar screws + crossed rod, C2 bilateral pedicle screws + parallel rod, and C2 bilateral pedicle screws + crossed rod. The ranges of motion of the C1-2 segments were measured in flexion-extension, lateral bending, and axial rotation.   RESULTS AND CONCLUSION: (1) The four fixed modes significantly increased stability compared with both the intact and destabilization group in flexion-extension, lateral bending, and axial rotation (P < 0.05). (2) When C2 was implanted with bilateral pedicle screws, whether crossed rod or parallel rod connection was stronger than that composed of C2 bilateral lamina screws. (3) The crossed rod fixation could enhance the stability of the internal fixation system composed of C2 bilateral lamina screws in extension, lateral flexion and rotation, and the stability of the screw rod system composed of C2 bilateral pedicle screws in the direction of rotation. (4) Therefore, crossed rod fixation can further improve the biomechanical properties of atlantoaxial posterior screw-rod system and can be used as a choice for clinical application. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of Pauwels type III femoral neck fracture fixed with three configurations of cannulated screws Yan Kun, Mou Limin, Yang Xiaohui, Wang Jian, Ran Jian 2022, 26 (18):  2807-2811.  doi: 10.12307/2022.685 Abstract ( 448 )   PDF (1832KB) ( 52 )   Save BACKGROUND: Cannulated screw is widely used in the clinical treatment of femoral neck fracture, while the traditional inverted triangle configuration has a high failure rate in the treatment of Pauwels III femoral neck fracture. Some scholars have proposed to use “F” configuration and off-axis configuration to obtain better therapeutic effects. However, there are few reports on the comparative analysis of the above-mentioned three configurations from the perspective of biomechanics.   OBJECTIVE: To compare the biomechanical properties of Pauwels type III femoral neck fracture with three cannulated screw placement methods of inverted triangle configuration, “F" configuration, and off-axis configuration by three-dimensional finite element method. METHODS:  A healthy male volunteer aged 35 years old with a body mass of 70 kg was recruited in this study. Image data (.dicom format) of his right proximal femur were obtained by computed tomography scanning. The three-dimensional images of the proximal femur was reconstructed using mimics 15.0 software. Solidworks 2017 software was used to construct the models of Pauwels type III femoral neck fracture fixed with inverted triangle configuration, “F” configuration, and off-axis configuration. The maximum displacement of the broken end of the fracture in the X, Y, and Z axes, the maximum stress in internal fixation, the total displacement of the proximal femur and the maximum stress distribution of the proximal femur in the three groups were compared under loading stress.   RESULTS AND CONCLUSION: The maximum stresses of inverted triangle configuration, “F” configuration, and off-axis configuration on the screw were 71.896, 66.792, and 59.071 MPa, respectively. The maximum stresses of inverted triangle configuration, “F” configuration, and off-axis configuration in the proximal femur were 12.791, 11.886, and 11.949 MPa, respectively. The maximum displacements of inverted triangle configuration, “F” configuration, and off-axis configuration at the fracture end were 0.844, 0.587, 0.538 mm on the X axis, 0.491, 0.295, 0.340 mm on the Y axis, and were 0.832, 0.752, 0.741 mm on the Z axis, respectively. The overall maximum displacements of inverted triangle configuration, “F” configuration, and off-axis configuration in the proximal femur were 1.707, 1.396, and 1.325 mm, respectively. To conclude, the stress of off-axis configuration and “F” configuration are more dispersed, and the displacement of fracture end is smaller, which is a better choice for the treatment of Pauwels type III femoral neck fracture. The off-axis configuration is slightly better than the “F” configuration in anti-inversion stress and longitudinal shear stress. Figures and Tables | References | Related Articles | Metrics

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Orthopedic force applied to the rib influences the displacement and rotation angle of thoracic vertebrae: a finite element analysis Ren Dong, Zhu Ye, Lei Lei, Wang Yuren 2022, 26 (18):  2812-2816.  doi: 10.12307/2022.686 Abstract ( 460 )   PDF (3778KB) ( 79 )   Save BACKGROUND: Scoliosis not only causes a shift of the vertebral body in the coronal plane, but also causes vertebral rotation. Vertebral rotation is rarely considered in the correction of scoliosis, which weakens the correction effect.   OBJECTIVE: To analyze the loading condition of the orthopedic force, and standardize the force application zone, release zone, orthopedic force magnitude and force area at the three-dimensional level through a finite element model. METHODS:  Based on the CT data of a 14-year-old adolescent with idiopathic scoliosis, a finite element model of the upper and lower ribs of the thoracic vertebra and the convex side of the parietal vertebra was established, and uniform orthopedic forces of 20, 40, 60, and 100 N were applied to the dorsal region, lateral region and anterior region of the ribs, respectively. Reference points were selected on the vertebral body to record displacement and rotation angle under different working conditions.   RESULTS AND CONCLUSION: Applying orthopedic force to the lateral area had the most obvious effect on scoliosis correction. The Cobb angle was corrected from 29° to 19° under 60 N to a small area, and the coronal plane was corrected by 4.5 mm. Applying force to the dorsal area had the most obvious effect on the rotation and correction of the vertebral body. Applying force to a large area could relatively gently rotate the adjacent vertebral body. When applying 100 N force to a large dorsal area, the rotation of the apex vertebral body was corrected by 76.9%, while applying force to the anterior area aggravated the rotational distortion of the vertebral body. All these findings indicate that applying force to a small area should be selected for coronal plane correction and applying a force to a large area should be selected for vertebral rotation correction. The lateral area should be selected for coronal orthopedic force. The force applied to the convex dorsal region is beneficial to the correction of vertebral rotation, while the force applied to the anterior region is unfavorable to the correction of vertebral rotation and had little effect on vertebral rotation. Therefore, in the three-dimensional thoracic orthopedic surgery, the lateral side of the convex, the dorsal area, and the anterior area of the concave should be set as the area that the force is applied, and the other areas should be set as the release area. Figures and Tables | References | Related Articles | Metrics

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3D printed porous titanium alloy fusion cage and autologous iliac bone in the treatment of cervical spondylotic myelopathy Ji Linsong, Wang Yanping, Lu tingsheng, Jia Yijia, Luo Chunshan 2022, 26 (18):  2817-2822.  doi: 10.12307/2022.687 Abstract ( 437 )   PDF (1835KB) ( 167 )   Save BACKGROUND: The most commonly used bone graft material for anterior cervical fusion surgery is autologous iliac bone, but the incidence of complications is high. In recent years, 3D printed fusion cages have become an ideal bone graft material for anterior cervical surgery because of their large contact area, good mechanical properties and biocompatibility, and elastic modulus similar to that of a vertebral body.   OBJECTIVE: To compare the effect of 3D printed porous titanium trabecular bone fusion cage and autologous iliac bone in treating cervical spondylotic myelopathy. METHODS:  From January 2011 to January 2020, sixty-five patients with cervical spondylotic myelopathy (38 males and 27 females) underwent anterior decompression and fusion in the Guizhou Orthopedic Hospital. Twenty-eight cases were treated with 3D printing titanium trabecular fusion and plate internal fixation (trial group).  Another 37 cases were treated with autogenous iliac bone graft and internal fixation (control group). At 1, 3, 6, and 12 months after surgery, the Japanese Orthopaedic Association (JOA) score, the height of the fusion segment, and the Cobb angle of the fusion segment were evaluated.   RESULTS AND CONCLUSION: (1) After 12-month follow-up, the incisions in the two groups of patients healed in the first intention. There were three and two cases of throat pain and dysphagia in the trial group and the control group after surgery, respectively. There were no internal fixation complications such as plate breakage, cage withdrawal, or subsidence. In the control group, three cases affected bone graft subsidence. (2) All 65 cases completed bony fusion within 6-9 months. There was no significant difference in JOA score, intervertebral height, and segment Cobb angle between the two groups (P > 0.05). (3) It is concluded that during anterior cervical interbody fusion for the treatment of cervical spondylotic myelopathy, 3D printed fusion cages and autogenous iliac bone grafts have achieved good results. Figures and Tables | References | Related Articles | Metrics

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3D printing technology assisted traditional plate fixation for the treatment of complex tibial plateau fractures Wang Sizhe, Gao Kunfan, Xu Zhenzhen, Gao Haiyan, Huang Haoran, Dai Shiyou, Ma Jianlin, Wang Feng 2022, 26 (18):  2823-2827.  doi: 10.12307/2022.688 Abstract ( 504 )   PDF (1326KB) ( 43 )   Save BACKGROUND: Traditional steel plate internal fixation, the common clinical standard procedure, is nothing new in treating fracture of tibia. The preoperative solid model, however, produced by 3D printing technology, works better in resetting the fracture, and is much safe, accurate and individualized, in contrast to classical approach.   OBJECTIVE: To explore the clinical effect and application value of 3D printing technology in healing complex tibial fractures. METHODS:  Two groups, 3D group and control group, were divided by 40 cases of unilateral tibial fractures that accepted surgical treatment at Qingdao Hospital of Shandong First Medical University from June 2017 to June 2019. Traditional surgical fixation method was applied to the control group, while the 3D group, however, received operations guided by the preoperative operation of 3D printed solid models, combining the model to perform preoperative simulated reduction and plate internal fixation to guide the actual surgical operation. All patients accepted a 12-month follow-up of comparing the operation time, intraoperative blood loss, intraoperative fluoroscopy times, knee Rasmussen radiology performance on the 3rd day after surgery, and knee HSS score 12 months later.   RESULTS AND CONCLUSION: (1) All 40 patients were treated ideally and received an effective follow-up visit for more than 12 months. There were no complications such as vascular and nerve injury, and no rejection reactions related to internal fixation materials. (2) Outcomes, such as operation time, intraoperative blood loss, and intraoperative fluoroscopy were less in the 3D group than those in the control group (P < 0.05). Knee Rasmussen radiology performance on the 3rd day after surgery was higher in the 3D group than that of the control group (P < 0.05). There was no significant difference in knee HSS score between the two groups at 12 months (P > 0.05). (3) Results indicate that in terms of complex tibial fractures treatment, 3D printing shines on significantly shortening the operation time, reducing intraoperative blood loss and fluoroscopy times, and enhancing knee function. Figures and Tables | References | Related Articles | Metrics

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Entry point of an intramedullary rod in knee arthroplasty: determined using singular value decomposition method Wang Zhen, Xu Yi, Tu Yihui 2022, 26 (18):  2828-2833.  doi: 10.12307/2022.689 Abstract ( 378 )   PDF (1510KB) ( 48 )   Save BACKGROUND: During knee arthroplasty, prosthesis alignment is a key point, which has a great impact on the life span of implants. The role of an intramedullary rod in the intraoperative alignment of prostheses implanted has been verified. Excessive insertion error of the intramedullary rod will increase the probability of prosthesis implantation failure and medial bone collapse. Moreover, the insertion path depends on the determination of anatomical axis.   OBJECTIVE: To improve the computer-aided method for positioning the anatomical axis based on singular value decomposition, so as to improve the insertion accuracy of intramedullary rod and prolong the life span of prostheses implanted. METHODS: We processed preoperative computed tomography images from nine patients scheduled for total knee arthroplasty, and reconstructed the three-dimensional model of the femur using MIMICS RESEARCH 17.0. MATLAB2018b software was subsequently used to improve the positioning of the anatomical axis of the femur using singular value decomposition method. Insertion of the intramedullary rod was simulated based on the anatomical axis fitted using multi-point method. After that, the model was introduced into 3-matic, and angle error was measured. Traditional method by which the anatomical axis was fitted by two-point method and the recommended method described above were compared and verified through the simulated insertion of the intramedullary rod.   RESULTS AND CONCLUSION: The varus and valgus angles measured by the multi-point method were (1.99±1.03)° and (2.35±1.34)°, respectively. The anterior and posterior offset angles were (1.83±0.67)° and (1.60±1.82)°, respectively. Compared with the traditional surgical method, the recommended method could improve the positioning accuracy, by which the average angle error was reduced by 0.41°. Therefore, the recommended method described above helps further improve the accuracy of prosthesis alignment in total knee arthroplasty and prolong the lifespan of prostheses implanted. Figures and Tables | References | Related Articles | Metrics

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Early and midterm effects of lower limb force line correction after mobile-bearing unicompartmental knee arthroplasty Tang Jixiang, Jing Lin, Zhang Hongmei, Yan Qi, Pan Li 2022, 26 (18):  2834-2838.  doi: 10.12307/2022.690 Abstract ( 459 )   PDF (1661KB) ( 39 )   Save BACKGROUND: Most unilateral knee compartment lesions are accompanied by varus deformities of varying degrees. If the lower limb force line is over-corrected, it is easy to increase the stress of the lateral compartment and cause osteoarthritis of the lateral compartment; if the correction is insufficient, the prosthesis will loosen due to uneven force.   OBJECTIVE: To observe the effect of lower extremity line correction after mobile-bearing unicompartmental knee arthroplasty on the clinical efficacy of patients in early and middle stages. METHODS:  Totally 137 cases undergoing unicompartmental knee arthroplasty at Wangjing Hospital of China Academy of Chinese Medical Sciences from January 2013 to December 2016 were enrolled in this study, aged from 45 to 83 years. Lower limb force line in the coronal plane was evaluated using X-ray films at 3 days after arthroplasty. The patients were divided into an obvious varus (5°-10°) group (n=11), a mild varus (1°-5°) group (n=59), a standard neutral position (0°-1°) group (n=65), and mild valgus (eversion more than 0°) group (n=2). Oxford knee score and American knee society score were analyzed before operation, 3, 6, 12, 36, and 60 months after operation.   RESULTS AND CONCLUSION: (1) All 137 patients were followed up for 60 months. Among them, few patients with mild valgus were not included in the result analysis. There were one case of aseptic prosthesis loosening, two cases of unexplained pain, and one case of compartment osteoarthritis in the obvious varus group. There were one case of infection, one case of joint instability, one case of aseptic prosthesis loosening, one case of unexplained pain, and one case of lateral compartment osteoarthritis in the mild varus group. There were one case of infection, one case of polyethylene liner dislocation, one case of joint instability, three cases of unexplained pain, and two cases of lateral compartment osteoarthritis in the standard neutral position group. There were significant differences in the incidence of lateral compartment osteoarthritis among the three groups (P < 0.05). (2) Compared with the score before operation, Oxford knee score was lower (P < 0.05) and American knee society score was higher (P < 0.05) at various time points after operation in the three groups. At 12 months after operation, Oxford knee score was higher in the obvious varus group than that in the mild varus and standard neutral position groups (P < 0.05); American knee society score was lower in the obvious varus group than that in the mild varus and standard neutral position groups (P < 0.05). At 3, 6, 36, and 60 months after operation, no significant difference was found in Oxford knee score and American knee society score among the three groups (P > 0.05). (3) At 60 months after operation, survival rates of prosthesis were 81.8%, 96.9%, and 94.9% in the obvious varus, mild varus, and standard neutral position groups, respectively. No significant difference in survival rate of the prosthesis was found among the three groups (P > 0.05). (4) The results confirm that early and mid-term clinical effects are better when the lower limb force line is maintained at 0°-5° after unicompartmental knee arthroplasty. Figures and Tables | References | Related Articles | Metrics

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Initial stability of integrated prosthesis or combined prosthesis in the treatment of Crowe III-IV developmental dysplasia of the hip Li Yang, Lyu Hui, Huang Denghua, Zou Longfei, Zhang Zhongjie, Tan Meiyun 2022, 26 (18):  2839-2843.  doi: 10.12307/2022.691 Abstract ( 436 )   PDF (3045KB) ( 95 )   Save BACKGROUND: In total hip replacement surgery for high dislocation developmental dysplasia of the hip, the advantages and disadvantages of using integrated Wagner cone prosthesis and combined S-ROM prosthesis after low femoral neck osteotomy are currently unclear.   OBJECTIVE: To explore the advantages and disadvantages of low femoral neck osteotomy combined with integrated prosthesis or combined prosthesis in the treatment of Crowe type III-IV developmental dysplasia of the hip patients. METHODS:  The clinical data of 36 patients with Crowe type III-IV developmental dysplasia of the hip in Affiliated Hospital of Southwest Medical University from September 2015 to August 2019 were analyzed retrospectively, including 5 males and 31 females, aged from 27 to 64 years. There were 19 cases on the left and 17 cases on the right. All underwent total hip replacement treatment. Among them, 18 patients were treated with Wanger cone prosthesis and 18 patients with S-ROM prosthesis. During follow-up, Harris score and visual analog score of hip joint function were compared between the two groups. Through imaging examination, differences in the prosthesis loosening, subsidence, length of the lower limbs, heterotopic ossification and osteolysis, and stress shielding of the proximal femur were observed in both groups.   RESULTS AND CONCLUSION: (1) All patients were followed up for 15 months and above in both groups. All incisions healed by first intention after surgery, and there was no dislocation of the prosthesis, aseptic loosening, infection around the prosthesis, osteolysis or heterotopic ossification. (2) There were 15 cases of I degree stress shielding effect in the proximal femur and 3 cases of II degree in the S-ROM group; 12 cases of I degree stress shielding effect and 6 cases of II degree in the proximal femur in the Wagner cone group; no significant difference was found between the two groups (P > 0.05). One patient in the S-ROM group with a shortened limb of 6.7 cm developed symptoms of femoral nerve palsy, and one patient in the Wagner cone group developed peroneal vein thrombosis after surgery; there was no significant difference in the length of the shortened limb between the two groups (P > 0.05). (3) There was no significant difference in the Harris score and visual analog score of hip joint function between the two groups at 15 months after operation (P > 0.05). (4) It is concluded that for patients with Crowe type III-IV developmental dysplasia of the hip, low femoral neck osteotomy combined with S-ROM prosthesis or integrated Wagner cone prosthesis can achieve satisfactory short-term results, but attention should be paid to the initial stability of the proximal cuff of S-ROM prosthesis. Figures and Tables | References | Related Articles | Metrics

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Femoral neck system for internal fixation of femoral neck fracture in high altitude areas Wang Lei, Li Jia, Li Tao, Liu Limin, Suonan Angxiu 2022, 26 (18):  2844-2848.  doi: 10.12307/2022.692 Abstract ( 416 )   PDF (1837KB) ( 37 )   Save BACKGROUND: Treatment of femoral neck fracture has always been a clinical research hotspot. Minimally invasive fixation using the femoral neck system is minimally invasive in the true sense, but there is a lack of long-term follow-ups.   OBJECTIVE: To investigate the short-term effectiveness of femoral neck system in the treatment of femoral neck fracture in high altitude areas. METHODS:  Twenty-four patients with femoral neck fracture admitted to the Department of Trauma Orthopedics of Qinghai Provincial People’s Hospital from November 2019 to January 2021 were divided into two groups according to different internal fixation materials: a femoral neck system group (n=14) and a hollow screw group (n=10). Patients in the femoral neck system group were treated with femoral neck system internal fixation, while patients in the hollow screw group were treated with traditional hollow screw internal fixation. Symptomatic treatment was performed in all patients after operation, and the corresponding lower limb functional rehabilitation training was conducted under the guidance.   RESULTS AND CONCLUSION: All patients were followed up for 6-20 months, and none of them developed incision infection, nonunion of fracture ends, and internal fixation failure. Patients in both groups were all satisfied with the reduction of fracture. There was no significant difference in operation time and fracture healing time between the two groups (P > 0.05). Intraoperative fluoroscopy frequency in the femoral neck system group was significantly lower than that in the hollow screw group (P < 0.05). There was no necrosis of femoral head in the two groups. During the last follow-up, the radiological examination showed no appearance of femoral neck shortening in both groups, and there was also no significant difference in Harris score of hip function between the two groups (P > 0.05). To conclude, compared with the traditional hollow screw internal fixation, the femoral neck system is characterized by less trauma and lower intraoperative fluoroscopy frequency in the treatment of femoral neck fracture in high altitude area. The femoral neck system can obtain satisfactory short-term effectiveness, which is in line with the principle of rapid trauma recovery. Figures and Tables | References | Related Articles | Metrics

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Comparison of double Kirschner wire with double screw fixation in the treatment of avulsion fracture at the base of the distal phalanx Gou Yongsheng, Ding Keyuan, Xu Shengqian, Li Haibo, Zhong Gang, Li Liang, Teng Lin 2022, 26 (18):  2849-2853.  doi: 10.12307/2022.693 Abstract ( 535 )   PDF (1725KB) ( 67 )   Save BACKGROUND: In recent years, miniature double screw fixation has achieved certain effects on the treatment of avulsion fracture at the base of the distal phalanx. However, by comparing miniature double screw fixation with Kirschner wire fixation, which treatment method has better curative effect is rarely reported.   OBJECTIVE: To compare the clinical efficacy of double Kirschner wire and miniature double screw fixation in the treatment of avulsion fracture at the base of distal phalanx. METHODS: Clinical data from 71 patients with avulsion fracture at the base of the distal phalanx who received surgical treatment at West China (Airport) Hospital of Sichuan University from January 2012 to January 2020 were retrospectively analyzed. There were 36 patients in double Kirschner wire group and 35 patients in double screw fixation group. The extensor flexor motion range, pain degree, satisfaction degree, and complications of the affected fingers were recorded. Overall therapeutic efficacy and subjective efficacy were evaluated using Crawford method and Buck-Gramcko, respectively.   RESULTS AND CONCLUSION: Patients in the double Kirschner wire group were followed up for 6-15 months, with an average of (8.89±1.75) months, while patients in the double screw fixation group were followed up for 6-16 months, with an average of (8.77±1.70) months. There was no significant difference in visual analogue scale scores between the two groups (P > 0.05). According to the Crawford evaluation criteria, the excellent rates of the double Kirschner wire group and the double screw fixation group were 34/36(94%) and 30/35(86%), respectively. However, there was no significant difference between the two groups (P > 0.05). According to the Buck-Gramcko evaluation criteria, the excellent rate was 33/36 (92%) in the double Kirschner wire group and 31/35 (89%) in the double screw fixation group, with no significant difference (P > 0.05). The incidence of postoperative nail deformity, recurrence rate of hammer-finger deformity and incidence of incision infection in the double screw fixation group were higher than those in the double Kirschner wire group, but there was no significant difference between the two groups (P > 0.05). The incidence of suture exposure in the double screw fixation group was significantly higher than that in the double Kirschner wire group (P=0.025). The total incidence of postoperative complications in the double Kirschner wire group was lower than that in the double screw fixation group (P=0.029). To conclude, double Kirschner wire and miniature double screw fixation has the same effect in the treatment of avulsion fracture at the base of the distal phalanx with, but miniature double screw fixation has a higher incidence of complications, especially a higher proportion of suture exposure. Figures and Tables | References | Related Articles | Metrics

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Establishment and evaluation of a validation model for the efficacy of external femoral fixator screws in rats Jia Qiyu, Guo Jian, Wei Qin, Guo Xiaobin, Chen Dongsheng, Feng Dongwei, Liu Yanshi, Ma Chuang 2022, 26 (18):  2854-2861.  doi: 10.12307/2022.694 Abstract ( 452 )   PDF (2741KB) ( 53 )   Save BACKGROUND: In order to solve the complications of external fixation screws, various modified screws have emerged, but there is a lack of suitable animal models and evaluation methods for validating their efficacy, especially for simulating real loads.   OBJECTIVE: To construct a simple, rational and efficient model that can be used to validate the efficacy of external fixator screws in Sprague-Dawley rats and establish the corresponding evaluation methods. METHODS:  Thirty male adult Sprague-Dawley rats underwent the right femoral osteotomy, followed by fixation with a homemade external fixator system. Routine X-ray films were taken on the day after operation and 1, 2, 4, and 6 weeks after operation. During this period, the activity of rats was observed. At 6 weeks after operation, the rats were euthanized, and the right thigh femur with screw specimens were taken for general observation, biomechanical measurement, micro-CT, three-dimensional reconstruction analysis of the screw path and histological observation.  RESULTS AND CONCLUSION: The modeling time of external fixation model of rat femoral fracture was (20±5) minutes. The general condition and activity of rats were good during the experiment. In general, 28 (93%) of the 30 femoral specimens with screws achieved bone healing; 1 case (3%) had poor pseudoarthrosis formation with severe screw loosening accompanied by large osteolysis around the proximal screw path; 1 case (3%) had mild screw loosening combined with severe screw path infection; 1 case (3%) only had severe screw path infection. The overall satisfactory rate of the model was 90% (27/30). Radiological findings revealed that the right femoral screws were fixed in place without loosening, the bone morphology was restored, the broken end was well aligned, no free body was seen around the broken end, and the right hip and knee were in position at 6 weeks after operation. Micro-CT three-dimensional analysis showed that body mineral density, bone volume fraction, and the number of bone trabeculae around the internal screw path were (0.426 7±0.088 7) mg/cm2, (3.125 2±1.004 2)%, and (0.000 3±0.000 1) /μm respectively, at 6 weeks after operation. Intra-model group distribution and normality test were performed, and all the data tended to be stable and normally distributed. Hematoxylin-eosin staining showed that the area around the screw path was repaired by a large amount of proliferating granulation tissue, and new bone tissue was visible at the edges. Von Kossa staining revealed the presence of extensive black or brownish-black calcium deposition around the screw path. Biomechanically, the screw extraction force was (130.416 7±35.008 0) N, which tended to be generally stable and normally distributed (P=0.245 6). To conclude, the validation model and evaluation method for the efficacy of external femoral fixator screws in Sprague-Dawley rats can be evaluated from three aspects: histology, imaging and biomechanics, and the screw path can be comprehensively evaluated. The design is scientific and reasonable, the procedure is simple, and the success rate is high. Therefore, this validation model has good value for scientific research and clinical application. Figures and Tables | References | Related Articles | Metrics

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Preparation and characterization of chitosan/polylactic acid/hydroxyapatite/polyvinyl alcohol composite bone scaffold Li Yaoming, Jiang Hong, Shi Yongfang 2022, 26 (18):  2888-2893.  doi: 10.12307/2022.699 Abstract ( 633 )   PDF (1934KB) ( 112 )   Save BACKGROUND: Bone tissue engineering scaffolds are prepared and applied to repair bone defects caused by osteosarcoma disease, which is the current hotspot of bone tissue engineering research.   OBJECTIVE: To determine the ratio of chitosan/polylactic acid/hydroxyapatite/polyvinyl alcohol composite material, and optimize the mechanical properties of bone scaffolds. METHODS:  The chitosan/polylactic acid/hydroxyapatite/polyvinyl alcohol bone scaffold was prepared using extrusion-based 3D printing technology. The maximum compressive strength was used as the evaluation index to design orthogonal experiments. The acetic acid concentration (1.5%, 2%, 2.5%, 3%), chitosan solution concentration (2%, 3%, 4%, 5%), hydroxyapatite:polylactic acid mass ratio (1:5, 1:6, 1:7, 1:8), and hydroxyapatite/polylactic acid:chitosan solution:polyvinyl alcohol gel mass volume ratio (1 g: 1 g: 0 mL, 2 g: 1 g: 1 mL, 2 g: 1 g: 1.2 mL, 2 g: 1 g: 1.4 mL) were independent variables to get the best material ratio. The mechanical properties, phase composition and bonding mode, porosity and degradation properties of the optimal ratio composite material were characterized.   RESULTS AND CONCLUSION: (1) Orthogonal experiment results exhibited that the concentration of acetic acid was 3%; the concentration of chitosan solution was 5%; the mass ratio of hydroxyapatite:polylactic acid was 1:6; the hydroxyapatite/polylactic acid:chitosan solution:polyethylene alcohol gel was 2 g:1 g:1.4 mL. The composite material had good mechanical properties. (2) The composite material scaffold with the best ratio had good connectivity; the porosity was (52.0±1.5)%; and the maximum compressive strength reached 6 MPa. X-ray diffraction scanning and Fourier infrared spectroscopy test results demonstrated that the main bonding method of composite materials was physical blending. Composite scaffolds had certain degradation properties, but the weight loss rate was low during the test time, and degradation property needs to be further improved. (3) These findings indicate that the chitosan/polylactic acid/hydroxyapatite/polyvinyl alcohol composite scaffold has high porosity and good mechanical properties. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of the low anterior inferior iliac spine and its imaging differences with non-low anterior inferior iliac spine Zhao Hui, Yan Peng 2022, 26 (18):  2862-2867.  doi: 10.12307/2022.695 Abstract ( 452 )   PDF (3087KB) ( 86 )   Save BACKGROUND: Subspine impingement caused by low anterior inferior iliac spine is often neglected, resulting in missed diagnosis or poor treatment effect in some patients.   OBJECTIVE: To compare and analyze the difference of hip joint of patients with anterior inferior iliac spine impingement and those without impingent, to investigate whether conventional X-ray and CT examination can directly or indirectly judge the existence of the low anterior inferior iliac spine. METHODS:  Totally 15 patients diagnosed with anterior inferior iliac spine impingement and undergoing hip arthroscopic surgery in First Affiliated Hospital of Jinzhou Medical University from January 2016 to June 2019 were selected as trial group. Fifteen patients with non-iliac anterior inferior iliac spine impingement who underwent standard anteroposterior pelvic X-ray and three-dimensional CT examination of the pelvis were selected as control group. The angle α, the center-edge angle of the hip joint, the Tönnis angle, the neck shaft angle, the anteversion angle of the acetabulum, and the horizontal and vertical distance between the anterior inferior iliac spine and the acetabular anterior edge, and the width of the anterior inferior iliac spine were compared between the two groups using X-ray film and CT examination. Finite element analysis was used to simulate the physiological activities of the hip joint in patients with anterior inferior iliac spine, and to observe the absence and presence of local pressure change.   RESULTS AND CONCLUSION: (1) The center-edge angle and the vertical distance of the anterior inferior iliac spine from the acetabular anterior edge of the trial group were smaller than those of the control group, but only the difference of vertical distance value between the groups was statistically significant (P < 0.05). The measured values of other indicators of the patients were slightly greater in the trial group than those in the control group, but the difference was not significant (P > 0.05). (2) Three-dimensional reconstruction of type II anterior inferior spinal impingement showed that anterior inferior iliac spine was proliferative, hypertrophic, and extends downward, but did not protrude to the acetabular anterior edge. The anterior inferior iliac spine gap disappeared. Moreover, the protruding hypertrophic part of the anterior inferior iliac spine did not make obvious contact with the proximal femur during the entire exercise loading process. (3) It is not possible to infer or judge whether there is a low anterior inferior iliac spine through X-ray and CT scans. The imaging diagnosis of the low anterior inferior iliac spine still mainly depends on three-dimensional reconstruction. Patients with anterior inferior iliac spine may not have abnormal contact between the distal end of the anterior inferior iliac spine hypertrophy and the proximal femur. Figures and Tables | References | Related Articles | Metrics

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Application of micro-CT in rabbit tibial osteomyelitis modeling Li Yufan, Lin Mingyue, Wang Chenxin, Zhang Rui, Li Yubao, Chen Li, Zou Qin 2022, 26 (18):  2874-2880.  doi: 10.12307/2022.697 Abstract ( 549 )   PDF (2073KB) ( 79 )   Save BACKGROUND: Micro-computed tomography (micro-CT) is a non-destructive three-dimensional imaging technology, which can clearly observe the internal microstructure of a sample without damaging. Its resolution is very high, and the spatial resolution reaches 1-10 μm, even 0.25 μm in some advanced models. Micro-CT has been widely used for data analysis and image processing in bone tissue engineering research.   OBJECTIVE: To analyze the inflammation-induced structural changes of the rabbit tibia using micro-CT to verify whether a rabbit model of osteomyelitis is successfully established. METHODS:  Twenty New Zealand white rabbits were selected, five of which were taken as the control group, and the remaining fifteen rabbits were used to establish the right tibia osteomyelitis model. After modeling, imaging characterization was conducted in the rabbit models (n=5 at each time point) at 2, 4, and 6 weeks. Feeding, pattern of sleeping, and wound healing in rabbits were observed postoperatively. X-ray in vivo imaging was used to detect the changes of bone tissue during the modeling of rabbit tibial osteomyelitis. Micro-CT was used to scan the affected limb layer by layer to obtain the corresponding cross-sectional images, followed by three-dimensional reconstruction. Bone volume and bone mineral density were calculated in each group.   RESULTS AND CONCLUSION: Gross observation: Purulent liquids and tissues could be found around the modeling site from the 4th week, and inflammatory reactions occurred. Large-area hyperostosis was observed at the 6th week. X-ray imaging observation: the swelling degree and periosteal reaction in the model group became gradually serious over time, and dead bones proliferated a lot. Micro-CT analysis: The cross-sectional images showed that osteoporosis and hyperplasia gradually appeared during the first 4 weeks. After 6 weeks of modeling, the rabbit cortical bone was significantly damaged and seriously proliferated, and inflammation spread to the medullary cavity. Through the three-dimensional reconstructions, a mass of dead bones formed around the bone window at the 6th week, accompanied by severe periosteal reaction, obvious swelling, and serious hyperostosis. Cancellous bone structure was seriously damaged and deformed, and trabecular bones were largely damaged and lost. Notably, the inflammation spread to the whole tibia. In addition, there was significant damage to endosteum and facies articularis ossium, and the cortical bone proliferated with voids. Findings from bone parameter calculation indicated that the bone volume was increased, the cortical bone mineral density was decreased, and the cancellous bone mineral density was increased after inflammation. To conclude, micro-CT can be used for cross-sectional imaging, three-dimensional reconstruction, and quantitative analysis of bone parameters. Micro-CT scan prominently makes up for the shortcomings of X-ray and gross observation, and provides experimental basis and new ideas for bone tissue engineering research related to osteomyelitis. Figures and Tables | References | Related Articles | Metrics

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Screening of differential genes and validation of key genes in synovial tissue of osteoarthritis Yao Jiawei, Xu Xiongfeng, Yi Peng, Qiu Bo 2022, 26 (18):  2881-2887.  doi: 10.12307/2022.698 Abstract ( 489 )   PDF (2539KB) ( 37 )   Save BACKGROUND: Osteoarthritis is a common degenerative disease. Its occurrence is related to a variety of risk factors. At present, there is no effective treatment plan other than surgical treatment. The regulatory genes related to osteoarthritis are involved in the occurrence and development of osteoarthritis. However, the gene regulatory network of osteoarthritis has not been established completely. OBJECTIVE: To carry out the bioinformatics analysis of osteoarthritis gene chip data set, so as to find new biomarkers of osteoarthritis and experimentally verify MYC and JUN genes.  METHODS: GEO database online analysis tool GEO2R was used to screen the differential genes of GSE55457 and GSE55235 chip data. The common differential genes of the two data sets were taken for GO function enrichment analysis and pathway enrichment analysis. String database was then used to construct protein interaction network, and Cytoscape3.8.0 software was applied to obtain the key genes. Finally RT-PCR and western blot were used to detect the mRNA and protein expression of MYC and JUN genes in osteoarthritic and normal synovial tissue. Synovial specimens were taken from the synovial tissues of three patients with osteoarthritis and three patients with meniscal injuries in the Renmin Hospital of Wuhan University.  RESULTS AND CONCLUSION: The GSE55457 dataset had 704 up-regulated genes and 113 down-regulated genes; the GSE55235 dataset had 492 up-regulated genes and 723 down-regulated genes; the two together had 89 up-regulated genes and 30 down-regulated genes. Functional enrichment showed that differential genes mainly played a role in response to macrophage colony stimulation and binding glucocorticoid receptors. Pathway enrichment analysis showed that differential genes were mainly involved in the MAPK signaling pathway and amino acid metabolism. Ten key target genes were identified based on the protein-protein interaction network, including MYC, JUN, MCL1, CDKN1A, HNRNPA1, VEGFA, NCOA3, ATF3, BTG2, and CD44. Two key genes, MYC and JUN, were obtained based on the higher score of the protein-protein interaction network graph algorithm and the number of protein interaction lines. The results of RT-PCR and western blot experiments showed that the expression of MYC and JUN at mRNA and protein levels was significantly increased in osteoarthritic synovial tissue compared with the control group (mRNA: MYC P=0.035 2, JUN P=0.015 6, protein: MYC P=0.027 2, JUN P=0.026 6). To conclude, the differential genes screened by comprehensive multiple biological information databases and R language analysis are involved in the occurrence and development of osteoarthritis. The 10 key genes identified are all involved in the key link of osteoarthritis. Up-regulation of MYC and JUN can promote the occurrence of osteoarthritis, which has been verified in the RT-PCR and western blot detections. Figures and Tables | References | Related Articles | Metrics

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Histological changes of cervical disc tissue and underlying ossification mechanism in patients with cervical degenerative ossification Xiong Yang, Yang Yingli, Gao Yushan, Wang Xiumei, Yang Yongdong, Zhao Dingyan, Zhao He, Li Chuanhong, Yang Kaitan, Yu Xing 2022, 26 (18):  2868-2873.  doi: 10.12307/2022.696 Abstract ( 440 )   PDF (1602KB) ( 33 )   Save BACKGROUND: Cervical degenerative ossification may aggravate nerve compression in patients with cervical degenerative disease, and also make the decompression procedure more challenging. However, the accompanied histological changes of the intervertebral disc and the underlying mechanism of degenerative ossification have not yet been documented. OBJECTIVE: To explore the histological features of the cervical disc in patient with cervical degenerative ossification and the underlying mechanisms of local ossification.  METHODS: Patients with cervical spondylosis undergoing surgical treatment were selected from the clinical practice, and cervical disc samples were harvested during the surgical process. Based on preoperative cervical X-ray and computed tomography (CT) examinations, all the disc samples were divided into ossification group and non-ossification group. Hematoxylin-eosin staining, Masson trichrome staining and Safranin O-fast green staining were used to compare the histological differences between the two groups. Furthermore, for the expression of transforming growth factor-β1, p-Smad2 and p-Smad3 in the disc and osteophyte samples, a semi-quantitative immunohistochemistry method was used to compare the difference between the two groups. RESULTS AND CONCLUSION: All the disc tissues could be clearly divided into the outer annulus fibrosus, the inner annulus fibrosus and the nucleus pulposus. Mature trabeculae and bone marrow cavities were detected in all ossification samples. Histologically, the number of disc cells in the ossification group was significantly higher than that of the non-ossification group (P < 0.05). However, the content of proteoglycan in the matrix was significantly lower than that in the non-ossification group (P < 0.05). Transforming growth factor β1/Smad2/3 was detected in all the disc and osteophyte tissues. Local content of transforming growth factor β1, p-Smad2 and p-Smad3 in the ossification group was significantly higher than that of the non-ossification group (P < 0.05). All the findings indicate that, compared with the non-ossification group, cervical degenerative ossification in patients in the ossification group is more severe. Higher expression of transforming growth factor β1 in the local microenvironment may promote the development of degenerative ossification. However, downstream-activated p-Smad2 and p-Smad3 may play different roles in the development of degenerative ossification. Figures and Tables | References | Related Articles | Metrics

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Effect of deep muscle stimulation on psoas surface electromyography and spatiotemporal and kinetic gait parameters in patients with chronic non-specific low back pain Chen Jin, Li Jiabin, Gu Mingxing, Tang Rong, Lu Jianxia 2022, 26 (18):  2894-2899.  doi: 10.12307/2022.700 Abstract ( 501 )   PDF (1392KB) ( 126 )   Save BACKGROUND: As a local vibration therapy, deep muscle stimulation therapy can effectively relieve the pain and functional limitation caused by traction or fatigue, lactic acid accumulation, or fascia adhesion. However, less is reported on its effect on chronic non-specific low back pain.   OBJECTIVE: To investigate the effect of deep muscle stimulation therapy on the changes of psoas surface electromyography as well as spatiotemporal and kinetic gait parameters in patients with chronic non-specific low back pain. METHODS:  This was a single-blind randomized controlled trial. A total of 102 patients with chronic non-specific low back pain admitted to Yancheng No. 1 People’s Hospital from February 2019 to June 2020 were enrolled and randomly divided into two groups (n=51 per group): a control group and an observation group. Patients in the control group received a traditional lumbar stabilization exercise, and patients in the observation group received deep muscle stimulation therapy based on the lumbar stabilization exercise. Clinical efficacy, pain degree, lumbar spine function, psoas surface electromyography changes, spatiotemporal and kinetic gait parameters, quality of life, and adverse reactions were statistically analyzed before treatment, 1 and 6 months after treatment.   RESULTS AND CONCLUSION: The overall efficiency of the observation group (96%) was higher than that of the control group (82%; P < 0.05). After 1 and 6 months of treatment, the visual analog scale scores of the observation group were lower than those of the control group (P < 0.05). The maximal electromyographic value of the multifidus and musculi rotatores at 60° anteflexion, 90° abduction, and 45° extension was significantly higher in the observation group than the control group (P < 0.05). The step length symmetry index, foot deflection angle symmetry index, standing relative index, initial double support vertical ground reaction force, single support phase vertical ground reaction force, and terminal double support vertical ground reaction force were lower in the observation group than the control group (P < 0.05). Compared with the control group, the Oswestry dysfunction index was lower (P < 0.05), and the SF-36 score was higher in the observation group (P < 0.05). The incidence of adverse reactions in the observation group and control group were 3.9% (2/51) and 5.9% (3/51), respectively, and there was no significant difference (P > 0.05). To conclude, deep muscle stimulation therapy can relieve pain, restore lumbar function and improve gait in patients with chronic non-specific low back pain. Figures and Tables | References | Related Articles | Metrics

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Risk factors of residual pain after percutaneous vertebral augmentation for osteoporotic thoracolumbar compression fractures Liu Chen, Hu Chengzhe, Yin Xun, Yu Ziheng, Yang Jiandong 2022, 26 (18):  2900-2905.  doi: 10.12307/2022.701 Abstract ( 352 )   PDF (1289KB) ( 117 )   Save BACKGROUND: Residual pain after percutaneous vertebral augmentation is one of the serious complications affecting the quality of life of patients, and also a difficult problem for clinicians. At present, some studies have analyzed the risk factors of residual pain after vertebral body strengthening, but they are not comprehensive and the mechanism is not clear.   OBJECTIVE: To analyze the risk factors of residual pain after vertebral body strengthening in osteoporotic thoracolumbar compression fractures, and to explore its mechanism. METHODS:  A total of 217 patients with osteoporotic vertebral compression fractures who received percutaneous vertebral augmentation in the Department of Spinal Surgery, Northern Jiangsu People’s Hospital from October 2019 to January 2021 were selected. Postoperative residual pain was considered if the visual analogue scale score was ≥4 at 1 week, 1, 3, and 6 months after surgery. According to whether there was residual pain, patients were divided into residual pain group (n=33) and no residual pain group (n=184). Gender, age, body mass index, the course of the disease, chronic medical history, history of trauma, vertebral fracture site, history of low back pain, lumbodorsal fascia injury, bone mineral density, adjacent vertebral fractures, surgical procedure, amount of bone cement, bone cement leakage, preoperative vertebral height compression rate, postoperative vertebral height recovery rate, and improvement rate of postoperative Cobb angle were surveyed between the two groups. Univariate and multivariate Logistic regression analyses were used to investigate the risk factors of postoperative residual pain.  RESULTS AND CONCLUSION: (1) There was no significant difference in gender, age, course of disease, chronic history, vertebral fracture site, surgical method, amount of bone cement, bone cement leakage, and preoperative vertebral height compression rate between the two groups (P > 0.05). (2) There were statistically significant differences in body mass index, trauma history, lumbodorsal fascia injury, history of low back pain, bone mineral density, adjacent vertebral fracture, postoperative vertebral height recovery rate, and improvement rate of postoperative Cobb angle between the two groups (P < 0.05). (3) Logistic regression analysis showed that body mass index, lumbodorsal fascia injury, bone mineral density, adjacent vertebral fractures, postoperative vertebral height recovery rate, and improvement rate of postoperative Cobb angle were the risk factors for postoperative residual low back pain (P < 0.05). (4) The results showed that body mass index, lumbodorsal fascia injury, bone mineral density, adjacent vertebral fractures, postoperative vertebral height recovery rate, and improvement rate of postoperative Cobb angle were the risk factors for postoperative residual pain. Corresponding preventive measures should be taken in clinical work to reduce the occurrence of postoperative residual pain. Figures and Tables | References | Related Articles | Metrics

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Visualization analysis of bone defect treatment based on knowledge map Dong Jiale, Wei Yuanhao, Zhang Hongwu 2022, 26 (18):  2906-2913.  doi: 10.12307/2022.702 Abstract ( 368 )   PDF (2007KB) ( 91 )   Save BACKGROUND: As a common disease of the motor system, bone defect is of great significance to be treated by effective means. However, there is still a lack of literature review on the treatment of bone defect by bibliometrics in China.   OBJECTIVE: To analyze the literature on the treatment of bone defect published in recent 10 years and to explore the research status, hotspots, and trends in this field, and to provide opinions and suggestions for its future development. METHODS:  Using Web of Science Core Collection database as the data source and the application of bibliometrics, CiteSpace V software was used to draw the knowledge map and conduct cluster analysis of the annual trends, the distribution of nations, the distribution of research institution, the distribution of authors and the key words in the field of bone defect treatment from 2011 to 2020.   RESULTS AND CONCLUSION: A total of 1 743 valid articles were selected. (1) The volume of publications shows a steady rise from 2011 to 2020 in general. In terms of scientific research funds, the National Natural Science Foundation of China funded the most projects (23.81%). (2) China and Shanghai Jiao Tong University are the country and research institution with the most publications in this field respectively. USA and Chinese Academy of Sciences play the role of academic hub with the strongest centrality. (3) A total of 476 authors were included. Lei Zhang, Changsheng Liu, and Ana Claudia Muniz Renno were the most prolific researchers, but the core authors did not form a close cooperative relationship. (4) Biomaterials is the journal with the largest number of articles, and has an authoritative position in the field of biological materials. (5) Repair, regeneration, in vitro, scaffold, and mesenchymal stem cell are the research hotspots in this field. (6) Time zone analysis showed that the previous research strategies were mainly for inducing differentiation and promoting regeneration of bone defects. Since 2015, nanoparticles, hydrogels and other materials are gradually widely used in the treatment of bone defects with the help of 3D printing technology. In recent years, researchers hope to explore the mechanism of bone defect treatment at the level of signaling pathway, and hope to use new composite scaffolds combined with drug/growth factor controlled release technology to achieve better therapeutic effect. (7) The future development directions of bone defect treatment are as follows: Continue to prepare new nano-composite scaffolds with good mechanical properties by using 3D printing and other technologies; preparation of double/multiple controlled release drug and/or growth factor stents; repair large bone defects, especially those caused by cancer, while inhibiting inflammation, oxidative stress and other reactions; to explore the mechanism of various growth factors in bone defect repair at the signaling pathway level; basic and clinical research on osteoporosis treatment drugs. It is concluded that bone defect treatment has been paid more and more attention in recent ten years. China has played an important role in this field. The results of this study provide a new perspective for the future research in this field, and play an enlightening role for domestic researchers. Figures and Tables | References | Related Articles | Metrics

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Reasonable choice and application of bio-ink sterilization technology for 3D bioprinting Yuan Long, Li Sen, Bian Jichao, Li Wanxiang, Wang Guodong 2022, 26 (18):  2914-2921.  doi: 10.12307/2022.703 Abstract ( 477 )   PDF (1473KB) ( 117 )   Save BACKGROUND: The application of 3D bioprinting is becoming more and more extensive, and the related bio-ink sterilization is very important. However, the sterilization problem of bio-ink used for clinical purposes has not been resolved.   OBJECTIVE: To summarize the current research progress of bio-ink sterilization technology for 3D bioprinting. METHODS:  Retrieve relevant documents were retrieved on CNKI, Wanfang Data Platform, PubMed, and Web of Science databases, with the search terms of “3D bioprinting, tissue engineering, additive manufacturing, bio-ink, biomaterials, sterilization, disinfect, aseptic”. Finally, 77 relevant articles were included for review.   RESULTS AND CONCLUSION: Different sterilization methods have bad effects on bio-ink for 3D bioprinting while sterilizing bio-ink. (1) Some sterilization methods can damage the microstructure in the biological ink. For example, radiation sterilization and ultraviolet light produced free radicals can affect biological fluid mechanics and plasticity of ink. Acetic acid peroxide dissolved biological ink ingredients due to its strong oxidizing. The mechanical performance requirements of high material should reduce to use this kind of sterilization method. (2) Some sterilization methods can damage the activity of the biological ink containing biological macromolecules, such as autoclaving of high-energy water vapor, radiation sterilization, and ultraviolet light produced free radicals can lead to loss of biological macromolecules such as protein and enzyme activity. Therefore, biological ink that requires biological macromolecules to be active should reduce to use this kind of sterilization method. (3) Some sterilization methods will remain some toxic substances: for example, ethylene oxide sterilization residues have carcinogenicity and affect the survival of seed cells, so the biological ink that needs to be loaded with seeds should reduce the use of this sterilization method. (4) Some sterilization methods for ink cannot complete a thorough sterilization. For example, ethanol and antibiotic during sterilization limited by its own nature cannot always be completed on biological sterilization of ink, so it often needs to be combined with other methods, such as the combination of different kinds of antimicrobial and the combination of peracetic acid with ethanol, which can not only realize the complementary advantages bus also avoid additional adverse effects. (5) Therefore, the material characteristics, the purpose of material application and the principle of sterilization should be considered when selecting the optimal bio-ink sterilization method for 3D bioprinting. Figures and Tables | References | Related Articles | Metrics

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Characteristics and application on animal models of different species of Perthes disease Chen Xianxiang, Liao Shijie, Li Boxiang, Li Chong, Huang Qian, Lin Chengsen, Liu Yun, Lu Rongbin, Ding Xiaofei 2022, 26 (18):  2922-2929.  doi: 10.12307/2022.704 Abstract ( 533 )   PDF (1493KB) ( 61 )   Save BACKGROUND: The pathogenesis of Perthes disease is insidious and easily missed at an early stage, and the mechanism of pathogenesis is still not fully understood. Animal models are an important tool for studying the pathogenesis of Perthes disease and for conducting in vivo experiments.   OBJECTIVE: To summarize the relevant domestic and foreign literature, classify animals of different species to review the characteristics and application of animal models of Perthes disease, and provide references for the in vivo experimental research of Perthes disease. METHODS:  Using “Perthes, Perthes disease, animal model, animal” as the Chinese and English search terms, articles were searched on PubMed, CNKI, Wanfang, and VIP databases. According to the inclusion and exclusion criteria, 61 articles were finally included.   RESULTS AND CONCLUSION: (1) The main species for establishing the animal models of Perthes disease are piglets, rats, mice, young rabbits, puppies, and young sheep. Piglets, rats, young rabbits, young dogs, and young sheep are modeled at the proximal femur, while mice are modeled at the distal femur. (2) So far, piglets are the most used animals to model Perthes disease, and femoral neck ligation is the most mature method to model piglets. The epiphyseal growth plate of rats exists for life, and spontaneously hypertensive rats have the characteristics of primary avascular necrosis of the femoral head. (3) Mice have the advantage of being conducive to gene manipulation, and mice have great application prospects in basic research. The size of the young rabbit is moderate, the size of the femoral head is moderate, and it is easy to observe and obtain materials. (4) The puppies are large and convenient for local operation research, but they are difficult to be kept in captivity and expensive. (5) The imaging changes of young sheep model were not similar to Perthes disease. (6) At present, on the whole, the specific animal and method for modeling are selected according to the experimental conditions and objectives of scholars. The femoral neck cerclage method is the most mature model for piglets, and this model is currently the best. Figures and Tables | References | Related Articles | Metrics

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Research progress of rheumatoid arthritis animal model with high expression of anti-citrullinated protein antibodies Yang Chao, Zhong Gejia, Liu Chunfang, Lin Na 2022, 26 (18):  2930-2937.  doi: 10.12307/2022.705 Abstract ( 452 )   PDF (1388KB) ( 85 )   Save BACKGROUND: Anti-citrullinated protein antibody is a specific and early diagnostic marker of rheumatoid arthritis, which is closely related to the occurrence and development of rheumatoid arthritis and the aggravation of bone destruction. The condition of patients with positive antibodies of this type is more serious and more difficult to treat than patients with negative antibodies. Collagen-induced arthritis and adjuvant-induced arthritis are two typical rheumatoid arthritis animal models, but they do not express or stably express anti-citrullinated protein antibody at a high level, which seriously affects the in-depth research regarding pathogenesis of anti-citrullinated protein antibody-positive rheumatoid arthritis and therapeutic drugs.   OBJECTIVE: To consult relevant domestic and foreign literature, to comprehensively analyze the current research status of the rheumatoid arthritis animal model with high anti-citrullinated protein antibody expression through the existing literature, to point out the existing problems, and to put forward research recommendations. METHODS:  Using “Rheumatoid Arthritis, ACPA” or “Rheumatoid Arthritis, anti-CCP” as English search terms, and “Rheumatoid Arthritis, anti-citrullinated protein antibody” as Chinese search terms, PubMed, Web of Science, CNKI, Wanfang, and VIP databases were searched for articles published before August 2021. Finally, 61 articles were included.   RESULTS AND CONCLUSION: (1) The methods for establishing rheumatoid arthritis animal models with high anti-citrullinated protein antibody expression include anti-citrullinated protein antibody monoclonal antibody induction, citrullinated protein induction, Porphyromonas gingivalis induction and other methods. Different modeling methods have their own characteristics. (2) The citrullinated protein induction model has the most reports and the most obvious features of arthritis. This type of protein is one of the target antigens for the onset of rheumatoid arthritis and can well simulate the pathological changes of the human body. It is the preferred model for establishment. (3) Citrullinated protein induction is the same as the anti-citrullinated protein antibody monoclonal antibody induction method. The preparation of the modeling agent is cumbersome and difficult to obtain. (4) The Porphyromonas gingivalis induction model has low economic cost and relatively simple and easy modeling materials. However, it will be combined with periodontitis and other complications. (5) Taken together, future research is to find suitable anti-citrullinated protein antibody monoclonal antibodies, citrullinated protein or short peptides as immune inducers, and select animals with genetic background and immunological factors that are suitable for the onset of human rheumatoid arthritis, and explore the rational use of Porphyromonas gingivalis, optimize the modeling conditions, and hope to establish an animal model that can reflect the entire process of human anti-citrullinated protein antibody-positive rheumatoid arthritis. This is an urgent task in the field of rheumatoid arthritis research in the future. Figures and Tables | References | Related Articles | Metrics

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Action and mechanism of autologous bone marrow aspiration concentrate in the treatment of knee osteoarthritis Zhao Jirong, Yang Tao, Xu Jiancheng, Zhao Ning, Xue Xu, Ma Tong 2022, 26 (18):  2938-2944.  doi: 10.12307/2022.706 Abstract ( 523 )   PDF (1351KB) ( 55 )   Save BACKGROUND: At present, although there are many clinical methods for the treatment of knee osteoarthritis, unfortunately, the clinical benefits of traditional treatment methods are limited. In recent years, there are many studies on intra-articular injection of autologous bone marrow aspiration concentrate in the treatment of knee osteoarthritis.   OBJECTIVE: To review effect and mechanism of autologous bone marrow aspiration concentrate in the treatment of knee osteoarthritis. METHODS:  Using “bone marrow aspiration concentrate, knee osteoarthritis, bone marrow mesenchymal stem cells, transforming growth factor β, platelet derived growth factor” as Chinese search terms, relevant articles were searched in the databases of CNKI, Wanfang, and VIP. Using “bone marrow aspirate concentrate, BMAC, knee osteoarthritis, KOA, bone marrow mesenchymal stem cells, BMSCs, transforming growth factor β, TGF-β, platelet derived growth factor, PDGF” as English search terms, relevant articles were searched in PubMed and Web of Science databases. The retrieval time was from database establishment to August 2021. According to the inclusion and exclusion criteria, 60 articles were finally included for review.   RESULTS AND CONCLUSION: (1) Various components in the autologous bone marrow aspiration concentrate can play an important role in the treatment of knee osteoarthritis, which is mainly reflected in the differentiation of bone marrow mesenchymal stem cells into chondrocytes. Transforming growth factor β promotes the proliferation of chondrocytes, and platelet-derived growth factors can regulate the migration, differentiation, and mineralization of mesenchymal stem cells. Insulin-like growth factor 1, fibroblast growth factor 18, and bone morphogenetic protein can protect and repair articular cartilage. (2) Many studies have confirmed that intra-articular injection of bone marrow aspiration concentrate can not only alleviate the pain of patients with knee osteoarthritis, improve mobility, and reduce their dependence on painkillers, but also promote the regeneration of articular cartilage. (3) Bone marrow aspiration concentrate comes from autologous, has no immune rejection, is easy to make, and has low cost. It is an effective way to treat early knee osteoarthritis. Nevertheless, the mechanism of bone marrow aspiration concentrate in the treatment of knee osteoarthritis is still unclear and needs further research and exploration. Figures and Tables | References | Related Articles | Metrics

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Interleukin 6 involved in a series of reaction processes of osteogenesis and bone repair Wang Jing, Wang Wanyuji, Zhang Yi, Ma Yaping, Wang Xin 2022, 26 (18):  2945-2951.  doi: 10.12307/2022.707 Abstract ( 556 )   PDF (1970KB) ( 78 )   Save BACKGROUND: The healing of large segmental bone defects has been a clinical challenge, although several substances that promote osteogenesis have been identified. However, further studies are needed on the effects of inflammatory factors on bone healing, especially on the important factors affecting osteogenesis in the early stage of bone healing.   OBJECTIVE: To summarize the relationship between interleukin-6 and bone metabolism, understand the mechanism of interleukin 6 in osteogenesis, and provide theoretical reference for new osteogenesis programs. METHODS:  A search was conducted by the first author between July and August 2021 to retrieve relevant articles on PubMed database from January 1990 to July 2021 and CNKI database from January 1979 to July 2021. The English key words were “interleukin 6” or “bone metabolism” or “osteoblast” or “osteoclast” or “bone regeneration” or “mesenchymal stem cells” or “vascularization”. The Chinese key words were “interleukin 6” and “bone regeneration”, “interleukin 6” and “osteoblast”, “interleukin 6” and “osteoclast”, “interleukin 6” and “bone metabolism”. A total of 903 Chinese and English articles were obtained and 88 articles were included for review and analysis according to inclusion and exclusion criteria.   RESULTS AND CONCLUSION: Interleukin 6, as a cytokine with a wide range of functions in vivo, also plays an important role in all stages of osteogenesis. (1) Interleukin 6 has been found to play an important role in various bone repair cells (such as mesenchymal stem cells, osteoblasts and osteoclasts) as well as in angiogenesis of bone defects. (2) Interleukin 6 interacts with a variety of osteogenic factors in vivo and exerts an effect in a vast network of bone repair. (3) Blood clots as an important factor can promote early bone healing; interleukin 6 can not only regulate the formation of blood clots, but also affect the structure of blood clots by regulating γ fibrin strips. The structure of blood clot has an important influence on the early stage of osteogenesis, so interleukin-6 can affect the early stage of bone healing by regulating the structure of blood clot. (4) In this paper, the specific mechanism of interleukin 6 affecting osteogenesis is reviewed, which is expected to further understand bone regeneration and healing, and provide new therapeutic strategies and protocols for osteogenesis. Figures and Tables | References | Related Articles | Metrics

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The first novel intellectual property rights creation by China in the world "Three-dimensional printing motion-preserving cervical joint system implantation for treating cervical spondylotic myelopathy" enters the clinical stage Meng Hao, Sun Tiansheng 2022, 26 (18):  2952.  doi: 10.12307/2022.708 Abstract ( 287 )   PDF (723KB) ( 79 )   Save Related Articles | Metrics